Multiparameter mai haƙuri saka idanu (Rarraba masu saka idanu) na iya samar da bayanan asibiti na farko da iri-irimuhimman alamu sigogi don lura da marasa lafiya da ceto marasa lafiya. Abisa ga yadda ake amfani da na'urori a asibitoci, wna koyi cewaeach sashen asibiti ba zai iya amfani da na'urar duba don amfani na musamman ba. Musamman ma, sabon ma'aikacin bai san da yawa game da na'urar ba, yana haifar da matsaloli da yawa a cikin amfani da na'urar, kuma ba zai iya cika aikin kayan aiki ba.Yonker hannun jaridaamfani da tsarin aiki namultiparameter saka idanu ga kowa da kowa.
Mai saka idanu mara lafiya na iya gano wasu mahimman mahimmancialamu sigogi na marasa lafiya a cikin ainihin lokaci, ci gaba da kuma na dogon lokaci, wanda yana da mahimmancin darajar asibiti. Amma kuma wayar hannu mai ɗaukar hoto, amfani da abin hawa, yana haɓaka mitar amfani sosai. A halin yanzu,multiparameter Mai saka idanu na haƙuri yana da ƙarancin gama gari, kuma manyan ayyukansa sun haɗa da ECG, hawan jini, zazzabi, numfashi,SpO2, ETCO2, IBP, fitarwar zuciya, da sauransu.
1. Tsarin asali na mai saka idanu
Na'urar duba yawanci tana kunshe ne da tsarin jiki mai dauke da firikwensin firikwensin daban-daban da ginanniyar tsarin kwamfuta. Duk nau'ikan siginar ilimin lissafi ana juyar da su zuwa siginar lantarki ta na'urori masu auna firikwensin, sannan a aika zuwa kwamfuta don nunawa, adanawa da gudanarwa bayan haɓakawa. Multifunctional siga m duba iya saka idanu ecg, numfashi, zazzabi, hawan jini,SpO2 da sauran sigogi a lokaci guda.
Modular majiyyaci dubaana amfani da su gabaɗaya a cikin kulawa mai zurfi. Sun ƙunshi ƙwararrun ma'auni na ma'auni na ilimin lissafi masu hankali da masu sa ido, kuma ana iya haɗa su da nau'o'i daban-daban bisa ga buƙatu na musamman.
2. The amfani da tsarin aiki namultiparameter saka idanu
(1) Kulawar numfashi
Yawancin ma'aunin numfashi a cikinmultiparametermara lafiya dubariki hanyar ƙirji. Motsin ƙirji na jikin ɗan adam a cikin tsarin numfashi yana haifar da canjin juriya na jiki, wanda shine 0.1 ω ~ 3 ω, wanda aka sani da rashin ƙarfi na numfashi.
Mai saka idanu yawanci yana ɗaukar alamun canje-canje a cikin rashin ƙarfi na numfashi a cikin na'urar lantarki guda ɗaya ta hanyar allurar amintaccen halin yanzu na 0.5 zuwa 5mA a mitar jigilar sinusoidal na 10 zuwa 100kHz ta hanyar lantarki guda biyu na ECG jagora. Za'a iya siffanta sigar motsin motsin numfashi ta hanyar bambance-bambancen rashin ƙarfi na numfashi, kuma ana iya fitar da sigogin ƙimar numfashi.
Motsi na thoracic da motsi mara motsi na jiki zai haifar da canje-canje a juriya na jiki. Lokacin da mitar irin waɗannan canje-canje ya zama daidai da na'urar faɗakarwar tashar numfashi, yana da wahala mai saka idanu ya tantance ko wanene siginar numfashi na yau da kullun kuma wanda shine siginar kutse ta motsi. A sakamakon haka, ma'auni na numfashi na iya zama mara kyau lokacin da majiyyaci yana da matsananciyar motsi na jiki.
(2) Ciwon hawan jini (IBP) saka idanu
A wasu ayyuka masu tsanani, saka idanu na ainihin lokacin hawan jini yana da mahimmancin ƙima na asibiti, don haka ya zama dole a yi amfani da fasahar sa ido kan cutar hawan jini don cimma shi. Ka'idar ita ce: na farko, ana dasa catheter a cikin tasoshin jini na wurin da aka auna ta hanyar huda. Wurin waje na catheter yana da alaƙa kai tsaye tare da firikwensin matsa lamba, kuma ana allurar saline na yau da kullun a cikin catheter.
Saboda aikin canja wurin matsa lamba na ruwa, za a watsa matsa lamba na intravascular zuwa firikwensin matsa lamba na waje ta hanyar ruwa a cikin catheter. Don haka, za'a iya samun nau'in motsi mai ƙarfi na canjin matsa lamba a cikin tasoshin jini. Matsin systolic, matsa lamba diastolic da matsa lamba na ma'ana ana iya samun ta ta takamaiman hanyoyin lissafi.
Ya kamata a ba da hankali ga ma'aunin hawan jini mai haɗari: a farkon saka idanu, kayan aiki ya kamata a daidaita su zuwa sifili a farkon; Yayin aikin sa ido, ya kamata a kiyaye firikwensin matsa lamba koyaushe a daidai matakin da zuciya. Don hana gudanwar catheter, yakamata a zubar da catheter tare da ci gaba da alluran saline na heparin, wanda zai iya motsawa ko fita saboda motsi. Don haka, ya kamata a gyara catheter sosai kuma a bincika a hankali, kuma a yi gyare-gyare idan ya cancanta.
(3) Kula da yanayin zafi
Thermistor tare da ƙarancin zafin jiki mara kyau ana amfani dashi azaman firikwensin zafin jiki a ma'aunin zafin jiki na saka idanu. Gabaɗaya masu saka idanu suna ba da zafin jiki ɗaya, kuma kayan aiki masu tsayi suna ba da yanayin yanayin jiki biyu. Hakanan ana rarraba nau'ikan binciken yanayin zafin jiki zuwa binciken saman jiki da binciken rami na jiki, bi da bi don lura da yanayin jikin jiki da zafin rami.
Lokacin aunawa, mai aiki zai iya sanya gwajin zafin jiki a kowane bangare na jikin mara lafiya gwargwadon bukata. Domin sassa daban-daban na jikin dan adam suna da yanayin zafi daban-daban, zafin da na’urar ke aunawa ita ce kimar yanayin da bangaren jikin majiyyaci ke yi don sanya binciken, wanda zai iya bambanta da yanayin zafin baki ko hammata.
Wkaza da za a auna zafin jiki, akwai matsalar ma'aunin zafin jiki tsakanin bangaren da aka auna na jikin mara lafiya da na'urar firikwensin da ke cikin binciken, wato lokacin da aka fara sanya na'urar, domin har yanzu na'urar hasashe bai daidaita da yanayin zafin jiki ba. jikin mutum. Don haka, zafin da ake nunawa a wannan lokacin ba shine ainihin zafin ma'aikatar ba, kuma dole ne a kai shi bayan wani lokaci don isa ga ma'aunin zafi kafin a iya nuna ainihin zafin jiki. Hakanan kula don kiyaye amintaccen lamba tsakanin firikwensin da saman jiki. Idan akwai tazara tsakanin firikwensin da fata, ƙimar ma'auni na iya zama ƙasa kaɗan.
(4) Kula da ECG
Ayyukan electrochemical na "sel masu ban sha'awa" a cikin myocardium yana sa myocardium ya zama mai sha'awar lantarki. Yana sa zuciya ta hargitse da injina. Rufewa da aiki na halin yanzu da wannan tsarin motsa jiki na zuciya ke gudana ta hanyar madubi na ƙarar jiki kuma yana yaduwa zuwa sassa daban-daban na jiki, wanda ke haifar da canji a halin yanzu tsakanin sassa daban-daban na jikin mutum.
Electrocardiogram (ECG) shine yin rikodin yuwuwar bambance-bambancen yanayin jikin jiki a cikin ainihin lokaci, kuma manufar gubar tana nufin tsarin raƙuman ruwa na yuwuwar bambance-bambance tsakanin sassa biyu ko fiye na jikin jikin ɗan adam tare da canjin yanayin bugun zuciya. Farkon ma'anar Ⅰ, Ⅱ, Ⅲ gubar ana kiransu da ma'aunin ma'auni a asibiti.
Daga baya, an ayyana jagorancin gaɓoɓin gaɓoɓin da aka matsa, aVR, aVL, aVF da ƙirji marasa lantarki suna kaiwa V1, V2, V3, V4, V5, V6, waɗanda sune daidaitattun jagororin ECG da ake amfani da su a halin yanzu a aikin asibiti. Domin zuciya tana sitiroscopic, sigar igiyar gubar tana wakiltar aikin lantarki a saman tsinkayar zuciya ɗaya. Wadannan jagororin guda 12 za su nuna aikin lantarki a kan sassa daban-daban na tsinkaye na zuciya daga wurare 12, kuma za a iya gano raunukan sassa daban-daban na zuciya gaba ɗaya.
A halin yanzu, daidaitaccen injin ECG da aka yi amfani da shi a aikin asibiti yana auna nau'in igiyar ECG, kuma ana sanya na'urar lantarki ta hannu a wuyan hannu da idon sawu, yayin da na'urorin da ke cikin kulawar ECG suna daidai da sanya su a cikin kirji da yankin cikin majiyyaci, duk da cewa wurin da aka sanya shi ne. daban-daban, daidai suke, kuma ma'anarsu iri ɗaya ce. Saboda haka, ECG gudanarwa a cikin saka idanu yayi dace da gubar a cikin na'ura na ECG, kuma suna da polarity iri ɗaya da waveform.
Masu saka idanu na iya saka idanu gabaɗaya jagororin 3 ko 6, suna iya nuna nau'in raƙuman ruwa na ɗaya ko duka biyun kuma suna fitar da sigogin bugun zuciya ta hanyar nazarin waveform.. Pmasu saka idanu masu ƙarfi na iya sa ido kan jagoranci guda 12, kuma suna iya ƙara yin nazarin tsarin igiyar ruwa don cire sassan ST da abubuwan arrhythmia.
A halin yanzu, daECGwaveform na saka idanu, da dabara tsarin ganewar asali ikon ba shi da karfi sosai, saboda manufar saka idanu shi ne yafi lura da bugun zuciya na majiyyaci na dogon lokaci kuma a ainihin lokacin.. AmmadaECGAna auna sakamakon jarrabawar na'ura a cikin ɗan gajeren lokaci a ƙarƙashin takamaiman yanayi. Saboda haka, nisa bandpass na amplifier na kayan aikin biyu ba iri ɗaya bane. Yawan bandwidth na injin ECG shine 0.05 ~ 80Hz, yayin da bandwidth na mai saka idanu shine gabaɗaya 1 ~ 25Hz. Siginar ECG sigina ce mai rauni, wacce tsoma baki daga waje ke shafar ta cikin sauki, kuma wasu nau'ikan kutse suna da matukar wahala a shawo kansu kamar:
(a) Tsangwama motsi. Motsin jikin mai haƙuri zai haifar da canje-canje a cikin siginar lantarki a cikin zuciya. Girman girman wannan motsi, idan a cikinECGamplifier bandwidth, kayan aiki yana da wuya a shawo kan su.
(b)Mtsoma bakin yoelectric. Lokacin da tsokar da ke ƙarƙashin na'urar lantarki ta ECG aka liƙa, ana haifar da siginar kutsawa ta EMG, kuma siginar EMG yana tsoma baki tare da siginar ECG, kuma siginar kutse ta EMG tana da bandwidth iri ɗaya kamar siginar ECG, don haka ba za a iya share shi kawai tare da tace.
(c) Tsangwama na wuka mai girma na lantarki. Lokacin da ake amfani da wutar lantarki mai yawan gaske ko na lantarki yayin tiyata, girman siginar lantarki da makamashin da aka ƙara a jikin ɗan adam ya fi na siginar ECG, kuma ɓangaren mitar yana da wadata sosai, ta yadda ECG ɗin ke samarwa. amplifier ya kai madaidaicin yanayi, kuma ba za a iya lura da yanayin motsin ECG ba. Kusan duk masu saka idanu na yanzu ba su da ƙarfi daga irin wannan tsangwama. Don haka, sashin katsalandan wuka mai karewa mai tsayin mita yana buƙatar mai duba ya koma yanayin al'ada a cikin 5s bayan an cire wuka mai girman mitar lantarki.
(d) Tsangwamawar hulɗar lantarki. Duk wani tashin hankali a hanyar siginar lantarki daga jikin ɗan adam zuwa amplifier na ECG zai haifar da ƙara mai ƙarfi da za ta iya ɓoye siginar ECG, wanda galibi ke haifar da rashin daidaituwa tsakanin wayoyin lantarki da fata. Rigakafin irin wannan tsangwama ya fi rinjaye ta hanyar amfani da hanyoyi, mai amfani ya kamata ya duba kowane sashi a kowane lokaci, kuma kayan aiki ya kamata a dogara da shi, wanda ba kawai yana da kyau don magance tsangwama ba, amma mafi mahimmanci, kare lafiyar marasa lafiya. da masu aiki.
5. Mara cin raiduban hawan jini
Hawan jini yana nufin hawan jini akan bangon tasoshin jini. A cikin kowane irin natsewa da annashuwa da zuciya ke yi, matsewar jini a bangon magudanar jini shima yana canjawa, haka kuma matsewar jijiyoyin jijiya da tasoshin jini daban-daban, haka nan ma yawan magudanan jini a sassa daban-daban ya bambanta. daban. A asibiti, ana amfani da ƙimar matsa lamba na daidaitattun lokutan systolic da diastolic a cikin tasoshin jijiyoyin jini a tsayi ɗaya da hannun babba na jikin ɗan adam don siffanta hawan jini na jikin ɗan adam, wanda ake kira systolic jini (ko hauhawar jini). ) da matsa lamba diastolic (ko ƙananan matsa lamba), bi da bi.
Hawan jini na jijiya na jiki shine ma'auni mai canzawa. Yana da alaƙa da yanayin tunanin mutane, yanayin motsin rai, da matsayi da matsayi a lokacin aunawa, bugun zuciya yana ƙaruwa, hawan jini na diastolic yana tashi, bugun zuciya yana raguwa, hawan diastolic yana raguwa. Yayin da adadin bugun jini a cikin zuciya ya karu, hawan jini na systolic zai karu. Ana iya cewa hawan jini na jijiya a kowace zagayowar zuciya ba zai kasance kwata-kwata ba.
Hanyar jijjiga sabuwar hanya ce ta ma'aunin hawan jini mara haɗari wanda aka haɓaka a cikin 70s,kuma taka'idar ita ce a yi amfani da cuff don kumbura zuwa wani matsa lamba lokacin da jijiyoyin jijiya suka datse gaba ɗaya tare da toshe magudanar jini, sannan kuma tare da raguwar bugun jini, jijiyoyin jijiyoyin jini zasu nuna canjin tsari daga cikakken toshewa → budewa a hankali → cikakken budewa.
A cikin wannan tsari, tun lokacin da bugun jini na bangon jijiyoyin bugun jini zai haifar da raƙuman motsin gas a cikin iskar gas a cikin cuff, wannan motsin motsi yana da ma'auni mai mahimmanci tare da karfin jini na systolic arterial, matsa lamba diastolic da matsakaicin matsa lamba, da systolic, ma'ana da kuma matsa lamba. Ana iya samun matsa lamba na diastolic na wurin da aka auna ta hanyar aunawa, yin rikodi da kuma nazarin raƙuman girgizar matsa lamba a cikin cuff yayin aiwatar da lalata.
Jigon hanyar girgiza shine don nemo bugun bugun jini na yau da kullun na bugun jini. In ainihin tsarin ma'auni, saboda motsi na mai haƙuri ko tsangwama na waje wanda ya shafi canjin matsa lamba a cikin cuff, kayan aiki ba zai iya gano ma'auni na yau da kullum ba, don haka zai iya haifar da gazawar aunawa.
A halin yanzu, wasu masu saka idanu sun ɗauki matakan hana tsangwama, kamar yin amfani da hanyar lalata tsani, ta hanyar software don tantance tsangwama ta atomatik da igiyoyin bugun jini na al'ada, ta yadda za su sami wani takamaiman matakin hana tsoma baki. Amma idan katsalandan ya yi tsanani ko kuma ya daɗe, wannan matakin hana tsangwama ba zai iya yin komai a kai ba. Sabili da haka, a cikin tsarin kula da cutar hawan jini, ya zama dole a yi ƙoƙari don tabbatar da cewa akwai yanayin gwaji mai kyau, amma kuma kula da zabin girman cuff, sanyawa da ƙuntatawa na damfara.
6. Jiyya na oxygen jikewa (SPO2) saka idanu
Oxygen abu ne da ba makawa a cikin ayyukan rayuwa. Ana jigilar kwayoyin oxygen masu aiki a cikin jini zuwa kyallen takarda a ko'ina cikin jiki ta hanyar ɗaure zuwa haemoglobin (Hb) don samar da haemoglobin oxygenated (HbO2). Ma'aunin da aka yi amfani da shi don siffanta adadin haemoglobin oxygenated a cikin jini ana kiran saturation na oxygen.
Ma'auni na jikewar oxygen jikewa ba tare da ɓarna ba ya dogara ne akan halayen sha na haemoglobin da haemoglobin oxygenated a cikin jini, ta amfani da tsayin tsayi daban-daban na haske ja (660nm) da hasken infrared (940nm) ta cikin nama sannan kuma ya canza zuwa siginar lantarki ta hanyar photoelectric receiver, yayin da kuma amfani da wasu sassa a cikin kyallen takarda, kamar: fata, kashi, tsoka, venous jini, da dai sauransu. Siginar sha ne akai-akai, kuma kawai siginar sha na HbO2 da Hb a cikin jijiya ana canza cyclically tare da bugun jini. , wanda aka samu ta hanyar sarrafa siginar da aka karɓa.
Ana iya ganin cewa wannan hanyar za ta iya auna ma'aunin iskar oxygen na jini ne kawai a cikin jinin jijiya, kuma yanayin da ake bukata don auna shi ne magudanar jini mai bugun jini. A asibiti, ana sanya firikwensin a cikin sassan nama tare da kwararar jini na jijiya da kauri wanda ba shi da kauri, kamar yatsu, yatsu, kunnuwa da sauran sassa. Koyaya, idan akwai motsi mai ƙarfi a cikin ɓangaren da aka auna, zai shafi haɓakar wannan siginar bugun jini na yau da kullun kuma ba za a iya aunawa ba.
Lokacin da kewayen majiyyaci ya yi rauni sosai, zai haifar da raguwar kwararar jini a wurin da za a auna, yana haifar da rashin daidaito. Lokacin da zafin jiki na wurin aunawa na majiyyaci tare da asarar jini mai tsanani ya yi ƙasa, idan akwai haske mai ƙarfi a kan bincike, zai iya sa aikin na'urar mai karɓar hoto ya ɓace daga kewayon al'ada, wanda zai haifar da rashin daidaituwa. Don haka, ya kamata a guje wa haske mai ƙarfi lokacin aunawa.
7. Kula da carbon dioxide na numfashi (PetCO2).
Carbon dioxide na numfashi shine muhimmin alamar kulawa ga marasa lafiya na sa barci da marasa lafiya da cututtukan tsarin rayuwa na numfashi. Ma'auni na CO2 yafi amfani da hanyar sha infrared; Wato, ma'auni daban-daban na CO2 suna ɗaukar digiri daban-daban na takamaiman hasken infrared. Akwai nau'ikan CO2 iri biyu: na al'ada da na gefe.
Nau'in al'ada yana sanya firikwensin gas kai tsaye a cikin bututun iskar gas na majiyyaci. Ana aiwatar da canjin maida hankali na CO2 a cikin iskar gas ɗin kai tsaye, sannan ana aika siginar lantarki zuwa mai saka idanu don bincike da sarrafawa don samun sigogin PetCO2. Ana sanya na'urar firikwensin gani na gefe a cikin mai saka idanu, kuma ana fitar da samfurin iskar gas na mai haƙuri a ainihin lokacin ta bututun samfurin gas kuma a aika zuwa mai saka idanu don nazarin tattarawar CO2.
Lokacin gudanar da saka idanu na CO2, ya kamata mu mai da hankali ga matsalolin masu zuwa: Tun da CO2 firikwensin firikwensin firikwensin gani ne, a cikin aiwatar da amfani, ya zama dole a kula da hankali don guje wa gurɓataccen gurɓataccen firikwensin kamar ɓoyewar haƙuri; Sidestream CO2 masu saka idanu gabaɗaya an sanye su da mai raba ruwan gas don cire danshi daga iskar numfashi. Koyaushe bincika ko mai raba gas-ruwa yana aiki yadda ya kamata; In ba haka ba, danshi a cikin iskar gas zai shafi daidaiton ma'auni.
Auna ma'auni daban-daban yana da wasu lahani waɗanda ke da wuya a shawo kan su. Ko da yake waɗannan masu sa ido suna da zurfin hankali, ba za su iya maye gurbin ɗan adam gaba ɗaya ba a halin yanzu, kuma ana buƙatar masu aiki don tantance su, yin hukunci da kuma magance su daidai. Dole ne aikin ya yi hankali, kuma dole ne a yi la'akari da sakamakon auna daidai.
Lokacin aikawa: Juni-10-2022
