Capnography a cikin aikin motsa jiki: me yasa muke buƙatar capnograph?

By Cristiano Antonino On Mar 24, 2023

Dole ne a yi iskar iska daidai, isasshen kulawa ya zama dole: capnographer yana taka muhimmiyar rawa a cikin wannan.

The capnograph a cikin inji samun iska na majiyyaci

Idan ya cancanta, samun iska na inji a cikin lokacin asibiti dole ne a yi shi daidai kuma tare da cikakken sa ido.

Yana da mahimmanci ba kawai don kai majiyyaci zuwa asibiti ba, har ma don tabbatar da babban damar samun murmurewa, ko kuma aƙalla kar a ƙara tsananta yanayin yanayin marasa lafiya yayin sufuri da kulawa.

Kwanaki na masu ba da iska mai sauƙi tare da ƙananan saitunan (yawan-girman) abu ne na baya.

Yawancin marasa lafiya da ke buƙatar samun iska na inji sun adana ɗan lokaci kaɗan na numfashi na kwatsam (bradypnoea da hypoventilation), wanda ke tsakiyar tsakiyar 'kewayo' tsakanin cikakkiyar bugun zuciya da numfashi na kwatsam, inda iskar iskar oxygen ya isa.

ALV (shakar huhu mai daidaitawa) gabaɗaya yakamata ya zama al'ada: rashin ƙarfi da haɓakar iska duka suna da illa.

Sakamakon rashin isassun iska a kan marasa lafiya da ke fama da cututtukan kwakwalwa (bugun jini, ciwon kai, da dai sauransu) yana da illa musamman.

Abokan gaba: hypocapnia da hypercapnia

Sanannen abu ne cewa numfashi (ko iska na inji) ya zama dole don wadata jiki da oxygen O2 da cire carbon dioxide CO2.

Lalacewar rashin iskar oxygen a bayyane yake: hypoxia da lalacewar kwakwalwa.

Yawan wuce haddi na O2 na iya lalata epithelium na hanyoyin iska da alveoli na huhu, duk da haka, lokacin amfani da iskar oxygen (FiO2) na 50% ko ƙasa da haka, ba za a sami babban lahani daga 'hyperoxygenation' ba: za a cire iskar oxygen da ba ta dace ba. tare da fitar numfashi.

CO2 excretion ba ya dogara da abun da ke ciki na cakuda da aka ba da shi kuma an ƙayyade shi ta hanyar ƙimar iska ta minti MV (mita, fx tidal volume, Vt); mafi girma ko zurfin numfashi, mafi yawan CO2 yana fitar da shi.

Tare da rashin samun iska ('hypoventilation') - bradypnoea / numfashi na sama a cikin mai haƙuri da kansa ko na'ura mai kwakwalwa 'rashin' hypercapnia (wuce CO2) yana ci gaba a cikin jiki, wanda akwai haɓakar pathological na tasoshin cerebral, karuwa a cikin intracranial. matsin lamba, edema na cerebral da lalacewarsa na biyu.

Amma tare da wuce gona da iri (tachypnoea a cikin majiyyaci ko wuce kima na iska sigogi), ana lura da hypocapnia a cikin jiki, wanda akwai pathological narrowing na cerebral tasoshin tare da ischemia na sassan sa, don haka ma na biyu kwakwalwa lalacewa, da kuma numfashi alkalosis ma kara tsananta. tsananin yanayin mara lafiya. Sabili da haka, samun iska na inji bai kamata kawai ya zama 'anti-hypoxic' ba, har ma 'normocapnic'.

Akwai hanyoyin da za a iya ƙididdige ma'auni na iska na inji, kamar tsarin Darbinyan (ko wasu masu dacewa), amma suna da nuni kuma maiyuwa ba za su yi la'akari da ainihin yanayin majiyyaci ba, misali.

Me yasa bugun jini oximeter bai isa ba

Tabbas, pulse oximetry yana da mahimmanci kuma yana samar da tushen sa ido na iska, amma kulawar SpO2 bai isa ba, akwai matsaloli da yawa na ɓoye, iyakancewa ko haɗari, wato: A cikin yanayin da aka bayyana, yin amfani da oximeter pulse sau da yawa ya zama ba zai yiwu ba. .

- Lokacin amfani da adadin iskar oxygen sama da 30% (yawanci FiO2 = 50% ko 100% ana amfani da shi tare da samun iska), raguwar sigogin iska (ƙididdigar ƙima da ƙararrawa) na iya isa don kula da "normoxia" yayin da adadin O2 da aka bayar ta kowane aikin numfashi yana ƙaruwa. Saboda haka, bugun jini oximeter ba zai nuna boye hypoventilation tare da hypercapnia.

- The pulse oximeter baya nuna cutar hawan jini ta kowace hanya, ƙimar SpO2 akai-akai na 99-100% yana ƙarfafa likita.

– The bugun jini oximeter da jikewa Manuniya ne sosai inert, saboda wadata da O2 a cikin jini zagawa da kuma physiological matattu sarari na huhu, da kuma saboda da ma'auni na karatu a kan wani lokaci tazara a kan bugun jini oximeter-kare. bugun jini na sufuri, a yayin wani lamari na gaggawa (katsewar kewayawa, rashin sigogin iska, da sauransu) n.) jikewa ba ya raguwa nan da nan, yayin da ake buƙatar amsa mai sauri daga likita.

- The pulse oximeter yana ba da karatun SpO2 ba daidai ba idan akwai guba na carbon monoxide (CO) saboda gaskiyar cewa hasken haske na oxyhaemoglobin HbO2 da carboxyhaemoglobin HbCO yayi kama, saka idanu a cikin wannan yanayin yana iyakance.

Amfani da capnograph: capnometry da capnography

Ƙarin zaɓuɓɓukan saka idanu waɗanda ke ceton rayuwar majiyyaci.

Ƙari mai mahimmanci da mahimmanci ga kula da isar da iskar iska na inji shine ma'auni akai-akai na CO2 maida hankali (EtCO2) a cikin iskar da aka fitar (capnometry) da kuma hoton hoto na cyclicity na CO2 excretion (capnography).

Abubuwan da ake amfani da su na capnometry sune:

- Bayyanar alamomi a cikin kowane yanayi na haemodynamic, ko da a lokacin CPR (a cikin matsanancin ƙarancin jini, ana yin sa ido ta tashoshi biyu: ECG da EtCO2)

– Canje-canjen masu nuni kai tsaye ga kowane aukuwa da sabani, misali lokacin da aka katse da'irar numfashi

- Kimanta matsayin farko na numfashi a cikin majiyyaci na ciki

- Hange na ainihi na hypo- da hyperventilation

Ƙarin fasalulluka na capnography suna da yawa: an nuna toshewar hanyar iska, ƙoƙarin mai haƙuri don yin numfashi ba tare da bata lokaci ba tare da buƙatar zurfafa maganin sa barci, motsa jiki na zuciya akan ginshiƙi tare da tachyarrhythmia, yuwuwar hauhawar zafin jiki tare da haɓaka EtCO2 da ƙari mai yawa.

Babban makasudin yin amfani da capnograph a cikin lokaci na asibiti

Kula da nasarar intubation na tracheal, musamman a cikin yanayi na amo da wahalar auscultation: tsarin al'ada na cyclic CO2 excretion tare da amplitude mai kyau ba zai taba yin aiki ba idan an shigar da bututu a cikin esophagus (duk da haka, auscultation ya zama dole don sarrafa samun iska na biyu. huhu)

Kulawa da maido da wurare dabam dabam na lokaci-lokaci yayin CPR: haɓakar metabolism da samar da CO2 suna ƙaruwa sosai a cikin kwayar halittar ''resuscitated', 'tsalle' ya bayyana akan capnogram kuma hangen nesa baya daɗaɗawa tare da matsawa na zuciya (sabanin siginar ECG)

Gabaɗaya sarrafa iskar injina, musamman a cikin marasa lafiya da ke da lalacewar kwakwalwa (buguwar bugun jini, rauni na kai, girgiza, da sauransu)

Auna "a cikin babban magudanar ruwa" (MAINSTREAM) da "a cikin magudanar ruwa" (SIDESTREAM).

Capnographs na nau'ikan fasaha ne guda biyu, lokacin aunawa EtCO2 'a cikin babban rafi' an sanya gajeriyar adaftar tare da ramukan gefe tsakanin bututun endotracheal da kewaye, ana sanya firikwensin U-dimbin yawa akansa, ana bincika iskar gas mai wucewa kuma an ƙaddara. An auna EtCO2.

Lokacin da ake auna 'a cikin magudanar ruwa', ana ɗaukar ƙaramin yanki na iskar gas daga da'ira ta wani rami na musamman a cikin kewaye ta hanyar kwampreshin tsotsa, ana ciyar da shi ta cikin bututu mai bakin ciki a cikin jikin capnograph, inda ake auna EtCO2.

Dalilai da yawa suna rinjayar daidaiton ma'auni, kamar tattarawar O2 da danshi a cikin cakude da ma'aunin zafin jiki. Dole ne a sanya firikwensin zafin jiki kuma a daidaita shi.

A wannan ma'anar, ma'aunin gefen gefen ya bayyana ya zama mafi daidai, saboda yana rage tasirin waɗannan abubuwa masu karkatarwa a aikace, duk da haka.

Abun iya ɗauka, nau'ikan capnograph 4:

a matsayin wani bangare na duban gado
a matsayin wani ɓangare na multifunctional defibrillator
ƙaramin bututun ƙarfe akan kewaye ('na'urar tana cikin firikwensin, babu waya')
na'urar aljihu mai ɗaukuwa ('jiki + firikwensin akan waya').

Yawancin lokaci, lokacin da ake magana akan capnography, ana fahimtar tashar saka idanu na EtCO2 a matsayin wani ɓangare na mai duba 'gefen gado' mai yawa; a cikin ICU, an kayyade shi har abada akan kayan aiki shiryayye.

Ko da yake na'urar ta duba abin cirewa ne kuma na'urar duba capnograph tana da batir da aka gina ta, har yanzu yana da wahala a yi amfani da shi lokacin motsi zuwa ɗakin kwana ko tsakanin motar ceto da sashin kulawa mai zurfi, saboda nauyi da girman yanayin saka idanu da rashin yiwuwar haɗa shi ga majiyyaci ko ga shimfidar ruwa mai hana ruwa, wanda aka fi aiwatar da jigilar kaya daga ɗakin kwana.

Ana buƙatar ƙarin kayan aiki mai ɗaukuwa.

An ci karo da irin wannan matsaloli lokacin amfani da ɗaukar hoto a matsayin ɓangare na ƙwararrun ƙwararru: Misali, irin waɗannan na'urori da za a sanya shi cikin nutsuwa a kan ruwa shimfiɗar shimfiɗa kusa da mara lafiya lokacin da aka sauko da matakan daga bene mai tsayi; ko da a lokacin aiki, rudani sau da yawa yana faruwa tare da adadi mai yawa na wayoyi a cikin na'urar.