Yadda za a zabi da amfani da bugun jini oximeter?

By Cristiano Antonino On Mar 21, 2023

Kafin cutar ta COVID-19, ƙungiyoyin motar daukar marasa lafiya, masu farfaɗo da huhu da huhu ne kawai ke amfani da oximeter na bugun jini (ko saturation meter).

Yaduwar cutar coronavirus ya kara shaharar wannan na'urar ta likitanci, da kuma sanin mutane game da aikinta.

Kusan koyaushe ana amfani da su azaman 'mitocin saturation', kodayake a zahiri suna iya faɗi da yawa.

A gaskiya ma, iyawar ƙwararrun ƙwararrun bugun jini ba'a iyakance ga wannan ba: a hannun gogaggen mutum, wannan na'urar na iya magance matsaloli da yawa.

Da farko, bari mu tuna abin da pulse oximeter ma'auni da nuni

Ana sanya firikwensin 'clip' (yawanci) akan yatsan majiyyaci, a cikin firikwensin LED akan rabi na jiki yana fitar da haske, ɗayan LED akan ɗayan rabin yana karɓa.

Yatsar mai haƙuri yana haskakawa da haske na tsayin raƙuman ruwa daban-daban guda biyu (ja da infrared), waɗanda ake ɗauka ko kuma watsa su daban ta hanyar haemoglobin mai ɗauke da iskar oxygen 'a kan kanta' (HbO 2), da haemoglobin maras isashshen oxygen (Hb).

Ana ƙididdige shayarwa yayin bugun bugun jini a cikin ƙananan arterioles na yatsa, don haka yana nuna alamar jikewar haemoglobin tare da iskar oxygen; a matsayin kashi na jimlar haemoglobin (jikewa, SpO 2 = ..%) da ƙimar bugun jini (yawan bugun jini, PR).

Al'ada a cikin lafiyayyen mutum shine Sp * O 2 = 96 - 99 %.

* Jikewa a kan pulse oximeter an sanya shi Sp saboda yana da 'pulsatile', na gefe; (a cikin microarteries) wanda aka auna ta hanyar oximeter pulse. Gwaje-gwajen dakin gwaje-gwaje don haemogasanalysis kuma suna auna jikewar jinin jijiya (SaO2) da jikewar jini mai jijiya (SvO 2).

A kan nunin oximeter pulse na samfura da yawa, Hakanan yana yiwuwa a duba hoton hoto na ainihi na cikawa (daga bugun bugun jini) na nama a ƙarƙashin firikwensin, abin da ake kira plethysmogram - a cikin hanyar 'bar. ' ko sine curve, plethysmogram yana ba da ƙarin bayanan bincike ga likita.

Amfanin na'urar shine cewa ba shi da lahani ga kowa da kowa (babu radiation ionizing), maras amfani (babu buƙatar ɗaukar digo na jini don bincike), fara aiki akan majiyyaci da sauri da sauƙi, kuma yana iya aiki a kowane lokaci. sake shirya firikwensin akan yatsu kamar yadda ake buƙata.

Duk da haka, duk wani bugun jini oximeter da pulse oximetry gabaɗaya yana da rashin amfani da iyakancewa waɗanda ba sa ba da damar cin nasarar amfani da wannan hanyar a duk marasa lafiya.

Wadannan sun hada da:

1) Rashin kwararar jini na gefe

- rashin jin daɗi inda aka shigar da firikwensin: ƙananan hawan jini da girgiza, farfadowa, hypothermia da sanyi na hannaye, atherosclerosis na tasoshin a cikin iyakar, buƙatar ma'aunin hawan jini (BP) akai-akai tare da cuff da aka manne a hannu, da dai sauransu - Saboda duk waɗannan dalilai, motsin bugun jini da siginar a kan firikwensin ba su da kyau, ma'auni mai dogara yana da wuya ko ba zai yiwu ba.

Kodayake wasu ƙwararrun ƙwararrun bugun jini suna da yanayin 'Siginar da ba daidai ba' ('muna auna abin da muke samu, ba a tabbatar da daidaito ba'), a cikin yanayin ƙarancin jini kuma babu kwararar jini na yau da kullun a ƙarƙashin firikwensin, zamu iya saka idanu ga mai haƙuri ta hanyar ECG. da tashoshi na capnography.

Abin takaici, akwai wasu marasa lafiya masu mahimmanci a cikin maganin gaggawa waɗanda ba za su iya amfani da pulse oximetry ba,

2) Matsalolin ƙusa" a cikin karɓar sigina akan yatsunsu: yankan yankan da ba a gogewa akan ƙusoshi, nakasar ƙusa mai tsanani tare da kamuwa da cuta na fungal, ƙananan yatsu a cikin yara, da sauransu.

Ma'anar iri ɗaya ce: rashin iya samun sigina na yau da kullun don na'urar.

Ana iya magance matsalar: ta hanyar kunna firikwensin akan yatsa 90 digiri, ta hanyar shigar da firikwensin a wuraren da ba daidai ba, misali a kan tip.

A cikin yara, har ma da waɗanda ba su kai ba, yawanci yana yiwuwa a sami sigina mai tsayayye daga babban firikwensin da aka ɗora akan babban yatsan hannu.

Na'urori masu auna firikwensin don yara suna samuwa kawai don ƙwararrun ƙwararrun bugun jini a cikin cikakken saiti.

3) Dogaro da surutu da rigakafi ga “ surutu

Lokacin da mai haƙuri ya motsa (canza hankali, tashin hankali na psychomotor, motsi a cikin mafarki, yara) ko girgiza a lokacin sufuri, ana iya watsar da firikwensin kuma za a iya samar da siginar maras kyau, yana haifar da ƙararrawa.

ƙwararrun ƙwararrun ƙwararrun ƙwanƙwasa bugun jini don masu ceto suna da algorithms na kariya na musamman waɗanda ke ba da damar yin watsi da tsangwama na ɗan gajeren lokaci.

Ana ƙididdige ma'auni a cikin daƙiƙa 8-10 na ƙarshe, ana watsi da tsangwama kuma baya shafar aiki.

Rashin hasara na wannan matsakaita shine wani ɗan jinkirin canza karatun karatun ainihin canjin dangi a cikin mai haƙuri (bacewar ɓoyayyen bugun jini daga ƙimar farko na 100, a zahiri 100-> 0, za a nuna shi azaman 100-> 80. -> 60-> 40-> 0), dole ne a yi la'akari da wannan yayin saka idanu.

4) Matsaloli tare da haemoglobin, latent hypoxia tare da al'ada SpO2:

A) Rashin haemoglobin (tare da anemia, haemodilution)

Za a iya samun ƙananan haemoglobin a cikin jiki (anemia, haemodilution), akwai hypoxia gabobin jiki da nama, amma duk haemoglobin da ke ciki yana iya cika da oxygen, SpO 2 = 99 %.

Ya kamata a tuna cewa bugun jini oximeter baya nuna dukkan oxygen abun ciki na jini (CaO 2) da kuma undissolved oxygen a cikin plasma (PO 2), watau yawan haemoglobin cike da oxygen (SpO 2).

Ko da yake, ba shakka, babban nau'in iskar oxygen a cikin jini shine haemoglobin, wanda shine dalilin da ya sa pulse oximetry yana da mahimmanci kuma mai mahimmanci.

B) Siffofin Haemoglobin na Musamman (ta guba)

Haemoglobin da ke daure da carbon monoxide (HbCO) wani abu ne mai ƙarfi, mai dadewa wanda a zahiri baya ɗaukar iskar oxygen, amma yana da halayen ɗaukar haske mai kama da oxyhaemoglobin na al'ada (Hbo 2).

Ana ci gaba da inganta na'urorin bugun jini, amma a halin yanzu, ƙirƙirar na'urorin bugun jini marasa tsada waɗanda ke bambanta tsakanin HbCO da HbO 2 lamari ne na gaba.

Game da guba na carbon monoxide a lokacin wuta, mai haƙuri na iya samun hypoxia mai tsanani kuma har ma da mahimmanci, amma tare da fuska mai laushi da ƙima na al'ada na SpO 2, wannan ya kamata a yi la'akari da shi a lokacin pulse oximetry a irin waɗannan marasa lafiya.

Matsaloli iri ɗaya na iya faruwa tare da wasu nau'ikan dyshaemoglobinemia, gudanar da aikin jijiya na magungunan rediyopaque da rini.

5) Rufe hypoventilation tare da shakar O2

Mai haƙuri tare da ɓacin rai na sani (bugun jini, rauni na kai, guba, coma), idan yana karɓar O2 inhaled, saboda yawan iskar oxygen da aka samu tare da kowane aikin numfashi (idan aka kwatanta da 21% a cikin iska mai iska), na iya samun alamun jikewa na al'ada ko da a 5. -8 numfashi a cikin minti daya.

A lokaci guda, wani wuce haddi na carbon dioxide zai tara a cikin jiki (oxygen maida hankali a lokacin FiO 2 inhalation ba zai shafar CO 2 cire), numfashi acidosis zai karu, cerebral edema zai karu saboda hypercapnia da Manuniya a kan bugun jini oximeter iya. zama al'ada.

Ana buƙatar kima na asibiti na numfashi da ɗaukar hoto na mai haƙuri.

6) Bambance-bambance tsakanin tsinkayen zuciya da ainihin bugun zuciya: bugun ' shiru'

A cikin yanayin rashin jin daɗi na gefe, da kuma rikicewar bugun zuciya (atrial fibrillation, extrasystole) saboda bambancin ƙarfin bugun bugun jini (cikawar bugun jini), na'urar na iya yin watsi da bugun bugun “silent”. ƙididdige yawan bugun zuciya (HR, PR).

Ainihin bugun zuciya (ƙaramar zuciya akan ECG ko lokacin auscultation na zuciya) na iya zama mafi girma, wannan shine abin da ake kira. 'kasarin bugun jini'.

Dangane da algorithm na ciki na wannan samfurin na'urar da bambanci a cikin cikawar bugun jini a cikin wannan majiyyaci, girman rashi na iya bambanta da canzawa.

A lokuta masu dacewa, ana ba da shawarar saka idanu na ECG lokaci guda.

Ana iya samun halin da ake ciki, tare da abin da ake kira. "Dichrotic pulse": saboda raguwar sautin jijiyoyin jini a cikin wannan majiyyaci (saboda kamuwa da cuta, da sauransu), ana ganin kowane motsin bugun jini akan jadawali na plethysmogram a matsayin sau biyu ("tare da koma baya"), kuma na'urar da ke kan nuni na iya ƙarya. ninka darajar PR.

Manufofin bugun jini oximetry

1) Diagnostic, SpO 2 da PR (PR).

2) Kulawa da haƙuri na lokaci-lokaci

Manufar bincike, misali auna SpO 2 da PR tabbas yana da mahimmanci kuma a bayyane yake, wanda shine dalilin da ya sa pulse oximeters yanzu ya zama ko'ina, duk da haka, ƙananan na'urori masu girman aljihu (sauki 'saturation meters') ba sa ba da izinin kulawa na yau da kullun, ƙwararre. ana buƙatar na'urar don saka idanu akai-akai.

Nau'in bugun jini oximeter da kayan aiki masu alaƙa

Mini mara waya ta bugun jini oximeter (allon kan firikwensin yatsa)
ƙwararrun masu saka idanu (ƙirar firikwensin-waya-ƙira tare da allo daban)
Pulse tashar oximeter a cikin mai duba aiki da yawa ko defibrillator
Mini Wireless Pulse Oximeters

Wireless pulse oximeters suna da ƙananan ƙananan, nuni da maɓallin sarrafawa (yawanci yawanci ɗaya ne kawai) suna samuwa a saman ɗakin firikwensin, babu wayoyi ko haɗin kai.

Saboda ƙarancin tsadarsu da ƙanƙanta, irin waɗannan na'urori yanzu ana amfani da su sosai.

Lallai sun dace da ma'aunin jikewa da bugun zuciya, amma suna da gazawa da rashin amfani ga ƙwararrun amfani da sa ido, misali a cikin yanayin motar asibiti ƙungiya.

Abũbuwan amfãni

Karamin, baya ɗaukar sarari da yawa a cikin aljihu da ajiya
Sauƙi don amfani, babu buƙatar tunawa da umarnin

disadvantages

Rashin hangen nesa yayin saka idanu: lokacin da majiyyaci ke kan shimfiɗa, dole ne koyaushe ku kusanci ko jingina zuwa yatsa tare da firikwensin, arha bugun jini oximeters suna da allon monochrome wanda ke da wahalar karantawa daga nesa (zai fi kyau siyan launi. daya), dole ne ku gane ko canza hoton da aka juyar da shi, fahimtar kuskuren hoto kamar SpO 2 = 99 % maimakon 66 %, PR=82 maimakon SpO 2 = 82 na iya samun sakamako mai haɗari.

Ba za a iya raina matsalar rashin gani ba.

Yanzu ba zai taɓa faruwa ga kowa ba don kallon fim ɗin horo akan talbijin ɗin baki da fari tare da allon diagonal 2 inci: kayan ya fi dacewa da babban allo mai launi.

Hoto mai haske daga nuni mai haske a kan bangon motar ceto, wanda ake gani a kowane haske da kowane nisa, yana ba da damar kada a shagaltar da mutum daga ayyuka masu mahimmanci yayin aiki tare da mai haƙuri a cikin mummunan yanayi.

Akwai fa'idodi masu fa'ida da fa'ida a cikin menu: iyakoki na ƙararrawa masu daidaitawa ga kowane siga, ƙarar bugun jini da ƙararrawa, yin watsi da sigina mara kyau, yanayin plethysmogram, da dai sauransu, idan akwai ƙararrawa, za su yi sauti da karkatar da hankali gabaɗaya ta hanyar ko kashewa. gaba daya.

Wasu na'urorin bugun jini mai arha da aka shigo da su, bisa gogewar amfani da gwajin dakin gwaje-gwaje, ba sa tabbatar da daidaito na gaske.

Yana da mahimmanci a auna fa'ida da rashin amfani kafin siye, dangane da bukatun yankinku.

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Bukatar cire batura a lokacin ajiya na dogon lokaci: idan ba a yi amfani da oximeter pulse ba akai-akai (misali a cikin gidan 'kan buƙatu'). taimakon farko kit), batura na cikin na'urar suna zubowa kuma suna lalata ta, a cikin ajiyar dogon lokaci, batir ɗin dole ne a cire su kuma a adana su kusa, yayin da filastik mai rauni na murfin baturin da makullinsa ba zai iya jure maimaita rufewa da buɗe ɗakin ba.

A cikin nau'i-nau'i da yawa babu yiwuwar samar da wutar lantarki na waje, buƙatar samun saitin batura a kusa shine sakamakon wannan.

A takaice: yana da ma'ana a yi amfani da oximeter mara waya ta pulse oximeter a matsayin kayan aikin aljihu don saurin bincike, yiwuwar sa ido yana da iyaka sosai, yana yiwuwa ne kawai a gudanar da saka idanu mai sauƙi a gefen gado, misali kula da bugun jini yayin gudanar da aikin jijiya. beta-blocker.

Yana da kyau a sami irin wannan oximeter na bugun jini don ma'aikatan motar asibiti a matsayin madadin na biyu.

Kwararrun saka idanu bugun jini oximeters

Irin wannan nau'in oximeter na bugun jini yana da jiki mai girma da nuni, firikwensin ya bambanta kuma mai maye gurbin (balagagge, yaro), an haɗa ta hanyar kebul zuwa jikin na'urar.

Nunin crystal na ruwa da/ko allon taɓawa (kamar a cikin wayar hannu) maimakon nunin kashi bakwai (kamar yadda yake cikin agogon lantarki) yana da nisa daga koyaushe kuma yana da inganci, ba shakka yana da zamani kuma yana da tsada, amma yana jure wa cututtukan fata. Mafi muni, ƙila ba zai amsa a fili ga matsa lamba na yatsa a cikin safofin hannu na likita ba, yana cin ƙarin wutar lantarki, yana da rauni idan an faɗi, kuma yana ƙara ƙimar na'urar sosai.

Abũbuwan amfãni

Sauƙaƙawa da tsabtar nuni: firikwensin a yatsa, na'urar da aka ɗaura bango akan madaidaicin ko a gaban idon likita, babban isasshe kuma bayyananne hoto, yanke shawara mai sauri yayin saka idanu.
Cikakken ayyuka da saitunan ci gaba, waɗanda zan tattauna daban da dalla-dalla a ƙasa.
Daidaita daidai
Kasancewar samar da wutar lantarki na waje (12V da 220V), wanda ke nufin yiwuwar yin amfani da sa'o'i 24 ba tare da katsewa ba.
Kasancewar firikwensin yaro (zai iya zama zaɓi)
Juriya ga disinfection
Samar da sabis, gwaji da gyara na'urorin gida

disadvantages

Ƙananan m kuma mai ɗauka
Masu tsada (kyakkyawan oximeters na irin wannan nau'in ba su da arha, kodayake farashin su yana da ƙasa da ƙasa da na cardiographs da defibrillators, wannan fasaha ce ta ƙwararru don ceton rayukan marasa lafiya)
Bukatar horar da ma'aikata da kuma kula da wannan samfurin na'urar (yana da kyau a saka idanu marasa lafiya tare da sabon oximeter na bugun jini a cikin "duk a jere" don samun kwanciyar hankali a cikin yanayi mai wahala).

Don taƙaitawa: ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun ƙwararrun tabbas tabbas sun zama dole ga duk marasa lafiya da ke fama da rashin lafiya don aiki da sufuri, saboda haɓakar aikin sa, a lokuta da yawa yana adana lokaci kuma baya buƙatar haɗa shi da mai saka idanu na tashoshi da yawa, yana iya kuma a yi amfani da sauki jikewa da bugun jini ganewar asali, amma shi ne kasa da mini-buga oximeters cikin sharuddan compactness da farashin.

Na dabam, ya kamata mu tsaya kan zaɓin nau'in nuni (allon) na ƙwararrun bugun jini oximeter.

Zai yi kama da cewa zabin a bayyane yake.

Kamar dai yadda wayoyin tura-button suka dade da ba wa wayoyi na zamani damar yin amfani da na'ura mai nunin faifan tabawa, ya kamata na'urorin likitanci na zamani su kasance iri daya.

Pulse oximeters tare da nuni a cikin nau'i na alamomin ƙididdiga masu kashi bakwai ana ɗaukar waɗanda ba su daɗe.

Duk da haka, aikin yana nuna cewa a cikin ƙayyadaddun aikin ƙungiyoyin motar asibiti, nau'in na'urar da ke da nuni na LED yana da manyan abubuwan da ya kamata a sani lokacin zabar da aiki tare da shi.

Lalacewar na'urar tare da nunin LED sune kamar haka:

Lalacewa: a aikace, na'urar da ke da nunin kashi bakwai cikin sauƙi tana jure wa faɗuwa (misali daga shimfiɗa a ƙasa), na'urar da ke da nunin LED - 'ta faɗi, sannan ta karye'.
Amsa mara kyau ta fuskar taɓawa don matsa lamba yayin saka safofin hannu: yayin barkewar COVID-19, babban aikin tare da oximeter na bugun jini yana kan marasa lafiya da wannan kamuwa da cuta, ma'aikatan sun sanye da kayan kariya, safofin hannu na likitanci suna kan hannayensu, sau da yawa sau biyu ko kauri. Nunin LED na taɓawa na wasu samfuran sun amsa mummunan ko kuskure don danna abubuwan sarrafawa akan allon tare da yatsu a cikin irin wannan safofin hannu, kamar yadda aka tsara allon taɓawa don a matse shi da yatsu mara kyau;
Duban kusurwa da aiki a cikin yanayin haske mai haske: nunin LED dole ne ya kasance mafi inganci, dole ne ya kasance a bayyane a cikin hasken rana mai haske (misali lokacin da ma'aikatan ke aiki a bakin rairayin bakin teku) kuma a kusurwar kusan 'digiri 180', Dole ne a zaɓi halin haske na musamman. Aiki yana nuna cewa allon LED ba koyaushe ya cika waɗannan buƙatun ba.
Juriya ga cututtuka mai tsanani: nunin LED da na'urar da ke da irin wannan allon bazai iya jure wa jiyya mai mahimmanci tare da masu kashe kwayoyin cuta ba;
Farashin: nunin LED ya fi tsada, yana ƙaruwa da farashin na'urar sosai
Ƙara yawan wutar lantarki: nunin LED yana buƙatar ƙarin kuzari, wanda ke nufin ko dai ƙarin nauyi da farashi saboda baturi mai ƙarfi ko gajeriyar rayuwar batir, wanda zai iya haifar da matsaloli yayin aikin gaggawa yayin bala'in COVID-19 (babu lokacin caji)
Ƙarƙashin kulawa: nunin LED da na'urar da ke da irin wannan allon ba su da ƙarancin kulawa a cikin sabis, maye gurbin nuni yana da tsada sosai, kusan ba a gyara ba.

Don waɗannan dalilai, a kan aikin, yawancin masu ceto suna yin shuru don zaɓar oximeter na bugun jini tare da nunin nau'in 'classic' akan alamomin lamba bakwai (kamar a agogon lantarki), duk da kasancewarsa na tsufa. Ana ɗaukar dogaro a cikin 'yaƙi' a matsayin fifiko.

Zaɓin na'urar saturation meter, saboda haka, dole ne a daidaita shi a gefe ɗaya ga buƙatun da yankin ya gabatar, kuma a ɗayan ɗayan abin da mai ceto ya ɗauka yana 'yi' dangane da ayyukansa na yau da kullun.