Momwe mungasankhire ndikugwiritsa ntchito pulse oximeter?

By Cristiano Antonino On Mar 21, 2023

Mliri wa COVID-19 usanachitike, ma pulse oximeter (kapena saturation mita) amangogwiritsidwa ntchito kwambiri ndi magulu a ambulansi, otsitsimutsa komanso akatswiri a pulmonologists.

Kufalikira kwa coronavirus kwachulukitsa kutchuka kwa chipangizo chachipatalachi, komanso chidziwitso cha anthu pa ntchito yake.

Nthawi zambiri amagwiritsidwa ntchito ngati 'mamita owonjezera', ngakhale kuti kwenikweni amatha kunena zambiri.

M'malo mwake, luso la oximeter la pulse oximeter silimangotengera izi: m'manja mwa munthu wodziwa zambiri, chipangizochi chimatha kuthetsa mavuto ambiri.

Choyamba, tiyeni tikumbukire zomwe pulse oximeter imayesa ndikuwonetsa

Sensa yopangidwa ndi 'clip' imayikidwa (kawirikawiri) pa chala cha wodwalayo, mu sensa ya LED pa theka limodzi la thupi imatulutsa kuwala, LED ina pa theka linalo imalandira.

Chala cha wodwalayo chimawunikiridwa ndi kuwala kwa mafunde awiri osiyana (ofiira ndi infrared), omwe amatengedwa kapena kufalitsidwa mosiyana ndi hemoglobin yokhala ndi okosijeni 'payokha' (HbO 2), ndi hemoglobin yaulere ya oxygen (Hb).

Mayamwidwe akuyerekeza pa kugunda kwa mafunde ang'onoang'ono arterioles chala, motero kusonyeza chizindikiro hemoglobin machulukitsidwe ndi mpweya; monga peresenti ya hemoglobini (machulukitsidwe, SpO 2 = ..%) ndi kugunda kwa mtima (kugunda kwa mtima, PR).

Chizolowezi mwa munthu wathanzi ndi Sp * O 2 = 96 - 99%.

* Machulukitsidwe pa pulse oximeter amasankhidwa Sp chifukwa ndi 'pulsatile', zotumphukira; (mu microarteries) yoyezedwa ndi pulse oximeter. Mayeso a labotale a haemogasanalysis amayezeranso kuchuluka kwa magazi m'mitsempha (SaO 2) ndi kuchuluka kwa magazi m'mitsempha (SvO 2).

Pa chiwonetsero cha pulse oximeter chamitundu yambiri, ndizothekanso kuwona chiwonetsero chanthawi yeniyeni cha kudzazidwa (kuchokera ku pulse wave) kwa minofu yomwe ili pansi pa sensa, yotchedwa plethysmogram - mwa mawonekedwe a bar. ' kapena sine curve, plethysmogram imapereka chidziwitso chowonjezereka kwa dokotala.

Ubwino wa chipangizocho ndikuti sichivulaza aliyense (palibe ma radiation ya ionizing), osasokoneza (palibe chifukwa chotenga dontho la magazi kuti awunike), amayamba kugwira ntchito kwa wodwalayo mwachangu komanso mosavuta, ndipo amatha kugwira ntchito nthawi yonseyi, kukonzanso sensa pa zala ngati pakufunika.

Komabe, pulse oximeter iliyonse ndi pulse oximetry ili ndi zovuta komanso zoperewera zomwe sizilola kugwiritsa ntchito bwino njirayi mwa odwala onse.

Njirazi ndi izi:

1) Kusayenda bwino kwa magazi

- kusowa kwa kuthirira komwe sensor imayikidwa: kutsika kwa magazi ndi kugwedezeka, kutsitsimuka, hypothermia ndi chisanu chamanja, atherosulinosis yaziwiya m'malekezero, kufunikira kwa kuyezetsa kwa magazi pafupipafupi (BP) ndi chikhomo chomangika pa mkono, etc. - Chifukwa cha zifukwa zonsezi, phokoso la pulse ndi chizindikiro pa sensa ndi osauka, kuyeza kodalirika kumakhala kovuta kapena kosatheka.

Ngakhale akatswiri ena a pulse oximeters ali ndi njira ya 'Incorrect Signal' ('timayesa zomwe timapeza, kulondola sikutsimikiziridwa'), pakakhala kutsika kwa magazi komanso kusayenda bwino kwa magazi pansi pa sensa, tikhoza kuyang'anitsitsa wodwalayo kudzera pa ECG. ndi ma capnography channels.

Tsoka ilo, pali odwala ena owopsa azachipatala omwe sangathe kugwiritsa ntchito pulse oximetry,

2) Mavuto a misomali polandira chizindikiro pa zala: manicure osatha pa misomali, kuwonongeka kwakukulu kwa misomali ndi matenda a mafangasi, zala zazing'ono kwambiri mwa ana, ndi zina zambiri.

Chofunikira ndi chofanana: kulephera kupeza chizindikiro chodziwika bwino cha chipangizocho.

Vuto litha kuthetsedwa: potembenuza sensa pa chala madigiri 90, ndikuyika kachipangizo m'malo osagwirizana, mwachitsanzo pansonga.

Kwa ana, ngakhale asanakwane, nthawi zambiri zimakhala zotheka kupeza chizindikiro chokhazikika kuchokera ku sensa yachikulire yomwe imayikidwa pa chala chachikulu.

Masensa apadera a ana amangopezeka kwa akatswiri a pulse oximeters mu seti yathunthu.

3) Kudalira phokoso ndi chitetezo ku "phokoso

Wodwala akamasuntha (chidziwitso chosinthika, kusokonezeka kwa psychomotor, kuyenda m'maloto, ana) kapena kugwedezeka panthawi yoyendetsa, sensa imatha kuchotsedwa ndipo chizindikiro chosakhazikika chikhoza kupangidwa, kuyambitsa ma alarm.

Professional transport pulse oximeters kwa opulumutsa ali ndi njira zapadera zotetezera zomwe zimalola kusokoneza kwakanthawi kochepa kunyalanyazidwa.

Zizindikiro zimawerengeredwa pamasekondi omaliza a 8-10, kusokoneza kumanyalanyazidwa ndipo sikukhudza ntchito.

Choyipa cha kuwerengera uku ndikuchedwa kwina pakusintha kuwerengera kwa kusintha kwenikweni kwa wodwala (kutayika kowonekera kwa kugunda kuchokera pamlingo woyamba wa 100, kwenikweni 100-> 0, kudzawonetsedwa ngati 100-> 80. ->60->40->0), izi ziyenera kuganiziridwa panthawi yowunika.

4) Mavuto a haemoglobin, hypoxia yobisika yokhala ndi SpO2 yabwinobwino:

A) Kuchepa kwa hemoglobini (ndi kuchepa kwa magazi, haemodilution)

Pakhoza kukhala hemoglobini yochepa m'thupi (kusowa magazi, haemodilution), pali chiwalo ndi minofu hypoxia, koma hemoglobini yonse yomwe ilipo ikhoza kukhala yodzaza ndi okosijeni, SpO 2 = 99%.

Tiyenera kukumbukira kuti kugunda kwa oximeter sikuwonetsa mpweya wonse wa magazi (CaO 2) ndi mpweya wosasunthika mu plasma (PO 2), mwachitsanzo, chiwerengero cha hemoglobini chodzaza ndi mpweya (SpO 2).

Ngakhale, ndithudi, mtundu waukulu wa okosijeni m'magazi ndi hemoglobini, chifukwa chake pulse oximetry ndi yofunika kwambiri komanso yamtengo wapatali.

B) Mitundu Yapadera ya Hemoglobin (mwa poizoni)

Hemoglobin yomangidwa ku carbon monoxide (HbCO) ndi chinthu cholimba, chokhala ndi moyo wautali chomwe sichimanyamula mpweya, koma chimakhala ndi mayamwidwe a kuwala ofanana kwambiri ndi oxyhemoglobin (HbO 2).

Ma pulse oximeters akusinthidwa nthawi zonse, koma pakali pano, kupanga ma oximeter otsika mtengo omwe amasiyanitsa HbCO ndi HbO 2 ndi nkhani yamtsogolo.

Pankhani ya poizoni wa carbon monoxide pamoto, wodwalayo akhoza kukhala ndi hypoxia yoopsa komanso yovuta, koma ndi nkhope yosungunuka komanso mfundo zabodza za SpO 2, izi ziyenera kuganiziridwa panthawi ya pulse oximetry kwa odwala otere.

Zofananazo zitha kuchitika ndi mitundu ina ya dyssheemoglobinaemia, makonzedwe a mtsempha wa ma radiopaque agents ndi utoto.

5) Kubisala kwa hypoventilation ndi mpweya wa O2

Wodwala ndi kupsinjika maganizo (stroke, kuvulala mutu, poizoni, chikomokere), ngati kulandira mpweya O2 , chifukwa cha owonjezera mpweya analandira ndi aliyense kupuma kupuma (poyerekeza ndi 21% mu mpweya mlengalenga), akhoza kukhala bwinobwino machulukitsidwe zizindikiro ngakhale pa 5. -8 kupuma mphindi imodzi.

Panthawi imodzimodziyo, mpweya woipa wochuluka udzaunjikana m'thupi (kuchuluka kwa okosijeni panthawi ya kupuma kwa FiO 2 sikukhudza kuchotsedwa kwa CO 2), kupuma kwa acidosis kumawonjezeka, edema ya ubongo idzawonjezeka chifukwa cha hypercapnia ndi zizindikiro za pulse oximeter. kukhala wabwinobwino.

Kuwunika kwachipatala kwa kupuma ndi capnography ya wodwalayo ndikofunikira.

6) Kusiyana pakati pa kugunda kwa mtima komwe kumadziwika ndi komwe kukuchitika: kugunda kwa 'chete'

Pankhani ya mpweya woipa wa zotumphukira, komanso kusokoneza mungoli wa mtima (atrial fibrillation, extrasystole) chifukwa cha kusiyana kwa mphamvu ya pulse wave (kudzaza kwa pulse), kugunda kwa 'chete' kumatha kunyalanyazidwa ndi chipangizocho ndipo osaganiziridwa. kuwerengera kugunda kwa mtima (HR, PR).

Kuthamanga kwa mtima kwenikweni (kugunda kwa mtima pa ECG kapena panthawi ya auscultation ya mtima) kungakhale kokwera kwambiri, izi ndizo zomwe zimatchedwa. 'pulse deficit'.

Malingana ndi ndondomeko yamkati yachitsanzo cha chipangizochi komanso kusiyana kwa kudzaza kwa pulse mwa wodwala uyu, kuchuluka kwa kuchepa kungakhale kosiyana ndi kusintha.

Pazifukwa zoyenera, kuwunika kwa ECG nthawi imodzi kumalimbikitsidwa.

Pakhoza kukhala zinthu zosiyana, ndi zomwe zimatchedwa. "dichrotic pulse": chifukwa cha kuchepa kwa mitsempha ya mitsempha mwa wodwala uyu (chifukwa cha matenda, ndi zina zotero), phokoso lililonse la pulse pa graph plethysmogram likuwoneka ngati lawiri ("ndi recoil"), ndipo chipangizo chomwe chikuwonetsedwa chikhoza kunama. kuwirikiza kawiri PR.

Zolinga za pulse oximetry

1) Diagnostic, SpO 2 ndi PR (PR) muyeso

2) Kuwunika kwa odwala nthawi yeniyeni

Cholinga cha diagnostics, mwachitsanzo kuyeza kwa SpO 2 ndi PR ndikofunikira komanso kodziwikiratu, ndichifukwa chake ma pulse oximeters tsopano ali ponseponse, komabe, zida zazing'ono zazing'ono zam'thumba (zosavuta 'mamita machulukitsidwe') sizilola kuwunika kwanthawi zonse, katswiri. chipangizo chofunika nthawi zonse kuwunika wodwalayo.

Mitundu ya pulse oximeter ndi zida zofananira

Mini wireless pulse oximeters (screen pa chala sensor)
Oyang'anira akatswiri (kapangidwe ka sensa-waya-case yokhala ndi chophimba chosiyana)
Pulse oximeter channel mu multifunction monitor kapena defibrillator
Mini Wireless Pulse Oximeters

Oximeters opanda zingwe ndi ochepa kwambiri, batani lowonetsera ndi kulamulira (nthawi zambiri limakhala limodzi lokha) lili pamwamba pa nyumba ya sensor, palibe mawaya kapena kugwirizana.

Chifukwa cha mtengo wake wotsika komanso wophatikizika, zida zotere tsopano zimagwiritsidwa ntchito kwambiri.

Ndikoyeneradi kuyeza kukhudzika kwapang'onopang'ono komanso kugunda kwa mtima, koma ali ndi malire komanso kuipa kogwiritsa ntchito ndi kuyang'anira akatswiri, mwachitsanzo pamikhalidwe ya ambulansi ogwira ntchito.

ubwino

Compact, satenga malo ambiri m'matumba ndi kusunga
Yosavuta kugwiritsa ntchito, osafunikira kukumbukira malangizo

kuipa

Kusawoneka bwino pakuwunika: wodwala akakhala pa machira, muyenera kumayandikira kapena kutsamira chala ndi sensa, ma pulse oximeters otsika mtengo amakhala ndi chophimba cha monochrome chomwe chimakhala chovuta kuwerenga patali (ndi bwino kugula mtundu. chimodzi), muyenera kuzindikira kapena kusintha fano lotembenuzidwa, malingaliro olakwika a fano monga SpO 2 = 99 % m'malo mwa 66%, PR=82 m'malo mwa SpO 2 =82 akhoza kukhala ndi zotsatira zoopsa.

Vuto losawoneka bwino silinganyalanyazidwe.

Tsopano sizingachitike kwa wina aliyense kuwonera filimu yophunzitsira pa TV yakuda ndi yoyera yokhala ndi chophimba cha 2 ″ diagonal: zinthuzo zimatengedwa bwino ndi chophimba chamtundu chokwanira.

Chithunzi chowoneka bwino kuchokera ku chiwonetsero chowala pakhoma la galimoto yopulumutsira, yowonekera mu kuwala kulikonse komanso pamtunda uliwonse, imalola munthu kuti asasokonezedwe ndi ntchito zofunika kwambiri pamene akugwira ntchito ndi wodwala muvuto lalikulu.

Pali zinthu zambiri komanso zomveka pamindandanda: malire osinthika a alamu pagawo lililonse, kuchuluka kwamphamvu ndi ma alarm, kunyalanyaza chizindikiro choyipa, mawonekedwe a plethysmogram, ndi zina zambiri, ngati pali ma alarm, amamveka ndikusokoneza njira yonse kapena kuzimitsa. zonse mwakamodzi.

Ma pulse oximeters otsika mtengo ochokera kunja, kutengera luso lakugwiritsa ntchito komanso kuyesa kwa labotale, sizitsimikizira kulondola kwenikweni.

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Kufunika kochotsa mabatire pakusungidwa kwanthawi yayitali: ngati pulse oximeter imagwiritsidwa ntchito pafupipafupi (mwachitsanzo, m'nyumba yomwe ikufunika" chithandizo choyambira zida), mabatire mkati mwa chipangizocho amatuluka ndikuwononga, posungira nthawi yayitali, mabatire ayenera kuchotsedwa ndikusungidwa pafupi, pomwe pulasitiki yosalimba ya chivundikiro cha batri ndi loko yake sizingapirire kutseka mobwerezabwereza ndikutsegula kwa chipindacho.

Mumitundu ingapo palibe kuthekera kwamagetsi akunja, kufunikira kokhala ndi mabatire otsalira pafupi ndi chifukwa cha izi.

Mwachidule: ndikwanzeru kugwiritsa ntchito pulse oximeter yopanda zingwe ngati chida chamthumba chodziwira matenda mwachangu, kuthekera kowunika ndikochepa kwambiri, ndizotheka kuchita zowunikira pafupi ndi bedi, mwachitsanzo, kuyang'anira kugunda kwa mtima pakuwongolera mtsempha. beta-blocker.

Ndikoyenera kukhala ndi pulse oximeter yotere kwa ogwira ntchito ku ambulansi ngati kubwezeretsa kachiwiri.

Katswiri wowunikira ma pulse oximeters

Oximeter yotereyi imakhala ndi thupi lalikulu ndikuwonetsa, sensa imasiyanitsidwa ndikusintha (wamkulu, mwana), wolumikizidwa kudzera pa chingwe kupita ku thupi la chipangizocho.

Chiwonetsero cha kristalo chamadzimadzi ndi / kapena chojambula chojambula (monga mu foni yamakono) m'malo mwa mawonekedwe a magawo asanu ndi awiri (monga pa wotchi yamagetsi) ndizovuta nthawi zonse komanso zoyenera, ndithudi ndi zamakono komanso zotsika mtengo, koma zimalekerera kupha tizilombo toyambitsa matenda. choyipa kwambiri, sangayankhe momveka bwino kukakamiza kwa chala mu magolovesi azachipatala, amadya magetsi ochulukirapo, osalimba ngati agwetsedwa, ndikuwonjezera kwambiri mtengo wa chipangizocho.

ubwino

Kusavuta komanso kumveka bwino kwa chiwonetsero: sensor pa chala, chipangizo chokhazikika pakhoma pa bulaketi kapena pamaso pa dokotala, chithunzi chachikulu chokwanira komanso chomveka bwino, kupanga zisankho mwachangu pakuwunika.
Magwiridwe athunthu ndi zokonda zapamwamba, zomwe ndikambirana padera komanso mwatsatanetsatane pansipa.
Kuyeza kolondola
Kukhalapo kwa magetsi akunja (12V ndi 220V), zomwe zikutanthauza kuti mutha kugwiritsa ntchito maola 24 osasokoneza.
Kukhalapo kwa sensor ya mwana (ikhoza kukhala njira)
Kukana disinfection
Kupezeka kwa ntchito, kuyesa ndi kukonza zipangizo zapakhomo

kuipa

Zocheperako komanso zonyamula
Zokwera mtengo (ma pulse oximeters amtundu uwu siwotsika mtengo, ngakhale mtengo wake ndi wotsika kwambiri kuposa wa cardiographs ndi defibrillators, iyi ndi njira yaukadaulo yopulumutsa miyoyo ya odwala)
Kufunika kophunzitsa ogwira ntchito ndikuwongolera chitsanzo ichi cha chipangizocho (ndikoyenera kuyang'anira odwala omwe ali ndi pulse oximeter yatsopano mu "zonse motsatira" kuti luso likhale lokhazikika pazovuta kwambiri)

Mwachidule: katswiri wowunikira pulse oximeter ndiyofunikira kwa odwala onse omwe akudwala kwambiri kuti agwire ntchito ndi zoyendera, chifukwa cha magwiridwe ake apamwamba, nthawi zambiri amapulumutsa nthawi ndipo safunikira kulumikizidwa ndi chowunikira chamitundu yambiri, imathanso Itha kugwiritsidwa ntchito pakuchulukira kosavuta komanso kuzindikira kugunda kwa mtima, koma ndiyotsika poyerekeza ndi ma mini-pulse oximeters potengera kuphatikizika ndi mtengo.

Payokha, tiyenera kukhala ndi kusankha kwa mtundu wowonetsera (wowonekera) wa akatswiri othamanga oximeter.

Zingawoneke kuti chisankhocho ndi chodziwikiratu.

Monga momwe mafoni akukankhira-batani akhala akupereka njira kwa mafoni amakono okhala ndi chiwonetsero chazithunzi cha LED, zida zamakono zamankhwala ziyenera kukhala zofanana.

Ma pulse oximeters okhala ndi chiwonetsero mu mawonekedwe a magawo asanu ndi awiri owonetsa manambala amawonedwa ngati osatha.

Komabe, machitidwe akuwoneka kuti akuwonetsa kuti mwachindunji ntchito ya magulu a ambulansi, mawonekedwe a chipangizocho ndi chiwonetsero cha LED ali ndi zovuta zazikulu zomwe munthu ayenera kuzidziwa posankha ndikugwira ntchito nazo.

Kuipa kwa chipangizo chokhala ndi chiwonetsero cha LED ndi motere:

Fragility: pochita, chipangizo chokhala ndi magawo asanu ndi awiri chimatha kupirira mosavuta kugwa (mwachitsanzo kuchokera pa machira pansi), chipangizo chokhala ndi chiwonetsero cha LED - 'chinagwa, kenako kusweka'.
Kuyankha koyipa kwa skrini pakukakamizidwa mutavala magolovesi: pakufalikira kwa COVID-19, ntchito yayikulu yokhala ndi pulse oximeter ili pa odwala omwe ali ndi matendawa, ogwira ntchito anali atavala masuti odzitchinjiriza, magolovesi azachipatala ali m'manja mwawo, nthawi zambiri kawiri kapena kukhuthala. Mawonekedwe amtundu wa LED wamitundu ina adayankha moyipa kapena molakwika kuti akanikizire zowongolera pazenera ndi zala m'magulovu oterowo, popeza chojambulacho chidapangidwa kuti chikanikizidwe ndi zala zopanda kanthu;
Kuyang'ana mbali ndikugwira ntchito m'malo owala kwambiri: chiwonetsero cha LED chiyenera kukhala chapamwamba kwambiri, chiyenera kuwoneka padzuwa lowala kwambiri (mwachitsanzo, pamene ogwira ntchito akugwira ntchito pamphepete mwa nyanja) komanso pamtunda wa pafupifupi '180 degrees', khalidwe lowala lapadera liyenera kusankhidwa. Zoyeserera zikuwonetsa kuti chophimba cha LED sichimakwaniritsa izi nthawi zonse.
Kukana kupha tizilombo toyambitsa matenda: chiwonetsero cha LED ndi chipangizo chokhala ndi chophimba chamtunduwu sichingathe kupirira chithandizo 'choopsa' ndi mankhwala ophera tizilombo;
Mtengo: chiwonetsero cha LED ndichokwera mtengo kwambiri, ndikuwonjezera mtengo wa chipangizocho
Kuchulukitsa kwamagetsi: chiwonetsero cha LED chimafunikira mphamvu zambiri, zomwe zikutanthauza kulemera ndi mtengo wochulukirapo chifukwa cha batri lamphamvu kwambiri kapena moyo wamfupi wa batri, zomwe zitha kubweretsa zovuta panthawi yantchito yadzidzidzi panthawi ya mliri wa COVID-19 (palibe nthawi yolipira)
Kusasunthika kochepa: chiwonetsero cha LED ndi chipangizo chokhala ndi chophimba choterocho sichimasungidwa bwino muutumiki, m'malo mwa chiwonetserocho ndi okwera mtengo kwambiri, osakonzedwa.

Pazifukwa izi, pantchito, opulumutsa ambiri amasankha mwakachetechete ma pulse oximeter okhala ndi mawonekedwe amtundu wa 'classic' pazizindikiro zamagulu asanu ndi awiri (monga pa wotchi yamagetsi), ngakhale akuwoneka kuti sakugwira ntchito. Kudalirika mu 'nkhondo' kumatengedwa ngati chinthu chofunikira kwambiri.

Kusankhidwa kwa mita ya saturation, motero, kuyenera kusinthidwa kumbali imodzi ku zosowa zomwe zimaperekedwa ndi dera, ndi zina zomwe wopulumutsira amawona kuti 'akuchita' mogwirizana ndi zomwe amachita tsiku ndi tsiku.