Capnography muzolowera mpweya wabwino: chifukwa chiyani timafunikira capnograph?
Mpweya wabwino uyenera kuchitidwa moyenera, kuyang'anira kokwanira ndikofunikira: capnographer amatenga gawo lenileni mu izi.
The capnograph mu makina mpweya mpweya wa wodwalayo
Ngati ndi kotheka, makina mpweya mpweya mu prehospital gawo ayenera kuchitidwa molondola komanso ndi kuwunika mokwanira.
Ndikofunika osati kuti wodwalayo apite kuchipatala, komanso kuonetsetsa kuti ali ndi mwayi wochira, kapena kuti asawonjezere kuopsa kwa mkhalidwe wa wodwalayo panthawi yoyendetsa ndi chisamaliro.
Masiku a ma ventilator osavuta okhala ndi zoikamo zochepa (ma frequency-volume) ndi zinthu zakale.
Odwala ambiri omwe amafunikira mpweya wabwino amateteza pang'ono kupuma mokhazikika (bradypnoea ndi hypoventilation), yomwe ili pakati pa "kupuma" pakati pa kupuma kwathunthu ndi kupuma modzidzimutsa, kumene kupuma kwa oxygen kumakhala kokwanira.
ALV (Adaptive lung ventilation) ambiri ayenera kukhala normoventilation: hypoventilation ndi hyperventilation zonse ndi zovulaza.
Zotsatira za mpweya wosakwanira kwa odwala omwe ali ndi vuto la ubongo (sitiroko, kupwetekedwa mutu, ndi zina zotero) ndizovulaza kwambiri.
Mdani wobisika: hypocapnia ndi hypercapnia
Ndizodziwika bwino kuti kupuma (kapena mpweya wabwino) ndikofunikira kuti thupi likhale ndi oxygen O2 ndikuchotsa mpweya woipa wa CO2.
Kuwonongeka kwa kusowa kwa okosijeni ndizodziwikiratu: hypoxia ndi kuwonongeka kwa ubongo.
O2 yowonjezera ikhoza kuwononga epithelium ya airways ndi alveoli ya m'mapapo, komabe, mukamagwiritsa ntchito mpweya wa okosijeni (FiO2) wa 50% kapena kucheperapo, sipadzakhala kuwonongeka kwakukulu kuchokera ku 'hyperoxygenation': mpweya wosasunthika udzachotsedwa. ndi mpweya.
Kutulutsa kwa CO2 sikutengera kaphatikizidwe kakusakaniza komwe kumaperekedwa ndipo kumatsimikiziridwa ndi mphindi ya mpweya wabwino wa MV (ma frequency, fx tidal volume, Vt); mpweya wochuluka kapena wozama, mpweya wa CO2 umatuluka kwambiri.
Ndi kusowa mpweya wabwino ('hypoventilation') - bradypnoea / wapamwamba kupuma mwa wodwalayo kapena makina mpweya 'akusowa' hypercapnia (kuchuluka CO2) ikupita patsogolo mu thupi, mmene pali pathological kukula kwa ziwiya ubongo, kuwonjezeka intracranial. kuthamanga, edema yaubongo ndi kuwonongeka kwake kwachiwiri.
Koma ndi mpweya wochuluka (tachypnoea mwa odwala kapena mpweya wambiri), hypocapnia imapezeka m'thupi, momwe mitsempha ya ubongo imapangidwira ndi ischemia ya zigawo zake, komanso kuwonongeka kwa ubongo, komanso kupuma kwa alkalosis. kuopsa kwa mkhalidwe wa wodwalayo. Choncho, mpweya wabwino wa makina sikuyenera kukhala 'anti-hypoxic', komanso 'normocapnic'.
Pali njira zowerengera zowerengera zamakina mpweya wabwino, monga chilinganizo cha Darbinyan (kapena zina zofananira), koma ndizowonetsa ndipo sizingaganizire momwe wodwalayo alili, mwachitsanzo.
Chifukwa chiyani pulse oximeter sikokwanira
Zoonadi, pulse oximetry ndiyofunikira ndipo imapanga maziko a kuwunika kwa mpweya wabwino, koma kuwunika kwa SpO2 sikokwanira, pali zovuta zingapo zobisika, zolephera kapena zoopsa, zomwe ndi: Muzochitika zomwe zafotokozedwa, kugwiritsa ntchito pulse oximeter nthawi zambiri kumakhala kosatheka. .
- Mukamagwiritsa ntchito mpweya wa okosijeni pamwamba pa 30% (kawirikawiri FiO2 = 50% kapena 100% amagwiritsidwa ntchito ndi mpweya wabwino), kuchepetsa mpweya wabwino (mulingo ndi voliyumu) zingakhale zokwanira kusunga "normoxia" pamene kuchuluka kwa O2 kuperekedwa pa kupuma kumawonjezeka. Chifukwa chake, kugunda kwa oximeter sikudzawonetsa kubisika kwa hypoventilation ndi hypercapnia.
- Kugunda kwa oximeter sikuwonetsa hyperventilation yovulaza mwanjira iliyonse, zokhazikika za SpO2 za 99-100% zabodza zimatsimikizira dokotala.
- Kuthamanga kwa oximeter ndi zizindikiro za machulukitsidwe ndizochepa kwambiri, chifukwa cha kuperekedwa kwa O2 m'magazi ozungulira komanso malo akufa a m'mapapo, komanso chifukwa cha kuchuluka kwa kuwerenga kwa nthawi yotetezedwa ndi oximeter. mayendedwe oyendetsa, pakachitika ngozi mwadzidzidzi (kutsekedwa kwa dera, kusowa kwa magawo a mpweya wabwino, etc.) n.) Kudzaza sikuchepa nthawi yomweyo, pamene kuyankha mwamsanga kuchokera kwa dokotala kumafunika.
- The kugunda oximeter amapereka olakwika SpO2 kuwerenga ngati mpweya monoxide (CO) poizoni chifukwa chakuti kuwala mayamwidwe oxyhaemoglobin HbO2 ndi carboxyhaemoglobin HbCO ndi ofanana, kuwunika mu nkhani iyi ndi ochepa.
Kugwiritsa ntchito capnograph: capnometry ndi capnography
Njira zina zowunikira zomwe zimapulumutsa moyo wa wodwalayo.
Chinthu chofunika komanso chofunika kwambiri pakuwongolera kukwanira kwa mpweya wabwino wa makina ndi kuyeza kosalekeza kwa CO2 concentration (EtCO2) mu mpweya wotuluka (capnometry) ndi chithunzithunzi cha cyclicity ya CO2 excretion (capnography).
Ubwino wa capnometry ndi:
- Zizindikiro zomveka bwino mumtundu uliwonse wa haemodynamic, ngakhale pa CPR (pakutsika kwambiri kwa magazi, kuyang'anitsitsa kumachitika kudzera mu njira ziwiri: ECG ndi EtCO2)
- Kusintha pompopompo kwa zizindikiro pazochitika zilizonse ndi zopatuka, mwachitsanzo, dera lopumira likachotsedwa
- Kuunika kwa kupuma koyambirira kwa wodwala yemwe ali ndi intubated
- Kuwonera zenizeni zenizeni za hypo- ndi hyperventilation
Zinanso za capnography ndizowonjezereka: kutsekedwa kwa mpweya kumasonyezedwa, kuyesera kwa wodwalayo kupuma modzidzimutsa ndi kufunikira kozama kwambiri kwa anesthesia, kuthamanga kwa mtima pa tchati ndi tachyarrhythmia, zotheka kukwera kwa kutentha kwa thupi ndi kuwonjezeka kwa EtCO2 ndi zina zambiri.
Zolinga zazikulu zogwiritsira ntchito capnograph mu gawo la prehospital
Kuyang'anira kupambana kwa tracheal intubation, makamaka pamakhala phokoso komanso zovuta za auscultation: pulogalamu yanthawi zonse ya cyclic CO2 excretion yokhala ndi matalikidwe abwino sizingagwire ntchito ngati chubu lilowetsedwa kum'mero (komabe, auscultation ndiyofunikira kuwongolera mpweya wa awiriwo. mapapo)
Kuyang'anira kubwezeretsedwa kwa kufalikira kwadzidzidzi panthawi ya CPR: kagayidwe kagayidwe kachakudya ndi kupanga CO2 kumawonjezeka kwambiri mu chamoyo 'chotsitsimutsidwa', 'kudumpha' kumawonekera pa capnogram ndipo maonekedwewo sakuipiraipira ndi kuponderezedwa kwa mtima (mosiyana ndi chizindikiro cha ECG)
Kuwongolera kwapang'onopang'ono kwa mpweya wabwino wamakina, makamaka kwa odwala omwe ali ndi vuto laubongo (sitiroko, kuvulala mutu, kugwedezeka, etc.)
Kuyeza "mukuyenda kwakukulu" (MAINSTREAM) ndi "mu lateral flow" (SIDESTREAM).
Capnographs ndi mitundu iwiri yaukadaulo, poyezera EtCO2 'mumtsinje waukulu' adaputala yayifupi yokhala ndi mabowo am'mbali imayikidwa pakati pa chubu cha endotracheal ndi dera, sensor yooneka ngati U imayikidwa pamenepo, mpweya wodutsa umafufuzidwa ndikutsimikiziridwa. EtCO2 imayesedwa.
Poyezera 'mu lateral flow', gawo laling'ono la gasi limatengedwa kuchokera kudera kudzera pa dzenje lapadera lozungulira ndi kompresa yoyamwa, imadyetsedwa kudzera mu chubu chopyapyala kulowa m'thupi la capnograph, pomwe EtCO2 imayesedwa.
Zinthu zingapo zimakhudza kulondola kwa kuyeza kwake, monga kuchuluka kwa O2 ndi chinyezi chosakanikirana ndi kutentha kwake. Sensor iyenera kutenthedwa ndi kusinthidwa.
M'lingaliro limeneli, muyeso wam'mphepete mwa nyanja ukuwoneka kuti ndi wolondola, chifukwa umachepetsa mphamvu ya zinthu zosokoneza izi pochita, komabe.
Portability, mitundu 4 ya capnograph:
- monga gawo la chowunikira pafupi ndi bedi
- monga gawo la multifunctional defibrillator
- mini-nozzle pa dera ('chipangizo chiri mu sensa, palibe waya')
- chipangizo chonyamula m'thumba ('thupi + sensor pawaya').
Kawirikawiri, ponena za capnography, njira yowunikira ya EtCO2 imamveka ngati gawo lazowunikira zambiri za 'bedside'; mu ICU, imakhazikika pa zida alumali.
Ngakhale choyimilira choyimiliracho chimachotsedwa ndipo chowunikira cha capnograph chimayendetsedwa ndi batri yomangidwa, zimakhala zovuta kuzigwiritsa ntchito posamukira kuchipinda chapansi kapena pakati pagalimoto yopulumutsa ndi chipinda chosamalira odwala kwambiri, chifukwa cha kulemera ndi kukula kwake. kuyang'anira mlandu ndi zosatheka kuziyika kwa wodwala kapena pa machira opanda madzi, pomwe zotengera kuchokera ku nyumbayo zidachitika makamaka.
Pakufunika chida chonyamulika kwambiri.
Mavuto omwewo amakumana nawo mukamagwiritsa ntchito capnograph ngati gawo la akatswiri odziwa ntchito zambiri: mwatsoka, pafupifupi onse akadali ndi kukula kwakukulu ndi kulemera kwake, ndipo kwenikweni samalola, mwachitsanzo, chipangizo choterechi kuti chiziyika bwino pamadzi. machira pafupi ndi wodwalayo pamene akutsika masitepe kuchokera pamwamba; ngakhale pakugwira ntchito, chisokonezo nthawi zambiri chimapezeka ndi mawaya ambiri mu chipangizocho.
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