Nzira yekusarudza uye kushandisa pulse oximeter?

By Cristiano Antonino On 21 Sea, 2023

Pamberi peCOVID-19 denda, iyo pulse oximeter (kana saturation mita) yaingoshandiswa zvakanyanya nezvikwata zveamburenzi, resuscitators uye pulmonologists.

Kupararira kwekoronavirus kwakawedzera mukurumbira wechigadzirwa ichi chekurapa, uye ruzivo rwevanhu nezvebasa rayo.

Anenge anogara achishandiswa se 'saturation metres', kunyangwe muchokwadi vanogona kutaura zvakawanda.

Muchokwadi, kugona kwehunyanzvi pulse oximeter hakugumiri pane izvi: mumaoko emunhu ane ruzivo, mudziyo uyu unogona kugadzirisa matambudziko mazhinji.

Chekutanga, ngatirangarirei izvo pulse oximeter inoyera uye inoratidza

Iyo 'clip' shaped sensor inoiswa (kazhinji) pamunwe wemurwere, mu sensor LED pane imwe hafu yemuviri inoburitsa mwenje, imwe LED kune imwe hafu inogamuchira.

Chigunwe chemurwere chinovhenekerwa nechiedza chewavelengths maviri akasiyana (tsvuku uye infrared), iyo inotorwa kana kuendeswa zvakasiyana neokisijeni-ine hemoglobin 'pachezvayo' (HbO 2), uye yakasununguka isina oxygen-isina hemoglobin (Hb).

Kutora kunofungidzirwa panguva yekuputika kwemafungu mudiki arterioles yemunwe, nokudaro kuratidza chiratidzo chehemoglobin saturation neokisijeni; sechikamu chehuwandu hwehemoglobin (saturation, SpO 2 = ..%) uye pulse rate (pulse rate, PR).

Chimiro mumunhu ane hutano ndiSp * O 2 = 96 - 99%.

* Saturation pane pulse oximeter inosarudzwa Sp nekuti iri 'pulsatile', peripheral; (in microarteries) inopimwa nepulse oximeter. Ongororo dzeLabhoreti dzehemogasanalysis dzinoyerawo kuzara kweropa (SaO 2) uye kuzara kweropa (SvO 2).

Pane iyo pulse oximeter inoratidzwa yemhando dzakawanda, zvinogoneka zvakare kuona chaiyo-nguva graphical inomiririra yekuzadza (kubva kune pulse wave) yetishu iri pasi pe sensor, iyo inonzi plethysmogram - muchimiro che 'bar. ' kana sine curve, iyo plethysmogram inopa rumwe ruzivo rwekuongorora kune chiremba.

Zvakanakira mudziyo ndezvokuti hazvikuvadzi kumunhu wese (hapana ionizing radiation), isiri-invasive (hapana chikonzero chekutora donhwe reropa kuti iongororwe), inotanga kushanda pamurwere nekukurumidza uye nyore, uye inogona kushanda nguva ichiripo, kurongazve sensor paminwe sezvinodiwa.

Zvisinei, chero ipi zvayo inonzi pulse oximeter uye pulse oximetry kazhinji ine zvisingabatsiri uye zvisingakwanisi izvo zvisingabvumiri kubudirira kushandiswa kweiyi nzira kune varwere vose.

Idzi dzinosanganisira:

1) Kutadza kweropa kuyerera kweropa

- kushaikwa kwekunhuhwirira kwakaiswa sensor: kuderera kweropa uye kuvhunduka, kudzoreredza, hypothermia uye chando chemaoko, atherosclerosis yemidziyo mumigumo, kudiwa kwekugara kweropa (BP) kuyerwa necuff yakasungirirwa paruoko; nezvimwewo - Pamusana pezvikonzero izvi zvose, kuputika kwemhepo uye chiratidzo pane sensor hazvina kunaka, kuyerwa kwakavimbika kwakaoma kana kusingakwanisi.

Kunyange zvazvo dzimwe nyanzvi dzepulse oximeter dzine 'Incorrect Signal' mode ('isu tinoyera zvatinowana, chokwadi hachina kuvimbiswa'), munyaya yekuderera kweropa uye pasina kubuda kweropa pasi pe sensor, tinogona kutarisa murwere kuburikidza neECG. uye capnography channels.

Nehurombo, kune vamwe varwere vakakomba mukurapa kwekukurumidzira vasingakwanise kushandisa pulse oximetry,

2) Nail” matambudziko mukugamuchira chiratidzo paminwe: isingadzimiki manicure pazvipikiri, yakakomba mbambo deformation ine fungal utachiona, zvigunwe zvidiki zvakanyanya muvana, nezvimwe.

Izvo zvakakosha zvakafanana: kusakwanisa kuwana chiratidzo chenguva dzose chemudziyo.

Dambudziko rinogona kugadziriswa: nekushandura sensor pamunwe 90 madhigirii, nekuisa iyo sensor munzvimbo dzisiri-yakajairwa, semuenzaniso pamuromo.

Muvana, kunyange vasati vasvika, zvinowanzogoneka kuwana chiratidzo chakagadzikana kubva kune munhu mukuru sensor akaiswa pachigunwe chikuru.

Special sensors yevana inongowanikwa yehunyanzvi pulse oximeters mune yakazara seti.

3) Kutsamira kweruzha uye kusadzivirirwa ku "ruzha

Kana murwere achifamba (kushanduka kwekuziva, psychomotor agitation, kufamba muchiroto, vana) kana kuzununguka panguva yekufambisa, sensor inogona kubviswa uye chiratidzo chisina kugadzikana chinogona kubudiswa, chinokonzera ma alarm.

Nyanzvi yekufambisa pulse oximeters yevanonunura vane yakakosha kuchengetedza algorithms inobvumira kupindira kwenguva pfupi kufuratirwa.

Iwo maratidziro akaverengerwa pamusoro pekupedzisira 8-10 masekonzi, iyo kupindira haina kufuratirwa uye haina kukanganisa kushanda.

Izvo zvisingabatsiri zveavhareji iyi ndeyekunonoka kwekuchinja kuverengwa kweiyo chaiyo shanduko yehama mumurwere (kunyangarika kwakajeka kwekupuruzira kubva pachiyero chekutanga che100, muchokwadi 100-> 0, icharatidzwa se 100-> 80 -> 60-> 40-> 0), izvi zvinofanirwa kuverengerwa panguva yekutarisa.

4) Matambudziko ane haemoglobin, latent hypoxia ine yakajairika SpO2 :

A) Kushaikwa kweHemoglobin (neanemia, haemodilution)

Panogona kuva nehemoglobin shoma mumuviri (anemia, haemodilution), pane nhengo uye tishu hypoxia, asi hemoglobin yose iripo inogona kunge yakazara neokisijeni, SpO 2 = 99 %.

Inofanira kuyeukwa kuti pulse oximeter hairatidzi okisijeni yose yeropa (CaO 2) uye okisijeni isina kunyungudutswa mu plasma (PO 2), kureva muzana ye hemoglobin yakazara neokisijeni (SpO 2).

Kunyange zvazvo, hongu, iyo huru yeokisijeni muropa ndeye hemoglobin, ndicho chikonzero pulse oximetry yakakosha uye yakakosha.

B) Mafomu Akakosha eHemoglobin (nechepfu)

Hemoglobin inosungirirwa kucarbon monoxide (HbCO) isimbi yakasimba, inogara kwenguva refu iyo pachokwadi haitakuri okisijeni, asi ine hunhu hwekunwa kwechiedza hwakafanana chaizvo nehwakajairika oxyhaemoglobin (HbO 2).

Pulse oximeters inogara ichivandudzwa, asi pari zvino, kusikwa kwezvisingadhuri zvema pulse oximeters zvinosiyanisa pakati peHbCO neHbO 2 inyaya yeramangwana.

Panyaya ye carbon monoxide poisoning panguva yemoto, murwere angave ane yakanyanya uye kunyange yakaoma hypoxia, asi nechiso chakaputika uye nhema dzeSpO 2 tsika dzenhema, izvi zvinofanira kuverengwa panguva yepulse oximetry muvarwere vakadaro.

Matambudziko akafanana anogona kuitika nemamwe marudzi edyshaemoglobinaemia, intravenous administration yeradiopaque agents uye dhayi.

5) Kuvhara hypoventilation neO2 inhalation

Murwere ane kuora mwoyo kwekuziva (stroke, kukuvara kwemusoro, chepfu, coma), kana achigamuchira inhaled O2 , nekuda kweokisijeni yakawandisa inogamuchirwa nechiito chimwe nechimwe chekufema (ichienzaniswa ne21% mumhepo yemhepo), inogona kuva nezviratidzo zvinowanzoitika kunyange pa5. -8 kufema paminiti.

Panguva imwecheteyo, kuwandisa kwekabhoni dioxide kuchaungana mumuviri (oxygen concentration panguva yeFiO 2 inhalation haina kukanganisa CO 2 kubvisa), kufema acidosis kuchawedzera, cerebral edema ichawedzera nekuda kwe hypercapnia uye zviratidzo pa pulse oximeter inogona kuwedzera. ivawo zvake.

Kuongororwa kwekliniki yekufema uye capnography yemurwere inodiwa.

6) Kusiyana pakati pezvinonzwisisika uye kurova kwemwoyo chaiko: kurova 'kunyarara'

Panyaya yehurombo hweperfusion yeperipheral, pamwe nekukanganisika kwemutsindo wemoyo (atrial fibrillation, extrasystole) nekuda kwekusiyana kwesimba rekupuruzira wave (pulse filling), 'silent' pulse beats inogona kufuratirwa nemudziyo uye isingafungidzirwe kana. kuverenga kurova kwemoyo (HR, PR).

Iyo chaiyo yemoyo (yekurova kwemoyo paECG kana panguva ye auscultation yemoyo) inogona kunge yakakwirira, iyi ndiyo inonzi. 'pulse deficit'.

Zvichienderana nealgorithm yemukati yemuenzaniso wemuchina uyu uye mutsauko wekuzadza pulse mumurwere uyu, kuwanda kwekushomeka kunogona kunge kwakasiyana uye kuchinja.

Muzviitiko zvakakodzera, panguva imwe chete ECG kutarisa inokurudzirwa.

Panogona kunge paine reverse situation, neinonzi. "dichrotic pulse": nekuda kwekuderera kwe vascular tone mumurwere uyu (nekuda kwehutachiona, nezvimwewo), imwe neimwe pulse wave pa plethysmogram graph inoonekwa seyakapetwa kaviri ("ine recoil"), uye chigadzirwa chiri pachiratidziro chinogona nhema. kaviri iyo PR tsika.

Zvinangwa zvepulse oximetry

1) Diagnostic, SpO 2 uye PR (PR) kuyerwa

2) Real-nguva yevarwere kutarisa

Chinangwa chekuongorora, semuenzaniso kuyerwa kweSpO 2 uye PR kwakakosha uye kuri pachena, ndosaka pulse oximeter yave kuwanikwa kwese, zvisinei, madiki ehomwe-saizi zvishandiso (zvakareruka 'saturation metres') hazvibvumire kutarisisa kwakajairwa, nyanzvi. mudziyo unodiwa kugara uchitarisa murwere.

Mhando dze pulse oximeter uye yakabatana michina

Mini wireless pulse oximeters (screen pamunwe sensor)
Nyanzvi monitors (sensor-waya-kesi dhizaini ine yakaparadzana skrini)
Pulse oximeter chiteshi mune multifunction monitor kana defibrillator
Mini Wireless Pulse Oximeters

Wireless pulse oximeters idiki kwazvo, iyo yekuratidzira uye yekudzora bhatani (inowanzo ingori imwe chete) inowanikwa pamusoro peiyo sensor imba, hapana waya kana makubatanidza.

Nekuda kwemutengo wakaderera uye compactness, michina yakadaro yava kushandiswa zvakanyanya.

Idzo dzakanakira chiyero chimwe chete chekuzara uye kurova kwemoyo, asi zvine zvipingamupinyi zvakakura uye zvakaipira pakushandiswa kwehunyanzvi uye kutarisa, semuenzaniso mumamiriro eiyo. amburenzi vashandi.

Advantages

Compact, haitore nzvimbo yakawanda muhomwe uye kuchengetedza
Zviri nyore kushandisa, hapana chikonzero chekuyeuka mirairo

payakaipira

Kusaona zvakanaka panguva yekutarisa: kana murwere ari pamubhedha, unofanirwa kugara uchiswedera kana kuzembera kumunwe ne sensor, yakachipa pulse oximeters ine monochrome skrini iyo yakaoma kuverenga kubva kure (zviri nani kutenga ruvara. imwe), iwe unofanirwa kuona kana kushandura mufananidzo wakatenderedzwa, maonero asiriwo echifananidzo chakadai seSpO 2 = 99 % pachinzvimbo che66%, PR=82 pachinzvimbo cheSpO 2 =82 inogona kuva nemhedzisiro ine njodzi.

Dambudziko rekutadza kuona zvakanaka haringatarisirwi.

Ikozvino hazvingambo itike kune chero munhu kuti aone firimu rekudzidzisa paTV nhema-ne-chena ine 2 ″ diagonal skrini: zvinyorwa zviri nani kunyudzwa neyakakura zvakakwana ruvara skrini.

Mufananidzo wakajeka kubva pakuratidzwa kwakajeka pamadziro emotokari yekununura, inoonekwa mune chero chiedza uye chero kure kure, inobvumira munhu kuti arege kutsauswa kubva kune mamwe mabasa anokosha pakushanda nemurwere mumamiriro ezvinhu akaoma.

Pane yakakura uye yakazara maficha mumenu: inogadziriswa alarm miganho kune yega yega parameter, pulse vhoriyamu uye maaramu, kufuratira chiratidzo chakashata, plethysmogram modhi, nezvimwewo, kana paine maaramu, anonzwika uye anovhiringidza nzira yese kana kudzima. zvese kamwe chete.

Mamwe anotengeswa kunze kwenyika zvakachipa pulse oximeters, zvichibva pane ruzivo rwekushandisa uye kuongororwa murabhoritari, hazvivimbise chokwadi chaicho.

Zvakakosha kuyera zvakanakira nezvayakaipira usati watenga, zvichienderana nezvinodiwa munharaunda yako.

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Iko kudikanwa kwekubvisa mabhatiri panguva yekugara kwenguva refu: kana iyo pulse oximeter ikashandiswa zvisingaite (semuenzaniso mu "on-demand" imba. rubatsiro rwekutanga kit), mabhatiri mukati memudziyo anodonhedza uye anokuvadza, mukuchengetedza kwenguva refu, mabhatiri anofanira kubviswa uye kuchengetwa pedyo, nepo plastiki isina kusimba yevhavha yebhatiri uye kuvhara kwayo haigoni kumira kuvharwa kwakadzokororwa nekuvhurwa kwekamuri.

Mune akati wandei mamodheru hapana mukana wekunze kwesimba rekupa, kudiwa kwekuve neseti yebhatiri padyo mhedzisiro yeizvi.

Kupfupisa: zvine musoro kushandisa isina waya pulse oximeter sechimbo chehomwe chekukurumidza kuongororwa, mikana yekutarisa ishoma, zvinogoneka chete kuita zviri nyore zvekutarisa padivi pemubhedha, semuenzaniso kutarisa kupuruzira panguva yekutonga kwe intravenous. beta-blocker.

Zvinokurudzirwa kuve neiyo pulse oximeter yevashandi veamburenzi sechipiri chekuchengetedza.

Nyanzvi yekutarisa pulse oximeters

Pulse oximeter yakadaro ine muviri wakakura uye inoratidzira, iyo sensor inoparadzaniswa uye inotsiviwa (mukuru, mwana), yakabatanidzwa kuburikidza netambo kune muviri wechigadzirwa.

A liquid crystal display uye/kana touchscreen (sezviri mu smartphone) pachinzvimbo chechinomwe-segment display (sezviri muwachi yemagetsi) iri kure nekugara ichidiwa uye yakakwana, hongu ndeyechimanjemanje uye inodhura, asi inoshivirira kuuraya utachiona. zvakaipisisa, zvingasapindura zvakajeka kumanikidziro emunwe mumagurovhosi ezvokurapa, zvinodya magetsi akawanda, hazvina kusimba kana zvakadonhedzwa, uye zvakanyanya kuwedzera mutengo wechigadzirwa.

Advantages

Kureruka uye kujeka kwekuratidzira: sensor pamunwe, mudziyo wakaiswa pamadziro pabhuraketi kana pamberi pemeso echiremba, mufananidzo wakakura uye wakajeka wakakwana, kukurumidza kuita sarudzo panguva yekutarisa.
Kushanda kwakakwana uye zvigadziriso zvepamberi, izvo zvandichakurukura zvakasiyana uye zvakadzama pazasi.
Kuyerwa kwechiyero
Kuvapo kwekunze kwemagetsi ekunze (12V uye 220V), zvinoreva mukana wemaawa makumi maviri nemana kushandiswa kusingapindirwe.
Kuvapo kwe sensor yemwana (inogona kunge iri sarudzo)
Kupokana ne disinfection
Kuvepo kwesevhisi, kuyedzwa uye kugadziriswa kwemidziyo yemumba

payakaipira

Zvishoma compact uye inotakurika
Inodhura (yakanaka pulse oximeters yerudzi urwu haina kudhura, kunyange zvazvo mutengo wavo wakaderera zvikuru kupfuura we cardiographs uye defibrillators, iyi inyanzvi yehutano yekuponesa hupenyu hwevarwere)
Kudiwa kwekudzidzisa vashandi uye kugona iyi modhi yechishandiso (zvinokurudzirwa kutarisa varwere vane pulse oximeter nyowani mu "zvese mumutsara" kuitira kuti hunyanzvi hugadzikane mune yakaoma chaizvo nyaya)

Kupfupisa: inyanzvi yekutarisa pulse oximeter inodiwa kune vese vanorwara zvakanyanya pabasa nekufambisa, nekuda kwekushanda kwayo kwepamberi, kazhinji inochengetedza nguva uye haidi kubatanidzwa kune akawanda-channel monitor, inogona zvakare. Inoshandiswa kune yakapusa saturation uye pulse diagnostic, asi yakaderera kune mini-pulse oximeters maererano nekusimba uye mutengo.

Takaparadzana, isu tinofanirwa kugara pane sarudzo yemhando yekuratidzira (skrini) yehunyanzvi pulse oximeter.

Zvingaita sekuti sarudzo iri pachena.

Sezvinongoita mafoni e-push-bhatani agara apihwa nzira kune emazuva ano mafoni ane touchscreen LED kuratidza, zvemazuva ano zvekurapa zvinofanirwa kunge zvakafanana.

Pulse oximeters ine chiratidziro muchimiro chezvikamu zvinomwe zvenhamba zviratidzo zvinoonekwa sezvisingashandi.

Zvisinei, maitiro anoita seanoratidza kuti mune zvakananga zvebasa rezvikwata zveamburenzi, shanduro yemudziyo ine LED inoratidzira ine zvipingamupinyi zvakakosha izvo munhu anofanira kuziva pakusarudza nekushanda nayo.

Izvo zvisingabatsiri zvemudziyo une LED kuratidza ndezvinotevera:

Fragility: mukuita, mudziyo une-segment-segment display inomira zviri nyore kudonha (semuenzaniso kubva pastretcher iri pasi), mudziyo une LED kuratidza - 'wakadonha, ukazotyoka'.
Yakashata yekubata skrini yekupindura kumanikidzwa uchipfeka magurovhosi: panguva yekubuda kweCCIDID-19, basa guru rine pulse oximeter riri pavarwere vane hutachiona uhu, vashandi vaive vakapfeka masutu ekudzivirira, magurovhosi ekurapa ari pamaoko avo, kazhinji kaviri kana kukora. A touchscreen LED inoratidzira yemamwe mamodheru yakapindura zvakashata kana zvisizvo kudzvanya zvidzoreso pachiratidziro neminwe mumagurovhosi akadaro, sezvo iyo touchscreen yakatanga kugadzirirwa kudzvanywa neminwe isina;
Kuona kona uye kushanda mumamiriro echiedza chakajeka: chiratidziro che LED chinofanira kunge chiri chemhando yepamusoro, chinofanirwa kuoneka muchiedza chezuva chakajeka (semuenzaniso kana vashandi vari kushanda pamahombekombe) uye pakona yeanoda kusvika '180 degrees', a. special light character inofanira kusarudzwa. Kudzidzira kunoratidza kuti iyo LED skrini haigaro kusangana nezvinodiwa izvi.
Kupokana nekuuraya hutachiona kwakasimba: ratidziro ye LED uye chishandiso chine rudzi urwu rwechidzitiro chinogona kusamira pakurapa 'zvakakomba' nemishonga inouraya utachiona;
Mutengo: iyo LED inoratidzira inodhura zvakanyanya, ichiwedzera zvakanyanya mutengo wechigadzirwa
Kuwedzera mashandisirwo emagetsi: iyo LED inoratidzira inoda simba rakawanda, zvinoreva kuti huremu uye mutengo nekuda kwebhatiri rine simba kana hupenyu hupfupi hwebhatiri, izvo zvinogona kugadzira matambudziko panguva yebasa rekukurumidzira panguva yeCOVID-19 denda (hapana nguva yekuchaja)
Kudzivirirwa kwakaderera: iyo LED inoratidzira uye mudziyo une skrini yakadaro haina kuchengetedzwa musevhisi, kutsiva kwechiratidziro kunodhura zvakanyanya, hazvigadzirike.

Nezvikonzero izvi, pabasa, vanunuri vazhinji chinyararire vanosarudza pulse oximeter ine 'classic' mhando yekuratidzira pane zvinomwe-zvikamu zvenhamba zviratidzo (sepaiyo yemagetsi wachi), zvisinei nekusashanda kwayo. Kuvimbika mu'hondo' kunoonekwa sechinhu chakakosha.

Sarudzo yemamita ekuzadza, saka, inofanirwa kuchinjirwa kune rumwe rutivi kune zvinodiwa zvinounzwa nenzvimbo, uye kune imwe kune izvo muponesi anozviona se 'kuita' maererano nemaitiro ake ezuva nezuva.