Indlela yokukhetha nokusebenzisa i-pulse oximeter?

By UCristiano Antonino On Mar 21, 2023

Ngaphambi kobhubhani we-COVID-19, ipulse oximeter (okanye imitha yokugcwalisa) yayisetyenziswa kuphela ngamaqela e-ambulensi, ii-resuscitators kunye neepulmonologists.

Ukusasazeka kwe-coronavirus kunyuse ukuthandwa kwesi sixhobo sonyango, kunye nolwazi lwabantu ngomsebenzi waso.

Phantse zisoloko zisetyenziswa 'njengemitha yokugcwalisa', nangona eneneni zinokuxela okuninzi ngakumbi.

Enyanisweni, izakhono ze-oximeter ye-pulse professional azikhawulelwanga kule nto: ezandleni zomntu onamava, esi sixhobo sinokucombulula iingxaki ezininzi.

Okokuqala, makhe sikhumbule ukuba i-pulse oximeter ilinganisa kwaye ibonisa ntoni

I-'clip' emile inzwa ibekwe (ngokuqhelekileyo) kumnwe wesigulane, kwi-sensor i-LED kwisiqingatha somzimba ikhupha ukukhanya, enye i-LED kwesinye isiqingatha ifumana.

Umnwe wesigulane ukhanyiswa ngokukhanya kwee-wavelengths ezimbini ezahlukeneyo (obomvu kunye ne-infrared), ezifunxwa okanye zihanjiswe ngokwahlukileyo nge-hemoglobin ene-oksijini 'kuyo ngokwayo' (HbO 2), kunye ne-hemoglobin yamahhala engena-oksijini (Hb).

Ukufunxa kuqikelelwa ngexesha le-pulse wave kwi-arterioles encinci yomnwe, ngaloo ndlela ibonisa isalathisi se-hemoglobin saturation nge-oxygen; njengepesenti ye-hemoglobin epheleleyo (i-saturation, i-SpO 2 = ..%) kunye nesantya se-pulse (izinga le-pulse, PR).

Isiqhelo kumntu ophilileyo ngu-Sp * O 2 = 96 - 99%.

• Uzaliso kwi-pulse oximeter yonyulwa njenge-Sp kuba 'i-pulsatile', i-peripheral; (kwi-microarteries) ilinganiswa nge-pulse oximeter. Iimvavanyo zeLebhu ze-haemogasanalysis nazo zilinganisa ukugcwala kwegazi kwi-arterial (SaO 2) kunye nokugcwala kwegazi kwi-venous (SvO 2).

Kumboniso we-pulse oximeter yeemodeli ezininzi, kuyenzeka kwakhona ukujonga umboniso wexesha lokwenyani lokuzaliswa (ukusuka kwi-pulse wave) yethishu ephantsi kwenzwa, ebizwa ngokuba yi-plethysmogram - ngendlela 'yebha. ' okanye i-sine curve, i-plethysmogram inikeza ulwazi olongezelelweyo lokuxilonga kugqirha.

Iingenelo zesixhobo kukuba ayinabungozi kuye wonke umntu (akukho imitha ye-ionizing), i-non-invasive (akukho mfuneko yokuthatha ithontsi legazi ukuhlalutya), iqala ukusebenza kwisigulane ngokukhawuleza kwaye kulula, kwaye inokusebenza ubusuku nemini, Ukulungisa kwakhona inzwa kwiminwe njengoko kufuneka.

Nangona kunjalo, nayiphi na i-pulse oximeter kunye ne-pulse oximetry ngokubanzi inezinto ezingalunganga kunye nezithintelo ezingavumeli ukusetyenziswa ngempumelelo kwale ndlela kuzo zonke izigulane.

Ezi ziquka:

1) Ukungahambi kakuhle kwegazi kwi-peripheral

- ukungabikho kwe-perfusion apho i-sensor ifakwe khona: uxinzelelo lwegazi oluphantsi kunye nokothuka, ukuvuselela, i-hypothermia kunye ne-frostbite yezandla, i-atherosclerosis yemikhumbi emaphethelweni, imfuneko yokulinganisa uxinzelelo lwegazi rhoqo (BP) kunye ne-cuff ibanjwe engalweni; njl - Ngenxa yazo zonke ezi zizathu, i-pulse wave kunye nesignali kwi-sensor impofu, ukulinganisa okuthembekileyo kunzima okanye akunakwenzeka.

Nangona ezinye ii-oximeters ze-pulse professional zinemodi 'yeSignali engalunganga' ('silinganisa into esiyifumanayo, ukuchaneka akuqinisekwanga'), kwimeko yoxinzelelo lwegazi oluphantsi kwaye akukho ukuhamba kwegazi okuqhelekileyo phantsi kwenzwa, sinokubeka iliso kwisigulane nge-ECG. kunye namajelo e-capnography.

Ngelishwa, kukho izigulana ezibalulekileyo kwiyeza likaxakeka ezingakwazi ukusebenzisa i-pulse oximetry,

2) Iingxaki zesikhonkwane ekufumaneni umqondiso kwiminwe: i-manicure engacimekiyo kwizikhonkwane, i-deformation enzima yezikhonkwane ezinosulelo lomngundo, iminwe emincinci kubantwana, njl.

Ingundoqo iyafana: ukungakwazi ukufumana isignali eqhelekileyo kwisixhobo.

Ingxaki ingasonjululwa: ngokuguqula inzwa kumnwe ngamadigri angama-90, ngokufaka inzwa kwiindawo ezingekho mgangathweni, umzekelo, kwincam.

Ebantwaneni, kwanabo bangaphambi kwexesha, ngokuqhelekileyo kunokwenzeka ukuba bafumane isignali ezinzileyo kwinzwa yabantu abadala ebekwe kwinzwane enkulu.

Izinzwa ezikhethekileyo zabantwana zifumaneka kuphela kwii-oximeters ze-pulse professional kwisethi epheleleyo.

3) Ukuxhomekeka kwengxolo kunye nokungakhuseleki "kwingxolo

Xa isigulane sihamba (ukuguqulwa kwengqondo, ukuphazamiseka kwengqondo, ukunyakaza ephupheni, abantwana) okanye ukugubha ngexesha lokuthutha, inzwa inokukhutshwa kwaye isignali engazinzanga inokuveliswa, ibangele i-alamu.

I-oximeter yezothutho ze-pulse oximeters yabahlanguli bane-algorithms yokukhusela ekhethekileyo evumela ukuphazamiseka kwexesha elifutshane ukuba kungahoywa.

Iimpawu zilinganiselwe kwimizuzwana eyi-8-10 yokugqibela, ukuphazamiseka akunakwa kwaye akuchaphazeli ukusebenza.

Ukungalungi kwalo myinge ukulibaziseka okuthile ekutshintsheni ukufundwa kwenguqu yokwenene yesihlobo kwisigulane (ukunyamalala okucacileyo kwe-pulse ukusuka kwinqanaba lokuqala le-100, ngokwenene i-100-> 0, iya kuboniswa njenge-100-> 80 -> 60->40->0), oku kufuneka kuthathelwe ingqalelo ngexesha lokubeka iliso.

4) Iingxaki nge- haemoglobin, i-latent hypoxia ene-SpO2 eqhelekileyo:

A) Ukunqongophala kweHemoglobin (kunye ne-anemia, i-haemodilution)

Kusenokubakho i-hemoglobin encinci emzimbeni (i-anemia, i-haemodilution), kukho i-organ kunye ne-tissue hypoxia, kodwa yonke i-hemoglobin ekhoyo inokuthi izaliswe yi-oksijini, i-SpO 2 = 99 %.

Kufuneka kukhunjulwe ukuba i-pulse oximeter ayibonisi yonke i-oxygen content yegazi (CaO 2) kunye ne-oksijini engapheliyo kwi-plasma (PO 2), oko kukuthi ipesenti ye-hemoglobin egcwele i-oksijeni (SpO 2).

Nangona, ngokuqinisekileyo, uhlobo oluphambili lwe-oksijini egazini yi-hemoglobin, yiyo loo nto i-pulse oximetry ibaluleke kakhulu kwaye ibalulekile.

B) Iintlobo ezikhethekileyo zeHemoglobin (ngetyhefu)

I-Hemoglobin ebotshelelwe kwi-carbon monoxide (HbCO) yinto eyomeleleyo, ehlala ixesha elide ukuba ngokwenene ayithwali i-oksijini, kodwa ineempawu zokufunxa ukukhanya ezifana kakhulu ne-oxyhaemoglobin eqhelekileyo (HbO 2).

Ii-oximeters ze-Pulse zihlala ziphuculwa, kodwa okwangoku, ukudalwa kwee-oximeters ze-pulse ezingabizi kakhulu ezahlula phakathi kwe-HbCO kunye ne-HbO 2 yinto yexesha elizayo.

Kwimeko ye-carbon monoxide poisoning ngexesha lomlilo, isigulane sinokuba ne-hypoxia enzima kunye neyona nto ibalulekileyo, kodwa ngobuso obuhlanjululweyo kunye nemilinganiselo yobuxoki eqhelekileyo ye-SpO 2, oku kufuneka kuthathelwe ingqalelo ngexesha le-pulse oximetry kwizigulane ezinjalo.

Iingxaki ezifanayo zinokuthi zenzeke kunye nezinye iintlobo ze-dyshaemoglobinaemia, ukulawulwa kwe-intravenous ye-radiopaque agents kunye nedayi.

5) Gubungela i-hypoventilation kunye ne-O2 inhalation

Isigulane esinoxinzelelo lwengqondo (i-stroke, ukulimala kwentloko, i-poisoning, i-coma), ukuba ifumana i-O2 i-inhaled, ngenxa ye-oksijini engaphezulu efunyenwe ngesenzo ngasinye sokuphefumula (xa kuthelekiswa ne-21% emoyeni we-atmospheric), ingaba nezibonakaliso eziqhelekileyo zokuzalisa nakwi-5. -8 ukuphefumla ngomzuzu.

Ngelo xesha, ukugqithisa kwe-carbon dioxide kuya kuqokelela emzimbeni (i-oksijeni ye-oksijeni ngexesha le-FiO 2 inhalation ayichaphazeli ukususwa kwe-CO 2), i-acidosis yokuphefumula iya kwanda, i-cerebral edema iya kwanda ngenxa ye-hypercapnia kunye nezalathi kwi-pulse oximeter. ibe yesiqhelo.

Uvavanyo lweklinikhi lokuphefumla kunye ne-capnography yesigulana iyafuneka.

6) Umahluko phakathi kokubonwayo kunye nesantya sentliziyo sangempela: ukubetha 'kuthe cwaka'

Kwimeko yokuphazamiseka kwe-peripheral peripheral, kunye nokuphazamiseka kwesigqi sentliziyo (i-fibrillation ye-atrial, i-extrasystole) ngenxa yomahluko kumandla we-pulse wave (ukuzaliswa kwe-pulse), ukubetha kwe-pulse 'kuthe cwaka' kunokungahoywa sisixhobo kwaye akuthathelwa ngqalelo xa ukubala ukubetha kwentliziyo (HR, PR).

Isantya senhliziyo sangempela (izinga lentliziyo kwi-ECG okanye ngexesha le-auscultation of heart) linokuba liphezulu, oku kubizwa ngokuba. 'i-pulse deficit'.

Ngokuxhomekeke kwi-algorithm yangaphakathi yale modeli yesixhobo kunye nokwahlukana kokuzaliswa kwe-pulse kwesi sigulana, ubungakanani bentsilelo bunokwahluka kwaye butshintshe.

Kwiimeko ezifanelekileyo, ukujongwa kwe-ECG ngaxeshanye kuyacetyiswa.

Kunokubakho imeko eguqukayo, kunye nento ebizwa. "i-dichrotic pulse": ngenxa yokuncipha kwethoni ye-vascular kwesi sigulana (ngenxa yosulelo, njl.), i-pulse wave nganye kwigrafu ye-plethysmogram ibonakala iphindwe kabini ("nge-recoil"), kunye nesixhobo esikumboniso sinokuxoka. kabini amaxabiso ePR.

Iinjongo ze-pulse oximetry

1) Ukuxilongwa, i-SpO 2 kunye ne-PR (PR) yokulinganisa

2) Ukujongwa kwesigulane ngexesha langempela

Injongo yokuxilonga, umz. umlinganiselo we-SpO 2 kunye ne-PR ngokuqinisekileyo ibalulekile kwaye icacile, yiyo loo nto i-pulse oximeters ngoku ifumaneka kuyo yonke indawo, nangona kunjalo, izixhobo ezincinci zepokotho (i-'saturation metres elula) ayivumeli ukubeka iliso okuqhelekileyo, ingcali. isixhobo siyafuneka ukuba sihlale sibeke iliso kwisigulana.

Iintlobo ze-pulse oximeter kunye nezixhobo ezinxulumene nazo

I-Mini wireless pulse oximeters (isikrini kwisivamvo somnwe)
Iimonitha zobuchwephesha (uyilo lwe-sensor-wire-case enescreen esahlukileyo)
I-Pulse oximeter channel kwi-monitor ye-multifunction okanye defibrillator
Mini Wireless Pulse Oximeters

I-oximeters ye-pulse engenazintambo incinci kakhulu, iqhosha lokubonisa kunye nokulawula (ngokuqhelekileyo kukho enye kuphela) ibekwe phezulu kwi-sensor yezindlu, akukho cingo okanye ukudibanisa.

Ngenxa yexabiso eliphantsi kunye nokudibana kwazo, ezo zixhobo ngoku zisetyenziswa ngokubanzi.

Ngokwenene zikulungele umlinganiselo wexesha elinye lokugcwala kunye nesantya sentliziyo, kodwa zinemida ebonakalayo kunye nezingeloncedo kusetyenziso lobuchwephesha kunye nokubeka iliso, umz. kwiimeko iigulane abasebenzi.

eziluncedo

I-Compact, ayithathi indawo eninzi kwiipokotho kunye nokugcinwa
Kulula ukuyisebenzisa, akukho mfuneko yokukhumbula imiyalelo

nezingeloncedo

Umbono ongemhle ngexesha lokubeka iliso: xa isigulana sikwi-stretcher, kufuneka uhlale usondela okanye ungqiyame ngomnwe ngenzwa, i-pulse oximeters eshibhile inescreen se-monochrome ekunzima ukusifunda ukude (kungcono ukuthenga umbala. enye), kufuneka ubone okanye utshintshe umfanekiso oguqulweyo, imbono engafanelekanga yomfanekiso onjenge-SpO 2 = 99 % endaweni ye-66%, PR = 82 endaweni ye-SpO 2 = 82 ingaba nemiphumo eyingozi.

Ingxaki yokungaboni kakuhle ayinakujongelwa phantsi.

Ngoku akunakuze kwenzeke nakubani na ukuba abukele ifilimu yoqeqesho kumabonakude omnyama namhlophe one-2 ″ diagonal screen: imathiriyeli ifunxwa ngcono sisikrini sombala esikhulu ngokwaneleyo.

Umfanekiso ocacileyo ovela kumboniso oqaqambileyo eludongeni lwesithuthi sokuhlangula, esibonakalayo nakuphi na ukukhanya kunye nakuphi na umgama, uvumela umntu ukuba angaphazamiseki kwimisebenzi ebaluleke kakhulu xa esebenza nesigulane kwimeko enzima.

Kukho iimpawu ezibanzi kunye nezibanzi kwimenyu: imida ye-alamu ehlengahlengiswayo kwipharamitha nganye, umthamo we-pulse kunye nee-alamu, ukungahoywa kwesignali embi, imodi ye-plethysmogram, njl., ukuba kukho ii-alamu, ziya kuvakala kwaye ziphazamise yonke indlela okanye zicime. zonke ngaxeshanye.

Ezinye ze-pulse oximeters ezithengwa kumazwe angaphandle, ezisekwe kumava okusetyenziswa kunye novavanyo lwaselabhoratri, aziqinisekisi ukuchaneka kokwenyani.

Kubalulekile ukulinganisa i-pros and cons phambi kokuthenga, ngokusekelwe kwiimfuno zendawo yakho.

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Isidingo sokususa iibhetri ngexesha lokugcinwa kwexesha elide: ukuba i-pulse oximeter isetyenziswa rhoqo (umz. kwikhaya 'elifunwayo' Uncedo yokuqala ikhithi), iibhetri ezingaphakathi kwesixhobo ziyavuza kwaye zonakalise, kwindawo yokugcina ixesha elide, iibhetri kufuneka zisuswe kwaye zigcinwe kufutshane, ngelixa iplastiki eethe-ethe yesigqubuthelo sebhetri kunye nokutshixa kwayo kungenakukwazi ukumelana nokuvalwa okuphindaphindiweyo kunye nokuvulwa kwekhompatimenti.

Kwinani leemodeli akukho nto inokwenzeka yokunikezelwa kwamandla angaphandle, isidingo sokuba neseti esecaleni yeebhetri ezikufutshane sisiphumo soku.

Ukushwankathela: kusengqiqweni ukusebenzisa i-oximeter yepulse engenazingcingo njengesixhobo sepokotho soxilongo olukhawulezileyo, amathuba okubeka esweni anqongophele kakhulu, kunokwenzeka kuphela ukwenza uhlolo olulula ecaleni kwebhedi, umz. ukujonga ukubetha kwentliziyo ngexesha lolawulo lwemithambo i-beta-blocker.

Kuyacetyiswa ukuba ube ne-pulse oximeter enjalo kubasebenzi be-ambulensi njenge-backup yesibini.

Ukubeka iliso kwi-pulse oximeters yobungcali

I-oximeter enjalo ye-pulse inomzimba omkhulu kunye nomboniso, inzwa iyahlukana kwaye ithathe indawo (umdala, umntwana), exhunywe ngekhebula kumzimba wesixhobo.

Umboniso wekristale yolwelo kunye / okanye isikrini esichukumisayo (njengakwi-smartphone) endaweni yesibonisi samacandelo asixhenxe (njengakwiwotshi ye-elektroniki) akusoloko kuyimfuneko kwaye ilungile, ngokuqinisekileyo yeyanamhlanje kwaye iyasebenza, kodwa iyakunyamezela ukubulala iintsholongwane. okubi kakhulu, kunokungaphenduli ngokucacileyo kwingcinezelo yeminwe kwiiglavu zonyango, idla umbane ongaphezulu, i-ethe-ethe xa iwa, kwaye inyusa kakhulu ixabiso lesixhobo.

eziluncedo

Ukulungeleka kunye nokucaca kokubonisa: inzwa emnweni, isixhobo esifakwe eludongeni kwisibiyeli okanye phambi kwamehlo kagqirha, umfanekiso omkhulu ngokwaneleyo kwaye ocacileyo, ukwenza izigqibo ngokukhawuleza ngexesha lokubeka iliso.
Ukusebenza okubanzi kunye noseto oluphambili, endiya kuxoxa ngalo ngokwahlukileyo nangeenkcukacha ezingezantsi.
Ukulinganisa ngokuchanekileyo
Ubukho bonikezelo lwamandla lwangaphandle (12V kunye ne-220V), oku kuthetha ukuba kunokwenzeka ukusetyenziswa kweeyure ezingama-24 ngaphandle kokuphazanyiswa.
Ubukho benzwa yomntwana (inokuba lukhetho)
Ukumelana nokubulala iintsholongwane
Ubukho benkonzo, uvavanyo kunye nokulungiswa kwezixhobo zasekhaya

nezingeloncedo

Incinci kwaye iyaphatheka
Iyabiza (i-pulse oximeters elungileyo yolu hlobo ayibizi, nangona ixabiso labo liphantsi kakhulu kunelo le-cardiographs kunye ne-defibrillators, le yindlela yobuchwephesha yokusindisa ubomi bezigulane)
Isidingo sokuqeqesha abasebenzi kunye nokulawula lo mzekelo wesixhobo (kuyacetyiswa ukuba ubeke iliso kwizigulane ezine-pulse oximeter entsha "konke ngokulandelelana" ukwenzela ukuba izakhono zizinzile kwimeko enzima ngokwenene)

Ukushwankathela: i-oximeter yokuhlola i-pulse oximeter ngokuqinisekileyo iyimfuneko kuzo zonke izigulana ezigula kakhulu emsebenzini kunye nokuthutha, ngenxa yokusebenza kwayo okuphezulu, kwiimeko ezininzi igcina ixesha kwaye ayifuni ukuqhagamshelwa kwi-monitor ye-multi-channel, iyakwazi isetyenziselwa ukugcwala okulula kunye nokuxilongwa kwe-pulse, kodwa ingaphantsi kwe-mini-pulse oximeters ngokuhambelana kunye nexabiso.

Ngokwahlukileyo, kufuneka sihlale kukhetho lohlobo lokubonisa (isikrini) se-oximeter ye-pulse professional.

Kuya kubonakala ngathi ukhetho lucacile.

Kanye njengokuba iifowuni ezicinezelayo kudala zinikwe indlela kwii-smartphones zanamhlanje ezinescreen se-LED, izixhobo zonyango zanamhlanje kufuneka zifane.

Ii-oximeters ze-Pulse kunye nomboniso ngendlela yezibonakaliso zamanani amacandelo asixhenxe zibhekwa njengento engapheliyo.

Nangona kunjalo, uqheliselo lubonakala lubonisa ukuba kwiinkcukacha zomsebenzi wamaqela e-ambulensi, inguqu yesixhobo esinesiboniso se-LED sinemiqobo ebalulekileyo ekufuneka umntu ayiqaphele xa ekhetha kwaye esebenza nayo.

Ukungalungi kwesixhobo esinomboniso we-LED zezi zilandelayo:

Ubuqhophololo: ekusebenzeni, isixhobo esinamacandelo asixhenxe simelana ngokulula ukuwa (umzekelo ukusuka kwi-stretcher ephantsi), isixhobo esinomboniso we-LED - 'sawa, saza saphuka'.
Ukusabela kakubi kwesikrini sokuchukumisa kuxinzelelo ngelixa unxibe iigloves: ngexesha lokuqhambuka kwe-COVID-19, owona msebenzi uphambili nge-pulse oximeter ikuzigulane ezinolusulelo, abasebenzi babenxibe iisuti zokuzikhusela, iigloves zonyango zisezandleni zabo, zihlala ziphindwe kabini okanye zijiyile. Umboniso we-LED wesikrini sezinye iimodeli ziphendule kakubi okanye ngokungalunganga ngokucinezela izilawuli kwisikrini ngeminwe kwiiglavu ezinjalo, njengoko isikrini sokuthintela ekuqaleni senzelwe ukucinezelwa ngeminwe engenanto;
Ukujonga i-angle kunye nokusebenza kwiimeko zokukhanya okuqaqambileyo: isibonisi se-LED kufuneka sibe sesona siphezulu somgangatho, kufuneka sibonakale ekukhanyeni kwelanga okuqaqambileyo (umz. xa abasebenzi besebenza elunxwemeni) kunye ne-engile ephantse ibe yi-'180 degrees', a uphawu olukhethekileyo kufuneka lukhethwe. Ukuziqhelanisa kubonisa ukuba isikrini se-LED asisoloko sihlangabezana nezi mfuno.
Ukumelana nokubulawa kweentsholongwane okumandla: isibonisi se-LED kunye nesixhobo esinolu hlobo lwesikrini sinokungamelani nonyango 'olunzulu' ngezibulali-ntsholongwane;
Iindleko: umboniso we-LED ubiza kakhulu, ukwandisa kakhulu ixabiso lesixhobo
Ukusetyenziswa kwamandla okongeziweyo: isiboniso se-LED sifuna amandla amaninzi, okuthetha ukuba ubunzima obuninzi kunye nexabiso ngenxa yebhetri enamandla ngakumbi okanye ubomi obufutshane bebhetri, obunokudala iingxaki ngexesha lomsebenzi kaxakeka ngexesha le-COVID-19 bhubhane (akukho xesha lokuhlawulisa)
Ukugcinwa okuphantsi: umboniso we-LED kunye nesixhobo esineskrini esinjalo asigcinwanga kangako kwinkonzo, ukutshintshwa kwesiboniso kubiza kakhulu, ngokuqinisekileyo akulungiswanga.

Ngenxa yezi zizathu, emsebenzini, abahlanguli abaninzi ngokuzolileyo bakhetha i-pulse oximeter kunye nohlobo lwe-'classic' yokubonisa kumanani amacandelo asixhenxe (njengakwiwotshi ye-elektroniki), nangona kubonakala ukuba iphelelwe lixesha. Ukuthembeka 'kwidabi' kuthathwa njengento ephambili.

Ukukhethwa kwemitha yokulinganisa, ngoko ke, kufuneka ilungelelaniswe kwelinye icala kwiimfuno ezinikezelwe ngummandla, kwaye kwelinye ukuba yintoni umhlanguli acinga ukuba 'uyenza' ngokumalunga nokusebenza kwakhe kwemihla ngemihla.