I-Capnography ekusebenzeni kwe-ventilatory: kungani sidinga i-capnograph?

By UCristiano Antonino On Mar 24, 2023

Ukungena komoya kufanele kwenziwe ngendlela efanele, ukuqapha okwanele kuyadingeka: i-capnographer idlala indima eqondile kulokhu.

I-capnograph ekungeneni komoya ngemishini yesiguli

Uma kunesidingo, ukungena komoya ngomshini esigabeni sangaphambi kwesibhedlela kumele kwenziwe ngendlela efanele nangokuqapha okuphelele.

Kubalulekile ukuthi ungagcini nje ngokuyisa isiguli esibhedlela, kodwa futhi nokuqinisekisa ukuthi kunamathuba amaningi okuthi silulame, noma okungenani singabhebhethekisi isimo sesiguli ngesikhathi sokuthutha nokunakekelwa.

Izinsuku zama-ventilators alula anezilungiselelo ezincane (i-frequency-volume) ziyinto yesikhathi esidlule.

Iningi leziguli ezidinga ukushaywa umoya ngokulungiswa lilondoloze ukuphefumula okuzenzakalelayo (i-bradypnoea kanye ne-hypoventilation), ephakathi 'kobubanzi' phakathi kwe-apnea ephelele nokuphefumula okuzenzakalelayo, lapho ukuhogela komoyampilo kwanele.

I-ALV (i-Adaptive lung ventilation) ngokuvamile kufanele ibe yi-normoventilation: i-hypoventilation kanye ne-hyperventilation kokubili kuyingozi.

Umphumela wokungena komoya okwanele ezigulini ezine-pathology enzima yobuchopho (ukushaywa unhlangothi, ukuhlukumezeka kwekhanda, njll.) kuyingozi kakhulu.

Isitha esifihliwe: i-hypocapnia ne-hypercapnia

Kuyaziwa ukuthi ukuphefumula (noma umoya omncane) kuyadingeka ukuze unikeze umzimba umoya-mpilo O2 futhi ukhiphe i-carbon dioxide CO2.

Ukulimala kokuntuleka komoya-mpilo kusobala: i-hypoxia nokulimala kobuchopho.

Ukweqile kwe-O2 kungalimaza i-epithelium yemigudu yomoya kanye ne-alveoli yamaphaphu, nokho, uma usebenzisa ukuhlushwa komoyampilo (i-FiO2) ka-50% noma ngaphansi, ngeke kube nomonakalo omkhulu ovela ku-'hyperoxygenation': umoya-mpilo ongaxutshiwe uzovele ususwe. ngokukhipha umoya.

Ukukhishwa kwe-CO2 akuncikile ekubunjweni kwengxube enikeziwe futhi kunqunywa inani elincane lokungenisa umoya i-MV (imvamisa, ivolumu ye-fx yamaza, i-Vt); lapho umoya ushubile noma ujula, i-CO2 iphuma kakhulu.

Ngokuntula umoya omncane ('hypoventilation') - i-bradypnoea/ukuphefumula okuphezulu esigulini ngokwaso noma ukungena komoya ngemishini 'kuntula' i-hypercapnia (i-CO2 eyeqile) ithuthuka emzimbeni, lapho kukhona ukwanda kwe-pathological kwemithambo yobuchopho, ukwanda kwe-intracranial ingcindezi, i-cerebral edema kanye nokulimala kwayo kwesibili.

Kepha ngokungena komoya ngokweqile (i-tachypnoea esigulini noma imingcele yokungena komoya ngokweqile), i-hypocapnia ibonakala emzimbeni, lapho kukhona ukuncishiswa kwemithambo yobuchopho nge-ischemia yezingxenye zayo, kanjalo nokulimala kobuchopho kwesibili, kanye ne-alkalosis yokuphefumula nayo iyanda. ubunzima besimo sesiguli. Ngakho-ke, ukungena komoya ngomshini akufanele kube 'i-anti-hypoxic' kuphela, kodwa futhi 'i-normocapnic'.

Kunezindlela zokubala ngokwethiyori imingcele yokungenisa umoya eyimishini, njengefomula kaDarbinyan (noma ezinye ezihambisanayo), kodwa ziyinkomba futhi zingase zinganaki isimo sangempela sesiguli, isibonelo.

Kungani i-pulse oximeter inganele

Yiqiniso, i-pulse oximetry ibalulekile futhi yakha isisekelo sokuqapha umoya wokuphefumula, kodwa ukuqapha kwe-SpO2 akwanele, kunezinkinga eziningi ezifihliwe, ukulinganiselwa noma izingozi, okungukuthi: Ezimweni ezichazwe, ukusetshenziswa kwe-pulse oximeter ngokuvamile kuba yinto engenakwenzeka. .

- Uma usebenzisa ukugxila kwe-oksijini ngaphezu kwe-30% (ngokuvamile i-FiO2 = 50% noma i-100% isetshenziswa nge-ventilation), imingcele ye-ventilation encishisiwe (isilinganiso nevolumu) ingase yanele ukugcina "i-normoxia" njengoba inani le-O2 elethwa ngesenzo sokuphefumula landa. Ngakho-ke, i-oximeter ye-pulse ngeke ibonise i-hypoventilation efihliwe nge-hypercapnia.

- I-pulse oximeter ayibonisi i-hyperventilation eyingozi nganoma iyiphi indlela, amanani angashintshi we-SpO2 we-99-100% aqinisekisa amanga udokotela.

- I-pulse oximeter kanye nezinkomba zokugcwala akusebenzi kakhulu, ngenxa yokuhlinzekwa kwe-O2 egazini elijikelezayo kanye nendawo efile ye-physiological yamaphaphu, kanye nangenxa yokulinganisa kokufunda ngokuhamba kwesikhathi ku-pulse oximeter evikelwe. i-pulse yokuthutha, uma kwenzeka isenzakalo esiphuthumayo (ukunqanyulwa kwesifunda, ukuntuleka kwemingcele ye-ventilation, njll) n.) Ukugcwaliswa akunciphi ngokushesha, kanti impendulo esheshayo evela kudokotela iyadingeka.

– I-pulse oximeter inikeza ukufundwa kwe-SpO2 okungalungile uma kwenzeka kuba nobuthi be-carbon monoxide (CO) ngenxa yokuthi ukumuncwa kokukhanya kwe-oxyhaemoglobin HbO2 ne-carboxyhaemoglobin HbCO kuyafana, ukuqapha kulokhu kulinganiselwe.

Ukusetshenziswa kwe-capnograph: i-capnometry ne-capnography

Izinketho ezengeziwe zokuqapha ezisindisa impilo yesiguli.

Ukwengezwa okubalulekile nokubalulekile ekulawulweni kokwanela kokuphefumula kwemishini ukulinganisa okuqhubekayo kokuhlushwa kwe-CO2 (EtCO2) emoyeni okhishwa umoya (i-capnometry) kanye nokumelela okucacile komjikelezo we-CO2 excretion (i-capnography).

Izinzuzo ze-capnometry yilezi:

- Izinkomba ezicacile kunoma yisiphi isimo se-haemodynamic, ngisho nangesikhathi se-CPR (ekucindezelweni kwegazi okubucayi, ukuqapha kwenziwa ngeziteshi ezimbili: i-ECG ne-EtCO2)

– Ukushintsha ngokushesha izinkomba zanoma yiziphi izehlakalo nokuchezuka, isb. lapho isifunda sokuphefumula sinqanyulwa

- Ukuhlolwa kwesimo sokuqala sokuphefumula esigulini esifakwe intuba

- Ukubukwa kwesikhathi sangempela kwe-hypo- kanye ne-hyperventilation

Ezinye izici ze-capnography ziningi: ukuvinjelwa kwendlela yokuphefumula kuboniswa, imizamo yesiguli yokuphefumula ngokuzenzakalelayo nesidingo sokujulisa i-anesthesia, i-oscillations yenhliziyo eshadini nge-tachyarrhythmia, ukunyuka okungenzeka kokushisa komzimba ngokunyuka kwe-EtCO2 nokunye okuningi.

Izinjongo eziyinhloko zokusebenzisa i-capnograph esigabeni sangaphambi kwesibhedlela

Ukuqapha impumelelo ye-tracheal intubation, ikakhulukazi ezimweni zomsindo nobunzima be-auscultation: uhlelo olujwayelekile lwe-cyclic CO2 excretion ene-amplitude enhle ngeke lusebenze uma ithubhu ifakwe emgodleni (noma kunjalo, i-auscultation iyadingeka ukuze kulawulwe ukungena komoya kokubili. amaphaphu)

Ukuqapha ukubuyiselwa kokujikeleza okuzenzakalelayo ngesikhathi se-CPR: i-metabolism kanye nokukhiqizwa kwe-CO2 kwanda kakhulu entweni 'evuselelwe', kuvela 'ukweqa' ku-capnogram futhi ukubonwa akubi kubi ngokucindezelwa kwenhliziyo (ngokungafani nesiginali ye-ECG)

Ukulawulwa okujwayelekile kokungena komoya ngomshini, ikakhulukazi ezigulini ezinokulimala kobuchopho (ukushaywa unhlangothi, ukulimala ekhanda, ukudlikizeka, njll.)

Ukulinganisa "ekugelezeni okuyinhloko" (MAINSTREAM) kanye "ekugelezeni kwe-lateral" (SIDESTREAM).

Ama-Capnographs ayizinhlobo ezimbili zobuchwepheshe, lapho kukalwa i-EtCO2 'emfudlaneni oyinhloko' i-adaptha emfushane enezimbobo eziseceleni ibekwa phakathi kweshubhu le-endotracheal kanye nesekhethi, inzwa emise okwe-U ibekwa kuyo, igesi edlulayo iyaskeniwa futhi kunqunywe. I-EtCO2 iyalinganiswa.

Lapho kulinganiswa 'ngokugeleza kwe-lateral', ingxenye encane yegesi ithathwa kusekethe ngembobo ekhethekile kusekethe nge-compressor yokumunca, idliswa ngeshubhu elincanyana lingene emzimbeni we-capnograph, lapho i-EtCO2 ikalwa khona.

Kunezici ezimbalwa ezithonya ukunemba kwesilinganiso, njengokugxila kwe-O2 kanye nomswakama engxubeni kanye nezinga lokushisa lokulinganisa. Inzwa kufanele ishiswe ngaphambili futhi ilinganiswe.

Ngalo mqondo, ukukalwa komfula oseceleni kubonakala kunembe kakhulu, njengoba kunciphisa umthelela walezi zici ezihlanekezelayo ekusebenzeni, nokho.

Ukuphatheka, izinguqulo ezi-4 ze-capnograph:

njengengxenye yemonitha eseceleni kombhede
njengengxenye yemisebenzi eminingi i-defibrillator
i-mini-nozzle kusekethe ('idivayisi ikunzwa, akukho ntambo')
idivayisi yephaketheni ephathekayo ('inzwa yomzimba + ocingweni').

Ngokujwayelekile, uma kukhulunywa nge-capnography, isiteshi sokuqapha i-EtCO2 siqondwa njengengxenye yokuqapha 'eceleni kombhede' esebenza ngezindlela eziningi; ku-ICU, ilungiswa unomphela ku- imishini ishalofu.

Nakuba i-monitor stand isuseka futhi i-capnograph monitor inikwa amandla yibhethri eyakhelwe ngaphakathi, kusenzima ukuyisebenzisa lapho uthuthela efulethini noma phakathi kwemoto yokuhlenga kanye neyunithi yokunakekela kakhulu, ngenxa yesisindo nosayizi we ukuqapha icala kanye nokungenakwenzeka kokulinamathisela esigulini noma ku-stretcher engenamanzi, lapho ukuthutha okuvela efulethini kwenziwa ngokuyinhloko.

Kudingeka ithuluzi eliphatheka kakhudlwana.

Izinkinga ezifanayo zihlangatshezwana nazo lapho kusetshenziswa i-capnograph njengengxenye ye-multifunctional defibrillator: ngeshwa, cishe zonke zisenosayizi omkhulu nesisindo, futhi empeleni azivumeli, isibonelo, idivayisi enjalo ukuba ibekwe ngokunethezeka endaweni engangeni manzi. uhlaka eduze kwesiguli lapho wehla ngezitebhisi usuka esitezi esiphezulu; ngisho nangesikhathi sokusebenza, ukudideka kuvame ukwenzeka ngenani elikhulu lezintambo kudivayisi.