Ungakhetha kanjani futhi usebenzise i-pulse oximeter?

By UCristiano Antonino On Mar 21, 2023

Ngaphambi kobhubhane lwe-COVID-19, i-pulse oximeter (noma imitha yokugcwala) yayisetshenziswa kabanzi kuphela ngamaqembu ama-ambulensi, ama-resuscitators kanye nama-pulmonologists.

Ukusabalala kwe-coronavirus kukhuphule ukuthandwa kwale divayisi yezokwelapha, kanye nolwazi lwabantu ngomsebenzi wayo.

Cishe ngaso sonke isikhathi asetshenziswa 'njengamamitha okugcwalisa', nakuba empeleni angasho okuningi.

Eqinisweni, amakhono ochwepheshe be-pulse oximeter awagcini kulokhu: ezandleni zomuntu onolwazi, le divayisi ingaxazulula izinkinga eziningi.

Okokuqala, ake sikhumbule ukuthi i-pulse oximeter ikala futhi iboniswa kanjani

Inzwa enomumo othi 'clip' ibekwa (imvamisa) emunweni wesiguli, kusizwa i-LED engxenyeni eyodwa yomzimba ikhipha ukukhanya, enye i-LED ngakolunye uhhafu ithola.

Umunwe wesiguli ukhanyiswa ngokukhanya kwamaza amaza amabili ahlukene (obomvu ne-infrared), adonswa noma adluliselwe ngokuhlukile nge-hemoglobin equkethe umoya-mpilo 'kuyona' (HbO 2), kanye ne-hemoglobin yamahhala engenawo umoya-mpilo (Hb).

Ukumuncwa kulinganiselwa ngesikhathi se-pulse wave kuma-arterioles amancane omunwe, ngaleyo ndlela kukhombisa inkomba yokugcwala kwe-hemoglobin nge-oxygen; njengephesenti le-hemoglobin ephelele (i-saturation, i-SpO 2 = ..%) kanye nesilinganiso sokushaya kwenhliziyo (isilinganiso sokushaya kwenhliziyo, i-PR).

Okujwayelekile kumuntu ophile kahle yi-Sp * O 2 = 96 – 99 %.

* Ukugcwala kwendawo ku-oximeter ye-pulse kuqokwe njengo-Sp ngenxa yokuthi 'i-pulsatile', i-peripheral; (kuma-microarteries) ikalwa nge-pulse oximeter. Ukuhlolwa kwaselabhorethri kwe-hemogasanalysis nakho kukala ukugcwala kwegazi kwe-arterial (SaO 2) kanye nokugcwala kwegazi kwe-venous (SvO 2).

Ekubonisweni kwe-pulse oximeter yamamodeli amaningi, kungenzeka futhi ukubuka ukumelwa kwesithombe sesikhathi sangempela sokugcwaliswa (kusuka kugagasi lokushaya kwenhliziyo) kwezicubu ezingaphansi kwenzwa, okuthiwa i-plethysmogram - ngendlela 'yebha. ' noma i-sine curve, i-plethysmogram inikeza ulwazi olwengeziwe lokuxilonga kudokotela.

Izinzuzo zedivayisi ukuthi ayinabungozi kuwo wonke umuntu (ayikho imisebe ye-ionizing), i-non-invasive (asikho isidingo sokuthatha iconsi legazi ukuze ihlaziywe), iqala ukusebenza esigulini ngokushesha futhi kalula, futhi ingasebenza ubusuku nemini, ukuhlela kabusha inzwa eminweni njengoba kudingeka.

Kodwa-ke, noma iyiphi i-pulse oximeter kanye ne-pulse oximetry ngokuvamile inemibi kanye nemikhawulo engavumeli ukusetshenziswa ngempumelelo kwale ndlela kuzo zonke iziguli.

Lezi zihlanganisa:

1) Ukugeleza kwegazi okungekuhle kwe-peripheral

- ukuntuleka kwe-perfusion lapho inzwa ifakiwe: umfutho wegazi ophansi kanye nokushaqeka, ukuvuselela kabusha, i-hypothermia kanye nesithwathwa sezandla, i-atherosclerosis yemithambo emaphethelweni, isidingo sokulinganisa umfutho wegazi ovamile (BP) nge-cuff eboshwe engalweni, njll - Ngenxa yazo zonke lezi zimbangela, i-pulse wave kanye nesignali ku-sensor impofu, ukulinganisa okuthembekile kunzima noma akunakwenzeka.

Nakuba amanye ama-pulse oximeter ochwepheshe anemodi ethi 'Isiginali Engalungile' ('sikala esikutholayo, ukunemba akuqinisekisiwe'), esimweni somfutho wegazi ophansi futhi kungekho ukugeleza kwegazi okuvamile ngaphansi kwenzwa, singakwazi ukuqapha isiguli nge-ECG. kanye neziteshi ze-capnography.

Ngeshwa, kuneziguli ezibucayi emithini ephuthumayo ezingakwazi ukusebenzisa i-pulse oximetry,

2) Izinkinga ze-Nail” ekutholeni isignali eminweni: i-manicure engacimeki ezinziphoni, ukuguga okunzima kwezinzipho ngokutheleleka kwefungal, iminwe emincane kakhulu ezinganeni, njll.

Ingqikithi iyafana: ukungakwazi ukuthola isignali evamile yedivayisi.

Inkinga ingaxazululwa: ngokuvula inzwa emunweni ngamadigri angu-90, ngokufaka inzwa ezindaweni ezingajwayelekile, isb.

Ezinganeni, ngisho nangaphambi kwesikhathi, ngokuvamile kuyenzeka ukuthola isignali ezinzile kusuka kunzwa yabantu abadala efakwe kuzwane olukhulu.

Izinzwa ezikhethekile zezingane zitholakala kuphela kuma-pulse oximeter ochwepheshe kusethi ephelele.

3) Ukuncika komsindo nokuvikeleka “emsindweni

Lapho isiguli sinyakaza (ukuqaphela okushintshile, ukuphazamiseka kwengqondo, ukunyakaza ephusheni, izingane) noma unyakazisa ngesikhathi sokuthutha, inzwa ingakhishwa futhi isignali engazinzile ingakhiqizwa, ibangele ama-alamu.

I-professional transport pulse oximeters yabatakuli banama-algorithms okuvikela akhethekile avumela ukuphazamiseka kwesikhathi esifushane ukuthi kunganakwa.

Izinkomba zilinganiselwa kumasekhondi wokugcina angu-8-10, ukuphazamiseka akunakwa futhi akuthinti ukusebenza.

Okubi kwalokhu kulinganisa ukubambezeleka okuthile ekuguquleni ukufundwa koshintsho oluhlobene lwangempela esigulini (ukunyamalala okucacile kwe-pulse kusuka kuzinga lokuqala le-100, empeleni 100->0, kuzoboniswa njenge-100->80 ->60->40->0), lokhu kumele kubhekwe ngesikhathi sokuqapha.

4) Izinkinga nge-hemoglobin, i-hypoxia equlekile ene-SpO2 evamile:

A) Ukushoda kweHemoglobin (ne-anemia, i-haemodilution)

Kungase kube ne-hemoglobin encane emzimbeni (i-anemia, i-haemodilution), kukhona i-hypoxia yesitho nezicubu, kodwa yonke i-hemoglobin ekhona ingase igcwale umoya-mpilo, i-SpO 2 = 99 %.

Kufanele kukhunjulwe ukuthi i-oximeter ye-pulse ayibonisi konke okuqukethwe kwe-oksijeni egazini (CaO 2) kanye ne-oksijeni engaqediwe ku-plasma (PO 2), okungukuthi iphesenti le-hemoglobin egcwele umoya-mpilo (SpO 2).

Nakuba, yiqiniso, uhlobo oluyinhloko lomoya-mpilo egazini i-hemoglobin, yingakho i-pulse oximetry ibaluleke kakhulu futhi iyigugu.

B) Amafomu Akhethekile E-Hemoglobin (ngobuthi)

I-Hemoglobin eboshelwe ku-carbon monoxide (HbCO) iyinhlanganisela eqinile, ehlala isikhathi eside empeleni engawuthwali umoya-mpilo, kodwa inezici zokumunca ukukhanya ezifana kakhulu ne-oxyhaemoglobin evamile (HbO 2).

I-Pulse oximeters ihlale ithuthukiswa, kodwa okwamanje, ukwakhiwa kwama-oximeter we-pulse mass angabizi ahlukanisa phakathi kwe-HbCO ne-HbO 2 kuyindaba yesikhathi esizayo.

Endabeni ye-carbon monoxide poisoning ngesikhathi somlilo, isiguli singase sibe ne-hypoxia enzima futhi ebucayi, kodwa ngobuso obuhlanjululwe kanye namanani ajwayelekile angamanga we-SpO 2, lokhu kufanele kucatshangelwe ngesikhathi se-pulse oximetry ezigulini ezinjalo.

Izinkinga ezifanayo zingase zenzeke nezinye izinhlobo ze-dyshaemoglobinaemia, ukuphathwa kwe-intravenous kwama-radiopaque agents kanye nodayi.

5) Vala i-hypoventilation nge-O2 inhalation

Isiguli esinokucindezeleka kwengqondo (ukushaywa unhlangothi, ukulimala kwekhanda, ubuthi, i-coma), uma sithola i-O2 ephefumulelwe, ngenxa ye-oxygen eyengeziwe etholwe ngesenzo sokuphefumula ngasinye (uma kuqhathaniswa ne-21% emoyeni womoya), singase sibe nezinkomba ezijwayelekile zokugcwala ngisho naku-5. -8 ukuphefumula ngomzuzu.

Ngasikhathi sinye, ukugcwala kwe-carbon dioxide emzimbeni kuzonqwabelana (ukugcwala komoya-mpilo ngesikhathi sokuphefumula kwe-FiO 2 akuthinti ukususwa kwe-CO 2), i-acidosis yokuphefumula izokwanda, i-cerebral edema izokhula ngenxa ye-hypercapnia kanye nezinkomba ku-pulse oximeter. kube okuvamile.

Ukuhlolwa komtholampilo kokuphefumula kanye ne-capnography yesiguli kuyadingeka.

6) Umehluko phakathi kokushaya kwenhliziyo okucatshangwayo kanye nokwangempela: amabhithi 'athule'

Endabeni yokungenwa kahle kwe-peripheral perfusion, kanye nokuphazamiseka kwesigqi senhliziyo (i-atrial fibrillation, extrasystole) ngenxa yomehluko wamandla e-pulse wave (i-pulse filling), ukushaya kwe-pulse 'kuthule' kungase kunganakwa idivayisi futhi kungacatshangwa lapho. ukubala ukushaya kwenhliziyo (HR, PR).

Isilinganiso senhliziyo sangempela (inhliziyo yenhliziyo ku-ECG noma ngesikhathi se-auscultation yenhliziyo) ingase ibe phezulu, lokhu okubizwa ngokuthi. 'i-pulse deficit'.

Ngokuya nge-algorithm yangaphakathi yale modeli yedivayisi kanye nomehluko ekugcwaliseni ukushaya kwenhliziyo kulesi siguli, izinga lokushoda lingase lihluke futhi lishintshe.

Ezimweni ezifanele, ukuqapha kwe-ECG kanyekanye kunconywa.

Kungase kube nesimo esiphambene, nalokho okubizwa ngokuthi. “i-dichrotic pulse”: ngenxa yokuncipha kwethoni yemithambo kulesi siguli (ngenxa yokutheleleka, njll.), igagasi lokushaya kwenhliziyo ngalinye kugrafu ye-plethysmogram libonakala liphindwe kabili (“nge-recoil”), futhi idivayisi esesibukweni ingase ibe ngamanga. kabili amanani e-PR.

Izinjongo ze-pulse oximetry

1) Isilinganiso sokuxilonga, i-SpO 2 ne-PR (PR).

2) Ukuqapha isiguli ngesikhathi sangempela

Inhloso yokuxilonga, isb ukukala kwe-SpO 2 kanye ne-PR kubalulekile futhi kusobala, yingakho ama-pulse oximeters esetholakala yonke indawo, nokho, amadivaysi amancane asayizi wephakethe ('amamitha wokugcwala' alula) awakuvumeli ukuqapha okuvamile, uchwepheshe. idivayisi iyadingeka ukuqapha njalo isiguli.

Izinhlobo ze-pulse oximeter kanye nemishini ehlobene

I-Mini wireless pulse oximeters (isikrini esisenzweni yomunwe)
Iziqaphi ezichwepheshile (idizayini ye-sensor-wire-case enesikrini esihlukile)
Ishaneli ye-Pulse oximeter kumonitha yemisebenzi eminingi noma i-defibrillator
Ama-Mini Wireless Pulse Oximeters

Ama-oximeter we-pulse oximeters angenantambo mancane kakhulu, inkinobho yokubonisa nokulawula (imvamisa kuba eyodwa kuphela) itholakala phezulu kwezindlu zezinzwa, azikho izintambo noma ukuxhumana.

Ngenxa yezindleko eziphansi nokubumbana kwawo, imishini enjalo manje isisetshenziswa kabanzi.

Akulungele ngempela ukukala okukodwa kokugcwala kanye nokushaya kwenhliziyo, kodwa anemikhawulo ebalulekile kanye nokubi ekusetshenzisweni kochwepheshe nokuqapha, isb ezimeni i-ambulensi abasebenzi.

Izinzuzo

Ihlangene, ayithathi isikhala esiningi emaphaketheni nasekugcinweni
Kulula ukuyisebenzisa, asikho isidingo sokukhumbula imiyalelo

Okumbi

Ukubona ngeso elibi ngesikhathi sokuqapha: lapho isiguli sise-stretcher, kufanele usondele njalo noma uncike emunweni ngenzwa, ama-pulse oximeters ashibhile anesikrini se-monochrome okunzima ukusifunda ukude (kungcono ukuthenga umbala. eyodwa), kufanele ubone noma ushintshe isithombe esihlanekezelwe, umbono ongalungile wesithombe esinjenge-SpO 2 = 99 % esikhundleni sika-66 %, i-PR=82 esikhundleni se-SpO 2 =82 ingaba nemiphumela eyingozi.

Inkinga yokungaboni kahle ngeso ayikwazi ukubukelwa phansi.

Manje ngeke kubonakale kunoma ubani ukuthi abukele ifilimu yokuqeqeshwa ku-TV emnyama nokumhlophe enesikrini esiyi-diagonal esingu-2″: okokusebenza kudonswa kangcono isikrini sombala esikhulu ngokwanele.

Isithombe esicacile esivela ekubonisweni okukhanyayo odongeni lwemoto yokuhlenga, ebonakalayo kunoma yikuphi ukukhanya nanoma yikuphi ibanga, ivumela umuntu ukuba angaphazanyiswa emisebenzini ebaluleke kakhulu lapho esebenza nesiguli esisesimweni esibucayi.

Kunezici ezibanzi neziphelele kumenyu: imikhawulo ye-alamu elungisekayo kupharamitha ngayinye, ivolumu yokushaya kwama-alamu nama-alamu, ukuziba isignali embi, imodi ye-plethysmogram, njll., uma kukhona ama-alamu, azokhala futhi aphazamise yonke indlela noma acime. konke ngesikhathi esisodwa.

Amanye ama-pulse oximeters ashibhile angenisiwe, asuselwa kulwazi lokusetshenziswa nokuhlolwa kwaselabhorethri, akuqinisekisi ukunemba kwangempela.

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Isidingo sokususa amabhethri ngesikhathi sokugcina isikhathi eside: uma i-pulse oximeter isetshenziswa njalo (isb. ekhaya 'elidingeka kakhulu' Insiza yezimo eziphuthumayo ikhithi), amabhethri angaphakathi ocingweni ayavuza futhi alimaze, ekugcinweni kwesikhathi eside, amabhethri kufanele akhishwe futhi agcinwe eduze, kuyilapho ipulasitiki entekenteke yekhava yebhethri kanye nesikhiya sayo kungase kungamelani nokuvalwa nokuvulwa ngokuphindaphindiwe kwekhompathimenti.

Kumamodeli amaningi awekho amandla okunikezwa kwamandla angaphandle, isidingo sokuba nesethi eyisipele yamabhethri eduze siwumphumela walokhu.

Ukufingqa: kunengqondo ukusebenzisa i-wireless pulse oximeter njengethuluzi lephakethe lokuhlola ngokushesha, amathuba okuqapha alinganiselwe kakhulu, kungenzeka kuphela ukwenza ukuqapha okulula okuseceleni kombhede, isb ukuqapha ukushaya kwenhliziyo ngesikhathi sokulawulwa komthambo i-beta-blocker.

Kutuswa ukuba ne-pulse oximeter enjalo yabasebenzi be-ambulensi njengesipele sesibili.

Ukuqapha okusebenzayo kwe-pulse oximeters

I-pulse oximeter enjalo inomzimba omkhulu nesibonisi, inzwa ihlukene futhi ithathelwa indawo (omdala, ingane), ixhunywe ngekhebula emzimbeni wedivayisi.

Isibonisi sekristalu ewuketshezi kanye/noma isikrini esithintwayo (njengaku-smartphone) esikhundleni sesibonisi esinezingxenye eziyisikhombisa (njengasewashi le-elekthronikhi) akusadingeki ngaso sonke isikhathi futhi kulungile, yebo kungokwesimanje futhi kuyabiza, kodwa kukubekezelela ukubulawa amagciwane. okubi nakakhulu, kungase kungaphenduli ngokucacile ekucindezelweni kweminwe kumagilavu wezokwelapha, kudla ugesi omningi, kuntekenteke uma kwehlisiwe, futhi kwandisa kakhulu intengo yedivayisi.

Izinzuzo

Ukunethezeka nokucaca kwesibonisi: inzwa esemunweni, idivayisi ebekwe odongeni kubakaki noma phambi kwamehlo kadokotela, isithombe esikhulu ngokwanele nesicacile, ukwenza izinqumo ngokushesha ngesikhathi sokuqapha.
Ukusebenza okuphelele nezilungiselelo ezithuthukisiwe, engizoxoxa ngazo ngokwehlukana nangemininingwane ngezansi.
Ukunemba kokulinganisa
Ukuba khona kwamandla angaphandle (12V kanye no-220V), okusho ukuthi kungenzeka ukusetshenziswa okungaphazamiseki kwamahora angama-24
Ukuba khona kwenzwa yengane (kungaba inketho)
Ukumelana nokubulala amagciwane
Ukutholakala kwesevisi, ukuhlolwa kanye nokulungiswa kwemishini yasekhaya

Okumbi

Ihlangene kancane futhi iyaphatheka
Kuyabiza (ama-pulse oximeter amahle alolu hlobo awashibhile, nakuba intengo yawo iphansi kakhulu kunaleyo yama-cardiographs nama-defibrillators, lena indlela yobuchwepheshe yokusindisa izimpilo zeziguli)
Isidingo sokuqeqesha abasebenzi futhi baphathe kahle le modeli yedivayisi (kuyancomeka ukuqapha iziguli ezine-pulse oximeter entsha "konke ngokulandelana" ukuze amakhono azinzile esimweni esinzima ngempela)

Ukufingqa: i-oximeter yokuqapha i-pulse oximeter iyadingeka kuzo zonke iziguli ezigula kakhulu emsebenzini nezokuthutha, ngenxa yokusebenza kwayo okuthuthukile, ezimweni eziningi yonga isikhathi futhi ayidingi ukuxhunywa kumonitha weziteshi eziningi, ingaphinda futhi. isetshenziselwe ukugcwaliswa kwenhliziyo okulula kanye nokuxilongwa kwe-pulse, kodwa iphansi kune-mini-pulse oximeters ngokuhambisana nentengo.

Ngokwehlukana, kufanele sihlale ekukhetheni uhlobo lokubonisa (isikrini) se-oximeter ye-pulse professional.

Kubonakala sengathi ukukhetha kusobala.

Njengoba nje amafoni acindezela inkinobho kade anikezwa indlela kuma-smartphones esimanje anombukiso we-LED wesikrini esithintwayo, imishini yesimanje yezokwelapha kufanele ifane.

Ama-oximeter e-Pulse anombukiso ngendlela yezinkomba zezinombolo ezinezingxenye eziyisikhombisa abhekwa njengengasebenzi.

Kodwa-ke, umkhuba ubonakala ubonisa ukuthi ekucacisweni komsebenzi wamaqembu e-ambulensi, inguqulo yedivayisi enesibonisi se-LED inezinkinga eziphawulekayo okufanele umuntu aziqaphele lapho ekhetha futhi esebenza nayo.

Ububi bedivayisi enesibonisi se-LED bumi kanje:

Ubuntekenteke: empeleni, idivayisi enesibonisi esinamasegimenti ayisikhombisa imelana kalula nokuwa (isb. isuka kuhlaka oluphansi), idivayisi enesibonisi se-LED – 'yawa, yabe isiphuka'.
Ukusabela okungekuhle kwesikrini esithintwayo ekucindezelweni ngenkathi ugqoke amagilavu: ngesikhathi kuqubuka i-COVID-19, umsebenzi oyinhloko nge-pulse oximeter usezigulini ezinaleli gciwane, abasebenzi bebegqoke amasudi okuzivikela, amagilavu ezokwelapha asezandleni zabo, ngokuvamile aphindwe kabili noma ajiyile. Isibonisi se-LED sesikrini esithintwayo samanye amamodeli siphendule kabi noma ngokungalungile ekucindezeleni izilawuli esikrinini ngeminwe kumagilavu anjalo, njengoba isikrini esithintwayo ekuqaleni siklanyelwe ukucindezelwa ngeminwe engenalutho;
I-engeli yokubuka nokusebenza ngaphansi kwezimo zokukhanya okukhanyayo: isibonisi se-LED kufanele sibe sekhwalithi ephezulu kakhulu, kufanele sibonakale ekukhanyeni kwelanga okugqame kakhulu (isb. lapho abasebenzi besebenza ogwini lolwandle) futhi nge-engeli ecishe ibe ngu-'180 degrees', a uhlamvu olukhanyayo olukhethekile kufanele lukhethwe. Ukuzijwayeza kubonisa ukuthi isikrini se-LED asihlali sihlangabezana nalezi zidingo.
Ukumelana nokubulawa kwamagciwane okunamandla: isibonisi se-LED kanye nedivayisi enalolu hlobo lwesikrini kungenzeka kungamelani nokwelashwa 'okubi' ngezibulala-magciwane;
Izindleko: isibonisi se-LED sibiza kakhulu, sikhulisa kakhulu intengo yedivayisi
Ukwenyuka kokusetshenziswa kwamandla: isibonisi se-LED sidinga amandla engeziwe, okusho ukuthi isisindo esiningi kanye nenani ngenxa yebhethri elinamandla noma ukuphila kwebhethri okufushane, okungadala izinkinga ngesikhathi somsebenzi ophuthumayo phakathi nobhadane lwe-COVID-19 (asikho isikhathi sokushaja)
Ukugcinwa okuphansi: isibonisi se-LED kanye nedivayisi enesikrini esinjalo azinakekelwa kancane kusevisi, ukushintshwa kwesibonisi kubiza kakhulu, cishe akulungiswa.

Ngenxa yalezi zizathu, emsebenzini, abatakuli abaningi bakhetha buthule i-pulse oximeter enohlobo 'lwakudala' lokuboniswa ezinkomba zezinombolo zezingxenye eziyisikhombisa (njengasewashi le-elekthronikhi), naphezu kokuthi isiphelelwe yisikhathi. Ukwethembeka 'empini' kuthathwa njengokubalulekile.

Ngakho-ke, ukukhethwa kwemitha yokugcwalisa indawo kufanele kushintshwe ngakolunye uhlangothi ukuze kuhambisane nezidingo ezilethwa indawo, futhi ngakolunye kube lokho umhlengi akubheka 'njengokwenza' maqondana nomsebenzi wakhe wansuku zonke.