Multiparameter ihangane gukurikirana (gutondekanya abakurikirana) birashobora gutanga amakuru yambere yubuvuzi nibindi bitandukanyeibimenyetso by'ingenzi ibipimo byo gukurikirana abarwayi no gutabara abarwayi. Acc ukurikije ikoreshwa rya monitor mu bitaro, we narabyizeeishami ryamavuriro ntirishobora gukoresha monitor kugirango ikoreshwe bidasanzwe.By'umwihariko, umuyobozi mushya ntabwo azi byinshi kuri moniteur, bikavamo ibibazo byinshi mugukoresha moniteur, kandi ntishobora gukina neza imikorere yigikoresho.Yonker imigabaneiimikoreshereze n'ihame ry'akazi ryaibipimo byinshi gukurikirana kuri buri wese.
Mugenzuzi wumurwayi arashobora kumenya bimwe mubyingenziibimenyetso ibipimo byabarwayi mugihe nyacyo, ubudahwema kandi igihe kirekire, gifite agaciro gakomeye kivuriro.Ariko na mobile igendanwa, ikoreshwa ryimodoka, itezimbere cyane inshuro zikoreshwa.Kugeza ubu,ibipimo byinshi gukurikirana abarwayi birasanzwe, kandi mubikorwa byingenzi birimo ECG, umuvuduko wamaraso, ubushyuhe, guhumeka,SpO2, ETCO2, IBP, umutima utanga, nibindi
1. Imiterere shingiro ya monitor
Ubusanzwe monite igizwe na module yumubiri irimo sensor zitandukanye hamwe na sisitemu ya mudasobwa.Ubwoko bwose bwibimenyetso bya physiologique bihindurwa mubimenyetso byamashanyarazi na sensor, hanyuma byoherezwa kuri mudasobwa kugirango byerekanwe, bibike kandi bicunge nyuma yo kwongerwaho imbaraga.Ikurikiranabikorwa ryinshi rishobora gukurikirana ecg, guhumeka, ubushyuhe, umuvuduko wamaraso,SpO2 nibindi bipimo icyarimwe.
Ikurikiranwa ry'abarwayizikoreshwa muri rusange.Zigizwe na discretable detacable physiologique parameter module kandi ikurikirana abayobora, kandi irashobora kuba igizwe na module zitandukanye ukurikije ibisabwa kugirango zuzuze ibisabwa byihariye.
2. T.he imikoreshereze n'ihame ry'akazi ryaibipimo byinshi gukurikirana
(1) Kwita ku myanya y'ubuhumekero
Ibipimo byinshi byubuhumekero muriibipimo byinshigukurikirana abarwayifata uburyo bwo kubuza igituza.Igituza cyimibiri yumubiri wumuntu mugihe cyo guhumeka gitera ihinduka ryumubiri wumubiri, ari 0.1 ω ~ 3 ω, uzwi kwizina ryubuhumekero.
Monitor ikunze gufata ibimenyetso byimpinduka zubuhumekero kuri electrode imwe mugutera inshinge zumutekano za 0.5 kugeza 5mA kuri sinusoidal itwara inshuro 10 kugeza 100kHz binyuze muri electrode ebyiri ECG kuyobora.Umuvuduko ukabije wubuhumekero urashobora gusobanurwa nuburyo butandukanye bwo guhumeka neza, kandi ibipimo byumuvuduko wubuhumekero birashobora gukurwa.
Kugenda kwa Thoracic no kudahumeka kwumubiri bizatera impinduka mukurwanya umubiri.Iyo inshuro zimpinduka zimeze nkumurongo wumurongo wubuhumekero wumuyoboro wubuhumekero, biragoye ko moniteri imenya nikimenyetso gisanzwe cyubuhumekero nicyo kimenyetso kibangamira icyerekezo.Nkigisubizo, ibipimo byubuhumekero bishobora kuba bidahwitse mugihe umurwayi afite umuvuduko ukabije kandi uhoraho.
(2) Gukurikirana umuvuduko wamaraso (IBP)
Mubikorwa bimwe bikomeye, kugenzura igihe nyacyo cyumuvuduko wamaraso bifite agaciro gakomeye mubuvuzi, bityo rero birakenewe ko hakoreshwa tekinoroji yo kugenzura umuvuduko wamaraso kugirango ubigereho.Ihame ni: icya mbere, catheter yatewe mumitsi yamaraso yikibanza cyapimwe binyuze mu gucumita.Icyambu cyo hanze cya catheter gihujwe neza na sensor sensor, kandi saline isanzwe yinjizwa muri catheter.
Bitewe nigikorwa cyo guhererekanya umuvuduko wamazi, umuvuduko wimitsi uza kwanduzwa na sensor sensor yo hanze binyuze mumazi muri catheter.Rero, imbaraga zumuvuduko wimpinduka zumuvuduko wamaraso zirashobora kuboneka.Umuvuduko wa sisitemu, umuvuduko wa diastolique hamwe nigitutu gishobora kuboneka muburyo bwihariye bwo kubara.
Hagomba kwitonderwa gupima umuvuduko wamaraso utera: mugitangira cyo kugenzura, igikoresho kigomba guhinduka kuri zeru mbere;Mugihe cyo gukurikirana, sensor yumuvuduko igomba guhora ibitswe kurwego rumwe numutima.Kugirango wirinde kwambika catheter, catheter igomba guhindurwa inshinge zihoraho za saline ya heparin, ishobora kwimuka cyangwa gusohoka kubera kugenda.Kubwibyo, catheter igomba gukosorwa neza no kugenzurwa neza, kandi bigomba guhinduka nibiba ngombwa.
(3) Gukurikirana ubushyuhe
Thermistor hamwe nubushuhe bubi bukoreshwa mubisanzwe nka sensor yubushyuhe mugupima ubushyuhe bwa monitor.Igenzura rusange ritanga ubushyuhe bumwe bwumubiri, nibikoresho byohejuru bitanga ubushyuhe bwumubiri bubiri.Ubwoko bwubushyuhe bwumubiri nabwo bugabanijwe mubice byubuso bwumubiri hamwe nubushakashatsi bwumubiri, bikoreshwa mugukurikirana ubuso bwumubiri hamwe nubushyuhe bwimyanya.
Iyo upimye, uyikoresha arashobora gushyira ubushakashatsi bwubushyuhe mubice byose byumubiri wumurwayi ukurikije ibikenewe.Kuberako ibice bitandukanye byumubiri wumuntu bifite ubushyuhe butandukanye, ubushyuhe bupimwe na monite nigiciro cyubushyuhe bwigice cyumubiri wumurwayi kugirango ushireho iperereza, rishobora kuba ritandukanye nubushyuhe bwumunwa cyangwa akaboko.
Winkoko ifata igipimo cy'ubushyuhe, hari ikibazo cyo kuringaniza ubushyuhe hagati yikigero cyapimwe cyumubiri wumurwayi na sensor muri probe, ni ukuvuga mugihe iperereza ryashyizwe bwa mbere, kubera ko sensor itarashyira hamwe nubushyuhe bwa umubiri w'umuntu.Kubwibyo, ubushyuhe bwerekanwe muriki gihe ntabwo ubushyuhe nyabwo bwa minisiteri, kandi bugomba kugerwaho nyuma yigihe runaka kugirango bugere kuburinganire bwumuriro mbere yuko ubushyuhe nyabwo bushobora kugaragara mubyukuri.Witondere kandi gukomeza umubano wizewe hagati ya sensor nubuso bwumubiri.Niba hari icyuho kiri hagati ya sensor nuruhu, agaciro ko gupima gashobora kuba gake.
(4) Gukurikirana ECG
Igikorwa c'amashanyarazi ya "selile zishimishije" muri myocardium gitera myocardium gushimishwa n'amashanyarazi.Bitera umutima kugabanuka muburyo bwa mashini.Umuyoboro ufunze kandi wibikorwa byatewe niyi nzira ishimishije yumutima unyura mumashanyarazi yumubiri kandi ugakwira mubice bitandukanye byumubiri, bikavamo impinduka zubu itandukaniro riri hagati yibice bitandukanye byumubiri wumuntu.
Amashanyarazi .Ibisobanuro byambere byasobanuwe Ⅰ, Ⅱ, Ⅲ kuyobora byitwa clinique bita bipolar standard limb lead.
Nyuma, hashyizweho ingufu za unipolar ingingo ziyobowe, aVR, aVL, aVF nigituza cya electrodeless iyobora V1, V2, V3, V4, V5, V6, aribwo buryo busanzwe bwa ECG bukoreshwa mubikorwa byubuvuzi.Kuberako umutima ari stereoskopique, icyerekezo cya sisitemu cyerekana ibikorwa byamashanyarazi hejuru yumutima umwe.Izi 12 ziyobora zizagaragaza ibikorwa byamashanyarazi kumurongo utandukanye wa projection yumutima uhereye kumyerekezo 12, kandi ibikomere byibice bitandukanye byumutima birashobora gupimwa byimazeyo.
Kugeza ubu, imashini isanzwe ya ECG ikoreshwa mu bikorwa by’ubuvuzi ipima imiterere ya ECG, kandi electrode yayo yo mu gihimba ishyirwa ku kuboko no ku kuguru, mu gihe electrode mu igenzura rya ECG ishyirwa kimwe mu gituza cy’umurwayi no mu nda, nubwo ishyirwa ari bitandukanye, barangana, kandi ibisobanuro byabo ni bimwe.Kubwibyo, imiyoboro ya ECG muri monite ihuye nuyoboye imashini ya ECG, kandi bafite polarite imwe hamwe na flake.
Abakurikirana barashobora gukurikirana muri rusange 3 cyangwa 6 bayobora, barashobora icyarimwe kwerekana icyerekezo cyumurongo umwe cyangwa byombi byayobora kandi bagakuramo ibipimo byumutima binyuze mubisesengura. Pmonitor ikurikirana irashobora gukurikirana 12 iyobora, kandi irashobora kurushaho gusesengura imiterere yumurongo kugirango ikuremo ibice bya ST hamwe na arththmia ibyabaye.
Kuri ubu ,.ECGwaveform of the monitoring, ubushobozi bwayo bwo gupima ubushobozi bwayo ntabwo bukomeye cyane, kuko intego yo kugenzura ahanini ni ugukurikirana injyana yumutima wumurwayi igihe kirekire kandi mugihe nyacyo. ArikoiECGibisubizo byo gusuzuma imashini bipimwa mugihe gito mubihe byihariye.Kubwibyo, amplifier bandpass ubugari bwibikoresho byombi ntabwo ari kimwe.Umuyoboro mugari wa mashini ya ECG ni 0.05 ~ 80Hz, mugihe umurongo wa monitor ari 1 ~ 25Hz.Ikimenyetso cya ECG nikimenyetso gisa nkintege nke, cyoroshye kwibasirwa nimbogamizi zo hanze, kandi ubwoko bumwebumwe bwo kwivanga buragoye cyane gutsinda nka:
(a) Kwivanga kwimuka.Imyitwarire yumubiri wumurwayi izatera impinduka mubimenyetso byamashanyarazi mumutima.Amplitude hamwe ninshuro zuru rugendo, niba muriECGamplifier bandwidth, igikoresho kiragoye gutsinda.
(b)Myoelectric kwivanga.Iyo imitsi iri munsi ya electrode ya ECG yanditswemo, hakorwa ikimenyetso cyo guhuza EMG, kandi ikimenyetso cya EMG kikabangamira ikimenyetso cya ECG, kandi ibimenyetso bya EMG bivanga bifite umurongo mugari nkikimenyetso cya ECG, kubwibyo ntibishobora gukurwaho gusa na a muyunguruzi.
(c) Kwivanga kwicyuma cyumuyagankuba mwinshi.Iyo amashanyarazi menshi cyangwa amashanyarazi akoreshwa mugihe cyo kubagwa, amplitude yikimenyetso cyamashanyarazi gitangwa ningufu zamashanyarazi zongerewe mumubiri wumuntu ziruta cyane icy'ikimenyetso cya ECG, kandi ibice bya frequence birakungahaye cyane, kuburyo ECG amplifier igera kuri leta yuzuye, kandi imiterere ya ECG ntishobora kugaragara.Abakurikirana hafi ya bose ntibafite imbaraga zo kurwanya kwivanga.Kubwibyo, monite anti-high frequency icyuma cyivanga cyicyuma gisaba gusa moniteri gusubira mumiterere isanzwe mugihe cya 5s nyuma yicyuma cyumuriro mwinshi cyakuweho.
(d) Kwivanga kwa electrode.Ihungabana iryo ari ryo ryose ryerekana inzira y'amashanyarazi kuva mumubiri wumuntu kugera kuri ECG amplifier bizatera urusaku rukomeye rushobora guhisha ibimenyetso bya ECG, akenshi biterwa no guhura nabi hagati ya electrode nuruhu.Kwirinda kwivanga guterwa ahanini no gukoresha uburyo, uyikoresha agomba kugenzura neza buri gice buri gihe, kandi igikoresho kigomba kuba gifite ishingiro ryizewe, ntabwo aribyiza byo kurwanya kwivanga gusa, ariko cyane cyane, kurinda umutekano wabarwayi n'abakora.
5. Kudashishikaramonitor y'umuvuduko w'amaraso
Umuvuduko wamaraso bivuga umuvuduko wamaraso kurukuta rwimiyoboro yamaraso.Muri gahunda yo kwikuramo no kuruhura umutima, umuvuduko wamaraso atembera kurukuta rwamaraso nayo arahinduka, kandi umuvuduko wamaraso yimitsi yimitsi hamwe nimiyoboro yamaraso iratandukanye, kandi umuvuduko wimiyoboro yamaraso mubice bitandukanye nabwo. bitandukanye.Mubuvuzi, indangagaciro zumuvuduko wibihe bya systolique na diastolique bihuye nimiyoboro ya arterial ku burebure bungana nububoko bwo hejuru bwumubiri wumuntu akenshi bikoreshwa mukuranga umuvuduko wamaraso wumubiri wumuntu, ibyo bita umuvuduko wamaraso wa systolique (cyangwa hypertension) ) n'umuvuduko wa diastolique (cyangwa umuvuduko muke).
Umuvuduko wamaraso wamaraso ni ibintu bihindagurika.Ifite byinshi bifitanye isano nimitekerereze yabantu, imiterere yumutima, nu gihagararo n'umwanya mugihe cyo gupimwa, umuvuduko wumutima uriyongera, umuvuduko wamaraso wa diastolique urazamuka, umuvuduko wumutima uratinda, kandi umuvuduko wamaraso wa diastolique uragabanuka.Mugihe ubwonko bwumutima bwiyongera, umuvuduko wamaraso wa systolique ugomba kwiyongera.Birashobora kuvugwa ko umuvuduko wamaraso wa arterial muri buri cyiciro cyumutima utazaba rwose.
Uburyo bwa Vibration nuburyo bushya bwo gupima umuvuduko wamaraso wa arterial udatera (70),naihame nugukoresha cuff kugirango yongere umuvuduko runaka mugihe imiyoboro yamaraso ya arterial ihagaritswe burundu ikabuza gutembera kwamaraso, hanyuma hamwe no kugabanya umuvuduko wa cuff, imiyoboro yamaraso ya arterial izerekana inzira yo guhinduka kuva guhagarika burundu → gahoro gahoro gufungura → gufungura byuzuye.
Muri ubu buryo, kubera ko impiswi y'urukuta rw'imitsi y'amaraso izabyara imyuka ihindagurika ya gaze muri gaze muri cuff, uyu muhengeri uhindagurika ufite aho uhurira n'umuvuduko w'amaraso wa arterial systolique, umuvuduko wa diastolique n'umuvuduko ugereranije, hamwe na systolike, bisobanura na umuvuduko wa diastolique wikibanza cyapimwe urashobora kuboneka mugupima, gufata amajwi no gusesengura umuvuduko wumuvuduko wumuvuduko muri cuff mugihe cyo guta.
Intangiriro yuburyo bwo kunyeganyega ni ugushaka impiswi zisanzwe zumuvuduko wamaraso.I.nuburyo nyabwo bwo gupima, bitewe nigikorwa cyumurwayi cyangwa kwivanga hanze bigira ingaruka kumihindagurikire yumuvuduko muri cuff, igikoresho ntigishobora kumenya ihindagurika ryimitsi isanzwe, bityo rero bishobora gutera kunanirwa gupima.
Kugeza ubu, abagenzuzi bamwe na bamwe bafashe ingamba zo kurwanya kwivanga, nko gukoresha uburyo bwo guta urwego, hakoreshejwe porogaramu kugira ngo ihite igena imivurungano hamwe n’imivurungano isanzwe ya arterial pulsation, kugira ngo igire urwego runaka rwubushobozi bwo kurwanya kwivanga.Ariko niba kwivanga gukabije cyangwa kumara igihe kirekire, iki cyemezo cyo kurwanya interineti ntigishobora kugira icyo kibikoraho.Kubwibyo, murwego rwo gukurikirana umuvuduko wamaraso udatera, birakenewe kugerageza kwemeza ko hari ikibazo cyiza, ariko nanone witondere guhitamo ingano ya cuff, gushyira hamwe no gukomera kwa bundle.
6. Gukurikirana Arterial ogisijene yuzuye (SpO2) gukurikirana
Oxygene ni ikintu cy'ingenzi mu bikorwa by'ubuzima.Molekile ikora ya ogisijeni ikora mu maraso ijyanwa mu ngingo zose z'umubiri zihuza na hemoglobine (Hb) kugira ngo ikore ogisijeni hemoglobine (HbO2).Ibipimo bikoreshwa mu kuranga igipimo cya ogisijeni ya hemoglobine mu maraso yitwa ogisijeni.
Igipimo cyo kuzura kwa ogisijeni ya arterial idafite imbaraga zishingiye ku kwinjiza imiterere ya hemoglobine na ogisijeni ya hemoglobine mu maraso, ukoresheje uburebure bubiri butandukanye bw'urumuri rutukura (660nm) n'umucyo utagira urumuri (940nm) unyuze mu myenda hanyuma ugahinduka ibimenyetso by'amashanyarazi na imashini ifata amashanyarazi, mugihe nayo ikoresha ibindi bice bigize tissue, nka: uruhu, amagufwa, imitsi, amaraso yimitsi, nibindi. , iboneka mugutunganya ibimenyetso byakiriwe.
Birashobora kugaragara ko ubu buryo bushobora gupima gusa amaraso ya ogisijeni yuzuye mu maraso ya arterial, kandi ibikenewe mu gupima ni amaraso atembera neza.Mubuvuzi, sensor ishyirwa mubice byumubiri hamwe namaraso ya arterial hamwe nububyimba bwumubiri butabyimbye, nkintoki, amano, gutwi nibindi bice.Ariko, niba hari imbaraga zikomeye mugice cyapimwe, bizagira ingaruka ku gukuramo iki kimenyetso gisanzwe kandi ntigishobora gupimwa.
Iyo umurwayi utembera neza cyane, bizatuma igabanuka ryamaraso ya arterial ahapimwa, bikavamo gupimwa nabi.Iyo ubushyuhe bwumubiri bwikibanza cyapimwe cyumurwayi ufite igihombo kinini cyamaraso kiri hasi, niba hari urumuri rukomeye rumurika kuri probe, birashobora gutuma imikorere yicyuma gifata amashanyarazi gitandukana nurwego rusanzwe, bikavamo gupimwa nabi.Kubwibyo, urumuri rukomeye rugomba kwirindwa mugihe cyo gupima.
7. Gukurikirana imyuka ya karuboni ya dioxyde (PetCO2)
Dioxyde de carbone de respiratory ni ikimenyetso cyingenzi cyo gukurikirana abarwayi ba anesteziya hamwe n’abarwayi bafite indwara zifata imyanya y'ubuhumekero.Gupima CO2 ahanini ikoresha uburyo bwo kwinjiza infragre;Nukuvuga ko ubunini bwa CO2 butwara urwego rutandukanye rwurumuri rwihariye.Hariho ubwoko bubiri bwo gukurikirana CO2: inzira nyamukuru na sidestream.
Ubwoko bwibanze bushyira sensor ya gaz mu muyoboro uhumeka wumurwayi.Guhinduranya kwa CO2 muri gaze ihumeka bikorwa mu buryo butaziguye, hanyuma ibimenyetso byamashanyarazi byoherezwa kuri monite kugirango bisesengurwe kandi bitunganyirizwe kugirango ibone ibipimo bya PetCO2.Icyuma gikoresha optique gishyirwa muri moniteur, kandi urugero rwa gazi ihumeka yumurwayi ikurwa mugihe nyacyo nigitereko cya gazi hanyuma ikoherezwa kuri moniteur kugirango isesengura ryibanze rya CO2.
Mugihe dukora igenzura rya CO2, dukwiye kwitondera ibibazo bikurikira: Kubera ko sensor ya CO2 ari sensor optique, mugikorwa cyo kuyikoresha, birakenewe ko twitondera kwirinda umwanda ukabije wa sensor nkururenda rwabarwayi;Ikurikiranwa rya Sidestream CO2 muri rusange rifite ibikoresho bitandukanya gaze-amazi kugirango bikureho umwuka uhumeka.Buri gihe ugenzure niba itandukanya gaz-amazi ikora neza;Bitabaye ibyo, ubuhehere buri muri gaze buzagira ingaruka kubipimisho.
Gupima ibipimo bitandukanye bifite inenge zimwe bigoye gutsinda.Nubwo abo bagenzuzi bafite ubwenge buhanitse, ntibashobora gusimbuza abantu muri iki gihe, kandi abakoresha baracyakenewe kubisesengura, guca imanza no guhangana nabo neza.Igikorwa kigomba kwitonda, kandi ibisubizo byo gupima bigomba gucirwa urubanza neza.
Igihe cyo kohereza: Jun-10-2022
