Hei taputapu tino noa i roto i te mahi haumanu, ko te aroturuki tūroro maha-tawhā he momo tohu koiora mō te kitenga roa, maha-tawhā o te āhua tinana me te mate o ngā tūroro i roto i ngā tūroro tino kino, ā, mā te tātari me te tukatuka aunoa i te wā tūturu, ka huri i te wā ki ngā mōhiohio tirohanga, te whakaoho aunoa me te tuhi aunoa i ngā huihuinga morearea pea. Haunga te ine me te aroturuki i ngā tawhā tinana o ngā tūroro, ka taea hoki e ia te aroturuki me te whakahaere i te āhua o ngā tūroro i mua me muri i te rongoā me te pokanga, te kimi i ngā huringa o te āhua o ngā tūroro tino mate i te wā tika, me te whakarato i te pūtake taketake mō ngā tākuta ki te tātaritanga tika me te whakatakoto mahere hauora, ā, ka tino whakaiti i te mate o ngā tūroro tino mate.
I te whanaketanga o te hangarau, kua whānuitia ngā tūemi aroturuki o ngā aroturuki tūroro maha-tawhā mai i te pūnaha tohanga toto ki ngā pūnaha manawa, io, pākia o te tinana me ētahi atu.Kua whakawhānuihia hoki te mātāpuna mai i te mātāpuna ECG (ECG) e whakamahia whānuitia ana, te mātāpuna manawa (RESP), te mātāpuna toto hāora (SpO2), te mātāpuna toto pēhanga kore-whakaeke (NIBP) ki te mātāpuna pāmahana (TEMP), te mātāpuna toto pēhanga (IBP), te mātāpuna nekehanga ngākau (CO), te mātāpuna nekehanga ngākau tonu kore-whakaeke (ICG), me te mātāpuna hauhā waro mutunga-manawa (EtCO2) ), te mātāpuna aroturuki electroencephalogram (EEG), te mātāpuna aroturuki hau rongoā (AG), te mātāpuna aroturuki hau kiri, te mātāpuna aroturuki hohonu rongoā (BIS), te mātāpuna aroturuki whakangā uaua (NMT), te mātāpuna aroturuki hemodynamics (PiCCO), te mātāpuna tikanga manawa.
Muri iho, ka wehewehea kia maha ngā wāhanga hei whakaatu i te pūtake ā-tinana, te mātāpono, te whanaketanga me te whakamahinga o ia kōwae.Me tīmata tātou ki te waeine electrocardiogram (ECG).
1： Te tikanga o te whakaputa i te electrocardiogram
Ko ngā cardiomyocytes e horapa ana i roto i te pūnga sinus, te hononga atrioventricular, te ara atrioventricular me ōna manga ka whakaputa i te mahi hiko i te wā whakaohooho, ā, ka whakaputa hoki i ngā mara hiko i roto i te tinana. Mā te whakanoho i tētahi irahiko whakarewa ki roto i tēnei mara hiko (i ngā wāhi katoa o te tinana) ka taea te hopu i te iahiko ngoikore. Ka huri tonu te mara hiko i te huringa o te wā nekehanga.
Nā te rerekētanga o ngā āhuatanga hiko o ngā kiko me ngā wāhanga rerekē o te tinana, i tuhia e ngā irahiko tirotiro i ngā wāhanga rerekē ngā huringa pūmanawa rerekē i roto i ia huringa ngākau. Ka whakanuia ēnei huringa pūmanawa iti, ka tuhia hoki e te electrocardiograph, ā, ko te tauira hua ka kiia he electrocardio-gram (ECG). Ka tuhia te electrocardiogram tuku iho mai i te mata o te tinana, e kiia nei ko te electrocardiogram mata.
2：Te hītori o te hangarau electrocardiogram
I te tau 1887, i angitu a Waller, he ahorangi mō te mahi tinana i te Hōhipera o Mary o te Royal Society of England, ki te tuhi i te tuatahi o ngā electrocardiogram tangata mā te whakamahi i te capillary electrometer, ahakoa ko ngā ngaru V1 me V2 anake o te ventricle i tuhia ki te pikitia, ā, kāore i tuhia ngā ngaru P atrial. Engari nā te mahi nui me te hua a Waller i whakaaweawe a Willem Einthoven, i roto i te hunga whakarongo, ā, i whakatakoto i te turanga mō te whakaurunga o te hangarau electrocardiogram.
------------------------（AugustusDisire Walle）----------------------------------------（Nā Waller i tuhi te electrocardiogram tuatahi o te tangata）------------------------------------------------（Ine hiko capillary ）------------
Mō ngā tau 13 e whai ake nei, i whakapau kaha a Einthoven ki te ako i ngā hiko o te manawa i hopukina e ngā hiko o te manawa. I whakapai ake ia i ētahi tikanga matua, mā te whakamahi angitu i te galvanometer aho, te hiko o te manawa o te mata o te tinana i hopukina ki te kiriata whakaahua-ataata, i hopukina e ia te hiko e whakaatu ana i te ngaru P atrial, te ngaru depolarization ventricular B, C me te repolarization D. I te tau 1903, ka tīmata te whakamahi i ngā hiko o te manawa i roto i ngā mahi haumanu. I te tau 1906, i hopukina e Einthoven ngā hiko o te fibrillation atrial, te atrial flutter me te ventricular premature beat. I te tau 1924, i whakawhiwhia a Einthoven ki te Tohu Nobel mō te Rongoā mō tana hanga i te hopunga hiko o te manawa.
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3：Te whakawhanaketanga me te kaupapa o te pūnaha arataki
I te tau 1906, i whakaarohia e Einthoven te ariā o te arataki peka bipolar. Whai muri i te hono i ngā irahiko hopu i te ringa matau, te ringa maui me te waewae maui o ngā tūroro i roto i ngā takirua, ka taea e ia te hopu i te hiko o te arataki peka bipolar (arataki I, arataki II me te arataki III) me te kaha teitei me te tauira pumau. I te tau 1913, i whakaurua mana te hiko o te arataki peka paerewa bipolar, ā, i whakamahia takitahi mō te 20 tau.
I te tau 1933, i oti i a Wilson te mahi i te electrocardiogram mata kotahi-polar, i whakatau i te tūranga o te pūmanawa kore me te pito hiko matua e ai ki te ture o nāianei a Kirchhoff, ā, i whakatūria te pūnaha mata 12 o te whatunga Wilson.
Heoi, i roto i te pūnaha arataki-12 a Wilson, he iti te kaha o te ngaru o te electrocardiogram o ngā arataki peka unipolar e toru, arā, VL, VR me VF, he mea uaua ki te ine me te tirotiro i ngā huringa. I te tau 1942, i whakahaerehia e Goldberger ētahi atu rangahau, ā, i hua ake ko ngā arataki peka pēhanga unipolar e whakamahia tonutia ana i ēnei rā: aVL, aVR, me aVF.
I tēnei wā, i whakaurua te pūnaha paerewa 12-arataki mō te tuhi i te ECG: 3 arataki peka bipolar (Ⅰ, Ⅱ, Ⅲ, Einthoven, 1913), 6 arataki ū unipolar (V1-V6, Wilson, 1933), me 3 arataki peka kōpeke unipolar (aVL, aVR, aVF, Goldberger, 1942).
4：Me pēhea te whiwhi tohu ECG pai
1. Te whakarite kiri. Nā te mea he ngoikore te kawe hiko o te kiri, me atawhai tika te kiri o te tūroro ki te wāhi e whakanohoia ana ngā irahiko kia whiwhi ai i ngā tohu hiko ECG pai. Kōwhiria ngā mea papatahi he iti ake te uaua.
Me rongoā te kiri kia rite ki ēnei tikanga: ① Tangohia te huruhuru o te tinana kei reira te hiko. Mirimiri mārire te kiri kei reira te hiko hei tango i ngā pūtau kiri mate. ③ Horoia te kiri kia tino horoia ki te wai hopi (kaua e whakamahia te ether me te waipiro parakore, nā te mea ka piki ake te ātete o te kiri). ④ Tukua kia maroke rawa te kiri i mua i te whakatakotoranga o te hiko. ⑤ Tāutahia he rawhi, he pātene rānei i mua i te whakatakotoranga o ngā hiko ki te tūroro.
2. Kia tūpato ki te tiaki i te waea kawe ngākau, āraia te takai me te here i te waea mata, āraia te pakaru o te paparanga tiaki o te waea mata, ā, horoia wawetia te paru i runga i te topenga mata, i te whitiki rānei hei ārai i te waikura mata.
Wā tuku: Oketopa-12-2023
