Ngā tawhā maha tūroro aroturuki (te whakarōpūtanga o ngā aroturuki) ka taea te whakarato i ngā mōhiohio haumanu tuatahi me te whānuitanga o ngāngā tohu ora ngā tawhā mō te aroturuki i ngā tūroro me te whakaora i ngā tūroro. Ae ai ki te whakamahinga o ngā aroturuki i roto i ngā hōhipera, wkua ako tātou i tērāeKāore e taea e ia tari haumanu te whakamahi i te aroturuki mō ngā whakamahinga motuhake. Ina koa, kāore te kaiwhakahaere hou i te tino mōhio ki te aroturuki, ā, he maha ngā raruraru e pā ana ki te whakamahinga o te aroturuki, ā, kāore e taea te purei katoa i te mahi a te taputapu.Ionaker ngā heatewhakamahinga me te kaupapa mahi omaha-tawhā aroturuki mō te katoa.
Ka taea e te aroturuki tūroro te kite i ētahi mea nui,ngā tohu ngā tawhā o ngā tūroro i te wā tūturu, tonu, me te wā roa, he mea nui tēnei ki te haumanu. Engari ko te whakamahi pūkoro kawe, e mau ana i runga i te waka, ka tino whakapai ake i te auau o te whakamahinga. I tēnei wā,maha-tawhā He mea noa te aroturuki tūroro, ā, ko ana mahi matua ko te ECG, te toto totoka, te pāmahana, te manawa,SpO2, ETCO2, IBP, te putanga o te ngākau, me ētahi atu
1. Hanganga taketake o te aroturuki
Ko te aroturuki he mea hanga i tētahi waeine tinana kei roto ngā momo pūoko me tētahi pūnaha rorohiko kua hangaia ki roto. Ka hurihia ngā momo tohu ā-tinana katoa hei tohu hiko e ngā pūoko, kātahi ka tukuna ki te rorohiko hei whakaatu, hei rokiroki me te whakahaere i muri i te whakanui-mua. Ka taea e te aroturuki whānui ngā tawhā maha-mahi te aroturuki i te ecg, te manawa, te pāmahana, te toto toto,SpO2 me ētahi atu tawhā i te wā kotahi.
Aroturuki tūroro modulare whakamahia whānuitia ana i roto i te tiaki nui. He mea tito ēnei mai i ngā kōwae tawhā ā-tinana motuhake me ngā kaihautū aroturuki, ā, ka taea te tito mai i ngā kōwae rerekē kia rite ki ngā whakaritenga hei whakatutuki i ngā whakaritenga motuhake.
2. The whakamahinga me te kaupapa mahi omaha-tawhā aroturuki
(1) Te tiaki i te manawa
Ko te nuinga o ngā inenga manawa i roto i temaha-tawhāaroturuki tūrorote whakamahi i te tikanga ārai uma. Ko te nekehanga o te uma o te tinana tangata i te wā e manawa ana ka puta te huringa o te ātete o te tinana, arā, ko te 0.1 ω ~ 3 ω, e mōhiotia ana ko te ārai manawa.
I te nuinga o te wā, ka hopukina e te aroturuki ngā tohu o ngā huringa o te aukati manawa i te irahiko kotahi mā te werohanga i te iahiko haumaru o te 0.5 ki te 5mA i te auau kawe sinusoidal o te 10 ki te 100kHz mā roto i ngā irahiko e rua o te ECG arataki. Ka taea te whakaahua i te āhua ngaru hihiri o te manawa mā te rerekētanga o te aukati manawa, ā, ka taea te tango i ngā tawhā o te tere manawa.
Ka puta he panoni i te ātete o te tinana i te nekehanga o te uma me te nekehanga kore-manawa. Ina rite te auau o ēnei panoni ki te aho auau o te whakakaha hongere manawa, he uaua ki te aroturuki te whakatau ko tēhea te tohu manawa noa, ko tēhea hoki te tohu pokanoa nekehanga. Nō reira, ka hē pea ngā inenga tere manawa ina he nui, he tonu hoki ngā nekehanga tinana o te tūroro.
(2) Te aroturuki i te toto totoka whakaeke (IBP)
I ētahi pokanga nui, he mea tino nui te uara haumanu o te aroturukitanga o te toto toto i te wā tūturu, nō reira me whakamahi te hangarau aroturukitanga toto toto whakaeke kia tutuki ai. Ko te kaupapa matua: tuatahi, ka whakauruhia te katitere ki roto i ngā oko toto o te wāhi i inehia mā te poka. Ka hono tika te putanga o waho o te katitere ki te pūoko pēhanga, ā, ka werohia te tote noa ki roto i te katitere.
Nā te mahi whakawhiti pēhanga o te wai, ka tukuna te pēhanga ā-roto ki te pūoko pēhanga o waho mā te wai i roto i te katitere. Nō reira, ka taea te whiwhi i te āhua ngaru hihiri o ngā huringa pēhanga i roto i ngā oko toto. Ka taea te whiwhi i te pēhanga systolic, te pēhanga diastolic me te pēhanga toharite mā roto i ngā tikanga tatau motuhake.
Me aro nui ki te ine toto toto nui: i te tīmatanga o te aroturukitanga, me whakarite te taputapu ki te kore i te tuatahi; i te wā e aroturukitia ana, me pupuri tonu te pūoko pēhanga kia rite ki te taumata o te ngākau. Hei ārai i te totohu o te katitere, me horoi te katitere ki ngā werohanga tote heparin tonu, ka neke pea, ka puta rānei i te nekehanga. Nō reira, me mau tonu te katitere, ā, me tirotiro marie, ā, me whakatikatika mēnā e tika ana.
(3) Te aroturuki i te pāmahana
Ko te thermistor me te tauwehenga pāmahana kino te mea e whakamahia whānuitia ana hei pūoko pāmahana i roto i te ine pāmahana o te aroturuki. Ka whakaratohia e ngā aroturuki whānui he pāmahana tinana kotahi, ā, ka whakaratohia e ngā taputapu kounga teitei he pāmahana tinana e rua. Ka wehea hoki ngā momo tirotiro pāmahana tinana ki te tirotiro mata tinana me te tirotiro poka tinana, e whakamahia ana hei aroturuki i te mata tinana me te pāmahana poka.
I te wā e ine ana, ka taea e te kaiwhakahaere te whakanoho i te ine pāmahana ki tētahi wāhanga o te tinana o te tūroro e ai ki te hiahia. Nā te mea he rerekē ngā pāmahana o ia wāhanga o te tinana tangata, ko te pāmahana e inehia ana e te aroturuki ko te uara pāmahana o te wāhanga o te tinana o te tūroro hei whakanoho i te ine, he rerekē pea i te uara pāmahana o te waha, o te kēkē rānei.
WIna inehia te pāmahana, ka puta he raruraru taurite pāmahana i waenganui i te wāhanga tinana o te tūroro me te pūoko i roto i te ine, arā, i te wā tuatahi i whakatakotoria ai te ine, nā te mea kāore anō kia taurite te pūoko ki te pāmahana o te tinana tangata. Nō reira, ko te pāmahana e whakaaturia ana i tēnei wā ehara i te pāmahana tūturu o te tari, ā, me tae atu i muri i tētahi wā kia tae atu ki te taurite pāmahana i mua i te whakaata pono i te pāmahana tūturu. Kia tūpato hoki kia mau tonu te hononga pono i waenganui i te pūoko me te mata o te tinana. Mena he āputa i waenganui i te pūoko me te kiri, tera pea he iti te uara ine.
(4) Te aroturuki i te ECG
Mā te mahi hikohiko o ngā "pūtau whakaoho" i roto i te uaua ngākau ka whakaoho te uaua ngākau i te hiko. Ka whakawhāitihia te ngākau e te miihini. Ka rere te ia kati me te ia mahi i hangaia e tēnei tukanga whakaoho o te ngākau mā roto i te kaiārahi rōrahi o te tinana, ka horapa ki ngā wāhanga rerekē o te tinana, ka hua ake he panoni i te rerekētanga o te ia i waenga i ngā wāhanga mata rerekē o te tinana tangata.
Te hiko o te manawa Ko te tikanga o te ECG he tuhi i te rerekētanga pūmanawa o te mata o te tinana i te wā tūturu, ā, ko te ariā o te mata e pā ana ki te tauira ngaru o te rerekētanga pūmanawa i waenga i ngā wāhanga mata o te tinana e rua, neke atu rānei, o te tinana tangata me te huringa o te huringa ngākau. Ko ngā mata Ⅰ, Ⅱ, Ⅲ kua tautuhia i mua rawa atu ka kiia he mata peka paerewa bipolar.
Nō muri mai, i tautuhia ngā arai peka kotahi-polar pēhanga, arā, aVR, aVL, aVF me ngā arai uma kore-hiko V1, V2, V3, V4, V5, V6, koinei ngā arai ECG paerewa e whakamahia ana i roto i te mahi haumanu. Nā te mea he stereoscopic te ngākau, ka tohu te āhua o te arai i te mahi hiko i runga i te mata whakaata kotahi o te ngākau. Ka whakaatahia e ēnei arai 12 te mahi hiko i runga i ngā mata whakaata rerekē o te ngākau mai i ngā taha 12, ā, ka taea te tātaritanga whānui i ngā whara o ngā wāhanga rerekē o te ngākau.
I tēnei wā, ko te mīhini ECG paerewa e whakamahia ana i roto i te mahi haumanu e ine ana i te āhua o te ngaru ECG, ā, ko ōna irahiko peka kei te ringaringa me te pona, ko ngā irahiko i roto i te aroturuki ECG kei roto i te uma me te puku o te tūroro, ahakoa he rerekē te tūnga, he ōrite tonu, ā, he rite tonu te whakamāramatanga. Nō reira, ko te arataki ECG i roto i te aroturuki e rite ana ki te arataki i roto i te mīhini ECG, ā, he rite tonu te polarity me te āhua o te ngaru.
Ka taea e ngā aroturuki te aroturuki i ngā ara iahiko e 3, e 6 rānei, ka taea te whakaatu i te āhua ngaru o tētahi, o ngā ara iahiko e rua rānei i te wā kotahi, me te tango i ngā tawhā tere o te manawa mā te tātari āhua ngaru.. PKa taea e ngā aroturuki kaha te aroturuki i ngā ara iahiko 12, ā, ka taea hoki te tātari atu i te āhua o te ngaru hei tango i ngā wāhanga ST me ngā kaupapa arrhythmia.
I tēnei wā, ko teECGte āhua ngaru o te aroturukitanga, kāore i te tino kaha te kaha ki te tautuhi i te hanganga ngawari, nā te mea ko te kaupapa matua o te aroturukitanga he aroturuki i te manawataki o te manawa o te tūroro mō te wā roa, ā, i te wā tūturu hoki.. EngariteECGKa inehia ngā hua whakamātautau mīhini i roto i te wā poto i raro i ngā āhuatanga motuhake. Nō reira, kāore te whānui o te whānuitanga o te amplifier o ngā taputapu e rua i te ōrite. Ko te whānui o te amplifier o te mīhini ECG he 0.05~80Hz, ko te whānui o te amplifier ia he 1~25Hz te nuinga. He ngoikore te tohu ECG, ka pāngia ngāwari e te pokanoa o waho, ā, he tino uaua ki te wikitoria i ētahi momo pokanoa pēnei i:
(a) Te pokanoa o te nekehanga. Ka puta he panoni i roto i ngā tohu hiko i roto i te ngākau i ngā nekehanga tinana o te tūroro. Ko te kaha me te auau o tēnei nekehanga, mēnā kei roto i teECGte whānui o te kaha whakakaha, he uaua ki te wikitoria i te taputapu.
(b)Mte pokanoa hiko. Ina whakapirihia ngā uaua i raro i te hiko ECG, ka puta he tohu pokanoa EMG, ā, ka pokanoa te tohu EMG ki te tohu ECG, ā, he rite te whānuitanga o te tohu pokanoa EMG ki te tohu ECG, nō reira kāore e taea te whakakore noa mā te tātari.
(c) Te pokanoa o te maripi hiko auau-teitei. Ina whakamahia te hiko auau-teitei, te hiko rānei i te wā pokanga, he nui ake te kaha o te tohu hiko e whakaputaina ana e te kaha hiko e tāpirihia ana ki te tinana tangata i tērā o te tohu ECG, ā, he tino whai rawa te wāhanga auau, ā, ka eke te whakakaha ECG ki te āhua kua mātotoru, ā, kāore e taea te tirotiro i te āhua o te ngaru ECG. Kāore he mana o te nuinga o ngā aroturuki iahiko ki te ārai i taua pokanoa. Nō reira, ko te wāhanga pokanoa maripi hiko ārai-auau teitei o te aroturuki me hoki noa te aroturuki ki tōna āhua noa i roto i te 5 hēkona i muri i te tangohanga o te maripi hiko auau-teitei.
(d) Te pokanoa ki te pā o te hikohiko. Mā te pokanoa i te ara tohu hiko mai i te tinana tangata ki te whakakaha ECG ka puta he haruru kaha ka huna pea i te tohu ECG, he maha ngā wā ka puta mai i te korenga o te pā o ngā hikohiko me te kiri. Ko te ārai i ēnei pokanoa ka taea te whakakore mā te whakamahi i ngā tikanga, me āta tirotiro te kaiwhakamahi i ia wāhanga i ia wā, ā, me tū tika te taputapu ki te whenua, ehara i te mea he pai anake mō te whawhai ki ngā pokanoa, engari he mea nui ake, ko te tiaki i te haumaru o ngā tūroro me ngā kaiwhakahaere.
5. Kore-whakaekengaaroturuki toto toto
Ko te pēhanga toto e pā ana ki te pēhanga o te toto i runga i ngā pakitara o ngā uaua toto. I roto i ia tukanga o te whakaheke me te whakangā o te ngākau, ka rerekē anō hoki te pēhanga o te rere o te toto i runga i te pakitara o ngā uaua toto, ā, he rerekē te pēhanga o ngā uaua toto me ngā uaua toto, ā, he rerekē anō hoki te pēhanga o ngā uaua toto i ngā wāhanga rerekē. I roto i te haumanu, ko ngā uara pēhanga o ngā wā systolic me te diastolic e rite ana i roto i ngā uaua toto i te teitei kotahi me te ringa o runga o te tinana tangata e whakamahia ana hei whakaahua i te pēhanga toto o te tinana tangata, e kiia nei ko te pēhanga toto systolic (te toto toto tiketike rānei) me te pēhanga diastolic (te pēhanga iti rānei).
He tawhā ā-tinana rerekē te toto toto o te tinana. He pānga nui ki te āhua hinengaro o te tangata, te āhua o ngā kare ā-roto, me te tū me te tūranga i te wā e inehia ana, ka piki ake te tere o te ngakau, ka piki ake te toto toto diastolic, ka puhoi te tere o te ngakau, ā, ka heke te toto toto diastolic. I te piki haere o te maha o ngā whiu i roto i te ngakau, ka piki ake te toto toto systolic. Ka taea te kī kāore te toto toto toto i roto i ia huringa ngakau e tino ōrite.
Ko te tikanga wiri he tikanga hou mō te ine i te pēhanga toto uaua kore-whakaeke i whakawhanakehia i te tekau tau atu i 1970,me ōnaKo te mātāpono he whakamahi i te poroporo hei pupuhi ki tētahi pēhanga ina tino pēhia ngā oko toto uaua, ā, ka aukati i te rere o te toto uaua, ā, i te hekenga o te pēhanga o te poroporo, ka whakaatu te tukanga panoni o ngā oko toto uaua mai i te aukati katoa → te whakatuwheratanga āta → te whakatuwheratanga katoa.
I tēnei tukanga, nā te mea ka puta he ngaru wiri hau i roto i te hau i roto i te poroporo, he rite tonu te hononga o tēnei ngaru wiri ki te toto toto systolic, te toto toto diastolic me te toto toto toharite, ā, ka taea te whiwhi i te toto toto systolic, te toto toharite me te toto toto diastolic o te wāhi i inehia mā te ine, te tuhi me te tātari i ngā ngaru wiri pēhanga i roto i te poroporo i te wā o te tukanga whakaheke toto.
Ko te kaupapa matua o te tikanga wiri ko te kimi i te pāorooro auau o te pēhanga uaua. AhauI roto i te tukanga ine tuturu, nā te nekehanga o te tūroro, te pokanoa rānei o waho e pā ana ki te huringa pēhanga i roto i te poroporo ringaringa, e kore e taea e te taputapu te kite i ngā piki me ngā heke o te uaua, nō reira ka kore pea e rahua te ine.
I tēnei wā, kua whakamahia e ētahi aroturuki ngā tikanga ārai-whakararuraru, pērā i te whakamahinga o te tikanga whakaheke arawhata, mā te pūmanawa hei whakatau aunoa i te whakararuraru me ngā ngaru pupuhi noa o te uaua, kia whai kaha ai ki te ārai-whakararuraru. Engari ki te nui rawa te whakararuraru, ki te roa rawa rānei, kāore e taea e tēnei tikanga ārai-whakararuraru te mahi i tetahi mea mōna. Nō reira, i roto i te tukanga aroturuki toto kore-whakaeke, me ngana ki te whakarite kia pai te āhua o te whakamātautau, engari me aro hoki ki te whiriwhiri i te rahi o te ringaringa, te tūnga me te piri o te paihere.
6. Te aroturuki i te mākū o te hāora o te uaua (SpO2)
He mea nui te hāora i roto i ngā mahi o te ao. Ka haria ngā ngota hāora hohe i roto i te toto ki ngā kiko puta noa i te tinana mā te herea ki te hemoglobin (Hb) hei hanga i te hemoglobin whai hāora (HbO2). Ko te tawhā e whakamahia ana hei tohu i te ōwehenga o te hemoglobin whai hāora i roto i te toto ka kiia ko te mākū o te hāora.
Ko te ine i te kukū hāora o te uaua kore-whakaeke e ahu mai ana i ngā āhuatanga mimiti o te hemoglobin me te hemoglobin whai hāora i roto i te toto, mā te whakamahi i ngā roangaru rerekē e rua o te mārama whero (660nm) me te mārama infrared (940nm) mā roto i te kiko, kātahi ka hurihia hei tohu hiko e te kaiwhiwhi whakaahua-hiko, me te whakamahi anō hoki i ētahi atu wāhanga o te kiko, pērā i: te kiri, te wheua, te uaua, te toto uaua, me ētahi atu. He pumau te tohu mimiti, ā, ko te tohu mimiti anake o te HbO2 me te Hb i roto i te uaua ka hurihia i te huringa me te pā, ka whiwhi mā te tukatuka i te tohu kua whiwhi.
Ka kitea ko tēnei tikanga anake ka taea te ine i te nui o te hāora i roto i te toto uaua, ā, ko te tikanga e tika ana mō te ine ko te rere o te toto uaua e pupuhi ana. I roto i te haumanu, ka whakanohoia te pūoko ki ngā wāhanga kiko kāore i te matotoru te rere o te toto uaua, pērā i ngā maihao, ngā māihao waewae, ngā taringa me ētahi atu wāhanga. Heoi, ki te mea he nekehanga kaha kei roto i te wāhanga i inehia, ka pā ki te tango i tēnei tohu pupuhi auau, ā, kāore e taea te ine.
Ina tino ngoikore te rere o te toto i roto i te tinana o te tūroro, ka heke te rere o te toto i te wāhi e inehia ana, ā, ka hē te ine. Ina iti te pāmahana o te tinana o te wāhi ine o te tūroro e tino ngaro ana te toto, ki te whiti te mārama kaha ki te mata o te taputapu, ka rerekē pea te mahi a te taputapu hopu hiko mai i te awhe noa, ā, ka hē te ine. Nō reira, me karo te mārama kaha i te wā e ine ana.
7. Te aroturuki i te hauhā waro manawa (PetCO2)
He tohu aroturuki nui te hauhā waro manawa mō ngā tūroro mate whakamoe me ngā tūroro e pāngia ana e ngā mate pūnaha pākia manawa. Ko te tikanga mimiti whero te nuinga o te wā e whakamahia ana mō te ine i te CO2; arā, he rerekē ngā taumata o te mārama whero motuhake e mimitihia ana e ngā kukū rerekē o te CO2. E rua ngā momo aroturuki CO2: te aroturuki matua me te aroturuki taha.
Ko te momo matua ka whakanoho tika i te pūoko hau ki roto i te awa hau manawa o te tūroro. Ka whakahaerehia tika te hurihanga kukū o te CO2 i roto i te hau manawa, kātahi ka tukuna te tohu hiko ki te aroturuki hei tātari me te tukatuka hei whiwhi i ngā tawhā PetCO2. Ka whakanohoia te pūoko whatu rere-taha ki roto i te aroturuki, ā, ka tangohia te tauira hau manawa o te tūroro i te wā tūturu e te ngongo tauira hau ka tukuna ki te aroturuki hei tātari kukū CO2.
I te wā e aroturuki ana i te CO2, me aro tātou ki ēnei raruraru e whai ake nei: Nā te mea he pūoko whatu te pūoko CO2, me aro nui tātou i te wā e whakamahia ana kia kore ai e pāngia te pūoko e te parahanga kino pērā i te paru o te tūroro; Ko ngā pūoko CO2 taha-rere he mea whakarite ki te wehewehe hau-wai hei tango i te makuku mai i te hau manawa. Me tirotiro tonu mēnā kei te mahi pai te wehewehe hau-wai; ki te kore, ka pā te makuku o te hau ki te tika o te ine.
He uaua ki te whakatika i ētahi hapa o te ine i ngā tawhā rerekē. Ahakoa he nui te mōhio o ēnei aroturuki, kāore e taea e rātou te whakakapi katoa i te tangata i tēnei wā, ā, me mahi tonu ngā kaiwhakahaere ki te tātari, ki te aromatawai me te whakahaere tika i aua tawhā. Me āta mahi, ā, me aromatawai tika hoki i ngā hua o te ine.
Wā tuku: Pipiri-10-2022
