Ipharamitha ehlukahlukene isiguli imonitha (ukuhlukaniswa kwama-monitor) kunganikeza ulwazi lwezokwelapha oluvela ngqo kanye nezinhlobonhloboizimpawu ezibalulekile imingcele yokuqapha iziguli kanye nokusindisa iziguli. Angokusetshenziswa kwama-monitor ezibhedlela, wngifundile ukuthieUmnyango ngamunye wezokwelapha awukwazi ukusebenzisa i-monitha ukuze usetshenziswe ngokukhethekile. Ikakhulukazi, umqhubi omusha akazi okuningi nge-monitha, okubangela izinkinga eziningi ekusetshenzisweni kwe-monitha, futhi akakwazi ukudlala ngokugcwele umsebenzi wethuluzi.Yonker amasheyaiukusetshenziswa kanye nesimiso sokusebenzaipharamitha ehlukahlukene imonitha wonke umuntu.
I-monitor yesiguli ingathola ezinye izinto ezibalulekile ezibalulekileizimpawu imingcele yeziguli ngesikhathi sangempela, ngokuqhubekayo nangesikhathi eside, okunenani elibalulekile lezokwelapha. Kodwa futhi ukusetshenziswa kweselula ephathekayo, okufakwe emotweni, kuthuthukisa kakhulu imvamisa yokusetshenziswa. Okwamanje,ipharamitha ehlukahlukene Ukuqapha isiguli kuvamile, futhi imisebenzi yaso eyinhloko ihlanganisa i-ECG, umfutho wegazi, izinga lokushisa, ukuphefumula,I-SpO2, I-ETCO2, I-IBP, ukuphuma kwenhliziyo, njll.
1. Isakhiwo esiyisisekelo sesibuko
Imonitha ivame ukwakhiwa yimojuli ebonakalayo equkethe izinzwa ezahlukahlukene kanye nohlelo lwekhompyutha olwakhelwe ngaphakathi. Zonke izinhlobo zezibonakaliso zomzimba ziguqulwa zibe yizibonakaliso zikagesi yizinzwa, bese zithunyelwa kukhompyutha ukuze ziboniswe, zigcinwe futhi ziphathwe ngemva kokwandiswa kwangaphambilini. Imonitha ephelele yamapharamitha amaningi ingaqapha i-ECG, ukuphefumula, izinga lokushisa, umfutho wegazi,I-SpO2 kanye neminye imingcele ngesikhathi esifanayo.
Isiqaphi sesiguli esijwayelekilengokuvamile asetshenziswa ekunakekelweni okujulile. Akhiwe ngamamojula wepharamitha ye-physiological ahlukanisiwe kanye nama-monitor host, futhi angakhiwa ngamamojula ahlukene ngokwezidingo ukuze ahlangabezane nezidingo ezikhethekile.
2. The ukusetshenziswa kanye nesimiso sokusebenzaipharamitha ehlukahlukene imonitha
(1) Ukunakekelwa kokuphefumula
Izilinganiso eziningi zokuphefumula kuipharamitha ehlukahlukeneisiqaphi sesigulisebenzisa indlela yokuvimba isifuba. Ukunyakaza kwesifuba somzimba womuntu enkambisweni yokuphefumula kubangela ushintsho lokumelana komzimba, okungu-0.1 ω ~ 3 ω, okwaziwa ngokuthi i-respiratory impedance.
Isikrini sivame ukubona izimpawu zokushintsha kwe-impedance yokuphefumula ku-electrode efanayo ngokufaka ugesi ophephile ongu-0.5 kuya ku-5mA ngemvamisa yokuthwala i-sinusoidal engu-10 kuya ku-100kHz ngama-electrode amabili e- I-ECG i-lead. I-dynamic waveform yokuphefumula ingachazwa ngokuhlukahluka kwe-respiral impedance, futhi imingcele yesilinganiso sokuphefumula ingakhishwa.
Ukunyakaza kwesifuba kanye nokunyakaza komzimba okungenakho ukuphefumula kuzobangela izinguquko ekumelaneni komzimba. Uma imvamisa yalezi zinguquko ifana nebhendi yemvamisa ye-amplifier yesiteshi sokuphefumula, kunzima ukuthi i-monitor inqume ukuthi yisiphi isignali evamile yokuphefumula nokuthi yisiphi isignali yokuphazamiseka kokunyakaza. Ngenxa yalokho, izilinganiso zesilinganiso sokuphefumula zingase zingabi zinembile lapho isiguli sinokunyakaza okukhulu nokuqhubekayo ngokomzimba.
(2) Ukuqapha umfutho wegazi ohlaselayo (IBP)
Kwezinye izindlela zokuhlinzwa ezinzima, ukuqapha umfutho wegazi ngesikhathi sangempela kunenani elibaluleke kakhulu kwezokwelapha, ngakho-ke kuyadingeka ukusebenzisa ubuchwepheshe bokuqapha umfutho wegazi ukuze kufezwe lokhu. Umgomo uwukuthi: okokuqala, i-catheter ifakwa emithanjeni yegazi yendawo elinganisiwe ngokubhoboza. Imbobo yangaphandle ye-catheter ixhunywe ngqo nenzwa yokucindezela, bese kufakwa i-saline evamile ku-catheter.
Ngenxa yomsebenzi wokudlulisa ingcindezi yoketshezi, ingcindezi yangaphakathi kwemithambo yegazi izodluliselwa ku-sensor yengcindezi yangaphandle ngoketshezi oluku-catheter. Ngakho-ke, kungatholakala i-dynamic waveform yezinguquko zengcindezi emithanjeni yegazi. Ingcindezi ye-Systolic, ingcindezi ye-diastolic kanye nengcindezi emaphakathi ngezindlela ezithile zokubala.
Kufanele kunakwe ukulinganiswa komfutho wegazi ongenelelayo: ekuqaleni kokuqapha, ithuluzi kufanele lilungiswe libe yi-zero ekuqaleni; Ngesikhathi senqubo yokuqapha, inzwa yokucindezela kufanele ihlale igcinwe ezingeni elifanayo nenhliziyo. Ukuze kuvinjelwe ukujiya kwe-catheter, i-catheter kufanele ihlanzwe ngokujova okuqhubekayo kwe-heparin saline, engase ihambe noma iphume ngenxa yokunyakaza. Ngakho-ke, i-catheter kufanele iqiniswe futhi ihlolwe ngokucophelela, futhi kufanele kwenziwe ukulungiswa uma kudingeka.
(3) Ukuqapha izinga lokushisa
I-Thermistor ene-negative temperature coefficient ivame ukusetshenziswa njengenzwa yokushisa ekulinganisweni kokushisa kwemonitha. Amamonitha ajwayelekile ahlinzeka ngokushisa komzimba okukodwa, kanti amathuluzi aphezulu ahlinzeka ngokushisa komzimba okuphindwe kabili. Izinhlobo ze-probe yokushisa komzimba nazo zihlukaniswe nge-probe yobuso bomzimba kanye ne-probe yomgodi womzimba, ngokulandelana esetshenziselwa ukuqapha izinga lokushisa lobuso bomzimba kanye nomgodi.
Uma elinganisa, umqhubi angafaka i-temperature probe kunoma iyiphi ingxenye yomzimba wesiguli ngokwesidingo. Ngenxa yokuthi izingxenye ezahlukene zomzimba womuntu zinamazinga okushisa ahlukene, izinga lokushisa elilinganiswa yi-monitor liyinani lokushisa lengxenye yomzimba wesiguli ukuze kufakwe i-probe, okungase kuhluke enanini lokushisa lomlomo noma ekhwapheni.
WUma kuthathwa isilinganiso sokushisa, kuba nenkinga yokulinganisela ukushisa phakathi kwengxenye elinganisiwe yomzimba wesiguli kanye nenzwa ephrobheni, okungukuthi, lapho iphrobheni ibekwa okokuqala, ngoba inzwa ayikakalingani ngokugcwele nokushisa komzimba womuntu. Ngakho-ke, izinga lokushisa eliboniswa ngalesi sikhathi akulona izinga lokushisa langempela lenkonzo, futhi kumele lifinyelelwe ngemva kwesikhathi esithile ukuze lifinyelele ukulingana kokushisa ngaphambi kokuba izinga lokushisa langempela libonakale ngempela. Futhi qaphela ukuthi ugcina ukuxhumana okuthembekile phakathi kwenzwa kanye nobuso bomzimba. Uma kukhona igebe phakathi kwenzwa nesikhumba, inani lokulinganisa lingase libe liphansi.
(4) Ukuqapha i-ECG
Umsebenzi we-electrochemical "wamaseli avuselelayo" ku-myocardium ubangela ukuthi i-myocardium ivuselelwe ngogesi. Kubangela ukuthi inhliziyo inciphe ngomshini. Ugesi ovaliwe kanye nowesenzo okhiqizwa yile nqubo yokuvuselela inhliziyo ugeleza ngomqhubi womthamo womzimba futhi usakazeke ezingxenyeni ezahlukene zomzimba, okuholela ekushintsheni komehluko wamanje phakathi kwezingxenye ezahlukene zomzimba womuntu.
I-Electrocardiogram (ECG) iwukuqopha umehluko ongaba khona ebusweni bomzimba ngesikhathi sangempela, futhi umqondo we-lead ubhekisela kuphethini yesimo samagagasi somehluko ongaba khona phakathi kwezingxenye ezimbili noma ngaphezulu zomzimba womzimba womuntu ngokushintsha komjikelezo wenhliziyo. Ama-lead achazwe kuqala Ⅰ, Ⅱ, Ⅲ abizwa ngokwezokwelapha ngokuthi ama-lead ajwayelekile e-bipolar.
Kamuva, kwachazwa ama-lead e-unipolar limb acindezelwe, i-aVR, i-aVL, i-aVF kanye nama-lead angena-electrode chest V1, V2, V3, V4, V5, V6, okuyi-lead ejwayelekile ye-ECG esetshenziswa njengamanje emtholampilo. Ngenxa yokuthi inhliziyo i-stereoscopic, i-lead waveform imelela umsebenzi kagesi endaweni eyodwa yokubuka yenhliziyo. Lawa ma-lead angu-12 azobonisa umsebenzi kagesi ezindaweni ezahlukene zokubuka zenhliziyo ezivela eziqondisweni ezingu-12, futhi izilonda zezingxenye ezahlukene zenhliziyo zingahlolwa ngokuphelele.
Njengamanje, umshini ojwayelekile we-ECG osetshenziswa emtholampilo ulinganisa isimo se-ECG waveform, kanti ama-electrode awo emilenze abekwa esihlakaleni nasemaqakaleni, kuyilapho ama-electrode ekuqapheni kwe-ECG abekwa ngokulinganayo esifubeni nasesiswini sesiguli, yize indawo ihlukile, ayalingana, futhi incazelo yawo iyafana. Ngakho-ke, ukuqhutshwa kwe-ECG kusikrini kuhambisana nomholi emshinini we-ECG, futhi ane-polarity efanayo kanye nesimo se-wave.
Ama-monitha ngokuvamile angaqapha ama-lead amathathu noma ayisithupha, angabonisa ngasikhathi sinye isimo se-wave somunye noma womabili ama-lead futhi akhiphe amapharamitha okushaya kwenhliziyo ngokuhlaziya isimo se-waveform.. PAmamonitha anamandla angaqapha ama-lead angu-12, futhi angahlaziya kabanzi i-waveform ukuze akhiphe izingxenye ze-ST kanye nemicimbi ye-arrhythmia.
Okwamanje, i-I-ECGI-waveform yokuqapha, ikhono layo lokuxilonga isakhiwo esicashile alinamandla kakhulu, ngoba inhloso yokuqapha ngokuyinhloko ukuqapha isigqi senhliziyo yesiguli isikhathi eside nangesikhathi sangempela.. KodwaiI-ECGImiphumela yokuhlolwa komshini ilinganiswa ngesikhathi esifushane ngaphansi kwezimo ezithile. Ngakho-ke, ububanzi be-bandpass ye-amplifier yalezi zinsimbi ezimbili abufani. I-bandwidth yomshini we-ECG ingu-0.05~80Hz, kuyilapho i-bandwidth yesikrini ngokuvamile ingu-1~25Hz. Isignali ye-ECG iyisignali ebuthakathaka, ethintwa kalula ukuphazamiseka kwangaphandle, futhi ezinye izinhlobo zokuphazamiseka kunzima kakhulu ukuzinqoba ezifana nalezi:
(a) Ukuphazamiseka kokunyakaza. Ukunyakaza komzimba wesiguli kuzobangela izinguquko ezimpawini zikagesi enhliziyweni. Ubukhulu kanye nokuvama kwalokhu kunyakaza, uma kungaphakathiI-ECGI-bandwidth ye-amplifier, ithuluzi kunzima ukulinqoba.
(b)Mukuphazamiseka kwe-yoelectric. Lapho imisipha engaphansi kwe-electrode ye-ECG inamathiselwa, kukhiqizwa isignali yokuphazamiseka kwe-EMG, bese isignali ye-EMG iphazamisa isignali ye-ECG, kanti isignali yokuphazamiseka kwe-EMG inomkhawulokudonsa ofanayo we-spectral njengesignali ye-ECG, ngakho-ke ayikwazi ukusulwa nje ngesihlungi.
(c) Ukuphazamiseka kommese kagesi osebenzisa imvamisa ephezulu. Uma kusetshenziswa ugesi noma ugesi osebenzisa imvamisa ephezulu ngesikhathi sokuhlinzwa, ubukhulu besiginali kagesi ekhiqizwa amandla kagesi angeziwe emzimbeni womuntu bukhulu kakhulu kunobowesignali ye-ECG, futhi ingxenye yemvamisa icebile kakhulu, kangangokuthi i-amplifier ye-ECG ifinyelela esimweni esigcwele, futhi isimo se-ECG asikwazi ukubonwa. Cishe zonke iziqaphi zamanje azinamandla okumelana nokuphazamiseka okunjalo. Ngakho-ke, ingxenye ye-monitor anti-high frequency electric ephazamisa ummese idinga kuphela ukuthi i-monitor ibuyele esimweni esijwayelekile zingakapheli imizuzwana emi-5 ngemuva kokuthi ummese kagesi osebenzisa imvamisa ephezulu uhoxisiwe.
(d) Ukuphazamiseka kokuxhumana kwe-electrode. Noma yikuphi ukuphazamiseka endleleni yesignali kagesi kusuka emzimbeni womuntu kuya ku-amplifier ye-ECG kuzobangela umsindo omkhulu ongase uvale isignali ye-ECG, okuvame ukubangelwa ukuxhumana okungekuhle phakathi kwama-electrode nesikhumba. Ukuvimbela ukuphazamiseka okunjalo kunqotshwa kakhulu ngokusebenzisa izindlela, umsebenzisi kufanele ahlole ngokucophelela izingxenye ngayinye njalo, futhi ithuluzi kufanele lisekelwe ngokuqinile, okungekuhle kuphela ekulweni nokuphazamiseka, kodwa okubaluleke kakhulu, ukuvikela ukuphepha kweziguli kanye nabaqhubi.
5. Okungahlaseliisiqaphi somfutho wegazi
Umfutho wegazi ubhekisela ekucindezelweni kwegazi ezindongeni zemithambo yegazi. Enkambisweni yokufinyela nokuphumula kwenhliziyo ngayinye, umfutho wegazi odongeni lwemithambo yegazi nawo uyashintsha, futhi umfutho wegazi odongeni lwemithambo yegazi kanye nemithambo yegazi emithanjeni uhlukile, kanti nomfutho wegazi ezingxenyeni ezahlukene nawo uhlukile. Ngokwezokwelapha, amanani omfutho wegazi ezikhathini ze-systolic kanye ne-diastolic ezihambisanayo emithanjeni yegazi ekuphakameni okufanayo nengalo engenhla yomzimba womuntu avame ukusetshenziswa ukuchaza umfutho wegazi womzimba womuntu, okubizwa ngokuthi umfutho wegazi ophansi (noma umfutho wegazi ophakeme) kanye nomfutho wegazi ophansi (noma umfutho wegazi ophansi), ngokulandelana.
Umfutho wegazi emzimbeni uyipharamitha eguquguqukayo yomzimba. Ihlobene kakhulu nesimo sengqondo sabantu, isimo sengqondo, kanye nesimo sabo ngesikhathi sokulinganisa, izinga lokushaya kwenhliziyo liyakhuphuka, umfutho wegazi we-diastolic uyakhuphuka, izinga lokushaya kwenhliziyo liyehla, kanti umfutho wegazi we-diastolic uyancipha. Njengoba inani lokushaya kwenhliziyo likhuphuka, umfutho wegazi we-systolic uzokhuphuka nakanjani. Kungashiwo ukuthi umfutho wegazi we-arterial kumjikelezo ngamunye wenhliziyo ngeke ufane ngokuphelele.
Indlela yokudlidliza iyindlela entsha yokulinganisa umfutho wegazi wemithambo engangenisi umfutho eyasungulwa ngawo-70s,futhiIsimiso siwukusebenzisa i-cuff ukuze ifuthwe iye ekucindezelweni okuthile lapho imithambo yegazi yemithambo icindezelwe ngokuphelele futhi ivimba ukugeleza kwegazi kwemithambo, bese kuthi ngokuncipha kwengcindezi ye-cuff, imithambo yegazi yemithambo izobonisa inqubo yokushintsha kusukela ekuvinjweni okuphelele → ukuvulwa kancane kancane → ukuvulwa okugcwele.
Kule nqubo, njengoba ukushaya kwenhliziyo kodonga lwemithambo yegazi kuzokhiqiza amagagasi okuzulazula kwegesi kugesi osesinqeni, leli gagasi lokuzulazula linokuhambisana okuqondile nomfutho wegazi we-systolic wemithambo yegazi, umfutho we-diastolic kanye nomfutho ojwayelekile, kanti umfutho we-systolic, omaphakathi kanye nowe-diastolic wendawo elinganisiwe ungatholakala ngokulinganisa, ukurekhoda kanye nokuhlaziya amagagasi okudlidliza kwengcindezi ku-cuff ngesikhathi senqubo yokuncibilika.
Isisekelo sendlela yokudlidliza ukuthola ukushaya kwenhliziyo okuvamile kwengcindezi yemithambo yegaziMinaNgenqubo yokulinganisa yangempela, ngenxa yokunyakaza kwesiguli noma ukuphazamiseka kwangaphandle okuthinta ushintsho lwengcindezi ku-cuff, ithuluzi ngeke likwazi ukubona ukuguquguquka okuvamile kwemithambo yegazi, ngakho-ke kungaholela ekwehlulekeni kokulinganisa.
Njengamanje, abanye abaqaphi basebenzise izindlela zokulwa nokuphazamiseka, njengokusebenzisa indlela yokukhuphula izinga lesitebhisi, ngesofthiwe ukuze kutholakale ngokuzenzakalelayo ukuphazamiseka kanye namagagasi avamile okushaya kwemithambo yegazi, ukuze kube nekhono elithile lokulwa nokuphazamiseka. Kodwa uma ukuphazamiseka kukhulu kakhulu noma kuthatha isikhathi eside kakhulu, lesi sinyathelo sokulwa nokuphazamiseka asinakwenza lutho ngakho. Ngakho-ke, enkambisweni yokuqapha umfutho wegazi ongewona owokuhlasela, kubalulekile ukuzama ukuqinisekisa ukuthi kukhona isimo esihle sokuhlola, kodwa futhi unake ukukhetha usayizi we-cuff, indawo kanye nokuqina kwesikhwama.
6. Ukuqapha ukugcwala komoya-mpilo we-arterial (SpO2)
I-oksijini iyinto ebalulekile emisebenzini yokuphila. Ama-molecule e-oksijini asebenzayo egazini athuthwa aye ezicutshini kuwo wonke umzimba ngokubopha ku-hemoglobin (Hb) ukuze akhe i-hemoglobin ene-oxygen (HbO2). Ipharamitha esetshenziselwa ukuchaza isilinganiso se-hemoglobin ene-oxygen egazini ibizwa ngokuthi ukugcwala kwe-oxygen.
Ukulinganiswa kokugcwala kwe-oxygen emithanjeni okungangenisi kusekelwe ezicini zokumunca ze-hemoglobin kanye ne-hemoglobin ene-oxygen egazini, ngokusebenzisa amaza amabili ahlukene okukhanya okubomvu (660nm) kanye nokukhanya kwe-infrared (940nm) ngezicubu bese kuguqulwa kube izimpawu zikagesi yi-photoelectric receiver, kuyilapho kusetshenziswa nezinye izingxenye ezicutshini, njenge: isikhumba, ithambo, imisipha, igazi lemithambo yegazi, njll. Isignali yokumunca ihlala njalo, futhi kuphela isignali yokumunca ye-HbO2 kanye ne-Hb emthanjeni eshintshwa ngokujikeleza nge-pulse, etholakala ngokucubungula isignali etholiwe.
Kungabonakala ukuthi le ndlela ingalinganisa kuphela ukugcwala komoya-mpilo egazini lemithambo yegazi, futhi isimo esidingekayo sokulinganisa ukugeleza kwegazi lemithambo yegazi elishayayo. Ngokwezokwelapha, inzwa ifakwa ezingxenyeni zezicubu ezinokugeleza kwegazi lemithambo yegazi kanye nobukhulu bezicubu obungebukhulu, njengeminwe, izinzwane, ama-earlobes nezinye izingxenye. Kodwa-ke, uma kukhona ukunyakaza okunamandla engxenyeni elinganisiwe, kuzothinta ukukhishwa kwalesi signali evamile yokushaya futhi akunakulinganiswa.
Uma ukujikeleza kwegazi kwesiguli kuphansi kakhulu, kuzoholela ekunciphiseni ukugeleza kwegazi emithanjeni endaweni okufanele ilinganiswe, okuzoholela ekulinganisweni okunganembile. Uma izinga lokushisa lomzimba lendawo yokulinganisa yesiguli esilahlekelwe yigazi kakhulu liphansi, uma kunokukhanya okunamandla okukhanya ku-probe, kungenza ukusebenza kwedivayisi yokwamukela i-photoelectric kuhluke ebangeni elijwayelekile, okuzoholela ekulinganisweni okunganembile. Ngakho-ke, ukukhanya okunamandla kufanele kugwenywe lapho kulinganiswa.
7. Ukuqapha kwe-carbon dioxide yokuphefumula (i-PetCO2)
I-carbon dioxide yokuphefumula iyisibonakaliso esibalulekile sokuqapha iziguli ezinesifo sokuphefumula kanye neziguli ezinezifo zesistimu yokuphefumula. Ukulinganiswa kwe-CO2 kusebenzisa kakhulu indlela yokumunca nge-infrared; Okusho ukuthi, amazinga ahlukene e-CO2 amunca amazinga ahlukene okukhanya kwe-infrared okuthile. Kunezinhlobo ezimbili zokuqapha i-CO2: okujwayelekile kanye nokuphuma eceleni.
Uhlobo olujwayelekile lubeka inzwa yegesi ngqo emgudwini wegesi yokuphefumula yesiguli. Ukuguqulwa kokuhlushwa kwe-CO2 kugesi yokuphefumula kwenziwa ngqo, bese isignali kagesi ithunyelwa kumonitha ukuze ihlaziywe futhi icutshungulwe ukuze kutholakale amapharamitha e-PetCO2. Inzwa yokukhanya eseceleni ifakwa kumonitha, bese isampula yegesi yokuphefumula yesiguli ikhishwa ngesikhathi sangempela yipayipi lokuhlola igesi bese ithunyelwa kumonitha ukuze kuhlaziywe ukuhlushwa kwe-CO2.
Lapho senza ukuqapha kwe-CO2, kufanele sinake lezi zinkinga ezilandelayo: Njengoba inzwa ye-CO2 iyinzwa yokukhanya, enkambisweni yokusetshenziswa, kubalulekile ukunaka ukuze kugwenywe ukungcoliswa okukhulu kwenzwa njengokuphuma koketshezi kwesiguli; Amamonitha e-CO2 aseceleni ngokuvamile afakwe isihlukanisi samanzi negesi ukuze kususwe umswakama kugesi ophefumulayo. Hlola njalo ukuthi isihlukanisi samanzi negesi sisebenza kahle yini; Ngaphandle kwalokho, umswakama kugesi uzothinta ukunemba kokulinganisa.
Ukulinganiswa kwamapharamitha ahlukahlukene kuneziphambeko ezithile okunzima ukuzinqoba. Nakuba la ma-monitor enobuhlakani obukhulu, awakwazi ukufaka abantu esikhundleni ngokuphelele okwamanje, futhi abaqhubi basadingeka ukuze bahlaziye, bahlulele futhi babhekane nabo ngendlela efanele. Umsebenzi kumele uqaphele, futhi imiphumela yokulinganisa kumele yahlulelwe ngendlela efanele.
Isikhathi sokuthunyelwe: Juni-10-2022
