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Ukusetshenziswa kanye nesimiso sokusebenza sokuqapha isiguli se-multiparameter

I-Multiparameter isiguli qapha (izigaba zabaqaphi) zinganikeza ulwazi lwezokwelapha lokuqala kanye nezinhlobonhloboizimpawu ezibalulekile imingcele yokuqapha iziguli kanye nokuhlenga iziguli. Angokusetshenziswa kwamamonitha ezibhedlela, wngifundile lokhoeumnyango ngamunye wezokwelapha awukwazi ukusebenzisa i-monitor ukuze isetshenziswe ngokukhethekile.Ikakhulukazi, u-opharetha omusha akazi okuningi mayelana nokuqapha, okuholela ezinkingeni eziningi ekusetshenzisweni komqapha, futhi akakwazi ukudlala ngokugcwele umsebenzi wensimbi.Yonker amasheyaiukusetshenziswa kanye nomgomo wokusebenza wei-multiparameter qapha wonke umuntu.

Umqaphi wesiguli angathola okuthile okubalulekile okubalulekileizimpawu imingcele yeziguli ngesikhathi sangempela, ngokuqhubekayo futhi isikhathi eside, esinenani elibalulekile lomtholampilo.Kodwa futhi ephathekayo ephathekayo, ukusetshenziswa imoto-agibele amahhashi, kakhulu ngcono ukusetshenziswa imvamisa.Okwamanje,i-multiparameter ukuqapha isiguli kuvamile, futhi imisebenzi yayo eyinhloko ihlanganisa i-ECG, umfutho wegazi, izinga lokushisa, ukuphefumula,I-SpO2, I-ETCO2, I-IBP, ukuphuma kwenhliziyo, njll.

1. Isakhiwo esiyisisekelo semonitha

Imonitha ivamise ukwakhiwa ngemojuli ephathekayo equkethe izinzwa ezahlukahlukene kanye nesistimu yekhompyutha eyakhelwe ngaphakathi.Zonke izinhlobo zezimpawu zomzimba ziguqulwa zibe amasignali kagesi ngezinzwa, bese zithunyelwa kukhompyutha ukuze ziboniswe, zigcinwe futhi ziphathwe ngemva kokukhulisa ngaphambilini.Ukuqapha okuphelele kwepharamitha esebenzayo kungaqapha i-ecg, ukuphefumula, izinga lokushisa, umfutho wegazi,I-SpO2 kanye neminye imingcele ngesikhathi esifanayo.

Modular isiguli qaphangokuvamile zisetshenziswa ekunakekelweni okukhulu.Akhiwe amamojula ahlukene ahlukanisekayo wepharamitha yokuphila kanye nokuqapha ababungazi, futhi angakhiwa amamojula ahlukene ngokuya ngezidingo ukuze ahlangabezane nezidingo ezikhethekile.

2. The ukusetshenziswa kanye nomgomo wokusebenza wei-multiparameter qapha

(1) Ukunakekelwa kokuphefumula

Izilinganiso eziningi zokuphefumula kui-multiparameterqapha isigulisebenzisa indlela ye-chest impedance.Ukunyakaza kwesifuba somzimba womuntu ngesikhathi sokuphefumula kubangela ukuguqulwa kokumelana nomzimba, okuyi-0.1 ω ~ 3 ω, eyaziwa ngokuthi i-impedance yokuphefumula.

Imonitha ivamise ukucosha amasignali ezinguquko zokuthikamezeka kokuphefumula ku-electrode efanayo ngokujova amandla amanje aphephile angu-0.5 kuya ku-5mA kumvamisa ye-sinusoidal carrier engu-10 kuya ku-100kHz ngokusebenzisa ama-electrode amabili I-ECG ukuhola.I-waveform eguquguqukayo yokuphefumula ingachazwa ngokuhlukahluka kwe-impedance yokuphefumula, futhi imingcele yezinga lokuphefumula ingakhishwa.

Ukunyakaza kwe-thoracic kanye nokunyakaza okungaphefumuli komzimba kuzodala izinguquko ekuphikisweni komzimba.Uma imvamisa yoshintsho olunjalo ifana nebhendi yokuvama yeamplifier yesiteshi sokuphefumula, kuba nzima ngomqapha ukunquma ukuthi iyiphi isignali evamile yokuphefumula nokuthi iyiphi isignali yokuphazamiseka kokunyakaza.Ngenxa yalokho, izilinganiso zezinga lokuphefumula zingase zinganembile lapho isiguli sinokunyakaza komzimba okunzima nokuqhubekayo.

(2) Ukuqapha komfutho wegazi ongenayo (IBP).

Kokunye ukuhlinzwa okunzima, ukuqapha ngesikhathi sangempela umfutho wegazi kunenani lomtholampilo elibaluleke kakhulu, ngakho-ke kuyadingeka ukusebenzisa ubuchwepheshe bokuqapha umfutho wegazi okuhlaselayo ukuze kufinyelelwe.Umgomo uthi: okokuqala, i-catheter ifakwa emithanjeni yegazi yesayithi elilinganisiwe ngokubhoboza.Imbobo yangaphandle ye-catheter ixhunywe ngokuqondile nenzwa yokucindezela, futhi usawoti ovamile ujovwa ku-catheter.

Ngenxa yomsebenzi wokudlulisa ingcindezi yoketshezi, ingcindezi ye-intravascular izodluliselwa kunzwa yokucindezela yangaphandle ngoketshezi oluku-catheter.Ngakho-ke, i-waveform eguquguqukayo yezinguquko zokucindezela emithanjeni yegazi ingatholakala.Ingcindezi ye-Systolic, i-diastolic pressure kanye ne-mean pressure ingatholwa ngezindlela ezithile zokubala.

Kufanele kuqashelwe ukulinganiswa komfutho wegazi okuhlaselayo: ekuqaleni kokuqapha, ithuluzi kufanele lilungiswe libe nguziro ekuqaleni;Phakathi nenqubo yokuqapha, inzwa yokucindezela kufanele ihlale igcinwe ezingeni elifanayo nenhliziyo.Ukuze uvimbele ukujiya kwe-catheter, i-catheter kufanele igezwe ngemijovo eqhubekayo ye-heparin saline, engase inyakaze noma iphume ngenxa yokunyakaza.Ngakho-ke, i-catheter kufanele ilungiswe ngokuqinile futhi ihlolwe ngokucophelela, futhi kufanele kwenziwe ukulungiswa uma kunesidingo.

(3) Ukuqapha izinga lokushisa

I-Thermistor ene-coefficient yezinga lokushisa elibi ngokuvamile isetshenziswa njengenzwa yezinga lokushisa esilinganisweni sokushisa semonitha.Amamonitha ajwayelekile ahlinzeka ngezinga lokushisa elilodwa lomzimba, futhi amathuluzi asezingeni eliphezulu ahlinzeka ngezinga lokushisa lomzimba elikabili.Izinhlobo zokuhlola izinga lokushisa lomzimba nazo zihlukaniswe zaba i-probe yendawo yomzimba kanye ne-probe ye-cavity yomzimba, ngokulandelanayo isetshenziselwa ukuqapha ubuso bomzimba kanye nezinga lokushisa lomgodi.

Lapho ekala, u-opharetha angafaka isivivinyo sokushisa kunoma iyiphi ingxenye yomzimba wesiguli ngokwesidingo.Ngenxa yokuthi izingxenye ezihlukene zomzimba womuntu zinamazinga okushisa ahlukene, izinga lokushisa elikalwa umqaphi inani lokushisa lengxenye yomzimba wesiguli yokubeka uphenyo, okungenzeka lwehluke enanini lokushisa lomlomo noma lekhwapha.

Wisikhukhukazi sithatha isilinganiso sokushisa, kunenkinga yebhalansi yokushisa phakathi kwengxenye elinganisiwe yomzimba wesiguli kanye nenzwa ku-probe, okungukuthi, lapho uphenyo lufakwa okokuqala, ngoba inzwa ayikalingani ngokugcwele nezinga lokushisa umzimba womuntu.Ngakho-ke, izinga lokushisa eliboniswa ngalesi sikhathi alilona izinga lokushisa langempela lenkonzo, futhi kufanele lifinyelelwe ngemva kwesikhathi esithile ukuze lifinyelele ukulingana kokushisa ngaphambi kokuba izinga lokushisa langempela libonakale ngempela.Futhi qaphela ukugcina ukuxhumana okuthembekile phakathi kwenzwa nobuso bomzimba.Uma kukhona igebe phakathi kwenzwa nesikhumba, inani lokulinganisa lingase libe liphansi.

(4) Ukuqapha kwe-ECG

Umsebenzi we-electrochemical "wamaseli ajabulisayo" ku-myocardium kubangela ukuthi i-myocardium ijabule ngogesi.Ibangela inhliziyo ukuthi ifinyeleke ngomshini.Umsinga ovaliwe kanye nesenzo okhiqizwa yile nqubo ethokozisayo yenhliziyo ugeleza ku-conductor wevolumu yomzimba futhi usakazekela ezingxenyeni ezihlukahlukene zomzimba, okuholela ekushintsheni umehluko wamanje phakathi kwezingxenye ezingaphezulu zomzimba womuntu.

I-Electrocardiogram ( ECG ) ukurekhoda umehluko ongase ube khona ebusweni bomzimba ngesikhathi sangempela, futhi umqondo wokuhola ubhekisela kuphethini ye-waveform yomehluko ongase ube khona phakathi kwezingxenye ezimbili noma ngaphezulu zomzimba womzimba womuntu ngokushintsha komjikelezo wenhliziyo.Imikhondo yakudala echazwe Ⅰ, Ⅱ, Ⅲ ibizwa ngokuthi i-bipolar standard limb lead.

Kamuva, imikhondo yemilenze ye-unipolar ecindezelwe yachazwa, i-aVR, i-aVL, i-aVF kanye nesifuba esingena-electrodeless ihola i-V1, i-V2, i-V3, i-V4, i-V5, i-V6, okuyizinkomba ezijwayelekile ze-ECG ezisetshenziswa njengamanje ekusebenzeni komtholampilo.Ngenxa yokuthi inhliziyo i-stereoscopic, i-lead waveform imelela umsebenzi kagesi endaweni eyodwa yenhliziyo.Le mikhondo eyi-12 izokhombisa ukusebenza kukagesi ezindaweni ezihlukene zenhliziyo kusuka ezinhlangothini eziyi-12, futhi izilonda zezingxenye ezihlukene zenhliziyo zingaxilongwa ngokuphelele.

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Njengamanje, umshini we-ECG ojwayelekile osetshenziswa emtholampilo ukala i-waveform ye-ECG, futhi ama-electrode ayo esitho abekwe esihlakaleni naseqakaleni, kuyilapho ama-electrode ekuqashweni kwe-ECG abekwe ngokulinganayo esifubeni nesisu sesiguli, nakuba ukubekwa ahlukene, ayalingana, futhi incazelo yawo iyafana.Ngakho-ke, ukuqhutshwa kwe-ECG ku-monitor kuhambisana nokuhola emshinini we-ECG, futhi bane-polarity efanayo ne-waveform.

Amamonitha ngokuvamile angaqapha imikhondo emi-3 noma engu-6, angabonisa ngasikhathi sinye i-waveform eyodwa noma yomibili umkhondo futhi akhiphe amapharamitha wesilinganiso senhliziyo ngokuhlaziywa kwe-waveform.. Pabaqaphi abanamandla bangakwazi ukuqapha imikhondo ye-12, futhi bangaqhubeka nokuhlaziya i-waveform ukuze bakhiphe izingxenye ze-ST kanye nemicimbi ye-arrhythmia.

Njengamanje, i-I-ECGi-waveform yokuqapha, ikhono layo lokuxilongwa kwesakhiwo esicashile alinamandla kakhulu, ngoba inhloso yokuqapha iwukuqapha isigqi senhliziyo yesiguli isikhathi eside nangesikhathi sangempela.. KodwaiI-ECGimiphumela yokuhlolwa komshini ikalwa ngesikhathi esifushane ngaphansi kwezimo ezithile.Ngakho-ke, ububanzi be-amplifier bandpass yezinsimbi ezimbili akufani.Umkhawulokudonsa womshini we-ECG ngu-0.05~80Hz, kuyilapho umkhawulokudonsa wemonitha ngokuvamile uba ngu-1~25Hz.Isignali ye-ECG iyisignali ebuthakathaka uma kuqhathaniswa, ethinteka kalula ukuphazamiseka kwangaphandle, futhi ezinye izinhlobo zokuphazamiseka okunzima kakhulu ukuzinqoba ezifana nalezi:

(a) Ukugxambukela kokunyakaza.Ukunyakaza komzimba wesiguli kuzodala izinguquko kumasignali kagesi enhliziyweni.I-amplitude kanye nemvamisa yalokhu kunyakaza, uma kungaphakathi kwe-I-ECGi-amplifier bandwidth, ithuluzi kunzima ukunqoba.

(b)Mukuphazamiseka kwe-yoelectric.Lapho imisipha engaphansi kwe-electrode ye-ECG inamathiselwe, kukhiqizwa isignali yokuphazanyiswa ye-EMG, futhi isignali ye-EMG iphazamisa isignali ye-ECG, futhi isignali yokuphazamiseka ye-EMG inomkhawulokudonsa we-spectral ofanayo njengesignali ye-ECG, ngakho ayikwazi ukusulwa kalula isihlungi.

(c) Ukuphazamiseka kommese kagesi osebenzisa amaza aphezulu.Lapho kusetshenziswa i-high-frequency electrocution noma i-electrocution ngesikhathi sokuhlinzwa, ukuphakama kwesignali kagesi ekhiqizwa amandla kagesi angezwe emzimbeni womuntu kukhulu kakhulu kunesiginali ye-ECG, futhi ingxenye yemvamisa icebile kakhulu, kangangokuthi i-ECG I-amplifier ifinyelela esimweni esigcwele, futhi i-waveform ye-ECG ayikwazi ukubonwa.Cishe bonke abaqaphi bamanje abanamandla okumelana nokuphazamiseka okunjalo.Ngakho-ke, ingxenye yokuqapha ephikisana nokuphakama kommese kagesi idinga kuphela ukuthi imonitha ibuyele esimweni esivamile phakathi kwama-5 ngemva kokuhoxiswa kommese kagesi oyifrikhwensi ephezulu.

(d) Ukuphazanyiswa kokuxhumana kwe-Electrode.Noma yikuphi ukuphazamiseka endleleni yesignali kagesi kusuka emzimbeni womuntu kuya ku-ECG amplifier kuzodala umsindo onamandla ongase ufihle isignali ye-ECG, evame ukubangelwa ukuthintana okungalungile phakathi kwama-electrode nesikhumba.Ukuvimbela ukuphazanyiswa okunjalo kunqotshwa ngokuyinhloko ekusetshenzisweni kwezindlela, umsebenzisi kufanele ahlole ngokucophelela izingxenye ngayinye ngaso sonke isikhathi, futhi insimbi kufanele isekelwe ngokuthembekile, okungeyona nje enhle ukulwa nokuphazanyiswa, kodwa okubaluleke nakakhulu, ukuvikela ukuphepha kweziguli. kanye nabaqhubi.

5. Ayivamisileukuqapha umfutho wegazi

Umfutho wegazi ubhekisela ekucindezelekeni kwegazi ezindongeni zemithambo yegazi.Enqubweni yokufinyela ngakunye nokuphumula kwenhliziyo, umfutho wokugeleza kwegazi odongeni lwemithambo yegazi nawo uyashintsha, nomfutho wemithambo yegazi ye-arterial kanye nemithambo yegazi ye-venous wehlukile, nomfutho wegazi ezingxenyeni ezahlukene nawo uhlukile. ezahlukene.Ngokomtholampilo, amanani okucindezela ezikhathi ezihambisanayo ze-systolic ne-diastolic emithanjeni ye-arterial ukuphakama okufana nengalo engenhla yomzimba womuntu ngokuvamile asetshenziselwa ukukhombisa umfutho wegazi womzimba womuntu, obizwa ngokuthi i-systolic blood pressure (noma umfutho wegazi ophakeme). ) kanye nengcindezi ye-diastolic (noma ingcindezi ephansi), ngokulandelana.

Umfutho wegazi we-arterial womzimba uyipharamitha yefiziyoloji eguquguqukayo.Kuhlobene kakhulu nesimo sengqondo somuntu, isimo somzwelo, ukuma kanye nesimo ngesikhathi sokulinganisa, ukushaya kwenhliziyo kuyenyuka, umfutho wegazi we-diastolic ukhuphuka, ukushaya kwenhliziyo kuyehla, nomfutho wegazi we-diastolic uyancipha.Njengoba inani lemivimbo enhliziyweni landa, umfutho wegazi we-systolic nakanjani uyanda.Kungashiwo ukuthi umfutho wegazi we-arterial emjikelezweni ngamunye wenhliziyo ngeke ufane ngokuphelele.

Indlela yokudlidliza iyindlela entsha yokulinganisa umfutho wegazi we-arterial non-invasive eyasungulwa ngeminyaka yama-70s,futhi yayoUmgomo uwukusebenzisa i-cuff ukufuthela ingcindezi ethile lapho imithambo yegazi icindezelekile ngokuphelele futhi ivimbe ukugeleza kwegazi le-arterial, bese kuthi ngokuncipha komfutho we-cuff, imithambo yegazi ye-arterial izokhombisa inqubo yoshintsho ekuvimbeni ngokuphelele → ukuvulwa kancane kancane → ukuvulwa okugcwele.

Kule nqubo, njengoba ukushaya kwe-arterial vascular wall kuzokhiqiza amagagasi e-gas oscillation egesi ku-cuff, leli gagasi le-oscillation linokuxhumana okuqondile ne-arterial systolic blood pressure, i-diastolic pressure kanye nokucindezela okuphakathi, kanye ne-systolic, isho kanye ingcindezi ye-diastolic yesayithi elilinganisiwe ingatholakala ngokulinganisa, ukurekhoda nokuhlaziya amaza okucindezela okucindezelayo ku-cuff ngesikhathi senqubo yokunciphisa umoya.

Isisekelo sendlela yokudlidliza ukuthola ishayela elivamile lomfutho we-arterial.In inqubo yokulinganisa yangempela, ngenxa yokunyakaza kwesiguli noma ukuphazamiseka kwangaphandle okuthinta ukuguqulwa kwengcindezi ku-cuff, ithuluzi ngeke likwazi ukubona ukuguquguquka kwe-arterial evamile, ngakho-ke kungase kuholele ekuhlulekeni kokulinganisa.

Njengamanje, abanye abaqaphi baye bathatha izinyathelo zokulwa nokuphazamiseka, njengokusetshenziswa kwendlela yokunciphisa isitebhisi, ngesofthiwe ukuze inqume ngokuzenzakalelayo ukuphazamiseka namagagasi okushaya kwe-arterial pulsation, ukuze kube nezinga elithile lekhono lokulwa nokuphazamiseka.Kodwa uma ukugxambukela kubi kakhulu noma kuhlala isikhathi eside, lesi sinyathelo sokulwa nokuphazamiseka asinakwenza lutho ngakho.Ngakho-ke, enkambweni yokuqapha umfutho wegazi ongenakuvinjelwa, kuyadingeka ukuzama ukuqinisekisa ukuthi kunesimo esihle sokuhlola, kodwa futhi unake ukukhethwa kosayizi we-cuff, ukubekwa nokuqina kwenqwaba.

6. Ukuqapha kwe-Arterial oxygen saturation (SpO2).

Umoya-mpilo uyisithako esibalulekile emisebenzini yokuphila.Amangqamuzana omoya-mpilo osebenzayo egazini athuthelwa ezicutshini emzimbeni wonke ngokubophezela ku-hemoglobin (Hb) ukuze akhe i-hemoglobin ene-oksijini (HbO2).Ipharamitha esetshenziselwa ukubonisa ingxenye ye-hemoglobin ene-oksijini egazini ibizwa ngokuthi ukugcwaliswa kwe-oxygen.

Isilinganiso sokugcwala komoyampilo we-arterial esingavayisi sisekelwe ezicini zokumuncwa kwe-hemoglobin kanye ne-hemoglobin ene-oksijini egazini, ngokusebenzisa amaza amaza okukhanya okubomvu ahlukene (660nm) nokukhanya kwe-infrared (940nm) ngezicubu bese iguqulwa ibe amasignali kagesi umamukeli wezithombe zikagesi, kuyilapho kusetshenziswa ezinye izakhi kusicubu, njengalezi: isikhumba, ithambo, umsipha, igazi le-venous, njll. Isignali yokumuncwa ayishintshi, futhi isignali yokumunca kuphela ye-HbO2 ne-Hb emithanjeni eshintshwa ngokujikeleza kanye neshayela. , etholwa ngokucubungula isignali eyamukelwe.

Kungabonakala ukuthi le ndlela ingakala kuphela ukugcwala komoyampilo egazini egazini le-arterial, futhi isimo esidingekayo sokulinganisa ukugeleza kwegazi kwe-arterial pulsating.Ngokomtholampilo, inzwa ifakwa ezingxenyeni zezicubu ezinokugeleza kwegazi le-arterial kanye nokuqina kwezicubu ezingeqile, njengeminwe, izinzwane, izindlebe nezinye izingxenye.Kodwa-ke, uma kukhona ukunyakaza okunamandla engxenyeni elinganisiwe, kuzothinta ukukhishwa kwalesi siginali ye-pulsation evamile futhi ayikwazi ukulinganiswa.

Lapho ukujikeleza kwe-peripheral kwesiguli kubi kakhulu, kuzoholela ekwehleni kokugeleza kwegazi emithanjeni endaweni ezolinganiswa, okuholela esilinganisweni esingalungile.Uma izinga lokushisa lomzimba lendawo yokulinganisa yesiguli esilahlekelwe kakhulu igazi liphansi, uma kunokukhanya okunamandla okukhanya ku-probe, kungase kwenze ukusebenza kwedivayisi yokwamukela ugesi wesithombe kuphambuke ebangeni elivamile, okuholela esilinganisweni esingalungile.Ngakho-ke, ukukhanya okuqinile kufanele kugwenywe lapho kulinganiswa.

7. Ukuqapha i-carbon dioxide (PetCO2) yokuphefumula

I-carbon dioxide yokuphefumula iyinkomba ebalulekile yokuqapha ezigulini ezibulala izinzwa kanye neziguli ezinezifo zesistimu yokuphefumula.Isilinganiso se-CO2 sisebenzisa kakhulu indlela yokumunca infrared;Okusho ukuthi, ukugxila okuhlukile kwe-CO2 kudonsa amazinga ahlukene okukhanya kwe-infrared ethile.Kunezinhlobo ezimbili zokuqapha kwe-CO2: okujwayelekile kanye ne-sidestream.

Uhlobo olujwayelekile lubeka inzwa yegesi ngqo emhubheni wegesi yokuphefumula yesiguli.Ukuguqulwa kokuhlushwa kwe-CO2 kugesi yokuphefumula kwenziwa ngokuqondile, bese isignali kagesi ithunyelwa kumqapha ukuze ihlaziywe futhi icutshungulwe ukuze kutholwe imingcele ye-PetCO2.I-side-flow Optical sensor ifakwa kumonitha, futhi isampula yegesi yokuphefumula yesiguli ikhishwa ngesikhathi sangempela ngeshubhu yesampula yegesi futhi ithunyelwe kumonitha ukuze kuhlaziywe i-CO2.

Lapho senza ukuqapha kwe-CO2, kufanele sinake izinkinga ezilandelayo: Njengoba inzwa ye-CO2 iyinzwa ye-optical, ngesikhathi sokusetshenziswa, kuyadingeka ukunaka ukugwema ukungcola okungathi sína kwenzwa njengokuyimfihlo kwesiguli;Amamonitha e-Sidestream CO2 ngokuvamile afakwe isihlukanisi samanzi egesi ukuze asuse umswakama egesini yokuphefumula.Njalo hlola ukuthi ingabe isihlukanisi samanzi egesi sisebenza ngempumelelo;Uma kungenjalo, umswakama wegesi uzothinta ukunemba kokulinganisa.

Isilinganiso samapharamitha ahlukahlukene sinokushiyeka okuthile okunzima ukukunqoba.Nakuba laba baqaphi benezinga eliphakeme lobuhlakani, abakwazi ukuvala indawo yabantu ngokuphelele njengamanje, futhi abaqaphi basadingeka ukuze bahlaziye, bahlulele futhi babhekane nabo ngendlela efanele.Umsebenzi kufanele uqaphele, futhi imiphumela yokulinganisa kufanele yahlulelwe ngendlela efanele.


Isikhathi sokuthumela: Jun-10-2022