Zviyero zvakawanda murwere monitori (kupatsanurwa kwevaongorori) vanogona kupa ruzivo rwekiriniki rwechokwadi uye zvakasiyana-siyanazviratidzo zvehupenyu parameters dzekutarisa varwere uye kununura varwere. Azvichienderana nekushandiswa kwemamonita muzvipatara, wndadzidza izvozvoeDhipatimendi rekiriniki rimwe nerimwe harigone kushandisa monitor iyi pakushandisa kwakakosha. Kunyanya, mushandi mutsva haazive zvakawanda nezve monitor iyi, zvichikonzera matambudziko akawanda pakushandisa monitor iyi, uye haakwanise kuita basa rayo zvizere.Yonker migoveiyokushandiswa uye musimboti wekushanda wemultiparameter monitori kune wese munhu.
Mucherechedzi wemurwere anogona kuona zvimwe zvinhu zvakakoshazviratidzo maparamita evarwere munguva chaiyo, nguva dzose uye kwenguva yakareba, izvo zvine kukosha kwakakosha mukurapa. Asiwo kushandiswa kunotakurika, kwakaiswa mumotokari, kunovandudza zvikuru mashandisirwo ekushandisa. Parizvino,multiparameter Mucherechedzi wevarwere anowanzoonekwa, uye mabasa ayo makuru anosanganisira ECG, BP, tembiricha, kufema,SpO2, ETCO2, IBP, kubuda kwemwoyo, nezvimwewo.
1. Chimiro chikuru chemonitor
Monitor inowanzova nemodule chaiyo ine masensa akasiyana-siyana uye sisitimu yekombuta yakavakirwa mukati. Mhando dzese dzemasaini emuviri anoshandurwa kuita masaini emagetsi nemasensa, uye obva atumirwa kukombuta kuti aonekwe, achengetwe uye atarisirwe mushure mekuwedzerwa simba. Monitor ine maparameter akawanda inogona kutarisa ecg, kufema, tembiricha, BP,SpO2 uye mamwe ma parameter panguva imwe chete.
Modular murwere moduleanowanzo shandiswa mukurapa kwakanyanya. Ane mamodule e physiological parameter anobviswa uye ma monitor hosts akasiyana, uye anogona kuumbwa nemamodule akasiyana zvichienderana nezvinodiwa kuti asvike kune zvinodiwa zvakakosha.
2. The kushandiswa uye musimboti wekushanda wemultiparameter monitori
(1) Kutarisirwa kwekufema
Zviyero zvakawanda zvekufema mumultiparametermonitori yemurwereshandisa nzira yekudzivisa chipfuva. Kufamba kwechipfuva chemuviri wemunhu panguva yekufema kunokonzera shanduko yekudzivirira kwemuviri, inova 0.1 ω ~ 3 ω, inozivikanwa se respiratory impedance.
Chinoongorora chinowanzo tarisa zviratidzo zvekuchinja kwemhepo inopinzwa paelectrode imwe chete nekupinza simba rakachengeteka re0.5 kusvika 5mA pafrequency yekutakura sinusoidal ye10 kusvika 100kHz kuburikidza nemaelectrode maviri e ECG Mutobvu. Mafambiro emhepo ekufema anogona kutsanangurwa nekusiyana kwesimba rekufema, uye zviyero zvekukurumidza kwekufema zvinogona kutorwa.
Kufamba kwechipfuva uye kufamba kwemuviri kusingapindi kufema kunokonzera shanduko mukuramba kwemuviri. Kana kuwanda kwekuchinja kwakadaro kwakafanana nebhendi refrequency respiratory channel amplifier, zvinonetsa kuti monitor ione kuti ndeipi chiratidzo chekufema chakajairika uye ndeipi chiratidzo chekupindira kwekufamba. Nekuda kweizvozvo, kuyerwa kwehuwandu hwekufema kunogona kunge kusina kururama kana murwere aine mafambiro emuviri akaomarara uye anoenderera mberi.
(2) Kuongororwa kweBP (Invasive blood pressure)
Mune mamwe maoparesheni akaomarara, kuongororwa kweropa panguva chaiyo kunokosha zvikuru, saka zvakakosha kushandisa tekinoroji yekuongorora BP kuti zvibudirire. Nheyo yacho ndeiyi: chekutanga, catheter inoiswa mutsinga dzeropa dzenzvimbo yakayerwa kuburikidza nekuboorwa. Nzvimbo yekunze yecatheter yakabatana zvakananga nesensor yekumanikidza, uye saline yakajairika inopinzwa mucatheter.
Nekuda kwebasa rekufambisa kumanikidzwa kwemvura, kumanikidzwa kweropa mukati meropa kuchaendeswa kune sensor yekumanikidza yekunze kuburikidza nemvura iri mucatheter. Saka, dynamic waveform yekuchinja kwekumanikidzwa mutsinga dzeropa inogona kuwanikwa. Kumanikidzwa kweSystolic, kumanikidzwa kwediastolic uye kumanikidzwa kwepakati zvinogona kuwanikwa nenzira dzakatarwa dzekuverenga.
Kuongororwa kweropa kunofanira kutariswa: pakutanga kwekuongorora, mudziyo unofanirwa kugadziriswa kusvika pazero pakutanga; Munguva yekutarisa, sensor yekumanikidza inofanira kugara iri padanho rakaenzana nemoyo. Kuti catheter isagwambe, catheter inofanira kusukwa nejekiseni reheparin saline nguva dzose, iro rinogona kufamba kana kubuda nekuda kwekufamba. Saka, catheter inofanira kugadziriswa zvakasimba uye kuongororwa nokungwarira, uye kugadziriswa kunofanira kuitwa kana zvichidikanwa.
(3) Kutarisa tembiricha
Thermistor ine negative temperature coefficient inowanzo shandiswa se sensor yetemperature pakuyera tembiricha yemonitor. General monitors dzinopa tembiricha imwe chete yemuviri, uye zvishandiso zvepamusoro zvinopa tembiricha mbiri yemuviri. Mhando dze probe yetembiricha yemuviri dzakakamurwawo kuita probe yemuviri ne probe yemuviri, zvichiteerana, dzinoshandiswa kutarisa tembiricha yemuviri nemuviri.
Pakuyera, mushandi anogona kuisa tembiricha muchikamu chipi zvacho chemuviri wemurwere zvichienderana nezvinodiwa. Nekuti zvikamu zvakasiyana zvemuviri wemunhu zvine tembiricha dzakasiyana, tembiricha inoyerwa nemonitor ndiyo tembiricha yechikamu chemuviri wemurwere kuti aise probe, izvo zvinogona kusiyana netembiricha yemuromo kana muhapwa.
WKana uchitora chiyero chekupisa, pane dambudziko rekupisa pakati pechikamu chakayerwa chemuviri wemurwere nesensa iri muprobe, ndiko kuti, apo probe inotanga kuiswa, nekuti sensa haisati yanyatsoenderana nekupisa kwemuviri wemunhu. Saka, tembiricha inoratidzwa panguva ino haisi tembiricha chaiyo yehushumiri, uye inofanira kusvikwa mushure menguva yakati kuti isvike pakuenzanisa kupisa isati yanyatsoonekwa tembiricha chaiyo. Chenjererawo kuchengetedza kubatana kwakavimbika pakati pesensa nepamusoro pemuviri. Kana paine mukaha pakati pesensa neganda, kukosha kwekuyera kunogona kunge kwakaderera.
(4) Kuongororwa kweECG
Basa remagetsi re "masero anofashukira" mumyocardium rinoita kuti myocardium ifashukire nemagetsi. Rinoita kuti mwoyo upfuure nemagetsi. Kuvharika kwesimba remoyo kunogadzirwa neiyi nzira yekufashukira kwemoyo kunoyerera nemuchina wemuviri uye kunopararira kuzvikamu zvakasiyana zvemuviri, zvichikonzera shanduko mumusiyano uripo pakati pezvikamu zvakasiyana zvemuviri wemunhu.
Kuongororwa kweElectrocardiogram (ECG) ndeyekunyora musiyano unogona kuitika pamusoro pemuviri panguva chaiyo, uye pfungwa ye lead inoreva maitiro e waveform emusiyano unogona kuitika pakati pezvikamu zviviri kana kupfuura zvemuviri wemunhu nekuchinja kwe cardiac cycle. Ma lead ekutanga anotsanangurwa Ⅰ, Ⅱ, Ⅲ anonzi ma bipolar standard limb leads.
Gare gare, tambo dzemakumbo dzine pressurized unipolar dzakatsanangurwa, aVR, aVL, aVF uye electrodeless chest leads V1, V2, V3, V4, V5, V6, idzo dziri tambo dzeECG dzinoshandiswa pari zvino mukurapa. Nekuti moyo uri stereoscopic, lead waveform inomiririra mashandiro emagetsi panzvimbo imwe chete yemoyo. Idzi tambo gumi nembiri dzicharatidza mashandiro emagetsi panzvimbo dzakasiyana dzemoyo kubva kumativi gumi nemaviri, uye maronda ezvikamu zvakasiyana zvemoyo anogona kuongororwa zvizere.
Parizvino, muchina weECG unoshandiswa mukiriniki unoyera waveform yeECG, uye maelectrode emakumbo awo anoiswa paruoko nepachitsitsinho, nepo maelectrode ari muECG monitoring akaiswa zvakaenzana munzvimbo yechipfuva nedumbu remurwere, kunyangwe nzvimbo yacho yakasiyana, akaenzana, uye tsananguro yawo yakafanana. Nokudaro, ECG conduction mumonitor inoenderana ne lead iri mumuchina weECG, uye ane polarity ne waveform zvakafanana.
Mamonita anogona kutarisa ma lead matatu kana matanhatu, anogona kuratidza panguva imwe chete ma waveform eimwe kana ese ari maviri uye kubvisa ma parameter ekurova kwemoyo kuburikidza nekuongorora ma waveform.. PMamonita ane simba anogona kutarisa ma lead gumi nemaviri, uye anogona kuongorora zvakare mafungu kuti abudise zvikamu zveST uye zviitiko zve arrhythmia.
Parizvino,ECGmafungu ekutarisa, kugona kwayo kuongorora chimiro chisina kusimba hakuna kusimba zvakanyanya, nekuti chinangwa chekutarisa ndechekutarisa kurova kwemoyo wemurwere kwenguva yakareba uye panguva chaiyo.. AsiiyoECGMhedzisiro yekuongorora kwemuchina inoyerwa munguva pfupi pasi pemamiriro chaiwo. Saka, upamhi hwe amplifier bandpass yezvishandiso zviviri hauna kufanana. Bandwidth yemuchina weECG i0.05~80Hz, nepo bandwidth yemonitor inowanzova 1~25Hz. Chiratidzo cheECG chiratidzo chisina kusimba, icho chinokanganiswa nyore nyore nekukanganiswa kwekunze, uye mamwe marudzi ekukanganiswa akaoma zvikuru kukunda akadai se:
(a) Kukanganiswa kwekufamba. Kufamba kwemuviri wemurwere kunokonzera shanduko mumasaini emagetsi mumoyo. Hurefu uye kuwanda kwekufamba uku, kana kuri mukati meECGbandwidth yeamplifier, chishandiso chakaoma kukunda.
(b)Mkupindirana kwemagetsi. Kana tsandanyama dziri pasi peelectrode yeECG dzakanamirwa, chiratidzo chekupindirana kweEMG chinogadzirwa, uye chiratidzo cheEMG chinopindirana nechiratidzo cheECG, uye chiratidzo chekupindirana kweEMG chine bandwidth yakafanana neyechiratidzo cheECG, saka hachigone kungobviswa nefirita.
(c) Kukanganiswa kwebanga remagetsi rine mafrequency akakwira. Kana electrocution kana electrocution yemagetsi ichishandiswa panguva yekuvhiyiwa, amplitude yechiratidzo chemagetsi chinogadzirwa nesimba remagetsi rinowedzerwa mumuviri wemunhu yakakura kupfuura iyo yechiratidzo cheECG, uye chikamu chefrequency chakapfuma kwazvo, zvekuti amplifier yeECG inosvika mumamiriro akazara, uye waveform yeECG haigone kuonekwa. Anenge mamonitor ese emagetsi haana simba rekudzivirira kukanganiswa kwakadaro. Saka, chikamu chemonitor anti-high frequency electric knife interference chinongoda kuti monitor idzokere kune yakajairika mukati memasekondi mashanu mushure mekunge banga remagetsi rine mafrequency akakwira rabviswa.
(d) Kukanganiswa kwemagetsi kubva mumuviri wemunhu kuenda kuECG amplifier kunokonzera ruzha rwakasimba runogona kuvharidzira chiratidzo cheECG, icho chinowanzo kukonzerwa nekusabatana zvakanaka pakati pemaelectrode neganda. Kudzivirira kukanganiswa kwakadaro kunonyanya kukundwa nekushandisa nzira, mushandisi anofanira kunyatsoongorora zvikamu zvese nguva dzese, uye chishandiso chinofanira kunge chakasimba, izvo hazvisi zvakanaka chete pakurwisa kukanganiswa, asi chinonyanya kukosha, kuchengetedza kuchengetedzeka kwevarwere nevanoshanda.
5. Hazvipindi muropachekuona kumanikidzwa kweropa
Kumanikidzwa kweropa zvinoreva kumanikidzwa kweropa pamadziro etsinga dzeropa. Mukuita kwega kwega kwekumanikidzwa uye kuzorora kwemoyo, kumanikidzwa kweropa pamadziro etsinga dzeropa kunochinjawo, uye kumanikidzwa kwetsinga dzeropa dzeropa netsinga dzeropa dzeropa dzakasiyana, uye kumanikidzwa kwetsinga dzeropa muzvikamu zvakasiyana kwakasiyanawo. Mukurapa, kukosha kwekumanikidzwa kwenguva dzinoenderana dzesystolic nediastolic mutsinga dzeropa pakukwirira kwakafanana neruoko rwepamusoro rwemuviri wemunhu kunowanzo shandiswa kuratidza kumanikidzwa kweropa kwemuviri wemunhu, kunonzi systolic blood pressure (kana hypertension) uye diastolic pressure (kana low pressure), zvichiteerana.
Kumanikidzwa kweropa kwemuviri mutsinga dzeropa chinhu chinochinja-chinja mumuviri. Chine chekuita zvakanyanya nemamiriro epfungwa dzevanhu, mamiriro emanzwiro, uye chimiro nenzvimbo panguva yekuyerwa, kurova kwemoyo kunowedzera, BP yediastolic inokwira, kurova kwemoyo kunodzikira, uye BP yediastolic inoderera. Sezvo huwandu hwekurohwa mumoyo huchiwedzera, BP yesystolic inotofanira kuwedzera. Zvinogona kutaurwa kuti BP yeropa mutsinga yega yega yemoyo haizove yakafanana zvachose.
Nzira yekudzungudza inzira itsva yekuyera BP yemutsinga isingapindi muropa yakagadzirwa muma70s,uye zvaroPfungwa huru ndeyekushandisa cuff kuzvimba kusvika pakumanikidzwa kwakati kana tsinga dzeropa dzemutsinga dzadzvinyirirwa zvachose uye dzichivhara kuyerera kweropa mutsinga, uye nekuderedzwa kwekumanikidzwa kwecuff, tsinga dzeropa dzemutsinga dzicharatidza shanduko kubva pakuvharika kwakazara → kuvhurika zvishoma nezvishoma → kuvhurika kwakazara.
Mukuita uku, sezvo kurira kwemhepo pamadziro etsinga dzeropa kuchizoburitsa mafungu emhepo anotenderera mugasi riri mucuff, fungu iri remhepo rinotenderera rine hukama hwakakwana nepfungwa yeropa iri mu arterial systolic, kumanikidzwa kwe diastolic uye kumanikidzwa kweavhareji, uye kumanikidzwa kwe systolic, avhareji uye diastolic kwenzvimbo yakayerwa kunogona kuwanikwa nekuyera, kunyora uye kuongorora mafungu emhepo anotenderera mucuff panguva yekudonha kweropa.
Chinangwa chenzira yekudzungudza ndechekuwana kutenderera kweropa kweropa nguva dzose.IniKana nzira chaiyo yekuyera, nekuda kwekufamba kwemurwere kana kupindira kwekunze kunokanganisa shanduko yekumanikidzwa kwemucuff, chishandiso hachizokwanisi kuona kuchinja-chinja kwetsinga dzeropa nguva dzose, saka zvinogona kukonzera kutadza kuyera.
Parizvino, mamwe mamonitor atora matanho ekudzivirira kukanganiswa, akadai sekushandisa nzira yekudzikisa makwinya emusana, nesoftware kuti vaone otomatiki kukanganiswa uye mafungu emusana akajairika, kuitira kuti vave nekukwanisa kwakati kwekudzivirira kukanganiswa. Asi kana kukanganiswa kwacho kwakanyanya kana kuti kwakagara kwenguva yakareba, nzira iyi yekudzivirira kukanganiswa haigone kuita chero chinhu nezvazvo. Saka, mukuita kwekutarisa BP isina kupinda muropa, zvakakosha kuedza kuona kuti pane mamiriro akanaka ekuyedza, asi zvakare teerera kusarudzwa kwehukuru hwecuff, nzvimbo uye kuoma kwebundle.
6. Kuongororwa kwe arterial oxygen saturation (SpO2)
Okisijeni chinhu chakakosha muhupenyu. Mamorekuru eokisijeni anoshanda muropa anotakurwa kuenda kumatishu mumuviri wese nekusunga kuhemoglobin (Hb) kuti agadzire hemoglobin ine oxygen (HbO2). Chiyero chinoshandiswa kuratidza huwandu hwehemoglobin ine oxygen muropa chinonzi oxygen saturation.
Kuyerwa kwekusakwana kweokisijeni muropa kunobva pahunhu hwekupinza kwehemoglobin nehemoglobin ine oxygen muropa, nekushandisa mawavelength maviri akasiyana echiedza chitsvuku (660nm) nechiedza che infrared (940nm) kuburikidza nenyama uye zvinozoshandurwa kuita zviratidzo zvemagetsi ne photoelectric receiver, ukuwo uchishandisa zvimwe zvikamu munyama, zvakaita se: ganda, mapfupa, tsandanyama, ropa remutsinga, nezvimwewo. Chiratidzo chekupinza hachichinji, uye chiratidzo chekupinza cheHbO2 neHb mutsinga ndicho chinongochinjwa ne pulse, iyo inowanikwa nekugadzira chiratidzo chinogamuchirwa.
Zvinogona kuonekwa kuti nzira iyi inongokwanisa kuyera huwandu hweokisijeni muropa muropa remutsinga, uye chinhu chinodiwa pakuyera ndiko kuyerera kweropa mutsinga. Panyaya yekiriniki, sensor inoiswa muzvikamu zvenyama zvine kuyerera kweropa mutsinga uye ukobvu hwenyama husina kukobvu, zvakaita seminwe, zvigunwe, nzeve nezvimwe zvikamu. Zvisinei, kana paine kufamba kwakasimba muchikamu chakayerwa, zvinokanganisa kuburitswa kwechiratidzo ichi chekurova kweropa uye hazvigone kuyerwa.
Kana kutenderera kweropa kwemurwere kwakashata zvakanyanya, zvichaita kuti ropa riderere panzvimbo inofanira kuyerwa, zvichikonzera kuyerwa kusina kururama. Kana tembiricha yemuviri yenzvimbo yekuyerwa yemurwere ane ropa rakawanda rakarasika iri shoma, kana paine chiedza chakasimba chinopenya paprobe, zvinogona kuita kuti mashandiro emuchina wekugamuchira maekisesaizi asiyane neakajairika, zvichikonzera kuyerwa kusina kururama. Saka, chiedza chakasimba chinofanira kudzivirirwa pakuyerwa.
7. Kuongororwa kwemhepo inofema (PetCO2)
Kabhoni dhayokisaidhi yekufema chiratidzo chakakosha chekutarisa varwere vane anesthesia nevarwere vane zvirwere zve metabolic system. Kuyerwa kweCO2 kunonyanya kushandisa nzira ye infrared absorption; Kureva kuti, kuwanda kwakasiyana kweCO2 kunotora madhigirii akasiyana echiedza che infrared. Kune mhando mbiri dzekutarisa CO2: mainstream ne sidestream.
Rudzi rwemainstream runoisa gas sensor zvakananga mumugero wegasi rekufema remurwere. Kuchinja kwehuwandu hweCO2 mugasi rekufema kunoitwa zvakananga, uye chiratidzo chemagetsi chinotumirwa kumonitor kuti chiongororwe uye chigadziriswe kuti pave nemaparamita ePetCO2. Sensor yemagetsi inoyerera parutivi inoiswa mumonitor, uye sampuro yegasi rekufema remurwere inoburitswa panguva chaiyo nechubhu yesampuro yegasi uye inotumirwa kumonitor kuti iongororwe huwandu hweCO2.
Patinenge tichitarisa CO2, tinofanira kutarisa matambudziko anotevera: Sezvo sensor yeCO2 iri sensor yemaziso, panguva yekushandiswa, zvakakosha kutarisisa kudzivirira kusvibiswa kwakanyanya kwe sensor senge kubuda kwemasero evarwere; Sidestream CO2 monitors inowanzo kuve ne gas-water separator kubvisa hunyoro kubva mumhepo inofema. Nguva dzose tarisa kana gas-water separator iri kushanda zvakanaka; Zvikasadaro, hunyoro mumhepo huchakanganisa kururama kwekuyera.
Kuyerwa kwema parameter akasiyana-siyana kune zvimwe zvikanganiso zvakaoma kukunda. Kunyangwe ma monitor aya aine hunyanzvi hwakakura, haakwanise kutsiva vanhu zvachose parizvino, uye vashandisi vachiri kudiwa kuti vaongorore, vatonge uye vagadzirise nemazvo. Kushanda kunofanira kungwarira, uye mhedzisiro yekuyera inofanira kutongwa nemazvo.
Nguva yekutumira: Chikumi-10-2022
