Multiparameter murwere monitor (classification of monitors) inogona kupa ruzivo rwekiriniki rwekutanga uye zvakasiyana-siyanazviratidzo zvinokosha ma parameter ekutarisa varwere nekununura varwere. Amaererano nekushandiswa kwemamonitor muzvipatara, wndakadzidza izvozvoeimwe dhipatimendi rekiriniki haigone kushandisa cheki chekushandisa chakakosha.Kunyanya, mushandisi mutsva haazive zvakawanda nezve cheki, zvichikonzera matambudziko mazhinji mukushandiswa kwemucherechedzo, uye haakwanise kutamba zvizere basa rechiridzwa.Yonker sharesthekushandiswa uye kushanda musimboti wemultiparameter monitor kumunhu wese.
Mutariri wemurwere anogona kuona zvimwe zvakakoshazviratidzo parameters yevarwere munguva chaiyo, nguva dzose uye kwenguva yakareba, iyo inokosha inokosha yekiriniki.Asi zvakare inotakurika mbozha, mota-yakaiswa kushandiswa, inovandudza zvakanyanya kushandiswa frequency.Parizvino,multiparameter kutarisisa kwevarwere kwakajairika, uye mabasa ayo makuru anosanganisira ECG, BP, tembiricha, kufema,SpO2, ETCO2, IBP, kubuda kwemwoyo, nezvimwewo.
1. Basic chimiro chemonitor
Yekutarisa inowanzo umbwa yemuviri module ine akasiyana masensa uye yakavakirwa-mukati komputa system.Ese marudzi ezviratidzo zvemuviri anoshandurwa kuita masaini emagetsi nemasensa, obva atumirwa kumakomputa kuratidzwa, kuchengetedza uye manejimendi mushure mekutanga-amplification.Multifunctional parameter comprehensive monitor inogona kutarisa ecg, kufema, tembiricha, BP,SpO2 uye mamwe ma parameter panguva imwe chete.
Modular murwere monitoranowanzo shandiswa mukuchengetwa kwakanyanya.Iwo anoumbwa ne discrete detachable physiological parameter modules uye yekutarisa mauto, uye anogona kuumbwa akasiyana mamodule zvinoenderana nezvinodiwa kuti isangane nezvinodiwa.
2. The kushandiswa uye kushanda musimboti wemultiparameter monitor
(1) Kutarisira kufema
Zviyero zvakawanda zvekufema mumultiparametermurwere monitortora chest impedance nzira.Kufamba kwechipfuva chemuviri wemunhu mukufema kunokonzera shanduko yekudzivirira kwemuviri, iyo 0.1 ω ~ 3 ω, inozivikanwa sekufema impedance.
Mucherechedzo unowanzo tora masaini ekuchinja kwekufema impedance pamagetsi mamwechete nekubaya jekiseni yakachengeteka ye0.5 kusvika 5mA pane sinusoidal carrier frequency ye10 kusvika 100kHz kuburikidza nemagetsi maviri eiyo. ECG tungamira.Iyo ine simba waveform yekufema inogona kutsanangurwa nekusiyana kwekufema impedance, uye iyo paramita yekufema inogona kubviswa.
Kufamba kweThoracic uye kusafema kwemuviri kunokonzera shanduko mukudzivirira kwemuviri.Kana kuwanda kwekuchinja kwakadaro kwakafanana neiyo frequency bhendi yekufema chiteshi amplifier, zvinonetsa kuti mutaridzi aone kuti ndeipi yakajairika kufema chiratidzo uye kuti ndeipi chiratidzo chekukanganisa.Somugumisiro, kuyerwa kwechiyero chekufema kunogona kunge kusina kururama kana murwere ane maitiro akaoma uye anoenderera mberi emuviri.
(2) Invasive blood pressure (IBP) kutarisa
Mune mamwe maoparesheni akanyanya, iyo chaiyo-nguva yekutarisisa yeropa ine yakakosha kukosha kwekiriniki, saka zvinodikanwa kutora invasive yeropa rekutarisa tekinoroji kuti uzviite.Nheyo yacho ndeiyi: kutanga, catheter inoiswa mutsinga dzeropa dzenzvimbo yakayerwa kuburikidza nekupinza.Iyo yekunze port ye catheter yakabatana zvakananga neiyo pressure sensor, uye yakajairika saline inopinzwa mu catheter.
Nekuda kwekumanikidza kwekufambisa basa remvura, iyo intravascular pressure ichaendeswa kune yekunze kudzvanywa sensor kuburikidza nemvura iri mu catheter.Saka, iyo ine simba waveform yekumanikidza shanduko mumidziyo yeropa inogona kuwanikwa.Systolic pressure, diastolic pressure uye mean pressure inogona kuwanikwa nenzira dzekuverenga.
Kuchenjerera kunofanira kubhadharwa kune invasive blood pressure kuyerwa: pakutanga kwekutarisa, chiridzwa chinofanira kugadziriswa kusvika zero pakutanga;Munguva yekutarisa, iyo yekumanikidza sensor inofanirwa kugara ichichengetwa padanho rakafanana nemoyo.Kuti udzivise kuvhara kwe catheter, catheter inofanira kunyungudutswa nemajekiseni anoramba achiitwa eheparin saline, iyo inogona kufamba kana kubuda nekuda kwekufamba.Nokudaro, catheter inofanira kunyatsogadziriswa uye kuongororwa zvakanyatsonaka, uye kugadzirisa kunofanira kuitwa kana zvichidiwa.
(3) Kutarisa kwekushisa
Thermistor ine negative tembiricha coefficient inowanzo shandiswa seye tembiricha sensor muyero yekuyera yekutarisa.General monitors inopa tembiricha yemuviri mumwe, uye zviridzwa zvepamusoro zvinopa tembiricha yemuviri miviri.Kupisa kwemuviri probe mhando dzakakamurwawo kuita muviri pamusoro pekuongorora uye muviri mhango probe, zvichiteerana ichishandiswa kutarisa pamusoro pemuviri uye tembiricha yegomba.
Pakuyera, mushandi anogona kuisa tembiricha probe mune chero chikamu chemuviri wemurwere zvinoenderana nezvinodiwa.Nekuda kwekuti mativi akasiyana emuviri wemunhu ane tembiricha dzakasiyana, tembiricha inoyerwa nemonitor kukosha kwetembiricha yechikamu chemuviri wemurwere kuisa probe, iyo inogona kunge yakasiyana nekukosha kwekushisa kwemukanwa kana kwehapwa.
Whuku ichitora tembiricha kuyerwa, pane dambudziko rekupisa pakati pechikamu chakayerwa chemuviri wemurwere uye sensor iri muprobe, ndiko kuti, kana probe yaiswa pekutanga, nekuti sensor haisati yanyatsoenderana nekupisa kwe. muviri wemunhu.Naizvozvo, tembiricha inoratidzwa panguva ino haisi iyo tembiricha chaiyo yehushumiri, uye inofanira kusvikwa pashure penguva yakati kuti isvike kuenzana kwekupisa kusati kwanyatsooneka tembiricha chaiyo.Uyewo chengetedza kuchengetedza kubatana kwakavimbika pakati pe sensor uye pamusoro pemuviri.Kana paine mukaha pakati pe sensor uye ganda, kuyerwa kukosha kunogona kunge kwakaderera.
(4) ECG kutarisa
Kuitwa kwe electrochemical ye "excitable cells" mumyocardium inoita kuti myocardium ifadze nemagetsi.Zvinokonzeresa kuti mwoyo ushande.Iyo yakavharwa uye chiito chazvino chinogadzirwa neichi chinonakidza chiitiko chemoyo chinoyerera kuburikidza nemuviri vhoriyamu conductor uye chinopararira kune akasiyana siyana emuviri, zvichikonzera shanduko yemusiyano uripo pakati penzvimbo dzakasiyana dzemuviri wemunhu.
Electrocardiogram (ECG) ndeyekunyora mutsauko unogona kuitika wepamusoro pemuviri munguva chaiyo, uye pfungwa yekutungamirira inoreva waveform pattern yemusiyano unokwanisa pakati pezvikamu zviviri kana kupfuura zvemuviri wepamusoro wemuviri wemunhu nekuchinja kwemwoyo.Iwo ekutanga anotsanangurwa Ⅰ, Ⅱ, Ⅲ anotungamira anonzi nekiriniki anonzi bipolar standard limb lead.
Gare gare, iyo yakamanikidzwa unipolar lemb lead yakatsanangurwa, aVR, aVL, aVF uye electrodeless chest inotungamira V1, V2, V3, V4, V5, V6, inova ndiyo yakajairwa ECG inotungamira parizvino inoshandiswa mukiriniki maitiro.Nekuti moyo une stereoscopic, lead waveform inomiririra chiitiko chemagetsi pane imwe fungidziro yemoyo.Aya gumi nemaviri anotungamira acharatidza chiitiko chemagetsi pane akasiyana fungidziro nzvimbo dzemoyo kubva kunzira gumi nembiri, uye maronda ezvikamu zvakasiyana zvemoyo anogona kuongororwa zvizere.
Parizvino, chiyero cheECG muchina unoshandiswa mumakiriniki maitiro anoyera ECG waveform, uye maelectrodes ayo emakumbo anoiswa paruoko nepachidzitiro, nepo maelectrodes ari muECG monitoring anoiswa zvakaenzana muchipfuva chemurwere nenzvimbo yedumbu, kunyangwe kuiswa kuri. zvakasiyana, zvakafanana, uye tsanangudzo yavo yakafanana.Nokudaro, ECG conduction mumonitori inoenderana nemutungamiri mumushini weECG, uye vane polarity yakafanana uye waveform.
Mamonitor anogona kazhinji kutarisa matatu kana matanhatu anotungamira, anogona panguva imwe chete kuratidza waveform yeimwe kana ese ari maviri ekutungamira uye kubvisa chiyero chemoyo paramita kuburikidza ne waveform kuongororwa.. Pvatariri vane simba vanogona kutarisa 12 inotungamira, uye inogona kuenderera mberi nekuongorora waveform kuti ibvise ST zvikamu uye arrhythmia zviitiko.
Parizvino, theECGwaveform yekutarisa, yakavanzika chimiro chekuongorora kugona haina kusimba zvakanyanya, nekuti chinangwa chekutarisa ndechekutarisa moyo wemurwere kwenguva yakareba uye munguva chaiyo.. AsitheECGMichina yekuongorora mhinduro inoyerwa munguva pfupi pasi pemamiriro chaiwo.Naizvozvo, iyo amplifier bandpass upamhi hwezviridzwa zviviri haina kufanana.Iyo bandwidth yemuchina weECG ndeye 0.05 ~ 80Hz, nepo bandwidth yemonitor inowanzo 1 ~ 25Hz.Chiratidzo cheECG chiratidzo chisina simba, chinokanganiswa nyore nekukanganiswa kwekunze, uye mamwe marudzi ekuvhiringidza akaoma zvikuru kukunda akadai:
(a) Kupindira kwekufamba.Kufamba kwemuviri wemurwere kuchakonzera shanduko mumasaini emagetsi mumoyo.Iyo amplitude uye kuwanda kwekufamba uku, kana mukati meECGamplifier bandwidth, chiridzwa chakaoma kukunda.
(b)Myoelectric kupindira.Kana mhasuru dziri pasi peECG electrode dzakanamirwa, chiratidzo cheEMG chekupindira chinogadzirwa, uye chiratidzo che EMG chinopindira nechiratidzo cheECG, uye chiratidzo che EMG chinopindira chine bandwidth yakafanana sechiratidzo cheECG, saka haigone kungocheneswa ne sefa.
(c) Kupindira kwebanga remagetsi repamusoro-frequency.Kana iyo yakakwirira-frequency electrocution kana electrocution inoshandiswa panguva yekuvhiyiwa, iyo amplitude yechiratidzo chemagetsi chinogadzirwa nemagetsi emagetsi akawedzerwa kumuviri wemunhu yakakura kwazvo kupfuura yechiratidzo cheECG, uye chikamu che frequency chakapfuma kwazvo, zvekuti ECG. amplifier inosvika pakazara, uye ECG waveform haigone kuonekwa.Anenge ese mamonitor aripo haana simba rekurwisa kupindira kwakadaro.Naizvozvo, iyo yekutarisa anti-yakakwira frequency yemagetsi banga inopindira chikamu chinongoda kuti iyo yekutarisa idzokere kune yakajairwa mamiriro mukati me5s mushure mepamusoro frequency banga remagetsi rabviswa.
(d) Electrode contact interference.Chero kukanganisa munzira yemagetsi yemagetsi kubva mumuviri wemunhu kuenda kune ECG amplifier kuchaita ruzha rwakasimba runogona kuvhara chiratidzo cheECG, icho chinowanzokonzerwa nekusabatana kwakashata pakati pemagetsi uye ganda.Kudzivirirwa kwekuvhiringidza kwakadaro kunonyanya kukundwa kubva pakushandiswa kwemaitiro, mushandisi anofanira kunyatsoongorora zvikamu zvega rega nguva dzose, uye chiridzwa chinofanira kuva chakavimbika pasi, izvo zvisina kunaka chete kurwisana nekupindira, asi zvinonyanya kukosha, kuchengetedza kuchengetedzwa kwevarwere. uye vashandisi.
5. Zvisingapindikiblood pressure monitor
Kutsikirira kweropa (blood pressure) zvinoreva kudzvanywa kweropa pamadziro etsinga.Mukuita kwega kwega kwega uye kuzorora kwemoyo, kudzvanywa kweropa kuyerera pamadziro emidziyo yeropa zvakare kunoshanduka, uye kudzvanywa kwetsinga dzeropa nemidziyo yeropa inosiyana, uye kudzvanywa kwetsinga dzeropa munzvimbo dzakasiyana kwakasiyanawo. zvakasiyana.Mukiriniki, kukosha kwekumanikidza kweiyo inoenderana systolic uye diastolic nguva mumidziyo ye arterial pahurefu hwakafanana nepamusoro peruoko rwemuviri wemunhu inowanzo shandiswa kuratidza BP yemuviri wemunhu, iyo inonzi systolic blood pressure (kana hypertension). ) uye diastolic pressure (kana kuti yakaderera kudzvinyirirwa), zvichiteerana.
Kuwanda kweropa remuviri kunoenderana nechimiro chemuviri.Zvine zvakawanda zvokuita nemamiriro ezvinhu epfungwa dzevanhu, mamiriro epfungwa, uye chimiro nechinzvimbo panguva yekuyera, kurova kwemwoyo kunowedzera, diastolic yeropa inokwira, kurova kwemwoyo kunoderera, uye diastolic yeropa inoderera.Sezvo huwandu hwekurohwa kwemoyo hunowedzera, systolic yeropa inosungirwa kuwedzera.Zvinogona kutaurwa kuti arterial blood pressure mune yega yega yemoyo kutenderera haizove yakangofanana.
Vibration nzira inzira nyowani yekusapinda arterial blood pressure kuyerwa kwakagadzirwa mu70s,uye itsmusimboti ndeyekushandisa cuff kupinza kune imwe dzvinyiriro kana tsinga dzeropa dzanyatso kudzvanywa uye kuvharira kuyerera kweropa, uyezve nekudzikiswa kwekumanikidzwa kwecuff, tsinga dzeropa dzinoratidza shanduko kubva pakuvharika zvachose → kuvhura zvishoma nezvishoma → kuvhura kuzere.
Mukuita uku, sezvo kupomba kwe arterial vascular wall kuchiburitsa gasi oscillation mafungu mugasi iri mucuff, iyi oscillation wave ine yakanangana yakanangana neiyo arterial systolic blood pressure, diastolic pressure uye average pressure, uye systolic, kureva uye. diastolic dzvinyiriro yenzvimbo yakayerwa inogona kuwanikwa nekuyera, kurekodha uye kuongorora mafungu ekudzvinyirirwa ekudengenyeka mucuff panguva yekuita deflation.
Mhedzisiro yenzira yekuzunguza ndeyekutsvaga iyo yenguva dzose pulse ye arterial pressure.In iyo chaiyo yekuyera nzira, nekuda kwekufamba kwemurwere kana kupindira kwekunze kunokanganisa kuchinja kwekumanikidza mucuff, chiridzwa chacho hachizokwanisi kuona kushanduka kwemaitiro nguva dzose, saka zvinogona kutungamirira pakuyera kukundikana.
Parizvino, mamwe mamonitor atora matanho ekurwisa-kupindira, sekushandisa manera deflation nzira, nesoftware kuti ingoona kupindira uye kwakajairwa arterial pulsation waves, kuitira kuti kuve nehumwe dhigirii rekudzivirira-kukanganisa.Asi kana kupindira kwakanyanyisa kana kunotora nguva yakareba, iyi anti-interference chiyero haigoni kuita chero chinhu pamusoro payo.Naizvozvo, mukuita kwekusingapindike kwekutarisa kweropa, zvinodikanwa kuedza kuve nechokwadi kuti pane yakanaka bvunzo mamiriro, asi zvakare teerera kune kusarudzwa kwecuff size, kuiswa uye kusimba kwebundle.
6. Arterial oxygen saturation ( SpO2 ) kutarisa
Okisijeni chinhu chakakosha muzviitiko zvehupenyu.Active okisijeni mamorekuru muropa anotakurwa kuenda kumatishu mumuviri wese nekusunga kuhemoglobin (Hb) kuumba oxygenated hemoglobin (HbO2).Iyo parameter inoshandiswa kuratidza chikamu cheokisijeni hemoglobin muropa inonzi oxygen saturation.
Kuyerwa kweasina kuvavasive arterial oxygen saturation kunobva pakubata hunhu hwehemoglobin uye oxygenated hemoglobin muropa, nekushandisa maviri akasiyana wavelengths emwenje dzvuku (660nm) uye infrared light (940nm) kuburikidza nenyama uye yozoshandurwa kuita masaini emagetsi ne photoelectric receiver, nepo uchishandisawo zvimwe zvinoumba munyama, zvakadai se: ganda, pfupa, tsandanyama, ropa retsinga, etc. Chiratidzo chekutora chinogara chiripo, uye chete chiratidzo chekugamuchira cheHbO2 neHb mutsinga chinoshandurwa cyclically ne pulse. , iyo inowanikwa nekugadzirisa chiratidzo chakagamuchirwa.
Zvinogona kuonekwa kuti nzira iyi inogona chete kuyera ropa reoxygen saturation muropa re arterial, uye mamiriro anodiwa ekuyera ndeye pulsating arterial blood flow.Kliniki, iyo sensor inoiswa muzvikamu zvematishu zvine arterial kuyerera kweropa uye ukobvu hwematishu husina kukora, senge zvigunwe, zvigunwe, earlobes uye zvimwe zvikamu.Nekudaro, kana paine kufamba kwakasimba muchikamu chakayerwa, zvinokanganisa kuburitswa kweichi chiratidzo chekupuruzira uye haigone kuyerwa.
Kana kutenderera kwemurwere kunenge kwakashata zvakanyanya, zvinotungamira mukuderera kwekuyerera kweropa panzvimbo inoyerwa, zvichikonzera kuyerwa kusina kururama.Kana kupisa kwemuviri kwenzvimbo yekuyera yemurwere ane kurasikirwa kwakanyanya kweropa kwakaderera, kana pane chiedza chakasimba chinopenya pane probe, inogona kuita kuti kushanda kwechigadzirwa che photoelectric receiver kutsauswe kubva kune yakajairika, zvichiita kuti kuyerwa kusina kururama.Nokudaro, chiedza chakasimba chinofanira kudziviswa pakuyera.
7. Respiratory carbon dioxide (PetCO2) kutarisa
Kufema kabhoni dioksijeni chinhu chakakosha chekutarisa chiratidzo chevarwere vane anesthesia uye varwere vane chirwere chekufema metabolic system.Kuyera kwe CO2 kunonyanya kushandisa infrared absorption nzira;Ndokureva kuti, kudzika kwakasiyana kweCO2 kunotora madhigirii akasiyana emwenje chaiwo infrared.Kune marudzi maviri e CO2 yekutarisa: mainstream uye sidestream.
Rudzi rwemainstream runoisa sensor yegasi yakananga mugetsi rekufema remurwere.Iko kutendeuka kwekugadzirisa kwe CO2 mumhepo yekufema inoitwa zvakananga, uye ipapo chiratidzo chemagetsi chinotumirwa kune chekucherechedza kuti chiongororwe uye chigadzirwe kuwana PetCO2 parameters.Iyo yedivi-inoyerera optical sensor inoiswa mumonitor, uye kufema kwegasi sampuli inotorwa munguva chaiyo negasi sampling chubhu uye inotumirwa kumonitor ye CO2 concentration yekuongorora.
Patinenge tichiita CO2 kutarisa, tinofanira kubhadhara kune matambudziko anotevera: Sezvo CO2 sensor inonzi optical sensor, mukushandiswa kwekushandiswa, zvakakosha kuchenjerera kudzivisa kusvibiswa kwakakomba kwe sensor yakadai sechivharo chemurwere;Sidestream CO2 mamonitor anowanzo kuve akashongedzerwa negasi-mvura yekuparadzanisa kubvisa hunyoro kubva pakufema gasi.Nguva dzose tarisa kana gasi-mvura separator iri kushanda zvakanaka;Kana zvisina kudaro, hunyoro huri mugasi huchakanganisa kurongeka kwechiyero.
Chiyero chezviyero zvakasiyana-siyana zvine zvimwe zvirema zvinonetsa kukunda.Kunyangwe mamonitor aya aine hungwaru hwepamusoro, haakwanise kutsiva vanhu zvachose parizvino, uye vashandi vachiri kudikanwa kuti vaongorore, kutonga uye kubata navo nemazvo.Kuvhiya kunofanirwa kungwarira, uye kuyerwa kwemhedzisiro kunofanirwa kutongerwa nemazvo.
Nguva yekutumira: Jun-10-2022
