Abubuwan asali na waniinjin sa barci
A lokacin aiki na injin sa barci, iskar gas mai ƙarfi (iska, oxygen O2, nitrous oxide, da dai sauransu) yana raguwa ta hanyar matsa lamba mai rage bawul don samun ƙananan matsi da iskar gas, sa'an nan kuma mita mai gudana da O2. -N2O rabo sarrafa na'urar ana gyara don samar da wani adadin kwarara kudi.Kuma adadin gauraye gas, cikin da'irar numfashi.
Magungunan maganin sa barci yana haifar da tururin anesthetic ta cikin tanki mai jujjuyawar, kuma tururin da ake buƙata na ƙididdigewa yana shiga cikin da'irar numfashi kuma an aika zuwa ga majiyyaci tare da gauraye gas.
Ya ƙunshi na'urar samar da iskar gas, evaporator, da'irar numfashi, na'urar sharwar carbon dioxide, na'urar busar da iska, tsarin kawar da sharar gas, da dai sauransu.
- Na'urar samar da iska
Wannan bangare ya ƙunshi tushen iska, ma'aunin matsa lamba da matsi na rage bawul, mita kwarara da tsarin daidaitawa.
Gabaɗaya ana samar da ɗakin aiki tare da oxygen, nitrous oxide, da iska ta tsarin samar da iska ta tsakiya.Dakin endoscopy na gastrointestinal gabaɗaya tushen iskar gas ne.Wadannan iskar gas da farko suna cikin matsanancin matsin lamba kuma dole ne a danne su ta matakai biyu kafin a iya amfani da su.Don haka akwai ma'auni na matsa lamba da bawuloli masu sauƙi.Bawul ɗin rage matsin lamba shine rage ainihin iskar gas mai matsa lamba zuwa amintaccen iskar gas mai ƙarancin ƙarfi don amintaccen amfani da injunan sa barci.Gabaɗaya, lokacin da babban silinda mai ƙarfi ya cika, matsa lamba shine 140kg/cm².Bayan wucewa ta hanyar matsi na rage bawul, a ƙarshe zai ragu zuwa kusan 3 ~ 4kg / cm², wanda shine 0.3 ~ 0.4MPa wanda sau da yawa muke gani a cikin litattafai.Ya dace da ƙananan matsa lamba a cikin injin sa barci.
Mitar kwarara daidai tana sarrafa kuma tana ƙididdige kwararar iskar gas zuwa sabon kanti na iskar gas.Mafi na kowa shine rotameter na dakatarwa.
Bayan an buɗe bawul ɗin sarrafa kwarara, iskar gas na iya wucewa cikin yardar kaina ta ratar shekara tsakanin tudun ruwa da bututu mai gudana.Lokacin da aka saita ƙimar kwarara, buoy ɗin zai daidaita kuma yana juyawa cikin yardar kaina a wurin da aka saita.A wannan lokacin, ƙarfin sama na motsin iska akan buoy yayi daidai da nauyin buoy ɗin kansa.Lokacin da ake amfani da shi, kar a yi amfani da karfi da yawa ko kuma ku dage kullin rotary, in ba haka ba zai iya sa ƙwanƙarar ta lanƙwasa, ko kuma kujerar bawul ɗin ta lalace, yana sa iskar gas ya kasa rufewa gaba ɗaya kuma ya haifar da zubar da iska.
Domin hana na'urar maganin sa barci fitar da iskar gas, na'urar sa barcin kuma tana da na'urar haɗin kai ta mita da kuma na'urar sa ido kan rabon iskar oxygen don kiyaye mafi ƙarancin iskar oxygen ta hanyar fitar da iskar gas da kusan kashi 25%.An karɓi ƙa'idar haɗin kai.A kan maɓallin motsi na N₂O, gears biyu suna haɗe da sarka, O₂ yana juyawa sau ɗaya, kuma N₂O yana juyawa sau biyu.Lokacin da bawul ɗin allura na O₂ flowmeter ɗin ya buɗe shi kaɗai, N₂O flowmeter ɗin yana nan har yanzu;lokacin da N₂O flowmeter aka cire, O₂ flowmeter da aka haɗa daidai da;idan aka bude dukkan na'urori biyu, sai a hankali a rufe O₂, sannan kuma N₂O flowmeter shima ya ragu tare da shi.
Shigar da mita kwararar iskar oxygen mafi kusa da kanti na gama gari.Idan akwai ɗigowa a matsayin iskar iskar oxygen, yawancin asarar shine N2O ko iska, kuma asarar O2 shine mafi ƙanƙanta.Tabbas, jerin sa baya bada garantin cewa hypoxia saboda fashewar mita kwarara ba zai faru ba.
2.Evaporator
Na'urar evaporator wata na'ura ce da za ta iya juyar da maganin sa barci mai jujjuyawar ruwa zuwa tururi da shigar da shi cikin da'irar maganin sa barci a wani adadi.Akwai nau'ikan evaporator da yawa da halayensu, amma ana nuna ƙa'idar ƙira gabaɗaya a cikin adadi.
Gas din da ake hadawa (wato O₂, N₂O, iska) yana shiga ma'aunin fitar da ruwa ya kasu kashi biyu.Hanya ɗaya ita ce ɗan ƙaramin iska wanda bai wuce kashi 20% na adadin adadin ba, wanda ke shiga ɗakin shayarwa don fitar da tururin anesthetic;Kashi 80% na mafi girman yawan iskar gas kai tsaye yana shiga babban hanyar iska kuma ya shiga tsarin madauki na sa barci.A ƙarshe, ana haɗa nau'ikan iska guda biyu a cikin iska mai gauraya don majiyyaci don shakar, kuma rabon rarraba iska guda biyu ya dogara da juriya a cikin kowace hanyar iska, wanda aka tsara ta hanyar kullin sarrafa hankali.
3.Yanayin numfashi
Yanzu abin da aka fi amfani da shi a asibiti shine tsarin madauki na jini, wato, tsarin sha na CO2.Ana iya raba shi zuwa nau'in rufaffiyar rufaffiyar da nau'in rufaffiyar.Nau'in rufaffiyar rufaffiyar yana nufin cewa wani ɓangare na iskar da aka fitar yana sake dawowa bayan an shayar da shi ta hanyar abin sha na CO2;nau'in rufaffiyar yana nufin cewa duk iskar da aka fitar tana sake dawowa bayan an shafe ta da abin sha na CO2.Duban zane-zane na tsari, an rufe bawul ɗin APL azaman tsarin rufaffiyar, kuma an buɗe bawul ɗin APL azaman tsarin rufewa.Tsarin biyu shine ainihin jihohin biyu na bawul na APL.
Ya ƙunshi sassa 7: ① sabon iska;② inhalation da exhalation bawul hanya daya;③ bututu mai zare;④ Y-dimbin haɗin gwiwa;⑤ bawul ɗin ambaliya ko bawul ɗin rage matsa lamba (Bawul ɗin APL);⑥ jakar ajiyar iska;Ƙwaƙwalwar haɓakawa da fitar da bawul ɗin hanya ɗaya na iya tabbatar da kwararar iskar gas guda ɗaya a cikin bututun da aka zare.Bugu da kari, santsi na kowane bangare ma na musamman.Ɗayan don kwararar iskar gas ta hanya ɗaya ce, ɗayan kuma don hana maimaita shakar CO2 da aka fitar a cikin kewaye.Idan aka kwatanta da buɗaɗɗen da'irar numfashi, irin wannan nau'in da'ira mai rufewa ko rufaffiyar numfashi na iya ba da damar sake numfashin iskar numfashi, rage asarar ruwa da zafi a cikin sassan numfashi, da kuma rage gurɓataccen gurɓataccen ɗakin aiki, da tattarawar abubuwa. maganin sa barci yana da kwanciyar hankali.Amma akwai rashin lahani a fili, zai ƙara yawan juriya na numfashi, kuma iskar da aka fitar yana da sauƙi don ƙaddamarwa a kan bawul ɗin hanya ɗaya, wanda ke buƙatar tsaftace ruwa akan lokaci guda.
Anan zan so in fayyace rawar APL bawul.Akwai 'yan tambayoyi game da shi waɗanda ba zan iya gane su ba.Na tambayi abokan karatuna, amma na kasa yin bayani a fili;Na tambayi malamina a baya, shi ma ya nuna mini bidiyon, kuma a bayyane yake a kallo.APL bawul, wanda kuma ake kira overflow valve ko decompression valve, cikakken sunan Ingilishi shine daidaitacce mai iyakancewa, komai daga Sinanci ko Ingilishi, kowa da kowa dole ne ya ɗan fahimci hanyar, wannan bawul ɗin da ke iyakance matsi na kewayawar numfashi.Ƙarƙashin kulawar hannu, idan matsa lamba a cikin da'irar numfashi ya fi girman ƙimar ƙimar APL, iskar gas zai fita daga bawul don rage matsa lamba a cikin kewayen numfashi.Ka yi la'akari da shi lokacin da aka taimaka samun iska, wani lokacin pinching ball yana da zafi sosai, don haka da sauri na daidaita darajar APL, manufar ita ce lalata da rage matsa lamba.Tabbas, wannan ƙimar APL shine gabaɗaya 30cmH2O.Wannan shi ne saboda gabaɗaya magana, matsa lamba mafi girma na iska ya kamata ya zama <40cmH2O, kuma matsakaicin matsa lamba na iska ya zama <30cmH2O, don haka yuwuwar pneumothorax kadan ne.Bawul ɗin APL a cikin sashen ana sarrafa shi ta hanyar bazara kuma an yi masa alama tare da 0 ~ 70cmH2O.Karkashin sarrafa injin, babu wani abu kamar bawul ɗin APL.Saboda iskar gas baya wucewa ta cikin bawul ɗin APL, an haɗa shi da injin iska.Lokacin da matsa lamba a cikin tsarin ya yi yawa, zai saki matsa lamba daga wuce haddi mai fitar da iskar gas na ƙwanƙwasa na iska na maganin sa barci don tabbatar da cewa tsarin jini ba zai haifar da barotrauma ga mai haƙuri ba.Amma don kare lafiya, ya kamata a saita bawul ɗin APL zuwa 0 na yau da kullun a ƙarƙashin ikon injin, ta yadda a ƙarshen aikin za a canza na'urar zuwa sarrafa hannu, kuma zaku iya bincika ko majiyyaci yana numfashi ba da da ewa ba.Idan ka manta don daidaita bawul ɗin APL, iskar gas kawai zai iya shiga cikin huhu, kuma ƙwallon zai ƙara ƙara girma, kuma yana buƙatar a cire shi nan da nan.Tabbas, idan kuna buƙatar kumbura huhu a wannan lokacin, daidaita bawul ɗin APL zuwa 30cmH2O
4. Na'urar sha na carbon dioxide
Abubuwan sha sun haɗa da lemun tsami soda, lemun tsami, da barium lemun tsami, waɗanda ba su da yawa.Saboda alamomi daban-daban, bayan shan CO2, canjin launi kuma ya bambanta.Soda lemun tsami da ake amfani da shi a cikin sashen yana da granular, kuma alamar sa shine phenolphthalein, wanda ba shi da launi idan sabo kuma ya zama ruwan hoda idan ya gaji.Kar a yi watsi da shi lokacin duba injin sa barci da safe.Zai fi kyau a maye gurbin shi kafin aikin.Na yi wannan kuskuren.
Idan aka kwatanta da na'urar hura wutar lantarki a cikin dakin farfadowa, yanayin numfashi na na'urar sa barci yana da sauƙi.Mai ba da iska da ake buƙata zai iya canza ƙarar iska kawai, ƙimar numfashi da rabon numfashi, yana iya tafiyar da IPPV, kuma ana iya amfani dashi.A lokacin shakawar numfashin da jikin dan adam ke yi ba tare da bata lokaci ba, diaphragm yana yin kwangila, kirji yana fadadawa, kuma mummunan matsa lamba a cikin kirji yana karuwa, yana haifar da bambancin matsa lamba tsakanin bude hanyar iska da alveoli, gas yana shiga cikin alveoli.A lokacin numfashi na inji, ana amfani da matsi mai kyau sau da yawa don samar da bambancin matsa lamba don tura iskar maganin sa barci cikin alveoli.Lokacin da aka dakatar da matsi mai kyau, ƙirji da nama na huhu suna jujjuyawa da ƙarfi don haifar da bambancin matsa lamba daga matsa lamba na yanayi, kuma iskar alveolar yana fitowa daga jiki.Don haka na’urar iska tana da ayyuka guda hudu, wato hauhawar farashin kaya, jujjuyawa daga shakar numfashi zuwa numfashi, fitar da iskar gas mai alveolar, da jujjuyawar numfashi zuwa shakar numfashi, da sake zagayowar a bi da bi.
Kamar yadda aka nuna a cikin hoton da ke sama, iskar gas ɗin tuƙi da na'urar numfashi suna keɓance da juna, iskar gas ɗin yana cikin akwatin bellow, kuma iskar daɗaɗɗen iska tana cikin jakar numfashi.Lokacin da ake shakar iskar gas ɗin yana shiga cikin akwatin ƙwanƙwasa, matsa lamba a cikinsa ya tashi, kuma ana rufe bawul ɗin sakin na'urar da farko, ta yadda iskar ba za ta shiga tsarin cire iskar gas ba.Ta wannan hanyar, iskar gas ɗin anesthetic a cikin jakar numfashi ana matsawa kuma ana fitar da shi cikin hanyar iskar majiyyaci.Lokacin fitar da iskar gas din da ke tukawa yana barin akwatin bellow din, kuma karfin da ke cikin akwatin bell yana sauka zuwa yanayin yanayi, amma numfashin ya fara cika mafitsarar numfashi.Wannan saboda akwai ƙaramin ball a cikin bawul, wanda ke da nauyi.Sai kawai lokacin da matsa lamba a cikin bellow ya wuce 2 ~ 3cmH₂O, wannan bawul ɗin zai buɗe, wato, wuce haddi gas zai iya wucewa ta cikin tsarin cire gas.Don sanya shi a hankali, wannan hawan hawan hawan zai haifar da PEEP (matsi na ƙarshe na ƙarshe) na 2 ~ 3cmH2O.Akwai nau'ikan asali guda 3 don sauyawar sake zagayowar numfashi na na'ura mai ba da hanya tsakanin hanyoyin sadarwa, wato ƙarar ƙara, matsa lamba da kuma sauyawa lokaci.A halin yanzu, mafi yawan masu satar numfashi suna amfani da yanayin sauya ƙarar akai-akai, wato, a lokacin lokacin inspiratory, ana aika ƙarar da aka saita a cikin na'urar numfashi na mai haƙuri har zuwa alveoli don kammala lokacin inspiratory, sa'an nan kuma canza zuwa lokacin karewa da aka saita. ta haka samar da zagayowar numfashi, wanda a cikinsa saitaccen adadin tidal, yawan numfashi da yanayin numfashi sune manyan sigogi uku don daidaita yanayin numfashi.
6.Exhaust gas kau tsarin
Kamar yadda sunan ya nuna, shine don magance iskar gas da kuma hana gurɓata a cikin ɗakin aiki.Ban damu sosai game da wannan a wurin aiki ba, amma dole ne a toshe bututun shaye-shaye, in ba haka ba za a matse iskar a cikin huhu na majiyyaci, kuma ana iya tunanin sakamakon.
Don rubuta wannan shine a sami fahimtar macroscopic na injin sa barci.Haɗa waɗannan sassa da motsa su shine yanayin aiki na injin sa barci.Tabbas, har yanzu akwai cikakkun bayanai da yawa waɗanda ke buƙatar yin la’akari da su sannu a hankali, kuma ƙarfin yana da iyaka, don haka ba zan kai ga ƙarshe ba har yanzu.Ka'idar tana cikin ka'idar.Komai yawan karantawa da rubutawa, har yanzu dole ne ku sanya shi cikin aiki, ko aiki.Bayan haka, yana da kyau a yi kyau da a ce da kyau.
Lokacin aikawa: Juni-05-2023
