Basic components of anmushonga weanesthesia
Munguva yekushanda kweaneshesia muchina, iyo yakakwira-kudzvanya gasi (mhepo, okisijeni O2, nitrous oxide, nezvimwewo) inoderedzwa kuburikidza nevhavha yekuderedza kudzvinyirira kuti iwane yakaderera-kumanikidza uye yakagadzikana gasi, uye ipapo kuyerera mita uye O2. -N2O reshiyo yekudzora mudziyo inogadziriswa kuti ibudise imwe chiyero chekuyerera.Uye chikamu chegasi rakasanganiswa, mumhepo yekufema.
Mushonga weanesthesia unogadzira anesthetic vapor kuburikidza netangi yekuvhuvhuta, uye inodiwa yakawanda anesthetic vapor inopinda mumhepo yekufema uye inotumirwa kumurwere pamwe chete negasi rakasanganiswa.
Iyo inonyanya kuumbwa negasi rekupa mudziyo, evaporator, kufema wedunhu, kabhoni dhaidhirodhi absorption mudziyo, anesthesia ventilator, anesthesia tsvina yekubvisa gasi system, nezvimwe.
- Chigadzirwa chekupa mweya
Ichi chikamu chinonyanya kuumbwa nemhepo sosi, gauge yekumanikidza uye kudzvinyirira kudzikisa valve, kuyerera kwemamita uye proportioning system.
Imba yekuvhiya inowanzopihwa oksijeni, nitrous oxide, uye mweya nepakati pemhepo yekupa system.Iyo gastrointestinal endoscopy kamuri inowanzova cylinder gasi sosi.Aya magasi anotanga ari pasi pekumanikidzwa kwakanyanya uye anofanira kuderedzwa mumatanho maviri asati ashandiswa.Saka kune magaji ekumanikidza uye mavharuvhu ekuyamura.The pressure kuderedza vharafu ndiko kuderedza chepakutanga high-kumanikidzwa compressed gasi kuti yakachengeteka, inogara yakaderera-kudzvanya gasi kuti akachengeteka kushandiswa kwokutindivadza michina.Kazhinji, kana iyo high-pressure gasi cylinder yakazara, kudzvanywa kuri 140kg/cm².Mushure mokupfuura nepakati pekudzvinyirira kuderedza valve, inozopedzisira yadonha kusvika ku3 ~ 4kg / cm², iyo 0.3 ~ 0.4MPa iyo yatinowanzoona mumabhuku ezvinyorwa.Inokodzera kugara yakaderera kudzvinyirirwa mumashini eanesthesia.
Iyo yekuyerera mita inodzora nemazvo uye kuyera kuyerera kwegasi kune nyowani gasi rinobuda.Iyo inonyanya kuzivikanwa ndeyekumiswa rotameter.
Mushure mokunge vharuvhu yekudzora kuyerera yakavhurwa, gasi rinogona kupfuura zvakasununguka nepakati pegore pakati pekuyangarara uye kuyerera kwechubhu.Kana chiyero chekuyerera chaiswa, buoy inodzikama uye inotenderera zvakasununguka panzvimbo yakatarwa kukosha.Panguva ino, simba rekumusoro remhepo rinoyerera pabhuya rakaenzana negiravhiti rebhuyo pacharo.Paunenge uchishandiswa, usashandise simba rakawandisa kana kuwedzeredza knob inotenderera, zvikasadaro zvinokonzeresa kuti thimble ikotame, kana chigaro chevharuvhu chinokanganisa, zvichiita kuti gasi ritadze kuvhara zvachose uye kukonzera kubuda kwemhepo.
Kuti kudzivirira yokutindivadza muchina kubva outputting hypoxic gasi, yokutindivadza muchina anewo kuyerera mita linkage mudziyo uye okisijeni reshiyo zvichiongororwa mudziyo kuchengeta shoma okisijeni yevasungwa goho kubudikidza itsva gasi chinobuda pane anenge 25%.Nheyo yekubatanidza giya inogamuchirwa.Pabhatani reN₂O flowmeter, magiya maviri akabatanidzwa neketani, O₂ inotenderera kamwe, uye N₂O inotenderera kaviri.Kana iyo valve yetsono yeO₂ flowmeter isina kuvharwa yega, iyo N₂O flowmeter inoramba yakanyarara;kana iyo N₂O flowmeter isina kuvharwa, iyo O₂ flowmeter inobatanidzwa zvinoenderana;apo ese ari maviri emvura akavhurwa, iyo O₂ flowmeter inovharwa zvishoma nezvishoma, uye iyo N₂O flowmeter Yakadzikirawo pamwe chete nayo.
Isai mita yeokisijeni iri padyo nenzvimbo inobuda.Muchiitiko chekudonha panzvimbo yemhepo yeokisijeni, yakawanda yekurasikirwa iN2O kana mhepo, uye kurasikirwa kweO2 ndiko kushoma.Zvechokwadi, kutevedzana kwayo hakuvimbisi kuti hypoxia nekuda kwekuyerera kwemamita kuputika hakuzoitiki.
2.Evaporator
An evaporator mudziyo unokwanisa kushandura mvura inoputika kutindivadza kuita mhute uye woipinza muchikamu cheanesthesia mune imwe chiyero.Kune akawanda marudzi eevaporator uye maitiro avo, asi iyo yakazara dhizaini musimboti inoratidzwa mumufananidzo.
Iyo gasi yakasanganiswa (kureva, O₂, N₂O, mweya) inopinda muevaporator uye yakakamurwa kuita nzira mbiri.Imwe nzira idiki mhepo inoyerera isingadariki makumi maviri kubva muzana yehuwandu hwese, iyo inopinda mukamuri yekuputira kuti ibudise iyo anesthetic vapor;80% yegasi yakakura inoyerera inopinda zvakananga mumugwagwa mukuru wemhepo uye inopinda muanesthesia loop system.Pakupedzisira, mhepo mbiri idzi dzinosanganiswa mumhepo yakavhenganiswa kuti murwere apinze, uye chiyero chekugovera chemhepo mbiri chinoenderana nekupikisa munzira imwe neimwe yemhepo, iyo inotungamirirwa nekomboti yekudzora.
3.Breathing circuit
Iye zvino inonyanya kushandiswa kukiriniki ndeye circulatory loop system, kureva, CO2 absorption system.Inogona kukamurwa kuita semi-yakavharwa mhando uye yakavharwa mhando.Iyo semi-yakavharwa mhando inoreva kuti chikamu chemhepo inofemerwa inodzokororwa mushure mekubatwa ne CO2 inonyudza;iyo yakavharwa yemhando inoreva kuti mhepo yese yakaburitswa inodzokororwa mushure mekubatwa ne CO2 inonyudza.Kutarisa pamufananidzo wekugadzirisa, APL valve yakavharwa sevhavha yakavharwa, uye APL valve inovhurwa semi-yakavharwa system.Iwo maviri masisitimu ari iwo chaiwo nyika mbiri dzeAPL valve.
Iyo inonyanya kuve nezvikamu zvinomwe: ① mweya mutsva sosi;② inhalation uye kufema nzira imwe-vharuvhu;③ pombi ine thread;④ chibatanidzwa chakaita Y;⑤ vharafu yekufashukira kana kumanikidza kuderedza valve (APL valve);⑥ bhegi rekuchengetedza mweya;Iyo yekufuridzira uye yekufemedza nzira imwe-vharuvhu inogona kuve nechokwadi chekuyerera kwegasi muhupu yakasungwa.Mukuwedzera, kutsetseka kwechikamu chimwe nechimwe kunonyanya kukosha.Imwe ndeye nzira imwe chete yekuyerera kwegasi, uye imwe ndeyekudzivirira kudzokorora inhalation ye exhaled CO2 mudunhu.Kuenzaniswa neyakavhurika kufema wedunhu, iyi mhando yehafu-yakavharwa kana yakavharwa kufema wedunhu inogona kubvumira kufemazve gasi rekufema, kuderedza kurasikirwa kwemvura uye kupisa munzira yekufema, uye zvakare kuderedza kusvibiswa kwekamuri yekuvhiya, uye kuwanda kwe anesthetics inenge yakagadzikana.Asi pane kukanganisa kwakajeka, kuchawedzera kufema kwekufema, uye mhepo inoputika iri nyore kunyunguduka pane imwe nzira valve, inoda kuchenesa nguva yemvura pane imwe nzira yevhavha.
Pano ndinoda kujekesa basa re APL valve.Pane mibvunzo mishoma pamusoro payo yandisingakwanise kuziva.Ndakabvunza vandaidzidza navo, asi handina kukwanisa kutsanangura zvakajeka;Ndakambobvunza mudzidzisi wangu, uye akandiratidzawo vhidhiyo yacho, uye yakanyatsojeka nokungotarisa.APL valve, iyo inonziwo overflow valve kana decompression valve, zita reChirungu rakazara ndiro rinogadziriswa kudzvinyirira, pasinei neChinese kana Chirungu, munhu wose anofanira kunge ane kunzwisisa kuduku kwenzira, iyi ivhavha inogadzirisa kudzvinyirira kwemhepo yekufema.Pasi pekutonga kwebhuku, kana kumanikidzwa mumhepo yekufema kwakakwirira kudarika kukosha kweAPL, gasi rinopera kubva pavhavha kuti rideredze kudzvinyirira mumhepo yekufema.Funga nezvazvo kana uchibatsirwa kufefetera, dzimwe nguva kudzvanya bhora kunowedzera kuwedzera, saka ndinokurumidza kugadzirisa kukosha kweAPL, chinangwa ndechekubvisa uye kuderedza kudzvanywa.Ehe, kukosha kweAPL uku kunowanzo 30cmH2O.Izvi zvinodaro nekuti kazhinji kutaura, peak airway pressure inofanirwa kunge iri <40cmH2O, uye avhareji yemhepo inofanirwa kunge iri <30cmH2O, saka mukana wepneumothorax idiki.Iyo APL valve mudhipatimendi inodzorwa nechitubu uye yakanyorwa ne 0 ~ 70cmH2O.Pasi pekutonga kwemuchina, hapana chinhu chakadai seAPL valve.Nekuti iyo gasi haichapfuuri nepakati pe APL valve, yakabatana kune inofefetera.Kana kudzvinyirirwa muhurongwa kwakanyanyisa, kunosunungura kumanikidzika kubva kune yakawandisa gasi kubuda kwevhavha yemhepo yeanesthesia ventilator kuti ive nechokwadi chokuti kutenderera kweropa hakuzokonzeri barotrauma kumurwere.Asi nekuda kwekuchengeteka, valve yeAPL inofanira kuiswa ku 0 inogara iri pasi pekutonga kwemuchina, kuitira kuti pakupera kwekushanda, kutonga kwemuchina kuchashandurwa kune kutonga kwemaoko, uye iwe unogona kutarisa kana murwere ari kufema pakarepo.Kana ukakanganwa kugadzirisa APL valve, gasi ichaita chete Inogona kupinda mumapapu, uye bhora richava rinowedzera kuwedzera, uye rinoda kubviswa pakarepo.Ehe, kana iwe uchida kupinza mapapu panguva ino, gadzirisa iyo APL valve kusvika 30cmH2O.
4. Carbon dioxide absorption mudziyo
Mishonga inosanganisira soda lime, calcium lime, uye barium lime, izvo zvisingawanzoitiki.Nekuda kwezviratidzo zvakasiyana, mushure mekutora CO2, kushanduka kwemavara kwakasiyanawo.Iyo soda lime inoshandiswa mudhipatimendi ine granular, uye chiratidzo chayo ndeye phenolphthalein, iyo isina ruvara kana ichangobva uye inoshanduka pink kana yapera.Usafuratira kana uchitarisa mushini weanesthesia mangwanani.Zvakanakisisa kuitsiva kusati kwaitwa.Ndakakanganisa iyi.
Kuenzaniswa neventilator muimba yekudzikinura, maitiro ekufema eanesthesia ventilator ari nyore.Iyo inofefetera inodiwa inogona chete kushandura vhoriyamu yemhepo, kufema mwero uye reshiyo yekufema, inogona kumhanya IPPV, uye inogona kushandiswa zvakanyanya.Muchikamu chekufemerwa chekufema kwemuviri wemunhu wega, diaphragm inobata, chipfuva chinowedzera, uye kudzvanywa kwakashata muchipfuva kunowedzera, zvichikonzera musiyano pakati pekuvhura kwemhepo nealveoli, uye gasi rinopinda mualveoli.Munguva yekufema kwemuchina, kudzvanywa kwakanaka kunowanzoshandiswa kuumba mutsauko wekumanikidza kusundira mweya weanesthesia mualveoli.Kana kudzvinyirirwa kwakanaka kwakamira, chipfuva nemapapu matishu anodzokera kumashure kuti abudise mutsauko kubva kumhepo yemhepo, uye gasi realveolar rinoburitswa kunze kwemuviri.Naizvozvo, mhepo inofefetera ine mabasa mana akakosha, anoti inflation, kutendeuka kubva mukufemerwa kuenda kumhepo, kubuda kwealveolar gasi, uye kutendeuka kubva pakufemesa kuenda kune inhalation, uye kutenderera kunodzokorora zvakare.
Sezvinoratidzwa mumufananidzo uri pamusoro, gasi rekufambisa uye mhepo yekufema yakaparadzaniswa kubva kune mumwe nemumwe, gasi rekufambisa riri mubhokisi remabhero, uye mhepo yekufema yemhepo iri muhomwe yekufema.Paunenge uchifema, gasi rinotyaira rinopinda mubhokisi remabhero, kudzvanywa mukati mayo kunokwira, uye vharuvhu yekuburitsa yevhavha inovharwa kutanga, kuitira kuti gasi isapinda mune yakasara gasi yekubvisa system.Nenzira iyi, gasi reanesthetic riri mubhegi rekufema rinotsikirirwa uye rinobudiswa mumhepo yemurwere.Paunenge uchifema, gasi rinotyaira rinosiya bhokisi remabhero, uye kudzvanywa kuri mubhokisi remabhero kunodonha kusvika kumhepo yemhepo, asi kufema kunotanga kuzadza dundira rekufemesa.Izvi zvinodaro nekuti pane bhora diki muvharuvhu, rine huremu.Chete kana dzvinyiriro mumabhero inopfuura 2 ~ 3cmH₂O, iyi valve inovhurika, kureva kuti, gasi rakawandisa rinogona kupfuura naro richipinda mune yakasara gasi yekubvisa system.Kutaura pachena, mabhero aya anokwira achaburitsa PEEP (positive end-expiratory pressure) ye2~3cmH2O.Kune matatu ekutanga modhi yekufema kutenderera kuchinjika kwemhepo inofefetera, kureva vhoriyamu inoramba iripo, inogara ichimanikidza uye kushandura nguva.Parizvino, vazhinji veanesthesia respirators vanoshandisa iyo inogara ichiita vhoriyamu switching mode, ndiko kuti, panguva yekufemerwa, iyo preset tidal volume inotumirwa mukati memurwere wekufema turakiti kusvika alveoli kupedza chikamu chekufema, uyezve chinja kune preset expiratory phase , nokudaro vachigadzira kutenderera kwekufema, umo preset tidal volume, kufema mwero uye reshiyo yekufema zvinhu zvitatu zvakakosha zvekugadzirisa kutenderera kwekufema.
6.Exhaust gasi kubvisa hurongwa
Sezvinoratidzwa nezita racho, ndeyekutarisana nemhepo inopisa uye kudzivirira kusvibiswa muimba yekushanda.Ini handina basa nezvakawanda pamusoro peizvi kubasa, asi pombi yekupedza haifanirwe kuvharwa, zvikasadaro gasi richasvinwa mumapapu emurwere, uye mhedzisiro inogona kufungidzirwa.
Kunyora izvi kuve nekunzwisisa macroscopic yemuchina weanesthesia.Kubatanidza zvikamu izvi nekuzvifambisa ndiyo mamiriro ekushanda emushini weanesthesia.Ehezve, pachine zvakawanda zvakawanda zvinoda kutariswa zvishoma nezvishoma, uye kugona kune kushoma, saka ini handisi kuzosvika kuzasi kwaro kwenguva iripo.Dzidziso ndeyedzidziso.Hazvinei kuti unorava nokunyora zvakawanda sei, unotofanira kuzviisa mubasa, kana kuti kudzidzira.Pamusoro pazvo, zviri nani kuita zvakanaka pane kutaura zvakanaka.
Nguva yekutumira: Jun-05-2023
