Amalungu asisiseko eumatshini wokubulala iintlungu
Ngethuba lokusebenza komatshini we-anesthesia, igesi ephezulu yoxinzelelo (umoya, i-oksijeni i-O2, i-nitrous oxide, njl. njl.) iyancipha nge-valve yokunciphisa uxinzelelo ukuze ifumane i-low-pressure kunye negesi ezinzileyo, emva koko imitha yokuhamba kunye ne-O2. Isixhobo sokulawula umlinganiselo we-N2O silungelelaniswa ukuvelisa izinga elithile lokuqukuqela.Nomlinganiselo werhasi exutyiweyo, kwisekethe yokuphefumla.
Iyeza le-anesthesia livelisa umphunga we-anesthetic ngetanki ye-volatilization, kwaye umphunga ofunekayo wobungakanani be-anesthetic ungena kwisekethe yokuphefumla kwaye uthunyelwa kwisigulane kunye negesi exutywe.
Ikakhulu inesixhobo sokubonelela ngegesi, i-evaporator, isekethe yokuphefumla, isixhobo sokufunxa i-carbon dioxide, i-anesthesia ventilator, inkqubo yokususa inkunkuma ye-anesthesia, njl.
- Isixhobo sokubonelela ngomoya
Le nxalenye iqulunqwe kakhulu ngumthombo womoya, igeyiji yoxinzelelo kunye nevalve yokunciphisa uxinzelelo, imitha yokuhamba kunye nenkqubo yokulinganisa.
Igumbi lokusebenza ngokubanzi libonelelwa ngeoksijini, i-nitrous oxide, kunye nomoya ngenkqubo yonikezelo komoya esembindini.Igumbi le-endoscopy yesisu ngokuqhelekileyo ngumthombo wegesi yesilinda.Ezi gesi ekuqaleni ziphantsi koxinzelelo oluphezulu kwaye kufuneka zithotywe ngamanyathelo amabini ngaphambi kokuba zisetyenziswe.Ke kukho iigeyiji zoxinzelelo kunye neevalvu zokunciphisa uxinzelelo.Ivalve yokunciphisa uxinzelelo kukunciphisa igesi yasekuqaleni yoxinzelelo oluphezulu ukuya kwindawo ekhuselekileyo, ehlala iphantsi yoxinzelelo lwegesi yokusetyenziswa ngokukhuselekileyo koomatshini be-anesthesia.Ngokuqhelekileyo, xa i-cylinder yegesi yoxinzelelo oluphezulu igcwele, uxinzelelo luyi-140kg/cm².Emva kokudlula kwi-valve yokunciphisa uxinzelelo, ekugqibeleni iya kuwela malunga ne-3 ~ 4kg / cm², eyi-0.3 ~ 0.4MPa esihlala siyibona kwiincwadi zezifundo.Kufanelekile ukunyamezela uxinzelelo oluphantsi rhoqo kumatshini we-anesthesia.
Imitha yokuhamba ilawula ngokuchanekileyo kwaye ilinganise ukuhamba kwerhasi ukuya kwindawo entsha yegesi.Eyona nto ixhaphakileyo yi-rotameter yokumiswa.
Emva kokuba i-valve yokulawula ukuhamba ivuliwe, igesi inokudlula ngokukhululekileyo kwi-gap ye-annular phakathi kwe-float kunye ne-flow tube.Xa isantya sokuhamba sisetwa, i-buoy iya kulungelelanisa kwaye ijikeleze ngokukhululekile kwindawo yexabiso elimiselweyo.Ngeli xesha, amandla aphezulu okuhamba komoya kwi-buoy alingana nobunzima be-buoy ngokwayo.Xa usetyenziswa, ungasebenzisi amandla amaninzi okanye uqinise kakhulu iqhosha elijikelezayo, kungenjalo kuya kwenza ukuba i-thimble igobe ngokulula, okanye isihlalo sevalvu siyakonakala, sibangele ukuba irhasi ingavali ngokupheleleyo kwaye ibangele ukuvuza komoya.
Ukuze kuthintelwe umatshini we-anesthesia ekukhupheni igesi ye-hypoxic, umatshini we-anesthesia nawo unesixhobo sokudibanisa imitha yokuhamba kunye nesixhobo sokujonga umlinganiselo we-oxygen ukugcina ubuncinci be-oxygen concentration ye-oksijini ye-oxygen kwi-outlet yegesi entsha malunga ne-25%.Umgaqo wonxibelelwano lwezixhobo uyamkelwa.Kwiqhosha le-flowmeter ye-N₂O, iigiya ezimbini zixhunywe ngekhonkco, i-O₂ ijikeleza kanye, kwaye i-N₂O ijikeleza kabini.Xa ivalve yenaliti ye-O₂ flowmeter ingasikriwa yodwa, i-N₂O flowmeter ihlala ihleli;xa i-flowmeter ye-N₂O ivuliwe, i-flowmeter ye-O₂ idibaniswa ngokufanelekileyo;xa zombini ii-flowmeters zivulwa, i-O₂ flowmeter ivalwa ngokuthe ngcembe, kunye ne-N₂O flowmeter Iphinde yehla ngokubambisana nayo.
Faka imitha yokuhamba kweoksijini ekufutshane kwindawo eqhelekileyo.Kwimeko yokuvuza kwindawo yomoya we-oxygen, ininzi yokulahlekelwa yi-N2O okanye umoya, kwaye ukulahlekelwa kwe-O2 kuncinci.Ngokuqinisekileyo, ukulandelelana kwayo akuqinisekisi ukuba i-hypoxia ngenxa yokuphuka kwemitha yokuhamba ayiyi kwenzeka.
2.Umphunga
I-evaporator sisixhobo esinokuguqula i-anesthetic ye-liquid volatile ibe ngumphunga kwaye ifake kwisiphaluka se-anesthesia kwisixa esithile.Kukho iintlobo ezininzi ze-evaporators kunye neempawu zabo, kodwa umgaqo woyilo jikelele uboniswe kumzobo.
Irhasi edibeneyo (oko kukuthi, O₂, N₂O, umoya) ingena kwi-evaporator kwaye ihlukaniswe kwiindlela ezimbini.Umzila omnye kukuhamba komoya omncinci ongagqithiyo kwi-20% yexabiso lilonke, elingena kwigumbi lokukhupha umphunga ukukhupha umphunga we-anesthetic;I-80% ye-gas flow flow enkulu ingena ngqo kwi-airway enkulu kwaye ingena kwi-anesthesia loop system.Ekugqibeleni, i-airflows emibini idibaniswe kwi-airflow edibeneyo ukuze isigulane siphefumle, kwaye umlinganiselo wokusabalalisa we-airflows ezimbini kuxhomekeke ekuchaseni kwindlela yomoya nganye, elawulwa yi-knob yokulawula i-concentration.
3.Isekethe yokuphefumla
Ngoku eyona nto isetyenziswa kakhulu eklinikhi yinkqubo ye-circulatory loop, oko kukuthi, inkqubo yokufunxa i-CO2.Inokwahlulwa ibe luhlobo oluvaliweyo kunye nohlobo oluvaliweyo.Uhlobo lwe-semi-closed luthetha ukuba inxalenye yomoya okhutshwayo iphinda ifakwe emva kokuba ifunnwe yi-CO2 absorbent;uhlobo oluvaliweyo luthetha ukuba wonke umoya okhutshiweyo uphinda ufakwe emva kokuba ufunnwe yi-CO2 absorbent.Ukujonga umzobo wesakhiwo, i-valve ye-APL ivaliwe njengenkqubo evaliweyo, kwaye i-valve ye-APL ivuliwe njengenkqubo evaliweyo.Ezi zixokelelwano zimbini ngenene ziimeko ezimbini zevalve ye-APL.
Ibandakanya ubukhulu becala ngamalungu asi-7: ① umthombo womoya omtsha;② ukuphefumla kunye nokukhupha ivalve yendlela enye;③ umbhobho onemisonto;④ Ijoyinti emile njengo-Y;⑤ ivalve yokuphuphuma okanye ivalve yokunciphisa uxinzelelo (i-APL valve);⑥ ingxowa yokugcina umoya;Ivalve yendlela enye ephefumlelayo kunye nokuphefumla inokuqinisekisa ukuhamba kwendlela enye yerhasi kumbhobho onemisonto.Ukongeza, ukuguda kwecandelo ngalinye kukwakhethekile.Enye yeyokuhamba kwendlela enye yegesi, kwaye enye kukuthintela ukuphefumla ngokuphindaphindiweyo kwe-CO2 ephumayo kwisekethe.Xa kuthelekiswa nesekethe yokuphefumla evulekileyo, olu hlobo lwesekethe yokuphefumla evaliweyo okanye evaliweyo inokuvumela ukuphefumla kwakhona kwegesi yokuphefumla, ukunciphisa ukulahleka kwamanzi kunye nobushushu kwindlela yokuphefumla, kwaye kunciphise ukungcoliseka kwegumbi lokusebenza, kunye nokuxinana kwegesi. i-anesthetics izinzile.Kodwa kukho ukungonakali okucacileyo, kuya kwandisa ukuchasana nokuphefumla, kwaye umoya ophumayo ulula ukudibanisa kwi-valve yendlela enye, efuna ukucocwa kwamanzi ngexesha elifanelekileyo kwi-valve yendlela enye.
Apha ndingathanda ukucacisa indima yevalve ye-APL.Kukho imibuzo embalwa malunga nayo endingakwaziyo ukuyifumanisa.Ndababuza abantwana endandifunda nabo, kodwa andizange ndikwazi ukuchaza ngokucacileyo;Ndakhe ndambuza utitshala wam ngaphambili, naye wandibonisa le vidiyo, yaye yacaca xa uthi krwada.I-valve ye-APL, ebizwa ngokuba yi-valve yokuphuphuma okanye i-valve ye-decompression, igama elipheleleyo lesiNgesi liyi-adjustable pressure limiting, kungakhathaliseki ukuba livela kwisiTshayina okanye kwisiNgesi, wonke umntu kufuneka abe nokuqonda okuncinci kwendlela, le yivalve ekhawulela uxinzelelo lwesiphaluka sokuphefumula.Ngaphantsi kolawulo lwesandla, ukuba uxinzelelo kwisiphaluka sokuphefumula luphezulu kunexabiso lomda we-APL, igesi iya kuphuma kwi-valve ukunciphisa uxinzelelo kwisiphaluka sokuphefumula.Cinga ngako xa uncedo lwe-ventilation, ngamanye amaxesha i-pinching yebhola inyuke kakhulu, ngoko ke ndilungisa ngokukhawuleza ixabiso le-APL, injongo kukukhupha nokunciphisa uxinzelelo.Ewe, eli xabiso le-APL liqhelekile yi-30cmH2O.Oku kungenxa yokuba ngokuqhelekileyo, i-peak yoxinzelelo lomoya kufuneka ibe <40cmH2O, kwaye i-avareji yoxinzelelo lwe-airway kufuneka ibe <30cmH2O, ngoko ke ukuba nokwenzeka kwe-pneumothorax kuncinci.Ivalve ye-APL kwisebe ilawulwa ngumthombo kwaye iphawulwe nge-0 ~ 70cmH2O.Ngaphantsi kolawulo lomatshini, akukho nto ifana ne-valve ye-APL.Ngenxa yokuba igesi ayisadluli kwivalve ye-APL, iqhagamshelwe kwi-ventilator.Xa uxinzelelo kwinkqubo luphezulu kakhulu, luya kukhulula uxinzelelo kwi-valve yokukhutshwa kwegesi engaphezulu kwe-bellows ye-anesthesia ventilator ukuqinisekisa ukuba inkqubo yokujikeleza ayiyi kubangela i-barotrauma kwisigulane.Kodwa ngenxa yokhuseleko, i-valve ye-APL kufuneka ibekwe kwi-0 ngokwesiqhelo phantsi kolawulo lomatshini, ukwenzela ukuba ekupheleni komsebenzi, ulawulo lomatshini luya kutshintshwa kulawulo lwezandla, kwaye unokujonga ukuba isigulane siphefumla ngokuzenzekelayo.Ukuba uyalibala ukulungelelanisa i-valve ye-APL, igesi iya kuphela Iyakwazi ukungena emiphungeni, kwaye ibhola iya kuba yinto ekhulayo, kwaye kufuneka ikhutshwe ngokukhawuleza.Ewe, ukuba ufuna ukunyusa imiphunga ngeli xesha, lungisa ivalve ye-APL ibe yi-30cmH2O.
4. Isixhobo sokufunxa icarbon dioxide
Izinto zokufunxa ziquka i-soda lime, i-calcium lime, kunye ne-barium lime, ezinqabileyo.Ngenxa yezibonakaliso ezahlukeneyo, emva kokufunxa i-CO2, utshintsho lombala lukwahlukile.I-soda lime esetyenziswa kwisebe yigranular, kwaye isalathisi sayo yi-phenolphthalein, engenambala xa isanda kwaye ijika i-pink xa iphelile.Musa ukuyihoya xa ujonga umatshini we-anesthesia kusasa.Kungcono ukuyibuyisela phambi kotyando.Ndenze le mpazamo.
Xa kuthelekiswa ne-ventilator kwigumbi lokubuyisela, indlela yokuphefumula ye-anesthesia ventilator ilula.I-ventilator efunekayo inokutshintsha kuphela umthamo wokuphefumla, izinga lokuphefumla kunye nomlinganiselo wokuphefumla, inokuqhuba i-IPPV, kwaye inokusetyenziswa ngokusisiseko.Kwinqanaba lokuphefumula lokuphefumla komzimba womntu ngokuzenzekelayo, i-diaphragm inkontileka, isifuba siyakhula, kwaye uxinzelelo olubi esifubeni luyanda, lubangela umahluko woxinzelelo phakathi kokuvuleka kwendlela yomoya kunye ne-alveoli, kwaye igesi ingena kwi-alveoli.Ngexesha lokuphefumula komatshini, uxinzelelo olulungileyo luhlala lusetyenziselwa ukwenza umehluko woxinzelelo ukutyhala umoya we-anesthesia kwi-alveoli.Xa uxinzelelo olulungileyo lunqunyanyisiwe, isifuba kunye nezicubu zemiphunga zihlehla ngokukhawuleza ukuze zenze umahluko woxinzelelo kuxinzelelo lwe-atmospheric, kwaye igesi ye-alveolar ikhutshwa ngaphandle komzimba.Ngoko ke, i-ventilator inemisebenzi emine esisiseko, oko kukuthi ukunyuka kwamaxabiso, ukuguqulwa kwe-inhalation ukuya ekuphumeni, ukukhutshwa kwegesi ye-alveolar, kunye nokuguqulwa kokuphuma kwi-exhalation ukuya kwi-inhalation, kwaye umjikelo uphinda ngokuphindaphindiweyo.
Njengoko kuboniswe kumzobo ongentla, igesi yokuqhuba kunye nesekethe yokuphefumula yodwa komnye nomnye, igesi eqhubayo ikwibhokisi ye-bellows, kwaye igesi yesiphaluka yokuphefumula ikwisikhwama sokuphefumula.Xa uphefumla, igesi yokuqhuba ingena kwibhokisi ye-bellows, uxinzelelo ngaphakathi kwayo lukhuphuka, kwaye i-valve yokukhupha i-ventilator ivalwe kuqala, ukwenzela ukuba igesi ayiyi kungena kwinkqubo yokususwa kwegesi eseleyo.Ngale ndlela, igesi yokuthomalalisa ekwingxowa yokuphefumla iyacinezelwa ize ikhutshelwe kumzila womoya womguli.Xa uphefumla, irhasi eqhubayo ishiya ibhokisi yemvunge, kwaye uxinzelelo olukwibhokisi yemvunge lwehla luye kuxinzelelo lwe-atmospheric, kodwa ukuphefumla kuqala kuzalisa isinyi sokuphefumla.Oku kungenxa yokuba kukho ibhola encinci kwivalve, enobunzima.Kuphela xa uxinzelelo kwi-bellows ludlula i-2 ~ 3cmH₂O, le valve iya kuvula, oko kukuthi, i-gas engaphezulu inokudlula kuyo ukuya kwinkqubo yokususwa kwegesi eseleyo.Ukuyibeka ngokucacileyo, oku kunyuka kwe-bellows kuya kuvelisa i-PEEP (i-positive end-expiratory pressure) ye-2 ~ 3cmH2O.Kukho iindlela ezi-3 ezisisiseko zokutshintsha umjikelo wokuphefumla we-ventilator, oko kukuthi umthamo ongaguqukiyo, uxinzelelo oluqhubekayo kunye nokutshintsha ixesha.Okwangoku, uninzi lwee-anesthesia respirators zisebenzisa imowudi yokutshintsha umthamo oqhubekayo, oko kukuthi, ngexesha lesigaba sokuphefumula, umthamo we-tidal preset uthunyelwa kwindawo yokuphefumula yesigulane de i-alveoli igqibe isigaba sokuphefumula, kwaye emva koko utshintshele kwisigaba sokuphefumula kwangaphambili , ngokwenza umjikelo wokuphefumla, apho umthamo wamaza osetwe kwangaphambili, izinga lokuphefumla kunye nomlinganiselo wokuphefumla ziziiparamitha ezintathu eziphambili zokulungelelanisa umjikelo wokuphefumla.
6.Exhaust inkqubo yokususa igesi
Njengoko igama libonisa, kukujongana negesi yokukhupha kunye nokuthintela ukungcola kwigumbi lokusebenza.Andikhathali kakhulu malunga nale nto emsebenzini, kodwa umbhobho wokukhupha kufuneka ungavalwa, ngaphandle koko igesi iya kuxinzelelwa kwimiphunga yesigulane, kwaye iziphumo zinokucinga.
Ukubhala oku kukuba nokuqonda kwe-macroscopic kumatshini we-anesthesia.Ukudibanisa ezi nxalenye kunye nokuzihambisa yimeko yokusebenza yomshini we-anesthesia.Ewe, kusekho iinkcukacha ezininzi ekufuneka zithathelwe ingqalelo kancinci, kwaye amandla anqongophele, ngoko ke andizukufika ezantsi okwangoku.Ithiyori yeyethiyori.Kungakhathaliseki ukuba ukufunda nokubhala kangakanani na, kusafuneka ukusebenzise, okanye ukuqhelisela.Ngapha koko, kulunge ngakumbi ukwenza kakuhle kunokuthetha kakuhle.
Ixesha lokuposa: Jun-05-2023
