Izingxenye eziyisisekelo ze-umshini wokubulala izinzwa
Ngesikhathi sokusebenza komshini wokulalisa izinzwa, igesi yokucindezela okuphezulu (umoya, i-oxygen O2, i-nitrous oxide, njll.) iyancipha ngokusebenzisa i-valve yokunciphisa ingcindezi ukuze kutholwe igesi ephansi yokucindezela futhi ezinzile, bese kuba imitha yokugeleza kanye ne-O2. Idivayisi yokulawula isilinganiso se-N2O iyalungiswa ukuze ikhiqize izinga elithile lokugeleza.Nengxenye yegesi exubile, kumjikelezo wokuphefumula.
Umuthi obulala izinzwa ukhiqiza umhwamuko obulala izinzwa ngethangi lokuvuthisa, futhi umhwamuko odingekayo womthamo obulala izinzwa ungena endaweni yokuphefumula bese uthunyelwa esigulini kanye negesi exubile.
Ikakhulukazi iqukethe idivayisi yokuhlinzeka ngegesi, i-evaporator, isifunda sokuphefumula, idivayisi yokumunca i-carbon dioxide, i-anesthesia ventilator, uhlelo lokususa igesi ye-anesthesia, njll.
- Idivayisi yokuhlinzeka ngomoya
Le ngxenye ikakhulukazi yakhiwe umthombo womoya, igeji yokucindezela kanye nevalvu yokunciphisa ukucindezela, imitha yokugeleza kanye nesistimu yokulinganisa.
Igumbi lokuhlinza ngokuvamile linikezwa umoya-mpilo, i-nitrous oxide, nomoya ngohlelo olumaphakathi lokuphakelwa komoya.Igumbi le-endoscopy yamathumbu ngokuvamile liwumthombo wegesi yesilinda.Lamagesi ekuqaleni angaphansi kwengcindezi ephezulu futhi kufanele acindezelwe ngezinyathelo ezimbili ngaphambi kokuba asetshenziswe.Ngakho-ke kukhona ama-gauge okucindezela kanye nama-valve okunciphisa ukucindezeleka.I-valve yokunciphisa ingcindezi iwukunciphisa igesi yokuqala ecindezelwe kakhulu ibe igesi ephephile, ehlala iphansi yokucindezela ukuze kusetshenziswe ngokuphephile imishini yokubulala izinzwa.Ngokuvamile, lapho isilinda segesi enomfutho ophezulu sigcwele, ingcindezi ingu-140kg/cm².Ngemva kokudlula kuvalvu yokunciphisa ingcindezi, ekugcineni izokwehla ibe cishe ku-3~4kg/cm², okungu-0.3~0.4MPa esivame ukuyibona ezincwadini zokufunda.Ifanele ukucindezela okuphansi okuqhubekayo emishinini ye-anesthesia.
Imitha yokugeleza ilawula ngokunembile futhi ilinganise ukugeleza kwegesi endaweni yokukhipha igesi entsha.Okuvame kakhulu yi-rotameter yokumiswa.
Ngemuva kokuvulwa kwe-valve yokulawula ukugeleza, igesi ingadlula ngokukhululekile igebe le-annular phakathi kwe-float ne-flow tube.Uma izinga lokugeleza lisethiwe, i-buoy izobhalansisa futhi ijikeleze ngokukhululekile endaweni yenani elimisiwe.Ngalesi sikhathi, amandla akhuphukayo okugeleza komoya ku-buoy alingana namandla adonsela phansi e-buoy uqobo.Uma usetshenziswa, ungasebenzisi amandla amaningi noma uqinise kakhulu iknob ejikelezayo, ngaphandle kwalokho kuzobangela kalula ukuthi i-thimble igobe, noma isihlalo sevalvu sizokonakala, okubangele ukuthi igesi yehluleke ukuvala ngokuphelele futhi kubangele ukuvuza komoya.
Ukuze uvimbele umshini wokulalisa izinzwa ekukhipheni igesi ye-hypoxic, umshini wokubulala izinzwa futhi unedivayisi yokuxhumanisa imitha yokugeleza kanye nedivayisi yokuqapha isilinganiso se-oxygen ukuze ugcine ukukhishwa okuncane okugxiliswa komoyampilo ngokuphuma kwegesi entsha cishe ku-25%.Umgomo wokuxhumanisa amagiya uyamukelwa.Enkinobho ye-flowmeter ye-N₂O, amagiya amabili axhunywe iketango, u-O₂ uzungezisa kanye, futhi u-N₂O uzungezisa kabili.Lapho i-valve yenaliti ye-flowmeter ye-O₂ ivuliwe yodwa, i-N₂O flowmeter ihlala inganyakazi;lapho i-Flowmeter ye-N₂O ingasikiwe, i-flowmeter ye-O₂ ixhunywe ngokufanele;lapho kuvulwa kokubili ama-flowmeters, i-O₂ flowmeter ivalwa kancane kancane, futhi i-N₂O flowmeter Iphinde yehla ngokuhambisana nayo.
Faka imitha yokugeleza komoyampilo eseduze nendawo yokuphuma evamile.Esimeni sokuvuza endaweni yokuvunguza komoya-mpilo, ukulahlekelwa okuningi yi-N2O noma umoya, futhi ukulahlekelwa kwe-O2 kuncane kakhulu.Yiqiniso, ukulandelana kwayo akuqinisekisi ukuthi i-hypoxia ngenxa yokuqhuma kwamamitha okugeleza ngeke kwenzeke.
2.I-Evaporator
I-evaporator iyisisetshenziswa esingaguqula isibulali-zinzwa esishintshashintshayo esiwuketshezi sibe umhwamuko bese siwufaka kusekethi yokubulala izinzwa ngenani elithile.Kunezinhlobo eziningi ze-evaporator nezici zazo, kodwa isimiso sokuklama jikelele siboniswa esithombeni.
Igesi exubile (okungukuthi, O₂, N₂O, umoya) ingena ku-evaporator futhi ihlukaniswe yaba izindlela ezimbili.Umzila owodwa uwukugeleza komoya okuncane okungeqile ku-20% yenani eliphelele, elingena egunjini lokuhwamuka ukuze likhiphe umhwamuko obulala izinzwa;I-80% yokugeleza kwegesi enkulu ingena ngqo emgwaqeni omkhulu womoya futhi ingene ohlelweni lwe-anesthesia loop.Ekugcineni, ukugeleza komoya okubili kuhlanganiswe kube ukugeleza komoya okuxubile ukuze isiguli sikuhogele, futhi isilinganiso sokusabalalisa sokugeleza komoya okubili sincike ekuphikisweni kwendlela yomoya ngayinye, elawulwa yinkinobho yokulawula ukuhlushwa.
3.Isekhethi yokuphefumula
Manje esetshenziswa kakhulu emtholampilo uhlelo lokujikeleza kwegazi, okungukuthi, uhlelo lokumunca i-CO2.Ingahlukaniswa ngohlobo oluvalwe kancane kanye nohlobo oluvaliwe.Uhlobo oluvaleke kancane lusho ukuthi ingxenye yomoya okhishwe umoya iphinde idonswe ngemva kokumuncwa i-CO2;uhlobo oluvaliwe lusho ukuthi wonke umoya okhishwe umoya uphinde udonswe ngemva kokumuncwa i-CO2.Uma ubheka umdwebo wesakhiwo, i-valve ye-APL ivaliwe njengesistimu evaliwe, futhi i-valve ye-APL ivulwa njengesistimu evaliwe kancane.Lezi zinhlelo ezimbili empeleni ziyizifunda ezimbili ze-valve ye-APL.
Ngokuyinhloko iqukethe izingxenye ezingu-7: ① umthombo womoya omusha;② ukuhogela kanye nokukhipha umoya ngendlela eyodwa;③ ipayipi elinentambo;④ Ihlangano emise okuka-Y;⑤ i-valve yokuchichima noma i-valve yokunciphisa ingcindezi (i-APL valve);⑥ isikhwama sokugcina umoya;I-valve yendlela eyodwa ephefumulayo neyokukhipha umoya ingaqinisekisa ukugeleza kwendlela eyodwa kwegesi kushubhu elinentambo.Ngaphezu kwalokho, ukushelela kwengxenye ngayinye nakho kukhethekile.Enye ingeyokugeleza kwegesi kwendlela eyodwa, kanti enye iwukuvimbela ukuhogela ngokuphindaphindiwe kwe-CO2 ekhishwe kumjikelezo.Uma kuqhathaniswa nesekhethi yokuphefumula evulekile, lolu hlobo lwesekethe yokuphefumula evalwe kancane noma evaliwe lungavumela ukuphefumula kabusha kwegesi yokuphefumula, ukunciphisa ukulahlekelwa kwamanzi nokushisa emgudwini wokuphefumula, futhi futhi kunciphise ukungcoliswa kwegumbi lokuhlinza, kanye nokugxila izinzwa zizinzile.Kodwa kukhona ukungahambi kahle okusobala, kuzokwandisa ukumelana nokuphefumula, futhi umoya ophefumulayo kulula ukuhlanganisa ku-valve yendlela eyodwa, okudinga ukuhlanzwa kwamanzi ngesikhathi esifanele ku-valve yendlela eyodwa.
Lapha ngithanda ukucacisa indima ye-valve ye-APL.Kunemibuzo embalwa ngayo engingakwazi ukuyithola.Ngabuza engangifunda nabo, kodwa angikwazanga ukuchaza ngokucacile;Ngake ngabuza uthisha wami ngaphambili, naye wangibonisa i-video, kwacaca uma uthi nhla.I-valve ye-APL, ebizwa nangokuthi i-valve yokuchichima noma i-decompression valve, igama eligcwele lesiNgisi liwukunciphisa ukucindezela okuguquguqukayo, kungakhathaliseki ukuthi uvela eShayina noma esiNgisini, wonke umuntu kufanele abe nokuqonda okuncane kwendlela, lena i-valve ekhawulela ukucindezela kwesifunda sokuphefumula.Ngaphansi kokulawula okwenziwa ngesandla, uma ingcindezi kumjikelezo wokuphefumula ingaphezu kwenani lomkhawulo we-APL, igesi izophela kuvalvu ukuze kuncishiswe ingcindezi kumjikelezo wokuphefumula.Cabanga ngakho lapho ukusizwa komoya, ngezinye izikhathi ukumpintsha ibhola kukhuphuke kakhulu, ngakho-ke ngilungisa ngokushesha inani le-APL, inhloso iwukuba nginciphise futhi nginciphise ingcindezi.Kunjalo, leli nani le-APL livamise ukuba ngu-30cmH2O.Lokhu kungenxa yokuthi ngokuvamile, umfutho womoya ophezulu kufanele ube u-<40cmH2O, futhi isilinganiso somfutho womoya kufanele sibe ngaphansi kuka-30cmH2O, ngakho amathuba okuba ne-pneumothorax mancane uma kuqhathaniswa.Ivalvu ye-APL emnyangweni ilawulwa isiphethu futhi imakwe ngo-0~70cmH2O.Ngaphansi kokulawulwa komshini, ayikho into efana ne-valve ye-APL.Ngenxa yokuthi igesi ayisadluli ku-valve ye-APL, ixhunywe kumshini wokuphefumula.Lapho ingcindezi ohlelweni iphezulu kakhulu, izokhulula ingcindezi evela ku-valve yokukhishwa kwegesi ngokweqile kwe-bellows ye-anesthesia ventilator ukuqinisekisa ukuthi uhlelo lokujikeleza kwegazi ngeke lubangele i-barotrauma esigulini.Kodwa ngenxa yokuphepha, i-valve ye-APL kufanele isethwe ku-0 ngokujwayelekile ngaphansi kokulawulwa komshini, ukuze ekupheleni kokusebenza, ukulawulwa komshini kuzoshintshelwa ekulawuleni okwenziwa ngesandla, futhi ungabheka ukuthi isiguli siphefumula ngokuzenzakalelayo.Uma ukhohlwa ukulungisa i-valve ye-APL, igesi izokwenza kuphela Ingangena emaphashini, futhi ibhola lizoqhuma kakhulu, futhi lidinga ukuchithwa ngokushesha.Kunjalo, uma udinga ukufutha amaphaphu ngalesi sikhathi, lungisa i-valve ye-APL ibe ngu-30cmH2O.
4. Idivayisi yokumunca i-carbon dioxide
Ama-absorbents afaka i-soda lime, i-calcium lime, ne-barium lime, okuyivelakancane.Ngenxa yezinkomba ezihlukene, ngemva kokumunca i-CO2, ukushintsha kombala nakho kuhlukile.I-soda lime esetshenziswa emnyangweni iyimbudumbudu, futhi inkomba yayo yi-phenolphthalein, engenambala uma isha futhi iba pink lapho isiphelile.Ungayizibi lapho uhlola umshini wokubulala izinzwa ekuseni.Kungcono ukuyishintsha ngaphambi kokuhlinzwa.Ngenze leli phutha.
Uma kuqhathaniswa ne-ventilator egumbini lokutakula, iphethini yokuphefumula ye-anesthesia ventilator ilula kakhulu.I-ventilator edingekayo ingashintsha kuphela umthamo wokuphefumula, izinga lokuphefumula kanye nesilinganiso sokuphefumula, ingasebenzisa i-IPPV, futhi ingasetshenziswa ngokuyisisekelo.Esigabeni sokuphefumula sokuphefumula komzimba womuntu ngokuzenzekelayo, i-diaphragm iyafinyela, isifuba siyakhula, futhi ukucindezela okungalungile esifubeni kuyanda, okubangela umehluko wengcindezi phakathi kokuvuleka komzila womoya kanye ne-alveoli, futhi igesi ingena ku-alveoli.Ngesikhathi sokuphefumula kwemishini, ukucindezela okuhle kuvame ukusetshenziselwa ukwakha umehluko wengcindezi ukusunduza umoya wokubulala izinzwa ungene ku-alveoli.Lapho ukucindezela okuhle kumisiwe, isifuba nezicubu zamaphaphu ziyahlehla ukuze zenze umehluko wengcindezi emkhathini, bese igesi ye-alveolar iphuma emzimbeni.Ngakho-ke, i-ventilator inemisebenzi emine eyisisekelo, okuwukuthi ukwehla kwamandla emali, ukuguqulwa kusuka ekuhogeleni kuye ekukhishweni, ukukhishwa kwegesi ye-alveolar, nokuguqulwa kusuka ekuphefumuleni kuye ekuhogeleni, futhi umjikelezo uphinda ngokushintshana.
Njengoba kuboniswe emfanekisweni ongenhla, igesi yokushayela kanye nesifunda sokuphefumula sihlukaniswe komunye nomunye, igesi yokushayela isebhokisini le-bellows, futhi igesi yesifunda sokuphefumula isesikhwameni sokuphefumula.Lapho uphefumula, igesi yokushayela ingena ebhokisini le-bellows, ingcindezi ngaphakathi kwayo ikhuphuka, futhi i-valve yokukhulula ye-ventilator ivalwe kuqala, ukuze igesi ingangeni ohlelweni lokususa igesi esele.Ngale ndlela, igesi yokubulala izinzwa esesikhwameni sokuphefumula iyacindezelwa bese idedelwa emgudwini wokuphefumula wesiguli.Lapho uphefumula, igesi eshayelayo ishiya ibhokisi le-bellows, futhi ukucindezela ebhokisini le-bellows kwehla kumfutho womkhathi, kodwa umoya ophefumulayo kuqala ugcwalise esinyeni esikhipha umoya.Lokhu kungenxa yokuthi kunebhola elincane ku-valve, elinesisindo.Kuphela uma ukucindezela ku-bellows kudlula i-2 ~ 3cmH₂O, le valve izovuleka, okungukuthi, igesi engaphezulu ingadlula kuyo ibe yisistimu yokususa igesi esele.Ukukubeka ngembaba, lokhu kubhonsa okukhuphukayo kuzokhiqiza i-PEEP (ingcindezi yokuphelelwa umoya) engu-2~3cmH2O.Kunezindlela eziyisisekelo ezi-3 zokushintsha umjikelezo wokuphefumula we-ventilator, okungukuthi ivolumu engaguquki, ukucindezela okungaguquki kanye nokushintsha kwesikhathi.Njengamanje, iningi lama-anesthesia respirators lisebenzisa imodi yokushintsha ivolumu engaguquki, okungukuthi, phakathi nesigaba sokuphefumula, ivolumu ye-tidal esethiwe ithunyelwa emgudwini wokuphefumula wesiguli kuze kube yilapho i-alveoli iqeda isigaba sokuphefumula, bese ishintshela esigabeni sokuphefumula esisethiwe , ngaleyo ndlela kwakha umjikelezo wokuphefumula, lapho ivolumu ye-tidal ehleliwe, izinga lokuphefumula kanye nesilinganiso sokuphefumula kuyimingcele emithathu eyinhloko yokulungisa umjikelezo wokuphefumula.
6.Exhaust gas ukususwa uhlelo
Njengoba igama liphakamisa, kuwukubhekana negesi ephumayo nokuvimbela ukungcola ekamelweni lokusebenza.Anginandaba kakhulu nalokhu emsebenzini, kodwa ipayipi le-exhaust akufanele livinjwe, ngaphandle kwalokho igesi izompindwa emaphashini esiguli, futhi imiphumela ingacatshangwa.
Ukubhala lokhu kuwukuba nokuqonda okukhulu komshini wokubulala izinzwa.Ukuxhuma lezi zingxenye nokuzihambisa kuyisimo sokusebenza somshini wokubulala izinzwa.Yebo, kusenemininingwane eminingi edinga ukucatshangelwa kancane, futhi ikhono lilinganiselwe, ngakho-ke ngeke ngifinyelele ekujuleni kwayo okwamanje.Ithiyori ingeyethiyori.Kungakhathaliseki ukuthi ufunda futhi ubhale kangakanani, kusafanele ukubeke emsebenzini, noma ukuzijwayeza.Phela kungcono ukwenza kahle kunokusho kahle.
Isikhathi sokuthumela: Jun-05-2023
