Monga chida chodziwika bwino kwambiri m'machitidwe azachipatala, chowunikira odwala okhala ndi magawo ambiri ndi mtundu wa chizindikiro chachilengedwe chodziwira nthawi yayitali, magawo ambiri a momwe thupi ndi matenda zimakhalira mwa odwala ofunikira, komanso kudzera mu kusanthula ndi kukonza nthawi yeniyeni komanso yodziwikiratu, kusintha kwa nthawi yake kukhala chidziwitso chowoneka, alamu yodziwikiratu komanso kujambula zochitika zomwe zingawopseze moyo. Kuphatikiza pa kuyeza ndikuwunika magawo a thupi la odwala, imathanso kuyang'anira ndi kuthana ndi momwe odwala alili asanayambe komanso atalandira mankhwala ndi opaleshoni, kupeza kusintha kwa momwe odwala amafunikira, ndikupereka maziko oyambira kuti madokotala azindikire bwino ndikupanga mapulani azachipatala, motero amachepetsa kwambiri imfa ya odwala ofunikira.
Ndi chitukuko cha ukadaulo, zinthu zowunikira za oyang'anira odwala okhala ndi magawo ambiri zakula kuchokera ku dongosolo la magazi kupita ku machitidwe opumira, amanjenje, kagayidwe kachakudya ndi zina.Gawoli limakulitsidwanso kuchokera ku gawo la ECG (ECG) lomwe limagwiritsidwa ntchito kwambiri, gawo lopumira (RESP), gawo losakwanira mpweya m'magazi (SpO2), gawo losalowerera la kuthamanga kwa magazi (NIBP) kupita ku gawo lotentha (TEMP), gawo losalowerera la kuthamanga kwa magazi (IBP), gawo losasinthasintha la mtima (CO), gawo losalowerera la mtima losalowerera (ICG), ndi gawo lopuma la carbon dioxide (EtCO2)), gawo lowunikira la electroencephalogram (EEG), gawo lowunikira mpweya wa anesthesia (AG), gawo lowunikira mpweya wa transcutaneous, gawo lowunikira kuzama kwa anesthesia (BIS), gawo lowunikira kupumula kwa minofu (NMT), gawo lowunikira hemodynamics (PiCCO), gawo la makina opumira.
Kenako, idzagawidwa m'magawo angapo kuti iwonetse maziko a thupi, mfundo, chitukuko ndi kagwiritsidwe ntchito ka gawo lililonse.Tiyeni tiyambe ndi gawo la electrocardiogram (ECG).
1: Njira yopangira ma electrocardiogram
Ma cardiomyocytes omwe amafalikira mu sinus node, atrioventricular junction, atrioventricular tract ndi nthambi zake amapanga magetsi panthawi yosangalatsa ndikupanga magetsi m'thupi. Kuyika electrode yachitsulo mu gawo lamagetsi ili (kulikonse m'thupi) kumatha kulemba mphamvu yofooka. Gawo lamagetsi limasintha mosalekeza pamene nthawi yoyenda ikusintha.
Chifukwa cha mphamvu zosiyanasiyana zamagetsi za minofu ndi ziwalo zosiyanasiyana za thupi, ma electrode ofufuza m'zigawo zosiyanasiyana adalemba kusintha kosiyanasiyana komwe kungachitike pa kayendedwe ka mtima uliwonse. Kusintha kwakung'ono kumeneku kumakulitsidwa ndikulembedwa ndi electrocardiograph, ndipo mawonekedwe otsatirawa amatchedwa electrocardio-gram (ECG). Electrocardiogram yachikhalidwe imajambulidwa kuchokera pamwamba pa thupi, yotchedwa surface electrocardiogram.
2: Mbiri ya ukadaulo wa electrocardiogram
Mu 1887, Waller, pulofesa wa physiology ku Mary's Hospital of the Royal Society of England, adalemba bwino mlandu woyamba wa electrocardiogram ya munthu pogwiritsa ntchito capillary electrometer, ngakhale kuti mafunde a V1 ndi V2 okha a ventricle ndi omwe adalembedwa pachithunzichi, ndipo mafunde a atrium P sanalembedwe. Koma ntchito yayikulu komanso yopindulitsa ya Waller idalimbikitsa Willem Einthoven, yemwe analipo pagulu, ndipo adakhazikitsa maziko a kuyambitsa ukadaulo wa electrocardiogram.
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Kwa zaka 13 zotsatira, Einthoven anadzipereka kwathunthu ku maphunziro a electrocardiograms ojambulidwa ndi ma capillary electrometers. Anasintha njira zingapo zofunika, pogwiritsa ntchito bwino galvanometer ya chingwe, electrocardiogram ya pamwamba pa thupi yojambulidwa pa filimu yowunikira, adalemba electrocardiogram yomwe inawonetsa mafunde a atrial P, ventricular depolarization B, C ndi repolarization D wave. Mu 1903, ma electrocardiograms anayamba kugwiritsidwa ntchito kuchipatala. Mu 1906, Einthoven adalemba ma electrocardiograms a atrial fibrillation, atrial flutter ndi ventricular premature beat motsatizana. Mu 1924, Einthoven adapatsidwa Mphoto ya Nobel mu Medicine chifukwa cha kupanga kwake kujambula ma electrocardiogram.
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3: Kukula ndi mfundo za dongosolo la lead
Mu 1906, Einthoven adapereka lingaliro la bipolar limb lead. Atalumikiza ma electrode ojambulira odwala awiriawiri m'dzanja lamanja, mkono wamanzere ndi mwendo wamanzere, amatha kujambula electrocardiogram ya bipolar limb lead (lead I, lead II ndi lead III) yokhala ndi ma amplitude apamwamba komanso mawonekedwe okhazikika. Mu 1913, electrocardiogram yoyendetsera limb conduction ya bipolar standard idayambitsidwa mwalamulo, ndipo idagwiritsidwa ntchito yokha kwa zaka 20.
Mu 1933, Wilson potsiriza anamaliza electrocardiogram ya unipolar lead, yomwe inatsimikiza malo a zero potential ndi central electric terminal malinga ndi lamulo la Kirchhoff lomwe lilipo, ndipo anakhazikitsa dongosolo la 12-lead la netiweki ya Wilson.
Komabe, mu dongosolo la Wilson la 12-lead, kutalika kwa mafunde a electrocardiogram a 3 unipolar limb leads VL, VR ndi VF ndi kochepa, zomwe sizophweka kuyeza ndikuwona kusintha. Mu 1942, Goldberger adachita kafukufuku wowonjezereka, zomwe zidapangitsa kuti ma lead a unipolar omwe ali ndi pressurized limbs omwe akugwiritsidwabe ntchito mpaka pano: aVL, aVR, ndi aVF leads.
Pa nthawiyi, njira yodziwika bwino yojambulira ECG inali ndi ma lead 12: ma lead atatu a bipolar limb (Ⅰ, Ⅱ, Ⅲ, Einthoven, 1913), ma lead 6 a unipolar breast (V1-V6, Wilson, 1933), ndi ma lead atatu a unipolar compression limb (aVL, aVR, aVF, Goldberger, 1942).
4: Momwe mungapezere chizindikiro chabwino cha ECG
1. Kukonzekera khungu. Popeza khungu siligwira ntchito bwino, chithandizo choyenera cha khungu la wodwalayo komwe ma electrode amayikidwa n'chofunikira kuti mupeze zizindikiro zabwino zamagetsi za ECG. Sankhani zosalala zokhala ndi minofu yochepa
Khungu liyenera kuchiritsidwa motsatira njira izi: ① Chotsani tsitsi la thupi pomwe electrode yayikidwa. Pakani pang'onopang'ono khungu pomwe electrode yayikidwa kuti muchotse maselo a khungu akufa. ③ Tsukani khungu bwino ndi madzi a sopo (musagwiritse ntchito ether ndi mowa woyera, chifukwa izi zidzawonjezera kukana kwa khungu). ④ Lolani khungu kuti liume kwathunthu musanayike electrode. ⑤ Ikani ma clamp kapena mabatani musanayike ma electrode pa wodwalayo.
2. Samalani kusamalira waya woyendetsa mtima, lekani kukulunga waya wotsogolera, lekani kuwononga gawo loteteza waya wotsogolera, ndipo yeretsani dothi lomwe lili pa chogwirira cha waya kapena chomangira cha waya kuti mupewe kusungunuka kwa waya wotsogolera.
Nthawi yotumizira: Okutobala-12-2023
