Zigawo zoyambira za anmakina opangira opaleshoni
Panthawi ya opaleshoni ya opaleshoni ya opaleshoni, mpweya wothamanga kwambiri (mpweya, oxygen O2, nitrous oxide, etc.) umadetsedwa kudzera muzitsulo zochepetsera mphamvu kuti mupeze mpweya wochepa komanso wokhazikika, ndiyeno mita yothamanga ndi O2. -N2O chiŵerengero chowongolera chipangizo chimasinthidwa kuti chipangitse kuthamanga kwina.Ndi gawo la gasi wosakanikirana, mumayendedwe opumira.
Mankhwala ochititsa dzanzi amatulutsa mpweya wochititsa mantha kudzera mu thanki yowonongeka, ndipo mpweya wofunikira wochuluka umalowa mu mpweya wopuma ndikutumizidwa kwa wodwalayo pamodzi ndi mpweya wosakanikirana.
Makamaka imakhala ndi chipangizo choperekera mpweya, evaporator, mpweya wopumira, chipangizo choyamwitsa mpweya woipa wa carbon dioxide, anesthesia ventilator, anesthesia waste gasi kuchotsa dongosolo, etc.
- Chida choperekera mpweya
Gawoli limapangidwa makamaka ndi gwero la mpweya, choyezera kuthamanga ndi valavu yochepetsera kuthamanga, mita yothamanga ndi njira yofananira.
Chipinda chochitira opaleshoni nthawi zambiri chimakhala ndi mpweya, nitrous oxide, ndi mpweya ndi makina apakati operekera mpweya.Chipinda cham'mimba cha endoscopy nthawi zambiri chimakhala gwero la gasi la silinda.Mipweya imeneyi poyamba imakhala yopanikizika kwambiri ndipo iyenera kuchepetsedwa pang'onopang'ono isanayambe kugwiritsidwa ntchito.Chifukwa chake pali ma gauges otsika komanso ma valve ochepetsa kuthamanga.Valavu yochepetsera kupanikizika ndikuchepetsa mpweya woyambira woponderezedwa kwambiri kuti ukhale wotetezeka, wosakhazikika mpweya wocheperako kuti ugwiritse ntchito makina oletsa opaleshoni.Nthawi zambiri, silinda yamagetsi ikakhala yodzaza, kuthamanga ndi 140kg/cm².Pambuyo podutsa valavu yochepetsera mphamvu, pamapeto pake idzagwera pafupifupi 3 ~ 4kg / cm², yomwe ndi 0.3 ~ 0.4MPa yomwe timawona nthawi zambiri m'mabuku.Ndi oyenera nthawi zonse otsika kuthamanga mu opaleshoni makina.
Miyendo yothamanga imayendetsa bwino ndikuyesa kuchuluka kwa gasi kupita kumalo atsopano.Chodziwika kwambiri ndi kuyimitsidwa kwa rotameter.
Pambuyo potsegula valavu yoyendetsera mpweya, mpweya ukhoza kudutsa momasuka kusiyana kwa annular pakati pa zoyandama ndi chubu.Pamene mlingo wothamanga wakhazikitsidwa, buoy idzalinganiza ndi kuzungulira momasuka pa malo otsika mtengo.Panthawi imeneyi, mphamvu yokwera ya mpweya pa buoy ndi yofanana ndi mphamvu yokoka ya buoy yokha.Mukagwiritsidwa ntchito, musagwiritse ntchito mphamvu zambiri kapena kukulitsa kondomu yozungulira, apo ayi zingapangitse kuti thimble ipindike, kapena mpando wa valve ukhoza kuwonongeka, zomwe zimapangitsa kuti mpweya ulephere kutseka kwathunthu ndikupangitsa kuti mpweya uzituluka.
Pofuna kupewa makina ochititsa dzanzi kuti asatulutse mpweya wa hypoxic, makina ochititsa dzanzi alinso ndi chipangizo cholumikizira mita komanso chipangizo chowunikira mpweya kuti asunge kuchuluka kwa ndende ya okosijeni ndi mpweya watsopano pafupifupi 25%.Mfundo yolumikizira zida imatengedwa.Pa batani la N₂O flowmeter, magiya awiriwa amalumikizidwa ndi unyolo, O₂ amazungulira kamodzi, ndipo N₂O imazungulira kawiri.Pamene valavu ya singano ya O₂ flowmeter imachotsedwa yokha, N₂O flowmeter imakhalabe;pamene flowmeter ya N₂O imachotsedwa, O₂ flowmeter imalumikizidwa molingana;pamene ma flowmeter onse amatsegulidwa, O₂ flowmeter imatsekedwa pang'onopang'ono, ndipo N₂O flowmeter Idachepanso molumikizana nayo.
Ikani mita yoyezera mpweya yomwe ili pafupi ndi malo wamba.Ngati kutayikira komwe kumakhala mpweya wa okosijeni, kutayika kwakukulu ndi N2O kapena mpweya, ndipo kutayika kwa O2 ndikocheperako.Zoonadi, kutsatizana kwake sikutsimikizira kuti hypoxia chifukwa cha kuphulika kwa mita sidzachitika.
2.Evaporator
Evaporator ndi chipangizo chomwe chimatha kusinthira mankhwala oletsa kupweteka amadzimadzi kukhala nthunzi ndikulowetsa mudera la anesthesia mu kuchuluka kwake.Pali mitundu yambiri ya ma evaporator ndi mawonekedwe awo, koma mfundo yonse yapangidwe ikuwonetsedwa pachithunzichi.
Mpweya wosakanikirana (ndiko kuti, O₂, N₂O, mpweya) umalowa mu evaporator ndipo umagawidwa m'njira ziwiri.Njira imodzi ndi mpweya wochepa wosapitirira 20% wa ndalama zonse, zomwe zimalowa m'chipinda cha evaporation kuti zitulutse mpweya wochititsa mantha;80% ya mpweya wokulirapo umalowa mwachindunji mumsewu waukulu ndikulowa mu dongosolo la opaleshoni ya anesthesia.Potsirizira pake, maulendo awiriwa amaphatikizidwa mu mpweya wosakanikirana kuti wodwalayo alowemo, ndipo chiwerengero cha kugawa kwa maulendo awiriwa chimadalira kukana kwa njira iliyonse ya mpweya, yomwe imayendetsedwa ndi ndondomeko yoyendetsera ndende.
3.Njira yopumira
Tsopano chomwe chimagwiritsidwa ntchito kwambiri pachipatala ndi circulatory loop system, ndiko kuti, CO2 absorption system.Ikhoza kugawidwa mu mtundu wotsekedwa ndi mtundu wotsekedwa.Mtundu wa semi-otsekedwa umatanthawuza kuti mbali ya mpweya wotuluka imalowetsedwanso pambuyo potengeka ndi mpweya wa CO2;mtundu wotsekedwa umatanthauza kuti mpweya wonse wotuluka umalowetsedwanso pambuyo potengeka ndi mpweya wa CO2.Kuyang'ana chithunzi cha mapangidwe, valve ya APL imatsekedwa ngati njira yotsekedwa, ndipo valve ya APL imatsegulidwa ngati njira yotsekedwa.Machitidwe awiriwa kwenikweni ndi zigawo ziwiri za valve ya APL.
Makamaka amakhala ndi magawo 7: ① kochokera mpweya wabwino;② kupuma ndi kutulutsa mpweya wa njira imodzi;③ chitoliro cha ulusi;④ cholumikizira chopangidwa ndi Y;⑤ valve kusefukira kapena valavu yochepetsera kuthamanga (valavu ya APL);⑥ thumba mpweya yosungirako;Valavu yolimbikitsa komanso yotulutsa mpweya wanjira imodzi imatha kuwonetsetsa kuyenda kwa gasi munjira imodzi.Kuphatikiza apo, kusalala kwa gawo lililonse kulinso makamaka.Imodzi ndi njira imodzi yopita kwa gasi, ndipo ina ndikuletsa kutulutsa mpweya mobwerezabwereza wa CO2 wotuluka mudera.Poyerekeza ndi dera lotseguka la kupuma, mtundu uwu wa mpweya wotsekedwa kapena wotsekedwa umatha kulola kupuma kwa mpweya wopuma, kuchepetsa kutaya kwa madzi ndi kutentha m'njira yopuma, komanso kuchepetsa kuipitsidwa kwa chipinda chopangira opaleshoni, komanso ndende ya mankhwala opha ululu ndi okhazikika.Koma pali cholakwika chodziwikiratu, chidzawonjezera kukana kupuma, ndipo mpweya wotuluka ndi wosavuta kusuntha pa valve ya njira imodzi, yomwe imafuna kuyeretsa madzi panthawi imodzi.
Pano ndikufuna kufotokozera ntchito ya valve ya APL.Pali mafunso angapo okhudza izi omwe sindingathe kuwazindikira.Ndinafunsa anzanga akusukulu, koma sindinathe kufotokoza bwinobwino;Ndidawafunsanso aphunzitsi anga, ndipo adandiwonetsanso kanemayo, ndipo idawoneka bwino mukangoyang'ana.Valve ya APL, yomwe imatchedwanso valve overflow kapena valve decompression valve, dzina lachingerezi lathunthu ndilokhazikika, mosasamala kanthu kuchokera ku Chitchaina kapena Chingerezi, aliyense ayenera kumvetsetsa pang'ono za njira, iyi ndi valve yomwe imachepetsa kuthamanga kwa mpweya wopuma.Poyang'aniridwa ndi manja, ngati kupanikizika kwa mpweya wopumira ndipamwamba kuposa mtengo wa APL, mpweya udzatuluka kuchokera ku valve kuti uchepetse kupanikizika kwa mpweya wopuma.Ganizirani izi pamene kuthandizidwa ndi mpweya wabwino, nthawi zina kukanikiza mpira kumakwera kwambiri, choncho ndimasintha mofulumira mtengo wa APL, cholinga chake ndikuchepetsa ndi kuchepetsa kupanikizika.Zachidziwikire, mtengo wa APL uwu nthawi zambiri ndi 30cmH2O.Izi zili choncho chifukwa nthawi zambiri, kuthamanga kwapamtunda wapanjira yopita kumtunda kuyenera kukhala <40cmH2O, ndipo mpweya wothamanga uyenera kukhala <30cmH2O, kotero kuthekera kwa pneumothorax kumakhala kochepa.Vavu ya APL mu dipatimenti imayendetsedwa ndi kasupe ndipo imalembedwa ndi 0 ~ 70cmH2O.Pansi pa makina olamulira, palibe chinthu ngati valve ya APL.Chifukwa gasi sadutsanso valavu ya APL, imalumikizidwa ndi mpweya wabwino.Pamene kupanikizika m'dongosolo kuli kwakukulu kwambiri, kumamasula kupanikizika kuchokera ku valavu yotulutsa mpweya wochuluka wa mpweya wa anesthesia ventilator kuonetsetsa kuti kayendedwe ka kayendedwe kake kamayambitsa barotrauma kwa wodwalayo.Koma chifukwa cha chitetezo, valve ya APL iyenera kukhazikitsidwa ku 0 kawirikawiri pansi pa makina oyendetsa makina, kotero kuti kumapeto kwa opaleshoniyo, makina oyendetsa makinawo adzasinthidwa kuti aziwongolera, ndipo mukhoza kuyang'ana ngati wodwalayo akupuma mwadzidzidzi.Ngati muiwala kusintha valve ya APL, mpweya wokhawo ukhoza kulowa m'mapapo, ndipo mpirawo udzakhala wochuluka kwambiri, ndipo uyenera kuchotsedwa mwamsanga.Zachidziwikire, ngati mukufuna kukulitsa mapapu panthawiyi, sinthani valavu ya APL kukhala 30cmH2O.
4. Chipangizo cha carbon dioxide mayamwidwe
Zosakaniza zimaphatikizapo soda laimu, laimu wa calcium, ndi laimu wa barium, zomwe ndizosowa.Chifukwa cha zizindikiro zosiyana, mutatha kuyamwa CO2, kusintha kwa mtundu kumakhalanso kosiyana.Laimu wa soda omwe amagwiritsidwa ntchito mu dipatimentiyi ndi granular, ndipo chizindikiro chake ndi phenolphthalein, yomwe imakhala yopanda mtundu ikakhala yatsopano ndipo imakhala pinki ikatopa.Osanyalanyaza poyang'ana makina ochititsa dzanzi m'mawa.Ndi bwino kuti m'malo pamaso opareshoni.Ndinalakwitsa.
Poyerekeza ndi mpweya wolowera m'chipinda chothandizira, njira yopumira ya anesthesia ventilator ndi yosavuta.Mpweya wofunikira umatha kusintha voliyumu ya mpweya wabwino, kuchuluka kwa kupuma komanso kupuma, kumatha kuyendetsa IPPV, ndipo chitha kugwiritsidwa ntchito.Mu gawo lopuma la kupuma kwa thupi la munthu, diaphragm imalumikizana, chifuwa chimakula, ndipo kupanikizika koipa kwa chifuwa kumawonjezeka, zomwe zimapangitsa kusiyana kwapakati pakati pa kutsegula kwa mpweya ndi alveoli, ndipo mpweya umalowa mu alveoli.Pa kupuma kwamakina, kupanikizika kwabwino nthawi zambiri kumagwiritsidwa ntchito kupanga kusiyana kwamphamvu kukankhira mpweya wa anesthesia mu alveoli.Kuthamanga kwabwinoko kukayimitsidwa, chifuwa ndi minyewa yam'mapapo imabwereranso kuti ipangitse kupanikizika kosiyana ndi kuthamanga kwa mumlengalenga, ndipo mpweya wa alveolar umatuluka m'thupi.Choncho, mpweya wabwino uli ndi ntchito zinayi zofunika kwambiri, zomwe ndi kukwera kwa mitengo, kutembenuka kuchokera ku mpweya kupita ku mpweya, kutuluka kwa mpweya wa alveolar, ndi kutembenuka kuchoka ku mpweya kupita ku mpweya, ndipo kuzungulira kumabwerezabwereza.
Monga momwe tawonetsera m'chithunzi pamwambapa, mpweya woyendetsa galimoto ndi mpweya wopumira umasiyanitsidwa wina ndi mzake, mpweya woyendetsa galimoto uli mu bokosi la bellows, ndipo mpweya wozungulira mpweya uli mu thumba la kupuma.Pokoka mpweya, mpweya woyendetsa galimoto umalowa mu bokosi la bellows, kupanikizika mkati mwake kumakwera, ndipo valve yotulutsa mpweya imatsekedwa poyamba, kuti mpweya usalowe mu njira yotsalira yochotsera gasi.Mwanjira imeneyi, mpweya wochititsa mantha womwe uli m'thumba lopumira umakanikizidwa ndikutulutsidwa munjira ya mpweya wa wodwalayo.Potulutsa mpweya, mpweya woyendetsawo umachoka m'bokosi la bellow, ndipo mphamvu ya bokosi la bellow imatsika mpaka kupanikizika kwa mumlengalenga, koma mpweyawo umadzaza chikhodzodzo.Izi zili choncho chifukwa pali mpira wawung'ono mu valve, womwe uli ndi kulemera.Pokhapokha pamene kupanikizika kwa mavuvuku kupitirira 2 ~ 3cmH₂O, valavu iyi idzatsegulidwa, ndiko kuti, mpweya wochuluka ukhoza kudutsamo mu njira yotsalira yochotsera gasi.Kunena mosapita m'mbali, mvuto iyi yokwera idzatulutsa PEEP (kupanikizika komaliza komaliza) kwa 2 ~ 3cmH2O.Pali mitundu itatu yoyambira yosinthira mpweya wopumira, womwe ndi kuchuluka kwanthawi zonse, kuthamanga kosalekeza komanso kusintha kwanthawi.Pakali pano, ambiri opaleshoni respirators ntchito zonse voliyumu kusintha akafuna, ndiko kuti, pa gawo inspiratory, ndi preset mafunde voliyumu amatumizidwa mu kupuma thirakiti wodwalayo mpaka alveoli kumaliza inspiratory gawo, ndiyeno kusinthana kwa preset expiratory gawo , potero kupanga mkombero wopumira, momwe mphamvu yamadzi yoyikidwiratu, kuchuluka kwa kupuma ndi chiŵerengero cha kupuma ndi magawo atatu akuluakulu osinthira kupuma.
6.Exhaust gasi kuchotsa dongosolo
Monga momwe dzinalo likusonyezera, ndiko kuthana ndi mpweya wotulutsa mpweya ndikuletsa kuipitsa m'chipinda chogwirira ntchito.Sindikusamala kwambiri za izi kuntchito, koma chitoliro chotulutsa mpweya sichiyenera kutsekedwa, mwinamwake mpweya udzakanikizidwa m'mapapu a wodwalayo, ndipo zotsatira zake zikhoza kuganiziridwa.
Kulemba izi ndikumvetsetsa macroscopic makina a anesthesia.Kulumikiza zigawozi ndi kuzisuntha ndi momwe makina ogwirira ntchito amagwirira ntchito.Zoonadi, pali zambiri zomwe ziyenera kuganiziridwa pang'onopang'ono, ndipo kuthekera kuli kochepa, kotero sindidzafika pansi pakali pano.Chiphunzitso ndi cha chiphunzitso.Ziribe kanthu kuchuluka kwa kuwerenga ndi kulemba, muyenera kuzigwiritsa ntchito, kapena kuchita.Ndipotu, ndi bwino kuchita bwino kusiyana ndi kunena zabwino.
Nthawi yotumiza: Jun-05-2023
