Zolakwitsa Zonse Ndi Zomwe Zimapangidwira Kwina

Transcutaneous pacing ndi yovuta kuposa momwe imawonekera.

Chimodzi mwa zovuta kwambiri pa chithandizo chadzidzidzi cha bradycardia yodabwitsa ndizoyendayenda pa atropine management ndi kulumphira molunjika kupita kunja. Ndizodziwika pakati pa opaleshoni . Maganizo ndi akuti atropine amachititsa kuti oxygen iwonjezere kuti imayika kupsinjika kosayenera pamutu wa mitsempha ndipo ingayambitse matenda a myocardial infarction .

Mmalo mwake, malingaliro akupita, gwiritsani ntchito transcutaneous pacing kuti muonjezere kuyima kwa mtima popanda zotsatira za atropine.

Popanda kukangana kuti ngati ndiko kusankha koyenera kapena ayi, ndikofunikira kuzindikira zovuta za kugwiritsira ntchito njira zopitilira zogwiritsa ntchito. Icho chiri kutali ndi kupambulana. Imeneyi ndi njira yodalirika kwambiri, yomwe imabweretsa zambiri kuposa chisokonezo chake pazidzidzidzi. Poyendetsa bwino wodwala wa bradycardia yodabwitsa, munthu ayenera kutsimikiza kuti amamvetsa bwino makinawo ndi ntchito yachipatala ya transcutaneous pacemaker.

Mbiri ya Pacing

Choyamba, okondweretsa mtima akhala ali ponseponse ngati mtima waumunthu uli pafupi. Zimabwera ndi zamoyo zawo zachilengedwe zokhazokha-ngakhale, maselo onse a mtima amatha kugwira ntchitoyi ngati kuli kotheka-koma kugwiritsa ntchito magetsi kumayambitsa kusweka kwa mtima kwakhala kozungulira kuyambira kumapeto kwa zaka za m'ma 1700, ngakhale ndi achule.

Odwala opaleshoni opanga opaleshoni anagonjetsa zochitika zachipatala cha m'ma 1900 ndipo akhala akukhala ochepa komanso ochenjera kuyambira pamenepo. Pali opanga mankhwala osokoneza bongo omwe amagwiritsidwa ntchito kwa odwala omwe amakhala ndi matenda a mtima wamaganizo. Kugwiritsiridwa ntchito kwa pacemaker kunja komwe kumagwiritsa ntchito electrode yomwe ili m'zigawo zomatira kumagwiritsidwa ntchito ndi kuchipatala kuyambira 1985.

Chipangizo

Pali mitundu yambiri yamagetsi ndi zitsanzo zamagetsi otuluka kunja, koma onse amatsatira zofanana. Pulogalamu ya mtima yokhala ndi makina oyendetsa magetsi (ECG) oyambirira, opitirira, osakanikirana (ECG) ndi opangidwa ndi pacemaker yomwe imabwera ndi magetsi awiri. Ma electrode amadziwika kuti amagwiritsidwa ntchito, osagwiritsa ntchito mapepala osakaniza. M'makono ambiri amakono, gawo la pacemaker ndi mapepala amadziphatikizira ngati opibrillator .

Ambiri a iwo amabweranso ndi wosindikiza kuti alembe nyimbo ya ECG ya wodwala ndi kuyesera kulikonse kapena kuyipitsa. Zipangizo zambiri zimatha kuyang'ana zozizwitsa zina, monga kuthamanga kwa magazi (NIBP), kuthamanga kwa mpweya , kutsekemera kumapeto, ndi zina zotero. Pali zizolowezi zina zomwe tingachite pogwiritsa ntchito zizindikiro zina zofunika kuti tipeze kuyendetsa bwino. Zambiri pa izo kenako.

Transcutaneous pacemakers ali ndi mitundu iwiri yomwe wosamalirayo ayenera kuyendetsa: mphamvu ya magetsi ndi mlingo wa zofuna pamphindi. Lingaliro ndi lodziŵika bwino. Ichi ndi chithandizo cha chizindikiro cha bradycardia, kotero kuti mlingo woyenera uyenera kukhala mofulumira kuposa momwe wodwalayo akukhalira. Kawirikawiri, timaponyera nambala pafupifupi 80 mphindi. Izi zimasiyanasiyana ndi malo amodzi, choncho onetsetsani kuti muyang'ane ndi mtsogoleri wamkulu wa zamankhwala kuti awatsogolere pazomwe mukuyenda bwino.

Mphamvu zamagetsi zimayesedwa mu milliamperes ( milliamps kwa iwo omwe akudziwa). Zimatengera kuchuluka kwa mphamvu kuti zithe kudutsa muyezo wa wodwalayo kuti zithetse chivundikiro. Chigawo chimenecho chiri chosiyana kwa wodwala aliyense ndipo cholakwika chofala kwambiri pogwiritsa ntchito transcutaneous pacemaker akulephera kusokoneza mphamvu yochuluka. Pofuna kuti zinthu zikhale zovuta kwambiri, pali malo osiyana siyana a pamtima ndi mtima weniweni, zomwe zikutanthauza kuti zotheka kuti ECG ione ngati pacemaker ikugwira ntchito, koma minofu ya mtima siimayankha.

Kukhazikitsa Chida

Chitsanzo chilichonse ndi chosiyana ndi chofunikira kwambiri kuti wothandizira aliyense amatha nthawi kudzidziwitsa yekha ndi chipangizo chomwe akuchigwiritsa ntchito mmunda. Zomwe zikunenedwa, njirayi ndi yofanana kwambiri pamagulu angapo.

Mitundu ya piritsi iyenera kugwiritsidwa pamodzi ndi magetsi oyang'anira. Pamene transcutaneous pacemakers ndi defibrillators anali opangidwa, zipangizo zoyendetsa zidazi zinkayenera kuchotsedwa kunja kwa njira yokhala ndi ziwalo zomenyana ndi thupi, kumangirira mtima, pochita masewera olimbitsa thupi. Tsopano magetsi ochuluka kwambiri opangidwa ndi transcutaneous monga opibrillators, zizindikirozi zimayikidwa chimodzimodzi kwa zonsezi. Apanso, tsatirani malangizo a wopanga.

Wodwala ayenera kulumikizidwa ku mawonekedwe a mtima. Izi ndi zofunika. Kwa iwo omwe amadziwa momwe njira zambiri zogwirira ntchito za thupi zimagwirira ntchito, ndi kulakwitsa kwakukulu kuganiza kuti magetsi a pacemaker (mapepala othamanga) adzatha kuyang'ananso kuyang'ana kwa mtima wa wodwala. Ndi momwe opibrillators amagwirira ntchito, koma opibrillators amachititsa mantha, ndikubweranso kuti ayang'ane nyimbo. Chombo cha transcutaneous pacemaker chimapereka chidziwitso ndipo sichikhala ndi mwayi wowunika chilichonse kupyolera pamapipi.

Onetsetsani kuti mawonekedwe a ECG aikidwa kuti awerenge kutsogolera kupyolera mwa magetsi oyendetsa komanso osati kudzera muzitsulo zamagetsi. Chifukwa chophatikizira / pacemaker chogwiritsira ntchito mankhwala omwe amagwiritsidwa ntchito pamagetsi onse a magetsi, ndi kosavuta kuziyika izi molakwika. Ngati ikonzedwa kuti iwerenge kupyolera mu mapepala, zipangizo zambiri sizingagwire ntchito pamene kuyesa kuyesedwa.

Kupatsa Woleza Mtima

Pamene chipangizochi chikugwiritsidwa ntchito bwino ndikuyang'aniridwa, yang'anani ma spikes oyendetsa mu kufufuza kwa ECG. Tikapeza izi, ndi nthawi yoti tiyende bwino.

1. Ikani mlingo wa ma beats omwe mumafunayo pa mphindi iliyonse. Zambiri zamakono zimakhala zosagwirizana pakati pa 70-80, koma mlingo umasinthidwa ndi wosamalira.
2. Lonjezerani mphamvu ya mphamvu mpaka zofuna zanu ziyambitse QRS complex, yomwe imadziwika kuti ikuwombedwa . Komiti ya ECG idzasonyezeratu kulimbika kwake kwachinthu chilichonse komanso pamene nthenda iliyonse imatsatidwa nthawi yomweyo ndi QRS yovuta, kugwidwa kumatheka (onani chithunzi pamwambapa).
3. Mvetserani chifukwa cha kutentha kwapadera. Pakuyenera kukhala phokoso lamtundu wa QRS zovuta, kapena chinthu ichi sichithandiza. Ngati wodwalayo sakupangitsa kuti thupi liziyenda bwino, kuthamanga kwa magazi sikudali kotsika kwambiri.
4. Dulani mphamvu 10 milliamps pamtundu wovuta. Izi zimachepetsa mwayi woperedwa kutenga mtsogolo.

Pamene pacemaker ikugwira ntchito ndipo mkhalidwe wa wodwala ukukula, ganizirani sedation. Chinthu ichi chimapweteka ngati wopenga. Padzakhala mitsempha yambiri ya mitsempha ya khoma ndi chifuwa chilichonse. Wodwala amatha kulekerera izo kwa mphindi pang'ono, koma osati kwa nthawi yayitali. Ngati izi zikugwiritsidwa ntchito m'munda, wodwalayo ayenera kutengedwera kuchipatala musanakhale china chosautsa (ndi zopweteka kwambiri) chingalowe m'malo mwa transcutaneous pacemaker.

Misampha ya Transcutaneous Pacing

Mawu atatu: Tengani! Tengani! Tengani! Cholakwika chofala kwambiri chomwe ndachiwonapo mu ntchito yopita kuchipatala transcutaneous pacemaker ndi kulephera kutenga. Chifukwa chachikulu ndicho kusokoneza ECG ndikukhulupirira kuti kugwidwa kwachitika.

Pamene spikes zoyenda zikuoneka kuti zikugunda pomwe QRS isamangidwe, zikhoza kuwoneka kuti chipangizo chikuthandiza (onani chithunzi pamwambapa). Pali zizindikiro zingapo zomwe zingakuthandizeni kupewa cholakwika ichi:

• Yerekezerani ndi chiyero choyendetsedweratu ndi zomwe womusamalira akukhulupirira kuti ndi "kayendetsedwe kake". Kuwomboledwa koona kudzawonetsa mapangidwe osiyanasiyana a QRS yovuta chifukwa chiganizo chachikulu chimachokera kumalo osiyana (giant patch pachifuwa chomwe chiri chachikulu ngati mtima mmalo mwa ena kuti apeze malo pamtunda wopondereza mtima). Ngati mapangidwe a QRS sanasinthe, kulanda sikungatheke.
• Ngati chiwopsezo chikuposa ma QRS complexes, sitinaphunzirepokambula. Mu chithunzi pamwambapa, pali ma spikes atatu, koma maofesi awiri okha a QRS omwe alibe gawolo.
• Ngati spikes zoyendayenda zili pamtunda wosiyanasiyana kuchokera ku QRS complexes, palibe kutengedwa.
• Ngati mphamvu ili pansi pa mamilimita 40 kwa wodwala wamkulu, sizikutheka kuti chigamulo chikhoza kuchitika. Odwala ambiri ali ndi malo oposa awa. Sinthani chizindikiro. Zambiri zimapangitsa mphamvu kuwonjezereka muzinthu zisanu kapena khumi-milliamp increments.

QRS ya mtundu uliwonse; eureka! Tatenga!

Osati mofulumira kwambiri ... kodi ife tiri ndi kugunda ndi zimenezo? Kugwidwa kwa magetsi kumadziwika pa ECG, koma kugwidwa kwa thupi kumayesedwa ndi zizindikiro zofunika. Chinthu chachiwiri cholakwika chomwe ndikuwona ndikulephera kutsimikizira kuthupi. Fufuzani zizindikiro izi:

• Kuthamanga kwapadera kwa QRS iliyonse ndi chizindikiro chabwino kwambiri. Izi zimauza womusamalira kuti kupanikizika kwa mtima kumapangitsa kuti magazi azisambira 80-90 mmHg.
• Kusokoneza odwala ovuta ndiko kuyang'ana mawonekedwe a mawonekedwe a oximetry. Ngati mawonekedwewa akufanana ndi chiwerengero cha QRS-chomwe chiyenera kukhala mlingo womwe waperekedwa pa chipangizochi, kapena sitigwidwa-ndiye tikudziwa kuti mtima ukugwirizana ndi QRS iliyonse. Tengani magazi kuti muone ngati vutoli liri lokhazikika. Ngati uli wotsika, pulogalamu yamadzimadzi ingathandize kuthetsa vutoli. Onetsetsani kuti mufunsane malangizo azachipatala.

Pewani kugwiritsira ntchito phokoso la carotid monga chizindikiro cha kulandidwa kwa thupi. Mitsempha yotsalira yomwe imabwera ndi kutuluka kwachitsulo, zimapangitsa kuti zikhale zovuta kudziwa mapulaneti a carotid. Iwo ali kumeneko, koma mwinamwake osati mofulumira monga kuyenda, ndicho chifukwa chonse chowunika kuyambira poyamba.

Pomalizira pake, pitirizani kupweteka. Pano pali chitsanzo chimodzi cha wodwalayo amene akuwotchera kuchoka pamatenda othamanga ndi odwala pafupifupi kulikonse akudandaula za ululu wa chifuwa cha minofu ndi transcutaneous pacing.

> Zotsatira:

> Bocka, J. (1989). Kutulutsa transcutaneous pacemakers. Annals Of Emergency Medicine , 18 (12), 1280-1286. yani: 10.1016 / s0196-0644 (89) 80259-8

> Muschart, X. (2014). Kutentha kukhala wamoyo: chovuta cha kusintha kwa mtima kwa transcutaneous. Thandizo Lofunika , 18 (6). lembani: 10.1186 / s13054-014-0622-x