I. Sumo
Mukurapa kwemazuva ano, pombi yemazuva ano inomira seyakaokosha uye yakasarudzika chishandiso, kuridza basa rakakosha mukuita kuti uve nechokwadi chekutonga chaiko kwemishonga uye mvura. Zvakandichinja nzira yevanopa hutano vanopa kurapwa, nekuvandudza kuchengetedza murwere uye kushanda kwekudyidzana kwekurapa. Ichi chinyorwa chinopera mumasekiniki akasiyana ezvipindwa zvejekiseni jekiseni, kujekesa chiedza pane kukosha kwavo kune dzakasiyana siyana zvekurapa.
Ii. Chii chinonzi jekisi jekiseni?
A. Tsanangudzo uye inoshanda nheyo
Pombi yejekiseni ishandiso yekurapa yakagadzirirwa kuendesa mvura, kunyanya mishonga, nenzira inodzorwa kwazvo uye chaiyo. Izvo zvinoshanda semhando yakavimbika yehutano hwehutano, dzinovimbisa kuti varwere vanogashira dosage chaiyo yezvinodhaka nenzira yakakodzera. Pazviri musimboti, iyo jekiseni pombi inoshanda pane iyo sarudzo yekushandisa kana yemagetsi zvinoreva kutyaira plinge plunge, nekudaro ichisundira mishonga yemvura kuburikidza neyekucheka yakabatana uye mumuviri wemurwere. Maitiro aya anonzwisisika, ne pombi inokwanisa kuendesa mineuscule kune yakakura mavhoriyamu yekunyora uye ichokwadi inoshamisa, kazhinji ichidzika kune zvidimbu zvea milliliter paawa. Kugadziriswa kwacho kunowanikwa kuburikidza neyakaora mota kudzora masisitimu ekushandura masaini mune yakatsetseka uye inowirirana mutsara wekutenderera kweiyo pistoni pistoni, kutevedzera jekiseni rakanakisa asi nekuvimbika kuvimbika uye kubereka kwakasimba uye kubereka.
B. Kiyi zvikamu uye mabasa avo
1. Syringe Holder : Ichi chikamu chakanyatso craadles syringe, ichiita kuti igare munzvimbo yakatarwa mukati meiyo inconussion maitiro. Yakagadzirirwa kuti igare yakasiyana-siyana syringe saizi, kubva kune diki, chaiyo syringes inoshandiswa kune mishonga ine simba kune yakakura kune mamwe mavhoriyamu manhamba ekunyomba. Iye anobata anopawo nzvimbo yekubatanidza yeiyo tubing inotungamira kumurwere, inovimbisa nzira yakasununguka-yakasununguka.
1. Dhiraivha Mechanism : Kazhinji mota, uye system yekutumira yakadai seyakafambisa screw kana mutsara wekutengesa, iyo drive mechanism inzvimbo yeiyo jekiseni. Iyo mota inotenderera mukuwedzera kwekuwedzera, ichidudzira kufamba kwayo kutenderera mumutsara wekutenderera kweiyo syringe plunge. Uku kufambisa kwakadzorwa kunorondedzera huwandu hwekuyerera kwemushonga, uchibvumira kugadzirisa mune yekumhanya uye vhoriyamu yekutumira nekukwezva kukuru.
1. Kudzora System : uropi hwenzvimbo jekiseni, hurongwa hwekutonga, hunosanganisira micropessor uye yakabatana rapamhama. Iyo inodudzira mushandisi mahupamhi, iyo inogona kusanganisira iyo yaunoda influsion coar, yakazara vhoriyamu kuti ibude, uye chero yakakosha dosing magadziriso. Zvichienderana nemirairo iyi, inotumira masaini kune iyo drive mechani kuti iite chaiyo yekuzvitakura. Pamusoro pezvo, iyo System System inotarisa pombi yemapomba, ichisimbisa kuti iyo chaiyo yekuyerera chiyero neyekutarisa paramita uye kugadzira chaiyo-nguva yekugadzirisa-nguva kana kutsauka kana kutsauka.
1. Ratidza uye mushandisi Interface : Yakajeka uye Intuitive Chiratidziro Panil Inoratidza Ruzivo rwakakosha kune mushandisi, sekuti iyo yazvino influsion coar, iyo vhoriyamu inosara ichishandiswa, uye chero alarm notes. Iyo mushandisi interface, yaiwanzoiswa nemabhatani kana batancreen, inogonesa varidzi vehutano nyore nyore pombi, tanga kana kumisa mafungiro, uye kuwana zvigadzirwa zvepamberi. Uku kureruka kwekushanda kunokosha munzvimbo yakamhan'arira uye yakakwirira-isina nzvimbo yehutano hwehutano, kuderedza mukana wekukanganisa panguva yekuronga.
1. Alarm uye Systems Systems : Kuchengetedza varwere vanobva kune zvinogona kukuvadza nekuda kwekurwara zvisiri izvo kana zvishandiso zvinoshamisa, majee jekiseni akashongedzwa neakarongeka alarm uye kuchengetedzwa maitiro. Izvi zvinosanganisira maalarnsicsion octalms anoona blockges mune tubing, mhepo-in-line anodzivirira mhepo embolms, uye yambiro-bhatiri-bhatiri. Kana iri chiitiko che alarm, pombi yakabva yadzima influsion uye kunyevera vashandi vekurapa, vachikurudzira kuti vatore kururamisa chiito nekukurumidza.
III. Clinical application zviitiko
A. Mune yakanyanya kuchengetwa unit (icu)
1. Administrister yemishonga inotarisirwa
Munzvimbo dzakakwirira-stakes of the icu, umo hupenyu hwevarwere hwakarembera mune chiyero, jekiseni jekiseni rinobuda kunge linchpin mukutumira kwakasimba mishonga inotarisirwa. Vasopressor zvinodhaka, senge dopmine uye norepinephrine, vanonzwisisika vachitamba vachishandisa jekiseni ekuramba vachiramba kugadzikana kweropa muvarwere vane kuvhundutsa kana hemodynamic kusagadzikana. Iyi mishonga, newindows yavo yeWindows, inoda dosing chairo; Kunyangwe kutsauka kushoma kunogona kuisirwa zvinokanganisa mhedzisiro kana kukanganisa mararamiro emurwere. Saizvozvo, kunyengera uye analgescs kunge propofol uye fentanyl inopihwa neyepenpoint yechokwadi kuti irambe yakagadzikana uye yakadzikama, kunyanya avo vari muchimiro chekutenderera. Kugona kwePump kwePump kune microdoses paminiti inovimbisa kuti murwere anoramba ari mumamiriro ezvinhu anodiwa ekusangana pasina kuyambuka senge mikana asnilatrony kana kuziva panguva yemaitiro.
2. Kutsigirwa noutsigiro kwevarwere vanorwara zvakanyanya
Kune varwere havagone kutora zvipo zvemuromo, huwandu hwevabereki vanovaka (TPN) hunova hupenyu hwakakosha. Mapepa jekiseni anotamba basa rakakosha muchimiro ichi nekunyatso kudzora huwandu hwekufutisa hwemidziyo yakaoma yemutengo. TPN Solutions, ine chiyero chisina kujairika cheAmino Iyo jekiseni pombi yezvirongwa zvinobvumidza hutano hwehutano hwekutora huwandu hwekufuka zvichienderana neyekuda kwemutungamiriri we metabolic, uremu hwemuviri, uye chipiniki mamiriro. Iyi nhanho yekunyatsojeka isingaruramisa kutyamadza kwekutora asi zvakare kuderedza njodzi ye metabolic kutsikisa, izvo zvinogona kuwedzera kurwara kwakasimba kwechirwere.
B. Munguva yekuvhiya
1. Anesthesia kuburitsa
Mune iyo yekushandisa yemitambo, iyo jekiseni pombi chishandiso chakakosha chishandiso chevanomira. Iyo inovimbisa kusanzwisisika uye kudzorwa kuendesa vamiririri anesthetic mukati mehunyanzvi hwekuvhiya. Kunyangwe iri chikamu chekunyengerera, kupi kwekukurumidza kutonga kwezvinodhaka senge propoofol kunodiwa kuti vasakureka, kana kuti chinyararidzo chesimba Iyo pombi inowedzera kuyerera chiyero inobvumira iyo anesthesiologist yekupindura nekukurumidza kuchinja mumuviri wemurwere, sekushanduka kwemurwere kana kuwanda kwemoyo, kuve nechokwadi chemoyo. Nekuchengeta kusarongeka kwekusangana kwezvinodhaka mumubayiro, jekiseni jecha rinobatsira kudzivirira kuziva kwekunzwa uye kupa iyo nzira yakagadzikana ineshinthetic, ichidzora mhinduro yemurwere uye zvikwangwani zvedzidziso.
2. Kutonga kwemishonga inorwisa mabhakitiriya uye heastatics
Kuvhiya saiti kutapukira kunokanganisa kupora mwoyo kupora, kuita nguva nenguva uye zvakaringana kurwisa mabhakitiriya yekutonga. Mishonga yekujekesa inogonesa kurongwa uye yakajeka yekuburitsa mishonga inorwisa mabhakitiriya, inoona kuti mushonga unosvika pamatanho ekurapa mumatisiki asati azvishingisa Iyi nzira yakatarwa inowedzera kushanda kwemishonga inorwisa mabhakitiriya apo kuderedza njodzi yekurwisa mabhakitiriya ekushandira. Pamusoro pezvo, panguva yekuvhiya uko kubuda ropa kuri kunetseka, majekisi jekiseni anoshandiswa kupa vagari vekumusoro-simptic. Iyi mishonga, iyo inosimudzira kutonhora kweropa, inoda kuunganidzwa panguva chaiyo uye chiyero kudzora kubuda ropa zvinobudirira pasina kukonzera zvisingadiwi system. Kujeka kwepombi kunovimbisa kuti hembe himpt hununurwa chaizvo kuti kupi uye kana zvichidikanwa, kuvandudza kuchengetedza kwekuvhiya uye kuderedza kudiwa kwekuisira ropa.
C. MuPediatric uye Neonatal Care
1. Precise mushonga wezviviri zvidiki
Pediatric nevarwere veNeonal varipo vanonhuwira vakasarudzika nekuda kwehukuru hwavo hwemuviri, masisitimu emhando, uye kukwidziridzwa kune mishonga yemishonga. Mishonga jekiseni iboon mune ino mamiriro sezvavanogona kunyatsounura minuscule zvinodhaka doses. Semuenzaniso, muNeonates nemwoyo wekuzvarwa zvine mishonga inoda kuremara mishonga kuti ishandise kutadza kwemoyo, iyo margin yekukanganisa mukudzikisira kwakanyanya kutetepa. Misungo madiki madiki anogona kutungamira kuhupenyu-kutyisidzira nehupfu hwehupfu kana kurapwa zvisina kukwana. Mapapu jekiseni, nekugona kwavo kuendesa madiki se microciters paawa, huwandu hwakakodzera hwezvinodhaka seDidoxin kana muzvivakwa zvejasi, kuchengetedza phiya yavo isina kusimba. Iyi chaiyo dosisi inobatsirawo mune mishonga inoshandiswa kubata neonatisa yaNeonatisal, uko iyo madhiri asiri iwo angave nemhedzisiro yakakura yemutsipa.
2. Kunonoka uye kuenderera mberi kwekunhuhwirira kweNeonates
Vacheche vasati vasvika uye neonates vanowanzoda kuenderera mberi kwehunyanzvi hwemishonga kuti vatsigire kusimudzira masisitimu ekuvandudza masisitimu okukura. Mapipi ejekiseni anoshandiswa kupa zvinhu kunge caffeine kuti ubvise kufema muPretermacheche vacheche kana intravenous mvura yekuchengetedza hydration uye yakaenzana neyemagetsi. Iyo inononoka uye yakatsiga influsion yakapihwa ne pombi inotsikirira musiyano wechisikigo, process matanho mumuviri unowedzera, zvichangoerekana zvawedzera kusimuka kana zvinodhaka zvinokonzeresa. Izvi zvinonyanya kukosha mukuwedzera kweNeonative neyenitsi (Nichosi), uko varwere vanonzwika vachivimba nekuiswa chaiko kwezvinhu zvekuraramisa zvinhu izvi kukura.
D. Mu oncology kurapwa
1. Chemotherapy drug infusion
Cancer Chemotherapy inoda kugadzirira kukuru mukusvitswa kwezvinodhaka. Chemotherapy vamiririri, nemhedzisiro yavo yekushatisa, inoda kunyatsoita titration kune chinangwa cancer cer.net Mabhonzo jekiseni ndiyo mwero wegoridhe wekupa mishonga yemitambo, ichisimbisa kuti dhi rakatarwa rinopindwa nemuchero wenguva dzose uye unodzorwa. Uku kufungidzira kwakasimba kunobatsira kuchengetedza iyo plasma plasma yekushambadzira mukati mehwindo rekurapa, kuvandudza kushanda kwayo nekanza cancer cancer. Semuenzaniso, mukurapa kwegomarara remazamu nezvinodhaka kunge doxorubicin, iyo jekiseni pombi inoiswa pachena seyakarongedzwa protocosing Pamusoro pezvo, kune varwere vanowana marefu-nguva refu
2. Zviratidzo zvekuyamura mushonga
Varwere veComncy vanowanzo kutsungirira hondo yematanho ekunetseka kubva kumapotherapy, sekusvotwa, kurutsa, uye kurwadziwa. Mapapu jekiseni anoshandirwa kupa zororo rokusingaperi nekupa antiometics, analgesics, uye dzimwe mishonga inotsigira. Nekununura izvi zvinodhaka pamwero wenguva dzose, pombi inobatsira kuchengetedza varwere vakagadzikana, vachivabvumira kuti vashoreke kushivirira kurapwa kwekara cancer. Semuenzaniso, varwere vanosangana nekushungurudzika kwakanyanya kukwanisa kugamuchira influsion yeOndansetron kana yekuzvidzivirira, kudzivirira mafungu echizunguzirisa, kushomeka kwehupenyu, uye hupenyu hwakadzikira. Panyaya yekanasi yekurwadziwa, opioids senge morphine inogona kuve chaiyo yekubatanidza uchishandisa jekissia yekuputika isina mapundu uye kuona varwere vanogona kutarisa kupora kwavo pane kutambura nekusarwadziwa kusingaperi.
E. Mukurwadziwa maneja
1. Kuendesa kweAnalges
Mudenga remitambo yekurwadziwa, majekisi jekiseni anopa nzira yakavimbika yekupa inoenderera ichirwadza. Post-kuvhiya varwere, semuenzaniso, kazhinji vanowana kurwadza kwakakosha panguva yekukurumidza nguva. Mapapu jekiseni anogona kuve akagadzirirwa kuendesa analgesics kunge fentanyl kana bupivcaine panguva yekugara ichiramba, ichiramba ichirapa yekuzorora kwekuzorora. Izvi hazvingarevereri kutambudzika kwemurwere asi zvakare kunosimudzira kupora nekukurumidza nekuvazivisa kuti vaite zvekusungirirwa kwekutanga uye kurovedza muviri kwakadzika, izvo zvinokosha kudzivirira matambudziko ekutanga senge pneumonia uye yakadzika vein thrombosis. Mukutonga kwekurwadziwa, zvakare, kune varwere vane mamiriro ezvinhu senge neuropathic kurwadziwa kana kuomarara, kuendesa kudiwa kweAnalgesics, kuderedza kuyamwa kwemajekiseni uye kugadzirisa hupenyu hwemurwere.
2. Murwere-anodzorwa analgesia (PCA)
PCA ndiyo nzira yekuchinja mukurwadzisa manejimendi anopa varwere kuti vatore basa rinoshanda mukunyaradza kwavo. Uchishandisa jekiseni remubato rakashongedzwa nePCA basa, varwere vanogona kuzvidzora zvidiki zvidiki zveAnalges, kazhinji opioids, mukati memoyo miganhu. Izvi zvinovatendera kuti vapindure nekukurumidza kurwadzisa, kupa pfungwa yekudzora uye kuderedza kunetseka kwakabatana nekurwadziwa. Iyo jekiseni pombi yekuchengetedza zvinhu zvinodzivirira zvakanyanya nekudzora iyo frequency uye dofo yekuzvibata-kuzvimiririra. Semuenzaniso, murwere achipora kubva pakuvhiya kukuru anogona kudzvanya bhatani kuti agamuchire dosi diki paMorphine kana kurwadziwa kwacho kuchisimbisa kuti huwandu hwakazara hwezvinodhaka hunoramba huripo mukati meyakagwinya. Kuyera uku pakati pekutongwa kwemurwere uye kuchengeteka kwakaita kuti PCA awedzeredzwa uye inobudirira kurwadza manejimendi zano mune razvino hutano hwehutano.
Iv. Zvakanakira jekiseni jekiseni mukushandiswa kwekiriniki
A. Yakakura chaiyo uye kurongeka
Mukuenzanisa netsika dzechinyakare dzakanaka, majekisi jekiseni anopa huwandu husina kumboitika. Manual infusion, anovimbika pane gravity uye bhuku remanyorero emari yekudonha, inowanzoitika kune zvisingaiti nekuda kwezvinhu zvakaita sekuchinja kwemurwere, kucheka kinks, kana kukanganisa kwevanhu mukuverenga madonhwe. Mapasi jekiseni, kune rumwe rutivi, shandisa yepamusoro mota kudzora mota uye yakasarudzika sensors kuti ive nechokwadi chekuti mushonga ununurwa nekunyora kwezvinhu. Ichi chaicho chakakosha mune zviitiko zvinowanikwa kunyange kutsauka kushoma mumugodhi kunogona kuve nemhedzisiro yakakosha. Semuenzaniso, muMemotherapy, mamirimita mashoma zvakanyanya kana kuti zvishoma nezvishoma yemushonga ane simba anogona kureva mutsauko uripo pakati pebundu rekutora MuChoonal Care, uko miviri yevacheche inoteerera zvakanyanya kumushonga, kugona kupa microgrammamso emushonga paawa nekuregeredza kwechokwadi kwavo kwekusvibisa kwavo. Iyo jekiseni pombi haina kungoita kuti kurapa kwekurapa asi zvakare kuderedza njodzi yekusagadzikana zvinodhaka, kuchengetedza kuchengetedza murwere.
B. Inogadziriswa inoyerera mitengo
Iko kuchinjika kugadzirisa iyo kuyerera kweiyo jekiseni pombi pane-kuda chimwe chiratidzo pane chimwe chinhu mukana. Hutano hwehutano hunogona kuwana mwero wekunyepedzera kwezvinodhaka zvichibva pane zvinodikanwa-nguva zvevarwere. Mukurongedza kwakakomba kwekutarisira, kana ropa reropa rakangoerekana radonha, mishonga yeVasopressor inogona kukurumidza kuongororwa kumusoro nekuwedzera iyo jekiseni yepombi yekuyerera kudzoreredza hemodenamic kugadzikana. Zvekare, kana murwere anoratidza zviratidzo zvekupandukira panguva yeanesthesia, mwero wekunyepedzera kunyengera kunogona kuderera nekukurumidza. Uku kujaira kunowedzera kune akasiyana ekiriniki zviitiko, kubva pakugadzirisa huwandu hwekunyepedzera mune chirwere cheshuga zvichienderana nemazinga eglucose kuti uise kuendesa mishonga yeAnti-yekukuvara mune yeNuologic emergency. Kugona kwePump kwePombi yekupindura nekukurumidza kusvika pakuchinja kwemamiriro ekunze kunopa vashandi vekurapa kuti vape kurapwa kwakaringana uye kwakaringana.
C. Kuchengetedza maficha
Kuchengetedza ndiko kurapa mune zvekurapa mudziyo dhizaini, uye mapapu jekiseni akashongedzerwa nehurongwa hwakazara hwevachengetedzeka. Masisitimu anotyisa ndiwo mutsara wekutanga wekudzivirira, kusvinura vashandi kune zvingangoitika. Ongorora maAlarms anozivisa kana iyo tubing yakavharwa, kudzivirira kunyanyisa kudzvanywa kudzvanywa kwekuvhara uko kunogona kukanganisa iyo yein kana kukuvadza iyo influsion saiti. Mhepo-in-line Detector inomirira kana mabhuru emhepo achipinda iyo tubing, bvisa njodzi inotyisidzira yehupenyu yemhepo yemhepo. Yakadzika-bhatiri yambiro inovimbisa kuti pombi haina kumira zvisingatarisirwi panguva yekunyanyisa infusion. Pamusoro pezvo, akawanda jekiseni maPumps anoratidza anti-emahara-emahara-kuyerera maitiro ekudzivirira kusingadzoreki kuendesa zvinodhaka kana syringe yakabviswa netsaona. Dzimwe mhando zvakare dziviriro password Aya maitiro ekuchengetedza anoshanda muTandem kuti ape nhoo inopinda pamusoro pezvikanganiso uye kukanganisa, inosimbisa chivimbo muhutano hwevanopa uye kuchengetedza varwere kubva mukukuvara.
V. Mhedziso
Mukupedzisa, majekisi jekiseni akazara anenge ese chikamu chemishonga yemazuva ano emurogiramu, ichibuda sechinhu chakakosha kune hutano hwevanopa. Kugona kwavo kuendesa mishonga neisina kukanganiswa, inogadziriswa inoyerera mitengo, uye kupisa maitiro ekuchengetedza kuchengetedza kwevarwere, kuvandudza zvibodzwa uye kuderedza njodzi.
