Intshayelelo
Kulo nyango lwanamhlanje, ipopu yenaliti imele njengesixhobo esibalulekileyo nesinobunkunkqele, idlale indima engenamsebenzi ekuqinisekiseni ulawulo oluchanekileyo lwamayeza kunye nolwelo. Ihambise indlela ababoneleli bempilo yokubonelela ngonyango, ukwandisa ukhuseleko lwezigulana kunye nokusebenza kongenelelo lonyango. Eli nqaku lidla izicelo ezahlukeneyo zeklinikhi yeziqhushumbisi ze-inaliti, ukuphalaza ukukhanya kubabalulekelele kwizinto ezahlukeneyo zonyango.
II. Yintoni impompo yenaliti?
A. Inkcazo kunye noMgaqo wokuSebenza
Impompo yenaliti sisixhobo sezonyango esekwe ukuhambisa amanzi, ngakumbi amayeza, ngendlela elawulwa kakhulu nangokuchanekileyo. Isebenza njengento enokuthenjwa yabantywili ezempilo, ukuqinisekisa ukuba abaguli bafumana idosi yeziyobisi ngereyithi efanelekileyo. Kwintloko yayo, impompo yena isebenza kumgaqo-nkqubo wokusebenzisa oomatshini okanye i-elektroniki kuthetha ukuqhuba isirinji ye-Syringe Plaller, ngaloo ndlela ukutyhala iyeza eliqhagamshelwe kunye nomzimba wesigulana. Le nkqubo ilawulwa ngocoselelo, kunye nempompo ekwaziyo ukuhambisa imithamo enkulu yolwelo ngokuchaneka okumangalisayo, ihlala iye ezantsi kwi-milliliter ngeyure. Ukuchaneka kufezekisiwe kwiinkqubo eziphambili zolawulo lweenqwelo moya eziguqula imiqondiso yombane kwi-Commar ye-Syringe Piston, imbise inaliti yencwadana efanelekileyo kodwa iqinisekiswe ngokunyaniseka.
B. Izinto eziphambili kunye nemisebenzi yazo
1. Umnini weSiringe Yenzelwe ukwamkela ubungakanani beSirinji, ukusuka kwizirinji ezincinci, ezichanekileyo ezisetyenziselwa amayeza anamandla kwiindawo ezinkulu zolawulo olungelulo lwamanzi. Umnini nawo ubonelela ngendawo yoqhagamshelo yetyhubhu ekhokelela kwisigulana, siqinisekisa indlela evulekileyo.
1. Indlela yokuqhuba : equka imoto, ngokwesiqhelo iqabane, kunye nenkqubo yothumelo enje ngesikhafu esikhokelayo okanye i-act thermator yendawo yendlu yendlu yenja. Imoto ijikeleza ukunyuka ngokuchanekileyo, ukuguqulela intshukumo yayo ejikelezayo ibe kukhululwa kwisuntswana lesirinji. Le ntshukumo ilawulwayo ichaza inqanaba lokuhamba kwamayeza, livumela uhlengahlengiso kwisantya kunye nesandi sokuhambisa kunye neendlela ezinkulu.
1. Inkqubo yokuLawula : Ingqondo yePounition Pump, inkqubo yokulawula, inika i-microrfacedor kwaye inxibelelanisa ukujikeleza. Icacisa igalelo lomsebenzisi, elinokubandakanya ireyithi ye-insulion oyifunayo, ivolumu epheleleyo ekufuneka ihluthwe, kwaye naziphi na iirejimeni zolawulo olukhethekileyo. Ngokusekwe kule miyalelo, ithumela imiqondiso kwi-drive yendlela yokuphumeza ukuhanjiswa ngokuchanekileyo. Ukongeza, inkqubo yokulawula ibeka iliso kwindlela yokusebenza kwempompo, iqinisekisa ukuba inqanaba lokuphuma lineparamitha elibekiweyo kwaye senze uhlengahlengiso lwexesha lokwenyani ukuba ukuphambuka kwenzeka.
1. Idisplo yokubonisa kunye nomsebenzisi I-intanethi yomsebenzisi, idla ngokuxhotyiswa ngamaqhosha okanye i-upriveccreen, yenza ukuba ababoneleli bezempilo ukuba basebenzise ngokulula impompo, qala okanye ukuba ufikelele kwiisethingi eziphezulu. Oku kulula kokusebenza kubalulekile kwindalo ekhawulezileyo kunye noxinzelelo oluphezulu loseto lwempilo, ukunciphisa amathuba okuqhutywa kwezimpazamo ngexesha lenkqubo.
1. Iinkqubo ze-alam kunye nokhuseleko : ukukhusela izigulana ezinokubangela ingozi ngenxa yedosi engachanekanga okanye izixhobo zokungasebenzi, iimpompo zixhotyiswe nge-alamu enkulu kunye neempawu zokhuseleko. Oku kubandakanya iialarms ze-ACECT ezifumana i-blobleges kwityhubhu, i-air-in-chinecutic yokuthintela i-ebhussiss ye-air, kunye nezilumkiso zebhetri eziphantsi. Kwimeko yomnyhadala wealam, impompo inyibilikisa i-insulion kwaye ilumkisa abasebenzi bezonyango, ukubakhuthaza ukuba bathathe amanyathelo okulungisa ngokukhawuleza.
III. Imeko yesicelo sekliniki
A. KwiYunithi yoKhathalelo oluBala (i-ICU)
1. Ulawulo lwamayeza okhathalelo aBaluleki
Kwimeko ephezulu ye-ICU, apho kuhlala khona izigulana ezixhonywe kwibhalansi, inaliti iphuma njenge-linchpin ekuhanjisweni kwamayeza alulekileyo. I-vaskopressor yamachiza, anjengeDopamine kunye ne-norepinephrine, ayacekeceke kakuhle kusetyenziswa iimpompo zegazi ukuze ugcine uxinzelelo lwegazi kwizigulana okanye ukungazinzi kwe-hemodynamic. La mayeza, kunye neefestile zabo ezinqabileyo, zifuna idosiy ye-dosive; Nokuba ukuphambuka kancinci kunokubangela iziphumo ezibi okanye ukutyeshela iziphumo zesigulana. Ngokufanayo, ii-sedtives kunye ne-analgesics njenge propofol kunye ne-fentanyl zilawulwa ngokuchaneka kwe-propomocution ukugcina izigulana zikhululekile kwaye zizolile, ngakumbi ezo zikwi-ventilation yoomatshini. Isakhono se-pump yokuhambisa imicrosdoses ngomzuzu oqinisekisa ukuba isigulana sihlala kwimo enqwenelekayo ngaphandle kwe-sedation ngaphandle kwe-ventilator okanye ulwazi ngexesha le-ventilator.
2. Inkxaso yesondlo kwizigulana ezigula kakhulu
Ukuze abaguli abakwazi ukuthatha isondlo sika-Oral, isondlo sesondlo se-paretaration (i-TPN) iba yinto ebalulekileyo yokuphila. I-pumps yenaliti idlala indima ebalulekileyo kule nkalo ngokulawula ngokuthe ngqo umbungu oboniswayo. Isisombululo se-TPN, esiqulethe ibhalansi ye-Amino Acid, iglucose, i-lipids, kunye neeminerali, kufuneka zilawulwe kancinci ukuthintela i-hyperglycemia, i-hypertrigrignigniemiel, okanye ukungalingani kwe-elektrolyte. Iimpawu ezinokufakwa kwepumps zempompo zivumela ababoneleli bezempilo ukuba balungelelanise iqondo lempikiswano esekwe kwimfuno yezigulana, ubunzima bomzimba, kunye nemeko yekliniki. Eli nqanaba lokuchaneka alikokukhuphela kuphela ukufunxa kwesondlo kodwa likwancitshise umngcipheko we-detabolic kwizilwanyana, ezinokuthi zenze oko kuyanda isigulo.
B. Ngexesha lotyando
1. Ukuhanjiswa kwe-Anesthesia
Kwithiyetha esebenzayo, impompo yenaliti sisixhobo esibalulekileyo kwi-anenescheologists. Iqinisekisa ukuhanjiswa okungenamthungo kunye nokulawulwa kwearhente ye-anesthetic kuyo yonke inkqubo yoqhaqho. Nokuba sisigaba sokuqhekeka, apho kulawulwa ngokukhawuleza kweziyobisi ezifana nepropofofolo-propofol, okanye isigaba sesondlo esiya kuthi gabalala i-anesthetics okanye i-Intrafu ye-Inravenous enjenge-Ismoniatia. Ireyithi yokuhamba ehlengahlengisiweyo ivumela i-anesthesiologist ukuphendulwa ngokukhawuleza kutshintsho lwe-paramerigical yelize, njengokutshintsha koxinzelelo lwegazi okanye ireyithi yentliziyo, iqinisekisa amava agudileyo. Ngokugcina ugxininiso lweziyobisi oluqhubekayo kwigazi, inaliti inceda ukuthintela ulwazi lobume bentrapile kwaye ubonelele ngendiza eqinileyo ye-anesthetic, ukunciphisa impendulo yoxinzelelo lwesigulana kunye neengxaki zeposti kaguli.
2. Ulawulo lwee-antibiotics kunye ne-hearics
Ukosuleleka kwendawo yokugcina indawo kubeka isoyikiso ebalulekileyo ekufumaneni isigulana, ukwenza ixesha elifanelekileyo kunye nokuchaneka kwe-antibiotic. I-pumps yenaliti yenza ukuba i-pumps icwangcisiwe icwangcisiwe kwaye ichaneke intetho ye-antibioctic, iqinisekisa ukuba ichiza lifikelela kumanqanaba onyango kwizicubu ngaphambi kokuba i-tijical met iyenziwa kwaye igcine ukugxininiswa kwenkqubo kuyo yonke le nkqubo. Le ndlela ijolise kuyo yandisa ukusebenza ngokukuko kwe-antibiotic ngelixa kuncitshiswa umngcipheko wophuhliso lokunganyangeki kwentsholongwane. Ukongeza, ngexesha lotyando apho ukopha inkxalabo, inaliti isetyenziselwa ukulawula iiarhente zentsimbi. La machiza, okhuthaza ukujikeleza kwegazi, kufuneka axhaswe ngomzuzu kunye nenqanaba lokulawula ukopha ngempumelelo ngaphandle kokubangela iziphumo ezingafunekiyo. Ukuchaneka kwempompo kuqinisekisa ukuba iarhente ye-heamonatic ihanjisiwe kanye apho kufuneka khona kwaye xa kufuneka khona, ukuphucula ukhuseleko lonyango kunye nokunciphisa imfuno yotofelo-gazi.
C. Kwi-Pediatric kunye nononophelo lweNeoTatal
1. Unyango oluchanekileyo lwamayeza amabhunga amancinci
Izigulana zabantwana kunye ne-Neonyana bakwa-Neonatal iyolisa imiceli mngeni eyodwa ngenxa yobungakanani babo bomzimba omncinci, iinkqubo zengqumbo, kunye nokuphakamisa imvakalelo kumayeza. Iimpompo zenaliti yi-Boon kule meko njengoko zinokuhambisa ngokufanelekileyo amachaphaza amachaphaza. Umzekelo, kwii-Nenates kunye neziphene zentliziyo yokuzalwa ezifuna amayeza okulawula ukungaphumeleli kwentliziyo, umda wokuba impazamo kwi-dosing inqabile kakhulu. Ukungaqhelekanga okuncinci kunokukhokelela kwityhefu yobomi obuyingozi okanye inyameko. Inaliti yeempompo, kunye nokukwazi kwabo ukusasaza iivolumu ezincinci njengamaccorotiter ngeyure, ziqinisekise ukuba inani elifanelekileyo lamachiza anjenge-digoxin okanye i-iotrocs ifikelela kumzimba obuthathaka bomzimba. Le dolsing yentsingiselo ikwanceda kumayeza asetyenziselwa ukunyanga ukungaxwili, apho idosi engalunganga inokuba neziphumo ezinzulu ze-neurological.
I-2. Ukucocwa kancinci kunye nokuqhubeka kwe-ionates
Iintsana zangaphambi kwexesha kunye nee-ionnetes zihlala zifuna ukuncitshiswa kwamayeza okuqhubekayo ukuxhasa iinkqubo zabo zokuphuhlisa. Iimpompo zenaliti zisetyenziselwa ukulawula izinto ezifana ne-caffeine ukuze zikhuthaze ukuphefumla kwiintsana ze-preym okanye i-intravenous fluids ukugcina ibhalansi ye-hydration kunye nebhalansi ye-electrolyte. I-insulion ecothayo neqinileyo enikezwe yimpompo iluma i-pump yokulinganisa indalo, inkqubo yokutsha kancinci kumzimba okhulayo, ukuthintela ukutshintsha kwe-fluid ngequbuliso okanye ukuhlangula iziyobisi. Oku kubaluleke kakhulu kwiiyunithi zononophelo ezinobuchule (NICUS), apho uninzi lwezigulana ezonabileyo zixhomekeke ekuhanjisweni kwezinto zobomi ukukhulisa nokuchuma.
D. Kunyango lwe-Unicology
1
I-chemotherapy yonyango inyanzelisa ukubaluleka kokunikezelwa kweziyobisi. I-chemotherapy ye-chemotherapy, ifuna iziphumo zabo zeCytotonity, zifuna ukubaluleka kwezinto ezinonophele ukuze zithagethi iiseli zomhlaza ngelixa ikhupha izicubu ezisempilweni kangangoko kunokwenzeka. I-Pumps Pumps yimigangatho yeGolide yokulawula iziyobisi zokuhamba kwe-chemotherapy, uqinisekisa ukuba idosi emiselweyo ihluthwe kwinqanaba eliqhelekileyo nelilawulwa. Olu xinzelelo oluzinzileyo lunceda ukugcina i-plasma ye-Plasma kwifestile yonyango, ukuphucula ukusebenza kwawo ngokuchasene neeseli zomhlaza. Umzekelo, kunyango lomhlaza webele kunye neziyobisi ezinjengeDoxorikin, impompo yenaliti iqinisekisa ukuba i-chemotherapy ihanjiswa ngokuchanekileyo ngokwenziwa kwenkqubo yonyango, inciphisa umngcipheko wokunganyangeki) kunye nokunyusa iziphumo ze-tumations). Ukongeza, kwizigulana eziphantsi kweerejimeni ze-chemotherapy ixesha elide, ukuthembeka kwempompo kunye nokuchaneka kokuthintela iimpazamo ze-DOFOTE ngexesha lonyango lomhlaza.
I-2. I-SIRY PRATOM
Izigulana zomhlaza zihlala zinyamezela iziphumo ebezingalindelekanga ezibi kwi-chemotherapy, ezinjenge-nausea, ukugabha, kunye nentlungu. Iimpompo zenaliti ziqeshwa ukubonelela ngoncedo oluqhubekayo ngokulawula i-antiemetics, i-analgesics, kunye namanye amayeza axhasayo. Ngokuhambisa la machiza kwinqanaba eliqhelekileyo, impompo inceda ukugcina izigulana zikhululekile, zibavumela ukuba banyamezele ngcono ukuphathwa gadalala. Umzekelo, izigulana ezifumana isicaphucaphu kakhulu i-Chemeause inokufumana inzuzo eqinileyo ye-Ondansetsen okanye i-aprepitant, ethintela amaza omxholo onokuthi akhokelele emzimbeni, ukungondleki, kunye nomgangatho wobomi oncitshisiweyo. Kwimeko yolawulo lweentlungu zomhlaza, ii-opioids uthanda i-morphine zinokuqina ngokuchanekileyo usebenzisa impompo yenaliti ukubonelela nge-analmia esebenzayo ngaphandle kwe-Possing kunye ne-Proups ehambelana nokuvuselela intlungu engapheliyo.
E. Kwiintlungu zentlungu
1. Ukuhanjiswa kwee-analgesics
Kwindawo yolawulo lweentlungu, inaliti ibonelela ngeendlela ezinokuthenjwa zokubonelela ngoncedo lwentlungu oluqhubekayo. Izigulana ezenziwa emva kotyando, umzekelo, zihlala zifumana iintlungu ezibalulekileyo ngexesha le-POSTOPE. I-Pumps Pumps inokucwangciswa ukuhambisa i-analgesics enje nge-fentanyl okanye i-bivachaene ngenqanaba eliqhelekileyo, ukugcina inqanaba lokuphambuka kwentlungu. Oku kungapheleli kuphela ukubandezeleka kwesigulana kodwa kukhusela kwakhona ukubuyela kwakhona ngokukhawuleza ngokubenza ukuba bakwazi ukuqhubela phambili kunye nokuzivocavoca okunzulu, okubaluleke kakhulu ekuthinteleni i-Pneumonia kunye ne-venis enzulu. Kulawulo lweentlungu ezingapheliyo, nabo, ngenxa yezigulana ezinemeko ezifana ne-neuropathic yentlungu okanye i-syndrome yentshulube yengingqi, impompo ingalawula inaliti ende, inciphisa imfuno yenaliti eqhubekayo kunye nokuphucula umgangatho wobomi bukanesigulana.
I-2. I-Analgesia elawulwa sisigulana (PCA)
I-PCA yindlela yotshintsho kulawulo lwentlungu oluxhobisa abaguli ukuba athathe inxaxheba kwintuthuzelo yabo. Usebenzisa impompo yenaliti exhotywe ngomsebenzi wePCA, abaguli banokuzilawula iidosi ezincinci ze-analgesics, ngokwee-opioids, ngaphakathi kwemida. Oku kubavumela ukuba baphendule ngokukhawuleza kwiintlungu zokuphelisa, ukubonelela ngemvakalelo yokulawula kunye nokunciphisa uxinzelelo olunxulumene nentlungu. Iimpawu zokhuseleko zempompo zempompo zithintela i-overdose ngokuthintela i-frequency kunye nedosi ye-boolis oziphetheyo. Umzekelo, isigulana siphonononge ugqirha ophambili sinokucinezela iqhosha lokufumana idosi encinci ye morphine xa intlungu enganyamezeleki, ngelixa impompo iqinisekisa ukuba iyonke ye-Provider. Oku kulungelelaniswa phakathi kokuzipha ukutya kunye nokhuseleko lwenze icebo lolawulo lwepeyinti elivunyiweyo kunye nempumelelo.
Iv. Izibonelelo zeempompo zenaliti kwi-eklini
A. Ukuchaneka okuphezulu kunye nokuchaneka
Xa kuthelekiswa neendlela zokuzuza kwemveli, iimpompo zenaliti zibonelela ngenqanaba lokuchaneka. Ukuncitshiswa kwezandla, ukuthembeka kwi-gravity kunye nokulawulwa kwezamasano zeerhafu ze-drip, kukwenza ukungachaneki ngenxa yezinto ezinje ngotshintsho kwisimo se-tub, okanye impazamo yomntu xa ubala. I-Ination Pumps, kwelinye icala, sebenzisa ulawulo lweemoto eziphezulu kunye nezinzwa ezinobunkunkqele ukuqinisekisa ukuba ichiza lihanjiswa ngokuchanekileyo. Oku kuchaneka kubalulekile kwimeko apho ukuphambuka kancinci komthamo kunokuba nemiphumo ebalulekileyo. Umzekelo, kwi-chemotherapy, i-millilit embalwa kakhulu okanye incinci kakhulu yeyeza elinamandla le-cytotoovity enokuthetha umahluko phakathi kwengcinezelo esebenzayo kunye netyhefu kakhulu kwizicubu ezisempilweni. Kwinkathalo kaNeoatal, apho imizimba yentsana inovelwano kakhulu kumayeza, amandla okulawula i-microgram yechiza ngeyure kunye nokuchaneka okungafunekiyo kuphakama. Ukuchaneka kwe-pump yokungacacanga akunakuthatha inxaxheba kwiziphumo zonyango kodwa kukuthoba umngcipheko wokuphendula okuchaseneyo, ukuphucula ukhuseleko lwezigulana.
B. Ixabiso lokuhamba eliqeshwayo
Ukuguquguquka kokulungisa inqanaba lokuhamba kwembangi ye-inaliti ye-Ination kwinkalo yenzuzo yenye iholo. Ababoneleli bezempilo abanokuthatha izinga lokuncipha kweziyobisi ngokusekwe kwiimfuno zexesha lokwenyani. Kwisimo sokhathalelo esibalulekileyo, ukuba uxinzelelo lwegazi lesigulana sehla ngequbuliso, amayeza eVaspressor anokuqina ngokukhawuleza ngokunyusa izinga lokuhamba kwe-pump yokubuyisela i-hemodynamic. Kwelinye icala, ukuba isigulana sibonisa iimpawu zokuhambisa ngaphezulu ngexesha le-anesthesia, iqondo lokunakaliseka kwe-savedive linqunyulwe ngokukhawuleza. Olu tshintsho ludlulela kwizimo ezahlukeneyo zeklinikhi, ukusuka ekuhlengahlengiseni izinga lokuncipha kwe-insulin ngokusekwe kumanqanaba eglucose yegazi ukulungisa ukuhanjiswa kwamayeza okuhlala kwi-neurologic kaxakeka. Inaliti ye-pump yokuphendula kwangoko ukutshintsha kweemeko zeklinikhi ixhobisa abasebenzi ukuba banike abantwana abagqirha ukuba bafumane ukhathalelo olwenziwe ngobuchule nangokusebenza kakuhle kwiimfuno ezizodwa zesigulana esikhethekileyo sesigulana esikhethekileyo sesigulana esikhethekileyo.
C. Iimpawu zoKhuseleko
Ukhuseleko lubaluleke kakhulu kuyilo lwesixhobo sezonyango, kwaye iimpompo zenaliti zixhotywe ngoluhlu olupheleleyo lweendawo ezikhuselekileyo. Iinkqubo ezoyikisayo ngumgca wokuqala wokuzikhusela, ukuthobela abasebenzi kwimicimbi enokubakho. I-Acerms Aberms yazisa ngokukhawuleza xa ityhubhu ivinjelwe, ukuthintela ukwakha okugqithisileyo okunokupeyinta i-vein okanye monakalo kwindawo yokunakana. I-Air-in-right of Air Acked I-tubble ukuba i-fubble ye-air ingena kwityhubhu, igqobhoze umngcipheko osoyikayo wobomi bomoya. Izilumkiso zebhetri eziphantsi ziqinisekisa ukuba impompo ayiyeki ngequbuliso ngexesha lokuzithemba okuqinisekileyo. Ukongeza, iimpompo ezininzi zenaliti zibonisa iindlela zokuhamba zihamba simahla ukuthintela ukuhanjiswa kweziyobisi ukuba isirinji sifuduke ngengozi. Ezinye iimodeli zikwanokukhusela iphasiwedi okanye i-louteut yenzekile ukuthintela ukuncipha okungagunyaziswanga kunye noseto lwembeko. Ezi mpawu zokhuseleko zisebenza kwi-qundem ukuba zinikezele ngempazamo kunye neempazamo, zincedisa ukuzithemba kwababoneleli bezempilo kunye nokukhusela abaguli bengozi.
V. ukuqhutywa
Ukuqukumbela, iimpompo zenaliti ziye zavela phantse zonke iinkalo zonyango lweklinikhi, ezivela njengesixhobo esibalulekileyo kubaboneleli bezempilo. Ukukwazi kwabo ukuhambisa amayeza ngokuchaneka okungafunekiyo, amaxabiso ahlengahlengiswayo, kunye nezinto zokhuseleko ezomeleleyo ziguqule ukhathalelo lwezigulana, ukuphucula iziphumo kunye nokunciphisa umngcipheko.
