I. Isingeniso
Ukujova ngomjovo kuma njengesisekelo ekwelapheni kwesimanjemanje, okusebenza njengendlela ebalulekile yokulethwa kwemithi, uketshezi, nemisoco ngokuqondile egazini lesiguli. Idlala indima ebalulekile ezimeni ezehlukene zezokwelapha, kusukela ekwelashweni okujwayelekile kuya ekungeneleleni kwezimo eziphuthumayo. Kodwa-ke, indlela yendabuko yokuthembela kuphela kumandla adonsela phansi ukuze kufakwe isinese kudala izinselele ekulawuleni ngokunembile izinga lokugeleza kanye nevolumu, okungabukela phansi ukusebenza kahle nokuphepha kokwelashwa. Faka iphampu yokufaka - isimangaliso sobuchwepheshe esiguqule ukwelapha ngokufakwa emthanjeni. Le ndatshana icubungula izinzuzo eziningi kanye nokubaluleka okujulile okulethwa amaphampu okumnika emkhakheni wezokwelapha, ihlola ukuthi akuthuthukisa kanjani ukunakekelwa kwesiguli, aqondisa ukuhamba komsebenzi womtholampilo, futhi anikele emiphumeleni engcono yezempilo.
II. Isimiso esisebenzayo samaphampu okumnika
A. Izingxenye Eziyinhloko
Enhliziyweni yephampu yokumnika kukhona inhlanganisela eyinkimbinkimbi yezingxenye ezisebenza ngokuvumelana. Isistimu yekhompyutha encane isebenza 'njengobuchopho,' ehlela yonke ingxenye yenqubo yokufaka. Itolika okokufaka komsebenzisi, icubungule idatha evela kuzinzwa, futhi ikhiphe imiyalo enembayo ukuze kuqinisekiswe ukuthi iphampu isebenza ngokunemba okunganaphutha. Idivayisi yephampu, noma ngabe i-piston driveven noma i-peristaltic pump, isebenza njengendlu yamandla, ikhiqiza amandla adingekayo ukuze uqhubekisele phambili uketshezi. Iphelezelwa uhide lwezinzwa - ukuthola izinga lokugeleza, ingcindezi, kanye nokuba khona kwamabhamuza omoya - kanye nesistimu ye-alamu eqaliswe ukuxwayisa abasebenzi bezokwelapha nganoma yikuphi ukungahambi kahle, lezi zici ziyahlangana ukuze zenze isisetshenziswa esithembekile nesihlulekayo ukuphepha.
B. Indlela Yokusebenza
Indlela yokusebenza yephampu yokufaka iyisimangaliso sobunjiniyela obunembayo. Lapho uchwepheshe wezokwelapha ehlela izinga lokumnika elifiswayo, uhlelo lwe-microcomputer luqala ukusebenza. Ilawula ngokucophelela isivinini lapho umshini wepompo usebenza khona, isho ukugeleza koketshezi ngeshubhu. Isibonelo, esimweni sokunakekelwa okubucayi lapho isiguli sidinga ukumnika okuqhubekayo kwesidakamizwa esinamandla se-vasoactive, iphampu ingasethwa ukuthi ilethe amavolumu amancane kodwa aqondile ngomzuzu, igcine ukugxila kwezidakamizwa ezihlala njalo futhi zokwelapha egazini. Leli zinga lokunemba aligcini nje ngokulungiselela ukuphumelela kokwelashwa kodwa futhi linciphisa ingcuphe yokusabela okungekuhle okungabangelwa ukuthasiswa okungaguquki.
III. Izinzuzo Zokumnika Amaphampu
A. Ukunemba Ekuletheni Uketshezi
Enye yezinzuzo eziphawuleka kakhulu zamaphampu wokumnika ilele ekunembeni kwawo okungenakuqhathaniswa. Ngokuphambene nendlela yokufaka evamile eqhutshwa amandla adonsela phansi, lapho ukuguquguquka kwesilinganiso sokugeleza kuyinto evamile, amaphampu okufakwayo angagcina ukugeleza okuzinzile ngokuphawulekayo. Ngokwesibonelo, ezikhungweni zokunakekela izingane ezisanda kuzalwa, lapho izinsana zidinga amanani amaminithi ambalwa kodwa anembile emithi, amaphampu afakwayo angalinganiswa ukuze alethe uketshezi ngenani eliphansi elingu-0.1 ml ngehora ngokunemba okungaphakathi kuka-±5% yenani elimisiwe. Leli zinga lokunemba liba bucayi nakakhulu lapho kunikezwa izidakamizwa ezinamandla njenge-heparin noma i-insulin, lapho ukubalwa kabi okuncane komthamo kungase kubangele imiphumela esongela ukuphila. Ekulashwa ngamakhemikhali, ukulethwa okunembile nokungaguquguquki kwama-ejenti e-cytotoxic akugcini nje ngokukhulisa umphumela wokwelapha kodwa futhi kunciphisa ubungozi bomthamo ongaphansi noma oweqile, ukuvikela iziguli ekulimaleni okungaba khona.
B. Ukuqedwa Kwezinguquko Ezibangelwa Umuntu
Izici zomuntu sekuyisikhathi eside ziyiva ekufakweni kwe-intravenous kwendabuko. Ukunyakaza okungaqondile kweziguli, njengokugingqika embhedeni noma ukunyakazisa ingalo, kungaphazamisa ukugeleza kokumnika, okuholela ekulethweni kwezidakamizwa okungajwayelekile. Amaphampu okumnika azenza ize lezi zindaba ngempumelelo. Amasistimu abo okulawula iluphu evaliwe kanye nezindlela zokulungisa eziqinile ziqinisekisa ukuthi izinga lokumnika lihlala lingashintshiwe kungakhathaliseki umsebenzi womzimba wesiguli. Lokhu kuzinza kunenzuzo ikakhulukazi ezigulini ezinezinkinga zokuhamba noma lezo ezingakwazi ukubambisana ngokugcwele, njengeziguli zezingane noma asebekhulile. Ngokuqeda ukuhlukahluka okubangelwa abantu, amaphampu okufakwayo ahlinzeka ngendlela ethembekile nengaphazamiseki yokuphathwa kwezidakamizwa, okuthuthukisa ukuphepha okuphelele nokusebenza ngempumelelo kokwelashwa.
C. Ukunciphisa Umthwalo Womsebenzi Womtholampilo
Endaweni ephithizelayo yewodi yasesibhedlela, abahlengikazi bahlezi benza imisebenzi eminingi. Amaphampu okufakelwa avela njengenzuzo, ehlisa kakhulu umsebenzi wawo. Cabangela isimo lapho unesi enesibopho sokunakekela iziguli ezimbalwa, ngasinye sidinga imithi ehlukene kanye namazinga okumnika. Ngaphandle kwephampu yokufaka, umhlengikazi uzodinga ukulungisa mathupha izinga lokugeleza lokuconsa ngakunye, inqubo edla isikhathi nenephutha. Ngokufika kwamaphampu okumnika, abahlengikazi bangahlela imingcele efiselekayo yokumnika bese begxila kwezinye izici ezibucayi zokunakekelwa kwesiguli, njengokuqapha izimpawu ezibalulekile, ukuhlinzeka ngokunakekelwa kwenxeba, noma ukunaka izidingo ezingokomzwelo zeziguli. Lokhu akugcini nje ngokuqondisa ukuhamba komsebenzi kodwa futhi kunciphisa amathuba okuba namaphutha ezokwelapha, ekugcineni kuholele emiphumeleni ethuthukisiwe yesiguli kanye nokwaneliseka komsebenzi okuthuthukisiwe phakathi kwabahlinzeki bezempilo.
IV. Ubumqoka Bamaphampu Okufakwa Kumsebenzi Womtholampilo
A. Ukuqinisekisa Ukusebenza Kokuxutshwa Kwezidakamizwa Okubalulekile
Emkhakheni wokunakekelwa okubucayi, ukulethwa kwemithi okunembile nangesikhathi kungase kube umehluko phakathi kokuphila nokufa. Amaphampu okumnika avela njenge-linchpin kulesi simo sezinga eliphezulu. Thatha izidakamizwa ze-vasopressor, isibonelo. Ezigulini ezinokushaqeka kwe-septic, lapho ukugcinwa komfutho wegazi owanele kubaluleke kakhulu, amaphampu okumnika alawula ngokucophelela ukumnika izidakamizwa ezifana ne-norepinephrine. Ikhono lephampu lokusekela ukugcwala kwezidakamizwa okungaguquki egazini liqinisekisa ukuthi umfutho wegazi wesiguli uhlala uzinzile, ukuvimbela iziqephu ze-hypotensive ezisongela ukuphila. Ngokufanayo, ekuphathweni kwe-arrhythmias yenhliziyo, izidakamizwa ze-antiarrhythmic ezifana ne-amiodarone zidinga ukulawulwa ngokunemba okuqondile. Ukwehluka okuncane kwesilinganiso sokumnika kungase kuthinte ibhalansi, noma kwehluleke ukulungisa i-arrhythmia noma ukuletha ukuphazamiseka kwesigqi senhliziyo okusha, okuyingozi kakhulu. Ngokuhlinzeka ngendlela yokulethwa ethembekile nenembayo, amaphampu okufakwayo anika amandla abahlinzeki bokunakekelwa kwezempilo ukuze bakwazi ukuzulazula kulezi zimo eziyinkimbinkimbi nezibucayi, bekhulisa amathuba okuba nomphumela omuhle wesiguli.
B. Ukuhlangabezana Nezidingo Ezikhethekile Zamaqembu Eziguli Ezisengozini
Iziguli esezikhulile nezinsana zimelela amaqembu amabili anokukhubazeka okuyingqayizivele uma kuziwa ekufakweni komthambo. Inqubo yokuguga ivame ukuholela emithanjeni entekenteke kubantu asebekhulile, ejwayele ukungena kanye nokulimala. Amaphampu okumnika, anoketshezi oluthambile kodwa olunembile, anciphisa ubungozi bokuhlukumezeka kwemithambo. Amazinga abo okugeleza alungisekayo futhi avumelane nezinhlelo zokujikeleza kwegazi ezihamba kancane ezivamile kubantu abadala asebekhulile, ukuvimbela ukugcwala koketshezi - isimo esingase sibhebhethekise izinkinga zenhliziyo noma zezinso ezicashile. Endabeni yezingane, i-physiology yazo ebucayi idinga ukunemba okukhulu. Izingane ezisanda kuzalwa, ikakhulukazi, zinemithambo emincane kanye nokubekezelela okulinganiselwe ukushintsha kwevolumu yoketshezi. Amaphampu okumnika angalinganiswa ukuze alethe amavolumu amancane, njengama-microgram ngekhilogremu ngomzuzu emithini ethile, ukuqinisekisa ukuthi ukwelashwa kusebenza futhi kuphephile. Leli zinga lokwenza ngokwezifiso aligcini nje ngokuvikela inhlalakahle yalezi ziguli ezisengozini kodwa futhi linikeza ukuthula kwengqondo kubanakekeli bazo, bazi ukuthi inqubo yokumnika ilawulwa ngokucophelela.
C. Ukugqugquzela Ukwelashwa Kokusekela Ukudla Okunempilo
Ezigulini ezingakwazi ukuthola ukudla okwanele ngokudla ngomlomo, ukwesekwa kokudla okunomsoco ngemithambo kuba umugqa wokuphila. Imithi yokudla okunomsoco kwangaphakathi kanye ne-parenteral idinga ibhalansi ethambile ekulethweni kwezakhi. Amaphampu okumnika adlala indima ebalulekile kulokhu. Izixazululo zokudla okunomsoco zabazali, ezinothile ngama-amino acid, ama-lipids, kanye ne-glucose, zidinga ukufakwa ngesilinganiso esilawulwa ngokucophelela ukuze kuvinjelwe i-hyperglycemia noma okunye ukuphazamiseka kwe-metabolic. Ukunemba kwephampu kuqinisekisa ukuthi ingxube eyinkimbinkimbi yemisoco ihanjiswa ngendlela elingisa izinqubo zokumuncwa kwemvelo komzimba ngokuseduze ngangokunokwenzeka. Ekondlekeni kwe-enteral, lapho okuphakelayo okuwuketshezi kwethulwa ngeshubhu ye-nasogastric noma ye-jejunostomy, iphampu ilawula ukugeleza ukuze igweme ukugcwala ngokweqile umgudu wamathumbu. Lokhu kubaluleke kakhulu ezigulini ezilulama ekuhlinzweni kwesisu noma lezo ezinokukhubazeka kwamathumbu. Ngokwenza kube lula ukulethwa kokudla okunomsoco okungenamthungo nokufanelekile, amaphampu afaka isandla ekubuyiseleni amandla eziguli, ukukhuthaza ukupholiswa kwesilonda, kanye nokwenza ngcono isimo sazo somtholampilo, kusheshiswe uhambo lokululama.
V. Imibono Neziphetho Zesikhathi esizayo
Njengoba sibuka ikusasa lobuchwepheshe bezokwelapha, ukuvela kwamaphampu okufakwayo kunesithembiso esikhulu. Intuthuko elindelwe ihlanganisa ukuxhumana okuthuthukisiwe, okunamaphampu ahlanganiswe ngaphandle komthungo ezinhlelweni zolwazi zesibhedlela sonke. Lokhu kuzokwenza ukwabelana ngedatha ngesikhathi sangempela phakathi kweminyango ehlukene, kuvumele ukunakekelwa kwesiguli okudidiyelwe futhi okuphelele. Isibonelo, esibhedlela esikhulu sokufundisa, odokotela egunjini labagula kakhulu bangaqapha bekude futhi balungise imingcele yokufakwa emahhovisi abo noma ngaphandle kwendawo, kuyilapho osokhemisi bengathola izexwayiso ezisheshayo mayelana nesimo sokulethwa kwezidakamizwa, okuqinisekisa ukugcwaliswa ngesikhathi.
I-Miniaturization kanye nokuphatheka nakho kusemkhathizwe. Cabanga ngesimo lapho iziguli ezinezimo ezingamahlalakhona, njengalezo ezidinga ukwelashwa ngokufakwa ekhaya isikhathi eside kwezifo ezifana ne-multiple sclerosis noma i-cystic fibrosis, zingaphatha iphampu yokufaka ehlangene, egqokekayo. Le divayisi ngeke ihlakaniphe nje kuphela, ingene ngokunganaki ezimpilweni zabo zansuku zonke, kodwa futhi ifakwe izici zokuphepha ezithuthukisiwe nezindawo ezisebenziseka kalula, ezinikeza iziguli amandla okuphatha imishanguzo yazo ngokuzibusa okukhulu.
Sengiphetha, iphampu yokufaka iye yavela njengamandla okuguqula emithini yesimanje. Ukunemba kwayo, ukwethembeka, nokuguquguquka kwayo kuchaze kabusha izindinganiso zokwelashwa ngokufakwa emthanjeni. Ngokuthuthukisa ukuphepha kwesiguli, ukuthuthukisa ukusebenza kahle kokwelashwa, kanye nokunciphisa umthwalo kubahlinzeki bezokunakekelwa kwempilo, sekuphenduke ithuluzi elibalulekile kuzo zonke izinhlobo zezilungiselelo zezokwelapha. Njengoba ubuchwepheshe buqhubeka buqhubekela phambili, singalindela ukuthi amaphampu okufakwayo aqhubeke nokuvela, avule amathuba amasha emithi yomuntu siqu kanye nemiphumela yokunakekelwa kwezempilo ethuthukisiwe. Kuyisibopho kubo bonke ababambiqhaza - kusukela kochwepheshe bezokwelapha nabacwaningi kuya kubenzi bezinqubomgomo neziguli - ukwamukela futhi basekele lezi ntuthuko, baqinisekise ukuthi amandla aphelele obuchwepheshe bephampu yokufaka asetshenziswa ukuze kuzuze impilo yomhlaba wonke.
