Ukwembula i-24h Ambulatory Blood Pressure Monitor
I. Isingeniso se-24h Ambulatory Blood Pressure Monitor
Imonitha ye-ambulatory blood pressure yamahora angama-24 iyisisetshenziswa esikala umfutho wegazi ngokuqhubekayo esikhathini esingamahora angama-24. Kubalulekile ekuhloleni umfutho wegazi ngenxa yezizathu eziningana. Okokuqala, inikeza umbono obanzi wephethini yomfutho wegazi womuntu usuku lonke nasebusuku. Ngokungafani neziqaphi zomfutho wegazi ezivamile ezithatha isifinyezo kuphela, isiqaphi se-ambulance sithwebula izinguquko zomfutho wegazi phakathi kwemisebenzi ehlukene, izikhathi zokuphumula, nokulala.
Isibonelo, ucwaningo lubonisa ukuthi cishe oyedwa kwabathathu abadala unomfutho wegazi ophezulu. Imonitha ye-ambulatory blood pressure yamahora angu-24 ingasiza ekutholeni umfutho wegazi ophakeme ongase uphuthelwe izilinganiso zezikhathi ezithile. Ingase futhi ihlonze 'i-white coat hypertension,' lapho umfutho wegazi womuntu ukhuphuka kuphela esimweni somtholampilo ngenxa yengcindezi.
Lawa mamonitha ngokuvamile ahlanganisa idivayisi encane, ephathekayo exhunywe emzimbeni wesiguli. Ine-cuff evuvukala ngezikhathi ezithile ukukala umfutho wegazi. Amanye amamodeli athuthukile, njengemonitha yomfutho wegazi engenantambo, anikeza ukunethezeka okukhulu nokusebenzisa kalula.
Ukubaluleka kokuqapha kwe-ambulatory blood pressure ye-24h kusemandleni ayo okunikeza ulwazi olubalulekile lokuxilonga nokulawula umfutho wegazi ophezulu. Ngokulandela umfutho wegazi isikhathi eside, abahlinzeki bezempilo bangenza izinqumo zokwelashwa ezinembe kakhudlwana futhi balungise imithi njengoba kudingeka. Lokhu kungaholela ekulawuleni kangcono umfutho wegazi kanye nokuncipha kwengozi yezinkinga ezihlobene nomfutho wegazi ophakeme, njengesifo senhliziyo nesifo sohlangothi.
II. Izinzuzo ze-Monitor
(a) Ukuhlola Okunembile
I-ambulatory blood pressure monitor ye-24h inikeza ukuhlolwa okunembe kakhudlwana komfutho wegazi uma kuqhathaniswa nezindlela zendabuko. Ikala umfutho wegazi ngokuqhubekayo ngezikhathi ezivamile usuku lonke nobusuku, ithwebula ukushintshashintsha okungase kugejwe izilinganiso zezikhathi ezithile. Isibonelo, ucwaningo lubonisa ukuthi laba baqaphi bangakwazi ukubona ukuhluka kwesikhashana okubangelwa izici ezifana nokucindezeleka, ukuvivinya umzimba, nokulala. Le datha egcwele ihlinzeka ngesithombe esinembe kakhudlwana samaphethini womfutho wegazi womuntu ngamunye.
(b) Ukutholwa Kwamaphethini Angajwayelekile
Imonitha futhi iyasebenza kakhulu ekutholeni amaphethini omfutho wegazi ongavamile. Ingahlonza amaphethini angadiphu, okhuphukela phezulu, kanye namaphethini ediphu adlulele. Amaphethini angaconsi, lapho umfutho wegazi wasebusuku unganciphi njengoba kulindelekile, kungaba uphawu lokukhuphuka kwengozi yenhliziyo nemithambo yegazi. Umqaphi angathola lokhu futhi axwayise abahlinzeki bezempilo ukuthi bathathe isinyathelo esifanele. Ngokufanayo, amaphethini okukhuphuka, lapho umfutho wegazi wasebusuku uphakeme kunomfutho wegazi wasemini, kanye namaphethini e-dipper adlulele, lapho umfutho wegazi wasebusuku wehla kakhulu kunokuvamile, nawo angatholwa. Ngokusho kocwaningo, cishe ama-25% eziguli ezinomfutho wegazi ophakeme kanye no-50% -80% weziguli ezinomfutho wegazi ophakeme we-refractory angase abonise la maphethini angajwayelekile. Ukutholwa kwala maphethini kubalulekile ukuze kuhlolwe kusenesikhathi kanye nokulawulwa komfutho wegazi ophezulu, njengoba kungasiza ekuvimbeleni izinkinga ezifana nesifo senhliziyo nesifo sohlangothi.
III. Indlela Esebenza Ngayo
Umshini wokuqapha umfutho wegazi ohamba amahora angama-24 usebenza ngenhlanganisela yobuchwepheshe obuthuthukisiwe kanye nomklamo osebenziseka kalula. Imonitha ngokuvamile iqukethe idivayisi encane, ephathekayo enamathiselwe emzimbeni wesiguli. Lo mshini ufakwe i-cuff evuvukala ngezikhathi ezithile ukuze ilinganise umfutho wegazi.
Indlela yokusebenza iqala ngokuthi inzwa ekwikhafu ithole ukucindezela emithanjeni yesiguli. Njengoba i-cuff ikhukhumala, icindezela ingalo, futhi inzwa ikala izinguquko zokucindezela. Umqaphi ube esesebenzisa ama-algorithms ukubala amanani womfutho wegazi we-systolic ne-diastolic.
Amanye amamodeli athuthukile, njengemonitha yomfutho wegazi engenantambo, asebenzisa i-Bluetooth noma obunye ubuchwepheshe obungenawaya ukudlulisa idatha kuhlelo lokusebenza leselula noma ikhompuyutha. Lokhu kuvumela ukuqapha nokuhlaziya idatha yomfutho wegazi kalula.
Imonitha ihlelelwe ukuthi ithathe izilinganiso ngezikhathi ezijwayelekile imini yonke nobusuku. Isibonelo, ingakala umfutho wegazi njalo emizuzwini eyi-15 kuye kwengama-30. Lokhu kuqapha okuqhubekayo kunikeza isithombe esiphelele sezindlela zomfutho wegazi wesiguli esikhathini esingamahora angama-24.
Idatha erekhodwe imonitha igcinwa kumemori yayo noma idluliselwe kusizindalwazi esimaphakathi ukuze ihlaziywe okwengeziwe. Abahlinzeki bezempilo bangakwazi-ke ukubuyekeza idatha futhi benze ukuxilonga okunembe kakhudlwana nezinqumo zokwelashwa.
Sengiphetha, ukuqapha kwe-blood pressure ye-ambulatory ye-24h kusebenza ngokusebenzisa izinzwa ezithuthukisiwe kanye ne-algorithms ukuze kulinganiswe ngokuqhubekayo umfutho wegazi nokuhlinzeka ngedatha ebalulekile kubahlinzeki bezempilo.
IV. Izinhlelo zokusebenza
(a) Ukuxilongwa kwe-Hypertension
Imonitha ye-ambulatory blood pressure yamahora angu-24 idlala indima ebalulekile ekuxilongeni izinhlobo ezahlukene ze-hypertension. Isibonelo, ingasiza ekuboneni umfutho wegazi ophakeme wasebusuku, ovame ukunganakwa ngezilinganiso zomfutho wegazi ezivamile. Ngokocwaningo, cishe u-10% kuya ku-20% wabantu abane-hypertension banomfutho wegazi ophakeme ebusuku. Imonitha ingakwazi ukubona ukuthi umfutho wegazi womuntu uphakeme yini ebusuku, ngisho noma ubonakala uvamile phakathi nosuku.
Ingakwazi futhi ukuxilonga umfutho wegazi ophakeme ebusuku, lapho umfutho wegazi wasebusuku uphezulu kodwa umfutho wegazi wasemini ungaphakathi kwemingcele evamile. Lesi yisimo esiyinselele ikakhulukazi ukusibona ngaphandle kokuqapha okuqhubekayo. Imonitha ye-ambulatory blood pressure ye-24h inikeza idatha ebalulekile kubahlinzeki bezokunakekelwa kwempilo ukuze baxilonge ngokunembile futhi baphathe lesi simo.
Ngaphezu kwalokho, ukuqapha kungasiza ukuhlukanisa phakathi kwe-white coat hypertension kanye ne-hypertension yangempela. I-White coat hypertension kwenzeka lapho umfutho wegazi womuntu ukhuphuka kuphela esimweni somtholampilo ngenxa yokucindezeleka. Ngokulinganisa umfutho wegazi esikhathini esingamahora angama-24, umqaphi angakwazi ukunquma ukuthi umfutho wegazi ophakeme uyahambisana yini noma ukusabela nje endaweni yomtholampilo.
(b) Ukuqapha Ukusebenza Ngempumelelo Kokwelashwa
Imonitha ye-ambulatory blood pressure yamahora angama-24 iyithuluzi elibalulekile lokuhlola ukusebenza kahle kokwelashwa kwe-antihypertensive. Ngokuqhubeka nokuqapha umfutho wegazi, kungabonisa ukuthi imithi enqunyiwe noma izinguquko endleleni yokuphila empeleni ziyehlisa umfutho wegazi ngokuhamba kwesikhathi.
Isibonelo, uma isiguli sithatha imithi ye-antihypertensive, umqaphi anganikeza idatha yokuthi umuthi usebenza kahle kangakanani usuku lonke nobusuku. Uma umfutho wegazi uhlala uphezulu naphezu kokwelashwa, abahlinzeki bezempilo bangalungisa umthamo noma bashintshe imithi.
Ngaphezu kwalokho, umqaphi angasiza ekunqumeni ukuthi ukuguqulwa kwendlela yokuphila njengokushintsha kokudla, ukuvivinya umzimba, nokunciphisa ukucindezeleka kunomthelela yini ekucindezelweni kwegazi. Ngokuqhathanisa ukufundwa komfutho wegazi ngaphambi nangemva kokwenza lezi zinguquko, abahlinzeki bezempilo bangahlola ukusebenza kokungenelela.
Ekuphetheni, ukuqapha kwe-ambulatory blood pressure ye-24h kunezinhlelo zokusebenza ezibalulekile ekuhloleni umfutho wegazi ophezulu kanye nokuqapha ukusebenza kokwelashwa. Amandla ayo okuqapha okuqhubekayo ahlinzeka ngemininingwane ebalulekile kubahlinzeki bokunakekelwa kwezempilo ukuze benze izinqumo ezinolwazi futhi bathuthukise imiphumela yesiguli.
V. Ukuphathwa Kwe-Hypertension Yasebusuku
(a) Ukuhlonza
Imonitha ye-ambulatory blood pressure yamahora angama-24 ibalulekile ekuhlonzeni umfutho wegazi ophakeme ebusuku. Njengokweziqondiso, i-hypertension yasebusuku ichazwa ngokuba nomfutho wegazi omaphakathi we-systolic wasebusuku ongu-≥120 mmHg kanye/noma umfutho wegazi we-diastolic ongu-≥70 mmHg. Imonitha ikala umfutho wegazi ngokuqhubekayo kuso sonke isikhathi samahora angama-24, okuhlanganisa phakathi nesikhathi sokulala. Lokhu kuvumela abahlinzeki bezempilo ukuthi bathole ngokunembile uma isiguli sinomfutho wegazi ophakeme phakathi nobusuku. Isibonelo, uma ukufundwa kwesiguli kukhombisa umfutho wegazi ophakeme ngokungaguquki phakathi namahora asebusuku aqoshwe umqaphi, kungaba inkomba ecacile ye-hypertension yasebusuku.
(b) Amasu Okwelapha
Kunezindlela eziningana zokwelapha i-hypertension yasebusuku. Okokuqala, ukuguqulwa kwendlela yokuphila kudlala indima ebalulekile. Ukudla okune-sodium ephansi ne-potassium kungasiza ekwehliseni umfutho wegazi. Ucwaningo lubonisa ukuthi ukunciphisa ukudla kwe-sodium kungaholela ekwehleni okukhulu komfutho wegazi. Ukwengeza, ukuthuthukisa ikhwalithi yokulala kubalulekile. Iziguli kufanele zelulekwe ukuthi zigcine isimiso sokulala esivamile futhi zibhekane nanoma yikuphi ukuphazamiseka kokulala noma ukuvuka njalo. Ukunciphisa umzimba nokuzivocavoca njalo kungase kube yinzuzo. Ucwaningo luye lwabonisa ukuthi ukulahlekelwa ngisho nesisindo esincane kunganciphisa umfutho wegazi.
Ukwelashwa kwe-Pharmacological kungenye indlela. Imithi ye-antihypertensive ethatha isikhathi eside ivame ukutuswa njengoba inganikeza ukulawulwa komfutho wegazi okuqhubekayo imini yonke nobusuku. Isibonelo, i-calcium channel blockers, i-ACE inhibitors, nama-ARB asetshenziswa kakhulu. Ukwelashwa okuhlangene nemithi eminingi kungase kudingeke kwezinye izimo ukuze kulawulwe ngempumelelo umfutho wegazi ophakeme ebusuku.
Ngaphezu kwalokho, ukwelapha izimo ezicashile ezibangela umfutho wegazi ophakeme ebusuku kubalulekile. Ngokwesibonelo, uma isiguli sine- obstructive sleep apnea syndrome (OSAS), ukwelapha lesi simo kungasiza ukwehlisa umfutho wegazi. Ukuphatha isifo sezinso esingamahlalakhona, isifo sikashukela, nezinye izifo ezihambisana nakho nakho kungaba nomthelela omuhle ku-hypertension yasebusuku.
Okokugcina, ukuqapha okuvamile nge-monitor ye-ambulatory blood pressure ye-24h kubalulekile ukuhlola ukusebenza ngempumelelo kokwelashwa. Ukulungiswa kungenziwa ngokusekelwe kudatha egadiwe ukuze kuqinisekiswe ukulawulwa komfutho wegazi okulungile.
