I. Isingeniso
Kwezokwelapha zanamuhla, ipompo yokujova imile njengethuluzi elibalulekile futhi eliyinkimbinkimbi, lidlala indima ebaluleke kakhulu ekuqinisekiseni ukuphathwa okunembile kwemithi noketshezi. Iguqule indlela abahlinzeki bezempilo abaletha ngayo ukwelashwa, bathuthukise ukuphepha kweziguli kanye nokusebenza kahle kokungenelela kokwelashwa. Le ndatshana idlulela ekusetshenzisweni kwemitholampilo ehlukahlukene yamaphampu wokujova, okhanyisa ngokubaluleka kwawo ezindaweni ezahlukahlukene zezokwelapha.
II. Iyini iphampu yomjovo?
A. Ukuchazwa kanye Nesimiso Esisebenzayo
Iphampu yomjovo idivaysi yezokwelapha eyenzelwe ukuletha uketshezi, ikakhulukazi umuthi, ngendlela elawulwa futhi eqondile. Isebenza njenge-ally ethembekile kwabasebenzi bezokunakekelwa kwempilo, baqinisekise ukuthi iziguli zithola umthamo ofanele wezidakamizwa ngezinga elifanele. Emgogodleni wayo, impompo yomjovo isebenza ngomgomo wokusebenzisa izindlela zemishini noma ze-elekthronikhi ukushayela i-plunger yesirikhi, ngaleyo ndlela ecindezela umuthi owuketshezi ngeshubhu elixhunyiwe nasemzimbeni wesiguli. Le nqubo ilawulwa ngokucophelela, ngephampu ekwazi ukuletha ama-minuscule emihlanganweni enkulu yoketshezi ngokunemba okumangazayo, okuvame ukwehlisa izingxenyana ze-millilit ngehora. Ukunemba kutholakala ngezinhlelo ezithuthukile zokulawula izimoto ezihumusha amasiginali kagesi abushelelezi futhi avumelanise ukunyakaza kwe-syripring piston, ukulingisa umjovo ofanele wencwadi kepha ngokuthembeka okuthuthukisiwe.
B. Izakhi ezibalulekile nemisebenzi yazo
1. Umnikazi wesirinji : Lesi sakhi sivikelekile ngokuphepha isirinji, siqinisekise ukuthi sihlala esimweni esinqunyelwe kuyo yonke inqubo yokumnika. Kwenzelwe ukwamukela osayizi abahlukahlukene besirinji, kusuka kuma-syringe amancane, anembile asetshenziselwa imithi enamandla kuya kwabakhulu abaphathi abasebenza kalula. Umnikazi futhi uhlinzeka ngephuzu lokuxhumeka le-tubing eholela kwisiguli, iqinisekisa indlela evuvukala.
1. I-Drive Mechanism : Ihlanganisa imoto, imvamisa i-motor, kanye nohlelo lokuhambisa olufana nesikulufa esiholayo noma i-actuator eliqondile, indlela yokushayela i-powerhouse yephampu yomjovo. Imoto ijikeleze ekukhuphukeni okunembile, ukuhumusha ukunyakaza kwayo ukujikeleza kube ukufuduka okuqondile kwe-plunger yesirikhi. Lokhu kunyakaza okulawulwayo kubeka izinga lokugeleza lokwelashwa, okuvumela ukulungiswa ngejubane kanye nevolumu yokulethwa ngenhlamba enkulu.
1. Uhlelo lokulawula : ubuchopho bephampu yokujova, uhlelo lokulawula, luhlanganisa i-microprocessor kanye nokuhlobisa umjikelezo. Ihumusha okokufaka komsebenzisi, okungafaka isilinganiso esifunekayo sokumnika, inani eliphelele elizofakwa, nanoma yiziphi izinhlobo ezikhethekile ze-dosing. Ngokusekelwe kule miyalo, ithumela amasiginali kwindlela yokushayela ukuze akhiphe ukulethwa okuqondile. Ngaphezu kwalokho, uhlelo lokulawula luqapha ukusebenza kwephampu, luqinisekise ukuthi isilinganiso sangempela sokugeleza siqondanisa namapharamitha asethiwe nokwenza ushintsho lwesikhathi sangempela uma ukuphambuka kwenzeka.
1. Isibonisi Sokubonisa Nomsebenzisi I-interface yomsebenzisi, imvamisa ifakwe izinkinobho noma isikrini sokuthinta, inika amandla abahlinzeki bezokunakekelwa kwezempilo ukuthi bakwazi ukuhlela kalula ipompo, baqale noma bamise infusions, bese ufinyelela izilungiselelo ezithuthukile. Lokhu kusebenza okulula kokusebenza kubalulekile endaweni enomdlandla esheshayo kanye nengcindezi ephezulu yezilungiselelo zezempilo, kunciphisa amathuba okuba namaphutha ngesikhathi sohlelo.
1. Izinhlelo nezinhlelo zokuphepha : ukuvikela iziguli ekulimaleni okungenzeka ngenxa yokuthola ukungasebenzi kahle okungalungile noma ukungasebenzi kahle kwemishini, amaphampu wokujova afakwe ngezici eziphelele ze-alamu nezokuphepha. Lokhu kufaka ama-alamu we-occlusion athola ama-blockages ku-tubing, anati-umugqa wokuthola ukuvimbela ama-embololisms e-air, kanye nezexwayiso zebhethri eliphansi. Uma kwenzeka umcimbi we-alamu, impompo imisa ngokushesha ukumnika futhi ixwayise abasebenzi bezokwelapha, ibashukumisela ukuba bathathe izinyathelo zokulungisa ngokushesha.
III. Izimo Zokusebenza Zomtholampilo
A. Ku-Intensiven Care Unit (ICU)
1. Ukuphathwa kwemithi yokunakekelwa okubucayi
Ezindaweni eziphakeme kakhulu ze-ICU, lapho izimpilo zempilo iziguli zilenga esilinganisweni, kuvela amaphampu wokujova njenge-linchpin ekulethweni kwemithi yokunakekelwa okubucayi. Izidakamizwa ze-Vasopresrer, njenge-Dopamine ne-NorePinephrine, zithathwe ngokucophelela kusetshenziswa amaphampu wokujova ukuze alondoloze umfutho wegazi ozinzile ezigulini noma ukungazinzi kwe-hemodynamic. Le mithi, ngamafasitela abo aphansi ahamba kancane, funa i-dosing eqondile; Ngisho nokuphambuka okuncane kungacacisa imiphumela emibi noma imiphumela yeziguli. Ngokufanayo, ama-sedatives kanye ne-analgesics efana ne-propofol kanye ne-fentanyl kulawulwa ngokunemba kwenkomba ukuze kugcinwe iziguli zibe nentofontofo futhi zizolile, ikakhulukazi lezo ezivela emshangwaneni. Amandla we-Umjovo we-Disection ukuletha ama-microdoses ngomzuzu ngamunye aqinisekisa ukuthi isiguli sihlala esimweni esifunekayo sokudambisa ngaphandle kokuphambuka ngokweqile noma ngaphansi kokuzikhandla, okungaholela ezinkingeni ezinjenge-asynchrony noma ukuqashelwa ngesikhathi senqubo.
2. Ukusekelwa kokudla okunempilo kweziguli ezigula kakhulu
Ezigulini ezingakwazi ukuthatha umsoco womzimba, isamba sokudla kwabazali (TPN) iba yindawo ebalulekile yokuphila. Amaphampu wokujova adlala indima ebalulekile kulesi sici ngokulawula ngokunembile isilinganiso sokumnika ngokunemba sokuxubana okuyinkimbinkimbi. I-TPN Solutions, equkethe ibhalansi entekenteke yama-amino acid, i-glucose, ama-lipid, amavithamini, namaminerali, kudingeka ukuthi uphathwe kancane kancane ukuvikela i-hyperglycemia, i-hypertriglyceriamemia, noma ukungalingani kwe-electrolyte. Izici ze-Umjovo Pump's Pumps ezihlelekile zivumela abahlinzeki bezempilo ukuthi basebenzise inani lokumnika ngokususelwa kwizidingo zesiguli se-metabolic, isisindo somzimba kanye nesimo somtholampilo. Leli zinga lokunemba aligcini ngokufaka kuphela ukumuncwa kwezakhi zomsoco kodwa futhi linciphisa ubungozi bokuncishiswa kwe-metabolic, okwakungakhulisa ngenxa yokugula okubucayi kwesiguli.
B. Ngesikhathi sokuhlinzwa
1. Ukulethwa kwe-anesthesia
Emidlalweni yeshashalazi esebenzayo, iphampu yokujova iyithuluzi elisemqoka ku-anesthesiologists. Iqinisekisa ukulethwa komthungo kanye nokulawulwa kwama-anesthetic agents kuyo yonke inqubo yokuhlinzwa. Noma ngabe yiSigaba sokungenisa, lapho ukuphathwa ngokushesha kwezomnotho okufana nokho kudingeka ukuthi kungazi lutho ngokusheshe, noma isigaba sokulungisa, lapho kufakwa khona ama-anesthetics aguquguqukayo noma ama-imeyili afana neLifetanil kugcina isiguli esifanele se-anesthesia. Izinga lokugeleza eliguqukayo lepompo livumela ukuthi udokotela obulala izinzwa aphendule ngaso leso sikhathi ukuthi aguquke kumapharamitha wesiguli esingokomzimba, njengokushintshashintsha kwengcindezi yegazi noma ukushaya kwenhliziyo, kuqinisekisa okuhlangenwe nakho okuhlangene. Ngokugcina okuhlushwa izidakamizwa njalo egazini, amaphampu wokujova asiza ukugwema ukuqwashisa nge-intrapeaperative futhi anikeze indiza yokubulala izinzwa, anciphise ukuphendula kwesiguli kanye nezinkinga zokuphatha.
2. Ukuphathwa kwama-antibiotic ne-hemstatics
Ukutheleleka kwesiza okuhlinzayo kufaka usongo olukhulu ekubuyiselweni kweziguli, okwenza kube lula futhi kunembile ukuphathwa kwe-antibiotic. Amaphampu wokujova anika amandla ukulethwa okuhleliwe nokunembile kwemithi elwa namagciwane angu-prophylactic, aqinisekise ukuthi umuthi ufinyelela amazinga wokwelapha ezicutshini ngaphambi kokuhlinzwa kwenziwa futhi ulondoloze ukugxila okusebenzayo kuyo yonke inqubo. Le ndlela ebhekiswe kuyo yandisa ukusebenza kwe-antibiotic ngenkathi inciphisa ubungozi bokuthuthukiswa kokumelana namagciwane. Ngokwengeziwe, ngesikhathi sokuhlinzwa lapho ukopha khona ukukhathazeka, amaphampu okujova asetshenziselwa ukuphatha ama-hegents e-herostatic. Le mishanguzo, ethuthukisa ukugcwala kwegazi, kudingeka ukuthi ifakwe ngesikhathi esifanele futhi izinga lokulawula ukopha ngempumelelo ngaphandle kokubangela imiphumela emihle ehleliwe. Ukucaciswa kwephampu kuqinisekisa ukuthi umenzeli we-heatustic ulethwa ngqo lapho kudingeka khona futhi nini, ethuthukisa ukuphepha okuhlinza kanye nokunciphisa isidingo sokumpompela igazi.
C. ekunakekelweni kwezingane nokunakekelwa kwe-neonatal
1. Imithi eqondile yemizimba emincane
Iziguli ze-Pediatric nezeNeonatal ziletha izinselelo ezihlukile ngenxa yosayizi wazo omncane, izinhlelo ezingavuthiwe kwezitho, nokuzwela kwemizwa emithini. Amaphampu wokujova yi-boon kulo mongo njengoba angaletha imithamo yezidakamizwa e-minuscule. Isibonelo, kuma-neonates anesiphene senhliziyo sokuzalwa esidinga imishanguzo ukuphatha ukwehluleka kwenhliziyo, umugqa wephutha kwi-dosing mncane kakhulu. Ukuhlolisisa okuncane kungaholela ekubizeni ubuthi obusongela impilo noma ukwelashwa okunganele. Amaphampu awo umjovo, enekhono labo lokukhipha amavolumu amancane njengama-microditars ngehora, aqinisekise ukuthi inani elifanele lezidakamizwa afana ne-digoxin noma i-inotropes lifinyelela egazini lengane, livikele i-physiology yabo ebuthaka. Le dosing enembile futhi isiza emithini esetshenziselwa ukwelapha ukuquleka kwe-neonatal, lapho umthamo ongalungile ungaba nemiphumela emibi emibi.
2. Ukufakwa kancane nokuqhubekayo kwama-neonates
Izinsana ezingaphambi kwesikhathi kanye nama-neonates zivame ukudinga ukuqhubeka kwemithi yemithi ukusekela izinhlelo zazo ezithuthukayo. Amaphampu wokujova asetshenziselwa ukuphatha izinto ezinjenge-caffeine ukukhuthaza ukuphefumula ezinkundleni ze-pretm baby noma uketshezi lwe-intravenous ukugcina ibhalansi ye-hydration ne-electrolyte. Ukufakwa okuhamba kancane nokuqinile okuhlinzekwe yi-POMP kulingisa izinqubo zemvelo, ezihamba kancane kancane emzimbeni okhulayo, ukuvimba amashifu uketshezi olungazelelwe noma ukuncipha kwezidakamizwa okungasehlula i-homestasis yabo ebucayi. Lokhu kubaluleke kakhulu kumayunithi wokunakekelwa kwe-neonatal (NICUS), lapho iziguli ezincane zincika kakhulu ekulethweni okunembile kwalezi zinto ezisekela impilo ukuze zikhule futhi zichume.
D. ekwelashweni kwe-Oncology
1. I-chemotherapy izidakamizwa ukumnika izidakamizwa
Umdlavuza Chemotherapy ufuna ukunemba okukhulu ekulethweni kwezidakamizwa. Ama-ejenti we-chemotherapy, ngemiphumela yawo enamandla ye-cytotoxic, adinga ukutholwa ngokucophelela ukukhomba amaseli omdlavuza ngenkathi kuvinjeze izicubu ezinempilo ngangokunokwenzeka. Amaphampu wokujova kuyindinganiso yegolide yokuphatha izidakamizwa ze-chemotherapy, uqinisekise ukuthi umthamo onqunyelwe uyakufaka ngesilinganiso esiqhubekayo futhi esilawulwayo. Lokhu kungeniswa okuqinile kusiza ukugcina ukugxila kwezidakamizwa ngewindi lezokwelapha, kuthuthukise ukusebenza kwalo ngokumelene namaseli omdlavuza. Isibonelo, ekwelapheni umdlavuza webele ngezidakamizwa ezinjenge-doxorubicin, ipompo yomjovo iqinisekisa ukuthi i-chemotherapy ilethwa ngokuqondile ngokwe-ukwenziwa kwe-underdosing (okungaholela emiphumeleni ye-underdosing) nokweqile (okuzokwenza imiphumela emibi). Ngokwengeziwe, iziguli ezenzelwe isikhathi eside samakhemikhali chemotherapy, ukuthembeka kwephampu nokunemba kuvimbela amaphutha we-dosing ngaphezulu kwezikhathi ezeluliwe, ethuthukisa ikhwalithi yokwelashwa komdlavuza.
2. Imithi yokusiza ngezimpawu
Iziguli ezinomdlavuza zivame ukukhuthazelela imiphumela yemiphumela emibi ewohlokayo evela ekhengwekhali, njenge-nausea, ukugabha nobuhlungu. Amaphampu wokujova aqashwa ukuhlinzeka ngokuthola impumuzo eqhubekayo ngokuphatha ama-antiemetics, ama-analgesics, neminye imithi yokusekela. Ngokuletha le mishanguzo ngesilinganiso esihlala njalo, impompo isiza ukugcina iziguli zibe nentofontofo, zibavumele zibekezelele kangcono ukuqina kokwelashwa komdlavuza. Isibonelo, iziguli ezibhekene ne-nausea ezingezinhle ze-chemotherapy-ezibangelwa ze-chemotherap zingathola ukumiliselwa okuqinile kwe-Odansetron noma i-aprepitant, ukuvimba amagagasi okusheshe aholele ekulimaleni komzimba, ukungondleki, kanye nekhwalithi yempilo eyehlisiwe. Endabeni yokuphathwa kobuhlungu be-Cancer Pain Management, ama-opioid anjenge-morphine angabanjwa ama-morphine ngokuqondile kusetshenziswa i-analgesia yokuhlinzeka nge-analgesia ephumelelayo ngaphandle kweziqongo nemikhombe ehlotshaniswa nokuthola ukululama kwabo kunokuba ahlupheke ebuhlungwini babo.
E. Ekuphathweni kobuhlungu
1. Ukulethwa kwama-analgesics
Endaweni yokuphathwa kwezinhlungu, amaphampu wokujova anikela ngezindlela ezithembekile zokuhlinzeka ngokukhululeka kobuhlungu obuqhubekayo. Iziguli ezengeziwe zokuhlinzwa, ngokwesibonelo, zivame ukuzwa ubuhlungu obukhulu ngesikhathi esisheshayo se-postoperative. Amaphampu wokujova angahlelwa ukuhambisa ama-analgesics afana ne-Fentanyl noma i-bupivacaine ngezinga elihlali njalo, eligcina izinga lokwelapha lokukhululeka kobuhlungu. Lokhu akugcini nje ngokuhlupheka kwesiguli kodwa futhi kuthuthukisa ukululama okusheshayo ngokubenza bakwazi ukuhlanganisa ukuhlanganisa izingane kwasekuqaleni kanye nokuzivocavoca okujulile kokuphefumula, okubaluleke kakhulu ukuvimbela izinkinga ze-pneumonia kanye ne-vein thrombosis ejulile. Ekuphathweni kobuhlungu obungapheli, futhi, ezigulini ezinezimo ezinjengobuhlungu be-neuropathic noma i-Complex Regional Pain syndrome, ipompo ingaphatha i-analgesics esebenza isikhathi eside, inciphisa ikhwalithi yempilo ejwayelekile.
2. I-analgesia elawulwa ngesineke (i-PCA)
I-PCA yindlela yezinguquko ekuphathweni kobuhlungu okunika amandla iziguli ukuba zibambe iqhaza elisebenzayo ukuze zinethezekile. Usebenzisa ipompo yokujova efakwe umsebenzi we-PCA, iziguli zingazisebenzisa imithamo emincane ye-analgesics, imvamisa ama-opioid, ngaphakathi kwemikhawulo esethiwe. Lokhu kuyabavumela ukuba baphendule ngokushesha ezinhlungwini zokwehlukana, banikeze umuzwa wokulawula nokwehlisa ukukhathazeka okuhambisana nobuhlungu. Izici zokuphepha zokujova zokujova zivimbela ukweqiwa ngokweqile ngokukhawulela imvamisa kanye nethamo lokuzilawula. Isibonelo, ukululama kwesiguli kusuka ekuhlinzweni okukhulu kungacindezela inkinobho ukuthola umthamo omncane we-morphine lapho izinhlungu zingabekezeleleki, ngenkathi ipompo ingabekezeleleki, kanti impompo iqinisekisa ukuthi inani eliphelele lezidakamizwa lihlala lisezingeni eliphephile. Lokhu kulinganisela phakathi kokuzimela ngesiguli nokuphepha kwenze i-PCA isuswe isu elitholwe kabanzi nelisebenzayo lobuhlungu ekunakekelweni kwezempilo kwanamuhla.
IV. Izinzuzo zamaphampu wokujova ekusetshenzisweni kwemitholampilo
A. Ukunemba okuphezulu nokunemba
Uma uqhathanisa izindlela zokufakwa zendabuko, amaphampu wokujova anikela ngezinga elingakaze libonwe ngokunemba. Ukufakwa ngesandla, okuthembela emazingeni adonsela phansi kanye nokulawulwa kwencwajana yamanani e-DRIT, kuthambekele kokunganembile ngenxa yezinto ezinjengezinguquko ezinjengezinguquko ezingezona zesineke, noma iphutha lomuntu ekubalweni kwamaconsi. Ngakolunye uhlangothi, amaphampu wemoto, asebenzisa ukulawulwa kwezimoto okuthuthukile nezinzwa eziyinkimbinkimbi ukuqinisekisa ukuthi umuthi ulethwa ngokunemba kwenkomba. Lokhu kucacisa kubalulekile ezimweni lapho ngisho nokuphambuka okuncane emthanjeni kungaba nemiphumela ebalulekile. Isibonelo, e-chemotherapy, ama-milliliter ambalwa kakhulu noma ancane kakhulu wesidakamizwa esinamandla se-cytotoxic angasho umehluko phakathi kokucindezela kwesimila okusebenzayo kanye nobuthi obukhulu bokuthola izicubu ezinempilo. Ekunakekelweni kwe-neonatal, lapho izidumbu zezinsana zizwela kakhulu emithi, amandla okuphatha ama-micrograms wesidakamizwa ngehora ngokunemba okungaphenduki kwavikela imizimba yabo entekenteke. Ukunemba kwephampu yomjovo akugcini ngokukwenza kwenze imiphumela yokwelashwa kepha futhi kunciphisa ubungozi bokungasebenzi kahle kwezidakamizwa, okwenza ngcono ukuphepha kweziguli.
B. Amanani wokugeleza aguqukayo
Ukuvumelana nezimo ukulungisa izinga lokugeleza kwephampu yokujova okufunwayo kungenye enye inzuzo eHallermark. Abahlinzeki bezokunakekelwa kwezempilo bangakwazi ukwenza kahle izinga lokufakwa kwezidakamizwa ngokususelwa kwizidingo zesiguli sangempela. Esimweni sokunakekelwa okubucayi, uma umfutho wegazi wesiguli wehla ngokuzumayo, umuthi we-vasopresresression angafuduswa ngokushesha ngokuya ngokwandisa isilinganiso sokugeleza komjovo wokujova ukuze ubuyisele ukuqina kwe-hemodynamic. Ngakolunye uhlangothi, uma isiguli sibonisa izimpawu zokudonswa ngokweqile ngesikhathi se-anesthesia, izinga lokufakwa okudilizwayo lingancishiswa ngokushesha. Lokhu kuguqulwa kufinyelela ezimweni ezahlukahlukene zemitholampilo, kusuka ekushintsheni kwezinga lokufakwa kwe-insulin ku-Siductical Sible ngokususelwa kumazinga we-glucose wegazi ukuze kuguqulwe ukulethwa kwemithi yokulwa ne-neurologic. Amandla wepompo wokujoyina aphendule ngaso leso sikhathi ekushintsheni kwezimo zemitholampilo amandla okunika amandla abasebenzi bezokwelapha ukuhlinzeka ukunakekelwa okwenziwe ngezifiso nokusebenzayo, ukwelashwa okuhambisana nezidingo ezihlukile zesiguli ngasinye.
C. Izici zokuphepha
Ukuphepha kubaluleke kakhulu ekwakhiweni kwamadivayisi wezokwelapha, kanye namaphampu wokujova kufakwe nezinhlu eziningi eziningi zokuvikela. Izinhlelo ezesabekayo ziwumugqa wokuqala wokuvikela, uqaphele abasebenzi ezindabeni ezingaba khona. I-Occlusion Alarms Yazisa ngokushesha lapho iTubling ivinjiwe, ukuvikela ukwakheka kwengcindezi ngokweqile okungaqhakambisa umthambo noma ukulimaza indawo yokumnika. Ama-air-in-line retoctors azwakala uma u-bubbles womoya Faka ishubhu, ukugwema ingozi esongela impilo ye-air embolism. Izexwayiso zebhethri eliphansi liqinisekisa ukuthi ipompo ayipheli ngokungazelelwe ngesikhathi sokumnika okubucayi. Ngokwengeziwe, amaphampu amaningi okujoyina abonisa izindlela zokulwa namahhala ukuze zivikele ukulethwa kwezidakamizwa okungalawulwa uma isirinji sidilizwa ngengozi. Amanye amamodeli nawo anokuvikelwa kwephasiwedi noma imisebenzi yokukhiya ukuvikela ukuphazamiseka okungagunyaziwe ngezilungiselelo zokumnika. Lezi zici zokuphepha zisebenza eTandem ukuhlinzeka ngesihlangu esiqinile emaphutheni nasekupheleni, ukuqinisa ukuzethemba kubahlinzeki bezokunakekelwa kwempilo kanye nokuvikela iziguli ekulimaleni.
V.Phiswano
Ekuphetheni, amaphampu wokujova avele acishe cishe zonke izici zomuthi wanamuhla wezokwelapha, aveze njengethuluzi elibalulekile labahlinzeki bezokunakekelwa kwempilo. Amandla abo okuletha imithi ngokunemba okungenakuphikwa, amanani okuguquguquka aguqukayo, nezici zokuphepha eziqinile ziguqule ukunakekelwa kweziguli, ukuthuthukisa imiphumela kanye nokunciphisa ubungozi.
