Heart-Lung Machine: nzube na ụkpụrụ nke ime ihe

Heart-Lung Machine - pụrụ iche ụlọọgwụ na bụ ike nke na-enye ụmụ mmadụ na Filiks nke ndụ, ma ọ bụrụ na obi ma ọ bụ n'akpa ume-akwụsị kpam kpam ma ọ bụ ikpe mezuo ya ọrụ. Echiche nke na o na-aghọta na "ichebe ndụ ọnọdụ nke ọ bụla akụkụ nke ahụ" pụtara na 1812, ma nke mbụ oge ochie ngwaọrụ, nke gụnyere ọbara pumping usoro na oxygenation, pụtara naanị na 1885.

The mbụ emeghe ịwa obi ebe obi-akpa ume ígwè e aka, rụrụ na 1930. Kemgbe ahụ, ọtụtụ isi usoro eji ngwa AIC: cardiopulmonary uzo kpamkpam dum organism, a na mpaghara, nke ndu ọmụmụ a na-nyere na otu ngwa ma ọ bụ na saịtị na inyeaka ọbara ọdịiche.

atụmatụ usoro

Common wuru mgbasa bụ a zuru nnọchi nke gbasara obi muscle ọrụ na gas mgbanwe ke akpa ume nke pụrụ iche n'ibu ngwá ọrụ na ngwaọrụ. Ọ na ọtụtụ-eji ịwa ahụ.

A na mpaghara ọbara a na-akpọ a akpan akpan ngwa ma ọ bụ ahu so. Ndị dị otú ahụ a usoro a na-eji ịme ịrịba ichekwa ọgwụ purulent ọrịa ma ọ bụ malignancy.

Regionarnoe cardiopulmonary uzo nhọrọ a na-eji maka obere arụmọrụ na obi jikọtara na kpachaara anya Mbelata ke ahu okpomọkụ (hypothermia). Ndị dị otú ahụ a usoro a na-akpọ akwara carotid perfusion.

atụmatụ ugbo ala

Modern obi-akpa ume igwe, nke bụ ụkpụrụ nke ime ihe ga-atụle n'okpuru, ga izute ndị na-esonụ chọrọ:

• na-akwado ndị chọrọ larịị nke nkeji olu nke ọbara na-aru nke onye ọrịa ahụ;
• qualitative oxygenation nke oxygen saturation ga-dị na a larịị na-erughị 95% na ego nke carbon dioxide - 35-45 mm HG. Nkeji edemede.;
• olu ndochi ngwa bụghị karịa 3 lita;
• ọnụnọ nke ngwaọrụ laghachi onye ọrịa ahụ ọbara na ọbara loop;
• ghara imerụ ọbara dị ka ọ na-agabiga bughi ọcha;
• ihe onwunwe nke na-eme usoro kwesịrị nontoxic ka rụrụ kụziere disinfection na nwoke ịga ụlọ ọgwụ.

ngwaọrụ

Ọ bụla akpa ume igwe agụnye n'ahụ (ọbara mgbapụta, oxygenator, ọbara loop) na a n'ibu unit. Anyụpụ ndidi venous ọbara abatakwa oxygenator, ebe ọ na enriched na oxygen na-adi-ọcha nke carbon dioxide, na n'ihu via a ọbara imipu ya azụ n'ime n'ọbara.

Tupu ọbara na-aga azụ, ọ na-agabiga pụrụ iche nzacha na kpọọ thrombi, ikuku egosipụta, calcium iberibe si valvụ usoro na site a okpomọkụ Exchanger na-akwado ihe ndị ha chọrọ okpomọkụ. Ọ bụrụ na ọbara na ahụ bụ na uji eze, ọ na-zitere na obi-akpa ume igwe na a pụrụ iche mgbapụta.

Isi ọcha

AIC nwere ndị na-esonụ bughi ọcha:

1. Oxygenators. E nwere usoro nke ọbara na enriched na oxygen site kpọmkwem kọntaktị, na e nwere ndị na ebe mmekọrịta emee site a pụrụ iche akpụkpọ ahụ.
2. Nfuli. Dị iche iche valvụ na valveless dabere n'ụzọ nke ije ọbara pụtara.
3. Okpomọkụ Exchanger. Ọ na-ekwusi okpomọkụ nke ọbara na aru nke onye ọrịa. Mgbazi nke okpomọkụ na-ewe ebe na mmiri nke washes ngwaọrụ.
4. Ọzọ ọnụ. Ndị a gụnyere afia, tankị maka na ịchekwa wepụrụ uji eze ma ọ bụ nkwado ndabere na mpaghara nke ọbara.
5. Mechanical unit. Ọ mejupụtara a ụlọ unit, na-akpụ akpụ akụkụ nke oxygenator, ngwa maka ịchọpụta ihe dị iche iche kwa, na mberede ntuziaka drive.

Heart-Lung Machine HL 20 - onye nke kasị mma ihe atụ. perfusion usoro na a na usoro osobo kasị elu ụkpụrụ na chọrọ. Ọ na-agwakọta nche na pụrụ ịdabere, mma data collection usoro, mgbanwe na ikike imeghari ka ọ bụla aghụghọ.

Nkwadebe na ngwaọrụ njikọ

Tupu were, jide n'aka na-elele readiness nke usoro na-arụ ọrụ. AIC (obi-akpa ume igwe) ga kpam kpam ọcha na Vol nke na-ebupụta nke na-kpọtụrụ na ọbara.

All bughi ọcha gụnyere ke n'ahụ unit, emeso ya na detergents ma ọ bụ a elu ịta nke alkalis na n'ihu saa na mmiri. Mgbe nwoke ịga ụlọ ọgwụ. Mgbe zuru nzukọ na ndochi ọbara usoro, ọ na jikọọ na ndidi na a akpan akpan na ogbo nke ọrụ.

Maka nloghachi ọbara ahụ na-esiwanye eji ohere site na femoral ma ọ bụ iliac akwara, mgbe ụfọdụ, site na-arịgo aorta. The ndu ọmụmụ abatakwa ngwaọrụ site na vena cava drained. Tupu ọbara abanye oxygenator onye ọrịa na-ndinọ heparin (2-3 mg kwa kilogram arọ ahụ). Na ndị ọrịa bụ ndị nchebe, ohere na ọbara usoro a rụrụ n'ihu venous catheterization.

Nkụnwụ na ná Nkụnwụ

The ojiji nke obi-akpa ume igwe arụmọrụ nwere ụfọdụ njirimara, otú ná Nkụnwụ na-ejide n'oge a bụ dị iche iche.

1. Multicomponent premedication.
2. The oge tupu perfusion achọ wuru ventilashion na elu nsogbu egosi na mmụọ nsọ na ume e kupụrụ ekupụ.
3. Na oge nke perfusion ọgwụ na-akụnwụ tinye ozu site na AIC. Eduzi ventilator e ji mụbaa nrụgide ume e kupụrụ ekupụ.
4. Na posleperfuzionnom oge weghachiri hemodynamics ka a ruo ogologo oge n'ibu ventilashion.

pathophysiology

Mgbe na-eji a obi-akpa ume igwe ahụ mmadụ n'okpuru ọhụrụ ọnọdụ. Ka ịzụlite enweghị nchịkwa Jeremaya mere kụziere perfusion ka retrograde ọbara na aorta, belata nsogbu na cavities nke obi, na enweghị ọrụ nke akpa ume mgbasa - ọnọdụ ndị na-adịghị ahụkarị ndị nkịtị ọnọdụ nke ahu.

N'oge aka nke a mmadụ na a ala nso hemorrhagic ujo. Ọ na-adị ẹsụhọde ọbara mgbali na ngụkọta elu eguzogide. N'okpuru nkịtị ọnọdụ, dị a mmeghachi omume na-atụle ga-echebe, ma na ọnọdụ nke ojiji nke AIC ya emetụtakarị nkịtị ọbara eruba mweghachi.

The pụta bụ mmepe nke hypoxia na metabolic acidosis ke iyịp. Prevention of nsogbu dabeere na mma nke microcirculation, mkpochapu onu nke na-echebe ọbara redistribution.

kwere omume nsogbu

Isi nsogbu bụ:

• vaskụla embolism nke ike-mere site a mkpọchi egbochi mkpụkọ nke ọbara, gas, lipid, calcium ahụ;
• hypoxia - nwere ike ime n'ihi na ezughi oke ọrụ oxygenator ma ọ bụ a ọbara mgbapụta site na nke ọbara ga-igba azụ n'ime ahu;
• hematological nsogbu - ọbara incompatibility n'etiti onye ọrịa ahụ na-enye onyinye nke ìgwè ma ọ bụ RH-akpata, a ọrịa ahụ mmeghachi omume nke infusion nke citrate ọbara traumatization nke mkpụrụ ndụ ọbara na a obi-akpa ume igwe, coagulation ọrịa.

Ekwentị mkpanaaka na-mgbe niile doro ndozi iji belata na o kwere omume nsogbu n'oge usoro. Modern ọhụrụ, nkà na ụzụ na ukwuu ruru eru ọgwụ otu - isi ihe na-aga nke ọma aka.