He tika te taumata hāora o tō toto? Kia ako tātou mō te whakamātautau ABG (Arterial Blood Gas) i roto i tētahi huarahi māmā!

E mōhio ana tātou katoa ki te hiranga o te hāora ki ō tātou tinana. He mea nui te manawa tika me te nui o te hāora i roto i te toto kia ora tonu ai. Nō reira, i ētahi wā me mōhio ngā tākuta ki te nui o te hāora me te hauhā waro i roto i ō toto. Ko te wā tēnā e mahia ai tēnei whakamātautau e kiia nei ko te ABG (Arterial Blood Gas).

He aha tēnei whakamātautau ABG (Hau Toto Arterial)?

I te whakarapopototanga, ko te whakamātautau ABG (Arterial Blood Gas) he whakamātautau e whakamahi ana i te tauira toto i tangohia mai i tō uaua hei ine i te nui o te hāora me te hauhā waro i roto i ō toto. Whakaarohia, e rua ngā momo uaua toto i roto i tō tātou tinana, ko tētahi ko ngā uaua toto, ko tētahi ko ngā uaua toto. Ka haria e ngā uaua toto te toto ma, whai hāora mai i te ngākau ki te toenga o te tinana. Nō reira, mō tēnei whakamātautau ABG, ka tangohia he tauira toto mai i aua uaua toto.

Ehara i te mea ko te hāora me te hauhā waro anake te mea e ine ana i tēnei whakamātautau, engari ko te taurite waikawa-pūtake , te pH rānei, o tō toto. Ko te tikanga, ka tino whakahaeretia e ō tātou tinana ngā taumata o te hāora me te hauhā waro i roto i ō tātou toto. Ki te heke te taumata hāora i roto i ō tātou toto (e kiia nei e tātou i roto i te rongoā ko te 'hypoxemia'), ka puta he raruraru tino kino . Ka taea e ia te kino i tō roro me tō ngākau.

Mā te whakamātautau ABG ka mārama ngā tākuta ki ngā mate e pā ana ki tō pūnaha manawa , tō pūnaha tohanga toto , me ngā tukanga pākia o te tinana (te huarahi e huri ai koe i te kai e kainga ana e koe hei pūngao). He mea nui rawa tēnei i ngā wā ohorere .

Tērā tētahi atu whakamātautau e kīia ana ko te "tātari hau toto". I roto i tēnei whakamātautau, ka taea te tango toto mai i ngā wāhi katoa o te tinana (he uaua toto, he uaua uaua, he uaua toto rānei). Heoi, i roto i te whakamātautau ABG, me tango toto mai i te uaua toto .

He maha atu anō ngā ingoa o tēnei whakamātautau ABG:

• Whakamātautau hau toto
• Ngā hau toto uaua
• ABG
• Te tātaritanga hau toto

He aha tonu te ine a te whakamātautau ABG?

Ko te whakamātautau ABG te tikanga e ine ana i:

• Te nui o te hāora (O2CT) : Mā tēnei ka ine i te nui o te hāora i roto i tō toto.
• Hemoglobin : Ko te hemoglobin he pūmua kei roto i ngā toto whero e kawe ana i te hāora puta noa i te tinana. Mā tēnei ka ine i te nui o te hemoglobin.
• Te mākū o te hāora (O2Sat) : Ka ine tēnei i te nui o te hāora e haria ana e te hemoglobin i roto i tō toto.
• Pēhanga wāhanga o te hāora (PaO2) : Ka ine tēnei i te pēhanga o te hāora kua rewa i roto i tō toto. Ka whakaatu i te pai o te urunga o te hāora ki roto i tō toto mai i ō pukahukahu.
• Te pēhanga wāhanga o te hauhā waro (PaCO2): Ka ine tēnei i te nui o te hauhā waro i roto i tō toto me te pai o te tangohanga o te hauhā waro mai i tō tinana.
• pH (`pH`) : Mā tēnei ka ine i te taurite i waenga i ngā waikawa me ngā kawakore i roto i ō toto. I te nuinga o te wā, me noho te pH o te toto i waenga i te 7.35 me te 7.45. Ki te iti iho i tēnā ka kiia he waikawa rawa, ā, ki te teitei ake i tēnā ka kiia he kawakore rawa, he kawakore rawa rānei.
• Paikāponate (`Paikāponate - HCO3`) : Ka tatauhia tēnei mā te whakamahi i te pH me te PaCO2. Ka whakatau i te nui o te matū turanga i hangaia mai i te hauhā waro.

Āhea te wā e mahia ai te whakamātautau ABG?

Ko te tikanga, ka tonoa e ngā tākuta he whakamātautau ABG i roto i ēnei take:

• Rongoā ohorere : E pā ana tēnei ki ngā mate, ki ngā aituā rānei e hiahia ana kia arohia wawetia e te rata.
• Anesthesiology : Te mara o te rongoā e pā ana ki te tiaki i ngā tūroro i mua, i te wā e pokanga ana, me muri i te pokanga.
• Pūkahukahu : Te mara e pā ana ki ngā mate e pā ana ki tō pūnaha manawa.

Ka whakamahia e ngā tākuta te whakamātautau ABG hei tātaritanga i ētahi āhuatanga, tae atu ki:

• Te mate manawa whakapeka (ARDS) : He mate pūkahukahu morearea tēnei e hua ai he iti rawa te taumata hāora i roto i te toto. Ka puta pea i ngā āhuatanga pēnei i te sepsis me te COVID-19.
• Sepsis kino : He āhuatanga ohorere hauora e morearea ana te Sepsis nā te urupare a tō tinana ki tētahi mate.
• Te ohorere o te toto : He āhuatanga morearea hoki tēnei ina tino heke te toto i muri i te mate.
• Te ohorere hypovolemic : He āhuatanga ohorere e kore ai e taea e te ngākau te pupuhi toto ki te tinana nā te nui o te toto e ngaro ana, te ngaronga rānei o ētahi atu wai.
• Te ketoacidosis e pā ana ki te mate huka (DKA) : He raruraru kino tēnei, he raruraru morearea ki te ora, e pā ana ki te hunga mate huka (ina koa te mate huka momo 1) me te mate huka momo 1 kāore anō kia tautuhia. Ka meinga te toto kia waikawa.
• Te waikawa ngongo whatukuhu (RTA) : I tēnei āhua, kāore ō whatukuhu e tango tika i ngā waikawa mai i ō toto ki roto i tō mimi, ka nui ake te waikawa o ō toto.
• Te ngoikore o te manawa whakapeka : Koinei te wā e kohia ai te wai i roto i ngā pēke hau i roto i ō pukahukahu, ka uaua ai te tuku hāora i roto i te toto.
• Te ngoikore o te ngākauHe āhuatanga tēnei e ngoikore whakarere ai te ngākau, ā, ka iti haere tana mahi.
• Te hopukanga o te manawa : Koinei te wā ka mutu ohorere te patu o tō manawa.
• Te whakaekenga o te mate huango : He pikinga ohorere o ngā tohumate mate huango i puta mai i te whakawhāititanga o ngā uaua huri noa i ngā ara manawa.
• Ngā hapa whānau o te pākia o te tinana : He āhuatanga onge ēnei, he āhuatanga ira (tuku iho) e kore ai e taea e te tinana te huri tika i te kai hei pūngao.

Mena kei a koe tētahi o ēnei mate pūkahukahu, ka whakahaerehia pea e tō tākuta he whakamātautau ABG hei tirotiro mēnā kei te pai te mahi a tō maimoatanga:

• Mate huango
• Te mate pūkahukahu ārai mau tonu (COPD)
• Te mate pukupuku kiriuhi
• Mate ngakau

Ko wai ka whakahaere i te whakamātautau ABG?

I te nuinga o te wā ka tangohia he toto e te kaiwhakaora manawa mō te whakamātautau ABG. Ka tangohia e rātou te toto mai i te uaua i roto i tō ringaringa, i tō ringaringa, i tō hope rānei. Kātahi ka whakamātautauhia e rātou te tauira toto, ka tukuna tere atu rānei ki te taiwhanga, ki reira ka whakamātautauhia ai te tauira e ngā kaipūtaiao taiwhanga hauora .

He aha ngā mea ka tupu i mua i te whakamātautau ABG?

I mua i te tango toto mai i tō ringaringa e te kaiwhakaora manawa, ka whakahaerehia pea e rātou he whakamātautau rere toto e kiia nei ko te whakamātautau Allen . Ko te tikanga o tēnei ko te pupuri i tō ringa ki runga me tō ringa i roto i te ringa. Ka pēhi te kaiwhakaora i te uaua i roto i tō ringaringa mō ētahi hēkona. Mā tēnei whakamātautau māmā ka tirohia mēnā kei te mahi tika ngā uaua e rua i roto i tō ringaringa, ā, kei te tuwhera hoki.

Mena kei te whiwhi koe i te hāora tāpiri, ka whakaweto pea tō kaiwhakaora i tō hāora i te 20 meneti i mua i te tango toto. Ka kiia tēnei he whakamātautau hau rūma . Heoi, ki te kore e taea e koe te manawa me te kore he hāora tāpiri, e kore rātou e mahi i tēnei whakamātautau.

He aha te momo wheako ka riro i a koe i te wā e mahi ana koe i te whakamātautau ABG?

Ko te nuinga o ngā whakamātautau toto ka tangohia te toto mai i tō uaua. Engari mō te whakamātautau ABG, ka tangohia e te kaiwhakaora manawa he tauira toto mai i tō uaua . Nā te mea he nui ake te nui o te hāora i roto i te toto uaua i te toto uaua.

I te nuinga o te wā ka tangohia e te kaiwhakaora manawa te toto mai i te uaua radial kei roto i tō ringaringa. I ētahi wā ka tangohia hoki e rātou te toto mai i te uaua i roto i tō ringa (te uaua brachial) te uaua rānei o te hope (te uaua femoral).

Mena me whakamātautau ABG te pēpi hou, ka tangohia pea e te tākuta he toto mai i te rekereke, i te pito rānei o te pēpi.

He mea nui: Ko te tango toto mai i te uaua he mea mamae ake i te tango toto mai i te uaua. Nā te mea he hohonu ake ngā uaua i roto i te tinana i ngā uaua, ā, he io kei te taha. Tērā pea ka pōuri koe, ka māuiui, ka whakapairuaki rānei ina tangohia ō toto.

Anei ngā mahi hei whai mā te tango toto mō te whakamātautau ABG:

1. Ka noho koe i runga i te tūru, ka takoto rānei i runga i te moenga. Ka kitea e te kaiwhakaora manawa he uaua, kei roto i tō ringaringa te nuinga. Tērā pea ka whakamahia e rātou he matawai ultrasound ('ultrasound imaging') hei kimi i te uaua.

2. Kia kitea te uaua, ka horoia te wāhi, ka patua hoki.

3. Kātahi ka werohia he ngira iti ki roto i tō uaua toto, ka tangohia he tauira toto. Tērā pea ka pāngia koe e te mamae nui i te wā e werohia ana te ngira ki roto i te uaua toto.

4. Whai muri i te werohanga o te ngira, ka kohia he iti o te toto ki roto i te ngira werohanga.

5. Kia oti te tango toto mō te whakamātautau, ka tangohia te ngira ka pēhia te wāhi ki te miro, ki te kākahu rānei hei whakamutu i te toto. Mena kei te tango koe i te rongoā whakaiti toto, me pupuri pea te pēhanga mō te rima ki te tekau meneti, neke atu rānei.

6. Ka tāpirihia he takai ki te wāhi. Kātahi ka oti te mahi.

He aha ngā mea ka taea e koe te tumanako i muri i te whakamātautau ABG?

Tērā pea ka pāngia koe e te marutanga me te mamae rānei i te wāhi i werohia ai te ngira. Tērā pea ka kī atu tō tākuta kia kaua e hiki i tētahi mea taumaha mō ngā haora 24 i muri i te tango toto.

He aha ngā mōrearea kei roto i te whakamātautau ABG?

Ki te tika te whakahaere a te kaiwhakaora manawa i tēnei whakamātautau, he iti rawa te mōrearea o te whakamātautau ABG. He rerekē te rahi o ngā uaua o ia tangata, ā, he rerekē i ia taha o te tinana ki tētahi taha. Nō reira, he uaua ake te tango toto mai i ētahi tāngata i ētahi atu.

He tino iti ngā mōrearea e pā ana ki te tango toto mō te whakamātautau ABG, engari ka taea ēnei mea te tupu:

• Te pōuriuri, te māhunga rānei.
• Me wero i te ngira kia maha ngā wā kia kitea ai te uaua.
• He toto totoka (he hematoma - he kohinga toto i raro i te kiri).
• Te toto nui rawa.
• Te mate urutā (he iti noa te mōrearea ina pakaru te kiri).

Kia pēhea te roa ka puta ngā hua o te whakamātautau ABG?

I te nuinga o te wā ka puta wawe ngā hua i roto i ngā whakamātautau ABG. Ko ngā kaiwhakaora manawa me ngā kaipūtaiao taiwhanga e whakamahi ana i ngā mīhini tātari hau toto aunoa, ka taea te whakaputa hua i roto i te 10-15 meneti.

He aha ngā kōrero a ngā hua o te whakamātautau ABG?

Ko ngā pūrongo whakamātautau toto, tae atu ki ngā pūrongo whakamātautau ABG, kei roto i ēnei mōhiohio e whai ake nei:

• Te ingoa o te whakamātautau toto, te mea rānei i inehia i roto i tō toto.
• Te tau, te ine rānei o ngā hua o tō whakamātautau toto.
• Koinei te awhe ine noa mō te whakamātautau.
• Ngā mōhiotanga e whakaatu ana mēnā he noa, he rerekē rānei tō hua, he teitei, he iti rānei.

Mena he rerekē ngā hua o tō whakamātautau ABG, tera pea ko ēnei te tikanga:

• Kāore e ranea ana te hāora e whiwhi ana koe.
• Kāore e ranea ana te hauhā waro e tukuna ana e koe.
• He kore taurite te pH o tō toto (he waikawa rawa, he kawakore rawa rānei).

Ka āwhina te whakamātautau ABG ki te tautuhi i ētahi mate. Mena he rerekē ō hua, ka tono pea tō tākuta i ētahi atu whakamātautau (pēnei i ētahi atu whakamātautau toto me/ranei ngā matawai) hei whakaū, hei whakakore rānei i te tautuhi.

He aha ngā uara noa mō te whakamātautau ABG?

Ka rerekē pea ngā awhe noa i ia taiwhanga ki ia taiwhanga. Ina whiwhi koe i ngā hua o tō whakamātautau toto, ka whakaurua he mōhiohio e whakaatu ana i ngā awhe noa mō ia inenga mai i taua taiwhanga. Mena he pātai āu mō ō hua, me pātai ki tō tākuta .

Ko te tikanga, ko ngā uara toharite i te taumata moana koia ēnei:

• pH : 7.35-7.45
• Pēhanga wāhanga o te hāora (`PaO2`) : 75 ki te 100 mirimita o te mercury (mmHg)
• Pēhanga wāhanga o te hauhā waro (`PaCO2`) : 35 ki te 45 mmHg
• Paikāponate (`HCO3`) : 22 ki te 26 milliequivalents ia rita (mEq/L)
• Te Mākū o te Hāora (`O2Sat`, `SaO2` rānei) : 95% ki te 100%

I ngā teitei o te 3,000 putu (900 mita) me runga ake, he iti iho te taumata hāora toharite.

Āhea ahau me toro atu ki taku tākuta?

Mena kei a koe tētahi mate pūkahukahu mau tonu pērā i te COPD, te mate huango rānei, me toro atu pea koe ki tō tākuta i ia wā, me whai whakamātautau ABG hoki kia mōhio ai kei te pai te mahi a tō maimoatanga. Mena ka puta he tohu āwangawanga e pā ana ki tō mate pūkahukahu, kōrero wawe tonu ki tō tākuta.

Hei whakamutunga, ngā mea hei maumahara

He taputapu tātaritanga whai hua te whakamātautau ABG, inā koa i ētahi āhuatanga ohorere. Ka whakamahia hoki e ngā tākuta tēnei whakamātautau hei aroturuki i ētahi āhuatanga hauora. Mena kei te whai whakamātautau ABG koe, kia maumahara he rerekē te tikanga i te whakamātautau toto noa, ā, ka nui ake te mamae. Mena he pātai āu mō te tikanga, he aha rānei ngā mea hei tumanako atu, kaua e mangere ki te pātai ki tō tākuta . Kei konei rātou hei āwhina i a koe.

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