Kodi mulingo wa okosijeni m'magazi mwanu ndi wolondola? Tiyeni tiphunzire za mayeso a ABG (Arterial Blood Gas) m'njira yosavuta!

Tonsefe timadziwa kufunika kwa mpweya m'thupi lathu. Kupuma bwino komanso kukhala ndi mpweya wokwanira m'magazi ndikofunikira kuti tikhale ndi thanzi labwino. Chifukwa chake, nthawi zina madokotala amafunika kudziwa kuchuluka kwa mpweya ndi mpweya woipa m'magazi mwanu. Pamenepo ndiye mayeso otchedwa ABG (Arterial Blood Gas) amachitika.

Kodi mayeso a ABG (Arterial Blood Gas) awa ndi otani?

Mwachidule, mayeso a ABG (Arterial Blood Gas) ndi mayeso omwe amagwiritsa ntchito chitsanzo cha magazi chomwe chatengedwa kuchokera mumtsempha wanu kuti ayesere kuchuluka kwa mpweya ndi carbon dioxide m'magazi anu. Taganizirani izi, pali mitundu iwiri ya mitsempha yamagazi m'thupi lathu, umodzi ndi mitsempha, ndipo wina ndi mitsempha. Mitsempha imanyamula magazi oyera, okhala ndi mpweya wambiri kuchokera mumtima kupita ku thupi lonse. Chifukwa chake, pa mayeso a ABG awa, chitsanzo cha magazi chimatengedwa kuchokera mu mitsempha imeneyo.

Kuyesa kumeneku sikuti kumayesa mpweya ndi carbon dioxide yokha, komanso acid-base balance , kapena pH, ya magazi anu. Matupi athu nthawi zambiri amawongolera kuchuluka kwa mpweya ndi carbon dioxide m'magazi mwathu kwambiri. Ngati kuchuluka kwa mpweya m'magazi mwathu kwatsika (komwe timatcha kuti 'hypoxemia'), kungayambitse mavuto akulu kwambiri . Kungawononge ubongo wanu ndi mtima wanu makamaka.

Mayeso a ABG amathandiza madokotala kumvetsetsa matenda okhudzana ndi dongosolo lanu la kupuma , dongosolo la magazi , ndi kagayidwe kachakudya (momwe mumasinthira chakudya chomwe mumadya kukhala mphamvu). Izi ndizofunikira kwambiri pazochitika zadzidzidzi .

Pali mayeso ena otchedwa "kusanthula mpweya m'magazi." Mu mayeso awa, chitsanzo cha magazi chikhoza kutengedwa kuchokera kulikonse m'thupi (mtsempha, mtsempha, kapena capillary). Komabe, mu mayeso a ABG, magazi ayenera kutengedwa kuchokera m'mtsempha .

Mayeso a ABG awa ali ndi mayina ena angapo:

• Kuyesa mpweya wa magazi
• Mpweya wa m'magazi
• ABG
• Kusanthula mpweya wa magazi

Kodi mayeso a ABG amayesa chiyani kwenikweni?

Mayeso a ABG nthawi zambiri amayesa:

• Kuchuluka kwa mpweya m'magazi (O2CT) : Izi zimayesa kuchuluka kwa mpweya m'magazi mwanu.
• Hemoglobin : Hemoglobin ndi puloteni yomwe imapezeka m'maselo ofiira a magazi omwe amanyamula mpweya m'thupi lonse. Izi zimayesa kuchuluka kwa hemoglobin.
• Kuchuluka kwa mpweya m'magazi (O2Sat) : Izi zimayesa kuchuluka kwa mpweya womwe hemoglobini imanyamula m'magazi anu.
• Kupanikizika pang'ono kwa mpweya (PaO2) : Izi zimayesa kuthamanga kwa mpweya wosungunuka m'magazi mwanu. Zimasonyeza momwe mpweya umalowera m'magazi mwanu kuchokera m'mapapu mwanu.
• Kupanikizika pang'ono kwa kaboni diokiside (PaCO2): Izi zimayesa kuchuluka kwa kaboni diokiside m'magazi mwanu komanso momwe kaboni diokiside ikuchotsedwera m'thupi lanu.
• pH (`pH`) : Izi zimayesa mulingo pakati pa ma acid ndi ma base m'magazi anu. Kawirikawiri, pH ya magazi iyenera kukhala pakati pa 7.35 ndi 7.45. Chilichonse chochepera pamenepo chimaonedwa kuti ndi acidic kwambiri, ndipo chilichonse choposa pamenepo chimaonedwa kuti ndi chosavuta kapena cha alkaline .
• Bicarbonate (`Bicarbonate - HCO3`) : Izi zimawerengedwa pogwiritsa ntchito pH ndi PaCO2. Zimazindikira kuchuluka kwa mankhwala oyambira omwe amapangidwa kuchokera ku carbon dioxide.

Kodi mayeso a ABG amachitidwa liti?

Madokotala nthawi zambiri amalamula mayeso a ABG pazochitika ngati izi:

• Chithandizo chadzidzidzi : Izi zikutanthauza matenda kapena ngozi zomwe zimafuna chithandizo chamankhwala mwachangu.
• Anesthesiology : Gawo la zamankhwala lomwe limakhudza chisamaliro cha odwala opaleshoni isanachitike, panthawi yake, komanso pambuyo pake.
• Pulmonology : Gawo lomwe limakhudza matenda okhudzana ndi dongosolo lanu la kupuma.

Madokotala amagwiritsa ntchito mayeso a ABG kuti adziwe matenda osiyanasiyana, kuphatikizapo:

• Matenda otupa kupuma (ARDS) : Uwu ndi matenda oopsa m'mapapo omwe amachititsa kuti mpweya m'magazi ukhale wochepa kwambiri. Amatha kuchitika chifukwa cha matenda monga sepsis ndi COVID-19.
• Sepsis yoopsa : Sepsis ndi vuto lachipatala lomwe limayambitsa imfa chifukwa cha momwe thupi lanu limayankhira matenda.
• Kugwedezeka kwa magazi : Ichinso ndi vuto lomwe lingayambitse imfa lomwe limaika moyo pachiswe pamene kuthamanga kwa magazi kumatsika moopsa mutatenga matenda.
• Kugwedezeka kwa magazi m'thupi (Hypovolemic shock ): Matenda adzidzidzi omwe mtima umalephera kupopera magazi okwanira kupita m'thupi chifukwa cha kutaya magazi ambiri kapena kutayika kwa madzi ena.
• Matenda a shuga otchedwa ketoacidosis (DKA) : Ichi ndi vuto lalikulu komanso loopsa lomwe limakhudza anthu omwe ali ndi matenda a shuga (makamaka matenda a shuga amtundu woyamba) komanso matenda a shuga amtundu woyamba omwe sanadziwike. Amapangitsa kuti magazi akhale ndi asidi.
• Renal tubular acidosis (RTA) : Pa vutoli, impso zanu sizichotsa bwino ma acid m'magazi mwanu kupita nawo mumkodzo wanu, zomwe zimapangitsa kuti magazi anu akhale ndi asidi wambiri.
• Kulephera kupuma bwino : Izi zimachitika pamene madzi amasonkhana m'matumba a mpweya m'mapapo mwanu, zomwe zimapangitsa kuti mapapo azilephera kutulutsa mpweya m'magazi.
• Kulephera kwa mtima kwambiri: Uwu ndi mkhalidwe umene mtima umafooka mwadzidzidzi ndipo ntchito yake imakhala yochepa.
• Kulephera kwa mtima : Apa ndi pamene mtima wanu umasiya kugunda mwadzidzidzi.
• Kuukira kwa mphumu : Kuwonjezeka kwadzidzidzi kwa zizindikiro za mphumu chifukwa cha kulimba kwa minofu yozungulira njira zopumira.
• Zolakwika zobadwa nazo pa kagayidwe kachakudya : Izi ndi zinthu zachilendo, zomwe zimachitika chifukwa cha majini (zobadwa nazo) zomwe thupi lanu silingathe kusintha chakudya kukhala mphamvu moyenera.

Ngati muli ndi vuto lililonse la m'mapapo, dokotala wanu angachitenso mayeso a ABG kuti aone ngati chithandizo chanu chikugwira ntchito bwino:

• Mphumu
• Matenda osatha oletsa kupuma (COPD)
• Matenda a cystic fibrosis
• Matenda a mtima

Ndani amachita mayeso a ABG?

Katswiri wothandiza kupuma nthawi zambiri amatenga magazi kuti akayesedwe ndi ABG. Amatenga magazi kuchokera mumtsempha wamagazi womwe uli m'dzanja lanu, mkono, kapena khosi. Kenako amayesa okha magaziwo, kapena amawatumiza mwachangu kwambiri ku labotale, komwe asayansi ofufuza za matenda amayesa magaziwo.

Kodi chimachitika ndi chiyani musanachite mayeso a ABG?

Katswiri wothandiza kupuma asanatenge magazi m'dzanja lanu, akhoza kuchita mayeso oyendera magazi otchedwa mayeso a Allen . Izi zimaphatikizapo kukweza dzanja lanu mmwamba ndi dzanja lanu m'chibakera. Katswiriyo adzakanikiza mtsempha wamagazi womwe uli m'dzanja lanu kwa masekondi angapo. Mayeso osavuta awa amafufuza ngati mitsempha yonse ya m'dzanja lanu ikugwira ntchito bwino komanso yotseguka.

Ngati mukumwa mankhwala owonjezera a okosijeni, katswiri wanu wa opaleshoni angazimitse mpweya wanu pafupifupi mphindi 20 magazi asanayambe kutengedwa. Izi zimatchedwa mayeso a mpweya m'chipinda . Komabe, ngati simungathe kupuma popanda mpweya wowonjezera, sangachite mayesowa.

Kodi mumapeza chidziwitso chotani mukamachita mayeso a ABG?

Mayeso ambiri a magazi amatenga magazi kuchokera m'mitsempha yanu. Koma poyesa ABG, katswiri wothandiza kupuma amatenga magazi kuchokera m'mitsempha yanu. Izi zili choncho chifukwa magazi a m'mitsempha amakhala ndi mpweya wambiri kuposa magazi a m'mitsempha.

Katswiri wothandiza kupuma nthawi zambiri amatenga magazi kuchokera mu mtsempha wamkati wa dzanja lanu. Nthawi zina amathanso kutenga magazi kuchokera mu mtsempha wamkati mwa dzanja lanu (brachial artery) kapena groin (femoral artery).

Ngati mwana wakhanda akufunika kuyezetsa ABG, dokotala angatenge magazi kuchokera pachidendene cha mwana kapena chingwe cha umbilical.

Chofunika: Kutenga magazi kuchokera mumtsempha nthawi zambiri kumakhala kowawa pang'ono kuposa kutenga magazi kuchokera mumtsempha. Izi zili choncho chifukwa mitsempha imakhala mkati mwa thupi kuposa mitsempha, ndipo imakhala ndi mitsempha yozungulira. Mungamve chizungulire pang'ono, mutu wopepuka, kapena nseru magazi anu akatengedwa.

Nazi njira zomwe muyenera kutsatira poyesa magazi a ABG:

1. Mudzakhala pampando kapena mutagona pabedi. Katswiri wothandiza kupuma adzapeza mtsempha wamagazi, nthawi zambiri mkati mwa dzanja lanu. Angagwiritsenso ntchito ultrasound scan (`ultrasound imaging`) kuti apeze mtsempha wamagazi.

2. Mtsempha wamagazi ukapezeka, malowo amayeretsedwa ndi kutsukidwa ndi mankhwala ophera tizilombo toyambitsa matenda.

3. Kenako adzaika singano yaying'ono mumtsempha wanu wamagazi ndikuyesa magazi. Mungamve kupweteka kwambiri singano ikalowa mumtsempha.

4. Mukayika singano, magazi ochepa amasonkhanitsidwa mu sirinji.

5. Akatenga magazi okwanira kuti ayezedwe, adzachotsa singanoyo ndikuyika mphamvu pamalopo ndi thonje kapena gauze kuti magazi asiye kutuluka. Ngati mukumwa mankhwala ochepetsa magazi, mungafunike kuigwira kwa mphindi zisanu mpaka khumi kapena kuposerapo.

6. Amaika bandeji pamalopo. Kenako ntchitoyo yatha.

Kodi mungayembekezere chiyani mutamaliza mayeso a ABG?

Mungamve kupweteka ndi/kapena kuvulala komwe kunayikidwa singano. Dokotala wanu angakuuzeni kuti musanyamule chilichonse cholemera kwa maola 24 mutatenga magazi.

Kodi pali zoopsa zilizonse ndi mayeso a ABG?

Ngati katswiri wothandiza kupuma achita mayesowa molondola, mayeso a ABG ndi oopsa kwambiri . Mitsempha ya munthu aliyense ndi yosiyanasiyana kukula, ndipo imasiyana kuchokera mbali imodzi ya thupi kupita mbali ina. Chifukwa chake zingakhale zovuta pang'ono kutenga magazi kuchokera kwa anthu ena kuposa ena.

Zoopsa zokhudzana ndi kutenga magazi kuti akapimidwe ABG ndizochepa kwambiri, koma zinthu ngati izi zitha kuchitika:

• Kumva chizungulire kapena mutu wopepuka.
• Kufunika kuboola singano kangapo kuti mupeze mtsempha wamagazi.
• Kuundana kwa magazi (hematoma - kusonkhanitsa magazi pansi pa khungu).
• Kutuluka magazi kwambiri.
• Matenda (pali chiopsezo chochepa nthawi iliyonse khungu likasweka).

Kodi zimatenga nthawi yayitali bwanji kuti mupeze zotsatira za mayeso a ABG?

Mayeso a ABG nthawi zambiri amapereka zotsatira mwachangu kwambiri . Akatswiri ofufuza za kupuma ndi asayansi a labotale nthawi zambiri amagwiritsa ntchito zida zoyezera mpweya wamagazi zokha, zomwe zimatha kupereka zotsatira mkati mwa mphindi 10-15.

Kodi zotsatira za mayeso a ABG zikuti chiyani?

Malipoti oyezetsa magazi, kuphatikizapo malipoti oyezetsa magazi a ABG, nthawi zambiri amakhala ndi izi:

• Dzina la mayeso a magazi kapena zomwe zinayesedwa m'magazi anu.
• Chiwerengero kapena muyeso wa zotsatira za mayeso anu a magazi.
• Umenewo ndiye muyeso wabwinobwino wa mayeso.
• Chidziwitso chomwe chimasonyeza ngati zotsatira zanu ndi zabwinobwino, zachilendo, kapena zapamwamba kapena zochepa.

Ngati zotsatira za mayeso anu a ABG sizili bwino, zingatanthauze zinthu monga:

• Simukupeza mpweya wokwanira.
• Simukutulutsa mpweya wokwanira wa carbon dioxide.
• Magazi anu ali ndi pH yosalinganika (kaya ndi acidic kwambiri kapena alkaline kwambiri).

Kuyezetsa kwa ABG kungathandize kuzindikira matenda ena. Ngati zotsatira zanu sizili bwino, dokotala wanu angakupatseni mayeso ena (monga kuyezetsa magazi ndi/kapena kusanthula) kuti atsimikizire kapena kutsimikizira kuti matendawa ndi olondola.

Kodi mayeso a ABG ndi otani?

Kuchuluka kwa magazi m'thupi kumatha kusiyana pang'ono malinga ndi labu. Mukapeza zotsatira za mayeso anu a magazi, zidzaphatikizapo chidziwitso chomwe chikuwonetsa kuchuluka kwa magazi m'thupi pa muyeso uliwonse wochokera ku labu imeneyo. Ngati muli ndi mafunso okhudza zotsatira zanu, onetsetsani kuti mwafunsa dokotala wanu .

Kawirikawiri, avareji ya mlingo wa nyanja ndi motere:

• pH : 7.35-7.45
• Kupanikizika pang'ono kwa mpweya (`PaO2`) : 75 mpaka 100 mamilimita a mercury (mmHg)
• Kupanikizika pang'ono kwa carbon dioxide (`PaCO2`) : 35 mpaka 45 mmHg
• Bicarbonate (`HCO3`) : 22 mpaka 26 milliequivalents pa lita imodzi (mEq/L)
• Kuchuluka kwa mpweya (`O2Sat` kapena `SaO2`) : 95% mpaka 100%

Pamwamba pa mamita 900 ndi kupitirira apo, mpweya wapakati umakhala wotsika kwambiri.

Ndiyenera kupita liti kwa dokotala wanga?

Ngati muli ndi matenda aakulu a m'mapapo monga COPD kapena mphumu, mwina muyenera kupita kwa dokotala nthawi zonse ndikuyesedwa ABG kuti muwonetsetse kuti chithandizo chanu chikugwira ntchito bwino. Ngati mukupeza zizindikiro zilizonse zodetsa nkhawa zokhudzana ndi matenda anu a m'mapapo, lankhulani ndi dokotala wanu mwachangu momwe mungathere.

Pomaliza, zinthu zoti muzikumbukira

Kuyezetsa kwa ABG ndi chida chothandiza pozindikira matenda , makamaka pazochitika zina zadzidzidzi. Madokotala amagwiritsanso ntchito mayesowa poyang'anira matenda ena. Ngati mukuyesedwa kwa ABG, kumbukirani kuti ndi njira yosiyana pang'ono ndi kuyezetsa magazi nthawi zonse, ndipo ikhoza kukhala yopweteka pang'ono. Ngati muli ndi mafunso okhudza njira imeneyi kapena zomwe mungayembekezere, musazengereze kufunsa dokotala wanu . Ali pano kuti akuthandizeni.

Kuyesa mpweya wa m'magazi , mpweya wa m'magazi, mpweya wa okosijeni, mpweya wa carbon dioxide, pH, dongosolo lopumira, mayeso azachipatala