Ingaba inqanaba le-oksijini egazini lakho lichanekile? Masifunde ngovavanyo lwe-ABG (Arterial Blood Gas) ngendlela elula!

Sonke siyazi ukuba ioksijini ibaluleke kangakanani emizimbeni yethu. Ukuphefumla ngokufanelekileyo nokuba nomlinganiselo ofanelekileyo weoksijini egazini kubalulekile ukuze uhlale usempilweni. Ngoko ke, ngamanye amaxesha oogqirha kufuneka bazi ukuba ingakanani na ioksijini kunye nekhabhoni dayokhsayidi egazini lakho. Kulapho olu vavanyo lubizwa ngokuba yi-ABG (Arterial Blood Gas) lwenziwa khona.

Yintoni le ABG (Arterial Blood Gas) uvavanyo?

Ngamafutshane, uvavanyo lwe-ABG (Arterial Blood Gas) luvavanyo olusebenzisa isampuli yegazi ethathwe kumthambo wakho ukuze kulinganiswe ubungakanani beoksijini kunye nekhabhoni dayoksayidi egazini lakho. Cinga ngako, kukho iintlobo ezimbini zemithambo yegazi emzimbeni wethu, enye yimithambo yegazi, kwaye enye yimithambo yegazi. Imithambo yegazi ithwala igazi elicocekileyo, elineoksijini eninzi lisuka entliziyweni liye emzimbeni wonke. Ngoko ke, kolu vavanyo lwe-ABG, kuthathwa isampuli yegazi kuloo mithambo yegazi.

Olu vavanyo alulinganisi nje kuphela ioksijini kunye nekhabhoni diokside, kodwa lukwalinganisa nebhalansi ye-asidi-base , okanye i-pH, yegazi lakho. Imizimba yethu idla ngokulawula amanqanaba eoksijini kunye nekhabhoni diokside egazini lethu ngokusondeleyo. Ukuba amanqanaba eoksijini egazini lethu ehla (esiyibiza ngokuba yi-'hypoxemia' ngokwezonyango), inokubangela iingxaki ezinkulu kakhulu . Ingonakalisa ingqondo yakho kunye nentliziyo yakho ngokukodwa.

Uvavanyo lwe-ABG lunceda oogqirha baqonde izifo ezinxulumene nenkqubo yakho yokuphefumla , inkqubo yokujikeleza kwegazi , kunye neenkqubo ze-metabolic (indlela oguqula ngayo ukutya okutyayo kube ngamandla). Oku kubaluleke kakhulu kwiimeko zikaxakeka .

Kukho olunye uvavanyo olubizwa ngokuba "luhlalutyo lwegesi yegazi." Kolu vavanyo, isampuli yegazi ingathathwa naphi na emzimbeni (umthambo, umthambo, okanye i-capillary). Nangona kunjalo, kuvavanyo lwe-ABG, igazi kufuneka lithathwe kumthambo .

Olu vavanyo lwe-ABG lunamagama amaninzi:

• Uvavanyo lwegesi yegazi
• Iigesi zegazi ezikwimithambo yegazi
• I-ABG
• Uhlalutyo lwegesi yegazi

Yintoni kanye kanye elinganiswa luvavanyo lwe-ABG?

Uvavanyo lwe-ABG ludla ngokulinganisa:

• Umthamo weoksijini (O2CT) : Oku kulinganisa ukuba ingakanani ioksijini egazini lakho.
• IHemoglobin : IHemoglobin yiproteni efumaneka kwiiseli zethu ezibomvu zegazi ethwala ioksijini emzimbeni wonke. Oku kulinganisa ubungakanani behemoglobin.
• Ukwanda kweoksijini (O2Sat) : Oku kulinganisa ukuba ingakanani ioksijini ethwalwa yi-hemoglobin egazini lakho.
• Uxinzelelo oluyinxenye lweoksijini (PaO2) : Oku kulinganisa uxinzelelo lweoksijini enyibilikisiweyo egazini lakho. Kubonisa indlela ioksijini engena ngayo egazini lakho isuka kwimiphunga yakho.
• Uxinzelelo oluncinci lwekhabhoni diokside (PaCO2): Oku kulinganisa ubungakanani bekhabhoni diokside egazini lakho kunye nokuba ikhabhoni diokside isuswa kakuhle kangakanani emzimbeni wakho.
• i-pH (`pH`) : Oku kulinganisa ibhalansi phakathi kwee-asidi kunye nee-bases egazini lakho. Ngokwesiqhelo, i -pH yegazi kufuneka ibe phakathi kwe-7.35 kunye ne-7.45. Nantoni na engaphantsi koko ithathwa njenge-asidi kakhulu, kwaye nantoni na ephezulu kunaleyo ithathwa njengesisiseko kakhulu okanye i-alkaline .
• I-Bicarbonate (`I-Bicarbonate - HCO3`) : Oku kubalwa kusetyenziswa i-pH kunye ne-PaCO2. Imisela ubungakanani bekhompawundi esisiseko eyenziwe nge-carbon dioxide.

Luqhutywa nini uvavanyo lwe-ABG?

Oogqirha badla ngokuyalela uvavanyo lwe-ABG kwiimeko ezifana nezi:

• Amayeza angxamisekileyo : Oku kubhekisa kwizifo okanye iingozi ezifuna unyango olukhawulezileyo.
• I-Anesthesiology : Isebe lezonyango elijongene nokunyamekela izigulana ngaphambi, ngexesha, nasemva kotyando.
• I-Pulmonology : Intsimi ejongene nezifo ezinxulumene nenkqubo yakho yokuphefumla.

Oogqirha basebenzisa uvavanyo lwe-ABG ukuxilonga iimeko ezininzi, kuquka:

• I-Acute Respiratory Distress Syndrome (ARDS) : Le yimeko yemiphunga esongela ubomi ebangela ukuba i-oxygen ibe sezantsi egazini. Inokubangelwa zizifo ezifana ne-sepsis kunye ne-COVID-19.
• I-sepsis enzulu : I-Sepsis yimeko engxamisekileyo yezonyango esongela ubomi ebangelwa yindlela umzimba wakho osabela ngayo kwisifo.
• Ukothuka kweSeptic : Le yimeko esongela ubomi apho uxinzelelo lwakho lwegazi luyehla ngokuyingozi emva kosulelo.
• Uxinzelelo lwe-Hypovolemic : Yimeko engxamisekileyo apho intliziyo ingakwaziyo ukupompa igazi elaneleyo emzimbeni ngenxa yokulahlekelwa ligazi elininzi okanye ukulahleka kwezinye izinto ezilulwelo.
• I-ketoacidosis enxulumene nesifo seswekile (i-DKA) : Le yingxaki enkulu, esongela ubomi echaphazela abantu abanesifo seswekile (ingakumbi isifo seswekile sohlobo loku-1) kunye nesifo seswekile sohlobo loku-1 esingafunyaniswanga. Ibangela ukuba igazi libe ne-asidi.
• I-Renal tubular acidosis (RTA) : Kule meko, izintso zakho azizisusi ngokufanelekileyo ii-acid egazini lakho ziye kumchamo wakho, nto leyo ebangela ukuba igazi lakho libe ne-acid eninzi.
• Ukusilela okukhulu kokuphefumla : Oku kwenzeka xa ulwelo luqokelelana kwiingxowa zomoya ezikwimiphunga yakho, nto leyo eyenza kube nzima ukuba imiphunga ikhuphe ioksijini egazini.
• Ukusilela kwentliziyo okukhawulezileyo: Le yimeko apho intliziyo ibuthathaka ngequbuliso kwaye umsebenzi wayo ulinganiselwe.
• Ukubanjwa yintliziyo : Kulapho intliziyo yakho iyeka ukubetha ngequbuliso.
• Uhlaselo lwe-asthma : Ukwanda ngequbuliso kweempawu ze-asthma okubangelwa kukuqina kwemisipha ejikeleze iindlela zomoya.
• Iimpazamo zokuzalwa kwimetabolism : Ezi ziimeko ezingaqhelekanga, ezibangelwa yimfuza (ezizuzwe njengelifa) apho umzimba wakho ungakwazi ukuguqula ukutya kube ngamandla ngokufanelekileyo.

Ukuba unayo nayiphi na kwezi meko zemiphunga, ugqirha wakho angenza uvavanyo lwe-ABG ukuze abone ukuba unyango lwakho lusebenza kakuhle na:

• Isifuba
• Isifo semiphunga esingapheliyo (i-COPD)
• Icystic fibrosis
• Isifo sentliziyo

Ngubani owenza uvavanyo lwe-ABG?

Ingcali yokuphefumla idla ngokuthatha igazi ukuze livavanywe i-ABG. Bathatha igazi kumthambo osesihlahleni sakho, engalweni, okanye emqolo. Emva koko bavavanya isampuli yegazi ngokwabo, okanye bayithumele ngokukhawuleza kwilabhoratri, apho izazinzulu zelabhoratri zonyango zivavanya isampuli.

Kwenzeka ntoni ngaphambi kovavanyo lwe-ABG?

Ngaphambi kokuba ingcali yokuphefumla ithathe igazi esihlahleni sakho, ingenza uvavanyo lokuhamba kwegazi olubizwa ngokuba luvavanyo lwe-Allen . Oku kuquka ukubamba ingalo yakho phezulu ngesandla sakho sibambe inqindi. Ingcali yokuphefumla iza kucinezela umthambo osesihlahleni sakho imizuzwana embalwa. Olu vavanyo lulula lujonga ukuba zombini imithambo esesihlahleni sakho isebenza kakuhle kwaye ivulekile na.

Ukuba usebenzisa unyango lwe-oksijini eyongezelelweyo, ugqirha wakho unokuwucima umoya wakho malunga nemizuzu engama-20 ngaphambi kokuba kutsalwe igazi. Oku kubizwa ngokuba luvavanyo lomoya wegumbi . Nangona kunjalo, ukuba awukwazi ukuphefumla ngaphandle kwe-oksijini eyongezelelweyo, abayi kulwenza olu vavanyo.

Luhlobo luni lwamava olufumanayo xa usenza uvavanyo lwe-ABG?

Uninzi lovavanyo lwegazi luthatha igazi kwimithambo yakho. Kodwa kuvavanyo lwe-ABG, ingcali yokuphefumla ithatha isampuli yegazi kwimithambo yakho yegazi . Oku kungenxa yokuba igazi lemithambo yegazi linomxholo ophezulu weoksijini kunegazi lemithambo yegazi.

Ingcali yokuphefumla idla ngokuthatha igazi kwi-radial artery engaphakathi esihlahleni sakho. Ngamanye amaxesha isenokuthatha igazi kwi-artery engalweni yakho (brachial artery) okanye kwi-groin (femoral artery).

Ukuba usana olusandul’ ukuzalwa lufuna uvavanyo lwe-ABG, ugqirha unokuthatha igazi esithendeni somntwana okanye kwi-umbilical cord.

Kubalulekile: Ukuthatha igazi kumthambo womthambo kudla ngokuba buhlungu ngakumbi kunokuthatha igazi kumthambo womthambo. Oku kungenxa yokuba imithambo yomthambo inzulu emzimbeni kunemithambo yomthambo, kwaye inemithambo yomthambo ejikelezileyo. Usenokuziva unesiyezi, unesizungu, okanye unesicaphucaphu xa igazi lakho lithathwa.

Nazi iindlela ekufuneka zilandelwe xa uthatha igazi ukuze wenze uvavanyo lwe-ABG:

1. Uza kuhlala esitulweni okanye ulele ebhedini. Ingcali yokuphefumla iza kufumana umthambo, odla ngokuba ngaphakathi esihlahleni sakho. Basenokusebenzisa i-ultrasound scan (`i-ultrasound imaging`) ukufumana umthambo.

2. Nje ukuba umthambo ufunyenwe, indawo iyacocwa ize ibulawe iintsholongwane.

3. Emva koko baza kufaka inaliti encinci kumthambo wakho wegazi baze bathathe isampuli yegazi. Usenokuva intlungu ebukhali njengoko inaliti ingena kumthambo.

4. Emva kokufaka inaliti, igazi elincinci liqokelelwa kwisirinji.

5. Emva kokuba bethathe igazi elaneleyo lovavanyo, baza kususa inaliti baze bafake uxinzelelo kuloo ndawo ngekotoni okanye i-gauze ukunqanda ukopha. Ukuba uthatha amayeza okunciphisa igazi, kunokufuneka ubambe uxinzelelo imizuzu emihlanu ukuya kwelishumi okanye ngaphezulu.

6. Bafaka ibhandishi kwindawo leyo. Emva koko umsebenzi ugqityiwe.

Yintoni onokuyilindela emva kovavanyo lwe-ABG?

Usenokuziva unamanxeba athile kunye/okanye ubuhlungu apho inaliti ifakwe khona. Ugqirha wakho angakuxelela ukuba ungaphakamisi nto inzima kangangeeyure ezingama-24 emva kokutsalwa kwegazi.

Ngaba kukho naziphi na iingozi ngovavanyo lwe-ABG?

Ukuba ingcali yokuphefumla yenza olu vavanyo ngokuchanekileyo, uvavanyo lwe-ABG lunomngcipheko omncinci kakhulu . Imithambo yegazi yomntu wonke yahlukile ngobukhulu, kwaye iyahluka ukusuka kwelinye icala lomzimba ukuya kwelinye. Ngoko ke kunokuba nzima kancinci ukutsala igazi kwabanye abantu kunabanye.

Iingozi ezinxulumene nokutsalwa kwegazi xa kusenziwa uvavanyo lwe-ABG ziphantsi kakhulu, kodwa izinto ezinje ngezi zinokwenzeka:

• Ukuziva unesizungu okanye unesizungu.
• Kuza kufuneka ndibhoboze inaliti izihlandlo ezininzi ukuze ndifumane umthambo.
• Ihlwili legazi (i-hematoma - ingqokelela yegazi phantsi kolusu).
• Ukopha kakhulu.
• Usulelo (kukho umngcipheko omncinci nanini na xa ulusu luphukile).

Kuthatha ixesha elingakanani ukufumana iziphumo zovavanyo lwe-ABG?

Uvavanyo lwe-ABG ludla ngokunika iziphumo ngokukhawuleza kakhulu . Iingcali zokuphefumla kunye neengcali zesayensi yelabhoratri zihlala zisebenzisa ii-analyzer zegesi yegazi ezenzekelayo, ezinokunika iziphumo kwimizuzu eli-10-15.

Zithini iziphumo zovavanyo lwe-ABG?

Iingxelo zovavanyo lwegazi, kuquka neengxelo zovavanyo lwe-ABG, zihlala ziqulathe olu lwazi lulandelayo:

• Igama lovavanyo lwegazi okanye oko kwalinganiswa egazini lakho.
• Inani okanye umlinganiselo weziphumo zovavanyo lwakho lwegazi.
• Lelo linqanaba eliqhelekileyo lokulinganisa uvavanyo.
• Ulwazi olubonisa ukuba iziphumo zakho ziqhelekile, aziqhelekanga, okanye ziphezulu okanye ziphantsi.

Ukuba iziphumo zakho zovavanyo lwe-ABG aziqhelekanga, oko kunokuthetha izinto ezifana nezi:

• Awufumani ioksijini eyaneleyo.
• Awukhuphi umoya owaneleyo kwi-carbon dioxide.
• Igazi lakho linokungalingani kwe-pH (nokuba yi-acid eninzi okanye i-alkaline eninzi).

Uvavanyo lwe-ABG lunokunceda ekuxilongeni izifo ezithile. Ukuba iziphumo zakho aziqhelekanga, ugqirha wakho unokuyalela ezinye iimvavanyo (ezifana nolunye uvavanyo lwegazi kunye/okanye iiskeni) ukuqinisekisa okanye ukuthintela ukuxilongwa.

Zithini ixabiso eliqhelekileyo lovavanyo lwe-ABG?

Amanqanaba aqhelekileyo anokwahluka kancinci kwilabhoratri nganye. Xa ufumana iziphumo zovavanyo lwegazi, ziya kubandakanya ulwazi olubonisa ukuba zithini amanqanaba aqhelekileyo okulinganisa ngakunye kuloo labhoratri. Ukuba unemibuzo malunga neziphumo zakho, qiniseka ukuba ubuza ugqirha wakho .

Ngokubanzi, amaxabiso aphakathi kwinqanaba lolwandle ngala alandelayo:

• i-pH : 7.35-7.45
• Uxinzelelo olungaphelelanga lweoksijini (`PaO2`) : 75 ukuya kwi-100 millimeters yemercury (mmHg)
• Uxinzelelo oluyinxenye lwekhabhoni dayokhsayidi (`PaCO2`) : 35 ukuya kuma-45 mmHg
• I-Bicarbonate (`HCO3`) : 22 ukuya kwi-26 milliequivalents ngelitha (mEq/L)
• Ukwanda kweOksijini (`O2Sat` okanye `SaO2`) : 95% ukuya kwi-100%

Kwindawo ephakamileyo yeemitha ezingama-900 nangaphezulu, amanqanaba aphakathi eoksijini aphantsi kakhulu.

Ndifanele ndimbone nini ugqirha wam?

Ukuba unesifo semiphunga esinganyangekiyo njenge-COPD okanye i-asthma, kuya kufuneka ubone ugqirha wakho rhoqo kwaye wenze uvavanyo lwe-ABG ukuqinisekisa ukuba unyango lwakho lusebenza kakuhle. Ukuba ufumana naziphi na iimpawu ezixhalabisayo ezinxulumene nesifo sakho semiphunga, thetha nogqirha wakho ngokukhawuleza.

Okokugqibela, izinto ekufuneka uzikhumbule

Uvavanyo lwe-ABG sisixhobo esiluncedo sokuxilonga , ingakumbi kwiimeko ezithile ezingxamisekileyo. Oogqirha basebenzisa olu vavanyo ukujonga iimeko ezithile zempilo. Ukuba wenza uvavanyo lwe-ABG, khumbula ukuba luyinkqubo eyahlukileyo kancinci kunovavanyo lwegazi oluqhelekileyo, kwaye lunokuba buhlungu ngakumbi. Ukuba unemibuzo malunga nenkqubo okanye into onokuyilindela, ungathandabuzi ukubuza ugqirha wakho . Balapha ukukunceda.

Uvavanyo lwegesi yegazi , igesi yegazi emithanjeni yegazi, ioksijini, ikharbon diokside, ixabiso le-pH, inkqubo yokuphefumla, uvavanyo lwezonyango