Ingabe izinga lakho le-oxygen egazini lilungile? Ake sifunde ngokuhlolwa kwe-ABG (Arterial Blood Gas) ngendlela elula!

Sonke siyazi ukuthi umoya-mpilo ubaluleke kangakanani emizimbeni yethu. Ukuphefumula kahle nokuba nenani elifanele lomoya-mpilo egazini kubalulekile ukuze uhlale uphilile. Ngakho-ke, ngezinye izikhathi odokotela kudingeka bazi kahle ukuthi ingakanani i-oxygen ne-carbon dioxide egazini lakho. Yilapho-ke kwenziwa khona lokhu kuhlolwa okubizwa ngokuthi i-ABG (Arterial Blood Gas).

Iyini le ABG (Arterial Blood Gas) test?

Kalula nje, ukuhlolwa kwe-ABG (Arterial Blood Gas) ukuhlolwa okusebenzisa isampula yegazi ethathwe emthanjeni wakho ukuze kulinganiswe inani le-oxygen kanye ne-carbon dioxide egazini lakho. Cabanga ngakho, kunezinhlobo ezimbili zemithambo yegazi emzimbeni wethu, enye yimithambo yegazi, kanti enye yimithambo yegazi. Imithambo yegazi ithwala igazi elihlanzekile, elinomoya-mpilo elivela enhliziyweni liye emzimbeni wonke. Ngakho-ke, kulokhu kuhlolwa kwe-ABG, kuthathwa isampula yegazi kuleyo mithambo yegazi.

Lokhu kuhlolwa akugcini nje ngokulinganisa umoya-mpilo kanye ne-carbon dioxide, kodwa futhi nokulinganisela kwe-acid-base , noma i-pH, yegazi lakho. Imizimba yethu ivame ukulawula amazinga omoya-mpilo kanye ne-carbon dioxide egazini lethu eduze kakhulu. Uma izinga lomoya-mpilo egazini lethu lehla (esilibiza ngokuthi 'i-hypoxemia' ngokwezokwelapha), kungabangela izinkinga ezinkulu kakhulu . Kungalimaza ubuchopho bakho kanye nenhliziyo yakho ikakhulukazi.

Ukuhlolwa kwe-ABG kusiza odokotela baqonde izifo ezihlobene nohlelo lwakho lokuphefumula , uhlelo lokujikeleza kwegazi , kanye nezinqubo ze-metabolic (indlela oguqula ngayo ukudla okudlayo kube amandla). Lokhu kubaluleke kakhulu ezimweni eziphuthumayo .

Kukhona olunye uhlolo olubizwa ngokuthi "ukuhlaziywa kwegesi yegazi." Kulolu hlolo, isampula yegazi ingathathwa noma kuphi emzimbeni (umthambo, umthambo, noma i-capillary). Kodwa-ke, ekuhlolweni kwe-ABG, igazi kumele lithathwe emthanjeni .

Lolu vivinyo lwe-ABG lunamagama amaningana:

• Ukuhlolwa kwegesi yegazi
• Amagesi egazi emithanjeni
• I-ABG
• Ukuhlaziywa kwegesi yegazi

Yini ngempela elinganiswa ukuhlolwa kwe-ABG?

Ukuhlolwa kwe-ABG kuvame ukukala:

• Okuqukethwe komoya-mpilo (O2CT) : Lokhu kulinganisa ukuthi ingakanani i-oxygen egazini lakho.
• I-Hemoglobin : I-Hemoglobin iyiprotheni etholakala emangqamuzaneni ethu abomvu egazi ethwala umoya-mpilo kuwo wonke umzimba. Lokhu kulinganisa inani le-hemoglobin.
• Ukugcwala komoya-mpilo (O2Sat) : Lokhu kulinganisa ukuthi ingakanani i-oxygen ethwalwa yi-hemoglobin egazini lakho.
• Ukucindezela okuyingxenye komoya-mpilo (i-PaO2) : Lokhu kulinganisa ukucindezela komoya-mpilo oncibilikisiwe egazini lakho. Kubonisa ukuthi umoya-mpilo ungena kahle kangakanani egazini lakho usuka emaphashini akho.
• Ukucindezela okuyingxenye kwe-carbon dioxide (PaCO2): Lokhu kulinganisa inani le-carbon dioxide egazini lakho nokuthi i-carbon dioxide isuswa kahle kangakanani emzimbeni wakho.
• i-pH (`pH`) : Lokhu kulinganisa ibhalansi phakathi kwama-asidi nezisekelo egazini lakho. Ngokuvamile, i -pH yegazi kufanele ibe phakathi kuka-7.35 no-7.45. Noma yini engaphansi kwalokho ibhekwa njenge-asidi kakhulu, futhi noma yini ephakeme kunalokho ibhekwa njengeyisisekelo kakhulu noma i-alkaline .
• I-Bicarbonate (`I-Bicarbonate - HCO3`) : Lokhu kubalwa kusetshenziswa i-pH ne-PaCO2. Kunquma inani le-base compound eyakhiwe nge-carbon dioxide.

Ukuhlolwa kwe-ABG kwenziwa nini?

Odokotela bavame uku-oda ukuhlolwa kwe-ABG ezimweni ezinjengalezi:

• Umuthi ophuthumayo : Lokhu kubhekisela ezifweni noma ezingozini ezidinga ukunakekelwa kwezokwelapha ngokushesha.
• I-Anesthesiology : Umkhakha wezokwelapha ophathelene nokunakekelwa kweziguli ngaphambi, ngesikhathi, nangemva kokuhlinzwa.
• I-Pulmonology : Insimu ebhekene nezifo ezihlobene nohlelo lwakho lokuphefumula.

Odokotela basebenzisa isivivinyo se-ABG ukuthola izimo eziningana, okuhlanganisa:

• I-Acute respiratory distress syndrome (ARDS) : Lesi yisimo samaphaphu esisongela ukuphila esibangela izinga eliphansi kakhulu lomoya-mpilo egazini. Singabangelwa yizimo ezifana ne-sepsis kanye ne-COVID-19.
• I-sepsis enzima : I-Sepsis iyisimo esiphuthumayo sezokwelapha esisongela ukuphila esibangelwa ukusabela komzimba wakho ekuthelelekeni.
• Ukushaqeka kwe-Septic : Lesi futhi yisimo esisongela impilo lapho umfutho wegazi wakho wehla khona ngendlela eyingozi ngemva kokutheleleka.
• Ukushaqeka kwe-Hypovolemic : Isimo esiphuthumayo lapho inhliziyo ingakwazi ukupompa igazi elanele emzimbeni ngenxa yokulahlekelwa igazi eliningi noma ukulahlekelwa olunye uketshezi.
• I-ketoacidosis ehlobene nesifo sikashukela (i-DKA) : Lesi yinkinga enkulu, esongela ukuphila ethinta abantu abanesifo sikashukela (ikakhulukazi isifo sikashukela sohlobo 1) kanye nesifo sikashukela sohlobo 1 esingatholakalanga. Sibangela ukuba igazi libe ne-asidi.
• I-Renal tubular acidosis (RTA) : Kulesi simo, izinso zakho azisusi kahle ama-acid egazini lakho ziwayise emchameni wakho, okwenza igazi lakho libe ne-acid eyengeziwe.
• Ukwehluleka okukhulu kokuphefumula : Lokhu kwenzeka lapho uketshezi luqoqana emasakeni omoya emaphashini akho, okwenza kube nzima ngamaphaphu ukukhipha umoya-mpilo egazini.
• Ukwehluleka kwenhliziyo okukhulu: Lesi yisimo lapho inhliziyo iba buthaka khona ngokuzumayo futhi ukusebenza kwayo kulinganiselwe.
• Ukuma kwenhliziyo : Yilapho inhliziyo yakho iyeka ukushaya ngokuzumayo.
• Ukuhlaselwa yi-asthma : Ukwanda okungazelelwe kwezimpawu ze-asthma okubangelwa ukuqina kwemisipha ezungeze izindlela zokuphefumula.
• Amaphutha okuzalwa nawo emetabolism : Lezi yizimo ezingavamile, ezibangelwa izakhi zofuzo (ezizuzwe njengefa) lapho umzimba wakho ungakwazi ukuguqula ukudla kube amandla ngendlela efanele.

Uma unezinye zalezi zimo zamaphaphu, udokotela wakho angase enze nokuhlolwa kwe-ABG ukuze abone ukuthi ukwelashwa kwakho kusebenza kahle yini:

• Isifuba somoya
• Isifo samaphaphu esingamahlalakhona (i-COPD)
• I-cystic fibrosis
• Isifo senhliziyo

Ubani owenza ukuhlolwa kwe-ABG?

Udokotela wezifo zokuphefumula uvame ukuthatha igazi ukuze lihlolwe i-ABG. Uthatha igazi emthanjeni osesihlakaleni sakho, engalweni, noma esinqeni. Bese behlola isampula yegazi ngokwabo, noma balithumele ngokushesha kakhulu elabhorethri, lapho ososayensi belabhorethri yezokwelapha behlola khona isampula.

Kwenzekani ngaphambi kokuhlolwa kwe-ABG?

Ngaphambi kokuba umelaphi wokuphefumula athathe igazi esihlakaleni sakho, angenza ukuhlolwa kokugeleza kwegazi okubizwa ngokuthi ukuhlolwa kwe-Allen . Lokhu kuhilela ukuphakamisa ingalo yakho ngesandla sakho esinqeni. Umelaphi uzocindezela umthambo osesihlakaleni sakho imizuzwana embalwa. Lokhu kuhlolwa okulula kuhlola ukuthi imithambo yomibili esihlakaleni sakho isebenza kahle futhi ivulekile.

Uma usebenzisa ukwelashwa komoya-mpilo okwengeziwe, umelaphi wakho angase avale umoya-mpilo wakho cishe imizuzu engama-20 ngaphambi kokukhipha igazi. Lokhu kubizwa ngokuthi ukuhlolwa komoya wegumbi . Kodwa-ke, uma ungakwazi ukuphefumula ngaphandle komoya-mpilo owengeziwe, ngeke bakwenze lokhu kuhlolwa.

Hlobo luni lwesipiliyoni olutholayo lapho wenza isivivinyo se-ABG?

Ukuhlolwa kwegazi okuningi kuthatha igazi emithanjeni yakho. Kodwa ekuhlolweni kwe-ABG, umelaphi wokuphefumula uthatha isampula yegazi emithanjeni yakho. Lokhu kungenxa yokuthi igazi emithanjeni line-oxygen ephezulu kunegazi emithanjeni.

Udokotela wezifo zokuphefumula uvame ukuthatha igazi emthanjeni ongaphakathi kwengalo yakho. Ngezinye izikhathi angase athathe igazi emthanjeni ongalweni yakho (umthambo we-brachial) noma embotsheni (umthambo we-femoral).

Uma umntwana osanda kuzalwa edinga ukuhlolwa kwe-ABG, udokotela angase athathe igazi esithendeni noma enkabeni yengane.

Okubalulekile: Ukuthatha igazi emthanjeni ngokuvamile kungaba buhlungu kakhulu kunokuthatha igazi emthanjeni. Lokhu kungenxa yokuthi imithambo ijule kakhulu emzimbeni kunemithambo, futhi inezinzwa ezizungezile. Ungase uzizwe unesiyezi, unesizungu, noma unesicanucanu lapho igazi lakho lithathwa.

Nazi izinyathelo okufanele uzilandele lapho uthatha igazi ukuze uhlolwe i-ABG:

1. Uzohlala esihlalweni noma ulele embhedeni. Udokotela wezifo zokuphefumula uzothola umthambo, ngokuvamile ngaphakathi kwesandla sakho. Bangase basebenzise ne-ultrasound scan (`i-ultrasound imaging`) ukuthola umthambo.

2. Uma umthambo usutholakele, indawo iyahlanzwa futhi ihlanzwe ngamagciwane.

3. Ngemuva kwalokho bazofaka inalithi encane emthanjeni wakho bese bethatha isampula yegazi. Ungase uzwe ubuhlungu obukhulu njengoba inalithi ingena emthanjeni.

4. Ngemva kokufaka inaliti, inani elincane legazi liqoqwa lifakwe kwisirinji.

5. Ngemva kokuthatha igazi elanele lokuhlolwa, bazosusa inaliti bese befaka ingcindezi endaweni ngekotoni noma i-gauze ukuze bamise ukopha. Uma uthatha umuthi wokunciphisa igazi, kungadingeka ukuthi ubambe ingcindezi imizuzu emihlanu kuya kweyishumi noma ngaphezulu.

6. Bafaka ibhandishi endaweni. Bese umsebenzi usuqedile.

Yini ongayilindela ngemva kokuhlolwa kwe-ABG?

Ungase uzizwe ubomvu noma ubuhlungu lapho inaliti ifakwe khona. Udokotela wakho angakutshela ukuthi ungaphakamisi lutho olusindayo amahora angama-24 ngemva kokukhipha igazi.

Ingabe zikhona izingozi ngokuhlolwa kwe-ABG?

Uma umelaphi wokuphefumula enza lokhu kuhlolwa ngendlela efanele, ukuhlolwa kwe-ABG kuyingozi encane kakhulu . Imithambo yegazi yawo wonke umuntu inobukhulu obuhlukile, futhi iyahlukahluka kusuka kolunye uhlangothi lomzimba kuya kolunye. Ngakho kungaba nzima kancane ukukhipha igazi kwabanye abantu kunabanye.

Izingozi ezihlobene nokukhishwa kwegazi ukuze kuhlolwe i-ABG ziphansi kakhulu, kodwa izinto ezinjengalezi zingenzeka:

• Ukuzizwa unesizungu noma unekhanda elibuhlungu.
• Kudingeka ngibhoboze inaliti izikhathi eziningana ukuze ngithole umthambo.
• Ihlule legazi (i-hematoma - iqoqo legazi ngaphansi kwesikhumba).
• Ukopha ngokweqile.
• Ukutheleleka (kunengozi encane noma nini lapho isikhumba siphukile).

Kuthatha isikhathi esingakanani ukuthola imiphumela yokuhlolwa kwe-ABG?

Ukuhlolwa kwe-ABG kuvame ukunikeza imiphumela ngokushesha okukhulu . Abelaphi bokuphefumula kanye nososayensi belebhu bavame ukusebenzisa izihlaziyi zegesi yegazi ezenzakalelayo, ezinganikeza imiphumela zingakapheli imizuzu eyi-10-15.

Ithini imiphumela yokuhlolwa kwe-ABG?

Imibiko yokuhlolwa kwegazi, okuhlanganisa nemibiko yokuhlolwa kwe-ABG, ngokuvamile iqukethe ulwazi olulandelayo:

• Igama lokuhlolwa kwegazi noma lokho okulinganiswe egazini lakho.
• Inombolo noma isilinganiso somphumela wokuhlolwa kwegazi lakho.
• Lelo ibanga lokulinganisa elijwayelekile lokuhlolwa.
• Ulwazi olukhombisa ukuthi umphumela wakho ujwayelekile, awujwayelekile, noma uphezulu noma uphansi.

Uma imiphumela yakho yokuhlolwa kwe-ABG ingajwayelekile, kungasho izinto ezifana nalezi:

• Awutholi umoya-mpilo owanele.
• Awukhiphi umoya owanele we-carbon dioxide.
• Igazi lakho linokungalingani kwe-pH (kungaba yi-acid kakhulu noma i-alkaline kakhulu).

Ukuhlolwa kwe-ABG kungasiza ekuxilongeni izifo ezithile. Uma imiphumela yakho ingajwayelekile, udokotela wakho angase acele ukuhlolwa okwengeziwe (njengokunye ukuhlolwa kwegazi kanye/noma ukuskena) ukuqinisekisa noma ukukhipha ukuxilongwa.

Yiziphi izindinganiso ezijwayelekile zokuhlolwa kwe-ABG?

Amabanga ajwayelekile angahluka kancane kusukela elabhorethri kuya kwelebhu. Uma uthola imiphumela yakho yokuhlolwa kwegazi, izofaka ulwazi olukhombisa ukuthi amabanga ajwayelekile ayini ngesilinganiso ngasinye esivela kulelo labhorethri. Uma unemibuzo mayelana nemiphumela yakho, qiniseka ukuthi ubuza udokotela wakho .

Ngokuvamile, amanani ajwayelekile ezingeni lolwandle angokulandelayo:

• i-pH : 7.35-7.45
• Ukucindezela okuyingxenye kwe-oxygen (`PaO2`) : amamilimitha angu-75 kuya kwangu-100 e-mercury (mmHg)
• Ingcindezi engaphelele ye-carbon dioxide (`PaCO2`) : 35 kuya ku-45 mmHg
• I-Bicarbonate (`HCO3`) : 22 kuya ku-26 milliequivalents ngelitha (mEq/L)
• Ukugcwala kwe-oksijini (`O2Sat` noma `SaO2`) : 95% kuya ku-100%

Ezindaweni eziphakeme ngamafidi angu-3,000 (amamitha angu-900) nangaphezulu, amazinga ajwayelekile omoya-mpilo aphansi kakhulu.

Kufanele ngimbone nini udokotela wami?

Uma unesifo samaphaphu esingamahlalakhona njenge-COPD noma i-asthma, cishe kuzodingeka ubone udokotela wakho njalo futhi wenze izivivinyo ze-ABG ukuqinisekisa ukuthi ukwelashwa kwakho kusebenza kahle. Uma uthola noma yiziphi izimpawu ezikhathazayo ezihlobene nesifo samaphaphu akho, khuluma nodokotela wakho ngokushesha okukhulu.

Okokugcina, izinto okufanele uzikhumbule

Ukuhlolwa kwe-ABG kuyithuluzi eliwusizo lokuxilonga , ikakhulukazi kwezinye izimo eziphuthumayo. Odokotela basebenzisa futhi lokhu kuhlolwa ukuqapha izimo ezithile zempilo. Uma uhlolwa i-ABG, khumbula ukuthi inqubo ehluke kancane kunokuhlolwa kwegazi okuvamile, futhi ingaba buhlungu kancane. Uma unemibuzo mayelana nenqubo noma ukuthi yini ongayilindela, ungangabazi ukubuza udokotela wakho . Balapha ukuzokusiza.

Ukuhlolwa kwegesi yegazi , igesi yegazi emithanjeni yegazi, umoya-mpilo, i-carbon dioxide, inani le-pH, uhlelo lokuphefumula, ukuhlolwa kwezokwelapha