Heart-Lung Machine: injongo siseko ukusebenza

Heart-Lung Machine - izixhobo zonyango ezizodwa olukwazi ngokunikela iinkqubo zabantu yobomi, ukuba intliziyo okanye imiphunga ayeke ngokupheleleyo okanye ngokuyinxenye izalisekise imisebenzi yayo. Kwabonakala Ingcamango ithuba ku tiva "ulondolozo imeko ephilileyo naliphi na ilungu lomzimba 'ngo-1812, kodwa ke isixhobo yokuqala abangekaphuhli, olu sapho lwaluquka mechanism zokumpompa igazi oxygenation, wabonakala kuphela ngo-1885.

Olu tyando lokuqala evulekileyo intliziyo apho umatshini intliziyo-lung wabandakanyeka, ebibanjwe ngo-1930. Ukususela ngoko, iindlela ezininzi ezingundoqo ezisetyenzisiweyo isicelo Aic: bypass cardiopulmonary ngokupheleleyo yonke ephilayo, a zommandla, apho ulwelo yendalo babonelelwa ilungu othile okanye indawo luye abangabancedani kwegazi.

iimpawu ubuchule

ejikeleza Common lokwenziwa uthatha ngokupheleleyo umsebenzi kwezihlunu ezesifuba exchange igesi nemiphunga izixhobo ezikhethekileyo ngoomatshini kunye nezixhobo. Isetyenziswa ngokubanzi kutyando intliziyo.

A ukuhamba kwegazi yommandla kuthiwa ilungu elithile okanye ingxenye yomzimba. Loo ndlela isetyenziswa ukwazisa ubeka imali ebonakalayo iziyobisi kusuleleko ubovu okanye yobubi.

Regionarnoe cardiopulmonary esa ukhetho sisetyenziselwa imisebenzi omfutshane entliziyweni kudityaniswe ekunciphiseni ngabom kwi lobushushu emzimbeni (emzimbeni). Loo nkqubo ibizwa coronary carotid perfusion.

izithuthi iimpawu

Modern umatshini intliziyo-lung, nto leyo ke siseko ukusebenza iya kuxoxwa ngezantsi, kufuneka anelise ezi mfuno zilandelayo:

• inkxaso kwinqanaba elifunekayo umthamo emfutshane ejikeleza igazi umzimba yesigulana;
• oxygenation esemgangathweni apho Ukwanda oxygen kufuneka zibekwe kwinqanaba hayi ngaphantsi kwe-95% yaye isixa-carbon dioxide - 35-45 mm HG. Inqaku.;
• volume ukuzaliswa izixhobo ayikho kweelitha ngaphezulu kwe-3;
• ubukho isixhobo ukubuyela igazi yomguli kwi loop kwegazi;
• akufuneki kwalimala igazi njengoko udlula izinto kwesakhiwo;
• ukwenza iindlela eziphathekayo kufuneka ubuthi ukuba kusiwa ukuqhuba kweentsholongwane kwaye nzala.

device

Nawuphi na umatshini lung iquka ukusebenza komzimba (pump esimbaxa, oxygenator, loop yegazi) kwaye iyunithi ngoomatshini. Idubule igazi nomonde lwemithambo ongena oxygenator, apho ahlanganiswe oksijini kungengokwentlambululo yendawo carbon dioxide, yaye ngakumbi kusetyenziswa igazi ukumpompa wayibuyisela umva egazini.

Phambi igazi liya umva, udlula okucoca ezizodwa ukuba capture thrombi, amaqamza, iziqwenga calcium evela kwinkqubo nokufakelwa ngokusebenzisa sokufudumeza exhasa amaqondo obushushu oyifunayo. Ukuba igazi umzimba em-, uthunyelwa kwi umatshini intliziyo-lung impompo okhethekileyo.

The main izinto

Aic unawo isakhiwo zilandelayo:

1. Oxygenators. Kukho iindlela apho igazi ahlanganiswe oksijini kukudibana ngqo, kwaye kukho abo apho kwenzeka khona intsebenziswano phakathi inwebu okhethekileyo.
2. Iimpompo. valve ezahlukeneyo kunye valveless kuxhomekeka ngendlela apho ukuhamba kwegazi kwenzeka.
3. Ubushushu umzimba. Likwalondoloza lobushushu igazi kunye umzimba umguli. Ukulungiswa lobushushu ithatha indawo amanzi ohlamba isixhobo.
4. nodes olongezelelweyo. Ezi ziquka izabatha, amatanki okugcina uzakususwa lweHo- okanye yogcino igazi.
5. unit Mechanical. Siqulathe uluhlu lwezindlu, iindawo uyivulele oxygenator, izixhobo zokubona parameters ezahlukeneyo, engxamisekileyo manual drive.

Heart-Lung Machine HL 20 - omnye weyona mizekelo kakhulu. inkqubo perfusion kule ndlela uyahlangabezana migangatho iphezulu kunye neemfuneko. Luhlanganisa ukhuseleko nokuthembeka, inkqubo ukuphuculwa ukuqokelelwa kwedatha, ukuthamba kunye nokukwazi ukumelana nayo nayiphi nokwenza izinto.

Ukulungiselela idivayisi uqhagamshelo

Phambi ukusetyenziswa, qiniseka ukuba ukujonga ukulungela sisixhobo ukusebenza. Aic (umatshini intliziyo-lung) kufuneka ukuhlambuluka ngokwenene inzalo ka imiphezulu leyo qhagamshelana ngqo igazi.

Zonke izinto kumaziko zifakiwe kwi-unit komzimba, aphathwe anesepha okanye xi eliphezulu alkalis kunye ngokuhlamba ngakumbi ngamanzi. Emva inzalo. Emva kwendibano epheleleyo kunye nokugcwaliswa kwinkqubo yegazi, elidityaniswe kuyo isigulana ngxexesha ethile yokusebenza.

Kuba ukubuya igazi emzimbeni ngokuya usebenzisa ufikelelo nge kwemithambo femoral okanye iliac, maxa wambi ngalo aorta inyuka. Kulwelo lomzimba ongena ifowuni ngokusebenzisa cava Vena mthombo. Phambi igazi ungena oxygenator kwisigulana ilawulwa lweeHedfowuni (2-3 mg kilogram ubunzima bomzimba ngalinye). Ukuba izigulane zikhuselekile, ufikelelo kwinkqubo esimbaxa lwenziwa phambi catheterization lwemithambo.

Ukubulawa and Ukubulawa

Ukusetyenziswa umatshini intliziyo-lung for Operations iimpawu ezithile, ngoko zomzimba kunye nokubamba ngeli xesha eyahlukileyo.

1. premedication Multicomponent.
2. Ixesha phambi kokuba perfusion ifuna umoya ngumntu zalathisi uxinzelelo ophezulu inkuthazo kunye nomphunga.
3. Xa ithuba iintlungu perfusion kungena emzimbeni nge Aic. Ukuqhuba le mpilo uphawuleka noxinzelelo zingumphunga.
4. Xa ixesha posleperfuzionnom wayibuyisela hemodynamics ezifuna yomatshini ixesha elide.

pathophysiology

Xa usebenzisa umatshini intliziyo-lung umzimba womntu phantsi kweemeko ezingaqhelekanga. Ngamana ukuphuhlisa Indlela zophendlo lwezifo ukuqhuba perfusion njengokuba retrograde igazi flow kwi aorta, kuncitshiswa uxinzelelo kwi nemingxuma zentliziyo, ukunqongophala umsebenzi zethala pulmonary - iimeko aziqhelekanga ukuba imeko eqhelekileyo umzimba.

Ngexesha ungenelelo yomntu sikwimo ekufutshane ukopha kukothuka. Kwenzeka uhle uxinzelelo lwegazi kunye nokumelana iyonke neuropathy. Kwiimeko eziqhelekileyo, ukusabela loo kuthathwa ukuba yokhuselo, kodwa iimeko ukusetyenziswa Aic uphazamisane eqhelekileyo ukuhamba kwegazi nokubuyiselwa.

Le nokulandelelana uphuhliso hypoxia kunye lactic pathways egazini. Uthintelo iingxaki isekelwe ukuphuculwa microcirculation, ukuphelisa lo mkhuba lezo komhlaba igazi.

iingxaki kunokwenzeka

Iingxaki eziphambili zezi:

• Embolism semithambo leyo ingabangelwa ukuvaleka amahlwili egazi, igesi, lipid, amasuntswana calcium;
• hypoxia - kunokwenzeka ngenxa yomsebenzi oxygenator ayoneli okanye pump igazi ngalo igazi kufuneka kungena emva umzimba;
• iingxaki hematological - igazi ukungavumelani phakathi isigulane kunye ngumnikeli leqela okanye RH into, omzimba wesigulane sokusabela nokuhlanganiswa citrate igazi traumatization leeseli gazi umatshini intliziyo-lung, ukuphazamiseka coagulation.

Iiselfowuni rhoqo phantsi ngcono ukunciphisa iingxaki kunokwenzeka ngexesha le nkqubo. ezintsha Modern, ubuchwepheshe kunye neqela lonyango abaqeqeshiweyo kakhulu - ngundoqo ungenelelo ngempumelelo.