Mwoyo-Lung Machine: chinangwa uye nhungamiro oparesheni

Mwoyo-Lung Machine - inokosha zvokurapa michina kuti anokwanisa kupa vanhu dzinotsanagura upenyu, kana mwoyo kana mapapu kurega zvachose kana zvishomanana kuzadzikisa mabasa ayo. Pfungwa mukana pakuziva "pakuchengetedza mupenyu mamiriro chero chikamu muviri" akazviratidza muna 1812, asi chokutanga mudziyo chinyakare, rwaiumbwa ropa kupomba mashandiro uye oxygenation, akaonekwa chete muna 1885.

Kuvhiya yokutanga rakazaruka mwoyo apo mwoyo-zvemapapu muchina zvaibatanidzwa, rakaitwa muna 1930. Kubvira ipapo, dzidziso nzira akawanda anoshandiswa kushanda AIC: Moyo yokunzvenga zvachose nhengo yose, imwe remunharaunda, sezvamakaropafadzwa chaivo mvura inopiwa imwe nhengo kana nzvimbo uye ebetsero kweropa zvakasiyana.

Features unyanzvi

Common chakagadzirwa kuparadzirwa anotsiva rakazara cardiac tsandanyama kushanda uye gasi mukutsinhana mumapapu chairo zvemaziso zvishandiso namano. Zvinonzi zvinowanzoshandiswa cardiac kuvhiyiwa.

A ropa kuyerera romunharaunda inonzi imwe nhengo kana muviri chikamu. Nzira yakadaro inoshandiswa kusuma zvinokosha rakawanda zvinodhaka kuti purulent hweHIV kana malignancy.

Regionarnoe Moyo yokunzvenga nzira inoshandiswa nokuda pfupi akavhiyiwa pamusoro mwoyo pamwe Mazvokuda zvinoderedza tembiricha muviri (hypothermia). mumwe muitiro kwakadaro anonzi coronary carotid perfusion.

Features motokari

Modern mwoyo-zvemapapu muchina, inova musimboti kushanda ichakurukurwa pazasi, vanofanira kusangana zvinotevera zvinodiwa:

• kutsigira zvaidiwa pamwero miniti Vhoriyamu kweropa mumuviri murwere;
• Qualitative oxygenation umo yakachena saturation inofanira riri pamwero usina asingasviki 95% uye uwandu carbon dioxide inobvisa - 35-45 mm HG. Article.
• Vhoriyamu zvekupfakira midziyo haasi kupfuura 3 litres;
• pamberi mudziyo kudzoka ropa murwere ari kweropa loop;
• dzirege kutadzira ropa parinopfuura kuburikidza STRUCTURAL zvinhu;
• zvinhu nokuita zvigadziriswe kunofanira hakuna zvinokuvadza kuti vakatakura kuitisa disinfection uye mbereko.

mudziyo

Chero zvemapapu muchina zvinosanganisira vasiri (arterial pombi, oxygenator, kweropa loop) uye zvokuimba chimwe. Yabudiswa murefu venous ropa anopinda oxygenator, apo kunowedzerwa pamwe okisijeni uye wokunatswa carbon dioxide, uye zvakare vachishandisa ropa kuchipomba shure kupinda muropa.

ropa risati odzokera, nepano anokosha filters kuti kubatwa thrombi, mhepo matema, karusiyamu zvidimbu kubva pavharuvhu hurongwa uye kuburikidza nekupisa exchanger inotsigira achida tembiricha. Kana ropa mumuviri uri mhango, zvakanyorwa akatuma mwoyo-zvemapapu muchina chaiwo pombi.

Huru zvinhu

AIC ane zvinotevera STRUCTURAL zvinhu:

1. Oxygenators. Pane nzira umo ropa kunowedzerwa pamwe okisijeni nenzira yakananga kuonana, uye pane avo apo kukurukurirana kunoitika kuburikidza rinokosha membrane.
2. Pumps. Siyana vharafu uye valveless zvichienderana mapiro kufamba ropa kunoitika.
3. Heat exchanger. It anoramba tembiricha ropa uye chitunha murwere. Nokururamiswa tembiricha kunoitika nemvura iyo anogeza mudziyo.
4. Zvimwe nodes. Izvi zvinosanganisira misungo, matangi kuchengeta abviswa mhango kana negadziriro yeparutivi ropa.
5. Zvokuimba chikwata. It rine dzimba Unit, iro zvinofamba zvikamu oxygenator, midziyo nokuti Pakusarudza parameters siyana, kuti zvashata Chinyorwa tikachirega.

Heart-Lung Machine HL 20 - mumwe mienzaniso yakanakisisa. perfusion wemuTesitamende mashandiro ichi asangana chikuru mitemo uye zvinodiwa. Chine kuchengeteka uye kuvimbika, nani mashoko muunganidzwa hurongwa, mukana wokushandiswa uye kukwanisa kuchinja upi evanhu.

Kugadzirira uye mudziyo kubatanidza

Asati kushandiswa, iva nechokwadi kuti kutarisa unoda mashandiro kubasa. AIC (mwoyo-zvemapapu machine) anofanira kuva nemhedziso kuchena uye kusabereka pamusoro hukawanika izvo zvakananga kutaura neropa.

Vose STRUCTURAL okunze dziri vasiri Unit, kubatwa detergents kana refu Kuwanda alkalis mimwe Washing nemvura. After mbereko. Mushure ungano zvakakwana uye kuzadza ropa gadziriro, hwakabatana murwere paneimwewo pavaipfuura oparesheni.

Nokuti kudzoka ropa kusvikira muviri kuramba vachishandisa mukana nomukombiyuta femoral kana iliac tsinga, dzimwe nguva achishandisa vachikwira yeropa. The chaivo mvura anopinda mudziyo kuburikidza vena cava vakapedzwa. Pamberi ropa kupinda oxygenator murwere chinotarisirwa heparin (2-3 MG pa kilogram muviri uremu). Kuti varwere vane ngozi, kuwana arterial gadziriro rinoitwa pamberi venous catheterization.

Yokutindivadza uye yokutindivadza

Kushandiswa mwoyo-zvemapapu muchini akavhiyiwa ane zvimwe zvinhu, saka yokutindivadza uye vakabata panguva ino yakasiyana.

1. Multicomponent premedication.
2. Nguva isati perfusion zvinoda chakagadzirwa kufefetedza dzakakwirira kumanikidzwa zviratidzi pamusoro kufuridzirwa uye nedzinovengwa.
3. Munguva perfusion dzokutindivadza kupinda muviri vachishandisa AIC. Kuitisa ventilator kunoratidzwa yakawedzera kuomesa pamusoro nedzinovengwa.
4. In posleperfuzionnom nguva akadzorera hemodynamics yaida refu zvokuimba kufefetedza.

pathophysiology

Kana uchishandisa mwoyo-zvemapapu muchina Muviri womunhu pasi kujairika ezvinhu. Zvingamuka pathological siyana kuti kuitisa perfusion sezvo retrograde ropa riyerere munzira yeropa, akaderedza kumanikidza ari in mwoyo, kushaya basa pulmonary riparadzirwe - ezvinhu kuti havasi kwese kuti chakaipa mamiriro muviri.

Panguva Kupindira munhu ari ezvinhu pedyo Hemorrhagic kuvhunduka. It rikauya BP uye zvachose peripheral nemishonga. Under kwomuzvarirwo ezvinhu akadai maitiro anoonekwa kuti unodzivirira, asi mamiriro ezvinhu kushandiswa AIC izvozvo kuzvirega zvichikanganisa zvakajairika ropa chokubuda kudzorerwa.

Mugumisiro uri kukura hypoxia uye metabolic acidosis muropa. Kudzivirira yematambudziko inobva kuvandudzika pakati microcirculation, kubviswa pakati Chiitiko rimwe runodzivirira ropa redistribution.

zvinogoneka yematambudziko

Huru yematambudziko ndiwo:

• vascular embolism izvo zvinogona kukonzerwa imwe blockage rimwe clots ropa, gasi, lipid, karusiyamu nezvimedu;
• hypoxia - zvingaitika nokuda kukwana basa oxygenator kana pombi ropa kuburikidza iro ropa anofanira iyerere kunyika muviri;
• hematological yematambudziko - ropa kusapindirana pakati murwere uye nomupi neboka kana kusapindirana kweropa chinhu, mumwe murwere muviri pavakanzwa aizomupa citrate ropa traumatization masero eropa mumwoyo-zvemapapu muchina, coagulation zvirwere.

Phones vanogara pasi kunatsiridza kuderedza zvichibvira yematambudziko munguva nzira. Modern utsanzi, ano uye chikwata zvikuru vanonyatsokwanisa zvokurapa - kiyi vanobudirira kupindira.