Ua hana ʻia ka oximeter pulse tip fingertip e Millikan i nā makahiki 1940 e nānā i ka nui o ka oxygen i loko o ke koko arterial, kahi hōʻailona koʻikoʻi o ke koʻikoʻi o COVID-19.ʻO Yonker i kēia manawa e wehewehe ana pehea e hana ai ka fingertip pulse oximeter?
ʻO nā ʻano omo spectral o nā ʻiʻo olaola: Ke hoʻomālamalama ʻia ka mālamalama i nā ʻiʻo olaola, hiki ke hoʻokaʻawale ʻia ka hopena o nā ʻiʻo olaola ma ka mālamalama i ʻehā mau ʻāpana, me ka omo ʻana, ka hoʻopuehu ʻana, ka noʻonoʻo ʻana a me ka fluorescence. Inā ʻaʻole i hoʻokaʻawale ʻia ka hoʻopuehu ʻana, ʻo ka mamao e hele ai ka mālamalama ma o nā ʻiʻo olaola e hoʻomalu nui ʻia e ka omo ʻana. Ke komo ka mālamalama i kekahi mau mea moakaka (paʻa, wai a kinoea paha), e emi nui ana ka ikaika o ke kukui ma muli o ka omo ʻana i kuhikuhi ʻia o kekahi mau ʻāpana alapine kikoʻī, ʻo ia ka hanana omo o ka mālamalama e nā mea. ʻO ka nui o ka mālamalama a kahi mea e omo ai ua kapa ʻia ʻo kona optical density, i ʻike ʻia hoʻi ʻo absorbance.
ʻO ke kiʻikuhi schematic o ka omo ʻana o ka mālamalama e ka mea i ke kaʻina holoʻokoʻa o ka hoʻolaha ʻana o ka mālamalama, ʻo ka nui o ka ikehu mālamalama i omo ʻia e ka mea e pili ana i ʻekolu mau mea, ʻo ia ka ikaika o ka mālamalama, ka mamao o ke ala mālamalama a me ka helu o nā ʻāpana omo kukui ma ka ʻāpana kea o ke ala mālamalama. Ma ke kumu o ka mea homogeneous, hiki ke manaʻo ʻia ka helu o nā ʻāpana omo kukui ma ke ʻāpana kea he mau ʻāpana omo kukui no kēlā me kēia anakahi leo, ʻo ia hoʻi ka nui o nā ʻāpana kukui omo mea, hiki ke loaʻa i ke kānāwai o Lambert Beer: hiki ke unuhi ʻia e like me ka nui o nā mea a me ka lōʻihi o ke ala optical no kēlā me kēia anakahi leo o ka optical density, hiki i ka mālamalama omo mea ke pane i ke ʻano o ka mālamalama omo mea. I nā huaʻōlelo ʻē aʻe, ua like ke ʻano o ke kiʻikuhi omo o ka mea like, a e loli wale ke kūlana piha o ka piko omo ma muli o ka ʻokoʻa o ka noʻonoʻo, akā e mau ana ke kūlana pili. I ke kaʻina omo, hana ʻia ka omo ʻana o nā mea a pau i ka nui o ka ʻāpana like, a ʻaʻohe pili o nā mea omo kekahi i kekahi, ʻaʻohe hui fluorescent, a ʻaʻohe hanana o ka hoʻololi ʻana i nā waiwai o ka medium ma muli o ka radiation kukui. No laila, no ka hopena me nā ʻāpana omo N, he mea hoʻohui ka nui o ka optical. Hāʻawi ka hoʻohui o ka nui o ka optical i kahi kumu kumumanaʻo no ke ana ʻana o nā ʻāpana omo i nā hui ʻana.
I loko o nā ʻano optics o nā ʻiʻo olaola, ʻo ka ʻāpana spectral o 600 ~ 1300nm ka mea i kapa pinepine ʻia ʻo "ka puka makani o ka spectroscopy olaola", a ʻo ke kukui i loko o kēia kāʻei he mea nui ia no nā ʻano lapaʻau spectral i ʻike ʻia a ʻike ʻole ʻia a me ka hōʻailona spectral. I loko o ka ʻāpana infrared, lilo ka wai i mea hoʻomehana kukui nui i loko o nā ʻiʻo olaola, no laila pono e pale ka nalu i lawe ʻia e ka ʻōnaehana i ka piko o ka wai i mea e loaʻa ai ka ʻike omo kukui o ka mea i manaʻo ʻia. No laila, i loko o ka laulā spectrum kokoke-infrared o 600-950nm, ʻo nā ʻāpana nui o ka ʻiʻo manamana lima kanaka me ka hiki ke omo kukui e komo pū me ka wai i loko o ke koko, O2Hb (hemoglobin oxygenated), RHb (hemoglobin hoʻemi ʻia) a me ka melanin ʻili peripheral a me nā ʻiʻo ʻē aʻe.
No laila, hiki iā mākou ke loaʻa ka ʻike kūpono o ka nui o ka ʻāpana e ana ʻia i loko o ka ʻiʻo ma o ka nānā ʻana i ka ʻikepili o ka spectrum hoʻokuʻu. No laila ke loaʻa iā mākou nā nui O2Hb a me RHb, ʻike mākou i ka saturation oxygen.ʻO ka saturation oxygen SpO2ʻo ia ka pakeneka o ka nui o ka hemoglobin oxygenated i hoʻopaʻa ʻia me ka oxygen (HbO2) i loko o ke koko ma ke ʻano he pakeneka o ka hemoglobin paʻa holoʻokoʻa (Hb), ka nui o ka pulse oxygen koko no laila no ke aha i kapa ʻia ai he pulse oximeter? Eia kahi manaʻo hou: ka nui o ke kahe koko pulse wave. I loko o kēlā me kēia pōʻaiapuni cardiac, ʻo ka ʻūlū ʻana o ka puʻuwai ke kumu o ka piʻi ʻana o ke koko i loko o nā kīʻaha koko o ke aʻa aortic, kahi e hoʻonui ai i ka paia o ke kīʻaha koko. I ka ʻaoʻao ʻē aʻe, ʻo ka diastole o ka puʻuwai ke kumu o ka hāʻule ʻana o ke koko i loko o nā kīʻaha koko o ke aʻa aortic, kahi e ʻūlū ai ka paia o ke kīʻaha koko. Me ka hana hou ʻana o ke pōʻaiapuni cardiac, ʻo ka loli mau o ke koko i loko o nā kīʻaha koko o ke aʻa aortic e hoʻouna ʻia i nā kīʻaha ma lalo e pili ana me ia a hiki i ka ʻōnaehana arterial holoʻokoʻa, a laila e hana ana i ka hoʻonui mau a me ka ʻūlū ʻana o ka paia vascular arterial holoʻokoʻa. ʻO ia hoʻi, ʻo ka hahau manawa o ka puʻuwai e hana i nā nalu pulse i loko o ka aorta e ripple i mua ma nā paia o ke kīʻaha koko ma o ka ʻōnaehana arterial. I kēlā me kēia manawa e hoʻonui a ʻūlū ai ka puʻuwai, ʻo ka loli o ke kaomi i loko o ka ʻōnaehana arterial e hana i kahi nalu pulse manawa. ʻO kēia ka mea a mākou e kapa nei he nalu pulse. Hiki i ka nalu pulse ke hōʻike i nā ʻike physiological he nui e like me ka puʻuwai, ke koko a me ke kahe ʻana o ke koko, hiki ke hāʻawi i ka ʻike koʻikoʻi no ka ʻike ʻole ʻana i nā ʻano kino kikoʻī o ke kino o ke kanaka.
I ka lāʻau lapaʻau, ua māhele pinepine ʻia ka nalu pulse i ʻelua ʻano o ka nalu pulse kaomi a me ka nalu pulse leo. Hōʻike nui ka nalu pulse kaomi i ka hoʻoili ʻana o ke koko, ʻoiai ʻo ka nalu pulse leo e hōʻike ana i nā loli manawa i ke kahe koko. Ke hoʻohālikelike ʻia me ka nalu pulse kaomi, loaʻa i ka nalu pulse volumetric ka ʻike cardiovascular koʻikoʻi e like me nā kīʻaha koko kanaka a me ke kahe koko. Hiki ke hoʻokō ʻia ka ʻike ʻole invasive o ka nalu pulse leo kahe koko maʻamau e ka photoelectric volumetric pulse wave tracing. Hoʻohana ʻia kahi nalu kukui kikoʻī e hoʻomālamalama i ka ʻāpana ana o ke kino, a hiki ke kukuna i ka sensor photoelectric ma hope o ka noʻonoʻo ʻana a i ʻole ka hoʻoili ʻana. E lawe ka kukuna i loaʻa i ka ʻike ʻano kūpono o ka nalu pulse volumetric. No ka mea, loli pinepine ka nui o ke koko me ka hoʻonui ʻana a me ka ʻūlū ʻana o ka puʻuwai, i ka wā e diastole ai ka puʻuwai, ʻo ka liʻiliʻi loa ka nui o ke koko, ʻo ka omo ʻana o ke koko o ke kukui, ʻike ka sensor i ka ikaika kukui kiʻekiʻe loa; Ke ʻūlū ka puʻuwai, ʻo ka nui ka nui a ʻo ka ikaika kukui i ʻike ʻia e ka sensor ka liʻiliʻi loa. I ka ʻike ʻole invasive o nā manamana lima me ka nalu pulse leo kahe koko e like me ka ʻikepili ana pololei, pono e hahai ke koho ʻana o kahi ana spectral i nā loina aʻe.
1. Pono e nui aʻe nā aa koko o nā kīʻaha koko, a pono e hoʻomaikaʻi ʻia ka hapa o ka ʻike kūpono e like me ka hemoglobin a me ICG i ka ʻike mea holoʻokoʻa ma ka spectrum
2. Loaʻa iā ia nā ʻano maopopo o ka loli o ke kahe koko e hōʻiliʻili pono i ka hōʻailona nalu pulse leo
3. I mea e loaʻa ai ke ʻano o ke kanaka me ka hana hou ʻana a me ke kūpaʻa maikaʻi, ʻaʻole i hoʻopilikia nui ʻia nā ʻano o nā ʻiʻo e nā ʻokoʻa o kēlā me kēia kanaka.
4. He maʻalahi ke hana i ka ʻike spectral, a maʻalahi hoʻi e ʻae ʻia e ke kumuhana, i mea e pale aku ai i nā mea hoʻopilikia e like me ka wikiwiki o ka puʻuwai a me ka neʻe ʻana o ke kūlana ana i hoʻokumu ʻia e ka manaʻo kaumaha.
Kiʻikuhi kiʻikuhi o ka hoʻolaha ʻana o nā kīʻaha koko ma ka lima kanaka ʻAʻole hiki i ke kūlana o ka lima ke ʻike i ka nalu pulse, no laila ʻaʻole kūpono ia no ka ʻike ʻana i ka nalu pulse o ke kahe koko; Aia ka pulima kokoke i ke aʻa radial, ikaika ka hōʻailona nalu pulse kaomi, maʻalahi ka ʻili e hana i ka haʻalulu mechanical, hiki ke alakaʻi i ka hōʻailona ʻike ma waho aʻe o ka nalu pulse nui e lawe pū ana i ka ʻike pulse ʻili, he paʻakikī ke wehewehe pololei i nā ʻano o ka loli o ka nui o ke koko, ʻaʻole kūpono no ke kūlana ana; ʻOiai ʻo ka lima kekahi o nā wahi kaha kiʻi koko lapaʻau maʻamau, ʻoi aku ka mānoanoa o kona iwi ma mua o ka manamana lima, a ʻoi aku ka haʻahaʻa o ka nui o ka nalu pulse o ka nui o ka lima i hōʻiliʻili ʻia e ka diffuse reflection. Hōʻike ka Kiʻi 2-5 i ka hoʻolaha ʻana o nā kīʻaha koko ma ka lima. Ke nānā nei i ke kiʻi, hiki ke ʻike ʻia he nui nā pūnaewele capillary ma ka ʻaoʻao mua o ka manamana lima, hiki ke hōʻike pono i ka ʻike hemoglobin i loko o ke kino kanaka. Eia kekahi, he mau ʻano maopopo kēia kūlana o ka loli o ka nui o ke kahe koko, a ʻo ia ke kūlana ana kūpono o ka nalu pulse nui. He lahilahi nā ʻiʻo a me nā iwi o nā manamana lima, no laila he liʻiliʻi ka mana o ka ʻike hoʻopilikia hope. Eia kekahi, maʻalahi ke ana ʻana i ka piko o ka manamana lima, a ʻaʻohe kaumaha noʻonoʻo o ke kumuhana, kahi mea e kūpono ai i ka loaʻa ʻana o ka hōʻailona spectral kiʻekiʻe paʻa o ka signal-to-noise ratio. ʻO ka manamana lima kanaka he iwi, kui, ʻili, ʻiʻo, koko venous a me ke koko arterial. I ke kaʻina hana o ka launa pū ʻana me ka mālamalama, loli ka nui o ke koko i loko o ke aʻa peripheral o ka manamana lima me ka puʻuwai e kuʻi ana, e hopena ana i ka loli o ke ana ʻana o ke ala optical. ʻOiai ʻo nā ʻāpana ʻē aʻe e mau ana i ke kaʻina holoʻokoʻa o ka mālamalama.
Ke hoʻopili ʻia kahi nalu māmā o ke kukui i ka epidermis o ka piko o ka manamana lima, hiki ke manaʻo ʻia ka manamana lima he hui ʻana, me ʻelua mau ʻāpana: ka mea paʻa (paʻa ke ala optical) a me ka mea dynamic (loli ke ala optical me ka nui o ka mea). Ke omo ʻia ka mālamalama e ka ʻiʻo piko o ka manamana lima, loaʻa ka mālamalama i hoʻouna ʻia e kahi photodetector. ʻIke ʻia ka emi ʻana o ka ikaika o ka mālamalama i hoʻouna ʻia e ka sensor ma muli o ka omo ʻana o nā ʻāpana ʻiʻo like ʻole o nā manamana lima kanaka. Wahi a kēia ʻano, ua hoʻokumu ʻia ke kumu hoʻohālike like o ka omo ʻana o ka mālamalama o ka manamana lima.
Kanaka kūpono:
ʻOximeter pulse piko manamana limaHe kūpono ia no nā kānaka o nā makahiki āpau, me nā keiki, nā pākeke, nā poʻe ʻelemakule, nā maʻi me ka maʻi puʻuwai coronary, hypertension, hyperlipidemia, cerebral thrombosis a me nā maʻi vascular ʻē aʻe a me nā mea maʻi me ka hānō, bronchitis, bronchitis mau, maʻi puʻuwai pulmonary a me nā maʻi hanu ʻē aʻe.
Ka manawa hoʻouna: Iune-17-2022
