Raws li cov khoom siv feem ntau hauv kev kho mob, ntau tus neeg saib xyuas tus neeg mob yog ib hom cim qhia txog lub cev rau kev kuaj mob ntev, ntau tus neeg mob ntawm cov neeg mob hnyav, thiab los ntawm kev tshuaj xyuas thiab ua tiav lub sijhawm tiag tiag thiab tsis siv neeg, hloov pauv raws sijhawm mus rau hauv cov ntaub ntawv pom, lub tswb ceeb toom tsis siv neeg thiab sau cia tsis siv neeg ntawm cov xwm txheej uas yuav ua rau tuag taus. Ntxiv nrog rau kev ntsuas thiab saib xyuas cov yam ntxwv ntawm tus neeg mob, nws kuj tseem tuaj yeem saib xyuas thiab daws cov xwm txheej ntawm cov neeg mob ua ntej thiab tom qab noj tshuaj thiab phais, tshawb pom cov kev hloov pauv ntawm cov neeg mob hnyav raws sijhawm, thiab muab lub hauv paus rau cov kws kho mob kom kuaj mob thiab tsim cov phiaj xwm kho mob kom raug, yog li txo qhov kev tuag ntawm cov neeg mob hnyav.
Nrog rau kev txhim kho thev naus laus zis, cov khoom saib xyuas ntawm ntau tus neeg mob saib xyuas tau nthuav dav los ntawm lub cev ncig mus rau kev ua pa, lub paj hlwb, lub cev zom zaub mov thiab lwm yam kab ke.Lub module kuj tau nthuav dav los ntawm cov ECG module (ECG), respiratory module (RESP), blood oxygen saturation module (SpO2), noninvasive blood pressure module (NIBP) mus rau temperature module (TEMP), invasive blood pressure module (IBP), cardiac displacement module (CO), noninvasive continuous cardiac displacement module (ICG), thiab end-breath carbon dioxide module (EtCO2), electroencephalogram monitoring module (EEG), anesthesia gas monitoring module (AG), transcutaneous gas monitoring module, anesthesia depth monitoring module (BIS), muscle relaxation monitoring module (NMT), hemodynamics monitoring module (PiCCO), respiratory mechanics module.
Tom ntej no, nws yuav raug muab faib ua ntau ntu los qhia txog lub hauv paus ntawm lub cev, lub hauv paus ntsiab lus, kev txhim kho thiab kev siv ntawm txhua lub module.Cia peb pib nrog lub electrocardiogram module (ECG).
1: Lub tshuab ntawm kev tsim cov electrocardiogram
Cov Cardiomyocytes faib nyob rau hauv lub sinus node, atrioventricular junction, atrioventricular tract thiab nws cov ceg tsim cov haujlwm hluav taws xob thaum lub sijhawm excitation thiab tsim cov teb hluav taws xob hauv lub cev. Tso lub electrode hlau probe rau hauv lub teb hluav taws xob no (txhua qhov chaw hauv lub cev) tuaj yeem sau cov hluav taws xob tsis muaj zog. Lub teb hluav taws xob hloov pauv tas li thaum lub sijhawm ntawm kev txav mus los hloov pauv.
Vim yog cov khoom siv hluav taws xob sib txawv ntawm cov nqaij thiab ntau qhov ntawm lub cev, cov electrodes tshawb nrhiav hauv ntau qhov sib txawv tau sau cov kev hloov pauv sib txawv hauv txhua lub voj voog plawv. Cov kev hloov pauv me me no tau nthuav dav thiab sau los ntawm electrocardiograph, thiab cov qauv tshwm sim hu ua electrocardio-gram (ECG). Cov electrocardiogram ib txwm muaj tau sau los ntawm qhov chaw ntawm lub cev, hu ua electrocardiogram saum npoo av.
2: Keeb kwm ntawm kev siv tshuab electrocardiogram
Xyoo 1887, Waller, tus xibfwb qhia txog lub cev ntawm Mary's Hospital ntawm Royal Society of England, tau ua tiav kev sau cov ntaub ntawv thawj zaug ntawm tib neeg lub plawv electrocardiogram nrog lub capillary electrometer, txawm hais tias tsuas yog V1 thiab V2 nthwv dej ntawm lub plawv ventricle tau sau tseg hauv daim duab, thiab atrial P nthwv dej tsis tau sau tseg. Tab sis Waller txoj haujlwm zoo thiab muaj txiaj ntsig tau tshoov siab rau Willem Einthoven, uas nyob hauv cov neeg tuaj saib, thiab tau tsim lub hauv paus rau kev qhia txog cov thev naus laus zis electrocardiogram thaum kawg.
------------------------（AugustusDisire Walle）----------------------------------------（Waller tau sau thawj daim electrocardiogram tib neeg）--------------------------------------------------（Capillary electrometer）-----------
Tau 13 xyoos tom ntej no, Einthoven tau mob siab rau nws tus kheej rau kev kawm txog electrocardiograms uas tau kaw los ntawm capillary electrometers. Nws tau txhim kho ntau yam txheej txheem tseem ceeb, ua tiav siv cov hlua galvanometer, lub cev electrocardiogram kaw rau ntawm daim zaj duab xis photosensitive, nws tau kaw cov electrocardiogram qhia txog atrial P nthwv dej, ventricular depolarization B, C thiab repolarization D nthwv dej. Xyoo 1903, electrocardiograms pib siv hauv kev kho mob. Xyoo 1906, Einthoven tau kaw cov electrocardiograms ntawm atrial fibrillation, atrial flutter thiab ventricular premature beat ua ntu zus. Xyoo 1924, Einthoven tau txais khoom plig Nobel hauv Tshuaj rau nws txoj kev tsim cov electrocardiogram kaw.
---------------------------------------------------------------------------------------------------Daim duab electrocardiogram tiav uas Einthoven tau kaw tseg------------------------------------------------------------------------------------------------------------
3: Kev tsim kho thiab lub hauv paus ntsiab lus ntawm cov txheej txheem ua txhuas
Xyoo 1906, Einthoven tau tawm tswv yim txog lub tswv yim ntawm bipolar limb lead. Tom qab txuas cov electrodes kaw hauv sab caj npab xis, sab caj npab sab laug thiab sab ceg laug ntawm cov neeg mob ua khub, nws tuaj yeem kaw bipolar limb lead electrocardiogram (lead I, lead II thiab lead III) nrog qhov siab thiab tus qauv ruaj khov. Xyoo 1913, bipolar tus qauv limb conduction electrocardiogram tau raug tshaj tawm, thiab nws tau siv ib leeg rau 20 xyoo.
Xyoo 1933, Wilson thaum kawg ua tiav qhov unipolar lead electrocardiogram, uas txiav txim siab qhov chaw ntawm xoom lub peev xwm thiab lub hauv paus hluav taws xob raws li Kirchhoff txoj cai tam sim no, thiab tsim kom muaj 12-lead system ntawm Wilson network.
Txawm li cas los xij, hauv Wilson lub 12-lead system, qhov electrocardiogram waveform amplitude ntawm 3 unipolar limb leads VL, VR thiab VF yog qis, uas tsis yooj yim ntsuas thiab pom kev hloov pauv. Xyoo 1942, Goldberger tau ua kev tshawb fawb ntxiv, ua rau muaj unipolar pressurized limb leads uas tseem siv niaj hnub no: aVL, aVR, thiab aVF leads.
Txog rau lub sijhawm no, tus qauv 12-lead system rau kev kaw ECG tau qhia: 3 bipolar limb leads (Ⅰ, Ⅱ, Ⅲ, Einthoven, 1913), 6 unipolar breast leads (V1-V6, Wilson, 1933), thiab 3 unipolar compression limb leads (aVL, aVR, aVF, Goldberger, 1942).
4: Yuav ua li cas kom tau txais lub teeb liab ECG zoo
1. Kev npaj daim tawv nqaij. Vim tias daim tawv nqaij tsis muaj zog, kev kho tus neeg mob daim tawv nqaij kom zoo yog qhov tsim nyog kom tau txais cov teeb liab hluav taws xob ECG zoo. Xaiv cov uas tiaj tus thiab muaj cov leeg tsawg dua.
Yuav tsum kho daim tawv nqaij raws li cov hau kev hauv qab no: ① Tshem cov plaub hau ntawm lub cev qhov chaw uas muab lub electrode tso rau. Maj mam txhuam daim tawv nqaij qhov chaw uas muab lub electrode tso rau kom tshem tawm cov hlwb tuag. ③ Ntxuav daim tawv nqaij kom huv si nrog dej xab npum (tsis txhob siv ether thiab cawv ntshiab, vim qhov no yuav ua rau daim tawv nqaij tsis kam). ④ Cia daim tawv nqaij kom qhuav tag ua ntej muab lub electrode tso rau. ⑤ Nruab cov clamps lossis cov nyees khawm ua ntej muab cov electrodes tso rau ntawm tus neeg mob.
2. Ua tib zoo saib xyuas cov hlau hluav taws xob uas siv rau lub plawv, txwv tsis pub ntswj thiab khi cov hlau txhuas, tiv thaiv cov txheej tiv thaiv ntawm cov hlau txhuas kom tsis txhob puas, thiab ntxuav cov av ntawm cov hlau txhuas kom raws sijhawm kom tiv thaiv cov hlau txhuas oxidation.
Lub sijhawm tshaj tawm: Lub Kaum Hli-12-2023
