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<section data-role="paragraph" data-color="rgb(182, 228, 253)" data-custom="rgb(182, 228, 253)"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section><p><p><img src="image/20201014/86b79d371e9862b01189f0252a03b2cd_1.png" /></p></p></section><section><section><span><strong></strong></span></section><p><span>医疗器械媒体报道先锋</span></p><p><span>分享专业医疗器械知识</span></p></section><section><section><section>关注</section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section><p><strong><span>来源:理邦仪器客户服务</span></strong></p><section powered-by="gulangu"><section><section><p><br /></p></section></section></section><section powered-by="gulangu"><section><section><p><span>监护仪在使用过程中，常常会出现许多问题，当监护仪警报响起，屏幕红黄灯闪烁，需要紧急处理吗？且慢，监护仪也有误导你的时候，监护仪的心电、血压、血氧三个部分，都可能存在误报的情况，需要具体情况具体分析。</span><br /></p><p><span><br /></span></p><p><span><p><img src="image/20201014/b017949a23ca26020b6aa0e946428d32_2.png" /></p></span></p></section></section></section><section powered-by="gulangu"><section><section><p><br /></p></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><strong>01</strong></p></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><section><p><strong>心电监护</strong></p></section><section></section></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section><p><p><img src="image/20201014/98482600fd597f59d35c8ca7431a8cde_3.png" /></p></p><p>1、P波、T波较高，或者QRS波较低，心电监护可将P或T波误判为QRS 波，显示的心率翻倍。例如原80次/分的心率，误报为160次/分，判定为「室上速」，这时切换为R波较高的导联通常能解决。</p><p><br /></p><p>2、心房颤动时，如遇到1.5s-2s的长R-R间期，心电监护显示心率减慢至 30次/分，触发心动过缓的报警。然而，房颤出现1.5-2s的长RR间期，尤其在夜间，是正常现象，并不提示房室传导阻滞，不需特殊处理。有研究发现，99% 的房颤患者Holter结果提示有 1.5s 的长RR间期。</p><p><br /></p><p><span>3、监护仪故障，或肌电干扰，可出现类似室速、室扑、室颤波型。</span><br /></p><p><br /></p><p>4、有些心律失常的鉴别诊断，对于心电监护的要求较高。例如，出现室上速并束支传导阻滞，或室上速并差传，监护通常会报告为室速；房扑通常会报告成室上速，很快的窦律，也可能报告为室上速。这时需要完善床边心电图进行鉴别。</p><p><br /></p></section></section></section><section powered-by="gulangu"><section><section><p><br /></p></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><strong>02</strong></p></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><section><p><strong>血压监护</strong></p></section><section></section></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section><p><span>监测的血压有时不能客观反映患者情况。标准的血压测量，患者应在安静、温度适当的环境里休息5~10分钟，取坐位被测的上臂裸露，手掌向上平伸，肘部位于心脏水平，上肢胳膊与身躯呈45度进行测量。然而实际上，在血压监护时，并不都在理想状态，而且有些情况对血压测量影响很大。</span></p><p><br /></p><p><span>例如，患者常是卧位，卧位血压可比坐位收缩压高5~10mmHg, 而对于有体位性低血压的患者，两者差距可达20mmHg 以上。侧卧也是常见的体位，可引起血压测量的明显误差。有研究发现，左侧卧位时，右上肢的收缩压较平躺测量值低10~20mmHg，同样右侧卧位时，左上肢的血压也是低于实际值的，肢体测量时正在活动（例如在吃饭），或者上肢过度屈曲，也会引起较大的测量误差。</span></p><p><br /></p><p><span>另外，房颤心律，因脉搏强弱不等，也可能引起测量结果误差较大，甚至血压测量不出。既然监护的血压测量有诸多的影响因素，在遇到明显异常值时应该注意复测鉴别。</span></p><p><br /></p></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><strong>03</strong></p></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><section><p><strong>血氧监护</strong></p></section><section><br /></section></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section><p><p><img src="image/20201014/dc5d869f9afa31960abc560864e857c1_4.png" /></p></p><p>正常值：吸入空气时 SpO2 测得值 ≥ 95%；＜90% 为轻度低氧血症，一般报警低限的设置应高于 90%。</p></section></section></section><section powered-by="gulangu"><section><section><p><br /></p></section></section></section><section powered-by="gulangu"><section><section><p><span>血氧饱和度（SpO2）是血液中被氧结合的氧合血红蛋白的容量占全部可结合的血红蛋白容量的百分比，而血氧监护测量的是指尖的SpO2。其原理是采用指套式光电传感器，使用波长660nm的红光（氧合血红蛋白吸收）和940nm的近红外光（还原血红蛋白吸收）作为射入光源，测定通过手指组织床的光传导强度，来计算血红蛋白浓度及血氧饱和度。</span></p><p><br /></p><p><span>指端的血液灌注，直接影响了指端SpO2的测量。例如在休克状态下（如下壁右室心肌梗死，严重感染等），指端灌注不良，引起SpO2数值较实际低，甚至测不出。指端暴露在外，温度低，引起灌注不良，也是常见的影响因素。</span></p><p><br /></p><p><span>另外，指套移位（红光未对准甲床），指端颜色异常（污垢、指甲油、甲床厚），同侧测血压，同侧输液并有外渗肿胀，都会引起SpO2偏低。在遇到与临床不符合的指尖SpO2值时，可先换其他部分测量，如仍异常，要思考原因，并行动脉血气分析。</span></p><p><span><br /></span></p></section></section></section><section data-id="1658"><section><section><section data-id="1658"><section><section><section data-id="1658"><section><section><section data-id="1658"><section><section><p><span><strong>相关阅读</strong></span></p></section><p><p><img src="image/20201014/ec237188ae1e9c03eb4d9814f31b18ab_5.gif" /></p></p><p><span>盘点2018年医疗器械领域最新发展技术！（上）</span></p><p><br /></p><p><span>【从业必读】各级医院重症监护病房的配置标准（含设备清单）</span></p><p><br /></p><p><span>警示！这几种医院里最常用的医疗器械，故障率最高！</span></p><p><br /></p><p><span>最全！超800款医疗器械入选《优秀国产医疗设备遴选品目录》！</span></p><p><br /></p><p><span>ICU的十大“救命神器”！（含收费标准）</span></p></section></section></section></section></section></section></section></section></section></section></section><p><br /><strong><span><p><img src="image/20201014/225eae26a91575de7508aebe3e999278_6.jpg" /></p></span></strong></p>
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发表于 2020-10-14 14:56:36