School of Health Sciences and Welfare, Helen McArdle Institute of Nursing and Nursing, University of Sunderland, Sunderland, UK
Nicholas Harland, School of Health Sciences and Welfare, Helen McArdle Institute of Nursing and Nursing, University of Sunderland City Campus, Chester Road, Sunderland SR1 3SD, UK.
School of Health Sciences and Welfare, Helen McArdle Institute of Nursing and Nursing, University of Sunderland, Sunderland, UK
Nicholas Harland, School of Health Sciences and Welfare, Helen McArdle Institute of Nursing and Nursing, University of Sunderland City Campus, Chester Road, Sunderland SR1 3SD, UK.
Gwiritsani ntchito ulalo womwe uli pansipa kuti mugawane zolemba zonse za nkhaniyi ndi anzanu komanso anzanu.Dziwani zambiri.
Ntchito ya COVID-19 Oximetry@Home yatsegulidwa mdziko lonse.Izi zimalola odwala omwe ali pachiwopsezo chachikulu omwe ali ndi zizindikiro zochepa za COVID-19 kuti azikhala kunyumba ndikupeza pulse oximeter kuti ayeze kuchuluka kwawo kwa okosijeni (SpO2) 2 mpaka 3 pa tsiku kwa milungu iwiri.Odwala amalemba zowerengera zawo pamanja kapena pakompyuta ndipo amayang'aniridwa ndi gulu lachipatala.Chisankho chachipatala chogwiritsa ntchito algorithm chimatengera kuwerengera kwa SpO2 mkati mwazocheperako, pomwe kusintha kwa mfundo za 1-2 kungakhudze chisamaliro.M'nkhaniyi, tidakambirana zinthu zingapo zomwe zimakhudza kuwerengera kwa SpO2, ndipo anthu ena "wabwinobwino" adzakhala ndi "zochepa" pamlingo wa kasamalidwe kachipatala popanda vuto lililonse la kupuma.Tinakambirana za kuopsa kwa vutoli potengera zolemba zoyenera, ndikuganizira momwe izi zidzakhudzire kugwiritsa ntchito ntchito ya Oximetry@home, yomwe ingasokoneze cholinga chake;kuchepetsa chithandizo chamankhwala chapamaso ndi maso.
Pali zabwino zambiri pakuwongolera milandu yocheperako ya COVID-19 mdera, ngakhale izi zimaletsa kugwiritsa ntchito zida zamankhwala monga ma thermometers, stethoscopes, ndi ma pulse oximeters pakuwunika.Komabe, popeza kuyeza kwa pulse oximetry kwa wodwala kunyumba ndikothandiza popewa maulendo osafunikira a dipatimenti yadzidzidzi (Torjesen, 2020) komanso kuzindikira koyambirira kwa asymptomatic hypoxia, komabe, NHS England imalimbikitsa kuti dziko lonse Lipereke ntchito ya "Spo2 Measurement@Home" (NHSE , 2020a)) Kwa odwala omwe ali ndi zizindikiro zochepa za COVID-19 koma omwe ali pachiwopsezo chachikulu chakuwonongeka kwa matenda, pulse oximeter imatha kugwiritsidwa ntchito masiku 14 akuchiza, kotero kuti nthawi 2-3 patsiku Kudziyang'anira momwe mpweya wake wakhalira (SpO2) .
Odwala omwe amatumizidwa ku Oximetry@Home service nthawi zambiri amalangizidwa kuti agwiritse ntchito pulogalamu kapena zolemba zamapepala kuti alembe zomwe awona.Pulogalamuyi mwina imapereka mayankho / malangizo, kapena dokotala amawunika zomwe zalembedwa.Ngati ndi kotheka, dokotala akhoza kulankhulana ndi wodwalayo, koma nthawi zambiri panthawi yogwira ntchito.Odwala amauzidwa momwe angatanthauzire zotsatira zawo kuti athe kuchita paokha pakufunika, monga kufunafuna chithandizo chadzidzidzi.Chifukwa cha chiwopsezo chowonjezereka cha matendawa, anthu opitilira zaka 65 zakubadwa komanso / kapena omwe ali ndi zovuta zingapo zomwe zimafotokozedwa kuti ndizowopsa kwambiri akukhala chandamale cha njirayi (NHSE, 2020a).
Kuwunika kwa odwala mu ntchito ya Oximetry@Home ndikoyamba kuyeza kuchuluka kwa mpweya wawo kudzera mu pulse oximeter SpO2, ndikuwunikanso zizindikiro zina.Pogwiritsa ntchito zizindikiro zofiira, amber, ndi zobiriwira (RAG), ngati SpO2 ya wodwala ili 92% kapena yotsika, wodwalayo amatchulidwa kuti ndi wofiira, ndipo ngati SpO2 yawo ndi 93% kapena 94%, amatchulidwa ngati amber, ngati SpO2 yawo ndi 95% kapena kupitilira apo, amagawidwa ngati obiriwira.Nthawi zambiri, odwala obiriwira okha ndi omwe ali oyenera kugwiritsa ntchito Oximetry@Home (NHSE, 2020b).Komabe, zinthu zosiyanasiyana zosakhudzana ndi matenda zimatha kukhudza kuchuluka kwa SpO2, ndipo izi sizingaganizidwe panjira.M'nkhaniyi, takambirana zinthu zosiyanasiyana zomwe zimakhudza SpO2 zomwe zingakhudze mwayi wa odwala ku Oximetry@Home services.Izi zitha kusokoneza pang'ono cholinga chake chochepetsa kukakamizidwa kwa chithandizo chamankhwala choyang'ana maso ndi maso.
Mtundu wovomerezeka wa "zabwinobwino" wamagazi okosijeni oyezedwa ndi pulse oximeter (SpO2) ndi 95% -99%.Ngakhale kukhalapo kwa zikalata monga World Health Organization Pulse Oximetry Training Manual (WHO, 2011), mawuwa ali ponseponse kotero kuti nkhani zachipatala sizitchula kawirikawiri.Mukasaka zowongolera pa SpO2 mwa anthu omwe si azachipatala, chidziwitso chochepa chimapezedwa.Pakufufuza kwa anthu 791 azaka 65 ndi kupitilira apo (Rodríguez-Molinero et al., 2013), ataganizira zosintha monga COPD, pafupifupi 5% SpO2 mphambu inali 92%, kuwonetsa muyeso wa 5% Kuchuluka kwa okosijeni m'magazi a anthu. ndi otsika kwambiri kuposa pamenepo popanda kufotokoza kulikonse kwachipatala.Pakufufuza kwina kwa anthu a 458 azaka za 40-79 (Enright & Sherrill, 1998), kuchuluka kwa okosijeni kusanachitike mayeso oyenda mphindi 6 anali 92% -98% mu 5th percentile, ndi 95th percentile.Gawo loyamba ndi 93-99% peresenti.Maphunziro onsewa sanalembe njira zomwe zimagwiritsidwa ntchito kuyeza SpO2 mwatsatanetsatane.
Kafukufuku wa anthu 5,152 ku Norway (Vold et al., 2015) adapeza kuti 11.5% ya anthu anali ndi SpO2 pansipa kapena ofanana ndi 95% otsika kapena otsika malire anthawi zonse.Mu kafukufukuyu, anthu ochepa okha omwe ali ndi SpO2 otsika adanenedwa kuti ali ndi mphumu (18%) kapena COPD (13%), pomwe anthu ambiri omwe ali ndi BMI yofunikira kwambiri adapitilira 25 (77%) ndipo anali akulu Ena ali ndi zaka 70 kapena wamkulu (46%).Ku United Kingdom, 24.4% mwa omwe adayezetsa COVID-19 pakati pa Meyi ndi Ogasiti 2020 anali azaka 60 kapena kupitilira apo, ndipo 15% anali azaka 70 kapena kupitilira apo[8] (Ministry of Health and Social Care, 2020).Ngakhale kuti kafukufuku wa ku Norway akuwonetsa kuti 11.5% ya anthu onse akhoza kukhala ndi SpO2 yochepa, ndipo zambiri mwazochitikazi sizidziwika ndi matenda opuma kupuma, zolembazo zimasonyeza kuti pangakhale "mamiliyoni" a COPD osadziwika (Bakerly & Cardwell, 2016) Ndipo mwinamwake ziwopsezo zazikulu za kunenepa kwambiri kwa hypoventilation syndromes (Masa et al., 2019).Gawo lofunikira kwambiri lazambiri zosadziwika "zotsika" za SpO2 zopezeka m'maphunziro a anthu zitha kukhala ndi matenda opumira omwe sanadziwike.
Kuphatikiza pa kusiyana kwakukulu, zinthu zenizeni za ndondomeko zomwe zimagwiritsidwa ntchito poyesa SpO2 zingakhudze zotsatira.Pali kusiyana kwakukulu pakati pa muyeso womwe umatengedwa popuma ndi muyeso womwe umatengedwa mutakhala (Ceylan et al., 2015).Kuphatikiza apo, komanso zaka komanso kunenepa kwambiri, SpO2 imatha kuchepa mkati mwa mphindi 5-15 zopumula (Mehta ndi Parmar, 2017), makamaka pakusinkhasinkha (Bernardi et al., 2017).Kutentha kwa miyendo komwe kumakhudzana ndi kutentha kozungulira kumatha kukhala ndi zotsatira zowerengera (Khan et al., 2015), monganso nkhawa, komanso kukhalapo kwa nkhawa kumatha kuchepetsa zambiri (Ardaa et al., 2020).Pomaliza, zimadziwika bwino kuti cholakwika chokhazikika pakuyezetsa kwa pulse oximeter ndi ± 2% poyerekeza ndi muyeso wofananira wa mpweya wamagazi wamagazi a SaO2 (American Thoracic Society, 2018), koma kuchokera pakuwona kwachipatala, kuchokera pamalingaliro othandiza, chifukwa Palibe njira yoganizira kusiyana kumeneku, kuyenera kuyesedwa ndikuchitapo kanthu poyang'ana.
Kusintha kwa SpO2 pakapita nthawi komanso kuyeza mobwerezabwereza ndi vuto lina, ndipo pali chidziwitso chochepa chokhudza izi mwa anthu omwe si achipatala.Kafukufuku wocheperako (n = 36) adasanthula kusintha kwa SpO2 mkati mwa ola limodzi [16] (Bhogal & Mani, 2017), koma sananene kusinthasintha pakuyezera mobwerezabwereza kwa milungu ingapo, monga mu Oximetry@ Panyumba.
Munthawi ya masiku 14 ya Oximetry@Home monitoring, SpO2 idayesedwa katatu patsiku, zomwe zitha kukhala pafupipafupi kwa odwala omwe ali ndi nkhawa, ndipo miyeso 42 imatha kuyesedwa.Ngakhale kuganiza kuti ndondomeko yoyezera yofanana imagwiritsidwa ntchito pazochitika zonse ndipo chikhalidwe chachipatala chimakhala chokhazikika, pali chifukwa chokhulupirira kuti pali kusiyana kwina pamiyeso iyi.Kafukufuku wa kuchuluka kwa anthu pogwiritsa ntchito muyeso umodzi akuwonetsa kuti 11.5% ya anthu akhoza kukhala ndi SpO2 ya 95% kapena kuchepera.M'kupita kwa nthawi, m'kupita kwa nthawi, mwayi wopeza kuwerenga kocheperako pakuyeza mobwerezabwereza kumachitika pakapita nthawi lingaliro la COVID -19 litha kukhala loposa 11.5%.
Ma algorithm kumbuyo kwa ntchito ya Oximetry@Home akuwonetsa kuti zotsatira zoyipa zimalumikizidwa ndi zigoli zochepa za SpO2 [17] (Shah et al., 2020);omwe ali ndi SpO2 akugwera ku 93% mpaka 94% ayenera kuyang'ana maso ndi maso ndikuyang'aniridwa kuti alowe, 92 % Ndipo pansipa ayenera kulandira chithandizo chamankhwala chadzidzidzi.Ndi kukhazikitsidwa kwa ntchito ya Oximetry@Home m'dziko lonselo, miyeso yobwerezabwereza ya SpO2 yotengedwa ndi odwala kunyumba idzakhala yofunika kwambiri pofotokozera zachipatala chawo.
Kuyeza kwa SpO2 kumachitika nthawi zambiri pakanthawi kochepa pomwe oximeter imayikidwa.Wodwala amakhala popanda kupuma kwa nthawi.Kuyenda kuchokera kumalo odikirira kupita kuchipatala kudzasokoneza ena onse.Ndi kuyambitsa kwa ntchito ya Oximetry@Home, kanema wa NHS YouTube (2020) watulutsidwa.Kanemayo amalimbikitsa kuti odwala omwe amayezera kunyumba agone pansi kwa mphindi 5, ikani oximeter, ndiyeno muwerenge mokhazikika mphindi imodzi mutatha kuyika.Ulalo wa vidiyoyi wafalitsidwa kudzera mu tsamba lamtsogolo la NHS lachigwirizano la NHS lomwe likukhudzana ndi munthu amene akukhazikitsa ntchito ya Oximetry@Home, koma sizikuwoneka kuti zikuwonetsa kuti izi zingapereke zochepa zowerengera poyerekeza ndi zowerengedwa zomwe zimatengedwa atakhala.Ndizofunikira kudziwa kuti kanema wina wamaphunziro azaumoyo a NHS ku England mu nyuzipepala ya Daily Mail amalimbikitsa ndondomeko yosiyana kotheratu, yomwe iyenera kuwerengedwa mutakhala (Daily Mail, 2020).
Mwa munthu wosadziwika bwino, ziwerengero zotsika za 95%, ngakhale kutsika kwa 1 point chifukwa cha matenda a COVID-19 kumatha kupangitsa kuti akhale ndi Amber, zomwe zimabweretsa chisamaliro chachindunji chachipatala.Zomwe sizikudziwika bwino ndizakuti ngati kutsika kumodzi kokha kungapangitse chisamaliro chachipatala chachindunji kugwiritsa ntchito bwino chuma pakati pa anthu omwe ali ndi ziwopsezo zocheperako.
Ngakhale kuti algorithm yadziko lonse imatchulanso za kugwa kwa SpO2, popeza kuti milandu yambiri sinalembe chiwerengero cha matenda a Pre-SpO2, chinthu ichi sichingayesedwe kusanayambike kugwa koyambirira chifukwa cha kachilombo komwe kamayambitsa kuwunika kwa SpO2.Kuchokera pamalingaliro opangira zisankho, sizikudziwika bwino ngati kuchuluka kwamadzimadzi bwino kwa munthu atakhala pansi kuyenera kugwiritsidwa ntchito ngati maziko a chisamaliro cha minofu, kapena ngati kuchepetsedwa kwa machulukidwe / kutulutsa mpweya pogona pambuyo popuma kuyenera kugwiritsidwa ntchito ngati zoyambira.Zikuwoneka kuti palibe ndondomeko yomwe dziko lino likuvomereza pa izi.
SpO2% ndi gawo lofunikira poyera pakuwunika COVID-19.NHS England yagula ma oximeter 370,000 kuti agwiritsidwe ntchito ndi odwala angapo kuti agawidwe kuntchito.
Zomwe zafotokozedwazi zingayambitse kusintha kwa miyeso ya single-point SpO2, kuyambitsa ndemanga za odwala pamasom'pamaso m'madipatimenti oyambirira kapena m'madipatimenti odzidzimutsa.Pakapita nthawi, odwala masauzande ambiri ammudzi amatha kuyang'aniridwa ndi SpO2, zomwe zingayambitse kuwunika kwamaso ndi maso kosafunikira.Zomwe zimakhudza kuwerengera kwa SpO2 pamilandu ya COVID-19 zikawunikidwa ndikuyikidwa pamiyezo yazachipatala komanso yapakhomo potengera kuchuluka kwa anthu, kukhudzidwa komwe kungachitike kumakhala kofunika kwambiri, makamaka kwa iwo "mamiliyoni akusowa" SpO2 yovuta ndiyotheka.Kuonjezera apo, ntchito ya Oximetry@Home ndiyotheka kusankha anthu omwe ali ndi chiwerengero chodulidwa poyang'ana anthu oposa 65 ndi omwe angakhale ndi BMI yapamwamba yokhudzana ndi comorbidities.Kafukufuku wasonyeza kuti chiwerengero cha anthu "otsika" chidzawerengera osachepera 11.5% mwa anthu onse, koma chifukwa cha zosankha za Oximetry@Home service, chiwerengerochi chikuwoneka kuti ndi chachikulu kwambiri.
Popeza zinthu zomwe zalembedwa kuti zikhudze kuchuluka kwa SpO2 zikugwira ntchito, odwala omwe ali ndi ziwerengero zotsika, makamaka omwe ali ndi 95%, amatha kusuntha pakati pa zobiriwira ndi amber kangapo.Chochitachi chikhoza kuchitika ngakhale pakati pa chizolowezi choyezetsa kachipatala pamene akutumizidwa ku Oximetry@Home ndi muyeso woyamba pamene wodwala akugwiritsa ntchito ndondomeko yogona ya 6 yamphindi kunyumba.Ngati wodwala akumva kuti sakumva bwino, nkhawa pakuyezera imatha kuchepetsanso omwe ali ndi maperesenti odulidwa pansi pa 95% ndikupeza chisamaliro.Izi zitha kubweretsa chisamaliro chamaso ndi maso kangapo, kuyika kukakamizidwa kwina kwa mautumiki omwe afika kapena kupitilira mphamvu.
Ngakhale kunja kwa njira yotumizidwa ya Oximetry@Home ndi zida zamankhwala zomwe zimapatsa odwala ma oximeters, malipoti okhudza kufunika kwa ma pulse oximeter afalikira, ndipo sizikudziwika kuti ndi anthu angati omwe angakhale ndi pulse oximeters poyankha mliri wa COVID -19, ngakhale. pali mavenda ambiri osiyanasiyana omwe amapereka zida zotsika mtengo komanso malipoti a zida zomwe zagulitsidwa (CNN, 2020), chiwerengerochi chikhoza kukhala mazana masauzande.Zomwe zafotokozedwa m'nkhaniyi zingakhudzenso anthuwa ndikuwonjezeranso kupanikizika pa ntchito.
Tikulengeza kuti aliyense wa olemba omwe adatchulidwa adathandizira kwambiri popanga nkhaniyi, ndipo adathandizira pamalingaliro ndi zomwe zidalembedwa.
Chifukwa cha chivomerezo cha komiti yowunikira mabuku ndi kafukufuku wamakhalidwe abwino, sizikugwiritsidwa ntchito popereka nkhaniyi.
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Nthawi yotumiza: Jul-15-2021