Isikolo seSayensi yezeMpilo kunye neNtlalontle, uHelen McArdle Institute of Nursing and Nursing, kwiYunivesithi yaseSunderland, eSunderland, e-UK
UNicholas Harland, iSikolo seSayensi yezeMpilo kunye neNtlalontle, uHelen McArdle Institute of Nursing and Nursing, University of Sunderland City Campus, Chester Road, Sunderland SR1 3SD, UK.
Isikolo seSayensi yezeMpilo kunye neNtlalontle, uHelen McArdle Institute of Nursing and Nursing, kwiYunivesithi yaseSunderland, eSunderland, e-UK
UNicholas Harland, iSikolo seSayensi yezeMpilo kunye neNtlalontle, uHelen McArdle Institute of Nursing and Nursing, University of Sunderland City Campus, Chester Road, Sunderland SR1 3SD, UK.
Sebenzisa ikhonkco elingezantsi ukuze wabelane ngoguqulelo olupheleleyo lweli nqaku kunye nabahlobo bakho kunye noogxa bakho.Funda nzulu.
I-COVID-19 Oximetry@Home inkonzo yenziwe yasebenza kwilizwe lonke.Oku kuvumela izigulana ezisemngciphekweni omkhulu ezineempawu ezibuthathaka ze-COVID-19 ukuba zihlale ekhaya kwaye zifumane i-pulse oximeter yokulinganisa ukugcwala kwazo komoyampilo (SpO2) izihlandlo ezi-2 ukuya kwezi-3 ngemini iiveki ezimbini.Izigulane zirekhoda ukufundwa kwazo ngesandla okanye nge-elektroniki kwaye zibekwe esweni liqela leklinikhi.Isigqibo seklinikhi sokusebenzisa i-algorithm sisekelwe ekufundeni kwe-SpO2 ngaphakathi kwinqanaba elincinci, apho utshintsho lwe-1-2 lunokuchaphazela ukunakekelwa.Kweli nqaku, sixoxe ngezinto ezininzi ezichaphazela ukufundwa kwe-SpO2, kwaye abanye abantu "abaqhelekileyo" baya kuba nenqaku "elisezantsi eliqhelekileyo" kumda wolawulo lwekliniki ngaphandle kweengxaki ezaziwayo zokuphefumla.Siye saxoxa ngobunzima obunokubakho bale ngxaki ngokusekwe kuncwadi olufanelekileyo, kwaye saqwalasela indlela oku kuya kuchaphazela ngayo ukusetyenziswa kwenkonzo ye-Oximetry@home, enokuthi ibhideke ngokuyinxenye injongo yayo;ukunciphisa unyango ubuso ngobuso.
Zininzi izinto eziluncedo ekulawuleni iimeko ze-COVID-19 ezingaqatha kangako eluntwini, nangona oku kuthintela ukusetyenziswa kwezixhobo zonyango ezifana nethemometha, i-stethoscopes, kunye ne-pulse oximeters ngexesha lovavanyo.Nangona kunjalo, ekubeni umlinganiselo we-pulse oximetry wesigulane ekhaya uluncedo ekuthinteleni ukutyelelwa kwesebe likaxakeka ngokungeyomfuneko (Torjesen, 2020) kunye nokuchongwa kwangaphambili kwe-asymptomatic hypoxia, nangona kunjalo, i-NHS yaseNgilani icebisa ukuba ilizwe lonke linikezele ngenkonzo "Spo2imetry@Home" (NHSE, 2020a)) Kwizigulana ezineempawu ezibuthathaka ze-COVID-19 kodwa zisemngciphekweni omkhulu wokuwohloka, i-pulse oximeter inokusetyenziselwa iintsuku ezili-14 zonyango, ukuze kube namaxesha ama-2-3 ngosuku Ukuzijonga ngokwawo ukugcwala kwayo komoyampilo (SpO2).
Izigulana ezithunyelwe kwinkonzo ye-Oximetry@Home zidla ngokuthunyelwa ukuba zisebenzise i-app okanye idayari yephepha ukurekhoda oko bakuqapheleyo.I-app mhlawumbi ibonelela ngeempendulo / iingcebiso ezizenzekelayo, okanye ugqirha ubeka iliso kwidatha.Ukuba kuyimfuneko, ugqirha unokuqhagamshelana nesigulane, kodwa ngokuqhelekileyo kuphela ngeeyure eziqhelekileyo zokusebenza.Izigulane zixelelwa ukuba zitolika njani iziphumo zazo ukuze zikwazi ukwenza ngokuzimeleyo xa zifuneka, njengokufuna unyango olungxamisekileyo.Ngenxa yomngcipheko ophezulu wokunyuka kwesi sifo, abantu abangaphezu kweminyaka engama-65 ubudala kunye / okanye abane-comorbidities ezininzi ezichazwa njengezisemngciphekweni kakhulu ziba yinjongo yale ndlela (NHSE, 2020a).
Uvavanyo lwezigulane kwinkonzo ye-Oximetry@Home kukuqala ukulinganisa i-oxygen saturation nge-pulse oximeter SpO2, kwaye emva koko kuqwalaselwe ezinye iimpawu kunye neempawu.Ukusebenzisa ukulinganisa obomvu, i-amber, kunye nohlaza (RAG), ukuba i-SpO2 yesigulane i-92% okanye iphantsi, isigulane sithathwa njengobomvu, kwaye ukuba i-SpO2 yabo i-93% okanye i-94%, ihlelwa njenge-amber, ukuba i-SpO2 yabo yi-95% okanye ngaphezulu, bahlelwa njengohlaza.Ngokubanzi, kuphela izigulana eziluhlaza ezifanelekileyo ukusebenzisa i-Oximetry@Home (NHSE, 2020b).Nangona kunjalo, izinto ezahlukeneyo ezingahambelani nezifo zinokuchaphazela amanqaku e-SpO2, kwaye ezi zinto azinakuqwalaselwa kwindlela.Kweli nqaku, sixoxe ngezinto ezahlukeneyo ezichaphazela i-SpO2 ezinokuchaphazela ukufikelela kwezigulane kwiinkonzo ze-Oximetry@Home.Ezi zinto zinokubhidanisa injongo yayo yokunciphisa uxinzelelo lweenkonzo zonyango zobuso ngobuso.
Uluhlu olwamkelekileyo lwe-blood oxygen saturation "eqhelekileyo" elinganiswa ne-pulse oximeter (SpO2) yi-95% -99%.Nangona kukho ubukho bamaxwebhu afana ne-World Health Organization Pulse Oximetry Training Manual (WHO, 2011), inkcazo ixhaphake kakhulu kangangokuba amanqaku ezonyango awafane achaze.Xa ukhangela idatha yokulawula kwi-SpO2 kubantu abangekho bezonyango, ulwazi oluncinci lufunyenwe.Kuphononongo lwabantu abangama-791 iminyaka eyi-65 nangaphezulu (uRodríguez-Molinero et al., 2013), emva kokuqwalasela izinto eziguquguqukayo ezifana neCOPD, i-avareji ye-5% ye-SpO2 amanqaku yayingama-92%, ebonisa umlinganiselo we-5% Ukuzaliswa kwe-oksijini yegazi labantu isezantsi kakhulu kunoko ngaphandle kwengcaciso yezonyango eyaziwayo.Kwesinye isifundo sabantu abangama-458 abaneminyaka eyi-40-79 (Enright & Sherrill, 1998), uluhlu lwe-oxygen saturation phambi kovavanyo lokuhamba ngomzuzu we-6 lwaluyi-92% -98% kwi-5th percentile, kunye ne-95th percentile.Ipesenti yokuqala yi-93% -99% yepesenti.Zombini izifundo azizange zibhale iinkqubo ezisetyenziselwa ukulinganisa i-SpO2 ngokweenkcukacha.
Uphononongo lwabantu be-5,152 eNorway (Vold et al., 2015) lufumene ukuba i-11.5% yabantu babe ne-SpO2 engezantsi okanye ilingana ne-95% ephantsi okanye ephantsi umda wesiqhelo.Kolu phononongo, kuphela linani elincinci labantu abane-SpO2 ephantsi baxelwe ukuba bane-asthma (18%) okanye i-COPD (13%), ngelixa uninzi lwabantu lune-BMI engaphezulu kwe-25 (77%), kwaye umlinganiselo omkhulu Ngaba neminyaka engama-70 ubudala okanye ngaphezulu (46%).E-United Kingdom, i-24.4% yamatyala avavanyelwe i-COVID-19 phakathi kukaMeyi no-Agasti ka-2020 yayineminyaka engama-60 okanye ngaphezulu, kwaye i-15% yayineminyaka engama-70 okanye ngaphezulu[8] (uMphathiswa wezeMpilo kunye noNonophelo lweNtlalo, ngo-2020).Nangona uphando lwaseNorway lubonisa ukuba i-11.5% yalo naliphi na inani labantu linokuba ne-SpO2 ephantsi, kwaye ininzi yala matyala ayinalo ukuxilongwa kokuphefumula okwaziwayo, uncwadi lubonisa ukuba kunokubakho "izigidi" zeCOPD engaxilwanga (Bakerly & Cardwell, 2016).) Kwaye amanqanaba aphezulu anokuthi afumaneke kwi-syndromes ye-hypoventilation yokutyeba kakhulu (Masa et al., 2019).Umlinganiselo obalulekileyo wezibalo ongachazwanga "ophantsi oqhelekileyo" amanqaku e-SpO2 afunyenwe kwizifundo zabemi anokuba nezifo zokuphefumla ezingafunyaniswanga.
Ukongeza kwintlukwano ngokubanzi, izinto ezithile zeprotocol ezisetyenziselwa ukulinganisa i-SpO2 zinokuchaphazela iziphumo.Kukho umahluko obalulekileyo ngokwezibalo phakathi komlinganiselo othathwe ekuphumleni kunye nomlinganiselo othathwe ngelixa uhleli (Ceylan et al., 2015).Ukongeza, kunye nobudala kunye nezinto ezityebileyo, i-SpO2 inokuncipha ngaphakathi kwe-5-15 imizuzu yokuphumla (i-Mehta kunye ne-Parmar, i-2017), ngakumbi ngakumbi ngexesha lokucamngca (uBernardi et al., 2017).Ubushushu belungu elinxulumene nobushushu be-ambient lunokuba nefuthe elibalulekileyo ngokwezibalo (uKhan et al., 2015), njengoko kunjalo ukuxhalaba, kunye nobukho bexhala kunokunciphisa amanqaku ngenqaku elipheleleyo (Ardaa et al., 2020).Ekugqibeleni, kwaziwa kakuhle ukuba impazamo esemgangathweni yokulinganisa i-pulse oximeter yi-± 2% xa kuthelekiswa nokulinganisa kwegesi yegazi ye-arterial edibeneyo i-SaO2 (i-American Thoracic Society, i-2018), kodwa kwimbono yeklinikhi, ukusuka kwindawo ebonakalayo, Ngenxa yokuba akukho ndlela yokuphendula kulo mahluko, kuyimfuneko ukulinganisa kunye nokwenza kwixabiso lobuso.
Utshintsho kwi-SpO2 ngokuhamba kwexesha kunye nemilinganiselo ephindaphindiweyo yenye ingxaki, kwaye kukho ulwazi oluncinci malunga noku kubantu abangewona amayeza.Isampula encinci yesampula (n = 36) isifundo sihlolisise utshintsho lwe-SpO2 kwiyure enye [16] (Bhogal & Mani, 2017), kodwa ayizange ichaze ukuguquguquka ngexesha lokulinganisa ngokuphindaphindiweyo kwiiveki ezininzi, njenge-Oximetry@ Ngexesha leKhaya.
Ngexesha le-14 leentsuku ze-Oximetry@Home esweni, i-SpO2 yalinganiswa amaxesha ama-3 ngosuku, enokuthi ixhaphake kakhulu kwizigulane ezixhalabileyo, kwaye imilinganiselo ye-42 inokuthathwa.Nokuba ucinge ukuba iprotocol yokulinganisa isetyenziswa kwimeko nganye kwaye imeko yekliniki izinzile, kukho isizathu sokukholelwa ukuba kukho ukungafani okuthile kule milinganiselo.Uphononongo lwabemi olusebenzisa umlinganiselo omnye lubonisa ukuba i-11.5% ye-SpO2 yabantu inokuba ngama-95% okanye ngaphantsi.Ngokuhamba kwexesha, ngokuthobela i-COVID-19, ngokuhamba kwexesha, ixesha elinye okanye Kucetyiswa ukuba ukubakho kokufundwa okuphantsi okuninzi kunokuba ngaphezulu kwe-11.5%.
I-algorithm emva kwenkonzo ye-Oximetry @ yeKhaya ibonisa ukuba iziphumo ezibi zihambelana namanqaku aphantsi e-SpO2 [17] (Shah et al., 2020);abo bane-SpO2 ewela kwi-93% ukuya kwi-94% kufuneka bahlole ubuso ngobuso bezonyango kwaye baqwalaselwe ukuba bamkelwe, 92 % Kwaye ngaphantsi kufuneka bafumane unyango lwesibini olungxamisekileyo.Ngokuphunyezwa kwenkonzo ye-Oximetry@Home kwilizwe lonke, imilinganiselo ye-SpO2 ephindaphindiweyo ethathwe zizigulane ekhaya iya kuba yinto ebalulekileyo ekuchazeni iimeko zabo zeklinikhi.
Umlinganiselo we-SpO2 udlalwa kakhulu ngexesha elifutshane xa i-oximeter ibekwe.Isigulana sihleli kwaye asiphumli kangangexesha elithile.Ukuhamba ukusuka kwindawo yokulinda ukuya kwindawo yekliniki, abanye baya kuphazamiseka ngokomzimba.Ngokusebenza kwenkonzo ye-Oximetry@Home, ividiyo ye-YouTube ye-NHS (2020) ikhutshiwe.Ividiyo incoma ukuba izigulane ezithatha imilinganiselo ekhaya zilale phantsi imizuzu emi-5, zibeke i-oximeter, emva koko zifumane ukufunda okuzinzile kwi-1 ngomzuzu emva kokubekwa.Eli khonkco levidiyo liye lasasazwa ngephepha le-platform le-NHS elizayo elihambelana nomntu omisela i-Oximetry @ inkonzo yasekhaya, kodwa akubonakali ukuba oku kunokubonelela ngokufunda okuphantsi xa kuthelekiswa nokufundwa okuthathiweyo xa uhleli.Kuyafaneleka ukuba uqaphele ukuba enye ividiyo yemfundo yezempilo ye-NHS eNgilani kwiphephandaba le-Daily Mail incoma iprotocol ehluke ngokupheleleyo, ekufuneka ifundwe ngelixa uhleli (Daily Mail, 2020) .
Kumntu ongaziwayo jikelele, amanqaku aphantsi angama-95%, nokuhla kwenqaku elinye ngenxa yosulelo lwe-COVID-19 kunokubangela umlinganiselo we-Amber, okhokelela kukhathalelo lwezonyango oluthe ngqo.Into engacacanga yeyokuba ingaba inqaku elinye lokuhla liza kwenza ukhathalelo lwezonyango oluthe ngqo lube lusetyenziso olusebenzayo lwezibonelelo phakathi kwabantu abanamanqaku asezantsi e-pre-morbid.
Nangona i-algorithm yesizwe iphinda ichaze ukuhla kwe-SpO2, ekubeni uninzi lwamatyala aluzange lurekhode amanqaku e-SpO2 angaphambi kwesifo, le nto ayinakuhlolwa ngaphambi kokuba nayiphi na ithontsi yokuqala ebangelwa yintsholongwane eyenza uvavanyo lwe-SpO2.Ngokombono wokwenza isigqibo, akukacaci ngokweklinikhi ukuba elona nqanaba lifanelekileyo lokuzalisa/lokuxutywa komntu ngelixa ehleli kufuneka lisetyenziswe njengesiseko sokhathalelo lwethishu, okanye nokuba inqanaba lokuzalisa/lokuxinanisa elicuthiweyo xa ulele phantsi emva kokuphumla kufuneka lisetyenziswe njengesiseko. isiseko.Kubonakala ngathi akukho mgaqo-nkqubo ekuvunyelwene ngawo lilizwe malunga noku.
I-SpO2% sisinyanzelo sepharamitha ekhoyo esidlangalaleni yokuvavanya i-COVID-19.I-NHS yaseNgilani ithenge i-370,000 oximeters ukuze isetyenziswe zizigulane ezininzi ukuze zisasazwe kwiinkonzo.
Izinto ezichazwe zingabangela ezininzi iinguqu zokulinganisa i-SpO2 ye-single-point, ezibangela ukuphononongwa kwezigulane ubuso ngobuso kwinkathalo ephambili okanye kumasebe angxamisekileyo.Ngokuhamba kwexesha, amawaka ezigulane kuluntu anokubekwa esweni kwi-SpO2, enokukhokelela kwinani elikhulu lokuphononongwa kobuso ngobuso okungafunekiyo.Xa impembelelo yezinto ezichaphazela ukufundwa kwe-SpO2 kwiimeko ze-COVID-19 ihlalutywa kwaye ibekwe kumxholo wekliniki esekwe kuluntu kunye nemilinganiselo yasekhaya, impembelelo enokubakho ibalulekile ngokwezibalo, ngakumbi kwabo "zizigidi ezilahlekileyo".Kusenokubakho i-SpO2 ebalulekileyo.Ukongeza, i-Oximetry @ Inkonzo yasekhaya iyakwazi ukukhetha abantu abanamanqaku anqunyulwe ngokujolisa abantu abangaphezu kweminyaka engama-65 kunye nabo banokuba ne-BMI ephezulu enxulumene ne-comorbidities.Uphononongo lubonise ukuba inani labantu "eliphantsi eliqhelekileyo" liya kubalelwa ubuncinane kwi-11.5% yabo bonke abantu, kodwa ngenxa yendlela yokukhetha ye-Oximetry @ inkonzo yasekhaya, le pesenti ibonakala iphezulu kakhulu.
Ekubeni izinto ezibhalwe ukuba zinefuthe kumanqaku e-SpO2 asemsebenzini, izigulane ezinamanqaku aphantsi ngokubanzi, ngakumbi abo banamanqaku angama-95%, banokuhamba phakathi kokulinganisa okuluhlaza kunye ne-amber amaxesha amaninzi.Esi senzo sinokuthi senzeke phakathi komlinganiselo wesiqhelo wekliniki xa uthunyelwa kwi-Oximetry@Home kunye nomlinganiselo wokuqala xa isigulane sisebenzisa iprotocol yemizuzu emi-6 yokulala phantsi ekhaya.Ukuba isigulana siziva singathandeki, ukuxhalaba ngexesha lokulinganisa kunokunciphisa abo banamanqaku anqunywe ngaphantsi kwe-95% kwaye bafune ukhathalelo.Oku kunokubangela ukhathalelo lobuso ngobuso oluninzi olungeyomfuneko, kubeka uxinzelelo olongezelelweyo kwiinkonzo ezithe zafikelela okanye zagqithisa umthamo.
Ngaphandle kokugunyazisa indlela ye-Oximetry@Home kunye nokubonelela abaguli ngezinto zonyango zee-oximeters, iingxelo zeendaba malunga nokuba luncedo kwe-pulse oximeters zixhaphakile, kodwa akwaziwa ukuba bangaphi abantu abanokuba ne-pulse oximeters ukuphendula kwi-COVID- Ubhubhani we-19. , nangona kukho abathengisi abaninzi abahlukeneyo abanikezela ngezixhobo ezingabizi kakhulu kunye neengxelo zezixhobo ezithengisiweyo (CNN, 2020), eli nani linokuba ngamakhulu amawaka ubuncinane.Imiba echazwe kweli nqaku inokuchaphazela naba bantu kwaye ibeke uxinzelelo olongezelelweyo kwinkonzo.
Sibhengeza ukuba ngamnye kubabhali abadwelisiweyo benze igalelo elikhulu ekuvelisweni kweli nqaku, kwaye banegalelo kwiingcamango nakumxholo obhaliweyo.
Ngenxa yokuvunywa kohlalutyo loncwadi kunye nekomiti yokuziphatha yophando, ayisebenzi kule nqaku.
Ukwabelana ngedatha akusebenzi kweli nqaku kuba akukho datha yedatha eyenziwe okanye ihlalutywe ngexesha lophando lwangoku.
Nceda ujonge i-imeyile yakho ngemiyalelo yokusetha kwakhona igama lokugqitha lakho.Ukuba awuyifumani i-imeyile kwimizuzu eli-10, idilesi yakho ye-imeyile isenokungabhaliswa kwaye unokufuna ukwenza i-akhawunti entsha yethala leencwadi ekwi-intanethi ye-Wiley.
Ukuba idilesi ihambelana neakhawunti ekhoyo, uya kufumana i-imeyile enemiyalelo yokufumana igama lomsebenzisi
Ixesha lokuposa: Jul-09-2021