Makarantar Kimiyyar Kiwon Lafiya da Jin Dadin Jama'a, Cibiyar Nazarin Jiyya da Jiyya ta Helen McArdle, Jami'ar Sunderland, Sunderland, Burtaniya
Nicholas Harland, Makarantar Kimiyyar Kiwon Lafiya da Jin Dadin Jama'a, Cibiyar Nursing da Nursing Helen McArdle, Jami'ar Sunderland City Campus, Chester Road, Sunderland SR1 3SD, UK.
Makarantar Kimiyyar Kiwon Lafiya da Jin Dadin Jama'a, Cibiyar Nazarin Jiyya da Jiyya ta Helen McArdle, Jami'ar Sunderland, Sunderland, Burtaniya
Nicholas Harland, Makarantar Kimiyyar Kiwon Lafiya da Jin Dadin Jama'a, Cibiyar Nursing da Nursing Helen McArdle, Jami'ar Sunderland City Campus, Chester Road, Sunderland SR1 3SD, UK.
Yi amfani da hanyar haɗin da ke ƙasa don raba cikakken sigar wannan labarin tare da abokanka da abokan aiki.Ƙara koyo.
An kunna sabis na COVID-19 Oximetry@Home a duk ƙasar.Wannan yana ba marasa lafiya masu haɗari masu ƙarancin alamun COVID-19 damar zama a gida kuma su sami oximeter na bugun jini don auna iskar oxygen (SpO2) sau 2 zuwa 3 a rana har tsawon makonni biyu.Marasa lafiya suna yin rikodin karatun su da hannu ko ta hanyar lantarki kuma ƙungiyar likitocin suna kula da su.Shawarar asibiti don amfani da algorithm ya dogara ne akan karatun SpO2 a cikin kewayon kunkuntar, inda maki 1-2 na iya shafar kulawa.A cikin wannan labarin, mun tattauna abubuwa da yawa da suka shafi karatun SpO2, kuma wasu "na al'ada" mutane za su sami "ƙananan al'ada" a matakin gudanarwa na asibiti ba tare da sanannun matsalolin numfashi ba.Mun tattauna yuwuwar tsananin wannan matsalar bisa la’akari da wallafe-wallafen da suka dace, kuma mun yi la’akari da yadda hakan zai shafi amfani da sabis na Oximetry@home, wanda zai iya rikitar da manufarsa a wani bangare;rage maganin ido-da-ido.
Akwai fa'idodi da yawa don sarrafa ƙananan cututtukan COVID-19 a cikin al'umma, kodayake wannan yana hana amfani da kayan aikin likita kamar na'urori masu auna zafin jiki, stethoscopes, da na'urorin bugun jini yayin kimantawa.Koyaya, tunda ma'aunin oximetry na majiyyaci a gida yana da amfani wajen hana ziyartar sashen gaggawa na gaggawa (Torjesen, 2020) da farkon gano hypoxia asymptomatic, duk da haka, NHS Ingila ta ba da shawarar cewa duk ƙasar Aminta da sabis na “Spo2 Measurement@Home” (NHSE) , 2020a)) Ga marasa lafiya da ke da alamun COVID-19 masu sauƙi amma mafi girman haɗarin lalacewar cuta, ana iya amfani da oximeter na bugun jini na tsawon kwanaki 14 na jiyya, ta yadda sau 2-3 a rana Kula da kai na saturation na oxygen (SpO2) .
Marasa lafiya da ake magana da su Oximetry@Sabis na Gida yawanci ana umurce su da yin amfani da ƙa'idar ko bayanin kula na takarda don yin rikodin abubuwan da suka gani.Ka'idar ko dai tana ba da amsa ta atomatik/shawarwari, ko kuma likitan yana sa ido kan bayanan.Idan ya cancanta, likita na iya tuntuɓar mai haƙuri, amma yawanci kawai a lokacin lokutan aiki na al'ada.Ana gaya wa marasa lafiya yadda za su fassara sakamakon su don su iya yin aiki da kansu lokacin da ake bukata, kamar neman kulawar gaggawa.Saboda babban haɗarin cutar da cutar, mutanen da suka wuce shekaru 65 da / ko tare da cututtuka masu yawa waɗanda aka ayyana a matsayin masu rauni suna zama makasudin wannan tsarin (NHSE, 2020a).
Ƙimar majiyyata a cikin sabis na Oximetry@Home shine farkon don auna iskar oxygen ta hanyar pulse oximeter SpO2, sannan a yi la'akari da wasu alamu da alamun.Yin amfani da kimar ja, amber, da kore (RAG), idan SpO2 na majiyyaci ya kasance 92% ko ƙasa, ana rarraba mara lafiyar a matsayin ja, kuma idan SpO2 ɗin su ya kasance 93% ko 94%, ana rarraba su azaman amber, idan SpO2 ɗin su. shine 95% ko sama da haka, an rarraba su azaman kore.Gabaɗaya, koren marasa lafiya ne kawai suka cancanci amfani da Oximetry@Home (NHSE, 2020b).Duk da haka, daban-daban abubuwan da ba su da alaka da cututtuka na iya rinjayar ma'aunin SpO2, kuma waɗannan abubuwan ƙila ba za a yi la'akari da su a cikin hanya ba.A cikin wannan labarin, mun tattauna abubuwa daban-daban da ke shafar SpO2 waɗanda zasu iya shafar damar marasa lafiya zuwa sabis na Oximetry@Home.Waɗannan abubuwan na iya ɗan ruɗar da manufarta na rage matsi na ayyukan likita ido-da-ido.
Matsakaicin yarda na “al’ada” jikewar iskar oxygen na jini wanda aka auna ta pulse oximeter (SpO2) shine 95%-99%.Duk da wanzuwar takardu irin su Hukumar Lafiya ta Duniya Pulse Oximetry Training Manual (WHO, 2011), bayanin ya cika ko'ina wanda ba kasafai labaran likitanci ke ambato ta ba.Lokacin nemo bayanan tsari akan SpO2 a cikin mutanen da ba likitocin ba, ana samun ƙaramin bayanai.A cikin nazarin mutane 791 masu shekaru 65 da haihuwa (Rodríguez-Molinero et al., 2013), bayan la'akari da masu canji kamar COPD, matsakaicin 5% SpO2 ya kasance 92%, yana nuna ma'auni 5% Matsayin jinin oxygen jikewa na yawan jama'a. yana da ƙasa da haka ba tare da wani sanannen bayanin likita ba.A cikin wani binciken na mutane 458 masu shekaru 40-79 (Enright & Sherrill, 1998), kewayon jikewar iskar oxygen kafin gwajin tafiya na mintuna 6 shine 92% -98% a cikin kashi 5th, kuma a cikin kashi 95th.Kashi na farko shine 93% -99% bisa dari.Duk karatun biyu ba su rubuta hanyoyin da aka yi amfani da su don auna SpO2 daki-daki ba.
Binciken yawan jama'a na mutane 5,152 a Norway (Vold et al., 2015) ya gano cewa 11.5% na mutane suna da SpO2 a ƙasa ko daidai da 95% ƙananan ko ƙananan iyaka na al'ada.A cikin wannan binciken, mutane kaɗan ne kawai masu ƙananan SpO2 aka ruwaito suna da asma (18%) ko COPD (13%), yayin da yawancin mutanen da ke da BMI mai mahimmanci sun wuce 25 (77%) kuma sun kasance manya Wasu suna da shekaru 70 ko babba (46%).A cikin United Kingdom, 24.4% na shari'o'in da aka gwada don COVID-19 tsakanin Mayu da Agusta 2020 sun kasance shekaru 60 ko sama da haka, kuma 15% sun kasance shekaru 70 ko fiye [8] (Ma'aikatar Lafiya da Kula da Jama'a, 2020).Kodayake binciken Yaren mutanen Norway ya nuna cewa 11.5% na kowane yawan jama'a na iya samun ƙananan SpO2, kuma mafi yawan waɗannan lokuta ba su da masaniyar ganewar numfashi, wallafe-wallafen sun nuna cewa za a iya samun "miliyoyin" na COPD da ba a gano ba (Bakerly & Cardwell, 2016) Kuma mai yiwuwa. Babban adadin cututtukan cututtukan da ba a gano su ba (Masa et al., 2019).Mahimman ƙididdiga na ƙididdiga na SpO2 "ƙananan al'ada" da ba a bayyana ba a cikin nazarin yawan jama'a na iya samun cututtuka na numfashi marasa ganewa.
Baya ga bambance-bambancen gaba ɗaya, takamaiman dalilai na ƙa'idar da aka yi amfani da su don auna SpO2 na iya shafar sakamakon.Akwai bambanci mai mahimmanci tsakanin ma'aunin da aka ɗauka yayin hutawa da ma'aunin da aka ɗauka yayin zaune (Ceylan et al., 2015).Bugu da ƙari, da kuma abubuwan da suka shafi shekaru da kiba, SpO2 na iya raguwa a cikin minti 5-15 na hutawa (Mehta da Parmar, 2017), musamman a lokacin tunani (Bernardi et al., 2017).Yanayin zafin jiki da ke da alaƙa da zafin yanayi na iya samun tasiri mai mahimmanci na ƙididdiga (Khan et al., 2015), kamar yadda yake damuwa, kuma kasancewar damuwa na iya rage ƙima da cikakken ma'ana (Ardaa et al., 2020).A ƙarshe, an san cewa daidaitaccen kuskuren ma'aunin bugun jini shine ± 2% idan aka kwatanta da daidaitaccen ma'aunin iskar gas na jini na jini SaO2 (American Thoracic Society, 2018), amma daga mahangar asibiti, daga mahimmin ra'ayi, domin babu yadda za a yi a yi la’akari da wannan bambamci, dole ne a auna shi kuma a yi aiki da shi daidai gwargwado.
Canje-canje a cikin SpO2 na tsawon lokaci da maimaita ma'auni wata matsala ce, kuma akwai ƙarancin bayanai game da wannan a cikin mutanen da ba likitocin ba.Ƙananan samfurin (n = 36) binciken yayi nazarin canje-canje na SpO2 a cikin sa'a daya [16] (Bhogal & Mani, 2017), amma bai bayar da rahoton bambancin ba yayin maimaita ma'auni a cikin makonni da yawa, kamar yadda a cikin Oximetry @ Yayin Gida.
A lokacin 14-day Oximetry@Home monitoring period, SpO2 an auna sau 3 a rana, wanda zai iya zama akai-akai ga marasa lafiya masu damuwa, kuma ana iya ɗaukar ma'auni 42.Ko da ɗauka cewa ana amfani da ƙa'idar ma'auni iri ɗaya a kowane hali kuma yanayin asibiti ya tabbata, akwai dalilin da za a yarda cewa akwai wani bambanci a cikin waɗannan ma'auni.Nazarin yawan jama'a ta amfani da ma'auni ɗaya ya nuna cewa 11.5% na mutane na iya samun SpO2 na 95% ko ƙasa da haka.Tsawon lokaci, akan lokaci, yuwuwar samun ƙaramin karatu yayin maimaita ma'auni yana faruwa akan lokaci shawarar COVID-19 na iya zama sama da 11.5%.
Algorithm bayan sabis na Oximetry@Home yana nuna cewa sakamako mara kyau yana da alaƙa da ƙananan makin SpO2 [17] (Shah et al., 2020);Wadanda ke da SpO2 sun fadi zuwa 93% zuwa 94% ya kamata a yi gwajin likita ido-da-ido kuma a yi la'akari da su don shigar da su, 92 % Kuma a ƙasa ya kamata a sami kulawar gaggawa ta sakandare.Tare da aiwatar da sabis na Oximetry@Home a duk faɗin ƙasa, maimaita ma'aunin SpO2 da marasa lafiya suka ɗauka a gida zai zama muhimmin abu don bayyana yanayin asibiti.
Ana yin ma'aunin SpO2 galibi a cikin ɗan gajeren lokaci lokacin da aka sanya oximeter.Mai haƙuri yana zaune ba tare da hutawa ba na wani lokaci.Yin tafiya daga wurin jira zuwa wurin asibiti zai katse sauran jiki.Tare da kunna sabis na Oximetry@Home, an fitar da bidiyon YouTube na NHS (2020).Bidiyon ya ba da shawarar cewa marasa lafiya waɗanda ke ɗaukar awo a gida su kwanta na mintuna 5, su sanya oximeter, sannan su sami mafi kwanciyar hankali karatu minti 1 bayan sanyawa.An yada wannan hanyar haɗin bidiyo ta hanyar dandalin haɗin gwiwar NHS na gaba wanda ke da alaƙa da mutumin da ya kafa Oximetry@Sabis na Gida, amma ba ze nuna cewa wannan na iya samar da ƙananan karatun ba idan aka kwatanta da karatun da aka ɗauka yayin zaune.Yana da kyau a lura cewa wani bidiyon ilimin kiwon lafiya na NHS a Ingila a cikin jaridar Daily Mail yana ba da shawarar wata yarjejeniya ta daban, wacce ita ce karanta yayin zaune (Daily Mail, 2020).
A cikin mutumin da ba a san shi gabaɗaya ba, ƙaramin maki na 95%, ko da digo na maki 1 saboda kamuwa da COVID-19 na iya haifar da ƙimar Amber, wanda ke haifar da kulawar asibiti kai tsaye.Abin da ba a sani ba shine ko maki guda na raguwa zai sa kulawar asibiti kai tsaye ta zama ingantaccen amfani da albarkatu a tsakanin mutane masu ƙarancin kima kafin kamuwa da cuta.
Kodayake algorithm na ƙasa kuma ya ambaci raguwar SpO2, tun da yawancin lokuta ba su yi rikodin makin SpO2 na riga-kafi ba, ba za a iya tantance wannan lamarin ba kafin duk wani faɗuwar farko da kwayar cutar ta haifar da ta haifar da ƙimar SpO2.Daga hangen nesa na yanke shawara, ba a sani a asibiti ba ko yakamata a yi amfani da mafi kyawun yanayin jikewa/perfusion yayin zaune a matsayin tushen kula da nama, ko kuma rage yawan jikewa/perfusion yayin kwanciya bayan hutu yakamata a yi amfani da shi azaman tushe.Da alama babu wata manufar da kasar ta amince da ita kan hakan.
SpO2% shine madaidaicin samuwa ga jama'a don kimanta COVID-19.NHS Ingila ta sayi oximeters 370,000 don amfani da marasa lafiya da yawa don rarrabawa ga ayyuka.
Abubuwan da aka bayyana na iya haifar da sauye-sauyen ma'aunin SpO2 guda ɗaya, yana haifar da sake dubawa na fuska da fuska a cikin kulawa na farko ko sassan gaggawa.A tsawon lokaci, ana iya lura da dubban marasa lafiya a cikin al'umma don SpO2, wanda zai iya haifar da adadi mai yawa na sake dubawa na fuska da fuska.Lokacin da aka bincika tasirin abubuwan da ke shafar karatun SpO2 a cikin shari'o'in COVID-19 kuma aka sanya su cikin mahallin asibiti na tushen yawan jama'a da ma'aunin gida, tasirin yuwuwar yana da mahimmanci a ƙididdiga, musamman ga waɗanda "bacewar miliyoyin" SpO2 mai mahimmanci yana da yuwuwa.Bugu da kari, sabis na Oximetry@Home yana da yuwuwar zaɓar mutanen da ke da maki mai yankewa ta hanyar niyya ga mutane sama da 65 da waɗanda ƙila suna da BMI mafi girma da ke da alaƙa da cututtuka.Nazarin ya nuna cewa yawan "ƙananan al'ada" zai yi lissafin aƙalla 11.5% na duk mutane, amma saboda zaɓin zaɓi na sabis na Oximetry@Home, wannan kashi yana da alama ya fi girma.
Tun da abubuwan da aka rubuta don tasiri maki SpO2 suna kan aiki, marasa lafiya da ke da ƙarancin ƙima gabaɗaya, musamman waɗanda ke da maki 95%, na iya motsawa tsakanin ƙimar kore da amber sau da yawa.Wannan aikin na iya faruwa tsakanin ma'aunin aikin asibiti na yau da kullun lokacin da aka koma Oximetry@Home da ma'aunin farko lokacin da majiyyaci yayi amfani da ka'idar kwance ta mintuna 6 a gida.Idan mai haƙuri ya ji rashin lafiya, damuwa yayin aunawa na iya rage waɗanda ke da maki mai yankewa a ƙasa da 95% kuma ya nemi kulawa.Wannan na iya haifar da kulawa ta fuska da fuska da yawa mara amfani, yana ƙara matsa lamba akan ayyukan da suka kai ko wuce gona da iri.
Ko da a wajen hanyar Oximetry@Home da aka ba da izini da kuma kayan aikin likita waɗanda ke ba marasa lafiya da oximeters, rahotannin labarai game da fa'idar pulse oximeters sun yadu, kuma ba a san adadin yawan jama'a na iya samun bugun bugun jini ba saboda cutar ta COVID-19, kodayake. akwai dillalai daban-daban da ke ba da kayan aiki masu arha da rahotannin kayan aikin da aka sayar (CNN, 2020), wannan lambar na iya zama aƙalla ɗaruruwan dubbai.Abubuwan da aka bayyana a cikin wannan labarin na iya shafar waɗannan mutane kuma su ƙara matsa lamba akan sabis ɗin.
Mun bayyana cewa kowane marubucin da aka jera ya ba da gudummawa mai mahimmanci ga samar da wannan labarin, kuma ya ba da gudummawa ga ra'ayoyi da abubuwan da aka rubuta.
Saboda amincewar kwamitin nazarin adabi da bincike, bai dace da ƙaddamar da wannan labarin ba.
Rarraba bayanai baya aiki ga wannan labarin saboda ba a ƙirƙira ko bincikar saitin bayanai ba yayin lokacin bincike na yanzu.
Da fatan za a duba imel ɗin ku don umarnin sake saita kalmar wucewa.Idan ba ku sami imel a cikin mintuna 10 ba, adireshin imel ɗin ku bazai yi rajista ba kuma kuna iya buƙatar ƙirƙirar sabon asusun Laburare na Wiley Online.
Idan adireshin ya yi daidai da asusun da ke akwai, za ku karɓi imel tare da umarni don dawo da sunan mai amfani
Lokacin aikawa: Yuli-15-2021