terça-feira, 21 de outubro de 2008

Oximetria de Pulso

Encontrei estas duas opiniões cheias de sabedoria em relaçao a esta temática e achei interessante expô-las aqui no blog... desde já os parabéns aos que opinaram...

Uma Opinião:

A oximetria de pulso é baseada em dois princípios: -A oxihemoglobina e a dioxihemoglobina diferem na absorção da luzvermelha e infravermelha (ou seja espectrofotometria).O volume de sangue arterial nos tecidos (e consequentemente, a absorção de luz por esse sangue) altera-se durante a pulsação(ou seja pletismografia). O oxímetro de pulso determina a SpO2passando luz vermelha e infravermelha pelo leito arteriolar e medindo as mudanças na absorção de luz durante o pulso.As fontes de luz no sensor de oximetria são emissores de luz vermelha e infravermelha; existindo um fotodetector (normalmente a própria ergonomia do aparelho leva-nos a dispensar o trabalho de raciocinar nesse aspecto…lol)Visto que a oxihemoglobina e a dioxihemoglobina diferem na absorção de luz, a quantidade de luz vermelha ou infravermelha absorvida pelo sangue está relacionada à saturação de oxigénio da hemoglobina. Para identificar a saturação de oxigénio dahemoglobina arterial, o monitor utiliza a natureza pulsátil do fluxo arterial. Durante a sístole, um novo pulso de sangue arterialpenetra no leito vascular e o volume de sangue e a absorção de luz aumentam. Durante a diástole, o volume de sangue e a absorção de luz atingem o seu ponto mais baixo. O monitor interpreta as medidas de SpO2 na diferença entre absorção máxima e mínima (por exemplo, medidas em sístole e diástole). Dessa maneira, ele “foca” a absorção de luz pelo sangue arterial pulsátil, eliminando os efeitos de absorventes não-pulsáteis, como tecidos,ossos e sangue venoso.Por isso, para que possamos considerar que o valor de SpO2 é real, ele tem de se coadunar com a frequência cardíaca e pulso( se tiveres uma monitorização invasiva da pressão arterial ainda notarás melhor isto pois a onda do oxímetro será semelhante à da TA, se tudo correr bem...lol) . Dai que num doente hipotenso seja por vezes difícil aferir a SpO2 ou também em casos de hipoperfusão periférica uma vez que o pulso pode não ser aferível, não pelo menos no local onde o oxímetro é colocado ( normalmente um dedo da mão num adulto, pode também ser usada a orelha e outras coisas afins).Muito mais há a dizer sobre isto...

Outra Opiniao...


O oxímetro mede a saturação funcional – hemoglobina oxigenada expressa como uma percentagemda hemoglobina que pode transportar oxigénio. Ele não detecta quantidades significativas de hemoglobina disfuncional, como carboxihemoglobina ou metahemoglobina. Por isso não é propriamente a dioxihemoglobina que poderá ser responsável por isso que referiu.São vários os factores que podem interferir com a leitura da oximetria de pulso:Dishemoglobinemias:Quando presentes em quantidades significativas, tanto a carboxihemoglobina (COHb) quanto a metahemoglobina (MetHb), podem alterar a leitura da SpO2. Não há previsibilidade de erro, isto é, se existirá sub ou sobrestimação da concentração, uma vez que o espectro de absorção destas hemoglobinas é semelhante ao da hemoglobina reduzida e oxihemoglobina. Corantes: Azul de metileno, fluoresceína, alguns vernizes para as unhas provocam falsas leituras(por baixo) da SpO2.Luz ambiente: Apesar de haver correcção automática na maioria dos oxímetros de pulso, luzes fluorescentes, focos cirúrgicos de xénon e luz solar podem alterar a leitura da SpO2, dando valores inferiores ao real (acreditem…).Artefactos de movimento: Os movimentos do sensor, por exemplo os que ocorrem durante tremores, dá medidas incorrectas e falsos alarmes. Hipoperfusão:Baixo débito cardíaco, hipotermia e vasoconstrição comprometem a intensidade do pulso arterial e portanto a intensidade do sinal “correcto” a ser lido.Anemia: A anemia isolada não compromete a leitura da oximetria de pulso, porém quando associada à hipoxémia, pode traduzir-se em leituras “esquisitas”.Pulso venoso: Estados de sobrecarga de volume, que condicionem sobrecarga da rede vascular venosa que possam determinar a presença de pulso venoso pode fornecer também uma falsa baixa leitura da SpO2, já que os oxímetros são programados para identificar o sinal pulsátil como de origem arterial.
Mesmo sendo uma parâmetro muito útil a oximetria de pulso dá-nos apenas uma estimativa da oxigenação. O diagnóstico de certeza é dado pela gasometria e aferição do valor de PaO2 e claro…também pelo doente.

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been revealed but it is thought that it could be up to £100 cheaper than the equivalent i - Pad model, which will
make it a very attractive proposition indeed once the Black - Berry Playbook release date arrives.
One of the first Black - Berry smartphones to feature Black - Berry OS
6, the Torch has been a breath of fresh air to the declining brand.


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