Endotracheal ochititsa dzanzi: chimene icho chiri, zizindikiro, mankhwala

Masiku ano, n'zosadabwitsa mu njira imeneyi mankhwala opaleshoni. Ndipo patapita zaka zingapo zapitazo opaleshoni anali wofanana ndi imfa, odwala ambiri anafa ndi mantha chopweteka kapena sepsis. Kwa nthawi yaitali munthu amene akutithandiza kuti maloto opaleshoni anakhalabe ntchito Herculean wa mankhwala. Ndi kuphunzira za ndondomeko zimapangidwira wapita mofulumira. Bwino zogwirizana zosakaniza ndi kukonzekera mankhwala, amene Komanso, tsopano ikuchitika m'njira zosiyanasiyana. Mmodzi wa iwo ndi endotracheal ochititsa dzanzi. Ndi chiyani icho? Momwe ntchito ndipo pamene chofunika? Awa ndi mafunso ena ambiri m'nkhani ino.

Mbiri ya endotracheal ochititsa dzanzi

Kwa nthawi yoyamba mtundu wa mankhwala oletsa ululu amayesedwa mu zaka XIV-XV, pamene dokotala Paracelsus Swiss anadzetsa munthu trachea chubu kuposa anapulumutsa moyo wake. Patapita zaka zitatu motere adapulumusa anthu pa kupanda mlengalenga. Mu 1942, katswiri wa zochititsa dzanzi ku Canada ntchito koyamba relaxants minofu - mankhwala kuti kumachepetsa chigoba minofu kamvekedwe mpaka kumaliza immobilization. Zikomo kuti kupezeka kwa mankhwala ochititsa dzanzi wakhala abwino ndi changwiro choposa, kulola akatswiri pa zonse kugona opaleshoni pa opaleshoni.

Mu pakati pa XX m'ma endotracheal ochititsa dzanzi wakhala akutukuka mofulumira, mothandizidwa ndi madokotala Soviet. Lero ndi njira yofala ya mankhwala ochititsa dzanzi ambiri, ntchito m'kupita kwa kwambiri ntchito ya.

Endotracheal ochititsa dzanzi: ndichiyani?

Pofuna kuteteza thupi maganizo yaikulu opaleshoni, mankhwala ochititsa dzanzi ntchito. Zimakhala m'deralo, dera kapena ambiri. Mtundu yamasika amatchedwa mankhwala ochititsa dzanzi. Iwo amakhala ndi zonse "kutali" kutsitsimuka kwa wodwala ndi isanayambike kugona opaleshoni. Mu mankhwala ochititsa dzanzi ano chikuyendetsedwera m'nsinga, chigoba kapena amaphatikiza ochititsa dzanzi. Last Chili njira ziwiri ndi zinthu kulowa m'magazi, ndi kapepala kupuma. Mtundu wa foni ndi ochititsa dzanzi endotracheal.

Akatswiri moyenerera amamuona ngati njira kwambiri otetezeka komanso zothandiza mpumulo ululu: timatha inu kulamulira bwinobwino mmene wodwalayo, kukwaniritsa tulo opaleshoni, ndi chigoba minofu yosangalala ndi kupewa mavuto amenewa zosasangalatsa monga chiyembekezo ndi kulephera kupuma.

umboni

Endotracheal ochititsa dzanzi kumathandiza wodwala ku ululu mantha ndi kulephera kupuma, zikhoza kugwiritsidwa ntchito pa ntchito ndi odwala mwakayakaya. Mwa zizindikiro kwa mankhwala ochititsa dzanzi akhoza pamodzi:

• ntchito pa mediastinum, pharynx, khutu wamkati, mkamwa ndi mutu;
• alowererepo, imene kufunika kogwiritsa ntchito relaxants minofu;
• wonongeka mu wamanjenje dongosolo;
• zonse m'mimba syndrome;
• chiopsezo airway kutsekeka.

Endotracheal ambiri ochititsa dzanzi kawirikawiri amagwiritsidwa ntchito pa ntchito nthawi yaitali ndi kukhwima kwa mphindi oposa 30. Thiabendazole angagwiritsidwe ntchito pa m'badwo uliwonse limati osiyana wodwalayo, T. Kwa. Iye safuna kutsegula mtima ndi zina zambiri njira zochepa poizoni wa mankhwala ochititsa dzanzi.

contraindications

Kusankidwa opaleshoni (mwachitsanzo, kuchotsedwa ntchito mediastinal zotupa) akutsatiridwa ndi kuphunzira mosamalitsa alili. dotolo ali nthawi kofunika kuonanso mbiri zachipatala, yosamalira kuwerengera mavuto zotheka ndikupeza contraindications ndi njira makamaka wa mankhwala ochititsa dzanzi. Tikaphatikiza mankhwala oletsa ululu ali osavomerezeka chifukwa zinthu zotsatirazi:

• nthenda;
• chiwindi matenda, impso;
• amaganiziridwa m'mnyewa wamtima infarction;
• Airways matenda;
• mbali thupi ya kapangidwe ka pharynx ndi;
• aakulu matenda endocrine.

Oopsa kwambiri, makamaka kugwiritsa ntchito mankhwala ochititsa dzanzi endotracheal ndi chapamwamba matenda kupuma thirakiti, T. K. A chiopsezo cha matenda a m'mapapo.

Gawo ophatikizana ochititsa dzanzi

Choncho, endotracheal ochititsa dzanzi. Kodi izo kwa dokotala? Dzanzi amachita magawo atatu motsatizana kanthu: mawu oyamba kugona opaleshoni, kukhalabe boma khola ndi kudzutsa. Gawo loyamba ndi kugwiritsa ntchito kupatsidwa ulemu kosavuta kwa mankhwala ochititsa dzanzi. Wodwala m'nsinga wolandira mankhwala kapena Mpweya mpweya osakaniza. Pamene minofu ali omasuka kwathunthu, ndi anesthetist amaika mu tracheal lumen endotracheal chubu. Imakhala makina mpweya wabwino ndi inhalation ya mpweya ndi dzanzi gaseous.

Kamodzi madokotala amaliza ntchito yawo, mukubwera nthaŵi yofunika kwa dzanzi ndi - linanena bungwe la wodwalayo mankhwala ochititsa dzanzi. Mlingo wa mankhwala yafupika pang'onopang'ono. Pambuyo pa kubwezeretsedwa kupuma mowiriza extubated - kuchotsa pa endotracheal chubu mu trachea a. The wodwala kuwapititsa ku ICU n'kumaonerera zizindikiro kwambiri ndipo postoperative ndondomeko kuchira.

kupatsidwa ulemu wa mankhwala ochititsa dzanzi

Easy koyamba mankhwala oletsa ululu ali wofunikila sabweretsa chisoni komanso otetezeka intubation, amene N'zosatheka kukhazikitsa endotracheal ochititsa dzanzi. Pofuna kukwaniritsa boma zoterozo ntchito inhalation kapena mankhwala opha mtsempha. Mbali yoyamba, wodwalayo amapuma kudzera chigoba awiriawiri "Etra", "Foran", "halothane" kapena zina zosakaniza chimodzimodzi dzanzi. Nthawi zina zokwanira nitrous oxide ndi oxygen.

Monga medicaments kutumikiridwa m'nsinga, amagwiritsidwa ntchito barbiturates ndi neuroleptics (droperidol, fentanyl). Iwo ntchito monga njira (pazipita 1%). Mlingowu dzanzi anasankha munthu mmodzi wodwala aliyense.

Pambuyo kuwala ochititsa dzanzi kuchita kuchita tracheal intubation. Kuchita izi, ntchito relaxants minofu kumasuka khosi minofu. chubu umayamba mwa laryngoscope, pambuyo imene wodwala ndi kunditumiza ku yokumba m'mapapo mpweya wabwino. Gawo ayamba mankhwala oletsa ululu waukulu.

Droperidol: malangizo

Droperidol - antipsychotic, kawirikawiri amagwiritsidwa ntchito mankhwala ochititsa dzanzi endotracheal. Mankhwala kapangidwe thunthu ndi ukachenjede amine. Kale zotsatira sedative 3 Mphindi pambuyo utsogoleli. Letsani dopamine zolandilira, kuchititsa neurovegetative braking. Komanso, hypothermic ndipo ali ndi zotsatira antiemetic. Kupuma amakhudza pang'ono.

Anasonyeza kuti premedication, kupatsidwa ulemu wa mankhwala, m'mnyewa wamtima infarction, mantha, angina kwambiri, edema m'mapapo mwanga ndi mavuto hypertensive. Tikulimbikitsidwa monga mankhwala ndi, kumatha kunyansidwa ndi kusanza. Ali otsika kawopsedwe, zikhoza kugwiritsidwa ntchito opaleshoni Dokotala ndi obstetrics.

Njira ya ntchito antipsychotics pa kupatsidwa ulemu wa mankhwala ochititsa dzanzi

Pali embodiments angapo neyroleptanalgezii lapansi. Kupatsidwa ulemu nthawi zonse umachitikira ndi chiwembu zotsatirazi: droperidol, amene kalozera wakhala taonazi, mu kuchuluka kwa 2-5 ml ya ndi 6-14 ml ya fentanyl kutumikiridwa kwa wodwala kudzera m'mitsempha. Imodzi chigoba kudyetsedwa ndi osakaniza a okusayidi nitrous ndi mpweya mu chiŵerengero cha 2: 1 kapena 3: 1. Pambuyo yimitsira cha chikumbumtima ndipo minofu relaxants ndi kutumikiridwa Zitatero intubation.

Droperidol ndi zotsatira neuroleptic kwa maola 4-5, komabe chikuyendetsedwera pa chiyambi cha chakudya mankhwala ochititsa dzanzi. Ndi kuchita masamu amaganizira thupi: 0.25-0.5 mg / kg. Mobwerezabwereza utsogoleli wa mankhwala ayenera pa ntchito nthawi yokha.

Fentanyl ali ndi kuchuluka kwa 0.1 mg wa kutumikiridwa aliyense mphindi 20, ndi kupereka zake anasiya kwa mphindi 30-40 lisanathe opaleshoni. Koyamba mlingo ndi 5-7 mg / kg.

intubation

Pambuyo yimitsira chikugwirabe anagwira mpweya yokumba ndi mpweya ntchito chigoba mankhwala ochititsa. Pambuyo pake, dotolo amachita intubation kudzera (zina mwa mphuno). Chitaya mmbuyo mutu wake, pakamwa pake lotseguka. Direct jekeseni laryngoscope tsamba limodzi midline pakati pathambo ndi lilime, kukanikiza oposa masika. Kulimbikitsa chida zina kukweza nsonga ya epiglottis lapansi. Kuonetsa glottis, limene endotracheal chubu. Iwo ayenera kupita trachea za 2-3 cm. Pambuyo bwino intubation chubu vuto ndi kugwirizana wodwalayo othandizira lapansi.

Pasanathe ambiri ntchito laryngoscope ndi tsamba yokhota kumapeto. Iwo umayamba pakati pa tsinde la epiglottis ndi muzu wa lilime, otdavlivaya lolimba mpaka ndekha. Ngati ndi kosatheka mayikidwe a chubu kudzera pakamwa pa ntchito meatus m'munsi m'mphuno. Mwachitsanzo, opareshoni kuchotsa cysts m'kamwa zibowo zam'mano.

Kukonza ndi kumasuka ku ochititsa dzanzi

Pambuyo intubation ndi kugwirizana wodwalayo kwa othandizira zidzachitika yaikulu ya. Kugwira ntchito monga dokotala, ndi dzanzi amaonetsetsa zizindikiro n'zodalirika. Aliyense mphindi 15, fufuzani kugunda kwa mtima, kuthamanga kwa magazi, mothandizidwa ndi oyang'anira kusunga wodwalayo mtima ntchito.

General ochititsa dzanzi anakhalabe ndi Mlingo zina mankhwala antipsychotic, relaxants mnofu, kapena zosakaniza inhalation dzanzi. Opaleshoni pogonekedwa ndi mankhwala ophatikizana mtundu akulola dzanzi kusintha zosowa za thupi anira ululu powapatsa msinkhu akadakwanitsira a chitetezo.

Pambuyo pa mapeto a popanga munthu opaleshoni gawo lotsiriza - kuchokera kugona chomwa mankhwalawa. Mpaka nthawi imeneyo pang'onopang'ono kuchepetsa mlingo wa mankhwala. Kubwezeretsa kupuma atropine ndi Neostigmine pa intervals wa Mphindi 5. Kuonetsetsa kuti wodwala akhoza kupuma awo, extubated. Kuchita izi, kukonza malo a mtengo tracheobronchial. Pambuyo kuchotsa chubu, ndi njira zofanana imagwiridwa ndi M'mimbamo m'kamwa.

postoperative anaziika

Atachoka chipinda cha opareshoni, wodwalayo ali pabwino mu odwala mwakayakaya, kumene kuwayang'anira mosamala chikhalidwe chake. Pambuyo mankhwala ochititsa dzanzi ambiri kukhala kusamva, kupatula mavuto. Kawirikawiri, odwala pambuyo ntchito amadandaula:

• kupweteka;
• kusapeza mu mmero;
• nseru;
• kufooka ndi minofu kutopa;
• kusinza;
• chisokonezo;
• kuzizira;
• ludzu, kusafuna kudya.

zizindikiro zambiri kutha mkati woyamba maola 2-48 pambuyo opaleshoni. Kuthetsa ululu analgesics zinalembedwa.

Choncho, tiyeni mwachidule. Endotracheal ochititsa dzanzi - ndichiyani? Njira imeneyi powapatsa munthuyo tulo opaleshoni, amalola kuchita ntchito zovuta, kuyan'anila ntchito dongosolo kupuma. Tikaphatikiza mankhwala oletsa ululu si poizoni, ndi zovuta kulamulira akuya ochititsa dzanzi pa nthawi alowererepo pa. Pogonekedwa ndi mankhwala endotracheal kwenikweni ankatanthauza intubation, namtsata polumikiza wodwalayo othandizira lapansi. Pamene ntchito monga Mpweya ndi mankhwala ochititsa mankhwala, amene amangoona pamodzi.