Zomzimba Endotracheal: oko kukuthi, izalathisi, iziyobisi

Namhlanje, akumangalisi kule ndlela unyango uqhaqho. Kwaye emva kokuba kwiinkulungwane embalwa edlulileyo utyando wayelingana ekufeni, izigulane ezininzi wabulawa yabanjwa kabuhlungu okanye nokudumba. Kangangethuba elide umntu lokuphatha iphupha ngotyando wahlala umsebenzi Herculean yeyeza. Nezifundo inkqubo chemistry uye ngokukhawuleza. Ngcono ukufanela imixube ngamalungiselelo zomzimba, leyo, kaloku ke, ngoku wenziwa ngeendlela ezininzi. Omnye wabo ke Ukubulawa endotracheal. Yintoni na? xa idingeka njani kusetyenziswa kuyo? Le mibuzo neminye emininzi ukuphendula kweli nqaku.

Ukusuka kwimbali endotracheal Ukubulawa

Kuba ixesha lokuqala olu hlobo zomzimba linyibilikisiwe kwi XIV-XV iinkulungwane, xa ugqirha Paracelsus Swiss kwangena indoda uqhoqhoqho ityhubhu ngaphezu kusindiswa ngobomi bakhe. Emva kwamakhulu amathathu ngale ndlela wabasindisa abantu yokunqongophala emoyeni. Ngowe-1942, i-anesthesiologist evela Canada kuqala kusetyenziswa relaxants imisipha - into leyo kunciphisa kwezihlunu skeletal ukugqiba immobilization. Ngenxa kule kwafunyanwa zomzimba iye ikhuseleke ugqibeleleyo, ukuvumela iingcali ulawulo ngokupheleleyo phezu ubuthongo ngotyando ngexesha utyando.

Embindini ye XX endotracheal ngenkulungwane zomzimba sele olukhula ngokukhawuleza, encediswa ngoogqirha yiSoviet. Namhlanje ke eyona ndlela iqhelekileyo ye zomzimba jikelele, ezisetyenziswa ngexesha ezininzi imisebenzi.

zomzimba Endotracheal: ntoni na?

Ukuze kukhuselwe umzimba ukusuka uxinzelelo olukhulu zotyando, kusetyenziswa zomzimba. Kunokuba wengingqi, wenqila okanye jikelele. Uhlobo yokugqibela kuthiwa zomzimba. Lubonakala ngumntu ngokupheleleyo "off" isenesazela isigulane xa kuqala ebuthongweni yotyando. Xa zomzimba mihla ilawulwa yegazi, imaski okanye Ukubulawa zidityanisiwe. Last idibanisa iindlela ezimbini izinto kungena egazini, kunye iphecana sokuphefumla. Olu hlobo umnxeba kunye Ukubulawa endotracheal.

Iingcali ngokufanele wamphatha njengoko indlela kakhulu ekhuselekileyo nephumelelayo ntlungu: kukuvumela ukulawula ngokupheleleyo imeko yomguli, ukuphumeza ubuthongo zotyando, kwaye skeletal kwemisipha zokwehlisa kwaye siphephe iingxaki angazithandiyo ezifana ezifana Eskom kunye nokungaphumeleli zokuphefumla.

ubungqina

zomzimba Endotracheal kuthintela isigulane ngenxa yokothuka intlungu ukusilela zokuphefumla, ukuba ingasetyenziswa ngexesha lomsebenzi kunye labagula kakhulu. Phakathi ezibonisa ukuba zomzimba zinokudityaniswa:

• imisebenzi mediastinum, pharynx, indlebe yangaphakathi, umlomo kunye nentloko;
• ngoncedo, apho imfuneko yokusebenzisa relaxants kwezihlunu;
• ukungasebenzi kakuhle luvo;
• syndrome isisu ngokupheleleyo;
• umngcipheko ngokuma kokuphazanyiswa.

zomzimba jikelele Endotracheal lidla kusetyenziselwa imisebenzi ixesha elide kunye ngokobudala ngaphezu kwemizuzu eli-30. Ingasetyenziswa na ubudala uthi ezahlukeneyo isigulane, t. To. Akayi ntoni ukulayisha intliziyo enye phi iindlela ayinabungozi ye zomzimba.

Izimo

utyando imbalo (umz, umsebenzi ukususwa nangezilonda mediastinal) kulandele ukufundisisa imeko yesigulane. Ugqirha unalo ixesha kufuneke kwenziwe imbali yezonyango, ukulawula ukubala ngeengozi nokuchonga Izimo ukuba indlela ethile zomzimba. zomzimba oludityanisiweyo akukhuthazwa ukuba le miqathango ilandelayo:

• isifo esosulelayo;
• isifo sesibindi, zezintso;
• eko iposi engabalulekanga;
• isifo Airways;
• iimpawu komzimba ye isakhiwo pharynx;
• iingxaki ezidalwe kakhulu.

Iyingozi kakhulu ukuba ukusebenzisa zomzimba endotracheal kunye izifo zangentla ezihlasela zosulele ngokuphefumla phecana, t. K. A basengozini enkulu yosulelo lwe semiphunga.

Stage Ukubulawa zihlangene

zomzimba Ngoko, endotracheal. Yintoni na ukuba ngugqirha? Anesthesiologist owenza izigaba ezithathu ezilandelelanayo ntshukumo: ukuqaliswa ebuthongweni ngotyando, nokugcina imeko ezinzileyo nokuvuka. Inqanaba lokuqala kukuba aphumeze elula kuFacebook zomzimba. Isigulana yegazi ifumana iziyobisi okanye umxube irhasi ukurhogele. Xa izihlunu bekhululekile ngokupheleleyo, ugqirha kubeka tracheal mithambo endotracheal ityhubhu. Inika yomatshini kunye inhalation ioksijini kunye iintlungu sukube.

Xa oogqirha begqibe umsebenzi wabo, kuza ngesiquphe kubme anesthesiologist - we isigulane zomzimba. Le umthamo iziyobisi licuthwa ngokucuthwa. Emva kokuba ukubuyiselwa ukuphefumla ezizenzekelayo extubated - ukususwa le endotracheal ityhubhu kwi noqhoqhoqho. Isigulane ithuthelwe ICU, ukubukela iimpawu ezibalulekileyo kunye nenkqubo recovery postoperative.

kuFacebook Ukubulawa

Easy zomzimba yokuqala efunekayo ukuze ekumfakeni yalula kwaye ikhuselekile, oko akunakwenzeka ngaphandle ukuphunyezwa endotracheal zomzimba. Ukuphumeza meko ukusetyenziswa inhalation okanye iintlungu efakwa. Kwimeko yokuqala, isigulana ephefumlayo ngokusebenzisa ngababini isigqumathelo "Etra", "Foran", "halothane" okanye eminye imixube efanayo iintlungu. Maxa wambi kuba oxide ngokwaneleyo oxide neoksijini.

Njengoko imithi ezilawulwa yegazi, eziqhele ukusetyenziswa barbiturates kunye neuroleptics (droperidol, fentanyl). Zisetyenziswa njengesisombululo (ubuninzi-1%). Umthamo anesthesiologist ezikhethiweyo ngayinye isigulane ngasinye.

Emva ukukhanya zomzimba isenzo ukwenza tracheal ekumfakeni. Ukuze wenze oku, ukusetyenziswa relaxants umsipha imisipha entanyeni. Ityhubhu yaziswa ngalo laryngoscope, emva koko isigulane idluliselwe kumntu umoya lung ngumntu. Inqanaba iqala Ukubulawa enzulu.

Droperidol: imfundo

Droperidol - antipsychotic, isoloko isetyenziswa Ukubulawa endotracheal. Ubume chemical ubuncwane i ngomdla ephakamileyo. Sele okulalisa kwemizuzu-3 emva nolawulo. Uvimba ezenza dopamine, ebangela unyathela neurovegetative. Ngaphezu koko, hypothermic kwaye anazo neziphumo antiemetic. Ukuphefumla sichaphazela kancinci.

Eboniswe premedication, wokuqhelaniswa zomzimba, iposi engabalulekanga, ukothuka, angina kakhulu, nokudumba yemiphunga nezengekho kwingxaki unesifo. Kucetyiswa ukuba ichiza, ephelisa isicaphucaphu nokugabha. Ngaba zinetyhefu esezantsi, inokusetyenziswa kutyando abantwana kunye nokubeleka.

Technique kokusebenzisa antipsychotics ngexesha kuFacebook Ukubulawa

Kukho embodiments abaliqela neyroleptanalgezii. Induction ngokuqhelekileyo luqhutywa yi le nkqubo ilandelayo: droperidol, leyo sikhokelo iye ingqalelo ngasentla, kwi-mali ka-2-5 ml kunye 6-14 ml fentanyl elawulwa ukuba isigulane yegazi. Kwangaxeshanye ukuwafihla wadliswa ngomxube nitrous oxide neoksijini umlinganiselo we-2: 1 okanye ezi-3: 1. Emva kwezithandani sezingqondweni izihlunu relaxants zilawulwa ukuba uqhubeke ekumfakeni.

Droperidol ukuba isiphumo neuroleptic iiyure 4-5, nangona kunjalo, ukuba ilawulwa ekuqaleni kobonelelo zomzimba. Oku kubalwa kuthathelwa ingqalelo ubunzima bomzimba: 0.25-0.5 mg / kg. ulawulo-phindo lwe ichiza kufuneka kuphela ngexesha lomsebenzi elide.

Fentanyl na isixa-mali ka-0.1 mg ezilawulwa rhoqo emva kwemizuzu engama-20, kunye nonikezelo yayo iyakuvingca imizuzu 30-40 phambi kokuphela zotyando. ithamo yokuqala 5-7 mg / kg.

ekumfakeni

Emva kwezithandani lokuqonda bamthwala umoya ngumntu mpilo usebenzisa imaski iintlungu. Emva koko, ugqirha owenza ekumfakeni ngomlomo (ngamanye amaxesha ngokusebenzisa ezimpumlweni). Olahla umva intloko yakhe, umlomo wakhe ezivulekileyo. Direct zifakwa blade laryngoscope ecaleni osembindini phakathi esibhakabhakeni kunye ulwimi, etyhalela phezulu yokugqibela. Ukukhuthaza isixhobo phakamisa ngakumbi incam yaloo epiglottis. Ukubonisa glottis, Elizifihla kuyo tube endotracheal. Kufuneka uye kulo uqhoqhoqho malunga 2-3 cm. Emva ngempumelelo ekumfakeni ityhubhu elungisa kwaye uqhagamshele isigulane mpilo.

Ngaphantsi iqhele ukusetyenziswa laryngoscope kunye blade egosogoso. Le kuqaliswa phakathi esisekweni epiglottis kwaye ingcambu kolwimi, otdavlivaya ingahlala ngokwam. Ukuba kufakwe akunakwenzeka ukuba ityhubhu ngokusebenzisa umlomo usebenzisa meatus asezantsi ngeempumlo. Umzekelo, umsebenzi asuse cysts umgodi ngomlomo.

Isondlo kunye nokufunyanwa Ukubulawa

Emva ekumfakeni ukudibanisa isigulane mpilo kwenzeka ngexesha zaseprayimari. Ngenkuthalo wayesebenza ugqirha, i anesthesiologist ngenyameko ijonga indicators yokuphila. Yonke imizuzu eli-15, khangela umlinganiselo kwentliziyo, uxinzelelo lwegazi, ngoncedo liso bebona umsebenzi kwentliziyo yesigulana.

zomzimba jikelele egcinwa yi amathamo ezongezelelweyo iziyobisi antipsychotic, relaxants imisipha, okanye iintlungu imixube inhalation. Ukusebenza phantsi zomzimba uhlobo zidibene kuvumela anesthesiologist ukunyenyisa iimfuno zomzimba kulawulo iintlungu ngokunikela inqanaba ngokupheleleyo ukhuseleko.

Emva kokuphela ukuhlinza loo kwinqanaba lokugqibela - ngaphandle ebuthongweni ezidakumbisayo. De kube lelo xesha ngokuthe ukunciphisa umthamo iziyobisi. Ukubuyisela ukuphefumla atropine kunye Neostigmine emva kwesithuba kwemizuzu emi-5. Ukuqinisekisa ukuba isigulana uyakwazi ukuphefumla ngokwabo, extubated. Ukuze wenze oku, ekucoceni indawo umthi tracheobronchial. Emva ukususwa ityhubhu, yaye inkqubo efanayo lwenziwa kunye kwisisu ngomlomo.

elibukhali postoperative

Emva kokuphuma kwigumbi yokusebenza, isigulane ibekwe kwiyunithi labagula kakhulu, apho esweni ngokusondeleyo imeko yakhe. Emva zomzimba jikelele ukuphuhlisa ukungakhululeki, iingxaki ngaphantsi. Ngokuqhelekileyo, izigulane post-operative ezikhala:

• buhlungu;
• kabi emqaleni;
• isicaphucaphu;
• ubuthathaka kunye kwemisipha nokudinwa;
• ukozela;
• ukudideka;
• Ukugodola;
• unxano nokungabi onombilini.

Ezi mpawu zikholisa zinyamalale kwisithuba seeyure 2-48 emva kotyando. Ukuze ukuphelisa analgesics iintlungu emiselweyo.

Ngoko ke, masikhe zishwankathela. Endotracheal zomzimba - ntoni na? Le ndlela yokwazisa mntu ubuthongo ngotyando, likuvumela ukuba wenze imisebenzi enzima, ukubeka esweni umsebenzi isixokelelwano sokuphefumla. zomzimba Ludityanisiwe ingaphantsi ezingenabungozi, yaye kulula ukulawula ubunzulu zomzimba ngethuba longenelelo. Phantsi zomzimba endotracheal ngokuyintloko kwakuthetha ekumfakeni, kulandele ngokudibanisa isigulane mpilo. Xa oku kusetyenziswa njengoko ukurhogele kwaye iintlungu amayeza, nto leyo kuhlanganiswa uqobo.