Kunzwisisa Utano Hwehutano
Iwe unonetseka pamusoro pengozi yeanesthesia nekuda kwechirwere chinoparadza chirwere cheplm (COPD) ?
Kubatanidzwa kweCOPD uye anesthesia kunogona kutakura ngozi yakawanda. Kugara kwenguva refu kwehuwandu hwevanhu vane COPD yakaoma avo vanovhiyiwa kazhinji vanoshaya. Panewo njodzi inokosha yekugadzirisa zvinetso zvemashure, kunyanya mumapapu. Asi izvi zvinoreva here kuti varwere veCOPD havafaniri kumbovhiyiwa?
Mhando ipi zvayo yokuvhiya inosanganisira zvipingamupinyi. Kuziva zvipingamupinyi pakutanga kwekutanga kwekugadzirira, kunyatsogadzirisa, uye kukodzera anesthesia kutarisira kunogona kubatsira kuderedza ngozi idzi. Ngatinyatsoongororei kuti izvi zvinosanganisirei:
Ngozi Ingozi
Kuziva zvipingamupinyi pakutanga kwekutanga kwekugadzirira kunotanga nenhoroondo yakazara nekuongorora kwepanyama. Nyaya iyo chiremba wako angakonzera inosanganisira:
- Basa rako rakagadziriswa kushivirira , zvikurukuru nekukwira makomo uye matanho.
- Kana, uye kazhinji sei, iwe wakawedzera kukura kweCOPD uye kana iwe wakambogara muchipatara kwavari.
- Kana iwe wakamboita kuti kwete-invasive kana mechanical ventilation kuti ikubatsire kufema.
- Nhoroondo yako yekutsva- vose varipo uye vekare vanoputa vanosvika pangozi.
- Kana iwe ikozvino uine chifuva uye / kana chipfeko chekutsvaga-chave chichibatanidzwa nehuwandu hwehuwandu hwemashure ekushanda.
- Chero humwe hutano-kusanzwisisa huripo-huripo hutano huripo (comorbid mamiriro) hunokosha zvikuru pakutsvaga zvimwe zvinokonzera ngozi.
- Zvichida kana kwete iwe une zviratidzo uye zviratidzo zvehutachiona hwemapapu.
- Unhu hwako hwehutano -hupo hunenge huri pasi pehuwandu uye huwandu hwehuwandu huwandu hunowedzera ngozi.
Preoperative Actions
Kuedzwa
Usati wambovhiyiwa, chiremba wako anogona kuraira chero chipi zvacho kana kuti zvose zvinotevera zviedzo:
- Chep x-ray - inobatsira kuziva mishonga yemapapu yemazuva ano kana zvimwe zvinetso mumapapu.
- EKG - inobatsira kuziva zvinetso zvemwoyo zvinogona kuwedzera ngozi yekuvhiyiwa.
- Spirometry - inoshandiswa kumativi maviri ekuongorora uye kutsanangura kuoma kweCOPD.
- Muchengetedze kuedzwa - inoudza chiremba wako kuti oxygi inopfuura zvakadini kubva kune alveoli yako kuenda kune ropa rako.
- Kuedza kwemaminitsi matanhatu kutengesa kufamba - kunobatsira kutanga kuvhivirira kushivirira.
- Arterial blood gases - inobatsira kuziva preoperative oksijeni uye carbon dioxide muropa.
Optimization
Preoperative optimization inosanganisira kushanda nesimba pakati pako nachiremba wako uye inogona kugoverwa muzvikamu zvina zvinotevera:
- Kuputa kusvuta. Nemhaka yokuti vatsva vemazuva ano vane ngozi yakawanda yekuvandudza post-operative lung complications kubva pakuvhiyiwa, avo vanofuta vanofanira kusiya masere masere masere. Kana uchiri kusvuta, tarisa mutungamiri wakazara wekusvuta kusvuta.
- Drug therapy optimization. Vazhinji vevarwere veCOPD vanobatsirwa nekutora kamwe muroti we nebulized bronchodilator vasati vashanda. Kana iwe uchida kubvarura pamarapirwo ako panyaya iyi, kana kana iwe kazhinji uchishandisa inhaler panzvimbo yeNebulizer, tarisa gwaro iri nhanho-nhanho pamusoro pekushandisa sei nebulizer kuti uve nechokwadi chokuti uri kuwana zvakakwana zvakakwana marapirwo ako. Mukuwedzera, kana iwe uri wehuwandu uye uri kuedza kuyeuka kuti mishonga inobata chii kune COPD, chengetedza ruzivo urwu pakunzwisisa maratidziro ako .
- Kurapa kwehutachiwana uye / kana kuwedzera. Kuva nechirwere chemapapu kana kuwedzera kweCOPD kunogona kupesana neanesthesia. Contraindicate inzira inofadza yekuti haugone kuvhiyiwa. Zviratidzo nezviratidzo zvehutachiona hwehutachiwana hunofanirwa kutarisirwa nemishonga inorwisa mabhakitiriya munguva iyo usati washanda.
- Chest physiotherapy. Kugeza mucus mushure mekuvhiyiwa kunobatsira kubvisa kudarika, izvo zvingaita kuti mushure mekushanda kuvhara kana pneumonitis. Zviyeuchidze nezvenzira idzi shanu dzokugadzirisa gwagwa uye chengetedza ichi bhiri-up pakuchenesa mucus nemashure emvura .
Kutarisira Ngozi Panguva Yokuvhiya
Chiremba wako uye anesthesiologist achashanda pamwechete kuti atarisire njodzi dzinobatanidza neanesthesia neCOPD panguva yokuvhiya kwako.
Zvinetso zvakanyorwa pasi apa zvinongova zvishomanana zvezvinetso zvauchazoongororwa:
- Bronchospasm
- V / Q zvisakarurama
- Mucus inogadzira
- Pneumothorax
- Post-operative hypo-ventilation
Chikonzero nei Rudzi rweAnesthesia Matters
Kana zvichikwanisika, kudzivisa hukuru aneshesia kunobatsira pakuderedza ngozi. Taura nechiremba wako pamusoro pezvimwe zvinogona kuitika, zvakadai sedunhu rekune imwe nzvimbo kana nzvimbo yeanesthesia . Zviongorori zvakawana kuti vanhu vane COPD vane njodzi yakaderera yepneumonia uye ventilator dependence kana nzvimbo yeanesthesia inoshandiswa pane nzvimbo yakawanda anesthesia. Kupfupisa nguva yekuvhiya uye nguva yakareba iwe uri pasi peanesthesia, kana izvi zvichidiwa, zvinogonawo kubatsira.
Zvinokonzera Matambudziko
Takataura pamusoro pokuderedza dambudziko, uye iwe wakambonzwa kubva kune vamwe kuti kunovhiyiwa neCOPD kune ngozi, asi chii chaizoitika? Ndezvipi zvakanyanya, iyo ngozi? Vamwe vanhu vanofarira kuziva zvinogona kuitika, asi vamwe vangasada kufunga nezvazvo. Kana iwe uri mumwe munhu anoda kuziva, heano zvinhu zvishoma zvinogona kuitika sezvinetso apo vanhu vane COPD vachivhiyiwa neaneshehesia yakawanda.
- Zvirwere zvakakomba zvakadai sepineumonia
- Sepsis (a "muviri wose" utachiona hunonyanya kuipa)
- Pneumothorax (mapapu akaputsika)
- Kukundikana nekuputika
- Varombo vakakuvara kuporesa
- Kusakwanisa kunyura kunze kwemagetsi ekuputika - Kuvhiya kukuru, bhuti inotorwa mumhepo yako kuti upe mweya. Chimwe chinonyanya kunetseka nemapapu chirwere ndechokuti kuwedzererwa kwezvekuvhiya pamapapu kuchaita kuti iwe "venzi-inotarisira" kunyange iwe waimbove uchifema OK pasina rubatsiro.
- Hypoxia - Kukuvadza kweTisue uye serofu kufa nekuda kwekushaya kukwana oksijeni mumuviri, kusanganisira uropi.
- Ropa rekuvhara uye mapurmita emboli zvakakurumbira kune vanhu vane COPD, kunyanya kana kuvhiyiwa kunoda kuti iwe usashanda kwenguva yakati.
- Cardiac kusungwa
Vose varwere veCOPD vari pangozi yakawanda yekugadzirisa matambudziko mushure mekuvhiyiwa kunosanganisira anesthesia. Kushanda kwekushanda panguva imwe nechikamu chekupindira kwekuvhiya kunokosha pakuita kuti kusagadzikana kusununguka.
Sources:
Cheng Q, Zhang J, Wang H, et al. Migumisiro yeHypercapnia Yakakosha Pamigumisiro uye Zviitiko Zvengozi Zvinotangisa Njodzi Kune Matambudziko Pakati Pevarwere Kugamuchira Zvirongwa zveBronchoscopic Pasi Gweta Anesthesia. PLOS One . 2015. 10 (7): e0130771.
Hausman M, Jewell E, Engoren M. Regional Versus General Anesthesia Mukurapa Zvokuvhiya Zvisingagadziriswi Zvirwere zvepulmonary: Kuzvidzivirira Kwazvo Anesthesia Inoderedza Dambudziko reMatambudziko Anonzi Postoperative? Anesthesia uye Analgesis . 2015. 120 (6): 1405-12.
Kim H, Lee J, Park Y, et al. Migumisiro yeGOLD Groups dzeHIV Zvisina Kuvhara Dambudziko Pamatambudziko Okuvhiya. International Journal of Chronic Obstructive Pulmonary Disease . 2016. 11: 281-7.
Kiss G, Claret A, Desbordes J, Pure H. Thoracic Epidural Anesthesia yeApractice Thoracic Surgery muSeverely Dyspnoeic Varwere Vasingabatanidzwi Nezve General Anesthesia. Interactive Cardiovascular and Thoracic Surgery . 2014. 19 (5): 816-23.