Chii Chiri Kuitika MuIntubation for Surgery
Intubation ndiyo nzira yekuisa chikwata, chinonzi endotracheal tube (ET), kuburikidza nemuromo uye kusvika mumugwagwa. Izvi zvinoitwa kuitira kuti murwere agone kuiswa pavhoteri kuti abatsire nekufema munguva yeanesthesia , sedation, kana chirwere chakakomba. Iyo tube iyo inobva yasunganidzwa kune ventilator, inoputira mhepo kumapapu kuti ipe mweya kumurwere.
Izvi zvinogadziriswa nokuti murwere haakwanisi kuchengetedza kufamba kwavo, haagoni kufema pachavo pasina rubatsiro, kana maviri. Izvi zvingave nokuti ivo vari kupiwa anesthesia uye havazokwanisi kufema pachavo pachavo pavanenge vachivhiyiwa, kana kuti vangave vachirwara kana kuti vakakuvara kuti vape oxygen yakakwana kumuviri pasina rubatsiro.
Intubation Inowanzoitwa
Asati attubation murwere anowanzogadzikana kana kuti kwete nekuda kwekurwara kana kukuvadzwa, izvo zvinobvumira muromo uye mhepo kuti ipumidze. Murwere anowanzoputika pamusana wavo uye munhu ari kuisa tube iri kumusoro pamubhedha, achitarisa tsoka dzomurwere. Muromo wemurwere unovhurika zvinyoro uye achishandisa chiridzwa chine chiedza kuti achengetedze rurimi kubva munzira uye kuvhara huro, iyo tube inotungamirirwa mukati mehuro uye ichienda mumugwagwa.
Pane ibhota duku iri pedyo ne tube iyo inofungidzirwa kubata tubhu munzvimbo uye kuchengeta mweya kubva pakupukunyuka.
Kamwe kamwe ibhota iri rakabvongodzwa, tubhu rakachengetedzwa zvakanaka mumugwagwa uye rinosungirwa kana rakagadzirirwa munzvimbo mumuromo.
Kubudirira kuiswa kunotariswa kutanga nekuteerera kumapapu ne stethoscope uye kazhinji kuonekwa nebhokisi x-ray. Mumunda, sekunge apo 911 inoshandiswa uye kufema kufema kunowanikwa nevanorapwa, shanduro inoshandiswa iyo inoshandura ruvara kana bhururo iri kuiswa zvakanaka.
Ngozi dzeIntubation
Kunyange zvazvo kuvhiyiwa kukuru kune ngozi shoma, uye intubation yakafanana nengozi shoma, pane zvimwe zvingaitika zvinogona kuitika kunyanya kana murwere achifanira kuramba ari muvhariyamu kwenguva yakareba. Njodzi dzinowanzosanganisira:
- Kutambudza kumeno, muromo, rurimi, uye / kana maruva
- Nenguva yakajeka intubation mueophagus (chikafu chekudya) pane chetrachea (air tube)
- Kutambudza kune trachea
- Bleeding
- Kusakwanisa kurumurwa kubva kumhepo, kunoda tracheostomy.
- Kusuruvara (inhaling) vomit, saliva kana zvimwe zvinonwa mvura painenge ichitsemuka
- Nyumoniya, kana chido chichiitika
- Huro inorwadza
- Hoarseness
- Kukanganiswa kwezvinyorwa zvinyoro (zvine nguva yakareba intubation)
Vhidhiyo vanoongorora uye vanoziva nezvezviitiko izvi zvinogona kuitika, uye vanoita zvavanokwanisa kuti vatarise.
Chii Chinonzi Nasal Intubation?
Mune zvimwe zviitiko, kana muromo kana kuti huro iri kushandiswa kana kuti yakakuvadzwa, kufema kunoputirwa nemumhino panzvimbo yemuromo, iyo inonzi inonzi inalbation. Itainracheal tube (NT) inopinda mumhino, pasi nechekumusoro kwehuro, uye mumugwagwa wepamusoro. Izvi zvinoitwa kuchengetedza muromo usina chinhu uye kubvumira kuti chirwere chiitwe.
Mhando iyi yekutaura haifaniri kuwanzana, sezvo inowanzo nyore kuisa mukana mukushandisa muromo wakakura, uye nokuti haisi izvo zvakakosha kune dzakawanda nzira.
Ndeipi Iyo Intubation Inokosha?
Intubation inobvunzwa apo aneshehesia yakawanda inopiwa. Anesthesia zvinodhaka zvinokonzera miviri yemuviri, kusanganisira diaphragm , izvo zvinoita kuti zvibvirire kutora mweya pasina ventilator.
Vazhinji varwere vanodzokorora, zvinoreva kuti kuputira bhuti kubviswa, pakarepo mushure mekuvhiyiwa. Kana vakatsungirira vachirwara zvikuru kana kuti vachiomerwa nokufema ivo pachavo, vanogona kuramba vari muvhariyeri kwenguva yakareba.
Mushure mokunge maitiro akawanda, mishonga inopiwa kuti ichinje migumisiro yeanesthesia, iyo inobvumira murwere kumuka nekukurumidza ndokutanga kufema pachavo.
Kune mamwe maitiro, akadai sekuzarura mwoyo maitiro, murwere haasi kupiwa mishonga yekudzosera anesthesia uye ichakurumidza kufamba pachega. Ava varwere vachadikanwa kuramba vari muvhariyumu kusvikira vasimuka zvakakwana kuti vadzivirire mhepo yavo uye vanofema ivo pachavo.
Intubation inoshandiswawo nekupora kusakundikana. Pane zvikonzero zvizhinji nei murwere angave achirwara zvokuti haafaniri kufema zvakanaka ivo pachavo. Vanogona kunge vakakuvadzwa kumapapu, vangave vane chirwere chakasimba, kana dambudziko rinopfurikidza seCOPD. Kana murwere asingakwanisi kutora okisijeni yakakwana ivo pachavo, ventilator inogona kudikanwa kusvikira yavazve yakasimba zvakakwana kufema pasina rubatsiro.
Pediatrics uye Intubation
Nzira yekutaurirana yakafanana nevakuru nevana, kunze kwehukuru hwemichina inoshandiswa panguva iyi. Mwana muduku anoda bhuku duku duku kupfuura munhu mukuru, uye kuisa iyo tube inogona kudikanwa nepamusoro-chepamusoro nokuti inoenda kumhepo yakawanda zvikuru. Mune zvimwe zviitiko, fiber optic scope, chigadziro chinobvumira munhu kuisa futi yekufema mukati kuti aone kushandiswa kwekuongorora, inoshandiswa kuita kuti intubation ive nyore.
Nepo iyo chaiyo yekuita iyo tube inenge yakangofanana, kugadzirira mwana kurapwa kwakasiyana zvakanyanya kune vanhu vakuru. Kunyange munhu mukuru angave ane mibvunzo pamusoro pehushandi hwehushuwarisi, njodzi, zvibatsiro uye nguva dzekudzorera, mwana achada kutsanangurwa kwakasiyana kwekuita kwaizoitika. Kuvimbiswa kunokosha, uye kugadzirirwa mupfungwa kwekuvhiya kuchasiyana zvichienderana nezera remurwere.
Kudyisa Munguva Intubation
Murefu uyo achave ari muvharidziro yegadziriro uye ozopedza kana chirongwa chacho chapera hachidi kudya, asi ungagamuchira zvirwere kuburikidza ne IV. Kana murwere anotarisirwa kuva mudziyo wekutengesa kwemazuva maviri kana kupfuura, kudya kunowanzotanga zuva kana maviri mushure mokutumirwa.
Hazvibviri kutora chikafu kana kunwa mvura nemuromo kana ichibvongodzwa, zvisingaiti nenzira iyo inowanzoitwa nekutora kuruma, kutsva, nekumedza.
Kuita kuti zvibvirire kuchengetedza zvakachengeteka, mishonga uye mvura inonzwika mumuromo, tube inowanikwa mumutsipa uye pasi kusvika mudumbu. Iyi tube inonzi "orogastric" (OG) iyo inowanikwa mumuromo, kana chirwere chinoputika (NG) kana ichiiswa mumhino uye ichidzika mukati mehuro. Mishonga, mvura inoshandiswa, uye kugadzirwa kweputi inobva yasimudzwa mukati mehubhu uye mukati mudumbu uchishandisa sirinho huru kana pombi.
Kune vamwe varwere, zvokudya, mvura, uye mishonga inofanira kupiwa mukati. IV feedings, inonzi TPA kana chiremba chizere cheprenrenal, inopa kudya uye makoriyori zvakananga muropa mumvura. Mhando iyi yekudyisa inowanzochengetwa kunze kwekunenge ichidikanwa, sezvo kudya kunonyanya kunakirwa kuburikidza nemukumbo.
Kubvisa Tube yeBreaten
Iyo tube iri nyore kwazvo kubvisa kupfuura kuisa. Kana iri nguva yokuti tube ibudiswe. zvisungo kana tepi iyo inobata panzvimbo yacho inofanira kutanga yabviswa. Zvadaro ibhaluni inobata pipe iri mumugwagwa inenge yakasvibiswa kuitira kuti tube inogona kubviswa zvinyoro. Kana imwechete iyo iri kunze, murwere achafanira kuita basa rokufema ari oga.
Usataure / Usadzokerazve
Vamwe varwere vanoita zvishuvo zvavo kuzivikanwa vachishandisa murairo wakafambiswa, rugwaro runoratidza zvakajeka zvavanoda nokuda kwehutano hwavo. Vamwe varwere vanosarudza "usatauri" chisarudzo, izvo zvinoreva kuti havadi kuiswa pavharidziro kuti varambe vachiwedzera hupenyu hwavo. Usadzokorora zvinoreva murwere anosarudza kusava neCPR.
Murwere ari kutungamirira sarudzo iyi, saka vanogona kusarudza kushandura kwechinguva chisarudzo ichi kuitira kuti vaite chirwere chinoda ventilator, asi iyi ibhuku repamutemo rinosungirirwa risingagoni kuchinjwa nevamwe pasi pemamiriro ezvinhu akadai.
Shoko Rinobva
Chido chekuvharwa uye kuiswa pavheti inowanikwa neaneshehesia yakawanda, iyo inoreva kuti mavhivhi akawanda achada rudzi urwu rwekutarisira. Kunyange zvazvo zvinotyisa kufunga kuti uri pane ventilator, varwere vazhinji vanovhiya vari kufema pachavo mukati memaminitsi ekuguma kwekuvhiyiwa. Kana iwe uine hanya nezvekuva muvharidzi wekuvhiyiwa, iva nechokwadi chekutaurirana nezvekunetseka kwako nechiremba wako kana munhu ari kupa anesthesia yako.
> Kwakabva:
> Endotracheal Intubation. Medline Plus. https://medlineplus.gov/ency/article/003449.htm