Tracheal stenosis inotsvedzesa chitunha chako, kana mhepo yemhepo, nekuda kwekugadzirwa kwemavara emucheka kana kuti kusagadzikana kwekatekete mumugwagwa. Kunyange zvazvo kunyatsonyatsodzika mumatchea yako kusingazivikanwi, kunyanya kuderera kwepamapfumbamwe kubva muzana kubva muzana yenyu kunogona kutungamirira kumatambudziko makuru. Zvinokonzera zvitatu zvinowanzoitika zvetracheal stenosis ndezvi:
- Kuiswa kwenguva yakareba kwe endotracheal tube (breathing tube) kana tracheostomy
- Chirwere chinokonzera chirwere
- Collagen vascular disease (granulomatosis ne polyangitis, inonziwo Wegener granulomatosis)
Zvimwe zvikonzero zvinozivikanwa zvinosanganisira:
- Congenital malformations (kuberekwa chirema)
- Trauma
- Inhalation inopisa
- Radiation therapy
- Zvirwere zve trachea
- Zvirwere zvinopisa (sarcoidosis kana amyloidosis)
- Cancer
Muchirwere uye kuberekwa kusina kunaka, mhepo inoenda kumhepo iri kunyorwa kubva kunze kwetrachea, kana kubva pakuderera kubva kune martilage asina kunaka. Zvimwe zvinokonzera tracheal stenosis zvinotanga nehutachiona mu trachea. Kusuruvara kunotanga kuputika kwekuputika , iyo inowanzopodza, iyo inogona kuwedzerwa uye inokonzera hutachiona hwakawanda kupfuura zvingawanzodiwa. Izvi zvinowedzera zvinyorwa zvishoma zvinowedzera nzvimbo iri mumutambo wako.
Kubata kweTracheal Stenosis
Kakawanda kwekuwana tracheal stenosis kunobva pane chikonzero chetracheal kuderedza.
Kukanganisa kweputi-intubation kumhepo inogona kuve yakajairika, kunyange zvakadaro njodzi yechirwere chechiratidzo chinowanzosvika 2 muzana. Zvinotevera zvinokonzera ngozi zvinowedzera mukana wako wekuva ne-post-intubation kana tracheostomy yakafanana tracheal stenosis:
- Mukadzi
- Overweight
- Chirwere cheshuga
- Hypertension
- Chirwere chemoyo
Post-intubation kana post-tracheostomy ngozi inogona kuderedzwa kana zvinotevera zvichiitwa muI ICU:
- Kuva ne-endoctracheal kana tracheostomy ibhoon kushandiswa kuva pakati pe20 kusvika ku 30 cm yemvura
- Kudzivirirwa kwehutachiona kuburikidza nekuchengetwa zvakanaka mumuromo kunoitwa nekutsvaira sezvinodiwa kudzivirira utachiona kana kuvhara mhepo kumhepo
- Kufema kufema kufema tube nzvimbo kunze kwemuromo kuti ibvise zvinetso
- Kuramba kwakadzika kwakakwana kwefemu yekufema
- Kuchengetedza zvinetso nekufema mabhesi panguva yekuisa uye kudzivirira kubviswa nenzira pangozi kana une nzira yakaoma yekuenda kumhepo.
Tracheal stenosis inogona kuva imwe yezviratidzo zvekutanga zvinowanikwa mugranulomatosis ne polyangitis. Stenosis inogona kuitika anenge 16 kusvika ku 23 muzana yenguva. Izvo hazvina zvakawanda zvakawanikwa nedzimwe huwandu hwehuwandu hwezvimwe zvikonzero zve tracheal stenosis.
Zviratidzo zveTracheal Stenosis
Mu congential tracheal stenosis, stenosis inogona kunyanya kushandurwa nenzira yakafanana seAhma kana chirwere chekare. Nekunyoroka kwechirwere che stenosis, iwe unogona kusaziva zviratidzo kusvika pakupedzisira mwana kana kuti achiri kuyaruka apo zviratidzo zvinoratidzika sekuoma kunopfurikidza nekuita muviri. Mune zvimwe zviitiko zvakanyanya zvepenital tracheal stenosis, unogona kuona zviratidzo zvinotevera:
- Stridor (yakanamatira kufema kurira)
- Cyanotic, ine miromo yakajeka yebhuruu
- Girai neine inhalation
- Kuwedzera kwekufema kwemhepo (dyspnea)
Mune dzimwe mamiriro ekuwana tracheal stenosis, zviratidzo zvingasazviratidza kwevhiki dzinoverengeka mushure mekukuvara kunoitika. Dambudziko nekufema ndiyo inowanzo chiratidzo chekutanga. Kufanana nekuberekwa tracheal stenosis, unogona kuona gwara, kuputika, kana kuperesa kwekufema.
Kuongororwa kweTracheal Stenosis
Nzira dzinoverengeka dzokuedza dzinogona kushandiswa kubatsira chiremba wako kuti aone kana une tracheal stenosis kana kwete. Bronchoscopy inonzi inonzi "Gold Standard" yekuongorora chirwere chetracheal stenosis nokuti chiremba wako achakwanisa kuona zvakananga yako trachea.
Zvisinei, kune dzimwe njodzi dzinobatanidza neizvi nokuti kushandiswa kwehuwandu huchawedzera hunovhiringidza kufamba kwako, saka kuchengetedza oxygenation yako mazinga angave akaoma. Kurukurai nezvemhando yako yega yega inokonzerwa ne bronchoscopy nachiremba wako.
Mimwe nzira iyo chiremba wako angashandisa inosanganisira x-ray, CT scan, ultrasound, MRI, uye pulmonary work test. Mitemo x-rays yakanaka pakutsanangurwa kwegadziriro, mapurisa emhepo, matambudziko, nezvimwewo dhekutanga. Zvimwe zvinodhura zvinonzi x-ray zvinogona kushandiswa (xeroradiography) kuti dzirambe dzichinyatsoziva stenosis, zvisinei nokuti kusvibiswa kwemhepo kunopfurikidza kune dzimwe nzira.
CT kuongorora kunogona kuva nzira yakanakisisa kune chiremba wako pakusarudza kana iwe une tracheal stenosis kana kwete. Iyo inobata, zvisinei, ine kuoma kutarisa zvinyoro zvishoma zvinokonzera kukanganisa kwetsika yako. Mamwe maitiro ari kushandiswa nenzira yekuumba "endoscopy yakakwana" kuti kuderedza kudiwa kwako kuti uwane bronchoscopy. Zvisinei, CT kupenya haisi nzira yakanakisisa yekuziva chidimbu chakawandisa che stenosis.
Ultrasound inogona kubatsira pakuratidza huwandu hwemhepo nzvimbo mu trachea. Izvi zvinobvumira chiremba wako kuti aone kana kana kwete kuongororwa kungave kwakakosha, zvisinei, zvichienderana nehuwandu hwehutikiti pedo netirachea, kunyatsoona kwekuedzwa kunogona kubvunzwa nekuda kwemumvuri migumisiro inokonzerwa nekuratidzwa kwemafungu emhepo anobva pamusana. Siyai muedzo uyu chete kune avo vane unyanzvi pakuziva tracheal stenosis ne ultrasound.
MRI kuparadzanisa zvakare inzira yakakura yekubatsira pakutsvaga tracheal stenosis, uye kuvana iyo iri kutaridzirwa kuva nzira yakakwana. Iko kukanganisa kukuru kweMRI ndiyo nguva yenguva yaunoda kuzvipira kuita kuti nzira yacho iite uye kusvibiswa kunogona kuitika kubva pakufema kwemazuva ose panguva yekuongorora. Nzira dzakagadziridzwa dziri kuramba dzichigadziridzwa kunatsiridza kushandiswa kwegadziriro iyi pakuongorora chetracheal stenosis.
Chirongwa chekuongorora chinogona kuitwa mune mamwe mahofisi echiremba, kana kana musingawanikwi, muchaendeswa kumapuroniary lab. Uyu muedzo unogona kushandiswa kutarisa kuti zvakadini zvinokonzera kuti stenosis iri kukuvhiringidza kufema kwako. Izvi zvichatibatsira mukukurukurirana pamusoro pekusarudzwa kwemishonga pamwe nachiremba wako.
Kurapa kweTracheal Stenosis
Nzira dzakasiyana-siyana dziripo pakurapa tracheal stenosis uye chiremba wako achakurukura kuti ndeapi maitiro angasanyanya kuitika uye anogona kuva nemugumisiro wakanakisisa wekutarisira kwako pachako. Mishonga yakawanda ndiyo endoscopic nzira dzinoda kuonekwa chaiyo kwetsika yako. Kana nzvimbo ye stenosis iri shoma, kuisa stent, kuwedzera terechea yako nebhaluni, kana kubvisa chimwe chezvisikwa zvitsvuku nemalasiti kunobatsira kuderedza stenosis. Munguva iyi, chiremba wako anogonawo kuisa maronda mumatchea yako ne steroids kuti ubatsire kuderedza kurira kupi zvako.
Nokuda kwechiremera chetracheal stenosis, chiremba wako anogona kukurudzira tracheal resection, inoda kuvhiyiwa. Iyi nzira yakachengeterwa kana zvirwere zvisingagoneki zvakakundikana, kana kuti tsvina ye stenosis inonyanya kukurira kumagumo ekupedzisira. Munguva iyi, chiremba wako achacheka chikamu chetrachea inoshandiswa uye kugadzirisa yako trachea neganda kana chema tissue.
Mushure mekuvhiyiwa, iwe pachako uchakwanisa kuva nefema yekufema inobviswa panguva yekudzikinura kubva kune anesthesia. Zvisinei, kana pane kunyanyisa kukuru, kupindira kwakasiyana-siyana kuchashandiswa. Muchiitiko ichi, unogona kutarisira kuiswa kune steroid kwemaawa 24 kusvika ku 48 uyewo diuretic seLasix. Vanamukoti vako vachavawo nechokwadi chekuchengeta musoro wemubhedha wako wakasimudzwa nemadrigiri makumi matatu kana kupfuura. Mushure memaawa 48, iwe uchadzoka kuimba yekushanda kuitira kuti bhudhi rako rinofema ribviswe. Kana iwe uchiri kukwanisa kutsigira mhepo yako yepamhepo, tracheostomy ichaiswa kuti uchengetedze kufamba kwako. Pamusana pekuvhiringidza kwekurapa uku, inoonekwa sekupedzisira kushandiswa mushure mokumwe kurapwa kwakakundikana.
> Sources:
> Axtel, AL & Mathisen, DJ. (2017). Chirwere chekuvhiya chazvino: The Management of Tracheal Stenosis. 882-887.
> Hofferberth, SC, Watters, K, Rahbar, R & Fynn-Thompson, F. (2015). Kutungamirirwa kweChenenal Tracheal Stenosis. Pediatrics. 136 (3): e660-9.
> Hyzy, RC. (2017) .Chirangariro chekuguma kwegomba rinotevera kushandiswa kwekutanga: Kudzivirira uye kutungamira muvanhu vakuru vakakura vanochengetedza varwere. http://www.uptodate.com (Kubhadhara Kunodikanwa)
> Patel, HH, Goldenberg, D & McGinn, JD. (2015). Cummings Otolaryngology: Surgical Management of Upper Airway Stenosis. 68, 982-992.e2
> Waizel-Haiat, S. (2015). Tracheal Stenosis Imaging. http://emedicine.medscape.com/article/362175-overview
> Won, C, Michaud, G & Kryger, MH. (2015). Fishman's Pulmonary Diseases and Disorders: Kuvharwa Kwemhepo Kukuru Kwevanhu Vakawanda. 5th edition. http://www.accessmedicine.com (Kubhadhara Kunodikanwa)