Tracheotomy ndi chiyani? Njira ya tracheotomy

Pa opaleshoni, pali ziganizo ziwiri - tracheotomy ndi tracheostomy.

Tracheotomy ndikutsegula kwa trachea ndi kuyika chubu kuti alowetse mpweya mkati mwa mpweya wopuma. Uwu ndi ntchito yapadera.

Tracheostomy ndikutseguka kwa trachea, koma ndi kutsekemera kwa mankhwala omwe amachititsa kuti thupi likhale lopuma komanso kupanga dzenje lakupuma.

Zakale za mbiriyakale

Njira imeneyi ya chisamaliro chapadera inali kale kale ku Igupto ndi India, pali umboni wosonyeza kuti unagwiritsidwa ntchito ngakhale ndi Alesandro Wamkulu kuti apulumutse asilikari mu gulu lake lankhondo. Njirayi inalembedwa ndi Hippocrates ndi Gallen, koma chifukwa cha kukhumudwa kwake komanso kuopseza moyo wake, sichinalimbikidwe kuti chigwiritsidwe ntchito nthawi zambiri.

Opaleshoni yoyamba yopambana inagwiridwa ndi dokotala wa ku Italy dzina lake Antony Brasavola mu 1546. Umenewu ndi umboni woyamba wolembedwa kuti pambuyo poyendetsa wodwalayo adakhalabe ndi moyo. Kuyambira m'chaka cha 1718 chithandizo chochita opaleshoni ichi chakhala chofala ndipo chikugwiritsidwa ntchito ndi madokotala ambiri. Ndipo komabe ambiri ankawopa kuti agwiritse ntchito. Mwachitsanzo, dokotala wa George Washington adasankha kuti wodwalayo afe, kusiyana ndi momwe adasinthira kuwononga.

Kuyamba kwa malamulo a aseptic ndi antiseptic kunachepetsera chiopsezo cha mavuto komanso imfa, komabe sanakhulupirire achipatala kuti njirayi ndi yotetezeka kwa wodwalayo. Pakalipano, tracheotomy ndi njira yapadera yosamalirako, yomwe imagwiritsidwa ntchito pokhapokha ngati njira zina (njira ya Heimlich, chidziwitso) sichitha kapena alibe nthawi.

Zizindikiro za opaleshoni

Ziribe kanthu mosavuta kuti tracheotomy iwonekere, umboni wake uli wovuta kwambiri, chifukwa chiopsezo cha moyo wa munthu panthawi yachisokonezochi chimaposa zopindulitsa. Izi ndi izi:

1. Matupi achilendo omwe ali pamwamba pa trachea, omwe sangathe kuchotsedwa ndi njira zina.
2. Kuvulala kotsekedwa, kupopetsa laryngeal lumen.
3. Mphuno yochuluka ya phula ndi diphtheritic croup, chifuwa, chifuwa, typhus, ndi zina zotero.
4. Kutanthauzira lumen wa trachea kapena larynx ndi chotupa.
5. Kupanikizika kwa tsamba lopumula kuchokera kunja.
6. Mankhwala amawotcha
7. Allergic stenosis.

Mitundu yosokoneza njira yopuma

• Mkokomo, kapena mphezi, - imakhala pamasekondi pang'ono. Izi zikhoza kukhala ngati kutsekedwa kwa matupi achilendo, komanso kuwonongeka kwa edema.
• Zovuta - zimadziwika pa mphindi zochepa, zomwe zimagwirizanitsidwa ndi diphtheria kapena matupi achilendo.
• Subacute - kutseka lumen wa airways kungathe kukhala maola ambiri, ndipo ngakhale maola. Matendawa ndi amtundu wonyenga, khosi, zamoto.
• Zosatha - zikhoza kukula kwa zaka zambiri monga matenda a khansa ya perry, perichondritis, kuchepa kwachitsulo cha trachea.

Kulemba

Pali mitundu yambiri ya tracheotomy, malingana ndi njira ya khalidwe lake.

Kudula:

• Pamwamba: pa mlingo wa cricoid cartilage.
• Avereji: pa mlingo wa karoti karotila.
• Low, kapena conicotomy.

Malingana ndi chikhalidwe cha gawolo:

• Longitudinal.
• Zosintha.
• Yofanana ndi mawonekedwe.

Zida

Musaiwale kuti chifukwa cha changu chake chonse ndi chisamaliro, njirayi imakhala ngati opaleshoni. Tracheotomy iyenera kuchitidwa ndi zipangizo zina, ngati zilipo. Momwemonso amatha kugawa m'magulu akulu awiri: izi ndizo zipangizo zamakono zopangira opaleshoni ndizopadera.

Gulu loyamba limaphatikizapo zozizira, zokopa, zokopa zowononga magazi, misewu yopanga opaleshoni, zikopa zoberekera, timatenda tating'onoting'ono, tizilombo tating'onoting'ono ndi singano. Gulu lachiwiri limaphatikizapo tracheotomy cannula ya Luer, yomwe ili ndi zipilala ziwiri zomwe zimakhala chimodzi mwa chimzake; Chikopa cha Chassignac, chokonzekera kuti chigwirizane ndi trachea popanda kusokoneza; Chombo chaching'onoting'ono chaching'onoting'ono chaching'onoting'ono cha ndowe.

Njira ya tracheotomy

Musanachite opaleshoni iliyonse, pamaphunziro oyenerera, omwe amathandiza dokotala mwamsanga ndipo sangamve kupweteka kwa wodwalayo kuti athandizidwe. Pankhaniyi, m'pofunika kuika wodwala kumbuyo kwake ndikupukuta mutu wake mobwerezabwereza kuti matumbo a trachea aoneke bwino. Pachifukwachi, nthawi zina amagwiritsidwa ntchito. Pambuyo pokonzekera, munthu amapeza anesthesia. Zitha kukhala zowonongeka kapena zapanyumba. Zonsezi zimadalira machitidwe omwe opaleshoni ikuchitidwa, msinkhu wa wodwalayo, mphamvu za dokotala ndi chipatala. Ngati vutoli liri lofulumira, adokotala amachititsa kuti asagwiritsidwe ntchito mopanda chithandizo. Pambuyo pokonzekera zonse, tracheotomy imayamba pomwepo.

Njira yothandizirayi imakhala ndi mdulidwe wa khungu, mafuta osokoneza bongo, fascia ndi fibrous nembanemba kuchokera ku chithokomiro cha chithokomiro. Ndiye minofu imadziwika, yomwe imadzipulidwa mwa njira yosamveka. Pansi pake pali khungu komanso khungu la chithokomiro. Chitsulocho chimasiyanitsidwa ndi trachea ndi kusunthira mmwamba, kusokoneza china fascia. Nkhumba yikani khungu ndipo, pochepetsa tsamba la scalpel ndi chala, bandage kapena pulasitala, pangani kachilombo kakang'ono. Cholinga chimakwaniritsidwa. Mpweya umalowa m'mapapo. Choyamba, mpweya umatha, koma wodwala amayamba kukangamira ndi kutembenuka pinki. Dokotala atangokhulupirira kuti munthuyo adayamba kupuma, nkhuni imalowetsedwa pa bala ndipo imakhala ndi sutures kapena plaster. Vutoli limasindikizidwa kuti likhale ndi chubu mwamphamvu.

Conicotomy

Uwu ndi opaleshoni yaing'ono yomwe imatsogolera pa tracheotomy, ngati palibe kuthekera komanso nthawi yokhala ndi tracheotomy yachibadwa. Kuchita izo, sizikuchititsanso zochitika pang'onopang'ono. Chikoka chimodzi chimadula khosi kupita ku cartilage ya cricoid ndi ligro-sacrificial ligament. Lembani chikwangwani mumalo osokoneza bongo, kuchepetsa mitsempha yake ndi kuikonza pa malo awa. Ngati wodwala adayamba kupuma, atembenuka pinki, anali ndi chifuwa, kenaka njirayi idapambana. Pambuyo pangozi, n'zotheka kutanthauzira conicotomy mu tracheostomy, pofuna kuonetsetsa kuti mpweya umayenda nthawi zonse kwa wodwalayo.

Zolakwitsa zingatheke panthawi yachinyengo

Opaleshoni iliyonse ili ndi zotsatira zake, tracheostomy sizosiyana. Zovuta zomwe zimachitika pokhudzana nazo zingagawidwe m'magulu atatu.

1. Pa opaleshoni:

• Mzere wolakwika wa incision ukhoza kuyambitsa kutuluka kwa mpweya , mpweya wa embolism, ndipo nthawizina kudula mitsempha yamtundu wa carotid ;
• Magazi amatha kulowa m'munsi mwa kupuma, kuchititsa kuti asokonezeke mobwerezabwereza;
• Chombocho chiyenera kukhala chofanana ndi chiwerengero cha mvula, mwinamwake chidzafunika kusonkhanitsidwa ndi kuvulaza minofu;
• Kuwongolera kwakukulu kungayambitse kuvulaza, kotero tsamba la scalpel liyenera kukhala lokha kwa 1 masentimita.

2. Kutangotha kumene:

• Hypoxia;
• Kupasuka kwa mphete yothandizira;
• Chithunzithunzi;
• Pneumothorax.

3. Zotsatira zochedwa:

• Tracheobronchitis;
• Stenosis ya trachea ndi kubwereza asphyxia;
• Kusintha (mawu osasunthika) a mawu chifukwa cha ziphuphu za mitsempha yowonongeka;
• Zosakaniza zolakwika.

Madokotala onse akumbukirabe kuchokera ku benchi ya ophunzira zomwe zimachitika kuti tracheotomy ndi yoopsa. Uku si opaleshoni yomwe ingachitidwe mosalekeza. Ndizidziwikiratu, zochitika zapadera, pamene wodwalayo ali pamapeto pa moyo ndi imfa, chifukwa mofulumira, zikhoza kuvulaza wodwalayo. Ndipo ngati kugwiritsidwa ntchito sikukuchitika kuchipatala, koma kwinakwake pamsewu kapena kunyumba, ndiye kuti ndizofunikira nthawi zambiri kuganiza musanasankhe. Chosavuta, pakuyang'ana koyamba, njira iyenera kuthandizidwa ndi chochitika chokwanira cha opaleshoni. Tracheotomy kunyumba sizingatheke, ndizoopsa. Ngati mulibe maphunziro azachipatala ndi luso loyenerera, musayese kubwereza.

Tracheotomy ndiyotheka kuti mupulumutse moyo wa munthu! Kuopsa kwa zotsatira zoopsa kapena kukula kwa mavuto aakulu ndizokwanira kukakamiza dokotala kulingalira za njira zina. Ngakhale kuganiza kuti opaleshoniyi imadziwika kuyambira kalekale, dera lachipatala silinadziwe momwe lingapangire bwinobwino.

Matenda otchedwa tracheotomy ndi mwayi wopulumutsa moyo wa munthu, koma nthawi imodzimodzi mwayi wokhala nawo.