Izinzwa Endotracheal: ukuthi kuyini, izinkomba, izidakamizwa

Namuhla, akumangalisi kule ndlela kwelashwa ukuhlinzwa. Futhi ngemva kwamakhulu ambalwa eminyaka edlule ukusebenza zazilingana ukufa, iziguli eziningi kakhulu wafa kusukela ukushaqeka ubuhlungu noma sepsis. Kwaphela isikhathi eside umuntu esasikhipha iphupho kuhlinzwa wahlala umsebenzi Herculean wezokwelapha. Nge ekutadisheni inqubo-chemistry usephendukele ngokushesha. Kungcono ehambisana Izingxube futhi amalungiselelo izinzwa, okuyinto, ngaphezu kwalokho, manje kwenziwe ngezindlela eziningi. Omunye wabo izinzwa endotracheal. Kuyini lokhu? Indlela esetshenziswa futhi uma sidingeka? Le mibuzo kanye neminye eminingi ukuphendula kule athikili.

Kusukela umlando endotracheal izinzwa

Ngokokuqala ngqá lolu hlobo yokubulala izinzwa wazama ekhulwini XIV-XV, uma udokotela Paracelsus Swiss busuka indoda uqhoqhoqho tube kuka kwasindisa ukuphila kwakhe. Ngemva kwamakhulu eminyaka amathathu ngale ndlela asindisa wakhulula abantu bengenalwazi emoyeni. Ngo-1942, ongudokotela obulala izinzwa lusuka eCanada lokuqala asetshenziswa imisipha relaxants - ikhemikhali kunciphisa lwamathambo imisipha ithoni up ukuqedela immobilization. Ngenxa yalesi kokutholakala izinzwa uye waba ephephile neliphelele kunalelo, ngokuvumela ochwepheshe eliphelele lokulawula ubuthongo kuhlinzwa phakathi nokuhlinzwa.

Ngo phakathi XX endotracheal ekhulwini izinzwa iye ithuthuka ngokushesha, abasizwa ama-odokotela Soviet. Namuhla-ke iyindlela ezivamile ukubulawa kwezinzwa okuvamile, elisetshenziswa inkambo iningi imisebenzi.

izinzwa Endotracheal: kuyini?

Ukuze uvikele umzimba kusuka ukucindezeleka enkulu ukuhlinzwa, izinzwa isetshenziswa. Kungaba emphakathini, endaweni noma jikelele. Uhlobo yokugcina ibizwa ngokuthi izinto zokubulala izinzwa. It libhekene a "off" ziphapheme isiguli lapho kuqala ukulala kuhlinzwa. Ngo izinzwa yesimanje iqondiswa ngemithambo yegazi, imaskhi noma izinzwa kuhlanganiswe. Kugcine ihlanganisa izindlela ezimbili futhi izinto lingene egazini, futhi leli pheshana zokuphefumula. Lolu hlobo ucingo futhi izinzwa endotracheal.

Ochwepheshe kufanele ambheka njengomunye indlela ephephile kunazo emhloleni ukukhululeka ubuhlungu: kukuvumela ukulawula ngokugcwele ngezimo zesiguli, ukufeza ubuthongo obukhulu kuhlinzwa, futhi lwamathambo muscle futhi ukugwema enjalo yezinkinga ezingemnandi ezifana nenshisekelo nokuvaleka kwemigudu yokuphefumula.

ubufakazi

izinzwa Endotracheal kuvimbela nesineke ebuhlungwini ukushaqeka nokuvaleka kwemigudu yokuphefumula, ingasetshenziswa lapho behlinza nasezimweni esegumbini labagula kakhulu. Phakathi izimpawu I-izinzwa zingahlanganiswa:

• imisebenzi mediastinum, pharynx, endlebeni engaphakathi, emlonyeni kanye ikhanda;
• kokungenela, lapho isidingo ukusebenzisa imisipha relaxants;
• ukungasebenzi in isimiso sezinzwa;
• egcwele syndrome esiswini;
• ingozi umgudu isimiso.

Endotracheal ukubulawa kwezinzwa okuvamile livame ukusetshenziswa imisebenzi yesikhathi eside nge ukuvuthwa of imizuzu engaphezu kuka-30. Ingasetshenziselwa ngasiphi yobudala ezifundeni ezehlukene esiguli, t. Ukuze. Akenzi ukulayisha inhliziyo kanti omunye kakhulu izindlela kancane anobuthi ngokusungula indlela yokubulala izinzwa.

Izimo

ukuhlinzwa ezokuziKhethela (isib ukususwa operation izimila mediastinal) kulandele Ukutadisha ngokucophelela isimo lesiguli. Udokotela has isikhathi kuyadingeka ukuze ubuyekeze umlando yezokwelapha, nokuphatha ukubala izingozi ezingase zibe khona futhi ukuze abone contraindications indlela ethile ngokusungula indlela yokubulala izinzwa. izinzwa Kuhlanganiswe akunconyelwe kwale mibandela elandelayo:

• isilulu samafayela;
• isifo sesibindi, izinso,
• okusolakala isilethikusebenza;
• isifo yomoya;
• izici bokuphila isakhiwo se-pharynx;
• ezinzima endocrine iziyaluyalu.

Ikakhulukazi iyingozi ukusebenzisa izinzwa endotracheal ne engenhla zokuphefumula ipheshana izifo, t. K. ingozi eliphezulu isifo esihlobene namaphaphu.

Isiteji izinzwa kuhlanganiswe

izinzwa Ngakho, endotracheal. Kuyini for udokotela? Udokotela wokudikizisa wenza izigaba ezintathu ngokulandelana kwazo yesenzo: ukwethulwa ubuthongo kuhlinzwa, ukugcina isimo sizinzile futhi uphaphame. Isigaba sokuqala ukuba nokuqhuba lokungeniswa lula ukubulawa kwezinzwa. Isiguli ngemithambo yegazi ithola izidakamizwa noma imuncwe igesi ingxube. Lapho imisipha ekhululekile ngokuphelele, lo obulala izinzwa kubeka tracheal inesikhala endotracheal tube. Linikeza ukupholisa mechanical ephefumula umoya-mpilo ne imithi yokubulala izinzwa gaseous.

Uma odokotela abahlinzayo baye abaqeda ngalo umsebenzi wabo, kuza sikhathi esibucayi ngenxa obulala izinzwa - okukhipha isiguli izinzwa. Umthamo izidakamizwa is kancane kancane. Ngemva kokubuyiselwa ukuphefumula nokuguqulwa extubated - ukususwa tube endotracheal e uqhoqhoqho. Isiguli is uyiswa ICU, ukubukela izimpawu ezibalulekile futhi nasezinkingeni ezilandela ngemva kokuhlinzwa inqubo yokutakula.

lokungeniswa ngokusungula indlela yokubulala izinzwa

Easy izinzwa kokuqala iyadingeka ukuze intubation kobuhlungu futhi iphephile, okuyinto awunakuba khona ngaphandle kokuthethelela ukuqaliswa endotracheal izinzwa. Ukuze sifinyelele isimo esinjalo ukusetshenziswa ezibonisa ukuthi uhogele noma imithi ebulala izinzwa ngomjovo. Esimweni sokuqala, isiguli uphefumula ngazimbili imaski "Etra", "foran", "halothane" noma ezinye Izingxube efanayo imithi ebulala izinzwa. Ngezinye izikhathi kwanele i-nitrous oxide ne-oksijini.

Njengoba imithi iqondiswa ngemithambo yegazi, ebisetshenziswa barbiturates futhi neuroleptics (droperidol, fentanyl). Asetshenziswa njengezitolo isixazululo (esiphezulu 1%). Dose obulala izinzwa ezikhethiwe ngayinye esigulini ngasinye.

Ngemva ukukhanya izinzwa isenzo ukwenza tracheal intubation. Ukuze wenze lokhu, ukusetshenziswa imisipha relaxants ukukhulula imisipha entanyeni. I tube yethulwa esebenzisa laryngoscope, ngemva kwalokho isiguli idluliselwe i yokufakelwa wamaphaphu ukupholisa. Isiteji iqala izinzwa ezijulile.

Droperidol: imfundo

Droperidol - antipsychotic, ngokuvamile lisetshenziswa izinzwa endotracheal. Isakhiwo amakhemikhali ayinto kuyinto Amine ephakeme. Kakade kunomphumela sine 3 imizuzu emva abaphathi. Ukuvimba Dopamine receptor, okubangela unyathela amabhuleki neurovegetative. Ngaphezu kwalokho, hypothermic possesses imiphumela antiemetic. Ukuphefumula kuthinta kancane.

Kuboniswe ngoba premedication, lokungeniswa ngokusungula indlela yokubulala izinzwa, isilethikusebenza, ukushaqeka, angina ezinzima, edema yamaphaphu kanye nenhlekelele abanomfutho wegazi ophakeme. Kunconywa njengoba izidakamizwa, aqede isicanucanu nokuhlanza. Ingabe ubuthi ongaphakeme, ingasetshenziswa ekuhlinzeni ezingane kanye zokubelethisa.

Inqubo ukusetshenziswa antipsychotics ngesikhathi lokungeniswa ngokusungula indlela yokubulala izinzwa

Kukhona embodiments eziningana neyroleptanalgezii. Lokungeniswa ngokuvamile eyenziwa isikimu ezilandelayo: droperidol, okuyinto Umhlahlandlela iye yabhekwa ngenhla, i inani 2-5 ml nge 6-14 ml fentanyl zaphathwa isiguli ngemithambo yegazi. Kanyekanye Mask fed nenye ka-nitrous oxide ne-oksijini isilinganiso 2: 1 noma 3: 1. Ngemva nokucindezela ukwazi imisipha relaxants iphathwa ukuqhubeka intubation.

Nokho, Droperidol kokuba umphumela neuroleptic amahora 4-5, iqondiswa ekuqaleni supply izinzwa. It is kubalwa ngekucikelela esisindo akhawunti: 0.25-0.5 mg / kg. ekuphathweni okuphindiwe kwe- izidakamizwa badinga kuphela ngesikhathi umsebenzi ngesikhathi eside.

Fentanyl ungaphakathi imali 0.1 mg iqondiswa njalo ngemva kwemizuzu engu-20, futhi supply yayo kuyekwa imizuzu 30-40 ngaphambi kokuphela ukuhlinzwa. umthamo lokuqala 5-7 mg / kg.

intubation

Ngemva ukucindezelwa ukwazi okwenziwa ukupholisa yokufakelwa yomoya-mpilo engasetshenziswa usebenzisa imaskhi imithi ebulala izinzwa. Ngemva kwalokho, udokotela wenza intubation ngomlomo (ngezinye izikhathi ngokusebenzisa ekhaleni). Ufaka emuva ikhanda lakhe, umlomo wakhe evulekile. Direct injected laryngoscope blade kanye umugca lohlukanisa emkhatsini phakathi esibhakabhakeni kanye nolimi, ngokucindezela phezulu yokugcina. Ukukhuthaza ithuluzi okwengeziwe phakamisa ichopho epiglottis. Ibonisa glottis, kulo tube endotracheal. Kufanele uhambe kuqhoqhoqho 2-3 cm. Ngemva yimpumelelo intubation tube fix bese uxhuma isiguli womoya-mpilo.

Ngaphansi evame ukusetshenziswa laryngoscope ngensingo lwalugobile. It is yethulwa phakathi kumila epiglottis kanye impande olimi, otdavlivaya kuhlale up ngokwami. Uma kuwukuthi Ukufakwa kungenzeki we tube ngomlomo usebenzisa meatus acinene aphansi. Ngokwesibonelo, i-operation ukususa izinhlumba ngalo ingaphakathi ngomlomo.

Maintenance and sokuthola izinzwa

Ngemva intubation bese uxhuma isiguli mpilo kwenzeka ngesikhathi eyinhloko. Ngezenzo wasebenza njengodokotela ohlinzayo, lo obulala izinzwa eduze uqaphe yokuziphilisa izinkomba. Njalo ngamaminithi angu-15, hlola inhliziyo ishaya, umfutho wegazi, ngosizo ngabaqaphi ukugcina umsebenzi lesiguli inhliziyo.

izinzwa Jikelele alondolozwa ngemithamo ezengeziwe izidakamizwa antipsychotic, imisipha relaxants, noma Izingxube ephefumula imithi ebulala izinzwa. Ukusebenza ngaphansi izinzwa uhlobo kuhlanganiswe ivumela obulala izinzwa ukuze ulungise izidingo zomzimba ubuhlungu ukuphathwa ngokunikeza ezingeni elikhulu zokuphepha.

Ngemva kokuphela izinqubo kuhlinzwa esigabeni yokugcina - aphume ubuthongo kwezidakamizwa. Kuze kube yileso sikhathi i-kancane kancane ukunciphisa umthamo izidakamizwa. Ukubuyisela ukuphefumula atropine futhi Neostigmine ngezikhathi imizuzu 5. Ukuqinisekisa ukuthi isiguli uyakwazi ukuphefumula bebodwa, extubated. Ukuze wenze lokhu, ukuhlanza indawo kwesihlahla tracheobronchial. Ngemva ukususwa tube, futhi inqubo efanayo wenziwa ne ngalo ingaphakathi ngomlomo.

nasezinkingeni ezilandela ngemva kokuhlinzwa ukubhekwa

Ngemva kokuhamba ekamelweni yokusebenza, isiguli ibekwe ku labagula kakhulu, lapho eduze nokuqapha isimo sakhe. Ngemva ukubulawa kwezinzwa okuvamile ukuthuthukisa ukungakhululeki, ukuxakeka kancane. Ngokuvamile, iziguli post-op esekhala:

• ubuhlungu;
• ukungakhululeki emphinjeni;
• isicanucanu;
• ubuthakathaka futhi imisipha ukukhathala;
• ukozela;
• ukudideka;
• Ukugodola;
• ukoma kanye nokuntuleka ukudla.

ngokuvamile lezi zimpawu ziyaphela emahoreni lokuqala 2-48 emva kokuhlinzwa. Ukuqeda analgesics ubuhlungu ebekiwe.

Ngakho, ake fingqa. Endotracheal izinzwa - kuyini? Le ndlela yokwazisa umuntu ubuthongo kuhlinzwa, ikuvumela ukwenza imisebenzi eziyinkimbinkimbi, ukuqapha umsebenzi umgudu wokuphefumula. izinzwa Kuhlanganiswe lingaphansi anobuthi, futhi kulula ukulawula indlela yokubulala izinzwa ukujula ngesikhathi kokungenela. Ngaphansi izinzwa endotracheal ngokuyinhloko kwakusho intubation, kulandele yokuxhuma isiguli womoya-mpilo. Uma le isetshenziswa njengoba imithi imuncwe futhi izinzwa, okuyinto zivamise kuhlanganiswe.