Izinzwa Epidural: nemiphumela, Izimo, ukuxakeka, ukubuyekezwa

Nsuku zonke, e imitholampilo yezempilo kukhona inani elikhulu imisebenzi. kokungenela Steel akunakwenzeka ngaphandle analgesia ezanele, izinzwa ukuthi ngempela kudingeka, kungenjalo sikhuthazele ubuhlungu esinjalo singabiza babulawa. Kukhona izinhlobonhlobo eziningi ngokusungula indlela yokubulala izinzwa. Lesi sihloko Bheka ukuthi kuyinto izinzwa epidural, kwezinye izimo, ingasetshenziswa uma kukhona Izimo.

Kuyini izinzwa epidural

Lolu hlobo lwe-izinzwa ingenye yezindlela ngoba izinzwa lesifunda. izinzwa Epidural - ukwethulwa izidakamizwa ngqo esikhaleni epidural ka ikholomu umgogodla ngokusebenzisa ipayipi. Ngokuhamba we izinzwa kungenzeka ukuze athole imiphumela elandelayo:

• Ukulahlekelwa ubuhlungu ukuzwela.
• Encishisiwe noma cishe ubalekela ukuzwela jikelele.
• Muscle.

Lo mshini wezenzo ngokusungula indlela yokubulala izinzwa epidural ngenxa yokuthi ukuthi izidakamizwa lingena emikhonweni dural e isikhala subarachnoid, kuphumele ndima ivinjiwe Izinzwa amaza.

Umgomo we operation ngokusungula indlela yokubulala izinzwa epidural

Kubantu, emgogodleni kanye kwalapho kuhlangana khona imizwa entanyeni basesimweni laseDura. esifundeni Epidural itholakala emhlabeni igobolondo kanye egobhoza emgogodleni. Sagcina bebheke entanyeni, izingalo namahlombe uyihambisa, ukuvuvukala yabo kuholela ubuhlungu endaweni epidural.

Izidakamizwa esilawulwa kule zoni kubangela ukulahlekelwa luvelo ekuthuntubezekeni kokuqapha ubuhlungu. Blocks ukudluliselwa nerve amaza, onikeza mphumela.

Lapho usebenzisa i-epidural

Uma ucabanga ukuthi lolu hlobo izinzwa sisetshenzisiwe phakathi nokuhlinzwa ezindaweni ezihlukahlukene zomzimba, singasho ukuthi ingozi isicelo kungenzeka ezinkulu noma ezincane. Ngokwesibonelo, izinzwa epidural esifubeni, imbilapho, imilenze nesisu akunazingozi kuka analgesia entanyeni izingalo. Ukusetshenziswa izinzwa ezifana inhloko akunakwenzeka, ngenxa innervation yomzimba esebenzisa kuhlasimulise uhlelo ingqondo.

izinzwa Epidural uvame esetshenziswa:

1. Ngenxa izinzwa wendawo, uma akuhloselwe kokungenela kuhlinzwa, isibonelo, ngesikhathi sokubeletha.
2. Njengoba i adjunct ukuba ukubulawa kwezinzwa okuvamile, uma kungenzeka ukunciphisa isibalo opioids esetshenziswa.
3. Ngokuvamile wasebenzisa izinzwa epidural sesigaba cesarean.
4. Esikhathini esiyiminyaka nasezinkingeni ezilandela ngemva kokuhlinzwa ngenxa yobuhlungu.
5. Ukuze ekwelapheni izinhlungu emuva. Kulokhu, endaweni yokufaka ama epidural futhi analgesics.

Yini izinzwa ukuze makudle, ukubulawa kwezinzwa okuvamile noma epidural, enquma esimweni ngasinye kudokotela.

Izindlela ze-izinzwa epidural

Njalo ngonyaka ku arsenal of odokotela zikhona izimali okuthuthukile ukuze sifeze lesi uhlobo izinzwa. Lapho kukhona lokuzikhethela lodokotela: ukubulawa kwezinzwa okuvamile noma epidural, mithandazo abakhethiwe, uma kungenzeka. ukukhetha Omkhulu izidakamizwa ngoba umhlangano ikuvumela ukuthi ukhethe ngayinye nesineke ukhetho ezifanele kakhulu.

Ngaphezu ezihlukahlukene izidakamizwa ngoba izinzwa, kukhona ezihlukahlukene izinzwa ezifana:

1. Okuqhubekayo. Kulokhu, izinzwa is injected isikhala umgogodla njalo. Ngale ndlela kungenzeka ukufeza ukukhululeka ubuhlungu ngesikhathi sonke isikhathi ukusebenza, futhi ngenxa yalokho edinga izidakamizwa kancane.
2. ekuphathweni Periodic. Irisidi zomuthi kunikezelwa kuphela uma kukhona lesi sidingo esiphuthumayo.
3. Anesthesia esicelo lesiguli. Uma usebenzisa le ndlela isiguli ngaphansi kwezandla inkinobho. Uma kukhona isidingo izinzwa ke uma chofoza kukho endaweni epidural wakhonza ingxenye izidakamizwa.

Thina odokotela kukhona amalungiselelo anjalo, okuyizinto ubuhlungu kahle okhrophiwe, kodwa ukugcina ukuhamba, futhi ukwazi ishiywa ecacile.

Kwezinye izimo, izinzwa epidural kuboniswa

odokotela abahlinzayo eziningi zikholelwa le ndlela yokubulala izinzwa afanelekile kakhulu kwebhizinisi lapho uqhuba ngezinyawo zabo. It likuvumela ukuthi ususe hhayi kuphela ubuhlungu futhi imisipha ngangokunokwenzeka, kodwa futhi ukunciphisa ukopha.

Izimpawu ze-izinzwa epidural ungaba uhlamvu ehlukene, njenge:

1. Lena indlela ngokuphelele ephephile izinso futhi wendlala.
2. It sisetshenziswa ngaphakathi komgodi ongaphakathi kwamathumbu kanye ukhalo encane.
3. Kabanzi phakathi nokuhlinzwa ku ingaphakathi lesisu, amathumbu.
4. Ingasetshenziselwa yezifo zenhliziyo noshukela.

Kodwa lokhu akusho ukuthi pathologies ezinjalo njalo wasebenzisa epidural. Konke inqunywa icala ngayinye.

Izimo ukusetshenziswa

izinzwa Epidural ine Izimo ezilandelayo: categorical futhi isihlobo. Emkhakheni yokuqala yilezi:

• Ukuba khona spondylitis tuberculous kanye nezinkinga zayo.
• Inqubo ukuvuvukala kule emuva.
• A beshaqekile ngenxa yokulimala.
• Ephambi kwezinduna ukuzwela anda okumelana nemithi esetshenziswayo.
• Pathology isimiso sezinzwa.
• Uma yomgogodla kabi likhubazeke.
• Aphazamise inqubo igazi ekunqandeni.
• Kukhona izifo ezingathi sína kwababhemayo ingaphakathi intraperitoneal.
• Ileus.

Izimo Isihlobo olukhudlwana, lezi zibandakanya:

• Ukhuluphele.
• Isimo esibi emzimbeni.
• izifo of ikholomu umgogodla.
• yobudala Wezingane.
• izifo kwemizwa.
• Hypotonia nabanye abaningi.

Ikhwalithi izinzwa epidural kuzoncika hhayi kuphela zokugula ekhona kanye nezempilo lesiguli, kodwa futhi kwi izidakamizwa ufuna ukusebenzisa.

izinzwa Epidural at Ukubeletha

Lapho kukhona zonke izinkomba sesigaba cesarean, ngokuvamile kuba esikhundleni ukubulawa kwezinzwa okuvamile Usebenzisa epidural. Le ndlela ikhethwa kusengaphambili, njengoba kudinga ukuqeqeshwa abanye.

ukuphatha izidakamizwa elivezwa indawo ethize ezingeni okhalweni lapho eziyimpumelelo ezinzwa zitholakala emgogodleni. Umuthi iqondiswa ngepayipi ekhethekile, ipayipi phakathi nokuhlinzwa noma nini, ungakwazi ukwengeza imithi.

Ngenxa yalokho ngokusungula indlela yokubulala izinzwa, ukwazi kucacile futhi ukuzwela ngezansi ibhande iphele. Owesifazane ikwazi ukubona nokuzwa odokotela, kodwa akusho ubuhlungu.

Lapho ubhekene nesinqumo - epidural noma ukubulawa kwezinzwa okuvamile ngoba Ukubeletha - kufanele acabangele izinkomba kanye contraindications ngoba izinto zokubulala izinzwa.

Izimpawu ze-izinzwa ezifana

Ngokuvamile, izinzwa epidural isetshenziswa:

1. Uma lwemishikashika waqala ngaphambi kwesikhathi, isibonelo, kwi 36-37 ngesonto. izinzwa okunjalo ephumula imisipha ukhalo, futhi inhloko nakho womntwana umthwalo zizinkulu ngesikhathi kusengaphambili ngokusebenzisa emgudwini wokuzala cha.
2. wegazi vele ophakeme kakhulu.
3. Discoordination zabasebenzi, lapho izingxenye ezihlukahlukene izinkontileka kwesibeletho ngamandla obuhlukahlukene. izinzwa Epidural evumela ukuba buthaka ukushuba Kufinyeta.
4. Phakathi zabasebenzi isikhathi eside, lapho isikhathi eside akukhona ukuphumula egcwele. Lokhu kungaholela lokuzalwa anomalies, ngakho sebenzisa izinzwa epidural kowesifazane ukuba sithole amandla.

Izimo

Ngaphezu wobufakazi, esimweni Ukubeletha nazo Izimo for izinzwa yalokho, zihlanganisa:

• Ukuba khona ukuvuvukala kusayithi wokubhoboza.
• Izifo ezithathelwanayo.
• Ukusabela iguliswa imithi.
• Ephambi kwezinduna lesizalo sesibazi.
• Uma ingane itholakala transversely noma kuthatha isikhundla etshekile.
• ukhalo Esincane omama.
• Omkhulu isisindo ingane.
• Uma owesifazane akafuni lolu hlobo izinzwa, odokotela lungayisebenziseli ngokumelene nentando yakhe.

Ngaphambi ukusebenzisa izinzwa epidural, imiphumela, emihle nemibi kumele kucatshangwe.

Izinzuzo izinzwa epidural ngoba Ukubeletha

Izinzuzo lolu hlobo izinzwa zihlanganisa:

1. Abesifazane kuyo yonke msebenzi engqondweni, akukho ingozi intubation noma isifiso.
2. Ayikho ukucasuka elingenhla ipheshana zokuphefumula njengoba i izinzwa, okuyinto ikakhulukazi ezisizayo iziguli isifuba somoya.
3. Isimiso senhliziyo nemithambo yegazi uqinile, kusukela izidakamizwa izenzo kancane kancane.
4. Agcinwayo nekhono ukunyakaza isihlobo.
5. Nale izinzwa zingandiswa isikhathi izinzwa, kusukela ipayipi sifakwe ngokusebenzisa izinzwa nganoma yisiphi isikhathi.
6. Ngemva kokuhlinzwa kungenzeka iqondiswa opioids ngenxa yobuhlungu.

Ngaphandle kwentuthuko, kufanele kuphawulwe nemibi izinzwa enjalo.

Okumbi ngokusungula indlela yokubulala izinzwa epidural

Noma yimuphi indlela ukuhlinzwa, kanye izinzwa, has nezihibe. I yokuntula ngokusungula indlela yokubulala izinzwa epidural zihlanganisa:

1. Iphutha obulala izinzwa lapho umuntu eba zomuthi, lapho izidakamizwa singena isitsha. Lokhu kungaholela Ukudlikizela, ukwehla elibukhali blood pressure.
2. Kukhona ingozi umjovo subarachnoid, okuyinto eba ngenxa block Imininingwane umgogodla.
3. Ukuze izinzwa ezifana Kumele ube namakhono ezinhle, njengoba lena izinzwa eziyinkimbinkimbi kakhulu.
4. Umuthi siyasebenza kuphela imizuzu 15-20, ngakho ukuhlinzwa awakwazi ngokushesha.
5. Kukhona ingozi singenele ubuhlungu impumuzo lapho eziyimpumelelo ezinzwa kungukuthi ikhiyiwe ngokugcwele, futhi ulondoloze ukungakhululeki ngesikhathi ukusebenza.
6. Kuyadingeka ukuba ngokucophelela ukukhetha imithi yokubulala izinzwa phakathi kwesigaba cesarean, njengoba abanye bangase bawele placenta futhi kubangele nokuvaleka kwemigudu yokuphefumula ne-fetus ube kwenhliziyo.
7. Ngemva kokuhlinzwa okungase kuthintwe iqolo, ikhanda.

Ukuze sikhethe kahle, uma kuzodingeka section caesarean, izinzwa epidural noma jikelele, kufanele uhlole "kochwepheshe" futhi "nebubi." Cabangela Izimo ezikhona, bese ukhetha uhlobo ezifanele kakhulu ukubulawa kwezinzwa.

Izinkinga ngokusungula indlela yokubulala izinzwa epidural

yezinkinga izinzwa Epidural unika ngempela ezingavamile, nakuba izimo ezinjalo futhi wathola. Ngokuvamile ekhonjiwe:

1. Y 1 iziguli ezingu-20, izidakamizwa engathathi isinyathelo ngokusebenzisa, futhi kwalapho akuyona sivinjelwe ngokuphelele, kusho ukuthi analgesia ngeke kuphumelele.
2. Ngo khona coagulopathy kunengozi of ukulinyazwa.
3. umonakalo ngephutha ngesikhathi wokubhoboza we Mater Dura kungaholela ukuvuza cerebrospinal fluid esifundeni epidural. Igcwele ikhanda ngemva kokuhlinzwa.
4. A umthamo enkulu umuthi wezinhlungu zingase zibe nobuthi obuyingozi, okuyinto kuthanda ukuvinjelwa ukungasebenzi kahle.
5. Kungase kube imiphumela emibi evela ukusetshenziswa izinzwa izidakamizwa ethize.

Kusukela zonke lezi zindlela osekukhulunywe ke kungenziwa baphetha ngokuthi epidural izinzwa imithelela zempilo unika ezimweni ezingajwayelekile kakhulu.

Izibuyekezo mayelana nokusetshenziswa analgesia epidural

Nokho, umzimba azifani, uma abanye ukubekezelela ukubulawa kwezinzwa okuvamile, ngoba ezinye encomekayo izinzwa epidural. Izibuyekezo yena ngokwesisekelo sabo buhle.

Iziguli eziningi ukubika izinga ezinhle analgesia, abesifazane ngesikhathi kwesigaba cesarean angabona zonke izenzo odokotela nokuzwa ukukhala ngomntanakhe ngokushesha emva kokuzalwa. Kukhona ithuba elihle kakhulu ubuhlungu emva kokuhlinzwa.

Omama abaningi bathi uma une-high blood pressure, ukubulawa kwezinzwa epidural ikuvumela ukuba ugcine amarekhodi kule uhla evamile, ukuthi kuba nemiphumela emihle kuphela zabasebenzi.

Kodwa ngaphandle Izibuyekezo ezingezinhle futhi abakwazi ukukwenza. Ezinye iziguli zizizwe ukukhululeka ubuhlungu emva ubuhlungu bekhanda ezinjalo, ubuhlungu emuva. Kunalabo lapho izidakamizwa nje ayisebenzanga, kanye nokuvinjelwa kwalapho akwenzekanga.

Nasibuka zonke izibuyekezo, ungakwazi ukufinyelela kwesakho isiphetho esisodwa kuphela: yiluphi uhlobo izinzwa kudinga abanekhono Uchwepheshe indlela. Uma ngisho elula ngokusungula indlela yokubulala izinzwa ukwelapha ulondekile, hhayi ukubala umthamo noma yimuphi umuthi, kungenzeka ukuthola imiphumela okungafunwa, ngezinye izikhathi ibe yinto engathi sina, nokuthi yini okumelwe ngiyikhulume mayelana epidural.

Yonke imibuzo kufanele kube pre-ukuxoxisana nodokotela wakho, ngakho-ke akazange abe ukubonakaliswa engathandeki.

Yiqiniso, kungaba ngokuphelele uma umuntu akazange kudingeka ahlinzwe, ngakho-ke ngeke kudingeke futhi izinzwa. Kodwa ezingokoqobo yethu yokuphila kangangokuthi ngezinye izikhathi ukusebenza akunakugwenywa ukuze kulondolozwe ukuphila nempilo. Zinakekele futhi uhlale unempilo.