Thoracentesis
1. Alamu
1. Zubewar da ba a sani ba, gwajin huda
2. Pleural effusion ko pneumothorax tare da matsawa bayyanar cututtuka
3. Empyema ko m pleural effusion, intrapleural gwamnati
2. Contraindications
1. Marasa lafiya marasa haɗin gwiwa;
2. Cutar coagulation mara kyau;
3. Rashin isasshen numfashi ko rashin kwanciyar hankali (sai dai idan an sauƙaƙa ta hanyar thoracentesis na warkewa);
4. Rashin lafiyar hemodynamic na zuciya ko arrhythmia;Rashin kwanciyar hankali angina pectoris.
5. Abubuwan da ke da alaƙa sun haɗa da samun iska na inji da cutar huhu.
6. Dole ne a cire kamuwa da cuta na gida kafin allura ta shiga cikin kirji.
3. Matsaloli
1. Pneumothorax: pneumothorax wanda ya haifar da zubar da iskar gas na allurar huda ko ciwon huhu a ƙarƙashinsa;
2. Hemothorax: kumburin pleural ko bangon kirji wanda ya haifar da allurar huda tana lalata tasoshin ruwa;
3. Zubar da ruwa mai yawa a wurin huda
4. Vasovagal syncope ko syncope mai sauƙi;
5. Cutar hawan jini (rare amma bala'i);
6. Kamuwa da cuta;
7. Raunin soka ko hanta wanda ya haifar da ƙananan allura ko zurfi;
8. Relapsing pulmonary edema lalacewa ta hanyar saurin magudanar ruwa> 1L.Mutuwa tana da wuyar gaske.
4. Shiri
1. Matsayi
A cikin wurin zama ko matsakaicin matsayi, gefen da abin ya shafa yana gefe, kuma an ɗaga hannun gefen da ya shafa sama da kai, don haka intercostals suna buɗewa.
2. Ƙayyade wurin huda
1) Pneumothorax a cikin na biyu intercostal sarari na tsakiyar clavicular line ko 4-5 intercostal sarari na tsakiyar axillary line.
2) Zai fi dacewa layin scapular ko 7th zuwa 8th intercostal sarari na layin axillary na baya.
3) Idan ya cancanta, ana iya zaɓar 6-7 intercostals na axillary midline
Ko 5th intercostal sarari na axillary gaban
A waje da kusurwar farashi, tasoshin jini da jijiyoyi suna gudana a cikin sulcus costal kuma an raba su zuwa rassa na sama da na kasa a layin axillary na baya.Reshe na sama yana cikin sulcus costal kuma reshe na ƙasa yana a gefen babba na haƙarƙarin ƙasa.Sabili da haka, a cikin thoracocentesis, bangon baya yana wucewa ta sararin samaniya, kusa da gefen babba na ƙananan haƙarƙari;Ganuwar gaba da ta gefe suna wucewa ta sararin samaniya kuma ta tsakiyar haƙarƙari biyu, wanda zai iya guje wa lalata tasoshin intercostal da jijiyoyi.
Alakar matsayi tsakanin tasoshin jini da jijiyoyi shine: jijiya, arteries da jijiyoyi daga sama zuwa kasa.
Ya kamata a saka allurar huda a cikin sararin intercostal tare da ruwa.Babu zubar da jini da aka rufe.Wurin huda galibi wuri ne mai tsada a ƙasan matakin ruwa, wanda yake a layin infrascapular.Bayan da aka lalata fata da tincture na iodine, ma'aikacin ya sanya safofin hannu mara kyau kuma ya shimfiɗa tawul na rami mara kyau, sannan ya yi amfani da 1% ko 2% lidocaine don maganin sa barci.Da farko a yi colliculus a kan fata, sa'an nan subcutaneous nama, periosteum infiltration a kan babba gefen haƙarƙari (don hana lamba tare da ƙananan gefen haƙarƙari na sama don kauce wa lalata subcostal jijiya da jijiyoyin bugun gini plexus), kuma a karshe zuwa parietal. pleura.Lokacin shiga cikin parietal pleura, bututun allura na maganin sa barci na iya tsotse ruwan ma'auni, sannan kuma a matse allurar sa barcin tare da matsewar jijiyoyin jini a matakin fata don alamar zurfin allurar.Haɗa babban ma'auni (No. 16 ~ 19) thoracentesis allura ko allura cannula na'urar zuwa maɓalli uku, kuma haɗa sirinji na 30 ~ 50ml da bututu don zubar da ruwa a cikin sirinji a cikin akwati.Likita ya kamata ya kula da alamar allurar maganin sa barcin da ta kai zurfin ruwan kirji, sannan a yi allurar har zuwa 0.5cm.A wannan lokacin, allura mai girman diamita na iya shiga cikin ramin ƙirji don rage haɗarin shiga cikin ƙwayar huhu da ke ƙasa.Allurar huda a tsaye tana shiga bangon ƙirji, nama mai nakasa, kuma ta shiga cikin ruwan ɓangarorin tare da saman gefen hakarkarin ƙasa.Catheter mai sassauƙa ya fi na al'ada mai sauƙi thoracentesis allura saboda zai iya rage haɗarin pneumothorax.Yawancin asibitoci suna da fayafai masu huda ƙirji da za'a iya zubar dasu don amintaccen huda mai inganci, gami da allura, sirinji, maɓalli da bututun gwaji.
Lokacin aikawa: Juni-06-2022
