Thoracentesis
1, Nā hōʻailona
1. Pleural effusion o ke ano ike ole, hoao puncture
2. Pleural effusion a i ʻole pneumothorax me nā hōʻailona compression
3. Empyema a i ʻole maʻi pleural effusion, intrapleural administration
2 、 Contraindications
1. ʻO nā poʻe maʻi hui ʻole;
2. ʻO ka maʻi coagulation i hoʻoponopono ʻole ʻia;
3. ʻAʻole lawa ʻole ka hanu ʻana (koe ke hoʻomaha ʻia e ka thoracentesis therapeutic);
4. ʻO ka maʻi hemodynamic instability a i ʻole arrhythmia;ʻO ka angina pectoris paʻa ʻole.
5. ʻO nā contraindications pili e pili ana i ka ventila mechanical a me ka maʻi ʻōpū bullous.
6. Pono e kāpae ʻia ka maʻi kūloko ma mua o ke komo ʻana o ka nila i loko o ka umauma.
3 、 Nā pilikia
1. Pneumothorax: pneumothorax ma muli o ke kahe ʻana o ke kinoea o ka nila puncture a i ʻole ka ʻeha ma lalo o ia;
2. Hemothorax: ka lua pleural a i ʻole ka hemorrhage o ka paia o ka umauma ma muli o ke kui puncture e hōʻino ana i nā moku subcostal;
3. Extravasated effusion ma kahi puncture
4. Vasovagal syncope a i ʻole syncope maʻalahi;
5. Air embolism (kakaʻikahi akā pōʻino);
6. Ka ma'i ma'i;
7. ʻO ka ʻeha ʻana o ka ʻāʻī a i ʻole ke akepaʻa ma muli o ka haʻahaʻa haʻahaʻa a i ʻole ka hohonu o ka hoʻokomo ʻana;
8. Ka ho'i hou 'ana o ka pulmonary edema ma muli o ka ho'okahe 'ana i ka wai > 1L.Kakaikahi loa ka make.
4、 Hoʻomākaukau
1. Kūlana
Ma ke kūlana noho a semi reclining paha, aia ka ʻaoʻao i hoʻopilikia ʻia ma ka ʻaoʻao, a ua hoʻokiʻekiʻe ʻia ka lima o ka ʻaoʻao i hoʻopilikia ʻia ma luna o ke poʻo, no laila e wehe ʻia nā intercostal.
2. E hoʻoholo i ke kiko puncture
1) Pneumothorax ma ka lua intercostal o ka laina clavicular waena a i ʻole 4-5 mau kikowaena intercostal o ka laina axillary waena.
2) ʻOi aku ka maikaʻi o ka laina scapular a i ʻole ka 7th a i ka 8th intercostal space o ka laina axillary hope.
3) Inā pono, hiki ke koho ʻia nā 6-7 intercostals o ka midline axillary
A i ʻole ka 5th intercostal space o mua axillary
Ma waho o ka huina costal, holo nā kīʻaha koko a me nā aʻalolo i ka sulcus costal a māhele ʻia i nā lālā luna a me lalo ma ka laina axillary hope.Aia ka lala luna ma ka sulcus costal a ʻo ka lālā lalo ma ka lihi luna o ka iwi ʻaoʻao lalo.No laila, i ka thoracocentesis, hele ka paia hope ma waena o ka intercostal space, kokoke i ka lihi luna o ka iwi ʻaoʻao haʻahaʻa;ʻO nā paia mua a me ka ʻaoʻao e hele i loko o ka intercostal space a ma waena o nā iwi ʻaoʻao ʻelua, hiki ke pale i ka hōʻino ʻana i nā moku intercostal a me nā aʻalolo.
ʻO ka pilina kūlana ma waena o nā kīʻaha koko a me nā aʻalolo: veins, arteries and nerves mai luna a lalo.
Pono e hoʻokomo ʻia ka nila puncture i loko o ka lumi intercostal me ka wai.ʻAʻohe effusion pleural encapsulated.ʻO ka puncture point he wahi kumukūʻai ma lalo o ka pae wai, aia ma ka laina infrascapular.Ma hope o ka hoʻomaʻemaʻe ʻia ʻana o ka ʻili me ka iodine tincture, ua hoʻokomo ka mea hana i nā mīkina lima sterile a waiho i kahi kāwele puka sterile, a laila hoʻohana i ka 1% a i ʻole 2% lidocaine no ka anesthesia kūloko.E hana mua i kahi colliculus ma ka ʻili, a laila ʻiʻo subcutaneous, infiltration periosteum ma ka ʻaoʻao o luna o ka iwi ʻaoʻao haʻahaʻa (e pale i ka pili ʻana me ka ʻaoʻao haʻahaʻa o ka iwi ʻaoʻao luna e pale ai i ka hōʻino ʻana i ke aʻalolo subcostal a me ka plexus vascular), a hope i ka parietal. pleura.I ke komo ʻana i ka pleura parietal, hiki i ka paipu nila anestheia ke omo i ka wai pleural, a laila hoʻopaʻa i ka nila anesthesia me kahi puʻupuʻu vascular ma ka pae ʻili e hōʻailona ai i ka hohonu o ka nila.E hoʻohui i ka nui caliber (No. 16 ~ 19) thoracentesis needle a i ʻole needle cannula device i kahi hoʻololi ʻekolu ala, a hoʻohui i kahi syringe 30 ~ 50ml a me kahi paipu e hoʻokaʻawale i ka wai i ka syringe i loko o ka pahu.Pono ke kauka e hoʻolohe i ka hōʻailona ma ka nila anesthesia e hiki i ka hohonu o ka wai o ka umauma, a laila e hoʻokomo i ka nila no 0.5cm.I kēia manawa, hiki i ka nila ke anawaena nui ke komo i loko o ka lua o ka umauma e hōʻemi i ka pilikia o ke komo ʻana i ka ʻiʻo māmā lalo.Hoʻokomo pololei ka nila puncture i ka paia o ka umauma, ka ʻiʻo subcutaneous, a komo i ka wai pleural ma ka ʻaoʻao o luna o ka iwi ʻaoʻao lalo.ʻOi aku ka maikaʻi o ka catheter maʻalahi ma mua o ka nila thoracentesis maʻalahi no ka mea hiki ke hōʻemi i ka pilikia o ka pneumothorax.Loaʻa i ka hapa nui o nā halemai nā disc puncture chest disposable i hoʻolālā ʻia no ka puncture palekana a maikaʻi hoʻi, me nā nila, nā syringes, nā hoʻololi a me nā paipu hōʻike.
Ka manawa hoʻouna: Jun-06-2022
