Indications ntawm thoracic puncture
Txhawm rau kom paub meej qhov xwm txheej ntawm pleural effusion, pleural puncture thiab aspiration kuaj yuav tsum tau ua los pab kuaj mob;Thaum muaj cov kua dej ntau los yog cov roj tsub zuj zuj ua rau cov tsos mob ntawm lub ntsws compression, thiab cov neeg mob pyothorax yuav tsum tau tso kua dej rau kev kho mob;Cov tshuaj yuav tsum tau txhaj rau hauv lub hauv siab kab noj hniav.
Contraindications ntawmthoracic puncture
(1) Qhov chaw puncture muaj o, qog thiab raug mob.
(2) Muaj cov tsos mob los ntshav hnyav, mob ntsws pneumothorax, ntshav txhaws, mob ntsws ntsws hnyav, mob ntsws, thiab lwm yam.
Kev ceev faj rau thoracic puncture
(1) Cov neeg mob uas muaj coagulation tsis xws luag, los ntshav cov kab mob thiab cov neeg siv tshuaj anticoagulant yuav tsum tau kho raws li ua ntej ua hauj lwm.
(2) Thoracic puncture yuav tsum tau muab tshuaj loog tag nrho kom tsis txhob poob siab pleural.
(3) Lub puncture yuav tsum tau ua nyob ze rau ntawm ntug sab sauv ntawm tav kom tsis txhob raug mob rau cov hlab ntsha intercostal thiab cov hlab ntsha.Lub koob, raj raj lossis peb-txoj kev hloov, koob lub tog raj kheej, thiab lwm yam yuav tsum kaw kom tsis txhob muaj cua nkag mus rau hauv siab thiab ua rau pneumothorax.
(4) Puncture yuav tsum ceev faj, cov txheej txheem yuav tsum tau txawj, thiab tshuaj tua kab mob yuav tsum nruj kom tsis txhob ua rau tus kab mob tshiab, pneumothorax, hemothorax los yog raug mob rau cov hlab ntsha, plawv, siab thiab tus po.
(5) Yuav tsum tsis txhob hnoos thaum lub sij hawm puncture.Saib xyuas tus neeg mob qhov kev hloov pauv txhua lub sijhawm.Nyob rau hauv cov ntaub ntawv ntawm lub ntsej muag daj ntseg, tawm hws, kiv taub hau, palpitation thiab tsis muaj zog pulse, lub puncture yuav tsum tau nres tam sim ntawd.Cia tus neeg mob pw tiaj tus, nqus pa oxygen thaum tsim nyog, thiab txhaj tshuaj adrenaline lossis sodium benzoate thiab caffeine subcutaneously.Tsis tas li ntawd, kev kho mob yuav tsum tau ua raws li tus mob.
(6) Cov kua dej yuav tsum tau maj mam nqus.Yog tias cov kua dej ntau yuav tsum tau muab tso rau vim kev kho mob, qhov kev hloov peb txoj kev yuav tsum tau txuas nrog tom qab rab koob.Cov kua dej yuav tsum tsis txhob ntws ntau dhau rau kev kho mob.Yog tias tsim nyog, nws tuaj yeem muab tso rau hauv ob peb zaug.Tus nqi ntawm cov kua twj tso kua mis thawj zaug yuav tsum tsis pub tshaj 600ml, thiab tus nqi ntawm cov kua pumped rau txhua lub sij hawm tom qab ntawd feem ntau yuav tsum yog li ntawm 1000ml.
(7) Yog tias cov kua los ntshav tawm, nres tam sim ntawd.
(8) Thaum nws yuav tsum tau txhaj tshuaj rau hauv lub hauv siab kab noj hniav, txuas lub syringe npaj uas muaj cov tshuaj kua tom qab nqus dej, sib tov me ntsis ntawm lub hauv siab kua nrog cov tshuaj kua, thiab txhaj ib zaug ntxiv kom paub meej tias nws yog txhaj rau hauv siab. kab noj hniav
Yuav ua li cas xaiv qhov thoracic puncture positioning point?
(1) thoracic puncture thiab kua dej: thawj kauj ruam yog ua percussion ntawm lub hauv siab, thiab xaiv ib feem nrog pom tseeb lub suab rau puncture, uas yuav tsum tau nyob rau hauv ua ke nrog X-ray thiab B-ultrasound.Cov taw tes rau ntawm qhov chaw tuaj yeem raug cim rau ntawm daim tawv nqaij nrog cov ntsia hlau violet, thiab nws feem ntau xaiv raws li hauv qab no: 7 ~ 9 kab intercostal ntawm lub kaum sab xis subscapular;7-8 intercostals ntawm posterior axillary kab;6 ~ 7 intercostals ntawm midaxillary kab;Lub axillary pem hauv ntej yog 5-6 tav.
(2) Encapsulated pleural effusion: puncture tuaj yeem ua nrog X-ray thiab ultrasonic localization.
(3) Pneumothorax decompression: qhov chaw thib ob intercostal nyob rau hauv midclavicular kab los yog 4-5 intercostal qhov chaw nyob rau hauv midaxillary kab ntawm cov cuam tshuam sab feem ntau xaiv.Vim tias cov hlab ntsha intercostal thiab cov hlab ntsha thiab cov hlab ntsha khiav raws ntug qis ntawm cov tav, lawv yuav tsum tau punctured los ntawm ntug sab sauv ntawm tav kom tsis txhob puas cov hlab ntsha thiab cov hlab ntsha.
Tag nrho cov txheej txheem ntawm thoracic puncture
1. Qhia tus neeg mob nqa lub rooj zaum tig rau sab nraub qaum ntawm lub rooj zaum, muab ob txhais caj npab rau ntawm lub nraub qaum ntawm lub rooj zaum, thiab nqa lub hauv pliaj ntawm lub hauv pliaj.Cov neeg uas tsis tuaj yeem sawv ntsug tuaj yeem ua haujlwm ib nrab zaum, thiab lub puab tsaig cuam tshuam tau tsa rau ntawm lub hauv ncoo.
2. Lub puncture point yuav tsum raug xaiv ntawm qhov pom tseeb tshaj plaws ntawm lub hauv siab percussion suab.Thaum muaj ntau cov kua pleural, cov kab scapular los yog 7th ~ 8th intercostal qhov chaw ntawm lub posterior axillary kab feem ntau yog noj;Qee zaum 6 mus rau 7th intercostal qhov chaw ntawm midaxillary kab los yog 5th intercostal qhov chaw ntawm lub hauv ntej axillary kab kuj raug xaiv raws li cov ntsiab lus puncture.Encapsulated effusion tuaj yeem txiav txim siab los ntawm X-ray lossis kuaj ultrasonic.Lub puncture point yog cim rau ntawm daim tawv nqaij nrog ib tug paj rwb swab dipped nyob rau hauv methyl violet (gentian violet).
3. Tsis tu ncua tshuaj tua kab mob ntawm daim tawv nqaij, hnav cov hnab looj tes tsis muaj menyuam, thiab npog lub qhov quav cov phuam so.
4. Siv 2% lidocaine los ua tshuaj loog hauv zos infiltration ntawm daim tawv nqaij mus rau phab ntsa pleural ntawm qhov taw tes rau ntawm ntug sab sauv ntawm sab tav.
5. Tus neeg teb xov tooj kho cov tawv nqaij ntawm qhov chaw puncture nrog tus ntiv tes taw ntawm sab laug tes thiab ntiv tes nruab nrab, tig peb txoj kev qaib ntawm rab koob mus rau qhov chaw uas lub hauv siab kaw nrog sab tes xis, thiab maj mam maj mam. pierces puncture koob rau hauv qhov chaw tshuaj loog.Thaum qhov kev tiv thaiv ntawm rab koob dheev ploj mus, tig peb txoj kev qaib kom nws txuas nrog lub hauv siab rau cov kua dej tawm.Tus neeg pab siv hemostatic forceps los pab kho cov koob txhaj tshuaj tiv thaiv kom tsis txhob mob ntsws los ntawm kev nkag mus tob heev.Tom qab cov koob txhaj tshuaj puv lawm, tig lub valve peb-txoj kev txuas nrog lub ntiaj teb sab nraud thiab tso cov kua.
6. Thaum kawg ntawm kev tshem tawm cov kua dej, rub tawm lub koob txhaj tshuaj, npog nws nrog cov ntaub qhwv tsis muaj menyuam, nias nws nrog lub zog me ntsis rau ib pliag, kho nws nrog cov nplaum nplaum thiab hais kom tus neeg mob pw tsaug zog.
Post lub sij hawm: Oct-20-2022
