Thoracentesis
1, Ngosipụta
1. Mfụfụ nke ọdịdị amaghi ama, ule ntụpọ
2. Mgbapụta nrịanrịa ma ọ bụ pneumothorax nwere mgbaàmà mkpakọ
3. Empyema ma ọ bụ malignant pleural effusion, intrapleural nchịkwa
2, Contraindications
1. Ndị ọrịa na-akwadoghị;
2. Ọrịa coagulation na-adịghị edozi;
3. Enweghị ike iku ume ma ọ bụ enweghị ike (ọ gwụla ma thoracentesis ọgwụgwọ ọgwụgwọ kwụsịrị);
4. Obi mgbawa hemodynamic ma ọ bụ arrhythmia;Angina pectoris na-adịghị ala ala.
5. Ndị ikwu contraindications gụnyere n'ibu ventilashion na bullous ngụgụ ọrịa.
6. A ga-ewepụrịrị ọrịa mpaghara tupu agịga abanye n'ime obi.
3. Nsogbu
1. Pneumothorax: pneumothorax kpatara site na ntapu gas nke agịga ntụpọ ma ọ bụ trauma ngụgụ n'okpuru ya;
2. Hemothorax: oghere pleural ma ọ bụ ọbara ọgbụgba mgbidi obi kpatara site na agịga mgbapu na-emebi arịa subcostal;
3. Mpụpụ nke ukwuu n'ebe ntụpọ
4. Vasovagal syncope ma ọ bụ syncope dị mfe;
5. Ikuku embolism (obere ma ọdachi);
6. Ọrịa;
7. mmerụ ahụ nke splin ma ọ bụ imeju kpatara oke ogbugba dị ala ma ọ bụ nke miri emi;
8. Ntughari edema nke akpa ume na-akpata site na ngwa ngwa drainage> 1L.Ọnwụ dị ụkọ nke ukwuu.
4, Nkwadebe
1. Nhazi
N'ebe a na-anọdụ ala ma ọ bụ ọkara, akụkụ ahụ emetụtara dị n'akụkụ, na ogwe aka nke akụkụ ahụ na-ebuli elu n'elu isi, nke mere na intercostals na-emeghe.
2. Kpebie ebe mgbaba
1) Pneumothorax na oghere intercostal nke abụọ nke ahịrị clavicular etiti ma ọ bụ 4-5 oghere intercostal nke ahịrị axillary etiti.
2) Ọkacha mma ahịrị scapular ma ọ bụ oghere 7th ruo 8th intercostal nke ahịrị axillary azụ.
3) Ọ bụrụ na ọ dị mkpa, 6-7 intercostals nke axillary midline nwekwara ike họrọ
Ma ọ bụ oghere intercostal nke ise nke axillary n'ihu
N'èzí ọnụ ahịa ọnụ ahịa, arịa ọbara na irighiri akwara na-agba ọsọ na sulcus costal ma kewara n'ime alaka elu na nke ala na azụ axillary akara.Alaka nke elu dị na sulcus costal na alaka nke ala dị na nsọtụ elu nke ọgịrịga ala.Ya mere, na thoracocentesis, mgbidi dị n'azụ na-agafe oghere intercostal, dị nso na nsọtụ elu nke ọgịrịga dị ala;Mgbidi dị n'ihu na nke dị n'akụkụ na-agafe oghere intercostal na site na etiti ọgịrịga abụọ, nke nwere ike izere imebi arịa intercostal na irighiri akwara.
Mmekọrịta dị n'etiti arịa ọbara na irighiri akwara bụ: veins, arteries na irighiri akwara site n'elu ruo ala.
Ekwesịrị ịtinye agịga mgbapu n'ime oghere intercostal na mmiri mmiri.Ọ dịghị ihe mkpuchi nke pleural effusion.Ebe nkwụsịtụ na-abụkarị oghere dị ọnụ ala n'okpuru ọkwa mmiri mmiri, nke dị na eriri infrascapular.Mgbe ejiri tincture iodine mebie akpụkpọ ahụ, onye ọrụ ahụ yiri gloves na-adịghị mma ma tinye akwa nhicha oghere na-adịghị mma, wee jiri lidocaine 1% ma ọ bụ 2% mee ihe maka mgbanwụ mpaghara.Mbụ mee colliculus na akpụkpọ ahụ, mgbe ahụ subcutaneous anụ ahụ, periosteum infiltration na elu nsọtụ nke ala ọgịrịga (iji gbochie kọntaktị na ala nsọtụ nke elu ọgịrịga iji zere imebi subcostal akwara na vaskụla plexus), na n'ikpeazụ na parietal. pleura.Mgbe ị na-abanye n'ime parietal pleura, tube agịga anesthesia nwere ike amịpụta mmiri nke pleural, wee jigide agịga anesthesia na mgbachi vaskụla n'ogo akpụkpọ iji gosi omimi nke agịga ahụ.Jikọọ nnukwu caliber (Ọ dịghị. 16 ~ 19) thoracentesis agịga ma ọ bụ agịga cannula ngwaọrụ na ngbanwe ụzọ atọ, ma jikọọ sirinji 30 ~ 50ml na ọkpọkọ iji kpochapụ mmiri mmiri na sirinji n'ime akpa ahụ.Dọkịta kwesịrị ịṅa ntị na akara dị na agịga anesthesia nke ruru omimi nke mmiri mmiri, wee gbanye agịga maka 0,5cm.N'oge a, agịga nke nnukwu dayameta nwere ike ịbanye n'ime oghere obi iji belata ihe ize ndụ nke ịbanye n'ime anụ ahụ ngụgụ.Agịga ahụ na-agbapụta na kwụ ọtọ na-abanye n'ime mgbidi obi, anụ ahụ subcutaneous, wee banye n'ime mmiri nke pleural n'akụkụ elu nke ọgịrịga ala.Catheter na-agbanwe agbanwe dị elu karịa agịga thoracentesis dị mfe n'ihi na ọ nwere ike ibelata ihe ize ndụ nke pneumothorax.Ọtụtụ ụlọ ọgwụ nwere diski mkpọmkpọ obi nke a na-atụfu maka ntupu dị mma ma dị irè, gụnyere agịga, sirinji, mgba ọkụ na tubes ule.
Oge nzipu: Jun-06-2022
