Zizindikiro za kuphulika kwa thoracic
Pofuna kumveketsa bwino chikhalidwe cha pleural effusion, pleural puncture ndi aspiration kufufuza ayenera kuchitidwa kuthandiza matenda;Pakakhala kuchuluka kwamadzimadzi kapena gasi kudzikundikira chifukwa cha zizindikiro za kupsinjika kwa mapapo, ndipo odwala a pyothorax amafunika kupopera madzimadzi kuti athandizidwe;Mankhwala ayenera kubayidwa mu chifuwa.
Contraindications wakupweteka pachifuwa
(1) Malo okhomerera ali ndi kutupa, chotupa ndi zoopsa.
(2) Pali chizolowezi cha magazi kwambiri, pneumothorax mowiriza, magazi kuundana kwakukulu, chifuwa chachikulu cha m'mapapo, emphysema, etc.
Njira Zopewera Kuphulika kwa Thoracic
(1) Odwala omwe ali ndi vuto la coagulation, matenda otaya magazi komanso omwe amamwa mankhwala oletsa magazi kutsekeka ayenera kuthandizidwa molingana ndi opareshoni.
(2) Kuphulika kwa thoracic kuyenera kuchitidwa opaleshoni kuti ateteze kugwedezeka kwa pleural.
(3) The puncture ayenera kuchitidwa pafupi ndi kumtunda m'mphepete mwa nthiti kupewa kuvulala kwa intercostal mitsempha ndi mitsempha.Singano, chubu la latex kapena kusintha kwanjira zitatu, silinda ya singano, ndi zina zotero ziyenera kutsekedwa kuti mpweya usalowe pachifuwa ndikuyambitsa pneumothorax.
(4) Kubowola kuyenera kukhala kosamala, njirayo iyenera kukhala yaluso, ndipo kupha tizilombo kuyenera kukhala kosamalitsa kuti tipewe kuyambitsa matenda atsopano, pneumothorax, hemothorax kapena kuvulaza mwangozi mitsempha yamagazi, mtima, chiwindi ndi ndulu.
(5) Chikhosomo chiyenera kupewedwa pa puncture.Yang'anani kusintha kwa wodwalayo nthawi iliyonse.Ngati nkhope yotuwa, thukuta, chizungulire, palpitations ndi kugunda kofooka, puncture iyenera kuyimitsidwa nthawi yomweyo.Lolani wodwala kugona mosabisa, kukoka mpweya wa okosijeni ngati kuli kofunikira, ndi kubaya adrenaline kapena sodium benzoate ndi caffeine subcutaneously.Kuphatikiza apo, chithandizo chofananira chidzapangidwa molingana ndi chikhalidwecho.
(6) Madzi amadzimadzi ayenera kupopa pang'onopang'ono.Ngati madzi ambiri amayenera kupopedwa chifukwa cha chithandizo, chosinthira chanjira zitatu chiyenera kulumikizidwa kuseri kwa singanoyo.Madzi amadzimadzi sayenera kutsanulidwa kwambiri kuti athandizidwe.Ngati ndi kotheka, imatha kupopera kangapo.Kuchuluka kwa madzi omwe amapopedwa kwa nthawi yoyamba sikuyenera kupitirira 600ml, ndipo kuchuluka kwa madzi omwe amapopedwa nthawi iliyonse pambuyo pake kumakhala pafupifupi 1000ml.
(7) Ngati madzi amene akutuluka magazi atulutsidwa, siyani kujambula mwamsanga.
(8) Kukafunika kubaya mankhwala pachifuwa, gwirizanitsani syringe yomwe mwakonza yokhala ndi madzi amankhwala mutapopa, sakanizani madzi a pachifuwa ndi mankhwala amadzimadzi, ndipo bayaninso kuti mutsimikize kuti wabayidwa pachifuwa. pakamwa
Momwe mungasankhire malo oyika pa thoracic puncture?
(1) thoracic puncture ndi ngalande: sitepe yoyamba ndi kuchita percussion pa chifuwa, ndi kusankha mbali ndi zoonekeratu olimba phokoso kwa puncture, amene akhoza ili osakaniza X-ray ndi B-ultrasound.Malo otsekemera amatha kuwonetsedwa pakhungu ndi violet violet, ndipo nthawi zambiri amasankhidwa motere: 7 ~ 9 intercostal mizere ya subscapular angle;7-8 intercostals wa posterior axillary mzere;6-7 ma intercostals a mzere wa midaxillary;Kutsogolo kwa axillary ndi nthiti 5-6.
(2) Encapsulated pleural effusion: puncture akhoza kuchitidwa osakaniza X-ray ndi akupanga kutanthauzira.
(3) Pneumothorax decompression: danga lachiwiri la intercostal mu mzere wa midclavicular kapena 4-5 intercostal space mu mzere wa midaxillary wa mbali yokhudzidwa nthawi zambiri amasankhidwa.Chifukwa minyewa ya intercostal ndi mitsempha ndi mitsempha imathamanga m'munsi mwa nthiti, iyenera kubayidwa kumtunda kwa nthiti kuti zisawononge mitsempha ndi mitsempha ya magazi.
Njira yonse ya puncture ya thoracic
1. Uzani wodwalayo kukhala mpando moyang'ana kumbuyo kwa mpando, ikani manja onse kumbuyo kwa mpando, ndi kutsamira mphumi pamphumi.Amene sangathe kudzuka akhoza kutenga theka atakhala udindo, ndipo anakhudzidwa mkono wapatsogolo amakwezedwa pa pilo.
2. Malo okhomerera adzasankhidwa pa mbali yowonekera kwambiri ya phokoso la chifuwa.Pakakhala madzi ambiri a pleural, mzere wa scapular kapena 7th ~ 8th intercostal space ya posterior axillary line nthawi zambiri imatengedwa;Nthawi zina malo a 6 mpaka 7 a intercostal mzere wa midaxillary kapena 5th intercostal space of front axillary line amasankhidwanso ngati malo opumira.Encapsulated effusion angadziwike ndi X-ray kapena akupanga kufufuza.Malo obowola amalembedwa pakhungu ndi swab ya thonje yoviikidwa mu methyl violet (gentian violet).
3. Nthawi zonse thirirani mankhwala pakhungu, valani magolovesi osabala, ndi kuphimba thaulo la bowo lophera tizilombo.
4. Gwiritsani ntchito 2% lidocaine wa 2% kuchita opaleshoni yolowera m'deralo kuchokera pakhungu kupita ku khoma la pleural pamphepete mwa nthiti ya m'munsi.
5. Wothandizira amakonza khungu la malo obowola ndi chala chakumanzere ndi chala chapakati, amatembenuzira tambala wanjira zitatu wa singano pamalo pomwe chifuwa chimatsekedwa ndi dzanja lamanja, ndiyeno pang'onopang'ono. amaboola singano pamalo ogonetsa.Pamene kukana kwa singano nsonga mwadzidzidzi kutha, tembenuzirani njira zitatu tambala kuti kugwirizana ndi chifuwa kwa madzimadzi m'zigawo.Wothandizira amagwiritsa ntchito mphamvu za hemostatic kuthandiza kukonza singano yoboola kuti minyewa ya m'mapapo isawonongeke polowera kwambiri.syringe ikadzadza, tembenuzani valavu yanjira zitatu kuti mulumikizane ndi dziko lakunja ndikutulutsa madziwo.
6. Kumapeto kwa m'zigawo zamadzimadzi, tulutsani singano yoboola, kuphimba ndi yopyapyala yopyapyala, kanikizani ndi mphamvu pang'ono kwa kamphindi, konzani ndi tepi yomatira ndikufunsa wodwalayo kuti agone.
Nthawi yotumiza: Oct-20-2022
