Matenda a thoracentesis
1, Zizindikiro
1. Pleural effusion ya chilengedwe chosadziwika, puncture test
2. Pleural effusion kapena pneumothorax yokhala ndi zizindikiro za kupanikizana
3. Empyema kapena malignant pleural effusion, intrapleural administration
2, Contraindications
1. Odwala osagwira ntchito;
2. Matenda a coagulation osakonzedwa;
3. Kulephera kwa kupuma kapena kusakhazikika (pokhapokha kumasulidwa ndi thoracentesis yochizira);
4. Kusakhazikika kwa mtima wa hemodynamic kapena arrhythmia;Kusakhazikika kwa angina pectoris.
5. Contraindications wachibale monga makina mpweya wabwino ndi bullous m'mapapo matenda.
6. Matenda am'deralo ayenera kuchotsedwa singano isanalowe pachifuwa.
3, Zovuta
1. Pneumothorax: pneumothorax chifukwa cha kutuluka kwa mpweya wa singano yoboola kapena kuvulala kwamapapu pansi pake;
2. Hemothorax: pleural patsekeke kapena pachifuwa khoma kukha magazi chifukwa choboola singano kuwononga subcostal ziwiya;
3. Kutulutsa kochulukira pa puncture point
4. Vasovagal syncope kapena syncope yosavuta;
5. Air embolism (yosowa koma yoopsa);
6. Matenda;
7. Kubaya kwa ndulu kapena chiwindi chifukwa cha jekeseni wochepa kwambiri kapena wozama kwambiri;
8. Kubwereranso m'mapapo mwanga edema chifukwa cha madzi othamanga> 1L.Imfa ndiyosowa kwambiri.
4. Kukonzekera
1. Kaimidwe
Pamalo okhala kapena okhazikika, mbali yomwe yakhudzidwa ili kumbali, ndipo mkono wa mbali yomwe yakhudzidwa imakwezedwa pamwamba pamutu, kotero kuti ma intercostals ndi otseguka.
2. Dziwani malo okhomerera
1) Pneumothorax mu danga lachiwiri la intercostal la mzere wapakati wa clavicular kapena 4-5 intercostal spaces of the middle axillary line
2) Makamaka mzere wa scapular kapena 7th mpaka 8th intercostal space of posterior axillary line
3) Ngati ndi kotheka, 6-7 intercostals axillary midline akhoza kusankhidwa
Kapena 5th intercostal danga la axillary kutsogolo
Kunja kwa ngodya yamtengo wapatali, mitsempha ya magazi ndi mitsempha imathamanga mu costal sulcus ndipo imagawidwa mu nthambi zapamwamba ndi zotsika pamzere wapambuyo wa axillary.Nthambi yakumtunda ili mu costal sulcus ndipo nthambi ya m'munsi ili m'mphepete mwa nthiti yapansi.Choncho, mu thoracocentesis, khoma lakumbuyo limadutsa mumtunda wa intercostal, pafupi ndi m'mphepete mwa nthiti yapansi;Makoma am'mbuyo ndi ofananira nawo amadutsa danga la intercostal ndikudutsa pakati pa nthiti ziwiri, zomwe zingapewe kuwononga mitsempha ya intercostal ndi mitsempha.
Ubale pakati pa mitsempha ya magazi ndi mitsempha ndi: mitsempha, mitsempha ndi mitsempha kuchokera pamwamba mpaka pansi.
The puncture singano ayenera anaikapo mu intercostal danga ndi madzi.Palibe encapsulated pleural effusion.Malo opumira nthawi zambiri amakhala malo okwera mtengo pansi pa mulingo wamadzimadzi, womwe uli pamzere wa infrascapular.Pambuyo pa khungu anali tizilombo toyambitsa matenda ndi ayodini tincture, woyendetsa anavala wosabala magolovesi ndipo anaika wosabala dzenje chopukutira, ndiyeno ntchito 1% kapena 2% lidocaine wa opaleshoni m`deralo.Choyamba pangani colliculus pakhungu, kenako subcutaneous minofu, periosteum kulowa m'mphepete chapamwamba cha nthiti m'munsi (kupewa kukhudzana ndi m'mphepete m'munsi mwa nthiti kumtunda kupewa kuwononga subcostal mitsempha ndi mtima plexus), ndipo potsiriza kwa parietal. pleura.Polowa parietal pleura, ndi opaleshoni singano chubu akhoza kuyamwa pleural madzimadzi, ndiyeno amachepetsa ululu singano ndi mtima achepetsa pa khungu mlingo chizindikiro kuya kwa singano.Lumikizani singano yayikulu (No. 16~19) ya thoracentesis ya thoracentesis kapena chipangizo cha singano cha cannula ku chosinthira chanjira zitatu, ndikulumikiza syringe ya 30 ~ 50ml ndi chitoliro kuti mutulutse madzi mu syringe muchotengera.Dokotala ayenera kulabadira chizindikiro pa opaleshoni singano kufika pachifuwa madzimadzi kuya kuya, ndiyeno jekeseni singano 0,5cm.Panthawi imeneyi, singano ya m'mimba mwake yaikulu imatha kulowa pachifuwa kuti ichepetse chiopsezo cholowera m'mapapo apansi.The puncture singano vertically amalowa pachifuwa khoma, subcutaneous minofu, ndi kulowa pleural madzimadzi m'mphepete kumtunda kwa nthiti m'munsi.Catheter yosinthika imakhala yapamwamba kuposa singano yosavuta ya thoracentesis chifukwa imatha kuchepetsa chiopsezo cha pneumothorax.Zipatala zambiri zimakhala ndi zimbale zotayira pachifuwa zomwe zimapangidwira kuti zibowole bwino, kuphatikiza singano, ma syringe, masiwichi ndi machubu oyesera.
Nthawi yotumiza: Jun-06-2022
