Thoracic okhalamo chubu - kutsekedwa thoracic ngalande
1 Zizindikiro
1. Kuchuluka kwa pneumothorax, pneumothorax yotseguka, kupanikizika kwa pneumothorax, pneumothorax kumapondereza kupuma (nthawi zambiri pamene kupanikizana kwa mapapu kwa unilateral pneumothorax ndi oposa 50%).
2. Thoracocentesis pochiza pneumothorax yapansi
3. Pneumothorax ndi hemopneumothorax zomwe zimafuna mpweya wabwino wamakina kapena wochita kupanga
4. Pneumothorax yobwerezabwereza kapena hemopneumothorax pambuyo pochotsa thoracic drainage chubu
5. Zowopsa za hemopneumothorax zomwe zimakhudza kupuma ndi ntchito zozungulira.
2 Kukonzekera
1. Kaimidwe
Kukhala kapena kutsamira pang'ono
Wodwalayo ali mu theka lagona malo (ngati zizindikiro zofunika sizili zokhazikika, wodwalayo ali pamalo ogona).
2. Sankhani malo
1) Kusankhidwa kwa danga lachiwiri la intercostal la mzere wapakati wa clavicular kwa pneumothorax drainage
2) Pleural effusion inasankhidwa pakati pa axillary midline ndi posterior axillary line, ndi pakati pa 6th ndi 7th intercostals.
3. Kupha tizilombo toyambitsa matenda
chizolowezi khungu disinfection, awiri 15, 3 ayodini 3 mowa
4. Mankhwala olowetsa m'deralo
jakisoni mu mnofu phenobarbital sodium 0 lg.
Local kulowetsedwa kwa pachifuwa khoma kukonzekera wosanjikiza mu mankhwala ochititsa incision m'dera kuti pleura;Dulani khungu 2cm motsatira mzere wa intercostal, onjezerani mitsempha ya mitsempha m'mphepete mwa nthiti, ndikulekanitsa zigawo za intercostal minofu ku chifuwa;Dongosolo la ngalande liziikidwa nthawi yomweyo madzi akatuluka.Kuzama kwa chubu chotayira m'chifuwa sikuyenera kupitirira 4 ~ 5cm.Chifuwa khoma la khungu incision ayenera sutured ndi sing'anga-kakulidwe silika ulusi, ngalande chubu ayenera ligated ndi anakonza, yokutidwa ndi wosabala yopyapyala;Kunja kwa yopyapyala, kulungani tepi yayitali kuzungulira chubu la ngalande ndikuyiyika pachifuwa khoma.Kumapeto kwa chubu cha ngalande kumalumikizidwa ndi chubu cha mphira chautali chopha tizilombo ku botolo lamadzi losindikizidwa, ndipo chubu cha rabara cholumikizidwa ndi botolo lamadzi losindikizidwa limayikidwa pa bedi ndi tepi yomatira.Botolo la ngalande limayikidwa pansi pa bedi lachipatala komwe sikophweka kugwetsedwa.
3 Intubation
1. Kucheka khungu
2. Kusiyanitsa kosanjikiza kwa minofu ndi kuika chubu chotayira pa thoracic ndi bowo lakumbali kudutsa m'mphepete mwa nthiti.
3. Bowo lakumbali la chubu la ngalande liyenera kukhala 2-3cm mkati mwa chifuwa
4 Kusamala
1. Ngati hematocele yaikulu (kapena effusion), kuthamanga kwa magazi kuyenera kuyang'aniridwa mwatcheru panthawi yoyamba ya ngalande kuti wodwalayo asagwedezeke mwadzidzidzi kapena kugwa.Ngati ndi kotheka, kuthamanga kwa magazi kuyenera kumasulidwa mosalekeza kuti apewe ngozi mwadzidzidzi.
2. Samalani kusunga chubu cha ngalande popanda kukakamizidwa kapena kupotoza.
3. Thandizani wodwalayo kusintha malo bwino tsiku lililonse, kapena kulimbikitsa wodwalayo kuti apume kwambiri kuti akwaniritse ngalande zonse.
4. Lembani kuchuluka kwa madzi a tsiku ndi tsiku (kuchuluka kwa ngalande pa ola mutangoyamba kuvulala) ndi kusintha kwa zinthu zake, ndikuyesanso X-ray fluoroscopy kapena filimu ngati kuli koyenera.
5. Pochotsa botolo lotsekedwa lamadzi osabala, chubu lotayira madzi lizitsekeka kaye kaye, kenako chubu lotayira madzi litulutsidwenso mutalowa m'malo kuti mpweya usalowemo chifukwa cha kukanikiza kwa pachifuwa.
6. Pofuna kuthetsa matenda achiwiri, chikhalidwe cha bakiteriya ndi kuyesedwa kwa mankhwala osokoneza bongo kungathe kuchitidwa ngati katundu wamadzimadzi asinthidwa.
7. Mukakoka chubu chonga madzi, khungu lozungulira pobowolo liyenera kupha tizilombo toyambitsa matenda kaye, chingwe chokhazikikacho chiyenera kuchotsedwa, chubu chotungira pafupi ndi khoma la pachifuwa chiyenera kumangirizidwa ndi mitsempha ya mitsempha, ndipo pobowola ngalandeyo kuphimbidwe ndi 12 ~ 16 zigawo za gauze ndi 2 zigawo za Vaseline yopyapyala (kuphatikizapo vaseline pang'ono ndi amakonda).Wogwiritsa ntchitoyo agwire chopyapyala ndi dzanja limodzi, kugwira chubu ndi dzanja lina, ndikuchikoka mwachangu.The yopyapyala pa kutsegulira ngalande anali osindikizidwa kwathunthu pa khoma pachifuwa ndi chidutswa chachikulu cha zomatira tepi amene dera kuposa yopyapyala, ndi kuvala akhoza kusinthidwa pambuyo 48 ~ 72 hours.
5 Unamwino wapambuyo pa opaleshoni
Pambuyo pa opaleshoni, chubu chotulutsa madzi nthawi zambiri chimakhala chochuluka kuti lumen isatsekeke.Kutuluka kwa ngalande kumalembedwa ola lililonse kapena maola 24.Pambuyo pa madzi, mapapo amakula bwino, ndipo palibe mpweya kapena madzi otuluka.The ngalande chubu akhoza kuchotsedwa pamene wodwala mpweya kwambiri, ndi bala akhoza kutsekedwa ndi vaseline yopyapyala ndi zomatira tepi.
Nthawi yotumiza: Jun-10-2022
