Thoracentezi
1 、 Ibyerekana
1. Pleural effusion ya kamere itazwi, ikizamini cyo gutobora
2. Pleural effusion cyangwa pneumothorax hamwe nibimenyetso byo kwikuramo
3. Empyema cyangwa malignant pleural effusion, ubuyobozi budasanzwe
2 、 Kurwanya
1. Abarwayi badakorana;
2. Indwara ya coagulation idakosowe;
3. Ubuhumekero budahagije cyangwa guhungabana (keretse iyo byorohewe no kuvura thoracentezi);
4. Imitsi idahungabana yumutima cyangwa kurwara;Angina pectoris idahindagurika.
5. Kurwanya indwara zirimo guhumeka no kurwara ibihaha.
6. Indwara zaho zigomba kuvaho mbere yuko urushinge rwinjira mu gituza.
3 、 Ingorane
1. Pneumothorax: pneumothorax iterwa no gusohoka kwa gaze y'urushinge rwacumita cyangwa ihahamuka munsi yacyo;
2. Hemothorax: cavity pleural cyangwa igikuta cyo kuva mu gatuza kuva amaraso biterwa n'urushinge rwacumita rwangiza imiyoboro ya subcostal;
3. Gukabya gukabije kurenza igihe
4. Syncope ya Vasovagal cyangwa syncope yoroshye;
5. Embolism yo mu kirere (idasanzwe ariko ibiza);
6. Kwandura;
7. Gukomeretsa intanga cyangwa umwijima biterwa no guterwa inshinge nke cyangwa nyinshi;
8. Gusubiramo ibihaha byatewe no gutemba byihuse> 1L.Urupfu ni gake cyane.
4 、 Kwitegura
1. Imyifatire
Mumwanya wicaye cyangwa igice cyicaye, uruhande rwanduye ruri kuruhande, kandi ukuboko kwuruhande rwafashwe kuzamurwa hejuru yumutwe, kuburyo intercostal zifunguye.
2. Menya aho utobora
1) Pneumothorax mumwanya wa kabiri intercostal yumurongo wo hagati wa clavicular hagati cyangwa 4-5 intera intercostal yumurongo wo hagati
2) Byaba byiza umurongo wa scapular cyangwa umwanya wa 7 kugeza ku wa 8 intercostal umwanya wumurongo winyuma
3) Nibiba ngombwa, 6-7 intercostal ya axillary midline nayo irashobora gutoranywa
Cyangwa umwanya wa 5 intercostal umwanya wa axillary imbere
Hanze y'inguni ihenze, imiyoboro y'amaraso n'imitsi ikora muri sulcus ihenze kandi igabanijwemo amashami yo hejuru no hepfo kumurongo winyuma.Ishami ryo hejuru riri muri sulcus ihenze kandi ishami ryo hepfo riri kumurongo wo hejuru wimbavu yo hepfo.Kubwibyo, muri thoracocentezi, urukuta rwinyuma runyura mumwanya wa intercostal, hafi yuruhande rwo hejuru rwurubavu rwo hasi;Urukuta rw'imbere n'uruhande runyura mu mwanya wa interineti kandi unyuze hagati y'imbavu zombi, zishobora kwirinda kwangiza imiyoboro n'imitsi.
Isano ihagaze hagati yimiyoboro yamaraso nu mitsi ni: imitsi, imitsi nimitsi kuva hejuru kugeza hasi.
Urushinge rwa puncture rugomba kwinjizwa mumwanya wa intercostal hamwe namazi.Hano nta effapisiyo ishimishije.Ingingo ya puncture mubisanzwe ni umwanya uhenze munsi yurwego rwamazi, uherereye kumurongo wa infrascapular.Uruhu rumaze kwanduzwa na tincure ya iyode, uwayikoresheje yambaraga uturindantoki twa sterile hanyuma ashyira igitambaro cya sterile, hanyuma akoresha lidocaine 1% cyangwa 2% muri anesthesi yaho.Banza ukore colliculus kuruhu, hanyuma uduce duto duto, inferi ya periosteum kumurongo wo hejuru wurubavu rwo hepfo (kugirango wirinde guhura nuruhande rwo hasi rwurubavu rwo hejuru kugirango wirinde kwangiza imitsi ya subcostal na plexus vasculaire), hanyuma amaherezo kuri parietal. pleura.Iyo winjiye muri parietal pleura, umuyoboro w'urushinge rwa anesteziya urashobora kunyunyuza amazi meza, hanyuma ugahambira urushinge rwa anesteziya hamwe nu mitsi y'amaraso kurwego rwuruhu kugirango ugaragaze ubujyakuzimu bwa inshinge.Huza kalibiri nini (No 16 ~ 19) urushinge rwa thoracentezi cyangwa urushinge rwa cannula igikoresho cyinzira eshatu, hanyuma uhuze seringe ya 30 ~ 50ml numuyoboro kugirango usibe amazi muri syringe muri kontineri.Muganga agomba kwitondera ikimenyetso kiri ku nshinge ya anesteziya igera mu burebure bw’amazi yo mu gatuza, hanyuma agatera inshinge kuri 0.5cm.Muri iki gihe, urushinge runini rwa diameter rushobora kwinjira mu cyuho cyo mu gatuza kugira ngo bigabanye ibyago byo kwinjira mu ngingo zifata ibihaha.Urushinge rwacumise rwinjira mu rukuta rw'igituza, ingirangingo z'umubiri, kandi rwinjira mu mazi meza ku nkombe yo hejuru y'urubavu rwo hepfo.Catheter yoroheje iruta urushinge rworoshye rwa thoracentezi kuko rushobora kugabanya ibyago byo kurwara pneumothorax.Ibitaro byinshi bifite disikuru zishobora guterwa mu gatuza zagenewe gutoborwa neza kandi neza, harimo inshinge, siringi, sisitemu na tebes.
Igihe cyo kohereza: Jun-06-2022
