Zvinoratidza kuti thoracic puncture
Kuti ujekese maitiro ekuputika kwepleural, pleural puncture uye aspiration kuongorora kunofanira kuitwa kubatsira kuongororwa;Kana paine huwandu hukuru hwemvura kana gasi kuunganidza zvichikonzera kudzvinyirira kwemapapu zviratidzo, uye varwere vepyothorax vanoda kupomba mvura yekurapwa;Mishonga inofanira kubaiwa mugomba rechipfuva.
Contraindications yekuputika kwechipfuva
(1) Nzvimbo yepuncture ine kuzvimba, bundu uye kushungurudzika.
(2) Pane katsika kekubuda ropa kwakanyanya, pneumothorax inongoerekana yaitika, magwamba makuru eropa, akanyanya pulmonary tuberculosis, emphysema, nezvimwe.
Kuchengetedza kweThoracic Puncture
(1) Varwere vane coagulation defects, zvirwere zvekubuda ropa uye avo vanotora anticoagulant zvinodhaka vanofanira kurapwa zvakakodzera vasati vavhiyiwa.
(2) Kuboorwa kwechipfuva kunofanira kuvharirwa zvakakwana kudzivirira kuvhunduka kwepleural.
(3) Iyo puncture inofanira kuitwa pedyo nechepamusoro pembabvu kudzivirira kukuvara kune intercostal tsinga dzeropa uye tsinga.Tsono, latex chubhu kana chinja-nzira nhatu, silinda yetsono, zvichingodaro ichachengetwa yakavharwa kudzivirira mweya kupinda muchipfuva nekukonzera pneumothorax.
(4) Pneumothorax, hemothorax kana kukuvara kwetsaona kumidziyo yeropa, mwoyo, chiropa uye spleen kunofanira kungwarira, uye nzira yekuuraya utachiona inofanira kuva yakasimba.
(5) Chikosoro chinofanira kudziviswa panguva yekubaya.Cherechedza kuchinja kwemurwere chero nguva.Kana chiso chakacheneruka, kudikitira, dzungu, palpitation uye kupera simba kupuruzira, kubaya kunomiswa nekukurumidza.Rega murwere arere akatambarara, femera mweya weokisijeni pazvinenge zvakakodzera, uye jekiseni adrenaline kana sodium benzoate uye caffeine pasi pecutaneously.Mukuwedzera, kurapwa kunoenderana kuchaitwa maererano nemamiriro acho.
(6) Mvura inofanira kupomba zvishoma nezvishoma.Kana huwandu hukuru hwemvura huchifanirwa kupomba nekuda kwekurapwa, iyo nzira-nhatu switch inofanirwa kubatana kuseri kwetsono yekubaya.Mvura yacho haifanirwe kudirwa zvakanyanya kuitira kurapwa.Kana zvichidikanwa, inogona kupombwa kakawanda.Huwandu hwemvura inopomba kekutanga haifanire kudarika 600ml, uye huwandu hwemvura inopomba nguva yega yega mushure mayo huchawanzoita 1000ml.
(7) Kana mvura iri kubuda ropa ikabuda, rega kudhirowa pakarepo.
(8) Pazvinenge zvakakodzera kubaya mushonga mugomba rechipfuva, batanidza jekiseni rine mvura yemushonga mushure mekupomba, sanganisa mvura shoma yemuchipfuva nemushonga wemushonga, wobayazve jekiseni kuti uone kuti wabayiwa muchipfuva. mhango
Nzira yekusarudza thoracic puncture positioning point?
(1) Thoracic puncture uye drainage: danho rekutanga kuita percussion pachipfuva, uye sarudza chikamu chiri pachena chakasimba ruzha rwekupinza, iyo inogona kuwanikwa pamwe chete ne X-ray uye B-ultrasound.Iyo puncture point inogona kuiswa paganda nembambo violet, uye inowanzosarudzwa sezvinotevera: 7 ~ 9 intercostal mitsara ye subscapular angle;7-8 intercostals ye posterior axillary line;6 ~ 7 intercostals ye midaxillary line;Iyo axillary kumberi ndeye 5-6 mbabvu.
(2) Encapsulated pleural effusion: puncture inogona kuitwa pamwe chete neX-ray uye ultrasonic localization.
(3) Pneumothorax decompression: yechipiri intercostal nzvimbo mumutsara wepakati kana 4-5 intercostal nzvimbo mu midaxillary line yerutivi rwakakanganiswa inowanzosarudzwa.Nekuti intercostal tsinga uye tsinga uye tsinga dzinomhanya nechepazasi pembabvu, dzinofanirwa kuboorwa nepamucheto wepamusoro pembabvu kudzivirira kukuvadza tsinga netsinga dzeropa.
Iyo yose nzira ye thoracic puncture
1. Raira murwere kuti atore chigaro chakatarisa kumashure kwechigaro, isa maoko ese ari maviri kumashure kwechigaro, uye akazembera huma pahuma.Avo vasingakwanise kusimuka vanogona kutora hafu yekugara, uye iyo yakabatwa forearm inosimudzwa papiro.
2. Nzvimbo yekupinza ichasarudzwa pachikamu chiri pachena chechipfuva chekurova.Kana paine yakawanda pleural fluid, scapular line kana 7th ~ 8th intercostal space ye posterior axillary line inowanzotorwa;Dzimwe nguva nzvimbo yechitanhatu kusvika yechinomwe yepakati pemutsara wemidaxillary kana 5th intercostal nzvimbo yemberi axillary mutsara inosarudzwawo senzvimbo dzekubaya.Encapsulated effusion inogona kutsanangurwa neX-ray kana ultrasonic kuongororwa.Iyo yekubaya inotarwa paganda nekotoni swab yakanyikwa mumethyl violet (gentian violet).
3. Gara uchibvisa utachiona paganda, pfeka magirovhosi asina utachiona, uye uvhare tauro regomba rekuuraya utachiona.
4. Shandisa 2% lidocaine kuti uite infiltration anesthesia kubva paganda kusvika kumadziro epleural panzvimbo yepuncture pamucheto wepamusoro wembabvu yepazasi.
5. Mushandi anogadzirisa ganda renzvimbo yekubaya nechigunwe cheruoko rweruboshwe nemunwe wepakati, anoshandura jongwe rematatu etsono kunzvimbo yakavharwa chipfuva neruoko rwerudyi, uye zvishoma nezvishoma. anobaya tsono inopinza munzvimbo yeanesthesia.Kana kushorwa kwetsono kunopera kamwe kamwe, shandura jongwe rematatu kuti ribatane nechipfuva kuti ribvise mvura.Mubatsiri anoshandisa hemostatic forceps kubatsira kugadzirisa tsono yekubaya kudzivirira kuti matishu emapapu asakuvadzwa nekupinda zvakanyanya.Mushure mekunge sirinji yazara, shandura vharafu-nzira nhatu kuti uibatanidze nenyika yekunze uye ubudise mvura.
6. Pakupera kwekubudiswa kwemvura, dhonza tsono yepuncture, uifukidze negauze isina kuberekwa, isimbise nesimba shoma kwekanguva, gadzirisa ne tepi yekunamatira uye kumbira murwere kuti arare akanyarara.
Nguva yekutumira: Oct-20-2022
