Thoracentesis
1, Zviratidzo
1. Pleural effusion yezvisikwa zvisingazivikanwi, puncture test
2. Pleural effusion kana pneumothorax ine compression zviratidzo
3. Empyema kana kuipa kwepleural effusion, intrapleural administration
2, Contraindications
1. Varwere vasingabatike;
2. Chirwere chisina kugadziriswa coagulation;
3. Kusakwana kwekufema kana kusagadzikana (kunze kwekunge kusunungurwa nekurapa thoracentesis);
4. Cardiac hemodynamic kusagadzikana kana arrhythmia;Angina pectoris isina kugadzikana.
5. Relative contraindications zvinosanganisira mechanical ventilation uye bullous mapapu chirwere.
6. Utachiona hwemunharaunda hunofanira kubviswa tsono isati yapinda muchipfuva.
3, Matambudziko
1. Pneumothorax: pneumothorax inokonzerwa negasi kubuda kwepuncture tsono kana kukuvadzwa kwemapapu pasi payo;
2. Hemothorax: pleural cavity kana chest wall hemorrhage inokonzerwa nekubaya tsono inokuvadza subcostal midziyo;
3. Kuwedzera kunyunguduka pakubuda
4. Vasovagal syncope kana syncope iri nyore;
5. Air embolism (kashoma asi njodzi);
6. Utachiona;
7. Kubaya kukuvara kwespleen kana chiropa kunokonzerwa nejekiseni rakaderera kana rakadzika;
8. Kudzorerazve pulmonary edema kunokonzerwa nekukurumidza kwemvura> 1L.Rufu rwakanyanya kushomeka.
4. Kugadzirira
1. Mamiriro
Munzvimbo yekugara kana semi reclining, rutivi rwakakanganiswa rwuri padivi, uye ruoko rwerutivi rwakakanganiswa runosimudzwa pamusoro pemusoro, kuitira kuti intercostals inenge yakazaruka.
2. Sarudza nzvimbo yekupinza
1) Pneumothorax mune yechipiri intercostal nzvimbo yepakati clavicular line kana 4-5 intercostal nzvimbo dzepakati axillary line.
2) Kunyanya mutsara we scapular kana 7th kusvika 8th intercostal space ye posterior axillary line.
3) Kana zvichidikanwa, 6-7 intercostals yeaxillary midline inogonawo kusarudzwa
Kana iyo 5th intercostal nzvimbo yeaxillary kumberi
Kunze kwekona inodhura, tsinga dzeropa netsinga dzinomhanya mumutengo wesulcus uye dzakakamurwa kuita matavi ekumusoro neazasi pamutsara weaxillary.Bazi repamusoro riri mu costal sulcus uye bazi rezasi riri pamucheto wepamusoro wembabvu yepazasi.Nokudaro, mu thoracocentesis, rusvingo rwemashure runopfuura nepakati pe intercostal space, pedyo nepamusoro pemucheto wepamusoro wembabvu yakaderera;Iyo anterior uye lateral madziro anopfuura nepakati intercostal nzvimbo uye nepakati pembabvu mbiri, izvo zvinogona kudzivirira kukuvadza intercostal midziyo uye tsinga.
Hukama hwenzvimbo pakati petsinga netsinga ndeidzi: tsinga, tsinga uye tsinga kubva kumusoro kusvika kuzasi.
The puncture tsono inofanira kuiswa mukati intercostal nzvimbo nemvura.Iko hakuna encapsulated pleural effusion.Iyo puncture poindi kazhinji inodhura nzvimbo pazasi peyero yemvura, iri pamutsara we infrascapular.Mushure mekunge ganda raiswa disinfected ane ayodhini tincture, mushandisi aipfeka magirovhosi asina utachiona uye akaisa jira risingabereki tauro, uye ipapo akashandisa 1% kana 2% lidocaine yenzvimbo yekutindivadza.Kutanga kuita colliculus paganda, ipapo subcutaneous tissue, periosteum infiltration pamucheto wepamusoro wembabvu yepazasi (kudzivirira kubata nechepazasi pembabvu yekumusoro kudzivirira kukuvadza subcostal tsinga uye vascular plexus), uye pakupedzisira kusvika parietal. pleura.Kana achipinda parietal pleura, yokutindivadza tsono chubhu anogona kusveta pleural fluid, uye ipapo kusungirira yokutindivadza tsono ane vascular chivharo paganda pamwero kuratidza kudzika tsono.Batanidza hombe caliber (No. 16 ~ 19) thoracentesis tsono kana tsono cannula mudziyo kune nzira nhatu, uye batanidza 30 ~ 50ml sirinji uye pombi kuti udururire mvura iri sirinji mumudziyo.Chiremba anofanira kuteerera mucherechedzo pamusoro yokutindivadza tsono inosvika muchipfuva kudzika mvura, uye ipapo jekiseni tsono 0.5cm.Panguva ino, tsono yakakura-dhayamita inogona kupinda mukati mechipfuva kuti kuderedze njodzi yekupinda mukati memukati wemapapu.Iyo tsono inobaya yakatwasuka inopinda mumadziro echipfuva, subcutaneous tissue, uye inopinda mu pleural fluid pamucheto wepamusoro wembabvu yepazasi.Iyo catheter inochinjika yepamusoro kune yechinyakare yakapusa thoracentesis tsono nekuti inogona kuderedza njodzi yepneumothorax.Zvipatara zvakawanda zvine madhisiki echipfuva anoraswa akagadzirirwa kubaya kwakachengeteka uye kunoshanda, kusanganisira tsono, majekiseni, switch uye test tubes.
Nguva yekutumira: Jun-06-2022
