Thoracic indwelling tube - yakavharwa thoracic drainage
1 Zviratidzo
1. Nhamba huru yepneumothorax, pneumothorax yakazaruka, tension pneumothorax, pneumothorax inodzvinyirira kufema (kazhinji apo kumanikidzwa kwemapapu kweunilateral pneumothorax inopfuura 50%).
2. Thoracocentesis mukurapa kwepasi pneumothorax
3. Pneumothorax uye hemopneumothorax inoda mechanical kana artificial ventilation
4. Recurrent pneumothorax kana hemopneumothorax mushure mekubviswa kwe thoracic drainage chubhu
5. Kushungurudza hemopneumothorax inokanganisa kufema uye kutenderera kweropa.
2 Kugadzirira
1. Mamiriro
Kugara kana semi reclining position
Murwere ari muhafu yekurara (kana zviratidzo zvakakosha zvisina kugadzikana, murwere ari munzvimbo yakarara).
2. Sarudza nzvimbo
1) Kusarudzwa kwechipiri intercostal nzvimbo yepakati clavicular line yepneumothorax drainage.
2) Pleural effusion yakasarudzwa pakati peaxillary midline uye posterior axillary line, uye pakati pe6th uye 7th intercostals.
3. Disinfection
Routine ganda disinfection, dhayamita 15, 3 iodine 3 doro
4. Local infiltration anesthesia
Intramuscular jekiseni ye phenobarbital sodium 0 lg.
Kupindira kwepanzvimbo yechipfuva chekugadzirira rusvingo munzvimbo yeanesthesia incision nzvimbo kune pleura;Cheka ganda 2cm pamwe nemutsara we intercostal, wedzera vascular forceps pamucheto wepamusoro wembabvu, uye iparadzanise intercostal muscle layers kusvika pachipfuva;Iyo chubhu yemvura inofanira kuiswa pakarepo kana mvura yayerera.Kudzika kwechubhu yemvura mugomba rechipfuva haifanire kudarika 4 ~ 5cm.Chifuva rusvingo rweganda rekucheka kunofanira kuiswa sutured nepakati-saizi sirika shinda, iyo drainage chubhu inofanira kusungirirwa uye yakagadziriswa, uye yakavharwa neyakaomeswa gauze;Kunze kwe gauze, peta tepi yakareba kumativi emvura yemvura uye uiise pamadziro echipfuva.Kupera kwechubhu yemvura yakabatanidzwa kune disinfection refu rubber chubhu kumvura yakavharwa bhodhoro, uye chubhu yerabha yakabatana nemvura yakavharwa bhodhoro inogadziriswa pamubhedha wepamusoro neadhesive tepi.Bhodhoro remvura rinoiswa pasi pemubhedha wechipatara uko zvisiri nyore kudonhedzwa pasi.
3 Intubation
1. Kuchekwa kweganda
2. Kupatsanurwa kusina tsandanyama kwemuscular layer uye kuiswa kwechubhu ye thoracic drainage ine buri repadivi nemupendero wembabvu.
3. Gomba reparutivi rwechubhu yemvura inofanira kunge yakadzika 2-3cm mugomba rechipfuva
4 Kungwarira
1. Muchiitiko chehematocele yakakura (kana kupera), ropa reropa rinofanira kunyatsoongororwa panguva yemvura yekutanga kudzivirira murwere kubva kamwe kamwe kudengenyeka kana kuputsika.Kana zvichidikanwa, BP inofanira kuramba ichisunungurwa kudzivirira njodzi kamwe kamwe.
2. Ngwarira kuchengeta chubhu yemvura isina kuvharwa pasina kumanikidzwa kana kukanganisa.
3. Batsira murwere kuti achinje nzvimbo yacho zvakanaka zuva rega rega, kana kukurudzira murwere kutora kufema kwakadzika kuti awane mvura yakakwana.
4. Nyora vhoriyamu yemvura yemazuva ese (iyo yemvura yemvura paawa muchikamu chekutanga mushure mekukuvara) uye shanduko yezvimiro zvayo, uye ita X-ray fluoroscopy kana firimu reexamination sezvakakodzera.
5. Pakutsiva bhodhoro remvura yakavharwa yakavharwa, chubhu yemvura ichavharwa kwekanguva, uye ipapo chubhu yemvura inoburitswa zvakare mushure mekutsiviwa kudzivirira kuti mhepo isamwirwe nekumanikidza kwakashata kwechipfuva.
6. Kuti abvise chirwere chechipiri, bhakitiriya tsika uye zvinodhaka zvekunzwa bvunzo yemvura inoyerera inogona kuitwa kana iyo drainage fluid inoshandurwa.
7. Paunenge uchidhonza chubhu yemvura, ganda rakatenderedza kuchekwa kunofanira kutanga kuisirwa disinfected, suture yakagadziriswa inofanira kubviswa, chubhu yemvura iri pedyo nemadziro echipfuva inofanira kusungirirwa nevascular forceps, uye kuvhura kwemvura kunofanira kuvharwa ne12 ~ 16 zvidimbu zvegauze uye 2 zvidimbu zveVaseline gauze (kusanganisira zvishoma vaseline inosarudzwa).Mushandi anofanira kubata gauze neruoko rumwe, bata chubhu yemvura nerumwe ruoko, uye oibudisa nokukurumidza.Iyo gauze pakuvhura kwemvura yakavharwa zvachose pamadziro echipfuva nechidimbu chakakura chetepi yekunamatira iyo nzvimbo yaipfuura gauze, uye kupfeka kwacho kunogona kuchinjwa mushure memaawa 48 ~ 72.
5 Kuyamwisa mushure mekuvhiyiwa
Mushure mekushanda, iyo chubhu yemvura inowanzovharwa kuitira kuti lumen irege kuvharwa.Kuyerera kwemvura kunonyorwa awa yega yega kana maawa makumi maviri nemana.Mushure memvura, mapapu anowedzera zvakanaka, uye hapana gasi kana mvura inobuda.Iyo chubhu yemvura inogona kubviswa apo murwere anofema zvakadzika, uye ronda rinogona kuvharwa ne vaseline gauze uye tepi yekunamatira.
Nguva yekutumira: Jun-10-2022
