Thoracentesis
1. Tilmaamaha
1. Dhiigbaxa xuubka ee dabeecadda aan la garanayn, baaritaanka dalool
2. Dhiig-baxa xuubka ama pneumothorax oo leh calaamado cadaadis
3. Empyema ama dheecaan malax leh, maamulka intrapleural
2, Contraindications
1. Bukaannada aan la shaqayn;
2. Cudurka xinjirowga dhiigga oo aan la saxin;
3. Ku filnaan la'aanta neefsashada ama xasilloonida (haddii aan laga nafisin thoracentesis daweynta);
4. Xasilooni la'aanta hemodynamic wadnaha ama arrhythmia;angina pectoris oo aan degganayn.
5. Caqabadaha qaraabada ah waxaa ka mid ah hawo-mareenada farsamada iyo cudurka sambabada.
6. Infekshanka maxalliga ah waa in laga saaro ka hor intaan irbaddu gelin laabta.
3. Dhibaatooyinka
1. Pneumothorax: pneumothorax oo ay keento gaas ka soo daadanaya irbad dalool ama dhaawac sambabada hoostiisa ah;
2. Hemothorax: dhiig-baxa xuubka xuubka ama laabta oo ka yimaada cirbad dalool oo waxyeello u geysta maraakiibta hoose;
3. Daadad xad dhaaf ah oo meesha daloolinaysa
4. Vasovagal syncope ama syncope fudud;
5. Dhiig-baxa hawada ( naadir laakiin masiibo ah);
6. Caabuqa;
7. Dhaawaca mindida ee beeryarada ama beerka oo ay sababtay cirbad aad u hoosaysa ama qoto dheer;
8. Bararka sambabada oo soo noqnoqda oo ay sababto dheecaan degdeg ah> 1L.Geeridu aad bay dhif u tahay.
4. Diyaarinta
1. Qaababka
Fadhiga ama fadhiga badhanka, dhinaca ay saamaysay waa dhinaca, iyo cududda dhinaca ay saamaysay ayaa kor loogu qaadayaa madaxa, si ay is-dhexgalayaashu u furan yihiin.
2. Go'aami barta daloolinta
1) Pneumothorax ee booska labaad ee intercostal ee xariiqda clavicular dhexe ama 4-5 boosaska intercostal ee xariiqda axillary dhexe
2) Waxaa la doorbidayaa xariiqda scapular ama booska 7aad ilaa 8aad ee intercostal ee xariiqda axillary ee dambe.
3) Haddii loo baahdo, 6-7 intercostals of axillary midline ayaa sidoo kale la dooran karaa
Ama booska 5-aad ee intercostal ee hore ee axillary
Ka baxsan xagasha kharashka, xididdada dhiigga iyo neerfayaasha ayaa ku orda sulcus costal waxayna u qaybsan yihiin laamo sare iyo hoose ee xariiqda axillary ee dambe.Laanta sare waxay ku taal sulcus costal, laanta hoosena waxay ku taal cidhifka sare ee feeraha hoose.Sidaa darteed, thoracocentesis, derbiga dambe wuxuu dhex maraa booska intercostal, oo u dhow cidhifka sare ee feeraha hoose;Darbiyada hore iyo kuwa dambe waxay sii maraan booska intercostalka iyo dhexda labada feeraha, taas oo ka fogaan karta waxyeellada xididada iyo dareemayaasha.
Xidhiidhka booska ee xididdada dhiigga iyo neerfayaasha waa: xididdada, halbowlayaasha iyo neerfaha kor ilaa hoos.
Cirbadda daloolku waa in lagu dhex geliyaa booska intercostalka iyadoo dareere ah.Ma jiro dareere xuubka xuubka oo duuban.Meesha daloolku badanaa waa meel kharash ah oo ka hooseeya heerka dareeraha, oo ku yaal khadka infrascapular.Ka dib markii maqaarka lagu jeermi-tiray tincture iodine, hawlwadeenku wuxuu xirtay galoofyada nadiifka ah wuxuuna dhigay shukumaan dalool nadiif ah, ka dibna wuxuu isticmaalay 1% ama 2% lidocaine suuxinta gudaha.Marka hore ka samee colliculus maqaarka, ka dibna unugyada subcutaneous, xuubka periosteum ee cidhifka sare ee feeraha hoose (si looga hortago xidhiidhka cidhifka hoose ee feeraha sare si looga fogaado waxyeello u geysto dareemaha subcostal iyo vascular plexus), iyo ugu dambeyntii in parietal. pleuraMarka la soo galo xuubka parietal, tuubada cirbadda suuxdinta waxay nuugi kartaa dareeraha xuubka xuubka, ka dibna waxay ku dhejin kartaa cirbadda suuxdinta iyada oo la isku dhejiyo xididdada dhiigga ee heerka maqaarka si loo calaamadiyo qoto dheer ee irbadda.Ku xidh caliber weyn (No. 16 ~ 19) irbadda thoracentesis ama irbadda cannula qalabka saddex-gees ah, oo ku xidh 30 ~ 50ml sirinji iyo tuubo si aad u faaruqiso dareeraha saliingaha galay weelka.Dhakhtarku waa inuu fiiro gaar ah u yeeshaa calaamadda cirbadda suuxinta ee gaadhaysa qoto dheer ee dareeraha laabta, ka dibna ku duri cirbadda ilaa 0.5cm.Waqtigaan, irbadda ballaaran ee dhexroorku waxay geli kartaa daloolka laabta si ay u yareyso khatarta ah in la galo unugyada sambabada hoose.Irbada daloolku waxay si toos ah u gashaa gidaarka laabta, unug ka hooseeya maqaarka, oo waxay gashaa dareeraha xuubka xuubka ee dhinaca sare ee feeraha hoose.Kateetarka dabacsan ayaa ka sarreeya cirbadda thoracentesis fudud ee dhaqameed sababtoo ah waxay yarayn kartaa khatarta pneumothorax.Isbitaalada intooda badani waxay leeyihiin saxamada feeraha ee la tuuri karo oo loogu talagalay daloolin badbaado leh oo waxtar leh, oo ay ku jiraan cirbadaha, saliingadaha, furayaasha iyo tuubooyinka tijaabada.
Waqtiga boostada: Jun-06-2022
