I-Thoracentesis
1, Iimpawu
1. I-Pleural effusion yendalo engaziwayo, uvavanyo lwe-puncture
2. I-Pleural effusion okanye i-pneumothorax eneempawu zoxinzelelo
3. I-Empyema okanye i-malignant pleural effusion, ulawulo lwe-intrapleural
2, Contraindications
1. Izigulana ezingenantsebenziswano;
2. Isifo esinganyangekiyo se-coagulation;
3. Ukungaphumeleli kokuphefumula okanye ukungazinzi (ngaphandle kokuba kukhululwe yi-thoracentesis yonyango);
4. Ukungazinzi kwe-hemodynamic yenhliziyo okanye i-arrhythmia;I-angina pectoris engazinzanga.
5. Izichaso ezihambelanayo ziquka ukungena komoya ngomatshini kunye nesifo se-bullous lung.
6. Usulelo lwendawo kufuneka lukhutshelwe ngaphandle phambi kokuba inaliti ingene esifubeni.
3. Iingxaki
1. I-Pneumothorax: i-pneumothorax ebangelwa ukuvuza kwegesi yenaliti yokubhoboza okanye ukwenzakala kwemiphunga phantsi kwayo;
2. I-Hemothorax: i-pleural cavity okanye i-chest wall hemorrhage ebangelwa kukuhlatywa kwenaliti eyonakalisayo kwiinqanawa ze-subcostal;
3. I-extravased effusion kwindawo yokugqobhoza
4. I-syncope yeVasovagal okanye i-syncope elula;
5. I-Air embolism (inqabileyo kodwa iyintlekele);
6. Usulelo;
7. Ukuhlatywa kokwenzakala kwe-spleen okanye kwesibindi okubangelwa yinaliti ephantsi kakhulu okanye enzulu kakhulu;
8. Ukubuyisela kwakhona i-edema ye-pulmonary ebangelwa ukukhupha ngokukhawuleza> 1L.Ukufa kunqabile kakhulu.
4, Ukulungiselela
1. Izimo
Kwindawo yokuhlala okanye i-semi reclining, icala elichaphazelekayo lisecaleni, kwaye ingalo yecala elichaphazelekayo liphakanyiswa ngaphezu kwentloko, ukwenzela ukuba i-intercostals ivuleke.
2. Qinisekisa indawo yokugqobhoza
1) I-Pneumothorax kwindawo yesibini ye-intercostal yomgca we-clavicular ophakathi okanye i-4-5 izithuba ze-intercostal zomgca we-axillary ophakathi
2) Ngokukhethekileyo umgca we-scapular okanye i-7th ukuya kwi-8th intercostal space yomgca we-axillary yangasemva
3) Ukuba kuyimfuneko, i-6-7 intercostals ye-axillary midline nayo ingakhethwa
Okanye indawo ye-5 ye-intercostal ye-axillary front
Ngaphandle kwe-engile yeendleko, imithambo yegazi kunye nemithambo-luvo ibaleka kwi-costal sulcus kwaye yahlulwe ibe ngamasebe aphezulu nasezantsi kumgca we-axillary yangasemva.Isebe elingasentla likwi-costal sulcus kwaye isebe elisezantsi likwincam ephezulu yombambo ongezantsi.Ngoko ke, kwi-thoracocentesis, udonga lwangasemva ludlula kwindawo ye-intercostal, kufuphi nomda ophezulu wembambo engaphantsi;Iindonga zangaphambili kunye nezisecaleni zidlula kwindawo ye-intercostal kwaye phakathi kweembambo ezimbini, ezinokuthi zigweme ukonakalisa iinqanawa ze-intercostal kunye nemithambo-luvo.
Ubudlelwane bendawo phakathi kwemithambo yegazi kunye nemithambo-luvo yile: imithambo, imithambo kunye nemithambo-luvo ukusuka phezulu ukuya ezantsi.
Inaliti yokubhoboza kufuneka ifakwe kwindawo ye-intercostal ngolwelo.Akukho ukufakwa kwe-pleural effusion.I-puncture point idla ngokuba yindawo yexabiso elingaphantsi kwinqanaba le-liquid, elibekwe kumgca we-infrascapular.Emva kokuba ulusu lukhutshelwe iintsholongwane nge-iodine tincture, umqhubi wayenxibe iiglavu ezinyumba kwaye wabeka itawuli yomngxuma oyinyumba, emva koko wasebenzisa i-1% okanye i-2% ye-lidocaine ye-anesthesia yendawo.Okokuqala yenza i-colliculus eluswini, emva koko i-subcutaneous tissue, i-periosteum infiltration kwi-edge engaphezulu yembambo engezantsi (ukuthintela ukudibanisa nomphetho ongezantsi wembambo ephezulu ukuphepha ukonakalisa i-nerve subcostal kunye ne-vascular plexus), kwaye ekugqibeleni kwi-parietal. ipleura.Xa ungena kwi-parietal pleura, ityhubhu yenaliti ye-anesthesia inokufunxa ulwelo lwe-pleural, kwaye emva koko ibambe inaliti ye-anesthesia nge-clamp ye-vascular kumgangatho wesikhumba ukuphawula ubunzulu benaliti.Qhagamshela i-caliber enkulu (No. 16 ~ 19) inaliti yethoracentesis okanye isixhobo senaliti ye-cannula kwi-switch yeendlela ezintathu, kwaye udibanise i-30 ~ 50ml yesirinji kunye nombhobho wokukhupha ulwelo kwisirinji kwisikhongozeli.Ugqirha kufuneka anikele ingqalelo uphawu kwinaliti ye-anesthesia efikelela kubunzulu be-fluid yesifuba, uze ujobe inaliti ye-0.5cm.Ngeli xesha, inaliti yobubanzi obukhulu inokungena kwindawo yesifuba ukunciphisa umngcipheko wokungena kwizicubu zemiphunga engaphantsi.Inaliti yokugqobhoza ingena ngokuthe nkqo kudonga lwesifuba, izicubu ezingaphantsi kwesikhumba, ize ingene kulwelo lwe-pleural ecaleni komphetho ophezulu wembambo engezantsi.I-catheter eguquguqukayo iphezulu kunenaliti yendabuko elula ye-thoracentesis kuba inokunciphisa umngcipheko we-pneumothorax.Uninzi lwezibhedlele zineediski zokuhlatywa kwesifuba ezilahlayo ezenzelwe ukuhlatywa okukhuselekileyo nokusebenzayo, kubandakanya iinaliti, iisirinji, iiswitshi kunye neetyhubhu zovavanyo.
Ixesha lokuposa: Jun-06-2022
