I-Thoracic indwelling tube - i-thoracic drainage evaliweyo
1 Iimpawu
1. Inani elikhulu le-pneumothorax, i-pneumothorax evulekileyo, i-tension pneumothorax, i-pneumothorax icinezela ukuphefumla (ngokubanzi xa ukunyanzeliswa kwemiphunga ye-unilateral pneumothorax ingaphezulu kwe-50%).
2. I-Thoracocentesis kunyango lwe-pneumothorax ephantsi
3. I-Pneumothorax kunye ne-hemopneumothorax ifuna i-ventilation yomatshini okanye eyenziweyo
4. I-pneumothorax ephindaphindiweyo okanye i-hemopneumothorax emva kokususwa kwe-thoracic drainage tube
5. I-hemopneumothorax ebuhlungu echaphazela imisebenzi yokuphefumula kunye ne-circulatory.
2 Ukulungiselela
1. Izimo
Ukuhlala okanye indawo yokutyela
Isigulane sikwisiqingatha sokulala (ukuba iimpawu ezibalulekileyo azizinzile, isigulane sikwindawo elele phantsi).
2. Khetha indawo
1) Ukukhethwa kwendawo yesibini ye-intercostal yomgca we-clavicular ophakathi kwi-pneumothorax drainage
I-2) I-Pleural effusion yakhethwa phakathi kwe-axillary midline kunye ne-posterior axillary line, kwaye phakathi kwe-6th kunye ne-7th intercostals.
3. Ukubulala iintsholongwane
I-disinfection yesikhumba yesiqhelo, ububanzi be-15, i-3 iodine 3 utywala
4. I-anesthesia yokungeniswa kwendawo
Inaliti ye-intramuscular ye-phenobarbital sodium 0lg.
Ukungeniswa kwendawo yendawo yokulungiselela udonga lwesifuba kwindawo yokucoca i-anesthesia kwi-pleura;Sika ulusu lwe-2cm kunye nomgca we-intercostal, wandise i-forceps ye-vascular kunye nomda ophezulu weembambo, kwaye uhlukanise i-intercostal muscle layers kwisifuba;Umbhobho wokuhambisa amanzi kufuneka ubekwe ngokukhawuleza xa ulwelo luphuma.Ubunzulu bombhobho wokukhupha amanzi kwindawo yesifuba akufanele budlule kwi-4 ~ 5cm.Isifuba eludongeni lwesikhumba kufuneka sifakwe ngentambo yesilika ephakathi, ityhubhu yokukhupha amanzi kufuneka ifakwe kwaye igxininiswe, kwaye igqunywe nge-gauze eyinyumba;Ngaphandle kwe-gauze, bhinqa i-tape ende malunga nombhobho wokuhambisa amanzi kwaye unamathele eludongeni lwesifuba.Isiphelo sombhobho wokuhambisa amanzi sidityaniswe ne-disinfection ityhubhu yerabha ende kwibhotile yamanzi etywinwe, kwaye ityhubhu yerabha edityaniswe nebhotile etywiniweyo yamanzi igxininiswe kumandlalo webhedi ngetape yokuncamathelisa.Ibhotile yokukhupha amanzi ifakwe phantsi kwebhedi yesibhedlele apho kungekho lula ukuwisa phantsi.
3 Intubation
1. Ukutsalwa kwesikhumba
2. Ukwahlula okungekuhle kwe-muscular layer kunye nokubekwa kwetyhubhu ye-thoracic drainage kunye nomngxuma osecaleni kumphetho ophezulu wembambo.
3. Umngxuma osecaleni wetyhubhu yokuhambisa amanzi kufuneka ube yi-2-3cm ubunzulu kumngxuma wesifuba
4 Izilumkiso
1. Kwimeko ye-hematocele enkulu (okanye i-effusion), uxinzelelo lwegazi kufuneka lubekwe esweni ngokusondeleyo ngexesha lokukhutshwa kwamanzi okuqala ukukhusela isigulane ekutshatyalalisweni ngokukhawuleza okanye ukuwa.Ukuba kuyimfuneko, uxinzelelo lwegazi kufuneka lukhutshwe ngokuqhubekayo ukuphepha ingozi yequbuliso.
2. Nika ingqalelo ukugcina ityhubhu ye-drainage ivuliwe ngaphandle koxinzelelo okanye ukuphazamiseka.
3. Nceda isigulane sitshintshe isikhundla ngokufanelekileyo yonke imihla, okanye sikhuthaze isigulane ukuba sithathe umoya onzulu ukuze sifezekise ukukhupha ngokupheleleyo.
4. Rekhoda umthamo wemihla ngemihla yokukhupha amanzi (umthamo wokukhupha amanzi ngeyure kwinqanaba lokuqala emva kokulimala) kunye nokutshintsha kweempawu zayo, kwaye uqhube i-X-ray fluoroscopy okanye ifilimu yokuhlola kwakhona ngokufanelekileyo.
5. Xa kufakwa endaweni yebhotile yamanzi acwebileyo evalekileyo, ityhubhu yokukhupha amanzi iya kuvaleka okwexeshana kuqala, emva koko ityhubhu yokukhupha amanzi ikhutshwe kwakhona emva kokutshintshwa ukuze kuthintelwe umoya ukuba ungafunxwa luxinzelelo olubi lwesifuba.
6. Ukuze kupheliswe usulelo lwesibini, inkcubeko yebhaktheriya kunye novavanyo lokuvalelwa kweziyobisi kwi-drainage fluid inokwenziwa ukuba iipropathi ze-drainage fluid zitshintshwa.
7. Xa ukhupha ityhubhu yokukhupha amanzi, ulusu olujikeleze ulwakhiwo kufuneka luhlanjululwe kuqala, i-suture esisigxina kufuneka isuswe, ityhubhu yokukhupha amanzi kufuphi nodonga lwesifuba kufuneka ibotshwe nge-vascular forceps, kwaye ukuvuleka kwamanzi kufuneka kugqunywe nge-12 ~ Iingqimba eziyi-16 ze-gauze kunye ne-2 ye-vaseline gauze (kubandakanywa ne-vaseline encinci ikhethwayo).Umsebenzisi kufuneka abambe i-gauze ngesandla esinye, ubambe ityhubhu yokukhupha amanzi ngesinye isandla, kwaye uyikhuphe ngokukhawuleza.I-gauze kwindawo yokuvula i-drainage ivalwe ngokupheleleyo eludongeni lwesifuba kunye neqhekeza elikhulu le-tape yokubambelela indawo yayo idlula i-gauze, kwaye ukugqoka kunokutshintshwa emva kweeyure ezingama-48 ~ 72.
5 Ukonga emva koqhaqho
Emva kokusebenza, ityhubhu yokukhupha amanzi idla ngokugqithiswa kakhulu ukugcina i-lumen ingathinteli.Ukuhanjiswa kwamanzi kurekhodwa rhoqo ngeyure okanye iiyure ezingama-24.Emva kokukhutshwa kwamanzi, umphunga uyanda kakuhle, kwaye akukho gesi okanye ukuphuma kwamanzi.Umbhobho wokukhupha amanzi unokususwa xa isigulane siphefumula ngokujulile, kwaye isilonda sinokuvalwa nge-vaseline gauze kunye ne-adhesive tape.
Ixesha lokuposa: Jun-10-2022
