Izimpawu zokubhoboza isifuba
Ukuze kucaciswe uhlobo lwe-pleural effusion, i-pleural puncture kanye nokuhlolwa kwe-aspiration kufanele kwenziwe ukusiza ukuxilongwa;Uma kunomthamo omkhulu woketshezi noma igesi ukunqwabelana okubangela izimpawu zokucindezelwa kwamaphaphu, futhi iziguli ze-pyothorax zidinga ukupompa uketshezi ukuze zelashwe;Izidakamizwa kufanele zijovwe emgodini wesifuba.
Contraindications ofukubhoboza isifuba
(1) Indawo yokubhoboza inokuvuvukala, isimila kanye nokuhlukumezeka.
(2) Kunomkhuba wokopha kakhulu, i-pneumothorax ezenzakalelayo, amahlule amakhulu egazi, isifo sofuba esinamandla samaphaphu, i-emphysema, njll.
Izinyathelo Zokuqaphela I-Thoracic Puncture
(1) Iziguli ezinokukhubazeka kokuqina kwe-coagulation, izifo ezophayo kanye nalezo ezithatha imishanguzo ye-anticoagulant kufanele zelashwe ngendlela efanele ngaphambi kokuhlinzwa.
(2) Ukubhoboza ithoracic kufanele kubulawe izinzwa ngokugcwele ukuze kuvinjelwe ukushaqeka kwe-pleural.
(3) Ukubhoboza kufanele kwenziwe eduze konqenqema olungenhla lombambo ukuze kugwenywe ukulimala emithanjeni yegazi ephakathi nendawo nezinzwa.Inalithi, ishubhu le-latex noma i-three way switch, isilinda yenaliti, njll. kufanele kugcinwe kuvaliwe ukuvimbela umoya ukuthi ungangeni esifubeni futhi ubangele i-pneumothorax.
(4) Ukubhoboza kufanele kucophelele, inqubo kufanele ibe nekhono, futhi ukubulala amagciwane kufanele kuqine ukugwema ukubangela ukutheleleka okusha, i-pneumothorax, i-hemothorax noma ukulimala ngengozi emithanjeni yegazi, inhliziyo, isibindi kanye nobende.
(5) Ukukhwehlela kufanele kugwenywe ngesikhathi sokubhoboza.Bheka izinguquko zesiguli nganoma yisiphi isikhathi.Uma ubuso buphaphathekile, ukujuluka, isiyezi, ukushaya kwenhliziyo kanye nokushaya kwenhliziyo okubuthakathaka, ukubhoboza kuzomiswa ngokushesha.Vumela isiguli silale sibhebhe, phefumula umoya-mpilo lapho kudingeka, futhi ujove i-adrenaline noma i-sodium benzoate ne-caffeine ngaphansi kwesikhumba.Ngaphezu kwalokho, ukwelashwa okuhambisanayo kuyokwenziwa ngokuvumelana nesimo.
(6) Uketshezi kufanele lumpontshwe kancane.Uma inani elikhulu loketshezi kufanele limponswe ngenxa yokwelashwa, ukushintshwa kwezindlela ezintathu kufanele kuxhunywe ngemuva kwenaliti yokubhoboza.Uketshezi akufanele lukhishwe kakhulu ukuze lwelashwe.Uma kunesidingo, ingampontshwa izikhathi eziningana.Inani loketshezi olumpontshwa okokuqala akumele leqe ku-600ml, kanti inani loketshezi olumpontshwa isikhathi ngasinye ngemva kwalokho ngokuvamile lizoba ngu-1000ml.
(7) Uma kukhishwa uketshezi oluphuma igazi, yeka ukudweba ngokushesha.
8 umgodi
Ungakhetha kanjani indawo yokubeka i-thoracic puncture?
(1) Ukubhoboza isifuba nokukhipha amanzi: isinyathelo sokuqala ukwenza i-percussion esifubeni, bese ukhetha ingxenye enomsindo osobala oqinile wokubhoboza, okungatholakala kuhlanganiswe ne-X-ray kanye ne-B-ultrasound.Iphuzu lokubhoboza lingamakwa esikhumbeni nge-nail violet, futhi livame ukukhethwa kanje: 7 ~ 9 imigqa ye-intercostal ye-angle ye-subscapular;7-8 intercostals of posterior axillary line;6 ~ 7 intercostals of midaxillary line;I-axillary front inezimbambo ezingu-5-6.
(2) I-encapsulated pleural effusion: ukubhoboza kungenziwa ngokuhambisana ne-X-ray kanye ne-ultrasonic localization.
(3) Ukuchithwa kwe-Pneumothorax: isikhala sesibili se-intercostal emgqeni we-midclavicular noma isikhala se-4-5 se-intercostal emgqeni we-midaxillary ohlangothini oluthintekile ngokuvamile sikhethwa.Ngenxa yokuthi imithambo ye-intercostal nemithambo nemithambo igijima eduze konqenqema olungezansi lombambo, kufanele ibhoboze onqenqemeni olungenhla lombambo ukuze kugwenywe ukulimaza imizwa nemithambo yegazi.
Yonke inqubo yokubhoboza isifuba
1. Yala isiguli ukuthi sithathe isihlalo esibheke ngemuva kwesihlalo, sibeke zombili izingalo ngemuva kwesihlalo, bese sincikisa isiphongo emahlombe.Labo abangakwazi ukusukuma bangathatha indawo yokuhlala, futhi umphambili othintekile uphakanyiswa phezu komcamelo.
2. Indawo yokubhoboza izokhethwa engxenyeni esobala kakhulu yomsindo wokushaywa kwesifuba.Uma kunoketshezi oluningi lwe-pleural, umugqa we-scapular noma isikhala se-7th ~ 8th intercostal ye-posterior axillary line ngokuvamile ithathwa;Ngezinye izikhathi indawo ye-6 kuya kweyesi-7 ye-intercostal yomugqa we-midaxillary noma indawo ye-5 ye-intercostal yomugqa we-axillary wangaphambili nawo akhethiwe njengamaphoyinti okubhoboza.Ukukhishwa kwe-encapsulated kunganqunywa nge-X-ray noma ukuhlolwa kwe-ultrasonic.Indawo yokubhoboza imakwe esikhunjeni ngeswabhu kakotini ecwiliswe ku-methyl violet (i-gentian violet).
3. Njalo bulala amagciwane esikhumbeni, gqoka amagilavu angenalutho, futhi umboze ithawula lembobo yokubulala amagciwane.
4. Sebenzisa i-lidocaine engu-2% ukuze wenze izibulala-zinzwa zendawo kusukela esikhumbeni uye odongeni lwe-pleural endaweni yokubhoboza emaphethelweni angaphezulu ombambo olungezansi.
5. Umsebenzisi ulungisa isikhumba sendawo yokubhoboza ngomunwe wokukhomba wesandla sobunxele nomunwe ophakathi, ajikise iqhude lenaliti yokubhoboza aliyise endaweni lapho isifuba sivalwe khona ngesandla sokudla, bese kancane kancane. ibhoboza inaliti yokubhoboza endaweni yokubulala izinzwa.Lapho ukumelana kwethiphu yenaliti kunyamalala ngokuzumayo, vula iqhude elinezindlela ezintathu ukuze ulenze lixhumane nesifuba ukuze likhiphe uketshezi.Umsizi usebenzisa i-hemostatic forceps ukusiza ukulungisa inaliti yokubhoboza ukuvimbela izicubu zamaphaphu ukuthi zilimale ngokungena ngokujule kakhulu.Ngemuva kokuthi isipetu sesigcwele, vula i-valve yezindlela ezintathu ukuze uyixhume nezwe langaphandle bese ukhipha uketshezi.
6. Ekupheleni kokukhipha uketshezi, khipha inaliti yokubhoboza, uyimboze nge-gauze oyinyumba, uyicindezele ngamandla amancane okwesikhashana, uyilungise nge-adhesive tape bese ucela isiguli ukuthi silale.
Isikhathi sokuthumela: Oct-20-2022
