I-Thoracentesis
1, Izinkomba
1. I-pleural effusion yemvelo engaziwa, ukuhlolwa kokubhoboza
2. I-Pleural effusion noma i-pneumothorax enezimpawu zokucindezelwa
3. I-Empyema noma i-pleural effusion eyingozi, ukuphathwa kwe-intrapleural
2. Contraindications
1. Iziguli ezingabambisani;
2. Isifo sokuqina kwesibindi esingakalungiswa;
3. Ukungakwazi ukuphefumula noma ukungazinzi (ngaphandle uma kukhululwe i-thoracentesis yokwelapha);
4. Ukungazinzi kwe-hemodynamic yenhliziyo noma i-arrhythmia;I-angina pectoris engazinzile.
5. Ukuphikisana okuhlobene kufaka phakathi ukungena komoya ngemishini kanye nesifo se-bullous wamaphaphu.
6. Ukutheleleka kwendawo kufanele kukhishwe ngaphambi kokuba inaliti ingene esifubeni.
3. Izinkinga
1. I-Pneumothorax: i-pneumothorax ebangelwa ukuvuza kwegesi inaliti yokubhoboza noma ukuhlukumezeka kwamaphaphu ngaphansi kwayo;
2. I-Hemothorax: i-pleural cavity noma ukopha kodonga lwesifuba okubangelwa ukubhoboza inaliti elimaza imikhumbi engaphansi;
3. Ukukhipha amanzi ngokweqile endaweni yokubhoboza
4. I-syncope ye-Vasovagal noma i-syncope elula;
5. I-air embolism (engavamile kodwa eyinhlekelele);
6. Ukutheleleka;
7. Ukugwazwa kobende noma isibindi okubangelwa umjovo ophansi kakhulu noma ojule kakhulu;
8. I-edema yamaphaphu ephindelelayo ebangelwa ukugeleza kwamanzi ngokushesha > 1L.Ukufa kuyivelakancane kakhulu.
4. Ukulungiselela
1. Izimo
Esikhundleni sokuhlala noma se-semi reclining, uhlangothi oluthintekile lusehlangothini, futhi ingalo yohlangothi oluthintekile iphakanyiswe ngaphezu kwekhanda, ukuze ama-intercostals avuleke.
2. Thola indawo yokubhoboza
1) I-Pneumothorax endaweni yesibili ye-intercostal yomugqa we-clavicular ophakathi noma izikhala ezi-4-5 ze-intercostal zomugqa we-axillary ophakathi
I-2) Ngokukhethekile umugqa we-scapular noma isikhala se-7th kuya ku-8th intercostal yomugqa we-axillary wangemuva
I-3) Uma kunesidingo, ama-intercostals angu-6-7 we-axillary midline nawo angakhethwa
Noma isikhala se-5 se-intercostal se-axillary front
Ngaphandle kwe-engeli ye-costal, imithambo yegazi nezinzwa zigijima ku-costal sulcus futhi zihlukaniswa zibe amagatsha aphezulu naphansi e-posterior axillary line.Igatsha elingenhla lise-costal sulcus futhi igatsha elingezansi lisonqenqemeni olungaphezulu lombambo olungezansi.Ngakho-ke, ku-thoracocentesis, udonga olungemuva ludlula endaweni ye-intercostal, eduze nomkhawulo ongaphezulu wombambo ongaphansi;Izindonga zangaphambili nezingemuva zidlula endaweni ye-intercostal futhi zidlule phakathi kwezimbambo ezimbili, ezingagwema ukulimaza imikhumbi ye-intercostal nezinzwa.
Ubudlelwano bendawo phakathi kwemithambo yegazi nemizwa yilokhu: imithambo, imithambo yegazi kanye nemizwa kusuka phezulu kuye phansi.
Inaliti yokubhoboza kufanele ifakwe esikhaleni se-intercostal ngoketshezi.Ayikho i-encapsulated pleural effusion.Iphuzu lokubhoboza ngokuvamile liyisikhala esibizayo esingaphansi kwezinga le-liquid, elitholakala kulayini we-infrascapular.Ngemuva kokuthi isikhumba sihlanjululwe nge-iodine tincture, opharetha wayegqoka amagilavu oyinyumba futhi abeke ithawula lembobo oyinyumba, bese esebenzisa i-lidocaine engu-1% noma engu-2% yokubulala izinzwa zendawo.Okokuqala yenza i-colliculus esikhumbeni, bese kuba izicubu ezingaphansi kwesikhumba, ukungena kwe-periosteum emaphethelweni angaphezulu ombambo olungezansi (ukuvimbela ukuthintana nonqenqema olungezansi lombambo olungenhla ukugwema ukulimaza i-subcostal nerve kanye ne-vascular plexus), futhi ekugcineni ku-parietal. i-pleura.Lapho ingena ku-pleura ye-parietal, ishubhu yenaliti ye-anesthesia ingamunca uketshezi lwe-pleural, bese ibopha inaliti yokubulala izinzwa nge-clamp yemithambo ezingeni lesikhumba ukuze iphawule ukujula kwenaliti.Xhuma inombolo enkulu (No. 16~19) inaliti ye-thoracentesis noma idivayisi ye-cannula yenaliti ekushintsheni kwezindlela ezintathu, bese uxhuma isirinji engu-30~50ml nepayipi ukuze uthulule uketshezi olukusirinji esitsheni.Udokotela kufanele anake uphawu yenaliti yokubulala izinzwa efinyelela ekujuleni koketshezi lwesifuba, bese ejova inaliti engu-0.5cm.Ngalesi sikhathi, inaliti enobubanzi obukhulu ingangena emgodini wesifuba ukuze kuncishiswe ingozi yokungena ezicubu zamaphaphu ezingaphansi.Inalithi yokubhoboza ingena iqonde odongeni lwesifuba, izicubu ezingaphansi kwesikhumba, bese ingena oketshezini lwe-pleural eduze konqenqema olungaphezulu lombambo olungezansi.I-catheter eguquguqukayo iphakeme kunenaliti yendabuko elula ye-thoracentesis ngoba inganciphisa ingozi ye-pneumothorax.Izibhedlela eziningi zinamadiski okubhoboza isifuba alahlwayo aklanyelwe ukubhoboza okuphephile nokuphumelelayo, okuhlanganisa izinaliti, amasirinji, amaswishi namashubhu okuhlola.
Isikhathi sokuthumela: Jun-06-2022
