Endotracheal yokutindivadza: chii, zviratidzo, zvinodhaka

Nhasi, hazvishamisi pakurapwa nzira iri kuvhiyiwa. Uye mushure emakore mashoma apfuura kuvhiyiwa akanga akaenzana rufu, varwere vakawanda vakafa zvinorwadza kuvhunduka kana sepsis. Kwenguva refu munhu vachiita kuvhiya kurota akaramba ari Herculean basa wemishonga. With nokudzidza kemisitiri kwacho kwakapera nokukurumidza. Better yakadekara wemisanganiswa uye kugadzirira yokutindivadza, izvo, uyezve, zvino kuitwa nenzira dzakawanda. Mumwe wavo ari endotracheal yokutindivadza. Chii? How rinoshandiswa uye kana zvichidikanwa? Izvi uye nemimwe mibvunzo yakawanda kupindura munyaya ino.

Kubva munhoroondo endotracheal yokutindivadza

Kokutanga kwakadai yokutindivadza rakaidzwa muna XIV-XV emakore, kana chiremba Paracelsus Swiss akatanga kupinda trachea chubhu murume pane akaponesa upenyu hwake. Pashure matatu emakore nenzira iyi akaponesa vanhu kubva nokushayiwa mhepo. Muna 1942, mutindivadzi kubva Canada pakutanga kushandiswa tsandanyama relaxants - a fuma kuti kunoderedza skeletal tsandanyama matauriro kuti apedzise immobilization. Pamusana Kuwanikwa uku yokutindivadza zvava njodzi uye akakwana, vachibvumira nenyanzvi kudzora pamusoro kuvhiya hope pakuvhiya.

In pakati XX remakore endotracheal yokutindivadza yave kusimukira nokukurumidza Ichibatsirwa vanachiremba eSoviet. Nhasi ndiro nzira vakawanda pakati vakawanda yokutindivadza, anoshandiswa nzira dzakawanda kushanda.

Endotracheal yokutindivadza: chii?

Kuitira kudzivirira muviri kubva guru mupfungwa wokuvhiya, yokutindivadza inoshandiswa. Rinogona kuva dzeko, emunharaunda kana mukuru. The ndewechiLatin unonzi yokutindivadza. Zvinonzi dzinoratidzwa zvizere "chose" hana murwere pakatanga kuvhiya hope. In yokutindivadza ano chinotarisirwa nomutsinga, kuti Mask kana kukabatanidzwa yokutindivadza. Last anosanganisa nzira mbiri uye zvinhu kupinda muropa, uye kufema turakiti. Izvi mhando kudanwa uye endotracheal yokutindivadza.

Nyanzvi Zvakakodzera nehanya naye sendarama yakachengeteka uye inobudirira nzira kurwadziwa: kunobatsira iwe kudzora zvizere ezvinhu omurwere, kuti vabudirire nehope zvomusejari, uye skeletal tsandanyama kutandara uye kudzivisa zvakadaro zvisingafadzi yematambudziko akadai chido uye kufema kukundikana.

umboo

Endotracheal yokutindivadza kunodzivisa murwere kubva marwadzo kuvhunduka uye kufema kukundikana, rinogona kushandiswa panguva akavhiyiwa uye yevanorwara zvikuru. Pakati zvairatidza kuti yokutindivadza dzinogona kubatanidzwa:

• mashandiro ari mediastinum, pharynx, munzeve, muromo uye musoro;
• Kupindira, umo kudiwa kushandisa mhasuro relaxants;
• atadze kushanda zvakanaka munyika tsinga;
• izere dumbu chirwere;
• mukana yemweya mhingaidzo.

Endotracheal vakawanda yokutindivadza rinowanzoshandiswa refu kuvhiyiwa ane kukura kwemaminitsi anopfuura 30. Rinogona kushandiswa chero zera dzakasiyana inoti murwere, t. To. Haaiti vapinze mwoyo uye mumwe ndoda chepfu nzira yokutindivadza.

Contraindications

Zvokuwedzera Kuvhiya (semuenzaniso, kubviswa oparesheni mediastinal mapundu) kunoteverwa kunyatsodzidza murwere ezvinhu. Chiremba ane zvakakodzera nguva kudzokorora vezvokurapa nhoroondo, tichigadzirisa kuverenga zvichibvira ngozi uye kuziva contraindications kune imwe nzira yokutindivadza. Combined yokutindivadza haina pachii zvinotevera ezvinhu:

• zvirwere;
• chiropa chirwere, itsvo;
• vanofungidzirwa myocardial infarction;
• Airways chirwere;
• vasiri zviri nemamiriro pharynx;
• zvakakomba kwemakemikari anobudiswa zvirwere.

Zvikurukuru ngozi kushandisa endotracheal yokutindivadza pamwe repamusoro kufema turakiti utachiona, t. K. A mukuru mukana zvemapapu hweHIV.

Stage vasanganiswa yokutindivadza

Saka, endotracheal yokutindivadza. Chii nokuda chiremba? Anesthesiologist anoita anotevedzana matatu zvokukura chiito: pakatanga kuvhiya hope, tichiramba yakatsiga nehurumende uye nehope. Danho rokutanga ezvidzidzo nyore induction kuti yokutindivadza. Murwere nomutsinga anogamuchira zvinodhaka kana inhaled gasi nezvakasanganiswa. Kana tsandanyama vari zvachose vasununguke, kuti nemukoti anokotsirisa anoisa kupinda tracheal lumen endotracheal chubhu. Inopa zvokuimba kufefetedza uye inhalation reokisijeni pamwe gaseous dzokutindivadza.

Kamwe vanachiremba vapedza basa ravo, kunouya yakaoma nokuti anesthesiologist - goho murwere yokutindivadza. The chipimo chemushonga zvinodhaka ipfupi zvishoma nezvishoma. Pashure pokudzorerwa vaingoerekana kufema extubated - kubviswa pakati endotracheal chubhu iri trachea. The murwere zvifambiswe kuti ICU, akataririra chinokosha zviratidzo uye postoperative kupora kwacho.

induction kuti yokutindivadza

Easy kwokutanga yokutindivadza inodiwa nyarara uye yakachengeteka intubation, riri hazviiti pasina Implementation kuti endotracheal yokutindivadza. Kuti vabudirire mumamiriro kushandisa inhalation kana intravenous dzokutindivadza yakadaro. Muchiitiko chokutanga, murwere anofema kuburikidza chokuzvivanza nomwe "Etra", "Foran", "halothane" kana zvimwe zvakafanana wemisanganiswa dzokutindivadza. Dzimwe nguva zvakakwana nitrous oxide uye oxygen.

Sezvo medicaments raitongwa nomutsinga, raiwanzoshandiswa barbiturates uye neuroleptics (droperidol, fentanyl). Vari kushandiswa senzira yokugadzirisa (kunonyanyisa 1%). Dose anesthesiologist yasarudzwa mumwe nomumwe nomumwe murwere.

Pashure chiedza yokutindivadza chiito kuita tracheal intubation. Kuti aite izvi, kushandisa tsandanyama relaxants kuzorora pamutsipa netsandanyama. The chubhu kutaurwa achishandisa laryngoscope, pashure iyo murwere zvaitambidzwa rakagadzirwa nevanhu zvemapapu kufefetedza. Stage kunotanga yakadzika yokutindivadza.

Droperidol: kurayira

Droperidol - antipsychotic, rinowanzoshandiswa endotracheal yokutindivadza. Makemikari mamiriro nefuma chinhu tertiary amine. Nechekare ane kunyaradza nomugumisiro 3 maminitsi pashure kutarisira. Ichivharira dopamine receptors, zvichikonzera neurovegetative braking. Uyezve hypothermic uye ane antiemetic nemigumisiro. Kufema kunokanganisa zvishoma.

Akaratidza kuti premedication, induction pamusoro yokutindivadza, myocardial infarction, kuvhunduka, zvikuru angina, pulmonary edema uye vane chirwere cheBP dambudziko. Zvinokurudzirwa somunhu mushonga, anobvisa svoto uye kurutsa. Ane yakaderera toxicity, rinogona kushandiswa chiremba oparesheni uye Obstetrics.

Chidobi kuti kushandiswa antipsychotics panguva induction kuti yokutindivadza

Kune embodiments inoverengeka neyroleptanalgezii. kazhinji Induction kuitwa anotevera zano: droperidol, iyo mutungamiriri zvakurukurwa apa, mune mari 2-5 Rine mamiririta pamwe 6-14 ml fentanyl raitongwa murwere nomutsinga. Panguva imwe chete masiki kudya musanganiswa pamusoro nitrous oxide uye okisijeni iri nhamba 2: 1 kana 3: 1. Pashure kudzvinyirira kuti pfungwa uye tsandanyama relaxants vari raitongwa kuti asaende intubation.

Zvisinei, Droperidol ane neuroleptic kushanda kwemaawa 4-5, kwakanyorwa chinotarisirwa pakutanga pamusoro yokutindivadza rive. It rinowanikwa kufungisisa muviri uremu: 0.25-0.5 MG / makirogiramu. Akadzokorora kwokubatsira mushonga vanoda chete munguva refu kushandiswa.

Fentanyl iri imwe uwandu 0.1 MG raitongwa maminitsi 20 ose, uye ayo zvisingasviki anomiswa kwemaminitsi 30-40 kuguma pakuvhiya pamberi. Initial dose ndiyo 5-7 MG / makirogiramu.

intubation

Pashure kudzvinyirira kuti pfungwa vakatakura chakagadzirwa kufefetedza pamwe okisijeni vachishandisa rufimbi chifukidzo. Pashure paizvozvo, chiremba anoita intubation achishandisa muromo (dzimwe nguva achishandisa mhino). Runodzingira musana musoro wake, muromo wake wakavhurika. Direct jekiseni laryngoscope chipande achitevedza midline pakati pedenga uye rurimi, kudzvanya yokupedzisira kumusoro. Kutsigira chishandiso mberi kusimudza muromo epiglottis. Achiratidza glottis, izvo kupinda endotracheal chubhu. Zvinofanira kuenda trachea vanenge 2-3 cm. Mushure akabudirira intubation chubhu parumananzombe uye batanidza murwere kuti ventilator.

Zvishoma yaiwanzoshandiswa laryngoscope ane curved reza. Zvinonzi akasuma pakati mujinga epiglottis uye mudzi rurimi, otdavlivaya yakareba kumusoro pachangu. Kana hazvibviri kupinza munhu chubhu kubudikidza muromo uchishandisa rezasi nasal meatus. Somuenzaniso, kuvhiyiwa kubvisa cysts nomumukanwa mhango.

Maintenance uye kupora kubva yokutindivadza

Mushure intubation uye batanidza murwere kuti ventilator kunoitika munguva inokosha. Achishingaira aishanda somuvhiyi, kuti anesthesiologist hwakada monitors nechouviri zviratidzo. Ose maminitsi 15, tarisa kwemwoyo, BP, achibatsirwa monitors kuchengeta murwere cardiac basa.

General yokutindivadza iri nekugadzirwa okuwedzera mishonga ine antipsychotic zvinodhaka, tsandanyama relaxants, kana wemisanganiswa inhalation dzokutindivadza. Operation pasi yokutindivadza vasanganiswa mhando anobvumira anesthesiologist kuchinjira zvinodiwa nomuviri marwadzo utariri nokupa ane optimum pamwero kuchengeteka.

Panopera maoparesheni rokupedzisira Danho - kubva marwadzo hope. Kusvikira panguva iyoyo zvishoma nezvishoma kuderedza uwandu husingakuvadzi nezvinodhaka. Kudzorera kufema atropine uye Neostigmine pane zvikamu maminitsi 5. Nechokwadi kuti murwere anogona kufema pachavo, extubated. Kuti aite izvi, kuchenesa nharaunda yacho tracheobronchial muti. Pashure nokubviswa chubhu, uye yakafanana muitiro rinoitwa pamwe nomumukanwa mhango.

postoperative ongororo

Abva mukamuri rokuvhiyira, murwere papi mune yevanenge, kupi kunyatsotevera akuteerere ezvinhu ake. Pashure vakawanda yokutindivadza kuva kusanzwa, zvishoma matambudziko. Kazhinji, varwere post-kushanda chokunyunyuta pamusoro:

• marwadzo;
• kusagadzikana mune huro;
• svoto;
• simba uye tsandanyama nekuneta;
• hope;
• kuvhiringidzika;
• chills;
• nyota uye kushaya havi.

Zviratidzo izvi kazhinji inonyangarika mukati maawa 2-48 rokutanga pashure kuvhiyiwa. Kubvisa marwadzo analgesics waakaudzwa.

Saka, ngationei muchidimbu. Endotracheal yokutindivadza - chii? Nzira iyi kudzidzisa munhu kuti kuvhiya hope, kunoita kuti kuvhiya zvakaoma, vachiongorora basa kufema hurongwa. Combined yokutindivadza iri zvishoma chepfu, uye nyore kudzora kudzama yokutindivadza panguva kupindira nguva. Under endotracheal yokutindivadza kunyanya kwaireva intubation, uchiteverwa unobva murwere kuti ventilator. Kana ichi rinoshandiswa sezvo inhaled uye rufimbi mishonga, izvo yemanyorero aibatanidza.