Endotracheal ná Nkụnwụ: ihe ọ bụ, na-egosi, ọgwụ ọjọọ

Taa, ọ bụ ọ na anya na nke a ọgwụgwọ usoro ịwa ahụ. Na mgbe a ole na ole narị afọ gara aga ọrụ hà ọnwụ, ọtụtụ ọrịa a nwụrụ si a na-egbu mgbu ujo ma ọ bụ sepsis. N'ihi na a ogologo oge na onye na-adọ nke ogwugwo dream nọgidere a Herculean ọrụ nke na nkà mmụta ọgwụ. Na ọmụmụ nke onwu usoro arahụ ngwa ngwa. Mma ahaziri mixtures na preparations maka ná Nkụnwụ Ahụ, nke, Ọzọkwa, na-now rụrụ n'ọtụtụ ụzọ. Otu n'ime ha bụ endotracheal ná Nkụnwụ. Gịnị ka ọ bụ? Olee otú ọ na-eji na mgbe ọ dị mkpa? Ndị a na ọtụtụ ajụjụ ndị ọzọ na-aza n'isiokwu a.

Site n'akụkọ banyere endotracheal ná Nkụnwụ

N'ihi na oge mbụ ụdị ná Nkụnwụ na-agbalị na XIV-XV narị afọ, mgbe dọkịta Paracelsus Swiss ẹkenam n'ime oghere eji ekunye ume tube nwoke karịa zọpụta ndụ ya. Mgbe narị afọ atọ na otú a zọpụta ndị mmadụ site na enweghi ikuku. Na 1942, nkụnwụ ahụ si Canada mbụ ji mee muscle relaxants - a umi na-ebelata skeletal Akwara ụda ruo mezue Immobilization. N'ihi nke a chọpụtara nke ná Nkụnwụ aghọwo odi mfe na ndị ọzọ zuru okè, ikwe ọkachamara full achịkwa nke ogwugwo ụra n'oge ịwa ahụ.

Ke n'etiti nke XX narị afọ endotracheal ná Nkụnwụ e-emepe emepe ngwa ngwa, enyere ha aka Soviet dọkịta. Taa, ọ bụ ihe kasị nkịtị usoro nke general ná Nkụnwụ Ahụ, eji na N'ezie nke kasị nke arụmọrụ.

Endotracheal ná Nkụnwụ: ihe ọ bụ?

Iji chebe ndị ozu nnukwu nchegbu nke ịwa ahụ, ná Nkụnwụ na-eji. O nwere ike ịbụ obodo, mpaghara ma ọ bụ ofụri ofụri. Nke ikpeazụ ụdị a na-akpọ ná Nkụnwụ. Ọ e ji a full "anya" nsụhọ nke onye ọrịa na mmalite nke ịwa ahụ na-ehi ụra. Na oge a ná Nkụnwụ na-ndinọ intravenously, nkpuchi ma ọ bụ jikọtara ná Nkụnwụ. Ikpeazụ agwakọta abụọ na usoro na bekee tinye n'ọbara, na akụkụ okuku ume na tract. Nke a na ụdị oku na endotracheal ná Nkụnwụ.

Ndị ọkachamara na-ezi na-ewere ya dị ka ndị kasị mma na irè usoro mgbu enyemaka: ya-enye gị ka n'ụzọ zuru ezu ịchịkwa ọnọdụ onye ọrịa, na-enweta oké ụra awa ahụ, na skeletal muscle ntụrụndụ na izere ndị dị otú ahụ wetara nsogbu ndị dị otú ahụ dị ka ọchịchọ na akụkụ okuku ume ọdịda.

na-agba akaebe

Endotracheal ná Nkụnwụ na-egbochi ọrịa si mgbu ujo na akụkụ okuku ume na ọdịda, ọ ga-eji n'oge arụmọrụ na kpụ ọkụ n'ọnụ na-elekọta. Otu n'ime ihe ndị na-egosi maka ná Nkụnwụ nwere ike ikpokọta:

• arụmọrụ na mediastinum, pharynx, n'ime ntị, ọnụ na isi;
• aka, na nke mkpa iji muscle relaxants;
• malfunction na ụjọ usoro;
• full afo syndrome;
• ihe ize ndụ nke airway mgbochi.

Endotracheal general ná Nkụnwụ a na-eji ogologo oge arụmọrụ a okè nke karịa 30 nkeji. Ọ ga-eji na mgbe ọ bụla afọ na dị iche iche na-ekwu, onye ọrịa, t. Iji. Ọ dịghị mara obi na ndị ọzọ bụ ihe na-erughị na-egbu egbu ụzọ nke ná Nkụnwụ.

contraindications

Nhoputa ịwa ahụ (e.g., mwepụ ọrụ mediastinal etuto) sotere nlezianya na-amụ ọrịa na-arịa. The dọkịta nwere ndị dị mkpa oge iji nyochaa ahụ ike na akụkọ ihe mere eme, ijikwa gbakọọ ekwe omume dị ize ndụ ma mata contraindications ka a akpan akpan usoro ná Nkụnwụ. Jikọtara ná Nkụnwụ na-adịghị akwadoro maka ndị na-esonụ ọnọdụ:

• na-efe efe ọrịa;
• ọrịa imeju, akụrụ;
• enyo enyo myocardial infarction;
• karị ọrịa;
• n'ahụ atụmatụ nke Ọdịdị nke ahụ pharynx;
• oké endocrine ọrịa.

Karịsịa dị ize ndụ iji endotracheal ná Nkụnwụ na elu akụkụ okuku ume na tract-efe efe, t. K. A elu n'ihe ize ndụ nke akpa ume ọrịa.

Ogbo jikọtara ná Nkụnwụ

Ya mere, endotracheal ná Nkụnwụ. Gịnị ka ọ bụ n'ihi na ndị dọkịta? Nkụnwụ anamde atọ nke soje nkebi nke ihe: iwebata ịwa ahụ na-ehi ụra, na-a anụ ala na edemede. The akpa ogbo bụ iji mejuputa ihe dị mfe itinye n'ọkwa nke ná Nkụnwụ. Onye ọrịa intravenously enweta ọgwụ ọjọọ ma ọ bụ kuru gas ngwakọta. Mgbe nke uru ahụ anyị kpamkpam nọrọ jụụ, na nkụnwụ naetinye tracheal lumen endotracheal tube. Ọ na-enye n'ibu ventilashion na inhalation nke oxygen na gaseous ọgwụ na-akụnwụ.

Ozugbo dọkịta na-awa dechara ọrụ ha, na-abịa a dị mkpa maka nkụnwụ - mmepụta nke ime ná Nkụnwụ. The onunu ogwu nke ọgwụ ọjọọ na-ebelata nwayọọ nwayọọ. Mgbe mweghachi nke n'amaghi ume extubated - mwepụ nke ndị endotracheal tube na oghere eji ekunye ume. Onye ọrịa na-gaa na ICU, na-ekiri mkpa ịrịba ama na postoperative mgbake usoro.

itinye n'ọkwa nke ná Nkụnwụ

Easy mbụ ná Nkụnwụ a chọrọ maka enweghi mgbu na mma-intubation, nke bụ-agaghị ekwe omume na-enweghị mmejuputa endotracheal ná Nkụnwụ. Iji nweta ihe ndị dị otú ahụ a na steeti ojiji nke inhalation ma ọ bụ igba ogwu n'akwara ọgwụ na-akụnwụ. Ke akpa idaha, onye ọrịa na-eku ume site a nkpuchi na abụọ "Etra", "Foran", "halothane" ma ọ bụ ndị ọzọ yiri mixtures nke ọgwụ na-akụnwụ. Mgbe ụfọdụ, ọ bụ iji na nitrous oxide na oxygen.

Dị ka ọgwụgwọ ndinọ intravenously, ejikarị barbiturates na neuroleptics (droperidol, fentanyl). Ha na-eji dị ka a ngwọta (kacha 1%). Dose nkụnwụ họrọ n'otu n'otu n'ihi na onye ọ bụla ndidi.

Mgbe ìhè ná Nkụnwụ eme ịrụ tracheal intubation. Iji mee nke a, jiri nke muscle relaxants iji zuru ike n'olu uru. The tube na ẹkenam site laryngoscope, mgbe nke onye ọrịa na-agafere keakamere akpa ume ventilashion. Ogbo amalite miri Nkụnwụ.

Droperidol: ntụziaka

Droperidol - antipsychotic, a na-eji na endotracheal ná Nkụnwụ. The chemical Ọdịdị umi bụ a tertiary amine. Ugbua nwere a ogwuura mmetụta 3 nkeji mgbe ochichi. Igbochi dopamine anabata, na-eme neurovegetative braking. Ọzọkwa, hypothermic na nwere antiemetic mmetụta. Iku ume na-emetụta ubé.

Gosiri maka premedication, itinye n'ọkwa nke ná Nkụnwụ Ahụ, myocardial infarction, ujo, oké rịaworo, akpa ume edema na hypertensive nsogbu. Na-atụ aro ka a ọgwụ, eliminates ọgbụgbọ na vomiting. Nwere ala toxicity, ọ ga-eji na ụmụaka ịwa ahụ na ịmụ nwa.

Usoro ojiji nke antipsychotics n'oge itinye n'ọkwa nke ná Nkụnwụ

E nwere ọtụtụ embodiments nke neyroleptanalgezii. Itinye n'ọkwa-emekarị rụrụ site na-esonụ atụmatụ: droperidol, nke ndu e atụle n'elu, ke ichekwa 2-5 ml na 6-14 ml nke fentanyl ndinọ onye ọrịa intravenously. N'out oge nkpuchi nri na a ngwakọta nke nitrous oxide na oxygen na a ruru nke 2: 1 ma ọ bụ 3: 1. Mgbe suppression nke nsụhọ na muscle relaxants na-ndinọ n'ihu intubation.

Droperidol enwe neuroleptic mmetụta 4-5 awa, Otú ọ dị, ọ na-ndinọ na mmalite nke ná Nkụnwụ ọkọnọ. Ọ na gbakọọ na-ewere n'ime akaụntụ arọ ahụ: 0.25-0.5 mg / n'arọ. Ugboro ugboro ochichi nke ọgwụ mkpa naanị n'oge ogologo arụmọrụ.

Fentanyl bụ na ego nke 0,1 mg ndinọ minit 20 ọ bụla, na ya ọkọnọ na-kwụsịrị maka 30-40 nkeji tupu ọgwụgwụ nke ịwa ahụ. Mbụ dose bụ 5-7 mg / n'arọ.

intubation

Mgbe suppression nke nsụhọ rụrụ wuru ventilashion na oxygen na-eji anestetiiki nkpuchi. Mgbe nke ahụ gasịrị, dọkịta anamde intubation site n'ọnụ (mgbe ụfọdụ site na imi). Achụpụ azụ isi-ya, ọnụ ya oghe. Direct agbara laryngoscope agụba tinyere midline n'etiti mbara igwe na ire, na ịpị ikpeazụ elu. E ngwá ọrụ n'ihu ebuli n'ọnụ nke epiglottis. Egosi glottis, n'ime nke endotracheal tube. Ọ ga-aga n'ime oghere eji ekunye ume banyere 2-3 cm. Mgbe ihe ịga nke ọma intubation tube fix na jikọọ na onye ọrịa na ventilator.

Naa-ejikarị laryngoscope na a curved agụba. Ọ na ẹkenam n'etiti isi nke epiglottis na mgbọrọgwụ nke ire, otdavlivaya ịdịru ruo onwe m. Ọ bụrụ na ọ gaghị ekwe omume ntinye nke a tube site n'ọnụ iji na ala dịghị òkè meatus. Ka ihe atụ, iji wepụ na cysts onu oghere.

Mmezi na mgbake si ná Nkụnwụ

Mgbe intubation na jikọọ na onye ọrịa na ventilator emee n'oge isi. Rụọ ọrụ dị ka a na-awa, na nkụnwụ anya Monitors oru egosi. Ọ bụla 15 nkeji, ịlele obi ọnụego, ọbara mgbali, na-enyemaka nke Monitors edebe ọrịa gbasara obi ọrụ.

General ná Nkụnwụ na-nọgidere na-enwe site ọzọ doses nke antipsychotic ọgwụ ọjọọ, muscle relaxants, ma ọ bụ mixtures inhalation ọgwụ na-akụnwụ. Ọrụ n'okpuru ná Nkụnwụ jikọtara ụdị na-enye ohere nkụnwụ ime mgbanwe iji na-egbo mkpa nke ahụ mgbu management site na ịnye kacha larịị nke nche.

Mgbe ọgwụgwụ nke usoro ịwa ahụ ikpeazụ ogbo - nke narcotic-ehi ụra. Na ruo mgbe ahụ na-eji nwayọọ nwayọọ belata onunu ogwu nke ọgwụ ọjọọ. Iji weghachite na-eku ume atropine na Neostigmine na etiti oge nke 5 nkeji. Na-eme ka n'aka na ndidi dị ike iku ume na ha onwe ha, extubated. Iji mee nke a, hichaa ebe nke tracheobronchial osisi. Mgbe mwepụ nke tube, na a usoro yiri a rụrụ na-edeghị ede oghere.

postoperative surveillance

Mgbe ahapụ ọrụ ime ụlọ ahụ, onye ọrịa na-positioned na kpụ ọkụ n'ọnụ na-elekọta unit, ebe anya nyochaa ọnọdụ ya. Mgbe general ná Nkụnwụ ịzụlite erughị ala, obere nsogbu. Na-emekarị, post-ịkpa ọrịa mkpesa nke:

• mgbu;
• erughị ala na akpịrị;
• ọgbụgbọ;
• n'adịghị ike na muscle ike ọgwụgwụ;
• iro ụra;
• mgbagwoju anya;
• akpata oyi;
• akpịrị ịkpọ nkụ na enweghị agụụ.

Ndị a mgbaàmà na-emekarị akwụsị n'ime akpa 2-48 awa mgbe ịwa ahụ. Iji kpochapụ ihe mgbu analgesics kenyere.

Ya mere, ka ichikota. Endotracheal ná Nkụnwụ - ihe ọ bụ? Nke a na usoro nke na-ewebata onye nke ogwugwo ụra, enye gị ohere igosi mgbagwoju arụmọrụ, nlekota ọrụ nke akụkụ okuku ume na usoro. Jikọtara ná Nkụnwụ bụ obere na-egbu egbu, na mfe ịchịkwa omimi nke ná Nkụnwụ n'oge aka oge. N'okpuru endotracheal ná Nkụnwụ isi pụtara intubation, soro site na njikọ onye ọrịa na ventilator. Mgbe a na-eji dị kuru na anestetiiki ọgwụ, nke na-a jikọtara.