Ibhubhu emqaleni emveni komsebenzi (isithombe). Kutheni ubeka ifowuni emqaleni?

Kwezinye iimeko, imingxuma iqhutywe emqaleni. Oku kuyimfuneko ukulimala okanye izifo ezithile ezihamba kunye nokuphulwa komphefumlo. I-tube inomphimbo iyadingeka ukuze ubuyisele lo msebenzi.

Iintlobo ezinokwenzeka

Ukuvulwa okhethekileyo okuvuliwe emqaleni kuya kuthiwa yi-tracheostomy. Kuxhomekeke ekufundeni, ityhutyana yexeshana okanye isigxina ingafakwa. Kodwa nangona kunjalo, lo ngumzimba wasemzini, onomphumo onomsindo kumzimba.

Ukuba kucetywayo ukuba ityhubhu emqaleni iya kuba ngaphezu kwenyanga, ngoko imida yesikhumba kufuneka ifakwe kwi-mucosa ye-trachea. Kule meko, i-tracheostomy eqhubekayo isungulwa. Kodwa ukuba kuyimfuneko ukuqinisekisa ukunikezelwa komoya ngale ndlela ngethuba elifutshane, benza ngendlela eyahlukileyo. I-cannula ekhethekileyo ifakwe kwisicatshulwa, kwaye iingcambu zesilonda esinqumleyo azithanga. Le yile divayisi evimbela ukuvalwa komgodi odiziweyo. Ukuba isusiwe, i-lumen iya kuvala iintsuku ezingama-2-3 zodwa.

Akukhuthazwa ukusebenzisa i-canula ngezihlandlo ezongeziweyo ngenxa yokuba kunokwenzeka ukuba isifo se-pathological reaction in the paratracheal tissue region.

Iimpawu zetracheostomy

Kukho izizathu ezininzi zokuba ungenakuyenza ngaphandle kokutshatyalaliswa kwemitshato. Le mfuneko iyimfuneko kwi-stenosis enzima ye-larynx.

Ziyakubangelwa zizinto ezilandelayo:

• Ukubanjwa kwamanye amazwe;
• Ukutshisa (iikhemikhali okanye i-thermal);
• Iingqolowa zamanga;
• IDiphtheria;
• Izidumbu;
• Ukukhubazeka kwamanye amabhondi.

Elinye iqela le zizathu apho i-tracheostomy iyimfuneko ukuphulwa komthi we-tracheobronchial tree. Oku kwenzeka xa:

• Ukulimala kancaniocebral;
• Ukungakwazi ukusabalalisa kwe-cerebral (kuquka kunye nangemva kwemivimbo);
• Izibilini zesibindi;
• I-Coma, ihamba kunye nokuphulwa komkhuhlane kunye nokugwinya iingcamango;
• Isimo se-asthmatic yexesha elide;
• Ukuphululwa kwengqibelelo yesakhelo sesifuba.

Kwakhona, xa i-neuromuscular apparatus ingenakulungelelaniswa, kufuneka i-tube emqaleni. Isithokiso senza kucacise ukuba oku akukho nto. Kodwa abaninzi abantu bazama ukumboza idivayisi ngeekholeji eziphezulu okanye kunye neentloko zabo. Iingxaki nge-neuromuscular device zivela ngenxa ye:

• Ifom ye-Bulbar ye poliomyelitis;
• Ukulimala kwintambo yomlomo wesibeletho;
• Polyradiculoneuritis;
• Myosthenia enamandla;
• Izilonda ze-neuroinfectious (butulism, tetanus, rabies).

I-Tracheostomy kunye ne-intubation ye-larynx

Kwimizekelo yamatyala, umntu akakwazi ukwenza ngaphandle kokuhlinzwa. I-Tracheostomy yenziwa kulawo maxesha xa kuyimfuneko ukuqinisekisa ukuba kunokuphefumula ixesha elide. Ngokuqhelekileyo kwenziwa ukwenzela ukuba ukwazi ukusebenzisa idivaysi yomoya wokungena umoya ngexesha elide.

Ukuba isigulane sidinga ukubuyisela ukuphefumula ngokuqhelekileyo, unikezele ngokutsha utshintshi lwegesi kwimiphunga ngexesha lokungenelela kokuhlinzwa, uze usebenzise i-trachea. Kule meko, ityhubhu ifakwe emqaleni kwimpumlo okanye emlonyeni. Kodwa le ndlela ingasetyenziselwa kuphela xa kuvalwa ukunyusa okungeziweyo kwiiyure ezimbalwa okanye iintsuku ezimbalwa. Enyanisweni, intubation ingonakalisa udonga lwangaphakathi lwe-trachea. Oku kuya kubangela ukunciphisa.

Xa usebenzisa ityhubhu, umoya awudluli ngaphezu kwe-tracheostomy, inxalenye efile ye-airways iyancipha. Ngelo xesha, kuba lula ukulawula ukuphefumla ixesha elide.

Amanyathelo angenelelo

Kwezinye iimeko, ngexesha lokusebenza, kubalulekile ukuqinisekisa ukutshintshwa kwegesi epheleleyo kwimiphunga kunye ne-bronchi. Abaninzi abayiqondi ukuba kungani ityhubhu emqaleni emlonyeni. Intubation ye-trachea yenziwe ukuqinisekisa ukuhamba kwe-airway. Le ngenye yeendlela ezinokuthenjelwa, ezikuvumela ukuba unambele kwi-bronchi kunye ne-trachea eyimfihlo ephumayo ngokusebenzisa i-catheters ekhethekileyo.

Ngaba intubation kwiimeko ezininzi. Oku kuyimfuneko ukuba kukho umngcipheko wesifiso - ukungena kwimiphunga yezinto zesisu. Le nkqubo ibonakaliswe ngenxa yokuphulwa kwemisebenzi yamanzi ye-trachea kunye ne-bronchi.

Kodwa ekunyangeni komhlaza we-larynx, i-tracheostomy iyimfuneko. Enye yezigaba zonyango. Ibhubhe emqaleni emva kokuhlinzwa ukuba kususwe i-larynx phambi koxinzelelo olubi luyimfuneko.

Inkqubo inika ithuba lokuqhuba ukuphefumula okuncedisayo okanye okulawulwayo. Isigulane, kungakhathaliseki ukuba sisikhundla somzimba, sihlinzekela ngokuqhelekileyo ukuhamba kwamanzi. Ukongezelela, amathuba okuxhamla kwi-aspiration ngamaninzi okuhlanza, i-muscus, igazi okanye kwi-spamm yegigaments, amaqela angaphandle angabandakanywa.

Iintlobo zemisebenzi

Ukuchithwa ngokuthe ngqo kwe-trachea ukuqinisekisa ukungena emoyeni nokususwa kwamalungu angaphandle, ukuba kuyimfuneko, kuthiwa yi-tracheotomy. I-tracheostomy yinto ebeka phezu kwendlela yokuvula yangaphandle. Emva kokungenelela okunjalo, ityhubhu ekhethekileyo ibonakala emqaleni ngenxa yokuphefumla.

Ngokuxhomekeka kwisayithi ye-incision, i-tracheostomy ephezulu, ephakathi kunye nephantsi. Inokuthi ibe yimizuzu engaphezulu, i-transverse kunye ne-U.

Nge-tracheostomy ephezulu, i-dissection isenziwa ngentla kwentamo ye-thyroid gland. Lo msebenzi uthathwa njengento elula kwaye edlalwa rhoqo.

Ukuba ukusikwa kwenziwa nge-isthmus, ke ukungenelela okunjalo kuthiwa ngumyinge we-tracheostomy. Le ngenye yezinto ezinobungozi kakhulu kwaye eziyinkimbinkimbi ngenxa yokuba kukho ingozi yomonakalo kwi-thyroid gland. Ukusebenza okunjalo kwenziwa kuphela kuloo matyala xa kungekho nto inokuyenza ngaphandle komzekelo, ngomdlavuza we-thyroid.

Kwakhona kunokwenzeka ukuqhuba i-tracheostomy ephantsi. Yenziwa phantsi kwesi siqhelo. Ukusebenza okunjalo kuboniswa kubantwana abangaphantsi kweminyaka eyi-15 ngenxa yezinto ezizodwa ezizimeko zesakhiwo sezitho. Abantu abaninzi bayazibuza ukuba kutheni i-tube in the throat ifunyanwa kubantwana. Ngokuqhelekileyo kubonakala kubantwana abaswele kwi-pathologies yokuzalwa yomoya.

I-Tracheostomy ye-air ventical

Ukuba isigulane sidinga umoya wokuphuphuma umoya, bacingisisa umbuzo wokungenelela kokuphaphaza kunye nokusika umqala. I-Tracheostomy iyakwazi ukuqinisekisa ukuzinza kwe - tube ye -IVL, ngelixa kungekho mngcipheko kummandla ophantsi kunye ne-larynx. Ngokuqhelekileyo umbuzo wokungenelela okunjalo kuvela emva kokungenwa kwesigulane kwiintsuku ezingama-7-10. Kulo xesha licaca ukuba ukuphuphuma umoya kwemiphunga kuyakufuneka ngexesha elide.

Emva koko kuyacaca kuwo wonke umntu ukuba kutheni ifayili ifakwe emqaleni. Iimviwo zenziwa kuphela kwiintsana kunye nezigulane ezincinci ngenxa yokuba i-tracheostomy ibangele iingxaki. Ukusebenza kwenziwa phantsi kwe-anesthesia kunye ne-intubation yesigulane.

Iimpawu ze-tracheostomy kubantwana

Kwezinye iimeko, izigulane ezincinci zifuna i-tube emqaleni. Luhlobo luni lokugula olubangela loo mfuneko? Faka ifowuni ngeentsholongwane zokubeleka okanye ezifunyenweyo, izibilini, izilonda ezibuhlungu, ukungahlanjululwa kwendlela yokuphefumula.

Umgqibela wokugqibela ubonakaliswe ngoluhlobo lwetracheomalacia kunye ne laryngomalacia. Kukho umgca wokuphefumula, ukuphambana kwesisundu se-intercostal, ukuphazamiseka kwamaphiko empumlo. Le meko inokuvela ngenxa yokukhubazeka kokuzalwa komzimba, izilonda zesimiso se-nervous, okanye i-laryngeal nererve. Izibonakaliso zentsapho ziquka i-trachea agniesia.

Kodwa kukho inani leepathologi ezifunyenweyo eziza kufuna ityhubhu emqaleni. Emva kokuhlinzwa, izigulane ezincinci zisetyenziselwa umzimba wangaphandle kwaye ziyaqhubeka zikhokela ngokuphila ngendlela eqhelekileyo. Ngokuqhelekileyo ityhubhu iyadingeka emva kokusebenza ixesha elide lokufakelwa umoya. Kwakhona, imfuneko yokuba kuqhutywe i- apnea yasebusuku, iingxaki ze-neuromuscular, intsingiselo engapheliyo kunye nezifo.

Iimpawu zabantwana abasebenza

Kungakhathaliseki ukuba yintoni ekhokelela ekufuneka ukuba kwenziwe i-tracheostomy yomntwana, kukho iinkalo ezikhethekileyo zeenkqubo kwiigulane ezincinci. Oku kubangelwa kwizinto ezizodwa zezakhiwo zabo. Ngoko ke, kubo bonke abantwana i-thyroid gland iphakamileyo ngokwaneleyo, ngoko bachitha i-tracheostomy ephantsi.

Izigulane ezincinci azizange zithande i-cartilage, eyakhiwe ukusuka eludongeni lwangaphandle, njengoko oku kungakhokelela ekuzinzekeni kwe-trachea ngokwayo kwaye kubangele uxinzelelo ngexesha lokuhlaselwa. Kwakhona, ukuhluka kwe-crosscutting akufanelekanga kubo. Kule meko, i-deformation ye-ring tracheal iyenzeka ngenxa yoxinzelelo lwe-tube.

Ukwakhiwa kwemisipha

Abantu abadala kunye nabantwana banokufuna i-tracheostomy ukuba bahlakulele i-teratomas okanye i-sarcomas. Kodwa kwizigulana ezincinci ukucima i-trachea inokuthi kunye nezixhobo ezifana ne-hemangioma okanye i-lymphangioma.

Xa ufumanisa umdlavuza we-laryngeal, iintshukumo zoogqirha kufuneka zingabhekiswa kuphela ekususeni i-tumor kwaye zikhusele ukukhula kwayo, kodwa kwakhona ukubuyisela imisebenzi yokukhusela, yezwi kunye nokuphefumula. Ngoko ke, ityhubhu emqaleni emva kokusebenza komdlavuza we-larynx kuyimfuneko kwiimeko apho isigulane sibhekene ne-laryngectomy - umsebenzi wokususa i-larynx yonke.

Oku kunokugwenywa kuphela xa umhlaza ufunyaniswa kwisigaba 1, ngelixa i-larynx ephakathi ichaphazelekayo. Kwiimeko ezinjalo, intambo yomlomo uyasuswa. Ngamanye amaxesha ukuthengiswa okwaneleyo kwe-larynx, okususa inxalenye yale nxalenye, kodwa yonke imisebenzi yayo igcinwa.

Ukuba kuyimfuneko ukukhutshwa ngokupheleleyo kwe-larynx, kufuneka umntu alungiselele ukuba ayiyi kukwazi ukusebenzisa i-apparatus njengezwi eliqhelekileyo. Kuya kufuneka ibuyiselwe.

Ukunyamekela i-tracheostomy

Kungakhathaliseki ukuba izizathu zokuba kutheni ufune ityhubhu emqaleni wakho, kufuneka ukhumbule indlela yokuyilandela. Ukunyamekela kubandakanya ukuhlamba rhoqo kunye nokungahlanjululwa kwesixhobo. Ukongezelela, kwindawo yecoma, kuyimfuneko ukuba uhlale uhlambulule ulusu ukuze ukhuphe ukungabikho komsindo. I-tube inokucutshungulwa ngamafutha ukuze kulungiswe ukuhambisa.

Ukongezelela, oogqirha bancoma ukuba bashiye i-stoma ngaphandle kwe-cannon ngokukhawuleza (malunga neyure). Kodwa okokuqala kubalulekile ukujonga ngokukhawuleza ukukhutshwa. Ngokudlulayo kwexesha, eli xesha linokunyuka de kubekho umgodi wenziwe ngokupheleleyo. Emva koko, ukugqithwa kwe-cannula kuyinto engadingekile. Oku kuphucula kakhulu imeko yesigulane. Emva kwakho konke, i-cannula okanye i-tracheostomy tube ityhawula udonga lwe-tracheal.

Impilo yokuphila

Emva kokuqonda ukuba kutheni i-tube emqaleni, kufuneka baninzi, ngenxa yokuba banemiqobo emininzi. Ngeli fowuni awukwazi ukuhlamba, udide, udide kumachibi, amagumbi okuhlambela. Emva koko, konke oku kufumaneka ingozi. Kodwa, inyaniso, xa kuthengiswa, kunokwenzeka ukuba ufumane iingubo ezikhethekileyo ezikhusela ithuba lokubetha kwamanzi kwi-ostomy.

Musa ukulibala ukuba ngobomi obuqhelekileyo kwiindawo ezikhuselekile nezothuli, ukukhuselwa kwemvelo kwe-nasopharynx kubangelwa. Kwaye abantu abanesiponsi emqaleni wabo abanalo. Ngoko ke, kungcono ukuphepha ukuhambela ezo ndawo. Zonke izigulane ezinee-tracheostomas zithandwa kakhulu kunye nezinye izifo ze-bronchopulmonary. Kufuneka bawugubungele i-stoma kunye ne-bandage ehambelana namanzi kwishushu eshushu. Kwaye kwixesha elibandayo, kuyinqweneleka ukufudumala emoyeni.

Iintlobo ze-tracheostom

Ngokuqhelekileyo kukho ityhubhu emqaleni ngexesha lotyando. Ngoko ke, ukuba ingenelelo yokutyhutyha ingenziwa ngokukhawuleza, isigulane sinokuqhagamshelana nogqirha, oko kukuthi i-tracheostomy iqalise.

Ngoku kukho ukukhethwa okukhulu kwezi zixhobo, kodwa ezininzi zazo zenziwe ngezinto ezikhethekileyo ze-thermoplastic. Ubunqabileyo babo bukho kwixa lokushisa malunga ne-35-38 ° C. Oku kuvumela ukugcina yonke i-membrane ye-mucous ye-trachea kunye nezinye izicubu ezikufutshane. Umda wangaphandle webhubhu uphela kwisakhiwo esifana nesigqubuthe esimo. Iyakwazi ukukhusela izithinte zangaphandle ezijikeleze i-lumen emqaleni.