Ikhuni ikhuselekile I-Vagosympathetic ngokweVishnevsky

Ukukhuselwa kwe-anti-vertebrae yomlomo wesibeleko , kunye ne-vagus nervous, kuthiwa "i-vagosympathetic blockade". Yayimiselwe nguAleksandr Aleksandrovich Vishnevsky ngenjongo yokuphazamisa impembelelo yesibindi ngexesha lokutshatyalaliswa kwamagama ngenxa yokuphazamiseka okuphazamisayo kunye nokulimala kwendawo ye-thoracic.

Unika umphumo osisigxina kwizifo ezivuthayo kunye nezifo ezahlukahlukeneyo zetoni ye-muscle.

I-neocaine blockade yavavanywa nguS. G. Zohrabyan ukwenzela ukuba iqaphele i-hypotensive syndrome yomsuka obulalayo. Ukuqwalaselwa kwenzelwa ukutshatyalaliswa kobuchopho, apho ukukhutshwa kwendawo yokuvalelwa kwintsholongwane yesibeleko kwizilwanyana ezine-cerebral hypotension kungakhokelela ekunyuseni kwexinzelelo lwangaphantsi kwexesha elifutshane. Intloko iyancipha kwi-80% yamatyala emva kwenkqubo. Kodwa isiphumo sahlala kuphela kwieyure ezimbalwa. Oku kubangelwa kukuba i-blockade isusa okwethutyana kweemikhumbi yengqondo, ngenxa yoko, ukunikezelwa kwegazi kwingqondo kuphucula.

Iyintoni inkqubo e sekelwe kuyo?

Ukukhutshwa kwe-vagosympathetic yindlela yokungaxhaswanga kwe-pathogenetic esekelwe kwi:

• Ngethuba elifutshane lokumisa kwendawo yokuphazamiseka kwemihlaba.
• Kwindlela yokusabela kwisisombululo esingenakulungiswa se-novocaine kwimisebenzi yokubonakalisa inkqubo ye-nervous central (CNS).

Iingenelelo zokucima

Ngokwale miqathango A. Vishnevsky weza kwizigqibo ezithile:

• Ngezizathu ezahlukahlukeneyo, inkqubo yokuvuvukala ekuqaleni kokukhula kwayo iyaxhomekeke kwimithetho efanayo.
• Ukukhula kwenkqubo yokuvuvukala kunokumiswa ngelixa esesiteji se-serous tissue impregnation.
• Ifomu ekhulayo yokuvuvukala ikhawuleza ngokukhawuleza, ikhutshwe kwaye isonjululwe, kwaye ifom yefayili ifumaneka.
• Iinjongo ezingenasiphelo, ezinzulu kunye nezinye iimeko ezingapheliyo zokuvuvukala zibonakaliswa ngokutshintsha kwe-trophic, ngamanye amaxesha zixazululwe ngokukhawuleza.
• Izifo ezinxulumene nezinguqu zentsholongwane kwimisebenzi yezitho. Ukucaphuka komnxeba, okwenziwa ngumlomo we-vagosympathetic block, ususa iqumrhu kwilizwe elitshintshileyo. Kule meko, ukukhutshwa kwiinkqubo ezinjalo kuthinta i-multifunctional: ivumela i-spasm, ibuyiselwe umsebenzi kwi-paresis.
• Iinkqubo zendalo yobuthakathaka obangelwa yimitshintsho yomsebenzi kunye nokuhamba kwe-capillaries, i-novocaine blockade ibangela ukulungiswa kwesimo somzimba sodonga lwe-vascular.

Ziziphi iintlobo ze-blockades ezikhoyo?

Makhe siqwalasele lo mbandela ngokubanzi. Iintlobo eziphambili zeeblockades:

• Ukukhutshwa kwendawo yokuqhekeka yamathambo amade asele.
• Ukukhutshwa kwamagxa ehlombe.
• I-Thoracic ivimbela umlenze ophantsi.
• Ukukhutshwa kwecandelo eliphambeneyo.
• Ukuvinjelwa kwentsholongwane yesifazane.
• I-nertic sciatic.
• I-nervous nerve.
• I-nerbular nerve.
• Intercostal umqhubi wecala.
• Ibloko leparavertebral.
• Kwaye, kunjalo, i-vagosympathetic yomlomo wesibeleko.

Vagosimpathetic blockade: izibonakaliso

Izibonakaliso zengcinezelo yomlomo wesibeleko nazo zi:

• Ukutshatyalaliswa kwePleuropulmonary.
• Iintlobo ezininzi zezimbambo.
• Iifayile ezivulekileyo, ezivaliweyo kunye ne-valvular.
• Ukutshisa kwephepha lokuphefumula.
• Pneumonia.
• Ama-Syndromes of suffocation suffocation.
• Ama-Syndromes of fatty blockages (ifom yamaphepha).

Uninzi ngokuqhelekileyo, xa ezi zintsholongwane zenzeka, inkqubo yenziwa.

Ukuze i-Vagosympathetic ivimbele ukuba yenziwe ngokweendlela zikaVishnevsky, kuyimfuneko ukwazi ukuxhamla kwe-clumsy-anatomical ye-trunk ne-vagus nererve. Ezi zicubu zilapha ngaphaya kwethambo le - hyoid kwisinye seeselinye, esichaza ukuba kunokwenzeka ukukhusela i-synchrone xa i-novocaine ilawulwa apha. Ngezantsi, bahluke ngephepha leparietal ye-fascia yesine.

Ukulungiselela isigulane

Ngaphambi kokuba i-blockade iqale, ugqirha uyayihlola into ebhalwe kwi-vial okanye i-ampoule nge-anesthetic. Isigulane simele sibe sesigxina, kuba ukuvela kweengxaki ezahlukeneyo akunakupheliswa ngenxa yento eyenziwa yi-anesthesia. Ngaphambi kokuhlinzwa, ulusu luhlala luphathwa ngesisombululo se-antiseptic. Ukukhusela i-blockade ifuna le nto. Unyango kufuneka luqhutywe ngesigunyaziso, kuba akunakwenzeka ukuvumela ii-microorganisms ze-pathogenic ukuba zingene kwindawo yokuhluthwa.

Emva koko, indawo yesikhumba kufuneka ikhutshwe ngeengubo zangaphantsi ezingaphantsi.

Kwenzeka ntoni emva koko?

Isigulane sibekwe emva, kwaye i-roller ifakwe phantsi kwamagxa. Intloko iphendukele kwelinye icala le-blockade. Isandla sesigulane ukusuka kwicala lokukhusela likhutshwa. Ngomda ongaphantsi komgca we-sternocleidomastoid wesokudla, malunga ne-1-1.5 cm ngaphezu kwesikhumba, 1-2 ml ye-0.25-5% isisombululo sesisifo se-anesthetic sijojowe ngaphezu kwesikhumba. Ukuba umlo wesigxina se-jigular awubonakali, ke indawo yedaliti ilungiselelwe ngaphambili kwinqanaba le-epiglottis ye-thyroid.

Ukuchithwa kwe-vagosympathetic kwenzani na?

Le ndlela iyingqayizivele, iingcali kuphela zeendlela zokuziphatha eziphezulu. Ngomnwe womnxeba wesandla samahhala, izihlunu kunye nemithambo yegazi zihanjiswe ngaphakathi kwaye zicubungele ubuso bokuqala be-vertebrae yommandla wesibeleko. Ukuqhubela phambili ekupheleni komnwe, inaliti enkulu ifakwa kwaye ihanjiswe ngaphakathi, ngokubhekiselele kumgangatho wokuqala we-vertebrae. Kwinkqubo yokuzisa inaliti enevolumu elincinci, 2-3 ml nganye, isisombululo se-anesthétic for anesthetizing le nkqubo yongezwa. Emva kokuphela kwenaliti kwathintela i-vertebrae, uvavanyo lwe-aspirate lwenziwa (ukuphepha ukujova kwe-intravascular of anesthetic). Emva kokuqinisekisa ukuba igazi alingena kwisirinji, yifake ngokukhawuleza i-30-60 ml yesisombululo se-anesthetic esingu-0.25%. Emva koko inaliti ikhutshwe ngaphandle, kwaye indawo yokuxilonga igxininiswe ngeperilization gauze pad for 1-2 imizuzu.

Ukuba unamathela ngokuthe ngqo kwaye ulandele imigaqo yokwenza i-vagosympathetic block blockkade, isisombululo se-anesthetic silungiselela intsholongwane yesisu kunye nezinye izibilini ezishiya kwiingcingo zomlomo wesibeleko.

Iimpawu emva kwenkqubo

Ngokuphumelelayo eyenziwe ukukhusela i-vagosympathetic kwisigulane kubangele iimpawu ezilandelayo:

• I-Ptosis (umgca wekhosidi ephezulu).
• I-Myos (ukunciphisa umfundi).
• U-Enophthalmus (ukudibanisa kwamehlo angaphakathi ngaphakathi, i-Triad Horner).
• Ubomvu buso kunye neembumba ezinamaqabunga kwamehlo.
• Inject injini yePericorneal.
• Ukunciphisa ukujuluka ukusuka kwicala lokukhusela.

Ingqungquthela ye-vagosympathetic ye-septal ngokwemigangatho ye-Vishnevsky ixinzezela ubuhlungu, ukuxilongoza kokukhwehlela, ukunyusa i-circulatory system kunye nokwandisa uxinzelelo lwegazi.

Ukukhusela i-Blockade ayinakwenziwa kumacala omabini ngamanye. Ikhefu phakathi kweenkqubo kufuneka libe nemizuzu engama-30-40. I-Adrenaline ayifanele ifakwe kwisisombululo se-anesthetic ngexesha le nkqubo.

Ziziphi izizathu zolu thintelo? Inyaniso yokuba ungaphumelela ukufezeka ukukhubazeka ngenxa yokuphefumula.

Iingxaki

Emva kwenkqubo, iingxaki zinokuvela:

• Ukuphazamiseka komzobo we-carotid ngexesha lokubhoboza.
• Ukuphululwa kwe-vein jugular vein.
• Ukuphazamiseka kwesifo.

Ubunokwenzeka bokuphuhliswa kwe-atony kunye neparresis yamathumbu (ezinjalo iingxaki azidingi unyango olukhethekileyo).

Konke oku kunokubangela ukuba i-vagosympathetic ivaliwe yintsholongwane ngokutsho kweVishnevsky. Sihlolisise ubungqina kuyo.

Ngenye indlela

Olunye ulungelelaniso kwiminyamo yentamo ludinga ukufikelela, oko kukuthi, ukutshatyalaliswa kohlu ngalunye lolusu. Ukuphumeza ukufikelela entanyeni, kuyimfuneko ukugcina ucoceko, kuba liyingxenye evulekileyo yomzimba. Ngenxa yalokhu, intamo iyafikelela kwi-Kocher, isebenza ngaphaya kweentlobo zesikhumba. I-Sutures emva kokuhlinzwa kulo mzekelo kaninzi ayibonakali. Xa usenza utyando kwiindawo zentamo kunye neendawo ezide, ukusetyenziswa kwexesha elide kusetyenziswa rhoqo kunye nomda wangaphantsi okanye ongaphantsi kwe-sternocleidomastoid muscle. Ebonakalayo ngokukodwa yi-sutures emva koxinzelelo lwexesha elide. I-Vagosimpathetic blockade (ubuchule buqhelekileyo) kuya kunceda ukuphepha lo msebenzi.

Ngempilo yakho, akufanele uhlekise, kufuneka ulandele iindlela zokukhusela kwaye ungalindeli. Emva koko izingozi ezingafaniyo zingagwenywa.