Yintoni uvavanyo lukaRuwilua-Gregoire?

Ehlabathini kukho isibalo esikhulu sezifo, abantu abaninzi abaye bakrokre. Kodwa kukho iimeko xa ufuna nje ukwazi ngeempawu zeemeko ezinzima zomntu, ukuze ukwazi ukunika uncedo lokuqala uncedo. Kodwa akusoloko isifo okanye ukukhubazeka okunzulu kunokumiselwa ngokubonakalayo, kule meko, iindlela zokuxilonga ziza kunceda , umzekelo, njengolu vavanyo lwe-Ruwila-Gregoire. Kodwa yintoni inqaku kulolu vavanyo lunokumiselwa kwaye luhlobo luni lokuhlalutya oku?

Ruvlua-Gregoire: yintoni na?

Olu vavanyo lulunye lweendlela zokuxilonga ezikuvumela ukuba uncede ngokukhawuleza ukuba kukho ukuphuma kwegazi okanye kungekhona nge-hemothorax. Uvavanyo oluhle lukaRuvila-Gregoire luthi ukuphuma kwamanzi ngaphakathi kwe-pleura kuyaqhubeka, kwaye ukungatshatyalali kungqina ukuba ukuyeka kwayo, okanye kunjalo, kodwa kungenjalo.

Kodwa yintoni i-hemothorax, indlela yokuyiphatha ngayo, yintoni imiphumo xa kungenakwenzeka kwisimo sengculazi?

Hemotorax: yintoni na?

I-Hemotorax yigazi eyenzeka ngaphakathi kwesikhalazo kwaye ibangela ukuqokelela kwegazi elikhulu kulo, ekugqibeleni lihamba kunye nokucima imiphunga. Uvavanyo lweRuvelua-Gregoire luvumela ixesha elifutshane kunokwenzeka ukuba kutholakale ukuvela kwegazi kunye nokuqina kwayo. Ukongeza kwi-diagnostic, unokukwazi ukulahlekelwa igazi ngenxa yeempawu:

• I intlungu zesifuba;
• Uxinzelelo oluphantsi;
• Utywala;
• Isikhumba kunye nabanye.

Ukuba isigulane sinemibonakalo enjalo, kufuneka ihanjiswe ngokukhawuleza esibhedlele ukuze ihlolwe kwaye ithathe yonke imilinganiselo yokumisa ukuphuma kwamanzi. Kodwa yintoni enokukhupha i-hemothorax?

Izizathu zokugula

Ukuxilongwa kwe-hemothorax kunokuba kuyimfuneko kulabo gulane abaye bafumana ukulimala kwesifuba, bavuyiswa ngamathambo okanye iatrogenic ezibangela ukuphuma kwegazi.

Phantsi koxinzelelo, oogqirha babonisa umonakalo kwisifuba semvelo eyahlukileyo. I-Hemotorax ingahlakulela njengengozi yengozi, inxeba yokubhunqa, intambo ephukile, ukuwa ukusuka ekuphakameni okukhulu, kunye nezinye izizathu.

Ukulimala okunjalo kungonakalisa nje imiphunga, kodwa nakwezinye izitho:

• Intliziyo;
• Ibindi;
• Ipere;
• I sithwaba;
• Iinqanawa ze-Intercostal;
• Umthi weTrarac;
• Imiba.

I-Hemotorax inokubangela nokugula kwesigulane, njengale:

• Aneorysm yeAortic;
• Isifo sofuba;
• Ukwakhiwa kakubi emiphakeni okanye kubuhlungu;
• Ukungabikho komphunga;
• I-diathesis yeHemorrhagic;
• Coagulopathy nabanye.

Izinto ezibangelwa iatrogenic ezikhokelela kwi-hemothorax (ukucacisa ukuba khona kwayo kuya kunceda uvavanyo lweRuvula-Gregoire), iingxaki zivela emva kokuhlinzwa kwiphaphu okanye inyembezo, umsele we-pleura, ukufakwa kwe-catheter kwiimvini eziphakathi.

I-Pathogenesis ye-hemothorax

Ukuqokelela kwegazi kwi-pleura kunokubangela ukunyanzeliswa kwemiphunga kunye nokufuduka kwezitho zangaphakathi, kwaye oku kukhokelela ekubeni indawo yokuphefumula yomphunga iyancishiswa kakhulu, kukho izifo zokuphefumula kunye ne-hemodynamic. Ngenxa yeso sizathu, i-hemothorax ihlala iveza umfanekiso weklinikhi wokutyhafaza okukhulu kunye ne-cardiopulmonary, ekhokelela ekubeni intliziyo kunye nezitho zokuphefumula azisebenzi kakuhle.

Kwiiyure zokuqala emva kokungena kwegazi kwi-pleura, inkqubo yokuvuvukala ikhula kule ndlela yokugqibela. Nge-hemothorax, inokumiselwa ngolu vavanyo lwe-Ruvelua-Gregoire (ukuvuvukala, ukungena kwe-leukocyte, ukuvuvukala kunye nokuhlutha kwamaseli e-mesothelium). Ekuqaleni, igazi eliye langena kwindawo ye-pleura ngokuphuma kwegazi alifani negazi le-peripheral, kwaye kamva emva kwinqanaba le-hemoglobin, isalathrocyte kunye ne-leukocyte yehla.

Ukuba ungena kwi-pleura, igazi liyacima, kodwa emva kwexesha elifutshane inkqubo ye-fibrinolysis iqala, ngenxa yokuba iyayiphinda kwakhona. Le nkqubo ikhuthazwa yizinto ze-anticoagulant. Kukho iindidi ezininzi ze-hemothorax. Ziziphi iintlukwano zabo?

Iiklasi ze-hemothorax

Sithe satsho ukuba i-hemothorax ingaba yingozi, i-pathological and iatrogenic. Ukongezelela, kunikwa amandla okuphuma, ikwahlukana ngamaqela amaninzi:

• Amancinci - ukuqoqwa kwegazi kwenzeka kwi-sinus, kwaye umthamo wokulahleka kwegazi awukho ngaphezu kwe-500 ml;
• Umyinge - igazi sele liye lahla ukuya kumanqanaba amane, kwaye ivolumu yayo i malunga neekitha ezili-alitha;
• I-Subtotal - igazi lehla kumgangatho ophantsi weembambo ezi-2, kunye nokulahleka kwegazi malunga neekitha ezimbini;
• Iyonke - kwi-X-ray, ukuphuma komda ukusuka kwicala le-lesion lesion kuphawulekayo, kwaye ukulahleka kwegazi kungaphezulu kwemoya yeelitha.

Ukongeza, i-hemothorax, enqunywe yi-Ruvelois-Gregoire uvavanyo kunye nezinye iindlela zokuxilonga, zinokuthi zibe yi-apical, i-inter-partisan, i-paracostal, i-over-diaphragmatic, i-paramediastinal, konke kuxhomekeke kwisiza sendawo. Kwakhona, ukuba ukuphuma kwegazi kuqhubeka, i-hemothorax ibizwa ngokuba yanda, kwaye xa ithe yaphela - inzile. Ukuba i-pleura ayifumaneli kuphela igazi, kodwa kunye nomoya, kule ngxaki sithetha nge-hemopneumovorax. Kodwa ziphi iimpawu ezingabhekisela kwi-hemothorax?

Iimpawu ze-hemothorax

Umfanekiso wekliniki uxhomekeke ngokuthe ngqo kwi-intensity yokuphuma kwegazi, ukucima izicubu zamaphaphu kunye nokufuduka kwamalungu. I-hemothorax encinci ayinakuhambelana neempawu, ngokukodwa isigulane sikhalazela intlungu yesifuba, esinokudakalisa ngexesha lokukhwehlela, kwaye sinokubonakala kufutshane.

Kodwa iiklasi eziphakathi kunye nezikhulu, ezinokuqinisekiswa ngoncedo lwe-Ruvelois-Gregoire, zihamba kunye nezifo zokuphefumula, izifo zentliziyo kunye nabanye. Ukungaqapheli imiqondiso kwinqanaba elinjengeli nqanaba liphela, emva kwayo yonke into inokuba nentlungu enamandla ephakamisa i-tussis, i-delicacy kuwo wonke umzimba, ingcinezelo yomsinga iyancipha. Ngomsebenzi omncinci, yonke impawu iba yimbi. Isigulana sikhetha indawo ekhululekile - ukuhlala okanye ukuhlala kwesiqingatha.

Kodwa nge-hemothorax enamandla, kukho ubuthathaka, obungavumeli nokuba buvuke, ikhanda lijika, i-tachycardia ikhula, isikhumba siphendukile, izimpukane zihamba phambi kwamehlo akho, zihlala ziphelile. Kodwa akusoloko impawu zikhokelela ngokuchanekileyo kwi-hemothorax, ngoko kukulungele ukuqhagamshelana nogqirha oya kuthi afundise inani leenfundo, kuquka uvavanyo lweRuwluois-Gregoire. Nge-hemothorax - le ndlela iyona ndlela ihamba phambili, leyo ngexesha elifutshane kuya kunceda ukubonisa ubukho okanye ukungabikho kwegazi.

Diagnostics

Ngethuba lokuxilongwa ngokuchanekileyo, ugqirha uchaza zonke iinkcukacha zesifo, kwaye ukhetha iindlela zenyama kunye nezinye iindlela zokubhalela iimviwo, kubandakanywa nebhubhoratri. Nge-hemothorax, kufuneka uqaphele ngokukhawuleza ukuba kukho i-lag kwicala elichaphazelekayo ngexesha lokunyuka kokuphefumula, ingaba isandi sokuxubusha sixiliswe phezu kwendawo apho umbane uqokelele khona, nokuba ukuphefumula kubuthathaka okanye xa kukho ukuthuthumela kwezwi.

I-X-ray yemiphunga ibonisa ukuphazamiseka kwemiphunga , ubukho be-fluid (isigulane kwisithuba esinqambileyo ngexesha lokufunda), okanye i-clots in pleura. Ngenjongo yokuxilongwa nokucaciswa kokuxilongwa, ukunyanzeliswa kwesigxina kunye ne-hemothorax kunokumiselwa, kule meko ukufumana igazi kuqinisekisa ukuxilongwa. Ukufumanisa i-hemothorax oyinyumba kunye ne-HIV, ii-sampuli ze-Petrov ne-Efendiyev zenziwe, ezivumela ukuvavanya ukungabonakali kunye neendwangu ze-aspirate.

Uvavanyo lwegazi lwebhubhoratri luya kugqiba inani lama-leukocyte kunye neeseli ezibomvu zegazi. Ezinye iinkqubo zokuxilonga, ezifana ne-ultrasound, i-X-ray, i-chest CT, i-thoracoscopy yokuxilonga, inokwenziwa kwakhona.

Yintoni evumela ukucacisa isampuli?

Ukuqinisekisa ukuba ukuphuma kwegazi kuqhubekile okanye ukuba sele kumisiwe, kuyimfuneko nje ukuqhuba isifundo esinjalo njengolu vavanyo lwe-Ruwilua-Gregoire. Indlela yokuxilonga yolu hlobo ibandakanya ukuthatha igazi kwi-pleura, kwaye ukhangele. Ukuba iphosa kwi-tube ye-test okanye i-syringe, ithetha ukuba ukuphuma kwegazi kuqhubeka, kwaye ukuba akukho nto i-coagulation, akukho. Iisampula ezongezelelweyo zithunyelwa kwibhubhoratri ukwenzela uphando olongezelelweyo, kwaye inani le-hemoglobin sele lichongiwe kubo.

Uvavanyo oluhle lweRuvelua-Gregoire luphawu lwe-thoracotomy engxamisekileyo, eya kunceda ukuyeka ukuphuma kwegazi. Le ndlela yokuxilonga ikwazisa, kodwa kungcono ukwenza iimvavanyo ezongezelelweyo ngaphezu kokuba yi-100% eqinisekisiweyo yokuxilongwa. Kodwa njani ukwenza isampuli ngokuchanekileyo?

Indlela yokuthabatha i-hemothorax

Ukuqhuba uvavanyo kufuneka kuphela ugqirha ofanelekileyo, ngenxa yokuba olu phofu luyinkimbinkimbi kakhulu, kwaye ukuba uthabatha isampuli yegazi ngokungalungile, unokuyonakalisa isigulane. Ukugqithisa nge-hemothorax yindlela ekhethekileyo yokuxilonga eyenziwa phakathi kwee-6 kunye ne-7 iimbambo eziphakathi kwemigca ye-middle-back and axillary. Ngeli xesha umguli kufuneka abe kwindawo ehleli. Igazi lithunyelwa kwisifundo, isisombululo sesicatshulwa se-antibacterial isjected.

Izindlela zokononophelo zonyango

Unyango olulondolozo lwentliziyo lunceda ukuba i-hemothorax epholileyo, kule ngxaki, isebenzisa i-analgesics kunye ne-haemostatic drugs. Kwakhona, umphumo omhle unikezwa ngonyango endaweni yokumpontshelwa kwegazi ngokukhawuleza ukuba i-hemothorax ingowomgangatho ophakathi okanye obunzima. Ukunyangwa kosulelo lwe-HT, ii-agrinolytic agents zilawulwa, ziyakunikwa kwakhona ukuthintela kunye nokunyangwa kwe-hemothorax, kunye nokunyanga okungaxilwanga kunye nokunyangwa kwamachiza kunokusetyenziswa.

I-hemothorax encinci ngokukhawuleza kwaye ngaphandle kwemiphumo inokupheliswa yindlela yokwenza unyango. Kodwa kwimeko apho uvavanyo oluhle lweRuvelois-Gregoire luchazwe ngexesha loviwo lwe sibini, ngoko akukho ndlela yokuyenza ngaphandle kokungenelela ngophengululo.

Unyango lwe-hemothorax unyango

Ukusebenza kuboniswa isigulane kwiimeko ezinjalo:

• Ukuba ukuphuma kwegazi kuqhubeka ngaphakathi kwesikhalazo;
• I-Hemothorax idibene kwaye ikhusela ukusasazeka kwemphunga;
• Ukuba kukho ukuqokelela okuphindaphindiweyo kwegazi emva kokuba uthathe i-puncture;
• Kukho ukukhutshwa kwegazi nge-draural drainage, kwaye umthamo wayo u malunga ne-500 ml ngeeyure eziyi-2-3;
• Izitho ezibalulekileyo.

Ukunyangwa kwe-hemothorax kusekelwe kwiimpawu ze-etiological factor, ubukhulu bokuphuma kwegazi kunye nobunzima bokutshatyalaliswa kwamanzi. Ukuvula izilonda ezingenele zomphunga kunye nezinye izitho zesifuba zidinga ukungenelela ngokukhawuleza ngokukhawuleza malunga nesifo soxinzelelo oluchasileyo, esilubandakanya nje kuphela i-analgesia yokwelapha, kodwa kunye nomzabalazo kunye ne-acute ifom ye-anemia kunye ne-hypoxia.

Ukusebenza kuyimfuneko kwiinjongo ezinjalo:

• Yeka ukuphuma kwegazi;
• Ukuphelisa umonakalo kwizitho zangaphakathi;
• Susa igazi elingaphezulu;
• Ukufakela umjelo wokunyuselwa kwephunga ngokukhawuleza;
• Ukucocwa kwengcango yesigxina kunye ne-antiseptics.

Kodwa iziphi izibikezelo oogqirha abanika ngazo kwizigulane ezithotywayo?

Ukuxela kunye nokukhuselwa kwe-hemothorax

Impumelelo yonyango nge-hemothorax incike kwiimeko zentlungu okanye ukukhubazeka, ukunyameka kwegazi kunye nokunyangwa kwexesha elifanelekileyo. Isilumkiso sithandeka kwizigulane ezine-hemothorax ezinobumnene okanye ezilinganayo. I-hemothorax ephikisiwe ingasongela ukuphuhliswa kwengxolo, kodwa ukulahla okuqhubekayo okanye ukulahleka kwegazi elilodwa kunokubangela ukufa.

Isiphumo se-hemothorax sinokubunjwa kwamalungu amakhulu amakhulu, okukhokelela ekuthinteleni ukuhamba kwesithintelo. Kule meko, kucetyiswa ukuba zonke izigulane eziye zafumana imeko enjalo, zibandakanya ukubhukuda kwaye zenza rhoqo i-gymnastics yokuphefumula.

Ukukhusela i-hemothorax inikezela ukuthintela ukulimala kwesifuba, ukubonisana nogqirha kwizigulana ezineengxaki zengqondo, ukulawula i-hemostasis kunye nokuhlinzwa kwiimiphunga kunye ne-mediastinum.

Isiphelo

Ukufingqa, ndifuna ukuthetha ukuba uvavanyo lukaRuvelua-Gregoire luyinto yezona zibalulekileyo ezibalulekileyo kwi-hemothorax. Ukuhlanjululwa kwingingqi yesigxina yimeko enzima kakhulu efuna unyango oluphuthumayo ugqirha. Yingakho xa iimpawu zokuqala okanye ngokukhawuleza emva kokulimala kukulungele ukufumana uncedo olufanelekileyo, ngaphandle kokungenzi nto kungaholela kwisiphumo esibulalayo.