Rehunga Endotracheal: he aha te mea te reira, tohu, taero

I teie mahana, he mea kahore ohorere i roto i tenei tikanga maimoatanga he pokanga. A i muri i te rau tau i ma'iri a'e nei i rite ki te mate te mahi, ka mate te nuinga o tūroro i te ru fakamamahi sepsis ranei. Hoki te wa roa i te tangata whakahaere i te moe hāparapara noho te mahi nānā o rongoā. Ki te ako o te tukanga matū kua kua tere. Pai whakahāngaitia ranunga me taka mo rehunga, e, ano, kei te kawea inaianei i roto i roto i ngā huarahi maha. Ko tētahi o ratou ko te rehunga endotracheal. He aha te mea te reira? Pehea te whakamahia i te reira me ka te hiahiatia ai? Enei a he tokomaha atu pātai ki te whakahoki kupu i roto i tenei tuhinga.

Mai i te hītori o te endotracheal rehunga

Hoki te wā tuatahi tamata tenei momo o te rehunga te i roto i te rau tau XIV-XV, ka whakaurua te tākuta Paracelsus Swiss ki te tangata pukorokoro ngongo atu ora i tona ora. I muri e toru tenetere i roto i tenei ara te iwi i whakaorangia i te kore o te rangi. I roto i te 1942, he anesthesiologist i Canada whakamahia tuatahi relaxants uaua - he taonga e whakaiti oro uaua kōhiwi ki runga ki te whakaoti i immobilization. Ngā mihi ki tenei kitea o te rehunga hei kua haumaru me te ake tino, tuku ngaio mana tonu ki runga i te moe hāparapara i roto i te pokanga.

kua i roto i te waenganui o te XX rau endotracheal rehunga kua whakawhanake tere, tauturuhia e te tākuta Soviet. I teie mahana ko reira te tikanga nui rawa mō o rehunga whānui, whakamahia i roto i te akoranga o te nuinga o nga ngā mahi.

rehunga Endotracheal: he aha te mea te reira?

I roto i te tikanga ki te tiaki i te tinana i te ahotea nui o pokanga, whakamahia rehunga te. Ka taea e te reira rohe, rohe whānui ranei. huaina te momo muri te rehunga. Kei te āhuatanga i te reira e te tonu "atu" mahara o te manawanui ki te tīmatanga o te moe hāparapara. I roto i te rehunga hou whakahaerea nei e pâmuhia, te kanohi rehunga ngā ranei. fakatahai whakamutunga nga tikanga e rua me te tomo matū te bloodstream, me te wahi romahā. Tenei momo o te karanga me te rehunga endotracheal.

e whakaaro tohunga tika ia rite te tikanga tino haumaru, me te whai hua o te mamae te tauturu: taea reira ki a koutou tino whakahaere te huru o te manawanui, ki te whakatutuki i hāparapara moe hohonu, me kōhiwi whakangā uaua, me te ki te karo taua pōauautanga kino pērā i wawata me te kore romahā.

iteraa papû

rehunga Endotracheal ārai te manawanui i te mamae ru, me te kore romahā, taea te whakamahi i te reira i roto i ngā mahi, me te tiaki kaha. I roto i te tohu mō te rehunga taea te ngā:

• ngā mahi i runga i mediastinum, pharynx, te taringa roto, te mangai me te upoko;
• wawaotanga, i roto i nei te hiahia ki te whakamahi i relaxants uaua;
• arā i roto i te pūnaha io;
• syndrome puku tonu;
• te mōrea o te airway tukuna ai.

Kei te maha whakamahia rehunga whānui Endotracheal mō ngā mahi wā roa-ki te paari o neke atu i te 30 meneti. Ka taea te whakamahi i te reira i tetahi tau i roto i āhua rerekē o te manawanui, t. Ki. e kore e te uta ia te ngakau, me te tahi atu, ko te nui tikanga iti paitini o te rehunga.

contraindications

pokanga fili (hei tauira, mahi tango pukupuku mediastinal) aru e ako tupato o huru o te manawanui. Ko te tākuta kua te wa e tika ana ki te arotake i te hītori hauora, whakahaere ki te tātai i te tūponotanga ka taea, me te ki te tāutu i contraindications ki te tikanga ngā o te rehunga. e kore te rehunga ngā tūtohutia hoki nga tikanga e whai ake nei:

• mate hopuhopu;
• mate ate, tākihi;
• whakapae infarction myocardial;
• mate Airways;
• āhuatanga whaiaroaro o te hanganga o te pharynx;
• disorders endocrine nui.

Ngā kino ki te whakamahi i rehunga endotracheal ki runga mate wahi romahā, t. K. He mōrearea tiketike o te pūkahukahu mate.

Wāhanga rehunga ngā

rehunga Na, endotracheal. He aha te mea mo te taote? Anesthesiologist mahi e toru ngā wāhanga ngā o mahi: te whakataki o te moe hāparapara, te pupuri i te āhua pūmau me te oho. Ko te wāhanga tuatahi ko te ki te whakatinana i te arataki ngāwari o te rehunga. Ko te manawanui e pâmuhia e tango taero ranunga hau hau ranei. A, no te e tino māhorahora nga uaua, e te kairehu ki tracheal lumen endotracheal ngongo. E whakarato ana ventilation pūkaha me te inhalation o te hāora ki anesthetics haurehu waihā.

Kia kua oti tākuta ratou mahi, i reira haere mai he momeniti mahu'inga mo te anesthesiologist - putanga o manawanui rehunga. iti te inenga o taero te āta. I muri i te faaho'iraa mai o te manawa noa extubated - tango o te ngongo endotracheal i roto i te pukorokoro. kawea te manawanui e ki te ICU, e matakitaki ana tohu faufaa me tukanga whakaora postoperative.

arataki o te rehunga

hiahiatia Easy rehunga tuatahi te mo te intubation ongonoa, me te haumaru, i te mea e taea waho te whakatinanatanga o te endotracheal rehunga. Hei whakatutuki i te āhua taua o te whakamahi o te inhalation anesthetics rō-uaua ranei. I roto i te take tuatahi, hopoi te manawanui i roto i te takirua kanohi "Etra", "foran", "halothane" ranei te tahi atu ranunga rite o anesthetics. I te tahi taime ko reira nui waikura Sinks me te hāora.

Ka rite ki medicaments whakahaerea e pâmuhia, whakamahia noa barbiturates me neuroleptics (droperidol, fentanyl). E whakamahia ratou rite te otinga (mōrahi 1%). Horopeta anesthesiologist tīpakohia takitahi hoki ia manawanui.

I muri i mahi rehunga marama ki te mahi i tracheal intubation. Ki te mahi i tenei, ki te whakamahi o relaxants uaua akaanga te uaua kaki. whakaurua te ngongo e tikanga o te laryngoscope, i muri i nei whakawhitia te manawanui e ki te ventilation pūkahukahu tāwhaiwhai. tīmata Wāhanga rehunga hohonu.

Droperidol: ako

Droperidol - ähotea, Kei te maha whakamahia i roto i te rehunga endotracheal. Ko te hanganga matū te taonga ko te Amen tuatoru. Kua kua 3 meneti i muri i whakahaere te pānga whakarokiroki. Ārai receptors dopamine, meinga braking neurovegetative. I tua atu, hypothermic me roaa pānga antiemetic. pānga manawa paku.

Tohua hoki premedication, arataki o rehunga, infarction myocardial, ru, angina nui, edema pūkahukahu, me te raruraru hypertensive. E tūtohu rite te tarukino, faaore whakapairuaki me te ruaki. He tāoke iti, e taea te whakamahi i te reira i roto i te pokanga pediatric me obstetrics.

Technique o te whakamahi o antipsychotics i roto i arataki o te rehunga

He maha ngā taatou o te neyroleptanalgezii. Arataki te nuinga o kawea i roto i te kaupapa e whai ake nei: droperidol, kua nei aratohu kua whakaaro i runga, i roto i te nui o 2-5 ml ki 6-14 ml o fentanyl whakahaere ki te manawanui e pâmuhia. Wä huna kanohi whangai ki te ranunga o te waikura Sinks me te hāora i roto i te ōwehenga o 2: 1 3 ranei: 1. I muri i pehanga o te mahara, me te uaua relaxants e whakahaere ki te puta intubation.

Droperidol he pānga neuroleptic mō te 4-5 haora, Heoi, kua whakahaerea ai i te timatanga o te supply rehunga. Kei te tatau tango te reira i ki pūkete taimaha tinana: 0.25-0.5 mg / kg. whakahaere toutou o te tarukino Me anake i roto i ngā mahi roa.

Ko Fentanyl i te nui o 0.1 mg whakahaeretia nga 20 meneti, me te mutu ona supply mō te 30-40 meneti i mua i te mutunga o te pokanga. horopeta tuatahi ko 5-7 mg / kg.

intubation

I muri i pehanga o te mahara kawea ventilation tāwhaiwhai ki te hāora te whakamahi i te kanohi whakarehu. I muri i taua, mahi te tākuta intubation roto i te mangai (i ētahi wā i roto i te ihu). Whiua hoki tona matenga, tuwhera tona mangai. mata Direct patia laryngoscope me te kātahi i waenganui i te rangi, me te arero, te pēhi i te whakarunga whakamutunga. Te whakatairanga i taputapu ara atu te matamata o te ngao horomi. Whakaatu glottis, ki nei te ngongo endotracheal. kia haere te reira i ki te pukorokoro e pā ana ki 2-3 cm. I muri angitu whakatika intubation ngongo, me te hono i te manawanui ki te ventilator.

Iti nuitia whakamahia laryngoscope ki te mata kōpiko. Kei te whakaurua te reira i waenganui i te turanga o te ngao horomi me te pakiaka o te arero, otdavlivaya muri ake ahau. Ki te he reira whakaurunga e taea o te ngongo i roto i te mangai te whakamahi i te meatus raro nasal. Hei tauira, ki te mahi tango i te cysts kōhao-waha.

Maintenance me te whakaora i te rehunga

I muri i intubation me te hono i te manawanui ki te ventilator puta i roto i te tuatahi. Tino mahi rite te taote, tata aroturuki te anesthesiologist tohu oranga. Katoa 15 meneti, tirohia te auau ngakau, pēhanga toto, ki te awhina o te aroturuki i mau mahi cardiac o te manawanui.

tonu rehunga General e pota atu o taero ähotea, relaxants uaua, ranei anesthetics ranunga inhalation. Operation i raro i rehunga momo ngā taea te anesthesiologist ki te whakarite ki nga hiahia o te tinana i roto i te whakahaere mamae na roto i te whakarato i te taumata tino arotau o te haumarutanga.

I muri i te mutunga o ngā tukanga hāparapara te atamira whakamutunga - i roto i o te moe whakapōauau. Tae noa taua wa te āta whakaiti i te inenga o te raau taero. Hei whakahoki te kupukupu atropine me Neostigmine i wā o te 5 meneti. Te hanga tino e taea ki te manawa i runga i to ratou ake, extubated te manawanui ko te. Ki te mahi i tenei, te horoi i te rohe o te rakau tracheobronchial. I muri i tango o te ngongo, me te tukanga rite whakamana te ki te kōhao-waha.

titiro postoperative

I muri ka mahue i te ruma whakahaere, tūnga te manawanui kei roto i te kōwae tiaki kaha, te wahi ki te āta aroturuki i tona huru. I muri i rehunga whānui whakawhanake hūhi, iti pōauautanga. Ko te tikanga, amuamu o tūroro pou-operative:

• mamae;
• hūhi i korokoro te;
• whakapairuaki;
• ngoikore, me te uaua rohirohi;
• te momoe;
• whakama;
• Chills;
• matewai me te kore o te hiahia.

Ēnei tohumate te tikanga ngaro i roto i nga haora tuatahi 2-48 i muri i te pokanga. Hei whakakore i te Pë mamae whakaritea.

Na, kia whakarāpopoto a. rehunga Endotracheal - he aha te mea te reira? Tenei tikanga o te whakauru i te tangata ki te moe hāparapara, taea ki a koe te mahi ngā mahi matatini, te aroturuki i te mahi o te pūnaha romahā. Ko iti paitini, me ngāwari rehunga ngā ki te whakahaere i te hohonu o te rehunga i roto i te wā wawaotanga. I raro i matua auraa rehunga endotracheal intubation, aru e tūhono i te manawanui ki te ventilator. A, no te whakamahia tenei te rite hau me te rongoā rongoā, e e te nuinga ngā.