Kodi munapitapo kwa munthu amene ali mu chipinda chosamalira odwala kwambiri (ICU)? Kapena munayamba mwaona dokotala akukufotokozerani za njira yopumira pamene mukukonzekera opaleshoni? Chimodzi mwa zinthu zomwe mumamva nthawi ngati zimenezi ndi chakuti akuikamo "chubu chopumira." Choncho, monga momwe akuikiramo chubuchi, kuchotsamo ndi njira yofunika kwambiri komanso yokonzedwa. Mu zamankhwala, kuchotsa chubuchi ndi chomwe timachitcha "extubation." Lero, tiyeni tikambirane za izi mosavuta, m'njira yomwe mungamvetse.
Choyamba, tiyeni tiwone kuti intubation ndi chiyani?
Tisanalankhule za extubation, tiyeni tikambirane mwachidule za intubation. Mwachidule, ichi ndi chinthu chomwe gulu lachipatala limachita kuti lipulumutse moyo wanu pamene mukuvutika kupuma nokha pazifukwa zina. Amaika chubu chapulasitiki chosinthasintha, chotchedwa endotracheal tube (ETT) , kudzera pakamwa panu kupita ku mphuno yanu (njira yayikulu yolowera mpweya).
Taganizirani izi motere: mapapo athu ali ngati injini ya galimoto. Amafunikira mpweya wokhazikika (oxygen) kuti agwire ntchito. Monga momwe galimoto singasunthire ngati pali kudzaza kwa magalimoto, ngati mpweya wanu watsekedwa kapena kupuma kwanu kuli kofooka, mpweya sudzafika m'mapapo mwanu. Pamenepo, chubu ichi chimayikidwa, ndipo makina, chopumira mpweya, chimalumikizidwa nacho, ndipo mumapatsidwa mpweya wochuluka womwe mukufuna. Izi zimatchedwa intubation.
Tsopano mwina mwamvetsa tanthauzo la extubation . Izi zikutanthauza kuti, njira yochotsera mosamala chubu chomwe chinalipo pambuyo poti gulu lachipatala latsimikiza kuti mutha kupuma bwino nokha, popanda thandizo lililonse.
Kodi extubation imachitidwa nthawi ziti?
Izi sizichitika kwa aliyense nthawi imodzi kapena m'njira imodzi. Zimatengera chifukwa chomwe mudayikidwa pa chubu komanso momwe thanzi lanu lilili lokhazikika.
Pambuyo pa opaleshoni
Mukachitidwa opaleshoni yaikulu, mumagona tulo tofa nato. Timatcha kuti mankhwala oletsa ululu . Mankhwala oletsa ululu awa amalepheretsa kwakanthawi minofu yomwe imalamulira kupuma kwanu. Panthawiyo, madokotala amaika chubu chopumira ichi kuti atsimikizire kuti mwalandira mpweya wokwanira panthawi yonse ya opaleshoniyo.
Pambuyo poti opaleshoni yatha bwino, gulu lachipatala lidzachotsa chubucho nthawi yomweyo zotsatira za mankhwala oletsa ululu zikatha ndipo mutha kupuma nokha. Nthawi zambiri, chubucho chidzakhala chitachotsedwa pofika nthawi yomwe mudzachira. Chifukwa chake simungachikumbukire. Pankhaniyi, chubucho chingakhale chitakhazikika kwa ola limodzi kapena awiri.
Chifukwa cha matenda kapena ngozi
Munthu akamayikidwa m'chubu chifukwa choti sangathe kupuma chifukwa cha ngozi, matenda oopsa (monga chibayo), kapena matenda ena oopsa, njira yochotsera chubucho imakhala yosiyana pang'ono. Munthu ameneyu nthawi zambiri amakhala m'chipinda chosamalira odwala kwambiri (ICU).
Musanachotse chubucho, madokotala ayenera kuonetsetsa kuti mwatha kupuma nokha. Adzachita mayeso apadera a izi. Amatchedwa Spontaneous Breathing Test (SBT) .
Mwachidule, izi zili ngati maphunziro pang'ono. Dokotala pang'onopang'ono adzachepetsa thandizo la chopumira ndikukuyesani kwa mphindi zochepa kuti aone momwe mungapumire bwino nokha. Kuchuluka kwa mpweya wanu, kugunda kwa mtima, ndi kuthamanga kwa mpweya kudzayang'aniridwa mosamala panthawiyi. Pokhapokha ngati mutapambana mayesowa, dokotalayo adzasankha kuchotsa chubucho.
Nthawi zina simungapambane mayesowa koyamba. Izi zimatchedwa "kulephera kuyamwa." Izi ndi zachilendo. Ngati izi zitachitika, dokotala adzadikira mpaka mutachira pang'ono kenako adzayesanso patatha tsiku limodzi kapena awiri.
Kodi zifukwa zazikulu zoperekera machubu m'mimba ndi ziti?
Kuti tichite extubation, intubation iyenera kuchitika kaye. Nazi zifukwa zina zomwe zimachitikira izi. Tiyeni tiyike izi patebulo ngati ili kuti timvetse bwino.
| Chifukwa Chopangira Intubation | Mwachidule... |
|---|---|
| Kutsekeka kwa Njira Yopumira | Kutsekeka kwathunthu kwa njira yopumira chifukwa cha chifukwa monga chakudya chomwe chimatsekeka mkamwa kapena vuto lalikulu la ziwengo. |
| Kumangidwa kwa Mtima | Chifukwa mtima ukaima mwadzidzidzi, ndikofunikira kupereka mpweya ku ubongo ndi thupi. |
| Kuvulala Kwambiri | Kuwonongeka kwa mpweya wopuma kapena kulephera kupuma chifukwa cha kuvulala kwakukulu pakhosi, pachifuwa, kapena pamimba. |
| Kutaya Chikumbumtima | Ngati munthu wakomoka kwambiri, lilime liyenera kubwezeretsedwa m'mbuyo kuti mpweya usamatsekeke komanso kuti mpweya usamapume bwino. |
| Opaleshoni | Kukhala ndi ulamuliro wonse pa kupuma pamene mukupumira mankhwala oletsa kupweteka. |
| Kulephera Kupuma | Chifukwa cha matenda oopsa monga chibayo, mapapo sangathe kupeza mpweya wokwanira womwe thupi limafunikira paokha. |
| Kuopsa kwa Kupuma Movutikira | Kuletsa zinthu m'mimba (chakudya, kusanza, magazi) za munthu wosadziwa kanthu kuti zisalowe m'mapapo. |
Kodi njira zotani zomwe zimakhudzidwa ndi njira yochotsera mabakiteriya m'thupi?
Chabwino, tsopano tiyeni tiwone momwe dokotala kapena namwino wophunzitsidwa angachotsere chubu ichi. Ichi si chinthu chomwe chingatulutsidwe nthawi imodzi. Pali masitepe angapo kuti chichitike.
1. Kukonzekeretsa wodwala: Choyamba, mutu wa bedi udzakwezedwa mmwamba. Mudzabweretsedwa pamalo okhala. Izi zithandiza mpweya kulowa m'mapapo ndikuchepetsa chiopsezo cha zinthu monga malovu kulowa m'mapapo chubu chikachotsedwa.
2. Kuchotsa Mafinya: Kenako, chipangizo chapadera (chipangizo chochotsera mafinya) chimagwiritsidwa ntchito kuchotsa mafinya onse, malovu, ndi zinthu zina zosafunikira mkamwa mwanu, pakhosi, ndi m'chubu chopumira. Izi ndizofunikira kwambiri, chifukwa apo ayi, zinthuzi zimatha kulowa m'mapapo mwanu chubucho chikachotsedwa.
3. Kutulutsa chubu: Lamba kapena tepi yomwe imagwirira chubu kumaso kwanu imachotsedwa mosamala.
4. Kulekanitsidwa ndi chopumira mpweya: Chubucho chimachotsedwa ku chopumira mpweya chomwe chalumikizidwa nacho.
5. Kuchotsa chubu: Tsopano ndiye gawo lofunika kwambiri. Dokotala akukuuzani kuti "pumirani mpweya wambiri ndikutsokomola."Mukatsokomola kapena kutulutsa mpweya, amakoka chubucho mwachangu komanso mosalala. Amachita izi mukatsokomola, zomwe zimatsegula mawu anu, zomwe zimathandiza kuti chubucho chituluke mosavuta. Ndipo chifuwacho chimachotsanso chilichonse chomwe chili pakhosi panu.
Kodi mumadziwa bwino pamene chubu chachotsedwa?
Funso limene anthu ambiri ali nalo ndi lakuti, nthawi zina inde, nthawi zina ayi.
- Pambuyo pa opaleshoni: Chubuchi nthawi zambiri chimachotsedwa musanabwererenso ku tulo, pamene mudakali pansi pa mankhwala oletsa ululu. Choncho chimachotsedwa mukadzuka.
- Ngati muli mu chipinda chosamalira odwala kwambiri (ICU): Chubucho chidzachotsedwa mukadali ndi chikumbumtima, chifukwa ndikofunikira kuti mukhale ndi chikumbumtima ndikumvetsera zomwe mukuuzidwa (monga chifuwa mukauzidwa kuti "chifuwa").
Kodi chimachitika ndi chiyani pambuyo pa extubation?
Kuchotsa chubu sikutanthauza kuti ntchito yatha. Maola angapo otsatira ndi ofunikira kwambiri. Gulu lachipatala lidzakuyang'anirani mosamala kwambiri.
- Mpweya: Nthawi zambiri, chubu chikachotsedwa, mumapatsidwa mpweya pang'ono kudzera mu kannula ya m'mphuno kapena chigoba cha mpweya kuti thupi lanu lizolowere mkhalidwe watsopano.
- Kuwunika: Kuchuluka kwa mpweya m'magazi mwanu (ndi chipangizo choyezera kugunda kwa mtima), kugunda kwa mtima, ndi kuthamanga kwa magazi zimawunikidwa nthawi zonse.
- Chifuwa: Mafinya amatha kusonkhana pakhosi panu chifukwa cha chubu. Chifukwa chake, mudzalangizidwa kuti mukhosomole pafupipafupi kuti muchotse. Ngati pakufunika, mungafunikenso kuyamwa kuti muchotse pakhosi panu.
Kodi pali zovuta zilizonse zomwe zingachitike panthawi yochotsa mimba?
Monga momwe zimakhalira ndi njira ina iliyonse yachipatala, pali zoopsa zina zazing'ono zomwe zimachitika pakuchotsa mabala. Koma kumbukirani kuti gulu lachipatala lili okonzeka kuchita zonsezi.
| Mavuto | Kodi chimachitika ndi chiyani ndi izi? |
|---|---|
| Kulephera kwa Extubation | Pambuyo poti chubucho chachotsedwa, wodwalayo sathanso kupuma yekha monga momwe amayembekezera. Ngati izi zitachitika, chubucho chiyenera kuyikidwanso kuti wodwalayo akhale otetezeka (re-intube).Izi zimachitika. Izi zitha kuchitika mwa anthu 10%-15%. Chiwopsezo chake ndi chachikulu pang'ono kwa anthu azaka zopitilira 65 komanso omwe ali ndi matenda a mtima kapena kupuma. |
| Kupuma mopanda phokoso (Stridor) | Chubuchi chingayambitse kutupa pang'ono m'njira yodutsa mpweya, makamaka mozungulira zingwe zolumikizira mawu. Izi zingayambitse phokoso lalikulu mukapuma chubuchi chitachotsedwa. Izi nthawi zambiri zimatha kuthetsedwa ndi mankhwala. |
| Kuwonongeka kwa zingwe za mawu | Kawirikawiri, kuwonongeka pang'ono kwa zingwe zoimbira mawu kumachitika poika kapena kuchotsa chubu. Izi zingayambitse kusintha kwa mawu (mawu omveka) kwa kanthawi kochepa. |
| Kutsokomola kwambiri ndi kutsekeka kwa mpweya (laryngospasm) | Anthu ena angakumane ndi kulimba kwadzidzidzi kwa zingwe zolumikizira mawu chifukwa cha kumva pakhosi pamene chubu chachotsedwa. Izi zidzabwerera mwakale mkati mwa masekondi ochepa. |
Kodi ubwino wa extubation ndi wotani?
Ichi ndi chinthu chabwino kwambiri. Kutulutsa munthu m'thupi kumatanthauza kuti wadutsa gawo lofunika kwambiri paulendo wake wochira.
- Chizindikiro cha kuchira: Phindu lalikulu ndilakuti mutha kupuma nokha. Izi zikutanthauza kuti mapapo ndi thupi lanu zikubwerera m'malo abwino.
- Kutha kulankhula: Simungathe kulankhula pamene chubu chilipo. Mukachichotsa, mudzatha kulankhulanso pakapita nthawi yochepa. Ngakhale kuti pakhosi panu pakhoza kupweteka poyamba ndipo mawu anu angasinthe pang'ono, izi zidzatha pakapita masiku ochepa. (Zidzatha pakapita masiku ochepa).
- Kutha kudya ndi kumwa: Mofananamo, simungadye kapena kumwa pakamwa pamene chubu chilipo. Mukachotsa chubucho ndipo mphamvu yanu yomeza (gag reflex) yatsimikizika, mutha kuyambanso kudya.
- Kupewa zoopsa za nthawi yayitali: Pali zoopsa zina zokhudzana ndi kukhala ndi chubu chopumira kwa nthawi yayitali (monga kulephera kugwira ntchito kwa mawu, chibayo, tracheomalacia ). Kutulutsa magazi kumatanthauza kuti mulibe zoopsa zimenezo.
Ngati inu kapena wina m'banja mwanu akuyenera kuchita izi, musachite mantha kapena kukayikira. Funsani dokotala wanu mafunso kapena nkhawa zilizonse zomwe mungakhale nazo. Adzakufotokozerani zonse.
Uthenga Wopita Nawo Kunyumba
- Kutulutsa mpweya ndi njira yochotsera chubu cha endotracheal (ETT) chomwe chimayikidwa mu trachea yanu mutatha kupuma bwino nokha.
- Ichi si chinthu chomwe chimachitika nthawi imodzi. Ndi chinthu chomwe gulu lachipatala lidzachita mutafufuza mosamala za vuto lanu komanso kukonzekera kwanu.
- Ndizachilendo kukhala ndi pakhosi lopweteka komanso mawu omveka kwa masiku angapo mutachotsa chubucho.
- Ngakhale kuti nthawi zina mavuto angabuke (monga kulephera kwa extubation), gulu lachipatala nthawi zonse limakhala lokonzeka kuthana nawo.
- Kutulutsa thupi kumatanthauza kuti mwatenga sitepe yayikulu komanso yofunika kwambiri paulendo wanu wochira. Ndicho chinthu chosangalatsa nacho!
- Ngati muli ndi nkhawa iliyonse yokhudza njira yachipatala kwa inu kapena wokondedwa wanu, nthawi zonse kambiranani ndi dokotala wanu.
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