Wakamboona murwere ari muchikamu chevarwere vanorwara zvakanyanya (ICU) ari kunetseka zvakanyanya kufema, achitariswa pasi navanachiremba nevashandi vekuchengeta varwere here? Ungave wakashamisika kuti sei vachiita izvi, uye kana zvingasafadza murwere. Iyi inzira yekurapa inokosha zvikuru inogona kuponesa hupenyu hwemurwere. Nhasi tichataura nezvenzira iyi inokosha itsva kuvanhu vazhinji, asi yave ichishandiswa mukurapa kwemakumi emakore. Izvi zvinonzi "Proning" mukurapa.
Chii chinonzi kungotaura zvishoma nezvishoma?
Zvichitaurwa zviri nyore, kukotamisa musoro chiito chekutendeudza murwere akarara akarara (nemusana) kuita seakarara (nedumbu). Mukurapa, nzvimbo iyi yekurara inonzi "Supine Position". "Prone Position" inoshandiswa navanachiremba kubatsira varwere vane matambudziko ekufema akaomarara avo vanoomerwa nekuwana oxygen yakakwana kumiviri yavo.
Nzira iyi inowanzo shandiswa kuvarwere vari kushandisa michina yekufema. Ungave wakambonzwa izwi iri panguva yedenda reCOVID-19 . Asi harisi idzva. Zvidzidzo zvakatoona kuti kana nzira iyi ikashandiswa pakutanga kwevarwere vane chirwere chakakomba chekufema, njodzi yekufa inogona kuderedzwa zvakanyanya.
Nzira iyi inoshandiswa pamhando dzipi dzemamiriro ezvinhu?
Nzira yekurerutsa kufema inonyanya kushandiswa kuvanhu vane zvirwere zvakakomba zvekufema vari mumamiriro ekuti "Hypoxia" apo muviri haugamuchire okisijeni yakakwana. Zvisinei, nzira iyi inonyanya kushandiswa mumamiriro ezvinhu anonzi Acute Respiratory Distress Syndrome (ARDS) .
Zvichitaurwa zviri nyore, ARDS chirwere chekuti tumapapu tudiki (alveoli) mumapapu edu tunozadzwa nemvura. Izvi zvinoita kuti zviome kufema. ARDS idambudziko guru rezvirwere zvakakomba zvekufema zvakaita sepneumonia neCOVID-19.
Sei mwero weokisijeni uchikwira kana ukatendeudza musoro wako?
Chikonzero cheizvi chinonakidza zvikuru. Chikonzero chikuru cheizvi ndechekuti miviri yedu haina kuenzana zvakakwana. Kunyatsotarisa kunoita zvinhu zviviri.
1. Kudzikira kwehuremu uye kumanikidzwa kwemapapu
Funga nezvazvo, nekuti miviri yedu yakagadzirwa kuti ive nemapfupa akawanda kunze kupfuura mukati mechipfuva chedu. Patinorara nemusana, huremu hwemwoyo wedu nedzimwe nhengo dzemudumbu hunowira zvakananga pamapapu edu. Uyewo, mvura inoungana mumapapu edu inodzvanya pasi pamabhegi emhepo ari kunze nekuda kwesimba rinokwevera pasi. Izvi zvinoderedza nzvimbo yekuti mapapu azare nemhepo zvizere.
Zvakafanana nechipanji chine huremu pachiri. Paunobvisa huremu, hunozvimba zvakanaka, handiti? Ndizvo zviri kuitikawo pano.
Asi patinodzora murwere kubva pachiso chake pasi, huremu hwemwoyo nedumbu zvinoenda kure nemapapu zvichienda kuchipfuva. Zvadaro, rutivi rwekumashure, rune mapfupa akawanda, runosunungurwa. Saka mapapu anokura zviri nani uye anogona kutora mhepo yakawanda.
2. Kuchinjana kweGasi kunoshanda zvakanaka
MuARDS, pane kusawirirana pakati pehuwandu hweokisijeni hunopinda mumapapu (kufema) nehuwandu hweokisijeni huri kupinda muropa (kuyerera kweropa). Pasinei nenzvimbo yemuviri wedu, kumashure kwemapapu kunowana ropa rakawanda.
Zvino tarisai, patinotarisa murwere pasi, tiri kubvumira mweya wakawanda kupinda mumapapu kune rimwe divi. Kune rimwe divi, tiri kutungamira okisijeni iyoyo kuchikamu chemapapu chine ropa rakawanda . Izvi zvinoita kuti kufema kushande zvakanaka. Zvichitaurwa zviri nyore, nzira iyi inotibvumira kutumira okisijeni kwainonyanya kudiwa.
Unoita sei kuti murwere anzwe kumeso kwake pasi?
Izvi hazvisi zvinhu zvinogona kuitwa nemunhu mumwe chete kana vaviri. Iri ibasa rakarongwa zvakanaka rechikwata. Nyanzvi yezvekufema, vanachiremba, nevashandi vekuchengeta varwere, vanhu vanosvika 5-6, vanoshanda pamwe chete kuti vaite izvi.
Danho rekutanga nderekusunga machubhu ese newaya dzakabatana nemuviri wemurwere (semuenzaniso, chubhu yekufema, chubhu yemunyu, EKG) kuitira kuti zvisabude pachena. Nyanzvi yekufema inobata mutsipa wemurwere nechubhu yekufema nokungwarira. Zvadaro, panguva imwe chete, zvichienderana nemurairo mumwe chete, timu yese inotendeudza murwere nerutivi rwake nokungwarira, vachishandisa mapillow nemachira. Zvese izvi zvinoitwa kudzivirira kukuvara kwemurwere.
Kazhinji, murwere anoiswa munzvimbo iyi kwemaawa ari pakati pe12 ne18. Kazhinji, maawa angangoita gumi nematanhatu anopedzwa panguva imwe chete, murwere akarara nechiso chake pasi obva atarisa pasi.
| Mabhenefiti enzira yeProning | Tsananguro iri nyore |
|---|---|
| Kuwedzera kwemazinga eokisijeni | Mhepo yakawanda inopinda mumapapu uye okisijeni inonyudzwa muropa zviri nani. |
| Kubvisa madzihwa kuri nyore | Simba remudumbu rinobatsira kuti mvura inoungana mumapapu ibude zviri nyore. |
| Kushanda kwemoyo kwakavandudzwa | Tsinga dzeropa dziri mumapapu dzinovhurika, zvichiita kuti zvive nyore kuti mwoyo upombe ropa. |
| Kuderera kwehuwandu hwevakafa | Ongororo dzakaratidza kuti inoderedza zvakanyanya huwandu hwerufu muvarwere veARDS. |
Pane njodzi dziripo here panzira iyi?
Sezvinongoita chero kurapwa kupi zvako, kune dzimwe njodzi dzinobatanidzwa mukuita uku. Zvisinei, njodzi idzi dzinogona kuderedzwa nekuva nechikwata chevanachiremba vane ruzivo vachinyatsoongorora zvinhu izvi.
- Kubviswa kwechubhu ye endotracheal netsaona
- Kurasikirwa ne catheter yemutsinga (yakadai sesaline):
- Matambudziko eBP kana kurova kwemoyo: (`Hemodynamic Instability`, `Arrhythmia`)
- Kuderera kwechinguva kwemazinga eokisijeni
- Kuvharika kwenzira yekufema
Njodzi idzi dzakaderera zvikuru muzvipatara zvine ruzivo rwemakore anopfuura mashanu uchishandisa nzira yeProning.
Yeuka, Proning mushonga wakatsigirwa nesainzi, unoponesa hupenyu hwevarwere vari kurwisana nezvirwere zvakakomba zvekufema.
Muzvimwe zviitiko, varwere vane dambudziko rekufema zvishoma vanorayirwa nachiremba wavo kuti varare vakatarisa pasi (`Awake Proning`). Izvi zvinogona kuvadzivirira kuti vasade mudziyo wekufema.
Mharidzo Yekuenda Nayo Kumba
- Kuchekerera mutsipa (proning) inzira yekurapa murwere ane dambudziko guru rekufema nekumutarisa pasi.
- Izvi zvinoderedza kumanikidzwa kwemapapu uye zvinobatsira muviri kuwana okisijeni yakawanda.
- Izvi zvinonyanya kuitika kana munhu abatwa nechirwere cheAcute Respiratory Distress Syndrome (ARDS).Mushonga unoponesa hupenyu unoshandiswa pakurapa zvirwere zvakakomba zvakaita se.
- Izvi zvinoitwa nokungwarira kukuru, nechikwata chevanachiremba vakadzidziswa.
- Kana ukaona mudiwa wako achirapwa nenzira iyi muchipatara, nzwisisa kuti idanho rakakosha zvikuru kuti apore. Kana uine zvinokunetsa, taura nachiremba ane basa nezvazvo.
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