Endotracheal chubu (endotracheal chubu): masitaelo, ukulu, zolinga. Anapereka intubation

Mwatsoka, zosiyanasiyana kuvulala ndi matenda sali angwiro. Zikavuta, muyenera yomweyo kuthandiza munthu m'mavuto. Makamaka ngati chawonongeka, moyo pachiswe. Zikuphatikizapo zinthu zimenezi mwamsanga monga airway kutsekeka, kumangidwa mtima, mantha, chikomokere. Mankhwalawa pathologies izi ziyenera kuchitikira mu odwala mwakayakaya. Komabe, kanthu mwamsanga ayenera kumwedwa nthawi yomweyo pambuyo kufufuza mtima, mwachitsanzo pa siteji ya mwadzidzidzi lapansi. M'galimoto, "ambulansi" wayikidwa akhale tracheal intubation, ndi Makina amenewa, Ambu thumba. zipangizozi zachipatala zifunika okha Zikavuta, pamene munthu sangathe kupuma paokha.

Kodi endotracheal chubu?

Mwamsanga tracheal intubation amatanthauza njira zosasangalatsa. Koma ngakhale pokusokoneza, m'pofunika kuti asapatsire. Wokulitsa Airways ndi kuonetsetsa mwayi kwa mpweya m'mapapo, ndi endotracheal chubu ndi anaikapo. Iyenela intubate dotolo wa specialization iliyonse. Makamaka luso limeneli ayenera ndipo resuscitators anaesthesiologists, madokotala ambulansi. Ndi oyamba a endotracheal chubu m'mapapo mpweya umakhala yachibadwa kachiwiri, ngakhale kuwonongeka kwa Airways. Komanso, pogwiritsa ntchito njira imeneyi idzachitika kotunga yokumba oxygen. Pali mitundu yambiri ya machubu endotracheal (20). Iwo zimasiyana-siyana ukulu ndi pamaso pa njira zina (kolala). zida zonse intubation anawagawa mitundu 2: yothiriridwa nasotracheal chubu. Amasiyana pa njira ya malowedwe dongosolo kupuma. Mbali yoyamba, ndi endotracheal chubu ndi anaikapo kudzera pakamwa, lachiwiri - kudzera ndime m'mphuno. Mu embodiments onse, zosokonezeka ungapezeke chifukwa kuwonongeka limba. Choncho, asanasankhe njira ya utsogoleli wa chubu, muyenera kuona kuopsa. Komabe, intubation ayenera kuchitidwa ngati kuli koyenera kuti ntchito yofunika thupi.

Zikuonetsa kwa akuluakulu a endotracheal chubu

Limati aakulu kupereka airway zimatheka mwa kuyambitsa tracheal chubu m'kamwa kapena m'mphuno. Nthawi zambiri, wodwala safuna kumva ululu ndondomeko. Popeza anthu amene amafuna kuwatsitsimula, nthawi zambiri atakomoka. Pali zizindikiro zotsatirazi kwa tracheal intubation:

1. Kufunika kwa mpweya wabwino makina. Mawotchi mpweya imagwiridwa osati pa siteji ya chithandizo mwadzidzidzi, komanso ICU lapansi. Pogwira njirayi N'zosatheka tracheal intubation.
2. Kufunika kwa mankhwala ochititsa dzanzi ambiri. Pankhaniyi kwambiri, kumayambiriro chubu pneumatic chofunika. Ndipotu, pa ochititsa dzanzi ambiri pansi minofu onse, kuphatikizapo minofu kupuma.
3. Kukhazikitsa tracheal ndi bronchial lavage. Ndondomeko anasonyeza odwala amene akupita ntchofu, zili m'mimba mwa airway lapansi.
4. Kupititsa patsogolo maphunziro ya kuwombola mpweya pakati mapapo ndi chilengedwe.

Akukhulupirira kuti endotracheal chubu umayamba ndi pakamwa (orotracheal) zikusonyezedwa zinthu kwambiri. Pakati pawo - kusiya kupuma ndi ntchito mtima (kukomoka) , ndipo chikomokere chiyambi iliyonse. Nasotracheal oyamba ali ndi zosokonezeka ochepa ndi imatengedwa zambiri zokhudza thupi. Komabe, kupewa kulephera pachimake kupuma, madokotala nthawi zambiri atchule chubu kudzera pakamwa.

Zida tracheal intubation

Mu tima katswiri chisamaliro inayenera kukhala anasiyira tracheal intubation. Iwo kusungidwa mu bokosi yakucemerwa ndi zida lakonzedwa kuti mpweya m'mapapo mwanga. Anapereka intubation ikuchitika cha odwala mwakayakaya ngati n'koyenera. Zimenezi zikugwira ntchito pa nthawi imene wodwala ndi mwachangu anasonyeza makina mpweya wabwino. zida Medical akupezeka ingachititse:

1. Laryngoscope. chipangizo ichi ukufanizidwa ndi zigawo ziwiri zikuluzikulu - tsamba ndi khasu. Iwo amagwira ntchito kuthokoza batire kapena mabatire. Iwo anaikapo mu chogwirira cha laryngoscope lapansi. masamba m'makulidwe osiyanasiyana ndi akalumikidzidwa (yokhota kumapeto ndipo molunjika). gawo ili anaikapo kuti patsekeke m'kamwa. Kumapeto kwa tsamba lili nyali zounikira Airways. Kusankha laryngoscope kukula zimadalira m'badwo wodwala, mkhalidwe wa M'mimbamo m'kamwa.
2. zosiyanasiyanazo machubu endotracheal. The zida zikuphatikizapo zida intubation achikulire ndi ana omwe. Iwo amasiyana kukula, kukhalapo kapena kusapezeka kwa khafu ndi awiri akunja, kutalika ndi chiwerengero cha lumens. Ndi machubu awa angathe kuchitidwa onse yothiriridwa nasotracheal intubation. Nthawi zambiri akazi ntchito ritsa kukula 7-8, amuna - 8-10. Ncholinga intubation odwala wamkulu amafuna endotracheal chubu ndi khafu a. Kuti patency wa Airways wa ana - popanda izo.
3. Kondakitala endotracheal chubu kuti atipatse unakhota ankafuna.
4. Yokhota kumapeto forceps.
5. mankhwala Nebulizer kwa mankhwala ochititsa dzanzi.

Ngakhale kuti kuchita zilibe ntchito zonse Zida zogwiritsira, pamaso pawo n'zofunika zonse.

Nthawi zina, mawu oyamba mu endotracheal chubu ndi zosavomerezeka?

Ngakhale intubation amatanthauza ndondomeko zofunika, lili angapo contraindications. Zikuphatikizapo: khosi choipa, zotupa mu cavities m'kamwa ndi m'mphuno, kutupa kwa Airways. Nthawi imeneyi, mawu oyamba chubu osati kubweretsa phindu koma kumathandiza kuti chitukuko cha mavuto aakulu (kusiyana minofu, msana choipa chingwe). Choncho, akuyendera kuti intubation, m'pofunika kufufuza pakamwa ndi mphuno, kulabadira boma la msana chapamwamba.

Komanso, oyamba a endotracheal chubu kungakhale kovuta akamaziwononga, si contraindications. Pakati pawo: lilime lalikulu, kanthawi khosi, kapena chibwano, kunenepa, kwambiri yotundumukira kunja kwa mpanda mano kutsogolo, ndi kamwa laling'ono trachea anomalies. Pamaso pa ziwalo wodwalayo, intubation ayenera kuchitidwa mosamala. Mu milandu, zokonda zapatsidwa kwa oyamba chubu nasotracheal. Ziyenera kukhala 1-2 kakang'ono.

Njira ya intubation

Orotracheal intubation imagwiridwa motere:

1. Wodwala aikidwa pa pamwamba zovuta, amaponyera mmbuyo mutu wake pang'ono ndipo kanikizirani nsagwada m'munsi patsogolo. Chifukwa cha zimenezi, incisors chapamwamba ndi airway M'ndegeyo. Ngati n'kotheka, aikidwa pansi pa khosi mayina.
2. Ngati ndi kotheka, kuyeretsedwa mwa pakamwa vomitus, kuundana dothi.
3. Lowani tsamba laryngoscope (kumanja). Nkofunika kukhudza mucosa mkamwa ndi mano.
4. Ndiye, endotracheal chubu ndi anaikapo. Chitadutsa m'kamwa ndi kukhosi. Pa mlingo wa zingwe amapilira, chubu ayenera mosamala kukopedwa pa iwo mu M'mimbamo wa trachea a.
5. Laryngoscope atachotsedwa.
6. Anakokomeza ndi khafu kwa kukonza endotracheal chubu.

Nasotracheal intubation imagwiridwa mu chimodzimodzi. Kusiyana ndi Maganizo a chubu ndi oyamba ake kuti patsekeke m'mphuno. Mu nkhani iyi, laryngoscope si ntchito.

Mmene angagwirire mpweya wabwino wa ana mapapo?

Pali milandu kumene tracheal intubation ndikofunikira kugwira ana. Nthawi zambiri, m'pofunika kuti kwambiri ophedwa pochotsa mimba mwana wosabadwayo. Komanso intubation kungakhale kofunika mu nthawi neonatal mu kupeza zopindika a dongosolo kupuma ndipo mtima. Nthawi zonse, chofunika makina mpweya wabwino. Zikuonetsa kuti intubation mu zaka junior ndi mkulu wa ubwana n'chimodzimodzi ndi akuluakulu. Ena mwa iwo: pachimake kupuma kulephera, chikomokere, kuchititsa mankhwala ochititsa dzanzi ambiri.

ndi sikelo ya akuya intubation chiyani?

Kuya kwa amene uyenera kulowa endotracheal chubu, zimadalira kukula kwake ndi kulemera kwa mwana. Kuchita izi, ntchito sikelo wapadera. Ndi ntchito ana azionera akhanda. Ndi kulemera kwa 1 makilogalamu mwana kugwiritsa ntchito kukula 2.5 endotracheal chubu. mozama ake chimaonekera akuluakulu a milomo ndi 6-7 cm. thupi kwa 2 kg ntchito chubu kukula wofanana 3. Kuya jekeseni sayenera kuposa 8 cm. Ngati mwana akulemerera pakati pa 2 ndi 4 makilogalamu umagwiritsidwa ritsa kukula № 3 5. Kuya mu nkhani iyi ndi ku masentimita 9 10. Pakuti ana ndi makanda, amene kulemera makilogalamu oposa 4, pogwiritsa chubu 4 kukula. Kuya kwa oyamba - 11 cm.

Kodi kukhala zosokonezeka pambuyo tracheal intubation?

Tiyenera kukumbukira kuti oyamba a endotracheal chubu Vuto zoopsa monga kuwonongeka kwa Kakhungu mucous ziwalo mkati. Choncho, mpheto izi ziyenera kuchitikira ndi katswiri wodziwa. Kusamalira kwambiri pachikhalidwe, musanayambe intubation, ochititsa dzanzi imagwiridwa. The mavuto ambiri monga: kuwononga mano, ndi mucosa wa pharynx, ndi kum'mero kulowa chubu. Popewa izi, m'pofunika mosamala kuwunika alili.

Kuika ndi endotracheal chubu: Katswiri maganizo

Njira ya intubation ali dokotala aliyense. Komabe, ndi bwino kuchita izi mpheto intensivists ndi Anesthesiologists. Malinga ndi iwo, popanda maphunziro apadera, ndipo pakalibe wosabala, ndi kosatheka kwa tracheal intubation. Ndipotu, mavuto a njirayi kungakhale sizingasinthe. Komabe, kupereka thandizo asapatsire anakakamizika dotolo wa zapaderazi iliyonse.