Msana ndi epidural (epidural) ochititsa dzanzi - kodi pali kusiyana kulikonse? The ntchito, contraindications, zosokonezeka zotheka

The zatsopano woyamba kugwiritsa ntchito mankhwala ochititsa dzanzi msana, chibwenzi ku chaka cha 1898, koma ambiri, njira ya mankhwala ochititsa dzanzi walandira patapita nthawi yaitali. Kugwiritsa ntchito njira imeneyi, dokotala ayenera tidziwe zina za thunthu la chingwe msana ndi zikopa zake.

Epidural ndi msana ochititsa dzanzi

Izi njira ya mankhwala ochititsa dzanzi ndi dera. Pa kumalo awo mankhwala ochititsa jekeseni mu dera wapadera lili chingwe msana. Zikomo kuti "mazira" hafu m'munsi mwa thupi. Ambiri sindikudziwa ngati pali kusiyana pakati pa msana ndi epidural ochititsa dzanzi.

Ndondomeko kukonzekera ndi wozengereza wa mankhwala oletsa ululu njira zimenezi ndi zofanana. Ndithudi, nthawi zonsezi kujambula kumbuyo. Kusiyana chachikulu chiri kuti msana mankhwala ochititsa jekeseni wagawo anatchula, ndipo epidural (peridural) - yoika wapadera chubu woonda kudzera amene mankhwala ochititsa ndi kutumikiridwa pa nyengo zina za nthawi.

Koma njira za - si kusiyana pakati pa njira ziwiri izi mpumulo ululu. Msana ochititsa dzanzi ntchito pa nthawi imene m'pofunika kuti tikwaniritse zotsatira yochepa. Malinga mtundu wa mankhwala Kutalika kwa analgesia lingayambire pakukhala maola 1 mpaka 4. Epidural mankhwala oletsa ululu si mwa nthawi. Mankhwala ochititsa dzanzi adzapitiriza bola wokwera kudzera catheter mu thupi kudyetsedwa mankhwala ochititsa. Nthawi zambiri njira imeneyi ntchito yochotsa mtima ululu osati pa opaleshoni, komanso nthawi postoperative.

Mfundo ntchito

Epidural ndi epidural ochititsa dzanzi - ndi mankhwala ochititsa dzanzi dera, mu zimene mankhwala jekeseni danga epidural msana. opaleshoni mfundo zake zochokera mankhwala ntchito kupyolera dural malaya amagwa danga subarachnoid. Chifukwa, ndi nyemba akamadutsa misempha radicular mu chingwe msana amatsekeka.

Pambuyo mankhwala chikuyendetsedwera umakhala pafupi maselo mitsempha ya thunthu. Ndipo iwo ali ndi udindo maonekedwe a ululu m'madera osiyanasiyana thupi ndi akuwazenga ubongo.

Malinga ndi malo makonzedwe akhoza kuletsa galimoto ntchito ndi kudziwa zinthu zina za thupi. Nthawi zambiri, epidural ochititsa dzanzi ntchito "kusinthana kuvula" theka m'munsi mwa thupi. Kuti tichite zimenezi, muyenera kulowa mankhwala ochititsa mu malo intervertebral pakati T10-T11. Pakuti mankhwala ochititsa dzanzi pa thorax dera la mankhwala umayamba kudera pakati T2 ndi T3, theka pamwamba m'mimba akhoza anesthetize pamene afese T7-T8 linkawonongeka m'deralo. M'dera ziwalo m'chiuno, "mwadzidzidzi" pambuyo kumayambiriro mankhwala ochititsa mu mpata pakati L1-L4, nthambi m'munsi - L3-L4.

Zikuonetsa ntchito mankhwala ochititsa dzanzi dera

Epidural ndi msana ochititsa dzanzi akhoza kugwiritsidwa ntchito mosiyana ndi osakaniza ndi ambiri. Njira yamasika ntchito pa nthawi imene opaleshoni khalidwe thoracic zakonzedwa (mu chifuwa) kapena njira yaitali opaleshoni m'dera la pamimba. kuphatikiza awo ndi kugwiritsa ntchito mankhwala opha kuchepetsa kufunika odwala opioids.

Payokha, ochititsa dzanzi epidural akhoza kugwiritsidwa ntchito mu zochitika izi:

- mpumulo ululu pambuyo opaleshoni;

- mankhwala oletsa ululu pamalopo pobereka;

- kufunika kugwira ntchito pa mapazi ndi ziwalo zina za theka m'munsi mwa thupi;

- Kaisara gawo.

Nthawi zina, ntchito yekha ndi epidural. Izo ntchito ngati n'koyenera, kugwira ntchito:

- mu mafupa a chiuno, ntchafu, m'miyendo, lalikulu tibia ;

- m'malo a m'chiuno kapena bondo mafupa;

- wovulala wa khosi femoral ;

- chophukacho.

mankhwala ochititsa dzanzi msana angagwiritsidwe ntchito ngati njira ya chithandizo cha kupweteka kwa nsana. Nthawi zambiri zachitika pambuyo opaleshoni. Ndiponso ntchito opaleshoni mtima milandu anthu pamene kuli kofunikira kuchita alowererepo pa malekezero m'munsi.

ntchito mpumulo ululu

Koposa akazi ntchito epidural kapena msana ndi mankhwala, kuti kumva contractions chopweteka. Pamene kutumikiridwa ululu mankhwala ochititsa kutha, koma kuzunza ndi anapitiriza yonse.

Epidural mankhwala oletsa ululu pobereka kawirikawiri amagwiritsidwa ntchito m'mayiko otukuka. Malinga ndi kafukufuku, amagwiritsidwanso ntchito pafupifupi 70% ya amayi akubereka. mtundu wa mankhwala oletsa ululu limakupatsani anesthetize ndondomeko yonse ya kubereka. Mu nkhani iyi, mwana wosabadwayo si bwanji.

Ngakhale kuti yobereka masoka zokhudza thupi ndondomeko, amene sikutanthauza kunja alowererepo, akazi kunadetsa kunena kuti iwo anali zamizidwa ndi kusakhala. Ngakhale pa nthawi ya kubadwa, thupi limapanga Mumakonda mlingo wa endorphins. Amalimbikitsa zachilengedwe mpumulo ululu, chifukwa mahomoni awa angathe kupereka Nyamulani maganizo, kupondereza kumverera chifukwa cha mantha ndi ululu.

Komabe, limagwirira cha ulimi wa endorphins zimadalira chikhalidwe ndi maganizo a akazi. Mwachitsanzo, yaitali ntchito ndi ululu kungasokoneze onse pa mkazi kwambiri pobereka, ndi mwana wosabadwa. Komanso, mkazi angadwale pofuna kuyamba kusokonezeka, chifukwa kusokonezeka kwa minofu chachikulu - mtima. Zikatero, ochititsa dzanzi n'kofunika.

Koma epidurals akhoza kuchitika kokha m'njira anakonza. Contraindications timaigwira si zachilendo. Koma zikafika poipa mulibe ntchito koma chifukwa zotsatira zake zimachokeradi yomweyo. Chiyambireni cha kubwera kwa dzanzi ndi kukatsiriza mpumulo ululu kutenga theka la ola.

maphunziro mokoma

Ngati n'kotheka, wodwalayo chisanadze wokonzedwera kwa khalidwe la mankhwala ochititsa dzanzi. Ngati mukufuna epidural (peridural), msana ndi mankhwala, mtima amaperekedwa madzulo 0,15 ga amatanthauza "Phenobarbital". Ngati ndi kotheka, izo awerenge ndi tranquilizer. Childs, madokotala amagwiritsa ntchito mankhwala "ntchito diazepam" kapena "hlozepida". Komanso, kwinakwake ora pamaso ochititsa dzanzi makonzedwe mu mnofu jekeseni zikutanthauza kusonyezedwa "ntchito diazepam" kapena "Promethazine" amathanso perekani "morphine" ndi "atropine" kapena "Fentalin".

Komanso, chinthu kuvomerezedwa ndi kukonza wazolongedza wosabala. Kumafuna chopukutira (yaikulu ndi yaing'ono), wosabala Golovesi, mipira gauze, masingano, syringes, catheters, ndi tweezers awiri magalasi awiri njira zothetsera dzanzi. M'pofunikanso kukonzekera zonse zofunika kuti akhale okhoza kuthetsa mavuto zotheka. Ndi mankhwala ochititsa dzanzi uwu sungakhoze amapatula imabwera kusokonezeka kwambiri chifukwa cha dongosolo kotunga magazi ndi kupuma.

Poyamba anakonza syringes 2, mmodzi amene ayenera kukhala buku la 5 ml, ndipo chachiwiri - 10 ml. Komanso, madokotala amakonzekera singano mu kuchuluka kwa ma PC 4., 2 amene ali wofunikila mankhwala oletsa ululu wa malo khungu kumene jekeseni waukulu adzapatsidwa. Wina kufunika kuti akalowe ndi kuthera mankhwala ochititsa catheter, ndi wotsiriza - potenga ululu mankhwala mu syringe lapansi.

kasamalidwe mankhwala ochititsa

Msana ndi epidural ochititsa dzanzi zimapangitsa mtima amene wakhala kapena kunama pa mbali yake. Monga ulamuliro, malo otsiriza ntchito pafupipafupi. Pankhaniyi, wodwala ayenera kukhala zotheka kukhotetsa nsana wanu, kumangitsa ntchafu yako pamimba ndi mutu anakakamizidwa pamtima.

Khungu m'dera la jekeseni mosamala kukonzedwa ndi chinsalu ndi matawulo wosabala. Izi zachitika chimodzimodzi monga kale iwowo. Pa zochitika za puncture adakonzeratu khungu dzanzi. Komanso, ntchito singano kudzera pakhungu tikulimbikitsidwa kuti yaing'ono puncture yopapatiza scalpel.

Akatswiri kuzindikira njira ziwiri za mmene akhoza kufika ku malo msana epidural: Mediya ndi paramedian. Pamene woyamba singano ndi anaikapo mu kusiyana njira Osistem. Pambuyo kudutsa khungu ndi mafuta, izo linkakhala mu nadostistuyu poyamba, ndiyeno mu mitsempha interspinous. Odwala achikulire, angakhale zakaltsinirovany kuti ndithu complicates ndi mayikidwe la singano.

Ofananira kapena paramedian njira imafotokoza kuti jekeseni zichitike dera malire, yomwe ili pakati vertebrae lapansi. Calibration zachitika ku mfundo 1.5 kapena 2 cm kuchokera njira spinous. Koma njira imeneyi ntchito pamene njira alibe olumpha apakatikati puncture njira. Ndi bwino odwala ndi kunenepa ndi Mitsemphayi sclerotic.

Features a "epiduralki"

Patsogolo ntchito ndandanda, odwala Anesthesiologists kusankha mtundu wanji wa mankhwala oletsa ululu zidzagwiritsidwanso ntchito. Koma odwala ambiri ndikufuna kuti timvetsere zomwe epidural ndi epidural ochititsa dzanzi. Kodi kusiyana pakati pa njira ziwiri izi simukhala kupeza. Ndithudi, izi ndi maina awiri njira womwewo wa mankhwala, mmene mankhwala ochititsa ndi umaperekedwa mu kudzera catheter thupi pang'onopang'ono.

dokotala ayenera kudziwa mokoma puncture lapansi. Mwachitsanzo, chifukwa singano epidural ali kupita kupyola pa mulu wa chikasu. Chifukwa chaichi, ndi mandrel chikutha ndi syringe amamangiriridwa, mmene sodium kolorayidi uli kusungunuka, kuti kusiya mpweya kuwira. Atangomva singano akulowa mtolo, mpweya kuwira adzaoneka zopotola. Koma iye anaweramuka mwamsanga kwenikweni akubwera mu dera epidural.

Komanso dzanzi Musaiwale za njira zina kufufuza ngati singano ali pabwino molondola. Izo zonse nzabwino, anasonyeza chifukwa analibe madzimadzi cerebrospinal mu singano pakatha kulitsimikizira mtanda stylet. Komanso kuunikira kuonetsetsa kuti pang'ono saline anayamba si ikuyenda mmbuyo kupyola singano pambuyo syringe ndi sakukhudzidwa. Koma uwu si mndandanda wa njira mayeso. dokotala ayenera achite matenda mabuku kuonetsetsa Kusinthaku moyenera singano.

Epidural ochititsa dzanzi kumafuna kufunika ntchito catheter. M'mawu ake oyamba, monga ulamuliro, kodi kulibe vuto lililonse. Kamodzi pa mtanda ofananira ndi kutsimikizira patsogolo ake kudzera singano mu danga epidural. Kenako, singano pang'onopang'ono kuchotsedwa, ndi catheter a chili ndi kutseka ake kuchoka malo bactericidal pulasitala kapena wosabala bandeji.

mankhwala ntchito

Kuchepetsa mavuto zotheka wa mankhwala oletsa ululu epidural, n'kofunika kusankha mlingo woyenerera wa mankhwala a mankhwala ochititsa ndi mwaluso kugwira ndondomeko wokha puncture lapansi. Kuchititsa mankhwala ochititsa dzanzi ntchito njira ayeretsedwe mankhwala ochititsa amene mulibe mchere; kutetezera.

Nthawi zina, njira "lidocaine wa" ntchito mankhwala ochititsa dzanzi epidural. Koma amagwiritsidwanso ntchito mankhwala monga "Ropivacaine", "Bupivacaine". Kuyang'aniridwa ndi dokotala kwambiri oyenerera komanso odziwa pamene anasonyeza kuti iwo akhoza kuwonjezeredwa mankhwala za thupi opiates. Zimakhala mankhwala monga "Morphine", "Promedol". Koma mlingo wa ndalama izi ndi kochepa. Iwo sangakhoze kuchifanizira amene amagwiritsidwa ntchito pa ochititsa dzanzi ambiri.

Ndi kumayambiriro mankhwala ochititsa mu malo epidural otsiriza kuwatumiza ku madera osiyana. Chitadutsa m'mwamba, pansi, paravertebral minofu intervertebral kudzera mipata mbali. Choncho, lodziwa ayenera kukhala ambiri "dicain" chifukwa ochititsa dzanzi epidural, ayenera kukumbukira kuti analgesia zone kudzadalira kuchuluka kwa njira, mphamvu ya kulamulira ndi mlingo. Kuwonjezera mutu, Angagwiritsidwenso ntchito amatanthauza "lidocaine wa", "Trimekain", "marcaine". Kwa analgesia wathunthu angagwiritse ntchito za 25-30 ml ya anati dzanzi njira. Koma ndalamazo akuti ndi pazipita.

zoletsa kofunika

Ngakhale kuti mmodzi wa otetezeka ankaona contraindications epidural ochititsa dzanzi iye akadali apo. Njirazi ndi monga:

- tuberculous spondylitis;

- pustules kumbuyo;

- zoopsa mantha;

- organic CNS;

- zovuta msana chilema, matenda ndiponso kuwonongeka pathological;

- ileus;

- mtima kugwa ndipo zinachititsa peritonitis;

- ambiri manda mmene wodwalayo;

- decompensation za mtima;

- zaka Ana;

- kuchuluka kudziwa zigawo zikuluzikulu mankhwala ochititsa;

- zikutha m'mayiko thupi.

mabvuto amene angadze

Koma musaiwale kuti si nthawi zonse sabweretsa chisoni ndipo popanda zotsatira akudutsa epidural. Contraindications, zosokonezeka izo zikuchitika, m'pofunika kuti tipeze musanapite kukagona kwa tebulo ya opareshoni.

Iwo ayenera kumvetsa kuti njira ya kuchita osiyanasiyana mankhwala, kotero dokotala Choyenereza n'kofunika kwambiri. The owopsa ndi zikamera wa kugwa kwambiri pambuyo msana kapena epidural ochititsa dzanzi. Nthawi zambiri, chikhalidwe ichi kumachitika pamene kuonongeka Dura Mater. Chifukwa cha anatseka misewu imeneyi ya innervation wachifundo zikachitika, monga Motero, yafupika mtima kamvekedwe anayamba hypotension kwambiri. Komabe, vuto limeneli angathe, ndipo pamene mwachita bwino, mankhwala oletsa ululu pamene kutumikiridwa kwa gawo lalikulu la mankhwala ochititsa ndi tizidalira osiyanasiyana kasamalidwe ululu.

Koma mavuto angathe kuyamba nthawi postoperative. Njirazi ndi monga:

- kuyambira suppurative yotupa ndondomeko mu ngalande za chingwe msana (chifukwa kawirikawiri amakhala malamulo antiseptics kuphwanya);

- mutu ndi kusapeza m'dera kumbuyo;

- paresis wa malekezero a m'munsi, ziwalo m'chiuno (ungapezeke chifukwa cha kuwonongeka kwa msana mizu singano).

Ngati odwala zamizidwa ndi kusakhala ndi "Morphine", ndiye kuti iwo muyenera kusamala kwambiri. Nthawi zina zimabweretsa kupuma maganizo amenewa epidural ochititsa dzanzi. Contraindications ntchito njira imeneyi si zokhazi. Koma kumbukirani kuti chiopsezo maganizo a ukuwonjezeka kupuma ndi akawawonjezere mlingo wa morphine.

Features wa mankhwala oletsa ululu msana

Ngakhale kufanana, pali kusiyana kwambiri pakati pa epidural ndi msana ochititsa dzanzi. Mwachitsanzo, malo a singano pambuyo puncture chikasu mitsempha si kofunika. Atangomva singano chimapita kupyola Dura Mater, dokotala amasangalala chifukwa cholephera singano. The catheter mu mtundu uwu wa mankhwala oletsa ululu si anaika.

Mu kukhazikitsa puncture ayenera anaonetsetsa kuti singano wosayendapo kutali kwambiri ndi sakuwupweteka mizu ya chingwe msana. Zimasonyeza chakuti nsonga ya kale m'gulu danga subarachnoid, n'zotheka, ngati inu kuchotsa stylet. Kotero singano kumayamba allocated madzimadzi cerebrospinal. Ngati izo zifika intermittently kapena zedi osakwanira, m'pofunika pang'ono kusintha malo ake ndi kasinthasintha. Pambuyo masingano zolondola unsembe kuyamba kukhazikitsa njira anelgiziruyuschih. Mlingo wawo ndi zosakwana kwa epidural ndi.