Ukuqonda iingozi zempilo
Ngaba ukhathazekile ngomngcipheko we-anesthesia ngenxa yesifo esingapheliyo se-pulmonary disease (COPD) ?
Ukuhlanganiswa kweCOPD kunye ne-aneshesia kungabangela ingozi enkulu. Izinga lokusinda ixesha elide labantu abaneCOPD ezinzulu abanokuhlinzwa ngokusoloko behluphekile. Kukho umngcipheko omkhulu woxinzelelo lwe-postoperative, ngakumbi kwimimopho. Kodwa ngaba oko kuthetha ukuba izigulane zeCOPD akufanele zenze utyando?
Nawuphi na uhlobo lotyando luquka iingozi. Ukuchonga ingozi ekuqaleni kwexesha eliphambili, ukulungiswa kwangaphambili kokusebenza, kunye nokuphathwa kwe-anesthesia efanelekileyo kunokuncedisa ukunciphisa loo ngozi. Masiqwalasele ngokuthe ngqalelo oko oku kubandakanya:
Ukuchonga Ingozi
Ukuchonga ingozi ekuqaleni kwexesha eliphambili lokuqala liqala ngembali epheleleyo kunye nokuhlolwa kwangokwenyama. Iingxaki ukuba ugqirha wakho unokuzibuza zibandakanya:
- Ukunyamezela kwakho ukunyamezela , ikakhulukazi ngokunyuka kweenduli kunye nezitebhisi.
- Ukuba, kwaye kaninzi kangakanani, uye wavelisa ukukhushulwa kwe-COPD kwaye ukuba wabuyela esibhedlele.
- Ukuba uke wacela ukungena okanye ukungena kwemishini ukuze kukuphefumule.
- Ingxelo yakho yokutshaya
- Ukuba okwamanje ukhwehlela kunye / okanye ukuvelisa i-sputum -bonke baye badibana nomngcipheko ophezulu weengxaki zokuhamba emva kokusebenza.
- Naliphina ezinye izifo -engxaki yokungaboni kakuhle kweemeko zonyango ezikhoyo (kubandakanyeka kweemeko) kubaluleke kakhulu ekuboniseni izinto ezinobungozi.
- Ingaba unayo okanye unayo iimpawu kunye neempawu zentsholongwane ekhuphayo yamaphaphu.
- Isimo sakho sezondlo -ziguli eziphantsi kokunciphisa umzimba kunye nokugqithisa kakhulu kunobungozi obandayo .
Izenzo zokuSebenza
U vavanya
Ngaphambi kokuhlinzwa, ugqirha wakho unokuyalela nayiphi na okanye zonke ezi zilandelayo:
- I-xst ray ye-Chest - inceda ukuchonga izifo ezikhoyo zamaphaphu okanye iingxaki ezingaphezulu kwimiphunga.
- I-EKG- inceda ukunceda iingxaki zentliziyo ezinokunyusa ingozi yokuhlinzwa.
- I-Spirometry - isetyenziswe kokubili ukuxilonga nokucacisa ubunzima beCOPD.
- Uvavanyo lwe-Lung diffusion - uxelela ugqirha wakho ukuba i-oksijeni idlula njani i- alveoli yakho kwigazi lakho.
- Uvavanyo lokuhamba ngomzuzu-ezintandathu- lunceda ukuseka ukunyamezela.
- Iigesi zegazi ezichaphazelekayo - zinceda ukuchonga i-oxygen engaphambili kunye ne-carbon dioxide egazini.
Ukucwangcisa
Ukulungiswa kwangaphambili kwemisebenzi kubandakanya umgudu wokusebenzisana phakathi kwakho kunye nogqirha kwaye unokwahlula kwiididi ezine ezilandelayo:
- Ukuyeka ukutshaya. Ngenxa yokuba ababhemayo banomngcipheko omkhulu wokuphuhliswa kwemiphunga emaphaphu emva kokuhlinzwa, abo bashunayo kufuneka bayeke ubuncinane iiveki ezisibhozo ngaphambili. Ukuba usabhema, qwalasela eli khokelo elipheleleyo lokuyeka ukutshaya.
- Ukusetyenziswa kweziyobisi ngonyango. Uninzi lwezigulane ze-COPD zinokuzuza ngokuthatha ubuncinane umthamo omnye we-bronchodilator engabonakaliyo phambi kokuba usebenze. Ukuba ufuna ukuxubha kwizonyango zakho malunga naloo nto, okanye ukuba usebenzisa i-inhaler endaweni ye-nebulizer, khangela ukuba isicatshulwa-nyathelo-sinyathelo sendlela yokusebenzisa i-nebulizer ukuqinisekisa ukuba uyafumana inzuzo epheleleyo zakho unyango. Ukongeza, ukuba ungowesininzi kwaye uzama ukukhumbula ukuba yiphi imithi yenza ntoni kwiCOPD, khangela le ngcaciso ekuqondeni i-bronchodilators yakho .
- Unyango lwentsholongwane kunye / okanye ukunyanzeliswa. Ukuba nesifo sofestile okanye ukukhushulwa kweCOPD kunokuncitshiswa kwe-anesthesia. Ukungqinelana nje kuyindlela ekhethekileyo yokuthi awukwazi ukuhlinzwa. Iimpawu kunye neempawu zentsholongwane echaphazelekayo kufuneka ziphathwe ngamayeza okulwa nexesha elithile ngaphambi kokuba usebenze.
- Physiotherapy. Ukucoca i-mucus ngaphambi kokuhlinzwa kunokunceda ukususa ukugqithisa, okungabangela ukufakelwa kwe-post-operation okanye i-pneumonitis. Khawukhumbule malunga nalezi zicwangciso ezinhlanu zokungena kwindlela yokuhamba nomoya kwaye ukhangele oku kutshabalalisa i- muscus kunye ne-postural drainage .
Ukulawula iingozi ngexesha loPhengululo
Ugqirha wakho kunye ne-anesthesiologist baya kusebenzisana ukulawula ingozi ehambisana ne-anesthesia ne-COPD ngexesha lokuhlinzwa.
Iingxaki ezibalwe apha ngezantsi zimbalwa zeengxaki eziza kujongwa ngazo:
- Bronchospasm
- V / Q engafanelekanga
- Iipukisi zeMucus
- Pneumothorax
- I-hypo-vententi ye-post-operative
Kutheni Uhlobo lweeAnesthesia Matters
Ukuba kunokwenzeka, ukuphepha i-anesthesia jikelele ngokufanelekileyo kukunciphisa ingozi. Thetha ugqirha malunga neendlela ezinokwenzeka, ezifana ne -aneshesia yendawo okanye yengingqi . Izifundo ziye zafumanisa ukuba abantu abaneCOPD banomngcipheko omncinci we-pneumonia kunye nokuxhomekeka kwe-ventilator ukuba i-anesthesia yesithili isetyenziswe endaweni ye-anesthesia jikelele. Ukunciphisa ixesha lotyando kunye nobude bexesha ophantsi kwe-anesthesia jikelele, ukuba oko kuyadingeka, kunokuba luncedo.
Iingxaki ezinokwenzeka
Siye sathetha malunga nokunciphisa ingozi, kwaye mhlawumbi uye wakuva kwabanye ukuba ukuhlinzwa kunye neCOPD kuyingozi, kodwa yintoni kanye eyenzekayo? Ziyintoni, ingakumbi, ezo ngozi? Abanye abantu banqwenela ukwazi ukuba kwenzekani, kodwa abanye bengafuni ukucinga ngako. Ukuba ungumntu onqwenela ukwazi, zizinto ezimbalwa ezinokuthi zenzeke nje ngeengxaki xa abantu abaneCOPD behlinzwa nge-anesthesia jikelele.
- Izifo ezinobungozi ezifana ne-pneumonia
- I-Sepsis ("umzimba wonke" usulelo olubi kakhulu)
- I-Pneumothorax (umphunga owenziwe)
- Ukungaphumeleli kokuphefumula
- Ukuphulukiswa kwephulo elibi
- Ukungakwazi ukucima ukutshala kwe-mechanical - Ukuhlinzwa okuqhelekileyo, ityhubhu ifakwe kwindlela yakho yokuhamba umoya ukubonelela umoya. Okuxhalabisa kakhulu ngesifo somphunga kukuba ukunyanzeliswa okongeziweyo kokuhlinzwa kwiimiphunga kukukwenza ube "ngumxhasi womoya" nangona ubukade uphefumla ngaphandle koko uncedo.
- I-Hypoxia - Umonakalo weTisue kunye nokufa kweselingo ngenxa yokungasebenzi ngokwaneleyo komzimba, kubandakanya ubuchopho.
- Iimpawu zegazi kunye ne-pulmonary emboli ziqheleke kakhulu kubantu abaneCOPD, ingakumbi ukuba utyando ludinga ukuba ungasebenzi ngexesha elithile.
- Ukubanjwa kwe-cardiac
Zonke izigulane zeCOPD zibeka ingozi enkulu ekuphuhliseni iingxaki emva kokuhlinzwa okubandakanya i-anesthesia. Ulawulo olusebenzayo kwisigaba ngasinye sokungenelela ngongxamiseko kubalulekile ekuqinisekiseni ukubuyiswa okulula.
Imithombo:
Cheng Q, Zhang J, Wang H, et al. Impembelelo ye-Hypercapnia eMpembelelo kwiZiphumo kunye nezinto eziPhambili zeengozi zeZingxaki eziphakathi kwezigulane ezitholwa ngamanyathelo angenelo lweBronchoscopic phantsi kwe-General Anesthesia. PLos One . 2015. 10 (7): e0130771.
UHausman M, Jewell E, Engoren M. uMmandla weeNgqungquthela kwi-General Anesthesia kwizigulane eziPhezulu ezinezifo ezingapheliyo zokuzikhusela izifo: Ngaba ukugwema i-Anesthesia jikelele kuNciphise ingozi yokuPhathwa kweeNgxaki? Anesthesia kunye neAlgesgesis . 2015. 120 (6): 1405-12.
Kim H, Lee J, Park Y, et al. Impembelelo yamaGOLD e-GOLD of Obstructive Disease on Complications Complications. I-International Journal ye-Pulmonary Disease . 2016. 11: 281-7.
Kiss G, Claret A, Desbordes J, Porte H. Thoracic Epidural Anesthesia yeVukan Thoracic Surgery kwii-Dyspnoeic ezigulane kakhulu ezibangelwa yi-General Anesthesia. I-Interactive Cardiovascular and Thoracic Surgery . 2014. 19 (5): 816-23.