Endotracheal chubhu (endotracheal chubhu): zvitaera, hukuru, zvinangwa. Set nokuti intubation

Zvinosuruvarisa kubva siyana akuvara uye zvirwere havana kukwana. In Muzviitiko zvakaipisisa, unofanira pakarepo kubatsira munhu pakutambudzika. Kunyanya kana wakaremara, upenyu pangozi. Izvi zvinosanganisira zvokukurumidzira ezvinhu akadai akadai yemweya mhingaidzo, cardiac kusungwa, kurohwa nehana, pakoma. The mishonga pathologies izvi zvinofanira kuitwa yevanenge. Zvisinei, nokukurumidza chiito anofanira kutorwa pakarepo mushure kunyatsoongorora murwere, kureva panguva pavaipfuura zvashata. Mumotokari, "amburenzi" wakaisirwa tracheal intubation, mumwe defibrillator, Ambu bhegi. Izvi kurapwa mano vanosungirwa chete Muzviitiko zvakaipisisa, kana munhu haagoni kufema vakazvimiririra.

Chii endotracheal chubhu?

Sezvinotarisirwa, tracheal intubation rinoreva zvisingafadzi dzokuvhiya. Asi, pasinei zvingasanakira, zvakakodzera nezvikonzero zvoutano. Kuti vawedzere kuti Airways nechokuita kuwana reokisijeni kuti mapapu, kuti endotracheal chubhu akaiswa. Vanofanira kukwanisa intubate chiremba upi specialization. Kunyanya unyanzvi ichi inoda uye resuscitators anaesthesiologists, vanachiremba amburenzi. Pakatanga ari endotracheal chubhu yemapapu kufefetedza anova kuipa zvakare, zvisinei kuvadza Airways. Uyezve, achishandisa mashandiro ichi chinogona kuitwa kubata okisijeni zvitengeswa. Kune mhando dzakawanda endotracheal sepombi (20). Ivo dzinosiyana kukura uye pamberi kweimwe mashandiro (chipika). All zvokushandisa kuti intubation akakamurwa 2 mhando: unodiridzwa uye nasotracheal chubhu. Vakasiyana munzira kupinda kune kufema hurongwa. Muchiitiko chokutanga, kuti endotracheal chubhu iri akaiswa achishandisa muromo, rechipiri - kuburikidza nasal ndima. In zvose embodiments, nemamwe matambudziko zvingamuka nokuda kukuvara nenyere. Saka, asati pakusarudza nzira chourongwa pamusoro chubhu, unofanira kuongorora ngozi. Zvisinei, intubation zvinofanira kuitwa kana zvakakodzera kuti muviri anokosha.

Zvairatidza kuti atarisire zviri endotracheal chubhu

In kwazvo inoti kupa yemweya zvinogoneka chete Pakusuma tracheal chubhu mumiromo kana nasal mhango. Kazhinji, murwere haafungi marwadzo panguva nzira. Sezvo vanhu vakanga zvinoda nokumutswa, kakawanda afenda. Pane zvinotevera zvairatidza kuti tracheal intubation:

1. Kudiwa zvokuimba kufefetedza. Zvokuimba kufefetedza rinoitwa kwete chete panguva padariro zvashata rubatsiro, asi naiyewo ICU. Patinoita nzira izvi hazvibviri pasina tracheal intubation.
2. Kudiwa zvayo yokutindivadza. In iyiwo, pakatanga pneumatic chubhu runodiwa. Pashure pezvose, panguva vakawanda yokutindivadza relaxes zvose tsandanyama, kusanganisira kufema netsandanyama.
3. Implementation kuti tracheal uye Árbol lavage. nzira Izvi zvinoratidzwa Varwere vane kuenda madzihwa, dumbu zviri mukati yemweya.
4. Improvement negasi mukutsinhana pakati mapapu uye zvakatipoteredza.

Zvinonzi vaidavira kuti endotracheal chubhu kutaurwa nemiromo (orotracheal) kunoratidzwa kwazvo ezvinhu. Pakati pavo - kurega kufema uye mwoyo basa (navanachiremba vafa) , uye chaanoziva chero mavambo. Nasotracheal sumo ane matambudziko vashoma uye anonzi zvikuru vasiri. Kunyange zvakadaro, nokuti kudzivirira chakasimba kufema kukundikana, vanachiremba kakawanda yokusuma kumicheto achishandisa muromo.

Zvaitibatsira tracheal intubation

In yevanorwara zvikuru nyanzvi vanofanira nguva dzose kuva yakarongwa nokuda tracheal intubation. It kunochengetwa mubhokisi hunokosha zvokushandisa akagadzirirwa pulmonary kufefetedza. Set nokuti intubation vakatakura kubva yevanenge kana zvakakodzera. Izvi zvinoshandawo zviitiko apo murwere kukurumidza akaratidza zvokuimba kufefetedza. Medical Zviridzwa zvinowanikwa yakatarwa:

1. Laryngoscope. Kombiyuta chinomiririrwa huru mbiri zvinoriumba - chipande uye mubato. It anoshanda kuvonga kuti bhatiri kana mabhatiri. Vari rakapinzwa mubato pamusoro laryngoscope. The mashizha kuuya hukuru siyana uye zvitarisiko (curved uye ngaatarire). Chikamu ichi chiri akaiswa munzvimbo nomumukanwa mhango. Panoperera chipande ane chiedza kuti rinovheneka Airways. Selection laryngoscope Kukura kunobva murwere zera, nezvevakafa nomumukanwa mhango.
2. Mhando dzakasiyana-siyana endotracheal sepombi. Mbuva zvinosanganisira maturusi kuti intubation zvose vakuru nevana. Vakasiyana kukura, kuvapo kana pasina cuff, rokunze dhayamita, urefu uye uwandu lumens. With sepombi izvi zvinogona kuitwa zvose unodiridzwa uye nasotracheal intubation. Kakawanda vakadzi vanoshandisa mutsinga dzinofamba nemukaka saizi 7-8, varume - 8-10. Aine maonero kuti intubation wevarwere vakura zvinoda endotracheal chubhu ine cuff. Kuti ave nechokwadi chokuti patency pakati Airways vana - pasina izvozvo.
3. Muitisi endotracheal chubhu kupa achida vanobwembura.
4. Curved forceps.
5. Nebulizer zvinodhaka nokuti yokutindivadza.

Pasinei chokwadi kuti uchidzidzira haashandisi zvose ane yakatarwa maturusi, kuvapo kwavo zvakakodzera zvizere.

Mune zvimwe zviitiko, okusuma ari endotracheal chubhu nezvisingabvumwi?

Kunyange zvazvo intubation zvinoreva zvakafanira nzira, ine nhamba contraindications. Idzi dzinosanganisira: akuvara mutsipa, namamota ari nemumuromo uye nasal in, kuzvimba Airways. Muzviitiko izvi, okusuma chubhu kuuya kubatsira asi chete zvinobatsira kuti pave kwazvo yematambudziko (gwanza rinenge musana kukuvara). Saka, asati vanoita kuti intubation, zvinokosha kuongorora muromo uye mhuno, nyatsoteerera mamiriro yokumusoro nomuzongoza.

Mukuwedzera, okutanga ari endotracheal chubhu zvingava zvakaoma pasi zvimwe zvinhu, asiri contraindications. Pakati pavo: norurimi guru, pfupi mutsipa, kana shaya, kufutisa, yekudyidzana yakabudikira meno pamberi, rakamanikana muromo uye trachea anomalies. In pamberi vakadaro Mumagazini murwere, intubation inofanira kuitwa nokungwarira. Muzviitiko izvi, zvatinofarira hunopiwa pakatanga nasotracheal chubhu. Zvinofanira kuva 1-2 saizi duku.

Chidobi kuti intubation

Orotracheal intubation rinoitwa sezvinotevera:

1. Patient anoiswa pamusoro zvakaoma pamusoro, vanorasira shure musoro wake zvishoma uye kusunda rezasi shaya mberi. Somugumisiro, okumusoro incisors vari yemweya pane imwe ndege. Kana zvichiita, anoiswa pasi pamutsipa roll.
2. Kana zvakakodzera, yakaidzwa muromo vomitus, clots tsvina.
3. Kupinda laryngoscope chipande (kurudyi). Zvakakosha kwete kubata mucosa mumuromo uye meno.
4. Zvadaro, endotracheal chubhu akaiswa. Chobudira muromo uye pahuro. At ufanane pahuro zvinokonzera, kuti chubhu anofanira kunyatsoongorora wakavhomorwa pakati pavo mhango pakati trachea.
5. Laryngoscope chinobviswa.
6. Achiwedzeredza munhu cuff kuti kugadzira kune endotracheal chubhu.

Nasotracheal intubation rinoitwa zvikuru zvakafanana. Kusiyana chisarudzo pamusoro chubhu wayo sumo munzvimbo nasal mhango. Panyaya iyi, kuti laryngoscope harishandiswi.

How kuita kufefetedza pakati mumapapu nevana?

Pane zviitiko apo tracheal intubation zvakakodzera kuita vana. Kakawanda, zvakakodzera kuti yakadzika aborted mudumbu. Uyewo intubation kungava kwakakodzera mune neonatal nguva Detective zvikanganiso zviri kufema uye kumwoyo. Muzviitiko zvacho zvose, runodiwa zvokuimba kufefetedza. Zvairatidza kuti intubation ari mudiki uye wechikuru makore pauduku zvakafanana kuti vakura. Pakati pazvo pane: chenjera kufema kukundikana, pakoma, kuitisa mukuru yokutindivadza.

Chii rapanzvimbo kudzika intubation?

Kusimba uko unofanira kupinda endotracheal chubhu, zvinoenderana kwayo ukuru uye kurema mwana. Kuti aite izvi, shandisa chaiyo pezvose. Zviri kushandiswawo vakurumidze uye vana vachangoberekwa. Aine kurema makirogiramu mwana 1 kushandisa saizi 2,5 endotracheal chubhu. udzamu Its kunoyerwa kubva kwokubatsira nemiromo uye 6-7 cm. uremu Rinodzora 2 makirogiramu anoshandiswa chubhu Kukura yakaenzana 3. jekiseni udzamu inofanira kuva kupfuura 8 cm. Kana mwana anoyera pakati 2 uye 4 makirogiramu kureva mutsinga dzinofamba nemukaka saizi № 3 5. Kusimba mune iyi inobva 9 kusvika 10 cm. Nokuti vachangoberekwa navacheche, ane uremu kupfuura 4 makirogiramu, uchishandisa kumicheto 4 saizi. The kudzika Sumo - 11 cm.

Chii chinogona kuva zvakaoma kunzwisisa pashure tracheal intubation?

Zvinofanira kurangarirwa kuti pakatanga yacho endotracheal chubhu ngozi kuomesa akadai kuvadza mucous Kamudzira pakati zvomukati. Naizvozvo, kumonyanisa ichi zvinofanira wakaitiswa ruzivo nyanzvi. The yevanenge, asati atanga intubation, yokutindivadza rinoitwa. Rakajairika yematambudziko dzinosanganisira: kukuvara pameno, iyo mucosa ari pharynx, yegurokuro kupinda chubhu. Kuti izvi zvisaitike, zvakakodzera nokungwarira kuongorora murwere ezvinhu.

Kuisa ane endotracheal chubhu: nyanzvi pfungwa

Chidobi kuti intubation ane chiremba ose. Kunyange zvakadaro, zvakanaka kuti vaite izvi kuchinja intensivists uye Anesthesiologists. Maererano navo, pasina kurovedza chaiyo, uye pasina chena ezvinhu, hazvibviri kuti tracheal intubation. Chokwadi, zvakaoma kunzwisisa nzira iyi angava kusingarapiki. Kunyange zvakadaro, kupa rubatsiro nezvikonzero zvoutano vanosungirwa chiremba upi dzakagadzirirwa rokutanga.