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Hluav taws kub, nqus pa thiab hlawv: lub hom phiaj ntawm kev kho thiab kev kho mob

By Cristiano Antonino On Tej zaum 18, 2023

Hluav taws kub yog ib qho ua rau raug mob, tuag thiab kev puas tsuaj rau kev lag luam. Txhua xyoo, ntawm 15 thiab 25 lab hluav taws kub tshwm sim hauv Tebchaws Meskas, ua rau kwv yees li 25,000 raug mob, 5,000 tus neeg tuag thiab $ 7 txog $ 9 nphom hauv kev puas tsuaj nyiaj txiag

Kev puas tsuaj los ntawm kev nqus pa pa ua rau muaj qhov ua rau muaj kev tuag ntawm cov neeg mob kub hnyiab: nyob rau hauv cov ntaub ntawv no, kev puas tsuaj rau cov pa nqus pa yog ntxiv rau hlawv puas, feem ntau ua rau tuag taus.

Kab lus no tau mob siab rau kev kho mob ntawm qhov kub hnyiab, nrog rau kev siv tshwj xeeb rau kev mob ntsws thiab kev puas tsuaj hauv cov neeg mob kub hnyiab uas tau nqus cov pa luam yeeb, thaum cov kab mob dermatological yuav tham txog ntau yam nyob rau lwm qhov.

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Lub hom phiaj ntawm kev saib xyuas ua pa hauv cov neeg mob kub hnyiab yog los xyuas kom meej

airway patency,
kev ua pa zoo,
txaus oxygenation,
txhim kho acid-base tshuav nyiaj li cas,
txhim kho cov hlab plawv stability,
kev kho mob sai sai.

Qee qhov xwm txheej, kev ua escharotomy yog qhov tseem ceeb los tiv thaiv cov ntaub so ntswg thoracic los ntawm kev cuam tshuam lub hauv siab txav.

Lub hom phiaj ntawm kev kho mob ntawm daim tawv nqaij muaj xws li

tshem tawm ntawm daim tawv nqaij uas tsis siv tau
kev siv cov ntaub qhwv tshuaj nrog tshuaj tua kab mob,
kaw lub qhov txhab nrog kev hloov ntawm daim tawv nqaij ib ntus thiab hloov pauv ntawm daim tawv nqaij los ntawm cov chaw noj qab haus huv lossis cov qauv cloned mus rau qhov chaw hlawv,
txo cov kua dej thiab kev pheej hmoo ntawm kev kis kab mob.

Cov ntsiab lus yuav tsum tau muab siab tshaj basal caloric kom yooj yim kho qhov txhab thiab tsis txhob catapolism.

TSEEM CEEB TSHAJ PLAWS NTAWM KEV KHO MOB: Mus ntsib SQUICIARINI RESCUE lub rooj muag khoom thiab nrhiav seb yuav npaj li cas rau qhov xwm txheej kub ntxhov

Kev kho mob ntawm cov neeg mob kub hnyiab

Hlawv cov neeg raug tsim txom me me los ntawm txoj hlab pa sab sauv, los yog muaj cov tsos mob ntawm kev ua pa tsis ua pa lossis mob ntsws, yuav tsum tau saib xyuas kom zoo.

Oxygen supplementation yuav tsum tau muab, los ntawm lub qhov ntswg cannula, thiab tus neeg mob yuav tsum tau muab tso rau hauv Fowler txoj hauj lwm siab kom txo tau txoj kev ua pa.

Bronchospasm yuav tsum tau kho nrog β-agonists hauv aerosol (xws li orciprenaline lossis albuterol).

Yog tias qhov kev thaiv ntawm txoj hlab pas tau npaj tseg, patency yuav tsum tau ua kom ntseeg tau nrog lub endotracheal cannula ntawm qhov tsim nyog calibre.

Feem ntau, tracheostomy thaum ntxov tsis pom zoo rau cov neeg mob kub hnyiab, vim tias cov txheej txheem no cuam tshuam nrog kev sib kis ntau dua thiab muaj kev tuag ntau ntxiv, txawm tias nws yuav tsim nyog rau kev saib xyuas ua pa ntev.

Nws tau raug pom tias thaum ntxov intubation tuaj yeem ua rau lub sijhawm ntev pulmonary edema hauv qee cov neeg mob uas ua pa raug mob.

Daim ntawv thov ntawm qhov zoo siab ntawm 5 lossis 10 cm H2O (CPAP) tuaj yeem pab txo qis pulmonary oedema thaum ntxov, khaws lub ntsws ntim, txhawb nqa txoj hlab ntsws oedematous, txhim kho qhov cua / perfusion piv thiab txo cov neeg tuag ntxov.

Kev tswj hwm ntawm cov kab mob corticosteroids rau kev kho mob ntawm edema tsis pom zoo vim tias muaj kev pheej hmoo kis mob ntxiv.

Kev kho mob ntawm cov neeg mob comatose yuav tsum raug coj mus rau qhov hnyav hypoxia thiab CO lom thiab yog raws li kev tswj hwm ntawm oxygen.

Lub dissociation thiab tshem tawm ntawm carboxyhaemoglobin yog nrawm los ntawm kev tswj hwm ntawm O2 tshuaj.

Cov neeg uas tau nqus cov pa luam yeeb, tab sis tsuas yog muaj qhov nce me ntsis hauv Hbco (tsawg dua 30%) thiab khaws cov kev ua haujlwm ntawm lub plawv, yuav tsum tau kho nrog 100% O2 tus me nyuam, los ntawm lub ntsej muag nruj, tsis muaj lub ntsej muag (uas tsis tso cai. cov huab cua freshly exhaled yuav tsum tau inhaled dua), ntawm ib tug txaus npaum li cas ntawm 15 litres / feeb, kom lub reservoir puv.

Kev kho cov pa oxygen yuav tsum txuas ntxiv mus txog thaum qib Hbco poob qis dua 10%.

Lub npog ntsej muag CPAP, nrog 100% O2 kev tswj hwm, tej zaum yuav yog ib qho kev kho mob tsim nyog rau cov neeg mob uas mob hypoxemia thiab tsis muaj lossis tsuas yog mob me me rau lub ntsej muag thiab cov pa sab saud.

Cov neeg mob uas muaj refractory hypoxemia los yog inhalation raug mob txuam nrog coma los yog cardiopulmonary instability yuav tsum tau intubation thiab ua pa kev pab nrog 100% O2 thiab yuav tsum tau xa mus sai sai rau kev kho mob hyperbaric oxygen.

Cov kev kho mob tom kawg tau txhim kho kev thauj mus los oxygen sai sai thiab ua kom cov txheej txheem ntawm CO tshem tawm ntawm cov ntshav.

Cov neeg mob uas muaj mob pulmonary oedema thaum ntxov, ARDS, los yog mob ntsws feem ntau xav tau kev pab ua pa nrog qhov zoo kawg ntawm lub ntsws (PEEP) nyob rau hauv lub xub ntiag ntawm haemogasanalysis qhia tias ua pa tsis ua hauj lwm (PaO2 qis dua 60 mmHg, thiab/los yog PaCO2 saum 50 mmHg, nrog pH hauv qab 7.25).

PEEP tau qhia yog tias PaO2 poob qis dua 60 mmHg thiab FiO2 xav tau tshaj 0.60

Kev pab ua pa yuav tsum tau ua kom ntev, vim tias cov neeg raug mob hlawv feem ntau muaj cov metabolism hauv nrawm, uas ua rau nws tsim nyog los ua kom cov pa ntim hauv ib feeb kom ntseeg tau tias homeostasis raug tswj.

cov cov khoom Kev siv yuav tsum muaj peev xwm xa tau qhov ntim siab / feeb (txog 50 litres) thaum tswj kev siab siab siab siab (txog 100 cm H2O) thiab ruaj khov kev tshoov siab / exhalation (I: E) piv, txawm tias nws yuav tsum tau nce. cov nqi siab.

Refractory hypoxemia tuaj yeem teb rau lub siab-nyob ntawm qhov cua nrog qhov sib piv

Txoj kev huv pulmonary tsim nyog yuav tsum tau ua kom lub ntsws tsis muaj hnoos qeev.

Passive respiratory physiotherapy pab txhawm rau txhawm rau zais thiab tiv thaiv kev ua pa ntawm txoj hlab pas thiab atelectasis.

Tsis ntev los no daim tawv nqaij grafts tsis zam percussion thiab vibration rau hauv siab.

Kev kho mob fibrobronchoscopy tuaj yeem tsim nyog txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhaws.

Ua tib zoo saib xyuas cov dej sib npaug yog qhov tsim nyog kom txo qis kev pheej hmoo ntawm kev poob siab, lub raum tsis ua haujlwm thiab pulmonary oedema.

Rov qab kho tus neeg mob cov dej sib npaug, siv Parkland's mis (4 ml isotonic tov ib kg rau txhua feem pua ntawm qhov chaw ntawm daim tawv nqaij kub hnyiab, rau 24 teev) thiab khaws cov diuresis ntawm 30 thiab 50 ml / teev thiab lub hauv paus venous siab ntawm 2 thiab 6. mmHg, khaws cia hemodynamic stability.

Hauv cov neeg mob uas ua pa raug mob, capillary permeability nce, thiab saib xyuas pulmonary arterial siab yog ib qho kev qhia tseem ceeb rau cov kua dej ntxiv, ntxiv rau kev tswj diuresis.

Cov neeg raug hluav taws kub hnyiab, electrolyte thiab acid-base tshuav yuav tsum tau saib xyuas

Lub xeev hypermetabolic ntawm tus neeg mob kub hnyiab yuav tsum tau ua tib zoo tshuaj xyuas ntawm kev noj zaub mov kom zoo, txhawm rau zam kom tsis txhob muaj catabolism ntawm cov leeg nqaij.

Cov qauv kev kwv yees (xws li cov ntawm Harris-Benedict thiab Curreri) tau siv los kwv yees siv cov metabolism hauv cov neeg mob no.

Tam sim no, portable analyzers muaj nyob rau hauv kev lag luam uas tso cai rau kev ntsuas tsis ncaj qha calorimetry, uas tau pom tias muab kev kwv yees ntau dua ntawm cov khoom noj khoom haus.

Cov neeg mob uas muaj qhov kub hnyiab heev (ntau dua 50% ntawm daim tawv nqaij saum npoo) feem ntau yog cov khoom noj uas nws cov calorie ntau ntau yog 150% ntawm lawv cov so kom txaus los pab txhawb qhov mob thiab tiv thaiv catabolism.

Raws li kev kub hnyiab, cov khoom noj khoom haus tau nce zuj zus mus rau 130% ntawm cov metabolism hauv basal.

Nyob rau hauv cov ntaub ntawv ntawm circumferential kub hnyiab ntawm lub hauv siab, caws pliav nqaij yuav txwv tsis pub lub hauv siab phab ntsa txav.

Lub escharotomy (kev phais tshem tawm ntawm daim tawv nqaij burnt) yog ua los ntawm kev ua ob sab incisions raws anterior axillary kab, pib ob centimeters hauv qab lub clavicle mus rau lub cuaj mus rau kaum intercostal qhov chaw, thiab ob qho tib si transverse incisions stretched ntawm qhov kawg ntawm lub qub, thiaj li delimit ib square.

Qhov kev ua haujlwm no yuav tsum txhim kho elasticity ntawm lub hauv siab phab ntsa thiab tiv thaiv cov nyhuv compressive ntawm caws pliav cov ntaub so ntswg retraction.

Kev kho mob ntawm qhov kub hnyiab suav nrog kev tshem tawm ntawm daim tawv nqaij uas tsis tuaj yeem siv tau, siv cov ntaub qhwv ntsej muag nrog tshuaj tua kab mob, kaw lub qhov txhab nrog kev hloov daim tawv nqaij ib ntus thiab kev hloov ntawm daim tawv nqaij los ntawm cov chaw noj qab haus huv lossis cov qauv cloned mus rau qhov chaw kub hnyiab.

Qhov no txo cov kua dej thiab kev pheej hmoo ntawm kev kis kab mob.

Cov kab mob feem ntau yog tshwm sim los ntawm coagulase-positive Staphylococcus aureus thiab cov kab mob gram-tsis zoo xws li Klebsiella, Enterobacter, Escherichia coli thiab Pseudomonas.

Cov txheej txheem kev sib cais tsim nyog, kev ntxhov siab ntawm ib puag ncig thiab kev pom huab cua yog lub hauv paus ntawm kev tiv thaiv kab mob.

Kev xaiv tshuaj tua kab mob yog ua raws li cov txiaj ntsig ntawm kev coj noj coj ua ntawm cov khoom siv los ntawm qhov txhab, nrog rau cov ntshav, zis thiab cov hnoos qeev.

Cov tshuaj tua kab mob yuav tsum tsis txhob muab tshuaj prophylactically hauv cov neeg mob no, vim qhov yooj yim ntawm cov kab mob resistant tuaj yeem raug xaiv, lub luag haujlwm rau cov kab mob refractory rau kev kho.

Hauv cov tib neeg uas tsis muaj zog rau lub sijhawm ntev, heparin prophylaxis tuaj yeem pab txo qis kev pheej hmoo ntawm pulmonary embolism, thiab tshwj xeeb yuav tsum tau them nyiaj tshwj xeeb los tiv thaiv kev txhim kho ntawm cov kab mob pulmonary embolism. siab mob.