Kutulutsa mpweya m'mapapo si njira yokhayo yomwe wodwala amafunikira: Covid-19 ya chaka chino yapanganso gawo la momwe thandizo la wopulumutsirali lasinthira komanso kuchuluka kwake

Ndendende chaka chimodzi chapitacho, gawo lalikulu la ambulansi zonyamula zimakhudza odwala opwetekedwa mtima, komanso maulendo apakati komanso opitilira kuchipatala.

Masiku ano, mpweya wabwino umagwira ntchito, ndipo ndikofunikira kuti uzolowere, ngakhale pang'ono chabe.

Inde, mpweya wabwino wa m'mapapo ndi chiyani? Kodi mpweya wopumira umagwira ntchito yanji pamoyo watsiku ndi tsiku wopulumutsa kapena wothandizira zaumoyo?

Kutulutsa mpweya m'mapapo, kochita kupanga kapena kwamakina kumalowetsa m'malo kapena kumathandizira zochitika za minofu yolimbikitsira, kuwonetsetsa kuchuluka kwamagesi m'mapapu.

Ndi njira yodziwikiratu, yodziwikiratu komanso yolimbitsa thupi, yoyendetsedwa ndi malo apamwamba omwe, ndi mafupa am'mafupa a m'mimba ndi kupumula, pamimba ndi nthiti, amalimbikitsidwa kusinthana kwa mpweya mu alveoli.

Pakuthira mpweya, kuthamanga kwa intra-alveolar kumakhala koyipa pang'ono kuyerekeza ndi kuthamanga kwa mumlengalenga (-1mmHg), ndipo izi zimapangitsa kuti mpweya uzilowera mkatimu.

Kumbali inayi, panthawi yotulutsa mpweya wambiri ma intra-alveolar pressure umakwera kuzungulira + 1mmHg, ndikupangitsa mpweya kutuluka kunjaku.

Chida chomwe chimagwira ntchitoyi chimatchedwa makina opumira m'mapapo kapena makina opumira kapena opangira opangira.

Mpweya wotsekemera umalowa m'malo mwa makina opumira m'makina athunthu kapena mbali ina pamene makina opumira amatha kulephera kugwira ntchito yakeyokha chifukwa cha matenda, zoopsa, zolakwika zobadwa nazo kapena mankhwala (monga anesthetics panthawi yochita opareshoni).

Mpweya wotsekemera umatha kusakanikirana ndi mpweya wamafuta m'mapapu kuwalola kutulutsa mpweya wodziwika bwino komanso kuthamanga koyenera.

Kuti mupereke mpweya wokwanira kwa wodwalayo ndikuchotsa mpweya woipa wopangidwa, mpweya wabwino uyenera:

- osakanikirana ndi mpweya kapena mpweya wosakanizika m'mapapu;

- siyani kusakwanira;

- lolani mpweya wotuluka kuthawa;

- kubwereza ntchito mosalekeza.

Mosiyana ndi mpweya wabwino wachilengedwe, popuma mpweya pogwiritsa ntchito mpweya wopumira, kupanikizika kumakhala koyenera osati munjira zakumpweya zokha komanso mothandizanso.

Pofuna kukulitsa mapapo ndi nthiti, opumira amayenera kutumiza mpweya mopanikizika: mapapo nthawi zonse amakhala pampanipani wamlengalenga, ngakhale kulibe kutuluka.

Kutulutsa kwa makina, pokhala pamavuto abwino, kumabweretsa kuwonjezeka kwa kusinthana kwa kupuma, ndikutsegulanso malo opanda mpweya wabwino kuti alowe mpweya, koma nthawi imodzimodzi kumatha kuvulaza dongosolo la kupuma (barotrauma).

Mawotchi othandizira amagwiritsidwa ntchito ngati:

- pachimake kwambiri matenda m'mapapo

- matenda obanika kutulo obwera chifukwa cha kupuma (komanso kuledzera);

- kwambiri ndi pachimake mphumu;

- pachimake kapena matenda kupuma acidosis;

- zolimbitsa thupi / kwambiri hypoxemia;

- kwambiri kupuma ntchito;

- kulumala kwa diaphragm chifukwa cha matenda a Guillain-Barré, Myasthenia Gravis, vuto lalikulu la muscular dystrophy kapena amyotrophic lateral sclerosis, Msana kuvulala kwa chingwe, kapena zotsatira za mankhwala oletsa ululu kapena otsitsimula minofu;

- kuchuluka kwa ntchito ya minofu ya kupuma, kuwonetseredwa kwakukulu kwa tachypnoea, supraclavicular ndi intercostal kukonzanso kulowa ndi kuyenda kwakukulu kwa khoma la m'mimba;

- hypotension ndi mantha, monga congestive mtima kulephera kapena sepsis.

Kutulutsa mpweya m'mapapo, mitundu yama mpweya opumira

Pali mitundu yosiyanasiyana yama makina opumira:

- zoipa kuthamanga makina makina

- kuthamanga kwa makina opumira

- makina osamalitsa mwamphamvu kapena othandizira kwambiri (kapena zoyendera mwadzidzidzi / zamankhwala)

- makina opumira makina osamalidwa mwapadera kapena osamalidwa kwambiri (kapena zoyendera mwadzidzidzi / zamankhwala)

Kuphatikiza apo, makina opumira amagawika:

- Wowononga Mpweya

- Mpweya Wowonongeka

Kukakamira koipa kwa makina opangira makina

Kupanikizika koipa kwamakina otulutsa mpweya kumaimira m'badwo woyamba wama makina opumira, omwe amadziwikanso kuti mapapu achitsulo.

Mpweya wachitsulo, mwachidule, umangopanganso makina opumira omwe amalembedwa pamikhalidwe yabwinobwino yomwe myopathy kapena neuropathy imapangitsa kukhala kosatheka ndi kusakwanira kwa minofu ya nthiti.

Machitidwe opanikizika akugwiritsabe ntchito, makamaka kwa odwala omwe ali ndi minofu yosakwanira ya thoracic, monga poliomyelitis.

Kupanikizika kwabwino kwamakina opangira makina / opangira (osagwira)

Zida izi zimapangidwira mpweya wabwino wosasokoneza, kuphatikiza kunyumba kuti azithandizira matenda obanika kutulo.

Mpweya wotulutsa mpweya umagwira ntchito popanga mpweya wosakanikirana (nthawi zambiri mpweya ndi mpweya) mopanikizika mumlengalenga wa wodwalayo.

Zida zopumira kunyumba (zamagetsi zamagetsi zamagetsi)

Pisitoni kapena mpope wobwezeretsanso: Amasonkhanitsa mpweya ngakhale atapanikizika pang'ono, amawasakaniza ndikuwakankhira kudera lakunja panthawi yolimbikitsira.

Zosagwira ntchito polipira kubwereka

Chopangira mphamvu: Amakoka mpweya, amawapanikiza ndi kuwatumiza kwa wodwalayo kudzera pa valavu yolimbikitsira njira imodzi.

Amatha kuwongolera kukakamira pakuyenda ndikutulutsa voliyumu.

Ma ventilator apanyumba (chopangira mphamvu chopanda mpweya wochepa):

1. CPAP ndi autoCPAP

1. Mulingo wanthawi zonse

3. Pressovolumetric

1. CPAP ndi autoCPAP (osati mpweya wabwino koma mtundu wa makina opumira)

- amagwiritsidwa ntchito pochiza matenda ogona;

- CPAP imapereka chiwonetsero chofanana chotsimikizika pamipikisano yonse yomwe imalepheretsa kugwa kwa ndege;

- CPAP yokhayo imapereka kukakamizidwa kwabwino m'magulu onse awiri a kupuma malinga ndi zosowa za wodwalayo panthawiyo (zovuta zimayikidwa).

2. Mbali yachiwiri

- makina osinthira omwe ali owopsa omwe amapereka mafunde awiri: IPAP (kupsinjika kolimbikitsa)

- musalole kuwunika momwe mpweya ulili;

- amagwiritsidwa ntchito pochiza matenda ogona;

- pamene CPAP siyikonza apnea ndi / kapena matenda obanika kutulo kapena hypoxemia yokhudzana.

3. Makina opumira ma Pressuvolumetric

Izi zimalola kugwiritsa ntchito makina opanikizika kapena opumira mpweya wabwino. Amadziwika ndi dera lomwe amagwiritsidwa ntchito.

Kutulutsa mpweya m'mapapo mwa chisamaliro champhamvu (pneumatic energy source)

Mphungu makina olowera imatha kugwira ntchito m'njira zowonongera komanso zosasokoneza mpweya wabwino, zochepa mwazinthu zazikulu ndi izi:

- Amagwira ntchito ndi mpweya wothinikizidwa kwambiri (4 BAR)

- Perekani kukhazikika kwa FiO2

- Amatsimikizira kutumizidwa kwama voliyumu ngakhale atakhala ndi vuto lalikulu (wodwala kwambiri)

FiO2 ndi kachigawo kakang'ono ka O2. Ndichidule chomwe chimagwiritsidwa ntchito ngati mankhwala posonyeza kuti% ya mpweya (O2) wopumira wodwala.

FiO2 imawonetsedwa ngati nambala pakati pa 0 ndi 1 kapena peresenti. FiO2 mumlengalenga ndi 0.21 (21%).

Mpweya wopumira umakhala ndi zinthu zotsatirazi

- jenereta woyenera wokhoza kupanga kupsyinjika pakati pamalengalenga akunja ndi alveoli, kuwonetsa kuchuluka kwa mpweya womwe ungakhale woperewera kwa wodwalayo.

Ntchitoyi imatheka mwina pakupanga mphamvu yomwe imagwiritsidwa ntchito kuphulika komwe kumakhala mpweya wosakanikirana, kapena pochepetsa kuthamanga kwa mpweya kwadongosolo lokhazikika kudzera pamagetsi angapo osokonekera;

- metering dongosolo la voliyumu yaposachedwa (VT);

- zida zingapo za nthawi yopumira yomwe, potsegula moyenera ndi kutseka mavavu omwe amayendetsa mayendedwe olimbikitsira komanso otulutsa, amalola kusintha kuchokera ku kudzoza kupita kumapeto ndipo mosemphanitsa;

- dera la wodwala, lomwe limakhala ndi ziwalo zonse zomwe zimalumikiza makina opumira ndi dongosolo la kupuma kwa wodwalayo. Pakhoza kukhala ma circuits otseguka (osapumanso), omwe amatulutsa mpweya uliwonse kunja, kapena ma circuits otsekedwa ndi ma CO2 absorbers kudzera momwe mpweya wa wodwalayo umapezekanso pambuyo pa kuyamwa kwa CO2;

- Zinthu zotsutsana zomwe zimakhala ndimadontho onse ophatikizika pakati pamagetsi abwino ndi makina opumira omwe amachititsa kuti mpweya usayende bwino.

Mpweya wabwino: momwe mpweya umagwirira ntchito

Ma ventilator amapatsa njira zosiyanasiyana zogwirira ntchito kuti zisinthidwe malinga ndi zosowa za wodwalayo.

Njira yayikulu yomwe azachipatala amasankhira mtundu wa mpweya wabwino ndi kuthekera kwa wodwalayo kupuma pawokha.

Njira yoyendetsedwa imasankhidwa pomwe wodwala alibe zochitika zapuma zokha ndipo amafuna kuti adokotala asinthe nthawi yogwiritsira ntchito (nthawi yolimbikitsira, kutha ntchito, kupumula kwakanthawi, kulimbikitsidwa pafupipafupi) pagulu loyang'anira mpweya wabwino.

Pali zotheka ziwiri zothandizila mpweya wabwino: kutuluka kwa mpweya mosalekeza komanso kupuma kwapompopompo, kutengera kuchuluka kwasankhidwe (kayendedwe kapena kukakamiza) monga gawo loyang'anira mpweya wabwino.

Njira yothandizirayi imagwiritsidwa ntchito polephera kupumira odwala omwe angathe kuyamba gawo lolimbikitsira.

Wopumira m'mapapo ayenera kudziwa zoyesayesa za wodwalayo polimbikitsa ndikuthandizira kutero.

Pomaliza, njira yolumikizirana imakhala ndi gawo loyambirira momwe wodwalayo amakhala ndi mpweya wabwino potumiza mpweya wina m'mapapu munthawi yodziwikiratu, munjira yoyendetsedwa mosalekeza; Izi zimatsatiridwa ndi nthawi yopumira mwadzidzidzi ngati wodwalayo apezanso magwiridwe antchito, kapena ndi nthawi yothandizira pakakhala zovuta.

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Source:

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