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Kumira m'madzi amchere kapena dziwe losambira: chithandizo ndi chithandizo choyamba

By Cristiano Antonino On Jun 24, 2022

Kumira muzamankhwala kumatanthauza mtundu wa asphyxia pachimake chifukwa cha zomwe zimapangidwira kunja kwa thupi, zomwe zimadza chifukwa chakuti malo am'mapapo a alveolar - omwe nthawi zambiri amakhala ndi mpweya - amadzazidwa ndi madzi pang'onopang'ono (mwachitsanzo, madzi amchere). Kumira m'nyanja kapena madzi a chlorini ngati amira m'dziwe losambira)

Madziwo amalowetsedwa m'mapapo kudzera mumsewu wapamwamba wa mpweya, womwe umachitika, mwachitsanzo, munthu akakomoka kwathunthu ndikugwera pansi pa mlingo wamadzimadzi, kapena akazindikira koma amakankhira pansi pa mlingo wa madziwo. mphamvu yakunja (monga mafunde kapena mikono ya wachiwembu) ndipo imatuluka mpweya m'mapapo ndi mpweya Usanabwerere kumtunda.

Kumira - kupha m'mphindi zochepa - sikumapha nthawi zonse, komabe: nthawi zina kumatha kuchiritsidwa bwino ndi njira zoyenera zotsitsimula.

Imfa yomizidwa m'madzi inali kugwiritsidwa ntchito ngati chilango cha imfa pamilandu ina, mwachitsanzo, mlandu woukira boma m'zaka za m'ma Middle Ages.

ZOFUNIKA KWAMBIRI: Ngati wokondedwa wanu adamirapo ndipo simukudziwa choti muchite, choyamba funsani chithandizo chadzidzidzi mwamsanga poyimba Nambala Yodzidzimutsa.

Kuopsa kwa kumira kumagawidwa m'madigiri 4:

Digiri ya 1: wozunzidwayo sanapume madzi, akupuma bwino, ali ndi mpweya wabwino wa ubongo, alibe kusokonezeka kwa chidziwitso, amafotokoza bwino;

Digiri ya 2: wozunzidwayo adakoka zakumwa pang'ono pang'onopang'ono, mabala ophwanyika ndi / kapena bronchospasm amatha kuzindikirika, koma mpweya wabwino ndi wokwanira, chikumbumtima sichili bwino, wodwalayo amasonyeza nkhawa;

Digiri ya 3: wovutitsidwayo adakoka zakumwa zochulukirapo, amawonetsa ma rales, bronchospasm ndi kupuma mavuto, imayambitsa cerebral hypoxia yokhala ndi zizindikiro zoyambira kusokonezeka mpaka kuuma mtima, mpaka kufika pamtima, kugunda kwa mtima kumakhalapo;

Digiri ya 4: wozunzidwayo adakoka madzi ambiri kapena amakhalabe mu hypoxic mpaka kumangidwa kwa mtima ndi kufa.

ZOFUNIKA: zizindikiro zazikulu kwambiri za kumira zimachitika pamene kuchuluka kwa madzi omwe amakokedwa kupitirira 10 ml pa kilogalamu ya kulemera kwa thupi, mwachitsanzo theka la lita imodzi ya madzi kwa munthu wolemera makilogalamu 50 kapena 1 lita ngati akulemera makilogalamu 100: ngati kuchuluka kwa madzi. Zochepa, zizindikiro zimakhala zochepa komanso zosakhalitsa.

Kumira kwachiwiri

Kumira kwachiwiri kumatanthauza kuoneka kwa zovuta m'mapapo ndi m'mapapo pambuyo pa chochitika chomira, ngakhale masiku angapo pambuyo pa chochitikacho, chifukwa cha kudzikundikira kwa madzi osungidwa m'mapapo.

Poyamba, edema ya m'mapapo sichimayambitsa vuto lililonse, koma pakatha maola angapo kapena masiku angapo, imatha kufa.

Ndikofunika kukumbukira kuti madzi osambira a chlorinated ali ndi mankhwala ambiri: ngati alowetsedwa ndikukhalabe m'mapapo, amachititsa kupsa mtima ndi kutupa, makamaka mu bronchi.

Pomaliza, kumbukirani kuti, kuchokera pamalingaliro a microbiological, kupuma madzi abwino ndikowopsa kwambiri chifukwa cha kuthekera kwakukulu kolowetsa ma virus, mabakiteriya ndi tizilombo toyambitsa matenda.

Kuwuma kumira

Kumira kowuma kumatanthauza kuchitika kwa zovuta m'mapapo ndi m'mapapo pambuyo pomira, ngakhale patatha masiku angapo chochitikacho, chifukwa cha laryngospasm.

Thupi ndi ubongo molakwika 'zimazindikira' kuti madzi atsala pang'ono kulowa kudzera munjira zodutsa mpweya, motero zimapangitsa kuti kholingo litseke kuti litseke ndikulepheretsa kulowa kwamadzimadzi, komwe kumapangitsanso kuti mpweya usalowe m'thupi, nthawi zina kutsogolera. mpaka kufa pomizidwa popanda kumizidwa m’madzi.

Imfa mwa kumizidwa

Chifukwa cha imfa mu kumira ndi hypoxaemia, amene amatsogolera pachimake hypoxia chifukwa mkhutu ntchito makamaka mu ubongo ndi myocardium ndi kutaya chikumbumtima, kulephera mtima kulephera ndi mtima kumangidwa.

Nthawi yomweyo, hypercapnia (kuchuluka kwa mpweya woipa m'magazi) ndi metabolic acidosis zimachitika.

Hypoxemia imayamba chifukwa cha kulowa kwa madzi m'mapapu ndi/kapena laryngospasm (kutseka kwa epiglottis, komwe kumalepheretsa madzi ndi mpweya kulowa).

Kufalitsa

Ku Italy, pafupifupi 1000 ngozi zoopsa zamadzi chaka chilichonse, ndipo chiwopsezo cha kufa chikuyandikira 50%.

Malinga ndi bungwe la World Health Organization, ana pafupifupi 5,000 azaka zapakati pa 1 ndi 4 amamwalira ku Ulaya chaka chilichonse, ndipo padziko lonse lapansi, pafupifupi 175,000 amafa chifukwa cha kumira m'zaka 17 zoyambirira za moyo.

Imfa yomizidwa iyenera kusiyanitsidwa ndi imfa yadzidzidzi yomizidwa, yomwe imayamba chifukwa cha kuvulala, kusakhazikika kwa mtima, kutsamwitsidwa. kusanza ndi kusalinganika kwa kutentha

Imfa ndi kumira: zizindikiro ndi zizindikiro

Imfa yomira m'madzi imatsogozedwa ndi magawo anayi:

1) Dongosolo lodabwitsa: limatenga masekondi angapo ndipo limadziwika ndi kupuma kofulumira komanso kozama momwe kungathekere munthuyo asanalowe m'madzi.

Zimachitikanso:

tachypnea (kuchuluka kwa kupuma);
tachycardia;
arterial hypotension ("kutsika kwa magazi");
cyanosis (khungu la buluu);
miosis (kuchepetsa kukula kwa diso).

2) Gawo la kukana: limatenga pafupifupi mphindi 2 ndipo limadziwika ndi kukomoka koyambirira, pomwe munthuyo amalepheretsa madzi kulowa m'mapapo potulutsa mpweya ndipo amayamba kunjenjemera poyesa kuwukanso, nthawi zambiri akutambasula manja awo pamwamba pamutu polowera komwe akupita. pamwamba pa madzi.

Mu gawo ili, zotsatirazi zimachitika pang'onopang'ono:

kupuma movutikira;
mantha;
kusuntha kwachangu poyesa kuyambiranso;
hypercapnia;
kuthamanga kwa magazi;
kutulutsidwa kwakukulu kwa adrenaline m'magazi;
tachycardia;
kusokonezeka kwa chidziwitso;
hypoxia ya ubongo;
kugwedezeka;
kuchepetsa mphamvu zamagalimoto;
kusintha kwamalingaliro;
kutulutsidwa kwa sphincter (chimbudzi ndi/kapena mkodzo zitha kutulutsidwa mwadala).

Munthuyo akamatuluka mpweya m’mapapo mwa kupuma, madzi amalowa m’mphepete mwa njira zodutsa mpweya zomwe zimayambitsa kutsekeka kwa mpweya chifukwa cha kutsekedwa kwa epiglottis (laryngospasm), zomwe zimapangidwira kuteteza dongosolo la kupuma kumadzi koma zomwe zimalepheretsanso kuyenda kwa mpweya.

Hypoxia ndi hypercapnia kenaka zimalimbikitsa minyewa kuti iyambitsenso kupuma: izi zimapangitsa kuti glottis atseguke mwadzidzidzi, zomwe zimapangitsa kuti madzi ochuluka alowe m'mapapu, kulepheretsa kusinthana kwa mpweya, kusintha kwa surfactant, kugwa kwa alveolar ndi chitukuko cha atelectasis ndi shunts.

3) Gawo la Apnoic kapena 'lowoneka ngati lakufa': limatenga pafupifupi mphindi 2, pomwe kuyesa kuyambiranso, kopanda phindu, kumachepetsedwa mpaka mutuwo ukhalebe wosasunthika.

Gawoli limadziwika pang'onopang'ono ndi:

kutha kotsimikizika kwa kupuma
miosis (kutsekeka kwa ana);
kutaya chidziwitso;
kumasuka kwa minofu;
bradycardia (kugunda kwa mtima pang'onopang'ono komanso kofooka);
chikomokere.

4) Gawo la terminal kapena 'kupuma': limatenga pafupifupi mphindi imodzi ndipo limadziwika ndi:

kupitiriza kutaya chidziwitso;
kwambiri mtima arrhythmia;
kumangidwa kwa mtima;
imfa.

Anoxia, acidosis ndi electrolyte ndi haemodynamic kusalinganika chifukwa cha asphyxia kumabweretsa kusokonezeka kwa kayimbidwe mpaka kumangidwa kwa mtima ndi kufa.

Kodi munthu amafa msanga bwanji?

Nthawi yomwe imfa imachitika imasinthasintha kwambiri chifukwa cha zinthu zosiyanasiyana monga zaka, thanzi, thanzi labwino komanso asphyxia.

Munthu wokalamba, amene akudwala matenda a shuga, matenda oopsa ndi emphysema m'mapapo mwanga, pamene kumira ndi wachibale suffocation, akhoza kutaya chikumbumtima ndi kufa pasanathe mphindi imodzi, monga momwe mwana akudwala mphumu bronchial.

Munthu wamkulu, woyenerera yemwe anazolowera kuchita khama kwa nthawi yayitali (ganizirani za katswiri wothamanga kapena wosambira m'madzi osambira) ngati akulephera kupuma amatha kutenga mphindi zingapo kuti azindikire ndikufa (ngakhale kupitirira mphindi 6), koma mutatha kupuma. Nthawi zambiri imfa imapezeka nthawi yosiyana kuyambira 3 mpaka 6 mphindi zonse, momwe magawo anayi omwe afotokozedwa m'ndime yapitayi amasinthasintha.

Nthawi zambiri, mutuwo amakhalabe ozindikira mu apnea kwa pafupifupi mphindi 2, kenako amataya chikumbumtima ndikukhalabe chikomokere kwa mphindi 3 mpaka 4 asanamwalire.

Kumira m'madzi atsopano, mchere kapena chlorinated

Pali mitundu itatu yamadzi yomwe imamira: atsopano, mchere kapena chlorinated.

Madzi amtundu uliwonse amachititsa kuti thupi likhale losiyana.

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Madzi amchere amafanana ndi malo am'madzi ndipo amakhala ndi mphamvu ya osmotic ya plasma kuwirikiza kanayi; hypertonicity izi zimagwirizana ndi kukhalapo kwa mchere mchere monga sodium, chlorine, potaziyamu ndi magnesium.

Pofuna kubwezeretsa homeostasis yachibadwa, kuyenda kwa madzi kuchokera ku capillary kupita ku pulmonary alveolus kumapangidwa, zomwe zimayambitsa haemoconcentration, hypernatriemia ndi hyperchloremia.

Mwanjira iyi, kuchuluka kwa magazi kumachepa ndipo, m'mapapo, alveoli imadzaza ndi madzimadzi omwe amachititsa kuti pulmonary edema iwonongeke.

Hypoxia ya m'deralo imalimbikitsanso pulmonary vasoconstriction powonjezera kupanikizika kwa mitsempha ya m'mapapo, kusintha mpweya wabwino / kutsekemera kwa mpweya ndi kuchepetsa kutsata kwa mapapo ndi mphamvu yotsalira yogwira ntchito;

Kumira m'madzi ozizira:

Madzi abwino amakhala ngati mitsinje ndi nyanja ndipo ali ndi mphamvu ya osmotic theka la magazi.

Chifukwa cha hypotonicity iyi, imatha kudutsa chotchinga cha alveolus-capillary ndipo motero imadutsa m'mitsempha ya m'mapapo yomwe imayambitsa hypervolaemia, haemodilution ndi hyponatriemia.

Izi zingayambitse kuwirikiza kwa voliyumu yozungulira.

Izi zimabweretsa kuchepa kwa kuthamanga kwa magazi kwa osmotic, zomwe zimapangitsa kuti erythrocyte haemolysis ndi hyperkalemia.

Zotsatira zonsezi ndizovuta kwambiri m'thupi: pamene kuchuluka kwa potaziyamu kungayambitse matenda oopsa a mtima (ventricular fibrillation), haemoglobinuria yobwera chifukwa cha haemolysis ingayambitse kulephera kwaimpso.

Madzi abwino amawononganso ma pneumocyte amtundu wa II ndi ma denatures surfactant, kulimbikitsa kugwa kwa alveolar ndi kupanga pulmonary atelectasis.

Izi zimachititsa kuti m'mapapo muchuluke madzimadzi, zomwe zimapangitsa kuti m'mapapo mukhale ndi edema ya pulmonary ndi kuchepa kwa mapapu, kuwonjezeka kwa intrapulmonary shunt ndi kusintha kwa mpweya wabwino / perfusion.

Kuchokera ku lingaliro la microbiological, mtundu uwu wa inhalation ndi woopsa kwambiri, chifukwa cha kuthekera kwakukulu kwa mavairasi, mabakiteriya ndi tizilombo toyambitsa matenda;

Kumira m'madzi a chlorine:

Madzi okhala ndi chlorine amafanana ndi maiwe osambira ndipo ndi owopsa kwambiri chifukwa cha zotsatira za maziko amphamvu (klorate) omwe amagwiritsidwa ntchito kuyeretsa madzi ndi malo.

Kuzikoka, kwenikweni, kumayambitsa kupsa mtima kwamankhwala kwa m'mapapo alveoli ndi kutsekeka kotsatira kupanga kwa surfactant yofunikira kuti mapapu azikhala ndi mpweya wabwino.

Izi zimabweretsa kuchepa kwakukulu m'malo osinthira mapapu, zomwe zimapangitsa kugwa kwamapapu ndi atelectasis.

Kuchokera kumalingaliro amtsogolo, mtundu uwu wa kupuma ndi woipa kwambiri, womwe umatsogolera ku imfa muzochitika zambiri.

Chinthu chodziwika bwino cha mitundu yonse itatu ya madzi (ngakhale kuti sichichitika kawirikawiri m'madziwe osambira) ndikuti kumizidwa nthawi zambiri kumaphatikizapo kukhala m'madzi pamtunda wochepa, motero kumathandizira kukula kwa hypothermia, komwe kumayamikiridwa kwa ana, makamaka ngati ndi ochepa kwambiri. kuchepetsa mafuta a subcutaneous.

Pamene pachimake kutentha kufika mfundo pansi 30 ° C, pachiswe pathophysiological mawonetseredwe zimachitika: kugunda kwa mtima, kuthamanga kwa magazi ndi kagayidwe kachakudya ntchito ya thupi pang`onopang`ono kuchepa ndi isanayambike asystole kapena yamitsempha yamagazi fibrillation;

Kumira: chochita?

Chithandizo choyambira imasonkhezeredwa ndi zinthu zosiyanasiyana ndipo, m’zochitika zazikulu kwambiri, ndithudi imaimira mphambano yeniyeni pakati pa kupulumuka ndi imfa ya munthu womirayo.

Wothandizira ayenera:

chitani zinthu mwachangu;
bwezeretsani munthuyo ndikumuchotsa m'madzi (samalani chifukwa munthu womira m'madzi, pofuna kupulumuka, akhoza kukankhira wopulumutsa pansi pamadzi)
kuwunika momwe chidziwitso chamunthuyo chilili, kuyang'ana patency ya airways (zotheka kukhalapo kwa ntchentche, algae, mchenga), kukhalapo kwa kupuma ndi kukhalapo kwa kugunda kwa mtima;
ngati n'koyenera, kuyambitsa resuscitation cardiopulmonary;
samalani posuntha wozunzidwayo: ngati mukukayikira, Msana kuvulala kuyenera kuganiziridwa nthawi zonse;
kuonetsetsa mpweya wokwanira, kuchititsa kuti oima pafupi asamuke;
sungani kutentha kwa thupi kokwanira kwa wozunzidwayo, kuumitsa wovulalayo ngati akadali wonyowa;
kunyamula wovulalayo kupita naye kuchipatala.

Nambala Yadzidzidzi iyenera kuyimbidwa posachedwa, kuchenjeza wogwiritsa ntchito kuopsa kwa vutoli.

Chithandizo chamankhwala cha munthu womizidwa ndi:

kuthandizira ndikuwunika ntchito zofunika
kusintha koyenera kwa organic;
kupewa zovuta zoyambilira komanso mochedwa.

Zotsatirazi ndi zofunika pa cholinga ichi

kukonza kusinthana kwa gasi kudzera mu chithandizo cha kupuma ndi mpweya wabwino;
kukhathamiritsa kwa haemodynamic mwa kukonza volaemia pogwiritsa ntchito madzi, zowonjezera madzi a m'magazi, madzi a m'magazi, albumin, magazi ndi, ngati zisonyezedwa, cardiokinetics;
kukonza kwa hypothermia, ngati kulipo.

Pofuna kuthana ndi zovuta zoyamba, zotsatirazi ndizofunikira

kutulutsa madzi m'mimba;
kupewa pachimake tubular necrosis pamaso pa haemolysis;
antibiotic prophylaxis;
chithandizo cha hydro-electrolyte ndi acid-base kusalinganika;
chithandizo cha zoopsa (monga mabala kapena kuthyoka kwa fupa).

Zovuta zomwe zingachitike mochedwa kumizidwa ndi:

chibayo aspiration;
abscess m'mapapo;
myoglobinuria ndi hemoglobin;
aimpso kulephera;
matenda ovutika kupuma (ARDS);
ischaemic-anoxic encephalopathy (kuwonongeka kwa ubongo chifukwa chosowa magazi/oxygen);
coagulopathy;
sepsis.