Moto, kupuma kwa utsi, ndi kuyaka: zolinga za chithandizo ndi chithandizo

By Cristiano Antonino On Apr 8, 2023

Zowonongeka zomwe zimadza chifukwa chokoka utsi zimawonetsa kuwonjezereka kwa kufa kwa odwala omwe akuwotchedwa: muzochitika izi zowonongeka zomwe zimabwera chifukwa cha mpweya wa utsi zimawonjezera zomwe zimadza chifukwa cha kupsa, nthawi zambiri zomwe zimakhala zakupha.

Nkhaniyi idaperekedwa pakuwotcha machiritso, makamaka kuwononga m'mapapo ndi mwadongosolo kwa anthu omwe adawotchedwa omwe adakoka utsi, pomwe zotupa za dermatological zidzafufuzidwa kwina.

Utsi inhalation ndi amayaka, zolinga za mankhwala

Zolinga za chithandizo cha kupuma kwa odwala oyaka ndikuwonetsetsa kuti:

mpweya patency,
mpweya wabwino,
mpweya wokwanira,
kusunga acid-base balance,
kusunga kukhazikika kwa mtima,
chithandizo chamsanga cha matenda.

Nthawi zina, kuchita excartomy ndikofunikira kuti tipewe zipsera za pachifuwa kuti zisasokoneze kuyenda kwa chifuwa.

Zolinga za chithandizo cha kutentha kwa khungu ndi:

kuchotsa khungu losafunikira,
kugwiritsa ntchito mabandeji okhala ndi ma antibayotiki apakhungu,
kutsekedwa kwa chilonda ndi zoloŵa m'malo kwakanthawi komanso kuyika khungu kuchokera kumadera athanzi kapena zitsanzo zojambulidwa pamalo owotchedwa,
kuchepetsa kutaya madzimadzi ndi chiopsezo chotenga matenda.

Phunziroli liyenera kupatsidwa ma calories apamwamba kuposa a basal, kuti athe kukonza mabala ndikupewa kusokoneza.

Chithandizo cha kutentha odwala ndi poizoni utsi inhalation

Anthu otenthedwa ndi zotupa zazing'ono zomwe zimakhudza njira yakumtunda kwa mpweya, kapena zizindikiro za kutsekeka kwa kupuma kapena, mulimonse, kukhudzidwa kwa pulmonary, ziyenera kuyang'aniridwa mosamala.

Ndikofunikira kupereka chowonjezera cha okosijeni, kudzera mu cannula ya m'mphuno, ndikupangitsa wodwala kuganiza malo apamwamba a Fowler, pofuna kuchepetsa ntchito yopuma.

Kuthamangitsidwa amathandizidwa ndi aerosolized β-agonists (monga orciprenaline kapena albuterol).

Ngati vuto la kutsekeka kwa mpweya likuyembekezeredwa, liyenera kutetezedwa ndi endotracheal chubu yoyenera.

Early kuchimachi nthawi zambiri sichivomerezeka kwa anthu omwe akuwotchedwa chifukwa njirayi imakhudzana ndi kuchuluka kwa matenda komanso kufa kwa anthu ambiri, ngakhale kuti kungakhale kofunikira kuti athandizidwe kupuma kwa nthawi yaitali.

Kudzidzimutsa koyambirira kwanenedwa kuti kumayambitsa edema ya m'mapapo yam'mapapo mwa odwala ena omwe amavulazidwa ndi inhalation.

Kugwiritsa ntchito 5 kapena 10 cm H2O mosalekeza kukakamiza kwa airway (CPAP) kungathandize kuchepetsa edema ya m'mapapo, kusunga mphamvu ya m'mapapo, kuthandizira mpweya wa edematous, kupititsa patsogolo mpweya wabwino / kuthirira, komanso kuchepetsa kufa msanga.

Zokhudza zonse makonzedwe a cortisone zochizira edema ali osavomerezeka, poona chiwopsezo cha matenda.

Chithandizo cha odwala chikomokere chimalunjikitsidwa ku hypoxia yoopsa kuchokera pakukoka utsi ndi poizoni wa CO ndipo imachokera ku kayendetsedwe ka mpweya.

Kupatukana ndi kuchotsedwa kwa carboxyhemoglobin kumachulukitsidwa ndi makonzedwe a oxygen supplements.

Odwala omwe adakoka utsi, koma amangowonjezera pang'ono Hbco (ochepera 30%) ndikukhalabe ndi moyo wabwinobwino wamtima, ayenera kuthandizidwa ndikupereka mpweya wa 100% kudzera pa chigoba chakumaso cholimba, monga "kusapumira" ( zomwe sizikulolani kuti mupume mpweya womwe mwangotulutsanso), ndikuthamanga kwa malita 15 / mphindi, kusunga tanki yosungiramo zinthu.

Chithandizo cha okosijeni chiyenera kupitilira mpaka milingo ya Hbco itsike pansi pa 10%.

Mask CPAP yokhala ndi 100% yopereka okosijeni ingakhale chithandizo choyenera kwa odwala omwe ali ndi vuto la hypoxemia ndipo palibe kapena zotupa zotentha za nkhope ndi mpweya.

Odwala omwe ali ndi refractory hypoxemia kapena aspiration kuvulala komwe kumakhudzana ndi chikomokere kapena kusakhazikika kwa mtima wamapapo amafunikira intubation ndi thandizo la kupuma ndi 100% oxygen ndipo amatumizidwa mwachangu ku hyperbaric oxygen therapy.

Chithandizo chotsirizirachi chimathandizira kuyendetsa bwino kwa oxygen ndikufulumizitsa njira yochotsera CO m'magazi.

Odwala omwe ali ndi edema yoyambirira ya pulmonary, ARDSchibayo, kapena chibayo nthawi zambiri chimafuna kupanikizika komaliza komaliza (PeEP) chithandizo cha kupuma pamaso pa ABGs chosonyeza kulephera kupuma (PaO2 osachepera 60 mmHg, ndi / kapena PaCO2 apamwamba kuposa 50 mmHg, ndi pH yotsika kuposa 7.25).

PeEP ikuwonetsedwa ngati PaO2 itsika pansi pa 60 mmHg ndipo kufunika kwa FiO2 kupitirira 0.60.

Thandizo la mpweya wabwino liyenera kukulitsidwa nthawi zambiri, chifukwa odwala omwe amawotcha nthawi zambiri amakhala ndi kagayidwe kachakudya, komwe kumafuna kuwonjezereka kwa mphindi zopumira kuti zitsimikizire kukonza kwa homeostasis.

The zida zogwiritsidwa ntchito ziyenera kutulutsa voliyumu yayikulu / mphindi (mpaka malita 50), ndikusunga kupanikizika kwapamtunda (mpaka 100 cm H2O) ndi kudzoza / kutha kwa nthawi (I: E) kokhazikika, ngakhale kuthamanga kwa magazi kukufunika ziwonjezeke.

Refractory hypoxemia imatha kuyankha potengera kukakamizidwa, mpweya wobwerera kumbuyo.

Ukhondo wokwanira wa m'mapapo ndi wofunikira kuti mpweya usakhale ndi sputum.

Physiotherapy yopanda kupuma imathandizira kulimbikitsa katulutsidwe ndikuletsa kutsekeka kwa mpweya ndi atelectasis.

Zomera zaposachedwa zapakhungu sizilola kugwedezeka pachifuwa ndi kugwedezeka.

Thandizo la fibrobronchoscopy lingakhale lofunikira kuti mutsegule njira zodutsa mpweya kuchokera pakuchulukana kwamadzimadzi.

Kusamalira bwino madzimadzi ndikofunikira kuti muchepetse chiopsezo cha kugwedezeka, kulephera kwaimpso, ndi edema ya m'mapapo.

Kubwezeretsedwa kwa madzi bwino a wodwala, pogwiritsa ntchito njira ya Parkland (4 ml ya isotonic solution pa kilogalamu iliyonse pamlingo uliwonse wamoto wapakhungu, kwa maola 24) ndikusunga diuresis pamitengo yapakati pa 30 ndi 50 ml / ola ndi venous yapakati. Kuthamanga kwapakati pa 2 ndi 6 mmHg, kumathandiza kusunga bata la hemodynamic.

Odwala omwe ali ndi vuto lolakalaka, kuchuluka kwa capillary kumawonjezeka, ndipo kuyang'anira kuthamanga kwa mitsempha ya m'mapapo ndi njira yothandiza yosinthira madzimadzi, kuphatikizapo kuwongolera kutuluka kwa mkodzo.

Ndikofunikira kuyang'anira chithunzi cha electrolyte ndi kuchuluka kwa acid-base.

Mkhalidwe wa hypermetabolic wa wodwala wowotcha umafunikira kuwunika mosamalitsa kadyedwe koyenera, pofuna kupewa catabolism ya minofu ya minofu.

Njira zolosera zam'tsogolo (monga za Harris-Benedict ndi Curreri) zakhala zikugwiritsidwa ntchito poyerekezera kukula kwa metabolism mwa odwalawa.

Pakalipano, zowunikira zonyamula katundu zilipo malonda omwe amalola kuti miyeso ya serial indirect calorimetry ipangidwe, yomwe yasonyezedwa kuti ikupereka kuyerekezera kolondola kwa zosowa za zakudya.

Odwala amayaka kwambiri (oposa 50% a khungu pamwamba) nthawi zambiri zotchulidwa zakudya amene caloric kudya ndi 150% ya mpumulo ndalama zawo, kuti atsogolere machiritso chilonda ndi kupewa catabolism.

Ndi machiritso oyaka, kudya zakudya zopatsa thanzi kumachepetsedwa pang'onopang'ono mpaka 130% ya basal metabolic rate.

M'mawotchi ozungulira pachifuwa, minofu yowotcha imatha kuletsa kuyenda kwa khoma la pachifuwa

The escharotomy (opaleshoni kuchotsa khungu wopsereza) ikuchitika popanga ma incisions awiri ofananira nawo pa anterior axillary line, kuyambira XNUMX centimita pansi pa clavicle mpaka XNUMX-khumi intercostal danga, ndi zina ziwiri zopingasa incision anatambasula pakati malekezero a choyamba, kutanthauzira lalikulu.

Izi zikuyenera kupititsa patsogolo kukhazikika kwa khoma la pachifuwa ndikuletsa kupsinjika kwa minofu yachilonda.

Kuchiza kwa chiwopsezocho kumaphatikizapo kuchotsa khungu losafunikira, kugwiritsa ntchito mankhwala opha tizilombo toyambitsa matenda, kutseka mabala ndi zolowa m'malo mwakhungu kwakanthawi, ndikumezanitsa khungu kuchokera m'malo athanzi kapena zofananira pamalo omwe adawotchedwa. chopangidwa.

Izi zimachepetsa kutaya madzimadzi komanso chiopsezo chotenga matenda.

Matendawa nthawi zambiri amayamba chifukwa cha coagulase-positive Staphylococcus aureus ndi mabakiteriya opanda gramu, monga Klebsiella, Enterobacter, Escherichia coli ndi Pseudomonas.

Njira yodzipatula yokwanira, kupanikizika kwa chilengedwe, kusefa kwa mpweya, kumayimira maziko a chitetezo ku matenda.

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