Chest trauma, mhedziso yechitatu inotungamira chikonzero chekufa kubva mukushungurudzika kwemuviri

By Cristiano Antonino On Apr 21, 2023

Chest trauma ndeimwe yeanowanzo anowanzo rubatsiro rwekutanga uye ambulensi vashandi vekurapa vanopindira mamiriro: inofanirwa kuzivikanwa nemazvo, saka.

Munhu achaonekwa kuti ane kukuvara kwechipfuva kana akakuvara zvakanyanya muchipfuva, uye inofanirwa kuongororwa nenzira kwayo, nokuti ndiyo yechitatu inokonzera rufu kubva mukukuvadzwa mumuviri munyika dzekuMadokero.

Kushungurudzika kwechipfuva kunosanganisira maronda epfuti, zvinogonawo kuitika semugumisiro wekudonha, mushure mekurohwa, kurohwa kana kurohwa.

Kuongororwa kunogona kuitwa nachiremba, kazhinji neX-ray.

Chest trauma inogona kukamurwa kuva marudzi maviri:

Kukuvara kunopinza kunoitika apo nyajambwa anokuvadzwa kunopwanya ganda, zvakadai sebanga riri muchipfuva kana kuti ronda repfuti;
Kukuvara kwekukuvadza kunoguma nekumwe kubvaruka kweganda, kubvaruka hakusi chikonzero chekukuvara pachako uye kukuvadza kunowanzova kushoma munzvimbo. Kukandwa nemhuka hombe kana kuve mutsaona yemotokari kunogona kukonzera kukuvara kwakanyanya.

Blunt trauma inokonzeresa 25% yevakafa vese nekuda kwenjodzi dzinotyisa dzekurapa.

Kukuvara kwechipfuva kuchapa zviratidzo zvakati wandei, chinonyanyozivikanwa kurwadziwa kwakanyanya uye kunetseka kufema

Zvimwe zviratidzo zvinosanganisira kubuda ropa, kuvhunduka, kupera kwekufema, kubuda ropa, maronda uye kurasikirwa nekuziva, izvo zvichaitika zvichienderana nechikonzero chekurwadziwa kwechipfuva.

Mabhonzo akaputsika anogonawo kuitika nekuda kwekukuvara kwe thoracic.

Kushungurudzika kwechipfuva kucharapwa zvichienderana nechikonzero; kupindira kunogona kudiwa kubvisa nzira yemhepo, zvichida kana mapapu achiputsika kana kuti kudzivirira kushungurudzika kubva pakukonzera kukuvadza kwakanyanya uye zvichiita kuti pave nehutachiona.

Kukuvadzwa kwechipfuva kunogona kukonzera maitiro akasiyana-siyana ekukuvadzwa kwemwoyo, zvakadai sekupinda kwemuviri wekunze, kuputika, tamponade, kuputika uye kuvharwa kwemaronary arteries, myocardial contusion, pericardial effusion, septal defects, valvular lesions, uye kuputika kwemidziyo mikuru.

Kukuvara uku kunowanzouraya.

Kukuvara kwemoyo kunopinda mukati kunowanzo kukonzerwa nezvombo zvakagomara kana pfuti uye zvichikonzera kufa kuri pakati pe50% ne85%.

Kukuvara kwakavharwa kunowanzobatanidzwa nekuputika kwemoyo, uye ventricle yakarurama inobatwa kakawanda kupfuura kuruboshwe, uye inoguma nehuwandu hwekufa kweanenge 50% muvarwere vanosvika muchipatara. chipinda chekukurumidzira mupenyu.

Kutevera kuputika kwekamuri yemwoyo kana kubvarura mumakoronari kana midziyo mikuru, ropa rinokurumidza kuzadza pericardial sac uye rinoguma ne cardiac tamponade.

Kunyangwe zvishoma se60-100 ml yeropa inogona kukonzera cardiac tamponade uye cardiogenic shock, zvichibva mukuderedzwa kwe diastolic kuzadza.

Maronda epfuti anopinda mu pericardial sac uye mukati memoyo anoguma nekukasira kubuda ropa, uko kunodzora mufananidzo wekiriniki.

Cardiac tamponade inotevera ronda repfuti kumoyo inobatanidzwa nekuwedzera kupona nekuda kwe systemic hypotension uye kuwedzera kudzvinyirira munzvimbo ye pericardial, iyo inobatsira kuderedza kubuda kweropa.

Tamponade yemwoyo inowanzobatanidzwa nezviratidzo zvekliniki zveBeck's triad (jugular venous distension, hypotension uye attenuation yematoni emwoyo).

Iyi triad inogona kunge isipo kune varwere vakave hypovolaemic nekuda kwekubuda ropa.

Radiographic humbowo hwekuwedzera kwemumvuri wemediastinal hunogona kuratidza kuputika mu mediastinum uye/kana tamponade.

Kusimbiswa kwe pericardial effusion inogona kupiwa ne echocardiography.

Emergency exploratory thoracotomy, ine cardiopulmonary bypass uye kugadziriswa kwekuvhiya, uye kuwedzerwa ropa sezvinodiwa nekliniki yehutano ichaitwa.

Kuchinja kweanatomopathological yemoyo yakakanganiswa inosanganisira intramyocardial haemorrhages, myocardial edema, coronary occlusion, myofibrillar degeneration uye necrosis yemyocardiocytes.

Izvi zvipembenene zvinotungamirira kune arrhythmias uye haemodynamic kusagadzikana kwakafanana neaya akaonekwa mushure mokunge myocardial infarction.

Intubation, ventilation kana dzimwe nzira dzeokisijeni dzinogonawo kudiwa; kuvhiyiwa, kurapwa nezvinodhaka, kuzorora zvakakwana uye mune dzimwe nguva kurapwa kwemuviri kungave kuri madikanwa.

Nekuda kwekuwedzera kwemarwadzo, mushonga weanesthetic wemunharaunda uchashandiswa kuderedza kuwanda kwemarwadzo. Analgesics ichaitwa ne epidural.

Varwere vasingaperi kana vasingarapike vanogona kupihwa kuzvidzora kuzvidzora kuti kushandiswe pakudiwa kugadzirisa marwadzo.