Chest trauma: zviratidzo, kuongororwa uye kutungamirirwa kwemurwere ane kukuvara kwakanyanya kwechipfuva

By Cristiano Antonino On 31 Sea, 2023

Munhu anozoonekwa kuti ane kukuvara kwechipfuva kana aine kukuvara kwakanyanya muchipfuva

Iyo inozivikanwawo sechest trauma, chirwere ichi chinozokonzera kuremara uye rufu runogona kuitika semhedzisiro; ndicho chechitatu chinokonzera rufu kubva mukukuvadzwa mumuviri.

Kushungurudzika kwechipfuva kunogona kuitika semugumisiro wekukuvara kwakasiyana-siyana; pakati pezvinowanzokonzera kukuvara kwechipfuva injodzi dzemotokari.

Kukuvara netsaona kana kwakashata kunogona kukonzera trauma trauma

Kukuvara kwechipfuva kunosanganisira maronda epfuti, anogonawo kuitika semugumisiro wekudonha, mushure mekurohwa, kurohwa kana kurohwa.

Kuongororwa kunogona kuitwa nachiremba, kazhinji neX-ray.

Zvechokwadi, trauma ye thoracic ndiyo imwe yenyaya dzakaoma zvikuru, uye muzvinyorwa zvakadzama zvichave zvichibvira kudzidza pamusoro pezvimwe zvakasiyana-siyana: hazvibviri kupfupisa nyaya yacho mune imwe rugwaro.

Chest trauma inogona kukamurwa kuva marudzi maviri:

Kufungidzira kwakanyanya, iyo inoitika apo munhu anenge akuvadzwa anenge akuvara kunotsemuka ganda, zvakadai sebanga riri pachipfuva kana kuti ronda repfuti;
Kukuvara kwekukuvadza kunoguma nekumwe kubvaruka kweganda, kubvaruka hakusi chikonzero chekukuvara pachako uye kukuvadza kunowanzova kushoma munzvimbo. Kurohwa nemhuka hombe kana kuva mu a ngozi yemotokari zvinogona kukonzera blunt trauma.

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

Kukuvadzwa kwechipfuva kuchapa zviratidzo zvakawanda, izvo zvinowanzoitika zvichave 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.

Kutyoka kwebhonzo kunogonawo kuitika nekuda kwekukuvara kwe thoracic.

Kukuvara kwechipfuva kucharapwa zvichienderana nechikonzero

Kupindira kunogona kudiwa kubvisa nzira yemhepo, zvose kana mapapu achidonha uye kudzivirira kukuvadzwa kubva pakukonzera kukuvadza kwakanyanya uye zvichiita kuti pave nehutachiona.

Kushungurudzika pachipfuva kunogona kukonzera nzira dzakasiyana dzekukuvara kwemoyo, sekupinda kwemuviri wekunze, kuputika, tamponade, kuputika uye kuvhara kwemakumbo emakumbo, myocardial contusion, pericardial effusion, septal defects, maronda evhavha, 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.

Kuboora maronda achipinda mu pericardial sac uye mukati memoyo kunoguma nekukasira kubuda ropa, izvo zvinotonga 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.

Mukuwedzera, intubation, ventilation kana dzimwe nzira dzeokisijeni dzinogona kudiwa, pamwe nekuvhiyiwa, kurapwa kwezvinodhaka, kuzorora kwakakwana uye mune dzimwe nguva kurapwa kwepanyama.

Nekuda kwekuwedzera kwemarwadzo, mushonga weanesthetic wemunharaunda uchashandiswa kuderedza kuwanda kwemarwadzo.