Kunyura: zviratidzo, zviratidzo, kuongorora kwekutanga, kuongororwa, kuoma. Kukoshera kweiyo Orlowski mamaki

By Cristiano Antonino On Dai 17, 2023

Kunyura kana kuti 'drowning syndrome' mumushonga inoreva chimiro cheacute asphyxia nekuda kwekunze kwemuchina chikonzero chinokonzerwa nekugarwa kwepulmonary alveolar space nemvura kana imwe mvura inounzwa kuburikidza nepamusoro pemhepo, iyo yakanyatsonyudzwa mumvura yakadaro.

Kana asphyxia ikarebeswa kwenguva yakareba, kazhinji maminetsi akati wandei, 'rufu nekunyura' runoitika, kureva kufa nekuda kwekudzipwa nekunyudzwa, kunowanzobatanidzwa neacute hypoxia uye kutadza kusimba kwe ventricle yakarurama yemoyo.

Mune zvimwe zviitiko zvisingaurayiwi, kunyura kunogona kurapwa zvinobudirira nemaitiro chaiwo ekumutsidzira.

ZVINOKOSHA: Kana mudikani akambonyura uye usingazive zvekuita, tanga wabata rubatsiro rwechimbichimbi nekukasira nekufonera Single Emergency Number.

Izvi nezvimwe zvinyorwa zvakagadzirirwa kudzamisa musoro, uye kuziva zvekutaura kune Emergency Number Center Operator.

Clinical zvinhu zvekunyura

Kuongorora kwekutanga kwevanonyura kunofanirwa kuve nekukurumidza sezvinobvira uye kwakanangana nekuona mamiriro ekuziva, pulse maitiro uye kufema.

Mashoko anounganidzwa kubva kune vakazviona anogonawo kubatsira zvikuru pakuongorora kuoma kwechirwere chemurwere.

Kana zvichikwanisika, zvimwe zvinhu zvinofanirwa kutsanangurwa, kusanganisira:

kwenguva yakareba sei, ingangoita, murwere akanyudzwa mumvura,
hunhu hwemvura yakaitika njodzi (munyu kana mvura yakachena, inopisa kana kutonhora, nezvimwewo),
kuvepo kunobvira kwezviratidzo zvakakosha panguva ye rubatsiro rwekutanga,
nguva yakapfuura isati yatanga kufambisa kwecardiopulmonary resuscitation (CPR), uye kana izvi zvakaitwa pakarepo mushure mekunge murwere abudiswa mumvura.
kwenguva yakareba sei CPR yaifanira kuenderera mberi zviratidzo zvakakosha zvisati zvaonekwazve,
kana zvichibvira tembiricha chaiyo yemvura,
zera remunhu uye mamiriro ake ezvinhu ngozi isati yaitika (semutauri ane chirwere chemapapu kana chemoyo?)
chero mamwe mamiriro angave ane chekuita nechiitiko (semuenzaniso tsaona paunenge uchinyura kana zvimwewo, kunwa doro kana zvinodhaka, nezvimwewo).

Kunyura: anamnesis uye bvunzo yechinangwa inofanira kunge ichikurumidza

Zviratidzo zvakakosha zvevanonyura zvinogona kusiyana zvakanyanya, ndosaka ruzivo rwuri murunyorwa rwuri pamusoro rwakakodzera.

Varwere vanogona kuuya mukusungwa kwemoyo wakakwana kana nekufema kwekuita uye peripheral pulse mukati memiganhu yakajairika.

Tembiricha yemuviri inosiyana uye zvinoenderana nekudziya kwemvura yakaitika njodzi, nzvimbo yemuviri weari kutaurwa uye nguva yekunyura.

Hypothermia inowanzoitika kana murwere anga ari mumvura inotonhora uye anogona kuvandudza kurarama.

Mumamiriro ezvinhu akadaro, kudziya kunofanira kuitwa nekuchenjerera.

Mhedzisiro yemwoyo yekutadza kunyura kazhinji inosanganisira bradycardia, inogona kuteverwa neasystole.

Kukuvadzwa kwetsinga kunobva ku hypoxia uye mishonga inopihwa panguva yekumutsiridza inotungamira kune mydriasis, nekuora mwoyo kana kusipo pupillary reflex kuchiedza.

Musoro uye mutsipa inofanira kunyatsoongororwa zviratidzo zvekushungurudzika, zvichiita, somuenzaniso, kubva pakunyura mumvura isina kudzika.

Kana kukuvadzwa kumusana kuchifungidzirwa, zvinodikanwa kumisa murwere asati atakurwa kuti adzivise kuwedzera kukuvadzwa, mune dzimwe nguva kusingagadziriswi uye kuremadza, senge izvo zvinotungamirira kukuoma mitezo.

Auscultation of the thorax inogona kuratidza kuvapo kwemhepo, nekuda kwebronchospasm kana chido chekunze kwezvinhu uye / kana tele-expiratory rales, yakabatana neatelectasis kana pulmonary edema.

Kuwanikwa kweruzha rwemapapu ekuwedzera (senge coarse ralesalesales) inoratidza chishuwo chekunze kwenyika uye njodzi yepneumonia uye ARDS.

Migumo yevarwere ava inowanzotonhora pane thermoprinting, nekuda kwe hypothermia uye peripheral mudziyo constriction.

Kunonoka kwekutenderera kweparipheral kunotungamirira pakurebesa kwecapillary reperfusion nguva.

Arterial haemogas analysis (ABG) inowanzoratidza hypoxaemia, kunyanya kana shungu yakaitika, uye metabolic acidosis.

Kuoma kwe metabolic acidosis kunowanzoenderana nekuoma kwetishu hypoxia.

Hemoglobin uye serum electrolyte concentrations uye hematocrit values inogona kuderera kana yakawanda yemvura yakachena ikamedzwa kana kushushwa, iyo inopinda mukutenderera uye inoita kuti ropa riwedzere.

Kuongorora kwekutanga uye kufungidzira mune zviitiko zvekunyura

Mapoinzi akati wandei masisitimu akagadzirwa kuti aongorore vanhu vanonyura, asi hapana kana mumwe wavo anogona kufanotaura kliniki yekufungidzira ne100% chokwadi.

Matatu anonyanya kushandiswa masisitimu ndeaya:

ari Glasgow Coma Scale (GCS),
chikamu cheOrlowski,
iyo post-submission neurological classification yeModel naConn.

Glasgow Coma Scale

Iyo Glasgow Coma Scale ine maparamita matatu, kune yega yega mhinduro yemurwere inotemerwa uye kupihwa kukosha kwenhamba (ona tafura iri pazasi).

Kuvhura kweziso:

rova
Mukupindura kune zvinorwadza zvinokurudzira
Mukupindura kurudziro yemashoko
Zvinowanzoitika

Mhinduro yemuromo yakanakisa:

hapana
Hazvinzwisisike
Hazvina kukodzera
Kuvhiringidzwa
Oriented

Best mota mhinduro

hapana
Kuwedzera (kwakaderedzwa)
Flexion (yakashongedzwa)
Localization yekukurudzira kunorwadza
Raira mhinduro

Chiyero cheGlasgow chikero chinotemerwa nekuongorora mhinduro yemurwere muchikamu chega chega.

Hwaro hwenhamba dzemaitiro akacherechedzwa anowedzerwa pamwechete uye anopa chibodzwa chese.

Nhamba yose ye3 ndiyo yakaderera zvikuru uye inoratidza mamiriro ezvinhu akaipisisa; chikamu che7 kana zvishoma chinoratidza kuti murwere ari mu coma uye chibodzwa che14 kuchengetedza kwekuziva kuzere.

Prognosis yakavakirwa pane kukosha kweGCS yakawanikwa panguva yekutanga bvunzo yekiriniki.

Vanonyura vakabatwa neiyo yekutanga GCS mamakisi mana kana mashoma vane makumi masere muzana mukana wekufa kana kukuvara zvachose kwetsinga.

Varwere vane GCS mamaki matanhatu kana kupfuura, kune rumwe rutivi, vari panjodzi yakaderera yerufu kana kukuvara zvachose kwetsinga.

Orlowski zvibodzwa

Chiyero cheOrlowski chinobva pakuvapo kwezvinhu zvisingafadzi zvekufungidzira zvine chekuita nekupora kwemurwere.

Zvisingafadzi zvekufungidzira zvinhu zveOrlowski mamaki

makore akaenzana kana asingasviki makore matatu;
inofungidzirwa kunyura nguva inopfuura maminitsi mashanu;
resuscitation maneuvers asina kuitwa mukati memaminitsi gumi ekutanga;
murwere akasvika mudhipatimendi rekukurumidzira ari mucomatose state;
arterial pH yakaenzana kana isingasviki 7.10 pahemogasanalysis.

Chibodzwa cheOrlowski chinopihwa zvichienderana nehuwandu hwezvinhu zvisingafadzi zvekufungidzira, zvakanyorwa pano, zvinowanikwa mumunhu akanyura.

Zvibodzwa zvakaderera zvine chekuita nekufungidzira kuri nani.

Avo vane zviviri kana zvishoma zvezvinhu izvi vane mukana we 90 per cent wekupora kuzere nepo, kune vane vatatu kana kupfuura, mukana uyu uri pasi pezvikamu zvishanu kubva muzana.

Modell naConn's post-submergence neurological classification

Muna 1980, Conn naModel nevashandi vavo vakaburitsa vakazvimiririra postresuscitation neurological classification zvichibva padanho rekutanga rekuziva kwemurwere. Conn et al., kusiyana neModel, vakaronga imwe kupatsanurwa mukati meboka re'coma.

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Category A. Mukai

Muka, anoziva uye akananga murwere

Chikamu B. Dulling

Kupera simba kwekuziva, murwere ane lethargic asi anogona kumutswa, mhinduro ine chinangwa kune zvinorwadza zvinokurudzira.

Murwere haakwanisi kumutswa, achipindura zvisina kujairika kune zvinorwadza zvinokurudzira.

Category C. Comatose

C1 Decerebrate-mhando kuchinjika kune zvinorwadza zvinokurudzira

C2 Decerebrate-mhando yekuwedzera kune zvinorwadza zvinokurudzira

C3 Flaccid kana kusipo mhinduro kune zvinorwadza zvinokurudzira

Prognosis inotemerwa zvinoenderana nechikamu, uye yakanakira varwere vari muzvikamu A uye B.

Muchikamu cheC, kufungidzira kunowedzera sezvo coma inodzika.

Muchidzidzo chekudzokororwa, varwere vese vakapihwa pakubvumidzwa muchikamu A vakapona pasina matambudziko.

90% yevarwere vari muchikamu B vakapona pasina kana imwe sequelae, asi gumi muzana vakafa.

Pavarwere vari muchikwata C, 55% vakapora zvachose, asi 34% vakafa uye 10% vakakuvara zvachose mutsinga.

Kuoma kwekunyura kwakakamurwa kuita madhigirii mana

Giredhi 1: munhu akabatwa haana kufema mvura, inofefetera zvakanaka, ine cerebral oxygenation yakanaka, haina kukanganisa kwekuziva, inoshuma kugara zvakanaka;

2nd degree: munhu akabatwa akafema zvinwiwa zvishoma, kuputika ma rales uye / kana bronchospasm zvinoonekwa, asi mhepo yekufema yakakwana, kuziva kwakasimba, murwere anoratidza kunetseka;

3rd degree: munhu akabatwa akafema zvinwiwa zvakasiyana, anopa rales, bronchospasm uye kushushikana kwekufema, anovandudza cerebral hypoxia nezviratidzo kubva pakuvhiringidzika kusvika kune hasha, kune soporific state, cardiac arrhythmias iripo;

4th degree: munhu akabatwa akafemera mvura yakawandisa kana kuramba ari muhypoxic kusvika kusungwa kwemoyo uye kufa.

ZVINOKOSHA: zviratidzo zvakakomba zvekunyura zvinoitika kana huwandu hwemvura yakafemerwa inopfuura 10 ml pakirogiramu yehuremu hwemuviri, kureva hafu yerita yemvura kumunhu anorema makirogiramu 50 kana 1 litre kana akayera makirogiramu zana: kana huwandu hwemvura. zvishoma, zviratidzo zvinowanzova pakati nepakati uye zvenguva pfupi.