Kukuvadzwa kunokonzerwa nekufemerwa nehutsi kunoratidza kuwedzera kunoshamisa kwekufa kwevarwere vakatsva: muzviitiko izvi kukuvadzwa kunobva mukufemerwa nehutsi kunowedzera kune kunobva mukutsva, kazhinji nemhedzisiro inouraya.

Chinyorwa ichi chakatsaurirwa kupisa marapirwo, kunyanya kutaura nezve pulmonary uye systemic kukuvadzwa muzvidzidzo zvakapiswa vakafemesa utsi, nepo dermatological maronda achiongororwa kumwewo.

Kusvuta inhalation uye kupisa, zvinangwa zvekurapa

Zvinangwa zvekubatsira kufema muvarwere vakatsva ndezvekuona:

• airway patency,
• kufefetedza kunobudirira,
• oxygenation yakakwana,
• kuchengeta acid-base balance,
• kuchengetedza moyo kugadzikana,
• kukurumidza kurapwa kwezvirwere.

Mune zvimwe zviitiko, kuita excartomy kwakakosha kudzivirira chero mavanga echipfuva kubva pakukanganisa kufamba kwechipfuva.

Zvinangwa zvekurapa kutsva kweganda ndezvi:

• kubviswa kweganda risingakoshi,
• kushandiswa kwemabhandeji ane medicated ane topical antibiotics,
• kuvharwa kwemaronda nekutsiva kweganda kwenguva pfupi uye kuisirwa ganda kubva munzvimbo dzine hutano kana sampuli dzakagadzirwa panzvimbo yakatsva,
• kuderedza kurasikirwa kwemvura uye njodzi yehutachiona.

Musoro wacho unofanirwa kupihwa huwandu hwema caloric hwakakwira kupfuura iwo ekutanga, kuitira kufambisa kugadzirisa maronda uye kudzivirira catapolism.

Kurapa kwevanopisa varwere vane chepfu inhalation yehutsi

Kupisa vanhu vane zvironda zvidiki zvinokanganisa nzira dzekumusoro dzemhepo, kana nezviratidzo zvekuvhara kufema kana, chero zvakadaro, kubatanidzwa kwepulmonary, kunofanirwa kutariswa zvakanyanya.

Izvo zvinodiwa kuti upe okisijeni yekuwedzera, kuburikidza nenasal cannula, uye kuita kuti murwere atore yakakwirira Fowler chinzvimbo, kuitira kuderedza basa rekufema.

Bronchospasm inobatwa neaerosolized β-agonists (yakadai se orciprenaline kana albuterol).

Kana kuvharirwa kwemhepo kuchitarisirwa, kunofanirwa kuchengetedzwa nehukuru hwakakodzera endotracheal chubhu.

mangwanani tracheostomy kazhinji hazvikurudzirwe muvanhu vakatsva nekuti nzira iyi ine chekuita nehuwandu hwehutachiwana uye kuwedzera kwekufa, kunyangwe zvingave zvakafanira kutsigirwa kwenguva refu yekufema.

Early intubation yakashumwa kuti ikonzerese kwenguva pfupi pulmonary edema mune vamwe varwere vane kukuvara kwekufema.

Kushandiswa kwe5 kana 10 cm H2O kuenderera mberi kwakanaka kwemhepo yemhepo (CPAP) inogona kubatsira kuderedza edema yekutanga yepulmonary, kuchengetedza huwandu hwemapapu, kutsigira edemamatous airways, optimize ventilation / perfusion ratio, uye kuderedza kufa nekukurumidza.

Systemic administration ye cortisone yekurapa edema haina kukurudzirwa, maererano nekuwedzera kwehutachiwana hwehutachiona.

Kurapa kwevarwere vane comatose kunonangidzirwa kune yakanyanya hypoxia kubva kuhutsi inhalation uye CO poisoning uye inobva pakutungamirirwa kweokisijeni.

Kuparadzaniswa uye kubviswa kwecarboxyhemoglobin kunokwidziridzwa nekutonga kweokisijeni yekuwedzera.

Zvidzidzo zvakafema utsi, asi zvinongowedzera zvishoma muHbco (pasi pe30%) uye kuchengetedza zvakajairika cardiopulmonary function, zvinofanirwa kurapwa nekuendeswa kwe100% okisijeni kuburikidza nemasikisi echiso akasimba, senge "nonrebreathing" ( iyo isingakubvumiri kuti ufeme mweya wawakangoburitsa zvakare), nekuyerera kwe15 litres / miniti, kuchengetedza tangi rekuchengetedza rakazara.

Oxygen therapy inofanira kuenderera mberi kusvikira mazinga eHbco awira pasi pe10%.

Mask CPAP ine 100% kuendesa okisijeni inogona kunge iri kurapa kwakakodzera kune varwere vane hypoxemia iri kuwedzera uye kwete kana chete zvinyoro zvinopisa zvironda kumeso uye kumusoro kwemhepo.

Varwere vane refractory hypoxemia kana aspiration kukuvara kwakabatana nekoma kana cardiopulmonary instability inoda intubation uye rubatsiro rwekufema ne 100% oksijeni uye inokurumidza kutumirwa hyperbaric oxygen therapy.

Kurapa kwekupedzisira kunokurumidza kunatsiridza kutakurwa kweokisijeni uye kukurumidza nzira yekubvisa CO kubva muropa.

Varwere vanotanga kutanga pulmonary edema, ARDS, kana pneumonia inowanzoda kumanikidzwa kwekupera-kupera simba (PeEP) rubatsiro rwekufema muhupo hweABGs hunoratidza kutadza kufema (PaO2 isingasviki 60 mmHg, uye / kana PaCO2 yakakwirira kupfuura 50 mmHg, ine pH yakaderera kupfuura 7.25).

PeEP inoratidzwa kana PaO2 inowira pasi pe60 mmHg uye FiO2 inoda inodarika 0.60.

Kubatsira kwekufema kunofanirwa kugara kwenguva refu, nekuti varwere vanopisa vanowanzove nekukasira metabolism, izvo zvinoda kuwedzera kwekufema miniti vhoriyamu kuve nechokwadi chekuchengetedza homeostasis.

The midziyo inoshandiswa inofanirwa kunge ichikwanisa kuburitsa yakakwira vhoriyamu/miniti (kusvika 50 litres), ichichengetedza yakakwira peak airway pressure (kusvika 100 cm H2O) uye kufemerwa/expiration ratio (I:E) yakagadzikana, kunyangwe kana BP ichida kuwedzera.

Refractory hypoxemia inogona kupindura kumanikidziro-inotsamira, reverse-ratio ventilation.

Utsanana hwemapapu hwakakwana hunodiwa kuti nzira dzemhepo dzigare dzisina sputum.

Passive kufema physiotherapy inobatsira kuunganidza zvakavanzika uye kudzivirira kuvharika kwemhepo uye atelectasis.

Achangoburwa ganda grafts haashiviriri chest percussion uye vibration.

Therapeutic fibronchoscopy ingave yakakosha kuvhura nzira dzemhepo kubva mukuunganidzwa kwezvakakora zvemukati.

Kunyatso chengetedza chiyero chemvura kunodiwa kuti uderedze njodzi yekuvhunduka, kutadza kwerenal, uye pulmonary edema.

Kudzoreredzwa kwechiyero chemvura yemurwere, uchishandisa nzira yeParkland (4 ml ye isotonic solution pakg pachikamu chimwe nechimwe cheganda rakatsva, kwemaawa makumi maviri nemana) uye kunyanya kuchengetedza diuresis pamitengo iri pakati pe24 ne30 ml/awa uye nechepakati venous. kudzvinyirira pakati pe50 ne2 mmHg, inobatsira kuchengetedza kugadzikana kwehemodynamic.

Mune varwere vane kukuvara kwekuda, capillary permeability inowedzera, uye pulmonary artery pressure monitoring igwara rinobatsira pakutsiviwa kwemvura, mukuwedzera kune weti kubuda kutonga.

Izvo zvinodikanwa kutarisa mufananidzo we electrolyte uye iyo acid-base chiyero.

Iyo hypermetabolic mamiriro emurwere anopisa inoda kuongororwa kwakadzama kwehutano hwekudya, hune chinangwa chekudzivirira catabolism yemhasuru tishu.

Mafungiro ekufungidzira (akadai seaHarris-Benedict uye Curreri) akashandiswa kufungidzira kusimba kwemasabolism muvarwere ava.

Parizvino, ma analyzer anotakurika anowanikwa mune zvekutengeserana anobvumira serial indirect calorimetry zviyero kuti zviitwe, izvo zvakaratidzwa kuti zvinopa kufungidzira kwakaringana kwezvinodiwa zvekudya.

Varwere vane kupisa kwakanyanya (kupfuura 50% yeganda repamusoro) vanowanzotarirwa kudya kune caloric kudya i150% yekuzorora kwavo kwesimba rekushandisa, kufambisa maronda ekupora uye kudzivirira catabolism.

Nekuporeswa kwekutsva, kudya kunovaka muviri kunodzikiswa zvishoma nezvishoma kusvika pa130% yebasal metabolic rate.

Mukutsva kwechifuva kwakatenderedza, mavanga mavanga anogona kudzora kufamba kwemadziro echipfuva

Iyo escharotomy (kuvhiya kubviswa kweganda rakatsva) inoitwa nekuita maviri lateral incision pamwe neanterior axillary line, kubva pamasendimita maviri pazasi pe clavicle kusvika kune yepfumbamwe-yegumi intercostal space, uye mamwe maviri akachinjika incision akatambanudzwa pakati pemigumo ye. yekutanga, kutsanangura mativi mana.

Kupindira uku kunofanira kuvandudza elasticity yemadziro echifuva uye kudzivirira kudzvanywa kweiyo scar tissue retraction.

Kurapa kwekutsva kunosanganisira kubviswa kweganda risingakoshi, kuiswa kwezvipfeko zvine mishonga nemishonga inorwisa mabhakitiriya, kuvhara maronda nezvinotsiva ganda kwenguva pfupi, uye kubatanidza ganda kubva munzvimbo dzine hutano kana zvienzaniso panzvimbo yakatsva. cloned.

Izvi zvinoderedza kurasikirwa kwemvura uye njodzi yehutachiona.

Utachiona hunowanzokonzerwa necoagulase-positive Staphylococcus aureus uye gram-negative mabhakitiriya, akadai seKlebsiella, Enterobacter, Escherichia coli uye Pseudomonas.

Nzira yakakwana yekuzviparadzanisa nevamwe, kudzvinyirira kwezvakatipoteredza, kusefa kwemhepo, kunomiririra matombo emakona ekudzivirira kurwisa zvirwere.

Sarudzo yemishonga inorwisa mabhakitiriya inobva pamigumo yetsika dzakatevedzana dzezvinhu kubva paronda, pamwe chete neropa, weti, uye sputum samples.

Prophylactic antibiotics haifanirwe kupihwa kune varwere ava, nekuda kwekureruka kusingagone kusarudzwa, kukonzeresa hutachiona hunopesana nekurapa.

Mune zvidzidzo zvinoramba zvisingagoneki kwenguva yakareba, heparin prophylaxis inogona kubatsira kuderedza njodzi yepulmonary embolism, uye kunyanya kukoshesa kunofanira kubhadharwa kudzivirira kukura kwemaronda ekudzvinyirira.

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