Zvehutano zvehutano zvakasangana nezvisingatarisirwe zvikumbiro, nguva pfupi yapfuura. COVID-19 coronavirus denda rakachinja nzira yekuita. Zvese zvekuvhiya zvakawedzera kuoma kupfuura zvanga zvamboita. Vanotsvaga muUK vakaita ongororo pane yazvino kiriniki tsika yekupindira tracheostomy panguva yekushambidzika muCOVID-19 varwere.

Sezvo isu tese tinoziva, COVID-19 denda rinoguma nemabayo uye inogona kukurumidza kufambira mberi kune yakasimba acute kupumha chirwere. [3] Varwere vazhinji mamiriro ezvinhu, akadai se coronavirus positive varwere, intubation uye michina mhepo yekufambisa inowanzodiwa. Vaya varwere vanoda nguva refu yekufambisa, vanoda tracheostomy kuti vabatsirwe. [5] Zvakanakira zvinosanganisira kuyamwisa uye chimbudzi chechimbuzi mune izvo zvinoda kugara zvichiratidzirwa mumhepo muIntral Care Unit. Tracheostomy mune varwere vakapinda mukati kazhinji yakaitwa pakati pezuva rechinomwe neregumi inotevera intubation. Nekudaro, ENT UK mirayiridzo yakaziva kukosha kwekungwarira kana uchiita tracheostomy muvarwere veCOVID-7. [10] Vatsvagiri kubva kumayunivhesiti muUK vakaburitsa ongororo iyi inotevera kuti vaone maitiro echipatara.

Zvakaitika muCOVID-19 varwere intubation: izvo zvatinazvo

Tracheostomy inogona kuitwa kunyange nenzira yakavhurika yekuvhiya kana nzira, kazhinji pamubhedha. [7] Nekudaro, diki data inoratidza iyo yakakwana nzira uye yakazotevera mhedzisiro muCOVID-19 yakanaka yakafinirwa varwere. Matunhu muChina akakunda zvakanyanya nedenda akavhura kunzwisisa kwemaitiro ekugona kubata varwere vane COVID-19. Ruzivo rwavo runobatsira kune dzimwe nzvimbo kutanga padenda redenda. Kwete chete maererano nezve kuronga varwere nzira uye hutano hwekuchengetedza zviwanikwa, asi zvakare kufanotaura zvabuda. Chikwata chevaongorori ichi chakaita ongororo yenyika kuti iongorore tracheostomy kupindira panguva yekushambidzika muCOVID-19 varwere vane hutano hwakanaka pakati pe ENT Surgeons.

 

Vanovhiya ENT: tracheostomy panguva yekushambidzika muCOVID-19 varwere: nzira nemhedzisiro

Ongororo iyi ndeye Sevhisi Yekuvandudza Basa rakawanikwa kubva kuDhipatimendi reKudzidza nekuvandudza reKing's College Hospital NHS Foundation Trust, London. Vatsvaguri vakatanga chirongwa chemubvunzo chepamhepo chine mibvunzo inotevera:

1. Ndeipi nyika / dunhu raunogara?
2. Vangani varidzi vemweya weCOVID-19 varwere vaunove navo kuchipatara chako?
3. Ipi muzana yevarwere vakapinda mune inodiwa inoda tracheostomy?
4. Paavhareji pazuva reiko iyo tracheostomy yakaitwa (semuenzaniso, zuva rechinomwe rekupinda)?
5. Mushure menguva yakareba sei tracheostomy murwere akarumurwa kubviswa kubva pamhepo?
6. Chii chikamu chevarwere vakafa kunyangwe tracheostomy?
7. Zviwanikwa zvaive nani nechero tracheostomy maitiro (semuenzaniso, percutaneous vs kuvhiya)?

Iyi mibvunzo yakaparurwa musi waKurume 27, 2020 uye dhata yakagamuchirwa kusvika munaKubvumbi 15, 2020. Varwere neruzhinji havana kubatanidzwa mukugadzirwa kweongororo iyi kana chinyorwa.

Ongororo iyi yakazadzikiswa nevane makumi mashanu vakapindurwa kubva vese kuUnited Kingdom (n = 50) neInternational units (Mufananidzo 8.) Huwandu hwevarwere vakapinda muropa hwaive mazana matatu nemakumi matatu nevatanhatu pamwe nevarwere makumi mana neshanu pachipatara Unit / Ruvimbiko (renji 1-3403). Iyo muzana yevarwere vakapinda muropa inoda tracheostomy yaive paavhareji 68% (huwandu 0% -600%) ine tracheostomy yakaitwa zvichitevera kupinza panguva yekureva kwemazuva 9.65 (huwandu 0-100).

Izvi zvakavezwa kubva kune makumi maviri nevapfumbamwe vakapindura kubva kuma 28 vakapinda mukati mevarwere vakapinda mweya (Mufananidzo 2701). Achibudirira, varwere vakarumidzira post tracheostomy paavhareji mushure memazuva 2 (huwandu hwemazuva 7.4-1). Kunyangwe iyo tracheostomy paavhareji 16% yevarwere vakafa (yakatorwa kubva kune gumi nevatanhatu vakapindura kubva muhuwandu hwevarwere gumi nevaviri vari mukati megumi nemazana nemazana maviri emukati). Nezve tracheostomy maitiro uye mhedzisiro, vatatu kubva makumi mashanu vakapindurwa akapa kusarudzika kune percutaneous tracheostomy. Nzira yakavhurika yekuvhiya yakafarirwa nevasere kubva makumi mashanu vakapindura. Vamwe vakapindura (13.5/14) havatauri zvekufarira, paine 1687/3 yakasara isingakwanise kubatsira.

 

Chii ichi chakaongorora tracheostomy panguva yekushambidzika muCOVID-19 varwere vakaenda?

Zvakabva kuWuhan zvinoratidza kuti nguva yepakati kubva pakupinzwa muchipatara kusvika parufu yaive mazuva mashanu mumwedzi yekutanga yedenda, zvinoreva kuti mazuva gumi nerimwe.[5] Denda reCOVID-11 rakonzera kudiwa kusingaenzaniswi kwemasevhisi ekuchengetedza akakosha uye kudiwa kweitubation uye mhepo yekufemesa. [14] Avo vanove vakatsoropodza vanoda intubation uye mechanical advanced ventilation nekuda kwekukurumidza kufambira mberi kwepneumonia. Inoshanduka kuita yakaoma acute mweya wekufema chirwere chinokonzera kutadza kufema zvakanaka uye kufa.[3,12,13]

Nongedzo dzazvino dzakabudiswa neAmerican Academy yeOtorhinolaryngology-Musoro uye Neck Kuvhiya kunokurudzira kuti tracheostomy haifanirwe kuitwa isati yasvika mazuva gumi nemana ekuchinjiswa. [14] Mhedzisiro yeongororo iyi inoratidza kuti vangangoita 15 kubva pagumi rega rega yakanyorova uye inofema varwere veCOVID-1 vanoda tracheostomy. Mimwe mhedzisiro ingaratidza kuti mauniti ari kutora mutemo wakafanana nevazhinji vanoita zvekutanga tracheostomy nguva nenguva.

Nekudaro, isu tinofanirwa kuziva nezve njodzi dzinogona kuitika dzekupfuurira kwemhepo mune avo vangarumurwa. Izvi zvinosanganisira kunonoka maronda emono, stenosis uye tracheo-esophageal fistula. [5] Yakawanikwa kurwara kwekuchengetera chirwere chinogona kunge chichiwedzera. [16]

Vazhinji varwere vachazoda kugara kwenguva refu. Izvi zvaizokonzeresa mhasuru atrophy iyo ingangotora kana kudzivirira kurumudza. [17] Mishumo yekudzvinyirira uye kuzvimba kwekuzvimba uye ulceration kungarambidze kuwedzeredza uye kuwedzera nguva yekuda kwekufambisa, kusimuka uye mhepo yekuzora. Izvi zvinogona kukurirwa ne tracheostomy.

Nekudaro, iyi ongororo yakatadza kugadza chero yakajeka pundutso maererano neye tracheostomy maitiro. Zvakataurwa nevapinduri zvakatsanangura kuti kupindira kwakatorwa pane imwe nyaya nenyaya dzezvinhu uye zvichienderana neruzivo rwekuvhiya. Zvinogumira zvinosanganisira huwandu hwevanopindura neCOVID-19 varwere vane hutano hwakanyanya hwakanangiswa muzvikamu zvakananga. Vanyori vanoratidza kuonga kwavo kukuru kune avo vakatora nguva yekupindura kuongororo iyi kutsigira sarudzo dzekuita pamwe nevamwe pasi rose.

 

VANHU

Ayman D'Souza: Christ Church, Yunivhesiti yeOxford, Oxford, UK

Ricard Simo FRCS (ORL-HNS): Dhipatimendi reOtorhinolaryngology, Guy's uye St Thomas 'NHS Foundation Trust, London, UK

Alwyn D'Souza FRCS (ORL-HNS): Dhipatimendi reOtorhinolaryngology, University Hospital Lewisham, London, UK

Francis Vaz FRCS (ORL-HNS): Dhipatimendi reMusoro neNeck Kuvhiya, University College Hospital, London, UK | Institute of Medical Sayenzi, Medway Campus, Canterbury Christ Church University, Kent, UK

Andrew Pamberi peFRS (ORL-HNS): Dhipatimendi reOtorhinolaryngology, Princess Royal University Hospital, Kent, UK

Rahul Kanegaonkar FRCS (ORL-HNS): Institute of Medical Science, Medway Campus, Canterbury Christ Church University, Kent, UK

 

References

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2. https://www.who.int/docs/default-source/coronaviruse/situationreports/20200414-sitrep-85-covid-19.pdf?sfvrsn=7b8629bb_4). Accessed April 14, 2020.
3. Wu C, Chen X, Cai Y, et al. Njodzi zvinhu zvinosanganiswa neakakomba kufema kutapudzika syndrome uye kufa mune varwere vane coronavirus chirwere 2019 pneumonia muWuhan. China JAMA Int Med. 2020; e200994. https://doi.org/10.1001/jamainternmed. 2020.0994.
4. Wu Z, McGoogan JM. Hunhu hwezvakakosha uye zvidzidzo zvakakosha kubva kuchirwere chekoronavirus 2019 (COVID-19) kubuda muChina: pfupiso yemishumo yemakumi manomwe nemakumi matatu nemakumi matatu nemakumi matatu emakore kubva kuChinese Center yeChirwere Chekutonga uye Kudzivirira. JAMA. 72; 314 (2020): 323–13. https://doi.org/1239/jama.1242
5. Dempster J. Tracheostomy (Chitsauko 35). Muna: Musheer Hussain S, ed. Logan Turner's Zvirwere zveMhino, Throat uye Nzeve Musoro uye Neck Kuvhiya. 11th ed. Boca Raton, FL: CRC Press; 2015.
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7. Lipton G, Stewart M, McDermid R, et al. Multispecialty tracheostomy chiitiko. Ann R Coll Surg Engl. 2020; 1: 1-5.
8. Takhar A, Walker A, Tricklebank S. Kurudziro yenhungamiro inoshanda yekuchengetedza tracheostomy panguva yeCOVID-19 denda. Eur Arch Otorhinolaryngol. 2020. http://dx.doi.org/ 10.1007 / s00405-020-05993-x.
9. Murthy S, Gomersall CD, Fowler RA. Kuchengeta kwevanorwara vanorwara neCCIDID-19. JAMA. 2020; 323 (15): 1499–1500. https://doi.org/10.1001/jama.2020.3633.
10. https://www.entuk.org/tracheostomy-guidance-during-covid19-pandemic. Accessed April 14, 2020.
11. https://www.who.int/docs/default-source/coronaviruse/ situation-reports/20200415-sitrep-86-covid-19.pdf?sfvrsn= c615ea20_6. Accessed April 14, 2020.
12. Guan WJ, Ni Z, Hu Y, et al. Clinical hunhu hwe coronavirus chirwere 2019 muChina. Nyowani J J. 2020; 382: 1708- 1720. https://doi.org/10.1056/NEJMoa2002032.
13. Chen J, Qi T, Liu L, et al. Kufambira mberi kwekiriniki kwevarwere vane muShanghai, China. J Hosha. 2020; 80 (5): E1-E6. https://doi.org/ 10.1016 / j.jinf.2020.03.004.
14. Leung C. Makiriniki emhando dzekufa mune ino novel coronavirus chirwere muChina. Ongororo mukurapa Virology. 2020; 323 (15): 1499–1500. https://doi.org/10.1002/rmv.2103.
15. AAO-HNS Position Statement. Tracheostomy Kurudziro Munguva yeCOVID-19 Denda https://www.ent.org/content/ tracheostomy -zvikurudzira- panguva-covid-19-dambudziko
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SOURCE

ResearchGate

University of Oxford 

Guy's uye St Thomas 'NHS Foundation Kuvimba

Yunivhesiti Chipatara Lewisham

University College Hospital

Princess Royal University Chipatara

MedCampus Canterbury Kristu ChurchUniversity