Tracheostomy inta lagu gudajiro bukaan-socodka COVID-19

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Tracheostomy inta lagu gudajiro bukaan-socodka COVID-19: sahan ku saabsan xirfad-caafimaadeedka hadda jira

By qolka Last updated Jul 17, 2020

Adeegyada daryeelka caafimaadku waxay dhawaanahanba la kulmeen codsiyo lama filaan ah. COVID-19 faafidda cudurka coronavirus wuxuu beddelay habka ficilka. Qalliin walba wuu ka adkaaday sidii hore. Baarayaasha gudaha Boqortooyada Midowday (UK) waxay sameeyeen daraasad ku saabsan dhaqanka caafimaad ee hada la joogo ee faragalinta cudurka maskaxda ee inta lagu gudajiro bukaanada COVID-19.

Sidaan wada ognahay, CVID-19 masiibada faafa waxay ku dhacdaa oof wareenka waxaana laga yaabaa inay si dhakhso leh ugu gudubto cudurka neefsashada daran. [3] Shuruudo badan oo bukaanley ah, sida bukaanka cudurka coronavirus, uur kujirta iyo hawo farsamo ayaa si joogto ah loogu baahan yahay. Bukaannada u baahan hawo-dheeraynta hawo-dheer, waxay u baahan yihiin tracheostomi si ay uga faa'iideystaan. [5] Faa'iidooyinka waxaa ka mid ah naas-nuujinta iyo musqusha sambabka kuwa u baahan nuugista marin-haweedka joogtada ah ee Qaybta Daryeelka Degdegga ah. Tracheostomy ee bukaannada ku jira xannibaadda waxaa badanaa la qaataa inta u dhexeysa maalinta 7 iyo 10 ka dib soo-kabashada. Si kastaba ha noqotee, tilmaamaha ENT UK waxay aqoonsadeen baahida loo qabo taxaddar marka ay ku sameynayaan qalliinka maskaxda ku dhaca bukaannada COVID-19. [8] Baarayaasha jaamacadaha UK ayaa daabacay sahankan soosocda si loo ogaado dhaqamada caafimaad.

Khibrad uyeelashada bukaanjiifka COVID-19: waxa aan haysano

Tracheostomi waxaa lagu samayn karaa iyada oo loo maro hab qalliin oo furan ama qalloocsan, badanaaba sariirta dhinaceeda. [7] Si kastaba ha noqotee, xog yar ayaa muujineysa habka ugu habboon iyo natiijada xigta ee bukaannada hawada ku jira ee COVID-19. Xuduudaha Shiinaha oo ay sida ugu badan u faafay waxay faafisay faham ballaaran oo ku saabsan sida ugu wanaagsan ee loo maareeyo bukaannada wanaagsan ee COVID-19. Khibraddooda waxay faa'iido u leedahay hay'adaha kale horaantii wareegii masiibada. Kaliya maaha xagga qorshaynta dariiqa bukaanka iyo ilaha daryeelka caafimaadka, laakiin sidoo kale saadaalinta natiijooyinka. Kooxda cilmi baadhayaasha waxay sameeyeen sahan caalami ah si ay u qiimeeyaan wax ka qabashada qalliinka maskaxda ku dhaca inta lagu gudajiro bukaan-socodka COVID-19 ee bukaannada qalliinka ee ENT.

Dhakhaatiirta qalliinka ee ENT: tracheostomi inta lagu gudajiro bukaan-socodka COVID-19: hababka iyo natiijooyinka

Sahankan waa Mashruuc Horumarineed oo laga Hirgaliyay Waaxda Cilmi baarista iyo Horumarinta ee Isbitaalka King's College Hospital NHS Foundation Trust, London Baarayaasha waxaay bilaabeen xog aruurinta internetka oo ka kooban su'aalaha soosocda:

Waddankee / Gobolkee ayaad ku saleysan tahay?
Immisa bukaan oo COVID-19 ah oo hawo qaboojiyey ayaad ku aragtay cisbitaalkaaga?
Boqolkiiba immisa bukaanjiifka uurjiifka ah ee u baahnaa qalliinka sambabada?
Celcelis ahaan maalin intee le'eg ayaa loo qabtay tracheostomi (tus., Maalinta 7 ee xiidanka)?
Muddo intee le'eg kadib markii tracheostomika bukaanka laga joojiyay hawo-mareenka?
Boqolkiiba immisa ayey bukaannada dhimanayaan in kasta oo ay kujiraan cudurka maskaxda?
Natiijooyinku miyey ku fiicnaadeen farsamo gaar ah oo tracheostomi (tusaale ahaan, qalloocnaan iyo qalliin)?

Foomka su'aalaha waxaa la faafiyay Maarso 27-keedii, 2020 waxaana la aqbalay xogta ilaa Abriil 15-keedii, 2020. Bukaanka iyo dadweynaha kama qeybqaadan soo saarista sahankaan ama maqaalkan.

Sahankan waxaa dhammeystirey 50 jawaab bixiye oo ka kala yimid labada Boqortooyada Midowday (n = 8) iyo cutubyada caalamiga ah (Jaantuska 1aad) Tirada bukaannada hawo qaba ayaa ahaa 3403 iyadoo 68 bukaan ay yihiin qeybta Unugyada / Awoodda (inta u dhaxeysa 0-600). Boqolkiiba bukaannada uur-jiifka ah ee u baahan tracheostomi waxay ahayd celcelis ahaan 9.65% (u dhexee 0% -100%) oo tracheostomi la sameeyay ka dib muddadii ay ahayd celcelis ahaan 14.4 maalmood (tirada 7-21).

Tan waxaa laga soo qaatay 28 jawaab bixiyeyaal 2701 bukaanjiif ah oo hawo qaboojiyay (Jaantus 2). Si guul leh, bukaannadu waxay naaska ka joojiyeen isku-dheellitirka wadnaha celcelis ahaan 7.4 maalmood kadib (inta u dhexeysa 1-16 maalmood). In kasta oo tracheostomy celcelis ahaan 13.5% bukaannadu ay dhinteen (waxaa laga keenay 14 jawaab bixiyeyaal ah oo ka kala yimid dad tiradoodu dhan tahay 1687 bukaan-jiif ah oo hawo qaboojiyey). Iyada oo la xidhiidha farsamada tracheostomi iyo natiijada, 3 ka mid ah 50kii jawaab bixiyaasha ayaa doorbiday tracheostomy qalloocan. Qaabilaad qalliin oo furan ayaa waxaa doorbiday 8 ka mid ah 50 jawaab bixiyeyaasha. Jawaab bixiyaasha kale (20/50) ayaa sheegay in labada midkood aysan door bidin, iyadoo 19/50 ka hartay aysan awoodin inay ku biiriyaan.

Maxuu ahaa sahankan ku saabsan cudurka maskaxda ee maskaxda ku dhaca inta lagu gudajiro bukaan-socodka COVID-19?

Xogta laga helay Wuhan waxay soo jeedinaysaa in wakhtiga dhexe ee isbitaalka la seexiyay ilaa dhimashada ay ahayd 5 maalmood bilihii ugu horeeyay ee cudurka faafa, taas oo macnaheedu yahay 11 maalmood.[14] Faafida COVID-19 waxay keentay baahida aan la barbar dhigi karin ee adeegyada daryeelka muhiimka ah iyo baahida loo qabo gelinta iyo hawo-mareenka.[1] Kuwa aadka u daran waxay u baahan yihiin hawo-qaadis iyo hawo horumarsan oo makaanikada ah sababtoo ah horumarka degdega ah ee oof-wareen. Waxay isu beddeshaa mid daran neefsashada oo dhib ah cilladda keenta in neefsashada oo xumaato iyo dhimasho.[3,12,13]

Tilmaamaha hada la daabacay ee Akademiyada Mareykanka ee Otorhinolaryngology-Head iyo Neck Qalliinka waxay kugula talineysaa in tracheostomi-ka aan la sameyn kahor 14 maalmood kahor intaritaanka. [15] Natiijooyinka sahankaan waxay soo jeedinayaan in ugu dhawaan 1 ka mid ah 10-kii bukaan-socodka ee hawo-galeen ama hawo-qaba ee COVID-19 u baahan yihiin tracheostomi. Natiijooyinka kale ayaa soo jeedin doona in cutubyadu ay qaadanayaan siyaasad la mid ah iyada oo dad tiro yar ay si joogto ah u samaynayaan shaqa-joojinta hore ee maskaxda.

Si kastaba ha noqotee, waa inaan ka warqabno halista suurtagalka ah ee hawo-dheeraynta kuwa laga yaabo inay naas-nuujiso. Kuwaas waxaa ka mid ah boog-xanuun ku dhaca xiidmaha, stenosis-ka iyo dhiig futada. Cudur darrada daryeelka xasaasiga ah ayaa waliba loo badinayaa inay sii badanayaan. [5]

Bukaanno badan ayaa u baahan doona hawo-dheerayn. Tani waxay sababi kartaa atrophy-ga murqaha kuwaas oo sii dheerayn kara ama ka horjoogsan kara naas-nuujinta. [17] Warbixinnada ku saabsan qanjirada sare iyo bararka sare iyo boogta ayaa sidoo kale mamnuuci karo faafinta iyo sii dheereeyaan baahida loo yaqaan 'intubation', suuxinta iyo hawo-mareenka. Tan waxaa lagu adkaan karaa tracheostomi.

Si kastaba ha noqotee, sahankan wuxuu ku fashilmay inuu dejiyo waxtarka cad ee la xiriira farsamada tracheostomi. Faallooyinka ay bixiyeyaasha jawaab bixintu waxay sharxeen in wax ka qabashada loo qaatay kiis kiis ahaan iyo ku tiirsanaan khibradeed qalliin maxalli ah. Xaddidaadaha waxaa ka mid ah tirada jawaabeyaasha qaba COVID-19 bukaanka togan ee ku ururay qaybo gaar ah. Qorayaashu waxay muujinayaan mahadnaq weyn oo ay u qabaan kuwa waqtigooda ku qaatay inay ka jawaabaan sahamintan si ay u taageeraan go'aan qaadashada asxaabta adduunka oo dhan.

AQOONSIGA

Ayman D'Souza: Christ Church, Jaamacadda Oxford, Oxford, UK

Ricard Simo FRCS (ORL-HNS): Waaxda Otorhinolaryngology, Guy's iyo St Thomas 'NHS Foundation Trust, London, UK

Alwyn D'Souza FRCS (ORL-HNS): Waaxda Otorhinolaryngology, Isbitaalka Jaamacadda Lewisham, London, UK

Francis Vaz FRCS (ORL-HNS): Waaxda Madaxa iyo Qalliinka Qoorta, Isbitaalka Jaamacadda, London, UK | Machadka Sayniska Caafimaadka, Xarunta Medway, Jaamacadda Canterbury Christ University, Kent, UK

Andrew hore FRCS (ORL-HNS): Waaxda Otorhinolaryngology, Princess Royal University Hospital, Kent, UK

Rahul Kanegaonkar FRCS (ORL-HNS): Machadka Sayniska Caafimaadka, Xarunta Jaamacadda Medway, Canterbury Christ Church University, Kent, UK

tixraacyada

Willan J, King AJ, Jeffery K, Bienz N. Caqabadaha haysta isbitaalada NHS inta lagu gudajiro cudurada faafa-19. BMJ. 2020; 368: m1117. https: // doi.org/10.1136/bmj.m1117.
https://www.who.int/docs/default-source/coronaviruse/situationreports/20200414-sitrep-85-covid-19.pdf?sfvrsn=7b8629bb_4). Accessed April 14, 2020.
Wu C, Chen X, Cai Y, et al. Sababaha halista ah ee laxiriira xanuunka daran ee neef-mareenka iyo dhimashada bukaanada qaba cudurka coronavirus 2019 pneumonia ee Wuhan. Shiinaha JAMA Int Med. 2020; e200994. https://doi.org/10.1001/jamainternmed. 2020.0994.
Wu Z, McGoogan JM. Astaamaha iyo casharada muhiimka ah ee cudurka coronavirus 2019 (COVID-19) ee ka dillaacay Shiinaha: soo koobid warbixin 72 314 xaaladood oo ka socota Xarunta Shiinaha ee Xakamaynta iyo Kahortagga Cudurrada. JAMA. 2020; 323 (13): 1239–1242. https://doi.org/10.1001/jama.2020.2648
Dempster J. Tracheostomi (Jabtarka 35). Gudaha: Musheer Hussain S, ed. Cudurka Logan Turner ee sanka, Cunaha iyo Madaxa Qaybta iyo Qalliinka Neck. 11aad ed. Boca Raton, FL: CRC Press; 2015.
Freeman BD, Borecki IB, Coopersmith CM, Buchman TG. Xiriirka udhaxeeya waqtiga tracheostomy iyo waqtiga hawo-warshadeynta bukaanka aadka u jiran. Crit Care Med. 2005; 33 (11): 2513-2520.
Lipton G, Stewart M, McDermid R, et al. Khibradda tracheostomy ee dhaqammada kala duwan. Ann R Coll Surg Engl. 2020; 1: 1-5.
Takhar A, Walker A, Tricklebank S. Soo jeedinta hagitaan la taaban karo ee tracheostomi aamin ah inta lagu jiro cudurka COVID-19. Eur Arch Otorhinolaryngol. 2020. http://dx.doi.org/ 10.1007 / s00405-020-05993-x.
Murthy S, Gomersall CD, Fowler RA. Daryeel bukaannada sida daran u bukooda COVID-19. JAMA. 2020; 323 (15): 1499–1500. https://doi.org/10.1001/jama.2020.3633.
https://www.entuk.org/tracheostomy-guidance-during-covid19-pandemic. Accessed April 14, 2020.
https://www.who.int/docs/default-source/coronaviruse/ situation-reports/20200415-sitrep-86-covid-19.pdf?sfvrsn= c615ea20_6. Accessed April 14, 2020.
Guan WJ, Ni Z, Hu Y, et al. Astaamaha caafimaad ee cudurka coronavirus 2019 ee Shiinaha. New Eng J Med. 2020; 382: 1708– 1720. https://doi.org/10.1056/NEJMoa2002032.
Chen J, Qi T, Liu L, et al. Horusocodka caafimaad ee bukaanka jooga Shanghai, China. J Cudur. 2020; 80 (5): E1 – E6. https://doi.org/ 10.1016 / j.jinf.2020.03.004.
Astaamaha caafimaad ee 'Leung C.' oo ah astaamaha dhimashada ee cudurka faafa ee coronavirus ee Shiinaha. Faallooyin ku saabsan Cilmiga Caafimaadka. 2020; 323 (15): 1499–1500. https://doi.org/10.1002/rmv.2103.
Bayaanka Mawqifka AAO-HNS. Talo soo-jeedinta Tracheostomi inta lagu gudajiray COVID-19 Faafida https://www.ent.org/content/ tracheostomy-talooyinka-inta lagu jiro -vid-19-safka.
Vassilakopoulos T. Muruqyada muruqyada neef-mareenka ee ku jira 'ICU': ma tahay waqtigii la ilaalin lahaa diaphragm-ka? Thorax. 2016; 71 (5): 397-398. https://doi.org/10.1136/thoraxjnl-2016-208354.
Bolton CF. Calaamadaha neuromuscular ee jirrooyinka halista ah. Dareemaha Murqaha. 2005;32(2):140-163.