Tracheostomy nakong ea ho kenella ho bakuli ba COVID-19

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Tracheostomy nakong ea ho kenella ho bakuli ba COVID-19: tlhahlobo mabapi le boikoetliso ba bongaka ba hajoale

By LITABA Last ntjhafatswa Jul 17, 2020

Litšebeletso tsa bophelo bo botle li fumane likopo tse sa lebelloang morao tjena. Seoa sa coronavirus sa 19 se fetotse tsela ea ho sebetsa. Ts'ebetso e 'ngoe le e' ngoe e ile ea e-ba thata ho feta pele. Bafuputsi UK ba ile ba etsa tlhahlobo mabapi le ts'ebetso ea bongaka ea ho kenella ha tracheostomy nakong ea ho kenella ho bakuli ba COVID-19.

Joalokaha bohle re tseba, koluoa ea COVID-19 e baka pneumonia 'me e ka tsoela pele ka potlako ho ba le ramatiki e matla ea ho phefumoloha. [3] Maemo a bakuli a mangata, joalo ka bakuli ba nang le tšoaetso e ntle ea coronavirus, intubation le ventilation tsa mochini li hlokahala hangata. Bakuli ba hlokang ho kenella ka nakoana nako e telele, ba hloka tracheostomy ho fumana molemo. [5] Melemo e kenyelletsa ho chesa le ntloana ea pulmonary ho ba hlokang ho ts'oaroa ha moea khafetsa Lefapheng la Tlhokomelo e Matla. Tracheostomy ho bakuli ba intubated hangata e entsoe pakeng tsa letsatsi la 7 le 10 kamora ho kenella kahare. Leha ho le joalo, tataiso ea ENT UK e hlokometse tlhoko ea ho ba hlokolosi ha o etsa tracheostomy ho bakuli ba COVID-19. [8] Bafuputsi ba tsoang liunivesithing tsa UK ba phatlalalitse tlhahlobo e latelang ho supa mekhoa ea bongaka.

Phihlelo ea li-intubation tsa bakuli ba COVID-19: tseo re nang le tsona

Tracheostomy e kanna ea etsoa ka mokhoa o bulehileng oa ho buuoa kapa ka mokhoa o ikhethileng, hangata haufi le bethe. [7] Leha ho le joalo, datha e nyane e bonts'a mokhoa o nepahetseng le sephetho se latelang ho bakuli ba kenang ba COVID-19. Libaka tsa China tse ileng tsa hlaseloa ke seoa sena haholo li ile tsa ba le kutloisiso e batsi ea ho sebetsana hantle le bakuli ba nang le ts'oaetso ea COVID-19. Boiphihlelo ba bona bo na le molemo ho mekhatlo e meng pejana ho koluoa ea seoa. Eseng feela ka maemo a ho rera litsela tsa bakuli le lisebelisoa tsa tlhokomelo ea bophelo bo botle, empa hape le sephetho sa ho bolela esale pele. Sehlopha sa bafuputsi se entse tlhahlobo ea machabeng ea ho hlahloba ho kenella ha tracheostomy nakong ea ho kenella ho bakuli ba nang le COVID-19 har'a baeti ba ENT.

Lingaka tsa lingaka tsa ENT: tracheostomy nakong ea ho kenella ho bakuli ba COVID-19: mekhoa le liphetho

Tlhahlobo ena ke Morero oa Ntlafatso ea Litšebeletso o fumanehang Lefapheng la Lipatlisiso le Nts'etsopele la King's College Hospital NHS Foundation Trust, London. Bafuputsi ba ile ba hlahisa lethathamo la lipotso tsa marang-rang tse nang le lipotso tse latelang:

U lula naheng efe?
O na le bakuli ba bangata hakae ba COVID-19 sepetleleng sa hau?
Ke liperesente life tsa bakuli ba kenelletseng ba batlang tracheostomy?
Ka karolelano, "tracheostomy" e entsoe ka letsatsi lefe (mohlala, letsatsi la 7 la ho kenella)?
Mokuli o khoesitsoe kantle ho moea ka mor'a nako e kae?
Ke liperesente life tsa bakuli ba shoeleng leha ho le joalo ke tracheostomy?
Na sephetho se bile betere ka mokhoa o ikhethileng oa "tracheostomy" (mohlala, percutaneous vs upasuaji)?

Karolo ea lipotso e ile ea tsamaisoa ka la 27 Hlakubele 2020 mme data e amoheloa ho fihlela la 15 Mmesa, 2020. Bakuli le sechaba ba ne ba sa kopanele tlhahiso ea lipatlisiso kapa sengoloa sena.

Tlhahlobo e phethetsoe ke kakaretso ea batho ba arabetseng ba 50 ho tsoa United Kingdom (n = 8) le li-unit tsa Machabeng (Setšoantšo sa 1.) Palo ea bakuli ba keneng moea o mong e ne e le 3403 le bakuli ba 68 ka Karolo e 'ngoe ea Sepetlele / Trust (bophara 0-600). Peresente ea bakuli ba kenelletseng ba hlokang tracheostomy e ne e le ka karolelano ea karolo ea 9.65% (bophara 0% -100%) ka tracheostomy e entsoeng ka mor'a ho kenella ka nako ea matsatsi a 14.4 (karolo ea 7-21).

Sena se nkiloe ho ba arabang ba 28 ho tsoa ho bakuli ba 2701 ba kentsoeng le ba moea o fehlang moea (Setšoantšo sa 2). Ka katleho, bakuli ba khoesitse post tracheostomy ka karolelano ka mor'a matsatsi a 7.4 (matsatsi a 1-16). Leha ho na le tracheostomy ka karolelano ea bakuli ba 13.5% ba shoele (ba nkiloeng ho ba arabang ba 14 ho tsoa ho bongata ba bakuli ba 1687 ba keneng le ba keneng moea o mong le o mong). Mabapi le mokhoa oa ho etsa li-tracheostomy le sephetho, ba 3 ho ba 50 ba arabelang ba ile ba khetha ho tracheostomy e poteletseng. Mokhoa o bulehileng oa ho buuoa o ratoa ke ba arabelang ho ba 8 ho ba 50. Babuelli ba bang (20/50) ha baa ka ba khetha ho khethoa, ha ba 19/50 ba setseng ba sa khone ho kenya letsoho.

Tlhahlobo ee ea "tracheostomy" nakong ea ho kenella ho bakuli ba COVID-19 e ile ea nka eng?

Lintlha tse tsoang ho Wuhan li fana ka maikutlo a hore nako ea mahareng ho tloha ho amoheloa sepetlele ho isa lefung e ne e le matsatsi a 5 likhoeling tsa pele tsa seoa sena, ho bolelang matsatsi a 11.[14] Seoa sa COVID-19 se bakile tlhokahalo e ke keng ea lekanngoa ea lits'ebeletso tsa tlhokomelo e mahlonoko le tlhoko ea ho kenella le moea oa mochini.[1] Bao ba fetohang ka ho teba ba hloka intubation le moea o tsoetseng pele oa mochini ka lebaka la tsoelo-pele e potlakileng ea pneumonia. E fetoha sehloho se matla matšoenyeho a ho hema lefu le lebisang ho hloleheng ho hema le lefu.[3,12,13]

Litataiso tsa hajoale tse phatlalalitsoeng ke American Academy of Otorhinolaryngology-Head le Nko Opereishene e khothaletsa hore tracheostomy ha ea lokela ho etsoa pele ho matsatsi a 14 a ho kenella. [15] Liphetho tsa phuputso ena li ka fana ka maikutlo a hore bakuli ba bang le ba bang le ba bang le ba bang ba leshome ba kenngoeng kahare ho ContID-1 ba hloka tracheostomy. Liphetho tse ling li ka fana ka maikutlo a hore likarolo li sebelisa leano le ts'oanang le la pele la tracheostomy nako le nako.

Leha ho le joalo, re lokela ho hlokomela likotsi tse ka ba teng tsa ho ba le moea o mongata ka nako e telele ho bao ba khoesitsoeng. Tsena li kenyelletsa ho ruruha ha morao ha lesapo la mokokotlo, stenosis le tracheo-esophageal fistula. [5] Boloetse bo fumanehang bo hlokolosi ba tlhokomelo bo boetse bo ka mpefala. [16]

Bakuli ba eketsehileng ba tla hloka moea o molelele oa moea. Sena se ka etsa hore sebopeho sa mesifa se ka holofatsang kapa sa thibela ho khoesoa. [17] Litlaleho tsa ho ruruha le ho ruruha ha lisekele li ka boela tsa thibela ho eketseha le ho eketsa tlhokahalo ea ho kenella kahare, ho kenella le ho kenella kahare ha moea. Sena se ka hloloa ke tracheostomy.

Leha ho le joalo, tlhahlobo ena e ile ea hloleha ho fumana mokhoa o hlakileng mabapi le mokhoa oa tracheostomy. Litlhaloso tsa ba arabileng li hlalositse hore ho kenella ho nkileng nyeoe ho latela mohlala ho latela boiphihlelo ba lehae ba bongaka. Meeli e kenyelletsa palo ea ba arabelang le bakuli ba khothatsang ba COVID-19 ba kenelletseng lihlopheng tse ikhethang. Bangoli ba bontša liteboho tsa bona tse kholo ho ba nkileng nako ea ho arabela tlhahlobong ena ho ts'ehetsa liqeto tsa basebetsi mmoho le lefats'e.

BANGATA

Ayman D'Souza: Christ Church, Univesithi ea Oxford, Oxford, UK

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

Alwyn D'Souza FRCS (ORL-HNS): Lefapha la Otorhinolaryngology, Sepetlele sa Lejisham, London, UK

Francis Vaz FRCS (ORL-HNS): Lefapha la Hlooho ea Hlooho le Nko, Sepetlele sa University College, London, UK | Setsi sa Saense ea Bongaka, Khampase ea Medway, Univesithi ea Kereke ea Canterbury Christ, Kent, UK

Andrew Pele ho FRCS (ORL-HNS): Lefapha la Otorhinolaryngology, Sepetlele sa Royal Royal University, Kent, UK

Rahul Kanegaonkar FRCS (ORL-HNS): Setsi sa Saense ea Bongaka, Khampasi ea Medway, Canterbury Christ Church University, Kent, UK

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