Ukungenisa umoya emiphungeni ayisiyo nje inkqubo efunwa sisigulana: kulo nyaka i-Covid-19 ikwenze ukuba ibe sisiseko sendlela kunye nendlela yokungenelela kwezonyango okuye kwatshintsha ngayo

Ngokuchanekileyo kunyaka ophelileyo, inani elikhulu le- iigulane Ukuhanjiswa kubandakanya abaguli abonzakeleyo, kunye nokuhanjiswa esibhedlele nangaphezulu.

Namhlanje, ukungena komoya emiphungeni kudlala indima, kwaye kubalulekile ukuba uqhelane nayo, nokuba imfutshane nje.

Ewe, yintoni umoya wokungena komoya? Iyiphi indima edlalwa ngumphunga wokuphefumla kubomi bemihla ngemihla bomhlanguli okanye umsebenzi wezempilo?

Ukungenisa umoya kwimiphunga, okwenziweyo okanye ngoomatshini kutshintsha indawo okanye kuxhasa imisebenzi yemisipha yokukhuthaza, ukuqinisekisa umthamo wegesi owaneleyo kwimiphunga.

Yinkqubo yoomatshini, ezenzekelayo kunye nesingqisho, elawulwa ngamaziko aphezulu apho, ngezihlunu zamathambo zesithambo sothambo kunye nokuphumla, isisu kunye neembambo, kukhuthaza ukutshintshiselana komoya kwi-alveoli.

Ngexesha lokuphefumla, uxinzelelo lwe-intra-alveolar luba mbi kancinane xa kuthelekiswa noxinzelelo lweatmosferi (-1mmHg), kwaye oku kubangela ukuba kungene umoya ngaphakathi ngaphakathi kwiindlela zomoya.

Kwelinye icala, ngexesha lomphunga oqhelekileyo uxinzelelo lwe-intra-alveolar lukhuphukela kwi-1mmHg ejikelezayo, lubangela ukuba umoya uphumele ngaphandle.

Isixhobo esenza lo msebenzi sibizwa ngokuba sisixhobo sokuphefumla semiphunga okanye isixhobo sokuphefumla okanye isixhobo sokuphefumla.

I-lung ventilator ithatha indawo yenkqubo yokuphefumla esebenza ngoomatshini iyonke okanye inxenye yayo xa inkqubo yokuphefumla ingakwazi ukwenza umsebenzi wayo iyodwa ngenxa yesifo, umothuko, iziphene zokuzalwa komntu okanye amayeza (umz. I-anesthetics ngexesha lotyando).

I-ventilator inokungenisa uhlobo lomxube wegesi kwimiphunga ebavumela ukuba bakhuphe umoya kunye noxinzelelo olufanelekileyo.

Ukuhambisa isixa esifunekayo seoksijini kwisigulana kunye nokususa ikhabhon dayoksayidi evelisiweyo, isixhobo sokuphefumla kufuneka sikwazi:

- insufflate izixa ezilawulwayo zomoya okanye imixube yegesi kwimiphunga;

- ayeke insufflation;

- vumela iigesi eziphefumliweyo ukuba zibaleke;

- Phinda umsebenzi ngokuqhubekayo.

Ngokuchasene nokungenisa umoya kwendalo, ekuphumezeni umoya okwenziwa ngumoya wokuphefumla kwemiphunga, uxinzelelo aluhambi nje kuphela kumoya womoya ongaphezulu kodwa nakwi-intrathoracically.

Ukuze wandise imiphunga kunye neembambo, i-ventilator kufuneka ithumele umoya koxinzelelo: imiphunga ihlala ihleli kuxinzelelo lomoya, nokuba akukho kuhamba na.

Ukungenisa umoya ngoomatshini, kuba uxinzelelo oluqinisekileyo, kukhokelela ekwandeni kokutshintshana kokuphefumla, ngokuvula kwakhona iindawo ezingenamoya ungenayo umoya, kodwa ngaxeshanye kungakhokelela ekonzakaleni kwenkqubo yokuphefumla (barotrauma).

Ukungenisa umoya ngoomatshini kusetyenziswa kwimeko:

- isifo esiqatha semiphunga

- i-apnea ehambelana nokubanjwa kokuphefumla (kunye nokunxila);

- sombefu kakhulu;

- i-acidosis yokuphefumula engapheliyo;

- ukumodareyitha / ukuqina kwehypoxemia;

- umsebenzi kakhulu wokuphefumla;

- ukukhubazeka kwe-diaphragm ngenxa ye-Guillain-Barré syndrome, i-Myasthenia Gravis, iingxaki ezinzulu ze-muscular dystrophy okanye i-amyotrophic lateral sclerosis; Umgudu ukulimala kwentambo, okanye umphumo we-anesthetics okanye i-muscle relaxants;

- ukwanda umsebenzi izihlunu zokuphefumla, ubungqina tachypnoea ngokugqithisileyo, supraclavicular kunye intercostal kwakhona ukungena kunye nentshukumo enkulu udonga esiswini;

- i-hypotension kunye nokothuka, njengokuphazamiseka kwentliziyo okanye isifo sepsis.

Ukungenisa umoya kwimiphunga, iintlobo zezinto zokuphefumla ngemiphunga

Kukho iintlobo ezahlukeneyo zokuphefumla ngomatshini:

Uxinzelelo olubi lokuphefumla ngomatshini

- uxinzelelo oluqinisekileyo lokuphefumla ngomatshini

- ukhathalelo olunzulu ngoomatshini okanye i-ventilator yokhathalelo olunamandla (okanye izithuthi ezingxamisekileyo / zothutho olungxamisekileyo lwezonyango)

-Umatshini wokuphefumla onganyanzelekanga okanye ononophelo olunzulu (okanye imeko yothutho engxamisekileyo / yezonyango)

Ukongeza, izixhobo zokuphefumla zoomatshini zahlulwe:

Umoya ongenelelayo

-Umoya ongenisa umoya

Uxinzelelo olubi loomatshini bokungenisa umoya

Uxinzelelo olubi loomatshini bokungenisa umoya lubonisa isizukulwana sokuqala semitshini yokuphefumla yemiphunga, ekwabizwa ngokuba yimiphunga yentsimbi.

Umphunga wentsimbi, ngamafutshane, uvelisa nje umatshini wokuphefumla orekhodwe kwiimeko eziqhelekileyo apho i-myopathy okanye i-neuropathy yenza ukuba kungabikho msebenzi owaneleyo wemisipha yeembambo.

Iinkqubo zoxinzelelo ezingalunganga zisasetyenziswa, ubukhulu becala kwizigulana ezinemithambo engonelanga yekheji, njengakwipoliyo.

Uxinzelelo oluqinisekileyo loomatshini / umoya opholileyo (ongangenisiyo)

Ezi zixhobo zenzelwe ukungangenisi umoya, kubandakanya nasekhaya kunyango lwe-apnea yokulala.

I-ventilator isebenza ngokungafumani imixube yegesi (ngesiqhelo umoya kunye neoksijini) kuxinzelelo oluqinisekileyo kwindlela yomoya yesigulana.

Izinto zokuphefumla ekhaya (umthombo wamandla we-electromechanical)

Ipiston okanye impompo yokubuyisa: Ukuqokelela iigesi nokuba kuxinzelelo oluphantsi, uzixube kwaye uzityhale kwisekethe yangaphandle ngexesha lesigaba sokuphefumlela.

Ayisebenzi kangako ekubuyekezeni ukuvuza

I-Turbine: Zitsala iigesi, ziyicinezele kwaye ziyithumele kwisigulana ngendlela ye-valve ekhuthaza indlela enye.

Banokulawula uxinzelelo ngokuhamba kunye nokuhanjiswa kwevolumu.

Izinto zokuphefumla ekhaya (i-turbine enesixokelelwano esiphantsi soxinzelelo lwegesi):

1. I-CPAP kunye ne-autoCPAP

1. Inqanaba lesibini

3. Pressovolumetric

1.I-CPAP kunye ne-autoCPAP (hayi imo yomoya kodwa uhlobo lomoya)

- zisetyenziselwa unyango lweengxaki zokulala;

-I-CPAP ibonelela ngenqanaba elichaziweyo lokulingana koxinzelelo oluchanekileyo kuwo omabini amanqanaba okuphefumla okuthintela ukuwa kwomoya;

-I-CPAP yakho ihambisa uxinzelelo oluqinisekileyo kuzo zombini izigaba zokuphefumla ngokweemfuno zesigulana ngelo xesha (uluhlu loxinzelelo lusetiwe).

2. Inqanaba lesibini

-Umatshini ongenisa umoya wokungenisa umoya onika amanqanaba oxinzelelo amabini: i-IPAP (uxinzelelo oluqinisekileyo kwisigaba sokuphefumlela) kunye ne-EPAP (uxinzelelo oluqinisekileyo kwisigaba sokuphefumla);

- sukuvumela ukubekwa kweliso kwiiparamitha zokungenisa umoya;

- zisetyenziselwa unyango lweengxaki zokulala;

- xa i-CPAP ingalungisi i-apnea kunye / okanye i-apnea enamandla okanye i-hypoxemia ehambelana nayo.

3. Ii-Pressuvolumetric ventilators

Oku kuvumela ukusetyenziswa kweendlela zoxinzelelo okanye zomthamo womoya. Ziyahlulahlula ngokusetyenziswa kwesekethe.

Ukungenisa umoya kwipulmonary kukhathalelo olunzulu (umthombo wamandla womoya)

Lung I-ventilators inokusebenza kuzo zombini iindlela ezingenayo kunye nezingangenisiyo zokungenisa umoya, zimbalwa izinto eziphambili zezi:

-Basebenza ngoxinzelelo oluphezulu lwegesi (4 BAR)

-Nika i-FiO2 uzinzo

-Bakuqinisekisa ukuhanjiswa kwevolumu nokuba imeko ye-impedance ephezulu (isigulana esityebileyo)

I-FiO2 sisiqwengana se-O2. Sisifinyezo esisetyenzisiweyo kunyango ukubonisa ipesenti yeoksijini (O2) ephefumlelwe ngumguli.

I-FiO2 ibonakaliswe njengenani eliphakathi kwe-0 ne-1 okanye njengepesenti. I-FiO2 emoyeni yomoya iyi-0.21 (21%).

I-ventilator yomphunga inezinto zilandelayo

-Umvelisi woxinzelelo olungileyo okwazi ukuvelisa i-gradient yoxinzelelo phakathi kobume boxinzelelo lwangaphandle kunye ne-alveoli, ukumisela ubungakanani bokuhamba kwegesi ukuba kungoneli kwisigulana.

Lo msebenzi uphunyezwa nokuba kungokuvelisa amandla asetyenziselwa imfutho equlathe umxube wegesi ongapheleliyo, okanye ngokunciphisa uxinzelelo lweegesi zenkqubo esisigxina ngothotho lweevelu zecascade;

- inkqubo yemitha yevolumu yangoku (VT);

- uthotho lwezixhobo zamaxesha omjikelo wokuphefumla othi, ngokuvula ngokufanelekileyo nangokuvala izivalo ezilawula ukuhamba nokuphefumlela, ukuvumela utshintsho ukusuka ekuphefumlweni ukuya ekuphelelweni nakwelinye icala;

- isekethe yesigulana, equka onke amalungu adibanisa umoya kunye nenkqubo yokuphefumla yesigulana. Kunokubakho imijikelezo evulekileyo (ngaphandle kokuphefumla kwakhona), ethi ekuphumeni komphefumlo ngamnye ikhuphe iigesi ezikhutshiweyo ziye ngaphandle, okanye iisekethe ezivaliweyo ezinezifunxi ze-CO2 ngendlela apho irhasi ekhutshiweyo yesigulana ifunyanwa emva kokufakwa kwe-CO2;

-Izinto ezichasayo ezibandakanya yonke imibhobho edityanisiweyo phakathi komvelisi woxinzelelo kunye nenkqubo yokuphefumla yesigulana evelisa ukumelana nokuqhubela phambili kwegesi kuzo.

Ukungenisa umoya kwimiphunga: isebenza njani into yokuphefumla

Iimpefumlo zemiphunga zibonelela ngeendlela ezahlukeneyo zokusebenza ukuze zilungiswe ngokweemfuno ezithile zesigulana.

Umgaqo osisiseko apho abasebenzi bezonyango bakhetha khona imodeli yokungenisa umoya kukukwazi ukuphefumla ngokuzimeleyo.

Imowudi elawulwayo ikhethwa xa isigulana singenawo umsebenzi wokuphefumla kwaye sifuna ugqirha ukuba ahlengahlengise amaxesha okusebenza (ixesha lokuphefumlelwa, ixesha lokuphelelwa lixesha, ixesha lokuphumla, ixesha lokukhuthaza) kwiphaneli yokulawula umoya yokuphefumla.

Zimbini izinto ezinokubakho zomoya olawulwayo: ukungena komoya rhoqo kunye nokungena koxinzelelo rhoqo, kuxhomekeke kubungakanani obukhethiweyo (ukuhamba okanye uxinzelelo) njenge parameter yolawulo lwenkqubo yokungena.

Imowudi yokuncedisa isetyenziselwa ubunzima bokuphefumla abaguli abasakwaziyo ukuqala isigaba sokuphefumla.

Umphefumli wemiphunga kufuneka alazi ilinge lesigulana lokukhuthaza kunye nokunceda ekwenzeni njalo.

Okokugqibela, imowudi ehambelanayo inesigaba sokuqala apho isigulana singena khona umoya ngokuthumela ivolumu ethile yomoya emiphungeni ngexesha elichazwe kwangaphambili, kwimo yokuhamba rhoqo; oku kulandelwa lixesha lokuphefumla ngokukhawuleza ukuba isigulana sifumene ukusebenza kwenkqubo yokuphefumla, okanye ixesha lokungenisa umoya elincedisiweyo kwimeko yobunzima obuqhubekayo.

Funda kwakhona: 

Umoya wokungenisa ngesandla, Izinto ezi-5 zokuzigcina engqondweni

I-Ventilator eNtshana yokuNceda abaguli kwi-COVID-19 kwizifo ezininzi eziPhuhlayo, olunye uphawu lweMpendulo yeHlabathi kwiNtsholongwane.

I-COVID-19 Izigulana: Ngaba i-Inhaled Nitric oxide ngexesha lokungenisa umoya ngoomatshini inika izibonelelo?

I-FDA ivuma iRecarbio yokuNyanga isibhedlele-esiFunyenwe kunye noMoya oyiNtloko

Funda iNqaku lase-Italiyane

umthombo:

Ventilatore Polmonare Stephan ® EVE IN terapia intensiva e trasporto intra-ospedaliero

Isixhobo se-EMD 112