Ukuqonda Izingozi Zezempilo
Ingabe ukhathazekile ngengozi ye-anesthesia ngenxa yesifo esingavamile se-pulmonary (COPD) ?
Inhlanganisela yeCOPD ne-anesthesia ingaba nengozi enkulu. Izindleko zokuphila zesikhathi eside zabantu abane-COPD enamandla abahlinzwa njalo kuvame. Kukhona ingozi enkulu yokucindezeleka emva kokusebenza, ikakhulukazi emaphashini. Kodwa lokhu kusho ukuthi iziguli ze-COPD akufanele neze zithole ukuhlinzwa?
Noma yiluphi uhlobo lokuhlinzwa luhilela izingozi. Ukuqaphela izingozi ekuqaleni kwesikhathi sokuqala, ukulungiselela ukusebenza kwangaphambili, nokuphathwa kwe-anesthesia efanele kungasiza ekunciphiseni lezo zingozi. Ake sihlolisise ukuthi lokhu kuhilela ukuthini:
Ukukhonjwa kweengozi
Ukubona izingozi ekuqaleni kwesikhathi sokuqala kuqala kuqala ngomlando ophelele kanye nokuhlolwa komzimba. Izinkinga ukuthi udokotela wakho angazibuza zihlanganisa:
- Ukubekezela kwakho kokuzivocavoca , ikakhulukazi ngokukhuphuka kwamagquma nezitebhisi.
- Uma, futhi kaningi kangakanani, uye wahlakulela ukukhushulwa kwe-COPD futhi uma uke waba esibhedlela ngenxa yabo.
- Uma ngabe uke wacela umoya ongenawo umoya noma umoya ongakusiza ukukusiza uphefumule.
- Umlando wakho wokubhema- kokubili ababhemayo bamanje nabangaphambili basengozini enkulu.
- Uma okwamanje unomkhuhlane kanye / noma ukukhiqizwa kwe-sputum -kukhona okuhlotshaniswa nengozi ephezulu yokucindezeleka kokuthutha.
- Noma yiziphi ezinye izifo- ukungaqondi kahle izimo zezokwelapha ezikhona (izimo ze-comorbid) zibaluleke kakhulu ekuboneni ezinye izinto eziyingozi.
- Kungakhathaliseki ukuthi unayo noma awunayo yini izimpawu nezimpawu zokutheleleka kwamaphaphu asebenzayo.
- Isimo sakho somsoco- iziguli zombili ezingaphansi kwesisindo somzimba kanye nokukhuluphala ngokweqile ziyingozi.
Izenzo zokulungiselela
Ukuhlola
Ngaphambi kokuhlinzwa, udokotela wakho angalawula noma yikuphi ukuhlolwa okulandelayo:
- I-x-ray ye-Chest - isiza ukukhomba izifo zamaphaphu wamanje noma izinkinga ezengeziwe emaphashini.
- EKG - kusiza ukuthola izinkinga zenhliziyo ezingase zande ingozi yokuhlinzwa.
- I-Spirometry - isetshenziselwa kokubili ukuxilonga futhi inqume ubukhulu be-COPD.
- Ukuhlolwa kwe-Lung diffusion - utshela udokotela wakho ukuthi i-oksijeni ihamba kanjani kahle kusuka e- alveoli yakho eya egazini lakho.
- Ukuhlolwa kokuhamba ngezinyanga eziyisithupha - kusiza ukuqala ukubekezelela ukuvivinya umzimba.
- Amagesi egazini egazi - kusiza ukukhomba ama-preoperative oksijini ne-carbon dioxide egazini.
Ukuthuthukisa
Ukulungiswa kokusebenza kwangaphambili kuhilela umzamo wokusebenzisana phakathi kwakho nodokotela wakho futhi ungahlukaniswa ngezigaba ezine ezilandelayo:
- Ukuyeka ukubhema. Ngenxa yokuthi ababhemayo bamanje banengozi enkulu yokuthuthukisa izinkinga zamaphaphu emva kokuhlinzwa, labo ababhema kufanele bashiye okungenani amasonto ayisishiyagalombili ngaphambili. Uma usabhema , hlola lo mhlahlandlela ophelele wokuyeka ukubhema.
- Ukusebenzisa imithi yokwelashwa ngokwemithi. Iziguli eziningi ze-COPD zizuza ngokuthatha okungenani umthamo owodwa we-bronchodilator engabonakali ngaphambi kokusebenza kwawo. Uma ufuna ukuxubha ngemithi yakho mayelana nalokhu, noma uma usebenzisa i-inhaler esikhundleni se-nebulizer, hlola lesi siqondiso sinyathelo ngesinyathelo ukuthi ungasebenzisa kanjani i-nebulizer ukuqinisekisa ukuthi uthola inzuzo egcwele izifo zakho. Ngaphezu kwalokho, uma ungomunye wabaningi futhi uzama ukukhumbula ukuthi yimiphi imithi eyenza i-COPD, hlola lolu lwazi ngokuqonda ama-bronchodilators akho .
- Ukwelashwa kokutheleleka kanye / noma ukukhushulwa. Ukuba nokutheleleka kwamapayipi noma ukukhushulwa kwe-COPD kungaphikisana ne-anesthesia. I-Contraindicate yindlela elula yokusho ukuthi awukwazi ukuhlinzwa. Izimpawu nezimpawu zokutheleleka okusebenzayo kufanele ziphathwe ngama-antibiotic esikhathini ngaphambi kokusebenza kwakho.
- I-physiotherapy yesifuba. Ukugcoba i-mucus ngaphambi kokuhlinzwa kusiza ukususa okungaphezu kwalokho, okungaholela ekutheni i-post-op plugging noma i-pneumonitis. Khumbuza ngalezi zindlela eziyisihlanu zokugudluza umoya womoya futhi uhlole lokhu kuqhuma ukukhipha i-mucus nge-postural drainage .
Ukuphatha Izingozi Phakathi Nokuhlinzwa
Udokotela wakho kanye no-anesthesiologist bazosebenza ndawonye ukuphatha izingozi ezihlobene ne-anesthesia ne-COPD ngesikhathi sokuhlinzwa kwakho.
Izinkinga ezibalulwe ngezansi ziyizinkinga ezimbalwa ozotholwa ngazo:
- I-bronchospasm
- I-V / Q engalungile
- Ama-plug Mucus
- I-Pneumothorax
- I-hypo-ventilation ye-Post-operative
Kungani Uhlobo Lwezincwadi Zama-Anesthesia
Uma kunokwenzeka, ukugwema i-anesthesia jikelele kulungile ekunciphiseni izingozi. Xoxa nodokotela wakho mayelana nezinye izindlela ezingenzeka, njenge- anesthesia yendawo noma yesifunda . Ucwaningo luye lwabona ukuthi abantu abaneCOPD banengozi encane ye-pneumonia kanye nokuxhomekeka kwe-ventilator uma i-anesthesia yesifunda isetshenziselwa esikhundleni se-anesthesia jikelele. Ukunciphisa isikhathi sokuhlinzwa kanye nobude besikhathi ophethwe yi-anesthesia jikelele, uma lokhu kuyadingeka, kungase kube nokuzuzisa.
Izinkinga ezingenzeka
Sikhulume ngokunciphisa izingozi, futhi mhlawumbe usuzwe kwabanye ukuthi ukuhlinzeka nge-COPD kuyingozi, kodwa yini ngempela engenzeka? Yiziphi lezo zingozi? Abanye abantu bafisa ukwazi ukuthi kwenzekani, kodwa abanye bangathanda ukucabanga ngakho. Uma ungumuntu othanda ukwazi, nansi izinto ezimbalwa ezingenzeka njengenkinga lapho abantu abaneCOPD behlinzwa ngokuhlinzeka ngama-anesthesia jikelele.
- Ukutheleleka kwe-Lung njenge-pneumonia
- I-Sepsis (isifo sofuba "umzimba wonke" esibi kakhulu)
- I-Pneumothorax (iphaphu eliphelile)
- Ukuhluleka kokuphefumula
- Ukuphulukiswa okulimazayo okulimazayo
- Ukuhluleka ukugcoba umoya we-mechanical - Ukuze uhlinzekwe ngokujwayelekile, ithubhu ibekwe emoyeni wakho ukuze uhlinze umoya. Ukukhathazeka okuphawulekayo ngesifo samaphaphu ukuthi ukucindezeleka okuqhubekayo kokuhlinzeka emaphashini kuzokukwenza ube "umxhasi we-ventilator" noma ngabe ubuphefumula ngaphambili ngaphandle kokusizwa.
- I-Hypoxia - Ukulimala kwezicubu nokufa kwamaseli ngenxa yokwenyuka kwe-oxygenation emzimbeni, kufaka phakathi ubuchopho.
- Ama-blood clots kanye ne-pulboary emboli zivame kakhulu kubantu abane-COPD, ikakhulukazi uma ukuhlinzwa kudinga ukuba ungasebenzi isikhathi esithile.
- Ukuboshwa kwe-cardiac
Zonke iziguli ze-COPD zisengozini enkulu yokuthuthukisa izinkinga emva kokuhlinzwa okubandakanya i-anesthesia. Ukuphathwa okusebenzayo phakathi nesigaba ngasinye sokungenelela kokuhlinzeka kubalulekile ekuqinisekiseni ukutholakala okunzima.
Imithombo:
Cheng Q, Zhang J, Wang H, et al. Imiphumela ye-Hypercapnia enemiphumela emiPhakathini kanye Nezibikezelo Zengozi Yokubhekana Nezinkinga Phakathi Kwabeziguli Abathola Ukungenelela Kwe-Bronchoscopic Ngaphansi Kokujwayelekile Kwe-Anesthesia. PLos One . 2015. 10 (7): e0130771.
UHausman M, Jewell E, Engoren M. M. Regional Versus General Anesthesia Ezilwelweni Ezihlinzayo Eziphethwe Izifo Eziphuthumayo Izifo Eziphuthumayo : Ingabe Ukugwema I-Anesthesia Ejwayelekile KuNciphisa Ingozi Yezinkinga Zomsebenzi ? I-Anesthesia ne-Analgesis . 2015. 120 (6): 1405-12.
Kim H, Lee J, Park Y, et al. Umthelela wamaGOLD we-GOLD wezifo ezithathelwanayo ezingapheli ezinkingeni zokuhlinzeka. I-International Journal ye-Chronic Obstructive Pulmonary Disease . 2016. 11: 281-7.
Kiss G, Claret A, Desbordes J, Porte H. Thoracic Epidural Ukuhlinzekwa kwezifo ze-Phaphama Thoracic Surgery ezigulini ezinde kakhulu ze-Dyspnoeic ezingekho ku-General Anesthesia. I-Interactive Cardiovascular and Thoracic Surgery . 2014. 19 (5): 816-23.