Endotracheal tube (endotracheal tube): styles, masu girma dabam, dalilai. Saita ga intubation

Abin baƙin ciki, daga da dama suka samu rauni da kuma cututtuka ba kamiltattu ba ne. A tsanani lokuta, dole ne ka nan da nan taimaka wani mutum cikin wahala. Musamman idan aka lalace, rai barazana. Wadannan sun hada da irin gaggawa yanayi kamar airway toshewa, sakamakon bugun zuciya, buga, coma. A lura da wadannan pathologies ya kamata a gudanar a cikin m kula naúrar. Duk da haka, nan da nan mataki dole ne a dauki nan da nan bayan da kimantawa da haƙuri, watau a mataki na gaggawa. A cikin mota, "motar asibiti" da aka kafa domin tracheal intubation, a defibrillator, Ambu jakar. Wadannan na'urorin kiwon lafiya da ake bukata kawai a mai tsanani lokuta, a lokacin da wani mutum ba zai iya numfashi da kansa.

Mene ne endotracheal tube?

Babu shakka, da tracheal intubation tana nufin m hanyoyin. Amma, duk da rashin jin dadin, shi wajibi ne ga kiwon lafiya dalilai. Don widen da Airways da kuma tabbatar da samun da oxygen zuwa huhu, da endotracheal tube an saka. Ya kamata su iya intubate likita na wani specialization. Musamman wannan fasaha bukatar da resuscitators anaesthesiologists, likitoci motar asibiti. Tare da gabatarwar da endotracheal tube huhu iska zama al'ada a sake, duk da lalacewar da Airways. Bugu da kari, ta hanyar amfani da wannan tsari za a iya za'ayi wucin gadi oxygen wadata. Akwai da yawa iri endotracheal shambura (20). Sun bambanta a size da kuma gaban wani ƙarin inji (kwala). Duk da kayayyakin aiki, don intubation ya kasu kashi 2 iri: noman da kuma nasotracheal tube. Suka sãɓã wa jũna a cikin hanyoyi na shigar azzakari cikin farji ga numfashi tsarin. A farkon yanayin, da endotracheal tube an saka ta cikin bakinka, a karo na biyu - ta hanyar hanci Tsarki. A cikin duka embodiments, rikitarwa iya ci gaba saboda sashin jiki lalacewa. Saboda haka, kafin zabar hanya na gwamnati na tube, kana bukatar ka tantance kasada. Duk da haka, intubation ya kamata a yi idan ya zama dole ga jiki ta harshen damo.

Alamomi ga gwamnati na endotracheal tube

A tsanani jihohin da samar da airway yiwu ne kawai ta hanyar gabatar da wani tracheal tube a cikin bakinsu, ko hanci kogo. A mafi yawan lokuta, da mãsu haƙuri ba ya jin zafi a lokacin hanya. Tun da mutanen da suka bukatar farfado da, sau da yawa sõmamme. Akwai wadannan alamomi ga tracheal intubation:

1. Bukatar for inji iska. Inji iska aka yi ba kawai a mataki na gaggawa, amma kuma a cikin ICU. Dauke da fitar da wannan hanya ne m ba tare da tracheal intubation.
2. Da bukatar janar maganin sa barci. A wannan yanayin ma, gabatarwar pneumatic tube ake bukata. Bayan duk, a lokacin janar maganin sa barci hūta duk tsokoki, ciki har da na numfashi tsokoki.
3. Aiwatar da tracheal da Bronchial lavage. Wannan hanya da aka nuna a marasa lafiya wanda za gamsai, ciki abinda ke ciki a cikin airway.
4. Inganta gas musayar tsakanin huhu da kuma muhalli.

An yi imani da cewa endotracheal bututu da ake gabatar da bakin (orotracheal) an nuna a mai tsanani yanayi. Daga cikin su - daina numfashi da kuma zuciya aiki (na asibiti mutuwa) , da kuma coma na wani asali. Nasotracheal gabatarwar yana da m rikitarwa kuma an dauki mafi physiological. Duk da haka, domin rigakafin m na numfashi rashin cin nasara, da likitoci sau da yawa gabatar da wani tube, ta bakin.

Kallo don tracheal intubation

A m kula gwani kamata ko da yaushe a sa ga tracheal intubation. An adana a cikin ta musamman akwatin tare da kayan aikin tsara don na huhu iska. Saita ga intubation za'ayi na da m kula naúrar idan ya cancanta. Wannan ya shafi a lokuta inda haƙuri ne gaggawa nuna inji iska. Medical kida suna samuwa a cikin sa:

1. Laryngoscope. Wannan na'urar da aka wakilta biyu main aka gyara - da ruwa da kuma makama. Yana aiki godiya ga wani baturi ko batura. Suna saka a cikin rike da laryngoscope. The ruwan wukake zo a cikin daban-daban masu girma dabam da kuma siffofi (mai lankwasa, kuma mike). Wannan bangare ne saka a cikin baka rami. A ƙarshen ruwa yana da wani haske cewa haskaka Airways. Selection laryngoscope size dogara a kan haƙuri ta shekaru, yanayin da na baka rami.
2. Daban-daban iri endotracheal shambura. A Kit hada da kayayyakin aiki, don intubation na biyu manya da yara. Suka sãɓã wa jũna a cikin size, gaban ko rashi na cuff, m diamita, tsawon da kuma yawan lumens. Tare da wadannan shambura za a iya za'ayi biyu noman da kuma nasotracheal intubation. Mafi sau da yawa mata amfani da bututu size 7-8, maza - 8-10. Tare da wani ra'ayi zuwa intubation na adult marasa lafiya bukatar endotracheal tube tare da wani cuff. Don a tabbatar da patency na Airways na yara - ba tare da shi.
3. Shugaba endotracheal tube don goya ake so lanƙwasa.
4. Lankwasa forceps.
5. Nebulizer kwayoyi don maganin sa barci.

Duk da cewa a yi da shi ba ya amfani da duk wani sa na kayan aikin, su hallara ne dole a cike.

A wasu lokuta, da gabatarwar da endotracheal tube shi ne unacceptable?

Ko da yake intubation yana nufin dole hanyoyin, shi yana da yawan contraindications. Wadannan sun hada da: wuyansa rauni, marurai a baka da kuma hanci cavities, kumburi da Airways. A cikin wadannan lokuta, da gabatarwar tube ba kawo amfani amma kawai na taimaka wa ci gaban mai tsanani da rikitarwa (rata nama, laka rauni). Saboda haka, kafin a ci gaba to intubation, shi wajibi ne, don su bincika baki da kuma hanci, kula da jihar daga cikin manya kashin baya.

Bugu da kari, gabatarwar da endotracheal tube iya zama da wahala a karkashin wani yanayi, da ba contraindications. Daga cikin su: babban harshe, wani gajeren wuyansa, ko muƙamuƙi, kiba, muhimmanci protruding gaban hakora, kunkuntar baki da kuma trachea anomalies. A gaban irin wannan fasali a wani haƙuri, intubation ya kamata a yi tare da taka tsantsan. A cikin wadannan lokuta, da fifita aka bai wa gabatarwar nasotracheal tube. Ya kamata ya zama 1-2 size karami.

Dabara na intubation

Orotracheal intubation aka yi kamar haka:

1. Haƙuri aka sanya a kan wani m surface, jefa mayar kansa kadan da kuma tura da ƙananan muƙamuƙi gaba. A sakamakon haka, da babba incisors ne airway a kan wannan jirgin sama. Idan zai yiwu, an sanya a karkashin wuyansa yi.
2. Idan dole, tsarkake ta bakin vomitus, clots datti.
3. Shigar da laryngoscope ruwa (a dama). Yana da muhimmanci kada a taba mucosa daga cikin bakin da hakora.
4. Sa'an nan kuma, endotracheal tube an saka. Yana wuce da bakin da makogwaro. A matakin na vocal igiyoyinsu, da tube ya kamata a hankali kõma tsakanin su a cikin rami na trachea.
5. Laryngoscope an cire.
6. Inflating a cuff domin kayyade da endotracheal tube.

Nasotracheal intubation aka yi a yawa guda. Bambance-bambance ne ƙuduri na bututu da kuma bullo da cikin hanci kogo. A wannan yanayin, da laryngoscope ba a amfani da.

Yadda za a gudanar da wani da samun iska daga huhu yara?

Akwai lokuta inda tracheal intubation wajibi ne a gudanar da wani yara. Mafi sau da yawa, ya zama dole ga zurfin zubar waccan tayin. Har ila yau intubation iya zama dole a neonatal lokaci a ganowa lahani na numfashi da kuma zuciya da jijiyoyin jini tsarin. A lokuta biyu, da ake bukata inji iska. Alamomi ga intubation a cikin manya da} anana da shekaru na yarantaka ne guda kamar yadda na manya. Daga cikin su akwai: m na numfashi rashin cin nasara, coma, gudanar da janar maganin sa barci.

Mene ne sikelin da zurfin intubation?

A zurfin abin da dole ne ka shigar da endotracheal tube, ya dogara a kan ta size da kuma nauyi na yaro. Don yin wannan, yi amfani da wani musamman sikelin. Shi ne zartar da wanda bai kai ba, kuma jariri jariran. Tare da wani nauyi na 1 kg yaro don amfani mai girman 2.5 endotracheal tube. Tana da zurfi da aka auna daga gwamnati na lebe da kuma shi ne 6-7 cm. Jiki nauyi zuwa 2 kg amfani tube size daidai 3. A allura zurfin ya kamata ba fiye da 8 cm. Idan yaro weighs tsakanin 2 da 4 kg aka yi amfani da bututu size № 3 5. A zurfin a cikin wannan yanayin ne daga 9 zuwa 10 cm. Domin jarirai, da jarirai, wanda nauyi fiye da 4 kg, yin amfani da wani bututu 4 size. A zurfin gabatarwar - 11 cm.

Abin da zai iya zama da rikitarwa bayan tracheal intubation?

Ya kamata a tuna cewa gabatarwar da endotracheal tube m wahala kamar lalacewar da mucous membrane na ciki gabobin. Saboda haka, wannan magudi dole ne a gudanar da wani gogaggen gwani. Da m kula naúrar, kafin fara intubation, maganin sa barci da aka yi. Mafi na kowa rikitarwa hada da: lalacewar da hakora, da mucosa daga cikin pharynx, da esophagus shigar da tube. Don kauce wa wannan, shi wajibi ne don a hankali saka idanu da haƙuri da yanayin.

Sa na wani endotracheal tube: gwani ra'ayi

Dabara na intubation yana da kowane likita. Duk da haka, shi ne mafi kyau a yi wannan magudi intensivists da anesthesiologists. A cewar su, ba tare da horo na musamman, da kuma a cikin rashi na bakararre yanayi, ba shi yiwuwa tracheal intubation. Bayan duk, da matsalolin da wannan hanya iya zama babu ja. Duk da haka, don samar da taimakon farko ga kiwon lafiya dalilai zamar masa dole likita na wani sana'a.