Ni iki cyitwa Tracheostomy? Impamvu, Uburyo bwo gukora & Gukira

Tracheostomy ni uburyo bwo kubaga bukora umwobo muto imbere mu ijosi ryawe kugira ngo bigufashe guhumeka. Uyu mwobo uhuza mu buryo butaziguye na trachea yawe (umuyoboro w'umwuka), ukarenga umunwa wawe n'amazuru. Nubwo bishobora kumvikana nk'ibintu bikomeye, ubu buryo bushobora kurokora ubuzima kandi akenshi ntibugire igihe kirekire, bugaha umubiri wawe ubufasha bwo guhumeka ukeneye mugihe cyo gukira.

Tracheostomy ni iki?

Tracheostomy ikora inzira itaziguye kugira ngo umwuka ugerere mu muhaha wawe unyuze mu mwobo muto wo mu ijosi ryawe. Mugikorwa, umuganga ubaga akora igikomere cyateguwe neza muri trachea yawe hanyuma agashyiramo urushinge rwihariye rwitwa tracheostomy tube cyangwa "trach tube."

Uru rushinge rukora nk'inzira nshya yo guhumeka irenga rwose inzira yawe yo hejuru. Tekereza nk'uko warema inzira yindi yo kwinjira mu buryo bwawe bwo guhumeka iyo inzira isanzwe inyura mu mazuru yawe n'umunwa itagikora neza.

Uwo mwobo ubwawo witwa stoma, kandi akenshi ungana nk'idime. Abantu benshi babaho neza bafite tracheostomy, kandi mu bihe byinshi, birashobora gukurwaho igihe ikibazo cyihishe kigenda gikira.

Kuki hakorwa tracheostomy?

Abaganga basaba tracheostomy iyo ukeneye ubufasha bwo guhumeka igihe kirekire cyangwa iyo inzira yawe yo hejuru yafunzwe cyangwa yangiritse. Ubu buryo bushobora gutegurwa mbere y'igihe cyangwa bugakorwa mu bihe by'ubutabazi iyo ubufasha bwo guhumeka bwihutirwa bukenewe.

Impamvu zisanzwe zirimo guhumeka bifashishije imashini igihe kirekire, ibikomere bikomeye mu muhogo cyangwa mu ijosi, n'indwara zimwe na zimwe zigira ingaruka ku guhumeka. Reka turebe ibihe byihariye aho ubu buryo bukenewe.

Dore ibihe by'ubuvuzi by'ingenzi bishobora gusaba tracheostomy:

• Gukoresha imashini ifasha mu guhumeka igihe kirekire (akenshi nyuma y'iminsi 7-10 ukoresha imashini ifasha mu guhumeka)
• Ukubyimba gukabije mu muhogo cyangwa mu muhogo biturutse ku ndwara cyangwa uruguma
• Kanseri zo mu mutwe cyangwa mu ijosi zifunga inzira y'umwuka
• Urugero rukabije rw'inkovu zo mu maso cyangwa mu ijosi zatewe n'impanuka
• Indwara zo mu bwonko zigira ingaruka ku misitsi ifasha mu guhumeka
• Ubumuga bwo mu nzira y'umwuka bw'abana bavuka bafite ubumuga
• Kugira ibibazo bikomeye byo guhumeka igihe cy'ibitotsi bitavurwa n'ubundi buryo bwo kuvura
• Ubumuga bw'imitsi ifasha mu guhumeka ku mpande zombi
• Ukwangirika gukabije ku ruhu rwo mu maso no mu ijosi

Buri kibazo kigenzurwa neza n'ikipe yawe y'abaganga kugira ngo hamenyekane niba tracheostomy ariyo nzira nziza yo kuvura ibibazo byawe byihariye. Intego ni ukugira ngo buri gihe wemeze ko ushobora guhumeka neza kandi mu buryo bworoshye.

Ni iki gikorerwa muri tracheostomy?

Tracheostomy ishobora gukorerwa mu cyumba cy'ibagishamo cyangwa ku ruhande rwawe mu cyumba cyita ku barwayi barembye. Iki gikorwa gikunda gufata iminota 20-45, bitewe n'uko ibibazo byawe byihariye bimeze niba byateguwe cyangwa bikozwe mu gihe cy'ubutabazi.

Umuvuzi wawe azakoresha anesthesia rusange (niba utarakoresha imashini ifasha mu guhumeka) cyangwa anesthesia y'ibanze hamwe no gutuza. Guhitamo biterwa n'uko umeze ubu n'uko uhumeka.

Ibi nibyo bibaho mugihe cyo gukora iki gikorwa:

1. Aho mu ijosi hahanagurwa neza hanyuma hagashyirwaho ibitambaro bisukuye
2. Umuvuzi akora agace gato kagororotse mu gice cyo hasi cy'ijosi ryawe
3. Imitsi n'utugingo bitandukanywa buhoro kugira ngo bigere kuri trachea
4. Umuvumo muto ukorwa muri trachea, akenshi hagati y'impeta za 2 na 4 za trachea
5. Urugo rw'umwuka rwa tracheostomy rushyirwa muri uyu mwobo
6. Urugo ruzingirwa hamwe n'imitsi n'imigozi ikikije ijosi ryawe
7. Agace gakikije urugo gafungwa hamwe n'imitsi

Nyuma y'igikorwa, uraza gukurikiranwa hafi kugirango wemeze ko urushinge rukora neza kandi uhumeka neza. Abantu benshi bamenyera guhumeka binyuze mu rusinge rwa tracheostomy mu masaha make.

Ni gute witegura tracheostomy yawe?

Niba tracheostomy yawe iteganyijwe aho gukorwa nk'igihe cy'ubutabazi, ikipe yawe y'abaganga izakuyobora mu ntambwe zidasanzwe zo kwitegura. Uburyo bwo kwitegura bufasha kwemeza igikorwa gishoboka kandi cyiza cyane kandi ibisubizo byiza byo gukira.

Muganga wawe azasuzuma amateka yawe y'ubuvuzi, imiti ukoresha ubu, kandi akore ibizamini bikenewe mbere y'igikorwa. Ibizamini by'amaraso n'ibizamini by'amashusho bishobora gukenerwa kugirango hateganijwe neza aho tracheostomy yawe izashyirwa.

Ibi nibyo ushobora kwitega mu gihe cyo kwitegura:

• Ibizamini by'amaraso kugirango barebe imikorere yawe yo gupfundika no kureba ubuzima bwawe muri rusange
• X-ray y'igituza cyangwa CT scan kugirango isuzume inzira yawe y'umwuka n'imyanya y'ijosi
• Urubanza rwo guhagarika imiti imwe nka ya miti ituma amaraso ataguma
• Uburyo bwo kwemera aho ibyago byose n'inyungu bisobanurwa
• NPO status (nta kintu mu kanwa) mu masaha menshi mbere y'igikorwa
• Gushyirwaho umurongo wa IV kubera imiti n'amazi
• Gushyiraho ibikoresho byo gushyiraho no gukurikirana

Niba umaze gukoresha ventilator, byinshi muri ibi biteguro bishobora kuba byaramaze gushyirwaho. Ikipe yawe y'abaganga izemeza ko uri mu mutekano uko bishoboka kose mbere yo gukomeza kubaga.

Ni gute usoma uburyo bwo kwita kuri tracheostomy yawe?

Kumenya uburyo bwo kwita kuri tracheostomy yawe birimo kwiga ibice bitandukanye by'urushinge rwawe no kumenya ibimenyetso byerekana ko byose bikora neza. Urushinge rwawe rwa tracheostomy rufite ibice byinshi bikorera hamwe kugirango inzira yawe y'umwuka ikingurwe kandi ikomeze.

Urushinge rwo hanze ruguma ahantu kandi rutanga inzira y'umwuka nyamukuru, mugihe urushinge rw'imbere rushobora gukurwaho kugirango rwozwe. Urushinge rwinshi kandi rufite agahogo (kitwa cuff) gashobora kuzurizwa kugirango dufunge inzira y'umwuka mugihe bibaye ngombwa.

Ibi ni ibintu by'ingenzi byo gukurikirana no gusobanukirwa:

• Uburyo urukweto ruriho - rugomba kuguma hagati kandi ruziritswe neza muri stoma
• Umutima wo guhumeka - ugomba kuba wumvikana neza kandi woroshye binyuze mu rukweto
• Ibara ry'ibyo umubiri utanga n'ubwinshi - ibyo umubiri utanga byera cyangwa byera ni ibisanzwe
• Uruhu ruzengurutse stoma - rugomba kuba rumeze neza kandi rukira nta gutukura cyane
• Imigozi y'urukweto cyangwa umufata - igomba kuba ifashe ariko itari nyinshi
• Umunaniro w'urukweto (niba bishoboka) - ugomba gukomeza ku rwego rwiza n'ikipe ivura

Ikipe yawe y'ubuvuzi izakwigisha cyangwa abagize umuryango wawe uburyo bwo gutanga ubuvuzi bw'ibanze bwa tracheostomy, harimo uburyo bwo gusukura no gukurura. Iyi nyigisho ni ingenzi mu kurinda ubuzima bwawe no kwirinda ingorane.

Ni gute wakwirinda ubuvuzi bwawe bwa tracheostomy?

Gukwirinda tracheostomy yawe bikubiyemo imirimo yo gusukura buri munsi, gukurikirana ingorane, no kumenya igihe cyo gushaka ubufasha. Ubuvuzi bwiza bwa tracheostomy birinda indwara kandi bituma guhumeka kwawe kuba kuryoshye kandi neza.

Ibintu by'ingenzi by'ubuvuzi birimo gukomeza ahantu hasukuye, gukwirinda ibyo umubiri utanga, no kumenya neza ko urukweto ruguma neza. Ikipe yawe y'ubuvuzi izatanga amabwiriza arambuye yagenewe ubwoko bwawe bw'urukweto rwa tracheostomy.

Ibi ni imirimo y'ingenzi y'ubuvuzi bwa buri munsi:

• Gusukura ahazengurutse stoma hamwe n'amazi asukuye cyangwa umuti wa saline
• Guhindura imyenda ya tracheostomy kugira ngo ahantu hakomeze kwohoka
• Gukurura ibyo umubiri utanga iyo bibaye ngombwa kugira ngo inzira y'umwuka ikomeze kuba isobanutse
• Gusukura cyangwa guhindura urukweto rw'imbere nk'uko byategetswe
• Kureba ko imigozi y'urukweto cyangwa abafata bafashe ariko batari nyinshi
• Gukurikirana ibimenyetso by'indwara cyangwa ingorane
• Guhumeka umwuka uhumeka kugira ngo wirinde kumuka

Abantu benshi bakwirinda neza ubuvuzi bwabo bwa tracheostomy mu rugo hamwe n'imyitozo ikwiye n'ubufasha. Ikipe yawe y'ubuvuzi izemeza ko wumva neza ibintu byose by'ubuvuzi mbere yo kurekura.

Ni ubuhe bwoko bwiza bwa tiyubu ya tracheostomy?

Tiyubu nziza ya tracheostomy iterwa n'ibyo ukeneye mu buvuzi, imiterere yawe, n'intego zawe za nyuma. Hariho ubwoko bwinshi bwa tiyubu zihari, buri imwe yakozwe kubera ibihe bitandukanye n'ibyo abarwayi bakeneye.

Muganga wawe azahitamo tiyubu ikwiriye cyane bitewe n'ibintu nk'uko ukeneye guhumeka ukoresheje imashini, ubushobozi bwawe bwo kuvuga, n'igihe uzamara ukeneye tracheostomy. Tiyubu akenshi irashobora guhindurwa nyuma niba ibyo ukeneye bihindutse.

Ubwoko busanzwe bwa tiyubu za tracheostomy burimo:

• Tiyubu zifite cuffed - zifite agahogo gashobora guhumeka kugirango gashyiremo umwuka wo guhumeka
• Tiyubu zitagira cuffed - zituma umwuka unyura hirya no hino muri tiyubu no mu nzira yawe yo hejuru yo guhumeka
• Tiyubu zifite fenestrated - zifite imyobo ituma umwuka unyura mu ngingo zawe zo kuvuga kugirango uvuge
• Valves zo kuvuga - ibikoresho byihariye bifasha kuvuga mugihe uhumeka ukoresheje tiyubu
• Tiyubu zo imbere zikoreshwa rimwe - byoroshya isuku kandi bigabanya ibyago byo kwandura
• Tiyubu zifite flange zihinduka - zirashobora guhindurwa kubera imiterere itandukanye y'ijosi

Itsinda ryawe ry'abaganga rizakorana nawe kugirango ribone ubwoko bwa tiyubu buguha uruvange rwiza rw'umutekano, ihumure, n'ubuzima bwiza. Tiyubu zirashobora guhindurwa uko ubuzima bwawe buzamo iterambere cyangwa uko ibyo ukeneye bihinduka.

Ni ibihe bintu byongera ibyago byo kugira ibibazo bya tracheostomy?

Ibintu bimwe na bimwe bishobora kongera ibyago byo kugira ibibazo hamwe na tracheostomy, nubwo abantu benshi babaho neza bafite ubuvuzi bukwiye. Kumva ibi bintu byongera ibyago bifasha itsinda ryawe ry'abaganga gufata ingamba zidasanzwe no kugukurikiranira hafi.

Imyaka, imiterere y'ubuzima muri rusange, n'impamvu ya tracheostomy yawe byose bigira uruhare muguteganya urwego rw'ibyago byawe. Ibibazo byinshi birashobora kwirindwa hamwe n'ubuvuzi bwiza no kumenya hakiri kare ibibazo.

Ibintu bishobora kongera ibyago byawe birimo:

• Ubukure bwo hejuru (imyaka irenga 65)
• Indwara ya diyabete cyangwa izindi ndwara zigira ingaruka ku gukira kw'ibikomere
• Kugabanuka kw'ubudahangarwa bw'umubiri biturutse ku miti cyangwa indwara
• Imirire mibi cyangwa urwego rwo hasi rwa poroteyine
• Amateka yo kunywa itabi cyangwa gukoresha itabi
• Umubyibuho ugira ingaruka ku myanya y'ijosi
• Kubagwa mu ijosi mbere cyangwa kuvurwa na radiyo
• Indwara zituma amaraso ava cyangwa gukoresha imiti ituma amaraso ataguma
• Indwara y'umwijima ihoraho cyangwa indwara zo mu myanya y'ubuhumekero zikunze kugaragara

Kugira ibintu bitera ibyago ntibisobanura ko uzagira ibibazo, ariko bisobanura ko ikipe yita ku buzima bwawe izitaho cyane mu gukumira ibibazo. Ibintu byinshi bitera ibyago birashobora gucungwa cyangwa bikongerwa imbaraga n'ubuvuzi bukwiye.

Ese ni byiza kugira trachesitomi y'agateganyo cyangwa ihoraho?

Trachesitomi nyinshi zigenewe kuba iz'agateganyo, hagamijwe gukuraho urwoya igihe indwara yawe yoroshye. Ariko, abantu bamwe bungukirwa na trachesitomi ihoraho bitewe n'ubuzima bwabo bwihariye.

Urufatiro rwo guhitamo hagati y'agateganyo na ihoraho rushingiye ku bintu nk'indwara yawe, ubushobozi bwo gukira, n'intego rusange z'ubuzima. Ikipe yawe y'abaganga izaganira kuri izi nzira nawe n'umuryango wawe.

Trachesitomi y'agateganyo ikundwa iyo:

• Uri gukira indwara ikaze cyangwa imvune
• Ukeneye ubufasha bw'igihe gito bwa ventilateri
• Guhuha cyangwa guhagarika mu nzira yawe yo hejuru y'ubuhumekero biteganijwe ko bizakemuka
• Uri gukira kubagwa gukomeye
• Uburwayi bwawe bwo mu mutwe bushobora kuzamura uko igihe kigenda

Trachesitomi ihoraho bishobora kuba ngombwa iyo:

• Ufite uburwayi bwo mu mutwe burushaho gukomera
• Kugurwa kw'inzira yo hejuru y'ubuhumekero ntibishoboka
• Ufite indwara ikaze y'umwijima
• Ubuvuzi bwa kanseri bwagize ingaruka ihoraho ku nzira yawe y'ubuhumekero
• Ukunda trachesitomi y'igihe kirekire kurusha izindi nzira

N'ubwo ufite "burundu" ya tracheostomy, uko ubuzima bwawe buhinduka, imiterere yawe ishobora gusuzumwa mu gihe, kandi gukuraho bishobora gushoboka.

Ni izihe ngaruka zishobora guterwa na tracheostomy?

Nubwo tracheostomy muri rusange ari uburyo bwizewe, kimwe n'andi mabwiriza yose, ishobora kugira ingaruka. Ingaruka nyinshi ni izitazwi kandi zirashobora kwirindwa cyangwa zigakemurwa neza iyo zibayeho.

Ingaruka zirashobora kubaho mugihe cyo gukora, mugihe cyo gukira ako kanya, cyangwa zigatera mugihe cyo gukoresha igihe kirekire. Itsinda ryawe ry'abaganga rikora igenzura rya hafi kubimenyetso byose by'ibibazo.

Ingaruka zo hambere (mugihe cy'iminsi mike) zirimo:

• Kuva amaraso ahantu hakorewe iseswa
• Udukoko dukwirakwira hafi ya stoma
• Kwirukanwa kw'urukiramende cyangwa gukurwaho ku buryo butunguranye
• Pneumothorax (igihaha cyaguye)
• Kwangiza ibintu biri hafi nk'imitsi y'amaraso
• Kugorana gushyira urukiramende

Ingaruka zo hanyuma (mu byumweru cyangwa amezi nyuma) zirimo:

• Tracheal stenosis (kugabanuka kw'inzira y'umwuka)
• Urubumbano rw'imyenda ruzenguruka stoma
• Kubangamirwa kw'urukiramende kuva mumavuta
• Uruhu rwangirika ruzenguruka stoma
• Kugorana kumeza
• Guhinduka kw'ijwi
• Tracheoesophageal fistula (ihuriro ritazwi hagati y'inzira y'umwuka na esophage)

Ingaruka nyinshi zirashobora kwirindwa hamwe n'ubwitange bukwiye n'igenzura risanzwe. Itsinda ryawe ry'ubuvuzi rizakwigisha uburyo bwo kumenya ibimenyetso byo kuburira no kumenya igihe cyo gushaka ubufasha bwihuse.

Nigute nkwiriye kubona umuganga kubera impungenge za tracheostomy?

Ugomba guhita uvugana n'umuganga wawe niba ubonye ibimenyetso byose by'ingaruka cyangwa niba ugoranye guhumeka unyuze muri tracheostomy yawe. Ibikorwa byihuse birashobora gukumira ibibazo bito guhinduka bikomeye.

Uko byagenda kose, hariho ibihe bisaba ubufasha bwihutirwa bwihutirwa, mugihe abandi bashobora gutegereza gahunda isanzwe cyangwa inama kuri terefone. Kwiga kumenya itandukaniro ni ngombwa kubw'umutekano wawe.

Shaka ubufasha bwihutirwa ako kanya niba ubonye:

• Kugorwa no guhumeka cyangwa guhumeka bigufi
• Umutsi wimuwe cyangwa wazibye rwose
• Amara menshi ava ku rwara
• Urubavu rubabaza cyangwa ibimenyetso bya pneumothorax
• Ukubura gukabije hirya no hino ku ijosi
• Ibimenyetso byo kwandura bikabije nk'umuriro n'imbeho
• Kutabasha kuvuga cyangwa kumira ako kanya

Vugana na muganga wawe mu masaha 24 kuri:

• Ubwiyongere cyangwa ibintu bifite ibara ritandukanye
• Amara make adahagarara n'umuvuduko
• Umutuku cyangwa ububyimbirwe hirya no hino ku rwara
• Umutsi usa nk'uworoheje cyangwa utashyizwe neza
• Inkorora ihoraho cyangwa impinduka mu ijwi ryawe
• Uburibwe bw'uruhu cyangwa gucika kw'uruhu hirya no hino ku mutsi

Kugirana umubano mwiza n'ikipe yawe y'ubuvuzi no gusobanukirwa igihe cyo gushaka ubufasha bishobora gutuma kubana na tracheostomy birushaho kuba byiza kandi byoroshye.

Ibikunze kubazwa kuri tracheostomy

Q.1 Ese tracheostomy iruta intubation irambye?

Yego, tracheostomy muri rusange iruta intubation irambye ku bantu bakeneye ubufasha bwo guhumeka igihe kirekire. Nyuma y'iminsi nka 7-10 kuri ventilateur unyuze mu muyoboro mu kanwa kawe, tracheostomy irushaho kuba nziza kandi yoroshye.

Tracheostomy igabanya ibyago byo kwangiza imitsi y'ijwi, byoroshya kwita ku kanwa, kandi bituma umurwayi arushaho kumva ameze neza. Binagabanya kandi icyifuzo cyo gukoresha imiti ikaze kandi bishobora koroshya gukurwa kuri ventilateur igihe witeguye.

Q.2 Ese urashobora kurya neza ufite tracheostomy?

Abantu benshi barashobora kurya neza bafite tracheostomy, ariko biterwa n'uko ubuzima bwawe bumeze n'ubwoko bw'umutsi. Niba ufite umutsi ufite cuff wuzuye, ushobora gukenera kuwuhagarika mu gihe cyo kurya kugirango wemerere kumira neza.

Umuvuzi wawe w’ijwi n’ikipe yawe y’abaganga bazasuzuma imikorere yo kumira, kandi bashobora kugusaba gukoresha uburyo runaka cyangwa guhindura ibyo urya. Abantu bamwe bakeneye imiyoboro y’ibiryo y’agateganyo mu gihe biga kongera kumira neza.

Q.3 Mbese nzabasha kuvuga mfite tracheostomy?

Kubasha kuvuga ufite tracheostomy birashoboka, nubwo bishobora gusaba guhindura bimwe na bimwe cyangwa ibikoresho byihariye. Niba ufite urushinge rutagira cuff cyangwa ushobora gukuramo cuff, umwuka urashobora kunyura mu nsinga zawe z’ijwi bigatuma uvuga.

Valves zivuga n’imiyoboro ifite fenestrated bishobora gufasha kugarura ijwi ryawe. Umuvuzi wawe w’ijwi azakorana nawe kugirango abone uburyo bwiza bukwiriye uko ubuzima bwawe bumeze. Abantu benshi bongera kugira ubushobozi bwiza bwo kuvugana binyuze mu myitozo ikwiriye n’ibikoresho.

Q.4 Bifata igihe kingana iki kugira ngo ukire nyuma yo kubagwa tracheostomy?

Gukira kwa mbere nyuma yo kubagwa tracheostomy mubisanzwe bifata icyumweru kimwe cyangwa bibiri, nubwo buri wese akira ku muvuduko we. Ahantu hakomerekeye mubisanzwe hakira mu minsi 5-7, kandi akenshi ushobora gutangira kwiga uburyo bwo kwitaho mu minsi mike ya mbere.

Kumenyera neza kubana na tracheostomy bishobora gufata ibyumweru byinshi kugeza ku mezi menshi, bitewe n’ubuzima bwawe muri rusange n’impamvu yo gukora uwo murimo. Ikipe yawe y’abaganga izatanga ubufasha buhoraho mu gihe cyo gukira kwawe.

Q.5 Mbese tracheostomy irashobora gukurwaho?

Tracheostomies nyinshi zirashobora gukurwaho iyo impamvu yateye uwo murimo ikemutse. Uwo murimo witwa decannulation kandi ugizwe no kugabanya buhoro buhoro kwishingikiriza ku rusinge.

Ikipe yawe y’abaganga izasuzuma guhumeka kwawe, kumira, n’ubuzima bwawe muri rusange mbere yo kugerageza gukuraho. Ahantu hakomerekeye mubisanzwe hafungwa mu buryo busanzwe nyuma y’iminsi mike kugeza ku byumweru nyuma yo gukuraho urusinge, nubwo abantu bamwe bashobora gukenera uburyo bwo kubagwa gato kugirango bahafunge rwose.