Chii chinonzi Tracheostomy? Chinangwa, Maitiro & Kupora

Tracheostomy inzira yekuvhiya inogadzira buri diki kumberi kwemutsipa wako kuti ikubatsire kufema. Buri iri rinobatanidza zvakananga netrachea yako (windpipe), richipfuura muromo wako nemhino. Kunyangwe zvichigona kuita sezvinotyisa pakutanga, nzira iyi inogona kuponesa hupenyu uye kazhinji yenguva pfupi, ichipa muviri wako rutsigiro rwekufema rwaanoda panguva yekupora.

Chii chinonzi tracheostomy?

Tracheostomy inogadzira nzira yakananga yemhepo kuti isvike kumapapu ako kuburikidza nebururi diki mumutsipa wako. Panguva yekuvhiya, chiremba anovhiya anoita incision yakanyatsoiswa mutrachea yako uye anopinza chubhu yakakosha inonzi tracheostomy tube kana "trach tube."

Chubhu iyi inoita semugwagwa mutsva wekufema unopfuura zvachose nzira yako yepamusoro yemhepo. Funga nezvazvo sekugadzira imwe nzira yekupinda muhurongwa hwako hwekufema kana nzira yenguva dzose kuburikidza nemhino dzako nemuromo isingashande zvakanaka.

Buri racho pacharo rinonzi stoma, uye rinowanzoita saizi yedhime. Vanhu vazhinji vanorarama zvakanaka netracheostomy, uye muzviitiko zvakawanda, inogona kudzoserwa kana mamiriro ezvinhu ari pasi achivandudzika.

Nei tracheostomy ichiitwa?

Vanachiremba vanokurudzira tracheostomy kana iwe uchida rutsigiro rwekufema kwenguva refu kana kana nzira yako yepamusoro yemhepo yakavharika kana kukuvadzwa. Nzira iyi inogona kurongwa pamberi penguva kana kuitwa mumamiriro ezvinhu ekukurumidzira kana rubatsiro rwekufema rwechimbichimbi ruchidiwa.

Zvikonzero zvakajairika zvinosanganisira mechanical ventilation yakareba, kukuvara kwakanyanya kwehuro kana mutsipa, uye mamwe mamiriro ezvinhu ekurapa anokanganisa kufema. Ngatitarisei mamiriro chaiwo apo nzira iyi inova yakakosha.

Heano mamiriro makuru ekurapa anogona kuda tracheostomy:

• Kufema kwemuchina kwenguva refu (kazhinji mushure memazuva 7-10 pamuchina wekufema)
• Kuzvimba kwakanyanya kwehuro kana laryngeal kubva mukutapukirwa kana kukuvara
• Kenza yemusoro kana mutsipa inodzivisa nzira yemhepo
• Kukuvara kwakanyanya kwemuviri kana mutsipa kubva kunjodzi
• Mamiriro ekuvhiya anokanganisa tsandanyama dzekufema
• Kusiyana kwemhepo kubva pakuzvarwa muvana
• Kufema kwakanyanya kwehope kusingapinduri kune dzimwe nzira dzekurapa
• Kuremara kwemazwi kunokanganisa mativi ese
• Kupisa kwakanyanya kumativi echiso nemutsipa

Mamiriro ese anoongororwa zvakanyanya nechikwata chako chekurapa kuti chione kana tracheostomy iri sarudzo yakanakisa yezvido zvako chaizvo. Chinangwa chinogara chiri chekuona kuti unogona kufema zvakachengeteka uye zvakanaka.

Ndeipi nzira ye tracheostomy?

Tracheostomy inogona kuitwa mukamuri rekuvhiya kana pamubhedha wako muchikamu chekuchengetwa kwakanyanya. Iyi nzira inowanzo tora maminitsi makumi maviri nemashanu, zvichienderana nemamiriro ako chaiwo uye kana yakarongwa kana kuitwa senjodzi.

Chiremba wako achashandisa kana general anesthesia (kana usati uri pane ventilator) kana local anesthesia ine sedation. Sarudzo inoenderana nemamiriro ako azvino uye kufema kwako.

Zvinoitika panguva yacho ndeizvi:

1. Nzvimbo yemutsipa wako inocheneswa uye yakafukidzwa nezvinhu zvakachena
2. Chiremba anogadzira incision diki yakatwasuka muchikamu chezasi chemutsipa wako
3. Tsandanyama uye matishu anoparadzaniswa zvinyoro nyoro kuti asvike trachea
4. Muvhuriro mudiki unogadzirwa mu trachea, kazhinji pakati pe 2nd ne 4th tracheal rings
5. Iyo tracheostomy tube inoiswa kuburikidza nemuvhuriro uyu
6. Iyo tube inochengetwa panzvimbo ine sutures uye zvisungo zvakatenderedza mutsipa wako
7. Iyo incision yakatenderedza tube inovharwa nemachira

Mushure mekuvhiyiwa, ucharindwa zvakanyanya kuti uve nechokwadi chekuti chubhu iri kushanda nemazvo uye uri kufema zvakanaka. Vanhu vazhinji vanojaira kufema kuburikidza nechubhu ye tracheostomy mukati memaawa mashoma.

Maitiro ekugadzirira tracheostomy yako?

Kana tracheostomy yako yakarongwa pane kuitwa senjodzi, timu yako yezvokurapa ichakufambisa kuburikidza nematanho chaiwo ekugadzirira. Maitiro ekugadzirira anobatsira kuona nzira yakachengeteka inogoneka uye mhedzisiro yakanakisa yekupora.

Chiremba wako achatarisa nhoroondo yako yezvokurapa, mishonga iripo, uye achaita bvunzo dzinodiwa pamberi pekuvhiyiwa. Bvunzo dzeropa uye zvidzidzo zvekuongorora zvinogona kudiwa kuronga nzvimbo chaiyo yetracheostomy yako.

Hezvino zvaunogona kutarisira muchikamu chekugadzirira:

• Bvunzo dzeropa kuti uongorore basa rako rekuvhara uye hutano hwese
• Chest X-ray kana CT scan kuti uongorore nzira yako yemhepo uye anatomy yemutsipa
• Kukurukurirana nezvekumisa mishonga yakati wandei senge zvinoderedza ropa
• Maitiro ekubvumirana uko njodzi dzese nemabhenefiti zvinotsanangurwa
• NPO chinzvimbo (hapana nemuromo) kwemaawa akati wandei pamberi pekuvhiyiwa
• IV mutsetse wekugadzirisa mishonga nemvura
• Kumisikidza uye kuisa mudziyo wekutarisa

Kana iwe watove pane ventilator, zvakawanda zvekugadzirira izvi zvinogona kunge zvatovepo. Chikwata chako chekurapa chichaita shuwa kuti wakagadzikana sezvinobvira usati waenderera mberi nekuvhiyiwa.

Maitiro ekuverenga kutarisirwa kwako kwe tracheostomy?

Kunzwisisa kutarisirwa kwako kwe tracheostomy kunosanganisira kudzidza nezvezvikamu zvakasiyana zvechubhu yako uye kuziva zviratidzo zvekuti zvese zviri kushanda nemazvo. Chubhu yako ye tracheostomy ine zvikamu zvakati wandei zvinoshanda pamwechete kuchengetedza nzira yako yemhepo yakavhurika uye yakachengeteka.

Chubhu yekunze inogara panzvimbo uye inopa nzira huru yemhepo, nepo chubhu yemukati inogona kubviswa kuti icheneswe. Mabvubhu mazhinji anewo bhuru (rinonzi cuff) rinogona kuzvimba kuti rivhare nzira yemhepo kana zvichidikanwa.

Hezvino zvinhu zvakakosha zvekutarisa nekunzwisisa:

• Nzvimbo yetube - inofanira kuramba iri pakati uye yakachengeteka mustoma
• Ruzha rwekufema - runofanira kunge rwakajeka uye nyore kuburikidza netube
• Ruvara rwekuvanza uye huwandu - zvakajeka kusvika kuchena zvinowanzoitika
• Ganda rakatenderedza stoma - rinofanira kunge riri pink uye richipora pasina kutsvuka kwakanyanya
• Tube ties kana mubati - inofanira kunge yakasimba asi kwete yakanyanya kusimba
• Cuff pressure (kana zvichibvira) - inochengetwa pamatanho akachengeteka nechikwata chako chekuchengetedza

Chikwata chako chekuchengetedza hutano chichakudzidzisa iwe kana nhengo dzemhuri yako maitiro ekupa kutarisirwa kwekutanga kwe tracheostomy, kusanganisira nzira dzekuchenesa nekukwevera. Dzidzo iyi yakakosha pakuchengetedza hutano hwako uye kudzivirira matambudziko.

Maitiro ekugadzirisa kutarisirwa kwako kwe tracheostomy?

Kugadzirisa tracheostomy yako kunosanganisira maitiro ezuva nezuva ekuchenesa, kutarisa matambudziko, uye kuziva nguva yekutsvaga rubatsiro. Kuchengetwa kwakanaka kwe tracheostomy kunodzivirira hutachiona uye kunochengeta kufema kwako kuri nyore uye kunoshanda.

Zvikamu zvakakosha zvekutarisira zvinosanganisira kuchengeta nzvimbo yakachena, kugadzirisa zvakavanzika, uye kuona kuti tube inoramba iri panzvimbo yakakodzera. Chikwata chako chekurapa chichapa mirairo yakadzama yakagadzirirwa rudzi rwako rwe tracheostomy tube.

Hezvino mabasa akakosha ezuva nezuva ekutarisira:

• Kuchenesa kutenderedza stoma nemvura yakachena kana saline solution
• Kuchinja tracheostomy dressing kuchengeta nzvimbo yakaoma
• Kukwevera zvakavanzika kana zvichidikanwa kuchengeta nzira yemhepo yakajeka
• Kuchenesa kana kuchinja tube yemukati sezvakarairwa
• Kutarisa kuti tube ties kana vabati vakachengeteka asi kwete vakanyanya kusimba
• Kutarisa zviratidzo zvehutachiona kana matambudziko
• Kunyudza mhepo yaunofema kudzivirira kuoma

Vanhu vazhinji vanobudirira kugadzirisa kutarisirwa kwavo kwe tracheostomy kumba nekudzidziswa kwakakodzera uye rutsigiro. Chikwata chako chekuchengetedza hutano chichaita shuwa kuti unonzwa wakasununguka nezvinhu zvese zvekutarisira usati waburitswa.

Ndeipi mhando yakanakisa yetube ye tracheostomy?

Iyo yakanakisa tracheostomy tube inoenderana nezvako zvaunoda zvekurapa, anatomy, uye zvinangwa zvenguva refu. Kune mhando dzakawanda dzematiubhu dziripo, imwe neimwe yakagadzirirwa mamiriro akasiyana uye zvinodiwa nemurwere.

Chiremba wako achasarudza iyo yakanyanya kukodzera tube zvichienderana nezvinhu zvakaita sekuti unoda here mechanical ventilation, kugona kwako kutaura, uye kuti uchada tracheostomy kwenguva yakareba sei. Iyo tube inogona kuchinjwa gare gare kana zvaunoda zvachinja.

Mhando dzakajairika dzetracheostomy tubes dzinosanganisira:

• Cuffed tubes - vane bhururu rinokwanisa kuzvimba kuti rivhare nzira yemhepo yekufema
• Uncuffed tubes - inobvumira mhepo kuyerera ichitenderera tube uye nemunzira yako yepamusoro yemhepo
• Fenestrated tubes - vane maburi anobvumira kuyerera kwemhepo kuburikidza nemashoko ako ekutaura
• Kutaura mavharuvhu - zvakakosha zvinonamatira zvinokubatsira kutaura uchifema kuburikidza netube
• Disposable inner tubes - ita kuti kuchenesa kuve nyore uye kuderedza njodzi yekutapukirwa
• Adjustable flange tubes - inogona kugadzirwa kune akasiyana mutsipa anatomies

Chikwata chako chekurapa chichashanda newe kuti uwane mhando yetube inokupa musanganiswa wakanakisa wekuchengeteka, kunyaradzwa, uye hupenyu hwemhando yepamusoro. Tubes inogona kuchinjwa sezvo mamiriro ako achivandudza kana zvaunoda zvichichinja.

Ndezvipi zvinhu zvine njodzi zvematambudziko e tracheostomy?

Zvimwe zvinhu zvinogona kuwedzera njodzi yako yematambudziko ane tracheostomy, kunyangwe vanhu vazhinji vachiita zvakanaka nekuchengetwa kwakakodzera. Kunzwisisa izvi zvinhu zvine njodzi kunobatsira chikwata chako chekurapa kutora matanho ekuwedzera uye kukutarisa zvakanyanya.

Zera, hutano hwese, uye chikonzero chetracheostomy yako zvese zvine basa pakuona njodzi yako. Matambudziko mazhinji anogona kudzivirirwa nekuchengetwa kwakanaka uye kuziva nekukurumidza matambudziko.

Zvikonzero zvinogona kuwedzera njodzi yako zvinosanganisira:

• Kukwegura (kupfuura makore 65)
• Chirwere cheshuga kana mamwe mamiriro anokanganisa kupora kwemaronda
• Kudzora immune system kubva kumishonga kana kurwara
• Kushaya chikafu kana mazinga mashoma eprotein
• Nhoroondo yekusvuta kana kushandisa fodya zvinoenderera mberi
• Kufutisa kunokanganisa anatomy yemutsipa
• Kuvhiyiwa kwemutsipa kare kana radiation therapy
• Matambudziko ekubuda ropa kana kushandiswa kwemishonga inoderedza ropa
• Chirwere chemapapu chisingaperi kana hutachiona hwekufema hunowanzoitika

Kuva nezvinhu zvine njodzi hazvirevi kuti zvechokwadi uchava nematambudziko, asi zvinoreva kuti timu yako yekutarisira ichanyatso tarisa kudzivirira matambudziko. Zvinhu zvakawanda zvine njodzi zvinogona kutarisirwa kana kuvandudzwa nekutarisirwa kwekurapa kwakakodzera.

Zvirinani kuva netracheostomy yenguva pfupi kana yechigarire here?

Tracheostomies zhinji dzakagadzirirwa kuva dzenguva pfupi, nechinangwa chekubvisa chubhu kana mamiriro ako ari pasi achivandudzika. Zvisinei, vamwe vanhu vanobatsirwa ne tracheostomy yechigarire zvichienderana nemamiriro avo chaiwo ekurapa.

Sarudzo pamusoro penguva pfupi versus yechigarire inoenderana nezvinhu zvakaita semamiriro ako ari pasi, mukana wekupora, uye zvese zvehutano zvinangwa. Chikwata chako chekurapa chichakurukura izvi zvingasarudzwa newe nemhuri yako.

Tracheostomies yenguva pfupi inosarudzwa kana:

• Uri kupora kubva kurwara kwakanyanya kana kukuvara
• Unoda rutsigiro rweventilator kwenguva pfupi
• Kuzvimba kana kuvharika mumhepo yako yepamusoro kunotarisirwa kugadzirisa
• Uri kupora kubva mukuvhiyiwa kukuru
• Mamiriro ako ekuongorora uropi anogona kuvandudzika nekufamba kwenguva

Tracheostomies yechigarire inogona kuve yakakosha kana:

• Une mamiriro ekuongorora uropi ari kufambira mberi
• Kuvakwazve kwemhepo yepamusoro hakugoneki
• Une chirwere chemapapu chisingaperi
• Kurapa kenza kwakakanganisa mhepo yako zvachose
• Unosarudza tracheostomy yenguva refu pane dzimwe sarudzo

Kunyangwe ne "chigarire" tracheostomy, mamiriro ako anogona kuongororwa zvakare nekufamba kwenguva, uye kubviswa kunogona kuita kuti zvikwanise sezvo hutano hwako huchichinja.

Ndezvipi zvipingamupinyi zvinogona kuitika zve tracheostomy?

Nepo tracheostomy kazhinji iri nzira yakachengeteka, senge chero kuvhiyiwa, inogona kuve nematambudziko. Zvizhinji zvezvipingamupinyi hazviwanzoitika uye zvinogona kudzivirirwa kana kubudirira kurapwa kana zvikaitika.

Zvipingamupinyi zvinogona kuitika panguva yekuita, munguva yekukurumidza kupora, kana kukura nekufamba kwenguva nekushandiswa kwenguva refu. Chikwata chako chekurapa chinonyatso tarisa chero zviratidzo zvematambudziko.

Zvipingamupinyi zvekutanga (mukati memazuva mashoma ekutanga) zvinogona kusanganisira:

• Kubuda ropa kubva panzvimbo yekuvhiya
• Kutapukirwa kutenderedza stoma
• Kutamisa chubhu kana kubviswa netsaona
• Pneumothorax (mapapu akawa)
• Kukuvadza kune zvimiro zvakavakidzana senge midzi yeropa
• Kutambudzika nekuisa chubhu

Zvipingamupinyi zvekupera (vhiki kusvika kumwedzi gare gare) zvinogona kusanganisira:

• Tracheal stenosis (kumanikidzwa kwemhepo)
• Granulation tissue formation kutenderedza stoma
• Chubhu kuvharika kubva mukuburitswa
• Kutyora kweganda kutenderedza stoma
• Kutambudzika kumedza
• Kushanduka kwezwi
• Tracheoesophageal fistula (isina kujairika kubatana pakati pemhepo nemuromo)

Zvizhinji zvezvipingamupinyi zvinogona kudzivirirwa nekuchengetwa kwakakodzera uye kuongororwa nguva dzose. Chikwata chako chehutano chichakudzidzisa maitiro ekuziva zviratidzo zvekuyambira uye kana kutsvaga rubatsiro rwechimbichimbi.

Ndingafonera chiremba rini nekuda kwezvinhu zvine chekuita ne tracheostomy?

Unofanira kubata mupi wako wehutano nekukasira kana ukaona chero zviratidzo zvematambudziko kana kana uine dambudziko rekufema kuburikidza ne tracheostomy yako. Kuita nekukurumidza kunogona kudzivirira matambudziko madiki kubva pakuva akakomba.

Dzimwe nguva dzinoda kutarisirwa kwechimbichimbi nekukasira, nepo dzimwe dzichigona kumirira kugadzwa kwenguva dzose kana kubvunzana nefoni. Kujairira kuziva musiyano kwakakosha kuchengeteka kwako.

Tsvaga rubatsiro rwekukurumidza nekukasira kana uine:

• Kutadza kufema kana kufema nekukurumidza
• Kusimudzwa kwetubhu kana kuvharika kwakazara
• Kubuda ropa zvakanyanya kubva pa stoma
• Kurwadziwa muchipfuva kana zviratidzo zve pneumothorax
• Kuzvimba kwakanyanya pamutsipa
• Zviratidzo zvehutachiona hwakanyanya senge fivha nekutonhora
• Kutadza kutaura kana kumedza kamwe kamwe

Bata chiremba wako mukati me24 maawa e:

• Kuwedzera kana kusvibiswa kwemvura
• Kubuda ropa zvishoma zvisingamire nekudzvanya
• Kutsvuka kana kuzvimba kutenderedza stoma
• Tubhu inoita seyakasununguka kana isina kumisikidzwa zvakanaka
• Kukosora kunoramba kuripo kana shanduko muzwi rako
• Kutsamwa kweganda kana kuparara kutenderedza tubhu

Kuva neukama hwakanaka nechikwata chako chehutano uye kunzwisisa kuti ungatsvaga rubatsiro rini kunogona kuita kuti kurarama netracheostomy kuve kwakachengeteka uye kwakanyanya kunyaradza.

Mibvunzo inowanzo bvunzwa nezve tracheostomy

Q.1 Ko tracheostomy iri nani pane intubation yakareba?

Hongu, tracheostomy inowanzoita nani pane intubation yakareba yevanhu vanoda rutsigiro rwekufema kwenguva refu. Mushure memazuva anenge 7-10 pane ventilator kuburikidza netubhu mumuromo mako, tracheostomy inova yakachengeteka uye yakasununguka.

Tracheostomy inoderedza njodzi yekukuvadzwa kwetambo yezwi, inoita kuti kuchengetwa kwemuromo kuve nyore, uye inobvumira kunyaradzwa kuri nani kwemurwere. Inoderedzawo kudiwa kwekunyanya sedation uye inogona kuita kuti zvive nyore kubvisa ventilator kana wava kuda.

Q.2 Unogona kudya zvakajairika netracheostomy?

Vanhu vazhinji vanogona kudya zvakajairika netracheostomy, asi zvinoenderana nemamiriro ako chaiwo uye rudzi rwetubhu. Kana uine tubhu yakaiswa cuffed inozvimba, unogona kuda kuideredza panguva yekudya kuti ubvumire kumedza kwakajairika.

Nyanzvi yako yekurapa kutaura uye timu yako yezvokurapa vachaongorora mabasa ako ekumedza uye vanogona kukurudzira nzira dzakatarwa kana shanduko dzekudya. Vamwe vanhu vanoda machubhu ekudyisa kwenguva pfupi vachidzidza kumedza zvakachengeteka zvakare.

Mubvunzo 3: Ndichakwanisa here kutaura ndine tracheostomy?

Kutaura uine tracheostomy zvinogoneka, kunyangwe zvingada zvimwe zvigadziriso kana midziyo yakakosha. Kana uine chubhu isina cuff kana uchikwanisa kudzikisa cuff, mweya unogona kuyerera nemu vocal cords yako zvichibvumira kutaura.

Mavharuvhu ekutaura uye machubhu ane fenestrated anogona kubatsira kudzorera izwi rako. Nyanzvi yako yekurapa kutaura ichashanda newe kuti uwane nzira yakanakisa yemamiriro ako ezvinhu. Vanhu vazhinji vanowana zvakare kugona kutaurirana zvakanaka nekudzidziswa kwakakodzera nemidziyo.

Mubvunzo 4: Zvinotora nguva yakareba sei kupora kubva mukuvhiyiwa kwe tracheostomy?

Kutanga kupora kubva mukuvhiyiwa kwe tracheostomy kunowanzo tora vhiki 1-2, kunyangwe munhu wese achipora pamwero wavo. Nzvimbo ye stoma inowanzo pora mukati memazuva 5-7, uye iwe unowanzo kutanga kudzidza nzira dzekuchengeta mukati memazuva mashoma ekutanga.

Kugadzirisa zvizere kurarama ne tracheostomy zvinogona kutora mavhiki akati wandei kusvika kumwedzi, zvichienderana nehutano hwako hwese uye chikonzero chekuvhiyiwa. Timu yako yezvokurapa ichapa rutsigiro rwuri kuenderera mberi mukati mekupora kwako.

Mubvunzo 5: Tracheostomy inogona kubviswa here?

Ma tracheostomies mazhinji anogona kubviswa kana chikonzero chekuvhiyiwa chazvigadzirisa. Maitiro acho anonzi decannulation uye anosanganisira zvishoma nezvishoma kuderedza kuvimba kwako nechubhu.

Timu yako yezvokurapa ichaongorora kufema kwako, kumedza, uye mamiriro ako ese usati waedza kubvisa. Iyo stoma inowanzo vhara zvakasikwa mukati memazuva mashoma kusvika kumavhiki mushure mekubviswa kwechubhu, kunyangwe vamwe vanhu vachida maitiro madiki ekuvhiya kuti vaivhare zvakakwana.