Yini i-Tracheostomy? Inhloso, Inqubo & Ukululama

I-tracheostomy iyinqubo yokuhlinzwa eyakha imbobo encane phambi kwentamo yakho ukukusiza ukuphefumula. Le mbobo ixhuma ngqo ku-trachea yakho (umoya), idlula umlomo wakho namakhala akho. Ngenkathi kungase kuzwakale kukhulu ekuqaleni, le nqubo ingasindisa impilo futhi ivame ukuba yesikhashana, inike umzimba wakho ukusekelwa kokuphefumula okudingayo ngesikhathi sokululama.

Yini i-tracheostomy?

I-tracheostomy idala indlela eqondile yomoya ukuze ifinyelele emaphashini akho ngembobo encane entanyeni yakho. Ngesikhathi senqubo, udokotela ohlinzayo wenza ukusikwa okubekwe ngokucophelela ku-trachea yakho futhi afake ipayipi elikhethekile elibizwa nge-tracheostomy tube noma "i-trach tube."

Le payipi lisebenza njengendlela entsha yokuphefumula edlula ngokuphelele umoya wakho ongaphezulu. Cabanga ngayo njengokudala umnyango ozongena ngomunye umzila ohlelweni lwakho lokuphefumula lapho indlela ejwayelekile ngamakhala akho nomlomo ingasebenzi kahle.

Imbobo ngokwayo ibizwa nge-stoma, futhi ivamise ukuba ngosayizi we-dime. Abantu abaningi baphila ngokunethezeka nge-tracheostomy, futhi ezimweni eziningi, ingahlehliswa uma isimo esingaphansi sithuthuka.

Kungani kwenziwa i-tracheostomy?

Odokotela batusa i-tracheostomy uma udinga ukusekelwa kokuphefumula isikhathi eside noma uma umoya wakho ongaphezulu uvinjelwe noma ulimele. Le nqubo ingahlelwa kusengaphambili noma yenziwe ezimweni eziphuthumayo lapho kudingeka khona usizo lokuphefumula ngokushesha.

Izizathu ezivame kakhulu zihlanganisa ukungenisa umoya ngomshini isikhathi eside, ukulimala okukhulu komphimbo noma intamo, kanye nezimo ezithile zezokwelapha ezithinta ukuphefumula. Ake sibheke izimo ezithile lapho le nqubo iba khona.

Nawa amabhodi ezokwelapha amakhulu angase adinge i-tracheostomy:

• Ukungenisa umoya ngomshini isikhathi eside (ngokuvamile ngemva kwezinsuku ezingu-7-10 emshinini wokuphefumula)
• Ukuvuvukala okukhulu komphimbo noma umphimbo ngenxa yokutheleleka noma ukulimala
• Umkhuhlane wekhanda noma wentamo ovimba umoya
• Ukwelashwa okukhulu kobuso noma intamo ngenxa yezingozi
• Izimo zemizwa ezithinta imisipha yokuphefumula
• Ukuphazamiseka komoya okuzalwa nakho ezinganeni
• I-sleep apnea enkulu engaphenduli kwezinye izindlela zokwelapha
• Ukuqina kwentambo yezwi okuthinta zombili izinhlangothi
• Ukusha okukhulu endaweni yobuso nentamo

Isimo ngasinye sihlolwa ngokucophelela ithimba lakho lezokwelapha ukuze linqume ukuthi i-tracheostomy iyona ndlela engcono kakhulu yezidingo zakho ezithile. Umgomo uhlala ukuqinisekisa ukuthi ungakwazi ukuphefumula ngokuphepha nangokunethezeka.

Yini inqubo ye-tracheostomy?

I-tracheostomy ingenziwa egumbini lokuhlinzela noma eceleni kombhede wakho esibhedlela esigxile ekunakekelweni okujulile. Le nqubo ngokuvamile ithatha imizuzu engu-20-45, kuye ngesimo sakho esithile nokuthi ihlelelwe yini noma yenziwa njengoba kuphuthumayo.

Udkt wakho ohlinzayo uzosebenzisa i-anesthesia ejwayelekile (uma ungakabi semshinini wokuphefumula) noma i-anesthesia yendawo enokuthulisa. Ukukhetha kuncike esimweni sakho samanje nesimo sokuphefumula.

Nakhu okwenzekayo ngesikhathi senqubo:

1. Indawo yakho yentamo ihlanzwa futhi imbozwe ngezinto eziyinyumba
2. Udkt ohlinzayo wenza ukusikeka okuncane okuvundlile engxenyeni engezansi yentamo yakho
3. Imisipha nezicubu zihlukaniswa ngobumnene ukuze kufinyelelwe ku-trachea
4. Kudalwa imbobo encane ku-trachea, ngokuvamile phakathi kwamasongo e-tracheal yesi-2 nesi-4
5. I-tracheostomy tube ifakwa ngale mbobo
6. I-tube ivikelekile endaweni ngama-sutures kanye nezibopho entanyeni yakho
7. Ukusikeka okuzungeze i-tube kuvalwa ngemithungo

Ngemuva kwenqubo, uzoqashwa eduze ukuqinisekisa ukuthi ithubhu lisebenza kahle futhi uphefumula ngokukhululeka. Abantu abaningi bajwayela ukuphefumula nge-tracheostomy tube kungakapheli amahora ambalwa.

Ungalungela kanjani i-tracheostomy yakho?

Uma i-tracheostomy yakho ihlelelwe kunokuba yenziwe njengoba kuyisimo esiphuthumayo, ithimba lakho lezokwelapha lizokuhambisa ngezinyathelo ezithile zokulungiselela. Inqubo yokulungiselela isiza ukuqinisekisa inqubo ephephe kakhulu nemiphumela engcono kakhulu yokululama.

Udokotela wakho uzobukeza umlando wakho wezokwelapha, imithi yamanje, futhi enze izivivinyo ezidingekayo ngaphambi kwenqubo. Ukuhlolwa kwegazi kanye nezifundo zokuthwebula izithombe kungase kudingeke ukuhlela ukubekwa okuqondile kwe-tracheostomy yakho.

Nakhu ongakulindela esigabeni sokulungiselela:

• Ukuhlolwa kwegazi ukuhlola ukusebenza kwegazi lakho kanye nempilo yonke
• I-X-ray yesifuba noma i-CT scan ukuhlola indlela yakho yomoya kanye ne-anatomy yentamo
• Ingxoxo mayelana nokuyeka imithi ethile efana ne-blood thinners
• Inqubo yokuvuma lapho zonke izingozi nezinzuzo zichazwa
• Isimo se-NPO (akukho ngomlomo) amahora ambalwa ngaphambi kwenqubo
• Ukubekwa komugqa we-IV wemithi kanye noketshezi
• Ukubekwa kwemishini yokuqapha nokubeka

Uma usuvele use-ventilator, okuningi kwalokhu kulungiselela kungase kube sekulungile. Ithimba lakho lezokwelapha lizoqinisekisa ukuthi uzinzile ngangokunokwenzeka ngaphambi kokuqhubeka nokuhlinzwa.

Ungayifunda kanjani ukunakekelwa kwe-tracheostomy yakho?

Ukuqonda ukunakekelwa kwe-tracheostomy yakho kuhilela ukufunda ngezinto ezihlukene zethumbu lakho nokubona izimpawu zokuthi konke kusebenza kahle. I-tracheostomy tube yakho inezingxenye eziningana ezisebenza ndawonye ukuze zigcine indlela yakho yomoya ivulekile futhi ivikelekile.

Ithumbu elingaphandle lihlala endaweni futhi linikeza indlela eyinhloko yomoya, kuyilapho ithubhu elingaphakathi lingasuswa ukuze lihlanzwe. Amathumbu amaningi nawo anebhaluni (elibizwa nge-cuff) elingakhukhumezwa ukuvala indlela yomoya uma kudingeka.

Nawa amaphuzu abalulekile okumele aqashelwe futhi aqondwe:

• Indawo yethumbu - kufanele ihlale imaphakathi futhi ivikelekile e-stoma
• Imisindo yokuphefumula - kufanele icace futhi ibe lula ngethumbu
• Umbala nokuningi kwemfihlo - imfihlo ecacile nemhlophe kuvamile
• Isikhumba esizungeze i-stoma - kufanele sibe pink futhi siphilile ngaphandle kokubomvu okukhulu
• Izibopho zethumbu noma isibambi - kufanele zibe ziqinile kodwa zingabi qinile kakhulu
• Ukucindezela kwe-cuff (uma kusebenza) - kugcinwa emazingeni aphephile yithimba lakho lokunakekela

Ithimba lakho lezempilo lizokufundisa wena noma amalungu omndeni wakho ukuthi anakekele kanjani i-tracheostomy eyisisekelo, okuhlanganisa izindlela zokuhlanza nokumunca. Le mfundo ibalulekile ekugcineni impilo yakho nokuvimbela izinkinga.

Ungayiphatha kanjani ukunakekelwa kwakho kwe-tracheostomy?

Ukuphatha i-tracheostomy yakho kuhilela imikhuba yokuhlanza yansuku zonke, ukuqapha izinkinga, nokwazi ukuthi ungacela nini usizo. Ukunakekelwa okuhle kwe-tracheostomy kuvimbela izifo futhi kugcina ukuphefumula kwakho kukhululekile futhi kusebenza kahle.

Izici ezibaluleke kakhulu zokunakekela zihlanganisa ukugcina indawo ihlanzekile, ukuphatha imfihlo, nokuqinisekisa ukuthi ithumbu lihlala endaweni efanele. Ithimba lakho lezokwelapha lizohlinzeka ngemiyalelo enemininingwane eyenzelwe uhlobo lwakho oluthile lwethumbu le-tracheostomy.

Nawa imisebenzi ebalulekile yokunakekela yansuku zonke:

• Ukuhlanza ngaphandle kwe-stoma ngamanzi ahlanzekile noma isixazululo se-saline
• Ukushintsha ukugqoka kwe-tracheostomy ukuze kugcinwe indawo yomile
• Ukumunca imfihlo uma kudingeka ukuze kugcinwe indlela yomoya icacile
• Ukuhlanza noma ukushintsha ithumbu elingaphakathi njengoba kuqondiswe
• Ukuqinisekisa ukuthi izibopho zethumbu noma izibambi zivikelekile kodwa zingabi qinile kakhulu
• Ukuqapha izimpawu zokutheleleka noma izinkinga
• Ukufaka umoya emoyeni owuphefumulayo ukuvimbela ukoma

Abantu abaningi baphatha ngempumelelo ukunakekelwa kwabo kwe-tracheostomy ekhaya ngokuqeqeshwa okufanele nokusekelwa. Ithimba lakho lezempilo lizoqinisekisa ukuthi uzizwa ukhululekile ngazo zonke izici zokunakekela ngaphambi kokukhishwa.

Yiluphi uhlobo olungcono kakhulu lwetube le-tracheostomy?

Itube le-tracheostomy elingcono kakhulu lincike ezidingweni zakho ezithile zezokwelapha, i-anatomy, kanye nemigomo yesikhathi eside. Kunezinhlobo eziningana zamatube atholakalayo, ngalinye lenzelwe izimo ezahlukene nezidingo zesiguli.

Udokotela wakho uzokhetha itube elifanele kakhulu ngokusekelwe ezintweni ezinjengokuthi ngabe udinga umoya-mpilo wokwenziwa, ikhono lakho lokukhuluma, nokuthi uzolidinga isikhathi esingakanani i-tracheostomy. Itube lingashintshwa ngokuhamba kwesikhathi uma izidingo zakho zishintsha.

Izinhlobo ezivamile zamatube e-tracheostomy zihlanganisa:

• Amatube ane-cuffed - anebhaluni elivuvukayo ukuvala umoya ukuze kube nomoya-mpilo
• Amatube angenayo i-cuffed - avumela umoya ukuthi ugeleze ngaphandle kwetube futhi udlule emoyeni wakho ongaphezulu
• Amatube ane-fenestrated - anezimbobo ezivumela ukuthi umoya ugeleze ngamathambo akho okukhuluma ukuze ukhulume
• Ama-valve okukhuluma - izinto ezinamathiselwe ezikhethekile ezikusiza ukuthi ukhulume ngenkathi uphefumula ngetube
• Amatube angaphakathi alahlwayo - enza ukuhlanza kube lula futhi anciphise ingozi yokutheleleka
• Amatube e-flange alungisekayo - angashintshwa ukuze alingane nama-anatomies entamo ahlukene

Ithimba lakho lezokwelapha lizosebenza nawe ukuthola uhlobo lwetube olukunikeza inhlanganisela engcono kakhulu yokuphepha, induduzo, kanye nekhwalithi yempilo. Amatube angashintshwa njengoba isimo sakho sithuthuka noma izidingo zakho zishintsha.

Ziyini izici eziyingozi zezinkinga ze-tracheostomy?

Ezinye izici zingakhuphula ingozi yakho yezinkinga nge-tracheostomy, nakuba abantu abaningi benza kahle ngokunakekelwa okufanele. Ukuqonda lezi zici eziyingozi kusiza ithimba lakho lezokwelapha ukuthi lithathe izinyathelo ezengeziwe zokuphepha futhi likuqaphe eduze.

Ubudala, isimo sempilo esiphelele, nesizathu se-tracheostomy yakho konke kunendima ekunqumeni izinga lakho lengozi. Iningi lezinkinga lingavinjelwa ngokunakekelwa okuhle kanye nokubona ngokushesha izinkinga.

Izici ezingase zikhuphule ingozi yakho zihlanganisa:

• Ubudala obuthuthukile (ngaphezu kweminyaka engama-65)
• Isifo sikashukela noma ezinye izimo ezithinta ukuphola kwamanxeba
• Ukucindezelwa komzimba okubangelwa imithi noma ukugula
• Ukudla okunganele noma amazinga aphansi amaprotheni
• Umlando wokubhema noma ukusetshenziswa okusaqhubeka kukagwayi
• Ukukhuluphala okuthinta i-anatomy yentamo
• Ukuhlinzwa kwentamo kwangaphambilini noma i-radiation therapy
• Izifo zokuphuma igazi noma ukusetshenziswa kwemithi eqeda igazi
• Isifo samaphaphu esingamahlalakhona noma izifo zokuphefumula ezivamile

Ukuba nezici eziyingozi akusho ukuthi nakanjani uzoba nezinkinga, kodwa kusho ukuthi ithimba lakho lokunakekela lizogxila kakhulu ekuvikeleni izinkinga. Izici eziningi eziyingozi zingalawulwa noma zithuthukiswe ngokunakekelwa okufanele kwezokwelapha.

Ingabe kungcono ukuba ne-tracheostomy yesikhashana noma yaphakade?

Ama-tracheostomy amaningi ahloselwe ukuba esikhashana, ngenhloso yokususa ithubhu uma isimo sakho esiyisisekelo sithuthuka. Kodwa-ke, abanye abantu bayazuza ku-tracheostomy yaphakade kuye ngesimo sabo sezokwelapha esithile.

Isinqumo mayelana nesikhashana vs esiphakade sincike ezintweni ezinjengesimo sakho esiyisisekelo, ithuba lokululama, kanye nemigomo yezempilo iyonke. Ithimba lakho lezokwelapha lizoxoxa lezi zinketho nawe nomndeni wakho.

Ama-tracheostomy esikhashana akhethwa uma:

• Uthola ukwelulama ekuguleni okukhulu noma ekulimaleni
• Udinga ukusekelwa kwe-ventilator yesikhashana
• Ukuvuvukala noma ukuvaleka emoyeni wakho ongenhla kulindeleke ukuthi kulungiswe
• Uthola ukwelulama ngemva kokuhlinzwa okukhulu
• Isimo sakho se-neurological singase sithuthuke ngokuhamba kwesikhathi

Ama-tracheostomy aphakade angase adingeke uma:

• Unesimo se-neurological esiqhubekayo
• Ukwakhiwa kabusha komoya ongenhla akunakwenzeka
• Unesifo samaphaphu esingamahlalakhona esibi kakhulu
• Ukwelashwa komdlavuza kuye kwathinta unomphela umoya wakho
• Ukhetha i-tracheostomy yesikhathi eside ngaphezu kwezinye izinketho

Noma ngabe une-“permanent” tracheostomy, isimo sakho singahlolwa kabusha ngokuhamba kwesikhathi, futhi ukususwa kungase kube nokwenzeka njengoba impilo yakho iguquka.

Ziyini izinkinga ezingase zibe khona ze-tracheostomy?

Ngenkathi i-tracheostomy ngokuvamile iyinqubo ephephile, njenganoma yikuphi ukuhlinzwa, ingaba nezinkinga. Izinkinga eziningi azivamile futhi zingavinjelwa noma ziphathwe ngempumelelo uma zenzeka.

Izinkinga zingenzeka ngesikhathi senqubo, esikhathini sokululama ngokushesha, noma zithuthuke ngokuhamba kwesikhathi ngokusetshenziswa kwesikhathi eside. Ithimba lakho lezokwelapha liqapha eduze noma yiziphi izimpawu zezinkinga.

Izinkinga zakuqala (ezinsukwini ezimbalwa zokuqala) zingabandakanya:

• Ukuphuma igazi endaweni yokuhlinzwa
• Ukutheleleka ngaphakathi nangaphandle kwe-stoma
• Ukuhanjiswa kwetube noma ukususwa ngengozi
• I-Pneumothorax (iphasha eliwile)
• Umonakalo ezakhiweni eziseduze njengemithambo yegazi
• Ubunzima bokubeka itube

Izinkinga zakamuva (amasonto kuya ezinyangeni kamuva) zingabandakanya:

• I-Tracheal stenosis (ukuncipha komgudu womoya)
• Ukwakheka kwesicubu se-Granulation ngaphakathi nangaphandle kwe-stoma
• Ukuvinjelwa kwetube okuvela ekukhishweni
• Ukuwohloka kwesikhumba ngaphakathi nangaphandle kwe-stoma
• Ubunzima bokugwinya
• Ushintsho lwezwi
• I-Tracheoesophageal fistula (ukuxhumana okungavamile phakathi komgudu womoya ne-esophagus)

Izinkinga eziningi zingavinjelwa ngokunakekela okufanele nokuqapha njalo. Ithimba lakho lezempilo lizokufundisa ukuthi ungazibona kanjani izimpawu zokuxwayisa nokuthi nini lapho kufanele ufune usizo ngokushesha.

Kufanele ngibone nini udokotela ngezinkinga ze-tracheostomy?

Kufanele uthinte umhlinzeki wakho wezempilo ngokushesha uma uqaphela noma yiziphi izimpawu zezinkinga noma uma unenkinga yokuphefumula nge-tracheostomy yakho. Isenzo esisheshayo singavimbela izinkinga ezincane ukuthi zingabi zimbi.

Ezinye izimo zidinga ukunakekelwa okuphuthumayo ngokushesha, kanti ezinye zingalinda ukuqokwa okuvamile noma ukubonisana ngocingo. Ukufunda ukubona umehluko kubalulekile ekuphepheni kwakho.

Funana ngokushesha usizo oluphuthumayo uma uhlangabezana nalokhu:

• Ukuphefumula kanzima noma ukuphefumula ngokushesha
• Ukuhlehla kwetube noma ukuvaleka okuphelele
• Ukuphuma kwegazi eliningi ku-stoma
• Ubuhlungu besifuba noma izimpawu ze-pneumothorax
• Ukuvuvukala okukhulu entanyeni
• Izimpawu zokutheleleka okukhulu njengomkhuhlane nokugodola
• Ukungakwazi ukukhuluma noma ukugwinya kungazelelwe

Xhumana nodokotela wakho kungakapheli amahora angama-24 ngezinto ezilandelayo:

• Ukukhula noma ukushintsha kombala kwemfihlo
• Ukuphuma kwegazi elincane okungami ngokucindezela
• Ububomvu noma ukuvuvukala eduze kwe-stoma
• I-tube ebonakala ivulekile noma ingabekiwe kahle
• Ukukhwehlela okuqhubekayo noma izinguquko ezwini lakho
• Ukuqubuka kwesikhumba noma ukuhlukana eduze kwetube

Ukuba nobuhlobo obuhle nethimba lakho lezempilo nokuqonda ukuthi ungasiza nini kungenza ukuphila nge-tracheostomy kuphephe kakhulu futhi kube lula.

Imibuzo evame ukubuzwa mayelana ne-tracheostomy

Q.1 Ingabe i-tracheostomy ingcono kune-intubation ende?

Yebo, i-tracheostomy ngokuvamile ingcono kune-intubation ende kubantu abadinga ukusekelwa kokuphefumula isikhathi eside. Ngemva kwezinsuku eziyi-7-10 usebenzisa i-ventilator ngetube emlonyeni wakho, i-tracheostomy iba iphephe futhi ithuthukise induduzo.

I-Tracheostomy inciphisa ingozi yokulimala kwentambo yezwi, yenza ukunakekelwa komlomo kube lula, futhi ivumela ukunethezeka okungcono kwesiguli. Futhi inciphisa isidingo sokuthulisa okukhulu futhi kungenza kube lula ukuyeka i-ventilator uma usulungele.

Q.2 Ungadla ngokujwayelekile nge-tracheostomy?

Abantu abaningi bangadla ngokujwayelekile nge-tracheostomy, kodwa kuncike esimweni sakho esithile nohlobo lwetube. Uma unetube eline-cuffed elivuvukile, ungase udinge ukulinciphisa ngesikhathi sokudla ukuze uvumele ukugwinya okujwayelekile.

Udokotela wakho wokwelapha ukukhuluma nethimba lezokwelapha bazohlola ukusebenza kwakho kokugwinya futhi bangase batusa amasu athile noma izinguquko ekudleni. Abanye abantu badinga amashubhu okudla okwesikhashana ngenkathi befunda ukugwinya ngokuphepha futhi.

Q.3 Ngizokwazi yini ukukhuluma nge-tracheostomy?

Ukukhuluma nge-tracheostomy kungenzeka, nakuba kungase kudingeke ukuthi kwenziwe izinguquko ezithile noma imishini ekhethekile. Uma uneshubhu elingena-cuffed noma ungakwazi ukukhipha i-cuff, umoya ungangena ngamazwi akho okukhuluma okuvumela ukukhuluma.

Ama-valve okukhuluma namashubhu ane-fenestrated angasiza ukubuyisela izwi lakho. Udokotela wakho wokwelapha ukukhuluma uzosebenza nawe ukuthola indlela engcono kakhulu yesimo sakho. Abantu abaningi babuyisela amakhono amahle okuxhumana ngokuqeqeshwa okufanele nemishini.

Q.4 Kuthatha isikhathi esingakanani ukululama emva kokuhlinzwa kwe-tracheostomy?

Ukuphola kokuqala emva kokuhlinzwa kwe-tracheostomy kuvamile ukuthatha amasonto angu-1-2, nakuba wonke umuntu ephola ngejubane lakhe. Indawo ye-stoma ivame ukuphola phakathi kwezinsuku ezingu-5-7, futhi uvame ukuqala ukufunda amasu okunakekela phakathi nezinsuku ezimbalwa zokuqala.

Ukuzivumelanisa ngokugcwele nokuphila nge-tracheostomy kungase kuthathe amasonto amaningana kuya ezinyangeni, kuye ngempilo yakho yonke nesizathu senqubo. Ithimba lakho lezokwelapha lizohlinzeka ngosekelo oluqhubekayo ngesikhathi sokululama kwakho.

Q.5 Ingabe i-tracheostomy ingasuswa?

Ama-tracheostomy amaningi angasuswa uma isizathu esiyisisekelo senqubo sesixazululiwe. Le nqubo ibizwa ngokuthi i-decannulation futhi ihlanganisa ukunciphisa kancane kancane ukuncika kwakho eshubhini.

Ithimba lakho lezokwelapha lizohlola ukuphefumula kwakho, ukugwinya, nesimo sakho esiphelele ngaphambi kokuzama ukususwa. I-stoma ivame ukuvala ngokwemvelo phakathi nezinsuku ezimbalwa kuya emavikini ngemva kokuthi ishubhu lisusiwe, nakuba abanye abantu bengase badinge inqubo encane yokuhlinzwa ukuze bayivale ngokuphelele.