Endotracheal tube (tube endotracheal): izitayela, osayizi, izinjongo. Setha i-intubation

Ngeshwa, kusuka ezihlukahlukene ukulimala kanye nokuguliswa awaphelele. Ezimweni ezimbi kakhulu, kufanele ngokushesha ukusiza umuntu ohluphekayo. Ikakhulukazi uma lilimele, okuyisimo esisongela ukuphila. Lezi zihlanganisa izimo esiphuthumayo ezifana umgudu isimiso, ukuboshwa inhliziyo, ukushaqeka, equlekile. Yokwelapha lezi pathologies kufanele kwenziwe labagula. Nokho, kufanele isenzo ezathathwa ngokushesha ngemva kokuhlaziywa kwamathenda isiguli, ie ngesikhathi qophelo eziphuthumayo. Emotweni, "ambulensi" isethelwe tracheal intubation, a ovuselela, isikhwama Ambu. Lezi amadivaysi ezokwelapha ziyadingeka kuphela ezimweni ezimbi kakhulu, uma umuntu akakwazi ukuphefumula ngokuzimela.

Uyini tube endotracheal?

Ngokwemvelo, lokhu kusho intubation tracheal libhekisela izinqubo edabukisayo. Kodwa, naphezu kwezinkinga, kubalulekile ukuze sibe nempilo enhle. Lokwanuleka yomoya futhi ukuqinisekisa ukufinyelela-mpilo emaphashini, tube endotracheal sifakwe. Kufanele bakwazi intubate udokotela iyiphi lunye. Ikakhulukazi lokhu khono kudingeka futhi resuscitators anaesthesiologists, odokotela ambulensi. Ngokwethulwa ukupholisa endotracheal tube wamaphaphu iba evamile futhi, naphezu ukulimala yomoya. Ngaphezu kwalokho, ngokusebenzisa le indlela kungaba kwenziwe i-oksijini yokufakelwa supply. Kunezinhlobo eziningi amashubhu endotracheal (20). Bona ziyahlukahluka ngobukhulu futhi zinikezwe uma kukhona indlela olwengeziwe (collar). Zonke amathuluzi intubation zihlukaniswe 2 izinhlobo: tube eniselwayo futhi nasotracheal. Ziyahlukahluka kuye ngezindlela Ukungena ohlelweni zokuphefumula. Esimweni sokuqala, tube endotracheal sifakwe ngomlomo, okwesibili - ngokusebenzisa izindima acinene. Kuzo zombili embodiments, ukuxakeka angagcina ngenxa umonakalo isitho. Ngakho-ke, ngaphambi kokuba sikhethe lokho umzila kokuphathwa tube, udinga ukuhlola izingozi. Nokho, intubation kufanele kwenziwe uma lokhu kudingekile ukuze imisebenzi ebalulekile emzimbeni.

Izinkomba kwezokuphatha tube endotracheal

Ngo uthi ezinzima ukuhlinzeka umgudu kungenzeka kuphela ngokwethula ngamapayipi tracheal emlonyeni noma acinene ingaphakathi. Ezimweni eziningi, isiguli engazizwa ubuhlungu phakathi naleyo nqubo. Njengoba abantu abadinga yokusiza umuntu ukuba aphefumule, ngokuvamile abazi lutho. Kukhona izimpawu ezilandelayo ukuze tracheal intubation:

1. Isidingo ukupholisa lokukhanda. ukupholisa Mechanical wenziwa hhayi kuphela at the stage of ezosizo oluphuthumayo, kodwa futhi ku-ICU. Kwenziwa le nqubo awunakuba khona ngaphandle kokuthethelela tracheal intubation.
2. Isidingo ukubulawa kwezinzwa okuvamile. Kulokhu kakhulu, ukwethulwa tube womoya liyadingeka. Phela, ngesikhathi ukubulawa kwezinzwa okuvamile ephumula zonke izicubu, kuhlanganise imisipha zokuphefumula.
3. Ukuqala kokusetshenziswa tracheal futhi lavage bronchial. Le nqubo kuvezwa iziguli kabani uya isikhwehlela, okuqukethwe isisu phakathi umgudu.
4. Ukuthuthukiswa negesi lokushintshisana phakathi emaphashini kanye nemvelo.

Kukholakala ukuthi tube endotracheal yethulwa ngomlomo (orotracheal) kuboniswa ezimweni ezinzima kakhulu. Phakathi kwabo - ayeke okumelwe uphefumule futhi ukhulume nomsebenzi inhliziyo (sebefile) , kanye ikhoma yanoma yimuphi umsuka. isingeniso Nasotracheal has nezinkinga ezimbalwa futhi kubhekwa bokuphila ngaphezulu. Noma kunjalo, ukuze kuvikelwe ukwehluleka oyingozi zokuphefumula, odokotela bavame ukwethula ngamapayipi ngomlomo.

Amathuluzi tracheal intubation

Egunjini labagula kakhulu onguchwepheshe njalo kufanele kube simiselwe tracheal intubation. Lilondolozwe ibhokisi ekhethekile ngamathuluzi eyenzelwe ukupholisa yamaphaphu. Setha i-intubation eyenziwa ka labagula uma kunesidingo. Lokhu kusebenza ezimweni lapho isiguli ngokushesha wabonisa ukupholisa lokukhanda. amathuluzi Medical ayatholakala iqoqo:

1. Laryngoscope. Le divayisi emelelwa izingxenye ezimbili eziyinhloko - ikhaba futhi isibambo. Isebenza sibonga ibhethri noma amabhethri. Basuke usufakwa isibambo laryngoscope. Izindwani ukuza lobehlukene nomumo (lwalugobile futhi iqonde). Le ngxenye ufakwa ngalo ingaphakathi ngomlomo. Ekupheleni ikhaba has a ukukhanya esikhanyisa yomoya. usayizi Ukukhethwa laryngoscope incike yobudala lesiguli, nesimo ngalo ingaphakathi ngomlomo.
2. izinhlobo ezahlukene amashubhu endotracheal. Le kit kuhlanganisa amathuluzi for intubation kokubili abadala kanye nezingane. Ziyahlukahluka kuye ngobukhulu, khona noma ukungabi khona cuff, ububanzi elingaphandle, ubude kanye nenani lumens. Ngalezi amashubhu kungaba kwenziwe kokubili intubation eniselwayo futhi nasotracheal. Ngokuvamile abesifazane zisebenzisa usayizi imbobo 7-8, amadoda - 8-10. Enombono intubation iziguli omdala zidinga endotracheal tube ne cuff. Ukuqinisekisa patency we yomoya kwezingane - ngaphandle kwalo.
3. Conductor endotracheal tube ukungadluliseli bend oyifunayo.
4. esebenzisa Lwalugobile.
5. izidakamizwa Nebulizer ngoba izinto zokubulala izinzwa.

Naphezu kweqiniso lokuthi e umkhuba alisebenzisi zonke amathuluzi, yobukhona babo kuyadingeka ngokugcwele.

Kwezinye izimo, ukwethulwa kwe-tube endotracheal Akwamukelekile?

Nakuba intubation libhekisela izinqubo ezidingekayo, it has eziningi Izimo. Lezi zihlanganisa: entanyeni ukulimala, izimila e izimbotshana temlomo na acinene, ukuvuvukala yomoya. Kulezi zimo, isingeniso tube engalethi inzuzo kodwa kunomthelela ukuthuthukiswa yezinkinga ezinzima (igebe izicubu, umgogodla cord yokulimala). Ngakho-ke, ngaphambi kokuqhubeka intubation, kubalulekile ukuba sihlole umlomo nekhala, sinake isimo sokukhubazeka komgogodla engenhla.

Ngaphezu kwalokho, ukwethulwa kwe-tube endotracheal kungase kube nzima ngaphansi kwezimo ezithile, non Izimo. Phakathi kwabo: nolimi enkulu, intamo esifushane, noma emhlathini, ukukhuluphala kakhulu ophumile amazinyo angaphambili, lokhu umlomo emincane kanye kuqhoqhoqho anomalies. Ephambi kwezinduna izici ezifana e isiguli, intubation kufanele kwenziwe ngokuqapha. Kulezi zimo, kubonelelwa kakhulu ama-ukwethulwa tube nasotracheal. Kufanele kube 1-2 usayizi ezincane.

Su intubation

intubation Orotracheal wenziwa ngendlela elandelayo:

1. Sibekezele ibekwe endaweni eqinile, Ufaka emuva ikhanda lakhe kancane futhi ibenze umhlathi ongezansi phambili. Ngenxa yalokho, i-amazinyo engenhla kukhona umgudu endizeni. Uma kungenzeka, ibekwe ngaphansi entanyeni roll.
2. Uma kudingeka, kuhlanzwe umlomo vomitus, amahlule udoti.
3. Faka ukudla laryngoscope (ngakwesokudla). Kubalulekile ukuba uthinte mucosa emlonyeni namazinyo.
4. Khona-ke, tube endotracheal sifakwe. Sidlule iyiphi indawo emlonyeni nasemphinjeni. Ezingeni yezwi, tube kufanele ngokucophelela ungenisa phakathi kwabo ngaphakathi komgodi we kuqhoqhoqho.
5. Laryngoscope iyasuswa.
6. Kufuthelwa a cuff zokuthola tube endotracheal.

intubation Nasotracheal wenziwa okuningi okufanayo. Umehluko kukhona isinqumo tube futhi yethula phakathi komgodi acinene. Kulokhu, lo laryngoscope alisetshenziswa.

Kanjani ukufeza ukupholisa yamaphaphu izingane?

Kukhona amacala lapho tracheal intubation kuyadingeka ukuze afeze izingane. Ngokuvamile, kuba nesidingo sokuba umbungu ezijulile sihoxisiwe. Futhi intubation kungase kudingeke esikhathini ezisanda kubelethwa uzingela ukukhubazeka umgudu wokuphefumula futhi senhliziyo. Kuzo zombili lezi zimo, edingekayo ukupholisa lokukhanda. Izimpawu I-intubation kule minyaka junior futhi senior ebuntwaneni ziyefana abadala. Phakathi kwabo kukhona: ukwehluleka oyingozi zokuphefumula, ikhoma, eqhuba ukubulawa kwezinzwa okuvamile.

Uyini izinga ka intubation ukujula?

Ukujula lapho kufanele ufake tube endotracheal, incike ubukhulu bawo isisindo ingane. Ukuze wenze lokhu, sebenzisa esikalini esikhethekile. Kuyinto kusebenza ababelethwa kungakafiki isikhathi nomntwana osanda kuzalwa. Nge Isisindo kg ingane 1 ukusebenzisa ubukhulu 2.5 endotracheal tube. Ukujula kwawo kukalwa kusukela ekuphathweni sezindebe futhi 6-7 cm. isisindo umzimba 2 kg esetshenziswa usayizi tube elilingana 3. ukujula umjovo kufanele kube hhayi ningi than 8 cm. Uma ingane ukala ephakathi kuka 2 no 4 kg sisetshenziswa usayizi imbobo № 3 5. Ukujula kulokhu kusukela 9 kuya ku-10 cm. Ukuze izinsana ezisanda, ogama zinesisindo kakhudlwana kunezinye 4 kg, usebenzisa ubukhulu tube 4. I of isingeniso ukujula - 11 cm.

Yini kungaba yezinkinga ngemva tracheal intubation?

Kufanele kukhunjulwe ukuthi ukwethulwa endotracheal tube inkinga eyingozi ezifana ukulimala ulwelwesi lwamafinyila we izitho zangaphakathi. Ngakho-ke, lokhu zokukhwabanisa kumele iqhutshwe uchwepheshe abanolwazi. Labagula, ngaphambi kokuqala intubation, izinzwa wenziwa. Yezinkinga ezivamile zihlanganisa: umonakalo emazinyweni le mucosa we pharynx, emphinjeni ngokufaka tube. Ukuze ugweme lokhu, kubalulekile ukuqapha ngokucophelela isimo lesiguli.

Ukufakwa ishubhu endotracheal: umbono uchwepheshe

Su intubation has zonke udokotela. Noma kunjalo, kungcono kakhulu ukwenza lokhu zokukhwabanisa intensivists nababulala izinzwa. Ngokusho kwabo, ngaphandle ukuqeqeshwa okukhethekile, futhi ukungabi khona izimo oyinyumba, akunakwenzeka tracheal intubation. Phela, ngenxa yezinkinga le nqubo ingase ibe engelapheki. Noma kunjalo, ukuhlinzeka usizo lokuqala ngenxa yezizathu zempilo ubophekile udokotela iyiphi okukhethekile.