Incazelo pneumothorax: izinhlobo izifo, izimbangela, ukuxilongwa kanye nokwelashwa

Ngo eziningi uchungechunge mayelana odokotela kanye abaseshi, kuvamile ukubona amagama, incazelo esho ezimbi noma bengaqondi neze. Ngokwesibonelo, pneumothorax. Kuyini lokhu sifo? Izimpawu, izimpawu ngawo eziphuthumayo abasebenzi ngakho ukunquma ngokunembile khona layo, inani aid, nezinye izici eziningi ndaba ekusithekeni. Kulesi sihloko uzothola izimpendulo azosiza eMpumalanga esimweni esibucayi.

definition

Pneumothorax - ukunqwabelana emoyeni noma ezinye igesi phakathi komgodi thoracic. Ngokuvamile kwenzeka ngemva kokulimala ngenxa evulekile ukwaphuka we izimbambo noma wamaphaphu ukulimala izwibela kwethambo, kanye ngenxa ukudabuka of wamaphaphu ithumba, kokuvula lezinkunzi noma encibilika ezindongeni umdlavuza bronchus. pneumothorax yesibili phambili a isikhathi eside isifo samaphaphu.

ukubonakaliswa Clinical izimpawu kuncike ngokuyinhloko ngokushesha kangakanani emoyeni igcwalisa ngalo ingaphakathi pleural. Ezimweni eziningi, ukuxilongwa kungenzeka sekuhloliwe isiguli endaweni yesehlakalo. Ngezinye izikhathi, izindlela ezengeziwe of luhlolo, ezifana-X-ray.

Ukwelashwa ngokuvamile kuhlinzwa. It kulingana ukususwa emoyeni kusukela ingaphakathi esifubeni amanzi noma umshini wokubhoboza, ukubuyisela umsebenzi zeNhlangano mediastinum bese ubuyela kubo ezihlalweni zabo.

Ukuxhumana imvelo yangaphandle

Ngesimo kunokwehluka eziningana pneumothorax. Izinhlobo zezifo zincike lapho ohlangothini imbobo kwakhiwa (ngaphandle noma ngaphakathi emzimbeni), kanye ubukhulu bawo izinga igesi inflow.

• pneumothorax Kuvaliwe kutholakala ukuthi uphethwe yini ezimweni lapho ingaphakathi pleural uwela lemali ezincane igesi imbobo, hhayi yokuxhumana imvelo yangaphandle. Ingcindezi ku ingaphakathi esifubeni luyanda kancane, futhi isici ivaliwe ngokwalo, ngaphandle uthole usizo olwengeziwe. Air Bubbles kancane chaza phakathi amaphepha pleura, wamaphaphu usunawo salo esivamile.
• Vula pneumothorax kukhulisa uma ifinyelela inhliziyo amanxeba odongeni besifuba noma ukudabuka we bronchus ezinkulu. Njalo baxhumana imvelo bangaphandle. Ngenxa yalesi ingcindezi ongathandeki ingaphakathi yangaphakathi ahambisana umzimba asemkhathini kuyiphi ukukhanya ehlala, futhi emoyeni akusho iyangena-ke.

• Ezicindezelayo noma pneumothorax umphini luvela kuphela lapho uhlelo ezihambisana ukuhlukumezeka (nilimaza esifubeni odongeni pleura umonakalo ukudabuka kakhulu ze- bronchi esikhulu), libhekene ngalolo emoyeni ingena ngaphakathi komgodi umzimba ku ephefumula, kodwa engashiyi exhale wakhe. Ingcindezi ku ingaphakathi pleural iqale eqhathaniswa emkhathini futhi luqhubeka lukhula. Ngenxa yalokho kwezitho mediastinal nazo ezilahlekelwe futhi onomfutho.

pathogenesis

Ukuze kusizwe kahle, kubalulekile ukwazi kwakhiwa kanjani pneumothorax is, izinhlobo zalo. Physiology yale nqubo itholakala lokuthi ukuthi evamile ingaphakathi pleural ngaphakathi ingcindezi ezimbi. Lokhu kusiza ukugcina emaphashini esimweni enwetshiwe, kanye isheshisa exchange yamagesi ku-alveoli. Lapho yobunzima esifubeni okuphukile emoyeni iqala ukugcwalisa ngaphakathi komgodi pleural, emaphashini ukwehla ivolumu.

It kuphazamise umoya evamile, futhi ngenxa yalokho umuntu uqala ukuba kuminyanise. Ngaphezu kwalokho, umoya licindezele futhi displaces izitho mediastinal: inhliziyo, aorta, emphinjeni, okwenza kube nzima ukuba bafeze imisebenzi yabo oqondile.

omsakazo

Kusukela ejenti okubuhlungu ngayo kuxhomeke kulokho kuyoba pneumothorax. Omsakazo, izinhlobo, pathogenesis, ukubonakaliswa emitholampilo zokwelapha i chain inextricable okunengqondo lolwazi kungasindisa ukuphila, ngisho noma ungenayo ukwenzani nabezokwelapha.

1. pneumothorax okuzenzekelayo igebe bronchus ezinkulu noma wamaphaphu parenchyma ongakaphathelani ukulimala mechanical esifubeni. It is zihlukaniswe ngamaqembu amabili amakhulu:

• Okuxhunyanwa, noma idiopathic, kukhona kwesizathu. Kwande izinsizwa ubude kuka e nabesifazane asebeneminyaka efanele yobudala efanayo futhi Yakha. Lokhu zingachazwa ngezinqubo izici ezilandelayo: izinguquko sokugembula kule wamaphaphu ngenxa isici zofuzo Kuhlanganisa enzyme-alpha-1-antitrypsin, okuyinto ehilelekile ukusebenza evamile alveoli; pleura kakhulu mncane, okungase uyeke azinakwa ingcindezi iconsi, ezifana ukhwehlela noma sneezing; okungazelelwe ingcindezi iconsi lapho ukugibela intaba (entabeni ukugula) noma zifakwa ngaphansi kwamanzi (isifo caisson).
• kwakhiwa pneumothorax yesibili ku isizinda isifo osuvele wamaphaphu ezifana COPD (ezingamahlalakhona obstructive isifo samaphaphu), cystic fibrosis futhi somoya.

2. ezivamile amacala pneumothorax esibuhlungu. Zokulimala zingena ngaphansi kwezigaba ezimbili: eyenza umuntu acabange eseZwini ukulimala we umgodi esifubeni (lisikiwe, izilonda oqoshiwe, waphuka evulekile izimbambo); lizha esifubeni ukuhlukumezeka (avtotravmy, ebhidliza phakathi izinto umile uphonsa).

3. Ngesikhathi izinqubo zokwelapha futhi musa ngakususi ukubukeka pneumothorax. Ezimweni ezinjalo, ibizwa ngokuthi iatrogenic. Izingozi zihlanganisa pleura noma wamaphaphu biopsy, zokuxilonga wokubhoboza okuqukethwe abscesses futhi izinhlumba, okuzobe kudlalelwa ipayipi subclavian futhi barotrauma kusukela ALV (yokufakelwa wamaphaphu ukupholisa).

umtholampilo

Ngemva kokubuza neluhlolo isiguli udokotela uyazinaka kungazelelwe ubuhlungu besifuba, iphika, ukuphefumula okusheshayo nokushaya kwenhliziyo, isifuba esomile. Acute uvalo ukuhlaselwa ingase futhi kube umphumela pneumothorax. Zokulimala kanye nesimo ukulimala, ngezinye izikhathi ngisho zibukeke selitholakala, kuzosiza ukuphothula Ihlahlubo ukuqondisa isiguli ekwelashweni. Lokhu kungaba umnyango kuhlinzwa noma zokwelapha esibhedlela noma eziphuthumayo. Konke kuncike kobukhulu isimo kanye umonakalo ethize.

ukuhlola

Njengoba ngishilo ngenhla, njengokuba nazi indlela, eye yabizwa abanye ngokuthi i pneumothorax, izinhlobo kanye umehluko. Imiphumela yaloku kuhlola okungenhla akunzima. Kuyinto anele okuthwala kokuxilongwa sangaphandle esifubeni wamaphaphu auscultation izigaba ziyalingana (ukuba kuqhathaniswa engxenyeni enempilo isiguli). Uma ukuthola umonakalo abakwazi ke ukuze siqiniseke ngokuphelele ukuthi ufuna ukuthumela isiguli X-ray noma ama-CT scan. Umoya akubonisi emisebeni enemisebe, ngakho kuzobonakala ngokucacile esithombeni.

Njengoba indlela ezengeziwe ungasebenzisa kwencazelo igesi igazi (ukuze anqume ukuthi bukhona yini shift okukhulu bebheke hypercapnia), electrocardiography (ukuvimbela yezinkinga ezifana ukuhluleka kwenhliziyo), kanye iphendukele kokubonisana kuhlinzwa (lokhu ngokuvamile kwenziwa at the stage of luhlolo lesiguli egumbini lezimo eziphuthumayo umnyango).

eziphuthumayo

Naphezu izinhlobo ezahlukene pneumothorax, usizo lokuqala kuyehla ukubiza i-ambulensi. Njengoba umuntu ongaqeqeshiwe ukubhekana ukulimala okungaphakathi, akunakwenzeka ukuba ke udinga isipiliyoni kanye nokwethuka ohlinzayo. Into kuphela ukuthi kungenziwa esimweni i okufana evulekile zesifo - kuyinto ukuphoqelela uphawu ngebhandeshi obukhulu ku isilonda. Ungasebenzisa oilcloth, plastic ukugoqa noma obukhulu ukotini gauze. Lezi manipulations kuzosiza ukwakha pneumothorax avaliwe.

Lesitshalo esiphuthumayo usizo zangaphambi yezokwelapha futhi uphethwe aphansi yalesi sifo kufanele zifakwe okungaphansi kwenkululeko ulwazi noma yimuphi umuntu, abafundi ngonyaka odlule (ukuzivikela civil). Wabe uzokwazi ngokwanele ukuhlola isimo futhi enze isinqumo esifanele.

ukwelashwa

Into yokuqala ukwazi kahle ukuthi uhlobo pneumothorax e isiguli. Uma inani emoyeni phakathi amashidi pleural kancane, usizo oluthile kungenzeka kudingeke. Kancane kancane ukuxazulula. Esimweni lapho inani igesi ngokuvamile kuvimbela lula ukuvula, kumele aspirated nge isipetu ngu puncturing ngalo ingaphakathi pleural. Lokhu kuzosiza ukuba ngokushesha ukuqeda pneumothorax. Izinhlobo (ukunakekelwa okuphuthumayo kuncike kule) izifo ibalulekile, ngenxa yokuthi adinga indlela ehlukile. A isamba esikhulu umonakalo kungadinga ukufakwa eyodwa emaceleni amanzi Byulau.

Ngaphezu kwalokho, lapho ukulimala okukhulu ezidinga ukuhlinzwa kokungenela i kuvalwe parenchyma wamaphaphu, pleura kanye zamehlo bronchial, kanye nokuvalwa eyenza umuntu acabange eseZwini amanxeba kwesifuba.

Njengoba ukwelashwa lingaze Kunconywa imithi yokubulala izinzwa kanye nowe-oxygen ephefumula. Uma pneumothorax iziqephu aphindaphindwe kaningi ngokwanele, isiguli singase wazi ukukhiqiza pleurodesis - pleura nokunamathisela ngomthofu ndawonye.

Izinkinga kanye Izibikezelo

Kanye emva yisiphi isifo, kukhona njalo imiphumela yokuhlaselwa pneumothorax. Amafomu ngakho kulesi simo ukudlala indima ezincane. Ngo nendawo ephambili phakathi nezinkinga kuwufanele ukopha noma hemothorax. Ngemva kwakhe ixazululwe pleurisy (ukuvuvukala sezicubu zezinzwa futhi kumiswa ukuvuvukala phakathi pleura) kanye ne-emphysema ongama (emoyeni ngokufaka izicubu ngaphansi kwesikhumba). isiguli angase afe endaweni enkulu yokulimala nosizo imisiwe.

zokuvimbela

Ukuze uvimbele ukuthuthukiswa pneumothorax, kwanele ukugcina izimiso ezimbalwa ezilula:

• Isikhathi esijwayelekile futhi aphathe ngokugcwele umgudu wokuphefumula futhi kuvimbele yezinkinga zayo, okuholela kwetinhlavu amaphuzu ezibuthakathaka wamaphaphu pleura.
• Dedela imikhuba emibi, ikakhulukazi - ubhema.
• Zama ukugwema uhlukunyezwe esifubeni.
• Thatha izinyathelo zokugwema kabusha pneumothorax.