Umgogodla futhi epidural (epidural) izinzwa - yini umehluko? Ukusetshenziswa, Izimo, ukuxakeka kungenzeka

I ucwaningo kuqala ku ukubulawa kwezinzwa umgogodla, eyaqala 1898, kodwa kwandile, le ndlela yokubulala izinzwa lithole kamuva kakhulu. Ukuze usebenzise le ndlela, udokotela kufanele selimazi anatomy of emgogodleni ulwelwesi lwalo.

izinzwa Epidural spinal

Lezi zindlela izinzwa kukhona lesifunda. Phakathi eliyifa yabo izinzwa is injected endaweni ekhethekile etholakala eduze emgogodleni. Ngenxa yaleli 'eqandisiwe "engxenyeni engezansi yomzimba. Abaningi abazi ukuthi kukhona umehluko phakathi izinzwa umgogodla futhi epidural.

Inqubo nokulungiselela ukufezeka izinzwa yalezi zindlela ezifanayo. Ngempela, umuntu ezimweni zombili, is sadutshulwa emhlane. Umehluko oyinhloko ukuthi umgogodla izinzwa ngomjovo iyunithi ayekhuluma ngalo, futhi epidural (peridural) - ukufakwa ngamapayipi ekhethekile mncane lapho izinzwa iqondiswa phakathi nenkathi ethile yesikhathi.

Kodwa le ndlela - akusiwona ukuphela komehluko owawukhona ngalezi zindlela ezimbili ukukhululeka ubuhlungu. izinzwa Spinal isetshenziswa ezimweni lapho kuyadingeka ukufeza umphumela wangaleso sikhathi. Kuye uhlobo izidakamizwa ubude analgesia zingaba phakathi 1 kuya 4 amahora. izinzwa Epidural akunqunywa isikhathi. Anesthesia uzoqhubeka nje ukukhwezwa ngokusebenzisa ipayipi emzimbeni uzobe ebulala izinzwa ukudla. Ngokuvamile le ndlela isetshenziswa ukuhlukana isiguli yobuhlungu phakathi nokuhlinzwa hhayi kuphela, kodwa futhi esikhathini postoperative.

Umgomo we operation

izinzwa Epidural futhi epidural - a izinzwa lesifunda, lapho imithi injected isikhala epidural sokukhubazeka komgogodla. yokusebenza isimiso sayo sisekelwe ukuthi izidakamizwa esetshenziswa ngokusebenzisa dural emikhonweni iwela isikhala subarachnoid. Ngenxa yalokho, i-pulses abadlula nezinzwa radicular emgogodleni avimbelwe.

Ngemva izidakamizwa iqondiswa iseduze amangqamuzana ezinzwa e-isiqu. Futhi bazi ukuthi banesibophezelo ukubukeka ubuhlungu ezingxenyeni ezihlukahlukene zomzimba futhi ebenza ubuchopho.

Kuye indawo ekuphathweni ingakhubaza motor umsebenzi nokuzwela ezindaweni ezithile emzimbeni. Ngokuvamile, izinzwa epidural isetshenziswa "ukucisha" engxenyeni engezansi yomzimba. Ukuze wenze lokhu, kufanele ufake i-izinzwa esikhaleni intervertebral phakathi T10-T11. Ukuze izinzwa esifundeni thorax zomuthi is busuka esifundeni phakathi T2 futhi i-T3, uhhafu ongenhla esiswini kungaba anesthetize nini bafake T7-T8 vertebra ndawo. Le ndawo kwezitho okhalo, "kuvaliwe" emva kusungulwa izinzwa endaweni phakathi L1-L4, izitho ephansi - L3-L4.

Izinkomba ngoba ukubulawa kwezinzwa lesifunda

izinzwa Epidural spinal lungasetshenziswa ngokwehlukana futhi lihambisana jikelele. Inketho yokugcina isetshenziswa ezimweni lapho ukuhlinzwa ukuziphatha thoracic sihlelelwe (esifubeni) noma eside ukungenelela kuhlinzwa endaweni esiswini. inhlanganisela yabo futhi imithi ebulala izinzwa ukunciphisa isidingo sokuba iziguli opioids.

Endaweni ehlukile, kungenzeka izinzwa epidural esetshenziswa kulezi zimo:

- ukukhululeka ubuhlungu emva kokuhlinzwa;

- izinzwa wendawo ngesikhathi sokubeletha;

- isidingo lokufeza imisebenzi phezu kwezinyawo kanye nezinye izingxenye nengxenye engezansi yomzimba;

- Ukubeletha.

Kwezinye izimo, sebenzisa kuphela i epidural. Isetshenziselwa, uma kudingekile, afeze imisebenzi:

- e ukhalo, senyonga, iqakala, ezinkulu tibia ;

- esikhundleni hip noma kwamajoyinti;

- ukwa entanyeni femoral ;

- umbhunu.

izinzwa Spinal ingasetshenziswa njengendlela indlela yokwelashwa yobuhlungu beqolo. Ngokuvamile kwenziwa ngemva kokuhlinzwa. Futhi-ke isetshenziswa ukuhlinzwa semithambo kulezo zimo lapho kudingeka ukuba sifeze ukungenela wemikhawulo aphansi.

impumuzo umsiko

abesifazane abaningi usebenzisa izinzwa epidural noma umgogodla, ukuze ngingasebenzisi ukuzizwa Kufinyeta ezibuhlungu. Lapho iqondiswa ubuhlungu izinzwa zinyamalale, kodwa ukwazi agcinwe ngokuphelele.

izinzwa Epidural ngesikhathi sokubeletha livame ukusetshenziswa emazweni asethuthukile. Ngokwezibalo, isetshenziswa cishe u-70% abesifazane kokubeletha. Lolu hlobo lwe-izinzwa ikuvumela anesthetize yonke inqubo bokubeletha. Kulokhu, i-fetus ayiphazamiseki.

Naphezu kweqiniso lokuthi nokubeletha kuyinqubo engokwemvelo bokuphila, okuyinto akudingi kokungenela ngaphandle, abesifazane ngokuya bagcizelele ukuthi babezindla izinzwa. Nakuba ngesikhathi sokuzalwa, umzimba ukhiqiza umthamo loading endorphins. Bakhuthaza ukukhululeka ubuhlungu zemvelo, ngoba la ma-hormone bayakwazi ukunikeza lift ngokomzwelo, ukucindezela babenakho ukwesaba ubuhlungu.

Nokho, lo mshini ukukhiqizwa endorphins kuncike isimo kanye nemizwelo abesifazane. Ngokwesibonelo, nomshikashika nokunwetshiwe uhlala esezinhlungwini ezinzima abe nomthelela omubi kokubili wona kanye obelethayo, futhi somntwana ongakazalwa. Ngaphezu kwalokho, owesifazane kungandisa ingcindezi ukuqala ukuwohloka, kubangele ukuphazamiseka imisipha eyinhloko - inhliziyo. Ezimweni ezinjalo, izinzwa kuyadingeka.

Kodwa epidurals kungaba kwenziwe kuphela ngendlela kuhlelwe. Izimo ngilifeze akukhona okungavamile ukuba likhithike. Kodwa ezimweni ezibucayi ungayisebenzisi okwamanje ngoba umphumela wawo ingabe kungenzeki ngokusheshayo. Kusukela ekuqaleni isingeniso imithi yokubulala izinzwa kanye ukuqedela ukukhululeka ubuhlungu kungathatha isigamu sehora.

ukuqeqeshwa umehluko wemisindo nemiqondo yamagama

Uma kungenzeka, lesiguli pre-olungiselelwe ukuziphatha ngokusungula indlela yokubulala izinzwa. Uma uhlela epidural (peridural), izinzwa emgogodleni, isiguli kunikezwa kusihlwa ukuba 0.15 g kusho "Phenobarbital". Uma kunesidingo, angabelwa kanye imijovo. Ngokuvamile, odokotela basebenzisa izidakamizwa "Diazepam" noma "hlozepida". Futhi, endaweni ethile ngehora ngaphambi izinzwa ekuphathweni esicutshini umjovo kusho ubonisa "Diazepam" noma "Promethazine" futhi enganika "morphine" futhi "atropine" noma "Fentalin".

Futhi, isinyathelo saziso iwukulungiselela nokupakisha oyinyumba. Kudinga napkin (kokubili ezinkulu nezincane), amagilavu oyinyumba iraba, gauze amabhola, izinaliti, imijovo, catheters, futhi udlawana ezimbili ezimbili izibuko amakhambi imithi ebulala izinzwa. Kubalulekile futhi ukulungisa konke okudingekile ukuze akwazi ukuqeda yezinkinga kungenzeka. Nale izinzwa akakwazi ukukhipha amathuba ukuphazamiseka okukhulu kwegazi supply system kanye ukuphefumula.

uzilungiselele Ngaphambili 2 imijovo, omunye okufanele kube ivolumu 5 ml, kanti eyesibili - 10 ml. Futhi, abasebenzi bezokwelapha silungiselela inaliti e isamba 4 nama-PC., 2 zazo ziyadingeka izinzwa kwendawo isikhumba lapho umjovo main zizokwenziwa. Esinye isidingo ukuze ufake futhi bachitha ipayipi izinzwa, kanti owokugcina uyoba ngo - ngokuthatha imithi ubuhlungu isipetu.

ukuphathwa izinzwa

izinzwa umgogodla futhi epidural kwenza isiguli ohlezi noma ngohlangothi yayo. Njengomthetho, isikhundla lokugcina lisetshenziswa izikhathi eziningi kakhulu. Kulokhu, isiguli kufanele kwenzeke ukuze agobe emuva yakho, qinisa nethanga esiswini ikhanda ecindezelwe esifubeni.

Isikhumba endaweni Umjovo icutshungulwe ngokucophelela kanye nolwelwe amathawula oyinyumba. Lokhu kwenziwa ngendlela efanayo njengoba phambi kuthengiselana. Ngesikhathi yesigameko wokubhoboza buhambe isikhumba indikindiki. Ngaphezu kwalokho, ukuba lula inaliti ngesikhumba Kunconywa ukuba enze wokubhoboza nommese encane emincane.

Ochwepheshe ukukhomba izindlela ezimbili kungenziwa kanjani afinyelelwe ukuba isikhala umgogodla epidural: imidiyeni futhi paramedian. Lapho kuqala inaliti sifakwe igebe phakathi Osistem izinqubo. Ngemva edabula isikhumba namafutha, kube luhlala nadostistuyu kuqala, bese ku umsipha interspinous. Ezigulini esezikhulile, zingaba amathuluzi zakaltsinirovany ukuthi kakhulu inkimbinkimbi the kufakwe inaliti.

indlela Lateral noma paramedian inikeza ukuthi umjovo kwenziwa esifundeni umngcele, elise phakathi amathambo. Isilawuli Samandla kwenziwa kusukela iphuzu 1.5 noma 2 cm kusukela izinqubo spinous. Kodwa le ndlela isetshenziswa lapho isiteshi ingeqi imidiyeni wokubhoboza indlela. Kunconywa in iziguli ukukhuluphala kanye nemisipha sclerotic.

Izici "epiduralki"

Ngaphambi imisebenzi ehleliwe, iziguli ezinemishini izinzwa zokunquma ukuthi waba ini ingasetshenziswa uhlobo izinzwa ngeke. Kodwa iziguli eziningi abafuni ukuba baqonde lokho okufundiswa epidural futhi izinzwa epidural. Uyini umehluko phakathi kwalezi ndlela ezimbili ungatholi ukuthola. Ngempela, lawa amagama amabili indlela efanayo izinzwa, lapho izinzwa ihlinzekwa e ngomzimba ipayipi kancane kancane.

Udokotela kufanele wazi ezicashile wokubhoboza. Ngokwesibonelo, i-inaliti epidural has ukudabula kweqembu ophuzi. Ngenxa yale njongo, lo mandrel kuyinto ekhishiwe kanye isipetu unamathele, lapho chloride sodium siphela, ukuze ushiye i bubble air. Njengoba nje inaliti ingena lenqwaba, bubble air zizovela waklinywa. Kodwa wahlala waqonda ngokushesha nje ichopho iza esifundeni epidural.

Futhi, obulala izinzwa akumelwe bayakhohlwa ngezinye izindlela ukuhlola ukuthi inalidi ibekwe ngendlela efanele. Kulungile, wabonisa ukungabi cerebrospinal fluid e inaliti ngemva kokuba liqinisekiswe cross-stylet. Futhi elibukhali ukuqinisekisa ukuthi inani elincane nosawoti kwalethela hhayi ageleze emuva ngokusebenzisa inaliti emva isipetu inqanyuliwe. Kodwa lokhu akulona uhlu oluphelele nezindlela zokuhlola. Udokotela kufanele afeze ukuxilongwa oluphelele ukuqinisekisa nokubekwa efanele yenaliti.

izinzwa Epidural kuhilela isidingo ukusebenzisa ipayipi. yethula, njengoba umthetho, akusho ukwethula noma ibuphi ubunzima. Uma esiphambanweni-ezifanayo futhi ukuqinisekiswa eziphambili yayo ngokusebenzisa inalithi isikhala epidural. Ngemva kwalokho, inaliti kancane kususwe, kanye ipayipi omiswe ukuvala ophumayo indawo yayo amagciwane usimende noma ngebhandeshi oyinyumba.

izidakamizwa ezisetshenziswa

Ukunciphisa yezinkinga kungenzeka ngokusungula indlela yokubulala izinzwa epidural, kubalulekile ukukhetha umthamo efanele izinzwa nangokucikoza sifeze inqubo ngokwalo we wokubhoboza. Ukuze siqhube izinzwa ukuhlanzwa izinzwa izixazululo okuyinto zingenalo nezivimbelakuvunda.

Kwezinye izimo, indlela "lidocaine" isetshenziselwa izinzwa epidural. Kodwa futhi lisetshenziswa izidakamizwa ezifana "Ropivacaine", "Bupivacaine". Ngaphansi kokuqondisa udokotela abaqeqeshiwe futhi abanolwazi lapho kuboniswe kubo kungaba ukungezwa izidakamizwa okuqondene opiates. Kungaba imithi efana "Morphine", "Promedol". Kodwa umthamo lezi zimali incane. Ngeke ngisho ongaqhathaniswa esetshenziswe ngesikhathi ukubulawa kwezinzwa okuvamile.

Ngokwethulwa izinzwa endaweni epidural zokugcina sizibeke bacondze etindzaweni letehlukene. Sidlule liye phezulu, phansi futhi paravertebral izicubu intervertebral ngokusebenzisa ohlangothini ukuvuleka. Ngakho, wokuqonda yini okufanele lokuhlushwa "dicain" I-izinzwa epidural, kumelwe kukhunjulwe ukuthi analgesia zone kuzoncika inani isixazululo, ukushuba abaphathi kanye umthamo. Ngaphandle isihloko, ingaphinda isetshenziswe kusho "Lidocaine", "Trimekain", "marcaine". Ukuze uthole analgesia ephelele zingasebenzisa mayelana 25-30 ml wathi isixazululo imithi ebulala izinzwa. Kodwa leli nani ubhekwa esiphezulu.

imikhawulo ezidingekayo

Naphezu kweqiniso lokuthi omunye ephephile kubhekwe izinzwa epidural Izimo usalokhu khona. Lezi zihlanganisa:

- spondylitis tuberculous;

- pustules ngemuva;

- ukushaqeka kuhlasimulise;

- CNS organic;

- eziyinkimbinkimbi deformity umgogodla, ke izifo kanye umonakalo sokugembula;

- ileus;

- nciphisa senhliziyo futhi lokhu kwaphumela ekwaziweni peritonitis;

- isimo jikelele ithuna esigulini;

- decompensation wenhliziyo;

- Wezingane ubudala;

- anda kuvelana izingxenye izinzwa;

- Ukuwohloka emzimbeni.

izinkinga ezingase zibe khona

Kodwa ungakhohlwa ukuthi ngaso sonke isikhathi ngaphandle kobuhlungu futhi ngaphandle umphumela sihamba epidural. Izimo, nezinkinga ezingase kwenzeke, kubalulekile ukuthola ngaphambi kokuyolala etafuleni yokusebenza.

Kufanele kuqondwe ukuthi inqubo kokwenza enjalo izinzwa eziyinkimbinkimbi, ngakho ikhwalifikheshini udokotela kubalulekile. I esiyingozi kakhulu kuyinto ukuvela ukuwohloka ngokujulile ngemva kokubulawa izinzwa emgogodleni noma epidural. Ezimweni eziningi, lokhu isimo kwenzeka uma ezilimele Dura Mater. Ngenxa yalokhu ukuvinjelwa kwe-innervation nozwela kwenzeka, ngenxa yalokho, encishisiwe ithoni semithambo athuthukile hypotension ezinzima. Nokho, kulesi simo ingaqala, futhi uma yenziwe kahle, izinzwa lapho zaphathwa ingxenye enkulu ukubulawa izinzwa, sithembele anhlobonhlobo ubuhlungu ukuphathwa.

Kodwa izinkinga ingaqala esikhathini postoperative. Lezi zihlanganisa:

- ekuqaleni suppurative ukuvuvukala e emseleni we nomgogodla (isizathu ngokuvamile iba imithetho antiseptics ukwephulwa);

- ubuhlungu bekhanda futhi kukhathaze ngayo kule ndawo emuva;

- paresis wemikhawulo aphansi, izitho kwezitho zangasese (angagcina ngenxa umonakalo umgogodla intambo izimpande inaliti).

Uma iziguli izinzwa nge "Morphine" ke ukuba babe ukubukela eduze kakhudlwana. Ngezinye izikhathi kuholela ukucindezeleka zokuphefumula enjalo izinzwa epidural. Izimo ukusetshenziswa le ndlela yedwa aziqabukeli. Kodwa khumbula ukuthi ingozi yokucindezeleka emishinini yokuphefumula kwanda okwandisa umthamo morphine.

Izici ngokusungula indlela yokubulala izinzwa emgogodleni

Naphezu ukufana, kunomehluko obalulekile phakathi epidural futhi izinzwa emgogodleni. Ngokwesibonelo, ukuma kokungathathi-inaliti emva wokubhoboza ophuzi umsipha akubalulekile kangako. Njengoba nje inaliti udabula Mater laseDura, udokotela azizwa yizehluleki inaliti. I ipayipi kulolu hlobo izinzwa ayifakiwe.

Ngo ukuqaliswa kwe-wokubhoboza Kumele kucinisekiswe kutsi inaliti usephendukele engekude kakhulu futhi akusho ubuhlungu izimpande emgogodleni. Zifakazela iqiniso lokuthi ithiphu kakade emananini esikhaleni subarachnoid, kungenzeka, uma ukhipha stylet. Ngakho kusukela siqala inaliti labelwe cerebrospinal fluid. Uma kuziwa ngezikhathi noma izinto eziningi enganele, kubalulekile ukuba kancane ukushintsha isikhundla sawo ngokuhlola ngokushintshana. Ngemva efanele ukufakwa izinaliti uqale ukwethula anelgiziruyuschih izindlela. Isikali yabo ingaphansi kuka- i epidural.