Matenda otchedwa tracheal stenosis ndi ochepa kwambiri, kapena mphepo yamkuntho, chifukwa chopanga minofu yambiri kapena malformation a cartilage mu trachea. Ngakhale kuti kuchepa kwanu kosavuta kungakhale kosazindikirika, kuponderezedwa kwakukulu kwaposa 50 peresenti ya ulendo wanu kungabweretse mavuto aakulu. Zomwe zimayambitsa katatu za tracheal stenosis ndi izi:
- Kuikapo kwa nthawi yaitali kwa pulogalamu yotchedwa endotracheal tube (breathing tube) kapena tracheostomy
- Matenda opweteka
- Collagen matenda aakulu (granulomatosis ndi polyangitis, amadziwika kuti Wegener granulomatosis)
Zina zomwe zimayambitsa zimaphatikizapo:
- Ziphuphu zobadwa mwadzidzidzi (vuto lobadwa)
- Zovuta
- Kutsekemera kumawotcha
- Kuchiza ma ARV
- Matenda a trachea
- Matenda otupa (sarcoidosis kapena amyloidosis)
- Khansa
Pokhala ndi khansa ndi matenda osokoneza bongo, mlengalenga ikuphatikizidwa mwina kuchokera kunja kwa trachea, kapena kuchoka ku kanyumba kowopsya. Zina mwa zifukwa za tracheal stenosis zimayamba ndi zilonda mu trachea. Chilonda chimayambitsa kutupa , komwe kumakhala kochiritsira, komwe kungapangidwe kwambiri komanso kumayambitsa minofu yambiri kusiyana ndi yomwe imafunikira. Zowonjezera zazing'ono izi zimapanganso malo anu.
Chikoka cha Tracheal Stenosis
Kawirikawiri kupeza chifuwa cha stenosis kumadalira chifukwa cha tracheal narrowing.
Kuwonongeka kwa posachedwa kwa mlengalenga kungakhale kofala, komabe chiopsezo cha matenda osokoneza bongo amakhala osachepera 2 peresenti. Zizindikiro zotsatirazi zidzakuthandizani kuti mukhale ndi vuto loti mukhale ndi chidziwitso kapena tracheostomy related tracheal stenosis:
- Mkazi
- Kunenepa kwambiri
- Matenda a shuga
- Kuthamanga kwa magazi
- Matenda a mtima
Kutumiza tsamba kapena post-tracheostomy ngozi ingachepetse ngati zotsatirazi zikuchitika mu ICU:
- Kukhala ndi mapulogalamu osokoneza bongo kapena tracheostomy akukhala pakati pa 20 mpaka 30 cm ya madzi
- Kupewa matenda pogwiritsira ntchito bwino mankhwala ochitidwa pakamwa pochitidwa moyenera pofuna kuteteza matenda kapena kutsegula maulendo a mumtsinje
- Malo ogwiritsira ntchito zipangizo zopuma kupuma pakamwa kuti athetse mphamvu
- Kusunga kapweya wokwanira wa chubu
- Kupewa zovuta ndi mapiritsi opuma panthawi yoikapo ndikupewa kutuluka mwangozi ngati muli ndi ulendo wovuta.
Tracheal stenosis ikhoza kukhala chimodzi mwa zizindikiro zoyambirira zomwe zimapezeka mu granulomatosis ndi polyangitis. Stenosis ikhoza kufika pafupifupi 16 mpaka 23 peresenti ya nthawiyo. Palibenso deta yambiri yomwe imapezeka pazifukwa zina za tracheal stenosis.
Zizindikiro za Tracheal Stenosis
Mu tracheal stenosis, mimba yofatsa imatanthauzira molakwika monga mphumu kapena khwangwala. Ngati muli ndi stenosis yochepa, simungadziwe zizindikiro mpaka mutangoyamba kumene kapena mukangoyamba kumene pamene zizindikiro zikuwoneka ngati kupuma kovuta ndi kuchita masewera olimbitsa thupi. Pa milandu yowopsa kwambiri yobadwa ndi matenda a stenosis, mukhoza kuona zizindikiro zotsatirazi:
- Stridor (kumveka kupuma kupuma)
- Zosakanikirana, ndi milomo yonyezimira
- Gwirani ndi inhalation
- Kupuma pang'ono (dyspnea)
Nthawi zina amatha kupeza mankhwala otchedwa tracheal stenosis, zizindikiro sizingakhalepo kwa milungu ingapo chivundi chikuchitika. Kuvuta ndi kupuma ndiko chizindikiro choyamba choyamba. Monga congenital tracheal stenosis, mukhoza kuona mphepo, kupuma, kapena kupuma pang'ono.
Kuzindikira kwa Tracheal Stenosis
Njira zingapo zoyesera zingagwiritsidwe ntchito kuthandiza dokotala kudziwa ngati muli ndi tracheal stenosis kapena ayi. Bronchoscopy imaonedwa kuti ndi "Gold Standard" kuti mupeze matenda opatsirana pogonana chifukwa dokotala wanu adzatha kuona bwinobwino momwe mumayendera.
Komabe, pali ngozi zina zomwe zimagwirizanitsidwa ndi izi chifukwa kugwiritsa ntchito chiwerengero chanu chidzakulepheretsani kuyenda, choncho kusunga mpweya wanu kumakhala kovuta kwambiri. Kambiranani zazifukwa zanu zomwe zimayambitsa matenda a bronchoscopy ndi dokotala wanu.
Njira zina zomwe dokotala angagwiritse ntchito zikuphatikizapo x-ray, CT scan, ultrasound, MRI, ndi pulmonary ntchito. Ma x-rays abwino amadziwika popangidwe kachitidwe, mizati ya mpweya, zoopsa, ndi zina zoyambirira. Makina ena owonjezera a X-ray akhoza kugwiritsidwa ntchito (zojambula zithunzi) kuti adziwe kuti stenosis ndi yotani, komabe kuwala kwa dzuwa kumakhala kosavuta kuposa njira zina.
Kuyeza kwa CT kungakhale njira yabwino kwa dokotala wanu kudziwa ngati muli ndi tracheal stenosis kapena ayi. Komabe, zimakhala zovuta kufotokozera zida zofewa zomwe zimayambitsa kusakaniza kwanu. Njira zina zikugwiritsidwa ntchito poyambitsa "endoscopy" kuti achepetse kufunika kokhala ndi bronchoscopy. Komabe, kuyesa kwa CT si njira yabwino yodziwira mlingo wochepa wa stenosis.
Ultrasound ingakhale yothandiza pozindikira kuchuluka kwa malo a mpweya mu trachea. Izi zimapangitsa dokotala wanu kudziwa ngati kuyesa kapena kuyeza kulibe kofunikira, komabe, chifukwa cha kuchuluka kwa karoti pamtundawu, kulondola kwa mayesero kungayambidwe chifukwa cha mthunzi wa zotsatira zomwe zimayambitsidwa ndi kuyang'ana mafunde a phokoso. Siyani mayeso okha kwa anthu omwe ali ndi luso lodziwika kuti tracheal stenosis ndi ultrasound.
Kuyeza kwa MRI ndi njira yowonjezereka yothandizira kupeza matenda a tracheal stenosis, ndipo kwa ana akuyesa kukhala njira yovomerezeka. Chotsatira chachikulu cha MRI ndi nthawi yomwe muyenera kuchitapo kuti mugwiritse ntchito ndi kusinthasintha kumene kungatheke kupuma mukamapenda. Njira zowonjezereka zikupangidwira patsogolo kuti zitheke kugwiritsa ntchito njirayi pozindikira kuti matendawa ndi otsekemera.
Kuyesera koyendetsa ntchito kumayendetsedwa m'maofesi ena a udokotala, kapena ngati simukupezeka, mudzatumizidwa ku labu la pulmonary. Mayesowa angagwiritsidwe ntchito pofuna kudziwa momwe mphamvu ya stenosis imakhudzira kupuma kwanu. Izi zidzakuthandizira pa zokambirana zokhudzana ndi chithandizo ndi dokotala wanu.
Kuchiza kwa Tracheal Stenosis
Pali njira zingapo zomwe mungapangire pochiza matenda a stenosis ndipo dokotala wanu adzakambirana zomwe mungachite kuti zisamakhale zovuta kwambiri ndipo mutha kukhala ndi zotsatira zabwino zomwe mungasamalire nokha. Mankhwala ambiri ndi oposcopic njira zomwe zimafuna kuwonetseratu kwenikweni za trachea yanu. Ngati malo a stenosis ndi ochepa, kuika mphuno, kutsegula trachea yanu ndi buluni, kapena kuchotsa minofu yambiri ndi laser kudzakuthandizani kuchepetsa stenosis. Pakati pa njirazi, dokotala wanu akhoza kupiritsanso minofu yanuyo ndi steroids kuti athe kuchepetsa kutupa kulikonse.
Ngati mukudwala kwambiri matenda a stenosis, dokotala wanu angakulimbikitseni tracheal resection, yomwe imafuna opaleshoni. Ndondomekoyi imasungidwa ngati mankhwala osokoneza bongo amalephera, kapena kuti stenosis yovuta imakhala yovuta kwambiri. Potsatira njirayi, dokotala wanu adzalanda mbali ya trachea yomwe imakhudzidwa ndi kukonza njira yanu ndi khungu kapena masaya.
Pambuyo pa opaleshoni, nthawi zambiri mumatha kupuma pogwiritsa ntchito mankhwala opuma. Komabe, ngati pali kutupa kochuluka, njira zingapo zingagwiritsidwe ntchito. Pankhaniyi, mukhoza kuyembekezera kuikidwa pa steroid kwa maola 24 mpaka 48 komanso diuretic ngati Lasix. Anamwino anu adzakhalanso otsimikiza kuti mutu wa bedi wanu udzakwezedwa ndi madigiri 30 kapena kuposa. Pambuyo maola 48, mudzabwerera ku chipinda chogwiritsira ntchito kuti bomba lanu lizichotsedwa. Ngati simungathe kuthandizira pandege yanu, tracheostomy idzalowetsedwa kuti mupitirize kuyenda. Chifukwa cha khalidwe losautsa la mankhwalawa, limatengedwa ngati njira yomaliza pokhapokha mankhwala ena atalephera.
> Zotsatira:
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> Hofferberth, SC, Watters, K, Rahbar, R & Fynn-Thompson, F. (2015). Kusamalira Mchitidwe Wosakanikirana Wokhazikika. Matenda. 136 (3): e660-9.
> Wosamala, RC. (2017) .Mavuto a endotracheal chubu pambuyo pa malo oyambirira: Kupewa ndi kusamalira odwala akuluakulu odwala kwambiri. http://www.uptodate.com (Kulembetsa Kufunikira)
> Patel, HH, Goldenberg, D & McGinn, JD. (2015). Cummings Otolaryngology: Kupanga Opaleshoni ya Kuthamanga Kwakuya Kwambiri. 68, 982-992.e2
> Waizel-Haiat, S. (2015). Kujambula kwa Stenosis ya Tracheal. http://emedicine.medscape.com/article/362175-buwonetsero
> Won, C, Michaud, G & Kryger, MH. (2015). Matenda ndi Matenda Okhudzidwa ndi Fishman's: Kuwonongedwa Kwakuya Kwakukulu kwa Anthu Akuluakulu. Kope lachisanu. http://www.accessmedicine.com (Kuyenera Kulembetsa)