Nthenda ya Postoperative ndi Vomiting (PONV) ndi vuto lalikulu limene odwala amakumana nalo opaleshoni. Mphuno ndi kusanza zingakhale zovuta kwambiri, ndipo nthawi zambiri zimakhala zovuta kwambiri ndi mankhwala omwe amagwiritsidwa ntchito pa chipatala. Mankhwala a anesthésia, makamaka, amadziwika chifukwa cha zotsatira zake zoyipa. Kuphatikizapo kupweteka kwa opaleshoni ndi kusanza kumayenera kupewa nthawi zonse, chifukwa ndi zosasangalatsa kwambiri ndipo zingathe kuika maganizo anu pa malo opangira opaleshoni.
Zowopsa
Anesthhesia yaikulu ndi chiopsezo chachikulu cha mseru ndi kusanza pambuyo pa opaleshoni. Ngati mumatha kusanza pambuyo pa opaleshoni, mungafune kufunsa ngati n'zotheka kuti mukhale ndi aneshesia, m'malo mwa mpweya wosasunthika. Mtundu wotsekedwa wa mankhwala a anesthésia amadziwika kuti amachititsa kunyoza kwambiri kuposa mtundu woperekedwa ndi IV.
Mtundu wa opaleshoni umadziwikanso kuti umayambitsa kunyoza ndi kusanza. Njira zowonongeka, ma opaleshoni okhudza nkhope ndi mutu, opaleshoni ya m'mimba, opaleshoni pamakina ochotsera mkodzo ndi opaleshoni pa ziwalo zoberekera amadziwika kuti ali ndi apamwamba kuposa PONV kuposa njira zina.
Amuna amakonda kukhala ndi nseru ndi kusanza pambuyo pochita opaleshoni kusiyana ndi odwala azimayi, ndipo odwala omwe amayamba kukhala odwala amakhala ndi odwala okalamba. Anthu omwe ali ndi chizoloŵezi chodwala matenda oyendayenda amakhala ndi chiwopsezo chokwanira kwambiri, monga osasuta. Wodwala amene wakhala akuyambanso kusambidwa ndi kusanza pambuyo pa opaleshoni yam'mbuyomu amatha kukhala nawo kuposa wodwalayo.
Chida chotchedwa Apfel Scale nthawi zambiri chimagwiritsidwa ntchito kuti mudziwe ngati wodwalayo angakhale ndi nseru ndi kusanza pambuyo pa opaleshoni. Pali mafunso anayi pamlingo:
- Kodi mkazi wodwala?
- Kodi wodwalayo ndi wosuta fodya?
- Kodi wodwalayo akudwala matenda oyenda?
- Kodi mankhwala opweteka a opioid ndi mbali ya dongosolo lachirendo?
Pa yankho lililonse la inde, wodwala amapatsidwa mfundo, ndi zinayi kukhala chiwerengero chachikulu cha mfundo. Wodwala ali ndi mfundo imodzi ali ndi mwayi wa 10% wotsitsimula ndi kusanza, pambuyo pake. Maphunzirowa athandizira wopereka mankhwala a anesthesia kuti adziwe ngati mankhwala opewera ayenera kuperekedwa nthawi yomweyo kapena atangochita opaleshoni. Ngati mutaponya pamwamba pa 2 pa mlingowu, mungafune kuti anzanu a anesthesia adziŵe kuti muli pangozi yowonongeka ndi kusanza pambuyo pa opaleshoni.
Kupewa
Kwa odwala ena, wopereka mankhwala a antiesthesia adzayambitsanso mankhwala osokoneza bongo ndi kusanza, kutanthauza kuti adzapereka mankhwala osokoneza bongo asanadziwe zizindikiro. Izi zimachitika nthawi zambiri pamene wodwalayo wachitidwa opaleshoni yomwe imakhala yovuta pamene kusanza kumachitika. Mwachitsanzo, odwala okhala ndi chipsyinjo chachikulu cha m'mimba akhoza kukhala ndi vuto lalikulu kwambiri lotchedwa dehiscence ndi kuvuta ngati kutaya kwa nthawi yaitali kumachitika. Mankhwala omwe amachiritsidwa nthawi zambiri amakhala othandiza popewera kunyozako kusiyana ndi kuchepetsa kunyowa.
Kubwerera ku chakudya choyenera nthawi zonse chiyenera kuchitika. Gawo loyambirira ndilokuyamwa pa zipsu za ayezi, ngati izi zikhoza kuchitidwa bwino, wodwalayo ayamba ndi zakumwa zoyera, kenako chakudya chamadzimadzi chonse, kutsata chakudya chofewa ndipo potsiriza chakudya chokhazikika.
Anthu omwe ali ndi zosowa zofunikira, monga matenda a shuga, angakhale ndi zakudya zofiira kwambiri za shuga, mogwirizana ndi zosowa zawo.
Kuchiza
Zofran (Ondansetron): Mankhwalawa angaperekedwe kudzera mwa IV kapena piritsi pofuna kupewa kapena kuchiza kusuta ndi kusanza.
Phenergan (Promethazine): Mankhwalawa amaperekedwa chifukwa cha kunyoza ndi kusanza, ndipo akhoza kupatsidwa IV, pamlomo ngati mapiritsi kapena madzi, monga suppository, kapena ngati jekeseni mu minofu. Zimadziwika kuti zimakhala ndi zotsatira zoyipa za sedation, zomwe zimachititsa odwala ambiri kugona.
Reglan (Metoclopramide): Mankhwalawa amaperekedwa kuti ayambe kuchulukitsa matumbo, chifukwa nthawi zambiri amakhala olumala pambuyo pa kupweteka kwa anesthesia, ndipo izi zingachititse kusuta ndi kusanza.
Amapatsidwa ngati mapiritsi kapena kudzera mwa IV.
Compazine: Mankhwalawa amagwiritsidwa ntchito pazinthu zingapo, koma amadziwika kuchepetsa kunyowa ndi kusanza mu odwala opaleshoni. Ikhoza kuperekedwa monga jekeseni mu minofu, kupyolera mu IV, monga mapiritsi kapena suppository. Ikhoza kuchepetsa nkhawa.
Scopolamine: Mankhwalawa amagwiritsidwa ntchito pa matenda oyendetsa matenda komanso kupwetekedwa pambuyo poyambira ndi kusanza. Ikhoza kugwiritsidwa ntchito monga chigamba, choperekedwa kudzera mu IV kapena ngati jekeseni.
Mankhwala a IV: Kwa anthu ena, kukhala hydrated bwino kumachepetsa kunyowa ndi kusanza. Kwa ena, njira yosanza imatha kuyambitsa madzi otaya madzi m'thupi nthawi zambiri amagwiritsidwa ntchito pamodzi ndi mankhwala othandizira kusuta ndi kusanza.
Tizilombo toyambitsa matenda: Kusupa kwakukulu, chubu yamkati imatha kulowa m'mimba. Thubuyi imalowetsedwa m'mphuno (kapena pakamwa ngati wodwalayo ali pamphepete mwa mpweya wabwino), kulowa m'mimba ndi m'mimba. Chipangizochi chikuphatikizidwa ndi chipangizo choyamwa chomwe chimaphatikizapo kuyamwa kwa chubu, kuchotsa zomwe zili m'mimba.
> Chitsime:
> Zowonongeka za Mavuto mu Unit Post Anesthesia Care. Zaposachedwa.