Zizindikiro za Pleurodesis, Ndondomeko, ndi Zovuta
Pleurodesis ndi njira yomwe nthawi zina imapangidwira anthu omwe ali ndi khansara yamapapo ndi zina. Kodi ndondomekoyi ikuphatikizapo ndi nthawi yanji?
Pleurodesis - Definition
Pleurodesis ndi ndondomeko yomwe yapangidwa kuti ikhale ndi zigawo ziwiri za mapaipi ( pleura ) kuti agwirane pamodzi. Izi zimathandiza kuthetsa danga pakati pa zigawo ( pleural cavity ) kotero kuti madzi (madzi, magazi, kapena pus) sangathe kumanga pakati pa zigawozo.
Pali ma teaspoons atatu kapena anai amadzimadzi pakati pa kunja (parietal) ndi mkati (visceral). Pomwe phokoso lachisokonezo limayambira, chifukwa chazirombo zonse ndi zoopsa, madziwa amamangirira ndipo mpweya wambiri umatha kukhala ndi malita owonjezera a madzi.
Asanavomereze pleurodesis, madokotala amafuna kuona poyamba kuti puloumothorax (kapena pneumothorax) idzabwereranso mtsogolomu. Ngati ndi nthawi imodzi, kuchita thoracentesis kuchotsa madzimadzi nthawi zambiri ndikofunikira. Mwamwayi, kupweteka kwachisokonezo (ndi pneumothoraces) komanso makamaka kupweteka kwachinyengo kumatsitsimutsa nthawi zambiri.
Pleurodesis Ndondomeko
Mu mankhwala enaake, mankhwala amagawanika pakati pa zida ziwiri zomwe zimagwiritsidwa ntchito pogwiritsa ntchito chifuwa chachikulu . Mankhwalawa amachititsa kutupa komwe kumayambitsa kupweteka. Izi zimapangitsa kuti zibulu ziwiri zikhale pamodzi kotero kuti madzi kapena mpweya sungathe kumanga ndi kusonkhanitsa mlengalenga.
Kuphimba mkati kumatchedwa visceral pleura, ndipo phokoso lakunja limatchedwa parietal pleura. Malingana ndi vutoli, njirayi ikhoza kupyolera mu kachipangizo kakang'ono (ma thoracoscopy kapena VATS) kapena thoracotomy (opaleshoni yotsegula m'mapapo.)
Pali mitundu iwiri ya pleurodesis yomwe imagwiritsidwa ntchito palimodzi.
- Mitambo pleurodesis imayambitsa kutupa ndi kupweteka mwakumangirira podetal (kunja) pleura ndi gauze.
- Mankhwala otchedwa pleurodesis amagwiritsa ntchito jekeseni wa mankhwala (nthawi zambiri talc) pakati pa ziwalo zothandizira kwambiri kuti apange kutupa ndi ululu (fibrosis.)
Zifukwa za Pleurodesis Zingachitike
Pali zinthu zambiri zomwe pleurodesis ikhoza kuchitidwa, zomwe zimachokera ku matenda monga khansa ya m'mapapo, mesothelioma, cystic fibrosis, ndi matenda ena.
- Kupweteka kosautsa - Anthu omwe ali ndi khansara yamapapu, khansara ya m'mawere , kapena metastases ku mapapo a khansa zina zingachititse kupweteka kwachinyengo kwachinyengo. Izi ndizomwe zilipo. Imodzi ndiyo kuchita thoracentesis ndikuika ntchentche yomwe imatha kusungunula madzi m'thupi mwake (gawo lina la catheter kapena catheter yodandaula). Mmodzi ndi pleurodesis.
- Zowonongeka mobwerezabwereza
- Kupitiriza pneumothorax - A pneumothorax ndi mawu omwe amagwiritsidwa ntchito pofotokozera mapapu akugwa. Ngati pneumothorax imapezeka ndipo chifuwa cha chifuwa chimayikidwa, pneumothorax nthawi zambiri amasankha. Ngati pneumothorax imapitirira (kuthamanga kwa mpweya wothamanga,) kapena kuchoka ndikubwerera, kuyambanso mankhwala kuti athetsere pneumothorax kapena kupewa kuchepetsa.
- Pneumothorax watsopano
Pamaso Pleurodesis - Kukonzekera
Asanafike pleurodesis, madokotala amalingalira zinthu zingapo.
Chofunika koposa, ndikofunika kuti kuchotsa mchere wambiri kukuthandizira kusintha kwa zizindikiro (kuchepa mpweya) kwa omwe ali ndi khansa. Kuchulukira kwachisembwereko komwe sikuwoneka ngati kupweteka pamfuwa kapena kupuma pang'ono pambaliyi nthawi zambiri kumasiyidwa ndekha. Kuphatikiza pa izi, ena adokotala amalimbikitsa njirayi ngati moyo wautali umaposa mwezi umodzi.
Kumbali ina, pneumothoraces mwadzidzidzi ikhoza kuchitika kwa anthu omwe ali aang'ono komanso odwala.
Pankhaniyi, njirayi ingalephereke kuti pneumothorax ina isapezeke mtsogolomu.
Mavuto
Kawirikawiri, njira ya pleurodesis imalekerera bwino. Kwa chiwerengero cha anthu, njirayi idzakhala yopanda ntchito komanso mankhwala ena okhala ndi catheter yosungira madzi, kukhetsa madzi, kapena pleurectomy (kuchotsedwa kwa pempho). Chodetsa nkhaŵa china, chifukwa cha anthu amene ali ndi mapapo amakolokera m'tsogolo, ndikuti pulosedesis yapitayi ikhoza kukhala yovuta kwambiri.
Kwa anthu omwe ali ndi vuto lachinyengo chifukwa cha zochepa, kapena amakhala ndi pneumothoraces (nthawi zambiri zokhudzana ndi cholowa chawo), pleurodesis amatha kutitsimikizira kuti mankhwala ena amodzi sangathe kupezeka pomwe thandizo lachipatala silipezeka.
Chitsanzo: Khansara ya Frank yamapapu inachititsa kuti phokoso likhale lopitilira, choncho adokotala anamuuza kuti achite njira yotchedwa pleurodesis.
> Zotsatira:
> Davies, H. et al. Zotsatira za Catheter Indwelling Vatican vs Chest Tube ndi Talc Pleurodesis Zothandizira Kutulutsa Dyspnea M'matenda Ndi Oopsa Pleural Effusions. TIME2 Randomized Controled Trial. JAMA . 2012. 307 (22): 2383-2389.
> Dugan, K., Laxmanan, B., Murgu, S., ndi D. Hogarth. Ulamuliro wa Kuthamanga kwa Mpweya Wopitirira. Chifuwa . 2017 Mar 3. (Epub patsogolo pa kusindikiza).
> Fortin, M., ndi A. Tremblay. Zotsutsana: kumakhala pleural catheter vs pleurodesis chifukwa chachisokonezo chopweteka. Journal of Thoracic Disease . 2015. 7 (6): 1052-7.
> Lenker, A., Mayer, D., ndi S. Bernard. Njira Zothandizira Malignant Pleural Effusions. Clinical Journal ya Oncology Nursing . 2015. 19 (5): 501-504.
> Thomas, J., ndi A. Musani. Zowopsya zofuula zowonongeka: ndemanga. Makliniki mu Chifu Medicine . 2013. 34 (3): 459-71.