Kuchita opaleshoni ndi chifukwa chofala chifukwa cha mapapu awa akugwa
Atelectasis ndi mawu a zachipatala omwe amagwiritsidwa ntchito pofotokozera kugwa kwathunthu kapena pang'ono kwa mapapo. Nthawi zina amatchedwa "mapaipi ogwa," ngakhale kuti mawuwo angagwiritsidwe ntchito ku chikhalidwe chotchedwa pneumothorax .
Pamene atelectasis imachitika, mpweya watsopano sungathe kufika pamapangidwe ang'onoang'ono a mapapo, otchedwa alveoli , kumene amatsitsimula mpweya ndi carbon dioxide.
Izi zimapangitsa kuti mpweya wabwino ukhale woperewera ku ziwalo ndi minofu ya thupi ( hypoxia ).
Atelectasis ikhoza kukhala yovuta, ikuchitika mosayembekezereka pa nkhani ya maminiti, kapena osapitirira, akukula kwa masiku angapo mpaka masabata.
Zifukwa za Atelectasis
Pali zifukwa zina zinayi zomwe zimayambitsa atelectasis: hypoventilation, kuthamangitsidwa kwa pandege, kupanikizika kwapansi, ndi kumangiriza.
- Hypoventilation (kupuma mopitirira malire mopitirira malire) ndi wamba panthawi ya opaleshoni, makamaka ndi anesthesia ambiri, kapena pamene munthu aikidwa pamtima. Kuchita kupuma pang'ono kumalepheretsa mpweya kuti ufike ku alveoli, kuchititsa mpweya kuti uwonongeke ndi kugwa. Hypoventilation ndi chifukwa chofala cha atelectasis, makamaka pambuyo pochita opaleshoni.
- Kutsekeka kwa ndege kungayambitse pamene chinachake chimatseka ndime mkati mwa mapapo (ngati ntchentche kapena chinthu chachilendo) kapena kunja kwa mapapo (ngati chotupa chimene chimayendetsa pamsewu ndi kumayambitsa chisokonezo). Bronchioloalveolar carcinoma ndi mtundu umodzi wa khansa yomwe imadziwika kuti imayambitsa zotupa mu alveoli ndi mabungwe ena.
- Kupanikizika kwa kayendedwe ka ndege kumayambitsidwa ndi kumangidwanso kwa madzi m'madera ozungulira mapapo ( pleural effusion ). Zingakhalenso zotsatira za mtima wochulukitsika, wamadzimadzi, wamatumbo, ma lymph node okulitsidwa, kapena kusungunuka kwa madzi m'mimba yam'mimba ( ascites ).
- Zilonda ndizosazolowereka pamene ziphuphu zimayamba kugwirizana. Kawirikawiri, ziwalo ndi ziwalo zamkati zimakhala ndi malo ozizira, kotero zimatha kuyenda mosavuta thupi likayenda. Mankhwalawa amatchedwa surfactant. Pamene opaleshoni yogwira ntchitoyi akusowa, mapapo amatha kutaya mphamvu ndipo akhoza kugwa.
Zina mwa zinthu zomwe zimapangitsa kuti zakudya zisawonongeke, zimakhala zowonjezera kwambiri, kusuta, kupuma kwa nthawi yayitali, kusowa kwa nthiti, zomwe zimachititsa kuti munthu asapume mpweya wambiri), mankhwala osokoneza bongo kapena omwe amachititsa kuti pang'onopang'ono apume.
Zizindikiro za Atelectasis
Atelectasis nthawi zambiri imakhala ndi zizindikiro zochepa ngati ikukula pang'onopang'ono kapena ikuphatikizapo pang'ono chabe m'mapapo. Mosiyana ndi zimenezi, ngati vuto likukula mofulumira kapena limakhudza chigawo chachikulu, zizindikiro zingakhale zodabwitsa komanso zimadodometsa. Atelectasis amapezeka pamtundu umodzi, kutanthawuza m'mapapo kapena m'mapapo.
Zizindikiro zofala zimaphatikizapo:
- Kupuma pang'ono ( dyspnea )
- Chifuwa chosasunthika
- Kupweteka kwa chifuwa chachikulu chomwe chimapweteka ndi kupuma kwakukulu ( kupweteka kwa chifuwa chachikulu )
- Bluish tinge kwa milomo, zala, kapena zala zomwe zimayambitsa vuto la oxygen ( cyanosis )
Kuzindikira kwa Atelectasis
Ngati dokotala akukudandaulirani kuti muli ndi atelectasis, iye adzayesa kupima thupi pogwiritsa ntchito (kugogoda) chifuwa kuti amvetsere kumveka kwa mawu. Ngati pali mapupa ang'onoang'ono kapena amphumphu akugwa, mkokomo wopuma umakhala chete kapena kuti palibe.
Pambuyo pake, dokotala adzalamula kufufuza kwambiri komwe kungaphatikizepo:
- Chifuwa cha X-ray , chomwe chingasonyeze kuti trachea ndi mtima zasintha
- Kujambula tomato (CT scan) kuti mupeze umboni wowoneka wosokoneza
- Maginito opanga maginito (MRI), pogwiritsa ntchito maginito mafunde kuti apange zithunzi
- Bronchoscopy , yomwe imakhala yotsekemera yotumizidwa mu mphepo kuti ipenye mapapo
- Magetsi a magazi (oximetry) kuti aone momwe mlingo wa oxygen umatayira
- Positron-emission tomography (PET scan), yomwe imatha kuzindikira kuti maselo amatha kukhala ndi khansa
Njira Zothandizira Atelectasis
Chithandizo cha atelectasis chimadalira chifukwa chachikulu, ndi cholinga chokonzanso mapapu mpaka kukula kwake. Njirazo zingasinthe. Ngati chotupa ndicho chomwe chimayambitsa kugwa, opaleshoni ingakhale yogwirizana.
Powonongeka, pempho la pempho lachangu liyenera kutero. Kuti zisawonongeke, mankhwalawa angagwiritsidwe ntchito kuchotsa chinthu chachilendo, pamene mankhwala a bronchodilation angathandize pa kutsegulidwa kwa ndime za pamsewu. Nthaŵi zambiri, njira zochiritsira zidzakhala zofunikira.
Pamene zizindikiro zimatchulidwa, kupuma kotsirizira kothamanga (PEEP) kungagwiritsidwe ntchito. Izi ndi mankhwala omwe amaphatikizidwa ndi mpweya wabwino pogwiritsa ntchito maski pansi pa kupanikizika, kuteteza mapapu kuti agwe pansi panthawi yopuma. Ngati zizindikiro zili zovuta, mpweya ndi mpweya wabwino zingakhale zofunikira mpaka vutoli likuyendetsedwa bwino.
Pamene atelectasis ndi yachilendo, nthawi zambiri zimakhala zovuta kuti mapapo apitirize kukwera. Kuchotsa gawo lowonongeka la mapapo (pogwiritsa ntchito lobectomy kapena segmental resection ) kungasonyezedwe.
Mavuto angayambitse ngati mabakiteriya atsekeredwa pakagwa. Izi zingachititse kuti pakhale chitukuko, kuphatikizapo chibayo ndi sepsis. Bronchiectasis , kuwonjezereka kwapadera kwa mpweya womwe umayambitsa kukhazikika kwa madzi m'mapapu, nthawi zina kumachitika. Pamene mbali yaikulu yamapapu imakhudzidwa ndi zinthu izi, kulephera kupuma kungawonongeke.
Kuteteza Atelectasis Pambuyo Opaleshoni
Kuchita opaleshoni pachifuwa kumakhalabe chifukwa chachikulu cha atelectasis. Pofuna kupewa kuti izi zisachitike pakapita opaleshoni, madokotala amakukakamizani kuti musiye kusuta fodya.
Pambuyo opaleshoni, pali zinthu zitatu zomwe muyenera kuonetsetsa kuti mapapu anu akhale okhutira:
- Pitirizani kupuma mokwanira, pogwiritsa ntchito makina otalika kwambiri komanso othawa. Mankhwala opweteka angaperekedwe ngati kupuma kumakhala kovuta kwambiri.
- Yesetsani kutsokomola kuti muchotse ntchentche kapena mphukira m'mapapo.
- Sinthani malo anu, mutakhala kapena mukuyendayenda mofanana ndi dokotala wanu amalola.
> Zotsatira:
> Ferrando, C., Romero, C., Tusman, G. et al. "Kulondola kwa Kuyesedwa kwa Mpweya Osaphatikizika Kwambiri Kuti Azindikire Atelectasis Odwala Odwala Pambuyo pa Opaleshoni: Phunziro Loyendetsa Ntchito Yophunzira." BMJ Open . 2017 '7 (5): e015560.
> Restrepo, R., ndi Braverman, J. "Mavuto Amakono Akuzindikira, Kuteteza, ndi Chithandizo cha Pulmonary Atelectasis." Katswiri Wowunika za Mankhwala Opuma . 2015; 9 (1): 97-102.