Nangemuva kwe-tamponade ekhaleni: izinkomba kanye nencazelo inqubo

tamponade acinene isetshenziswa kabi ENT ukumisa ukopha acinene of etiologies ehlukahlukene. Futhi uma ngaphambili tamponade - inqubo evame kakhulu, ezingemuva kuphela "okhethiweyo." Labo abanomthetho igazi akafuni ukuyeka ngenxa yanoma yisiphi isizathu, noma labo umonakalo lungaphezu sokukhaphela sasisibi ngaphezu kubonakala efika kuqala.

epistaxis

acinene Ngokuthi ngopha ingaphakathi acinene, lapho uketshezi kugeleza emakhaleni ebusweni noma ngokusebenzisa choanae phezu emuva emphinjeni. Kunezinhlobo ezimbili zama-ukopha: front futhi bakhulise. Kwezinye izimo, igazi singena imbobo nasolacrimal (ngenxa umphumela ukuncela), kanye ugobhozela ngokusebenzisa isokhethi iso. Lokhu kungase ukudukisa lofakazi lokhu mkhuba futhi odokotela ukuhlinzeka usizo lokuqala.

Fresh igazi amahlule angawa ngokusebenzisa kuqhoqhoqho zingene esiswini, okubangela umuzwa isicanucanu noma ukuhlanza. Kakhulu akuvamile umongozima kungaba yingozi. Lezo zincwadi ngawe umholi Attila, ngubani ayiminyanisa ku ngegazi lakhe siqu elele ngobusuku lwabo lomshado.

tamponade acinene kuyadingeka ukuze ukopha acinene. Mhlawumbe ukulahlekelwa uketshezi ngesikhathi esifanayo futhi encane, kodwa khona izinkinga owenza lokhu isimo wokuphuthuma.

izizathu

Inqubo Ukukhethwa (anterior noma posterior acinene tamponade kudinga nesineke) kuncike imikhumbi zilimele. Lona umbandela kuphela. Kodwa lapha izinto ezingaphazamisa avuse ukopha impela eningi. Basuke ihlukaniswe zendawo letindzala.

Zendawo zihlanganisa:

• ukulimala ekhaleni;
• imizimba angaphandle;
• ukuvuvukala nokuvuvukala we ulwelwesi lwamafinyila amavesi acinene.

Lawa izici ezintathu ezivame kakhulu ezibangela umongozima. Kukhona ezingavamile ngaphezulu:

• ukusonteka yokwakheka;
• izidakamizwa ephefumula;
• izinqubo somdlavuza ingaphakathi acinene;
• umoya abandayo futhi omile;
• ukuhlukunyezwa amathonsi kusukela umkhuhlane;
• barotrauma nokuhlinzwa.

izici lefundo zihlanganisa komzimba, ukwanda unomphela wegazi, khona imikhuhlane. Ngaphezu kwalokho, ngopha emakhaleni kungaholela izidakamizwa nonsteroidal eqeda ukuvuvukala, utshwala, kukhona izinkinga coagulation uhlelo, amavithamini C no-K ukuntuleka kwamavithamini, ukungezwani izifo letindzala sokuhlasela kwamasosha omzimba.

pathophysiology

Ukuvula ukopha, udinga kulimaze odongeni isitsha. Ulwelwesi lwamafinyila ikhala kahle vascularized kakhulu, ngakho ngisho isicelo encane amandla anele ukuba igazi wathela.

Ngokuvamile umongozima zenzeka izingane ezingaphansi kweminyaka eyishumi ubudala futhi abantu abangaphezu kuka-ayisithupha, ngokuvamile amadoda.

Against isizinda umfutho ophakeme ukopha kwenzeka ngokuzenzakalelayo futhi isikhathi eside kakhulu, uma isikhathi engathathi sinyathelo. Lapho esegugile le lwamafinyila mncane kangangokuthi ngisho nezinqubo zenhlanzeko eziyisisekelo ungakwazi avuse ukudabuka bomkhumbi.

Ngo-95% umthombo ukopha iyona septum acinene anteroinferior ahlukaniswe. Kukhona okuthiwa Kisselbahovo plexus. Kukhona futhi "isibonakaliso" ukopha. Basuke izimpawu iletha, futhi inqwaba yezimila ezinhlobonhlobo esifushane. Kulezi zenzakalo kungenzeka kubangelwa kulimaze ukuze imikhumbi emikhulu ebusweni, isifo sokuvuvukala kwemithambo ukudabuka noma ezibolile lwesimila.

Ngaphambili ekhaleni tamponade

Ngaphambili ekhaleni tamponade ngoba ukopha ngokuvamile isetshenziselwa. "Uthando" inqubo enjalo yezokwelapha ukuze oholele iqiniso ukuthi ezimweni eziningi, ezilimele izitsha phambi ingaphakathi acinene, kanye nesidingo ezinye izindlela ungapheli.

Njengomthetho, ukopha ezinjalo azibona izifo ezimele. Bona - kuphela izimpawu izinguquko umzimba global sika. Ngakho-ke, nge njalo ukopha yansukuzonke kudingeka sicabange ngalokho ezinye izinguquko eziye zaba khona impilo yakho futhi ukuthi kunesizathu ukubheka kudokotela.

omsakazo

Ukwabela izimbangela ebuhlungu ukopha. Bahlanganisa ukulimala kwanoma yimuphi umsuka, kuhlanganise nokuhlinzwa. Futhi kukhona izizathu lingaze okuhlotshaniswa izenzo izifo letindzala kanye yokwakheka acinene ubuqotho.

Abesifazane imakwe konkomentiruyuschie (ie egijima kanyekanye lapho eseqala ukuya esikhathini) kanye ngokuzibona (okungukuthi, esikhundleni umsebenzi wokuya esikhathini) ukopha. Mshini kumiswa yabo kodwa ayiqondakali kahle.

Noma kunjalo, yini imbangela igazi amavesi acinene, qiniseka ukumisa isikhathi saso.

Izindlela ukuyeka ngopha emakhaleni

Namuhla, kunezindlela eziningi ukuze ukopha. Kukhethwa incike massiveness futhi kubangela lesimo. Akunjalo ngempela njenge ndlela eyinhloko okufanele sisetshenziswe ekhaleni tamponade. Isithombe esiqoshiwe algorithm ukopha siqukethe izinyathelo ezilandelayo:

1. Thola ukopha.
2. Nquma ukuthi yini imbangela.
3. Khomba isitsha lilimele.
4. Misa ukopha ngendlela elula kakhulu futhi ngokushesha.
5. Gada isimo isiguli.

Lungisa iyiphi umongozima okuncane ngezindlela ezilandelayo:

1. ekhaleni tamponade. Le nqubo elula: mafutha anciphisa isikhala esingaphakathi turbinate is ukwelula noma ukotini gauze afuthwe ngesibulali-3% i-hydrogen peroxide.

2. moisten a turunda ukotini in vasoconstrictor lehla, bese ufaka endimeni acinene, kusukela lapho igazi ageleza.

3. Buza isiguli ukuthi sengidonsa umoya kuleli ekhaleni, exhale ngomlomo futhi ngesikhathi esifanayo ukubeka ice ku ibhuloho ekhaleni nentamo.

Lapho efeza yimiphi izinqubo isiguli kufanele ahlale noma ukuthatha ingxenye isikhundla okuqondile bese ngihlaliswa ikhanda lakhe phambili. Lokhu kwenzelwa ukuqinisekisa ukuthi igazi akusho kudambise emuva emphinjeni kuya esiswini.

Isisetshenziswa phambi tamponade

Uma zonke Kulezi zindlela ezingenhla, ayizwakali, ugijima phambi ekhaleni tamponade. Isisetshenziswa ilula ngempela asebenze. Ngokuyinhloko udokotela kufanele wenze izinzwa wendawo we lidocaine acinene umgodi noma novocaine (ngaphambili olwenziwa allergoproby Yiqiniso). Khona-ke udokotela ifaka ibe ukopha unhlangothi gauze oyinyumba ofakwe izidakamizwa hemostatic noma Vaseline wamafutha. gauze obuphelele singaba ayisikhombisa amasentimitha, kodwa ububanzi - isigamu kuphela. Turunda afakwe ngesimo inkositini ukuze ugcwalise ngalo ingaphakathi acinene.

a Tampon okunjalo ishiywa cishe izinsuku ezintathu, futhi isuswe ekupheleni kwalesi sikhathi. Ngo ukopha zibe nzima ngokukhethekile, gauze kungenziwa kwesokunxele izinsuku eziyisikhombisa, kodwa kulokhu kufanele oswakanyiswe isixazululo kwamaphilisi kanye aminocaproic acid.

Izimbangela tamponade emuva

Ngaphambili ekhaleni tamponade angeke kube nemiphumela ekahle kulindeleke. Noma umthombo ukopha awasona ekuqaleni obekulindelekile. Ezimweni ezinjalo iphendukele ngaphezulu ukudliwa isikhathi, kodwa indlela ephumelelayo.

Ngemuva tamponade ekhaleni wenziwa ukuba ukopha acinene, uma:

1. nesineke kwaba buhlungu ngqo ekhaleni noma acinene ndima eseke nomzimba angaphandle.
2. Uma ukopha kubangelwa eside rhinitis ogelezayo noma sinusitis.
3. Ezimweni lapho okusezingeni eliphezulu letindzala blood pressure akusho eliwele phansi izindonga isitsha iphinde ivimbele kumiswa ihlule legazi.
4. Imbangela ukopha - isimila ezibolile.
5. Isiguli sinelungelo isifo igazi.

Technique acinene tamponade

Qalisa le zokukhwabanisa kuphela okwazi umuntu oqeqeshiwe, ungazami ukuzithiba medicate ekhaya. Ngaphezu udokotela kulesi senzo uye wahilela abantu ababili noma abathathu. Omunye wabo kuyadingeka ukuze silondoloze indawo efanele zekhanda lesiguli. Eyesibili kuthatha swabs futhi azisize ukuze silungise, kanti eyesithathu uzakuhlala njengobana swabs entsha oyinyumba, uma kunesidingo.

Ngaphambi kokuthi uqale inqubo, isiguli iqondiswa iyiphi sine ukuze uphumule kuye nokwehlisa reflex Gag. Khona-ke, kuze kube ngalo ingaphakathi ngomlomo ngokusebenzisa ipayipi ezithambile sifakwe ekhaleni, ezinamafutha akahle oyinyumba uwoyela Vaseline. Ekupheleni kwalesi tube kuboshelwe gauze yobukhulu ezifanele. On the swab has imicu emithathu: ezimbili fixed it on ipayipi, futhi omunye uhlala emlonyeni, bese sinamathela patch esihlathini. Isinyathelo esilandelayo - kokukhipha ipayipi ngokusebenzisa ekhaleni. Kulokhu, lo swab icindezelwa ukuba UJoan uvala ngokugcwele nasopharynx. Ngemva kwalokho, ukwenza phambi tamponade futhi ifindo phambi asele imigqa emibili. Susa swab futhi ngemva kwezinsuku ezimbili noma ezintathu.

yezinkinga

Tamponade we ingaphakathi acinene, kanye nanoma yimuphi omunye zokukhwabanisa kungabangela izinkinga. Phakathi kwalezi ezinjengokungcoliswa necrosis we mucosa acinene. Lokhu kwenzeka ngenxa yokucinana nokunwetshiwe imithambo nezinzwa ngesikhathi ukuchayeka turundy. Inkinga yesibili kungenzeka exacerbation ubovu noma ukuthuthukiswa kwezifo of the sinuses (sinusitis maxillary, sinusitis), njengoba igazi gauze ukumela naphakathi esihle sokwanda virus.

Ezimweni eziyinkimbinkimbi, le tamponade ezingemuva kungadala ukusonteka kwekhala kanye septum acinene. Ngaphezu kwalokho, ukwelashwa kungase kuholele ekwakhekeni hematoma noma septum ukonakala ngenxa ukuncibilika ngokujoyina igciwane yesibili.