Kuongororwa kwemukati, kwakagadzirwa nokuda kwekuongororwa kana kuti kurapa, kunoitwa nekubatsirwa nenzira inoperacopic, iyo bracoscopi inoshandawo. Chii chinonzi bronchoscopy, nzira yakadaro sei uye nei-mubvunzo unoda kunyatsofungisisa.
Chii chinonzi bronchoscopy?
Kutanga, iwe unofanira kufungisisa iyo tsanangudzo yemafungiro ebronchoscopy, rudzii rwekuita uye kana rakatemerwa. Zita rakakwana ndiro tracheobronchoscopy. Iyi ndiyo nzira yemazuva ano iyo inokubvumira kuti uone maitiro echechea uye bronchi. Ita bronchoscopy uchishandisa chipfeko chakakosha fibrobronhoscope, iyo inosanganisira kambo yakakosha ine vhidhiyo kana kamera pamagumo. Kudzora iyo shandisa shanduro yakakosha yakagadzirwa ne manipulator.
Chii chinonzi bronchoscopy?
Kuwana kuti bronchoscopy chii uye kuti ungaita sei izvi, iwe unofanirwa kuziva nezvimwe zvikamu zvinokosha. Tracheobronchoscopy inowanzoitwa nekuisa chigadzirwa kuburikidza nemhino, kakawanda kuburikidza nemuromo. Nyanzvi isati yasvika iyo inoshandiswa sedatives uye inzvimbo yeanesthetics yepamunharaunda kuti isabvise kufara kwakanyanya, kupisa uye kuderedza marwadzo. Mumatambudziko akanyanya kuoma, aneshehesia inoshandiswa. Ipapo iyo inofanirwa kupinda munhengo iri pasi pekuongorora. Mukuwedzera pane kuonekwa kunoonekwa, bronchoscope inobvumira kuti biopsy iitwe kuti iwedzere kuongororwa.
Chii chinonzi bronchoscopy chinoratidzwa muchidzidzo:
- sputum, pus uye mucus;
- kuvhiringidza zvirongwa;
- kuvapo kwemamwe mitumbi;
- pulmonary abscesses;
- cysts;
- chiso chinopenya chebronchi kana kuwedzera kusina kuchena kwebronchi;
- kuvapo kwemakumbo;
- fistula, kuzvimba, kudengenyeka;
- kubuda ropa.
Bronchoscopy - zviratidzo
Izvozvo zvakaoma nzira iyo bronchoscopy yebronchi uye trachea ine zviratidzo zvayo, izvo zvinogona kuongororwa kana kurapwa. Kana mubvunzo iwoyo, bronchoscopy - izvo zvatakurukura izvi, zvino titevera maonero uye kusagadzikana kwekutarisa nyaya iyi, mumwe anofanirwa kufunga nezvekushandiswa kukuru kwekushandiswa kwebronchoscope.
Zviratidzo zvetracheobronchoscopy nokuda kwemishonga yekurapa:
- kuvapo kwemitumbi yekunze mumitumbi yekufema, nechinangwa chokubviswa kwavo;
- kubviswa kwemakumbo ebenzi uye akaipa, mamwe mahara nemapucki.
- kuiswa kwepenzi yakakosha paunenge uchifambisa ndege nemakumbo.
- kubviswa kwemucus uye pus.
Nechinangwa chokuongororwa, zviratidzo zvebronchoscopy ndezotevera:
- zvipembenene mumapapu;
- pneumonia inowanzoitika;
- kupfira ropa;
- anofungidzirwa neoplasm;
- kutsvaga zvinokonzera zvirwere zvakakomba zvekufema;
- tuberculosis;
- fodya kusvuta;
- kuora mwoyo kusina basa.
Bronchoscopy - zvinopesana
Nzira ye bronchoscopy ine zvinopesana zvakasiyana-siyana kune basa, iro rinokosha zvikuru kuziva. Kazhinji, nyanzvi dzinounganidza nhoroondo yakakwana isati yanyorera nzira yekuregedza mhinduro dzisingadiwi uye dzimwe nguva dzine ngozi dzebruzinoscopy dzakaitwa pasina kufunga nezvekupesana kunogona kuenderana uye kwakakwana.
Absolute contraindications:
- kurwadziwa kwemoyo, kutambura kwemwedzi inopfuura mitanhatu yakapfuura;
- pulmonary and cardiac insufficiency of the degree of third;
- acroke;
- kusawirirana kune anesthetics;
- bronchial asthma mumukanwa wakaoma;
- kurwadziwa mu peritoneum;
- stenosis yemarara uye trachea;
- neuropsychic matenda;
- arrhythmia.
Relative:
- chirwere cheshuga mellitus;
- wechipiri hafu yemimba;
- kuenda kumwedzi;
- dhigirii rechitatu yegori;
- IHD;
- ARI;
- kunwa doro mune chimiro chisingaperi.
Ko bronchoscopy yakaitwa sei?
Mubvunzo wekuti bronchoscopy yakaitwa sei inokosha kune avo vanopiwa iyi nzira. Tracheobronchoscopy inofanira kuitika mushure mekugadzirira, uye nzira yekuitisa kwayo inotsanangurwa neyanyanzvi, zvichibva pachikonzero uye kusanzwisisika kwegadziriro yekugadzirisa. Bronchoscopy, nzira yekuita nayo uye nzira yekuigadzirira nayo - nyaya inokosha iyo inogumira kubudirira kwekugadzirisa kwetsika.
Kugadzirira bronchoscopy
Mhosva yekugadzirira murwere kune bronchoscopy inosanganisira kuverengeka kwekuongorora:
- ECG;
- X-ray yemapapu ;
- kuongororwa ropa kweHIV, syphilis, hepatitis uye general;
- coagulogram.
Mukuwedzera kune miedzo, murwere anofanirwa kutevedzera zvimwe zvido zvisati zvaitika:
- Iwe unogona kudya kwemasikati kana mushure memairi masere manheru uye kwete zvakare zvakasimba.
- Mumazuva masikati vasati vaenda kunorara zvinoda kutora sedatives.
- Pazuva rekugadzirisa, iwe unofanirwa kurega kusvuta.
- Tracheobronchoscopy yakaitwa pane chisina chinhu chiri mudumbu.
- Pamberi pemitambo yacho, zvakakosha kubvisa bladder uye mumatumbo.
Bronchoscopy ne biopsy
Kuziva kuti bronchoscopy inopfuura sei nechirwere, iwe unogona kugadzirira mupfungwa nenzira iyi isingafadzi. Kunyangwe, tsanangudzo yekutonga kwakadaro hakufadzi uye tsanangudzo dzekuzvibata kwayo inogona kutyisa chero munhu. Saka, kuwirirana kwezviito ndezvekuti:
- Ihuipi yezvigadzirwa inowanikwa kuburikidza nebronchi kuenda kunzvimbo iri pasi pekuongorora (apo shanduro yemashoko yakarongwa).
- Nokudzora nzira yacho kuburikidza ne-X-ray terevhizheni, shandisai mapikicha anokosha kusvika kumugumo.
- Pakuzorora, mhedziso ye forceps inomiririrwa mu parenchyma yemapapu uye inotora chirwere chekuedza.
- Kana panguva ino murwere anonzwa kurwadziwa, kuti simbaps inofanira kubviswa nokukurumidza uye mashoko akatorwa mune imwe nzvimbo.
- Iyi nzira inotora kubva pamatatu kusvika kune manomwe.
- Nzira yacho inopera chete mushure mekunge vaine chokwadi chekumira kwakakwana kwekubuda ropa kwezvinhu zvakakanganisika. Ropa kubva kubronchi uye trachea rinoshuva.
Bronchoscopy pasi peanesthesia
Mune zvimwe zviitiko, tracheobronchoscopy inowanikwa pasi peanesthesia yakawanda. Kwete makiriniki ose ane teknolojia yezvigadzirwa zveizvi, saka iwe unofanira kufanirwa kuzivei pamusoro pekuwanikwa kwezvinhu zvinodiwa zvekuita. Kubudirira kukuru kwemuitiro uyu kunovhara manzwiro emumazuva ekupedzisira, ayo anoratidzwa nekutambudzika kwakanyanya uye kuora kunorwadza, izvo zvisingatokubvumiri kuti uende. Bronchoscopy, iyo inoshandiswa mune chero zvipi zvayo, inoitwa kunze kwekurwisana neanesthetics.
Mutemo we bronchoscopy wakaitwa ndeyotevera:
- Mapapu emurwere ane purogiramu kwemaminitsi mashomanana.
- A 1% solution ye sodium thiopental inogadziriswa.
- Mushure mokutanga kwechidimbu chechitatu cheanesthesia, mushonga wacho unomira uye vanozorodza vemuenzaniso wekuchera ropa vanowanikwa uye kuputika kunoitwa.
- Mushure mokutanga kwekuzorora, masikisi inobviswa uye inopinda nenzira chaiyo ye tracheobronchoscopy, urongwa hwayo hunotsanangurwa pamusoro apa.
- Hazviwanzoitiki nguva dzose kuti uite zvakakwana-ventilation nemasikisi (anesthesia apparatus), saka kana zviratidzo zve hypo hypoia zvichionekwa, murwere anofanira kuvharidzirwa uye kuramba achiita mapapu kuburikidza ne tube.
Bronchoscopy - zvinetso
Zvinosuruvarisa, zvinetso zvinogona kuitika mushure mokunge maronchoscopy, kunyange zvazvo nzira iyi inofungidzirwa yakachengeteka sezvinobvira. Dambudziko rekuonekwa kwavo harisi, asi hapana anogona kupa chivimbo chekuchengetedza zvakakwana.
- kurwadziwa mubhokisi;
- kuwedzera kwekushisa kwemuviri;
- kushungurudzika, kazhinji kuenda pamwe nekurutsira;
- choking and wheezing;
- kuperesa kwenguva refu.
Mushure mokunge bronchoscopy, yakaitwa pasi peanesthesia, zvinetso zvinogona kunge zvinotevera:
- bronchospasm uye loringospasm;
- utano uye hyperthermia;
- kupererwa kwebronchus (kusanyanya kuwanikwa);
- aspiration pneumonia.
Migumisiro ye bronchoscopy
Mushure mokunge bronchoscopy yaitwa, kuti kududzirwa kwemigumisiro kwakaitwa sei uye zvavaigona kuva, mubvunzo chii zaknomerny. Zvichienderana nezviratidzo zvekutanga zvekuita, uyewo nenzira iyo yakaitwa nayo, zvimwe zvidzidzo zvezvinyorwa (mumamiriro ezvinyorwa) zvichararama. Bronchoscopy, mushure mokunge miedzo inowanikwa mu laboratori, inogona kubatsira mukugadzirisa kwekunyatsoongorora. Kazhinji kazhinji kuongororwa zvirwere, izvo panguva yekutanga pane zviratidzo zvekuita.
Chirevo chinowanzoitika mushure mekutengesa terecheobronchoscopy ndeyotevera:
- fistula iyo chiratidzo chechifuba ;
- Chimedu chinopenya uye chinokonzera kusagadzikana chinogona kutaura uye cystic fibrosis ;
- endobronchitis;
- zviratidzo zvehutachiona hwechibhakoma: zvakawanda zvekutuka pasina pus, kubwinya kwemucosa nekudada kwayo;
- kuderera kwe lumen uye kuzvimba kwemasvingo kunogona kutaura pamusoro pokukura kwemarara;
- rutivi rwakapetwa, rutivi rwakasara, kuvapo kwezvipembenene zvechizivo - zviratidzo zveoncology;
- Chirwere cheBronchoectatic chinoperekedzwa ne purulent sputum ne pus uye kuputika kwebhanchial.