Filosilivá me epidural (epidural) rehunga - he aha te te rerekētanga? Te whakamahi, contraindications, pōauautanga taea

Ko te ngā tuatahi i runga i te whakamahi o te rehunga filosilivá, teiti hoki ki 1898, engari whānui, kua riro tenei tikanga o te rehunga nui i muri. Hei whakamahi i tenei tikanga, kia whai i te rata i te tahi matauranga o te anatomy o te ua, me ona kiriuhi.

rehunga epidural me filosilivá

He rohe enei tikanga o te rehunga. I roto i to ratou pupuri e patia rongoā ki te wāhi motuhake kei tata te ua. Ngā mihi ki tenei "tio" te hawhe o raro o te tinana. kahore e tokomaha mohio ranei reira ko te rerekētanga i waenganui i te rehunga tuaiwi me epidural.

Ko te tukanga mō te faaineineraa, me te mau ana i roto o te rehunga e rite enei tikanga. Oia mau, i roto i te wā e rua, e koperea i roto i te hoki. Ko te tino rerekētanga ko e te wae faataoto i werohia filosilivá tuku ki, me epidural (peridural) - tāutanga o te ngongo angiangi motuhake i roto i i whakahaerea te faataoto te i runga i te tetahi wā o te wā.

Ko te tikanga - e kore te reira anake te rerekētanga i waenganui i enei tikanga e rua o te mamae te tauturu. rehunga filosilivá whakamahia i roto i te wā i reira he mea tika ki te whakatutuki i te pānga wā-poto. Tei runga i te momo o te raau taero roa o analgesia kia ngā i te 1 ki te 4 haora. e kore te rehunga epidural iti e te wā. Ka haere tonu rehunga rite te roa rite eke i roto i te pū tōngāmimi ki te tinana ka whangai rongoā. E mea pinepine whakamahia tenei tikanga te ki whakakahoretia te manawanui o te mamae i roto i te pokanga kore anake, engari ano hoki i roto i te wā postoperative.

parau tumu o te mahi

rehunga epidural me epidural - he rehunga rohe, i roto i nei e patia taero ki te wāhi epidural o te tuaiwi. hāngai ana tōna parau tumu whakahaere i runga i taua raau taero whakamahia i roto i taka ringaringa dural ki te wāhi subarachnoid. Ka rite ki te hua, te ngātere haere e raru radicular i roto i te ua e āraia.

I muri whakahaere te tarukino e i roto i te tata ki te pūtau karere o te kātua. A ko ratou kawenga mo te ahua o te mamae i roto i te wahi ngā o te tinana, me te pupuri ratou ki te roro.

Tei runga i te wāhi o te whakahaere kia mono mahi nekeneke me te tūtohutanga ki etahi wāhanga o te tinana. Nuinga o ngā wā, whakamahia rehunga epidural te ki "whakawhiti atu" te hawhe o raro o te tinana. Ki te mahi i tenei, me tomo koutou te faataoto i roto i te wāhi intervertebral i waenganui T10-T11. Hoki rehunga kua whakaurua te rohe ãpoko o te tarukino ki te rohe i waenganui i T2 ko T3, te hawhe runga o te puku e taea anesthetize ka ki te wero i te wāhi pūwaha T7-T8. Ko te rohe o nga whekau papatoiake, "tahuri atu" i muri i te kupu whakataki o te faataoto ki te wāhi i waenganui i L1-T4, nga wahi o raro - L3-T4.

Tuhinga mo te whakamahi o te rehunga rohe

kia whakamahia ai rehunga epidural me filosilivá e rua motuhake, me te i roto i ngā ki te whānui. whakamahia te kōwhiringa muri i roto i te wā i reira whakaritea te pokanga whakahaere rei te (i roto i te pouaka) ranei wā roa-wawaotanga hāparapara i roto i te rohe o te puku. Ratou huinga me te whakamahi o anesthetics ki whakaiti i te hiahia mō ngā tūroro ki opioids.

Wehe, kia te whakamahi rehunga epidural i roto i teie mau huru:

- te mamae te tauturu i muri i te pokanga;

- rehunga rohe i roto i whakawhanau;

- ki te hiahia kawe i ngā mahi i runga i nga waewae, me te tahi atu wahi o te hawhe o raro o te tinana;

- wāhanga whakawhānau.

I roto i ētahi wā, te whakamahi i anake te epidural. Kei te whakamahia te reira, ki te tika, te kawe ngā mahi i roto i:

- i roto i te papatoiake, huha, raparapa, nui tibia ;

- whakakapinga o te hip turi ranei hononga;

- whati o te kaki femoral ;

- whaturama.

Ka taea te whakamahi rehunga filosilivá rite te tikanga o te maimoatanga o te mamae hoki. E mea pinepine te mahi i te reira i muri i te pokanga. Kei te whakamahia hoki te reira i roto i te pokanga iaia i roto i aua wā i te mea e tika ana ki te kawe i te wawaotanga i roto i te topito o raro.

te tauturu te mamae mahi

Ētahi atu a atu wahine kei te whakamahi i rehunga epidural filosilivá ranei, kia rite ki te kore ki te ite contractions fakamamahi. A, no te whakahaere mamae rongoā ngaro, engari puritia te mahara kei roto i ki tonu i.

Kei te maha rehunga epidural i roto i whanau whakamahia i roto i te whenua whakawhanakehia. E ai ki ngā tatauranga, kua whakamahia te reira e pā ana ki 70% o nga wahine e whanau ana. Tenei momo o te rehunga taea ki a koe anesthetize te tukanga katoa o te whanau ana. I roto i tenei take, e kore e pāngia i te kukune.

Ahakoa te meka e whanau ko te tukanga whaiaroaro māori, e kore nei e rapua e te wawaotanga waho, tohe wahine fakautuutu e i pohe to ratou. Ahakoa i te wa o te whanau, te tinana hua te utanga o horopeta o endorphins. whakatairanga ratou manawa mamae tūturu, no te mea e taea e ki te whakarato i tētahi ara aronganui enei taiaki, pehi te mana'o o te wehi, me te mamae.

Heoi, ko te huarahi o te hanga o endorphins tei runga i te huru me te huru o te wahine. Hei tauira, roa mahi ki te mamae kino i te pānga tōraro e rua i runga i te wahine rawa i roto i te whanau ana, me te tamaiti e parauhia te. I tua atu, ka taea e te wahine ake i te pēhanga ki te tīmata i te rärangi, meinga tauwhatinga o te uaua matua - ngakau. I roto i te wā pērā, he tika rehunga.

Ko taea te kawea epidurals i anake i roto i te tikanga whakamaheretia. e kore e nohinohi Contraindications ki te kawe i te reira i roto i. Otiia i roto i te wā tino kore e whakamahi i te reira ano te mea e kore e tona pānga puta hangatonu. Mai te timatanga o te whakataki o anesthetics me ki te whakaoti i te mamae te tauturu kia tango te hawhe haora.

whakangungu onäianei

Ki te taea, rite-mua o te manawanui mo te whakahaere o te rehunga. Ki te whakamahere koe epidural (peridural), rehunga filosilivá, hoatu te manawanui kei roto i te ahiahi ki te 0.15 g tikanga "Phenobarbital". Ki te tika, e taea te whakaritea reira me te mea whakarokiroki. Tikanga, whakamahi tākuta taero "Diazepam" ranei "hlozepida". Ano, tetahi wahi haora i mua i whakahaere rehunga intramuscular werohia tikanga kia hoki whakaaturanga "Diazepam" ranei "Promethazine" tautapa "rehunanu" me "atropine" ranei "Fentalin".

Ano, he taahiraa whakahauanga ko ki te faaineine i te tarapēke horomata. E titau te reira i te tauera (e rua nui, me te iti), karapu horomata rapa, pōro whāriki, ngira, pāhorehore, catheters, me rua kopikopi rua mōhiti mō rongoā anesthetics. He mea nui hoki ki te faaineine i mea katoa e tika ana i roto i te tikanga ki te taea ki te whakakore pōauautanga taea. Ki tenei rehunga kore e taea e tutakina i te tūponotanga o te tauwhatinga nui o pūnaha supply toto me te manawa.

I mua rite 2 pāhorehore, tetahi o nei me waiho te rōrahi o te 5 ml, me te tuarua - 10 ml. Ano, te tokotoko hauora faaineine mo te ngira i te nui o 4 RW., 2 o nei e hiahiatia ana mō te rehunga o te rohe kiri te wahi e kia hanga te werohanga matua. Tētahi atu te hiahia i roto i te tikanga ki te tomo me te noho pū tōngāmimi rongoā, me te whakamutunga - mō te tango mamae rongoā i roto i te pūwero.

whakahaere rongoā

hanga rehunga filosilivá me epidural te manawanui e te noho takoto i runga i tona taha ranei. Ka rite ki te tikanga, whakamahia te tūranga whakamutunga kei te nui atu pinepine. I roto i tenei take, kia waiho te manawanui taea ki te whakapiko i tō hoki, whakakikī te huha ki te puku, me te upoko e aki ki tona uma.

Ko te hiako i roto i te rohe o te werohia te āta tukatuka me te kopaki ki te tauera horomata. meatia tenei e i roto i te ara ano e rite ana i mua i te hoko. I te scene o te poka whakamaheretia numbed te kiri. I tua atu, ki te whakahaere i te ngira i roto i te kiri tūtohutia te ki te hanga i te scalpel kuiti iti poka.

te tāutu i ngā tohunga e rua ngā tikanga o te āhua o taea te uru ki te wāhi epidural filosilivá: te tau waenga, me te paramedian. A, no te tuatahi whakaurua te ngira e i roto i te wahi pakaru i waenganui i ngā tukanga Osistem. I muri haere i roto i te kiri, me te ngako, kei reira i roto i te nadostistuyu tuatahi, a ka i roto i te nape interspinous. I roto i te tūroro ruhiruhia, e taea e ratou zakaltsinirovany e tino fakafaingata'a'ia'i te kōkuhu o te ngira.

whakarato tikanga lateral paramedian ranei i meatia i te werohanga e i roto i te rohe rohe, kei waenganui o te pekehoe. mahi whakatika i te wāhi 1.5 ranei 2 cm i te tukanga spinous. Ko whakamahia tenei tikanga te ka kore e nui ake te awa te tikanga poka waenga. e tūtohu ana i roto i te tūroro ki te mōmona me te ki tuhonohono sclerotic.

Ngā Āhuatanga o "epiduralki"

I mua i ngā mahi whakaritea, kia tūroro ki toketā fakamohé whakatau he aha e kia whakamahia ahua o rehunga. Ko e hiahia maha tūroro ki te matau ki ta te epidural me rehunga epidural. He aha te mea te rerekētanga i waenganui i enei tikanga e rua e kore e whiwhi ki te kitea i roto i. Ko e mo'oni, ko e rua ingoa mo te tikanga ano o rehunga, tukua ai e te faataoto i roto i roto i te tinana pū tōngāmimi āta enei.

kia mohio te tākuta te mita o te poka. Hei tauira, mō te ngira epidural kua ki te haere i roto i te paihere o te kōwhai. Hoki tenei whakaaro, he tango i te mandrel me te piri te pūwero, rewa ai te te konutai pūhaumāota, kia rite ki te waiho i te mirumiru rangi. Ka rite ki te ngira e tomo te paihere, te mirumiru rangi ka puta notia. Otiia tika ia, no te te matamata mai i roto i te rohe epidural.

Ano, e kore me te anesthesiologist wareware e pā ana ki te tahi atu mau rave'a ki te taki mēnā tūnga te ngira te tika. Ko te tika katoa, tohua e te ngaro o te inu cerebrospinal i roto i te ngira i muri i te reira manatoko e ripeka-stylet. aroturukitia hoki ki te whakarite kia kore fakafe'iloaki he nui iti o te saline hoki rere i roto i te ngira i muri i momotu te pūwero te. Otiia e kore e he te rārangi tino o tikanga whakamātautau tenei. kia kawe i te tākuta i te tātaritanga whānui ki te whakarite whakanohonga tika o te ngira.

rehunga epidural tā te hiahia ki te whakamahi i te pū tōngāmimi. Ko tōna whakataki, rite ki te tikanga, e kore e tapaea tetahi fifi. Kia i runga i te ripeka-ōrite me te whakaū o ona matatau i roto i te ngira ki te wāhi epidural. I muri iho, Kei te āta nekehia te ngira, ka whakaritea te pū tōngāmimi e kati tona wāhi putanga te raima bactericidal takai horomata ranei.

raau taero whakamahia

Hei whakaiti i te pōauautanga taea o rehunga epidural, he mea nui ki te whiriwhiri i te horopeta tika o te faataoto me mātau kawe i te tikanga iho o te poka. Ki te whakahaere i rehunga te whakamahi i rongoā whakarehu e purea ana e kore e nei i roto i korotutu.

I roto i ētahi wā, kua whakamahia he tikanga o "lidocaine" mo rehunga epidural. Ko te whakamahia hoki reira drugs pērā i "Ropivacaine", "Bupivacaine". I raro i te mātakitaki o rata tino tohu, me te wheako, ka tohua ki a ratou e taea te tāpiri ki taero no ki opiates. E nehenehe te reira i taua rongoā rite "rehunanu", "Promedol". Ko te inenga o enei moni he iti. taea e kore noa e rite te reira ki te tetahi whakamahia i roto i rehunga whānui.

Ki te whakataki o te faataoto i roto i te rohe epidural whakamutunga wehea reira i roto i ngā tohutohu rerekē. haere te reira i whakarunga, intervertebral kiko whakararo me te paravertebral roto i tatau taha. Ko te kupu, fakakaukau'i atu he aha kia te kukū o "dicain" mo te rehunga epidural, me mahara te reira e ka whakawhirinaki rohe analgesia i runga i te nui o te otinga, te kaha o te whakahaere, me te inenga. Haunga te taitara, hoki kia te whakamahi tikanga "Lidocaine", "Trimekain", "marcaine". Hoki kia whakamahi i te analgesia oti e pā ana ki 25-30 ml o anesthetics otinga mea. Ko whakaaro tenei nui te ki hei te mōrahi.

here e tika ana

Ahakoa te meka e tetahi o te haumaru contraindications rehunga epidural āta whakaaro ko ia tonu i reira. Ko ētahi o ēnei:

- spondylitis tuberculous;

- pustules i runga i te hoki;

- ru pāmamae;

- organic CNS;

- hira filosilivá matatini, reira mate me te kino pathological;

- ileus;

- tiango Cardiovascular ka hua i roto i te peritonitis;

- tu'unga urupa whānui o te manawanui;

- decompensation o te ngakau;

- tau o tamariki;

- nui haere te tūtohutanga ki te wāhanga faataoto;

- kēkeno o te tinana.

raruraru pea

Otiia e kore e wareware, e kore te mea te reira tonu ongonoa me kahore haere epidural tupu. Contraindications, pōauautanga i tupu, he mea e tika ana ki te kitea i roto i te aroaro o te haere koe ki te moenga ki te tepu whakahaere.

kia mohio ki te reira e te tikanga o te raveraa i taua rehunga matatini, pera he faufaa he tohu tākuta. Ko te tino mōrearea ko te putanga o te tiango hohonu i muri i rehunga tuaiwi epidural ranei. I roto i te nuinga o te wā, puta tenei huru ka pakaru Rura mater. No te mea o puta tenei pā o te innervation kaungāongo'i, rite te putanga, whakawhanakehia āhua iaia iti hypotension nui. Heoi, ka taea e tenei huru whakawhanake, me ka mahi tika, rehunga ka whakahaere ki te wahi nui o te faataoto, falala ki he whānui o te whakahaere mamae ngā.

Ko taea raruraru whakawhanake i roto i te wā postoperative. Ko ētahi o ēnei:

- tukanga inflammatory suppurative timata i roto i te awa o te ua (te tikanga riro i te take ture antiseptics takahi);

- pāhoahoa me hūhi i roto i te rohe hoki;

- paresis o nga topito o raro, whekau papatoiake (kia whakawhanake hoki o kino ki te filosilivá pakiaka taura ngira).

Ki te tūroro pohe to ki "rehunanu", ka hoki ratou ki te whai ki te mataara tata atu. I te tahi taime arata'i te reira ki te whārua romahā taua rehunga epidural. e kore te Contraindications ki te whakamahi o tenei tikanga anake tawhiti. Engari kia mahara e te mōrea o te korekore o piki respiration ki te whakanui ake i horopeta o rehunanu.

Āhuatanga o te rehunga tuaiwi

Ahakoa te ōritenga, i reira e nui ngā rerekētanga i waenganui i te epidural me rehunga tuaiwi. Hei tauira, e kore te mea pera nui te tūranga o te ngira i muri i te nape kōwhai poka. Ka rite ki te ngira haere i roto i te mater Rura, mana'o te tākuta he tikanga o te kore ngira. E kore te te pū tōngāmimi i roto i tenei momo o te rehunga tāutatia.

I roto i te whakatinanatanga o te poka Me whakarite e kua haere kore te ngira tawhiti rawa, a e kore e kino ia nga pakiaka o te ua. Faaite ki te meka e te ngā kē te matamata i roto i te wāhi subarachnoid, he mea e ahei, ki te tango koe i te stylet. Ko te kupu i te tīmata ngira tohaina inu cerebrospinal. Ki te tae mai te reira i taratahitahi ranei i iti rawa rahinga, he mea e tika ana ki te paku huri tona tūranga i te hurihanga. I muri ngira tāutanga tika timata ki te whakauru i anelgiziruyuschih tikanga. ko te iti rawa hoki te epidural ratou inenga.