Spinal kunye ebulewe (ebulewe) zomzimba - yintoni umahluko? Ukusetyenziswa, Izimo, iingxaki kunokwenzeka

Yemifuniselo yokuqala ukusetyenziswa zomzimba spinal, imvelaphi yayo elandwa 1898, kodwa ngokubanzi, le ndlela zomzimba ifumene kakhulu kamva. Ukusebenzisa le ndlela, ugqirha kufuneka babe nolwazi inxalenye kwendlela ezakhiwe ngayo umnqonqo kunye iinwebu zayo.

zomzimba ebulewe spinal

Ezi iindlela zomzimba ezi lwengingqi. Ngexesha ekuphatheni iintlungu into lesitofu indawo ekhethekileyo ibekwe kufuphi umnqonqo. Ngenxa le "frozen" kwisiqingatha esezantsi umzimba. Abaninzi abazi nokuba kukho umahluko phakathi zomzimba nomqolo kunye ebulewe.

Inkqubo yokulungisa kunye nokuphunyezwa kwe zomzimba ezi ndlela ezifanayo. Eneneni, kuzo zombini ezi meko, into wadutyulwa emqolo. Umahluko Inqununu ukuba iyunithi ziphene iintlungu spinal ekubhekiselwe kuyo, yaye ebulewe (peridural) - ufakelo ityhubhu ekhethekileyo obhityileyo ekuthe ndindisholo ilawulwa kangangexesha elithile.

Kodwa buciko - akunakuba umahluko phakathi kwezi ndlela zimbini ntlungu. zomzimba spinal isetyenziswa kwiimeko apho kukho imfuneko yokwenza oko kuzuzwe isiphumo elifutshane. Ngokuxhomekeka kuhlobo iziyobisi ubude analgesia zingaqala iiyure-1 ukuya ku-4. zomzimba ebulewe ayiphelelanga yi ixesha. Ukubulawa uya kuqhubeka logama nje imvelaphi inyuselwa khona nge-catheter emzimbeni womntu uza kufakwa iintlungu. Amaxesha amaninzi le ndlela isetyenziswa kukukhupha isigulana ngentlungu kuphela xa kusenziwa utyando, kodwa kwixesha postoperative.

isimiso ukusebenza

zomzimba ebulewe kunye ebulewe - a zomzimba yengingqi, apho amachiza lesitofu kwisithuba ebulewe yomqolo. Umgaqo layo lokusebenza lisekelwe kuloo amachiza asetyenziswa ngokusebenzisa dural sleeve beyela kwisithuba subarachnoid. Ngenxa yoko, lihlaleni la yi luvo radicular apha emqolo uthintelwe.

Emva kokuba ichiza elo lilawulwa kufutshane iiseli zemithambo-luvo buti. Yaye zinoxanduva imbonakalo intlungu kwiindawo ezahlukeneyo lomzimba ebenza ebuchotsheni.

Kuxhomekeka indawo yolawulo ukuze khubaza umsebenzi motor novakalelo kwiindawo ezithile zomzimba. Amaninzi, zomzimba ebulewe isetyenziselwa "cima" kwisiqingatha esezantsi umzimba. Ukuze wenze oku, kufuneka ufake ndindisholo kwisithuba intervertebral phakathi T10-T11. Kuba zomzimba kummandla Isifuba beziyobisi yaziswa kummandla phakathi T2 kunye T3, nakwisiqingatha phezulu esiswini nga anesthetize nini ukuba bafake kwindawo vertebra T7-T8. Ummandla amalungu zangasese, "icinyiwe" emva kokwaziswa ndindisholo kwi va L1-L4, imilenze ephantsi - L3-L4.

Izinto ezibonisa ukuba ukusetyenziswa kwe Ukubulawa lommandla

zomzimba ebulewe spinal zingasetyenziswa ngokwahlukeneyo kwaye zidityaniswe kunye jikelele. Le ndlela yokugqibela kusetyenziswa kwiimeko apho utyando yokuziphatha thoracic ecwangcisiweyo (esifubeni) okanye ungenelelo zotyando ixesha elide kwingingqi esiswini. indibanisela yazo kunye nokusetyenziswa iintlungu yokunciphisa imfuneko yokuba izigulane ukuba opioids.

Ngokwahlukeneyo, zomzimba ebulewe ukuze zisetyenziswe kwezi meko:

- ntlungu emva kotyando;

- zomzimba yendawo ngexesha lokuzalwa komntwana;

- imfuneko ukuphumeza imisebenzi iinyawo kunye nezinye iinxalenye kwesiqingatha esezantsi umzimba;

- icandelo ngoqhaqho.

Kwezinye iimeko, sebenzisa kuphela i ebulewe. Lusetyenziswa, ukuba kuyimfuneko, enze imisebenzi:

- kule isinqe, umlenze, iqatha, ezinkulu lesiquluba ;

- replacement kasikrobana okanye idolo amalungu;

- ukwa entanyeni femoral ;

- Ithemba.

zomzimba spinal zingasetyenziswa njenge indlela ukunyanga iqolo. Lidla kwenziwa emva kotyando. Kwakhona isetyenziswa kutyando nemithambo kwezo meko xa kuyimfuneko ukwenza ungenelelo ngoncedo kwi yesiqephu asezantsi.

ntlungu zabasebenzi

Ngakumbi nangakumbi abafazi usebenzisa zomzimba ebulewe okanye emqolo, ukuze uzive kwamathumbu ezibuhlungu. Xa ufakwe intlungu iintlungu shwaka, kodwa ezingqondweni lugciniwe ngokupheleleyo.

zomzimba ebulewe ngexesha lokuzalwa isoloko isetyenziswa kumazwe aphuhlileyo. Ngokutsho manani, isetyenziswa malunga nama-70% abasetyhini lokuzala. Olu hlobo zomzimba ikuvumela ukuba anesthetize inkqubo yonke zokubeleka. Kulo mzekelo, ingane ayiphazamiseki.

Nangona isibakala sokuba lokuzalwa yinkqubo yendalo komzimba, nto leyo ayifuni ungenelelo ngaphandle, abafazi ngokuya inyanzelise ukuba anesthetized. Nangona ngexesha lokuzalwa, umzimba uvelisa kulayishwa idosi iiendorphin. Ikhuthaza ntlungu zendalo, ngokuba ezi emzimbeni abakwaziyo ukunika i lift ngokweemvakalelo, abayithintelayo imvakalelo yoloyiko neentlungu.

Nangona kunjalo, indlela yemveliso iiendorphin kuxhomekeka kwimeko kwaye isimo kwabasetyhini. Umzekelo, ixesha elide zabasebenzi kunye neentlungu kakhulu kuba nefuthe elibi zombini kanye njengomfazi ozalayo, kunye nosana olungekazalwa. Ukongeza, kukho umfazi ukwandisa xi ukuqala ngokuqhawuka, abangele uphazamiseko izihlunu eziphambili - intliziyo. Kwiimeko ezinjalo, zomzimba kuyimfuneko.

Kodwa epidurals enokwenziwa kuphela ngendlela ecwangcisiweyo. Izimo ukuba sithwalwe ngazo ngaphandle ivamile. Kodwa kwiimeko kakhulu musa ukusebenzisa nto noko, ngenxa yokuba ifuthe layo lungenzeki washona. Ukususela ekuqalekeni ngokuqaliswa iintlungu kunye ukugqibezela ntlungu ingathatha isiqingatha seyure.

uqeqesho bokuqonda

Ukuba kunokwenzeka, yomguli pre-elungiselelwe ukuziphatha zomzimba. Ukuba uceba ebulewe (peridural), zomzimba spinal, isigulana inikwa ngokuhlwa ukuya 0,15 g lithetha "Phenobarbital". Ukuba kuyimfuneko, oko linokukwenziwa kunye tranquilizer. Ngokuqhelekileyo, oogqirha basebenzisa iziyobisi "Diazepam" okanye "hlozepida". Kwakhona, kwenye iyure phambi kokuba isitofu yolawulo zomzimba intramuscular kuthetha iziboniso "Diazepam" okanye "Promethazine 'inokuba kwakhona abele" icaffeine "yaye" atropine "okanye" Fentalin ".

Kwakhona, inyathelo mandatory kulungiselelwe ivale wawuqalekisa. Ifuna neqhiya (ezinkulu nezincinane), iiglavu engenazintsholongwane irabha, iibhola igozi, iinaliti, iisirinji, catheters, kunye amashiya ezimbini iiglasi ezimbini izisombululo iintlungu. Kubalulekile kwakhona ukuba ukulungiselela yonke into eyimfuneko ukuze akwazi ukuphelisa iingxaki kunokwenzeka. Ngale zomzimba akakwazi ngaphandle amathuba ukuphazamiseka kakhulu inkqubo yonikezelo igazi nokuphefumla.

Ngaphambili walungisa iisirinji-2, enye yazo kufuneka ibe ngumqulu ml-5, kwaye eyesibini - 10 ml. Kwakhona, abasebenzi bezempilo elungiselela ukuba inaliti isixa iiPC 4., 2 ezo eziyimfuneko zomzimba ummandla ulusu apho kuya kwenziwa inaliti engundoqo. Enye imfuneko ukuze bangene baze bachithe catheter iintlungu, nabokugqibela - ngokuthatha amayeza iintlungu emzimbeni walo.

ulawulo iintlungu

zomzimba spinal kunye ebulewe kwenza umguli lowo uhleli okanye ulele ngecala. Njengoko umthetho, ukuma yokugqibela isetyenziswa kakhulu ngakumbi rhoqo. Kulo mzekelo, isigulane kufuneka kunokwenzeka ukuba sigobe umva wakho, nsinya nethanga esisu kunye nentloko licinezelwe esifubeni sakhe.

Isikhumba kule ndawo isitofu kusetyenzwa ngononophelo kwaye kusongelwe kunye iitawuli abawaziyo. Oku kwenziwa ngendlela efanayo phambi yingisela. Xa imeko okuhlatywa izicwangciso esikhumbeni ndindisholo. Ukongeza, ukwenza lula inaliti ngesikhumba Kucetyiswa ukuba wenze okuhlatywa kuphungula encinane elimxinwa.

Iingcali ukuchonga iindlela ezimbini njani zingafumaneka ukuya kwindawo spinal ebulewe: amanqaku angumndilili paramedian. Xa kuqala inaliti eyafakwa umsantsa phakathi kweenkqubo Osistem. Emva edlula ulusu kunye namanqatha, oko kuhlala nadostistuyu kuqala, uze emva koko kwi lungu interspinous. Kubantu abalupheleyo, inokuba zakaltsinirovany ukuba kakhulu nzima ukuba kufakwe inaliti.

indlela osecaleni okanye paramedian ubonelela ukuba isitofu kwenziwa kummandla umda, ephakathi amathambo. YoLungiso-sandi lweSihambisi lwenziwa ukusuka kwindawo 1.5 okanye 2 cm ukusuka iinkqubo spinous. Kodwa le ndlela isetyenziswa xa ijelo ayidluli indlela okuhlatywa udibaniso. Kuyacetyiswa kwizigulane kunye nokutyeba kunye nemisipha sclerotic.

Iimpawu "epiduralki"

Phambi imisebenzi ecwangcisiweyo, izigulane Iintlungu ukugqiba uhlobo zomzimba iza kusetyenziswa ntoni. Kodwa izigulane abaninzi bafuna ukuqonda ukuba yintoni na ebulewe kunye Ukubulawa ebulewe. Yintoni umahluko phakathi kwezi ndlela zimbini abayifumani ukufumana phandle. Eneneni, la amagama amabini indlela efanayo zomzimba, apho ndindisholo ikhutshwa kwi ngomzimba catheter ngokuthe ngcembe.

Ugqirha kufuneka bayazi bokuqonda le okuhlatywa. Umzekelo, ukuba inaliti ebulewe kufuneka zidlule ligquba omthubi. Ukulungiselela le njongo, le mandrel na ezisusiweyo kunye nesirinji iqhotyoshelwe, apho chloride sodium iyapheliswa, ukwenzela ukuba ashiye i-air kwiqamza. Kwathi kamsinya nje akuba inaliti engena esiqhumeni, kwiqamza umoya izakuvela ekrwitshiweyo. Kodwa waqonda ngokukhawuleza kwincam iza kummandla ebulewe.

Kwakhona, lo anesthesiologist kufuneka ungalibali ngezinye iindlela ukujonga ukuba ngaba inaliti imiswe ngokuchanekileyo. Ilungile loo nto, kuboniswe kukungabikho ulwelo fluid kwi inaliti emva kokuba zingqinwe cross-stylet. Kwakhona esweni ukuze kuqinisekiswe ukuba kukho imali encinane saline wazisa ibingafumaneki buyela inaliti emva kokuba isirinji kobonelelo. Kodwa oku uluhlu olupheleleyo iindlela zovavanyo. Ugqirha kufuneka enze unxilongo esibanzi ukuqinisekisa ukufakwa ngokufanelekileyo inaliti.

zomzimba ebulewe kubandakanya imfuneko yokusebenzisa i catheter. ingenisiwe, ukuba umthetho, angezanga naziphi na iingxaki. Xa emnqamlezweni ethelekisa nokuqinisekiswa yoveliso oluqhubele phambi kwaso ngenaliti kwisithuba ebulewe. Emva koko, lo inaliti kancinane kususwe, kwaye catheter busisigxina ngokuvala yayo uphumo indawo udaka bactericidal okanye bandage wawuqalekisa.

amachiza asetyenziswa

Ukunciphisa iingxaki zomzimba ebulewe kunokwenzeka, kubalulekile ukuba ukhethe idosi esichanekileyo ndindisholo kwaye ngobuchule iqalise le nkqubo ngokwawo okuhlatywa. Ukuqhuba zomzimba usebenzisa izisombululo ntlungu lihlanjululwe ezo ayiqulathanga kwisigcinakaliso.

Kwezinye iimeko, njengendlela "lidocaine" lisetyenziswa xa Ukubulawa ebulewe. Kodwa kananjalo wasebenzisa iziyobisi ezifana "Ropivacaine", "Bupivacaine". Phantsi kweliso ugqirha kakhulu nabanamava xa yabonisa kubo zifakwe eziyobisi abangabakhe opiates. Kusenokuba amayeza afana "icaffeine", "Promedol". Kodwa ke umthamo kwezi mali kuba ncinci. Alinako ziyekile kuthelekiswa lowo kusetyenziswa ngexesha Ukubulawa jikelele.

Ngenxa ukuqaliswa iintlungu kwindawo ebulewe asasazwa yokugqibela kumacala ahlukeneyo. Ithe phe phezulu, izicwili intervertebral phantsi baze paravertebral ngokusebenzisa kwimingxuma icala. Ngenxa yoko, nokuhlanganisa kufuneka ibe yintoni uyondelelwano lwee- "dicain" ngenxa zomzimba ebulewe, kufuneka kukhunjulwe ukuba ummandla analgesia iza kuxhomekeka kwimali yesisombululo, amandla nolawulo kunye balawule. Ngaphandle kwesihloko, nazo zingasetyenziswa lithetha "Lidocaine", "Trimekain", "marcaine". Kuba analgesia epheleleyo angasebenzisa malunga 25-30 ml iintlungu isisombululo utshilo. Kodwa lo mali kucingwa ukuba ubuninzi.

izithintelo ezidingekayo

Nangona isibakala sokuba omnye Izimo ikhuselekileyo zomzimba ebulewe luthathwa wayesebenza khona. Ezi ziquka:

- spondylitis tuberculous;

- pustules phezu ngasemva;

- yashiya ebuhlungu;

- organic CNS;

- nesilima entsonkothileyo spinal, oko izifo kunye umonakalo zophendlo lwezifo;

- ileus;

- ukuwa sentliziyo kwaphumela peritonitis;

- imeko jikelele engcwabeni ye yesigulana;

- decompensation intliziyo;

- Abantwana ubudala;

- anda ubuntununtunu amacandelo iintlungu le;

- zokuncipha umzimba.

neengxaki

Kodwa musa ukulibala ukuba akusoloko yalula kwaye ngaphandle yoko idlule ebulewe. Izimo, izigulo ukuba yenzeke, oko kuyimfuneko ukufumana phandle phambi kokuba uye kulala etafileni yokusebenza.

Kufuneka kuqondwe ukuba ubuchule ukwenza zomzimba ezintsonkothileyo, ngoko ke isiqinisekiso ugqirha ibalulekile. Eyona eyingozi ukuvela yokuwa nzulu emva zomzimba nomqolo okanye ebulewe. Kwiimeko ezininzi, le meko yenzeka xa yonakele laseDura mater. Ngenxa yale kuvalwe iindlela i innervation onovelwano kwenzeka, ngenxa yoko, ukuncipha ilizwi nemithambo liphuhlise hypotension kakhulu. Nangona kunjalo, le meko ukuphuhlisa, yaye xa kwenziwa ngokuchanekileyo, zomzimba xa elawulwa ukuba nenxaxheba enkulu okuphelisa iintlungu, sithembele kuluhlu olubanzi yolawulo intlungu.

Kodwa iingxaki ukuphuhlisa kwixesha postoperative. Ezi ziquka:

- ekuqaleni inkqubo suppurative ukudumba kwi enikelwe umnqonqo (isizathu udla imithetho ebulala ukungathobeli);

- yintloko kuhlolwe kwindawo umva;

- paresis kweqondo asezantsi, amalungu zangasese (nxeba ngenxa yomonakalo kwi-spinal iingcambu intambo inaliti).

Ukuba izigulane anesthetized with "icaffeine", emva koko ukuba kufuneka ukubukela ngokusondeleneyo kakhulu. Maxa wambi ngokuphumela kuxinezeleko yokuphefumla loo Ukubulawa ebulewe. Izimo ukusetyenziswa kwale ndlela kuphela ukuba bodwa. Kodwa khumbula ukuba umngcipheko uxinezeleko lusanda nokuphefumla kunye ukwandisa ithamo icaffeine.

Iimpawu zomzimba spinal

Nangona ukufana, kukho umahluko omkhulu phakathi ebulewe kunye Ukubulawa spinal. Umzekelo, ukuba indawo inaliti emva kokuba okuhlatywa lungu emthubi nto kubaluleke kangaka. Kamsinya nje inaliti sidlula mater Dura, ugqirha uvakalelwa ingqiqo ukusilela inaliti. Le catheter kule hlobo zomzimba ayifakwanga.

Xa ukuphunyezwa okuhlatywa kufuneka kuqinisekiswe ukuba inaliti iye akaphumanga kude kakhulu kwaye ayinakulimaza esineengcambu umnqonqo. Bayayazi into yokuba kwincam sele ifakiwe kwisithuba subarachnoid, kunokwenzeka, ukuba asuse stylet. Ngaloo ukusuka siqala inaliti eyabelwe cerebrospinal fluid. Ukuba uza nqapha okanye izixa enganelanga, kuyimfuneko ukuba utshintshe kancinane endaweni yayo ujikelezo. Emva iinaliti ufakelo oluchanekileyo aqale azise anelgiziruyuschih iindlela. umthamo yabo ngaphantsi kwe ukuba ebulewe.