Uburyo bukoreshwa
(I) Anesthesia
Brachial plexus block ikoreshwa kumaguru yo hejuru, icyorezo cya epidural cyangwa subarachnoid block ikoreshwa kumaguru yo hepfo, kandi anesthesia rusange cyangwa anesthesi yaho nayo irashobora gukoreshwa nkuko bikwiye.
(II) Umwanya
Amaguru yo hejuru: supine, inkokora yoroheje, ukuboko imbere yigituza.
Ibihimba byo hepfo: supine, ikibuno, gushimuta, guhindagurika kw'ivi hamwe no kuguru hamwe na dogere 90 yo kwagura dorsal.
(III) Urutonde rukurikirana
Urukurikirane rwihariye rwibikorwa byo gutunganya hanze ni ugusubiramo, gusubiramo no gukosora.
[Inzira]
Nukuvuga ko kuvunika kwabanje kubanza gusubirwamo (gukosora ubumuga bwo kuzenguruka no guhuzagurika), hanyuma bigacumita hamwe na pin kure yumurongo wavunitse hanyuma bikabanza gukosorwa, hanyuma bikongera bigashyirwa hamwe hanyuma bigacumita hamwe na pin hafi yumurongo wavunitse, hanyuma bigasubizwa muburyo bwo kunyurwa kuvunika hanyuma bigashyirwa muburyo bwuzuye. Mu bihe bimwe bidasanzwe, kuvunika kurashobora kandi gukosorwa no gukomeretsa mu buryo butaziguye, kandi mugihe ibintu bibyemereye, kuvunika birashobora kwimurwa, guhindurwa no kongera gukosorwa.
Kugabanya kuvunika]
Kugabanya kuvunika nigice cyingenzi cyo kuvura kuvunika. Niba kuvunika kugabanutse ku buryo bushimishije bigira ingaruka itaziguye kumiterere yo gukira kuvunika. Ivunika rirashobora gufungwa cyangwa munsi yicyerekezo gikurikije ibihe byihariye. Irashobora kandi guhindurwa ukurikije firime ya X-ray nyuma yumubiri wumubiri. Uburyo bwihariye nuburyo bukurikira.
1. Mu iyerekwa ritaziguye: Kubuvunika bufunguye bufite impera zavunitse, kuvunika birashobora gusubirwamo mubyerekezo bitaziguye nyuma yo kuvanaho neza. Niba kuvunika gufunze binaniwe gukoreshwa, kuvunika nabyo birashobora kugabanuka, gutoborwa no gukosorwa munsi yicyerekezo nyuma yo gutemwa gato kwa 3 ~ 5cm.
2. Uburyo bwo kugabanya gufunga: banza ukore kuvunika hafi hanyuma hanyuma ukore ukurikije uko bikurikirana, urashobora gukoresha pin yicyuma hafi yumurongo wavunitse, hanyuma ugakoresha uburyo bwo guterura no gufunga kugirango ufashe kuvunika kugirango bisubirwemo kugeza byuzuye. hanyuma bigakosorwa. Birashoboka kandi kugira ibyo uhindura muburyo bwo kwimuka cyangwa guhindagurika ukurikije X-ray nyuma yo kugabanuka no gukosorwa ukurikije ubuso bwumubiri cyangwa ibimenyetso byamagufwa. Ibisabwa kugirango ugabanye kuvunika, mubisanzwe, ni kugabanuka kwa anatomique, ariko kuvunika gukomeye gukabije, akenshi ntibyoroshye kugarura imiterere yambere ya anatomique, muriki gihe kuvunika bigomba kuba imikoranire myiza hagati yumutwe wavunitse, no gukomeza umurongo mwiza wingufu zisabwa.
[Pinning]
Gukora ni tekinike nyamukuru yo gukora amagufwa yo hanze, kandi tekinike nziza cyangwa mbi yo gutobora ntabwo igira ingaruka gusa kumitekerereze yo kuvunika, ariko kandi ifitanye isano nubwinshi cyangwa buke bwo kwandura. Kubwibyo, uburyo bukurikira bwo gukora bugomba gukurikizwa cyane mugihe uhuza urushinge.
1. Irinde kwangiriza ingwate: Sobanukirwa neza na anatomiya yikibanza cyo gutobora kandi wirinde gukomeretsa imiyoboro yamaraso n imitsi.
2. Ubuhanga bukomeye bwo gukora aseptic, urushinge rugomba kuba 2 ~ 3cm hanze yanduye.
3. Tekinike idahwitse: mugihe wambaye urushinge rwa kimwe cya kabiri na diameter yuzuye umubyimba wuzuye, kwinjira no gusohoka urushinge rwicyuma ukoresheje icyuma gityaye kugirango ukore uruhu rwa 0.5 ~ 1cm; mugihe wambaye igice cya inshinge, koresha imbaraga za haemostatike kugirango utandukanye imitsi hanyuma ushire urumogi hanyuma utobore umwobo. Ntukoreshe imbaraga zihuta zo gucukura mugihe cyo gucukura cyangwa guhuza inshinge. Nyuma yo guhambira urushinge, ingingo zigomba kwimurwa kugirango harebwe niba hari impagarara zuruhu kurushinge, kandi niba hari impagarara, uruhu rugomba gucibwa no kudoda.
4. Hitamo neza ahantu hamwe nu mfuruka y'urushinge: urushinge ntirugomba kunyura mumitsi nkibishoboka, cyangwa urushinge rugomba kwinjizwa mumyanya yimitsi: mugihe urushinge rwinjijwe mumurongo umwe, intera iri hagati ya inshinge mu gice cyacitse ntizigomba kuba munsi ya cm 6; iyo urushinge rwinjijwe mu ndege nyinshi, intera iri hagati yinshinge mugice cyacitse igomba kuba nini ishoboka. Intera iri hagati yipine n'umurongo wavunitse cyangwa ubuso bwa arctular ntigomba kuba munsi ya 2cm. Inguni yambukiranya ibinini mu inshinge nyinshi igomba kuba 25 ° ~ 80 ° kuri pin yuzuye na 60 ° ~ 80 ° kuri kimwe cya kabiri na pin yuzuye. .
5. Hitamo neza ubwoko na diameter y'urushinge rw'icyuma.
6. Kizingira umwobo urushinge neza hamwe na alcool ya gaz na sterile.
Umwanya w'urushinge rwa kure rwa humeral rwinjira mubijyanye nu mitsi yo mu mitsi y'amaraso yo hejuru (Umurenge ugaragara ku gishushanyo ni agace k’umutekano wo guhuza inshinge.)
[Gushiraho no gukosora]
Kenshi na kenshi kugabanya kuvunika, gukubita no gukosora bikorwa ubundi buryo, kandi gukosora birangira nkuko bisabwa mugihe ibyuma byateganijwe mbere byacumiswe. Ivunika rihamye ryakosowe hamwe no kwikuramo (ariko imbaraga zo kwikuramo ntizigomba kuba nini cyane, bitabaye ibyo guhinduka kwinguni kuzabaho), kuvunika kugabanijwe gukosorwa muburyo butabogamye, kandi inenge zamagufwa zishyirwa mumwanya wo kurangaza.
Uburyo bwo gukosora muri rusange bugomba kwitondera ibibazo bikurikira: 1.
1. Gerageza ituze ryo gukosorwa: uburyo nugukoresha icyerekezo, gushushanya birebire cyangwa kuruhande rusunika impera; iherezo rihamye ryavunitse ntirigomba kugira ibikorwa cyangwa gusa ibikorwa bike bya elastique. Niba ituze ridahagije, harashobora gufatwa ingamba zikwiye zo kongera ubukana muri rusange.
2. Intera iva kumagufwa yo hanze asohora uruhu: 2 ~ 3cm kumubiri wo hejuru, 3 ~ 5cm kumubiri wo hepfo, kugirango wirinde kwikuramo uruhu no koroshya kuvura ihahamuka, mugihe kubyimba bikomeye cyangwa ihahamuka rinini. , intera irashobora gusigara nini murwego rwo hambere, kandi intera irashobora kugabanuka nyuma yo kubyimba kugabanuka no guhahamuka.
3. Iyo iherekejwe no gukomeretsa bikomeye byumubiri, ibice bimwe birashobora kongerwamo kugirango urugingo rwakomeretse ruhagarike cyangwa hejuru, kugirango byorohereze kubyimba no kwirinda gukomeretsa.
4. Amagufa yo gutunganya amagufwa ya cadre yamagufa ntagomba kugira ingaruka kumyitozo yimikorere yingingo, ingingo yo hepfo igomba kuba yoroshye kugenda munsi yumutwaro, kandi ingingo yo hejuru igomba kuba yoroshye mubikorwa bya buri munsi no kwiyitaho.
5. Impera y'urushinge rw'icyuma irashobora guhura na clip yo gukosora inshinge zigera kuri 1cm, kandi umurizo muremure cyane w'urushinge ugomba gucibwa. Impera y'urushinge hamwe na kashe ya pulasitike cyangwa kaseti ipfunyitse, kugirango idacumita uruhu cyangwa guca uruhu.
[Intambwe zigomba guterwa mu manza zidasanzwe]
Ku barwayi bafite ibikomere byinshi, kubera ibikomere bikomeye cyangwa ibikomere byangiza ubuzima mu gihe cyo kuzura, ndetse no mu bihe byihutirwa nko gutabarwa bwa mbere mu murima cyangwa gukomeretsa mu cyiciro, urushinge rushobora kubanza gushyirwaho urudodo kandi rukabanza gukosorwa, hanyuma rukongera gukosorwa, byahinduwe, kandi bifite umutekano mugihe gikwiye.
[Ingorane zisanzwe]
1. Indwara ya pinhole; na
2. Gukomeretsa uruhu necrosis; na
3. Gukomeretsa kw'imitsi
4. Gutinda gukira cyangwa kudakiza kuvunika.
5. Amapine yamenetse
6. Kuvunika inzira
7. Gukora nabi
(IV) Kuvura nyuma yo kubagwa
Kuvura neza nyuma yubuvuzi bigira ingaruka ku buryo butaziguye ku mikorere y’ubuvuzi, bitabaye ibyo ibibazo nko kwandura pinhole no kudahuza kuvunika bishobora kubaho. Kubwibyo, hakwiye kwitabwaho bihagije.
[Ubuvuzi rusange]
Nyuma yo kubagwa, ingingo yakomeretse igomba kuzamurwa, kandi hagomba kugaragara umuvuduko wamaraso no kubyimba ingingo yakomeretse; mugihe uruhu rwahagaritswe nibigize igufwa ryo hanze ryamagufwa bitewe numwanya cyangwa kubyimba kwingingo, bigomba gukemurwa mugihe. Imiyoboro irekuye igomba gukomera mugihe.
[Kurinda no kuvura indwara]
Kubireba amagufwa yo hanze ubwayo, antibiotique ntabwo ikenewe kugirango wirinde kwandura pinhole. Ariko, kuvunika nigikomere ubwacyo bigomba gukomeza kuvurwa na antibiotique uko bikwiye. Kuvunika gukinguye, nubwo igikomere cyangiritse neza, antibiyotike igomba gukoreshwa muminsi 3 kugeza kuri 7, naho kuvunika kwanduye bigomba guhabwa antibiotike mugihe kirekire nkuko bikwiye.
[Pinhole care]
Imirimo myinshi nyuma yo gukosora amagufwa yo hanze irasabwa kwita kuri pinholes buri gihe. Kwitaho pinhole bidakwiye bizaviramo kwandura pinhole.
1. Mubisanzwe imyambarire ihindurwa rimwe kumunsi wa 3 nyuma yo kubagwa, kandi imyambarire igomba guhinduka buri munsi mugihe habaye gusohora kuri pinhole.
2
3. Iyo habaye impagarara kuruhu kuri pinhole, uruhande rwo guhagarika umutima rugomba gucibwa mugihe kugirango ugabanye impagarara.
4. Witondere imikorere ya aseptic mugihe uhindura amagufwa yo hanze cyangwa uhindura iboneza, hanyuma ukanduza uruhu ruzengurutse pinhole nurushinge rwicyuma buri gihe.
5. Irinde kwandura mugihe cyo kwita kuri pinhole.
6. Iyo indwara ya pinhole imaze kubaho, hakwiye kuvurwa neza kubaga, kandi ingingo yakomeretse igomba kuzamurwa kugirango iruhuke kandi hagomba gukoreshwa imiti igabanya ubukana.
[Imyitozo ikora]
Imyitozo ngororangingo ku gihe kandi ikwiye ntabwo ifasha gusa kugarura imikorere ihuriweho gusa, ahubwo ni no kongera kubaka haemodinamike no gukangura imihangayiko kugirango biteze imbere gukira kuvunika. Muri rusange, kugabanya imitsi hamwe nibikorwa bihuriweho bishobora gukorwa muburiri bitarenze iminsi 7 nyuma yo kubagwa. Ibihimba byo hejuru birashobora gukora ugufata no gufata amaboko hamwe nigikorwa cyigenga cyikiganza ninkokora, kandi imyitozo yo kuzunguruka irashobora gutangira nyuma yicyumweru 1; ingingo zo hepfo zirashobora kuva muburiri igice zifashishije inkoni nyuma yicyumweru 1 cyangwa igikomere kimaze gukira, hanyuma buhoro buhoro ugatangira kugenda ufite uburemere bwuzuye nyuma yibyumweru 3. Igihe nuburyo bwo gukora imyitozo biratandukanye kubantu, cyane cyane bitewe nuburyo bwaho na sisitemu. Mugihe cyimyitozo ngororamubiri, niba pinhole igaragara itukura, yabyimbye, ibabaza nibindi bigaragara byerekana umuriro bigomba guhagarika ibikorwa, kuzamura ingingo yibasiwe kuruhuka.
[Kurandura amagufwa yo hanze]
Ikibaho cyo gukosora hanze kigomba kuvaho mugihe kuvunika bigeze kubipimo byubuvuzi kugirango bikire. Mugihe ukuyeho igufwa ryo hanze ryamagufwa, imbaraga zo gukiza zavunitse zigomba kugenwa neza, kandi gukosora amagufwa yo hanze ntibigomba gukurwaho hakiri kare nta gushidikanya ko kumenya imbaraga zo gukiza amagufwa nibibazo bigaragara byo gutunganya amagufwa yo hanze, cyane cyane mugihe cyo kuvura ibintu nko kuvunika bishaje, kuvunika gukabije, no kudahuza amagufwa.
Igihe cyo kohereza: Kanama-29-2024
