Cov Txheej Txheem Saib Xyuas Neeg Mob rau Cov Neeg Mob uas Muaj Kab Mob Hlwb
Cov kab mob ntawm lub paj hlwb suav nrog ntau yam mob uas cuam tshuam rau cov hlab ntsha hauv nruab nrab thiab sab nraud, suav nrog mob stroke, raug mob taub hau, qaug dab peg, mob meningitis, qog hauv hlwb, Parkinson's kab mob, ntau yam sclerosis, peripheral neuropathy, thiab cov kab mob ntawm cov leeg nqaij. Qhov cuam tshuam ntawm cov kab mob no feem ntau nyuaj heev, vim tias lawv tuaj yeem hloov pauv kev nco qab, kev txav mus los, kev hais lus, kev nqos, kev xav, tus cwj pwm, thiab kev ua haujlwm ntawm lub cev xws li kev ua pa thiab ntshav siab. Yog li ntawd, kev saib xyuas neeg mob rau cov neeg mob ntawm lub paj hlwb yuav tsum ua kom zoo, tsom mus rau kev nyab xeeb ntawm tus neeg mob, saib xyuas ze ntawm kev hloov pauv ntawm cov xwm txheej ntawm lub paj hlwb, kev tiv thaiv cov teeb meem, thiab kev txhawb nqa rau kev kho mob thiab kev kawm ntawm tsev neeg.
1. Kev Ntsuam Xyuas Kev Saib Xyuas Neeg Mob Hlwb
Kauj ruam thawj zaug yog ua qhov kev ntsuam xyuas kom meej siv txoj kev ABCDE (Airway, Breathing, Circulation, Disability, Exposure), tshwj xeeb tshaj yog rau cov neeg mob mob hnyav. Thaum cov cim tseem ceeb ruaj khov, tus kws saib mob yuav ua qhov kev ntsuam xyuas lub paj hlwb.
Cov khoom tseem ceeb ntawm kev ntsuam xyuas suav nrog:
– Qib kev nco qab: Soj ntsuam siv Glasgow Coma Scale (GCS) lossis lwm qhov ntsuas raws li qhov chaw kho mob. Kev hloov me me hauv GCS tuaj yeem yog ib qho cim qhia tias muaj kev puas tsuaj ntxiv.
– Cov cim qhia tseem ceeb thiab cov ntshav khiav zoo: ntshav siab, lub plawv dhia ceev, ua pa ceev, kub, oxygen saturation. Tej yam tsis zoo yuav qhia tau tias lub hlwb muaj zog ntau, muaj kab mob, lossis ua haujlwm tsis zoo.
– Kev kuaj xyuas cov qhov muag: qhov loj, qhov sib npaug, thiab qhov kaj rov qab los. Cov qhov muag uas nthuav dav thiab tsis teb rau qhov teeb meem yuav tsum raug suav hais tias yog ib qho cim ntawm kev herniation lossis kev siab hauv lub hlwb ntau ntxiv.
- Kev ua haujlwm ntawm lub cev thiab kev hnov: lub zog ntawm cov leeg nqaij, lub suab, kev sib koom tes, qhov tsis muaj zog ntawm ib sab, tshee hnyo, spasticity, paresthesia, lossis txo qis kev hnov.
- Kev ua haujlwm ntawm lus thiab kev paub: kev taw qhia, kev hais lus, kev nkag siab cov lus txib, aphasia, dysarthria, kev hloov pauv tus cwj pwm.
- Mob thiab mob taub hau: tus cwj pwm, qhov hnyav, cov yam ua rau mob, nrog rau xeev siab, ntuav lossis ntshai duab.
- Keeb kwm mob nkeeg: pib muaj cov tsos mob, cov yam ua rau muaj kev pheej hmoo (ntshav siab, ntshav qab zib, haus luam yeeb), keeb kwm qaug dab peg, siv tshuaj anticoagulant, keeb kwm raug mob, thiab ua xua.
Cov kev ntsuam xyuas raug ua tsis tu ncua nrog qhov zaus txiav txim siab los ntawm tus neeg mob tus mob (piv txwv li txhua 15-60 feeb hauv theem mob hnyav).
2. Tswj Kev Ua Pa thiab Kev Ua Pa
Hauv cov teeb meem ntawm lub paj hlwb, qhov kev pheej hmoo ntawm kev nqus pa thiab kev ua pa tsis zoo nce ntxiv, tshwj xeeb tshaj yog rau cov neeg mob uas tsis nco qab lossis muaj teeb meem nqos. Cov txheej txheem tseem ceeb ntawm kev saib xyuas neeg mob suav nrog:
- Soj ntsuam qhov ua pa tau zoo, muaj cov kua qaub tawm, suab ua pa, thiab tus cwj pwm ua pa.
– Tso tus neeg mob lub taub hau ntawm lub txaj rau ntawm 30 degrees (tshwj tsis yog tias tsis muaj kev txwv) kom pab ua pa thiab txo qhov kev pheej hmoo ntawm kev nce siab hauv lub hlwb.
- Siv lub tshuab nqus tsev raws li qhov xav tau kev siv tshuaj aseptic thiab lub sijhawm luv luv los tiv thaiv hypoxia.
- Saib xyuas qhov oxygen saturation thiab muab kev kho mob oxygen raws li cov lus qhia kho mob.
- Txheeb xyuas cov cim qhia tias koj lub cev nqus tau dej: hnoos thaum noj mov, suab nrov nrov, ua pa luv luv, lossis tsis nqus dej txaus.
Yog tias tus neeg mob muaj teeb meem dysphagia, kev kho mob yuav tsum ua raws li kev ntsuam xyuas kev nqos. Kev pub mis rau hauv qhov ncauj tuaj yeem ua los ntawm kev siv lub raj mis nasogastric (NGT) lossis lwm txoj hauv kev, yog tias muaj kev nyab xeeb.
3. Kev Saib Xyuas Qhov Xwm Txheej ntawm Lub Hlwb thiab Kev Tiv Thaiv Kev Nce Siab Hauv Lub Taub Hau
Cov kws tu mob ua lub luag haujlwm tseem ceeb hauv kev kuaj pom thaum ntxov ntawm kev puas tsuaj ntawm lub paj hlwb. Cov haujlwm tseem ceeb suav nrog:
- Saib xyuas GCS, cov qhov muag, lub zog ntawm lub cev, thiab cov cim tseem ceeb tsis tu ncua.
- Tsis txhob ua tej yam uas ua rau lub hlwb muaj zog ntxiv: hypercapnia, hypoxia, kub taub hau, mob heev, thiab raug txhawb ntau dhau.
- Tuav lub taub hau kom ncaj, tsis txhob khoov caj dab lossis tig uas cuam tshuam cov ntshav ntws.
– Txwv txoj kev siv Valsalva: qhia kom siv cov txuj ci hnoos kom zoo, tsis txhob cem quav nrog kev pab kom tso zis tawm (haus dej kom txaus, muaj fiber ntau, thiab tso zis raws li qhov kev pab cuam).
- Tswj qhov kub ntawm lub cev, vim tias qhov kub taub hau ua rau lub hlwb xav tau oxygen ntau ntxiv.
- Saib seb puas muaj cov cim qhia tias ICP nce ntxiv: mob taub hau zuj zus tuaj, ntuav tawm ntawm lub qhov ntswg, tsis nco qab, cov qhov muag hloov pauv, lub plawv dhia tsis zoo thiab ntshav siab (Cushing's triad).
Yog tias lub chaw siv cov khoom siv saib xyuas ICP, cov kws tu mob yuav saib xyuas cov nqi, xyuas kom meej tias lub kaw lus tsis muaj qhov xau, thiab tswj kom tsis muaj kab mob.
4. Kev Tswj Xyuas Kev Qaug Dab Peg thiab Kev Nyab Xeeb ntawm Tus Neeg Mob
Cov neeg mob hlwb, tshwj xeeb tshaj yog cov neeg uas muaj qaug dab peg lossis raug mob hlwb, muaj feem yuav mob qaug dab peg. Cov txheej txheem saib xyuas neeg mob suav nrog:
– Npaj ib qho chaw nyab xeeb: cov ntaiv txaj raug tsa thiab tiv thaiv qhov twg muaj, cov khoom ntse raug tshem tawm.
- Muab cov pa oxygen thiab cov pa nqus ze ntawm tus neeg mob.
– Yog tias muaj qaug dab peg: tsis txhob txwv tus neeg mob txoj kev txav mus los, tsis txhob muab khoom rau hauv qhov ncauj, tso tus neeg mob rau ntawm lawv ib sab kom tswj tau txoj kev ua pa, sau cia lub sijhawm thiab hom qaug dab peg.
– Tom qab qaug dab peg: ntsuam xyuas kev ua pa, qib kev nco qab, kev raug mob, thiab ua cov cim tseem ceeb thiab kev kuaj mob hlwb.
- Kev koom tes hauv kev muab cov tshuaj anticonvulsant raws li tau sau tseg thiab saib xyuas cov kev mob tshwm sim xws li kev siv tshuaj loog ntau dhau lossis kev nyuaj siab ntawm kev ua pa.
5. Kev Tiv Thaiv Cov Teeb Meem ntawm Kev Tsis Tuav Tes
Cov leeg nqaij tsis muaj zog, hemiparesis, lossis tuag tes tuag taw ua rau muaj kev pheej hmoo ntawm cov kab mob ulcers, cov leeg ntshav tob, thiab kev sib cog lus. Kev pab cuam saib xyuas neeg mob suav nrog:
– Rov qab zaum tsawg kawg yog txhua ob teev, siv lub txaj pw tiv thaiv decubitus yog tias tsim nyog.
- Kev kuaj xyuas qhov zoo ntawm daim tawv nqaij, tshwj xeeb tshaj yog nyob rau thaj chaw uas pom tseeb ntawm cov pob txha.
- Kev tawm dag zog passive thiab active raws li kev kam rau siab.
- Siv cov thom khwm nruj lossis cov khoom siv tiv thaiv thrombosis raws li qhov kev pab cuam.
- Yog tias muaj mob, mus ntsib kws kho mob lub cev ua ntej.
Cov kws tu mob kuj yuav tsum tau saib xyuas cov cim ntawm DVT xws li o ib sab, mob plab hlaub, lossis liab, thiab qhia lawv tam sim ntawd.
6. Kev Saib Xyuas Kev Noj Haus, Kev Nqos, thiab Kev Tshem Tawm
Cov kab mob ntawm lub paj hlwb feem ntau cuam tshuam rau kev noj haus vim yog dysphagia, xeev siab, lossis txo qis kev nco qab. Cov txheej txheem saib xyuas neeg mob:
- Soj ntsuam seb koj noj zaub mov li cas, qhov hnyav ntawm koj lub cev, thiab koj noj dab tsi txhua hnub.
– Ua kev kuaj mob dysphagia; yog tias xav tias muaj teeb meem, tsum tsis txhob noj kom txog thaum kuaj xyuas ntxiv.
– Muab zaub mov zaum ncaj, muab me me, thiab muab cov khoom noj uas zoo li cov lus qhia.
- Tswj kev tu cev qhov ncauj kom huv si tiv thaiv kev kis kab mob thiab ua kom muaj kev nplij siab ntxiv.
– Saib xyuas kev tso zis: tso zis tsis tau, tso zis tsis tau, cem quav. Kev kho mob suav nrog kev teem sijhawm mus rau chav dej, kev tso catheter yog tias qhia, thiab kev tswj cov kua dej.
Kev cem quav yuav tsum tau kho vim tias nws tuaj yeem ua rau muaj kev siab ntxiv hauv lub hlwb vim yog kev siv zog.
7. Kev Txhawb Nqa Kev Sib Txuas Lus thiab Kev Noj Qab Haus Huv ntawm Lub Siab thiab Lub Zej Zog
Cov neeg mob uas muaj aphasia, dysarthria, lossis kev puas hlwb xav tau txoj kev sib txuas lus tshwj xeeb:
Siv cov kab lus luv luv, meej, muab sijhawm los teb.
- Siv cov duab kos, cov ntawv sau, lossis cov lus qhia uas tsis yog lus.
– Koom nrog tsev neeg kom nkag siab txog tus neeg mob tus cwj pwm sib txuas lus.
- Muab kev txhawb nqa kev xav rau cov neeg mob yooj yim ntxhov siab, nyuaj siab, lossis chim siab vim muaj kev txwv kev ua haujlwm.
Cov kws tu mob kuj yuav tsum tau soj ntsuam qhov kev pheej hmoo ntawm kev chim siab, tshwj xeeb tshaj yog rau cov neeg mob laus, thiab tsim kom muaj ib puag ncig uas nyob ntsiag to thiab muaj tseeb (lub moos, daim ntawv qhia hnub, teeb pom kev zoo txaus).
8. Kev Koom Tes Ua Haujlwm thiab Kev Kho Dua Tshiab ntawm ntau yam kev kawm sib txawv
Kev saib xyuas zoo rau cov neeg mob hlwb yog muab los ntawm ib pab neeg: cov kws kho mob, cov kws tu mob, cov kws kho lub cev, cov kws kho mob ua haujlwm, cov kws kho kev hais lus, cov kws noj zaub mov, thiab cov neeg ua haujlwm hauv zej zog. Cov kws tu mob ua haujlwm ua cov neeg sib txuas lus, xyuas kom meej tias txoj kev npaj kho mob tau ua tiav thiab cov kev xav tau ntawm tus neeg mob tau ua tiav.
Kev kho kom rov zoo thaum ntxov pab kom rov zoo li qub. Cov kws tu mob txhawb kom muaj kev tawm dag zog kom muaj kev nyab xeeb, cob qhia cov tsev neeg kom paub txog kev saib xyuas yooj yim, thiab saib xyuas kev ua ub ua no kom ua tau zoo.
9. Kev Qhia Txog Tus Neeg Mob thiab Tsev Neeg thiab Kev Npaj Tso Tawm Tsev Kho Mob
Kev kawm ntawv yog qhov tseem ceeb heev kom tiv thaiv kev rov qab mob dua lossis muaj teeb meem tom qab tawm hauv tsev kho mob. Cov ntaub ntawv qhia ntawv suav nrog:
- Kev ua raws li kev noj tshuaj (tshuaj anticonvulsants, tshuaj antihypertensive, tshuaj antiplatelets) thiab cov sijhawm tswj hwm.
- Cov cim qhia txog kev phom sij uas yuav tsum tau kho mob tam sim ntawd: tsis nco qab, qaug zog tam sim ntawd, qaug dab peg ntau zaus, mob taub hau hnyav, lossis ua tsis taus pa.
– Kev hloov pauv txoj kev ua neej: kev noj zaub mov zoo, tso kev haus luam yeeb, tswj cov ntshav siab thiab qab zib, kev tawm dag zog raws li lub peev xwm.
- Kev saib xyuas hauv tsev: kev tiv thaiv kev poob, kev tawm dag zog ROM, cov txheej txheem hloov pauv, thiab kev saib xyuas tawv nqaij.
- Kev txhawb nqa thiab kev pabcuam hauv zej zog thaum muaj.
Kev npaj tso tawm hauv tsev kho mob yuav tsum pib thaum pib kho mob, suav nrog kev ntsuam xyuas qhov xav tau cov khoom siv pab (lub rooj zaum muaj log, cov khoom siv taug kev), kev hloov kho hauv tsev, thiab cov neeg saib xyuas.
Xaus
Cov txheej txheem saib xyuas neeg mob rau cov neeg mob uas muaj teeb meem ntawm lub paj hlwb xav tau kev ua tib zoo, kev ntsuam xyuas rov ua dua, thiab kev cuam tshuam sai sai kom tiv thaiv kev puas tsuaj ntxiv. Kev tsom mus rau kev saib xyuas thawj zaug suav nrog kev ua kom ABCs ruaj khov, saib xyuas qhov xwm txheej ntawm lub paj hlwb, tiv thaiv kev nce siab ntawm lub hlwb, tswj kev qaug dab peg, tiv thaiv cov teeb meem ntawm kev tsis txav mus los, ua kom tau raws li kev xav tau kev noj haus thiab kev tshem tawm, txhawb kev sib txuas lus, thiab koom tes nrog kev kho kom rov zoo. Nrog rau txoj hauv kev dav dav thiab kev kawm zoo, cov kws saib xyuas neeg mob tuaj yeem pab txhim kho kev nyab xeeb, lub neej zoo, thiab lub sijhawm rov zoo rau cov neeg mob uas muaj teeb meem ntawm lub paj hlwb.
Yog tias koj xav tau, kuv tuaj yeem hloov kho tsab xov xwm no mus rau hauv hom ntawv tshawb fawb (nrog kev taw qhia-cov txheej txheem-kev sib tham), ntxiv cov ntaub ntawv teev cia, lossis tsom mus rau cov txheej txheem rau ib qho mob tshwj xeeb xws li mob stroke lossis raug mob taub hau.
