Mitundu ya Anesthesia mu Dentistry
Kuletsa kupweteka ndi gawo lofunika kwambiri pakuchita opaleshoni ya mano chifukwa kumathandiza kuchepetsa ululu, nkhawa, komanso kusasangalala panthawi ya opaleshoni. Posankha mtundu woyenera wa mankhwala oletsa kupweteka, madokotala a mano amatha kuchita opaleshoni bwino, pomwe odwala amadzimva otetezeka komanso omasuka. Kawirikawiri, mankhwala oletsa kupweteka mu mano amatha kugawidwa m'magulu akuluakulu angapo: mankhwala oletsa kupweteka pamutu, mankhwala oletsa kupweteka am'deralo, mankhwala oletsa kupweteka (ochepetsa kupweteka pang'ono mpaka pang'ono), ndi mankhwala oletsa kupweteka wamba. Chilichonse chili ndi zizindikiro zake, njira yogwirira ntchito, ubwino, ndi zoopsa zomwe ndizofunikira kumvetsetsa.
1. Mankhwala Oletsa Kupweteka Pakhungu
Mankhwala oletsa ululu m'malo olumikizirana mafupa ndi mtundu wa mankhwala oletsa ululu omwe amaikidwa mwachindunji pamwamba pa minofu, nthawi zambiri mkamwa (mkamwa, masaya amkati, kapena lilime). Angagwiritsidwe ntchito ngati ma gels, mafuta odzola, opopera, kapena mabala. Mankhwala oletsa ululu m'malo olumikizirana mafupa amagwira ntchito poletsa mitsempha yomwe imatuluka m'malo olumikizirana mafupa, kuchepetsa ululu m'dera lomwe amaikidwa.
Kugwiritsa ntchito kwakukulu kwa mankhwala oletsa ululu m'malo olumikizirana mafupa ndi awa:
- Amachepetsa ululu mukalandira jakisoni wa mankhwala oletsa ululu, poika kaye malo obayira jakisoni.
- Amachepetsa kuvutika ndi njira zazing'ono monga kuyeretsa tartar m'malo ovuta kapena kuyika zida zina zochizira mano.
- Kuthandiza odwala omwe ali ndi vuto la gag reflex (pazifukwa zina komanso mosamala).
Ubwino wa mankhwala oletsa ululu pamutu ndi wakuti ndi osavuta kugwiritsa ntchito, amagwira ntchito mwachangu, ndipo nthawi zambiri amakhala otetezeka. Komabe, zotsatira zake zimakhala pamalo ocheperako ndipo nthawi yake ndi yochepa. Kwa odwala ena, makamaka ana, kugwiritsa ntchito mopitirira muyeso kumakhala ndi chiopsezo chomeza, zomwe zimafuna madokotala a mano kuti awerengere mosamala mlingo ndi njira yogwiritsira ntchito.
2. Mankhwala Oletsa Kupweteka a M'deralo
Mankhwala oletsa ululu am'deralo ndi njira yodziwika kwambiri yoletsa ululu m'mano. Cholinga chake ndi kupangitsa kuti dera linalake la pakamwa lisakhudze chikumbumtima cha wodwalayo. Mankhwala oletsa ululu am'deralo nthawi zambiri amabayidwa mozungulira mitsempha inayake kapena m'minofu yomwe ili pafupi ndi malo ochitira opaleshoni.
Mwa njira ya makina, mankhwala oletsa ululu am'deralo amaletsa kufalikira kwa mitsempha mwa kutseka njira za sodium m'maselo a mitsempha, zomwe zimaletsa zizindikiro za ululu kufika muubongo. Zitsanzo za mankhwala oletsa ululu am'deralo omwe amagwiritsidwa ntchito kwambiri ndi monga lidocaine, articaine, mepivacaine, ndi bupivacaine. Mankhwala oletsa ululu am'deralo nthawi zambiri amaphatikizidwa ndi vasoconstrictors (monga epinephrine) kuti apitirize kugwira ntchito kwawo ndikuchepetsa kutuluka magazi.
a. Kulowerera m'malo
Njira yolowera m'mano imaphatikizapo kubaya mankhwala oletsa ululu m'minofu yozungulira dzino kuti ilandire chithandizo. Njira imeneyi nthawi zambiri imagwiritsidwa ntchito m'chibwano chapamwamba chifukwa fupa limakhala ndi mabowo ambiri, zomwe zimathandiza kuti mankhwalawa alowe m'mitsempha yaying'ono mosavuta.
Zizindikiro: kudzaza mano, kuchiza m'mimba, kupanga korona, ndi njira zazing'ono zochizira mano m'deralo.
b. Kutsekeka kwa Mitsempha
Mu njira zochepetsera mitsempha, mankhwala oletsa ululu amabayidwa pafupi ndi thunthu lalikulu la mitsempha, zomwe zimapangitsa kuti dera lalikulu likhale lopanda dzanzi. Chitsanzo chodziwika bwino ndi chochepetsera mitsempha ya alveolar yomwe imagwiritsidwa ntchito pochiza mano a m'magawo ang'onoang'ono.
Zizindikiro: kuchotsa mano otsetsereka, chithandizo cha mizu ya nsagwada ya m'munsi, kapena opaleshoni ya pakamwa yomwe imafuna malo ambiri oletsa ululu.
c. Kutsekeka kwa m'mimba (PDL) ndi m'mimba mwa osteoporosis
Mankhwala oletsa ululu a m'mimba amaphatikizapo kubaya mankhwala oletsa ululu mu ligament ya periodontal yozungulira muzu wa dzino, pomwe mankhwala oletsa ululu a m'mimba amaperekedwa mwachindunji m'fupa lozungulira dzino. Zonsezi zimagwiritsidwa ntchito pamene kulowetsedwa kapena kutsekeka kwa mitsempha sikukugwira ntchito bwino kapena pamene mankhwala oletsa ululu akufunika kwambiri.
Ubwino wa mankhwala oletsa ululu am'deralo ndi wakuti amagwira ntchito bwino, amathamanga, ndipo wodwalayo amakhalabe wodziwa bwino. Zoopsa zake zingakhale monga kupweteka panthawi ya jakisoni, hematoma, dzanzi kwa nthawi yayitali, ziwengo (zosowa), komanso zotsatirapo za thupi ngati mankhwalawo alowa m'magazi. Chifukwa chake, kumwa madzi asanaperekedwe jakisoni ndikuyang'anira momwe wodwalayo alili ndikofunikira.
3. Kuchepetsa ululu mu mano
Kugona pansi ndi njira yochepetsera nkhawa ndikuwonjezera chitonthozo cha wodwalayo, makamaka kwa odwala omwe ali ndi nkhawa ya mano, kugwedezeka kwamphamvu, kapena omwe akuchita opaleshoni yayitali. Kugona pansi kumasiyana ndi kugona pansi: kugona pansi kumakhudza mulingo wa chidziwitso ndi bata, pomwe kugona pansi kumachititsa kuti malo enaake asamagwire bwino ntchito. Mwachizolowezi, kugona pansi nthawi zambiri kumaphatikizidwa ndi kugona pansi kuti kutsimikizire kuti ululu ungathe kuchepetsedwa.
a. Kuchepetsa Kugona (Anxiolysis)
Kuchepetsa kupumula kumathandiza wodwalayo kupumula koma kukhalabe ndi chikumbumtima chokwanira komanso kuyankha bwino malangizo. Nthawi zambiri amagwiritsidwa ntchito mankhwala omwa (monga benzodiazepines yotsika) yomwe inatengedwa musanachite opaleshoni.
Oyenera: odwala ofooka mpaka ovutika maganizo, opaleshoni yaifupi, kapena odwala omwe amaopa singano.
b. Kugona Pang'ono (Kugona Mosazindikira)
Pakupumula pang'ono, wodwalayo amakhalabe wozindikira komanso womvera, koma amagona ndipo sadziwa zambiri za nthawi ndi malo ozungulira. Njira zomwe zimagwiritsidwa ntchito kwambiri ndi kupumula pogwiritsa ntchito mpweya wa nitrous oxide (mpweya woseka) kapena kupumula kudzera m'mitsempha (IV).
– Nitrous oxide imayamba msanga ndipo ndi yosavuta kuyipereka. Pambuyo pa opaleshoniyi, zotsatira zake zimathanso msanga, zomwe zimathandiza odwala kuchira mwachangu.
– Kugonetsa munthu m'mitsempha kumapereka mphamvu yabwino yolamulira kuchuluka kwa kugona, koma kumafuna malo ogona, maphunziro, ndi kuyang'aniridwa bwino.
c. Kugona movutikira
Kugonetsa thupi kwambiri kumapangitsa wodwalayo kukhala ngati wakomoka, zomwe zimachepetsa kwambiri momwe amayankhira zinthu zomwe zimamuvutitsa. Chifukwa cha chiopsezo chachikulu cha kupuma komanso matenda a mtima, mtundu uwu wa kugona umafunika kuyang'aniridwa mosamala ndipo nthawi zambiri umachitidwa ndi anthu ophunzitsidwa bwino omwe ali ndi zida zokwanira zotsitsimutsira thupi.
Ubwino wa mankhwala oletsa ululu ndi wakuti amathandiza odwala omwe ndi ovuta kugwirira ntchito limodzi ndipo amalola dokotala wa mano kugwira ntchito bwino. Zoopsa za mankhwala oletsa ululu ndi monga kupuma pang'ono, nseru, chizungulire, kuchepa kwa kuthamanga kwa magazi, komanso kufunikira kuyang'aniridwa pambuyo pa opaleshoni. Odwala nthawi zambiri amalangizidwa kuti asayendetse galimoto komanso kuti aziperekezedwa kunyumba, makamaka akapatsidwa mankhwala oletsa ululu pakamwa kapena m'mitsempha.
4. Mankhwala Oletsa Kupweteka Kwambiri
Mankhwala oletsa ululu amachititsa wodwalayo kusazindikira konse, kusamva ululu, komanso osakumbukira zomwe zinachitika. Mankhwala oletsa ululu amenewa amapereka mphamvu zambiri zowongolera, komanso amakhala ndi zoopsa zazikulu. Mu mano, mankhwala oletsa ululu nthawi zambiri sagwiritsidwa ntchito pazochitika zachizolowezi, koma pazochitika zinazake.
Zizindikiro za anesthesia wamba ndi izi:
- Kuchitapo kanthu opaleshoni ya pakamwa chachikulu (monga opaleshoni zina za nsagwada).
- Odwala omwe ali ndi zosowa zapadera omwe sangathe kuwathandiza ngakhale atayesa njira zina.
- Ana aang'ono omwe ali ndi mano ovunda kwambiri omwe amafunika chithandizo chambiri nthawi imodzi.
- Kuopa kwambiri chisamaliro cha mano, pamene njira zina zalephera.
Popeza opaleshoni yoletsa kupweteka imakhudza ntchito zonse za thupi, njirayi imafuna malo oyenera (chipatala kapena chipatala chokhala ndi zipangizo zonse), kuwunika kwa dokotala opaleshoni isanayambe opaleshoni, ndi kuyang'aniridwa mosamala ndi dokotala woletsa kupweteka.
5. Kudziwa Zinthu Zofunika Posankha Mtundu wa Anesthesia
Kusankha mankhwala oletsa ululu sikumachitika mwachisawawa. Madokotala a mano amaganizira zinthu zingapo, monga:
- Mtundu ndi nthawi ya opaleshoni (monga chigamba chaching'ono poyerekeza ndi opaleshoni).
- Nkhawa ya wodwala komanso mgwirizano.
- Mbiri ya matenda (kuthamanga kwa magazi, matenda a mtima, mphumu, matenda a shuga, matenda a chiwindi/impso).
- Ziwengo za mankhwala ndi mbiri ya zotsatirapo za mankhwala oletsa ululu.
- Zaka ndi momwe thupi limakhalira (ana, okalamba, amayi apakati).
- Kufunika kowongolera kutuluka kwa magazi, makamaka pochita opaleshoni.
Kuyezetsa koyamba ndi kuyankhulana ndi dokotala wa mano kumathandiza dokotala wa mano kusankha njira zotetezeka kwambiri. Kulankhulana pakati pa wodwalayo ndi dokotala wa mano n'kofunika kwambiri kuti wodwalayo amvetse zomwe angayembekezere komanso zomwe angayembekezere atalandira chithandizo.
Mapeto
Mankhwala oletsa ululu mu mano amaphatikizapo njira zosiyanasiyana, kuyambira mankhwala oletsa ululu opangidwa ndi pamwamba kuti achepetse ululu pamwamba, mankhwala oletsa ululu am'deralo kuti asachite dzanzi pamalopo, mankhwala oletsa ululu kuti achepetse nkhawa ndikuwonjezera chitonthozo, komanso mankhwala oletsa ululu kwa anthu omwe akufuna kusazindikira konse. Mtundu uliwonse uli ndi ubwino ndi zoopsa zosiyanasiyana, kotero chisankhocho chiyenera kusinthidwa malinga ndi zosowa za opaleshoniyo, thanzi la wodwalayo, komanso chitonthozo. Ndi njira yoyenera, mankhwala oletsa ululu angapangitse kuti chithandizo cha mano chikhale chotetezeka kwambiri, chogwira mtima, komanso chosakhala ndi zoopsa zambiri kwa odwala.
