Anesthesia mukuvhiyiwa kwemapfupa
Kuvhiyiwa kwemapfupa kunosanganisira nzira dzakasiyana-siyana dzinosanganisira hurongwa hwemapfupa, kusanganisira mapfupa, majoini, mitsipa, marunda, uye tsandanyama. Kubva pakuiswa kwepini uye kugadziriswa kwekutyoka kusvika ku arthroscopy nekutsiva majoini (arthroplasty), nzira dzese dzinoda kuronga mushonga wekunzwa kurwadziwa nekungwarira. Kuvhiyiwa kwemapfupa hakusi kungo "kurara murwere" kana "kuita kuti nzvimbo yacho ive nenzara" chete; asi, kunosanganisira nzira dzakasiyana-siyana dzekuona kuti kuvhiyiwa kwakachengeteka uye kwakanaka uye kukurudzira kupora kwakakwana. Sarudzo yenzira yekunzwa kurwadziwa inotevedzerwa nerudzi rwekuvhiyiwa, mamiriro emurwere, nguva yekuvhiyiwa, njodzi yekubuda ropa, kudiwa kwekutonga marwadzo mushure mekuvhiyiwa, uye nzvimbo dzechikwata chekurapa nehunyanzvi.
Basa reAnesthesia Mukuvhiya kweMafupa
Mukuvhiyiwa kwemapfupa, anesthesia ine zvinangwa zvikuru. Chekutanga, inobvisa marwadzo panguva yekuvhiyiwa kuitira kuti chiremba agone kushanda pasina chinomutadzisa. Chechipiri, inopa tsandanyama dzakakwana kuzorora, kunyanya pakuita zvinoda kugadziriswa kwemajoini kana kuderedza kutsemuka kwemapfupa. Chechitatu, inochengetedza kugadzikana kweropa—kumanikidzwa kweropa, kurova kwemoyo, uye oxygenation—kuti ive nechokwadi chekuti kuchengetedzeka panguva yekuvhiyiwa. Chechina, inoderedza kushushikana kwemuviri pakuvhiyiwa, izvo zvinogona kukanganisa hurongwa hwemwoyo, hwekufema, uye hwemetabolism. Chekupedzisira, anesthesia inoita basa rakakosha mukugadzirisa marwadzo mushure mekuvhiyiwa, zvichibvumira varwere kufamba nekukurumidza, kuita physiotherapy, uye kuderedza njodzi yezvinetso zvakaita se deep vein thrombosis.
Mhando Dzinowanzo shandiswa dzeAnesthesia Techniques
Kazhinji, mushonga wekurwadziwa kwemapfupa unogona kuva mushonga wekurwadziwa kwemapfupa, mushonga wekurwadziwa kwemunzvimbo, mushonga wekurwadziwa kwemunzvimbo pamwe nekurapisa, kana musanganiswa wenzira dzakasiyana-siyana.
1. Anesthesia Yakajairika
Kushandiswa kweanesthesia kwakajairika kunoita kuti murwere asanyatsoona kana kuziva. Nzira iyi inowanzo shandiswa pakuvhiyiwa kwemapfupa kwakakura kana kwakaoma, sekuvhiyiwa kwemusana, kuvhiyiwa kwekukuvara kwakawanda, kana maitiro anotarisirwa kugara kwenguva yakareba. Zvakanakira zveanesthesia kwakajairika zvinosanganisira kudzora zvizere nzira yekufema nemhepo, pamwe nekureruka kwekugadzirisa kudzika kweanesthesia. Zvisinei, anesthesia kwakajairika kunewo migumisiro inogona kuitika senge kuda kurutsa mushure mekuvhiyiwa, kurwadziwa pahuro nekuda kwekuiswa kwechubhu, uye vamwe varwere vanogona kubatwa nedambudziko rekufema kana kuvhiringidzika mupfungwa mushure mekuvhiyiwa.
2. Anesthesia Yenharaunda
Nzira yekunzwa kurwadziwa kwemusana inovhara tsinga dziri munzvimbo yakati, zvichiita kuti nzvimbo yemuviri iri kuvhiyiwa isashande zvakanaka. Nzira iyi inozivikanwa zvikuru mukuvhiyiwa kwemapfupa nekuti inopa kudzora marwadzo zvakanaka, inoderedza kudiwa kwemishonga yeopioid, uye inowanzo kurumidza kupora.
– Kuvhiyiwa kwemusana (subarachnoid): Kunowanzoitwa pakuvhiyiwa kwemakumbo epasi, sekuvhiyiwa kwebvi, gumbo, uye mamwe mahudyu. Kuvhiyiwa kwemusana kunoshanda nekukurumidza nekushandisa mushonga mudiki wemusana.
– Anesthesia yeEpidural: Inogona kushandiswa pakuvhiyiwa kwemakumbo epasi kana senzira yekuderedza marwadzo mushure mekuvhiyiwa, semuenzaniso mukuvhiyiwa kukuru kwechiuno kana kuvhiyiwa kwemativi maviri.
– Kuvhara tsinga dzemudumbu: Semuenzaniso, mabhuroko e brachial plexus ekuvhiya pafudzi kana ruoko, mabhuroko e femoral/adductor canal ekuvhiya ibvi, uye mabhuroko e sciatic ekuvhiya tsoka. Kuvhiya ne ultrasound-assisted kunowedzera kururama uye kunoderedza njodzi yematambudziko.
Zvakanakira zveanesthesia yemunharaunda zvinosanganisira kudzora marwadzo mushure mekuvhiyiwa uye kuderedza migumisiro yakaipa mumuviri. Zvisinei, kune njodzi dzekufunga nezvadzo, dzakadai sekudzikira kweBP, kuchengetedza weti, musoro mushure mekubuda mumuzongoza, uye matambudziko asingawanzoitika akadai se hematoma kana hutachiona panzvimbo yejekiseni.
3. Anesthesia yemunzvimbo ine sedation
Pakurapa kudiki kwemapfupa—kwakadai sekubviswa kwemaronda, kubviswa kwemamwe majoini, kana nzira dziri nyore dzekurapa mapfupa muvarwere vakasarudzwa—anesthesia yemunzvimbo inogona kusanganiswa nekunyaradza. Varwere vanogona kufema vega uye vanowanzo pora nekukurumidza. Zvisinei, nzira iyi inoda kutariswa zvakanyanya nekuti kunyaradza kunogona kuderedza kufema, kunyanya kuvarwere vakwegura kana avo vane chirwere chemapapu.
4. Maitiro Ekubatanidza uye Kurapa Kwemarwadzo Kwemhando Dzakawanda
Imwe nzira yemazuva ano yekurapa marwadzo emapfupa ndeyekushandisa multimodal analgesia, musanganiswa wenzira dzakasiyana-siyana dzekudzora marwadzo (semuenzaniso, regional anesthesia, paracetamol, NSAIDs, uye opioid ine dose shoma, kana zvichidikanwa) kuderedza migumisiro yemushonga wega wega. Pakuvhiyiwa kukuru kwakadai sekutsiva mabvi ese, musanganiswa wespinal anesthesia ine peripheral nerve blocks uye multimodal analgesia regimen inowanzo sarudzwa kuti kukurumidze kufamba uye physiotherapy.
Kuongorora Kuvhiyiwa Kusati Kwaitwa: Kiyi Yekuchengetedza
Vasati vavhiyiwa, chiremba weanotindivadza anoita ongororo yakakwana. Nhoroondo yezvirwere zvemwoyo, BP, chirwere cheshuga, asima, matambudziko eitsvo, uye kushandiswa kwemishonga inoomesa ropa (anticoagulants/antiplatelet) zvinokanganisa zvakanyanya chirongwa cheanesthetic. Mukuvhiyiwa kwemapfupa, nyaya yeanticoagulants yakakosha nekuti varwere vazhinji vakwegura vari kutora mishonga yakaita seaspirin, clopidogrel, warfarin, kana DOACs. Mishonga iyi inogona kuwedzera njodzi yekubuda ropa, kusanganisira panguva yekurapa kwe neuraxial (spinal/epidural), zvichida kugadziriswa kwepurogiramu yekumira uye kutsiva kurapwa zvichienderana nemirairo.
Pamusoro pezvo, kuongororwa kwemhepo inoyerera uye kuongororwa kwengozi yekufema kunoitirwa kuti vaone kana murwere achida kuisirwa nhubhu. Miedzo yekutsigira yakaita sekuverengwa kweropa rose, bvunzo dzekushanda kweitsvo, maelectrolyte, ECG, kana X-ray yechipfuva inoitirwa zvichienderana nemamiriro ekurapa uye rudzi rwekuvhiyiwa. Muzviitiko zvekukuvara, kuongororwa kunowanzoitwa nekukurumidza asi kwakarongeka, tichifunga nezve mukana wekubuda ropa zvakanyanya, kukuvara kwemusoro, kana kukuvara kwenhengo.
Matambudziko Akakosha Mukuvhiyiwa Kwemapfupa
Kuvhiyiwa kwemapfupa kunopa matambudziko akasiyana-siyana ekurwadziwa kwemudumbu:
1. Kubuda ropa uye kudiwa kwekuwedzerwa ropa
Kuvhiyiwa kwekutyoka kwehudyu, musana, uye makumbo emukadzi kunogona kukonzera kubuda ropa zvakanyanya. Vanachiremba vanogadzira nzira dzakakwana dzekupinda mutsinga, nzira dzekudzorerazve mvura mumuviri, uye, kana zvichidikanwa, kuwedzerwa ropa.
2. Njodzi ye thromboembolism
Kuvhiyiwa mushure mekuvhiyiwa kwemajoini, kunyanya kutsiva majoini uye kutyoka kwechiuno, kunowedzera njodzi yekudzikira kweropa mutsinga uye pulmonary embolism. Kukurumidza kufamba, hydration, uye kudzivirira ropa kubva muropa, zvichienderana nemutemo wechipatara, zvinhu zvakakosha pakurapwa kweperiodic operation.
3. Marwadzo akanyanya mushure mekuvhiyiwa
Kurapa kwakawanda kwemapfupa kunokonzera kurwadziwa kwakanyanya. Apa ndipo panogona kubatsira zvikuru tsinga dzemumitsipa, epidural analgesia, uye nzira dzakasiyana-siyana dzekurapa.
4. Tourniquet mukuvhiyiwa kwemakumbo
Ma "tourniquets" anowanzo shandiswa panguva yekuvhiyiwa kwebvi kana maoko kuderedza kubuda ropa. Kushandiswa kwawo kunogona kukonzera marwadzo e "tourniquet", kuchinja kweBP, uye kana akabviswa, anogona kukonzera shanduko dzechinguvana dzemuviri. Kunyatso tarisa kunodiwa.
5. Nzvimbo yemurwere panguva yekuvhiyiwa
Kuvhiyiwa kwemusana kana fudzi kungada kuiswa panzvimbo yakapfava kana yakatetepa, izvo zvinogona kudzvinyirira tsinga, kukanganisa mhepo, kana kukonzera kukuvara kwekumanikidzwa. Chikwata cheanesthesia chinoita basa rekuona kuti nzvimbo yacho yakachengeteka.
Kutarisa uye Kuchengetedzwa Pakuvhiyiwa
Munguva yekuvhiyiwa, kuongororwa kwakajairika kunosanganisira ECG, BP, oxygen saturation, uye end-tidal CO₂ kana murwere ari pasi peanesthesia. Mukuvhiyiwa kukuru, kuongororwa kwakaitwa nevanovhiya kwakadai se arterial line yekuongororwa kweBP panguva chaiyo uye kutorwa kweropa kakawanda kunogona kuwedzerwa. Kudzora tembiricha kwakakoshawo nekuti hypothermia inowedzera kubuda ropa uye inononoka kupora.
Kuchengetedzeka kwemurwere kunosimbiswa kuburikidza nekutarisa zvinhu zvinoongororwa pakuvhiyiwa, kutaurirana kwakanaka kwechikwata, uye nzira dzekudzivirira hutachiona. Munyaya yemapfupa, kudzivirira hutachiona kwakakosha, sezvo hutachiona hweimplant hunogona kutungamira kumatambudziko kwenguva refu uye kugadziriswa kwekuvhiyiwa.
Kutarisirwa Mushure mekuvhiyiwa: Tarisa pakurwadziwa uye kufamba
Mushure mekuvhiyiwa, chinhu chikuru ndechekuona kuti mweya uri kufamba zvakanaka, kugadzikana kweropa, uye kudzora marwadzo. Kuvharika kwetsinga kunogona kupa mushonga wakanaka wekuderedza marwadzo kwemaawa anosvika 12-24 kana kupfuura, zvichienderana nemushonga uye nzira (semuenzaniso, catheter inopinzwa nguva dzose). Kudzora marwadzo kunobvumira varwere kuti vatange kurovedza muviri kwakadzama, kugara, kumira, uye physiotherapy nekukurumidza—zvinhu zvakaratidzwa kuti zvinoderedza matambudziko uye zvinokurumidzisa kubuda kweropa.
Zvisinei, nzira dzekugadzirisa marwadzo dzinofanira kufunga nezvemigumisiro yacho. Maopioid anogona kukonzera kuda kurutsa, kuvimbiwa, hope, uye kuora mwoyo kwekufema. Mishonga yeNSAID inogona kukanganisa mashandiro eitsvo kana kuwedzera njodzi yekubuda ropa mune vamwe varwere. Saka, nzira yakayerwa, ine nzira dzakawanda ndiyo sarudzo huru.
Mhedziso
Kunzwa kuda kurutsa mukuvhiyiwa kwemapfupa chinhu chakakosha chinoona kuchengetedzeka kwemurwere uye kunaka kwekupora. Sarudzo pakati pekushandisa anesthesia yakajairika, yemunharaunda, kana yakasanganiswa inoenderana nerudzi rwekuvhiyiwa uye mamiriro emurwere, nezvinangwa zvikuru zviri kudzora marwadzo, kuchengetedza kugadzikana kwemuviri, uye kukurudzira kufamba nekukurumidza. Kufambira mberi kwetekinoroji senge ultrasound-based nerve blocks uye pfungwa ye multimodal analgesia zvakavandudza nyaradzo yemurwere uku zvichideredza njodzi yematambudziko. Nekuongororwa kwakazara kwepamberi pekuvhiyiwa, kutarisa kwakanyatsoitwa mukati mekuvhiyiwa, uye manejimendi inoshanda mushure mekuvhiyiwa, anesthesia inogona kuva chinhu chakakosha mukubudirira kwese kwekuvhiyiwa kwemapfupa.
