I-Anesthesia Ekuhlinzeni Kwamathambo
Ukuhlinzwa kwamathambo kuhlanganisa izinqubo eziningi ezihilela uhlelo lwemisipha, okuhlanganisa amathambo, amalunga, imisipha, imisipha, kanye nemisipha. Kusukela ekubekweni kwephini kanye nokufakwa kokuqhekeka kuya ku-arthroscopy kanye nokufakwa kwamalunga (i-arthroplasty), zonke izinqubo zidinga ukuhlela ngokucophelela i-anesthetic. I-anesthesia ekuhlinzeni kwamathambo ayikona nje "ukubeka isiguli ebuthongweni" noma "ukwenza kube nzima" indawo; kunalokho, ihlanganisa uchungechunge lwamasu okuqinisekisa ukuhlinzwa okuphephile nokukhululekile nokukhuthaza ukululama okuhle. Ukukhetha indlela yokwelapha i-anesthetic kuthonywa uhlobo lokuhlinzwa, isimo sesiguli, ubude benqubo, ingozi yokopha, isidingo sokulawula ubuhlungu ngemva kokuhlinzwa, kanye nezikhungo kanye nekhono leqembu lezokwelapha.
Indima Yokubulala Izinzwa Ekuhlinzeni Kwamathambo
Ekuhlinzweni kwamathambo, i-anesthesia inemigomo eminingana eyinhloko. Okokuqala, iqeda ubuhlungu ngesikhathi sokuhlinzwa ukuze udokotela ohlinzayo asebenze ngaphandle kwezithiyo. Okwesibili, inikeza ukuphumula kwemisipha okwanele, ikakhulukazi ezinqubweni ezidinga ukuphathwa kwamalunga noma ukunciphisa ukuphuka. Okwesithathu, igcina ukuzinza kwe-hemodynamic—umfutho wegazi, ukushaya kwenhliziyo, kanye nokufakwa komoya-mpilo—ukuqinisekisa ukuphepha ngesikhathi sokuhlinzwa. Okwesine, inciphisa impendulo yokucindezeleka komzimba ekuhlinzweni, okungathinta izinhlelo zenhliziyo, zokuphefumula, kanye neze-metabolic. Okokugcina, i-anesthesia idlala indima ebalulekile ekuphathweni kobuhlungu ngemva kokuhlinzwa, okuvumela iziguli ukuba zihambe ngokushesha, zenze i-physiotherapy, futhi zinciphise ingozi yezinkinga ezifana ne-deep vein thrombosis.
Izinhlobo Ezivame Ukusetshenziswa Zezindlela Zokubulala Izinzwa
Ngokuvamile, i-anesthesia ekuhlinzeni kwamathambo ingaba i-anesthesia ejwayelekile, i-anesthesia yesifunda, i-anesthesia yendawo ene-sedation, noma inhlanganisela yezindlela eziningana.
1. I-Anesthesia Ejwayelekile
I-anesthesia ejwayelekile yenza isiguli singabi nalwazi nhlobo. Le ndlela ivame ukusetshenziswa ekuhlinzeni okukhulu noma okuyinkimbinkimbi kwamathambo, njengokuhlinzwa komgogodla, ukuhlinzwa okuningi kokuhlukumezeka, noma izinqubo okulindeleke ukuthi zihlale isikhathi eside. Izinzuzo ze-anesthesia ejwayelekile zifaka phakathi ukulawula ngokuphelele indlela yokuphefumula kanye nokuphefumula, kanye nokulula kokulungisa ukujula kwe-anesthesia. Kodwa-ke, i-anesthesia ejwayelekile nayo inemiphumela emibi engaba khona njengokucasuka nokuhlanza ngemva kokuhlinzwa, umphimbo obuhlungu ngenxa yokufakwa kwepayipi, kanti ezinye iziguli zingase zibe nokucindezeleka kokuphefumula noma ukuphazamiseka kwengqondo ngemva kokuhlinzwa.
2. I-Anesthesia Yesifunda
I-anesthesia yesifunda ivimba izinzwa endaweni ethile, iqede ukungasebenzi kahle kwendawo yomzimba ehlinzwa kuyo. Le ndlela ithandwa kakhulu ekuhlinzeni kwamathambo ngoba inikeza ukulawula okuhle kobuhlungu, inciphisa isidingo sama-opioid, futhi ivame ukusheshisa ukululama.
– I-anesthesia yomgogodla (i-subarachnoid): Ivame ukuhlinzwa kwemilenze engezansi, njengokuhlinzwa kwedolo, iqakala, kanye nokunye kwe-hip. I-anesthesia yomgogodla isebenza ngokushesha ngomthamo omncane we-anesthesia yendawo.
– I-anesthesia ye-Epidural: Ingasetshenziswa ekuhlinzeni kwemilenze engezansi noma njenge-analgesia yangemva kokuhlinzwa, isibonelo ekuhlinzeni okukhulu kwe-pelvic noma ekuhlinzeni okubili.
– Amabhlogo ezinzwa ezisemaceleni: Isibonelo, amabhlogo e-brachial plexus okuhlinzwa kwehlombe noma ingalo, amabhlogo emisele ye-femoral/adductor okuhlinzwa kwedolo, kanye namabhlogo e-sciatic okuhlinzwa kwezinyawo. Ukuhlinzwa okusizwa yi-ultrasound kuthuthukisa ukunemba futhi kunciphisa ingozi yezinkinga.
Izinzuzo zokusebenzisa i-anesthesia yesifunda zifaka phakathi ukulawula ubuhlungu obungcono ngemva kokuhlinzwa kanye nemiphumela emibi encishisiwe yomzimba. Kodwa-ke, kunezingozi okufanele zicatshangelwe, njengokwehla komfutho wegazi, ukugcinwa komchamo, ikhanda elibuhlungu ngemva komgogodla, kanye nezinkinga ezingavamile njenge-hematoma noma ukutheleleka endaweni yomjovo.
3. I-Anesthesia Yendawo Ene-Sedation
Ngezinqubo ezincane zamathambo—njengokususwa kwenxeba, ukususwa kwezicubu ezithile, noma izinqubo ezilula ze-arthroscopic ezigulini ezikhethiwe—i-anesthesia yendawo ingahlanganiswa ne-sedation. Iziguli zisengaphefumula ngokuzenzakalelayo futhi ngokuvamile zilulame ngokushesha. Kodwa-ke, le ndlela idinga ukubhekwa eduze ngoba i-sedation ingacindezela ukuphefumula, ikakhulukazi ezigulini esezikhulile noma labo abanesifo samaphaphu.
4. Amasu Okuhlanganisa kanye Nokuhlunguphaza Okuhlukahlukene
Umkhuba wanamuhla wokubulala izinzwa kwamathambo ukusetshenziswa kwe-multimodal analgesia, inhlanganisela yezindlela eziningana zokulawula ubuhlungu (isb., i-regional anesthesia, i-paracetamol, ama-NSAID, kanye nama-opioid anesilinganiso esiphansi, uma kudingeka) ukunciphisa imiphumela emibi yomuthi ngamunye. Ekuhlinzeni okukhulu njengokushintsha idolo ngokuphelele, inhlanganisela ye-spinal anesthesia enezithiyo ze-peripheral nerve kanye ne-multimodal analgesia regimen ivame ukukhethwa ukuze kusheshiswe ukunyakaza kanye ne-physiotherapy.
Ukuhlolwa Kwangaphambi Kokuhlinzwa: Isihluthulelo Sokuphepha
Ngaphambi kokuhlinzwa, udokotela wezinzwa wenza ukuhlolwa okuphelele. Umlando wesifo senhliziyo, umfutho wegazi ophakeme, isifo sikashukela, i-asthma, izinkinga zezinso, kanye nokusetshenziswa kwemithi yokunciphisa igazi (ama-anticoagulants/ama-antiplatelet) kuthinta kakhulu uhlelo lokubulala izinzwa. Ekuhlinzeni kwamathambo, udaba lwemithi yokunciphisa igazi lubalulekile ngoba iziguli eziningi esezikhulile zithatha imithi efana ne-aspirin, i-clopidogrel, i-warfarin, noma i-DOACs. Le mithi ingandisa ingozi yokopha, okuhlanganisa nezinqubo ze-neuroaxial (umgogodla/i-epidural), okudinga ukulungiswa ohlelweni lokuyeka nokushintsha ukwelashwa ngokweziqondiso.
Ngaphezu kwalokho, kwenziwa ukuhlolwa komoya kanye nokuhlolwa kwengozi yokufuthwa ukuze kutholakale ukuthi isiguli sidinga yini ukufakwa kwepayipi. Ukuhlolwa okusekelayo okufana nokubalwa kwegazi okuphelele, ukuhlolwa kokusebenza kwezinso, ama-electrolyte, i-ECG, noma i-X-ray yesifuba kwenziwa ngokusekelwe esimweni somtholampilo kanye nohlobo lokuhlinzwa. Ezimweni zokulimala, ukuhlolwa kuvame ukushesha kodwa kuhlelekile, kucatshangelwa ukuthi kungenzeka ukopha okukhulu, ukulimala ekhanda, noma omunye umonakalo wesitho.
Izinselele Ezikhethekile Ekuhlinzeni Kwamathambo
Ukuhlinzwa kwamathambo kuveza izinselele eziningana eziyingqayizivele zokubulala izinzwa:
1. Ukopha kanye nesidingo sokumpontshelwa igazi
Ukuhlinzwa kokuphuka kwenqulu, umgogodla, kanye nokwephuka kwe-femoral kungabangela ukopha okukhulu. Odokotela be-anesthesiologists basungula ukufinyelela okwanele ngemithambo yegazi, amasu okuvuselela uketshezi, futhi, uma kudingeka, ukumpontshelwa igazi.
2. Ingozi ye-thromboembolism
Ukuhlinzwa ngemva kokuhlinzwa kwamathambo, ikakhulukazi ukufakwa kwamalunga esikhundleni sawo kanye nokuphuka kwezinqe, kwandisa ingozi ye-deep vein thrombosis kanye ne-pulmonary embolism. Ukuqala kokusebenza, uketshezi, kanye nokuvimbela ukubola kwamathambo, ngokwenqubomgomo yesibhedlela, kuyizinto ezibalulekile zokunakekelwa kwangemva kokuhlinzwa.
3. Ubuhlungu obukhulu ngemva kokuhlinzwa
Izinqubo eziningi zamathambo zibangela ubuhlungu obukhulu. Yilapho ukuvimba kwemizwa yangaphandle, i-epidural analgesia, kanye nezindlela zokwelapha eziningi kungaba yinzuzo enkulu.
4. I-Tourniquet ekuhlinzweni kwemilenze
Ama-tourniquet avame ukusetshenziswa ngesikhathi sokuhlinzwa kwamadolo noma kwesandla ukunciphisa ukopha. Ukusetshenziswa kwawo kungabangela ubuhlungu be-tourniquet, izinguquko ekucindezelweni kwegazi, futhi uma esusiwe, kungabangela izinguquko zesikhashana ze-metabolic. Ukuqapha okuseduze kuyadingeka.
5. Indawo yesiguli ngesikhathi sokuhlinzwa
Ukuhlinzwa komgogodla noma kwehlombe kungadinga ukubekwa endaweni eqondile noma eceleni, okungacindezela izinzwa, kuphazamise ukuphefumula, noma kubangele ukulimala kwengcindezi. Ithimba le-anesthesia lidlala indima ekuqinisekiseni ukubekwa endaweni ephephile.
Ukuqapha Nokuphepha Ngesikhathi Sokuhlinzwa
Ngesikhathi sokuhlinzwa, ukuqapha okujwayelekile kuhlanganisa i-ECG, umfutho wegazi, ukugcwala komoya-mpilo, kanye ne-CO₂ yokugcina uma isiguli singaphansi kwe-anesthesia ejwayelekile. Ekuhlinzweni okukhulu, ukuqapha okungenayo njengomugqa wemithambo yegazi wokuqapha umfutho wegazi ngesikhathi sangempela kanye nokuthatha amasampula egazi okuphindaphindiwe kungangezwa. Ukulawula izinga lokushisa nakho kubalulekile ngoba i-hypothermia ikhulisa ukopha futhi ibambezele ukululama.
Ukuphepha kwesiguli kukhuliswa ngokuhlolwa kokuhlinzwa, ukuxhumana kweqembu okuphumelelayo, kanye nezinqubo zokuvimbela ukutheleleka. Ngokwesimo samathambo, ukuvimbela ukutheleleka kubalulekile, njengoba ukutheleleka okufakwe emzimbeni kungaholela ezinkingeni zesikhathi eside kanye nokulungiswa kokuhlinzwa.
Ukunakekelwa Ngemva Kokuhlinzwa: Gxila Ebuhlungwini Nasekuhambeni
Ngemva kokuhlinzwa, okubaluleke kakhulu ukuqinisekisa ukuthi umoya uphephile, ukuqina kwe-hemodynamic, kanye nokulawula ubuhlungu. Ukusetshenziswa kwama-nerve blocks kunganikeza i-analgesia enhle kakhulu kuze kube amahora angu-12-24 noma ngaphezulu, kuye ngohlobo lomuthi kanye nendlela (isb., i-catheter yokufaka njalo). Ubuhlungu obulawulwayo buvumela iziguli ukuthi ziqale ngokushesha ukuvivinya umzimba okujulile, ukuhlala, ukuma, kanye ne-physiotherapy—izinto ezifakazelwe ukuthi zinciphisa izinkinga futhi zisheshise ukuphuma.
Kodwa-ke, amasu okulawula ubuhlungu kumele acabangele imiphumela emibi. Ama-opioid angabangela isicanucanu, ukuqunjelwa, ukozela, kanye nokucindezeleka kokuphefumula. Ama-NSAID angathinta ukusebenza kwezinso noma andise ingozi yokopha ezigulini ezithile. Ngakho-ke, indlela elinganisiwe, enezindlela eziningi iyona eyinhloko.
Isiphetho
I-anesthesia ekuhlinzeni kwamathambo iyinto ebalulekile enquma ukuphepha kwesiguli kanye nekhwalithi yokululama. Ukukhetha phakathi kwe-anesthesia ejwayelekile, yesifunda, noma ehlanganisiwe kuncike ohlotsheni lokuhlinzwa kanye nesimo sesiguli, kanti imigomo eyinhloko iwukulawula ubuhlungu, ukugcina ukuzinza komzimba, kanye nokukhuthaza ukunyakaza kwasekuqaleni. Intuthuko yezobuchwepheshe efana nokuvimba kwemizwa okusekelwe ku-ultrasound kanye nomqondo we-multimodal analgesia kuthuthukise induduzo yesiguli ngenkathi kunciphisa ingozi yezinkinga. Ngokuhlolwa okuphelele kwangaphambi kokuhlinzwa, ukuqapha okuseduze kwangaphakathi kokuhlinzwa, kanye nokuphathwa okuphumelelayo kwangemva kokuhlinzwa, i-anesthesia ingaba yinto ebalulekile empumelelweni iyonke yokuhlinzwa kwamathambo.
