Ukuvinjelwa Nokunakekelwa kwe-Intraoperative Hypothermia - Ingxenye 1

Ukuvinjelwa Nokunakekelwa kwe-Intraoperative Hypothermia - Ingxenye 1

I. Umqondo we-hypothermia:

• Izinga lokushisa eliphakathi kuka-36 ℃ yi-hypothermia

• Izinga lokushisa eliyinhloko izinga lokushisa emithanjeni yamaphaphu yomzimba, ulwelwesi lwe-tympanic, umphimbo, i-nasopharynx, i-rectum nesinye, njll.

• I-perioperative hypothermia (Inadvertentperioperative hypothermia, IPH), I-hypothermia emaphakathi ingase yenzeke ku-50% -70% we-anesthesiology kanye neziguli ezihlinzwa.

II. Ukulinganisa kwe-Hypothermia:

• Ngokomtholampilo, izinga lokushisa elingumongo elingu-34℃-36℃ livame ukubizwa ngokuthi yi-mild hypothermia.

• 34℃-30℃njenge-hypothermia engashoni

• 30℃-28℃ i-hypothermia emaphakathi

• <20℃ ye-hypothermia ejulile

• <15℃ i-ultra-deep hypothermia

III. Izinkinga ze-hypothermia ye-intraoperative

(I) Ukuzibangela:

A. Iminyaka:

Abantu abadala:  Ukungasebenzi kahle kwe-thermoregulation (ukuncipha kwemisipha, ithoni yemisipha ephansi, igazi lesikhumba, umthamo we-tube contractile strain wehla, umsebenzi ophansi wokugcinwa kwenhliziyo).

Izingane ezizalwa ngaphambi kwesikhathi, izingane ezizalwa ezinesisindo esiphansi:  Isikhungo se-thermoregulatory asithuthukisiwe.

B. Umzimba (amafutha omzimba)

Amafutha ayisivikelo esinamandla sokushisa, angavimbela ukulahlekelwa ukushisa komzimba.

Wonke ama-fat cells ayakwazi ukuzwa izinga lokushisa, futhi ayashisa ngokukhulula amandla. Ucwaningo lwase-Harvard University lwathola ukuthi le nqubo yokushisisa incike ephrotheni ebizwa ngokuthi i-coupling protein-1. Lapho umzimba ubhekene namakhaza, inani lokuhlanganisa amaprotheni-1 liphindwe kabili.

Ezimweni ezijwayelekile, iziguli zidinga ukuzila ukudla cishe amahora ayi-12 ngaphambi kokuhlinzwa. Uma ubungqabavu babo bomzimba bubuthakathaka, bazozwela kakhulu ekugqugquzeleni amakhaza, okuholela ekwehliseni ukumelana. Ukugqugquzeleka okubandayo okubangelwa ukuhlinzwa kungabangela kalula ukuthi izinga lokushisa lomzimba lehle.

C. Isimo somqondo

Ukuguquguquka kwemizwelo yesiguli njengokwesaba, ukushuba, nokukhathazeka kubangela ukuba igazi lisatshalaliswe kabusha, kuthinte ukubuya kwegazi enhliziyweni kanye ne-microcirculation, futhi kulula ukubangela i-hypothermia ngesikhathi sokuhlinzwa.

D. Ukugula okubucayi

Igula kakhulu, ikhubazekile kakhulu: umthamo ophansi wokukhiqiza ukushisa.

Ukuthembeka kwesikhumba okukhubazekile: ukuhlukumezeka okukhulu, amanxeba okunciphisa, ukushisa okukhulu.

(II)Ezemvelo

Izinga lokushisa egumbini lokuhlinza livamise ukulawulwa ku-21-25°C. ngaphansi kwezinga lokushisa lomzimba.

Ukushisa okuvamile kwegumbi lokusebenza lokugeleza kwe-laminar kanye nokuhanjiswa okusheshayo komoya wangaphakathi kuzokwandisa ukuchithwa kokushisa komzimba wesiguli, okungenzeka ukuthi kubangele ukushisa komzimba wesiguli.

(III)Ukukhipha ukushisa komzimba

A. Ukukhipha amagciwane esikhumbeni:

Izinga lokushisa lesibulala-magciwane liphansi, futhi inhloso yokubulala amagciwane ingafinyelelwa kuphela ngemva kokuba isibulala-magciwane somile. Ukuvuthwa kwesibulali magciwane kususa ukushisa okuningi futhi kwehlisa izinga lokushisa lomzimba.

B. Ukushaywa kanzima:

Ukugeza ngosawoti omningi ojwayelekile noma amanzi omjovo ngesikhathi sokuhlinzwa nakho kuholela ekulahlekelweni kokushisa komzimba, okuyisizathu sokuthi izinga lokushisa lomzimba wesiguli lehle.

C. Ukuhlinzwa okukhulu kuthatha isikhathi eside, futhi isikhathi sokuchayeka kwesifuba nezitho zesisu side

D. Abasebenzi bezokwelapha abakwazi ukuqaphela ukugcinwa kokushisa

IV.Izinzwa

Izidakamizwa zingashintsha indawo ebekiwe yesikhungo se-thermoregulatory.

I-anesthesia ejwayelekile - izibulala-zinzwa eziningi zingakwazi ukunweba ngokuqondile imithambo yegazi, futhi iziphumlisi zemisipha zingavimbela impendulo yokuqhaqhazela.

I-anesthesia yendawo ye-block block - imicu ehlangene ye-peripheral sensation ebandayo ivinjelwe, ukuze isikhungo sikholelwe ngephutha ukuthi indawo evinjiwe ifudumele.

V. Uketshezi kanye nokumpontshelwa igazi

Ukufakwa kwenani elikhulu legazi eliwuketshezi kanye nelesitoko endaweni yokushisa efanayo yegumbi noma inani elikhulu loketshezi olushaywayo endaweni yokushisa yegumbi ngesikhathi sokusebenza kuzofeza umphumela 'wokuhlanjululwa okubandayo' futhi kubangele i-hypothermia.

Ukungeniswa emthanjeni ka-1L woketshezi ekamelweni lokushisa noma iyunithi engu-1 yegazi elingu-4C kubantu abadala kunganciphisa izinga lokushisa eliyisisekelo lomzimba cishe ngo-0.25°C.

Kucashunwe ku: Wu Zhimin. Yue Yuan. Ucwaningo Nobuhlengikazi Be-Hypothermia Ngesikhathi Sokuhlinzwa Kwesibindi Sokufakelwa Kwesibindi]. I-Chinese Journal of Practical Nursing, 2005