Izitho ezisemqoka zokuphefumula zivikelwe ngendwangu yesikhala esinezikhala ezimbili futhi isikhala esingenalutho phakathi kwabo. Ukucindezela ekolandeni yangaphandle yamaphaphu kufanele kube ngaphansi kwesimo sezulu. Uma umoya ungena emgodini wesikhala, uyanda, futhi i-pneumothorax iqala. Imifula ayifuni futhi iqede ukubamba iqhaza kwinqubo yokuphefumula.
I-Pneumothorax - isigaba
Kunezinketho eziningi zokuthayipha i-pathology okucatshangelwayo: ubuqili, indawo yangaphakathi, ukuxhumana nemvelo yangaphandle, ivolumu yokuwa kanye nezinye izinqubo. Ukuhlukaniswa ngokuhambisana nezimbangela zesifo kubhekwa njengokucacile ngangokunokwenzeka. Ihlanganisa izinhlobo ezilandelayo ze-pneumothorax:
- i-traumatic;
- ukuzenzekelayo;
- okufakelwayo.
I-pneumothorax eyingozi
Leli fomu lesi sifo livame ukuhamba nezingozi, izingozi zomgwaqo nokuhlaselwa. I-pneumothorax eyingozi iqoqo lomoya phakathi kwe-loural pleural ngenxa yokungena (isibhamu, ummese) noma ukulimala okumsulwa esifubeni (ukuvuna, ukushaya). Ngezinye izikhathi umonakalo kugobolondo lokuzivikela uqala ngokumelene nokwehluleka kokuphathwa kwezokwelapha. Ezimweni ezinjalo, i-pneumothorax iatrogenic yamaphaphu inqunywa. Kungenzeka emva:
- i-puncture;
- i-biopsy;
- ukuphuza umoya;
- ukufakwa kwe-catheter yase-subclavia.
I-Pneumothorax yefomu lokuzenzekelayo
Uhlobo oluchazwe lesi sifo luhlukaniswa ngokwehlukana zibe yi-idiopathic ne-subtype ephawulekayo. Ifomu lokuqala livela ngokuphelele kubantu abanempilo futhi abasha, izimbangela eziqondile zalesi simo azicacile. Izici zokudalwa yizinto:
- ukungafani nokuzalwa okungavamile kwezakhi zofuzo;
- ubulili besilisa;
- ubudala kusukela eminyakeni engu-20 kuya kweyengu-40;
- umlutha kagwayi;
- ukukhula okuphezulu;
- imisebenzi efakazela ukungafani kokucindezela (ukuhamba endizeni, ukuhamba, ukugibela izintaba nokunye okunjalo);
- umsebenzi owenziwe ngokweqile.
I-pneumothorax ephawulekayo noma eyesibili yamaphaphu itholakala kubantu abane-pathologies ethinta imisebenzi yesimiso sokuphefumula. Ukuphakamisa ukuqoqwa komoya emgodini wesikhala kungase kube nezifo ezilandelayo:
- i-cystic fibrosis ;
- ukucwiliswa kwesifo sokuphefumula kwesisu;
- i-pneumonia;
- i-sarcoidosis;
- i-fibrosing alveolitis;
- isifo se-chronic obstructive pulmonary;
- isifo sofuba;
- i-histiocytosis X;
- i-systemic scleroderma;
- i-arthritis ye-rheumatoid;
- i-abscess yamaphaphu;
- umdlavuza;
- lymphangioleiomyomatosis;
- dermatomyositis nabanye.
Ezimweni ezimbi, umoya owandayo phakathi kwe-pleural lobes ubangele ukukhuphuka kwengcindezi egobolondo yamaphaphu, kodwa futhi kunciphisa okwe-oksijini okusheshayo, ukwehla okusheshayo ekucindezeni kwegazi emithanjeni. Lesi simo sibizwa ngokuthi i-pneumothorax ejulile futhi kubhekwa njengenye yezinto eziyingozi kakhulu ezifundweni zesifo. Ngaphandle kokwelashwa okuphuthumayo, kungabangela izinkinga ezinkulu ezisongela ukuphila komuntu.
I-pneumothorax yokufakelwa
Isimo esinikeziwe ukuphathwa ngokukhethekile kwezokwelapha. Ngaphambi kokusungulwa kwamalungiselelo amakhemikhali anamuhla, izindlela ezincane zokungenelela kokuhlinzwa nokungena kwe-tomography, i-pneumothorax yokufakelwa isifo sofuba (collapsotherapy) yindlela ephumelela kakhulu yokwelashwa nokuxilongwa. Ukwehla okuncane okuphoqelelwe kwamaphaphu ethintekile kunomthelela ekulahlekeni kwe-foci yezicubu ze-necrosis, ukuguqulwa kwe-granulations ne-fibrosis.
I-pulmonologists eqhubekayo ayifuni neze ukusebenzisa umoya wokufakelwa emkhathini. Kulokuhlukumeza kukhona izinkomba eziqinile:
- ukuphuma kwangaphakathi (uma kukwaziwa, okuvela kuyo lungapha);
- isifo sofuba esibhubhisayo ngezinkukhu ezintsha;
- ukungenakwenzeka kwe-chemotherapy yanamuhla.
I-Pneumothorax - izimbangela ze
Ngezinye izikhathi ukugula okucatshangelwayo kuvela ngokuzenzekelayo, ikakhulukazi ezinsizweni ezincane, ezithintekayo ngenxa yobudala, ubudala, indlela yokuphila noma yokuzilibazisa. Izimbangela eziyinhloko ze-pneumothorax:
- ukulimala;
- Izifo zokuphefumula;
- ukungenelela kwezokwelapha.
Vule pneumothorax
Leli fomu lesi sifo livela ngokulimala okukhulu esifubeni. I-pneumothorax evulekile ukuqoqa umoya phakathi kwe-pleural lobes, ene-outlet eya ngaphandle. Lapho uphefumula, igesi igcwalisa umgodi, futhi lapho kuphuma umoya. Ukucindezela kugobolondo kancane kancane kufaniswa nokubaluleka kwezulu, ngakho-ke amaphaphu akakwazi ukuqondisa. Ngenxa yalokhu, liyeka ukubamba iqhaza ezinhlelweni zokuphefumula futhi linikeze igazi nge-oxygen.
I-valve evulekile lungumaphaphu we-pneumothorax. Lesi simo sibonakala ngokufuduka kwezicubu zesitho esilimele, i-bronchi, noma imisipha. Ngenxa yalokho, umoya ugcwalisa umgudu wokuvuvukala, kodwa awuqedi ngokuphelele. Ukucindezela nomthamo wegesi emkhatsini wezikhala zilokhu zanda, okuholela ekuhambeni kwenhliziyo nezitsha ezinkulu kanye nokuphahlazeka kwamaphaphu. Kukhona ukwephulwa okunamandla kokujikeleza kwegazi, ukuphefumula nokushintshaniswa kwe-oxygen.
I-pneumothorax evaliwe
Abahlaseli balezi zindlela zokukhubazeka bangaba izivunguvungu ezincane nokulimala okungokoqobo. Ngokufanayo, kuyabonakala uma kukhona i-pneumothorax engavamile, izimbangela zazo ezingakaze zenziwe. Ukuqoqa umoya phakathi kwamagundane we-lung membrane kwakha ngoba i-defect encane ibonakala ku-pleura. Ukulimala emgodini awunawo uhambo ngaphandle, futhi umthamo wegesi kuwo awukhulumi. Kancane kancane umoya uyaziqhayisa ngisho ngaphandle kokungenelela kwezokwelapha, futhi isici sivaliwe.
I-Pneumothorax - izimpawu
Isithombe sesitholampilo sixhomeke ekujuleni kwesimo, ubuningi bomoya obuthelela endaweni yesikhalazo. Ngezinye izikhathi izimpawu ze-pneumothorax azikho. Lokhu kuyiqiniso ikakhulukazi ekuziphatheni okuyisisekelo okuzenzakalelayo. Kwezinye izimo, i-pneumothorax yamaphaphu ingaba nezimpawu ezilandelayo:
- ubuhlungu esifubeni, ukunikeza ehlombe kusukela ohlangothini olonakele;
- ukukhwehlela owomile;
- ukuphefumula;
- izinhliziyo zenhliziyo eziningi;
- ukwesaba ukufa;
- ukukhululwa kwesithukuthezi se-viscous ebandayo;
- ubuthakathaka emzimbeni;
- isikhumba esinombala obomvu nesibhakabhaka;
- ukukhala ngekhanda ngesikhathi sokuphefumula (nge-open lung pneumothorax);
- izikhala ezihamba phakathi kwezimbambo;
- isikhwama esivelele esifubeni;
- ukuvuvukala ngaphansi kwesikhumba (emphysema), uma uchofoza lapho uzwa khona i-crunch, njengeqhwa;
- ukunciphisa ukucindezelwa kwegazi;
- ukuphelelwa amandla.
I-Pneumothorax - ukuxilongwa
Okokuqala, i-pulmonologist yenza ukuhlolwa ngokomzimba ngesiguli usebenzisa amasu okucubungula (ukushaya ngomunwe) kanye nokuhlaziya (ukulalela i-phonendoscope). Indlela esemqoka yokuthola i-pneumothorax yi-X-rays. Kuyasiza ukubona umoya wamahhala esihlokweni somlomo, ukuhlola izinga lokubola kwephunga, ukufuduka kwezitho zomzimba. Uma ukuhlolwa kwe-X-ray kungabi nolwazi olwanele, izindlela zokuxilongwa okusizayo ziyasetshenziswa:
- i-tomography ehlanganisiwe ;
- i-thoracoscopy;
- Ukuhlaziywa kwe-Exudate kusuka endaweni ye-pleural (ukukhishwa kwesikhumba kwenziwa nge-pneumothorax);
- ukutadisha ukwakhiwa kwegesi kwegazi;
- i-electrocardiography.
I-Pneumothorax - ukwelashwa
Amacala ajwayelekile ehlobo oluvaliwe lwe-pathology awadingi ukwelashwa okukhethekile. Uma kungekho izimpawu ezinzima ngesistimu yokuphefumula nesifo senhliziyo, kuphela ukubhekwa kwesimo samaphaphu ngosizo lwe-radiography kuthiwa. Kwezinye izimo, isinqumo sendlela yokwelapha i-pneumothorax sithathwa udokotela ohlinzayo. Ngaphambi kokufika kwesisulu esibhedlela, kubalulekile ukuvimbela ukuthuthukiswa kwezinkinga, ngoba lokhu kudingeka wenze imisebenzi embalwa elula.
I-Pneumothorax - usizo oluphuthumayo
Into yokuqala okufanele uyenze uma usola isimo esibhekene nayo ukubiza ithimba lezokwelapha bese uzolile umuntu. I-pneumothorax evaliwe nesisindo esindayo idinga amanzi okusheshayo emgodini we-pleural. Lokhu ukukhwabanisa kuzonikeza umoya wokuqoqa ngaphandle futhi kusize ukunciphisa ingcindezi phakathi kwamagundane egobolondo lokuvikela lamalungu okuphefumula.
Uma isiguli sinomzimba ovulekile we-pathology, i-pneumothorax yephaphu elimelekile lizwakale, njengokumemeza ngokuphefumula nokuphefumula kwilonda. Isisulu kubalulekile ukuzola futhi simnike ukufinyelela mahhala oksijini, lokhu kuzobuyisela inqubo yokuphefumula kancane. Usizo lokuqala e-pneumothorax evulekile yilona lokusebenza lokugqoka okujwayelekile okuvalwe. It kuvimbela ukugeleza komoya emgodini wesikhala.
Ukugeleza kwe-pneumothorax
Kuyinto efiselekayo ukuthi lokhu kuqhutshwa kwenziwa ngumchwepheshe oqeqeshiwe. Ukunciphisa ubuchwepheshe be-pneumothorax kunomthelela ekunciphiseni okusheshayo ekucindezelekeni kwegobolondo yamaphaphu nokujwayelekile kokuphefumula. Uma isimo sesiguli siwohloka ngokushesha, ungaqhuba amanzi okuphuthumayo. Ukwenza lokhu, uphonsa udonga lwesifuba ohlangothini olonakele ngenaliti ekhululekile engasetshenzisiwe, ithubhu elincanyana elinokuphela okubukhali noma into efanayo.
Emnyangweni wokuhlinza, ukuxosha umoya owandayo kusuka emgodini womfutho wenziwa ngamasethi akhethekile, isibonelo, izinto zokusebenza zikaBobrov. Ngaphansi kwe-anesthhesia yendawo, udokotela wenza i-thorax nge-tricar oyinyumba. Emgodini ufakwe amanzi okugeleza ngekhonsathi engilazini yevolumu ethile (ibhange likaBobrov). Uma umoya usengasheshi kakhulu, uyenziwa ngokuwushisa ngenkuthalo nge-vacuum aspirator (ukuncibilika).
Ukuboshwa kwe-Occlusion nge-pneumothorax
Indlela eyinhloko yokwelapha okuphuthumayo ifomu elivulekile lokukhubazeka ukuvimbela ukungena emoyeni kwilonda. I-bandage ye-pneumothorax ingenziwa kusukela ohlangothini olukhulu lweboya bekotini ehlanganiswe nge-bandage oyinyumba, noma izinto ezilungisiwe - izingubo, amathawula nezinye izinto. Kumelwe ukumboze ngokuphelele umonakalo futhi kuvimbele ukungena kwegesi emgodini. Ukuze ubukhulu obukhulu, ibhande eligcwele i-pneumothorax livulekile ngefilimu yeplastiki noma isikhwama se-cellophane.
Esikhathini esibhedlela, isisulu sizohlinzeka ngosizo olufanelekayo, olubandakanya:
- ukwelapha oksijini;
- i-anesthesia;
- ukubopha ukuhlinzwa kwamanxeba avulekile, amaphaphu aphuphuka kanye nezibilini zalo;
- ukugxila kwamagalelo ezinxushunxushu kanye namalungiselelo akhethekile (pleurodesis).
I-Pneumothorax - izinkinga
Cishe isigamu seziguli esichaza lesi simo sibangela imiphumela eyingozi. Okubi kunayo yonke i-valve pneumothorax, ukuhlinzeka ngokuvulwa kwesifuba, ukuphuza umoya nokulonda amanxeba akusebenzi ngaso sonke isikhathi. Kwezinye izimo, iphetha ngomphumela obulalayo. Ezinye izinkinga ezivamile ze-pathology:
- ukuvuvukala okuphazamisayo kwe-pleura (pyopneumothorax);
- emphysema encane ;
- ukucindezelwa kwezitsha ezinkulu nenhliziyo;
- ukuphuma egazini ngaphakathi kwesikhala;
- ukuhluleka okukhulu kokuphefumula;
- ukuqina (ukulahlekelwa umsebenzi) wamaphaphu.
Imiphumela ye-pneumothorax
Umphumela wokuqoqa umoya emlonyeni wesibindi uncike esimweni sesifo, ubuhlungu bawo, ukulimala okuhambisanayo esifubeni. I-valve pneumothorax ine-prognosis engavumelekile kakhulu, ikakhulukazi ngamanxeba amabi emaphashini. Ezinye izinhlobo ze-pathology ziphendula kahle ukwelashwa, kodwa zingabangela imiphumela engozini futhi zijwayele ukubuyela emuva. Emiphakeni ye-pneumothorax engaqondakali, izibikezelo ziyavuma.