Epidural anesthesia ndi gawo la msuzi amagwiritsidwa ntchito monga maziko a mtundu wa anesthesia. Mtundu uwu wamagulu a anesthesia umathandiza kwambiri, uli ndi zotsatira zochepa. Talingalirani izi mwatsatanetsatane, kuwonetsa zizindikiro, zizindikiro za khalidwe ndi zotsutsana.
Zochitika za Epidural anesthesia - zizindikiro
Epidural anesthesia ndi mchere wachitetezo amachitika ndi chikhumbo cha mkazi wogwira ntchito. Amayi ambiri amtsogolo omwe amalembedwa chigawo chokonzekera amakonda mwachindunji mtundu uwu wa anesthesia. Ndi chitsimikizo chotere, mkaziyo amakhalabe chidziwitso, akumva kulira koyamba kwa mwana wake, koma samamva kalikonse. Palinso zinthu zina zomwe zimakhala zovuta kuti munthu asatayike. Zina mwa izo ndi:
- kukhalapo kwa preeclampsia ;
- kuthamanga kwa magazi;
- matenda a chiwindi ndi impso;
- kutchulidwa myopia;
- shuga;
- zotsutsana ndi anesthesia;
- ntchito yochuluka;
- zizindikiro za chiberekero.
Kodi gawoli limakhala bwanji ndi matenda oopsa?
Akazi, pokonzekera opaleshoni, nthawi zambiri amakhala ndi chidwi ndi madokotala, monga chigawo cha msuzi ndi matenda oopsa. Asanayambe opaleshoni, mayi wapakati amakhala pansi pa kama, kapena amakhala pambali pake. Malo a msana wam'mimba kumene singano imalowetsedwa amachiritsidwa mosamala ndi mankhwala oyambitsa matenda. Pambuyo poyambitsa matenda a anesthesia, madokotala amachititsa mimba m'mimba, mwinamwake pamwamba pa malo osambira. Pa bala la opaleshoni, owonjezera amaikidwa, kutsegula mwayi wopita kwa mwanayo.
Pambuyo pa kutsegula bwino kwa chikhodzodzo, madokotala amayamba kuchotsa chipatso kunja. Pambuyo pomaliza kukwanitsa gawoli, mwanayo amadulidwa chingwe cha umbilical ndipo chimbudzi chimagwiritsidwa ntchito. Amayi amapatsidwa oxytocin, chifukwa cholekanitsa kubereka. Pambuyo pake, suturing ikuchitika. M'malo mwa msoko patapita miyezi ingapo pamakhala chilonda, chomwe chiri pafupifupi chosawoneka, sichimayambitsa amayi kusokoneza.
Kodi epidural anesthesia imachitidwa bwanji ku gawo la misala?
Epidural anesthesia mu gawo losungirako kaŵirikaŵiri nthawi zambiri amadziwika pa malo okhala. Pachifukwa ichi, wodwalayo akupatsidwa udindo: miyendo kuti iwonongeke pamabondo, ikani mabowo pamgedi, igule kumbuyo, iwononge gawo lachiberekero. Njira ina ndi yomwe mkazi amagona pambali pake (nthawi zambiri kumanja). Komabe, chithandizo cha zamankhwala chikusonyeza kuti ndi kosavuta kupereka mankhwala osokoneza bongo m'malo odwala.
Mankhwala otsekemera, mothandizidwa ndi singano yapadera, amalowetsedwa pakati pa khoma la ngalande ya msana ndi chipolopolo cholimba cha msana wam'mimba (epidural space). Kapadera kamene kali kofiira (catheter) imayikidwa kupyolera mu singano, yomwe imasiyidwa ndi jekeseni wa mankhwala osokoneza bongo. Epidural anesthesia, ndi gawo la misala, imaphatikizapo kuchepetsa mankhwalawa: kuwonjezereka kwa ndondomeko kapena kuimitsa.
Kodi ndi zopweteka kuchita matenda osokoneza bongo?
Njirayi, monga epidural anesthesia, imakhala yopweteka kwambiri kwa wodwala mwiniwake. Asanayambe kugwira ntchito, madokotala amachititsa anesthesia kumidzi. Kuvutika pang'ono, ululu wochepa mimba ukhoza kumverera nthawi yokha. Mulimonsemo ndondomekoyi siimachititsa ululu, amavomerezedwa bwino ndi amayi omwe alipo. Zochitika za amayi amtsogolo, ponena za kupweteka kwa njira zoterezi, monga zoopsa zowonongeka m'magazi, sizilibe kanthu.
Kodi gawoli likutenga nthawi yayitali bwanji?
Gawo la Kaisara pansi pa zozizwitsa zowopsya sichitha kuposa theka la ora. Pa nthawi yomweyi, kuyambira nthawi ya mautumiki kupita ku feteleza kunja kwa mimba, zimatenga mphindi 10-15. Nthaŵi yonseyo imagwiritsidwa ntchito pokhala chilonda cha postoperative. Pa nthawi yomweyi, mayi amapatsidwa mahomoni pofuna kuchotsa ndi kubadwa kwa pulasitiki. Pofuna kuteteza matenda, amayi amapatsidwa mankhwala oletsa antibacterial.
Cesarea pansi pa zozizwitsa zowopsya
Ndibwino kuti mukhale ndi anesthesia, mayi samamva kalikonse panthawiyi. Zomwe zimagwiritsidwa ntchito m'dera la misala pansi pa zozizwitsa zowopsya zimagwirizanitsa ndi kuyambira kwa zomwe zimayambitsa matendawa. Pambuyo pa jekeseni, mayi woyembekezera amayamba kuzindikira chikondi, kumverera kwa kupsinjika kwa miyendo yake. Patapita kanthawi, amayi amtsogolo samamva kwathunthu pamtunda wa thunthu - chirichonse pansi pa malo opangira jekeseni. Nkhungu pang'ono imafalikira mthupi lonse. Chodabwitsa ichi chikhoza kutsagana ndi kung'ung'onong'ono pang'ono, kumverera kwa goosebumps, zomwe zimatayika pambuyo poyeretsa anesthesia.
Ndi angati omwe amatha kupweteka kwambiri?
Epidural anesthesia ndi caesarean ndi pafupi maola awiri. Nthaŵi yomweyo, madokotala amaletsa mkazi kuti adzuke pambuyo pa opaleshoniyo. Ndi mtundu uwu wa anesthesia, magazi akuthamanga m'munsi otsika amachepetsanso. Chifukwa cha ichi, ngati muyesa kudzuka, pali zofooka m'milingo yanu - pali mwayi waukulu wokugwa. Kuonjezera apo, kawirikawiri atatha opaleshoni pali kupwetekedwa mtima, chizungulire, zomwe zimaipitsa moyo wabwino watsopano.
Epidural anesthesia mu gawo la msuzi - zotsatira
Zotsatira zotsatira zowopsa kwa anesthesia mu gawo lotukuka kawirikawiri zimagwirizanitsidwa ndi kusagwirizana ndi kutsutsana kwa khalidwe lake kapena kuphwanya mchitidwe wogwiritsira ntchito anesthesia. Pachifukwa ichi mavuto amatha kudziwika, kuyambira mayi ndi mwana. Tsatirani zotsatira za nthendayi zoopsa zowopsa kwa amayi (panthaŵi ya zowawa):
- kupwetekedwa kwa chipolopolo cholimba cha msana wa msana;
- kuchepa kwa mtima;
- maonekedwe a kunyoza ndi kusanza;
- zimakhala zosavomerezeka ndi mankhwala osokoneza bongo.
Kusokonezeka kungapangitse m "mene mwangoyamba kumene kuberekera:
- ululu kumbuyo ndi mutu;
- kuphwanya lactation ;
- kuchepa kwa miyendo;
- kusokonezeka kwa CNS.
Kuchita moperewera kachilombo ka anesthesia ndi gawo la chakudya kumakhudzanso chikhalidwe cha mwana:
- kuchepa kwa mtima wamtima (bradycardia);
- kuphwanya njira yopuma;
- kuphwanya reflex kuyamwa;
- chisokonezo;
- kusagwirizana.
Ululu wam'mimba mutatha kupwetekedwa ndi anesthesia ndi mchere
Epidural anesthesia ndi mchere, zotsatira zake zomwe zimatchulidwa pamwambapa, nthawi zambiri zimakhala ululu wamkazi pambuyo pa kubadwa kwa mwanayo. Pakhoza kukhala zifukwa zambiri za izi. Zoopsa ndi epidurit - njira yotupa m'mlengalenga. Izi zimachitika chifukwa cha kathete kumbuyo kapena pamene mbali yake imakhalabe. Kuonjezerapo, ululu ukhoza kuwonjezereka pambuyo pa opaleshoni chifukwa cha chosowa chopezekapo.
Zina zomwe zimayambitsa kupweteka kumbuyo kumagwirizana kwambiri ndi khalidwe loipa la njira monga epidural anesthesia mu gawo loperewera, momwe thupi limayankhira ndi mankhwala osokoneza bongo. Chifukwa chosoŵa zambiri, dokotala akhoza kuvulaza jekeseni wolimba kwambiri, kumene mizu ya mitsempha imapezeka. Mosiyana, nkofunikira kusiyanitsa ululu wamphongo, womwe umagwirizana kwambiri ndi maganizo a wodwala.
Mutu pambuyo pa matenda oopsa a anesthésia ndi osowa
Kufotokozera za zotsatira ndi zovuta za epidural anesthesia mu gawo losakanikirana, m'pofunika kusiyanitsa ndi kupweteka mutu pambuyo pa ntchito. Maonekedwe awo akugwirizanitsidwa ndi zotsatira za chiwalo chogwiritsira ntchito mankhwala m'thupi. Izi zimachitika mwa odwala 50 peresenti omwe anadwala matenda oopsa. Nthawi yovuta kumva - kuyambira maola ambiri mpaka masabata angapo. Mutu ukhoza kuyambitsidwa chifukwa cha kusintha kwapopeni, chifukwa cha kutuluka kwa cerebrospinal fluid mu epidural space (ndi kuwonongeka kwa ubongo).
Zinthu ngati zimenezi zimafuna opaleshoni. Opaleshoniyi imakhala mobwerezabwereza komanso kumamwa kwa madziwo pogwiritsa ntchito zipangizo zamakono. Pambuyo pa kusokoneza, chigawo cha magazi chimayikidwa pa malo otsekedwa. Magazi a wodwalayo atengedwa kuchokera mu mitsempha amajambulidwa pa tsamba la malo. Zotsatira zake, kutuluka kwa cerebrospinal fluid kumatsekedwa. Mthandizi wa amayi abwino amadziwa kale tsiku lotsatira pambuyo pa ndondomekoyi.
Epidural anesthesia ndi gawo la zakudya - zosiyana
Mtundu uwu wamagulu a anesthesia sangagwiritsidwe ntchito nthawi zonse. Ndipo kuwonetseratu kwachipatala kulikonse, koletsedwa kuchita ndi matenda oopsa omwe ali ndi Kaisareya, otsutsana ndi zomwe zikutsatiridwa ndi izi:
- kukana kwa wodwala;
- kusakhala zida zapadera kapena katswiri wodziwa bwino;
- kupweteka kwakukulu;
- kutaya thupi kwa thupi;
- kusokonezeka kwa dongosolo la magazi coagulation;
- hypotension;
- kutenga antiticoagulants ;
- kuvulala kwa msana;
- kuthamanga kwakukulu;
- osayanjanitsidwa ndi mankhwala osokoneza bongo;
- kusokonezeka kwa mtima;
- fetal hypoxia ;
- zopweteka za mwana.