Kodi chiopsezo cha opareshoni ndi chiani ndipo kuwunika koyambirira kumachitika bwanji?

Zamkati

• Momwe kuwunika koyambirira kumachitikira
• 1. Kuchita kafukufuku wamankhwala
• 2. Kuwunika kwa mtundu wa opareshoni
• 3. Kuunika kwa chiwopsezo cha mtima
• 4. Kuchita mayeso ofunikira
• 5. Kupanga kusintha kwa preoperative

Kuopsa kwa opareshoni ndi njira yodziwira momwe thanzi la munthu yemwe angawachitire opaleshoni, kuti zoopsa zamavuto zizidziwike nthawi yonse isanachitike, mkati ndi pambuyo pa opaleshoni.

Amawerengedwa kudzera pakuwunika kwamankhwala ndi pempho la mayeso ena, koma, kuti izi zikhale zosavuta, palinso ma protocol omwe amatsogolera kulingalira kwachipatala, monga ASA, Lee ndi ACP, mwachitsanzo.

Dokotala aliyense amatha kuwerengetsa izi, koma nthawi zambiri zimachitidwa ndi dokotala wamba, katswiri wamtima kapena wodwalayo. Mwanjira imeneyi, ndizotheka kuti chisamaliro china chimaperekedwa kwa munthu aliyense asanafike pochita izi, monga kupempha mayeso oyenera kapena kulandira chithandizo chamankhwala kuti achepetse ngozi.

Momwe kuwunika koyambirira kumachitikira

Kuwunika kwachipatala komwe kumachitidwa opaleshoni isanachitike ndikofunikira kwambiri kuti mumvetsetse bwino mtundu wamankhwala omwe munthu aliyense angathe kapena sangachite, ndikuwona ngati zoopsa zake zikupitilira maubwino ake. Kuwunika kumaphatikizapo:

1. Kuchita kafukufuku wamankhwala

Kuyesedwa kwachipatala kumachitika ndikutolera deta kwa munthuyo, monga mankhwala omwe amagwiritsidwa ntchito, zizindikilo, matenda omwe ali nawo, kuphatikiza pakuwunika kwakuthupi, monga kukondoweza kwamtima ndi m'mapapo mwanga.

Kuchokera pakuwunika kwamankhwala, ndizotheka kupeza mtundu woyamba wamagulu owopsa, opangidwa ndi American Society of Anesthesiologists, otchedwa ASA:

• Mapiko 1: munthu wathanzi, wopanda matenda amachitidwe, matenda kapena malungo;
• Mapiko 2: munthu amene ali ndi matenda ofatsa, monga kuthamanga kwa magazi, matenda a shuga, kunenepa kwambiri, zaka zopitilira 80;
• Mapiko 3: munthu yemwe ali ndi matenda owopsa koma osalepheretsa matenda, monga kubweza mtima, kulephera kwa mtima kwa miyezi yopitilira 6, angina wamtima, arrhythmia, cirrhosis, matenda a shuga kapena kuthamanga kwa magazi;
• Mapiko 4: munthu yemwe ali ndi matenda owopsa omwe amalepheretsa moyo wake, monga kulephera kwamtima, matenda amtima osakwana miyezi 6, mapapo, chiwindi ndi impso;
• Mapiko 5: munthu amene akudwala mwakayakaya, osayembekezera kuti adzapulumuka kwa maola opitilira 24, monga pambuyo pangozi;
• Mapiko 6: munthu amene wapezeka kuti wamwalira muubongo, yemwe adzachitidwa opaleshoni yothandizira ziwalo.

Kuchulukitsa kuchuluka kwa gulu la ASA, kumawonjezera chiopsezo chakufa ndi zovuta kuchokera ku opareshoni, ndipo wina ayenera kuwunika mosamala mtundu wanji wa opaleshoni yomwe ingakhale yopindulitsa komanso yopindulitsa kwa munthuyo.

2. Kuwunika kwa mtundu wa opareshoni

Kumvetsetsa mtundu wa opareshoni yomwe ichitidwe ndikofunikanso kwambiri, chifukwa pakuchita opaleshoni kovuta komanso kudya nthawi, kumawonjezera ngozi zomwe munthuyo angavutike nazo komanso chisamaliro chomwe chiyenera kuchitidwa.

Chifukwa chake, mitundu ya opareshoni imatha kugawidwa malinga ndi chiwopsezo cha zovuta zamtima, monga:

3. Kuunika kwa chiwopsezo cha mtima

Pali ma algorithms ena omwe amayeza kwambiri kuopsa kwa zovuta ndi kufa pakuchita opaleshoni yopanda mtima, mukafufuza momwe munthu aliri komanso mayesero ena.

Zitsanzo zina zama algorithms omwe amagwiritsidwa ntchito ndi Ndondomeko Yowopsa kwa Mtima wa Goldman, Mndandanda wa Lee's Revised Heart Risk Index ndi Ziwerengero za American College of Cardiology (ACP), Mwachitsanzo. Kuti adziwe zoopsa, amalingalira zambiri za munthuyo, monga:

• Zaka, yemwe ali pachiwopsezo chachikulu kuposa zaka 70;
• Mbiri ya infarction yam'mnyewa wamtima;
• Mbiri ya kupweteka pachifuwa kapena angina;
• Kukhalapo kwa arrhythmia kapena kuchepa kwa zotengera;
• Kutsegula magazi oxygenation;
• Kukhalapo kwa matenda a shuga;
• Kukhalapo kwa kulephera kwa mtima;
• Kukhalapo kwa mapapo edema;
• Mtundu wa opaleshoni.

Kuchokera pazambiri zomwe zapezeka, ndizotheka kudziwa kuwopsa kwa opaleshoni. Chifukwa chake, ngati ndiwotsika, ndizotheka kumasula opaleshoniyi, chifukwa ngati chiwopsezo cha opaleshoni ndichapakatikati mpaka chapamwamba, adotolo amatha kupereka chitsogozo, kusintha mtundu wa opareshoni kapena kupempha mayeso ena omwe angakuthandizeni kuwunika bwino za chiopsezo cha munthu.

4. Kuchita mayeso ofunikira

Mayeso opangira opareshoni ayenera kuchitika ndi cholinga chofufuza zosintha zilizonse, ngati pali kukayikira, komwe kumatha kubweretsa zovuta pakuchita opaleshoni. Chifukwa chake, mayeso omwewo sayenera kulamulidwa kwa aliyense, popeza palibe umboni kuti izi zithandizira kuchepetsa zovuta. Mwachitsanzo, mwa anthu omwe alibe zizindikilo, omwe ali ndi chiopsezo chochepa cha opaleshoni ndipo ndani angachite opareshoni yochepa, sikofunikira kuchita mayeso.

Komabe, ena mwa mayesero omwe amafunsidwa kwambiri ndikuti:

• Kuwerengera kwa magazi: anthu omwe amachitidwa opaleshoni yapakatikati kapena yoopsa, ali ndi mbiri yakuchepa kwa magazi m'thupi, akukayikiridwa pakadali pano kapena matenda omwe angayambitse kusintha kwama cell amwazi;
• Mayeso a coagulation: anthu omwe amagwiritsa ntchito ma anticoagulants, kulephera kwa chiwindi, mbiri ya matenda omwe amachititsa magazi, apakati kapena maopaleshoni oopsa;
• Mlingo wa creatinine: anthu omwe ali ndi matenda a impso, shuga, kuthamanga kwa magazi, matenda a chiwindi, kulephera kwa mtima;
• X-ray pachifuwa: anthu omwe ali ndi matenda monga emphysema, matenda amtima, azaka zopitilira 60, anthu omwe ali pachiwopsezo chachikulu cha mtima, omwe ali ndi matenda angapo kapena omwe angachite opareshoni pachifuwa kapena pamimba;
• Electrocardiogram: anthu omwe akuganiza kuti ali ndi matenda amtima, mbiri ya kupweteka pachifuwa komanso odwala matenda ashuga.

Kawirikawiri, mayeserowa ndi othandiza kwa miyezi 12, osafunikira kubwereza munthawi imeneyi, komabe, nthawi zina, adokotala angaone kuti ndikofunikira kuwabwereza zisanachitike. Kuphatikiza apo, madotolo ena angawone kuti ndikofunikira kuyitanitsa mayesowo ngakhale kwa anthu omwe sakuwakayikira.

Mayeso ena, monga kupsinjika kwa nkhawa, echocardiogram kapena holter, mwachitsanzo, atha kulamulidwa chifukwa cha mitundu ina yovuta ya opareshoni kapena anthu omwe akuganiza kuti ali ndi matenda amtima.

5. Kupanga kusintha kwa preoperative

Pambuyo pochita mayeso ndi mayeso, dokotalayo amatha kukonza zochitikazo, ngati zonse zili bwino, kapena atha kupereka malangizo kuti chiwopsezo cha zovuta mu opareshoni chichepe momwe zingathere.

Mwanjira imeneyi, amatha kulimbikitsanso mayeso ena, kusintha mlingo kapena kuyambitsa mankhwala, kuwunika kufunika kokonza mtima, kudzera pakuchita opaleshoni ya mtima, mwachitsanzo, kuwongolera zolimbitsa thupi, kuwonda kapena kusiya kusuta, pakati pa ena .