Inyuma yo kubagwa thyroide canke carotide, kwagura amaraso yo mu ijosi: Gufatanya umutsi w’umubiri no gukiza inzira y’impwemu¶

Igitera amaraso agenda arakura imbere canke mu ruhande rw’izosi mu masaha 6 gushika ku 72 ya mbere inyuma y’ugukuraho thyroïde, parathyroïde, carotide endarterectomy (CEA), gukuraho umutwe w’intanga imbere n’ugukoranya (ACDF), canke gucagura izosi ry’imbere ry’izosi** ni inzira y’impwemu ihita, umunota ku munota. Kubera ko umutsi w’inkondo y’umura uzingira umuhogo, umuhogo, igitanda c’umubiri, n’umutsi w’umutwe imbere mu gice c’imitsi gikomeye kandi kidashobora gukomera, mbere n’imitsi 30 gushika ku 100 (1 gushika ku 3,4 ounce z’amazi) z’amaraso y’imitsi canke y’imitsi y’umubiri, imitsi y’umubiri n’imitsi y’umubiri iramenagura ningoga. guhindura imitsi y’ijwi n’iy’inyuma y’ururimi bikaba uruhome rw’ibivyimba rwuzuye kandi rudashobora guca kera cane imbere y’uko amaraso yigera asohoka biciye mu gipfukisho co hanze. Iyo umurwayi w’izosi amaze kubagwa agira izosi rikomeye canke rivyimba, akagorwa no kumira, ijwi ryiwe ricitse intege, akagira ubwoba canke amajwi y’uguhema avuga cane (stridor), hamagara aho uba inomero z'ivyihutirwa ubwo nyene. Ku bijanye n’ibintu vyihutirwa bijanye n’inzira y’impwemu yo hejuru be n’inyuma y’ugubagwa, nubaze epiglottite, croup, stridor, n’uguhagarara kw’inzira y’impwemu yo hejuru, amaraso ava inyuma y'uguca amatonsille n'amaraso ava mu gisebe, na Angine ya Ludwig n'indwara zikomeye zo mw'izosi.

Ntukigere urindira ko amaraso anywa igitambaro co hanze canke ngo yuzuze igitambaro co gukura amazi mu gitereko c’ipulasitike imbere y’uko ukora; mu bice birenga 80 kw’ijana vy’amaraso yica umuntu amaze gukurwako thyroïde, umuyoboro w’amaraso w’ipulasitike wa Jackson-Pratt urazibira burundu canke usa n’uwutagira ikintu mu buryo buhenda mu gihe umukazo uriko uraduga imbere mu gice c’imitsi gipfutse. Kwicara umugozi w’umurwayi uhagaze, ugakuraho umugozi wo hanze wo mw’izosi ubwo nyene, ugaca wirukira mu bitaro vy’ibiza kugira ngo uhite ushireko ibikomere iruhande y’igitanda SCOOP bikiza umurwayi guhungabana.

Ivyo ubikore ubu¶

1. Hamagara inomero y’ivyihutirwa yo mu karere kawe ubwo nyene. Hamagara 911 muri Leta Zunze Ubumwe za Amerika na Canada, 112 mu bihugu vyose vy’Ubumwe bw’Uburayi, 999 mu Bwongereza, 000 muri Australiya, canke urabe ububiko bwacu bwa inomero z'ivyihutirwa. Bwira uwurungitse neza: "Ubazwe vuba kw'izosi/thyroïde/carotide/umugongo w'intanga n'amaraso y'izosi avyimba vuba cane n'ugucika intege kw'inzira y'impwemu; ukeneye abaganga bafasha ubuzima buteye imbere ubwo nyene."
2. Icara umugozi w'umurwayi uhagaze ku burebure bwa degre 45 gushika kuri 90 (high Fowler's position). Ntukigere uhatira umurwayi afise izosi ryavyimvye amaze kubagwa ngo aryamye ku mugongo. Kuryama ku mugongo bituma uburemere bw’isi n’umuvuduko wo hejuru w’imitsi bishobora gutuma hematoma y’izosi ivyimba kandi bikagabanya umutwe w’ururimi n’ururimi rwuzuye inyuma ku nzira y’umuyaga, bigatuma umuyaga uhagarara ubwo nyene.
3. Kuraho imigozi yose y’inyuma y’izosi, imigozi y’inguvu, n’impuzu zifatanya ubwo nyene (kandi ufungure umugozi wose ukomeye wo mu nda nimba ugushikama kw’umugongo w’intanga kwemerera canke nk’uko vyategetswe na EMS). Ntukingire umugozi w’izosi uvyimvye, kandi ntuzingire umugozi w’imbere n’ukuboko kwawetrachea) kugira ngo "ahagarike amaraso." Gukanda hasi imbere y’izosi ry’umuntu amaze gukurwako igihimba c’umubiri citwa thyroïde, bica bisunika amaraso yafunzwe agaca asubira inyuma mu ruhome rw’inyuma rw’umubiri rworoshe, maze bigatuma umurwayi aniha. Mukureho buhoro buhoro igipande co hanze n’igitambaro co gupfuka kugira ngo wewe n’abaganga mubone aho babazwe maze mureke urukoba rwaguke ruje hanze.
4. Guma umurwayi atuje, ataco yinyiganza, kandi ntaco afata mu kanwa (ntaco arya, anywa canke amira). Kurira, gukorora, gukorora, canke gutera umuvuduko bitera umuvuduko w’amaraso mu mitsi yo hagati no mu mitsi y’umubiri imbere mu mitsi y’umubiri, bigatuma amaraso yihuta kuva mu gice c’izosi.
5. Suzuma igikoresho co gukura amazi mu gihe c’ugubaga (niba kiriho), ariko NTUKIGEZE wizigira igikoresho co gusohora amazi ataco kirimwo. Nimba umurwayi yoherejwe muhira afise igikoresho co kunyonga ca Jackson-Pratt (JP) canke Blake, suzuma nimba ico gikoresho gifise ishusho ya grenade cavuye mu buryo butunguranye cuzuye amaraso atukura cane canke kikabura ubusa bwaco. Ariko rero, niwibuke yuko amaraso menshi cane akunda gufunga utunogo dutoduto two mu nzira ijana amazi mu kubagwa mu minota mikeyi, agasiga iyo nkoko ata co imaze mu gihe izosi rigenda ritera umupira mu buryo buteye akaga.
6. Nimba umurwayi amaze kubagwa thyroïde canke parathyroïde, urabe kandi ko ata n’umwe afise ububabare bwo ku minwa n’intoke canke ko ata n’ibiganza bitera (hypocalcemic laryngospasm). Gukomeretswa canke gukuraho utugingo ngengabuzima tune dutoduto mu gihe umuntu abazwe, bituma umugera wa calcium mu maraso ugabanuka cane amasaha 12 gushika ku 72 inyuma yo kubagwa, bikaba bituma iminwa/intoke zitera ububabare, ibiganza bikaguma bikomeye nk’ibirenge (Trousseau's sign), n’ugucika intege bukwi na bukwi kw’imitsi y’ijwi (stridor) mbere n’aho ata hematoma.

Igiti c'ingingo: ukuvyimba inyuma yo kubagwa kw'izosi n'ugutoranya inzira y'impwemu¶

flowchart TD
    A["Umurwayi Inyuma yo Kubagwa Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihugu (CEA), canke Umugongo w’Igihimba c’Igihimba c’Igihimba (ACDF)"] --> B{"Suzuma ukuntu izosi risa, ijwi, ukumira, n'uguhema"}
    B -->|"Stridor (guhema n’ijwi rirenga), iminwa y’ubururu, uguhungabana, canke ukudashobora kuvuga/guhema"| C["GUFUMA MU GIHE: Hamagara 911/112/999 maze wicare umurwayi ahagaze"]
    C --> D["Ubwo nyene ushireko imyambaro yo hanze; NTUKANDA ku muhogo"]
    D --> E["Ibitaro/EMS SCOOP Porotokole: Gufungura urukoba n'imitsi y'imitsi kugira ngo ukureho igihimba c'umubiri"]
    B -->|"Izosi kuvyimba, gufatanya, kwuzura, ijwi ripfutse, canke ingorane zo kumira amacandwe"| F["HEMATOMA YO GUKORA MU IZOSI (Intambwe ya mbere imbere y’uko umuntu agira stridor)"]
    F --> G["Icara ugororotse ku 45 gushika kuri 90 degrees, ukureho umugozi ushikamye, ugume ukora NPO, hamagara EMS ubu"]
    B -->|"Gutera ububabare mu kanwa/intoke + ibiganza bifatanye (‘ukuboko kw’urutoke’) + izosi ryoroshe"| H["INYUMA YO GUKURAMWO THYROIDE HYPOCALCÉMIE (Ingorane y'ugutera indwara y'amatwi)"]
    H --> I["Gutanga umuti wo mu kanwa witwa calcium carbonate + calcitriol nimba ushobora kuwumira; genda mu bitaro vya ER kugira ngo ubone umuti witwa calcium gluconate"]
    B -->|"Gutemba bukwi na bukwi ku ruhande rumwe mu maso, intege nke z’ukuboko, canke amajambo atari meza inyuma yo kubagwa Carotid"| J["INYUMA Y'IGIHUGU CANKE IGIHUGU C'UMUTUMA CANKE MU MUTIMA: Hamagara EMS ubwo nyene"]

Ingene hematoma ntoyi yo mw’izosi ituma inzira y’impwemu ifunga bukwi na bukwi¶

Abarwayi benshi be n’abagize umuryango biyumvira yuko iyo umutsi w’amaraso utanguye kuva amaraso inyuma yo kubagwa mw’izosi, bazobona amaraso atonyanga mu gikiriza, canke ko bisaba amaraso menshi cane kugira ngo umuntu amenagure impeta z’imitsi y’umuyaga. Ivyo vyiyumviro vyompi ni ibinyoma kandi birashobora kwica.

Kubera iki umutsi w’inkondo y’umura ukora nk’igitekerezo c’umuriro gipfutse¶

Imbere y’izosi ry’umuntu rigabanywemwo ibice vy’umubiri bikomeye bipfutse n’ibipande bikomeye kandi bitashobora gukomera vyitwa deep cervical fascia (vyihariye igice c’intanga c’intanga, igihimba c’imbere c’intanga gikikuje igitanda c’umubiri n’igitanda c’intanga, n’igitanda c’intanga). Iyo umuganga amaze kubaga thyroïde, parathyroïde, canke kubaga umugongo w’imbere w’intanga, akenshi adodera imitsi y’umugozi ihagaze (sternohyoid na sternothyroid) zigasubira hamwe mu murongo wo hagati hejuru y’umutsi w’impwemu hanyuma zigafunga umutsi wo hejuru (platysma) n’urukoba rufise imidodo, ibikoresho vyo kubaga canke ivyuma bifata urukoba vyitwa cyanoacrylate.

Iyo ishami ry’umutsi w’igitigu wo hejuru, umutsi w’igitigu wo hasi, umutsi wo hagati w’igitigu, canke umutsi w’imbere w’igitigu** rinyereye canke rigasubira gufunguka igihe umurwayi akorora, aruka, canke akora cane inyuma y’aho umuti wo kumunezereza uheze, amaraso asuka mu gice c’imbere c’iburyo c’imbere y’igihimba c’irondoka. Kubera ko imitsi y’umugozi udozwe n’umutsi w’intanga ukomeye udashobora kurambura hanze bitagoranye, umukazo uri muri ico gice c’intanga uraduga cane (cervical compartment syndrome).

Uburyo bubiri bwica bwo kuzibira inzira y'impwemu¶

Igikoko c’amaraso co mw’izosi kigenda kirakura kirafunga inzira y’impwemu y’umuntu biciye mu buryo bubiri butandukanye bw’umubiri - kandi uburyo bwa kabiri ni ubwo bufata mbere n’abaganga bazi utuntu n’utundi:

1. Ugufatanya kw’umubiri kw’umubiri w’inyuma: Mu gihe imbere n’inyuma y’umubiri bishigikiwe n’ibizingiti bifise ishusho ya C vy’umubiri w’umubiri witwa hyaline cartilage, uruhome rw’inyuma rw’umubiri (pars membranacea) - yicara ataco ihinduye ku nzira y’umuhogo n’umugongo w’imbere y’umugongo - ikozwe mu ruhu rworoshe, rushobora guhinduka, rudafise igihimba c’umubiri gifasha. Uko amaraso atera mu kibanza c’imbere y’umuhogo n’inyuma y’umuhogo, iyo hematoma irafyonda umuhogo kuva imbere no ku mpande maze igafatanya uruhome rw’inyuma rworoshe rw’umubiri, igatuma umuhogo ugabanuka.
2. Ugupfuka imitsi n'amaraso bitera ububabare bwinshi bw'umubiri (The Real Killer):
3. Amaraso y’imitsi yinjira mu rwara no mu mitsi y’ijwi afise umuvuduko munini (90 gushika kuri 120 mmHg), mu gihe amaraso y’imitsi n’amaraso y’umubiri biva mu rwara biciye mu mitsi y’imbere y’ibere n’iy’igitigu ifise inkuta ndende kandi ifise umuvuduko muto (5 gushika kuri 15 mmHg gusa).
4. Igihe umuvuduko uri imbere mu gitanda c’amaraso c’umubiri gipfutse urenga 15 gushika kuri 20 mmHg, amazi ava mu mitsi n’amaraso ava mu nzira y’amatwi, mu mitsi y’ijwi, mu mitsi y’amajwi, no mu nzira y’amatwi aracika burundu, mu gihe imitsi iguma ipompa amazi.
5. Amazi asuka avuye mu mitsi y’amatwi yuzuye, akaja mu bihimba vy’umubiri vy’imbere y’ijwi n’imitsi y’ijwi. Mu minota 15 gushika kuri 45, epiglotte n’imitsi y’ijwi y’ikinyoma birahinduka ibice bininibinini, bica ibibatsi, vyuzuye amazi (massive laryngeal edema) bifunga inzira y’impwemu igasubira gufunga kuva imbere - kandi bituma gutera umutsi w’impwemu mu bitaro hafi bidashoboka kiretse iyo umutsi w’impwemu ushobora gufungurwa. umukazo.

Kubera iki gupima umwuka w’umutima (SpO2) na stridor ni ibimenyetso biteye akaga vy'UKUREBA .¶

Igipfunsi c’umuntu akuze gifise amagara meza gifise umurongo w’imbere w’iminota 15 gushika kuri 20 (0,6 gushika kuri 0,8 inches). Kubera ko ubushobozi bwo guhangana n’umuyaga unyura mu nzira y’umurongo mutoyi bujanye n’ubushobozi bwa ububasha bwa kane bw’uruzitiro (Poiseuille's law), umurwayi ahumeka mu gacerere mu gihe aruhutse azogira umwuka w’umwuka usanzwe (98% gushika ku 100% ku gipimo c’umuvuduko w’urutoke) kandi nta stridor yumvikana gushika aho 70 kw’ijana vy’umurongo w’impwemu wabo bimaze gupfungwa.

Igihe inzira y’impwemu igabanutse gushika ku milimetero 4 gushika kuri 5 za nyuma (0,16 gushika kuri 0,2 inches), umuyaga utera umuvurungano utuma umuntu agira impwemu n’ijwi rirenga stridor, umurwayi agaca ahagarika umutima maze agahema cane, ingaruka mbi zo mu gifu zikwegera imitsi y’ijwi yavyimvye yose uko ingana (**the Venturiation itatu). iminota. Ntukigere urindira stridor canke igisomwa c’umwuka w’ikirere kiri hasi; ukore ku kimenyetso ca mbere nyene c’uko izosi rifatanye, rivyimba canke rigoye kumira.

Igihe n'amadirisho y'ingorane inyuma yo kubagwa mw'izosi¶

Ibimenyetso vy'imburi vy'imbere n'inyuma: urutonde rw'igenzura ry'ubuvuzi "DESATS"¶

Amabwirizwa y’Ubwongereza n’ay’amakungu yerekeye ugubaga kw’imitsi y’umubiri akoresha ubuhinga bwo kwibuka DESATS kugira ngo amenyereze abaforomo, abarwayi, n’abajejwe kwitwararika umuryango kubona amaraso yo mu ijosi ariko aragwira imbere y’uko stridor itera:

• D - Kugorwa no kumira (Dysphagia) canke ukudatekana: Umurwayi aca yumva bukwi na bukwi nk’aho umupira wa golf canke umugozi ukomeye uriko uramukandagira ku muhogo igihe agerageza kumira amacandwe yiwe bwite, canke agatangura gusesa amazi kubera ko kumira bibabaza. Ico kenshi ni co kimenyetso ca mbere cane, kigaragara isaha imwe imbere y’uko umuntu agira ingorane zo guhema.
• E - Igitigiri c'imburi mbere y'igihe / ihinduka ry'ingenzi: Ukwiyongera kw'umutima kutasobanuwe (tachycardia over 100 bpm), ukuduga kw’umuvuduko w’amaraso (bivuye ku adrenaline n’ububabare), canke ukuduga kw’urugero rwo guhema (over 20 breaths per minute).
• S - Kuvyimba: Ukwuzura kugaragara canke gufatwa, kuvyimba, gukomera, canke gutakaza umurongo w’umwobo usanzwe (suprasternal notch) mu ntango y’imbere y’izosi, canke ibikomere bikwiragira hejuru bigana ku kibuno canke bikaja hasi ku gikiriza.
• A - Amaganya, uguhagarika umutima, canke ukudatekana: Umurwayi ashobora kuryama ataco akora, akura ku mpuzu canke ku nkweto yiwe yo mu bitaro, ashimika ku kwicara agororotse, canke akavuga ngo "Hari ikintu kimeze nabi, numva umengo ndiko ndanyiganyiga" aba ariko arashikirwa n’inzara y’umuyaga y’imbere y’igihe (hypoxic/hypercapnic tracheal air hunger). Ntukigere ureka amaganya y'inyuma yo kubagwa mw'izosi nk'igitero c'ubwoba canke ngo uhe imiti yo guhoza.
• T - Tachypnea / kugorwa no guhema: Guhumeka nabi, gukenera kwiheka imbere kugira ngo uhumeke, canke uguhinduka kw'ijwi (ijwi ry'"hot-potato" ripfutse canke uguhumeka gushasha).
• S - Stridor (IKIMENYETSO C'IKIMENYETSO): Ijwi ry'ijwi rirenga, ry'umuziki, ry'ugusemerera canke ry'ugusemerera ryumvikana iyo umuntu ahumekera mu (inspiratory stridor) canke vyose biva n’ivyo hanze (biphasic stridor), hanyuma hakaza ugugabanya umwuka w’ikirere (SpO2).

Gutahura uburyo bwo gukuraho ububabare bwo mu bitaro "SCOOP"¶

Mu mwaka w’2022, Ishirahamwe ry’Ivy’Imitsi Igoye (DAS), Ishirahamwe ry’Abaganga b’Imitsi n’Imitsi y’Imitsi (BAETS), n’Ishirahamwe ry’Ubwongereza ry’Abaganga b’Imitsi n’Imitsi (ENT UK)** vyasohoye amabwirizwa y’agaciro y’ubuhinga bwinshi ashinga ubuhinga bwihutirwa bwo kuvura **SCOOP hematoma y’inyuma y’ugukuraho thyroïde. Umuntu wese yitwararika abana, umuganga w’abagwayi be n’umuganga w’abarwayi bihutirwa, akwiye gutahura igituma ivyo bigenda be n’ingene bigenda.

Ico SCOOP ihagarariye¶

1. S - Gushira ahabona urukoba: Kuraho igitambaro co hanze, umugozi, na Steri-Strips vyose kugira ngo ushire ahabona igice c’izosi cabazwe mu gihe wicaye umurwayi ahagaze kandi utanga 100% y’umwuka w’umwuka mwinshi.
2. C - Kata imidodo (canke ukureho ibipfukisho) vy’urukoba: Ukoresheje ibikoresho bica imidodo, umukasi utagiramwo ubumara, canke igikoresho co gukurako imidodo, fungura uburebure bwose bw’urukoba rwo hejuru n’ugufunga kwa platysma ku ijosi ryo hasi.
3. O - Gufungura igice c’imitsi kiri imbere cane (Strap muscles): Iyi ni yo ntambwe ihambaye cane. Gufungura urukoba rwonyene kenshi ntibihagije kuko hematoma ifata munsi y’imitsi y’umugozi yo hagati idozwe neza (sternohyoid na sternothyroid). Abaganga barakata umudozi wo hagati uhagaze uhagaze ufatanya imitsi y’umukanda maze bagashira inda z’imitsi zitandukanye n’intoke canke n’ibikoresho bitagira ibara.
4. O - Ugurure igikomere maze ukuremwo igihimba c’umubiri: Kura amaraso y’umwirabura ameze nk’ay’umunyu aruhukiye hejuru y’umutsi w’umubiri ukoresheje intoke canke igitambaro c’umubiri kitagiramwo ubumara. Ubwo nyene, umuvuduko wo mu bice uragabanuka ukaja kuri zero, imitsi iva mu mitsi y’ijwi igasubira gusohoka, edema y’amatwi igatangura guhera, maze uruhome rw’inyuma rw’umuhogo rugasubira gufunguka.
5. P - Pakira igikomere n’agatambaro k’umunyu (NTUKANDE hasi ku nzira y’umuyaga) hanyuma uce ukijana mu kibanza co kubagiramwo kugira ngo amaraso ahagarare neza mu gihe c’ugutera umuti w’ububabare.

Ivyiyumviro bidasanzwe bishingiye ku bwoko bwo kubagwa: Carotide, ACDF Umugongo, na Parathyroïde¶

Naho gukuraho igihimba c’umubiri citwa thyroïde ari co kintu nyamukuru gituma umuntu agira amahematoma yo mu ijosi, hari ibindi bikorwa bitatu bikunze kubaga mw’izosi bifise ibintu bidasanzwe bishobora gutuma umuntu apfa:

1. Inyuma y’ugukuraho umutsi w’umutima (CEA) Ukwagura amaraso yo mu ijosi¶

Mu gihe c’uguca umutsi w’umutima, umuganga abaga imitsi arafungura umutsi w’umutima rusangi n’uw’imbere ku ruhande rumwe rw’izosi kugira ngo akureho igihimba c’umubiri gitera umutsi w’umutima, hanyuma akadoda igipande (bovine pericardium, Dacron, canke umutsi) ku ruhome rw’umutsi rufise umuvuduko munini.

• Igituma hematoma y’inyuma ya CEA iturika: Bitandukanye n’ugusohoka kw’imitsi, ugusohoka kw’amaraso kuva ku murongo w’umutsi w’umutwe w’umuvuduko munini (suture-line blowout) yuzuza izosi ryo mu ruhande ratusan y’imililitiro y’amaraso yo mu mitsi mu gihe c’imivuduko y’imitsi y’amaraso (systolic pressures) iri hagati ya 140 na 200 mmHg mu minota mikeyi.
• Massive tracheal deviation: Hematoma y’uruhande rumwe isunika umutsi wose w’umuhogo n’umuhogo bikomeye cane bikajabuka ku ruhande rumwe rw’izosi, bigatuma inzira y’impwemu igoramye mu mfuruka ikarishe mu gihe bifatanya umutsi w’imbere w’izosi n’imitsi y’imbere y’izosi.
• Ikibazo c’ugufatwa n’indwara y’umutima bivuye ku gufatanya hanze: Gukanda cane ku hematoma y’izosi inyuma ya CEA birashobora gufunga umutsi w’imbere w’ubwonko uherutse gusanurwa canke gukuraho thrombus y’uruhome igororotse mu mutsi wo hagati w’ubwonko, bikaba bituma umuntu ahita agira indwara y’umutima ikomeye cane (paraphasiaarly a/ paraphasia a). Gumana umurwayi yicaye agororotse, ugenzure umuvuduko w’amaraso nimba imiti yandikiwe yabuze, hanyuma uhamagare 911/112/999 ubwo nyene.

2. Inyuma y’uguca umutwe w’intanga n’ugutera amaraso (ACDF)¶

Mu gihe c’ugubaga umugongo w’izosi ukoresheje ubuhinga bwa ACDF, abaganga babaga umugongo w’imitsi canke amagufa baraca imbere y’izosi, bagasubiza inyuma umutsi w’umugongo n’umuhogo w’umuhogo mu ruhande, bagakuraho iyo disiki, hanyuma bagashira igipande c’ivyuma vyitwa titanium ku ruhande rw’imbere rw’umugongo w’intanga (C3 to C7).

• Ikibanza c’imbere y’umugongo / inyuma y’umuhogo: Amaraso ava mu gitanda c’amagufa canke mu mitsi y’umubiri yo hejuru/yo hasi akoranira inyuma cane y’umuhogo n’umuhogo mu ikibanza c’inyuma y’umuhogo gushika ku mugongo w’intanga ukomeye.
• Ukuvyimba kw’izosi kwo hanze kwoshobora gusa n’ugutobato mu buryo buhenda: Kubera ko amaraso afashe cane mu mugongo inyuma y’umuhogo, hanze y’izosi yoshobora gusa n’aho yuzuye gatoyi gusa mu gihe umurwayi ashobora gutakaza ubushobozi bwo kumira amacandwe bukwi na bukwi (aphagia), akanywa amazi, maze akagira stridor ikaze cane yo guhema.
• Ugucungera umugozi w'intanga ukomeye: Iyo umurwayi yambaye umugozi w'intanga ukomeye w'ipulasitike (Aspen canke Miami J collar) iriko iranyiganyiga izosi ryihuta kuvyimba, fungura imigozi y’imbere ya Velcro maze ukureho igice c’imbere c’izosi mu gihe umutwe n’izosi vy’umurwayi bigumye bishigikiwe mu kibanza kitagira aho kigarukira mu murongo n’ibitambaro canke amapillows ku mpande zompi kugira ngo imbere y’izosi ntihagire ikintu gifatanye rwose.

3. Inyuma yo gukuraho thyroïde / Parathyroïdectomy Hypocalcémie vs.¶

Si umurwayi wese amaze gukugwako thyroïde afise urusaku rwo guhema (stridor) afise igisebe c’amaraso. Ingorane zibiri zitava amaraso mu kubagwa na zo nyene zirashobora gutuma umuntu agira ijwi ry’agahomerabunwa iyo izosi ubwaryo ryoroshe kandi ryoroshe:

Uko wotandukanya seroma nziza inyuma yo kubagwa n'amaraso ateye akaga¶

Hagati y’imisi 3 n’imisi 14 inyuma yo kubagwa izosi**, abarwayi benshi babona amazi yoroshe, apfutse, atagira ububabare, apfutse ataco akora munsi y’aho baciye bakira, ahindukahinduka gatoyi nk’agace k’amazi gatoyi. Gutahura itandukaniro riri hagati ya seroma idashobora gutera ingorane n’iyitevye hematoma canke igisebe co mw’izosi bitera ubwoba mu gihe umuntu afata ibintu vyihutirwa vy’ukuri:

• Seroma y’inyuma y’ugukorwa idatera ingorane: Ihuriro ry’amazi y’umuhondo asobanutse y’amaraso/y’amaraso yirundanira buhoro buhoro imisi myinshi inyuma y’aho umuyoboro w’amaraso ukuweho. Urukoba ruri hejuru y’igisebe c’umubiri ruraryoshe, rurakonja kandi rufise ibara risanzwe; gukanda buhoro buhoro bimeze nk’umusego w’amazi woroshe; umurwayi afise ingorane zo kumira amacandwe, ijwi rihinduka, n’uguhema ata nkomanzi rwose iyo aryamye canke yicaye ku ruhande. Utugingo ngengabuzima dutoduto turasubira kwinjira mu mubiri mu kiringo c’indwi 2 canke 4 canke tugashobora guhumekwa n’umuganga abaga umuntu mu gihe ariko aragendera ivuriro.
• Hematoma itevye (Imisi 2 gushika ku 10, cane cane inyuma yo gusubira gufata imiti igabanya amaraso): Abarwayi basubira gufata imiti ivura amaraso yitwa apixaban, rivaroxaban, dabigatran, warfarin, clopidogrel, canke heparine y’ubuvuzi amasaha 48 gushika ku 72 inyuma yo kubagwa mw’izosi, barashobora gutera indwara y’umutima itunguranye. Izosi rica rikomera, rifatanye, rigira ubugwaneza, kandi rigenda rikura mu minota 30 gushika ku 120, akenshi rijana n’ibikomere vy’umutuku w’umutuku bikwiragizwa bishika ku rubavu, umuhogo ukazura, n’ingorane zo kumira. Hagarika umuti wo gutuma amaraso agenda neza ubwo nyene, wicare ugororotse, hanyuma ugende ugororotse mu cumba c’abarwayi bihutirwa.
• Igikomere co mw’izosi gikomeye inyuma yo kubagwa (Imisi 4 gushika ku 14): Ububabare butera, gukwiragiza umutuku w’umuriro (cellulitis), ubushuhe, umuriro urenga degre 38,0 Celsius (degre 100,4 Fahrenheit), canke ibisebe vy’ibicu bimota nabi biva hagati y’ibidodo canke Steri-Strips. Kubera ko indwara iri imbere mu kibanza c’imbere y’umuhogo ishobora gukurikirana ishika hasi mu mfuruka y’igikiriza (descending necrotizing mediastinitis), igice cose c’izosi gifise indwara gisaba ko umuntu afata imiti y’imitsi y’ibitaro uwo musi nyene, akayikuramwo amazi.

Ukwitaho neza mu rugo mu masaha 72 ya mbere inyuma yo kubagwa thyroïde canke parathyroïde¶

Iyo umurwayi asezerewe muhira uwo musi nyene canke mu gitondo amaze gukurwako hemithyroïde, parathyroïdectomy canke umugongo w’intanga, kwubahiriza cane ingingo zine zo kwirinda zo muhira biragabanya cane ingorane zo gufuha umutsi w’amaraso uboshe mw’izosi:

1. Usinzire ku bushuhe bwa degre 30 gushika kuri 45 mu majoro 3 gushika kuri 5 ya mbere: Koresha amapillow abiri canke atatu canke umusego (canke uryamye mu ntebe y’imbere) kugira ngo umuvuduko w’imitsi imbere mu gitanda c’umubiri ugume uri hasi ijoro ryose kandi inyuma yo kubagwa umuvuduko w’amaraso ushire hasi.
2. Kwirinda gukorora, gukorora, gukorora, no gukorora uko bishoboka kwose: Igihe kimwe gusa umuntu agira ububabare bw’umubiri buva ku miti y’ububabare canke gukorora ku bwiherero, bituma umuvuduko w’amaraso wo mu rubavu urenga 60 gushika kuri 80 mmHg kandi bishobora gutuma umutsi w’imbere wo mu rubavu canke umutsi wo hejuru uhagarara. Fata umuti wo kurwanya iseseme (ondansetron) ubwo nyene ubonye ko ufise iseseme, ukoreshe ibintu biyorosha amavyi aho kuyatera, kandi wirinde guterura ibintu biremerera birenze ibiro 4,5 canke gupfukama umutwe munsi y’amafyigo.
3. Guma ufise itara ry’umuyagankuba n’umukasi wo gudodera aho ukuboko ushobora gushika, kandi ntukigere uryama wenyene mw’ijoro rya mbere: Umurwayi wese abazwe thyroïde canke parathyroïde ategerezwa kuba afise umuntu akuze afise inshingano ari maso kandi akamugenzura mu masaha 24 ya mbere amaze kubagwa. Gumana imyambaro yo hanze y’izosi iboneka (ntihambwe munsi y’amashati canke ibitambaro vy’amaboko maremare) kugira ngo ukubura kwose kw’agahomerabunwa kw’umwobo uri mu ntango y’umuhogo kuboneke ubwo nyene.
4. Fata calcium na vitamine D (calcitriol) mu kanwa bitegekanijwe ku gihe iyo bitegekanijwe: Ntutegereze ko iminwa yawe canke intoke zawe zigutera ububabare imbere yo gufata imiti y’ivyatsi bita calcium carbonate inyuma yo gukuraho thyroïde; kuguma ufise calcium mu maraso bituma umutsi w’ijwi ugira ububabare butunguranye.

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

• Leta Zunze Ubumwe za Amerika na Canada: Hamagara 911. Ishirahamwe ry’Abanyamerika ryitaho ivy’ubuvuzi bw’umubiri (ATA) Itangazo ku bijanye no gukuraho umubiri w’abarwayi bavuye mu bitaro n’ishirahamwe ry’abarwayi b’umutwe n’izosi ryo muri Amerika (AHNS) ritegeka ko abarwayi basohotse mu bitaro inyuma yo kubagwa umubiri canke parathyroïde baronka amabwirizwa yanditse y’ivyihutirwa kugira ngo baje mu bitaro vyihutirwa biri hafi ubwo nyene ku bijanye n’uguvyimba kw’izosi, dysbrea physici/ amategeko yo gukuraho umubabaro iruhande y’igitanda imbere y’uko umuntu akora intubation igoye mu nzira y’impwemu.
• Ubwongereza: Hamagara 999. Ishirahamwe ry’abaganga b’inzira y’impwemu igoye (DAS), ishirahamwe ry’Abongereza ry’abaganga babaga imitsi y’umubiri n’imitsi y’umubiri (BAETS), n’ishirahamwe ry’abaganga b’imitsi y’umubiri ryo mu Bwongereza Ingingo ngenderwako zitandukanye zijanye n’ugucungera amaraso ava inyuma y’ugubagwa kw’imitsi y’umubiri barahuza urutonde rw’ibintu vyo kwemeza DESATS n’imitsi y’umubiri, Sopen, layer, Gufungura/gukuraho igihimba c’umubiri, Gupakira igikomere) urutonde rw’ugutabara iruhande y’igitanda mu bitaro vyose vya NHS.
• Ubumwe bw'Uburayi: Hamagara 112. Amabwirizwa y’ishirahamwe ry’abaganga b’i Buraya (ESES) n’ishirahamwe ry’i Buraya ry’abaganga babaga imitsi y’umubiri (ESAIC) asaba ko umuntu ahita ahagarara ahagaze, akamukurako imitsi y’umubiri n’imitsi y’umubiri imbere y’uko atera imitsi y’umubiri mu bihimba vy’umubiri bifata amaraso mu ijosi (cricothyroidotomy) ukwitegura.
• Ostraliya na Nouvelle-Zélande: Hamagara kuri 000 muri Australiya canke 111 muri Nouvelle-Zélande. Abaganga bo muri Australiya no muri Nouvelle-Zélande (ANZES) n’amabwirizwa ya ANZCA arategeka gufungura ibikomere vyo ku buriri kugira ngo umuntu agire ingorane zo mu nzira y’impwemu inyuma yo gukuraho thyroïde.
• Ubuhindi na Aziya-Pasifike: Hamagara 112 mu Buhindi, 995 muri Singapore, 119 mu Buyapani na Koreya y’Epfo, canke 999 muri Maleziya na Hong Kong. Ku bindi bihugu, raba ububiko bwacu bwa inomero mpuzamakungu z'ivyihutirwa.

Ibibazo bikunda kubazwa¶

Iyo igikoresho co gukura amazi mw’izosi ryanje ry’ugubagwa kiri ubusa kandi umugozi wo hanze ukaba usukuye kandi wumutse, noba nshobora kuba mfise hematoma y’izosi iteye akaga?¶

Egome. Mu bihimba vyinshi vy’amaraso bitera ubuzima inyuma yo gukurwako thyroïde, umugozi wo hanze urasukuye rwose kandi igitambaro co gukuramwo amaraso c’ipulasitike kirimwo amaraso make cane. Iyo amaraso yo mu mitsi canke yo mu mitsi y’amaraso akoranye imbere mu kibanza gikomeye gikikuje umuyoboro w’umuyaga, arafatanya akagira nk’umunyu munini mu minota mikeyi, agafunga utunogo dutoduto turi mu muyoboro w’amazi w’ipulasitike kugira ngo ntihagire ikintu na kimwe kija mu nzira y’umuyaga yo hanze. Imisi yose nucire urubanza ivy’ivyihutirwa ukurikije ingene izosi ry’umurwayi ryumva be n’ingene amira n’ingene ahumeka, ntukigere ucira urubanza ukurikije nimba igikoresho co gukura amazi kiriko kirazura.

Ni kuki gufungura imidodo iri ku ijosi bifasha umuntu guhema iyo amaraso ari hanze y’umuyoboro w’umuyaga?¶

Igihimba c’umubiri citwa thyroïde cicara mu mufuko w’imitsi ukomeye cane hejuru cane y’umutsi w’umuyaga, ukaba ukingijwe n’imitsi y’izosi ihagaze idozwe (imitsi y’umugozi) be n’imitsi ikomeye y’inkondo y’umura. Iyo amaraso yuzuye muri uwo mufuko ukingiye, umukazo uragwira cane ku buryo upfunyariza uruhome rworoshe rw’inyuma rw’umuhogo rworoshe imbere maze ugaca unyiganyiga imitsi isohora amazi mu mitsi y’ijwi, bigatuma imbere mu muhogo bivyimba bikafunga. Gucagura ududodo twompi tw’urukoba be n’utudodo tw’imitsi turi munsi yawo, bica bikuraho igipfukisho c’ico kibanza gifise umukazo, bigatuma amaraso aseseka hanze maze agaca asubira gufungura imitsi y’amaraso n’inzira y’impwemu.

Ni kubera iki kenshi kugorwa no kumira amacandwe ari co kimenyetso ca mbere c’uko umuntu afise amaraso yo mw’izosi amaze kubagwa igihimba c’umubiri citwa thyroïde canke umugongo?¶

Umuhogo ni uruzitiro rworoshe kandi rufise imitsi rushobora gusenyuka, rwicaye inyuma y’umutsi w’umuyaga kandi rukaba rufatanye n’amagufa akomeye y’umugongo w’izosi. Iyo amaraso atangura kwirundanira mu bice vy’izosi vy’imbere inyuma yo kubagwa thyroïde canke kubagwa umugongo w’imbere w’intanga, arafatanya umuhogo woroshe cane imbere y’uko umukazo uba mwinshi cane ku buryo ushobora gufatanya impeta z’imitsi y’umuhogo zikomeye cane. Umurwayi yumva bukwi na bukwi igihimba gikomeye igihe ariko aramira amacandwe canke agatangura gusohoka, arakeneye guca asuzumwa n’ibitaro imbere y’uko guhumeka gutangura guhagarara.

Ni igiki gituma iminwa itera ububabare n'ugutera "ibiganza vy'amano" umusi umwe canke ibiri inyuma yo kubagwa thyroïde?¶

Utugingo ngengabuzima tune dutoduto dufise ubunini nk’ubw’intete y’umuceri twitwa parathyroïde twicara inyuma y’igihimba c’umubiri citwa thyroïde kandi tukagenzura urugero nyarwo rw’ivyuma bita calcium biri mu maraso yawe. Mu gihe c’uguca igihimba c’umubiri citwa thyroïde cose, izo nkoko zidakomeye zirashobora gukomeretswa, zigatangazwa n’amaraso mu gihe gitoyi canke zigakurwako ata co zizi. Mu masaha 12 gushika kuri 72 akurikira, calcium mu maraso iragabanuka (hypocalcemie), igatuma imitsi n’imitsi bitera umuriro ubwavyo - bitangura n’ugucika intege n’ugucika intege hirya no hino y’akanwa n’intoke, bikaja ku biganza bikomeye (tetany), kandi bishobora gutuma umuntu agira ububabare buteye akaga (hecordy orngopasm) umuziki urahinduka.

Mbega ni ibisanzwe ko umuntu agira ijwi ry’agahinda gatoyi canke ry’urushe inyuma yo kubagwa umugongo w’imbere canke w’izosi?¶

Urushe rw’ijwi rutoyi, umuhogo ugenda urakaraba gatoyi uva ku nzira yo guhema ikoreshwa mu gihe co gutera umuti wo gutera umuti wo gutera umuti, canke ugusemerera gutoyi gukomeye biva ku nsinga z’imitsi y’amatwi zisubira inyuma zikomeretse, ni ibisanzwe kandi ntibitera ubuzima iyo guhema no kumira bitagira utwigoro rwose kandi izosi ryari ryiza kandi ryipfutse. Ariko rero, uguhoza kwose gukomeza gukomera ningoga, kujana n’ukuvyimba kw’izosi, kugorwa no kumira amacandwe, canke ijwi ry’ugusemerera ry’agahomerabunwa igihe umuntu ahumeka (stridor) ni ikintu gikomeye co mu buvuzi.

Amasoko n'ubuyobozi buzwi¶

• Ishirahamwe ry'abarwayi b'imitsi y'impwemu igoye (DAS), Ishirahamwe ry'Abongereza ry'abaganga babaga indwara z'imitsi n'imitsi y'umubiri (BAETS), & ENT UK (Ubwongereza): Ingingo ngenderwako z'ubuhinga bwinshi zijanye n'ugucungera amaraso ava inyuma y'ugubagwa kw'imitsi y'umubiri (Iliff HA n'abandi, *Anaesthesia202 SCOOP umurongo wo gukuraho ibikomere biri iruhande y’igitanda).
• Ishirahamwe ry’Abanyamerika ry’Ivy’Imitsi y’Imitsi (ATA, Leta Zunze Ubumwe za Amerika): *Itangazo ku bijanye no Gukura Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi: Ukwirinda, Kwemera no Gucungera Indwara y’Imitsi y’Imitsi y’Imitsi y’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba) (Terris DJ et al., Thyroïde).
• Ishirahamwe ry’abaganga babaga indwara z’ibihimba vy’irondoka ryo muri Amerika (AAES, Leta Zunze Ubumwe za Amerika): Ingingo ngenderwako zo kubaga indwara y’ibihimba vy’irondoka mu bantu bakuze (Patel KN n’abandi, Annals of Surgery: ubuhinga bwo kubaga indwara y’ibihimba vy’irondoka, ukudashobora kwizigirwa kw’ibihimba vy’irondoka).
• Ishirahamwe ry’abaganga b’imitsi (SVS) & Ishirahamwe ry’i Buraya ry’abaganga b’imitsi (ESVS): Ingingo ngenderwako z’ubuvuzi ku bijanye no kuvura indwara y’imitsi y’umugongo n’iy’umugongo (Ugufasha indwara y’imitsi y’umugongo n’inzira y’impwemu inyuma yo kubagwa).
• Ishirahamwe ry’umugongo ryo muri Amerika y’Uburaruko (NASS) & Ishirahamwe ry’ubushakashatsi ku mugongo w’intanga (CSRS): Ugufasha umuntu afise ubuzibuzi bw’inzira y’impwemu n’amaraso yo mu mutwe inyuma yo kubagwa umugongo w’intanga (ACDF).

Inyobora zifitaniye isano¶

• Epiglottite, croup, stridor, n’uguhagarara kw’inzira y’impwemu yo hejuru
• Inyuma y’uguca amatonsille, amaraso ava mu misi 5 gushika ku 10, n’ugutoranya inzira y’impwemu
• Angine ya Ludwig, ibisebe vy'amenyo, n'indwara yo munsi y'amano
• Igihuhusi ca thyroïde na myxedema coma ivyihutirwa
• Kwemera indwara y'umutima n'ugusubiza vyihutirwa