Indwara y’Umubabaro Inyuma yo Guguruka, Barotrauma y’Ugutwi, n’Ingendo y’Ubuvuzi¶

Guguruka mu ndege y’ubudandaji canke gutwara imodoka ujabuka umusozi muremure ubwo nyene umaze kwibira mu mazi, bituma umubiri wawe ugabanuka ningoga umuvuduko w’ikirere uri mu kirere. Naho indege z’ubudandaji zifise ivyumba vy’indege bifise umukazo, ingingo mfatirwako z’indege za Leta Zunze Ubumwe za Amerika be n’iz’amakungu ziremeza ko umukazo wo mu bibanza vy’indege iyo umuntu ari hejuru y’ikiyaga ugabanuka ukagera ku metero 1.830 gushika ku 2.440 (amafuti 6.000 gushika ku 8.000) hejuru y’urugero rw’ikiyaga. Ukwo kugwa kw’umuvuduko kungana n’ikirere 0,75, kikava ku kirere 1,0 ku rugero rw’ikiyaga. Nimba ugifise azote isigaye mu maraso yawe no mu bihimba vy’umubiri biva mu kwibira mu mazi, canke nimba ufise umufuko w’umuyaga ufunzwe imbere mu gutwi kwo hagati, mu mfuruka y’ibihaha, aho uherutse kubagwa, canke mu gifu kitagira umwuka, iyo nzira yo gusenyuka bukwi na bukwi irashobora gutuma ugira ububabare butera ubumuga, ububabare buhoraho bushobora gutuma umuntu apfa. hagati mu kirere.

Waba uriko urashikirwa n’ububabare bw’ingingo n’ugucika intege mu gihe c’indege y’inyuma y’ikiruhuko, urwana n’umubabaro wo mu matwi utazongana iyo umanutse, canke uriko urasuzuma nimba uwo mu muryango afise ubushobozi bwo kwinjira mu ndege mpuzamakungu inyuma yo kwakirwa mu mahanga, kwemerwa vyihuse n’amategeko akomeye y’ubuvuzi bw’imbere y’igihe. Iyi nkuru ivuga ku bikorwa vyihutirwa mu gihe c’indege kubera indwara zikekwa ko zitera, Divers Alert Network (DAN) n’Ishirahamwe ry’Abaganga bo mu Kiyaga n’Ivy’Indege (UHMS) imbere y’uko indege igenda, uburyo bwo gukora neza kubera ububabare bukomeye bw’amatwi n’ubw’ibihaha, n’Ishirahamwe ry’Abaganga bo mu Kirere (AsED-Flyness).

Ivyo ubikore ubu¶

1. Umenyeshe ubwo nyene mu ndege canke mu nzira ivy’ubuvuzi vyihutirwa iyo ibimenyetso vy’imitsi canke vy’ingingo bigaragaye inyuma yo kwibira. Iyo wewe canke uwo mufatanije mugira ububabare bukomeye mu ngingo, urukoba rugira amabara, ububabare, ububabare, ugusinzira, uguhinduka kw’amaso, canke guhumeka nabi igihe uriko uraguruka canke uriko uratwara imodoka inyuma yo guca hejuru y’umusozi, ubwo nyene canke ukwegere maze uhamagare inomero y’ivyihutirwa yo mu karere iwanyu (911 muri Leta Zunze Ubumwe za Amerika no muri Kanada, 112 mu bihugu vyose vy’Ubumwe bw’Uburaya, 999 mu Bwongereza) dukoresheje . inomero z'ivyihutirwa ububiko.
2. Saba 100 kw'ijana oxygène y'ubuvuzi ubwo nyene. Bwira abakozi bo mu ndege canke abaganga: *"Ndi umuhinga mu vyo kwibira mu mazi mu masaha 48 aheze, kandi ndiko ndashikirwa n'indwara y'ugucika intege. Ndakeneye umwuka w'ubuzima 100 kw'ijana kugira ngo nkore mask." valve iyo iri mu bikoresho vy’ubuvuzi vyihutirwa vy’indege, aho gukoresha igikoresho co mu mazuru gikoreshwa n’amazi make.
3. Hamagara Divers Alert Network (DAN) amasaha 24 kugira ngo ubone ubuyobozi bw’umuganga w’umunyamibabaro. Ukimara kuronka Wi-Fi y’inyenyeri, telefone iva mu kirere ija hasi, canke ikimenyetso c’amatelefone yo hasi, hamagara umurongo w’ivyihutirwa wa DAN kuri +1-919-684-9111 (kw’isi yose, gutora amatelefone yemerewe) canke ku murongo w’ubutumwa wa DAN Europe kuri +39-06-4211-8685 rero umuhinga mu vy’ubuvuzi bwo kwibira arashobora gukorana n’ubugenzuzi bw’ubuvuzi bwo ku butaka bw’indege (nk’ubwa MedAire canke Stat-MD) maze akarondera icumba c’indege gikora hafi cane.
4. Urambike umurwayi (supine) hanyuma umushiremwo amazi asanzwe nimba afise ubwenge bushitse. Umuntu arwaye agume aryamye aringaniye. Ntushire amaguru hejuru canke ngo ushire umurwayi umutwe hasi (Trendelenburg position), kuko guhengamira umutwe hasi bituma imitsi yo mu bwonko igira umuvuduko mwinshi kandi bigatuma ubwonko bugira ibisebe vyinshi. Uwo muntu umuhe amazi atari inzoga, atagira kafeyine nimba ashobora kuyamira ata nkomanzi.
5. Hagarika gufuha izuru n’inguvu ubwo nyene iyo wumvise umutwe utunguranye, uguhungabana kw’amatwi, canke ukubura ugutwi mu gihe c’uguringaniza amatwi. Iyo ugerageje gutera amatwi yawe bituma wumva uzunguruka bukwi na bukwi, uvuga cane, canke ukumva gupfutse, ushobora kuba waracitse uruzitiro rw’uruzitiro rw’uruzitiro rwawe rw’uruzitiro rw’uruzitiro rw’uruzitiro rwa barotraner e oval). Hagarika gukora igikorwa ca Valsalva, wicare ugororotse, wirinde gutera canke guterura imifuko iremereye, kandi urondere gusuzumwa vyihuse ugutwi, izuru n’umuhogo (ENT) iyo umaze kugwa.
6. Ntukigere winjira mu ndege canke ngo utware imodoka hejuru ya metero 610 (amafuti 2.000) imbere y'uko urangiza igihe cawe co kwibira inyuma yo kwibira. Nimba mudasobwa yawe yo kwibira ikigaragaza ikimenyetso c'uko "Ntuguruke" canke utashitse ku ngingo ngenderwako z'igihe co kwibira amasaha 12 gushika kuri 24, DMSAN yawe ishobora gusubiramwo canke fHbook yawe. Kwishura amahera yo guhindura indege ni ikintu gitoyi cane ugereranije no gufatwa n’indwara y’umutsi w’umugongo uri ku metero 11.000 hejuru y’ikiyaga.

flowchart TD
    A["Umugenzi Agira Ibimenyetso Bikomeye mu Ndege canke mu Musozi"] --> B{"Mbega Umugenzi Yari Scuba Dive canke Freedive Mu Masaha 72 Aheze?"}
    B -->|"Ego"| C{"Ibimenyetso: Ububabare bw’Ingingo, Ugucika intege, Ugutera umutwe, Gutera ibisebe, canke Guhumeka nabi?"}
    B -->|"Oya"| D{"Ibimenyetso: Ububabare bukomeye bwo mu gutwi/mu bihaha, Gutera, canke Gupfa amatwi bukwi na bukwi?"}
    C -->|"Ego - Akekwa ko ari DCS canke AGE"| E["Ubwo nyene umenyeshe abakozi bo mu ndege kandi usabe 100% y'umwuka w'umwuka mwinshi"]
    E --> F["Mushire umurwayi mu mfuruka (Supine) + Muhe amazi yo mu kanwa nimba ari mu mutima"]
    F --> G["Gusaba umudereva w'indege guhamagara ubugenzuzi bw'ubuvuzi bwo hasi + Gusaba uburebure bw'indege yo hasi / guhindura inzira"]
    G --> H["Hamagara DAN ku murongo w'ivyihutirwa (+1-919-684-9111) Igihe ugeze ku butaka kugira ngo ushire mu cumba c'ivyuma"]
    D -->|"Ububabare bwo mu matwi/mu bihaha gusa"| I["Koresha amazi yo mu kanwa, kumira, Toynbee, canke gutera umuti w’ubugwaneza + Oxymetazoline"]
    D -->|"Vertigo, Iseseme canke Ubumuga bwo kutumva bukwi na bukwi"| J["Ivyiyumviro vy'ugutwi kw'imbere / fistule périlymph: Hagarika Valsalva burundu"]
    J --> K["Gumana umutwe hejuru, Irinde gutera umubabaro canke gufuha mu zuru, Rondera isuzuma ryihuse ry’ubuvuzi bw’amatwi iyo ushitse"]

Ni kuki kuguruka canke kujabuka imisozi miremire umaze kwibira bitera indwara y’uguhagarika umutima¶

Iyo uhumekera umuyaga ufunze canke umuyaga ufise nitrox uri munsi y’amazi, umuvuduko w’amazi wiyongera utuma umwuka w’azote udakora uca mu bihimba vy’amahaha yawe ukaja mu maraso yawe no mu bihimba vy’umubiri wawe. Buri metero 10 z’amazi y’ikiyaga yongerako umuvuduko w’ikirere 1,0 (ikilopascal 101,3 canke amapawundi 14,7 ku nkuru y’inusu y’inusu y’inusu y’inusu). Uko uduga werekeza ku ruhande rw’amazi mu mpera y’ukwibira, umukazo uri mu kirere uragabanuka, ivyo bikaba bituma haba umukazo utuma azote yanyuze iva mu bihimba vyawe igasubira mu mahaha yawe kugira ngo uyisohoke.

Naho woba umaze gusohoka mu mazi ata bimenyetso vy’indwara, utugingo ngengabuzima twawe tugenda tugenda buhoro buhoro (nk’umutsi w’amagufa, umutsi w’amagufa, imitsi y’umugongo, myeline y’umutsi w’umugongo be n’ibinure vy’amavuta) turaguma wuzuye cane azote iyunguruye mu kiringo c’amasaha 12 gushika ku 48. Ivyuma bikoreshwa mu gukuraho umuvuduko w’ikirere biharura ibipimo vy’uguduga bifise umutekano wiyumvira ko uzoguma ku rugero rw’ikiyaga (1,0 ATA, canke 760 mmHg) mu gihe uriko urasohoka.

Fizike y'indege y'ubudandaji¶

Abagenzi benshi barihenda mu kwiyumvira yuko amazu y’indege y’ubudandaji akoreshwa n’umukazo ku rugero rw’ikiyaga. Gutera umukazo ku gice c’umubiri c’indege ku buryo kigera ku gipimo c’ikiyaga igihe iriko iragenda ku metero 10.600 gushika ku 12.500 (amafuti 35.000 gushika ku 41.000) vyotuma umubiri w’indege uruha cane. Mu mategeko y’Ishirahamwe ry’Indege ryo muri Leta Zunze Ubumwe za Amerika (FAA) (14 CFR § 25.841) be n’ingingo ngenderwako z’Ishirahamwe ry’Ubumwe bw’Uburayi ryitaho umutekano w’indege (EASA), indege z’ubudandaji zigenewe kuguma zifise uburebure bw’indege burengeye 2.438 metero (8.000 feet:)

• Indege zifise umubiri muto n'uw'umubiri munini (nka Boeing 737, 767, 777, na Airbus A320/A330): Gukomeza uburebure bw'indege buri hagati ya metero **1.830 na 2.438 (uburebure bw'amafuti 6.000 gushika ku 8.000) 0,75 gushika kuri 0,80 vy’ikirere (565 gushika kuri 609 mmHg).
• Indege zifise amaguru abiri (nka Boeing 787 na Airbus A350): Ziguma zifise uburebure bwo hasi bw’indege 1.524 gushika ku 1.830 (amafuti 5.000 gushika ku 6.000), canke hafi **0.80 gushika kuri 0.83s at.
• Indege n’indege zitwara abantu zidafise umuvuduko: Indege ntoyi zikoreshwa hagati y’ibirwa vy’amazi zikoreshwa n’amaguru canke zikoreshwa n’amapistoni, akenshi ntizigira umuvuduko kandi zituma abagenzi bashikirwa n’umuvuduko wo mu bidukikije w’uburebure nyabwo bw’indege zabo.

Kuva ku rugero rw’ikiyaga (1,0 ATA) ukaja mu nzu y’indege ku metero 2.438 (amafuti 8.000, canke 0,75 ATA) ni nk’ukuduga uva ku metero 3,3 (amafuti 11) y’amazi y’ikiyaga ukaja hejuru. Ukwo kugwa kw’ibice 25 kw’ijana kw’umuvuduko wo mu bidukikije bituma utugingo ngengabuzima dutoduto tw’azote tusigaye mu bihimba vyawe twaguka tukagira ibimenyetso vy’ibibumbano vy’umuyagankuba bizibira imitsi y’amaraso, bikarambura imitsi y’amaraso, bigatuma umuntu arwara Indwara y’uguhagarika umutima (DCS).

Umutego wo guca ku musozi wihishije ku mazinga yo kwibira¶

Si ngombwa ngo winjire mu ndege kugira ngo urware indwara y’ugucika intege iterwa n’uburebure bw’ikirere. Ku bibanza vyinshi vyo kwibiramwo mu kirunga, amaduka yo kwibiramwo yo ku nkengera y’ikiyaga yicara ku rugero rw’ikiyaga mu gihe inzira ndende isubira aho ubaye canke ku kibuga c’indege iduga hejuru y’uruzi rurerure:

• Hawaii (Izinga Rinini na Maui): Utwara imodoka mu nzira ya Saddle hagati ya Kona na Hilo uduga ushika ku metero 2.021 (amafuti 6.632), kandi utwara imodoka uduga Haleakala ushika ku metero 3.055 (amafuti 10.023).
• Ibirwa vya Canary, Izinga rya Reunion, Bali, Tayiwani, na Kosta Rika: Amabarabara manini manini ava ku nkengera y’ikiyaga aja mu gihugu hagati akunda kujabuka imisozi iri hagati ya metero 1.000 na 2.500 (amafuti 3.300 gushika ku 8.200) mu minota 45 uvuye ku nkengera y’ikiyaga.

Igihe cose umuntu atwara imodoka canke akoresha imirongo y’amaguru hejuru y’ibilometero 300 gushika kuri 610 (amafuti 1.000 gushika ku 2.000) ubwo nyene amaze kwibira mu mazi, arafise ingorane yo kwaguka kw’ibibumbano nk’iyo umuntu ashobora gutera mu ndege ikoreshwa n’umuyagankuba.

Amabwirizwa yemewe y'igihe c'imbere y'indege (DAN na UHMS)¶

Kugira ngo umuntu ntarware indwara y’ugucika intege kubera uburebure bw’ikiyaga, Divers Alert Network (DAN) na Ishirahamwe ry’ubuvuzi ryo munsi y’ikiyaga n’iry’amazi (UHMS) vyashizeho amabwirizwa y’uguhurizako yerekana igihe gitoyi utegerezwa kurindira ku rugero rw’ikiyaga umaze kuva mu bwato bwawe bwa nyuma bwo kwibira imbere y’uko uduga mu kirere canke mu kirere c’ubudandaji.

Imbonerahamwe y'ingingo y'igihe c'imbere y'indege¶

Kumenya no gucungera indwara y'ugucika intege mu ndege (DCS)¶

Ibimenyetso vy’indwara y’ugucika intege iterwa n’uburebure bw’indege mu bisanzwe bitangura mu gihe indege itangura kuduga gushika ku kirere c’indege (mu minota 20 gushika ku 60 imaze guhaguruka) canke mu masaha abiri canke ane ya mbere y’indege. Abaganga bashira mu migwi Ubwoko bwa mbere (Iy’imitsi, urukoba, n’amaraso) na Ubwoko bwa II (Ivy’imitsi, ugutwi kw’imbere, n’umutima), naho nyene zompi zisaba gusuzumwa vyihuse 100 kw’ijana vy’umwuka w’ikirere n’ugusuzumwa kw’ubuvuzi kw’umubiri mu gihe ubwoko bwa mbere butera imbere gushika ku bwoko bwa II. uburebure.

Ibimenyetso n'ibimenyetso vy'indwara y'ugucika intege inyuma yo kwibira¶

• Ubwoko bwa I DCS (Ububabare-Gusa n'Urukoba):
  • Ububabare bukomeye bw'ingingo ("The Bends"): Ububabare buteye ubwoba, bukomeye imbere mu ngingo nini, cane cane ku rutugu, ku nkoko, ku ivi canke ku rubavu. Mu buryo butandukanye n’ugucika intege, ububabare bw’ingingo za DCS akenshi ntibukomera cane iyo umuntu yinyiganza neza, kandi gutera umugozi wo gupima umuvuduko w’amaraso ukikuje ingingo birashobora kugabanya ububabare mu gihe gito.
  • DCS y’urukoba (Cutis Marmorata / Skin Bends): Urushavu rwinshi rukurikirwa n’ibisebe bifise ibice, bifise amabuye y’agaciro, bifise ibara ry’umutuku canke ry’umweru ry’ubururu ku mubiri, ku bitugu, ku gikiriza canke mu nda. Ivyigwa vy’ubuvuzi vyerekana ko cutis marmorata ifitaniye isano rikomeye n’uguhinduka kw’umutima kuva iburyo uja ibubamfu (Patent Foramen Ovale, canke PFO) kandi kenshi ibanza imbere y’uguhinduka kw’umutima kw’umugongo canke kw’ubwonko.
  • Ukuvyimba kw’amaraso: Uguvyimba kw’amaraso canke utuvyimba tw’amaraso mu ruhome rw’igikiriza, mu gikiriza, canke mu gikiriza.
• Ubwoko bwa II bwa DCS (Indwara zishobora gutera ubuzima bw'umuntu n'umutima n'amahaha):
  • Umutsi w’umugongo DCS: Gucika intege canke gucika intege (paresthesia) mu birenge, mu maguru canke mu biganza; ubugoyagoye bw’amaguru bugenda buratera imbere; ingorane zo kumanuka mu nzira y’indege; igihimba kimeze nk’umugozi gikikuje inda canke igihimba c’irondoka; canke ukudashobora gusohora bukwi na bukwi (ugufata umuhogo bitewe n’imitsi) canke ukubura ubushobozi bwo gucungera amara.
  • Cerebral DCS: Umutwe ukaze, ubumuga bwo kubona (ibice vy’impumyi, ukubona mu nzira, ukubona kabiri), kuvuga nabi, gutera urujijo, urushe cane, canke ubugoyagoye bwo ku ruhande rumwe bwigana umuntu indwara y'umutima.
  • Ugutwi kw’imbere DCS (Vestibular Bends / "The Staggers"): Gutera umutwe mu buryo butunguranye, gusesa amaraso no gusesa amaraso, guhungabana kw’amaso ataco bimaze (nystagmus), no gutakaza uburinganire.
  • Cardiopulmonary DCS ("The Chokes"): Ububabare bwo mu gikiriza busha munsi y'igifu, uguhema kwumye guterwa n'uguhema cane, guhema vyihuta bitari kure cane, n'indwara y'umutima (cyanose) iterwa n'umuyagankuba w'imitsi yuzuye mu gicuncuro c'amahaha. Ivyo bishobora gutera imbere gushika aho amaraso agenda neza mu minota mikeyi.

Intambwe ku yindi y'ivyihutirwa imbere mu nzu y'indege¶

Niba wewe canke umugenzi wawe wo kwibira mufise kimwe muri ibi bimenyetso mu gihe muri mu kirere:

1. Umenyeshe umuyobozi w’indege (Purser) ubwo nyene kandi ntuhishe ibimenyetso vyawe. Abaroba rimwe na rimwe baraceceka mu ndege kubera batinya ko bobacira urubanza rwo kurenga ku mategeko agenga indege inyuma yo kwibira canke ko batuma indege ihindura inzira. Gucerezwa umwuka w’ikirere (oxygène) mu gihe ibibumbano vy’azote bifatanya umutsi wawe w’umugongo ukajabuka ikiyaga birashobora gutuma urema ubudasiba.
2. Vuga ijambo nyaryo ry'ubuvuzi kugira ngo ushireho ubugenzuzi bw'ubuvuzi bwo ku butaka bw'indege: > "Ndi umuhinga mu vyo kwibira mu mazi afise indwara y'ugusenyuka kw'indege iterwa n'uburebure bw'indege. Ndagusavye ushikire Kapiteni n'umuganga wawe w'indege wo hasi (MedAire canke Stat-MD) ubwo nyene. Ndakeneye umwuka w'ubuvuzi uhoraho 100 kw'ijana ku rugero rwo hejuru rwo gusohoka."
3. Gukoresha neza uburyo bwo gutanga umwuka w'indege:
   • Amacupa y’umwuka w’abagenzi ashobora gutwarwa mu ndege z’ubudandaji akenshi atunganijwe n’igikoresho co gucungera uruja n’uruza rw’amazi gishirwa ku litiro 2 ku munota (LPM) canke 4 LPM biciye ku nzira yoroshe yo mu mazuru canke igipfukisho c’ishimikiro.
   • Sigurira neza abakozi bo mu ndege ko umwuka w’ikirere mu ndwara y’uguhagarika umutima utangwa kugira ngo haboneke umuvuduko w’amazi udafise azote ku buryo azote ikwiragizwa ningoga iva mu bibumbano. Saba abakozi bo mu ndege basuzume Igikoresho c’ubuvuzi c’ivyihutirwa (EEMK) c’indege kugira ngo bamenye nimba hari Igipfukisho c’indege kidashobora gusubira guhumeka gifise umufuko wo kubika maze ushireho umugenzuzi w’umwuka w’ikirere ku rugero rwo hejuru rw’uruja n’uruza rw’indege (10 gushika kuri 15 LPM), ugenzure igihe umuco w’indege uguma utanga.
4. Saba Captain agabanye uburebure bw'umuvuduko w'indege nimba bishoboka:
   • Bivanye n’ubwoko bw’indege, uruja n’uruza rw’indege mu kirere, n’amavuta y’indege, abakozi bo mu ndege barashobora gushiramwo n’amaboko igikoresho co kugenzura umuvuduko wo mu ndege kugira ngo bagume bafise umuvuduko munini w’itandukaniro ku rugero rwo hasi rw’indege, bikagabanya uburebure bw’indege buja ku rugero rw’ikiyaga (canke metero 600 gushika ku 1.200 gushika ku mahera 2.000). Igice cose c’ikirere c’umuvuduko wo mu nzu y’indege kirushirije gufatanya mu buryo bw’umubiri ibibumbano vy’azote hakurikijwe Itegeko rya Boyle (\(P_1 V_1 = P_2 V_2\)).
   • Iyo uwuriko araroba afise Ibimenyetso vy'ubwoko bwa II vy'imitsi canke vy'umutima (ubugoyagoye bw'amaguru, ubumuga, ugufata umuhogo, uguhagarika umutima, canke "uguhagarika umutima") mu rugendo rurerure, abajejwe ivy'ubuvuzi bo hasi bazohanura Kapiteni ngo ahite akora urugendo rw'ubuvuzi aja ku kibuga c'indege ca hyperba cabiline kiri hafi cane.
5. Gukomeza guhagarara neza no gufata amazi mu kanwa:
   • Nimushire ivyicaro vyuzuye canke mushire uwuriko araroba hejuru y’ivyicaro vy’umurongo biri ubusa, umukanda w’umutekano ushizwe mu gihe c’umuvurungano.
   • Uwuroba anywe amazi agera kuri militiro 500 gushika ku 1.000 (ama ounce 17 gushika ku 34) canke umuti wo gusubiza amazi mu kanwa mw’isaha ya mbere nimba ari maso neza kandi atariko araruha. Ugutakaza amazi mu mubiri bitewe n’umuyaga wumye wo mu nzu y’indege be n’ugutera amaraso mu mubiri bituma amaraso agira amaraso menshi, ivyo bikaba bituma amaraso agira ububabare bwinshi mu bihimba vy’umubiri bikikuje ibibumbano vy’azote.
   • Ntuhe aspirine canke ibuprofen kiretse iyo utegetswe n’umuganga w’ivy’ugucukura, kandi ntukigere utanga umuti wo gutera ububabare iyo uvuwe mu nyuma mu bitaro, kuko uwo muti ukwiragira mu bibumbano vy’azote maze ukavyagura ningoga.
6. Guma uboshe mudasobwa yo kwibira ku murwayi canke mu musaho wiwe wo gutwara:
   • Umuganga w’ivy’ubuhinga bwa hyperbaric ku bitaro vyakira abarwayi azosuzuma igitabu c’igihe c’uburebure bw’amazi c’umudasobwa wo kwibira kugira ngo ahitemwo hagati y’imbonerahamwe y’ubuvuzi bw’ingabo z’amazi za Amerika 6** (itegeko ry’amasaha 4 n’iminota 45 ry’ugusubiramwo umwuka w’ubuzima bw’amazi ku 2,8 ATA / uburebure bungana na metero 18) canke imbonerahamwe yagutse.

Ugutwi n'ibihaha bikomeye cane mu gihe c'indege no kuduga imisozi¶

Mbere n’abagenzi batigeze bisuka mu mazi barakunda gushikirwa n’indwara y’umutima (otic barotrauma)** n’indwara y’umutima (sinus barotrauma)** mu gihe c’indege z’ubudandaji, mu gihe c’indege zitwa gondola, canke mu gihe c’ugutwara imodoka zica ku misozi iteye igomwe. Gutahura Itegeko rya Boyle be n’ingene umubiri w’umubiri w’umuntu ukora, biratuma ushobora gutandukanya ugufyonda kw’ugutwi kwo hagati bibabaje be n’ugufyonda kw’ugutwi kw’imbere bibabaje.

Kubera iki kumanuka ari akaga cane ku matwi yawe kuruta guhaguruka .¶

Dushingiye ku Itegeko rya Boyle, ubunini bw’umuyagankuba udahinduka burahuye n’umuvuduko wawo wose ku bushuhe budahinduka. Ihinduka rinini ry’ubunini bw’umuyagankuba ribera hafi y’urugero rw’ikiyaga (hagati ya metero 0 na 2.440 / amafuti 8.000):

• Mu gihe co guhaguruka no kuduga (Ascent): Uko umuvuduko wo mu ndege uva kuri 1.0 ATA ukaja kuri 0.75 ATA, umuyaga ufunzwe mu mfuruka y’ugutwi kwawe kwo hagati uragwira nk’ibice 33 kw’ijana. Igihe umuvuduko uri imbere mu gutwi kwawe kwo hagati urenze umuvuduko wo mu nzu n’iminota nka 15 gushika kuri 20 mmHg, uwo muyaga uriko uragwira usunika Eustachian tube ishobora guhinduka igafunguka ataco ikora nk’umuvuduko w’inzira imwe, ugasohora ibibumbano mu zuru ryawe inyuma. Ububabare bwo kuduga akenshi bushika gusa mu mfuruka y’amaso canke mu gihe ca alternobaric vertigo, aho ugutwi kumwe gusohoka bukwi na bukwi mu gihe ukundi kuguma gufise umukazo.
• Mu gihe c’ugushika (Kumanuka): Uko indege imanuka isubira ku rugero rw’ikiyaga mu minota 20 gushika kuri 30, umuvuduko wo mu nzu y’indege uraduga uva kuri 0.75 ATA ugasubira kuri 1.0 ATA. Igikapu c’umuyaga kiri imbere mu gutwi kwawe kwo hagati kigabanuka mu bunini n’ibice 25 kw’ijana, kigatuma haba ubusa busanzwe imbere mu kibanza co hagati mu gutwi kwawe. Kubera ko ibice bibiri vya gatatu vyo hasi vy’uruzitiro rwa Eustache ari uruzitiro rworoshe rushobora gusenyuka, utegerezwa gukorana n’umwete imitsi y’ururimi rwawe rworoshe n’urw’ururimi rwawe (mu kumira, gupfukama canke kungana) kugira ngo ukwegere uruzitiro rwuguruke maze ureke umuyaga ugende mu gutwi kwo hagati.
• Ikibazo co gufunga (Ku 90 gushika kuri 120 mmHg differential): Iyo uryamye gushika mu ntango y’ugumanuka kw’indege canke ukaba ufise ibivyimba vy’umubiri bitewe n’ubukonje canke allergies, umuvuduko wo mu nzu uriko uraduga hanze y’inguvu yawe uca upfunyariza inkuta z’umubiri wawe zitwa Echista shut. Igihe umuvuduko w’amazi urengeye 90 gushika kuri 120 mmHg (bihwanye n’ugumanuka ku metero 900 gushika ku 1.200 / amafuti 3.000 gushika ku 4.000 ataco ungana), umuyaga mubi urafunga umuvuduko w’amazi w’umubiri wa Eustache. Gumira no gusesa amaraso ntibishobora kugifungura iyo nzira, ingoma y’ugutwi irarambura imbere, imitsi y’amaraso iri mu gipfukisho c’ugutwi kwo hagati iratabuka (hemotympanum), kandi ingoma y’ugutwi irashobora gutoboka.

Ubuhinga bwo kuringaniza ugutwi gutekanye n'ugutera akaga¶

Gutandukanya ububabare bwo mu gutwi kwo hagati n’ububabare bwo mu gutwi kwo mu mutima (Perilymph Fistule)¶

Niwumva ububabare bukomeye butunguranye canke bugutera mu gutwi mu gihe uriko uraguruka canke umaze kwibira, tandukanya ibikomere bibiri bitandukanye:

• Barotrauma y'ugutwi kwo hagati (Ugucika kw'urukoba rw'ugutwi / Hemotympanum):
  • Ibimenyetso: Ukwongerekana kw’ububabare bw’umuvuduko mu gihe umuntu ariko aramanuka bushobora kugabanuka inyuma y’ugutera ijwi ry’agahomerabunwa, hanyuma ukubura ugutahura gupfutse, ukumva wuzuye canke amazi inyuma y’uruzitiro rw’ugutwi, rimwe na rimwe n’agatotsi gatoyi k’amaraso canke amazi agaragara mu muyoboro w’ugutwi.
  • Imfashanyo ya mbere: Guma ugutwi kwumye rwose. Ntukigere ushiramwo amatonyanga y’ugutwi, amazi, amavuta, peroxyde d’hydrogène, canke ivyuma vy’ipampa mu gutwi gukekwa ko gutoboye. Ivyimburwa vyinshi vy’ugutwi bitera ububabare birakira ubwavyo mu ndwi 2 gushika ku 6, naho nyene umuganga akwiye gusuzuma ugutwi.
• Barotrauma y'ugutwi kw'imbere (Idirisha ry'uruziga canke ry'uruzitiro / Fistule y'uruzitiro):
  • Ibimenyetso: Bishika ubwo nyene inyuma y’ugukora inguvu za Valsalva iyo ugerageza guhatira ugutwi kwazibiye gusohoka. Uca ugira vertigo rotational (kabine irazunguruka), iseseme n’ugutakara, uboroga cane canke uvuga tinnitus, n’ugutakaza ugutahura kw’imitsi (ugupfa amatwi kw’imitsi muri ukwo gutwi).
  • Igikorwa c’ivyihutirwa: Ivyo bisigura ko uruzitiro rudakomeye rutandukanya ugutwi kwawe kwo hagati n’uruzitiro rw’ugutwi kwawe rwuzuye amazi rwataburutse, rukava amazi y’ugutwi kw’imbere. Hagarika gufuha izuru ryose no kuringaniza ubwo nyene. Icara umutwe wawe ushizwe hejuru ku degre 30 gushika kuri 45, wirinde gutera canke guterura imifuko iremereye, maze ugende ugororotse uvuye ku kibuga c’indege uja mu kigo c’abarwayi bihutirwa, ufise Otolaryngologist (ENT surgeon) ariko araguhamagara. Kugira ngo umuntu ashobore kwumva ubudasiba, birakenewe ko afata imiti yitwa corticosteroids, akaruhuka mu gitanda canke akabaga igihimba c’umubiri citwa fistule.

Guguruka n’ibindi bibazo vy’ubuvuzi: Amategeko agenga ivy’ukunonora imitsi y’ishirahamwe ry’abaganga bo mu kirere (AsMA)¶

Gucukura mu mazi si co kintu conyene aho ugucika intege mu nzu y’indege bituma umuntu agira ingorane z’ubuvuzi. Mu Itegeko rya Boyle, umufuko wose w’umuyaga ufunzwe mu mubiri w’umuntu uragwira n’ibice 30 gushika ku bice 35 kw’ijana ku kirere co mu nzu y’indege kiri ku metero 2.438 (amafuti 8.000). Mbere no mu ngenzi zifise amagara meza, umuvuduko w’umwuka w’amaraso (\(PaO_2\)) ugabanuka uva ku 95 gushika ku 100 mmHg ku rugero rw’ikiyaga ukamanuka ku 55 gushika ku 60 mmHg ku kirere c’amafuti 8.000 (igipimo c’umuvuduko w’amaraso \(SpO_8 kw’ijana ku 9\) around).

Iyo ukomeretse, ubazwe, canke urwaye mu mahanga, amashirahamwe y’indege arashiraho Ishirahamwe ry’ubuvuzi ryo mu kirere (AsMA) na Ishirahamwe mpuzamakungu ry’indege ry’indege (IATA) ibihe vyo guhabwa uburenganzira bwo gufata indege y’ubudandaji imbere y’uko akurekurira kwinjira mu ndege y’ubudandaji ugasubira i muhira.

Igihe co kurindira ubuvuzi gitegekanijwe imbere y'urugendo rw'indege y'ubudandaji (amabwirizwa ya IATA / AsMA)¶

Uko woronka uruhusha rwo kuvura mu ndege (IATA MEDIF Form) n’ubwishingizi bw’urugendo¶

Niba uriko urakira ubuvuzi bwo gukuraho ububabare bwo mu mazi, igufa ryavunitse, indwara y’amahaha, canke kubagwa mu mahanga kandi ukeneye gusubira i muhira mu ndege y’ubudandaji:

1. Saba urupapuro rw'imfashanyo idasanzwe / ubuvuzi (MEDIF) rw'indege nibura amasaha 48 gushika kuri 72 imbere y'uko ugenda:
   • Hafi amashirahamwe yose y’indege mpuzamakungu akoresha urupapuro rw’ibice bibiri Ifomu y’amakuru y’ubuvuzi ya IATA (MEDIF).
   • Igice ca 1 kirangizwa n’umugenzi canke uwujejwe ivy’ingendo (gutanga urutonde rw’inomero z’indege, ivyo intebe y’ibimuga ikeneye, ivyo usaba ku bikoresho vyo gutwara, canke urugero rw’umwuka w’ikirere uri mu ndege).
   • Igice ca 2 kirangizwa kandi kigashirwako umukono n’umuganga wawe agufasha mu bitaro vyo mu karere (uvuga urutonde rw’ivyo wasuzumye, urugero rwa hemoglobine, umuvuduko w’umwuka wo mu cumba \(SpO_2\), itariki waherukiye kwibira canke kubagwa, nimba hariho utugingo ngengabuzima two kubaga canke ibikoresho vyo mu gikiriza vyacitsemwo ibice, n’uko hariho ubuvuzi bukenewe).
2. Uhuze n'umuyobozi wawe w'ubwishingizi bw'urugendo / ubufasha bw'ubuvuzi imbere yo gufata itike yawe yo gutaha:
   • Niba wararwaye indwara yo guhagarika umutima canke iyindi ndwara y’ubuvuzi ikomeye cane mu mahanga, soma uburongozi bwacu ku ivyihutirwa vy'ubuvuzi no kwimukira mu mahanga kandi uhamagare ubwishingizi bwawe bw’urugendo bukora amasaha 24 yose bwo gufasha mu bihe vy’ivyago vyihutirwa ubwo nyene.
   • Inyuma y’indwara ikaze y’ubwoko bwa II, indege y’ubudandaji iri mu kirere c’amafuti 8.000, mbere n’amasaha 72 inyuma y’aho umuntu avuwe cane, rimwe na rimwe irashobora gutuma ibimenyetso vy’imitsi bisubira kugaragara. Mu bihe bikomeye, ubwishingizi bwawe bwo kwibira canke ubwishingizi bw’ubuvuzi bwo mu rugendo buzotunganya ugukura abantu mu ndege y’ubuvuzi ikoresheje umuvuduko wo ku rugero rw’ikiyaga (aho indege y’ubuvuzi yihariye iguruka ifise umuvuduko wo ku rugero rwa 1.0 ATA ku rugero rw’ikiyaga) kugira ngo ntugire umubabaro wo gukuraho umuvuduko mu rugendo rwo gutaha.

Ibibazo bikunda kubazwa¶

Noshobora kuguruka ata nkomanzi ubwo nyene maze gukora ubushakashatsi canke kwoga ku mazi?¶

Iyo woga gusa ku ruhande rw’amazi uhumekera mu gikoresho co gupfuka amazi ataco wibiye munsi y’amazi, uba wirundanirije azote irengeje urugero kandi urashobora guca uguruka ubwo nyene. Ariko rero, iyo ukoze igikorwa co kwibira mu mazi (ugusubiramwo kwibira mu mazi gushika ku metero 10 gushika kuri 30 / amafuti 33 gushika ku 100 mu masaha menshi), cane cane iyo nawe wibiye mu mazi mu ntango z’indwi, azote irashobora kwirundanira bihagije kugira ngo umuntu ashobore kwibira mu mazi. Inyuma y’ugusubiramwo cane kwibira mu mazi maremare, rindira n’imiburiburi amasaha 12 gushika ku 24 imbere y’uko uguruka.

Bigenda gute iyo mfise ububabare bukeyi mu ngingo canke urukoba rwanje rugira amabara y’ibitoke inyuma y’aho maze kumanuka mvuye mu ndege nsubira i muhira?¶

Ntukigere wiyumvira ko ibimenyetso vy’inyuma y’uguhunga bizogenda ubwavyo ubu umaze gusubira hasi. Ivyuma vy’azote bivyurwa mu gihe c’uguguruka biratuma utugingo ngengabuzima two mu mubiri twononekara, utugingo ngengabuzima tugateranira hamwe, n’uguvyimba kw’umururumba imbere mu bihimba vyawe bikabandanya mbere n’inyuma yo gusubira ku rugero rw’ikiyaga. Hamagara umurongo w’ivyihutirwa w’ishirahamwe ry’abacukura amazi (+1-919-684-9111) ubwo nyene maze ugende mu gisata c’ivyihutirwa gifatanye n’ikigo c’ubuvuzi bw’ivyihutirwa. Ubuvuzi bw’umwuka w’ikirere (hyperbaric oxygène) buraguma bukora neza mbere n’igihe umuntu atanguye amasaha 24 gushika ku 72 inyuma y’aho ibimenyetso bitanguriye.

Mbega vy’ukuri ibipfukisho vy’amatwi bikoreshwa n’umuyagankuba birakingira barotrauma y’amatwi mu ndege?¶

Ivyuma bipfuka amatwi bigenzura umuvuduko w’amazi bikoreshwa n’ivyuma vy’ibara ry’agahama birimwo akayunguruzo gafise utunogo gatuma umuvuduko w’umuyaga wo mu nzu uhinduka utera ku ntugu yawe igihe uriko uraduga canke uriko uramanuka. Naho badashobora gufungura umurongo wa Eustache uzibiye bonyene, gutevya ihinduka ry’umuvuduko bituma umurongo w’ubunebwe ugira umwanya wo kwongerako wo kungana imbere y’uko ufunga. Bishiremwo imbere y’uko uhaguruka, ubikuremwo iyo uri mu kirere c’indege, hanyuma wongere ubishiremwo iminota 45 imbere y’uko uguruka mu gihe uriko uramira no kunywa amazi.

Ni kuki umuganga w’ubuvuzi bwihutirwa yambwiye ko igikomere canje co mu gutwi co kwibira ari indwara y’ugutwi igihe catanguye mu gihe co kwibira canke co mu ndege?¶

Abaganga batari abahinga mu vy’ubuvuzi bwo kwibira canke bwo mu kirere rimwe na rimwe baraba igihimba c’ugutwi gitukura kandi gisohoka amaraso, inyuma yaco hakaba hari amazi inyuma y’uguguruka canke kwibira, bagaca bavuga nabi ko barotrauma y’ugutwi kwo hagati ari acute bacterial otitis media. Imisi yose nubwire umuganga asuzuma amateka nyayo y’ivy’ubuhinga bwa barometrie: nimba ububabare bwatanguye mu gihe co kumanuka, nimba wakoze igikorwa c’inguvu ca Valsalva, be n’uko woba ufise umutwe canke ugutera ijwi ry’agahomerabunwa.

Amasoko yasuzumwe¶

• Ishirahamwe ry’abaroba (DAN) & Ishirahamwe ry’ubuvuzi bwo mu mazi n’iry’amazi (UHMS): Ivyiyumviro vy’amahugurwa y’uguguruka inyuma y’imyidagaduro n’amabwirizwa y’uguhurizako (Impuzamakungu / Leta Zunze Ubumwe za Amerika).
• Igisirikare ca Leta Zunze Ubumwe za Amerika: U.S. Igitabo c’abasirikare bo mu mazi co kwibira, Isubiramwo rya 7, igitabu ca 2, igice ca 9 (Uburyo bwo kuduga no kuguruka inyuma yo kwibira) & Igitabo ca 5, igice ca 20 (Igitabu co gupima no kuvura indwara y’ugucika intege n’indwara y’umuyaga) (Leta Zunze Ubumwe za Amerika).
• Ishirahamwe ry’abaganga bo mu kirere (AsMA): Ingingo ngenderwako z’ubuvuzi ku rugendo rw’indege, Integuro y’igihe ca 2 / Komite y’ubuvuzi bwo mu ndege impanuro ku bijanye n’ugutera imbere mu ndege (Impuzamakungu).
• Ishirahamwe mpuzamakungu ry’ivy’indege (IATA): Igitabo c’ubuvuzi ca IATA, Integuro y’ica 12: Ukwitwararika abagenzi, Igihe co gusohoka muri MEDIF, n’Ivy’Imibiri y’Indege (Igitabu Mpuzamakungu).
• Ishirahamwe ry’abaganga b’amafyigo ry’Ubwongereza (BTS): Itangazo ry’ubuvuzi ku mpanuro z’urugendo rw’indege ku bagenzi bafise indwara zo mu bihimba vy’impwemu n’igihe co kurindira inyuma y’indwara y’amafyigo (Ubwongereza).

Inyobora zifitaniye isano¶

• Ivyihutirwa vy’ubuvuzi n’uguhunga mu mahanga
• Imfashanyo ya Ambasade n'iya konsula
• Yagumye mu mahanga canke indege irasubirwamwo
• Ivyihutirwa vy'ubwato bw'abagenzi, guheba ubwato, n'umuntu aja mu kiyaga
• Ububiko bw'inomero z'ivyihutirwa