Indwara ya Pneumothorax, Ibimenyetso by'ibihaha byaguye, hamwe n'ububabare bwo mu gatuza bwa Pleuritis¶

Indwara ya pneumothorax (ikunze kwitwa ibihaha yaguye) ibaho mugihe umwuka usohotse mumyanya y'ibihaha hanyuma ugafatirwa mumwanya wishimishije, umwobo woroheje-wuzuye amavuta hagati yinyuma yibihaha n'imbere y'urukuta rw'igituza. Bitandukanye n'ihahamuka ryasenyutse ryatewe na a kuvunika imbavu cyangwa gukomeretsa mu gatuza cyangwa a kwinjira mu gituza, pneumothorax ihita ikubita mu kiruhuko gitunguranye nta ngaruka z'umubiri. Itera ububabare butunguranye, butyaye, butera uruhande rumwe ububabare bwo mu gatuza bukomera hamwe na buri mwuka (ububabare bwo mu gatuza pleuritis) no guhumeka gitunguranye. Niba ukeka ibihaha byaguye, hamagara numero yawe yihutirwa ukoresheje iwacu nimero yihutirwa Ububiko ako kanya kandi ukomeze umuntu wicaye neza kandi aracecetse rwose, kuko ibihaha byose byaguye bishobora kwangirika mubuzima bwangiza pneumothorax cyangwa bigana a embolism cyangwa umutima.

Kora ubu¶

1. ** Hamagara nimero yawe yihutirwa ako kanya **: Hamagara ** 911 ** muri Amerika na Kanada, ** 112 ** hirya no hino mubumwe bw’ibihugu by’Uburayi, ** 999 ** mu Bwongereza, ** 000 ** muri Ositaraliya, cyangwa urebe mpuzamahanga nimero yihutirwa urutonde. Bwira abohereje ko umurwayi afite ububabare butunguranye, butyaye uruhande rumwe rwa pleuritis ububabare bwo mu gatuza no guhumeka neza hamwe n'ibihaha bikekwa ko byaguye (pneumothorax).
2. ** Shyira umuntu ahantu heza cyangwa hagororotse hicaye (umwanya wa Fowler) cyangwa wegamiye gato kuruhande rubabaza **: Kwicara uhagaze kuri dogere 45 kugeza kuri dogere 90 bikurura ingingo zo munda hepfo hamwe nuburemere, bigatuma icyumba kinini cyibihaha kitagira ingaruka kugirango cyaguke. Ntuzigere uhatira umurwayi ubabara mu gatuza uhumeka kuryama ku mugongo.
3. ** Hagarika imbaraga zose z'umubiri, kugenda, gukorora, cyangwa kunaniza (manuvers ya Valsalva) **: Ntukemere ko umuntu agenda kumadarajya kuri ambulance, gutwara imifuka, guterura ibintu, cyangwa guhuha izuru ku gahato. Impemu zose zikomeye, inkorora, cyangwa imbaraga za Valsalva zitwara umwuka mwinshi unyuze mu mitsi yamenetse mu gituza kandi byihuta gusenyuka kw'ibihaha.
4. ** Ihanagura imyenda ifatanye mu gituza, mu ijosi, no mu rukenyerero hanyuma utuze guhumeka kwabo **: Abakoroni batafunguye, imikandara irekuye cyangwa imikufi ifatanye, n'umutoza utinda, utuje, utuje. Guhagarika umutima byatewe no guhumeka byongera umuvuduko ukabije kandi bikarushaho gutera ububabare.
5. ** Gutegeka ogisijene yiyongera cyane niba yaratojwe kandi ifite ibikoresho **: Niba silinderi yihutirwa ya ogisijeni yihutirwa hamwe na mask idasubirwaho iraboneka kumurimo wakazi, ubwato bwokwibira, cyangwa ivuriro, tanga ogisijeni itembera cyane kuri litiro 10 kugeza kuri 15 kumunota ** (keretse niba umurwayi azi ko karuboni ya dioxyde de chronique idakira kuri COPD ikabije, kugeza aho igereranya na gaze ya ogisijeni ya ** 88 kugeza 92% **. Umwuka mwinshi wa ogisijeni ukosora ogisijeni yo mu maraso make (hypoxemia) kandi wihutisha reabsorption ya azote yafashwe neza ku buryo bune.
6. ** Witegereze ubudahwema amabendera atukura ya Tension Pneumothorax **: Reba ijosi ry'umuntu, iminwa, impiswi, no kuba maso mumutwe buri minota 2. Niba bihindutse cyane cyanotic (iminwa yubururu), urujijo, kuzunguruka, hypotensive, guhumeka bidasanzwe, cyangwa gukura imitsi yagutse, bwira abashinzwe ubutabazi bwihuse ko umurwayi arimo kwangirika mubikekwa ko ** byitwa pneumothorax ** bisaba guhita inshinge zinkeragutabara.
7. ** Irinde ingendo zose zo mu kirere, imodoka zo mu misozi, hamwe no kwibira mu mazi **: Nubwo ububabare bwo mu gatuza bwumva bworoheje kandi bushobora gucungwa, umuntu ufite pneumothorax itavuwe cyangwa itaremezwa agomba ** kutigera yinjira mu ndege, gutwara hejuru y’imisozi miremire, cyangwa kwinjira mu mazi ngo yibire **, kuko impinduka z’umuvuduko zigengwa n’amategeko ya Boyle yaguye kandi zigatera impanuka z'umutima.

Igiti cyemezo: Bitunguranye ububabare bwuruhande rumwe pleuritis ububabare bwigituza hamwe na pneumothorax triage¶

flowchart TD
    Start["Mu buryo butunguranye Ububabare bwo mu gatuza Uruhande rumwe (Ibibi kuri Inspiration) hamwe no Guhumeka gukabije (Nta ihahamuka)"] --> TensionCheck{"Hoba hari impagarara Pneumothorax Ibendera ritukura rirahari? 1."}

    TensionCheck -->|"YEGO: Akaga Ubuzima Bwihuse"| TensionProtocol["ICYEMEZO CYA PNEUMOTHORAX CYANGWA PNEUMOTHORAX YA KABIRI: 1. Hamagara 911/112/999 STAT hanyuma utangaze ukekwaho guhagarika umutima Pneumothorax 2. Komeza wihangane wicaye neza (dogere 45 kugeza kuri 90) kandi utaragera kuri 3. NTUKIGERE ushyira CPAP, BiPAP, cyangwa umufuka wimbaraga-valve-mask uhumeka mbere yo gutuza igituza 5. Inkeragutabara zihita inshinge thoracostomy ikurikirwa no kwinjiza igituza igituba."]

    TensionCheck -->|"OYA: Hemodinamike ihamye, ivuga interuro yuzuye, impiswi zisanzwe"| RiskProfile{"Suzuma Umwirondoro W’abarwayi: Ibanze (PSP) vs Secondary (SSP) vs Catamenial"}

    RiskProfile -->|"Nyamwasa (15 kugeza 35 yrs), muremure / yoroheje kubaka, itabi / vaper, nta ndwara y'ibihaha yabanje"| PSP["Ukekwaho Ibanze Byibanze Pneumothorax (PSP): Ruptured apical subpleural bleb"]
    RiskProfile -->|"Imyaka irenga 50 yrs, CYANGWA amateka ya COPD, emphysema, asima, fibrosis ya cystic, Marfan"| SSP["Ukekwaho Secondary Spontaneous Pneumothorax (SSP): Ikigega cyo hasi cyibihaha hamwe ningaruka nyinshi zo kwangirika vuba"]
    RiskProfile -->|"Bibaho mu masaha 72 mbere cyangwa nyuma yo gutangira imihango"| Catamenial["Ukekwaho Catamenial / Thoracic Endometriose Pneumothorax: Muburyo bwiburyo (hejuru ya 90%)"]

    PSP --> HospitalEval["Gutwara mumwanya wicaye mubitaro ED (Ntugende cyangwa ngo ukore): Emeza ubunini ukoresheje Upright Inspiration Chest X-Ray, Thoracic Ultrasound (kunyerera ibihaha bidahari), cyangwa CT"]
    SSP --> HospitalEval
    Catamenial --> HospitalEval

    HospitalEval --> SizeBranch{"Gutwara Ibitaro ukurikije Ingano n'ibimenyetso (Amabwiriza ya BTS / ATS / ERS)"}

    SizeBranch -->|"Gitoya PSP (munsi ya cm 2 rim kuri hilum) KANDI ntagihumeka"| Conservative["Kwitegereza Konservateur + Ubuvuzi bwa Oxygene Bwinshi: Reabsorbs kuri 1.25% kugeza 2% kumunsi (4x yihuta kumasoko menshi O2) Subiramo X-ray mumasaha 4 kugeza kuri 6, hanyuma ukurikiranwe kwa muganga kandi nta tegeko RIKURIKIRA"]
    SizeBranch -->|"Kinini PSP (cm 2 rim cyangwa nini) CYANGWA Uhumeka CYANGWA Pneumothorax Yisumbuye (SSP)"| Intervention["Gukora Pleural Decompression: - Byoroshye Urushinge (14G kugeza 16G cannula) CYANGWA Igikoresho cya Ambulatory Heimlich Valve Igikoresho - Gitoya ya Beld Seldinger Chest Tube (8 kugeza 14 Fr) ihujwe na kashe y'amazi - VATS pleurodeis niba umwuka uhoraho (iminsi 3 kugeza 5), umwuga usubiramo, cyangwa ibyago byinshi."]

Pathophysiology: Uburyo ibihaha bisenyuka nta ihahamuka ryo mu gatuza¶

Muri thorax nzima, hejuru yinyuma yibihaha (visceral pleura) hamwe nurukuta rwimbere rwurubavu (parietal pleura) rwiziritse hamwe hejuru ya firime yoroheje y'amazi meza (mililitiro 10 kugeza kuri 20 [0.3 kugeza 0.7 ounci y'amazi]). Kuberako ibihaha bya elastique bisanzwe bisubirana imbere mugihe urubavu rukurura hanze, umwanya uri hagati yibi bice byombi ukomeza umuvuduko wa ** munsi-ya-munsi (munsi) ya -3 kugeza kuri 5 cmH2O kuruhuka, ukamanuka kuri -8 kugeza kuri cm10H2O mugihe cyo guhumeka cyane. Iyi vacuum mbi ituma imifuka yumwuka (alveoli) yuzuye hejuru yimbavu.

1. Amashanyarazi meza, Bullae, hamwe no Gutakaza Amahirwe Mabi¶

Udukapu duto tumeze nk'udusimba twitwa ** subpleural blebs ** (munsi ya santimetero 1 kugeza kuri 2 [0.4 kugeza 0.8 cm] z'umurambararo, muri pleura ya visceral) cyangwa bullae nini ya ** emphysematous bullae ** (hejuru ya santimetero 1 kugeza kuri 2, zakozwe n'inkuta za alveolar zasenyutse) zikura cyane hejuru (** apex **) ya lobes yo hejuru y'ibihaha.

Imbaraga rukuruzi zikurura urufatiro ruremereye rw'ibihaha hepfo yerekeza kuri diafragma. Ku muntu ufite uburibwe burebure, bwagutse bwo mu gatuza (kubaka ectomorphique), uburebure bwa veritike ya thorax butera umuvuduko ukabije wa ** wishimye ** (0,25 cmH2O kuri santimetero z'uburebure bwibihaha). Alveoli iri hejuru cyane yibihaha ihura ningaruka zikomeye zo kugabanya umuvuduko ukabije kuruta alveoli hepfo, kurambura ingirabuzimafatizo kugeza igihe havutse uruzitiro ruto rukomeye.

Iyo ibibyimba bidasanzwe byacitse binyuze mu mitsi ya visceral, uburyo bwo gufungura hagati yumuyaga uhumeka hamwe nigitutu cyumuvuduko ukabije: 1. Umwuka uva mu bihaha ujya mu mwanya wishimye kugeza igihe icyuho kibi kibuze kandi umuvuduko udasanzwe uhwanye n’umuvuduko w’ikirere (0 cmH2O). 2. Yakuweho icyuho cyayo cyo hanze, ibihaha bya elastike bisubira imbere imbere yerekeza kumuzi wacyo (hilum), bigwa igice cyangwa burundu. 3. Ibihaha byasenyutse bihagarika kwitabira guhanahana gaze, bigatera ** guhumeka-parufe (V / Q) bidahuye ** hamwe n’iburyo-ibumoso kugeza ** hypoxic pulmonary vasoconstriction ** iyobora amaraso mu bihaha bizima.

2.¶

Hafi ya ** 78 ku ijana bya gaze ya pleural yafashwe igizwe na azote (N2) **, gaze ya inert ishonga nabi mumaraso. Mugihe gihumeka gisanzwe cyumuyaga, pneumothorax ifunze yisubiramo muri capillaries yishimye kuri ** 1.25 kugeza kuri 2,2% yubunini bwa hemithorax kumasaha 24 ** (bivuze ko kugwa 30% bifata ibyumweru 2 kugeza kuri 3 kugirango bisibe wenyine).

Iyo inkeragutabara cyangwa abaganga byihutirwa bakoresheje ** ogisijeni yuzuye yuzuye (litiro 10 kugeza kuri 15 kumunota ukoresheje mask idasubizwa inyuma) **, umwuka wa ogisijeni wahumetswe woza azote mu maraso ya arterial, bikagabanya umuvuduko wigice cya azote muri capillaries ziva kuri mm 573 zerekeza kuri zeru mugihe ogisijeni ya capillary ikoreshwa na tissue. Ibi birema ** igice kinini cyumuvuduko ukwirakwiza ** hagati yumufuka wa azote ukungahaye kuri azote hamwe namaraso ya capillary ya azote yagabanutse, gukuramo gaze yafashwe mumwanya wishimishije ** inshuro enye byihuse ** (kugeza kuri ** 4 kugeza 8% byubunini bwa hemithorax kumunsi **).

Ugereranije ubwoko bune bwamavuriro ya pneumothorax¶

Gusobanukirwa nicyiciro umurwayi agwa mubuyobozi bwa triage, kubera ko umukinnyi ukiri muto ufite ubuzima bwiza waguyeho 25% ashobora kugaragara neza kuruhuka, mugihe umusaza wimyaka 65 urwaye emphysema hamwe no kugwa 10% arashobora gufatwa byihuse.

Kumenya ibimenyetso: Gusenyuka bitagoranye na Tension Pneumothorax¶

1. Ibimenyetso bya kera bya Pneumothorax yoroshye¶

Mu barenga ** 80 ku ijana by'imanza **, pneumothorax yibanze uba mu kiruhuko aho kuba mu myitozo iremereye: - ** Ububabare butunguranye, butyaye, butera icyuma kimwe cyo mu gatuza (Ububabare bwa Pleuritike) **: Gufata umwuka uhagije, gukorora, guseka, cyangwa kugoreka umubiri bitera gufata gukomeye bitera guhumeka bigufi, bidakabije ("gucamo ibice"). - ** Ububabare butandukanye bwigitugu cyangwa umugongo wo hejuru (scapular) ububabare **: Kuberako parietal pleura itwikiriye diafragma yo hagati yinjizwamo nu mwijima wa ** frenic (imizi yinkondo y'umura C3, C4, na C5) **, kurakara biturutse kumyuka ihunga byerekeza hejuru yigitugu kuruhande rumwe. - ** Guhumeka gukabije (Dyspnea) **: Impinduka kuva inzara yumuyaga woroheje ku ngazi kugeza umubabaro mwinshi kuruhuka. - ** Kuma, kwiba, inkorora idatanga umusaruro **: Biterwa no kwakirwa neza kwakirwa nkuko ibihaha bigenda byangirika. - ** Emphysema ya Subcutaneous ("Umuceri Krispies" irashwanyuka munsi yuruhu) : Gukurikirana ikirere muri mediastinum (pneumomediastinum) no mu ijosi bitanga urusaku munsi y'intoki cyangwa ijwi rijanjagura hamwe n'umutima ( Ikimenyetso cya Hamman **). - ** Ibisubizo by'ibizamini bifatika : Uruhande rwanduye rugenda ruto mugihe cyo guhumeka, amajwi adafite akamaro iyo akubiswe ( hyperresonance to percussion **), kandi yagabanije ** amajwi ahumeka cyangwa adahari ** kuri auscultation.

2¶

A ** tension pneumothorax ** ibaho mugihe ingirabuzimafatizo zacitse zikora nka ** inzira imwe ya **: guhumeka bikuramo umwuka mubiti bya bronchial bikinjira mu cyuho cyiza, ariko guhumeka bifunga flap ifunze kugirango umwuka udashobora guhunga.

Hamwe na buri mwuka, umuvuduko mwiza wubaka imbere mu gituza (+10 kugeza +20 cmH2O cyangwa irenga): 1. ** Ibihaha byuzuye gusenyuka **: Ibihaha byanduye byajanjaguwe neza na hilum. 2. ** Guhinduranya hagati no kwikuramo ibihaha bitandukanye **: Umuvuduko ukabije usunika umutima, umuyaga (trachea), hamwe nimiyoboro minini yambukiranya umupaka hagati ikagira ubuzima bwiza, igahuza ibihaha bisigaye. 3. ** Kinking ya Vena Cava na Shock Obstructive Shock **: Umuvuduko mwiza wa intrathoracic ukanda ** vena cava ** isumba iyindi kandi ntoya. Gusubira mu mitsi kwa atrium iburyo bigabanuka kuri zeru, umutima uva mu mutima ugabanuka muri ** guhagarika umutima **, kandi umurwayi arwaye ** Pulseless Electrical Activity (PEA) ifata umutima ** mu minota mike keretse iyo yatewe inshinge cyangwa igituba.

Gutandukanya Byoroheje Pneumothorax na Tension Pneumothorax kumuriri¶

Isuzuma ritandukanye: Izindi mpamvu zitera ububabare bwo mu gatuza¶

Inkeragutabara n'abaganga byihutirwa basuzuma buri gihe ibintu byihutirwa byigituza:

1. Embolism y'ibihaha (PE): Amaraso atembera ava mumitsi yimbitse (DVT) yerekeza mumitsi yumutima itera ububabare bwo mu gatuza butunguranye, dyspnea, na tachycardia. Bitandukanye na pneumothorax, ** amajwi yo guhumeka angana kumpande zombi **, abarwayi barashobora gukorora amaraso (hemoptysis), hamwe ningaruka ziterwa no kubaga vuba, indege ndende, immobilisation, gutwita, cyangwa kanseri.
2. Acite Pericarditis na Myocarditis.
3. Indwara y'umutima na Gutandukana kwa Aortic.
4. ** Esophageal Rupture (Syndrome ya Boerhaave) **: Amarira ya Esophageal transmural nyuma yo kuruka ku gahato, kurekura aside gastricike n'umwuka muri mediastinum hanyuma bigasiga mu cyuho cyiza.

Mbere y'ibitaro no kwita ku bitaro: Icyo ugomba gutegereza inkeragutabara na ED¶

1.¶

Niba umurwayi ufite pneumothorax atamenyekanye ahumeka, agashyiraho ** CPAP, BiPAP, cyangwa umufuka wimbaraga-valve-mask (BVM) uhumeka ** pompe umwuka wumuyaga unyuze mumosozi yishimye mumyanya yigituza, ugahindura gusenyuka byoroshye muri pneumothorax **. Abashubije buri gihe batera ibihaha byombi (kandi bagakoresha ultrasound yo kuryama) mbere yo gukoresha umuvuduko mwiza wo guhumeka.

2. Gusuzuma Ibitaro: Isanduku Yuzuye X-Ray na Thoracic Ultrasound (POCUS)¶

• ** Upright Posteroanterior (PA) Isanduku X-Ray : Yerekana umurongo wera utyaye ( visceral pleural edge **) hamwe nibimenyetso byibihaha bidahari kumurongo. Filime ya expiratory ya firime ntabwo ikenewe.
• ** Ingingo-yo-Kwitaho Thoracic Ultrasound (POCUS) **: Itahura pneumothorax mumasegonda 30 hamwe na sensibilité irenze X-ray. Ibihaha byasenyutse byerekana ** kubura kunyerera kw'ibihaha **, kubura umurongo wa comet-umurizo B-imirongo, barcode ** "ikimenyetso cya stratosifera" kuri M-mode **, hamwe no gusuzuma ** "ibihaha" **.

3. Amahitamo agezweho yo kuvura: Kwitegereza, Kwifuza, Igituba, na TVA¶

Yahujwe na ** 2023 Sosiyete y'Abongereza Thoracic (BTS) Amabwiriza y’indwara ya Pleural ** hamwe n’ibigeragezo mpuzamahanga:

1. ** Ubuyobozi bwa Conservateur (Indorerezi Yonyine) **: Ku barwayi bakiri bato, bafite ubuzima bwiza bafite ** Primary Spontaneous Pneumothorax (PSP) ** bafite ** minimal cyangwa idafite umwuka uhumeka ** hamwe na vitamine zihamye, kwitegereza hamwe na ogisijeni itembera cyane hamwe nigituza X-ray mu masaha 4 bituma amarira yishimye akira bisanzwe nta urushinge cyangwa umuyoboro.
2. ** Urushinge rworoshye cyangwa Ambulatory Heimlich Valve **: Ku barwayi ba PSP badahumeka, abaganga barashobora kwifuza umwuka bakoresheje urumogi rwa ** 14G kugeza kuri 16G ** (kugeza kuri litiro 2,5)
3. ** Gitoya ya Beld Seldinger Intercostal Chest Drain (8 Fr kugeza 14 Fr) **: Kubwa Secondary Spontaneous Pneumothorax (SSP), ibyifuzo byananiranye, cyangwa kugwa kwinshi ibimenyetso, abaganga binjiza catheter ya ** 8 kugeza 14 yubufaransa ya Seldinger ** munsi ya anesthesi yaho binyuze kuri ** "Triangle of Umutekano" ** (ihana imbibi na latice axilla), ihujwe na ** icupa rya kashe y'amazi **.
4. ** Urushinge rwihutirwa (Thoracostomy) : Kubireba pneumothorax hamwe no guhungabana, abaganga binjiza urumogi runini ( 14G, uburebure bwa santimetero 4,5 kugeza kuri santimetero 1.75 kugeza kuri santimetero 1.75]
5. ** Kwirinda Kubaga Kwisubiramo (VATS Bullectomy na Pleurodesis) **: Kubijyanye no guhumeka ikirere (iminsi irenga 3 kugeza kuri 5), pneumothorax isubirwamo, cyangwa imyuga ishobora guteza ibyago byinshi (abaderevu, abadive), poudrage **, kugabanya kugaruka kuva ** 30 kugeza kuri 50 ku ijana kugeza kuri 1 kugeza 5% **.

Uburebure, ingendo zo mu kirere, kwibiza mu mazi, no kwirinda nyuma yo gukira¶

Iyo pneumothorax imaze gukira kandi umurwayi asohotse murugo, amategeko akomeye ya barometrici nubuzima arinda indwara ishobora guhitana abantu:

• ** Amategeko yo gutegereza ingendo zo mu kirere (BTS & Association Medical Medical Association) **:
• Ugomba ** NTIBIGENDE kuguruka hamwe na pneumothorax ikora, isigaye, cyangwa itavuwe ** yubunini ubwo aribwo bwose.
• Iyo isanduku ya X-ray imaze kuvurwa yemeje ** 100 ku ijana byuzuye bya radiografiya ** (ibihaha byaguwe neza kurukuta rwigituza hamwe na zeru zisigaye zumufuka wumwuka), Sosiyete yo mubwongereza Thoracic irasaba gutegereza byibuze iminsi ** 7 yuzuye nyuma ya X-ray isanzwe ** (hamwe nindege nyinshi hamwe n’ishyirahamwe ry’ubuvuzi bw’indege zirasaba gutegereza ** iminsi 14 nyuma y’imyuka yuzuye ya radiyo itaragera ku ndege y’ubucuruzi, kugira ngo isuzume niba indege idahwitse kuri televiziyo.
• ** Kubuza Kwibira Byibihe Byose **:
• Kuberako kuzamuka no kuva kuri metero 10 (metero 33) zo koga cyangwa kwibira mu nyanja bikubye kabiri ubunini bwa gaze iyo ari yo yose yafashwe kandi birashobora gutera impanuka ya ** pulmonary barotrauma na embolisme ya gaze ya arterial (AGE) **, amateka ya pneumothorax yihitiramo ni ** burundu burundu kuburibwe hamwe na gasutamo ya ** imikorere yimpyisi hamwe ninzobere mu buvuzi bwo kwibira.
• ** Reka kunywa itabi no guswera byuzuye **:
• Gukomeza kunywa itabi, itabi ry'urumogi / bongs (birimo guhumeka cyane hamwe no gufata umwuka uhumeka wa Valsalva), cyangwa itabi rya elegitoroniki / vapi nimwe mumashanyarazi manini ashobora guhinduka. Guhagarika umwotsi wose hamwe numwuka uhumeka bigabanya ibyago byamahaha ya kabiri yaguye kuva kuri ** hejuru ya 40 kugeza kuri 50% kugeza kuri 15 kugeza kuri 20% **.
• ** Irinde Umuhengeri Ukomeye, Ibikoresho byumuyaga, hamwe na Siporo yo Guhuza Ibyumweru 2 kugeza 4 **:
• Tegereza kugeza byuzuye bya radiografiya kandi bisobanurwe numuvuzi wawe wa pulmonologue mbere yo gusubira muburemere buremereye (irinde gufata umwuka wa Valsalva uhumeka), ukina imiringa irwanya cyane cyangwa ibikoresho byo mu biti, cyangwa kwitabira siporo yo guhura.

Inomero zihutirwa zo mukarere hamwe na protocole yikigo¶

• ** Amerika na Kanada **: Hamagara ** 911 ** ako kanya kubabara giturumbuka gituza no guhumeka neza. Inkeragutabara zibanziriza ibitaro zikurikiza ** Ishyirahamwe ry’umutima w’abanyamerika (AHA) ** na ** Inkunga y’ubuzima bw’imbere y’ibitaro (PHTLS) / Ishyirahamwe ry’abaganga ba EMS (NAEMSP) ** protocole yubuyobozi bwa ogisijeni itembera cyane, impiswi oximetry, hamwe ninshinge zihutirwa za thoracostomy (Umwanya wa 2 intercostal space midclavicular line cyangwa umurongo wa ⅘ wa interineti intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space intercostal space line Ubuyobozi bwibitaro bukurikiza ** Sosiyete y'Abanyamerika Thoracic (ATS) ** na ** Ishuri Rikuru ry’abaganga bo mu gatuza (CHEST) **.
• ** Ubwongereza **: Hamagara ** 999 ** kuri ambulance yihutirwa (ububabare bukabije bwo mu gatuza hamwe no guhumeka ni guhamagara 999). Kuvura ibitaro bikurikiza ** Thoracic Society yo mu Bwongereza (BTS) 2023 Amabwiriza agenga indwara zanduye ** na ** NICE **, agenga imicungire y’aba conservateurs, ambulatory ambulatory pleural vents, hamwe na Seldinger imiyoboro mito mito.
• ** Umuryango w’ubumwe bw’ibihugu by’i Burayi **: Hamagara ** 112 ** mu bihugu byose bigize Umuryango w’ubumwe bw’ibihugu by’Uburayi. Amatsinda y'ibitaro akurikiza ** Umuryango w’uburayi w’ubuhumekero (ERS) ** amabwiriza y’imyitozo ngororamubiri y’ubuvuzi bwa pneumothorax y'ibanze n'ayisumbuye, akoresheje ultrasound yo kuryama ku gitanda, sisitemu yo gukuramo igituza cya digitale, hamwe no kugisha inama VATS hakiri kare.
• ** Australiya na Nouvelle-Zélande **: Hamagara ** 000 ** muri Ositaraliya cyangwa ** 111 ** muri Nouvelle-Zélande. Serivise ishinzwe ubutabazi n’ishami ryihutirwa bakurikiza ** Sosiyete ya Thoracic yo muri Ositaraliya na Nouvelle-Zélande (TSANZ) ** na ** Komite ya Ositaraliya na Nouvelle-Zélande ishinzwe ubuzima (ANZCOR) **, ikubiyemo ubushishozi buva mu kimenyetso cy’ibanze cya ANZ cy’ibigo by’ibidukikije hamwe n’urubanza rwa PSP.
• ** Ubuhinde na Aziya-Pasifika **: Hamagara ** 112 ** mu Buhinde, ** 995 ** muri Singapuru, ** 119 ** mu Buyapani na Koreya y'Epfo, cyangwa ** 999 ** muri Hong Kong na Maleziya. Saba ubufasha bwihuse bwubuzima (ALS) bwihutirwa bwitwa ogisijeni kandi umenyeshe ishami ryihutirwa ryakira kwitegura radiografiya igororotse hamwe na decompression.

Ibibazo bikunze kubazwa¶

Ni ukubera iki abasore barebare, bananutse bafite ingimbi na makumyabiri bakunze kwibasirwa nibihaha?¶

Mugihe cyihuta cyubwangavu bwihuta, uburebure burebure, bwigituza bwigituza butera imbaraga zikomeye zihagaritse kuva hejuru yibihaha kugeza hasi. Isakoshi yo mu kirere (alveoli) hejuru cyane y ibihaha ihura ningutu zikomeye zo kurambura kurenza ibindi bihaha, bigatuma uduce duto duto tumeze nk'udusimba tumeze nk'udusimba twinshi hejuru ya lobes yo hejuru. Niba kimwe muri ibyo biti bitobito bitobito byacitse (cyane cyane iyo bigabanutse kubera umuriro uhumeka uturutse ku itabi cyangwa vaping), umwuka winjira mumwanya utari mwiza wumuvuduko ukabije ugasenya ibihaha nubwo wicaye wicaye.

Nyuma yigihe kingana iki ibihaha byaguye bimaze gukira ni byiza kuguruka mu ndege yubucuruzi?¶

Ntugomba na rimwe kwinjira mu ndege mugihe pneumothorax isigaye ikiri ku gituza X-ray, kubera ko umuvuduko wa kabine utera umwuka wo mu gatuza wafashwe waguka kugera kuri 25 kugeza kuri 38%. Nk’uko bitangazwa na Sosiyete y'Abongereza Thoracic (BTS), ugomba gutegereza byibura iminsi 7 yuzuye nyuma yo gukurikiranwa mu gatuza X-ray yemeza ko 100% byakemuwe neza na pneumothorax (hamwe n’indege nyinshi hamwe n’ishyirahamwe ry’ubuvuzi rya Aerosmace bisaba gutegereza iminsi 14 nyuma y’ibyemezo bya radiyo byuzuye) mbere yo kuguruka.

Nshobora kongera kwibira nyuma yo kugira pneumothorax?¶

Muri Sosiyete y'Abongereza Thoracic, Divers Alert Network (DAN), hamwe n’amabwiriza mpuzamahanga y’imiti yo kwibira, pneumothorax yabanje kwizana ni itemewe burundu kuva kwibiza mu kirere hamwe n’umwuka uhumanye, ndetse n’ibihaha bikira burundu ndetse na nyuma ya talc cyangwa abrasion pleurodeis. Umuvuduko ukabije w’amazi urashobora guturika mikorosikopi mu bihaha no kwagura umwuka wafashwe kugeza kuri 200 kugeza kuri 400 ku ijana mugihe cyo kuzamuka, bigatera pneumothorax itera ubwoba mbere yo kugera hejuru; gusa abakandida badasanzwe babazwe muburyo bwo kubaga pleurectomie kandi bafite ibisanzwe bisanzwe byuzuye CT scan hamwe nibizamini byimikorere yibihaha bigeze bifatwa nkibisabwa na muganga wibiza.

Kuki ububabare bwanjye bwo mu gatuza bwatangiye kumererwa neza kumunsi wa kabiri nubwo muganga yavuze ko ibihaha byanjye bigisenyuka?¶

Iyo umwuka winjiye bwa mbere mu cyuho cyiza kandi ukuraho ibihaha kure y'urukuta rw'igituza, urambura kandi ukarakaza fibre y'ububabare muri parietal pleura, bigatera ububabare bukabije bwo gutera icyuma na buri mwuka. Ibihaha bimaze kurangira bihagaze neza nyuma yamasaha 12 kugeza 24, kurira no guhindagurika bikabije birahagarara, bityo ububabare bukabije akenshi burashira mububabare bukabije cyangwa gukomera byoroheje nubwo ibihaha bikomeza kugwa 30 kugeza 60%. Ntuzigere na rimwe wibwira ko ibihaha byaguye byakize kubera ko ububabare bwa mbere bwo gutera icyuma bwagabanutse.

Pneumothorax ya catamenial niki kandi kuki bibaho mugihe cyimihango?¶

Indwara ya pneumothorax ni ibihaha byongeye kugwa bibaho ku bagore bafite imyaka y'imyororokere mu masaha 24 mbere kugeza amasaha 72 nyuma yo gutangira imihango, bikagira ingaruka ku bihaha by'iburyo mu bice birenga 90 ku ijana. Iterwa na thoracic endometriose (aho microscopique yatewe na nyababyeyi yo mu nda ibyara kuri diaphragm iburyo na visceral pleura) ihujwe nuduce duto twavukanye (fenestrations) muri diafragma ituma umwuka nu mwijima byinjira mu cyuho cyigituza mugihe cyimihango. Umugore uwo ari we wese ufite ububabare bwo mu gatuza cyangwa ibihaha byaguye mu gihe cye agomba kubimenyesha umuganga we w’umuganga w’umugore bityo rero intego yo gusana diaphragmatique ya VATS no kuvura imisemburo irashobora kwirinda ukwezi.

Ese pneumothorax ihita ikenera igituba kibabaza igituza kibabaza?¶

Oya. Ibigeragezo bigezweho byubuvuzi hamwe nubuyobozi bwa 2023 bwabongereza Thoracic Society byerekana ko niba ukiri muto, ubundi ukagira ubuzima bwiza (Primary Spontaneous Pneumothorax), kandi udahumeka neza, ibihaha byawe byaguye birashobora gucungwa neza hamwe no kwitegereza hamwe na ogisijeni itemba cyane yonyine nta nshinge cyangwa umuyoboro. Nubwo mugihe amazi akenewe, abaganga muri iki gihe bakoresha icyifuzo cyihuta cyinshinge, icyuma gishobora kwambarwa gifite ubunini bwa ambulatori igikoresho kimwe cya valve iguha uburenganzira bwo gutaha umunsi umwe, cyangwa ikaramu yoroheje yoroheje ya catheteri (8 kugeza 14 yubufaransa) yashyizwe munsi yimiti yo kubaga aho gukoresha umuyoboro munini wo kubaga.

• Aka gatabo gatanga amakuru yuburezi bwihutirwa kandi ntasimbuza ubuvuzi bwumwuga cyangwa kwisuzumisha. Kubera ko ububabare bukabije bwo mu gatuza hamwe n’ububabare bw’ubuhumekero bushobora gutera imbere byihuse bikabije guhitana ubuzima cyangwa gufatwa n’umutima, turasaba cyane ko twafata ibyemezo by’ubufasha bwa mbere byemejwe n’amasomo ya CPR muri Croix-Rouge, Ambulance ya St John, cyangwa abatanga amahugurwa yihutirwa yemewe. *

Kuyobora¶

• Umuvuduko ukabije pneumothorax no konsa igikomere ubufasha bwambere
• Igituza cyoroshye, kuvunika imbavu, no guhahamuka kwa thoracic
• Embolism yo mu bihaha hamwe na trombose ndende (DVT)
• Pericarditis, myocarditis, hamwe na virusi yibituza nyuma ya virusi ibendera ritukura
• Asima yibasiye ubutabazi bwambere

Inkomoko nubuyobozi¶

• ** Sosiyete y'Abongereza Thoracic (BTS, Ubwongereza): ** * Amabwiriza ya Sosiyete y'Abongereza ya Thoracic yo Kurwanya Indwara ya Pleural (2023) *: Porotokole ishingiye ku bimenyetso bifatika ku micungire y’aba conservateur, imiyoboro ya ambulatori, ibyifuzo by’urushinge, kuvoma igituza cya Seldinger, igihe cyo gutegereza ingendo zo mu kirere, no kubuza kwibira.
• ** Umuryango w’uburayi w’ubuhumekero (ERS): ** * Itangazo rya Task Force ya ERS kuri Pneumothorax yibanze: Gusuzuma no gucunga ibice byambere kandi bigaruka *.
• ** Sosiyete y'Abanyamerika Thoracic (ATS) hamwe n’ishuri rikuru ry’abaganga bo mu gatuza (CHEST, Amerika): ** * Imicungire y’ubwumvikane buke bwa Pneumothorax * na * New England Journal of Medicine Conservative hamwe na Interventional Treatment for Primary Spontaneous Pneumothorax Trial (Brown et al., ANZ) *.
• ** Ishyirahamwe ry’ubuvuzi bwo mu kirere (AsMA) n’ishyirahamwe mpuzamahanga ryo gutwara abantu n'ibintu mu kirere (IATA): ** * Amabwiriza y’ubuvuzi mu ngendo z’indege: Ubuzima bwo guhumeka buguruka nyuma ya Pneumothorax no kubaga Thoracic *.
• ** Inkunga Yubuzima Bwambere Yibitaro (PHTLS) hamwe nishyirahamwe ryumutima wabanyamerika (AHA): ** * Ubufasha bwimibereho yumutima nimiyoboro yimitsi (ACLS) Kumenyekanisha no gutesha agaciro ihungabana ryatewe na Tension Pneumothorax *.