Pneumothorax lama filaan ah, Calaamadaha Sambabka oo Burburtay, iyo Xanuunka Xabadka Pleuritic¶

Pneumothorax iskiis ah (oo loo yaqaan sambabada burburay) waxay dhacdaa marka hawadu ka soo baxdo unugyada sambabada oo ay ku xayirto gudaha booska xuubka, dheecaan khafiif ah oo saliidaysan oo u dhexeeya bannaanka sambabada iyo gudaha gidaarka xabadka. Si ka duwan sambabada burburtay oo uu sababay a feeraha jaban ama dhaawac laabta oo ba'an ama a nabar laabta dhex gala, pneumothorax iskiis ah ayaa si lama filaan ah ugu dhuftey nasashada iyada oo aan wax saameyn ah oo jireed ah yeelan. Waxay keentaa xanuun degdeg ah, fiiqan, mindi hal dhinac ah oo laabta ah oo ka sii dara neef kasta ( xanuunka laabta ee pleuritic) iyo neefta oo degdeg ah. Haddii aad ka shakisan tahay sambabada soo duntay, wac nambarka xaaladda degdegga ah ee degaankaaga nambarada degdega ah tusaha isla markaaba qofka si toos ah u fadhiiso oo si buuxda u aamus, maadaama sambab kasta oo burburay uu u xumaan karo oof-wareenka nafta halis gelinaya ama u ekaan kara a sambabada sambabada ama wadne xanuun.

Hadda samee tan¶

1. ** Isla markiiba wac lambarkaaga degdega ah ***: garaac 911 gudaha Maraykanka iyo Kanada, 112 guud ahaan Midowga Yurub, 999 gudaha Boqortooyada Ingiriiska, 000 gudaha Australia, ama hubi caalimkeena nambarada degdega ah liiska. U sheeg diraha in bukaanku qabo xanuun laabta ah oo degdeg ah oo hal-dhinac leh iyo neefta oo gaaban oo looga shakisan yahay sambab soo duntay (pneumothorax).
2. Qofka dhig meel fadhi ah oo toosan ama toosan oo toosan (Fowler's booska) ama u janjeero dhinaca dhinaca xanuunka leh: Si toos ah u fadhida xagal 45-degree ilaa 90-degree waxay xubnaha caloosha hoos u soo jiidataa cuf-jiid, taasoo siinaysa qolka ugu badan ee sambabada ee aan waxyeelayn si ay u balaarto. Weligaa ha ku qasbin bukaan laabta xanuunaya oo neefta la'a inuu dhabarka u jiifsado.
3. **Jooji dhammaan jimicsiga jirka, socodka, qufaca, ama cadaadiska (Valsalva maneuvers) ***: Ha u oggolaan in qofku uu hoos ugu socdo jaranjarada ambalaaaska, ha qaadan bacaha, alaabta kor u qaadin, ama sanka si xoog ah ugu dhufan. Neef kasta oo xoog leh, qufac, ama cadaadis Valsalva ayaa hawo badan kaxeeya iyada oo soo marta xuubka xuubka jeexan ee godka laabta oo uu soo dedejiyo burburka sambabada.
4. ** Ka fur dharka ku dheggan laabta, luqunta, iyo dhexda oo deji neefsashadooda**: Furaha badhannada, suumanka debecsan ama rajabeetada dhegta, iyo tababaraha neefsasho gaabis ah, gacmeed, deggan. Neefta qoto dheer ee argagaxa ay wado waxay kordhisaa cadaadiska xuubka xuubka waxayna ka sii daraysaa xanuunka mindida.
5. ** Maamul ogsijiin dheeri ah oo qulqulaya haddii la tababaro oo la qalabeeyo ***: Haddii dhululubo oksijiin degdeg ah leh maaskaro aan dib u soo celinayn laga heli karo goobta shaqada, doonta quusta, ama rugta caafimaadka, ku bixi oxygen socodka qulqulka badan ** 10 ilaa 15 litir daqiiqadii *** (ilaa uu bukaanku garanayo haynta kaarboon oksijiinta dabadheeraad ah ee COPD daran, taas oo lala beegsanayo qulqulka oksijiinta ee boqolkiiba 2) Ogsajiinta qulqulka badan waxay saxaysaa ogsijiinta dhiigga hooseysa (hypoxemia) waxayna deddejisaa dib u nuugista nitrogen pleural ee ku xayiran afar qodob.
6. ** Si joogto ah u fiirso calamada cas ee Pneumothorax kacsan ***: Ka hubi qofka qoortiisa, dibnaha, garaaca wadnaha, iyo feejignaanta maskaxeed 2dii daqiiqoba mar. Haddii ay si daran u noqdaan cyanotic (dabshimo buluug ah), wareer, wareer, hypotensive, neefta oo aan caadi ahayn, ama ay yeeshaan xididdada qoorta oo kala go'a, u sheeg direyaasha degdegga ah isla markiiba in bukaanku u sii xumaanayo tuhunka ** pneumothorax * kacsanaan ah oo u baahan depression irbad degdeg ah.
7. ** Mamnuuci dhammaan safarrada hawada, baabuurta xadhkaha buurta, iyo quusitaanka**: Xataa haddii feedhaha xanuunku dareemo khafiif oo la maarayn karo, qofka qaba pneumothorax aan la daawayn ama aan la xaqiijin waa in ** waligiis uusan raacin diyaarad, kaxayn meelaha buuraha dhaadheer, ama uusan gelin biyaha si uu u quuso**, marka cadaadiska isbeddelo ee lagu maamulo sharciga Boyle ayaa balaadhinaya hawada laabta ku xanniban oo burburtay.

Geedka go'aanka: xanuun laabta ah oo hal dhinac ah oo degdeg ah iyo kala soocida pneumothorax¶

flowchart TD
    Start["Xanuunka Xabadka ah ee fiiqan ee degdega ah (Ka sii daran waxyoonay) iyo Neefta oo ku yaraata (Ma jirto dhaawac laabta)"] --> TensionCheck{"Calan guduudan ma jiraan Pneumothorax kacsanaan ah? 1. Gaajo ba'an oo hawada ah ama awood la'aanta in ay hadlaan"}

    TensionCheck -->|"HAA: Khatarta Nolosha Degdega ah"| TensionProtocol["1. Wac 911/112/999 STAT oo caddeeya xiisadda laga shakisan yahay ee Pneumothorax 88 ilaa 92% bartilmaameedka haddii COPD aad u daran tahay) 4. Marna ha marin CPAP, BiPAP, ama hawo-qaad xoog leh oo bac-valve-mask ah ka hor inta aan xabadku soo bixin"]

    TensionCheck -->|"MAYA: Hemodynamically deggan, ku hadlaya weedho buuxa, garaaca garaaca caadiga ah"| RiskProfile{"Qiimee Xogta Khatarta Bukaanka: Primary (PSP) vs Secondary (SSP) vs Catamenial"}

    RiskProfile -->|"Dhallin (15 ilaa 35 jir), dhismo dheer/dhuuban, sigaar cabba, ma jiro cudur sambabada oo hore"| PSP["Pneumothorax Primary Spontaneous (PSP): xinjir hoose oo dillaacsan"]
    RiskProfile -->|"Da'da ka weyn 50 sano, AMA taariikhda COPD, emphysema, neefta, cystic fibrosis, Marfan"| SSP["Pneumothorax Labaad ee Laga Shakisan yahay (SSP): Kaydka sambabada hoose iyo khatarta sare ee u-bax"]
    RiskProfile -->|"Waxay ku dhacdaa 72 saacadood gudahood ka hor ama ka dib bilawga caadada"| Catamenial["Catamenial laga shakisan yahay / thoracic Endometriosis Pneumothorax: Caadi ahaan dhinaca midig (in ka badan 90%)"]

    PSP --> HospitalEval["Gaadiidka Meesha Fadhiga ee Cisbitaalka ED (Ha Socon ama Samayn): Ku xaqiiji cabbirka iyada oo loo marayo X-Ray Laab toosan, Ultrasound Thoracic (sababada oo maqan), ama CT"]
    SSP --> HospitalEval
    Catamenial --> HospitalEval

    HospitalEval --> SizeBranch{"Kala soocida Cusbitaalka Xajmiga iyo Calaamadaha (BTS / ATS / ERS Tilmaamaha)"}

    SizeBranch -->|"PSP yar (ka hooseeya 2 cm cirifka hilum) IYO neefsasho yar ama aan lahayn"| Conservative["Kormeerka Conservative + Daaweynta Ogsajiinta Socodka Sare: Dib u soo celiya 1.25% ilaa 2% maalintii (4x si degdeg ah O2 socodka sarreeya) Ku celi raajada 4 ilaa 6 saacadood, ka dibna bukaan-socod la socosho leh oo leh sharci adag NO FLYING"]
    SizeBranch -->|"PSP weyn (gees ahaan 2 cm ama ka weyn) AMA Neef la'aan AMA Pneumothorax Sare (SSP)"| Intervention["xuubka xuubka fir-fircoon: - Niyad fudud oo irbad ah (14G ilaa 16G cannula) AMA Aaladda Heimlich Valve Device - Tuubbada Xabadka Yaryar ee Seldinger (8 ilaa 14 Fr) oo ku xidhan shaabadda biyaha hoosteeda - VATS pleurodesis haddii hawo soo daadasho joogto ah (in ka badan 3 ilaa 5 maalmood), soo noqnoqda, xirfad sare, ama soo noqnoqda,"]

Pathophysiology: Sida sambabku u dumo iyada oo aan dhaawac feedhaha ahi dhicin¶

Dhuunta caafimaad qabta, dusha sare ee sambabada (visceral pleura) iyo gidaarka gudaha ee feeraha (parietal pleura) ayaa isku dheggan filim khafiif ah oo dareere ah (10 ilaa 20 millilitir [0.3 ilaa 0.7 wiqiyadood dareere]). Sababtoo ah sambabada laastikada ah ayaa si dabiici ah dib ugu soo noqnoqda gudaha halka feeraha u soo baxayo dibadda, booska u dhexeeya labadan xuubka waxay ilaalinaysaa cadaadiska ** sub-atmospheric (negative) ee cadaadiska intrapleural ** ee -3 ilaa -5 cmH2O marka la nasto, hoos u dhacaya -8 ilaa -10 cmH2O inta lagu jiro neefsashada qoto dheer. Nuugista faakuumka xun waxa ay ka ilaalisaa in kiishyada hawada (alveoli) ay ka bararaan feeraha.

1. Nabarrada Apical, Bullaae, iyo Luminta Dhuuqida Xumada Xun¶

Kiishash hawo leh oo finan yaryar ah oo loo yaqaan ** blebs subpleural *** (ka hooseeya 1 ilaa 2 sentimitir [0.4 ilaa 0.8 inji] dhexroor, oo ku dhex jira xuubka visceral visceral pleura) ama ka weyn ** emphysematous bullae ** (in ka badan 1 ilaa 2 sentimitir, oo ay sameeyeen derbiyada sare ee alveolar) waxay si joogto ah u koraan xagga sare (**)

Cufisjiidku wuxuu u jiidaa salka culus ee sanbabada xagga hoose ee diaphragmka. Qofka leh dalool dheer oo cidhiidhi ah oo laabta ah (dhis ectomorphic ah), dhererka tooska ah ee dhidibbada wuxuu abuuraa tabar ** cadaadiska xuubka** (0.25 cmH2O sentimitir dhererka sambabada). Alveoli ee sare ee sambabada ayaa la kulma cadaadis xoog badan oo diidmo ah oo soo jiidasho leh marka loo eego alveoli ee hoose, iskala fidiya unugyada apical ilaa ay ka sameysmaan finan hoose oo dhuuban.

Marka xuubka apical uu ka dillaaco xuubka visceral-ka, furitaanka ayaa ka dhex abuurma marinnada hawada iyo daloolka cadaadiska taban: 1. Hawadu waxa ay sambabada ka soo yaacdaa oo gasha godka xuubka ilaa inta faakuumka taban uu ka lumo cadaadiska intrapleural-ku uu la siman yahay cadaadiska atmospheric (0 cmH2O). 2. Iyaga oo ka go'ay xadhkaha faakuumka ee dibadda, sambabada laastikada ah ayaa dib ugu soo laabanaya xagga xididka dhexe (hilum), oo qayb ahaan ama gebi ahaanba burburaya. 3. Unugyada sambabada ee burburay waxay joojiyaan ka qayb qaadashada gaaska beddelka, abuurista ** hawo-mareen-perfusion (V/Q) is-dheeli-tiran** iyo shunt-midig-ilaa-bidix ilaa **

2. Waa maxay sababta Ogsajiinta-qulqulka badan ay u kordhiso dib u nuugista boqolkiiba 400 (Nitrogen Washout)¶

Qiyaastii 78 boqolkiiba gaaska ku xayiran wuxuu ka kooban yahay nitrogen (N2), gaas aan shaqayn oo si liidata ugu milma dhiigga. Neefsashada qolka-hawo ee caadiga ah, pneumothorax iskiis ah oo xiran ayaa dib u soo celinaysa xididdada xuubka xuubka xuubka xuubka xuubka xuubka 24 saacadood oo keliya ** 1.25 ilaa 2.2 boqolkiiba mugga hemithorax 24 saacadoodba ** (macnaheedu waa 30 boqolkiiba burburku waxay qaadanayaan 2 ilaa 3 toddobaad si ay u nadiifiyaan keligiis).

Marka dhakhaatiirta caafimaadka degdega ah ama takhaatiirta degdega ah ay codsadaan ** oxygen dheeri ah oo qulqulaya (10 ilaa 15 litir daqiiqadii iyada oo loo marayo maaskaro aan dib u soo celinayn), oksijiinta waxyooday waxay nadiifisaa nitrogen ka soo baxa dhiiga halbowlaha wareegaya, hoos u dhigista cadaadiska qayb ka mid ah nitrogen ee xididada xuubka xuubka xuubka ilaa 573 mmHg ilaa eber halka ogsijiinta xididada ay cunaan unugyo. Tani waxay abuurtaa tabar ** qayb cadaadiska qaybeed gradient ** u dhexeeya jeebka pleural-ka nitrogen-ku hodanka ah iyo dhiigga xididada nitrogen-ku-dhiman, ka soo jiidaya gaaska ku xanniban booska xuubka ** afar jeer dhakhso ah ** (ilaa ** 4 ilaa 8 boqolkiiba mugga hemithorax maalintii).

Isbarbardhigga afarta nooc ee bukaan-socodka ee pneumothorax iskiis ah¶

Fahamka qaybta uu bukaanku ku dhacayo kala soocida hagaha, sababtoo ah ciyaaryahan da'yar oo caafimaad qaba oo leh boqolkiiba 25 burburay ayaa laga yaabaa inuu u muuqdo mid ku raaxaysan nasashada, halka 65-jirka qaba emphysema iyo 10 boqolkiiba burburku uu si degdeg ah u soo gaari karo xiritaan hypoxic ah.

Aqoonsiga calaamadaha: Burbur aan dhib lahayn vs. Pneumothorax kacsanaan ah¶

1. Calaamadaha caadiga ah ee Pneumothorax iskiis ah oo fudud¶

In ka badan ** 80 boqolkiiba kiisaska *, pneumothorax iskiis ah ee aasaasiga ah wuxuu ku dhacaa nasasho halkii uu ka ahaan lahaa jimicsiga culus: - ** Xanuunka laabta oo kedis ah, fiiqan, mindi (Pleuritic Pain): Neef qoto dheer oo qaadata, qufaca, qoslida, ama qalloocida jirku waxay sababtaa qabsasho fiiqan oo xoogaysa neefsasho gaaban, gaaban ("kabid"). - ** cirifka garabka-caarada ama dhabarka sare (scapular) xanuunka *: Sababtoo ah xuubka parietal ee daboolaya diaphragm dhexe waxaa ku j ** dareemaha phrenic (xididdada ilmagaleenka C3, C4, iyo C5) ***, xanaaqa ka soo baxa hawada waxaa loo gudbiyaa dhinaca sare ee garabka. - ** Neefsasho ba'an (Dyspnea): Waxay u dhexeysaa gaajo hawo fudud oo jaranjarada saaran ilaa diiqad kadeednasashada. - ** Qalalan, jabsi, qufac aan wax soo saar lahayn ***: Waxaa kiciyay daaweeyayaasha xuubka xuubka xuubka sida sambabku u furfurmo. - ** empsema subcutaneous ("Rice Krispies" dillaaca maqaarka hoostiisa)**: Raadinta hawada gudaha mediastinum (pneumomediastinum) iyo qoorta waxay soo saartaaillaaca faraha hstooda ama dhawaaqa garaaca wadnaha garaaca ( calaamad Hamman**). - **Natiioyinka baadhista jireed: dhinaca ay saamaysay way yara dhaqaaqdaa marka la neefsanayo, waxay u dhawaaqdaa meel bannaan marka la taabto

2. Horumarka Kacsanaanta Pneumothorax: Gurmadka Hal-Wadka ah¶

A ** pneumothorax kacsan *** waxay dhacdaa marka unugyadu jeexjeexay ay u dhaqmaan sidii ** waalka hal-jidka ah ***: neefsashadu waxay nuugtaa hawo ka soo baxda geedka bronki ilaa daloolka xuubka, laakiin neeftu waxay xirtaa daboolka si aanay hawadu u baxsan karin.

Neef kasta, cadaadis togan ayaa ku dhisma gudaha laabta (+10 ilaa +20 cmH2O ama ka badan): 1. Sambabada ipsilateral oo burburay: Sambabka ay saamaysay ayaa si siman loogu jajabiyey hilum. 2. **Isbeddelka dhexdhexaadka ah iyo isku-buufinta sambabada ka soo horjeeda : Cadaadiska kor u kaca ayaa riixaya wadnaha, tuubada dabaysha (trachea), iyo maraakiibta waaweyn ee dhexda u gudba dhinaca caafimaadka, cadaadisa sambabada soo hadhay. 3. Kinging of the Vena Cava iyo Shock Obstructive: Cadaadiska togan ee intrathoracic wuxuu tuujiyaa cava-ga sare iyo hoose. Ku soo laabashada xididdada dhiigga ee atrium-ka midig waxay hoos ugu dhacdaa eber, wax-soo-saarka wadnuhu wuxuu hoos ugu dhacayaa ** shoog xannibaad ah **, waxaana bukaanku la ildaran yahay ** Dhaqdhaqaaqa Korantada ee aan garaaca lahayn (PEA) wadnaha oo istaagay ** daqiiqado gudahooda ilaa ay ka soo baxdo irbad depression ama tuubo laabta.

Kala soocida Pneumothorax Fudud ee Pneumothorax kacsan ee sariirta dhinaceeda¶

Ogaanshaha kala duwanaanshaha: Sababaha kale ee xanuunka laabta ee pleuritic¶

Dhakhaatiirta caafimaadka degdega ah iyo dhakhaatiirta degdega ah waxay si nidaamsan u qiimeeyaan xaaladaha degdega ah ee laabta:

1. Dhiig-baxa sambabada (PE): Dhiigxinjirow ka soo socdaalaya xidid qotodheer (DVT) una socda halbowlayaasha sambabada ayaa keena xanuun laabta oo degdeg ah, dyspnea, iyo tachycardia. Si ka duwan pneumothorax, ** dhawaqa neefsashadu waa siman yihiin labada dhinac **, bukaanku waxaa laga yaabaa inay qufacaan dhiig (hemoptysis), iyo arrimaha khatarta ah waxaa ka mid ah qalliin dhowaan, duulimaadyo dhaadheer, dhaqdhaqaaq-la'aan, uur, ama kansar.
2. Pericarditis ba'an iyo myocarditis: Waxay keentaa xanuunka laabta ee dhexe ama bidix ee fiiqan oo ka soo baxaya cirifka trapezius kaas oo ** ka sii dara marka si siman loo jiifsado oo soo roona marka la fadhiisto oo hore loo tiirsado ***, leh dhawaaqyo neefsasho laba geesood ah oo caadi ah.
3. Wadna xanuunka iyo Kala-baxa xididada: Wadnaha wadnaha wuxuu keenaa cadaadis dib-u-celin culus, halka kala-baxa aortic-ku uu keeno jeexjeexid kedis ah oo ka soo baxaya dhabarka (muhiim u ah in meesha laga saaro ** Marfan syndrome ***, kaas oo u saadaliya pneumothorax iyo kala-baxa aortic).
4. ** Dilaaca hunguriga (Boerhaave Syndrome)**: Jeex-jeexjeexa hunguriga ee transmural ka dib matag xoog leh, oo sii daaya aashitada gastric iyo hawada dhexda mediastinum iyo godka xuubka xuubka.

Daryeelka isbitaalka ka hor iyo isbitaalka: waxa laga filayo dhakhaatiirta caafimaadka iyo ED¶

1. Waa maxay sababta hawo-qaadista-cadaadiska togan (CPAP, BiPAP, ama BVM) ay khatar u tahay¶

Haddii bukaanka qaba pneumothorax aan la aqoonsan uu noqdo neefta, codsanaya ** CPAP, BiPAP, ama hawo xoog leh bag-valve-mask (BVM) *** waxay ku shubtaa hawo cadaadis ah iyada oo jeexan jeexan gudaha godka laabta, u beddela burbur fudud oo loo beddelo ** pneumothorax kacsanaan ah ***. Jawaab-bixiyeyaashu had iyo jeer waxay ku dhawaaqaan labada sambab (oo waxay isticmaalaan ultrasound-ka sariirta dhinaceeda) ka hor intaysan marin cadaadiska marin-haweedka togan.

2. Ogaanshaha Cisbitaalka: Raajo laabta oo toosan vs. Ultrasound Thoracic (POCUS)¶

• ** Raajada laabta ee toosan (PA) ee laabta : Waxay muujisaa xariiq cad oo fiiqan ( cidhifka xuubka xuubka cambarka*) oo leh calaamado sambabada oo maqan oo ku wareegsan xariiqda. Looma baahna filimaanta dhiciska caadiga ah.
• Ujeedka-Daryeelka Ultrasound Thoracic (POCUS): Wuxuu ku ogaadaa pneumothorax in ka yar 30 ilbiriqsi isagoo leh dareen ka sarreeya raajo-jiif. Sambabada duntay waxay tusinaysaa ** maqnaanshaha sambabada silbashada**, maqnaanshaha xadhkaha goos gooska B-ka, barcode "calaamadaha stratosphere" ee qaabka M-mode, iyo ogaanshaha "barta sambabada".

3. Ikhtiyaarada Daawaynta Casriga ah: U fiirsashada, Hamiga, Tubooyinka laabta, iyo VAT¶

La jaanqaaday 2023 British Thoracic Society (BTS) Tilmaamaha Cudurrada xuubka iyo tijaabooyinka caalamiga ah:

1. ** Maareynta Konserfatifka (U fiirsashada Keligiis) : Bukaannada da'da yar, caafimaadka qaba ee qaba ** Pneumothorax Is-ka-Aad ah (PSP) kuwaas oo leh ** ugu yar ama aan lahayn neefsasho* iyo maaddooyin deggan, la fiirsashada ogsijiinta qulqulka badan iyo raajo laabta oo soo noqnoqda 4 saacadood waxay u oggolaanaysaa jeexjeexa xuubka inuu si dabiici ah u bogsado iyada oo aan irbad ama tuubo lahayn.
2. ** Hamiga irbad fudud ama Ambulator Heimlich Valve ***: Bukaanka PSP ee neefta aan neefsanayn, dhakhaatiirtu waxay hami karaan hawo iyagoo maraya **14G ilaa 16G cannula *** (ilaa 2.5 litir [2.6 quarts]) 4 maalmood.
3. Dheecaan Laabta Dhexdhexaadiyaha Yaryar (8 Fr ilaa 14 Fr) ***: Dugsiga Sare ee Isbadalka ah ee Pneumothorax (SSP), hammiga fashilmay, ama burburka calaamadaha waaweyn, dhakhaatiirtu waxay geliyaan ** 8 illaa 14 kateetarka Seldinger ee Faransiiska *** hoos suuxinta maxalliga ah iyada oo loo marayo "Saddex xagal ee Safessictor dorsi, 5^th intercostal space, iyo axilla), oo ku xidhan ** dhalada biyaha hoostooda ah.
4. *** Cirbad-jabka degdega ah (Thoracostomy) ***: pneumothorax kacsanaan leh oo shoog leh, daaweeyayaasha waxay geliyaan cannula ballaaran (14G, dhererka 4.5 ilaa 8 sentimitir [1.75 ilaa 3.25 inji]) dhexda 2aad ama dhexda dhexe ee xariiqda dhexda dhexe5 laynka midaxillary *** (oo ka sarreeya cidhifka feeraha sare), isagoo isla markiiba hawada ka saaraya cadaadiska xanniban.
5. Kahortagga Qalliinka Soo-noqoshada (VATS Bullectomy iyo Pleurodesis): Daaqsinta hawada joogtada ah (in ka badan 3 ilaa 5 maalmood), pneumothorax soo noqnoqda, ama xirfado khatar sare leh ( duuliyeyaal, quusayaal), Pleura iyada oo loo marayo ** nabar, pleurectomy, ama talc poudrage ***, hoos u dhigista soo noqoshada ** 30 ilaa 50 boqolkiiba hoos ilaa 1 ilaa 5 boqolkiiba **.

Dhererka, safarka hawada, quusitaanka, iyo ka hortagga ka dib soo kabashada¶

Marka pneumothorax iskii u bogsado oo bukaanku guriga laga saaro, xeerarka hab-nololeedka ee adag ayaa ka ilaaliya soo noqoshada suurtagalka ah ee dhimashada:

• ** Xeerka Sugitaanka Safarka Hawada Ganacsiga ee Ganacsiga (BTS & Ururka Caafimaadka Hawada) ***:
• Waa inaadan waligaa ku duulin pneumothorax firfircoon, haraaga, ama aan la daawayn** cabir kasta ha ahaadee.
• Marka raajo laabta daawaynta ka dib ay xaqiijiso **100 boqolkiiba xallinta shucaaca oo dhammaystiran *** (sanbabada ayaa si buuxda ugu fidday gidaarka laabta oo leh jeebka hawada ee eber), Ururka British Thoracic Society wuxuu ku talinayaa in la sugo ugu yaraan ** 7 maalmood oo buuxa ka dib raajada caadiga ah ** (iyo shirkado badan oo diyaaradeed iyo Ururka Caafimaadka Aerospace waxay ku talinayaan inay sugaan ** 14 maalmood ka dib xallinta shucaaca buuxa, ka hor intaysan fuulin duulimaadka muuqaalka ah. ma furna marka cadaadiska qolku hoos u dhaco xagga sare.
• ** Xannibaadda Quusidda Quusta ee Joogtada ah**:
• Sababtoo ah kor u kaca xitaa barkada dabaasha ee 10-mitir ah (33-foot) ama quusitaanka badda waxay labanlaabaysaa mugga gaas kasta oo ku xayiran waxayna sababi kartaa dhimasho ** barotrauma sambabada iyo gaaska arterial embolism (AGE) Pleurectomy** oo waxay dhaaftay CT-ga laabta oo heer sare ah oo gaar ah iyo nadiifinta shaqada sambabada oo ay la socoto khabiirka dawada quusitaanka.
• ** Jooji sigaar cabista iyo sigaarka oo dhammaystiran ***:
• Sii wadida cabista sigaarka tubaakada, xashiishadda kala goysyada/bongs (taasoo ku lug leh neefsasho qoto dheer iyo dhaqdhaqaaqa neefsiga dheer ee Valsalva), ama sigaarka/vapes elegtarooniga ah waa darawalka kaliya ee wax ka bedeli kara soo noqnoqda. Joojinta qiiqa la nuugo oo dhan iyo uumiga la nuugo waxay yaraynaysaa halista sambabada labaad ee duntay ** in ka badan 40 ilaa 50 boqolkiiba ilaa 15 ilaa 20 boqolkiiba**.
• **Ka fogow cadaadis culus, Qalabka dabaysha, iyo Xiriirka Ciyaaraha 2 ilaa 4 usbuuc ***:
• Sug ilaa inta ay si buuxda uga soo kabanayso shucaaca iyo nadiifinta dhakhtarkaaga sambabada ka hor inta aanad ku soo laaban miisaan qaadis culus (ka fogow wiishashka Valsalva ee neefta qabta), ciyaarista qalabka naxaasta leh ee adkaysiga sare leh, ama ka qayb qaadashada ciyaaraha xidhiidhka.

Lambarada degdega ah ee gobolka iyo borotokoolka wakaalada¶

• Maraykanka iyo Kanada Dhakhaatiirta cisbitaalka kahor waxay raacaan ** Ururka Wadnaha Mareykanka (AHA) ** iyo ** Taageerada Nolosha Dhaawaca Isbitaalka kahor (PHTLS) / Ururka Qaranka ee Dhakhaatiirta EMS (NAEMSP) ** nidaamyada maamulka oksijiinta socodka-sare, oximetry garaaca, iyo cirbadda degdega ah ee thoracostomy (2^nd intercostal space midclavicular line ama interxistalth line 5) physiology horumariyo. Maaraynta cisbitaalku waxay raacdaa ** American Thoracic Society (ATS) iyo ** American College of Chest Physicians (Chest)** tilmaamaha.
• **United Kingdom ***: Wac 999 ambalaas degdeg ah (xabad xanuun daran oo leh neef la'aan had iyo jeer waa wac 999). Daryeelka cisbitaalku wuxuu raacayaa British Thoracic Society (BTS) 2023 Tilmaamaha Cudurada xuubka iyo NICE, kaas oo xukuma maaraynta konservative-ka, bukaan-socodyada sambabada sambabada, iyo Seldinger-ka-baxyada feeraha yaryar
• Midowga Yurub: garaac 112 dhamaan wadamada xubnaha ka ah EU. Kooxaha isbitaalku waxay raacaan Bulshada Neefsiga ee Yurub (ERS) hab-dhaqanka hawleed ee daaweynta pneumothorax aasaasiga ah iyo sare, iyadoo la isticmaalayo ultrasound-ka dhuunta dhinaceeda sariirta, nidaamyada dhijitaalka ah ee dhijitaalka ah, iyo la-tashiga hore ee VATS.
• Australia iyo New Zealand: Wac 000 gudaha Australia ama 111 gudaha New Zealand. Adeegyada ambalaaska iyo waaxaha degdega ah waxay raacaan ** Thoracic Society of Australia iyo New Zealand (TSANZ)** iyo ** Australian iyo New Zealand Committee on Resuscitation (ANZCOR) *** tilmaamaha, oo ay ku darayaan fikradaha laga soo bilaabo ANZ konservative-ka badan ee dhex-dhexaadinta iyo tijaabada PSP.
• Hindiya iyo Aasiya-Pacific ***: garaac 112 gudaha Hindiya, 995 gudaha Singapore, 119 gudaha Japan iyo Kuuriyada Koonfureed, ama 999 gudaha Hong Kong iyo Malaysia. Codso ambulaans Taageero Nololeed Sare leh (ALS) oo ku qalabaysan ogsijiin una wargali waaxda gargaarka degdegga ah si ay ugu diyaar garoobaan shucaaca laabta oo toosan iyo depression xuubka.

Su'aalaha soo noqnoqda¶

Waa maxay sababta ragga yaryar ee dhuuban ee ku jira tobaneeyo iyo labaatanaad ay ugu nugul yihiin sambabada iskood u dumay?¶

Inta lagu jiro koritaanka degdega ah ee qaan-gaarka, dalool dheer oo laabta ah oo cidhiidhi ah ayaa abuurta cufis-jiid toosan oo toosan oo ka bilaabmaya sambabada sare ilaa salka. Kiishashyada hawada (alveoli) ee ku yaal cirifka sare ee sambabada waxay la kulmaan cadaadis taban oo aad uga xoog badan marka loo eego sambabada inteeda kale, taasoo keenaysa finan yaryar oo finan hoose ah oo u eg inay ka samaysmaan xagga sare ee lakabyada sare. Haddii mid ka mid ah finan yaryar oo dhuuban oo dhuuban uu dillaaco (gaar ahaan haddii ay daciifto caabuqa marin-haweedka yar ee ka yimaada sigaar cabista ama uumiga), hawadu waxay u soo daadataa meesha bannaan ee cadaadiska diidmada ah waxayna duntaa sambabada xitaa adigoo weli fadhiya.

Intee in le'eg ayay sambabada duntay ka bogsadeen miyay badbaado u tahay in lagu duulo diyaarad ganacsi?¶

Waa inaadan waligaa fuulin diyaarad iyadoo pneumothorax ka hadhay uu weli ku jiro raajo laabta, sababtoo ah cadaadiska joogitaanka qolka wuxuu keenaa hawada laabta ku xayiran inay ballaariso 25 ilaa 38 boqolkiiba. Sida laga soo xigtay Ururka British Thoracic Society (BTS), waa inaad sugto ugu yaraan 7 maalmood ka dib raajo laabta daba-galka ah waxay xaqiijinaysaa 100 boqolkiiba xallinta dhammaystiran ee pneumothorax (iyo diyaarado badan iyo Ururka Caafimaadka Aerospace waxay u baahan yihiin sugitaanka 14 maalmood ka dib xallinta shucaaca buuxa) ka hor inta aanad duulin.

Weligay ma quusan karaa mar kale ka dib markii aan iskiis u sameeyay oof-wareen?¶

Marka loo eego Society Thoracic Society, Divers Alert Network (DAN), iyo tilmaamaha daawada quusitaanka caalamiga ah, pneumothorax hore oo iskiis ah ayaa ah ka-hortag joogto ah oo ka timaadda quusitaanka hawo cadaadis leh, xitaa ka dib marka sambabku si buuxda u bogsado iyo xitaa ka dib talc caadiga ah ama abrasion pleurodesis. Cadaadiska ba'an ee biyaha hoostooda wuxuu dilaaci karaa finan yaryar oo sambabada midkood ah wuxuuna balaadhin karaa hawada ku xayiran 200 ilaa 400 boqolkiiba inta lagu jiro kor u kaca, taasoo keenta pneumothorax kacsanaan ah ka hor intaysan gaarin dusha sare; Kaliya musharixiinta dhifka ah ee lagu sameeyay qalliinka laba geesoodka ah ee loo yaqaan 'pleurectomy' oo leh baaritaannada CT-ga ee xallinta sare ee caadiga ah iyo baaritaannada shaqada sambabada ayaa weligood loo tixgaliyaa nadiifinta dhakhtarka quusitaanka.

Waa maxay sababta xanuunka feedhaha ee fiiqan uu u bilaabay inuu ka roonaado maalintii labaad inkasta oo dhakhtarku sheegay in sambabadaygu wali dunsan yihiin?¶

Marka ugu horraysa ee hawadu u soo daadato daloolka xuubka xuubka oo ay sambabada ka siibto gidaarka laabta, way kala baxdaa oo ka xanaajisaa fiilooyinka xanuunka ee ku jira xuubka parietal, taasoo keenta xanuun aad u daran neef kasta. Marka sambabada ay dhammeeyaan u rogitaanka xaalad joogto ah 12 ilaa 24 saacadood ka dib, jeexjeexa firfircoonida iyo cadaadiska ayaa joogsada, markaa xanuunka fiiqan wuxuu inta badan ku dhacaa xanuun caajis ah ama cidhiidhi khafiif ah inkasta oo sambabku weli sii jiro 30 ilaa 60 boqolkiiba burburay. Weligaa ha u qaadan in sambabkii dumay uu bogsaday sababtoo ah xanuunkii tooriyaynta ee bilawga ahaa wuu yaraatay.

Waa maxay pneumothorax catamenial iyo sababta ay u dhacdo xilliga caadada?¶

Catamenial pneumothorax waa sambab soo noqnoqda oo burburay oo ku dhaca haweenka da'da dhalmada 24 saacadood ka hor ilaa 72 saacadood ka dib bilowga caadada, taas oo saamaysa sambabada saxda ah in ka badan boqolkiiba 90 kiisaska. Waxaa keena endometriosis thoracic (halkaas oo implants microscopic ee unugyada xuubka ilmo-galeenka ay ku degaan diaphragm midig iyo visceral pleura) oo ay weheliyaan godadka yaryar ee lagu dhasho (feestrations) ee diaphragm taas oo u oggolaanaysa hawada iyo unugyada endometrial inay galaan daloolka laabta inta lagu jiro caadada. Haweeney kasta oo la kulma xanuunka laabta ama sambabada duntay agagaarka caadadeeda waa inay ogaysiisaa sambabada iyo dhakhtarka dumarka si loo hagaajiyo VATS diaphragmatic iyo daawaynta hoormoonka waxay ka hortagi kartaa soo noqoshada bilaha ah.

pneumothorax iskiis ma u baahan yahay tuubo laabta qalliin oo xanuun badan?¶

Maya. Tijaabooyinka caafimaad ee casriga ah iyo tilmaamaha 2023 British Thoracic Society waxay muujinayaan in haddii aad da'yar tahay, haddii kale caafimaad qabto (Primary Spontaneous Pneumothorax), oo aan si weyn u neefsaneyn, sambabkaaga burburay ayaa inta badan loo maareyn karaa si taxadar leh iyadoo la eegayo iyo ogsijiinta qulqulka badan oo kali ah iyada oo aan lahayn irbad ama tuubo. Xataa marka biyo-mareenka loo baahan yahay, dhakhaatiirtu maanta waxay isticmaalaan irbad degdeg ah oo degdeg ah, qalab calaacasha leh oo la gashado oo la gashado oo kuu ogolaanaya inaad guriga aado isla maalintaas, ama kateetarka dabacsan ee qalin-qafiifka ah (8 ilaa 14 Faransiis) oo lagu dhejiyo daawada kabuubyada maxalliga ah halkii ay ka ahaan lahayd tuubo qalliin oo weyn.

*Hagahan waxa uu bixinayaa macluumaad waxbarasho oo degdeg ah mana bedelayo daryeelka caafimaadka xirfada leh ama ogaanshaha. Sababtoo ah xanuunka laabta ee ba'an iyo cidhiidhiga neefsiga ayaa si degdeg ah ugu gudbi kara shoog nafta halis gelisa ama wadnaha oo istaaga, waxaan si adag kuugula talineynaa inaad ka qaadato gargaarka degdega ah ee gacmaha oo shahaadeysan iyo koorsada CPR ee Laanqeyrta Cas, St John Ambulance, ama bixiye tababbarka degdega ah ee degaanka oo la aqoonsan yahay.

Tilmaamaha la xidhiidha¶

• pneumothorax kacsanaan ah iyo nabar laabta oo nuugaya Gargaarka degdega ah
• Laabta oo jilicsan, feeraha jaban, iyo dhaawac ba'an oo laabta ah
• Dhiig-baxa sambabada iyo xinjirowga dhiigga ee qoto dheer (DVT)
• Pericarditis, myocarditis, iyo xanuunka laabta ka dib fayraska ayaa calaamado casaan ah
• Asthma weerar gar gaar deg deg ah

Ilaha iyo hanuuninta rasmiga ah¶

• British Thoracic Society (BTS, United Kingdom): *British Thoracic Society Guideline for Pleural Disease (2023): Xeerarka caddaynta ku salaysan ee maaraynta konserfatifka, marinnada xuubka xuubka, irbada rabitaanka, dheecaanka laabta ee Seldinger, VATS pleurodesis, xaddidaadaha safarka hawada, wakhtiyada sugitaanka, iyo quusitaanka.
• Bulshada Neefsiga ee Yurub (ERS): * Qoraalka Kooxda Hawsha ee ERS ee Ku Saabsan Pneumothorax Aasaasiga ah: ogaanshaha iyo Maareynta Dhacdooyinka Koowaad iyo Soo-noqoshada*.
• ** American Thoracic Society (ATS) iyo Kulliyada Maraykanka ee Dhakhaatiirta Xabadka (Chest, United States):** * Maaraynta Bayaanka Oggolaanshaha ee Pneumothorax Spontaneous* iyo * New England Journal of Medicine Conservative oo ka soo horjeeda Daawaynta Dhexdhexaadinta ee Tijaabada Pneumothorax Aasaasiga ah (Brown et al., ANZ)*.
• Ururka Caafimaadka Aerospace (AsMA) iyo Ururka Gaadiidka Cirka ee Caalamiga ah (IATA): * Tilmaamaha Caafimaadka ee Safarka Diyaarada: Habboonaanta Neefsashada ee Duulidda Kadib Pneumothorax iyo Qalliinka Xididdada*.
• ** Taageerada Nolosha Dhaawaca Cisbitaalka Ka Hor (PHTLS) iyo Ururka Wadnaha ee Maraykanka (AHA):** Taageerada Nolosha Wadnaha ee Sare ee Wadnaha (ACLS) Aqoonsiga iyo Kala-baxa Shoogga Hortaagan ee ka yimaadda Pneumothorax Kacsan.