Intamo vagosympathetic ukuvinjelwa ku Vishnevsky

Izidakamizwa nokuvinjelwa amathambo wesibeletho isiqu nozwela kanye emsipheni vagus ubizwa ngokuthi 'ukuvinjelwa vagosympathetic ". Uyalele Aleksandr Aleksandrovich Vishnevsky ngenhloso uphazamisa ezinzwa amaza ngesikhathi ukushaqeka plevropulmonalnogo ngenxa iziyaluyalu kuhlasimulise futhi ukulimala esifubeni ndawo.

Inikeza yalokho esitebeleni omuhle yezifo bemvelo ukuvuvukala kanye izifo ezihlukahlukene kwemisipha ithoni.

Shane novocaine ukuvinjelwa wazibonela S. G. Zograbyan ngenhloso ukuqaphela gipotenzionny syndrome imvelaphi esibuhlungu. I kugcinwa zokuhlola nokulimala engqondweni lapho nokuvinjelwa wesibeletho ganglia nozwela izilwane nge hypotension cerebral kungaholela okhushuliwe ingcindezi intracranial isikhathi esifushane. Inciphisa ikhanda e-80% amacala ngemva kokuhlinzwa. Kodwa umphumela yathatha kuphela kwamahora ambalwa. Lokhu kungenxa yokuthi ukuvinjelwa ngesikhathi cerebral spasm semithambo aqede, ngenxa ngcono igazi ebuchosheni.

Ngokusekelwe kulokho inqubo?

Ukuvinjelwa vagosympathetic - indlela yokwelapha ngokwezifiso-pathogenetic okusekelwe:

• Ngamafuphi bayeke patency neuropathy uvalo.
• Ngo ukusabela isixazululo novocaine zokusetshenziswa for okuphawula nemisebenzi isimiso sezinzwa esiyinhloko (CNS).

izinzuzo ukuvinjelwa

Ngaphansi la malungiselelo Vishnevsky ukuza eziphethweni:

• Ngenxa yezizathu ezihlukahlukene, inqubo ukuvuvukala ekuqaleni ekukhuleni kwayo kungaphansi kwemithetho efanayo.
• Inqubo ukukhula ukuvuvukala kungenziwa okwesikhashana kuze kuba at the stage of kokuziphatha serous kwezicubu.
• ukuvuvukala Sinzima ifomu kungagcini ngokushesha okukhulu, abscesses futhi wavuma Ukudlula kancane - kwembulwa.
• Infiltrative, esingakhanyisiwe nezinye izinhlobo ezingamahlalakhona ukuvuvukala kuvetwa ukuqhela trophic, ngezinye izikhathi bystrorazreshimymi.
• Izifo ezihambisana nezinguquko sokugembula kwezitho. Iya kancane ukucasuka isimiso sezinzwa, okuyinto wenza wesibeletho vagosympathetic ukuvinjelwa isitho sicashunwa isimo ukushintshwa. Kulesi ukuvinjelwa kuzinqubo enjalo iyosithinta multi-function: ivumela spasm, elikhishiwe kwezinye izinguqulo paresis.
• Izinqubo imvelo sokugembula, okuyinto kwabangelwa ukushintsha endimeni yokusebenza capillary, novocaine block uqondisa ukulungisa isikhundla bokuphila odongeni semithambo.

Yiziphi izinhlobo blockades khona?

Cabanga ngalo mbuzo kabanzi. Izinhlobo ezinkulu ukuvalwa:

• Ukuvinjelwa kwe-ukwa lamathambo eside.
• Futlyarnoy ehlombe block.
• Futlyarnoy ukuvinjelwa shin.
• Nokuvinjelwa esigabeni cross.
• Nokuvinjelwa emsipheni femoral.
• ezinzwa Sciatic.
• ezinzwa Tibial.
• ezinzwa Peroneal.
• Intercostal conduction ukuvinjelwa.
• ukuvinjelwa Paravertebral.
• Futhi-ke, intamo vagosympathetic.

ukuvinjelwa Vagosympathetic: Ubufakazi

Izinkomba wesibeletho ukuvinjelwa vagosympathetic nazo:

• Plevropulmonalnoe ukushaqeka.
• Multiple ubambo waphuka.
• Vula, ivaliwe futhi valve amaqoqo.
• Burns yaleli pheshana zokuphefumula.
• inyumoniya postoperative.
• Syndromes ukuklinya esibuhlungu.
• Syndromes of okunamafutha okuvimba (ifomu yamaphaphu).

Ngokuvamile kwenzeka lezi pathologies ukwenza inqubo.

Ukuze ukuvinjelwa owenziwa vagosympathetic Vishnevsky indlela, kumele wazi uxhumano Clumsy-yokwakheka isiqu nozwela futhi izinzwa vagus. Lezi neoplasms ngaphezu ithambo hyoid kwelinye kletchatochnyh endaweni enikeza incazelo yokuthi i-zokuvumelanisa Ukuvinjwa okungenzeka lapho zaphathwa lapha novocaine. Ngezansi zihlukaniswe parietal ungqimba we fascia lesine.

ukulungiselela isiguli

Ngaphambi ekuqaleni nokuvinjelwa udokotela ehlola umbhalo isitsha noma ampoule imithi ebulala izinzwa. Isiguli kufanele njalo siyibonakalise lisalele ngenxa isenzo ngokusungula indlela yokubulala izinzwa akusho ukubeka eceleni ukubukeka yezinkinga ezihlukahlukene. Ngaphambi kokuba ahlinzwe ayiziphathanga isikhumba nge isixazululo isinqandakuvunda. Nokuvinjelwa iyadingeka futhi. Icubungula kuyadingeka azokuqhubela isisekelo saziso, ngenxa yokuthi kunzima ukuze ugweme ukuxhumana ngamagciwane kule site wokubhoboza.

Ngemva kwalokho, endaweni isikhumba kuyadingeka ukuphoqelela nelineni oyinyumba.

Kwenzekani ngokulandelayo?

Isiguli ibekwe emhlane wakhe ngaphansi ikhaba ngesikhathi esifanayo ubeka umcamelo. Inhloko ijikeleziswa kolunye uhlangothi lapho ukuvinjelwa. Ingalo isiguli ngokudonsa phansi nokuvinjelwa. Ngu onqenqemeni ezingemuva kwesokudla imisipha sternocleidomastoid, ngenhla isikhungo salo cishe 1-1.5 cm injected ngaphansi kwesikhumba 1-2 ml 0.25-5% isixazululo yesixazululo imithi ebulala izinzwa. Uma ukuma Yarema umthambo ayibonakali ke kufakwe indawo inaliti kusengaphambili ezingeni lokuthola onqenqemeni engenhla yegilo epiglottis.

Kanjani ncamashi owenza nokuvinjelwa vagosympathetic?

Technique uhlukile, it is kwenziwe ongoti abaqeqeshiwe kuphela. emamasela lamancane esandla khulula nezitsha umunwe index kugudlukela futhi satshanyana ebusweni kokuqala amathambo nomgogodla wesibeletho. Ngaphezu kwalokho ekupheleni umunwe yethulwa inaliti ezinkulu bese ukuhambisa ngaphakathi maqondana kokuqala kwamanzi vertebral. Phakathi kufakwe yenaliti nge nomqulu omncane, at 2-3 ml, ikhambi waba ngaphezu kwalokho injected izinzwa ngoba inqubo ukuqedwa kwezinhlungu. Uma ichopho inaliti wathinta amathambo ukwenza aspirate (eyenziwa ukuze ugweme ekuphathweni intravascular we izinzwa). Ngemva kokuqinisekisa ukuthi igazi akusekelwe ifinyelele isipetu kancane wanezela 30-60 ml 0.25% isixazululo of imithi ebulala izinzwa. Inalidi ke basuka yayicindezele umjovo indawo inzalo gauze imizuzu 1-2.

Uma ngokuqinile uzigcine futhi athobele imithetho vagosympathetic isixazululo ukuvinjelwa izinzwa kuvikela emsipheni vagus nezinye emizweni ukunweba kusukela wesibeletho nozwela isiqu ISIZINDA.

Izimpawu emva inqubo

Ukuziphatha ngempumelelo isiguli nokuvinjelwa vagosympathetic kubangela lezi zimpawu ezilandelayo:

• Ptosis (sawo leso elingenhla).
• Miosis (ukusikwa umfundi).
• Enophthalmos (confluence Eyeballs owangaphakathi triad Horner sika).
• Ububomvu ebusweni nolwelwesi lwamafinyila kwamehlo.
• Perikornealnaya umjovo semithambo.
• ukujuluka encishisiwe kwenziwa nokuvinjelwa.

Intamo ukuvinjelwa vagosympathetic ku Vishnevsky suppresses ubuhlungu, ukukhwehlela reflex, asenze isimiso sokujikeleza kwegazi futhi kwandisa umfutho wegazi.

Ukuvinjelwa asikwazi ukwenziwa nhlangothi zombili ngasikhathi sinye. Isikhawu esiphakathi ukwelashwa kufanele kube okungenani imizuzu engu-30-40. Futhi ngesikhathi inqubo ayikwazi ukwengezwa ikhambi adrenaline imithi ebulala izinzwa.

Yini ebangela imingcele enjalo? Iqiniso liwukuthi ungakwazi ngephutha uthole ukukhubazeka zokuphefumula ngenxa nokuvinjelwa.

yezinkinga

Ngemva Ungase futhi zenzeka yezinkinga:

• Ukwephula Umthambo carotid ngesikhathi Ukubhoboza.
• Ukwephula yangaphakathi vein jugular.
• Ukwephula emphinjeni.

Amathuba atonia futhi paresis emathunjini (yezinkinga ezifana angadingi ukwelashwa okukhethekile).

Konke lokhu kungabangela wesibeletho ukuvinjelwa vagosympathetic ku Vishnevsky. Izinkomba kuso siye sibuyekezwe.

okunye

Okunye okwenziwe ukungenelela kulesi entanyeni sidinga ukufinyelela, okungukuthi, usike ungqimba isikhumba ngamunye. Ukuze ufinyelele inhlanzeko entanyeni kufanele kugcinwe, njengoba livezwe ingxenye yomzimba. Ngenxa yalokhu, entanyeni usebenzisa ukufinyelela transverse Kocher, behamba isikhumba transverse emphethweni. Sutures ngemuva kokuhlinzwa kulokhu ngokuvamile ezingabonakali. Lapho efeza umsebenzi imisebenzi izingxenye entanyeni longitudinal ngokuvamile zisebenzisa isigaba longitudinal eduze phambi noma onqenqemeni ezingemuva imisipha sternocleidomastoid. Ikakhulukazi ezivuzayo lubonakale emva kwesigaba lesemkhatsini longitudinal. ukuvinjelwa Vagosympathetic (amasu kuvamile impela) kuzokusiza ukugwema lo msebenzi.

Nge svom abanempilo enhle abamdingi amahlaya, kufanele agcine siphephe futhi ahlale eqaphile. Khona-ke izingozi ehlukahlukene ezingemnandi kungagwenywa.