Cudurka Tracheal-ka waa cillad-darrada trachea , ama qallajis, sababtuna tahay samaynta nudaha unugyada ama malawil-xuubka kaadida ee trachea. Inkasta oo cidhiidhi gelinta qafiifka ah ee trachea aan waligaa la aqoonsan karin, cidhiidhi gelinta in ka badan 50% hawo-mareenadaada waxay keeni kartaa dhibaatooyin halis ah. Sababaha 3-da ugu badan ee keena xanuunka tracheal stenosis waa:
- Goobta joogtada ah ee tuubada endotracheal (tuubada neefsashada) ama tracheostomy
- Cudurka caabuqa ee caabuqa
- Cudurka kaansarka ee kolajka (granulomatosis leh polyangitis, oo loo yaqaanno Wegener granulomatosis)
Sababaha kale ee la yaqaan waa:
- Cilad-xumada dhasha (cilladda dhalashada)
- Dhaawaca
- Neefsashada gubatay
- Daweynta shucaaca
- Infakshanka trachea
- Cudurrada faafa (sarkacosis ama amyloidosis)
- Kansarka
Kansarka iyo cillad la'aanta dhalmada, marinka hawadu waa la xakameynayaa marka laga reebo trachea, ama laga yaabo in uu ka yimaado naqshad jilicsan. Sababaha kale ee xanuunka qanjirada 'tracheal stenosis' ayaa badanaa ku bilaabanaya boog-goyska trachea. Murugadu waxay bilaabmaysaa xakameynta caabuqa , taas oo ah habka daaweynta caadiga ah, taas oo noqon karta mid la buunbuuniyo oo sababi karta unugyo badan oo nabaro ka badan inta caadiga ahayd. Cudurkaan nudaha dheeriga ahi wuxuu ku dhacaa aagga ku yaala trachea.
Xaalad ka timaada Cudurka Tracheal Stenosis
Tirada soo noqoshada qanjidhada tracheal stenosis waxay ku xirantahay sababta keentay xanuunka tracheal.
Hase yeeshee, khatarta ka imaan karta marinka hawadu waa mid caadi ah, hase yeeshee halista astaamaha xasaasiyadda ayaa caadi ahaan ka yar 2 boqolkiiba. Waxyaabaha khatarta ah ee soo socdaa waxay kordhin doontaa suurtogalnimada inaad yeelatid post-entubation ama tracheostomy la xiriirta qanjirka 'tracheal stenosis':
- Dumar
- Miisaanka dheeraadka ah
- Sonkorowga
- Dhiirrigelin
- Cudurka Wadnaha
Xilliga ka-dambeeynta ama khatarta post-tracheostomy ayaa la yareeyn karaa haddii ay soo socoto la socdo inta lagu jiro ICU:
- Haysashada cadaadiska ba'an ee finanku ama tracheostomy waxay u dhexeysaa 20 ilaa 30 cm cadaadiska biyaha
- Ka hortagga caabuqa adoo haysta daryeel afka ah oo wanaagsan oo lagu sameeyo naas-nuujinta marka loo baahdo si looga hortago caabuq ama xiro hawo-mareenka oo leh xabka
- Meelaha tube ee ku soo noqda meel ka baxsan afka si loo yareeyo cadaadiska
- Joogteynta qoto dheer ku filan tubbada neefsiga
- Ka hortagidda dhibaatooyinka leh tuubbooyinka neefsiga inta lagu jiro galinta iyo ka hortagga helitaanka shil haddii aad leedahay marin hawo oo adag.
Dhibaatada Tracheal waxay noqon kartaa mid ka mid ah calaamadaha ugu horeeya ee lagu arko granulomatosis leh polyangitis. Stenosis waxay dhici kartaa ilaa 16 ilaa 23 boqolkiiba waqtiga. Ma jiro macluumaad badan oo la heli karo oo ku saabsan cudurada kale ee sababaha kale ee xanuunka tracheal stenosis.
Calaamadaha Cudurka Tracheal Stenosis
Gubashada qanjirada qallalan ee ku-meel-gaadhka ah, boog-gariirka yar-yar ayaa badanaa lagu tilmaami karaa sida neefta ama boronitis-ka soo noqda. Xanuunka cuncunka cuncunka leh, ma ogaan kartid calaamadaha illaa carruurnimada ama horay dhalinyaro ah marka calaamaduhu u muuqdaan inay ku adagtahay neefsashada jimicsiga. Xaaladaha aadka u daran ee ku dhasha qanjidhka tracheal-ka, waxaa laga yaabaa inaad aragto calaamadaha soo socda:
- Stridor ( dhawaaq sare oo neefsasho leh)
- Cyanotic, oo leh dibnaha muuqaalka buluugga ah
- Huujin leh neefsasho
- Neefsasho aan caadi aheyn (dyspnea)
Xaaladaha kale ee xanuunka 'tracheal stenosis', ayaa calaamaduhu u muuqan karaan isbuucyo dhowr ah ka dib marka dhaawacu dhaco. Dhibaato neefsashadu waa calaamadaha ugu horreeya. Sida stenosis-ka xanuunka dareen-celinta, waxaa laga yaabaa inaad aragto garaacid, xiiq, ama neefsasho aan fiicnayn.
Ciladeynta Cudurka Tracheal Stenosis
Qaar ka mid ah hababka tijaabada ah ayaa loo isticmaali karaa si loo caawiyo dhakhtarkaaga si loo ogaado haddii aad qabto xanuunka tracheal ama haddii kale. Bronchoscopy waxaa loo tixgeliyaa "Heerka Dahabka" ee loogu talagalay baarista xanuunka tracheal-ka sababtoo ah dhakhtarkaaga ayaa si toos ah u arki kara trachea.
Hase yeeshee, waxaa jira khataro la xidhiidha tan sababtoo ah isticmaalka baaxadda ayaa sii xoojin doonta marin-haweedkaaga, markaa sii wadida heerka oksijiin-kaaga ayaa sii adkaan karta. Kala hadal arrimahaaga khatarta khaaska ah ee lala xiriiriyo bronchoscopy dhakhtarkaaga.
Qaabab kale oo uu dhakhtarkaagu isticmaali karo waxaa ka mid ah raajada, sawirka CT, ultrasound, MRI, iyo baaritaanka shaqada sanbabada. Raajada caadiga ah waxay ku fiican tahay aqoonsiga dhismaha, xayawaanka hawada, trauma, iyo xog kale oo hordhac ah. Mashiinnada raajada oo kale oo dheeraad ah ayaa loo isticmaali karaa (xerooradiography) si loo aqoonsado jeermiska, hase yeeshee, shucaacu si aad ah ayuu uga sarreeyaa hababka kale.
Baadhitaanka CT-ga wuxuu noqon karaa farsamo weyn oo loogu talagalay dhakhtarkaaga inuu go'aamiyo inaad qabto xanuunka trhkenosis ama haddii kale. Si kastaba ha noqotee, way ku adagtahay in la aqoonsado sababaha jilicsan ee cilladaynta trachea. Farsamooyinka qaarkood ayaa loo adeegsadaa si loo abuuro "endoscopy virtual" si loo yareeyo baahidaada inaad u gudubto bronchoscopy. Si kastaba ha noqotee, baaritaanka CT-ga ma ahan hab weyn oo lagu aqoonsanayo heerka daroogada ee daran.
Ultrasound wuxuu caawin karaa aqoonsiga qadarka hawada ee trachea. Tani waxay u oggolaaneysaa takhtarkaaga in uu go'aamiyo haddii baaritaan dheeraad ah lagama maarmaan noqon karo, hase yeeshee, sababtoo ah xajmiga ku wareegsan hareeraha trachea, saxnaanta baaritaanka waa la is waydiin karaa sababtoo ah saameynta hooska ee ay keentay muraayadda mowjadda ka baxsan kareemka. Imtixaankan u dhaaf kuwa kaliya ee xirfad leh marka la aqoonsanayo qanjirada tracheal stenosis by ultrasound.
Baadhitaanka MRI wuxuu kaloo yahay qaab kale oo weyn oo lagu caawiyo baarista xanuunka tracheal stenosis, iyo carruurta waxaa loo tixgeliyaa in ay noqdaan hab caadi ah. Dhibaatada weyn ee MRI waa dhererka waqtiga aad u baahan tahay in la gooyo habka loo sameeyo iyo cilladda ka iman karta neefsiga caadiga ah inta lagu jiro imtixaanka. Farsamooyinka horumarinta ayaa si joogta ah loo horumariyaa si loo wanaajiyo isticmaalka farsamadan si lagu ogaado xanuunka tracheal stenosis.
Baaritaanka shaqada sambabarka waxaa lagu sameyn karaa xafiisyada dhakhtarka qaarkood, ama haddii aan la heli karin, waxaa laguu diri doonaa shaybaarka sambabada. Baaritaankaan waxaa loo isticmaali karaa si loo go'aamiyo inta saameyn ku yeelan karta qanjiradu uu joojinayo neefsashadaada. Tani waxay ku caawinaysaa wadahadal ku saabsan fursadaha daaweynta dhakhtarkaaga.
Daaweynta Tracheal Stenosis
Fursado dhowr ah ayaa jira oo lagu daaweynayo xanuunka tracheal stenosis iyo dhakhtarkaaga ayaa kaala hadli doona ikhtiyaarrada uugu yaryihiin ee ugu yaraan soo jiidasho leh oo leh kartida ugu wacan natiijada ugu fiican ee daryeelkaaga shakhsi ahaaneed. Daawooyinka intooda ugu badan waxay yihiin hababka endoscopic ee u baahan in la arko dhabta ah ee trachea. Haddii aagga gumaarka uu yaryahay, adigoo ku riixaya stenta, adigoo dhajinta trachea leh baalal, ama ka saarida qaar ka mid ah nudaha unugyada leh laserka ayaa kaa caawin doona yaraynta xanuunka. Inta lagu gudajiro hababkaas, dhakhtarkaagu wuxuu sidoo kale ku mudi karaa unugyadaaga trachea oo leh steroids si loo yareeyo barar kasta.
Dhibaatada cuncunka daran ee daran, dhakhtarkaagu wuxuu kugula talin karaa qufac qallalan, kaas oo u baahan qalliin. Nidaamkani waa mid loogu talagalay marka daaweynta endoscopic ay ku fashilantay, ama qanjirada trhakeosis-ka waa mid aad u daran oo loo maro hababka endoscopic. Inta lagu gudajiro nidaamkan, dhakhtarkaagu wuxuu jarayaa qeyb ka mid ah trachea kaas oo saameeya isla markaana dib u hagaajin kara trachea maqaarkaaga ama maqaashiisa.
Qalliinka ka dib, waxaad caadi ahaan awood u yeelan doontaa in tuubada neefsashada laga saaro inta lagu jiro raysashada suuxdinta. Si kastaba ha noqotee, haddii uu jiro barar badan, waxqabadyo badan ayaa la isticmaali doonaa. Xaaladdan, waxaad filan kartaa in lagu meeleeyo steroids 24 ilaa 48 saacadood iyo sidoo kale sida duriinka sida Lasix. Kalkaaliyeyaashu waxay sidoo kale hubin doonaan in madaxa sariirtaadu kor u kacdo 30 darajo ama wax ka badan. Ka dib 48 saacadood, waxaad ku noqon doontaa qolka qalliinka si aad uhesho tuubadaada neefsashadaada. Haddii aadan weli awoodin inaad taageerto marin-haweedkaaga, tracheostomy ayaa laguu gelin doonaa si aad u ilaaliso marin-haweedkaaga. Sababtoo ah dabeecada isdaba-joogga ah ee daaweynta, waxaa loo tixgeliyaa inay tahay ta ugu dambeyntii ka dib markii daweyno kale ay ku fashilmeen.
> Ilo:
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> Hyzy, RC. (2017) .Calaamadaha tube-damiska dhoobada (endotracheal) ka dib meeleynta hore: Ka hortagga iyo maareynta bukaanka qaangaarka ee qaangaarka ah. http://www.uptodate.com (Qalabka Loo Baahan Yahay)
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