I-epestural aneshesia kunye necesarean section isetyenziswe njengesiseko sohlobo lwe-anesthesia. Olu hlobo lwe-anesthesia yesithili lusebenza kakuhle, lunemiphumo emincinci. Cinga ngeenkcukacha ezingakumbi, ukugqamisa izibonakaliso, iimpawu zokuziphatha kunye nokuchasene.
I-Epidural anesthesia - izibonakaliso
I-epidural anesthesia ene-cearean yenziwa ngomnqweno wesifazane osebenzayo. Oomama abaninzi bokamva abachazwe icandelo elicwangcisiweyo bakhethe ngqo kulolu hlobo lwe-anesthesia. Nge-anesthesia enjalo, lo mfazi uhlala eqonda, uva ukukhala kokuqala komntwana wakhe, kodwa akayiva nantoni na. Kukho neemeko phambi kokuba i-anesthesia ye-epidural iyimfuneko yokuvala. Phakathi kwazo:
- ubukho be- preeclampsia ;
- uxinzelelo lwegazi oluphezulu;
- isifo kunye nesifo sesifo;
- i-myopia;
- isifo sikashukela;
- ukuchasene kwi-anesthesia jikelele;
- msebenzi ogqithiseleyo;
- imeko zeentsholongwane zesisu.
Inxalenye yesigqeba sinokuphi na i-anesthesia ye-epidural?
Abasetyhini, ukulungiselela ukuhlinzwa, bahlala benomdla oogqirha, njengenxalenye yexesarean nge-epidural anesthesia. Ngaphambi kokuqala komsebenzi, umfazi okhulelweyo uhleli phantsi embhedeni, okanye ulala ngasecaleni lakhe. Indawo yendawo yomgcini apho umlingo ufakwa khona uyaphathwa ngokucophelela nge-antiseptic. Emva kokuqala kwe-anesthesia, oogqirha benza i-incision kwisisu esezantsi, mhlawumbi ngaphezu kwe-pubic. Kwilonda lokutyanda, ukwandiswa kufakwa, ukuvula ukufikelela kumntwana.
Emva kokuvulwa okufanelekileyo kwesikhumba, oogqirha baqala ukukhupha iziqhamo ngaphandle. Emva kokuphumelela kweli nqanaba, umntwana unqunywe intambo yomlomo kunye ne-clamp isetyenziswa. Umama unikezwa i-oxytocin, ngenxa yokuhlukana kokuzalwa komntwana. Emva koko, i-suturing yenziwa. Esikhundleni somsila emva kweenyanga ezimbalwa kukho inqabunga, ephantse ingabonakaliyo, ayibangela ukuba umama akhathazeke.
Unjani i-anesthesia ye-epidural eyenziwa kwinqanaba lokutya?
I-epidural aneshesia kwiqendu eliqhelekileyo lidlalwa rhoqo kwindawo yokuhlala. Kule meko, isigulane sinikezelwa ukuba sithathe indawo: imilenze yokutshatyalaliswa emadolweni, ukubeka amaqatha embhedeni, ukuguqula umva, ukuguqula isigxina somlomo wesibeleko. Eyona ndlela indawo yowesifazane olele ehlangothini lwakhe (ngokuphindaphindiweyo ngakwesokudla). Nangona kunjalo, ukusetyenziswa kwezonyango kubonisa ukuba kulula ukulawula i-anesthetic kwisigxina sokuhlala kwesigulane.
I-Anesthetic, ngoncedo lwenaliti ekhethekileyo, ifakwe kwisithuba phakathi kwodonga lomgcini womgogodla kunye negobolondo elukhuni yendawo yomgogodla (indawo ye-spinal). I-tube ekhethekileyo engumzimba oyinyumba (catheter) ifakwe kwisaliti, esele isele i-injection. I-epidural anesthesia, kunye necandelo lesondlo, iquka ukuhlawula izidakamizwa: ukwandisa uxinzelelo okanye ukuyeka ukunikezelwa kwayo.
Ngaba kubuhlungu ukwenza i-anesthesia ye-epidural ne-carean?
Le nkqubo, njenge-anesthesia ye-epidural, ayibuhlungu kwintlungu ngokwayo. Ngaphambi kokugqitywa, oogqirha benza i-anesthesia yendawo. Intlungu encinci, ubuhlungu obukhulelweyo abakhulelweyo banokuziva kuphela ngexesha lokugqitywa. Ngalo lonke inqubo ayibangeli intlungu, iyakunyamezela ngokufanelekileyo ngabafazi abasesikhundleni. Amava omama ozayo, ngokubhekiselele kubuhlungu obunjalo bokuphathwa, njengengxaki ye-epestural anesthesia kwiqendu eliqhelekileyo, alinanto.
Kuze kube nini iqela elikulo lihlala ixesha elidlulileyo kwi-anesthesia ye-epidural?
Icandelo le-Caesarea phantsi kwe-anesthesia ye-epidural engapheli ngaphezu kwesigama seyure. Ngexesha elifanayo, ngokuqhelekileyo, ukususela kumzuzu wolawulo ukuya ekukhutsheni komntwana ngaphandle kwelo esiswini, kuthatha imizuzu eyi-10-15. Eli lonke ixesha lisetyenziselwa ukuxubha isilonda emva kokusebenza. Ngelo xesha, ibhinqa lilawulwa ihomoni yokususwa kunye nokuzalwa kwe-placenta. Ukuze kuthintela usulelo, umama unikezwa iziyobisi ezichasayo.
I-Caesarea phantsi kwe-epestural anesthesia - sensations
Ngokusebenza kakuhle kwe-anesthesia, ibhinqa ayiva nantoni na ngexesha lokusebenza. Ukubonwa kwinqanaba le-caesarean phantsi kwe-anesthesia ye-epidural kudibene nokuqaliswa kwesenzo se-anesthetic. Emva kwentsholongwane, umfazi okhulelweyo uqala ukuqaphela ukufudumala, ukuvakalelwa kwemilenze yakhe. Emva kwexesha elithile, umama ozayo akayi kuvakalelwa ngokupheleleyo engxenyeni engezantsi ye-trunk - nantoni na ngaphantsi kwe-site injection. I-little numbness yandalala kuwo wonke umzimba. Le ngxaki inokuhamba kunye nokukhwaza okuncane, ukuvakalelwa kwe-goosebumps, ephika emva kwe-anesthesia epheleleyo.
Zingaphi i-anesthesia emva kokusasaza?
I-epestural anesthesia ene-caesarean i-2 iiyure. Ngokukhawuleza ngeli xesha, oogqirha banqabela umfazi ukuba avuke emva kokusebenza. Ngolu hlobo lwe-anesthesia, ukuhamba kwegazi kumaphepha angaphantsi kunciphisa. Ngenxa yoko, ukuba uzama ukuvuka, kukho ubuthathaka emilenzeni yakho-kukho ukuphakama okuphezulu kokuwa. Ukongezelela, ngokuphindaphindiweyo emva kokusebenza kukho iintloko, utywala, okwenza kube nzima ukuhlala kwintsapho yolutsha.
I-epidural anesthesia kwi-cesarean section - imiphumela
Imiphumo emva kokuba i-anesthesia ye-epidural kwinqanaba le-laarean ivame ukudibana nokungahambisani nokuchasene nokuziphatha kwayo okanye ukuphulwa kwe-algorithm ye-anesthesia. Kule meko ingxaki iyakwazi ukuphawulwa, kokubili kumama nomntwana. Landela imiphumo ye-anesthesia ye-epidural kwabesifazane abahamba phambili (ngexesha lobasebenzi):
- ukuxhwaleka kwegobolondo elukhuni lomtya womthambo;
- izinga lentliziyo elinciphileyo;
- ukubonakala kweentlanzi kunye nokuhlanza;
- isenzo esichaphazelekayo kwi-anesthetic.
Ukuphazamiseka kunokuhlakulela kumtsha omtsha kwisithuba sokugqibela:
- intlungu emhlane nangentloko;
- ukuphulwa komthetho;
- ukunciphisa ububele bemilenze;
- ukuphazamiseka kweNCS.
Ukusetyenziswa kakubi kwe-epestural anesthesia kunye necesarean section kunokuchaphazela imeko yengane:
- ukwehla kwenani lentliziyo (bradycardia);
- ukuphulwa komsebenzi wokuphefumula;
- ukuphula umthetho
- ukuphazamiseka;
- encephalopathy.
Intlungu emva kwe-anesthesia ye-epidural ne-cearean
I-epidural anesthesia ene-caesarean, iziphumo zazo zikhankanywe ngasentla, zihlala ziba yintlungu yomfazi emva kokuzalwa komntwana. Kukho izizathu ezininzi zezi. Inengozi yi-epidurit-inkqubo yokuvuvukala kwendawo yokuhlala. Le nkcenkceshe iyaqhubeka ngenxa yendawo ehlala ixesha elide le-catheter ngasemva okanye xa inxalenye yayo ihlala. Ukongezelela, intlungu ingaba yingozi emva kokuhlinzwa ngenxa ye-hernia ye-vertebral etholakalayo.
Ezinye izizathu zentlungu kwindawo yangasemva zihambelana ngqo nokuziphatha okungalunganga kwenkqubo efana ne-anesthesia ye-epidural kwinqanaba le-laarean, impendulo yomzimba kwi-anesthetic. Ngenxa yokungabikho kwamava amaninzi, ugqirha angalimaza injector ngegobolondo elukhuni, apho izimpande zentliziyo zifumaneka khona. Ngokwahlukileyo, kuyimfuneko ukuhlukanisa intlungu ye-phantom, ehambelana ngqo nesimo sengqondo somguli.
Intloko emva kwe-anesthesia ye-epidural ne-cearean
Ukuthetha ngemiphumo kunye neengxaki ze-anesthesia ye-epidural kwi-section cache, kuyimfuneko ukuhlula kunye neentloko emva kokusebenza. Ukubonakala kwazo kuhambelana nomphumo wecandelo lomzimba onomzimba. Le mpendulo iyabonwa kwi-50% yezigulane ezenza i-analgesia ye-epidural. Ixesha elide lokuvakalelwa - kwiiyure eziliqela ukuya kwiiveki ezimbalwa. Intloko ingabangelwa yinguqu ekunyanzelekeni kwe-intracranial, ngenxa yokuphuma kwe-cerebrospinal fluid kwi-space epidural (kunye nomonakalo kwimbumbano yengqondo).
Iimeko ezinjalo zifuna ukungenelela. Umsebenzi uququzelelwe ngokuphindaphindiweyo nokutshatyalaliswa komnyuzi ngokuncediswa kwezixhobo ezikhethekileyo. Emva kokuqhutyelwa, i-punketi yegazi ifakwe kwisayithi yokuqhawula. Igazi lomguli elisetyenziselwa kwisitya lijojowe kwisiza sokutshitshiswa. Ngenxa yoko, ukuphuma kwe-cerebrospinal fluid ivaliwe. Ukuncedwa kwamabhinqa enkcazo kubhekisele kwintsuku elandelayo emva kwenkqubo.
I-epidural aneshesia kunye necesarean section-contraindications
Olu hlobo lwe-anesthesia yengingqi alunakusetyenziswa rhoqo. Kwaye naluphina ulwaphulo lwezokwelapha, ukuthintela ekusebenzeni kunye ne-epestural anesthesia kunye neKesareya, ukuchasene nokuphunyezwa kwezi zinto zilandelayo:
- ukwenqaba kwesigulane;
- ukungabikho kwezixhobo ezizodwa okanye uchwepheshe oqeqeshiwe;
- kutyhafa;
- ukucima amanzi emzimbeni;
- ukuphazanyiswa kwenkqubo yokuguqula igazi;
- hypotension;
- ukuthatha i- antiticoagulants ;
- ukulimala komlenze;
- uxinzelelo oluphezulu;
- isenzo esichaphazelekayo kwi-anesthetic;
- ukuphazamiseka kwentliziyo;
- i-hypoxia yobusana ;
- ukungalunganga komntwana.