【Zvipingamupinyi】

1) Kusakodzera kwepfungwa kana muviri kuvhiyiwa mumamiriro ezvinhu akajairika

2) Kubuda ropa kwakanyanya uye kuonda kweropa.

3) Huwandu hwemasero machena eropa huri pasi pe3×109/L

4) Kusawirirana nemifananidzo inopikisa

5) Zvinosanganiswa nechirwere chemapapu chinovhara mapapu chakakomba.

6) Varwere vanozivikanwa kana kuti vanofungidzirwa kuti vane allergy nezvinhu zviri mupakeji yemuchina.

7) Kuvapo kana fungidziro yehutachiona hunokonzerwa nemudziyo, bhakitiriya kana sepsis.

8) Kurapwa neRadiotherapy panzvimbo yaunoda kuiswa.

9) Kufungidzira kana kubaya mishonga ye embolic.

 

【Gadzira zuva】 Ona chinyorwa chechigadzirwa

 

【Nguva yekupera】 Ona chinyorwa chechigadzirwa

 

【Nzira yekushandisa】

1. Gadzirira mudziyo wekuisa mushonga unoiswa mumuviri uye tarisa kana zuva rekupera rapfuura; bvisa paki yemukati uye tarisa kana paki yacho yakuvara.
2. Unofanira kushandisa nzira dzekubvisa utachiona kuti ucheke pasuru yemukati wobvisa mushonga wacho kuti ugadzirire kushandiswa.
3. Kushandiswa kwemidziyo yekuisa zvinhu zvinoiswa muchimiro chepurasitiki kunotsanangurwa zvakasiyana kune modhi yega yega seizvi.

 

RudziⅠ

1. Kuyedza kushamba, kuburitsa mweya, uye kudonhedza mvura

Shandisa sirinji (tsono yechinhu chinoiswa mudumbu) kuti uboore chinhu chinoiswa mudumbu uye ubaye 5mL-10mL yesaline yemuviri kuti ubvise chigaro chejekiseni necatheter lumen wobvisa. Kana pasina kana mvura inononoka yawanikwa, tenderedza mugumo wecatheter (divi rekupedzisira) neruoko kuti uvhure chiteshi chekutumira mishonga; wobva wavhara mugumo wecatheter, ramba uchisundidzira saline (pressure isingapfuure 200kPa), tarisa kana paine kubuda kwemvura kubva pachigaro chejekiseni uye kubatana kwecatheter, mushure mezvose zvakajairika. Kana zvese zvajaira, catheter inogona kushandiswa.

1. Kubvisa tsvina nekusunga

Zvichienderana nekuferefeta kwakaitwa panguva yekuvhiyiwa, isa catheter (mugumo wekutumira mushonga) mutsinga yeropa inoenderana zvichienderana nenzvimbo yebundu, uye shandisa suture dzisinganyorovi kuti uise catheter zvakanaka mutsinga. Catheter inofanira kusungirirwa zvakanaka (kupfuura kaviri kana kupfuura) uye kugadziriswa.

1. chemotherapy uye sealing

Mushonga wechemotherapy unopinzwa panguva yekuvhiyiwa unogona kubaiwa kamwe chete zvichienderana nehurongwa hwekurapa; zvinokurudzirwa kuti chigaro chejekiseni necatheter lumen zvisukwe ne 6-8 mL ye physiological saline, zvichiteverwa ne 3 mL ~ 5 mL. Catheter inozovharwa ne 3mL kusvika 5mL ye heparin saline pa 100U/mL kusvika 200U/mL.

1. Kugadzika kwechigaro chejekiseni

Kaburi kemukati meganda kanogadzirwa panzvimbo yekutsigira, iri 0.5 cm kusvika 1 cm kubva pamusoro peganda, uye chigaro chejekiseni chinoiswa mukati meganda rogadziriswa, uye ganda rinosungirirwa mushure mekubuda ropa zvakanyanya. Kana catheter yakareba zvakanyanya, inogona kumonerwa kuita denderedzwa kumucheto weproximal yogadziriswa zvakanaka.

 

RudziⅡ

1. Kubvisa tsvina nekubvisa mweya

Shandisa sirinji (tsono yechinhu chinopinzwa chinoiswa) kubaya saline muchigaro chejekiseni necatheter zvakateerana kuti ubvise mweya uri mulumen, uye uone kana mvura inoyerera yakatsetseka.

2. Kubvisa tambo nekubatanidza tambo

4. Kuyedzwa kwekubuda kwemvura

4. Kana kubatana kwapera, peta uye vhara catheter iri kumashure kwekiyi yekukiya uye ramba uchiisa saline muchigaro chejekiseni uchishandisa sirinji (tsono yekuisa mushonga unoiswa) (kumanikidzwa kupfuura 200kPa). (kumanikidzwa kusingapfuure 200kPa), tarisa kana paine kubuda kwemvura kubva mujekiseni necatheter.

kubatana, uye shandisa chete kana zvese zvangoitwa zvakajairika.

5. Kurapa nemakemikari, chubhu yekuvhara

Mushonga wechemotherapy unopinzwa panguva yekuvhiyiwa unogona kubaiwa kamwe chete zvichienderana nehurongwa hwekurapa; zvinokurudzirwa kubvisa 6~8mL yesaline yemuviri zvakare, wobva washandisa 3mL~5mL yesaline yemuviri.

Catheter inozovharwa ne3mL kusvika 5mL ye heparin saline pa100U/mL kusvika 200U/mL.

6. Kugadzika chigaro chejekiseni

Kaburi kemukati meganda kakagadzirwa panzvimbo yekutsigira, 0.5 cm kusvika 1 cm kubva pamusoro peganda, uye chigaro chejekiseni chakaiswa mukati meganda ndokugadziriswa, uye ganda rakasungirirwa mushure mekubviswa kweropa zvakanyanya.

 

Nyora Ⅲ

Sirinji (tsono yakakosha yemudziyo unopinzwa) yakashandiswa kubaya 10mL ~ 20mL yemunyu wakajairika mumudziyo unopinzwa mushonga kuti ibvise chigaro chejekiseni nepaburi recatheter, uye kubvisa mweya uri muburi, uye kuona kana mvura yacho yakanga isina kuvharika.

2. Kubvisa tambo nekubatanidza tambo

Zvichienderana nekuongorora kwakaitwa panguva yekuvhiyiwa, isa catheter iri pamadziro edumbu, uye chikamu chakavhurika chemugumo we catheter chinofanira kupinda mudumbu uye chive pedyo nechinoda bundu sezvinobvira. Sarudza mapoinzi maviri kusvika matatu ekubatanidza uye kugadzirisa catheter.

3. chemotherapy, chubhu yekuvhara

Mushonga wechemotherapy unopinzwa panguva yekuvhiyiwa unogona kubaiwa kamwe chete zvichienderana nehurongwa hwekurapa, uye chubhu yacho inovharwa ne 3mL~5mL ye 100U/mL~200U/mL heparin saline.

4. Kugadzika chigaro chejekiseni

Kaburi kemukati meganda kakagadzirwa panzvimbo yekutsigira, 0.5 cm kusvika 1 cm kubva pamusoro peganda, uye chigaro chejekiseni chakaiswa mukati meganda ndokugadziriswa, uye ganda rakasungirirwa mushure mekubviswa kweropa zvakanyanya.

Kuiswa kwemishonga uye kutarisirwa

A.Kushanda zvisina utachiona zvachose, kusarudza zvakanaka nzvimbo yekuisa jekiseni usati waisa jekiseni, uye kubvisa hutachiona hwakasimba panzvimbo yekuisa jekiseni.B. Paunenge uchibaya jekiseni, shandisa tsono yekuisa mushonga unoiswa mujekiseni, sirinji ye10 mL kana kupfuura, neruoko rweruboshwe uchibata nzvimbo yakaboorwa uye chigunwe chikuru chichibata ganda uchigadzirisa chigaro chejekiseni, neruoko rwerudyi rwakabata sirinji yakatwasuka mujekiseni, kudzivirira kuzununguka kana kutenderera, uye kuisa saline zvishoma nezvishoma 5 mL ~ 10 mL kana paine kunzwa kwekudonha uye muromo wetsono wozobata pasi pechigaro chejekiseni, uye tarisa kana nzira yekuendesa mushonga yakapfava (kana isina kupfava, unofanira kutanga watarisa kana tsono yakavharwa). Tarisa kana paine kukwira kweganda rakatenderedza paunenge uchisunda.

C. Sundidzira mushonga wekurapa nemakemikari zvishoma nezvishoma mushure mekusimbisa kuti hapana chikanganiso. Munguva yekusundidzira, nyatsocherechedza kana ganda rakatenderedza rakakwira kana kuti rakachenuruka, uye kana paine kurwadziwa kwenzvimbo yacho. Mushure mekunge mushonga wasundidzirwa, unofanira kuchengetwa kwemaminitsi gumi nemashanu kusvika makumi matatu.

D. Mushure mekubaiwa jekiseni rega rega, zvinokurudzirwa kuti mugeze chigaro chejekiseni necatheter lumen ne 6 ~ 8mL ye physiological saline, mozovhara catheter ne 3mL ~ 5mL ye 100U/mL ~ 200U/mL ye heparin saline, uye kana 0.5mL yekupedzisira ye heparin saline yaiswa jekiseni, mushonga unofanira kusundidzirwa uchidzokera shure, kuitira kuti system yemushonga izadzwe ne heparin saline kudzivirira crystallization yemushonga uye kuvharika kweropa mu catheter. Catheter inofanira kusukwa ne heparin saline kamwe chete pamavhiki maviri panguva ye chemotherapy.

E. Mushure mekubaiwa jekiseni, bvisa mushonga wekuuraya utachiona paziso retsono, rifukidze nejira rekudzivirira utachiona, uye chenjerera kuchengetedza nzvimbo yacho yakachena uye yakaoma kudzivirira hutachiona panzvimbo yakaboorwa.

F. Nyatsoteerera maitiro emurwere mushure mekupiwa mushonga uye nyatsocherechedza paunenge uchibayiwa mushonga.

 

【Chenjero, yambiro uye zvinhu zvinonyengera】

1. Chigadzirwa ichi chinonatswa ne ethylene oxide uye chinoshanda kwemakore matatu.
2. Ndapota verenga bhuku remirayiridzo usati washandisa kuti uve nechokwadi chekuti kushandiswa kwakachengeteka.
3. Kushandiswa kwechigadzirwa ichi kunofanirwa kutevedzera zvinodiwa nemitemo yekurapa, uye kuiswa, kushandiswa uye kubviswa kwezvishandiso izvi kunofanira kuganhurirwa kuvanachiremba vane magwaro. Kuiswa, kushandiswa uye kubviswa kwezvishandiso izvi kunoganhurirwa kuvanachiremba vane magwaro, uye kutarisirwa kwevashandi vekurapa vane magwaro mushure mekuvhiyiwa kunofanirwa kuitwa nevashandi vezvehutano vane magwaro.
4. Maitiro ese anofanira kuitwa pasi pemamiriro asina kuchena.
5. Tarisa zuva rekupera kwechigadzirwa uye kurongedza kwemukati kuti uone kana chakakuvara usati waita izvi.
6. Mushure mekushandisa, chigadzirwa ichi chinogona kukonzera njodzi dzezvipenyu. Ndokumbirawo mutevedzere nzira dzekurapa dzinogamuchirwa pamwe nemitemo yese yakakodzera yekubata nekurapa.
7. Usashandise simba rakawandisa panguva yekupinza tsinga uye isa tsinga yacho nemazvo uye nekukurumidza kudzivirira kuputika kweropa. Kana kupinza tsinga kwakaoma, shandisa minwe yako kutenderedza catheter kubva kurutivi kuenda kurutivi uchipinza tsinga.
8. Kureba kwecatheter inoiswa mumuviri kunofanira kunge kwakakodzera, kureba kwakanyanya kuri nyore kukotama kuita kona, zvichikonzera kusafema zvakanaka, kupfupika zvakanyanya ndiko kana murwere achisangana nemabasa echisimba anogona kubuda mumudziyo weropa. Kana catheter iri pfupi zvakanyanya, inogona kubuda mumudziyo weropa kana murwere achifamba nesimba.
9. Catheter inofanira kuiswa mumudziyo ine ma ligature anopfuura maviri uye yakasimba zvakakwana kuti ive nechokwadi chekuti mushonga unopinzwa zvakanaka uye kudzivirira kuti catheter isatsvedze.
10. Kana mudziyo wekuisa ganda uri werudzi rwechipiri, kubatana pakati pecatheter nechigaro chejekiseni kunofanira kunge kwakasimba. Kana jekiseni remushonga panguva yekuvhiyiwa risingadiwi, jekiseni remushonga wesaline rinofanira kushandiswa kusimbisa ganda risati rasukwa.
11. Pakupatsanura nzvimbo iri pasi peganda, kuvhara ropa kunofanira kuitwa kudzivirira kuumbwa kweropa remunzvimbo, kuungana kwemvura kana hutachiona hwechipiri mushure mekuvhiyiwa; suture ye vesicular inofanira kudzivirira chigaro chejekiseni.
12. Zvinonamira zvekurapa zve α-cyanoacrylate zvinogona kukanganisa zvinhu zvejekiseni; usashandise zvinonamira zvekurapa zve α-cyanoacrylate pakurapa nzvimbo yakachekwa yakatenderedza nzvimbo yakachekwa. Usashandise zvinonamira zvekurapa zve α-cyanoacrylate pakurapa nzvimbo yakachekwa yakatenderedza nzvimbo yakachekwa.
13. Ngwarira zvakanyanya kudzivirira kubuda kwecatheter nekuda kwekukuvara netsaona kubva kumidziyo yekuvhiya.
14. Pakuboora, tsono inofanira kuiswa yakatwasuka, sirinji ine simba re10mL kana kupfuura inofanira kushandiswa, mushonga unofanira kubaiwa zvishoma nezvishoma, uye tsono inofanira kubviswa mushure mekumbomira kwenguva pfupi. Kumanikidzwa kwekusundidzira hakufanirwe kudarika 200kPa.
15. Shandisa tsono dzakakosha chete pakushandisa mishonga inoiswa mumuviri.
16. Kana uchida kuisirwa mushonga kwenguva refu kana kutsiva mushonga, zvakakodzera kushandisa mudziyo wekuisa mushonga unoiswa kamwe chete une tsono kana tee yekuisirwa mushonga, kuitira kuderedza huwandu hwemaburi uye kuderedza kukuvara kumurwere.
17. Deredza huwandu hwemaburi ekuboorwa, deredza kukuvara kwetsandanyama dzemurwere uye zvikamu zvinozvisunga zvega. Munguva yekumira kubaya mushonga, jekiseni rekudzivirira ropa rinovhara ropa rinodiwa kamwe chete pamavhiki maviri ega ega.
18. Chigadzirwa ichi chinoshandiswa kamwe chete, chisina utachiona, hachina hutachiona, chakaparadzwa mushure mekushandiswa, kushandiswazve kwacho kwakarambidzwa zvachose.
19. Kana pasuru yemukati yakakuvara kana kuti zuva rekupera kwechigadzirwa rapfuura, ndapota chidzosere kumugadziri kuti chiraswe.
20. Huwandu hwemaboore ebhoore repaburi rega rega rejekiseni hahufanirwe kudarika 2000 (22Ga). 21.
21. Huwandu hushoma hwekushambidza i6ml