{"id":43201,"date":"2019-07-15T20:21:12","date_gmt":"2019-07-15T18:21:12","guid":{"rendered":"https:\/\/fjala.info\/?p=43201"},"modified":"2019-07-15T20:30:40","modified_gmt":"2019-07-15T18:30:40","slug":"simpoziume-te-ndryshme-te-pergatitura-nga-mjeku-otorino-laringolog-z-bajram-cena","status":"publish","type":"post","link":"https:\/\/jehonashqiptare.al\/fjala\/simpoziume-te-ndryshme-te-pergatitura-nga-mjeku-otorino-laringolog-z-bajram-cena\/","title":{"rendered":"Simpoziume t\u00eb ndryshme t\u00eb p\u00ebrgatitura nga mjeku otorino \u2013 laringolog z. Bajram Cena"},"content":{"rendered":"

REPUBLIKA E SHQIPERISE<\/strong>
\nDREJTORIA E MJEKIMIT<\/strong><\/p>\n

Bajram Cena<\/strong> – Kuk\u00ebs, m\u00eb 26.05.1972<\/em><\/p>\n

Tema<\/strong><\/p>\n

Trakeotomia si metod\u00eb mjekimi e urgjenc\u00ebs,
\nkund\u00ebr insufiqeenc\u00ebs akute t\u00eb frym\u00ebmarrjes<\/h3>\n

Gjat\u00eb shekujve trakeotomia \u00ebsht\u00eb p\u00ebrdorur n\u00eb praktik\u00ebn mjek\u00ebsore, kryesisht p\u00ebr t\u00eb m\u00ebnjanuar asfiksin\u00eb e shkaktuar nga d\u00ebmtimet e kalueshm\u00ebris\u00eb t\u00eb rrug\u00ebve t\u00eb sip\u00ebrme t\u00eb aparatit t\u00eb frym\u00ebmarrjes, si n\u00eb rastin e trupave t\u00eb huaj nestenozat, etj.<\/p>\n

N\u00eb k\u00ebto 10 \u2013 20 vjet\u00ebt e fundit indikacionet e trakeotomis\u00eb jan\u00eb zgjeruar shum\u00eb, ajo doli jasht\u00eb sfer\u00ebs s\u00eb ngusht\u00eb t\u00eb urgjenc\u00ebs laringologjike dhe zuri nj\u00eb vend t\u00eb r\u00ebnd\u00ebsish\u00ebm n\u00eb praktik\u00ebn klinike, gjat\u00eb mjekimit t\u00eb s\u00ebmundjeve t\u00eb ndryshme. N\u00eb mjek\u00ebsin\u00eb e koh\u00ebs nuk ka sfer\u00eb veprimi n\u00eb kirurgji ose patologji kur nuk futet trakeotomia dhe t\u00eb mos ket\u00eb ndikuar pozitivisht n\u00eb rikthimin e jet\u00ebs, si rezultat i normalizimit metabolizmit t\u00eb gazeve, m\u00ebnjanimin e shfaqjeve t\u00eb ndryshme patologjike t\u00eb lidhura k\u00ebto me \u00e7rregullimin e frym\u00ebmarrjes nga t\u00eb gjitha format e saj. Kjo b\u00ebhet m\u00eb e qart\u00eb kur dihet se vdekja mund t\u00eb vij\u00eb prej dy shkaqeve t\u00eb nd\u00ebrlidhura n\u00eb mes tyre n\u00eb pro\u00e7eset baz\u00eb t\u00eb veprimtaris\u00eb jet\u00ebsore.<\/p>\n

Prej \u00e7rregullimit, ose d\u00ebmtimit t\u00eb qarkullimit t\u00eb gjakut edhe d\u00ebmtimit ose \u00e7rregullimit t\u00eb frym\u00ebmarrjes ose i t\u00eb dyjave s\u00eb bashku. N\u00eb k\u00ebto raste, trakeotomia mund t\u00eb ket\u00eb dhe shpesh her\u00eb ka nj\u00eb r\u00ebnd\u00ebsi veprimtare n\u00eb rip\u00ebrt\u00ebritjen ose n\u00eb zgjatjen e jet\u00ebs duke siguruar mund\u00ebsin\u00eb e mjekimit t\u00eb plot\u00eb dhe p\u00ebrkat\u00ebs sidomos n\u00eb kondita t\u00eb ve\u00e7anta, si\u00e7 mund t\u00eb jen\u00eb p.sh: ato t\u00eb koh\u00ebs s\u00eb luft\u00ebs. Shpesh her\u00eb n\u00eb praktik\u00eb \u00e7uditemi prej atij efekti t\u00eb madh klinik q\u00eb vjen si rezultat i k\u00ebtij operacioni t\u00eb thjesht\u00eb, i cili duhet t\u00eb kryhet prej cilitdo mjek, qoft\u00eb edhe n\u00eb \u00e7do kondit\u00eb.<\/p>\n

N\u00eb literatur\u00eb jan\u00eb t\u00eb njohura rastet kur gjendje shum\u00eb t\u00eb r\u00ebnda traumatike ose patologjike jan\u00eb m\u00ebnjanuar me ndihm\u00ebn e trakeotomis\u00eb. N\u00eb baz\u00eb t\u00eb studimeve t\u00eb fundit t\u00eb fiziologjis\u00eb dhe t\u00eb patologjis\u00eb t\u00eb frym\u00ebmarrjes, trakeotomis\u00eb, hap nj\u00eb seri mund\u00ebsish t\u00eb veprimit aktiv n\u00eb metabolizmin e gazrave. K\u00ebshtu, autor\u00ebt e ndrysh\u00ebm si: Mukin, duke analizuar shkaqet e vdekjes nga mbytjet shtroi problemin e trakeotomis\u00eb si factor kurues. Q\u00eb n\u00eb vitin 1911 Jak Son theksoi se n\u00eb shum\u00eb pro\u00e7ese patologjike njeriu mund t\u00eb mbytet nga produktet sekretore t\u00eb aparatit t\u00eb frym\u00ebmarrjes. U desh\u00ebn shum\u00eb vite t\u00eb studiohej thell\u00ebsia fiziologjike dhe patologjia e frym\u00ebmarrjes q\u00eb n\u00eb m\u00ebnyr\u00eb p\u00ebrfundimtare t\u00eb formulohej idea principale se trakeotomia mund t\u00eb sh\u00ebrbej p\u00ebr pastrimin aktiv nga produktet sekretore t\u00eb rrug\u00ebve t\u00eb frym\u00ebmarrjes, duke evituar aspirimin e tyre tek t\u00eb s\u00ebmur\u00ebt q\u00eb jan\u00eb n\u00eb gjendje t\u00eb r\u00ebnd\u00eb p\u00ebr shkaqe t\u00eb ndryshme dhe i kanoset vdekja nga asfiksia.<\/p>\n

\"\"<\/p>\n

K\u00ebto cil\u00ebsi t\u00eb ve\u00e7anta terapeutike t\u00eb trakeotomis\u00eb si mjet p\u00ebr normalizimin e metabolizmit t\u00eb gazrave u vun\u00eb qart\u00eb n\u00eb dukje n\u00eb mjekimin e epidemis\u00eb s\u00eb poliomelitit n\u00eb vendet Skandinave dhe n\u00eb Amerik\u00eb, n\u00eb mjekimin e traumave t\u00eb r\u00ebnda kranjale dhe torokale me fraktura t\u00eb shumta t\u00eb brinj\u00ebve, m\u00eb von\u00eb ajo gjeti edhe kurimin komplet t\u00eb shum\u00eb s\u00ebmundjeve dhe traumave t\u00eb ndryshme. Sipas Laskenit, trakeotomia e hershme b\u00ebri t\u00eb mundur t\u00eb ulet mortaliteti n\u00eb form\u00eb akute t\u00eb poliomelitit bulbar prej 80 % deri n\u00eb 40 %.<\/p>\n

Trakeotomia dhe frym\u00ebmarrja artificial zun\u00eb vendin q\u00ebndror n\u00eb sistemin e veprimeve q\u00eb kan\u00eb t\u00eb b\u00ebjn\u00eb me reanimacionin e frym\u00ebmarrjes.<\/p>\n

Ky system reanimacioni b\u00ebri t\u00eb mundur mjekimin e shum\u00eb s\u00ebmundjeve dhe traumave q\u00eb lidhen me \u00e7rregullimet ose me munges\u00ebn e frym\u00ebmarrjes spontane. K\u00ebshtu mjekohen n\u00eb kurimin kompleks eklamsija, tetanozi, botulizmi, t\u00ebrbimi, miastenia e r\u00ebnd\u00eb, siringomielia, intoksikacionet e r\u00ebnda nga preparati narkotik, gjendjet e ndryshme komatoze t\u00eb shoq\u00ebruara me hiper ose hipo kalemi, fraktura cerebrale t\u00eb kolon\u00ebs vertebrale me d\u00ebmtim t\u00eb modul\u00ebs spinale.<\/p>\n

Kon n\u00eb vitin 1958, Bastin, Denis, n\u00eb vitin 1960, Rrapin n\u00eb vitin 1957, Mollarret n\u00eb vitin 1961, Kolitkin n\u00eb vitin 1962, Llan, Dubrovski n\u00eb vitin 1962.
\nLe t\u00eb shikojm\u00eb shkurtimisht veprimin e trakeotomis\u00eb n\u00eb disa aspekte me shembuj nga urgjenca e spitalit ton\u00eb.<\/p>\n

Trakeotomia n\u00eb traumat e r\u00ebnda kraniale<\/strong>. Traumat e r\u00ebnda akute t\u00eb kok\u00ebs shpesh her\u00eb shoq\u00ebrohen me \u00e7rregullime t\u00eb ndryshme t\u00eb aktit t\u00eb frym\u00ebmarrjes. N\u00eb traumat e kok\u00ebs njiheshin gjurm\u00eb koh\u00ebt e fundit, si rezultat i shfaqjeve t\u00eb patologjis\u00eb, t\u00eb rregullimit q\u00ebndror t\u00eb frym\u00ebmarrjes (qendra e frym\u00ebmarrjes). Por, k\u00ebrkimet dhe studimet e fundit t\u00eb b\u00ebra n\u00eb k\u00ebt\u00eb drejtim mb\u00ebrrit\u00ebn n\u00eb p\u00ebrfundimin se \u00e7rregullimet e frym\u00ebmarrjes n\u00eb traumat e kok\u00ebs shpesh u n\u00ebnshtrohen shkaqeve t\u00eb tjera.<\/p>\n

K\u00ebshtu, n\u00eb traumat e r\u00ebnda t\u00eb kok\u00ebs dob\u00ebsohen ose humbasin reflekset e fytit si ai i g\u00eblltitjes dhe i koll\u00ebs. I d\u00ebmtuari duke qen\u00eb n\u00eb gjendje t\u00eb r\u00ebnd\u00eb pa coherence, pa koshienc\u00eb aspiron gjakun, t\u00eb vjellat dhe n\u00eb frakturat e baz\u00ebs krani dhe likorin cerebrospinal.<\/p>\n

N\u00eb k\u00ebt\u00eb m\u00ebnyr\u00eb rrug\u00ebt e frym\u00ebmarrjes mbushen me produktet e aspirimit dhe sekrecionet e tyre. Lino, k\u00ebshtu hypoventilacioni, hypoksemia dhe hiperkapnia. Ndryshimet e p\u00ebrb\u00ebrjes s\u00eb gazrave n\u00eb gjak ndikojn\u00eb n\u00eb try, q\u00eb \u00ebsht\u00eb i d\u00ebmtuar nga trauma. Pak\u00ebsimi i oksigjenit n\u00eb gjak rrit kalueshm\u00ebrin\u00eb e paretave t\u00eb vazave n\u00eb tru, kurse hiperkarpnia i zgjeron ata. (Krvdov, viti 1960). Si rezultat i k\u00ebtyre ndryshimeve shtohet hemoragjia n\u00eb indet e trurit, e cila nga ana e saj shton edem\u00ebn e k\u00ebtij t\u00eb fundit dhe presionin endokranial, q\u00eb reflektohet k\u00ebshtu n\u00eb thell\u00ebsin\u00eb e pro\u00e7eseve patologjike n\u00eb tru.<\/p>\n

Nga ana tjet\u00ebr, dob\u00ebsimi i ventilimit alveolar (shkaktuar nga bllokimi i sekrecioneve) rrit mekanizmin kompesator. Sfrocimet q\u00eb b\u00ebhen n\u00eb aktin e marrjes frym\u00eb shtohen si rezultat i d\u00ebmtimit t\u00eb kalueshm\u00ebris\u00eb s\u00eb rrug\u00ebve t\u00eb frym\u00ebmarrjes, rrit k\u00ebshtu pro\u00e7esin negative endotorakal q\u00eb ndihmon n\u00eb daljen e plazm\u00ebs n\u00eb alveola, d.m.th n\u00eb formimin e edem\u00ebs polmunare. Thelbi kryesor i \u00e7rregullimit t\u00eb frym\u00ebmarrjes n\u00eb traumat e kok\u00ebs \u00ebsht\u00eb mekanizmi periferik q\u00eb njihet prej shum\u00eb autor\u00ebve. I gjith\u00eb ky pro\u00e7es i mekanizmit periferik e r\u00ebndon edhe m\u00eb shum\u00eb gjendjen e t\u00eb d\u00ebmtuarit, formohet k\u00ebshtu cireus vicioz. K\u00ebt\u00eb rreth mund ta prish\u00eb vet\u00ebm vet\u00ebm trakeotomia me rivendosjen e kalueshm\u00ebris\u00eb normale t\u00eb aparatit t\u00eb frym\u00ebmarrjes. Ajo pastron at\u00eb nga aspirimi i masave t\u00eb vjella dhe sekrecione mukoide t\u00eb grumbulluara dhe k\u00ebshtu shmang asfiksin\u00eb, pak\u00ebson diapn\u00ebn dhe n\u00eb shkall\u00eb t\u00eb madhe normalizon k\u00ebmbimin e gazrave (Hrapof, Pa\u00e7enko, Ekols, Dekot, Kole, Mek, Rozenaur, etj).<\/p>\n

Me pak\u00ebsimin e rezistenc\u00ebs s\u00eb frym\u00ebmarrjes, trakeotomia normalizon qarkullimin e gjakut n\u00eb venat jugulare, leht\u00ebson evakuimin e gjakut nga sistemi venoz i trurit, duke luajtur rolin e nj\u00eb valvule sigurac, ajo pak\u00ebson edem\u00ebn e trurit dhe presionin endokranial. Disa autor\u00eb supozojn\u00eb se n\u00eb traumat patologjia e frym\u00ebmarrjes mund t\u00eb shkaktohet dhe nga mbyllja reflektore e rimaglotis\u00eb. Pik\u00ebrisht, me k\u00ebt\u00eb e lidhin ato p\u00ebrmir\u00ebsimin e gjendjes s\u00eb t\u00eb s\u00ebmurit dhe normalizimin e frym\u00ebmarrjes mbas trakeotomis\u00eb, bile edhe n\u00eb ato raste ku nuk ka okluzion t\u00eb rrug\u00ebve t\u00eb frym\u00ebmarrjes prej produkteve sekretore ose aspirimi, Zotov n\u00eb 1961. Si p\u00ebrfundim i t\u00eb dh\u00ebnave t\u00eb shumta t\u00eb literatur\u00ebs mund t\u00eb t\u00eb thuhet se n\u00eb traumat e r\u00ebnda akute t\u00eb kok\u00ebs veprimi kryesor i trakeotomis\u00eb, \u00ebsht\u00eb dranjimi sistematik i rrug\u00ebve t\u00eb frym\u00ebmarrjes.<\/p>\n

P\u00ebr k\u00ebt\u00eb q\u00ebllim, trakeotomia p\u00ebrdoret n\u00eb \u00e7rregullimet akute t\u00eb qarkullimit t\u00eb gjakut n\u00eb tru, si n\u00eb insult, trombos\u00eb, aneuriz\u00ebm, tumore, absese, dhe n\u00eb nd\u00ebrhyrje t\u00eb ndryshme kirgjikale n\u00eb tru. N\u00eb qoft\u00eb se shfaqen \u00e7rregullime t\u00eb frym\u00ebmarrjes (Ekols, Ugromov, Spirin etj, n\u00eb vitin 1961). P\u00ebr sa u flo\u00ebn m\u00eb sip\u00ebr, veprimi terapeutik i trakeotomis\u00eb q\u00ebndron dhe n\u00eb at\u00eb se ajo pak\u00ebson hap\u00ebsir\u00ebn e vdekur t\u00eb rrug\u00ebve t\u00eb sip\u00ebrme t\u00eb frym\u00ebmarrjes dhe \u00e7on n\u00eb largimin e CO2 t\u00eb tep\u00ebrt dhe n\u00eb oksigjenimin m\u00eb t\u00eb mir\u00eb t\u00eb gjakut. P\u00ebrdorimi i trakeotomis\u00eb p\u00ebr k\u00ebto q\u00ebllime u b\u00eb nga Kortes dhe Xhuzefi n\u00eb vitin 1954. K\u00ebt\u00eb po e ilustroj me nj\u00eb shembull nga urgjenca jon\u00eb, kartel\u00eb nr. 329 i S.P n\u00eb mosh\u00ebn 4 vje\u00e7are, dat\u00eb 26.06.1971 u soll urgjentisht n\u00eb spital, pasi kishte r\u00ebn\u00eb nga nj\u00eb lart\u00ebsi mase 4 m me pozicion kok\u00eb dhe n\u00eb krahun e djatht\u00eb, gjendja e p\u00ebrgjithshme shum\u00eb e r\u00ebnd\u00eb, i zbeht\u00eb n\u00eb fytyr\u00eb, i mbuluar n\u00eb djers\u00eb t\u00eb ftohta, n\u00eb gjendje ikoshiente, nga ana e hund\u00ebs djatht\u00eb rridhte gjak, aparati C.V, tonet e zemr\u00ebs t\u00eb dob\u00ebsuara, ritmike, pulsi me mbushje t\u00eb dob\u00ebt 80 n\u00eb minut\u00eb, nuk reagon ndaj ngacmimeve, koka q\u00ebndron e kthyer nga e majta.<\/p>\n

Pupilat e zgjeruara dhe nuk reagojn\u00eb n\u00eb drit\u00eb, ekstremitetet me tonus thuajse t\u00eb zhdukura, babinksi shum\u00eb pozitiv n\u00eb an\u00ebn e djatht\u00eb, reflekset t\u00eb ulura n\u00eb p\u00ebrgjith\u00ebsi n\u00eb ekzaminimin e hund\u00ebs n\u00eb rinoskopi anteriore, duket se gjaku vjen nga meatusi superior, pacienti ka konvulcione, por jo shum\u00eb t\u00eb shprehura, diagnoza komocio cerebli grada e tret\u00eb n\u00eb status prekumatozus. Iu b\u00eb terapia m\u00eb e fuqishme e urgjenc\u00ebs dhe u hospitalizua. Gjendja gjithnj\u00eb vjen e r\u00ebndohet, kjo p\u00ebr shkak t\u00eb edem\u00ebs cerebrale, konvulksionet iu shtuan, cianoza e buz\u00ebve u theksua, grumbullimi i sekrecioneve n\u00eb orofarinks dhe n\u00eb larinkea u b\u00eb i konsideruesh\u00ebm, se nj\u00eb her\u00eb u mor\u00ebn masat urgjente dhe u b\u00eb aspirimi i tyre me aspirator pastaj iu b\u00eb intubimi. Gjendja e f\u00ebmij\u00ebs relativisht u qet\u00ebsua, filloi t\u00eb zhduket cianoza n\u00eb fytyr\u00eb, por gjendja e p\u00ebrgjithshme vazhdon t\u00eb ishte shum\u00eb e r\u00ebnd\u00eb.<\/p>\n

Me dat\u00ebn 27.06.1971 ora 1000 gjendja e f\u00ebmij\u00ebs u r\u00ebndua shum\u00eb, cianoza u theksua n\u00eb buz\u00eb, respiracioni u v\u00ebshtir\u00ebsua shum\u00eb, kjo p\u00ebr shkak t\u00eb grumbullimit n\u00ebn nivelin e tubit t\u00eb sekrecionit, pulsi 130 n\u00eb minut\u00eb, fytyra u mbulua me djers\u00eb t\u00eb ftohta, mungojn\u00eb krejt reflekset sidomos ato pupilar, tirazhi shum\u00eb i theksuar, kjo na detyroi t\u00eb b\u00ebjm\u00eb trakeotomin\u00eb urgjente inferior, e cila solli ndryshime t\u00eb theksuara n\u00eb gjendjen e pacientit u reabilitua frym\u00ebmarrja normale, u shfaq\u00ebn reflekset, u zhduk cianoza, pacienti filloi t\u00eb reagoj\u00eb. Ky ndryshim i gjendjes u b\u00eb p\u00ebr dy \u2013 tre minuta pas trakeotomis\u00eb. Pra, k\u00ebtu u tregua shum\u00eb mir\u00eb se sa i madh \u00ebsht\u00eb roli i trakeotomis\u00eb n\u00eb gjendje prekomatoze n\u00eb traumat cerebrale. Pacientit n\u00eb dit\u00ebn e 10 iu b\u00eb heqja e kanjul\u00ebs dhe respiracioni u normalizua p\u00ebr rrug\u00eb natyrale dhe pas 20 dit\u00ebsh pacienti shkon n\u00eb sht\u00ebpi i sh\u00ebruar.<\/p>\n

Trakeotomia n\u00eb trupat e huaj n\u00eb laring\u00ebs<\/h3>\n

N\u00eb rastet e kalimit t\u00eb trupave t\u00eb huaj n\u00eb larink\u00ebs, trakeotomia ka indikacion absolute dhe \u00ebsht\u00eb e vetmja metod\u00eb e shp\u00ebtimit nga vdekja.<\/p>\n

Koj \u00ebsht\u00eb si\u00e7 e citon nj\u00eb autor anglez Berfort, \u00ebsht\u00eb tragjedi p\u00ebr mjekun dhe dram\u00eb p\u00ebr pacientin, n\u00eb k\u00ebto raste duhet q\u00eb mjeku t\u00eb b\u00ebj menj\u00ebher\u00eb trakeotomin\u00eb pa humbur koh\u00eb, kudo q\u00eb t\u00eb jet\u00eb dhe me \u00e7far\u00ebdo mjeti q\u00eb t\u00eb ket\u00eb, \u00ebsht\u00eb e k\u00ebshillueshme q\u00eb b\u00ebj\u00eb trakeotomin\u00eb superior dhe pastaj ta d\u00ebrgoj\u00eb n\u00eb spital ke specialisti otojater p\u00ebr trajtim t\u00eb m\u00ebtejsh\u00ebm. Po e ilustrojm\u00eb me nj\u00eb shembull nga urgjenca e spitalit ton\u00eb, pacienti I.K nga katundi Brrut, kartel\u00eb nr 29, n\u00eb mosh\u00ebn 2 vje\u00e7are, dat\u00eb 26.08.1970 u soll n\u00eb spital n\u00eb gjendje prej asfiksije me cianoz\u00eb t\u00eb fytyr\u00ebs, me medriaz\u00eb t\u00eb pupilave, i mbuluar me djers\u00eb t\u00eb ftohta, pulsi takikardiak me 140 n\u00eb minut\u00eb, shpesh her\u00eb nj\u00eb koll\u00eb sticoze, tirazhi i theksuar, respiracioni me zhurm\u00eb dhe shpesh her\u00eb mungonte.<\/p>\n

N\u00eb anamnez\u00eb prind\u00ebrit tregojn\u00eb se ka kaluar nj\u00eb kok\u00ebrr mis\u00ebr n\u00eb rrug\u00ebn e frym\u00ebmarrjes. Meqen\u00eb se gjendja e f\u00ebmij\u00ebs ishte shum\u00eb e r\u00ebnd\u00eb u b\u00eb trakeotomia inferior urgjente. Gjendja e f\u00ebmij\u00ebs u p\u00ebrmir\u00ebsua n\u00eb m\u00ebnyr\u00eb t\u00eb menj\u00ebhershme, respiracioni u normalizua, cianoza u zhduk, tirazhi u qet\u00ebsua dhe f\u00ebmija reagoi menj\u00ebher\u00eb, pulsi u normalizua dhe gjendja e f\u00ebmij\u00ebs u b\u00eb mjaft e mir\u00eb, pas kat\u00ebr dit\u00ebsh iu b\u00eb bronkoskopia dhe u nxor kokra e misrit nga dega e sip\u00ebrme e bronkut t\u00eb djatht\u00eb, pas 15 dit\u00ebsh u hoq kanjula dhe pas 30 dit\u00ebsh f\u00ebmija shkoi sh\u00ebndosh e mir\u00eb n\u00eb gjirin e familjes s\u00eb tij.<\/p>\n

Trakeotomia n\u00eb traumat toraksale<\/h3>\n

N\u00eb traumat toraksale me fraktura t\u00eb shumta t\u00eb brinj\u00ebve n\u00eb m\u00ebnyr\u00eb reflektore shtohen sekrecionet e gj\u00ebndrave mukoide t\u00eb rrug\u00ebve t\u00eb sip\u00ebrme t\u00eb frym\u00ebmarrjes, po ashtu dhe likuidi interaticial dhe intra \u2013 alveolar q\u00eb mbush rrug\u00ebt e frym\u00ebmarrjes.<\/p>\n

Hypersekrecioni mukos dhe spazma reflektore e bronkeve, e ulin shum\u00eb kapacitetin vital t\u00eb mushk\u00ebrive. Lind e ashtuquajtura sindrom\u00eb e mushk\u00ebris\u00eb s\u00eb lagur, ose e njom\u00eb t\u00eb tromatizuar (Tromatik vetlung) q\u00eb p\u00ebr her\u00eb t\u00eb par\u00eb e p\u00ebrshkroi Berfort dhe Berbong n\u00eb vitin 1945. N\u00eb traumat toraksale me fraktur\u00eb t\u00eb brinj\u00ebve prishet biomekanika e aktit t\u00eb frym\u00ebmarrjes dhe b\u00ebhet k\u00ebshtu nxjerrja jasht\u00eb e sekrecioneve mukohemoragjik\u00eb, akti i koll\u00ebs nuk kryhet nga shkaku i d\u00ebmtimit toraksal dhe iraksionit t\u00eb dhimbjes. Si rezultat i k\u00ebtyre shkaqeve zhvillohet hypoventilacioni akut, q\u00eb nuk konpensohet me frym\u00ebmarrjen e shpesht\u00eb dhe t\u00eb sip\u00ebrfaqshme, progreson k\u00ebshtu \u00e7rregullimi i frym\u00ebmarrjes, i cili shpesh t\u00eb qon n\u00eb ekzistuese. Trakeotomia n\u00eb k\u00ebto raste t\u00eb tilla siguron drenimin e rrug\u00ebve t\u00eb frym\u00ebmarrjes dhe kalueshm\u00ebrin\u00eb e tyre duke leht\u00ebsuar shum\u00eb gjendjen e r\u00eb\u00ebnd\u00eb t\u00eb traumatizuarit.<\/p>\n

Por, roli i trakeotomis\u00eb nuk kufizohet vet\u00ebm me drenimin e rrug\u00ebve t\u00eb frym\u00ebmarrjes (Karter dhe Xhusef) n\u00eb m\u00ebnyr\u00eb eksperimentale kan\u00eb v\u00ebrtetuar se trakeotomia pak\u00ebson 2\/3 tratat e hap\u00ebsir\u00ebs s\u00eb vdekur ose t\u00eb d\u00ebmshme t\u00eb rrug\u00ebve t\u00eb frym\u00ebmarrjes. Kjo do t\u00eb thot\u00eb se ai volum ajri q\u00eb u \u00e7lirua nga hap\u00ebsira e d\u00ebmshme i shtohet volumit t\u00eb ajrit n\u00eb mushk\u00ebri. Si rrjedhoj\u00eb, utilizimi i O2 dhe ekspirimi i CO2 t\u00eb tep\u00ebrt q\u00eb ka shum\u00eb r\u00ebnd\u00ebsi n\u00eb rregullimin e frym\u00ebmarrjes t\u00eb shkaktuar nga traumat e taraksit. Ve\u00e7 k\u00ebsaj trakeotomia m\u00ebnjanon rrug\u00ebt e sip\u00ebrme respiratore, hund\u00ebn me anekset e saj, nazofarnsgi, faringsin, laringsin.<\/p>\n

Si rezultat i nd\u00ebrhyrjes s\u00eb trakeotomis\u00eb pak\u00ebson sforcimet n\u00eb aktin e frym\u00ebmarrjes, ndjenj\u00ebn e dhimbjes dhe ajo e asfiksis\u00eb. N\u00eb k\u00ebt\u00eb m\u00ebnyr\u00eb trakeotomia jo vet\u00ebm q\u00eb siguron drenimin e pem\u00ebs bronkiale, por ndikon shum\u00eb n\u00eb metabolizmin e gazrave duke pak\u00ebsuar hap\u00ebsir\u00ebn e d\u00ebmshme. Pik\u00ebrisht k\u00ebto jan\u00eb arsyet, shkaqet e p\u00ebrdorimit t\u00eb gjer\u00eb t\u00eb trakeotomis\u00eb n\u00eb rastet e insufiqienc\u00ebs akute t\u00eb frym\u00ebmarrjes. K\u00ebt\u00eb e ilustrojm\u00eb me nj\u00eb shembull, kartel\u00eb nr 224, dat\u00eb 20.06.1971. n\u00eb spitalin ton\u00eb shtrohet urgjent pacienti I.P n\u00eb mosh\u00ebn 45 vje\u00e7are, sipas t\u00eb dh\u00ebnave t\u00eb shoq\u00ebruesve ka p\u00ebsuar nj\u00eb traum aksidentale. N\u00eb mb\u00ebrritje gjendja cijanotike pothuajse e nxir\u00eb, frym\u00ebmarrja e \u00e7rregullt, e v\u00ebshtir\u00ebsuar me zhurm\u00eb. N\u00eb pjes\u00ebn e sip\u00ebrme t\u00eb tetoraksit deri n\u00eb qaf\u00eb, ka skimoza t\u00eb shumta. N\u00eb konkluzion mendohet kontuzijo toraksi dhe comacio kok\u00ebs.<\/p>\n

N\u00eb k\u00ebt\u00eb gjendje b\u00ebhet menj\u00ebher\u00eb trakeotomia pas s\u00eb cil\u00ebs frym\u00ebmarrja normalizohet, zhduket cianoza, gjendja e t\u00eb d\u00ebmtuarit p\u00ebrmir\u00ebsohet.<\/p>\n

Trakeotomia n\u00eb operacionet e zemr\u00ebs<\/h3>\n

N\u00eb operacionet e zemr\u00ebs v\u00ebrehet rritja e presionit t\u00eb gazit karbonik n\u00eb gjakun arterial, dhe si pasoj\u00eb prishjen e ekuilibrit acidobazik. Rritja e acidoz\u00ebs shkakton gjendje somnambul dhe humbje t\u00eb koshienc\u00ebs sipas (Bare). Trakeotomia ul presionin e gjakut karbonik n\u00eb gjakun arterial, normalizon balonc\u00ebn acidobazike dhe p\u00ebrmir\u00ebson k\u00ebshtu gjendjen e pacientit. Vitet e fundit trakeotomia b\u00ebhet 10 \u2013 15 dit\u00eb p\u00ebrpara operacionit t\u00eb zemr\u00ebs.<\/p>\n

Operacioni i par\u00eb i b\u00ebr\u00eb n\u00eb transplantimin e zemr\u00ebs nga Krba Barner u krye pas trakoetomis\u00eb s\u00eb pacientit. Disa autor\u00eb rekomandojn\u00eb trakeotomin\u00eb edhe pas operacioneve n\u00eb abdomen, sidomos n\u00eb t\u00eb s\u00ebmur\u00ebt e dob\u00ebt e t\u00eb kaluar nga mosha. Sipas t\u00eb dh\u00ebnave t\u00eb literatur\u00ebs n\u00eb plag\u00ebt e marra nga zjarri ose ka t\u00eb ftoht\u00eb n\u00eb regjionin e qaf\u00ebs duhet para s\u00eb gjithash t\u00eb b\u00ebhet trakeotomis\u00eb dhe t\u00eb lirohet menj\u00ebher\u00eb pasha bronkiale nga aspirimi i gjakut. Nj\u00eb nd\u00ebrhyrje e till\u00eb normalizon ventilimin e mushk\u00ebrive nga gjaku aspirues, m\u00ebnjanon rrug\u00ebt e frym\u00ebmarrjes nga fusha operatore dhe lejon n\u00eb konditat e qeta t\u00eb p\u00ebrpunohet plaga duke mos lejuar aspirimin e gjakut dhe spazm\u00ebn reflektore t\u00eb rimaglotis\u00eb. Plag\u00ebt n\u00eb k\u00ebt\u00eb rajon shpesh shoq\u00ebrohen me v\u00ebshtir\u00ebsi t\u00eb frym\u00ebmarrjes sipas Udri\u00e7it, gjat\u00eb luft\u00ebs s\u00eb dyt\u00eb bot\u00ebrore, gjysma e tyre k\u00ebrkonin trakeotomin\u00eb.<\/p>\n

Trakeotomia ka nj\u00eb r\u00ebnd\u00ebsi t\u00eb m\u00ebdha n\u00eb mjekimin e nj\u00eb seri s\u00ebmundjesh pediatrike si n\u00eb rastin e bronkopolmanive q\u00eb v\u00ebshtir\u00ebsojn\u00eb shum\u00eb frym\u00ebmarrjen e f\u00ebmij\u00ebs, n\u00eb dispepsit\u00eb toksike dhe n\u00eb toksikozat e r\u00ebnda. N\u00eb k\u00ebto gjendje kemi prishje t\u00eb ekuilibrit acido bazik, rritjet e acidoz\u00ebs n\u00eb gjak q\u00eb shkakton gjendje somnalente, rritje t\u00eb presionit t\u00eb gazit karbonik n\u00eb gjak arterial, n\u00eb k\u00ebt\u00eb gjendje ka nj\u00eb indikacion absolute, trakeotomia e cila ul presionin e gazit karbonik n\u00eb gjakun arterial, normalizon balanc\u00ebn acidobazike dhe p\u00ebrmir\u00ebson k\u00ebshtu gjendjen e pacientit duke u nisur nga t\u00eb mirat e m\u00ebdhaja t\u00eb trakeotomis\u00eb n\u00eb l\u00ebmin\u00eb e pediatris\u00eb, sot ajo p\u00ebrdoret gjer\u00ebsisht n\u00eb gjendjet e sip\u00ebrp\u00ebrmendura dhe ka ulur k\u00ebshtu n\u00eb m\u00ebnyr\u00eb t\u00eb konsiderueshme mortalitetin infantile.<\/p>\n

Konkluzion<\/h3>\n

\u2022 Trakeotomia lejon t\u00eb m\u00ebnjanohet asfiksia nga pengesa mekanike n\u00ebn nivelin e fytit.
\n\u2022 \u00cbsht\u00eb mjet p\u00ebr drenimin sistematik t\u00eb rrug\u00ebve t\u00eb frym\u00ebmarrjes n\u00eb okluzionet e tij nga produktet sekretore ose t\u00eb aspiruara.
\n\u2022 Trakeotomia \u00ebsht\u00eb e paz\u00ebvend\u00ebsueshme n\u00eb rastet e nevojshme t\u00eb frym\u00ebmarrjes artificial p\u00ebr nj\u00eb koh\u00eb t\u00eb gjat\u00eb me an\u00eb t\u00eb aparateve.
\n\u2022 Trakeotomia pak\u00ebson dy t\u00eb tretat e hap\u00ebsir\u00ebs s\u00eb d\u00ebmshme t\u00eb rrug\u00ebve t\u00eb frym\u00ebmarrjes.
\n\u2022 Trakeotomia pak\u00ebson n\u00eb 50 % t\u00eb rezistenc\u00ebs n\u00eb aktin e frym\u00ebmarrjes si hunda me labirintin e saj. Ky fakt ka r\u00ebnd\u00ebsi t\u00eb madhe sidomos n\u00eb traumat toraksale p\u00ebr pak\u00ebsimin e dhimbjeve n\u00eb takipnon tromatike.
\n\u2022 Trakeotomia lejon t\u00eb hidhet n\u00eb pem\u00ebn bronkiale antibiotik\u00eb dhe medikamente t\u00eb tjera q\u00eb pak\u00ebsojn\u00eb vizkozitetin e sekrecioneve dhe leht\u00ebson aspirimin.
\n\u2022 Nj\u00eb r\u00ebnd\u00ebsi t\u00eb madhe ka trakeotomia n\u00eb koh\u00ebn e luft\u00ebs s\u00eb dyt\u00eb bot\u00ebrore, mendoj se n\u00eb konditat e sotme t\u00eb dh\u00ebnies s\u00eb ndihm\u00ebs s\u00eb shpejt\u00eb n\u00eb organizimin e urgjenc\u00ebs s\u00eb zakonshme, trakeotomia do t\u00eb justifikoj\u00eb p\u00ebrdorimin e saj t\u00eb gjer\u00eb n\u00eb fush\u00ebn e luft\u00ebs.
\n\u2022 P\u00ebrdorimi i trakeotomis\u00eb n\u00eb sfer\u00ebn e s\u00ebmundjeve pediatrike do t\u00eb ndikoj\u00eb shum\u00eb n\u00eb uljen e mortalitetit infantile.<\/p>\n

Shefi Repartit O. R. L. Spitali Kuk\u00ebs<\/em>
\nDr. Bajram Cena<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

REPUBLIKA E SHQIPERISE DREJTORIA E MJEKIMIT Bajram Cena – Kuk\u00ebs, m\u00eb 26.05.1972 Tema Trakeotomia si metod\u00eb mjekimi e urgjenc\u00ebs, kund\u00ebr insufiqeenc\u00ebs akute t\u00eb frym\u00ebmarrjes Gjat\u00eb shekujve trakeotomia \u00ebsht\u00eb p\u00ebrdorur n\u00eb praktik\u00ebn mjek\u00ebsore, kryesisht p\u00ebr t\u00eb m\u00ebnjanuar asfiksin\u00eb e shkaktuar nga d\u00ebmtimet e kalueshm\u00ebris\u00eb t\u00eb rrug\u00ebve t\u00eb sip\u00ebrme t\u00eb aparatit t\u00eb frym\u00ebmarrjes, si n\u00eb rastin e […]<\/p>\n","protected":false},"author":1,"featured_media":43202,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,4],"tags":[],"class_list":["post-43201","post","type-post","status-publish","format-standard","has-post-thumbnail","category-artikuj","category-histori"],"yoast_head":"\nSimpoziume t\u00eb ndryshme t\u00eb p\u00ebrgatitura nga mjeku otorino \u2013 laringolog z. 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