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სიცოცხლის შენარჩუნება ტრავმული შოკის დროს

თარიღი: 29 მაისი, 2020

გაიგეთ, რა სამედიცინო ღონისძიებების გატარებაა საჭირო პაციენტის გადასარჩენად ტრავმული შოკის დროს

ტრავმული შოკი სიცოცხლისთვის კრიტიკულად საშიში მდგომარეობაა. რა იწვევს მის განვითარებას და რა სამედიცინო ღონისძიებების გატარებაა საჭირო პაციენტის გადასარჩენად? ამ საკითხებზე გვესაუბრება ალადაშვილის კლინიკის ექიმი-რეანიმატოლოგი, ბატონი გიორგი აფციაური.

- რა არის ტრავმული შოკი და რამდენად საშიშია იგი სიცოცხლისათვის?

ტრავმული შოკი ორგანიზმის ზოგადი მძიმე რეაქციაა ქსოვილების მასობრივი ტრავმისა და სისხლის დანაკარგის დროს. ტრავმულ შოკში იგულისხმება სიცოცხლისათვის მნიშვნელოვანი ორგანოების დისფუნქცია. შოკი შეიძლება დავყოთ ორ ფაზად:

- ერექტიული

- ტორპედული.

ერექტიული ფაზის დროს პაციენტი აგზნებულია, აღელვებული, ის შეიძლება ყვიროდეს ტკივილისაგან და ითხოვდეს დახმარებას, ხოლო ტორპედული ფაზის დროს პაციენტი ხდება ადინამიური, ფერმკრთალი, ტუჩები და ხილული ლორწოვანი ციანოზური, ჰემოდინამიკური მაჩვენებლები ხდება არასტაბილური. ცუდი სისხლმომარაგების გამო ვითარდება ქსოვილების ჰიპოქსია, ე.ი. ირღვევა ჟანგბადის მიწოდება, რამაც შეიძლება, მიგვიყვანოს შეუქცევად პროცესებამდე და დადგეს ბიოლოგიური სიკვდილი.

- რა იწვევს ტრავმული შოკის განვითარებას?

ტრავმული შოკის განვითარებას იწვევს:

- ღია მოტეხილობები,

- დიდი ზომის ღრმა ჭრილობები,

- გულმკერდის, მუცლის ან თავის ღია ან დახურული ტრავმები,

- დამწვრობები,

- ინტოქსიკაციები, რამაც შეიძლება გამოიწვიოს მოცირკულირე სისხლის შემცირება, ეს კი მიგვიყვანს ქსოვილების ჰიპოქსიამდე, როცა უჯრედები განიცდიან „ჯანგბადის შიმშილს“.

სამწუხაროდ, ადამიანების დაუდოვრობის გამო საკმაოდ ხშირია მსგავსი შემთხვევები.

- რა სამედიცინო ღონისძიებების გატარებაა საჭირო პაციენტისათვის სიცოცხლის შესანარჩუნებლად

სხვადასხვა მიზეზით გამოწვეული ტრავმული შოკის დროს სამედიცინო მიდგომებიც განსხვავებულია. მაგალითად: ღრმა ჭრილობების დროს აუცილებელია სისხლდენის შეჩერება, დატამპონება, დამწოლი ნახვევის დადება. ავტოსაგზაო და სიმაღლიდან ვარდნის შემთხვევებში მნიშვნელოვანი როლი ენიჭება ინსტრუმენტულ კვლევებს (ულტრასაონოგრაფია, რენტგენი, კომპიუტერული ტომოგრაფია), რომელიც საშუალებას გვაძლევს ადრეულ ეტაპზე შეფასდეს ტრავმის ხარისხი და მოხდეს შესაბამისი ჩარევა (ქირურგიული).

ტრავმის დროს ძალიან ხშირია პნევმოთორაქსი ან ჰემოთორაქსი რაც იწვევს სუნთქვის მწვავე უკმარისობას და საჭიროებს პლევრის ღრუების გადაუდებელ დრენირებას. საჭიროების შემთხვევაში ხდება სასუნთქი გზების პროთეზირება. ინტენსიური ინფუზიური და ტრანსფუზიული თერაპია არის წამყვანი მეთოდი ჰემოდინამიკის კრიტიკული დარღვევების დროს ჰიპოვოლმეიის (სისხლის შემცირებული მოცულობის) საკორექციოდ.

სისხლის მასიური დაკარგვისას აუცილებელია შესაბამისი ჯგუფისა და რეზუსის სისხლის კომპონენტების ტრანსფუზია (გადასხმა). პოლიტრავმის შემთხვევაში მნიშვნელოვანი როლი ენიჭება ანალგეზიას (გაუტკივარებას) ამასთან ერთად, უნდა გვახსოვდეს, რომ არტერიული წნევის დაბალი ციფრებისას, ჰიპოვოლემიის დროს, ზოგადმა ანალგეზიამ შეიძლება გამოიწვიოს პაციენტის მდგომარეობის გაუარესება, ამიტომ აუცილებელია, გაუტკივარება მოხდეს დამცველობითი ინფუზიის (სითხის გადასხმის) ფონზე. ზოგად ანესთეზიას ატარებენ ნარკოტიკული ანალგეტიკებით, ჰემოდინამიკისა და სუნთქვის აუცილებელი კონტროლით.

- რა არის გადამწყვეტი რეანიმაციული დახმარების დროს

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