Abantwana: Ukukhetha I-Nedle Yokunqula Okufanele

Isisekelo sokwanamuchi: Njani ukuthutha kwegolide yabantwana kubandla ukukhetha kwebhendane

Ukufakwa okunenzedwa kahle kwebhuloki yendawo kubantwana kuyalapha kule ukuzinika kahle yegolide yabantwana enqunyulwene. Ngaphandle kuka igolide yabantu abaqasha, igolide yabantwana, kubancane nabantwana, iyaguquka kakhulu eyayimpinda ngqo kuphi nokunjani ibhendane yekulahlekelwa kwabantwana iyafakwa ngokulungile.

Uguquleka kwemigomo yegolide neukuphela kwesakhiwo se-Dura ngokwezinsuku

I-conus medullaris nezinyakhiwa ngokupheleleyo; izikhundla zazo kusuka kuzinhlaka zezibhodi zezivertebrali zihamba ngokuphambuka phakathi kwezinsukwane ezibalulekile. Kusukela emzalweni, i-dural sac iphuma ku-S3–S4 interspace, futhi i-conus ishiya ngokujwayelekile ku-L3 (Dalens 2014). Ngeminyaka eyisibili, ukuthuthukisa okuhlinzekile kwezivertebrali ne-spinal cord kubangela ukuthi kubonwe ukuthi kuhamba ngokuphambuka: ngomnyaka wa-5, i-dural sac iphuma ngokujwayelekile ku-S1–S2, futhi i-conus ishiya ngokupheleleyo ku-L1–L2, kufanana nesilinganiso sasezinsukwane zomkhakha. Lokhu kubangela ukuthi kunezidingo zokuphepha okuncane kubantwana: ukuthatha isampula yelumbar noma ukufaka i-epidural ku-L4–L5 interspace esingatholakali njengokuthi “yinkambo yokuphepha”, kungabangela ukuthi kubhekwe i-dural noma kubhekwe i-cord kubantwana abancane kakhulu. Ukusebenzisa umgqa wokuphakama kwemilayi (Tuffier’s line), owenziwa ngokujwayelekile ku-L4–L5 kubantwana, kusiza—kepha akuyiyo yinkambo engeyona yonke ngaphambi kokuphambuka. Abasemthethweni kufanele bakhetha i-interspace engeyona yonke ephakade—ngokujwayelekile ku-L4–L5 noma ku-L5–S1 ukufaka i-spinal anesthesia—futhi bahlale bafaka i-needle yekhliniki yabantwana ngokuphambuka ngokucacile ukuze bakhumbule ukuthi i-termination iyisisekelo esincane. Ukusebenzisa i-ultrasound ngaphambi kokwenza isikhundla kusiza ukuthi kubonwe isikhundla se-conus futhi kusiza kakhulu ukuthi akubhekwe isikhundla esingafanele ngalesi sizindawo (Sury et al. 2016).

Umbhalo phakathi kwe-skin ne-dura nokuthintha kwezindlela zokusebenzisa izihlangothi zokunamathela kubantwana

Izinkulungwane zokusebenza kwezinto eziyisifunda kuzo ziyachaza ubude obuncinci be-needle ofanele ukufika emaphakathini okunye noma kwi-epidural space ngaphandle kokuphazimula. Ubude phakathi kwezinye ne-dura mater ubuyabagcina ukuba ubuyakhula ngendlela engavamile: kuma-neonates asezingeni le-“term”, ubude obubhekene ngezinye ne-dura bungaba ngu-1.3–1.6 cm kuphela (Polaner 2017). Ngenkathi yezintandane (1–3 iminyaka), lobude lubuyakhula ku-2.0–2.5 cm, futhi ngenkathi yezintandane ezikhulu libuyafika ku-3.0–4.0 cm, okufanana nezintandane ezingabi nalo. Lokhu kubude obuncinci kusho ukuthi izi-needle ze-spinal zezinkulungwane zokusebenza kwezintandane, ezingabi nalo ubude be-90 mm, zibiza isivumelwano esingasemthethweni sokufaka kakhulu, okungaba yisiphumo sokubeka i-ventral epidural hematoma noma ukubeka i-catheter yasezinye ngendlela engalungile. Izifomula zokubeka ngokubeka kwezindawo noma kwe-body surface area zingakwazi ukubeka ubude obufanele ngokulinganisa ngaphansi kwe-±5 mm, kodwa ukubeka ngokuqondisa kwe-ultrasound kubhekise kubaluleke kakhulu. Ngoko ke, iziprothokholi zezindlela zokusebenza kwezintandane zokusebenza kwezintandane zizocwepha ukuthi kuma-baby angaphezu kwe-5 kg, i-25–30 mm styletted needle ibaluleke, futhi i-50 mm needle ibaluleke kuma-baby angaphezu kwe-30 kg. Ukukhetha i-needle encane ngokubeka ubude obubhekene ngezinye ne-dura, ngaphandle kokukhetha indlela eyodwa-yodwa, kuhlela ubude be-tissue trauma futhi kuhlela isivumelwano sokubeka i-needle kwe-dura ngendlela engalungile ngokusebenzisa i-needle enene noma engaqondi kakhulu.

Ukubhekisela Kwe-Needle Kubalulekile: Ukuchitha vs. Ukubhekisela Ngokwesikhala Sokugcina Ukuhlanganisa Amasiko Okuziphatha Ngokupheleleyo Kwabafana Nokuziphatha Ngokupheleleyo Kwabafazi

Ukunciphisa Isivumelwano Sokufa Ngokwesikhala Sokugcina Ngamashini Amanye Amashumi Amabili Nanye (27G) Okubhekisela Ngokwesikhala Sokugcina Kwabafana Nokuziphatha Ngokupheleleyo Kwabafazi

Upho lomlando wokugcina isikhumba (PDPH) kubhekwa kusukela emthwakathini wokuphuma kwemithwakathi yasezansi yomhlaba ngaphandle kokuba kubhekwe isikhumba ngokuphatha kwe-lumbar puncture. Indlela yokwakha umshini wokuphatha yisibonelo esibalulekile sokuthi ukuphatha kuyakwenza ukuphuma kwe-mithwakathi kuyakwenzeka kangakanani. Umshini owenziwe ngokuchitha, njengomshini we-Quincke, uyachitha amafibra asekhumba ngokucacile, uye uyadala indawo engeyona isikhumba esingaphansi esiyakuvula ngokushesha. Ngaphandle koko, umshini wokuphatha wesikhumba esingafana nesikhumba sesihlangu siyabuka amafibra ngokuhlanganisa, sivula isikhumba esincane esiyakuvula ngokushesha uma umshini usukela. Umhlangozi wase-Cochrane wabonisa ukuthi amashini wesikhumba esingafana nesikhumba sesihlangu ayakhula okunzima kwe-PDPH ngokulingana namashini owenziwe ngokuchitha (Arevalo‑Rodriguez 2017). Emasayensi ezingaphansi kwezintombi, umshini wesikhumba esingafana nesikhumba sesihlangu wesigaba se-27-G uyavula ukuthi ukuphuma kwe-PDPH kuyakwenzeka ngapansi kwe-1%, futhi lokhu kuyakwenza ukuthi yilokho okufanele kusebenziswa ekuphatheni isikhumba kwezintombi. Abantwana abadala, abanamthwakathi omkhulu kanye nabantu ababheka ngokuphambili, bakhula okunzima kwe-PDPH, bafuna lokho kakhulu. Noma umshini wesikhumba esingafana nesikhumba sesihlangu se-27G uyadinga umshini wokungena ukuthi ubheke isikhumba, lokhu kungahlinzeka ukuthi kuyakwenzeka ukuthi kubhekwe isikhumba. Ukudluliswa kwe-gauge esincane kanye nomshini wokuphatha awuchithi yilokho okubalulekile nokuthi kuyakwenzeka ngokuzimisa ukuthi akukho PDPH kwezintombi.

Imithambo Yokuqonda Okuphathelene Nokusebenzisa Amaphutha Emiswakama Yezintwana

Izindlela zokusebenza ezisemthwakathini zikaAmerican Society of Regional Anesthesia and Pain Medicine (ASRA) neEuropean Society of Regional Anaesthesia (ESRA) zibhekise kuzo ukusebenzisa izikhumba zokuphuma kwe-spinal ezingenzi ngokuphambuka kwezikhumba zokuthatha isitha kubantwana. I-ASRA 2021 yenzela ukuthi kusetyenziswe isikhumba esingasitha, esingaphansi kwe-spinal, nesikhumba esincane kakhulu esihlanganisa izinkinga zokusebenza—kufanele kube 25G noma 27G kubantu abangaphansi kwe-30 kg. Kukhululekile ukuthi kusetyenziswe isikhumba sokunqamula ukuze sikhubaze ukuthatha isitha kwesifunda sokugcina isitha futhi ukuvumela ukulawula ngokucophelela isikhumba esincane sokuphuma kwe-spinal. Izimboni zokuhlola kwe-anesthesiologists kubantwana zibonisa lokhu kuthinteka: nakuba izikhumba zikaQuincke ze-22G zayisemthwakathini, kunezinkambo eziningi kakhulu (ezingu-80%) zokusebenzisa izikhumba zokuphuma kwe-spinal ekupheleni kwezikhumba zokuphuma kwe-spinal. Ukulinganisa ngokusebenzisa i-ultrasound ukuthi ubude phakathi kwe-skin nase-dura kuyabiza ukwahlukanisa ubude obuyidingekayo, ukunciphisa ukuthi kuboneke isitha sokugcina isitha nasezinkinga zokungafanele. Lokhu kubonisa ukuthi isikhumba sokuphuma kwe-spinal sibonakalisa ukuthi isikhumba sokuphuma kwe-spinal siyisimo esibalulekile sokuhlinzekwa, akusiyo isikhumbu esincane. Ukulandela izindlela zokusebenza—isikhumba esingasitha, isikhumba esincane, nokwahlukanisa ubude ngokusebenzisa i-ultrasound—kuyavumela ukuthi konke okuphuma kwe-lumbar kuyabe nokuhlinzekwa kancane kakhulu, ukunciphisa izinkinga zokuhlinzekwa kanye nezinkinga zokuhlinzekwa kahle.

Ukuhlelwa kwezinkomba zokugcina izibonelo zezintandokazi: isigaba, ubude, nokuthi kuyaphakanywa kuphi

Amasiko okukhetha isigaba nobude bezinkomba zokugcina izibonelo zezintandokazi ngomlando nobunzima bamtoto

Ukukhetha isigaba nobude bekhozinkomba zokugcina izibonelo zezintandokazi kubangena ngomlando nobunzima bamtoto ukuze ukungavumeli ukugcina kwezinyawo futhi ukuze ukwenzeka kahle ukuphakanywa kwezibonelo.

Injekshini yezinkumbu zokugcina izimboni zokufa kwezinkumbu ezingaphansi kuka-27G iyakunciphisa isivumelwano sokubona ukuphuma kwamaphuzu emhlabathini ngaphezu kwe-1% kubantwana abadala, kusukela ku-6% ngezinhlangothi zokugcina izimboni zokufa kwezinkumbu ezingaphansi kuka-25G (ESRA 2022). Ukuthi kubhekwe ngokuvumela kwe-ultrasonography ukuthi i-conus medullaris iphele kuleveli liyisifundiswa—kungabonakala njengoba iphele kuleveli L3 kubantwana abancane, futhi lokhu kuyikhethekile ukuthi kusebenzise amaphuzu aphantsi kwe-lumbar.

Ukuziphatha Ngokuthandabuzwa Kwabantu: Ukunciphisa Ukuzithanda Kwenjekshini Yokugcina Izimboni Zokufa Kwezinkumbu Kubantwana

Ukufaka indawo yokuqinisa kwezinye zezimpilo zokuphatha izintwana kungahleli ukuthi kubhekiswe ngokukhulu—kungakhathalelwa kuphela ukuchitha okukhathalelwa kodwa futhi ukuzibiza ngokungaziwa nokuhlanjulwa kwezindlu zokuphatha. Indlela eyinhloko yomuntu, eyavumelana nezindlela zokuphatha ngokungafanele kwezimpilo, iyaphatha umntwana nomndeni wakhe ngokuphambana ukuze kunciphisele lezi zizindlela zokuchitha zokuzibiza. Izindlela eziphelele zikhusele ukuvumela umama noma umuntu omkhulu othembekile ukuba abe ngezinsuku zokuphatha, okunika umphakathi wokuchitha nokunciphisa ukubhekiswa ngokuthi kuyizinkinga. Izindlela zokuchitha ezihlanganisa izinto zokufunda ngendlela esifanayo nezinsuku—njengokugcina amasimu, amadhibhayisi, noma ukubhala izimboni—zihlukanisa ukubhekiswa kwesikhathi sokufaka indawo yokuqinisa. Ngokushesha, ukusebenzisa kahle izinkampani zokuchitha zokuphatha (njenge-EMMLA cream noma lidocaine ephakanyisiwe) ziyabhekisa ukuchitha okwenza ngokuphatha, okwenza ukuthi kubhekiswe ngokukhulu nokucaphuna ukuchitha nokuthanda ukuphatha. Ukuguqula isikhundla sokuphatha ngokuphakanyisa amalayiti, ukuphakanyisa amazwi, nokubeka izinto zokuchitha ziyabhekisa isikhundla sokuphatha sokuchitha. Uma lezi zindlela ziyasebenziswa ngokuphambana, ukufaka indawo yokuqinisa kwezinye zezimpilo zokuphatha izintwana kungahleli ukuthi kubhekiswe ngokukhulu, kubhekisa ubuso lwabantwana nokuthanda ukuphatha nokuthanda ukuphatha.

Imibuzo Emaninzi (FAQ)

Kungani ubunzima be-conus medullaris ne-dural sac kubantwana abancane kuhlukile kubantu abadala?

Ubunzima be-conus medullaris ne-dural sac bavula ngokuphambuka kwezikhathi zokuphila kahle ngokuphambuka kwezinhlobo zokuphila phakathi kwe-spinal cord ne-vertebral column, futhi bavula ngokuphambuka kwezinhlobo zokuphila kubantu abadala ngomnyaka we-5.

Kungani kufanele sisebenzise amaphuzu okugcina izimboni zokufa kwezinkumbu angaphezulu kubantwana?

Amaphutha amancane, athathelwe kumahlaka wokubhala kwezinye izinsizakwane, akunciphisa isibopho sokufaka kakhulu, ukugqiba kwemithi, nokuhlukahluka kwezinkinga njengezinkinga zokubhala kwezinye izinsizakwane.

Yini imiph advantage yamaphutha amahle ngaphezu kwezinye izinsizakwane?

Amaphutha amahle ayenza izihlalo ezincane zokubhala kwezinye izinsizakwane okuzobuyela kahle kakhulu, akunciphisa isibopho sokubhala kwezinye izinsizakwane ngokuphelele ngaphezu kwezinye izinsizakwane.

Sizinga yokubhala kwezinye izinsizakwane kungasiza kanjani ekukhetheni amaphutha?

Ukubhala kwezinye izinsizakwane kungakhombisa ngokucophelela indawo yokuqala yezinye izinsizakwane nehlaka phakathi kwezinye izinsizakwane, kunciphisa isibopho sokufaka amaphutha esilinganiso nokuhlukahluka kwezinkinga zokubhala kwezinye izinsizakwane.

Kuzithola izindlela zokuphepha ukuzwela kwezinye izinhloso zokugcina umsila wasezulwini kubantwana?

Ukuvumela ukuthi abaphathi babethe, ukuthintana ngokwesibonelo sokufunda ngokwemidlalo, amasipho okugcina isikhumba, nokusika imithombo yezindawo zokuphepha kuyizindlela ephumelelayo yokuphepha ukuzwela nokuthuthukisa ukuthembana.