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I l l bob. Q O N K ETISH VA Q O N Y O 'Q O T IS H
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I l l bob. Q O N K ETISH VA Q O N Y O 'Q O T IS H . HARB1Y SH A R O IT D A Q O N Q U Y ISH Q on ketish va qon y o ‘qotish M a sh g ‘u lo tn in g maqsadi: y a ra d o rla rd a q o n k e tish in in g y e ta rli d a - v olash p r in s ip la r in i o ‘rg an ish . T a la b a la rn i tib b iy p u n k t va j o n la n ti- rish m a y d o n id a q o n k e tish n i v a q tin c h a t o ‘x ta tish u su llarig a o ‘rgatish. 0 ‘quv savollari: u ru s h d a q o n k e tish , y a ra d o rla r 0 ‘lim in in g sa b a - bi. Q o n k e tish ta sn ifi. 0 ‘tk ir q o n y o ‘q o tish klinikasi. T ibbiy k o ‘c h irish bosqichi va ja n g m a y d o n id a q o n k e tish n i v a q tin c h a to ‘xtatish u sullari. M a sh g ‘u lo tn i o ‘tkazish uslubi: m a s h g 'u lo t o ‘quv x o n asi, b e m o r - x o n a b o 'lim id a o ‘tk a z ila d i. 0 ‘q u v x o n a d a q o n k etish n in g n a z a riy sa- vollar ta sn ifi va k lin ik a si k o ‘rib c h iq ila d i. B e m o rx o n a d a k o ‘p q o n y o ‘q o tg a n b e m o rla r k o ‘rsatilad i. 0 ‘quv x o n a s id a t a l a b a l a r q o n k e tis h n i v a q tin c h a t o ‘x ta tis h u s u lla r in i o ‘rg a n a d ila r, b ir-b irla rig a jg u t, b o su v c h i b o g ‘lam q o ‘y ad ilar, m ag istral to m irla rn i b a r m o q b ila n b o sa d ilar, q o ‘l-o y o q n i m aksim al b u k a d ila r. «Q o ‘l-o y o q sh ik astlan g an d a q o n k etish n i v aqtincha to 'x ta tish » , jg u t- la r in d iv id u l b o g ‘Iov p a k e ti, q o n t o ‘x ta tu v c h i q isq ich larn in g tu rla ri. M ash g‘uIot m azm uni: u ru sh d a q o n k etish i y a ra d o rla r o ‘lim in in g sababidir. Ik k in c h i j a h o n u ru s h id a ja n g m a y d o n id a q o n k etish d a n o 'lg a n la r h a m m a o ‘lg a n y a ra d o rla rn in g 50% ini tash k il qildi. (M .F .G Ia z n o v , 1953-yil). V .I .S tr u c h k o v (1 9 5 3 ) b o ‘y ic h a ja n g m a y d o n id a q o n k e tis h d a n o lg a n la r n in g 6 1 % i q o rin va k o ‘k ra k b o ‘sh lig ‘i to m irla ri ja r o h a tig a , 36,1% i q o ‘l- o y o q la m in g yirik to m irla ri ja ro h a tig a , 29% i b o s h q a so h a to m irla ri ja r o h a tig a t o ‘g ‘ri k elad i. V .l. B y alik (1 9 5 3 ) h a y o t u c h u n xavfli b o ‘lgan ta sh q i va ich k i q o n k e tish la rd a ja r o h a t joylashishini o ‘rgandi. U ning m a ’lum otiga k o ‘ra ta sh q i q o n k e tis h d a n o ‘lg a n ia r ic h id a q o ‘l-o y o g ‘i s h ik a s tla n g a n la r (86,9% ) y a r a d o r s h a x s la rd a n u stu n tu ra d i. H ay o t u c h u n xavfli ichki q o n k e tish la r ic h id a q o rin ja ro h a ti 4 1 % , to ra k o a b d o m in a l ja r o h a tla r 20% , c h a n o q 8 % , b o s h q a ja ro h a tla r 1% ni tash k il qiladi. S h u n d a y q ilib , q o n k e tish m u a m m o s in in g ak tu allig i ja r o h a t a so - ra tid a n o ‘lim o q ib a tla r in in g p a sa y ish i ja n g m a y d o n id a y a ra d o rg a o ‘z v a q tid a b ir in c h i tib b iy y o rd a m h a m d a v ra c h lik , m alak ali y o rd a m n i tib b iy k o 'c h ir is h b o s q ic h la rid a k o ‘rs a tis h n i ta sh k il q ilish n i b ilish b i lan a n iq la n a d i. Q on k etish ta sn ifi. Q o n ketish d e b to m irla r b u tu n lig in in g b u z il- ishi n a tija sid a u n d a n q o n o q ib k e tish ig a ay tiladi. www.ziyouz.com kutubxonasi Q uyidagi ta sn if qabul qilingan: B irlam chi q o n ketish tra v m a yoki ja r o h a td a n b ir o z vaqt o ‘tg a n d a n k ey in turli q o n to m irla rn in g sh ik a stla n ish i n a tija s id a y u zag a keladi. Q a y e rd a n q o n k e ta y o tg a n ig a k o ‘ra q o n k e tis h la r b o ‘ladi: arte ria l — a rte riy a q o n to m ir d a n ; a r te r io - v e n o z — a r te r iy a va v e n o z q o n t o m i r b irg alik d a s h ik a s tla n g a n d a ; v e n o z - v e n a q o n to m irla rid a n ; k a p illy a r — k a p illy a r q o n to m ir la r d a n ; p a r e n x im a to z — tu rli xildagi p a re n x im a o rg a n la rd a n . T u rli x ild a g i q o n k etish b e lg ila ri: 1. A rte ria l q o n k e tish . Q o n o q im b ila n , f o n ta n s im o n k etad i. C h iq a y o tg a n q o n m iq d o ri q o n to m ir k a lib rla ri v a q o n to m ird a g i ja ro h a t kattaligiga b o g ‘liq. Q o n rangi o c h q iz il. A rte ria l q o n k etish n i ja ro h a t va yurak o ra lig ‘id ag i q o n to m irn i b o s ib t o ‘x ta tila d i. 2. A rte ria l-v e n o z q o n k e tish . Q o n te z d a ja r o h a t n i t o ‘ld irad i. Q o n ran g i qizil. J a ro h a td a n y u q o rid a g i q o n to m ir b o s ilg a n d a q o n ketish t o ‘x ta m a y d i, le k in q o n ra n g i h a m o ‘z g a rm a y d i. J a r o h a td a n pastki q o n to m irla r b o silg an d a h a m q o n k etish t o ‘x ta m a y d i, lek in q o n rangi e sa o c h qizil b o la d i. 3. V en o z q o n ketish. Q o n b ir xilda se k in u r ib tu rm a y d ig a n oqim b ila n k etad i. O q im rangi t o ‘q (qizil) ra n g d a . J a r o h a td a n yuqoridagi to m ir la r bosilsa, q o n k e tish k u c h a y a d i. 4. P a re n x im a to z q o n k e tish . P a re n x im a to z o r g a n la r q o n tom iri o rg a n n in g birik tiru v ch i to 'q im a stro m a si b ila n u z v iy a lo q a d a , sh u n in g u c h u n k esilganda u la r b ir - b ir id a n o c h ilib q o la d i v a b ir-b irig a m os k elm ay d i. Q o n k etish k o ‘p va t o ‘x ta tish ju d a q iy in . Ik k ilam ch i q o n k e tish b irla m c h i q o n k e tis h d a q o n to m ir bevosita z a ra rla n ib , u o ‘zi yoki q a n d a y d ir d av o u su lla ri b ila n to 'x ta tilg a n d a n k ey in rivojlanadi. Ik k ila m c h i q o n ketish a s o s a n b ir m a rta b o la d i, www.ziyouz.com kutubxonasi lek in q a y ta rilish i h a m m u m k in . B u n d a u la rn i q a y ta la n u v ch i y o k i re t- s id iv li d e y i l a d i . E rta va k e c h k i ik k ila m c h i q o n k e tish y a q in 2 - 3 k u n ic h id a ja ro - h a tla n g a n q o n to m ir d e fe k tin i to 'ld ir ib tu rg a n tro m b n in g k o ‘ch ish i, q o ‘yilgan lig a tu ra n i siljib k etish i yoki q o n to m ir d evoridagi y o t ta n a n i k o ‘ch ish id a n k elib c h iq a d i. E rta ik k ilam ch i q o n ketish h o llari k a m d a n k a m k u z a tila d i va aso sa n bu sh ik a stla n g a n q o ‘l yoki o y o q n i yaxshi im m o b iliz a tsiy a q ilm a y tra n s p o rtiro v k a q ilg an d a k uzatiladi. Ich k i q o n k e tish o d a td a 1 0 - 1 5 k u n d a n k eyin, b a ’z a n ja ro h a tla - n ish d a n b ir n e c h a so a td a n k e y in b o l a d i . Ik k ilam ch i q o n k e tish n in g sabablari: 1. D o ri v o s ita la rn i q ab u l q ilg a n d a A /B ni o sh ish i q o n to m ird a sh a k lla n ib u lg u rm a g a n tro m b n i k o ‘c h irib y u b o ra d i. 2. Q o n to m irg a q o ‘yilg an d re n a jn in g , q a ttiq bo sish i y o t m etall ( o ‘q , p a r c h a ) , sin g a n suy ak p a rc h a s in in g su rilib q o lish i q o n to m ird a y o to q y a ra n i p a y d o q ilad i va n a tija d a ik k ilam ch i q o n k etish b o la d i. 3. Q o n k e tis h d a te x n ik u s u lla m i n o to ‘g ‘ri q o ‘llash - q o n to m irg a q o ‘yilgan lig a tu ra n in g su rilib k e tish i, y e c h ilib k etishi. Ja ro h a td a g i y i- ringli - y a llig ‘Ia n ish ja ra y o n i tro m b n in g y u m sh a sh i va erish ig a o lib keladi va n a tija d a bu h a m ik k ila m c h i q o n k etish ig a sab ab b o l a d i . Ik k ila m c h i q o n k e tish sa b ab larig a y a n a sepsis tro m b n in g erish ig a o lib k elad i, s h u n in g d e k , q o n to m irla rd a u m u m iy va q ism an re p a ra tiv ja ra - y o n la rn in g b u z ilish ig a o lib k e lu v c h i h o la tla r: q o n y o ‘q o tish , tra v m a - tik sh o k , o q sil y e tish m o v c h ilig i va b o s h q a la r sab ab b o ‘ladi. 0 ‘tk ir q o n y o ‘q o tish klinikasi 0 ‘tk ir q o n y o ‘q o tish b e lg ilari q o n k etish tezligi va y o ‘q o tilg a n q o n k e tish i q a n c h a k u ch li b o l s a , o ‘tk ir q o n y o ‘q o tish klinikasi sh u n - c h a o g ‘ir k e c h a d i. Q o n h a jm i 1 /3 q ism in in g tez y o ‘q o tilish i h ay o t u c h u n x a v f s o la d i; u m u m iy q o n h a jm in in g y arm in i y o ‘q o tish esa o ‘lim ga o lib k e la d i. 65 kg o g ‘irlik d a q o n hajm i besh litrn i tash k il q ilad i. S h u n d a y q ilib 1 ,5 - 1 ,7 litr q o n y o ‘q o tish xavfli, 2 ,5 litr esa o i i m g a o lib k e la d i. L e k in k lin ik a d a q o n y o ‘q o tish g a in d iv id u a l se z u v c h a n lik b ila n b o g l i q o g ‘is h la r h a m b o lg a n . Y osh b o la la r va q a r i l a r q o n y o ‘q o t is h n i y o m o n o ‘tk a z a d ila r . A y o lla r j in s i q o n y o ‘q o tish g a c h id a m li. Q o n n in g te z o q ib k etish i, u zo q q o n k e tish d a m o sla sh u v c h i m e x a n iz m la r ishga tu sh ish g a ulgurm aydi. S u ru n k ali q o n k e tish d a m o s la s h tiru v c h i m e x a n iz m la r q o n k etish n i m o v o fiq lash tirad i. O rg a n iz m n in g u m u m iy h o la ti - o z g ‘in , h olsiz, jism o n iy c h a rc h a g a n , kasallik va o p e ra ts iy a o ‘tk a z g a n , se m iz sh ax sla r q o n k etish n i y o m o n o ‘tk a z a d ila r. 0 ‘tk ir q o n y o ‘qotish belgilari. T eri qoplam lari va ko‘rinadigan shilliq www.ziyouz.com kutubxonasi q a v a tla m in g quruqligi, y uzning o 'tk irla sh ish i, k o ‘z oldi q o ro n g 'ila sh ish i, q u lo q d a sh ovqin, bosh aylanish, k o ‘ngi) aynish, qayt qilish — q a y t qi- lish m arkazi va bosh miya p o ‘stlo g ‘in in g ta ’sirlanishi b ila n tu sh in tirila d i. Puls tez, kuchsiz, ipsim on. A rterial va m arkaziy venoz b o s im in in g p asa- yishi kuzatiladi. A /B 6 0 - 5 0 m m .sim .u st. va u n d an p asay g an d a oliy nerv faoliyatida o ‘sib boradi: dastlab bezovtaljk, keyin q o ‘rquv, h a lo k b o ‘lish hissi, y u zn in g tushkunlik k o ‘rin ish d a b o ‘lishi, d ezo riy en tatsiy a, d ep re s- siya, h u sh chalkashligi va y o 'q o tis h boMadi. H ushni y o ‘q o tg a n d a n keyin talvasa, siydik, axlatni ixtiyorsiz ajralishi va o ‘lim b o ‘lad i. T a sh q i qon ketishda birinchi tibbiy yordam q o ‘l ostidagi b o r narsalar b ilan shoshilinch tez q o n ketishni vaqtincha t o ‘x ta tish d a n iborat. Q o n k e tish n i v a q tin c h a t o ‘x ta tis h u su llari, B T Y (b ir in c h i tib b iy y o rd am ). U ru sh m aydonida q o n k e tish b o lg a n d a y o rd a m , q o n k etish n i v a q tin c h a t o ‘x tatish usullari q o ‘lla n a d i (a rte riy a yoki v e n a s h ik a s tla - n ish ig a k o ‘ra ). A rteriy an i b a r m o q b ila n b o sish , ja r o h a td a n y u q o ri jo y b o silad i. Bu usul kam h o lla rd a q o ‘lla n ad i. B T P y o k i B rT P d a bu usul e r ta q o 'y ilg a n jg u tn i te k s h iris h yoki a lm a sh ilish d a y a r a d o r k o ‘p q o n y o ‘qo tm aslig i u ch u n qoM lanadi. M asalan , q o n k e ta y o tg a n to m irg a q o n t o ‘x ta tu v c h i zajim lar q o ‘y ila d i. B a rm o q b ila n bosish a rte riy a b o sila d ig a n n u q ta la rd a b o silib , bu y e rd a a rte riy a suy ak u stid an o ‘ta d i. C h a k k a arteriyasi c h a k k a su y ak k a, ta sh q i y u q o ri ja g ‘ arteriyasi — p a s tk i ja g ‘ b u rc h a g ig a , u y q u a rte riy a si to ‘s h - o ‘m ro v s o ‘rg‘ic h sim o n m u s h a k n in g ichki y u zasi b o ‘y la b , o ‘rta yoki p a stk i 1,3 q ism id an b o ‘y in u m u rtq a la ri to m o n g a b o sila d i. 0 ‘ m r o v o s ti a r t e r i y a s i n i o ‘m r o v n in g o ‘r t a s i n i n g o r q a s i d a n q o v u rg ‘aga b a rm o q b ilan b o s ila d i; q o ‘ltiq o sti a rte riy a la ri e sa q o ‘ltiq osti c h u q u rc h a si to m o n d a n y elk a su y ag in in g p ro k sim al u c h ig a b o silad i. Y elka a rte riy a si yelk an in g ikki b o s h li m u sh a g in i ic h k i y u z a s i to m o n i- d a n y elk a suyagiga bosiladi. S o n a rte riy a si c h o v b o y la m i o s tid a n son su y a g in in g p ro k sim al oxiriga b o sila d i. B a rm o q b ilan bosish a s o s a n q isq a v aq t ic h id a , m a s a la n , jg u t b o g ‘la sh d a qoM lanadi. B a rm o q b ila n q o n t o ‘x ta tish n i v ra c h g a c h a va b irin c h i v ra c h lik y o rd am k o krsa tish d a g i a h a m iy a ti a n a s h u la r. Q o ‘l-o y o q n i m aksim al b u k ish . Q o 'ltiq o sti c h u q u r c h a s i va ularg a yaqin jo y la sh g a n to m irlard an q o n k etish n i to 'x ta tish u c h u n b o ‘g ‘im n in g b u k ilu v c h i y u zasig a p a x ta b o ‘lagi q o ‘y ilad i va u n in g u s tid a n sh u b o ‘g ‘im b u k ila d i. K eyin q o ‘l y o k i o y o q b u k ilg an h o la td a b in t b ilan b o g ‘la n a d i. Bu usul keng ta r q a lm a g a n , lek in u n in g y o r d a m id a q iy in a h v o ld a n c h iq ish m u m k in . Q o ‘l-o y o q la rn in g o ‘q te k k a n s in is h la rid a b u usul q o ‘Ilanilm aydi. B u n d a y h o la td a b in tla n g a n y a r a d o r la r n i o lib c h iq ish va ev a k u atsiy a qilish q iy in . B o su v ch i b o g ‘lam . Ik k in c h i j a h o n u ru sh i d a v rid a ja n g m a y d o n id a m a y d a kalib rli a rte ria l va v e n o z to m irla rd a n , k a p illy a rd a n q o n k e - www.ziyouz.com kutubxonasi ta y o tg a n y a ra d o rla m i 29,6% d a q o ‘11angan. B osuvchi b o g 'la m q o ‘yish u c h u n o d a td a 1 ta yoki 2 t a in d iv id u a l b o g ‘lam p a k e ti q o lla n ila d i. J g u t q o ‘yish. J a n g m a y d o n id a q o n k e tish n i v a q tin c h a t o ‘x ta tish u su li h is o b la n a d i. Ik k in c h i ja h o n u ru sh i d a v rid a s h u m a q sa d d a u n i 6 5 ,6 % y a ra d o r- la r d a qoM lashgan. J g u t q o ‘l o y o q la m i distal q is m in in g ishem iyasini c h a q ira d i. M uskul k a m b o ‘lg an va nerv suyakka y a q in jo y lash g an jo y d a n erv stvoli suyak- ka s iq ilish i n atija sid a k u ch li sh ik a s tla n a d i (y e lk an in g o ‘rtasi ~ b ilak n e rv i, b o ld im in g y u q o risi — k ic h ik b o ld ir n ervi). U z o q v aq t (ikki s o a t va u n d a n o rtiq ) q o ‘y ilg an jg u t o y o q -q o ‘lni c h in g a n g re n a sin i k e ltirib c h iq a ra d i, sh u n in g u c h u n so v u q boMmagan v a q td a 2 so atg ach a, s o v u q d a v r d a 1 s o a td a n k e y in j g u t s h ik a s tla n g a n q o ‘l- o y o q d a k o lla te r iy a la r b o ‘ylab o q im in i v a q tin c h a tik la sh u c h u n jg u t y e ch ilad i v a ja ro h a tla n g a n n i tra n sp o rtiro v k a qilish m aqsadida jg u t qayta q o ‘yiladi. Q u ro lli k u c h la r shaxsiy ta rk ib i jg u t q o ‘yish q o id a sin i b ilishi va jg u t q o ‘y ish q o id a sin i b a ja ra o lis h i kerak. U y irik a rte riy a la r sh ik a st- la n g a n d a q o ‘yiladi. J g u t q o ‘y ish qo id asi. T e r in i ezm aslik va n e k ro z n i c h a q irm a slik u c h u n u n i b in td a n q ilingan y o k i b o s h q a b ir m a to d a n (so ch iq , yirtilgan k o 'y la k v a b .) o raliq b ila n h im o y a q ilin ad i. Jg u t t o ‘g ‘ri kiyim ga, u n in g b u rm a la rin i t o ‘g ‘rilab q o ‘y ish m u m k in . Jg u t y elk a n in g 1,3 q is m in in g o ‘rta sig a , b o ld im in g y u q o ri qism iga b ila k va k ich ik b o ld ir n e rv la rin i sh ik a stla m a slik u c h u n q o ‘yilm aydi. J g u t q o ‘y ish d a n o ld in a rte ria l q o n n i to 'x ta tis h u c h u n o y o q yoki q o ‘l k o ‘ta r ila d i. J g u t j a r o h a t d a n p ro k s im a lro q , iloji b o r ic h a u n g a y a q in r o q , o r tiq c h a to r tm a s d a n ja r o h a td a n q o n o q ish i t o ‘x ta g u n c h a v a p e r if e r ik a rte riy a la rd a p u ls y o ‘q o lg u n c h a siq ib q o ‘y ilad i. Jg u t b o s im i q o ‘y ilg a n jo y d a a r te r ia l b o s im d a n 15—20 m m . sim o b .u st. y u q o ri boM ishi k erak. Jg u t y a r a d o r d a k o ‘rin ish i k e ra k . Q o ‘yilgan v a q ti h a q id a q o g ‘ozga b e lg ila b q o ‘y ila d i, jg u t o y o q - q o ‘lda 2 s o a t d a n k o ‘p tu rm a s lig i k e ra k , q is h d a e sa 1 so at. J g u t q o ‘yish texnikasi. Jg u t q o ‘yayotgan sh ax sn in g b ir q o l i tashqi to m o n d a , ikkinchisi o y o q - q o ‘ln in g ic h k i to m o n id a b o lis h i kerak. Jgut c h o 'z ila d i va c h o ‘zilgan q ism i b ila n asosiy sh ik astlan g an to m ir so h asi- g a q o ‘yiladi. 1-tur b o ‘shashib ketm asligi u chun kesishm a qilinadi. H am - m a v a q t jg u t to rtilib tu rila d i, u n i q o ‘l-oyoq atro fid a b ir n e c h a m arta jg u t y o ‘llari y o n m a -y o n qilib, b ir-b ir in i ustiga tu sh irm a sd a n o ‘raladi. J a r o h a tn i zieh ta m p o n a d a la s h (B rT P ). A gar bo su v ch i bogM ashning n a tija si b o l m a s a , jg u t q o ‘y ish g a e sa ja ro h a t so h a n in g a n a to m ik x u - s u s iy a tla ri y o ‘l q o ‘y m asa (d u m b a s o h a sin in g c h u q u r ja r o h a ti, so n n in g y u q o r i 1,3 q ism id a g i c h u q u r ja r o h a t ) , u z u n ste ril sa lfe tk a b ila n ja r o h a tg a z ie h b osib ta m p o n q o ‘y ilad i. www.ziyouz.com kutubxonasi Jang m ay d o n id a va vrachgacha boM gan yordam (B T P). J a n g m a y - d o n id a q o n ketishni vaqtincha t o ‘xtatish u c h u n q o kllaniladigan b a r c h a B T P tartibini o ‘z ichiga oladi. L ek in B T P dagi o ‘rta tibbiy x o d im in in g malakasiga qarab qon ketishni v a q tin c h a t o ‘xtatish anch a sifatliroq bo*ladi va erta q o ‘yilgan bog‘lam va jg u tla r b e m o r ahvolini yengillashtiradi. V rach y o rd a m i (B rT P ). B rT P b o g ‘!ov x o n asid a b arch a y a r a d o r la r - ga erta q o ‘yilgan jg u tla r ko‘zd an k e c h irila d i va ular k o ‘rsatm aga b in o a n q o ‘yilganm i, y o ‘q m i shuni an iq iay d i. E rta q o 'y ilg a n jg u tn i nazorat q ilish tex n ik asi. J a ro h a td a n b o g ‘la m , jgut y e ch ilad i, ja ro h a t ko‘zd an k e c h irila d i. Jg u t yechiiganda h a tto k a t- ta arterial q o n to m irla r ham q o n a m a y d i. 2 - 3 d aq iq ad an s o ‘ng re a k tiv giperem iya b o sh lan ad i. A gar a rte ria l q o n ketish b o l s a , y a ’ni o c h qizil rangli q o n u r ib tu rib , fo n ta n g a o ‘xshab o q sa , m a g is tra l q o n to m ir b a rm o q b ila n 2 d a q iq a b o silad i (b u - jg u tn i y e c h is h d a n a w a l q o n k e tish n i o ld in i olish u c h u n q o n to m irn i b o sib tu ris h h a m m u m k in ). K u tib tu r ila d i. Bu q o ‘l-o y o q distal qism lariga a rte ria l q o n n i kollateral a rte ria l q o n to m irla r b o ‘ylab oqishini t a ’m in la y d i. Jgut y e c h ilg a n d a n so ‘ng a g a r q o n k e tis h d av o m etsa, q u y id a g ila r am alg a o sh irilad i: a) B rT P d a k a tta qon to m ir d a n k u c h li q o n k e tsa , y a n a jg u t q o ‘yiladi va b irin c h i o ‘rin d a A T O g a q o n k e tish n i d o im iy t o ‘x ta tis h u c h u n y u b o rilad i; b) ja r o h a tn i ilm o q bilan o c h ib , a rte riy a g a q o n t o ‘x ta tu v c h i z a jim q o ‘yishiga va q o n to m irn i ja ro h a td a b o g ‘lash g a h arakat q ilin ad i. S h u b - hali h o lla rd a zajim o linm aydi: sh u h o ld a y a ra d o r A T O ga y u b o r ila d i;. d) q o n to m ir n i ja ro h a td a tik ish ; e) ja r o h a t tu b id a n kuchli q o n k e tg a n d a ja ro h a tg a steril d o k a d a n zieh ta m p o n a d a q o ‘yiladi va ta m p o n u s tid a n te ri, teri o sti y o g ‘ k le t- c h a tk a va m u sh a k la rn i birga q o ‘s h ib , 2 —3 c h u q u r c h o k q o ‘y ila d i; f) k o ‘rsa tilg a n h o llard a q o n to m ir n i sh ik a stla n g a n jo y d a n y u q o - riro q d a n bogMash (tikish). B u n d a y h o l l a r d a 1- t i b b i y k a r t o c h k a t u t i l i b , u n g a k e r a k i i m a ’lu m o tla r y o ziiad i va y a ra d o rn i A T O g a yuboriladi. A gar jg u t y ec h ilg a n d an s o ‘ng j a r o h a t d a n arterial q o n t o ‘x ta m a s a , kerakii asoslarsiz q o ‘yilgan b o iis h i m u m k in . Q o n k etish n i t o ‘x ta tis h d a bosu v ch i b o g ‘la m q o 'y ish m a q sa d g a m u v o fiq . H a r q an d ay u su l b ila n v a q t i n c h a q o n t o ‘x ta t i s h d a n s o kn g a s e p t i k b o g i a m q o ‘y i l a d i (k o ‘rsa tm a g a b in o a n ), q o ‘l-o y o q t r a n s p o r t im m o b ilizatsiy asi q ilin a d i, qish v a q tid a q o ‘l-o y o q isitiladi. J a n g m a y d o n id a q isq a m u d d a t g a j g u t q o ‘y ilg a n y a r a d o r l a r (4 s o a td a n k e c h boM m agan), q o n k e tis h in i d o im iy t o ‘x ta tis h g a t u - sh ish la ri k erak . www.ziyouz.com kutubxonasi M a sh g ‘uIot m av zu si b o ‘y ic h a ta la b a la r ega b o 'lis h i kerak b o 'Ig an a m a liy k o ‘n ik m alar. Q o n ketish in i v a q tin c h a t o ‘x tatish: 1. A rte riy an i b a rm o q b ila n bo sish . 2. O y o q -q o ‘lni m a k s im a l b u k ish . 3. B osuvchi bogM am . 4: J a ro h a tn in g z ic h ta m p o n a d a s i. 5. Jg u t q o ‘yish. 6. J a ro h a td a q o n a y o tg a n to m irg a qisqich b o g ‘lash. 7. J a ro h a td a to m ir n i b o g ‘lash. 8. Q o n a y o tg a n j a r o h a t d a n y u q o rid a to m irn i b o g 'la s h (tikish). V a ziya tii masala P u is d aq iq ag a 130 t a , y u m s h o q , A /B 7 5 /5 0 m m .sim .u st. C h a p y e lk a n i y u q o ri q ism ig a jg u t, o ‘rta qism iga b o g la m q o ‘yilgan. B og'lam q o n b ila n h o ‘llan g an . QoMi ta n a sig a b in tla n g a n . T irs a k a rteriy asid a p u lsa tsiy a a n iq la n m a y d i. Y e lk a so h asid a p ato lo g ik h a ra k a t y o ‘q. 1. T ashxis q o ‘yin g v a a so slan g . 2. P u n k t ic h id a s a r a la s h n i o ‘tkazing. 3. T ib b iy y o rd a m h a jm in i an iq lan g . B rT P oddiy a s k a r N . o sk o lk a li ja ro h a t b ila n 1 so a td a n keyin k e ld i. H o la ti q o n iq a rli. T e r i q o p la m la ri ra n g p a r. P u is d aq iq ag a 86 t a , q o n iq a rli, t o ‘lis h g a n , ta r a n g A / B - l 10/70 m m .sim . ust. 0 ‘ng b o l- d ir n in g o ‘rta q ism id a q o n b ila n h o ‘llangan bogM am. O y o q u ch zinali s h in a b ila n im m o b iliz a tsiy a q ilin g a n . 0 ‘ng s o n i o ‘rta qism iga jgut q o ‘yilgan. 1. D iag n o z q o ‘y in g v a a so slan g . 2. P u n k t ic h id a s a r a la s h n i oMkazing. 3. T ib b iy y o rd a m h a jm in i an iq lan g . Download 24.3 Kb. Do'stlaringiz bilan baham: 
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