Stridor inzwi riri kufemereka, rinowanzoita ruzha rwepamusoro-soro rwunobudiswa nekumhanya, kubvongodza kuyerera kwemhepo kuburikidza nechikamu chakatetepa chenzira dzepamusoro dzemhepo. Kazhinji kazhinji inofuridzira, inenge nguva dzose inonzwika pasina stethoscope. Iripo muvana, inogona kuvapowo muvakuru here? Ndezvipi zvikonzero? Uye migumisiro yacho? Nzira yekurapa nayo?

Stridor inguva isina kujairika, kufemereka, yakawedzera kana kushoma ruzha rwunobudiswa nekufema. Kazhinji, inenge ichirira zvokuti inonzwika kure kure. Ichi chiratidzo, kwete chekuongorora, uye kutsvaga zvikonzero zvakakosha zvakanyanya sezvo stridor inowanzova emergency emergency. 

Kubva palaryngotracheal mavambo, stridor inokonzerwa nekukurumidza, kubvongodza kuyerera kwemhepo inoyerera kuburikidza yakamanikana, kana zvishoma yakavharidzirwa, yepamusoro yekufema turakiti. Anogona kuva:

• yepamusoro-soro uye mimhanzi, pedyo nerwiyo;
• zvakakomba, zvakadai sokudzvova kana ngonono;
• kusheedzera nemhando yenyanga, kunge kurira.

Stridor inogona kuva:

• inspiratory: inonzwika pakufemerwa panguva yekudzikisa kwepathological dhayamita yekumusoro extra-thoracic airways (pharynx, epiglottis, larynx, extra-thoracic trachea);
• biphasic: pakaitika chivharo chakanyanya, chiri biphasic, ndiko kuti chiripo pamatanho maviri ekufema;
• kana kupera simba: kana paine chinovharira chiri muintrathoracic airways, stridor inowanzopera.

Stridor ndiyo inowanzoitika muvana pathology yekufema turakiti. Chiitiko chayo hachizivikanwi muhuwandu hwevana. Zvisinei, kuwanda kwepamusoro kwakaonekwa muvakomana.

Izvo zvinofanirwa kucherechedzwa kuti kunyangwe isiri yakanyanya kuwanda, stridor inowanikwawo muvakuru.

Vana vane tunzira tuduku, twakatetepa uye vanowanzoita ruzha rwekufema. Stridor inokonzerwa nemapathologies anosanganisira larynx uye trachea. Wheezing inowanzoitika yebronchial pathology. Kana kufema kune ruzha kunowedzera panguva yehope, chikonzero chiri muoropharynx. Kana kufema kunowedzera kana mwana akamuka, chikonzero chiri mularynx kana trachea.

Muvana, zvikonzero zvinowanzoitika zvinosanganisira congenital zvikonzero uye zvakawanikwa zvikonzero.

Congenital zvikonzero zve stridor muvana

• Laryngomalacia, kureva kuti jira rakapfava: ndiyo inonyanya kukonzera congenital stridor uye inomiririra 60 kusvika 70% ye congenital laryngeal anomalies;
• Kuoma mitezo yezwi;
• A stenosis, kureva kutetepa, congenital subglottis;
• Tracheomalacia, kureva trachea yakapfava uye inoshanduka;
• A subglottic hemangioma;
• Dandemutande (laryngeal web), kureva membrane inobatanidza tambo dzezwi mbiri nekuda kwekusagadzikana kwekuzvarwa;
• Laryngeal diastema, kureva kutadza kuumbika kunoita kuti mboro itaurirane nemudumbu.

Zvakawanikwa zvikonzero zve stridor muvana 

• Yakawana subglottic stenosis;
• Croup, inova kuzvimba kwetrachea nevocal cords, kazhinji inokonzerwa nehutachiona hwehutachiona hwehutachiona;
• Muviri wekunze wakafemerwa;
• shrill laryngitis;
• Epiglottitis, inova hutachiona hweepiglottis hunokonzerwa nebhakitiriya Haemophilus influenzae rudzi b (Hib). Chikonzero chinowanzoitika che stridor muvana, chiitiko chayo chakadzikira kubva pakatangwa mushonga wekudzivirira Haemophilus influenzae rudzi B;
• tracheitis, nezvimwewo.

Zvinowanzoitika muvakuru

• Mamota emusoro nemutsipa, akadai sekenza yeraryngeal, anogona kukonzera stridor kana akavharira nzira dzekumusoro dzemhepo;
• An abscess;
• Edema, kureva kuzvimba, kwepamusoro pemhepo yekufema iyo inogona kuitika semugumisiro we extubation;
• Vocal cord dysfunction, inonziwo paradoxical vocal cord mobility;
• Kuora mitezo yezwi, kutevera kuvhiyiwa kana intubation kunyanya: apo tambo mbiri dzezwi dzakaoma mitezo, nzvimbo iri pakati payo yakamanikana zvikuru uye nzira dzemhepo dzinova dzisina kukwana;
• Muviri wekunze wakafemerwa sechikafu chekudya kana kamvura kadiki kakapinzwa mumapapu zvichiita kuti dokoriro igume;
• Epiglottitis;
• Allergic maitiro.

Zvikonzero zve stridor zvinogona zvakare kurongeka zvichienderana nezwi rayo:

• Acute: laryngomalacia kana kuoma mitezo yezwi;
• Zvakaoma: laryngomalacia kana subglottic pathology;
• Hoarseness: laryngitis, stenosis kana subglottic kana yakakwira tracheal angioma.

Stridor inogona kupindirana nekufema kana mhedzisiro yekudya, inoperekedzwa nezviratidzo zvekuomarara senge:

• kuoma mukudya kwekudya;
• zvikamu zvekushaya mweya panguva yekudya;
• kunonoka uremu kukura;
• dyspnea, iyo yakaoma mukufema;
• zvikamu zvekutambudzika kwekufema;
• zvikamu zve cyanosis (bluish discoloration yeganda uye mucous membranes);
• obstructive sleep apnea;
• kusimba kwezviratidzo zvekufema kurwisa: kuputika kwemapapiro emhino, intercostal uye suprasternal retraction.
  

Pamberi pechero stridor, kuongororwa kweENT nekuita nasofibroscopy kunofanirwa kutsanangurwa. A biopsy, CT scan, uye MRI zvinoitwawo kana bundu richifungidzirwa.

Stridor inokonzera kutadza kufema munhu akazorora idambudziko rekukurumidzira. Kuongororwa kwezviratidzo zvakakosha uye dhigirii rekufema kunetseka ndiyo nhanho yekutanga mukutarisira. Mune zvimwe zviitiko, kuchengetedza nzira dzemhepo kunogona kudikanwa pamberi kana pamwe chete nekiriniki yekuongorora.

Nzira dzekurapa dze stridor dzinosiyana zvichienderana nechikonzero chechiratidzo.

Kana iri laryngomalacia

Pasina maitiro ekukomba, kana chiratidzo chakabatana, nguva yekucherechedza inogona kurongerwa, zvichienderana nekuitwa kweanti-reflux kurapwa (antacids, kukora kwemukaka). Kutevera kunofanirwa kuve kwenguva dzose kuitira kuve nechokwadi kudzoreredzwa zvishoma nezvishoma kwezviratidzo uyezve kunyangarika kwavo mukati menguva inotarisirwa.

Zviratidzo zvelaryngomalacia zvakanyanya kupfava uye zvinoenda zvega vasati vasvika makore maviri. Zvisinei, vangangosvika 20% yevarwere vane laryngomalacia vane zviratidzo zvakakomba (zvakanyanya stridor, kunetsa kudya, uye kukura kunonoka) zvinoda kurapwa ne endoscopic surgery (supraglottoplasty).

Muchiitiko chemuviri wekunze wakafemerwa

Kana munhu wacho ari kunze kwechipatara, mumwe munhu anogona, kana akarovedzwa, kumubetsera kudzinga muviri wokumwe kupfurikidza nokuita Heimlich maneuver.

Kana munhu wacho ari muchipatara kana mukamuri rekukurumidzira, chubhu inogona kuiswa nemumhino kana muromo wemunhu (tracheal intubation) kana zvakananga mutrachea mushure mekuvhiyiwa kudiki (tracheostomy) , kubvumira mweya kupfuura chipingamupinyi uye kudzivirira. kutadza kufema.

Kana iri edema yekufema turakiti

Nebulized racemic adrenaline uye dexamethasone inogona kukurudzirwa kune varwere vane airway edema inobatanidzwa.

Muchiitiko chekutambudzika kwakanyanya kwekufema

Seyero yenguva pfupi, musanganiswa wehelium neokisijeni (heliox) inovandudza kutenderera kwemhepo uye inoderedza stridor mumatambudziko makuru emhepo senge post-extubation laryngeal edema, stridular laryngitis uye mapundu edoro. Heliox inobvumira kuderedzwa kwekuyerera kwemhepo nekuda kwekuderera kwehelium kana ichienzaniswa neokisijeni uye nitrogen.