Stridor ndi phokoso lopumira, lomwe nthawi zambiri limakhala lokwera kwambiri, lomwe limapangidwa ndi mpweya wothamanga, waphokoso kudzera pagawo lopapatiza la mlengalenga. Nthawi zambiri zimakhala zolimbikitsa, pafupifupi nthawi zonse zimamveka popanda stethoscope. Zopezeka mwa ana, zitha kukhalanso mwa akulu? Kodi zimayambitsa chiyani? Ndipo zotsatira zake? Kodi kuchitira izo?

Stridor ndi phokoso losazolowereka, lopuma pang'onopang'ono, locheperako kapena lochepera lomwe limatuluka popuma. Kaŵirikaŵiri, kumamveka mokweza kwambiri moti kumamveka chapatali. Ichi ndi chizindikiro, osati matenda, ndipo kupeza zomwe zimayambitsa ndizofunikira kwambiri chifukwa stridor nthawi zambiri imakhala yadzidzidzi. 

Kuchokera ku laryngotracheal, stridor imayamba chifukwa cha kuthamanga kwa mpweya wothamanga, wosokonekera kudzera munjira yopapatiza, kapena yotsekeka pang'ono, yakumtunda yakupuma. Iye akhoza kukhala:

• nyimbo zapamwamba komanso zoyimba, pafupi ndi nyimbo;
• zovuta, monga kulira kapena kuwomba;
• phokoso ndi mtundu wanyanga, ngati kulira.

Stridor ikhoza kukhala:

• inspiratory: imamveka pa kudzoza panthawi yochepetsera m'mimba mwake pamtunda wowonjezera wa thoracic airways (pharynx, epiglottis, larynx, extra-thoracic trachea);
• biphasic: ngati kutsekeka kwakukulu, kumakhala biphasic, ndiko kunena kuti kupezeka pazigawo zonse ziwiri za kupuma;
• kapena kupuma: ngati kutsekeka komwe kuli munjira ya intrathoracic airways, stridor nthawi zambiri imakhala yopuma.

Stridor ndi mawonetseredwe pafupipafupi ana a matenda a kupuma thirakiti. Zochitika zake sizidziwika mwa ana ambiri. Komabe, ma frequency apamwamba adawonedwa mwa anyamata.

Tiyenera kudziwa kuti ngakhale ndizochepa kwambiri, stridor imapezekanso mwa akulu.

Ana ali ndi tinjira tating'ono, tating'ono ta mpweya ndipo amakonda kupuma kwaphokoso. Stridor imayamba chifukwa cha ma pathologies okhudzana ndi m'phuno ndi trachea. Kupuma kumakhala kofanana ndi matenda a bronchial. Pamene kupuma kwaphokoso kumawonjezeka panthawi ya tulo, chifukwa chake chiri mu oropharynx. Pamene kupuma kumakhala kokulirapo pamene mwanayo ali maso, chifukwa chake chiri mu larynx kapena trachea.

Kwa ana, zomwe zimayambitsa kwambiri zimaphatikizapo zomwe zimayambitsa zobadwa nazo komanso zomwe zimapezeka.

Congenital zimayambitsa stridor ana

• Laryngomalacia, ndiko kuti larynx yofewa: ndiyomwe imayambitsa congenital stridor ndipo imayimira 60 mpaka 70% ya congenital laryngeal anomalies;
• Kupuwala kwa zingwe za mawu;
• A stenosis, ndiko kunena kuti kung'ung'udza, kobadwa nako;
• Tracheomalacia, ndiko kunena kuti trachea yofewa komanso yosinthasintha;
• subglottic hemangioma;
• Kholo, ndiko kunena kuti nembanemba yomwe imalumikiza zingwe ziwiri za mawu chifukwa cha vuto lobadwa nalo;
• Diastema ya m’mphuno, kutanthauza kusapangana bwino komwe kumapangitsa m’phuno kulankhulana ndi m’mimba.

Anapeza zimayambitsa stridor ana 

• Anapeza subglottic stenosis;
• Croup, yomwe ndi kutupa kwa trachea ndi zingwe zapakhosi, zomwe nthawi zambiri zimayambitsidwa ndi kachilombo koyambitsa matenda opatsirana;
• Thupi lachilendo lokokedwa;
• Matenda a laryngitis;
• Epiglottitis, yomwe ndi matenda a epiglotti omwe amayamba chifukwa cha bakiteriya Hemophilus influenzae mtundu b (Ndithu). A pafupipafupi chifukwa cha stridor ana, zochitika zake zachepa kuyambira kumayambiriro katemera Haemophilus fuluwenza mtundu B;
• tracheitis, etc.

Zomwe zimayambitsa mwa akuluakulu

• Kutupa kwamutu ndi khosi, monga khansa ya m'mphuno, kungayambitse stridor ngati kutsekereza pang'ono kumtunda kwa mpweya;
• abscess;
• Edema, mwachitsanzo, kutupa, kwa pamwamba kupuma thirakiti zomwe zingachitike chifukwa cha extubation;
• Kusagwira bwino ntchito kwa zingwe za mawu, komwe kumatchedwanso paradoxical vocal cord kuyenda;
• Kupuwala kwa zingwe za mawu, kutsata opaleshoni kapena kulowetsedwa makamaka: pamene zingwe ziwiri za mawu zimapuwala, malo pakati pawo ndi opapatiza kwambiri ndipo mpweya umakhala wosakwanira;
• Thupi lachilendo lokokedwa monga kagawo kakang'ono ka chakudya kapena madzi pang'ono olowetsedwa m'mapapo kuchititsa kuti m'phuno ugwire;
• Epiglottitis;
• Thupi lawo siligwirizana.

Zomwe zimayambitsa stridor zitha kugawidwanso molingana ndi kamvekedwe kake:

• Pachimake: laryngomalacia kapena ziwalo za mawu;
• Kwambiri: laryngomalacia kapena subglottic pathology;
• Hoarseness: laryngitis, stenosis kapena subglottic kapena high tracheal angioma.

Stridor ikhoza kugwirizana ndi kupuma kapena zotsatira za chakudya, limodzi ndi zizindikiro zowawa monga:

• kuvutika kudya;
• zochitika za kupuma pa nthawi ya chakudya;
• kukula kwapang'onopang'ono;
• dyspnea, yomwe imakhala yovuta kupuma;
• zovuta za kupuma;
• cyanosis (kutayika kwa bluish pakhungu ndi mucous nembanemba);
• kutsekereza kugona tulo;
• Kuchuluka kwa zizindikiro za kupuma movutikira: kukupiza mapiko a mphuno, intercostal ndi suprasternal retraction.
  

Pamaso pa stridor iliyonse, kuyezetsa kwa ENT pogwiritsa ntchito nasofibroscopy kuyenera kuperekedwa. A biopsy, CT scan, ndi MRI amachitidwanso ngati chotupa chikuganiziridwa.

Stridor yomwe imayambitsa kupuma movutikira pamene munthuyo ali kupumula ndi ngozi yachipatala. Kuwunika kwa zizindikiro zofunika ndi kuchuluka kwa kupuma kwapang'onopang'ono ndi gawo loyamba pakuwongolera. Nthawi zina, kutetezedwa kwa mpweya kungakhale kofunikira musanayambe kapena mogwirizana ndi kufufuza kwachipatala.

Njira zochizira stridor zimasiyanasiyana kutengera chomwe chimayambitsa chizindikirocho.

Ngati laryngomalacia

Popanda njira zakuzama, kapena chizindikiro chofananira, nthawi yowonera ikhoza kuganiziridwa, kutengera kukhazikitsidwa kwa mankhwala a anti-reflux (maantacid, kukhuthala kwa mkaka). Kutsatira kuyenera kuchitika pafupipafupi kuti zitsimikizire kuti zizindikiro zayamba kuchepa pang'onopang'ono kenako kuzimiririka munthawi yomwe akuyembekezeredwa.

Zizindikiro za laryngomalacia nthawi zambiri zimakhala zofatsa ndipo zimatha zokha asanakwanitse zaka ziwiri. Komabe, pafupifupi 20% ya odwala omwe ali ndi laryngomalacia amakhala ndi zizindikiro zowopsa (kuvuta kwambiri, kuvutika kudya, ndi kuchepa kwa kukula) zomwe zimafunikira chithandizo cha opaleshoni ya endoscopic (supraglottoplasty).

Pakachitika thupi lachilendo litakoka mpweya

Ngati munthuyo ali kunja kwa chipatala, munthu wina angathe, ngati ataphunzitsidwa, kumuthandiza kutulutsa thupi lachilendo mwa kuchita njira ya Heimlich.

Ngati munthuyo ali m'chipatala kapena m'chipinda chodzidzimutsa, chubu chikhoza kulowetsedwa kudzera m'mphuno kapena pakamwa pa munthuyo (tracheal intubation) kapena mwachindunji mu trachea pambuyo pa opaleshoni yaing'ono (tracheostomy) , kuti mpweya udutse chopingacho ndi kuteteza. Kulephera kupuma.

Pankhani ya edema ya kupuma thirakiti

Nebulized racemic adrenaline ndi dexamethasone akhoza kulangizidwa mwa odwala omwe ali ndi edema ya airway.

Ngati mukuvutika kwambiri kupuma

Monga muyeso kwakanthawi, kusakaniza kwa helium ndi okosijeni (heliox) kumathandizira kuyenda kwa mpweya komanso kumachepetsa stridor muzovuta zazikulu zapanjira ya mpweya monga post-extubation laryngeal edema, stridular laryngitis ndi zotupa za m'phuno. Heliox imalola kuchepetsa chipwirikiti chothamanga chifukwa cha kuchepa kwa helium poyerekeza ndi mpweya ndi nayitrogeni.