Kugwedezeka kwa Septic: ndi chiyani, zizindikiro, zomwe zimayambitsa komanso momwe amathandizira

Zamkati

• Zizindikiro zazikulu
• Momwe mungatsimikizire matendawa
• Zoyambitsa za septic mantha
• Ndani ali pachiwopsezo chachikulu
• Momwe mankhwalawa amachitikira
• 1. Kugwiritsa ntchito maantibayotiki
• 2. Kutsekemera m'mitsempha
• 3. Mankhwala a kuthamanga kwa magazi
• 4. Kuikidwa magazi
• 5. Kugwiritsa ntchito corticosteroids
• 6. Kutulutsa magazi

Kusokonezeka kwa Septic kumatanthauzidwa kuti ndi vuto lalikulu la sepsis, momwe ngakhale mutalandira chithandizo choyenera ndimadzimadzi ndi maantibayotiki m'malo mwake, munthu akupitilizabe kutsika magazi komanso ma lactate opitilira 2 mmol / L. Magawo awa amawunikidwa pafupipafupi mchipatala kuti aone momwe wodwalayo amasinthira, kuyankha kwake kuchipatala komanso kufunika kochita njira zina.

Matenda a Septic amaonedwa kuti ndi ovuta, chifukwa wodwalayo akafika pamatendawa, amakhala atafooka kale, kupatula apo pamakhala chiwopsezo chachikulu chopatsirana komanso kuchuluka kwa zinthu za poizoni zopangidwa ndi tizilombo tating'onoting'ono.

Chifukwa chakuchepa kwa kuthamanga kwa magazi, ndizofala kuti anthu omwe amadwala matenda amiseche amakhalanso ndi vuto lalikulu pakuyenda magazi, zomwe zimapangitsa kuti mpweya wocheperako ufikire ziwalo zofunika monga ubongo, mtima ndi impso. Izi zimapangitsa kuti zizindikilo zina zowoneka bwino, monga kuchepa kwa mkodzo komanso kusintha kwamaganizidwe.

Kuchiza kwadzidzidzi kumachitika mu Intensive Care Unit (ICU), kugwiritsa ntchito mankhwala osokoneza bongo ndi maantibayotiki kuti athetse vuto la mtima ndi impso ndikuchotsa tizilombo tomwe timayambitsa matendawa, kuphatikiza pakuwunika kuthamanga ndi ma lactate.

Zizindikiro zazikulu

Monga mantha amiseche amawerengedwa kuti ndi vuto la sepsis, zizindikilo ndi zizindikilo zomwe wodwalayo amakhala nazo ndizofanana, ndi kutentha thupi kosalekeza komanso kuwonjezeka kwa kugunda kwa mtima. Kuphatikiza apo, pakagwedezeka mwamphamvu ndizotheka kuti:

• Kuthamanga kwambiri kwa magazi, komwe kumakhala ndi kuthamanga kwa magazi (MAP) kochepera kapena kofanana ndi 65 mmHg;
• Kuwonjezeka kwa kuchuluka kwa kufalikira kwa lactate, komwe kumakhala kopitilira 2.0 mmol / L;
• Kupuma mofulumira poyesera kuwonjezera kuchuluka kwa mpweya woyenda;
• Kutentha kumakwera pamwamba pamagulu abwinobwino kapena mopitilira muyeso;
• Kuchuluka kwa kugunda kwa mtima;
• Kupanga mkodzo pang'ono;
• Kutaya chidziwitso kapena kusokonezeka kwamaganizidwe;

Zizindikiro zodabwitsika zimayamba matendawa atafika m'magazi ndikutulutsa poizoni wake, womwe umalimbikitsa chitetezo cha mthupi kutulutsa ndi kutulutsa ma cytokines ndi oyimira yotupa kuti athane ndi matendawa. Ngati wodwalayo samvera mankhwala kapena kuwopsa kwa tizilombo tating'onoting'ono kwambiri, ndizotheka kuti wodwalayo azidwala sepsis yoopsa kenako mantha am'magazi.

Chifukwa chakuchuluka kwa poizoni, pakhoza kukhala kusintha kwa mpweya wokwanira womwe umafikira ziwalo, zomwe zimatha kubweretsa kulephera kwa ziwalo ndikuyika moyo wa munthu pachiwopsezo.

Momwe mungatsimikizire matendawa

Kuzindikira kwadzidzidzi kwadzidzidzi kumachitika potengera kuyeza kwamankhwala ndi mayeso a labotale. Nthawi zambiri, kuyezetsa magazi kumachitika kuti muwone ngati kuchuluka kwama cell a magazi kwasinthidwa (maselo ofiira, ma leukocyte ndi ma platelets), ngati pali vuto ndi impso, mpweya wa oxygen umakhala pati ndipo ngati alipo ndi kusintha kulikonse kuchuluka kwa maelekitirodi omwe amapezeka m'magazi. Mayesero ena omwe adokotala angayitanitse ndi okhudzana ndikudziwika kwa tizilombo toyambitsa matenda omwe amachititsa mantha.

Matendawa ndiwodziwika bwino chifukwa chododometsa pomwe, kuwonjezera pazizindikiro za sepsis, kuwonjezeka kwa kusungunuka kwa lactate ndikupitilizabe kuthamanga kwa magazi kumadziwika ngakhale atalandira chithandizo.

Zoyambitsa za septic mantha

Zomwe zimadabwitsa anthu zikugwirizana ndi kukana kwa tizilombo pakuthandizidwa, kuphatikiza chitetezo chamthupi cha munthu. Kuphatikiza apo, kupezeka kwa ma probes ndi ma catheters omwe ali ndi kachilombo, omwe ndi zida zamankhwala omwe amalumikizana molunjika ndi munthu yemwe wagonekedwa mchipatala, amathanso kukondweretsanso septic, chifukwa tizilombo titha kufalikira mosavuta m'magazi, kufalikira ndikumatulutsa poizoni omwe amatha kusiya kugwira ntchito kwa thupi komanso kupatsa mpweya kumatumba.

Chifukwa chake, matenda aliwonse amatha kuyambitsa sepsis kapena septic mantha ndipo amayamba chifukwa cha:

• Mabakiteriya, mongaStaphylococcus aureus, Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Streptococcus sp., Neisseria meningitidis, mwa ena;
• Kachilombo, monga fuluwenza H1N1, H5N1, kachilombo ka yellow fever kapena kachilombo ka dengue, pakati pa ena;
• Bowa, makamaka jendaKandida sp.

Matenda omwe amatsogolera ku septic shock amatha kuwonekera paliponse mthupi, ndipo ena mwa omwe amapezeka ndi chibayo, matenda am'mikodzo, meningitis, erysipelas, cellulitis yopatsirana, matenda a zilonda zamankhwala kapena kuipitsidwa kwa catheters.

Ndani ali pachiwopsezo chachikulu

Anthu omwe angakhudzidwe kwambiri ndi matenda opatsirana kwambiri ndikuchita mantha kwambiri ndi omwe ali mchipatala, makamaka ku ICU, chifukwa ndi malo omwe tizilombo tating'onoting'ono titha kulimbana kwambiri ndi maantibayotiki, pomwe pali kuyambitsa ma probes ndi catheters kapena kuyezetsa, komwe kumatha kutenga matenda, komanso chifukwa chitetezo chamthupi cha wodwalayo chimatha kukhala chofooka chifukwa cha matenda ena.

Kuphatikiza apo, kukhala ndi matenda osachiritsika monga matenda ashuga, kufooka kwa mtima, ma aplasia, impso kulephera, komanso kugwiritsa ntchito mankhwala osokoneza bongo monga chemotherapy, corticosteroids, maantibayotiki kapena radiotherapy imathandizanso kuti anthu azitha kudwala matenda amiseche komanso mantha, chifukwa amatha kuwononga momwe chitetezo chamthupi chimagwirira ntchito.

Momwe mankhwalawa amachitikira

Chithandizo cha septic shock chiyenera kuchitidwa ku ICU (Intensive Care Unit) ndipo cholinga chake ndi kuthetsa wothandizirayo yemwe amachititsa sepsis ndipo, mwanjira imeneyi, kuti athetse mantha am'magazi. Kuphatikiza apo, kugwiritsa ntchito mankhwala osokoneza bongo kuti athe kuwongolera kuthamanga kwa magazi kukuwonetsedwa, kuphatikiza pakusintha kwamadzimadzi kuti kuwonjezere kuchuluka kwa magazi ndipo, chifukwa chake, kuvomereza mayendedwe a oxygen kumatumbawo.

1. Kugwiritsa ntchito maantibayotiki

Ngati septic shock yatsimikiziridwa, maantibayotiki oyenera ayenera kuyambitsidwa, ngakhale cholinga cha matendawa sichikudziwika. Izi ndichifukwa choti tizilombo tomwe timayambitsa matendawa timachotsedwa mwachangu, zomwe zimapangitsa kuti chitetezo chamthupi chitetezeke.

Chithandizo chimachitika pogwiritsa ntchito maantimicrobials (maantibayotiki) malinga ndi tizilombo tomwe tadziwika. Dziwani zambiri za mayeso omwe amakuthandizani kudziwa mankhwala abwino kwambiri.

2. Kutsekemera m'mitsempha

Pozunguzika, magazi amayenda bwino kwambiri, zomwe zimapangitsa kuti thupi likhale lovuta. Kupanga seramu wambiri mumtsinje, pafupifupi 30 ml pa kg, ndikulimbikitsidwa ngati njira yothandizira kuti magazi aziyenda bwino ndikuthandizira kuyankha mankhwala.

3. Mankhwala a kuthamanga kwa magazi

Chifukwa cha kutsika kwa kuthamanga kwa magazi, komwe sikungathetsedwe kokha ndi kutsekemera m'mitsempha, nthawi zambiri kumakhala kofunikira kugwiritsa ntchito mankhwala osokoneza bongo, otchedwa vasopressor kuti akwaniritse kuthamanga kwa magazi osachepera 65 mmHg.

Zitsanzo zina za mankhwalawa ndi Noradrenaline, Vasopressin, Dopamine ndi Adrenaline, omwe ndi mankhwala omwe amayenera kugwiritsidwa ntchito poyang'anitsitsa kuchipatala kupewa mavuto ena. Njira ina ndikugwiritsa ntchito mankhwala omwe amachulukitsa kugunda kwamtima, monga Dobutamine.

4. Kuikidwa magazi

Kungakhale kofunikira kwa odwala omwe ali ndi zizindikiro zosakwanira magazi komanso omwe ali ndi kuchepa kwa magazi ndi hemoglobin pansi pa 7mg / dl. Chongani zikuluzikulu za kuikidwa magazi.

5. Kugwiritsa ntchito corticosteroids

Mankhwala a Corticosteroid, monga Hydrocortisone, atha kuwonetsedwa ngati njira yochepetsera kutupa, komabe, pamakhala maubwino okhawo pakakhala kusokonekera kwa septic, ndiye kuti, ngati sizingatheke kukweza kuthamanga kwa magazi ngakhale mutamwa madzi ndi kugwiritsa ntchito mankhwala.

6. Kutulutsa magazi

Hemodialysis sikuti nthawi zonse imasonyezedwa, komabe, ikhoza kukhala yankho pamavuto akulu pomwe kuchotsedwa mwachangu kwa ma electrolyte owonjezera, acidity m'magazi kapena kuyimitsidwa kwa impso.