ECMO (Kupitilira Kakhungu Kakhungu Kowonjezera)

Zamkati

• Ndani akufuna ECMO?
• Makanda
• Ana
• Akuluakulu
• Kodi mitundu ya ECMO ndi iti?
• Kodi ndikonzekera bwanji ECMO?
• Kodi chimachitika ndi chiyani pa ECMO?
• Kodi zovuta zomwe zimakhudzana ndi ECMO ndi ziti?
• Kodi chimachitika ndi chiyani ECMO itatha?

Kodi extracorporeal membrane oxygenation (ECMO) ndi chiyani?

Extracorporeal membrane oxygenation (ECMO) ndi njira yoperekera kupuma ndi mtima. Kawirikawiri amagwiritsidwa ntchito kwa ana odwala kwambiri omwe ali ndi vuto la mtima kapena mapapo. ECMO imatha kupatsa mwana wakhanda mpweya wokwanira pomwe madotolo amathetsa vutoli. Ana okalamba ndi akulu atha kupindulanso ndi ECMO nthawi zina.

ECMO imagwiritsa ntchito mtundu wamapapu opangira otchedwa membrane oxygenator kuti ipangitse magazi magazi. Zimaphatikizana ndi zotentha komanso zosefera kuti mupereke mpweya m'magazi ndikubwezeretsanso thupi.

Ndani akufuna ECMO?

Madokotala amakupatsani inu pa ECMO chifukwa muli ndi mavuto akulu, koma osinthika, amtima kapena am'mapapo. ECMO imagwira ntchito yamtima ndi mapapo. Izi zimakupatsani mwayi woti mupeze bwino.

ECMO imapatsa mitima yaying'ono ndi mapapo a ana akhanda nthawi yambiri kuti apange.ECMO ikhozanso kukhala "mlatho" isanachitike komanso itatha chithandizo chonga kuchitidwa opaleshoni yamtima.

Malinga ndi Cincinnati Children's Hospital, ECMO ndiyofunikira pokhapokha pamavuto. Mwambiri, izi ndi pambuyo poti njira zina zothandizira sizinapambane. Popanda ECMO, kupulumuka kwamtunduwu ndi pafupifupi 20% kapena kuchepera. Ndi ECMO, chiwerengerochi chikhoza kukwera mpaka 60%.

Makanda

Kwa makanda, zomwe zingafune ECMO ndizo:

• kupuma kwamavuto (kupuma movutikira)
• kobadwa nako diaphragmatic chophukacho (dzenje pa zakulera)
• meconium aspiration syndrome (kutulutsa zinyalala)
• kuthamanga kwa magazi (kuthamanga kwa magazi m'mitsempha yam'mapapo)
• chibayo chachikulu
• kupuma kulephera
• kumangidwa kwamtima
• opaleshoni ya mtima
• sepsis

Ana

Mwana angafunike ECMO ngati atakumana ndi izi:

• chibayo
• matenda aakulu
• kobadwa nako kupindika mtima
• opaleshoni ya mtima
• zoopsa ndi zina zadzidzidzi
• kukhumba zinthu zakupha m'mapapu
• mphumu

Akuluakulu

Mwa munthu wamkulu, zomwe zingafune ECMO ndi izi:

• chibayo
• zoopsa ndi zina zadzidzidzi
• kuthandizira mtima pambuyo poti mtima walephera
• matenda aakulu

Kodi mitundu ya ECMO ndi iti?

ECMO ili ndi magawo angapo, kuphatikiza:

• mfuti: ma catheters akulu (machubu) amalowetsedwa m'mitsempha yamagazi kuti achotse ndikubwezera magazi
• nembanemba oxygenator: mapapu opangira omwe amapangitsa magazi kupuma
• kutentha ndi kusefa: makina omwe amatenthetsa ndi kusefa magazi magazi asanawabwezeretsere thupi

Pakati pa ECMO, ma cannulae amapopa magazi omwe atha mpweya. Kakhungu oxygenatorator kenaka kamaika mpweya m'magazi. Kenako amatumiza magazi okhala ndi mpweya kudzera mukutentha ndi kusefa ndikubwezeretsa thupi.

Pali mitundu iwiri ya ECMO:

• veno-venous (VV) ECMO: VV ECMO imatenga magazi pamitsempha ndikuyibweza mumtambo. Mtundu uwu wa ECMO umathandizira mapapo kugwira ntchito.
• veno-arterial (VA) ECMO: VA ECMO imatenga magazi pamitsempha ndikuyibwezeretsa kumtundu. VA ECMO imathandizira mtima komanso mapapo. Ndizowopsa kuposa VV ECMO. Nthawi zina mtsempha wama carotid (mtsempha waukulu kuchokera pamtima kupita kuubongo) ungafunike kutsekedwa pambuyo pake.

Kodi ndikonzekera bwanji ECMO?

Dokotala amamuyesa munthu pamaso pa ECMO. Cranial ultrasound idzaonetsetsa kuti palibe magazi muubongo. Ultrasound ya mtima imatsimikizira ngati mtima ukugwira ntchito. Komanso, mukakhala ku ECMO, mudzakhala ndi X-ray ya chifuwa tsiku lililonse.

Atazindikira kuti ECMO ndiyofunikira, madokotala azikonzekera zida. Gulu lodzipereka la ECMO, kuphatikiza dokotala wovomerezeka ndi board ndi maphunziro ndi chidziwitso ku ECMO achita ECMO. Gululi limaphatikizaponso:

• ICU analembetsa anamwino
• othandizira kupuma
• perfusionists (akatswiri ogwiritsa ntchito makina amtima ndi mapapo)
• ogwira ntchito othandizira ndi alangizi
• gulu loyendetsa 24/7
• akatswiri okonzanso

Kodi chimachitika ndi chiyani pa ECMO?

Kutengera msinkhu wanu, madokotala ochita opaleshoni amayika ndikuteteza ma cannulae m'khosi, kubuula, kapena pachifuwa mukakhala kuti muli ndi anesthesia. Nthawi zambiri mumakhala pansi mukakhala ku ECMO.

ECMO imagwira ntchito yamtima kapena yamapapu. Madokotala adzayang'anitsitsa nthawi ya ECMO potenga ma X-ray tsiku ndi tsiku ndikuwunika:

• kugunda kwa mtima
• kupuma
• misinkhu mpweya
• kuthamanga kwa magazi

Chitubu chopumira komanso makina opumira mpweya amapangitsa mapapu kugwira ntchito ndikuthandizira kuchotsa zotsekemera.

Mankhwala azisunthira mosalekeza kudzera m'mitsempha yamagetsi. Mankhwala amodzi ofunikira ndi heparin. Kuchepetsa magazi uku kumathandiza kuti magazi asamaundane chifukwa magazi amayenda mkati mwa ECMO.

Mutha kukhala ku ECMO kulikonse kuyambira masiku atatu mpaka mwezi. Mukakhalabe pa ECMO, chiopsezo chimakhala chachikulu.

Kodi zovuta zomwe zimakhudzana ndi ECMO ndi ziti?

Chiwopsezo chachikulu cha ECMO ndikutaya magazi. Heparin imachepetsa magazi kuti asamateteze. Zimapangitsanso chiopsezo chotaya magazi mthupi komanso muubongo. Odwala a ECMO amayenera kuwunikidwa pafupipafupi pamavuto akutuluka magazi.

Palinso chiopsezo chotenga kachilombo chifukwa cha kulowetsa kwa cannulae. Anthu omwe ali pa ECMO atenga magazi pafupipafupi. Izi zimakhalanso ndi chiopsezo chaching'ono chotenga matenda.

Kulephera kapena kulephera kwa zida za ECMO ndi ngozi ina. Gulu la ECMO limadziwa momwe angachitire mwadzidzidzi ngati ECMO kulephera.

Kodi chimachitika ndi chiyani ECMO itatha?

Pamene munthu apita patsogolo, madokotala adzawachotsa ku ECMO pochepetsa pang'onopang'ono kuchuluka kwa magazi okosijeni kudzera mu ECMO. Munthu akangotsika ku ECMO, amakhalabe pa mpweya kwa kanthawi.

Iwo omwe adakhalapo pa ECMO adzafunikiranso kuwatsata kuti adziwe momwe alili.