Kodi Toxic Epidermal Necrolysis (TEN) Ndi Chiyani?

Zamkati

• Zoyambitsa
• Mankhwala
• Matenda
• Zizindikiro
• Zitsanzo zowoneka
• Kulumikizana ndi matenda a Stevens-Johnson
• Zowopsa
• Matendawa
• Chithandizo
• Chiwonetsero
• Tengera kwina

Poizoni wa epidermal necrolysis (TEN) ndizosowa komanso zoopsa pakhungu. Nthawi zambiri, zimachitika chifukwa chokana mankhwala ngati ma anticonvulsants kapena maantibayotiki.

Chizindikiro chachikulu ndikutulutsa khungu komanso kuphulika. Kukula kwake kumapita patsogolo mwachangu, ndikupangitsa malo akulu obiriwira omwe amatha kutuluka kapena kulira. Zimakhudzanso mamina am'mimba, kuphatikiza mkamwa, mmero, maso, ndi maliseche.

Popeza kuti TEN ikukula mwachangu, ndikofunikira kupeza thandizo posachedwa. TEN ndiwopseza moyo womwe umafunikira chithandizo chamankhwala mwachangu.

Werengani kuti muwone zomwe zimayambitsa ndi zisonyezo za TEN, komanso momwe amathandizidwira.

Zoyambitsa

Chifukwa chakuti TEN ndi yosowa kwambiri, sikumveka bwino. Nthawi zambiri zimayamba chifukwa chazosazolowereka zamankhwala. Nthawi zina, zimakhala zovuta kuzindikira chomwe chimayambitsa TEN.

Mankhwala

Chifukwa chofala kwambiri cha TEN ndichosavomerezeka pamankhwala. Amadziwikanso ngati mtundu wowopsa wamankhwala osokoneza bongo, ndipo amachititsa 95% ya milandu TEN.

Nthawi zambiri, vutoli limayamba mkati mwa masabata asanu ndi atatu oyamba kumwa mankhwalawa.

Mankhwala otsatirawa amapezeka kwambiri ndi TEN:

• anticonvulsants
• oxicams (nonsteroidal anti-inflammatory drug)
• mankhwala a sulfonamide
• allopurinol (yoteteza gout ndi kupewa miyala ya impso)
• nevirapine (anti-HIV mankhwala)

Matenda

Nthawi zambiri, matenda onga a TEN amalumikizidwa ndi kachilombo ka bakiteriya kotchedwa Mycoplasma pneumoniae, zomwe zimayambitsa matenda opuma.

Zizindikiro

Zizindikiro za TEN ndizosiyana ndi munthu aliyense. Kumayambiriro, nthawi zambiri zimayambitsa zizindikiro ngati chimfine. Izi zingaphatikizepo:

• malungo
• kupweteka kwa thupi
• ofiira, maso oluma
• zovuta kumeza
• mphuno
• kukhosomola
• chikhure

Pakatha masiku 1 mpaka 3, khungu limasenda kapena popanda matuza. Zizindikirozi zimatha kupitilira patadutsa maola angapo kapena masiku angapo.

Zizindikiro zina ndizo:

• zigamba zofiira, zapinki, kapena zofiirira
• khungu lopweteka
• malo akulu, akhungu (zotupa)
• Zizindikiro zofalikira m'maso, mkamwa, ndi kumaliseche

Zitsanzo zowoneka

Chizindikiro chachikulu cha TEN ndikupweteka khungu. Pamene vutoli limakula, khungu limafalikira thupi lonse.

M'munsimu muli zitsanzo zowoneka za TEN.

Kulumikizana ndi matenda a Stevens-Johnson

Matenda a Stevens-Johnson (SJS), monga TEN, ndimatenda akhungu omwe amayamba chifukwa cha mankhwala osokoneza bongo kapena, kawirikawiri, omwe amapezeka ndi matenda. Zinthu ziwirizi ndizofanana ndi matenda ndipo zimasiyana kutengera kuchuluka kwa khungu lomwe likukhudzidwa.

SJS ndi yocheperako. Mwachitsanzo, mu SJS, ochepera 10 peresenti ya thupi limakhudzidwa ndiku khungu. Mu TEN, oposa 30 peresenti amakhudzidwa.

Komabe, SJS idakali vuto lalikulu. Ikufunikanso chithandizo chadzidzidzi mwachangu.

SJS ndi TEN nthawi zambiri zimakumana, chifukwa chake mikhalidwe yotchedwa Stevens-Johnson syndrome / poizoni epidermal necrolysis, kapena SJS / TEN.

Zowopsa

Ngakhale aliyense amene amamwa mankhwala amatha kukhala ndi TEN, anthu ena amakhala pachiwopsezo chachikulu.

Zomwe zingakhale pachiwopsezo ndi izi:

• Ukalamba. TEN imatha kukhudza anthu azaka zonse, koma ndizotheka kukhudza achikulire.
• Jenda. Akazi akhoza kukhala ndi chiopsezo chachikulu cha TEN.
• Kufooka kwa chitetezo cha mthupi. Anthu omwe ali ndi chitetezo chamthupi chofooka nthawi zambiri amakhala ndi TEN. Izi zitha kuchitika chifukwa cha matenda ngati khansa kapena HIV.
• Edzi. SJS ndi TEN ndizofala ku 1,000 anthu omwe ali ndi Edzi.
• Chibadwa. Chiwopsezo chimakhala chachikulu ngati muli ndi HLA-B 1502 allele, yomwe imafala kwambiri kwa anthu ochokera kumwera chakum'mawa kwa Asia, China, ndi India. Jini limatha kukulitsa chiopsezo cha TEN mukamamwa mankhwala enaake.
• Mbiri ya banja. Mutha kukhala ndi mwayi wokhala ndi TEN ngati wachibale wapafupi adali ndi vutoli.
• Zotsatira zamankhwala am'mbuyomu. Ngati mwakhazikitsa TEN mutamwa mankhwala enaake, mumakhala pachiwopsezo chachikulu ngati mutamwa mankhwala omwewo.

Matendawa

Dokotala amagwiritsa ntchito mayeso osiyanasiyana kuti azindikire zizindikiro zanu. Izi zingaphatikizepo:

• Kuyesa kwakuthupi. Mukayezetsa thupi, dokotala amayang'ana khungu lanu kuti lisinthe, kukoma mtima, kutenga nawo mbali mucosal, komanso matenda.
• Mbiri yazachipatala. Kuti mumvetsetse thanzi lanu lonse, adokotala adzafunsa za mbiri yanu yazachipatala. Afunanso kudziwa mankhwala omwe mumamwa, kuphatikizapo mankhwala atsopano omwe amwedwa miyezi iwiri yapitayi, komanso ziwengo zilizonse zomwe muli nazo.
• Khungu lakhungu. Pakati pa khungu, khungu la khungu lomwe limakhudzidwa limachotsedwa mthupi lanu ndikulitumiza ku labu. Katswiri adzagwiritsa ntchito maikulosikopu kuti ayang'ane minofu ndikuyang'ana zizindikilo za TEN.
• Kuyezetsa magazi. Kuyezetsa magazi kumatha kuthandiza kuzindikira zizindikilo za matenda kapena zovuta zina ndi ziwalo zamkati.
• Zikhalidwe. Dotolo amathanso kuyang'ana matenda mwa kuyitanitsa magazi kapena chikhalidwe cha khungu.

Ngakhale adotolo nthawi zambiri amatha kudziwa kuti TEN ndi woyezetsa thupi yekha, kuyezetsa khungu kumachitika nthawi zambiri kutsimikizira kuti ali ndi matendawa.

Chithandizo

Nthawi zonse, chithandizo chimaphatikizapo kusiya mankhwala omwe adakupangitsani kuchitapo kanthu.

Njira zina zamankhwala zimadalira pazinthu zingapo, monga:

• zaka zanu
• thanzi lanu komanso mbiri yazachipatala
• kuopsa kwa matenda anu
• madera okhudzidwa
• kulekerera kwanu njira zina

Chithandizo chidzaphatikizapo:

• Chipatala. Aliyense amene ali ndi TEN ayenera kusamaliridwa pamalo oyaka moto.
• Mafuta ndi mabandeji. Kusamalira mabala moyenera kumathandiza kuti khungu lisawonongeke komanso kuteteza khungu laiwisi kutaya madzi ndi matenda. Pofuna kuteteza khungu lanu, gulu lanu lachipatala lidzagwiritsa ntchito mafuta odzola komanso mavalidwe azilonda.
• Mitsempha (IV) yamadzimadzi ndi ma electrolyte. Kuchuluka kwa khungu ngati khungu, makamaka mu TEN, kumabweretsa kuwonongeka kwa madzimadzi ndi kusalinganizana kwa ma electrolyte. Mupatsidwa madzimadzi a IV ndi ma electrolyte kuti muchepetse chiopsezo. Gulu lanu lachipatala liziwunika mosamala ma electrolyte anu, momwe ziwalo zanu zamkati zilili, komanso kuchuluka kwanu kwamadzimadzi.
• Kudzipatula. Popeza kuwonongeka kwa khungu kwa TEN kumawonjezera chiopsezo chotenga kachilombo, mudzapatulidwa kwa ena komanso komwe kungayambitse matenda.

Mankhwala ogwiritsira ntchito TEN ndi awa:

• Maantibayotiki. Pafupifupi aliyense amene ali ndi TEN amapatsidwa maantibayotiki oletsa kapena kuchiza matenda aliwonse.
• Kulowetsa m'mimba immunoglobulin G (IVIG). Ma immunoglobulins ndi ma antibodies omwe amathandizira chitetezo chanu chamthupi. IVIG nthawi zina imagwiritsidwa ntchito kuwongolera zomwe zimachitika. Izi ndizogwiritsira ntchito IVIG.
• TNF alpha inhibitor etanercept ndi immunosuppressant cyclosporine. Awa ndi mankhwala olonjeza omwe nthawi zambiri amalimbikitsidwa ndi akatswiri pochiza TEN. Izi ndizogwiritsa ntchito mankhwala onsewa.

Ziwalo zenizeni za thupi zimafunikira mankhwala osiyanasiyana. Mwachitsanzo, ngati mkamwa mwanu mukukhudzidwa, kutsuka mkamwa kungagwiritsidwe ntchito kuwonjezera pa mankhwala ena.

Gulu lanu lachipatala liziwunikiranso maso anu ndi maliseche anu ngati muli ndi zizindikiro. Akawona zizindikiro zilizonse, adzagwiritsa ntchito mankhwala apadera kuti ateteze zovuta, monga kutaya masomphenya ndi mabala.

Pakadali pano, palibe njira yovomerezeka yothandizira TEN. Chithandizo chimatha kusiyanasiyana kutengera kuchipatala. Mwachitsanzo, zipatala zina zitha kugwiritsa ntchito IVIG, pomwe zina zingagwiritse ntchito kuphatikiza kwa etanercept ndi cyclosporine.

Etanercept ndi cyclosporine sizimavomerezedwa pakadali pano ndi Food and Drug Administration (FDA) kuti ichiritse TEN. Komabe, atha kugwiritsidwa ntchito ngati cholembera pachifukwa ichi. Kugwiritsa ntchito mankhwala osokoneza bongo kumatanthauza kuti dokotala wanu akhoza kukupatsani mankhwala osavomerezeka ngati akuganiza kuti mutha kupindula ndi mankhwalawa. Phunzirani zambiri zakugwiritsa ntchito mankhwala osokoneza bongo.

Chiwonetsero

Kuchuluka kwa imfa ya TEN kuli pafupifupi 30 peresenti, koma kungakhale kwakukulu kwambiri. Komabe, zinthu zambiri zimakhudza momwe mumaonera zinthu, kuphatikizapo:

• zaka
• thanzi lathunthu
• kuopsa kwa matenda anu, kuphatikizapo thupi lomwe likukhudzidwa
• mankhwala

Nthawi zambiri, kuchira kumatha kutenga milungu 3 mpaka 6. Zotsatira zoyipa zazitali ndizo:

• khungu
• zipsera
• khungu louma ndi mamina
• kutayika tsitsi
• kuvuta kukodza
• mkhutu kukoma
• ziwalo zoberekera
• kusintha kwa masomphenya, kuphatikizapo kutayika

Tengera kwina

Poizoni wa epidermal necrolysis (TEN) ndizowopsa mwadzidzidzi. Monga khungu lomwe lingawononge moyo, limatha kubweretsa kuchepa kwa madzi m'thupi komanso matenda. Pitani kuchipatala nthawi yomweyo ngati inu kapena munthu wina amene mumamudziwa ali ndi zizindikiro za TEN.

Chithandizochi chimaphatikizapo kuchipatala komanso kulowetsedwa kuchipatala. Gulu lanu lachipatala liziika patsogolo chisamaliro cha bala, chithandizo chamadzimadzi, komanso kuwongolera ululu. Zitha kutenga mpaka milungu isanu ndi umodzi kuti mukhale bwino, koma chithandizo choyambirira chimawongolera kuchira kwanu komanso malingaliro anu.