Isifo esimandundu soxinzelelo lwamalungu okuphefumla

Isifo esibuhlungu sokuphefumla (i-ARDS) yimeko esongela ubomi yemiphunga ethintela ioksijini eyoneleyo ukuba ingene emiphungeni nasegazini. Iintsana nazo zinokuba nesifo sokuphefumla.

I-ARDS inokubangelwa nakuphi na ukwenzakala ngokuthe ngqo okanye ngokungathanga ngqo kumphunga. Izizathu eziqhelekileyo zibandakanya:

• Ukuphefumla ukugabha kwimiphunga (umnqweno)
• Ukungenisa imichiza
• Ukufakelwa kwemiphunga
• Ukukrala kwemiphunga
• Ukothuka okwenzeka emzimbeni (usulelo emzimbeni wonke)
• Umonzakalo

Kuxhomekeka kwinani leoksijini egazini kwaye ngexesha lokuphefumla, ubungqongqo be-ARDS buhlelwa njenge:

• Ubumnene
• Iphakathi
• Kakhulu

I-ARDS ikhokelela kulwakhiwo lolwelo kwiisaka zomoya (alveoli). Olu lwelo luthintela ioksijini eyaneleyo ukuba ingadluleli egazini.

Ukwakhiwa kolwelo kwenza imiphunga ibe nzima kwaye iqine. Oku kunciphisa amandla emiphunga okukhula. Inqanaba leoksijini egazini inokuhlala iphantsi ngendlela eyingozi, nokuba umntu ufumana ioksijini kumatshini wokuphefumla (i-ventilator) ngombhobho wokuphefumla (ityhubhu endotracheal).

I-ARDS ihlala yenzeka kunye nokusilela kwezinye iinkqubo zomzimba, ezinjengesibindi okanye izintso. Ukutshaya icuba kunye nokusetyenziswa kotywala kakhulu kunokuba zizinto ezinobungozi kuphuhliso lwazo.

Iimpawu zihlala zikhula ngaphakathi kwe-24 ukuya kwiiyure ze-48 zokulimala okanye zokugula. Rhoqo, abantu abane-ARDS bagula kakhulu abakwazi ukukhalaza ngeempawu. Iimpawu zinokubandakanya nayiphi na kwezi zinto zilandelayo:

• Ukuqhawukelwa ngumphefumlo
• Ukubetha kwentliziyo okukhawulezayo
• Uxinzelelo lwegazi oluphantsi kunye nokusilela komzimba
• Ukuphefumla ngokukhawuleza

Ukumamela esifubeni nge-stethoscope (i-auscultation) kutyhila izandi zokuphefumla ezingaqhelekanga, ezinje ngokuqhekeka, ezinokuba ziimpawu zolwelo emiphungeni. Rhoqo, uxinzelelo lwegazi luphantsi. ICyanosis (ulusu oluhlaza okwesibhakabhaka, imilebe, kunye nezikhonkwane ezibangelwa kukungabikho kweoksijini kwizicwili) zihlala zibonwa.

Uvavanyo olusetyenziselwa ukufumanisa i-ARDS lubandakanya:

• Irhasi yegazi ejikelezayo
• Uvavanyo lwegazi, kubandakanya i-CBC (ubalo lwegazi olupheleleyo) kunye neekhemestri zegazi
• Iinkcubeko zegazi kunye nomchamo
• I-Bronchoscopy kwabanye abantu
• I-x-ray yesifuba okanye i-CT scan
• Iinkcubeko zesikhohlela kunye nohlalutyo
• Uvavanyo losulelo olunokwenzeka

Kusenokufuneka i-echocardiogram ukulawula ukuphuma kwentliziyo, enokubonakala ifana ne-ARDS kwisifuba x-ray.

I-ARDS ihlala ifuna ukunyangwa kwicandelo lokhathalelo olunzulu (ICU).

Injongo yonyango kukubonelela ngenkxaso yokuphefumla kunye nokunyanga unobangela we-ARDS. Oku kunokubandakanya amayeza anyanga usulelo, ukunciphisa ukudumba, kunye nokususa ulwelo kwimiphunga.

I-ventilator isetyenziselwa ukuhambisa iidosi eziphezulu zeoksijini kunye noxinzelelo oluqinisekileyo kwimiphunga eyonakalisiweyo. Abantu bahlala befuna ukuthotywa ngokunzulu ngamayeza. Ngexesha lonyango, ababoneleli ngezempilo benza konke okusemandleni ukukhusela imiphunga ekonakaleni okungaphaya. Unyango luxhasa ikakhulu de imiphunga ibuye.

Ngamanye amaxesha, unyango olubizwa ngokuba yi-extracorporeal membrane oxygenation (ECMO) lwenziwe. Ngexesha le-ECMO, igazi lihluzwa ngomatshini ukubonelela ngeoksijini kunye nokususa ikhabhon diokside.

Amalungu osapho amaninzi abantu abane-ARDS baphantsi koxinzelelo olukhulu. Banokulukhulula olu xinzelelo ngokujoyina amaqela enkxaso apho amalungu abelana ngamava aqhelekileyo kunye neengxaki.

Phantse isinye kwisithathu sabantu abane-ARDS babulawa sesi sifo. Abo bahlala bahlala bebuya nomsebenzi wabo oqhelekileyo wemiphunga, kodwa abantu abaninzi banomonakalo osisigxina (uhlala uthambile) wemiphunga.

Abantu abaninzi abasinda kwi-ARDS banokulahleka kwememori okanye ezinye iingxaki zobomi emva kokuba befumene. Oku kungenxa yokonakala kwengqondo okwenzeke xa imiphunga yayingasebenzi kakuhle kwaye nengqondo yayingafumani oksijini yaneleyo. Abanye abantu banokuba noxinzelelo lwasemva koxinzelelo emva kokusinda kwi-ARDS.

Iingxaki ezinokubangelwa yi-ARDS okanye unyango lwayo zibandakanya:

• Ukusilela kweenkqubo ezininzi zamalungu
• Umonakalo wemiphunga, njengomphunga owileyo (obizwa ngokuba yi-pneumothorax) ngenxa yokwenzakala kumatshini wokuphefumla ekufuneka kunyangiwe
• I-pulmonary fibrosis (ukukhwabanisa komphunga)
• I-pneumonia ehambelana nomoya

Ii-ARDS zihlala zenzeka ngexesha lokugula, nalapho umntu sele esibhedlele. Ngamanye amaxesha, umntu ophilileyo unenyumoniya ebukhali esiba mandundu kwaye iba yi-ARDS. Ukuba unengxaki yokuphefumla, tsalela umnxeba kwindawo yakho yongxamiseko (enje nge-911) okanye uye kwigumbi likaxakeka.

I-edema yamaphaphu engapheliyo; Ukonyuka kokuqina kwe-edema yemiphunga; I-ARDS; Ukulimala kwemiphunga

• Umkhuhlane kunye nomkhuhlane - yintoni oza kuyibuza ugqirha wakho - umntu omdala
• Umkhuhlane kunye nomkhuhlane-yintoni oza kuyibuza ugqirha-umntwana wakho
• Xa usana lwakho okanye usana lwakho lunomkhuhlane

• Amaphaphu
• Inkqubo yokuphefumla

U-Lee WL, uSlutsky AS. Ukungaphumeleli kakuhle kokuphefumla okuphefumlayo kunye ne-ARDS. Ku: Broaddus VC, Mason RJ, Ernst JD, et al, ii-eds. Incwadi kaMurray kunye neNadel yeyeza lokuphefumla. Umhla wesi-6. IPhiladelphia, PA: Elsevier Saunders; 2016: isahluko 100.

UMatthay MA, uLW weLB. Ukungaphumeleli kakuhle kokuphefumula. Ku: IGoldman L, iSchafer AI, ii-eds. Amayeza eGoldman-Cecil. Ngomhla wama-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 96.

Seigel TA. Ukungenisa umoya ngomatshini kunye nenkxaso yomoya engasebenziyo. Ku: Iindonga RM, iHockberger RS, iGausche-Hill M, ii-eds. Unyango lukaRosen oluNgxamisekileyo: iikhonsepthi kunye nokuziqhelanisa neklinikhi. Umhla we-9. IPhiladelphia, PA: Elsevier; I-2018: isahluko 2.