Umothuko we-Septic: yintoni, iimpawu, oonobangela kunye nendlela yokwenziwa kwonyango

Umxholo

• Iimpawu eziphambili
• Indlela yokuqinisekisa ukuxilongwa
• Oonobangela bothuka
• Ngubani osengozini enkulu
• Unyango lwenziwa njani
• 1. Ukusetyenziswa kwee-antibiotics
• 2. Ukuntywila emanzini
• 3. Amayeza oxinzelelo lwegazi
• 4. Utofelo-gazi
• 5. Ukusetyenziswa kwee-corticosteroids
• 6. IHemodialysis

Ukutshatyalaliswa kwe-Septic kuchazwa njengengxaki enkulu ye-sepsis, apho nangona unyango olufanelekileyo kunye nokutshintshwa kwe-antibiotic, umntu uyaqhubeka nokuba noxinzelelo lwegazi oluphantsi kunye namazinga e-lactate ngaphezu kwe-2 mmol / L. Ezi paramitha zivavanywa rhoqo esibhedlele ukujonga isigulana, impendulo kunyango kunye nesidingo sokwenza ezinye iinkqubo.

Umothuko othathelwa ingqalelo uthathwa njengomceli mngeni, kuba xa isigulana sifika kweli nqanaba lesi sifo, sele sidodobala ngakumbi, ngaphandle koko kukho ukugxila okukosulelayo kwaye ubukhulu becala bezinto ezinobuthi eziveliswa ziintsholongwane.

Ngenxa yokwehla koxinzelelo lwegazi, kuyinto eqhelekileyo kubantu abothukayo ukuba babe nobunzima ekujikelezeni kwegazi, okubangela ioksijini encinci ifikelele kumalungu abalulekileyo anje ngengqondo, intliziyo kunye nezintso. Oku kubangela ukuba ezinye, iimpawu ezithile kunye neempawu zokuothuka zivele, njengokuhla komchamo kunye notshintsho kwisimo sengqondo.

Unyango lokothuka okwenziwa nge-septic lwenziwa kwiCandelo eliKhawulezileyo loKhathalelo (i-ICU), kusetyenziswa iziyobisi kunye namayeza okubulala iintsholongwane ukulawula ukusebenza kwentliziyo kunye nezintso kunye nokuphelisa i-microorganism ebangela usulelo, ukongeza kuxinzelelo lokujonga kunye namanqanaba e-lactate

Iimpawu eziphambili

Njengothuko lwe-septic luthathwa njengengxaki ye-sepsis, iimpawu kunye neempawu ezibonakaliswa sisigulana ziyafana, kunye nefiva ephezulu kunye neqhubekayo kunye nokunyuka kwentliziyo. Ukongeza, kwimeko yokothuka okubonakalayo kunokwenzeka ukuba uqaphele:

• Uxinzelelo lwegazi olusezantsi kakhulu, kunye noxinzelelo lwe-arterial (MAP) engaphantsi okanye elingana ne-65 mmHg;
• Ukonyusa uxinzelelo lokujikeleza kwe-lactate, ngoxinzelelo olungaphezulu kwe-2.0 mmol / L;
• Ukuphefumla ngokukhawuleza kumzamo wokunyusa inani lokujikeleza kweoksijini;
• Ukunyuka kwamaqondo obushushu ngaphezulu kokuwa okuqhelekileyo okanye okugqithileyo;
• Ukunyuka kwentliziyo;
• Ukuveliswa komchamo okuncinci;
• Ukuphulukana nokuqonda okanye ukudideka kwengqondo;

Iimpawu zothuko lwe-septic zivela xa i-microorganism ifikelela kwigazi kwaye ikhuphe i-toxins yayo, evuselela amajoni omzimba ukuba avelise kwaye akhuphe ii-cytokines kunye nabalamli abakhoyo ukudumba esi sifo. Ukuba isigulana asiphenduli kunyango okanye ityhefu ye-microorganisms iphezulu kakhulu, kunokwenzeka ukuba isigulana siphuhlise isifo sepsis esiqatha emva koko sothuke.

Ngenxa yobuninzi beetyhefu, kusenokubakho utshintsho kwiqondo leoksijini elifikelela kumalungu, elinokubangela ukusilela kwamalungu nokubeka ubomi bomntu emngciphekweni.

Indlela yokuqinisekisa ukuxilongwa

Ukuchongwa kokothuka kwenziwa ngokusekwe kuvavanyo lweklinikhi kunye novavanyo lwaselebhu. Ngokwesiqhelo, uvavanyo lwegazi luyenziwa ukuze kuchongwe ukuba ngaba inani leeseli zegazi litshintshiwe (iiseli ezibomvu zegazi, iiseli ezimhlophe zegazi kunye neeplatelets), ukuba kukho ingxaki ekusebenzeni kwezintso, yintoni uxinzelelo lweoksijini egazini kwaye ukuba kukho Naluphi na utshintsho kwinani lee-electrolyte ezikhoyo egazini. Olunye uvavanyo olunokuyalelwa ngugqirha lunxulumene nokuchongwa kwento ebangela umothuko.

Ukuxilongwa kugqityiwe kukothuka xa, ukongeza kwiimpawu zesifo sepsis, ukonyuka koxinzelelo lwe-lactate kunye nokuzingisa koxinzelelo lwegazi olusezantsi zichongiwe nasemva konyango.

Oonobangela bothuka

Ukuvela komothuko we-septic kunxulumene nokuchasana neentsholongwane kunyango, ukongeza kwinkqubo yomzimba yokuzikhusela. Ukongeza, ubukho bezinto ezosulelekileyo kunye neecatheters, ezizizixhobo zonyango ezinxibelelana ngokuthe ngqo nomntu olaliswe esibhedlele, zinokuxhasa ukothuka, kuba i-microorganism inokusasazeka ngokulula kwigazi, yande kwaye ikhuphe iityhefu ezigqibela ngokulalanisa. ukusebenza komzimba kunye nokuhanjiswa kweoksijini kwizicwili.

Ke, naluphi na usulelo lunokubangela i-sepsis okanye ukothuka okubangelwa sisifo septic kwaye ikakhulu kubangelwa:

• Iintsholongwane, njengeIStaphylococcus aureus, iStreptococcus pneumoniae, iKlebsiella pneumoniae, i-Escherichia coli, iPseudomonas aeruginosa, iStreptococcus sp., Neisseria meningitidis, phakathi kwabanye;
• Intsholongwane, njenge-influenza H1N1, H5N1, intsholongwane ye-yellow fever okanye intsholongwane yedengue, phakathi kwezinye;
• Ngunda, ikakhulu ngokwesiniUCandida sp.

Usulelo olukhokelela kukothuka okubangelwa sisifo septic lunokuvela naphina emzimbeni, kwaye ezinye zezona zixhaphakileyo sisifo semiphunga, usulelo lomchamo, isifo sokudumba kwenwebu yengqondo, i-erysipelas, i-cellulitis esosulelayo, usulelo lwamanxeba otyando okanye ukungcoliseka kwee-catheters

Ngubani osengozini enkulu

Abantu abanokuchaphazeleka kukosuleleka kakhulu kwaye bahlakulele ukothuka okubolileyo ngabo balaliswe esibhedlele, ngakumbi e-ICU, kuba ziindawo apho ii-microorganisms zinokufumana uxhathiso olukhulu kunyango lwe-antibiotiki, apho kukho ukuqaliswa kweenkqubo kunye iicatheters okanye iimvavanyo, ezinokuba yimithombo yosulelo, kunye nangenxa yokuba amajoni omzimba wesigulana angaphazamiseka ngenxa yesifo esithile.

Ukongeza, ukuba nezifo ezinganyangekiyo ezinje ngesifo seswekile, ukungaphumeleli kwentliziyo, umongo, isifo sezintso, kunye nokusebenzisa iziyobisi ezifana ne-chemotherapy, i-corticosteroids, i-antibiotics okanye i-radiotherapy kunokwenza ukuba abantu bathambekele kwi-sepsis kunye nokothuka, kuba kungonakalisa isenzo samajoni omzimba.

Unyango lwenziwa njani

Unyango lokothuka okwenziwe nge-septic kufuneka lwenziwe kwi-ICU (iCandelo loKhathalelo oluKhulu) kwaye ijolise ekupheliseni iarhente ebangela i-sepsis kwaye, ngale ndlela, ukusombulula ukothuka. Ukongeza, ukusetyenziswa kweziyobisi ze-vasoactive ukulawula uxinzelelo lwegazi kubonisiwe, ukongeza kutshintsho olunamanzi ukwandisa inani legazi kwaye, ngenxa yoko, ukuthanda ukuhanjiswa kweoksijini kwizicwili.

1. Ukusetyenziswa kwee-antibiotics

Ukuba umothuko we-septic uqinisekisiwe, isibulala-zintsholongwane esinamandla kufuneka siqaliswe, nokuba ugqaliso losulelo alukaziwa. Oku kwenzelwa ukuba i-microorganism ebangela usulelo isuswe ngokukhawuleza, ukunciphisa ukuphendula komzimba.

Unyango lwenziwa ngokusetyenziswa kwee-antimicrobials (antibiotics) ngokwe-microorganism echongiweyo. Fumanisa ngakumbi malunga novavanyo olukunceda ekuchongeni eyona ntsholongwane ilungileyo.

2. Ukuntywila emanzini

Ngomothuko we-septic, ukujikeleza kwegazi kuphazamiseke kakhulu, okwenza i-oxygenation yomzimba ibe nzima. Ukwenza imithamo ephezulu yeserum emthanjeni, malunga ne-30 ml ngekg nganye, kuyacetyiswa njengendlela yokunceda ukugcina ukuhamba kwegazi okwamkelekileyo kunye nokuphucula impendulo kumayeza.

3. Amayeza oxinzelelo lwegazi

Ngenxa yokwehla koxinzelelo lwegazi, olungasombululekiyo kuphela nge-hydration emthanjeni, kuhlala kufanelekile ukusebenzisa iziyobisi ukunyusa uxinzelelo lwegazi, olubizwa ngokuba yi-vasopressors ukufezekisa uxinzelelo lwegazi lwe-65 mmHg.

Eminye imizekelo yala machiza yiNoradrenaline, iVasopressin, iDopamine kunye neAdrenaline, ezi ziyobisi ekufuneka zisetyenziswe ekubekweni esweni ngokusondeleyo ukuthintela ezinye iingxaki. Olunye ukhetho kukusebenzisa amayeza anyusa ukubetha kwentliziyo, njengeDobutamine.

4. Utofelo-gazi

Kungafuneka kwizigulana ezineempawu zokungahambi kakuhle kwegazi kwaye ezine-anemia enehemoglobin engaphantsi kwe-7mg / dl. Jonga ezona zinto ziphambili kutofelo-gazi.

5. Ukusetyenziswa kwee-corticosteroids

Amayeza e-Corticosteroid, anje ngeHydrocortisone, anokuboniswa njengendlela yokunciphisa ukudumba, nangona kunjalo, kukho izibonelelo kuphela kwimeko yokothuka okubangelwa kukuphazamiseka, oko kukuthi, kwiimeko apho kungenakwenzeka ukuphucula uxinzelelo lwegazi nokuba uhambisa amanzi kunye nokusetyenziswa amayeza.

6. IHemodialysis

I-Hemodialysis ayisoloko iboniswa, nangona kunjalo, inokuba sisisombululo kwiimeko ezinzima apho ukususwa ngokukhawuleza kwe-electrolyte engaphezulu, i-asidi egazini okanye xa kukho ukumiswa ekusebenzeni kwezintso.