I-ECMO (i-Oxygenation ye-membrane engaphezulu)

Umxholo

• Ngubani ofuna i-ECMO?
• Iintsana
• Abantwana
• Abantu abadala
• Zeziphi iintlobo ze-ECMO?
• Ndiyilungiselela njani i-ECMO?
• Kwenzeka ntoni ngexesha le-ECMO?
• Zeziphi iingxaki ezinxulunyaniswa ne-ECMO?
• Kwenzeka ntoni emva kweECMO?

Yintoni i-membrane yangaphandle yeoksijini (ECMO)?

I-membrane engaphezulu ye-membrane oxygenation (ECMO) yindlela yokubonelela ngokuphefumla kunye nenkxaso yentliziyo. Ihlala isetyenziselwa abantwana abagula kakhulu abaneentliziyo okanye ukuphazamiseka kwemiphunga. I-ECMO inokubonelela ngeoksijini eyimfuneko kusana ngelixa oogqirha banyanga imeko engaphantsi. Abantwana abadala kunye nabantu abadala banokuxhamla kwi-ECMO phantsi kweemeko ezithile.

I-ECMO isebenzisa uhlobo lwemiphunga yokufakelwa ebizwa ngokuba yi-membrane oxygenator ukwenza igazi lifuthe. Idityaniswa nefudumeleyo kunye nefilitha yokuhambisa ioksijini egazini kwaye uyibuyisele emzimbeni.

Ngubani ofuna i-ECMO?

Oogqirha bakubeka kwi-ECMO ngenxa yokuba uneengxaki ezinzulu, kodwa eziguqukayo, zentliziyo okanye zemiphunga. I-ECMO ithatha umsebenzi wentliziyo kunye nemiphunga. Oku kukunika ithuba lokuchacha.

I-ECMO inokunika iintliziyo ezincinci kunye nemiphunga yeentsana ixesha elininzi lokukhula.I-ECMO isenokuba "yibhulorho" ngaphambi nasemva konyango njengotyando lwentliziyo.

Ngokutsho kweSibhedlele saBantwana saseCincinnati, i-ECMO iyimfuneko kuphela kwiimeko ezigwenxa. Ngokubanzi, oku kusemva kokuba amanye amanyathelo enkxaso engaphumelelanga. Ngaphandle kwe-ECMO, inqanaba lokusinda kwiimeko ezinjalo lijikeleze iipesenti ezingama-20 okanye ngaphantsi. Nge-ECMO, inqanaba lokusinda linokunyuka liye kuma kwiipesenti ezingama-60.

Iintsana

Kubantwana, iimeko ezinokufuna i-ECMO zibandakanya:

• uxinzelelo lokuphefumla (ubunzima bokuphefumla)
• i-hernia yokuzalwa ene-diaphragmatic (umngxunya kwisithambisi)
• meconium aspiration syndrome (inhalation yeemveliso zenkunkuma)
• uxinzelelo lwegazi kwimiphunga (uxinzelelo lwegazi oluphezulu kwimithambo yegazi)
• inyumoniya ebukhali
• ukusilela ekuphefumuleni
• ukubanjwa kwe-cardiac
• utyando lwentliziyo
• ispsis

Abantwana

Umntwana unokufuna i-ECMO ukuba unamava:

• ukukrala kwemiphunga
• izifo ezosulelayo
• iziphene zentliziyo ozelwe nayo
• utyando lwentliziyo
• umothuko nezinye iimeko zikaxakeka
• ukufuna izinto eziyityhefu emiphungeni
• umbefu

Abantu abadala

Kubantu abadala, iimeko ezinokufuna i-ECMO zibandakanya:

• ukukrala kwemiphunga
• umothuko nezinye iimeko zikaxakeka
• inkxaso yentliziyo emva kokusilela kwentliziyo
• izifo ezosulelayo

Zeziphi iintlobo ze-ECMO?

I-ECMO inamalungu aliqela, kubandakanya:

• cannulae: iicatheters ezinkulu (iityhubhu) ezifakwe kwimithambo yegazi ukususa nokubuyisa igazi
• inwebu yeoksijiniImiphunga engeyiyo eyoksijini egazini
• kushushu kunye nefilithaoomatshini abashushu nabacoca igazi ngaphambi kokuba i-cannulae ibuyisele emzimbeni

Ngexesha le-ECMO, umpompo we-cannulae wegazi ophelelwe lioksijini. I-membrane oxygenator ke ibeka ioksijini egazini. Emva koko ithumela igazi elinomoya opholileyo ngokufudumeleyo nokucoca ulibuyisele emzimbeni.

Zimbini iintlobo ze-ECMO:

• veno-venous (VV) ECMO: I-VV ECMO ithatha igazi emthanjeni ize ilibuyisele emthanjeni. Olu hlobo lwe-ECMO luxhasa ukusebenza kwemiphunga.
• veno-arterial (VA) ECMO: I-VA ECMO ithatha igazi emthanjeni ize ilibuyisele kumthambo. VA ECMO ixhasa zombini intliziyo kunye nemiphunga. Ingenangqondo ngakumbi kune-VV ECMO. Ngamanye amaxesha umthambo we-carotid (umthambo ophambili osuka entliziyweni uye kwingqondo) unokufuna ukuvalwa emva koko.

Ndiyilungiselela njani i-ECMO?

Ugqirha uya kujonga umntu phambi kwe-ECMO. I-cranial ultrasound iya kuqinisekisa ukuba akukho kuphuma kwegazi kwingqondo. I-cardiac ultrasound iya kugqiba ukuba intliziyo isebenza. Kwakhona, ngelixa ukwi-ECMO, uya kuba nesifuba se-X-ray yemihla ngemihla.

Emva kokufumanisa ukuba i-ECMO iyimfuneko, oogqirha baya kulungisa izixhobo. Iqela le-ECMO elizinikeleyo, kubandakanya ugqirha oqinisekisiweyo webhodi onoqeqesho kunye namava kwi-ECMO uya kuyenza i-ECMO. Iqela likwabandakanya:

• Abongikazi ababhalisiweyo e-ICU
• iingcali zokuphefumla
• perfusionists (iingcali ekusebenziseni oomatshini bentliziyo-nemiphunga)
• abasebenzi abanika inkxaso nabacebisi
• iqela lezothutho lama-24/7
• iingcali zokubuyisela kwimeko yesiqhelo

Kwenzeka ntoni ngexesha le-ECMO?

Ngokuxhomekeke kubudala bakho, oogqirha baya kubeka kwaye bakhusele i-cannulae entanyeni, kwi-groin, okanye esifubeni ngelixa uphantsi kwe-anesthesia ngokubanzi. Uhlala uhlala uhleli ngelixa ukwi-ECMO.

I-ECMO ithatha umsebenzi wentliziyo okanye wemiphunga. Oogqirha baya kwenza esweni ngokusondeleyo ngexesha le-ECMO ngokuthatha i-X-ray mihla le kunye nokubeka iliso:

• inqanaba lentliziyo
• izinga lokuphefumla
• amanqanaba eoksijini
• ifuthe legazi

Umbhobho wokuphefumla kunye nomoya ophefumlayo ugcina imiphunga isebenza kwaye uncede ukususa ukhuseleko.

Amayeza aya kugqitywa ngokuqhubekayo ngokusebenzisa i-catheters efakwa ngaphakathi. Elinye iyeza elibalulekileyo yiherparin. Eli gazi licothayo lithintela ukubamba njengoko igazi lihamba ngaphakathi kwe-ECMO.

Ungahlala kwi-ECMO naphina ukusuka kwiintsuku ezintathu ukuya kwinyanga. Xa uhlala ixesha elide kwi-ECMO, umngcipheko ophezulu weengxaki.

Zeziphi iingxaki ezinxulunyaniswa ne-ECMO?

Umngcipheko omkhulu kwi-ECMO ukopha. I-heparin iyalincinisa igazi ukuthintela ukubamba. Ikonyusa umngcipheko wokopha emzimbeni nasengqondweni. Izigulana ze-ECMO kufuneka zifumane ukuhlolwa rhoqo kweengxaki zokopha.

Kukho umngcipheko wosulelo ukusuka ekufakweni kwe-cannulae. Abantu abakwi-ECMO banokufumana utofelo-gazi rhoqo. Ezi zikwanomngcipheko omncinci wosulelo.

Ukungasebenzi kakuhle okanye ukusilela kwezixhobo ze-ECMO ngomnye umngcipheko. Iqela le-ECMO liyayazi indlela yokwenza kwiimeko ezingxamisekileyo ezinje ngokusilela kwe-ECMO.

Kwenzeka ntoni emva kweECMO?

Njengoko umntu ephucula, oogqirha baya kubakhupha kwi-ECMO ngokunciphisa ngokuthe ngcembe inani legazi le-oxygenated nge-ECMO. Nje ukuba umntu aphume kwi-ECMO, baya kuhlala kumatshini wokuphefumla kangangexesha elithile.

Abo bebekwi-ECMO basazakufuna ukulandelelwa okusondeleyo kwimeko yabo.