Ukushaqeka kwe-Septic: kuyini, izimpawu, izimbangela nokuthi kwenziwa kanjani ukwelashwa

-Delile

• Izimpawu eziyinhloko
• Ungakuqinisekisa kanjani ukuxilongwa
• Izimbangela zokushaqeka okubucayi
• Ubani osengozini enkulu
• Yelashwa kanjani
• 1. Ukusetshenziswa kwama-antibiotic
• 2. Ukuvuthwa emthanjeni
• 3. Imishanguzo yegazi
• 4. Ukumpontshelwa igazi
• 5. Ukusetshenziswa kwama-corticosteroids
• 6. IHemodialysis

Ukushaqeka kwe-Septic kuchazwa njengenkinga enkulu ye-sepsis, lapho nangokwelashwa okufanele ngokufakwa kuketshezi kanye namagciwane, umuntu uyaqhubeka nokuba nomfutho wegazi ophansi namazinga e-lactate angaphezu kuka-2 mmol / L. Le mingcele ihlolwa njalo esibhedlela ukubheka ukuvela kwesiguli, impendulo ekwelashweni kanye nesidingo sokwenza ezinye izinqubo.

Ukushaqeka okwenziwa ngomzimba kubhekwa njengenselelo, ngoba lapho isiguli sifinyelela kulesi sigaba sesifo, sesivele sikhubazeke ngokwengeziwe, ngaphandle kwalokho kunokugxila kokutheleleka okukhulu nokuvelela okukhulu kwezinto ezinobuthi ezikhiqizwa amagciwane amancane.

Ngenxa yokwehla komfutho wegazi, kujwayelekile ukuthi abantu abathuke ngokweqile babe nobunzima obukhulu ekujikelezeni kwegazi, okwenza ukuthi umoya-mpilo omncane ufinyelele ezithweni ezibalulekile njengobuchopho, inhliziyo nezinso. Lokhu kubangela ukuthi kuvele ezinye, izimpawu kanye nezimpawu ezithe xaxa zokwethuka, njengokuncipha komchamo kanye nezinguquko esimweni sengqondo.

Ukwelashwa kokushaqeka okwenziwa ngamaselepisi kwenziwa e-Intensive Care Unit (ICU), kusetshenziswa imishanguzo kanye nemithi elwa namagciwane ukulawula imisebenzi yenhliziyo nezinso nokuqeda igciwane elibanga ukutheleleka, ngaphezu kokuqapha ingcindezi namazinga e-lactate.

Izimpawu eziyinhloko

Njengoba ukushaqeka okubhekwa njengokweqile kubhekwa njengenkinga ye-sepsis, izimpawu nezimpawu ezivezwa yisiguli ziyefana, ngemfiva ephezulu nephikelelayo nokwenyuka kokushaya kwenhliziyo. Ngaphezu kwalokho, uma kwenzeka ukushaqeka okubucayi kungenzeka futhi ukuthi kugcinwe:

• Umfutho wegazi ophansi kakhulu, nomfutho we-arterial mean (MAP) ongaphansi noma olingana no-65 mmHg;
• Khulisa ekugxileni kwe-lactate ejikelezayo, ngokugxila okungaphezu kuka-2.0 mmol / L;
• Ukuphefumula ngokushesha ngomzamo wokukhulisa inani le-oxygen ejikelezayo;
• Izinga lokushisa likhuphuka ngaphezu kokwehla okujwayelekile noma ngokweqile;
• Ukunyuka kwenhliziyo;
• Ukukhiqizwa okuncane komchamo;
• Ukulahlekelwa ukwazi noma ukudideka kwengqondo;

Izimpawu zokushaqeka okubangelwa ukucasuka kuvela lapho i-microorganism ifinyelela egazini futhi ikhiphe ubuthi bayo, obushukumisa amasosha omzimba ukuthi akhiqize futhi akhiphe ama-cytokines kanye nabalamuli abavuthayo ukulwa nalesi sifo. Uma isiguli singaphenduli ekwelashweni noma ubuthi bama-microorganism buphakeme kakhulu, kungenzeka ukuthi isiguli sizoba ne-sepsis enamandla bese sishaqeka ngokweqile.

Ngenxa yobuningi bobuthi, kungahle kube nezinguquko enanini le-oxygen elifinyelela ezithweni, okungaholela ekuhlulekeni kwesitho nokubeka impilo yomuntu engcupheni.

Ungakuqinisekisa kanjani ukuxilongwa

Ukutholakala kokushaqeka okubangelwa ukwesaba kwenzeka ngokuhlolwa komuntu emtholampilo nasekuhlolweni kwelabhorethri. Imvamisa, kwenziwa ukuhlolwa kwegazi ukuze kutholakale ukuthi ingabe isibalo segazi siyashintsha yini (amaseli abomvu egazi, ama-leukocyte nama-platelets), uma kunenkinga yokusebenza kwezinso, yini ukugxila komoya-mpilo egazini futhi uma kukhona noma yiluphi ushintsho enanini lama-electrolyte akhona egazini. Ezinye izivivinyo udokotela angazi-oda zihlobene nokuhlonza i-microorganism edala ukwethuka.

Ukuxilongwa kuphetha ngokushaqeka okubangelwa yi-septic lapho, ngaphezu kwezibonakaliso nezimpawu zesifo sepsis, ukwanda kokuhlushwa kwe-lactate nokuphikelela kwengcindezi yegazi ephansi kubonakala ngisho nangemva kokwelashwa.

Izimbangela zokushaqeka okubucayi

Ukwenzeka kokushaqeka okubangelwa yisepptic kuhlobene nokumelana kwama-microorganisms ekwelashweni, ngaphezu kohlelo lokuzivikela komzimba lomuntu. Ngaphezu kwalokho, ukuba khona kwama-probe ane-catheters kanye ne-catheters enegciwane, okuyizinto zokwelashwa ezixhumana ngqo nomuntu osesibhedlela, nakho kungavumela ukushaqeka okubangelwa yi-septic, ngoba i-microorganism ingasakazeka kalula egazini, yande futhi ikhiphe ubuthi obugcina bube sengozini ukusebenza komzimba nokuphakelwa komoya-mpilo ezicutshini.

Ngakho-ke, noma yikuphi ukutheleleka kungadala i-sepsis noma ukushaqeka kweseptic futhi kubangelwa ikakhulu yi:

• Amagciwane, njengeIStaphylococcus aureus, iStreptococcus pneumoniae, uKlebsiella pneumoniae, i-Escherichia coli, iPseudomonas aeruginosa, iStreptococcus sp., Neisseria meningitidis, phakathi kwabanye;
• Igciwane, njengomkhuhlane i-H1N1, i-H5N1, i-yellow fever virus noma i-dengue virus, phakathi kokunye;
• Isikhunta, ikakhulukazi ngobuliliUCandida sp.

Ukutheleleka okuholela ekuthukeni okwedlulele kungavela noma kuphi emzimbeni, kanti okunye okuvame kakhulu yi-pneumonia, ukutheleleka ngomgudu womchamo, i-meningitis, i-erysipelas, i-cellulitis esithathelwanayo, ukutheleleka kwamanxeba okuhlinzwa noma ukungcoliswa kwama-catheters.

Ubani osengozini enkulu

Abantu okungenzeka ukuthi bathintwe ukutheleleka okungathi sína futhi bathuke ngokweqile yilabo abalaliswe esibhedlela, ikakhulukazi e-ICU, njengoba kuyizindawo lapho ama-microorganisms angathola khona ukumelana okukhulu nemithi yokwelapha, lapho kukhona ukwethulwa kwama-probe kanye ama-catheters noma izivivinyo, okungaba imithombo yokutheleleka, nokuthi amasosha omzimba wesiguli angakhubazeka ngenxa yesifo esithile.

Ngaphezu kwalokho, ukuba nezifo ezingamahlalakhona njengesifo sikashukela, ukwehluleka kwenhliziyo, umongo we-aplasia, ukwehluleka kwezinso, kanye nokusebenzisa imishanguzo yokuzivikela njenge-chemotherapy, i-corticosteroids, i-antibiotics noma i-radiotherapy nakho kungenza abantu bathambekele kakhulu ekuthuthumeleni kwe-sepsis nokwesaba, ngoba kungaphazamisa isenzo samasosha omzimba.

Yelashwa kanjani

Ukwelashwa kokushaqeka okubangelwa yizinzwa kufanele kwenziwe e-ICU (Intensive Care Unit) futhi kuhlose ukuqeda i-ejenti ebangela i-sepsis futhi, ngale ndlela, ukuxazulula ukushaqeka okubangelwa yizinhlungu. Ngaphezu kwalokho, ukusetshenziswa kwemithi ye-vasoactive yokulawula ukucindezelwa kwegazi kuyakhonjiswa, ngaphezu kokushintshwa kuketshezi ukwandisa inani legazi futhi, ngenxa yalokho, kuvuna ukuthuthwa komoya-mpilo ezicutshini.

1. Ukusetshenziswa kwama-antibiotic

Uma ukushaqeka kweseptic kuqinisekiswa, kufanele kuqale i-antibiotic enamandla, noma ngabe ukugxila kokutheleleka akukaziwa. Lokhu kwenzelwa ukuthi i-microorganism ebanga ukutheleleka isuswe ngokushesha okukhulu, kunciphise ukusabela komzimba.

Ukwelashwa kwenziwa ngokusetshenziswa kwama-antimicrobial (ama-antibiotics) ngokuya nge-microorganism ekhonjiwe. Thola kabanzi mayelana nokuhlolwa okusiza ukuthola i-antibiotic engcono kakhulu.

2. Ukuvuthwa emthanjeni

Ngokushaqeka okubangelwa ukushaqeka kwegazi, ukusakazwa kwegazi kukhubazeke kakhulu, okwenza ubunzima be-oxygenation yomzimba bube nzima. Ukwenza imithamo ephezulu ye-serum emthanjeni, cishe i-30 ml kg ngayinye, kunconywa njengendlela yokusiza ukugcina ukugeleza kwegazi okwamukelekayo nokwenza ngcono ukuphendula emithini.

3. Imishanguzo yegazi

Ngenxa yokwehla komfutho wegazi, ongaxazululwa kuphela nge-hydration emthanjeni, imvamisa kuyadingeka ukusebenzisa izidakamizwa ukukhuphula umfutho wegazi, obizwa nge-vasopressors ukuthola umfutho wegazi omaphakathi okungenani wama-65 mmHg.

Ezinye izibonelo zale mithi yiNoradrenaline, Vasopressin, Dopamine ne-Adrenaline, okuyizidakamizwa okumele zisetshenziswe ngokuqapha okuseduze kwemitholampilo ukugwema ezinye izinkinga. Enye indlela ukusebenzisa imishanguzo ekhulisa amandla okushaya kwenhliziyo, njengeDobutamine.

4. Ukumpontshelwa igazi

Kungadingeka kwiziguli ezinezimpawu zokungahambi kahle kwegazi futhi ezine-anemia ene-hemoglobin engaphansi kwe-7mg / dl. Hlola izinkomba eziyinhloko zokumpontshelwa igazi.

5. Ukusetshenziswa kwama-corticosteroids

Imithi ye-Corticosteroid, efana neHydrocortisone, ingakhonjiswa njengendlela yokwehlisa ukuvuvukala, kepha-ke, kunezinzuzo kuphela uma kwenzeka ukushaqeka okubangelwa yi-septic, okungukuthi, ezimweni lapho kungenzeki khona ukwenza ngcono umfutho wegazi noma nge-hydration kanye nokusetshenziswa imithi.

6. IHemodialysis

I-Hemodialysis ayikhonjiswa ngaso sonke isikhathi, noma kunjalo, ingaba yisixazululo ezimweni ezinzima lapho ukususwa okusheshayo kwama-electrolyte amaningi, i-asidi egazini noma lapho kumiswa ukusebenza kwezinso.