Njira Zochiritsira Matenda Opatsirana
Pendauluan
Matenda opatsirana akadali vuto lalikulu pa ntchito zachipatala padziko lonse lapansi, kuphatikizapo ku Indonesia. Matendawa amatha kuyambitsidwa ndi mabakiteriya, mavairasi, bowa, kapena tizilombo toyambitsa matenda, ndipo kasamalidwe kawo kamafunika njira yokonzedwa bwino kuti ikhale yothandiza, yotetezeka, komanso yothandiza kuchepetsa chiopsezo cha zovuta komanso kukana mankhwala. Njira yothandizira matenda opatsirana ndi njira zingapo zachipatala komanso zogwirira ntchito zomwe zimatsogolera ogwira ntchito zachipatala pakukhazikitsa matenda, kudziwa chithandizo, kuyang'anira momwe angayankhire, komanso kupewa kufalikira kwa matendawa. Nkhaniyi ikufotokoza mwatsatanetsatane mfundo ndi zigawo zazikulu za njira yothandizira matenda opatsirana.
Cholinga cha Ndondomeko ya Chithandizo
Ma protocol si "malamulo" okha, koma ndi zida zowongolera ubwino wautumiki. Zolinga zawo ndi izi:
1. Perekani chithandizo cholunjika kutengera chomwe chayambitsa matendawa.
2. Kuchepetsa kuchedwa kwa chithandizo, makamaka matenda oopsa monga sepsis.
3. Kupewa kukana maantibayotiki chifukwa cha kugwiritsa ntchito mankhwala mosayenera.
4. Onetsetsani kuti wodwala ali otetezeka pochepetsa zotsatirapo zake komanso momwe mankhwala amagwirizanirana ndi wodwalayo.
5. Kulamulira kufalikira kwa matendawa kudzera mu njira zodzipatula komanso zopewera matenda.
1. Kuwunika Koyamba ndi Kuyesa Kachipatala
Gawo loyamba ndikuwunika mwachangu momwe wodwalayo alili. Ogwira ntchito zachipatala amawunika zizindikiro zofunika kwambiri (kuthamanga kwa magazi, kugunda kwa mtima, kutentha, kuthamanga kwa mpweya, kuchuluka kwa mpweya m'thupi), kuchuluka kwa chidziwitso, ndi zizindikiro zazikulu. Pazifukwa zina, monga kutentha thupi kwa nthawi yayitali, kupuma movutikira, kuthamanga kwa magazi, kuchepa kwa chikumbumtima, kapena kukayikira kuti ali ndi meningitis kapena sepsis, wodwalayo ayenera kutumizidwa nthawi yomweyo kuchipatala chadzidzidzi.
Pa gawo ili, dokotala amachitanso kafukufuku wofunikira: mbiri ya ulendo, kukhudzana ndi matenda opatsirana, kukhudzana ndi odwala, kugwiritsa ntchito maantibayotiki kale, matenda a chitetezo chamthupi (monga HIV, kugwiritsa ntchito ma steroid), ndi zina monga matenda a shuga kapena matenda a impso.
2. Dziwani komwe kumachokera ndi mtundu wa matenda
Ndondomeko yabwino imayang'ana kwambiri kuzindikira komwe kwayambitsa matenda: kaya ndi njira yopumira, njira ya mkodzo, khungu ndi minofu yofewa, matenda am'mimba, kapena matenda am'thupi. Zifukwa zosiyanasiyana zingafunike njira zosiyanasiyana zochiritsira. Mwachitsanzo, matenda opatsirana ndi mavairasi nthawi zambiri safuna maantibayotiki, pomwe matenda a bakiteriya nthawi zambiri amafunikira maantibayotiki oyenera.
Magulu ena ofunikira ndi awa:
- Matenda opatsirana m'dera (omwe amapezeka kunja kwa zipatala)
- Matenda a nosocomial (opezeka kuchipatala)
- Matenda okhudzana ndi njira yochizira matenda (monga ma catheter, ma ventilator)
Matenda a nosocomial nthawi zambiri amakhala ndi majeremusi osagonja kwambiri, kotero njira zina nthawi zambiri zimaphatikizapo kuganizira za majeremusi a MDR (osagonja ndi mankhwala ambiri).
3. Kufufuza Kothandizira ndi Kuzindikira Matenda a Etiological
Ngakhale kuti nthawi zina chithandizo chimayenera kuyambitsidwa nthawi yomweyo, njira zochiritsira zimalimbikitsa kutenga zitsanzo musanapereke mankhwala opha tizilombo ngati n'kotheka. Mayeso ofala ndi awa:
- Kuchuluka kwa magazi, CRP, procalcitonin (m'malo ena)
- Kuchuluka kwa magazi m'magazi ngati muli ndi malungo aakulu kapena mukukayikira kuti muli ndi sepsis
- Kusanthula mkodzo ndi kupanga mkodzo ngati matenda a mkodzo akuganiziridwa kuti ndi ofala
- Kupukuta (pakhosi, bala, sputum) kuti mupeze culture/PCR monga momwe zasonyezedwera
- X-ray pachifuwa cha chibayo
- Mayeso achangu monga mayeso a antigen kapena PCR a ma virus ena
Cholinga chachikulu ndikudziwa ngati matendawa ayambitsidwa ndi mabakiteriya, mavairasi, bowa, kapena tizilombo toyambitsa matenda. Izi zimathandiza kuti pakhale chithandizo chanzeru komanso chokonzedwa bwino mukangopeza zotsatira za mayeso.
4. Mfundo Zachithandizo Champhamvu
Nthawi zambiri, zotsatira za chitukuko zimatenga nthawi. Chifukwa chake, ndondomekoyi imaphatikizapo malangizo a chithandizo choyesera, chomwe chimaphatikizapo kupereka mankhwala kutengera matenda omwe angapezeke kutengera komwe kachilombo kamapezeka, kuopsa kwake, komanso momwe mabakiteriya alili.
Mfundo zazikulu za chithandizo chamankhwala:
1. Chizindikiro cholondola: maantibayotiki amaperekedwa pokhapokha ngati pali kukayikira kwakukulu kwa matenda a bakiteriya kapena matenda omwe amafunikira maantibayotiki.
2. Sipekitiramu yoyenera: gwiritsani ntchito sipekitiramu yokwanira, koma osati yochuluka kwambiri.
3. Mlingo woyenera ndi nthawi yoyenera kumwa: ganizirani kulemera kwa thupi, momwe impso/chiwindi zimagwirira ntchito, komanso kuopsa kwa matenda.
4. Njira yoyenera: kudzera m'mitsempha ya matenda oopsa; kumwa ngati kuli bwino komanso ngati kuli koyenera kumwa.
5. Pa nthawi yake: mu sepsis, kupereka maantibayotiki mwachangu kumayenderana ndi zotsatira zabwino.
Kwa odwala omwe ali pachiwopsezo chachikulu cha kusamva mankhwala (mbiri ya kugonekedwa m'chipatala, kugwiritsa ntchito maantibayotiki mobwerezabwereza, kugwiritsa ntchito zipangizo zowononga), njira zambiri zimatsogolera kusankha maantibayotiki ambiri, koma ziyenera kuunikidwanso.
5. Chithandizo Chokhazikika ndi Kuchepetsa Kuchuluka kwa Matenda
Zotsatira za mayeso okhudzana ndi chikhalidwe ndi maantibayotiki zikapezeka, ndondomekoyi ikugogomezera kusintha kupita ku chithandizo chotsimikizika: kusintha maantibayotiki amphamvu kukhala mankhwala othandiza kwambiri, ocheperako, komanso otetezeka.
Kuchepetsa kufalikira kwa matendawa kumatanthauza kuchepetsa mphamvu ya chithandizo ngati n'kotheka:
- kuyambira pa kuphatikiza mankhwala opha tizilombo toyambitsa matenda a bakiteriya
- kuyambira pa broad spectrum mpaka pa narrow spectrum
- kuyambira pakamwa mpaka pa mtsempha pamene vutolo lili bwino
Kuchepetsa kufalikira kwa matendawa ndi chinsinsi chofunikira kwambiri pa mapulogalamu oletsa kukana maantibayotiki ndipo kumathandiza kuchepetsa zotsatirapo zoyipa monga kutsegula m'mimba komwe kumayambitsidwa ndi maantibayotiki kapena chiopsezo cha matenda opatsirana.
6. Nthawi ya Chithandizo
Njira zamakono zimalimbikitsa nthawi yokwanira, koma osati yochulukirapo. Nthawi yake imadalira mtundu wa matenda, momwe wodwalayo akuyankhira kuchipatala, komanso momwe wodwalayo alili. Matenda ena amatha kusintha ndi chithandizo cha kanthawi kochepa, pomwe ena (monga endocarditis, osteomyelitis, kapena chifuwa chachikulu) amafunika chithandizo cha nthawi yayitali komanso kuyang'aniridwa mosamala.
Chithandizo nthawi zambiri chimayesedwa m'maola 48-72 oyambirira kuti zitsimikizire kuti:
- malungo amachepetsa
- zizindikiro za moyo zimakula
- zizindikiro zachepa
- palibe mavuto omwe amabwera
- zotsatira za mayeso zimathandiza kusankha chithandizo
Ngati palibe kusintha, ndondomekoyi imalimbikitsa kuti pakhale kuwunikiranso: pakhoza kukhala matenda olakwika, thumba lomwe likufunika kutuluka madzi, gwero la matenda osachiritsidwa, kapena kachilombo kolimba.
7. Chithandizo Chothandizira ndi Kusamalira Mavuto
Kuchiza matenda sikungokhudza mankhwala opha tizilombo toyambitsa matenda okha. Ma protocol amaphatikizaponso chithandizo chothandizira ngati pakufunika, monga:
- madzi olowetsedwa m'mitsempha kuti achepetse madzi m'thupi kapena kuti achepetse kugwedezeka
- mankhwala ochepetsa ululu komanso oletsa kutupa
- mpweya kapena mpweya wabwino m'matenda opumira
- Kuwongolera shuga m'magazi mwa odwala matenda a shuga
- kukonza ma electrolyte ndi kuyang'anira ntchito ya ziwalo
Mu sepsis, njira zambiri zimaphatikizapo chithandizo monga kubwezeretsanso madzi m'thupi, kuyezetsa lactate, kukulitsa, kupereka maantibayotiki mwachangu, ndi kuyang'aniridwa mosamala m'chipinda chosamalira odwala kwambiri ngati pakufunika kutero.
8. Kupewa Kufalikira ndi Kuletsa Matenda
Gawo lofunika kwambiri la ndondomekoyi ndikuletsa kufalikira kwa matendawa, m'zipatala komanso m'madera osiyanasiyana. Njira zodziwika bwino ndi izi:
- Sambani m'manja ndikugwiritsa ntchito PPE
- kulowetsedwa kwa madontho/kutuluka m'mlengalenga/kukhudzana ndi kukhudzana malinga ndi mtundu wa matenda
- khalidwe la chifuwa, gwiritsani ntchito chigoba ngati pakufunika kutero
- kuyeretsa zida ndi malo ozungulira
- katemera wa odwala kapena anthu omwe akugwirizana nawo omwe akwaniritsa zofunikira
Kupewa kufalikira kwa matendawa si udindo wa zipatala zokha, komanso kuphunzitsa odwala: nthawi yopumula kunyumba, nthawi yobwerera kuntchito/kusukulu, komanso momwe mungachepetsere chiopsezo chotenga kachilomboka m'banja.
9. Kuwunika, Zotsatirapo, ndi Kuwunika Nthawi ndi Nthawi
Pa nthawi ya chithandizo, odwala amawunikidwa kuti awone ngati chithandizocho chili ndi mphamvu komanso zotsatira zake. Maantibayotiki ena amatha kukhudza impso ndi chiwindi, kapena kuyambitsa ziwengo. Chifukwa chake, ndondomekoyi ikugogomezera izi:
- kuyang'anira momwe impso/chiwindi zimagwirira ntchito mukamagwiritsa ntchito mankhwala enaake
- kuwunika momwe mankhwala amagwirizanirana ndi anthu makamaka odwala omwe ali ndi mankhwala ambiri
- kusiya ndi kusintha mankhwala ngati pakhala zotsatirapo zoyipa kwambiri
Kuwunika nthawi zonse kumathandiza kuonetsetsa kuti ubwino wa chithandizocho ndi woposa zoopsa zake.
10. Maphunziro a Odwala ndi Kutsatira Chisamaliro
Kuchiza bwino matenda kumadalira kwambiri kutsatira malamulo. Odwala ayenera kumvetsetsa:
- kufunika komwa mankhwala motsatira mlingo ndi nthawi yake
- musasiye kumwa mankhwala popanda upangiri wa dokotala
- musagwiritse ntchito maantibayotiki otsala kapena kugawana mankhwala
- zizindikiro zoopsa zomwe zimafuna kubwerera kuchipatala
Maphunziro abwino amachepetsanso kugwiritsa ntchito mankhwala opha tizilombo mosayenera, zomwe ndi chifukwa chachikulu chokhalira osagwira ntchito.
Kutseka
Njira zochiritsira matenda opatsirana ndi malangizo ofunikira omwe amaphatikiza kuzindikira matenda mwachangu, chithandizo choyenera, kusintha kutengera zotsatira za labotale, nthawi yoyenera, komanso kupewa kufalikira kwa matendawa. Ndi kugwiritsa ntchito njira zokhazikika, zotsatira za odwala zimatha kusintha, kuchuluka kwa zovuta kumatha kuchepa, ndipo chiopsezo cha kukana maantibayotiki chitha kuchepa. Pamapeto pake, njira zochiritsira sizili zikalata zokha, koma machitidwe ogwirizana omwe amaphatikizapo madokotala, anamwino, akatswiri a labotale, akatswiri a zamankhwala, ndi odwala kuti akwaniritse bwino komanso moyenera njira zothanirana ndi matenda.
Ngati mukufuna, nditha kusintha nkhaniyi kuti ikhale yeniyeni (monga njira zochizira chibayo, UTI, sepsis, kapena TB) kapena kuwonjezera mawonekedwe monga magawo, tebulo lachidule la njira zochiritsira, ndi mndandanda wa mabuku.
