Maitiro Ekurapa Zvirwere Zvinotapukira
Pendauluan
Zvirwere zvinotapukira zvichiri dambudziko guru kumabasa ehutano pasi rese, kusanganisira muIndonesia. Zvirwere zvinogona kukonzerwa nemabhakitiriya, mavhairasi, fungi, kana tupukanana, uye kurapa kwavo kunoda nzira yakarongeka kuti ishande zvakanaka, yakachengeteka, uye ikwanise kuderedza njodzi yezvinetso uye kusakwanisa kushandisa mishonga. Nzira yekurapa zvirwere zvinotapukira inhevedzano yematanho ekurapa uye ekushanda anotungamira vashandi vehutano mukuona kuongororwa, kuona kurapwa, kutarisa mhinduro, uye kudzivirira kutapurirana. Chinyorwa chino chinokurukura zvakarongeka misimboti nezvikamu zvikuru zvenzira yekurapa zvirwere zvinotapukira.
Chinangwa cheMutemo weKurapwa
Maitiro ekushandisa haasi "mitemo" chete, asi zvishandiso zvekuvandudza mhando yebasa. Zvinangwa zvavo zvinosanganisira:
1. Ipai mushonga wakanangana zvichienderana nechikonzero chehutachiona.
2. Deredza kunonoka kurapwa, kunyanya kana paine zvirwere zvakakomba zvakaita se sepsis.
3. Kudzivirira kusakwanisa kurwisa mabhakitiriya nekuda kwekushandiswa kwemishonga zvisina kukodzera.
4. Iva nechokwadi chekuti murwere akachengeteka nekuderedza migumisiro yakaipa uye kusangana kwemishonga.
5. Kudzora kutapurirana kuburikidza nekuzviparadzanisa uye matanho ekudzivirira hutachiona.
1. Kuongorora Kwekutanga uye Kuongororwa Kwekiriniki
Danho rekutanga kuongorora mamiriro emurwere nekukurumidza. Vashandi vezvehutano vanoongorora zviratidzo zvinokosha (BP, kurova kwemoyo, tembiricha, kufema, oxygen saturation), huwandu hwekuziva, uye zviratidzo zvikuru. Mune mamwe mamiriro ezvinhu, akadai sefivha yakareba kwenguva refu, kufema kushoma, hypotension, kudzikira kwekuziva, kana kufungidzirwa kuti ane meningitis kana sepsis, murwere anofanira kutumirwa nekukurumidza kunzvimbo yekutarisirwa kwekukurumidzira.
Panguva ino, chiremba anoitawo anamnesis yakanangana: nhoroondo yekufamba, kusangana nezvirwere zvinotapukira, kusangana nevanhu vane chirwere ichi, kushandisa mishonga inorwisa mabhakitiriya kare, zvirwere zvemuviri (semuenzaniso, HIV, kushandisa steroid), uye zvimwe zvirwere zvakaita sechirwere cheshuga kana chirwere cheitsvo.
2. Sarudza Kwakabva uye Rudzi rweUtachiona
Nzira yakanaka yekutevera inoratidza kunobva hutachiona: kungave kuri kufema, nzira yeweti, ganda nenyama yakapfava, hutachiona hwemudumbu, kana hutachiona hwemuviri. Zvikonzero zvakasiyana zvinogona kuda kurapwa kwakasiyana. Semuenzaniso, hutachiona hwemavhairasi hahudi mishonga inorwisa mabhakitiriya, nepo hutachiona hwemabhakitiriya hunowanzoda mishonga inorwisa mabhakitiriya yakakodzera.
Zvimwe zvikamu zvakakosha ndeizvi:
- Utachiona hwemunharaunda (hunowanikwa kunze kwezvipatara)
- Utachiona hwemunosocomial (hunowanikwa muchipatara)
- Utachiona hunokonzerwa nekuvhiyiwa (semuenzaniso, macatheter, mafekitori)
Utachiona hwepanocomial hunowanzo sanganisira utachiona husingarapike zvakanyanya, saka maitiro anowanzo sanganisira kufunga nezvehutachiona hweMDR (husingarapike nemishonga yakawanda).
3. Kutsigira Kuongorora uye Kuongororwa kweEtiological
Kunyange zvazvo dzimwe nguva kurapwa kuchifanira kutanga nekukasika, nzira dzinokurudzirwa kuti munhu atore mishonga yekuuraya utachiona asati apiwa mushonga kana zvichibvira. Miedzo inowanzo sanganisira:
- Kuverengwa kweropa rose, CRP, procalcitonin (mune dzimwe nzvimbo)
- Kuunganidzwa kweropa kana paine fivha yakanyanya kana kuti sepsis inofungidzirwa kuti inokonzerwa nechirwere ichi
- Kuongororwa kweweti uye kuumbwa kweweti muvanhu vanofungidzirwa kuti vane chirwere cheweti
– Supu (pahuro, ronda, sputum) yekuongorora/PCR sezvakaratidzwa
- X-ray yechipfuva yepneumonia
- Kuongororwa nekukurumidza kwakadai sekuongororwa kweantigen kana PCR kwemamwe mavhairasi
Chinangwa chikuru ndechekuona kana hutachiona hwacho huchikonzerwa nemabhakitiriya, mavhairasi, fungi, kana tupukanana. Izvi zvinoita kuti pave nekurapa kwakanyatsorongeka uye kwakagadzirirwa kana mhinduro dzebvunzo dzawanikwa.
4. Nheyo dzeEmpirical Therapy
Kazhinji, mhedzisiro yekurapa inotora nguva. Nokudaro, gwara iri rinosanganisira nhungamiro dzekurapa kwekuongorora, izvo zvinosanganisira kupa mishonga zvichienderana nekuongororwa kwakajairika zvichibva panzvimbo yehutachiona, kuoma kwahwo, uye maitiro ebhakitiriya emunharaunda.
Nheyo huru dzekurapa kwe empirical:
1. Zviratidzo zvakarurama: mishonga inorwisa mabhakitiriya inongopihwa chete kana paine fungidziro yakasimba yehutachiona hwebhakitiriya kana hutachiona hunoda mishonga inorwisa mabhakitiriya.
2. Spectrakiti yakakodzera: shandisa spectrakiti yakakwana, asi kwete yakawandisa.
3. Chipimo chakakodzera uye nguva chaiyo: funga nezvehuremu hwemuviri, mashandiro eitsvo/chiropa, uye kuoma kwehutachiona.
4. Nzira yakakodzera: inopinzwa neropa kana paine hutachiona hwakakomba; inonwiwa kana yakagadzikana uye ichikwanisa kunwiwa.
5. Nenguva: mu sepsis, kupa mishonga inorwisa mabhakitiriya nekukurumidza sezvinobvira kunobatanidzwa nemigumisiro iri nani.
Muvarwere vari panjodzi huru yekusagona kurapwa nemishonga (nhoroondo yekugara muchipatara, kushandiswa kwemishonga inorwisa mabhakitiriya kakawanda, kushandiswa kwemidziyo inorwisa mabhakitiriya), maitiro anowanzo tungamira sarudzo yakakura yemishonga inorwisa mabhakitiriya, asi inofanira kuongororwazve.
5. Kurapa Kwechokwadi uye Kuderedza Kuwanda Kwezvinhu
Kana mhinduro dzekuongorora kukanganiswa kwemishonga inorwisa mabhakitiriya nekurapwa kwemishonga inorwisa mabhakitiriya dzawanikwa, protocol iyi inosimbisa kuchinja kuenda kukurapa kwakasimba: kushandura mishonga inorwisa mabhakitiriya kuita mishonga inoshanda zvakanyanya, yakamanikana, uye yakachengeteka.
Kuderedza kukwira kweropa zvinoreva kuderedza simba rekurapa kana zvichibvira:
- kubva pamusanganiswa wemushonga unorwisa mabhakitiriya mumwe chete
- kubva pa broad spectrum kusvika pa narrow spectrum
- kubva pakupinda mutsinga kusvika pamuromo kana mamiriro acho agadzikana
Kudzikira kwehuwandu hwehutachiona inzira yakakosha yezvirongwa zvekudzora kusashanda kwemishonga inorwisa utachiona uye kunobatsira kuderedza migumisiro yakaipa yakaita semanyoka anokonzerwa nemishonga inorwisa utachiona kana njodzi yezvirwere zvinongoerekana zvatanga.
6. Nguva Yekurapwa
Maitiro emazuva ano anowanzo kurudzira nguva yakakwana, asi kwete yakawandisa. Nguva yacho inoenderana nerudzi rwehutachiona, mhinduro yekiriniki, uye mamiriro emurwere. Humwe hutachiona hunogona kuvandudzika nekurapwa kwenguva pfupi, nepo humwe (semuenzaniso, endocarditis, osteomyelitis, kana TB) huchida kurapwa kwenguva refu uye kutariswa zvakanyanya.
Kurapa kunowanzo ongororwa mumaawa ekutanga 48-72 kuti zvive nechokwadi chekuti:
- fivha inoderera
- zviratidzo zvehupenyu zvinovandudzika
- zviratidzo zvakaderedzwa
- hapana matambudziko anomuka
- mhedzisiro yebvunzo inotsigira sarudzo yekurapa
Kana pasina kuvandudzika, gwaro iri rinokurudzira kuongororwazve: panogona kunge paine chirwere chisina kunaka, pfupa rinoda kubuda ropa, hutachiona husina kurapwa, kana utachiona husingarapike.
7. Kurapa Kunotsigira uye Kutarisira Matambudziko
Kurapa hutachiona hakusi kwemishonga inorwisa utachiona chete. Mitemo inosanganisirawo mishonga inotsigira chirwere ichi sezvinodiwa, yakaita se:
- mvura inopinzwa mutsinga yekuderedza kushaya mvura mumuviri kana kuvhunduka
- marwadzo uye antipyretic
- okisijeni kana kufefetera kwemhepo muzvirwere zvekufema
- kudzora shuga muropa muvarwere vane chirwere cheshuga
- kugadziriswa kwema electrolyte uye kutarisa mashandiro enhengo
Muchirwere che sepsis, nzira dzekurapa dzinowanzo sanganisira mushonga wekubatsira munhu kupora, kuyedzwa kwe lactate, kurera vana, kupiwa mishonga inorwisa mabhakitiriya nekukurumidza, uye kutariswa kwakanyatsojeka mukamuri revanorwara zvakanyanya kana zvichidikanwa.
8. Kudzivirira Kutapurirana uye Kudzora Kutapurirana
Chinhu chikuru chechirongwa ichi kudzivirira kupararira kwechirwere ichi, muzvipatara nemunharaunda. Matanho akajairika anosanganisira:
- geza maoko uye shandisa PPE
- kudonhedzwa kwemvura/kuburitswa nemhepo/kupatsanurwa kwekubatana nevanhu zvichienderana nerudzi rwechirwere
- tsika dzekukosora, shandisa masiki kana zvichidikanwa
- kucheneswa kwezvishandiso nenzvimbo yakapoteredza
- kubaiwa nhomba kwevarwere kana vanhu vanosangana navo vanosangana nezvinodiwa
Kudzivirira kutapurirana kwehutachiona hakusi basa rezvipatara chete, asiwo kudzidzisa varwere: nguva yekuzorora kumba, nguva yakachengeteka yekudzoka kubasa/kuchikoro, uye nzira yekuderedza njodzi yekutapurirana kwehutachiona mumhuri.
9. Kutarisa, Migumisiro, uye Kuongorora Nguva Nenguva
Panguva yekurapwa, varwere vanotariswa kuti vaone kana kurapwa kwacho kuchishanda zvakanaka uye kuti kune migumisiro yakaipa. Mamwe maantibiotic anogona kukanganisa itsvo nechiropa, kana kukonzera allergic reactions. Saka, protocol inosimbisa:
- kutarisa mashandiro eitsvo/chiropa kana uchishandisa mimwe mishonga
- kuongororwa kwekudyidzana kwemishonga kunyanya muvarwere vane mishonga yakawanda
- kumisa uye kutsiva mushonga kana paine migumisiro yakakomba
Kuongorora nguva dzose kunobatsira kuona kuti mabhenefiti ekurapa anopfuura njodzi.
10. Kutevedzera Kutevedzera Kudzidziswa Kwevarwere Nekurapwa
Kubudirira kwekurapwa kwehutachiona kunoenderana zvakanyanya nekutevedzera mitemo. Varwere vanofanira kunzwisisa:
- kukosha kwekutora mushonga zvichienderana nedosi uye nguva yakatarwa
– usarega kutora mishonga usina kurairwa nachiremba
- usashandise mishonga inorwisa mabhakitiriya yasara kana kushandisa mishonga yekugovana
- zviratidzo zvengozi zvinoda kudzokera kuchipatara
Dzidzo yakanaka inoderedzawo kushandiswa kwemishonga inorwisa mabhakitiriya zvisina kufanira, iyo iriyo honzeri huru yekusagona kurapwa nemishonga.
Penutup
Maitiro ekurapa zvirwere zvinotapukira ndiwo nhungamiro dzakakosha dzinobatanidza kuongororwa nekukurumidza, kurapwa kwakarongeka, kugadziriswa zvichibva pamhedzisiro yerabhoritari, nguva yakakodzera, uye kudzivirira kutapurirana. Nekushandisa maitiro nguva dzose, mhedzisiro yemurwere inogona kuvandudzika, huwandu hwezvinetso hunogona kudzikira, uye kutyisidzira kwekusagona kurwisa mabhakitiriya kunogona kuderedzwa. Pakupedzisira, maitiro haasi magwaro chete, asi maitiro ekubatsirana anosanganisira vanachiremba, vanamukoti, matekiniki erabhoritari, varapi vemishonga, nevarwere kuti vawane manejimendi yehutachiona inoshanda uye ine mutoro.
Kana muchida, ndinogona kugadzirisa chinyorwa chino kuti chive chakanyatsojeka (semuenzaniso, maitiro ekurapa pneumonia, UTI, sepsis, kana TB) kana kuwedzera mafomati akadai sezvikamu, tafura pfupiso yesarudzo dzekurapa, uye bhuku remabhuku.
