Ikhemisi Yezingane Nezinselele Zayo
Ikhemisi yezingane iyigatsha lesayensi yezokwelapha kanye nomkhuba ogxile ekusetshenzisweni kwemithi ezinsaneni, ezinganeni, kanye nasebancane. Leli qembu leminyaka alinakuphathwa "njengabantu abadala abancane" ngoba banezici ezihlukile zomzimba, zengqondo, kanye nezenhlalo. Lokhu kwehluka kuthinta indlela imithi emuncwa ngayo, esatshalaliswa ngayo, egaywa ngayo, futhi ikhishwa ngayo ngumzimba. Ukukhethwa kwemithi okunembile, ukubalwa komthamo, uhlobo lomthamo, kanye nendlela yokuphatha kubalulekile. Ngaphezu kwalokho, izinselele ekhemisi yezingane ziya ngokuya ziyinkimbinkimbi ngenxa yezidingo zokwelapha ezahlukahlukene, idatha yokuhlolwa kwemitholampilo elinganiselwe ezinganeni, kanye nezidingo zokuphepha eziphezulu.
Ukuhluka kweziguli zezingane ekwelashweni ngezidakamizwa
Ukukhula kwezingane nokuthuthuka kwazo kuthuthuka ngokushesha. Esikhathini esifushane, kwenzeka izinguquko ezibalulekile esisindweni somzimba, ukwakheka koketshezi lomzimba, ukusebenza kwezitho zomzimba, kanye namandla ezinhlelo zama-enzyme esibindi nezinso. Lezi zinguquko zithinta ngqo i-pharmacokinetics (lokho umzimba okusabela kukho ezidakamizweni) kanye ne-pharmacodynamics (lokho okwenziwa yizidakamizwa emzimbeni).
Isibonelo, izinsana ezisanda kuzalwa zinenani elikhulu lamanzi emzimbeni kunabantu abadala, ngakho-ke izidakamizwa ezincibilika emanzini zivame ukusabalala kabanzi. Okwamanje, ukusebenza kwesibindi nezinso akukavuthwa, ngakho-ke eminye imithi ingase ihlale emzimbeni isikhathi eside, okwandisa ingozi yobuthi. Ezinganeni ezindala, i-metabolism ingashesha kunakwabantu abadala ngemithi ethile, okudinga ukulungiswa komthamo noma imvamisa yokuphathwa. Lezi zinguquko zenza ukwelashwa kweziguli zezingane kudinge ukuqapha okuseduze nokuqonda okujulile kwezokwelapha.
Inselele enkulu: ukunqunywa komthamo okunembile
Enye yezinselele ezinkulu ekhemisi lezingane ukukala umthamo. Imithamo yezingane ivame ukubalwa ngokusekelwe esisindweni somzimba (mg/kg) noma endaweni yomzimba (mg/m²). Lezi zibalo zibonakala zilula, kodwa zivame ukuba namaphutha, ikakhulukazi ezindaweni ezimatasa zezokwelapha noma lapho idatha yesisindo inganembile noma isiphelelwe yisikhathi. Iphutha elincane ekubaleni umthamo womuntu omdala lingase lingabi likhulu, kodwa ezinsaneni noma ezinganeni ezincane, umehluko omncane ungasho ukudlula umthamo okukhulu noma ukungabi namthamo ofanele.
Enye inkinga ukuthi kukhona imikhawulo ephezulu yomthamo. Empeleni, imithamo ebalwa ngokusekelwe esisindweni somzimba kumele isaqhathaniswe nomkhawulo ophezulu womthamo wabantu abadala ukuze kuvinjelwe ukumuncwa ngokweqile. Osokhemisi badlala indima ebalulekile njengabahloli abazimele abazimele, baqinisekisa ukumuncwa okunengqondo, bacabangele ukusebenza kwezitho zomzimba, futhi bahlole ukusebenzisana okungenzeka kwemithi.
Ukutholakala okulinganiselwe kwemithi elungele izingane
Imithi eminingi etholakala emakethe yenzelwe abantu abadala, kokubili ngokwamandla omthamo kanye nefomu lomthamo. Izingane zivame ukudinga imithamo emincane kanye nefomu okulula ukuligwinya. Kodwa-ke, akuyona yonke imithi etholakala kumaphilisi esiraphu, amaconsi, noma ahlakazekayo. Ngenxa yalokho, ochwepheshe bezempilo ngezinye izikhathi kudingeka benze izinguquko: ukuhlukanisa amaphilisi, ukuchoboza nokuxuba nokudla, noma ukulungiselela amalungiselelo oketshezi ngaphandle kwesikhashana.
Yilapho kuvela khona izinselele zokuphepha. Ukuhlukanisa amaphilisi akuhlali kuholela kumthamo ofanele, ikakhulukazi uma ithebhulethi ingenawo umugqa ohlukanisiwe noma okuqukethwe kwemithi kusatshalaliswa ngokungalingani. Amaphilisi okuchoboza angashintsha futhi iphrofayili yokukhishwa kwemithi, ikakhulukazi ekwakhiweni okuhlala isikhathi eside noma okumbozwe nge-enteric, okubangela imiphumela emibi noma ukunciphisa ukusebenza kahle. Ukuhlanganisa uketshezi kudinga nezindinganiso eziqinile: ukukhethwa kwesinyibilikisi, ukuzinza, ukulingana, kanye nokugcinwa okufanele. Ngaphandle kwezinqubo ezicacile, ingozi yokwehluka komthamo kanye nokungcola iyanda.
Izinkinga ngokuzwakala kahle kanye nokuhambisana nemithi
Ukunambitheka kwemithi kuyisici esibalulekile ezinganeni. Imithi eminingi inokunambitheka okubabayo noma iphunga elibi, okungabangela izingane ukuba zenqabe ukuphuza imithi yazo. Lokhu akuyona nje indaba yokulula kodwa futhi kuthinta impumelelo yokwelashwa. Ukungathathi ama-antibiotic ngesikhathi esibekiwe, isibonelo, kungandisa ingozi yokwehluleka kokwelashwa kanye nokumelana nama-antimicrobial.
Osokhemisi bangafaka isandla ngokunikeza imfundo ngezindlela zokuphatha ezifanele, basikisele amasu okunciphisa ukunambitheka okungathandeki ngaphandle kokuphazamisa ukumuncwa kwemithi, noma basikisele izindlela zokulinganisa ezamukelekayo. Kodwa-ke, izixazululo azitholakali ngaso sonke isikhathi, ikakhulukazi emithini ebalulekile okunzima ukuyilungisa.
Ukuntuleka kwedatha yokuhlolwa kwemitholampilo emiphakathini yezingane
Ngokomlando, izidakamizwa eziningi ezisetshenziswa ezinganeni zazisekelwe kudatha yabantu abadala "eyahunyushwa" njengezokwelapha izingane. Lokhu kungenxa yokuthi izivivinyo zemitholampilo ezinganeni zibhekene nemikhawulo yokuziphatha, yezokuhlela, kanye nezindleko. Kodwa-ke, izingane zisabela ngendlela ehlukile ezidakamizweni, ngakho-ke ukuqoqwa okuvela kubantu abadala akufanelekile ngaso sonke isikhathi. Ngenxa yalokho, imikhuba engekho ohlwini (ukusetshenziswa kwezidakamizwa ngaphandle kwenkomba evunyelwe, umthamo, noma ibanga lobudala) ivame kakhulu ezidakamizweni zezingane.
Nakuba ukusetshenziswa ngaphandle kwelebula ngezinye izikhathi kuyadingeka ukuze kuhlinzekwe ukwelashwa okungcono kakhulu, lokhu kudinga ukuqapha okuseduze, imibhalo ecacile, kanye nokuxhumana okusobala nabazali. Osokhemisi bezokwelapha badlala indima ekuhloleni ubufakazi bamuva, balinganise izinzuzo nezingozi, futhi basize ithimba lezokwelapha ekukhetheni ukwelashwa okuphephile nokuphumelelayo kakhulu.
Ingozi ephezulu yamaphutha emithi
Uhlelo lwemithi yezingane lunamaphuzu amaningi asengozini: ukubalwa kwemithamo, ukuncishiswa kwemithi, ukusetshenziswa kwezinsimbi zokulinganisa ezingezona ezejwayelekile, ngisho nokunikezwa ngabazali ekhaya. Amaphutha angenzeka ngenxa yamayunithi ahlukene (mg vs. mL), ukusetshenziswa kwezipuni njengamathuluzi okulinganisa, noma ukudideka mayelana nezikhathi zemithi. Ezibhedlela, amaphutha angenzeka lapho kulungiswa imijovo, ikakhulukazi yemithi enenkomba yokwelapha encane njenge-aminoglycosides noma imithi ye-chemotherapy.
Ukuvimbela kudinga indlela yesistimu: ukusetshenziswa kwe-e-prescribing nge-calculator yesilinganiso sezingane, ukulebula okucacile, amazinga ajwayelekile okujova, kanye nokuqeqeshwa kwabasebenzi bezempilo. Kwabagulayo abangalaliswa esibhedlela, imfundo ngokusetshenziswa kwamadivayisi okulinganisa (amasirinji omlomo), imiboniso yokuphathwa kwawo, kanye nolwazi olubhaliwe oluqondakala kalula kuyasiza.
Izinselele ezimweni ezikhethekile: izingane ezisanda kuzalwa kanye nezifo ezingamahlalakhona
Izingane ezisanda kuzalwa (izinsana) yiqembu elisengozini kakhulu. Ukusebenza kwazo kwezitho ezingakavuthwa kwenza kube nzima ukukhetha imithi kanye nomthamo wayo. Ngaphezu kwalokho, izingane ezisanda kuzalwa zivame ukwelashwa e-NICU ngemithi eyinkimbinkimbi, okuhlanganisa ukudla okunomsoco kanye nokufakwa kwemithi eminingi. Ukufinyelela okulinganiselwe emithanjeni kwenza ukuhambisana kwemithi kanye nokuphathwa kwe-IV line kube inselele eyengeziwe.
Ezinganeni ezinezifo ezingamahlalakhona—njengesifo sokuwa, i-asthma, isifo sikashukela, isifo senhliziyo esizalwa naso, noma umdlavuza—ukwelashwa kwesikhathi eside kudinga amazinga aphezulu okunamathela kanye nokuqapha imiphumela emibi. Ukukhula kwengane kudinga nokulungiswa njalo kwemithamo. Osokhemisi bangasiza ngokubuyekezwa kwemithi okuvamile, ukuqapha imithi yokwelapha, kanye nokwelulekwa komndeni ngokuphathwa kwemithi ekhaya.
Indima yabasokhemisi eqenjini lezokunakekelwa kwempilo yezingane
Phakathi kwalezi zinselele, osokhemisi badlala indima ebalulekile. Osokhemisi abagcini nje "ngokulungisa imithi," kodwa futhi baqinisekisa ukuthi ukwelashwa ngemithi kuphephile, kuyasebenza, futhi kufanela izidingo zengane. Imisebenzi yabo ebalulekile ihlanganisa:
1. Ukuqinisekiswa kwemithi kadokotela kanye nokulungiswa komthamo ngokusekelwe esisindweni somzimba, ubudala, ukusebenza kwezinso/isibindi, kanye nesimo somtholampilo.
2. Ukuqapha ukusebenzisana kwezidakamizwa kanye nemiphumela emibi, okuhlanganisa ukusabela kokungezwani komzimba kanye nobuthi.
3. Ukuhlanganisa amalungiselelo ezingane azinzile futhi anembile, ahambisana nezinqubo ezijwayelekile.
4. Imfundo yabazali neziguli, okuhlanganisa nendlela yokusebenzisa amathuluzi okulinganisa, amashejuli emithi, kanye nezimpawu zengozi.
5. Ukubambisana kochwepheshe nodokotela nabahlengikazi ukuthuthukisa izindlela zokwelapha kanye nezindinganiso zokugxila kwezidakamizwa.
Iziqondiso zesikhathi esizayo: ukusungula izinto ezintsha kanye nokuqinisa uhlelo
Ikusasa lekhemisi lezingane likhomba ekuthuthukisweni kwemithi yokwelapha evumela izingane, ucwaningo olwandisiwe lwezokwelapha lwezingane, kanye nokusetshenziswa kobuchwepheshe ukuvimbela amaphutha okulinganisa. Imithi yokwelapha efana namaphilisi amancane, amafilimu ahlakazekayo, noma amalungiselelo okuvala ukunambitheka athembisa ukuthuthukisa ukunamathela. Ohlangothini lwezinhlelo, ukuhlanganiswa kwamarekhodi ezokwelapha kagesi, ukuphathwa kwemithi yebhakhodi, kanye neziqondiso zokulinganisa ezisekelwe ebufakazini kunganciphisa amazinga amaphutha.
Ngaphezu kwalokho, imfundo yomphakathi nayo ibalulekile. Abazali kudingeka baqonde ukuthi "ukunciphisa umthamo wemithi yabantu abadala" akuphephile ngaso sonke isikhathi, nokuthi ukusebenzisa imithi ngaphandle kokubonisana nengane kungaba yingozi. Ukuqinisa imithetho, ukuqinisekisa ukutholakala kwemithi ebalulekile yezingane, kanye nokunikeza ukufinyelela kosokhemisi bezokwelapha ezikhungweni zokunakekelwa kwempilo kuzothuthukisa ikhwalithi yokunakekelwa.
Isiphetho
Ikhemisi lezingane liyinsimu edinga ukunemba okuphezulu ngoba izingane zinezimpawu zomzimba ezihlukile futhi zisabela emithini ngendlela ehlukile kunabantu abadala. Izinselele ezibalulekile zifaka phakathi ukunquma imithamo efanele, ukwakheka okulinganiselwe okulungele izingane, izinkinga zokunambitha nokuhambisana nomthetho, ukuntuleka kwedatha yokuhlolwa kwezokwelapha, kanye nengozi ephezulu yamaphutha emithi. Naphezu kwalokhu bunzima, osokhemisi badlala indima ebalulekile njengabaqaphi bokuphepha kokwelapha, abalingani bemfundo yomndeni, kanye namalungu eqembu elinobungcweti. Ngokusungula izinto ezintsha, ukuqinisa izinhlelo zesevisi, kanye nokwanda kocwaningo lwezingane, ukwelashwa ngemithi ezinganeni kungaba okuphephile, okusebenzayo, nokugxile esigulini.
