Ukuqapha Ukwelashwa Ngezidakamizwa Ezibhedlela
Ukuqapha ukwelashwa ngemithi ezibhedlela kuyinqubo ehlelekile yokuqinisekisa ukuthi iziguli zithola imithi efanele, ngomthamo ofanele, ngendlela efanele, ngesikhathi esifanele, futhi ziqashwe njalo ukuze kutholakale impendulo nemiphumela emibi. Esimweni sesibhedlela, ubunzima bezimo zeziguli, inani elikhulu lemithi enikezwayo, kanye nezinguquko ezisheshayo zezokwelapha kwenza ukuqapha ukwelashwa ngemithi kube yingxenye ebalulekile yokuphepha kwesiguli kanye nekhwalithi yokunakekelwa. Ngaphandle kokuqapha okufanele, ingozi yamaphutha emithi, ukusebenzisana kwemithi, izehlakalo ezimbi kakhulu, ngisho nokwehluleka kokwelashwa kunganda.
Incazelo kanye Nenhloso Yokuqapha Ukwelashwa Ngezidakamizwa
Ukuqapha ukwelashwa ngezidakamizwa kuwumsebenzi wokuhlola nokulandelela ukusetshenziswa kwezidakamizwa ngokusekelwe esimweni somtholampilo sesiguli, imiphumela yelabhorethri, imingcele ebalulekile, kanye nezikhalazo ezitholwa yisiguli. Umgomo oyinhloko ukufeza imiphumela yokwelapha efanele nokunciphisa izingozi. Ngokuningiliziwe, ukuqapha ukwelashwa kuhlose: (1) ukuqinisekisa ukuthi izinkomba zemithi ziyahambisana nokuxilongwa, (2) ukuhlola ukusebenza kahle kokwelashwa, (3) ukuthola nokuphatha imiphumela emibi kanye nokusabela okubi kwemithi, (4) ukuvimbela ukusebenzisana kwemithi okuyingozi, (5) ukuqinisekisa ukuhambisana neziqondiso zokwelapha kanye nezindlela zokwelashwa esibhedlela, kanye (6) nokwenza ngcono ukusetshenziswa kwezinsiza ukuze ukwelashwa kube ngcono.
Kungani Ukuqapha Ukwelashwa Ngezidakamizwa Kubalulekile Ezibhedlela?
Iziguli zasesibhedlela zivame ukuba nezifo ezinzima kakhulu noma izimo ezingamahlalakhona ezinezinkinga. Iziguli eziningi zithola ukwelashwa okuhlanganisiwe, okuhlanganisa ama-antibiotic, imithi yenhliziyo, ama-anticoagulant, ama-analgesic, imithi yesifo sikashukela, ngisho nemithi yokudambisa ukuvuvukala. Izimo ezinjengokukhubazeka kwezinso noma kwesibindi, izinguquko esimweni soketshezi, noma ukuguga kungashintsha i-pharmacokinetics kanye ne-pharmacodynamics yemithi. Ngenxa yalokho, imithamo "ejwayelekile" ingaba phezulu kakhulu noma iphansi kakhulu. Ngaphezu kwalokho, ukusetshenziswa kwamadivayisi ezokwelapha, izinqubo zokuhlinzwa, kanye nezinguquko zokudla nakho kungathinta ukwelashwa ngemithi.
Ukuqapha ukwelashwa ngemithi nakho kubalulekile ngoba izibhedlela ziyizindawo lapho kwenzeka khona izinguquko zokushintsha, ukudluliselwa kwamagumbi, kanye nokushintsha kokunakekelwa (isb., ukusuka egumbini eliphuthumayo ukuya ewadini noma kusuka egunjini lokunakekelwa okujulile kuya ekunakekelweni kweziguli ezilalisiwe). Kungale nkathi lapho amaphutha okuqopha imithi, ukuphindaphindwa kokwelashwa, noma ukuyeka imithi ngokungahlosile. Ngokuqapha okuqinile, lezi zingozi zingancishiswa.
Izingxenye Eziyinhloko Zokuqapha Ukwelashwa Kwezidakamizwa
Ukuqapha ukwelashwa ngemithi ezibhedlela ngokuvamile kuhlanganisa izingxenye ezilandelayo eziyinhloko.
1. Ukuhlanganiswa Kwemithi
Ukulungiswa kwemithi kwenziwa lapho umuntu engeniswa esibhedlela, edluliselwa egunjini elisha, nalapho ekhishwa esibhedlela. Le nqubo iqhathanisa uhlu lwemithi yesiguli ngaphambi kokuba angene esibhedlela nemithi enikezwe ngesikhathi sokwelashwa. Umgomo ukuvimbela imithi ephuthelwe, ukuphindaphindeka, noma ukusebenzisana okungaba yingozi. Ukulungiswa okuphumelelayo kudinga ukuxhumana nesiguli/umndeni, ukubuyekeza imithi yangaphambilini, kanye nokubuyekeza noma yikuphi ukungezwani komzimba kanye nokusabela kwemithi.
2. Ukubuyekezwa Komuthi Kadokotela Nokufaneleka Kwezinkomba
Yonke imithi enqunyiwe kumele ibe nophawu olucacile. Osokhemisi bezokwelapha noma osokhemisi basezibhedlela banesibopho sokubukeza imithi enqunyiwe ukuze banqume ukuthi noma yimiphi imithi ayidingeki yini, ukuthi kunezinye izindlela eziphephile yini ezitholakalayo, nokuthi ngabe ukwelashwa kuyahambisana neziqondiso. Isibonelo, ama-antibiotic kufanele anqunywe ngokusekelwe ekuxilongweni futhi, uma kungenzeka, asekelwe ukuhlolwa kokukhuliswa kanye nokuzwela.
3. Ukuqapha Ukusebenza Kahle
Ukuphumelela kuhlolwa ngokuthuthukiswa kwezimpawu zomtholampilo, izilinganiso ezibalulekile, ukuhlolwa ngokomzimba, kanye nemiphumela yelabhorethri. Isibonelo, ukwelashwa kwe-antihypertensive kubhekwa ngomfutho wegazi; i-insulin ngamazinga kashukela; ama-antibiotic ngokunciphisa umkhuhlane, ukubalwa kwama-leukocyte, kanye nokuthuthukiswa kwendawo yokutheleleka; kanye nama-anticoagulant ngokusebenzisa izilinganiso ze-coagulation noma izimpawu zokopha/i-thromboembolism.
4. Ukuqapha Ukuphepha Nomphumela Ongemuhle
Yonke imithi inemiphumela emibi engaba khona. Ezibhedlela, ukuqapha ukuphepha kumele kube yinto eqaphayo. Ezinye izibonelo zemingcele yokuphepha evame ukubhekwa zifaka: ukusebenza kwezinso (i-creatinine, i-eGFR) yemithi enobuthi; ukusebenza kwesibindi (i-AST/ALT) yemithi enobuthi besibindi; ama-electrolyte (i-potassium, i-sodium) yemithi yokukhipha isisu noma yenhliziyo; kanye nokuqapha izimpawu zokungezwani komzimba kanye ne-anaphylaxis. Ukubika Ukusabela Okubi Kwemithi (ama-ADR) kuyingxenye ebalulekile yokuqapha imithi.
5. Ukuqapha Ukusebenzisana Nokukopisha
I-Polypharmacy yandisa ingozi yokusebenzisana phakathi kwemithi nemithi kanye nokudla kwemithi. Ukusebenzisana kungandisa ubuthi noma kwehlise ukusebenza kahle. Isibonelo, ukuhlanganisa ama-anticoagulant nama-NSAID kwandisa ingozi yokopha; amanye ama-antibiotic angandisa isikhathi se-QT, kudinga ukuqaphela lapho kusetshenziswa neminye imithi enemiphumela efanayo. Ukuphindaphinda kokwelashwa nakho kuvamile, isibonelo, ukusetshenziswa okungafanele kwemithi emibili enendlela efanayo.
6. Ukulungiswa Kwesilinganiso Esikhethekile
Imithi eminingi idinga ukulungiswa komthamo ngokusekelwe eminyakeni, isisindo, ukusebenza kwezinso, ukusebenza kwesibindi, noma izimo ezithile njengokukhulelwa. E-ICU, izinguquko ekusebenzeni kwezitho zomzimba zenzeka ngokushesha, okudinga ukuhlolwa komthamo okuvamile. Ukuqapha ukwelashwa kuqinisekisa ukukala okuphephile nokusebenzayo, okuhlanganisa nemithi enenkomba yokwelapha encane njenge-digoxin, i-phenytoin, ne-warfarin.
7. Ukuqapha Imithi Yokwelapha (TDM)
I-TDM ukukala amazinga emithi egazini ukuqinisekisa ukuthi angaphakathi kobubanzi bokwelashwa. I-TDM ibalulekile emithini enokuguquguquka okuphezulu kokuphendula kanye nengozi enkulu yobuthi, njenge-aminoglycosides, i-vancomycin, i-phenytoin, kanye ne-valproate. Imiphumela ye-TDM isiza ithimba lezokwelapha ukulungisa imithamo ngayinye ukuze kutholakale ukwelashwa okunembe kakhudlwana.
Indima Yethimba Lezempilo Ekuqapheni
Ukuqapha ukwelashwa ngezidakamizwa kuwumzamo weqembu ohlanganisa imikhakha eminingi. Odokotela banesibopho sokunquma isu lokuxilonga kanye nokwelapha, kanye nokuhlola impendulo yezokwelapha. Osokhemisi bezokwelapha bahlola ukufaneleka kwemithi, umthamo, kanye nokusebenzisana, futhi banikeze izincomo ezisekelwe ebufakazini. Abahlengikazi badlala indima ebalulekile ekuphathweni kwemithi, ukuqapha izimpawu ezibalulekile, ukubheka imiphumela emibi, kanye nokufundisa iziguli. Ochwepheshe bezokudla basiza ekuhloleni ukusebenzisana kwemithi nezakhamzimba kanye nokulungisa ukudla. Ukubambisana okuphumelelayo, okuhlanganisa nokuxhumana okucacile phakathi kochwepheshe, kubalulekile ekuqapheni okuphumelelayo.
Izinselele Ekusetshenzisweni
Ezinye izinselele ezivame ukuhlangana nazo ezibhedlela zifaka phakathi umthwalo omningi womsebenzi, amadokhumenti angaphelele, izinhlelo zolwazi ezilinganiselwe, kanye nekhono elihlukahlukene labasebenzi. Ngaphezu kwalokho, iziguli ngezinye izikhathi azazi ukuthi zithatha miphi imithi noma zikhohlwe imithamo yazo, okwenza kube nzima ukuvumelanisa imithi. Ukufinyelela okulinganiselwe ezivivinyweni ezithile zelebhu nakho kungaphazamisa ukuqapha. Ngakho-ke, izibhedlela zidinga izinqubo zokusebenza ezijwayelekile (ama-SOP) zokuqapha ukwelashwa, uhlelo lokubika oluhlelekile, kanye nokuqeqeshwa okuqhubekayo.
Isu Lokuthuthukisa Ikhwalithi Yokuqapha Ukwelashwa
Ukuze kuthuthukiswe ikhwalithi yokuqapha ukwelashwa ngezidakamizwa, kungasetshenziswa amasu amaningana: ukusetshenziswa kwamarekhodi ezokwelapha kagesi anezici zokuxwayisa ngokusebenzisana kwezidakamizwa kanye nokungezwani komzimba; ukusetshenziswa kwezindlela zemitholampilo kanye neziqondiso zokwelapha; ukuhlolwa kokusetshenziswa kwezidakamizwa; izinhlelo zokuphatha ama-antibiotic; kanye nokubika okungenasijeziso ngezigameko zokuphepha kwesiguli ukuze kuvinjelwe abasebenzi ukuthi bangazibiki. Ukufundisa isiguli ngaphambi kokukhishwa esibhedlela nakho kubalulekile ukuqinisekisa ukuqhubeka kahle kokwelashwa ekhaya.
I-Penutup
Ukuqapha ukwelashwa ngemithi ezibhedlela kuyinqubo ebalulekile eqinisekisa ukuthi imithi enqunyiwe inikeza inzuzo ephezulu kakhulu ngengozi encane. Ngokuvumelana kwemithi okuphumelelayo, ukuhlolwa kokusebenza kahle nokuphepha, ukulungiswa kwemithamo efanele, kanye nokubambisana kochwepheshe, ikhwalithi yokunakekelwa ingathuthukiswa kakhulu. Phakathi kobunzima bezinsizakalo zesibhedlela, ukuqapha ukwelashwa ngemithi akuyona nje inqubo yokuphatha kodwa kuyindlela yokwelapha ethinta ngqo ukuphepha kwesiguli kanye nokululama. Ngezinhlelo eziqinile kanye nesiko lokuphepha eliqinile, izibhedlela zinganikeza ukwelashwa ngemithi okuphephile, okusebenzayo kakhudlwana, okuqondiswe emiphumeleni yezokwelapha engcono kakhulu.
