Ukuphathwa Kwezibeletho Ezimweni Ze-Leukemia
I-Pendahuluan
I-leukemia iyisifo esibi ohlelweni lokwakha igazi esibonakala ngokwanda okungavamile kwamangqamuzana amhlophe egazi emnkantsheni wamathambo. Lesi simo singaphazamisa ukukhiqizwa kwamangqamuzana abomvu egazi ajwayelekile, ama-platelet, nama-leukocyte, okuholela ekuntulekeni kwegazi, ukopha, kanye nokuthambekela ekuthelelekeni. Esimweni sokubeletha, i-leukemia iyinkinga ngoba ukukhulelwa ngokwako kubangela izinguquko zomzimba ezinhlelweni zegazi, zenhliziyo, kanye nezokugomela. Ukuhlanganiswa kwe-leukemia nokukhulelwa kungandisa ingozi yezinkinga kumama nosana, kuyilapho futhi kuyinkimbinkimbi ekwenzeni izinqumo zomtholampilo. Ngakho-ke, ukuphathwa kwamacala e-leukemia okubeletha kumele kube yimikhakha eminingi, kusekelwe ebufakazini, futhi kuqondiswe ekuphepheni komama kanye nemiphumela emihle yokukhulelwa.
Ukubuka konke kanye nokuhlukaniswa kwe-Leukemia
I-leukemia ihlukaniswa ngezigaba ezibukhali nezingamahlalakhona, futhi ngokusekelwe kuhlu lwamaseli, ibe yi-myeloid kanye ne-lymphoid. Izinhlobo ezine eziyinhloko yi-acute myeloid leukemia (AML), i-acute lymphoblastic leukemia (ALL), i-chronic myeloid leukemia (CML), kanye ne-chronic lymphocytic leukemia (CLL). Ekukhulelweni, i-acute leukemia ivame ukuba yisimo esisongela ukuphila ngoba ithuthuka ngokushesha futhi idinga ukwelashwa okusheshayo. I-leukemia engapheli, njenge-CML, ingaba nokuzinza kakhudlwana, futhi ezinye iziguli kungenzeka ukuthi sezivele zithole ukwelashwa okuqondiwe ngaphambi kokukhulelwa.
Umphumela Wokukhulelwa Ku-Leukemia Nangokuphambene nalokho
Ukukhulelwa kubangela ukwanda komthamo we-plasma okungafihla izimpawu ze-anemia, kanye nezinguquko emazingeni ajwayelekile elabhorethri (isb., i-physiologic leukocytosis). Lokhu kungalibazisa ukuxilongwa kwe-leukemia. Ngokuphambene nalokho, i-leukemia ingenza ukukhulelwa kube kubi kakhulu nge-anemia enzima, i-thrombocytopenia, kanye nengozi ephezulu yokutheleleka, konke okubangela ingozi ye-preeclampsia, ukuphuma kwegazi ngaphambi kokubeletha kanye nokubeletha ngemva kokubeletha, ukubeletha ngaphambi kwesikhathi, kanye nokuvinjelwa kokukhula komntwana osanda kuzalwa.
Izimiso Eziyisisekelo Zokuphathwa Kokubelethisa
Ukuphathwa kokubeletha kwamacala e-leukemia kusekelwe ezimisweni eziningana:
1. Ukubaluleka kokuphepha kukamama: ngoba ukubikezela kwengane esanda kuzalwa kuncike kakhulu ekuzinzeni kukamama.
2. Ukubambisana kwemikhakha eminingi: ukubelethisa, i-hematology-oncology, i-anesthesia, i-neonatology, kanye nemithi yangaphakathi kanye ne-ICU uma kudingeka.
3. Ukuhlolwa komuntu ngamunye: uhlobo lwe-leukemia, i-trimester yokukhulelwa, ubukhali, kanye nokusabela ekwelashweni yikho okunquma uhlelo.
4. Ukuxhumana kanye nokuvuma isinyathelo: ukwelulekwa okujulile mayelana nezingozi zokwelapha, ukuqedwa okungenzeka, kanye nezinketho zokwelapha ezisekelayo.
Ukuphathwa Kwangaphambi Kokubeletha
1. Ukutholwa Nokuxilongwa
Kusolwa ukuthi i-leukemia kwabesifazane abakhulelwe abanezimpawu ezifana nobuthakathaka, ubomvu besikhumba, umkhuhlane ophindaphindayo, ukopha kwezinsini/ikhala, i-petechiae, noma i-spleen ekhuphukile. Ukuhlolwa kokuqala kufaka phakathi ukubalwa kwegazi okuphelele, i-peripheral blood smear, kanye nokuhlolwa kokusebenza kokuqina kwegazi. Ukuqinisekiswa kokuxilongwa kudinga ukufuthwa komnkantsha wethambo kanye ne-immunophenotyping; lezi zinqubo ngokuvamile ziphephile ngesikhathi sokukhulelwa uma zenziwa ngokucophelela.
2. Ukuqapha Omama
– Isimo segazi: i-hemoglobin, ama-platelet, ama-leukocyte, kanye nemingcele yokwakheka kwama-coagulation kuyaqashwa njalo.
– Izimpawu zokutheleleka: umkhuhlane esigulini esine-leukemia yisimo esibucayi; ukukhuliswa kwamagciwane kanye nama-antibiotic avamile kuyadingeka.
– Ukuhlolwa kwezitho zomzimba: ukusebenza kwesibindi nezinso, kanye nesimo senhliziyo kubalulekile ngoba kuthonya ukukhetha umuthi.
3. Ukuqapha Umbungu Wengane
Ukuqapha kuhlanganisa ukuhlolwa kwe-ultrasound okulandelanayo kokukhula, umthamo woketshezi lwe-amniotic, kanye ne-Doppler, uma kudingeka. Ku-trimester yokugcina, kwenziwa ukuhlolwa kwenhlalakahle yombungu, njengokuhlolwa okungekona ukucindezeleka (i-NST) noma iphrofayili ye-biophysical, kuye ngesimo sikamama. Ingozi yokuvuthwa ngaphambi kwesikhathi ivame ukwanda, ngakho-ke ukucabangela kusenesikhathi ukulungiselela usana kubalulekile.
Ukwelashwa Kwe-Trimester kanye Nokucabangela
I-trimester yokuqala
Ku-trimester yokuqala, ingozi yokwelashwa ngamakhemikhali iphezulu kakhulu ngenxa ye-organogenesis. Ku-leukemia ebukhali edinga ukwelashwa okusheshayo, ukwelulekwa mayelana nokwenzeka kokuqeda ukukhulelwa kuvame ukuba yingxenye yengxoxo yezokwelapha neyokuziphatha, ikakhulukazi uma ukwelashwa okunamandla kungenakulibaziseka. Uma isiguli sikhetha ukuqhubeka nokukhulelwa, ithimba lezokwelapha kufanele lichaze amathuba okuba nezinkinga zokuzalwa, ukuphuphuma kwesisu, noma ukukhula komntwana osanda kuzalwa kube nokukhubazeka.
Ikota yesi-II–III
Kuma-trimester yesibili neyesithathu, ezinye izindlela zokwelashwa ngamakhemikhali zinganikezwa ngengozi ephansi ye-teratogenic kune-trimester yokuqala, yize izingozi zokukhulelwa ngaphambi kwesikhathi, isisindo esiphansi sokuzalwa, kanye nokucindezelwa komnkantsha embungwini zisekhona. Ku-CML, izindlela zokwelapha eziqondiwe njenge-tyrosine kinase inhibitors (TKIs) zivame ukugwenywa ekuqaleni kokukhulelwa ngenxa yengozi embungwini; izinketho ezifana ne-interferon zingacatshangelwa ezimweni ezikhethiwe. Zonke izinqumo zokwelapha kufanele zicabangele ukuphuthuma komdlavuza kanye nobudala bokukhulelwa.
Ukuphathwa Okusekelayo Kwezifo Zokubeletha
Ukulungiswa Kokufakelwa Kwegazi kanye Ne-Hematology
– Ukumpontshelwa amangqamuzana abomvu egazi kwenziwa ngenxa yezimpawu ze-anemia noma i-Hb ephansi ephazamisa ukugcwaliswa komoya-mpilo komama nomntwana.
– Ukumpontshelwa igazi nge-platelet kubalulekile uma kwenzeka i-thrombocytopenia enkulu, ikakhulukazi lapho sekusondele ukubeletha noma uma kukhona ukopha. Izinhloso ze-platelet zinganqunywa ngokusekelwe ohlelweni lokubeletha kanye nolwe-anesthesia (isibonelo, isidingo se-anesthesia yesifunda ngokuvamile sidinga ama-platelet anele).
– Ukulungiswa kwezinkinga zokuqina kwamalunga kwenziwa ngokwemiphumela yelabhorethri, okuhlanganisa nokuphathwa kwe-plasma entsha eqandisiwe uma kudingeka.
Ukuvimbela Nokuphatha Ukutheleleka
Iziguli ezine-leukemia zinomzimba ongasebenzi kahle. Odokotela bezokubelethisa kumele baqinisekise ukuthi bahlanzeka kahle, bahlole ukutheleleka, futhi basebenzise ama-antibiotic uma kunezimpawu ze-sepsis. Izinqubo kufanele zingangenisi kakhulu ngangokunokwenzeka futhi zenziwe kusetshenziswa indlela yokuhlanza.
Ukudla Okunomsoco, Ukuphumula, Nokusekelwa Kwengqondo
Ukuphathwa kokubeletha akubandakanyi nje ukunakekelwa kwezokwelapha kodwa futhi nokusekelwa kwengqondo, njengoba iziguli zibhekene nokuxilongwa okubili okuyinhloko: ukukhulelwa kanye nomdlavuza. Ukwelulekwa, ukwesekwa komndeni, kanye nokudluliselwa kwengqondo/kwezifo zengqondo, uma kudingeka, kusiza ekuthuthukiseni ukuthobela imithetho kanye nekhwalithi yokuphila.
Ukuhlela Ukuzalwa
Isikhathi sokuthumela
Isikhathi sokubeletha sincike esimweni sikamama, impendulo yokwelashwa, kanye nobudala bokukhulelwa. Uma umama ezinzile, ukubeletha kungahlehliswa kuze kube yilapho ingane ikhula. Kodwa-ke, ezimweni zezimo zegazi eziba zimbi kakhulu noma isidingo sokwelashwa okujulile okungahambisani nokukhulelwa, ukubeletha kungasheshiswa ngemva kokucabanga ngokulungela ingane.
Indlela Yokulethwa
Ukubeletha ngesitho sangasese sowesifazane ngokuvamile kuyathandwa uma kungekho zimpawu zokubeletha zokubeletha ngokuhlinzwa, njengoba ukuhlinzwa kwandisa ingozi yokopha nokutheleleka. Kodwa-ke, uma kunezibonakaliso ezifana nokucindezeleka kombungu, ukuvezwa kabi, noma izimo zikamama ezivimbela ukusunduza, ukuhlinzwa ngokuhlinzwa kungenziwa ngokulungiselela ukumpontshelwa igazi kanye nokulawula okuqinile kwe-hemostatic.
Ukubulala izinzwa
Ukukhetha i-anesthesia kuncike kakhulu esimweni se-platelet kanye nesimo sokujiya. I-anesthesia yesifunda ingaba yingozi ezimweni ze-thrombocytopenia ngenxa yokuthi kungenzeka kube ne-spinal hematoma. I-anesthesia ejwayelekile ingase ikhethwe ezimweni ezithile, ngaphansi kokubhekwa eduze ngudokotela we-anesthesia.
Ukuphathwa Kwesigaba Sesithathu Sokubeletha kanye Nangemva Kokubeletha
Isigaba sesithathu sokubeletha siyingozi enkulu ngenxa yokopha ngemva kokubeletha, ikakhulukazi ezigulini ezine-thrombocytopenia kanye nezinkinga zokuqina kwamalunga. Ukuvimbela i-uterotonic, njenge-oxytocin, kunikezwa ngokwenqubo, futhi ukutholakala kwegazi nama-platelet kubalulekile. Ngemva kokubeletha, ukuqapha eduze izimpawu ezibalulekile, ukopha, kanye nezimpawu zokutheleleka kuyaqhubeka. Iziguli zivame ukudinga ukwelashwa ngamakhemikhali ngemva kokubeletha okuqhubekayo noma okuqinisiwe, ngakho-ke ukuxhumana nodokotela wegazi kubalulekile.
Ncelisa ibele
Isinqumo sokuncelisa sincike ohlotsheni lokwelashwa olunikezwayo. Imithi eminingi yamakhemikhali kanye nokwelashwa okuqondiwe kungakhishwa ubisi lwebele futhi kungalimaza ingane. Ngakho-ke, ukuncelisa ngokuvamile akukhuthazwa ngesikhathi sokwelashwa okusebenzayo. Ukwelulekwa ngokuncelisa kanye nezinketho zokudla kosana kufanele kuxoxwe ngazo kusenesikhathi ukuqinisekisa ukuthi umndeni ukulungele.
Isiphetho
Ukuphathwa kwe-leukemia ngokubeletha kudinga indlela ephelele neyinkimbinkimbi. Ukugxila okuyinhloko kusekuzinzeni nasekuphepheni kukamama, kuyilapho kwandiswa imiphumela yombungu ngokuqapha okuseduze nokuhlela ukubeletha ngokucophelela. Ukuphathwa kuhlanganisa ukuxilongwa okunembile, ukwelashwa okufanele ngekota yesithathu, ukwesekwa kokumpontshelwa igazi, ukuvimbela ukutheleleka, kanye nokulungela ukopha ngemva kokubeletha. Ngenxa yokuthi icala ngalinye lihlukile, izinqumo zezokwelapha kumele zenziwe ngabanye, zihilele isiguli nomndeni enkambisweni yokuvuma enolwazi, futhi zilinganise izici zezokwelapha, zokuziphatha, nezengqondo. Ngokubambisana okuhle phakathi kwamaqembu okubelethisa kanye ne-hematology, iziguli eziningi zingakhulelwa ngokuphephile ngenkathi zithola ukwelashwa kwe-leukemia okudingekayo.
