Ndani Ali pachiwopsezo chachikulu cha Sepsis?

Ngakhale aliyense atha kukhala ndi sepsis ngati ali ndi matenda, magulu otsatirawa ali pachiwopsezo chachikulu ndipo amafunika kusamala kwambiri:

1. Makanda ndi Okalamba: Chikhalidwe chofala mwa anthuwa ndi kusakhazikika kwa chitetezo chamthupi. Chitetezo cha makanda ndi ana aang'ono sichinakwaniritsidwebe, pamene chitetezo cha okalamba chimachepa ndi msinkhu ndipo nthawi zambiri chimakhala ndi matenda ambiri, zomwe zimapangitsa kuti zikhale zovuta kuti athe kulimbana ndi matenda.
2. Odwala omwe ali ndi matenda osachiritsika: Odwala omwe ali ndi matenda monga matenda a shuga, khansa, chiwindi ndi impso, matenda osachiritsika a m'mapapo (COPD) kapena HIV/AIDS ali ndi njira zofooka zodzitetezera mthupi komanso magwiridwe antchito a ziwalo, zomwe zimapangitsa kuti matendawo asamayende bwino.
3. Anthu Omwe Ali ndi Immunocompromised: Izi zikuphatikizapo odwala khansa omwe akulandira mankhwala a chemotherapy, anthu omwe amamwa ma immunosuppressants pambuyo poika chiwalo, ndi anthu omwe ali ndi matenda a autoimmune, omwe chitetezo chawo cha mthupi chimalephera kuyankha bwino tizilombo toyambitsa matenda.
4. Odwala Opweteka Kwambiri Kapena Opaleshoni Yaikulu: Kwa odwala omwe amawotcha kwambiri, ovulala kwambiri kapena opaleshoni yaikulu, khungu kapena mucosal chotchinga chimawonongeka, kupereka njira yoti tizilombo toyambitsa matenda tilowe, ndipo thupi limakhala lopanikizika kwambiri.
5. Ogwiritsa Ntchito Zida Zachipatala Zowononga: Odwala omwe ali ndi ma catheter (monga ma catheter apakati, ma catheter a mkodzo), pogwiritsa ntchito ma ventilator kapena okhala ndi machubu otulutsa madzi m'matupi awo, zidazi zitha kukhala "njira zazifupi" kuti tizilombo toyambitsa matenda tilowe m'thupi la munthu.
6. Anthu Amene Ali ndi Matenda Aposachedwa Kapena Ogonekedwa M’zipatala: Makamaka kwa odwala chibayo, matenda a m’mimba, matenda a mkodzo kapena matenda a pakhungu, ngati chithandizocho sichinafike panthaŵi yake kapena chosagwira ntchito, matendawa amatha kufalikira mosavuta m’magazi ndi kuyambitsa sepsis.

Kodi kudziwa sepsis? Ma reagents ofunikira amatenga gawo lalikulu

Ngati anthu omwe ali pachiwopsezo chachikulu ayamba kukayikira kuti ali ndi matenda (monga kutentha thupi, kuzizira, kupuma movutikira, kugunda kwamtima mwachangu, ndi kusokonezeka maganizo), ayenera kupita kuchipatala mwamsanga. Kuzindikira koyambirira kumadalira kuwunika kwakanthawi kachipatala komanso kuyesa kwa labotale, komwe mitundu yosiyanasiyana ya in vitro diagnostic (IVD) ndi "maso" ofunikira kwambiri a asing'anga.

1. Microbial Culture (Chikhalidwe Chamwazi) - The Diagnostic "Gold Standard"
   • Njira: Zitsanzo za magazi a wodwala, mkodzo, sputum, kapena malo ena omwe akuganiziridwa kuti ali ndi matenda amasonkhanitsidwa ndikuyikidwa m'mabotolo omwe ali ndi chikhalidwe cha chikhalidwe, chomwe chimakulungidwa kuti chilimbikitse kukula kwa tizilombo toyambitsa matenda (mabakiteriya kapena bowa).
   • Udindo: Uwu ndiye "muyezo wagolide" wotsimikizira sepsis ndikuzindikiritsa tizilombo toyambitsa matenda. Kachilomboka kakamera, kuyezetsa kwa antimicrobial susceptibility test (AST) kutha kuchitidwa kuti atsogolere madokotala posankha maantibayotiki ogwira mtima kwambiri. Komabe, cholepheretsa chake chachikulu ndi nthawi yofunikira (nthawi zambiri maola 24-72 pazotsatira), zomwe sizikugwirizana ndi kupanga zisankho zodzidzimutsa.
2. Kuyesa kwa Biomarker - Mwachangu "Ma Alarm Systems"
   Pofuna kuthana ndi vuto la chikhalidwe lomwe limatenga nthawi, ma reagents osiyanasiyana ozindikira ma biomarker amagwiritsidwa ntchito kwambiri kuti azindikire mwachangu.
   • Kuyesa kwa Procalcitonin (PCT).: Ichi ndicho chizindikiro chofunikira kwambiri komanso chodziwika bwino chokhudzana ndi sepsis.PCTndi mapuloteni omwe amapezeka pamilingo yotsika kwambiri mwa anthu athanzi, koma amapangidwa mochulukira m'magulu angapo m'thupi lonse panthawi ya matenda oopsa a bakiteriya.PCT kuyesa (nthawi zambiri pogwiritsa ntchito njira za immunochromatographic kapena chemiluminescent) kumapereka zotsatira zochulukira mkati mwa maola 1-2. ZokwezekaPCTMilingo imawonetsa kwambiri za sepsis ya bakiteriya ndipo imatha kugwiritsidwa ntchito kuyang'anira momwe maantibayotiki amagwirira ntchito ndikuwongolera kusiya.
   • Kuyeza kwa C-reactive protein (CRP).: Mtengo wa CRP ndi puloteni yomwe imakhala yovuta kwambiri yomwe imawonjezeka mofulumira chifukwa cha kutupa kapena matenda. Ngakhale tcheru kwambiri, sichidziwika kwenikweniPCTchifukwa akhoza kukwezedwa mu zinthu zosiyanasiyana, kuphatikizapo matenda tizilombo ndi zoopsa. Nthawi zambiri amagwiritsidwa ntchito limodzi ndi zolembera zina.
   • Kuwerengera kwa Maselo Oyera a Magazi (WBC) ndi Maperesenti a Neutrophil: Uku ndiye kuyezetsa magazi athunthu (CBC). Odwala a Sepsis nthawi zambiri amawonetsa kuwonjezeka kwakukulu kapena kuchepa kwa WBC komanso kuchuluka kwa neutrophils (kumanzere kumanzere). Komabe, tsatanetsatane wake ndi wochepa, ndipo uyenera kutanthauziridwa pamodzi ndi zizindikiro zina.
3. Njira Zodziwira Maselo a Molecular - Precision "Scouts"
   • Njira: Njira monga Polymerase Chain Reaction (PCR) ndi Metagenomic Next-Generation Sequencing (mNGS). Ukadaulowu umagwiritsa ntchito zoyambira ndi ma probes (omwe amatha kuwonedwa ngati "ma reagents") kuti azindikire mwachindunji ma nucleic acid (DNA kapena RNA).
   • Udindo: Safuna chikhalidwe ndipo amatha kuzindikira mwachangu tizilombo toyambitsa matenda m'magazi mkati mwa maola angapo, ngakhale kuzindikira zamoyo zomwe zimakhala zovuta kuzikhalidwe. Makamaka pamene zikhalidwe zachikhalidwe zili zoipa koma kukayikirana kwachipatala kumakhalabe kwakukulu, mNGS ikhoza kupereka zizindikiro zowonongeka. Komabe, njirazi ndizokwera mtengo kwambiri ndipo sizipereka chidziwitso chokhudza maantibayotiki.
4. Kuyeza kwa Lactate - Kuyeza Mulingo wa "Vuto".
   • Kuperewera kwa minofu ndi hypoxia ndizopakati pa kulephera kwa chiwalo cha sepsis. Kuchuluka kwa lactate ndi chizindikiro chodziwika bwino cha minofu hypoxia. Zida zoyesera zam'mphepete mwa bedi zimatha kuyeza kuchuluka kwa plasma lactate (mphindi zochepa). Hyperlactatemia (> 2 mmol / L) imawonetsa kwambiri matenda oopsa komanso kusazindikira bwino, ndipo ndi chizindikiro chofunikira choyambitsa chithandizo chambiri.

Mapeto

Sepsis ndi mpikisano wotsutsana ndi nthawi. Okalamba, ofooka, omwe ali ndi matenda osachiritsika, komanso omwe ali ndi vuto linalake lazachipatala ndiwo chandamale chachikulu. Kwa magulu omwe ali pachiwopsezo chachikulu, zizindikiro zilizonse za matenda ziyenera kuthandizidwa mosamala. Mankhwala amakono akhazikitsa njira yodziwira matenda mofulumira kudzera m'njira zosiyanasiyana, kuphatikizapo zikhalidwe zamagazi, kuyesa kwa biomarker mongaPCT/Mtengo wa CRP, matenda a maselo, ndi kuyezetsa lactate. Zina mwa izi, mitundu yosiyanasiyana yodziwika bwino komanso yozindikira bwino ndiyo maziko a chenjezo loyambirira, kuzindikira kolondola, komanso kuchitapo kanthu panthawi yake, kumathandizira kwambiri mwayi wamoyo wa odwala. Kuzindikira zoopsa, kuthana ndi zizindikiro zoyamba, komanso kudalira njira zamakono zodziwira ndizo zida zathu zamphamvu kwambiri zolimbana ndi "wakupha wosaonekayo."