Kazhinji ARDS Mishonga
Mishonga yeArdS
ARDS, kana chirwere chinoputika chirwere, chirwere chakanyanya kufema chinogona kutungamirira kurwere hunotyisa. Kunyanya kuongororwa uye kurapwa kunokosha pakugadzirisa ARDS isati yave yakanyanya kukuvadza kuti chikamu chekuvadzwa kana rufu hazvidzivirike. Kunyanya kuongororwa uye kurapwa kunokosha pakuponesa hupenyu hwomurwere anonzi ane ARDS.
Zvirwere Zvichienderana NezveArdS
Oxygen: Kurapa kunotanga nokupa murwere wehutomu oxygen kuti ubatsire kuchengetedza zvakakwana masero egijeni muropa. Izvi zvinowanzoitwa nekutura murwere uye kushandisa ventilator . Izvi zvinogonesa murwere kufema, kunyange kana vasina simba rekufema ivo pachavo, uye vanokwanisa kutora oksijeni akawanda kudarika inowanika neanal cannula kana kusangana mashekisi.
Mishonga inorwisa mabhakitiriya: Mishonga inorwisa mabhakitiriya inopiwa kuvarwere veArdS nokuda kwehutachiona , zvakadai sepineumonia, kana mamwe marudzi ehutachiona. Zviitiko zvakawanda zveAARS zvinotanga sechirumonia kana chido chinonzi pneumonia, kuita ma antibiotics anokosha.
IV Fluids: Mvura inoita basa rinokosha pakubatsira muviri kusimbisa mabasa ayo ose anokosha, asi kuwana huwandu hwakanaka hwehutachiona hunogona kunge hwakaoma. Zvirwere zvishoma zvishoma uye muviri unova usina mvura yakaoma, zvichiita kuti zvive nyore kutumira ropa rakawanda uye okisijeni kune nhengo nemigumo. Mvura yakawandisa inogona kudzivisa kukwanisa kwemapapu kukonzera ropa.
Muviri Positioning: Mune zvimwe zviitiko zvinogona kubatsira oxygenation kuti murwere ararame mudumbu. Asi, varwere vazhinji veArdS vanorwara zvikuru zvokuti kunyange kuchinja kuduku munzvimbo kunogona kuita kuti mamiriro avo ave akaipa, izvo zvinoita kuti kududzwa kwevashandi kuve kwakaoma zvikuru. Bhedha inotenderera murwere ichi kupinda mudumbu yavo asi ichibvumira vatsigiro reMidhiyo uye ventilator kutsigirwa kuti ienderere ichine chikamu chinowanikwa chekurapa.
- Ona RotoProne, mubhedha wakashandiswa mukurapa ARDS nemamwe zvirwere zvokufema. Kuonekwa komubhedha kunoshamisa uye kunogona kutyisa kumhuri dzemhuri apo pavanotanga kuona mudiwa wavo mairi.
Inhaled Medication:
- Nitric Oxide: Inhaled Nitric Oxide, kana INO, ine gasi isina ruvara uye isina kunakidza iyo dzimwe nguva inotarisirwa sechirapi kune varwere veArdS. Inopiwa kuvandudza kupararira mukati me pulmonary system, iyo inowedzera oxygenation. Zvidzidzo hazvina kukwana maererano nehutano hweNO.
- Albuterol: Imishonga inoputika, albuterol inowanzoshandiswa kurapa zviratidzo zvechirwere nekuzarura bronchus. Inogona kushandiswa mukurapa kweArdS kubatsira kuchengetedza kufamba kwemhepo.
Steroids: Kutungamirirwa kweVIV steroid kune varwere vanorwara kuti vane ARDS inyaya yakakurukurudzwa mumishonga. Vanachiremba vanopatsanurwa pamusoro kana kana kwete steroid inobatsira kurapa kweArdS.
Levophed: Iyi mishonga inopiwa kuvandudza kuwedzera kweropa nekudzivirira mishonga yeropa yemuviri. Varwere vazhinji vane ARDS vane dambudziko rokuchengeta ropa ravo ravo; iyi mishonga inopa rubatsiro rwemutsipa weropa uye ndiyo mishonga inosarudzwa kune varwere vose vari vaviri uye vane ruzivo rwekuita oxygen.
Sedatives uye Paralytics: Zvipembenene zvinopiwa kuchengetedza murwere kugadzikana uye kuvabatsira kuti vatsungirire pane vhairati, izvo zvinogona kukonzera kushungurudzika kukuru. Vakarara mitezo, kana zvinodhaka zvinokonzera misi miviri yemuviri, zvinoshandiswa apo murwere ari kurwisa ventilator kuti abvumira ventiri kuti aite basa rayo. Vakagwinya mitezo havasati vashandiswa pasina sedation, asi sedation inogona kushandiswa isina mapofu.
Anoshamisika: Wisina kushanda chinhu chakagadzirwa nemafuta uye mapuroteni anowanikwa pane alveoli (air bags) yemapapupa. Iyo inogadzirisa muviri inowedzera basa realveoli, inovandudza oksijeni.
Munhu akashandisa surfactant anowanzopiwa kuvana vasati vasvika, avo vangave vasina kubudisa zvakakwana zvavo. Izvozvi mushonga unopiwa kuvarwere veArdS muzviitiko zvisingawanzoitiki.
Pashure peArdS
Pane imwe nguva murwere achionekwa kuti ane ARDS, kuwedzera kwekufa kunokwira kusvika 40%, zvinoreva vana gumi pavatatu vanowanikwa vane ARDS vanofa. Varwere vanopona vanowanzoita izvi nokuti vakaongororwa kare uye vanorapwa zvakanyanya nechisimba zvakakodzera. Kunyange zvazvo nhamba idzi dzakaipa, chirwere cheArdS chinowedzera gore roga roga, uye varwere vakawanda vanopona.
Izvo zvinonzwisisika kuti uchinzwe wakaneta, kupfupika kwekufema uye kurwara kazhinji mushure mekupedzisira kweAARS. Inogona kutora mavhiki kana mwedzi kuti inzwe yakanaka, kunyange mushure mekubuda kubva kuchipatara. Kune vamwe varwere, kupora kwemapapu kunogona kureva kuti okisijeni haisi yakanaka sezvakanga isati yasvika kurwara, zvichiita kuti unzwe kunzwa kuneta.
Sources:
Inhaled Nitric Oxide For Adult Respiratory Distress Syndrome. The New England Journal of Medicine. Yakasvika munaJanuary 2011. http://www.nejm.org/doi/full/10.1056/NEJM199307153290313
Kufa Kuwanda Kwevarwere Vane Mungozi Yakakomba / ARDS Yakaderera Penguva. M. Zambon, J. Vincent. Bofu: Journal of the American College of Lung Physicians. July 2008.
Chii chinonzi ARDS? National Heart Lung uye Blood Institute. Yakasvika munaJanuary 2011. http://www.nhlbi.nih.gov/health/dci/Diseases/Ards/Ards_WhatI.html