ECMO-nzira yehupenyu yekutsigira vanhu vanorwara zvikuru-yasvika kure
Kunyange zvazvo tiri kure nekubudirira kweA Dark-Vaderesque hupenyu hutsigiro hutsika, ECMO kana kuti extracorporeal membrane oxygenation yakasvika nenzira yakareba mumakore achangopfuura. Kunyange zvazvo pakutanga nzira yekurapa inoshandiswa kubatsira vana vachangoberekwa, nhamba inowedzera yevanhu vakuru vari kugamuchira ECMO, uye ECMO nzvimbo dzinowanikwa munyika yose.
Maererano neAdcorporeal Life Support Organisation (ELSO), iyo inoramba ichishanda mabhesi pa ECMO, kubvira muna 1990, ECMO yakashandiswa kubatsira vanhu 58 842 munyika yose, uye nhamba iyoyo ichiwedzera gore negore.
Kunyange zvazvo inenge hafu yezviitiko izvi zvinosanganisira neonates ane zvinetso zvokufema, pamwe chete mumiedzo 10 426 inosanganisira vanhu vakuru vane kuporesa uye matambudziko emwoyo kana kuti vanoda kubuda patsva.
Chii chiri ECMO?
ECMO (AKA extracorporeal life support kana ECLS) inzira shomanana yekupa hupenyu muupenyu hwevanhu vanorwara zvakanyanya (fungidzira mapapu kana mwoyo kusagadzikana). Kunyanya, ECMO inokonzera oksijeni muropa ndokubvisa carbon dioxide. Inogona kupawo hemodynamic (blood pressure) kutsigirwa. ECMO inzira yekusarura mapiritsi emaradhi uye inoshandiswa kunze kwekamuri yekushandisa. Mishonga yakakwana yepoddiopulmonary bypass (makomo emwoyo-mapapu) anoshandiswa kwemaawa mashomanana panguva yokuvhiyiwa.
ECMO inowanzoshandiswa kutora matambudziko mumapapu nemwoyo kwemazuva mazhinji, izvo zvinodzidzisa kuti kuporesa. Inoshandiswa muvarwere avo, kana vakakurumidza kubata, mikana yavo yokupona yakanaka, uye ndiani angave angafa pasina ECMO.
Kubva kare muna 1944, vatsvakurudzi vakaziva kuti ropa raipfuura nepakati pemakemikari yakagadzirwa yakava oxygenated. Uku kuona kwakava chikonzero chechirwere chemapurisa. Pakutanga, cardiopulmonary bypass inotenderera kuhutu kana kuti disk oksijeni inoratidzira ropa zvakananga kumhepo. Kukanganisa kwakaipa kwepakutanga kwechimiro chepakutanga kwakabatanidza hemolysis kana kuparadzwa kwemasero eropa izvo zvisingakwanisi kubatsirwa nemaawa mashomanana.
Muna 1956, kukura kwe membrane oxygenator yakagadzirisa dambudziko iri nekuisa nheyo yekushandiswa kwenguva refu kweCMO.
Hezvino izvo zvikamu zveEECMO chaiyo:
- heat heat exchanger
- membrane oxygenator
- roller kana centrifugal pump
- circuit tubing
- catheters zvakananga kune nzvimbo yekuwanika (VV ECMO inodzorera ropa kune inowous system kuburikidza nepamusoro vena cava kana right atrium, uye VA ECMO inodzorera ropa kuhutano hwemagetsi kuburikidza neAorta kana kuti inowanikwa karotid arteri)
Mune mamwe magadziriro, rimwe dunhu rakafanana rine rimwe pombi uye oxygenator rinoshandiswa kubatsira nemhepo inokonzera uye carbon-dioxide kubviswa. Kuyerera kwemitengo kunogadziriswa zvichienderana nekucherechedza kwakaperera kwekhaya patientas patient: blood pressure, acid-based base, end-organ organ, uye mamiriro evanhu vane mhuka yakavhenganiswa. Nyaya, VA VAMMO chete inopa hemodynamic kana kutsigira kweropa. Pakupedzisira, kunyange zvazvo chizere chepoddiopulmonary bypass chakanyongedzerwa muimba yekushandira pasi pevanhu vakawanda anesthesia, ECMO inowanzogadziriswa uchishandisa anesthesia yemunharaunda.
Varwere vari kuECMo vanowanzorwara zvikuru, uye havasi vose vanopona pane zvakaitika. Muna 2013, ELSO yakarondedzera kuti pasi rose 72 muzana yevanhu vakapukunyuka ECMO nematambudziko aya ari kunyanya kuyerwa mukuda neonates avo vane chirwere chakakwana chepapu chinopinda muitiro.
(Ramba uchiyeuka kuti mwana ane mapapu matsva uye saka anowanzopinda ECMO pasina comorbidity kana kuperekedzwa nemapapu zvinowanzoitwa nevanhu vakuru.) Uyezve, kunyange zvazvo 72 muzana yevanhu vose vakapukunyuka ECMO, 60 chete muzana yakaita kuti ibudise kana kutamisa-zvakare iyi nhamba yakayerwa mukufarira vana vachangoberekwa. Kunyanya, 56 muzana chete yevanhu vakuru vane matambudziko ekufema vakaita kuti ibudise kana kutamisa.
Zvakaipa zvinokonzerwa neCMO zvinosanganisira kubuda mukati uye kunze kunobva ropa, utachiona, thrombosis (ropa rinopisa upenyu rinovhara mukati memidziyo yeropa) nekuputi kusakundikana. Kuti udzikise kutyisidzira kweprombosi, zvikamu zve ECMO zvakaputirwa muheparin, ropa rakapfava.
Apo ECMO Inoshandiswa Sei?
Heano mamwe mamiriro ezvinhu apo ECMO inoshandiswa muzvitsva:
- kupfurikidza nemapemetheni yeropa rekuzvarwa patsva (PPHN)
- neonatal meconium aspiration syndrome
- Pneumonia kana zvimwe zvirwere zvakanyanya
- congenital diaphragmatic hernia
- congenital heart disease
Heano mamwe mamiriro ezvinhu apo ECMO inoshandiswa muvana vakwegura:
- post-op cardiac repair
- aspiration pneumonia
- pneumonia
- sepsis
- poisoning
- pedyo-kunyura
- yakaoma asthma
- poisoning
Kushandiswa kwe ECMO kuri kuwana nzira yaro mukurapa kwevanhu vakuru. Kunyangwe pane urombo hwehupupuriro hunotsigira kushandiswa kwepasi rose (kuti tinoda hukuru hunoshandiswa-kutonga miedzo kuitira kuti tive nezvose zvinotungamirirwa), nhoroondo dzenyaya, zvidzidzo zvekudzoka uye zvimwe zvakadaro zviri kuitika zvinoratidza kuti ECMO inogona kubatsira kune mamiriro ezvinhu. Nyaya yekuti, kunyange zvazvo pasina mhedziso yakakwana yemashandisirwo ayo, zvimwe zvinopesana zvinyorwa, muchidimbu zvichienderana nenyanzvi maonero, zvakataurwa zvinosanganisira kuora simba kwezvirwere zvezvirwere (immunosuppression), ngozi yakawanda yeropa (yakanyorwa coagulopathy), yakwegura uye yakakwirira BMI.
Heano mamwe mamiriro ezvinhu umo ECMO inoshandiswa kune vanhu vakuru:
- chirwere chemwoyo chichibatanidza chikamu kune myocardial infarction kana pulmonary embolism
- mwoyo kukanganisa
- kuporesa kusakwirikana kwechipiri kusvika pakufuridzira kupera simba chiratidzo (ARDS) kana H1N1 virusi
Zvimwe zviviri zvigadziriswa pamashoko pamusoro pe ECMO sezvainoreva vakuru. Kutanga, kusiyana nemhepo inopisa, ECMO inodzivirira kuparadza mapapu kuburikidza nenjodzi (barotrauma) kana atelectasis (kuparara kwemapapu). Chechipiri, kuongorora meta (kutsvakurudza kwakaitwa) kunoratidza kuti ECMO inogona kunge isingabatsiri kune avo vanogadziriswa nemwoyo, avo vanorwara nehutachiona hwehutachiona (hutachiona hwehutano hwemwoyo) uye avo vane arthmiaas vakakundikana kutarisana nekugadzirwa kwechirwere.
Pamusoro pekupedzisira, ECMO ingangodaro mushonga wausingazombotarisirwi nawo mune hupenyu hwako kana hupenyu hwevadiwa vako vane ruzivo; ECMO yakakomba uye yakachengeterwa avo vanorwara zvikuru. Kunyange zvakadaro, ECMO inomiririra nzira itsva yakavimbika yekubatsira vanhu vakawanda. Kunyange zvazvo tisingatomboregi hupenyu hwehupenyu hunoita sechikwata chezvombo chakakodzera chaDarth Vader, tiri kuwedzera kunzwisiswa kwatinoona nezvemamiriro ekugara kwenguva pfupi.
Sources
"Membrane Extracorporeal Oxygenation yeKuberekwa Kwevanhu Vakwegura" (bhuku chitsauko) naJL Cameron naAm Cameron kubva kuneNokuti Surgical Therapy .
Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS. Kutarisira Kwakakosha uye Kutambudzika. Mu: Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS. eds. Williams Obstetrics, Twenty-Fourth Edition . New York, NY: McGraw-Hill; 2013. Yakasvika munaNovember 18, 2014.
Darst JR, Collins KK, SD Miyamoto. Mwoyo Mwoyo. Muna: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ. eds. KUCHENGA KUZIVA KUTAURIRWA & KUKURWA: Pediatrics, 22e . New York, NY: McGraw-Hill; 2013. Yakasvika munaNovember 18, 2014.
"Chii chitsva mu ECMO: kuongorora zviratidzo zvakaipa" naKen Parhar naAriin Vuylsteke kubva kune Intensive Care Medicine yakabudiswa musi wa9/3/2014. Yakawanikwa kubva kuPublicMu on 11/17/2014.
Zviyero DC, Granton JT. Chitsauko 90. Mucherechedzo Wokuchera. Mu: Imba JB, Schmidt GA, Wood LH. eds. Nheyo dzekutarisira kwakakosha, 3e . New York, NY: McGraw-Hill; 2005. Yakasvika musi waNovember 18, 2014.