Kusasarudza dialysis inzira yakakodzera, asi ndeipi migumisiro
Varwere vane chirwere chakakura chepfungwa chinosvika pachigamba chechipiri vane zvisarudzo zviviri kana zvasvika pakugadzirisa chirwere chavo, kana kutanga kutanga pane imwe rudzi rwe dialysis (pakati pehemodialysis inowanzoonekwa muU.S., kana kumba dialysis iyo inogona kuva hemodialysis kana peritoneal dialysis ), kana kuti kuwana impempa kupindira. Asi zvakadini kana murwere asingakwanisi kuva, kana kuti asingadi chero ipi zvayo yekusarudza pane chero chikonzero.
Chii chinoitika kana murwere ane tsindi kukanganisa asingagamuchiri dialysis kana kuiswa? Vanotarisira kurarama kwenguva yakareba sei? Nyaya ino ichaedza kupindura mimwe yemibvunzo iyi.
HERE KUSARUDZA DIALYSIS ZVINOKOSHA KUSARUDZA KUNYANYA, KUNA KUTI KUTI PATI
Kusarudza kuti ndiani "uyo ane murwere wakarurama" isarudzo inonyanya kusiyiwa mukukurukurirana pakati pemurwere uye nephrologist yavo. Nenzira, apo varwere vaisati vaonekwa sevanoda kubhadhara dialysis, nephrologists vaiti, "tichatora dialysis kuna Ms. X". Zvisinei, kutaura "kurega" kune mafungiro asina kunaka (funga "isu ticharamba kutsigira hupenyu, nezvimwewo"). Kune mumwe munhu anorwara uye mhuri yavo, inopa pfungwa yokuti chiremba haasi kuzopa chero chinhu uye isu tinonyanya kumirira kusvikira murwere afa. Zvisinei, izvi hazvigoni kuwedzera kubva muchokwadi sezvo zvakawanda zvezvinetso zvezvirwere zvepfungwa zvinogona uye zvinofanira kutarisirwa nemishonga.
Mune mamwe mazwi, nephrologists angadai achiri kupa zvakawanda; zvakanaka zvikuru zvose zvisingakwanisi kusvitsa murwere kumushandi we dialysis. Uye zvino, kutaurirana zviri nani izvo zvichiri kuitika-zvakakwanisa kune murwere, nguva yakakodzera yekusagadzirisa dialytic kwepso kusakundikana ikozvino iko kushandiswa ndeye Maximal Conservative Management (MCM) .
Izvi zvakafukidzwa zvakadzama pano.
NDIANI ANODZIDZA PATIENT YOKUTAURIRWA KUDZIDZWA KUDNEY KUSAURA NOKUZIVA HERE HERE YOSE
Haasi murwere wese angaita kuti awane chikwata cheMMM, uye zvimwe zvingasarudzwa zvinogona kunge zvakakodzera. Conservative management ndiyo yakanaka yakakwana munzvimbo dzakasiyana-siyana. Izvi zvinogona kusanganisira kukwegura uye kushaya simba, kuora mwoyo kwakaoma, kuvapo kwemamwe zvirwere zvakakomba zvakadai sekushaya kwemoyo kana kenza yemasitasi, nezvimwewo. Mamiriro ezvinhu akadaro, zvakaoma kugara uchifanotaura kana chirwere che dialysis chingawedzera chinhu kune hutano / huwandu hwehupenyu. Uye kazhinji, varwere vari kungotarisa "mufananidzo mukuru", kunyanya kana tarisiro yehupenyu ishoma.
Zvisinei, MCM haisi yevanhu vose. Varwere vanofanira kuve vakadzidziswa kuti pane zvinetso zvakawanda zveinso kusakwanisa kunorapwa nemishonga, uye zvimwe zviratidzo / zviratidzo zvinongopindura chete ku dialysis. Izvi ndezvokuti izvo zvinonzi uremic tsvina inounganidza muhupi kusakundikana uye ndicho chikonzero chezvinetso zvakawanda hazvizobviswi nekuchengetedzwa kwekuchengetedza (kunyange kunyange dialysis hazvibvise zvachose zvachose). Murwere uye chiremba angave achida kugara pamwe chete kuenda kune izvo zvinotarisirwa uye kuronga hurongwa hwekutarisira.
Uye kana hurukuro iri pamusoro pezvaunotarisirwa, mibvunzo miviri inowanzobuda kubva kune varwere vari kuramba dialysis:
- Ndinganzwa sei kana ndaramba dialysis?
- Dai upenyu hwangu hwaizotapudzwa kana ndakaramba dialysis?
Zvichigovera zvishoma zvedhizha, izvi hazvisi mibvunzo iri nyore kupindura. Asi isu tine deta yakawanda inowanika pamusoro pekutarisira hupenyu kune varwere vanosarudza dialysis. Sezvakataurwa neUnited States Renal Data System mushumo, kuponeswa kunotarisirwa kwevarwere pa dialysis kunogona kuenzana kubva pamakore 8 (kune varwere vane makore makumi mana kusvika makumi mana nemakumi mana nemana makumi mana nemana) kusvika kumakore mashanu (varwere vari pakati pemakore makumi matanhatu kusvika makumi matanhatu nematanhatu). Izvi ndezvimwewo muvhareji, uye kuchinja kukuru kunoonekwa zvichienderana nezera remurwere, chikafu chekudya, uye kuvapo kwemamwe zvirwere zvinokonzerwa nemararamiro sekushaya chirwere chemwoyo, kenza, nezvimwewo.
Ndinodawo kutarisa pfungwa yako kune girafu inofanidza kutarisira kwemurume ane makore 55 ane makore makumi maviri nemashanu kumurume akafanana nemurwere pa dialysis, kana munhu akawana chirwere chepfungwa.
KUKUNDA NOKUPENYANA NEMUPENYU NEMUNHU ASINA DIALYSIS
Ngatitarisei zvimwe zvidzidzo zvakaedza kuenzanisa kupona pakati pezvikamu zviviri. Chidzidzo pamusoro pevarwere vane chirwere chepakati chechirwere chepfungwa 5 chaive nemakore makumi mapfumbamwe nemakore makumi matatu (80) ane makore akaratidza hupenyu hwomukati hwakareba mamwedzi makumi maviri (gumi nemwedzi nemwedzi 9) kune varwere vanosarudza dialysis. Chimwe chidzidzo chakafananidza kuponeswa pakati pevarwere vakasarudza dialysis nevaya vakasarudza vashandi vanochengetedzawo vakaratidzawo kupona kwakanaka kune varwere vakasarudza dialysis. Vose varwere vaiva nemakore makumi manomwe nemakore makumi manomwe. Makore ekupona kwemakore 1 aiva 84% muboka rakasarudza dialysis uye 68% muboka racho kusarudza kusina dialytic kutarisira. Mumwe anogona kutora kubva kune deta iyi iyo mafungiro ekushaya kukwana avo vanosarudza dialysis vanozogara vachirarama kwenguva refu.
Zvisinei, zviri pamusoro apa zvinenge zvisiri nyore kufunga. Varwere vane chirwere chepfungwa chinokurudzira vachawanzove nezvimwe zvirwere zvakakomba zvakadai sekushaya mwoyo, chirwere cheshuga, kenza, etc; izvo isu vanachiremba tinozviti "co-morbidities" . Uye saka, kana tikatora imwe kutarisa dambudziko ratakakurukura pamusoro apa, tinoona kuti tarisiro yehupenyu muvarwere avo vaiva nezvimwe zvirwere zvakanyanya-zvinovapo sehutachiona hwemwoyo zvechokwadi hazvina kusiyana; pasinei nokuti vanosarudza dialysis kana kwete ! Mune mamwe mazwi, mumurwere ane hutano hwakanyanya, kupona kunogona kutsanangurirwa nemamiriro ezvinhu aya kupfuura kana murwere ari dialyzed kana kwete. Iko kutora mharidzo kumusha ndeyekuti dialysis inowedzera hupenyu hwako chero bedzi iwe usina huwandu humwe hutano hwakakomba hunotaurwa pamusoro apa. Iniwo ndichaisa pfungwa yako kuMufananidzo 2 kubva munyaya ino inotsigira zvatachangobva kukurukura.
Pakupedzisira, regai nditaure nhamba dzinokosha (tsanangudzo pano, pano, uye pano). Ivhareji yeupenyu hurefu mushure mekunge murwere anenge atoona dialysis achibviswa dialysis mazuva matanhatu kusvika kumasere, asi huwandu hwakanyanya hunogona kuchinja kune imwe mazuva maviri kusvika kune zana.
MHURI YOKUDZIDZA NOMUNYORI WOUPENYU ASINA DIALYSIS
Kune varwere vanosarudza kusasarudza dialysis mushure mekukurukurirana nephrologists avo, mubvunzo wakajeka unomuka ndewokuti, "Ndinganzwa sei"? Vakawanda varwere vari kunyanya kunetseka pamusoro peizvi kupfuura pamusoro pekukwanisa kuderedza mukurarama kwehupenyu.
Muna 1949, Dr David Karnofsky akarondedzera chiyero (100 kuva munhu akaremara ane utano, uye 0 zvinoreva rufu) iyo inogona kushandiswa kuenzanisa zvakajeka maitiro anoshanda evanhu vanorwara nekenza. Chiyero chave chave chave chichishandiswa kuyera muyero wekushanda kwebasa kwetsvo kusakatika varwere vanochengetedzwa nekuchengetedza pasina dialysis. Icho chinyorwa pano (ona Mufananidzo 1) chinotsanangura kuti vakadai vakadai vaizove kubva kune hutano / hutano hwehupenyu muupenyu hwegore rapera rehupenyu hwavo. Chinofadza kuziva ndechekuti varwere vakadai vangangodaro vanoda rubatsiro rwemamwe nguva kusvikira kumwedzi wapera wehupenyu hwavo, mushure mokunge vazoona kuderera kwakanyanya mumamiriro avo ezvinhu, saka zvishoma nezvishoma zvinoda kutarisirwa zvakanyanya / kubvumirwa kuchipatara. Nhamba uye nyaya yacho inotipa mamwe mazano pamusoro pezvatinofanira kutarisira kana mafungiro ekushaya kukwana vatarisa vachitarisa mune ramangwana uye vanosarudza kusarudza hupenyu pasina dialysis. Izvo zvandinoda kusimudzira pano ndezvokuti izvi zvinogadziriswa zvakabva pakufungidzira kuti varwere vakanyatsotarisirwa kuchengetedzwa, nenzira isina utsinye. Izvi ndizvo zvatiri kunzi Maximal Conservative Management (MCM) uye pano ndiyo tsanangudzo yaro.