Izvi zvinokonzerwa nechiropa chinogona kukonzera kusvuta kwepfungwa
Overview
Nhengo dzevanhu hadziiti mabasa avo muga woga. Vanotaura kune mumwe nomumwe. Vanovimba kune mumwe nomumwe. Kunzwisisa nhengo yomuitiro kunoda kuti munhu anzwisise basa remaimwe nhengo pamwe chete. Muviri womunhu wakafanana nechemberi chaiyo. Kana iwe ukangoteerera kune mumwe munhu mumhanzi, iwe ungasada kunzwisisa symphony.
Kana tikangonzwisisa pfungwa iyi inokosha, zvinova nyore kunzwisisa kuti matambudziko ane nhengo imwe yebasa ingakanganisa mumwe.
Tsanangudzo yeHepatorenal Syndrome (HRS)
Sezvo izwi iri rinoratidza, shoko rokuti "hepato" rinoreva chiropa, asi "renal" rinoreva mafungiro. Nokudaro, hepatorenal syndrome inoreva chiitiko umo chirwere chechiropa chinotungamirira kuchirwere chepfungwa kana mumamiriro ezvinhu akaipisisa, kupera kwepvo kukwana .
Asi, nei tichifanira kuziva nezve hepatorenal syndrome? Chirwere chirwere chinhu chinowanzojairika (funga Hepatitis B kana C, doro, nezvimwewo). Uye mune zvose zvechiropa chirwere, hepatorenal syndrome haisi chinhu chisingawanzoitiki. Kana ikashandurwa, maererano nenhamba imwe chete, 40 muzana yevarwere vane cirrhosis (tsvina, shrunken chiropa) uye ascites (kusviba mumvura inowedzera mudumbu iro rinoitika mune chirwere chinokonzerwa nechiropa) kuchakura hepatorenal syndrome mukati pemakore mashanu.
Risk Factor
Icho chinotora mu hepatorenal syndrome nguva dzose chinorwara chechiropa.
Izvi zvinogona kuva zvinhu zvose zvakabva kune hepatitis (kubva kumavirusi akaita seHepatitis B kana C, zvinodhaka, chirwere chemoto, etc.), kune zvipembenene muropa, kusvika ku-cirrhosis, kana kunyange iyo yakavhunduka yakawanda yechiropa chinokonzerwa nokukurumidza kurwara muropa, anonzi fulminant chiver failure. Zvose izvi zvinogona kukonzera zvirwere zvepfungwa uye kushaya kwepvo zvekusiyana kwakasiyana-siyana kwechipatara che hepatorenal.
Zvisinei, kune zvimwe zvakajeka uye zvakajeka zvinokonzerwa nehuwandu izvo zvinonyanya kuwedzera mikana yemumwe munhu ari kukura kushaya mafungiro nekuda kweswere chechiropa.
- Kurwara kwemuviri wepamu (iyo dzimwe nguva inogona kuitika kune vanhu vane cirrhosis), inonzi yakanganisa bhakteria peritonitis (SBP)
- Kusvetwa mukati memvura, iyo inowanzosangana nevarwere kubva mumidyo yeropa iyo inopinda mumugwagwa semuenzaniso (esophageal varices)
Mishonga yemvura (diuretics yakadai sefurosemide kana spironolactone) inopiwa kuvarwere vane cirrhosis uye mvura inopfuura yepamusoro haigadziri hepatorenal syndrome (kunyange zvazvo inogona kukuvadza itsvo mune dzimwe nzira).
Dendaase Kufambira mberi
Nzira dzinoita kuti chirwere chechiropa chinokonzera matambudziko nemishonga yepfungwa inofungidzirwa kuti yakabatana ne "kudengenyeka" kweropa rekusiya kure neitsvo uye mukati mimwe yese nhengo dzomuviri (iyo inonzi " splanchnic circulation ").
Chimwe chinhu chikuru chinoita kuti ropa ripiwe chero nhengo chero ipi zvayo kushorwa kunosangana neropa rinoyerera kune ichocho. Nokudaro, zvichibva pamitemo yefizikiki, iyo yakaderera midziyo yeropa, iyo yakanyanya kukwira iyo yaizoita kuti kubuda ropa .
Somuenzaniso, fungidzira kana iwe uri kuedza kupomesa mvura kuburikidza nemhando mbiri dzakasiyana dzebindu uchishandisa muyero wakaenzana wekumanikidzwa (iyo mumunhu wemunhu inoumbwa nemwoyo).
Kana zvose zviri zviviri zvaiva nezviedza zvakange zvakakura zvakafanana / zvakafanana, mumwe aizotarisira kuti zviyero zvakaenzana zvemvura zviyerere kuburikidza nazvo. Iye zvino, chii chaizoitika kana imwe yemapapiro aya yakanga yakawedzera (yakawanda caliber) kupfuura imwe? Zvakanaka, mvura zhinji inofanirwa kupararira kuburikidza neipapuriro yakawanda nekuda kwekusagadzikana kunoshandiswa nemvura ikoko.
Saizvozvowo, munyaya ye hepatorenal syndrome, kuwedzera (kuputika) kwemimwe midziyo yeropa mumudumbu weplanchnic kuparadzanisa kunobudisa ropa kubva kuneivo (mitsipa yeropa inodziviswa). Kunyange zvazvo izvi zvisingaiti kuti zviitike mumatanho akasiyana-siyana, nokuda kwekunzwisisa, heino mhedzisiro atingaita nayo iyi:
- Nhanho 1- Kutanga kwekutanga kune chimwe chinonzi portal hypertension (kuwedzerwa muropa reropa mumamwe mitsemvu inodurura ropa kubva mudumbu, spleen, pancreas, mumatumbo), iyo inowanzosvika pakurwara kwevarwere vane chiropa. Izvi zvinoshandura kubuda kwemuviri mukati mechidziro chemuviri kuburikidza nekuderedza mitsara yeropa splanchnic nekuda kwekugadzira kemikari inonzi " nitric oxide ". Izvi zvinobudiswa nemidziyo yeropa pachavo uye ndiyo imwechete yemakemikari iyo masayendisiti akabatanidzwa mukugadzira mishonga seViagra.
- Nhanho 2 - Kunyange zvazvo mishonga yepamusoro yepamusoro yeropa iri kuwedzera (uye nenzira iyo inofanirwa kuwana ropa rinopfuura kuti riyerere kuburikidza navo), kune mutezo yeropa muitsvo dzinotanga kuisa (saka kuderedza ropa razvo). Nzira dzakanyatsotsanangurwa dzeizvi dzinopfuura kudarika kwechinyorwa ichi, asi inofungidzirwa kuti inobatana nekushandiswa kwezvinonzi renin-angiotensin system.
Kuchinja kweropa uku ndiko kunoguma uye kunounza kuderera kwakakurumidza muhupi basa.
Kuziva
Kuongororwa kwe hepatorenal syndrome hakusi kuongororwa kwakajeka kweropa. Kazhinji vanachiremba vanoshevedza kufungidzirwa kwekuregererwa . Mune mamwe mazwi, mumwe aizotarisa kuchipatara kuratidzwa kwechirwere chirwere chechiropa chinouya pamwe nekushaya kutsanangurwa kwepfungwa kusina. Chokutanga chekuongororwa kwaizove kuti chiremba achada kubvisa kuti kushaya kwepuro hakusi mhedziso yeimwe mhaka (kupera simba, mishonga yemishonga inogona kukuvadza itsvo semaronda eNSAID kurwadziwa , maitiro ekudzivirira zvirwere zveHepatitis B kana C viruses, autoimmune chirwere, kudzivirira, nezvimwewo). Kana chiitiko ichocho chave chasangana, tinotanga nekuona kuderera kwepfungwa yepfungwa nekutarisa pane zvimwe zvikamu zvechipatara uye miedzo:
- Nhamba yakakwirira ye creatinine muropa, inobatanidzwa nekuderedza muinso filtration rate (GFR)
- Drop in urine output
- A low level of sodium iri mumugini
- Ipiyi ultrasound, iyo isingarati inoratidza chero chinhu, asi inogona kubvisa zvimwe zvinokonzera mafungiro kusagadzikana mune murwere anofungidzirwa kuti ane hepatorenal syndrome
- Kuedza ropa kana mapuroteni mumuginhi. Hapana zvisizvo / zvishoma zvayo zvinotsigira kuongororwa kwe hepatorenal syndrome
- Mhinduro kumushonga inoshandiswawo sechidzo chekudzoka "test surrogate" yekuongorora. Mune mamwe mazwi, kana basa repvo rinonyatsovandudzwa mushure me "hydration" (iyo inogona kusanganisira kupa murwere muchetura inonvenous fluid kana puroteni infusion ye albumin), hazvisi nyore kuva hepatorenal syndrome. Muzvokwadi, kurwisana nemishonga iyi yekuchengetedza inowanzoita kuti vanhu vafungidzire nezve hepatorenal syndrome iripo
Ndinoda kusimbisa kuti kunyange kuongororwa kwetsvo kusagadzikana hakusi nguva dzose yakananga mumurwere ane chirwere chakakomba chechiropa kana cheprhosis. Izvi ndezvokuti muedzo wakajairika watinovimba nawo kuti uongorore basa rehso, serum creatinine level, haagoni kukwidziridza zvakanyanya muvhiringidzi vekuvhiringidzi munzvimbo yekutanga. Nokudaro, kutarisa pane sarum creatinine kunogona kukanganisa chiongorori sezvo ichizoita kuti kuderedzwa kwekuoma kwemapvo kukanganisa. Nokudaro, mamwe mimwe miedzo yakafanana nemaminetsi makumi maviri nemasere emuviri wechivini angave akadikanwa kutsigira kana kuramba uwandu hwenyoka kusakundikana.
Aina
Kana chiongorori ichi chichinyatsogadziriswa uchishandisa zvinoratidzwa pamusoro apa, vanachiremba vacharonga hepatorenal syndrome muTein-I kana Type-II. Misiyano iri muhutano uye nzira yechirwere. Iti I ndiyo yakaoma kwazvo, inoshamwaridzana nekukurumidza uye yakadzika (inopfuura 50%) inopera muhupi basa mukati pemasvondo maviri.
Kurapa
Iye zvino zvatinoziva kuti hepatorenal syndrome inorambidzwa nechirwere chechiropa (pamwe nehutachiona hwehutachiona huri hurumende inogumbura), zviri nyore kunzwisisa kuti sei kubata chirwere chepachiropa chinonyanya kukosha uye crux yekurapa. Zvinosuruvarisa, izvozvo hazviiti nguva dzose. Kutaura zvazviri, pangava nemamwe masangano asina hutano huripo kana, sezvinoitika pakuzara kwechiropa kusakundikana, kupi uko kurapwa (kunze kwechiropa kushandiswa) kusingatomboshandisi. Pakupedzisira, pane chikonzero chenguva. Kunyanya mu-Type-I HRS. Nokudaro, nepo chirwere chiropa chinogona kurapwa, zvingave zvisingakwanisi kumirira kurapwa kwaro mumurwere ane mafungiro anokundikana nokukurumidza. Mune izvozvi, mishonga uye dialysis inodiwa . Heano dzimwe sarudzo shomanana dzatinazvo:
- Mumakore achangobva kupfuura, pane humwe humwe humwe hwakanaka hune chokuita nebasa remishonga mitsva inonzi terlipressin. Zvinosuruvarisa, hazvisi nyore nyore muUnited States, kunyange zvazvo kushandiswa kwayo kwakakurudzirwa mune dzakawanda zvenyika ye hepatorenal syndrome kurapwa. Zvatinowana pano, zvino, zvinoshandiswa nemishonga inonzi norepinephrine (mushonga unowanzoshandiswa muI ICU kuwedzera kukanda ropa mukati mevanhu vane kunyanya kuderedza ropa mukati mekutya), pamwe chete ne "cocktail regimen" inosanganisira 3 madhiragi, anonzi octreotide, midodrine uye albumin (protein huru iri muropa).
- Kana mishonga iyi isingashandisi, nzira inopindira inonzi TIPS (transjugular intrahepatic portosystemic shunt) kuisa iyo inogona kubatsira, kunyange iyo inouya nematambudziko ayo.
- Pakupedzisira, kana zvose zvisingakwanisi uye maitsvo asingadzokizve, dialysis inogona kudiwa se "bridge breathair" kusvikira chirwere chechiropa chinogona kutariswa zvakasimba.
Kazhinji, kana mishonga inotsanangurwa pamusoro apa isingashandisi mukati memavhiki maviri, kurapwa kunogona kuonekwa sebasa uye njodzi yekufa inokwira zvakanyanya.
Kudzivirira
Izvo zvinoenderana. Kana murwere ane chirwere chakazivikanwa chechiropa uye zvinetso zvinonzwisiswa zvakanyanya (sezvinotsanangurwa pamusoro apa mune chikamu chiri pamusoro pevarwere vane ngozi) yehepatorenal syndrome, mamwe maitiro ekudzivirira angashanda. Semuenzaniso, varwere vane cirrhosis uye mvura mumudumbu (inonzi ascites), vanogona kubatsirwa nemishonga inorwisa mabhakitiriya inonzi norfloxacin. Varwere vanogona kubatsirwa nekudengenyeka kwema albumin zvakare.
> Sources:
> Kuitika, maitiro ekufananidzira, uye kufungidzira kwe hepatorenal syndrome mu cirrhosis ne ascites. Gines et al. Gastroenterology. 1993 Jul; 105 (1): 229-36.
> Terlipressin mu hepatorenal syndrome: Uchapupu hwezviratidzo zvemazuva ano. Rajekar et al.J Gastroenterol Hepatol. 2011 Jan; 26 Suppl 1: 109-14. doi: 10.1111 / j.1440-1746.2010.06583.x
> Primary prophylaxis yebhakteria peritonitis inokonzera kuchema hepatorenal syndrome uye inovandudza kupona muhutrhosis. Fernández J. Gastroenterology. 2007 Sep; 133 (3): 818-24. Epub 2007 Jul 3.