Aleke wò aklã ƒe lãmesẽ le? Kpɔe ɖa kple Child-Pugh ƒe Dzesi!

Ɣeaɖewoɣi ne ɖɔktawo gblɔ nya yeyewo na mí alo atikewɔwɔ ŋuti dodokpɔ yeyewo na mí la, míetsia dzodzodzoe vie, alo? Ema sɔ. Egbea míele nu ƒom tso nane si ŋu ɖewohĩ miese nu tsoe, alo ɖewohĩ miase nu tsoe le etsɔme ŋu. Woyɔe be Ðevi-Pugh ƒe Dzeside . Mègavɔ̃ ne èse ŋkɔ sia o, elabena mɔ aɖe koe wònye si dzi nàto akpe ɖe ɖɔktawo ŋu woase wò aklã ƒe nɔnɔme gɔme. Mina míaƒo nu tso eŋu bɔbɔe eye eme nakɔ.

Nukae nye Ðevi-Pugh ƒe Dzeside? Kpuie ko la,...

Bu eŋu kpɔ abe ne ètsɔ wò ʋu yi dɔwɔƒe aɖe si dzraa ʋu ɖo ene la, mɔ̃ɖaŋudɔwɔla la léa ŋku ɖe nu vovovowo ŋu eye wògblɔa wò ʋua ƒe nɔnɔme na wò. Child-Pugh ƒe dzesi nye mɔnu si dzi woato akpɔ alesi aklãa le dɔ wɔm nyuie le amesi ŋu aklãdɔléle si nɔa anyi didi , vevietɔ cirrhosis, si nye nɔnɔme si me amiwo ƒoa ƒu ɖe aklãa me eye wònana wòsesẽna la ŋu.

Kpuie ko la, dzesideɖoɖo sia na ɖɔktawo sea nusiwo gbɔna gɔme:

• Aleke gbegbee wò aklã le dɔ wɔm nyuie?
• Ðe afɔku aɖe li be aklã nawɔ dɔ nyuiea? Aleke wòanya wɔe?
• Atikewɔwɔ ka ƒomevie nyo na wò wu?

Esia wɔa nu bubu aɖe hã. Ekpena ɖe ɖɔkta siwo le xexeame godoo ŋu woƒoa nu tso wò aklã ƒe nɔnɔme ŋu nenema ke. Woyɔa esia ɣeaɖewoɣi be ``Child-Turcotte-Pugh (CTP) calculator.'' Gake ɖo ŋku edzi be, togbɔ be dzesi sia le vevie hã la, megblɔa wò lãmesẽ ŋutinya bliboa o. Akpa ɖeka koe wònye.

Nu 5 kawo ŋue wole ŋku lém ɖo le esia me?

Ðɔktawo léa ŋku ɖe nu vevi atɔ̃ ŋu tsɔ wɔa Child-Pugh ƒe dzesi. Esiawoe nye:

1. Bilirubin ƒe agbɔsɔsɔ bliboa le ʋu me: Bilirubin nye atike ɣi aɖe si le míaƒe ŋutilã ƒe ʋumenugbagbeviɣi me. Wozãnɛ tsɔ dzidzea nenye be aklãa le dɔ wɔm nyuie. Ne edzi ɖe edzi la, ŋkuwo kple ŋutigbalẽa zua ɣie (abe jaundice ene).

2. Serum albumin ƒe agbɔsɔsɔ: Albumin nye protein si wò aklã wɔ. Ekpena ɖe ame ŋu wòtsɔa nunyiamewo yia wò ŋutilã katã me. Ne wò aklã gbɔdzɔ la, ewɔa protein sia fũu akpa.

3. Alesi wò ʋu ƒona kabakabae (Prothrombin time alo INR): Aklã hã kpɔa gome le alesi wò ʋu ƒoa kabakabae me. Esia le alea elabena wowɔa nusiwo hiã hena ʋu ƒe sisi dometɔ aɖewo le aklã me. Ɣeyiɣi sia ƒe dzidziɖedzi fia be exɔa ɣeyiɣi didi hafi ʋua tsina.

4. Ascites: Esia fia tsi ƒe ƒoƒo ɖe wò ƒodo me le mɔ si mesɔ o nu (ƒodo ƒe do). Esia ate ŋu adzɔ ne aklãdɔlélewo abe aklãdɔ ene nu sẽ.

5. Ðe aklãdɔ (Encephalopathy) kpɔa ŋusẽ ɖe ahɔhɔ̃a ƒe dɔwɔwɔ dzia:Ne aklãa gblẽ la, aɖi siwo wòle be woaɖe le ŋutilãa me dometɔ aɖewo ate ŋu aƒo ƒu ɖe ʋua me. Esiawo ate ŋu azɔ mɔ ayi ahɔhɔ̃a me eye woakpɔ ŋusẽ ɖe ahɔhɔ̃a ƒe dɔwɔwɔ dzi. Esia ate ŋu ana tɔtrɔwo nava nuwo abe ŋkuɖoɖonudzi, susu tsɔtsɔ ɖe nu ŋu, kple nuwɔna ene me.

Wotsɔa dzesi si wotu ɖe wò dodokpɔa me tsonu dzi naa nu atɔ̃ siawo dometɔ ɖesiaɖe. Emegbe, wotsɔa wo katã ƒoa ƒui be woakpɔ dzesi bliboa. Le esia nu la, woma wò ɖe hatsotso etɔ̃ dometɔ ɖeka me: A, B, alo C.

Aleke wòle be madzra ɖo ɖe Child-Pugh Score ŋu?

Be nàbu Child-Pugh ƒe dzesi sia la, ahiã be nàdo dodokpɔ geɖe. Esiawo ate ŋu anye ŋutilãdodokpɔ , ʋudodokpɔ , kple ɖewohĩ nɔnɔmetatawo dodokpɔ.

Ðɔktaa abia tso asiwò be nàxɔ ʋu atsɔ akpɔ nusiawo ɖa:

• Bilirubin ƒe agbɔsɔsɔ: Abe alesi míegblɔe va yi ene la, esia nye aklã ƒe dɔwɔwɔ ƒe dzidzenu.
• Albumin ƒe agbɔsɔsɔ: Protein si aklã wɔna si tsɔa nunyiamewo yia teƒe bubuwo.
• Prothrombin time (PT) alo INR: Ʋu ƒe sisi kabakaba.

Wò ɖɔkta ate ŋu awɔ ƒodo ƒe ultrasound alo CT scan atsɔ akpɔe ɖa be tsi le wò ƒodo me (ascites) hã. Ascites nye tsi si sɔ gbɔ ɖe ƒodoa me ƒe ƒuƒoƒo. Cirrhosis ye nye nusi koŋ gbɔ esia tsona.

Woate ŋu awɔ ŋutilãmedodokpɔ kple/alo susuŋutinunya dodokpɔ atsɔ akpɔe ɖa be aklãa gblẽ si gblẽa nu le ahɔhɔ̃a ŋu hã (encephalopathy). Nɔnɔme sia ate ŋu adzɔ ne aklãa gblẽ eye aɖiwo ƒo ƒu ɖe ʋua me.

Vevietɔ: Be nàkpɔ dodokpɔ siawo me tsonu siwo de pɛpɛpɛ wu la, woate ŋu abia tso asiwò be nàtsri nuɖuɖu alo nunono gaƒoƒo ʋɛ aɖewo hafi dodokpɔa (nutsitsidɔ) nadze egɔme. Eyata bia wò ɖɔkta be dzadzraɖo kawo tututue wòle be nàwɔ.

Ðewohĩ womawɔ dodokpɔ siawo le ŋkeke ɖeka dzi alo le teƒe ɖeka o. Ema menyo o. Ne ɖɔktaa xɔ dodokpɔ siawo katã me tsonu vɔ la, woƒoa wo katã nu ƒu tsɔ bua wò Child-Pugh ƒe dzesi.

Aleke wobua Child-Pugh ƒe dzesi?

Ele bɔbɔe ŋutɔ. Ðɔktawo léa ŋku ɖe nu atɔ̃ siwo míeyɔ ɖe etame siwo do ƒome kple wò aklã ƒe lãmesẽ ŋu. Woate ŋu ana dzesi 1, 2, alo 3 nu mawo dometɔ ɖesiaɖe, le wò nɔnɔmea nu. (Dzesi 1 ye nye esi nu sẽ wu, dzesi 3 ye nye esi nu sẽ wu).

Ne ɖɔktaa de dzesi nu atɔ̃awo katã vɔ la, eƒoa wo katã nu ƒu. Èxɔa dzesi bliboa tso 5 va ɖo 15. Emae nye wò Child-Pugh ƒe dzesi.

Tabla aɖe si ɖe alesi wotsɔa dzesiawo naa amewo le nu atɔ̃ mawo me tsonu nu lae nye esi:

| Nusi gbɔ wòtso | Dzesi 1 lia | Dzesi 2 lia | Dzesi 3 lia |

| :--------------------------------------------------------- | :------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | :------------------------------------------------------ | :------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

| Bilirubin `(Bilirubin bliboa)` (mg/dL) | < 2 | 2 - 3 | > 3 |

| Serum albumin `(Serum albumin)` (g/dL) | > 3.5 ƒe xexlẽme | 2.8 - 3.5 | < 2.8 ƒe xexlẽme |

| INR (ʋu ƒe sisi) | < 1.7 ƒe xexlẽme | 1.7 - 2.3 | > 2.3 ƒe xexlẽme |

| Ascites ƒe dɔléle | Ðeke meli o | Susu sue/Wokpɔ ŋusẽ ɖe edzi | Dadaɖeanyi/Womekpɔa edzi nyuie O |

| Tagbɔdɔléle | Ðeke meli o | Klas 1-2 (Fɔ/si le titina) | Klas 3-4 (Esesẽ) |

Le dzesi si katã nèxɔ nu la, woama wò ɖe hatsotso vevi etɔ̃ me:

• Klass A: Wò aklã le dɔ wɔm nyuie. Wò dzesiwo katã le 5 va ɖo 6 dome.
• Klass B: Aklã ƒe gbegblẽ le mɔ si sɔ nu. Wò dzesiwo katã le 7 va ɖo 9 dome.
• Klass C: Aklã ƒe gbegblẽ vevie alo dɔléle si nu sẽ. Wò dzesiwo le 10 va ɖo 15 dome.

Na míakpɔ eƒe kpɔɖeŋu aɖe ɖaa?

Tsɔe be ame aɖe ƒe dodokpɔ me tsonuawo le ale:

• Bilirubin - 3 mg/dL (dzesi 2) .
• Albumin - 2.9 g/dL (dzesi 2) .
• INR - 1 (dzesi 1) .
• Tsi si le ƒodo me (Ascites) - sue aɖe (2 points) .
• Tagbɔdɔléle - Ao (1 point) .

Ame sia ƒe Child-Pugh ƒe dzesi nye 2 + 2 + 1 + 2 + 1 = 8 dzesiwo . Esia fia be ele Klass B me.

Nukae wò Child-Pugh Score fia?

Dzesi sia naa wò aklãdɔléle ƒe nɔnɔmetata le ɣeyiɣi ma me. Enɔa te ɖe nu atɔ̃ siawo dzi gblɔa alesi wò aklã le dɔ wɔm nyuie na wò ɖɔkta. Child-Pugh ƒe dzesi kpena ɖe wò ɖɔkta ŋu:

• Wɔ wò atikewɔwɔ ƒe ɖoɖo: Esia akpe ɖe ŋuwò nàtso nya me nenye be woatsɔ atike, amekoko, alo aklã dodo na wò , kple nenye be atikewɔwɔ mawo akpɔ dzidzedze.
• Da afɔku si le eme kpɔ:Ne wole dɔ wɔm na wò la, esia akpe ɖe ŋuwò nànya alesi gbegbe afɔku le eme eye wòɖea vi na wò lãmesẽ bliboa. Ne amekokoa kpɔ dzidzedze la, ate ŋu agblɔ alesi wò agbenɔnɔ ƒe nyonyome anɔ le amekokoa megbe hã.
• Bu wò agbetsitsi ƒe akɔnta: Togbɔ be akɔntabubu si wogblɔ ɖi le agbetsitsi ƒe ɣeyiɣi ŋu nye akɔntabubu si me kɔ ko hã la, wò ɖɔkta ate ŋu azã esia atsɔ agblɔ ɣeyiɣi didi si nàte ŋu anɔ agbe, ne wowɔ atike na wò alo mèzãe o, le wò dzesi nu.

Ðo ŋku edzi be ɖɔktae atso nya me le esia katã ŋu. Mɔfiame aɖe koe dzesidegbalẽvi sia nye na wo.

Ɣekaɣie wòle be makpɔ nye ɖɔkta?

Ne nya aɖe le asiwò ku ɖe wò Child-Pugh ƒe dzesi alo alesi wobu akɔntae ŋu la, kpɔ egbɔ be yeƒo nu kple yeƒe ɖɔkta . Ne ètsi dzi ɖe wò dodokpɔ me tsonu alo nusi adzɔ emegbe le wò atikewɔwɔ ƒe ɖoɖoa me ŋu la, gblɔ ema hã na wò ɖɔkta.

Fifia dzesi aɖe le asiwò si gblɔa wò aklã ƒe lãmesẽ na wò. Eyata nukae nèwɔna fifia? Gbã la, mèganɔ dzesi siawo alo dodokpɔ me tsonu siawo ŋu bum ko ne mèƒo nu kple wò ɖɔkta o. Woate ŋu aɖe wò emetsonuwo me na wò kple nusi wofia. Wò Child-Pugh ƒe dzesi kpena ɖe wo ŋu wotsoa nya me le wò atikewɔwɔ ƒe ɖoɖoa ŋu. Gake wò hã ènye nyametsotso ma ƒe akpa aɖe. Eyata ƒo nu kple wò atikewɔlawo ƒe ƒuƒoƒoa tso nusi wò dzesia fia kple nusi wokafu ŋu. Mègatsi dzi o, wole afisia be yewoakpe ɖe ŋuwò.

Mlɔeba la, nusiwo dzi wòle be woaɖo ŋkui (Take-Home Message) .

Child-Pugh Score nye dɔwɔnu vevi aɖe si wotsɔ dzidzea aklã ƒe lãmesẽ, gake megblɔa ŋutinya bliboa o.

• Esia ate ŋu ana ɖɔktawo nakpɔ wò aklã ƒe lãmesẽ nyuie.
• Esia kpena ɖe ame ŋu be woawɔ ɖoɖo ɖe atikewɔwɔ ŋu ahada afɔku siwo le eme la kpɔ.
• Mègatsi dzi ɖe dzesiawo ɖeɖeko ŋu o. Dzro nusianu me kple wò ɖɔkta.
• Wɔ akpa vevi aɖe le nyametsotso wɔwɔ le wò lãmesẽ ŋu me.

Aklã nye ŋutinu vevi aɖe ŋutɔ le míaƒe ŋutilã me. Enye míaƒe agbanɔamedzi be míakpɔ eta. Ne aklãdɔ le ŋuwò la, wɔ ɖe wò ɖɔkta ƒe mɔfiamewo dzi pɛpɛpɛ. Nɔ agbe si me lãmesẽ le. Ekema mahiã be nàtsi dzi ɖe dzesi mawo tɔgbe ŋu o. Nusianu anyo!

` Child-Pugh ƒe dzesi, aklã, aklãdɔ, aklãdɔ, bilirubin, albumin, aklã ƒe dɔwɔwɔ