Cia peb kawm txog qhov mob txaus ntshai no uas tshwm sim sai sai thaum phais: Malignant Hyperthermia!

Yog tias koj lossis ib tus neeg uas koj paub yuav tsum tau phais, tej zaum koj tau hnov ​​​​lo lus "anesthesia". Nws txhais tau tias peb raug muab tso pw tsaug zog thaum phais. Tab sis koj puas tau xav tias qee tus neeg tuaj yeem muaj kev tsis haum tshuaj txaus ntshai heev, txawm tias yuav ua rau tuag taus rau cov tshuaj loog no? Qhov ntawd yog ib qho mob tsis tshua muaj, tab sis mob hnyav heev hu ua Malignant Hyperthermia. Lub npe yuav zoo li ntshai me ntsis, tab sis yog tias koj paub zoo txog nws, ntau yam teeb meem tuaj yeem zam tau. Yog li, cia peb tham txog nws kom meej hnub no.

Malignant hyperthermia yog dab tsi?

Hais yooj yim xwb, 'Malignant Hyperthermia' yog ib yam mob uas muaj los ntawm noob caj noob ces . Uas yog, nws yog los ntawm kev hloov pauv hauv peb cov noob caj noob ces. Thaum ib tug neeg uas muaj yam mob no tau txais qee yam tshuaj loog, lawv lub cev yuav ua rau mob heev. Qhov no yog ib qho xwm txheej ceev uas tuaj yeem ua rau tuag taus.

Qhov zoo tshaj plaws yog, txawm hais tias qhov no feem ntau yog ib yam dab tsi uas tau kis los ntawm ib tiam dhau ib tiam, muaj kev kho rau nws . Thiab, yog tias koj paub txog qhov kev pheej hmoo no thaum ntxov, koj tuaj yeem tiv thaiv koj tus kheej ntawm nws.

Peb paub tias thaum peb raug muab tshuaj loog rau lub cev, peb yuav tsis hnov ​​dab tsi thaum peb phais. Muaj ntau hom tshuaj uas siv los muab tshuaj loog no. Txawm li cas los xij, tsuas yog ob peb hom tshuaj ntawd ua rau muaj qhov mob no hu ua 'Malignant Hyperthermia'. Feem ntau cov tshuaj loog tsis ua rau muaj qhov no.

Lwm yam tseem ceeb yog tias qee zaum ib tus neeg yuav tsis paub tias lawv muaj qhov kev hloov pauv caj ces uas tuaj yeem ua rau Malignant Hyperthermia, vim tias lawv yuav tsis qhia cov tsos mob kom txog thaum lawv raug cov tshuaj tshwj xeeb uas tau hais.

Leej twg yuav muaj feem ntau dua los tsim qhov no?

Cia peb saib seb leej twg muaj feem yuav mob "Malignant Hyperthermia" no ntau dua.

Yog tias ib tug neeg hauv koj tsev neeg tau muaj tus mob "Malignant Hyperthermia" yav dhau los , ces lwm tus neeg hauv tsev neeg ntawd kuj yuav muaj feem yuav muaj tus mob no thiab. Tshwj xeeb, yog tias ib tug txheeb ze (piv txwv li niam, txiv, kwv tij neej tsa, menyuam) tau muaj tus mob no, ces suav tias koj yog tus "muaj feem yuav muaj tus mob no."

Yog li ntawd, yog tias koj yuav tsum tau phais, nws yog ib qho tseem ceeb heev uas yuav tsum qhia rau tus kws kho mob kom siv tshuaj loog yog tias muaj dab tsi zoo li no tau tshwm sim rau ib tus neeg hauv koj tsev neeg.

Xav txog, cia peb hais tias koj tsev neeg yeej tsis tau muaj qhov kev tsis haum tshuaj 'Malignant Hyperthermia' zoo li no. Txawm li cas los xij, cov neeg uas muaj qee yam kab mob ntawm cov leeg kuj tseem yuav muaj feem ntau dua. Ib txhia ntawm cov kab mob no yog:

• Kab mob plawv nruab nrab
• Kab mob ntau yam
• Kab mob King-Denborough
• 'STAC3 kev puas siab puas ntsws'

Txawm hais tias qhov no yuav zoo li nyuaj me ntsis, nws yog qhov zoo rau cov neeg uas muaj cov mob no kom paub txog qhov no.

Tus mob no feem ntau tshwm sim li cas?

Qhov mob "Malignant Hyperthermia" no muaj ntau npaum li cas? Txawm hais tias cov ntaub ntawv tsis sib xws me ntsis, feem ntau kwv yees tias qhov mob no tuaj yeem tshwm sim hauv kwv yees li ib qho ntawm 100,000 qhov kev phais mob rau cov neeg laus. Ntawm cov menyuam yaus, tus lej no yog kwv yees li ib qho ntawm 30,000 qhov kev phais mob. Nws tseem ceeb heev tias ib nrab ntawm cov neeg mob uas tau txheeb xyuas yog hnub nyoog qis dua 19 xyoos.

Tiamsis cov kws tshawb fawb xav tias cov neeg uas muaj tus mob 'Malignant Hyperthermia' no yuav muaj feem ntau dua nyob hauv zej zog. Vim tias muaj ntau tus neeg tsis tau raug cov tshuaj tshwj xeeb uas ua rau nws thoob plaws hauv lawv lub neej, lawv yuav tsis paub tias lawv muaj kev pheej hmoo.

Cov tsos mob ntawm qhov no yog dab tsi?

Cov tsos mob ntawm 'Malignant Hyperthermia' yuav txawv me ntsis ntawm ib tus neeg mus rau ib tus neeg. Lawv tuaj yeem tshwm sim thaum lub sijhawm phais lossis thaum koj tab tom rov zoo los ntawm kev phais. Piv txwv li, yog tias koj raug tshuaj loog thiab cov tsos mob no tshwm sim thaum lub sijhawm phais, koj yuav tsis hnov ​​​​​​nws. Txawm li cas los xij, koj tus kws kho mob anesthesiologist lossis tus kws saib xyuas kev siv tshuaj loog yuav ceev faj heev txog qhov no. Lawv saib xyuas txhua tus neeg uas raug tshuaj loog kom zoo zoo. Thaum lawv pom cov tsos mob no, lawv yuav pib kho mob rau 'Malignant Hyperthermia' tam sim ntawd.

Cov cim qhia thaum ntxov

Nov yog thawj cov cim qhia uas koj yuav pom:

• Lub plawv dhia ceev zuj zus yam tsis paub ua (tachycardia). Lub plawv dhia ceev zuj zus tam sim ntawd.
• Kev nce ntxiv ntawm cov pa roj carbon dioxide uas tawm hauv lub cev sai sai . Qhov no kuj tuaj yeem kho tau nrog cov khoom siv kho mob.
• Ua pa ceev heev (tachypnea). Koj pib ua pa sai sai, zoo li koj tab tom ua pa tsis taus pa.
• Cov leeg nqaij tawv, tawv ('cov leeg nqaij tawv'). Cov leeg nqaij hauv lub cev tawv zoo li lawv raug pob zeb tsoo.
• Kub lub cev nce sai sai . Lub cev pib kub.

Cov tsos mob uas tshwm sim tom qab

Thaum qhov xwm txheej hnyav zuj zus tuaj, koj kuj tseem yuav pom cov tsos mob xws li:

• Kub lub cev nce siab dua li qhov kub ib txwm muaj .
• Cov zis tsaus . Tej zaum nws yuav hloov mus ua xim av.
• Cov kev kuaj ntshav qhia tau tias cov leeg nqaij tawg .
• Lub plawv dhia tsis xwm yeem (arrhythmia). Lub plawv dhia tsis xwm yeem.
• Los ntshav .
• Cov mob xws li qaug dab peg .

Vim li cas ho muaj malignant hyperthermia tshwm sim?

Tam sim no cia peb saib seb vim li cas qhov mob no hu ua 'Malignant Hyperthermia' thiaj tshwm sim.

Cov neeg uas muaj tus mob no muaj cov protein txawv txav hauv lawv cov leeg nqaij. Qhov no yog vim muaj kev hloov pauv hauv lawv cov noob caj noob ces, hu ua kev hloov pauv caj ces .

Hais yooj yim xwb, peb cov DNA zoo li ib phau ntawv qhia uas muaj cov ntaub ntawv uas cov cell hauv peb lub cev xav tau los ua lawv txoj haujlwm. Yog tias muaj me ntsis cov ntaub ntawv ploj lawm qhov twg hauv cov DNA no, lossis yog muaj kev puas tsuaj rau ib yam dab tsi, ces yog thaum cov kab mob caj ces zoo li no tshwm sim.

Qhov kev hloov pauv caj ces no tsis ua rau muaj tsos mob hauv lub neej ib txwm. Txawm li cas los xij, yog tias ib tus neeg uas muaj qhov kev hloov pauv no raug rau cov tshuaj loog tshwj xeeb uas tau hais los saum toj no - lossis, tsis tshua muaj, yog tias raug rau qhov kub thiab txias lossis yog tias lawv koom nrog kev tawm dag zog hnyav - lawv cov leeg nqaij pib tso calcium tawm tsis zoo.

Yog li ntawd, cov leeg nqaij txuas ntxiv mus thiab ua rau nruj lossis tawv, lub cev lub cev metabolism thiab lub cev kub nce ntxiv tsis zoo li qub. Thaum kawg, cov hlwb nqaij tuag, thiab muaj ntau cov potassium sib sau ua ke hauv cov ntshav. Qhov no tuaj yeem ua rau muaj cov tsos mob thiab teeb meem ntxiv.

Cov tshuaj loog tuaj yeem ua rau muaj qhov mob no.

Ib tug neeg uas muaj caj ces ua rau muaj tus mob 'Malignant Hyperthermia' yuav muaj qhov kev tsis haum no yog tias lawv tau txais cov tshuaj loog hauv qab no:

Cov tshuaj uas nqus tau:

• `Halothane`
• `Desflurane`
• `Sevoflurane`
• `Isoflurane`

Cov tshuaj txhaj rau hauv cov hlab ntsha:

• Succinylcholine - Qhov no yog ib qho tshuaj ua kom cov leeg nqaij so sai.

Koj paub qhov no li cas?

Yog koj phais mob siv tshuaj loog uas txaus ntshai yam tsis paub tias koj muaj tus mob 'Malignant Hyperthermia', koj thiab tus kws kho mob loog yuav tsis paub tias koj muaj tus mob no kom txog thaum tom qab muaj kev tsis haum tshuaj.

Txawm li cas los xij, thaum koj lossis lwm tus neeg tau txais tshuaj loog, tus kws kho mob anesthesiologist lossis tus kws saib xyuas neeg mob yuav saib xyuas koj cov cim qhia tseem ceeb thiab kev noj qab haus huv ze heev thaum lub sijhawm phais thiab tom qab phais. Yog tias koj muaj 'Malignant Hyperthermia', lawv yuav paub nws los ntawm cov cim qhia tseem ceeb thiab cov tshuaj tiv thaiv tsis zoo uas tau hais ua ntej. Ntawd yog:

• Lub plawv dhia ceev dua yam tsis muaj laj thawj.
• Kub ntawm lub cev nce sai.
• Kev nce ntxiv ntawm cov pa roj carbon dioxide uas tawm hauv lub cev sai sai.
• Cov leeg nqaij nruj.

Cov kws kho mob siv tshuaj loog tau kawm txog kev paub txog cov kev hloov pauv no thaum ntxov . Tom qab ntawd lawv tuaj yeem teb sai rau qhov xwm txheej ceev no. Kev kuaj mob sai dua, kev kho mob thiab kev tswj hwm tus mob yuav ua tau ntau dua.

Koj paub ua ntej li cas yog tias koj muaj qhov kev pheej hmoo no?

Yog tias koj lossis koj tus kws kho mob xav tias koj yuav muaj feem yuav mob Malignant Hyperthermia, txawm yog vim koj tsev neeg keeb kwm lossis lwm yam, muaj qee qhov kev kuaj tshwj xeeb uas ua tau los xyuas qhov no:

• Kev kuaj mob Caffeine halothane contracture test (CHCT) : Rau qhov kev kuaj no, ib daim me me ntawm koj cov leeg nqaij (cov leeg nqaij biopsy) raug coj mus thiab cov qauv ntaub so ntswg raug tso rau hauv cov tshuaj halothane thiab caffeine kom pom tias nws puas teb rau cov roj anesthetic.
• Kev kuaj noob caj noob ces : Cov kev kuaj no tuaj yeem txheeb xyuas cov kev hloov pauv hauv cov noob caj noob ces hauv DNA hu ua RYR1, STAC3, thiab CACNA1S. Muaj ntau tshaj 45 qhov kev hloov pauv tau raug txheeb xyuas uas tuaj yeem ua rau muaj Malignant Hyperthermia.

Txawm li cas los xij, cov kev kuaj no los nrhiav kev pheej hmoo rau 'Malignant Hyperthermia' kim heev, thiab lawv tsuas yog ua tau hauv ob peb lub chaw kuaj mob tshwj xeeb xwb. Piv txwv li, qhov kev kuaj 'CHCT' tsuas yog muaj nyob rau plaub qhov chaw hauv Tebchaws Meskas. Yog li ntawd, yog tias koj xav tau kev phais mob thaum muaj xwm txheej ceev thiab ib tus txheeb ze ze tau muaj 'Malignant Hyperthermia' yav dhau los, cov kws kho mob anesthesiologist feem ntau siv cov tshuaj loog uas muaj kev nyab xeeb dua li cov tshuaj uas muaj kev pheej hmoo.

Cov kev kho mob rau qhov no yog dab tsi?

Txoj kev kho mob tseem ceeb rau qhov kub siab heev yog tshuaj dantrolene (lub npe lag luam Dantrium®).

Thaum cov kws kho mob tshuaj loog xav tias muaj mob hu ua 'Malignant Hyperthermia', lawv muab cov tshuaj 'dantrolene' no. Tib lub sijhawm, lawv tsum tsis txhob muab cov tshuaj loog uas ua rau muaj kev tsis haum tshuaj, thiab tus kws phais ua tiav qhov kev phais sai li sai tau.

Tsis tas li ntawd xwb, pab pawg tshuaj loog thiab phais kuj kho lwm cov tsos mob thiab teeb meem uas tshwm sim los ntawm 'Malignant Hyperthermia'. Qee qhov kev kho mob no yog:

• Kev kho mob hyperthermia yog siv cov txheej txheem txias , xws li muab cov kua dej txias rau hauv cov hlab ntshav thiab muab cov dej khov rau.
• Muab cov pa oxygen los ntawm lub npog ntsej muag lossis lub raj tso rau hauv lub trachea.
• Yog tias lub plawv dhia tsis xwm yeem (arrhythmia), yuav muab tshuaj rau nws.

Thaum koj tus mob ruaj khov lawm, koj yuav raug khaws cia rau hauv chav saib xyuas mob hnyav (ICU) tsawg kawg ib hnub rau kev soj ntsuam . Pawg neeg kho mob yuav ua lwm yam kev kuaj mob (piv txwv li kev kuaj ntshav) thiab muab kev kho mob ntxiv yog tias tsim nyog.

Qhov no puas tiv thaiv tau?

Mob malignant hyperthermia nyuaj me ntsis rau kev tiv thaiv, tshwj tsis yog tias koj paub tias koj muaj kev hloov pauv caj ces uas ua rau nws , lossis ib tus neeg hauv koj tsev neeg muaj tus mob thiab koj tau qhia rau koj tus kws kho mob anesthesiologist. Yog li ntawd, tus kws kho mob anesthesiologist yuav tsis siv cov tshuaj txaus ntshai no hauv koj txoj kev npaj anesthesia.

Tab sis, qhov tu siab yog, feem ntau cov neeg tsuas pom tias lawv muaj feem yuav mob Malignant Hyperthermia tom qab nws tshwm sim rau lawv.

Tom qab muaj tus mob no lawm, yuav muaj li cas? Puas kho tau?

Yog tias cov tsos mob ntawm 'Malignant Hyperthermia' raug lees paub thaum ntxov thiab kho kom zoo, kev rov zoo tag nrho yuav ua tau . Kev ua haujlwm sai ntawm pab pawg tshuaj loog thiab phais yog qhov tseem ceeb heev ntawm no.

Txawm li cas los xij, peb yuav tsum nco ntsoov tias qee zaum, txawm tias kho tau sai los xij, ntau lub cev tsis ua haujlwm thiab txawm tias tuag tau.

Muaj lwm yam teeb meem dab tsi tshwm sim vim yog malignant hyperthermia?

Malignant hyperthermia tuaj yeem ua rau muaj teeb meem loj xws li:

• Kev puas tsuaj rau cov leeg nqaij
• Kev ua haujlwm tsis zoo ntawm lub raum
• Kev ua haujlwm tsis zoo ntawm daim siab
• Los ntshav
• Kev nres plawv
• Qaug dab peg
• Coma
• Kev tuag

Qhov no puas yog qhov ua rau tuag taus?

Yog tias tsis kho, 'Malignant Hyperthermia' yuav ua rau tuag taus . Txawm tias kho tau zoo los xij, tus nqi tuag uas tau tshaj tawm yog nyob nruab nrab ntawm 3% thiab 5%. Yog li ntawd, qhov no tsis yog ib yam dab tsi uas yuav tsum tau saib yooj yim.

Thaum twg kuv yuav tsum mus ntsib kws kho mob txog qhov no?

Yog tias koj tab tom npaj rau kev phais, nws yog ib qho tseem ceeb heev uas yuav tsum qhia rau cov kws kho mob yog tias muaj leej twg hauv koj tsev neeg tau muaj teeb meem nrog kev siv tshuaj loog yav dhau los .

Tsis tas li ntawd xwb, yog tias koj nyuam qhuav kuaj pom tias muaj kev hloov pauv caj ces uas ua rau Malignant Hyperthermia hauv ib tug txheeb ze (txheeb ze ntawm tus kheej), lossis yog tias koj paub tias tus neeg ntawd tau muaj tus mob hu ua Malignant Hyperthermia, nws yog ib qho tseem ceeb heev uas yuav tsum qhia rau koj tus kws kho mob thiab sau qhov no rau hauv koj cov ntaub ntawv kho mob.

Cov yam tseem ceeb tshaj plaws uas koj yuav tsum nco ntsoov hauv tsab xov xwm no

Malignant Hyperthermia yog ib qho kev tsis haum tshuaj loj heev, uas muaj peev xwm ua rau tuag taus rau qee cov tshuaj loog.

Qhov xov xwm zoo yog tias nws tuaj yeem kho tau thiab, yog tias koj paub tias koj muaj kev pheej hmoo, nws tuaj yeem tiv thaiv tau.

Yog tias ua tau, paub txhua yam txog keeb kwm kev kho mob ntawm koj cov txheeb ze ntshav. Qhia cov ntaub ntawv ntawd rau koj tus kws kho mob. Vim tias 'Malignant Hyperthermia' yog tshwm sim los ntawm kev hloov pauv caj ces uas tau kis mus rau ntau tiam neeg, yog tias ib tug neeg hauv koj tsev neeg muaj nws, koj kuj muaj feem yuav muaj feem ntau dua.

Yog tias koj muaj lus nug lossis kev txhawj xeeb txog kev phais thiab kev siv tshuaj loog uas koj yuav tau txais, tsis txhob yig nug koj tus kws kho mob. Lawv yeej npaj siab pab koj. Koj txoj kev paub thiab kev sib txuas lus nrog koj pab neeg kho mob yog qhov kev tiv thaiv zoo tshaj plaws rau koj.

` Kev kub taub hau ntau dhau, kev siv tshuaj loog, kev phais, cov kab mob caj ces, keeb kwm tsev neeg, teeb meem siv tshuaj loog, kub cev siab