Whakaarohia tētahi e mōhiotia ana e koe, he mema whānau pea, kei te rongoatia mō te mate pukupuku. Ina koa ko tētahi o ngā maimoatanga matatau rawa atu e wātea ana i ēnei rā. I muri i ētahi rā i te tīmatanga o te maimoatanga, ka pāngia rātou e te kirika nui, te mamae o te tinana, ā, ka rite ki te makariri kino. He maha ngā wā ka whakaaro tātou he pānga taha noa iho tēnei o te maimoatanga. Heoi, he tohu pea tēnei mō tētahi mea kino ake. He mate hauora tēnei e kiia nei e tātou ko te Cytokine Release Syndrome (CRS) .
He aha te CRS?
Hei mārama ki tēnei, me whakaaro tuatahi tātou ki te pūnaha ārai mate o tō tātou tinana. He rite ki tētahi ope taua e tiaki ana i tō tātou whenua. He karere kei tēnei ope taua e whakawhitiwhiti karere ana i waenga i āna hōia (ngā pūtau ārai mate). Waihoki, kei reira ngā pūmua motuhake e āwhina ana i ō tātou pūtau ārai mate ki te whakawhitiwhiti kōrero me te whakahaere i ā rātou mahi, e kiia nei ko ngā cytokine . He mea nui ēnei mō te pūnaha ārai mate hauora.
Engari i ētahi wā, inā koa mō ētahi maimoatanga mate pukupuku, pērā i te immunotherapy , ka nui rawa te whakaohooho o tō tātou pūnaha ārai mate. Ka puta he tukunga ohorere o ēnei karere, e kiia nei ko ngā cytokine, ki roto i te toto. He rite ki tētahi ope taua e haere ana ki te riri me te tuku mano tini o ngā karere i te wā kotahi. I ētahi wā ka kiia tēnei he "awha cytokine." Ina tukuna he maha o ngā cytokine i te wā kotahi, ka puta te mumura puta noa i te tinana. Koinei te mea e kiia nei e tātou ko te CRS.
He aha ngā tino take o te CRS?
Ko te tino take o te CRS ko ētahi o ngā maimoatanga hou e whakamahia ana mō te mate pukupuku.
- Te rongoā ārai mate: Koinei te tino take. Ko ngā maimoatanga pēnei i te rongoā pūtau CAR-T me ngā paturopi takirua he tino mōrearea ki te CRS. Ka whakaohohia e ēnei maimoatanga tō tātou ake pūnaha ārai mate ki te whawhai ki ngā pūtau matepukupuku. I roto i tēnei tukanga, ka kaha rawa te mahi a te pūnaha ārai mate i ētahi wā.
- Ētahi atu take: Tērā pea ka nui ake te mōrearea o te hunga whai mate ira, mate pūnaha ārai mate rānei. Hei tauira, he mate ira e kiia nei ko te Hemophagocytic lymphohistiocytosis (HLH) .
He aha ngā tohu pea o te CRS?
He rite tonu ngā tohu o te CRS ki ērā o te makariri noa, nō reira he uaua ki te kite i ētahi wā. Heoi anō, ka tere tonu te kino o ēnei tohu.
| Tohu | Whakaahuatanga |
|---|---|
| Te kirika nui me te makariri | Koinei te tohu tuatahi e kitea pinepine ana. |
| Te pōuri me te whanoke | Ka pā te pōhēhē me te ngaronga o te mahara ki ngā pānga ki te roro. |
| Whakapairuaki me te ruaki | Ka puta ēnei tohu nā ngā pānga ki te pūnaha nakunaku. |
| Mamae puku/korere | Ko te pupuhi o te puku tētahi atu tohu noa. |
| Te mamae o te upoko me te mamae o te tinana | Tērā pea ka pā te mamae o ngā hononga me ngā uaua, he rite ki te kirika dengue. |
| Ponana kiri | Tērā pea ka puta he whero i runga i te kiri o ētahi tāngata. |
| Te uaua ki te horomi | Ka uaua pea te horomi i te korokoro mamae. |
| Mahi uaua | Te ngenge rawa ki te mahi i tetahi mea. |
Kia pēhea te kino o tēnei āhuatanga?
He mate te CRS, mai i te ngawari ki te mate morearea. Ka taea e te mumura nui puta noa i te tinana te kino i ngā whekau nui pēnei i ngā whatukuhu, te ate, ngā pukahukahu, me te ngākau.
Ko te mea nui ko te tautuhi wawe i tēnei mate, me te tīmata i te maimoatanga, ki te kore ka puta he raruraru nui.
Ko ētahi o ngā raruraru kino ka pā mai ko ēnei e whai ake nei:
- Ngā pānga ki te ngākau: Ka puta pea te cardiomyopathy me te ngoikore o te ngākau.
- Ngā pānga ki ngā pukahukahu: Ka pā pea te ngoikore o te pukahukahu me te tino iti o te taumata hāora i roto i te toto.
- Te ngoikore o te whatukuhu me te ate: Ka kore pea ēnei whekau e mahi.
- Te mate turuturu o te capillary: Ka taea e te wai e turuturu ana i roto i ngā oko toto iti te heke kino o te toto.
Me pēhea te kitenga a ngā tākuta i tēnei?
He tino mātau te tīma hauora e rongoā ana i a koe mō te CRS, nō reira, ki te mea kei te whiwhi koe i tētahi maimoatanga pēnei i te immunotherapy, ka aro turukihia e rātou ō tohumate.
Mena ka puta ngā tohu, ka whakaritea e te tākuta ētahi whakamātautau hei whakaū i te mate.
- Tatau Toto Katoa (CBC): Aroturuki i ngā huringa o ngā pūtau toto.
- Ngā taumata cytokine: Ine i te nui o ngā cytokine i roto i te toto.
- Whakamātautau pūmua C-reactive (CRP): Ka āwhina tēnei whakamātautau ki te ine i te taumata o te mumura i roto i te tinana.
- Te tirotiro i te mahi a te whatukuhu me te ate: Kimihia mēnā kua pakaru ēnei whekau.
I runga i te kaha o te mate, ka whakarōpūhia e ngā tākuta hei Taumata 1 ki te 4. Ka teitei ake te tau, ka nui ake te kino o te mate. Ka whakatauhia tēnei wāhanga mā te whakaaro ki ngā āhuatanga pēnei i te kirika, te toto toto, ngā taumata hāora, me te mahi a ngā okana.
He aha ngā maimoatanga mō te CRS?
Ko te maimoatanga e whakawhirinaki ana ki te kaha o ō tohumate. Mō ngā mate ngawari, he nui pea ngā mea ngawari pēnei i ngā rongoā whakaheke kirika. Engari ki te kino rawa te mate, me whai maimoatanga motuhake ake pea.
| Tikanga maimoatanga | Ka aha te mea ka tupu? |
|---|---|
| Ngā corticosteroids | Ka whakahaere i te mumura nui i roto i te tinana me te mahi a te pūnaha ārai mate. |
| Ngā rongoā e aro ana ki ngā cytokine motuhake | Ka aro atu, ka ārai hoki i ngā cytokine kua nui rawa te whakaputa. Hei tauira: tocilizumab, siltuximab, anakinra. |
| Manaaki Tautoko | Hoatu he rongoā mō te toto toto iti, hoatu he hāora, ā, whakamahia te manawa miihini mēnā e tika ana. |
Āhea ahau me rapu tohutohu hauora?
Koinei te wāhanga tino nui.
Mena kei te whiwhi koe i te rongoā ārai mate mō te mate pukupuku, ā, ka pāngia koe e te kirika, e ētahi atu tohumate CRS rānei (pēnei i te mamae o ngā hononga, te pōhēhē) i muri i te maimoatanga, ehara i te mea pai kia whakaroahia mō tētahi wā poto.
Ka tere tonu te kino o tēnei mate. Nō reira, me whakamōhio atu ki tō tākuta, ki tō hōhipera rānei. Mā te wawe o te tīmatanga o te maimoatanga, ka iti ake te tūponotanga o ngā raruraru nui.
He mea mārama te mataku me te pouri ki te rongo i tētahi mea pēnei i a koe e whawhai ana ki te mate pukupuku. Engari kia maumahara, e mōhio ana te tīma hauora e rongoā ana i a koe ki te CRS. Kei te mātakitaki tata atu rātou i a koe. Kaua e wehi ki te kōrero ki a rātou mō ngā huringa katoa o tō tinana, ahakoa ngā mea iti rawa. Mā tō tautoko, ka taea te whakahaere i tēnei āhuatanga i mua i te kino rawa atu.
Karere Tangohia ki te Kāinga
- He mate kino te CRS nā te kaha rawa o te pūnaha ārai mate. Ka puta pea tēnei mate, inā koa i muri i ngā maimoatanga ārai mate mō te mate pukupuku.
- Tērā pea ka tīmata ngā tohumate pērā i te makariri noa, engari ka tere tonu te kino. Ko ngā tohu matua ko te kirika nui, te makariri, me te pōhēhē.
- Mena kei te whiwhi koe i te rongoā ārai mate, whakamōhio atu ki tō tākuta tonu mena ka pāngia koe e te kirika, e ētahi atu tohu rerekē rānei.
- He maimoatanga whai hua kei reira mō te CRS. Mā te maimoatanga wawe ka ārai i ngā raruraru nui.
- Me whakamōhio atu ki tō tīma hauora tēnei. Kōrerotia mā te mahorahora ki a rātou mō ō āwangawanga me ō tohumate.
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