He maha ngā okana o tō tinana e ngoikore ana i te wā kotahi? Me kōrero tātou mō tēnei āhuatanga e kiia nei ko te Multiple Organ Dysfunction Syndrome (MODS)!

Kua rongo pea koe i te wā e pāngia ohoreretia ana te tangata e te mate nui, ā, kei roto i te wāhanga tiaki nui (ICU) o te hōhipera, ka mea rātou, "I kī mai ngā tākuta kāore ētahi wāhanga o tōna tinana e mahi tika ana." Mēnā rānei, "Kei te ora tonu rātou mā ngā mīhini." Inaa, i taua wā, tera pea he mate tino kino tō taua tangata. I roto i te rongoā, ka karangahia tēnei ko te Multiple Organ Dysfunction Syndrome, i te reo Pākehā rānei, ko te "Multiple Organ Dysfunction Syndrome - MODS." He ahua whakamataku te ingoa, engari me kōrero tātou mō te aha, te take e puta ai, me pēhea te ora i roto i tētahi huarahi māmā e mārama ai koe.

He aha rawa te MODS?

Ki te kī ngāwari, he mate hauora tino ohorere (whakamataku) te MODS. Ko te mea ka puta i tēnei, ko ngā pūnaha okana e rua, neke atu rānei, o roto i tō tātou tinana e mahi tahi ana, kāore e mahi tika i te wā kotahi. Whakaarohia, he maha ngā pūnaha o roto i tō tātou tinana pērā i te pūnaha manawa, te pūnaha nakunaku, te pūnaha mimi. Ka mahi tahi ēnei hei pupuri i tō tātou hauora. Ina puta te MODS, kāore e taea e ēnei pūnaha okana te mahi takitahi. Kātahi ka hiahiatia he taputapu tautoko ora ('tautoko ora') hei mahi i ngā mahi a aua okana.

Ka pāngia e te MODS tetahi okana o te tinana, engari ko ngā mea e tino pāngia ana ko:

• Ngā pūkahukahu
• Ngākau
• Roro
• Ngā whatukuhu
• Ate
• Toto (toto)

He maha ngā take o te MODS. Ko te tino take ko te mate kino (sepsis) . I te rongoā i te MODS, ka ngana tuatahi ngā tākuta ki te whakahaere i te mate taketake i puta ai te mate. Ka mahi hoki rātou i ngā mahi hei ārai i te kino o ētahi atu pūnaha okana.

He mate hauora tino morearea te MODS. Ka mate pea mēnā kāore e tere te rongoā. He maha ngā tāngata whai MODS e whakaurua ana ki te wāhanga tiaki nui (ICU) ā, me aroturuki tonu me te tautoko ora.

He maha atu anō ngā ingoa mō tēnei āhuatanga, tae atu ki:

• Te ngoikore o ngā okana maha
• Te ngoikore o te pūnaha okana maha

He aha ngā pūnaha okana ka pāngia e te MODS?

Ka pā pea te MODS ki ngā pūnaha okana e rua, neke atu rānei:

1. Pūnaha manawa (pūkahukahu)

Ina kore e taea e ō tātou pūkahukahu te whakarato i te nui o te hāora e hiahiatia ana e te tinana, arā, kāore e nui te hāora e whiwhihia ana e ngā kiko o te tinana (hypoxia) kāore rānei e nui te hauhā waro (CO2) e whiwhihia ana e te tinana (hypercapnia), ka kiia tēnei he ngoikore o te manawa. I roto i te MODS, ka uaua te manawa, ā, ka hiahia pea koe ki te manawa ā-ringa hei āwhina i a koe ki te manawa. Ko te kino nui rawa atu o te pūkahukahu i roto i te MODS ko te Acute Respiratory Distress Syndrome (ARDS).I roto i tēnei āhua ARDS, ka pakari ngā pukahukahu, ā, ka tino uaua ki te pupuri i ngā taumata hāora noa i roto i te toto.

2. Pūnaha manawa (ngākau)

Ko tā tātou pūnaha manawa te mea e pupuhi ana i te toto puta noa i te tinana. Ko te ngoikore o te ngakau me te ohorere o te tohanga toto he āhuatanga e ngoikore ai, e pakari ai rānei te uaua o te ngakau, e kore ai e pupuhi i te toto e ranea ana puta noa i te tinana. Ko te mumura nui e puta mai ana me te MODS ka taea te whakawhanui i ngā oko toto, ka whakaiti i te nui o te toto e tae atu ana ki ngā kiko me ngā whekau. Ka taea e tēnei te arahi ki te toto toto iti (te toto toto iti, te ohorere rānei) i roto i te MODS. Ka taea hoki e te wai te turuturu mai i ēnei oko toto, ka pupuhi (edema).

3. Pūnaha toto (toto)

Ka taea e te MODS te whakararu i te taurite o ētahi pūmua i roto i te toto. Ka arahi pea tēnei ki ngā raruraru toto me te toto totoka . Tērā pea ka kite koe i te marutanga i runga i te kiri, i te toto rānei i roto i tō puku. Ko te raruraru tino kino ka pā ki tō pūnaha toto ko te Disseminated Intravascular Coagulation (DIC) . I roto i tēnei āhuatanga, ka tīmata te toto ki te turuturu mai i ngā catheter, i ngā ngongo rānei i roto i tō kiri.

4. Pūnaha io (roro)

He okana nui tō tātou roro e whakahaere ana i ngā pūnaha katoa o te tinana. Ina mutu te mahi a tētahi wāhanga, te mahi katoa rānei o te roro nā te kino o te roro, o ētahi atu wāhanga rānei o te pūnaha io matua (tae atu ki te taurakira me ōna io e pā ana), ka kiia e tātou he 'raruraru io'. I roto i te MODS, ka taea e te mumura, te toto totoka nā ngā raruraru o te pūnaha toto, me te toto toto iti te whakaiti i te nui o te toto e rere ana ki te roro. Ka taea e tēnei te kino i te roro, ā, ka puta he pōhēhētanga ('delirium') .

5. Pūnaha whatukuhu (ngā whatukuhu)

Ko te ngoikore o te whatukuhu te wā e kore ai e taea e ngā whatukuhu te mahi i ētahi, i te katoa rānei o ā rātou mahi, tae atu ki te tātari i ngā hua para mai i te toto. Ka tātarihia e te pūnaha whatukuhu ō tātou toto, ka hanga mimi, ka tangohia hoki ngā wai kāore e hiahiatia mai i te tinana. I roto i te MODS, ka taea te whakararu i tēnei tukanga.

6. Pūnaha ate (ate)

Ko te ngoikore o te ate ko te wā e kore ai e taea e te ate te mahi i ētahi, i te katoa rānei o ana mahi maha, pērā i te tango i ngā paitini mai i te toto, te tātari i ngā toto toto whero tawhito, me te whakaputa au (he waikawa kōwhai/kakariki e āwhina ana ki te nakunaku kai). Ka taea e te mumura me te heke o te rere o te toto ki te ate te meinga kia ngoikore te ate. Ka taea e tēnei te huri kōwhai i te kiri me/ngā kanohi rānei (te jaundice). Ka taea hoki e te ngoikore o te ate te meinga kia ngoikore ētahi atu okana.

He pēhea te noa o te MODS?

He mate noa te MODS e kitea ana i roto i ngā mate ohorere, tino kino. E ai ki ngā rangahau, kei waenganui i te 28% me te 88% o ngā tūroro i roto i ngā wāhanga tiaki nui ka pāngia e te MODS. Koia anō tētahi o ngā tino take o te mate i roto i ngā wāhanga tiaki nui pokanga (ICU).

He aha ngā tohu tōmua o te MODS?

Nā te mea ka pāngia tetahi okana o te tinana e te MODS, ka whakawhirinaki ngā tohu ki te okana e pāngia ana. Ka ngawari pea ēnei tohu i ngā wāhanga tōmua o te mate e puta ai te MODS, ka kino rānei . I a MODS e ahu whakamua ana mai i te mate whakapeka, ka pāngia pea koe e:

• Whakapairuaki me te ruaki
• Hiahia kai
• Te ngoikore rawa, te ngenge rānei
• Kirika
• Te whakamatao
• Te pōhēhē, te uaua rānei ki te arotahi
• Te manawa tere, te manawa pāpaku
• Te tere o te manawa, te koretake rānei o te manawa
• Te mamae roa o te uma me/ranei te puku
• Te pupuhi o te puku
• Te pupuhi o ngā peka
• Te kōwhai o te kiri, o ngā kanohi rānei (te jaundice)
• Te tae kikorangi, hina/mā rānei o te kiri, ngutu, arero, kapia, maikuku, kanohi rānei (cyanosis)
• Ngaronga o te māramatanga

He aha ngā take o te MODS?

Ka pāngia pea te MODS e tetahi mate nui, whara, mate pāwera rānei. Kāore anō kia mōhiotia e ngā tākuta me ngā kairangahau te tino take o te MODS. Heoi, e kī ana ngā rangahau o nāianei ko te mumura me te iti o te rere o te toto te take o te MODS. Kāore te MODS i puta mai i tētahi mate hauora kotahi. Ka puta mai i tētahi raupapa o ngā kaupapa e pā ana ki te maha, ki te katoa rānei o ngā pūnaha okana o te tinana. Ka taea e te iti o te rere o te toto me te hāora te arahi ki te kino.

Whakaarohia, i roto i tētahi mate kino, tera pea he maha ngā huihuinga ka arahi atu ki te MODS.

1. Te kaupapa matua: Koinei te take tuatahi. Hei tauira, he mate kino (sepsis), he aituā nui (pēnei i te aituā motuka), he whakaeke ngakau kino rānei.

2. Te tuarua o ngā āhuatanga: Koinei te wā ka nui rawa te tauhohenga a tō pūnaha ārai mate, ka puta ai te mumura nui puta noa i te tinana.

3. Te tuatoru o ngā āhuatanga: Mena ka pāngia koe e tētahi mate hou, ka hiahiatia rānei kia pokangahia hei rongoā i tētahi mate taketake, tera pea ko tētahi atu āhuatanga.

Ko ētahi o ngā tino take o te MODS ko:

• Sepsis, septic shock rānei: He mumura kino tēnei i puta mai i te mate kitakita, te mate huaketo rānei.
• Whara whara: Ngā mea pēnei i te aituā motuka, ngā wera nui, te wero, te pupuhi rānei.
• Pancreatitis: Te mumura o te repe taiaki. Ka puta pea tēnei i ngā kohatu o te pūkahukahu, te nui o te inu waipiro, ētahi rongoā, me ētahi atu āhuatanga.
• Te whakaeke ngakau nui: I puta mai i te aukati i roto i te uaua toto e tuku toto ana ki te ngakau.
• Te ngoikore o te ate: Ka puta pea tēnei i te Hepatitis B, te Hepatitis C, te mate ate momona, te nui o te inu waipiro, me te cirrhosis.
• Ngā whara me te paitini paitini:Nā te pānga ki ngā paitini. Hei tauira, te whakamahi tarukino, waipiro rānei i ngā wā roa, ngā matū paitini pērā i ngā patupatu me ngā rauemi whakamahana tawhito (asbestos), me ngā mate kitakita.

Ka puta ngā huringa nui i roto i tō pūnaha ārai mate me te pūnaha toto i ēnei āhuatanga, ka pā hoki ki ētahi atu okana.

Ko tēhea okana te tuatahi ka hē i roto i te MODS?

Tata ki te katoa e pāngia ana e te MODS ka pāngia tuatahitia e ngā raruraru pūkahukahu , engari kāore anō kia mārama ngā tākuta me ngā kairangahau he aha te take e puta ai te ngoikore o te pūkahukahu i mua i te MODS.

Ko wai te hunga e tino pāngia ana e te MODS?

Ka taea e te tangata katoa te pāngia e te MODS, engari ka nui ake te tūponotanga ka pāngia koe e te MODS mēnā he mate kei roto i a koe, pērā i te mate mau tonu, te ngoikore rānei o te pūnaha ārai mate.

Me pēhea te tautuhi i ngā MODS?

He maha ngā whakamātautau ka whakamahia e ngā tākuta hei kite i te ngoikore o ngā okana puta noa i tō tinana. Kei roto pea i ēnei:

• Ngā whakamātautau toto
• Whakamātautau hau toto uaua
• Ngā whakamātautau mahi ate
• Ngā whakamātautau mahi whatukuhu
• Ngā ahurea toto me ngā ahurea kiko
• Echocardiogram (orooro o te ngākau)
• Ngā whakamātautau whakaahua pēnei i te ultrasound, te CT scan rānei

Me pēhea te rongoā mō ngā MODS?

Ko te maimoatanga mō te MODS ka whakawhirinaki ki te pūtake me ngā pūnaha okana e pāngia ana. Ko ētahi o ngā kōwhiringa maimoatanga ko:

• Whakaorahia te iti o te toto mā te hoatu wai i roto i te uaua (IV) .
• Te hoatu rongoā vasopressor hei whakanui ake i te rere o te toto i roto i ngā oko toto me ngā kiko (te rere o te toto ki roto i ngā kiko).
• Hoatu he paturopi hei rongoā i ngā mate urutā me/ranei te sepsis.
• Te whakawhiti toto hei whakakapi i te toto i ngaro i tētahi whara, i tētahi pokanga rānei.
• Te whakaora hāora hei whakarato i te nui ake o te hāora ki te tinana.
• Ki te kore e taea e koe te manawa ko koe anake, me whakamahi pea koe i te pūnaha manawa ā-ringa hei āwhina i a koe ki te manawa.
• Te dialysis hei āwhina i te tango i ngā para me te wai nui i roto i tō tinana.
• Te whakahāngaitanga o te hāora ki waho o te tinana (ECMO) hei tāpiri i te hāora ki te toto, hei tango hoki i te hauhā waro.
• He pūnaha mimiti anō ngota ngota (MARS) hei tautoko i te ate.
• Te pokanga mō ngā tūroro he nui ngā whara.
• Ko te pokanga whakawhitinga okana he whakakapinga i tētahi okana mate, he okana ngoikore rānei ki tētahi okana hauora mai i tētahi kaituku.
• Mena he toto tōu i roto i te puku (GI), he mate puku rānei e kore ai koe e kai, kāore rānei e taea e koe te kai, me whiwhi pea koe i ngā matūkai mā te IV (intravenous) te enteral rānei (parenteral).

Kia pēhea te tere o taku pai ake i muri i te maimoatanga?

Ka whakawhirinaki tō whakaoranga ki te take me te maimoatanga. Ka taea e te tākuta te hoatu he whakaaro pai ake mō te wā ka kite koe i te whakapainga i muri i te maimoatanga.

He aha te heke mai o MODS?

Ko te heke mai o te MODS kei runga i te pūtake. I ētahi wā ka hoki pea ētahi, ka hoki katoa rānei ōu māramatanga ki te āhua noa, engari me āwhina pea koe i te wā poto kia ora rā anō koe.

He mea nui te tautuhi me te rongoā wawe i te MODS me tōna pūtake kia angitu ai te whakahaere i tēnei āhuatanga.

He rerekē te āhua o te MODS i ngā wāhanga tiaki nui (ICU). E whakaaro ana ngā tākuta he tino take mate tēnei mate i roto i ngā tūroro e whakaurua ana ki ngā wāhanga tiaki nui pokanga.

Ki te horapa te mate ki te wāhi kino rawa atu, ka pā mai pea he kino tuturu ki ngā okana. Tērā pea me āwhina koe i te oranga mō te wā roa, me te whakawhitinga okana rānei. Tērā pea ka mate pea koe.

Me nui ake ngā rangahau hei tautuhi i ngā āhuatanga ka pā ki te MODS, ā, ka pai ake pea te heke mai mō ngā tūroro.

He aha te auau oranga mai i te MODS?

E whakatau ana ngā tākuta me ngā kairangahau ko te ōrau oranga mō te MODS kei waenga i te 50% me te 60% .

Ka taea te ārai i ngā MODS?

Kāore e taea te ārai i ētahi o ngā āhuatanga e puta ai te MODS. Ā, kāore anō kia kitea he rongoā motuhake hei āwhina i te aukati i te MODS. Kei te rapu huarahi ngā kairangahau ki te rongoā i te MODS i ōna wāhanga tōmua kia kore ai e kino haere te mate. He maha ngā rangahau kei te haere tonu i tēnei mara.

Ka taea e koe te āwhina ki te tiaki i ō whekau mā te mahi i ngā mea penei:

• Tiakina ō whekau mai i te ru mā te mau whitiki nohoanga i a koe e eke ana i roto i te waka, me ngā taputapu tiaki i a koe e takaro ana i ngā hākinakina kaha.
• Me werohanga hei ārai i ngā mate kino ina tūtohutia e ngā tākuta.
• Whakaitihia, kati rānei te tango i ngā rongoā kāore i tohua, pērā i ngā rongoā anti-inflammatory kore-steroidal (NSAID), ka kino pea ēnei i ngā whatukuhu.
• Whakaitihia, kati rānei te tango i ngā rongoā, i ētahi atu mea rānei ka pāngia ai te puku, pērā i ngā NSAID, te momi hikareti, me te waipiro .
• Tikina he rongoā mō te toto toto tiketike (hypertension) .

Mena kei te hōhipera koe me te mate urutā, ka taea e ō tākuta te mahi i ēnei mea hei ārai i te kino haere o te MODS:

• Te whakaiti i te kino o ōu pukahukahu mai i te whakapūngao manawa ā-ringa.
• Whakawhāitihia ngā whakawhiti toto kia tino hiahiatia rā anō.
• Te whakamahi i ngā rongoā whakaheke toto mēnā e tika ana hei ārai i te totoka.

Āhea ahau me toro atu ki te tākuta?

Mena he mate pūmau tōu, ā, kei te pāngia koe e ngā tohu o te MODS, ka arahi pea tēnei ki te mate kino me te ngoikore o ngā okana, he mea pai tonu kia toro atu koe ki te tākuta. Ka taea e rātou te kī atu ki a koe he aha ngā tohu motuhake hei tirotiro māu, me pēhea hoki te whakahaere i tētahi āhuatanga.

Āhea ahau me haere ki te Tari Whawhati Tata (ETU) ?

Mena kei a koe ngā tohu o te MODS, haere ki te rūma whawhati tata, waea atu rānei ki te 911. Ka mate pea tēnei mena kāore e rongoatia wawetia.

He aha ngā pātai me pātai atu ahau ki te tākuta?

Anei ētahi pātai ka hiahia pea koe ki te pātai atu ki tō tākuta:

• He aha ngā take o te MODS?
• He aha ngā kōwhiringa maimoatanga kei a au?
• He aha ngā rongoā e taunaki ana koe?
• He aha ngā whāinga o taku tiaki?
• Kia pēhea te auau o taku hiahia ki te maimoatanga?

Whakarāpopototanga me te karere whakamutunga

Āe, kua mōhio koe inaianei ko te mate ngoikore o ngā okana maha (MODS) he mate kino e pā ana ki ngā pūnaha okana e rua, neke atu rānei i roto i tō tinana. Ahakoa ka pā te MODS ki tētahi pūnaha okana, ko te nuinga o te wā ka pā ki ngā pukahukahu, te ngākau, ngā whatukuhu, te ate, te roro, me te toto. He maha ngā take pea mō tēnei. Ko ngā mea tino noa ko te whara nui, te mate nui, me ngā mate pāwera whānui. Ko te arotahi o te maimoatanga ko te rongoā i te mate taketake me te ārai i ngā kino atu ki ētahi atu pūnaha okana.

He mea noa te mataku ina rongo koe kāore ngā whekau o tō tinana, o tō whanaunga rānei e mahi ana. Engari kua whakangungua ngā tākuta me ngā kaimahi o te Wāhanga Maimoatanga Ohotata (ETU) me te Wāhanga Tiaki Kaha (ICU) ki te tautoko i ō pūnaha whekau katoa, ki te ārai i ngā kino atu, me te āwhina i tō tinana kia ora. Nō reira kaua e mutu te tumanako. Mā te maimoatanga tere me te tohutohu hauora tika, ka taea e koe te ngana ki te puta atu i tēnei āhuatanga.

` Te ngoikore o ngā okana maha, MODS, te ngoikore o ngā okana, te sepsis, te tiaki nui, te ngoikore o ngā okana, te tautoko ora