Tangoganizani kuti mwangoyamba kumene kumwa mankhwala atsopano a matenda enaake. Pakatha pafupifupi sabata imodzi kapena ziwiri, mukumva kusasangalala, ngati kuti mwatsala pang'ono kuyamba kudwala chimfine. Thupi lanu limapweteka, mukumva kutentha thupi, mukunjenjemera... Kenako mwadzidzidzi, thupi lanu limayamba kutuluka madontho ofiira omwe pang'onopang'ono amasanduka matuza amadzimadzi, ndipo khungu lanu limayamba kung'ambika ngati kuti mwapsa. Uwu ndi mkhalidwe woopsa kwambiri, wopweteka, komanso womwe ungawopseze moyo. Lero tikulankhula za mkhalidwe woopsa uwu, womwe ndi Toxic Epidermal Necrolysis (TEN) .
Mwachidule, kodi Toxic Epidermal Necrolysis (TEN) ndi chiyani?
Kutupa kwa khungu kotchedwa Toxic Epidermal Necrolysis, kapena TEN mwachidule, ndi vuto la pakhungu lopweteka kwambiri komanso lomwe lingathe kupha. Limayambitsa matuza ndi kutsekeka kwa madera akuluakulu a thupi lanu, nthawi zambiri osachepera 30% ya thupi lanu. Kutsekeka kumeneku kungachitikenso m'malo omwe ali ndi nembanemba ya mucous, monga pakamwa, m'maso, ndi m'mimba.
Vuto loopsali nthawi zambiri limachitika chifukwa cha mankhwala enaake omwe timamwa. Khungu likawonongeka kwambiri, pamakhala chiopsezo chachikulu cha kutaya madzi m'thupi komanso matenda oopsa.
Kunena zoona, TEN ndi mtundu woopsa kwambiri wa matenda ena a pakhungu otchedwa Stevens-Johnson syndrome (SJS). Mu SJS, khungu lochepera 10% la thupi limatuluka. Pamene 10% mpaka 30% ya thupi lakhudzidwa, timatcha kuti SJS-TEN overlap condition. Ngati khungu loposa 30% latuluka, limaonedwa kuti TEN.
Ndani amene ali pachiwopsezo chachikulu chotenga matendawa?
Anthu omwe ali ndi chitetezo chamthupi chofooka amakhala ndi mwayi waukulu wopeza matenda a Stevens-Johnson (SJS) kapena TEN. Pali zifukwa zingapo zomwe chitetezo chamthupi chingafookere.
- Anthu omwe ali ndi kachilombo ka HIV (human immunodeficiency virus).
- Anthu omwe ali ndi khansa zina, monga lymphoma.
Kuphatikiza apo, zinthu za majini nazonso zingathandize. Matupi a anthu ena sangathe kusweka ndikugwiritsa ntchito mankhwala ena mwachizolowezi. Ichi ndi chinthu chomwe chimachokera ku majini awo. M'machitidwe otere, mankhwalawo amatha kusonkhana m'thupi ndi kuyambitsa zotsatirapo zoopsa monga SJS kapena TEN. Komanso, chifukwa cha kusintha (kusintha) kwa majini ena, anthu ena amatha kuchitapo kanthu ndi mankhwala ena.
Ngakhale kuti TEN imatha kuchitika pa msinkhu uliwonse, imapezeka kwambiri mwa okalamba. Komabe, ndi vuto losowa kwambiri .Ndikofunikira kukumbukira kuti padziko lonse lapansi, SJS ndi TEN pamodzi zimakhudza anthu pafupifupi miliyoni imodzi kapena ziwiri pachaka.
Kodi zifukwa zazikulu za TEN ndi ziti?
Nthawi zambiri, madokotala amakhulupirira kuti mankhwala ena ndi omwe amachititsa TEN. Tiyeni tiwone mankhwala omwe ali pachiwopsezo chachikulu.
| Gulu la mankhwala | Kufotokozera kosavuta |
|---|---|
| Allopurinol | Mankhwala ogwiritsidwa ntchito pochiza matenda monga miyala ya impso ndi gout. |
| Mankhwala Oletsa Kupweteka kwa Mtima | Gulu la mankhwala operekedwa kuti athetse matenda monga khunyu. |
| Mankhwala oletsa kachilombo ka HIV | Makamaka mankhwala omwe amagwiritsidwa ntchito pochiza matenda a HIV (monga nevirapine). |
| Oxicams | Izi ndi gulu la mankhwala ochepetsa ululu ndi oletsa kutupa omwe ali m'gulu la NSAIDs. |
| Sulfonamides | Izi ndi mtundu wa mankhwala opha tizilombo toyambitsa matenda. |
Kuwonjezera pa mankhwala awa, nthawi zina matenda ena kapena katemera angayambitsenso TEN. Koma izi sizimachitika kawirikawiri. Nthawi zina, chomwe chimayambitsa TEN sichingapezeke.
Kodi zizindikiro za TEN ndi ziti?
Zizindikiro khumi nthawi zambiri zimayamba kuonekera patatha milungu ingapo mutayamba kumwa mankhwala atsopano. Zimayamba ndi zizindikiro zonga chimfine.
- Kupweteka kwa thupi
- Chifuwa
- Malungo ndi kuzizira
- Mutu
- Kufiira kwa maso ndi kutupa
Pambuyo pa zizindikiro zoyamba izi, mabala ofiira opweteka (ziphuphu) amayamba kuonekera pakhungu. Mabalawa amakula pang'onopang'ono, amasanduka matuza odzaza ndi madzi, ndipo pamapeto pake khungu limayamba kung'ambika. Mabala omwe amapangika khungu likang'ambika amatchedwa kukokoloka . Awa ndi mabala opweteka kwambiri, otseguka omwe amawoneka ngati kupsa kwambiri.
Zilonda zimenezi zimayamba kuonekera pankhope ndi pachifuwa, kenako zimatha kufalikira ku ziwalo zina za thupi.
- Maso: Mkati mwa chikope (conjunctiva) ndi mbali yakunja ya diso lakuda (cornea) zitha kuwonongeka.
- Ma nembanemba a mucous: Mabala amatha kuchitika mkamwa, m'mphuno, pakhosi, komanso m'njira yopumira.
- Malo otsekeka m'mimba, m'makoswe, ndi m'mimba: Malo amenewa amathanso kuvulala kwambiri.
Kuvulala kumeneku kumapangitsa kuti ntchito zosavuta monga kudya, kumeza, kupuma, kutseka maso, ndi kukodza zikhale zopweteka kwambiri komanso zovuta.
Mavuto aakulu omwe angachitike chifukwa cha TEN
TEN si vuto lofunika kulitenga mopepuka. Lingayambitse mavuto aakulu komanso oopsa.
- Matenda: Khungu likasweka, pamakhala mwayi waukulu woti majeremusi alowe m'thupi. Ngati majeremusiwa alowa m'magazi, matenda oopsa kwambiri otchedwa sepsis angachitike.
- Kulephera kwa ziwalo zingapo: Kutupa kwambiri ndi matenda m'thupi kungayambitse ziwalo zamkati monga impso, chiwindi, ndi mapapo kulephera kugwira ntchito.
- Chibayo: Pali chiopsezo chowonjezeka cha matenda opatsirana m'mapapo chifukwa cha kuvulala kwa njira yopumira.
Chifukwa cha kuthekera kwa mavuto aakulu otere, munthu amene ali ndi zizindikiro za TEN ayenera kugonekedwa m'chipatala ndikulandira chithandizo nthawi yomweyo .
Kodi madokotala amazindikira bwanji matendawa?
Dokotala wodziwa bwino ntchito yake nthawi zambiri amatha kuzindikira TEN mwa kufufuza khungu lanu ndikufunsa za zizindikiro zanu. Nthawi zina, pangafunike kuyesedwa khungu kuti atsimikizire matendawa.
Izi zikuphatikizapo kutenga khungu laling'ono kwambiri kuchokera ku chotupa cha pakhungu pogwiritsa ntchito mankhwala oletsa ululu ndikuchiyang'ana pogwiritsa ntchito maikulosikopu. Kuyesa kumeneku kungathe kuwona bwino ngati pali maselo a khungu akufa (maselo otupa) komanso ngati gawo lapamwamba la khungu (epidermis) lapatukana ndi gawo lapansi.
Kodi mankhwala ochizira izi ndi otani?
Chofunika kwambiri, TEN ndi vuto lachipatala.Uwu si matenda omwe angachiritsidwe kunyumba. Muyenera kupita ku chipatala cha Emergency Treatment Unit (ETU) nthawi yomweyo zizindikiro zikayamba.
Mu chipatala, wodwalayo nthawi zambiri amalowetsedwa mu chipinda chosamalira odwala kwambiri (ICU) kapena malo ochitira opaleshoni yoyaka moto, chifukwa odwalawa amafunikira chisamaliro chapadera chofanana ndi chomwe chimaperekedwa kwa wodwala woyaka moto.
Njira zochiritsira zitha kugawidwa m'magawo awiri akuluakulu.
| Njira zochiritsira za TEN | |
|---|---|
| Chithandizo chachangu | |
| Kuletsa mankhwala oyambitsa matendawa | Mankhwala onse omwe akuganiziridwa kuti amayambitsa TEN amachotsedwa nthawi yomweyo. |
| Kulamulira kuchuluka kwa madzi m'thupi | Kutuluka kwa khungu kumapangitsa kuti madzi ambiri atuluke m'thupi. Chifukwa chake, madzi amchere (IV fluids) amaperekedwa kudzera mumtsempha kuti azitha kuwongolera kuchuluka kwa madzi m'thupi. |
| Kupewa matenda | Mafuta oletsa kupha tizilombo toyambitsa matenda amapakidwa pa mabala otseguka. Mankhwala opha tizilombo amaperekedwa zizindikiro zoyamba za matenda. |
| Mankhwala ena enieni | |
| Chitetezo chamthupi (IVIG) | Ichi ndi madzi omwe amaperekedwa kudzera mu mitsempha. Ali ndi ma antibodies ochokera m'magazi a anthu athanzi. Izi zimathandiza kuwongolera momwe chitetezo cha mthupi chimayankhira. |
| Mankhwala oletsa chitetezo chamthupi | Mankhwala amaperekedwa kuti aletse chitetezo cha mthupi kuti chisaukire maselo ake, zomwe zimafooketsa ntchito yake. |
| Plasmapheresis | Izi zikuphatikizapo kutumiza magazi a wodwalayo ku makina apadera, kulekanitsa ndi kuchotsa ma antibodies oopsa mu plasma ya magazi, ndikubwezeretsa magazi oyeretsedwawo m'thupi. |
Zotsatirapo za nthawi yayitali mutachira
Anthu opulumuka TEN angakumane ndi zotsatirapo zina kwa nthawi yayitali. Ngakhale khungu litachira kwathunthu, mavuto ena angabuke.
- Khungu, tsitsi ndi misomali: kukula kapena kutayika kwa misomali kosazolowereka, mawanga a pakhungu (akuda kapena oyera), kutayika kwa tsitsi m'malo ena (alopecia areata), khungu louma komanso loyabwa, thukuta lochuluka.
- Maso: Kutupa kapena kufiira kwa maso kwa nthawi yayitali, maso ouma, matenda a zikope, kukhudzidwa ndi kuwala, kusawona bwino kapena, kawirikawiri, kusawona bwino.
- Pakamwa, mphuno ndi dongosolo lopumira: Matenda a bronchitis, matenda a m'mapapo monga COPD, pakamwa pouma, matenda a chingamu, kutayika kwa kukoma ndi fungo, kuwonongeka kwa mapapo.
- Mkodzo ndi njira zoberekera: Kuvulala kapena kutupa kwa mkodzo kwa nthawi yayitali, nyini, kapena mbolo, kuvutika kukodza, kuuma kwa nyini mwa akazi.
Ndikofunikira kwambiri kulankhula ndi dokotala wanu za zotsatirapo za nthawi yayitali izi ndikupempha chithandizo chofunikira.
Uthenga Wopita Nawo Kunyumba
- Toxic Epidermal Necrolysis (TEN) ndi njira yoopsa kwambiri komanso yowopsa yogwiritsira ntchito mankhwala ena.
- Zimayamba ndi zizindikiro zodziwika bwino monga malungo ndi kupweteka kwa thupi, koma kenako zimakula kukhala matuza opweteka komanso kutentha komwe kumayambitsa khungu kusweka.
- Izi ndi zadzidzidzi zachipatala. Ngati mukumva zizindikirozi, muyenera kupita ku chipatala nthawi yomweyo.
- Ngati mukuyamba kutupa pakhungu, kutupa, kapena zizindikiro zina zachilendo mutayamba kumwa mankhwala atsopano, musanyalanyaze. Pitani kwa dokotala nthawi yomweyo.
- Ngati mudakumanapo ndi vuto la mankhwala aliwonse, onetsetsani kuti mwadziwitsa dokotala wanu za izi nthawi iliyonse mukapita kukatenga mankhwala.
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