Nanga bwanji ngati kuthamanga kwa magazi kwatsika kwambiri? Tiyeni tiphunzire za mankhwala opulumutsa moyo (Vasopressors)

Tonsefe tamva za kuthamanga kwa magazi. Koma kodi mumadziwa kuti kuthamanga kwa magazi kutsika kungakhale koopsa chimodzimodzi, komanso mwina koopsa kwambiri? Mwina mwamvapo za munthu amene mwadzidzidzi amadwala kwambiri ndipo amagonekedwa mu Intensive Care Unit (ICU). Nthawi ngati zimenezi, kuthamanga kwa magazi kwa munthuyo kungakhale kotsika kwambiri. Izi zikachitika, ziwalo zofunika kwambiri m'thupi, monga ubongo, mtima, ndi impso, zimasowa magazi okwanira okosijeni omwe amafunikira. Lero, tikambirana za mtundu wapadera komanso wamphamvu kwambiri wa mankhwala omwe madokotala amagwiritsa ntchito kupulumutsa miyoyo pazidzidzidzi zoopsa kwambiri. Uwu ndi womwe umatchedwa Vasopressors mu zamankhwala.

Kodi vasopressors ndi chiyani kwenikweni?

Mwachidule, vasopressor ndi mtundu wa mankhwala omwe madokotala amagwiritsa ntchito kuthandiza anthu omwe ali ndi kuthamanga kwa magazi kochepa kwambiri kuti abwerere mwakale. Mankhwalawa amagwira ntchito pochepetsa, kapena kuchepetsa, mitsempha yamagazi m'thupi lathu.

Taganizirani motere. Magazi omwe amazungulira m'thupi lathu ali ngati njira ya mapaipi amadzi. Ngati mapaipi awa (mitsempha yamagazi) mwadzidzidzi akukula kapena kumasuka, kuthamanga kwa madzi (magazi) omwe amadutsa m'magaziwo kumachepa. Ichi ndi chomwe timachitcha mkhalidwe wa kugwedezeka. Nthawi zina ngati izi, magazi amasiya kuyenda kupita ku ziwalo zofunika kwambiri za thupi. Popanda mpweya, ziwalo zimenezo zimasiya kugwira ntchito, ndipo moyo wa munthuyo ukhoza kukhala pachiwopsezo.

Kawirikawiri, kuthamanga kwa magazi kukatsika motere, chinthu choyamba kuchita ndi kupereka saline (IV fluids). Koma ngati kuthamanga kwa magazi sikubwerera mwakale ngakhale mutagwiritsa ntchito saline, ndiye kuti chinthu chotsatira chomwe madokotala amachita ndikugwiritsa ntchito mtundu wa mankhwala otchedwa vasopressor. Awa ndi mankhwala omwe amabayidwa mwachindunji mumtsempha. Nthawi zambiri amaperekedwa kudzera mu chubu chapadera chomwe chimayikidwa mumtsempha waukulu pakhosi kapena pachifuwa, wotchedwa central venous catheter. Kenako mankhwalawa amapita mwachangu kumtima ndikufalikira thupi lonse.

Kodi mankhwalawa amagwira ntchito bwanji m'thupi?

Mankhwala a vasopressor amachita zinthu ziwiri zazikulu akalowa m'thupi.

1. Kuchepetsa mitsempha yamagazi: Ichi ndiye chinthu chachikulu. Chimachepetsa mitsempha yamagazi m'thupi lonse. Monga momwe kufinya chitoliro chamadzi kumathandizira kuti madzi aziyenda mofulumira, mitsempha yamagazi ikachepa, kuthamanga kwa magazi mkati mwake kumawonjezeka.

2. Kuchulukitsa kuuma kwa mtima: Ma vasopressor ena amagwira ntchito pa mtima, ndikuwonjezera kuchuluka kwa magazi omwe amapopa nthawi iliyonse. Izi zikutanthauza kuti amawonjezera kwakanthawi mphamvu ya mtima yopopa.

Njira zonsezi zimabwezeretsa kuthamanga kwa magazi mwachangu ndikubwezeretsa kuyenda kwa magazi ku ziwalo zofunika monga ubongo, mtima, ndi impso .

Ndi mitundu iti ya vasopressors yomwe imagwiritsidwa ntchito kwambiri?

Mankhwala ochepetsa kuthamanga kwa magazi (vasopressors) amagwiritsidwa ntchito m'zipinda zosamalira odwala kwambiri (ICUs) pochiza kuthamanga kwa magazi kochepa chifukwa cha zifukwa zosiyanasiyana. Dokotala amasankha mankhwala oyenera kwambiri kutengera momwe wodwalayo alili.

Kodi timagwiritsa ntchito mankhwala amtunduwu pa moyo wathu watsiku ndi tsiku?

Inde. Timagwiritsa ntchito mankhwala ena tsiku lililonse omwe amagwira ntchito mofanana ndi mankhwalawa, ngakhale kuti si amphamvu ngati awa.

• Mankhwala Ochotsera Mphuno M'mphuno: Mukakhala ndi chimfine, mphuno yanu imatsekeka. Madontho ena a m'mphuno kapena ma lozenges omwe timagwiritsa ntchito ali ndi zinthu monga `(Ephedrine)` ndi `(Pseudoephedrine).` Izi zimagwira ntchito potseka mitsempha yamagazi mkati mwa mphuno, kuchepetsa kutupa, ndikupangitsa kuti kupuma kukhale kosavuta.
• EpiPen®: EpiPen®, yomwe imagwiritsidwa ntchito ngati pali ziwengo zoopsa, monga anaphylaxis yoyambitsidwa ndi njuchi kapena mavu, kapena kudya zakudya zina, ili ndi mankhwala omwewo otchedwa Epinephrine.
• Mankhwala ena a chimfine: Mapaketi ena a mankhwala a chimfine angakhale ndi `(Phenylephrine)`. Amenewonso ndi a gulu la vasopressor.

Kodi Vasopressors ndi Inotropes ndi chinthu chimodzi?

Inde, awa ndi mitundu iwiri ya mankhwala. Koma madokotala nthawi zambiri amagwiritsa ntchito mitundu yonseyi pamodzi. Tiyeni timvetse kusiyana kwake mosavuta.

• Mankhwala ochepetsa magazi m'mitsempha: Mankhwalawa amagwira ntchito pochepetsa mitsempha yamagazi ndikuwonjezera kuthamanga kwa magazi.
• Inotropes: Mankhwalawa amawonjezera mphamvu ya injini ya madzi (mtima) , zomwe zimapangitsa kuti ipope madzi ambiri nthawi imodzi.

Choncho, ngati munthu ali ndi kuthamanga kwa magazi kochepa ndipo mtima wake ndi wofooka, madokotala amapereka mankhwala onsewa pamodzi, kuonjezera kuthamanga kwa magazi mwa kufinya chubu mbali imodzi, ndikuwonjezera mphamvu ya injini mbali inayo kuti ipompe magazi kupita m'thupi moyenera momwe angathere.

Kodi ma vasopressor ofunikira amafunika pazochitika ziti?

Mankhwala ochepetsa ululu m'mitsempha yamagazi ndi mtundu wa mankhwala opulumutsa moyo omwe amaperekedwa kwa wodwala amene ali pakati pa moyo ndi imfa. Awa si mankhwala operekedwa pa matenda wamba. Nazi zina mwa zinthu zazikulu zomwe zimafunika.

Kodi pali zotsatirapo zilizonse pa mankhwalawa?

Inde. Mankhwala ochepetsa kuthamanga kwa magazi (vasopressors) ndi amphamvu kwambiri . Chifukwa chake, amatha kuyambitsa zotsatirapo zoyipa. Pachifukwa ichi, mankhwalawa amaperekedwa m'chipinda chosamalira odwala kwambiri (ICU), pomwe nthawi zonse amayang'anira thanzi la wodwalayo . Madokotala ndi anamwino nthawi zonse amayang'anira kugunda kwa mtima wa wodwalayo, kuthamanga kwa magazi, ndi kuchuluka kwa mpweya m'thupi.

Zina mwa zotsatirapo zake ndi izi:

• Nkhawa ndi kusakhazikika
• Mutu
• Kupweteka pachifuwa
• Kuvuta kupuma
• Kugunda kwa mtima pang'onopang'ono (Bradycardia)
• Kuthamanga kwa mtima kosazolowereka (Tachycardia)
• Kugunda kwa mtima kosakhazikika (Arrhythmia)
• Kuthamanga kwa magazi komwe kuli kokwera kuposa momwe kungafunikire. (Izi zingayambitse matenda oopsa monga kutuluka magazi muubongo)
• Kuchepa kwambiri kwa mitsempha yamagazi kumapangitsa kuti magazi aziyenda pang'onopang'ono m'zala za m'manja ndi zala, zomwe zimapangitsa kuti madera amenewo asinthe kukhala akuda.

Ngakhale kuti zotsatirapo zake ndi zoopsa, ndikofunikira kukumbukira kuti mankhwalawa amaperekedwa m'mikhalidwe yoopsa kwambiri komanso yoopsa kwambiri. Madokotala nthawi zonse amayesetsa kuyeza zabwino ndi zoyipa zake ndikuchita zomwe zingakhale zabwino kwa wodwalayo.

Kodi zimatenga nthawi yayitali bwanji kuti munthu achire?

N'kovuta kupereka yankho limodzi pa funso ili, chifukwa nthawi yomwe imatenga kuti muchire siimatsimikiziridwa ndi mankhwala oletsa vasopressor omwe mudapatsidwa, koma ndi matenda omwe adayambitsa kuti muperekedwe .

Mwachitsanzo, munthu amene wagwidwa ndi matenda oopsa a septic shock angafunike kukhala m'chipatala kwa milungu ingapo, ngakhale miyezi ingapo, kuti achire. Komabe, munthu amene wapatsidwa mankhwala amenewa kwa kanthawi kochepa panthawi ya opaleshoni kuti achepetse kupanikizika komwe kumachitika chifukwa cha mankhwala oletsa ululu angachire msanga.

Mukabwerera kunyumba kuchokera kuchipatala, musafulumire kubwerera kuntchito yanu yachizolowezi. Imwani mankhwala omwe dokotala wanu wakupatsani pa nthawi yake. Komanso, onetsetsani kuti mwasunga nthawi yanu yokumana ndi dokotala. Ngati simukumva bwino, mwachitsanzo, ngati mukuvutika kupuma, kupweteka pachifuwa, kapena simukumva bwino, imbani dokotala wanu nthawi yomweyo kapena pitani ku Dipatimenti Yothandiza Pachipatala (ETU) yapafupi.