Wakambonzwa here vanachiremba vachiti, "Tichabvisa murwere" kana mumwe wehama dzako kana shamwari dziri muICU (intensive care unit)? Kana kuti ungayeuka izwi rekuti 'kuburitsa murwere' richishandiswa kakawanda panguva yedenda reCOVID-19. Kunyange zvazvo izvi zvingave zvitsva kune vazhinji, chaizvoizvo inzira yakakosha uye yekare inoshandiswa navanachiremba kuponesa hupenyu hwevarwere vane dambudziko guru rekufema. Saka, nhasi tichataura nezvazvo zvese nenzira iri nyore, nenzira yaunogona kunzwisisa.
Zvichitaurwa zviri nyore, chii chinonzi 'Proning'?
Kucheuka chitarisiko chinhu chiri nyore kwazvo. Kuchinja murwere ari pamubhedha akarara kuita seasingatarisiki. Zvakafanana nekucheuka nedumbu kuti arare. Asi ichi hachisi chinhu chatinoita zvisina kurongeka, chinhu chinoitwa nokungwarira uye nemaune nevashandi vekurapa muchipatara.
Izvi zvinowanzoitirwa varwere vane dambudziko guru rekufema , kunyanya avo vari pakushandisa michina yekufema. Izvi zvinowedzera huwandu hweokisijeni hunosvika mumuviri wemurwere.
Kunyangwe zvakazonyanya kufarirwa panguva yedenda reCOVID-19, izvi hazvisi zvitsva. Vanachiremba vanga vachishandisa nzira iyi kwemakumi emakore. Tsvagiridzo yakaratidza kuti kukurumidza kuyerera kwechirwere muvarwere vane chirwere chekufema chakanyanya vari pamuchina wekufema kunogona kuderedza zvakanyanya kufa .
Nzira iyi inoshandiswa pakurapa kwemarudzi api?
Nzira yekurerutsa kufema inonyanya kushandiswa kubatsira varwere vane zvirwere zvakakomba zvekufema uko muviri usiri kuwana oxygen yakakwana (hypoxia). Chirwere ichi chinowanzoonekwa iAcute Respiratory Distress Syndrome (ARDS).
Zvichitaurwa zviri nyore, ARDS kuunganidzwa kwemvura mumabhegi madiki emhepo ari mumapapu edu, alveoli. Funga nezvazvo sechipanji chinonwisa mvura uye chinovhara mipata. Kana mabhegi aya emhepo azara nemvura, hapana nzvimbo yekufema mweya. Ichi chirwere chakakomba zvikuru. ARDS inogona kuitika sechirwere chakakomba chezvirwere zvakaita sepneumonia neCOVID-19.
Sei oxygenation ichivandudzika kana uchitendeudza dumbu rako?
Ichi ndicho chinhu chinonyanya kukosha. Mwero weokisijeni unowedzera sei kana ukatendeuka nedumbu rako? Pane zvikonzero zviviri zvikuru zveizvi. Chikonzero ndechekuti miviri yedu haina kuenzana.
1. Kudzikira kwehuremu uye kumanikidzwa kwemapapu (Kufema Kwakavandudzwa)
Nekuda kwechimiro chemuviri wedu, tine mapfupa akawanda kumusana kupfuura pachipfuva.Patinorara nemusana wedu, huremu hwemwoyo wedu nedzimwe nhengo dzemudumbu hunowira zvakananga pamusoro pemapapu edu. Uyewo, mumamiriro ezvinhu akaita seARDS, mvura inoungana mumapapu inomanikidzawo masaga emhepo ari kunze nekuda kwesimba rinokwevera pasi. Izvi zvinoderedza kugona kwemapapu kuzadza zvizere nemhepo.
Fungidzira uine mutoro pachipfuva chako uye uchinetseka kufema. Izvi zvinoitikawo kumapapu ako.
Zvisinei, kana murwere akatendeudzirwa nedumbu rake (nzvimbo yaanogara), huremu hwemwoyo nedzimwe nhengo hahuwire pamapapu, asi pamapfupa echipfuva. Uyewo, mvura iri mumapapu inoungana munzvimbo diki yemapapu epamberi. Izvi zvinosunungura nzvimbo huru yemapapu kumusana. Ipapo , mweya unogona kupinda munzvimbo iyoyo zvakanaka, zvichibvumira mapapu kukura kusvika paanokwanisa.
2. Kubudirira kwekuchinjana kwegasi mumapapu
Mumamiriro ezvinhu akaita seARDS, pane kusawirirana pakati pehuwandu hwemhepo inopinda mumapapu (kufema) nehuwandu hweokisijeni iri kupinda muropa (kuyerera kweropa). Mumunhu ane hutano, maitiro maviri aya anonyatsoenderana.
Chero zvatinenge tiri, kumashure kwemapapu edu kunowana ropa rakawanda kupfuura pamberi. Chimbofungidzira zvinoitika kana murwere akatendeudzirwa mudumbu make.
- Zvichienderana nepfungwa yekutanga, makamuri ekunze emapapu akavhurika zvakanaka uye azere nemhepo.
- Chechipiri ndechekuti chikamu chemusana chinozadzwa nemhepo chinewo ropa rakawanda.
Zvichitaurwa zviri nyore, kana paine okisijeni yakawanda, kufamba kweropa kwakanakawo. Zvakafanana nekuendesa zvinhu panzvimbo chaiyo yazvinofanira kuva. Izvi zvinoita kuti kufema kushande zvakanaka.
| Chinzvimbo chemurwere | Chii chinoitika kumapapu? |
|---|---|
| Kurara pasi | Mapapu anomanikidzwa nekuda kwekurema kwemoyo nenhengo dzemuviri. Zvinonetsa kuti mweya usvike kumashure kwemapapu. |
| Kugara kwenguva refu | Mapapu anosunungurwa sezvo huremu hwenhengo dzemuviri huchienda kuchipfuva. Makamuri makuru epamusana emapapu anovhurika zvakanaka uye anozadzwa nemhepo. |
Unoita sei kuti murwere ari muchipatara anzwe zviri nyore?
Ichi chinhu chinorongwa uye chinoitwa nokungwarira. Hazvina kufanana nekungochinja munhu panguva imwe chete. Zvinosanganisira chikwata chevanachiremba, vanamukoti, uye vanachiremba vekufema vachishanda pamwe chete. Izvi ndizvo zvinowanzoitika:
- Kutanga, machubhu ese newaya dzakabatana nemurwere (semuenzaniso, machubhu emunyu, machubhu ekufema, waya dzeECG) zvinonyatsorongwa kuitira kuti zvisasununguke kana kupwanyika.
- Chiremba wekufema anobata zvakanaka chubhu ye endotracheal mumusoro nemumuromo memurwere.
- Zvadaro vamwe vese vechikwata vanogadzirira murwere nekuisa jira pasi pemurwere, vachiisa mapiro nerimwe jira pamusoro pemurwere.
- Zvadaro, munhu wese pamwe chete, panguva imwe chete, zvichienderana nechiratidzo chakapihwa, anotendeudza murwere kurutivi rumwe rwemubhedha, ozoenda kune rumwe rutivi.
- Panguva iyi, tinoongororazve kuti mapaipi ese newaya zviri munzvimbo yazvo.
- Pakupedzisira, murwere anotendeudzirwa padumbu rake rose oiswa zvakanaka pamapiro aakamboiswa. Mapiro anoiswawo kuti musoro nemutsipa zvive zvakanaka.
Izvi zvinogona kusiyana zvishoma kubva kuchipatara kuenda kuchipatara, uye dzimwe nguva michina yakakosha inoshandiswa pachinangwa ichi.
Ndinofanira kuichengeta yakadaro kwenguva yakareba sei?
Mwero weokisijeni wevamwe varwere unotanga kuvandudzika muawa imwe chete. Zvisinei, kuti vave nechokwadi chekuti murwere anowana zviri nani, vanachiremba vanowanzo chengeta murwere akakotama kwemaawa gumi nemaviri kusvika gumi nemasere panguva imwe chete . Kana mamiriro emurwere akavandudzika, vanomuchengeta ari panzvimbo iyi kwemaawa gumi nematanhatu pazuva, vozodzokera panzvimbo yake yekurara kwenguva yakati rebei.
Ndezvipi njodzi uye mabhenefiti ekushandisa proning?
Kufanana nechero nzira yekurapa, kuchekerera ganda kune dzimwe njodzi, asi mabhenefiti acho anopfuura njodzi idzodzo.
| Mabhenefiti | Njodzi |
|---|---|
| Zvinonyanya kunatsiridza mwero weokisijeni muropa. | Kubuda kwechubhu ye endotracheal netsaona pakutenderedza murwere. |
| Zvinoita kuti zvive nyore kuburitsa zvinhu zvakaita semanyoka mumapapu. | Catheter yemutsinga yakaburitswa inoburitsa saline. |
| Inovhura mitsipa yeropa mumapapu uye inovandudza mashandiro emoyo. | Kuva nematambudziko eBP kana kurova kwemoyo. |
| Inowedzera kugona kubvisa nekukurumidza kubva muchina wekufema. | Kuvharika kwenzira yekufema. |
| Zvakaratidzwa kuti zvinoderedza kufa kwevarwere vane ARDS dzakakomba. | Mikana yekuva nemaronda ekumanikidzwa paganda. |
Kuti vaderedze njodzi idzi, vanachiremba nevashandi vekuchengeta varwere vanoshanda pamwe chete sechikwata nenzira yakarongwa zvakanyanya. Njodzi iyi yakaderera zvikuru, kunyanya muzvipatara zvine ruzivo mune izvi.
Chii chinonzi 'Awake Proning'?
Ungave wakambonzwawo nezveizvi. Kumuka uchimira padivi inzira yekuraira murwere anoziva asina kubatana nemuchina wekufema kuti azvitenderedze padumbu rake. Izvi zvinoitwa muzviitiko zvisina kunyanya kuoma, nechinangwa chekudzivirira kudiwa kwemuchina wekufema.
Asi izvi zvakakosha zvikuru. Izvi hazvisi zvinhu zvaunogona kuita wega. Unofanira kuzviita chete kana chiremba wako anyatsoongorora mamiriro emurwere uye akakurudzira kuti zviitwe. Kunyangwe zvakadaro, vashandi vekurapa vachakubatsira kudzidza nzira yekupinda munzvimbo iyoyo zvakachengeteka.
Kuona mudiwa ari muchipatara, kunyanya mukamuri rekutarisirwa zvakanyanya, ari mumamiriro ezvinhu akaomarara inyaya inotyisa uye inoshungurudza. Newaya dzese, machubhu, uye michina yekubhejera, zvinogona kunetsa. Tinogona kusanzwisisa zvimwe zvezvinhu zvinoitwa navanachiremba. Kurembera ndechimwe chezvinhu zvakakosha zvinoshandiswa navanachiremba kuponesa hupenyu hwemurwere. Kunyange hazvo isiri nzira dzese dzekurapa dzinoshanda 100%, tsvakiridzo yakaratidza kuti kurembera inzira yakanaka yekuponesa hupenyu hwevarwere vane zvirwere zvakakomba zvekufema uye kukurumidzisa kupora kwavo.
Mharidzo Yekuenda Nayo Kumba
- Kucheuka kwemusoro inzira yekudzosera murwere ane chirwere chekufema chakanyanya mudumbu rake kuti awedzere huwandu hweokisijeni mumuviri.
- Izvi zvinonyanya kushandiswa pazvirwere zvakakomba zvakaita seARDS, kunyanya kuvarwere vari pamuchina wekufema.
- Inoshanda nekuderedza kumanikidzwa kwemapapu uye kupa ropa rakanaka kunzvimbo inopinda mweya.
- Kuchekerera chiuno inzira yakarongwa uye yakanyatsorongwa inoitirwa muchipatara nechikwata chevanachiremba chakadzidziswa.
- Pasinei nenjodzi dziripo, kuchembera kwakaratidzwa kuti kunobatsira zvikuru kuderedza huwandu hwekufa kwevarwere muzviitiko zvakakomba.
- Usamboedza "Kumuka" uri kumba kana muchipatara usina kupiwa mazano nachiremba. Gara uchibvunza chiremba wako.
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