Ngaba amalungu amaninzi emzimbeni wakho ayasilela ngaxeshanye? Masithethe ngale meko ibizwa ngokuba yiMultiple Organ Dysfunction Syndrome (MODS)!

Mhlawumbi ukhe weva ukuba xa umntu egula kakhulu ngequbuliso aze abe kwiyunithi yokhathalelo olunzulu (ICU) yesibhedlele, bathi, "Oogqirha bathi ezinye iindawo zomzimba wakhe azisebenzi kakuhle." Okanye, "Bagcinwa bephila ngoomatshini." Enyanisweni, ngelo xesha, loo mntu usenokuba nemeko embi kakhulu. Kwizonyango, sibiza le Multiple Organ Dysfunction Syndrome, okanye ngesiNgesi, ``Multiple Organ Dysfunction Syndrome - MODS.'' Eli gama livakala liyoyikisa kancinci, kodwa masithethe ngento eyenzeka ngayo, isizathu sokuba yenzeka, nendlela yokusinda ngendlela elula onokuyiqonda.

Yintoni kanye kanye iMODS?

Ngamafutshane, i-MODS yimeko yezonyango engxamisekileyo (eqatha) kakhulu . Okwenzekayo koku kukuba ezimbini okanye ngaphezulu zeenkqubo zomzimba wethu ezidibeneyo ziyeka ukusebenza kakuhle ngequbuliso. Cinga ngako, imizimba yethu ineenkqubo ezininzi ezifana nenkqubo yokuphefumla, inkqubo yokugaya ukutya, kunye nenkqubo yomchamo. Ezi zisebenza kunye ukusigcina siphilile. Xa i-MODS isenzeka, ezi nkqubo zomzimba azinakusebenza zodwa. Emva koko kufuneka izixhobo zokuxhasa ubomi ('inkxaso yobomi') ukuze zenze umsebenzi waloo malungu.

I-MODS inokuchaphazela naliphi na ilungu emzimbeni, kodwa ezona zixhaphakileyo zezi:

• Imiphunga
• Intliziyo
• Ingqondo
• Izintso
• Isibindi
• Igazi (igazi)

I-MODS inokuba nezizathu ezininzi. Eyona nto ixhaphakileyo lusulelo olunzima (i-sepsis) . Xa benyanga i-MODS, oogqirha baqala bazama ukulawula imeko ebangela le meko. Bakwathatha amanyathelo okuthintela umonakalo kwezinye iinkqubo zomzimba.

I-MODS yimeko yezonyango eyingozi kakhulu . Inokuba yingozi ukuba ayinyangwa ngokukhawuleza. Abantu abaninzi abane-MODS bangeniswa kwigumbi lonyango oluphezulu (ICU) kwaye bafuna ukubekwa esweni rhoqo kunye nenkxaso yobomi.

Le meko ibizwa ngamanye amagama aliqela, kuquka:

• Ukungasebenzi kakuhle kwamalungu amaninzi
• Ukusilela kwenkqubo yezitho ezininzi

Zeziphi iinkqubo zomzimba ezinokuchaphazeleka yiMODS?

I-MODS inokuchaphazela ezimbini okanye ngaphezulu kwezi nkqubo zomzimba zilandelayo:

1. Inkqubo yokuphefumla (imiphunga)

Xa imiphunga yethu ingakwazi ukunika umzimba umlinganiselo weoksijini oyidingayo, oko kuthetha ukuba izicubu zomzimba azifumani oksijini eyaneleyo (i-hypoxia) okanye umzimba awufumani i-carbon dioxide eyaneleyo (i-CO2) (i-hypercapnia), sikubiza ngokuba kukusilela kokuphefumla. Kwi-MODS, unobunzima bokuphefumla kwaye usenokufuna nomoya womoya ukuze ukuncede uphefumle. Umonakalo omkhulu wamaphaphu kwi-MODS yi -Acute Respiratory Distress Syndrome (ARDS).Kule meko ye-ARDS, imiphunga iyaqina, nto leyo eyenza kube nzima kakhulu ukugcina amanqanaba e-oksijini aqhelekileyo egazini.

2. Inkqubo yentliziyo (intliziyo)

Inkqubo yethu yentliziyo yiyo epompa igazi emzimbeni wonke. Ukusilela kwentliziyo kunye noxinzelelo lokujikeleza kwegazi ziimeko apho izihlunu zentliziyo ziba buthathaka okanye ziqine, zithintele ekupompeni igazi elaneleyo emzimbeni wonke. Ukuvuvukala okugqithisileyo okwenzeka nge-MODS kunokubangela ukuba imithambo yegazi ikhule, kunciphisa inani legazi elifikelela kwizicwili nakwizitho zomzimba. Oku kunokukhokelela kuxinzelelo lwegazi oluphantsi (uxinzelelo lwegazi oluphantsi okanye uloyiko) kwi-MODS. Ulwelo lunokuvuza kule mithambo yegazi, lubangele ukudumba (i-edema).

3. Inkqubo yegazi (igazi)

I-MODS inokubangela ukungalingani kwiiproteni ezithile egazini. Oku kunokubangela iingxaki zokopha kunye nokugabha igazi . Ungaphawula ukukrweleka eluswini okanye ukopha ngaphakathi esiswini sakho. Eyona ngxaki inzima enokuchaphazela inkqubo yakho yegazi yi -Disseminated Intravascular Coagulation (DIC) . Kule meko, igazi lingaqala ukuvuza kwii-catheters okanye kwiityhubhu eluswini lwakho.

4. Inkqubo yemithambo-luvo (ubuchopho)

Ingqondo yethu sisitho esibalulekileyo esilawula yonke inkqubo emzimbeni. Xa inxalenye okanye yonke ingqondo iyeka ukusebenza ngenxa yomonakalo kwingqondo okanye kwezinye iindawo zenkqubo yemithambo-luvo ephakathi (kuquka umqolo kunye nemithambo-luvo enxulumene nayo), sikubiza ngokuba yi-'neurological failure'. Kwi-MODS, ukudumba, ukujiya kwegazi ngenxa yeengxaki zenkqubo yegazi, kunye noxinzelelo lwegazi oluphantsi kunokunciphisa inani legazi elihamba liye engqondweni. Oku kungonakalisa ingqondo kwaye kubangele ukudideka ('delirium') .

5. Inkqubo yezintso (izintso)

Ukungasebenzi kakuhle kwezintso kuxa izintso zingakwazi ukwenza eminye okanye yonke imisebenzi yazo, kuquka nokucoca inkunkuma egazini. Inkqubo yezintso ihluza igazi lethu, yenza umchamo, kwaye isusa ulwelo olungafunekiyo emzimbeni. KwiMODS, le nkqubo inokuphazamiseka.

6. Inkqubo yesibindi (isibindi)

Ukungasebenzi kakuhle kwesibindi kuxa isibindi singakwazi ukwenza eminye okanye yonke imisebenzi yaso emininzi, njengokususa iityhefu egazini, ukucoca iiseli ezibomvu zegazi ezindala, kunye nokuvelisa i-bile (i-asidi etyheli/eluhlaza enceda ekugayeni ukutya). Ukudumba kunye nokuncipha kokuhamba kwegazi esibindini kunokubangela ukuba isibindi singaphumeleli. Oku kunokubangela ukuba ulusu kunye/okanye amehlo ajike abe tyheli (i-jaundice). Ukungasebenzi kakuhle kwesibindi kunokubangela ukuba amanye amalungu omzimba angaphumeleli.

Ixhaphake kangakanani iMODS?

I-MODS yimeko eqhelekileyo ebonwa kwizifo ezibukhali neziqatha. Izifundo zibonisa ukuba phakathi kwama-28% nama-88% ezigulana ezikwiiyunithi zokhathalelo oluphezulu zinokuba ne-MODS. Ikwangunobangela ophambili wokufa kwiiyunithi zokhathalelo oluphezulu (ii-ICU).

Ziziphi iimpawu zokuqala zeMODS?

Ngenxa yokuba i-MODS inokuchaphazela naliphi na ilungu emzimbeni, iimpawu zixhomekeke kwilungu elichaphazelekileyo. Ezi mpawu zinokuba buthathaka kwizigaba zokuqala zesifo esibangela i-MODS, okanye zinokuba nzima kakhulu . Njengoko i-MODS iqhubeka ukusuka kwisifo esiqatha, unokufumana oku kulandelayo:

• Isicaphucaphu nokuhlanza
• Umnqweno wokutya
• Ukuziva ubuthathaka kakhulu okanye udiniwe
• Ifiva
• Ukuphola
• Ukudideka okanye ubunzima bokugxila
• Ukuphefumla ngokukhawuleza, okungenzulu
• Ukubetha kwentliziyo okukhawulezayo okanye okungaqhelekanga
• Intlungu yesifuba kunye/okanye yesisu ende
• Ukudumba kwesisu
• Ukudumba kwamalungu
• Ukutyheli kolusu okanye amehlo (i-jaundice)
• Ukutshintsha kombala wesikhumba, imilebe, ulwimi, iintsini, iinzipho, okanye amehlo okwesibhakabhaka okanye ngwevu/mhlophe (cyanosis)
• Ukulahlekelwa yingqondo

Yintoni ebangela iiMODS?

I-MODS inokubangelwa nasiphi na isifo esikhulu, ukwenzakala, okanye usulelo. Oogqirha nabaphandi abakayazi eyona nto ibangela i-MODS. Nangona kunjalo, uphando lwangoku lubonisa ukuba ukudumba kunye nokuncipha kokunikezelwa kwegazi kudla ngokuba yimbangela ye-MODS. I-MODS ayibangelwa yimeko enye yezonyango engaphantsi. Ivela kuthotho lweziganeko ezichaphazela uninzi okanye zonke iinkqubo zomzimba. Ukuncipha kokunikezelwa kwegazi kunye neoksijini kunokukhokelela kumonakalo.

Khawucinge nje, kwisifo esinzima, kunokubakho iziganeko ezininzi ezikhokelela kwi-MODS.

1. Isiganeko esiphambili: Esi sisizathu sokuqala. Umzekelo, usulelo olunzima (i-sepsis), ingozi enkulu (njengengozi yemoto), okanye ukuhlaselwa yintliziyo okukhulu.

2. Isiganeko sesibini: Oku kwenzeka xa inkqubo yakho yokuzikhusela komzimba isabela ngokugqithisileyo, nto leyo ebangela ukudumba okukhulu emzimbeni wonke.

3. Isiganeko sesithathu: Ukuba ufumana usulelo olutsha, okanye kufuneka wenze utyando ukuze kunyangwe imeko yokuqala, eso sisenokuba sisiganeko sesithathu.

Ezinye zezizathu eziqhelekileyo zeMODS zezi:

• I-Sepsis okanye i-septic shock: Oku kungaba kukudumba okukhulu okubangelwa lusulelo olukhulu lwebhaktiriya okanye lwentsholongwane.
• Ukwenzakala okubuhlungu: Izinto ezifana nengozi yemoto, ukutsha kakhulu, ukuhlatywa, okanye ukudutyulwa.
• I-Pancreatitis: Ukudumba kwe-pancreas. Oku kunokubangelwa ngamatye enyongo, ukusela utywala kakhulu, amayeza athile, kunye nezinye izinto.
• Uhlaselo olukhulu lwentliziyo: Lubangelwa kukuvaleka komthambo wegazi ohambisa igazi entliziyweni.
• Ukungasebenzi kakuhle kwesibindi: Oku kunokubangelwa yiHepatitis B, iHepatitis C, isifo sesibindi esinamafutha, ukusetyenziswa kakhulu kotywala, kunye ne-cirrhosis.
• Ukulimala okunobuthi kunye netyhefu:Ibangelwa kukuvezwa ziityhefu. Umzekelo, ukusetyenziswa kweziyobisi okanye utywala ngokukhawuleza okanye ngokungapheliyo, iikhemikhali ezinobungozi ezifana nezibulali zinambuzane kunye nezinto zokukhusela ezindala (i-asbestos), kunye nosulelo lweebhaktheriya.

Ezi meko zibangela utshintsho olukhulu kwinkqubo yakho yokuzikhusela komzimba kunye nenkqubo yegazi, nto leyo echaphazela nezinye izitho zomzimba.

Ngowuphi umzimba oqala ukungaphumeleli kwiMODS?

Phantse wonke umntu one-MODS ufumana iingxaki zemiphunga kuqala , kodwa oogqirha nabaphandi abakaqondi kakuhle ukuba kutheni ukungasebenzi kakuhle kwemiphunga kwenzeka ngaphambi kwe-MODS.

Ngubani ochaphazeleka kakhulu yiMODS?

Nabani na unokuba ne-MODS, kodwa unamathuba amaninzi okuba ne-MODS ukuba unesifo esingabonakaliyo, esifana nesifo esingapheliyo okanye ukungakwazi ukuzikhusela komzimba.

Ungazichonga njani iiMODS?

Oogqirha basebenzisa iintlobo ngeentlobo zovavanyo ukuze babone ukungasebenzi kakuhle kwamalungu omzimba wakho. Ezi zingabandakanya:

• Uvavanyo lwegazi
• Uvavanyo lwegesi yegazi lwe-arterial
• Uvavanyo lokusebenza kwesibindi
• Uvavanyo lokusebenza kwezintso
• Iinkcubeko zegazi kunye nezicubu
• I-Echocardiogram (i-ultrasound yentliziyo)
• Uvavanyo lwemifanekiso olufana ne-ultrasound okanye i-CT scan

Iphathwa njani iMODS?

Unyango lwe-MODS luxhomekeke kwisizathu esiyintloko kunye neenkqubo zomzimba ezichaphazelekayo. Ezinye iindlela zonyango ziquka:

• Nyanga umlinganiselo wegazi ophantsi ngokunika ulwelo olufakwa kwimithambo yegazi (IV) .
• Ukunika amayeza okunciphisa imithambo yegazi ukuze kwandiswe ukuhamba kwegazi ngemithambo yegazi kunye nezicubu (ukutyibilika kwezicubu).
• Nika amayeza okubulala iintsholongwane ukunyanga izifo kunye/okanye i-sepsis.
• Utofelo-gazi oluthatha indawo yegazi elilahlekileyo ngenxa yokwenzakala okanye utyando.
• Unyango lweoksijini ukuze umzimba ufumane ioksijini engaphezulu.
• Ukuba awukwazi ukuphefumla wedwa, unokufuna umoya ongeniswa ngomatshini ukuze ukuncede uphefumle.
• I-Dialysis inceda ekususeni inkunkuma kunye nolwelo olugqithisileyo emzimbeni wakho.
• I-oxygenation ye-extracorporeal membrane (ECMO) yokongeza i-oxygen egazini kunye nokususa i-carbon dioxide.
• Inkqubo yokujikeleza kwegazi efunxa iimolekyuli (i-MARS) yokuxhasa isibindi.
• Utyando lwezigulane ezonzakele kakhulu.
• Utyando lokufakelwa amalungu omzimba kukutshintshwa kwesitho esigulayo okanye esingasebenzi kakuhle ngesitho esiphilileyo esivela kumntu onikelayo.
• Ukuba unesifo sokopha esiswini (GI) okanye imeko yesisu ekuthintelayo ekutyeni, okanye ukuba awukwazi ukutya ngokwasemzimbeni, unokufuna ukufumana izondlo nge-IV (intravenous) okanye i-enteral nutrition (parenteral nutrition).

Ndiza kuziva ngcono ngokukhawuleza kangakanani emva konyango?

Ukuchacha kwakho kuya kuxhomekeka kwisizathu esiyintloko kunye nonyango. Ugqirha angakunika umbono ongcono wokuba ungalindela nini ukubona utshintsho emva konyango.

Liyintoni ikamva leMODS?

Ikamva leMODS lixhomekeke kwisizathu esiyintloko. Ngamanye amaxesha ezinye okanye zonke iimvakalelo zakho zinokubuyela esiqhelweni, kodwa unokufuna inkxaso yobomi bexeshana de uphile.

Ukuchongwa kwangethuba kunye nonyango lweMODS kunye nesizathu sayo esiyintloko kubalulekile ekulawuleni ngempumelelo le meko.

Ingqikelelo ye-MODS iyahluka kwiiyunithi zokhathalelo olunzulu (ii-ICU). Oogqirha bacinga ukuba le meko yimbangela eqhelekileyo yokufa kwizigulane ezifakwe kwiiyunithi zokhathalelo olunzulu ngotyando.

Ukuba isifo siqhubeka sisiya kwinqanaba elibi kakhulu, umonakalo osisigxina kwisitho somzimba unokwenzeka. Ungadinga inkxaso yobomi bakho bonke okanye ukufakelwa isitho somzimba. Sinokuba yingozi.

Kufuneka uphando olongezelelekileyo ukuze kuchongwe izinto ezinokubangela ukuba kubekho iingxaki ezinokuthi zichaphazele iMODS, nto leyo enokubangela ikamva elingcono kwizigulana.

Ingakanani izinga lokusinda kwiMODS?

Oogqirha nabaphandi baqikelela ukuba izinga lokusinda kwi-MODS liphakathi kwe-50% kunye ne-60% .

Ngaba iiMODS zingathintelwa?

Ezinye zezinto ezibangela iMODS azinakuthintelwa. Okwangoku akukho nyango luthile olunokunceda ukuthintela iiMODS. Abaphandi bebekhangela iindlela zokunyanga iiMODS kwisigaba sazo sokuqala ukuthintela ukuba esi sifo singabi mandundu. Izifundo ezininzi ziyaqhubeka okwangoku kweli candelo.

Unokunceda ekukhuseleni amalungu akho omzimba ngokwenza izinto ezinje:

• Khusela amalungu akho omzimba ekoyikeni ngokunxiba amabhanti okhuseleko xa ukhwela imoto kunye nezixhobo zokuzikhusela xa udlala imidlalo echaphazela kakhulu umzimba.
• Gonyelwa ukuthintela usulelo olunzima xa oogqirha becebisa.
• Nciphisa okanye uyeke ukuthatha amayeza angabhalwanga ngugqirha, anjengee -nonsteroidal anti-inflammatory drugs (NSAIDs), ezinokonakalisa izintso.
• Nciphisa okanye uyeke ukuthatha amayeza okanye ezinye izinto ezinokubangela izilonda zesisu, ezifana nee-NSAIDs, ukutshaya, kunye notywala .
• Fumana unyango loxinzelelo lwegazi oluphezulu (uxinzelelo lwegazi oluphezulu) .

Ukuba usesibhedlele unesifo esiqatha, oogqirha bakho banokwenza izinto ezinje ukuthintela iMODS ukuba ingabi mandundu:

• Ukunciphisa umonakalo kwimiphunga yakho ngenxa yomoya ophuma kwimibhobho yoomatshini.
• Nciphisa utofelo-gazi kude kube yimfuneko ngokupheleleyo.
• Ukusebenzisa izinto zokunciphisa igazi ukuba kuyimfuneko ukuthintela ukuqhekeka kwegazi.

Ndifanele ndimbone nini ugqirha?

Ukuba unesifo esingapheliyo kwaye uneempawu zeMODS, ezinokukhokelela ekuguleni okukhulu nasekungasebenzini kakuhle kwamalungu omzimba, kusoloko kuyinto entle ukubona ugqirha. Banokukuxelela ukuba zeziphi iimpawu okanye iimpawu ezithile ekufuneka uziqaphele kunye nendlela yokulawula naziphi na iimeko.

Ndingaya nini kwiSebe leeNgxamiseko (i-ETU) ?

Ukuba uneempawu zeMODS, yiya kwigumbi likaxakeka elikufutshane okanye utsalele umnxeba ku-911. Oku kunokuba yingozi ukuba akunyangelwa ngokukhawuleza.

Yeyiphi imibuzo endifanele ndiyibuze ugqirha?

Nantsi eminye imibuzo ongathanda ukuyibuza ugqirha wakho:

• Yintoni ebangela iiMODS?
• Ziziphi iindlela zonyango endinazo?
• Ngawaphi amayeza owacebisayo?
• Zithini iinjongo zokhathalelo lwam?
• Ndidinga unyango kangaphi?

Isishwankathelo kunye nomyalezo wokugqibela

Kulungile, ngoku uyazi ukuba i-multiple organ dysfunction syndrome (MODS) yimeko enzima echaphazela iinkqubo zomzimba ezimbini okanye ngaphezulu emzimbeni wakho. Nangona i-MODS inokuchaphazela nayiphi na inkqubo yomzimba, idla ngokuchaphazela imiphunga, intliziyo, izintso, isibindi, ubuchopho kunye negazi. Zininzi izizathu ezinokubangela oku. Ezona zixhaphakileyo kukwenzakala okukhulu, ukugula kakhulu, kunye nosulelo olusasazekayo. Unyango lugxile ekunyangeni imeko engaphantsi ngelixa luthintela umonakalo ongakumbi kwezinye iinkqubo zomzimba.

Kuqhelekile ukuba noloyiko xa usiva ukuba amalungu akho okanye omntu omthandayo asebenzi. Kodwa oogqirha kunye nabasebenzi kwiYunithi yoNyango oluNgxamisekileyo (ETU) kunye neYunithi yoKhathalelo oluNzulu (ICU) baqeqeshwe ukuxhasa zonke iinkqubo zamalungu akho, ukuthintela umonakalo ongakumbi, kunye nokunceda umzimba wakho uphile. Ngoko ke musa ukuphelelwa lithemba. Ngonyango olukhawulezileyo kunye neengcebiso zonyango ezifanelekileyo, ungazama ukuphuma kule meko.

Ukusilela kwamalungu amaninzi , iMODS, ukusilela kwamalungu, i-sepsis, unyango olunzulu, ukusilela kwamalungu, inkxaso yobomi