Ingabe nawe uzizwa wesaba kancane uma unikezwa umuthi wokubulala izinzwa wendawo? Ake sixoxe nge-LAST (Local Anesthetic Systemic Toxicity)!

Wake wathatha umuthi wokubulala izinzwa wendawo ukuze ukhiphe izinyo, uthunge inxeba, noma uhlinzwe kancane? Bese uzizwa ungezwakali futhi kungenzeki lutho? Kungase kuzwakale kungavamile, kodwa lo muthi wokubulala izinzwa uyinto ebaluleke kakhulu kwezokwelapha. Kodwa-ke, akuvamile kakhulu, okungukuthi, akuvamile kakhulu, lo muthi wokubulala izinzwa ungadala inkinga encane emzimbeni wethu. Yilokho esikubiza ngokuthi i-Local Anesthetic Systemic Toxicity , noma i-LAST . Ungakhathazeki, lokhu akuvamile kakhulu. Kodwa kuhle ukwazi okuncane ngalokhu.

Ngakho-ke kuyini i-LAST (Local Anesthetic Systemic Toxicity)?

Kalula nje, OKUGCINA umphumela lapho umuthi udliwa, onayo ezinhlelweni zomzimba wethu, ikakhulukazi i-Central Nervous System (CNS), okuyingqondo nomgogodla, kanye ne-Cardiovascular System, okuyinhliziyo nemithambo yegazi.

Cabanga ngendlela ama-painkiller asebenza ngayo. Avimba okwesikhashana imizwa (izinzwa ezingaphandle) engxenyeni ethile yomzimba wethu. Bese leyo mizwa iyeka ukuthumela imizwa efana nobuhlungu nokuthinta ebuchosheni. Yingakho sizizwa sengathi sithuthumela kuleyo ndawo. La ma-painkiller eza ngesimo semijovo, ama-gel, kanye nama-spray.

Ngakho-ke, i-LAST yenzeka ngemizuzu embalwa ngemva kokujova umuthi wokubulala izinhlungu. Kodwa ingxenye engcono kakhulu ukuthi, kukhona ukwelashwa kwalokhu. Uma udokotela wakho ebona lezi zimpawu, uzothatha isinyathelo ngokushesha.

Yiziphi izimpawu ze-LAST? Sizibona kanjani?

I-LAST ithinta kakhulu uhlelo lwethu lwezinzwa oluphakathi (i-CNS). Izimpawu zokuqala zingaba:

Izimpawu ezihlobene nesistimu yezinzwa ephakathi (i-CNS):

• Ukuquleka: Lolu uphawu oluvame kakhulu. Kukhona ukuquleka okungazelelwe kanye nokulahlekelwa ukwazi.
• Ukuphazamiseka noma ukudideka: Ukungakwazi ukuhlala unganyakazi, ukungakwazi ukugxilisa ingqondo, nokungaqondi okwenzekayo.
• Ukushintsha kwendlebe: Ukukhala okuqhubekayo ezindlebeni (i-Tinnitus) .
• Ukuba ndindindi okuzungeze umlomo wakho: Ukuba ndindindi okuzungeze umlomo wakho, njengalapho udokotela wamazinyo efaka umuthi.
• Ukunambitheka kwensimbi emlonyeni wakho: Kunambitheka njengengcezu yensimbi emlonyeni wakho.
• Inkulumo engacacile (i-Dysarthria): Amagama ayangacacile futhi kuba nzima ukukhuluma ngokucacile.
• Ukuphupha izinto ezingekho: Ukubona noma ukuzwa izinto ezingekho ngempela.
• Ukungahambi kahle kokunyakaza kwamehlo: Amehlo ahamba ngokungalawuleki, ebonakala sengathi ahamba kusukela kolunye uhlangothi kuya kolunye.

Izimpawu ezihlobene nesistimu yenhliziyo:

ISIMO SOKUGCINA singathinta nezinhliziyo zethu. Ngemuva kwalokho kungase kuvele izimpawu ezinjengalezi:

• Umfutho wegazi ophansi:Ingcindezi iyancipha.
• Izinguquko ekushayeni kwenhliziyo: Isilinganiso senhliziyo singase sibe sincane kakhulu (i-Bradycardia) , sisheshe kakhulu (i-Tachycardia) , noma izigqi zenhliziyo ezingajwayelekile (i-Arrhythmias) .
• Ukuphefumula kanzima (Dyspnea): Ubunzima bokuphefumula, ukuphefumula kanzima.
• Ukuma kwenhliziyo: Ukuphela kokusebenza kukagesi kwenhliziyo ngokuzumayo. Lokhu kungabangelwa ukulahlekelwa ngokuphelele komsebenzi kagesi enhliziyweni (i-asystole) , noma ukushaya kwamaseli enhliziyo ngokushesha okukhulu nangokungajwayelekile (i-ventricular fibrillation) .

Okubalulekile: Uma kungelashwa ngokushesha, i-LAST ingaholela ekumisweni kokuphefumula noma ekukhomeni .

Lezi zimpawu zivame ukuvela zingakapheli imizuzu emihlanu uphuze umuthi wokuqeda izinhlungu. Ngezinye izikhathi lezi zimpawu zingaqala kancane kakhulu futhi zikhule kancane kancane, noma zingaba zimbi ngokuzumayo. Yingakho odokotela bezokuqapha eduze ngemva kokukunikeza umuthi wokuqeda izinhlungu, ikakhulukazi uma usengozini enkulu yokuthola isifo SOKUGCINA.

Kungani lokhu kwenzeka KOKUGCINA? Yiziphi izizathu?

Imbangela eyinhloko ye-LAST ukujova ngengozi umuthi wokubulala izinhlungu emthanjeni wegazi. Cabanga ngakho, umuthi wokubulala izinhlungu kufanele ujovwe eduze komthambo wegazi. Kodwa ngezinye izikhathi uma ungena emthanjeni wegazi, umuthi ungasakazeka ngokushesha emzimbeni wonke futhi ubangele lesi simo.

Kubikwa ukuthi ingozi yokuthi kwenzeke i-LAST lapho kwenziwa ama-nerve blocks aqeda amandla emilenzeni icishe ibe ngu-20%. Kodwa-ke, akusikho konke lokhu:

• I-LAST iphinde yathuthukiswa njengomuthi osetshenziswa esikhumbeni ngesimo sejeli .
• I-LAST ibangelwa futhi yimithi ecasula ulwelwesi lwamafinyila lomlomo, umphimbo, kanye nemigudu yokuphefumula .

Lokhu kusho ukuthi i-LAST ingenzeka kungakhathaliseki ukuthi uyisebenzisa kanjani i-painkiller. Kodwa-ke, ezinye izici zandisa le ngozi.

Ubani osengozini enkulu yokuthola isifo sokugcina? (Izici Eziyingozi)

Izinto ezithile ezihlobene nesimo sakho sempilo zingase zandise ingozi yakho yokuba nomdlavuza WOKUGCINA.

Izici eziyingozi ezihlobene nempilo yakho:

• I-Metabolic acidosis: Lapho ibhalansi yamakhemikhali emzimbeni ishintsha futhi i-acidity iyanda.
• Amazinga aphansi omoya-mpilo emzimbeni (i-Hypoxia): Lapho inani lomoya-mpilo egazini lehla.
• Isifo senhliziyo esivele sikhona: Ikakhulukazi labo abanezimo ezifana ne -ischemia , i-arrhythmias , ukungasebenzi kahle kokuhamba kwegazi , kanye nengxenye ephansi yokukhipha igazi .
• Abantu abangaphezu kweminyaka engama-65 ubudala:Futhi, izingane ezingaphansi kwezinyanga ezine ubudala zisengozini enkulu yokukhula NGOKUGCINA.
• Isifo sesibindi noma sezinso: Abantu abanalezi zimo bangase baphuze kakhulu NGOKUGCINA ngoba kuthatha isikhathi eside ukuthi umuthi uphume emzimbeni.
• Ukukhulelwa.
• Izifo ze-Mitochondria: Lezi yizifo ezithinta izingxenye zamaseli ethu ezikhiqiza amandla ezibizwa ngokuthi i-mitochondria.

Izici zengozi ezihlobene nomuthi we-Hiri:

Eminye imithi yokubulala izinzwa, njenge -bupivacaine , inamathuba amaningi okubangela i-LAST kuneminye. Futhi, ingozi iyanda uma imithi yokubulala izinzwa inikezwa ngemithamo ephezulu .

Izici zengozi ezihlobene nendlela yokwelapha ngomlomo:

Ezinye izindlela zokunikeza imithi yokubulala izinhlungu zingase zandise nengozi ye-LAST. Ucwaningo olwenziwe emacaleni angu-125 e-LAST luthole:

• Amasu okungena emzimbeni yizindlela lapho umuthi ufakwa khona ngaphansi kwesikhumba. Lokhu kubalelwa cishe ku-20% wezimo ZOKUGCINA.
• Ama-central neuraxial blocks, njenge -epidural kanye ne-caudal blocks, anikezwa umgogodla. Angaba ngu-15% wazo zonke izimo ezibikiwe.
• Cishe ama-13% abikwe ngenxa yokufakwa okuqhubekayo kwemithi yobuhlungu, njenge-saline .

Okokugcina, i-LAST ingenzeka kakhulu uma kufakwa imithi yokubulala izinzwa ezindaweni ezinemithambo yegazi ephezulu . Isibonelo, amacala e-LAST avame ukubikwa lapho kwenziwa amabhlogo ezinzwa zepenile .

Odokotela baxilonga kanjani i-LAST? (Ukuxilongwa)

Odokotela baxilonga i-LAST ngokusekelwe ezimpawini zakho. Ngenxa yokuthi i-LAST iyisimo esiphuthumayo esidinga ukwelashwa okusheshayo, ukuxilongwa akukwazi ukulibaziseka. Akuvamile kakhulu, udokotela wakho angase akucele i-EKG (electrocardiogram) ukuqinisekisa lokhu.

Yiziphi izindlela zokwelapha ze-LAST?

Ubuthi Besistimu Yendawo Yokubulala Izinzwa buyisimo esiphuthumayo sezokwelapha. Ngakho-ke, odokotela bazoqala ukwelashwa ngokushesha okukhulu. Ukwelashwa okuvamile kungokulandelayo:

• Ukuphathwa komoya: Ukwelashwa nge-oxygen kunikezwa ngokushesha ukuze kugcinwe ukuphefumula kwakho, futhi kunikezwa umoya uma kudingeka.
• Ukuvimbela noma ukwelashwa kokuquleka: Lokhu kuhilela ukunikeza imithi efana ne -benzodiazepines .
• Ukufakwa kwe-lipid emulsion nge-IV: Lona umuthi okhethekile ofakwa emthanjeni . Usebenza ngokumunca ama-painkiller egazini nasezicutshini. Lokhu kunciphisa ukugcwala kwama-painkiller afinyelela ebuchosheni nasenhliziyweni.
• I-CPR (Ukuvuselelwa Kwenhliziyo Nemiphunga):Uma i-LAST ithinta ukusebenza kwenhliziyo, odokotela benza i-CPR futhi basebenzisa ezinye izindlela zokuzinzisa inhliziyo.

Ngemva kokwelashwa, uzogcinwa ngaphansi kokubhekwa ngudokotela okungenani amahora ayisithupha ukuze kuhlolwe ukuthi ukwelashwa kuphumelele yini nokuthi kukhona yini ezinye izinkinga.

Kuzokwenzekani kumuntu onesifo sokugcina? (Isibikezelo)

Labo abaxilongwa futhi belashwe kusenesikhathi bavame ukuba nomphumela ongcono. Ukwelashwa kungaguqula kakhulu isimo se-LAST.

Kodwa-ke, uma i-LAST enzima ingelashwa ngokushesha, ingaholela e-coma noma ngisho nasekufeni. Kodwa-ke, lokhu akuvamile kakhulu. Isibonelo, ngokusho kwedatha evela ezikhungweni zokulawula ubuthi e-United States, kwakunabantu abane kuphela ababulawa yimithi yokubulala izinhlungu ngo-2016.

Ingabe i-LAST ingavinjelwa?

I-LAST ayinakuvinjelwa njalo, kodwa odokotela basebenzisa izindlela neziqondiso ezithile ukunciphisa le ngozi.

Isibonelo, udokotela wakho uzosebenzisa umthamo ophansi kakhulu wemithi yobuhlungu edingekayo . Futhi, ngezinye izikhathi bazosebenzisa izithombe ze-ultrasound ukuze banikeze umjovo, ukuqinisekisa ukuthi awungeni ngengozi emthanjeni wegazi.

Uma unezici eziyingozi zokuthi ube ne-LAST, udokotela wakho uzocabangela ngokucophelela imithi yobuhlungu ephephile, umthamo, kanye nendlela yokuphatha.

Uma uyothola umuthi wokuqeda izinhlungu, cishe awucabangi kakhulu nge-LAST. Cishe ukhathazeka kakhulu ngokuthi umjovo uzoba buhlungu noma uzozizwa ungenamizwa kakhulu. Lokho kuvamile, ngoba i-LAST ayivamile. Kodwa khumbula, udokotela wakho uzokunakekela kahle ngemva kokukunikeza umuthi wokuqeda izinhlungu. Uma uba nezimpawu ze-LAST, zizosebenza ngokushesha.

Ekugcineni, umyalezo okufanele uwuthathe uye ekhaya:

Uma unemibuzo, ukukhathazeka, noma ukungabaza mayelana ne-anesthesia yakho, ungangabazi ukubuza udokotela wakho. Bakhona ukukusiza. I-Local Anesthesia Systemic Toxicity (LAST) ayiyona into okufanele uyesabe, njengoba ingavamile kakhulu futhi inezindlela zokwelapha ezinhle. Into ebaluleke kakhulu ukuqaphela lokhu futhi ukhulume ngokukhululekile nodokotela wakho. Ngemuva kwalokho ungabhekana nanoma yikuphi ukwelashwa ngokuthula kwengqondo.

` I-Anesthetic Yasendaweni Ubuthi Besistimu, I-LAST, ubuthi be-anesthetic, imiphumela emibi ye-anesthetic, uhlelo lwezinzwa, uhlelo lwenhliziyo, izimpawu, ukwelashwa