Ukungaphumeleli kweentliziyo ezibangelwa yimonakalo ezintsheni, ezinokuthi zenzeke ngenxa yokulahleka kwegazi, i-toxins okanye ukulimala emzimbeni. Ukungaphumeleli kweengtso ezintle kwenzeka ngokukhawuleza, kubangela iimpawu eziqhelekileyo, ezifana nokulahleka kwesidlo nokudideka. Yimeko enzima, kodwa inokunyangwa, kwaye nangonyango olufanelekileyo, abaninzi abantu banokuphila kwisiqhelo sokungaphumeleli kweengxaki ngaphandle kwexesha elide.
Iimpawu
Iinjongo zibeka esweni isixa samanzi, i-electrolytes kunye nenkunkuma emzimbeni, kwaye ithumela izinto ezigqithisiweyo ukuba zipheliswe kumchamo. Iimpawu zesifo sezintso ezinzima zenzeka ngenxa yokuba ezi zinto ziqokelela emzimbeni xa iinjongo zingasebenzi ngendlela efanele. Amanqanaba aqhelekileyo amanzi kunye ne-electrolyte ayimfuneko ukuba umzimba wonke usebenze ngokufanelekileyo. Izinto zokunkunkuma zinetyhefu kwiininzi zeeseli kunye nezicubu zomzimba, ezibangele iimpawu ezibanzi. Izibonakaliso zokungaphumeleli kweengtso ziphuthuma ngokukhawuleza, ngaphezu kweeyure eziliqela okanye iintsuku.
Iimpawu eziqhelekileyo zokungaphumeleli kweentliziyo ziyiyo:
- Ukungabi namandla kunye nokukhathala: Esi sisiphumo sokungasebenzi kakubi kwamalungu emzimbeni wakho, ongenalo ukuxinwa okufanelekileyo kwe-electrolytes ukuba isebenze njengoko kufanelekile xa unesifo esibi sezintso.
- Ukulahleka kwesidlo, isicupunu kunye nokuhlanza: Le ntliziyo iyenzeka ngenxa yokuba inkqubo yakho yokugaya inyama, efuna i-enzymes yokutya inyama, imisipha, kunye neentsholongwane zikwazi ukusebenza kakuhle, zinganciphisa, zingakwazi ukugcina umsebenzi oqhelekileyo ukuba iinjongo zakho aziyikulawula kakuhle izinto zakho umzimba.
- Ubuthakathaka obunzima bomzimba: Imisipha yakho idinga ukuba i-electrolytes ikwazi ukusebenza, kwaye xa unesifo sokungaphumeleli kwintliziyo, oku kubangela ukuba umsizi usebenze.
- Iintliziyo ezinqambileyo ezikhawulezileyo, ezincinane okanye eziqhelekileyo: Intliziyo yakho ilawulwa yintsholongwane yakho yentliziyo (inhliziyo), encike kwiqela elingu-electrolyte ebalulekileyo ukuze isebenze ngokufanelekileyo. Umzimba wakho uzama ukulondoloza umsebenzi wentliziyo ixesha elide kunokwenzeka. Ukuba umzimba wakho awukwazi ukuhlawulela imiphumo yokungaphumeleli kweentliziyo ezinzima, umsebenzi wakho wentliziyo unokubandezeleka, uvelise izitho zentliziyo ezingavumelekanga. Oku kunokubangela ukungabikho kwegazi elaneleyo kulo lonke umzimba.
- Ukudideka: Isibonakaliso esinzulu sokwehluleka kwesifo sezintso, ukudideka kuthetha ukuba ubuchopho bakho abufumani ngegazi elaneleyo. Ukuba ufumana ukudideka ngenxa yesiphumo esinzima sezintso, unokukhawuleza uqhubekele ekubeni ulahlekelwe yintliziyo okanye i-coma.
- Ukulahlekelwa kwengqondo okanye i-coma: Esi sibonakaliso sithetha ukuba ingqondo ayinakho ukunikezelwa kwegazi okwaneleyo, kwaye inokubangela ukuba umonakalo ongunaphakade ngaphandle kokuba ufumane unyango oluphuthumayo.
Izizathu
Iinjongo zichaphazelekayo kwizinto ezininzi, ezinjengeengcinezelo zegazi, unyango, impilo yonke, ukutya, kunye nomlinganiselo wamanzi umntu aselayo. Kukho iindlela ezahlukeneyo ezinokuthi ukuhluleka kweentso ezinzima kunokwenzeka . Nantoni na eyonakalisa ngokukhawuleza iinjongo ziya kunciphisa inani lomsebenzi abakwaziyo ukwenza. Ukungaphumeleli kweengtso kungasesikhashana okanye nokuba ngumqondiso weengxaki ezinkulu.
Kukho iintlobo ezintathu eziphambili zezimbangela zokungaphumeleli kweengtso. Ixesha elithi renal lichaza iintso, kwaye amagama alezi zigaba yi-prerenal, intrisic ne-postrenal.
I-Prerenal: Oku kuchaza izizathu zesaphulelo sezintso eziqalayo ngaphambi kokuba igazi lifike ezintsheni. Uxinzelelo lwegazi oluphantsi, umzekelo, luya kwenzeka xa intliziyo yakho ingasebenzi kakuhle, okanye ukuba ukhululeka kakhulu.
Kule meko, iintso ngokwazo aziyiyo ingxaki ebalulekileyo, kodwa zichaphazeleka ngokunikezelwa kwegazi ephantsi, okwenza kube nzima ezintsheni ukwenza umsebenzi wokucofa igazi.
Usuleleko olunzulu luya kuqhubela phambili ukutshatyalaliswa kwesohlwayo , imeko enokubangela ukuba intsholongwane echaphazelekayo yingozi ngenxa yokuba uxinzelelo lwegazi luwela kwinqanaba eliphantsi ukuba izintso azikwazi ukusebenza ngokufanelekileyo.
Intrinsic: Oku kuchaza izizathu zeengxaki zokungaphumeleli apho izintso ngokwazo zilimala khona. Iifomsi, kuquka iikhemikhali, iziyobisi ezingekho mthethweni, kunye neminye imithi enqunyiwe, kufuneka zidlule ezintsheni, kwaye ziwonakalise zona.
Imizekelo yamachiza enokubangela ukungaphumeleli kweengxaki zentlungu ziquka izinto ezichaseneyo zokujonga iimvavanyo. Ezi ntloba zonyango azibangela ukuba wonke umntu owathathayo abe nokuhluleka kwe-renal, okanye akukho mntu uya kuzisebenzisa. Kodwa zinokubangela ukungaphumeleli komnxeba omninzi kwabanye abantu, kwaye kunokuba nzima ukuqikelela ukuba ngaba uya kuphendula. Ngamanye amaxesha, unokufuna iimvavanyo zegazi ezilinganisa umsebenzi wakho wezintso ngaphambi kokuba uthathe imishanguzo enokuthi ibangele ukungaphumeleli kwentso.
Ezinye iimeko ezinokubangela ukungaphumeleli kweentliziyo eziphambili kwi-intrinsic category ziquka ukungabikho kwe-oksijini egazini, ukusuleleka kwengqondo, ukuvutha kweentso, kunye nezifo zengqondo. Ilitye elikhulu kakhulu leentso lingabangela ukuba umonakalo wangaphakathi kwiimpongo.
I-postrenal: Oku kuchaza izizathu zokungaphumeleli kwezintso ezigxilwe kwiphepha le-urinary, apho umchamo uhamba emva kokuba uqhutywe yizintso. Ezi zizathu zibandakanya iingxaki ezibandakanya i-ureters, eziyi-tubes ezithwala umchamo kwi-bladder, i-vestile, okanye i-urethra, eyona bhubhe ephethe umchamo ophuma emzimbeni.
Umthi omkhulu weentso okanye isisu, ngokomzekelo, unokufumaneka kwindawo yebladder okanye urethra. Ukuba lukhulu ngokwaneleyo ukuba umchamo awukwazi ukudlulela, umchamo uqala ukubuyela emva, ekugqibeleni ungene ezintso. Olu xinzelelo kunye nomjikelezo ongasemva we-urine kunokubangela ukulimala okukhulu kwiintso.
Ukuxilongwa
Kukho imilinganiselo yokuxilongwa kwephutha elibi lezintso. Ukuba unomnye weendlela ezilandelayo ezintathu kwixesha leeyure ezingama-48, oku kuthetha ukuba unesifo esibi sezintso.
- I-serum creatinine yonyango lwegazi elenza umsebenzi wezintso. Ukuba iphakanyiswa ngu .3 mg / dl, oku kuthetha ukuba unesifo sokungaphumeleli.
- Ukuba i-serum yakho creatinine iphakama ngamashumi ama-50% okanye ngaphezulu ukusuka kumanqanaba aqhelekileyo, oku kuthetha ukuba unesifo sengqondo.
- Ukuba ukuveliswa komchamo kwakho ku-.5 milliliters nganye ngeekhilogram yesisindo somzimba ngeyure ngaphezulu kweeyure ezingama-6, ngoko uya kufunyaniswa ukuba unesifo sengqondo.
Ukuveliswa kweeUni
Ukuba unobungozi obunzima besifo, unokuba wenza okwaneleyo umchamo okanye umchamo omncinci. Unokunyuka okwenyuka kwinqanaba lakho le-creatinine, elibonisa ukulimala kweentso ezinzima, kodwa usenza iqondo eliqhelekileyo lomchamo. Ingaphezulu kwesiqingatha sabo bonke abantu abanokuhluleka kweentso ezinzima bayaqhubeka nokuvusa umchamo kwinto ebonakala ngathi iyimodeli evamile.
Kubantu abadala, i-urine output ye-0.5 ukuya kwi-1 milliliter ngeyure nganye ngekhilomitha yesisindo somzimba, okanye enye ukuya kweekitha ezimbini ngosuku. Kwabantwana, malunga ne-1 milliliter ngeyure nganye ngeekhilogram ziqhelekileyo, kunye neentsana, ii-milliliters ngeyure nganye ngekhilomitha yesisindo somzimba kuthathwa njengesiqhelo. Ukubhekisela, ama-milliliters angama-30 anesigidi esisodwa se-urine.
Kukho iintlobo ezintathu ezichaza inani lemveliso yomchamo ngexesha lokulimala koluhlungu.
- Okungekho-oliguric: Oku kuchaza imeko apho umntu eqhubeka nokwenza umthamo okwaneleyo womchamo, oqhelekileyo ngaphezu kwama-milliliters angama-400 ngosuku, okanye ngaphezulu, kuxhomekeke kwiimeko zempilo kunye nokutya kwamanzi.
- I-Oliguric: Oku kuchaza imeko apho umntu enza ii-milliliters zamanzi emvini okanye ngaphantsi komhla.
- U-Anuric: Oku kuchaza imeko apho umntu enza okungaphantsi kwama-milliliters e-urine ngosuku.
Unyango
Ukunyangwa kokuhluleka kwezintso ezinzulu kuxhomekeke kwimbambano yenkinga, kunye nokukhawuleza kwimeko. Abantu abaninzi baphucula unyango ngenxa yokungaphumeleli kweengtso kwaye abanakuhlangabezana neengxaki zexesha elide okanye ukungaphumeleli kwintsholongwane engapheliyo . Ukuchonga ingxaki, kwaye ukufumana unyango ngokukhawuleza, kuyona ndlela eyona ndlela ingcono yokukhusela umonakalo wezintso obangela ubomi beengxaki zeengxaki okanye ufuna unyango lwe-dialysis.
- I-intravenous (IV) i-fluids: Umntu onentsholongwane ephosakeleyo yezintso ngenxa yokuphelelwa ngumdaka obunzima emva kokufumana ukutshatyalaliswa kweshushu kunokuphucula nge- IV fluids . Xa umthamo we-fluid ophantsi ungesizathu sokungaphumeleli kweentliziyo ezinzima, ukubonelela ngomzimba ngamanzi anokunceda kunokubuyisela amanqanaba amanzi
- Ulawulo lwe-Electrolyte: Ukuba i-fluids yakho kunye ne-electrolytes ayikho kwindawo efanelekileyo, oogqirha bakho bangakunika i-electrolyte supplements, okanye banike imishanguzo enokuthi ilahle ama-electrolytes angaphezulu.
- Yeka ukusebenzisa i-toxin: Ukuba ukungaphumeleli kweengtso kubangelwa yimilisi okanye isongezelelo, unyango kufuneka lubandakanye ukuyeka imithi.
- I-Dialysis: Xa i-toxin ingalindelekanga ukuba ipheliswe ngokufanelekileyo xa uyeka ukumthatha, unyango lwe-kidey ehlulekayo kufuneka lugqithise umzimba weemichiza ngokukhawuleza. Ngamanye amaxesha i- dialysis iyadingeka, indlela apho umatshini angenza umsebenzi weentso ngokususa i-toxins nokulawula ibhalansi ye-fluid kunye ne-electrolyte.
Iinjongo zokusebenza Iimvavanyo
Iimvavanyo zomsebenzi weezintso ziqela leemvavanyo ezihlola umsebenzi wengqondo yakho. Ezi zivivinywa azisetyenziselwa ukuxilonga ukungaphumeleli kweentliziyo ezinzima, kodwa zisetyenziselwa ukubeka esweni ukuba ukungaphumeleli kwezintso zakho kuphucula okanye kukubi. Iimvavanyo zemiSebenzi yeezintso zihlala zibonisa ukuba ingxaki enzima kangakanani, inokubonelela ngenye into ebangela ingxaki, kwaye iyakwazi ukuphindaphinda ukubonisa ukuba iintso ziphendula unyango.
Iimvavanyo zomsebenzi weezintso ziquka:
- I-Creatinine: Imveliso engcolileyo eveliswa ukuphazamiseka kwemisipha, izinga le-creinine egazini lakho linika ingcamango yokuba iinjongo zakho zisebenza njani kakuhle ngenxa yokuba iintso zifanele zisuse i-creatinine egazini. I nqanaba elingaphezu kwe-1,21 mg / dL libhekwa liphezulu, kwaye libonisa ukuba iintso azisebenzi njengoko zifanele.
- I-Blood Urea Nitrogen (BUN): I-nitrogen ye-Urea, ephinda ilinganiswe egazini, isuswe yizintso. Amanqanaba angaphezu kwama-25 mg / dL abonisa ukusilela kweengtso.
- Izinga lokuhlanjululwa kwe-Glomerular (GFR): Le nani ibalwa ngokusekelwe kwinqanaba le-creatin egazini lakho, ngokubala okubala iminyaka, ukuphakama, ubunzima kunye nezinye izinto ezenza iinguqu ezithile. I-GFR eqhelekileyo kufuneka ibe ngaphezu kwe-60, kwaye i-GFR engaphantsi kwe-20 idla ngokubhekisela ekubeni umntu unesifo sengqondo.
- I-Urinalysis: Ukuchithwa kwe-urinalysis kunokukwazi ukubona igazi, iiprotheni, izifo, ukuvuvukala kunye neziyobisi. Olu lwazi lunika ingqiqo kwisizathu, kwaye ngamanye amaxesha ukuqhubela phambili, kokungaphumeleli kwangempela.
> Imithombo:
> Lavergne A, Vigneau C, Polard E, et al. Ukulimala kweentliziyo ezinobungozi ngexesha lotyando nge-dox-cloxacillin ephezulu: Ingxelo yamatyala angama-23 kunye nokuphononongwa kwincwadi. Int J A Antimicrob Agents. 2018 Apreli 14. pii: S0924-8579 (18) 30109-2. i-doi: 10.1016 / j.ijantimicag.2018.04.007. [Epub ngaphambi kokuprinta]
> I-Qiu T, iZhou J, iZhang C. izidakamizwa ezixhasayo kunye nomngcipheko wesifo seengtso: Ukuhlaziywa ngokuchanekileyo kunye nokuhlaziywa kwemeta. J Gastroenterol Hepatol. 2018 Apreli 12: i-doi: 10.1111 / jgh.14157. [Epub ngaphambi kokuprinta]