Le nkxwaleko yesifo sesibindi ingabangela ukuhluleka kwezintso
Sibanzi
Amalungu esintu awafezekanga uxanduva lwazo. Bathethana nabanye. Zixhomekeka komnye nomnye. Ukuqonda umsebenzi wequmrhu kufuna umntu ukuba aqonde indima yezinye izitho ngokunjalo. Umzimba womntu unjenge-orchestra enzima kakhulu. Ukuba ubuza kuphulaphula kuphela iziculi zomntu ngamnye, usenokungayixabisi i sym symphony.
Emva kokuba siyiqonda le ngqiqo ebalulekileyo, kuba lula ukuqonda ukuba iingxaki zomsebenzi omnye wodwa zingathintela omnye.
Inkcazo ye-Hepatorenal Syndrome (HRS)
Njengoko eli gama libonisa, igama elithi "hepato" libhekisela kwisibindi, ngelixa "ingqumbo" ibhekisela kwiintso. Ngenxa yoko, i-hepatorenal syndrome ibonisa imeko apho isifo sesibindi sikhokelela kwisifo seengtso okanye kwiimeko ezinzima, ukuphelelwa kweentso ngokupheleleyo.
Kodwa, kutheni sifuna ukwazi nge-hepatorenal syndrome? Isifo sesibindi siyinto eqhelekileyo (cinga i-Hepatitis B okanye i-C, utshwala, njl. Kwaye kwimeko yonke yesifo sesibindi, i-hepatorenal syndrome ayiyona imeko engavamile. I-statistic enye, i-statistic, i-40 ekhulwini yezigulane ezine-cirrhosis (inqabile, isibindi senyuka) kunye ne-ascites (ukuqokelela kwamanzi kwisisu esenzeka kwisifo esiphambili sesibindi) kuya kuphuhlisa i-hepatorenal syndrome kwiminyaka emi-5.
Umngcipheko
Isiqalo sokuqala kwi-hepatorenal syndrome isoloko isifo sesibindi.
Le nto ingaba yinto ephuma kwi-hepatitis (ukusuka kwiintsholongwane ezifana ne-Hepatitis B okanye i-C, iziyobisi, izifo ezithintekayo, njl), ukuya kwiimvumba esibindi, kwi-cirrhosis, okanye kwimeko eyoyikisayo yesifo sesibindi ehambelana nokuhla kwexesha eliphantsi kwesibindi, ebizwa ngokuba yi-fulminant fover failure. Yonke le miqathango ingabangela isifo sesifo kunye nokungaphumeleli kwezintso zamanqanaba ahlukeneyo kwisigulane se-hepatoreal.
Nangona kunjalo, kukho ezinye izinto ezichazwe ngokucacileyo kunye nemingcipheko ekhethekileyo eyandisa kakhulu amathuba omntu ophuhlisayo intsholongwane yezintso ngenxa yesifo sesibindi.
- Ukukhulelwa kwesiguli esisisu (okungenzeka ngezinye iimeko kubantu abane-cirrhosis), ebizwa ngokuba yi-bacterial peritonitis (SBP)
- Ukuqhaqhazela emathunjini, okuqhelekileyo kwizigulane ze-cirrhosis ezivela emithanjeni yegazi ezigqithiseleyo kwi-esophagus umzekelo (i-esophageal varices)
Iipilisi zamanzi (i-diuretics ezifana ne-furosemide okanye i-spironolactone) ezinikezwa izigulane ezine-cirrhosis kunye nokugqithisa kwamanzi angagxininisi i-hepatorenal syndrome (nangona iyakwazi ukulimaza iinjongo ngezinye iindlela).
Izifo eziqhubekayo
Iindlela ezisetyenziswa ngayo izifo zesibindi zenza iingxaki ngeentsholongwane ezicatshangelwe ukuba zihambelana "nokuphambukiswa" kwegazi ngaphandle kweentso kunye nakwezinye izitho zomzimba zesisu (oko kuthiwa " ukusabalalisa kwe-splanchnic ").
Enye into ebalulekileyo eyenza ukunikezelwa kwegazi kunoma yimuphi umbutho ukuchasana okuhlangene negazi eligeleza kulolo lungu. Ngenxa yoko, ngokusekelwe kwimithetho ye-physics, inqabileyo yesitya segazi, ukuphakanyiswa kokuphakanyiswa kwayo kuya kubangela ukuhamba kwegazi .
Ngokomzekelo, cingela ukuba uzama ukupompoza amanzi ngokusebenzisa izidibaniso ezimbini zeegadi ezahlukeneyo usebenzisa umlinganiselo olinganayo woxinzelelo (owenziwe emzimbeni womntu wenziwa yintliziyo).
Ukuba zombini iiplanga zazinobungakanani obukhulu obufanayo / ubungakanani, omnye unokulindela inani elilinganayo lamanzi ukugeleza kubo. Ngoku, kuya kwenzeka ntoni ukuba enye yezo zibonda yayinkulu kakhulu (i-caliber enkulu) kunomnye? Eyona ndlela, amanzi amaninzi aya kuhamba ngokukhawuleza ngokusebenzisa ipayipi ebanzi ngenxa yokunganyaniseki kwamanzi apho.
Ngokufanayo, kwimeko ye-hepatorenal syndrome, ukwandisa (ukuhlanjululwa) kwemithambo ethile yegazi kwi-splanchnic circulation circulation ichithe igazi ngaphandle kweentso (iimithwalo zegazi zazo zithintela). Nangona oku kuqhubekiyo kumanyathelo athile ahlukeneyo, ngenxa yokuqonda, nantsi indlela esingayenza ngayo imephu:
- Inyathelo 1- Intambo yokuqala yinto ebizwa ngokuba yi- portal hypertension (ukwanda kwexinzelelo lwegazi kwiimvumba ezithile ezikhupha igazi ukusuka esiswini, i-pleen, i-pancreas, emathunjini), eqhelekileyo kwizigulane zezifo eziphezulu. Oku kuguqula ukuhamba kwegazi kwisigxina segazi esiswini ngokunyusa iimithambo zegazi ngenxa yokuveliswa kweekhemikhali ebizwa ngokuthi " nitric oxide ". Oku kuveliswa yimithambo yegazi kunye kwaye yinto efana neyayimfuneko yenzululwazi ukuba idale imithi njengeViagra.
- Inyathelo 2 - Nangona iinqanawa zegazi ezingentla zihlalutya (kwaye ngoko ke ikhefu legazi liza kuphuma kuzo), kukho imithwalo yegazi ezintsheni eziqala ukunyanzela (ngokunjalo ukunciphisa ukunikezelwa kwegazi). Iinkqubo ezichanekileyo zezi zikho ngaphaya kweli nqaku, kodwa kucatshangelwa ukuba zihambelana nokusebenza kwenkqubo ebizwa ngokuba yi-renin-angiotensin.
Ezi zinguqulelo zegazi zigqityiwe kwaye zivelise ukuhla kwehla ngokukhawuleza kwimisebenzi yengqondo.
Ukuxilongwa
Ukuxilongwa kwe-hepatorenal syndrome ayilona uvavanyo oluchanekileyo lwegazi. Ngokuqhelekileyo amagqirha abiza ukuxilongwa kokungabikho . Ngamanye amazwi, omnye wayeya kubonakala kwinkcazo yeklinikhi yesigulane sesifo sesibindi esivela ngenye indlela ukungaphumeleli kwezintso. Imfuno ebalulekileyo yokuxilongwa yinto yokuba ugqirha uya kufuneka ukuba angabandakanyi ukuba ukungaphumeleli kwezintso akusisiphumo salo nawuphi na isizathu (ukungcoliswa kwamanzi, umphumo wamachiza onokulimaza iinjongo ezinjenge- NSAID intlungu yeengxaki , umphumo wokuzivikela komzimba we-Hepatitis B okanye iiV virus, i-autoimmune izifo, ukuphazamiseka, njl). Emva kokuba loo mqathango sele idibene, siqala ngokuqinisekisa ukuhla kweentsebenzo zengqondo ngokujonga ezinye iimpawu zeclini kunye neemvavanyo:
- Izinga eliphakamileyo le-creinine egazini, edibene nokunciphisa intlawulo yokufakela izintso (GFR)
- Yehla kwimveliso yomchamo
- Inani eliphantsi le-sodium ekhoyo kumchamo
- Iintsholongwane ze-ultrasound, ezingayi kubonakalisa nantoni na into, kodwa ingabandakanyi ezinye izizathu zokungaphumeleli kwezintso kwisigulane esicinga ukuba ne-hepatorenal syndrome
- Ukuvavanya igazi okanye iiprotheyini kumchamo. Amanqanaba angabikho / amancinci aya kukuxhasa ukuxilongwa kwe-hepatorenal syndrome
- Ukuphendula kwonyango kusetyenziswe njengendlela yokujonga "ukuhlolwa kwemigudu" yokuxilongwa. Ngamanye amagama, ukuba umsebenzi weentso uphucula ngokugqithisileyo emva kokuba "i-hydration" (leyo ingabandakanya ukunika isigulane esiswini okanye iproteinin infusion ye-albumin), akunakwenzeka ukuba ibe yi-hepatorenal syndrome. Enyanisweni, ukuchasana kwezi zonyango ezikhuselekileyo kuya kufakazela ukusola malunga ne-hepatorenal syndrome ekhoyo
Ndifuna ukugxininisa ukuba nokuba kufumanisa ukuhluleka kweengtso akunakuze kube lula kwi sigulane ngesifo sesibindi esiphezulu okanye i-cirrhosis. Oku kungenxa yokuba uvavanyo oluqhelekileyo oluxhomekeke ekuhloleni umsebenzi wezintso, inqanaba le-serum creatinine, alinakuphakamisa kakhulu izigulane ze-cirrhosis kwindawo yokuqala. Ngoko ke, ukujonga nje inqanaba le-serum creatinine lingakhohlisa umxilongwane ngenxa yokuba kuya kubangela ukuba ungaphantsi kobunzima bokungaphumeleli kwezintso. Ngoko ke, ezinye iimvavanyo ezinjengeemitha ezingama-24 ze-urin creatinine imvume zingabalulekanga ukuxhasa okanye ukuphikisa izinga lokungaphumeleli kwezintso.
Iintlobo
Xa ukuxilongwa kugqityiweyo kusetyenziswa izi khankanywe ngasentla, oogqirha baya kubeka i-hepatorenal syndrome kwi-Type-I okanye i-Type-II. Ukwahlukana kukuxinzelelo kunye nekhosi yokugula. Uhlobo I luhlobo olubi kakhulu, olubandakanya ukuhla kwexesha elikhawulezayo nelisisigxina (ngaphezulu kwe-50%) kwintsebenzo yezintso zingaphantsi kweeveki ezimbini.
Unyango
Ngoku ngoku siqonda ukuba i-hepatorenal syndrome isetyenziswe sisifo sesibindi (kunye nesifo sengxinzelelo se-portal sokuba yinkampani ekhuselekileyo), kulula ukuqonda ukuba kutheni ukuphathwa kwesifo sesibindi kukubaluleke kakhulu kunye ne-crux yonyango. Ngelishwa, oko akunakwenzeka njalo. Enyanisweni, kunokubakho iindawo ezingekho unyango okanye, njengokuba kwenzeka ekungabikho kwesibindi, apho unyango (ngaphandle kokufakelwa kwesibindi) lungenakusebenza. Ekugqibeleni, kukho ixesha lexesha. Ngokukodwa ngohlobo-I-HRS. Ngenxa yoko, nangona isifo sesibindi sinokunyangwa, akunakwenzeka ukuba ulinde unyango kwisigulane ngeentsholongwane ezingaphumeleli ngokukhawuleza. Kwimeko apho, amayeza kunye ne- dialysis kuyafuneka . Nazi iindlela ezimbalwa esizenzayo:
- Kwiminyaka yakutshanje, kukho ubungqina obuhle malunga nenxaxheba yonyango elitsha elibizwa ngokuba yi-terlipressin. Ngelishwa, ayifumaneki lula e-United States, nangona isetyenziselwa ukusetyenziswa kwiindawo ezininzi ze-hepatorenal syndrome. Oko esikufumana apha, ngoko, mhlawumbi imithi ebizwa ngokuthi i-norepinephrine (isilwanyana esifanayo esisetyenziswe kwi-ICU ukuphakamisa uxinzelelo lwegazi kubantu abanexinzelelo oluphantsi kwegazi ngenxa yokoyika), kunye ne-"regimen regimen" ebandakanya iziyobisi ezintathu, kuthiwa i-octreotide, i-midodrine kunye ne-albin (iprotheni enkulu ekhoyo egazini).
- Ukuba la mayeza ayisebenzi, inqubo yokungenelela ebizwa ngokuba yi-TIPS (intlahepatic intrahepatic portosystemic shunt) ingaba yinzuzo, nangona ihamba neengxaki zayo.
- Ekugqibeleni, ukuba konke kungaphumeleli kunye neentso zingabuyisanga, i-dialysis inokuba yinto efunekayo njenge-"bridge" kuze kubekho isifo sesibindi singabhekiswa ngokucacileyo.
Ngokuqhelekileyo, ukuba imithi echazwe ngasentla ayisebenzi phakathi kweveki ezimbini, unyango lunokuthi lucingwe nje kwaye ingozi yokufa iya kunyuka.
Thintelo
Kuyaxhomekeka. Ukuba isigulane sinesi sifo sesifo sesibindi kunye neengxaki eziqatshelwayo (njengokuba kuchaziwe ngasentla kwicandelo elibhekiselele kwizigulane ezisengozini enkulu) ye-hepatorenal syndrome, ezinye iindlela zokwelapha zokukhusela zingasebenza. Ngokomzekelo, izigulane ezine-cirrhosis kunye ne-fluid esiswini (ezibizwa ngokuba yi-ascites), zinokuzuza kwi-antibiotic ebizwa ngokuthi i-norfloxacin. Izigulana zinokufumana inzuzo ekubuyiselweni kwe-albumin.
> Imithombo:
> Isiganeko, iziganeko zokuqikelela, kunye nokugxekwa kwe-hepatorenal syndrome kwi-cirrhosis ne-ascites. Gines et al. Gastroenterology. 1993 Jul; 105 (1): 229-36.
> Terlipressin kwi-hepatorenal syndrome: Ubungqina bokuba kukho izibonakaliso zamanje. Rajekar et al.J Gastroenterol Hepatol. NgoJan ngo-2011; 26 iSondlo 1: 109-14. i-doi: 10.1111 / j.1440-1746.2010.06583.x
> Iprophylaxis yaseprayimine ye-bacterial peritonitis yanciphisa i-hepatorenal syndrome kwaye iphucula ukusukela kwi-cirrhosis. Fernández J. Gastroenterology. 2007 Sep; 133 (3): 818-24. Epub 2007 Julayi 3.