Ukungakhethi i-dialysis kuyindlela efanelekileyo, kodwa ziziphi iimpembelelo
Izigulane ezinezifo zesifo eziphambili eziza kwisigaba sesi-5 zinokukhetha ezimbini xa ziphathelele ekulawuleni izifo zabo, nokuba ziqalise ngolunye uhlobo lwe- dialysis (ephakathi kwe-hemodialysis exhaphakileyo kwi-US, okanye i-dialysis yekhaya okungenzeka ibe yi-hemodialysis okanye i-peritoneal dialysis ), okanye ukutshintshwa kweengtso. Kodwa kuthekani ukuba isigulane asinakho, okanye akafuni naluphi na olu khetho nangaliphi na isizathu.
Yintoni eyenzekayo xa isigulane esinokuphelelwa yintliziyo asifumani i-dialysis okanye ukutshintshwa? Bangalindela ixesha elingakanani ukuhlala? Eli nqaku liya kuzama ukuphendula embalwa yale mibuzo.
UKUKHETHA I-DIALYSIS KUNYE OKUQHELEKILEYO, NGAPHANDLE KUNYE UKUQHUBEKA
Ukugqiba ukuba ngubani "ofanelekileyo isigulane" yisigqibo esona sishiyekileyo kwingxoxo phakathi kwesigulane kunye nephrologist yabo. Ngokwesiko, xa izigulane zingabonwa njengabaviwa be-dialysis, izazi ze-nephrologists zithi, "siya kugcina i- dialysis kuNksz X". Nangona kunjalo, ukutsho "ukugodla" kunemeko engathandekiyo (cinga "siya kugcina inkxaso yenkxaso, njl njl njl."). Kumguli ogqirhayo kunye nosapho lwabo, linika ingcamango yokuba ugqirha akayi kunika nantoni na kwaye silindele ukuba isiguli sifele. Nangona kunjalo, oku akunakwenzeka kwi nyaniso kuba ezininzi iingxaki zesifo seengtso zingakwazi kwaye zilawulwe ngamachiza.
Ngamanye amazwi, i-nephrologists isenokunikela ngokubanzi; kakhulu kunene konke okufutshane ukugubungela isigulane kumatshini we-dialysis. Kwaye ke, ukuthetha kangcono into eqhubekayo-eyakwazi isigulane, ixesha elifanelekileyo lokulawulwa kweengxaki ezingenayo i-dialytic esetyenziswa ngoku yi- Maximal Conservative Management (MCM) .
Oku kuboniswe ngcaciso apha.
NGABANI UMGQUBA WOKUBHALWA KWEZINDAWO ZOKUPHATHWA KWE-KIDNEY KUNYE NOKUBA NGENYE YONKE
Akunjalo sonke isigulane singenza umviwa ofanelekileyo we-MCM, kwaye ezinye iinketho zinokuba zifanelekileyo. Ulawulo olugcinayo luyilungelelwano olufanelekileyo kwizicwangciso ezahlukeneyo. Ezi zingabandakanya ukukhula kunye nobubuthakathaka obukhulu, ukukhubazeka komzimba, ubukho bezinye izifo ezinzima ezifana nokuhluleka kwentliziyo okanye umhlaza wesifo se-metastatic, njl. Kwiimeko ezinjalo, kunzima ukuhlala uqikelele ukuba i-dialysis izongezelela nayiphi na into esemgangathweni / ubungakanani bomi. Kwaye ngokuqhelekileyo, izigulane zijonge nje "umfanekiso omkhulu", ingakumbi ukuba ixesha lokuphila lilinganiselwe.
Nangona kunjalo, i-MCM ayilona wonke umntu. Izigulane kufuneka zifundiswe ukuba kukho iingxaki ezininzi zokungaphumeleli kwezintso eziphathekayo kunye neepilisi, kwaye ezinye iimpawu / iimpawu ziya kuphendula kuphela kwi-dialysis. Oku kungenxa yokuba izinto ezibizwa ngokuba yi- uremic toxins eziqokelelwa ekuphelelweni kwezintso kwaye sisona sizathu senkxalabo eninzi ayiyi kususwa kunye nolawulo olugcinayo (nangona nokuba i-dialysis ayibasuse yonke into). Isigulane kunye nodokotela angadinga ukuba ahlale ndawonye ukuze ahambe ngaphezu kwezinto ezilindelweyo kwaye athathe isicwangciso sokunyamekela.
Yaye xa intetho iphathelene nokulindela, imibuzo emibili iya kuvela kwiigulane ezilahla i-dialysis:
- Ndingayivakalelwa njani ukuba ndiyalila i-dialysis?
- Ngaba ubude bam ubomi buya kufutshane xa ndingenalo i-dialysis?
Ukunikezelwa kwemali encinci yedatha, oku akuyona imibuzo elula ukuphendula. Kodwa sinakho ulwazi oluthe lufumaneke malunga nokulindela ubomi kwizigulane ezenza i-dialysis. Ngokwe-United States ingxelo ye-Renal Data System, ukusinda okulindelekileyo kwizigulane kwi-dialysis kuyahluka ukusuka kwiminyaka eyi-8 (kwizigulane ezineminyaka engama-40 ukuya ku-44) ukuya kwiminyaka engama-4.5 (izigulane eziphakathi kweminyaka engama-60 ukuya kuma-64 ubudala). Le ke kunjalo ke umyinge, kunye nokuguquka okubanzi kuboniswe kuxhomekeke kwisithuba somguli, isimo sesondlo, kunye nobukho bezinye izifo zesifo esifumanekayo, njengesifo senhliziyo yesifo, umhlaza, njl.
Ndiyakufuna ukunceda ingqalelo yakho kwibrafu efanisa ukulindeleka kwindoda eneminyaka engama-55 ubudala eliqhelekileyo ukuya kwisigulane esifanayo kwi-dialysis, okanye umntu oye wafumana ukutshintshwa kweentso.
UKUPHILA KWENKCUKACHA NOKUPHILA KWEZEMPILO KUNYE NAKUNYE I-DIALYSIS
Makhe sijonge ezinye izifundo ezizame ukuqhathanisa ukusinda phakathi kwezi zigaba zibini. Uphando lwezigulane ezineesigaba sesi-5 sesifo sesifo esinesibhozo esingama-80 ubudala sasichaza ixesha lobomi obuphakathi kweenyanga ezingama-29 (iinyanga ezingama-29 kunye neenyanga ezili-9) kwizigulane ezikhetha i-dialysis. Olunye uphando olulinganisa ukusinda phakathi kwezigulane ezikhethiweyo zokudityaniswa kwe-dialysis kunye nabanyula ukhetho olugcinwe ngolo hlobo lugqithise nokuphila okungcono kwizigulane ezakhetha i-dialysis. Zonke izigulane zazingeneminyaka engama-75 ubudala. Iimali zokusinda iminyaka engama-1 zazingama-84% kwiqela elikhetha i-dialysis kunye nama-68% kwiqela elikhetha ukuphathwa kwe-dialytic. Omnye unokuncedisa kule datha ukuba izigulane zokuhluleka kweentso ezikhethiweyo zedayalysis ziyakuthi ziphile ixesha elide.
Nangona kunjalo, oku ngasentla bekuya kuba yinto elula yokucinga. Izigulane ezinezifo zengqondo eziphambili ziza kuba nezinye izifo ezinzulu zesifo ezifana nesifo senhliziyo, isifo sikashukela, umhlaza, njll; oko sichaza oogqirha ngokuthi "ukudibanisa" . Kwaye ke, ukuba sithatha enye ingqalelo kwidatha esiye sixoxe ngayo ngasentla, siyaqonda ukuba ukulindela ubomi kwizigulane ezinezinye izifo zesifo esinezifo ezinzulu ezifana nesifo senhliziyo esisodwa asizange sichasane; ingaba bakhethe i-dialysis okanye hayi ! Ngamanye amagama, kwisigulane esinokubambisana kakhulu, ukunyamekela kunokugqithiswa ngaphezulu kwezi meko kunokuba ngaba isigulane senziwe idialyzed okanye cha. Ukuthatha umyalezo wekhaya kukuba i-dialysis iya kwandisa ubomi bakho xa ungezinye ezininzi izifo ezibi zikhankanywe ngasentla. Ndiza kubeka ingqwalasela yakho kwi-Figure 2 kule nqaku eqinisa into esixubusha ngayo.
Ekugqibeleni, makhe ndikhankanye i-statistic ebalulekileyo (iinkcukacha apha, apha, apha). Umyinge wobomi obude emva kokuba isiguli esele sise-dialysis sithathwe kwi-dialysis ziintsuku ezingama-6 ukuya kwezi-8, kodwa uluhlu olugqithiseleyo lunokuguquka naphakathi kweentsuku ezimbini ukuya kwiintsuku ezili-100.
ISICWANGCISO SOMSEBENZI NEMPILO YOBUPHILA NGAPHANDLE NE-DIALYSIS
Kwizigulane ezigqibayo ukungakhethi i-dialysis emva kwengxoxo kunye nephrologists zabo, umbuzo ocacileyo ovela, "Ndingayivakalelwa njani"? Uninzi lwezigulane zixhalabele ngakumbi ngolu hlobo kunokuba luncitshiswe ekunciphiseni ixesha lokuphila.
Ngo-1949, uDkt David Karnofsky wachaze isixa (100 sisisigxina somntu onempilo, kunye ne-0 echaza ukufa) enokusetyenziswa ngokulinganayo ngokulinganisa isimo somsebenzi wezigulane zomhlaza. Isiko sele sisetyenzisiwe ukulinganisa izinga lokunciphisa ukusebenza kwezigulane ezingakwazi ukuphelelwa yintsholongwane ezilawulwa ngokungazenzisiyo ngaphandle kwe-dialysis. Eli nqaku apha (jonga umzobo 1) uchaza ukuba zeziphi izigulane ziza kubakho kwimisebenzi / umgangatho wobomi bonyaka kunyaka wokugqibela wobomi babo. Into ebangelisayo ukuphawula ukuba izigulane zifuna ukuba zifumane uncedo kuphela ngezihlandlo zokugqibela kwimeko yokuphila kwazo, emva koko ziya kubona ukuhla kwehla kwimeko yazo yokusebenza, ngaloo ndlela zidinga ukunakekelwa okuthe ngqo / ukungeniswa kwezibhedlele. Isilinganisi kunye neli nqaku lisinika ingqiqo ngakumbi malunga noko kukulindela xa izigulane zezokwehluleka kweentso zijonge kwixesha elizayo kwaye zenze isigqibo sokukhetha ubomi ngaphandle kwe-dialysis. Into endiyathanda ukuyigxininisa apha kukuba ezi zigqibo zisekelwe ekucingeni ukuba izigulane zizinyamekele ngokuzenzekelayo, ngendlela engacinekanga. Yiyo esiyibhekisela ngoku njenge- Maximal Conservative Management (MCM) kwaye nantsi iinkcukacha zayo.