I-ECMO-indlela yokuxhasa ubomi kubantu abagulayo kakhulu-uye wahamba ngendlela ende
Nangona sisekude nokuphuhliswa kwenkqubo yoxhasano lobomi be-Dark-Vaderesque, i-ECMO okanye i-membrane yocomferensi ye-oksijeni yenze indlela ende kwiminyaka yamuva. Nangona okokuqala indlela yokwelapha isetyenziselwa ukunceda iintsana ezisandul 'ukuzalwa, inani elinyukayo labantu abadala bafumana i-ECMO, kunye namaziko e-ECMO aphuma kuwo wonke umhlaba.
Ngokwe-Extracorporeal Life Support Organisation (ELSO), eqhubeka iqhuba iithebhu kwi-ECMO, ukususela ngo-1990, i-ECMO isetyenziselwe ukunceda abantu abangama-58,842 kuwo wonke umhlaba, kunye nelo nani landa ngonyaka.
Nangona phantse isiqingatha sale matyala zibandakanya i-neonates neengxaki zokuphefumula, iimeko ezidibeneyo ezi-10,426 zibandakanya abantu abaneengxaki zokuphefumula kunye neengqondo okanye abanesidingo sokuvuselelwa kwamapulmoni.
Yintoni i-ECMO?
I-ECMO (i-AKA inkxaso yendalo okanye inkxaso ye-ECLS) yindlela efutshane-mali yokubonelela ngempilo kubantu abagula kakhulu (cinga umonakalo okanye ukungaphumeleli kwentliziyo). Ngokukodwa, i-ECMO ixhaphaza i-oksijini egazini ize isuse i-carbon dioxide. Iyakwazi ukubonelela nge-hemodynamic (uxinzelelo lwegazi). I-ECMO yindlela yokusebenzisa i-cardiopulmonary bypass kwaye isetyenziswe ngaphandle kwegumbi lokusebenza. Imishini epheleleyo ye-cardiopulmonary bypass (i-heart-lung machines) isetyenziselwa iiyure ezimbalwa ngexesha lotyando.
I-ECMO isoloko isetyenziselwa ukuthatha uxinzelelo kwimiphunga kunye nentliziyo iintsuku eziliqela, ezo zikhuthaza ukuphilisa. Isetyenziswe kwizigulane, ukuba ngaba baphathwa ngokukhawuleza, amathuba abo okusinda ayenzileyo, kwaye ngubani oza kufa mhlawumbi ngaphandle kwe-ECMO.
Kusukela ngowe-1944, abaphandi baqaphela ukuba igazi elidlulayo kwiimbrane ezinokumelana neziqu zaba ne-oxygen. Lo mbono waba sisiseko se-cardiopulmonary bypass. Ekuqaleni, i-cardiopulmonary bypass incike kwi-bubble okanye i-disk oxygenators eyabonakalisa igazi ngqo emoyeni. Impembelelo embi yolu hlobo lwangaphambili lwe-overpass lwalubandakanya i-hemolysis okanye ukutshatyalaliswa kweeseli zegazi ezinciphisa inzuzo yayo kwiiyure ezimbalwa kakhulu.
Ngowe-1956, ukuphuhliswa kwe-membrane oxygenator kwanyanzele le ngxaki kwaye kuseka isiseko sokusebenzisa ixesha elide leCMO.
Nazi izixhobo ze-ECMO eziqhelekileyo:
- ukutshatyalaliswa kweshushu
- i-membrane oxygenator
- ipompoji okanye ipompofugal
- isitifiketi yesiphaluka
- I-VM ECMO ibuyisela igazi kwi- systemous venous ngokusebenzisa i-vena cava ephezulu okanye i-atrium efanelekileyo, kwaye i-VA ECMO iphinda ibuyisele igazi kwisistim sokuguqula i-aorta okanye i-carotid artery)
Kwezinye iiseti-ups, isiphaluka esifanayo equkethe enye ipom kunye ne-oxygenator isetyenziselwa ukunceda nge-oxygenation ne-carbon-dioxide ukususwa. Amanqanaba okuhamba ahlaziywa ngokusekelwe ekuhloleni okufutshane kwe-homeostasis yesigulane: uxinzelelo lwegazi, isimo se-asidi-siseko, umsebenzi wesigxina, kunye nesimo se-venous mix mix. Ingqalelo, kuphela i-VA ECMO inikeza i-hemodynamic okanye inkxaso yegazi. Ekugqibeleni, nangona i-cardiopulmonary bypass epheleleyo igxininiswe kwigumbi elingaphantsi kwe-anesthesia jikelele, i-ECMO isetyenziswe ngokusetyenziswa kwe-anesthesia yendawo.
Abagulane abakwi-ECMO badla ngokugula kakhulu, kwaye akusiyo wonke umntu ophilayo kumava. Ngomhla ka-2013, i-ELSO ibike ukuba amazwe ngama-72 kuphela abantu abasinda kwi-ECMO kunye nale nani-manani ixatywe kakhulu ngenxa yeenonates eziye zanciphisa ukulimala kwemiphunga ukuya kwinkqubo.
(Gcina ukhumbule ukuba umntwana unemiphunga emitsha kwaye ngaloo ndlela unokungena kwi-ECMO ngaphandle kokulimala okanye ukuphazamiseka komonakalo oqhelekileyo wabantu abadala). Ngaphezu koko, nangona iipesenti ezingama-72 zabantu bonke basinda kwi-ECMO, kuphela iipesenti ezingama-60 ezenza ukuba zikhuphe okanye zidlulise wayelinganiswa ngokuthanda iintsana. Ngokukodwa, ngamaphesenti ama-56 kuphela abantu abadala abaneengxaki zokuphefumula benza ukuba kukhutshwe okanye batshintshe.
Imiphumo emibi ye-ECMO ibandakanya ukuphuma kwamanzi kwangaphakathi nangaphandle, ukusuleleka, ukuthintela i-thrombosis (igazi elisongela ubomi ngaphakathi kwemithambo yegazi) kunye nokungaphumeleli kwepompo. Ukuze kuncitshiswe ingongoma ye-thrombosis, iincandelo ze-ECMO ziboshwe kwi-heparin, igazi elincinci.
I-ECMO isebenzise nini?
Nazi ezinye iimeko apho i-ECMO isetyenziswa kwiintsana:
- ukuqhubeka kwengcinezelo yengozi yomsana wengane (PPHN)
- I-neonatal meconium aspiration syndrome
- Isifo sesifo se-Pneumonia okanye olunye usuleleko olunzulu
- isithintelo sokuzalwa esiswini
- isifo senhliziyo esiswini
Nazi ezinye iimeko apho i-ECMO isetyenziswa kubantwana abadala:
- ukulungiswa komzimba kwithuba lokugqibela
- isifo somphefumlo
- pneumonia
- sepsis
- utyhefu
- esondayo
- i-asthma
- utyhefu
Ukusetyenziswa kwe-ECMO kufumanisa indlela yayo kwiyeza elidala. Nangona kukho ukungabikho kobubungqina obuxhasa ukusetyenziswa kwayo yonke indawo (oko kukuthi sifuna iilingo ezinkulu zokulawula ukulandelelana ukuze kufike izikhokelo zendawo yonke), iingxelo zeengxelo, izifundo eziphindaphindiweyo kunye nokunye okuvelisayo ezibonisa ukuba i-ECMO inokuba luncedo kwiindawo ezahlukeneyo iimeko. Ingqalelo, nangona kungekho ziphikisana ngokupheleleyo zokusetyenziswa kwayo, ezinye iingqinisiso ezichaseneyo, ngokuyinxalenye esekelwe kwiingcamango zengcali, ziye zaphakanyiswa zibandakanya inkqubo ye-immune ekhuselekanga (ukuxilongwa kwe-immunosuppression), ingozi enkulu yokuphuma kwegazi (i-coagulopathy ephawulwe), ubudala obudala kunye ne-BMI ephezulu.
Nazi ezinye iimeko apho i-ECMO isetyenziswa kubantu abadala:
- ukubethelwa kwimizimba yesibini ukuya kwi-myocardial infarction okanye i- pulmary embolism
- ukumelwa yintliziyo
- Ukungaphumeleli kokuphefumula kwesibini kwiimpawu zokuphefumula (ARDS) okanye i-H1N1
Izibini ezimbini kwiinkcukacha ze-ECMO njengoko kuthethwa ngabantu abadala. Okokuqala, ngokungafani nama-ventilators, i-ECMO igweme ukulimaza imiphunga ngenxa yengozi (i-barotrauma) okanye i-atelectasis (ukuwa kwephunga). Okwesibini, uhlalutyo lwe-meta (uphando oluhlanganisiweyo) lubonisa ukuba i-ECMO ingaba yinzuzo encinci kulabo bafumana iintliziyo zentsholongwane, abo abane-viral cardiomyopathy (intsholongwane yentsholongwane yentliziyo) kunye nalabo abane-arrhythmias abangakwazi ukuphendula unyango oluqhelekileyo.
Kwinqaku yokugqibela, i-ECMO mhlawumbi unyango ongeke uze udibane nayo ebomini bakho okanye kubomi bakho abathandekayo abanenhlanhla; I-ECMO inzulu kwaye igcinwe kulabo abagula kakhulu. Nangona kunjalo, i-ECMO ibonisa indlela entsha ethembisayo yokunceda abantu abaninzi. Nangona singenakuze siphucule inkqubo yenkxaso yokuphila ephindwe kabini njenge-suitarm of armor efanelekileyo yaseDarth Vader, sihlaziya ngakumbi ukuqonda kwethu indawo esekelwe yenkxaso yokuphila kwexesha elifutshane.
Imithombo
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