Izi zokhudzana ndi matenda a chiwindi zingayambitse matenda a impso
Mwachidule
Ziwalo za anthu sizichita ntchito zawo padera. Amalankhulana. Zimadalira wina ndi mnzake. Kumvetsetsa ziwalo za thupi kumadalira wina kumvetsetsa udindo wa ziwalo zina. Thupi la munthu liri ngati gulu loimba nyimbo zovuta kwambiri. Ngati mutangomvetsera nyimbo, simungayamikire symphony.
Tikazindikira mfundo yofunikayi, zimakhala zosavuta kumvetsa kuti mavuto omwe ali ndi chiwalo chimodzi akhoza kuwononga wina.
Tanthauzo la Hepatorenal Syndrome (HRS)
Monga momwe mawuwa akusonyezera, mawu akuti "hepato" amatanthauza chiwindi, pamene "chiwindi" amatanthauza impso. Choncho, matenda a hepatorenal amatanthauza chikhalidwe chimene matenda a chiwindi amatsogolera ku matenda a impso kapena nthawi zambiri, kuthetsa kwathunthu kwa impso .
Koma, n'chifukwa chiyani tifunika kudziwa za hepatorenal syndrome? Matenda a chiwindi ndi chinthu chodziwika bwino (ganizirani Hepatitis B kapena C, alcohol, etc.). Ndipo m'chilengedwe chonse cha matenda a chiwindi, matenda a hepatorenal si achilendo. Malingana ndi chiŵerengero chimodzi, pafupifupi 40 peresenti ya odwala matenda a cirrhosis (scarred, shrunken chiwindi) ndi ascites (kutuluka kwa madzi m'mimba zomwe zimachitika pachiwindi cha chiwindi) zidzatha hepatorenal syndrome mkati mwa zaka zisanu.
Zinthu Zowopsa
Choyambitsa matenda a hepatorenal syndrome nthawi zonse ndi mtundu wa matenda a chiwindi.
Izi zikhoza kukhala zonse kuchokera ku matenda a chiwindi (kuchokera ku mavairasi monga Hepatitis B kapena C, mankhwala osokoneza bongo, matenda odzimadzimadzimodzi, etc.), ku matumbo pachiwindi, ku chiwindi, kapena ngakhale mantha omwe amawopsa kwambiri ku chiwindi, wotchedwa fulminant chiwindi chosalimba. Zonsezi zikhoza kuchititsa matenda a impso ndi impso kulephera kwa zovuta zosiyanasiyana mu wodwala wa hepatoreal.
Komabe, palinso zinthu zina zomwe zimayambitsa chiopsezo zomwe zimapangitsa kuti munthu wina akhale ndi ubongo chifukwa cha matenda a chiwindi.
- Kutenga kwa mimba yamimba (yomwe nthawi zina ikhoza kuchitika kwa anthu omwe ali ndi chibwibwi), otchedwa bakiteriya peritonitis (SBP)
- Kuwombera m'matumbo, omwe amapezeka m'magulu a mitsempha omwe amawombera m'mimba, amatha kupitirira m'mimba (esophageal varices)
Mapiritsi a madzi (diuretics monga furosemide kapena spironolactone) omwe amaperekedwa kwa odwala matenda a chiwindi ndi madzi samapititsa hepatorenal syndrome (ngakhale kuti akhoza kupweteka impso m'njira zina).
Kukula kwa Matenda
Njira zomwe matenda a chiwindi amachititsa mavuto ndi ntchito ya impso zimaganiziridwa kuti zimagwirizana ndi "kutaya" kwa magazi kunja kwa impso ndi kumbali zonse za m'mimba zomwe zimatchedwa " splanchnic circulation ").
Chinthu chimodzi chachikulu chomwe chimapereka magazi ku chiwalo chirichonse ndi kukana kumene kukumana ndi magazi akuyenda mpaka ku chiwalo chimenecho. Choncho, pogwiritsa ntchito malamulo a fizikiki, kuchepa kwa mitsuko ya magazi, ndiko kukwera kwa kukana kumene kungapangitse kuti magazi awonongeke .
Mwachitsanzo, taganizirani ngati mukuyesera kupopera madzi kudzera m'mitengo yosiyanasiyana ya munda pogwiritsa ntchito kuchuluka kwa mphamvu (yomwe mumthupi mwa munthu imapangidwa ndi mtima).
Ngati zonsezi zikanakhala ndi kuwala kofanana, munthu angayang'ane madzi okwanira ofanana nawo. Tsopano, chingachitike ndi chiyani ngati imodzi mwa mapepalawo inali yaikulu kwambiri kuposa yina? Eya, madzi ambiri adzasunthira mwadongosolo pamtunda waukulu chifukwa cha kuchepa komwe madzi akukumana nawo.
Mofananamo, pa vuto la hepatorenal syndrome, kufalikira kwina kwa mitsempha yambiri yamagazi m'magazi a pamimba splanchnic amachotsa magazi kutali ndi impso (omwe mitsempha ya magazi imaletsedwa). Ngakhale izi sizikuyenda muzigawo zosiyana, kuti tizindikire, apa ndi momwe tingapezere izi:
- Khwerero 1 - Choyamba choyamba chimatchedwa portal hypertension (yowonjezera kuthamanga kwa magazi m'mitsempha ina imene imatulutsa magazi kuchokera m'mimba, nthata, kapangidwe, m'matumbo), omwe amapezeka m'magulu akuluakulu a chiwindi. Izi zimapangitsa kuti magazi aziyenda m'mimba m'mimba mwa kuchepetsa mitsempha ya magazi chifukwa cha kupanga mankhwala otchedwa " nitric oxide ". Izi zimapangidwa ndi mitsempha ya mthupi ndipo ndizofanana zomwe asayansi amalowetsa kuti apange mankhwala monga Viagra.
- Gawo 2 - Pamene mitsempha yapamwambayi ikukhalitsa (ndipo potero imatenga magazi ochulukirapo kupyolera mwa iwo), pali mitsempha ya magazi impso zomwe zimayambira kukhazikika (motero kuchepetsa magazi). Njira zowonjezereka za izi sizingatheke pa nkhaniyi, koma zikuganiziridwa kuti zokhudzana ndi kuyambitsa njira yotchedwa renin-angiotensin.
Kusintha kwa magazi uku kumapeto kwake ndipo kumapangitsa kuchepa mofulumira mu ntchito ya impso.
Kudziwa
Kuzindikira matenda a hepatorenal syndrome sikumayesa magazi mwachindunji. Kawirikawiri madokotala amachititsa kuti munthu asatuluke . Mwa kuyankhula kwina, munthu amakhoza kuyang'ana pa chithandizo chachipatala cha wodwala matenda a chiwindi akupereka ndi kulephera kwapadera kwapadera. Chofunika kwambiri kuti munthu adziwe kuti ndibwino kuti dokotala asapitirize kusokonezeka kwa impso si chifukwa cha zifukwa zina (kuchepa kwa madzi, zotsatira za mankhwala omwe angapweteke impso monga mankhwala a NSAID, kupweteka kwa chitetezo cha chitetezo cha chitetezo cha Hepatitis B kapena C, magetsi matenda, kulepheretsa, ndi zina zotero). Pomwe vutoli litakwaniritsidwa, timayamba poyesa kuchepa kwa ntchito ya impso pakuyang'ana pa zochitika zina zam'chipatala ndi mayesero:
- Mlingo wapamwamba wa creatinine m'magazi, womwe umagwirizanitsidwa ndi kuchepa kwa impso filtration rate (GFR)
- Gwiritsani ntchito mkodzo
- Mlingo wochepa wa sodium uli mu mkodzo
- Impso ultrasound, zomwe sizingasonyeze chirichonse, koma zikhoza kulepheretsa zifukwa zina za impso kulephera kwa wodwala amene akuganiza kuti ali ndi matenda a hepatorenal
- Kuyezetsa magazi kapena mapuloteni mu mkodzo. Maseŵera omwe salipo / osachepera amathandizira kuti matenda a hepatorenal syndrome azindikire
- Kuyankha kwa mankhwalawa kumagwiritsidwanso ntchito ngati "kubwereza" kuti mudziwe. Mwa kuyankhula kwina, ngati ntchito ya impso ikuwoneka bwino pambuyo pa "kuthamanga" (zomwe zingaphatikize kupereka odwala odwala m'madzi kapena kupiritsika kwa albumin), sichikhoza kukhala hepatorenal syndrome. Ndipotu, kukana mankhwala ochiritsira ameneŵa kumayambitsa kukayikira kuti matenda a hepatorenal alipo
Ndikufuna kutsimikiziranso kuti ngakhale kupezeka kwa impso sikungakhale kosavuta kwa wodwalayo ndi matenda aakulu a chiwindi kapena chiwindi. Ichi ndi chifukwa chakuti mayeso omwe timadalira kwambiri kuti tiwone ntchito ya impso, mlingo wa serum creatinine, sangathe kukweza odwala kwambiri m'mimba mwawo. Choncho, kuyang'ana pa digiri ya serum creatinine ikhoza kusokoneza wodwala matendawa chifukwa zidzatengera kuchepa kwa impso zolephera. Choncho, mayesero ena monga mzere wamakina 24 a creatinine angakhale oyeneranso kuthandizira kapena kutsutsa kukula kwa impso.
Mitundu
Ngati matendawa atsimikiziridwa pogwiritsira ntchito zomwe zili pamwambazi, madokotala adzaika matenda a hepatorenal syndrome mu Type-I kapena Type-II. Kusiyana kumeneku kumakhala pa kuuma komanso nthawi ya matenda. Mtundu Woyamba ndi mtundu waukulu kwambiri, womwe umagwiridwa ndi kuchepa kwakukulu (mopitirira 50%) mu ntchito ya impso pasanathe milungu iwiri.
Chithandizo
Tsopano popeza timadziwa kuti matenda a chiwindi amachotsedwa ndi matenda a chiwindi (ndi kutsekula kwa chiopsezo chokhala ndi pulogalamu yapamwamba kuti akhale wothandizira), zimakhala zosavuta kudziwa kuti kuchiza matenda a chiwindi ndi chinthu chofunika kwambiri komanso chithandizo cha mankhwala. Tsoka ilo, sizingatheke nthawi zonse. Ndipotu, pakhoza kukhala zipangizo zomwe palibe mankhwala kapena, monga momwe chiwonongeko cha chiwindi chimatha, kumene mankhwala (osati chiwindikiro cha chiwindi) sangagwire ntchito ngakhale. Pomalizira, pali nthawi ya nthawi. Makamaka mu mtundu wa I HRS. Choncho, ngakhale matenda a chiwindi angachiritsidwe, sikutheka kuyembekezera chithandizo chake kwa wodwala ndi impso zovuta kwambiri. Zikatero, mankhwala ndi dialysis zimafunika . Nazi zosankha zingapo zomwe tili nazo:
- Zaka zaposachedwapa, pakhala umboni wabwino wonena za ntchito ya mankhwala atsopano otchedwa terlipressin. Mwamwayi, sizipezeka mosavuta ku United States, ngakhale kuti ntchito yake ikulimbikitsidwa m'mayiko ambiri chifukwa cha matenda a hepatorenal syndrome. Zomwe timapeza apa, ndiye mankhwala omwe amatchedwa norepinephrine (mankhwala omwe amagwiritsidwa ntchito ku ICU pofuna kuthamangitsa magazi mwa anthu omwe ali ndi vuto lochepa kwambiri la magazi kuchokera ku mantha), komanso "zakudya zamagetsi" zomwe zimakhudza mankhwala atatu, otchedwa octreotide, midodrine ndi albumin (mapuloteni aakulu omwe ali m'magazi).
- Ngati mankhwalawa sakugwira ntchito, njira yothetsera vutoli yotchedwa TIPS (plajugular intrahepatic portosystemic shunt) ingakhale yopindulitsa, ngakhale kuti imabwera ndi mavuto ake omwe.
- Pomaliza, ngati chirichonse chikulephera ndipo impso zisabwerere, dialysis ikhoza kukhala yofunikira ngati "mlatho" mpaka matenda a chiwindi atha kuwongolera motsimikizika.
Kawirikawiri, ngati mankhwala omwe tatchulidwa pamwambawa sagwira ntchito mkati mwa milungu iwiri, chithandizo chingaoneke ngati chopanda phindu ndipo chiopsezo cha imfa chikukwera mwamphamvu.
Kupewa
Zimatengera. Ngati wodwalayo ali ndi matenda omwe amabwera chifukwa cha chiwindi ndi mavuto omwe amadziwika kuti ali ndi vutoli (monga momwe tafotokozera pamwambapa pa chiopsezo chachikulu cha odwala) a hepatorenal syndrome, njira zina zothandizira zothandizira zingagwire ntchito. Mwachitsanzo, odwala odwala matenda a chiwindi komanso amadzimadzi m'mimba (otchedwa ascites), akhoza kupindula ndi antibiotic yotchedwa norfloxacin. Odwala angapindule ndi kubwezeretsedwa kwa albumin.
> Zotsatira:
> Zochitika, zifukwa zowonongeka, ndi kutsekula kwa hepatorenal syndrome mu chisokonezo ndi ascites. Gines et al. Gastroenterology. 1993 Jul; 105 (1): 229-36.
> Terlipressin mu hepatorenal syndrome: Umboni wa zisonyezero zamakono. Rajekar ndi al JJ Gastroenterol Hepatol. 2011 Jan; 26 Suppl 1: 109-14. lembani: 10.1111 / j.1440-1746.2010.06583.x
> Primary prophylaxis ya bacteria peritonitis imachedwa kuchepetsa hepatorenal syndrome ndipo imapulumuka kupulumuka ku chiwindi. Fernández J. Gastroenterology. 2007 Sep; 133 (3): 818-24. Epub 2007 Jul 3.