ECMO-njira yopezera moyo kwa anthu odwala kwambiri-yayambira kutali
Ngakhale kuti tili kutali ndi chitukuko cha moyo wa Dark-Vaderesque, ECMO kapena kapangidwe ka memphane oxygenation yakhala yayitali muzaka zaposachedwa. Ngakhale poyamba njira yothandizira imathandizira ana akhanda, chiwerengero chowonjezeka cha akuluakulu akulandira ECMO, ndipo malo a ECMO akufalikira padziko lonse lapansi.
Malingana ndi bungwe lothandizira za moyo wa Extracorporeal Life (ELSO), lomwe limapitirizabe kugwira ntchito ku ECMO, kuyambira 1990, ECMO yathandiza anthu 58,842 padziko lonse, ndi chiwerengero chimenecho chikuwonjezeka chaka chilichonse.
Ngakhale kuti theka la milanduyi imakhudzana ndi mavuto opuma, ophatikizapo 10,426 amakhudzidwa ndi akuluakulu omwe ali ndi vuto la kupuma ndi mtima kapena kusowa kwa mapulaneti.
Kodi ECMO n'chiyani?
ECMO (AKA chithandizo chamoyo wapadera kapena ECLS) ndi njira yochepa yopereka moyo kwa anthu omwe akudwala kwambiri (kuganiza za mapapo kapena mtima wosalimba). Mwachindunji, ECMO imayambitsa mpweya m'magazi ndikuchotsa carbon dioxide. Ikhoza kupatsanso thandizo la magazi (hyper pressure). ECMO ndi njira yokhala ndi mbali yodalirika yamagalimoto ndipo imagwiritsidwa ntchito kunja kwa chipinda chogwirira ntchito. Makina odzaza ma cardiopulmonary (makina a mtima-lung) amagwiritsidwa ntchito kwa maola angapo panthawi yopaleshoni.
ECMO nthawi zambiri imagwiritsidwa ntchito kuthetsa nkhawa m'mapapo ndi mtima kwa masiku angapo, omwe amaphunzitsa kuti kuchiritsa. Amagwiritsidwa ntchito kwa odwala amene, ngati atangotengedwa mwamsanga, mwayi wawo wopulumuka ndi wabwino, ndipo ndani angakhale afe popanda ECMO.
Kuyambira mu 1944, ofufuza adazindikira kuti mwazi umene umadutsa m'magazi omwe sungathe kuzimitsidwa unakhala okosijeni. Kuwona izi kunayambira maziko a kupitirira kwa mtima kwa mtima. Poyamba, chombo cha cardiopulmonary bypass chinadalira kuphulika kapena disk oksijeni omwe anavumbula magazi mwachindunji mpweya. Zotsatira zake zowonongeka za hemolysis kapena kuwonongeka kwa maselo a magazi zomwe zimakhala zopindulitsa kwa maola ochepa kwambiri.
Mu 1956, kupangidwa kwa nthunzi yotetezera maselo kunakonza vutoli ndikukhazikitsa maziko a ntchito yambiri ya ECMO.
Nazi zotsatira za ECMO:
- wosakaniza kutentha
- membrane oxygenator
- kapu kapena centrifugal pampu
- zida zapakati
- Catheter yeniyeni yopezera malo (VV ECMO) imabweretsanso magazi ku vine cava kapena pa atrium yabwino, ndipo VA ECMO imabweretsanso magazi ku njira yowonongeka kudzera mu aorta kapena mitsempha yamtundu wa carotid)
Muzigawo zina, dera lofanana lokhala ndi mpweya wina ndi oxygenator limagwiritsidwa ntchito kuthandizira kutulutsa mpweya ndi carbon-dioxide. Mitengo imayenda chifukwa cha kuyang'anitsitsa kwapachipatala: matenda a magazi, chikhalidwe cha asidi, ntchito yotsiriza, ndi mawonekedwe oopsya. Dziwani kuti VA ECMO yokha imapereka chithandizo cha hemodynamic kapena magazi. Potsirizira pake, ngakhale kuti chombo chodzaza thupi chodzaza chimagwedezeka mu chipinda chogwiritsira ntchito pansi pa anesthesia ambiri, ECMO imakhala ikugwiritsidwa ntchito pogwiritsa ntchito anesthesia.
Odwala omwe ali pa ECMO nthawi zambiri amadwala kwambiri, ndipo si onse omwe amapulumuka pazochitikazo. Mu 2013, ELSO inanena kuti padziko lonse lapansi, anthu 72 pa anthu 100 aliwonse ndi amene adapulumuka ku ECMO, ndipo izi zimawerengedwa kwambiri pofuna kuthandiza anthu omwe ali ndi vuto lopweteka m'mapapo.
(Kumbukirani kuti mwana ali ndi mapapu atsopano ndipo nthawi zambiri amalowa mu ECMO popanda chiwonongeko kapena kupweteka kwa mapapo ngati anthu akuluakulu.) Komanso, ngakhale kuti 72 peresenti ya anthu onse anapulumuka ku ECMO, 60% ankayesedwa kuti azikonda ana obadwa kumene. Makamaka, 56 peresenti ya anthu akuluakulu omwe ali ndi vuto la kupuma amapangitsa kuti azitha kutulutsa kapena kusintha.
Zoipa za ECMO zimaphatikizapo kutuluka kwa mkati ndi kunja komwe, matenda, thrombosis (magazi owopsya amawombera mkati mwa mitsempha ya mitsempha ya magazi) ndi kupopera mpweya. Pofuna kuthetsa vuto la thrombosis, zigawo za ECMO zimayikidwa mu heparin, magazi owonda.
Kodi ECMO Imagwiritsa Ntchito Liti?
Nazi zina zomwe ECMO imagwiritsiridwa ntchito kwa ana obadwa:
- Pitirizani kukhala ndi pang'onopang'ono kwambiri kwa mwana watsopano (PPHN)
- matenda a aspirin a neonatal
- Chibayo kapena matenda ena oopsa
- nthendayi yokhayokha
- matenda opatsirana mtima
Nazi zina zomwe ECMO imagwiritsidwa ntchito kwa ana okalamba:
- Kukonzekera kwa mtima kumbuyo
- aspiration chibayo
- chibayo
- sepsis
- poizoni
- pafupi-kumiza
- mphumu yaikulu
- poizoni
Kugwiritsiridwa ntchito kwa ECMO ndiko kupeza njira yopita kuchipatala chachikulire. Ngakhale kuti pali umboni wochuluka wosonyeza kuti zonsezi zikugwiritsidwa ntchito padziko lonse lapansi (kuti tifunikire mayesero akuluakulu othandizira kuti tipeze njira zogwirira ntchito zonse), malipoti, nkhani zotsatizana ndi zina zotero zikuchitika zomwe zikusonyeza kuti ECMO ikhoza kukhala yothandiza pazinthu zosiyanasiyana mikhalidwe. Zolemba, ngakhale kuti palibe zotsutsana zogwiritsiridwa ntchito kwake, zotsutsana zina zogwirizana, mwazinthu zomwe zimagwirizana ndi lingaliro la akatswiri, zakhala zikuperekedwa kuphatikizapo mphamvu yowononga chitetezo (kuteteza thupi), kutaya magazi koopsa (chizindikiro chogwiritsidwa ntchito), ukalamba komanso mkulu wa BMI.
Nazi zina zomwe ECMO imagwiritsidwa ntchito kwa akuluakulu:
- mtima wam'mwamba umamangidwa kuti ukhale wopweteka kwambiri
- mtima kulephera
- Kupuma kwapachilombo koyambitsa matenda opatsirana (ARDS) kapena kachilombo ka H1N1
Zina ziwiri zowonjezera pa ECMO monga momwe zimakhudzira akuluakulu. Choyamba, mosiyana ndi mpweya wabwino, ECMO imapewa kuwononga mapapu kudzera mu zoopsa (barotrauma) kapena atelectasis (kugwa kwa mapapo). Chachiwiri, kufufuza kwa meta (kufufuza kafukufuku) kumasonyeza kuti ECMO ikhoza kukhala yopindulitsa kwenikweni kwa iwo omwe amalandira mtima, omwe ali ndi matenda a virusi (matenda a mtima) ndi omwe ali ndi arrhythmias omwe alephera kuvomereza mankhwala ochiritsira.
Pamapeto pake, ECMO mwina ndi mankhwala omwe simukuyenera kukumana nawo m'moyo wanu kapena miyoyo ya okondedwa anu omwe ali ndi mwayi; ECMO ndi yaikulu komanso yosungiratu anthu omwe akudwala kwambiri. Komabe, ECMO ikuimira njira yatsopano yolonjezera kuthandiza anthu ambiri. Ngakhale kuti sitidzakhala ndi moyo wothandizira zida monga Darth Vader, tikukonzanso kumvetsetsa kwathu komwe kumakhala panthawi yochepa.
Zotsatira
"Membrane Yopangidwira Kwambiri Oxygenation ya Kulephera Kupewa Kupewa Kwa Achikulire" (mutu wa buku) ndi JL Cameron ndi AM Cameron kuchokera ku Current Surgical Therapy .
Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS. Chisamaliro Chovuta ndi Chisautso. Mu: Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS. eds. Williams Obstetrics, Chigawo Chamasanu ndi Zinayi . New York, NY: Hill ya McGraw; 2013. Inapezeka pa November 18, 2014.
Darst JR, Collins KK, SD Miyamoto. Matenda a Mtima. Mu: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ. eds. Kufufuza Koyamba ndi Kuchiza: Matenda, 22e . New York, NY: Hill ya McGraw; 2013. Inapezeka pa November 18, 2014.
"Ndi chiyani chatsopano mu ECMO: ndikulemba zizindikiro zoipa" ndi Ken Parhar ndi Alain Vuylsteke kuchokera ku Mankhwala Okhudzidwa Kwambiri atafalitsidwa pa 9/3/2014. Idapezeka kuchokera ku PubMed pa 11/17/2014.
Masikelo DC, Granton JT. Mutu 90. Wodwala Wosakaniza. Mu: Hall JB, Schmidt GA, Wood LH. eds. Mfundo Zothandiza Zosamalidwa, 3e . New York, NY: Hill ya McGraw; 2005. Ifikira pa November 18, 2014.