Osasankha dialysis ndizovuta, koma zotsatira zake ndi zotani
Odwala omwe ali ndi matenda a impso oyandikira omwe ali pa siteji 5 ali ndi zisankho ziwiri pankhani yothetsera matenda awo, mwina kuyamba kuyambitsa mtundu wina wa dialysis (pakati pa hemodialysis yomwe imapezeka kwambiri ku US, kapena home dialysis yomwe ingakhale hemodialysis kapena peritoneal dialysis ), kapena kutenga impso. Koma bwanji ngati wodwala sangathe, kapena sakufuna chilichonse mwazifukwazi.
Kodi chimachitika n'chiyani ngati wodwala ali ndi impso kulephera kulandira dialysis kapena kumuika? Kodi angayembekezere kukhala ndi moyo mpaka liti? Nkhaniyi iyankha mafunso angapo awa.
Kusasankha DIALYSIS N'CHOFUNIKA KUSANKHA KUKHALA, KOMA KOMANSO KUKHALA WOTSATIRA PATIENT
Kusankha yemwe ali "wodwala woyenera" ndi chisankho chomwe chingakhale chotsalira pa zokambirana pakati pa wodwala ndi nephrologist wawo. Mwachikhalidwe, pamene odwala sankaonedwa kuti ndi odwala dialysis, asayansi amatha kunena kuti, "sitidzasiya dialysis kwa Ms. X". Komabe, kunena "kuletsa" kuli ndi malingaliro oipa (ganizirani kuti "tidzasiya kulembetsa moyo, ndi zina zotero"). Kwa wodwalayo komanso banja lawo, zimapereka chitsimikizo chakuti dokotala sadzatipatsa chilichonse ndipo timayang'anira mpaka wodwalayo afa. Komabe, izi sizingapitirire kuchokera ku choonadi popeza mavuto ambiri a matenda a impso angathe ndipo ayenera kuyendetsedwa ndi mankhwala.
Mwa kuyankhula kwina, a nephrologists akanatha kupereka zambiri; Chosavuta kwambiri kumangotengera wodwala kuchipatala cha dialysis. Ndipo kotero, kuti muyankhulane bwino zomwe zikuchitikabe-zomwe zingatheke kwa wodwala, nthawi yoyenera yosamalira dialytic ya kugunda kwa impso yomwe tsopano ikugwiritsidwa ntchito ndi Maximal Conservative Management (MCM) .
Izi zikufotokozedwa mwatsatanetsatane apa.
NDANI WOTSATIRA KUKHALA KUDZIWA KUKHALA KUDZIWA KUDZIWA NDI CHIFUKWA CHIYANI SALI WONSE WINA?
Osati wodwala aliyense angapange mgwirizano wabwino wa MCM, ndipo zosankha zina zingakhale zoyenera kwambiri. Gulu loyendetsa bwino ndiloyenera ku malo osiyanasiyana. Izi zingaphatikizepo ukalamba ndi zofooka, matenda a dementia oopsa, kukhalapo kwa matenda ena aakulu monga matenda a mtima kapena khansa ya mthempha, etc. Muzochitika zotere, n'zovuta kufotokozera ngati dialyse idzawonjezera chirichonse pa umoyo / kuchuluka kwa moyo. Ndipo kawirikawiri, odwala akungoyang'ana "chithunzi chachikulu", makamaka ngati nthawi ya moyo ndi yoperewera.
Komabe, MCM si aliyense. Odwala ayenera kuphunzitsidwa kuti pali mavuto ambiri a impso omwe amatha kuchiritsidwa ndi mapiritsi, ndipo zizindikiro zina / zizindikiro zidzangowonjezera dialysis. Izi zili choncho chifukwa zotchedwa kuti uremic poizoni zomwe zimagwiritsidwa ntchito mu impso zomwe zimatha kusokonekera komanso chifukwa cha mavuto ambiri sichidzachotsedwa ndi chisamaliro chodziletsa (ngakhale ngakhale dialysis sichichotsa onsewo). Wodwala ndi dokotala angafunikire kukhala limodzi kuti agwire zoyembekezera ndikukonzekera dongosolo la chisamaliro.
Ndipo pamene nkhaniyo ikukhudzana ndi kuyembekezera, mafunso awiri nthawi zambiri amachokera kwa odwala omwe akukana dialyse:
- Ndingamve bwanji ngati ndakana dialysis?
- Kodi moyo wanga ukanafupikitsidwa ngati ndimakana dialyse?
Chifukwa cha kuchuluka kwa deta, izi sizili mafunso osavuta kuyankha. Koma tili ndi deta yambiri yopezera chiyembekezo cha moyo kwa odwala omwe amasankha dialysis. Malingana ndi lipoti la United States Renal Data System, kupulumuka kwa odwala pa dialysis kumatha kusiyana zaka 8 (kwa odwala 40 mpaka 44) mpaka zaka 4.5 (odwala pakati pa 60 mpaka 64). Izi ndizomwe zimakhala zowonjezereka, zomwe zimawoneka malinga ndi msinkhu, zakudya, komanso kukhalapo kwa matenda ena omwe alipo monga matenda a mtima, khansara, ndi zina zotero.
Ndikufuna ndikuwonetseni galasi yomwe ikufanizira momwe munthu wachikulire wazaka 55 aliri ndi kuyembekezera kwa odwala omwe ali ndi dialysis, kapena amene walandira impso.
KUKHALA NDI MOYO WOSATHA NDI MOYO NDI NDIPONSO OSAMASANKHA
Tiyeni tiwone kafukufuku amene ayesa kuyerekeza kupulumuka pakati pa magulu awiriwa. Kuphunzira kwa odwala omwe ali ndi matenda a impso 5 omwe anali ndi zaka 80 anafotokoza moyo wautali womwe unali miyezi 20 (miyezi 29 ndi miyezi 9) kwa odwala omwe akusankha dialysis. Kafukufuku wina amene amafanizira kupulumuka pakati pa odwala omwe anasankha dialysis ndi omwe amasankha oyang'anira okhazikika amawonanso kupulumuka kwa odwala omwe anasankha dialysis. Odwala onse anali osachepera zaka 75. Zomwe zinapulumuka zaka 1 zinali 84 peresenti pagulu losankha dialysis ndipo 68% mwa gululo akusankha osagwiritsidwa ntchito ndi dialytic. Mmodzi akhoza kutengera kuchokera ku deta iyi yomwe odwala akulephera kulemba dialysis nthawi zambiri amakhala ndi moyo wautali.
Komabe, zomwe zili pamwambazi ndizo lingaliro losavuta. Odwala omwe ali ndi matenda a impso ambiri amatha kukhala ndi matenda akuluakulu monga matenda a mtima, shuga, khansa, ndi zina; zomwe madokotala amatcha "co-morbidities" . Ndipo kotero, ngati tiyang'ananso deta yomwe talongosola pamwambapa, tikuzindikira kuti chiyembekezo cha moyo kwa odwala omwe ali ndi matenda ena omwe amakhalapo monga matenda a mtima wosagwirizana kwenikweni sichinafanane; kaya amasankha dialysis kapena ayi ! Mwa kuyankhula kwina, mwa wodwala amene ali ndi co-morbidities ovuta, moyo ukhoza kutsimikiziridwa kwambiri ndi zikhalidwe izi kuposa ngati wodwalayo ali ndi dialyzed kapena ayi. Uthenga wotenga kunyumba ndi wakuti dialysis idzawonjezera moyo wanu malinga ngati mulibe matenda ena akuluakulu omwe atchulidwa pamwambapa. Ndidzakulangizani ku Chithunzi chachiwiri kuchokera m'nkhani ino yomwe imalimbikitsanso zomwe takambirana.
Pomaliza, ndiloleni ndifotokoze ziwerengero zofunika (mfundo apa, apa, ndi apa). Kawirikawiri moyo umatha munthu wodwala kale dialysis atachotsedwa pa dialysis masiku asanu ndi limodzi kapena asanu ndi atatu, koma kusiyana kwakukulu kumatha kusintha pakati pa masiku awiri mpaka masiku zana limodzi.
ZOKHUDZA NTCHITO NDI CHIKHALIDWE CHA MOYO OSATI DIALYSIS
Kwa odwala omwe sanasankhe chisamaliro cha dialysis atatha kukambirana ndi a nephrologists, funso lodziwika lomwe limabwera ndi, "Ndingamve bwanji"? Odwala ambiri akudandaula kwambiri ndi izi kusiyana ndi kuchepetsa kuthekera kwa moyo.
Mu 1949, Dr. David Karnofsky adalongosola chiwerengero (100 kukhala munthu wathanzi, ndi 0 kutanthawuza imfa) yomwe ingagwiritsidwe ntchito moyenera kuyeza momwe odwala alili ndi khansa. Pakali pano ntchitoyi ikugwiritsidwa ntchito poyesa kuchuluka kwa kuchepa kwa matenda a impso odwala omwe amasungidwa mosamala popanda dialysis. Nkhaniyi (onani chithunzi 1) ikufotokoza zomwe okalambawa angakhale nazo kuchokera m'moyo wapadera m'chaka chatha cha moyo wawo. Chokondweretsa ndikudziwa kuti odwalawa angafunike kuthandizidwa pokhapokha m'mwezi watha wa moyo wawo, pambuyo pake adzawona kuchepa kwakukulu pa ntchito yawo, motero pang'onopang'ono amafunikanso chisamaliro chapadera / kuvomereza kuchipatala. Kuchuluka ndi nkhaniyi kumatithandiza kuzindikira zambiri zomwe tingayembekezere pamene odwala akulephera kuyang'ana mtsogolo ndikusankha moyo popanda dialysis. Chimene ndikufuna kutsindika apa ndi chakuti izi zikugwirizana ndi lingaliro lakuti odwala amasamalidwa mosamala, mosaganizira. Izi ndi zomwe timazitcha Maximal Conservative Management (MCM) ndipo apa pali mfundo zake.