Ngati munauzidwa kuti muli ndi empyema, zimatanthauzanji? Kodi zimayambitsa matendawa ndi ndani omwe ali pangozi? Kodi ndi njira zotani zothandizira mankhwala zomwe zilipo ndipo kodi mumagwiritsa ntchito mankhwala otani?
Tanthauzo
An empyema ndi mndandanda wa pus pakati pa magawo awiri a minofu ( pleura ) mzerewu m'mapapu. Chowopsa kwambiri chimakhala ngati vuto la chibayo, kupuma kwa mapapo, kapena chifuwa chachikulu.
Anatomy
Malo osungirako zida kapena malo omwe ali pakati pa visceral pleura (nembanemba kunja kwa mapapo) ndi parietal pleura (nembanemba yomwe ili mkati mwa khoma la chifuwa. Pali masipuni a tizilombo tomwe timapempha tizilombo toyambitsa chithandizo. M'madera ena, malowa akhoza kukhala ndi timadzi kapena timadzi ta tizilombo toyambitsa matenda.
Matenda a Empyema
Madzi otchedwa empyema amatchulidwa ngati pus ndipo ali ndi kuphatikiza mabakiteriya, maselo akufa, ndi maselo oyera. Mabakiteriya ambiri omwe amachititsa empyema ndi Streptococcus pneumoniae (mabakiteriya a "chibayo") ndi Staphylococcus aureus .
Pamene chithunzi cha mchere chikufufuzidwa, mitambo ndi mawonekedwe wandiweyani a empyema kawirikawiri zimakhala zoonekeratu momwe zimasiyanitsira ndi zowonongeka zamadzimadzi zomwe ziri zochepa komanso zochepa.
Zizindikiro ndi Zizindikiro
Zizindikiro zokhudzana ndi empyema zimayambitsidwa chifukwa cha kukhalapo kwa matenda ndi kupanikizika pamapapu ndi chifuwa kuchokera kuwonjezeka kwa madzi m'dzinthu. Zizindikiro ndi zizindikiro zimaphatikizapo:
- Kutentha ndi kuzizira
- Kutuluka kwa usiku: Izi zikhoza kukhala zofunikira kwambiri ndi kutulutsa thukuta usiku umene ukufuna kusintha zovala usiku
- Chifuwa cha chifuwa, nthawi zambiri chakuthwa ndipo chimapweteka ndi kudzoza
- Kupuma pang'ono: Kuvuta kupuma kungabwere pang'onopang'ono kapena mofulumira malingana ndi kukula kwa kuwonongeka ndi kuopsa kwake
- Chifuwa chowuma: Chifuwa chingathenso kubala chifukwa cha chibayo
- Mafupa: Kuwopsya kwa mitsempha ndi mitsempha m'dera lino chifukwa chakumanga kwa madzimadzi kungabweretse
- Kutaya kwa kulemera kwa thupi (kutayika kosafuna mwangozi)
- Kutopa
- Kukhala ndi moyo wamba wosakhala bwino
Zimayambitsa
Pali zikhalidwe zosiyanasiyana zomwe zingabweretse mavuto. Ena mwa awa ndi awa:
- Chibayo (Ichi ndicho chifukwa chofala kwambiri cha empyema.)
- Chifuwa cha chifuwa.
- Opaleshoni yamphongo, monga khansara yamapapo.
- A thoracentesis: Nthawi zina matenda amatha kuchitika mosazindikira pamene thoracentesis (phokoso la singano la phokoso lamkati) lachitidwa kuti apeze matenda kapena pamene chifuwa cha chifuwa chimayikidwa (monga pneumothorax) kapena madzi (monga mu chithunzithunzi chachisoni.)
- Fistula ya bronchopleal: Fistula ya bronchoplegu ndi fistula kapena ngalande yomwe ingapangidwe pakati pa malo achinyengo ndi bronchi panthawi ya opaleshoni ya mapapo, kuti mabakiteriya apitirire kuchoka ku bronchi kupita ku malo osungirako.)
- Kuchulukitsa kwa matenda: Matenda m'mimba (peritonitis) kapena malo pakati pa mapapo (mediastinitis) akhoza kufalikira mu malo opempherera.
- Kupumula kwa mapapo kungapatuke kumalo osalimba.
Zowopsa
An empyema amapezeka kwambiri kwa munthu amene ali ndi:
- Matenda a shuga
- Mbiri ya uchidakwa
- Matenda osokoneza bongo monga matenda a nyamakazi
- Chitetezo cha m'thupi, monga chemotherapy
- Matenda opweteka monga COPD ndi matenda a bronchitis
- Matenda a reflux a m'mimba
Kudziwa
Pofuna kudziwa kuti vutoli ndi lovuta, madokotala amayamba kafukufuku wosamalitsa ndikuyamba kuyeza. Mbiri yakale ikhoza kuthandizira kudziwa ngati pali zifukwa zilizonse zoopsa, ndipo kuunika kwa thupi kungasonyeze kuti phokoso limakhala lochepa. Pambuyo pake, chifuwa cha x-ray kapena chifuwa cha CT chikuchitidwa kuti apitirize kufufuza mapapo.
Nthaŵi zina komanso ultrasound angapangidwenso. Kuti mudziwe ngati mabakiteriya alipo, komanso kuti mudziwe kuti antibiotic ndi mabakiteriya awa ndi otani, thoracentesis imatengera chitsanzo cha empyema (madziwo akhoza kuthiridwa.) Madzi otumizidwa amatumizidwa ku labu kuti Kuchita kafukufuku wamadzimadzi, kuyesa zomwe zili mu madzi. Mayeso a magazi angaperekedwe kuti ayang'ane umboni wa matenda.
Njira Zothandizira
Chithandizo cha empyema chikhoza kuphwanyidwa pansi; Njira yoyamba ndiyo kuchotsa madzi, kenako matendawa ayenera kuchiritsidwa.
Kutuluka kwa madzi: Madzi amachotsedwa kudzera pa thoracentesis. Nthawi zina izi zimakhala zophweka, makamaka ngati empyema sakhalapo kwa nthawi yayitali. Chida chofufuzira chingathe kuikidwa kuti apitirize kukhetsa madzi.
Pamene mphema yakhalapo kwa kanthaŵi, ingathe kupezeka. Izi zimachitika pamene zimakhala zofiira ndipo zimasiyanitsa madziwa kuti akhale osiyana. Izi zimapangitsa kuti madziwa asakhale ovuta kwambiri, ndipo nthawi zina amayesetsa kuchotsa madzi.
Kuchiza matenda: Madokotala amayamba mankhwala opha tizilombo atangotengedwa. Anthu ena amadabwa chifukwa chake osati pomwepo, koma kuyamba kwa mankhwala opha tizilombo kawirikawiri kumachedwa kuchepa kuti apange labu mwayi wabwino wodziwa bwino mabakiteriya omwe akuyambitsa matendawa. (Ngati maantibayotiki ayambitsidwa musanayambe thoracentesis, zingakhale zovuta kudziwa mabakiteriya omwe ali ndi kachilombo ka HIV.) Mukayamba mankhwala ophera tizilombo, labu idzachita mayesero ena kuti ayang'ane ma antibayotiki omwe mabakiteriya ali ovuta kwambiri. Mankhwala opha majeremusi omwe mumapatsidwa akhoza kusintha pambuyo pa masiku angapo.
Mavuto / Opaleshoni
Ndi empyema, makamaka yomwe yakhalapo kwa kanthaŵi, minofu yowopsya ingamange. Zingakhale zofunikira kuti dokotala wa opaleshoni amuchotsere ziwalo zofiira ndi mbali zina za pleura kuti athetse matendawa. Izi zikhoza kuchitidwa kupyolera mu thoracotomy (opaleshoni ya m'mapapo yotseguka) kapena opaleshoni yokhala ndi opaleshoni (opaleshoni yochepa ya mapapo,) ndi zokongoletsera zamagetsi zogwiritsa ntchito mavidiyo kukhala njira yowonongeka komanso yopanda mphamvu kwa anthu ambiri. Kuwonjezera apo, kafukufuku waposachedwapa apeza kuti njira zopanda opaleshoni nthawi zambiri zimakhala zothandiza monga njira yopaleshoni ya mankhwala a empyema. Zovuta zina zingaphatikizepo sepsis-matenda opweteka kwambiri m'thupi, ndi kupweteka ndi kuphulika kwa zidutswa zowonjezera.
Kuthamangitsani
Chizindikiro cha empyema chimadalira makamaka chifukwa chomwe chimayambira.
Pansi
Mawu akuti empyema amagwiritsidwa ntchito pofotokozera kukhalapo kwa madzi okhudzana ndi kachilombo koyambitsa matenda m'mapapo. Chowopsa kwambiri ndi chibayo, koma zikhalidwe zina, komanso opaleshoni ndi zoopsa, zingakhale ndi udindo. Chithandizo chimaphatikizapo kutengera nyemba ya madzi kuti imatumize ku labu ndikuchotsa madzi owonjezera omwe angapangitse kupuma pang'ono ndi zizindikiro zina. Mankhwala opha tizilombo amaperekedwa kuti athetse matendawa.
Kutchulidwa: em-pie-ee-ma
Amatchedwanso : pyrothorax, matenda opatsirana, purulent pleuritis, empyema thoracis
Zitsanzo: Jerry anakhazikitsa empyema pambuyo pa opaleshoni yake ya khansa ya m'mapapo, ndipo dokotala wake anachita njira yothetsera madzi.
> Zotsatira:
> McCauley, L, ndi N. Dean. Chibayo ndi empyema: causal, wamba kapena wosadziwika. Journal of Thoracic Disease . 2015. 7 (6): 992-8.
> National Library of Medicine. MedlinePlus. Empyema. Kusinthidwa 02/15/15. https://medlineplus.gov/ency/article/000123.htm
> Redden, M., Chin, T., ndi M. van Driel. Kupanga Opaleshoni Kupanda Kusamalira Opanda Opaleshoni kwa Pleural Empyema. Dongosolo la Cochrane la Zosintha Zogwirizana . 2017. 3: CD010651.
> Zanotti, G., ndi J. Mitchell. Zida zamtundu wa Fistula ndi Empyema Pambuyo pa Chiyanjano cha Anatomic Lung. Zipatala Zopha Opaleshoni . 2015. 25 (4): 421-7.