ECMO-hanyar hanyar tallafi ga mutane marasa lafiya - ya zo mai tsawo
Ko da yake muna da nisa daga ci gaba da tsarin tallafi na rayuwar Dark-Vaderesque, ECMO ko ƙananan kwakwalwar jikin mutum ya kasance mai tsawo a cikin 'yan shekarun nan. Ko da yake a farkon hanyar hanyar farfado da ake amfani dasu don taimakawa jariran jarirai, yawancin manya suna karɓar ECMO, kuma cibiyoyin ECMO suna tasowa a duk faɗin duniya.
Bisa ga Ƙungiyar Taimako na Ƙarƙashin Ƙarƙashin Ƙarƙwara (ELSO), wanda ke rike da shafuka masu gujewa a kan ECMO, tun daga shekarar 1990, an yi amfani da ECMO don taimaka wa mutane 58,842 a duk faɗin duniya, tare da lambar ta karu a kowace shekara.
Kodayake kusan rabin waɗannan lokuta sun haɗa da matsaloli tare da matsaloli na numfashi, halayen da ake haɗu da su 10,426 ya hada da manya da matsaloli na zuciya da na zuciya ko kuma bukatar bugun jini na huhu.
Menene ECMO?
ECMO (AKA goyon bayan rayuwar jiki ko ECLS) wani gajeren lokaci na samar da goyon bayan rayuwa ga mutanen da ke fama da rashin lafiya (tunanin ƙwaƙwalwa ko ƙin zuciya). Musamman, ECMO ya sa oxygen cikin jini kuma ya kawar da carbon dioxide. Hakanan zai iya samar da goyon bayan hemodynamic (karfin jini). ECMO wata hanya ce ta wucewa na kwakwalwa ta jiki kuma ana amfani dasu a waje da ɗakin aiki. Cikakken na'urorin inji na zuciya (na zuciya-huhu) suna amfani ne kawai don 'yan sa'o'i kadan a lokacin tiyata.
Ana amfani da ECMO sau da yawa don ɗaukar damuwa daga cikin huhu da zuciya na kwanaki da yawa, wanda akasin haka yana inganta warkarwa. An yi amfani da shi a marasa lafiya wadanda, idan aka bi da su, ba su da wata rayuwa mai kyau, kuma wanda zai mutu ba tare da ECMO ba.
Tun daga shekarar 1944, masu bincike sun gane cewa jini yana wucewa ta jikin membranes ya zama oxygenated. Wannan kallo ya zama tushen hanyar kewaye da kwayoyin halitta. Da farko, zagaye na cardiopulmonary ya dogara ne akan kumfa ko kuma iska mai kwakwalwa wanda jini wanda ke nunawa kai tsaye zuwa iska. Wani mummunar tasirin wannan tsari na farko shine ya shafi hemolysis ko lalata jini wanda ke iyakance amfaninta zuwa wasu 'yan sa'o'i a mafi yawancin.
A shekara ta 1956, ci gaba da samfurin oxygenator ya gyara wannan matsala kuma ya kafa tushe don amfani da ECMO mai tsawo.
Ga waɗancan abubuwa na al'ada ECMO:
- mai musayar zafi
- membrane oxygenator
- abin nadi ko centrifugal famfo
- tubing mai zagaya
- masu kama da ƙayyadaddun wurin shafukan yanar gizo (VV ECMO ya sake dawo da jini zuwa ga tsarin mugunta ta hanyar kariya mai mahimmanci ko tafin dama, kuma VA ECMO ya sake dawo da jini zuwa tsarin tsarin ta hanyar aorta ko carotid carotid)
A wasu saitunan, an yi amfani da wani tsari mai layi tare da wani famfo da oxygenator don taimakawa tare da oxygenation da cire carbon-dioxide. Ana gyara tsabar farashin bisa tsarin kulawa na gida mai rashin lafiya: jinin jini, matsayi na acid, aiki na ƙarshen, da kuma ƙwayar wuta. Na bayanin kula, kawai VA ECMO na bada hemodynamic ko tallafin jini. A ƙarshe, kodayake zagaye na kwakwalwa ta tsakiya yana ƙuƙuwa a cikin ɗakin aiki a ƙarƙashin ƙwayar rigakafi, ECMO an kafa shi ne ta hanyar amfani da cutar ta gida.
Marasa lafiya da ke cikin ECMO yawanci suna da lafiya sosai, kuma ba kowa ya tsira ba. A shekara ta 2013, ELSO ya ruwaito cewa a duniya duka kashi 72 cikin 100 na mutanen da suka tsira daga ECMO tare da wannan ƙididdiga da aka yi nauyi a kan waɗanda ba su da yawa waɗanda ke da ƙananan ciwo na huhu wanda zai shiga cikin hanya.
(Ka tuna cewa jaririn yana da sabon huhu kuma ta shiga cikin ECMO sau da yawa ba tare da haɗuwa ba ko kuma haɗuwa tare da hanta na huhu). Bugu da ƙari, ko da yake kashi 72 cikin 100 na dukan mutane sun tsira daga ECMO, kawai kashi 60 ne kawai ya sanya shi don fitarwa ko canja wuri-sake wannan maƙallafi an auna nauyi ga jarirai. Musamman, kawai kashi 56 cikin dari na manya da matsaloli na numfashi ya sanya shi don fitarwa ko canja wuri.
Hanyoyin cututtukan ECMO sun haɗa da zubar da jini na ciki da na waje, kamuwa da cuta, thrombosis (rugun jini da jini a cikin jini) da kuma gazawar famfo. Don magance barazanar maganin thrombosis, ana gyara naurorin ECMO a hebarin, jinin jini.
Yaushe ake amfani da ECMO?
Ga wasu yanayi inda aka yi amfani da ECMO cikin jarirai:
- ciwon hauhawar jini na babba (PPHN)
- neonatal meconium aspiration ciwo
- Ciwon huhu ko wasu kamuwa da cuta mai tsanani
- ƙarancin haɗin gine-gine na al'ada
- cututtukan zuciya
Ga wasu yanayi inda aka yi amfani da ECMO a cikin yara tsofaffi:
- gyare-gyaren zuciya na post-op
- fatawa ciwon huhu
- ciwon huhu
- sepsis
- guba
- kusa-nutsewa
- babban fuka
- guba
Amfani da ECMO yana gano hanyarsa zuwa likita mai girma. Kodayake akwai hujjoji da ke nuna goyon bayanta na duniya (wato muna bukatar manyan gwaje-gwajen da ba zazzabi ba don muyi jagorancin jagorancin duniya), rahotanni, binciken nazari da sauransu suna fitowa wanda ya bada shawarar cewa ECMO na iya amfani da shi a fannoni daban daban. yanayi. Bayanin kulawa, kodayake babu cikakkiyar takaddama don amfani da shi, wasu maganganun zumunta, a bangare bisa la'akari da ra'ayoyin masana, an nuna su ciki har da tsarin raunin da ya raunana (immunosuppression), hadarin jini mai tsanani (alama coagulopathy), tsofaffi mai girma da kuma BMI.
Ga wasu yanayi da aka yi amfani da ECMO a cikin manya:
- an kama shi a karo na biyu zuwa ga wani mummunan ƙwayar cuta na wucin gadi ko kuma embolism na wucin gadi
- ƙin zuciya
- rashin lafiya na numfashi na biyu don nuna rashin lafiya na numfashi (ARDS) ko cutar H1N1
Ƙari biyu na raguwa akan bayani game da ECMO kamar yadda ya shafi manya. Na farko, ba kamar magunguna ba, ECMO na guje wa lalata kwayoyin cutar ta hanyar rauni (barotrauma) ko atelectasis (ruguwar rugu). Na biyu, meta bincike (bincike mai bincike) ya nuna cewa ECMO na iya amfani da ita ga masu karɓar zuciya, waɗanda ke dauke da kwayar cutar kwayar cuta (cututtukan zuciya da cututtukan zuciya) da wadanda suke da maganganun da ba su dace da maganin magani ba.
A bayanin karshe, ECMO wataƙila wata magani ce ba za ku taba saduwa da rayuwarku ba ko rayuwar rayukanku waɗanda suke da sa'a; ECMO mai tsanani ne kuma an adana wa marasa lafiya. Kodayake, ECMO tana wakiltar sabuwar hanyar da za ta taimaka wa mutane da yawa. Kodayake ba zamu iya samar da tsarin tallafiyar rayuwa ba wanda ya zama daidai da kayan aikin makamai na Darth Vader, muna ƙara sake fahimtar fahimtar bayanan rayuwar dan lokaci.
Sources
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