Kuzindikira msanga matenda a m'magazi

Matenda a m'magazi (BSI) amatanthawuza za systemic inflammatory reaction syndrome yomwe imabwera chifukwa cha kuukira kwa tizilombo toyambitsa matenda osiyanasiyana ndi poizoni wawo m'magazi.

Njira ya matendawa nthawi zambiri imadziwika ndi kuyambitsa ndi kumasulidwa kwa oyimira pakati otupa, kuchititsa mndandanda wa zizindikiro zachipatala monga kutentha thupi, kuzizira, tachycardia kupuma movutikira, zidzolo ndi kusintha maganizo, ndipo pazovuta kwambiri, mantha, DIC ndi Mipikisano. -kulephera kwa chiwalo, ndi chiwopsezo chachikulu cha kufa. adapeza HA) milandu ya sepsis ndi septic shock, yomwe imawerengera 40% ya milandu ndipo pafupifupi 20% ya ICU idapeza milandu. Ndipo zimagwirizana kwambiri ndi kusazindikira bwino, makamaka popanda mankhwala oletsa tizilombo toyambitsa matenda panthawi yake komanso kuyang'anira matenda.

Gulu la matenda a m'magazi malinga ndi kuchuluka kwa matenda

Bacteraemia

Kukhalapo kwa mabakiteriya kapena bowa m'magazi.

Septicemia

The Clinical Syndrome chifukwa cha kuukira kwa mabakiteriya a pathogenic ndi poizoni wawo m'magazi, ndi matenda oopsa a systemic..

Pyohemia

Kukanika kwa chiwalo choyika pachiwopsezo chifukwa cha kusokonekera kwa momwe thupi limayankhira matenda.

Zomwe zimadetsa nkhawa kwambiri zachipatala ndi matenda awiri otsatirawa omwe amakhudzidwa.

Matenda apadera okhudzana ndi magazi a Catheter

Matenda a m'magazi okhudzana ndi ma catheter omwe amaikidwa m'mitsempha yamagazi (mwachitsanzo, ma catheter a venous catheter, catheter yapakati, ma catheter a arterial, dialysis catheters, etc.).

Special Infective endocarditis

Ndi matenda opatsirana chifukwa cha kusamuka kwa tizilombo toyambitsa matenda ku endocardium ndi mtima mavavu, ndipo amakhala ndi mapangidwe redundant zamoyo mu mavavu ngati mawonekedwe a pathological kuwonongeka, ndi embolic matenda metastasis kapena sepsis chifukwa redundant zamoyo kukhetsa.

Kuopsa kwa matenda a m'magazi:

Matenda a m'magazi amatanthauzidwa ngati wodwala yemwe ali ndi chikhalidwe chabwino cha magazi ndi zizindikiro za matenda opatsirana. Matenda a m'magazi amatha kukhala achiwiri ku malo ena opatsirana monga matenda a m'mapapo, matenda a m'mimba, kapena matenda oyambirira. Zanenedwa kuti 40% ya odwala omwe ali ndi sepsis kapena septic shock amayamba chifukwa cha matenda amagazi [4]. Akuti anthu 47-50 miliyoni amadwala matenda a sepsis chaka chilichonse padziko lonse, ndipo anthu oposa 11 miliyoni amafa, ndipo pafupifupi munthu mmodzi amamwalira masekondi 2.8 aliwonse.

Njira zodziwira matenda omwe akupezeka m'magazi

01 PCT

Pamene matenda opatsirana ndi kutupa kumachitika, kutulutsa kwa calcitoninogen PCT kumawonjezeka mofulumira pansi pa kulowetsedwa kwa poizoni wa bakiteriya ndi cytokines yotupa, ndipo mlingo wa seramu PCT umasonyeza mkhalidwe woopsa wa matendawa ndipo ndi chizindikiro chabwino cha matenda.

0.2 Maselo ndi zinthu zomatira

Ma cell adhesion molecules (CAM) amakhudzidwa ndi njira zingapo za thupi, monga kuyankha kwa chitetezo chamthupi komanso kuyankha kotupa, ndipo amagwira ntchito yofunika kwambiri polimbana ndi matenda komanso matenda oopsa. Izi zikuphatikizapo IL-6, IL-8, TNF-a, VCAM-1, etc.

03 Endotoxin, G mayeso

Mabakiteriya a gram-negative omwe amalowa m'magazi kuti atulutse endotoxin angayambitse endotoxemia; (1,3) -β-D-glucan ndi imodzi mwazinthu zazikulu zamatenda a fungal cell ndipo imachulukitsidwa kwambiri ndi matenda oyamba ndi fungus.

04 Biology ya Molecular

DNA kapena RNA yotulutsidwa m'magazi ndi tizilombo toyambitsa matenda imayesedwa, kapena pambuyo pa chikhalidwe chabwino cha magazi.

05 chikhalidwe cha magazi

Mabakiteriya kapena bowa m'miyambo yamagazi ndi "muyezo wagolide".

Chikhalidwe cha magazi ndi imodzi mwa njira zosavuta, zolondola komanso zogwiritsidwa ntchito kwambiri kuti zizindikire matenda a m'magazi ndipo ndi maziko a pathogenic otsimikizira matenda a m'magazi m'thupi. Kuzindikira koyambirira kwa chikhalidwe cha magazi komanso chithandizo choyambirira komanso choyenera cha antimicrobial ndi njira zazikulu zomwe ziyenera kuchitidwa kuti athe kuwongolera matenda a m'magazi.

Chikhalidwe cha magazi ndi muyezo wagolide wodziwira matenda a m'magazi, omwe amatha kulekanitsa tizilombo toyambitsa matenda molondola, kuphatikiza ndi kuzindikira zotsatira za kukhudzidwa kwa mankhwala ndikupereka ndondomeko yolondola komanso yolondola ya mankhwala. Komabe, vuto la nthawi yayitali yopereka lipoti labwino la chikhalidwe cha magazi lakhala likukhudza kuzindikirika ndi chithandizo chamankhwala munthawi yake, ndipo zanenedwa kuti kuchuluka kwaimfa kwa odwala omwe sanalandire chithandizo ndi maantibayotiki anthawi yake komanso ogwira mtima kumawonjezeka ndi 7.6% pa ola pambuyo pa maola 6. woyamba hypotension.

Chifukwa chake, chikhalidwe chamagazi chapano komanso chizindikiritso cha kukhudzidwa kwa mankhwala kwa odwala omwe akuwaganizira kuti ali ndi matenda amagazi nthawi zambiri amagwiritsa ntchito njira yoperekera malipoti ya magawo atatu, omwe ndi: malipoti oyambira (malipoti ofunikira, zotsatira za smear), lipoti lachiwiri (kuzindikira mwachangu kapena/ndi kukhudzidwa mwachindunji ndi mankhwala. malipoti) ndi malipoti apamwamba (malipoti omaliza, kuphatikiza dzina la zovuta, nthawi yabwino ya alamu ndi zotsatira zoyeserera za kukhudzidwa kwa mankhwala) [7]. Lipoti loyamba liyenera kufotokozedwa ku chipatala mkati mwa 1 h la lipoti labwino la vial; lipoti la maphunziro apamwamba ndiloyenera kumalizidwa mwamsanga (nthawi zambiri mkati mwa 48-72 h kwa mabakiteriya) kutengera momwe ma laboratory alili.