I-pneumonia engenayo i-nosocomial: ama-pathogens, ukwelashwa nokuvimbela

I-pneumonia ye-ososomi yinkimbinkimbi eqhamukayo eyenzeka emzimbeni ngaphansi kwethonya lomsebenzi obalulekile osebenzayo wama-bacterium e-pathogenic. Izici zesifo yilona ukunqotshwa komnyango wokuphefumula komnyango we-pulmonary nokuqoqwa kwangaphakathi komthamo omkhulu wamanzi. U-Exudate uhamba ngokuya emangqamuzaneni futhi angena ezinhlotsheni zezinso.

Kubuyekezwa izincomo zikazwelonke ze-neocomial pneumonia

Kusukela ngo-2014, iNhlangano Yezokuphefumula inikeze izincomo zomtholampilo emhlabeni . Zisekelwe ku-algorithm yokuxilongwa kanye nokwelashwa ezimweni lapho kucatshangwa ukuthi isiguli siyaqhubeka ne-neocomial pneumonia. Izincomo zikazwelonke zenzelwa ochwepheshe, odokotela, ukusiza abasebenzi bezokwelapha abaye bahlangabezana nezifo eziphefumulayo zokuphefumula.

Ngamafuphi, i-algorithm inamaphuzu amane.

1. Thola isidingo sokunakekelwa esibhedlela ngesiguli. Isinqumo esihle senziwa uma isiguli sichaze ngokucacile ukuphefumula kokuphefumula, kunciphisa ukungcoliswa kwezicubu, ukuzibulala ngokweqile, ukungazi kahle, ukucindezeleka kwegazi okungaphephile. Ukubekwa esibhedlela kunele ukunquma okungenani uphawu olulodwa.
2. Thola isizathu sesifo. Ukuze wenze lokhu, isiguli sinikezwe inani lezincwadi zokuhlolwa kwezinto eziphilayo: isiko legazi kusuka emithanjeni, i-sputum bacillus, ukuhlolwa okusheshayo kwe-bacterium antigenyura.
3. Ukunqunywa kwesikhathi sokwelapha. Kuncike ekutheni lesi sifo sivela empilweni, kepha imbangela yangempela ayitholakali, ukwelashwa kwenziwa ngezinsuku eziyishumi. Ngenkinga ehlukahlukene noma indawo yangasese yokugxila, inkambo yokwelapha ingaba izinsuku ezingu-21.
4. Izinyathelo ezidingekayo zokuhlala iziguli. Esimweni esinzima, iziguli zidinga umoya wokuphefumula noma ongenawo umoya.

Izinyathelo zokuvimbela nazo zibekiwe ezincomo zikazwelonke. Okuphumelela kakhulu ukugonywa ngokumelene nomkhuhlane kanye ne-pneumococcus, enqunyiwe ikakhulukazi ezigulini ezine-pneumonia ezingapheli nabantu basebekhulile.

Izici ze-Pneumonia ezitholakale umphakathi

I-pneumonia ye-nosocomial etholakale emphakathini inegama elinye elivamile - ngaphandle kwesibhedlela. Lesi sifo sibangelwa ukutheleleka kwe-etiology yebhaktheriya. Indlela eyinhloko yokutheleleka yindawo. Ngakho-ke, le ncazelo izofundwa ngalendlela elandelayo: umlutha wokuvuvukala komnyango we-pulmonary, owamukelwa ngamaconsi, lapho isiguli singathintana nabathwali bokutheleleka ezikhungweni zezokwelapha.

I-pneumonia etholakale emphakathini kanye ne-nosocomial ye-bacterial origin is more often diagnosed in patients with infinite immune, lapho umzimba ungakwazi ukumelana nezinambuzane ezincane ze-pathogenic (i-pneumococci, induku ye-hemophilic, i-Klebsiella). Bangene emapulazini emaphaphu ngokusebenzisa i-nasopharynx.

Iqembu lezinhlekelele lihlanganisa izingane zeqembu elidala kanye neziguli ezinezifo ezingapheli zamaphaphu. Kulesi simo, i-agent causative yi-Staphylococcus aureus.

I-pneumonia ye-nosocomial etholakale umphakathi: izimiso zokuhlukaniswa kwesifo

Ukuthuthukisa ukwelashwa okulungile, i-pneumonia ihlukaniswa ngokwemigomo elandelayo:

• Izifo, hhayi ezihambisana nokunciphisa emsebenzini wokuzivikela womzimba;
• Isifo esiye savela ngesimiso se-immunity ephansi;
• Isifo esenzeka esigabeni esiyingozi se-AIDS;
• Isifo esakhiwe ngokubambisana nezinye izifo.

Njengomthetho, ukuxilongwa kuqinisekiswe ezigulini ezinenkinga ngesimo sokuzivikela esincishisiwe ngemuva kwesizinda se-oncology noma i-hematology. Futhi engozini kukhona iziguli eziye zathatha i-high-dose glucocorticosteroids isikhathi eside. Futhi, kunezimo lapho lesi sifo sitholakala ezigulini ezine-immune pathologies ezingapheli.

Ngaphezu kwalokho, isigaba esihlukile sihlanganisa lolu hlobo lwe-pneumonia, isifiso.

Odokotela bathi ngaleso sikhathi ngendlela yokuvela kwanoma yiluphi uhlobo lwe- aspiration pneumonia kunezidumbu zangaphandle, lapho zingena kulesi sifo ziqala.

Izici ze-neocomial pneumonia

Kulo mqondo, odokotela batshale isimo esinjalo sesiguli lapho inqubo yokuvuvukala emnyangweni wepulmonary ibonakala cishe amahora angu-72 ngemuva kokutheleleka. Ingozi ukuthi i-nosocomial nosocomial pneumonia inezinkinga eziyinkimbinkimbi futhi ngokuvamile iphela emphumela wokubulala. Lokhu kungenxa yokuthi amabhaktheriya ahlala ngaphakathi kwezindonga zesikhungo sezokwelapha ayamelana nemithi eminingi yezokwelapha, ngakho-ke kunzima kakhulu ukuthola imithi elwa namagciwane kusuka kuqala.

I- Pneumonia Yengculazi Yomtholampilo : Izimiso Zokubalwa Kwezifo

Okokuqala isibhedlela esibhedlela sase-nosocomial se-pneumonia sichazwa esigabeni sokutheleleka:

1. Isigaba sokuqala - ezinsukwini zokuqala ezinhlanu zokuhlala kwesiguli esibhedlela, izimpawu ezicacile zesifo ziqala ukuvela.
2. Isigaba sekwephuzile - ukubonakaliswa kwezimpawu kuqhubeka isikhathi esingaphezu kwezinsuku ezinhlanu.

Ngokuya nge-etiology yokuthuthukiswa kwesifo, izinhlobo ezintathu zihlukaniswa:

1. Ukuphefumula nosocomial pneumonia.
2. I-Postoperative.
3. Okuhlobene ne-Fan.

Kumele uqaphele ukuthi ukuhlukaniswa okwenziwe ngohlobo kunemibandela, futhi ezimweni eziningi isibhamu sitholakala endaweni exutshwe. Lokhu, futhi, kunzima kakhulu isimo sesiguli futhi kunciphisa amathuba okuthola kabusha.

Ukuphefumula

Ifomu lesifo esinikezwe yilona elivame kakhulu. Uma i-nasopharynx enegciwane lesandulela ngculaza ingena emnyangweni wepulmonary, ukuzitholela ukutheleleka kwenzeka.

I-nasopharyngeal fluid yindawo ekahle yokudla amabhaktheriya e-pathogenic, ngakho-ke, ukungena emaphashini, ama-microorganisms aqala ukuphindaphindiwe ngenkuthalo, okubangela ekuthuthukiseni i-aspiration pneumonia.

I-Postoperative

Uhlobo olunikezwayo lwe-pneumonia lufunyanwa ngamacala angu-18 emitholampilo avela ku-100 futhi litholakala kuphela kwiziguli ezahlinzwa.

Kule nkinga, ukutheleleka kwenzeka ngendlela efanayo ne-aspiration pneumonia, kuphela imfihlo yesisu esisetshenziselwa uketshezi lwe-nasopharyngeal, okungesiyingozi kakhulu. Futhi, ungafaki ukutheleleka kwesiguli ngamathuluzi wezokwelapha namadivayisi. Nge-probe noma i-catheter, ukutheleleka kungasakazeka kalula emgwaqeni ophansi wokuphefumula.

I-ventilator-ehlobene

Kutholakale ezigulini eziye zavezwa isikhathi eside kwomoya wokufakelwa umoya. Isikhathi esiphephile asikho ngaphezu kwamahora angama-72 okuhlala kuleli zwe, bese ingozi yokuthuthukisa i-pneumonia yanda nsuku zonke.

Ama-Pathogens of Pneumonia Nosocomial

I-pneumonia yezibhedlela ezingenasosayensi ivame ukubangelwa yi-pneumococci. Ukuhlola okunjalo kuvela kumaphesenti angama-30 ukuya kwangu-50 kuwo wonke amacala omtholampilo.

Ama-bacteria amabi kakhulu angama-chlamydia, i-mycoplasma ne-legionella. Ngaphansi kwethonya labo, i-pneumonia iqala ngamacala angaphezu kwama-30%, kodwa angaphansi kuka-8%.

Okungavamile yiyona isifo esasuka ngokumelene nomsebenzi osebenzayo: izinduku ze-hemophilic, i- Staphylococcus aureus, iKlebsiella kanye ne-enterobacteria.

Enye i-causative agent ye-nosocomial pneumonia i-influenza A ne-B, i-parainfluenza, i-adenovirus, igciwane lesifo se-syncytial.

Ama-pathogens avame kakhulu ohlobo lwe-neocomial pneumonia oluhlukumezayo, olukwazi ukukhiqiza ukuqubuka kwesifo - i-mycoplasma ne-legionella. Kulokhu, okokuqala, intsha kanye nabantu abasha eminyakeni engama-25 bavame ukugula. Futhi ukutheleleka ngeLegionella kwenzeka ngamanzi, isibonelo, eshahleni lomphakathi, echibini nokunye.

Izindlela zokwelapha zanamuhla

Uma isiguli sinesifo sofuba sohlobo olungaphandle kwesibhedlela, kuvame ukutholakala ngesikhathi sokuhlolwa kwezokwelapha. Esimweni ngasinye somtholampilo, ukuze kube lula ukuqapha isimo sesiguli kanye nezimpawu zesifo, ikhadi elihlukile noma umlando wezokwelapha usungulwa.

Ukuxilongwa kwesifo esiphuthumayo sekulandelayo:

• Imidwebo yesifuba - indlela yokuxilongwa kwemisebe, okuyinto ezithombeni ezithuthukisa isimo samaphaphu ezindizeni eziningana. Ngaphambi kwamnyama, izindawo ezinomsoco, ukuxilongwa kuqinisekisiwe. Ukuxilongwa kuboniswa kabili: ekuqaleni kokwelapha nangemva kokwelashwa kwama-antibiotic.

• Izivivinyo zeLatholo - isiguli siyodinga ukunikela ngegazi ngokuhlaziywa jikelele nokuzimisela kwenani lama-leukocyte, i-glucose kanye ne-electrolyte.
• Ucwaningo lwe-microbiological - ukuhlaziywa kwamanzi aphikisayo futhi umbala wephethini elingaphansi lokuphefumula kwenziwa, ukutholakala kwama-antigens kumchamo kunqunywa.

Imiphumela yalezi zinqubo zokuxilonga zanele ukuthola ukuhlonza okucacile nokuthuthukisa uhlelo lokwelapha.

Izincomo zokwelashwa kweziguli

Izincomo zokwelapha zokwelashwa kwe-nosocomial pneumonia yiyona njongo enkulu ye-antibiotic esekelwe kabanzi.

Ngemuva kokuthola imiphumela yezivivinyo, kungaphakathi kwamakhono kadokotela ukushintsha umuthi wezokwelapha ukuze usebenze ngokwengeziwe. Uhlobo lwezinambuzane ze-pathogenic kuthathwe njengesisekelo.

Izimiso zokwelapha iziguli ezine-neocomial pneumonia

Ukwelashwa kwe-neocomial pneumonia kuqukethe ukukhethwa kwe-antibiotic efanele, irejista yokuphatha kwayo, indlela yokuphatha kanye nesilinganiso. Lona kuphela odokotela oya khona. Okunye okuyingxenye ebalulekile yokwelashwa yinkqubo yokuhlanzwa kwendle yokuphefumula (ukukhishwa kwamanzi abilayo).

Iphuzu elibalulekile ukuthola isiguli esimweni somsebenzi wemoto. Kubalulekile ukwenza ukuvocavoca okuphefumula nemisebenzi encane yomzimba ngendlela yama squats. Iziguli ezisesimweni esibucayi ziyasizwa ngabahlengikazi. Benza ushintsho oluvamile esimweni sesiguli, okuyinto evumela ukuthi angabi nciphisa uketshezi endaweni eyodwa.

Ukuvimbela isifo esivamile kungasiza ekuvimbeleni i-neocomial pneumonia, okuyinto ngokuningiliziwe izokutshela udokotela ophethe.

Ukwelashwa kwama-antibiotic

Ukwelashwa okuhloswe ukulwa nama-bacterium kunezinhlobo ezimbili: okuhloswe futhi okunamandla. Ekuqaleni, zonke iziguli zithola ukwelashwa kohlobo lwe-empiric, futhi okuqondiswayo kubelwe ngemuva kokuthi i-agent e causative iqunyiwe.

Izimo ezibaluleke kakhulu zokulondoloza ziyi:

1. Ukuthuthukisa ukwelashwa okulwa namagciwane.
2. Ukunciphisa ukusetshenziswa kwama-antimicrobial.

Ukuthatha imishanguzo ye-antibacterial, kanye nomthamo wabo kuphela ongangena odokotela ozofika, okumele kube khona ukulungiswa kwamalungiselelo akuvumelekile.

Isibikezelo sokuthola kabusha

Ngokuya ngokufaneleka kwezidakamizwa ezikhethiwe, ukuqina kwesifo kanye nesimo jikelele sesiguli, umphumela wokwelapha ungase ube ngale ndlela: ukutakula, ukuthuthukiswa okuncane esimweni, ukwelashwa okuncane, ukubuyela emuva, ukufa.

Nge-pneumonia ye-nosocomial, amathuba okuba nomphumela obulalayo aphezulu kakhulu kunewohlobo oluthola umphakathi.

Izinyathelo zokuvimbela

Ukuvinjelwa kwe-neocomial pneumonia kuboniswa izinyathelo eziyinkimbinkimbi zokwelapha nezesifo se-epidemiological:

• Ukwelashwa okwesikhashana kwezifo ezixhumeneyo;
• Ukuhambisana nemigomo nemigomo yokuhlanzeka;
• Ukwamukelwa kwama-immunomodulating agents;
• Ukugonywa.

Kubaluleke kakhulu ukuthuthukisa isimo sesiguli - ukuvimbela ukuphindaphinda - ukuqapha ukuhambisana nemithetho elula: ukungcola okuvamile kwesigxobo somlomo, ukuhlolwa kwe-fluid eqoqwe, umsebenzi womzimba.