Esimeni esiguqukayo njalo semithi yesimanje, ukulawulwa okunembayo nokulawulwa ngokucophelela koketshezi kubambe ukhiye wemiphumela yokwelashwa kwesiguli eyimpumelelo. Iminyaka eminingi, isethi yendabuko yokufakwa emthanjeni ibilokhu ikhona yonke indawo ezikhungweni zezempilo, ifeza indima yayo ngokuzibophezela. Kodwa-ke, ngegxathu elimangalisayo lobuchwepheshe bezokwelapha, iphampu yokufaka isivele njengendlela eshintshayo futhi enembe ngendlela emangalisayo, iveza indawo yayo ebaluleke kakhulu ezimeni eziningi ezibucayi zezokwelapha.
I. Izimo Zomtholampilo Ezidinga Amaphampu Okufakwa
A. Amayunithi Okunakekelwa Okubalulekile
Izikhungo ezinakekela abaguli kakhulu (i-ICUs) kanye neminyango yezimo eziphuthumayo emi njengemigqa ephambili yezinkinga zezokwelapha, lapho iziguli zivame ukufika zisesimweni esiyingozi, izimpawu zazo ezibalulekile azizinzile. Kulezi zinkundla ezisezingeni eliphezulu, amaphampu okufakelwa afakazela ukuthi ayimpahla esindisa impilo. Ngokwesibonelo, cabanga ngokwelashwa kweziguli ezibhekene nokushaqeka kwe-septic. Ezimweni ezinzima kangaka, imishanguzo ye-vasoactive efana ne-norepinephrine iba yizikhonkwane zokugcina ukulingana komfutho wegazi okuqinile. Ukunemba okumangazayo kwephampu yokufaka inika amandla amaqembu ezokwelapha ukuthi enze izinguquko ezingapheli kuzinga lokugeleza, ngezinye izikhathi zilinganiswa zehle zibe izingxenye ezincane zemililitha ngehora. Leli zinga lokunemba alifinyeleleki kalula ngesethi yokufaka evamile, encike kakhulu endleleni yakudala yokubala amaconsi. Ngaphezu kwalokho, leli zinga lokuconsa lingasuswa kalula yizici ezivamile - ishubhu elihlanganisiwe, ukushintsha kwesiguli ngokungazi - okungase kuholele emiphumeleni eyinhlekelele.
Esimweni sokulawula ukuhluleka kwenhliziyo, imithi efana ne-dobutamine ijwayele ukunikezwa ukuqinisa ukuphuma kwenhliziyo ehlulekayo. Lapha, iphampu yokufaka ithatha indawo emaphakathi, iqinisekisa ukuthi umuthi ulethwa ngenani eliqondile elinqunywe udokotela ngokucophelela. Noma yikuphi ukuchezuka kulo mthamo oqondile, kungakhathaliseki ukuthi umthamo ongaphansi noma oweqile, kungase kubangele ukungezwani kwenhliziyo esongela ukuphila noma kubeke engozini isimo sesiguli esesivele sintekenteke. Ukuqapha okuqhubekayo kwephampu namandla okulungisa okuzenzakalelayo kunikeza uchungechunge oluthembekile noluqhubekayo lokulethwa kwezidakamizwa, kufaka umuzwa wokuzola nokuzethemba eqenjini lezokwelapha phakathi nalezi zimo zokucindezela okukhulu, ukuphila noma ukufa.
B. Ukunakekelwa Kwezingane Nezinsana
Uma kuziwa ekunakekeleni izingane, ikakhulukazi izingane ezisengcupheni kakhulu nezisanda kuzalwa, umkhawulo wephutha ekudoseni izidakamizwa uyancipha uze ufike ezingeni elicishe lingabonakali. Amafreyimu azo amancane kanye nesistimu yezemvelo ebucayi kakhulu idinga izinga eliphakeme nakakhulu lokunemba. Amaphampu omjovo, kule ndawo, awawona awokunethezeka kodwa ayisidingo esiphelele. Thatha indaba yengane ezalwa ngaphambi kwesikhathi ebhekana nesifo sokucindezeleka kokuphefumula. Ukulawulwa kwama-surfactants, adlala indima ebalulekile ekuvumela ukuthi usebenze kahle wamaphaphu, kudinga izinga lokunemba elingatholwa kuphela ngephampu yokufaka. Ingalinganiswa ngobuchwepheshe ukuze ikhiphe amavolumu amancane adingekayo, isebenze njengesivikelo ekulimaleni okungaba ngumphumela wokubalwa kabi okuncane komthamo.
Ezweni elidabukisayo lokwelapha ngamakhemikhali ezingane, ubuthi bezidakamizwa obuhilelekile bugunyaza ukulawulwa kwe-ironclad phezu kwezinga lokumnika. Isisindo esiyingqayizivele sengane ngayinye kanye nephrothokholi ethile yokwelapha ngamakhemikhali kufanele kufakwe phakathi, futhi amaphampu afakwayo ahlomisa abahlinzeki bezempilo ngamathuluzi okwenza lokho kanye. Ngokusetha izinga ngokunembile, banganciphisa imiphumela emibi ewohlozayo evame ukuhambisana nokumpontshelwa kwezidakamizwa ngokushesha noma okungaguquki, baqinisekise ukuthi lezi ziguli ezisencane zinokudutshulwa okungcono kakhulu kumphumela wokwelashwa oyimpumelelo kuyilapho zivikela izinga lempilo yazo.
C. Izinqubo Ezikhethekile Zokuhlinza
Lapho iminyango yegumbi lokuhlinza ivuleka ukuze kwenziwe ukuhlinzwa okuyinkimbinkimbi njengokuhlinzwa kwenhliziyo evulekile noma i-ballet eyinkimbinkimbi ye-neurosurgery, ukugcina uketshezi oluzinzile kanye nokulawula izidakamizwa ezinembile kuba yindaba yokuphila nokufa. Esigabeni sokumisa inhliziyo sokuhlinzwa kwenhliziyo evulekile, izixazululo ze-cardioplegic kufanele zifakwe ngezikhathi ezibekelwe isikhathi kanye namazinga ukuze kuboshwe inhliziyo ngokuphephile, okuvumela odokotela abahlinzayo ukuthi benze umsebenzi wabo osindisa ukuphila. Iphampu yokumnika isebenza njengomlindi othule, eqinisekisa ukuthi isixazululo silethwa ngokunemba okukhomba, ngaleyo ndlela igwema izinkinga ezingase zibe khona ezihlobene nokuvikelwa kwenhliziyo okungafanele, njengokulimala kwe-myocardial noma ukuma kwenhliziyo okunganele.
Esizindeni esifuna ngokulinganayo sokuhlinza kwezinzwa, lapho ukwakheka kobuchopho okuntekenteke kanye nemisebenzi eyinkimbinkimbi kusemgqeni, izidakamizwa ezilawula ukucindezela kwe-intracranial noma ezigcina ukugcwaliswa kobuchopho kufanele zilawulwe ngezinga lokunemba elisondela kulokho okukhathazayo. Noma yikuphi ukuguquguquka okuguquguqukayo kwesilinganiso sokumnika kungase kudedele imiphumela eyinhlekelele emsebenzini wobuchopho besiguli, okungase kuholele ekuntulekeni okuhlala njalo kwemizwa. Kukulezi zilungiselelo zokuhlinzwa ezibucayi lapho ukuthembeka nokunemba kwephampu yokufaka amanzi kucwebezela ngempela, okuyenza ibe inketho engenakuphikiswa encanyelwayo kodokotela abahlinzayo nodokotela ababulala izinzwa ngokufanayo.
II. Izinzuzo zamaphampu okumnika ngaphezu kwamasethi ajwayelekile wokufakwa
A. Ukunemba ekulawuleni izinga lokugeleza
Inzuzo evelele kakhulu yamaphampu wokumnika ilele ekunembeni kwawo okungenakuqhathaniswa. Njengoba kuphawuliwe ngaphambilini, lezi zimangaliso zobuchwepheshe zingakhipha uketshezi ngamanani abonakala sengathi awamanye amazwe, ngezinye izikhathi aphansi njengengxenye yemililitha ngomzuzu. Leli zinga lembudumbudu yiminyaka elula ngaphambi kwalokho okungahlanganiswa yisethi yokufaka evamile. Cabangela usizi lweziguli ezinesifo sikashukela ezithembele ku-insulin. Iwindi lezokwelapha lalesi sidakamizwa esisindisa impilo lincane kakhulu; ukubalwa kabi okuncane ekudoseni kungathumela amazinga kashukela egazini ehle abe yi-hypoglycemia noma enyukele ku-hyperglycemia. Kodwa-ke, ngephampu yokumnika, abahlinzeki bezempilo bangaphumula kalula bazi ukuthi inani elifanele le-insulin lizophathwa ngokungaguquguquki okungaguquki, ihora nehora, usuku nosuku.
Ngokuphambene kakhulu, ukunqunywa kwezinga lokugeleza kokumnika okungokwesiko kuncike esenzweni somuntu esinephutha sokubala amaconsi. Le ndlela ayigcini nje ngokugcwele amaphutha omuntu kodwa futhi isengozini enkulu yokuphazamiseka kwangaphandle. Ukuphazamiseka okulula okubangela umhlengikazi ukuba abale amaconsi ngokungalungile noma ukushintsha okuncane endaweni yesiguli okushintsha izinga lokuthonta kungase kube ukushayisana okukhulu kwenani lomuthi noma uketshezi olulethwa ngokuhamba kwesikhathi, okungase kubeke engcupheni inhlalakahle yesiguli.
B. Izici Zokuphepha
Amaphampu okufakwayo afika egcwele i-cornucopia yezici zokuphepha ezingekho ngokusobala kozakwabo abangajwayelekile. Lezi zivikelo ezakhelwe ngaphakathi zisebenza njengesivikelo esinamandla ezinhlekeleleni ezingase zibe khona. Isibonelo, uma ishubhu livaleka - isenzakalo esivamile ngenxa yokwakheka kwehlule noma i-kink ngephutha - izinzwa ezizwelayo zephampu zizongena esenzweni ngokushesha, zikhale i-alamu ehlabayo futhi zimise ukumnika kufile emikhondweni yawo. Lesi sinyathelo sokuqala siwukungenelela okusindisa ukuphila, ukuvimbela i-embolism yomoya esesabekayo noma ukunqwabelana okucashile kokucindezela okukhulu ngaphakathi kweshubhu, okungase kubikezele inhlekelele esigulini.
Esinye isici sokuphepha esibalulekile yindlela yokuthola i-air-in-line. Ngisho nebhamuza elincane kakhulu, elicishe lingabonakali elizama ukungena kushubhu lizotholwa yizinzwa eziqaphile zephampu, okucupha isixwayiso esisheshayo. Lokhu kubaluleke kakhulu lapho ufaka izidakamizwa ezizwela kakhulu emoyeni, njenge-intravenous immunoglobulin. Ukuba khona kwamabhamuza omoya ezimeni ezinjalo kungabangela umuthi ukuthi uhlanganiswe, ulenze lingabi namandla futhi lifake engozini ukusebenza kokwelashwa kwesiguli.
C. Ukusebenzisa Kalula Kanye Nesikhathi Esiphumelelayo
Nakuba kuyiqiniso ukuthi amaphampu okumnika angase abonakale eyinkimbinkimbi futhi esabisa kulabo abasha kubo, ekugcineni afakazela ukuthi ayizimangaliso ezonga isikhathi nezinciphisa ukusebenza kwabahlinzeki bezempilo. Uma imingcele yokuqala isisethwe ngokucophelela - inqubo okuthi, ngokuqeqeshwa kancane, ibe imvelo yesibili - iphampu ithatha izintambo, igcine ngokusemthethweni izinga lokugeleza elilungile ngokunemba komshini. Lokhu kukhulula abahlengikazi nodokotela ukuthi baqondise kabusha ukunaka kwabo namandla kwezinye izici ezibalulekile zokunakekelwa kwesiguli, kungaba ukuqapha izimpawu ezibalulekile, ukuhlola ukunethezeka kwesiguli, noma ukuxhumana namanye amalungu ethimba lezokwelapha.
Esiphithiphithini sewodi yasesibhedlela ematasa, lapho izibalo kanye nezinsiza zesekhondi ngalinye zincipha, lesi sixazululo esizenzakalelayo sinikeza ukuphumula okwamukelekayo. Uma kuqhathaniswa nomsebenzi onzima futhi odla isikhathi wokuqapha njalo futhi ulungisa izinga lokuconsa lesethi yokufaka evamile - inqubo edinga ukuhlolwa okuvamile okubonwayo kanye nokudweba ngesandla okudwetshiwe - iphampu yokufaka ilula ukuhamba komsebenzi futhi inciphisa ngokuphawulekayo umthwalo womsebenzi. Iphinde inciphise amathuba okuba namaphutha angena ngokungagwemeki phakathi nokuphathwa koketshezi okwenziwa ngesandla, kuthuthukise ukuphepha kwesiguli kanye nokusebenza kahle kokunakekelwa kwezempilo kukonke.
Sengiphetha, amaphampu okufaka amanzi aveze ngokungangabazeki i-niche ebalulekile nebaluleke kakhulu kwezokwelapha zesimanje. Ikhono labo lokukhipha uketshezi nezidakamizwa ngokunemba okuqondile, okuqiniswe izici eziningi zokuphepha ezithuthukisiwe kanye nokuthuthukiswa kokusebenza kahle kokusebenza, kubenza babe yikhona okukhethayo kuzimo eziningi zomtholampilo. Kochwepheshe bezokunakekelwa kwempilo, ukuqonda okuhlukile kokuthi nini futhi kungani kufanele kusetshenziswe iphampu yokufaka akuyona nje indaba yamakhono omsebenzi kodwa kuyisibopho sokuziphatha, njengoba kuthinta ngokuqondile ikhwalithi yokunakekelwa kanye nempilo enhle yokugcina yeziguli zabo. Njengoba ubuchwepheshe buqhubekela phambili, singalindela okunye ukulungiswa kanye nokwandiswa kwezicelo zalezi zisetshenziswa ezimangalisayo ezisindisa ukuphila, okumemezela inkathi entsha yokwelashwa okunembe nakakhulu nangempumelelo.
