Cov txheej txheem ntawm kev hloov ntshav (hloov ntshav, ntshav ntshav) tsis tuaj yeem siv tau yooj yim. Txhawm rau kom tswj tau qhov kev xav tau ntawm kev kho mob, nws yog ib qho tseem ceeb uas yuav tau xaiv cov khoom pub dawb thiab npaj cov neeg txais.
Qhov kev vam meej ntawm qhov kev tswj hwm no nyob ntawm ntau yam tsis tuaj yeem hloov pauv. Lub luag haujlwm tseem ceeb yog ua los ntawm kev ua tiav ntawm qhov kev ntsuam xyuas ua ntej ntawm cov cim qhia rau hemotransfusion, qhov tseeb phasing ntawm kev ua haujlwm. Txawm hais tias kev txhim kho ntawm kev hloov pauv niaj hnub no, nws tsis tuaj yeem tshem tawm qhov tseeb ntawm qhov kev pheej hmoo ntawm qhov tshwm sim ntawm cov ntshav plasma hloov pauv raws li qhov tshwm sim tuag.
keeb kwm luv ntawm kev tswj hwm
Hauv Moscow, txij li xyoo 1926, National Research Center for Hematology, lub chaw tshawb fawb tseem ceeb ntawm Russia, tau ua haujlwm. Nws hloov tawm tias thawj qhov kev sim ntshav tau sau tseg hauv Nrab Hnub nyoog. Lawv feem ntau tsis ua tiav. Yog vim li cas rau qhov no tuaj yeem hu ua qhov yuav luag tiav tsis muaj kev paub txog kev tshawb fawb hauv thaj tsam ntawm transfusiology thiab qhov tsis tuaj yeem tsim pab pawg thiab Rh koom nrog.
Kev hloov ntshav plasma nyob rau hauv rooj plaub ntawm kev tsis sib haum xeeb ntawm cov tshuaj antigens yuav ua rau tus neeg txais kev tuag, yog li niaj hnub no cov kws kho mob tau tso tseg kev coj ua ntawm kev qhia tag nrho cov ntshav hauv kev pom zoo ntawm kev cog nws tus kheej cov khoom. Txoj kev no suav hais tias muaj kev nyab xeeb thiab siv tau ntau dua.
Risks rau tus neeg txais
Txawm tias kev hloov ntshav zoo ib yam li kev qhia txog saline lossis tshuaj los ntawm drip, cov txheej txheem no nyuaj dua. Hemotransfusion yog ib qho kev sib npaug sib npaug rau kev hloov pauv ntawm cov ntaub so ntswg nyob. Implantable cov ntaub ntawv, nrog rau cov ntshav, muaj ntau heterogeneous cellular Cheebtsam uas muaj txawv teb chaws antigens, proteins, thiab molecules. Cov ntaub so ntswg zoo sib xws yuav tsis muaj qhov xwm txheej zoo ib yam nrog tus neeg mob cov ntaub so ntswg, yog li kev pheej hmoo ntawm kev tsis lees paub yog ib txwm muaj. Thiab nyob rau hauv qhov kev nkag siab no, lub luag haujlwm rau qhov tshwm sim ntawm kev hloov ntshav plasma tsuas yog nyob ntawm lub xub pwg nyom ntawm tus kws kho mob tshwj xeeb.
Txhua qhov kev cuam tshuam muaj kev pheej hmoo uas tsis nyob ntawm qhov tsim nyog ntawm tus kws kho mob lossis ntawm kev npaj ua ntej rau txheej txheem. Nyob rau tib lub sijhawm, nyob rau txhua theem ntawm kev hloov ntshav plasma (piv txwv lossis kev txhaj tshuaj ncaj qha), tus cwj pwm ntawm cov neeg ua haujlwm kho mob ua haujlwm, maj lossis tsis muaj kev tsim nyog txaus yog qhov tsis tsim nyog. Ua ntej tshaj plaws, tus kws kho mob yuav tsum ua kom paub tseeb tias qhov kev tswj hwm no yog qhov tseem ceeb. Yog tias muaj qhov qhia txog kev hloov ntshav plasma, tus kws kho mob yuav tsum paub tseeb tias tag nrho lwm txoj kev kho tau tas lawm.
Leej twg xav tau ntshav
Qhov kev tswj hwm no muaj lub hom phiaj meej. Feem ntauqhov infusion ntawm cov khoom pub dawb yog vim qhov xav tau los ntxiv cov ntshav uas ploj lawm nyob rau hauv cov ntaub ntawv ntawm kev los ntshav ntau. Tsis tas li ntawd, kev hloov ntshav tuaj yeem yog tib txoj hauv kev los ua kom cov platelet nce ntxiv txhawm rau txhim kho cov ntshav txhaws. Raws li qhov no, cov lus qhia rau kev hloov ntshav plasma yog:
- tuag ntshav;
- shock condition;
- mob ntshav qab zib;
- kev npaj rau kev npaj phais mob, raug liam tias nrog cov ntshav poob qis thiab ua tiav siv cov khoom siv dag zog (lub plawv, phais vascular).
Cov kev nyeem ntawv no yog qhov tseeb. Ntxiv rau lawv, sepsis, kab mob ntshav, tshuaj lom neeg lub cev tuaj yeem ua rau muaj kev hloov ntshav.
Kev hloov pauv rau menyuam yaus
Tsis muaj hnub nyoog txwv rau kev hloov ntshav. Yog hais tias nws yog objectively tsim nyog, manipulation tuaj yeem raug sau rau tus menyuam yug tshiab. Kev hloov ntshav plasma thaum muaj hnub nyoog ntxov muaj qhov qhia zoo sib xws. Tsis tas li ntawd, thaum xaiv ib txoj kev kho mob, qhov kev txiav txim siab ntawm kev tso ntshav yog ua nyob rau hauv cov ntaub ntawv ntawm kev loj hlob sai ntawm tus kab mob. Hauv cov me nyuam mos, kev siv ntshav tuaj yeem tshwm sim los ntawm jaundice, lub siab loj lossis tus po, lossis nce cov qe ntshav liab.
Qhov kev sib cav tseem ceeb hauv kev pom zoo ntawm qhov kev tswj hwm no yog qhov ntsuas bilirubin. Piv txwv li, yog hais tias nyob rau hauv ib tug me nyuam mos nws ntau tshaj 50 µmol / l (cov khoom siv rau kev tshawb fawb yog cojlos ntawm umbilical cord ntshav), lawv pib ua tib zoo saib xyuas tus mob ntawm tus menyuam, vim qhov kev ua txhaum cai no qhia txog qhov xav tau rau kev qhia txog cov ntshav pub dawb rau yav tom ntej. Cov kws kho mob saib xyuas tsis tau tsuas yog cov ntsuas ntawm bilirubin, tab sis kuj yog tus nqi ntawm nws tsub zuj zuj. Yog tias nws hnyav dhau qhov kev cai, tus menyuam yuav tsum tau txhaj cov ntshav.
YContraindications
Kev txheeb xyuas cov contraindications yog ib qho tseem ceeb sib npaug ntawm cov txheej txheem ntawm kev npaj rau cov txheej txheem. Raws li cov cai ntawm kev hloov ntshav plasma, cov teeb meem tseem ceeb ntawm kev tswj hwm no suav nrog:
- lub plawv tsis ua hauj lwm;
- tsis ntev los no myocardial infarction;
- mob plawv ischemic;
- mob plawv tsis xws luag;
- kab mob endocarditis;
- kev kub ntxhov siab;
- mob cerebrovascular raug mob;
- thromboembolic syndrome;
- pulmonary edema;
- glomerulonephritis ntawm theem ntawm exacerbation;
- siab thiab raum tsis ua haujlwm;
- Yuav ua xua rau ntau yam khaus;
- bronchial hawb pob.
Qee zaum, thaum txhaj tshuaj yog tib txoj hauv kev los cawm tus neeg mob txoj sia, tus neeg mob yuav tsis quav ntsej. Nyob rau tib lub sijhawm, cov ntaub so ntswg ntawm tus neeg tau txais kev pab thiab tus neeg pub dawb yuav tsum tau ua ntau yam kev ntsuam xyuas kom paub meej tias kev sib haum xeeb. Kev hloov ntshav ntshav yuav tsum tau ua ntej los ntawm kev kuaj mob.
Xa ntshav rau cov neeg tsis haum tshuaj
Rau tus neeg muaj kev tsis haum tshuaj, cov cai sib txawv siv rau kev hloov ntshav plasma. Tam sim ntawd ua ntejmanipulation, tus neeg mob yuav tsum tau mus rau ib chav kawm ntawm desensitizing txoj kev kho. Rau qhov no, calcium chloride yog siv rau intravenously, nrog rau cov tshuaj tua kab mob Suprastin, Pipolfen, thiab tshuaj hormonal npaj. Txhawm rau txo qhov kev pheej hmoo ntawm kev tsis haum tshuaj rau cov khoom siv txawv teb chaws, tus neeg tau txais kev txhaj tshuaj yuav tsum tau txhaj cov ntshav tsawg kawg nkaus. Ntawm no qhov tseem ceeb tsis yog nyob rau hauv quantitative, tab sis nyob rau hauv nws cov qualitative indicators, As. Tsuas yog cov khoom xyaw uas tus neeg mob tsis muaj nyob hauv cov ntshav plasma rau kev hloov pauv. Nyob rau tib lub sijhawm, cov kua ntim tau ntxiv nrog cov ntshav hloov pauv.
Biomaterial rau kev hloov pauv
Raws li cov kua dej tuaj yeem siv tau:
- pub ntshav tag nrho, uas tsis tshua muaj;
- erythrocyte loj uas muaj cov lej me me ntawm leukocytes thiab platelets;
- platelet loj, uas tuaj yeem khaws cia tsis pub dhau peb hnub;
- cov ntshav khov tshiab (hloov yog siv thaum muaj cov kab mob staphylococcal nyuaj, kab mob tetanus, kub hnyiab);
- cov khoom siv txhawm rau txhim kho cov ntshav txhaws.
Kev taw qhia ntawm cov ntshav tag nrho feem ntau ua tsis tau vim yog kev noj cov khoom siv biomaterial siab thiab muaj kev pheej hmoo siab tshaj plaws ntawm kev tsis lees paub. Tsis tas li ntawd, tus neeg mob, raws li txoj cai, xav tau tshwj xeeb cov khoom uas ploj lawm, tsis muaj qhov taw tes rau "loading" nws nrog cov hlwb txawv teb chaws ntxiv. Tag nrho cov ntshav yog transfused tsuas yog thaum qhib lub plawv phais, nrog rau thaum muaj xwm txheej ceev uas yuav ua rau lub neej poob. Kev taw qhia txog kev hloov pauv nruab nrab tuaj yeem ua tau ntau txoj hauv kev:
- Kev tso ntshav ntxiv ntawm cov ntshav uas ploj lawm.
- Kev hloov pauv - ib feem ntawm tus neeg tau txais cov ntshav yog hloov nrog cov ntaub so ntswg pub dawb. Txoj kev no muaj feem xyuam rau intoxication, kab mob nrog hemolysis, mob raum tsis ua haujlwm. Kev hloov pauv ntau tshaj plaws yog cov ntshav khov tshiab.
- Autohemotransfusion. Nws suav nrog qhov infusion ntawm tus neeg mob nws tus kheej cov ntshav. Xws li cov kua yog sau thaum los ntshav, tom qab ntawd cov khoom raug ntxuav thiab khaws cia. Hom kev hloov ntshav no muaj feem cuam tshuam rau cov neeg mob uas tsis tshua muaj pab pawg uas muaj teeb meem hauv kev nrhiav tus neeg pub dawb.
Hais txog kev sib haum xeeb
Kev hloov ntshav ntshav lossis ntshav tag nrho suav nrog kev siv cov ntaub ntawv ntawm tib pab pawg, sib piv Rh affiliation. Tab sis, raws li koj paub, txhua txoj cai muaj kev zam. Yog tias tsis muaj cov ntaub so ntswg uas tsim nyog, thaum muaj xwm txheej ceev, cov neeg mob uas pab pawg IV raug tso cai txhaj cov ntshav (plasma) ntawm ib pawg. Nyob rau hauv cov ntaub ntawv no, nws yog ib qho tseem ceeb kom soj ntsuam tsuas yog compatibility ntawm Rh yam. Lwm qhov nthuav tshwj xeeb cuam tshuam txog cov ntshav ntawm pab pawg I: rau cov neeg mob uas xav tau ntxiv cov ntim ntawm erythrocytes, 0.5 l ntawm cov kua dej no tuaj yeem hloov 1 liter ntawm cov erythrocytes ntxuav.
Ua ntej pib txheej txheem, cov neeg ua haujlwm yuav tsum ua kom pom tseeb qhov tsim nyog ntawm kev hloov pauv nruab nrab, tshawb xyuas hnub tas sij hawm ntawm cov khoom, nws qhov chaw cia, thiab qhov nruj ntawm lub thawv. Nws tseem yog ib qho tseem ceeb los ntsuas qhov pom ntawm cov ntshav (plasma). Yog hais tias flakes muaj nyob rau hauv cov kua,coj txawv txawv impurities, convolutions, ib zaj duab xis nyob rau saum npoo, nws yog tsis yooj yim sua kom txhaj rau hauv tus neeg tau txais kev pab. Ua ntej qhov ncaj qha manipulation, tus kws tshaj lij yuav tsum tau qhia meej ib zaug ntxiv rau pab pawg thiab Rh yam ntawm cov ntshav ntawm tus neeg pub dawb thiab tus neeg mob.
Npaj rau kev hloov ntshav
Cov txheej txheem pib nrog kev cai. Ua ntej tshaj plaws, tus neeg mob yuav tsum paub nws tus kheej txog qhov yuav muaj kev pheej hmoo ntawm qhov kev tswj hwm no thiab kos npe rau tag nrho cov ntaub ntawv tsim nyog.
Cov kauj ruam tom ntej yog ua kev tshawb fawb thawj zaug ntawm pawg ntshav thiab Rh yam raws li ABO system siv coliclones. Cov ntaub ntawv tau txais raug kaw rau hauv phau ntawv teev npe tshwj xeeb ntawm lub tsev kho mob. Tom qab ntawd cov ntaub so ntswg tshem tawm raug xa mus rau chav kuaj kom paub meej txog cov ntshav phenotypes los ntawm antigens. Cov txiaj ntsig ntawm txoj kev tshawb fawb tau qhia rau ntawm nplooj ntawv npe ntawm keeb kwm kho mob. Rau cov neeg mob uas muaj keeb kwm muaj teeb meem ntawm kev hloov ntshav plasma lossis lwm yam ntshav, nrog rau cov poj niam cev xeeb tub thiab cov menyuam yug tshiab, qhov kev hloov pauv nruab nrab yog xaiv ib tus zuj zus hauv chav kuaj.
Hnub ntawm kev tswj hwm, ntshav tau los ntawm tus neeg tau txais los ntawm cov hlab ntsha (10 ml). Ib nrab yog muab tso rau hauv ib lub raj uas muaj anticoagulant, thiab tus so yog xa mus rau ib lub thawv rau ib tug series ntawm kev ntsuam xyuas thiab cov qauv lom. Thaum hloov ntshav plasma lossis lwm yam khoom siv ntshav, ntxiv rau kev kuaj xyuas raws li ABO system, cov khoom raug kuaj rau tus neeg sib raug zoo siv ib txoj hauv kev:
- kev sib txuas nrog polyglucin;
- Yconglutination nrog gelatin;
- indirect Coombs cov tshuaj tiv thaiv;
- reactions ntawm lub dav hlau ntawm chav tsev kub.
Cov no yog lub ntsiabhom kev kuaj uas tau ua thaum lub sij hawm hloov ntshav plasma, tag nrho cov ntshav los yog nws tus kheej cov khoom. Lwm qhov kev xeem raug muab rau tus neeg mob raws li kev txiav txim siab ntawm tus kws kho mob.
Thaum sawv ntxov koj tsis tuaj yeem noj dab tsi rau ob tus neeg koom nrog hauv txheej txheem. Kev hloov ntshav, plasma yog ua nyob rau hauv thawj ib nrab hnub. Tus neeg tau txais kev qhia kom ntxuav lub zais zis thiab cov hnyuv.
Yuav ua li cas cov txheej txheem ua haujlwm
Kev ua haujlwm nws tus kheej tsis yog kev cuam tshuam nyuaj uas xav tau cov cuab yeej siv kho mob hnyav. Rau kev hloov pauv, cov hlab ntsha subcutaneous ntawm ob txhais tes yog punctured. Yog tias muaj kev tso ntshav ntev ntev, cov hlab ntsha loj yog siv - jugular lossis subclavian.
Ua ntej yuav pib nrog kev txhaj tshuaj ncaj qha ntawm cov ntshav, tus kws kho mob yuav tsum tsis txhob muaj qhov tsis ntseeg me ntsis txog qhov zoo thiab qhov tsim nyog ntawm cov khoom cog. Nco ntsoov ua kom tiav kev tshuaj xyuas lub thawv thiab nws qhov nruj, qhov tseeb ntawm cov ntaub ntawv nrog.
Thawj kauj ruam hauv kev hloov ntshav ntshav ntshav yog ib qho kev txhaj tshuaj ntawm 10 ml ntawm kev hloov pauv nruab nrab. Cov kua yog txhaj rau hauv tus neeg tau txais cov hlab ntshav maj mam, ntawm qhov zoo ntawm 40-60 tee ib feeb. Tom qab kev txhaj tshuaj 10 ml ntawm cov ntshav pub dawb, tus neeg mob tus mob tau saib xyuas rau 5-10 feeb. Cov qauv roj ntsha rov ua dua ob zaug.
Cov cim phom sij uas qhia txog qhov tsis sib haum xeeb ntawm cov khoom siv biomaterials ntawm tus neeg pub dawb thiab tus neeg tau txais yog ua tsis taus pa sai, ua rau lub plawv dhia ntau, reddening ntawm daim tawv nqaij ntawm lub ntsej muag, txo cov ntshav siab, ua tsis taus pa. Hauv qhov xwm txheej ntawdCov tsos mob nres qhov kev tswj hwm thiab muab kev pab kho mob tsim nyog rau tus neeg mob tam sim ntawd.
Yog tias tsis muaj kev hloov pauv tsis zoo, mus rau qhov tseem ceeb ntawm kev hloov ntshav. Ib txhij nrog kev noj cov ntshav cov khoom hauv tib neeg lub cev, nws yog ib qho tsim nyog yuav tsum tau saib xyuas qhov ntsuas kub ntawm nws lub cev, ua haujlwm saib xyuas kev mob plawv, thiab tswj diuresis. Tus nqi ntawm kev tswj ntshav los yog nws tus kheej cov khoom yog nyob ntawm qhov qhia. Raws li txoj cai, kev tswj hwm dav hlau thiab cov dej ntws tau tso cai ntawm tus nqi kwv yees li 60 tee txhua feeb.
Thaum muab ntshav, ntshav txhaws tuaj yeem nres koob. Hauv qhov no, koj tsis tuaj yeem thawb cov hlab ntsha mus rau hauv cov leeg. Cov txheej txheem raug tshem tawm, koob thrombosed raug tshem tawm ntawm cov hlab ntsha thiab hloov nrog ib qho tshiab, uas twb tau muab tso rau hauv lwm txoj hlab ntsha thiab cov kua dej ntws rov qab los.
Tom qab hloov ntshav
Thaum tag nrho cov ntshav pub dawb nkag mus rau tus neeg mob lub cev, qee cov ntshav (plasma) tau tso rau hauv lub thawv thiab khaws cia rau ob mus rau peb hnub hauv lub tub yees. Qhov no yog qhov tsim nyog yog tias tus neeg mob dheev tsim teeb meem tom qab hloov pauv. Cov tshuaj yuav qhia lawv qhov laj thawj.
Cov ntaub ntawv tseem ceeb ntawm kev tswj hwm raug kaw hauv keeb kwm kho mob. Cov ntaub ntawv qhia txog qhov ntim ntawm cov ntshav txhaj tshuaj (nws cov khoom), muaj pes tsawg leeg, cov txiaj ntsig ntawm kev sim ua ntej, lub sijhawm tiag tiag ntawm kev tswj hwm, kev piav qhia ntawm tus neeg mob kev noj qab haus huv.
Tom qab cov txheej txheem, tus neeg mob yuav tsum tsis txhob sawv tam sim ntawd. Ob peb teev tom ntej no yuav tsum tau pw tsaug zog. Iblub sijhawm no, cov neeg ua haujlwm kho mob yuav tsum ua tib zoo saib xyuas lub plawv dhia, ntsuas kub. Ib hnub tom qab txhaj tshuaj, tus neeg tau txais kev tso zis thiab kuaj ntshav.
Qhov sib txawv me ntsis hauv kev noj qab haus huv tuaj yeem qhia txog qhov tsis pom zoo ntawm lub cev, kev tsis lees txais cov ntaub so ntswg. Nrog rau kev nce hauv lub plawv dhia, txo qis hauv siab thiab mob hauv siab, tus neeg mob raug xa mus rau chav saib xyuas mob hnyav lossis chav kho mob hnyav. Yog hais tias, nyob rau hauv plaub teev tom ntej tom qab tso ntshav plasma los yog lwm yam ntshav, tus neeg tau txais kev pab lub cev kub tsis nce, thiab lub siab thiab mem tes ntsuas nyob rau hauv ib txwm txwv, peb yuav tham txog kev vam meej manipulation.
Yuav ua li cas yog qhov teeb meem
Raws li qhov tseeb algorithm thiab cov cai ntawm kev hloov ntshav, cov txheej txheem muaj kev nyab xeeb rau tib neeg. Qhov yuam kev me me tuaj yeem ua rau tib neeg lub neej. Yog li, piv txwv li, thaum huab cua nkag los ntawm lumen ntawm cov hlab ntsha, embolism lossis thrombosis tuaj yeem tshwm sim, uas tshwm sim los ntawm kev ua pa tsis zoo, cyanosis ntawm daim tawv nqaij, thiab cov ntshav siab poob qis. Cov xwm txheej zoo li no xav tau kev pab kho mob xwm txheej ceev, vim tias lawv tuag rau tus neeg mob.
Cov teeb meem tom qab hloov pauv tau hais los saum toj no tsis tshua muaj kev phom sij rau lub neej thiab feem ntau sawv cev rau kev tsis haum tshuaj rau cov khoom noj pub dawb. Antihistamines pab tiv nrog cov no.
Ib qho teeb meem txaus ntshai nrog qhov tshwm sim tuag,yog qhov tsis sib haum xeeb ntawm cov ntshav los ntawm pab pawg thiab Rh, vim tias qhov kev puas tsuaj ntawm cov qe ntshav liab tshwm sim, ntau lub cev tsis ua haujlwm tshwm sim thiab tus neeg mob tuag.
Kab mob los yog kis kab mob thaum lub sij hawm tus txheej txheem yog ib qho teeb meem tsis tshua muaj, tab sis tseem nws muaj peev xwm tsis tuaj yeem txiav txim siab tag nrho. Yog tias qhov kev hloov pauv tsis tau khaws cia nyob rau hauv cov xwm txheej cais tawm, thiab tag nrho cov kev cai ntawm kev tsis muaj menyuam tsis tau soj ntsuam thaum lub sijhawm nws npaj, tseem muaj qhov pheej hmoo tsawg kawg ntawm kev kis kab mob siab lossis HIV.
