Nosocomial nemabayo: utachiona, kurapwa uye ekudzivirira

Nosocomial nemabayo - chinhu chakasimba kutapuriranwa kwacho kuitika mumuviri pasi pokudzora vanoshingaira upenyu pathogenic mabhakitiriya. Maitiro zviri hosha ndiwo pulmonary yemweya lesion kadhi munyika kuunganidza hombe vhoriyamu emura. Exudate vakazoroorwa seeps kuburikidza uye chinopinda masero ari renal tishu.

Updated nhungamiro yenyika nokuda chipatara-vawana nemabayo

Kutanga kubva 2014 "respiratoria Society" akatanga nyika yokuora nhungamiro. Vari kwakavakirwa imwe algorithm kuti chirwere uye kurapa mumamiriro ezvinhu apo pane fungidziro kuti murwere mberi nosocomial nemabayo. National nhungamiro yakatanga nenyanzvi, vanachiremba, vashandi vezveutano, atarisana chakasimba kufema chirwere.

Muchidimbu, kuti algorithm ine mana pfungwa.

1. Sarudza kana uchida muchipatara. A Chisarudzo akanaka unoitwa, kana murwere yakajeka kufema kutambudzika, pane kuderera rinenge perfusion, rikwanise kuzvidzora chepfu, havachanyatsogoni kuziva, kusagadzikana BP. Kuiswa muchipatara zvikuru kusarudza pane imwe chiratidzo.
2. Pakusarudza mhaka chirwere. Kuti aite izvi, murwere ushandiswe dzakawanda Murabhoritari zvidzidzo zviri zvipenyu nezvinhu: tsika ropa, tsika kubva tsinga, bakposev sputum, mukuru-nokukurumidza bvunzo kuona antigenurii kwemabhakitiriya hunhu.
3. Pakusarudza ya kurapwa. Kunopiwa kuti hosha iri kwemabhakitiriya mavambo, asi chikonzero chaicho haangasimbiswi, kurapa kuitwa pamusoro mazuva gumi. At yematambudziko siyana kana extrapulmonary pfungwa kurapa nzira ingava kusvika mazuva 21.
4. Matanho zvakafanira inpatient mutsigiri. In chakakomba ezvinhu, varwere vanoda afemeruke kana zvisiri invasive kufefetedza.

Uyewo ari National nhungamiro waakaudzwa matanho. Inonyatsobudirira iri kubaya pamusoro yokuSpain uye pneumococcus, vakagadzwa zvikurukuru varwere chisingaperi nemabayo uye vanhu vakura zera boka.

Kunyanya munharaunda vawana nemabayo

Community-vakatodzidza nosocomial nemabayo ndechimwe chakajairika zita - munharaunda-yakawanikwa. The chirwere kunokonzerwa chirwere kwemabhakitiriya etiology. The chikuru nzira chirwere - kwezvakatipoteredza. Saizvozvowo, kutsunga achava sezvinotevera: anogumbura zvemapapu lesion kadhi yaunganidzwa mumate, sezvamakaropafadzwa pamusoro kuonana vatakuri chirwere zveutano Kurongwa murwere akanga asina.

Community-vawana uye nosocomial nemabayo kwemabhakitiriya mavambo kazhinji chirwere pavarwere vane akaderedza kutapata, kana muviri haakwanisi kudzivisa utachiona (pneumococcus, Haemophilus influenzae, Klebsiella). Ivo kupinda mukati mhango pakati mumapapu kuburikidza nasal ndima.

Boka pangozi zvinosanganisira vana vaduku boka uye varwere nezvirwere chirwere zvemapapu. Panyaya iyi, iyo causative mumiririri ndiye anonzi Staphylococcus aureus.

Community-vakatodzidza nosocomial nemabayo: zviga kupatsanura zvirwere

Kuti vave kurapwa nemabayo kuti patsanura kubudikidza parameters:

• chirwere haisi aine kuderera pamusoro runodzivirira mashandiro anoita nhengo;
• chirwere kubuda tikafunga shoma kutapata;
• chirwere yomuka ari rikwanise padariro AIDS;
• chirwere, akaumba pachiimbwa nezvimwe zvirwere.

Kazhinji, nechirwere kunosimbiswa Varwere vane dambudziko iri muchimiro kuderedzwa kutapata pamusoro colour kubva oncology kana hematology. Uyewo vari boka pangozi, varwere achitora steroids kwenguva refu refu chipimo chemushonga. Uyewo, pane nguva apo hosha kunoitika pavarwere vane chirwere zvirwere pathologies.

Uyezve, imwe yoga muchikwata zvinosanganisira ichi mhando nemabayo ndiyo chido.

Vanachiremba chinyorwa kuti panguva ino mashandiro yaigara chero mhando ose chido nemabayo pane miviri yokumwe uchikurukura iyo chirwere hwapedyo.

Kunyanya nosocomial nemabayo

Pfungwa iyi akaisa yokurapwa ezvinhu omurwere, kana kuzvimba ari zvemapapu chikamu anoratidzwa pashure anenge 72 maawa pashure chirwere. Ngozi yacho iri pakuti nosocomial nosocomial nemabayo rakaoma nokuda hunhu kosi uye kazhinji kunoguma murufu. It kunokonzerwa utachiona kuti kurarama masvingo tsika yokurapa, husingakwanisi mishonga yakawanda, saka zvakaoma chaizvo kuwana kokutanga zvakarurama mushonga.

Nosocomial Nosocomial nemabayo: zviga kupatsanura zvirwere

Pokutanga mhando chipatara nosocomial nemabayo iri Classified mune chirwere danho:

1. Early Danho - mumazuva mashanu yokuwana murwere muchipatara rokutanga vanotanga kuratidza zviratidzo pachena zvirwere.
2. Late Danho - kuratidzwa zviratidzo ari kunonoka nevanhu mazuva anopfuura mashanu.

Zvichienderana etiology chirwere zvitatu mhando:

1. Chido nosocomial nemabayo.
2. Postoperative.
3. Ventilator-chokuita.

Zvinokosha kucherechedza kuti kupatsanura anoratidzwa ne mhando pane zvinodiwa, uye kazhinji kacho vari panoonekwa nemabayo makawanda chimiro. Izviwo, kuwedzera zvikuru mamiriro ezvinhu murwere uye anoderedza mikana nokupora.

chido

Akauya chimiro chirwere ndicho. Kana utachiona nasal madzihwa anopinda pulmonary dhipatimendi, ipapo autoinfection muviri.

Liquid nasopharyngeal - nzvimbo yakanaka pathogenic bacteria zvokudya, saka, kamwe mumapapu, kuti tupukanana tusingaoneki vanotanga nokushingaira kuwanda, uye chinowedzera kukura chido nemabayo.

postoperative

Akauya ne mhando nemabayo iri chirwere muna 18 zvekuchipatara zviitiko kubva 100, uye rinowanikwa chete varwere vanenge inini kuvhiyiwa.

Panyaya iyi, utachiona rinowanikwa nenzira sezvakunoitwa chido nemabayo, chete nasopharyngeal mvura iri wakawedzera gastric secretions, izvo hakuna zvishoma ngozi. Uyewo, regai kutonga kubva chirwere zvokurapa zviridzwa murwere uye namano. Kuburikidza chubhu kana anobudisa mushonga zvishoma nezvishoma chirwere chinogona nyore kupararira rezasi kufema turakiti.

Ventilator-chokuita

Chirwere Varwere vari kwenguva refu tichitarisa kubata zvemapapu kufefetedza. Safe kumwedzi haasi maawa anopfuura 72 ari mamiriro ichi, zvinotevera zuva roga roga kunowedzera ngozi yokuva nemabayo.

Nosocomial nemabayo

Nosocomial nemabayo muchipatara kazhinji kunokonzerwa pneumococci. diagnoses akadaro kubva 30 kusvika 50 muzana zvose zvekuchipatara kacho.

Muduku hasha utachiona vari Chlamydia, Mycoplasma uye Legionella. Under kwavo simba, kukudziridza mabayo haasi anopfuura 30% asi kwete asingasviki 8%.

Muduku zvichida kuwanikwa nyonganyonga kwakamuka colour kuti simba basa: Haemophilus influenzae, anonzi Staphylococcus aureus, klebsiella uye enterobacteria.

Dzimwe utachiona kubva nosocomial nemabayo - yokuSpain nemavhairasi ndiye kirasi A uye B, parainfluenza, adenovirus, kufema syncytial utachiona.

Vakawanda utachiona kubva nosocomial nemabayo hasha mhando kuti anogona kukonzera dambudziko panomuka, - Mycoplasma uye Legionella. Muchiitiko chokutanga, kazhinji kurwara kuyaruka uye kusvika makore 25 vechiduku. A Legionella chirwere kunoitika kuburikidza nemvura, semuenzaniso, pachena pfungwa, bheseni nezvimwe.

Nzira Diagnostics ano

Kana murwere ane nemabayo, munharaunda akawana mhando, chinowanzoonekwa chirwere ne kuongorora chaiko. In kurapwa mhosva nomumwe, nokuti zvivanakire vachiongorora murwere ezvinhu uye zviratidzo hosha nokutanga yoga kadhi kana nhoroondo zvokurapa.

Phased kunze-murefu chirwere chiri sezvinotevera:

• Chest X-ray - X-ray Diagnostics nzira kuti racho mifananidzo iri ezvinhu mapapu ari ndege dzakawanda. Pamberi murima, gobvu makwapa chirwere kunosimbiswa. Chirwere kunoratidzwa kaviri: pakutanga kurapwa uye pashure asingaurayiwi kurapa.

• Laboratory miedzo - murwere anotarisirwa kuti vape ropa kuti ongororo uye kutsunga kwakaita uwandu leukocytes, shuga uye electrolytes.
• Zvidzidzo Microbiological - kunze kuongorora zviri pleural mvura uye coloring repasi kufema turakiti chinorondedzerwa nokuvapo maantigen iri weti.

Zvakabuda izvi chirwere kurapa kwakakwanira zvachose chirwere uye kurapwa urongwa kukura.

Zvinotarisirwa kuti pakurapa varwere

Clinical nhungamiro nokuti pakurapa nosocomial nemabayo kwakaita nyaya varwere mishonga pahupamhi-chakarondedzera.

Pashure pokugamuchira kuongorora zvabuda ari kukwanisa chiremba kushandura mushonga pakutanga kwakaitwa rikurumidze. Hwaro ndiro chimiro pathogenic tusingaoneki.

Mazano kurapa varwere nosocomial nemabayo

Mabatirwo nosocomial nemabayo kunoratidzwa kusarudza mushonga zvakakodzera, ayo anonetsa, nzira chourongwa uye uwandu husingakuvadzi. Rinotaura chete kupinda chiremba. Hazvina chinhu chinokosha mishonga iri pakurapa kufema turakiti remediation (kubviswa pamusaka Urume).

The inokosha ndiko kuwana murwere vachingotya kurovedza muviri. Unofanira kuita zviitwa kufema uye duku muviri muchimiro vanogara kupota. Varwere vari chakakomba ezvinhu, batsirai vanamukoti. Vari kuita nguva dzose kuchinja nzvimbo murwere, vachibvumira nemvura asingagari stagnate panzvimbo imwe.

Kudzivirira idzokororo chirwere kungabatsira kudzivirira nosocomial nemabayo, izvo hunonyatsodonongodza chiremba.

inorwisa mabhakitiriya kurapa

Treatment zvainanga chinorwisa utachiona, ane mhando mbiri: nemaune uye thumbs. Pakutanga, varwere vose vabatwe empirically kutaipa uye runounzwa vakagadzwa pashure Pakusarudza causative pomutumwa.

Chinonyanya kukosha ezvinhu kuti kupora vari:

1. Kuumba kwakakodzera inorwisa mabhakitiriya kurapwa.
2. Kwakaderedza kushandiswa tupukanana.

Pick zvinodhaka antibacterial uye chipimo chemushonga zvavo vanogona chiremba chete, kuzvicheka-yokutsiva zvinodhaka isingagamuchiriki.

The for kupora

Zvichienderana vakasarudzwa kwakarurama zvinodhaka, kwokuomerwa chirwere uye mukuru mamiriro murwere mugumisiro kurapwa angava sezvinotevera: kupora, zvishoma kuvandudzika, kurapwa kukundikana, zvinodhaka, uye rufu.

In nosocomial nemabayo mukana rufu kwakakwirira zvikuru kupfuura munzanga-vawana chimiro.

matanho

Kudzivirira nosocomial nemabayo waimiririra zvakaoma zvokurapa uye epidemiological matanho:

• nenguva Mabatirwo ukama zvirwere;
• zvaidiwa mitemo uye mwero utsanana;
• kugamuchira immunomodulatory yomuchipatara;
• kubaya.

Zvakakosha zvikuru kuwedzera murwere nemamiriro - kudzivirira kuitazve - kuongorora kuchengetwa mitemo nyore: dzose kutsvinda of nomumukanwa mhango, vangakosora kumusoro Urume kuwanda, kurovedza muviri.