Inyumoniya Nosocomial: magciwane, unyango kunye nothintelo

inyumoniya Nosocomial - yinkqubo yondele esosulelayo ibakho umzimba phantsi kwempembelelo ubomi asebenzayo lwegciwane izifo. iimpawu uphawu esi sifo ngokuma sisilonda esidumbileyoesingaphakathi ikhadi yemiphunga kunye olwenzeka ngaphakathi umthamo omkhulu wamanzi. Exudate kamva engena kwaye ingena iiseli inyama kwezintso.

isikhokelo sikazwelonke Updated for semiphunga ezifunyanwa esibhedlele

Ukuqala ukususela 2014 "Society kungaPhefumli" wazisa ihlabathi ukuba izikhokelo zonyango. Zisekelwe algorithm moshilongo kunye nonyango kwiimeko apho kukho urhano lokuba isigulana iqhubeka inyumoniya nosocomial. izikhokelo National kuphuhliswa ziingcali, oonoklinikhi, abasebenzi bezempilo, bejamelene usuleleko ezihlasela zosulele ngokuphefumla.

Ngokufutshane, i algorithm lenziwa ngongoma zine.

1. Ukumisela ukuba udinga nokulaliswa esibhedlele. A sigqibo yenziwe, ukuba isigulane ichazwe ngokucacileyo ukubandezeleka yokuphefumla, kukho ukuhla izihlunu perfusion, etsolo ukuzeyisa yityhefu, ukwazi kakuhle, ezingazinzanga uxinzelelo lwegazi. Ukuze ibekwe esibhedlele kakhulu ukuqinisekisa uphawu olunye ubuncinane.
2. Ukumisela unobangela sifo. Ukuze benze oku, isigulane emiselweyo inani lezifundo kwilebhu izinto eziphilayo: inkcubeko igazi, inkcubeko ukusuka apho iphuma khona, bakposev isikhohlela,-high speed uvavanyo ukuqinisekisa uhlobo yebhaktiriya antigenurii.
3. Ekumiseleni ixesha lonyango. Ngaphandle kokuba esi sifo of imvelaphi esosulela ngokudluliselwa kwentsholongwane, kodwa isizathu omele lusekiwe, uthomalaliso kuqhutywa iintsuku ezilishumi. Xa iingxaki ezahlukeneyo okanye ikhondo extrapulmonary ekugxilwe zonyango inokuba ukuya kwiintsuku ezingama-21.
4. Amanyathelo ayimfuneko inpatient nokuhlala. Zikwimeko kakhulu, izigulane ezifuna nokuphefumla okanye umoya non-invasive test.

Kwakhona kwizikhokelo zikazwelonke emiselweyo amanyathelo othintelo. Ngempumelelo kakhulu ugonyo zokulwa umkhuhlane kunye pneumococcus, amisiweyo ikakhulu kwizigulane kunye nenyumoniya ezingapheliyo kunye nabantu iqela ubudala nangaphezulu.

inyumoniya ngakumbi eluntwini ezifunyenwe

inyumoniya nosocomial ezifunyanwa Community lelinye igama eliqhelekileyo - ufumene ekuhlaleni. Esi sifo sibangelwa ukusulelwa umyalezo amagciwane. Eyona ndlela losulelo - bume. Ngako oko, ukumiselwa iza kuba ngolu hlobo lulandelayo: ukudumba ikhadi lung sisilonda esidumbileyoesingaphakathi afunyenwe amachaphaza, apho qha ngasentla kunye abathwali wosulelo izicwangciso zokhathalelo lwempilo isigulane wayengekho.

kunye nenyumoniya nosocomial imvelaphi ziibhakteriya ngokuqhelekileyo olufunyanwa izigulane nokuphungulwa sifo, xa umzimba akakwazi ukumelana kwamagciwane (pneumococcus, Haemophilus influenzae influenzae, Klebsiella) ezifunyanwa ekuhlaleni. Bona ingangena kungena em- imiphunga ngokusebenzisa iivesi ngeempumlo.

Iqela Umngcipheko kuquka abantwana kwiqela besebancinane kwaye izigulane zizifo zamaphaphu ezingapheliyo. Kulo mzekelo, i-arhente causative yi Staphylococcus aureus.

Community ezifunyanwa nenyumoniya nosocomial: Imigaqo yokuhlelwa izifo

Ukuze ukuphuhlisa unyango olufanelekileyo yinyumoniya lokuhlela yi parameters:

• sifo ezingahambi ukwehla imisebenzi ibakhusela eziphilayo;
• sifo ukuvela ngokuchasene nentsukaphi nokuphungulwa okukwazi;
• isifo evela kwi nqanaba nokoyika AIDS;
• izifo, kwakheka kunye nezinye izifo.

Ngokuqhelekileyo, uxilongo kuqinisekiswa izigulane abanenkinga ngohlobo yokwehla okukwazi sizoku lwisana Oncology okanye Haematology. Kwakhona kwiqela umngcipheko ke, izigulane steroid ixesha elide izinga eliphezulu. Kwakhona, kukho amaxesha xa sifo kwenzeka kwizigulane kunye ezimbi ezingapheliyo omzimba.

Ukongeza, uhlobo eyahlukileyo ziquka olu hlobo yinyumoniya lo mgomo.

Oogqirha uqaphele ukuba le ndawana indlela imvelaphi naluphi na uhlobo yokulangazelela yinyumoniya kukho imizimba amazwe wadibana apho sifo kuphuhliswa.

pneumonia ikakhulu nosocomial

Le mbono ibekwa imeko yempilo yomguli, xa ukudumba kwicandelo imiphunga iboniswa emva kweeyure ezimalunga 72 emva kokosuleleka. Ingozi siyifumana yokuba semiphunga nosocomial nosocomial nzima uhlobo kwekhosi kwaye usoloko kuphelela ekufeni. Oku kubangelwa ziibhaktheriya ezihlala iindonga kwiziko lonyango, ukumelana ukuba amayeza ezininzi, ngoko kunzima kakhulu ukufumana ixesha lokuqala olwa echanekileyo.

Nosocomial Nosocomial pneumonia: Imigaqo yokuhlelwa izifo

uhlobo ephambili kwisibhedlele yinyumoniya nosocomial zicacisa inyathelo losuleleko:

1. sigaba kweXesha - kwiintsuku zokuqala ezintlanu ekufumaneni njengesigulana esibhedlele kuqala ukubonisa iimpawu ezicacileyo sifo.
2. lamva - ngokubonakala iimpawu isalityaziswa yi ngaphezu kweentsuku ezintlanu.

Kuxhomekeka umyalezo we sifo iintlobo ezintathu:

1. Eskom inyumoniya nosocomial.
2. Postoperative.
3. Mpilo-ehlobene.

Kubalulekile ukuphawula ukuba ulwahlulohlulo thaca ngokohlobo lunemiqathango, kwaye kwiimeko ezininzi abafunyenwe inyumoniya ngohlobo mixed. Oku, aggravates kakhulu imeko yomguli kunye kunciphisa amathuba achache.

mgomo

uhlobo thaca lo sifo ezivame kakhulu. Xa yencindi eyosulelekileyo ngeempumlo ungena isebe pulmonary, umzimba autoinfection apho.

nasopharyngeal alulwelo - yeyona ndawo bathanda ukutya iintsholongwane ebangela isifo, ngoko, kanye emiphungeni, magciwane aqale ukwanda ngamandla, kwaye uyalenza igalelo kuphuhliso yokulangazelela pneumonia.

postoperative

Ebonakaliswa luhlobo yinyumoniya banesifo kwiimeko 18 clinical ngaphandle kwe-100, yaye lifumaneka kuphela kwizigulane abanikwe utyando.

Kulo mzekelo, usulelo lwenzeka ngendlela efanayo naleyo echazwe yokulangazelela pneumonia, kuphela ulwelo nasopharyngeal idityaniswa kunye netuwa esiswini, apho kungekho ngaphantsi yingozi. Kwakhona, musa kuthintelwe usulelo kwizixhobo yomguli zonyango kunye nezixhobo. Ngokusebenzisa ityhubhu okanye usulelo catheter lula kwalutyhutyha iphecana ukungaphefumli.

Mpilo enxulumene

Sifo e kwizigulane na ixesha elide ngokwemiqathango kwezindlela umoya semiphunga. ixesha Safe ayikho ngaphezulu kweeyure ezingama-72 kule meko, kule ilandelayo suku ngalunye kwandisa ingozi yokuba nesifo sengqele.

inyumoniya Nosocomial

isibhedlele inyumoniya Nosocomial ezibangelwa pneumococci. iSifo ezinjalo zivela-30 ukuya kuma-50 ekhulwini zonke iimeko zonyango.

Igciwane ubuncinane ndlongondlongo na chlamydia, Mycoplasma kunye Legionella. Phantsi impembelelo yazo, nokuphuhlisa inyumoniya ayikho ngaphezu kwe-30%, kodwa hayi ngaphantsi kwe-8%.

Wesuka kancane ukuba kufunyanwa disorder sizoku lwisana umsebenzi ngamandla: Haemophilus influenzae influenzae, Staphylococcus aureus, klebsiella kunye enterobacteria.

Kanti nezinye amagciwane yinyumoniya nosocomial - iintsholongwane Umkhuhlane iklasi A and B, parainfluenza, adenovirus, intsholongwane yokuphefumla syncytial.

Eyona amagciwane uqhelekileyo nosocomial yinyumoniya uhlobo silwe ukuba zinokubangela ukuba noqhambuko bhubhane, - Mycoplasma kunye Legionella. Kwimeko yokuqala, ngokufuthi elivisayo abagulayo kunye nabantu abatsha ukuya kwiminyaka engama-25. A usuleleko Legionella kwenzeka ngokusebenzisa amanzi, umz, engqondweni yoluntu, nesitya kunye nezinye.

Iindlela noxilongo lwangoku

Ukuba umntu ogulayo inyumoniya, uhlobo ezifunyenwe ekuhlaleni, oku kudla axilonge nokuxilongwa kwemizimba yabo. Kwimeko nganye lwezonyango, kuba lula esweni imeko yomguli kunye iimpawu zesi sifo qala ikhadi eyahlukileyo okanye imbali yezonyango.

Ikhutshelwe uphethwe out-isigulane ngolu hlobo lulandelayo:

• Chest X-ray - X-ray uxilongo indlela Iiprojekthi imifanekiso kwi imeko imiphunga e iinqwelomoya ezininzi. Phambi yobumnyama, amatshatshazi ashinyeneyo uxilongo iqinisekisiwe. Uxilongo uboniswa kabini: ekuqaleni konyango kunye emva konyango isibulala-zintsholongwane.

• iimvavanyo Laboratory - isigulane kufuneka ukuba unikele ngegazi ze acalulwe kubalwa inani elipheleleyo leukocytes, glucose electrolytes.
• izifundo ekuzakuqalwa - zazide uhlalutyo ulwelo pleural kunye Umbala we phecana ukungaphefumli sichazwa bubukho ezisegazini kwi yokuchama.

Iziphumo zezi nkqubo zokuxilonga kwanele moshilongo esichazayo nophuhliso isicwangciso sonyango.

Izindululo ngokuba unyango lwezigulane

izikhokelo zonyango ukuze unyango yinyumoniya nosocomial yile ngumbandela emisela antibiotics ebanzi-omoya.

Emva kokufumana iziphumo zophando kwi kwisakhono igqirha ukutshintsha ichiza ngaphambili akumiselweyo ngakumbi kakuhle. Isiseko na uhlobo ezincinane izifo.

Imigaqo yonyango kwezigulane pneumonia nosocomial

Unyango yinyumoniya nosocomial iqulathe ekukhetheni olwa efanelekileyo, irejimeni yayo, indlela yolawulo balawule. Ukwachaphazela kuphela ngugqirha khona. Kwakhona yinxalenye nothomalaliso na unyango nokuphefumla phecana ukulungiswa (ukususwa ulwelo accumulated).

Ingongoma ebalulekileyo kukuba ukufumana umguli kwimo umzimba. Kufuneka wenze imithambo yokuphefumla kunye umthambo encinane ngohlobo zihleli-ups. Izigulane zikwimeko kakhulu, ukunceda abongikazi. Bona benza utshintsho rhoqo imeko yomguli, ngokuvumela ulwelo angaxingi endaweni enye.

Nqanda isifo nezolo iza kunceda uthintelo yinyumoniya nosocomial, ezichaza ngokweenkcukacha gqirha.

therapy isibulala-zintsholongwane

Unyango ejoliswe iintsholongwane ukulwa, uye iindidi ezimbini: ngabom kunye ubhontsi. Ekuqaleni, zonke izigulane baphathwa empirically ukuchwetheza waza wayalela baqeshwa emva eqingqa arhente causative.

Imiqathango ibalulekileyo sokubuyisela zezi:

1. Ukuphuhlisa unyango olufanelekileyo isibulala-zintsholongwane.
2. ukusetyenziswa Ukuncipha antimicrobials.

Khetha iziyobisi antibacterial kwaye umthamo wabo gqirha kuphela, iziyobisi self-nokutshintsha ayamkelekanga.

Sase- sokubuyisela

Kuxhomekeka amachiza ezichanekileyo ezikhethiweyo, nobungozi besi sifo kunye nemeko ngokubanzi ngesiphumo ngomonde unyango ngolu hlobo lulandelayo: wobuyiselo, ukuphucuka okungephi, ukusilela kunyango, ndiphinde ndazisebenzisa, kunye nokufa.

Xa nenyumoniya nosocomial amathuba ukufa iphezulu kakhulu kunaleyo kwifomu ufumene ekuhlaleni.

amanyathelo othintelo

Uthintelo yinyumoniya nosocomial emelwe amanyathelo zonyango kunye kwezifo ezinzima:

• unyango ngexesha izifo ezinxulumene;
• ukuthotyelwa kwemithetho kunye nemigangatho yezempilo;
• abafumana agents immunomodulatory;
• ugonyo.

Kubaluleke kakhulu ekuphuculeni imeko yomguli - ukuthintela ndiphinde - esweni nokulandelwa kwemithetho elula: ucoceko rhoqo kwisisu ngomlomo, ukukhohlela up ulwandiso fluid, eyahlukahlukeneyo.