Chilblains, pernio, ndi phazi la ngalande: chisamaliro chosazizira chozizira¶

Kuvulala kozizira kosazizira (NFCI) kumayimira gulu lofala, lopweteka, komanso lomwe nthawi zambiri limafooketsa zachilengedwe zomwe zimasiyana ndi chisanu chenicheni. Ngakhale kuti chipale chofewa chimafuna kutentha kocheperako kuti apange madzi oundana mkati mwa thupi, kuvulala kosazizira kozizira kumayamba kuzizira kwambiri kuposa kuzizira, nthawi zambiri kumakhala pakati pa 0 °C ndi 15 °C (32 °F ndi 59 °F). Khungu la munthu likakhala lopanda kanthu kapena losatetezedwa bwino, limakhala lonyowa mosalekeza, nsapato zonyowa, komanso kuzizira kwa maola ambiri kapena masiku angapo, kuwonongeka kwakukulu kwa mitsempha kumachitika popanda kristalo wa ayezi umodzi.

Zizindikiro ziwiri zoyambirira za kuvulala kosazizira kozizira ndi chilblains (omwe amadziwikanso kuti pernio kapena perniosis) ndi phazi la ngalande (phazi lomiza). Chilblain amawoneka ngati am'deralo, oyabwa kwambiri, otupa kapena otupa pakhungu pazala, zala, mphuno, kapena makutu, zomwe zimayendetsedwa ndi microvascular vasospasm pakuwotha. Trench phazi ndi chozama, chokhazikika cha neurovascular chikhalidwe chomwe chimayamba chifukwa cha kumizidwa kwa nthawi yayitali kapena chinyezi mkati mwa nsapato zolimba, zomwe zimayambitsa ma epidermal maceration, kuwonongeka kwa mitsempha yodziyimira payokha, kuzizira kosalekeza kwa hypersensitivity, komanso kupweteka kwa neuropathic. Kumvetsetsa zosiyana za pathophysiology, kachitidwe kachipatala, njira zowumitsa pang'onopang'ono, komanso zotsutsana zotsutsana ndi kutenthetsanso kwa madzi otentha kumateteza odwala ku mitsempha ya moyo wonse komanso kulumala kwa mitsempha.

Chitani izi tsopano¶

1. Chotsani nsapato zonyowa, masokosi, ndi zovala zonyowa nthawi yomweyo. Kuchotsa kukhudzana mwachindunji ndi nsalu yonyowa kumayimitsa kuzizira kosalekeza ndipo kumayimitsa epidermal maceration.
2. Kutenthetsa mawondo omwe akhudzidwa pang'onopang'ono pa kutentha kwa chipinda. Lolani miyendo kuti itenthetse pang'onopang'ono mumpweya pakati pa 20 °C ndi 22 °C (68 °F mpaka 72 °F); osamiza kuvulala kozizira kosazizira m'mabafa amadzi otentha.
3. *Tsukani khungu mofatsa kwambiri pogwiritsa ntchito sopo wocheperako komanso madzi ofunda. Tsukani thukuta, mabakiteriya, ndi chinyalala chomwe chachuluka mosakolopa, chifukwa misozi imafooketsedwa, khungu lopanda madzi.
4. *Umitsani khungu ndi chopukutira chofewa komanso choyera. Chotsani chinyezi pang'onopang'ono; osapaka, kusisita, kapena kusisita mwamphamvu zala zomwe zakhudzidwa, pansi, kapena zala zomwe zakhudzidwa.
5. Kwezani mapazi kapena manja pamwamba pang'ono pa mlingo wa mtima. Kuyika miyendo ndi miyendo pamapilo kapena mabulangete okulungidwa kumachepetsa kuthamanga kwa magazi ndipo kumachepetsa kutupa kowawa.
6. Umitsani khungu lopanda kanthu mumpweya waukhondo ndi wowuma musanagwiritse ntchito masokosi otayirira, aukhondo. Sungani miyendo yomwe yakhudzidwa ndi mpweya wozungulira mchipindacho kwa mphindi zosachepera 30 mpaka 60, onetsetsani kuti khungu lauma kwathunthu musanagwiritse ntchito nsapato zotayirira, zosathina.

Pathophysiology ya kuvulala kosazizira kozizira: vasospasm ndi maceration¶

Kuvulala kozizira kosazizira kumasiyana kwambiri ndi chisanu m'machitidwe awo a biophysical, nthawi yowonekera, ndi zotsatira za nthawi yayitali za neurovascular.

flowchart TD
    A["Kunyowa Kwanthawi yayitali, Kuzizira (0 °C mpaka 15 °C / 32 °F mpaka 59 °F)"] --> B["Kukhazikika kwa Peripheral Arteriolar Vasoconstriction"]
    B --> C["Capillary Endothelial Hypoxia & Fluid Leakage"]
    C --> D["Epidermal Hydration & Stratum Corneum Maceration"]
    D --> E{"Kuwonetsa Zachipatala?"}
    E -- Superficial Inflammatory Papules --> F["Chilblains (Pernio): Microvascular Vasospasm"]
    E -- Deep Neurovascular Breakdown --> G["Phazi la Trench (Kumiza Phazi): Mitsempha & Capillary Stasis"]
    F --> H["Kutsitsimula Mofatsa + Topical Corticosteroid"]
    G --> I["Kuyanika Kwapang'onopang'ono + Kukwera + Kupewa Kwambiri Madzi Otentha"]
    I --> J["Kuwongolera Kwanthawi yayitali kwa Neuropathic Pain & Raynaud Phenomenon"]

Kulephera kwa Microvascular ndi kulephera kuchitapo kanthu kwa kusaka¶

Thupi la munthu limayankhidwa mozungulira kuzizira ndi cyclic:

Kutentha kwapakhungu kukatsika, ulusi wosalala wa m'dera la cutaneous arterioles umalumikizana (cold-induced vasoconstriction) kuteteza magazi ofunda kuti asatenthetse pakhungu.

Nthawi ndi nthawi, dongosolo lamanjenje la autonomic limayambitsa nthawi yayifupi ya vasodilation, yomwe imadziwika kuti Lewis hunting reaction (cold-induced vasodilation), yomwe imatulutsa magazi ofunda mu manambala kwa mphindi 5 mpaka 10 kuti apereke mpweya ndi michere musanayambe kulimbitsanso.

Kwa anthu omwe ali pachiwopsezo kapena panthawi yachinyezi chokhazikika, kusaka sikulephera:

Ma arterioles odulidwa amakhalabe otsekedwa mu vasospasm yokhazikika.

Magazi a capillary agaya mpaka kuyima, ndikulepheretsa endothelium yozungulira ndi minyewa yozungulira mpweya.

Ma cell a endothelial a Vascular amatulutsa kutupa kwa hypoxic, pomwe ma cell a perivascular mast ndi mathero a minyewa amakhala okhudzidwa kwambiri.

Mnofu wozizira ukatenthedwanso mwachangu kwambiri, kuyankha kotupa kwachilendo kumayaka:

Ma Arterioles amakula mwadzidzidzi, pomwe ma venous otsika amakhalabe ochepa.

Kupsyinjika kwakukulu kumeneku kumapangitsa madzimadzi, maselo ofiira a magazi, ndi ma cytokines otupa kutuluka kunja kupyolera mu makoma a capillary owonongeka kulowa mu dermis, kutulutsa edema kwambiri, kuyabwa kwambiri, kutupa kwa papules, ndi microvascular thrombosis.

Biophysics ya epidermal maceration¶

Ngalande phazi amafuna yaitali chinyezi. Mapazi akatsekeredwa mkati mwa nsapato za rabara zosapumira, ma wader apulasitiki, kapena nsapato zachikopa zonyowa, khungu la mapazi limatulutsa thukuta lomwe silingasunthe:

Phazi la munthu wathanzi limakhala ndi zotupa za thukuta pafupifupi 250,000, zomwe zimatha kutulutsa chinyezi cha 250 ml (8.5 ounces) tsiku lililonse pochita zolimbitsa thupi.

Potsekeredwa m'kati mwa nsapato zosasunthika, stratum corneum (yosanjikiza kunja kwambiri ya maselo akufa, odzaza ndi keratin) imayamwa madzi ngati siponji.

Khungu lachibadwa lili ndi madzi okwanira 15 mpaka 20 peresenti; pansi pa chinyezi mosalekeza, madzi amaposa 50 peresenti, njira yotchedwa hyperhydration kapena maceration.

Khungu la macered limasanduka loyera kwambiri, lotupa, lokwinya, komanso lotuwa kwambiri.

Zomangira zapakati pa lipid zomwe zimamangiriza keratinocyte palimodzi zimasungunuka, zomwe zimapangitsa chotchinga pakhungu kutaya mphamvu yake yokhazikika.

Kuyenda movutikira mkati mwa boot kumameta epidermis yofewa kutali ndi papillary dermis, ndikutsegula ming'alu yaying'ono yomwe imakopa tizilombo toyambitsa matenda (monga cellulitis, gangrene yonyowa, ndi zilonda zamapazi).

Chilblains (pernio): chiwonetsero chachipatala ndi kasamalidwe¶

Chilblains (pernio kapena perniosis) amaimira zotupa zapakhungu zotupa kapena zotupa zomwe zimayambitsidwa ndi kuyankha kwapang'onopang'ono kwa kuzizira kopanda kuzizira. Nthawi zambiri amakhudza ogwira ntchito kunja, okwera mapiri, asilikali, ndi anthu omwe ali ndi vuto la autoimmune kapena kusokonezeka kwa kayendedwe ka kayendedwe kake.

Chilblains (Pernio) Anatomical Distribution:
--------------------------------------------------------------------------------
Primary Sites:    Dorsal surfaces of toes, fingertips, heels, ears, nose.
Visual Appearance: Erythematous (bright red) to violaceous (purple) swollen papules.
Key Symptoms:     Intense itching, burning pain upon rewarming, localized edema.
Distinction:      Skin remains soft and pliable; NO hard wooden freezing.
--------------------------------------------------------------------------------

Zizindikiro zachipatala ndi zizindikiro za chillblains¶

Chilblains amakula mkati mwa maola 2 mpaka 14 pambuyo pokumana ndi mpweya wonyowa, wozizira:

• Zotupa za erythematous mpaka violous papules. Zotupazo zimayamba ngati tinthu tambiri totupa tofiira tomwe timasanduka tofiirira kapena timadontho tofiirira. Amawonekera kwambiri pa zala zam'mapazi, m'mbali mwa mapazi, nsonga za zala, mlatho wa mphuno, ndi makutu.
• Kuyabwa kwambiri (kuyabwa) ndi kuwawa kotentha. Chizindikiro cha chiphuphu ndi kuyabwa koopsa komwe kumakula kwambiri munthu akalowa m'chipinda chotenthedwa kapena akalowa m'chipinda chofunda. Magazi akalowa mu minofu ya vasospastic, kuyabwa kumayambitsa kupsa mtima kwambiri.
• Kutuluka matuza ndi zilonda zikafika povuta kwambiri. Pa pernio yoopsa kapena yobwerezabwereza, edema yoopsa kwambiri imatulutsa mphuno, kupanga matuza ang'onoang'ono owoneka bwino. Ngati mkangano ugwiritsidwa ntchito, matuzawa amang'ambika, ndikusiya zilonda za erythematous zosaya, zowawa, zowonongeka pang'onopang'ono zomwe zimakhala ndi matenda achiwiri a staphylococcal.

Thandizo loyamba ndi chithandizo chamankhwala kwa chillblains¶

Kuwongolera chilblain kumakhazikika pakuchepetsa kuyankha kwapamtima komanso kuteteza khungu lowonongeka:

1. Kutenthetsanso khungu mosasamala. Lowetsani m'nyumba m'chipinda chotenthetsera bwino (20 °C mpaka 22 °C / 68 °F mpaka 72 °F). Lolani khungu kutentha mwachibadwa. Osayika chillblain pafupi ndi radiator, chotenthetsera chamagetsi, kapena poyatsira moto, ndipo musawalowetse m'madzi otentha, chifukwa kutentha kumawonjezera kuyabwa ndi kutupa.
2. Pewani kukanda ndi kukangana konse. Kukwapula kwa chilblain kumang'amba minyewa yopyapyala pamwamba pa papules, zomwe zimayambitsa zilonda zotseguka komanso kufalikira kwa mabakiteriya. Khalani ndi zikhadabo zazifupi ndikuyika thonje kapena ubweya wa thonje.
3. Ikani topical corticosteroid zonona. Kupaka mankhwala otchedwa topical corticosteroid (monga 1 peresenti ya hydrocortisone kapena 0.1 peresenti ya triamcinolone acetonide) kawiri pa tsiku kumachepetsa kutupa kwa capillary, kumachepetsa edema, ndi kuthetsa kuyabwa.
4. Dzitetezeni ku mikangano mkati mwa nsapato. Ngati wodwala akuyenera kuvala nsapato, valani bandeji ya hydrocolloid chithuza kapena manja a gel osakaniza paziphuphuzo kuti muteteze tinatake tozungulira kuti asasike ndi makina.
5. Thandizo lazachipatala la milandu yayikulu kapena yosasinthika. M'nyengo yozizira kwambiri, madokotala amatha kupereka mankhwala oletsa calcium channel blockers (monga nifedipine, 20 mg mpaka 60 mg tsiku lililonse). Nifedipine imatsitsimula minofu yosalala ya mitsempha, imachepetsa mitsempha ya m'mitsempha, ndikufulumizitsa kuthetsa zotupa za violaceous.

Phazi la Trench (phazi lomiza): magawo anayi azachipatala¶

Trench foot (phazi lomiza) ndi matenda owononga kwambiri kuposa chillblains. Zimayimira kuphwanya kophatikizana kwa neurovascular ndi kuvulala kwa ischemic komwe kumakhudza minofu yakuya ya mapazi. Podziŵika koyamba pamlingo waukulu kwambiri pakati pa asilikali amene anaima m’ngalande zodzadza ndi madzi m’Nkhondo Yadziko Loyamba, phazi la ngalande lidakali ngozi yosatha pakati pa asilikali amakono, oyenda m’mapiri, anthu opanda nyumba, ndi opulumuka tsoka amene anatsekeredwa m’madzi osefukira.

Phazi la Trench limadutsa m'magawo anayi osiyana a thupi, iliyonse imafunikira thandizo loyamba komanso kasamalidwe kachipatala.

flowchart TD
    A["Gawo 1: Pre-Hyperemic (Ischemic)"] -->|Slow Passive Room Air Warming| B["Gawo 2: Hyperemic (Reperfusion Inflammatory)"]
    B -->|Elevation, Bed Rest, Pain Management| C["Gawo 3: Post-Hyperemic (Chronic Neuropathic)"]
    C -->|Long-Term Nerve Recovery: 6 to 24 Months| D["Gawo 4: Sequelae Yamuyaya / Raynaud / Autonomic"]

Gawo 1: Gawo la pre-hyperemic (ischemic).¶

Gawo la pre-hyperemic limachitika nthawi yozizira, yonyowa komanso kupulumutsa nthawi yomweyo:

Phazi ndi lozizira, lotupa, lotumbululuka, lotuwa, kapena lotuwa.

Khungu limakhala lotumbululuka komanso lopanda madzi, kuwonetsa zopindika zakuya, zoyera, zopindika mozungulira mbewuyo komanso pakati pa zala.

Mitsempha ya m'mitsempha (dorsalis pedis ndi posterior tibial) imakhala yofooka kwambiri kapena yosatheka chifukwa cha kupindika kwakukulu kwa arteriolar.

Kumverera kumachepa kwambiri. Wodwalayo akufotokoza phazi ngati likumva kulemera, kufa, kapena ngati "kuyenda pazikhomo zamatabwa." Kumverera kogwirika, kukhudza pang'ono, ndi kuyankha kwa pinprick sizipezeka pazala zonse ndi kutsogolo kwakutali.

Zowonongeka panthawiyi zimakhazikika pa endothelial cell kutupa, microvascular stasis, komanso kuchepa kwa axonal koyambirira kwa zotumphukira zomverera ndi autonomic nerve fibers.

Gawo 2: Gawo la hyperemic (inflammatory reperfusion).¶

Gawo la hyperemic limayamba maola angapo phazi litachotsedwa kuzizira ndikuwotha kutentha. Zimayimira kuphulika kwa kutupa komwe kumatenga masiku angapo mpaka masabata angapo:

Phazi limasintha kukhala lotentha kwambiri, louma, lotsekeka lofiira. Kuthamanga kwapang'onopang'ono kumakhala kodzaza, kumangirira, ndi hyper-dynamic.

Edema yayikulu imayamba, zomwe zimapangitsa phazi, akakolo, ndi mwendo wakumunsi kutupa kuwirikiza kawiri kuchuluka kwake kwanthawi zonse.

Matuza aakulu, olimba odzazidwa ndi serous kapena hemorrhagic fluid amakweza khungu la macerated. Madera a khungu lachiphamaso amatsika, amawonetsa dermis yaiwisi, yolira.

Odwala amafotokoza kupweteka kwakukulu, kuyaka, kugunda komanso kumva kugwedezeka kwadzidzidzi kwamagetsi (kuwombera paresthesias) komwe kumafika pamlingo wovuta kwambiri, makamaka usiku.

Ululu pa siteji imeneyi amayamba ndi mankhwala kutupa kukwiyitsa regenerating minyewa mathero ndi pachimake reperfusion hyperemia kutambasula ischemic minofu mabedi.

Gawo 3: Gawo la post-hyperemic¶

Gawo la post-hyperemic limayamba pamene kutupa kwakukulu ndi kutsekeka kwa hyperemia kumachepa, nthawi zambiri kumatenga miyezi iwiri mpaka 12:

Kutupa ndi kufiira kumachepa pang'onopang'ono, ndipo matuza amauma kukhala zolimba.

Komabe, phazi limakhalabe lachilendo kwambiri. Khungu limakhala lozizira, lotumbululuka, ndi hypersensitive kusintha kwa kutentha.

Hyperhidrosis (kuchuluka, thukuta lozizira) limayamba chifukwa cha kuwonongeka kwa mitsempha ya autonomic yomwe imayambitsa thukuta.

Odwala amavutika ndi ululu wosalekeza, wosasunthika wa neuropathic, womwe umadziwika ndi allodynia (ululu wobwera chifukwa cha zinthu zosapweteka, monga kupukuta mapepala ndi zala) ndi kusalolera kuzizira. Kuyenda ngakhale mtunda waufupi kumayambitsa kupweteka kwakuya, kupweteka kwa mafupa komanso kutopa kwambiri.

Gawo 4: Zotsatira zosatha zanthawi zonse¶

Pazovuta kwambiri za phazi la ngalande pomwe kuwonekera kupitilira maola 48 mpaka 72, kulumala kokhazikika komanso magwiridwe antchito kumakhalabe moyo wonse:

Kutayika kwakukulu kwa zotumphukira za unmyelinated ndi myelinated nerve axon kumabweretsa kukhazikika kwa minyewa yamagazi ndi dzanzi.

Chochitika chachiwiri cha Raynaud chimachitika, pomwe kuwonekera pang'ono kwa mpweya wozizira kumayambitsa mwadzidzidzi, kupweteka kwa digito ndi cyanosis.

Odwala amakumana ndi matenda a nyamakazi msanga m'malo olumikizirana phazi, muscular atrophy m'minofu yamkati ya phazi (kuyambitsa zala za nyundo ndi pes cavus deformities), komanso hyperhidrosis yosalekeza yomwe imawonjezera kutengeka kwa matenda oyamba ndi fungus ndi mabakiteriya.

The kuyanika modekha ndi chipinda-kutentha rewrming protocol¶

Kasamalidwe kachipatala ka kuvulala kosazizira kozizira kumasiyana kotheratu ndi chisanu. Ngakhale chisanu chimafuna mwachangu, kutenthetsanso mwaukali mu 37 °C mpaka 40 °C (99 °F mpaka 104 °F) osambira m'madzi kuti asungunuke makhiristo oundana mwachangu, kutentha kofulumira kwa kuvulala kosazizira kumatsutsana.

Kuyika phazi la ngalande m'madzi otentha kumayambitsa kutulutsa kwadzidzidzi, komwe kumawonjezera kuwonongeka kwa mitsempha yamagazi, kumayambitsa ululu wosaneneka wa m'mitsempha, kufulumizitsa matuza, komanso kumayambitsa necrosis yowonda kwambiri.

Pang'onopang'ono osazizira ozizira kukonzanso ndikusamalira¶

Tsatirani ndondomeko yachipatala iyi poyang'anira ngalande kapena chilblain:

1. Kusintha kupita ku malo owuma, ofunda. Sonkhanitsani wodwalayo m'chipinda chamkati kapena m'chihema chosungidwa bwino, kutentha kwachipinda bwino: 20 °C mpaka 22 °C (68 °F mpaka 72 °F).
2. Chotsani nsapato zonse zonyowa ndi zovala mosamala. Masulani nsapato kwathunthu. Osagwedeza kapena kugwedeza nsapato pamapazi odzaza madzi. Dulani masokosi onyowa ndi masiketi a bandeji ngati atsatira khungu lofewa, lopindika.
3. Sambani mofatsa ndi sopo wofatsa wa antiseptic. Sambani mapazi kapena manja pogwiritsa ntchito madzi ofunda (pafupifupi 25 °C mpaka 30 °C / 77 °F mpaka 86 °F) ndi sopo wofatsa, wosanunkhiritsa. Osatsuka kapena kugwiritsa ntchito nsalu zochapira zokhala ndi zowoneka bwino.
4. Yatsani zowuma kwathunthu ndi matawulo ofewa. Patsani khungu pang'onopang'ono ndi matawulo oyera, ofewa kapena ma microfiber. Samalani kwambiri ndi mipata yapakati pa zala zala zala (malo opezeka pa intaneti), pomwe chinyezi chotsekeka chimabala maceration ndi mafangasi. Osapaka khungu mmbuyo ndi mtsogolo.
5. Onetsani mapazi poyanika mpweya. Sungani mapazi opanda kanthu poyera ndi mpweya wabwino, wozungulira chipinda kwa mphindi 30 mpaka 60. Kuwonekera kwa mpweya kumapangitsa kuti stratum corneum yodzaza madzi iwonongeke, kulimbitsa, ndikubwezeretsanso zotchinga zake zachilengedwe.
6. Kwezani malekezero apansi. Kwezani miyendo mmwamba pa mapilo kapena matumba ogona opinda kuti mapazi apumule 15 cm mpaka 30 cm ( mainchesi 6 mpaka 12) pamwamba pa mlingo wa mtima. Kukwera kumachepetsa kuthamanga kwa hydrostatic venous, kumachepetsa kutupa, komanso kumachepetsa kupweteka kwapang'onopang'ono.
7. Ikani ubweya wouma wotayirira, wosamangitsa kapena masokosi opangira. Khungu likawuma bwino komanso lolimba, valani masokosi aukhondo, owuma, otayirira opangidwa ndi ubweya wa merino kapena ubweya waubweya wapamwamba kwambiri. Osagwiritsa ntchito masokosi olimba, okhazikika, omwe amalepheretsa kutulutsa kwapang'onopang'ono kwa mitsempha yamagazi.
8. Pitirizani kugona mokwanira mu Gawo 2 hyperemia. Musalole kuti wodwala yemwe ali ndi hyperemic, matuza a ngalande ayende kapena kunyamula zolemera pamapazi awo. Kuyenda kumaphwanya ma capillaries a plantar ndipo kumayambitsa kuvulala kwakukulu kwa dermal shear.

+-----------------------------------------------------------+
|          NON-FREEZING COLD CARE SAFETY RULES              |
|                                                           |
|  [.] REWARM SLOWLY at room temperature (20 °C to 22 °C)   |
|  [.] PAT DRY GENTLY; never scrub or massage softened skin |
|  [.] AIR-DRY BARE FEET for 30 to 60 minutes               |
|  [.] ELEVATE FEET above heart level to control swelling   |
|  [.] NEVER USE HOT WATER BATHS; hot water causes necrosis |
|  [.] STRICT BED REST during acute hyperemic swelling      |
+-----------------------------------------------------------+

Njira zopewera: kuwongolera phazi ndi kasamalidwe ka zida¶

Kuvulala kozizira kosazizira kumatha kupewedwa chifukwa chaukhondo wamunthu, kusamalidwa mwamphamvu kwa chinyezi, ndi zida zowongolera. Asilikali padziko lonse lapansi apanga njira zambiri zogwirira ntchito nyengo yozizira zomwe zimapangidwira kuthetsa phazi lankhondo m'munda.

Njira yozungulira yamasokisi atatu¶

Kuwongolera chinyezi pamapazi kumafuna kusinthasintha kwamasoko tsiku lililonse:

Ogwira ntchito panja, okwera mapiri, ndi oyenda m'nyengo yozizira ayenera kunyamula mapeyala atatu a ubweya wolemera kwambiri kapena masokosi opangira chinyezi:

• Awiri 1: Amavala kumapazi mkati mwa nsapato paulendo kapena ntchito.
• Awiri 2: Awiri oyera, owuma m'mafupa omwe amasungidwa m'thumba lopanda madzi, losungidwa kuti ligone mumsasa.
• Awiri 3: Kusiya kuyanika mkati mwa jekete yanu motsutsana ndi kutentha kwa thupi lanu kapena kupachikidwa papaketi yanu.

Osavala masokosi omwewo kwa maola opitilira 12 akuyenda mosalekeza. Sinthani kukhala masokosi atsopano, owuma masana. Chotsani zonyowa ziwiri, tulutsani thukuta, ndikuziyika mkati mwazovala zanu zamkati momwe kutentha kwa thupi lanu kumawumitsa masana.

Ukhondo wa mapazi ndi zolepheretsa chinyezi¶

Kusamalira mapazi tsiku ndi tsiku kumalepheretsa chotchinga pakhungu kuti chisawonongeke:

Sambani ndi kupukuta mapazi tsiku ndi tsiku. Madzulo aliwonse, sambitsani mapazi bwinobwino ndi madzi aukhondo, ndi kuunika mosamala pakati pa chala chilichonse, ndipo mulole kuti mapazi opanda nsapato aume mpweya kwa mphindi zosachepera 30 musanavale masokosi ogona.

Ikani ufa wa phazi woyamwa chinyezi. Kupaka fumbi kumapazi ndi ufa wopanda mankhwala kapena phazi ufa wokhala ndi zinc oxide, aluminiyamu chlorohydrate, kapena chimanga chimayamwa thukuta ndipo khungu limakhala louma.

Gwiritsani ntchito antiperspirant sprays kapena roll-ons. Kupaka aluminium chloride antiperspirant ku mapazi kamodzi tsiku lililonse kwa masiku atatu kapena asanu musanayambe maulendo a nyengo yozizira kumachepetsa thukuta la phazi ndi 50 peresenti, kuteteza epidermal maceration.

Mafuta otsekemera ndi mafuta a petrolatum. M'malo ozizira kwambiri, omwe nsapato zidzanyowetsedwa, kugwiritsa ntchito chotchinga chochepa kwambiri cha dimethicone-based barrier cream kapena mafuta odzola (petrolatum) ku zala ndi zala kumapanga chotchinga cha hydrophobic chomwe chimalepheretsa madzi akunja kulowa mu stratum corneum.

Kukula bwino kwa nsapato ndi kusankha boot¶

Okonza nsapato amathandizira kwambiri pakuvulala kosazizira kozizira:

Osavala nsapato zothina. Nsapato zomwe zimagwirizana bwino nyengo yofunda zimakhala zoopsa m'nyengo yozizira. Kuvala masokosi achisanu mkati mwa nsapato zolimba kumakakamiza dorsal pedis artery, kutsamwitsa microcirculation, ndikufulumizitsa ischemia ya minofu.

Nsapato zachisanu zachisanu ndi theka kapena kukula kwakukulu kuposa nsapato zamtundu wamba. Izi zimapanga malo otseguka ozungulira phazi, kulola kuti magazi a capillary aziyenda mopanda malire, ndipo amalola mpata wa masokosi a ubweya wokhuthala popanda kumanga.

Sankhani nsapato zopumira, zopanda madzi zanyengo yozizira (monga Gore-Tex kapena eVent). Pamadzi osalekeza, oyimirira kapena matope, gwiritsani ntchito nsapato zapac-layer-layer pac zokhala ndi zomverera zochotseka kapena zopangira.

Dry boot liners usiku uliwonse. Osagona ndi zomangira nsapato zonyowa mkati mwa nsapato zachisanu. Chotsani zomangira kapena zaubweya pazipolopolo za nsapato ndikugona nazo mkati mwachikwama chanu chogona pamutu wanu kuti muwonetsetse kuti nsapato zouma, zotentha m'mawa wotsatira.

Malangizo azachipatala apadziko lonse lapansi ndi miyezo yozizira yantchito¶

Kuvulala kozizira kosazizira kumatsatira miyezo yodziwika bwino, ziphunzitso zachipatala zankhondo, ndi malamulo aumoyo wapantchito m'maiko onse.

United States: Miyezo ya ntchito ya DoD, OSHA, ndi NIOSH¶

Ku United States, kuvulala kosazizira kozizira kumayendetsedwa pansi pamiyezo yankhondo ya Department of Defense (DoD) ndi malangizo a Occupational Safety and Health Administration (OSHA):

US Army Public Health Center imakakamiza Technical Bulletin Medical 505 (TB MED 505: Prevention and Management of Cold-Weather Injuries), kukhazikitsa kuwunika kovomerezeka kwa phazi latsiku ndi tsiku, ma regimens osintha masokosi, komanso nthawi yayitali yowonekera m'malo amvula.

Malangizo a OSHA ozizira amafunikira olemba ntchito pantchito zaulimi, zomangamanga, ndi zam'madzi kuti azipereka malo otentha, owuma, kukakamiza kusintha kwa nsapato, ndikuyang'anira ogwira ntchito kuti azindikire zizindikiro zoyamba za chilblains ndi phazi lomiza.

Kuwunika kwachipatala ndi kutumiza mwadzidzidzi ku United States kumapezeka poyimba 911.

United Kingdom: Unduna wa Zachitetezo ndi Upangiri wachipatala wa NHS¶

United Kingdom ili ndi gulu lambiri la kafukufuku wazachipatala wokhudzana ndi kuvulala kosazizira kozizira, motsogozedwa ndi zomwe zidachitika asitikali aku Britain pankhondo ya Falklands ndi maphunziro aku Northern Europe:

Unduna wa Zachitetezo ku UK (MoD) umakakamiza Joint Service Publication 539 (JSP 539: Kuvulala kwa Nyengo mu Gulu Lankhondo), ndikuyika NFCI ngati anthu ovulala omwe amanenedwa. Malamulo ankhondo aku Britain amalamula kuti membala aliyense yemwe ali ndi mapazi atachita dzanzi, mapazi otumbululuka atakumana ndi kuzizira, akhazikitsidwe ntchito yomweyo, ndikuwothanso kutentha m'chipinda, ndikuwunikiridwa ndi azachipatala.

National Health Service (NHS) imapereka zipatala zapadera zamatenthedwe am'madera omwe amagwiritsa ntchito infrared thermography ndi kuyezetsa kumverera kwa kutentha kuti athe kudziwa kuwonongeka kwa mitsempha yodziyimira payokha komanso kuthana ndi ululu wa post-NFCI neuropathic. Ntchito zadzidzidzi ku UK zimafikiridwa kudzera pa 999 kapena 112.

Canada: Canada Forces ndi Canada Center for Occupational Health¶

Ku Canada, kuvulala kozizira kumayang'aniridwa motsogozedwa ndi National Defense ndi Canadian Center for Occupational Health and Safety (CCOHS):

Malangizo a Canadian Forces Health Services akugogomezera kuzindikirika kwamunda mwachangu kwa pernio ndi phazi la kumizidwa panthawi yamayendedwe apansi panthaka ndi m'mphepete mwa nyanja.

Malamulo a zaumoyo kuntchito amalamula kuti ogwira ntchito kumalo ozizira, amvula alandire nsapato zotentha zosalowa madzi zokhala ndi zotchingira zolimba komanso zomangira zotchingira zosagwira zomwe zimagwirizana ndi CSA Standard Z195. Thandizo ladzidzidzi limafikiridwa ku Canada konse poyimba 911.

Australia: Ntchito Yotetezedwa ku Australia ndi chiphunzitso chankhondo chapamwamba¶

Ku Australia, kuvulala kosazizira kozizira kumayang'aniridwa ndi Safe Work Australia ndi Australian Defense Force (ADF):

Ogwira ntchito zaulimi kumadera akumwera kwa mvula-yozizira (Tasmania, Victoria) ndi asitikali omwe amagwira ntchito m'malo ophunzitsira a High Country amayesedwa pa ngozi ya kuzizira kwa ntchito.

Ntchito Yotetezedwa ku Australia Malamulo ogwirira ntchito amafunikira olemba anzawo ntchito kuti azipereka zotsekera zotsekera, zotsekera madzi, masokosi otenthetsera, ndi zipinda zowumira zofunda kwa ogwira ntchito m'mafakitale onyowa, ozizira komanso akunja. Pazochitika zadzidzidzi, aku Australia amayimba 000.

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi mungatenge phazi la ngalande ngati kutentha sikuzizira?¶

Inde. Ngalande phazi sikutanthauza kuzizira. Imakula m'malo onyowa osazizira kwambiri kuyambira 0 °C mpaka 15 °C (32 °F mpaka 59 °F). Mapazi akatsekeredwa mkati mwamadzi, nsapato zonyowa kwa maola 12 kapena kuposerapo, kutsekeka kwa capillary mosalekeza, kusowa kwa okosijeni wa minofu, ndi maceration pakhungu zimayambitsa kuwonongeka kwakukulu kwa mitsempha ndi minofu popanda kupanga ayezi m'thupi.

Chifukwa chiyani madzi otentha ali owopsa kwa munthu yemwe ali ndi phazi kapena chillblains?¶

Kuyika kuvulala kozizira kosazizira m'madzi otentha kumapangitsa kuti mitsempha yamagazi ikhale yadzidzidzi m'minyewa yomwe yawonongeka kale capillary. Kuthamanga kwa magazi mwadzidzidzi kumeneku kumayambitsa kutupa kwambiri, kufulumizitsa matuza, kumatulutsa ululu woopsa wa mitsempha, ndipo kungayambitse minofu necrosis. Zovulala zozizira zosazizira ziyenera kutenthedwa pang'onopang'ono kutentha kwapakati.

Kodi ndingasiyanitse bwanji pakati pa chilblains ndi frostbite?¶

Chilblain amapezeka m'malo otentha kwambiri kuposa kuzizira ndipo amawonekera ngati kutupa, kuyabwa, zotupa zofiira pa zala, zala, kapena makutu zomwe zimakhala zofewa komanso zomveka kuzikhudza. Frostbite imachitika pakazizira kwambiri ndipo kumapangitsa kuti khungu likhale lolimba, lolimba komanso lamatabwa, kenako dzanzi ndi matuza akulu odzaza madzimadzi akamasungunuka.

Zimatenga nthawi yayitali bwanji kuti phazi la ngalande lichiritsidwe kwathunthu?¶

Milandu yocheperako yomwe idagwidwa koyambirira kwa pre-hyperemic imatha kutha mkati mwa masiku ochepa pakupumula kowuma ndi kutentha. Komabe, phazi laling'ono mpaka lolimba kwambiri lomwe lalowa m'magawo a hyperemic ndi matuza nthawi zambiri limafunikira miyezi iwiri kapena khumi ndi iwiri kuti achiritse. Zikavuta kwambiri ndi mitsempha yambiri ndi kuwonongeka kwa capillary, odwala amawonongeka kwamuyaya, kuzizira kwa hypersensitivity, ndi kupweteka kosalekeza kwa moyo wonse.

Kodi njira yabwino yowumitsa mapazi odzaza madzi ndi yanji m'munda ndi iti?¶

Chotsani nsapato zonyowa ndi masokosi nthawi yomweyo, sambitsani mapazi pang'onopang'ono ndi sopo wocheperako ndi madzi ofunda osakucha, ndi kuwapukuta ndi chopukutira choyera. Lolani mapazi opanda kanthu kuti awume mu mpweya wotentha wa chipinda kwa mphindi 30 mpaka 60 kuti khungu lofewa likhale lolimba. Kwezani mapazi kuti muchepetse kutupa, ndipo valani masokosi owuma owuma akawuma.

Chitsimikizo cha thandizo loyamba¶

Kuzindikira ndi kuchiza kuvulala kosazizira kozizira ngati chilblains ndi phazi la ngalande kumafuna chidziwitso chothandiza chamankhwala oteteza zachilengedwe, physiology yotchinga khungu, komanso chisamaliro chofatsa. Kuphunzira kusiyanitsa zoopsa zomwe sizimazizira kwambiri ndi chisanu chakuya, kupewa zolakwika zowopsa zomwe zimatenthedwa mwachangu, komanso kuyanika bwino ndikugawika m'munda kungalepheretse kulemala kwanthawi zonse kwa anthu ogwira ntchito panja, oyenda m'misewu, ndi opulumuka tsoka.

Timalimbikitsa kwambiri aliyense amene amagwira ntchito panja, kuchita nawo zosangalatsa m'nyengo yozizira, kapena kutsogolera magulu akunja kuti amalize ziphaso zovomerezeka ku wilderness first aid (WFA) kapena thandizo loyamba lokhazikika ndi kutsitsimula mtima kwamtima (CPR). Othandizira odziwika monga American Red Cross, St John Ambulance, British Red Cross, ndi Canadian Red Cross amapereka maphunziro ochuluka pa kupewa kuvulala kwa chilengedwe, kasamalidwe ka maceration, ndi chithandizo choyamba cha zoopsa.

Magwero afufuzidwa¶

• Wilderness Medical Society (WMS, United States): Malangizo Othandizira Othandizira Kupewa ndi Kuchiza Malonda Osazizira Ozizira.
• U.S. Army Public Health Center (United States): Technical Bulletin Medical 505: Kupewa ndi Kusamalira Kuvulala kwa Cold-Weather.
• UK Ministry of Defense (United Kingdom): Ntchito Yophatikizana Yofalitsidwa 539: Kuvulala Kwa Nyengo M'magulu Ankhondo: Kuvulala Kosazizira Kwambiri.
• National Health Service (NHS, United Kingdom): Upangiri Wachipatala pa Chilblains (Pernio) ndi Zovulala Zosatha za Kutentha.
• Canadian Center for Occupational Health and Safety (CCOHS, Canada): Cold Weather Workers Safety and Immersion Foot Guidance.
• Ntchito Yotetezeka ku Australia (Australia): Kuwongolera Zowopsa Zogwira Ntchito Panyengo Yanyengo Yambiri: Kupsinjika Kwambiri.

Maupangiri ogwirizana¶

• Hypothermia ndi frostbite chithandizo chadzidzidzi
• Kukhazikika kwa chilala, kumizidwa m'madzi ofunda, ndikuzimitsanso zoopsa
• Kuzindikira modabwitsa ndi kasamalidwe mu zoopsa
• Mkuntho wa dzinja komanso njira zopulumutsira mvula yamkuntho
• Nambala zadzidzidzi malinga ndi dziko