Amaraso y'Ifistule ya Dialyse (Itegeko ry'Icupa) n'Ivyihutirwa vy'Idialyse¶

Ku muntu ariko araronka ubuvuzi bwo gusukura amaraso kubera ubumuga bw’amafyigo (Indwara y’amafyigo y’Iherezo, canke ESRD), fistule y’imitsi (AV) yiwe, AV graft, canke catheter y’ugusukura amaraso mu mitsi yo hagati ni umurongo w’ubuzima bwiwe, ariko kandi ni umurongo w’ubuzima bw’umubiri udafise umuvuduko munini w’umuyoboro w’amafyigo ushobora gutuma umuntu apfa. iminota iyo igisebe co gutobora urushinge gipfutse. Igikoko citwa AV gikomeye gifatanya umutsi n'umutsi wo mu kuboko, kigatwara **\(600\text{ kugeza kuri }2.000\text{ mililitiro}\) (\(0.6\text{ kugeza kuri }2.0\text{s car{s}\)) c'amaraso y'umutsi buri munota umwe wose a' umubiri wose usohora. Muri ico gihe nyene, kubura mbere n’igihe kimwe canke bibiri vyo gusukura amaraso (mu gihe c’igihuhusi, umuyagankuba uzimye canke indwara) bituma umuntu agira indwara zibiri zica zicereje: hyperkalemia (potasiyumu y’ubumara mu maraso) ishobora guhagarika umutima ata n’umwe abimenyesheje, be n’indwara y’umutima ishobora guhagarika umutima ata n’umwe abimenyesheje, be n’indwara y’umutima ishobora gutera indwara y’umutima. amahaha. Ubutabazi bwa mbere busaba kumenya neza Pinpoint One-Finger / Bottle-Cap Pressure (ntiwigere uzingira igitambaro kinini cane ku fistule iva amaraso), gukingira ukuboko kw’umuvuduko w’amaraso ku bipfukisho canke ku bipfukisho vy’umuvuduko w’amaraso, no kumenya intege nke z’umuvuduko w’amaraso imbere y’uko umutima uhagarara.

Ivyo ubikore ubu¶

1. Ku AV fistule canke graft iva amaraso: Kanda urutoke RUmwe canke igipfukisho c’icupa ry’ipulasitike risukuye ushire ku mwobo w’ibara ry’agahama ubwo nyene. Ntutaze amasegonda 10 urondera imibavu. Shira urukumu rwawe canke urutoke rw’urutoke (canke agapfukisho k’icupa ry’impuzu / igipfukisho c’icupa ry’ipulasitike) ushize hejuru y’umwobo nyawo w’urushinge canke igisebe aho amaraso ariko arasohoka. Ushireko umukazo ukomeye, wibanda ku rutoke rwawe, bihagije gusa kugira ngo uhagarike amaraso ava mu gihe ukiriko wumva ukunyiganyiga kw’amaraso ("thrill") kw’amaraso atemba mu fistule iri munsi y’urutoke rwawe, hanyuma uwufate ubudasiba utavyitegereje mu minota 15 gushika kuri 20.
2. Hamagara inomero y’ivyihutirwa yo mu karere kawe ubwo nyene ku nkuru y’ijwi maze ushire ukuboko hejuru y’urugero rw’umutima. Hamagara 911 muri Leta Zunze Ubumwe za Amerika na Canada, 112 hirya no hino mu Bumwe bw’Uburayi, 999 mu Bwongereza, canke urabe vyose inomero z'ivyihutirwa. Umurwayi aryamye ku mugongo hasi canke ku gitanda (kugira ngo ntibacike intege ngo bakure ukuboko kwabo ku rutoke rwawe) hanyuma ufate ukuboko kuva amaraso kuduze hejuru y’urugero rw’umutima wabo. Naho amaraso yoba ahagaze inyuma y’iminota 15 muhira, igihe cose umuntu apfuye canke agacitse igihimba c’irondoka, ategerezwa gusuzumwa mu kigo c’ubuvuzi bw’ibihe vyihutirwa, kuko uruhome rw’umutsi w’amaraso (pseudoaneurysm) rushobora guturika rwo kwica mu gihe umuntu asinziriye amasaha makeyi
3. NTUSHERE igikoresho co gufatanya amaraso kiretse iyo umurwayi ariko arapfa kubera amaraso adashobora gucungerwa kandi umuvuduko w’amaraso direct pinpoint ukaba wananiwe rwose. Gushirako igikoresho co gufatanya amaraso canke igikoresho co gupima amaraso ku kuboko kw’ugukora dialyse birazibira amaraso kandi bikasenya umurongo w’ubuzima bw’umurwayi. Ariko rero, "Ubuzima Buza Imbere y'Igihimba c'Igihimba canke Igihimba c'Igihimba c'Igihimba c'Igihimba": iyo umutsi w'igihimba c'umubiri (fistule) wacitse intege uturitse cane kandi umuvuduko w'amaraso udashobora kugenzura amaraso ava mu mitsi ashobora gutuma umuntu apfa n' guhungabana, ushireko umugozi w’umuyaga hejuru (hafi y’) y’igihimba c’umubiri citwa fistule yerekeza ku rutugu kugira ngo ukize ubuzima bw’umurwayi (raba kuva amaraso).
4. Ku bijanye n’umutsi w’amaraso wo hagati (Permcath / Vas-Cath mu gikiriza canke mw’izosi) udafise igipfukisho canke udafise igipfukisho (Permcath / Vas-Cath mu gikiriza canke mw’izosi): Fata igipfukisho maze ushire umurwayi ku ruhande rwiwe rw’IBUMOSO ubwo nyene. Iyo igipfukisho kiguye ku gifu canke igipfukisho c’izosi canke igipfukisho c’ipulasitike kigaca kifunguka, umwuka ushobora gufunguka. mu gihe amaraso aseseka:
5. Ubwo nyene ushire umurongo w’amaraso mu gitereko n’intoke zawe (canke ushireko igipfukisho c’ipulasitike ku gitereko c’amaraso gipfutse, canke ushire umurongo w’amazi mu bice bibiri).
6. Rambika umurwayi ahagaze ku ruhande rw'IBUMOSO umutwe wiwe uzungurutse gatoyi (Ikibanza ca Durant / ibubamfu ca Trendelenburg) kugira ngo ufate neza ibibumbano vyose vy'umuyaga mu gitereko c'iburyo kure y'amahaha, hanyuma uhamagare 911 / 112 / 999.
7. Ku murwayi yabuze dialyse afise ubugoyagoye butunguranye bw'amaguru, ububabare, umutima ugenda buhoro, canke ibimenyetso vy'igikiriza: Hamagara 911 / 112 / 999 ku "Ukwikeka ko afise ubumuga bwo mu mutwe." Iyo potasiyumu iduze hejuru ya \(6.5\text{ gushika kuri }7.0\text{ m\)mol) irarema imitsi y’amaguru kandi igatuma umutima ugira ubumara bw’umuyagankuba. Ntureke ngo umurwayi arye canke ngo anywe ikintu na kimwe, kandi usabe abaganga bagufashe vuba bafise ECG y’amabuye y’agaciro 12 n’imiti y’amaraso y’umubiri.
8. Ku murwayi ya dialyse yabuze ariko arahengamira umwuka afise amazi menshi: Mumwicare ahagaze ku degre 90 amaguru azunguruka hasi. Ntukigere uhatira umurwayi ya dialyse afise amazi menshi ngo aryamye. Kwicara ugororotse amaguru amanitse hasi bitera amazi arenze urugero mu maguru kure y’amahaha mu gihe imodoka itwara abarwayi ibajana mu gusukura amaraso vyihutirwa.

Igiti c'ingingo y'ingorane zo gutoranya no gusukura amaraso vyihutirwa¶

Koresha iki kigereranyo c’ubuvuzi kugira ngo wishure ikibazo cose c’ugushika ku mitsi canke ingorane y’imitsi mu murwayi akora hemodialyse canke dialyse peritoneale.

flowchart TD
    Start["Ivyihutirwa mu murwayi ariko arakoreshwa Diyalize<br/>(Igikoresho co gusukura amaraso AV Fistula, Igihimba c’umubiri, Catheter,<br/>canke Igihe co gusukura amaraso cabuze)"] --> CrisisType{"Ni igiki gihambaye cane ubu?"}

    CrisisType -->|"1. Kuva amaraso ava ku kuboko AV Fistula canke Graft"| FistulaBleed["AMATEGEKO YO GUSOHOKA AMARASO:<br/>1. Kanda URUTOKE RUmwe canke UMUGAMBI W'ICUPA ku mwobo<br/> (NTUKIGEZE uzingira ku kuboko igitambaro co kwoga kinini)<br/>2. Rara umurwayi hasi; gushira ukuboko hejuru y’umutima<br/>3. Hamagara kuri 911 / 112 / 999 kuri telefone y'ijwi<br/>4. Gufata umukazo udacitse iminota 15-20 (NTA GUSOBANURA)<br/>5. Genda muri ER kugira ngo basuzumwe imitsi naho amaraso yohagarara"]

    CrisisType -->|"2. Gufungura, Gusaduka, canke Gusohoka Amaraso mu Gikiriza/Izosi"| CathEmerg["IVYUHUTWA VY'IKIMENYETSO C'IKIMENYETSO C'IKIMENYETSO:<br/>(Ingorane yo Gutera Umuyaga mu Mitsi n'Ugusohoka Amaraso)<br/>1. Fata neza igipfukisho c'ipulasitike CANKE igipfukisho c'ipulasitike<br/> (Igipfukisho kiri hagati y'iherezo ry'impuzu n'igikiriza c'umurwayi)<br/>2. Fuka igihimba c’umubiri n’agatambaro k’impuzu; NTUZOKWIGEZE ukoresha umukasi hafi y’uruzitiro<br/>3. Rambika umurwayi ku ruhande rw'IBUMOSO umutwe uri hasi iyo umuyaga unyonka<br/>4. Hamagara kuri 911 / 112 / 999 ubwo nyene"]

    CrisisType -->|"3. Dialyse yabuze + Amaguru aremereye/Agoyagoya,<br/>Iminwa/Intoke zitera ububabare, Umutima utera buhoro/udasanzwe"| HyperK["UBUZIMA BWO GUTERA AKAGA (Potasiyumu nyinshi):<br/>1. Hamagara 911 / 112 / 999: Menyesha ko 'Umurwayi w'Idiyalize afise indwara y'amaraso menshi'<br/>2. Gusaba Ambulance ya ALS kugira ngo ukore ECG y'amabara 12 + IV y'ugutabara<br/>3. NPO (Zero ivyokurya/umutobe); gufata igikoresho co gufatanya ivyuma vyihutirwa GUSA<br/> iyo uri maso kandi ukaba wategekanijwe mu buryo butomoye muri Gahunda y'Ibikorwa vy'Ivyago"]

    CrisisType -->|"4. Yabuze Dialyse + Guhema Umwuka,<br/>Gukorora Ifu y’Ibara ry’Umutuku, Ntishobora Kuryama Hasi"| FluidOverload["EDEMA Y'AMAHAHA (Ugutera amazi menshi cane):<br/>1. Hamagara 911 / 112 / 999 Ubwo nyene<br/>2. Icara umurwayi BOLT AHAGAZUWE (90 degrees) amaguru azunguruka hasi<br/>3. Gutanga umwuka w'umwuka mwinshi / nitroglycérine yo munsi y'ururimi iyo bitegetswe"]

    CrisisType -->|"5. Umuriro/Ugukonja + Catheter itukura CANKE<br/>Igicu c’umufuko wo gukura amazi mu nda + Ububabare bwo mu nda"| DialSepsis["CATHETER SEPSIS CANKE PD PERITONITIS:<br/>Igisata c’Ivyihutirwa UBU ku bijanye n’Imico kama y’Amaraso/PD<br/>n’Imiti y’Imigera y’Imitsi canke y’Inda"]

Igice ca 1: Guhagarika Fistula AV canke Amaraso y’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba c’Igihimba (Itegeko ry’Urutoke n’Igipfukisho c’Icupa)¶

Kubera iki Amafistula ya Dialyse Asohoka Amaraso Cane (n’Igituma Amafistula Yakayangana Ari Amabombe y’Igihe)¶

Mu gihe c’ugusukura amaraso incuro zitatu mu ndwi, inshinge zibiri zifise uburebure bunini zishirwa mu fistule arteriovenous (AV) y’umurwayi (umutsi w’imvukira udozwe ataco uhinduye ku mutsi wo mu kiganza canke mu gice co hejuru c’ukuboko (FE**ft canke PT AV tu) guhuza umutsi n’umutsi), maze umurwayi agahabwa umuti ugabanya amaraso heparin kugira ngo amaraso yabo ntashire mu mashine yo gusukura amaraso.

Ubwoko bubiri butandukanye bw’amaraso ava mu fistule bushika hanze y’ivuriro: 1. Ugusubira gusohoka amaraso mu gihe c’urushinge (Isaha 1 gushika kuri 6 za mbere mu rugo): Amaze kuva mu kigo c’urushinge, igipfukisho gishasha c’amaraso gikingira kimwe mu binogo bibiri vy’urushinge kirasohoka iyo umurwayi adugije ibifungurwa, apfutse ukuboko, akorora, canke ariko arakora impanuka. 2. Igisebe c'umutsi w'umutsi / Igisebe c'umutsi w'ibinyoma (The "Shiny Black Scab" Emergency): Mu mezi canke imyaka myinshi umuntu asubiramwo urushinge ahantu hamwe, uruhome rw'igihimba c'umubiri canke igihimba c'umubiri gifatanye rushobora kurambura rugacika igisebe c'umutsi canke igihimba c'umubiri c'ibinyoma. Iyo urukoba ruri hejuru y’ico gipfunsi rucitse urutoke nk’urupapuro, rukomeye, ruca ibibatsi, rudafise ibara, rutukura, canke rugira igisebe c’umwirabura (eschar) kidakira amayinga menshi, uruhome rw’imitsi y’amaraso ruriko rurasenyuka biciye mu rukoba. Iyo iyo nkoko yirabura iguye mu gikarabiro canke igakomeretswa mu gihe umuntu asinziriye, inking y’amaraso y’umuvuduko munini iraca mu cumba cose.

Intambwe ku yindi: Uburyo bwo gukoresha urutoke rumwe n’igipfukisho c’icupa¶

Kurikiza uburyo buzwi bwo gusohoka amaraso mu mitsi bwigishijwe n’ishirahamwe ry’igihugu ry’amafyigo (NKF)**, Ishirahamwe ry’amafyigo ryo mu Bwongereza / Ishirahamwe ry’amafyigo ryo mu Bwongereza, na Ishirahamwe ry’amafyigo ryo mu Bwongereza:

1. Ushire ahabona Icobo Nyaco (Ukureho Ibitambaro Vyashizwemwo Amaraso):
2. Ntushobora guhagarika indege y’umuyagankuba ifise umuvuduko munini iyo uriko urakanda ata co ubona ku kirundo c’impuzu zitose. Raba neza urukoba rw’ico gikoko kugira uronke umwobo nyawo \(1\text{- gushika }3\text{-millimeter}\) aho amaraso ariko arasohoka.
3. Shira Pinpoint Pressure n'Urutoke RUmwe, Urukumu, canke Icupa ry'Ipulasitike Risukuye:
4. Ihitamwo A (Isonga ry’Urutoke / Igikumwe): Zinga agace gatoyi kamwe k’agatambaro k’impuzu y’impuzu (canke ukoreshe urukumu rwawe rusukuye/urutoke rw’ikigereranyo nimba ata gazi y’impuzu y’impuzu iri hafi) hanyuma ukande ugororotse hasi hejuru y’umwobo w’ibara ry’umuhondo.
5. Ihitamwo B (Ubuhinga bwo Gufunga Icupa ry’Ipulasitike Risukuye): Ivyumba vyinshi vyo gusukura amaraso bitanga abarwayi Igipfukisho c’Icupa ry’Ipulasitike kidasanzwe canke bikigisha Uburyo bwo Gufunga Icupa ry’Ipulasitike ry’Ipulasitike (ukoresheje igipfukisho c’icupa ry’Ipulasitike ry’Ipulasitike ry’Isuku ry’Icupa ry’Amazi canke ry’Isoda He*x
   • Gukanda igipfukisho c’icupa gisukuye hejuru y’agapande gatoyi k’impuzu ku kibanza co gutobora bituma umukazo ukomeye kandi ungana hirya no hino y’impeta y’akaga y’amadolari 2\text{-centimeter}$ ata gumenagura ubwaguke bwose bw’ukuboko, kandi bigabanya urushe rw’urutoke mu gihe urindiriye iminota 15 ngo imodoka itwara abarwayi ize.
   • (Iciyumviro: Imisi yose gumana n’umurwayi kandi ufate igipfukisho c’icupa canke urutoke mu kibanza caco n’ukuboko; ntukigere ufata igipfukisho gikomeye ukikuje ukuboko maze ugende, kuko amaraso ashobora gukurikirana mu ruhande munsi y’urukoba akaja mu maraso menshi iyo igipfukisho kivuye hagati)
6. Calibrate Pressure Yawe ("Hagarika Amaraso, Gumana Umunezero"):
7. Kanda cane ku buryo amaraso zero asohoka munsi y’urutoke rwawe.
8. Niba bishoboka, kanda cane ku buryo ushobora gufunga umwobo uri mu ruhome rwo hejuru rw’ico gikoko utapfutse uruhome rwo hasi rwugarijwe rwose: ushobora gukomeza kwumva ukunyiganyiga kw’uguhungabana (uguhungabana) munsi y’urutoke rwawe. Ariko rero, niba amaraso abandanya gusohoka, ushiremwo cane gushika amaraso yose ahagaze, kuko guhagarika gutakaza amaraso ni vyo vyama biza imbere.
9. Ushire Umurwayi Mu Mugongo Ushire hejuru Ukuboko:
10. Umurwayi aca aryama hasi canke ku sofa ubwo nyene. Gutakaza amaraso vyihuta bituma umuntu agira ubwoba bukwi na bukwi (syncope vasovagal ou hémorragique); iyo umurwayi ahagaze ku gikarabiro co mu bwogero igihe bacitse intege, bazotabura ukuboko kwabo ku kuboko kwawe, bakubite umutwe.
11. Duza ukuboko kw’isuku ry’amaraso hejuru y’urugero rw’umutima kugira ngo ugabanye umuvuduko w’imitsi n’uw’amazi imbere muri fistule.
12. Gufata umukazo udacitse iminota 15 gushika kuri 20 yuzuye (Ntukigere wihweza kare):
13. Raba isaha. Fata urutoke rwawe mu kibanza cawe nibura iminota 15 gushika kuri 20 idahagarara gushika abaganga bashitse bagafata ingingo.
14. Isuzuma ry'ibitaro ry'itegeko naho amaraso yohagarara burundu:
15. Ntukigere uhagarika ambulance canke ngo ugume muhira inyuma y’aho amaraso y’igihimba c’umubiri gihagaze. Iyo pseudoaneurysme y’uruhome rworoshe canke igihimba c’umubiri gifashwe n’indwara ari co catumye amaraso ava, iyo nkoko y’urutoke rwawe ishobora gusenyuka kenshi irasubira gusohoka haciye amasaha 2 ikava amaraso yica. Umuganga abaga imitsi ategerezwa guca asuzuma ingene umuntu ashobora gushika kugira ngo asubire kubagwa, ashiremwo stent canke ashiremwo umutsi.

Ibimenyetso vy’imburi vy’uko Fistula iriko iraca (Igihe co kuja mu bitaro vy’abarwayi imbere y’uko iva amaraso)¶

Suzuma fistule AV canke igihimba c’irondoka buri musi. Genda mu bitaro vy'ivyihutirwa canke uhamagare umuganga wawe w'imitsi uwo musi nyene (imbere y'uko iturika) niwabona kimwe muri ivyo bitanu "Ibendera ry'umutuku ry'imbere y'uguturika":

"Amategeko atatu atazokwigera" yo gukingira ukuboko kw'ugukoresha Dialyse¶

Kugira ngo fistule nticike canke ngo ipfuke mu gihe c’ubuvuzi canke c’ubutabazi bwa mbere: - NTUKIGERE ufata igiharuro c’umuvuduko w’amaraso ku kuboko gufise fistule AV canke graft (kandi ntukigere ufata BP ku kuboko aho fistule izoza itegekanijwe). - NTUKIGEZE ukura amaraso canke ngo utangure umurongo wo gutera amaraso (IV) mu gice co gushikamwo dialyse. - NTUKIGEZE wemera amasaha akomeye, amaboko akomeye, amasakoshi, imifuko y’ibifungurwa, canke kuryama umutwe uruhukiye kuri ukwo kuboko.

Igice ca 2: Ivyihutirwa vy’ugukora Dialyse: Hyperkalemia n’Ivyiyumviro vy’Amahaha¶

Amafyigo afise amagara meza arayungurura litiro 150 gushika kuri 180 z’amaraso buri musi, agasohora potassium (\(K^+\)), amazi, sodium, aside, n’ubumara bw’amaraso** birenze urugero. Umurwayi akora hemodialyse akora amasobe make canke ntayo akora (anuric) bivana n’amasaha 4 akora dialyse incuro zitatu mu ndwi (ku wa mbere/ku wa gatatu/ku wa gatanu canke ku wa kabiri/ku wa kane/ku wa gatandatu). Iyo umurwayi abuze mbere igihe kimwe canke bibiri vyo gusukura amaraso (canke mu kiringo kirekire c’impera y’umusi w’amasaha 72 hagati y’uwa gatanu/uwa gatandatu n’uwa mbere/uwa kabiri), ibintu bibiri vyihutirwa bishobora gutuma apfa biratera ningoga:

1. Hyperkalemia itera ubuzima (Potassium nyinshi mu maraso, "Igihagarika umutima ucereje")¶

Potasiyumu isanzwe mu maraso ipfungiwe cane hagati ya \(3,5\igisomwa{ na }5,0\igisomwa{ mmol/L}\) (\(mEq/L\)). Iyo potasiyumu iduze hejuru ya \(6.0\text{ gushika kuri }6.5\text{ mmol/L}\) inyuma y’igihe c’ugusukura amaraso (canke inyuma yo kurya ivyokurya birimwo potasiyumu nyinshi, gukomeretswa n’ugumenagura utugingo ngengabuzima, gukura amaraso mu nda, canke gufata imiti igabanya ACE/spironolactone/spironolactone it), umuriro w’ingingo z’imitsi n’ingingo z’imitsi y’umutima (cardiomyocytes).

Igituma Hyperkalemie Itera Akaga Cane: Mu buryo butandukanye n’ingwara nyinshi, hyperkalemia ishobora gutuma umutima uhagarara bukwi na bukwi (ugutera kw’imitsi y’umutima canke asystole) ata n’umwe abanze kugabisha, canke ishobora kwigana ikintu gikomeye c’imitsi nk’indwara ya Guillain-Barre: - Ibimenyetso vy'Imburi vy'Imitsi y'Ubwonko (Akenshi Bibura): - Gutera ububabare canke "ibipimo n'inshinge" (paresthesias) bikikuje iminwa, ururimi, ibiganza, n'ibirenge. - Intege nke z'amaguru ziremereye ziduga vuba (Hyperkalemic Flaccid Paralysis): Umurwayi aca yumva bukwi na bukwi amaguru yiwe "akozwe mu mabuye y'agaciro," ntashobora guhaguruka avuye ku ntebe canke ku gitanda, intege nke zigaduga zija ku mubiri no ku maboko. - Gusesa amaraso cane, gukorora canke gutera inda. - Ibimenyetso vy'imburi y'umutima: - Umutima utera buhoro buhoro bukwi na bukwi (bradycardie), umutima utera buhoro buhoro, umutima utera cane, gusinzira, canke gusinzira. - Ku ECG y'umuganga w'amabara 12, potasiyumu igenda iraduga ituma habaho ugutera imbere kwa kera: imipfunda miremire, ifise amahema "imipfunda T" \(\umuheto\) n'imipfunda P isongoye/itaboneka n'igihe kirekire ca PR \(\umuheto\) umuvuduko wa QRS wagutse wasine gusa $\hal second" umutima urahagarika gutera.

Uko abaganga n'ibitaro bakiza umurwayi w'indwara y'umutima mu minota mikeyi: Iyo ubwiye uwurungika 911 / 112 / 999 "Umurwayi w'i Dialyse yabuze ubuvuzi kubera ubugoyagoye bw'amaguru kandi akeka ko afise hyperkalemie," abaganga n'abaganga b'ibihe vyihutirwa bakora urutonde rw'intambwe zitatu zo gukiza ubuzima: 1. Guhagarika imitsi y'umutima mu minota 1 gushika kuri 3: Gutera umutsi Gluconate ya calcium (\(10\%\), \(10\text{ gushika kuri }30\text{ mL}\)) canke Calcium Chloride ntibigabanya potassium mu maraso, ariko biratera membrane** mu masegonda 60 kugira umutima ntuhagarare mu gihe potassium iriko irakurwako. 2. Guhindura Potasiyumu Imbere mu Ngingo mu Minota 15 gushika kuri 30: Insuline isanzwe (\(10\text{ ibice}\)) ifatanijwe n'ivyo gutera mu mutsi**, albuterol (salbutamol, \(10\text{ kugeza ku }text{ ibice}\)) bicarbonate (iyo ari aside) ikura potassium mu maraso igasubira mu ngingo z’umubiri mu gihe gito. 3. Kura Potasiyumu mu Mubiri Ubudasiba: Ivyo gufatanya potasiyumu mu nda n’amara (ivyo bita zirconium [Lokelma], patiromere [Veltassa], canke [Kayexalate]) n’ivyo bita ivyo gukura amaraso mu nda.

2. Ugutera amazi menshi cane (Edema y’amahaha) n’indwara y’umutima¶

Iyo amafyigo atasohora amasobe, igikombe cose c’amazi, isupu, barafu canke ivyamwa umurwayi w’ivy’amafyigo arya, biguma ata guca ku ruhande mu maraso yiwe no mu bihimba vy’umubiri. Amaze kubura imiti 1 canke 2 y’ugusukura amaraso, litiro 3 canke 6 z’amazi arenze urugero arashobora gusubira mu mahaha (ivyuka vy’umutima bikomeye/ivy’amahaha vy’uburemere) no hirya no hino y’umutima (pericardite uremique / tamponade cardiaque): - Ibimenyetso vy'indwara y'amahaha: - Guhema nabi cane bituma bidashoboka kuryama mu gitanda (orthopnea). - Guhema umwuka, guhema ("asthme cardiaque"), amajwi y'impwemu atera canke atera, no gukorora ibicurane vy'ibara ry'agahama, bifise urufuro. - Kuvyimba cane (edema) mu maguru, mu maguru, mu mugongo, no mu maso, bifatanye n’ugutera imbere kw’umuvuduko w’amaraso kenshi urenga \(180/110\text{ mmHg}\). - Ibimenyetso vy'indwara y'umutima: - Ububabare bukomeye kandi butera inkoni mu gikiriza inyuma y’igufa ry’ibere butera cane iyo uryamye hasi ku mugongo, bugatera imbere iyo wicaye wihetse imbere. - Gushiramwo ubufasha bwa mbere ubwo nyene kubera amazi arenze urugero: - Icara umugozi w'umurwayi ugororotse mu mfuruka ya degre 90 amaguru yompi azunguruka hasi hejuru y'uruhande rw'igitanda canke intebe. Inguvu zikwegakwega zifata amaraso y'imitsi agera ku madolari 500\text{ gushika kuri }800\text{ millilitres}$ mu maguru yo hasi aho kuyareka akaja mu mahaha. - Ntukigere uduza amaguru y’umurwayi afise amazi menshi cane, kandi wizigire amazi yose yo mu kanwa mu gihe urindiriye ambulance.

Kurokoka mu biza: "Ivyokurya vyihutirwa vy'iminsi 3 bifise potassium nke, bifise amazi make"¶

Mu gihe c'inkubi y'umuyaga, imyuzure, inkubi y'umuyaga, canke ukuzima kw'amashanyarazi iyo amavuriro y'ubuvuzi bw'amafyigo yugaye mu kiringo c'amasaha 48 gushika kuri 72, hakurikijwe Ishirahamwe ry'Igihugu ry'Impyiko (NKF) n'Ikigo kijejwe kugenzura no kwirinda indwara (CDC) "3-Day Emergency Renal Diet" keeps possilung until gusubiramwo:

Ivyihutirwa bidasanzwe ku barwayi ba Dialyse Peritoneale (PD): Peritonite y’Isaho y’Igicu¶

Abarwayi bakora Dialyse péritonéale (PD) muhira bakoresheje igikoresho co gutera amaraso mu nda (igikoresho ca Tenckhoff) bahura n’ikibazo kidasanzwe citwa PD Peritonitis: - Uko wobibona ubwo nyene: Raba mu gafuko k’amazi k’ipulasitike gatomoye inyuma y’uguhinduranya kwose. Mu bisanzwe, amazi y’isuku ry’umubiri (effluent) asa n’ay’umuhondo w’agahama (ushobora gusoma neza icapa ry’ikinyamakuru biciye mu musaho wuzuye). Nimba amazi asohotse asa n’ibicu, nk’amata, nk’ay’urubura, canke nk’ay’umutuku, CANKE iyo umurwayi agira ububabare bwo mu nda, ububabare, iseseme, canke umuriro, wiyumvire ko afise Acute Bacterial Peritonitis. - Ico wokora vuba: 1. Zika umufuko w’amazi y’ibicu (uwufunge maze uwutware mu bitaro canke mu kigo ca PD kugira abaforomo bashobore gukura amazi mu mufuko kugira ngo baharure utugingo ngengabuzima n’imigera). 2. Hamagara umuforoma wawe w’amasaha 24 akora Dialyse Peritoneale / On-Call Nephrologist canke ugende mu bitaro vy’Ivyihutirwa ubwo nyene kugira ngo ubone imiti yo mu nda (IP) canke yo mu mutsi. 3. Iyo umutsi wa PD ucitse ku mpanuka canke igikoresho co kwimurira umutsi kigacitse neza canke mu mucafu: Ubwo nyene ushireko umupira w’amaguru Beta-Clamp (canke ufate/ushire umutsi woroshe hagati y’aho uvunitse n’urukoba rw’inda yawe), ufunge impera yuguruye n’igipfukisho c’inda kandi ugende mu kigo cawe ca PD canke mu cumba c’ubuvuzi bw’ivyihutirwa ubwo nyene kugira ngo ubone guhindura adapteur/transfer-set y’ivyuma bitagiramwo ubumara n’imiti yo kwirinda.

Inyandiko nyayo y'itumanaho kuri 911 / 112 / 999 n'Ibitaro¶

• Ku Fistula ya AV canke Amaraso y'Igihimba:

  "Ndakeneye imodoka itwara abarwayi vyihutirwa kuri [Aderesi nyayo]. Umurwayi ni umurwayi w'ubuvuzi bw'amaraso, ukuboko kwiwe AV [fistula / graft] kwacitse kandi kuriko kurava amaraso menshi. Mfashe urutoke rumwe rwo gutera umukazo ku kibanza c'urushinge, narashize umurwayi hasi, maze ndaduza ukuboko hejuru y'ibitaro. kubagwa."

• Ku murwayi yabuze Dialyse akekwa ko afise Hyperkalemia canke ko afise amazi menshi:

  "Ndakeneye ambulance y'ivyihutirwa kuri [Aderesi nyayo] ku murwayi w'isuku ry'amaraso, igihe ca nyuma co gusukura amaraso cari [X] imisi iheze ku musi [Umusi]. Flash Pulmonary Edema] Ndabinginze mwohereze abaganga bashobora gukora ECG y'amabara 12 no gutanga calcium gluconate mu mutsi ubwo nyene."

Urutonde rw'ibintu vyihutirwa vy'abarwayi ba diyalize¶

• Kopi z'urupapuro rwawe rwa nyuma rwo kuvura Hemodialyse ("Run Sheet"): Rwerekana Uburemere bwawe bwumye (uburemere bw'intumbero), ubunini bw'akayunguruzo k'amaraso, urugero rw'amaraso, urugero rwa potassium yo mu bwogero bwa dialysate, n'urugero rwa heparine kugira ngo ibitaro vyose vyihutirwa bishobore kuguvura ata nkomanzi.
• Ibipfukisho vy’amacupa vy’ipulasitike 2 gushika kuri 3 bisukuye, ibipfukisho vy’impuzu bitagiramwo ubumara vy’amadolari 4\times4$, n’igipfukisho c’ubudandaji co gukingira amaraso (ChitoGauze / Celox) mu mufuko wawe canke mu gasakoshi kawe ibihe vyose.
• Igipfukisho c’imitsi c’ipulasitike kiryoshe (igipfukisho ca catheter) iyo ufise Permcath yo mu gikiriza canke mw’izosi, canke Beta-Clamp yera iyo uri ku nzira ya Dialyse Peritoneale.
• Gutanga vyihutirwa vy’imisi 3 vy’ibipapuro vy’ibifatanya n’ibindi bigabanya potasiyumu (ibifatanya n’ibinyabuzima bigabanya potasiyumu [Lokelma] canke patiromere [Veltassa]) n’ibifatanya n’ibinyabuzima bigabanya potasiyumu.

Ibibazo bikunda kubazwa¶

Ni kuki gupfuka igitambaro ku fistule ya dialyse iva amaraso bituma abarwayi bava amaraso gushika bapfuye?¶

Fistule y’imitsi (AV) itwara amaraso y’imitsi mu gihe c’umuvuduko munini cane ku rugero rwa militiro 600 gushika ku 2.000 ku munota biciye mu mwobo mutoyi w’imilimetero 1 gushika ku 2 uri mu rukoba. Guzingira ukuboko igitambaro co kwoga gikomeye bihisha aho amaraso ava kugira ngo ntihaboneke kandi bikakwiragiza umukazo mu buryo bugoyagoya ahantu hagari aho gukingira ako gatotsi gatoyi. Mu minota 3 canke 5, uwo murwayi arashobora gutakaza igice c’amaraso yiwe mu gitambaro maze agafatwa n’indwara y’umutima ishobora kumuhitana. Imisi yose urabe neza igikomere maze ukande urutoke RUmwe, urukumu canke igipfukisho c’icupa ry’ipulasitike risukuye ushire ku mwobo nyawo mu minota 15 gushika kuri 20 idahagarara.

Iyo fistule ya dialyse iva amaraso ihagaritse kuva amaraso inyuma y’iminota 15 umuntu akoresheje urutoke muhira, ni kuki nkikeneye kuja mu bitaro vyihutirwa?¶

Amaraso ava mu gitereko canke mu gitereko c’amaraso hanze y’ivuriro, akenshi aterwa n’uguceceka no gusenyuka kw’uruhome rw’umutsi w’amaraso ruri munsi canke n’indwara y’imitsi y’amaraso yihishije. Naho nyene igihimba c’umubiri c’igihe gito gipfutse umwobo uri munsi y’urutoke rwawe, umuvuduko munini w’imitsi uri imbere muri iyo fistule urakunda gufuha uwo mutsi ugasubira hanze haciye amasaha makeyi, akenshi igihe umurwayi asinziriye mu gitanda. Amaraso yose ava mu nzu afise fistule ategerezwa gusuzumwa ubwo nyene mu bitaro vy’ibiza n’umuhinga mu vy’imitsi.

Nomenya gute ko umuntu yabuze igihe co gusukura amaraso afise potassium nyinshi cane (hyperkalemie) biteye akaga?¶

Potasiyumu nyinshi mu maraso iratera ubumara amashanyarazi y’imitsi n’imitsi imbere y’uko ihagarika umutima. Raba ubugoyagoye bukomeye butunguranye mu maguru yompi (kugorwa no guhaguruka canke kugenda), gucika intege canke gucika intege hirya no hino y’iminwa, ururimi, ibiganza canke ibirenge, gucika intege ata co bimaze, canke gutera umutima mu buryo butunguranye canke kudasanzwe. Kubera ko hyperkalemia ishobora gutuma umutima uhagarara bukwi na bukwi igihe cose, hamagara 911 / 112 / 999 ubwo nyene kugira abaganga bashobore gukora ECG no gutanga calcium ikingira umutima mu mitsi.

None nkore iki iyo igisebe c’umwirabura giteye hejuru y’igisebe kiri ku fistule ya dialyse?¶

Igisebe c’umwirabura (eschar), urukoba ruca ibibatsi nk’urupapuro, ugutukura canke utudodo dutoduto tw’amaraso turiko turatemba hirya no hino y’igisebe ca kera hejuru y’igisebe c’umubiri canke igihimba c’umubiri giteye nk’igihimba c’umubiri giteye nk’igihimba c’umubiri, ni ikimenyetso c’uko umuntu abazwe ubwo nyene ko hari hagiye guca ibice vy’agahomerabunwa. NTUTORE, ntukarabe, canke ngo woze igisebe nabi, NTUREKE umuntu wese yinjize urushinge rwo gusukura amaraso biciye muri ico gisebe canke hafi y’ico gisebe, ugume ufise igipfukisho c’icupa gisukuye n’igitambaro co gupfuka mu kuboko kwawe, hanyuma ugende ugororotse ku kigo c’ubuvuzi bw’ibihe vyihutirwa canke ku muganga wawe w’imitsi uwo musi nyene kugira ngo uruhome rushobore gusanurwa imbere y’uko ruturika.

Amasoko yasuzumwe¶

• Ishirahamwe ry’igihugu ry’amafyigo (NKF, Leta Zunze Ubumwe za Amerika): Ingingo ngenderwako y’ubuvuzi ya KDOQI ku bijanye no gushika ku mitsi: Ivyashizwe ku rubuga rwa 2019 (Lok n’abandi, Ikinyamakuru c’Amerika kivuga ku ndwara z’amafyigo, gufasha mu buryo bwihutirwa amaraso ava mu mfyigo n’amafyigo y’ibinyoma, Itegeko rya NKF ry'Ivyihutirwa: Inyobora y'abantu bafise indwara y'amafyigo idakira.
• Ishirahamwe ry’amafyigo ryo mu Bwongereza (UKKA), Ishirahamwe ry’imitsi ry’Ubwongereza na Irlande (VSGBI), n’Ishirahamwe ry’Ubwongereza ry’Ivy’Imitsi (BSIR): *Ugusohoka kw’amaraso ashobora gutuma umuntu apfa bivuye ku nzira y’imitsi: Bottle-Cap / Pinpoint Pressure Patient Safety Alert and Client.
• Inama y’Uburaya y’Ugusubiza Ubuzima (ERC) n’Ishirahamwe ry’Umutima ryo muri Amerika (AHA): Ingingo ngenderwako zo Gusubiza Ubuzima bw’Umutima n’Amahaha n’Ukwitwararika Umutima n’Imitsi vyihutirwa: Ubudasa bw’Imitsi y’Umutima n’Ikibazo c’Umutima gitera Ingorane mu Barwayi Bakoreshwa Dialyse.
• Ishirahamwe Mpuzamakungu ry'Ivy'Imitsi y'Igifu (ISPD): Impanuro z'Ingingo ngenderwako z'Ivy'Imitsi y'Imitsi y'Imitsi y'Imitsi y'Imitsi y'Imitsi y'Imitsi y'Imitsi y'Imitsi y'Imitsi: 2022 Ivyagezwe ku bijanye no kwirinda no kuvura (Li et al., Dialyse Mpuzamakungu y'Imitsi y'Imitsi y'Imitsi).
• Ibigo bijejwe kugenzura no kwirinda indwara (CDC, Amerika) & Ivy’ugufasha abantu mu bihe vy’amafyigo (KCER): Ukwitegurira ivy’amafyigo n’ivyo kurya vy’iminsi 3 vy’ivyago vy’amafyigo ku barwayi bavuwe amaraso.

Inyobora zifitaniye isano¶

• Gucungera amaraso menshi, gupfuka ibikomere, no gupfuka ibikomere
• Igikomerekezo gikomeye c'amafyigo, rhabdomyolyse, n'ugutoranya amasobe y'umwirabura
• Sepsis na septic shock kwemera n'ugusubiza vyihutirwa
• Kwemera uguhungabana no gucungera ubutabazi bwa mbere
• Gusubiza ubuzima mu mutima n'amahaha (CPR) n'ubuyobozi bwa AED