Gukorora amaraso (Hemoptysis) n’ugusohoka kw’amaraso mu nzira y’impwemu Ubufasha bwa mbere¶

Hemoptysis ni ugukorora amaraso canke umunyu ufise imirongo y’amaraso uva mu nzira y’uguhema yo hasi (inzira y’impwemu [trachea], inzira z’impwemu z’ibihaha, canke inzira y’amahaha iri imbere cane). Naho utuvungukira dutoduto tw’amaraso tuvanze n’ibihaha mu gihe c’indwara y’ibihaha akenshi tudatera ingorane ubuzima, gutera amaraso menshi (na vyo vyitwa ugutera amaraso gutakaza ubuzima) ni ingorane y’inzira y’impwemu y’umurwayi ihita itera imbere y’uko amaraso asohoka vuba cane mu giti c’ibihaha umubare w’amaraso kugira ngo uve amaraso gushika apfuye. Kubera ko inzira yose y’impwemu y’amahaha y’abantu bakuze (umutsi w’impwemu n’umutsi w’impwemu, uzwi kw’izina rya ikibanza gipfuye c’umubiri) ishobora gufata gusa mililitiro 150 (ama ounce 5 y’amazi, canke nk’ibice bibiri vya gatatu vy’agakombe k’ikawa), mililitiro 100 gushika ku 150 z’amazi zishobora gukoreshwa gusa. inzira z’impwemu zifise amaraso kandi zigatuma ugupfa (gupfuka) mu minota mikeyi. Ugukira umurwayi imbere y’uko aja mu bitaro bivana no kuguma atuje, akareka akorora amaraso akaja hanze mu gitereko, ntiwigere uyashira ku mugongo, no kuyashira Bleeding-Lung-Side DOWN iyo uruhande ruva amaraso ruzwi kugira ngo uburemere bw’isi bugumye amahaha yo hejuru afise amagara meza kugira ngo ashobore guhema.

Ivyo ubikore ubu¶

1. Hamagara ku nimero y’ivyihutirwa yo mu karere kawe ubwo nyene ku bijanye n’ugukorora kw’amaraso kwose, gusukuye, canke gusubiramwo, canke ugukorora kw’amaraso kwose n’uguhumeka nabi. Hamagara 911 muri Leta Zunze Ubumwe za Amerika na Canada, 112 mu Bumwe bw’Uburayi bwose, 999 mu Bwongereza, canke urabe vyose inomero z'ivyihutirwa. Bwira uwumurungitse: "Umurwayi ariko arakorora amaraso atukura cane (bikekwa ko ari hemoptyse) kandi arakeneye gutwara abarwayi mu nzira y'impwemu."
2. Umushire ahantu ubwo nyene kugira ngo amahaha yiwe meza atagira amaraso:
3. Nimba UTAZI amahaha ariko arasohoka KANDI uwo muntu ari maso: Bamwicare bagororotse kandi bihetse gatoyi imbere (baruhutse amaboko yabo ku meza canke ku mavi) rero uburemere bw’isi bubafashe gukorora no guca amaraso imbere avuye mu muyoboro wabo w’umuyaga aho kuyareka akaja inyuma hirya no hino muri bompi.
4. Niba uzi amahaha ariko arava amaraso (avuye mu gisebe kizwi c’amahaha y’iburyo canke y’ibubamfu, mu mfuruka, mu gisebe c’igituntu, mu gice c’amahaha gikomeye, mu bihimba vy’amahaha biherutse gufatwa, canke mu gikiriza buvuza ububabare): Zirikana umurwayi ku ruhande rwiwe n’igihimba c’amahaha kiva **BLEEDING LUNG SIDE Toward the Labith DOWN the Kuryama amahaha ava amaraso ari hasi bikoresha uburemere bw’isi kugira ngo amaraso afate imbere mu mahaha yo hasi arwaye mu gihe amahaha yo hejuru afise amagara meza aguma ari hejuru, yumutse, kandi afise umwidegemvyo wo guhema.
5. Iyo umuntu asinziriye canke akabura ubwenge kandi uruhande ruva amaraso rutazwi: Mumuzunguruke ku ruhande rwiwe mu recovery position (ntimwigere mutera umugongo).
6. Ha uwo muntu igikombe, igikombe canke igitereko gitomoye co guca amacandwemwo, kandi uremeshe gukorora mu buryo buyoroshe kandi bugenzuwe (NTUZIGEZE uhagarika igikomere). Saba umurwayi amacandwe amaraso yose yakoroye mu gitereko kimwe aho kuyasuka mu gikarabiro canke mu bwiherero. Kubona ubunini nyabwo bw’amaraso n’ukuntu asa (umutuku ukeye kandi afise urufuro n’umutuku w’agahama) bibwira abaganga b’ivyihutirwa ubwo nyene nimba ari amaraso ava mu mahaha y’imitsi (hemoptysis) canke amaraso yo mu nda (hematemesis).
7. Uhagarike ivyokurya vyose, amazi, imiti yo mu kanwa, na cane cane imiti igabanya amaraso canke igabanya igikomere. Gumana umuntu ataco afata mu kanwa (NPO) kuko bishobora gusaba ko umuntu ahita afata umutsi w’amaraso, akora ubuhinga bwo gupima umubiri, canke akora ubuhinga bwo gupima **Bronchial Artery Arril (BA E) Ntureke ngo bafate imiti yabo ikurikira y’ibitera indwara, indwara y’ibicurane, indwara y’ibicurane, indwara y’ibicurane canke indwara y’ibicurane.
8. Uce usuzuma ubwo nyene ko ata ndwara y’umutsi w’umutsi w’umutima (TIF) idasanzwe, ishobora gutera akaga, nimba umurwayi afise umurongo w’amaraso wo mu ijosi. Iyo umurwayi afise umurongo w’amaraso akorora bukwi na bukwi canke akava amaraso atukura cane asohotse canke akikuje umurongo w’amaraso, mushire umutsi w’amaraso mu ijosi (\(50\igisomwa{ mmHg}\)) ubwo nyene maze usige iyo nzira mu kibanza cayo; iyo amaraso menshi abandanya ava hirya no hino y’uruzitiro rudafise amaboko, abajejwe kwitwararika abarwayi bamenyerejwe bategerezwa gukora Utley Finger Maneuver (gufatanya umutsi utagira izina imbere n’inyuma y’igufa ry’ibere).
9. Guma mu cumba gicereje, utoze guhema buhoro buhoro hagati y’ugukorora, kandi ushire hamwe amakuru yerekeye kanseri, amahaha, n’imiti igabanya amaraso kugira ngo abaganga bafashe. Ubwoba n’ugukorora bikomeye bitera umuvuduko w’amaraso imbere mu mitsi y’amaraso y’umuvuduko munini imitsi y’amahaha. Nimuremeshe umurwayi atuje, murekure impuzu zifatanye, kandi murondere raporo zose za CT z’igikiriza ziherutse gusohoka zigaragaza igice canke amahaha afise igisebe, umwobo canke ububabare bw’amahaha.

Hemoptysis ivyihutirwa gutoranya no gushiramwo igiti c'ingingo¶

Koresha iki kigereranyo c’ubuvuzi kugira ngo utandukanye amaraso y’ukuri ava mu mahaha n’amaraso ava mu mazuru canke mu nda, usuzume akaga kari mu nzira y’impwemu, kandi uhitemwo neza aho umubiri uri kugira ngo ukize ubuzima.

flowchart TD
    Start["Amaraso Asohoka mu Kanwa:<br/>Ubanze Wemeze Inkomoko y'Umubiri"] --> SourceCheck{"Amaraso ava hehe?<br/>Suzuma Inkorora n'Iruha, Ibara, Ifu, n'Amateka"}

    SourceCheck -->|"Iterwa n’ugusesa amaraso/ugusesa amaraso, umutuku wijimye canke<br/>‘ikawa-y’inzobe’, ivanze n’ibifungurwa, ifise aside"| GI_Bleed["HEMATEMESIS (Amaraso yo mu Gifu co Hejuru):<br/>Raba Inyobora y’Amaraso yo mu Nda<br/>(Ikibanza mu Kibanza co Gukira co mu Ruhande rw’Ibubamfu)"]

    SourceCheck -->|"Amaraso atemba inyuma y’umuhogo avuye mu zuru,<br/>acirwa hanze ata gukorora gukomeye mu gikiriza"| Nose_Bleed["POSTERIOR EPISTAXIS (Amaraso mu zuru):<br/>Icara uhagaze, wihebe imbere, ufate izuru ryoroshe cane<br/>iminota 15 (Raba Inyobora y’Amaraso mu Zuru)"]

    SourceCheck -->|"Kurerwa n'igikiriza kinini GUKORORA,<br/>umutuku ukeye, ufise ifu/ifu n'ibibumbano vy'umuyaga"| TrueHemoptysis["HEMOPTYSISE Y'UKURI IREMEJWE<br/>(Amaraso yo mu nzira y'impwemu yo hasi / amahaha)"]

    TrueHemoptysis --> SeverityCheck{"Mbega ivyo ni ugutera ubuzima / gutera amaraso menshi?<br/>1. >100-150 mL mu masaha 1-24 CANKE >1-2 ibiyiko vy'amaraso meza rimwe?<br/>2. Guhema nabi, guhema nabi, canke SpO2 < 92%?<br/>3. Gusinzira, gutera umutima vyihuta >100 bpm, urukoba rwo mu mubiri?<br/>4. Umurwayi ari ku miti igabanya amaraso CANKE afise ibimenyetso vya kanseri y’amahaha / igituntu / PE?"}

    SeverityCheck -->|"EGO: Ikimenyetso cose c'akaga gakomeye kiriho"| EmergencyCall["IVYITURWA VYO MU NZIRA Y'INDEGE:<br/>1. Hamagara 911 / 112 / 999 Ubwo nyene<br/>2. Amaraso yose ushire mu gitereko/igikombe (NTUMIRE canke ngo uhagarike inkorora)<br/>3. Ntaco ubika mu kanwa (NPO); reka imiti yose igabanya amaraso"]

    EmergencyCall --> SideKnown{"Woba uzi AMAhaha ayahe (Iburyo vs. Ibubamfu)<br/>ariko arava amaraso?"}

    SideKnown -->|"EGO: Igisebe c'amahaha c'ibubamfu canke c'iburyo kizwi,<br/>umwobo, biopsy, canke igifu gitera"| BleedSideDown["GUSHIRA AMARASO AVA MU RUHANDE RW'AMAHAHA HASI<br/>(Lateral Decubitus Kuja ku Mahaha Ava Amaraso):<br/>- Amahaha y'iburyo asohoka amaraso -> Uryama ku ruhande rw'IBURY<br/>- Amahaha y'ibubamfu ava amaraso -> Uryama ku ruhande rw'IBUMOSO<br/>Imitego y'isi ifata amaraso sick lungy top bo"]

    SideKnown -->|"OYA: Amaraso ava ku ruhande rw’amahaha ntamenyekana"| UprightPos["Vyuka: Icara UHAGARUKA (90 deg) wihetse imbere gatoyi<br/>Utazi/Usinziriye: Igihagararo co gukira mu ruhande<br/>(NTUKIGEZE uryama ku mugongo / uhagaze)"]

    SeverityCheck -->|"OYA: Uturongo dutoduto tw’amaraso mu mubiri gusa (<akayiko k’icayi 1),<br/>guhema vyoroshe, ivy’ingenzi bisanzwe"| MildHemoptysis["Hemoptysis yoroshe / yoroshe:<br/>- Gutegura isuzuma ryihutirwa ry’ubuvuzi ku musi umwe canke amasaha 24 & X-ray/CT y’igifu<br/>- Hamagara 911/112/999 ubwo nyene iyo amaraso meza abonetse canke guhema bikomeye"]

Intambwe ya 1: Mbega vy’ukuri biva mu mahaha? (Ugutera amaraso n’ugutera amaraso n’ugutera amaraso y’ibinyoma)¶

Iyo amaraso abonetse bukwi na bukwi mu kanwa k’umuntu, mu gitereko canke mu gikarabiro co mu bwogero, mbere n’abaganga bazi utuntu n’utundi bategerezwa kubanza kumenya nimba ayo maraso yakozwe mu mahaha (hemoptyse), yavuye mu nzira canke mu nda (gukura amaraso), canke biva inyuma y’umuhogo bivuye ku . kuva amaraso mu zuru canke amaraso ava mu minwa (pseudohemoptyse). Ikintu kirushiriza kugorana ni uko umuntu afise amaraso ava mu zuru canke mu nda igihe asinziriye, yoshobora guhumekera itosi ry’amaraso ku mitsi y’ijwi ryiwe maze akayakorora, mu gihe umuntu akorora amaraso y’amahaha mu gihe asinziriye yoshobora kuyamira mu nda maze akayaruha mu nyuma.

Koresha iyi mbonerahamwe y’ukugereranya ubuvuzi iruhande n’uruhande kugira ngo umenye inkomoko nyayo:

Anatomie na physiologie: Kubera iki amaraso ava mu mahaha ari munsi y’umuvuduko munini kandi kubera iki 150 mL ipfuka¶

1. Amahaha atanga amaraso abiri: Kubera iki 90% vy’amaraso menshi ava mu mitsi y’amahaha¶

Abantu benshi biyumvira yuko amaraso ava mu mahaha ava mu mitsi y’amahaha itwara amaraso ava iburyo bw’umutima kugira ngo atore umwuka w’ikirere. Mu vy’ukuri, amahaha arafise amaraso abiri atandukanye rwose: 1. Imitsi y’amahaha (99% y’umubare w’amaraso, umuvuduko MUTO): Itwara amaraso atagira umwuka w’ikirere biciye mu mifuko y’umuyaga y’amahaha ku muvuduko muto wo kuruhuka gusa \(15\text{ gushika }25 / 8\text{ gushika }10\text{ mmHg}\). Igira 5 gushika ku 10 kw’ijana vy’abantu bafise indwara y’amaraso menshi (nk’iyi Rasmussen’s aneurysms yasenyutse imbere mu binogo vya kera vy’igituntu canke mu binogo vy’imitsi y’amahaha). 2. Umutsi w'ibihaha (1% y'umuvuduko w'amaraso, umuvuduko munini w'amaraso): Amashami agenda ataco akora ku umutsi w'igifu umanuka kugira ngo agaburire inkuta z'umutsi w'umuyaga n'imitsi y'ibihaha mu gihe umuvuduko w'amaraso wuzuye umuvuduko w'amaraso ($120/80\g}er mm. - Iyo umururumba w’inzira y’impwemu uhoraho (uvuye ku indwara y’ibihaha, igituntu, imipira y’ibicurane Aspergilloma, ibisebe vy’amahaha bihoraho, canke kanseri y’amahaha iterwa n’ibihaha) yononekaye uruhome rw’ibihaha, umubiri urakura ugoramye, ugoramye, ugira amahaha mashasha y’ibihahao). - Iyo imwe muri iyo mitsi y’ibihaha igoyagoya ipfutse ifunguka ikaja mu nzira y’impwemu, amaraso aca ava mu mutsi w’ibihaha aja mu giti c’ibihaha ku \(120+\text{ mmHg}\) systolic pressure.

2. Itegeko ry'"150 mL Dead Space": Ingene Ugupfa Bishika Imbere y'Uguhungabana¶

Umuntu akuze afise nk’amadolari 5.000\text{ mililitiro}$ (\(5\text{ litres}\)) y’amaraso agendagenda**, kandi ategerezwa gutakaza amadolari 750\text{ gushika kuri }1.500\text{ mL}$ imbere y’uko yerekana ibimenyetso vy’ugusohoka amaraso guhungabana. - Ariko rero, igiti cose c’amashami c’inzira z’impwemu zijana akanwa kawe zihuza akanwa kawe n’amahaha yawe abiri (umutsi w’impwemu, amahaha y’iburyo n’ay’ibubamfu, n’amahaha y’iburyo/ay’igice, azwi kw’izina rya ikibanza gipfuye c’umubiri) gifise umubare wose wo mu mutima w’amazi **text \(150{lli\)te\te ama ounce}\()**. - Mu buryo butandukanye n’utusaho dutoduto tw’umuyaga tw’amahaha (tushobora gufata amalita y’amazi aho hantu), iyo **\)100\text{ gushika }150\text{ mL}$ y’amaraso asutswe mu nzira z’umuyaga zikomeye z’amahaha vyihuta kuruta uko umuntu ashobora gukorora akameneka hejuru y’iburyo bw’amahaha . (the carina), kimanuka mu mahaha afise amagara meza, kigaca kigira amashami akomeye ameze nk’umupira w’umupira w’umuyaga (amaraso y’umuyaga). - Iyo izo nzira zompi z’amaraso zipfutse n’amaraso canke n’ibihimba vy’umubiri, nta mwuka w’umwuka (oxygène) ushobora kwinjira mu maraso, kandi umutima uhagarara mu minota 3 gushika ku 5, naho umurwayi yoba yatakaje amaraso yose atari munsi ya 3 kw’ijana.

Uko abaganga basigura indwara y’amaraso yoroshe, iringaniye be n’ishobora gutera ubuzima (Massive)¶

Mu mateka, ibitabu vy’inyigisho vyasobanura ububabare bw’amaraso menshi hakoreshejwe amasaha 24 y’uguca ijwi (\(200\text{ gushika }600\text{ mL}\) ku masaha 24). Amabwirizwa y’ubuvuzi bw’ibihe vyihutirwa n’ay’amahaha yo muri iki gihe avuga yuko kurindira amasaha 24 kugira ngo umuntu apime indobo y’amaraso ata co bimaze mu gihe umuntu afise ingorane zikomeye cane. Ahubwo, ushireho uburemere bw’ibintu hakurikijwe igipimo c’isaha, uburemere bw’igikomere kimwe, n’ingaruka z’inzira y’impwemu/uguhema:

Inyigisho y'ido n'ido y'aho umuntu ahagaze: Kumenya neza itegeko ry'uko "Amaraso-Amahaha-Uruhande RUMANUKA"¶

Igikorwa kimwe gihambaye kuruta ibindi vyose umuntu ariko arabona canke umuganga ashobora gukora mu gihe umuntu afise amaraso menshi ni ukwitandukanya n’amahaha n’uburemere bw’isi:

Kubera iki "Uruhande rw'Amaraso RUJE HASI" rukora (Kandi kuki "Uruhande rw'Amaraso RUJE HEJURU" rwica)¶

Ibaze ko umuyoboro w’umuyaga (trachée) usaduka hasi (carina) nk’urudome "Y" ruhindukiye rukaja mu Bronchus y’iburyo no mu Bronchus y’ibubamfu: - Twibaze ko umurwayi afise igisebe c’amahaha kiva amaraso canke umwobo w’amahaha (bronchiectase) imbere mu mahaha yiwe Y’IBURYO. - Iyo uwo murwayi aryamye ku ruhande rwabo rw’ibubamfu (ashize amahaha y’iburyo ava amaraso HEJURU), uburemere bw’isi burakwega itosi ryose ry’amaraso asuka mu mahaha y’iburyo yo hejuru rigororotse hasi rijabuka carina rikajugunya ataco rihinduye mu mahaha y’iburyo yo hasi afise amagara meza IBUMBO. Mu minota 2, amahaha yompi yuzuye amaraso umurwayi agaca aniha. - Ku rundi ruhande, iyo uzungurutse uwo murwayi ku ruhande rwiwe RW’IBURYO (Bleeding-Lung-Side DOWN), uburemere bw’isi burafata amaraso imbere mu mahaha y’iburyo ashingiye ku ruhande rwo hasi. Naho amahaha y’iburyo yoba yuzuye amaraso yose, amahaha y’IBUMOSO afise amagara meza yicaye hejuru hejuru aguma yumutse 100 kw’ijana kandi yuguruye, kandi umuntu arashobora kubaho neza ku amahaha imwe gusa afise amagara meza gushika abaganga bo mu bitaro bapfutse amaraso.

Womenya gute ko AMAhaha (Ibubamfu n’Iburyo) ariko arasohoka amaraso imbere y’uko ukora CT scan?¶

Koresha gusa ikibanza co mu ruhande Bleeding-Side-Down nimba ufise ikimenyetso co kwizigirwa ku bijanye n’amahaha ariko arava amaraso (niba vy’ukuri ata ciyumviro ufise c’amahaha ariko arava amaraso, ugumye umurwayi ari maso yicaye agororotse ku degre 90 yihetse gatoyi imbere kugira ngo nta yindi mahaha ihinduke hejuru): 1. Indwara y'amahaha izwi y'uruhande rumwe: Suzuma impapuro z'ugusohoka kw'umurwayi canke umubaze uti: "Ni amahaha ayahe afise igihimba cawe, umwobo w'igituntu, ububabare bw'amahaha, umupira w'ibiherere ku mubiri, canke amahaha aherutse gufatwa/kubagwa?" 2. Inyiyumvo y'Umurwayi Ubwiwe "Chest Gurgle": Igitangaje, abarwayi bashika kuri 50 gushika kuri 60 kw'ijana bari maso bafise ububabare bw'amaraso bwihuta bashobora kwumva neza uruhande rw'igikiriza cabo ruriko rurava amaraso. Baze uti: "Imbere y'uko amaraso aduga mu muhogo wawe, woba wumva ubushuhe bugutera, bugutera, canke butera ku ruhande rw'IBUMOSO canke ku ruhande rw'IBURYO rw'igikiriza cawe?" 3. Ububabare bwo mu gikiriza canke uguvuza induru kw’ivyuma bifata amajwi: Ububabare bwo mu gikiriza buva ku ruhande rumwe canke uguvuza induru kw’ijwi rirenga kwumvikana ku ruhande rumwe rw’igikiriza.

Impamvu zisanzwe z'amaraso n'ibimenyetso vy'umutuku bishobora gutera ingorane nyinshi¶

Naho indwara y’ibihaha n’amahaha bitera inkorora nyinshi zidakomeye cane zifise amaraso, abaganga bafasha abantu mu bihe vy’ibihe vyihutirwa baca basuzuma ibintu bitandatu bishobora gutuma umuntu apfa:

1. Indwara y'amahaha (PE, Amaraso atera mu mahaha):
2. Igihe amaraso agenda avuye mu mutsi wimbitse wo mu kuguru (DVT) mu mahaha maze bigatuma igice c’umubiri c’amahaha gitera, umurwayi akagira ububabare butunguranye bwo mu gikiriza (ububabare bukomeye iyo ahumeka), akabura impwemu bukwi na bukwi, umutima ugatera vuba (\(> 100\text{ bpm}\)), n’ugucika kw’amaraso mu gihe kirekire, kenshi na kenshi ac orcomp guhunga/kanseri.
3. Kanseri y'amahaha canke igihimba c'umubiri:
4. Umuntu wese akuze afise imyaka irenga 40 (na cane cane abanywa itabi ubu canke abahora banywa itabi) akorora mbere n’utuvungukira dutoduto tw’amaraso mu kiringo kirenze indwi 1 canke 2**, canke akagabanya ibiro ataco asigura, ijwi ry’umuntu rivuga nabi, canke akorora ubudasiba, bisaba ko akorora vyihuse **ivyo bihimba vy’umubiri bikoresheje ubuhinga bwo gupima igifu, e CT scan of the bisa n’ibisanzwe rwose (igishushanyo c’igikiriza gisanzwe kirabura ibivyimba bishika kuri 20 kw’ijana vyo mu nzira y’impwemu yo hagati).
5. Indwara y'ibihaha, igituntu (TB), n'ibicurane vy'ibiherere ku mubiri (Aspergilloma):
6. Ku isi yose, igituntu c’amahaha gikora canke ca kera gikize na indwara y’amahaha inyuma y’aho umuntu arwaye ni vyo bitera indwara y’amahaha myinshi kandi ishobora gutuma umuntu apfa. Niba umuntu akeka ko afise igituntu (inkorora idakira \(> 3\text{ weeks}\), ivyuya mw’ijoro, kugabanya ibiro, umuriro), nusabe umurwayi afate igitambaro ku munwa wiwe igihe akorora mu gitereko ciwe kandi urabe ko mu cumba hari umwuka mwiza (canke wambare igipfukisho co guhumeka N95/FFP2 iyo kiriho)
7. Umutima w'ibubamfu canke ubumuga bw'umutima ("Ivyimba vy'umutuku"):
8. Iyo umuvuduko munini wo mu ruhande rw’ibubamfu rw’umutima uhatira amazi n’utugingo ngengabuzima dutukura guca mu mitsi y’amaraso (cardiogenic pulmonary edema), umurwayi aragorwa no guhema iyo aryamye hasi (orthopnea) maze agakorora **ibipfunsi vyinshi, vy’amazi, vy’ibara ry’agahama kuruta. Nimwicare abo barwayi bolt bagororotse amaguru yabo azunguruka hasi.
9. Ugusohoka kw'amaraso mu bihimba vy'umubiri (DAH) n'indwara y'imitsi y'umubiri:
10. Ibintu nk’ivyo Indwara ya Goodpasture (ingwara irwanya GBM), granulomatose n’indwara y’amahaha menshi (GPA / Wegener’s), lupus, canke guhumeka crack cocaine bituma amaraso ava mu mitsi y’amaraso mitoyi cane ica mu mahaha yose icarimwe.
11. Imiti igabanya amaraso canke igabanya amaraso menshi cane ("Indwara y'amaraso itera amaraso"):
12. Abarwayi bafata warfarin, apixaban, rivaroxaban, dabigatran, edoxaban, clopidogrel, canke imiti ibiri irwanya amaraso barashobora guhindura ububabare bukeyi bwo mu bihaha bukaba ububabare bwinshi bw’amaraso; ivyumba vy’ubuvuzi vyihutirwa bica bitanga imiti igabanya ububabare ifatanye n’aside tranexamique (TXA) iterwa mu mutsi canke iterwa mu mutsi.

Ivyago bidasanzwe vyo kubagwa: Gusohoka amaraso mu nzira y’amaraso (Fistule artérielle trachéonominée)¶

Iyo witaho umurwayi muhira afise umurongo w'izosi agaca akorora amaraso canke akava amaraso akikuje igihimba c'umubiri ciwe, utegerezwa kumenya itegeko ry'"Sentinel Bleed" na Tracheoinnominate Fistule (TIF):

Ivyo bishika mu modoka itwara abarwayi no mu bitaro: TXA iterwa mu maraso, Intubation y’amahaha amwe, n’Embolisation¶

Kumenya ingene abaganga b’ibihe vyihutirwa be n’abahinga mu vy’amaradiyo bahagarika indwara y’amaraso menshi bifasha imiryango gutahura inzira y’ibitaro:

1. Aside ya Tranexamic (TXA) iterwa mu mutsi kandi iterwa mu mutsi:
2. Ivyigwa vy’ubuvuzi vyerekanye ko gutanga asidi ya tranexamic (\(500\text{ mg}\) mu \(5\text{ mL}\) ihumekerwa ataco ihinduye nk’igihu) canke TXA (\(1,000\text{ mg}\) IV) mu mutsi kare mu cumba c’ubuvuzi bw’ivyihutirwa, bigabanya umubare w’amaraso mu cumba c’ubuvuzi bw’ivyihutirwa ku bijanye n’ugutera umuti.
3. Gukingira inzira y'impwemu (Igikoresho co mu mfuruka gifise uburebure bunini canke Intubation y'umubiri):
4. Iyo umurwayi adashobora gukura amaraso kandi umwuka w’ikirere ugaca ugabanuka, abaganga bamushiramwo umurongo munini wo mu mfuruka (ubunini \(8.0\text{ gushika kuri }9.0\text{ mm}\) inner diameter) kugira ngo ama catheters y’umwuka munini n’ibikoresho bishobora guhinduka bishobore guca bitagoranye. Iyo amaraso ariko arasuka ava mu mahaha amwe azwi (nk’akarorero, amahaha y’iburyo), umuganga arashobora gutera imbere umurongo wo guhema ukarenga carina akaja mu muhaha w’ibubamfu ufise amagara meza (canke yinjiza umuti wo gukingira umupira w’amahaha mu muhaha usohoka amaraso) kugira ngo amahaha apfunge neza kandi ashiremwo umwuka.
5. Ugutera umutsi w'amahaha (BAE, umuti w'inzahabu udakoreshwa mu kubaga):
6. Aho kubaga igifu (ivyo bikaba bitera urupfu rwinshi mu gihe umuntu ariko arasohoka amaraso), umugwi w’abahinga mu vy’amaradiyo wo mu bitaro Intervention Radiology (IR) ushiramwo umutsi w’amaraso mutoyi cane uva mu mutsi w’igihimba c’irondoka uri mu gifu ukaja hejuru ukaja mu mutsi w’amaraso wo mu gikiriza, ugatera irangi ry’ugutandukanya amaraso ku CT Angiogram ton (CTA) n’ugutera utugingo ngengabuzima dutoduto tw’inzoga yitwa polyvinyl canke utugingo ngengabuzima twa platine kugira ngo ufunge umutsi uva amaraso uva imbere, bigahagarika ugusohoka kw’amaraso kwinshi mu 85 gushika ku 95 kw’ijana.

Inyandiko nyayo yo guhanahana amakuru kuri 911 / 112 / 999 n'ugutoranya abarwayi¶

Koresha iyi nyandiko itomoye y'ubuvuzi igihe uhamagara abaganga b'ivyihutirwa:

*"Ndakeneye imodoka itwara abarwayi vyihutirwa kuri [Aderesi nyayo]. Umurwayi ni [Imyaka] [umugabo/umugore] yakoroye hafi [Igitigiri mu mL / ibiyiko / ibikombe] vy'amaraso atukura cane ava mu mahaha mu myaka iheze [Iminota/Amasaha] afise kanseri y'amahaha]. bronchiectasis / tuberculose / imiti igabanya amaraso / umuyoboro wo gukuraho umutsi w'umutima].

Ibibazo bikunda kubazwa¶

Ni kuki umuntu ariko arakorora amaraso akwiye kuryama amahaha yiwe ava amaraso araba HANSI yerekeza ku gitanda aho kuraba hejuru?¶

Iyo umuntu avuye amaraso imbere mu mahaha amwe, akaga gakomeye kuruta ayandi yose ku buzima bwiwe si ukubura umubare w’amaraso, ahubwo ni uko ayo maraso aseseka ajabuka igice co hagati c’umuyoboro w’umuyaga (carina) maze akaroha irindi mahaha ryiwe rifise amagara meza. Kuryama ku ruhande rwawe amahaha ava amaraso ari hasi (Bleeding-Side Down) bikoresha ububasha bw’isi kugira ngo amaraso yose agume akoranye imbere mu mahaha yo hasi arwaye mu gihe amahaha yo hejuru afise amagara meza aguma ari hejuru, yumutse kandi yuguruye kugira ngo umuntu ashobore guhema umwuka w’ikirere.

Ni kuki ari akaga gufata umuti w’inkorora (nk’uwa dextromethorphan canke codeine) kugira ngo ureke gukorora iyo uriko urakorora amaraso?¶

Iyo amaraso ariko arasohoka mu nzira z’impwemu zawe, uburyo bwo gukorora ni bwo bwonyene butuma umuyoboro wawe w’impwemu uguma ufunguye kugira ngo ushobore guhema. Gufata imiti igabanya igikomere biguhagarika gukorora amaraso y’amazi, bigatuma ayo maraso atera imbere mu muhogo wawe no mu bihaha bikuru aho yihuta gukomera akagira igihimba gikomeye, gifise amashami nk’igihimba c’umupira (igihimba c’amahaha) kibuza umuyaga gushika mu mahaha yompi, kigatuma umuntu agira suffoction bukwi na bukwi.

Nomenya gute ko amaraso yo mu kanwa kanje yakorowe avuye mu mahaha (hemoptyse) canke yajugunywe hejuru avuye mu nda (hématemesis)?¶

Amaraso akorora ava mu mahaha (hemoptyse) abanza gukorora mu gikiriza canke gukorora mu gikiriza, asa n’umutuku utukura cane, kandi akagira urufuro canke nk’urufuro kubera ko avunganye n’utuvungukira dutoduto tw’umuyaga wo mu mahaha. Mu buryo butandukanye n’ubwo, amaraso avuye mu nda (hematemesis) abanzirizwa n’ugusesa amaraso n’ugusesa amaraso mu nda, nta na rimwe agira urufuro, akenshi abamwo ibintu vy’ibifungurwa, kandi kenshi asa n’ay’umuhondo w’umuhondo canke w’umuhondo w’umuhondo nk’ikawa itose kubera ko aside yo mu nda ituma amaraso agira umwiza mu buryo bw’imiti.

Iyo nkorora gusa akarongo gatoyi k’amaraso mu maraso yanje rimwe canke kabiri maze nkumva nkiri muto rwose, noba nkikeneye kuja kwa muganga?¶

Egome, amaraso yose ataco asiguye mu bivyimba vyawe (na canecane iyo amara imisi irenga mikeyi canke akaboneka ku muntu akuze afise imyaka irenga 40, uwunywa itabi ubu canke yahora anywa itabi, umuntu anywa imiti igabanya amaraso, canke umuntu afise amateka y’indwara ya kanseri, amaraso atera canke igituntu) bisaba ko abaganga bamusuzuma vyihuse bikoresheje amashusho yo mu gikiriza. N’agace gatoyi k’amaraso karashobora kuba ikimenyetso ca mbere co gukira c’igisebe co mu nzira y’impwemu yo hagati, bronchiectasis, embolie pulmonaire, canke “amaraso y’umurinzi” ava mu mutsi w’amaraso ugoyagoya.

Amasoko yasuzumwe¶

• Ishure ry’abaganga bo muri Amerika (CHEST, Leta Zunze Ubumwe za Amerika): Isuzuma n’ugucungera indwara y’amaraso ishobora gutera ubuzima: Amabwirizwa y’ubuvuzi bwa CHEST n’Iraporo z’Inama y’Abahinga (ubuhinga bwo gufata amaraso mu kibanza c’abapfuye, uburyo bwo gusohoka amaraso mu ruhande rw’umubiri, gusohoka amaraso mu ruhande rw’umubiri n’ugutera amaraso mu ruhande rw’umubiri).
• Ishirahamwe ry’Ubwongereza ry’Abaganga b’Igifu (BTS, Ubwongereza) n’Ikigo c’Igihugu c’Ubuzima n’Ukwitwararika (NICE, Ubwongereza): Impanuro z’ubuvuzi ku bijanye n’itohoza n’ugucungera kanseri y’amahaha n’iyikekwa (NG12) na Umugambi w’igihugu wo gukingira kanseri y’amahaha (NTgogeno Tracheostomy) Ugusohoka amaraso n’Igikoko c’Igikoko.
• Ishirahamwe ry’Uburayi ryitaho ivy’uguhema (ERS) n’Ishirahamwe ry’Uburaya ry’Ivy’Umutima n’Ivy’Imitsi y’Imitsi (CIRSE): Ingingo ngenderwako z’Ibikorwa ku bijanye no Gutera Imitsi y’Imitsi (BAE) n’Ivy’Imitsi y’Imitsi y’Ibihaha (Multidetector CT Angiography) mu gihe umuntu arwaye amaraso menshi.
• Ishure ryisumbuye ry’Amerika ry’Ivy’Ivyuma (ACR, Leta Zunze Ubumwe za Amerika): Ivyangombwa vy’Ugukora ACR: Hemoptysis.
• Inkoni O, n’abandi. (CHEST Igerageza ry'Igihugu ry'Igihugu): Aside ya Tranexamic Ihumekwa mu Buvuzi bw'Indwara y'Amaraso: Igerageza ry'Igihugu ry'Igihugu (ryerekana umutekano n'ubushobozi bw'aside ya tranexamic ikoreshwa mu guhumeka \(500\text{ mg}/5\text{ mL}ty\) mu buvuzi bw'amaraso bukomeye).

Inyobora zifitaniye isano¶

• Amaraso ava mu nda: amaraso yo guruka (hematemesis) na melena
• Indwara y'amahaha n'indwara y'imitsi y'amaraso (DVT) ibendera ry'umutuku
• Amaraso ava mu zuru (epistaxis): ubuhinga bwo gucapura n’amaraso ava inyuma y’amabendera atukura
• Ubutabazi bwa mbere bwo kuniha no kuzibira inzira y'impwemu
• Kwemera uguhungabana no gucungera ubutabazi bwa mbere