Sepsis na septique ihungabana: byangiza ubuzima byihutirwa¶

Sepsis nigisubizo kirenze umubiri, cyangiza ubuzima bwanduye. Bibaho mugihe ubwandu bwaho usanzwe ufite (nka pnewoniya, kwandura kwinkari, gukomeretsa uruhu, kurwara amenyo, cyangwa kwandura munda) bitera urunigi rutagenzuwe mumaraso yawe yose hamwe na sisitemu yumubiri.

Aho kwibasira gusa bagiteri zitera, virusi, cyangwa fungus, sisitemu yumubiri wawe itangira kwangiza imiyoboro yamaraso yawe, ingirangingo, ningingo zikomeye. Iyo itavuwe neza, sepsis iratera imbere mu masaha kugira ngo ihungabanye septique, ikwirakwizwa ry'amaraso ya microscopique ikabije, kunanirwa kw'ingingo nyinshi, no gupfa. Sepsis ni ibintu byihutirwa byubuvuzi bisaba umuvuduko nukuri byihutirwa nkumutima cyangwa inkorora.

Kora ubu¶

1. ** Hamagara nimero yawe yihutirwa ako kanya. ** Hamagara 911 muri Amerika na Kanada, 112 mu bihugu by’Uburayi, 999 mu Bwongereza, cyangwa 000 muri Ositaraliya (reba byose nimero yihutirwa).
2. ** Vuga ijambo "sepsis" kubohereje n'inkeragutabara. ** Vuga neza: "Ndakeka sepsis." Gukoresha iryo jambo nyaryo bitera kwihuta mbere yibitaro sepsis triage protocole, kwipimisha ingingo-y-ibizamini, no kumenyesha ibyumba byihutirwa.
3. ** Reba ibimenyetso byo kuburira IGIHE no kwitegereza ku mubiri. uruhu rwahinduwe).
4. ** Shyira umuntu kugirango ashyigikire amaraso no guhumeka. ** Niba bumva bacitse intege, bazunguye, cyangwa bafite umuvuduko ukabije wamaraso, ubishyire kumugongo kugirango amaraso agere mubwonko; niba bafite umusonga ukabije cyangwa urugamba rwo guhumeka mugihe uringaniye, komeza umutwe n'ibitugu byerekeje kuri dogere 30 kugeza 45.
5. ** Komeza uborohewe nta bushyuhe bukabije.
6. ** Ntukagire icyo utanga kumunwa kandi utegure urutonde rwimiti. ** Ntugatange ibiryo, amazi, cyangwa kugabanya umuriro wumunwa, kuko sepsis ikunze gutera kuruka no kugabanya ubwenge biganisha kumyuka yumuyaga. Kusanya imiti yose iriho, impapuro zo kubaga vuba, hamwe nibimenyetso nyabyo byatangiye kubatabazi.

Ibihe byihutirwa bya sepsis no kumenyekana¶

flowchart TD
    Start["Indwara ikekwa cyangwa yemejwe <br/> Umusonga, UTI, igikomere, nyuma yo kubyara, cyangwa indwara ya virusi"] --> Screen{"Reba Ibendera ritukura Ibimenyetso: <br/> Urujijo, guhumeka vuba (> 22 / min), <br/> guhinda umushyitsi bikabije, uruhu ruvanze, cyangwa nta nkari?"}

    Screen -->|Yes, 1 or more present| Call911["Hamagara ubutumwa bwihutirwa ako kanya <br/> 911 US / Kanada, 112 EU, 999 UK <br/> Vuga neza: 'Ndakeka sepsis'"]
    Screen -->|No red flags yet| AgeCheck{"Ese umurwayi ni uruhinja (<1 yr), atwite / nyuma yo kubyara, <br/> ashaje (> 65 yr), cyangwa kuri chimiotherapie?"}

    AgeCheck -->|Yes, high-risk group| UrgentEval["Shakisha umunsi umwe Isuzuma ryihutirwa ryubuvuzi <br/> Abarwayi bafite ibyago byinshi bakunze kubura umuriro <br/> Kurikirana imitekerereze no guhumeka buri saha"]
    AgeCheck -->|No| Monitor["Fata Indwara zaho nkuko byateganijwe <br/> Reba ubushyuhe na hydrata buri masaha 4 <br/> Ongera usuzume ako kanya niba ibimenyetso bikabije"]

    Call911 --> FirstAid["Guhagarika ibitaro mbere yibitaro <br/> Komeza umurwayi aryamye cyangwa igice cya kabiri kigororotse kugirango uhumeke <br/> Ntukagire icyo utanga kumunwa; tegura urutonde rwimiti"]
    FirstAid --> HospitalBundle["Isaha y'Ibitaro-1 Sepsis Bundle <br/> Amaraso yonsa n'imico y'amaraso <br/> Ako kanya antibiotike ya IV na IV"]

Pathophysiology: burya kwandura kwaho guhinduka septique¶

Amatsinda yubuvuzi akurikirana iterambere ryubwandu bwa sisitemu mubice bitandukanye bya physiologique mugihe umuvuduko wa microcasculaire ugabanuka:

1. Indwara yaho¶

Indwara nka bagiteri (* Escherichia coli *, * Staphylococcus aureus *, * Streptococcus pneumoniae *), virusi (ibicurane, ibicurane, SARS-CoV-2), cyangwa ibihumyo bigwira ahantu runaka bidasanzwe. Ingingo zikunze gutangirira ni ibihaha (umusonga, bingana na kimwe cya kabiri cy’indwara zose za sepsis), inzira y’inkari n’impyiko, inzira yo mu gifu (appendicite, diverticulitis, indwara y’uruhago rwanduye), hamwe n’uruhu cyangwa uduce tworoshye (selileite, ibice byo kubaga, ibisebe by’umuvuduko, cyangwa gutwika).

2. Sisitemu ya sisitemu na endoteliyale¶

Iyo uburozi bwa mikorobe hamwe na molekuline bifitanye isano na molekuline byinjira mumaraso, sisitemu yumubiri irekura ubwinshi bwa poroteyine zerekana ibimenyetso byitwa cytokine. Aho gukomeza kuba hafi, iyi cytokine yibasiye endotelium (umurongo wimbere wimitsi yamaraso mumubiri). Imiyoboro y'amaraso ihinduka ibintu bidasanzwe, bigatuma amazi ava mu mitsi ava mu ngingo ziyikikije, mu gihe okiside ya nitric itera vasodilasiyo ya sisitemu igabanya umuvuduko w'amaraso.

3. Gukwirakwiza mikorobe yimitsi no kudakora neza kwingingo¶

Icyarimwe, cascade yaka umuriro ikora sisitemu yo guhuza amaraso, igakora ibihumbi n'ibihumbi bya microscopique fibrin yibibyimba imbere yigitanda gito cya capillary (inzira ishobora kwiyongera ikwirakwizwa na Coagulation, cyangwa DIC). Izi mikorobe zibuza amaraso akungahaye kuri ogisijeni kugera mu ngingo, mugihe urya platine yumubiri hamwe nimpamvu zitera kugeza igihe amaraso atunguranye kandi ibibara byuruhu rwumutuku (purpura) bigaragara:

• ** Ibihaha **: Amaraso ya capillary yuzura imifuka yo mu kirere (alveoli) n'amazi akungahaye kuri poroteyine, bigatuma Syndrome ya Acute Respiratory Distress Syndrome (ARDS) na hypoxemia ikabije.
• ** Impyiko **: Kugabanuka k'umuvuduko w'impyiko bitera Gukomeretsa kw'impyiko zikomeye (AKI), guhagarika umusaruro w'inkari (oliguria cyangwa anuria) no kwemerera urea na potasiyumu kwiyongera mu maraso.
• ** Ubwonko **: Encephalopathie ya septique ibangamira umuvuduko wamaraso wubwonko hamwe nubwonko bwamaraso bwubwonko, bikerekana nka delirium ikaze, guhagarika umutima, kuvuga nabi, cyangwa koma.
• ** Umutima n'umwijima **: Kwiheba kwa Myocardial bigabanya umusaruro wumutima, mugihe umwijima wanduye umwijima uzamura bilirubin kandi ukarinda glucose isanzwe.

4. Gutangara kwa septique¶

Septique ihungabana nicyiciro cyica cyane cya sepsis. Irasobanuwe mubuvuzi nka sepsis iherekejwe no gutembera kwinshi hamwe na selile metabolike idasanzwe aho umuvuduko wamaraso wa systolike ukomeza kuba muke (munsi ya 90 mmHg, cyangwa Umuvuduko ukabije wa Arterial uri munsi ya 65 mmHg) nubwo ububyutse bwamazi bwinjira mumaraso, buherekejwe nurwego rwamaraso ya serumu hejuru ya 2 mmol / L. Kuri iki cyiciro, ingirabuzimafatizo z'umubiri ntizishobora gukuramo cyangwa gukoresha ogisijeni (cytopathic hypoxia), biganisha ku mitsi n'imitsi yihuta.

Kugereranya kwandura kwanduye na sisitemu ya sisitemu¶

Koresha iyi mbonerahamwe yo kugereranya ivuriro kugirango utandukanye igisubizo gisanzwe cya feri nikibazo cyangiza ubuzima bwa sepsis.

Kumenya bidasanzwe sepsis mumatsinda yimyaka myinshi¶

Imwe mu ngaruka zikomeye za sepsis nuko abaturage batishoboye badakunze kwerekana umuriro mwinshi wa kera. Gutegereza ko termometero isoma cyane muruhinja, umuntu mukuru, cyangwa umurwayi wa kanseri birashobora guhitana ubuzima bwabo.

Neonatal na pediatric sepsis (impinja nabana)¶

Impinja ziri munsi y'amezi 12 (na cyane cyane impinja zikivuka muminsi 28 yambere yubuzima) zifite sisitemu yumubiri idakuze ituma indwara ziterwa na bagiteri zanduye (nka Group B Streptococcus, * E. Shakisha ubutabazi bwihuse niba umwana cyangwa umwana yerekanye:

• ** Kugena ubushyuhe budasanzwe **: Ubushyuhe bwurukiramende bwa dogere selisiyusi 38.0 (dogere 100.4 Fahrenheit) cyangwa burenga ku mwana uwo ari we wese uri munsi y’amezi 3 ni ibintu byihutirwa byubuvuzi, nkuko ubushyuhe bwumubiri bukonje budasanzwe buri munsi ya dogere selisiyusi 36.0 (dogere 96.8 Fahrenheit).
• ** Ubunebwe hamwe nijwi ryahinduwe **: Uruhinja runyerera, rucumbagira, rugoye kubyuka kubiryo, cyangwa kwanga kugaburira kabiri bikurikiranye.
• ** Kurira cyane cyangwa intege nke kurira **: Gukomeza, kutavogerwa kwijwi rirenga cyangwa gutaka kwintege nke, gutontoma byumvikana bitandukanye rwose no kurira bisanzwe.
• ** Umubabaro w'ubuhumekero **: Gutwika izuru, urusaku rutontoma urusaku hamwe na buri mwuka uhumeka, gukuramo igituza (uruhu rwonsa cyane mu rubavu no mu gituza), cyangwa guhagarara mu guhumeka (apnea) bimara amasegonda arenga 15.
• ** Ibimenyetso bya parufe na fontanelle **: Uruhu rwera, ruhindagurika, cyangwa rwijimye rwubururu ruzengurutse iminwa, amaboko akonje n'ibirenge nubwo icyumba gishyushye, ahantu horoheje cyangwa harohamye (fontanelle) hejuru yumutwe, cyangwa igishishwa cyumutuku kidahinduka mugihe ukanze uruhande rwikirahure gisukuye neza kuruhu.

Sepsis ya nyababyeyi na nyuma yo kubyara (gutwita no kugeza ibyumweru 6 nyuma yo kuvuka)¶

Gutwita no kubyara bihindura ibisubizo byubudahangarwa kandi bigakora inzira zidasanzwe zo kwandura nyuma yo kubyara, igice cya cesarien, gukuramo inda, cyangwa amniocentez. Impinduka zisanzwe zifatika zo gutwita (umuvuduko wumutima no guhumeka byihuse) guhisha ibimenyetso bya sepsis kare. Witondere neza mugihe utwite no muminsi 42 nyuma yo kubyara:

• Ububabare bwo munda bwo hepfo, pelvic, cyangwa nyababyeyi hamwe nubugwaneza biherekejwe no gusohora ibyuka bihumura neza (lochia).
• Umutuku, ibibyimba, kubyimba, cyangwa gutandukanya impande zose zometse kuri cisariya cyangwa amarira ya perineal.
• Gutukura cyane kwamabere no kubabara nkibicurane (mastitis) bitunguranye bikabije urujijo, kuzunguruka, cyangwa guhumeka vuba.
• Hypothermia itunguranye, tachycardia idahwema gukubitwa inshuro 100 kumunota, cyangwa ububabare bukabije bwimitsi (ibimenyetso byambere biranga itsinda A Streptococcal puerperal sepsis).

Abakuze bakuze (atifical afebrile delirium presentation)¶

Abantu bakuru bafite imyaka 65 nayirenga barenga 60 ku ijana mubitaro byose bya sepsis, nyamara abagera kuri 30 kugeza 40% byabarwayi ba sepsis bakuze ** ntibigera bagira umuriro **. Aho kugira ubushyuhe bwo hejuru, sisitemu yumubiri ishaje akenshi isubiza hamwe na hypothermia cyangwa ubushyuhe busanzwe hamwe no kugabanuka gutunguranye kwimitsi no mumikorere:

• ** Delirium ikaze no kwitiranya **: Umuntu mukuru ukuze ufite ubwandu bw'inkari butamenyekanye cyangwa umusonga hakiri kare arashobora kunanirwa gutahura abo mu muryango, guhungabana bidasanzwe, guhagarika umutima, cyangwa guhinduka mu magambo mu masaha make.
• ** Kugwa kudasobanutse no kudahungabana gutunguranye **: Kudashobora gutungurwa kuva ku ntebe, kutitonda gushya, cyangwa kugwa bidasobanutse hasi ni ikimenyetso cya mbere kigaragara cyane cya sepsis kumuntu mukuru ukuze.

Immunocompromised abarwayi na neutropenic sepsis¶

Abarwayi bakira chimiotherapie ya cytotoxic ya kanseri, abahawe transplant organisation bafata immunosuppressants, nabantu bafata biologique ikabije cyangwa corticosteroide bagabanije cyane selile yamaraso yera (neutrophile).

• ** Neutropenic sepsis ni umunota ku munota byihutirwa **: Mu murwayi wa chimiotherapie, ubushyuhe bumwe bwo mu kanwa bwasomye dogere selisiyusi 38.3 (dogere 101 Fahrenheit), cyangwa ubushyuhe bwa dogere selisiyusi 38.0 (dogere 100.4 Fahrenheit) bwakomeje kumara isaha imwe, cyangwa guhinda umushyitsi * udafite umuriro uhagije kugira ngo uhite ugera kuri minisiteri yihutirwa.
• ** Ntuzigere utanga parasetamol (acetaminofeni) cyangwa ibuprofen kugirango uhishe umuriro ** mumurwayi wa chimiotherapie mbere yo guhamagara umurongo wihutirwa wa oncology cyangwa kujya mubitaro.

Ibibera mubitaro: Isaha-1 Sepsis Bundle¶

Iyo ugeze mu ishami ryihutirwa ukavuga ko ukeka sepsis, abaganga bakoresha ibikoresho byogusuzuma byihuse nka ** qSOFA ** (Isuzuma ryihuse rya Sequential Organ Failure Assessment: igipimo cyubuhumekero 22 cyangwa kirenga, imitekerereze yahinduwe, hamwe numuvuduko wamaraso wa sisitemu 100 mmHg cyangwa munsi) cyangwa ** AMAKURU2 ** (National Early Warning Score 2 in the UK):

• ** Ibipimo bya serumu ya ** urwego ruri hejuru ya 2 mmol / L rwerekana tissue hypoperfusion, naho urwego ruri hejuru ya 4 mmol / L rwerekana ihungabana rikomeye.
• ** Imico yamaraso mbere ya antibiotike **: Ibice bibiri byimico yamaraso (aerobic na anaerobic) hamwe ninkari, ururenda, cyangwa imico yakomeretse ako kanya kugirango laboratoire ibashe kumenya nyirabayazana ya antibiyotike idatinze kwivuza.
• ** Antibiyotike yagutse yagutse **: Imiti mikorobe ikomeye ya IV yinjizwa muminota 60 yambere kugirango ihagarike kwigana ako kanya.
• ** Kwihuta kwa kristalloid fluid **: Kuri hypotension cyangwa lactate ya 4 mmol / L cyangwa irenga, abaforomo binjiza mililitiro 30 kuri kilo yuburemere bwumubiri wumuti uringaniye (nka Lactated Ringer's cyangwa saline isanzwe) mumasaha 3 yambere.
• ** Inkunga ya Vasopressor no kugenzura inkomoko **: Niba umuvuduko wamaraso ukomeje kuba munsi yumuvuduko ukabije wa Arterial ya 65 mmHg nubwo hari amazi, amatsinda yitaweho cyane atangira kwanduza norepinephrine kandi akanategura uburyo bwo kubaga byihutirwa ibisebe byose, ibuye ryimpyiko zanduye, cyangwa tissue nekrotic.

Indwara ya Syndrome na Post-Sepsis (PSS)¶

Kurokoka sepsis nintangiriro yurugendo rurerure rwo gusubiza mu buzima busanzwe. Abagera kuri 50 ku ijana by'abarokotse sepsis bafite uburambe ** Indwara ya nyuma ya Sepsis (PSS) **, ihuriro ry'ingaruka z'umubiri, ubwenge, na psychologiya zishobora kumara amezi cyangwa imyaka nyuma yo gusohoka mu bitaro:

• ** Ingorane z'umubiri **: Intege nke z'imitsi no kwangirika kw'imitsi (intege nke zatewe na ICU cyangwa uburwayi bukomeye polyneuropathie), ububabare buhoraho, guhumeka, guta umusatsi, imisumari imenetse, n'impyiko zidakira cyangwa ubumuga bw'umutima.
• ** Ingaruka zo kumenya no kumarangamutima **: Kubura kwibuka, ingorane zo kwibanda ("igihu cyubwonko"), kudasinzira, kurota nabi, kwiheba kwa clinique, na Post-Traumatic Stress Disorder (PTSD) byatewe na delirium no kwitabwaho cyane bigumaho.
• ** Ibyago byo kongera kwandura **: Sisitemu yubudahangarwa ikomeza kutagengwa amezi nyuma ya sepsis ikabije, bivuze ko abarokotse bahura n’ibyago byinshi byo kwandura ibitaro ku ndwara zanduye. Menya neza ko abarokotse bahabwa urukingo rwa pneumococcal, ibicurane, na COVID-19 bimaze gukurwa na muganga wabo, hanyuma bakavura ibimenyetso bishya cyangwa inkari byihuse.

Ibibazo bikunze kubazwa¶

Inkomoko yagenzuwe¶

• Kurokoka ubukangurambaga bwa Sepsis (Umuryango w’ubuvuzi bukomeye n’umuryango w’ibihugu by’i Burayi w’ubuvuzi bukomeye): * Amabwiriza mpuzamahanga yo gucunga Sepsis na Septike Shock *.
• Ishami ry'Umuryango w'Abibumbye ryita ku Buzima (OMS): * Raporo y'Isi yose kuri Epidemiologiya n'Umutwaro wa Sepsis *.
• Ibigo byo muri Amerika bishinzwe kurwanya no gukumira indwara (CDC): * Ibyerekeye Sepsis no Kubanziriza Amabwiriza y’ubuvuzi ya Sepsis *.
• Ikigo cy’Ubwongereza gishinzwe ubuzima n’ubuvuzi (NICE): * Ukekwaho Sepsis: Kumenyekana, Gusuzuma no Gucunga hakiri kare (NG51) * na * UK Sepsis Trust ibikoresho by’ubuvuzi *.
• Ihuriro rya Sepsis (Amerika): * Sepsis TIME Protocol Protocol hamwe nubuyobozi bwa Syndrome ya nyuma ya Sepsis *.

Kuyobora¶

• Kumenya no kuvura ihungabana ry'ubuvuzi
• Imyitwarire ikabije ya allergique na anaphylaxis
• Ibikomere byanduye, gukata, n'ibisigazwa
• Amenyo yakuweho hamwe n'ibisebe by'amenyo
• Ububiko bwihutirwa