Ukusabela kwe-Anaphylactoid: iimpawu, ukuxilongwa kunye nokwahlula

Ukuvela kwe- reaction (anaphylactic) yokusabela kubangelwa yi-agents eyaziwayo, kwaye ikhosi yayo ibonakaliswe ngokukhawuleza kwimeko ye-hypersensitivity. Njengomthetho, kunokwenzeka ukubonakalisa impendulo yendalo kunye nesimo esisongela ubomi besifo esikhumbeni, ukuphefumula kunye nempilo ye-cardiovascular. Emva kokuqhagamshelana kokuqala kunye ne-antigen, ukuphuhliswa kwee-antibodies IgE, ngokukhethekileyo ngenjongo yayo ejoliswe kuyo, iqala. Zidibanisa neeseli ezinoxanduva lweenkqubo ze-immunological emzimbeni, kunye nokukhuthaza ukulwa ne-antigen.

Ukuphendulelwa kwamagciwane kubonakala njani?

I-ingress elandelayo ye-allergen ikhuthaza ukukhutshwa kwezinto eziphilayo ezijongene nemikhosi ye-immune, ikakhulukazi i-histamine. Ngethuba lokutshintshwa kweenkqubo zeekhemikhali ezingavumelekanga kwi-physiology engokwemvelo, utshintsho lubonakala ngokukodwa kwimithambo yegazi, i-lymph nodes, i-muscular bronchial, efaka isandla ekuphuhliseni nasekuboniseni kwangaphambili kwezi zilandelayo:

• Ukunciphisa isalathisi;
• Ukuqhaqhazela ngokukhawuleza kweesisu ezihamba kakuhle zomathumbu , i-bronchi, isisu;
• Ukuchithwa kwegazi;
• Ukuvuvukala nokuvuvukala kwemithambo yegazi.

Ngokungafani ne-allergic, i-anaphylactoid yokusabela, oogqirha abahlala bebiza nge-pseudoallergic, iintsholongwane ze-IgE azihambelani ne-basophil. Nangona kufana nokubonakaliswa kweenkqubo zempendulo, zombini ukubonakaliswa yimpendulo eyenziwe ngokubanzi ngokuxhomekeka komzimba.

Izigulane zezokwelapha ezibangelwa i-anaphylactoid

Ukuphendula kwe-anaphylactoid kwakhona kukukhululwa kwe-histamine, ngokuqhelekileyo sele sele iqhagamshelana neyokuqala. I-Pseudoallergens ngethuba lihle kakhulu. Ngokudlulileyo, le mpendulo yomzimba iphinda iyenzeka ngexesha lokufumana iziyobisi eziyeka ukunyuka.

Uhlobo lwe-Anaphylactic kunye ne-anaphylactoid yoluhlobo olukhawulezayo lwenzeka ngokuphindaphindiweyo emva kokulawulwa kwemisipha yokuphumula, iziyobisi, iziyobisi ze-anesthetic, i-opioids, i-anesthetics yendawo, ukugonywa, i-hormone therapy, i-atropine kunye ne-vithamini B. Ukufumanisa izifo ezithintekayo, izifo ze-venereal. Iziganeko zokuchasene neemveliso ze-latex ziye zanda rhoqo. Ukuphendula kwe-Anaphylactoid kwi-lidocaine kuthathwa njengento exhaphakileyo, njengoko isilwanyana sisetyenziswa rhoqo kwi-anesthesia yendawo, kodwa ukubunjwa kweekhemikhali eziyinkimbinkimbi kunokudala imiphumo emihle kwimizimba enempilo apho ukungathinteli kwimizimba yonyango kungeyona nto.

I-non-medicative stimuli

Ukuba sicinga ngamacandelo ezempendulo zempembelelo yomzimba ukuba zenze i-stimuli yendalo engekho-mveliso, ngoko ngokuqinisekileyo ukutya kunokuthi "kube yingxaki":

• Ierberberries;
• Crustaceans;
• Ubusi;
• Amantonga;
• Amakhowe;
• Intlanzi yezinye iintlobo;
• Amaqanda;
• Izithelo zeCitrus.

Impendulo ye-Anaphylactoid iyakwenzeka xa inambuzane okanye i-agent yezilwanyana ezinobuthi ezinobuthi. Izigulane ezisoloko zifumana ukubonakaliswa kweempawu zomntu ongeyena unobungozi zinomngcipheko omkhulu wokuhlakulela i-anaphylaxis kwimeko yokungenwa kwe-anesthesia jikelele.

Ulwahlulo lwe-anaphylaxis

Ngoko ke ukuhlengahlengiswa kweempendulo. Ibloko lokuqala liquka iintlobo ezahlukeneyo zokuphendula kwe-anaphylactic ezahlula kwi-IgE edibeneyo ye-IgG edibeneyo kunye ne-IgE edibeneyo kunye nomsebenzi wokwenyama. Impendulo ye-Anaphylactoid i-pseudoallergic iyanqamla ngokulandelelana okulula kwabanamlamli, ilandelwa ngamanyathelo angcolisa iziyobisi, ukutya kunye nezinto ezibonakalayo. Udidi oluhlukileyo luyi-anaphylactoid ukusabela kwi-mastocytosis; Ukuxhaswa ngama-immune complexes, izigulane ze-immunoglobulin kunye nokuqaliswa kwee-immune policy kunye ne-mediated antibodies, i-radiopaque.

Njani i-anaphylaxis?

I-Morphine kunye neerbiturates ezininzi, i-muscle relaxants, i-pethidine inokuchaphazela amangqamuzana amancinci, okudala ukukhululwa kwe-histamine. Ngethuba elifanayo, umfanekiso wekliniki uxhomekeke kumlinganiselo kunye nesantya apho izinto ezisebenzayo zingena emzimbeni. Ukuziqhelanisa kubonisa ukuba ngokukodwa impendulo iyabonakalisa, ingaphelelanga kuphela kwimbonakalo elukhumbeni.

Impendulo ye-Anaphylactoid (i-ICD 10 eyabelwe kule ntshoyo ye-pathological syndrome) ibonakaliswa ngokungalindelekanga kokuphuhliswa okuqhubekayo kwaye, mhlawumbi, ukungabikho ngokupheleleyo kolwazi kwiimpendulo zangaphambili ezithintekayo zomzimba kuma-antigen. Ekubeni imiphumo ye-anaphylaxis kwi-crane iyingozi kwimpilo nobomi, kubalulekile ukufumanisa inkqubo yeengxaki ngexesha elifanelekileyo kwaye uthathe amanyathelo afanelekileyo. Kungakhathaliseki ukuba i-anaphylactic okanye i-pseudoallergic stimulus, i-symptomatology ingahluka kakhulu. Ukuzala isicatshulwa ngokuzimeleyo, ukubonakaliswa kunokuvela kwiqela elincinci kwixinzelelo legazi kunye neengcephe zesikhumba kwi-bronchospasm enzima kunye nokuwa kwe-system ye-cardiovascular system.

Kule nqanaba, kulula ukuphawula enye imohluko kwenzo ye-pseudoallergenes emzimbeni. Okwangoku, ukuphendula kwe-anaphylactoid, iimpawu zazo ezifunyanwa ngabanye okanye ezenziwe ngokudibanisa ezahlukeneyo, akukho nengozi.

Uphawu lwe-anaphylactoid

Izibonakaliso zempendulo yokumangalisa kwisigulane kwindawo yokuvuka zi:

• Utywala;
• Ubuthathaka obunzima bomzimba;
• Ukuphulwa kwentliziyo yeengcamango (tachycardia, arrhythmia);
• Ukunciphisa uxinzelelo lwegazi;
• Ukuphefumula okunzima, ukuhlaselwa kwe-suffocation, i-broncho- kunye ne-laryngospasm, i-edema yamaphaphu kunye ne-larynx;
• Ukuvutha kwesikhumba, ukuvuthwa kweengqungquthela, imihlathi, i-hyperemia yemifuno, i- edema Quincke ;
• Iintlanzi zamathumbu emathunjini, isisongomso, ihudo, ukuhlanza;
• Ukungabikho kwe-pulse;
• Ukuwa kweenhliziyo;
• Ukucima nokuyeka umsebenzi wentliziyo.

Iingxaki ezinokwenzeka emva kokuphendula kwe-anaphylactoid

Ingongoma enkulu yinto yokutshatyalaliswa, idibene ne-bronchospasm. Emva kwithuba elithile lexesha (ukususela kumasekhondi angu-30 ukuya kwisiqingatha seyure, ngamanye amaxesha iiyure eziyi-2-3) i-antigen engena emzimbeni inomdla ekuphuhlisweni kweenkqubo ze-pathological allergenic emzimbeni. Kwimiba ephakamileyo inkqubo yokuphendula ixhomekeke kwindlela yokungena kwe-stimulus (ngomlomo okanye ngomzali). Uphuhliso olukhawulezayo lubangele ukufa, kubangele ukungaphumeleli ngokukhawuleza kokuphefumula, ukuphazamiseka okubalulekileyo ekunyanzelekeni komngcipheko, okukhokelela ekuchaseni okunzima kwegazi, i-edema ye-cerebral okanye i-hemorrhage, umsebenzi ongenakukhubazeka, isifo se-thrombosis.

Ngosuku lwesibini emva kokutshatyalaliswa, isongelo ebomini nasekuphumeni likhona ekuqhubekeni kwezifo ezithintekayo ezibangelwa yindlela yokuphendula. Nangona emva kweveki ezimbalwa, umngcipheko weengxaki zihlala zikhulu. Ngokuphindaphindiweyo, emva kokutshatyalaliswa kwe- anaphylactic, oogqirha baxilonga ngezi zifo kunye nezifo:

• Pneumonia;
• Vasculitis;
• I-Renal ne-hepatic insufficiency, hepatitis, glomerulonephritis;
• I-Epidermal necrolysis;
• Myocarditis;
• Arthritis.

Imiphumo efana nayo ingasongela ubomi be-anaphylactic kunye ne-anaphylactoid. Ukwahlukeka kokutshatyalaliswa kwe-anaphylactic kwezi zifo kuleso sihlandlo sidinga ukuvuselelwa kwangaphambili kwaye asikwazi ukuhlakulela ukuqala kokuhlangana ne-allergenic.

Unyango lwe-anaphylaxis

Kuyachaneka ukwenza isicwangciso sonyango ngokukhawuleza ngokuxilongwa, kuphela i-anamnesis iya kunceda, ngoko kubaluleke kakhulu ukuyiqokelela. Iimpawu zokunqongophala, oko kukuthi, umfanekiso weklinikhi, udlala indima ebalulekileyo ekwenzeni isigqibo esisisigqibo. Nangona kunjalo, impendulo enokwethenjelwa neyipheleleyo kwimibuzo yokuxilongwa ingatholakala kuphela emva kokuba i-allergists kunye ne-immunologists beqhube isifundo sebhubhoratri. Kule meko, ngokusekelwe kwiimeko ezibuhlungu zesigulane, okokuqala kufuneka ukuba unikezwe ngononophelo lwengxamisekileyo, kwaye xa kwenzeka ukuboshwa kwentliziyo okanye ukuphefumla - izenzo zokuvuselela.

Kwinqanaba lokuqonda izizathu ezingundoqo zokuphendula komzimba, umsebenzi woogqirha kufuneka ukwenze ukuxilongwa ngokucacileyo. Olu hlobo loviwo lusetyenziswe ukuba lukhuphe ngaphandle kweemeko ezinokuthi zithintele, ezingahambelani nokukhululwa kwe-histamine.

Ukuphendula okufanayo komzimba kwezinye izizathu ezingezona ziphumo

Ininzi kaninzi i-anaphylactic kunye ne-anaphylactoid yokusabela (yintoni na kwaye yintoni eyingozi ye-pathologies, kubalulekile ukwazi abantu abaxhomekeke kwintlonelo, ekubonweni kokuqala, ukubonakaliswa kwezinto ezinobungozi ngesimo se-rhinitis) banokufana nezinye izinto ezinokukwazi ukudala i-bronchospasm, i-hypotension:

• Ukugqithisa nge-anesthetics;
• I-Thromboembolism ngenxa ye-ingress yomoya okanye uphuhliso lwe-atherosclerosis;
• Iinjongo ezinzulu zokuqukethwe kwesisu;
• I-myocardial infarction, i-tamponade ye-pericardial;
• Ukuthuthumela kweSeptic;
• I-Edema yemiphunga kunye nezinye iimpawu ezingahambelani neentlungu.

Uphuhliso olukhawulezileyo ngokuphuhlisa ngokukhawuleza ukusabela kwe-anaphylactic kunye ne-anaphylactoid akufani nahlulo lwezenzo ezijolise ekupheliseni nasekunyangekeni kwe-anaphylactic.

Umyalelo wezenzo eziphuthumayo

Ngokuqhubela phambili kokungabikho komzimba, uqeqesho lwezonyango kunye nokubonelelwa ngoncedo kwikamva elikufutshane luyintloko epilweni yonyango. Amanyathelo ophambili ekukhutsheni i-anaphylaxis yoluhlobo olukhawulezayo luqulethwe kwinqanaba elinyanzelisiweyo lamanyathelo athile:

1. Ukuqaliswa kwe-antigen engaqinisekisiweyo, kodwa inokuba yingozi, kufuneka ishiywe.
2. Ukusabela kwe-Anaphylactic okanye i-anaphylactoid (iifoto kwinqaku libonisa ngokucacileyo ukubonakaliswa okuqhelekileyo kunye nempawu zentsholongwane), ukuphucula ngexesha le-anesthesia okanye ngexesha lotyando, kufuna ukumiswa kwangoko. Uvavanyo olungqinelanayo lufanele lwenziwe kwi-introduction of allergens. Ngokuxhuma ngokukhawuleza kwixinzelelo legazi phantsi, kuyimfuneko ukuphazamisa ukubonelelwa kwe-anesthetic. Kwimeko ye-bronchospasm, inhalation anesthetics inyanzelekile.
3. Ukuphulukiswa kwamanzi kunye nokuhamba kwamanzi kufuneka kuqinisekiswe kwinqanaba xa isigulane sesimo singakhange siphume kakhulu. Kwi-intubation, imiphunga idinga rhoqo, de ifike ekugqibeleni ukuba i-airway inikezelwa ngumzimba yedwa.
4. Impendulo ye-Anaphylactoid, unyango oludinga i-adrenaline enomdla, kuyingozi kwisigulane nangemva kweeyure eziliqela emva kokususwa kwe-bronchospasm. Isisombululo se-epinephrine kunye nokulawulwa ngokuphindaphindiweyo kunokunyuka, kuba le nkunkuma ichaphazela ngokuqinisekileyo ukuzinzisa kweeseli zamathambo, ukwehla ekuphelelweni kwe-endothelium yemithambo yegazi, ebaluleke kakhulu kunyango lwe-anaphylaxis.
5. Ngomfuneko ophuthumayo wokuvuselela, kubalulekile ukwandisa umthamo wokujikeleza umbane emzimbeni. Kule nto, oogqirha bafaka i-catheter ye-diameter eninzi ngaphakathi (i-vein asetyenzisiweyo ayinakuhlala iphakathi-ixesha lokuyifuna lingadlala ngokubhekiselele kwimeko yesigulane) kwaye uthele kwiititha ezimbalwa ze-crystalloids.
6. Ukuba akunakwenzeka ukufumana izilwanyana ezibangelwa i-anaphylactoid ukusabela, kuyafaneleka ukubeka ingqalelo ekusebenziseni izinto ze-latex ngexesha lokudibanisa nesigulane. Iiglavu zokugada, iziyobisi eziqokelelwa ngamacwecwe e-latex, i-urinary catheters - konke oku kunokuvusa i-anaphylaxis.

Emva kwonyango olungxamisekileyo, ukusabela kwe-anaphylactoid (kunye nokuphendula kwe-anaphylactic) kudinga inkambo yokwelapha ixesha elide ukwenzela ukukhusela ukuphindaphindiweyo kwezifo. Ukungayithobeli imiyalelo yoogqirha kwandisa umngcipheko wokwandisa uluhlu lwezinto ezinokubakho.

Ukulandelwa kwonyango

Phakathi kwenkqubo yeyeza kunyango lwe-bronchospasm, indima ebalulekileyo yile nkunkuma "iSalbutomol", inokuthi ithathelwe indawo yi "Aminophylline". Ukuba kunokwenzeka, kongeza ukhenkethe kwi-inhalation kunye ne-isoproterenol okanye i-orciprenaline. Ngenxa yokuba ukusabela kwe-anaphylactoid kukubonakaliswa kwenkqubo yekliniki apho iimpawu ezinokuba nzima, kuyimfuneko ukusebenzisa i-glucocorticoids (umzekelo, "iDexamethasone", "Hydrocortisone"), ekhubaza inkqubo yokuwa kwegazi.

Ngokuqhelekileyo, ukuxhatshazwa kwe-anaphylactic ukutshutshiswa kulandelwa lixesha elilindileyo loogqirha. Inyani kukuba ukuphuhliswa kwexesha elidlulileyo kungenza njalo, ngoko ke, nangona naluphi na umlinganiselo wesimo somguli, ukubhedlelelwa esibhedlele yisigqibo esingafanelekanga. Oogqirha abanyanzelekileyo baphinda baqwalasele uviwo lokuza kwesikhumba ekufumaneni i-antibodies ezithile.

Ukuthintela ukusabela kwe-anaphylactic kunye ne-anaphylactoid

Iqoqo epheleleyo le-anamnesis yindlela efanelekileyo yokukhusela nokukhusela i-anaphylaxis. Emva kokuqokelela lonke ulwazi oluyimfuneko malunga nekhosi yesifo, kunokwenzeka ukuhlukanisa isigulane kwiqela elijongene nobungozi kwaye sinqume oko kuya kusongelwa ngempembelelo yesibili ye-anaphylactoid. Kuthetha ukuthini oku?

Ngenxa yokuba uhlaselo olulandelelanayo lunokuba lunzima kakhulu, izigulana zifuna ukhetho olupheleleyo lwezilwanyana kwi-aneshesia kunye nokunakekelwa okukhulu. Ngaphambi kokumpontshelwa igazi, abantu abanelisekile kwi-anaphylaxis bavavanywa ukuhambelana nemveliso ethile yegazi.

Ubuninzi bokungabikho komzimba kwimveliso ye-latex bubeka phambili ekuhambeni kweendlela ezahlukeneyo ngaphandle kokusetyenziswa kwezi ndlela.