Ukuxilongwa ngokukhawuleza kosulelo lwegazi

Ukusuleleka kwi-Bloodstream (BSI) ibhekisela kwi-syndrome ye-systemic inflammatory reaction syndrome ebangelwa ukuhlaselwa kwee-microorganisms ezahlukeneyo ze-pathogenic kunye ne-toxins yazo kwigazi.

Ikhosi yesi sifo idla ngokubonakaliswa ngokusebenza kunye nokukhululwa kwabalamli abavuthayo, okubangela uthotho lweempawu zeklinikhi ezifana nomkhuhlane ophezulu, ukugodola, ukuphefumla kwe-tachycardia, i-rash kunye nokuguqulwa kwesimo sengqondo, kwaye kwiimeko ezinzima, ukothuka, i-DIC kunye neninzi. -ukungaphumeleli kwelungu, kunye nezinga eliphezulu lokufa. ifumene i-HA) iimeko ze-sepsis nezothuso lwe-septic, zibalelwa kuma-40% eemeko kwaye malunga ne-20% ye-ICU efunyenweyo. Kwaye inxulunyaniswa ngokusondeleyo nokungachazeki kakuhle, ngakumbi ngaphandle konyango lwe-antimicrobial ngexesha elifanelekileyo kunye nolawulo olujoliso losulelo .

Ukuhlelwa kosulelo lwegazi ngokweqondo losulelo

I-Bacteraemia

Ubukho bebhaktheriya okanye umngundo egazini.

Septicemia

I-syndrome yeklinikhi ebangelwa kuhlaselo lwebhaktheriya ye-pathogenic kunye ne-toxins yazo egazini, lusulelo olubi lwenkqubo..

I-Pyohemia

Ukungasebenzi kakuhle kwamalungu okusongela ubomi okubangelwa kukungasebenzi kakuhle kwempendulo yomzimba kusulelo.

Eyona nto ixhalabisayo ngokwezonyango zezi zimbini zilandelayo zosulelo ezinxulumeneyo.

Usulelo olukhethekileyo lwegazi olunxulumene neCatheter

Usulelo lwegazi olunxulunyaniswa neecatheter ezifakwe kwimithambo yegazi (umzekelo, ii-catheters ze-venous ze-peripheral, i-catheter ye-venous ephakathi, i-catheters ye-arterial, i-dialysis catheters, njl.).

I-Endocarditis eYosulelayo ekhethekileyo

Sisifo esosulelayo esibangelwa ukufuduka kwe-pathogens kwi-endocardium kunye ne-valve yentliziyo, kwaye ibonakaliswe ngokuqulunqwa kwezinto eziphilayo ezingenamsebenzi kwi-valve njengendlela yomonakalo we-pathological, kunye ne-embolic infection metastasis okanye i-sepsis ngenxa yokuchithwa kwezinto eziphilayo.

Iingozi zosulelo lwegazi:

Usulelo lwegazi luchazwa njengesigulane esinenkcubeko yegazi elungileyo kunye neempawu zentsholongwane yesistim. Usulelo lwegazi lunokuba lwesibini kwezinye iisayithi zosulelo ezifana nokusuleleka kwemiphunga, izifo zesisu, okanye izifo eziphambili. Kuye kwaxelwa ukuba i-40% yezigulane ezine-sepsis okanye i-septic shock zibangelwa lusulelo lwegazi [4]. Kuqikelelwa ukuba nyaka ngamnye abantu abazizigidi ezingama-47-50 zesepsis zenzeka ehlabathini lonke, nto leyo ebangela ukufa kwabantu abangaphezu kwezigidi ezili-11, ngokomlinganiselo wokufa komntu omnye rhoqo kwimizuzwana emi-2.8 [5].

Iindlela zokuxilonga ezifumanekayo zosulelo lwegazi

01 PCT

Xa ukusuleleka kwenkqubo kunye nokuphendula okuvuthayo kwenzeka, i-secretion ye-calcitoninogen PCT ikhula ngokukhawuleza phantsi kwe-induction stimulation ye-toxins ye-bacterial toxins kunye ne-cytokines evuthayo, kwaye inqanaba le-serum ye-PCT libonisa imeko enzulu yesifo kwaye luphawu oluhle lwe-prognosis.

0.2 Iiseli kunye nezinto zokubambelela

Iimolekyuli ze-cell adhesion (CAM) zibandakanyeka kwiinkqubo ze-physiopathological, ezifana ne-immune response response and inflammatory response, kwaye idlala indima ebalulekileyo ekuchaseni ukusuleleka kunye nokusuleleka kakhulu. Ezi ziquka i-IL-6, i-IL-8, i-TNF-a, i-VCAM-1, njl.

03 I-Endotoxin, uvavanyo lwe-G

Iibhaktheriya zegram-negative ezingena egazini ukukhulula i-endotoxin zingabangela i-endotoxemia; (1,3) -β-D-glucan yenye yezakhiwo eziphambili zodonga lweseli yefungal kwaye yanda kakhulu kwizifo zefungal.

04 Ibhayoloji yeMolekyuli

I-DNA okanye i-RNA ekhutshwe egazini yi-microorganisms ivavanywa, okanye emva kwenkcubeko yegazi elungileyo.

05 inkcubeko yegazi

Iibhaktheriya okanye i-fungi kwiinkcubeko zegazi "ngumgangatho wegolide".

Inkcubeko yegazi yenye yezona ndlela zilula, zichanekileyo kwaye zisetyenziswa ngokuqhelekileyo ukufumana usulelo lwegazi kwaye lusisiseko se-pathogenic sokuqinisekisa ukusuleleka kwegazi emzimbeni. Ukufunyaniswa kwangoko kwenkcubeko yegazi kunye nonyango lwakwangoko kunye nolufanelekileyo lwe-antimicrobial yimilinganiselo ephambili ekufuneka ithathwe ukulawula usulelo lwegazi.

Inkcubeko yegazi ngumgangatho wegolide wokuxilongwa kosulelo lwegazi, elinokuthi lihlukanise ngokuchanekileyo i-pathogen eyosulelayo, idibanise kunye nokuchongwa kweziphumo zobuntununtunu beziyobisi kwaye inike isicwangciso sonyango esichanekileyo nesichanekileyo. Nangona kunjalo, ingxaki yexesha elide lokunika ingxelo elungileyo kwinkcubeko yegazi iye yachaphazela ukuxilongwa kweklinikhi ngexesha elifanelekileyo kunye nonyango, kwaye kuye kwaxelwa ukuba izinga lokufa kwezigulane ezinganyangwanga ngamayeza okubulala iintsholongwane ngexesha kunye nokusebenzayo landa nge-7.6% ngeyure emva kweeyure ze-6. i-hypotension yokuqala.

Ke ngoko, isiko legazi langoku kunye nokuchongwa kobuntununtunu beziyobisi kwizigulana ezinosulelo lwegazi olukrokrelekayo ikakhulu zisebenzisa inkqubo yokunika ingxelo enemigangatho emithathu, eyile: ingxelo esisiseko (ingxelo yexabiso elibalulekileyo, iziphumo ze-smear), ingxelo yesibini (ukuchongwa okukhawulezayo okanye/kunye novelwano ngokuthe ngqo kwiziyobisi. ingxelo) kunye nengxelo yenqanaba lesithathu (ingxelo yokugqibela, kubandakanywa igama loxinzelelo, ixesha le-alam eliqinisekileyo kunye neziphumo zovavanyo oluqhelekileyo lweziyobisi) [7]. Ingxelo yokuqala kufuneka ixelwe kwiklinikhi ngaphakathi kwe-1 h yengxelo ye-vial ye-positive yegazi; Ingxelo yemfundo ephakamileyo iyacetyiswa ukuba igqitywe ngokukhawuleza (ngokukodwa kwiiyure ezingama-48-72 kwiibhaktheriya) ngokuxhomekeke kwimeko yelabhoratri.