Uma utshelwe ukuthi unempilo, kusho ukuthini? Ziyini izimbangela zalesi simo futhi ngubani osemngciphekweni? Yiziphi izinketho zokwelapha ezitholakalayo nokuthi yini okuchazayo?
Incazelo
I-empyema iqoqo le-pus phakathi kwezingxenye ezimbili zezicubu ( pleura ) ezibeka emaphashini. Ngokuvamile inhlekelele ibonakala njengengcindezi ye-pneumonia, i-abscess yamaphaphu, noma isifo se-chest.
Anatomy
Isikhala somlomo noma isikhala sendawo esifundeni sesifuba esivela phakathi kwe-visceral pleura (i-membrane ngaphandle kwamaphaphu) kanye ne-parietal pleura (i-membrane efaka ngaphakathi kwendonga yesifuba.) Ngokujwayelekile, le ndawo iqukethe kuphela ambalwa amathisipuni we- pleural fluid . Ngaphandle kwalokho, le ndawo ingase iqukathe i-pint noma ngaphezulu ye-pleural fluid.
I-Empyema Fluid
Uketshezi oluqukethwe ku-empyema lubhekiselwa njenge-pus futhi liqukethe inhlanganisela yamagciwane, amaseli afile, namaseli amhlophe egazi. Amabhaktheriya avame kakhulu okubangela ukuphazamiseka yi- Streptococcus pneumoniae (i-"pneumonia" bacteria) ne- Staphylococcus aureus .
Uma isampula se-pleural fluid iscwatshiwe, ukubonakala okunamafu nokugcizelele kwe-empyema kuvame ukucacile ukuthi kuhluke kanjani nohlobo olujwayelekile lwe-pleural fluid elula futhi eguquguqukayo.
Izimpawu Nezibonakaliso
Izimpawu ezihlobene ne-empyema zingabangela kokubili ukutholakala kokutheleleka nokucindezelwa emaphashini nasesikhumeni kusukela ekukhuphukeni ketshezi endaweni yokukhalaza. Izimpawu kanye nezimpawu ezivamile zihlanganisa:
- I-Fever kanye nama-chills
- Izithukuthuku ebusuku: Lokhu kungabonakala kakhulu ngokugcoba ukujula ebusuku okudinga ukuguqulwa kwezingubo zobusuku
- Ubuhlungu besifuba, ngokuvamile bukhali futhi bubuhlungu kakhulu
- Ukuphefumula: Kunzima ukuphefumula kungena kancane kancane noma ngokuya kuye ngokuthi ubukhulu be-effusion kanye nobukhulu benkambiso engaphansi
- Ukukhwehlela owomile: Ukukhwehlela kungase kukhiqize ngenxa ye-pneumonia ehambisanayo
- Ama-Hiccups: Ukucasuka kwe- diaphragm kanye nezinzwa kule ndawo ngenxa yokwakhiwa kwe-fluid kungabangela ama-hiccups
- Ukulahlekelwa kwesisindo (ukulahlekelwa kwesisindo okungenhloso)
- Ukukhathala
- Umqondo jikelele wokungahlali kahle
Izimbangela
Kunemibandela eminingi ehlukene engase iholele ku-empyema. Ezinye zazo zihlanganisa:
- I-pneumonia (Lena yimbangela evamile kakhulu ye-empyema.)
- I-traum trauma.
- Ukuhlinzwa kwesifuba, njengaleyo yomdlavuza wamaphaphu.
- I-thoracentesis: Ngezinye izikhathi ukutheleleka kungabangelwa ngokungaqondile lapho i-thoracentesis (inaliti "ithinta" yesikhala se-pleural) isenziwa ukuxilonga izifo noma uma ithubhu lesifuba lifakwa ukukhipha umoya (njengalokhu ku-pneumothorax) noma oketshezi (njengokungathi ukukhishwa kwamagama.)
- I-fistula ye-bronchopleural: I-fistula e-bronchopleural iyinhlangano ye-fistula noma umsele ongase uthuthuke phakathi kwesikhala se-pleural ne- bronchi ngesikhathi sokuhlinzwa kwamaphaphu, okuvumela ukuthi amabhaktheriya adlule ukusuka ku-bronchi kuya esikhaleni se-pleural.)
- Ukwandiswa kokutheleleka: Ukutheleleka esiswini (peritonitis) noma indawo emkhatsini wamaphaphu (mediastinitis) ingasakazeka endaweni yokukhala.
- I-abscess yamaphaphu ingase ihlukane ibe isikhala sokukhala.
Izingozi Zezingozi
I-empyema ingase ibe khona kumuntu onokuthi:
- Isifo sikashukela
- Umlando wokudakwa ngokweqile
- Izifo ezizenzekelayo ngokuzenzakalela njenge-arthritis ye-rheumatoid
- Isivikelo somzimba sokuzivikela, njengokuthi i-chemotherapy
- Izifo ezinamafutha ezifana ne-COPD ne-bronchitis engapheli
- Isifo se-reflux se-gastroesophageal
Ukuxilongwa
Ukuze kutholakale ukuthi kukhona okungazenzisi, odokotela baqala ukuthatha umlando ngokucophelela futhi bahlole ukuhlolwa ngokomzimba. Umlando ungasiza ekunqumeni ukuthi kukhona yini izici eziyingozi, futhi ukuhlola ngokomzimba kungabonisa ukunciphisa umsindo. Ngemva kwalokhu, i-x-ray yesifuba noma isifuba CT scan kwenziwa ukuze uqhubeke uhlola amaphaphu.
Ngesinye isikhathi futhi i-ultrasound ingenziwa futhi. Ukuze wazi ukuthi amabhaktheriya akhona yini, futhi ukuthola ukuthi yiziphi antibiotics lawa ma-bacteria azwelayo, i-thoracentesis yenziwa ukuthatha isampula ye-empyema (umthamo ungase uphelelwe futhi.) Umswakama uthunyelwa ebhodini ukuze ukwenza ukuhlaziywa kwamanzi abizayo, ukuhlolwa kokuqukethwe ketshezi. Ukuhlolwa kwegazi kungenziwa futhi ukufuna ubufakazi bokutheleleka.
Izinketho zokwelapha
Ukwelashwa kwe-empyema kungaphulwa zibe yizinyathelo ezimbili; isinyathelo sokuqala ukukhipha uketshezi, emva kwalokho ukutheleleka kufanele kuphathwe.
Ukususwa kwe-flux: I- Fluid isuswe nge-thoracentesis. Ngezinye izikhathi lokhu kulula, ikakhulukazi uma lo mkhuba ungazange ube khona isikhathi eside. I- tube yamathumba ingabekwa khona ukuze iqhubeke igcoba uketshezi.
Uma kutholakala amandla amakhulu okwesikhashana, kungase kutholakale. Lokhu kwenzeka uma amafomu amancane amancane futhi ehlukanisa umkhuhlane abe yizicucu ezihlukene.Lokhu kwenza uketshezi lube nzima nakakhulu, futhi ngezinye izikhathi imizamo eminingana ye-thoracentesis iyadingeka ukuze isuse umthamo.
Ukwelapha ukutheleleka: Odokotela bazoqala ama-antibiotic ngokushesha uma isampula ithathwa. Abanye abantu bayazibuza ukuthi kungani kungekudala, kepha ukuqala kwama-antibiotic kuvame ukulibaziseka ukuze unike lebhu ithuba elihle lokunquma ukuthi iyiphi amabhaktheriya abangela ukutheleleka. (Uma ama-antibiotics eqala ngaphambi kwe-thoracentesis, kungaba nzima ukubona ukuthi yiziphi amagciwane ezibhekene nokutheleleka.) Ngemva kokuqala ngama-antibiotics ibhubhu izokwenza ukuhlolwa okuqhubekayo ukuhlola ukuthi yimaphi ama-antibiotics ama-bacteria azwela kakhulu-futhi ama-antibiotic anikezwa angashintshwa emva kwezinsuku ezimbalwa.
Izinkinga / Ukuhlinzwa
Ngenhlawulo, ikakhulukazi ekhona okwesikhashana, izicubu ezinzima zingakha. Kungase kudingeke ukuba udokotela ohlinzayo asuse ezinye izicubu ezibomvu kanye nezingxenyana ze-pleura ukuze kuxazululwe ukutheleleka. Lokhu kungenziwa noma nge- thoracotomy (ukuvula ukuhlinzwa kwamaphaphu) noma ukuhlinzeka nge-thoracoscopic (ukuhlinzeka kancane kwemaphaphu okungavamile,) ngokuhlobisa i-thoracoscopic okusizwa ngevidiyo kube inketho ephumelelayo futhi engavamile kubantu abaningi. Ngaphezu kwalokho, ucwaningo lwamuva luye lwathola ukuthi izindlela ezingezona zokuhlinzwa zivame ukusebenza njengezindlela zokuhlinzwa zokwelapha. Ezinye izinkinga zingase zibandakanye i-sepsis-ukutheleleka okukhulu kakhulu emzimbeni wonke, nokukhwabanisa nokuqina kwezingqimba zomlomo.
Isibikezelo
Ukuchazwa kwe-empyema kuxhomeke kakhulu ekubambeni.
Ngaphansi
Okubaluleke kakhulu igama elisetshenziselwa ukuchaza ukutholakala kwe-fluural fluid enegciwane elizungeze amaphaphu. Isizathu esivame kakhulu yisifo se-pneumonia, kodwa ezinye izimo, kanye nokuhlinzwa kanye nokuhlukunyezwa, kungase kube nomthwalo wemfanelo. Ukwelashwa kuqukethe ukuthatha isampula ketshezi ukuthumela ebhodini nokukhipha uketshezi okwedlulele okungabangela ukuphefumula kanye nezinye izimpawu. Ama-antibiotic anikezwa ukuphatha ukutheleleka.
Igama lokubiza: em-pie-ee-ma
Futhi ibizwa ngokuthi : i-pylothorax, ukutheleleka kwe-pleural, i-purulent pleuritis, i-empyema thoracis
Izibonelo: UJerry wahlakulela ukuhlinzwa ngokuhlinzwa komdlavuza wamaphaphu, kanti udokotela wakhe wenza inqubo yokukhipha uketshezi olugciwane.
> Imithombo:
> McCauley, L, noN. Dean. I-pneumonia ne-empyema: i-causal, engavamile noma engaziwa. I-Journal ye-Thoracic Disease . 2015. 7 (6): 992-8.
> I-National Library of Medicine. I-MedlinePlus. Empyema. Kubuyekezwa 02/15/15. https://medlineplus.gov/ency/article/000123.htm
> Redden, M., Chin, T., noMn. Van Driel. Ukuhlinzekwa Okuhlinzekwa Ukuphathwa Okungeyona Okuhlinzekwa Pleural Empyema. I-Cochrane Database yezibuyekezo ezihleliwe . 2017. 3: CD010651.
> Zanotti, G., noJ. Mitchell. I-Bronchopleural Fistula ne-Empyema Ngemuva kokutholakala kwe-Anatomic Lung. Imitholampilo yezokwelapha . 2015. 25 (4): 421-7.