Abamukeli be-transplant bangakwazi ukuhlakulela isifo sikashukela njengengxube ye-transplantation
Sibutsetelo
Nakuba isifo sikashukela sinesifo esivamile futhi esiqondakala kahle, bambalwa abantu abazi ukuthi isifo sikashukela singakhula njengesifo esisha esiyinkimbinkimbi kulabo abakuthola ukufakelwa kwezinso . Noma ubani onokwehluleka kwezinso ekubhekiseni ukufakelwa kwezinso njengokwelashwa kwesifo sezinso kufanele aqaphele le ngozi, eyaziwa ngokuthi isifo sikashukela esisha ngemuva kokufakelwa (NODAT).
Ngenkathi ingozi ikhona, kubalulekile ukuqaphela ukuthi akuwona wonke umuntu osemngciphekweni, kanti labo abanezinketho zokwelashwa kufanele kuthuthukiswe ukuguqulwa kwesifo sikashukela.
Isigameko
I-NODAT yinkinga ebonakalayo kwinani elikhulu leziguli ezithola ukufakelwa kwezinso. Noma kunjalo, izibalo ezicacile kule namba azitholakali. Lokhu kungenxa yokuthi kwakungekho incazelo eqinisekisiwe ye-NODAT isikhathi eside, kuze ku-2003. Ngakho-ke, kuye ngokuthi uchaza kanjani i-NODAT, izimo zingahluka.
Ucwaningo oluthile lubonakala lubonisa ukuthi amaphesenti angaba ngu-30 alabo abangenayo isifo sikashukela ngaphambi kokuthola ukufakelwa kwezinso angathuthukisa ukuphakama okuqhubekayo emazingeni kashukela egazini okusikisela i-NODAT ngezinyanga eziyisithupha ngemuva kokufakelwa kwezinso zabo. Lokhu ngokucacile inombolo ephawulekayo, ephakamisa ukuthi ukululekwa mayelana ne-NODAT kufanele kube yingxenye ebalulekile yokunakekelwa kweziguli ezihlulekayo kwezinso ezithintekayo ekutholeni ukufakelwa kwezinso.
Impact
Isifo sikashukela esanda kuthuthukiswa ngemuva kokuthola ukufakelwa kwezinso kunemiphumela evulekile, ezinye zazo zibonakala nangomuntu ojwayelekile onesifo sikashukela. Ngakho-ke, laba bantu bayakwazi ukuthuthukisa izinkinga ezithile. Izibonelo ezimbalwa zihlanganisa:
- I-Ketoacidosis : i-ketone ekhuphukile namazinga e-asidi egazini elibonwe ezigulini ezingenalo i-insulin, engabangela ukuphazamiseka okujulile nokuphazamiseka kwe-electrolyte, kanye noshukela wegazi ophakeme. Isiguli esithintekile ngokuvamile sigula kakhulu.
- I-neuropathy: ukuthi "izikhonkwane nezinaliti" inzwa ezandleni nasezinyaweni ezihlupha isifo sikashukela esilawulwa kabi.
- Ingozi enkulu yokutheleleka kusukela ushukela ephakeme wegazi yiyona imbangela eyaziwayo yokunciphisa amasosha omzimba. Lokhu kungabonakala njengemvamisa ekhuphukile yezifo ezibangelwa umchamo, izifo zesikhumba, izifo zamaphaphu, njll.
- Ngokuqondile, i-NODAT izoba nomthelela omubi hhayi nje kuphela kwesikhathi sokuphila kwesiguli kanye nobungozi bokufa, kodwa futhi nokuphila kwezinso ezifakwe ngaphakathi. Ukukufaka ngamanye amazwi, umamukeli wokufakelwa kwezinso othuthukisa i-NODAT angaba nempilo emifushane futhi abone ukuthi izinso ezitshalwe kabusha zihluleka ngokushesha.
Yeka ukuthi lokhu kuthinta kangakanani? Njengokwesifundo esivela ku-State University of New York, ngenkathi kusinda iziguli ezingenaso isifo sikashukela ekupheleni kweminyaka emihlanu ngemuva kokufakelwa kwezinso ngamaphesenti angu-92, kwakungaphansi kwamaphesenti angu-87 kulabo abathole i-NODAT. Ngokufanayo, kuye kwaba nobufakazi obuvela ezifundweni ezibonisa ukuthi ukusinda kwezinso ezifakwe kufinyelelwe, uma umamukeli eqala isifo sikashukela ngemuva kokuthola ukufakelwa kwesifo sezinso.
Izingozi Zezingozi
Nakuba umthelela ubalulekile, inothi ukuthi akuzona zonke izifo ezingenayo izinso ezitholwa yizinso ezithola isifo sesifo sikashukela njengesixazululo sokuthutha.
Imithi ethile kanye nezinye izinto eziyingozi kubandisa amathuba okuba nesiguli esithile esakha i-NODAT. Ezinye zazo zihlanganisa:
- Imithi: lokhu kubandakanya i-glucocorticoids (isib. Prednisone) nezinye izidakamizwa esizisebenzisayo ukuvimbela isimiso somzimba sokuzivikela somthumeli wokufakelwa ukuze kuvikelwe ukwenqatshwa kwezinso ezifakwe emzimbeni (njengoba isimiso somzimba sokuzivikela samukeli sibona ukuthi izinso "njengenhlangano yangaphandle") . Izibonelo zale mithi zihlanganisa isigaba semithi ebizwa ngokuthi "i-calcineurin inhibitors" (isibonelo i-tacrolimus ne-cyclosporine, okwakungenzeka ukuthi ingaba nesifo sikashukela), ne-sirolimus. Sicela uqaphele ukuthi akuyona yonke imithi yokwelashwa yokulahla isifo se-NODAT (lokhu kufaka phakathi nezinye izifo ezijwayelekile zokufakelwa ukuthunyelwa komzimba njenge-mycophenolate mofetil, eyaziwa ngokuthi i-CellCept).
- Izifo ziyimbangela eyaziwayo. Lezi zihlanganisa igciwane lesifo se-Hepatitis C (HCV), ukutheleleka kwe-cytomegalovirus (CMV).
- Ngaphandle kwezici ezithile eziphathelene nemithi / ukutheleleka ezihlobene nokutheleleka, uhlanga lwase-Afrika-American, ukukhuluphala, nomlando womndeni wesifo sikashukela kukhulisa ingozi yeNODAT.
Ukulinganisela Ingozi Yokunqatshwa Ngengozini Ye-NODAT
Njengoba kungase kubonakale kunengxoxo engenhla, imithi efanayo esiyisebenzisayo ukuze silondoloze izinga elifanele lokunciphisa isisombululo sokuzivikela somzimba (ukuze singanqamuli izinso ezintsha ezitshalwe kabusha), futhi kwandisa ingozi yesifo sikashukela. Ngamanye amazwi, ingabe ungakubeka engozini yokulahla isilwane, noma ingabe ungakubeka engozini yokuhlakulela isifo sikashukela? Noma ngabe yikuphi, ungase uzizwe sengathi ubeka impilo yezinso zakho zokufakelwa, impilo yakho entsha yokuphila, engozini. Ukulinganisa lezi zinto ezimbili ezibalulekile ngokuncintisana kubalulekile ngokucacile, ngakho-ke ubhekana kanjani nakho?
Nansi umlayezo wokuthatha ekhaya: Ukwenqaba izinso ezitshalisiwe kusengumgogodla omkhulu owenza ikhono laso lokuphila nokusebenza esigulini, ngisho nangaphezulu kwengozi yesifo sikashukela esanda kuthuthukiswa .
Ngakho-ke, imihlahlandlela eminingi isikisela ukubeka phambili imithi yokuvimbela ukuvimbela ukulahlwa, noma ngabe kusho ukukhuphuka engozini yomamukeli wokufakelwa ukuthuthukisa i-NODAT.
Ukuxilongwa
Njengoba sinokuqonda kahle izinto ezibeka ingozi ezikhulisa ingozi ye-NODAT, ukuqapha iziguli ezinobungozi eziphezulu kunconywa kakhulu. Isikhungo esihle sokufakelwa izokunikeza iseluleko ngengozi ye-NODAT ngisho nangaphambi kokuba bathole izinso ukuze wenze isinqumo esinolwazi.
Kodwa-ke, uma usuqashwe ngemuva kokuthola izinso ezitshalwe kabusha, lezi zincazelo ezilandelayo zizosebenza ukuze uhlolisise isifo sikashukela esisha ngemva kokufakelwa kokufakelwa. Lezi zincazelo zibekwe yi-panel yolwazi lwamazwe ngamazwe:
- Izimpawu zesifo sikashukela ngaphezu kwezinga elingenangqondo le-plasma glucose ezingaphezu kuka-200 mg / dL
- Ukuzila ukudla i-plasma glucose enkulu kunazo zonke noma kulingana no-126 mg / dL
- I-2-hour ye-plasma glucose enkulu kunazo zonke noma ilingana no-200 mg / dL ngesikhathi sokuhlolwa kwe-glucose ukubekezelelana ngomlomo
- Ungase ujwayelane nokuhlolwa okuvamile okuthiwa i- glycosylated hemoglobin A1c , esiyisebenzisela ukuxilongwa ngesifo sikashukela kubantu abaningi. Ukusetshenziswa kwalo njengethuluzi lokuxilonga akukhuthazwa ezinyangeni ezintathu zokuqala ngemuva kokufakelwa kwezinso. Nokho, emva kwalokho, incazelo efanayo yokuxilongwa ngesifo sikashukela njengoba isetshenziswe kubantu jikelele isebenza. Lokhu kungaba amazinga a-hemoglobin A1c amakhulu kunawo noma alingana no-6.5 ngaphambi kokuthola i-NODAT.
Ukuphathwa
Ukuphathwa kokuQala kokuQala
Ingabe kufanele uhlakulele i-NODAT (ikakhulukazi ekusetshenzisweni kwezinkinga ezibalulwe ngenhla), indlela yokuqala yokuqapha isungulwa ukuze kutholakale ushukela ophezulu wegazi. Nazi ezinye izinto okufanele wazi:
- Ukubhekwa okusebenzayo kwe-NODAT kusobala ukuthi kuyincenye yokunakekelwa okujwayelekile komamukeli wokufakelwa kwezinso. Ishukela legazi lilinganiswa njalo kaningi ngesonto okungenani ngenyanga yokuqala, nakuba imvamisa yokuhlolwa ingancishiswa kamuva.
- Enye yezindlela zokunciphisa ingozi ye-NODAT, futhi ukunciphisa ubunzima bayo uma seyithuthukile kakade, kuhloswe ukunciphisa umthamo we-steroids (enye ye-linchpins yemithi yokulahla prophylaxis). Kodwa-ke, njengoba ingozi yokulahla isakhi esakhiwe ikhuphuka kakhulu uma i-steroids imisiwe ngokuphelele, ukuqedwa okuphelele ngokuvamile akunconywa.
- Ngokufanayo, umthamo we-tacrolimus (esinye isidakamizwa sokuzivivinya umzimba), njengoba kuvunyelwe inengozi yokulahlwa, kungase kuthathwe njengokunciphisa. Uma konke okuhlulekayo futhi isiguli sinezinye izibonakaliso / izimpawu ze-NODAT, ukushintshela kumuthi ofanayo obizwa nge-cyclosporine kungase kudingeke.
Ukwelapha Okudokotela Okucacile
Uma ukuphathwa okulondoloziwe okungenhla akusizi futhi isifo sikashukela siyaqhubeka nokukhula futhi siphuthumise ngemva kokufakelwa kwezinso, umamukeli wokufakelwa isifo sikashukela esanda kuthuthukiswa angadinga ukuphathwa okuqondile ngemithi yesifo sikashukela. Njenganoma yimuphi omunye umuntu onesifo sikashukela, ngokuvamile siqala ngemithi yomlomo.
Izibonelo ezivamile zihlanganisa izidakamizwa ezibizwa ngokuthi i-glipizide (ngezinye izikhathi zikhethwa ngenxa yokuthi ukuphuma kwayo emzimbeni akuxhomekile kakhulu ezinyangeni '; uma ngabe kwakungenjalo, imithi yesifo sikashukela ingaxhuma kumazinga aphakeme ezigulini zesifo sezinso futhi ibangele ngokungazelelwe amazinga kashukela egazi). Uma imithi eyodwa enganele, iminye imithi ingeziwe kuze kube sekugcineni, ukujova okungaphansi kwe-insulin kungase kudingekile ukulawula amazinga kashukela egazini ngokwanele.
Ukuvimbela
Ukwazi ingozi, cishe nawe uyazibuza ukuthi kukhona yini ongayenza ukuze uyinciphise. Njengombhalo ohlangothini, ezinye izikhungo zenza ukufakelwa ama-pancreas (isitho lapho kukhishwa khona i-insulin futhi okungajwayelekile okungabangela isifo sikashukela) kanyekanye nezinso ezigulini eziphethwe isifo sesifo sikashukela sokuphela kwesifo sikashukela. Ziyizifundo ezithile ezibonisa ukuthi inqubo enjalo ibangela impilo engcono neyesikhathi eside.
Lokhu kuhlotshaniswa ngendlela enkulu ekulawuleni ngcono uhlobo lwesifo sikashukela (okuyinto egalela cishe "ukwelashwa" okuphelele kwalesi sifo ngenxa ye-pancreas okufakelwe kabusha), kodwa akukabikho amacala enqubo enjalo azame icala le-NODAT, ngenxa yesizathu esicacile ukuthi ngencazelo, isiguli se-NODAT ngeke sibe nesifo sikashukela ngaphambi kokufakelwa.
Izwi elivela
Ngokuvamile, ingozi yokuthuthukisa i-NODAT ingase ibe nzima ukwamukela futhi ingase ibeke ukungabaza ngokuthi ngabe kufanele uhambe ngenqubo. Qinisekisa ukukhuphula futhi uxoxe nodokotela wakho ngokukhathazeka kwakho. Uzokusiza ukuthi wenze isinqumo esingcono kakhulu kuwe. Ngokuvamile, unikezwe izinketho zokuphatha uma isifo sikashukela sithuthukile, izinga lokuphila emva kokufakelwa lingadlula ingozi ye-NODAT.
> Imithombo:
> Isifo sikashukela esisha emva kokufakelwa kwesitshalo (NODAT): ukuhlolwa kwezincazelo ezivivinyweni zomtholampilo. UMnu wokuqala, et al. Ukufakelwa kwezitshalo. 2013.
> Isifo sikashukela esisha ngemuva kokufakelwa kwesitshalo (NODAT): ukubuka konke okuningiliziwe. I-Phuong-Thu T Pham. I-Diabetes Metab Syndr Obes. 2011.
> Isifo sikashukela esisha ngokusuka emva kokufakelwa kwesifo sezinso: Izingozi zengozi. Emilio Rodrigo. Umagazini we-American Society of Nephrology. 2006.