Ukungakhethi i-dialysis kuyindlela evumelekile, kodwa yimiphi imiphumela
Iziguli ezinesifo esiphezulu sezinso esondela esiteji sesi-5 sinokukhetha okubili uma kuziwa ekuphatheni isifo sabo, noma ukuqala ngolunye uhlobo lwe- dialysis (phakathi nendawo i-hemodialysis ejwayelekile e-US, noma i-dialysis ekhaya okungaba i-hemodialysis noma i-peritoneal dialysis ), noma ukuthola ukufakelwa kwezinso. Kodwa kuthiwani uma isiguli singenakho, noma asifuni noma iyiphi yalezi zindlela nganoma yisiphi isizathu.
Kwenzekani lapho isiguli esinokwehluleka kwezinso singatholi i-dialysis noma ukufakelwa? Bangalindela isikhathi esingakanani ukuhlala? Lesi sihloko sizozama ukuphendula embalwa yale mibuzo.
UKUKHETHA UDIALYSIS NGOKUKHETHA OKUKHETHEKILE, KODWA KUPHELA UKUQALA
Ukunquma ukuthi ngubani lowo "isiguli esifanele" yisinqumo esingahle sishiye engxoxweni phakathi kwesiguli kanye nephrologist yabo. Ngokwesiko, lapho iziguli zingabhekwa njengabazobhalwa yi-dialysis, izazi zezinkanyezi zingathi, " sizogodla i- dialysis kuNksz X". Kodwa-ke, ukusho "ukugodla" kunemigomo engafanele (cabanga ukuthi "sizogodla ukwesekwa kokuphila, njll njll"). Kumguli ojwayelekile kanye nomndeni wabo, kunika umqondo wokuthi udokotela ngeke abanikeze noma yini futhi silinde kuze kube yilapho isiguli sifa. Noma kunjalo, lokhu akukwazi ukuqhubeka eqinisweni ngoba izinkinga eziningi zesifo sezinso zingakwazi futhi zilawulwe ngemithi.
Ngamanye amazwi, izazi ze-nephrologists zisenganikeza okuningi; Konke okuncane kakhulu okusho ukufinyelela isiguli kumshini we-dialysis. Futhi-ke, ukukhulumisana kangcono okwamanje okwenzayo-okukwazi isiguli, isikhathi esifanele sokulawulwa okungewona udialytic kokuhluleka kwezinso manje osetshenziswa nguMaximal Conservative Management (MCM) .
Lokhu kuhlanganiswe ngokuningiliziwe lapha.
UBANI UMPHAZI WOKUPHAKATHI WOKUPHATHWA KWEZINDAWO ZOKUPHILA KWEZINDAWO NOMA NGANI NGEKHO NGOMUNTU WONKE?
Akuzona zonke iziguli ezizokwenza ukhetho oluhle lwe-MCM, futhi ezinye izinketho zingase zifaneleke kakhulu. Ukuphathwa kwe-Conservative kuyinto enhle kakhulu kuzilungiselelo ezihlukahlukene. Lezi zingabandakanya ukuguga nokuguga okuphezulu, ukuwohloka komqondo okukhulu, ukutholakala kwezinye izimo ezinzima zezifo ezifana nokuhluleka kwenhliziyo noma umdlavuza we-metastatic, njll. Ezimweni ezinjalo, kunzima ukubikezela ukuthi ngabe i-dialysis ingafaka yini noma yikuphi izinga / ubungako bokuphila. Futhi kaningi, iziguli zivele zibuka "isithombe esikhulu", ikakhulukazi uma isikhathi sokuphila sinciphile.
Noma kunjalo, i-MCM akuyona wonke umuntu. Iziguli kufanele zifundiswe ukuthi kunezinkinga eziningi kakhulu zokuhluleka kwezinso ezitholwa ngamaphilisi, futhi ezinye izimpawu / izimpawu zizophendula kuphela ku-dialysis. Lokhu kungukuthi okuthiwa yi- toxins okuthiwa yi- uremic eqoqa ukuhluleka kwezinso futhi yisona isizathu sezinkinga eziningi ngeke sisuswe ngokuphathwa okuzimele (nakuba ngisho ne-dialysis ingasuseli nabo bonke). Isiguli nodokotela bangase badinge ukuhlala ndawonye ukuze bahambe ngaphezu kwalokho okulindelwe futhi bashise uhlelo lokunakekelwa.
Futhi uma inkulumo iphathelene nokulindela, imibuzo emibili iyovame ukuvela ezigulini ezilahla i-dialysis:
- Ngingazizwa kanjani uma ngilahla i-dialysis?
- Ingabe isikhathi sami sokuphila sasingafinyelelwa uma ngilahla i-dialysis?
Njengoba inikezwe ngemali encane yedatha, lokhu akuyona imibuzo elula yokuphendula. Kodwa sinalo idatha eyengeziwe etholakalayo mayelana nokuphila kwesikhathi ezigulini ezikhetha i-dialysis. Njengombiko we-United States Renal Data System, ukusinda okulindelekile kweziguli ku-dialysis kungahlukahluka eminyakeni engu-8 (iziguli ezineminyaka engama-40 kuya ku-44) kuya eminyakeni engu-4.5 (iziguli eziphakathi kweminyaka engu-60 kuya kwengu-64 ubudala). Lokhu kunjalo-ke isilinganiso, ngokuguquguquka okubanzi okubonwayo kuye ngokuthi uneminyaka yesiguli, isimo somsoco, nokuba khona kwezinye izimo zesifo ezikhona-nje njenge-ischemic isifo senhliziyo, umdlavuza, njll.
Ngingathanda futhi ukuqondisa igrafu efanisa ukulindela owesilisa oneminyaka engu-55 ubudala ojwayelekile kuya kwesiguli esifanayo ku-dialysis, noma oye wathola ukufakelwa kwezinso.
UKUPHILA NOKUPHILA NOKUPHILA NAKUNYE NEMINYANGO YOKUPHILA
Ake sibheke ezinye izifundo eziye zazama ukuqhathanisa ukusinda phakathi kwalezi zigaba ezimbili. Ucwaningo olwenziwe ngeziguli ezinezinkinga zesifo sezinso ezingu-5 ezingenani okungenani engu-80 zabika isikhathi sokuphila esiphakathi kwezinyanga ezingu-20 (izinyanga ezingu-29 vs izinyanga ezingu-9) kuziguli ezikhetha i-dialysis. Olunye ucwaningo oluqhathanisa ukusinda phakathi kweziguli ezikhethile ukudayela i-dialysis nalabo abakhetha ukuphathwa ngokuzimelela futhi babike ukuqhubeka okungcono kuziguli ezakhethile i-dialysis. Zonke iziguli zazingenani iminyaka engu-75 ubudala. Izindleko zokusinda iminyaka engu-1 zazingu-84% eqenjini elikhetha i-dialysis kanye nama-68% eqenjini elikhetha ukuphathwa okungezona ukudidliza. Omunye angase ahluke kule datha ukuthi iziguli ezihluleka izinso ezikhetha i-dialysis zizovame ukuhlala isikhathi eside.
Nokho, lokhu ngenhla kungaba ukucabanga okulula. Iziguli ezinesifo sezinso eziphambili zizoba nezinye izifo eziningi ezimbi ezifana nesifo senhliziyo, isifo sikashukela, umdlavuza, njll; lokho thina odokotela esikubiza ngokuthi "co-morbidities" . Futhi-ke, uma sibheka enye idatha esixoxile ngenhla, siyabona ukuthi ukulinda impilo ezigulini ezinezinye izifo ezinzima kakhulu ezikhona njengezifo zesifo senhliziyo empeleni azifani; kungakhathaliseki ukuthi bakhethe i-dialysis noma cha ! Ngamanye amazwi, esigulini esinezinkinga ezimbi kakhulu, ukusinda kungase kunqunywe kabanzi ngalezi zimo kunokuba ngabe isiguli siphelile noma cha. Umlayezo wekhaya owathathayo wukuthi i-dialysis izothuthukisa impilo yakho uma nje ungenayo ezinye izifo eziningi ezibucayi okukhulunywe ngenhla. Ngizophinde ngikubhekise embonweni wesi-2 kusuka kulokhu okushicilela lokho esikuxoxile ngakho.
Ekugcineni, ake ngikhulume ngezibalo ezibalulekile (imininingwane lapha, lapha, lapha). Isilinganiso sokuphila ngemva kwesiguli esivele sise-dialysis sithathwe i-dialysis ngezinsuku ezingu-6 kuya kwezingu-8, kodwa ububanzi obuningi bungaba khona phakathi kwezinsuku ezimbili kuya kwezinsuku ezingu-100.
IMISEBENZI YOKUSEBENZA NOKUPHILA KWEZEMPILO NGAPHAKATHI NOKUPHILISWA KWEZEMPILO
Kulezi ziguli ezinquma ukungakhethi i-dialysis ngemuva kwengxoxo nabaphrofethi bazo, umbuzo obonakalayo ovela ukuthi, "ngizozizwa kanjani"? Iningi leziguli empeleni likhathazeka ngalokhu kunokuba kunciphise isikhathi sokuphila.
Ngo-1949, uDkt. David Karnofsky wachaza isixazululo (100 sibe umuntu onempilo ejwayelekile, futhi okushiwo ukufa) okungasetshenziselwa ukulinganisa ngokulinganisela isimo sokusebenza sesiguli somdlavuza. Isikali sesisetshenzisiwe manje ukukala izinga lokunciphisa ukusebenza kwezilwane ezihlulekayo kwezinso eziphethwe ngokuzenzekelayo ngaphandle kwe-dialysis. Lesi sihloko lapha (bheka Umfanekiso 1) sichaza ukuthi iziguli ezinjalo ziyoba yini kusukela ekusebenzeni / izinga lempilo yokuphila ngonyaka odlule wokuphila kwabo. Okuthakazelisayo ukuphawula ukuthi iziguli ezinjalo zizodinga usizo kuphela ngezikhathi ezithile kuze kube ngenyanga edlule yokuphila kwazo, emva kwalokho zizobona ukwehla okunamandla esimweni sabo sokusebenza, ngaleyo ndlela zidinga ukunakekelwa okukhethekile / ukungena esibhedlela. Isikali nesigcawu kusinikeza ukuqonda okuningi ngalokho okumele sikulindele uma iziguli ezihluleka izinso zibheke esikhathini esizayo futhi zinqume ukukhetha ukuphila ngaphandle kwe-dialysis. Engingathanda ukugcizelela lapha ukuthi lezi ziphetho zisekelwe ekucatshangweni ukuthi iziguli zigcinwa kahle ngokunakekelwa, ngendlela engavuthi. Yilokho manje esikubhekisela njenge- Maximal Conservative Management (MCM) futhi nansi imininingwane yayo.