Kukurumidza kuongororwa kwezvirwere zveropa

Bloodstream infection (BSI) inoreva systemic inflammatory response syndrome inokonzerwa nekupindwa kwemhando dzakasiyana siyana dzepathogenic microorganisms uye chepfu yadzo muropa.

Chirwere chechirwere chinowanzoonekwa nekushanda uye kusunungurwa kwevarevereri vanopisa, zvichiita kuti zviratidzo zvekliniki zvakadai sefivha yakanyanya, chills, tachycardia kufema, kuputika uye kuchinjwa kwepfungwa, uye mumamiriro ezvinhu akaoma, kuvhunduka, DIC uye yakawanda. -kukundikana kwenhengo, nehuwandu hwekufa. yakawana HA) sepsis uye septic shock kesi, inoverengera 40% yemakesi uye ingangoita 20% yeICU yakawana kesi. Uye yakanyatsobatanidzwa nehutachiona husina kunaka, kunyanya pasina nguva inorwisa antimicrobial therapy uye focal control yehutachiona .

Kurongwa kwezvirwere zveropa maererano nehuwandu hwehutachiona

Bacteraemia

Kuvapo kwebhakitiriya kana fungi muropa.

Septicemia

Chirwere chekiriniki chinokonzerwa nekupinda kwemabhakitiriya epathogenic uye chepfu yavo muropa, chirwere chakakomba che systemic..

Pyohemia

Kusashanda zvakanaka kwenhengo yehupenyu kunokonzerwa nekusagadzikana kwekuita kwemuviri kune hutachiona.

Kunyanya kunetseka kwekiriniki ndezviviri zvinotevera zvine chekuita nehutachiona.

Special Catheter-yakabatana neropa rezvirwere

Zvirwere zveropa zvine chekuita nemakatheta akaiswa mutsinga dzeropa (semuenzaniso, peripheral venous catheters, central venous catheters, arterial catheters, dialysis catheters, nezvimwewo).

Special Infective endocarditis

Chirwere chinotapukira chinokonzerwa nekutama kwezvirwere kune endocardium uye mavharuvhu emwoyo, uye inoratidzwa nekuumbwa kwezvipenyu zvisingaverengeki mumavharuvhu sechimiro chekukuvara kwepathological, uye ne embolic utachiona metastasis kana sepsis nekuda kwekuderera kwezvisikwa zvipenyu.

Ngozi dzezvirwere zveropa:

Utachiona hweropa hunotsanangurwa semurwere ane tsika yakanaka yeropa uye zviratidzo zvehutachiona hwehutachiona. Zvirwere zveropa zvinogona kuva zvechipiri kune dzimwe nzvimbo dzehutachiona dzakadai sehutachiona hwemapapu, zvirwere zvemudumbu, kana zvirwere zvekutanga. Zvinonzi 40% yevarwere vane sepsis kana septic shock inokonzerwa nehutachiona hweropa [4]. Inofungidzirwa kuti mamiriyoni 47-50 ezviitiko zve sepsis zvinoitika pasi rose gore negore, zvichikonzera kufa kwevanhu vanopfuura mamiriyoni gumi nerimwe, neavhareji yemunhu mumwe chete anofa 2.8 seconds [5].

Nzira dziripo dzekuongorora zvirwere zveropa

01 PCT

Kana hutachiona hwehutachiona uye hutachiona hwehutachiona hunoitika, kuvharwa kwe calcitoninogen PCT kunowedzera nokukurumidza pasi pekusimudzira kukurudzirwa kwehutachiwana hwebhakitiriya uye cytokines inoputika, uye chiyero cheserum PCT chinoratidza mamiriro ezvinhu akakomba echirwere uye chiratidzo chakanaka chekufungidzira.

0.2 Masero uye adhesion zvinhu

Cell adhesion molecules (CAM) inobatanidzwa mune zvakatevedzana zve physiopathological process, senge immune immune uye mhinduro yekuzvimba, uye inoita basa rakakosha mukurwisa hutachiona uye hutachiona hwakakomba. Izvi zvinosanganisira IL-6, IL-8, TNF-a, VCAM-1, nezvimwe.

03 Endotoxin, G bvunzo

Gram-negative mabhakitiriya anopinda muropa kuti asunungure endotoxin anogona kukonzera endotoxemia; (1,3) -β-D-glucan chimwe chezvimiro zvefungal cell wall uye inowedzera zvakanyanya muzvirwere zvefungal.

04 Molecular Biology

DNA kana RNA yakaburitswa muropa nema microorganisms inoedzwa, kana mushure memaitiro akanaka eropa.

05 tsika yeropa

Utachiona kana fungi mutsika dzeropa ndiyo "yegoridhe standard".

Tsika yeropa ndeimwe yenzira dzakareruka, dzakarurama uye dzinowanzoshandiswa pakuona utachiona hweropa uye ndiyo hwaro hwepathogenic hwekusimbisa hutachiona hweropa mumuviri. Kukurumidza kuonekwa kwetsika yeropa uye kutanga uye kwakakodzera antimicrobial therapy ndiwo matanho ekutanga anofanirwa kutorwa kudzora hutachiona hweropa.

Tsika yeropa ndiyo chiyero chegoridhe chekuongororwa kwehutachiona hweropa, iyo inogona kunyatso patsanura hutachiona hwehutachiona, kusanganisa nekuzivikanwa kwemhedzisiro yekunzwa kwezvinodhaka uye kupa hurongwa hwekurapa hwakakwana uye hwechokwadi. Zvisinei, dambudziko renguva yakareba yekutaura kwakanaka kwetsika yeropa rave richikanganisa kuongororwa kwekliniki uye kurapwa, uye zvakanzi uwandu hwekufa kwevarwere vasina kurapwa nenguva uye hunobudirira hunowedzera ne7.6% paawa mushure memaawa matanhatu. yekutanga hypotension.

Naizvozvo, tsika yeropa iripo uye kuzivikanwa kwekunzwa kwezvinodhaka kune varwere vanofungidzirwa kuti vane hutachiona hweropa vanonyanya kushandisa matatu-tier yekubika maitiro, anoti: yekutanga kuzivisa (yakakosha kukosha kwekuzivisa, smear zvabuda), kushuma kwechipiri (kuzivikanwa nekukurumidza kana / uye zvakanangana nemishonga senitivity. kushuma) uye kushuma kwepamusoro (yekupedzisira kushuma, kusanganisira zita rekunetsa, yakanaka alarm nguva uye yakajairwa zvinodhaka senitivity test results) [7]. Mushumo wekutanga unofanirwa kutaurirwa kukiriniki mukati me1 h yemushumo wakanaka wevhavha yeropa; chirevo chepamusoro chinokurudzirwa kuti chipedzwe nekukasira (kazhinji mukati me48-72 h yebhakitiriya) zvichienderana nemamiriro e laboratory.