ʻIke wikiwiki o nā maʻi kahe koko

ʻO ka maʻi kahe koko (BSI) e pili ana i kahi maʻi pane inflammatory systemic i hana ʻia e ka hoʻouka ʻana o nā microorganism pathogenic like ʻole a me kā lākou mau toxins i loko o ke kahe koko.

ʻO ke ʻano o ka maʻi i hōʻike pinepine ʻia e ka hoʻoulu ʻana a me ka hoʻokuʻu ʻana i nā mea hoʻoponopono inflammatory, e hōʻike ana i kahi ʻano o nā hōʻailona lapaʻau e like me ke kuni kiʻekiʻe, ke anuanu, ka tachycardia pōkole o ka hanu, ka ʻūlū a me ke ʻano o ke kūlana noʻonoʻo, a ma nā hihia koʻikoʻi, haʻalulu, DIC a me nā lehulehu. -ʻaʻole kino, me ka nui o ka make. loaʻa iā HA) nā hihia sepsis a me nā maʻi haʻalulu septic, helu no 40% o nā hihia a ma kahi o 20% o nā hihia i loaʻa i ka ICU. A pili pili ia me ka prognosis maikaʻi ʻole, ʻoi loa me ka ʻole o ka antimicrobial therapy i ka manawa a me ka mālama ʻana i ka maʻi.

ʻO ka hoʻokaʻawale ʻana i nā maʻi koko e like me ke ʻano o ka maʻi

Bacteraemia

ʻO ka loaʻa ʻana o ka hua bacteria a i ʻole nā ​​haʻi i loko o ke kahe koko.

Septicemia

ʻO ka maʻi maʻi maʻi i hana ʻia e ka hoʻouka ʻana o nā bacteria pathogenic a me kā lākou mau meaʻawaʻawa i loko o ke kahe koko, he maʻi ʻōnaehana koʻikoʻi.

Pyohemia

ʻO ke kino hoʻoweliweli i ke ola ma muli o ka dysregulation o ka pane ʻana o ke kino i ka maʻi.

ʻO nā maʻi ʻelua e pili ana i kēia mau maʻi e pili ana.

ʻO nā maʻi kahe koko pili i ka Catheter

ʻO nā maʻi o ke kahe koko e pili ana me nā kīʻaha koko i hoʻokomo ʻia i loko o nā kīʻaha koko (e laʻa, nā catheters venous peripheral, nā catheters venous central, nā kīwī arterial, nā catheters dialysis, etc.).

ʻO ka endocarditis maʻi kūikawā

He maʻi maʻi ia ma muli o ka neʻe ʻana o nā pathogens i ka endocardium a me nā puʻuwai puʻuwai, a ua ʻike ʻia e ka hoʻokumu ʻana o nā mea ola i loko o nā kiwi e like me ke ʻano o ka pōʻino pathological, a ma o ka maʻi embolic maʻi metastasis a i ʻole sepsis ma muli o ka redundant organism shedding.

ʻO ka pōʻino o nā maʻi koko：

Ua wehewehe ʻia kahi maʻi koko e like me ka mea maʻi me ka moʻomeheu koko maikaʻi a me nā hōʻailona o ka maʻi ʻōnaehana. Hiki i nā maʻi o ke kahe koko ke kūlana kiʻekiʻe ma nā wahi ʻē aʻe o ka maʻi e like me ka maʻi māmā, nā maʻi ʻōpū, a i ʻole nā ​​maʻi mua. Ua hōʻike ʻia ʻo 40% o nā maʻi me ka sepsis a i ʻole ka haʻalulu septic ma muli o nā maʻi koko [4]. Ua manaʻo ʻia he 47-50 miliona mau maʻi sepsis e loaʻa ana ma ka honua holoʻokoʻa i kēlā me kēia makahiki, ʻoi aku ka nui o ka make ma mua o 11 miliona, me ka awelika o 1 make i kēlā me kēia 2.8 kekona [5].

Loaʻa nā ʻenehana diagnostic no nā maʻi kahe koko

01 PCT

Ke hiki mai ka maʻi ʻōnaehana a me ka hopena inflammatory, piʻi wikiwiki ka huna ʻana o ka calcitoninogen PCT ma lalo o ka hoʻoulu ʻia ʻana o nā toxins bacterial a me nā cytokines inflammatory, a ʻo ke kiʻekiʻe o ka serum PCT e hōʻike ana i ke kūlana koʻikoʻi o ka maʻi a he hōʻailona maikaʻi o ka prognosis.

0.2 Nā pūnaewele a me nā mea pili

Hoʻokomo ʻia nā molekele adhesion cell (CAM) i nā kaʻina hana physiopathological, e like me ka pane ʻana o ka immune a me ka pane inflammatory, a pāʻani i kahi hana koʻikoʻi i ka anti-infection a me ka maʻi koʻikoʻi. ʻO kēia me IL-6, IL-8, TNF-a, VCAM-1, etc.

03 Endotoxin, G hoao

ʻO nā hua bacteria Gram-negative e komo ana i ke kahe koko e hoʻokuʻu i ka endotoxin hiki ke hana i ka endotoxemia; ʻO (1,3) -β-D-glucan kekahi o nā hale nui o ka pā hale fungal a ua hoʻonui nui ʻia i nā maʻi fungal.

04 Koolaola Molekula

Hoʻāʻo ʻia ka DNA a i ʻole RNA i hoʻokuʻu ʻia i loko o ke koko e nā microorganism, a i ʻole ma hope o kahi moʻomeheu koko maikaʻi.

05 moʻomeheu koko

ʻO nā maʻi bacteria a i ʻole nā ​​​​hani i loko o nā moʻomeheu koko ka "standard gula".

ʻO ka moʻomeheu koko kekahi o nā ala maʻalahi, pololei a hoʻohana pinepine ʻia e ʻike i nā maʻi o ke koko a ʻo ia ke kumu pathogenic no ka hōʻoia ʻana i nā maʻi koko i loko o ke kino. ʻO ka ʻike mua ʻana i ka moʻomeheu koko a me ka hoʻomaʻamaʻa antimicrobial mua a kūpono hoʻi nā hana mua e pono ai e hoʻopaʻa i nā maʻi koko.

ʻO ka moʻomeheu koko ke kūlana gula no ka hōʻoia ʻana i ka maʻi o ke kahe koko, hiki ke hoʻokaʻawale pololei i ka pathogen infecting, hui pū me ka ʻike ʻana i nā hopena ʻike lāʻau a hāʻawi i ka hoʻolālā lapaʻau pololei a pololei. Eia naʻe, ʻo ka pilikia o ka manawa hōʻike maikaʻi lōʻihi no ka moʻomeheu koko e pili ana i ka maʻi maʻi a me ka mālama ʻana i ka manawa, a ua hōʻike ʻia ʻo ka nui o ka make ʻana o nā maʻi i mālama ʻole ʻia me nā lāʻau lapaʻau kūpono e hoʻonui ʻia e 7.6% i kēlā me kēia hola ma hope o 6 mau hola o ka lāʻau lapaʻau. ka hypotension mua .

No laila, ʻo ka moʻomeheu koko o kēia manawa a me ka ʻike ʻana i ka naʻau o ka lāʻau no nā poʻe maʻi i manaʻo ʻia he maʻi kahe koko ke hoʻohana nui nei i kahi kaʻina hana hōʻike ʻekolu papa, ʻo ia hoʻi: ka hōʻike mua (ka hōʻike waiwai koʻikoʻi, nā hopena smear), ka hōʻike lua (ka ʻike wikiwiki a i ʻole / a me ka ʻike lāʻau pololei. hōʻike) a me ka hōʻike kula kiʻekiʻe (ka hōʻike hope loa, me ka inoa strain, ka manawa hoʻāla maikaʻi a me nā hopena hoʻokolohua maʻamau o ka lāʻau lapaʻau) [7]. Pono e hōʻike i ka hōʻike mua i ke keʻena maʻi i loko o 1 mau hola o ka hōʻike o ka vial koko maikaʻi; pono e hoʻopau koke ʻia ka hōʻike kula kiʻekiʻe (maʻamau i loko o 48-72 mau hola no ka maʻi bacteria) ma muli o ke kūlana ʻoihana.