Ukumpontshelwa igazi kwezinja

 I-Hemotransfusion ukumpontshelwa kwezilwane ezigulayo ngegazi eliphelele, noma izakhi, noma amalungiselelo amaprotheni e-plasma. Lena inqubo ebucayi kakhulu.Ezimweni ezingu-80%, ukumpontshelwa igazi ezinjeni kubangelwa i-anemia, futhi ku-20% - ukushaqeka kwe-hemorrhagic. Ukumpontshelwa igazi ngezinye izikhathi kusindisa ukuphila kwenja futhi kudlala indima ebalulekile ekunqobeni isimo esibucayi.

Inhloso yokumpontshelwa igazi ezinjeni

1. Ukufaka esikhundleni. Ama-Erythrocyte atholwe kumnikeli ahlala egazini lomamukeli izinyanga ezingu-1-4, okwandisa izinga le-oxygen ezicutshini.
2. Ukugqugquzela – umthelela ezinhlelweni nasezithweni ezahlukene zenja.
3. Ukuthuthukiswa kwe-hemodynamics. Ukuthuthukisa umsebenzi wesimiso senhliziyo, ukwandisa umthamo wamaminithi wenhliziyo, njll.
4. i-hemostatic target. I-Homeostasis iyashukunyiswa, i-hyperoagulation emaphakathi iyabonwa.

Izinkomba zokumpontshelwa igazi ezinjeni

1. Kuhlonzwe ukopha okukhulu, okuboniswa ulwelwesi lwamafinyila oluphaphathekile, ukushaya kwenhliziyo okubuthakathaka nokuvamile, izidladla ezibandayo.
2. Ukulahleka kwegazi okungapheli kanye ne-hemodynamics engazinzile, okubonisa ukuntuleka komoya-mpilo ezicutshini ngobuningi obanele.
3. I-anemia engatholakali ye-etiologies ehlukahlukene.
4. I-coagulopathy yofuzo noma etholiwe, i-thrombocytopenia, i-leukopenia, i-hypoproteinemia.

Izinto zokumpontshelwa igazi zezinja

Indlela elula yokuthola izinto ezivela egazini elisha. Ngakho-ke, isetshenziswa kabanzi emithini yezilwane. Ama-erythrocyte ekheniwe, agcinwe epholile (izinga lokushisa 3 - 6⁰C) futhi isetshenziswe izinsuku ezingama-30 noma kuze kube yilapho ama-erythrocyte eshintsha umbala. I-Erythromass iyadingeka ukugcwalisa indawo yokugcina ama-erythrocyte (ye-anemia engapheli) noma engcupheni yokulayisha ngokweqile ngomthamo owengeziwe woketshezi. Iphinde isetshenziselwe ukulahlekelwa igazi acute (kuhlanganiswe crystalloids). I-Plasma iyadingeka ukubuyisela izici zokujiya, okubandakanya. izingxenye ezingazinzile. Impahla igcinwa at -40⁰C phakathi nonyaka ongu-1. Ngaphambi kokumpontshelwa, kushisiswe ku-+30 - 37⁰C, bese ujova emzimbeni wenja ngokushesha ngangokunokwenzeka.

Izindlela zokuphatha

Njengomthetho, igazi kanye nezingxenye zalo zilawulwa nge-intravenously. Uma kungenakwenzeka ukujova igazi emthanjeni (amathumba, i-edema enzima), ukumnika kwe-intraosseous kuyasetshenziswa.

Izingozi Nezinkinga Zokumpontshelwa Igazi Ezinjeni

Izinkinga ezinzima zihlotshaniswa nokuphulwa kokwakheka kwe-acid-base yegazi, amaphutha endleleni yokumpontshelwa, nokuphazamiseka kwe-hemodynamic. Izinkinga ezibambezelekile zingase zihlotshaniswe nokumpontshelwa kwegazi elishisa kakhulu, eline-hemolyzed noma elinegciwane: ukushaqeka ngemva kokumpontshelwa (i-hemolytic), ukushaqeka kwe-citrate (anaphylactic), izifo ezithathelwanayo. Ukusabela okungeyona i-immunological (ifomu elibukhali) kubonakala njengemfiva. Isizathu ukusabela phakathi kwe-antigen ne-antibody ehlanganisa ama-platelet, ama-granulocyte noma ama-lymphocyte, noma ukungcoliswa kwebhaktheriya egazini. Kwesinye isikhathi kuba nokungezwani komzimba (i-urticaria enokulunywa nokuqubuka). Umthwalo owandayo ohlelweni lokujikeleza kwegazi kuboniswa ngokuhlanza, i-tachycardia, ukucasuka, ukukhwehlela, ukuphefumula noma i-cyanosis. Ezinye izici zobungozi:

• i-edema yamapulmari
• izifo ezithathelwanayo
• imfiva
• ukugcwala kwe-circulatory kwangemva kokumpontshelwa
• i-hypervolemia
• ukusabela okunamandla ngemva kokumpontshelwa
• i-syndrome yokwehluleka kwezitho eziningi, njll.

 Amaphaphu, isibindi, izindlala ze-endocrine nezinye izinhlelo nezitho zingase zithinteke. Ukulayisha ngokweqile kungaholela ekuvulekeni okukhulu kanye nokuboshwa kwenhliziyo. Ukumpontshelwa kungabangela umphumela we-immunomodulatory futhi kwandise ingozi yokutheleleka kwe-nosocomial, ukulimala kwamaphaphu acute, izifo ezizimele. Inkinga enzima kakhulu ukushaqeka kwe-anaphylactic. Uma kuvela izimpawu ezincane, ukumpontshelwa igazi kufanele kumiswe ngokushesha ngangokunokwenzeka.

Ukumpontshelwa igazi ezinjeni njengendlela yokwelapha

Le nqubo ibaluleke kakhulu eminyakeni yamuva. Izinzuzo zayo ziye zaqinisekiswa ngokuphindaphindiwe ekwelapheni inani lezifo ze-hematological. Ngenxa yobulula bohlelo lokuqoqa igazi le-canine kanye namazinga aphansi ama-isoantibodies enzeke ngokwemvelo, odokotela bezilwane bacishe bakushaya indiva ukungahambisani kwezinhlobo zegazi phakathi komamukeli kanye nomnikeli. inja ngaphandle kokulimala empilweni (kufika ku-10 ml / kg). Isampula yegazi elilandelayo akwenziwa ngaphambi kwezinsuku ezingama-45 - 60.

Ubani ongaba umnikeli

Uma inja ingampontshelwa igazi lanoma yiliphi iqembu. Kodwa uma ukumpontshelwa okulandelayo kuyadingeka, uhlobo lwegazi kufanele lufane. Izinja ezine-Rh-negative zingathola igazi elingenayo i-Rh kuphela. Noma yiliphi igazi lingatholwa yizinja ezine-Rh-positive. Ngezinye izikhathi kudingeka ukumpontshelwa igazi okuphuthumayo. Kulokhu, kusetshenziswa umnikezeli “ongahleliwe” (inja enempilo eyagcina iphelele emtholampilo ukuze igonywe, ukugunda izinzipho, njll.) noma isilwane esifuywayo somunye wodokotela. Isilwane kumele sibe neminyaka esukela ku-1,5 kuya kweyisi-8 ubudala, kufanele sibe nempilo ngokuphelele .Bathatha izinja ezolile, ezithambile njengabanikeli. Isisindo somzimba wenja yokunikela (isisindo somzimba) kufanele sibe ngaphezu kwama-25 kg. Uhlobo lwegazi olufanele yi-DEA 1.1. negative. Uma onikelayo kungowesifazane, kufanele abe nulliparous. Umnikezeli akumele asuke endaweni yangakini.

Ukuqapha isimo senja ngesikhathi sokumpontshelwa igazi

Njalo ngemizuzu eyi-15-30 ngesikhathi sokumpontshelwa kanye namahora angu-1, 12, 24 ngemva kwenqubo, imingcele elandelayo iyahlolwa:

1. Ukuziphatha.
2. Ikhwalithi nokuqina kwenhliziyo.
3. Izinga lokushisa elingunxande.
4. Imvelo namandla okuphefumula.
5. Umbala womchamo kanye ne-plasma.
6. Umbala we-mucosal, isikhathi sokugcwalisa i-capillary.
7. Isikhathi se-Prothrombin ne-hematocrit zibhekwa ngaphambi, ngokushesha ngemva kokuqedwa, namahora angu-12 no-24 ngemva kokumpontshelwa.

Amaqembu egazi lezinja

Kukholakala ukuthi izinja zinezinhlobo zegazi eziyisi-7. Lokhu akulona iqiniso ngokuphelele. Uhlu A - G luyisimiso samaqembu egazi, noma kunalokho, i-1 kuphela yezinketho "zokukhululwa" kwe-1961. Kusukela ngaleso sikhathi, kuye kwenziwa imizamo eminingi eyengeziwe yokuqondisa idatha, futhi ngo-1976 kwasungulwa i-nomenclature ye-DEA, manje eseyamukelwa ngokuvamile e-United States. Ngokwalesi sigaba samagama, amasistimu egazi angaqokwa njenge-DEA 1.1, DEA 1.2, DEA 3, DEA 4, DEA 5, DEA 7 kanye ne-DEA 8. Uhlelo lwe-DEA 1 lubaluleke kakhulu ngokomtholampilo. Lolu hlelo lunamapheya ofuzo-amaprotheni angu-3 kanye nama-phenotype angu-4 okungenzeka: DEA 1.1., 1.2, 1.3 kanye no-0. Inja eyodwa ine-phenotype engu-1 kuphela. Kodwa izinja azinawo amasosha omzimba alwa nama-antigen elinye iqembu, ngakho inja engakaze impontshelwe igazi ngaphambili ingampontshelwa igazi ngaphandle kokuhambisana kwe-DEA 1.1, futhi ukumpontshelwa kuyophumelela. Kodwa uma ukumpontshelwa kwesibili kudingekile, izinkinga zingenzeka. Lapho i-DEA 1 impontshelwa kumamukeli ongemuhle (phenotype 0) wegazi lomuntu onikelayo we-DEA 1 (noma iyiphi i-phenotype ngaphandle kuka-0), umzimba womamukeli ngemva kwezinsuku ezingu-7 kuya kweziyi-10 uyakwazi ukukhiqiza amasosha omzimba ku-antigen ye-DEA 1, ebulalayo. noma yimaphi amangqamuzana egazi abomvu, anale antigen. Esikhathini esizayo, umamukeli onjalo uzodinga ukumpontshelwa kuphela kwe-DEA 1-negative yegazi, ngaphandle kwalokho, esikhundleni samaviki angu-3 ajwayelekile, ama-erythrocyte anikelayo azohlala emzimbeni womamukeli, okungcono kakhulu, amahora ambalwa kuphela, noma ngisho nemizuzu embalwa, okuyinto. yenza ize umphumela wokumpontshelwa, futhi ingase yenze isimo sibe sibi nakakhulu. Kulokhu, umnikeli omuhle we-DEA 1 angampontshelwa ngegazi le-DEA 1-negative, nokho, ngesimo sokuthi lo mnikeli akakaze abe umamukeli. I-antigen ye-DEA 1 imelwe inani lezinhlobonhlobo: DEA 1.1, DEA 1.2., DEA 1.3. igazi DEA 1. amasosha omzimba akhiqizwa yiyo avele abhubhise amaseli abomvu egazi nge-DEA 1.1. futhi kubangele ukusabela okunamandla kwe-hemolytic, okugcwele izinkinga ezinzima. Kulokhu, amangqamuzana egazi abomvu ane-DEA 1.2 no-1.3 azohlanganisa la masosha omzimba, kodwa angawabhubhisi (nakuba lokhu kubi esigulini). Uma sikhuluma ngohlelo lwe-DEA 3, inja ingaba yi-DEA 3 enhle noma engeyinhle. Ukumpontshelwa kwegazi elihle le-DEA 3 esilwaneni esinama-antigroup afanelekile (esitholiwe noma ngokwaso) kubhubhisa amangqamuzana egazi abomvu omnikeli futhi kungabangela ukusabela okunamandla kokumpontshelwa ezinsukwini ezingu-5 ezilandelayo. Uhlelo lwe-DEA 4 luphinde lube ne-+ kanye - phenotypes. Ngaphandle kokugonywa kwangaphambili, izinja ze-DEA 4-negative azinawo amasosha omzimba ku-DEA 4. Ukumpontshelwa okuphindaphindiwe komamukeli we-DEA 4-negative, ngisho nalapho kukhona amasosha omzimba ku-DEA 4, akubangeli ukusabela kwe-hemolytic. Nokho, icala le-hemolysis laziwa enjeni eyathola ukumpontshelwa igazi okungahambelani izikhathi eziningana zilandelana. Uhlelo lwe-DEA 5 nalo luhle futhi lubi. I-10% yezilwane ze-DEA 5-negative zinamasosha omzimba ku-DEA 5. Ukumpontshelwa igazi esigulini esizwelayo kubangela ukusabela kwe-hemolytic nokufa kwe-erythrocyte yomnikeli zingakapheli izinsuku ezintathu. Uhlelo lwe-DEA 6 lunama-phenotypes angu-2, + kanye -. Ngokuvamile, awekho amasosha omzimba kule antigen. Ukumpontshelwa igazi kumamukeli owazisiwe kubangela ukusabela kokumpontshelwa okumaphakathi kanye nokwehla okumaphakathi kwesikhathi sokuphila samaseli abomvu egazi anikelayo. Uhlelo lwe-DEA 7 lunama-phenotypes angu-3: negative, 0, kanye ne-Tr. Ama-antibodies kuya ku-Tr kanye no-0 akhona ku-25% wezilwane ezingenayo i-DEA, kodwa azinawo umphumela oshiwo we-hemolytic. Kodwa ngokuzwela okulandelayo, ezinye ziyathuthukiswa ezikwazi ukubola igazi labanikelayo esikhathini esingaphansi kwezinsuku ezi-3. Isistimu ye-DEA 8 ayizange ifundwe kahle. Ngaphezu kwalokhu okungenhla, kunezinye izinhlelo ezingafakiwe ku-DEA, njengoba zisanda kutholwa, kanye nenani lezinhlelo eziqondene nezinhlobo ezithile (isibonelo, izinja zasempumalanga - i-Shibu-in, njll.) Kukhona izinsiza zokuxilonga. ukuze kutholwe ukungabikho noma ukuba khona kwama-antigen e-DEA 1.1., 1.2, 3, 4, 5 kanye no-7, kodwa abiza kakhulu. Njengomthetho, empeleni, ikakhulukazi emadolobheni amancane, abekho abanikeli abenziwe ngomumo, futhi ukuhambisana kunqunywa "engilazini".