Kamuwa da cuta yana daya daga cikin matsalolin da suka fi tsanani bayan maye gurbin haɗin gwiwa na wucin gadi, wanda ba wai kawai ya kawo nau'i na tiyata da yawa ga marasa lafiya ba, amma har ma yana cinye manyan albarkatun likita. A cikin shekaru 10 da suka gabata, yawan kamuwa da cuta bayan maye gurbin haɗin gwiwa na wucin gadi ya ragu sosai, amma yawan ci gaban da ake samu a halin yanzu na majinyata da ke yin maye gurbin haɗin gwiwa ya zarce adadin raguwar kamuwa da cuta, don haka bai kamata a yi watsi da matsalar kamuwa da cuta ba.
I. Abubuwan da ke haifar da cututtuka
Ya kamata a yi la'akari da cututtuka na maye gurbin haɗin gwiwa bayan aikin wucin gadi a matsayin cututtukan da aka samu a asibiti tare da kwayoyin cututtuka masu jure wa ƙwayoyi. Mafi na kowa shine staphylococcus, lissafin kashi 70 zuwa 80%, gram-negative bacilli, anaerobes da streptococci marasa A rukuni suma na kowa.
II Pathogenesis
Cututtuka sun kasu kashi biyu: daya kamuwa da wuri ne dayan kuma kamuwa da cuta ne a makare ko kuma ake kira kamuwa da cuta a makare. Cututtukan farko suna faruwa ne ta hanyar shigar ƙwayoyin cuta kai tsaye zuwa cikin haɗin gwiwa yayin tiyata kuma yawanci Staphylococcus epidermidis ne. Cututtukan da ke faruwa a ƙarshen lokaci ana haifar da su ta hanyar watsawa ta hanyar jini kuma galibi sune Staphylococcus aureus. Hanyoyin haɗin gwiwa da aka yi wa tiyata sun fi kamuwa da cutar. Alal misali, akwai kashi 10% na kamuwa da cuta a lokuta na bita bayan maye gurbin haɗin gwiwa na wucin gadi, kuma yawan kamuwa da cuta ya fi girma a cikin mutanen da suka sami maye gurbin haɗin gwiwa don maganin arthritis na rheumatoid.
Yawancin cututtuka suna faruwa a cikin 'yan watanni bayan tiyata, farkon zai iya bayyana a cikin makonni biyu na farko bayan tiyata, amma kuma a cikin 'yan shekaru kafin bayyanar farkon bayyanar cututtuka na kumburi mai tsanani, zafi da zazzabi. , Alamun zazzabi dole ne a bambanta da sauran matsaloli, kamar ciwon huhu bayan tiyata, cututtuka na urinary tract da sauransu.
Game da kamuwa da cuta da wuri, zafin jiki ba kawai ya warke ba, amma yana tashi kwanaki uku bayan tiyata. Ciwon haɗin gwiwa ba kawai a hankali ya rage ba, amma a hankali yana kara tsanantawa, kuma akwai ciwo mai zafi a hutawa. Akwai fitowar da ba ta dace ba ko ɓoyayyiyar ɓoyayyiya daga ɓarnar. Ya kamata a yi nazari a hankali, kuma ba za a iya danganta zazzaɓin a cikin sauƙi ga cututtukan da ke faruwa a wasu sassan jiki kamar huhu ko urinary fili ba. Yana da mahimmanci ba kawai a watsar da zubar da ciki ba kamar yadda aka saba yi kamar zubar da kitse. Har ila yau, yana da mahimmanci a gano ko kamuwa da cuta yana samuwa a cikin kyallen takarda na sama ko zurfi a kusa da prosthesis.
A cikin marasa lafiya da suka ci gaba da kamuwa da cuta, yawancin waɗanda suka bar asibiti, kumburin haɗin gwiwa, zafi, da zazzaɓi bazai yi tsanani ba. Rabin marasa lafiya na iya samun zazzabi. Staphylococcus epidermidis na iya haifar da kamuwa da cuta mara raɗaɗi tare da ƙarin adadin farin jinin jini a cikin 10% kawai na marasa lafiya. Hawan jini ya fi yawa amma kuma ba takamaiman ba. A wasu lokuta ana kuskuren jin zafi a matsayin sassaukarwa na prosthetic, na karshen shine ciwon da ke hade da motsi wanda ya kamata a sauƙaƙa ta hanyar hutawa, da ciwon kumburi wanda ba a sauƙaƙa ta hanyar hutawa. Duk da haka, an ba da shawarar cewa babban abin da ke haifar da raguwar prosthesis shine jinkirta kamuwa da cuta na kullum.
III. Bincike
1. Gwajin jini:
Yawanci sun haɗa da adadin fararen ƙwayoyin jini da rarrabuwa, interleukin 6 (IL-6), furotin C-reactive (CRP) da ƙimar erythrocyte sedimentation (ESR). Abubuwan da ake amfani da su na gwajin jini suna da sauƙi da sauƙi don aiwatarwa, kuma ana iya samun sakamakon da sauri; ESR da CRP suna da ƙananan ƙayyadaddun ƙayyadaddun bayanai; IL-6 yana da matukar muhimmanci wajen tantance kamuwa da cuta a farkon lokacin aiki.
2. Binciken hoto:
Fim ɗin X-ray: ba mai hankali ba ko takamaiman don gano kamuwa da cuta.
X-ray fim na maye gurbin gwiwa gwiwa
Arthrography: babban aikin wakilci a cikin ganewar asali na kamuwa da cuta shine fitowar ruwan synovial da ƙura.
CT: hangen nesa na haɗin gwiwa effusion, sinus tracts, m nama abscesses, yashwa kashi, periprosthetic kashi resorption.
MRI: mai matukar damuwa don ganowar farko na ruwan haɗin gwiwa da ƙura, ba a yi amfani da shi sosai a cikin ganewar cututtuka na periprosthetic cututtuka.
Duban dan tayi: tarin ruwa.
3.Maganin nukiliya
Technetium-99 kashi scan yana da hankali na 33% da ƙayyadaddun 86% don gano cututtukan cututtukan periprosthetic bayan arthroplasty, kuma indium-111 mai lakabin leukocyte scan ya fi mahimmanci don gano cututtukan cututtukan periprosthetic, tare da hankali na 77% kuma musamman 86%. Lokacin da aka yi amfani da sikanin guda biyu tare don bincikar cututtuka na periprosthetic bayan arthroplasty, za a iya samun mafi girman hankali, ƙayyadaddun bayanai da daidaito. Wannan gwajin har yanzu shine ma'aunin zinare a cikin magungunan nukiliya don gano cututtukan cututtukan da ke da alaƙa. Fluorodeoxyglucose-positron emission tomography (FDG-PET). Yana gano ƙwayoyin kumburi tare da ƙara yawan glucose a cikin yankin da ya kamu da cutar.
4. Dabarun ilimin halitta
PCR: babban hankali, tabbataccen ƙarya
Fasahar Gene chip: matakin bincike.
5. Ciwon zuciya:
Binciken cytological na ruwan haɗin gwiwa, al'adun ƙwayoyin cuta da gwajin jiyya na ƙwayoyi.
Wannan hanya ce mai sauƙi, sauri kuma daidai
A cikin cututtukan hanji, ƙwayar leukocyte na haɗin gwiwa> 3,000 / ml tare da haɓaka ESR da CRP shine mafi kyawun ma'auni don kasancewar kamuwa da cuta na periprosthetic.
6. Intraoperative m daskararre sashen histopathology
Wurin daskararre na cikin gaggawa na cikin nama na periprosthetic shine hanyar da aka fi amfani da ita ta ciki don gwajin ilimin tarihin. Ma'auni na binciken Feldman, watau, mafi girma ko daidai da 5 neutrophils a kowane girman girma (400x) a cikin aƙalla filaye 5 daban-daban na ƙananan ƙwayoyin cuta, galibi ana amfani da su zuwa sassan daskararre. An nuna cewa hankali da ƙayyadaddun wannan hanya za su wuce 80% da 90%, bi da bi. Wannan hanyar a halin yanzu ita ce ma'aunin zinare don ganewar ciwon ciki.
7. Bacterial al'adar pathological nama
Al'adar ƙwayoyin cuta na kyallen jikin bango suna da ƙayyadaddun ƙayyadaddun ƙayyadaddun kamuwa da cuta kuma an ɗauke su a matsayin ma'aunin zinare don gano cututtukan periprosthetic, kuma ana iya amfani da shi don gwajin ƙwarewar ƙwayoyi.
IV. Bambance-bambancen bincikes
Cututtukan haɗin gwiwa marasa raɗaɗi waɗanda Staphylococcus epidermidis ke haifarwa sun fi wahalar bambancewa da sassautawar prosthetic. Dole ne a tabbatar da shi ta hanyar X-ray da sauran gwaje-gwaje.
V. Magani
1. Sauƙaƙan maganin ƙwayoyin cuta masu ra'ayin mazan jiya
Tsakaysma da se,gawa an rarraba cututtuka bayan arthroplasty zuwa nau'i hudu, nau'in I asymptomatic type, mai haƙuri yana cikin al'adun nama na tiyata kawai da aka gano yana da girma na kwayoyin cuta, kuma aƙalla samfurori guda biyu da aka yi da kwayoyin cuta iri ɗaya; nau'in II shine kamuwa da cuta da wuri, wanda ke faruwa a cikin wata daya na tiyata; nau'in IIl shine jinkirin kamuwa da cuta; kuma nau'in IV cuta ce mai saurin kamuwa da cutar hanta. Ka'idar maganin rigakafi yana da mahimmanci, isasshen adadin da lokaci. Kuma huda rami na haɗin gwiwa kafin a yi aiki da al'adun nama na ciki suna da matukar mahimmanci ga zaɓin maganin rigakafi daidai. Idan al'adar ƙwayoyin cuta ta tabbata ga nau'in kamuwa da cuta na I, aikace-aikacen sauƙi na maganin rigakafi masu mahimmanci na makonni 6 na iya samun sakamako mai kyau.
2. Riƙewar prosthesis, lalatawa da magudanar ruwa, aikin tube ban ruwa
Tushen ɗaukar jigon jiyya mai riƙe da rauni shine cewa prosthesis yana da ƙarfi kuma yana da saurin kamuwa da cuta. Kwayoyin da ke kamuwa da cuta a bayyane suke, ƙwayar ƙwayar cuta ba ta da ƙarfi kuma ana samun maganin rigakafi masu mahimmanci, kuma ana iya maye gurbin layi ko spacer yayin da ake cirewa. Adadin warkewa na kashi 6% kawai tare da maganin rigakafi kadai da 27% tare da maganin rigakafi tare da lalatawa da adanar prosthesis a cikin wallafe-wallafen.
Ya dace da kamuwa da cuta a matakin farko ko kamuwa da cuta mai saurin jini tare da gyaran kafa mai kyau; Har ila yau, a bayyane yake cewa kamuwa da cuta shine ƙananan ƙwayoyin cuta na ƙwayoyin cuta wanda ke kula da maganin rigakafi. Hanyar ta ƙunshi ƙwanƙwasa sosai, zubar da maganin ƙwayoyin cuta da magudanar ruwa (tsawon makonni 6), da ƙwayoyin rigakafin ƙwayoyin cuta na ciki bayan tiyata (tsawon makonni 6 zuwa watanni 6). Rashin hasara: babban gazawar (har zuwa 45%), tsawon lokacin jiyya.
3. Tiyatar bita mataki daya
Yana da fa'idodi na ƙarancin rauni, ɗan gajeren zaman asibiti, ƙarancin farashi na likita, ƙarancin rauni da taurin haɗin gwiwa, wanda ke da amfani don dawo da aikin haɗin gwiwa bayan tiyata. Wannan hanya ta fi dacewa don maganin kamuwa da cuta da wuri da kuma ciwon hanta mai tsanani.
Sauya mataki ɗaya, watau, hanyar mataki ɗaya, an iyakance ga ƙananan cututtuka masu guba, ƙaƙƙarfan ɓarna, simintin kashi na ƙwayoyin cuta, da samun magungunan rigakafi masu mahimmanci. Dangane da sakamakon daskararrun nama na intraoperative, idan akwai kasa da 5 leukocytes/filin girma girma. Yana da nuni ga ƙananan ƙwayar cuta. Bayan da aka cire sosai an yi aikin arthroplasty mataki ɗaya kuma ba a sake samun kamuwa da cuta ba bayan an gama aikin.
Bayan an cire shi sosai, ana maye gurbin prosthesis nan da nan ba tare da buƙatar buɗaɗɗen hanya ba. Yana da abũbuwan amfãni daga ƙananan rauni, gajeren lokacin jiyya da ƙananan farashi, amma yawan sake dawowa na kamuwa da cuta ya fi girma, wanda shine kusan 23% ~ 73% bisa ga kididdigar. Sauyawa prosthesis mataki-mataki ya fi dacewa da tsofaffi marasa lafiya, ba tare da haɗa kowane ɗayan waɗannan ba: (1) tarihin tiyata da yawa akan haɗin gwiwa na maye gurbin; (2) samuwar sassan sinus; (3) kamuwa da cuta mai tsanani (misali septic), ischemia da tabo na kyallen jikin da ke kewaye; (4) rashin cika lalacewa na rauni tare da ragowar siminti; (5) X-ray da ke nuna osteomyelitis; (6) lahani na kashi da ke buƙatar gyaran kashi; (7) gauraye cututtuka ko kwayoyin cuta masu saurin kamuwa da cuta (misali Streptococcus D, kwayoyin cutar Gram-negative); (8) asarar kashi da ke buƙatar dashen kashi; (9) asarar kashi da ke buƙatar dashen kashi; da (10) gyaran kashi da ke bukatar dashen kashi. Streptococcus D, Gram-negative kwayoyin cuta, musamman Pseudomonas, da dai sauransu), ko fungal kamuwa da cuta, mycobacterial kamuwa da cuta; (8) Al'adar kwayoyin cuta ba ta bayyana ba.
4. tiyatar bita na mataki na biyu
Likitocin tiyata sun sami tagomashi a cikin shekaru 20 da suka gabata saboda yawan alamomin sa (isasshen adadin kashi, wadataccen kayan laushi na periarticular) da kuma yawan kawar da kamuwa da cuta.
Spacers, masu ɗaukar ƙwayoyin cuta, maganin rigakafi
Ko da kuwa fasahar sararin samaniya da aka yi amfani da ita, gyare-gyaren siminti tare da maganin rigakafi ya zama dole don ƙara yawan ƙwayar maganin rigakafi a cikin haɗin gwiwa da kuma ƙara yawan maganin kamuwa da cuta. Magungunan rigakafi da aka fi amfani dasu sune tobramycin, gentamicin da vancomycin.
Ƙungiyar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙasa ta Duniya sun gane mafi mahimmancin magani ga cututtuka mai zurfi bayan arthroplasty. Hanyar ta ƙunshi ƙwanƙwasa sosai, cirewar prosthesis da jikin waje, sanya wuri na haɗin gwiwa, ci gaba da yin amfani da magungunan rigakafi masu mahimmanci na cikin jini na akalla makonni 6, kuma a ƙarshe, bayan ingantaccen kulawar kamuwa da cuta, sake dawo da prosthesis.
Amfani:
Isashen lokaci don gano nau'in ƙwayoyin cuta da magungunan ƙwayoyin cuta masu mahimmanci, waɗanda za'a iya amfani da su yadda ya kamata kafin sake duba aikin tiyata.
Haɗuwa da sauran ƙwayoyin cuta na kamuwa da cuta za a iya bi da su a kan lokaci.
Akwai dama guda biyu don lalatawa don cire ƙwayoyin necrotic da jikin waje da kyau sosai, wanda ke rage yawan sake dawowar cututtuka na baya-bayan nan.
Rashin hasara:
Sake maganin sa barci da tiyata yana kara haɗari.
Tsawon lokacin magani da tsadar magani.
Farfadowar aikin bayan tiyata ba shi da kyau kuma a hankali.
Arthroplasty: Ya dace da cututtuka masu tsayi waɗanda ba su amsa magani ba, ko don manyan lahani; yanayin mara lafiya yana iyakance sake aiki da gazawar sake ginawa. Rage ciwon bayan tiyata, buƙatar yin amfani da takalmin gyaran kafa na dogon lokaci don taimakawa motsi, rashin kwanciyar hankali na haɗin gwiwa, raguwar hannu, tasirin aiki, iyakokin aikace-aikacen yana iyakance.
Arthroplasty: maganin gargajiya don cututtuka na baya-bayan nan, tare da kwanciyar hankali mai kyau da jin zafi. Lalacewar sun haɗa da gajarta gaɓoɓi, raunin tafiya da asarar motsin haɗin gwiwa.
Yankewa: Ita ce hanya ta ƙarshe don maganin cututtukan zurfafawa bayan tiyata. Ya dace da: (1) babban hasara mai tsanani wanda ba za a iya gyarawa ba, lahani mai laushi; (2) ƙwayoyin cuta mai ƙarfi na ƙwayoyin cuta, cututtuka masu gauraye, maganin ƙwayoyin cuta ba su da tasiri, yana haifar da ƙwayar cuta na tsarin, barazanar rayuwa; (3) yana da tarihin gazawa da yawa na tiyatar bita na marasa lafiya masu kamuwa da cuta.
VI. Rigakafi
1. Abubuwan da za a fara aiki:
Haɓaka yanayin kafin aikin majiyyaci kuma duk cututtukan da ke akwai yakamata a warke su da wuri. Mafi yawan cututtukan da ke haifar da jini sune waɗanda ke fitowa daga fata, urinary tract, da kuma na numfashi. A cikin hip ko gwiwa arthroplasty, fata na ƙananan sassan ya kamata ya kasance ba a karye ba. Asymptomatic bacteriuria, wanda ya zama ruwan dare a cikin tsofaffi marasa lafiya, ba ya buƙatar a yi masa magani da wuri; da zarar bayyanar cututtuka sun faru dole ne a magance su da sauri. Marasa lafiya masu fama da tonsillitis, cututtuka na numfashi na sama, da tinea pedis ya kamata a kawar da su a cikin gida na kamuwa da cuta. Manyan ayyukan haƙori na iya zama tushen kamuwa da cutar jini, kuma ko da yake an kauce masa, idan aikin haƙori ya zama dole, ana ba da shawarar cewa a yi irin waɗannan hanyoyin kafin aikin arthroplasty. Marasa lafiya tare da mummunan yanayi na yau da kullun kamar anemia, hypoproteinemia, hadewar ciwon sukari da cututtukan urinary na yau da kullun yakamata a bi da su da ƙarfi da wuri don cutar ta farko don inganta yanayin tsarin.
2. Gudanar da aikin ciki:
(1) Gabaɗaya dabarun aseptic da kayan aikin yakamata kuma a yi amfani da su a cikin tsarin warkewa na yau da kullun zuwa arthroplasty.
(2) Ya kamata a rage yawan zuwa asibiti kafin a yi aiki don rage haɗarin da fatar majiyyaci za ta iya mamayewa da nau'in ƙwayoyin cuta da aka samu a asibiti, kuma a yi maganin yau da kullun a ranar tiyata.
(3) Ya kamata a shirya wurin da za a fara aikin da kyau don shirya fata.
(4) Rigunan tiyata, abin rufe fuska, huluna, da gidajen wasan kwaikwayo na aikin laminar suna da tasiri wajen rage ƙwayoyin cuta masu iska a cikin gidan wasan kwaikwayo. Saka safar hannu biyu na iya rage haɗarin hulɗar hannu tsakanin likitan fiɗa da majiyyaci kuma ana iya ba da shawarar.
(5) An tabbatar da asibiti cewa yin amfani da ƙarin ƙuntatawa, musamman hinged, prosthesis yana da haɗari mafi girma na kamuwa da cuta fiye da yadda ba tare da ƙuntatawa gabaɗayan ƙwanƙwasa gwiwa ba saboda tarkacen ƙarfe na ƙarfe wanda ke rage aikin phagocytosis, don haka ya kamata a kauce masa a cikin zaɓi na prosthesis. .
(6) Inganta fasahar tiyata na mai aiki da rage tsawon lokacin aikin (<2.5 h idan zai yiwu). Rage tsawon lokacin tiyata na iya rage lokacin da ake sha iska, wanda hakan na iya rage lokacin amfani da yawon shakatawa. A guji yin aiki mai tsanani yayin tiyata, ana iya ba da rauni akai-akai ( bindigar ban ruwa mai ɗigon ruwa ita ce mafi kyau), kuma ana iya yin nutsar da tururi-iodine don ƙeƙasasshen da ake zargin ya gurɓata.
3. Abubuwan da suka biyo baya:
(1) Ciwon tiyata yana haifar da juriya na insulin, wanda zai iya haifar da hyperglycemia, lamarin da zai iya dawwama na tsawon makonni bayan tiyata kuma yana haifar da rikice-rikice masu alaka da rauni, wanda kuma yana faruwa a cikin marasa lafiya marasa ciwon sukari. Don haka, kulawar glucose na jini na asibiti bayan tiyata yana da mahimmanci daidai.
(2) Ciwon jini mai zurfi yana ƙara haɗarin hematoma da matsalolin da ke da alaƙa da rauni. Wani binciken da aka gudanar ya gano cewa bayan yin amfani da ƙananan heparin na kwayoyin don hana thrombosis mai zurfi yana da amfani wajen rage yiwuwar kamuwa da cuta.
(3) Rufe magudanar ruwa hanya ce mai yuwuwar shiga don kamuwa da cuta, amma dangantakarta da adadin kamuwa da rauni ba a yi nazari ta musamman ba. Sakamakon farko ya nuna cewa catheters na intra-articular da aka yi amfani da su azaman gudanarwa na analgesics na iya zama mai saurin kamuwa da kamuwa da cuta.
4. Maganin rigakafi:
A halin yanzu, aikace-aikacen asibiti na yau da kullun na allurai na rigakafi na rigakafi da ake gudanarwa ta hanyar jijiya kafin da bayan tiyata yana rage haɗarin kamuwa da cuta bayan tiyata. Cephalosporins galibi ana amfani da su a asibiti azaman maganin rigakafi na zaɓi, kuma akwai alaƙar lanƙwasa U-dimbin yawa tsakanin lokacin amfani da ƙwayoyin cuta da adadin cututtukan wuraren aikin tiyata, tare da haɗarin kamuwa da cuta gabaɗaya da bayan mafi kyawun lokaci don maganin rigakafi. amfani. Wani babban bincike na baya-bayan nan ya gano cewa maganin rigakafi da aka yi amfani da su a cikin mintuna 30 zuwa 60 kafin a yanka shi yana da mafi ƙarancin kamuwa da cuta. Sabanin haka, wani babban bincike na jimillar arthroplasty na hip ya nuna mafi ƙanƙanta yawan kamuwa da cuta tare da maganin rigakafi da aka gudanar a cikin minti 30 na farko na ƙaddamarwa. Don haka ana ɗaukar lokacin gudanarwa gabaɗaya shine mintuna 30 kafin a fara aiki, tare da sakamako mafi kyau yayin shigar da maganin sa barci. Ana ba da wani kashi na rigakafin rigakafi bayan tiyata. A Turai da Amurka, ana amfani da maganin rigakafi har zuwa rana ta uku bayan tiyata, amma a China, an ba da rahoton cewa ana ci gaba da amfani da su har tsawon makonni 1 zuwa 2. Duk da haka, yarjejeniya ta gaba ɗaya ita ce, ya kamata a guji yin amfani da dogon lokaci na yin amfani da maganin rigakafi mai ƙarfi mai ƙarfi sai dai idan akwai yanayi na musamman, kuma idan dogon amfani da maganin rigakafi ya zama dole, yana da kyau a yi amfani da magungunan antifungal tare da maganin rigakafi don hana cututtuka na fungal. . An nuna Vancomycin yana da tasiri a cikin majinyata masu haɗari masu ɗauke da Staphylococcus aureus mai jurewa methicillin. Ya kamata a yi amfani da allurai mafi girma na maganin rigakafi don tsawaita aikin fida, gami da fiɗa biyu, musamman lokacin rabin rayuwar ƙwayoyin cuta ba ta daɗe.
5. Amfani da maganin kashe kwayoyin cuta a hade da siminti kashi:
An kuma fara amfani da simintin da aka haɗa da ƙwayoyin cuta a cikin arthroplasty a Norway, inda da farko wani binciken da aka yi a Norway Arthroplasty Registry ya nuna cewa yin amfani da haɗin maganin rigakafi IV da siminti (hade prosthesis na rigakafi) ya rage yawan kamuwa da cuta mai zurfi fiye da kowane hanya kadai. . An tabbatar da wannan binciken a cikin jerin manyan bincike a cikin shekaru 16 masu zuwa. Nazarin Finnish da Ƙungiyar Orthopedic ta Ostiraliya 2009 sun cimma irin wannan matsaya game da rawar da siminti da aka sanya a cikin maganin rigakafi a farkon lokaci da kuma gyaran arthroplasty na gwiwa. Har ila yau, an nuna cewa abubuwan da ke cikin simintin kashi ba su da tasiri lokacin da aka ƙara foda na ƙwayoyin cuta a cikin allurai da ba su wuce 2 g da 40 g na simintin kashi ba. Duk da haka, ba duk maganin rigakafi ba ne za a iya ƙarawa zuwa simintin kashi. Kwayoyin rigakafi waɗanda za a iya ƙarawa zuwa simintin kashi ya kamata su sami yanayi masu zuwa: aminci, kwanciyar hankali na thermal, hypoallergenicity, kyakkyawan solubility na ruwa, m maganin rigakafi, da kayan foda. A halin yanzu, an fi amfani da vancomycin da gentamicin a aikin asibiti. An yi tunanin cewa allurar rigakafi a cikin siminti za ta ƙara haɗarin rashin lafiyan halayen, bayyanar nau'ikan nau'ikan juriya, da sassautawar aikin prosthesis, amma ya zuwa yanzu babu wata shaida da ta goyi bayan waɗannan abubuwan.
VII. Takaitawa
Yin gaggawar ganewar asali ta hanyar tarihi, gwajin jiki da gwaje-gwajen ƙwararru wani abu ne da ake buƙata don samun nasarar maganin cututtukan haɗin gwiwa. Kawar da kamuwa da cuta da kuma maido da wani raɗaɗi, mai aiki da haɗin gwiwa na wucin gadi shine ainihin ka'ida a cikin maganin cututtuka na haɗin gwiwa. Kodayake maganin rigakafi na kamuwa da cuta na haɗin gwiwa yana da sauƙi kuma maras tsada, kawar da ciwon haɗin gwiwa yawanci yana buƙatar haɗuwa da hanyoyin tiyata. Makullin zabar maganin tiyata shine la'akari da matsalar cirewar prosthesis, wanda shine ainihin abin da ke magance cututtuka na haɗin gwiwa. A halin yanzu, haɗakar aikace-aikacen maganin rigakafi, lalatawa da arthroplasty ya zama cikakkiyar magani ga yawancin cututtukan haɗin gwiwa. Duk da haka, har yanzu yana buƙatar ingantawa da kamala.
Lokacin aikawa: Mayu-06-2024
