Hoʻokahe koko no nā ʻīlio

 ʻO ka hemotransfusion ka hoʻololi ʻana i nā holoholona maʻi me ke koko holoʻokoʻa, a i ʻole nā ​​ʻāpana, a i ʻole ka hoʻomākaukau ʻana i ka protein plasma. He hana koʻikoʻi kēia.Ma 80% o nā hihia, hoʻokahe koko i nā ʻīlio ma muli o ka anemia, a ma 20% - ma ka hemorrhagic shock. Hoʻopakele ke koko i kekahi manawa i ke ola o ka ʻīlio a he hana koʻikoʻi i ka lanakila ʻana i kahi kūlana koʻikoʻi.

ʻO ke kumu o ke kahe koko i nā ʻīlio

1. Pani. ʻO nā Erythrocytes i loaʻa mai kahi mea hāʻawi e noho i loko o ke koko o ka mea loaʻa no 1-4 mau mahina, kahi e hoʻonui ai i ke kiʻekiʻe o ka oxygen i loko o nā kiko.
2. Hoʻoulu - ka hopena i nā ʻōnaehana like ʻole a me nā kino o ka ʻīlio.
3. Hoʻonui i ka hemodynamics. Hoʻonui i ka hana o ka ʻōnaehana cardiovascular, hoʻonui i ka nui o ka minuke o ka puʻuwai, etc.
4. pahu hopu hemostatic. Hoʻoulu ʻia ka homeostasis, ʻike ʻia ka hyperoagulation haʻahaʻa.

Nā hōʻailona no ke kahe koko i nā ʻīlio

1. ʻIke ʻia ke kahe koko, ka mea i hōʻike ʻia e nā pale mucous pale, nāwaliwali a me ka pulse pinepine, nā wāwae anu.
2. ʻO ke kahe o ke koko maʻamau a me ka hemodynamics paʻa ʻole, e hōʻike ana i ka nele o ka hāʻawi ʻana i ka oxygen i nā ʻiʻo i nā nui.
3. ʻO ka anemia hoʻihoʻi ʻole o nā ʻano etiologies.
4. ʻO ka coagulopathy hoʻoilina, thrombocytopenia, leukopenia, hypoproteinemia.

Mea hoʻokahe koko no nā ʻīlio

ʻO ke ala maʻalahi loa e kiʻi i nā mea mai ke koko hou holoʻokoʻa. No laila, hoʻohana nui ʻia i ka lāʻau lapaʻau holoholona. Hoʻopili ʻia nā Erythrocytes, mālama ʻia i ke anuanu (ka mahana 3-6⁰C) a hoʻohana ʻia no 30 mau lā a i ʻole a ʻeleʻele ka erythrocytes. Pono ʻo Erythromass e hoʻopiha i ka waihona o nā erythrocytes (no ka anemia maʻi) a i ʻole ka pilikia o ka hoʻonui ʻana me ka nui o ka wai. Hoʻohana pū ʻia ia no ke kahe koko nui (i hui pū me nā crystalloids). Pono ka plasma e hoʻihoʻi i nā kumu clotting, incl. nā mea paʻa ʻole. Mālama ʻia ka mea ma -40⁰C i loko o 1 makahiki. Ma mua o ka hoʻololi ʻana, hoʻomehana ʻia i +30 - 37⁰C, a hoʻokomo koke ʻia i loko o ke kino o ka ʻīlio.

Nā ʻano hoʻokele

Ma ke ʻano he kānāwai, lawelawe ʻia ke koko a me kāna mau ʻāpana. Inā hiki ʻole ke hoʻokomo i ke koko i loko o kahi vein (abscesses, edema koʻikoʻi), hoʻohana ʻia ka infusion intraosseous.

Nā pilikia a me nā pilikia o ka hoʻokahe koko i nā ʻīlio

Hoʻopili ʻia nā hoʻopiʻi koʻikoʻi me ka hōʻino ʻana i ka hui ʻana o ka acid-base o ke koko, nā hewa i ka ʻenehana transfusion, a me nā pilikia hemodynamic. Hiki ke hoʻopili ʻia nā hoʻopiʻi lohi me ka hoʻoheheʻe ʻana o ke koko overheated, hemolyzed a i ʻole ka maʻi maʻi: haʻalulu post-transfusion (hemolytic), citrate (anaphylactic) shock, nā maʻi maʻi. Hōʻike ʻia nā hopena non-immunological (acute form) e like me ke kuni. ʻO ke kumu he hopena ma waena o kahi antigen a me kahi antibody e pili ana i nā platelets, granulocytes a i ʻole lymphocytes, a i ʻole ka maʻi bacterial o ke koko. I kekahi manawa aia kahi maʻi maʻi (urticaria me ka ʻili a me ka ʻūlū). Hōʻike ʻia ka hoʻonui nui ʻana i ka ʻōnaehana circulatory e ka luaʻi, tachycardia, irritability, cough, shortness of breath or cyanosis. Nā kumu pilikia ʻē aʻe:

• kahema pulmonary
• ma'i hikiwawe
• wela
• post-transfusion circulatory overload
• hypervolemia
• nā hopena ma hope o ka hoʻololi ʻana
• ʻO ka maʻi maʻi o ka hemahema o nā kino he nui, etc.

 Hiki ke hoʻopili ʻia ka māmā, ka ate, nā ʻōpū endocrine a me nā ʻōnaehana a me nā ʻano ʻē aʻe. Hiki i ka overloading ke alakaʻi i ka dilation a me ka hopu ʻana i ka naʻau. Hiki i ka hoʻololi ke hoʻoulu i kahi hopena immunomodulatory a hoʻonui i ka pilikia o nā maʻi nosocomial, ʻeha ʻeha ʻeha, nā maʻi autoimmune. ʻO ka hoʻopiʻi koʻikoʻi loa he haʻalulu anaphylactic. Inā ʻike ʻia nā hōʻailona liʻiliʻi, pono e hoʻōki koke i ka hoʻololi ʻana.

ʻO ke kahe koko i nā ʻīlio ma ke ʻano he lāʻau lapaʻau

Ua lilo kēia kaʻina hana i mea nui i nā makahiki i hala iho nei. Ua hōʻoia pinepine ʻia kona mau pono i ka mālama ʻana i kekahi mau maʻi hematological. Ma muli o ka maʻalahi o ka ʻōnaehana hui koko canine a me nā haʻahaʻa haʻahaʻa o nā isoantibodies kūlohelohe, ʻaneʻane hiki i nā mea lapaʻau ke nānā ʻole i ka like ʻole o nā ʻano koko ma waena o ka mea loaʻa a me ka mea hāʻawi. i ka ʻīlio me ka ʻole o ka pōʻino i ke olakino (a hiki i 10 ml / kg). ʻAʻole ma mua o 45 - 60 mau lā ke koko koko aʻe.

ʻO wai ka mea hiki ke lilo i mea hāʻawi

I ka manawa hiki ke hoʻokahe ʻia ka ʻīlio me ke koko o kēlā me kēia hui. Akā inā koi ʻia ka hoʻololi ʻana ma hope, pono ke ʻano o ke koko. Hiki i nā ʻīlio Rh-negative ke loaʻa wale ke koko Rh-negative. Hiki ke loaʻa ke koko i nā ʻīlio Rh-positive. I kekahi manawa, koi ʻia kahi hoʻololi koko wikiwiki. I kēia hihia, hoʻohana ʻia kahi mea hāʻawi "ʻokoʻa" (he ʻīlio olakino i hoʻopau ʻia i loko o ke keʻena lapaʻau no ka ʻoki ʻana i nā kui, ʻoki ʻia nā kui, a me nā mea ʻē aʻe) a i ʻole kahi holoholona a kekahi o nā kauka. Pono ka holoholona mai ka 1,5 a hiki i ka 8 mau makahiki, pono ke ola kino loa . Lawe lākou i nā ʻīlio mālie, ʻoluʻolu i mea hāʻawi. ʻO ke kaumaha o ke kino o ka ʻīlio hāʻawi (ʻoi aku ka nui o ka ʻiʻo) ma mua o 25 kg. ʻO ke ʻano koko kūpono ʻo DEA 1.1. ʻinoʻino. Inā he wahine ka mea hāʻawi, pono ʻo ia he nulliparous. ʻAʻole paha i haʻalele ka mea hāʻawi i ka wahi kūloko.

Ka nānā ʻana i ke kūlana o ka ʻīlio i ka wā e hoʻokahe koko

ʻO kēlā me kēia 15-30 mau minuke i ka wā o ka transfusion a me 1, 12, 24 mau hola ma hope o ke kaʻina hana, loiloi ʻia nā ʻāpana aʻe:

1. ʻAno lawehala.
2. ʻO ka maikaʻi a me ka ikaika o ka pulse.
3. Ka wela wela.
4. ʻO ke ʻano a me ka ikaika o ka hanu.
5. Ke kala o ka mimi a me ka plasma.
6. Ka waihoʻoluʻu mucosal, ka manawa hoʻopiha capillary.
7. Nānā ʻia ka manawa prothrombin a me ka hematocrit ma mua, ma hope koke o ka pau ʻana, a me 12 a me 24 mau hola ma hope o ka hoʻololi ʻana.

Hui koko ilio

Manaʻo ʻia he 7 ʻano koko i nā ʻīlio. ʻAʻole ʻoiaʻiʻo loa kēia. ʻO ka papa inoa A - G kahi ʻōnaehana o nā hui koko, a i ʻole, 1 wale nō o nā koho no ka "hoʻokuʻu" 1961. Mai ia manawa, ua nui nā hoʻāʻo ʻana e hoʻopololei i ka ʻikepili, a i ka makahiki 1976 i hoʻomohala ai i ka nomenclature DEA, i ʻae ʻia i kēia manawa ma ʻAmelika Hui Pū ʻIa. Wahi a kēia nomenclature, hiki ke koho ʻia nā ʻōnaehana koko e like me DEA 1.1, DEA 1.2, DEA 3, DEA 4, DEA 5, DEA 7 a me DEA 8. ʻO ka ʻōnaehana DEA 1 ka mea pili pono loa. Loaʻa i kēia ʻōnaehana he 3 mau pūhui gene-protein a me 4 mau phenotypes: DEA 1.1., 1.2, 1.3 a me 0. Hoʻokahi ʻīlio he 1 phenotype wale nō. Akā, ʻaʻohe ʻīlio i nā antigens o ka hui ʻē aʻe, no laila hiki ke hoʻololi ʻia ka ʻīlio ʻaʻole i hoʻokahe koko ma mua me ke koko me ka ʻole o ka DEA 1.1, a e hana maikaʻi ka hoʻololi ʻana. Akā inā pono ka hoʻololi hou ʻana, hiki ke pilikia. Ke hoʻololi ʻia ʻo DEA 1 i loko o kahi mea loaʻa maikaʻi ʻole (phenotype 0) o ke koko o kahi mea hāʻawi DEA 1 maikaʻi (kekahi phenotype koe wale nō 0), hiki i ke kino o ka mea loaʻa ma hope o 7 a 10 mau lā ke hana i nā antibodies i ka antigen DEA 1, nāna e luku. nā ʻāpana koko ʻulaʻula, e lawe ana i kēia antigen. I ka wā e hiki mai ana, e koi ana ka mea loaʻa i ka hoʻololi wale ʻana o ke koko DEA 1-negative, inā ʻaʻole, ma kahi o nā wiki he 3 maʻamau, e noho nā erythrocytes hāʻawi i loko o ke kino o ka mea loaʻa, ʻoi aku ka maikaʻi, he mau hola wale nō, a i ʻole mau minuke. hoʻopau i ka hopena o ke kahe ʻana, a hiki ke hoʻonui i ke kūlana. I kēia hihia, hiki ke hoʻololi ʻia kahi mea hāʻawi DEA 1 maikaʻi me ke koko o kahi DEA 1-negative, akā naʻe, me ke ʻano ʻaʻole i loaʻa i kēia mea hāʻawi. Hōʻike ʻia ka antigen DEA 1 e kekahi mau ʻano like ʻole: DEA 1.1, DEA 1.2., DEA 1.3. koko DEA 1. nā antibodies i hana ʻia e ia e luku koke i nā ʻulaʻula ʻulaʻula me DEA 1.1. a hoʻoulu i kahi hopena hemolytic koʻikoʻi, piha i nā pilikia koʻikoʻi. I kēia hihia, ʻo nā ʻulaʻula ʻulaʻula me DEA 1.2 a me 1.3 e hōʻuluʻulu i kēia mau antibodies, akā ʻaʻole e luku iā lākou (ʻoiai he mea ʻino kēia no ka mea maʻi). Inā mākou e kamaʻilio e pili ana i ka ʻōnaehana DEA 3, hiki i ka ʻīlio ke lilo i DEA 3 maikaʻi a maikaʻi ʻole paha. ʻO ka hoʻoneʻe ʻana o DEA 3 koko maikaʻi i loko o kahi holoholona me nā antibodies antigroup kūpono (loaʻa a iā ʻoe iho) e hoʻopau i nā keʻena koko ʻulaʻula o ka mea hāʻawi a hiki ke hoʻoulu i nā hopena hoʻololi i nā lā 5 e hiki mai ana. Loaʻa i ka ʻōnaehana DEA 4 ka + a me - phenotypes. Me ka loaʻa ʻole o ka lāʻau lapaʻau mua, ʻaʻohe ʻīlio ʻino DEA 4 i DEA 4. ʻO ka hoʻololi hou ʻana o ka DEA 4-negative recipient, ʻoiai ma ke alo o nā antibodies i DEA 4, ʻaʻole ia he hopena hemolytic. Eia nō naʻe, ʻike ʻia kahi hihia o ka hemolysis i loko o kahi ʻīlio i loaʻa i ke kahe koko like ʻole i nā manawa he nui i ka lālani. He maikaʻi a maikaʻi ʻole ka ʻōnaehana DEA 5. 10% o DEA 5-nā holoholona ʻino i loaʻa nā antibodies i ka DEA 5. ʻO ka hoʻokahe koko i ka mea maʻi sensitized ka hopena hemolytic a me ka make o nā erythrocytes o ka mea hāʻawi i loko o ʻekolu lā. He 6 phenotypes ka DEA 2, + a me -. ʻO ka mea maʻamau, ʻaʻohe antibodies i kēia antigen. ʻO ka hoʻokahe koko i ka mea hoʻokipa maʻalahi ka hopena i ka hopena o ka hoʻololi ʻana a me ka emi ʻana o ke ola o nā mea hāʻawi ʻulaʻula. ʻO ka ʻōnaehana DEA 7 he 3 phenotypes: ʻino, 0, a me Tr. Aia nā antibodies i ka Tr a me 0 i ka 25% o nā holoholona DEA-negative, akā ʻaʻohe o lākou hopena hemolytic i ʻōlelo ʻia. Akā me ka sensitization ma hope, ua hoʻomohala ʻia nā mea ʻē aʻe i hiki ke hoʻopau i ke koko hāʻawi ma lalo o 3 mau lā. ʻAʻole i aʻo pono ʻia ka ʻōnaehana DEA 8. Ma waho aʻe o ka mea i luna, aia nā ʻōnaehana ʻē aʻe ʻaʻole i hoʻokomo ʻia i DEA, ʻoiai ua ʻike ʻia lākou i kēia manawa, a me nā ʻōnaehana kikoʻī i kekahi mau ʻano (e like me nā ʻīlio hikina - Shibu-in, etc.) Aia nā kit diagnostic. no ka hoʻoholo ʻana i ka loaʻa ʻole a i ʻole ka hele ʻana o DEA 1.1., 1.2, 3, 4, 5 a me 7 antigens, akā nui ke kumukūʻai. Ma ke ʻano he kānāwai, ʻoiaʻiʻo, ʻoi aku ma nā kūlanakauhale liʻiliʻi, ʻaʻohe mea hāʻawi i mākaukau, a ua hoʻoholo ʻia ka hoʻohālikelike "ma ke aniani".