Ukutshisa, sibi kangakanani isigulana? UVavanyo kunye noMthetho kaWallace weThoba

By UCristiano Antonino On Ngo-Apr 26, 2023

Umthetho weThoba, owaziwa ngokuba nguWallace woLawulo lweThoba, sisixhobo esisetyenziselwa ukuxhwaleka kunye neyeza likaxakeka ukuvavanya indawo yonke yomzimba (TBSA) echaphazelekayo kwizigulane ezivuthayo.

Ukujongana nemeko engxamisekileyo ebandakanya ukubakho kokutshisa okukhulu kubangela isantya esithile sovavanyo.

Ngoko ke kubalulekile ukuba umhlanguli axhotyiswe ngolwazi oluthile olusisiseko oluya kumenza ukuba enze isakhelo ngokuchanekileyo ixhoba elitshileyo.

Ukulinganisa indawo yokuqala yokutshisa kubalulekile ekuqikeleleni iimfuno zokuvuselela ulwelo njengoko izigulane ezinokutshisa kakhulu ziya kufumana ilahleko enkulu yolwelo ngenxa yokususwa komqobo wolusu.

Esi sixhobo sisetyenziselwa ukutshisa okwesibini kunye neyesithathu (ekwabizwa ngokuba yi-party-thickness and full-thickness burns) kwaye incedisa umboneleli ekuvavanyeni okukhawulezayo ukufumanisa ubunzima kunye neemfuno zamanzi.

Ukuguqulwa koMthetho weThoba kungenziwa ngokuhambelana nobukhulu bomzimba (BMI) kunye nobudala

Umthetho weThoba ubonakalise ukuba yi-algorithm edlalwa rhoqo ngoogqirha kunye nabongikazi ukuqikelela indawo etshileyo kwizifundo ezininzi. [1] [2] [3]

Uqikelelo lweMithetho yesiThoba yendawo yomzimba otshisiweyo isekelwe ekwabeleni iipesenti kwiindawo ezahlukeneyo zomzimba.

Intloko yonke iqikelelwa kwi-9% (4.5% ngaphambili nangasemva).

I-torso yonke iqikelelwa kwi-36% kwaye inokuphinda ihlulwe ibe yi-18% ngaphambili kunye ne-18% ngasemva.

Inxalenye engaphambili yesiqu ingaphinda yohlulwe ibe yithorax (9%) kunye nesisu (9%).

Amanqaku aphezulu aphelele i-18% kunye ne-9% kwinqanaba ngalinye eliphezulu. Umgca ngamnye ophezulu unokuphinda uhlulwe ngaphambili (4.5%) kunye ne-posterior (4.5%).

Amalungu asezantsi aqikelelwa kwi-36%, i-18% kwilungu ngalinye elingaphantsi.

Kwakhona oku kunokwahlulwa kwakhona kwi-9% kwi-anterior aspect kunye ne-9% kwi-posterior aspect.

Igroin iqikelelwa kwi-1%.[4][5]

Umsebenzi woMthetho weThoba

Umthetho weThoba usebenza njengesixhobo sokuvavanya indawo yesibini kunye neyesithathu yesidanga somzimba wonke (TBSA) kwizigulane ezitshileyo.

Nje ukuba i-TBSA ifunyaniswe kwaye isigulane sizinzile, ukuvuselela ulwelo kunokuqala ngokusetyenziswa kwefomula.

I-formula yaseParkland isoloko isetyenziswa.

Ibalwa njenge-4 ml emithanjeni (IV) yolwelo ngekhilogram yobunzima bomzimba obufanelekileyo ngokwepesenti ye-TBSA (echazwa njengedesimali) ngaphezu kweeyure ezingama-24.

Ngenxa yeengxelo zokuvuselela ngokugqithiseleyo, ezinye iifomyula ziye zacetywayo ezifana ne-formula ye-Brooke eguqulwayo, eyanciphisa i-IV fluid kwi-2 ml endaweni ye-4 ml.

Emva kokumisela umthamo opheleleyo wokuvuselela kunye nolwelo lwe-intravenous kwiiyure zokuqala ze-24, isiqingatha sokuqala somthamo silawulwa kwiiyure zokuqala ze-8 kwaye esinye isiqingatha silawulwa kwiiyure ze-16 ezizayo (oku kuguqulwa kwisantya seyure ngokuhlukana. isiqingatha somthamo opheleleyo we-8 kunye ne-16).

Ixesha levolumu yeeyure ezingama-24 liqala ngexesha lokutshisa.

Ukuba isigulane sibonisa iiyure ze-2 emva kokutshisa kunye nokuvuselelwa kwamanzi akukaqalwa, isiqingatha sokuqala somthamo kufuneka silawulwe kwiiyure ze-6 kunye nesiqingatha esisele se-fluids esilawulwa njengeprotocol.

Ukuvuselelwa kolwelo kubaluleke kakhulu kulawulo lokuqala lweqondo lesibini kunye nelesithathu lokutsha olubandakanya ngaphezulu kwe-20 pesenti ye-TBSA njengoko iingxaki zokungaphumeleli kwezintso, i-myoglobinuria, i-haemoglobinuria kunye nokungaphumeleli kwamalungu amaninzi ukuba ngaba ayinyangwanga ngokukhawuleza.

Ukufa kubonakaliswe ukuba kuphezulu kwizigulane ezine-TBSA ezitshisa ngaphezu kwe-20% ezingafumani ukuvuswa kwamanzi okufanelekileyo ngokukhawuleza emva kokulimala.[6][7][8]

Kukho inkxalabo phakathi kooklinikhi malunga nokuchaneka koMthetho wesithoba kubantu abatyebe kakhulu kunye nabantwana.

Umgaqo weNine unokusetyenziswa kakuhle kwizigulane ezinobunzima obungaphezu kweekhilogram ezili-10 kunye neekhilogram ezingaphantsi kwe-80 ukuba zichazwe yi-BMI njengengaphantsi kokutyeba.

Kwiintsana kunye nezigulana ezityebileyo, ingqalelo ekhethekileyo kufuneka ihlawulwe koku kulandelayo:

Izigulana ezityebe ngokugqithiseleyo

Izigulana ezichazwa njengezityebe kakhulu yi-BMI zineziqu ezinkulu ngokungafaniyo xa kuthelekiswa nabalingane babo abangatyebanga.

Izigulane ezityebe ngokugqithiseleyo zikufutshane ne-50% ye-TBSA yomboko, i-15% ye-TBSA kumlenze ngamnye, i-7% ye-TBSA kwingalo nganye kunye ne-6% ye-TBSA yentloko.

Izigulana ezinokwakheka kwe-Android, ezichazwa njengokusasazwa okukhethekileyo kwesiqu kunye nezicubu ze-adipose emzimbeni (isisu, isifuba, amagxa kunye entanyeni), babe nesiqu esikufutshane ne-53% ye-TBSA.

Izigulane ezinemilo ye-gynoid, echazwe njengokusasazwa okukhethiweyo kwezicubu ze-adipose kumzimba ophantsi (isisu esisezantsi, i-pelvis kunye namathanga), zine-trunk ekufutshane ne-48% ye-TBSA.

Njengoko iqondo lokukhuluphala landa, iqondo lokungajongelwa phantsi kwe-TBSA yokubandakanyeka kwe-trunk kunye nemilenze yanda xa ihambelana noMthetho weThoba.

Iintsana

Iintsana zineentloko ezinkulu ngokulinganayo eziguqula igalelo elingaphezulu kwamanye amacandelo amakhulu omzimba.

'Umthetho weSibhozo' ulungile kwiintsana ezinobunzima obungaphantsi kwe-10 kg.

Lo mgaqo umisela malunga nama-32% e-TBSA kwisiqu sesigulana, ama-20% e-TBSA entloko, i-16% ye-TBSA kumlenze ngamnye kunye ne-8% ye-TBSA kwingalo nganye.

Nangona ukusebenza kakuhle kweMithetho yeThoba kunye nokungena kwayo kwiingcali zonyango lotyando kunye nongxamiseko, uphando lubonisa ukuba kwi-25% TBSA, i-30% ye-TBSA kunye ne-35% ye-TBSA, ipesenti ye-TBSA i-overestimated yi-20% xa kuthelekiswa nezicelo ezisekelwe kwikhompyutheni.

Ukuqikelelwa ngokugqithisileyo kwe-TBSA etshisiweyo kunokukhokelela ekuvuseleleni ngokugqithisileyo ngolwelo olufakwa emithanjeni, ukunika ithuba lokugcwala komthamo kunye ne-pulmonary edema kunye nokunyuka kwemfuno yentliziyo.

Izigulane ezine-comorbidities esele zikhona zisemngciphekweni we-acute cardiac kunye ne-respiratory decompensation kwaye kufuneka zibekwe esweni kwiyunithi yokhathalelo olunzulu (ICU) ngexesha lesigaba esinamandla sokuvuselela ulwelo, ngokukodwa kwiziko lokutshisa. [9][10]

Umthetho weThoba sisixhobo esikhawulezayo nesilula esisetyenziselwa ulawulo lokuqala lokuvuselela izigulane ezivuthayo

Uphononongo lufumanise ukuba emva kokuphonononga isigulana esinganxibanga ngokupheleleyo, ipesenti ye-TBSA inokumiselwa nguMthetho weThoba phakathi kwemizuzu.

Izifundo ezininzi ezifunyenwe kuphononongo loncwadi zichaze ukuba intende yesigulane, ngaphandle kweminwe, ibalwa malunga neepesenti ze-0.5 ze-TBSA kwaye ukuqinisekiswa kwafunyanwa ngezicelo ezisekelwe kwikhompyutheni.

Ukufakwa kweminwe entendeni kubalele malunga ne-0.8% ye-TBSA.

Ukusetyenziswa kwesundu, okuyisiseko apho uMthetho weThoba wawusekwe khona, uthathwa njengento efanelekileyo kakhulu kwizinto ezincinci zokutshisa okwesibini kunye nesithathu.

Kuye kwaphawulwa ukuba uqeqesho olungakumbi ingcali inalo, iyancipha i-overestimation, ngakumbi ekutshiseni okuncinci.

Ezinye iingxaki

Ngenxa yobume bendalo bempazamo kuvavanyo lokutshiswa komntu nakwinkqubo yomthetho, usetyenziso olusekwe kwikhompyuter olufumanekayo lwee-smartphones ziveliswa ukunciphisa ngaphezulu kunye nokujongelwa phantsi kweereyithi ze-TBSA.

Usetyenziso lusebenzisa ubungakanani obuqhelekileyo beemodeli ezincinci, eziphakathi kunye nezityebileyo zamadoda nabasetyhini.

Ukusetyenziswa kwakhona kujonge kwimilinganiselo yeentsana ezisanda kuzalwa.

Ezi zicelo zekhompyutha zifumana ukuguquguquka kwingxelo yezinga le-TBSA ukuya kuthi ga kwi-60 yepesenti yoqikelelo olugqithisileyo lomphezulu otshileyo ukuya kutsho kuma-70 ekhulwini kuqikelelo olungaphantsi.

Ukuvuselela ulwelo lwe-intravenous olukhokelwa nguMthetho weThoba lusebenza kuphela kwizigulane ezinepesenti ye-TBSA engaphezu kwama-20% kwaye ezi zigulane kufuneka zithuthwe zisiwe kwiziko le-trauma elikufutshane.

Ngaphandle kweendawo ezikhethekileyo, ezifana nobuso, izitho zangasese kunye nezandla, okufuneka zibonwe yingcali, ukudluliselwa kumaziko amakhulu okwenzakala kuyimfuneko kuphela ngaphezu kwe-20% yokutsha kwe-TBSA.

I-American Burn Association (ABA) iphinde ichaze imigaqo apho izigulane kufuneka zidluliselwe kwiziko lokutshisa.

Emva kokuba ukuvuselelwa kwamanzi kuqalile, kubalulekile ukuchonga ukuba i-perfusion efanelekileyo, i-hydration kunye nomsebenzi wezintso zikhona.

Ukuvuselela okuphuma kuMthetho weThoba kunye nefomula ye-intravenous fluid (i-Parkland, i-Brooke iguqulwe, phakathi kwabanye) kufuneka ihlolwe ngokucophelela kwaye ilungiswe njengoko ezi zikhokelo zokuqala zikhokelo.

Ukulawulwa kokutshisa okukhulu yinkqubo yolwelo efuna ukubekwa esweni rhoqo kunye nohlengahlengiso.

Ukunqongophala kwengqwalasela kwiinkcukacha kunokukhokelela ekwandeni kokugula kunye nokufa njengoko ezi zigulana zigula kakhulu.

Umthetho weThoba, owaziwa ngokuba nguWallace's Rule of Nine, sisixhobo esisetyenziswa ngabasebenzi bezempilo ukuvavanya indawo yonke yomzimba (TBSA) ebandakanyekayo kwizigulane ezitshayo.

Ukulinganiswa kwendawo yokuqala yokutshisa indawo liqela lezempilo libalulekile ekuqikeleleni iimfuno zokuvuselela ulwelo ngenxa yokuba izigulane ezinokutshisa kakhulu zinelahleko enkulu yolwelo ngenxa yokususwa komqobo wesikhumba.

Umsebenzi uhlaziya amaqela okhathalelo lwempilo ngokusetyenziswa koMthetho weThoba kumaxhoba atshileyo aza kuvelisa iziphumo ezingcono kwizigulane. [Inqanaba V].

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