Ukusha, sibi kangakanani isiguli? Ukuhlola ngomthetho ka-Wallace wesishiyagalolunye

By UCristiano Antonino On Apr 26, 2023

Umthetho Wesishiyagalolunye, owaziwa nangokuthi Umthetho Wesishiyagalolunye KaWallace, iyithuluzi elisetshenziselwa ukuhlukumezeka kanye nemithi ephuthumayo ukuhlola indawo yonke yomzimba (TBSA) ehilelekile ezigulini ezishile.

Ukubhekana nesimo esiphuthumayo esihilela amathuba okusha kanzima kubangela isivinini esithile sokuhlola.

Ngakho-ke kubalulekile ukuthi umhlengi ahlonyiswe ngolwazi oluyisisekelo oluzomsiza ukuthi akwazi ukuhlaka kahle lowo oshile.

Ukulinganisa indawo yokuqala yokusha kubalulekile ekulinganiseni izidingo zokuvuselela uketshezi njengoba iziguli ezishile kakhulu zizolahlekelwa uketshezi olukhulu ngenxa yokususwa kwesithiyo sesikhumba.

Leli thuluzi lisetshenziselwa ukusha kwezinga lesibili kanye nelesithathu kuphela (okubuye kubizwe ngokuthi ukujiya okuyingxenye kanye nokushiswa okugcwele) futhi lisiza umhlinzeki ekuhloleni okusheshayo ukuze anqume ubunzima kanye nezidingo zoketshezi.

Ukuguqulwa koMthetho Wesishiyagalolunye kungenziwa ngokuya nge-body mass index (BMI) kanye neminyaka

Umthetho Wesishiyagalolunye ufakazele ukuthi uyi-algorithm evame ukushiwo odokotela nabahlengikazi ukuze balinganisele indawo eshile ezifundweni eziningi.[1][2][3]

Umthetho Wesishagalolunye Ukulinganisa kwendawo yomzimba oshile kusekelwe ekunikeni amaphesenti ezindaweni ezahlukene zomzimba.

Ikhanda lonke lilinganiselwa ku-9% (4.5% ngaphambili nangemuva).

Umzimba wonke ulinganiselwa ku-36% futhi ungabuye uhlukaniswe ube ngu-18% ngaphambili no-18% ngemuva.

Ingxenye engaphambili ye-trunk ingabuye ihlukaniswe ibe yi-thorax (9%) kanye nesisu (9%).

Amaphethelo angaphezulu afinyelela ku-18% bese kuba ngu-9% endaweni ngayinye ephezulu. Umkhawulo ngamunye ongaphezulu ungaphinde uhlukaniswe ube ngaphambili (4.5%) nangemuva (4.5%).

Izitho ezingezansi zilinganiselwa ku-36%, 18% ngesitho ngasinye esingezansi.

Futhi lokhu kungabuye kuhlukaniswe ku-9% ku-aspect yangaphambili kanye ne-9% yesici sangemuva.

I-groin ilinganiselwa ku-1%.[4][5]

Umsebenzi Womthetho Wesishiyagalolunye

Umthetho Weziyisishiyagalolunye usebenza njengethuluzi lokuhlola indawo engaphezulu yomzimba enezinga lesibili nelesithathu (i-TBSA) ezigulini ezishile.

Uma i-TBSA isinqunyiwe futhi isiguli sizinzile, ukuvuselela uketshezi ngokuvamile kungase kuqale ngokusetshenziswa kwefomula.

Ifomula yaseParkland ivame ukusetshenziswa.

Ibalwa njengoketshezi olu-4 ml lwe-intravenous (IV) ngekhilogremu ngayinye yesisindo somzimba esifanelekile ngephesenti ngalinye le-TBSA (elichazwa njengedesimali) emahoreni angama-24.

Ngenxa yemibiko yokuphefumula ngokweqile, amanye amafomula aye ahlongozwa njengefomula ye-Brooke eshintshiwe, eyehlisa uketshezi lwe-IV lube ngu-2 ml esikhundleni sika-4 ml.

Ngemuva kokuthola umthamo ophelele wokuvuselela ngoketshezi olufakwa emthanjeni emahoreni angama-24 okuqala, ingxenye yokuqala yevolumu iphathwa emahoreni ayi-8 okuqala kanti enye ingxenye isetshenziswa emahoreni ayi-16 alandelayo (lokhu kuguqulwa kube isilinganiso sehora ngokuhlukanisa. ingxenye yevolumu ephelele ka-8 no-16).

Isikhathi sevolumu yamahora angama-24 siqala ngesikhathi sokusha.

Uma isiguli sibonisa amahora angu-2 ngemva kokushiswa nokuvuselelwa koketshezi kungakaqalwa, ingxenye yokuqala yevolumu kufanele ilawulwe emahoreni angu-6 nengxenye esele yoketshezi ilawulwa njengephrothokholi ngayinye.

Ukuvuselela uketshezi kubaluleke kakhulu ekulawuleni kokuqala kokusha kweziqu zesibili nesesithathu okuhlanganisa ngaphezu kwamaphesenti angu-20 e-TBSA njengoba izinkinga zokuhluleka kwezinso, i-myoglobinuria, i-hemoglobininuria kanye nokwehluleka kwezitho eziningi uma kungelashwanga ngonya kusenesikhathi.

Ukufa kuboniswe ukuthi kuphakeme ezigulini ezinokusha kwe-TBSA ezingaphezu kuka-20% ezingakutholi ukuvuselelwa koketshezi okufanele ngokushesha ngemva kokulimala.[6][7][8]

Kunokukhathazeka phakathi kodokotela mayelana nokunemba koMthetho Wesishiyagalolunye wabantu abakhuluphele kanye nezingane

Umthetho Wesishiyagalolunye ungasetshenziswa kangcono ezigulini ezinesisindo esingaphezu kwamakhilogremu angu-10 nangaphansi kwamakhilogremu angu-80 uma kuchazwa i-BMI njengengaphansi kokukhuluphala.

Ezinsaneni kanye neziguli ezikhuluphele, ukunakwa okukhethekile kufanele kukhokhwe kulokhu okulandelayo:

Iziguli ezikhuluphele

Iziguli ezichazwa njengokukhuluphala ngokweqile yi-BMI zineziqu ezinkulu ngokulinganayo uma kuqhathaniswa nozakwabo abangakhuluphali.

Iziguli ezikhuluphele zine-TBSA esondele ku-50% yesiqu, i-TBSA engu-15% emlenzeni ngamunye, i-TBSA engu-7% engalweni ngayinye kanye ne-TBSA engu-6% ekhanda.

Iziguli ezimise okwe-Android, ezichazwa njengokusabalalisa okukhethekile kwezicubu ze-adipose emzimbeni (isisu, isifuba, amahlombe kanye intamo), babe nesiqu esisondele ku-53% we-TBSA.

Iziguli ezinesimo se-gynoid, esichazwa njengokusabalalisa okukhethekile kwezicubu ze-adipose ezansi nomzimba (isisu esingezansi, i-pelvis namathanga), zinesiqu esiseduze nama-48% we-TBSA.

Njengoba izinga lokukhuluphala likhula, izinga lokungabukelwa phansi kokubandakanyeka kwe-TBSA kwesiqu nemilenze liyakhula lapho kulandelwa uMthetho Wesishiyagalolunye.

izinsana

Izinsana zinamakhanda amakhulu ngokulinganayo ashintsha umnikelo ongaphezulu kwamanye amasegimenti omzimba amakhulu.

'Umthetho Wesishiyagalombili' ungcono kakhulu ezinganeni ezinesisindo esingaphansi kuka-10 kg.

Lo mthetho ubeka cishe u-32% we-TBSA womboko wesiguli, u-20% we-TBSA ekhanda, u-16% we-TBSA emlenzeni ngamunye kanye no-8% we-TBSA engalweni ngayinye.

Naphezu kokusebenza kahle koMthetho Wesishiyagalolunye kanye nokungena kwawo emikhakheni ekhethekile yemithi yokuhlinzwa kanye nezimo eziphuthumayo, ucwaningo lubonisa ukuthi ku-25% TBSA, 30% TBSA kanye ne-35% TBSA, iphesenti le-TBSA lilinganiselwe ngo-20% uma kuqhathaniswa nezinhlelo zokusebenza ezisekelwe kukhompyutha.

Ukulinganisa ngokweqile kwe-TBSA eshisiwe kungaholela ekuphefumuleni okweqile ngoketshezi olufakwa emthanjeni, okunikeza ithuba lokugcwala kwevolumu kanye ne-pulmonary edema ngokukhuphuka kwesidingo senhliziyo.

Iziguli ezinezinkinga ezikhona ngaphambilini zisengozini yokuwohloka kwenhliziyo kanye nokuphefumula futhi kufanele ziqashwe egunjini labagula kakhulu (ICU) phakathi nesigaba esinamandla sokuvuselela uketshezi, okungcono kakhulu endaweni yokusha.[9][10]

I-Rule of Nine iyithuluzi elisheshayo nelilula elisetshenziselwa ukuphathwa kokuqala kokuvuselela ezigulini ezishile

Ucwaningo luthole ukuthi ngemva kokuhlola isiguli esingagqokile ngokuphelele, iphesenti le-TBSA linganqunywa Umthetho Wesishiyagalolunye phakathi nemizuzu.

Ucwaningo oluningana olutholwe ekubuyekezweni kwezincwadi luthi intende yesiguli, ngaphandle kweminwe, ibalwa cishe ngamaphesenti angu-0.5 we-TBSA nokuthi ukuqinisekiswa kutholwe ngezinhlelo zokusebenza ezisekelwe kukhompyutha.

Ukufakwa kweminwe entendeni kwenza cishe u-0.8% we-TBSA.

Ukusetshenziswa kwesundu, okuyisisekelo okwasungulwa uMthetho Weziyisishiyagalolunye, kubhekwa njengokufanelekile kakhulu ekushiseni okuncane kwesibili nesesithathu.

Kuye kwaphawulwa ukuthi lapho uchwepheshe eba nokuqeqeshwa okwengeziwe, kuyancipha ukucabangela ngokweqile, ikakhulukazi ekushiseni okuncane.

Ezinye izinkinga

Ngenxa yemvelo yephutha ekuhlolweni kokushiswa komuntu ngisho nasezimisweni zemithetho, izinhlelo zokusebenza ezisekelwe kukhompuyutha ezitholakalayo zama-smartphone zikhiqizwa ukuze kuncishiswe ukweqiwa nokubukelwa phansi kwamazinga e-TBSA.

Izinhlelo zokusebenza zisebenzisa osayizi abajwayelekile bamamodeli amancane, aphakathi nendawo nakhuluphele abesilisa nabesifazane.

Izicelo nazo zibheke ekulinganisweni kwezingane ezisanda kuzalwa.

Lezi zinhlelo zekhompuyutha zithola ukuguquguquka ekubikweni kwamazinga e-TBSA afinyelela kumaphesenti angama-60 okulinganisa ngokweqile kwendawo eshile kuze kufike kumaphesenti angama-70 wokubukelwa phansi.

Ukuvuselelwa koketshezi olungena emthanjeni okuqondiswa uMthetho Weziyisishiyagalolunye kusebenza kuphela ezigulini ezinephesenti le-TBSA elingaphezu kuka-20% futhi lezi ziguli kufanele zithuthelwe esikhungweni sokuhlukumezeka esiseduze.

Ngaphandle kwezindawo ezikhethekile, njengobuso, izitho zangasese nezandla, okufanele zibonwe nguchwepheshe, ukudluliselwa ezikhungweni zokuhlukumezeka ezinkulu kuyadingeka kuphela ngaphezu kwama-20% okushiswa kwe-TBSA.

I-American Burn Association (ABA) nayo ichaze izindlela okufanele iziguli zidluliselwe esikhungweni sokusha.

Uma ukuvuselela uketshezi sekuqalile, kubalulekile ukukhomba ukuthi ukugcotshwa okufanelekile, ukufakwa kwamanzi kanye nokusebenza kwezinso kukhona yini.

Ukuvuselela okuvela kuMthetho Wesishiyagalolunye kanye nefomula yoketshezi olungena emthanjeni (i-Parkland, i-Brooke elungisiwe, phakathi kokunye) kufanele iqashwe ngokucophelela futhi ilungiswe njengoba lawa manani okuqala eyiziqondiso.

Ukulawulwa kokusha okukhulu kuyinqubo ewuketshezi edinga ukuqapha nokulungiswa njalo.

Ukunganakwa kwemininingwane kungaholela ekwandeni kokugula nokufa njengoba lezi ziguli zigula kakhulu.

Umthetho Wesishiyagalolunye, owaziwa nangokuthi Umthetho Wesishiyagalolunye Ka-Wallace, iyithuluzi elisetshenziswa ochwepheshe bezokunakekelwa kwempilo ukuhlola indawo yonke yomzimba (TBSA) ehilelekile ezigulini ezishile.

Ukukalwa kwendawo yokuqala yokusha yithimba lezokunakekelwa kwempilo kubalulekile ekulinganiseni izidingo zokuvuselela uketshezi ngoba iziguli ezishile kakhulu zilahlekelwa uketshezi olukhulu ngenxa yokususwa kwesithiyo sesikhumba.

Lo msebenzi ubuyekeza amaqembu okunakekelwa kwezempilo ngokusetshenziswa koMthetho Wesishiyagalolunye kuzisulu ezishile ozoveza imiphumela engcono ezigulini. [Izinga V].

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