Ntshav ntshav rau dev

 Hemotransfusion yog kev hloov pauv ntawm cov tsiaj muaj mob nrog rau cov ntshav tag nrho, lossis cov khoom xyaw, lossis cov plasma protein npaj. Qhov no yog ib txoj kev mob hnyav heev.Hauv 80% ntawm cov neeg mob, kev tso ntshav hauv cov dev yog tshwm sim los ntawm ntshav qab zib, thiab hauv 20% - los ntawm hemorrhagic shock. Kev muab ntshav qee zaum cawm tus dev txoj sia thiab ua lub luag haujlwm txiav txim siab kom kov yeej qhov xwm txheej tseem ceeb.

Lub hom phiaj ntawm kev muab ntshav rau cov dev

1. Hloov pauv. Erythrocytes tau txais los ntawm tus neeg pub dawb nyob hauv tus neeg tau txais cov ntshav rau 1-4 lub hlis, uas ua rau cov pa oxygen nce ntxiv hauv cov ntaub so ntswg.
2. Stimulation - qhov cuam tshuam rau ntau lub cev thiab lub cev ntawm tus dev.
3. Kev txhim kho hauv hemodynamics. Txhim kho kev ua haujlwm ntawm cov hlab plawv, ua kom lub ntim ntim ntawm lub plawv, thiab lwm yam.
4. hemostatic phiaj. Homeostasis yog stimulated, nruab nrab hyperoagulation yog pom.

Cov lus qhia rau kev hloov ntshav hauv cov dev

1. Cov tsos mob tshwm sim los ntshav, uas qhia tau hais tias los ntawm daj ntseg mucous daim nyias nyias, tsis muaj zog thiab nquag mem tes, txias paws.
2. Cov ntshav poob ntev thiab tsis ruaj khov hemodynamics, qhia tias tsis muaj oxygen rau cov ntaub so ntswg txaus.
3. Non-recovering anemia ntawm ntau yam etiologies.
4. Cov kab mob los yog tau txais coagulopathy, thrombocytopenia, leukopenia, hypoproteinemia.

Cov khoom siv ntshav rau cov dev

Txoj kev yooj yim tshaj plaws kom tau txais cov khoom los ntawm cov ntshav tshiab. Yog li ntawd, nws yog dav siv nyob rau hauv veterinary tshuaj. Erythrocytes cov kaus poom, khaws cia txias (kub 3 - 6⁰C) thiab siv rau 30 hnub los yog kom txog thaum cov erythrocytes hloov pauv. Erythromass yog qhov tsim nyog los ntxiv cov khoom cia ntawm erythrocytes (rau mob ntshav qab zib) lossis muaj kev pheej hmoo ntawm overloading nrog cov kua dej ntxiv. Nws kuj yog siv rau kev mob ntshav siab (ua ke nrog crystalloids). Plasma yog qhov tsim nyog los kho cov kab mob ntshav khov, incl. cov khoom tsis ruaj khov. Cov khoom yog khaws cia ntawm -40⁰C hauv 1 xyoos. Ua ntej kev txhaj tshuaj, nws yog rhuab mus rau +30 - 37⁰C, thiab tom qab ntawd txhaj rau hauv tus dev lub cev sai li sai tau.

Cov txheej txheem ntawm kev tswj hwm

Raws li txoj cai, cov ntshav thiab nws cov khoom xyaw yog muab intravenously. Yog tias nws tsis tuaj yeem txhaj cov ntshav mus rau hauv cov hlab ntsha (abscesses, edema hnyav), siv cov intraosseous infusion.

Kev pheej hmoo thiab teeb meem ntawm ntshav ntshav hauv cov dev

Cov teeb meem mob hnyav yog txuam nrog kev ua txhaum ntawm cov kua qaub-puag cov ntshav, kev ua yuam kev hauv cov txheej txheem hloov pauv, thiab kev cuam tshuam hemodynamic. Cov teeb meem ncua sij hawm tuaj yeem cuam tshuam nrog kev hloov pauv ntawm overheated, hemolyzed lossis mob ntshav: tom qab hloov pauv (hemolytic) poob siab, citrate (anaphylactic) poob siab, kab mob sib kis. Cov tshuaj tiv thaiv tsis yog tshuaj tiv thaiv kab mob (mob mob) tshwm sim ua npaws. Yog vim li cas yog cov tshuaj tiv thaiv ntawm ib qho antigen thiab cov tshuaj tiv thaiv uas muaj cov platelets, granulocytes los yog lymphocytes, los yog cov kab mob paug ntawm cov ntshav. Qee zaum muaj kev tsis haum tshuaj (urticaria nrog khaus thiab pob liab liab). Ib qho ntxiv load ntawm cov hlab ntsha yog qhia los ntawm ntuav, tachycardia, chim siab, hnoos, ua tsis taus pa los yog cyanosis. Lwm yam kev pheej hmoo:

• pulmonary edema
• kis tau tus kab mob
• ua npaws
• post-transfusion circulatory overload
• hypervolemia
• mob ntshav qab zib tshwm sim
• Syndrome ntawm ntau lub cev tsis ua haujlwm, thiab lwm yam.

 Lub ntsws, daim siab, cov qog endocrine thiab lwm yam kab mob thiab cov kabmob tuaj yeem cuam tshuam. Overloading tuaj yeem ua rau mob hnyav thiab mob plawv. Kev hloov pauv tuaj yeem ua rau muaj cov nyhuv immunomodulatory thiab ua rau muaj kev pheej hmoo ntawm cov kab mob nosocomial, mob ntsws raug mob, kab mob autoimmune. Qhov teeb meem loj tshaj plaws yog anaphylactic shock. Yog tias txawm tias cov cim me me tshwm sim, kev tso ntshav yuav tsum tau nres sai li sai tau.

Kev muab ntshav rau cov dev ua ib txoj kev kho mob

Cov txheej txheem no tau dhau los ua qhov tseem ceeb hauv xyoo tas los no. Nws cov txiaj ntsig tau rov qab lees paub hauv kev kho mob ntawm ntau yam kab mob hematological. Vim qhov yooj yim ntawm cov kab mob ntshav canine thiab cov qib qis ntawm cov isoantibodies tshwm sim, cov kws kho tsiaj yuav luag tsis quav ntsej txog qhov tsis sib haum xeeb ntawm cov ntshav ntawm tus neeg tau txais kev pab thiab tus neeg pub dawb. nyob rau hauv ib tug dev tsis muaj kev puas tsuaj rau kev noj qab haus huv (txog 10 ml / kg). Kev kuaj ntshav tom ntej yog ua tsis pub dhau 45 - 60 hnub.

Leej twg tuaj yeem ua tus pub dawb

Ib zaug ib tug dev tuaj yeem hloov nrog cov ntshav ntawm txhua pab pawg. Tab sis yog tias yuav tsum tau txhaj tshuaj ntxiv, hom ntshav yuav tsum sib npaug. Rh-negative dev tsuas tau txais cov ntshav Rh-negative xwb. Txhua cov ntshav tuaj yeem tau txais los ntawm Rh-positive dev. Qee zaum yuav tsum tau txhaj ntshav sai. Nyob rau hauv cov ntaub ntawv no, yog siv ib tug "random" pub (ib tug noj qab haus huv aub uas tau mus rau hauv lub tsev kho mob rau txhaj tshuaj tiv thaiv, ntsia thawv trimming, thiab lwm yam) los yog ib tug tsiaj ntawm ib tug kws kho mob. Tus tsiaj yuav tsum yog los ntawm 1,5 mus rau 8 xyoo, nws yuav tsum noj qab nyob zoo kiag li .Lawv noj qab haus huv, docile dev li pub. Lub cev hnyav ntawm tus dev pub (cov leeg nqaij) yuav tsum yog ntau tshaj 25 kg. Hom ntshav zoo tshaj yog DEA 1.1. tsis zoo. Yog hais tias tus pub yog ib tug poj niam, nws yuav tsum yog nuliparous. Tus neeg pub dawb yuav tsum tsis txhob tawm hauv cheeb tsam.

Saib xyuas tus dev tus mob thaum muab ntshav

Txhua 15-30 feeb thaum muab tshuaj thiab 1, 12, 24 teev tom qab cov txheej txheem, cov kev ntsuas hauv qab no raug soj ntsuam:

1. Cwj pwm.
2. Qhov zoo thiab kev siv ntawm cov mem tes.
3. Qhov kub thiab txias.
4. Qhov xwm thiab kev siv ua pa.
5. Xim ntawm cov zis thiab ntshav.
6. Mucosal xim, capillary refill lub sij hawm.
7. Prothrombin lub sij hawm thiab hematocrit raug saib xyuas ua ntej, tam sim ntawd tom qab ua tiav, thiab 12 thiab 24 teev tom qab tso zis.

Cov ntshav dev

Nws ntseeg tias dev muaj 7 hom ntshav. Qhov no tsis muaj tseeb kiag li. Sau npe A – G yog ib pawg ntawm cov ntshav, los yog, tsuas yog 1 ntawm cov kev xaiv rau xyoo 1961 "tso tawm". Txij thaum ntawd los, ntau qhov kev sim ntau ntxiv tau ua kom yooj yim cov ntaub ntawv, thiab xyoo 1976 tau tsim DEA nomenclature, uas tam sim no feem ntau lees txais hauv Tebchaws Meskas. Raws li cov npe no, cov ntshav tuaj yeem raug xaiv raws li DEA 1.1, DEA 1.2, DEA 3, DEA 4, DEA 5, DEA 7 thiab DEA 8. DEA 1 system yog qhov tseem ceeb tshaj plaws hauv kev kho mob. Cov kab ke no muaj 3 pawg gene-protein khub thiab 4 qhov ua tau phenotypes: DEA 1.1., 1.2, 1.3 thiab 0. Ib tug dev tsuas muaj 1 phenotype xwb. Tab sis cov dev tsis muaj cov tshuaj tiv thaiv kab mob rau cov tshuaj tiv thaiv ntawm lwm pab pawg, yog li tus dev uas tsis tau txhaj ntshav ua ntej tuaj yeem hloov nrog cov ntshav yam tsis muaj DEA 1.1 compatibility, thiab kev hloov pauv yuav ua tau zoo. Tab sis yog tias qhov kev txhaj tshuaj thib ob yog qhov tsim nyog, muaj teeb meem tshwm sim. Thaum DEA 1 hloov mus rau tus neeg txais qhov tsis zoo (phenotype 0) ntawm cov ntshav ntawm tus neeg pub dawb DEA 1 zoo (ib yam phenotype tshwj tsis yog 0), tus neeg tau txais lub cev tom qab 7 mus rau 10 hnub tuaj yeem tsim cov tshuaj tiv thaiv rau DEA 1 antigen, uas rhuav tshem. cov qe ntshav liab, uas muaj cov tshuaj tiv thaiv no. Nyob rau hauv lub neej yav tom ntej, xws li ib tug neeg tau txais kev pab yuav xav tau tsuas yog cov ntshav ntawm DEA 1-tsis zoo cov ntshav, txwv tsis pub, es tsis txhob ntawm tus qauv 3 lub lis piam, erythrocytes pub dawb yuav nyob rau hauv tus neeg txais lub cev, qhov zoo tshaj plaws, tsuas yog ob peb teev, los yog txawm ob peb feeb, uas. nullifies cov nyhuv ntawm kev tso ntshav, thiab tej zaum yuav ua rau qhov teeb meem loj dua. Hauv qhov no, tus neeg pub dawb DEA 1 zoo tuaj yeem hloov pauv nrog cov ntshav ntawm DEA 1-tsis zoo, txawm li cas los xij, nrog rau tus neeg pub dawb no yeej tsis tau txais. DEA 1 antigen yog sawv cev los ntawm ntau qhov sib txawv: DEA 1.1, DEA 1.2., DEA 1.3. ntshav DEA 1. cov tshuaj tiv thaiv uas tsim los ntawm nws instantly rhuav tshem cov qe ntshav liab nrog DEA ​​1.1. thiab ua rau mob hemolytic cov tshuaj tiv thaiv, fraught nrog cov teeb meem loj. Hauv qhov no, cov qe ntshav liab nrog DEA 1.2 thiab 1.3 yuav agglutinate cov tshuaj tiv thaiv no, tab sis tsis ua rau lawv puas tsuaj (txawm tias qhov no kuj yog qhov phem rau tus neeg mob). Yog tias peb tham txog DEA 3 system, tus dev tuaj yeem yog DEA 3 zoo lossis tsis zoo. Kev hloov ntshav ntawm DEA 3 zoo rau hauv cov tsiaj uas muaj cov tshuaj tiv thaiv kab mob uas tsim nyog (kawm lossis tus kheej) rhuav tshem tus neeg pub ntshav cov qe ntshav liab thiab tuaj yeem ua rau mob ntshav siab hauv 5 hnub tom ntej. Lub DEA 4 system kuj muaj qhov + thiab - phenotypes. Yog tsis muaj kev txhaj tshuaj ua ntej, DEA 4-tsis zoo dev tsis muaj tshuaj tiv thaiv rau DEA 4. Kev rov ua dua ntawm DEA 4-tsis zoo tus neeg txais, txawm tias muaj cov tshuaj tiv thaiv rau DEA 4, tsis ua rau cov tshuaj tiv thaiv hemolytic. Txawm li cas los xij, ib rooj plaub ntawm hemolysis paub nyob rau hauv ib tug dev uas tau txais cov ntshav tsis sib haum ob peb zaug ua ke. Lub DEA 5 system kuj zoo thiab tsis zoo. 10% ntawm DEA 5-negative tsiaj muaj cov tshuaj tiv thaiv rau DEA 5. Kev muab ntshav rau tus neeg mob rhiab heev ua rau muaj cov tshuaj tiv thaiv hemolytic thiab tuag ntawm tus neeg pub dawb erythrocytes hauv peb hnub. DEA 6 system muaj 2 phenotypes, + thiab -. Feem ntau, tsis muaj cov tshuaj tiv thaiv rau cov antigen no. Kev hloov ntshav mus rau tus neeg tau txais txiaj ntsig tau ua rau muaj kev hloov pauv nruab nrab ntawm cov tshuaj tiv thaiv kab mob thiab txo qis hauv lub neej ntawm cov qe ntshav liab pub dawb. DEA 7 system muaj 3 phenotypes: tsis zoo, 0, thiab Tr. Cov tshuaj tiv thaiv rau Tr thiab 0 muaj nyob rau hauv 25% ntawm DEA-negative tsiaj, tab sis lawv tsis muaj cov nyhuv hemolytic. Tab sis nrog rau tom qab rhiab heev, lwm tus tau tsim muaj peev xwm decompose cov ntshav pub dawb hauv tsawg dua 3 hnub. DEA 8 system tsis tau kawm kom raug. Ntxiv rau qhov saum toj no, muaj lwm cov tshuab uas tsis suav nrog hauv DEA, txij li lawv tau tshawb pom tsis ntev los no, thiab ntau lub tshuab tshwj xeeb rau qee hom tsiaj (piv txwv li, oriental dev - Shibu-in, thiab lwm yam) Muaj cov khoom siv kuaj mob. rau kev txiav txim qhov tsis tuaj los yog muaj DEA 1.1., 1.2, 3, 4, 5 thiab 7 antigens, tab sis lawv kim heev. Raws li txoj cai, nyob rau hauv kev muaj tiag, tshwj xeeb tshaj yog nyob rau hauv me me lub zos, tsis muaj npaj txhij-ua pub, thiab compatibility yog txiav txim siab "ntawm iav".