Kev kuaj mob sai ntawm cov kab mob hauv cov hlab ntsha

Cov kab mob hauv cov hlab ntshav (BSI) yog hais txog cov kab mob inflammatory teb uas tshwm sim los ntawm kev cuam tshuam ntawm ntau yam kab mob pathogenic microorganisms thiab lawv cov co toxins rau hauv cov hlab ntsha.

Cov chav kawm ntawm tus kab mob no feem ntau tshwm sim los ntawm kev ua kom muaj zog thiab tso tawm cov kab mob sib kis, ua rau muaj cov tsos mob tshwm sim xws li kub taub hau, ua daus no, ua tsis taus pa tachycardia, ua pob liab liab thiab hloov kev puas siab puas ntsws, thiab mob hnyav, poob siab, DIC thiab ntau yam. - lub cev tsis ua haujlwm, nrog kev tuag siab. tau txais HA) cov mob sepsis thiab septic shock, suav txog 40% ntawm cov neeg mob thiab kwv yees li 20% ntawm ICU tau txais. Thiab nws muaj feem cuam tshuam nrog kev ua haujlwm tsis zoo, tshwj xeeb tshaj yog tsis muaj kev kho tshuaj tua kab mob raws sij hawm thiab kev tswj focal ntawm tus kab mob.

Kev faib cov kab mob hauv cov hlab ntsha raws li qib kev kis kab mob

Bacteremia

Muaj cov kab mob los yog fungi nyob rau hauv cov hlab ntsha.

Septicemia

Kev kho mob syndrome tshwm sim los ntawm kev cuam tshuam ntawm cov kab mob pathogenic thiab lawv cov co toxins mus rau hauv cov hlab ntsha, yog ib qho kab mob loj heev..

Pyohemia

Lub neej ua rau lub cev tsis ua haujlwm tshwm sim los ntawm dysregulation ntawm lub cev teb rau kab mob.

Ntawm qhov kev txhawj xeeb ntau dua ntawm kev kho mob yog ob yam kab mob hauv qab no.

Tshwj xeeb Catheter-associated bloodstream kab mob

Cov kab mob hauv cov hlab ntsha cuam tshuam nrog cov catheters cog rau hauv cov hlab ntsha (xws li, peripheral venous catheters, central venous catheters, arterial catheters, dialysis catheters, etc.).

Tshwj xeeb kab mob endocarditis

Nws yog ib qho kab mob sib kis los ntawm kev tsiv teb tsaws ntawm cov kab mob mus rau endocardium thiab lub plawv li qub, thiab yog tus cwj pwm los ntawm kev tsim cov kab mob tsis tu ncua hauv cov li qub raws li ib qho kev puas tsuaj ntawm cov kab mob, thiab los ntawm kab mob embolic metastasis lossis sepsis vim tsis muaj kab mob hauv lub cev.

Kev phom sij ntawm cov hlab ntsha:

Cov kab mob hauv cov hlab ntshav txhais tau tias yog tus neeg mob uas muaj cov kab mob ntshav zoo thiab cov tsos mob ntawm cov kab mob hauv lub cev. Cov kab mob hauv cov hlab ntsha tuaj yeem ua rau lwm qhov chaw kis kab mob xws li mob ntsws, mob plab, lossis kab mob thawj. Nws tau tshaj tawm tias 40% ntawm cov neeg mob sepsis lossis septic shock yog tshwm sim los ntawm cov kab mob ntshav [4]. Nws kwv yees tias 47-50 lab tus neeg mob sepsis tshwm sim thoob ntiaj teb txhua xyoo, ua rau ntau dua 11 lab tus neeg tuag, nrog qhov nruab nrab ntawm 1 tus neeg tuag txhua 2.8 vib nas this [5].

Muaj cov txheej txheem kuaj mob rau cov kab mob ntshav

01 Pkt

Thaum muaj kab mob hauv lub cev thiab cov tshuaj tiv thaiv kab mob tshwm sim, qhov tso tawm ntawm calcitoninogen PCT nce sai heev nyob rau hauv qhov induction stimulation ntawm cov kab mob co toxins thiab inflammatory cytokines, thiab qib ntawm cov ntshav PCT qhia txog lub xeev loj ntawm tus kab mob thiab yog ib tug zoo qhia ntawm prognosis.

0.2 Cells thiab adhesion yam

Cell adhesion molecules (CAM) tau koom nrog hauv cov txheej txheem physiopathological, xws li lub cev tiv thaiv kab mob thiab cov lus teb inflammatory, thiab ua lub luag haujlwm tseem ceeb hauv kev tiv thaiv kab mob thiab kab mob loj. Cov no suav nrog IL-6, IL-8, TNF-a, VCAM-1, thiab lwm yam.

03 Endotoxin, G test

Gram-negative kab mob nkag mus rau hauv cov hlab ntsha kom tso endotoxin tuaj yeem ua rau endotoxemia; (1,3)-β-D-glucan yog ib qho ntawm cov qauv tseem ceeb ntawm cov phab ntsa ntawm cov kab mob fungal thiab tau nce ntau hauv cov kab mob fungal.

04 Molecular Biology

DNA lossis RNA tso rau hauv cov ntshav los ntawm cov kab mob microorganisms raug kuaj, lossis tom qab kuaj ntshav zoo.

05 ntshav kab lis kev cai

Kab mob los yog fungi nyob rau hauv cov ntshav kab lis kev cai yog "tus qauv kub".

Ntshav kab lis kev cai yog ib qho yooj yim tshaj plaws, qhov tseeb tshaj plaws thiab feem ntau siv txoj hauv kev los kuaj xyuas cov kab mob hauv cov hlab ntsha thiab yog lub hauv paus pathogenic rau kev lees paub cov kab mob ntshav hauv lub cev. Kev tshawb pom ntxov ntawm cov ntshav kab lis kev cai thiab kev kho mob thaum ntxov thiab tsim nyog yog cov kev ntsuas tseem ceeb uas yuav tsum tau coj los tswj cov hlab ntshav.

Ntshav kab lis kev cai yog tus qauv kub rau kev kuaj ntshav cov kab mob, uas tuaj yeem cais cov kab mob kis tau zoo, ua ke nrog kev txheeb xyuas cov txiaj ntsig ntawm cov tshuaj rhiab heev thiab muab cov phiaj xwm kho kom raug thiab raug. Txawm li cas los xij, qhov teeb meem ntawm lub sijhawm tshaj tawm zoo rau cov ntshav kab lis kev cai tau cuam tshuam rau kev kuaj mob raws sijhawm thiab kev kho mob, thiab nws tau tshaj tawm tias cov neeg mob tuag tsis tau kho raws sijhawm thiab cov tshuaj tua kab mob zoo tau nce 7.6% ib teev tom qab 6 teev. thawj hypotension.

Yog li, tam sim no cov ntshav kab lis kev cai thiab kev txheeb xyuas cov tshuaj rhiab heev rau cov neeg mob uas xav tias muaj kab mob hauv cov hlab ntsha feem ntau yog siv cov txheej txheem qhia peb-tier, xws li: kev qhia thawj (kev qhia txog tus nqi tseem ceeb, cov txiaj ntsig smear), kev qhia theem nrab (kev qhia ceev ceev lossis / thiab kev siv tshuaj ncaj qha. ceeb toom) thiab tertiary tshaj tawm (kev tshaj tawm zaum kawg, suav nrog lub npe strain, lub sij hawm ceeb toom zoo thiab cov txiaj ntsig ntawm kev ntsuas tshuaj rhiab heev) [7]. Thawj daim ntawv tshaj tawm yuav tsum tau tshaj tawm rau lub tsev kho mob tsis pub dhau 1 teev ntawm qhov pom zoo ntawm cov ntshav vial; tsab ntawv ceeb toom tertiary yog xav kom ua kom tiav sai li sai tau (feem ntau nyob rau hauv 48-72 h rau cov kab mob) nyob ntawm seb qhov chaw kuaj mob.