Edema Pūkahukahu

Ko te mumura o te pūkahukahu he āhuatanga e puta mai ana i te nui o te wai i roto i ngā pūkahukahu. Ka kohikohi tēnei wai ki roto i ngā putea hau maha o ngā pūkahukahu, ā, ka uaua ai te manawa.

I te nuinga o ngā wā, ko ngā raruraru o te ngakau te take o te mumura o te pūkahukahu. Engari ka taea e te wai te kohikohi ki roto i ngā pūkahukahu mō ētahi atu take. Kei roto i ēnei ko te mumura o te pūkahukahu, te pā ki ētahi pokanoa, ngā rongoā, te whara ki te pakitara uma, me te haere ki runga, ki te whakakori rānei i ngā wāhi teitei.

Ko te mumura o te pūkahukahu e puta mai ana i te tere (te mumura o te pūkahukahu ohorere) he āhuatanga mate e hiahia ana ki te tiaki wawe. Ka taea e te mumura o te pūkahukahu te mate i ētahi wā. Ka āhei pea te awhina o te rongoā tere. Ko te rongoā mō te mumura o te pūkahukahu e whakawhirinaki ana ki te take, engari ko te nuinga o ngā wā kei roto ko te oksikena atu me ngā rongoā.

Ka puta mai ngā tohu o te mumura o ngā pūkahukahu pea i te wa poto, ā, pea ka tupu haere i te wā. Ko ngā tohu e whakaatu ana ka whakawhirinaki ki te momo mumura o ngā pūkahukahu.

Ko te pupū o te manawa e puta mai ana i te wa poto (pupū o te manawa ohorere) he mea whakamate. Karangatia te 911, te 111 ranei, ki te awhina hauora ohorere, ki te whai koe i ētahi o ēnei tohu ohorere:

• Te poto o te manawa, ina koa ki te puta mai i te wa poto
• Te raruraru o te manawa, te ngaungaunau ranei (dyspnea)
• He oro pupū, he ngunguru ranei i te manawa
• Te kohukohu i te waipū e whero ana, kei roto ranei te toto
• Te uaua o te manawa me te tino werawera
• He kikorangi, he hina ranei te kiri
• Te pohehe
• Te heke nui o te toto e puta ai te māngere, te wiri, te ngoikore ranei
• Te kino ohorere o ētahi o ngā tohu o te pupū o te manawa

Kaua e tarai koe ki te hōhipera. Karangatia te 911, te 111 ranei, ki te awhina hauora ohorere, ka tatari ki te awhina.

Ko ngā take o te mumura o ngā pūkahukahu e rerekē ana. Ka wehewehea te mumura o ngā pūkahukahu ki ngā wāhanga e rua, kei te wāhi e tīmata ai te raruraru.

• Ki te mea he raruraru ngākau te take o te mumura o ngā pūkahukahu, ka kiia ko te mumura o ngā pūkahukahu cardiogenic. Ko te nuinga o te wā, ko te nui o te wai i roto i ngā pūkahukahu nā te āhuatanga o te ngākau.
• Ki te kore te mumura o ngā pūkahukahu e pā ana ki te ngākau, ka kiia ko te mumura o ngā pūkahukahu noncardiogenic.
• I etahi wā, ka taea te whakaohooho i te mumura o ngā pūkahukahu e te raruraru ngākau me te raruraru kore-ngākau.

Ko te mārama ki te hononga i waenganui i ngā pūkahukahu me te ngākau ka āhei te whakamārama i te take pea ka puta mai te mumura o ngā pūkahukahu.

Ka piki ake te tūponotanga o te mumura o ngā pūkahukahu (pulmonary edema) i ngā mate ngākau me ētahi atu āhuatanga o te ngākau e whakapiki ake ana i te pehanga i roto i te ngākau. Ko ētahi o ngā take morearea mō te korenga o te ngākau ko:

• Ngā rōpū o te ngākau kaore i te tika (arrhythmias)
• Te inu waipiro
• Te mate ngākau whānau
• Te mate o ngā āti o te ngākau
• Te mate huka
• Te mate o ngā taumanu o te ngākau
• Te pehanga toto teitei
• Te apnea moe

Ka piki ake hoki te tūponotanga i ētahi āhuatanga o te pūnaha io me te kino o ngā pūkahukahu nā te tata kī, te whakamahinga rongoā, te ngau i te paowa, ngā mate huaketo me ngā toto kōtiti.

He nui ake te tūponotanga o te hunga e haere ana ki ngā wāhi teitei ake i te 8,000 putu (tau 2,400 mita) ki te whanake i te mumura o ngā pūkahukahu i teitei (HAPE). Ko te nuinga te pānga ki te hunga kaore i whakapau i te wā – i etahi ra ki te wiki, ki te roa atu – ki te whakamahi i te teitei.

Ka nui ake pea te tūponotanga o ngā tamariki kua pangia e te pehanga toto o ngā pūkahukahu me ngā hapa hanganga o te ngākau ki te whiwhi HAPE.

Ko ngā raruraru o te pupū ngākau e ngākau ana ki te take.

Hei te nuinga, ki te haere tonu te pupū ngākau e ngākau ana, ka piki te pehanga i roto i te āti pupū (te toto teitei o te pupū). I te mutunga, ka ngoikore te ngakau ka timata te kore, ka piki ake te pehanga i roto i te ngakau me te ngākau.

Ko ngā raruraru o te pupū ngākau e ngākau ana pea:

• Te uaua o te manawa
• Te pupū o ngā waewae, ngā waewae me te puku
• Te hanga o te wai i roto i ngā kiri e karapoti ana i te ngākau (te pupū o te pleural)
• Te kōkī me te pupū o te ate

He mea tika te rongoā wawe mō te pupū ngākau e ngākau ana kia ārai ai i te mate.

Ka taea pea e koe te aukati i te mumura o te pūkahukahu mā te whakahaere i ngā āhuatanga o te ngakau, o te pūkahukahu rānei, me te whai i te oranga hauora. Hei tauira, ka taea e te whakahaere i te kolesterol me te toto te whakaiti i te tūponotanga o te mate ngakau. Whai i ēnei tohutohu hei tiaki i tō ngakau:

• Kai kai hauora e whai hua ana i ngā hua hou, ngā huawhenua, ngā witi katoa, te waiū momona iti, me te maha o ngā pūmua.
• Kaua e whakakī.
• Haere ki te whakakori tinana.
• Whakaitihia te tote me te waipiro.
• Whakahaerehia te ahotea.
• Whakahaerehia te taumaha.

Ko ngā raruraru manawa e hiahia ana ki te whakamātautau me te rongoā wawe. Ka taea e te kaiwhakarato hauora te whakawhirinaki ki te tātaritanga o te mumura o te pūkahukahu i runga i ngā tohu me ngā hua o te whakamātautau tinana me ētahi whakamātautau.

Ina kua pumau ake te āhuatanga, ka taea e te kaiwhakarato te uiui mō te hītori hauora, inā te hītori o te mate ngakau, o te mate pūkahukahu rānei.

Ko ngā whakamātautau ka taea te awhina i te tātaritanga o te mumura o te pūkahukahu, te whakatau rānei i te take o te wai i roto i ngā pūkahukahu, ko ēnei:

• X-ray uma. Ka taea e te X-ray uma te whakau i te tātaritanga o te mumura o te pūkahukahu, me te whakakore i ētahi atu take pea o te poto o te manawa. Ko te tikanga koinei te whakamātautau tuatahi ka mahia ina whakaaro te kaiwhakarato hauora he mumura te pūkahukahu.
• CT scan uma. Ka homai e te CT scan uma ngā kōrero atu mō te āhua o ngā pūkahukahu. Ka taea te awhina i te kaiwhakarato ki te tātaritanga, ki te whakakore rānei i te mumura o te pūkahukahu.
• Pulse oximetry. Ka honoa he pūoko ki te matihao, ki te taringa rānei. Ka whakamahia te mārama hei whakatau i te nui o te hāora i roto i te toto.
• Whakamātautau hau toto arterial. Ka ine tenei whakamātautau i te nui o te hāora me te kāponikara i roto i te toto.
• Whakamātautau toto B-type natriuretic peptide (BNP). Ka taea e te nui ake o te B-type natriuretic peptide (BNP) te tohu i te āhuatanga o te ngakau.
• Ētahi atu whakamātautau toto. Ko ngā whakamātautau toto hei tātaritanga i te mumura o te pūkahukahu me ōna take, ko te tikanga kei roto hoki tētahi kaute toto katoa, te papatono metabolic hei tirotiro i te mahi whatukuhu me te whakamātautau mahi thyroid.
• Electrocardiogram (ECG, EKG rānei). Ka kitea, ka tuhia e tēnei whakamātautau kore mamae te wā me te kaha o ngā tohu o te ngakau. Ka whakamahia ngā pūoko iti (electrodes) e honoa ana ki te uma, ā, i ētahi wā ki ngā ringa, ki ngā waewae rānei. Ka hono ngā wāea i ngā pūoko ki tētahi mīhini, ka whakaatu, ka taarua rānei i ngā hua. Ka taea e te electrocardiogram (ECG) te whakaatu i ngā tohu o te māngai o te pakitara o te ngakau, o te mate ngakau o mua rānei. Ka taea te whakamahi i tētahi taputapu kawe penei i te kaitūpato Holter hei aroturuki tonu i te tukituki o te ngakau i te kāinga.
• Echocardiogram. Ka whakamahi te echocardiogram i ngā ngaru oro (ultrasound) hei hanga i ngā pikitia o te ngakau e tukituki ana. Ka taea te tohu i ngā wāhi o te rere toto ngoikore, ngā take o te waewae ngakau me te uaua ngakau kāore e mahi tika. Ka taea e te echocardiogram te awhina i te tātaritanga o te wai i te taha o te ngakau (pericardial effusion).
• Cardiac catheterization me te coronary angiogram. Ka taea te mahi i tēnei whakamātautau ki te kore ngā whakamātautau ke e whakaatu i te take o te mumura o te pūkahukahu, ki te pēhia hoki te uma. Ka awhina i ngā kaiwhakarato hauora ki te kite i ngā aukati i ngā uaua ngakau. Ka whakauruhia he pūtau roa, ngawari (catheter) ki roto i te oko toto, te nuinga i te huha, i te pupu rānei. Ka aratakihia ki te ngakau. Ka rere te tae i roto i te catheter ki ngā uaua i te ngakau. Ka awhina te tae i ngā uaua kia kitea mārama ake i runga i ngā whakaahua X-ray me te ataata.
• Ultrasound o ngā pūkahukahu. Ka whakamahi tēnei whakamātautau kore mamae i ngā ngaru oro hei ine i te rere toto i roto i ngā pūkahukahu. Ka taea te whakaatu wawe i ngā tohu o te hanga wai me ngā whakaheke pleural.

Ko te oxygen te rongoā tuatahi mō te mumura o ngā pūkahukahu. Ka rere te oxygen i roto i te peihana kanohi, i te tūpē kirihou ngawari rānei e rua ngā rua (nasal cannula) e tuku ana i te oxygen ki ia pongaponga. Me whakaora tēnei i ētahi o ngā tohu.

Ka aroturuki te taumata o te oxygen e te kaiwhakarato hauora. I etahi wa, pea ka tika te awhina i te manawa me te mīhini penei i te pūmanawa miihini, i tetahi e whakarato ana i te pehanga ara hau pai rānei.

I runga i te kino o te āhuatanga me te take mō te mumura o ngā pūkahukahu, ko te rongoā pea ka whakauruhia tētahi, atu rānei o ngā rongoā e whai ake nei:

He mea nui kia whakatauhia te mate, ā, ki te taea, kia rongoāhia ngā raruraru pūnaha io, ngā take rānei o te korenga o te ngakau.

Ko te oxygen te rongoā tuatahi. Ki te kore e wātea te oxygen, ka taea e te ruma hyperbaric kawe te whakaatu i te heke ki raro i teitei iti ake kia taea ra ano te neke ki teitei iti ake.

Ko ngā rongoā mō te mumura o ngā pūkahukahu teitei (HAPE) ka whakauruhia hoki:

• Diuretics. Ka whakaitihia e ngā diuretics, penei i te furosemide (Lasix), te pehanga e puta mai ana i te wai nui i roto i te ngakau me ngā pūkahukahu.

• Rongoā pehanga toto. Ka āwhina ēnei ki te whakahaere i te pehanga toto teitei, iti rānei, ka puta pea me te mumura o ngā pūkahukahu. Ka taea hoki e te kaiwhakarato te whakahau i ngā rongoā e whakaiti ana i te pehanga e haere ana ki roto, ki waho rānei o te ngakau. Ko ētahi tauira o aua rongoā ko te nitroglycerin (Nitromist, Nitrostat, ētahi atu) me te nitroprusside (Nitropress).

• Inotropes. Ka hoatu tēnei momo rongoā i roto i te IV mō te hunga kei te hōhipera me te korenga o te ngakau nui. Ka whakapai ake ngā inotropes i te mahi pupuhi o te ngakau, ā, ka pupuri i te pehanga toto.

• Morphine (MS Contin, Infumorph, ētahi atu). Ka taea te tango i tēnei narcotic mā te waha, te hoatu rānei i roto i te IV hei whakaora i te poto o te manawa me te awangawanga. Engari, e whakapono ana etahi kaiwhakarato tiaki ko ngā tūponotanga o te morphine ka nui atu i ngā painga. He nui ake te tūponotanga ka whakamahi ratou i ētahi atu rongoā.

• Te heke tonu atu ki teitei iti ake. Mō te tangata kei ngā teitei teitei kei a ia ngā tohu ngawari o te mumura o ngā pūkahukahu teitei (HAPE), ko te heke iho i te 1,000 ki te 3,000 putu (tautau 300 ki te 1,000 mita) i te tere rawa ka taea te awhina. Pea ka hiahia te tangata he HAPE nui ki te awhina whakaora kia puta atu i te maunga.

• Te mutu o te whakakori tinana me te noho māhana. Ka kaha ake te mumura o ngā pūkahukahu i te mahi tinana me te makariri.

• Rongoā. Ka tango etahi kai-eke i ngā rongoā whakahaunga penei i te acetazolamide, i te nifedipine rānei (Procardia) hei awhina i te rongoā, i te aukati rānei i ngā tohu o te HAPE. Hei aukati i te HAPE, ka tīmata rātou ki te tango i te rongoā i te rā kotahi i mua i te haere ki teitei ake.

He mea nui ngā huringa oranga mō te hauora o te ngākau, ā, ka āwhina pea i ētahi momo o te mumura o ngā pūkahukahu.

• Kia mau te toto teitei i raro i te mana. Mō te toto teitei, tangohia ngā rongoā rite tonu ki te whakahau, ā, tirohia te toto teitei i ia wā. Tūtohuhia ngā hua. Ka taea e te kaiwhakarato hauora te awhina i te whakatakoto i te toto teitei e whai ana.
• Whakahaerehia ētahi atu āhuatanga hauora. Whakatikahia ngā āhuatanga hauora kei raro. Hei tauira, te whakahaere i ngā taumata huka mēnā he mate huka tōu.
• Kaua e whakakore i te take o tō āhuatanga. Ki te puta mai te mumura o ngā pūkahukahu i te whakamahinga rongoā, i ngā teitei teitei rānei, hei tauira, ko te karo i te whakamahinga rongoā, i te noho rānei i ngā teitei teitei ka āwhina i te aukati i te nui atu o te pakaru o ngā pūkahukahu.
• Kaua e kai hikareti. He whakaaro hauora tonu te mutu i te kai hikareti. Mō te awhina ki te mutu, kōrero atu ki te kaiwhakarato hauora.
• Kai iti te tote. Ka āwhina te tote i te tinana ki te pupuri wai. I ētahi tāngata he pakaru i te ventricle maui o te ngākau, ka taea e te tote nui rawa te whakaoho i te ngoikore o te ngākau. Ka taea e te kaiwhakaako kai te awhina ki te tapahi tote mā te whakaatu me pēhea te whakatakoto i te nui o te tote i roto i ngā kai, me te hanga i te kai kai hauora, reka. I te nuinga, me kai iti iho i te 2,300 milligrams i te rā o te tote (sodium) te nuinga o te iwi. Pātai atu ki tō kaiwhakarato tiaki he aha te taumata e ora ana mōu.
• Kōwhiria he kai hauora. Kei roto i te kai hauora te nui o ngā hua, ngā huawhenua me ngā witi katoa. Tāpirihia ngā ngako makariri me ngā ngako whakawhiti, ngā huka tāpiri, me te sodium.
• Whakahaerehia te taumaha. Ko te taumaha nui rawa atu, ahakoa he iti noa iho, ka whakapiki ake i te tūponotanga o te mate ngākau. Engari ko te ngaro atu i ngā taumaha iti ka whakaiti i te toto teitei me te cholesterol, ā, ka whakaiti i te tūponotanga o te mate huka.
• Haere ki te whakakori tinana i ia wā. Me whiwhi ngā pakeke hauora i te iti rawa o te 150 meneti o te mahi aerobic ngawari, i te 75 meneti rānei o te mahi aerobic kaha i te wiki, i te whakakotahitanga rānei o ngā rua. Ki te kore koe e whakamahi ki te whakakori tinana, tīmata haere noa, ā, hanga haere noa. Kia tino whiwhi koe i te OK a tō kaiwhakarato tiaki i mua i te tīmatanga o te kaupapa whakakori tinana.