Necrosis Epidermal Kawa Kino

Ko te TEN e pā ana ki ngā wāhi whānui o te kiri pupuhi, me te wehewehe.

He mate kiri onge, he mate pea, te toxic epidermal necrolysis (TEN), te nuinga o te wā e puta mai ana i te rongoā. He āhua kino te Stevens-Johnson syndrome (SJS). Ki te hunga e pangia ana e te SJS, ka tautuhia te TEN ina pā ana te 30% neke atu rānei o te mata o te kiri, ā, he nui te pakaru o ngā kiri ngawari o te tinana (ngā kiri mucous).

He āhuatanga mate pea te TEN e pā ana ki te hunga o ngā tau katoa. Te nuinga o te wā ka tukatukahia te TEN i te hohipera. I te wā e ora ana te kiri, ko te tiaki tautoko e whakauru ana i te whakahaere i te mamae, te tiaki i ngā whara, me te whakarite kia nui ngā wai e inu ana koe. Ka roa pea ngā wiki ki ngā marama te ora.

Ki te mate koe i te rongoā, me karo tonu koe i taua rongoā me ētahi atu e rite ana ki a ia.

Ngā tohu me ngā pūāhua o te epidermal necrolysis kawa e whai ake nei: Te mamae o te kiri whānui Te pupuhi e horapa ana e kapi ana i te 30% neke atu rānei o te tinana Ngā pupuhi me ngā wāhi nui o te kiri e maunu ana Ngā mate, te pupū me te kirikiri i runga i ngā kiri kiri, tae atu ki te waha, ngā kanohi me te tara. He mea nui te rongoā wawe mō te hunga e pangia ana e te mate Stevens-Johnson/toxic epidermal necrolysis (SJS/TEN). Ki te whai koe i ētahi tohu, rapu kia tere te awhina hauora. Ka hiahia pea koe ki te tiaki i tetahi tohunga kiri (dermatologist) me ētahi atu tohunga i te hohipera.

Ko te rongoā wawe te mea nui mō te hunga e pangia ana e te mate Stevens-Johnson/te ngoikore o te kiri (SJS/TEN). Ki te whai tohu koe, rapu kia tere te awhina hauora. He mea tika pea kia whakarongo koe ki tetahi tohunga kiri (runga kiri) me ētahi atu tohunga i te hohipera.

Ko te SJS/TEN te nuinga o te wā e puta mai ana i te āhuatanga o te kiri ki te rongoā. Ka tīmata pea ngā tohu i te kotahi ki te whā wiki i muri i tō tīmatanga ki te tango i te rongoā hou.

Ko ngā kaiwhakaoho rongoā tino noa o te SJS/TEN ko ngā rongoā mate huaketo, ngā rongoā mate kōkō, ngā rongoā sulfa me te allopurinol (Aloprim, Zyloprim).

Ngā take e piki ai tō raru o te SJS/TEN e whai ake nei:

• Te mate HIV. I roto i te hunga e pangia ana e te HIV, ko te nui o te SJS/TEN e 100 teitei atu i te hunga whānui.
• Te pūnaha ārai mate ngoikore. Ka pā te pūnaha ārai mate ki te whakawhiti whekau, te HIV/AIDS me ngā mate ārai mate whaiaro.
• Te mate pukupuku. Ko te hunga e pangia ana e te mate pukupuku, ina koa ngā mate pukupuku toto (hematologic malignancies), kei te piki ake te raru o te SJS/TEN.
• Te hītori o te SJS/TEN. Ki te mea kua pangia koe e tētahi momo rongoā o tēnei āhuatanga, kei te raru koe ki te puta mai anō ki te whakamahi anō koe i taua rongoā.
• Te hītori whānau o te SJS/TEN. Ki te mea he whānau tata, pēnei i tētahi mātua, i tētahi teina rānei, kua pangia e te SJS/TEN, ka nui ake pea tō tūmanako ki te whanake i taua mate.
• Ngā take irahiko. Ko te whai i ētahi rerekētanga irahiko ka piki ake ai tō raru o te SJS/TEN, ina koa ki te tango rongoā koe mō ngā āwangawanga, te mate gout, te mate hinengaro rānei.

Ko ngā tāngata kei te tino tūpono ki ngā raruraru o te TEN ko te hunga kua neke atu i te 70 tau te pakeke, me te hunga he mate ate cirrhosis rātou, he pūngāwerewere (metastatic) te mate pukupuku. Ko ngā raruraru o te TEN e whai ake nei:

• Te mate toto (sepsis). Ka puta te sepsis ina tomo ngā pūtau mate i te mate ki tō toto ka horapa puta noa i tō tinana. He āhuatanga tere te whanake, he āhuatanga kino e mate ai te sepsis, ā, ka taea te whakaeke me te kore mahi o ngā whekau.
• Te whakauru o ngā pūkahukahu. Ka taea e tēnei te whakaeke i te mare, te uaua o te manawa, ā, ki te mate kino, te kore manawa ohorere.
• Te ngoikore o te tirohanga. Ka taea e te TEN te whakaeke i ngā raruraru o te kanohi, pēnei i te kanohi maroke, ngā makawe o te kanohi e tipu ana ki roto, te tohu o te cornea, ā, he iti rawa, te matapo.
• Te kino o te kiri mau tonu. I muri i te ora mai i te TEN, ka taea pea te pupuhi, te tohu, me te tae o tō kiri. Ka taea e ngā raruraru kiri roa te taka o tō makawe, ā, ka kore pea e tipu noa ō makawe me ō niho waewae.
• Ngā wheka o te tara. I ngā wāhine, ka taea e te TEN te whakaeke i ngā wheka i ngā kiko e hipoki ana i te tara, ā, ka arahi ki te mamae, ki te whakakōtaha rānei o te tara, ki te kore e rongoā.
• Te pouri o te ngākau. Ka whakaeke tēnei āhuatanga i te pouri, ā, ka taea te pānga hinengaro roa.

Kia kore ai e puta tetahi atu wāhanga o te TEN, ako mena i puta mai i te rongoā. Ki te penei, kaua rawa e inu i taua rongoā rā, kāore rānei i tetahi mea rite. Ka nui ake te kino o te tōngatanga, ā, ka mate pea. Korero atu hoki ki ētahi atu kaiwhakarato hauora mō tō hītori o te TEN, ā, kakahuria he kākahu whakatūpato rongoā, he wērei rānei, me ngā kōrero mō tō āhuatanga. Ā, mau rānei i tetahi pukapuka mate pāwera.

Ka tautuhia te TEN ki te whakaatu i te mate kino o te hunga e pangia ana e te SJS, e pa ana ki te 30% neke atu rānei o te tinana.

Mēnā kei te whakaaro to tākuta he rongoā nāu i inu te take o tō TEN, ka hiahia koe ki te mutu te inu i taua rongoā. Katahi ka nekehia pea koe ki tētahi hōhipera mō te whakaora, pea i roto i tōna pokapū tahuna, i te wāhanga tiaki matatau rānei. Ka roa pea ngā marama kia ora katoa.Ko te rongoā matua mō te TEN ko te ngana ki te whakamarie i a koe kia pai rawa atu te ora o tō kiri. Ka whiwhi koe i tēnei tiaki tautoko i a koe e noho ana i te hōhipera. Ka uru pea ki roto:

• Te whakakapi wai me te kai. Nō te mea ka taea e te ngaro o te kiri te ngaro o te wai i roto i te tinana, he mea nui kia whakakapihia ngā wai me ngā electrolytes. Ka whiwhi pea koe i ngā wai me ngā kai mā te tūpū i whakauruhia ki te ihu ka arā atu ki te puku (tūpū nasogastric).
• Te tiaki o te whara. Ka horoi māori pea tō rōpū hauora te kiri e pā ana, ka whakamahi i ngā kakahu motuhake e whakauruhia ana ki te kiri hinu (Vaseline) te rongoā rānei. Ka tirotiro hoki tō rōpū tiaki i a koe mō te mate, ka hoatu ki a koe ngā rongoā mate pāwera mēnā e hiahiatia ana.
• Te awhina manawa. Ka hiahia pea koe ki ngā whakamātautau me ngā tukanga hei aromatawai i tō ara hau, ā, hei āwhina i te pupuri i te mārama. Ki te mate whānui, ka hiahia pea koe ki te intubation, ki te awhina manawa miihini rānei (whakahauhau).
• Te whakahaere mamae. Ka whiwhi koe i te rongoā mamae hei whakaiti i tō mamae. Mō te mamae i roto i tō waha, ka hoatu pea ki a koe tētahi horoi waha e whakauru ana i tētahi mea whakangū, pēnei i te lidocaine.
• Te tiaki kanohi. Mō ngā tohu kanohi ngawari, ka pai pea koe ki te whakamahi i ngā roimata mahi kore-whakaora i te iti rawa e whā ngā wā i te rā. Ka taea te whakamahi i ngā matū kanohi me ngā corticosteroids hei whakahaere i te mumura o te kanohi. Ka uru pea tō rōpū tiaki ki tētahi tohunga kanohi (ophthalmologist).

Ka uru pea te whakaora i te TEN ki tētahi, ki tētahi huinga rānei o ngā rongoā e pā ana ki te tinana katoa (ngā rongoā pūnaha), pēnei i te cyclosporine (Neoral, Sandimmune), etanercept (Enbrel) me te immunoglobulin intravenous (IVIG). He mea nui kia nui ake te ako kia taea ai te whakatau i tōna painga, mēnā kei reira tētahi.

Kaore he uauatanga