Isidingo Esikhulayo Sokwelapha Nokuhlinza Ngaphandle Kwegazi

“Bonke abasebenza ngegazi nabanakekela iziguli ezihlinzwayo kufanele bacabangele ukuhlinza ngaphandle kwegazi.”—UDkt. Joachim Boldt, uprofesa wesayensi yokubulala izinzwa, eLudwigshafen, eJalimane.

INHLEKELELE yengculaza iye yashukumisela ososayensi nodokotela ukuba bathathe izinyathelo ezengeziwe zokwenza amagumbi okuhlinza aphephe. Kusobala ukuthi lokhu kuye kwadinga izinqubo ezicophelelayo zokuhlola igazi. Kodwa ochwepheshe bathi ngisho nalezi zinyathelo aziqinisekisi ukumpontshelwa okungenazo nhlobo izingozi. Umagazini i-Transfusion uthi: “Nakuba umphakathi uchitha imali eningi ukuze igazi eligciniwe liphephe kakhulu kunanini ngaphambili, sikholelwa ukuthi iziguli zisazoqhubeka zizama ukugwema ukumpontshelwa igazi [elithekeliswé] abanye abantu ngenxa nje yokuthi igazi alinakuphepha ngokuphelele.”

Yingakho odokotela abaningi sebekuxwaya ukumpompela igazi. UDkt. Alex Zapolanski, waseSan Fransisco, eCalifornia, uthi: “Ukumpontshelwa igazi akulungile neze, futhi sikulwela kanzima ukugwema ukumpompela bonke abantu.”

Umphakathi uwonke nawo usuyaziqaphela izingozi zokumpontshelwa. Eqinisweni, inhlolo-vo yango-1996 yembula ukuthi abantu baseCanada abangamaphesenti angu-89 bangancamela ukwelashwa ngezinye izindlela kunokumpontshelwa igazi elithekelisiwe. “Akubona bonke abantu abayokwenqaba ukumpontshelwa igazi labanye abantu njengoFakazi BakaJehova,” kusho i-Journal of Vascular Surgery. “Noma kunjalo, izingozi zokungenwa yizifo nokuphazamiseka kwesimiso somzimba sokuzivikela kunikeza ubufakazi obusobala bokuthi kufanele sithole ezinye izindlela zokwelapha zonke iziguli zethu.”

Indlela Ekhethwayo

Ngokujabulisayo, ikhona enye indlela—ukwelapha nokuhlinza ngaphandle kwegazi. Iziguli eziningi azikubheki njengesinyathelo sokugcina kodwa njengendlela yokwelashwa eziyikhethayo, futhi ngesizathu esihle. UStephen Geoffrey Pollard, udokotela ohlinzayo waseBrithani ongumxhumanisi, uphawula ukuthi amathuba okugula nokufa kulabo abahlinzwa ngaphandle kwegazi “cishe ayalingana naweziguli ezimpontshelwa igazi, kodwa ezimweni eziningi bayaphepha ezifweni nasezinkingeni ezilandela ngemva kokuhlinzwa ngokuvamile ezibangelwa yigazi.”

Kwaqala kanjani ukwelapha ngaphandle kwegazi? Lo mbuzo uthanda ukuba yinqaba ngandlela-thile, ngoba ukwelapha ngaphandle kwegazi kwaba khona ngaphambi kokuba kusetshenziswe igazi. Eqinisweni, ubuchwepheshe bokumpompela igazi bathuthuka baze basetshenziswa njalo ekuqaleni kwekhulu lama-20. Noma kunjalo, emashumini eminyaka amuva nje abanye baye bakhulumela umkhakha wokuhlinza ngaphandle kwegazi. Ngokwesibonelo, ngawo-1960 udokotela ohlinzayo owaziwayo uDenton Cooley wenza ukuhlinzwa kokuqala kwenhliziyo ngaphandle kokusebenzisa igazi.

Ngenxa yokwanda kwesifo sokusha kwesibindi kubantu ababempontshelwé igazi ngawo-1970, odokotela abaningi baqala ukufuna ezinye izindlela esikhundleni segazi. Ngawo-1980 amaqembu amaningi amakhulu ezokwelapha ayesehlinza ngaphandle kwegazi. Khona-ke, lapho kuqubuka ubhadane lwengculaza, la maqembu ayethintwa njalo amanye ayefuna ukusebenzisa izinqubo ezifanayo. Phakathi nawo-1990 izibhedlela eziningi zasungula izinhlelo ezinikeza iziguli ithuba lokukhetha ukwelashwa ngaphandle kwegazi.

Manje odokotela baye baphumelela ekusebenziseni izinqubo ezingahileli igazi lapho behlinza nasezimweni eziphuthumayo ezazidinga ukumpontshelwa igazi ngokuvamile. Kuyi-Canadian Journal of Anaesthesia, uD. H. W. Wong uyaphawula: “Ukuhlinzwa okukhulu okuthinta inhliziyo, imithambo yegazi, izifo zabesifazane nokubelethisa, amathambo nemigudu yomchamo kungenziwa ngokuphumelelayo ngaphandle kokusebenzisa igazi noma imikhiqizo yalo.”

Enye inzuzo yokuhlinza ngaphandle kwegazi ukuthi kuthuthukisa izinga lempatho. “Ikhono likadokotela ohlinzayo libaluleke kakhulu ekuvimbeleni ukopha,” kusho uDkt. Benjamin J. Reichstein, umqondisi wezinqubo zokuhlinza eCleveland, e-Ohio. Iphephabhuku lezomthetho laseNingizimu Afrika lithi ngaphansi kwezinye izimo ukuhlinza ngaphandle kwegazi “kungashesha, kube okuhlanzekile futhi kungambi eqolo.” Liyanezela: “Ngokuqinisekile ukwelashwa ngemva kokuhlinzwa ezimweni eziningi kuye kwaba okungabizi futhi konga isikhathi.” Lezi yizizathu nje ezimbalwa zokuthi kungani okwamanje kunezibhedlela ezingaba ngu-180 emhlabeni wonke ezinezinhlelo ezinobuchwepheshe bokwelapha nokuhlinza ngaphandle kwegazi.

Igazi NoFakazi BakaJehova

OFakazi BakaJehova bayenqaba ukumpontshelwa igazi ngezizathu ezisekelwe eBhayibhelini.a Kodwa bayazamukela—futhi bazifuna kakhulu—izindlela zokwelapha ngaphandle kwegazi. UDkt. Richard K. Spence, ngesikhathi esengumqondisi wezinqubo zokuhlinza esibhedlela saseNew York, wathi: “OFakazi BakaJehova bakufuna ngentshiseko ukwelashwa okungcono kakhulu. Njengeqembu, bangamakhasimende anolwazi olungcono kakhulu udokotela ohlinzayo angasebenzelana nawo.”

Odokotela baye bazama izinqubo eziningi zokuhlinza oFakazi BakaJehova ngaphandle kwegazi. Cabangela okuhlangenwe nakho kukadokotela ohlinza imithambo yenhliziyo uDenton Cooley. Eminyakeni engu-27, iqembu lakhe lahlinza izinhliziyo zoFakazi BakaJehova abangu-663 ngaphandle kwegazi. Imiphumela ibonisa ngokucacile ukuthi inhliziyo ingahlinzwa ngokuphumelelayo ngaphandle kokusebenzisa igazi.

Yiqiniso, abaningi baye babagxeka oFakazi BakaJehova ngokwenqaba igazi. Kodwa isiqondiso esanyatheliswa yi-Association of Anaesthetists of Great Britain and Ireland sithi umbono woFakazi “uwuphawu lokuhlonipha ukuphila.” Eqinisweni, ukuma koFakazi okuqinile kuye kwaba neqhaza elikhulu ekwenzeni ukuba bonke abantu bathole ukwelashwa okuphephile. UProfesa Stein A. Evensen, weNational Hospital eNorway, uyabhala: “OFakazi BakaJehova abadinga ukuhlinzwa baye baba amavulandlela futhi bashoshozela intuthuko emkhakheni obalulekile wezempilo eNorway.”

Ukuze basize odokotela belaphe ngaphandle kokusebenzisa igazi, oFakazi BakaJehova ba-ye basungula inkonzo ewusizo yokubonisana. Okwamanje, amaKomiti Okubonisana Nezibhedlela angaphezu kuka-1 400 emhlabeni wonke ahlonyiselwe ukunikeza odokotela nabacwaningi izincwadi zezokwelapha ezisekelwe ekwazisweni kwezihloko ezingaphezu kuka-3 000 eziphathelene nokwelapha nokuhlinza ngaphandle kwegazi. UDkt. Charles Baron, onguprofesa eBoston College Law School, uyaphawula: “Akubona oFakazi BakaJehova kuphela, kodwa zonke iziguli namuhla, cishe azinakumpontshelwa igazi ngokungadingekile ngenxa yomsebenzi wamaKomiti Okubonisana Nezibhedlela oFakazi.”b

Ukwaziswa okuphathelene nokwelapha nokuhlinza ngaphandle kwegazi okuye kwaqoqwa oFakazi BakaJehova kuye kwaba yinzuzo kwabaningi emkhakheni wezokwelapha. Ngokwesibonelo, lapho belungiselela incwadi enesihloko esithi Autotransfusion: Therapeutic Principles and Trends, abalobi bacela oFakazi BakaJehova ukuba babanikeze ukwaziswa okuphathelene nezinye izindlela zokwelapha ngaphandle kwegazi. OFakazi basifeza ngenjabulo isicelo sabo. Lapho bebonga, kamuva laba balobi bathi: “Kuzo zonke izinto esake sazifunda ngale ndaba, asikaze sibone uhlu olucacile, noluphelele ngale ndlela lwezinqubo zokugwema ukumpontshelwa igazi labanye abantu.”

Intuthuko emkhakheni wezokwelapha iye yabangela abanye ukuba bacabangele ukwelapha ngaphandle kwegazi. Singalindela yiphi intuthuko esikhathini esizayo? UProfesa Luc Montagnier, owathola igciwane lengculaza, uthi: “Ukuqonda kwethu okuthuthukayo kulo mkhakha kubonisa ukuthi ngolunye usuku ukumpontshelwa igazi kumelwe kuphele.” Okwamanje, ezinye izindlela zokwelapha ngaphandle kwegazi kakade zisindisa ukuphila.

[Imibhalo yaphansi]

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Lokho Abanye Odokotela Abakushoyo

‘Ukuhlinza ngaphandle kwegazi akukhona nje okoFakazi BakaJehova kuphela kodwa okwazo zonke iziguli. Ngicabanga ukuthi bonke odokotela kufanele bakwenze.’—UDkt. Joachim Boldt, uprofesa wesayensi yokubulala izinzwa, eLudwigshafen, eJalimane.

“Nakuba ukumpontshelwa igazi kuphephile namuhla kunasesikhathini esidlule, kusenezingozi, kuhlanganise nokuwohloza amandla omzimba okuzivikela kanye nokuthola isifo sokusha kwesibindi noma izifo ezithathelwana ngobulili.”—UDkt. Terrence J. Sacchi, isekela likaprofesa wezokwelapha.

“Odokotela abaningi bamane bacabange ukumpompela igazi futhi bakwenza bekhululekile benganaki. Mina angikwenzi.”—UDkt. Alex Zapolanski, umqondisi womnyango ohlinza izinhliziyo eSan Francisco Heart Institute.

“Akukho ukuhlinzwa kwesisu okuvamile kumuntu ophile kahle okudinga ukumpontshelwa igazi ngaso sonke isikhathi.”—UDkt. Johannes Scheele, uprofesa wezokuhlinza, eJena, eJalimane.

[Izithombe]

UDkt. Joachim Boldt

UDkt. Terrence J. Sacchi

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Zokwelapha Nokuhlinza Ngaphandle Kwegazi

Ezinye Izinqubo

Uketshezi: I-Ringer’s lactate solution, i-dextran, i-hydroxyethyl starch nokunye kusetshenziselwa ukulondoloza umthamo wegazi, kuvimbele ukufa kwezinqubo zomzimba ngenxa yokungatholi igazi. Olunye uketshezi oluhlolwayo manje lungase lukwazi ukuthutha umoya-mpilo.

Imithi: Amaprotheni ashintshwe izakhi zofuzo angashukumisa ukukhiqizwa kwamangqamuzana egazi abomvu (i-erythropoietin), izinhlayiya zegazi (i-interleukin-11) namangqamuzana egazi amhlophe ahlukahlukene (i-GM-CSF, i-G-CSF). Eminye imithi inciphisa kakhulu ukopha phakathi nokuhlinza (i-aprotinin, ama-antifibrinolytic) noma isiza ekunqandeni ukopha ngokweqile (i-desmopressin).

Izinto ezinqanda ukopha: Izindwangu ze-collagen neze-cellulose zisetshenziselwa ukunqanda ukopha ngokuzibeka ngokuqondile enxebeni. Inhlaka ye-fibrin nezinto ezinamathelayo zingavala amanxeba avulekile noma zimboze ingxenye enkulu yezicubu ezophayo.

Ukonga igazi: Imishini eyonga igazi ilondoloza igazi lapho kuhlinzwa noma esimweni esiphuthumayo. Leli gazi liyahlanzwa bese libuyiselwa esigulini ngesimiso somshini esivalekile. Ezimweni eziphuthuma ngempela, kungalondolozwa amalitha amaningi egazi ngokusebenzisa lesi simiso.

Amathuluzi okuhlinza: Amanye amathuluzi asika futhi avale imithambo yegazi ngesikhathi esifanayo. Amanye amathuluzi anganqanda ukopha engxenyeni enkulu yezicubu zomzimba. Amathuluzi e-laparoscopy nalawo angazisiki kakhulu izicubu avumela ukuba ukuhlinza kwenziwe ngaphandle kokopha okubangelwa ukusikwa kakhulu.

Amasu okuhlinza: Ukuhlela ngokucophelela inqubo yokuhlinza, kuhlanganise nokuthintana nodokotela abanolwazi, kusiza iqembu elihlinzayo ukuba ligweme izinkinga ezingase zivele. Kubalulekile ukunqanda ukopha ngokushesha. Ukuzindela amahora angaphezu kuka-24 kungandisa amathuba okufa kwesiguli. Ukuhlukanisa izinqubo zokuhlinza ezinkulu zenziwe kancane kancane kunciphisa ukopha.

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Ukwelapha Ngaphandle Kwegazi “Indinganiso Yokunakekela” Entsha

I-PHAPHAMA! yaxoxa ngezinzuzo zokwelapha nokuhlinza ngaphandle kwegazi nochwepheshe abane kulo mkhakha.

Ngaphandle kweziguli ezenqaba ukumpontshelwa igazi ngenxa yezizathu ezingokwenkolo, obani abanye abathakasela ukwelashwa ngaphandle kwegazi?

UDkt. Spahn: Esikhungweni sethu ngokuvamile labo abacela ukwelashwa ngaphandle kwegazi yiziguli ezinolwazi ngempela.

UDkt. Shander: Ngo-1998, inani leziguli ezenqaba igazi ngezizathu zomuntu siqu lalingaphezu kwenani leziguli ezenqaba igazi ngenxa yezizathu ezingokwenkolo.

UDkt. Boyd: Ngokwesibonelo, kuneziguli ezinomdlavuza. Kuye kwafakazelwa kaningi ukuthi uma zingalimpompeli igazi, zilulama kangcono futhi lesi sifo asivami ukubuya.

UDkt. Spahn: Sivame ukwelapha oprofesa baseyunivesithi nemikhaya yabo ngaphandle kokusebenzisa igazi. Ngisho nodokotela abahlinzayo bacela ukuba sikugweme ukumpompela igazi! Ngokwesibonelo, omunye udokotela ohlinzayo wafika ezobonisana nathi ngomkakhe, okwakufanele ahlinzwe. Wathi: “Ngicela niqiniseke ngento eyodwa—ukuthi akampontshelwa igazi!”

UDkt. Shander: Amalungu omnyango wami wokubulala izinzwa athi: ‘Lezi ziguli ezingampontshelwa igazi zilulama kahle, futhi mhlawumbe kangcono kakhulu. Kungani kufanele sibe nezindinganiso ezimbili zokunakekela abagulayo? Uma lena kuyindlela engcono yokunakekela, kufanele siyisebenzise kubo bonke abantu.’ Ngakho manje sesilangazelela ukuba ukwelapha ngaphandle kwegazi kube yindinganiso yokunakekela.

UMnu. Earnshaw: Kuyiqiniso ukuthi oFakazi BakaJehova ngokukhethekile abafuna ukuhlinzwa ngaphandle kwegazi. Kodwa-ke, sifuna ukwelapha wonke umuntu ngale ndlela.

Ingabe ukwelapha ngaphandle kwegazi kumba eqolo noma kushibhile?

UMnu. Earnshaw: Konga imali.

UDkt. Shander: Izindleko zincipha ngamaphesenti angu-25 uma selapha ngaphandle kwegazi.

UDkt. Boyd: Noma ngabe bekuyileso kuphela isizathu, kufanele sikusebenzise.

Sesithuthuke kangakanani ekusebenziseni indlela yokwelapha ngaphandle kwegazi?

UDkt. Boyd: Ngicabanga ukuthi kuyathuthuka ngempela. Intuthuko isaqhubeka. Njalo sithola esinye isizathu esihle esisha sokuba singalisebenzisi igazi.

[Izithombe]

UDkt. Donat R. Spahn, uprofesa wesayensi yokubulala izinzwa, eZurich, eSwitzerland

UDkt. Aryeh Shander, isekela likaprofesa wezokwelapha wesayensi yokubulala izinzwa, e-United States

UMnu. Peter Earnshaw, FRCS, udokotela ohlinza amathambo ongumxhumanisi, eLondon, eNgilandi

UDkt. Mark E. Boyd, uprofesa wokubelethisa nezifo zabesifazane, eCanada

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Indima Yesiguli

▪ Xoxa nodokotela wakho ngezindlela zokwelapha ezingalisebenzisi igazi ngaphambi kokuba kuphakame isidingo sokwelashwa. Lokhu kubalulekile ikakhulukazi kwabesifazane abakhulelwe, abazali abanezingane ezincane kanye nabantu asebekhulile.

▪ Zibhale phansi izifiso zakho, ikakhulukazi uma kunencwadi engokomthetho yokwenza kanjalo.

▪ Uma udokotela wakho engazimisele ukukwelapha ngaphandle kwegazi, funa udokotela ozovumelana nezifiso zakho.

▪ Njengoba ezinye izindlela zokwelapha ngaphandle kwegazi zidinga isikhathi ukuze zisebenze, ungazindeli ukufuna ukwelashwa uma wazi ukuthi kuzodingeka ukuba uhlinzwe.