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Ciwon huhu shine mafi yawan kamuwa da cutar nosocomial kuma mai tsanani, wanda ciwon huhu mai alaka da iska (VAP) ya kai kashi 40%. VAP da ke haifar da cututtukan ƙwayoyin cuta har yanzu matsala ce ta asibiti mai wahala. Shekaru da yawa, jagororin sun ba da shawarar hanyoyin da za a yi amfani da su (kamar lalatawar da aka yi niyya, ɗaga kai) don hana VAP, amma VAP yana faruwa a cikin kashi 40% na marasa lafiya tare da intubation na tracheal, wanda ke haifar da tsawan zaman asibiti, ƙara yawan amfani da maganin rigakafi, da mutuwa. Mutane koyaushe suna neman ƙarin ingantattun matakan rigakafi.

Ciwon huhu mai alaƙa da Ventilator (VAP) wani sabon kamuwa da ciwon huhu ne wanda ke tasowa sa'o'i 48 bayan bututun tracheal kuma shine mafi yawan kamuwa da cutar nosocomial a cikin sashin kulawa mai zurfi (ICU). Societoungiyar Cututtukan Cututtukan Cututtukan Cututtukan cututtukan cuta sun banbanta da ƙwayar cutar huhu (HAP kawai ke da iska ta Tracheal; [1-3].

A cikin marasa lafiya da ke karɓar iskar inji, abubuwan da suka faru na VAP sun tashi daga 9% zuwa 27%, ana kiyasta adadin mace-mace a 13%, kuma yana iya haifar da ƙara yawan amfani da ƙwayoyin cuta na tsarin, daɗaɗɗen iska na inji, tsawan lokaci na ICU, da ƙarin farashi [4-6]. HAP/VAP a cikin marasa lafiya marasa lafiya yawanci ana haifar da su ta hanyar kamuwa da cuta, kuma rarraba ƙwayoyin cuta na yau da kullun da halayen juriya sun bambanta da yanki, ajin asibiti, yawan marasa lafiya, da bayyanar cututtukan ƙwayoyin cuta, da canzawa akan lokaci. Pseudomonas aeruginosa ya mamaye ƙwayoyin cuta masu alaƙa da VAP a Turai da Amurka, yayin da ƙarin Acinetobacter baumannii keɓe a manyan asibitoci a China. Kashi ɗaya cikin uku zuwa rabi na duk mutuwar da ke da alaƙa da VAP ana haifar da su kai tsaye ta hanyar kamuwa da cuta, tare da yawan mace-mace na lamuran da Pseudomonas aeruginosa da acinetobacter ke haifarwa sun fi girma [7,8].

Saboda tsananin nau'in VAP mai ƙarfi, ƙayyadaddun ƙayyadaddun ƙayyadaddun alamun bayyanarsa na asibiti, hoto da gwaje-gwajen gwaje-gwaje sun yi ƙasa, kuma kewayon bambance-bambancen ganewar asali yana da faɗi, wanda ya sa ya zama da wahala a gano VAP a cikin lokaci. A lokaci guda, juriya na kwayan cuta yana haifar da ƙalubale mai tsanani ga maganin VAP. An kiyasta cewa haɗarin haɓaka VAP shine 3% / rana a cikin kwanakin 5 na farko na amfani da iska, 2% / rana tsakanin kwanaki 5 zuwa 10, da 1% / rana don sauran lokacin. Mafi yawan abin da ya faru gabaɗaya yana faruwa bayan kwanaki 7 na samun iska, don haka akwai taga da za a iya rigakafin kamuwa da cuta da wuri [9,10]. Yawancin karatu sun kalli rigakafin VAP, amma duk da shekarun da suka gabata na bincike da yunƙurin hana VAP (kamar guje wa intubation, hana sake kunnawa, rage jinkirin, ɗaga kan gado ta 30 ° zuwa 45 °, da kula da baki), abin da ya faru bai bayyana ya ragu ba kuma nauyin da ke tattare da lafiyar ya kasance mai girma.

An yi amfani da maganin rigakafi da aka shaka don magance cututtuka na hanyoyin iska tun daga shekarun 1940. Saboda yana iya haɓaka isar da magunguna zuwa wurin da aka yi niyya (watau hanyar iska) da kuma rage tasirin sakamako na tsarin, ya nuna ƙimar aikace-aikacen mai kyau a cikin cututtuka iri-iri. Hukumar Abinci da Magunguna ta Amurka (FDA) da Hukumar Kula da Magunguna ta Turai (EMA) sun amince da maganin rigakafi da aka shaka yanzu don amfani da cystic fibrosis. Magungunan rigakafi da aka shayar da su na iya rage yawan nauyin kwayoyin cuta da kuma yawan tashin hankali a cikin bronchiectasis ba tare da ƙara yawan abubuwan da suka faru ba, kuma jagororin yanzu sun gane su a matsayin jiyya na farko ga marasa lafiya da pseudomonas aeruginosa kamuwa da cuta da kuma m exacerbations; Ana iya amfani da maganin rigakafi da aka shaka yayin lokacin aikin dasawa na huhu a matsayin magunguna ko magungunan rigakafi [11,12]. Amma a cikin jagororin VAP na Amurka na 2016, ƙwararrun ba su da kwarin gwiwa game da tasirin maganin rigakafi da ke shakar adjuvant saboda rashin manyan gwaje-gwajen da aka sarrafa bazuwar. Gwajin Mataki na 3 (INHALE) wanda aka buga a cikin 2020 shima ya kasa samun sakamako mai kyau (shakar amikacin taimakon maganin rigakafi na ciki don kamuwa da cutar kwayan cuta ta Gram-negative wanda marasa lafiya VAP suka haifar, makafi biyu, bazuwar, placebos sarrafawa, gwajin inganci na lokaci 3, jimlar marasa lafiya 807, magani na tsari + taimako na kwanaki 1).

A cikin wannan mahallin, ƙungiyar da masu bincike daga Cibiyar Yawon shakatawa na Jami'ar Yanki (CHRU) ta Faransa ta yi amfani da dabarun bincike daban-daban kuma sun gudanar da bincike-bincike, multicenter, biyu-makafi, bazuwar gwajin ingancin sarrafawa (AMIKINHAL). An kwatanta amikacin ko placebo don rigakafin VAP a cikin 19 icus a Faransa [13].

Jimillar manya marasa lafiya 847 da ke da iska mai iska tsakanin sa'o'i 72 zuwa 96 an ba su bazuwar 1:1 zuwa inhalation na amikacin (N= 417,20 mg/kg manufa nauyin jiki, QD) ko inhalation na placebo (N=430, 0.9% sodium chloride daidai) na kwanaki 3. Babban ƙarshen ƙarshen shine farkon farkon VAP daga farkon aikin bazuwar zuwa rana 28.

Sakamakon gwajin ya nuna cewa a cikin kwanaki 28, marasa lafiya 62 (15%) a cikin rukunin amikacin sun haɓaka VAP da marasa lafiya na 95 (22%) a cikin rukunin placebo (22%) a cikin rukunin placebo sun haɓaka VAP.

Dangane da aminci, marasa lafiya bakwai (1.7%) a cikin rukunin amikacin da marasa lafiya huɗu (0.9%) a cikin rukunin placebo sun sami mummunan al'amuran da suka shafi gwaji. Daga cikin wadanda ba su da mummunan rauni na koda a bazuwar, marasa lafiya 11 (4%) a cikin rukunin amikacin da marasa lafiya 24 (8%) a cikin rukunin placebo sun sami raunin koda a ranar 28 (HR, 0.47; 95% CI, 0.23 ~ 0.96).

Gwajin asibiti yana da abubuwa uku. Na farko, dangane da ƙirar binciken, gwajin AMIKINHAL ya zana a kan gwajin IASIS (wani bazuwar, makafi biyu, mai sarrafa wuribo, gwaji na lokaci-lokaci na 2 wanda ya shafi marasa lafiya 143). Don kimanta aminci da tasiri na amikacin - fosfomycin inhalation tsarin tsarin kula da kwayar cutar kwayar cutar gram-korau da VAP ta haifar) da gwajin INHALE don ƙare tare da darussan da ba su da kyau da aka koya, waɗanda ke mayar da hankali kan rigakafin VAP, kuma sun sami sakamako mai kyau. Saboda halaye na yawan mace-mace da kuma tsawon zaman asibiti a cikin marasa lafiya tare da samun iska da VAP, idan amikacin inhalation zai iya samun sakamako daban-daban na rage mutuwa da zaman asibiti a cikin waɗannan marasa lafiya, zai zama mafi mahimmanci ga aikin asibiti. Duk da haka, idan aka yi la'akari da bambancin jiyya da kulawa a cikin kowane majiyyaci da kowace cibiya, akwai wasu abubuwa masu ruɗani da za su iya tsoma baki cikin binciken, don haka yana iya zama da wahala a sami sakamako mai kyau wanda aka danganta ga maganin rigakafi. Sabili da haka, nazarin asibiti mai nasara yana buƙatar ba kawai kyakkyawan ƙirar nazarin ba, har ma da zaɓin abubuwan da suka dace na farko.

Na biyu, ko da yake ba a ba da shawarar maganin rigakafi na aminoglycoside a matsayin magani guda ɗaya a cikin jagororin VAP daban-daban, maganin rigakafi na aminoglycoside na iya rufe ƙwayoyin cuta na kowa a cikin marasa lafiya na VAP (ciki har da pseudomonas aeruginosa, acinetobacter, da dai sauransu), kuma saboda iyakancewar su a cikin ƙwayoyin epithelial na huhu, babban taro a wurin kamuwa da cuta, da ƙananan ƙwayoyin cuta. Aminoglycoside maganin rigakafi an fi so a tsakanin maganin rigakafi. Wannan takarda ta yi daidai da cikakken kimanta girman tasirin tasirin intracheal gudanarwa na gentamicin a cikin ƙananan samfurori da aka buga a baya, wanda a haɗin gwiwa ya nuna tasirin maganin rigakafi na aminoglycoside da aka shaka wajen hana VAP. Har ila yau, ya kamata a lura da cewa mafi yawan abubuwan sarrafawa na placebo da aka zaɓa a cikin gwaje-gwajen da suka shafi maganin rigakafi da aka shayar da su saline ne na al'ada. Duk da haka, la'akari da cewa atomized inhalation na al'ada Saline kanta iya taka wani rawa a diluting sputum da kuma taimaka expectorant, al'ada Saline iya haifar da wani tsangwama a cikin bincike na binciken sakamakon, wanda ya kamata a comprehensively la'akari a cikin binciken.

Bugu da ƙari, daidaitawa na gida na maganin HAP/VAP yana da mahimmanci, kamar yadda ya kamata rigakafin ƙwayoyin cuta. A lokaci guda, ba tare da la'akari da tsawon lokacin intubation ba, ilimin halittu na ICU na gida shine mafi mahimmancin haɗarin kamuwa da cuta tare da ƙwayoyin cuta masu yawa. Sabili da haka, magani mai mahimmanci ya kamata ya koma bayanan ƙananan ƙwayoyin cuta na asibitocin gida gwargwadon iyawa, kuma ba zai iya makantar da shi ga jagororin ko ƙwarewar asibitocin manyan makarantu ba. A lokaci guda kuma, marasa lafiya marasa lafiya waɗanda ke buƙatar samun iska na injiniya galibi ana haɗuwa da su tare da cututtuka masu yawa, kuma a ƙarƙashin aikin haɗin gwiwar abubuwa masu yawa kamar yanayin damuwa, ana iya samun sabon abu na ƙwayoyin cuta na hanji zuwa huhu. Babban nau'in cututtukan cututtukan da ke haifar da babban matsayi na ciki da na waje kuma yana ƙayyade cewa babban haɓakar asibiti na kowane sabon saƙo yana da nisa.