ﺍﻟﻰ ﻃﻼﺏ ﻋﻠﻢ ﺍﻟﺼﻴﺪﻟﺔ ﺍﻟﺴﺮﻳﺮﻳﺔ :: ﺍﻟﺨﻄﺔ ﺍﻟﻌﻼﺟﻴﺔ ﺍﻟﻜﺎﻣﻠﺔ ﻟﻤﺮﺽ nephritic syndrom ﻋﻨﺪ ﺍﻻﻃﻔﺎﻝ : ﺍﻏﻠﺐ ﺍﻟﺤﺎﻻﺕ ﻳﻤﻜﻦ ﺍﻥ ﺗﻌﺎﻟﺞ ﻭﺑﻨﺠﺎﺡ ﻓﻲ ﺍﻟﺒﻴﺖ ﺑﺪﻭﻥ ﺍﻟﺤﺎﺟﺔ ﻟﻠﺪﺧﻮﻝ ﻟﻠﻤﺴﺘﺸﻔﻰ ﻭﻟﻜﻦ ﺑﻌﺾ ﺍﻻﺣﻴﺎﻥ ﻓﻲ ﺍﻟﺤﻼﺕ ﺍﻟﺸﺪﻳﺪﺓ ﻭﺍﻟﺘﻲ ﺗﻨﻜﺲ ﻳﺤﺘﺎﺝ ﺍﻟﻰ ﻋﻼﺝ ﺩﺍﺧﻞ ﺍﻟﻤﺴﺘﺸﻔﻰ ﻭﺍﻟﻌﻼﺝ ﻳﻜﻮﻥ ﻛﺎﻟﺘﺎﻟﻲ : ﺍﻭﻻ - ﻳﻤﻜﻦ ﺍﻟﺴﻴﻄﺮﺓ induction of remission ﻋﻠﻰ ﺍﻟﻤﺮﺽ ﺑﻮﺍﺳﻄﺔ ﺍﻋﻄﺎﺀ ﺍﺣﺪ ﺍﺩﻭﻳﺔ ﺍﻟﺴﺘﻴﺮﻭﻳﺪﺍﺕ steroid ﻣﺜﻞ ﺍﻟﺒﺰﻭﻟﻮﻥ prednisolone ﺑﺠﺮﻋﺔ 2 ﻣﻠﻐﻢ / ﻛﻐﻢ /ﺍﻟﻴﻮﻡ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﻣﻘﺴﻤﺔ 4-3 ﻣﺮﺍﺕ ﻳﻮﻣﻴﺎ ﻭﺗﺴﺘﻤﺮ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﻰ ﺍﺳﺒﻮﻉ ﻭﺍﺣﺪ ﺑﻌﺪ ﺍﺧﺘﻔﺎﺀ ﺍﻟﺒﺮﻭﺗﻴﻦ ﻣﻦ ﺍﻟﺒﻮﻝ urine ﺣﻴﺚ ﻋﺎﺩﺓ ﺗﻈﻬﺮ ﺍﻻﺳﺘﺠﺎﺑﺔ ﻟﻠﻌﻼﺝ ﺑﻌﺪ 4-2 ﺍﺳﺒﻮﻉ ﻣﻦ ﺍﻟﺒﺪﺀ ﺑﺎﻟﻤﻌﺎﻟﺠﺔ ﺍﻣﺎ ﺍﺫﺍ ﻟﻢ ﺗﻈﻬﺮ ﺍﻻﺳﺘﺠﺎﺑﺔ ﻟﻠﻌﻼﺝ ﺑﻌﺪ ﻓﺘﺮﺓ ﺷﻬﺮ ﻣﻦ ﺍﻻﺳﺘﻌﻤﺎﻝ ﺍﻟﻴﻮﻣﻲ ﻟﻠﻌﻼﺝ ﻓﻴﺠﺐ ﻋﻤﻞ renal biopsy . :: maintenance of remission ﺍﻣﺎ ﺍﺫﺍ ﺣﺪﺛﺖ ﺍﻻﺳﺘﺠﺎﺑﺔ ﻓﻴﺠﺐ ﺍﻻﺳﺘﻤﺮﺍﺭ ﺑﺎﻋﻄﺎﺀ ﺍﻟﻌﻼﺝ ﺣﻴﺚ ﺗﻌﻄﻰ ﺍﻟﺠﺮﻋﺔ ﺍﻟﻤﻮﺻﻮﻓﺔ ﺳﺎﺑﻘﺎ 2 ﻣﻠﻐﻢ /ﻛﻐﻢ / ﺑﻴﻦ ﻳﻴﻮﻡ ﻭﺍﺧﺮ ﺻﺒﺎﺣﺎ ﺑﻌﺪ ﺍﻟﻔﻄﻮﺭ ))ﺑﺲ ﻣﻮ ﻭﺍﺣﺪ ﺳﻬﺮﺍﻥ ﻋﻠﻰ ﺍﻟﻔﻴﺲ ﺑﻮﻙ ﻭﻳﻜﻌﺪ ﺍﻟﺴﺎﻋﺔ ﺍﻟﺜﺎﻧﻴﺔ ﻇﻬﺮﺍ ﻫﻬﻬﻬﻪ ﻭﻳﺘﻨﺎﻭﻝ ﺍﻟﻌﻼﺝ ﺍﻗﺼﺪ ﺻﺒﺎﺣﺎ ﺍﻻﻓﻀﻞ ﺍﻟﺴﺎﺩﺳﺔ ﺻﺒﺎﺣﺎ )) ﻭﻧﺴﺘﻤﺮ ﺑﺎﻋﻄﺎﺀ ﺍﻟﻌﻼﺝ ﻟﻤﺪﺓ 6-3 ﺷﻬﺮ ،ﻭﻓﻲ ﺣﺎﻟﺔ ﺭﺟﻮﻉ ﺍﻟﻤﺮﺽ ﺍﺛﻨﺎﺀ ﺍﻋﻄﺎﺀ ﺟﺮﻋﺔ ﺍﻟﺼﻴﺎﻧﺔ ﻓﻴﺠﺐ ﺍﻟﺮﺟﻮﻉ ﺑﺎﻋﻄﺎﺀ ﺍﻟﻌﻼﺝ ﻳﻮﻣﻴﺎ ﺍﻟﻰ ﺍﻥ ﺗﺘﻢ ﺍﻟﺴﻴﻄﺮﺓ ﻋﻠﻰ ﺍﻟﻤﺮﺽ ﻣﻦ ﺟﺪﻳﺪ ﻭﻣﻦ ﺛﻢ ﻧﻌﻄﻲ ﺍﻟﻌﻼﺝ ﺑﻴﻦ ﻳﻮﻡ ﻭﺍﺧﺮ ﻟﻤﺪﺓ ﺍﻃﻮﻝ 12-6 ﺷﻬﺮ . ::ﺍﻣﺎ ﻓﻲ ﺍﻻﻃﻔﺎﻝ ﺍﻟﺬﻱ ﻳﺤﺪﺙ ﻋﻨﺪﻫﻢ frequent relapses ﻓﻴﻌﺎﻟﺠﻮﻥ ﺑﻮﺍﺳﻄﺔ ﻋﻼﺝ cyclophosamide ﺏﺟﺮﻋﺔ 3-2 ﻣﻠﻐﻢ /ﻛﻐﻢ / ﺍﻟﻴﻮﻡ ﻟﺠﺮﻋﺔ ﻭﺍﺣﺪﺓ ﻳﻮﻣﻴﺎ ﻟﻤﺪﺓ 8 ﺍﺳﺎﺑﻴﻊ ﻣﻊ ﺍﻻﺳﺘﻤﺮﺍﺭ ﺑﺠﺮﻋﺔ ﺍﻟﺒﺰﻭﻟﻮﻥprednisolone ﺑﻴﻦ ﻳﻮﻡ ﻭﺍﺧﺮ ﻻﻃﺎﻟﺔ ﻓﺘﺮﺓ ﺍﻟﺴﻴﻄﺮﺓ ﻋﻠﻰ ﺍﻟﻤﺮﺽ ﻣﻊ ﻗﻴﺎﺱ ﻋﺪﺩ ﻛﺮﻳﺎﺕ ﺍﻟﺪﻡ ﺍﻟﺒﻴﻀﺎﺀ ﺍﺳﺒﻮﻋﻴﺎ ﻭﻋﻨﺪﻣﺎ ﺗﻨﺨﻔﺾ ﻋﻦ 5000 ﻛﺮﻳﺔ ﻳﻘﻄﻊ ﻋﻼﺝ cyclophosamide .. ﺛﺎﻧﻴﺎ - ﺍﺫﺍ ﻛﺎﻧﺖ mild odema ﻓﺘﻘﻠﻴﻞ ﺗﻨﺎﻭﻝ salt ﻭﺍﺳﺘﻌﻤﺎﻝ ﺍﺩﻭﻳﺔ steroid ﺟﺪﺍ ﻛﺎﻓﻴﺔ ﻟﻌﻼﺟﻬﺎ ،ﺍﻣﺎ ﺍﺫﺍ ﻛﺎﻧﺖ moderate odema ﻓﺘﻌﺎﻟﺞ ﺑﻮﺍﺳﻄﺔ ﺍﻋﻄﺎﺀ furosemide ﻳﻌﻄﻰ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻔﻢ ﺑﺠﺮﻋﺔ 2 ﻣﻠﻐﻢ /ﻛﻐﻢ / ﺍﻟﻴﻮﻡ ﻭﺍﻳﻀﺎ ﺗﻨﺎﻭﻝ ﺍﻻﻏﺬﻳﺔ ﺍﻟﺘﻲ ﺗﺤﺘﻮﻱ ﻋﻠﻰ ﻛﻤﻴﺔ ﻣﻠﺢ ﻗﻠﻴﻠﺔ ﻭﺗﻘﻠﻴﻞ ﺗﻨﺎﻭﻝ ﺍﻟﺴﻮﺍﺋﻞ ﻟﻤﺪﺓ ﺍﺳﺒﻮﻉ ﺍﻳﻀﺎ ﻗﺪ ﺗﺴﺎﻋﺪ ﻋﻼﺝ ﺍﺗﻤﺎﻡ ﺍﻟﻌﻼﺝ ﺑﺼﻮﺭﺓ ﺍﻓﻀﻞ . ﻓﻲ ﺣﺎﻟﺔ marked odema ﻣﻊ ﻧﻘﺺ ﻓﻲ ﺍﻻﻟﺒﻮﻣﻴﻦ ﻓﻲ ﺍﻟﺠﺴﻢ ﺑﺼﻮﺭﺓ ﺷﺪﻳﺪﺓ ﻓﻴﺠﺐ ﻓﻲ ﻫﺬﻩ ﺍﻟﺤﺎﻟﺔ ﺍﻋﻄﺎﺀ albumine ﺑﺘﺮﻛﻴﺰ 20 %ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪ ﺑﺠﺮﻋﺔ 5 ﻣﻠﻐﻢ / ﻛﻐﻢ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪ ﺧﻼﻝ ﺳﺎﻋﺘﻴﻦ ﻣﺘﺒﻮﻋﺔ ﺑﺎﻋﻄﺎﺀ furosemide ﺑﺠﺮﻋﺔ 2 ﻣﻠﻐﻢ / ﻛﻐﻢ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻮﺭﻳﺪ ﻭﺑﻌﺪ ﺫﻟﻚ ﻳﺘﺤﻮﻝ ﺍﻟﻰ ﺍﻻﻋﻄﺎﺀ ﺍﻟﻔﻤﻮﻱ ﻟﻠﻤﺪﺭﺭﺍﺕ . ﺛﺎﻟﺜﺎ –ﺍﻟﻐﺬﺍﺀ ﻳﺠﺐ ﺍﻥ ﻳﻜﻮﻥ ﻏﻨﻲ ﺑﺎﻟﺒﺮﻭﺗﻴﻦ ﻟﺘﻌﻮﻳﺾ ﺍﻟﺒﺮﻭﺗﻴﻦ ﺍﻟﻤﻔﻘﻮﺩ ﻓﻲ urine ﻭﻳﺠﺐ ﺍﻥ ﺗﻜﻮﻥ ﺍﻻﻏﺬﻳﺔ ﺍﻟﺘﻲ ﻳﺘﻨﺎﻭﻟﻬﺎ ﺍﻟﻤﺮﻳﺾ ﺧﺎﻟﻴﺔ ﻣﻦ ﺍﻟﻤﻠﺢ ﻟﻤﺪﺓ ﺍﺳﺒﻮﻉ ﺍﻭ ﺍﺳﺒﻮﻋﻴﻦ ﺍﻟﻰ ﺍﻥ ﺗﺘﻢ ﺍﻟﺴﻴﻄﺮﺓ ﻋﻠﻰ odemaﺍ ﻣﺎ ﺍﻟﺴﻮﺍﺋﻞ ﻓﻴﺠﺐ ﺍﻥ ﺗﻘﻠﻞ ﺍﺫﺍ ﻛﺎﻧﺖ odema ﻣﺘﻮﺳﻄﺔ ﺍﻭ ﺷﺪﻳﺪﺓ . ﺭﺍﺑﻌﺎ –ﺍﻟﺴﻴﻄﺮﺓ ﻋﻠﻰ infection ﺍﻟﺘﻲ ﺭﺑﻤﺎ ﺗﺤﺪﺙ ﺍﺛﻨﺎﺀ ﺍﻟﻤﺮﺽ ﻧﺘﻴﺠﺔ ﻗﻠﺔ ﻣﻨﺎﻋﺔ ﺍﻟﻤﺮﻳﺾ ﻭﻳﺘﻢ ﺍﻟﺘﺎﻛﺪ ﻣﻦ ﺫﻟﻚ ﻣﻦ ﺧﻼﻝ ﺍﺭﺗﻔﺎﻉ ﺩﺭﺟﺔ ﺍﻟﺤﺮﺍﺭﺓ ﻭﺯﺭﻉ ﺍﻟﺪﻡ ﻭﺑﻌﺾ ﺍﻻﻃﺒﺎﺀ ﻳﺼﻒ ﺑﻌﺾ ﺍﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻮﻳﺔ ﻣﺜﻞ ﺍﻻﻣﺒﺴﻠﻴﻦ ﻛﻌﻼﺟﺔ ﻭﻗﺎﺋﻲ ﻣﻦ ﺣﺪﻭﺙ infection . ﺍﻟﻤﺼﺪﺭ practical pediatric therapy
Posted on: Tue, 03 Sep 2013 08:45:45 +0000
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