Tuhinga
Te puru metilīni mō te mamae i muri i te pokanga hemoroiti: ngā kitenga o ngā whakamātautau
Ka tūtohu te rata pokanga kia mahia he pokanga tango hemoroiti. Kotahi noa te kupu ka rangona e te tūroro: ko te mamae. Ka whai wawe mai te pātai. He maimoatanga ā-rohe rānei, ka tukuna i te wā o te pokanga, hei whakangāwari i te wiki tuatahi? E toru ngā whakamātautau matapōkere e whakamātau ana i tētahi kōwhiringa: ko te puru metilīni ka werohia ki te kiri huri noa i te nonotou i te wā o te pokanga. E pūrongo ana ia whakamātautau he iti iho te mamae tōmua ina whakamahia te puru metilīni. He herenga anō tō ia whakamātautau e whakarerekē ana i te whānuitanga o te whakamahinga o taua kitenga.
Ka whakataurite tēnei whārangi i ngā whakamātautau e toru, tētahi ki tētahi. I tuhia mō ngā momo kaipānui e rua. Ka taea e te tūroro te whakamahi hei whakarite pātai mā te rōpū pokanga. Ka taea e te kaituhi te whakamahi hei tirotiro i ngā mea i tuhia e ngā rangahau mō te mamae ā-rohe nā ngā tukanga hauora, mō ia rā.
He aha ēnei whakamātautau, ā, he aha kāore i whakamātauria
I whakaurua e ia whakamātautau he pakeke e whai ana i te pokanga tango hemoroiti Milligan-Morgan, arā, te pokanga tango hemoroiti ka waiho tuwhera te patunga. I ia whakamātautau, ka tuku tētahi kaimātai hauora i te puru metilīni tata ki te wāhi pokanga i te wā e whakamoehia ana te tūroro. Ko ngā putanga i inea ko te mamae i muri i te pokanga, te whakamahinga o ngā rongoā mamae tāpiri ina hiahiatia, me ngā raruraru.
Kāore tētahi o ngā whakamātautau e toru i rangahau i te māngeongeo mauroa o te nonotou, te maimoatanga mō te kapiti o te nonotou, ngā tohumate hemoroiti kāore anō kia pokangatia rānei. Ka kōrerotia ngā rangahau māngeongeo hei whakamārama anake i tētahi tikanga mahi e whakaarohia ana, arā, te whakangoikore rangitahi i ngā io tairongo ā-rohe, ehara i te whakamahinga i whakamātauria. I aukatia e te whakamātautau 2024 te hunga he kapiti, he ara fistula hoki i taua wā. I aukatia e te whakamātautau 2026 te hunga he kapiti, he ara fistula, he whēwhē, he mate whēkau kē atu rānei. Ki te rangirua koe i ngā tauine mamae, ka whakamārama te aratohu mō te pānui whakamātautau mamae i te VAS me te NRS i mua i tō whakataurite i ngā tau. He raru rerekē te māngeongeo me te pakaru o te kiko; tirohia ngā āhuatanga kapiti me te māngeongeo o te nonotou kia mārama ai ngā rohe o tēnei kaupapa.
Te whakaritenga o ngā whakamātautau e toru
He nui ngā rerekētanga o ngā tikanga tuku rongoā, nō reira kaua e whakaarotia he momo tukunga kotahi. Tekau whakareatanga te rerekētanga i waenga i te horopeta iti rawa me te mea nui rawa, ā, he rerekē hoki te wā tuku, te paparanga kiko, me te rōpū whakatairite. Ko te pokanga tētahi o ngā kōwhiringa maimoatanga hemoroiti; ko te mamae i muri i te pokanga anake te kaupapa o ēnei whakamātautau.
| Whakamātautau | Ngā tūroro i tātarihia | Te tikanga tuku puru metilīni | Te rōpū whakatairite me te tiaki taketake |
|---|---|---|---|
| Sim me Tan 2014 | 67 (puru metilīni 37, whakatairite 30), pokanga tango hemoroiti tuwhera mā te wera hiko | 4 mL o te puru metilīni 1 ōrau (40 mg) i konatunatua ki te 16 mL o te bupivacaine 0.5 ōrau, ka werohia ki roto i te kiri huri noa i te nonotou i mua i te tapahi kiko | Ko taua bupivacaine anō me te wai tote hei whakakapi i te waikano puru; i pūrongotia te paracetamol taketake me te diclofenac i tētahi tangohanga raraunga tuarua |
| Azhough 2024 | 97 (puru metilīni 48, whakatairite 49), kōeke III, IV rānei, kotahi te rōpū pokanga, whakamoe mā te tuaiwi | 5 mL o te puru metilīni 1 ōrau (50 mg), hei putunga e rima o te 1 mL ki roto i te kiri, tata ki te 2 cm mai i te tapa tapahanga, i muri i te tangohanga | 5 mL o te bupivacaine 0.5 ōrau i muri i te tangohanga; ketorolac i ngā wā kua whakaritea, tramadol tāpiri ina hiahiatia, kātahi ko te naproxen me te acetaminophen me te codeine i te putanga i te hōhipera |
| Zhu 2026 | 60 (30 ki ia rōpū), hemoroiti hanumi, kotahi te rata pokanga, whakamoe mā te wāhanga hope o te tuaiwi | He puru kua waimehatia ki te 0.1 ōrau (1 mL o te 1 ōrau me te 9 mL wai tote), 0.5 ki te 1 mL ki ia tapahanga, he āhua kōpaki e hora ana, me te mirimiri poto, ko te tapeke 5 mL, iti iho rānei (5 mg, iti iho rānei), i muri i te tangohanga | Kāore he werohanga ā-rohe; lornoxicam 8 mg ina tonoa e te tūroro, me te 6 hāora neke atu i waenga i ngā horopeta |
E rua ngā āhuatanga hoahoa e whai take ana. Tuatahi, ka whakataurite ngā whakamātautau 2014 me 2024 i te waikano ki te tuku bupivacaine ki te kiko. Nō reira, ko ngā rerekētanga ko te pānga tāpiri o te waikano ki runga i te rongoā whakamoe ā-rohe, engari ka whakataurite te whakamātautau 2026 i te waikano ki te kore werohanga ā-rohe. Tuarua, he ngoikore te huna i te rōpū maimoatanga mēnā ka kitea te tae puru. E kī ana ngā kaituhi o te whakamātautau 2026 nā te rerekē o te tae o te kiko me te mimi i kore ai e taea te huna whai hua i te rōpū maimoatanga, nō reira ka whakaraerae ngā kaute mamae whaiaro ki te whakaruhi.
Te mamae mō ia rā whai muri i te pokanga
Ko te tauira e kitea ana i te katoa, he wehe tōmua o ngā kaute, kātahi ka tata haere. He rerekē te tauine o ia whakamātautau, nō reira me pānui ia mea i runga i tōna ake tikanga. Kei te whakahaere mamae i muri i te pokanga ngā tikanga whānui, e whakamārama ana i ngā rongoā mamae taketake me te whakaritenga o ngā rongoā tāpiri ina hiahiatia.
I tētahi whakamātautau matapōkere, matapō kotahi, mō te puru metilīni ki roto i te kiri i muri i te pokanga tango hemoroiti tuwhera mā te wera hiko, i pupuri ngā tūroro i tētahi rātaka tauine tairitenga ā-kanohi. He iti iho te mamae toharite i te rōpū puru metilīni i ngā rā 1 ki te 3 whai muri i te pokanga, ā, he whai hiranga ā-tauanga tēnei. He iti iho hoki te whakamahinga paracetamol i taua wā, ā, kāore he painga whai hiranga ā-tauanga i muri i te rā 3. Kāore ngā kaute toharite tika i te tuhinga whakarāpopoto e wātea ana, nō reira kāore tēnei arotake e hanga tau mō ia rā.
I tētahi whakamātautau matapō rua mō te puru metilīni ki roto i te kiri i muri i te pokanga tango hemoroiti, i tuhi ngā tūroro i tō rātou mamae mōrahi o ia rā i te wā moe, ki tētahi tauine 11 ira mai i te 0 ki te 10, mō ngā rā 14. He whai hiranga ā-tauanga te rerekētanga i ngā rā 1 ki te 7, me te p i raro i te 0.001 i ia rā, ā, kāore i whai hiranga ā-tauanga i ngā rā 8 ki te 14:
- Rā 1: puru 4.08 tāpiri, tango rānei 1.23, whakatairite 5.20 tāpiri, tango rānei 1.40.
- Rā 2: puru 3.94 tāpiri, tango rānei 1.17, whakatairite 5.22 tāpiri, tango rānei 0.87.
- Rā 3: puru 3.90 tāpiri, tango rānei 1.10, whakatairite 5.02 tāpiri, tango rānei 0.95.
- Rā 4: puru 3.71 tāpiri, tango rānei 1.25, whakatairite 4.71 tāpiri, tango rānei 1.21.
- Rā 5: puru 3.60 tāpiri, tango rānei 1.27, whakatairite 4.67 tāpiri, tango rānei 1.21.
- Rā 6: puru 3.46 tāpiri, tango rānei 1.27, whakatairite 4.31 tāpiri, tango rānei 1.21.
- Rā 7: puru 3.35 tāpiri, tango rānei 1.27, whakatairite 3.92 tāpiri, tango rānei 1.21.
- Ngā rā 8 ki te 14: ka heke ngā rōpū e rua ki te takiwā o te 2.5 ki te 3.5, ā, kāore he rerekētanga whai hiranga ā-tauanga i waenga i ngā rōpū i tētahi o ēnei rā o muri (kei runga ake i te 0.2 ngā p katoa).
I tētahi rangahau matapōkere 2026 mō te tuku puru metilīni waimeha ki te kiko i muri i te pokanga Milligan-Morgan, he iti iho te mamae i te wā whakatā, i inea ki te tauine ā-kanohi 0 ki te 10, i te rōpū puru metilīni i te 6, 24, 48, me te 72 hāora, me te p i raro i te 0.001 i ia wā. Kei tētahi kauwhata anake ngā toharite tika, kāore i tētahi ripanga tau, nō reira ka pūrongo tēnei arotake i te tauira, kāore e huri i ngā teitei o te kauwhata hei tau e whakapaetia hētia ana he tino tika.
Ngā rongoā mamae tāpiri ina hiahiatia
Kei te pūrongo i te whakamahinga rongoā tāpiri ngā rerekētanga o te kounga pūrongo o ngā whakamātautau.
E pūrongo ana te whakamātautau 2014 he iti iho te whakamahinga paracetamol i te rōpū puru metilīni i ngā rā 1 ki te 3, ā, he whai hiranga ā-tauanga tēnei, e hāngai ana ki tōna wā hekenga mamae. Engari kāore te whakarāpopototanga e wātea ana e whakaatu i ngā rahinga, ngā ōwehenga, te uara p tika rānei.
I whakaritea e te whakamātautau 2024 te ketorolac i ngā wā kua whakaritea, me te tramadol tāpiri ina hiahiatia, me te tuhi i ngā pire i kainga ki te kāinga. Engari kāore ngā hua i whakaputaina e pūrongo i te whakamahinga mō ia rōpū. He kitenga anō taua korenga: kei runga i ngā kaute mamae anake te taunakitanga mō te whakaiti mamae.
Ko te whakamātautau 2026 te mea tino mārama i konei. Ko te toharite o te tapeke lornoxicam i ngā hāora 72 he 22.67 tāpiri, tango rānei 17.01 mg i te rōpū puru metilīni, ki te 56.80 tāpiri, tango rānei 9.32 mg i te rōpū kore werohanga, me te p i raro i te 0.001. Me mōhio ki te kore ōrite: i whiwhi te rōpū whakatairite i te rongoā mamae ina tonoa anake, engari i whiwhi te rōpū waikano i tētahi maimoatanga kotahi i te wā o te pokanga.
Ngā raruraru me te aroturuki whai muri
Kāore tētahi whakamātautau e pūrongo i tētahi tohu nui mō te mōrea haumaru ā-rohe, engari kāore tētahi i hangaia hei kite i ngā pānga kino onge, tōmuri rānei. Mō ngā kōrero mō ngā mōrea, tirohia te kōtaha haumaru o te puru metilīni i te taha o ngā ripanga raruraru i raro nei.
Ka whakanui te whakarāpopototanga 2014 i tētahi kitenga whakamīharo: ko te ōwehenga mōrea mō te kore ohorere e puta o te mimi i te wā kāore te puru metilīni i whakamahia, he 2.32, me te awhe whakapono 95 ōrau mai i te 1.75 ki te 3.07. Kāore he rerekētanga whai hiranga ā-tauanga o ngā auau o ētahi atu raruraru.
Ka pūrongo te whakamātautau 2024 i ngā raruraru i te 14 rā. I pā te kore e puta o te mimi ki te 5 o te 48 i te rōpū puru, me te 5 o te 49 i te rōpū whakatairite. I pā te kore e taea te pupuri mō te wā poto ki te 3, ki te 1 i te rōpū whakatairite, ā, ko te toto rere tuarua he 0 ki te 2. Ko te mate o te kiko kiri, te whakapokenga, te tauhohenga kiri ā-rohe, me te whāiti o te ara, he kore i ngā rōpū e rua, ā, kotahi te pānga māngeongeo ki ia rōpū. Kāore tētahi o ngā rerekētanga i eke ki te hiranga ā-tauanga.
Ko ngā hāora 72 anake ka pūrongotia e te whakamātautau 2026. Ko te mumura whakapoke o te kiko huri noa i te nonotou, te mate o te kiko kiri, me te katinga toto huri noa i te nonotou, he kore i ngā rōpū e rua. Kāore i tukuna he tau i kohia ā-nahanaha mō te kore e puta o te mimi, te toto rere, te whakapokenga, te kore e taea te pupuri, te tōmuri o te whakaora, te hokinga mai rānei. E whakaaetia ana ko te tae puru o te kiko me te mimi he raruraru mō te huna i te rōpū maimoatanga, kāore i whakaurua hei pānga ki tētahi ripanga.
Ko te roanga o te aroturuki whai muri te herenga matua mō ngā whakamātautau e toru: tata ki te 14 rā i ngā whakamātautau tuatahi e rua, me te 72 hāora i te tuatoru. Kāore e taea te whakatau mai i ēnei raraunga te tōmuri o te whakaora, te kaha pupuri i roto i ngā marama, me te hokinga mai o ngā hemoroiti.
Te ripanga taunakitanga mō ia rā whai muri i te pokanga
Ko te ripanga i raro nei te rauemi whakakotahi mō tēnei whārangi. Kei te tirohanga kotahi te mamae, te whakamahinga rongoā tāpiri, ngā rōpū whakatairite, ngā raruraru, me te aroturuki whai muri.
| Whakamātautau | Te tohu mamae mō ia rā | Ngā rongoā mamae tāpiri | Te rerekētanga ki te rōpū whakatairite | Ngā raruraru | Te aroturuki whai muri |
|---|---|---|---|---|---|
| Sim me Tan 2014, n e ōrite ana ki te 67 | He iti iho te VAS me te puru i ngā rā 1 ki te 3; kāore he rerekētanga whai hiranga ā-tauanga i muri i te rā 3; kāore ngā toharite tika i te whakarāpopototanga e wātea ana | He iti iho te paracetamol me te puru i ngā rā 1 ki te 3; kāore ngā rahinga i tukuna | Te puru me te bupivacaine ki te bupivacaine me te wai tote; ka wehe i te pānga tāpiri o te waikano | Te ōwehenga mōrea mō te kore e puta o te mimi 2.32 ina kore te puru; kāore he rerekētanga whai hiranga ā-tauanga mō ētahi atu pānga | He rātaka mamae mō te takiwā o te 14 rā |
| Azhough 2024, n e ōrite ana ki te 97 | He iti iho te NRS mōrahi o ia rā me te puru i ngā rā 1 ki te 7 (he āputa tata ki te 1.1 ira i te tīmatanga, 0.6 i te rā 7); kāore he rerekētanga i ngā rā 8 ki te 14 | I whakaritea te kawa, engari kāore i pūrongotia te whakamahinga mō ia rōpū | Te puru 50 mg ki te bupivacaine; ka wehe i te pānga tāpiri o te waikano | Te kore e puta o te mimi 5 ki te 5; te kore e taea te pupuri mō te wā poto 3 ki te 1; te toto rere 0 ki te 2; te mate kiko me te whakapokenga 0 ki te 0; kāore tētahi i whai hiranga ā-tauanga | 14 rā |
| Zhu 2026, n e ōrite ana ki te 60 | He iti iho te VAS i te wā whakatā me te puru i te 6, 24, 48, 72 hāora, p i raro i te 0.001 i ia wā; kei te kauwhata anake ngā toharite | Te tapeke lornoxicam 22.67 ki te 56.80 mg, p i raro i te 0.001 | Te puru waimeha 5 mg, iti iho rānei, ki te kore werohanga; koinei te rerekētanga nui rawa o te whakaritenga | Te mumura whakapoke o te kiko, te mate kiko, te katinga toto 0 ki te 0; kāore i pūrongotia ā-nahanaha te kore e puta o te mimi, te toto rere, te whakaora, te hokinga mai | 72 hāora |
Te tikanga o ēnei kitenga mō te whakawhiti kōrero ki te rata pokanga
E whakaae ana ngā whakamātautau iti e toru, i mahia ia mea ki te pokapū kotahi, me ngā horopeta waikano rerekē e toru ki ngā momo rōpū whakatairite rerekē e rua, he iti iho te mamae i ngā rā tuatahi i muri i te tango hemoroiti ina tāpirihia te puru metilīni i te wā o te pokanga. Ko te tohu roa rawa ka mau mō ngā rā 7. E tautoko ana ngā raraunga rongoā tāpiri i taua tauira i ngā whakamātautau e rua, ā, kāore aua raraunga i te tuatoru. Nā te poto o te aroturuki whai muri me te iti o ngā tauira, kāore e taea te whakakore i te tūponotanga o ngā pānga onge, tōmuri rānei.
Ngā pātai e tika ana kia kawea ki te rata pokanga:
- Ko tēhea pokanga e whakaritea ana, ā, he aha ngā tikanga ā-rohe e whakamahia ana i reira i ngā wā katoa?
- Ka tukuna rānei he waikano puru ki te kiko, he aha te horopeta me te paparanga kiko, ā, he aha te kōwhiringa kē?
- He aha ngā rongoā mamae taketake me ngā rongoā tāpiri kua whakaritea, ā, me pēhea te tuhi i te whakamahinga?
- Me pēhea te aroturuki i te kore e puta o te mimi, te toto rere, te whakapokenga, me te kaha pupuri, ā, mō ngā wiki e hia?
- He pēhea te āhua e tūmanakohia ana o te tae puru rangitahi o te kiri, o te mimi rānei, ā, āhea memeha ai?
Mō ngā kaituhi e arotake ana i ngā rangahau mamae nā ngā tukanga hauora, he poto te rārangi arowhai: te kukū tika, te rōrahi, me te horopeta tapeke; te paparanga kiko me te wā tuku i mua, i muri rānei i te tangohanga; te matū hohe kei te pūwero o te rōpū whakatairite; ngā rongoā mamae taketake i ngā wā kua whakaritea, ki ngā mea ka tukuna ina tonoa; ngā tapeke rongoā tāpiri mō ia rōpū; ngā kaute mamae e pūrongotia ana mō ia rā; me tētahi ripanga raruraru e whakaatu ana i ngā tau o ia rōpū me te roanga o te aroturuki whai muri. Ki te kore aua wāhanga, kāore e tautokona tētahi whakapae whakakotahi mō te horopeta, nā te mea he maimoatanga rerekē te waikano 50 mg ki roto i te kiri ka whakatauritea ki te bupivacaine, me te waikano 5 mg ki raro i te kiri ka whakatauritea ki te kore maimoatanga.