IKINYA, sobanukirwa n’ibyacyo hamwe n’inzobere Mutangana – UMUSEKE
RALC Ntibavuga bavuga

IKINYA, sobanukirwa n’ibyacyo hamwe n’inzobere Mutangana

*Uko byamera kose ikinya gisinziriza ngo ntawe kidafata
*Abanywi b’inzoga nyinshi ngo bashobora kumutera ikinya cy’iminota 15 kigashira muri 7
* Ni ryari ikinya kidafata umuntu?
* Ikinya ngo ntabwo kica
* Mu Rwanda hari inzobere hagati ya 450 na 550 mu gutera ikinya
* Utera ikinya ngo aba afite impungenge kurusha ugiye kugiterwa

Ikinya ni umuti ufasha abarwayi gusinzira mu gihe bagiye gusuzumwa, kubagwa cyangwa kuvurwa indwara runaka ishobora kubabaza cyane. Gusa abatazi ibyacyo hari byinshi bumva bivugwa bikanibazwa ibyacyo neza kuko ngo hari n’abo bagitera ntibakanguke. Twaganiriye na muganga utera ikinya.

Alexis Mutangana ni umuganga utera ikinya, ahagarariye kandi ihuriro ry’abaganga batera ikinya mu Rwanda (Rwanda Association of Anesthetists, RAA).

Hari byinshi biba bivugwa ku kinya, umva ibyo abakizi bakivugaho

Hari byinshi biba bivugwa ku kinya, umva ibyo abakizi bakivugaho

Umuseke: Ikinya ni iki? Gikozwe muki gituma umubiri utumva uburibwe?

Alexis Mutangana:  Ikinya ni uburyo bukoreshwa kugira ngo umuntu mu gihe arimo abagwa cyangwa se mu gihe bamusuzuma, kuko hari igihe ibintu bisaba gusuzuma ariko bikaba byatuma uwo muntu ababara, ikinya gifasha umuntu kuza kuba ari mu mimerere ituma atabyumva, atanababara.

Hari igihe bashobora kugutera ikinya ukaba wumva ariko utababara ariko hakabaho n’igiheha uhabwa ikinya ukaba utumva(Nukuvuga usinziriye) utanababara.

Ibyo ndaza kubigabanyamo ibice bigeze muri bitatu:

1.Igice cya mbere hari icyo bita anesthesie generale cyangwa ikinya cyo gusinzira. Iki ni cya kinya baha umuntu umuti agasinzira. Iyo umaze gusinzira hari indi miti tugutera ituma utababara kuko iyo umuntu asinziriye ashobora burya kubabara ndetse tukaguha indi miti ituma umuntu akomeza guhumeka (Muscles relaxant drugs) bitewe n’igihe kubaga biri bumare ndetse naho ubagwa kuko haraho bisaba ko uba udahumeka kugirango operation igende neza, Urugero: Umuntu ubagwa amara, ibihaha cg mubwonko.

Muri ya miti itera gusinzira hari ishira mu mubiri w’umuntu mu gihe gito k’uburyo rero umuntu atagize ikindi agukorera wahita ukanguka operation ubwayo itararangira,ibi bituma uhabwa imiti igusinziriza binyuze mu guhumeka ikaba ivangwa na oxygene.Ibyo bikaba bikorwa mu gutera ikinya (Manual ventillation) cg akoresheje imashini yabugenewe. Ibi bifasha ko operation amasaha yamara yose ntakibazo cyo kuba umurwayi yakanguka itarangiye.

Muri iyi miti dutanga ituma umurwayi akomeza guhumeka iba ivanze n’umwuka wa oxyegene, iyi miti igakomeza kumufasha gukomeza guhumeka mu gihe cyose operation iba.

Iyo operation irangiye imiti turayihagarika. Nyuma ariko tuguha indi ituma wongera guhumeka mu butyo busanzwe (Reversal drugs)

Ubusanzwe ikinya kiba gikozwe mu miti ikorwa mu bintu bitandukanye birimo ibimera, ibinyabutabire bikorerwa mu nganda  hari n’ibikomoka ku nyamaswa runaka.

 

Ese ikinya kigira izihe ngaruka ku bwonko?

A.Mutangana: Nari ntarasoza, buriya nari ndangije kukubwira ibyerekeranye n’ikinya cyo gusinzira.

Hari ikindi kinya twita Local regional. Iki ni ikinya batera umuntu akagira igice runaka kitumva kitanababara. Hari icyo dutera nko mu mugongo k’uburyo ibice nk ’amaguru, igice cy’inda…bitumva, ntibibabare kandi utanabinyeganyeza, ariko hejuru: amaboko, igituza, ugakanura , mbese hejuru hagakora bisanzwe kuburyo uba uganira n’abaganga muri kumwe.

Ibi biterwa n’uko imyakura (Nerves) y’igice cyo hasi iba itumva itanababara kuko tuba twashyizemo imiti ituma ububabare butabasha kugera ku bwonko kuko iyo miti iba yahagaritse itumanaho riba hagati y’igice runaka cyumubiri n’ubwonko ubusanzwe bukora akazi ko kuyobora umubiri wose. Iki kinya nicyo twita mu ndimi z’amahanga Rachianesthesie cyangwa spinal Anesthesia.

 Muri ubu bwoko bw’ikinya harimo ikindi gice aho umuganga ashobora gufata agace gato cyangwa igice gito runaka cy’urugingo ukaba aricyo utera ikinya.

Ndaguha nk’urugero: Ushobora kuba wavunitse ukuboko, wavunitse nk’amagufwa y’imbere y’inkokora, hari ikinya umuntu ashobora kuguha uko kuboko konyine aho wavunitse honyine hakaba ariho hatumva ntihababare ariko ahandi hameze neza nta kibazo. Iki kinya nicyo twita mundimi z’amahanga locale or Blocks.

 

Ese birashoboka ko umuntu bamubaga cyangwa bakamuvura batamuteye ikinya?

A.Mutangana: Ibyari aribyo byose ntabwo kwa muganga bashobora kuvura umuntu muburyo bwo kubaga batamuteye ikinya kuko kukubaga ubwabyo birababaza kandi niba waje kwa muganga ni uko uba ubabaye bityo rero umuganga icyo aba aharanira ni ukugira ngo akugabanyirize cyangwa se akumaraho ububabare.

Urumva rero ntabwo waza ubabara ngo hanyuma umuganga akudode cyangwa akubage ubabara. Ububabare nabwo ubwabwo bwagutera ibindi bibazo birenze ibyakuzanye.

 

Dusobanurire inzira ikinya gicamo kugira ngo kigere mu bwonko n’igice cyabwo kigiraho ingaruka

A.Mutangana: Kubisobanura bishobora kuba birebire ariko ndagerageza kubisobanura mu magambo avunaguye. Ikinya cyo gusinzira ni umuti dutera mu mutsi. Iyo ugiye kwa muganga bafata umutsi bakawuteramo agashinge karimo umuti. Uwo muti ujyana n’amaraso. Amaraso ubundi iyo ari mu migarura (veines) asubira mu mutima nawo ukayohereza mu bihaha, nabyo bikayaha oxygene nyuma yo gukuramo umwuka wamaze kwandura (Co2).

Kubera ko rero ubwonko bw’umuntu aribwo buyobora umuntu wese muri rusange ni nacyo gice kibanza kubona amaraso.

Kubera ko ya maraso avuye mu mutima akajya mu bwonko aba arimo ikinya birumvikana ko aribwo bukorwaho nacyo vuba kandi cyane.

Amaraso rero ahita agaruka mu mutima ndetse no mubindi bice(Systemes) harimo ibihaha n’impyiko.

Hari ibice(Systemes) bigera kuri bine aribyo ubwonko, umutima, ibihaha n’impyiko ndetse n’umwijima(les organs nobles)nibyo bibanza kubona amaraso mbere y’ibindi.

Iyo ya maraso arimo umuti usinziriza ageze ku bwonko aboneza mu gice gishinzwe gusinzira hanyuma nyine umuntu agasinzira. Wibuke ko ubwonko bw’umuntu bufite ibice byinshi bifite inshingano zitandukanye byuzuza.

Uko amaraso akomeza kuzenguruka mu muntu akirimo wa muti n’uko akomeza gusinzira kugeza igihe twateganyije kumubagira kirangiye bitewe n’umuti twatanze na yayindi twamuhaye ituma akomeza guhumeka.

Ikinya gisinziriza umubiri wose byanze bikunze ngo umuntu wese kiramufata

Ikinya gisinziriza umubiri wose byanze bikunze ngo umuntu wese kiramufata

Hari igihe twumva ngo bateye umuntu ikinya nticyafata, ese biba byagenze gute? Aba afite ibihe bibazo?

A.Mutangana: Hari ibintu ndibutandukanye. Kiriya kinya gitera abantu gusinzira nta muntu n’umwe kitasinziriza. Iyo tukiguhaye byanze bikunze urasinzira, uko byagenda kose.

Gusa hari nk’abantu banywa inzoga nyinshi nka za liqueurs  cyangwa ibindi biyobyabwenge… hari ukuntu imibiri yabo iba ifite ubushobozi bwo gukoresha imiti bayihaye vuba vuba bityo ikaba yabashiramo vuba.

Ibi rero no ku kinya birashoboka ko icyo twabateye imibiri yabo igikoresha ibyo bita metabolism yihuse bakaba bakanguka vuba ugereranyije n’abandi, waba wamuteye ikinya kiri bumare iminota 15 akaba yakanguka mu minota nk’ irindwi ,nukuvuga micye ugereranije nisanzwe

Nubwo bimeze gutya ariko ntabwo wavuga ko ikinya kitamusinzirije, nta muntu ikinya kitasinziriza rwose.

Ku rundi ruhande ariko cya kinya nakubwiye cya ‘local regional’ nakubwiye haruguru cyo hari igihe gishobora kwanga gufata kubera impamvu  nk’ebyiri z’ingenzi arizo: Kuba umuti wagiye aho utagombaga kujya aha bishatse kuvuga ko aho urushinge rwagombaga gushyira umuti rushobora kuhahusha kubera wenda kwibeshya kwa muganga cg hari ubundi busembwa bw’umubiri (malformation anatonique) w’umurwayi.

Ubusanzwe kugira ngo ikinya gifate bisaba ko giterwa mu nkengero z’aho umwakura uri kugira ngo ubashe kuwukurura, iyo rero uhushije abantu bashobora kuvuga ko ikinya kitafashe.

Ikindi twavuga gishobora gutuma ikinya kidakora ni uko wenda umuti waba warabitswe nabi ukangirika ugatakaza imbaraga zawo zo gutanga ikinya.

Ubundi ariko nta muntu wavuga ngo ntajya afatwa n’ikinya ahubwo haba hari impamvu zihishe inyuma.

 

Ese mbere yo gutera umuntu ikinya mwibanda kuki?

A.Mutangana: Igihe cyose iyo umurwayi aje kwa muganga akeneye kubagwa cyangwa gusuzumwa ariko bigaragara ko icyamukorerwa cyose cyatuma ababara, igihe cyose babanza kumwoherereza muganga utera ikinya kugira ngo arebe niba koko ari umurwayi watwera ikinya ntikimugireho ingaruka.

Icyo gihe rero iyo uje natwe turagusuzuma tukita ku bintu byinshi. Turibaza tuti: Ese ko hari imiti turi butange ikajya mu mutwe w’uyu muntu, ubusanzwe nta bibazo asanzwe afite mu mutwe? Tureba niba umutima w’umuntu nta bibazo usanganywe kuko hari imiti dutanga ishobora gutuma habaho umuvuduko w’amaraso uzamuka cyangwa ukagabanuka (Hyper & Hypotension) cyangwa umutima ugatera inshuro nyinshi(Tacchycardie) cyangwa nkeya (Bradycardie),ndetse hakaba hari n’iyatuma uhagarara mugihe yaba idatanzwe neza cyangwa umurwayi yari afite ibindi bibazo by’umutima..

Tureba kandi n’uko impyiko z’umurwayi zikora binyuze mu bizamini. Dukoresha ibizami kandi kubera ko hari imiti dutanga iba igomba gusohoka mu mubiri inyuze mu mpyiko ikaza mu nkari, hari inyura mu mwijima, hari indi miti inyura mu bihaha mu guhumeka, hari inyura mu byuya…ibyo byose rero twebwe bidusaba kubanza gusuzuma twitonze tukareba niba izi ngingo zose ari nzima.

Hari abantu dutuma batinda mu kinya kubera ko tuba dushaka ko ubuzima bwabo bubanza bukamera neza.

 Urugero niba umuntu yabazwe mu bwonko, bishobora kuba ngombwa ko tumugumisha mu kinya kugira ngo bwa bwonko bubanze kongera gukora neza, cyangwa se tuvuge nk’umuntu watakaje amaraso menshi tukamutera andi hari igihe tubona kumukangura ako kanya bitari bufashe umutima we, bitari bufashe impyiko ze noneho tukaba tumuretse agasinzira, tukamushyira muri soins intensifs bakamwitaho akazagenda akanguka buhoro buhoro.

Hari n’igihe mu gihe twateraga umuntu ikinya hari indwara runaka yari afite twaba tutarabonye iyi ndwara ikaza gutuma ikinya kitamushiramo vuba.

 

Ese ikinya gishobora guherana umuntu?

A.Mutangana: Ikinya sicyo ubwacyo kica umuntu ahubwo bishobora guterwa n’uburwayi bwe. Ntabwo kwa muganga bahagarika urupfu, bagerageza gukumira urupfu ariko ari uri bupfe arapfa kuko harigihe usanga kubagwa ari ukureba niba hari icyo waramira ariko mubyukuri biboneka ko bigoye. Icyo gihe rero ntiwavuga mubyukuri ko azize ikinya.

 

Ubuhanga bwo gutera ikinya bwigwa na  bande? Mu byiciro bingahe?

A.Mutangana: Ubusanzwe abiga ubuhanga mu gutera ikinya bari mu byiciro bitatu:

Hari ababyiga muri Kaminuza nka Specialisation ariko basanzwe barize kuvura muri Kaminuza(Dr).

Hari abazamuka mu mashuri yisumbuye barize ibinyabuzima n’ubutabire ariko bagera muri Kaminuza bagatangirana na Anesthesia kugeza barangije (Non physicians anesthetists)

Hari noneho n’abiga gutera ikinya muri Kaminuza ariko barazamutse biga ubuforomo bakabikomereza no muri Kaminuza (Nurse Anesthetists)

Nubwo baba bafite ibyo batandukaniyeho bitewe n’ibyo bize ariko baba bahuriye ku mwuga wo gutera ikinya.

 

Kugeza ubu mu Rwanda abaganga bafite impamyabushobozi mu gutera ikinya ni bangahe?

A.Mutangana: Kugeza ubu abo dufite bari mu kazi bari muri cya cyiciro cyaba docteurs (specialists)  mu ugutera ikinya bari hagati ya 18 na 20. Ariko dufite n’abandi bari kwiga gutera ikinya kuri uru rwego babarirwa hafi ku 10 (Imibare sinyifite neza mu mutwe).

Muri ba bandi navuze  baba batarabanje kwiga muri faculty ya Medecine ariko bakaba barabyize muri kaminuza (Non physician Anesthetists) batera ikinya dufite abari hagati ya 450 na 550, aba bakaba ari inzobere ndetse bakaba aribo bagize igice kinini cyabatanga ikinya mu Rwanda kuko aribo bakora mu bitaro byose byo mugihugu. Aba harimo abari ku rwego rwa A1,A0 ndetse na maitrise.

Hari kandi abagera kuri 15 batera ikinya ariko barabanje kwiga ubuforomo nyuma baaza kongeraho amasomo yikinya(Nurse Anesthetists).

Alexis Mutangana aganira n'umunyamakuru w'Umuseke

Alexis Mutangana aganira n’umunyamakuru w’Umuseke

Ni izihe nama mwaha abantu batararwara ngo bakenere ikinya?

A.Mutangana: Urakoze cyane! Mbere y’uko wenda mvuga ibyo bakwirinda, nabwira abazasoma iyi nkuru ko nta muntu ukwiye kugira ubwoba bw’ikinya kuko utera ikinya niwe muntu wa mbere uba afite impungenge z’icyaba ku murwayi yahaye ikinya kurusha uri bugiterwe.

Utera ikinya aba akeneye ko umuntu waje amugana ari bumusinzirize akanamukangura. Niba ari na cya kindi cy’igice kiri bumushiremo. Niyo mpamvu tubanza no kubasuzuma.

Akenshi rero usanga abantu bafite ubwoba ngo ntibari bukanguke. Utera ikinya iyo abonye wagira ikibazo arabikubwira cyangwa akakohereza ku muganga uri bukuvure uburwayi akubonyemo bwatuma ugira ikibazo ku kinya.

Urugero hari igihe muganga ubaga aguha rendez-vous yo kukubaga ariko waza mbere yo kukubaga twagusuzuma twasanga hari ikintu cyatuma kugutera ikinya byatera ikibazo, tugasaba ko ubanza kujya ku wundi muganga akagikemura mbere y’uko tugutera ikinya kugira ngo ubagwe.

Ariko, ibi ntibireba urgences kuko biba arukuramira ubuzima, dukora ibishoboka byose kuko umwanya wo kubanza gukemura ubwo burwayi bundi tugusanzemo wasanga ubuzima bwe buducite.

Ikindi nsaba ni uko abantu bagomba kumenya ko umwuga wacu usaba ubumenyi butajenjetse kandi usaba kwitonda cyane.

Kubw’ibyo rero turasaba abarwayi kumva ko niba muganga akubwiye ko ibintu bimeze gutya utagomba kubyanga kuko icyo aba agamije aruko bigenda neza.

Hari abarwayi usanga bafite ukuntu babwiwe ikinya kutari ko n’abantu bo mu miryango, inshuti cyangwa abandi bantu bashobora kuba baragihawe bityo ugasanga yumvise cyane ibyo bamubwiye kurusha ibyuwabyize unabikora yamubwiye.

Icyo nasaba bene abo bantu nuko bajya bagirira ikizere abaganga kurusha ibyo bumviye ahandi hatari kubabyize.

 

Muganga Mutangana yabwiye Umuseke ko ubusanzwe mbere yo gutera umuntu ikinya biba ngombwa ko aganirizwa akabwirwa icyo kiri bumufashe, ingaruka cyagira ndetse n’ubufasha yahabwa mu bihe runaka bibaye ngombwa.

Iyo ibi bamaze kubyemeranywaho impande zombi zirabisinyira kugira ngo hatazabaho kwitana bamwana.

Jean Pierre NIZEYIMANA
UMUSEKE.RW

10 Comments

  1. fa

    May 19, 2017 at 6:28 am

    thx umuseke!!! muzadushakira abaganga binzobere mukkubaga:
    -ubwonko
    umutima
    ibihaha
    n’ ipyiko
    mubatuganirizee
    merci beaucoup!!!

  2. zooo

    May 19, 2017 at 6:52 am

    thx muzadushakire uko imibare yabaganga ihagaze murwanda muri category zose kdi muri buri level

  3. vestine

    May 19, 2017 at 8:15 am

    umuseke muri abanyamwuga rwose kuko mukora kumpande zose nanjye natinyaga ikinya cyane ariko ndasobanukiwe Dr arakoze kubisobanuro byiza atanze.

  4. Mukamana

    May 19, 2017 at 9:16 am

    Muraho, Mbanje gushimira Umuseke kuko mukora inkuru kinyamwuga. Ndagira ngo mbaze jyewe narabazwe ngiye kubyara hanyuma muganga yanteye ikinya local cyanga gufata knd mubyukuri nta kibazo nari mfite bantera general ubwo byatewe niki?

    • j Claude

      May 20, 2017 at 1:36 am

      Niba wabisomye neza hari impamvu 2 yasobanuye zatuma icyo kinya kitagufata. Harimo kuba uwo muti watewe ahatariho habayemo kwibeshya gato cg uwo muti ukaba utarafashwe cg utarabitswe neza ukaba utagifite ubuziranenjye

  5. rwanyonga rwabugiri

    May 19, 2017 at 11:07 am

    Dr urakoze cyane ,gusa ibyo binya byose narabitewe ari icyo gusinziriza ni danger barakinteye nkajya numva nagiye muyindi si numva ntazi ibyo ndimo gusa nabao naga aho nagiye atari habi niyo nkipfira sinari gupfa nabi

  6. Mygod

    May 19, 2017 at 7:29 pm

    Mwarimu wa primaire yabisobanura neza kurushaho, kuko we ntatera ikinya, nicyo kimutunze hamwe na serumu.

  7. Antoine

    May 19, 2017 at 9:07 pm

    Alexis turakwemera nge narinkuzi nja M.C kumbi uri ninzobere bigezaho komerezaho

  8. Peace

    May 19, 2017 at 11:14 pm

    nanjye byose narabitewe pe cyiriya bagutera mumugongo kigafata partie yo hepfo cyo nabonye biba bitangaje kuko abaganga muba munaganira gusa icyo gusinzira cyo ni danger nanjye numvaga ntazi aho ndi nkumva meze nkuri mu ijuru pe narakangutse ndibaza ese ni ibiki byabaye? eeeeeh gusa cyera najyaga mbyibaza ariko ubu sinkyibitinya kuko iyo byakugezeho ntakundi

  9. j Claude

    May 20, 2017 at 1:32 am

    Murakoze cyane muganga Mutangana kubisobanuro uduhaye. Ibi byajya bifasha inzobere zitanga ikinya ndetse n’abarwayi ubwabo. Kuko iyo uje hari amakuru ubifiteho bikorohera kwakira ibisobanuro byose uhawe nugitera. Ikindi kandi abantu bamenyeko ari umwuga usaba ubushishozi buhambaye atari nkababandi bavuga ati ni ugutera urushinge gusa. Mudahari ntabuzima twaba dufite bwuzuye.

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