Gulu la tanthauzo mantha

Mu moyo zikhoza kuchitika mazana a zinthu zimene zingachititse mantha. Anthu ambiri kusonkhana yekha ndi amphamvu mantha mantha, koma ichi ndi mwina woona. Mu mankhwala, pali gulu mantha, liwulo pathogenesis ake, mwamphamvu, chikhalidwe cha kusintha kwa ziwalo ndi njira amawaitana. Choyamba anafotokoza chikhalidwe ichi zaka zoposa 2 zikwi zapitazo, wotchuka Hippocrates, ndi mawu akuti "mantha" mu ntchito zachipatala anayambitsa mu chaka cha 1737 Parisian dokotala Henri Ledran. Nkhaniyi ikufotokoza mwatsatanetsatane zifukwa zimene zimachititsa mantha, gulu, chipatala, chisamaliro pangozi mwambo uwu chikhalidwe osautsa ndi amaneneratu.

Lingaliro kakasi

Ndi mantha ya English akhoza kumasuliridwa ngati mantha aakulu, kuti si matenda, osati chizindikiro ndiponso si matenda. Zochita dziko mawu akutchulidwa zimene lake ndi machitidwe ake nzothandiza amphamvu (kunja kapena mkati), zomwe zina ndi ntchito ya mantha dongosolo, ndi kupukusa chakudya, kupuma ndi magazi aziyenda. Nawu kamphindi mtima mantha. Gulu la boma kudziwa chifukwa cha mantha, mlingo wa ukulu wake ndi kuyamba mankhwala. The Mapa zabwino pokhapokha ngati matenda olondola ndipo mwamsanga chiyambi cha kuwatsitsimula.

Classifications

Canada dokotala wodziwa za vutoli Selye kuzindikiridwa masiteji atatu, ziri chimodzimodzi kwa mitundu yonse ya mantha:

1.Obratimaya (kulipidwa), imene kotunga magazi ku ubongo, mtima, mapapo ndi ziwalo zina wasweka, koma sanasiye. Kuti madokotala ananena zawo kwa gawo lino zambiri zabwino.

2.Chastichno kusintha (mphumu). Pa kuphwanya womwewo wa kusowa magazi (perfusion) kwambiri, koma mwamsanga ndi moyenera mankhwala alowererepo mwayi kubwezeretsa magwiridwe.

3.Neobratimaya (osachiritsika). Ichi ndi gawo aakulu amene chisokonezo thupi silingaone kubwezeretsedwa ngakhale ndi amadza aakulu thanzi. Kuneneratu ndiye 95% akumane.

Gawo lina ukugawa sitepe pang'ono kusintha ndi 2 - subkompensatsionnuyu ndi dekompensatsionnuyu. Chifukwa, iwo kupeza 4:

• 1 kulipidwa (kuwala kukhala madokotala ananena zawo zabwino).
• 2 subcompensated (m'ma kulemera kuti amafuna kuwatsitsimula yomweyo. Mapa maganizo).
• Chachitatu dekompensatsionnaya (lolemera kwambiri, ngakhale kukhazikitsa atangochimwa zinthu zonse zofunika zanyengo ndi zovuta).
• 4 sizingasinthe (Kulosera tsogolo la matenda ndi osauka).

Pirogov wathu wotchuka allocated mu mkhalidwe mantha magawo awiri:

-torpidnaya (wodwala mu stupor kapena aulesi kwambiri, akuyankha zikuchitika nkhondo, sayankha funsoli);

-erektilnaya (wodwalayo okondwa, kufuula, kupanga kwambiri kayendedwe chikomokere kusalankhula).

Mitundu kakasi

Malinga zifukwa zimene zachititsa kuti vutoli mu kachitidwe thupi, pali mitundu yosiyanasiyana kakasi. Gawo mawu a matenda magazi amenewa:

-gipovolemichesky;

-distributivity;

-kardiogenny;

-obstruktivny;

-dissotsiativny.

Gawo la pathogenesis kakasi ndi ichi:

-gipovolemichesky;

-travmatichesky;

-kardiogenny;

-septichesky;

-anafilaktichesky;

-infektsionno-poizoni;

-neyrogenny;

Amodzi-kuphatikiza.

hypovolemic mantha

Zovuta akuti ndi yosavuta kumva, podziwa kuti hypovolemia - chikhalidwe kumene magazi amazungulira kudzera ziwiya pasanathe voliyumu chofunika. zifukwa:

-obezvozhivanie;

amayaka -Extensive (anataya zambiri plasma);

-pobochnye zochita mankhwala, monga vasodilators;

-large magazi imfa, umene ziwalo kulandira zochepa mpweya ndi chakudya, i.e. wosweka perfusion.

Hypovolemic mantha chifukwa imfa magazi Tingaone monga hemorrhagic mantha. Gulu la chikhalidwe ichi ndi chimodzimodzi kuti olemera Selye, ndi pa siteji yomweyo zimadaliranso magazi salandira matupi. Mantha nthawi zonse mtundu wa chitetezo cha thupi zinthu monyanyira. Ndiko kuti, akuyamba mndandanda wa njira, kufuna kuteteza ntchito ziwalo zofunika kwambiri ndipo potero tipulumutse dongosolo lonse. Makamaka, ndi kutaika kwa magazi Mitsempha amatayika kubwerera magazi (pafupifupi 10% ya okwana) kwa chiwindi ndi ndulu. Ngati izi sikokwanira, kapena yafupika magazi akuima zosafuni- kwa chakudya m'madi- thupi, mwachitsanzo, kuti malekezero, kotero kuti magazi otsalawo zinali zokwanira kwa perfusion wa mtima, ubongo ndi mapapo. Gawo mantha imalongosola masitepe ziwirizi pang'ono kusintha ndi invertible. Pankhaniyi, ngati nthawi kuchitapo kanthu, mungasonyeze munthu pa mkhalidwe mantha, ndi kusunga moyo.

Long ntchito pa kubwerera kwa perfusion magazi ndi zinthu zina ziwalo likuvutika zamoyo zina sindingakhoze. Choncho, ngati inu musayambe kuwatsitsimula, akubwera lomaliza (sizingasinthe) siteji. Ziwalo anati ziwiya anzawo utachepa m'menemo kwambiri, magazi akuyenderera ku periphery, ndi kumakula kwa milingo kuweruza perfusion kuchepekedwa ubongo, mtima ndi mapapo.

madzi m'thupi

The madzi mu thupi la munthu, malingana ndi msinkhu ndi kugonana, pa 60 ndi 80%. Imfa ya% 20 okha cha ndalamazo kungasokoneze, ndi zomvetsa zafika 10%, chifukwa hypovolemic mantha, amene Pankhaniyi imatengedwa ngati madzi m'thupi, kusonyeza kuchepetsa kufalitsidwa mitsempha chifukwa cha madzi m'thupi mkulu. zifukwa:

-zabolevaniya, zikubweretsa m'mimba, kusanza, pafupipafupi pokodza chambiri;

-nedopoluchenie madzi m'thupi (nedopivanie) pansi kwambiri zinthu, monga kutentha, makamaka pa mkulu zofuna kukhetsa thukuta;

-nerazumnye zakudya.

Makamaka ayenera madzi m'thupi ana ndi okalamba.

Gulu la mantha, zinachitika chifukwa cha kusowa kwa madzi, anafotokoza njira ya:

-invertible;

ndi pang'ono kusintha;

-neobratimuyu.

Komanso, kuchepa madzi m'thupi ndiye m'magulu atatu awa:

1.Izotonicheskoe (imfa ya Na ndi K ayoni). Madzimadzi mu thupi lathu ndi okhudza maselo ambiri ndi intercellular. Pamene zomvetsa isotonic chifukwa cha kutsegula m'mimba makamaka excreted anasonyeza potaziyamu kwambiri ndi sodium, ndilo cation chachikulu madzimadzi extracellular akudutsa mu maselo kwa amapanga potaziyamu anataya m'menemo.

2.Gipotonicheskoe, yomwe ndi chotsatira cha isotonic. Iwo amatchuka zomvetsa mkulu wa madzimadzi extracellular (chifukwa ndi sodium wadutsa mu maselo). Magawo awiri oyambirira amaonedwa kukhala kusintha ngati n'kotheka kukwaniritsa imfa ya electrolytes. Pang'ono kulowa m'malo mwa kupereka mtima madzimadzi kudya, makamaka okhala ndi sodium ayoni.

3.Gipertonicheskoe kuti kuyambika m'mimba limodzi retching popewa madzimadzi otaya mu thupi kuwauza kapena ambiri osokoneza ena zinthu zoyambitsa pokodza zina. The madzi kachiwiri amapatsirana maselo mu danga extracellular kuti asunge kuthamanga osmotic. Kawiri maselo limafooka kuphwanya ntchito yawo ndi kuchepetsedwa M'BUKU. Makamaka oopsa kuchepa buku ubongo, imbaenda kukha mwazi subdural.

zizindikiro

Tafotokoza kuti alipo pofotokoza gulu la mantha hypovolemic. Clinic boma, osayang'ana zifukwa, zinapangitsa za chomwecho. Pa siteji kusintha, wodwalayo mu malo supine, zizindikiro kutchulidwa mwina kwina. kuyambira zizindikiro za vuto ndi:

- palpitations;

-small kutsitsa magazi;

wosayamikira machitidwe clammy khungu pa malekezero (chifukwa kuchepa perfusion);

-When pali madzi m'thupi kuyanika milomo, mucous m'kamwa, kusowa kwa misozi.

Pa gawo lachitatu, kudabwitsa zizindikiro koyamba kukhala yapadera kwambiri.

Odwala anati:

-tahikardiya;

-Reduction magazi pansipa mfundo yovuta;

-Violation kupuma;

-oliguriya;

wosayamikira machitidwe kwa kukhudza (osati nthambi);

-mramornost khungu ndi / kapena kusintha mtundu wawo ku wachibadwa wotumbululuka cyanotic;

-nitevidny zimachitika;

-with kukakamiza mosavuta, iwo ali wotumbululuka ndi mtundu pambuyo kuchotsa katundu yafupika ndi masekondi oposa 2 kuika ponseponse. Chipatala chomwecho ali hemorrhagic mantha. Gulu la magawo ake, malinga ndi buku la magazi kufalitsidwa ziwiya makhalidwe zina zikuphatikizapo:

-on kusintha gawo tachycardia kuti kumenyedwa 110 pa mphindi imodzi;

-on pang'ono kusintha - tachycardia a 140 kumenyedwa / Mph;

-on sizingasinthe - kugunda kwa mtima pamwamba 160 kumenyedwa / min. Pa yovuta malo zimachitika sangathe kumva, ndi systolic magazi ikagwa 60 mamilimita Hg kapena zochepa. Danga.

Pamene madzi m'thupi amatha zizindikiro hypovolemic mantha akuwonjezeka:

mucous -suhost;

-reduction kamvekedwe eyeballs;

Y ana kuchotsa ndi fontanelle lalikulu.

Ndi maonekedwe onse akunja, koma molondola kudziwa mmene vutoli, kafukufuku zasayansi. Wodwala yomweyo anachita umagwirira magazi, kudziwa mlingo wa hematocrit, acidosis, mu nkhani zikuluzikulu, kufufuza plasma osalimba. Komanso, madokotala mlingo potaziyamu ulamuliro, ndi electrolytes chachikulu, creatinine, magazi urea. Ngati zinthu chilolezo, anaphunzira yokha ndi mtima sitiroko voliyumu ndi venous kuthamanga kwambiri.

zoopsa mantha

Mtundu wa mantha m'njira zambiri zofanana hemorrhagic, koma chifukwa chake akhoza kuchita kokha mabala Link (kubaya, gunshot, amayaka) amakumana (chotupa cha zimakhala ndi ziwalo, mwachitsanzo, nkhonya mphamvu). mantha Mantha pafupifupi nthawi zonse limodzi ndi ululu molimba iwowo, zina pofuna kukwaniritsa zolinga za mkhalidwe wa wovulalayo. Mu ena amanena iwo akutchedwa mantha chowawa, zimayambitsa imfa. The mwamphamvu kakasi zoopsa watsimikiza kwambiri kuchuluka kwa magazi atayika, mmene imfa imeneyi ya liwiro. Ndiko kuti, ngati magazi umatuluka m'thupi pang'onopang'ono, wozunzidwayo mwayi bwino kuthawa. Komanso kukuwonjezera vuto ndi digiri ya kufunika kwa chiwalo kuonongeka kwa thupi. Ndiko kuti, apulumuke mfuti mkono kudzakhala kosavuta kuposa pa bala kumutu. Awa ndi maonekedwe a mantha zoopsa. Gawo la dziko la kusalekerera motere:

Primordial mantha (limapezeka pafupifupi nthawi yomweyo pambuyo zoipa);

-vtorichny mantha (limapezeka pambuyo opaleshoni, kuchotsa mitolo, pansi pa katundu zina pa akhudzidwa Mwachitsanzo, mayendedwe ake).

Komanso, zoopsa mantha anati magawo awiri - erectile ndi torpid.

Zizindikiro za erectile:

-strong kuwawa;

makhalidwe -neadekvatnoe (akulira, overexcitation, nkhawa, nthawi zina mokwiya);

-tremor;

thukuta wosayamikira machitidwe;

-Advanced ana;

-tahikardiya;

-tahipnoe.

Zizindikiro torpid:

-bolnoy amakhala osagwirizana;

-Over kumeneko, koma munthu alibe amaulandira;

-arterialnoe kuthamanga zikuchepa amachepetsa;

-glaza zokha;

-poyavlyaetsya wotumbululuka khungu, cyanosis cha milomo;

-oliguriya;

chilankhulo -oblozhennost;

mucous -suhost;

wosayamikira machitidwe thukuta sachita, koma khungu wotaya turgor ake;

-puls thready;

-cherty nkhope chinzake.

Otani mantha, gulu

chikhalidwe ichi kumachitika chifukwa malowedwe mu thupi la matenda, ie, mavairasi ndi mabakiteriya amene amayambitsa kuledzera kwambiri chifukwa cha ntchito zawo. Nthawi zambiri wolakwa kuukira mantha streptococcus, staphylococcus, nsomba, Pseudomonas aeruginosa. Iwo amalowa m'thupi, monga mwa mabala lotseguka (puerperal sepsis, amayaka opaleshoni) kapena popanda (typhoid, AIDS, tracheitis, sinusitis, chibayo, fuluwenza ndi matenda ena).

tizilombo toyambitsa matenda kubala superantigens kuti yambitsa T maselo ndipo maselo ena T. Anthu nawonso, secrete cytokines, kuchititsa chitetezo cha wodwala ndi kuletsedwa, ndi kuchuluka yaikulu poizoni anamasulidwa mu mwazi wake, kuchititsa mantha poizoni. Gulu la chikhalidwe ichi chimasiyanitsa magawo atatu:

1.Obratimaya. Mu kuthamanga magazi kungakhale kwabwino, ikhala chikumbumtima bwino, khungu amakhala pinki kapena wofiira. Wodwala kawirikawiri mwakwiya, kudandaula ululu mu thupi kapena pamimba, iye anaona m'mimba, malungo komanso kusanza.

2.Chastichno kusintha. Zizindikiro: malungo, ofooka zimachitika, tachycardia, utachepa kuthamanga, wodwalayo lethargic, anachita imathetsa.

3.Neobratimaya. Zizindikiro: kufupika kwa mpweya, kupweteka, khungu cyanosis, zimachitika ndi ofooka, kuthamanga kwa magazi m'munsimu yovuta, wodwalayo anakomoka.

Gulu la mantha anaphylactic

Chotero chikhalidwe kumachitika pamene ingested ziphe kwa njoka kuluma, akangaude, mavu ndi zina zamoyo, sanaphe zakumwa ndi zakudya, ndi akuluakulu a mankhwala zimene zimapatsidwa kwa allergens wodwalayo. Zimenezi nthawi zambiri anapatsidwa procaine penicillin organic. Shock angayambe masekondi angapo pambuyo kukhudzana ndi allergen thupi kaya mwa nthawi yotalikirapo, ndipo mwamsanga zimene zinachitika, koyipitsitsa madokotala ananena zawo. Pali njira zosiyanasiyana za yatsoka kakasi anaphylactic:

-tipichnaya (redness pa kuluma malo (jekeseni malo), kapena kupweteka m'mimba, pakhosi pa m'kamwa kukhudzana allergen, decompression, psinjika a nthiti pansi m'mimba nkotheka kapena kusanza);

-gemodinamicheskaya (mu malo oyamba matenda a mtima);

-asfiksicheskaya (kupuma kulephera, dyspnea);

-tserebralnaya (wonongeka kwa dongosolo chapakati mantha, khunyu, kukomoka, ndi kupuma kumangidwa);

-abdominalnaya (pachimake pamimba).

chithandizo

Kuchitapo kanthu mwamsanga n'kofunika gulu olondola a zodabwitsa. Mwamsanga chisamaliro pangozi onsewa ali limatchula zake, koma mwamsanga imayambira kuperekedwa, wodwalayo mwayi bwino. Pa sitepe sizingasinthe imfa anati mu oposa 90% ya milandu. Mantha mantha zofunika yomweyo ndigwire kutaya magazi (tourniquet) ndi kupulumutsa anavulala kuchipatala. Pali anagwira mtsempha saline ndi njira colloidal, magazi, madzi a m'magazi, zamizidwa ndi kusakhala, ngati n'koyenera, olumikizidwa kwa makina.

Mu anaphylactic mantha yomweyo kutumikiridwa wa epinephrine, wodwalayo ali intubated ndi asphyxia. Kenako kutumikiridwa corticosteroids ndi mankhwala.

Pamene mantha poizoni anagwira madzimadzi mankhwala chachikulu ndi mankhwala amphamvu, immunomodulators glucocorticoid plasma.

Pamene hypovolemic mantha ntchito yaikulu ndi kubwezeretsa kotunga magazi ziwalo zonse, Kupha hypoxia, ndi normalization wa kuthamanga kwa mtima. Pamene mantha chifukwa cha kuchepa madzi m'thupi, izo Komanso ankafuna resumption buku otaika wa madzimadzi ndi electrolytes onse.