Magazi kuundana mu mapapo. M'mapapo mwanga embolism: zimayambitsa, zizindikiro, zotsatira, chithandizo

matenda akayakaya ndi embolism m'mapapo mwanga (Pe). Tikuyankhula zokhudza magazi kuundana anapanga. Pakati pa pathologies onse embolism m'mapapo mwanga adzamasulidwa ziwerengero kwambiri. magazi kuundana mu mapapo amatha pa mphindi iliyonse kuti asalalikire mtsempha wamagazi ndi. Mwatsoka, nthawi zambiri ndi amapha. Pafupifupi gawo limodzi la odwala onse atamwalira mwadzidzidzi kumachitika chifukwa cha blockage wa mtsempha wamagazi ndi m'mapapo mwanga ndi magazi aumirira.

Zochita za matenda

Pe si nthenda palokha. Monga dzina zikusonyeza, izi ndi zotsatira za thrombosis.

Magazi aumirira, kuyang'ana kwa malo ake a maphunziro, azinyamulidwa mwa dongosolo magazi. Nthawi zambiri, magazi kuundana zimachitika malekezero m'munsi. Nthawi zina isanafalikire mu mtima chabwino. A magazi aumirira umadutsa lamanja atrium, ventricle ndi mu makope m'mapapo mwanga. Iye amasuntha mmodzi mtsempha wamagazi thupi nthunzi ndi magazi venous - m'mapapo.

Oyendayenda aumirira akutchedwa embolus. Iye iri yofulumira m'mapapo. Ichi ndi ndondomeko woopsa kwambiri. A magazi aumirira mu mapapo mwadzidzidzi ndigwire nthambi mtsempha wamagazi. zotengera ndi lambiri mu chiwerengero. Komabe, awiri awo amachepetsa. Kamodzi mu chotengera yomwe magazi aumirira sangathe pochitika, izo midadada magazi. Zimenezi n'zimene zambiri limadzetsa imfa.

Ngati wodwala anathyola magazi aumirira ku phapo, zotsatira zimadalira zimene kunapezeka kuti yatsekera chotengera. Embolus disrupts yachibadwa kotunga magazi zimakhala ndi kuthekera kuwombola mpweya pa mlingo wa nthambi zazing'ono, kapena mitsempha yaikulu. Wodwalayo amaoneka hypoxia.

The kukula kwa matenda

magazi kuundana mu phapo zotsatira ku matenda a matenda pambuyo pobereka ndi opaleshoni zinthu. Imfa ku matenda ndi mkulu. Ndi kutsogolera 3 chifukwa cha imfa, yokha matenda a mtima ndiponso a khansa.

Today Pe kupangika makamaka pa maziko a zinthu zotsatirazi:

• aakulu kudwala;
• zovuta opaleshoni;
• zoipa.

Matendawa ali ndi makhalidwe oipa kwambiri, zizindikiro zosiyanasiyana anthuwo, kufupika matenda, chiopsezo imfa. Kafukufuku amasonyeza, pa maziko a positi-mortem bwinobwino magazi kuundana mu mapapo amene sanali yake matenda pafupifupi 50-80% ya anthu anafa chifukwa embolism m'mapapo mwanga.

Matendawa amapezeka mofulumira kwambiri. N'chifukwa chake n'kofunika msanga molondola oterewa kuvutika. Komanso mankhwalawa kuti akhoza kupulumutsa anthu.

Ngati panali yake wapezeka ndi magazi aumirira ku phapo, kuchuluka kwa adzapulumuke ndi kwambiri. The amafa mwa odwala amene mankhwala kofunika, ndi 10%. Popanda matenda ndi chithandizo chokwanira, akafika 40-50%.

Zimayambitsa matenda

A magazi aumirira mu mapapo, chithunzi limene lili m'nkhani ino chifukwa cha:

• kwambiri mtsempha thrombosis wa malekezero a m'munsi;
• mapangidwe ndi magazi aumirira m'dera lililonse la dongosolo venous.

Kuli kawirikawiri, kudwala izi zikhoza isanafalikire mu mitsempha ya peritoneum, kapena malekezero chapamwamba.

Zifukwa, kutanthauza chitukuko cha wodwalayo m'mapapo mwanga embolism ndi 3 kudzipheralo chikhalidwe. Iwo amatchedwa "wa ku wa Virchow." zinthu zimenezi ndi izi:

1. Yafupika magazi mathamangidwe mu dongosolo venous. Stagnation mu ziwiya. Wosakwiya magazi.
2. The propensity kuchuluka kwa thrombosis. Gipersvertyvaemost magazi.
3. Kuvulala kapena kuwononga khoma venous.

Choncho, pali zochitika zina kumaputa zinthu pamwamba, umene wapezeka chifukwa cha aumirira ku phapo. zifukwa kubisika m'mikhalidwe zotsatirazi.

Ndi liwiro la venous magazi kungachititse:

• maulendo yaitali, kuyenda, chifukwa cha zimene munthu ali kwa nthawi yaitali kukhala pa ndege, galimoto, sitima;
• hospitalization imene chofunika bedi mpumulo kwa nthawi yaitali.

Ndi magazi gipersvertyvaemosti zingachititse:

• kusuta;
• kugwiritsa ntchito mankhwala olera, esitirojeni;
• kutengera za kumtundu;
• Oncology;
• polycythemia - ambiri maselo ofiira;
• opaleshoni;
• mimba.

Ndi venous khoma choipa kutsogolera:

• kwambiri mtsempha thrombosis;
• kuvulala zoweta mwendo;
• opaleshoni ya nthambi m'munsi.

Zina mwa zifukwa

Madokotala izi zinanso ziti pa zimene pazipita magazi aumirira amapezeka m'mapapo. Zotsatira za matenda oopsa kwambiri. Choncho m'pofunika kulabadira thanzi la anthu amene aona zinthu ananena pansipa:

• yafupika zolimbitsa thupi;
• zaka zaka 50;
• oncologic kudwala;
• opaleshoni;
• mtima kulephera, m'mnyewa wamtima;
• zoopsa choipa;
• varicose mitsempha;
• ntchito za kulera m'thupi;
• pobereka zosokonezeka;
• erythremia;
• onenepa;
• matenda majini;
• zokhudza zonse lupus erythematosus.

Nthawi zina zikhoza matenda magazi kuundana mu mapapo akazi akabereka, makamaka lolemera. Monga ulamuliro, monga boma ali yoyamba mapangidwe nthinthi mu ntchafu kapena ng'ombe. Iye amapanga lokha anamva kupweteka m'thupi kutentha thupi, redness kapena kutupa. About matenda ayenera kukanena kwa dokotala nthawi yomweyo, kuti kukulitsa njira matenda.

Zizindikiro khalidwe

Pofuna oterewa ndi magazi aumirira mu mapapo, zizindikiro za matenda bwino. Iwo ayenera kusamala kwambiri ndi zotheka chitukuko cha matenda. Mwatsoka, chithunzi matenda a embolism m'mapapo mwanga ndi osiyanasiyana ndithu. Amaonekera ndi kuopsa kwa kudwala, mlingo wa chitukuko ndi kusintha zizindikiro m'mapapo mwanga wa matenda chimapangitsa chikwiyire ndi vuto ili.

Ngati pali magazi aumirira mu mapapo, zizindikiro (imawunikidwa) wodwalayo zotsatirazi:

1. Kufupika kwa mpweya, mwadzidzidzi popanda chifukwa chenicheni.
2. Pali kuwonjezeka kugunda kwa mtima (pa miniti imodzi oposa 100 zikwapu).
3. Wotumbululuka khungu ndi khalidwe imvi kulocha.
4. Ululu, kunachitika mu madera osiyana a sternum lapansi.
5. Mkhutu matumbo motility.
6. Lakuthwa hyperemia khosi mitsempha ndi a plexus dzuwa, anati oumbidwa awo, zooneka pulsation kwa msempha.
7. Pokwiya peritoneum - khoma ndiye yomangika zokwanira, pali ululu kumverera m'mimba.
8. Mtima kung'ung'udza.
9. Amphamvu kuthamanga yafupika.

Odwala amene apeza magazi aumirira ku phapo, zizindikiro pamwamba alipo kwenikweni. Komabe, palibe zizindikiro zimenezi si zokhudzana ndi yeniyeni.

Kuwonjezera makhalidwe ofunika, zigawo zotsatirazi angathe:

• malungo;
• kutsokomola magazi;
• kukomoka;
• ululu sternum ya;
• kusanza;
• chopitirira ntchito;
• madzi mu sternum ya;
• chikomokere.

Mayendedwe a matenda

Popeza kudwala amatanthauza matenda loopsa kwambiri, osati kupatulapo imfa, tiyenela kuiganizila zizindikiro mwatsatanetsatane akuwuka.

Poyamba, wodwalayo akufotokozera kupuma movutikira. pakuwonekera kwake si yoyamba zizindikiro. Chifukwa mawonetseredwe a zizindikiro nkhawa kwina kwathunthu. Kufupika kwa mpweya limapezeka pa kutulutsa lapansi. Iwo amakhala ndi phokoso chete, kenako mthunzi kaphokoso. Komabe, zopezeka.

Kuwonjezera ake, Pedaya limodzi ndi kuchuluka kugunda kwa mtima. Amapatutsidwa kuchokera pamwamba kumenyedwa 100 pa mphindi imodzi.

Mbali yotsatira kwambiri ndi kuchepa lakuthwa magazi. Mlingo wa kuchepetsa index izi inversely njila malinga ndi kukula kwa matendawa. Kuthamanga madontho m'munsi, zotupa lalikulu kwambiri chikwiyire Pe.

Ululu zimadalira kukula kwa matendawa, komanso kuchuluka kwa matenda zowonongeka mtima mlingo kunachitika thupi:

1. Ululu kumbuyo breastbone, amene ali lakuthwa, discontinuous khalidwe. kusapeza uwu khalidwe mtsempha wamagazi blockage. Zotsatira zowawa kuchokera psinjika mitsempha ya linga chotengera.
2. Stenokardicheskie nkhawa. Ululu ndi compressing khalidwe. Ili m'chigawo cha mtima. Nthawi zambiri amapatsa tsamba phewa, mudzikonzere.
3. Kupweteka kusapeza mu sternum lonse. kudwala Izi akhoza zimaonetsa Vuto - infarction m'mapapo mwanga. kusapeza The kumadalira pamene gulu lililonse - kupuma kwambiri, kukhosomola, sneezing.
4. Ululu pansi pa nthiti kumanja. Kuli kusapeza zimachitika m'dera chiwindi, ngati wodwalayo magazi kuundana mu mapapo.

osakwanira magazi anamuona pa chotengeracho. Zimakhala imautsa mtima:

• chowawa hiccups;
• mavuto khoma m'mimba;
• paresis wa intestine ya;
• oumbidwa ya mitsempha yaikulu mu khosi ndi miyendo.

Khungu pamwamba limakhala mtundu wotumbululuka. Nthawi zambiri kukhala ashy kapena imvi mafunde. Kenako, mwina kujowina milomo buluu. Mbali yamasika lingaliro embolism chachikulu.

Nthawi zina wodwala akhoza kumva khalidwe mtima musadandaule, arrhythmia ndi wapezeka. Pankhani ya m'mapapo mwanga infarction zavuta hemoptysis, pamodzi ndi kupweteka kwambiri mu chifuwa, ndi kutentha mokwanira mkulu. Hyperthermia kumachitika kwa masiku angapo ndipo nthawi zina sabata ndi theka.

Odwala amene thrombus mu mapapo, zingaoneke kuyan'anila za kufalitsidwa ubongo. odwalawo kaŵirikaŵiri akumapezeka:

• kukomoka;
• kupweteka;
• chizungulire;
• chikomokere;
• hiccups.

Nthawi zina zizindikiro anafotokoza angalowe nawo zizindikiro za kulephera aimpso, pachimake mawonekedwe.

mavuto a embolism m'mapapo mwanga

Izi pathologies woopsa kwambiri imene isanafalikire magazi aumirira mu mapapo. Zotsatira zake thupi akhoza zosiyanasiyana. Izo zimatengera njira ya mavuto a matenda, khalidwe ndi nthawi ya moyo wa wodwalayo.

Zotsatira waukulu wa Pedaya ndi:

1. Matenda kukwezeka kuthamanga ziwiya m'mapapo mwanga.
2. M'mapapo mwanga infarction.
3. Paradoxical embolism ziwiya bwalo lalikulu.

Komabe, si onse okhumudwa, ngati yake matenda magazi kuundana mu mapapo. Mapa monga momwe tafotokozera pamwambapa, ndi zabwino, ngati wodwalayo alandire chithandizo choyenera. Pankhaniyi, mwayi ndi mkulu kuchepetsa chiopsezo zotsatira zoipa.

M'munsimu muli matenda waukulu madokotala anandipeza chifukwa cha mavuto a embolism m'mapapo mwanga:

• pleurisy;
• infarction m'mapapo mwanga;
• chibayo;
• empyema;
• m'mapapo abscess;
• aimpso kulephera;
• pneumothorax.

kobwereza m'mapapo mwanga embolism

kudwala ichi amatha kubwereza odwala kangapo pa moyo. Pankhaniyi, ndi mawonekedwe thromboembolism kobwereza. Pafupifupi 10-30% odwala pambuyo matenda ina yotero, sachedwa nkhani kobwereza wa embolism m'mapapo mwanga. wodwala wina zingakhale ndi anthu angapo kuukira osiyana. Pafupifupi chiwerengero chawo zimasiyanasiyana 2 20. Makanema ambiri asamuka kudwala akuimira blockage nthambi yaing'ono. Kenako kudwala umenewu umatipatsa lalikulu mtsempha wamagazi embolization. Iwo anapanga yaikulu m'mapapo mwanga embolism.

Zimayambitsa mitundu kobwereza kungakhale:

• matenda aakulu a kupuma ndi machitidwe mtima;
• matenda oncologic;
• alowererepo opaleshoni m'dera m'mimba.

fomu iyi alibe bwino zizindikiro matenda. Iwo amakhala ndi anangotengeka pa. Bwino oterewa chikhalidwe ichi ndi zovuta. Kawirikawiri zizindikiro asanawonetseredwebe kolakwika kwa zizindikiro za matenda ena.

Kobwereza m'mapapo mwanga embolism angayambe zinthu zotsatirazi:

• kulimbikira chibayo, zinachitika chifukwa chosadziwika;
• kukomoka;
• pleurisy zikuchitika pa masiku angapo;
• mphumu;
• mtima kugwa;
• kufupika kwa mpweya;
• chinawonjezeka kugunda kwa mtima;
• malungo, silithetseratu mankhwala antibacterial;
• mtima kulephera, matenda aakulu, pakalibe m'mapapo kapena mtima.

Matendawa akhoza kuyambitsa mavuto otsatirawa:

• ndiko kumayambitsa ;
• m'mapapo mwanga fibrosis - m'mapapo minofu m'malo mwa connective;
• mtima kulephera;
• oopsa m'mapapo mwanga.

Kobwereza m'mapapo mwanga embolism ndi oopsa chifukwa yanthaŵi aliwonse otsatirapo akhoza kupha.

matenda a matenda

Zizindikiro pamwamba, monga tanenera kale, si yeniyeni. Choncho, potengera zizindikiro sangathe matenda. Komabe, pamene Pate kwenikweni azipereka khalidwe chizindikiro 4:

• kufupika kwa mpweya;
• tachycardia - chinawonjezeka kugunda kwa mtima;
• ululu pachifuwa;
• kupuma movutikira.

Ngati wodwala alibe chizindikiro cha anayi, ndiye iye alibe thromboembolism.

Koma si zonse zimakhala zophweka. kudwala matenda ndi kovuta. Kuti amaganiziridwa Pe asanthule n'zotheka kukhala matenda. Choncho, dokotala poyamba imatiuza kuti zinthu zikanasokoneza: pamaso pa mtima, thrombosis opaleshoni. Zimenezi zimathandiza kudziwa chifukwa cha matenda, dera limene aumirira ku mapapo.

Kafukufuku Kuvomerezedwa kwa kudziwika kapena osati embolism m'mapapo mwanga ndiwo maphunziro zotsatirazi:

1. ECG. nkhani kwambiri njira matenda. Electrocardiogram amapereka lingaliro la mlingo wa kusalekerera matenda. Ngati inu kuphatikiza zambiri ndi mbiri ya matenda, embolism m'mapapo mwanga matenda mwandondomeko mkulu.
2. X-ray. Izi kuphunzira kwa kupanga matenda Pe ndi uninformative. Komabe, n'zotheka kusiyanitsa matenda kuchokera pathologies ena ambiri amene ali ndi zizindikiro zofanana. Mwachitsanzo, ndi chibayo lobar, pleurisy, pneumothorax, kung'ambika aneurysm, pericarditis.
3. Echocardiography. phunziro ukusonyeza malo enieni a thrombus, maonekedwe, kukula, voliyumu.
4. M'mapapo scintigraphy. Njira imeneyi amapereka dokotala ndi 'chithunzi' wa ziwiya m'mapapo mwanga. Iye amadziwitsidwa dera kusokonezedwa magazi. Koma kupeza malo isanafalikire kuundana mu mapapo, sikutheka. Kafukufukuyu ali mkulu matenda wapatali pokhapokha pamene akuluakulu mtima kudwala. Kupeza mavuto mu nthambi zazing'ono mothandizidwa ndi njira iyi yosatheka.
5. Ultrasonography ya mitsempha mwendo.

Ngati ndi kotheka, wodwala akhoza anatumizidwa njira zina za kafukufuku.

thandizo mwamsanga

Kumbukirani, ngati inu kuchokamo nthinthi magazi mu mapapo, zizindikiro za wodwala akhoza kukhala pa liwiro mphezi. Ndipo basi mwamsanga ndi imfa. Choncho, ngati pali umboni wa embolism m'mapapo mwanga ayenera kupatsidwa kwa wodwalayo pa mpumulo ndi yomweyo kuyitana cardiology "ambulansi." The wodwala anavomereza kuti odwala mwakayakaya.

chisamaliro Emergency zachokera zochitika zotsatirazi:

1. Emergency chapakati mtsempha catheter ndi kulowa mankhwala "Reopoligljukin" kapena shuga-novocaine kusakaniza.
2. Kutumikiridwa m'nsinga kutumikiridwa mankhwala, "Heparin", "dalteparin", "Enoxaparin".
3. zotsatira zopweteka inathetsedwa analgesics chomwa mankhwalawa, monga "Promedol," "Fentanyl", "Morin," "Leksir", "Droperidol".
4. Mpweya mankhwala.
5. The wodwala kutumikiridwa thrombolytics: amatanthauza "Streptokinase", "Urokinase".
6. Nthawi ya arrhythmia chikugwirizana zotsatirazi mankhwala: "mankhwala enaake a sulphate", "Digoxin", "ATP", "Ramipril", "Panangin".
7. Ngati wodwala kutumikiridwa mantha anachita izo "Prednisolone" kapena "Hydrocortisone" ndipo MANKHWALA OLETSA VUTOLI, "palibe nkhokwezi-", "Eufillin", "papaverine".

Kuthana ndi Pe

Kuwatsitsimula angathe kubwezeretsa magazi m'mapapo, kupewa chitukuko cha sepsis mu mtima, komanso kuteteza motsutsana mapangidwe matenda oopsa m'mapapo mwanga.

Komabe, pambuyo thandizo wodwala thandizo la mankhwala anapitiriza. Kulimbana kudwala umalimbana yopewera zisadzachitikenso matendawa, wathunthu resorption wa magazi aumirira.

Pakali pano, pali njira ziwiri kuchotsa magazi kuundana mu mapapo. Njira mankhwala a pathologies zotsatirazi:

• thrombolytic mankhwala;
• opaleshoni.

mankhwala thrombolytic

mankhwala zachokera mankhwala monga:

• "Heparin";
• "Streptokinase";
• "Fraksiparin";
• minofu plasminogen activator;
• "Urokinase."

mankhwala akhoza kuyimisa nchito magazi kuundana ndi kuteteza mapangidwe kuundana latsopano.

Mankhwala "Heparin" kutumikiridwa kwa wodwala m'nsinga pa masiku 7-10. Mu magawo izi zosamala clotting magazi. Kwa masiku 3-7 isanafike mankhwala wodwala anali kutumikiridwa wina wa mankhwala zotsatirazi mawonekedwe piritsi:

• "Warfarin";
• "Trombostop";
• "Cardiomagnyl";
• "Thrombotic ACC."

Control wa clotting magazi sakusiya. Atatumidwa kumatenga miyala (pambuyo akudwala m'mapapo mwanga embolism) 1 chaka.

Mankhwala "Urokinase", "streptokinase" kutumikiridwa m'nsinga masana. mpheto Izi akubwerezedwa 1 nthawi pamwezi. Mtsempha ntchito ndi minofu plasminogen activator. Mlingo umodzi kuperekedwa pa maola angapo.

mankhwala Thrombolytic si ikuchitika pambuyo opaleshoni. nawonso oletsedwa pa nkhani ya pathologies, sipangakhalenso kobvuta ndi magazi. Mwachitsanzo, chironda chachikulu. Chifukwa mankhwala thrombolytic akhoza azitaya magazi ambiri.

chithandizo opaleshoni

Funso ngati liukitsidwa okha kugonjetsedwa kwa dera lalikulu. Pankhaniyi, muyenera mwamsanga kuchotsa mukuchitika magazi aumirira mu mapapo. Chithandizo zotsatirazi bwino. zipangizo zina zapadera atachotsedwa chotengera thrombus. ntchito Zimenezi zimathandiza kuthetsa chopinga kwa magazi njira.

Zovuta alowererepo opaleshoni imagwiridwa ngati nthambi zikuluzikulu kapena yatsekera mtsempha wamagazi thunthu. Pankhaniyi m'pofunika kuti abwezeretse magazi pafupifupi m'madera onse a phapo.

Kupewa embolism m'mapapo mwanga

matenda thromboembolism ali ndi vuto Inde kobwereza. Choncho, n'kofunika kuti musaiwale za miyeso wapadera njira kuti akhoza kuteteza motsutsana ndi zisadzachitikenso a kwambiri ndi oopsa kudwala.

kukhwimitsa ndi zofunika kwambiri kuti anthu ndi chiopsezo cha kudwala matenda izi. gulu Izi zikuphatikizapo anthu:

• wamkulu kuposa zaka 40;
• Sitiroko kapena vuto la mtima;
• ndi onenepa;
• amene limapangidwa mbiri yanthaŵi a kwambiri mtsempha thrombosis kapena embolism m'mapapo mwanga;
• maopaleshoni pa chifuwa, miyendo, ziwalo m'chiuno, m'mimba.

Kuteteza kumaphatikizapo kuchita zofunika kwambiri:

1. Ultrasonography ya mitsempha mwendo.
2. Zonse kutumikiridwa pansi kukonzekera khungu "Heparin", "Fraksiparin" kapena mankhwala jekeseni m'mitsempha "Reopoligljukin".
3. Superimposition wa bandeji mwamphamvu mapazi ake.
4. Kufinya wapadera cuffs mitsempha ng'ombe.
5. Zingwe phazi mitsempha yaikulu.
6. Implantation ya Zosefera vena cava.

The njira otsiriza ndi kupewa kwambiri a thromboembolism. zosiyanasiyana Zosefera cava tinapangidwa lero:

• "Mobin-Uddin";
• "Günther Tulip";
• "Greenfield";
• "Hourglass".

Pa nthawi yomweyo, kumbukirani kuti limagwirira izi ndi zovuta kukhazikitsa. The pachithunzichi cava fyuluta osati kukhala odalirika kupewa, koma angathe kuyambitsa kuwonjezeka chiopsezo thrombosis mapangidwe ndi chitukuko wotsatira wa embolism m'mapapo mwanga. Choncho, ntchito imeneyi ayenera kuchitika okonzeka kuchipatala, Oyeretsedwa ndi katswiri wodziwa bwino.