Mendelson ta ciwo manifestations. Mai tsanani numfashi cuta

A yawa rikitarwa iya faruwa a marasa lafiya da suke a m kula. Daya daga cikin wadannan jihohi ne mafi tsananin Mendelson ta ciwo.

Abin da irin Pathology?

By Mendelson ta ciwo ne mafi sau da yawa nufi obstructive na huhu cuta da raunuka na huhu nama (pneumonitis), masu tasowa, a kan bango na fadowa daga ciki ruwan 'ya'yan itace a cikin Airways. Wannan yanayin da aka farko aka bayyana a cikin shekarar 1946. An lura a kafofin rashin lafiya marasa lafiya da suka yi a kai rauni, ciki tiyata (musamman na ciki) da kuma haihuwa. A mafi yawan lokuta, Mai ƙãga halittar wannan irin Pathology aka anesthetized (saboda shi hūta m tsokoki). A kan backdrop na annashuwa da rasa tsoka sautin auku tsammãni (inhalation) na ciki da abinda ke ciki (yawanci kawai na ciki da ruwan 'ya'yan itace). A sakamakon haka ne a sha kashi a matsayin Bronchial itace da kuma huhu nama. Yanayin ne musamman tsanani, zai iya kai ga mutuwa idan gazawar samar dace taimako. Yana da su fahimci a more daki-daki me ya sa akwai irin wannan m cuta, da kuma cewa shi ya kamata a yi.

dalilai

By ci gaban Mendelssohn ta ciwo zai iya sa da dama cututtuka. Wadannan sun hada da:

• Pathology na juyayi tsarin (tsanani kwakwalwa rauni, lalacewar da glossopharyngeal jijiya, ƙarfafa m tsari na ciki parietal Kwayoyin kuma motility na m gabobin na gastrointestinal fili).
• Cututtuka na narkewa kamar fili (hiatal hernia, achalasia).
• Cututtuka na numfashi fili (trachea takaice, fistulas tsakanin esophagus da maƙogwaro).

Bugu da kari a wadannan cututtuka, to pneumonitis iya sa mai tsanani cututtuka. Babba da tasiri a kan ci gaban da ɗammãni da ciki tiyata (ta nagarta na rage tsoka sautin gabobin da kuma raguwa a baya shugabanci peristaltic tãguwar ruwa) da kuma ciki (saboda diaphragm hijirar). Alal misali, a da rabo daga m shisshigi up to 70% na lokuta.

Duk da haka, ya fi na kowa dalili na ciki ruwan 'ya'yan itace shigar da ƙananan numfashi fili ne m yayyo sabõda zãluncin da matsayi na haƙuri kuma rauni na cardiac sphincter.

A pathogenesis na tsammãni pneumonitis

Haka kuma cutar tasowa saboda raunuka na huhu da kuma Bronchial nama hydrochloric acid dauke a cikin ciki. Ba zato ba tsammani tasowa coagulative necrosis (wanda, a sake, shi ne saboda aikin da na acid a kan Bronchial mucosa). A sakamakon Bronchial secretory iya aiki an rage, wadda take kaiwa zuwa ga issushivaniyu. Layi daya acid shiga cikin huhu, yana sa da ci gaban pneumonitis - aseptic kumburi huhu nama. Rage huhu numfashi surface, rage-rage ƙarni na surfactant. Duk da wannan take kaiwa zuwa wani karuwa a lightness na ce jiki (saboda wannan tsari da kuma asirce biyu pathologies: asthmatic - yafi shafar da bronchus, kuma obstructive - tare da wani rauni daga cikin huhu da nama da kuma ci gaban toshewa ciwo). Har aka ƙaddara da PH na ciki ruwan 'ya'yan itace (ƙananan shi ne, da mafi mayar da hankali da acid, da mafi lalacewa). A mafi tsanani canje-canje suna lura a cikin Alveoli.

Bayyananen a kan matakin da Alveoli

Sau da yawa sosai a cikin tattaunawa da wani cuta da kuma hade da bayyanar cututtuka Masu karatu ana kiran su zuwa wani photo. Cututtuka irin pneumonitis, yawanci tare da wasu takamaiman waje siffofin ba su bambanta ba. Amma idan ka dubi abin ya shafa yankin na nama ta microscope (wanda mafi yawa ana yi a lokacin bude), yana yiwuwa a gane wasu canje-canje.

A sakamakon na sama tafiyar matakai da kuma ƙarƙashin rinjayar nauyi saukad da hydrochloric acid a cikin Alveoli. Akwai, saboda gida tasiri a kan alveolar nama, da samuwar effusion (sau da yawa hemorrhagic). A sakamakon haka, shi yana bunkasa hemorrhagic na huhu edema. Ƙarƙashin rinjayar wulakanci ne a cikin Alveoli lura asarar fibrin, kazalika da shigar azzakari cikin farji na jini Kwayoyin ta cikin ginshiki membrane (musamman leukocytes da macrophages). A sakamakon haka, samar da enzymes masu tasowa necrosis na alveolar ganuwar saboda huhu Gininsu, wanda aka gaji da damuwa. A wani wuri inda tasoshin ne kiyaye endothelial lalacewa da kuma samuwar microthrombi. Wannan duk kaiwa zuwa ƙãra exudation na ruwa ta hanyar da membrane da kuma samuwar atelectasis. Yawancin lokaci suna cikin hanyar abin da aka tasowa obstructive na huhu cuta. Idan acid a cikin huhu samun guda na undigested abinci ko wasu kasashen waje jikinsu, kamar samuwar hemorrhagic edema a hade tare da ci gaba da jinkirin dauki na granuloma samuwar kewaye ya shiga cikin jiki. Wannan irin cuta da aka ci gaba da sannu sannu, amma mafi tsanani.

Clinical bayyananen cuta

Ta yaya za ka ƙayyade cewa haƙuri yana da tsammãni pneumonitis? Specific "cuta photo" za a iya wakilta kamar haka:

• A farko asibitin zai zama saboda da kai tsaye sakamako na acid a kan mucous membrane. Akwai asibiti hoto na m, kuma mai tsanani numfashi gazawar - bronchospasm, kara cyanosis, na numfashi gazawar.
• Cardio-jijiyoyin bugun gini tsarin da aka lura da tachycardia, drop a jini. A wasu lokuta, shi ne zuciya rashin cin nasara ko rushewa daga cikin launi. Ba zato ba tsammani rage cardiac fitarwa da kuma ƙara matsa lamba a cikin huhu jijiyoyi. Saboda gas musayar munanan lura da ci gaban na numfashi da kuma na rayuwa alkalosis. The fi girma da girma na huhu nama buga, da mutum da haƙuri, da kuma wuya zai kasance da mu bi shi.
• Yawanci, raunuka da kuma alamun numfashi gazawar bayyana for 2 hours, akalla - daga baya. Wani lokacin bayyanar cututtuka za a iya sharewa, da kuma aikin hanawa ba faruwa a duk.

bincikowa da

Identification Mendelson ta ciwo - mai wuya aiki, tun da Pathology tasowa yawanci a debilitated marasa lafiya, da kuma ba ko da yaushe, kamar yadda muka ce a sama, da na asibiti hoto na iya faruwa. Abu na farko da sanin gaban numfashi gazawar (shortness na numfashi, wheezing, cyanosis). Wadannan cututtuka su ne ba ko da yaushe iya gane marasa lafiya da suke kan inji iska. A mafi m Hanyar diagnosing Mendelson ta ciwo ne mai radiography ko fluorography huhu. A hoto ba za ka iya ganin gaban exudate a cikin huhu, da kara su airiness. A wasu lokuta, waye bambanci na bronchi (al'ada a kan radiograph a kai tsaye tsinkaya daga cikin bronchi ba su da bayyane, kuma za ka iya Label su, kawai idan ka yi gefen Shots). Idan kawai fluorography haƙuri da ake zargi da aiki ciwo ne saboda ci gaba necrosis, tubular reshe na trachea zai zama a bayyane da kuma a kan layi radiograph.

tsammãni ciwo magani

Idan, duk da haka, akwai tsammãni daga ciki abinda ke ciki, magani ya kamata a fara nan da nan. A mataki na farko shi ne ware daga sake shigar da acid a cikin ƙananan Airways. Don yin wannan (idan haƙuri da yanayin) ake bukata don ya dauke da headboard na gadonsa. Nan da nan wajibi ne don daidaita iska a cikin huhu da kuma samar da mai kyau jini oxygenation. Yawanci, wajabta ventilator karkashin intermittent tabbatacce matsa lamba da kuma hyperbaric oxygen jikewa (da yin amfani da ventilator tsarin, monitoring na jini gas). Duk wannan zai taimaka wajen hana acidosis.

Don rage ƙarar na huhu nama rauni nada glucocorticosteroids intravenously da kuma kananan kashi na - intrabronhialno. Hormones damar aiwatar dakatar da rarraba da kuma iyakance shi. maganin rigakafi (yawanci cephalosporins da macrolides) amfani da rigakafin. Ya kamata kuma a sympathomimetics (domin rage samuwar secretions a cikin bronchi da kuma huhu).

ciwo rikitarwa

Lokacin da lokaci fara jiyya da rikitarwa yawanci kauce masa. Idan marigayi, tsammãni ciwo zai iya kai wa ga m da makaruhai sakamakon.

Sau da yawa bayan da cutar idan aka ci gaba da fashewa kudi, iya baya faruwa atrial fibrillation ko m nau'i na na ramin zuciya fibrillation. Idan ta kama shi ne ba zai yiwu, amma haƙuri ba koka, za ka iya barin haƙuri a karkashin kulawa da kawai na gida ilimin.

Wani wahala ne ci gaban da na huhu atelectasis ko na kullum shãmakacẽwa. A wannan yanayin, da aiwatar da karfafawa zai zama wajen tsawo, da kuma girmamawa mafi yawa ana yi a kan ya ɗauke bayyanar cututtuka, tun da wannan cuta ne m.

A mafi tsanani wahala ne m pneumonitis. Musamman sau da yawa da shi ya auku a lokuta inda tasowa tsammãni ciwo a jariri jarirai.

Yin rigakafi da hangen nesa da cutar

Don hana tsammãni ciwon huhu, shi yana bukatar a gudanar da wani hadadden wasu ayyukan. Ainihi, dukan marasa lafiya da mata a cikin aiki, wanda ya nuna kutse a karkashin janar maganin sa barci ya kamata a wofintar da ciki da kuma hanjinsu. Wannan gusar da babban factor a ci gaba da pneumonitis.

Kafin maganin sa barci bada shawarar zuwa sha kirji X-haskoki domin ware da abinda ke ciki na ciki ruwan 'ya'yan itace a cikin Airways. Intubating da haƙuri kamata a da za'ayi koda lokacin da haƙuri ne m. Man aza haka da cewa sama na jiki an tashe dan kadan. Wannan aka samu da daidaitawa da shugaban na gado ko da aiki tebur (yayin guje wa da yiwuwar m wicking abinda ke ciki na narkewa kamar tsarin a cikin numfashi fili).

Subject intubation kuma dace shiri dabara haƙuri ga tiyata, hadarin Mendelson ta ciwo kadan.

A hangen nesa da wannan cuta ne kamar haka: yawanci mutu zuwa 56 bisa dari na marasa lafiya da kafa airway pneumonitis. Idan remedial matakan da aka qaddamar a dace hanya, hadarin da rikitarwa da kuma mutuwa rage wa sifili.