Pericardial effusion: cututtuka da kuma haddasawa. Ganewar asali da kuma magani

Exudative pericardial effusion - wata cuta halin da kumburi a cikin membrane rufi ciki surface na pericardium. By da yanayin da ya kwarara exudative pericarditis ne m ko na kullum.

Cutar na iya zama serous, hemorrhagic, surkin jini, fibrinous da serosanguineous. A exudative fibrinous pericarditis auku shaida na fibrin filaments a pericardium, kuma accumulates wani adadin na ruwa a cikin pericardial kogo. Yawanci, a cikin pericardial rami ya ƙunshi kamar 20-40 ml na ruwa.

A lokacin m pericarditis dauki yana tare da inganta salon salula exudation a pericardial rami na wani ruwa jini sulusi da murabba'i. Cases lokacin da kumburi tsari na iya komawa subepicardial Layer, wanda da cika fuska tabarbarewa.Idan ta aiki.

cardiogenic buga

Sau da yawa kwatsam jari na ruwa a cikin pericardial rami zai iya sa cardiac tamponade, wanda shi ne symptomatic ãyõyin cardiogenic buga:

• zuciya palpitations.
• numfashi cuta ga dyspnea irin;
• ƙara matsa lamba a cikin venous tsarin na kananan da manyan wurare dabam dabam.
• rage a cikin systolic jini.

zai yiwu rikitarwa

Tare da resorption exudative ruwa iya samar da tabo nama, kunsha na fibrin, wanda a nuna za a iya kai wa ga m ko cikakken imperforate pericardial kogo. Yawancin lokaci da tabo da aka kafa a cikin atrial yankin, a mahaɗar tsakãninsu manya da ƙananan vena cava, kusa da atrioventricular tsagi.

Tare da irin wannan m yanayin pericardial effusion iya kai ga tsanani da rikitarwa, da ake kira da "dutse zuciya" a sakamakon calcification na pericardium. An muhimmanci batu a cikin pathological aiwatar da exudative pericarditis a take da diastolic jini ya dawo zuwa ga zuciya ventricles. Exudate tara a cikin pericardial rami ko gaban constrictive pericarditis take kaiwa zuwa rushewa daga subepicardial da subendocardial yadudduka a cikin koli. A rare lokuta, fibrosis na pericardium iya zama expandable sashe, ta hanyar abin da wani bulging ventricle a lokacin diastole tabbatar da al'ada bayarwa na jini zuwa zuciya.

Wannan sabon abu ne da ake kira fenestration (da "bude taga"). Systolic lokaci, wanda ya samar da madauwari murdede Layer, kullum, ba ya sha. Tare da dogon lokacin da take hakkin da venous koma cikin zuciya akwai wani stagnation na jini a cikin huhu jijiya. Lokacin da venous stasis a cikin tsari dabam dabam tsarin na ruwa ne extravasation cikin kewaye kyallen takarda.

Pericardial effusion: haddasawa (etiologies)

Daya daga cikin mafi m Sanadin exudative pericarditis ne RNA-dauke da ƙwayoyin cuta (A da B), echovirus, mura A kuma kwayan cututtuka na daban-daban yanayi (pneumococci, staphylococci, streptococci, mycobacteria da tarin fuka da kuma fungi).

An fito da cuta iya wahalad da hanya na tsari cututtuka (SLE, ko Libman-kori cuta, rheumatic gidajen abinci, rheumatism, na tsari scleroderma) da kuma cuta na genitourinary tsarin (uremic pericarditis). Pericardial effusion ICD iya zama wata alama postperikardialnogo ciwo cewa tasowa bayan pericardiotomy ko matsayin farkon wahala na tsokar zuciya infarction, da ake kira Dressler ta ciwo. Yawancin lokaci, wannan wahala taso a tsananin ayyana lokaci, wato, daga kwanaki 15 zuwa 2 watanni.

Wani lokaci exudative m pericarditis iya faruwa saboda ingestion na wasu kwayoyi: gidralizin, phenytoin, anticoagulants, saboda m aikace-aikace procainamide, radiotherapy. A waɗannan lokuta idan wani babban pericardial effusion gano effusion abun ciki, dalilin da ya kamata a nemi a metastasis marurai: nono, da huhu, sarcoma, lymphoma. A cikin wadannan lokuta, yawanci hemorrhagic exudates, kasa serous.

Akwai musamman irin exudative pericarditis, da ake kira hemopericardium. Wannan yanayin ya auku a lokacin da shiga raunin da kirji yanki a cikin zuciya na tsinkaya, kamar yadda a discontinuities infarction a marasa lafiya bayan tsokar zuciya infarction, ko dissecting aortic aneurysm, haifar da jini cika da pericardial kogo. Idan cutar faru ga unknown causative dalilai, sa'an nan shi nasa ne a rukuni na nonspecific ko idiopathic.

Bugu da kari, da pericardial effusion a yara, ma, wani lokacin. A dalilai domin wannan su ne: streptococcal da staphylococcal cututtuka, da tarin fuka, HIV, uncontrolled magunguna, marurai, rauni, kusa da zuciya, koda gazawar, zuciya tiyata.

Pericardial effusion: bincike da kuma na asibiti siffofin

Exudate tara a cikin pericardial kogo da kuma maras ban sha'awa zafi bayyana aching da zuciya, mahaukaci numfashi a irin apnea, wanda aka rage a cikin wani Sitting matsayi, palpitations. A matsa lamba exerted da ruwa a kan trachea da bronchi to sa bushe tari.

Janar yanayin marasa lafiya dogara a kan kudi na samuwar ruwa bangaren a cikin pericardium a jinkirin gudun - m jihar a lokacin da m - matsakaici da kuma tsanani.

A jarrabawa, da haƙuri za a iya gano wadannan siffofin exudative pericarditis: kodadde fata, mucosa cyanotic lebe, edema na ƙananan wata gabar jiki, acrocyanosis.

Lokacin da dubawa yankin daga cikin kirji za a iya gano jeri na bangaren, gefen hagu za a iya ƙara, wannan mai yiwuwa ne kawai idan da tari a pericardial exudate girma ya kai fiye da 1 lita. Palpation iya gane yanayin Jardin lokacin da apical turu aka gudun hijira sama da kuma a cikin gida, saboda da matsa lamba exerted, da ruwa tara a ciki.

Feat. Irfan iya gane fadada daga cikin iyakoki na zumunta dullness na zuciya a duk inda: hagu, a kasa (a cikin ƙananan ƙungiyoyin) zuwa gaban ko zuwa tsakiyar axillary line, a karo na biyu da kuma na uku intercostal sarari ga tsakiyar clavicular line, dama a cikin ƙananan ƙungiyoyin, da dama daga SCR (tsakiyar -klyuchichnoy line), fiili wani obtuse kwana maimakon a kai tsaye al'ada zuwa iyakar mika mulki hanta dullness. Duk wannan na iya nuna cewa haƙuri yana pericardial effusion.

Auscultatory juna: kaifi weakening na zuciya sauti a cikin zuciya koli, a Botkin-Erb da xiphoid tsari. A tushe daga cikin zuciya ake ji m sautunan ne saboda gaskiyar cewa zuciya ne muhallinsu exudative ruwa sama da kuma na baya. Surutu pericardial gogayya, yawanci auscultation ba bayyana kanta. jini ne a kan ƙi, kan bango na raguwa a cardiac fitarwa.

Idan jari na ruwa na faruwa a sannu a hankali a kan lokaci, da inji aiki na zuciya na dogon lokaci ba damuwa saboda gaskiyar cewa pericardium yana faɗaɗa sannu a hankali a wannan harka. A cikin hali na wani m jari na ruwa a cikin pericardial effusion da kuma yankin shiga tachycardia, asibiti zuciya rashin cin nasara tare da cunkoso mamaki a wurare dabam dabam da'irori (manya da kanana).

Bisa ga bincike na ECG data halin da wadannan exudative pericarditis. Lokacin da cunkoso exudative ruwa m lissafi irin ƙarfin lantarki rage QRS hadaddun da lantarki canji na ramin zuciya gidaje. Radiographically lura karuwa a cikin inuwa daga cikin zuciya da kuma raunana yankin na kewaye ripple. Jijiyoyin bugun gini cuta ba taqaitaccen. Wani lokaci yana yiwuwa don gane effusion cikin hagu pleural kogo.

Echo ECG a pericardial rami jari na exudative ruwa da aka lura da daga baya na hagu ventricle na zuciya, a yankin na raya bango. Lokacin da babban kundin na exudative ruwa, shi nuna a gaban dama ventricle na zuciya. A kan yawan tara ruwa a cikin pericardium aka yi hukunci da tazara tsakanin nuna amo mara sa a daga epicardium da pericardium.

Kafa factor da ta haifar da cutar

Don tsayar da etiologic dalilai entailing exudative form pericarditis kwashe virological jarrabawa, da gwaje-gwaje don gaban takamaiman antibodies (HIV), seeding a nazarin halittu abu (msl, jini) ya kawar da cututtuka yanayin exudative pericarditis kwashe tuberculin fata gwajin, serological nazarin fungal kamuwa da cuta.

Har ila yau, immunological nazari a tsari connective nama cututtuka, ƙayyade gaban anti-nukiliya antibodies, rheumatoid factor titre antistreptolysin-O, sanyi agglutinin - tare da Mycoplasma kamuwa da cuta, uremia look magani creatinine da urea.

Bambanci ganewar asali na exudative pericarditis

Pericardial effusion aka bambanta da wadannan cuta abokai: m tsokar zuciya infarction, vasogenic zafi prollaps mitral bawul, bushe pleurisy.

A m tsokar miokarada zafi ciwo sa da jari na rayuwa kayayyakin a cikin zuciya tsoka (myocardium). Pain ciwo tsokar zuciya infarction tare da wani yawan asibiti da dakin gwaje-gwaje da ãyõyi bayyana kansu a take hakkin tsakiyar hemodynamics tafiyar matakai arrhythmias, madugu matakai a myocardium, stagnation mamaki a wani karamin da'irar (na huhu) wurare dabam dabam halayyar tsokar zuciya infarction a kan ECG canje-canje. Biochemical bincike na tsokar zuciya infarction nuna aiki na cardiac isoenzymes.

Lokacin da bushe pleurisy ne muhimmin al'amari na ciwon zafi da siffofin hade tare da numfashi, tari, jiki matsayi, amo a auscultatory jarrabawa gogayya pleura, wasu fiye da sama-da aka bayyana, ya kamata a lura da cewa bushe pleurisy babu canje-canje a kan fim electrocardiograms . Ba kamar aortic aneurysm daga exudative pericarditis shi kunshi a gaskiyar cewa a cikin hanyar shi ne a kayyade cuta - Marfan ciwo ko atherosclerotic rauni ta ciki harsashi. A wasu lokuta, shi iya samar da wata kullum pericardial effusion.

Symptomatic aortic aneurysm bayyana kanta kamar haka: zafi a cikin sama kirji, ba tare da wani sakawa a iska mai guba, dysphagia, wanda muryarsa ta duƙushe murya, dyspnea, tari, ya sa ta matsawa na mediastinum. Aortic aneurysms ake bincikar lafiya ta amfani da radiological jarrabawa na thoracic rami, echocardiography, kuma aortography.

Lokacin da dissecting aortic aneurysm zafi bayyana kwatsam a cikin kirji, da hali ya sakawa a iska mai guba tare da lakã. A lokaci guda, marasa lafiya ne a cikin tsanani yanayin, sau da yawa bacewar ripples a kan wata babbar jijiya. Auscultation auscultated aortic bawul insufficiency. Bincike matakan lokacin dissecting aortic aneurysm ne: transesophageal duban dan tayi da kuma lissafta tomography daga cikin kirji kogo.

Abin da ya kamata ka kula da

Yana da muhimmanci a bambance pericardial effusion ICD 10 tare da yaxuwa myocarditis, wanda yana tare da kara girma daga cikin zuciya rami tare da ãyõyin Sistem gazawar. Symptomatic myocarditis bayyana kanta a cikin wadannan hanya: shi iya zama wahala anginal yanayi, ji na wani nauyi a cikin zuciya yankin, zuciya kari disturbances.

Auscultation auscultated muting zuciya sauti, na farko da na hudu zuciya sauti iya bifurcated, a cikin bayanin da electrocardiogram iya gane da wadannan siffofin: da maras kyau P kalaman, wani canji a cell voltages hakori R, T kalaman za a iya mĩƙe. A lokacin echocardiogram lura kara girma daga cikin zuciya da bẽnãye, kuma rage contractility na katangu.

Warkewa shisshigi a lura da exudative pericarditis

Mayakan m pericardial effusion ne gaggawa bukatar hospitalize da mãsu haƙuri a cikin asibiti. Idan akwai ciwo mai tsanani, dole wajabta asfirin a kwamfutar hannu tsari, da sashi na daya gram ciki tazara kowane uku ko hudu. Yana yiwuwa don ƙara asfirin Allunan indomethacin kashi na 25 -50 MG, shan ruwa, wani lokaci-lokaci na kowace awa shida.

Idan akwai alamomi da cewa rubũta kara bayani da 50% dipyrone for intramuscular gwamnati na 2 ml ko narcotic analgesics (morphine) maida hankali 1%, dosing sau daya ko rabin milliliters, jinkiri kowane awa shida. Lokacin da psychomotor agitation kan backdrop na yanayin, ko rashin barci sanya "Sibazon" ( "Ina") a ciki, da sashi na 5-10 MG uku ko sau hudu a rana.

Don kawar da kumburi tafiyar matakai fi amfani a yi da "Prednisolone" sashi na 20-80 MG / rana. a cikin 'yan matakai. Far da glucocorticoids a high allurai ne da za'ayi a cikin shakka daga 7-10 kwana, tare da peculiarity cewa a cikin m sashi ya kamata a rage hankali, a cikin shekaru biyu da rabi a milligram kowace rana.

a lokacin jiyya

Yaushe aka bi da pericardial effusion? A lura yana game biyu ko uku makonni, da kuma wani lokacin dole ka budewa zuwa watanni da dama, tsananin a kan shaida. Bayani dalla-dalla na magani ya dogara etiological factor da ya sa pericardial effusion.

A gano kwayar etiology aka sanya da ba-steroidal anti-kumburi jamiái, hormones haka ba su rababbe. Pericarditis wanda suke saboda Streptococcus ciwon huhu, suna bi daban - rubũta maganin rigakafi, msl, penicillin G sashi 200,000 U / kg / rana. intravenously ba kashi ne zuwa kashi shida injections, duration na magani - ba kasa da kwana goma.

ƙarin gwaje-gwaje

Bugu da kari, idan suka kamu da pericardial effusion, shi ya kamata a gudanar pericardiocentesis (hanya da ciwon warkewa da kuma bincike a cikin yanayi, wanda yana da za'ayi a wata musamman allura huda pericardium domin ci ruwa domin analysis). Bayan da cewa seeding ne da za'ayi exudate domin gane wani irin wakili na wannan cuta, shi ne muhimmanci a ƙayyade bincike na ta ji na ƙwarai to antibacterial shirye-shirye. Idan aka same shi staphylococcus aureus, da halitta ne yawanci gudanar "Vancomycin" kashi na daya gram igiyar jini jinkiri kowane sa'a goma sha biyu warkewa rate - daga 14 zuwa kwanaki 21.

Wani lokaci, fungal cututtuka zai iya sa pericardial effusion. Jiyya a cikin wannan yanayin ne da za'ayi "Amphotericin". A farko kashi da aka 1 MG, ta glucose bayani tare da wani kaso daidai da kashi 5 cikin dari da hamsin milliliters a juz'i, gudanar parenterally (via jijiya), drip tsawon minti 30. Idan wani m da miyagun ƙwayoyi ne da jure, da dosing gwamnatin canji kamar haka: 0.2 MG / kg kan sa'a daya. Daga bisani, da sashi ne ta ƙara hankali har zuwa rabin ko daya microgram / rana. uku ko hudu kafin farko na da kyau sakamako.

Sakamakon sakamako na "Amphotericin", wanda ya dace a kula da - nephrotoxic, a cikin wannan, sa idanu ga ayyukan kodan. Idan mikiyar pericarditis ya taso ne saboda amfani da magunguna, to za a yi amfani da dabarun maganin tabbatar da cewa an dakatar da karbar wadannan kwayoyi kuma a kara da cewa sanya wasu kwayoyi masu tsai da cututtukan steroidal tare da corticosteroids, sun hada kai tare da saurin dawowa, musamman Idan an umarce su daga farkon kwanakin farkon cutar.