Kupatsanura nehana tsananguro

Muupenyu inogona kuitika mazana ezvinhu anogona kukonzera ndisingafungiri. Vanhu Vazhinji kufambidzana nayo chete ane simba huta kuvhunduka, asi ichi ndicho chete pamwe wechokwadi. Mukurapa, pane kuvhunduka kupatsanura, zvaraireva pathogenesis yayo, zvakaoma kwazvo, hunhu kuchinja nhengo uye nzira kutaura navo. akatsanangura First ichi ezvinhu anopfuura zviuru 2 years ago, yakakurumbira Hippocrates, uye shoko rokuti "kuvhunduka," iri tsika zvokurapa hwakatangwa muna 1737 maererano Parisian chiremba Henri Ledran. Nyaya ino inokurukura muudzame zvikonzero kuti anokonzera kuvhunduka, kupatsanura, kiriniki, nechimbichimbi hanya zvinoitirwawo inoremadza ezvinhu ichi uye Zvaifungidzirwa.

Pfungwa nehana

With zvaitika kuna Chirungu ringashandurwa sevakuru kuvhunduka, kuti hachisi chirwere, kwete chiratidzo uye kwete chirwere. Munyika tsika ino izwi anonzi kwaiita Muviri dzemuviri kuti simba anotikurudzira (kwokunze kana zvemukati), iro kuzvirega zvichikanganisa basa tsinga, muviri, afemeruke uye kufamba kweropa. Heino nguva ndisingafungiri kutsunga. The kupatsanura wehurumende ichi vanofanira kuziva chikonzero nehana, ukuru kwayo zvakaoma uye kutanga kunobudirira kurapwa. The kushurudzira kuchabatsirawo chete kana zvakarurama zvokuongorora uye pakarepo paitangira nokumutswa.

Classifications

Canadian pathologist Selye akataura matanho matatu, nehasha saizvozvo marudzi ose nehana:

1.Obratimaya (ndanyarara hangu), umo ropa wedzerai uropi, mwoyo, mapapu nedzimwe nhengo yaputswa, asi kwete akamira. The fungidziro nokuti Danho iri kazhinji zvakanaka.

2.Chastichno reversible (asima). Nenguva kutyora romugove ropa (perfusion) rinokosha, asi nokukurumidza uye zvakakodzera zvokurapa kupindira ane mukana rokudzorera functionality.

3.Neobratimaya (inouraya). Izvi ndiyo yakanyanya Danho umo vachivavhiringidza mumuviri haagoni kudzorerwa kunyange zvikuru kwazvo utano rova. Kufembera ipapo 95% zvisingafadzi..

Chimwe kupatsanura runoparadzanisa ubatanidzwewo reversible nhanho 2 - subkompensatsionnuyu uye dekompensatsionnuyu. Somugumisiro, havana kuwana 4:

• 1st ndanyarara hangu (chiedza kuva zvakanaka fungidziro).
• 2nd subcompensated (mid-uremu kuti rinoda pakarepo nokumutswa. Achatanda nharo).
• Third dekompensatsionnaya (rinorema kwazvo, kunyange kana yepakarepo Implementation ose anodiwa matanho ramangwana zvikuru kunzwisisa).
• 4th kusingarapiki (fungidziro murombo).

wakakurumbira Our Pirogov dzinounzwa vachingotya nehana maitikiro maviri:

-torpidnaya (murwere ari ndivete kana zvikuru usimbe, kwete kuita mikana yakawanda yokukurudzira kurwa, asingadi kupindura mubvunzo);

-erektilnaya (murwere rinofarira chaizvo, vachidanidzira, zvichiita yakawanda chavanoziva kudzora kufamba).

Mhando nehana

Zvichienderana zvikonzero zvakaita kuti kusaenzana mune muviri hurongwa, pane marudzi akasiyana nehana. Kupatsanura tichitarisa kweropa zvirwere zvakadai:

-gipovolemichesky;

-distributivity;

-kardiogenny;

-obstruktivny;

-dissotsiativny.

Kupatsanura pakati pathogenesis nehana ndeichi:

-gipovolemichesky;

-travmatichesky;

-kardiogenny;

-septichesky;

-anafilaktichesky;

-infektsionno-chepfu;

-neyrogenny;

Wakasimba-mubatanidzwa.

hypovolemic kugwinha

Complex izwi zviri nyore kunzwisisa, tichiziva kuti hypovolemia - mamiriro apo ropa circulates kuburikidza midziyo iri shoma pane inodiwa vhoriyamu. zvikonzero:

-obezvozhivanie;

-Extensive hudiki (akarasikirwa yakawanda yeplasma);

-pobochnye kwezvinodhaka kuita, zvakadai vasodilators;

-large kurasikirwa neropa, apo nhengo kugamuchira zvishoma okisijeni uye zvinovaka muviri, i.e. wakaputsika perfusion.

Hypovolemic kuvhunduka nokuda yakakwirira kurasikirwa ropa zvinogona kuonekwa sezvo Hemorrhagic kuvhunduka. The kupatsanura iri ezvinhu kwakafanana kuti dzakasimukira Selye, uye panguva imwecheteyo Danho pakutsvaga uwandu ropa asingagamuchiri miviri. Shock anogara rudzi vadzivirirwe muviri mumamiriro ezvinhu akaomesesa. Kureva, anotanga dzakatevedzana pezvakaitwa, vachitsvaka kuchengetedza basa zvinokosha nadzo uye azoponesa upenyu yose yezvinhu. Zvikurukuru, nokurasikirwa mumidziyo ropa ropa inorasikira negadziriro yeparutivi ropa (anenge 10% zvachose) kubva chiropa uye chirwatata. Kana izvi hazvina kukwana, kana ropa riyerere kwakaderedza anomira kuti kukosha kuti zvokudya pamusoro madhipatimendi muviri Somuenzaniso, kune wamativi, zvokuti ropa asara akanga zvinokwana perfusion mwoyo, uropi uye nemapapu. Kupatsanura kugwinha rinorondedzera matanho aya maviri sezvo ubatanidzwewo reversible uye invertible. Panyaya iyi, kana nguva yekuti, unogona kuratidza munhu kubva mamiriro nehana, uye achakomborerwa.

Long basa negadziriro yeparutivi ropa perfusion uye anopa dzimwe nhengo tichiregeredza zvimwe zvinenge asingagoni. Naizvozvo, kana imi musatanga nokumutswa, anouya okupedzisira (kusingarapiki) Danho. Nourema vaichengeta midziyo, kumanikidza kunoderedza mariri kwazvo, ropa ichayerera arikunze, kuwedzera kune kutsoropodza kwevari perfusion dhefisiti uropi, mwoyo nemapapu.

kupera mvura mumuviri

Mvura mumuviri womunhu, zvichienderana nezera uye pabonde, kubvira 60 kusvika 80%. Kufirwa 20 chete% kuti mari iyi kunogona kuparadza, uye kurasikirwa zvasvika 10%, kukonzera hypovolemic kuvhunduka, izvo iyi ichaongororwa sezvo kupera muviri, zvichiratidza zvinoderedza achiparadzira tsinga nokuda mukuru kupera mvura mumuviri. zvikonzero:

-zabolevaniya, zvichitungamirira manyoka, kurutsa, kuita weti kakawanda rukuru;

-nedopoluchenie mvura muviri (nedopivanie) pasi ezvinhu akaipisisa, zvakadai yokunyanyisa kupisa, kunyanya panguva yakakwirira chaiko nesimba;

-nerazumnye kudya.

Kunyanya zvichida kupera mvura mumuviri mune vana uye vakwegura.

Kupatsanura nehana, kwakaitika somugumisiro kushaya mvura, unoratidza tsoka:

-invertible;

munhu aoma reversible;

-neobratimuyu.

Uyezve, kupera mvura mumuviri rakakamurwa izvi mumapoka matatu:

1.Izotonicheskoe (kurasikirwa Na uye K ions). The Urume mumuviri wedu ndiye intracellular uye intercellular. Kana isotonic nezvinhu zvinokonzerwa manyoka ainyanya yabudiswa akaratidza potassium yakawanda uye yavaibvisa, inova huru nokuo- nga mu extracellular mvura zvinoenda masero kuti vanoumba vakarasika potassium mairi.

2.Gipotonicheskoe, iri mugumisiro isotonic. It rinozivikanwa dzakakwirira nezvinhu zviri extracellular mvura (nekuti yavaibvisa wakapfuurira masero). muzvikamu zviviri wokutanga vanoonekwa kuti reversible sezvinobvira kudzikamisa kurasikirwa electrolytes. Aoma anobudirira pakupa murwere mvura yaunodya, kunyanya rine yavaibvisa ions.

3.Gipertonicheskoe kuti anovandudza apo manyoka pamwe retching yokudzivisa mvura iyerere mumuviri nomuromo kana ovhadhozi vamwe zvinhu kuti vanotsamwisa okuwedzera weti. The mvura zvakare chinopinda kubva masero munzvimbo extracellular nzvimbo kuti arambe aine osmotic kumanikidzwa. masero Double tasara tisina mvura kutyora basa ravo uye kuderedzwa bhuku. kuderera Kunyanya ngozi MUBHUKU uropi, iyo inotungamirira kuupenyu subdural ropa.

zviratidzo

Takurukura kuti ariko kurondedzera kupatsanura pakati hypovolemic kuvhunduka. Clinic mamiriro ichi, pasinei zvikonzero, yakakonzera pamusoro chete. On the reversible danho, murwere riri supine chinzvimbo, akazivisa zvingaratidza kusava. kutanga zviratidzo dambudziko vari:

- palpitations;

-small BP;

coldly ndakatota ganda pamakona (nokuda vasanyanye perfusion);

-Zvamungaita pane zvokusava nemvura nokuomesa miromo, mucous mumuromo, kushaya misodzi.

Panguva Danho rechitatu, kuvhundutsa kutanga zviratidzo huchawedzera raidudzwa.

Varwere vari akati:

-tahikardiya;

-Reduction BP pazasi dzinonetsa tsika;

-Violation kufema;

-oliguriya;

coldly kuti kubatwa (kwete chete maoko nemakumbo);

-mramornost ganda uye / kana kuchinja ruvara yavo zvakajairika hapana cyanotic;

-nitevidny kufamba kweropa;

pamwe chete kumanikidzwa pamusoro nyore, vane akacheneruka uye ruvara pashure kubviswa mutoro ipfupi neinopfuura 2 masekonzi akaisa chakaipa nazvo. Chete kiriniki ane Hemorrhagic kuvhunduka. Kupatsanura pakati mumatanho ayo, zvichienderana Vhoriyamu ropa achiparadzira mumidziyo unhu mberi zvinosanganisira:

-on reversible danho tachycardia kusvika 110 anorova paminiti;

-on ubatanidzwewo reversible - tachycardia 140 anorova / Maminitsi;

-on kusingarapiki - kwemwoyo kupfuura 160 anorova / min. Panguva yakaoma nzvimbo kupomba hazvigoni kunzwa, uye systolic BP ikasawira 60 mm HG zvichidzika. mbiru.

Kana kupera mvura mumuviri anokwanisa hypovolemic kuvhunduka zviratidzo anowedzerwa:

-suhost mucous;

-reduction matauriro eyeballs;

Y vacheche kusiya hombe fontanelle.

Zvose kwokunze zvomunhu, asi kuona zvakarurama mwero dambudziko, zvidzidzo tsvakurudzo murabhoritari. Murwere akanga pakarepo akaita ropa kemisitiri, kuona padanho hematocrit, acidosis, muna dzakaoma kunzwisisa, kuongorora plasma arambe achirema. Uyezve, vanachiremba vane potassium pamwero kuzvidzora, chikuru electrolytes, creatinine, ropa urea. Kana mamiriro mvumo, akadzidza miniti uye mwoyo nesitiroko vhoriyamu uye nechepakati venous kuvafurira.

randakambosangana naro kugwinha

Izvi mhando nehana munzira dzakawanda akafanana Hemorrhagic, asi ayo chikonzero anogona kuita maronda chete zvokunze (uchibaya vapfurwa, kutsva) kana zvemukati (atsamwira kuti nyama uye nhengo Somuenzaniso, kubva simba furidza). Dzechimwe kuvhunduka ari inenge nguva dzose pamwe chete nzwisisika kurwadziwa zvakaoma, mberi exacerbates ezvinhu rechipfuwo. Mune dzimwe manyuko nayo anonzi kunorwadza kuvhunduka, kazhinji zvichiita kuti rufu. Kwokuomerwa dzechimwe kuvhunduka akatsunga kuita zvakawanda uwandu vakarasika ropa, sei zvakawanda nokurasikirwa uku nokukurumidza. Ndiko, kana ropa mumuviri zvishoma nezvishoma, munhu nani mukana kupukunyuka. Uyewo kuwedzera mamiriro ezvinhu uye ukuru kukosha dzaparadzwa nhengo kumuviri. Ndiko, vapukunyuke vapfurwa iri ruoko zvichava nyore kupfuura ronda kuti musoro. Ndivo zvinhu munhu wakapona kuvhunduka. Kupatsanura mamiriro nekuomarara sezvinotevera:

Primordial kuvhunduka (kunoitika anenge pakarepo mushure zvinokuvadza);

-vtorichny kuvhunduka (sokuti pashure pokuvhiyiwa, kubviswa mwanda, pasi okuwedzera mutoro pamusoro nedambudziko Somuenzaniso, chokufambisa kwayo).

Uyezve, dzechimwe kuvhunduka vakachengeta maitikiro maviri - erectile uye torpid.

Zviratidzo erectile:

-strong kurwadziwa;

-neadekvatnoe maitiro (kuchema, overexcitation, kufunganya, dzimwe nguva hasha);

-tremor;

ziya coldly;

-Advanced vadzidzi;

-tahikardiya;

-tahipnoe.

Zviratidzo torpid:

-bolnoy anova hanya;

-Over imomo, asi munhu akasaita kwairi;

-arterialnoe kumanikidzwa zvikuru zvinoderedza;

-glaza kupera;

-poyavlyaetsya hapana ganda, cyanosis zvemiromo;

-oliguriya;

mutauro -oblozhennost;

-suhost mucous;

coldly ziya haaiti, asi ganda anorasikirwa turgor kwayo;

-puls thready;

-cherty chiso anorodzerwa.

Chepfu kugwinha, kupatsanura

Ichi chirwere kunoitika nokuda kupinda mumba muviri pazvirwere, kureva, nemavhairasi uye utachiona kuti anokonzera zvakakomba kudhaka avo mabasa. Kazhinji kacho mhosva vari kurwisa kuvhunduka streptococcus, anonzi Staphylococcus, salmonella, Pseudomonas aeruginosa. Vapinda muviri, sezvo achishandisa namavanga akazaruka (puerperal sepsis, kutsva, kuvhiya) kana pasina (fivha, AIDS, tracheitis, sinusitis, mabayo, yokuSpain, uye zvimwe zvirwere).

Pathogenic tusingaoneki berekai superantigens kuti Activate T masero, uye dzimwe T masero. Avo, akavapindurawo, secrete cytokines, kukonzera murwere zvirwere iri woutsinye, uye guru mari zvinokachidza akasunungura kupinda ropa rake, zvichikonzera muchetura kuvhunduka. The kupatsanura iri ezvinhu chinosiyanisa muzvikamu zvitatu:

1.Obratimaya. In ropa iri kumanikidzwa angava kuipa, inoramba yakajeka kuziva, ganda anova Pink kana tsvuku. The murwere kazhinji Dederai, vachinyunyuta kurwadziwa mumuviri kana mudumbu, akacherechedza manyoka, nefivhiri uye dzimwe nguva kurutsa.

2.Chastichno reversible. Zviratidzo: fivha, simba kupomba, tachycardia, ungaderedza kumanikidzwa, murwere lethargic, akaita hwakaipa.

3.Neobratimaya. Zviratidzo: kupfupika mweya, kugwinha, ganda cyanosis, kupomba simba, BP pasi dzinonetsa, murwere azheuka.

Kupatsanura pakati anaphylactic kuvhunduka

ezvinhu akadaro kunoitika kana anwa chepfu kubva nyoka kuruma, madandaude, wasps nezvimwe zvipenyu, kubva adya kunwa uye zvokudya, uye nokuda kwokubatsira zvinodhaka kuti vanopiwa murwere allergens. kwakadaro maitiro kakawanda kupiwa procaine kuti penicillin, makemikari. Shock kunogona kuitika mukati masekonzi mashoma pashure neVadzidzi allergen muviri richishandisa nguva refu, uye nokukurumidza nezvinoita chakaitika, zvakaipisisa yacho fungidziro. Pane zvakawanda siyana panowanikwa anaphylactic kuvhunduka:

-tipichnaya (akatsvuka panguva nokuruma nzvimbo (jekiseni nzvimbo), kana abdominal marwadzo, huro pamusoro nemumuromo kuonana allergen, decompression, compression pamusoro mbabvu pasi zvinoita manyoka kana kurutsa);

-gemodinamicheskaya (pakutanga zvemwoyo zvirwere);

-asfiksicheskaya (kufema kukundikana, dyspnea);

-tserebralnaya (atadze kushanda zvakanaka pamusoro nechepakati tsinga, kugwinha, kufenda, kufema nokusungwa);

-abdominalnaya (chenjera dumbu).

mabatiro

Nokuti nokukurumidza chiito kunokosha yakarurama kupatsanura pakati ukapisa murwi. Urgent chimbichimbi hanya nechimwe ane pachake chaizvo ayo, asi nokukurumidza rwunotanga rupiwe, murwere nani mukana. At danho kusingarapiki rufu iri kuchengetwa anopfuura 90% nyaya. Dzechimwe kuvhunduka inokosha pakarepo adzikatidza kurasikirwa neropa (tourniquet) uye kununura vakuvara kuchipatara. Pane akatakura intravenous sesaline uye colloidal zvinogadzirisa, ropa, plasma, anesthetized, kana zvakakodzera, zvakabatana kuti unomubatsira kufema.

In anaphylactic kuvhunduka pakarepo raitongwa epinephrine, murwere intubated pamwe asphyxia. Naizvozvo achiita corticosteroids uye antihistamines.

Kana hunokachidza kuvhunduka vakatakura muhombe mvura jekiseni rine simba nemishonga, immunomodulators glucocorticoid plasma.

Kana hypovolemic kuvhunduka chikuru mabasa ari kudzorera ropa nerubatsiro nhengo dzose, kubviswa hypoxia, uye normalization kwokudzvinyirira mwoyo. Kana kuvhunduka anokonzerwa kupera muviri, zviri Uyezve waitoda resumption vakarasika Vhoriyamu Urume uye electrolytes zvose.