Ropa clots mumapapu. Pulmonary embolism: zvinokonzera, zviratidzo, migumisiro, kurapwa

Chinouraya chirwere pulmonary embolism (Pe). Tiri kutaura kuumbwa ropa. Pakati pathologies ose pulmonary embolism asunungurwa anovhundutsa nhamba. clots ropa mumapapu vanokwanisa chero nguva adzikatidza tsinga. Zvinosuruvarisa kazhinji zviri zvinouraya. Chinenge chikamu chimwe muzvitatu zvose varwere kufirwa kunoitika pamusana blockage of pulmonary tsinga pedyo ropa clot.

Zvinoitwa chirwere

Pe haisi yakazvimirira chirwere. Sezvinoratidzwa nezita racho, iri mugumisiro thrombosis.

Blood clot, achitarisa kubva panzvimbo yake dzidzo, vakatakura pachishandiswa ropa hurongwa. Kazhinji, clots ropa munguva rezasi migumo. Dzimwe nguva vemunyika zvakarurama mwoyo. A clot ropa ichipfuura rworudyi atrium, ventricle uye kupinda pulmonary riparadzirwe. Anobvisa mune rimwe muviri hwemvura tsinga pamwe venous ropa - zvemapapu.

Vatariri clot anonzi embolus. Iye anongovangira mumapapu. Uyu aiva nengozi chichingoitwa. A clot mumapapu ropa anogona pakarepo adzikatidza tsinga mapazi. midziyo Ava yakawanda pauwandu. Zvisinei, dhayamita yavo kunoderedza. Kamwe ari mudziyo kuburikidza nawo ropa clot haangaupfuuri, izvozvo mabhuroko ropa riyerere. Ndizvo kazhinji kunotungamirira kurufu.

Kana murwere vakaputsa ropa clot iri zvemapapu, zvinokonzerwa kuvimba chii zvakazoonekwa kuti tsinga mudziyo. Embolus kuchambokanganisa inowanzotorwa ropa wedzerai munyama uye nomukana gasi mukutsinhana pachiyero matavi zviduku, kana arteries makuru. Murwere anooneka hypoxia.

The kwokuomerwa chirwere

clots ropa zvemapapu zvinokonzerwa yematambudziko urwere mumuviri pashure yokusununguka uye uchishandisa mamiriro. Rufu kubva chirwere ichi chaizvo. Icho 3rd kukonzera rufu, wechipiri chete zvemwoyo zvirwere uye kenza.

Today Pe kunokudziridzwa zvikurukuru pamusoro pakanyorwa zvinhu zvinotevera:

• zvakakomba zvokurwara;
• kunzwisisa Kuvhiya;
• zvinokuvadza.

The chirwere kunoratidzwa kwazvo, akasiyana-siyana zvakasiyana zviratidzo, kupfupika nechirwere, mukuru mukana huno. Nhamba dzinoratidza, pahwaro post-mortem ongororo, clots ropa mumapapu vakanga vasina dzaibatsira chirwere anenge 50-80% yevanhu vakafa nokuda pulmonary embolism.

The chirwere kunoitika nokukurumidza. Ndokusaka zvichikosha kuti nokukurumidza uye zvakarurama rokuongorora abnormalities. Uyewo kurapwa kuti anogona kuponesa munhu upenyu.

Kana akanga yakakodzera dzakaonekwa rimwe ropa clot iri zvemapapu, kupona kubva muzana ichiwedzerwa kwazvo. Mwero wokufa kwevanhu pavarwere vakagamuchira zvakafanira kurapwa, inenge 10%. Pasina chirwere uye zvakakwana kurapwa, wasvika 40-50%.

Zvinokonzera chirwere

A clot mumapapu, mufananidzo riri munyaya ino ropa pamusana:

• zvakadzama tsinga thrombosis repasi wamativi;
• paumbwe imwe ropa clot chero nzvimbo venous hurongwa.

Ndoda kazhinji, zvokurwara ichi inogona vemunyika ari mutsinga ari peritoneum, kana repamusoro migumo.

Njodzi zvikonzero, zvichireva kukura murwere pulmonary embolism vari 3 triggering ezvinhu. Vari kunzi "vanamwari vatatu vatatu kuti Virchow." Zvinhu izvi zvinosanganisira:

1. Akaderedza ropa kuyerera velocity munyika venous ino. Kurega kunotanga nenhumbi. Slow chokubuda ropa.
2. The zvakawedzera propensity kuti thrombosis. Gipersvertyvaemost ropa.
3. Kukuvara kana kukuvadza venous rusvingo.

Saka, pane mamwe mamiriro ezvinhu ayo kutsamwisa pamusoro zvinhu, iyo dzakaonekwa somugumisiro clot ari zvemapapu. Zvikonzero mungavanzwa pasi zvinotevera ezvinhu.

By kuderera kubva venous ropa kuyerera kungaguma:

• yenzendo refu, kufamba, somugumisiro iyo munhu kwenguva refu kugara mundege, motokari, chitima;
• muchipatara umo zvaida mubhedha zororo kwenguva yakareba.

By gipersvertyvaemosti ropa kunogona kukonzera:

• kusvuta;
• kushandiswa yokuronga mapiritsi, inonzi estrogen;
• nemagene kubatwa;
• oncology;
• polycythemia - vakawanda masero matsvuku;
• kuvhiya;
• pamuviri.

Kusvika venous rusvingo kukuvara kutungamirira:

• yakadzika tsinga thrombosis;
• epamba gumbo kukuvara;
• Kuvhiya repasi maoko nemakumbo.

zvinokonzera njodzi

Vanachiremba ndeizvi predisposing zvinhu panguva iyo kunonyanyisa ropa clot aiwanzowanika mumapapu. Migumisiro chirwere kune ngozi chaizvo. Naizvozvo zvakafanira kuti kuteerera utano vanhu avo vaona zvinhu akataura pazasi:

• neb kurovedza muviri;
• zera makore 50;
• oncologic zvokurwara;
• kuvhiya;
• mwoyo kukundikana, myocardial;
• randakambosangana naro zvinokuvadza;
• varicose mutsinga;
• Kushandisa hormone pamuviri;
• pakusununguka;
• erythremia;
• remesa;
• nemagene chirwere;
• chinonzi systemic lupus erythematosus.

Dzimwe nguva zvinogona chirwere ropa clots mumapapu pavakadzi pashure ekubereka, kunyanya inorema vaya. Kazhinji, vagumirwe iri pashure paumbwe imwe clot ari pahudyu kana mhuru. Anoita pacharo akanzwa kurwadziwa, fivha, akatsvuka kana kuzvimba. About chirwere ichi anofanira vakaudza chiremba pakarepo, kuitira kuti kutowedzera chirwere rikurumidze.

The mamirire Zviratidzo

Kuti rokuongorora ropa clot mumapapu, zviratidzo chirwere zvinofanira kuva pachena. Zvinofanira kungwarira chaizvo chete zvinoita kukura chirwere ichi. Sezvineiwo, chiremba mufananidzo pulmonary embolism iwayo siyana. Zvinonzi pakutsvaga kwokuomerwa ari zvokurwara, mwero kukura uye kuchinja pulmonary zviratidzo chaicho chirwere kushatiriswa kuomesa ichi.

Kana pane ropa clot mumapapu, zviratidzo (kuongororwa) ari murwere zvinotevera:

1. Kupfupika mweya, nokukundwa pasina chikonzero.
2. Pane kuwedzera kwemwoyo (paminiti imwe miniti kurohwa anopfuura 100).
3. Akacheneruka ganda ane maitiro pfumbu tint.
4. Kurwadziwa, zvichiitika dzakasiyana dzenyika sternum.
5. Havachanyatsogoni bowel motility.
6. Sharp hyperemia mutsipa mutsinga uye zuva nenyika dzinotenderera pariri plexus, akacherechedza bulging dzavo, rinooneka pulsation yacho yeropa.
7. Ashatirwa peritoneum - ari rusvingo nerongo zvakakwana, kune marwadzo mudumbu kunzwa.
8. Heart ino- tsutsumwa.
9. kumanikidzwa Strong ipfupi.

Varwere vanenge vakawana ropa clot iri zvemapapu, pamusoro apa zviratidzo varipo hazvo. Zvisinei, hapana zvezviratidzo izvi haisi chokuita chairo.

Kuwedzera zvinokosha zvatariswa, zvinotevera rinoti zvingamuka:

• fivhiri;
• vangakosora ropa;
• kufenda;
• kurwadziwa sternum;
• kurutsa;
• kufenda basa;
• mvura kupinda sternum;
• pakoma.

Weboka chirwere

Sezvo zvokurwara zvinoreva zvirwere ane ngozi zvikuru, kwete dzakakudzingai rufu, dzinofanira kuzokurukurwa muudzame yomuka zviratidzo.

Pakutanga, murwere hwapedyo kupfupika mweya. chiitiko chacho haisi pashure chero zviratidzo. Zvikonzero kuratidzwa mwoyo zviratidzo zviri zvachose vasipo. Kupfupika mweya anozviratidza pamusoro exhale. Zvinonzi dzinoratidzwa inzwi yakanyarara, zvichiteverwa zenze mumvuri. Zvisinei, nguva dzose aripo.

Kunze kwake, Pe achabatsirwa kwakawedzera kwemwoyo. Akarova kubva kumusoro anorova 100 paminiti.

Inotevera chinokosha ndiko unopinza kuderera BP. The mwero rutapudzo ose indekisi iri inversely Proportional kuti kwokuomerwa chirwere. The repasi kumanikidzwa madonhwe, zvikuru zvakakomba maronda vakatsamwisa Pe.

Marwadzo kunobva kwokuomerwa chirwere, uye uwandu tagovera vascular zvirwere Level kuitika mumuviri:

1. Marwadzo seri breastbone, iro rine unopinza, discontinuous hunhu. Izvi kusagadzikana kunoratidzwa tsinga blockage. The marwadzo kunobva tsinga compression ngarava rusvingo.
2. Stenokardicheskie kusanzwa. Pain ari compressing hunhu. Zvinowanikwa munzvimbo mwoyo. Kazhinji anopa pamapfudzi chipande, ruoko.
3. Rwadza kusanzwa iri yose sternum. zvokurwara Izvi zvinogona maitiro kuomesa - pulmonary infarction. The kusagadzikana kunowedzerwa kana chero kufamba kwazvo - kufema yakadzika, vangakosora, sneezing.
4. Marwadzo pasi mbabvu kurudyi. Ndoda kusagadzikana munogona chiropa nzvimbo, kana murwere ane ropa clots mumapapu.

kushomeka ropa kuyerera aona ari mudziyo. It kungakonzera murwere:

• rwadza hiccups;
• makakatanwa ari abdominal parusvingo;
• paresis of ura;
• bulging huru mutsinga dziri mumutsipa uye makumbo.

The ganda pamusoro anova ruvara rakachenuruka. Kazhinji kuva ashy kana pfumbu vavimbezve. Zvadaro, zvichida kujoina miromo mutema. Zvapedzisira Pakanzi rinoratidza hombe embolism.

Dzimwe murwere anogona kunzwa maitiro mwoyo vakan'un'una, arrhythmia iri dzakaonekwa. Kana pulmonary infarction may hemoptysis, pamwe marwadzo ari mubhokisi, uye zvakakwana yakakwirira tembiricha. Hyperthermia zvingaitika kwemazuva uye dzimwe nguva vhiki uye nehafu.

In varwere maari thrombus mumapapu, anogona kuitwa kutyorwa pfungwa kutenderera. Varwere ava kazhinji chipo:

• kufenda;
• nokugwinha;
• dzungu;
• chaanoziva;
• hiccups.

Anorondedzerwa Zviratidzo zvinogona kubatana zviratidzo renal kukundikana, rikwanise chimiro.

matambudziko anoitika pulmonary embolism

Izvi pathologies aiva nengozi umo vemunyika ropa clot mumapapu. Migumisiro nokuti muviri kunogona zvakasiyana. It anosarudza nzira yematambudziko nehosha, unhu uye nguva upenyu murwere.

The chikuru Migumisiro Pe vari:

1. Vanotogara akakwidziridzwa kumanikidzwa ari pulmonary midziyo.
2. Pulmonary infarction.
3. Gangaidzo embolism iri nhumbi guru denderedzwa.

Zvisinei, havasi vose saka kusuruvara, kana nenguva akaonekwa ropa clots mumapapu. Achatanda sezvaratidzwa pamusoro apa, zviri zvakanaka, kana murwere achagamuchira kurapwa. Panyaya iyi, mukana kumusoro kurerutsa ngozi nemigumisiro.

Pazasi pane pfungwa zvirwere kuti vanachiremba chirwere somugumisiro yematambudziko ose pulmonary embolism:

• pleurisy;
• pulmonary infarction;
• nemabayo;
• empyema;
• bapu pute;
• renal kukundikana;
• pneumothorax.

idzokororo pulmonary embolism

zvokurwara ichi anokwanisa kudzokororwa Varwere kakawanda muupenyu. Muchiitiko chino, zviri rudzi idzokororo thromboembolism. Inenge 10-30% wevarwere pashure rimwe chirwere zvakadaro, asingatani idzokororo Zvikamu zviri pulmonary embolism. Mumwe murwere anogona kuva nhamba kurwiswa siyana. Paavhareji, nhamba yavo zvichisiyana 2 kusvika 20. Vazhinji vaitama zvokurwara Zvikamu inomiririra blockage nemapazi duku. Gare gare zvokurwara ichi zvinotungamirira hombe tsinga embolization. It akaumba hombe pulmonary embolism.

Zvinokonzera idzokororo siyana zvinogona kuva:

• chisingaperi zvirwere kufema uye zvemwoyo nehurongwa;
• oncologic zvirwere;
• kuvhiya Kupindira ari abdominal munharaunda.

chimiro ichi hakuna kunotoda zviratidzo zvakajeka. It kunoratidzwa avhiringidzwa pamusoro. Zvakanaka rokuongorora ichi zvakaomera chaizvo. Kazhinji unexpressed zviratidzo zvisiri kuti zviratidzo zvimwe zvirwere.

Idzokororo pulmonary embolism anogona kuitika zvinotevera ezvinhu:

• Kuramba nemabayo, kwakaitika pasina chikonzero;
• kufenda;
• pleurisy yokuvamba pamusoro mazuva akawanda;
• asima;
• zvemwoyo dhirika;
• kupfupika mweya;
• yakawedzera kwemwoyo;
• nefivha, asingadi kutsakatisa antibacterial zvinodhaka;
• mwoyo kukundikana, chirwere pasina zvemapapu kana mwoyo.

The chirwere kungatungamirira zvinotevera matambudziko:

• emphysema ;
• pulmonary fibrosis - zvemapapu rinenge kuchatsiviwa connective;
• mwoyo kutadza;
• pulmonary neBP.

Idzokororo pulmonary embolism ndiyo ngozi nekuti chero chiitiko hwakazotevera zvinogona kuuraya.

kuongorora chirwere zvirwere

The pamusoro zviratidzo, Sezvambotaurwa, hakusi zvakananga. Saka, pana zviratidzo izvi hazvigoni chirwere. Zvisinei, apo Pate hazvo kupa mamirire chiratidzo 4:

• kupfupika mweya;
• tachycardia - yakawedzera kwemwoyo;
• bhokisi marwadzo;
• kupfupika mweya.

Kana murwere asina chiratidzo mana, ipapo asina thromboembolism.

Asi hazvisi zvinhu zvose zviri nyore kudaro. zvokurwara chirwere zvakaoma zvikuru. Kuti vanofungidzirwa Pe vanofanira kuongorora mukana kusimukira chirwere. Naizvozvo, chiremba pakutanga inotiratidza kuti zvinoita zvinokonzera njodzi: kuvapo yomwoyo, thrombosis, kuvhiya. Izvi zvinobvumira kuti kuona mhosva chirwere, nharaunda umo clot mumapapu.

Fanira kuongorora kuti vasabatwa kana achisiya pulmonary embolism ndedzinotevera zvidzidzo:

1. ECG. Very zvakwo nzira nechirwere. Electrocardiogram anopa pfungwa ukuru chirwere nekuomarara. Kana iwe sangana ruzivo urwu pamwe nhoroondo chirwere, pulmonary embolism nechirwere kumusoro nemazvo.
2. X-ray. Kudzidza uku pagadzirwe Pe nechirwere chinonzi uninformative. Zvisinei, zvinobvira kusiyanisa chirwere nezvimwe pathologies zvakawanda zviratidzo zvakafanana. Somuenzaniso, maererano lobar mabayo, pleurisy, pneumothorax, kutsemuka aneurysm, pericarditis.
3. Echocardiography. Kudzidza pachena chaiyo nzvimbo yacho thrombus, chimiro, ukuru, vhoriyamu.
4. Lung scintigraphy. nzira iyi kunoita chiremba 'mufananidzo' ari pulmonary nhumbi. Iye zvakajeka akacherekedza nzvimbo dzavari kweropa. Asi kuwana nzvimbo vemunyika clots mumapapu, hazvibviri. Kudzidza ane yakakwirira chirwere ukoshi chete kana chikuru vascular zvokurwara. Ziva matambudziko mapazi diki tichibatsirwa nzira iyi hazvibviri.
5. Ultrasonography gumbo mutsinga.

Kana zvakakodzera, murwere anogona kupiwa mamwe nzira tsvakurudzo.

kubatsirwa nokukurumidza

Yeuka, kana iwe adonhe ropa clot mumapapu, zviratidzo murwere anogona kuva panguva semheni. Uye chete nokukurumidza kurufu. Naizvozvo, kana paine uchapupu pulmonary embolism inofanira kupiwa kuna murwere pa zororo uye pakarepo kudana cardiology "amburenzi." The murwere vakabvuma kuti yevanenge.

Emergency nokutarisirwa inobva zvinotevera zviitiko:

1. Emergency nechepakati tsinga anobudisa mushonga zvishoma nezvishoma uye kupinda zvinodhaka "Reopoligljukin" kana shuga-novocaine nezvakasanganiswa.
2. Raitongwa nomutsinga raitongwa zvinodhaka, "Heparin", "dalteparin", "Enoxaparin".
3. Chinorwadza mugumisiro kubviswa marwadzo analgesics, akadai "Promedol," "Fentanyl", "Morin," "Leksir", "Droperidol".
4. Okisijeni mushonga.
5. Murwere chinotarisirwa thrombolytics: rinoreva "Streptokinase", "Urokinase".
6. Muzviitiko arrhythmia kwakabatana zvinotevera zvinodhaka: "Magnesium Sulfate", "Digoxin", "ATP", "Ramipril", "Panangin".
7. Kana murwere chinotarisirwa ndisingafungiri maitiro pairi "Prednisolone" kana "Hydrocortisone", uye antispasmodics, "hapana-silos", "Eufillin", "papaverine".

Aungazviita Pe

Nokumutswa anogona kudzorera ropa riyerere kuti mapapu, kudzivirira kukura sepsis mune murwere, uyewo kudzivirira kuzorwa paumbwe pulmonary neBP.

Zvisinei, pashure rwekutanga murwere vachida akaramba kurapwa. Kurwisa zvokurwara nechinangwa kutadzisa dzokororo kwechirwere chacho, kwakakwana resorption kweropa clot.

To musi, pane nzira mbiri kubvisa ropa clots mumapapu. Nzira yokurapa anotevera pathologies:

• thrombolytic kurapa;
• Kuvhiya.

thrombolytic kurapa

Drug kurapwa Rinoshandisa mishonga yakadai:

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

zvinodhaka kwakadaro kunogona kukurumidza ropa clots uye kudzivirira paumbwe clots itsva.

The mushonga "Heparin" raitongwa murwere nomutsinga pamusoro mazuva 7-10. In ichi nokungwarira aidzora parameters ropa pakugwamba. Kwamazuva 3-7 risati kurapwa murwere raitongwa mumwe anotevera zvinodhaka zviri piritsi muchimiro:

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

Kudzora kweropa mberi. Kugamuchira basa rinovapo mahwendefa (pashure achirwadziwa pulmonary embolism) anenge 1 gore.

Mishonga "Urokinase", "streptokinase" raitongwa nomutsinga masikati. bata iri rinodzokororwa 1 nguva pamwedzi. Intravenous kushandiswa uye zvinyama plasminogen activator. The chete dose chinofanira kutarisirwa pamusoro akawanda maawa.

Thrombolytic kurapa haina kuitwa pashure kuvhiyiwa. zviri wairambidza munyaya pathologies, iyo inogona zvakaomesa nekudeura ropa. Somuenzaniso, peptic urikanwi. Nekuti mishonga thrombolytic anogona kuwedzera mukana ropa.

kuvhiya kurapwa

mubvunzo akadaro amutswa chete ari kukundwa imwe nzvimbo huru. Muchiitiko chino, unofanira kukurumidza kubvisa vemunyika ropa clot mumapapu. Treatment zvinotevera inokurudzirwa. Special midziyo rinobviswa ngarava thrombus. oparesheni Izvi zvinobvumira kubvisa chipingamupinyi ropa riyerere nzira.

Complex kuvhiya kupindira rinoitwa kana guru mapazi kana tsinga yakavharika hunde. Muchiitiko ichi zvakafanira kudzorera ropa riyerere munzira dzinenge zvose nzvimbo yemapapu.

Kudzivirira pulmonary embolism

thromboembolism chirwere ane tsika idzokororo kosi. Naizvozvo, zvakakosha kuti kukanganwa pamusoro hunokosha matanho kuti anogona kudzivirira pamusoro dzokororo chakakomba uye kwakakwidibira zvokurwara.

matanho akadaro kunokosha kuti vanhu rurefu pangozi yokuita chirwere ichi. chikamu ichi zvinosanganisira vanhu:

• mukuru kupfuura makore 40;
• Kurohwa kana kurwisa mwoyo;
• kuva remesa;
• iyo unotora Chiitiko nhoroondo yakadzika tsinga thrombosis kana pulmonary embolism;
• inini pakuvhiya mubhokisi, makumbo, pelvic zvomukati, mudumbu.

Kudzivirira kunosanganisira zviito inokosha zvikuru:

1. Ultrasonography gumbo mutsinga.
2. Kugara raitongwa pasi ganda kugadzirira "Heparin", "Fraksiparin" kana kurapwa jekiseni kupinda tsinga "Reopoligljukin".
3. Superimposition pamusoro zvakasimba bhandeji tsoka dzake.
4. Kudzvinya chaiwo hand cuffs mutsinga mhuru.
5. Dzokubatanidza rutsoka mutsinga makuru.
6. Muchibereko vena cava filters.

Nzira rokupedzisira ndiro rakanakisisa kudzivirira thromboembolism. zvakasiyana-siyana cava filters yakagadzirirwa nhasi:

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

Panguva iyoyowo, yeuka kuti mashandiro ichi Zvakaoma chaizvo kuti asimbise. The sizvo cava Sefa kwete chete kuva akavimbika kudzivirira, asi anokwanisa kukonzera kuwedzera mukana thrombosis inotungamirwa uye haizopereri kukura pulmonary embolism. Naizvozvo, kuvhiyiwa uku kunofanira chete kuitwa muna vakanyatsoshongedzwa utano centre, bedzi kupfurikidza anokwanisa mukoti.