Kufotokozera za pneumothorax: mitundu ya matenda osiyanasiyana, matenda ndi mankhwala

Mu ambiri onena za madokotala komanso ofufuza, ife nthawi zambiri mawu tanthauzo la zomwe zikutanthauza zoipa kapena sindikumvetsa konse. Mwachitsanzo, pneumothorax. Kodi matenda? Zizindikiro, zizindikiro imene mwadzidzidzi ndodo molondola kudziwa kupezeka kwake, kuchuluka kwa chithandizo, ndi zinthu zina zambiri pa nkhani mseri. M'nkhani ino mudzapeza mayankho amene angathandize Asia mu vuto yovuta.

tanthauzo

Pneumothorax - ndi kudzikundikira mpweya kapena mafuta ena kuti patsekeke thoracic. Nthawi zambiri kumachitika pambuyo kuvulala chifukwa cha lotseguka wovulala nthiti kapena kuvulala m'mapapo umagawanika fupa, komanso chifukwa cha chotupa cha abscess m'mapapo, kutsegula ng'ombe kapena kusungunuka mpanda wa bronchus chotupa chija. pneumothorax Secondary ndi kupitiriza matenda yaitali m'mapapo mwanga.

Matenda mawonetseredwe zizindikiro chimadalira kwenikweni mmene msanga mpweya chimadzaza M'mimbamo pleural. Nthawi zambiri, matenda n'zotheka ndikatha kumfunsafunsa wodwala pa powonekera. Nthawi zina, njira zina bwinobwino monga X-ray.

Chithandizo zambiri opaleshoni. Kumayambitsa kuchotsa mpweya chifuwa M'mimbamo ndi ngalande kapena puncture, kubwezeretsa ntchito ya ziwalo mediastinum ndi kubwerera iwo mipando yawo.

Kulankhulana ndi chilengedwe kunja

Mu mawonekedwe pali yofanana angapo pneumothorax. Matenda amadalira mbali iti ya dzenje anapanga (kunja kapena mkati thupi), komanso kukula kwake ndi mlingo mpweya inflow.

• Tatseka pneumothorax matenda milandu pamene M'mimbamo pleural imagwera zazing'ono kuchuluka kwa mpweya kudzera kabowo, osati kulankhulana ndi chilengedwe kunja. Kuthamanga pamtima M'mimbamo ndi chinawonjezeka pang'onopang'ono, ndipo chirema chatsekedwa palokha, popanda thandizo zina. Air thovu pang'onopang'ono kupasuka pakati pa mapepala pleura, m'mapapo, natenga mawonekedwe mwake.
• Open pneumothorax akufotokozera anapereka ozama mabala a linga chifuwa, kapena chotupa cha bronchus lalikulu. Nthawi zonse kukambilana ndi chilengedwe kunja. Chifukwa mavuto sizabwino M'mimbamo mkati limagwirizana ndi mumlengalenga chamoyo imene kuwala n'kugwa, ndi mpweya sakhala kuyenda mu izo.

• Mavuto kapena pneumothorax vavu imapezeka pamene kugwirizana zoopsa (chilonda pachifuwa khoma pleura ndi kuwonongeka ndi chophukacho wa bronchi chachikulu), ndi yodziwika kuti mpweya amalowa m'thupi M'mimbamo pa inhalation, koma sasiya kutulutsa ake. Kuthamanga mu M'mimbamo pleural koyamba poyerekeza ndi mumlengalenga ndipo susiya kukula. Chifukwa cha ziwalo mediastinal ali osamukira ndi wothinikizidwa.

pathogenesis

Pofuna kuthandiza bwino, m'pofunika kudziwa mmene pneumothorax aumbike, mitundu yake. Maphunziro Akakhalidwe Kazolengedwa cha ndondomekoyi kwagona kuti yachibadwa pleural M'mimbamo mkati makhalidwe oipa. Izi zimathandiza kusunga mapapo mu boma kukodzedwa, komanso kufulumizitsa kuwombola mpweya mu alveoli lapansi. Pamene zikayamba ndi yosweka ndi mlengalenga wayamba lembani M'mimbamo pleural, mapapo kuchepa mu Volume.

Ndi zina ndi mpweya wabwinobwino, ndi chifukwa munthu wayamba kutsamwa. Komanso, mpweya compresses ndi displaces ziwalo mediastinal: mtima, msempha, kum'mero, limapangitsa kuti agwire ntchito zawo mwachindunji.

etiology

Kuyambira wothandizila zoopsa izo zimatengera chimene chidzakhala pneumothorax. Etiology, mitundu, pathogenesis, matenda mawonetseredwe ndi mankhwala ali ndi inextricable zomveka unyolo akudziwiratu zomwe angakumane Kupulumutsa moyo, ngakhale mulibe chochita ndi zachipatala.

1. kucoka kupando pneumothorax kusiyana lalikulu bronchus kapena m'mapapo parenchyma si kugwirizana ndi kuvulala makina a chifuwa. Iwo m'magulu awiri akuluakulu:

• Chachikulu, kapena idiopathic, palibe chifukwa chenicheni. More zofala anyamata wamtali kuposa akazi a zaka zofanana ndi kumanga. Izi zingathe kufotokozedwa ndi mbali zotsatirazi: kusintha pathological mu phapo chifukwa chilema majini mu synthesizing enzyme alpha-1-antitrypsin, zomwe zimafunika kugwira ntchito za masiku onse alveoli ya; pleura kwambiri wochepa thupi, omwe mwina munasiya dontho negligible kuthamanga, monga kutsokomola kapena sneezing; kuthamanga dontho mwadzidzidzi pamene kukwera phiri (phiri matenda) kapena adalowetsedwa m'madzi (matenda caisson).
• pneumothorax Secondary aumbike pa maziko a matenda kale m'mapapo monga COPD (aakulu obstructive m'mapapo mwanga matenda), enaake fibrosis ndi mphumu.

2. Ambiri milandu la pneumothorax zoopsa. Mitundu kuvulala m'magulu awiri: ozama kuvulala a chifuwa M'mimbamo (sliced, akanadulidwa mabala, fractures lotsegula la nthiti); yosamveka pachifuwa zoopsa (avtotravmy, onongani pakati pa zinthu n'kupuma kusiya).

3. Pa chamankhwala salola kukusalani maonekedwe a pneumothorax. Zikatero, umatchedwa iatrogenic. Zoopsa monga pleura kapena m'mapapo biopsy, matenda abscesses puncture okhutira ndi cysts, staging subclavian catheter ndi barotrauma ku ALV (yokumba m'mapapo mpweya).

chipatala

Atadziŵa zoona wodwalayo dokotala amamvetsera mwadzidzidzi ululu chifuwa, kufupika kwa mpweya, kupuma mofulumira ndi mlingo mtima, youma chifuwa. Pachimake amantha angakhalenso chifukwa cha pneumothorax. Mitundu kuvulala ndi chikhalidwe cha kuvulala, nthawi zina zowoneka zimadziŵika, kudzakuthandizani kutsirizitsa matenda ndi kutsogolera wodwalayo mankhwala. Zimenezi zingakhale opaleshoni kapena achire kuchipatala kapena mwadzidzidzi dipatimenti. Zonse zimadalira kukula kwa chikhalidwe ndi kuwonongeka yeniyeni.

diagnostics

Monga ndanenera pamwamba, podziwa limagwirira, umene umatchedwa ndi pneumothorax, mitundu ndi masiyanidwe. matenda sikovuta. Ndi chokwana kuunikidwa kunja chifuwa ndi m'mapapo auscultation zigawo symmetrical (kulinganizidwa ndi gawo wathanzi wodwalayo). Ngati muli ndi kamtima kuwonongeka simungathe, ndiye kuti kukhala bwinobwino mukufuna kutumiza wodwalayo X-ray kapena CT mapanga sikani. Mpweya susonyeza ndi cheza nyukiliya, ndipo chotero zidzakhala bwino kuonekera pa cipangizo.

Monga njira zina zowonjezera mungathe kugwiritsa tanthauzo mpweya magazi (kuti aone ngati pali kusintha kosangalatsa kwambiri malangizo a hypercapnia), electrocardiography (kupewa mavuto monga matenda a mtima), komanso amachita upo opaleshoni (Izi kawiri kawiri zimachitika pa siteji ya kumupima wodwala ovulala pangozi dipatimenti).

zadzidzidzi

Ngakhale losiyanasiyana pneumothorax, thandizo yafupika itanani ambulansi. Popeza wosaphunzitsidwa munthu kuthana ndi kuvulala mkati, n'zokayikitsa, ndiye muyenera zinachitikira ndi zoopsa opaleshoni. Chinthu chokha chomwe tingachite pa nkhani ya zosinthika lotseguka matenda - ndi zoika losindikizidwa wandiweyani bandeji pa chilonda. Mukhoza kugwiritsa ntchito oilcloth, pulasitiki Manga kapena lakuda thonje-gauze. mwai izi zidzathandiza kupanga chatsekedwa pneumothorax.

Species mwamsanga chisanadze mankhwala thandizo ndi maziko matenda a matenda ayenera kukhala mbali mwa kuchuluka kwa zinthu za munthu, chaka chatha ophunzira (yapachiweniweni chitetezo). Ndiye adzakhala mokwanira mmene zinthu zilili pamoyo ndi kusankha mwanzeru.

chithandizo

Chinthu choyamba kudziwa ndendende zotani pneumothorax wodwalayo. Ngati kuchuluka kwa mpweya pakati pa mapepala a pleural pang'ono, thandizo ndi zina osati kuchita. Iye pang'onopang'ono kuthetsa. Ngati kumene kuchuluka kwa mpweya bwinobwino chindiletsa chosavuta kutsegula, ziyenera aspirated ndi syringe mwa puncturing M'mimbamo pleural. Izi zidzathandiza kuti msanga kuthetsa pneumothorax. Mitundu (chisamaliro mwadzidzidzi zimadalira izi) matenda ndi zofunika, chifukwa iwo amafuna njira ina. A yambiri ya kuwonongeka kungafune unsembe wa munthu amaganiza ngalande Byulau.

Komanso, pamene kuvulala chachikulu zofuna opaleshoni alowererepo pa kutsekedwa kwa m'mapapo parenchyma, pleura ndi zilema bronchial, komanso kutsekedwa kwa ozama mabala a chifuwa.

Monga mankhwala symptomatic analimbikitsa dzanzi ndi mpweya inhalation. Ngati nkhani pneumothorax ali kawirikawiri zokwanira, wodwalayo mwina analangiza kubala pleurodesis - soldering pleura pamodzi.

Zovuta ndi madokotala ananena zawo

Komanso pambuyo matenda, pali nthawi zonse zotsatira za akudwala pneumothorax. Kwina Kulikonse mu nkhani iyi kumathandiza zazing'ono. Mu malo oyamba mwa mavuto ofunika magazi kapena hemothorax. Kumbuyo kwake anakakhala pleurisy (kutupa kwa minofu connective ndi mapangidwe adhesions pakati pleura) ndi subcutaneous ndiko kumayambitsa (mpweya kulowa minofu pansi pa khungu). wodwalayo angafe dera chidwi kuvulazidwa ndi thandizo anachedwa.

kupewa

Pofuna kupewa chitukuko cha pneumothorax, zokwanira kusunga malamulo wamba ochepa:

• Panthawi yake ndiponso mokwanira kuchitira dongosolo kupuma ndi kupewa mavuto ake, zikubweretsa mapangidwe zofooka mu m'mapapo ndi pleura.
• Kusiya zizolowezi zoipa, makamaka - kusuta.
• Pewani ululu wa pachifuwa.
• Amayesetsa kupewa kukonzanso pneumothorax.