Mendelson ndi matenda mawonetseredwe. Aakulu matenda kupuma

A zambiri mavuto angayambe odwala amene ali odwala mwakayakaya. Mmodzi wa limati awa ndi matenda ovuta kwambiri Mendelson a.

Kodi mtundu wa kudwala?

Ndi matenda Mendelson wa nthawi zambiri anatanthauza obstructive m'mapapo mwanga matenda ndi zotupa za m'mapapo minofu (pneumonitis), kukhala pa maziko a kugwa kwa madzi muzituluka mu Airways. chikhalidwe ichi anafotokozedwa koyamba mu 1946. Iwo anati odwala adwala amene anali ndi choipa mutu opaleshoni m'mimba (makamaka m'mimba) kubereka. Nthawi zambiri, woyambitsa wa mtundu uwu kudwala ndi zamizidwa ndi kusakhala (chifukwa izo pansi minofu yosalala). Motsutsa likhale omasuka ndiponso kutaya minofu kamvekedwe amapezeka kukhumba (Inhalation) muzituluka nkhani (zambiri yekha chapamimba madzi). Chifukwa ndi kugonjetsedwa ngati mtengo bronchial ndi minofu ya m'mapapo. Chikhalidwe ndi aakulu kwambiri, kungachititse kuti imfa ngati kulephera kupereka chithandizo choyenera. Ndi kumvetsa mwatsatanetsatane chifukwa pali matenda chonyansa, ndi kuti zizichitidwa.

zifukwa

Ndi chitukuko cha matenda Mendelssohn akhoza kuyambitsa matenda angapo. Njirazi ndi monga:

• Kudwala ya ubongo (aakulu choipa ubongo, kuwonongeka kwa mitsempha glossopharyngeal, kulimbitsa lamulo mantha maselo chapamimba parietal ndi motility ziwalo dzenje la kapepala kakuti m'mimba).
• Matenda a thirakiti m'mimba (hiatal chophukacho, achalasia).
• Matenda pa mundawo kupuma (trachea lalifupi, fistulas pakati pa kum'mero ndi windpipe).

Kuwonjezera matenda awa, kuti pneumonitis angayambitse matenda aakulu. Ndithu chikoka pa chitukuko ndi chiyembekezo opaleshoni m'mimba (pamaziko a kuchepetsa minofu kamvekedwe ziwalo ndi kuchepetsa n'zosiyana malangizo peristaltic mafunde) ndi mimba (chifukwa zakulera kusamutsidwa). Mwachitsanzo, pa chiwerengero cha zikunena opaleshoni 70% ya milandu.

Komabe, chifukwa ambiri a madzi chapamimba kulowa thirakiti m'munsi kupuma ndi ikudontha chabe chifukwa cha udindo molakwa wodwalayo komanso kufooka kwa sphincter mtima.

The pathogenesis wa chiyembekezo pneumonitis

Matendawa akufotokozera chifukwa zotupa asidi m'mapapo mwanga ndi bronchial minofu hydrochloric ali mmimba. Zodabwitsa ndizakuti akufotokozera coagulative necrosis (lomwe, kachiwiri, chifukwa zochita za asidi pa mucosa bronchial). Chifukwa cha mphamvu bronchial secretory yafupika, imbaenda issushivaniyu awo. asidi kufanana atagonjetsa mu mapapo, chimachititsa chitukuko cha pneumonitis - aseptic kutupa minofu ya m'mapapo. Yafupika m'mapapo kupuma pamwamba, amachepetsa m'badwo wa surfactant. Zonsezi amatsogolera ndi kuwonjezeka lightness thupi anati (chifukwa fomu iyi ndi secrete pathologies awiri: mphumu - makamaka okhudza bronchus, ndi obstructive - ndi chotupa ya m'mapapo minofu ndi chitukuko kutsekeka syndrome). mmene anatsimikiza ndi pH madzi chapamimba (m'munsi ndi, m'pamenenso anaikira asidi, kuwonongeka kwambiri). The kusintha kwenikweni ambiri anaona mu alveoli lapansi.

Mawonetseredwe pa mlingo wa alveoli ndi

Nthawi zambiri mu zokambirana za matenda makamaka ndi kugwirizana zizindikiro Oŵerenga akupemphedwa chithunzi. Matenda monga pneumonitis, kawirikawiri ndi zina zenizeni kunja musati amasiyana. Koma ngati inu muyang'ana pa zinkakhala m'dera minofu kudzera maikulosikopu (zomwe kawiri kawiri zimachitika pa kutsegula kwa), n'zotheka kudziwa kusintha zina.

Chifukwa cha njira pamwamba ndi pansi pa kukopa yokoka akutsikira acid amathiridwa mu alveoli lapansi. Kumeneko, chifukwa cha polojekitiyi pachilumbachi minofu alveolar, mapangidwe effusion (zambiri hemorrhagic). Chifukwa, izo kukhala hemorrhagic m'mapapo mwanga edema. Mothandizidwa kudzitsitsa pa alveoli anaona imfa ya Ulimbo, komanso malowedwe a maselo magazi kudzera chapansi Kakhungu (mu leukocytes makamaka ndi macrophages). Motero, ulimi wa michere osauka necrosis makoma alveolar chifukwa dongosolo m'mapapo amene kusokonezedwa. Mu malo ziwiya ndi inati kuwonongeka za indofeliyamu ndi mapangidwe microthrombi. Izi zonse kumabweretsa kuchuluka exudation madzi kupyolera Kakhungu ndi mapangidwe atelectasis. Kawirikawiri ndi chifukwa chimene kusiyana obstructive m'mapapo mwanga matenda. Ngati asidi mu mapapo kupeza zidutswa za undigested chakudya kapena matupi ena achilendo, monga mapangidwe hemorrhagic edema pamodzi ndi chitukuko cha zimene wozengereza granuloma mapangidwe padziko walowa thupi. mtundu uwu matenda akuchita pang'onopang'ono, koma kwambiri.

Chipatala kuwonekera kwa matenda

Kodi mungadziwe kuti wodwalayo ali chiyembekezo pneumonitis? Specific "matenda chithunzi" akhoza ankaimira motere:

• Chipatala oyamba adzakhala chifukwa zotsatira mwachindunji asidi pa Kakhungu mucous. Muli chithunzi matenda a pachimake ndi aakulu kupuma kulephera - bronchospasm wowonjezera cyanosis, kupuma kulephera.
• Cardio-mtima dongosolo zimawonedwa tachycardia, akuponya magazi. Nthawi zina, ndi mtima kulephera kapena kusokoneza mungoli lapansi. Zodabwitsa ndizakuti utachepa linanena bungwe mtima ndi kumawonjezera kuthamanga mu mitsempha m'mapapo mwanga. Chifukwa kuvutika kuwombola mpweya anati chitukuko cha kupuma ndi kagayidwe kachakudya alkalosis. Ikuluikulu buku la minofu m'mapapo kukanthidwa, ikakhala yolemera kwambiri wodwalayo, ndi kovuta kudzakhala kuchitira izo.
• Childs, zotupa ndi zizindikiro kulephera kupuma kuoneka maola 2, osachepera - Patapita. Nthawi zina zizindikiro akhoza kufutidwa, ndi zinchito kuwonongeka zisadzachitike konse.

diagnostics

Chiphaso Mendelson ndi matenda - yovuta, kuyambira kudwala akufotokozera zambiri odwala debilitated, ndipo si nthawi zonse, monga ife tinanena pamwamba, chithunzi matenda angagwe. Chinthu choyamba kudziwa pamaso pa kulephera kupuma (kufupika kwa mpweya, wheezing, cyanosis). Zizindikiro zimenezi si nthawi zonse kudziwa odwala amene ali pa mpweya makina. The njira yolondola kwambiri a Kupeza Vuto syndrome Mendelson ndi radiography kapena mapapo fluorography. M'chithunzithunzi munakwanisa sangathe kuona pamaso pa exudate mu mapapo, kuwonjezeka airiness awo. Nthawi zina, kusiyana kuzikonzanso wa bronchi ndi (yachibadwa pa radiograph mu ziyerekezo mwachindunji bronchi ndi zosaoneka, ndipo mukhoza kuwanena, pokhapokha ngati inu kupanga akatemera mbali). Ngati chabe fluorography mtima amaganiziridwa matenda yogwira ndi chifukwa kukhala necrosis, nthambi tubular wa trachea adzakhala zooneka ndi pa mzere radiograph.

kukhumba chithandizo syndrome

Koma ngati panali chiyembekezo cha nkhani chapamimba, mankhwala ayenera kuyamba pomwepo. Sitepe yoyamba ndi kuti achotse ku mpando kulowa asidi mu Airways m'munsi. Kuchita izi (ngati mmene alili) chofunika kuchotsa headboard pabedi lake. Pomwepo zofunika kusintha mpweya mu mapapo ndi kupereka zabwino magazi oxygenation. Childs, Kwalamulidwa othandizira opanikizika likukulira zabwino ndi hyperbaric mpweya machulukitsidwe (ntchito dongosolo othandizira, kuwunika mpweya magazi). Zonsezi zingathandize kuletsa acidosis.

Kuchepetsa voliyumu ya m'mapapo minofu chotupa yoikidwiratu glucocorticosteroids m'nsinga ndi mlingo ka - intrabronhialno. Mahomoni kulola ndondomeko kuti suspend yogawa ndi kuchepetsa izo. mankhwala (kawirikawiri cephalosporins ndi macrolides) ntchito kupewa. Kuyenera sympathomimetics (kuti kuchepetsa mapangidwe secretions mu bronchi ndi mapapu).

zosokonezeka syndrome

Nthawi wayamba mavuto chithandizo zambiri kupewedwa. Ngati mochedwa, kukhumba syndrome kungachititse kuti zotsatira zowawa ndi osafunika.

Kawirikawiri pambuyo matenda ngati anachita ndi mlingo oipa, akhoza kenako zimachitika matenda fibrillation kapena mtundu okhazikika wa fibrillation yamitsempha yamagazi. Ngati anamangidwa sizingatheke, koma wodwala safuna kudandaula, mukhoza kusiya wodwala kuyang'aniridwa ndi dokotala yekha m'deralo.

Vuto lina ndi chitukuko cha atelectasis m'mapapo mwanga kapena kutsekeka aakulu. Pankhaniyi, ndondomeko olimba adzakhala m'malo yaitali, ndipo amatsimikiza kawiri kawiri zimachitika pa akuvutika zizindikiro, kuyambira matenda osachiritsika.

The Vuto aakulu ndi oopsa pneumonitis. Makamaka zambiri kumachitika pa nthawi imene osauka chiyembekezo syndrome makanda obadwa kumene.

Kupewa ndi madokotala ananena zawo za matendawa

Pofuna kupewa kukhumba chibayo, pamafunika kugwira kuipidwa wa zinthu zina. Kwenikweni, odwala onse ndi akazi mu ntchito, zomwe zikusonyeza kusokonezedwa pogonekedwa ndi mankhwala ambiri ayenera anadzikhuthula m'mimba ndipo matumbo. Izi kumatha chinthu chachikulu mu chitukuko cha pneumonitis.

Pamaso ochititsa dzanzi tikulimbikitsidwa kuti alandire pachifuwa X-ray kuti kukusalani nkhani za madzi muzituluka mu Airways. Intubating wodwala ayenera kuchitidwa ngakhale pamene wodwala sadziwa. Man kuyalidwa kuti kumtunda kwa thupi anaukitsidwa pang'ono. Izi zimatheka ndi kusintha mutu wa bedi kapena tebulo ya opareshoni (ongofuna kuthekera zili chabe wicking a dongosolo m'mimba mwa mundawo kupuma).

Mutu intubation ndi choyenera yokonza njira mtima opaleshoni, ngozi ya matenda Mendelson a kochepa.

Kuti madokotala ananena zawo za matenda ndi monga izi: Nthawi zambiri akamwalira peresenti 56 odwala ndi kukhazikika airway pneumonitis. Ngati miyeso choipa akhala anayambitsa m'nthawi yake, ngozi za mavuto ndi imfa kusanduka ziro.