Pericardial effusion: zizindikiro ndi zinthu. Matendawa ndi mankhwala

Exudative pericardial effusion - matenda yodziwika ndi kutukusira mu nembanemba ndi kumalumikiza pamwamba lamkati la pericardium lapansi. Ndi chikhalidwe cha otaya exudative pericarditis ndi yopweteka kwambiri kapena yokhalitsa.

Matendawa akhoza kukhala serous, hemorrhagic, purulent, fibrinous ndi serosanguineous. Mu exudative fibrinous pericarditis amapezeka mafunsidwe a filaments Ulimbo mu pericardium, ndipo amasonkhana wina kuchuluka kwa madzimadzi mu M'mimbamo pericardial. Childs, mu M'mimbamo pericardial lili pafupifupi 20-40 ml ya madzimadzi.

Pa pachimake pericarditis anachita limodzi ndi exudation kumatheka ma mu M'mimbamo pericardial wa kachigawo madzi magazi. Milandu pamene ndondomeko yotupa kuti athandize wosanjikiza subepicardial, amene kwambiri chatsitsa ntchito yake.

cardiogenic mantha

Nthawi zambiri mwadzidzidzi kudzikundikira madzimadzi mu M'mimbamo pericardial zingachititse mtima tamponade, lomwe ndi zizindikiro symptomatic kakasi cardiogenic:

• palpitations mtima;
• matenda kupuma kwa mtundu dyspnea;
• kuthamanga mu dongosolo venous wa kufalitsidwa ang'ono ndi lalikulu;
• ndichepe mu kuthamanga systolic magazi.

zosokonezeka zotheka

Ndi resorption exudative madzimadzi akhoza kupanga minofu yovulazidwa, wopangidwa mwa Ulimbo, womwe kungachititse kuti tsankho kapena wathunthu imperforate pericardial patsekeke. Kawirikawiri chilonda aumbike m'dera matenda, pa confluence a chapamwamba ndipo m'munsi vena cava, pafupi ndi poyambira atrioventricular.

Zoterezi chikhalidwe wokonda effusion pericardial zingachititse mavuto aakulu, chimene chimatchedwa "mwala mtima" chifukwa cha calcification wa pericardium lapansi. Zikusonyezanso mu ndondomeko pathological wa pericarditis exudative ndi kuphwanya akadzabweranso diastolic magazi ventricles mtima. Exudate atasunga M'mimbamo pericardial kapena pamaso pa pericarditis constrictive kumabweretsa kusokonezeka kwa zigawo subepicardial ndi subendocardial mu pamwamba pa. Nthawi zina, fibrosis wa pericardium mwina expandable gawo, amene ndi ventricle oumbidwa pa diastole kuonetsetsa yobereka yachibadwa magazi mtima.

zodabwitsazi amatchedwa fenestration (a "windo"). Systolic gawo, yomwe imapereka zozungulira wosanjikiza minofu, zambiri, si kuwawa. Ndi yaitali kuphwanya kubwerera venous mtima pali stagnation magazi mu mtsempha wamagazi ndi m'mapapo mwanga. Pamene venous stasis mu zokhudza zonse dongosolo makope madzi ndi extravasation mu zimakhala ozungulira.

Pericardial effusion: zimayambitsa (etiologies)

Chimodzi mwa zifukwa zambiri za pericarditis exudative ndi RNA munali mavairasi (A ndi B), echovirus, fuluwenza A ndi matenda bakiteriya zachilengedwe zosiyanasiyana (pneumococci, staphylococci, streptococci, mycobacteria TB ndi bowa).

matenda ankaona akhoza kusokoneza njira ya matenda zokhudza zonse (SLE, kapena matenda Libman-Sacks, enaake ophwanya mafupa, misempha, zokhudza zonse matendawa) ndi matenda a dongosolo genitourinary (uremic pericarditis). Pericardial effusion ICD mwina kumasonyeza postperikardialnogo syndrome kuti akufotokozera pambuyo pericardiotomy kapena ngati vuto oyambirira infarction m'mnyewa wamtima, wotchedwa syndrome Dressler a. Kawirikawiri, vuto ili ikutuluka chimango mosamalitsa kumatanthauza nthawi, ndicho masiku 15 kapena miyezi 2.

Nthawi zina exudative zomatira pericarditis angayambe chifukwa ingestion mankhwala: gidralizin, phenytoin, anticoagulants, chifukwa ntchito kawirikawiri procainamide, radiotherapy. Nthawi anthu pamene lalikulu pericardial effusion wapezeka effusion okhutira, chifukwa ayenera anafuna mu metastasis a zotupa: khansa, m'mapapo, sarcoma, lymphoma. Mu milandu, kawirikawiri hemorrhagic exudates, kupatula serous.

Pali mtundu wapadera wa pericarditis exudative wotchedwa hemopericardium. chikhalidwe ichi kumachitika pamene ozama kuvulala m'dera pachifuwa mu mtima wa ziyerekezo, monga pa mipata infarction odwala pambuyo infarction m'mnyewa wamtima, kapena kugaŵa kung'ambika aneurysm, kuchititsa magazi chimadzaza M'mimbamo pericardial. Ngati matenda anamvekanso zinthu zosadziwika causative, ndiye adzaupereka kwa gulu la nonspecific kapena idiopathic.

Komanso, pericardial effusion ana, inenso, nthawizina. The zifukwa: streptococcal ndi staphylococcal matenda, chifuwa chachikulu, matenda HIV, mankhwala kusalankhula, zotupa, zoopsa, pafupi mtima, kulephera impso, opaleshoni ya mtima.

Pericardial effusion: Matendawa ndi mbali yachipatala

Exudate atasunga M'mimbamo pericardial ndi wosasamala ululu amasonyeza kupweteka ndi mtima, nthenda kupuma pa mtundu wa apnea, amene yafupika atakhala malo, palpitations. Ndi mavuto a madzi pa trachea ndi bronchi kupangitsa chifuwa youma.

General chikhalidwe cha odwala zimadalira mlingo wa mapangidwe madzi chigawo mu pericardium pa liwiro pang'onopang'ono - boma zogwira mtima pamene mofulumira - lochepa kwambiri.

Kuzionetsetsa, wodwala akhoza wapezeka mbali exudative pericarditis zotsatirazi: wotumbululuka khungu, mucosa cyanotic milomo, edema wa miyendo m'munsi, acrocyanosis.

Pamene dera anayendera chifuwa angathe kuonedwa asymmetry, chakumbali akhoza zochuluka, izi ndi zotheka ngati m'bulu mu pericardial exudate buku ukufika lita oposa 1. Palpation angazindikire Mbali Jardin pamene apical Apa ndi osamukira oposa ndi inwards, chifukwa kuthamanga ankachititsa, madzi anadzadza mkati.

Percussion angazindikire kukula kwa malire a afiira wachibale wa mumtima mbali zonse: lamanzere, pansi (m'magulu m'munsi) kutsogolo kapena kwa mzere pakati axillary, mu malo wachiwiri ndi wachitatu intercostal mzere m'ma clavicular, pomwe m'magulu m'munsi, kudzanja lamanja la SCR (m'ma -klyuchichnoy mzere), motero kupanga makona obtuse m'malo yachibadwa mwachindunji kwa malire kusintha kwa chiwindi afiira. Zonsezi zikusonyeza kuti wodwalayo pericardial effusion.

Auscultatory chitsanzo: kufooka lakuthwa wa mtima zikumveka mu pamwamba mtima, pa Botkin-Erb ndi ndondomeko xiphoid. Mu m'munsi mwa mtima amamva malankhulidwe mokweza ndi chifukwa chakuti Mitima osamukira exudative madzimadzi oposa ndipo m'mbuyo. Phokoso pericardial mikangano, kawirikawiri auscultation alibe kuonekera. magazi ndi kuchepa, ndi maziko a kuchepetsa linanena bungwe mtima.

Ngati kudzikundikira madzimadzi kumachitika pang'onopang'ono nthawi, ntchito makina a mtima kwa nthawi yaitali si kutanganidwa chifukwa chakuti pericardium zambiri pang'onopang'ono mu nkhani iyi. Mu nkhani ya kudzikundikira mofulumira madzimadzi mu effusion pericardial ndi madera akulowa tachycardia, matenda kulephera mtima ndi zochitika kuchulukana mu mabwalo kufalitsa (zazikulu ndi zazing'ono).

Yachokera pa kusanthula ECG deta yodziwika ndi zotsatirazi exudative pericarditis. Pamene kuchulukana exudative madzimadzi zina kuwerengetsa voteji kuchepetsa QRS zovuta ndi magetsi zosinthidwa yamitsempha yamagazi maofesi. Radiographically anati kuwonjezeka mu mthunzi wa mtima ndi wofooka Malo dera ripple. Mtima mtolo si adzafupikitsidwa. Nthawi zina n'zotheka kudziwa effusion mu kumanzere pleural patsekeke.

Echo ECG mu pericardial M'mimbamo kudzikundikira madzimadzi exudative zimawonedwa kuchokera kumbuyo kwa ventricle kumanzere kwa mtima, m'dera la pakhoma kumbuyo. Pamene mabuku yaikulu ya madzimadzi exudative, zimasonyeza kutsogolo kwa ventricle lamanja la mtima. Chiwerengero cha anasonkhanitsa madzimadzi mu pericardium ndi adzaweruzidwa ndi imeneyi pakati kumatikumbutsabe anasonyeza ku epicardium ndi pericardium.

Kukhazikitsa ndi chinthu chimodzi chimene zimayambitsa matendawo

Kukhazikitsa mfundo etiologic entailing exudative mawonekedwe pericarditis anagwira Kupenda virological mayesero pamaso pa chitetezo yeniyeni (HIV), seeding ndi zinthu zamoyo (mwachitsanzo, magazi) kuthetsa chikhalidwe opatsirana a pericarditis exudative anagwira tuberculin khungu mayeso, maphunziro serological mafangasi matenda.

Komanso kafukufuku immunological amachitika zokhudza zonse matenda connective minofu, kudziwa kukhalapo kwa chitetezo odana nyukiliya rheumatoid chinthu titre antistreptolysin-O, ozizira agglutinin - ndi matenda mycoplasma, uremia tione seramu creatinine ndi urea.

Masiyanidwe matenda a pericarditis exudative

Pericardial effusion ndi kusiyanitsidwa ndi mabungwe otsatirawa matenda: pachimake m'mnyewa wamtima infarction, vasogenic ululu prollaps mitral valavu, youma pleurisy.

Mu pachimake m'mnyewa wamtima miokarada ululu syndrome chifukwa kudzikundikira katundu kagayidwe kachakudya mu mnofu mtima (myocardium). Ululu syndrome m'mnyewa wamtima infarction limodzi ndi chiwerengero zizindikiro matenda ndi zasayansi kuti zimapezeka kuphwanya hemodynamics chapakati njira arrhythmias, njira conduction mu myocardium, stagnation zochitika bwalo yaing'ono (m'mapapo mwanga) makope khalidwe la infarction m'mnyewa wamtima pa kusintha ECG. Amuzolengedwa kusanthula infarction m'mnyewa wamtima limasonyeza ntchito isoenzymes mtima.

Pamene pleurisy youma ndi mfundo yofunika kwambiri ndi ululu ndi mbali kugwirizana ndi kupuma, chifuwa, malo thupi, phokoso pa auscultatory Kupenda mikangano pleura, ena kuposa pamwambapa anafotokoza, tisaiwale kuti pleurisy youma palibe kusintha pa electrocardiograms filimu . Mosiyana ndi kung'ambika aneurysm ku exudative pericarditis tichipeza mu chakuti chifukwa ndi chibadwa matenda - Marfan matenda kapena atherosclerotic chotupa chigoba chake mkati. Mu zina, akhoza kupanga aakulu pericardial effusion.

Symptomatic kung'ambika aneurysm kumaonekera motere: ululu chifuwa chapamwamba, palibe walitsa, dysphagia, mawu mawu, dyspnea, chifuwa, chifukwa psinjika a mediastinum lapansi. aneurysms kung'ambika amapezeka ntchito radiological mosamala thoracic M'mimbamo, echocardiography, ndi aortography.

Pamene kugaŵa kung'ambika aneurysm ululu kuoneka mwadzidzidzi mu chifuwa, ali ndi chizolowezi walitsa pamodzi msempha. Pa nthawi yomweyo, odwala ali mu chikhalidwe lalikulu, nthawi zambiri kutha kwa nambwibwi pa mtsempha wamagazi yaikulu. Auscultation auscultated kung'ambika vavu insufficiency. Matenda miyeso pamene kugaŵa kung'ambika aneurysm ndi: transesophageal ultrasound ndi yopangidwa tomography a chifuwa patsekeke.

Kodi muyenera kulabadira

Nkofunika kusiyanitsa pericardial effusion ICD 10 ndi myocarditis akakufunsani, amene anatsagana ndi kukulitsa wa M'mimbamo mtima ndi zizindikiro za kulephera magazi. myocarditis Symptomatic unaonekera mwa njira zotsatirazi: zingakhale ululu anginal chikhalidwe, kumverera kwa kulemera m'dera, mtima mungoli chisokonezo.

Auscultation auscultated muting mtima zikumveka, choyamba ndi wachinayi phokoso mtima akhoza bifurcated, pofotokoza za electrocardiogram angazindikire mbali zotsatirazi: ndi opunduka P yoweyula, kusintha selo voltages dzino R, T yoweyula akhoza flattened. Pa echocardiogram chidwi kukulitsa mwa zipindazo mtima ndi kuchepa contractility pakhoma.

Achire zikunena mankhwalawa pericarditis exudative

Amaganiziridwa pachimake pericardial effusion Akufunika kuti hospitalize wodwala ku chipatala. Ngati pali ululu, kwenikweni Kwalamulidwa ndi aspirin mu mawonekedwe piritsi, mlingo tidziwe mkati imeneyi mawola atatu kapena anayi. N'zotheka kuwonjezera miyala ndi aspirin mlingo indomethacin 25 -50 mg, kumwa madzi, ndi imeneyi ya mawola asanu.

Ngati pali zizindikiro zosonyeza kuti mankhwala njira zina 50% dipyrone kwa makonzedwe mu mnofu wa 2 ml kapena analgesics chomwa mankhwalawa (morphine) ndende ya 1%, n'zimene kamodzi kapena Botolo theka, intervals mawola asanu. Pamene psychomotor mukubwadamuka motsutsa likhale chikhalidwe kapena kugona adzaika "Sibazon" ( "Ine") mkati, mlingo wa 5-10 mg wa katatu kapena kanayi pa tsiku.

Kuthetseratu njira yotupa kwambiri amagwiritsidwa kwambiri mchitidwe "Prednisolone" mlingo wa 20-80 mg / tsiku. mwa njira zochepa. Therapy ndi glucocorticoids mu mlingo waukulu ikuchitika mu masiku 7-10, ndi peculiarity kuti mlingo wotsatira ayenera kuchepetsedwa pang'onopang'ono, awiri ndi munthu milligram hafu tsiku lirilonse.

pa mankhwala

nthawi yaitali bwanji amaliona pericardial effusion? Mankhwalawa kumatenga za masabata awiri kapena atatu, ndi zina muli kutambasula kwa miyezi ingapo, mosamalitsa pa umboni. Kulunjika yoperekera chithandizo kumatengera pa chinthu etiological imene inachititsa pericardial effusion.

Kudziwa etiology tizilombo amapatsidwa sanali steroidal wothandizila odana ndi yotupa, mahomoni Choncho sanagaŵiridwe. Pericarditis amene ali chifukwa Streptococcus chibayo, ndi zinthu zofanana - mankhwala opha tizilombo, mwachitsanzo, Penicillin G mlingo 200,000 U / kg / tsiku. m'nsinga kupatsidwa mlingo lagawidwa jakisoni asanu, nthawi ya mankhwala - masiku osachepera khumi.

mayesero zina

Komanso, ngati matenda pericardial effusion, chiyenera kuchitikira pericardiocentesis (ndondomeko ndi achire ndi matenda mu chikhalidwe, yomwe ikuchitika pa wapadera singano puncture pericardium kuti madzi kudya kwa kusanthula). Pambuyo seeding ikuchitika exudate kuti azindikire mtundu winawake wa wothandizila za matenda, n'kofunika kudziwa kusanthula tilinazo yake kukonzekera antibacterial. Ngati anapeza Staphylococcus aureus, chiphunzitso nthawi kutumikiridwa "Vancomycin" mlingo wa munthu galamu mtsempha intervals mawola khumi achire mlingo - kuchokera masiku 14 mpaka 21.

Nthawi zina, matenda a mafangasi zingachititse pericardial effusion. Chithandizo mu nkhani iyi ikuchitika "Amphotericin". Mlingo woyamba unali 1 mg, shuga ake njira ndi kuchuluka wofanana ndi 5 peresenti ndi Botolo makumi asanu mu Volume, kutumikiridwa parenterally (kudzera mu mtsempha), kukapanda kuleka kwa mphindi 30. Ngati wodwalayo mankhwala bwino analekerera, ndi n'zimene kusintha boma motere: 0.2 mg / kg pa pa ola limodzi. Kenako, mlingo ndi chinawonjezeka pang'onopang'ono mpaka theka kapena microgram / tsiku. kwa maola atatu kapena anayi pamaso pa isanayambike zotsatira zabwino.

Chotsatira cha "Amphotericin", chomwe chiyenera kuonetsetsa - nephrotoxic, pankhaniyi, nkofunika kuyang'anira ntchito za impso. Ngati mankhwalawa amayamba chifukwa cha kugwiritsa ntchito mankhwala, ndiye kuti njira zamankhwala zidzakonzedweratu pofuna kuonetsetsa kuti ndalama zowonjezerekazo zatha, komanso kuika mankhwala osagwiritsidwa ntchito ndi mankhwala osokoneza bongo kuphatikizapo corticosteroids. Ngati adauzidwa kuyambira masiku oyambirira a matendawa.