Raws li lub ntsiab lus ntawm reperfusion syndrome nkag siab txog tus mob uas tshwm sim tom qab rov pib dua ntawm cov ntshav ncig hauv cheeb tsam cuam tshuam los ntawm ischemia. Cov kws kho mob feem ntau yuav tsum tau nrog txhua yam kev tshwm sim ntawm ischemia hauv kev xyaum. Txo cov ntshav ntws tuaj yeem yog vim muaj ntau yam.
Kev ua txhaum cai no tuaj yeem ua rau lub sijhawm luv lossis ntev, nws tuaj yeem npog thaj tsam me lossis cuam tshuam rau ib feem ntawm lub cev. Qhov xwm txheej no txiav txim siab seb qhov kev rov ua tau zoo npaum li cas.
Hauv paus ntsiab lus, tus mob reperfusion tuaj yeem suav hais tias yog ib yam ntawm lub cev teb rau ischemia ntawm txhua lub hauv paus chiv keeb. Hauv kev kho mob, tus mob no tseem hu ua "tig rau." Txawm li cas los xij, lub tswv yim ntawm reperfusion cardiac syndrome yuav tsum paub rau cov neeg mob lawv tus kheej. Kab lus no tau npaj rau qhov no.
Reperfusion mechanism
Nyob rau hauv cov mob infarction, vim qhov tsis muaj peev xwm ntawm cov hlab ntsha, muaj qhov tsis txaus rau cov nqaij mos ntawm lub plawv.
Ib yam tshwm sim zoo sib xws tshwm sim nrog mob stroke. Raws li txoj cai, xws li kev ua txhaum cai yog qhov tshwm sim ntawmstenosis los yog tshwm sim ntawm thrombus tsim. Thaum nws muaj peev xwm nthuav dav lumen ntawm cov hlab ntsha, cov ntshav rov ua dua tshiab tsis tuaj yeem ua kom cov txheej txheem metabolic ib txwm ua. Ntawm qhov tsis sib xws, tus neeg mob tus mob yuav deteriorate sharply, uas yog piav qhia los ntawm kev loj hlob ntawm reperfusion syndrome. Nws yog ib qho ua tau kom tus neeg mob tawm ntawm qhov teeb meem nyuaj no tsuas yog nrog kev pab ntawm kev kho mob tam sim ntawd.
Ib lub tsev kho mob zoo sib xws tuaj yeem taug qab tom qab tshem cov sutures, yog tias tus neeg mob tau txais kev phais. Piv nrog rau lub sij hawm ntev ischemia, lub sij hawm luv luv (tsis pub ntau tshaj 3 teev) los yog ib feem ntawm cov ntshav khiav tsis tau nrog rau qhov tshwm sim loj. Nyob rau hauv tas li ntawd, cov ntshav ncig feem ntau sai normalizes, thiab nrog rau nws cov chav kawm ntawm metabolic dab stabilizes.
Ntev ischemia yog qhov txaus ntshai vim tias thaum lub sijhawm ua txhaum cai, cov khoom ntawm cov metabolism tsis raug tsim, thiab thaum cov ntshav ntws rov zoo li qub, lawv raug xa mus rau cov chaw nyob sib ze, ua rau cov ntaub so ntswg puas lawm.
Reperfusion Clinic
Cov tsos mob ntawm tus mob no tsis yog ib txwm zoo ib yam, vim tias thaj chaw cuam tshuam los ntawm ischemia ua lub luag haujlwm tseem ceeb. Nws yog ib qho tsim nyog los xav txog cov yam ntxwv ntawm lub tsev kho mob nyob ntawm qhov xwm txheej no.
Qhov hnyav ntawm daim duab kho mob ntawm reperfusion syndrome hauv myocardial infarction feem ntau nyob ntawm lub sijhawm ntawm ischemia. Cov kws tshaj lij raug coj los ntawm cov ntsuas hauv qab no. Yog tias lub sijhawm zoo li no tawm mus txog 20 feeb, ces tej zaum yuav tsis muaj tus mob reperfusion kiag li.
Tab sisnyob rau hauv lub xeev 40-feeb, thaum cov ntshav ib txwm muaj kev cuam tshuam, feem ntau tom qab rov pib dua ntawm cov ntshav, vim li ntawd, kev puas tsuaj rau cov leeg hauv lub plawv yuav tshwm sim. Ntawd yog, tus mob ntawm ischemic thiab reperfusion raug mob ntawm myocardium yog ib qho mob txaus ntshai.
Heart attacks
Cov mob Infarct yog tus cwj pwm los ntawm qhov tseeb tias qee cov tsos mob feem ntau tau sau tseg nyob rau theem ntawm kev kho cov ntshav ncig. Cia peb sau lawv:
- arrhythmia;
- nce cov cim qhia ntawm HF (lub plawv tsis ua haujlwm);
- BP poob;
- nthuav dav ciam teb ntawm lub siab;
- muaj kev pheej hmoo ntawm kev tsim pob txha.
mob hlwb
Cov xwm txheej zoo li no feem ntau pom tom qab raug mob hlwb (TBI). Tawm tsam keeb kwm yav dhau los ntawm txheeb ze stabilization ntawm hemodynamics nrog kev kho raws sijhawm, tus neeg mob tus mob yuav maj mam zuj zus. Tib lub sijhawm, cov cim ntawm kev tsim txom ntawm kev nco qab nce siab hauv cov neeg mob.
Resuscitators, nrog rau cov kws kho mob neurosurgeons, tau nrhiav txoj hauv kev los tiv thaiv kev puas tsuaj ntawm lub hlwb, tab sis txog tam sim no lawv qhov kev ntshaw tsis tau ua tiav.
Stroke
Nrog rau ischemic stroke, cov tsos mob hauv qab no tau pom:
- reflexes tawg;
- kev nco qab yog cuam tshuam txog nws qhov kev poob tiav;
- hais lus phem;
- mob ntawm lub cev muaj zog tshwm sim;
- nce cov cim qhia ntawm cerebral edema;
- yuav muaj cramps.
Yog tias ischemia hnyav dua los ntawm hemorrhage, lub sijhawm rov qab los, txawm tias muaj kev saib xyuas hnyav, tuaj yeem siv ntau lub hlis, thiab feem ntauxyoo.
Lerish Syndrome
Nov yog ib yam kab mob uas tsis tshua muaj nyob rau hauv uas ib feem ntawm lub aorta nyob rau hauv lub plab mog poob nws lub peev xwm, thiab yog yus muaj los ntawm ib tug vivid chaw kho mob ntawm "on" syndrome.
Txawm hais tias rov pib dua ntawm peripheral ncig, raws li muaj pov thawj los ntawm qhov sov so, cov neeg mob yws ntawm qhov mob hnyav hauv cheeb tsam lumbar. Daim duab yog ua tiav los ntawm kev ua txhaum ntawm lub plawv dhia. Nws tsis yog qhov tsis yooj yim rau cov neeg mob no ua kom pom cov tsos mob sai sai.
Kev kho cov ntshav ntws hauv cov ceg ceg
Reperfusion syndrome nyob rau hauv cov ntaub ntawv no feem ntau kuj nrog cov tsos mob tshwm sim. Cov xwm txheej no tshwj xeeb tshaj yog ib hnub tom qab pib kho.
Yog tias peb sau cov ntaub ntawv saum toj no, peb tuaj yeem txiav txim siab tias lub sijhawm rov pib dua ntawm cov ntshav ncig hauv thaj chaw uas muaj cov ntaub so ntswg hnyav feem ntau yog nrog rau ob qho tib si hauv zos thiab cov kab mob. Piv txwv li, thaum lub sij hawm reperfusion ntawm lub hlwb, cov ntaub so ntswg edema nce, thiab tom qab kev phais nyob rau hauv lub qis qis, qhov kev siv ntawm qhov mob nce, thiab trophic mob raug soj ntsuam.
Los ntawm cov kab mob tshwm sim ntawm "on" syndrome, kev saib xyuas tshwj xeeb yuav tsum tau them rau kev txhim kho ntau yam hauv nruab nrog cev - qhov no yog qhov tshwm sim hnyav tshaj plaws ntawm lub cev. Nyob rau hauv feem ntau cov neeg mob, muaj kev nce hauv cov tsos mob ntawm ARDS (ua pa nyuaj siab syndrome), encephalopathy.
Hauv lwm lo lus, tus mob reperfusion tshwm sim qhov twg rov tshwm sim ntawm ischemia. Ntxiv mus, qhov loj dua qhov chaw cuam tshuam thiabLub sijhawm ntev ntawm cov ntshav tsis txaus, qhov pom tau tias cov tsos mob tshwm sim ntau dua.
Reperfusion laj laj
Nyob rau hauv qhov xwm txheej tseem ceeb, thaum cov ntshav khiav tsis zoo, cov ntaub so ntswg tau txais oxygen tsawg, ua rau hypoxia.
Rau lub hauv paus ntawm pathogenesis ntawm "on" syndrome yog qhov hu ua "oxygen paradox". Nws cov ntsiab lus nyob rau hauv qhov tseeb hais tias thaum ib txwm cov ntshav ncig yog tsim tom qab ib ntus hypoxia, qhov tshwm sim tshwm sim los ntawm tsis muaj oxygen tsis nres, tab sis, ntawm qhov tsis tooj, tshwm sim lawv tus kheej li pronouncedly li sai tau. Qhov no yog lub peculiarity ntawm no phenomenon. Ntawd yog, nrog rau kev ua kom muaj zog ntawm cov txheej txheem oxidation, cov txheej txheem rau kev tsim ntawm ntau cov dawb radicals tau tshwm sim.
Raws li cov txheej txheem no, kev ncaj ncees ntawm cov cell membranes raug cuam tshuam, uas thaum kawg ua rau kev puas tsuaj loj ntawm cov qauv ntawm cov ntaub so ntswg puas.
Yog vim li cas rau qhov txo qis hauv patency ntawm lub txaj vascular feem ntau yog vim kev tsim cov ntshav txhaws, qhov tshwm sim ntawm atherosclerotic plaques ntawm phab ntsa, thiab spasm ntawm cov hlab ntsha. Tag nrho cov no ua rau cov hlab ntsha hauv cov hlab ntsha tseem ceeb thiab cov hlab ntsha ntawm lub hlwb, uas yog nrog cov tsos mob ntawm ischemia.
Kev kho cov ntshav ntws hauv cov xwm txheej zoo li no yuav yog vim muaj cov hauv qab no:
- kev so ntawm lub nkoj phab ntsa;
- kev tswj hwm ntawm antispasmodic lossis tshuaj kho mob;
- txhaws tawg nrog cov khoom enzymatic;
- phais tshem tawm cov ntshav txhaws;
- stent placement(special catheter);
- shunting lub nkoj lumen (tsim txoj kev bypass rau cov ntshav ntws);
- kev kho cov ntshav rov qab los tom qab kev phais tshem tawm cov ntshav txhaws lossis thaum hloov pauv cov ntshav ntws raws lwm txoj hauv kev.
Raws li qhov tshwm sim ntawm cov ntshav rov pib dua - nyob rau hauv cov ntaub so ntswg ntawm lub hlwb thiab lub plawv cov leeg, muaj cov chaw sib txawv uas txawv ntawm qib ntawm kev ua haujlwm ntawm lub cev thiab cov txheej txheem metabolic. Ntxiv mus, ib feem ntawm cov cheeb tsam no tseem tsis tau txais cov ntshav ntim uas xav tau vim yog kev ua txhaum ntawm patency ntawm cov hlab ntsha me me, thaum cov ntaub so ntswg nrawm nrawm tau pom nyob rau lwm qhov chaw.
Hauv lwm lo lus, tom qab rov pib dua ntawm cov ntshav, cov ntaub so ntswg tsuas yog tsis tuaj yeem, vim yog cov ischemia yav dhau los, txhawm rau ua kom cov pa oxygen, kua dej, thiab cov as-ham yav dhau los. Vim li no, tsis muaj kev tsim kho hluav taws xob. Raws li qhov tshwm sim, o ntawm cov ntaub so ntswg nce, cov txheej txheem inflammatory tshwm sim.
txoj kev kho
Kev kho mob rau cov tsos mob ntawm reperfusion syndrome yog ua los ntawm txoj kev nyuaj. Nyob rau tib lub sijhawm, tus kws kho mob yuav tsum coj mus rau hauv tus account tag nrho cov hauv paus pob zeb uas provoke txoj kev loj hlob ntawm pathology, uas yog:
- nquag tsim ntawm cov dawb radicals;
- magnesium deficiency;
- ntau dhau calcium ntsev;
- txhim kho ntawm arrhythmia (ua rau rov ua dua tus mob hauv myocardial infarction);
- kev tsis sib haum xeeb zog.
Muab rau hauv cov ntsiab lus saum toj no, cov hauv qab no suav nrog hauv kev kho mob.
KhoElectrolyte tsis ua haujlwm
Txhawm rau tshem tawm cov txiaj ntsig ntawm calcium ions, antagonist tshuaj siv: Norvax, Diacordin, Isoptin.
Hauv cov xwm txheej mob stroke, "Cinnarizine" raug tshuaj. Cov tshuaj no txo qis spasm thiab txo qhov kev pheej hmoo ntawm platelet aggregation.
YAntioxidant kho
Aimed ntawm kev tiv thaiv cellular qauv ntawm cov ntaub so ntswg. Cov tshuaj "Quercetin" zoo heev. Nws txo cov kev ua ntawm platelets, thiab tshem tawm cov asymmetry ntawm cov ntshav khiav.
Qhov txiaj ntsig zoo yog tau los ntawm kev siv cov ntsiab lus xws li "Kudesan", "Mexidol".
Txhawb nqa cov txheej txheem metabolic
Txoj kev siv tshuaj:
- nrog lub plawv nres - "Trimetazidine";
- nrog mob stroke - "Ceraxon".
Cov tshuaj no normalizes cov electrolytes ntws. Lawv pab txhawb rau kev tsim cov khoom siv hluav taws xob tag nrho.
Ntxiv rau, cov tshuaj ua kom cov txheej txheem rov qab los ntawm cov ntaub so ntswg puas los ntawm ischemia.
Kev kho mob ntshav qab zib
Txo rau kev siv tshuaj xws li "Lidocaine", "Kordaron". Cov tshuaj no txo cov kev pheej hmoo ntawm kev tsim ventricular fibrillation nrog nquag tawm tsam ntawm tachycardia los yog cov tsos ntawm ib tug series ntawm extrasystoles.
Yog tias kev kho mob ua pov thawj tias tsis muaj txiaj ntsig, yuav raug sivdefibrillation. Txhawm rau normalize cov txheej txheem metabolic hauv lub plawv cov leeg, "Kurantil", "Magnesium sulfate" raug sau.
Tshuaj tonic
Feem ntau kuj suav nrog hauv kev kho mob reperfusion syndrome. Lawv tsim nyog los kho cov kev tiv thaiv kev tiv thaiv ntawm tus neeg mob lub cev, nrog rau kom rov ua kom cov kab mob uas ploj lawm hauv cov ntaub so ntswg. Raws li txoj cai, cov vitamins ntawm pab pawg "B", nicotinic acid (vitamin PP), ascorbic acid yog siv.
Tau kawg, kev kho kom rov zoo yuav tsum tau ua tshwj xeeb hauv tsev kho mob. Kev siv tag nrho cov txheej txheem kho mob yuav tsum tau tswj los ntawm kws kho mob.
Kev tiv thaiv ntawm tus mob reperfusion
Raws li lawv hais, nws yooj yim dua rau "kab mob thaum nws tseem mos" dua li kho nws tom qab. Yog li ntawd, nws tsim nyog xav txog kev tiv thaiv kev ntsuas. Txhawm rau tshem tawm qhov kev txhim kho ntawm tus mob reperfusion lossis ua kom nws cov tsos mob tsis zoo, hauv kev xyaum niaj hnub, cov kws kho mob siv txhais tau tias:
- tshem tawm tag nrho cov tsim ntawm ROS (reactive oxygen hom):
- muab cov pa oxygen ncaj qha rau cov qauv ntawm tes;
- pab rov qab cov metabolism hauv aerobic;
- tso cai tiv thaiv cov ntaub so ntswg los ntawm kev puas tsuaj.
Los ntawm kev siv cov kev tiv thaiv zoo hauv kev xyaum, nws muaj peev xwm tiv thaiv qhov tshwm sim ntawm kev puas tsuaj rau cov ntaub so ntswg tom qab hnyav TBI. Yog tias peb tab tom tham txog kev mob plawv, ces yog tias qee qhov kev ntsuas tau ua raws, nws muaj peev xwm tiv thaiv qhov tshwm sim ntawm arrhythmias, uas feem ntau yog. Nrog kev kho tsis zoo, lawv xaus rau qhov tshwm sim tuag.
Tau kawg, peb yuav tsum tsis txhob hnov qab tias ntau nyob ntawm tus neeg mob nws tus kheej. Tom qab tag nrho, lub hauv paus chiv keeb ntawm tag nrho cov tseem ceeb, lub neej hem thawj tshwm sim los ntawm lub neej txhua hnub. Cov no yog kev noj zaub mov tsis zoo thiab tus cwj pwm phem, tsis muaj kev pw tsaug zog thiab kev ua neej tsis muaj zog. Nws yog cov xwm txheej no uas yog lub luag haujlwm rau feem ntau mob stroke thiab myocardial infarction.
