Kab mob plawv yog ib qho ntawm peb yam kab mob feem ntau. Lawv sib npaug feem ntau cuam tshuam rau cov hluas thiab cov laus. Cardiac tamponade yog kab mob txaus ntshai uas feem ntau ua rau tuag taus. Tus neeg ntawd yuav tsum tau kho mob tam sim ntawd.
Cov kab mob uas nthuav tawm yuav tsum tsis yog tsuas yog kev kho kom zoo xwb, tab sis kuj yog kev phais mob. Ntxiv mus, txoj kev thib ob yog siv nyob rau hauv yuav luag txhua rooj plaub. Nrog lub plawv tamponade, cov laj thawj thiab cov tsos mob tau qhia meej ntawm kev kuaj mob los ntawm kws kho plawv.
kab mob dab tsi?
Txhua tus neeg muaj cov kua dej me me hauv pericardium - txog li 40 ml. Daim duab no suav hais tias yog qhov qub. Tab sis nrog lub plawv tamponade, muaj kua ntau dhau. Nws puv qhov chaw nruab nrab ntawm daim nyias nyias uas npog cov leeg nqaij.
Nws tuaj yeem yog exudate lossis ntshav. Qee lub sij hawm ntawm lub plhaub muaj cov qog thiab cov kua paug. Raws li qhov tshwm sim ntawm cov kua dej sib sau ua ke, cov khoom nruab nrog cev tau qis thiab tsis tuaj yeem ua nws txoj haujlwm ib txwm. Sau cov kab noj hniav ntawm lub siabtsis txaus. Nws tsis tuaj yeem ntsws zoo li nws tau siv. Muaj qhov txo qis hauv venous inflow thiab cardiac output.
Mob tamponade nrog ntshav yog qhov txaus ntshai dua. Txog li 1 litre ntawm cov kua tuaj yeem khaws cia rau hauv lub pericardium, uas twb muaj kev phom sij rau lub neej, vim tias lub cev tsis tuaj yeem ua haujlwm li qub.
Kev faib tawm
Lub plawv tamponade tuaj yeem sib txawv. Qhov kev kwv yees nyob ntawm qhov tseeb txhais ntawm hom kab mob. Nws muaj xws li:
- Spicy. Nws loj hlob sai, thiab nws cov tsos mob tau hais. Txog li 250 ml ntawm cov kua dej yog nchuav rau hauv cov kab noj hniav pericardial. Cov chav kawm ntawm tus kab mob no nyuaj heev rau kwv yees. Ib tug neeg xav tau kev pab kho mob ceev.
- Ntawm. Qhov chaw pericardial yog maj mam sau. Thaum kawg, muaj 1-2 litres kua muaj. Ntawm no qhov kev kwv yees muaj txiaj ntsig zoo dua, vim tias qhov kev phom sij ntawm lub neej tsis tshwm sim sai dhau. Cov kws kho mob muaj sij hawm los daws qhov teeb meem.
- Ntseeg. Tamponade tshwm sim vim muaj qhov tsis xws luag hauv cov hlab plawv lossis cov hlab ntsha.
Txoj kev kho mob, nrog rau nws cov txiaj ntsig, nyob ntawm hom kab mob. Tamponade yog uremic, kab mob, kab mob, lossis neoplastic.
Vim txoj kev loj hlob
Caus ntawm lub plawv tamponade yog:
- Qhib lossis kaw hauv siab raug mob, nrog rau lub cev puas tsuaj.
- Radiation exposure.
- Malignant lossis benign neoplasm.
- Lub cev qhuav dej ntau dhau.
- teeb meem ntshav siab.
- Hypothyroidism lossis lwm yam kev ua haujlwm ntawm endocrine system.
- Myocardial infarction lossis lub plawv tsis ua haujlwm.
- siv sijhawm ntev ntawm cov ntshav nyias.
- Hemodialysis ua rau lub raum tsis ua haujlwm.
- Nyob ntev ntawm cov kab mob ntev.
- Mixedema.
- Rheumatism.
- tuberculosis.
- mob khaub thuas fungal.
- Rupture of aortic aneurysm.
- Kev phais tshem tawm cov ntaub so ntswg myocardial lossis soj ntsuam ntawm cov hlab plawv.
- Leukemia.
Hom tamponade feem ntau tshwm sim los ntawm cov kab mob hauv lub cev uas ua rau cov ntaub so ntswg puas. Kev saib xyuas tshwj xeeb yuav tsum tau them rau kev txhim kho tus kab mob hauv cov menyuam yaus hnub nyoog qis dua ib xyoos.
Cov tsos mob thiab cov tsos mob
Cov tsos mob ntawm lub plawv tamponade sib txawv. Nws tag nrho yog nyob ntawm daim ntawv ntawm pathology. Koj tuaj yeem paub qhov txawv ntawm cov tsos mob hauv qab no:
- Kev tsis zoo ntawm kev noj qab haus huv.
- mob thiab tsis xis nyob hauv thaj tsam hauv siab.
- Kev ntxhov siab ntau dhau.
- tsis ua pa, ua tsis taus pa.
- mob thiab qaug zog.
- Impaired mem tes.
- Cyanosis ntawm daim tawv nqaij (yuav tau xiav tint los ntawm nws).
- Nyob rau hauv siab thiab ntshai tuag.
- Nkauj qab zib.
- Lub suab lub plawv tau hnov, nrog rau lub pericardial rub.
Thaum nyuaj, tus neeg mob kiv taub hau,tsis nco qab, nrog rau hemorrhagic vau. Daim ntawv mob ntev yog tus cwj pwm los ntawm qhov nce ntawm cov hlab ntsha, kev hloov pauv ntawm daim siab loj, ua tsis taus pa thaum qoj ib ce.
Kev kuaj mob nta
Kev kuaj mob ntawm lub plawv tamponade yuav tsum yog qhov nyuaj thiab sib txawv. Nws muab rau cov kev tshawb fawb hauv qab no:
- kuaj lub cev los ntawm kws kho plawv thiab sau cov lus tsis txaus siab ntawm tus neeg mob.
- ECG rau lub plawv tamponade. Nws tsis yog siv ntau zaus, tab sis nws yuav cia koj xam lub plawv dhia.
- X-ray. Daim duab qhia txog cov txheej txheem ntawm lub cev, uas nthuav dav rau txhua qhov kev qhia. Tseem muaj ib tug smoothness ntawm tus duab ntxoov ntxoo ntawm lub plawv ntawm sab laug. Daim duab qhia tias tsis muaj cov cim qhia ntawm stagnation hauv cov kab mob ua pa, muaj qhov txo qis ntawm sab laug ventricle thaum lub sij hawm so.
- Echocardiography. Ua tsaug rau nws, lub xub ntiag thiab tus nqi ntawm cov kua yog txiav txim siab. Tsis tas li ntawd, txoj kev tshawb fawb tau ua tsis tu ncua txhawm rau txhawm rau taug qab qhov kev ua haujlwm ntawm tus neeg mob rov qab los tom qab kev phais mob. Qhov tshwm sim ntawm kev kuaj mob: qib ntawm kev sib tsoo ntawm qhov tsis zoo vena cava ntawm kev tshoov siab txo qis, cov kab noj hniav ntawm cov kab mob plawv txo qis, cov nplooj ntawv ntawm pericardium diverge.
- MRI. Txoj kev tshawb no tso cai rau koj txheeb xyuas tus kab mob thaum ntxov. Nws muab cov txheej txheem los ntawm-txheej txheej ntawm cov ntaub so ntswg uas muaj peev xwm txheeb xyuas qhov mob me tshaj plaws.
- Ultrasound. Kev tshuaj xyuas pom cov kua dej hauv thaj tsam pericardial.
- Cov kab mob noob thiab biopsy ntawm cov kua dej. Nws yog qhov tsim nyog los qhia meej qhov kev kuaj mob.
- Pulsed Doppler ntawm nkoj.
- Catheterizationkab noj hniav ntawm lub plawv. Qhov no yog cov txheej txheem invasive uas yog siv thaum phais. Cov ntaub ntawv tau txais yog txhim khu kev qha raws li qhov ua tau.
Kev kuaj xyuas cov kabmob hauv nruab nrog cev kuj tau ua. Koj tsis tuaj yeem ua txhaum nrog kev kuaj mob. Nws yog ib qho tsim nyog kom paub qhov txawv tamponade los ntawm constrictive pericarditis, myocardial insufficiency.
Hauv cov menyuam yaus, ultrasound thiab puncture yog cov kev tshawb fawb tshaj plaws. Lwm txoj kev kuaj mob tsis siv tau.
Kev kub ntxhov
Nrog rau qhov mob hnyav ntawm lub plawv, tus neeg mob qee zaum xav tau kev kho mob sai. Lub plawv tamponade feem ntau ua rau tuag taus yog tias tus neeg mob tsis tau txais kev pabcuam raws sijhawm. Kev tawm tsam tuaj yeem tshwm sim thaum twg los tau. Yog tias ib tug neeg mob hauv tsev, nws yuav tsum tau muab kev kho mob xwm txheej ceev thiab hu rau kws kho mob.
Thaum lub sijhawm tawm tsam, koj tsis tuaj yeem muab tshuaj rau tus neeg raug tsim txom, vim ntshav siab yuav poob ntau dua. Nws yog ib qho tseem ceeb los muab kev nplij siab tshaj plaws rau tus neeg. Tom qab tuaj txog ntawm cov kws kho mob, koj yuav tsum tau piav qhia meej thiab meej txog tus neeg mob.
Ua ntej ntawm tag nrho, hauv tsev kho mob, ua tiav pericardial puncture. Ib rab koob nrog qhov kawg nthuav tau muab tso rau hauv qhov chaw no thiab cov kua dej ntau dhau tau tso tawm. Qhov chaw txhaj tshuaj yog thaj tsam ntawm sab laug 7th tav. Cov koob yog ntxig rau 1.5 cm tob, qhia upwards thiab thawb txawm tob (3-5 cm). Thaum cov txheej txheem ua tiav lawm, cov kua pib ntws.
Cov txheej txheem yog ua raws li kev saib xyuas ntawm ultrasound lossis X-ray. Kev ua haujlwm tso cai tsuas yog txo tus neeg mob lub sijhawm. Yog tias qhov laj thawj tsis raug kho, qhov teeb meem yuav rov qab los. Tom qabpuncture, lub pericardial kab noj hniav yog ntxuav nrog sclerosing, tshuaj tua kab mob los yog tshuaj tua kab mob. Cov tshuaj nquag siv yog Hydrocortisone, Prednisolone.
Nrog lub plawv tamponade, kev saib xyuas xwm txheej ceev yuav txo tau txoj kev tuag.
Nyob zoo ib tsoom niam txiv kwv tij neej tsa sawv daws.
Kev kho mob tau suav hais tias ua tiav yog tias qhov ua rau ntawm kev txhim kho ntawm cov kab mob raug tshem tawm, thiab qhov xwm txheej tau ruaj khov. Tus neeg mob tus mob yuav tsum zoo dua.
Tom qab qhov mob plawv tamponade raug tso tseg, kev kho mob nrog tshuaj tau ua tiav. Tus neeg mob yog infused nrog cov tshuaj infusion: tshuaj metabolic lossis ntshav ntshav.
Txhawm rau kho cov txheej txheem ntawm kev noj zaub mov zoo thiab cov metabolism hauv myocardium, txhawm rau txhim kho cov ntaub so ntswg, cov kws kho mob tau sau "Mildronate", "Carnitine" rau ib tus neeg. Yog hais tias, vim yog cov dej ntim ntawm pericardium nrog cov kua dej, tus neeg mob muaj teeb meem, tom qab ntawd kev kho mob raug coj mus rau kev kho mob ntawm cov kab mob pathological.
Yog tias qhov ua rau tamponade tau raug tshem tawm tiav, tom qab ob peb hnub tus neeg mob tau tawm hauv tsev kho mob thiab txuas ntxiv kev kho mob ntawm tus neeg mob sab nraud hauv tsev.
Kuv puas xav tau kev phais?
Kev kho mob plawv tamponade tsis yog kev saib xyuas xwb. Yog tias qhov kev pheej hmoo ntawm kev rov tshwm sim yog siab, ces kev phais yog ua. Cov kev qhia rau cov txheej txheem yog: rupture ntawm lub plawv, calcification los yog cicatricial hloov nyob rau hauv lub pericardium, ntev tsim ntawm exudate.hauv lub hnab pericardial.
Tus neeg mob feem ntau tau teem sijhawm rau qhov kev cuam tshuam no:
- Pericardiotomy. Phab ntsa ntawm pericardium raug muab tshem tawm kom ntws nws cov kab noj hniav, tshem tawm cov kua dej ntau dhau, thiab txheeb xyuas cov kab mob foci.
- Subtotal pericardectomy. Kev tshem tawm kom tiav ntawm qhov tawg, tsuas yog qhov uas nyob ib sab ntawm lub koob yees duab tom qab.
Tom qab kev phais, tus neeg mob xav tau kev rov zoo. Nws yog ib qho tseem ceeb kom tsis txhob muaj lub cev hnyav, muaj kev ntxhov siab, noj kom raug.
Txoj kev ntws tawm
Lub pericardium yog lub hnab lub plawv uas nyiam ncab, yog li daim duab kho mob hloov pauv. Nrog nws cov kua dej nrawm nrawm, tus neeg mob tsim lub xeev ntawm kev poob siab. Yuav tsum tau tso dej tam sim.
Kev tshem tawm ua kua tsis tuaj yeem ua tiav sai. Yog tias 1 liter muaj nyob rau hauv pericardium, cov txheej txheem tshem tawm yuav kav li 40 feeb. Txwv tsis pub, tus neeg mob ntshav siab txo qis heev. Hypotension tuaj yeem kav ib lub lim tiam. Txawm li cas los xij, tus neeg mob cov lus teb rau kev kho yog tsis tsim nyog.
Cov tshuaj tiv thaiv no cuam tshuam nrog kev ua haujlwm ntau dhau ntawm lub plawv sab xis, ua txhaum ntawm kev rov ua haujlwm ntawm cov leeg myocardial.
kev nyuaj siab ntxov
Yog tias kev kho mob ntawm lub plawv tamponade tsis ua raws sijhawm lossis tsis ua haujlwm, ces tus neeg mob yuav muaj teeb meem. Lawv tshwm sim ob qho tib si nyob rau lub sijhawm ncaj qha txhaws ntawm lub cev nrog cov ntshav, thiab qee lub sijhawm tom qab ntawd. Qhov tsis zoo suav nrog:
- Arrhythmia.
- mob plawv mob plawv.
- Cardiogenic shock.
- Sudden death.
Cov kab mob ntev ntev ua rau muaj teeb meem lig:
- Fibrous pericarditis (mob ntawm cov ntaub so ntswg sib txuas ntawm lub cev sac).
- Kev ua txhaum ntawm impulse conduction ntawm ventricles thiab atria.
Qhov tshwm sim muab thiab puncture ntawm pericardium. Tus neeg mob tuaj yeem tsim mob plawv sclerosis. Nrog rau kev tshawb pom raws sij hawm thiab kev kho mob kom zoo ntawm cov kab mob pathology, qhov kev cia siab yog qhov zoo.
Tiv thaiv kab mob
Qhov ua rau thiab cov tsos mob ntawm lub plawv tamponade yuav tsum paub rau cov neeg uas muaj kev pheej hmoo siab ntawm kev mob plawv.
Cov kab mob uas nthuav tawm tuaj yeem tiv thaiv tau, tab sis rau qhov no koj yuav tsum ua raws li kev tiv thaiv hauv qab no:
- Cov tshuaj tiv thaiv kab mob thiab lwm yam tshuaj mob plawv yuav tsum tau noj raws li qhia thiab nrog koj tus kws kho mob tham.
- Kho txhua yam kab mob sib kis hauv lub sijhawm.
- Tsis txhob raug mob hauv siab.
- tso siab rau cov txheej txheem mob plawv nkaus xwb rau cov kws tshaj lij.
- Nyob zoo thiab muaj nuj nqis.
Nws nyuaj los tham txog qhov tshwm sim ntawm tus kheej, vim qhov ua rau tshwm sim txawv, thiab tsis yog txhua tus tuaj yeem tshem tawm tag nrho.
Txhawm rau zam kev tuag lossis qhov tshwm sim loj, nws yuav tsum tau kuaj xyuas thiab kho cov kab mob plawv hauv lub sijhawm. Koj tseem yuav tau nyob rau hauv kev tswj ntawm tus kws kho mob tas li.
