Angioneurotic edema, paub zoo tias yog angioedema, yog ib qho kev tsis haum tshuaj loj uas yuav ua rau muaj kev phom sij rau lub neej. Yog li ntawd, nws yog ib qho tsim nyog yuav tsum paub tias nws thawj cov tsos mob tshwm sim li cas. Quincke's edema xav tau kev saib xyuas xwm txheej ceev rau tus neeg mob hauv tsev ua ntej cov kws kho mob tuaj txog.
Tus kab mob no tshwm sim los ntawm qhov mob hnyav ntawm daim tawv nqaij thiab cov mucous daim nyias nyias. Qhov xwm txheej no tau piav qhia thawj zaug los ntawm Marcello Donati (1576). Lub sij hawm "angioneurotic edema" tau qhia los ntawm Henryk Quincke (1882), uas nws lub npe cov kab mob pathological tseem dais niaj hnub no. Cov tshuaj uas ua rau nws raug txheeb xyuas hauv xyoo 1964. Txij thaum ntawd los, cov kws kho mob muaj peev xwm ua tau cov hom phiaj kho mob.
ua rau ntawm pathology
Cov kws kho mob tshwj xeeb muab faib ua kev ua xua thiab pseudo-allergic Quincke's edema. Cov tsos mob thiab kev kho mob ntawm cov mob no txawv me ntsis. Allergic edema yog ib qho tshuaj tiv thaiv ntawm lub cev rau ib qho kev ua xua. Tus kab mob no tshwm sim nyob rau hauv cov neeg uas xav kom lub cev tiv thaiv kab mob.
Edema ntawm pseudo-allergic yam yog ib qho kab mob hauv lub cev ntawm cov kab ke ntxiv. Cov tshuaj tiv thaiv tam sim no tsim nyob rau hauv cov lus teb rau txias, cua sov thiab tshuaj stimuli. Feem ntau ua rau angioedema suav nrog qee pawg ntawm allergens. Cov tshuaj tiv thaiv tuaj yeem txhim kho rau cov tshuaj hauv tsev thiab cov tshuaj chlorine detergents thiab cov tshuaj ntxuav tes, cov tshuaj pleev ib ce thiab cov khoom siv tu cev, cov cua fresheners thiab iav ntxuav, zaub mov thiab paj ntoos los ntawm qee cov nroj tsuag.
Ntau zaus hauv cov neeg laus, cov tsos mob ntawm Quincke's edema tshwm sim ntawm cov tshuaj. Feem ntau, cov tshuaj tiv thaiv no yog tshwm sim los ntawm cov tshuaj uas tsis yog-steroidal anti-inflammatory tshuaj, tshuaj tua kab mob, acetylsalicylic acid, tshuaj uas tswj ntshav siab.
Tej yam ntuj tso kuj tuaj yeem ua rau kev loj hlob ntawm Quincke's edema. Cov tsos mob yog tshwm sim los ntawm dej hiav txwv thiab hnub ci hluav taws xob, muv thiab waps stings. Cov zaub mov tsis txaus ntshai tshaj plaws yog:
- niam;
- cocoa;
- txiv laum huab xeeb;
- chocolate;
- coffee;
- virtually all seafood.
Hereditary factor
Kev yug me nyuam yog ib qho tseem ceeb hauv kev tsim ntawm angioedema. Cov tsos mob tau pom meej meej thaum tus kab mob nkag mus rau hauv lub cev, nrog kev raug mob lossis kev ntxhov siab. Raws li qhov tshwm sim ntawm lub cev tiv thaiv kab mob, basophils raug rhuav tshem thiab cov tshuaj lom neeg lom neeg raug tso tawm uas txhawb nqa tag nrho cov xwm txheej hauv lub cev (cov neeg sib kho). Allergens provoke o thaum xub thawjtiv tauj, tsis muaj kev tso tawm ntawm immunoglobulin E thiab ua kom cov hlwb mast.
Yog li, edema tshwm sim hauv cov menyuam yaus txog peb xyoos thiab hauv cov neeg uas muaj lub cev ua haujlwm ntxiv. Feem ntau lub cev ua raws li txoj kev no rau nab thiab kab tom.
Indirect factors
Lwm yam ua rau Quincke's edema suav nrog:
- kab mob kab mob lossis kab mob helminthic.
- Pathology ntawm endocrine system.
- Kab mob hauv nruab nrog cev.
Gastrointestinal form
Qhia tau tias yog kev noj zaub mov tsis zoo, pib nrog cov tsos mob ntawm kev ua xua rau plab. Nyob rau hauv cov ntaub ntawv no, cov phab ntsa ntawm lub plab yog tawm tsam los ntawm cov zaub mov allergens, basophils thiab eosinophils accumulates nyob rau hauv lawv. Nyob rau hauv lub chav kawm ntawm lawv kev puas tsuaj, ib tug loj vascular spasm tshwm sim, thiab ces o tshwm. Tib daim duab yog pom nyob rau hauv txoj hnyuv. Tus neeg mob raug tsim txom los ntawm mob hnyav nyob ib ncig ntawm lub plab los yog hauv thaj tsam epigastric, nyob rau sab nraud ntawm lub plab kab noj hniav. Nws mob xeev siab, palate thiab tus nplaig tingling, ntuav, nws cov quav ua kua.
daim ntawv kos npe
Nws ua rau o ntawm txheej sab hauv ntawm lub hnab articular. Kev teeb tsa ntawm lub hnab hloov pauv, kev txav mus los yog ib nrab poob.
o nrog urticaria
Qhov kev sib xyaw no suav tias yog qhov ntau tshaj plaws. Nyob rau hauv cov ntaub ntawv no, ntxiv rau puffiness, ib pob khaus tshwm - hlwv ntawm ntau yam duab thiab ntau thiab tsawg. Tus neeg mob tau khaus khaus heev lossis kub hnyiab.
Kev kuaj kab mob
Daim duab kho mob ib txwm (hais cov tsos mob ntawm Quincke's edema hauv qhov chaw qhib ntawm lub cev) ua rau nws yooj yim rau kev kuaj mobthaum kuaj pom. Qhov xwm txheej yog qhov nyuaj ntau dua hauv daim duab kho mob ntawm lub plab mob hnyav lossis mob ischemic transient nres, thaum tus kws kho mob yuav tsum sib piv cov tsos mob uas hais nrog ntau cov kab mob ntawm cov kab mob hauv nruab nrog cev thiab cov kab mob ntawm lub paj hlwb.
Nws yog qhov nyuaj rau kev paub qhov txawv ntawm qhov tau txais thiab keeb kwm ntawm angioedema, txheeb xyuas qhov laj thawj ntawm cov kab mob pathology. Tus kws kho mob tshuaj xyuas keeb kwm, txiav txim siab txog qhov muaj keeb kwm yav dhau los rau kev tsis haum tshuaj, muaj cov xwm txheej ntawm Quincke's edema hauv cov txheeb ze. Tsis tas li ntawd, nws txaus siab rau cov neeg txheeb ze tuag los ntawm kev ua pa vim edema. Txhawm rau tsim kev kuaj mob, nws yog ib qho tseem ceeb kom paub seb tus neeg mob puas muaj kab mob autoimmune, seb nws puas noj receptor blockers, ACE inhibitors, estrogens.
Cov kab mob Lymphoproliferative, autoimmune pathology, qhov txo qis hauv qib thiab kev ua haujlwm ntawm C1 inhibitor tuaj yeem kuaj pom los ntawm kev kuaj mob hauv qhov tsis ua xua angioedema. Angioedema ntawm kev tsis haum tshuaj yog txiav txim siab los ntawm kev nce qib ntawm tag nrho IgE, ntshav eosinophilia, kuaj tawv nqaij zoo.
Thaum tus mob laryngeal edema aggravated los ntawm stridor ua tsis taus pa, laryngoscopy yuav tsum tau, nyob rau hauv cov ntaub ntawv ntawm lub plab syndrome - kuaj los ntawm ib tug kws phais thiab instrumental kev tshawb fawb, suav nrog endoscopic (colonoscopy, laparoscopy).
Cov tsos mob ntawm angioedema hauv cov neeg laus. Duab thiab piav qhia
Ntau zaus qhov edema yog nyob rau ntawm lub ntsej muag, ntes cov mucous ntawm qhov muag thiab qhov ncauj. Nyob rau tib lub sijhawm, cov xwm txheej ntawm kev puas tsuaj rau lub plab zom mov, daim nyias nyias ntawm lub hlwb thiab cov pob qij txha tau raug kaw. Edema txhim khosai sai thiab hais txog cov xwm txheej xwm txheej ceev uas yuav tsum tau kho mob sai. Hmoov zoo, qhov xwm txheej txaus ntshai no tshwm sim hauv tsuas yog 2% ntawm kev tsis haum tshuaj. Nrog kev kho mob tsis tu ncua, Quincke's edema tsim nyob rau hauv lub larynx tuaj yeem ua rau tuag vim asphyxia (suffocation). Thawj cov tsos mob hauv qhov no yog lub suab nrov nrov thiab hnoos qhuav.
Nws tuaj yeem yog qhov sib txawv ntawm qhov sib txawv: hauv qee tus neeg mob, cov tsos mob hloov me ntsis, tab sis feem ntau qhov kev hloov pauv ua rau tus neeg mob thiab nws cov txheeb ze ntshai. Nws twb tau hais saum toj no sai npaum li cas Quincke's edema tsim. Cov tsos mob nyob rau hauv daim ntawv ntawm edema feem ntau tshwm nyob rau ntawm lub ntsej muag, nyob rau hauv tej rooj plaub ntawm nws tus kheej qhov chaw: daim di ncauj, daim tawv muag, lub taub ntswg, lub puab tsaig, pob ntseg. Lub ntsej muag yuav puffy, lub qhov muag tig mus rau hauv slits thiab dej hnyav heev. Cov tawv nqaij daj ntseg. Nws tau kub thiab nruj. Lub edema yog tuab heev uas xyaum tsis muaj ib tug nyob rau hauv nws tom qab siab.
Nws tuaj yeem kis mus rau lub plab sab sauv thiab hauv siab, mus rau caj dab. Qee zaum ob txhais taw, qhov chaw mos, txhais tes swell. Cov no tsis yog cov cim phem tshaj plaws ntawm Quincke's edema. Cov tsos mob qhia tau hais tias pathology tau npog lub suab qaum, cov ntaub so ntswg ntawm lub larynx thiab nqis mus rau hauv lub trachea yog qhov tuag taus. Hoarseness, mob caj pas, ua tsis taus pa luv, hnoos hnoos, thiab ua pa nyuaj thaum nqus tau yuav tsum tau mus kho mob ceev. Txwv tsis pub, tus neeg mob yuav tuag.
Kev mob ntawm cov menyuam yaus
Feem ntau cov kab mob no cuam tshuam rau cov neeg muaj hnub nyoog 20 xyoo, tsawg dua - cov neeg laus. Hauv cov menyuam yaus, tus kab mob no feem ntau tshwm sim thiab tuaj yeem mob hnyav heev. Feem ntau nws yog ua ke nrog urticaria. Hauv cov ntawv kho mob tshwj xeeb, koj tuaj yeem pom cov duab ntawm cov tsos mob ntawm Quincke's edema. Kev kho mob ntawm cov menyuam yaus yog qhov nyuaj vim tias nws nyuaj rau cov kws kho mob txhawm rau kuaj mob: txawm tias cov menyuam yaus hauv tsev kawm ntawv tsis tuaj yeem piav qhia lawv tus mob kom txaus, tshwj xeeb tshaj yog rau cov menyuam hnub nyoog ob thiab peb xyoos.
Vim hais tias xws li kev tiv thaiv kab mob tuaj yeem ua rau mob plab thiab asphyxia, cov niam txiv yuav tsum ua tib zoo saib xyuas tus menyuam tus mob ua ntej cov kws kho mob tuaj txog. Qhov o ntawm lub ntsws tuaj yeem nyob ntawm ib teev mus rau ib hnub. Yog tias tus menyuam yws yws ntawm tus nplaig thiab palate, tom qab ntawd ntuav thiab raws plab, nrog rau qhov mob hnyav hauv plab, ces qhov edema kuj cuam tshuam rau txoj hnyuv.
Nrog edema, cov me nyuam yuav kub taub hau, ua rau mob pob qij txha. Qee tus menyuam yaus zoo siab heev, feem ntau lawv tsis nco qab. Tom qab tus menyuam tau kuaj pom tseeb thiab pom qhov ua xua uas ua rau Quincke's edema, cov niam txiv yuav tsum tsis txhob sib cuag nrog nws thiab muaj tag nrho cov tshuaj tsim nyog hauv tsev los pab hauv tsev.
pab thawj rau tus mob
Nws yog ib qho tseem ceeb heev los muab kev pab raws sij hawm rau tus neeg mob thaum cov tsos mob ntawm Quincke's edema tshwm. Kev kho mob hauv tsev pib nrog tshuaj tua kab mob, tab sis ua ntej nws yog qhov tsim nyoghu lub tsheb thauj neeg mob. Raws li txoj cai, cov neeg muaj kev fab tshuaj ib txwm muaj cov tshuaj tsim nyog ntawm tes (Zirtek, Tavegil, Suprastin). Yog tias tsis muaj cov tshuaj tiv thaiv hauv tsev, nrog cov tsos mob ntawm Quincke's edema, kev kho mob tuaj yeem pib nrog cov tshuaj paub zoo Naphthyzin. Tso ob tee rau hauv lub qhov ntswg, ua kom tus neeg mob siab, qhib qhov rais: tus neeg mob xav tau huab cua ntshiab. Tshem koj lub caj dab thiab lub hauv siab los ntawm cov khaub ncaws nruj.
Yog tus me nyuam mob, muab tus me nyuam rau hauv koj txhais tes. Sim ua kom ntsiag to, vim tias koj qhov kev ntxhov siab yog kis mus rau tus menyuam. Yog tias koj paub tias qhov ua xua ua rau cov tshuaj tiv thaiv, tshem tawm nws. Txias yuav tsum tau siv rau qhov chaw ntawm qhov o. Yog tias tus neeg mob tsis nco qab lawm, nws tau txais kev ua pa tawm dag zog. Cov txheeb ze ntawm cov neeg uas muaj edema rov tshwm sim tau paub zoo txog qhov ua tau zoo ntawm Prednisolone thiab, raws li txoj cai, tuaj yeem ua rau nws tus kheej txhaj tshuaj intramuscular.
Nws yuav tsum nco ntsoov tias tib neeg lub neej nyob ntawm kev sib koom tes thiab kev ntseeg siab hauv kev tshem tawm cov tsos mob ntawm Quincke's edema ua ntej tuaj txog ntawm cov kws kho mob. Yog li ntawd, nws yog ib qho tseem ceeb kom tsis txhob ntxhov siab kom tsis txhob nco lub sij hawm muaj nuj nqis.
kho mob hauv tsev
Kev ntsuas ntxiv rau kev kho mob ntawm Quincke's edema txuas ntxiv hauv tsev kho mob. Hauv cov neeg laus, cov tsos mob ntawm pathology raug tshem tawm nrog cov tshuaj antihistamines. Tsis tas li ntawd, txoj kev kho mob ntshav qab zib infusion yog nqa tawm. Nws tsub kom lub ntim ntawm cov ntshav ncig, thiab tseem lim cov allergens los ntawm ob lub raum nrog kev pab los ntawm protease inhibitors ("Kontrykal"), saline, epsilon aminocaproic acid, zoo nyob rau hauv cov tshuaj.pseudo-allergic edema.
Lasix, Furosemide tau muab tso rau hauv cov hlab ntsha. Tus kws kho mob yuav sau ntawv Askorutin thaum kawg ntawm kev kho infusion, uas yuav pab txo qis vascular permeability. Kev kho mob nrog enterosorbents kuj pom (Enterosgel, Polyphepan, Polysorb, Filtrum STI). Cov tshuaj no khi cov zaub mov tsis haum rau hauv plab.
Tshuaj kho mob angioedema
Hauv kab lus no, peb nthuav tawm ib daim duab ntawm cov tsos mob ntawm Quincke's edema. Kev kho mob ntawm cov neeg laus lossis menyuam yaus yuav tsum tau pib tam sim tom qab qhov pib ntawm nws thawj cov cim. Txhawm rau ua qhov no, koj yuav tsum muaj cov tshuaj tiv thaiv kab mob hauv tsev ib txwm muaj. Lawv raug sau los ntawm kws kho mob, tab sis hauv qab no yog cov npe tshuaj tiv thaiv kab mob uas siv rau lub sijhawm mob edema.
Thawj tiam tshuaj:
- "Diprazine".
- Y"Suprastin".
- Fenistil.
- Y"Hifenadine".
- "Tavegil".
Cov tshuaj no ua haujlwm hauv peb lub hlis twg ntawm ib teev. Lawv tau zoo nres Quincke's edema, tab sis ntev lub sij hawm cov tshuaj tiv thaiv, yog li ntawd lawv yog contraindicated rau cov neeg tsav tsheb thiab ua rau tsaug zog. Muaj kev cuam tshuam rau histamine H-1 receptors.
thib ob tiam tshuaj tiv thaiv kab mob stabilize mast hlwb los ntawm cov histamine nkag mus rau hauv cov hlab ntsha. "Ketotifen" relieves spasm ntawm txoj hlab ntsws. Pom zoo rau kev sib xyaw ntawm bronchial hawb pob nrog angioedema lossis kab mob broncho-obstructive.
Tshuaj ntawm peb tiam stabilize phab ntsa ntawm mast hlwb, tsis txhob depress lub hauv nruab nrab paj hlwb, thaiv histamine receptors. Cov no suav nrog:
- Semprex.
- Y"Loratadine".
- Zyrtec.
- "Terfenaddin".
- Cetrin.
Kev xaiv tshuaj yog ua los ntawm tus kws kho mob raws li cov lus pom zoo hauv qab no:
- Cov menyuam yaus hnub nyoog qis dua ib xyoos - Fenistil.
- Txij li ib mus rau plaub xyoos - Loratadine.
- Txij tsib mus rau kaum ob - Astemizol, Terfenadine.
- Rau cov poj niam cev xeeb tub - Loratadin, Telfast.
- Rau cov niam laus - "Cleastin", "Pheniramine".
Quincke's edema yog yooj yim los tiv thaiv dua li kho. Txhawm rau tiv thaiv kab mob, tsev neeg thiab zaub mov ua xua yuav tsum raug cais tawm, tsis txhob noj tshuaj rau tus kheej, thiab thaum thawj qhov tshwm sim ntawm kev tsis haum tshuaj (urticaria, dermatitis, conjunctivitis, raws caij nyoog rhinitis, bronchial hawb pob), urgently hu rau tus neeg ua xua.
