Cov ntsiab lus "kev tsis haum", "Qincke's edema", "anaphylactic shock" tau tshwm sim hauv cov tshuaj tsis ntev los no, thaum pib ntawm lub xyoo pua nees nkaum. Lawv tau qhia rau lub ntiaj teb los ntawm tus kws tshawb fawb Fabkis, tus yeej Nobel nqi zog hauv tshuaj, tus kws kho mob lub cev Charles Richet. Tom qab ntawd Alexander Mikhailovich Bezredko khaws nws lub tswv yim hauv cov tshuaj hauv tsev, nws tau txhim kho txoj kev siv tshuaj rau cov neeg mob uas muaj keeb kwm ntawm kev ua xua. Tom qab ntawd, cov txheej txheem xwm txheej ceev tau tsim rau cov neeg mob zoo li no, thiab cov neeg tuag tau txo qis. Txawm li cas los xij, txawm tias cov tshuaj niaj hnub no, qhov kev tuag ntawm anaphylaxis tseem siab.
Definition
Hauv kev nkag siab dav dav, kev ua xua yog qhov ua rau muaj kev nkag siab ntawm lub cev tiv thaiv kab mob rau cov kab mob tshwj xeeb thiab nws cov tshuaj tiv thaiv hnyav thaum nws rov ntsib dua. Muaj ntau hom kev tsis haum tshuaj:
- tam sim lossis anaphylactic;
- cytotoxic (cov tshuaj tiv thaiv kab mob sib kis nrog cov ntaub so ntswg hauv lub cev);
- immunocomplex (vascular puas tsuaj los ntawm lub cev tiv thaiv kab mobcomplexes);
- ncua sijhawm, lossis cell-dependent.
Cov tshuaj tiv thaiv Anaphylactic yog qhov tshwm sim ntawm kev tsis haum tshuaj ntawm thawj hom, uas yog, tam sim ntawd.
Ntxiv rau, cov tshuaj tiv thaiv anaphylactoid kuj raug cais tawm hauv kev kho mob, uas zoo ib yam hauv kev kho mob tshwm sim rau anaphylaxis, tab sis cov txheej txheem ntawm lawv tsim yog vim kev ua kom cov hlwb ua mob los ntawm cov khoom txawv teb chaws, ntxiv cov proteins, thiab tsis yog los ntawm Antigen-antibody complexes.
Yog vim li cas
Thaum pib, kev tsis haum tshuaj anaphylactic tshwm sim thaum muaj cov tshuaj lom nkag mus rau tib neeg lub cev. Ib qho piv txwv yog qhov tom ntawm kab kab thiab cov tsiaj reptiles. Tab sis nyob rau hauv lub ntiaj teb niaj hnub no, lub cev tuaj yeem hnov txog qhov tsis raug txawm tias paub, banal yam:
- Khoom noj - zib ntab, mis nyuj, txiv ntseej, qe, nqaij nruab deg, chocolate, citrus.
- Tshuaj - cov tshuaj hormones, cov tshuaj sib txawv, tshuaj tiv thaiv thiab ntshav, tshuaj loog.
- Nroj tsuag thiab tsiaj - paj paj ntoos, fungus, tsiaj fur, plua plav mites.
- Ambient kub - txias / kub.
- Muaj feem yuav ua xua rau cov neeg mob hawb pob, vasomotor rhinitis, eczema.
Qhov no tsuas yog luv luv, cov npe dav dav ntawm cov khoom uas tuaj yeem ua rau muaj kev fab tshuaj rau tus neeg nruab nrab. Tsis tas li ntawd, yog tias muaj kev cuam tshuam zoo li no hauv cov txheeb ze ntawm thawj kab ntawm kev sib raug zoo, ces feem ntau tus me nyuam kuj yuav muaj qhov tshwm sim zoo ib yam.
Reaction txoj kev loj hlob
Kev tsis haum tshuaj ntawm hom anaphylactic cuam tshuam nrog cov lus teb pathological ntawm lub cev tiv thaiv kab mob rau kev noj cov tshuaj txawv teb chaws. Nquag, ntawm thawj lub rooj sib tham nrog antigen, lub cev tsim cov tshuaj immunoglobulins M, thiab ntawm qhov thib ob - G. Tab sis qee zaum cov txheej txheem no mus yuam kev. Cov tshuaj tiv thaiv anaphylactic tshwm sim thaum cov pej xeem ntawm cov tshuaj immunoglobulins E nce ntxiv, lawv tshwm sim txij li lub sijhawm sib cuag nrog cov tshuaj thawj zaug, tab sis thaum xub thawj lawv tsis tshwm sim lawv tus kheej. Hloov chaw, lawv tau tsau rau saum npoo ntawm mast hlwb (basophils) thiab tos hauv tis. Yog hais tias ib tug neeg raug rov qab mus rau lub antigen, ces IgE qhib basophils thiab tso inflammatory mediators xws li histamine, cytokines, interleukins, prostaglandins thiab leukotrienes. Hauv qhov ntau, lawv cuam tshuam rau cov ntaub so ntswg ntawm lub cev, ua rau edema, vasodilation, contraction ntawm cov nqaij ntshiv nyob rau hauv cov phab ntsa ntawm lub hollow kab mob, ua tsis taus pa, thiab nce secretion ntawm qog. Ib cheeb tsam ntawm qhov mob yog tsim nyob rau ntawm qhov chaw ntawm kev nkag mus ntawm cov allergen. Qhov no yog theem siab siab tam sim ntawd.
Tab sis txoj kev loj hlob ntawm cov tshuaj tiv thaiv anaphylactic muaj lub sij hawm thib ob, lossis theem, hu ua qeeb hypersensitivity. Txhawm rau tsim kom pom kev mob, cov hlwb nkag mus rau qhov ntawd los ntawm chemotaxis - lymphocytes, neutrophils, eosinophils, macrophages. Lawv muaj cov tshuaj nyob rau hauv cytoplasm uas yog tsim nyog los tua ib tug txawv teb chaws tus neeg sawv cev, tab sis es tsis txhob lawv ua puas lub cev cov ntaub so ntswg, thiab connective ntaub so ntswg yog tsim es tsis txhob. Feem ntau cov lus teb qeebtuaj rau 6 teev tom qab mob hnyav thiab kav ntev txog ob hnub.
Systematization of anaphylactic reactions
Hom tshuaj tiv thaiv anaphylactic tau muab faib raws li qhov hnyav ntawm lawv qhov kev kho mob tshwm sim. Cov cim qhia tshwj xeeb pab ntsuas tus neeg mob sai sai thiab muab kev pab tsim nyog rau nws.
- Cov tshuaj anaphylactic me me tsis ua rau muaj kev hem thawj rau tib neeg lub neej. Subjectively, cov neeg mob piav lawv raws li kev xav ntawm paresthesia - tingling los yog sov nyob rau hauv cov ceg, uas yog ua ke nrog ib tug me ntsis o ntawm mucous daim nyias nyias ntawm lub qhov ntswg, qhov ncauj los yog daim tawv muag. Ua tau txham, lacrimation, khaus. Cov tsos mob tuaj thiab mus hauv ib hnub.
- Kev mob hnyav tshwm sim nws tus kheej hauv daim ntawv ntawm bronchospasm, reactive edema ntawm mucous daim nyias nyias ntawm lub larynx thiab bronchi. Cov neeg muaj qhov ua tsis taus pa hnyav heev, hnoos, cua nkag mus rau hauv lub ntsws nrog lub suab nrov nrov. Hauv cov xeev zoo li no, Quincke's edema, urticaria yog ua tau. Tej zaum yuav muaj kev qaug dab peg, xws li xeev siab, ntuav, mob taub hau, ua npaws. Qee qhov xwm txheej, erythema, khaus khaus hnyav, thiab kev ntxhov siab tshwm sim.
- Cov tshuaj tiv thaiv anaphylactic hnyav pib mob hnyav thiab zoo li mob me me thaum xub thawj. Tom qab ntawd, tom qab ob peb feeb, theem thib ob pib nrog bronchospasm, o ntawm lub ntsws sab sauv thiab bronchi, thiab ua pa tsis ua haujlwm. Tom qab ntawd cyanosis tshwm, tej zaum yuav muaj qhov ua pa nres. Cov kauj ruam tom ntej yog qhov kev nthuav dav ntawm cov tsos mob. Lub mucous daim nyias nyias swells tsis tau tsuas yog nyob rau hauv lub pa kab mob, tab sis kuj nyob rau hauv lub digestive ib ntsuj av. Qhov no ua rau kev ua txhaum caiperistalsis, ntuav, raws plab thiab mob plab. Nyob rau ntawm ib feem ntawm lub paj hlwb, qaug dab peg qaug dab peg, impaired innervation ntawm lub plab hnyuv siab raum tuaj yeem tshwm sim. Kev nthuav dav ntawm cov hlab ntsha peripheral thiab tso tawm cov kua ib feem ntawm cov ntshav mus rau hauv cov ntaub so ntswg ib puag ncig vim edema provokes ib qho kev poob siab mus txog rau lub cev. Qhov hnyav ntawm tus mob yog nyob ntawm tus nqi ntawm txoj kev loj hlob ntawm tus txheej txheem, lawv nyob rau hauv ncaj qha faib ua feem: qhov ceev, qhov loj tshaj qhov prognosis. Txog hnub tuag.
Cov tsos mob hauv zos
Feem ntau tshwm sim nrog kev tsis haum tshuaj me me mus rau nruab nrab, ua rau tus neeg mob tsis xis nyob, tab sis tsis txhob ua rau tuag:
- catarrhal tshwm sim hauv daim ntawv ntawm rhinitis, conjunctivitis, rhinorrhea;
- bronchospasm, ua tsis taus pa luv, mob hawb pob, o ntawm txoj hlab pa sab sauv kom ua tiav;
- hnov tsis hnov lus vim o ntawm cov mucosa hauv Eustachian raj;
- ntau daim tawv nqaij pob khaus xws li khaus khaus, khaus khaus, khaus khaus khaus khaus khaus khaus khaus khaus khaus khaus khaus khaus khaus khaus khaus khaus khaus khaus khaus khaus khaus khaus khau khau khau khau khau khau khau khau khau khau khau khau khau khau khau khau khau khau khau khau khau khau khau khau khau khau khau khiab feem ntau symmetrical.
Cov tsos mob dav dav
Koom nrog cov nyhuv nyuaj ntawm cov tshuaj tsis haum rau lub cev:
- mob taub hau, qaug zog, qaug zog, tsaug zog;
- xeev siab, ntuav, mob dyspeptic nyob rau hauv daim ntawv ntawm raws plab lossis cem quav, mob plab hauv plab;
- - Lub plawv atherosclerosis lub plawv, poob, tsaus muag, vau, poob siab.
Anaphylactic shock
Nws yog tus tshaj plawshnyav tshwm sim ntawm qhov kev tsis haum tshuaj muaj peev xwm ua tau. Anaphylactic shock pib sai sai, nyob rau hauv thawj feeb tom qab kev sib cuag nrog cov antigen. Ua ntej tshaj plaws, tus kws kho mob yuav tsum tau ceeb toom los ntawm kev ua phem hauv zos rau cov tshuaj, khoom noj lossis tom. Qhov no tej zaum yuav mob heev, reactive o, khaus khaus, los yog poob siab heev. Yog tias qhov ua xua yog zaub mov, txhua yam tuaj yeem pib ntuav thiab o ntawm lub qhov ncauj, larynx lossis pharynx.
theem thib ob yog qhov ua pa ntawm lub bronchi thiab qhov thaiv ntawm txoj hlab pa lumen, mus txog qhov ua pa nres. Hypoxia nce, daim di ncauj thiab ceg ceg tig xiav, tus neeg mob tsis nco qab, faints los yog plunges rau hauv coma. Yog tsis muaj kev cuam tshuam sai ntawm tus neeg ua haujlwm kho mob, ib tus neeg tuag sai heev yam tsis nco qab.
Kev kub ntxhov
Txhawm rau tiv thaiv kev sib kis ntawm cov tshuaj tiv thaiv thoob plaws hauv lub cev, lub tourniquet yog siv rau saum qhov chaw txhaj tshuaj ntawm cov tshuaj allergen (yog tias ua tau) thiab ib nrab lub voos xwmfab ntawm 0.1% adrenaline daws tau nrawm nrawm (subcutaneously lossis intravenously). Thiab lawv ntxiv muaj, nyob rau hauv cov hlab ntsha, "Prednisolone" ntawm tus nqi ntawm 5 mg ib kilogram ntawm tus neeg mob qhov hnyav kom qeeb cov tshuaj tiv thaiv kab mob. Yog tias cov kev ntsuas no tsis pab, thiab tus neeg tseem ua tsis taus pa, nws yog ib qho tsim nyog yuav tsum tau intubate lub trachea thiab pib ua pa tawm ntawm lub ntsws nrog lub hnab Ambu lossis lub tshuab ua pa. Nws tshwm sim tias nws tsis tuaj yeem ntxig lub raj ua pa, tom qab ntawd txiav txim siab txog caticotomy lossis tracheotomy. Qhov no yuav muab oxygen thiab cawm tus neeg mob txoj sia.
Txoj kev taw qhiatshuaj
Tag nrho lub sijhawm no, thaum ntsuas kev kub ntxhov, koj tuaj yeem txuas ntxiv txhaj tshuaj adrenaline mus txog rau tag nrho cov koob tshuaj ntawm ob milliliters. Tab sis tsis txhob nqa mus nrog lawv, vim tias kev siv tshuaj ntau dhau tuaj yeem ua rau tus mob hnyav dua thiab ua rau cov tshuaj tiv thaiv anaphylactic hnyav dua. Txhawm rau txo qis bronchospasm (yog tias tom qab kev qhia txog adrenaline nws tsis ploj mus ntawm nws tus kheej), koj tuaj yeem txhaj nees nkaum milliliters ntawm "Eufillin" intravenously (them) rau hauv tus neeg mob.
Yog tias tsis muaj prednisolone, nws tuaj yeem hloov pauv nrog kev thauj khoom ntawm lwm cov glucocorticoids, piv txwv li, nkag 500 milliliters ntawm Metyprednisolone lossis cov ntsiab lus ntawm tsib ampoules ntawm Dexamethasone. Cov koob tshuaj me me yuav siv tsis tau.
Kev Tiv Thaiv
Cov tshuaj tiv thaiv Anaphylactic yooj yim los tiv thaiv dua li kho. Txhawm rau ua qhov no, kev sib cuag nrog cov tshuaj yuav tsum raug zam yog tias nws paub rau tus neeg, thiab nws yog ib qho tsim nyog yuav tsum tau tshaj tawm cov kev cuam tshuam no rau cov kws kho mob ua ntej muab tshuaj, kev phais phais lossis cov txheej txheem kho lub cev. Tsis tas li ntawd, cov neeg muaj kev fab tshuaj tsis haum yuav tsum nqa ib tus cwj mem adrenaline thiab lub tshuab ua kom luv luv bronchodilator nebulizer. Qhov no yuav ua rau kom muaj kev kho mob sai heev thaum muaj kev tawm tsam thiab tuaj yeem cawm tib neeg txoj sia.
