Qhov tshwm sim ntawm kev ua xua (anaphylactic) cov tshuaj tiv thaiv yog tshwm sim los ntawm cov neeg ua haujlwm exogenous, thiab nws cov chav kawm yog tus cwj pwm los ntawm kev kub siab tam sim ntawd. Raws li txoj cai, lub cev cov lus teb tuaj yeem ua rau muaj kev phom sij rau lub neej ntawm cov kab mob ntawm daim tawv nqaij, ua pa thiab cov hlab plawv. Tom qab thawj zaug kev sib cuag nrog cov antigen, kev tsim cov tshuaj tiv thaiv IgE, tshwj xeeb rau lawv lub hom phiaj, pib. Lawv sib koom ua ke nrog cov hlwb ua lub luag haujlwm rau cov txheej txheem tiv thaiv kab mob hauv lub cev, thiab kev nkag mus rau cov tshuaj tiv thaiv tshwm sim.
Yuav ua li cas ua xua tshwm sim?
Kev ntaus tom ntej ntawm kev ua xua txhawb kev tso tawm cov tshuaj bioactive, tshwj xeeb yog histamine, los ntawm cov hlwb ua lub luag haujlwm tiv thaiv lub cev.
Thaum lub sijhawm hloov pauv ntawm cov txheej txheem tshuaj lom neeg mus rau qhov tsis zoo ntawm lub cev, kev hloov pauv feem ntau tshwm sim hauv cov hlab ntsha, cov qog nqaij hlav, cov nqaij ntshiv du, uas ua rau muaj kev loj hlob thiab tshwm sim thaum ntxov ntawm cov tsos mob hauv qab no:
- txo qis hauv vascular tone;
- sudden txocov nqaij mos ntawm txoj hnyuv, bronchi, uterus;
- ntshav siab;
- mob thiab o ntawm cov hlab ntsha.
Tsis zoo li kev ua xua, cov tshuaj tiv thaiv anaphylactoid, uas cov kws kho mob feem ntau hu ua pseudo-allergic, IgE antibodies tsis kho los ntawm basophils. Txawm hais tias qhov zoo sib xws ntawm qhov tshwm sim ntawm cov txheej txheem teb, ob qho tib si tshwm sim yog cov lus teb dav dav ntawm lub cev qhov tsis txaus ntseeg.
Tshuaj tua kab mob ua rau cov tshuaj tiv thaiv anaphylactoid
Ib qho tshuaj tiv thaiv anaphylactoid kuj yog qhov tso tawm ntawm cov tshuaj histamine, feem ntau twb yog thawj zaug kev sib cuag nrog kev khaus. Pseudoallergens tam sim no sawv cev rau ntau yam. Paradoxically, qhov tshuaj tiv thaiv ntawm lub cev feem ntau tshwm sim thaum noj tshuaj uas txwv tsis pub ua xua.
Tam sim anaphylactic thiab anaphylactoid cov tshuaj tiv thaiv tau tshwm sim tom qab kev tswj hwm cov leeg nqaij, tshuaj tua kab mob, tshuaj loog, tshuaj opioids, tshuaj kho mob hauv zos, tshuaj tiv thaiv, tshuaj kho tshuaj hormones, atropine, thiab B vitamins. Allergens kuj suav nrog sera, antigens siv rau kev kuaj mob. lub hom phiaj txhawm rau txheeb xyuas daim tawv nqaij, kab mob venereal. Kev ua xua rau cov khoom latex tau nce.
Ib qho tshuaj tiv thaiv anaphylactoid rau lidocaine yog suav tias yog ib qho tshwm sim, txij li cov tshuaj feem ntau siv hauv tshuaj loog hauv zos, tab sis nws cov tshuaj complex muaj peev xwm ua rau muaj kev phiv txawm nyob rau hauvlub cev noj qab nyob zoo, uas ua xua rau cov khoom ntawm cov tshuaj tsis raug.
Tsis yog tshuaj tsis haum tshuaj
Yog tias peb xav txog cov xwm txheej ntawm lub cev cov lus teb rau cov tshuaj tsis yog tshuaj, ces zaub mov tuaj yeem yog "teeb meem" ntawm no:
- strawberry;
- crustaceans;
- niam;
- txiv ntseej;
- nceb;
- ntses ntawm qee yam;
- qe;
- citrus.
Ib qho tshuaj tiv thaiv anaphylactoid tuaj yeem tshwm sim thaum raug kab los yog tshuaj lom invertebrate sawv cev ntawm cov tsiaj. Cov neeg mob uas niaj hnub muaj kev tsis haum tshuaj tsis haum tshuaj yog qhov txaus ntshai ntawm kev tsim anaphylaxis yog tias kev phais tau ua raws li kev siv tshuaj loog.
Kev faib tawm ntawm anaphylaxis
Qhov no yog qhov kev faib tawm ntawm kev tsis haum tshuaj los ntawm. Thawj qhov thaiv suav nrog ntau yam ntawm cov tshuaj tiv thaiv anaphylactic, uas tau muab faib ua kev sib kho los ntawm IgE, kho los ntawm IgG thiab kho los ntawm IgE thiab kev tawm dag zog. Cov tshuaj tiv thaiv anaphylactoid pseudo-allergic yog kho los ntawm kev tso tawm yooj yim ntawm cov neeg kho kom haum xeeb, tom qab ntawd yuav tsum raug hu ua provoked los ntawm kev ua yeeb yam, zaub mov thiab lub cev yam.
Cov tshuaj tiv thaiv anaphylactoid hauv mastocytosis yog ib pawg cais; mediated los ntawm lub cev tiv thaiv kab mob, immunoglobulin aggregates thaum siv tshuaj tiv thaiv kab mob thiab kho los ntawm cytotoxic antibodies, radiopaque agents.
Kev anaphylaxis nce qib li cas?
Morphine thiab ntau barbiturates, cov leeg nqaij so, pethidine tuaj yeem ua rau cov hlwb mast, ua rau tso tawm histamine. Hauv qhov no, daim duab kho mob nyob ntawm qhov ntau npaum li cas thiab tus nqi nkag mus rau hauv lub cev ntawm cov tshuaj nquag. Kev xyaum qhia tau hais tias cov tshuaj tiv thaiv feem ntau yog benign, txwv tsuas yog rau kev tshwm sim ntawm daim tawv nqaij.
Cov tshuaj tiv thaiv Anaphylactoid (ICD 10 muab rau cov kab mob pathological no) yog tus cwj pwm los ntawm qhov tsis muaj peev xwm ntawm kev txhim kho ntxiv thiab, tej zaum, qhov tsis tiav ntawm cov ntaub ntawv hais txog kev ua xua dhau los ntawm lub cev rau cov tshuaj tiv thaiv. Txij li thaum qhov tshwm sim ntawm anaphylaxis yog qhov txaus ntshai rau kev noj qab haus huv thiab lub neej, nws yog ib qho tseem ceeb uas yuav tsum tau kuaj xyuas cov teeb meem ntawm lub sijhawm thiab ntsuas qhov tsim nyog. Txawm hais tias tus txheej txheem ntawm anaphylactic lossis pseudo-allergic stimulus, cov tsos mob tuaj yeem sib txawv. Hnav tus cwj pwm ntawm tus kheej nkaus xwb, qhov tshwm sim tuaj yeem tshwm sim los ntawm kev dhia me ntsis hauv cov ntshav siab thiab cov tawv nqaij ua pob khaus mus rau qhov hnyav bronchospasm thiab lub cev qhuav dej ntawm kev ua haujlwm ntawm cov hlab plawv.
Nyob rau theem no, nws yog ib qho yooj yim kom nco ntsoov ib qho ntxiv qhov sib txawv ntawm cov nyhuv pseudo-allergens ntawm lub cev. Lub caij no, cov tshuaj tiv thaiv anaphylactoid, cov tsos mob uas tuaj yeem kuaj pom tus kheej lossis tshwm sim hauv ntau qhov sib txuas, tsis muaj qhov txaus ntshai.
Cov tsos mob ntawm cov tshuaj tiv thaiv anaphylactoid
Cov tsos mob ntawm kev tsis haum tshuaj hauv tus neeg mob tsaug zog yog:
- kiv taub hau;
- kev qaug zogkab mob;
- ua txhaum lub plawv dhia (tachycardia, arrhythmia);
- txo qis ntshav siab;
- ua pa nyuaj, mob hawb pob, bronchospasm thiab laryngospasm, pulmonary thiab laryngeal edema;
- tawv nqaij tawv, khaus khaus, urticaria, hyperemia ntawm integument, Quincke's edema;
- plab hnyuv, xeev siab, raws plab, ntuav;
- no pulse;
- kab mob plawv;
- slow down and stop the heart.
Cov teeb meem tshwm sim tom qab qhov tshuaj tiv thaiv anaphylactoid
Qhov kev hem thawj loj tshaj plaws yog fraught nrog kev poob siab, ua ke nrog bronchospasm. Tom qab ib lub sij hawm ntawm lub sij hawm (los ntawm 30 vib nas this mus rau ib nrab ib teev, tej zaum 2-3 teev), cov antigen uas tau nkag mus rau hauv lub cev muaj txhawb rau txoj kev loj hlob ntawm pathological allergic txheej txheem nyob rau hauv lub cev. Nyob rau hauv ntau txoj kev, cov txheej txheem ntawm cov tshuaj tiv thaiv nyob ntawm daim ntawv ntawm kev nkag mus ntawm lub stimulus (qhov ncauj los yog parenteral).
Kev loj hlob sai feem ntau ua rau tuag taus, ua rau muaj kev ua pa tsis ua haujlwm tam sim ntawd, qhov kev poob qis hauv lub siab perfusion, ua rau lub plawv tsis ua haujlwm, cerebral edema lossis hemorrhage, qia ua haujlwm tsis zoo, arterial thrombosis.
Nyob rau hnub thib ob tom qab kev poob siab, kev hem thawj rau lub neej thiab kev rov qab los yog nyob rau hauv kev loj hlob ntawm cov kab mob sib kis los ntawm kev tsis haum tshuaj. Txawm tias tom qab ob peb lub lis piam, qhov kev pheej hmoo ntawm cov teeb meem tseem nyob siab. Feem ntau, tom qab anaphylactic poob siab, cov kws kho mob kuaj pom cov kev ua haujlwm tsis zoo thiabkab mob:
- pneumonia;
- vasculitis;
- raum thiab siab tsis ua haujlwm, kab mob siab, glomerulonephritis;
- epidermal necrolysis;
- myocarditis;
- mob caj dab.
Cov txiaj ntsig zoo li no tuaj yeem raug hem los ntawm ob qho tib si anaphylactic thiab anaphylactoid cov tshuaj tiv thaiv. Qhov txawv ntawm anaphylactic poob siab ntawm cov kab mob no yog qhov tom kawg yuav tsum muaj kev nkag siab ua ntej thiab tsis tuaj yeem txhim kho ntawm thawj lub rooj sib tham nrog cov tshuaj tsis haum.
kho mob Anaphylaxis
Tsuas yog anamnesis yuav pab kom kos cov kev kho mob xwm txheej ceev raws li kev kuaj mob, yog li nws tseem ceeb heev uas yuav tsum tau sau nws.
Cov tsos mob ua xua, piv txwv li daim duab kho mob, kuj ua lub luag haujlwm tseem ceeb hauv kev txiav txim siab nrawm. Txawm li cas los xij, qhov kev ntseeg siab tshaj plaws thiab ua tiav cov lus teb rau cov lus nug ntawm kev kuaj mob tuaj yeem tau tsuas yog tom qab cov allergists thiab immunologists ua kev tshawb fawb hauv chav kuaj. Nyob rau tib lub sijhawm, raws li qhov xwm txheej tseem ceeb ntawm tus neeg mob, ua ntej ntawm tag nrho, nws yuav tsum tau muab kev kho mob xwm txheej ceev, thiab thaum muaj mob plawv lossis ua pa tsis ua pa, rov ua haujlwm.
Nyob rau theem ntawm kev paub txog lub hauv paus ua rau lub cev ua xua, txoj haujlwm ntawm cov kws kho mob yog ua kom paub meej qhov kev kuaj mob sib txawv. Hom kev ntsuam xyuas no yog tsim los tshem tawm cov yam ntxwv ntawm kev cuam tshuam uas tsis cuam tshuam nrog kev tso tawm ntawm histamine.
Zoo lub cev cov tshuaj tiv thaiv rau lwm yam tsis ua xua
Ntau zausanaphylactic thiab anaphylactoid cov tshuaj tiv thaiv (nws yog dab tsi thiab vim li cas pathologies yog qhov txaus ntshai, nws yog ib qho tseem ceeb kom paub rau cov neeg uas nquag mus rau qhov tsis zoo tshaj plaws, thaum xub thawj siab ib muag, kev tsis haum tshuaj tshwm sim hauv daim ntawv ntawm rhinitis) zoo ib yam li lwm yam uas tuaj yeem ua rau muaj feem cuam tshuam. ua rau bronchospasm, hypotension:
- tshuaj loog overdose;
- thromboembolism vim yog huab cua nkag lossis kev loj hlob ntawm atherosclerosis;
- mob plab plab aspiration syndrome;
- myocardial infarction, pericardial tamponade;
- septic shock;
- pulmonary edema thiab lwm yam cim tsis cuam tshuam rau kev ua xua.
Kev saib xyuas xwm txheej ceev rau kev tsim kho sai sai ntawm cov tshuaj anaphylactic thiab anaphylactoid cov tshuaj tiv thaiv tsis txawv ntawm cov txheej txheem tsom rau kev tshem tawm thiab kho kev poob siab anaphylactic.
Urgent Action Order
Nrog rau kev ua xua, kev tsim nyog ntawm cov kws kho mob thiab kev pabcuam sai li sai tau yog tus yuam sij rau kev kho kom zoo.
Cov kev ntsuas tseem ceeb los nres anaphylaxis ntawm hom tam sim no yog qhov yuav tsum tau ua ntawm ntau theem:
- Kev taw qhia ntawm qhov tsis lees paub tab sis muaj peev xwm txaus ntshai antigen yuav tsum raug tso tseg.
- Anaphylactic lossis anaphylactoid cov tshuaj tiv thaiv (cov duab hauv kab lus qhia kom meej meej pom qhov tshwm sim feem ntau thiab cov tsos mob ntawm pathology), uas tshwm sim thaum siv tshuaj loog lossis thaum phais, yuav tsum tau ncua tam sim. Yuav tsum yogib qho kev kuaj xyuas qhov tseeb ntawm kev qhia txog kev ua xua. Nrog ib tug ntse dhia hauv ntshav siab, nws yog ib qhov tsim nyog los cuam tshuam cov khoom siv tshuaj loog. Nyob rau hauv cov ntaub ntawv ntawm bronchospasm, inhalation anesthetics yuav tsum tau.
- Kev ua pa thiab cua patency yuav tsum tau ua kom ntseeg tau txawm tias nyob rau theem thaum tus neeg mob tus mob tsis tau hnyav heev. Lub ntsws xav tau intubation tas li, kom txog thaum nws paub meej tias txoj hlab pa yog patency muab los ntawm lub cev ntawm nws tus kheej.
- Cov tshuaj tiv thaiv Anaphylactoid, kev kho mob uas yuav tsum tau txhaj tshuaj adrenaline, yog qhov txaus ntshai rau tus neeg mob txawm tias ob peb teev tom qab tshem tawm ntawm bronchospasm. Cov koob tshuaj ntawm adrenaline nrog kev rov ua dua tuaj yeem nce ntxiv, vim tias cov tshuaj no muaj txiaj ntsig zoo rau kev ruaj khov ntawm cov hlwb mast, txo cov permeability ntawm endothelium ntawm cov hlab ntsha, uas yog qhov tseem ceeb heev hauv kev kho mob anaphylaxis.
- Thaum muaj qhov xav tau ceev kom resuscitation, nws tseem ceeb heev kom ua kom lub ntim ntawm cov kua hauv lub cev. Txog rau qhov kawg no, cov kws kho mob muab ib lub catheter ntawm ib txoj kab uas hla tseem ceeb intravenously (cov hlab ntsha siv tej zaum yuav tsis yog ib txwm nyob hauv nruab nrab - lub sij hawm mus nrhiav nws muaj peev xwm ua si tawm tsam tus neeg mob tus mob) thiab ncuav ob peb litres ntawm crystalloids.
- Yog tias nws tsis tuaj yeem kuaj pom cov tshuaj tsis haum uas ua rau muaj kev cuam tshuam anaphylactoid, nws tsim nyog ua tib zoo saib xyuas kev siv cov khoom latex thaum sib cuag nrog tus neeg mob. Cov hnab looj tes phais, tshuaj kos los ntawm lub kaus mom latexvials, urinary catheters - tag nrho cov no tuaj yeem ua rau anaphylaxis.
Tom qab kev kho mob xwm txheej ceev, cov tshuaj tiv thaiv anaphylactoid (nrog rau cov tshuaj tiv thaiv anaphylactic) yuav tsum muaj kev kho mob ntev txhawm rau tiv thaiv kev rov tshwm sim ntawm cov kab mob. Kev tsis saib xyuas cov kws kho mob cov lus qhia yuav ua rau muaj kev pheej hmoo ntawm kev nthuav dav ntau yam ntawm cov khoom ua xua.
Txoj kev kho mob
Ntawm cov kev pabcuam tshuaj rau kev kho mob bronchospasm, lub luag haujlwm tseem ceeb yog cov tshuaj "Salbutomol", nws tuaj yeem hloov tau los ntawm "Aminophylline". Yog tias ua tau, lawv kuj siv rau kev nqus pa nrog isoproterenol lossis orciprenaline. Txij li thaum cov tshuaj tiv thaiv anaphylactoid yog ib qho kev kho mob tshwm sim uas cov tsos mob tuaj yeem ua rau nyuaj, nws yuav tsum tau siv cov glucocorticoids (piv txwv li, Dexamethasone, Hydrocortisone), uas inhibit cov txheej txheem ntawm cov hlab plawv..
Feem ntau, qhov kev pab ntawm anaphylactic poob siab yog nrog los ntawm kev ceeb toom ntev ntawm cov kws kho mob. Qhov tseeb yog tias kev txhim kho ntawm kev ua haujlwm lig tuaj yeem tshwm sim, yog li ntawd, nrog rau ib qho kev mob hnyav ntawm tus neeg mob, kev mus pw hauv tsev kho mob yog qhov kev txiav txim siab tsis meej. Cov kws kho mob tseem xav txog qhov kev kuaj tawv nqaij yav tom ntej txhawm rau txhawm rau kuaj cov tshuaj tiv thaiv tshwj xeeb uas yuav tsum tau ua.
Tiv thaiv anaphylactic thiab anaphylactoid cov tshuaj tiv thaiv
Kev noj qab haus huv keeb kwm yog qhov kev ntsuas zoo tshaj plaws los tiv thaiv thiab tiv thaiv kev rov tshwm sim anaphylaxis. Tau sau tag nrhocov ntaub ntawv tsim nyog hais txog cov txheej txheem ntawm tus kab mob, nws muaj peev xwm txheeb xyuas tus neeg mob los ntawm pab pawg muaj kev pheej hmoo thiab txiav txim siab dab tsi cuam tshuam nws nrog kev rov ua haujlwm anaphylactoid. Qhov no txhais li cas?
Vim tias txhua qhov kev tawm tsam tom ntej tuaj yeem hnyav dua, cov neeg mob yuav tsum tau ceev faj xaiv cov tshuaj nyob rau hauv cov tshuaj loog thiab thaum lub sij hawm kho mob hnyav. Ua ntej kev hloov ntshav, cov tib neeg uas muaj anaphylaxis raug kuaj kom ua tau raws li cov khoom siv ntshav.
Qhov muaj qhov tsis haum rau cov khoom latex ua ntej txiav txim siab txog yav tom ntej ntawm ntau yam kev siv yam tsis tas siv cov khoom zoo li no.
