Hemorrhagic syndromes hauv cov menyuam yug tshiab, hmoov zoo, muaj tsawg heev. Thiab daim ntawv hnyav ntawm tus kab mob no tseem tsawg dua. Tab sis txawm tias qhov tseeb no yuav tsum tsis txhob ua rau koj xav tias qhov no yuav tsis cuam tshuam rau koj. Tom qab tag nrho, raws li koj paub, forewarned yog forearmed. Yog li ntawd, nws tsim nyog saib xyuas txhua yam tsos mob hauv koj tus menyuam kom cawm nws txoj sia thiab kev noj qab haus huv. Nyeem tsab xov xwm no kom paub ntau ntxiv txog tus kab mob no, nrog rau cov tsos mob thiab kev kho mob.
Hemorrhagic syndrome hauv cov menyuam mos: nws yog dab tsi?
Tus kab mob Hemorrhagic ntawm tus menyuam mos yog ib yam kab mob los yog kis tau. Nws yog tus cwj pwm los ntawm kev los ntshav ntau ntxiv uas tshwm sim los ntawm qhov tsis muaj qee yam ntawm cov ntshav txhaws uas nyob ntawm cov ntsiab lus ntawm vitamin K.
Tus kab mob no feem ntau yog 0,3-0.5% ntawm tag nrho cov me nyuam mos. Tab sis tom qab kev qhia txog vitamin K prophylaxis, cov xwm txheej zoo li no tseem tsis tshua muaj - 0.01%.
Tus kab mob no tshwm sim los ntawm ntuav cov ntshav, daim tawv nqaij hematomas, cov quav los ntshav thiab los ntshav. Qee lub sij hawm muaj hemorrhagic shock, jaundice thiab yaig ntawm txoj hnyuv.
Vitamin K thiab nws txoj haujlwm hauv lub cev
Vitamin K - nws tseem hu ua antihemorrhagic lossis coagulation factor. Vitamin K yog ib pab pawg ntawm cov vitamins uas tseem ceeb rau kev tsim cov protein thiab ua kom cov ntshav khov. Nws kuj tseem ceeb hauv cov metabolism hauv cov ntaub so ntswg sib txuas, hauv cov pob txha thiab lub raum ua haujlwm.
Kev tsis txaus ntawm cov vitamin no tshwm sim los ntawm kev tsis txaus ntawm cov zaub mov hauv cov hnyuv. Qhov no ua rau kev tsim tsis tiav ntawm HLA radicals, uas tsis ua tiav lawv txoj haujlwm. Raws li qhov tshwm sim ntawm qhov tsis muaj vitamin K, kev ua haujlwm ntawm cov hlab ntshav tau cuam tshuam. Tsis tas li ntawd, qhov tsis txaus no tuaj yeem ua rau pob txha ossification, pob txha deformity, los yog cov ntsev tso rau hauv cov hlab ntsha. Nws tau raug pov thawj tias cov neeg laus tsis tshua muaj kev txom nyem los ntawm qhov tsis txaus ntawm cov vitamin no, txij li cov kab mob plab hnyuv tsim nws kom txaus. Tab sis hauv cov menyuam yaus, muaj ntau qhov laj thawj vim tias daim tawv nqaij hemorrhagic syndrome tshwm sim hauv cov menyuam mos.
Vitamin K muaj nyob hauv cov zaub mov nram qab no: tshuaj yej ntsuab, kale, spinach, nplej (bran), taub dag, avocado, txiv tsawb, kiwi, khoom noj siv mis, qe, thiab zaub txhwb qaib.
Tab sis, piv txwv li, ntau dhau ntawm cov vitamin K yuav ua rau cov platelets nce ntxiv, nce ntshav viscosity. KujNws yog qhov tsis tsim nyog siv cov khoom noj uas muaj vitamin K rau cov neeg mob thrombophlebitis, migraines, varicose veins, thiab cov neeg muaj roj cholesterol siab.
kab mob thiab cov tsos mob
Muaj peb hom kev tshwm sim ntawm hemorrhagic syndrome hauv cov menyuam mos:
- Early form. Thaum ntxov ntawm tus kab mob no yog yus muaj los ntawm xws li tshwm sim: nyob rau hauv thawj teev los yog hnub ntawm ib tug me nyuam lub neej, hematemesis, hemorrhages nyob rau hauv lub nruab nrog cev (adrenal qog, spleen, siab). Tsis tas li ntawd, tus kab mob no tuaj yeem pib hauv utero, thiab qhov no yuav raug kuaj pom thaum yug los, thaum tus menyuam yuav pom cov tawv nqaij hemorrhages thiab intracranial hemorrhage. Daim foos no muaj tsawg heev thiab feem ntau tshwm sim los ntawm leej niam cov tshuaj.
- Classic shape. Daim ntawv no yog tshwm sim los ntawm hemorrhage nyob rau hnub thib ob lossis thib tsib ntawm tus menyuam lub neej. Nyob rau hauv daim ntawv classic, qhov ntswg los ntshav, daim tawv nqaij hemorrhages tshwm tom qab kev txiav ntawm cov nqaij nyob rau hauv cov tub hluas los yog tom qab cov seem seem ntawm lub pob txha poob tawm. Cov menyuam yaus uas raug kev txom nyem los ntawm kev yug me nyuam thiab hypoxia kuj tseem muaj kev pheej hmoo ntawm intracranial los ntshav, sab hauv hematomas, thiab lwm yam. Ischemic daim tawv nqaij necrosis vim mob thrombotic tuaj yeem tshwm sim. Raws li cov tsev kho mob, hom kab mob no feem ntau tshwm sim.
- Daim ntawv lig. Late hemorrhagic syndrome ntawm tus me nyuam yug tshiab tshwm sim tom qab ob lub lis piam ntawm tus me nyuam lub neej. Qhov no tshwm sim tawm tsam keeb kwm yav dhau los ntawm cov kab mob yav dhau los. Manifested raws li intracranial los ntshav(raws li 50% ntawm cov neeg mob), nrog rau cov hemorrhage uas nws kim heev, chalky (semi-kua dub quav nrog ib qho tsis kaj siab tsw) thiab los ntshav los ntawm daim tawv nqaij qhov chaw txhaj tshuaj. Thaum muaj teeb meem, hemorrhagic shock yuav tshwm sim.
Kev cais raws hom ntshav
Hemorrhagic Syndrome nyob rau hauv cov me nyuam mos yog ib yam kab mob loj heev. Txhawm rau txiav txim siab nws txoj kev sib raug zoo nrog lwm cov kab mob, hauv cov tshuaj, hom ntshav ntshav tau coj mus rau hauv tus account hauv kev kuaj mob. Cov hauv qab no yog qhov txawv:
- Hematoma. Nws feem ntau tshwm sim los ntawm kev raug mob thiab manifests nws tus kheej nyob rau hauv daim ntawv ntawm bruises ntawm daim tawv nqaij, pob qij txha, cov leeg. Vim yog cov kev tshwm sim no, ntau yam deformities raug tsim, nrog rau kev nruj ntawm cov pob qij txha, pob txha loj thiab contractures. Los ntshav muaj lub sijhawm ntev ntawm qhov tshwm sim, thiab yav tom ntej, kev phais yuav tsum tau ua. Cov kab mob zoo sib xws tuaj yeem pom hauv hemophilia.
- Vasculitis ntshav liab. Nws tshwm sim los ntawm o ntawm cov hlab ntsha uas tshwm sim los ntawm kev kis kab mob thiab kev puas tsuaj ntawm cov kab mob autoimmune. Outwardly, nws yog sawv cev los ntawm cov pob liab liab thoob plaws lub cev, cov npuas me me uas tig mus rau hauv cov pob txha. Yog tias lawv tshwm sim rau ntawm lub plab mucosa, lawv tuaj yeem ua rau mob hnyav heev, zoo ib yam li kev kub ntxhov. Hom ntshav no tuaj yeem ua rau tus kab mob Henoch-Schonlein lossis kab mob hemorrhagic fevers.
- Petechial pom. Nws yog manifested los ntawm asymmetrical kev npaj ntawm me me petechiae. Loj hematomas tsim tsawg heev. Feem ntau, cov no yog los ntshav los ntawm cov pos hniav, los ntawm lub qhov ntswg, cov ntshav nyob rau hauv cov zis thiab uterine los ntshav nyob rau hauv cov poj niam. Muaj kev pheej hmoo mob stroke. Cov ntshav no yog cov yam ntxwv ntawm kev mob: thrombocytopathy, ntshav txhaws, thrombocytopenic mob thiab tsis muaj fibrinogen.
- Angiomatous. Nws tshwm sim vim muaj ntau hom angiomas, telangiectasias lossis arteriovenous shunts.
- Nco. tshwm sim vim muaj kev txawv txav hauv cov ntshav txhaws lossis ntau dhau ntawm fibrinolytics thiab anticoagulants.
Pathogenesis. Yuav ua li cas?
Pim mob hemorrhagic syndromes hauv cov menyuam mos liab feem ntau yog vim qhov tseeb tias tus me nyuam mos muaj cov ntsiab lus ntawm cov vitamin K tsawg. Tsis tas li ntawd, thaum tus me nyuam yug los, ib koob me me ntawm vitamin K los ntawm leej niam lub mis. Tab sis kev tsim cov tshuaj vitamin no los ntawm cov hnyuv yuav pom tau tsuas yog 3-5 hnub tom qab yug me nyuam.
Cov me nyuam yug ntxov ntxov muaj qib qis ntawm kev sib txuas ntawm cov ntshav coagulation yam. Nyob rau hauv lub lig daim ntawv ntawm tus kab mob, ib tug kab mob ntawm cov ntshav txhaws tshwm sim los ntawm lub siab kab mob los yog malabsorption syndrome (kev puas tsuaj ntawm cov txheej txheem thiab kev ua hauj lwm nyob rau hauv cov hnyuv me).
Melena yog ib qho ntawm cov teeb meem tshwm sim ntawm cov kab mob hemorrhagic hauv cov menyuam yug tshiab. Qhov ua rau ntawm nws tshwm sim yog tsim ntawm me me rwj nyob rau hauv lub plab mucosa, nce acidity ntawm gastric kua txiv, gastroesophageal reflux (tso tawm ntawm lub plab cov ntsiab lus rau hauv txoj hlab pas) thiab peptic esophagitis (mob siab, belching thiab qhuav.hnoos).
Ntxiv rau, yam uas tuaj yeem ua rau muaj kev loj hlob ntawm cov kab mob hypovitaminosis K tuaj yeem yog: raws plab (ntau tshaj 1 lub lis piam), biliary atresia (congenital pathology), kab mob siab thiab mob daj ntseg.
Yog vim li cas
Ntau qhov ua tau ntawm tus kab mob no twb tau teev tseg saum toj no, yog li nws tsim nyog sau cov lus tau hais thiab ntxiv ob peb yam. Yog li, qhov ua rau hemorrhagic syndrome hauv cov menyuam yug tshiab tuaj yeem yog:
- yug me nyuam ntxov;
- niam siv tshuaj tiv thaiv kab mob thaum cev xeeb tub;
- niam txiv tsis zoo;
- siv tshuaj tua kab mob lossis tshuaj tiv thaiv kab mob thaum cev xeeb tub;
- enteropathy nyob rau hauv niam (ua txhaum lossis ua tsis tiav ntawm kev tsim cov enzymes uas koom nrog hauv kev zom zaub mov);
- niam txiv kab mob siab (kab mob siab);
- plab hnyuv dysbacteriosis;
- preeclampsia (late toxicosis ntawm cov poj niam cev xeeb tub);
- kab mob siab rau menyuam yaus;
- malformations (cov qauv tsis raug ntawm cov kab mob biliary);
- malabsorption syndrome;
- tsis muaj kev tiv thaiv tom qab yug menyuam, kev tswj hwm ntawm vitamin K analogues;
- pub mis rau menyuam;
- tshuaj tua kab mob.
Primary diagnostics
Kev kuaj mob ntawm daim tawv nqaij-hemorrhagic syndrome hauv cov menyuam yug tshiab yog ua los ntawm kev qhia meej txog yam, thiabkuj yog ib qho kev soj ntsuam ntxaws, kev soj ntsuam cov txiaj ntsig ntawm kev sim. Tom qab noj keeb kwm, tus kws kho mob yuav tsum pom:
- niam noj tshuaj;
- malnutrition;
- kab mob uas tuaj yeem ua rau hemorrhagic syndrome hauv menyuam yaus.
Ntxiv rau, tus kws kho mob nug cov lus nug txog thawj cov tsos mob ntawm tus menyuam mob thiab qhov hnyav ntawm nws qhov tshwm sim. Nrog hemorrhagic syndrome nyob rau hauv cov me nyuam mos, cov txheej txheem tau ua tiav tom qab txhua yam ntawm lub cev kev tshawb fawb.
Tom qab ntawd kev tshuaj xyuas lub cev yog ua tiav, uas yog, kev tshuaj xyuas thiab kev ntsuas ntawm lub xeev ntawm kev nco qab ntawm tus menyuam, nws lub cev ua si. Xws li kev ntsuam xyuas yuav tuaj yeem txiav txim siab hemorrhages ntawm daim tawv nqaij, jaundice, thiab hemorrhagic shock.
Lab kuaj mob
Cov kev tshawb fawb hauv chaw kuaj mob tau muab los txiav txim thiab ntsuas hemostasis (lub cev cov kev cuam tshuam, kev ua haujlwm uas yog los tiv thaiv thiab tsis txhob los ntshav). Kev sau cov kev txheeb xyuas suav nrog:
- ntsuas lub sijhawm thrombin (qhov taw qhia ntawm cov ntshav coagulation);
- kawm txog cov nyiaj fibrinogen (koom nrog ua tiav cov txheej txheem ntshav coagulation);
- tshuaj xyuas qib platelets (kom ntseeg tau tias ntshav txhaws);
- txiav txim siab lub sijhawm ntawm kev tshem tawm cov ntshav txhaws (txheej txheem ntawm kev sib cog lus thiab kev cog lus ntawm cov ntshav);
- ntsuas cov ntshav txhaws lub sijhawm raws li Burker;
- txiav txim siab lub sijhawm ntawm cov ntshav rov ua kom rov ua dua (qhov taw qhia ntawm lub xeev ntawm ib theem ntawm cov ntshav coagulation).
Yog qhov ua rau thiab qhov tshwm sim ntawm hemorrhagic syndrome hauvCov menyuam mos yug tshiab tsis tau txheeb xyuas, tom qab ntawd tau muab tshuaj ultrasound, uas yuav pom cov ntshav hauv cov pob txha pob txha.
Ntxiv rau, kev kuaj mob ntxiv tuaj yeem raug sau:
- kab mob coagulopathy;
- thrombocytopenic purpura (ib kab mob uas muaj cov platelet tsawg);
- DIC (nce ntshav txhaws vim muaj kev tso tawm ntawm cov tshuaj thromboplastic los ntawm cov ntaub so ntswg).
Kev kho mob
Hemorrhagic syndromes hauv cov menyuam mos yog kho los ntawm kev qhia cov vitamin K analogs (tseem hu ua vikasol) rau hauv tus menyuam lub cev. Cov tshuaj 1% no yog muab rau tus menyuam intramuscularly rau 2-3 hnub ib zaug txhua 24 teev.
Yog tias lub neej ntawm tus menyuam yug tshiab raug hem los ntawm kev los ntshav thiab lawv qhov kev siv zog siab, ces cov kws kho mob muab cov tshuaj prothrombin complex npaj ntawm tus nqi ntawm 15-30 U / kg lossis cov ntshav khov tshiab 10-15 ml ib 1 kg ntawm tus me nyuam lub cev.
Yog tias tus menyuam muaj qhov poob siab hemorrhagic, ces cov kws kho mob tshwj xeeb ua cov tshuaj infusion (qhia cov tshuaj rau hauv cov hlab ntsha tom qab hloov cov ntshav khov tshiab). Tom qab ntawd, yog tias tsim nyog, tus menyuam tau hloov pauv nrog erythrocyte loj 5-10 ml / kg.
Kev pab ib zaug
Kev pab xub thawj, raws li koj paub, tuaj yeem cawm txoj sia, thiab nrog cov mob hemorrhagic hauv cov menyuam yug tshiab - qhov no tsis muaj qhov zam. Cov dej num uas pom zoo yog:
- Txhob los ntshav. Txhawm rau ua qhov no, koj yuav xav tau cov ntaub qhwv lub siab (yog tias muaj ntshav los ntawm cov leeg), ib qhopob dej khov (thaum muaj cov ntshav hauv lub cev), turundas lossis swabs (yog tias qhov ntswg los ntshav), tourniquet (nyob rau hauv cov hlab ntsha los ntshav).
- Txhaj aminocaproic acid los ntawm dav hlau lossis drip rau hauv cov leeg.
- Txhaj ntshav hloov pauv: dextran, saline lossis plasma npaj.
- Nco ntsoov saib xyuas txhua qhov ntsuas: ua pa, lub cev kub, mem tes thiab ntshav siab.
- Nws yog ib qho tseem ceeb kom tus menyuam mus pw hauv tsev kho mob.
Huab cua
Thaum hemorrhagic syndrome hauv cov menyuam yug tshiab, qhov tshwm sim thiab kev mob tshwm sim tuaj yeem ua tau zoo heev. Ntawd yog, yog tias pom muaj tus kab mob me me, thiab kev kho mob raws sij hawm, ces qhov kev cia siab yuav zoo. Tab sis, hmoov tsis, cov neeg mob tau piav qhia hauv cov tshuaj thaum tus kab mob tshawb pom lig ua rau muaj teeb meem ntawm tus mob thiab txawm tias tuag.
Kev mob nkeeg
Qhov tshwm sim yog dab tsi thiab sijhawm npaum li cas los kho tus mob hemorrhagic hauv cov menyuam mos? Qhov no yuav nyob ntawm seb cov niam txiv tau them sai sai rau qhov kev hloov pauv sab nraud thiab sab hauv ntawm tus menyuam. Ntawm qhov tshwm sim tau tshwm sim, feem ntau tuaj yeem paub qhov txawv:
- b hlwb hemorrhages;
- adrenal insufficiency;
- hnyav sab hauv los ntshav;
- kev mob plawv;
Hypovolemic poob siab kuj feem ntau yog qhov tshwm sim, thiab nws tshwm sim nws tus kheej hauv daim ntawv ntawm lub cev kub, pallor ntawm daim tawv nqaij, ntshav siab thiab tsis muaj zog.
Yuav tiv thaiv txhua qhov no, ua li casTsuas yog thawj cov tsos mob ntawm hemorrhagic syndrome tshwm sim, nws yog ib qho tseem ceeb mus ntsib kws kho mob sai li sai tau.
Hemorrhagic syndrome hauv cov menyuam yug tshiab - cov lus qhia kho mob
Txhawm rau zam qhov tshwm sim hnyav tshaj plaws ntawm tus mob no, nws yog ib qho tsim nyog yuav tsum tau noj vikasol rau kev tiv thaiv kab mob rau cov menyuam yug tshiab uas muaj kev pheej hmoo rau cov laj thawj saum toj no. Pab pawg txaus ntshai no suav nrog cov menyuam yaus:
- yog leej niam txhawj xeeb txog dysbacteriosis thaum cev xeeb tub;
- muaj sia nyob ib qho nyuaj thiab raug mob;
- mob asphyxia thaum yug;
- yog leej niam tau noj tshuaj uas cuam tshuam rau coagulation;
- tus neeg yug los ntawm kev phais.
Yog tias cov niam txiv muaj teeb meem hemorrhagic, ces koj yuav tsum ua raws li kev noj haus uas yuav tsum muaj cov vitamins A, C, E (cuam tshuam rau lub zog ntawm cov hlab ntsha) thiab K, zaub, txiv hmab txiv ntoo thiab cov proteins. Sim kom tsis txhob raug mob lossis lwm yam kev puas tsuaj. Tsis tas li ntawd, cov neeg uas muaj tus kab mob no yuav tsum tau kuaj xyuas los ntawm kws kho mob. Yog koj npaj yuav xeeb tub ces koj yuav tsum mus cuag kws tshuaj caj ces.
Txhua tus paub tias yog qhov zoo tshaj rau kev tiv thaiv thiab tiv thaiv kev loj hlob ntawm tus kab mob dua li kev tswj hwm ntawm kws kho mob tas li koj lub neej.
Kab lus no ib zaug ua pov thawj tias txhua yam txheej txheem hauv lub cev, txawm li cas los xij, nws yuav yog, sib cuam tshuam, thiab yog tias ib qho kev sib tsoo, lwm tus yuav tsis ua haujlwm raug. Qhov tsuas yog qhov uas txaus siab yog qhov tseeb tias edematous-hemorrhagic syndrome nyob rau hauv cov menyuam yug tshiab tsis tshua pom nyob rau hauv qhov xwm txheej tseem ceeb thiab tuaj yeem kho tau.
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