Dressler's syndrome nyob rau hauv cardiology yog pericarditis ntawm tus kab mob autoimmune ntawm keeb kwm, uas tshwm sim ob peb lub lis piam tom qab myocardial infarction hauv daim ntawv mob. Qhov teeb meem no yog tshwm sim los ntawm cov tsos mob ntawm triad: mob hauv siab, pulmonary manifestations (hnav, hawb pob, ua tsis taus pa), rub suab nrov ntawm cov nplooj ntawv ntawm pericardium.
Dressler's syndrome nyob rau hauv cardiology (los yog post-infarction syndrome) yog ib qho kev puas tsuaj autoimmune rau cov ntaub so ntswg ntawm pericardial sac. Qhov no yog ib qho teeb meem uas tshwm sim los ntawm kev tiv thaiv kab mob tsis txaus rau kev hloov pauv hauv myocardial proteins. Cov txheej txheem pathological no tau piav qhia los ntawm kws kho mob plawv los ntawm Asmeskas W. Dressler hauv xyoo 1955. Hauv nws txoj kev hwm, tus kab mob tau txais nws lub npe thib ob. Tsis tas li ntawd, hauv cov ntaub ntawv kho mob koj tuaj yeem pom cov ntsiab lus xws li: post-infarction polyserositis, lig pericarditis, post-traumatic, post-cardiotomy thiab pericardial syndrome. Feem ntau, qhov tshwm sim ntawm qhov teeb meem ntawm infarction yog 3-4%. Txawm li cas los xij, raws li cov ntaub ntawv los ntawm ntau qhov chaw,coj mus rau hauv tus account asymptomatic thiab atypical cov ntaub ntawv, qhov teeb meem no tshwm sim nyob rau hauv kwv yees li 15-30% ntawm cov neeg mob uas tau raug kev txom nyem dua, nyuaj los yog dav myocardial infarction.
Yog vim li cas
Qhov pib ua rau Dressler's syndrome hauv plawv plawv yog ib qho mob ischemic ntawm cov txheej txheem fibers ntawm lub plawv cov leeg, uas ua rau kev tuag ntawm cardiomyocytes. Feem ntau, nws tshwm sim nrog ib qho nyuaj macrofocal infarction. Thaum lub sij hawm kev puas tsuaj ntawm cov ntaub so ntswg necrotic, denatured proteins pib nkag mus rau hauv cov hlab ntsha. Lub cev tiv thaiv kab mob, nyob rau hauv lem, reacts rau lawv zoo li yog txawv teb chaws. Raws li qhov tshwm sim, cov tshuaj tiv thaiv autoimmune tshwm sim, uas yog qhov ua rau kev txhim kho ntawm post-infarction syndrome.
Cov ntshav antigens nkag mus rau hauv pericardium hauv cov txheej txheem ntawm myocardial kev ncaj ncees yog qhov tseem ceeb hauv kev tsim cov tsos mob ntawm qhov teeb meem ntawm lub plawv nres. Yog li ntawd, nyob rau hauv tas li ntawd mus rau lub mob theem, tus tshwm sim rau tsim ntawm tus kab mob yuav ua tau hemopericardium, yam ntxwv los ntawm hemorrhage mus rau hauv lub pericardial kab noj hniav. Tsis tas li ntawd, tus mob no yuav yog vim lub hauv siab raug mob, mob plawv, lossis kev phais plawv tsis txaus. Kuj tseem muaj kev pheej hmoo yog cov neeg mob post-infarction nrog autoimmune pathologies. Qee tus kws kho mob ntseeg tias tus kab mob kis tau los ntawm kev txhim kho cov txheej txheem inflammatory. Txawm li cas los xij, cov kws kho plawv tseem tsis tau muaj lus teb meej txog qhov teeb meem no.
Pathogenesis
SyndromeDressler hauv cardiology yog cov txheej txheem autoimmune uas tsim los ntawm kev siv zog ntawm kev tsim cov tshuaj tiv thaiv rau lub plawv antigens. Hauv qhov no, kev ua txhaum loj ntawm cov txheej txheem ntawm cov ntshav xa mus rau myocardium thiab kev tuag ntawm nws cov hlwb entails resorption ntawm necrosis aav thiab tso tawm cov khoom denatured rau hauv cov hlab ntsha. Qhov no ua rau muaj kev loj hlob ntawm kev tiv thaiv kab mob nrog kev tsim ntawm autoantibodies, qhov kev txiav txim ntawm uas yog qhia tawm tsam cov proteins uas muaj nyob rau hauv cov muaj pes tsawg leeg ntawm cov serous integument ntawm lub hom phiaj kab mob.
Immune antibodies rau cardiomyocytes, uas muaj ntau nyob rau hauv cov ntshav ntawm cov neeg mob postinfarction, tsim cov tshuaj tiv thaiv kab mob nrog cov ntsiab lus ntawm cov hlwb ntawm lawv cov ntaub so ntswg. Lawv circulate dawb nyob rau hauv cov hlab ntsha, sib sau nyob rau hauv lub visceral, pericardial pleura thiab nyob rau hauv lub puab tsaig ntawm articular capsules, provoking ib aseptic inflammatory txheej txheem. Ntxiv rau qhov no, qib ntawm cytotoxic lymphocytes pib nce, uas rhuav tshem cov hlwb hauv lub cev. Yog li, lub xeev ntawm ob qho tib si humoral thiab cellular tiv thaiv yog qhov cuam tshuam loj heev, uas lees paub qhov autoimmune xwm ntawm cov tsos mob complex.
Ntau yam
Dressler's syndrome tom qab myocardial infarction - yog dab tsi? Tus kab mob no tau muab faib ua 3 hom. Nyob rau hauv txhua tus ntawm lawv kuj muaj ob peb subspecies, kev faib tawm uas yog raws li nyob rau hauv localization ntawm o. Yog li, Dressler's syndrome tshwm sim:
1. Hom. Cov kev kho mob tshwm sim ntawm daim ntawv no yog txuam nrog o ntawm visceral pleura, pericardium thiab pulmonary.ntaub. Nws suav nrog kev sib xyaw ua ke thiab ib qho txawv ntawm autoimmune puas tsuaj rau cov ntaub so ntswg sib txuas:
- pericardial - cov parietal thiab visceral txheej ntawm lub hnab pericardial ua o;
- pneumonic - infiltrative disorders yog tsim nyob rau hauv lub ntsws, ua rau mob ntsws;
- pleural - lub pleura dhau los ua lub hom phiaj ntawm cov tshuaj tiv thaiv, cov cim qhia ntawm hydrothorax tsim;
- pericardial-pleural - muaj cov tsos mob ntawm kev nkag siab ntawm lub pleura thiab serosa ntawm pericardium;
- pericardial-pneumonic - cov ntaub so ntswg pericardial thiab lub ntsws raug cuam tshuam;
- pleural-pericardial-pneumonic - mob kis los ntawm lub plawv lub hnab mus rau lub ntsws thiab cov kab mob pleural.
2. Atypical. Daim ntawv no yog tus cwj pwm los ntawm kev sib txawv los ntawm kev swb ntawm cov tshuaj tiv thaiv kab mob hauv cov pob qij txha thiab cov ntaub so ntswg vascular. Nws yog nrog los ntawm cov txheej txheem inflammatory nyob rau hauv cov pob qij txha loj lossis cov tawv nqaij: pectalgia, "lub xub pwg nyom syndrome", erythema nodosum, dermatitis.
3. Asymptomatic (tshem tawm). Nrog rau daim ntawv no, nrog cov tsos mob me me, ua npaws, mob caj dab thiab hloov pauv ntawm cov ntshav dawb.
Thaum kuaj pom cov kab mob atypical thiab tshem tawm cov tsos mob, qee qhov teeb meem feem ntau tshwm sim, uas ua rau kev kawm tob tshaj plaws ntawm tus kab mob no cuam tshuam.
Symptoms
Classic Dressler syndrome tshwm sim kwv yees li 2-4 lub lis piam tom qab lub plawv nres. Rau feem ntauCov tsos mob muaj xws li hnyav thiab mob hauv siab, ua npaws, hnoos, ua tsis taus pa. Cov txheej txheem pathological feem ntau pib mob hnyav, nrog rau qhov kub thiab txias rau febrile lossis subfebrile cov cim. kiv taub hau, qaug zog, xeev siab tshwm sim, ua pa thiab mem tes nrawm.
Pericarditis yog ib qho tseem ceeb ntawm cov tsos mob complex. Rau nws, qhov kev hnov mob ntawm qhov sib txawv ntawm qhov chaw hauv plawv yog qhov raug, txuas mus rau lub plab, caj dab, lub xub pwg nyom, lub xub pwg hniav thiab ob txhais tes. Qhov mob tej zaum yuav ntse, paroxysmal, los yog npub, nyem. Thaum nqos thiab hnoos, nruj hauv siab tau sau tseg, qhov mob hnyav zuj zus. Nyob rau hauv txoj hauj lwm pw ntawm lub plab los yog sawv, nws tsis muaj zog. Palpitations, ua tsis taus pa luv, ua tsis taus pa nquag nquag pom. Hauv 85% ntawm cov neeg mob, muaj kev sib txhuam ntawm cov nplooj ntawv pericardial. Tom qab ob peb hnub, qhov mob tshwm sim. Ib tug yam ntxwv tshwm sim ntawm pleurisy yog ib tug unilateral stabbing mob nyob rau hauv lub Upper cheeb tsam ntawm lub cev, uas intensifies nrog ib tug sib sib zog nqus pa thiab qaij mus rau lub noj qab nyob zoo sab.
Rau mob ntsws feem ntau ua pa tsis muaj zog, hawb pob, ua tsis taus pa, hnoos. Tsis tshua muaj tshwm sim hauv qab lobe pneumonia. Tus kab mob no nrog rau kev qaug zog, tawm hws ntau dhau thiab febrile syndrome. Ntshav impurities tuaj yeem tshwm sim hauv cov hnoos qeev. Hauv cov kab mob atypical, cov haujlwm ntawm cov pob qij txha raug cuam tshuam.
Pericarditis thiab Dressler's syndrome
Pericarditis yog ib qho mob ntawm lub hnab pericardial ntawm rheumatic, kis los yog tom qab mob. Pathology yog manifested los ntawm kev qaug zog, mob tom qab lub sternum, uasaggravated los ntawm inhalation thiab hnoos. Yuav tsum tau so hauv txaj los kho pericarditis. Nyob rau hauv cov ntaub ntawv ntawm ib tug ntev daim ntawv ntawm tus kab mob, lub regimen yog txiav txim los ntawm tus neeg mob tus mob. Nyob rau hauv mob fibrinous pericarditis, cov tsos mob ntawm kev kho mob yog muab: anti-inflammatory nonsteroidal tshuaj, analgesics kom tshem tawm qhov mob, tshuaj uas normalize metabolic dab nyob rau hauv lub plawv cov leeg, thiab lwm yam. Hauv Dressler's syndrome, pericarditis yog kho nrog cov tshuaj uas tshem tawm cov kab mob hauv qab.
Abdominal localization of the syndrome
Pathology yog txiav txim siab los ntawm peritonitis, txheej txheem inflammatory nyob rau hauv cov kab noj hniav sab hauv. Muaj daim duab kho mob vivid:
- mob siab, mob plab hauv plab. Lub zog ntawm kev hnov mob tau txo qis thaum pom lub cev xis nyob - feem ntau pw ntawm koj sab nrog ob txhais ceg;
- quav quav;
- hais kom kub nce ntxiv.
Nrog rau txoj kev loj hlob ntawm daim ntawv no ntawm tus mob no, nws yog ib qho tseem ceeb kom paub qhov txawv ntawm cov kab mob autoimmune los ntawm tus kab mob, uas feem ntau tshwm sim los ntawm pathologies ntawm lub plab zom mov. Kev kho mob tactics nyob ntawm cov txiaj ntsig ntawm kev kuaj mob raws sij hawm, uas feem ntau suav nrog kev siv ntau pawg tshuaj.
YKev kuaj mob ntawm pathology
Peb txuas ntxiv piav qhia txog Dressler's syndrome tom qab myocardial infarction. Tam sim no qhov tseeb yog dab tsi. Txawm li cas los xij, qhov xwm txheej tau piav qhia tsuas yog hauv cov ntaub ntawv dav dav, nws yog qhov zoo dua rau txhua tus neeg tshwj xeeb los sab laj nrog lawv tus kws kho mob. Thaum kuaj xyuas qhov teeb meem ntawm lub plawv nres, tus neeg mob qhov kev tsis txaus siab, tus yam ntxwvCov tsos mob thiab cov txiaj ntsig ntawm kev ntsuas ntsuas dav dav thiab kev kuaj hauv chav kuaj. Cov kev kuaj mob muaj txiaj ntsig uas muab cov duab tiav ntawm tus neeg mob tus mob muaj xws li:
- Cov txheej txheem kho mob. Cov cim qhia pom tias muaj feem yuav tshwm sim ntawm Dressler's polyserositis yog febrile fever thiab pericarditis.
- Kev tshawb fawb hauv chav kuaj. Hauv KLA yog ua tau: eosinophilia, leukocytosis, nce ESR. Tsis tas li ntawd, kev kuaj ntshav yog ua rau cov cim ntawm kev puas tsuaj rau lub plawv cov leeg. Kev nce qib ntawm globular proteins - troponin T thiab troponin I - lees paub qhov tseeb ntawm cell tuag.
- Hauv kev kuaj mob ntawm Dressler's syndrome, ib qho ECG feem ntau siv, uas qhia txog qhov tsis zoo. Cov cim feem ntau yog unidirectional txav ntawm ST ntu hauv ob peb txoj hauv kev.
- Ultrasound ntawm pericardium thiab kab noj hniav pleural.
- lub hauv siab x-ray. Nrog rau txoj kev loj hlob ntawm pleurisy, lub interlobar pleura thickens, nrog pericarditis, lub plawv duab ntxoov ntxoo nthuav, nrog mob ntsws, darkening nyob rau hauv lub ntsws yog txiav txim. Qee zaum, cardiomegaly pom meej meej hauv Dressler's syndrome tom qab mob plawv.
- Nyob rau hauv cov xwm txheej tsis paub meej, MRI ntawm lub ntsws thiab lub plawv tau raug tshuaj.
Kev kho tus kab mob no
Kev kho mob tshwm sim hauv qhov chaw nyob ruaj khov. Kev saib xyuas xwm txheej kub ntxhov rau Dressler's syndrome feem ntau tsis tas yuav tsum tau ua, vim tsis muaj kev hem thawj rau lub neej. Txawm li cas los xij, yog tias kev kho mob pib sai dua, txoj hauv kev rov qab los tau nce ntau.
MainLub luag haujlwm hauv cov kev ntsuas kev kho mob hauv postinfarction Dressler's syndrome yog ua los ntawm kev kho tshuaj, uas muaj ntau lub hom phiaj thiab koom nrog kev siv tshuaj ntau yam:
- Cardiotropic, uas pab tshem tawm cov mob plawv. Cov no yog cov tshuaj siv los kho cov kab mob coronary artery: beta-blockers, tshuaj antianginal, nitrates, calcium channel blockers, cardiac glycosides.
- Anti-inflammatory. Nyob rau hauv rooj plaub ntawm tsis kam mus rau NVPS, cov kev kawm luv luv ntawm kev tswj hwm glucocorticoid tau ua. Hauv cov kab mob hnyav, siv tshuaj ntawm lwm pab pawg ("Methotrexate", "Colchicine").
Anticoagulants vim qhov muaj feem ntau ntawm kev tsim hemopericardium hauv kev kho mob tom qab lub plawv nres tsis siv. Yog tias tsim nyog, lawv cov kev siv yog muab cov tshuaj subtherapeutic. Nyob rau hauv txhua rooj plaub, kev kho mob ntawm no pathology yog xaiv tus kheej. Nrog kev mob hnyav heev, kev tswj hwm intramuscular ntawm analgesics yog qhia. Nrog rau qhov sib txuam tseem ceeb ntawm effusion, ib qho puncture ntawm pericardial kab noj hniav los yog pleurocentesis yog ua. Nrog lub plawv tamponade, kev phais kev phais yog ua - pericardiectomy.
Yuav ua li cas tiv thaiv kev txhim kho ntawm Dressler's syndrome?
Tus mob no tsis suav tias yog qhov ua rau muaj kev phom sij rau lub neej, txawm tias qhov kev kawm hnyav tshaj plaws, qhov kev cia siab rau tus neeg mob yog qhov zoo. Cov txheej txheem ntawm kev tiv thaiv thawj, uas yog tsom rau kev tshem tawm qhov ua rau ntawm kev loj hlob ntawm Dressler's syndrome, niaj hnub notseem tsis tau tsim. Txawm li cas los xij, txhawm rau txo qhov yuav tshwm sim ntawm articular manifestations nyob rau hauv cov neeg mob uas muaj ib tug mob infarction, thaum ntxov ua kom pom zoo. Hauv cov kab mob pathologies nrog cov chav kawm rov qab los, kev kho tshuaj tiv thaiv rov qab los tiv thaiv kev rov ua kom rov zoo dua ntawm cov txheej txheem pathological.
Cov Lus Qhia Kho Mob rau Dressler Syndrome
Txhawm rau txo qhov kev pheej hmoo ntawm tus kab mob no, nws yuav tsum ua tib zoo xav txog txhua yam tshwm sim tshwm sim cuam tshuam nrog kab mob plawv. Txij li thaum thawj qhov ua rau ntawm kev txhim kho ntawm Dressler's syndrome yog myocardial infarction, kev tiv thaiv kev tiv thaiv yuav tsum tau tsom rau kev tiv thaiv kev loj hlob ntawm tus mob no. Lub ntsiab lus pom zoo hauv kev kho mob yog kev soj ntsuam raws sijhawm los ntawm kws kho plawv, noj tshuaj tiv thaiv ischemic, tshuaj tiv thaiv thrombotic, nrog rau cov tshuaj kom txo cov roj cholesterol siab.
Teeb meem ntawm qhov pathology
Thaum tsis muaj kev kuaj mob zoo thiab raws sijhawm thiab kev kho mob, Dressler's syndrome tuaj yeem ua rau muaj kev tsim kho lossis hemorrhagic pericarditis (qhov tsos ntawm cov ntshav exudate los yog nyem ntawm lub plawv cov ntaub so ntswg), thiab nyob rau hauv cov ntaub ntawv siab dua., nws ua rau mob plawv tamponade. Qhov no pathology yog tus yam ntxwv los ntawm ib tug relapsing chav kawm nrog remissions thiab exacerbations tshwm sim ntawm lub sij hawm ntawm 1-2 lub lis piam mus rau 2 lub hlis. Hauv kev cuam tshuam ntawm kev kho mob, muaj qhov tsis muaj zog ntawm cov tsos mob, thiab thaum tsis khokab mob, raws li txoj cai, tawm tsam nrog lub zog tshiab.
