Pulmonary los ntshav yog ib yam mob hnyav heev tshwm sim los ntawm cov ntshav tawm mus rau hauv cheeb tsam bronchial. Nws yuav tsum tau mus kho mob ceev. Pulmonary los ntshav yog ib qho teeb meem txaus ntshai ntawm ntau yam kab mob ua pa, hematological thiab mob plawv. Qhov no pathology muaj lub npe thib ob - diffuse alveolar los ntshav syndrome. Ntshav tawm los ntawm cov hlab ntsha yog tsim los ntawm kev ua txhaum ntawm lawv txoj kev ncaj ncees, thiab, ntxiv rau, vim lub cev qhuav dej ntawm lub ntsws. Kev poob ntshav hnyav tuaj yeem ua rau tus neeg mob txoj kev noj qab nyob zoo, cuam tshuam rau kev ua haujlwm ntawm lub plawv, ua pa, thiab tib lub sijhawm, cov ntshav tsim cov kabmob.
Cov ntaub ntawv qhia txog tus kab mob
Pulmonary los ntshav, uas yog tshwm sim los ntawm kev raug mob los yog kev ua ntawm cov tshuaj lom neeg,yog ib qho kab mob ywj pheej. Nyob rau hauv cov ntaub ntawv no, qhov txaus ntshai rau tus neeg mob lub cev yog txiav txim los ntawm lub degree ntawm kev puas tsuaj, thiab, nyob rau hauv tas li ntawd, los ntawm nws siv. Hemoptysis feem ntau tsis muaj kev hem thawj rau lub neej thiab suav tias tsis tshua muaj kev phom sij. Nws tshwm sim thaum tsob ntoo tracheobronchial puas, nrog rau kev tiv thaiv keeb kwm yav dhau los ntawm cov kab mob ntawm lub ntsws los yog pharynx. Hauv qhov no, ntshav poob nruab nrab yog 50 milliliters ib hnub. Qhov laj thawj tseem ceeb ntawm tus kab mob yog kev puas tsuaj rau lub hauv paus vascular pulmonary bundle.
Feem ntau, kev tuag vim los ntshav li ntawm kaum mus rau xya caum feem pua. Tus kab mob no feem ntau cuam tshuam rau cov neeg muaj hnub nyoog tsib caug xyoo. Feem ntau, cov kab mob cuam tshuam rau cov txiv neej uas haus luam yeeb ntev los yog cov neeg uas raug kev txom nyem los ntawm pulmonary dysfunction.
Shapes
Pulmonary los ntshav hauv cov tshuaj muab faib ua peb hom:
- me me los ntshav. Hauv qhov no, ntshav poob mus txog 100 milliliters ib hnub.
- hom nruab nrab. Tawm tsam keeb kwm yav dhau los ntawm daim ntawv no, tso ntshav mus txog 500 milliliters ib hnub.
- daim ntawv xaiv loj. Tawm tsam keeb kwm ntawm daim ntawv no, tso ntshav ntau tshaj 500 milliliters ib hnub.
Qhov txaus ntshai tshaj plaws yog suav tias yog los ntshav loj nyob rau hauv cov ntsiab lus ntawm tag nrho cov ntim, tshwm sim tshwm sim nyob rau lub sijhawm luv luv. Lawv feem ntau xaus rau hauv kev tuag vim mob asphyxia. Pulmonary los ntshav, ntawm lwm yam, yog sab hauv nrog qhov tshwm sim ntawm hemothorax, sab nraud thiab sib xyaw.
Yog vim li casPathology
Pulmonary hemorrhage yog ib qho mob polyetiological uas tshwm sim los ntawm cov kab mob ntawm cov kabmob hauv nruab nrog cev, raug mob, nrog rau cov tshuaj lom neeg sab nraud thiab cuam tshuam.
Qhov ua rau los ntshav yog kis kab mob ntawm lub ntsws thiab lub ntsws, cov kab mob uas ua rau cov phab ntsa ntawm cov hlab ntsha thiab alveoli. Tuberculosis, staphylococcal, pneumococcal, meningococcal thiab parasitic kab mob cuam tshuam rau lub ntsws parenchyma nrog rau kev loj hlob ntawm infiltrates thiab cysts. Muaj tsawg zaus, cov kab mob hauv qab no ntawm cov kab mob ua pa tuaj yeem ua rau lub ntsws los ntshav:
- muaj tus mob pneumosclerosis;
- muaj cov benign neoplasms ntawm bronchopulmonary system;
- kev txhim kho mob ntsws cancer;
- tshwm sim ntawm pulmonary infarction;
- tshwm sim ntawm arrosion ntawm cov hlab ntsha thiab pneumoconiosis.
Cov kab mob hauv qab no cuam tshuam ncaj qha rau cov hlab ntshav ntawm lub ntsws, thiab lawv ua rau los ntshav los ntawm lub cev. Peb tab tom tham txog kev mob plawv, pulmonary embolism, kub siab, cardiosclerosis thiab kab mob plawv. Pulmonary los ntshav kuj tshwm sim hauv qee cov kab mob hauv daim ntawv ntawm vasculitis, diathesis, rheumatism, capillaritis, pulmonary hemosiderosis thiab Goodpasture's syndrome. Yam tseem ceeb uas ua rau muaj kev loj hlob ntawm cov ntshav los ntawm lub ntsws muaj xws li cov laj thawj hauv qab no:
- Nyob ntev thiab tswj tsis tau tshuaj tiv thaiv coagulant.
- Kev tswj ntshav tsis tiav thaum lub sijhawm ua haujlwm tom qab ntxov.
- Ntawm cov khoom txawv teb chaws hauv lub bronchi.
- Nyob rau hauv lub hlwb thiab lub siab lub ntsws.
- Irradiation ntawm lub cev nrog rau cov tshuaj tiv thaiv.
- Qhov cuam tshuam ntawm cov tshuaj lom hauv lub cev.
- Kev hloov pauv ntawm cov pob txha thiab lwm yam kabmob.
- Qhov tshwm sim ntawm venous stasis hauv pulmonary ncig.
Cov pab pawg txaus ntshai, raws li txoj cai, yog cov neeg uas raug mob los ntawm mob ntsws, mob ntshav qab zib thiab mob ntsws ntsws. Cov poj niam cev xeeb tub, cov neeg uas noj glucocorticoids, thiab, ntxiv rau, cov menyuam yaus uas feem ntau raug mob ntsws kuj tseem raug rau tus kab mob no. Pawg pheej hmoo suav nrog cov neeg laus thiab cov pej xeem uas muaj kev noj qab haus huv tsawg.
Cov tsos mob ntawm pulmonary hemorrhage yog dab tsi?
Symptoms of disease
Cov neeg mob tuaj yeem yws txog qhov muaj zog, thiab tib lub sijhawm hnoos qhuav tas li. Nyob rau tib lub sijhawm, qhov no tuaj yeem ua kom ntub dej, ua rau cov hnoos qeev, uas, dhau los, sib xyaw nrog cov ntshav txhaws. Cov neeg mob yuav ntsib cov tsos mob hauv qab no ntawm pulmonary hemorrhage:
- Kev muaj hemoptysis, ua tsis taus pa thiab tsis muaj zog.
- Qhov tshwm sim ntawm qhov tsis xis nyob thiab mob hauv thaj tsam hauv siab.
- Zoo ua npaws.
- Kev muaj pallor thiab marbling ntawm daim tawv nqaij.
- Kev txhim kho ntawm lub hauv paus cyanosis.
- Zoo siab heev.
- tshwm sim hawb pob, hypotension, ntshai tsos thiab kiv taub hau.
Hemoptysis thiab pulmonarylos ntshav feem ntau nrog ib leeg. Tib lub sijhawm, cov neeg mob xav tias txaus siab heev, vim cov ntshav tau tawm qeeb heev thiab tsawg heev los ntawm lub cev.
Pulmonary los ntshav feem ntau tshwm sim sai sai, tawm tsam keeb kwm ntawm kev noj qab haus huv. Tawm tsam keeb kwm yav dhau los no, cov neeg mob thaum xub thawj tsis tshua pom lawv lub caj pas. Lub xub ntiag ntawm reddening ntawm cov hnoos qeev yuav qhia tau tias cov ntaub so ntswg puas. Maj mam, qhov hnoos tuaj yeem ua ntau zaus thiab ua nruj ua tsiv, ua rau muaj cov hnoos qeev los ntshav. Cov tsos mob ntawm pulmonary hemorrhage yuav hnyav zuj zus.
Sij hawm dhau mus, hnoos hnyav heev, yuav luag nres tsis tau. Los ntshav loj tuaj yeem tshwm sim los ntawm kev tsis pom kev, convulsive syndrome, pre-syncope, asphyxia thiab dyspepsia.
Tom ntej no, xav txog dab tsi cov kab mob uas tib neeg tuaj yeem tshwm sim los ntshav.
Kev kho mob xwm txheej ceev tau teev tseg hauv qab no.
tuberculosis lesion
Tuberculosis lesions ntawm lub ntsws cov ntaub so ntswg nrog kev puas tsuaj ntawm lub ntsiab qauv ntawm lub cev yuav tshwm sim los ntawm ib tug intoxication syndrome, thiab, nyob rau hauv tas li ntawd, malaise, qhuav hnoos, subfebrile mob, mob hauv siab. Cov tsos mob ntawm hemoptysis nyob rau hauv cov ntaub ntawv no tuaj yeem ua rau cov kab mob hnyav zuj zus, ua pa luv tshwm sim nrog rau acrocyanosis, kub taub hau, ua daus no thiab tawm hws ntau. Nyob rau tib lub sijhawm, hnoos yuav ntub, thiab tag nrho cov tsos mob ntawm cov kab mob pathology yuav ua tau raws li qhov ua tau.
Yuav ua li cas los ntshav pulmonary yuav tsum tau soj ntsuam los ntawm kws kho mob.
Bronchoectatickab mob
Hemoptysis yog ib qho ntawm cov cim tseem ceeb ntawm bronchiectasis pathology, qhia txog cov txheej txheem kev puas tsuaj. Cov tsos mob ntawm tus kab mob muaj xws li hnoos rov tshwm sim nrog rau hawb pob, ua tsis taus pa, mob hauv siab, kub taub hau, tsis taus, tsis muaj zaub mov noj, kev loj hlob qeeb, lub ntsej muag puffiness, thiab lwm yam.
Kev saib xyuas xwm txheej kub ntxhov rau pulmonary hemorrhage tseem ceeb heev.
ntsws abscess
Ib lub ntsws abscess tuaj yeem nrog hemoptysis. Nyob rau hauv cov ntaub ntawv no, tus neeg mob secretes purulent, thiab nyob rau tib lub sij hawm fetid hnoos qeev, tom qab uas ib ntus nyem yuav tshwm sim. Clinically, tiv thaiv keeb kwm yav dhau ntawm daim duab no, cov tsos mob ntawm intoxication hnyav predominate.
ntsws cancer
mob ntsws cancer tuaj yeem tshwm sim los ntawm hemoptysis, thiab, ntxiv rau, los ntshav pulmonary. Kev loj hlob ntawm cov qog nqaij hlav thiab lawv cov lwj ua rau kev puas tsuaj ncaj qha ntawm bronchi, thiab tib lub sijhawm ua rau cov hlab ntsha puas tsuaj. Nyob rau hauv thawj theem ntawm tus kab mob, cov neeg mob txhawj xeeb txog ib tug mob hnoos, uas nws thiaj li hloov mus rau ib tug ntub dej. Cov neeg mob tiv thaiv keeb kwm yav dhau los ntawm tus kab mob no poob hnyav heev, thiab lawv kuj muaj qhov nce hauv cov qog ntshav hauv cheeb tsam. Pulmonary los ntshav hauv ntsws cancer feem ntau xaus rau ntawm tus neeg mob tuag. Kev kuaj mob ntawm pathology yog nyob ntawm daim duab kho mob, thiab, ntxiv rau, ntawm cov tsos mob ntawm cov kab mob radiological.
Nrog rau lwm yam pneumoconiosis, lawv tau tshwm sim los ntawm hemoptysis. Tam sim ntawd nyob rau theem kawg ntawm cov neeg mobpulmonary hemorrhage tshwm sim. Cov neeg uas ua haujlwm hauv cov plua plav nrog cov khoom siv quartz feem ntau cuam tshuam rau txoj kev loj hlob ntawm cov kab mob no.
Thaum muaj mob ntshav siab, txhua tus yuav tsum paub txog kev kho mob xwm txheej ceev.
Diagnosis
Kev kuaj mob thiab kev kho mob ntawm qhov xwm txheej txaus ntshai xws li mob ntshav siab yog ua los ntawm cov kws kho mob ntawm ntau yam tshwj xeeb. Cov txheej txheem kuaj mob tshaj plaws yog cov kev tshawb fawb hauv qab no:
- Ua qhov kev tshuaj ntsuam pom dav dav, kev sib tsoo thiab auscultation.
- Kev kuaj X-ray lossis ultrasound ntawm lub ntsws.
- Kev sib nqus resonance lossis xam tomography.
- Ua bronchial arteriography thiab angiopulmonography.
- Ua ib qho echocardiogram kom txiav tawm mitral stenosis.
- Ua kom tiav cov ntshav suav nrog cov coagulogram.
- Kev kuaj kab mob microbiological ntawm cov hnoos qeev los txiav txim qhov etiology ntawm los ntshav.
- Kev kuaj ntshav nrog rau kev kawm txog cov tshuaj tiv thaiv kab mob polymerase.
- Kev xeem serological.
Bronchoscopy feem ntau yog siv los txheeb xyuas qhov chaw los ntshav. Raws li ib feem ntawm cov txheej txheem no, cov neeg ua haujlwm kho mob siv dej ntxuav rau kev tshuaj ntsuam xyuas, ua ib qho biopsy los ntawm cov chaw hloov pauv pathological, thiab tseem ua haujlwm kom tsis txhob los ntshav. Rov qab los ntshav pulmonary yog kuaj pom los ntawm qhov sib txawv ntawm radiodiagnostics. tus neeg sawv cev zoo sib xwsyog muab tso rau hauv ib lub catheter rau hauv cov hlab ntsha peripheral, thiab ib tug series ntawm dluab yog coj tom qab ib tug tej lub sij hawm ntawm lub sij hawm.
Txoj kev tswj hwm xwm txheej kub ntxhov rau pulmonary hemorrhage yog nthuav tawm hauv qab no.
kev pab thaum muaj xwm ceev
Kev pab thawj zaug tiv thaiv los ntshav sab hauv yog qhov txwv tsis pub tshaj. Cov neeg mob zoo li no tau mus pw hauv tsev kho mob sai hauv chav haujlwm ntawm kev phais lossis pulmonology. Kev thauj mus los yog nqa tawm hauv qhov chaw zaum nrog ob txhais ceg.
Kev kho mob xwm txheej ceev suav nrog kev tshem cov ntshav tawm ntawm txoj hlab pa los ntawm lub tshuab nqus pa tshwj xeeb. Tsis tas li ntawd, cov tshuaj hemostatic thiab tshuaj tua kab mob tau muab coj los siv, cov tshuaj ntshav tau hloov pauv nrog rau kev kho mob bronchoscopy thiab kev kho phais.
Qhov xwm txheej ceev pulmonary hemorrhage thiab tswj tus neeg mob cov txheej txheem suav nrog cov lus qhia dav dav rau nqos cov dej khov nab kuab, haus dej txias me me, thiab siv cov compresses txias rau hauv siab. Nws yog ib qho tseem ceeb heev uas yuav tau ua kom cov neeg mob zoo li no los ntawm kev piav qhia rau lawv txog qhov yuav tsum tau hnoos hnoos qeev. Kev ntxhov siab ntau dhau tuaj yeem ua rau qhov xwm txheej hnyav dua.
Hauv chav haujlwm, cov neeg mob tau muab tso rau ntawm qhov cuam tshuam, lawv tau txais cov pa nqus pa nrog cov tshuaj tsim nyog. Bronchoscopy yog ua, thiab, yog tias tsim nyog, qhov kev pom zoo ntawm kev phais raug txiav txim siab. Hauv qhov no, peb tab tom tham txog kev phais ntsws los yog pneumonectomy.
Muaj ib ntus thiab kawg txoj hauv kevkev pab thawj zaug rau pulmonary los ntshav, tsom rau nws. Kev kho mob ib ntus suav nrog kev kho mob hypotension, tshuaj hemostatic, thiab cov txheej txheem endobronchial hemostasis. Thiab pab pawg thib ob muaj feem cuam tshuam rau feem ntau cov haujlwm xws li kev phais lub ntsws, vascular ligation, thiab lwm yam.
kev kho mob
Kev pab rau cov ntshav pulmonary yog ib qho tseem ceeb los muab raws sijhawm.
Kev kho mob yog txhawm rau tshem tawm cov kab mob hauv qab. Niaj hnub no, cov tshuaj tsuas yog siv rau cov ntaub ntawv me thiab nruab nrab ntawm cov hlab ntsws los ntshav. Cov tshuaj uas tau muab rau cov neeg mob uas muaj tus kab mob no feem ntau yog cov hauv qab no:
- Kho nrog cov tshuaj hemostatic hauv daim ntawv ntawm "Vikasol", "Etamsylate sodium", "Gordox" thiab "Kontrykal"
- Kev siv tshuaj tiv thaiv ntshav siab txo qis rau kev siv Pentamin, Benzohexonium, Arfonade thiab Clonidine.
- Kho nrog cov tshuaj tiv thaiv kab mob thiab glucocorticoids, xws li Cyclophosphamide.
- Cov tshuaj kho mob kuj tseem siv tau, piv txwv li, Analgin, qee qhov tshuaj loog thiab Ketorol.
- Txhawm rau txhawm rau hnoos mob, cov tshuaj siv hauv daim ntawv ntawm Codeine, Dionin, Promedol, Strophanthin thiab Korglikon.
- Kev kho mob nrog cov tshuaj desensitizing hauv daim ntawv ntawm Pipolfen thiab Dimedrol.
- Ntawm diuretics, Lasix feem ntau nyiam.
Raws li ib feem ntawm kev hloov kho ntawm erythrocyte pawg tiv thaiv keeb kwm ntawm kev poob ntshav tseem ceeb, cov neeg mob tau muab "Polyglukin" thiab "Reopoliglyukin". Kuj ua tausiv saline daws, "Trisol" thiab "Ringer". Txhawm rau txo qis bronchospasm, Alupent tau muab rau cov neeg mob nrog rau Salbutamol thiab Berotek.
Siv cov txheej txheem endoscopic
Tawm tsam keeb kwm yav dhau los ntawm qhov tsis muaj txiaj ntsig ntawm kev saib xyuas kev kho mob, cov kws kho mob tig mus rau bronchoscopy, uas cov hlab ntsws los ntshav tau nres ntau txoj hauv kev. Txhawm rau ua qhov no, cov kws kho mob tshwj xeeb siv cov ntawv thov siv tshuaj, ib daim txhuam cev hemostatic raug teeb tsa thiab cov hlab ntsha hauv thaj tsam cuam tshuam tau coagulated. Ntawm lwm yam, lub bronchi yog obturated nrog txhaws thiab cov hlab ntsha yog embolized. Tab sis cov txheej txheem no tsuas yog muab kev pab ib ntus xwb.
X-ray endovascular occlusion ntawm cov hlab ntsha los ntshav yog ua los ntawm cov kws paub txog hluav taws xob uas paub meej hauv cov tswv yim angiography. Ua tsaug rau arteriography, cov kws kho mob tuaj yeem txiav txim siab los ntshav. Yuav kom embolize cov hlab ntsha, polyvinyl cawv yog siv. Txoj kev no ntawm kev kho cov ntshav pulmonary yog qhov zoo heev. Tab sis nws tuaj yeem ua rau muaj ntau yam teeb meem, xws li myocardial ischemia mus rau lub hlwb pathologies.
Yog li kev mob ntshav siab, kev kho mob xwm txheej ceev tsis yog txhua yam.
kev kho mob phais
hom haujlwm tseem ceeb yog:
- Kev cuam tshuam tsis zoo nyob rau hauv daim ntawv ntawm kev kho mob plab, thoracoplasty, pulmonary artery ligation thiab pneumotomy.
- Radical cov txheej txheem suav nrog ib feem ntawm lub ntsws resection nrog rau segmentectomy, lobectomy,bilobectomy thiab pneumonectomy.
Kev tuag ntawm tus neeg mob los ntshav hnyav feem ntau yog vim asphyxia, thiab tsis yog vim ntshav poob.
Peb tau tshuaj xyuas pulmonary hemorrhage thiab algorithm ntawm kev pab.
