Lub plawv yog ib qho tseem ceeb hauv tib neeg lub cev. Qhov kev tso tseg ntawm nws txoj hauj lwm yog cim kev tuag. Muaj ntau cov kab mob uas cuam tshuam rau kev ua haujlwm ntawm tag nrho cov hlab plawv system. Ib qho ntawm cov no yog PE, chaw kho mob pathology, cov tsos mob thiab kev kho mob uas yuav tau tham hauv qab no.
Dab tsi yog kab mob
PE, lossis pulmonary embolism, yog ib yam kab mob uas tshwm sim thaum cov hlab ntsha pulmonary los yog nws cov ceg tau txhaws nrog cov ntshav txhaws. Lawv feem ntau tsim nyob rau hauv cov hlab ntsha ntawm qis extremities los yog pelvis.
Hauv kev kho mob, lub tsev kho mob PE kuj tau txiav txim siab thaum cov hlab ntsha raug thaiv los ntawm cov kab mob cab, neoplasms lossis lub cev txawv teb chaws.
Thromboembolism yog thib peb ua rau tuag, tom qab tsuas yog ischemia thiab myocardial infarction.
Feem ntau tus kab mob no tau kuaj pom thaum muaj hnub nyoog laus. Cov txiv neej muaj peb npaug ntau dua li cov poj niam raug mob los ntawm tus kab mob no. Yog tias PE txoj kev kho mob (ICD-10 code - I26) tau pib raws sijhawm, ces nws tuaj yeem txo qis kev tuag ntawm 8-10%.
Vim txoj kev loj hlobkab mob
Nyob rau hauv cov txheej txheem ntawm kev txhim kho ntawm pathology, txhaws daim ntawv thiab txhaws ntawm cov hlab ntsha tshwm sim. Ntawm cov laj thawj ntawm PE yog cov hauv qab no:
- Impaired blood flow. Qhov no tuaj yeem pom tawm tsam keeb kwm ntawm kev loj hlob: varicose leeg, compression ntawm cov hlab ntsha los ntawm cov qog, phlebothrombosis nrog kev puas tsuaj ntawm cov hlab ntsha li qub. Cov ntshav ncig raug cuam tshuam thaum tus neeg raug yuam kom nyob twj ywm.
- Kev puas tsuaj rau phab ntsa ntawm cov hlab ntsha, ua rau cov ntshav txhaws.
- YProsthetic veins.
- Kev txhim kho catheters.
- Kev cuam tshuam ntawm cov leeg.
- Kab mob kis ntawm tus kab mob lossis kab mob uas ua rau muaj kev puas tsuaj rau endothelium.
- Kev ua txhaum ntawm cov txheej txheem ntuj tsim ntawm fibrinolysis (clot dissolution) thiab hypercoagulability.
Kev sib xyaw ua ke ntawm ntau yam ua rau muaj kev pheej hmoo ntawm PE, lub chaw kho mob pathology qhia txog kev kho mob mus ntev.
Risk factors
Cov kev pheej hmoo hauv qab no rau PE ua rau muaj kev pheej hmoo ntawm kev tsim cov txheej txheem pathological:
- mus ntev los yog yuam pw so.
- Lub plawv lossis ua pa tsis ua haujlwm.
- Kev kho mob ntev nrog cov tshuaj diuretics, uas ua rau poob dej ntau thiab nce ntshav viscosity.
- Neoplasms, xws li tsim ntawm hemablastosis.
- Cov ntshav platelets siab thiab cov qe ntshav liab hauv cov ntshav, uas ua rau muaj kev pheej hmoo ntawm cov ntshav txhaws.
- siv sijhawm ntev hormonalCov tshuaj tiv thaiv kab mob, kev kho tshuaj hormone hloov pauv - qhov no ua rau kom ntshav txhaws.
- Kev ua txhaum ntawm cov txheej txheem metabolic, uas feem ntau pom hauv ntshav qab zib mellitus, rog.
- Nkauj ruam dhau los thiab lub plawv nres.
- ntshav siab.
- tshuaj kho mob.
- Tshuaj qaum qaum.
- Lub sijhawm yug me nyuam.
- Kev haus luam yeeb.
- Nyob laus.
- Varicose veins. Tsim cov xwm txheej zoo rau stagnation ntawm cov ntshav thiab tsim cov ntshav txhaws.
Los ntawm cov xwm txheej uas tau teev tseg, peb tuaj yeem xaus tias tsis muaj leej twg tiv thaiv los ntawm kev txhim kho PE. Tus lej ICD-10 rau tus kab mob no yog I26. Nws yog ib qho tseem ceeb kom xav tias muaj teeb meem hauv lub sijhawm thiab ua haujlwm.
hom kab mob
Lub tsev kho mob PE yuav nyob ntawm hom kab mob, thiab muaj ntau yam ntawm lawv:
- Massive PE. Raws li qhov tshwm sim ntawm nws txoj kev loj hlob, feem ntau ntawm cov hlab ntsha ntawm lub ntsws raug cuam tshuam. Qhov tshwm sim tuaj yeem yog kev poob siab lossis kev loj hlob ntawm hypotension.
- Submassive. Ib feem peb ntawm tag nrho cov hlab ntsha hauv lub ntsws raug cuam tshuam, uas yog tshwm sim los ntawm txoj cai ventricular tsis ua haujlwm.
- Daim ntawv tsis loj. Nws yog tus cwj pwm los ntawm kev puas tsuaj rau cov nkoj me me, yog li tej zaum yuav tsis muaj tsos mob ntawm PE.
- Tuag thaum ntau dua 70% ntawm cov hlab ntsha raug cuam tshuam.
chav kho mob ntawm pathology
Lub tsev kho mob PE tuaj yeem yog:
- xob laim. Thaiv ntawm lub ntsiab pulmonary artery los yog lojceg. Kev ua pa tsis ua haujlwm tshwm sim, ua pa tsis ua pa tuaj yeem tshwm sim. Kev tuag yog ua tau nyob rau hauv feeb.
- Spicy. Kev loj hlob ntawm pathology yog nrawm. Qhov pib tshwm sim sai sai, ua raws li kev loj hlob sai. Cov tsos mob ntawm plawv thiab pulmonary insufficiency tau pom. Hauv 3-5 hnub, pulmonary infarction tshwm sim.
- Nyob. Thrombosis ntawm cov hlab ntsha loj thiab nruab nrab thiab kev loj hlob ntawm ob peb pulmonary infarctions txuas ntxiv mus rau ob peb lub lis piam. Pathology maj mam nce ntxiv nrog cov tsos mob ntawm kev ua pa thiab lub plawv tsis ua haujlwm.
- Ntawm. Recurrent thrombosis ntawm ceg ntawm pulmonary hlab ntsha yog tas li pom. Recurrent pulmonary infarcts lossis ob tog pleurisy raug kuaj pom. Maj mam nce ntshav siab. Daim ntawv no feem ntau tsim tom qab phais, tawm tsam keeb kwm ntawm oncology thiab cov kab mob plawv uas twb muaj lawm.
Kev txhim kho kab mob
Pulmonary embolism maj mam dhau los ntawm cov theem hauv qab no:
- Airway blockage.
- Nyob rau hauv pulmonary artery.
- Vim muaj kev cuam tshuam thiab thaiv, kev sib pauv roj cuam tshuam.
- Qhov tshwm sim ntawm oxygen deficiency.
- Tsim txoj hauv kev ntxiv rau kev thauj cov ntshav tsis zoo oxygenated.
- nce load ntawm sab laug ventricle thiab kev loj hlob ntawm nws cov ischemia.
- Txo qis hauv plawv index thiab poob ntshav siab.
- Pulmonary arterialsiab nce.
- Kev mob ntshav siab hauv plawv.
- Pulmonary edema.
Ntau tus neeg mob PE ntsib kev mob ntsws ntsws.
Signs of disease
Cov tsos mob ntawm PE nyob ntawm ntau yam:
- Txoj kev mob ntawm tus neeg mob lub cev.
- Ntau cov hlab ntsha puas.
- Qhov loj ntawm cov khoom txhaws cov hlab ntsha.
- Tus nqi ntawm tus kab mob.
- Degrees of disorders in ntsws ntsws.
Kev kho PE yuav nyob ntawm qhov chaw kho mob ntawm tus neeg mob. Cov kab mob hauv qee qhov tshwm sim yam tsis tau muab cov tsos mob, thiab tuaj yeem ua rau tuag sai. Qhov nyuaj ntawm kev kuaj mob kuj yog nyob rau hauv qhov tseeb hais tias cov pathology ntawm cov tsos mob zoo li ntau cov kab mob plawv, tab sis qhov sib txawv tseem ceeb yog qhov tshwm sim ntawm kev loj hlob ntawm pulmonary embolism.
Pathology yog tus yam ntxwv los ntawm ntau yam mob:
1. Los ntawm sab ntawm cov hlab plawv system:
- Kev mob plawv tsis ua hauj lwm.
- txo qis ntshav siab.
- Irregular heart rhythm.
- Npaj siab lub plawv dhia.
- Kev txhim kho ntawm cov hlab ntsha tsis txaus, uas tshwm sim los ntawm qhov mob hnyav tom qab sternum, kav ntev li 3-5 feeb mus rau ob peb teev.
- Cor pulmonale, tus mob no tshwm sim los ntawm o ntawm cov leeg hauv caj dab, tachycardia.
- Cerebral disorders nrog hypoxia, cerebral hemorrhage thiab nyob rau hauv mob hnyav nrog cerebral edema. Tus neeg mob yws ntawm lub suab nrovpob ntseg, kiv taub hau, ntuav, convulsions thiab fainting. Hauv qhov xwm txheej hnyav, qhov tshwm sim ntawm kev mob coma yog siab.
2. Pulmonary-pleural syndrome manifests nws tus kheej:
- Qhov tshwm sim ntawm kev ua pa luv thiab kev loj hlob ntawm kev ua pa tsis ua haujlwm. Cov tawv nqaij ua grey, cyanosis tsim.
- xov qw nrov nrov tshwm.
- Pulmonary infarction feem ntau tshwm sim 1-3 hnub tom qab pulmonary embolism, hnoos nrog hnoos qeev nrog cov ntshav, lub cev kub nce, thaum mloog, noo noo zoo bubbling rales pom meej.
3. Feverish syndrome nrog cov tsos ntawm febrile lub cev kub. Nws cuam tshuam nrog cov txheej txheem inflammatory hauv lub ntsws.
4. Kev loj hlob ntawm daim siab, irritation ntawm peritoneum, plab hnyuv paresis ua rau plab syndrome. Tus neeg mob yws ntawm qhov mob ntawm sab xis, belching thiab ntuav.
5. Cov kab mob tiv thaiv kab mob yog tshwm sim los ntawm pulmonitis, pleurisy, daim tawv nqaij ua pob khaus, cov tsos mob ntawm kev tiv thaiv kab mob hauv kev kuaj ntshav. Tus mob no feem ntau tshwm sim 2-3 lub lis piam tom qab kuaj mob PE.
Cov lus pom zoo rau kev txhim kho cov tsos mob no yog pib kho sai.
ntsuas ntsuas
Nyob rau hauv kev kuaj mob ntawm tus kab mob no, nws yog ib qho tseem ceeb los tsim qhov chaw tsim cov ntshav txhaws hauv cov hlab ntsha pulmonary, nrog rau kev ntsuas qhov kev puas tsuaj thiab qhov mob hnyav. Tus kws kho mob tau ntsib nrog txoj haujlwm ntawm kev txiav txim siab qhov chaw ntawm thromboembolism txhawm rau tiv thaiv kev rov qab los.
Vim qhov nyuaj ntawm kev kuaj mob, cov neeg mob raug xa mus rautshwj xeeb vascular departments, uas tau nruab nrog technology thiab muaj peev xwm los ua ib tug kev kawm thiab kev kho mob.
Yog xav tias PE, tus neeg mob tau txais cov kev kuaj hauv qab no:
- Keeb kwm noj thiab tshuaj xyuas ntawm txhua yam kev pheej hmoo.
- Kev tshuaj ntsuam ntshav, zis.
- ntshav ntsuas roj, kev txiav txim siab ntawm D-dimer hauv ntshav.
- ECG hauv kev ua kom muaj zog los txiav txim siab lub plawv nres, lub plawv tsis ua haujlwm.
- X-ray ntawm lub ntsws kom tsis suav nrog mob ntsws, pneumothorax, qog hlav malignant, pleurisy.
- Echocardiography yog ua los txhawm rau txhawm rau ntsuas qhov siab hauv cov hlab ntsha pulmonary.
- Kev kuaj lub ntsws yuav pom qhov txo qis lossis tsis muaj ntshav txaus vim PE.
- Angiopulmonography raug tshuaj xyuas kom paub meej qhov chaw ntawm lub thrombus.
- USDG ntawm cov leeg ntawm sab qis.
- Kev sib piv phlebography txhawm rau txheeb xyuas qhov chaw ntawm PE.
Tom qab ua qhov kev kuaj mob kom raug thiab nrhiav qhov ua rau tus kab mob, kev kho mob tau raug sau tseg.
pab thawj rau PE
Yog tias muaj tus kab mob tshwm sim thaum tus neeg nyob hauv tsev lossis tom haujlwm, nws yog ib qho tseem ceeb uas yuav tsum tau muab kev pabcuam raws sijhawm rau nws txhawm rau txo qhov kev pheej hmoo ntawm kev hloov pauv tsis tau. Lub algorithm yog raws li nram no:
- Muab tus neeg rau ntawm qhov chaw tiaj tus, yog tias nws poob lossis zaum ntawm qhov chaw ua haujlwm, tsis txhob cuam tshuam nws, tsis txhob hloov.
- Txhob khawm sab saum toj ntawm koj lub tsho, tshem koj cov khi kom tso cai tshiabair.
- Yog tias ua tsis taus pa, ua kom resuscitation: ua pa ua pa thiab, yog tias tsim nyog, compressions hauv siab.
- Hu lub tsheb thauj neeg mob.
Kev saib xyuas kom raug PE yuav cawm tib neeg txoj sia.
Kev kho mob
Kev kho rau PE tsuas yog xav tau hauv tsev kho mob xwb. Tus neeg mob tau mus pw hauv tsev kho mob thiab tau muab tag nrho lub txaj so kom txog thaum kev hem thawj ntawm vascular blockage dhau lawm. Kev kho PE tuaj yeem muab faib ua ob peb theem:
- Kev kho sai sai kom tshem tawm txoj kev pheej hmoo ntawm kev tuag sai.
- Restore lub lumen ntawm cov hlab ntsha kom deb li deb tau.
Kev kho lub sijhawm ntev rau PE suav nrog cov haujlwm hauv qab no:
- Kev tshem tawm cov ntshav txhaws los ntawm cov hlab ntsha ntawm lub ntsws.
- Kev ua ub ua no los tiv thaiv thrombosis.
- Ntawm txoj kab uas hla ntawm cov hlab ntsha pulmonary.
- Kev nthuav dav ntawm cov hlab ntsha me me.
- Txoj kev tiv thaiv tiv thaiv kev txhim kho cov kab mob ntawm cov hlab plawv thiab ua pa.
Kev kho mob ntawm pathology suav nrog kev siv tshuaj. Cov kws kho mob sau rau lawv cov neeg mob:
1. Kev npaj los ntawm pab pawg ntawm fibrinolytics lossis thrombolytics. Lawv raug txhaj ncaj qha rau hauv cov hlab ntsha pulmonary los ntawm catheter. Cov tshuaj no ua rau cov ntshav txhaws, ob peb teev tom qab kev tswj hwm ntawm cov tshuaj, tus neeg mob tus mob zoo dua, thiab tom qab ob peb hnub tsis muaj kab mob ntshav txhaws.
2. Nyob rau theem tom ntej, tus neeg mob tau pom zoo kom noj "Heparin". Ua ntejLub sij hawm, cov tshuaj yog muab nyob rau ntawm qhov tsawg kawg nkaus npaum li cas, thiab tom qab 12 teev nws yog nce ntau zaus. Cov tshuaj yog ib qho tshuaj tiv thaiv kab mob thiab, nrog rau Warfarin lossis Phenilin, tiv thaiv kev tsim cov ntshav txhaws hauv thaj chaw pathological ntawm lub ntsws.
3. Yog tias tsis muaj PE hnyav, ces cov lus pom zoo hauv kev kho mob qhia txog kev siv Warfarin tsawg kawg yog 3 lub hlis. Cov tshuaj tau muab tshuaj rau hauv ib qho me me noj, thiab tom qab ntawd, raws li cov txiaj ntsig ntawm kev ntsuam xyuas, nws tuaj yeem hloov kho.
Txhua tus neeg mob tau txais kev kho mob txhawm rau kho tsis tau tsuas yog cov hlab ntsha pulmonary xwb, tab sis tag nrho lub cev. Nws txhais tau tias:
- Kev kho mob plawv nrog Panangin, Obzidan.
- Noj tshuaj antispasmodics: Papaverine, No-shpa.
- Tshuaj kho cov txheej txheem metabolic: npaj muaj vitamin B.
- Kev tiv thaiv kev poob siab nrog Hydrocortisone.
- Kev kho mob nrog tshuaj tua kab mob.
- Noj tshuaj tiv thaiv kab mob: Suprastin, Zodak.
Thaum muab tshuaj, tus kws kho mob yuav tsum tau coj mus rau hauv tus account tias, piv txwv li, "Warfarin" nkag mus rau hauv lub placenta, yog li ntawd, thaum cev xeeb tub, nws yog txwv tsis pub noj, thiab "Andipal" muaj ntau yam contraindications. sau tseg nrog ceev faj rau cov neeg mob uas muaj kev pheej hmoo.
Feem ntau ntawm cov tshuaj yog txhaj rau hauv lub cev los ntawm drip infusion mus rau hauv cov hlab ntsha, kev txhaj tshuaj intramuscular yog mob thiab provoke tsim ntawm bruises loj.
Kev ua haujlwmkev cuam tshuam
Kev phais mob ntawm cov kab mob tsis tshua muaj tshwm sim, vim tias qhov kev cuam tshuam no muaj feem pua ntawm cov neeg mob tuag. Yog tias phais tsis tuaj yeem zam tau, kev siv tshuaj intravascular embolectomy. Cov kab hauv qab yog tias nrog kev pab los ntawm catheter nrog lub nozzle, cov ntshav txhaws raug tshem tawm los ntawm cov chav hauv plawv.
Txoj kev yog suav tias pheej hmoo thiab siv tsuas yog thaum tsim nyog.
Thaum PE, nws tseem pom zoo kom nruab cov lim dej, piv txwv li, "Greenfield's umbrella". Nws tau muab tso rau hauv lub vena cava, thiab muaj nws cov hooks qhib rau fixation rau phab ntsa ntawm lub nkoj. Qhov tshwm sim mesh dawb dhau los ntshav, tab sis cov hlab ntsha tau khaws cia thiab tshem tawm.
Kev kho mob ntawm PE qib 1 thiab 2 muaj qhov pom zoo. Tus naj npawb ntawm cov neeg tuag tsawg tsawg, qhov yuav rov qab los yog siab.
Kev nyuaj siab ntawm PE
Ntawm cov teeb meem tseem ceeb thiab txaus ntshai tshaj plaws ntawm tus kab mob yog:
- Sudden tuag vim mob plawv.
- Kev nce qib ntawm cov kab mob hemodynamic theem nrab.
- Kev mob ntsws pulmonary infarction.
- Kev loj hlob ntawm cov kab mob pulmonale.
tiv thaiv kab mob
Nyob rau hauv lub xub ntiag ntawm cov kab mob plawv loj lossis keeb kwm ntawm kev phais mob, nws yog ib qho tseem ceeb uas yuav tsum tau koom nrog kev tiv thaiv pulmonary embolism. Cov lus pom zoo muaj raws li hauv qab no:
- Tsis txhob tawm dag zog ntau.
- Siv sij hawm taug kev ntau.
- Ua raws li kev ua txhua hnub.
- Nco ntsoovpw tsaug zog zoo.
- Txhob tus cwj pwm phem.
- Kho cov zaub mov thiab tshem tawm cov zaub mov tsis zoo ntawm nws.
- Nco ntsoov mus ntsib tus kws kho mob kom tiv thaiv kev kuaj mob thiab phlebologist.
Cov kev tiv thaiv yooj yim no yuav pab kom tsis txhob muaj tus kab mob hnyav.
Tab sis txhawm rau txhawm rau tiv thaiv pulmonary embolism, nws yog ib qho tseem ceeb kom paub tias cov mob thiab cov kab mob twg tuaj yeem ua rau muaj kev loj hlob ntawm venous thrombosis. Ua tib zoo saib xyuas koj txoj kev noj qab haus huv:
- Tib neeg kuaj mob plawv.
- Cov neeg mob dag.
- Cov neeg mob ntawm kev kho mob ntev ntev.
- Siv tshuaj hormonal.
- Stroke survivors.
Cov neeg mob muaj kev pheej hmoo yuav tsum tau txais kev kho mob heparin ib ntus.
PE yog ib qho mob hnyav, thiab thawj cov tsos mob nws yog ib qho tseem ceeb uas yuav tsum tau muab ib tus neeg pab raws sijhawm thiab xa nws mus rau tsev kho mob lossis hu rau lub tsheb thauj neeg mob. Nov yog tib txoj hauv kev los tiv thaiv kev loj hlob ntawm qhov tshwm sim loj thiab cawm tib neeg txoj sia.
