Kev kawm txog cov kua dej serous (lawv tseem hu ua effusions) yog qhov muaj txiaj ntsig zoo hauv cov tshuaj niaj hnub. Cov ntaub ntawv hais txog cov kev tshawb fawb no ua rau tus kws kho mob tsim kev kuaj mob thiab sau ntawv kho kom zoo raws sijhawm. Yog li cia peb txheeb xyuas seb nws yog dab tsi, hom dej serous yog dab tsi thiab hauv cov kab mob dab tsi lawv tuaj yeem kuaj tau.
cov ntaub ntawv dav dav
Exudative kua yog ib qho ultrafiltrate ntawm tib neeg cov ntshav. Qhov no txhais tau hais tias cov tshuaj no yog tsim los ntawm kev pom cov ntshav los ntawm cov hlab ntsha mus rau hauv cov kab noj hniav thiab cov ntaub so ntswg. Ntxiv mus, nyob rau hauv lub classical kev txiav txim zoo, effusion yog ib tug kua uas accumulates precisely nyob rau hauv cov kab noj hniav ntawm tib neeg lub cev. Thiab dab tsi yog sau rau hauv cov ntaub so ntswg hu ua edematous fluid.
Nquag, tsuas yog ib feem ntawm cov ntshav uas muaj qhov hnyav me me (dej thiab electrolytes, piv txwv li) tuaj yeem dhau los ntawm cov pores ntawm capillaries. Thiab cov khoom uas muaj qhov hnyav molecular (proteins, tsim cov ntsiab lus) yuav tsum nyob twj ywm hauv cov hlab ntsha. Txawm li cas los xij, yog tias muajHauv lub cev ntawm cov txheej txheem inflammatory, cov phab ntsa ntawm cov hlab ntsha puas lawm, thiab cov molecules loj ntawm cov proteins thiab cov qe ntshav tuaj yeem nkag mus rau hauv lub cev kab noj hniav.
Cov ntsiab lus ntawm cov kab noj hniav thiab daim nyias nyias
Cov kab mob serous yog qhov chaw bounded los ntawm cov serous membranes.
Serous membranes yog cov yeeb yaj kiab uas muaj ob daim ntawv: parietal (nyob ze rau cov leeg) thiab visceral (tightly covering the internal organs).
Cov ntawv ntawm cov serous membranes yog sawv cev los ntawm cov txheej hauv qab no:
- mesothelium;
- ciam teb membrane;
- fibrous collagen txheej;
- superficial network ntawm elastic fibers;
- dub longitudinal network ntawm fibers;
Mesothelium nyob rau hauv muaj pes tsawg leeg ntawm cov serous daim nyias nyias ua ib qho tseem ceeb muaj nuj nqi: nws cov hlwb tas li tsim kua dej tsim nyog rau cushioning.
Daim ntawv visceral (organ) ntawm cov serous membrane tau txais cov ntshav los ntawm cov hlab ntsha uas muab cov khoom nruab nrog cev npog. Thiab daim ntawv parietal tau txais cov ntshav los ntawm ntau lub network ntawm anastomoses.
Serous membranes muaj cov qog ntshav tawm tau zoo. Yog li ntawd, kev ua txhaum me ntsis ntawm cov lymphatic outflow tuaj yeem ua rau cov kua dej ntau ntxiv.
Lub luag haujlwm tseem ceeb
Vim li cas ib tug neeg xav tau cov kua dej hauv cov kab noj hniav? Txhawm rau teb cov lus nug no, peb qhia txog lub luag haujlwm tseem ceeb ntawm cov kua dej effusion:
- tiv thaiv muaj nuj nqi - tiv thaiv kev sib txhuam ntawm lub cev tiv thaiv ib leeg thiab lawvkev raug mob;
- kom ntseeg tau cov khoom muaj zog ntawm cov kabmob hauv nruab nrog cev;
- sliding-amortization muaj nuj nqi, ua ib qho ntawm cov khoom tiv thaiv.
Nyob ntawm effusion
Exudative kua yog muab faib ua ob hom: transudate thiab exudate.
Transudate yog cov kua, qhov sib txuam uas tsis cuam tshuam nrog kev muaj cov txheej txheem inflammatory hauv lub cev. Yog tias nws khaws cov ntaub so ntswg, qhov mob no hu ua edema.
Yog tias cov transudate sau rau hauv pericardium (lub plawv lub hnab), muaj hydropericardium, yog nyob rau hauv lub plab kab noj hniav - ascites, nyob rau hauv lub pleural kab noj hniav - hydrothorax, nyob ib ncig ntawm lub testicle - hydrocele.
Exudate yog cov kua dej uas sau rau hauv lub cev kab noj hniav vim muaj cov txheej txheem inflammatory.
Yog li, txawm hais tias ob qho tib si transudate thiab exudate yog ob hom ntawm tib txheej txheem, lawv muaj qhov sib txawv kiag li, thiab, yog li, qauv.
Transudate: ua rau tsub zuj zuj
Cov kua dej serous nyob rau hauv daim ntawv ntawm transudate tuaj yeem tshwm sim los ntawm cov kab mob hauv qab no:
- hypoproteinemia - txo qis ntawm cov protein hauv cov ntshav, feem ntau yog vim albumin; pom nyob rau hauv glomerulonephritis nrog nephrotic syndrome, kab mob siab heev nrog kev loj hlob ntawm hepatocellular insufficiency, dav dav ntawm lub cev;
- ua txhaum ntawm cov qog ntshav tawm vim qhov txhaws ntawm cov hlab ntsha lymphatic;
- nce siab hauv venous uas tshwm sim thaum lub plawvvascular insufficiency, mob siab heev thiab raum kab mob.
- nce siab ntawm sodium hauv cov ntshav, pom hauv lub plawv tsis ua haujlwm, nephrotic syndrome, siab tsis ua haujlwm.
- nce synthesis ntawm aldosterone, uas ua rau kom muaj zog nqus ntawm sodium thiab dej hauv lub raum.
Exudate: species
Thaum kuaj xyuas hom kua dej serous thiab paub meej tias muaj cov exudate, nws yuav tsum tau qhia tias hom twg pom:
- serous - muaj pob tshab lossis pos huab, dawb;
- serous-purulent, los yog purulent - pos huab, daj-ntsuab xim nrog sediment;
- putrid - pos huab nrog pungent tsw;
- hemorrhagic - liab lossis liab-xim av;
- hillous - hazy yellowish xim;
- roj cholesterol - cov kua daj daj nrog cov roj cholesterol;
- mucilaginous - nrog ntau mucin;
- fibrinous - suav nrog fibrin strands;
- cov ntawv sib xyaw - serous-fibrinous, mucopurulent, thiab lwm yam.
Kev hloov pauv thiab exudate: sib txawv
Qhov sib txawv ntawm ob qhov effusions no yog nyob ntawm lawv cov concentration ntawm cov protein, qabzib, lub ntiajteb txawj nqus ntawm ob lub kua, nrog rau lawv cov yam ntxwv macroscopic (xim, pob tshab).
Raws li tau sau tseg saum toj no, qhov sib xyaw ntawm cov transudate hauv cov kab noj hniav tsis muaj feem cuam tshuam nrog kev mob. Yog li ntawd, qhov muaj qhov sib txawv ntawm ob hom effusions no yog qhov laj thawj heev.
Cia peb pib nrog qhov tshwj xeebhnyav. Nyob rau hauv exudate, nws yog ntau dua nyob rau hauv transudate, tus nqi rau >1.015 thiab <1.015, feem.
Qib ntawm cov protein nyob rau hauv lub transudate kuj tsawg dua nyob rau hauv exudate - ib tug muaj tseeb protein kua. Nws concentration yog 30 g / l rau exudate.
Muaj ib qho kev sim tshwj xeeb kom paub qhov txawv ntawm ob hom effusions. Nws yog hu ua Riv alta xeem. Txawm hais tias qhov kev sim no tau siv rau hauv kev kho mob rau ntau tshaj 60 xyoo, nws tseem siv dav heev thaum nws tsim nyog los sib txawv ntawm ob hom serous kua. Nws lub ntsiab kom zoo dua yog qhov ceev kom tau txais cov txiaj ntsig. Ntawm no, qhov txawv ntawm transudate thiab exudate yog tias nyob rau hauv lub xub ntiag ntawm transudate, tus qauv tsis zoo (uas tsis tuaj yeem hais txog exudate).
| Kev hloov pauv | Exudate | |
| Txoj kev sib nqus | 1,006–1,015 | ntau dua 1,015 |
| Y Protein concentration | tsawg dua 30 g / l | ntau dua 30 g / l |
| Muaj kab mob | Tsis raug | yam ntxwv yog muaj cov kab mob (streptococci, staphylococci, thiab lwm yam) |
| Cells uas kuaj pom nyob rau hauv sediment | Mesothelium, lymphocytes, tej zaum me me ntawm cov qe ntshav liab | Neutrophils, lymphocytes, ntau ntawm erythrocytes thiab macrophages, eosinophils, qog hlwb |
| Qhov piv ntawm effusion protein concentration rau ntshav protein concentration | < 0.5 | > 0.5 |
| Glucose concentration (mmol/l) | >5, 3 | <5, 3 |
| Cov roj (cholesterol) siab (mmol/l) | <1, 6 | >1, 6 |
| Tus naj npawb ntawm cov hlwb, hauv tshuaj lo lus "cytosis" yog siv | < 1×109/l | > 1×109/l |
Yog li, lub peev xwm los paub qhov txawv ntawm transudate thiab exudate yog qhov tseem ceeb heev rau tus kws kho mob. Tom qab tag nrho, qhov no ua rau muaj kev kuaj mob kom raug, thiab yog li ntawd, teem caij kho kom raug.
