Ntau tus neeg tsis xav txog kev loj hlob ntawm kev ua xua ua rau lub neej hem. Qhov no feem ntau yog qhov teeb meem, tab sis qee qhov xwm txheej muaj kev phom sij tshwm sim uas ua rau mob angioedema (Qincke's edema). Pathology manifests nws tus kheej nyob rau hauv daim ntawv ntawm ib tug nce nyob rau hauv lub ntsej muag los yog ceg ceg raws li ib tug tshwm sim ntawm o ntawm lub tob txheej ntawm daim tawv nqaij thiab cov ntaub so ntswg subcutaneous. Xws li cov tshuaj tiv thaiv tsis haum rau hauv qhov xwm txheej, nws tuaj yeem tshwm sim los ntawm kev siv tshuaj, zaub mov tsis haum, paj ntoos, tsiaj pov tseg, lossis kab tom. Qhov no pathology yog tus cwj pwm los ntawm qhov txawv txav ntawm lub cev rau qee yam stimuli.
yam ntxwv thiab piav qhia ntawm pathology
Angioneurotic edema - thaj chaw o ntawm cov ntaub so ntswg subcutaneous vim qhov nce ntawm vascular permeability thiab tso dej tawm ntawm lawv. Qhov tshwm sim no feem ntau nrog kev txhim kho ntawm urticaria thiab khaus ntawm txheej txheej ntawm daim tawv nqaij. Qee zaum, cov txheej txheem rau kev txhim kho ntawm pathology tseem tsis paub.
Feem ntau Quincke's edema tsim vim muaj kab moblub cev tiv thaiv kab mob rau ib qho irritant uas los ntawm ib puag ncig sab nraud. Yog li ntawd, lub cev pib tsim cov tshuaj histamines thiab prostaglandins - cov tshuaj uas muaj lub luag haujlwm rau cov lus teb rau cov txheej txheem inflammatory. Lawv pab txhawb kom nce permeability ntawm cov hlab ntsha, los ntawm cov lymph ntws mus rau hauv cov ntaub so ntswg, angioedema tshwm sim (ICD 10 - T78.3). Qhov tshwm sim no tau paub rov qab rau xyoo pua 19th, thaum tus kws kho mob German G. Quincke tau piav qhia txog cov xwm txheej zoo sib xws hauv nws cov neeg mob, thiab kuj tau tsim txoj hauv kev zoo rau lawv txoj kev kho.
Quincke's edema kuj tuaj yeem pom ntawm cov kab mob hauv nruab nrog cev, tab sis feem ntau nws tshwm sim ntawm caj dab, caj npab thiab ntsej muag. Qhov txaus ntshai tshaj plaws hauv cheeb tsam ntawm angioedema yog cov kab mob ua pa thiab daim nyias nyias ntawm lub paj hlwb, lawv qhov kev puas tsuaj tuaj yeem ua rau cov hlab ntsha tsis zoo thiab ua rau tsis taus pa. Yog tsis muaj kev pab, kev tuag tshwm sim.
qhov tshwm sim no tshwm sim tsuas yog hauv 2% ntawm tag nrho cov kev ua xua. Raws li kev txheeb cais, txhua tus neeg thib kaum hauv ntiaj teb tau ntsib teeb meem zoo sib xws hauv qee yam ntawm nws qhov tshwm sim.
Tus nqi ntawm kev loj hlob ntawm kev ua xua tuaj yeem sib txawv. Qee zaum, qhov o tuaj yeem tshwm sim hauv ob peb feeb, thiab qee zaum nws tshwm sim maj mam dhau ib lossis ob peb hnub, nyob ntawm seb muaj pes tsawg tus allergen thiab lub sijhawm nws raug rau lub cev. Lub sijhawm ntawm tus mob tsis zoo kuj tuaj yeem sib txawv, qee zaum cov kab mob tuaj yeem nyob ntev dua rau lub lis piam (hloov daim ntawv).
Nyob rau hauv me nyuam
Angioneurotic edema hauv cov menyuam yaus thiab cov poj niam feem ntau raug kuaj pom. Cov neeg uas muaj kev fab tshuaj rau kev ua xua kuj ua rau cov tshuaj tiv thaiv zoo li no. Qee zaum, pathology tuaj yeem tshwm sim hauv cov neeg noj qab haus huv ntawm txhua lub hnub nyoog.
Cov menyuam yaus tuaj yeem raug mob angioedema txij thawj hnub ntawm lub neej. Pathology nyob rau hauv cov ntaub ntawv no tuaj yeem txhim kho yog tias lawv tau noj nrog cov khoom sib xyaw, nyuj cov mis nyuj, nrog rau kev siv tshuaj.
Nyob rau hauv cov me nyuam mos, tus kab mob no hnyav heev thiab feem ntau ua rau tuag. Edema ntawm lub plab thiab meninges feem ntau kuaj tau. Quincke's edema nyob rau hauv cov me nyuam feem ntau yog nrog los ntawm bronchial hawb pob.
Yog tias pallor tshwm rau ntawm tus menyuam daim tawv nqaij, qhov nasolabial ntawm lub ntsej muag tig xiav, lub plawv dhia nce, ua tsis taus pa, koj yuav tsum hu rau tus kws kho mob tam sim ntawd, vim qhov no yuav qhia tau tias o ntawm lub ntsws. Sij hawm dhau mus, lub blueness yuav kis mus rau lwm qhov chaw ntawm daim tawv nqaij, suffocation yuav tshwm sim, tus me nyuam yuav tsis nco qab.
Ntau yam ntawm pathology
Kev tsis haum tshuaj angioedema tuaj yeem ua tau ntau yam:
- Mob edema tshwm sim los ntawm kev tsim cov tshuaj tsis haum rau ib qho kev ua xua. Nws yog nrog los ntawm kev loj hlob ntawm urticaria. Feem ntau cov tshuaj tiv thaiv no tshwm sim rau opiates, tus neeg sawv cev sib piv siv hauv x-rays, NSAIDs thiab tshuaj aspirin, nrog rau ACE inhibitors. Nyob rau hauv cov ntaub ntawv no, lub ntsej muag, lub Upper pa ib ntsuj av tau thiab txoj hnyuv raug cuam tshuam. Tus kab mob tuaj yeem tshwm sim ntau xyoo tom qab pib kho nrog cov tshuaj saum toj no.
- Daim ntawv mob ntev uas edema tshwm sim rau ntau tshaj rau lub lis piam. Yog vim li cas rau qhov tshwm sim no tsis paub txog tshuaj. Kev tsis haum tshuaj yog xav tias yog tshwm sim los ntawm cov tshuaj noj ntev, khoom noj khoom haus ntxiv, thiab tshuaj tua kab mob.
- Daim ntawv idiopathic tsim tsis muaj urticaria. Hauv qhov no, lub sijhawm exacerbation thiab regression hloov pauv. Yog vim li cas rau txoj kev loj hlob ntawm xws pathology yog tsis paub.
- Hereditary angioedema tshwm sim vim C1 inhibitor deficiency. Kev loj hlob ntawm edema nyob ntawm kev ntxhov siab thiab microtrauma. Feem ntau, cov kab mob pathology tshwm sim hauv cov txiv neej thiab tuaj yeem tau txais txiaj ntsig. Feem ntau nrog rau daim ntawv no ntawm edema, lub larynx raug kev txom nyem.
Cas of edema development
Ntau tus neeg paub li cas angioedema manifests nws tus kheej. Tab sis tsis yog txhua tus paub qhov laj thawj rau nws qhov tsos. Qhov tshwm sim no tshwm sim nyob rau hauv teb rau cov teebmeem ntawm allergens ntawm tib neeg lub cev. Cov tshuaj tsis haum tuaj yeem yog co toxins, tshuaj pleev ib ce, tshuaj tua kab, tshuaj, tsiaj dander, thiab lwm yam.
Qee zaum, Quincke's edema tuaj yeem tshwm sim raws li kev ua xua, uas tshwm sim vim muaj kev nkag siab zoo rau qee yam tshuaj thiab zaub mov. Tsis tas li ntawd, qhov teeb meem yuav tshwm sim raws li qhov teeb meem ntawm kev kho mob nrog ACE inhibitors. Qhov no feem ntau pom nyob rau hauv cov neeg laus, nyob rau hauv uas cov tshuaj maj txo cov kev puas tsuaj ntawm bradykinin nyob rau hauv lub cev, uas provokes dilation ntawm cov hlab ntsha.thiab nce permeability ntawm lawv phab ntsa.
Hereditary angioedema tshwm sim vim qhov tsis muaj C1 inhibitor, uas tswj cov haujlwm ntawm cov protein ua lub luag haujlwm rau ntshav txhaws, tswj kev mob thiab ntshav siab, thiab mob. Nws qhov tsis muaj peev xwm yog vim muaj cov kab mob caj ces lossis kev noj ceev. Qhov tshwm sim no tuaj yeem tshwm sim los ntawm kev sib kis thiab kab mob autoimmune, qog nqaij hlav cancer. Qee zaum qhov o tuaj yeem tshwm sim los ntawm hypothermia lossis kev ntxhov siab hnyav.
Kev ua tsis ncaj ntawm txoj kev loj hlob ntawm pathology suav nrog qee cov kab mob ntawm cov kabmob hauv nruab nrog cev, kab mob helminthic thiab cov kab mob endocrine.
Symptoms and signs of disease
Cov tsos mob ntawm angioedema yog tshwm sim nyob rau hauv daim ntawv ntawm o thiab o ntawm lub ntsej muag (pob muag, plhu, daim di ncauj), qhov ncauj mucosa, qhov chaw mos. Qee lub sij hawm lub ntsej muag o ntau heev kom nws zoo li lub zais pa, thaum tus neeg tsis tuaj yeem qhib nws lub qhov muag. Ob txhais tes kuj yuav o, tshwj xeeb tshaj yog cov ntiv tes, ko taw, thiab hauv siab. Hauv qhov xwm txheej no, khaus khaus, xim ntawm daim tawv nqaij tsis hloov. Feem ntau ntawm cov mob me, qhov o yuav ploj mus tsis pub dhau peb hnub, tab sis qee zaum nws kis mus rau lub larynx, ua rau ua pa nyuaj. Nyob rau hauv rooj plaub no, ib tug neeg tsim ib tug hnoos, hoarseness, pallor ntawm daim tawv nqaij ntawm lub ntsej muag, thiab ib tug hais lus tsis meej tshwm sim. Nyob rau hauv cov xwm txheej hnyav, kev ua pa ntawm txoj hlab ntsws tsim, hypercapnic coma, thiab tom qab ntawd tuag. Tsis tas li ntawd nyob rau hauv cov ntaub ntawv no, muaj ib tug mob syndrome nyob rau hauvcheeb tsam plab, ntuav, redness los yog blueness ntawm daim tawv nqaij, los ntshav ntawm cov mucous daim nyias nyias. Xws li cov tsos mob ntawm kev ua xua raug kuaj pom hauv 1/4 ntawm cov neeg mob. Quincke's edema yog txawv los ntawm cov urticaria zoo tib yam los ntawm qhov tob ntawm daim tawv nqaij lesion. Qee zaum qhov o no hu ua urticaria loj heev.
Cov tsos mob ntawm angioedema tuaj yeem tshwm sim raws li cov ntshav qis, tachycardia, tawm hws, tsis meej pem, kev sib koom ua ke, kev loj hlob ntawm kev ntshai tuag, ceeb.
Nrog plab hnyuv edema, cov tsos mob yuav zoo li cov tsos mob ntawm kev zom zaub mov: xeev siab, nrog rau ntuav, mob plab, raws plab. Cov xwm txheej zoo li no tsis muaj qhov txaus ntshai, vim tias nws tuaj yeem ua rau muaj kab mob peritonitis.
Nrog o ntawm lub hlwb ntawm lub hlwb, cov tsos mob ntawm cov kab mob yuav zoo li mob meningitis. Nyob rau hauv rooj plaub no, muaj mob taub hau, photophobia, loog ntawm caj dab cov leeg, convulsions, hnov lus thiab tsis pom kev, tuag tes tuag taw.
Angioneurotic edema ntawm pob qij txha tsis ua rau muaj kev phom sij rau tib neeg lub neej. Nyob rau hauv cov ntaub ntawv no, lub synovial ib feem ntawm cov pob qij txha yog puas, uas provokes impaired mus thiab kev loj hlob ntawm mob. Hauv 50% ntawm cov neeg mob, o yog nrog los ntawm kev loj hlob ntawm urticaria. Ib tug neeg mob khaus, hlwv ntawm ntau qhov ntau thiab tsawg, conjunctivitis thiab qhov muag dej.
pab xub thawj
Txij li cov kab mob no tuaj yeem ua rau muaj kev phom sij rau lub neej, tus neeg raug tsim txom yuav tsum tau kho tus mob angioedema. Qhov no tshem tawm tib neeg kev sib cuag nrogallergen, yog paub, hu rau lub tsheb thauj neeg mob. Thaum txhaj tshuaj los yog kab tom, ib daim ntaub qhwv nruj nreem rau saum qhov chaw txhaj tshuaj lossis tom chaw los yog txias yog siv los ua kom tsis txhob kis kab mob hauv lub cev vim yog vasoconstriction. Tom qab ntawd tus neeg tau unfastened nws cov khaub ncaws, yog li muab ib tug influx ntawm huab cua ntshiab, calm nws, muab ib tug haus dej ntawm activated charcoal, uas yog yav tas los yaj nyob rau hauv dej, los yog ib tug antihistamine. Nws yog qhov zoo tshaj yog tias cov tshuaj antihistamine tau txhaj tshuaj. Yog tsis ua tsis tau, tus neeg raug tsim txom yuav tsum tau muab cov dej alkaline. Ua li no, ib gram ntawm dej qab zib yog yaj nyob rau hauv ib liter dej.
Thaum tsis muaj tshuaj tiv thaiv, tshuaj vasoconstrictors xws li Otrivin lossis Nozivin tuaj yeem pab. Ib tug ntawm cov tshuaj no nyob rau hauv tus nqi ntawm ob peb tee yog instilled rau hauv lub larynx thiab nasopharynx.
Survey method
Kev kuaj mob ntawm angioedema pib nrog kev kawm ntawm anamnesis thiab kuaj tus neeg mob, nws nug. Feem ntau, thaum tsis muaj urticaria, tus kws kho mob qhia meej txog kev siv ACE inhibitors. Nyob rau hauv lub xub ntiag ntawm Quincke's edema nyob rau hauv lub ntsej muag thiab caj dab, cov txheej txheem kuaj mob tsis tshua muaj siv, txij li kev kuaj mob tuaj yeem tsim los ntawm kev kuaj pom ntawm tus neeg. Nyob rau hauv cov ntaub ntawv ntawm ib tug ntev lub sij hawm ntawm pathology, kws kho mob kawm cov neeg mob noj cov zaub mov thiab cov tshuaj uas nws noj. Yog tias lwm tus neeg hauv tsev neeg muaj qhov tshwm sim zoo sib xws, tus kws kho mob tau sau ib qho kev tshawb fawb ntawm C1 inhibitors los txiav txim seb tus kab mob pathology.
Nws nyuaj rau kev kuaj mob angioedema ntawm lub paj hlwb thiab plab hnyuv, raws li cov tsos mob qhia txog kev ua txhaum ntawm cov ntshav ncig hauv lub hlwb. Hauv qhov no, kuaj ntshav kuaj tau ua. Nrog angioedema, cov txiaj ntsig ntawm kev tshuaj ntsuam yuav pom qhov nce hauv cov concentration ntawm immunoglobulins thiab eosinophilia. Nrog rau qhov tsis ua xua edema, cov tsos mob ntawm cov kab mob autoimmune yuav tshwm sim.
Tus kws kho mob kuj tseem sib txawv ntawm cov kab mob dermatomyositis, hypothyroidism, protoporphyria, kab mob raum thiab superior vena cava compression syndrome.
YPathology Therapy
Kev kho mob Angioneurotic edema suav nrog ib qho uas yog tsom rau kev rov ua pa, tshem tawm qhov ua xua thiab nres qhov edema. Nws yog ib qho tseem ceeb heev nyob rau hauv rooj plaub no los txiav txim qhov ua rau ntawm txoj kev loj hlob ntawm pathology, txheeb xyuas cov allergen. Hauv qhov mob hnyav thiab mob me, tus neeg mob tau mus pw hauv tsev kho mob. Nws tau sau tshuaj antihistamines thiab glucocorticosteroids, enterosorbents, thiab infusion kho kuj tau qhia. Hauv daim ntawv keeb kwm ntawm pathology, kev qhia txog C1 inhibitor yog ua. Yog tias tsis muaj cov tshuaj no, kev hloov ntshav plasma tau ua. Tus neeg mob tau muab tshuaj androgens thiab antifibrinolytic tshuaj. Nrog o ntawm caj dab, cov tshuaj hormones thiab diuretics tau muab tso rau hauv cov hlab ntsha.
kev kho mob
tshuaj Angioedema qhia siv cov hauv qab no:
- Kev daws ntawm adrenaline kom nce ntshav siab thiab tshem tawm asphyxia.
- tshuaj Hormonal, xws li Prednisolone.
- Antihistamines, xws li."Suprastin" lossis "Zirtek"
- tshuaj diuretic (Lasik lossis saline).
- C1 inhibitors, tshwj xeeb "Kontrykal".
- Sorbents.
Txoj haujlwm tseem ceeb tshaj plaws ntawm kev kho mob yog kev tiv thaiv kab mob ua pa, yog li kev kho mob yog tsom rau kev tshem tawm lawv cov edema. Feem ntau nyob rau hauv cov ntaub ntawv no resort mus rau endotracheal intubation ntawm lub trachea. Adrenaline yog siv los tiv thaiv kev loj hlob ntawm kev ua tsis taus pa. Cov theem kawg ntawm kev kho yog teem caij noj tshuaj.
Huab cua
Nrog kev pab raws sijhawm, tus kab mob muaj peev xwm ua rau kev kwv yees. Hauv cov xwm txheej hnyav, anaphylactic shock, ua pa thiab tuag tuaj yeem tshwm sim. Tsis muaj kev lees paub tias Quincke's edema yuav tsis tshwm sim thaum tsis muaj kev cuam tshuam rau kev ua xua. Tib neeg lub cev tiv thaiv kab mob tuaj yeem rov tsim kho dua thaum lub sijhawm, piv txwv li, tom qab raug tus kab mob sib kis. Qee lub sij hawm qhov o tuaj yeem tshwm sim tsis yog tom qab thawj zaug kev sib cuag nrog cov tshuaj tsis haum, tab sis hauv ib qho ntawm cov hauv qab no, thaum tus neeg tsis tau npaj rau qhov xwm txheej zoo li no.
Kev Tiv Thaiv
Txhawm rau zam kev sib cuag nrog cov tshuaj tsis haum hauv lub ntiaj teb niaj hnub no yuav luag tsis tuaj yeem, tab sis koj tuaj yeem txo cov rooj sib tham nrog lawv, uas tau pom zoo. Cov kws kho mob qhia cov neeg uas muaj kev pheej hmoo tsis txhob sim cov khoom noj tshiab, tshwj xeeb tshaj yog cov kab txawv txawv. Thaum muab tshuaj los ntawm kws kho mob, nws yog ib qho tsim nyog yuav tsum tau kuaj xyuas seb puas muaj cov tshuaj tsis haum, thiab yuav tsum zam cov kab tom.
Yog tias koj nquag ua xua, kws kho mob pom zoo kom muaj tshuaj tiv thaiv kab mob ntawm tes, nrog rau paub txog cov tsos mob ntawm Quincke's edema txhawm rau tiv thaiv kev txhim kho cov teeb meem txaus ntshai raws sijhawm. Tsis tas li ntawd, txhua tus neeg yuav tsum paub yuav ua li cas muab kev pab thawj zaug hauv kev loj hlob ntawm edema, vim tib neeg lub neej tuaj yeem nyob ntawm qhov kev paub no.
txhawm rau tiv thaiv kev mob angioedema rov tshwm sim, nws raug nquahu kom ua raws li kev noj zaub mov tshwj xeeb, tsis txhob siv tshuaj yam tsis muaj kws kho mob sau ntawv. Nrog rau hom kab mob ntawm cov kab mob, tus neeg yuav tsum tsis txhob muaj kev ntxhov siab thiab kev ntxhov siab, nrog rau kev kis kab mob thiab kev raug mob. Xws li cov neeg mob yuav tsum tsis txhob noj cov tshuaj uas muaj estrogen. Thaum cov neeg zoo li no tau txais kev phais xaiv, lawv thawj zaug tau txais kev kho mob prophylactic siv cov ntshav plasma.
