Qhov tseem ceeb ntawm qhov teeb meem tshwm sim los ntawm kev los ntshav obstetric yog vim qhov tseeb tias cov kab mob no ua rau qhov tseem ceeb thiab tam sim ua rau tuag hauv 60-70% ntawm cov poj niam. Nws ua raws li cov ntshav tom qab yug me nyuam yog ib qho tseem ceeb tshaj plaws nyob rau hauv lub cev ntawm leej niam tuag. Los ntawm txoj kev, nws tau sau tseg tias lub luag haujlwm tseem ceeb ntawm obstetric hemorrhages yog nyob ntawm cov hypotonic, uas qhib tom qab yug menyuam hauv thawj 4 teev.
Yuav ua li cas
Qhov laj thawj tseem ceeb ntawm cov ntshav hypotonic tuaj yeem yog: atony thiab hypotension ntawm lub tsev menyuam, cov ntshav txhaws tsis zoo, ib feem ntawm tus menyuam qhov chaw uas tsis tau tawm ntawm lub tsev menyuam, raug mob rau cov nqaij mos hauv qhov chaw yug menyuam.
uterine hypotension yog dab tsi
Hypotension ntawm lub tsev menyuam yog ib qho mob uas lub suab nrov thiab nws lub peev xwm sib cog lus txo qis. Ua tsaug raucov kev ua ub no thiab nyob rau hauv tus ntawm cov tshuaj uas excite lub contractile muaj nuj nqi, cov nqaij ntshiv pib cog lus, txawm hais tias feem ntau lub zog ntawm cov contractile cov tshuaj tiv thaiv tsis sib npaug zos rau lub zog ntawm cov kev cuam tshuam. Vim li no, hypotonic los ntshav tsim.
Atonia
Uterine atony yog ib qho mob uas cov nyiaj siv los txhawb lub tsev menyuam tsis muaj peev xwm cuam tshuam rau nws. Lub apparatus ntawm lub neuromuscular system ntawm lub tsev menyuam yog nyob rau hauv lub xeev ntawm tuag tes tuag taw. Tus mob no tsis tshwm sim ntau zaus, tab sis tuaj yeem ua rau los ntshav hnyav.
Txhob los ntshav
Qhov ua rau hypotonic thiab atonic los ntshav yuav txawv. Ib qho ntawm cov laj thawj tseem ceeb yog qhov tsis muaj zog ntawm lub cev, i.e. lub hauv nruab nrab lub paj hlwb tsis muaj zog vim kev yug menyuam ntev thiab mob, kev ua haujlwm tsis tu ncua tsis muaj zog, ntxiv rau, kev ua haujlwm sai thiab kev siv oxytocin tuaj yeem ua rau. Tsis tas li ntawd, cov ua rau muaj xws li mob hnyav gestosis (nephropathy, eclampsia) thiab kub siab. Postpartum hypotonic los ntshav yog qhov txaus ntshai heev.
Qhov laj thawj tom ntej no yuav yog qhov tsis zoo ntawm lub tsev menyuam ntawm qib anatomical: kev loj hlob tsis zoo thiab kev ua tsis zoo ntawm lub tsev menyuam; ntau yam fibroids; muaj qhov caws pliav ntawm lub tsev menyuam tom qab ua haujlwm dhau los; Cov kab mob tshwm sim los ntawm o los yog rho menyuam, hloov ib feem tseem ceeb ntawm cov leeg nrog cov ntaub so ntswg.
Tsis tas li ntawd, qhov tshwm sim ntawm cov ntshav hypotonic thaum ntxov tom qab yug me nyuam yog: uterine dysfunction, i.e.nws muaj zog stretching raws li ib tug tshwm sim ntawm polyhydramnios, muaj ntau tshaj ib tug fetus, yog hais tias lub fetus loj; placenta previa thiab low insertion.
Hypotonia lossis atony
Ntshav los ntawm hypotonic thiab atonic xwm yuav tshwm sim los ntawm kev sib xyaw ua ke ntawm ob peb yam saum toj no. Hauv qhov no, los ntshav yuav txaus ntshai. Raws li qhov tseeb tias thaum thawj cov tsos mob tuaj yeem nyuaj nrhiav qhov sib txawv ntawm hypotonic los ntshav thiab atonic, nws yuav raug siv thawj lub ntsiab lus, thiab kuaj mob uterine atony yog tias qhov ntsuas tau ua tsis tau zoo.
Yog vim li cas thiaj tso ntshav
Kev tso ntshav tawm, uas yog tshwm sim los ntawm placental abruption thiab yug ntawm placenta, raws li txoj cai, tau piav qhia los ntawm ob yam tseem ceeb: myometrial retraction thiab thrombus tsim nyob rau hauv cov hlab ntsha ntawm placental site. Kev nce ntxiv ntawm myometrium ua rau muaj qhov tseeb tias cov hlab ntsha venous yog compressed thiab twisted, thiab cov hlab ntsha kauv kuj tau kos rau hauv cov nqaij tuab ntawm lub tsev menyuam. Tom qab no, thrombus tsim pib nyob rau hauv cov hlab ntsha ntawm lub tsev menyuam, uas yog yooj yim los ntawm cov txheej txheem ntawm cov ntshav txhaws. Cov txheej txheem ntawm cov ntshav txhaws tuaj yeem siv sijhawm ntev heev, qee zaum ob peb teev.
Cov poj niam hauv kev ua haujlwm muaj kev pheej hmoo siab rau kev mob ntshav qab zib thaum ntxov hypotonic hemorrhage yuav tsum tau ua tib zoo tshuaj loog vim tias kev sib cog lus nrog kev mob hnyav ua rau muaj kev cuam tshuam ntawm lub hauv paus paj hlwb thiabtsim nyog kev sib raug zoo ntawm subcortical formations thiab, raws li, cerebral cortex. Raws li qhov tshwm sim, kev ua txhaum ntawm cov generic dominant yog ua tau, uas yog nrog los ntawm qhov sib npaug ntawm cov kev hloov hauv lub tsev menyuam.
Kev kho mob, xws li los ntshav yog tshwm sim los ntawm qhov tseeb tias nws tuaj yeem pib thaum lub sijhawm yug menyuam tom qab yug menyuam, thiab tom qab ntawd dhau los ua ntshav thaum ntxov tom qab yug menyuam.
kho mob hloov pauv ntawm hypotension
M. A. Repina (1986) tau txheeb xyuas ob qhov kev kho mob ntawm uterine hypotension. Raws li qhov kev xav no, nyob rau hauv thawj qhov sib txawv, los ntshav ntau los ntawm qhov pib, ntshav poob yog loj heev. Lub tsev menyuam ua flabby, atonic, qhia tau hais tias tsis muaj zog tshuaj tiv thaiv rau kev qhia txog cov tshuaj uas ua rau nws txo qis. Hypovolemia tshwm sim sai heev, hemorrhagic shocks nyob rau hauv, thiab nthuav tawm intravascular coagulation (DIC) feem ntau tshwm sim.
Hauv qhov thib ob ntawm txoj kev xav, ntshav poob yog qhov tsis tseem ceeb, daim duab kho mob yog tus yam ntxwv ntawm lub cev hypotonic ntawm lub tsev menyuam: rov qab ntshav hloov pauv nrog lub sijhawm luv luv ntawm myometrial tone thiab tso tseg los ntshav ib ntus. Raws li qhov tshwm sim ntawm kev saib xyuas kev kho mob (xws li kev qhia txog kev txo cov neeg ua haujlwm, kev zaws sab nraud ntawm lub tsev menyuam). Raws li qhov tshwm sim ntawm cov ntshav rov qab me me, tus poj niam pib ib ntus ua rau cov neeg mob hypovolemia: ntshav siab qis me ntsis, pom cov tsos ntawm pallor ntawm daim tawv nqaij thiab pom cov mucous daim nyias nyias, thiab qhov tsis tseem ceeb.tachycardia.
Raws li qhov txiaj ntsig ntawm kev them nyiaj feem ntau ntawm cov ntshav poob, qhov pib ntawm hypovolemia feem ntau mus tsis pom los ntawm cov kws kho mob. Thaum kev kho mob thaum pib ntawm uterine hypotension tsis ua haujlwm, nws txoj haujlwm ua haujlwm tsis zoo pib ua haujlwm, cov lus teb rau kev kho mob ua rau luv luv, thiab qhov ntim ntawm cov ntshav nce ntxiv. Ntawm qee theem, los ntshav pib nce zuj zus, ua rau muaj qhov tsis zoo ntawm tus neeg mob tus mob thiab tag nrho cov tsos mob ntawm hemorrhagic shock thiab DIC syndrome pib tsim.
Kev txiav txim siab qhov ua tau zoo ntawm cov haujlwm ntawm thawj theem yuav tsum ceev ceev. Yog tias 10-15 feeb. Lub tsev menyuam tsis zoo, thiab cov ntshav hypotonic hauv lub sijhawm tom qab yug me nyuam tsis tso tseg, tom qab ntawd kev tshuaj xyuas ntawm lub tsev menyuam yuav tsum tau ua tam sim ntawd thiab lub tsev menyuam zaws ntawm lub nrig yuav tsum tau thov. Raws li kev paub txog kev noj qab haus huv, kev kuaj xyuas lub tsev menyuam raws sij hawm, ntxuav nws ntawm cov ntshav txhaws, thiab tom qab ntawd zaws nws ntawm lub nrig pab txhawm rau xyuas kom meej lub tsev menyuam hemostasis thiab tiv thaiv kev poob ntshav hnyav.
Cov ntaub ntawv tseem ceeb uas yuav tsum tau kuaj xyuas tes ntawm lub tsev menyuam hauv qhov xwm txheej ntawm hypotonic los ntshav thaum ntxov tom qab yug menyuam yog muab los ntawm M. A. Repina hauv nws tus kheej monograph "Bleeding in obstetric practice" (1986). Raws li nws cov kev soj ntsuam, nyob rau hauv cov neeg uas tuag los ntawm nws, kwv yees lub sij hawm los ntawm qhov pib ntawm los ntshav mus rau phau ntawv ntsuam xyuas ntawm lub uterine kab noj hniav.nruab nrab 50-70 feeb. Tsis tas li ntawd, qhov tsis muaj txiaj ntsig ntawm kev ua haujlwm no thiab qhov tsis sib xws ntawm lub xeev hypotonic ntawm myometrium qhia tsis tau tsuas yog tias kev ua haujlwm tau ua lig, tab sis kuj hais txog qhov tsis zoo ntawm kev tso ntshav tawm txawm tias siv lwm txoj kev kho mob.
Terminating method raws li N. S. Baksheev
Thaum lub sijhawm ua haujlwm ntawm theem ob, nws yuav tsum siv cov tswv yim uas ua rau tsawg kawg ntawm cov ntshav ntws mus rau lub tsev menyuam, uas tuaj yeem ua tiav nrog kev pab ntawm ntiv tes siab ntawm lub aorta, clamping ntawm Parametria, ligation ntawm cov hlab ntsha tseem ceeb, thiab lwm yam Niaj hnub no, ntawm ntau yam ntawm cov txheej txheem Qhov nrov tshaj plaws yog txoj kev clamping raws li NS Baksheev, ua tsaug rau qhov ntau zaus nws muaj peev xwm nres hypotonic uterine los ntshav, uas nyob rau hauv lem pab tau. ua tsis tau kev phais kom tshem lub tsev menyuam.
N. S. Baksheev txoj kev siv thaum lub ntim ntawm cov ntshav poob tsis loj (tsis ntau tshaj 700-800 ml). Lub sijhawm ntawm qhov muaj cov terminals ntawm qhov ntsuas yuav tsum tsis txhob ntau tshaj 6 teev, nyob rau hauv cov ntaub ntawv uas, nyob rau hauv lub xub ntiag ntawm superimposed terminals, los ntshav tsis nres, yam tsawg kawg nkaus nyob rau hauv me me, yuav tsum tau puzzled nyob rau hauv lub sij hawm. los ntawm cov lus nug ntawm kev tshem lub tsev menyuam. Qhov kev ua haujlwm no yog hu ua supravaginal amputation lossis extirpation ntawm lub tsev menyuam. Kev phais kom tshem tawm lub tsev menyuam, ua tiav raws sijhawm, yog txoj hauv kev txhim khu kev qha tshaj plaws los tiv thaiv hypotoniclos ntshav tom qab yug me nyuam.
Sijhawm thiab tsim nyog ua
Qhov no yog vim muaj kev pheej hmoo los ntshav. Yog li, nyob rau hauv kev sib ntaus tawm tsam uterine hypotension, nrog rau kev kho cov hemodynamics, nws yog ib qho tsim nyog yuav tsum tau ua tib zoo saib xyuas qhov xwm txheej ntawm cov ntshav txhaws hauv tus neeg mob, uas tshwm sim los ntawm qhov chaw mos, nrog rau qhov tshwm sim ntawm petechial daim tawv nqaij hemorrhages, tshwj xeeb ntawm qhov chaw txhaj tshuaj.
Yog tias cov tsos mob me me ntawm hypofibrinogenemia tshwm sim, lawv pib ua haujlwm ceev ntawm cov tshuaj uas ua rau kom cov ntshav coagulating. Thaum nyob rau hauv cov ntaub ntawv no cov lus nug tshwm sim ntawm qhov yuav tsum tau ua hauj lwm kom tshem tawm lub tsev menyuam, extirpation yog yuav tsum tau, thiab tsis amputation ntawm lub tsev menyuam. Qhov no tau piav qhia los ntawm qhov tseeb tias tej zaum qhov seem ntawm lub ncauj tsev menyuam tuaj yeem ua haujlwm txuas ntxiv ntawm cov txheej txheem frolicking pathological, yog tias muaj kev ua txhaum ntawm cov ntshav txhaws. Thiab txwv tsis pub los ntshav hypotonic yuav tsum tau raws sijhawm.
