Hauv cov lus kho mob, lub tswv yim ntawm "kev poob siab" yog hais txog qib tseem ceeb ntawm microcirculation hauv tib neeg lub cev, uas lub peev xwm ntawm cov hlab ntsha tag nrho tsis sib haum rau cov ntshav ncig.
Ntawm cov laj thawj ntawm tus mob no tuaj yeem ua rau cov ntshav poob qis - nws tam sim ntawd tawm tam sim ntawd dhau qhov txwv ntawm lub nkoj txaj. Xws li ib qho kev poob siab, uas tshwm sim vim kev mob ntshav qab zib ntau dua 1-1.5% ntawm lub cev hnyav, hu ua hemorrhagic lossis hypovolemic.
Ntau lub cev tsis ua haujlwm thiab txo cov ntshav mus rau cov kabmob uas nrog rau tus mob no tshwm sim raws li tachycardia, ntshav siab, thiab pallor ntawm cov mucous daim nyias nyias thiab epidermis.
Yog vim li cas
Qhov ua rau hemorrhagic shock nyob rau hauv mob hnyav tau muab faib ua peb pawg los ntshav loj:
- post-traumatic;
- Nyob zoo ib tsoom phooj ywg;
- postoperative.
Ntau lub npe mob tshwm sim hauv obstetrics, ua ib qho tseem ceeb ua rau poj niam tuag. Raws li txoj cai, lawv coj mus rau nws:
- placenta previa los yog ntxov ntxov abruption;
- ntshav tom qab yug menyuam;
- uterine atony thiab hypotension;
- kev raug mob obstetric ntawm qhov chaw mos thiab lub tsev menyuam;
- ectopic cev xeeb tub;
- fetal tuag hauv plab;
- vascular amniotic kua embolism.
yam ntxiv
Ntxiv mus, hemorrhagic shock tuaj yeem tshwm sim los ntawm cov kab mob oncological thiab cov txheej txheem sepsis, uas ua rau cov nqaij mos necrosis thiab yaig ntawm phab ntsa vascular.
Tsis muaj qhov tseem ceeb me me hauv qhov pom ntawm qhov piav qhia pathology yog tus nqi ntawm cov ntshav poob. Yog tias los ntshav qeeb, ces cov txheej txheem them nyiaj tau qhib, thiab yog li ntawd hemodynamic cuam tshuam tshwm sim maj mam thiab tsis ua rau muaj qhov tshwm sim tseem ceeb. Thiab nrog kev poob ntshav sai (txawm tias nws ntim tsawg dua), qhov no ua rau muaj qhov tsis xws luag hemodynamic uas xaus rau hauv hemorrhagic shock.
Symptoms
Rau kev kuaj mob hemorrhagic shock raws li kev soj ntsuam ntawm cov tsos mob tseem ceeb:
- ntawm tus neeg mob lub siab;
- xim ntawm pom daim tawv nqaij thiab cov mucous;
- ua pa;
- tus nqi thiab qhov xwm txheej ntawm lub plawv;
- venous thiab systolic siab ntau;
- tus nqi diuresis, uas yog, cov zis tawm tawm.
Txawm tias qhov tseem ceeb ntawm kev ntsuasntsuas, nws yog qhov tsis tshua pom kev pom luv luv thiab txaus ntshai tsuas yog tso siab rau qhov kev xav ntawm tus neeg mob. Cov tsos mob tseem ceeb tshwm sim feem ntau yog nyob rau hauv qhov tsis tau them nyiaj, theem thib ob ntawm hemorrhagic shock nyob rau hauv obstetrics, thiab qhov tseem ceeb tshaj plaws ntawm lawv yog ib qho kev txo qis hauv cov ntshav siab, uas qhia txog kev txo qis ntawm tus neeg mob cov txheej txheem them nyiaj.
Kev txiav txim siab qib ntshav poob
Yuav kom ua tau zoo thiab ua tiav kev kho mob rau hemorrhagic shock, nws yog ib qho tseem ceeb heev uas yuav tsum tau tsim kom muaj cov ntshav poob raws sijhawm thiab raug. Ntawm cov kev faib tawm uas tam sim no muaj, cov hauv qab no tau siv dav tshaj plaws hauv kev xyaum:
- Mild degree (ntshav poob ntawm 10 mus rau 20% ntawm cov ntshav ntim), uas tsis pub tshaj ib liter.
- Qib Nruab Nrab (cov ntshav poob ntawm 20 txog 30%) - txog li ib thiab ib nrab litres.
- mob hnyav (txog plaub caug feem pua ntawm cov ntshav poob), nce mus txog ob litres.
- Kev poob ntshav loj lossis hnyav heev - ntau dua 40% ntawm cov ntshav ntim tau ploj, uas yog, ntau dua ob litres.
Nyob rau hauv qee kis, nrog kev poob ntshav hnyav, qhov tsis xws luag hauv homeostasis txhim kho, uas tsis raug kho txawm tias los ntawm cov ntshav ntim tam sim.
Ntau yam ntshav poob
Cov ntshav hauv hemorrhagic shock cais li cas? Cov kws kho mob ntseeg tias cov ntshav poob hauv qab no tuaj yeem ua rau tuag taus:
- Poob txhua hnub100% ntawm nws tag nrho.
- Poob tshaj 3 teev 50%.
- Instant poob ntawm 25%.
- Txoj ntshav poob txog li 150 ml ib feeb.
Kev ntsuas
txhawm rau txhawm rau txhim kho qhov hnyav ntawm hemorrhagic shock thiab ntshav poob, kev ntsuam xyuas dav dav ntawm hemodynamic, paraclinical thiab kho tsis tau. Qhov tseem ceeb tshaj plaws yog kev suav ntawm Algover shock Performance index, uas txhais tau tias yog ib qho txiaj ntsig los ntawm kev faib lub plawv dhia los ntawm systolic siab.
Qhov ntsuas qhov poob siab ib txwm tsawg dua ib qho. Nyob ntawm qhov hnyav ntawm kev poob siab thiab qib ntshav poob, qhov no tuaj yeem yog qhov ntsuas hauv qhov ntau:
- 1-1, 1 - sib raug rau qib qis;
- 1, 5 - nruab nrab degree;
- 2 - hnyav;
- 2, 5 - hnyav heev.
Ntxiv rau qhov ntsuas Algover, koj tuaj yeem suav qhov ntim ntawm cov ntshav poob los ntawm kev ntsuas lub hauv paus venous thiab arterial siab, saib xyuas ib teev thiab feeb diuresis, cov ntsiab lus hemoglobin hauv cov ntshav, thiab tseem nrhiav pom qhov sib piv nrog tus nqi hematocrit., uas yog, qhov tshwj xeeb ntawm cov qe ntshav liab nyob rau hauv tag nrho cov ntshav ntim.
ntshav poob qis yog qhia los ntawm cov tsos mob hauv qab no:
- Lub plawv dhia qis dua 100 ntaus ib feeb.
- Dryness, pallor thiab qis ntawm daim tawv nqaij.
- Tus nqi ntawm hematocrit yog nyob rau hauv 38-32%.
- Central venous siab - peb mus rau rau millimeterskem dej, tso zis ntau tshaj peb caug milliliters.
Kev poob ntshav nruab nrab yog qhov tseem ceeb tshaj:
- Lub plawv dhia nce mus txog 120 neeg ntaus ib feeb.
- Kev ntxhov siab thiab ntxhov siab, pom tus neeg mob mob hauv lub hws txias.
- Txo hauv CVP rau peb mus rau plaub centimeters ntawm kab dej.
- Txo qis hauv hematocrit li ntawm 22-30%.
- tso zis qis dua peb caug milliliters.
Kev poob ntshav hnyav yog tus yam ntxwv raws li hauv qab no:
- Tachycardia tshaj 120 neeg ntaus ib feeb.
- Cov ntshav siab qis dua 70 mm Hg, venous siab tsawg dua 3 mm H2O.
- Tshuaj tawv nqaij pallor, uas yog nrog los ntawm hws nplaum, tsis muaj zis (anuria).
- Hematocrit tsawg dua 22% thiab hemoglobin tsawg dua 70 grams ib liter.
Cia peb xav txog cov theem ntawm hemorrhagic shock hauv obstetrics.
Degrees ntawm qhov hnyav
Qhov kev qhia pom ntawm daim duab kho mob ntawm tus mob no yog txiav txim siab los ntawm cov ntshav poob thiab muab faib raws li qhov no:
- thawj (yooj yim);
- second (middle);
- thib peb (hnyav);
- plaub (nyuaj heev).
Nyob rau hauv tus neeg mob uas muaj thawj qib hemorrhagic shock, ntshav poob tsis ntau tshaj 15% ntawm tag nrho. Nyob rau theem no, cov neeg mob raug kev sib cuag, lawv kev nco qab yog khaws cia. Paleness ntawm mucous daim nyias nyias thiab daim tawv nqaijnrog los ntawm cov mem tes ntau zaus (nce txog 100 neeg ntaus), qis arterial hypotension thiab oliguria, uas yog, txo cov zis tso zis.
Cov tsos mob ntawm kev poob siab ntawm qib thib ob yog, ntxiv rau cov uas tau teev tseg, tawm hws siab, ntxhov siab, acrocyanosis, uas yog, cyanosis ntawm cov ntiv tes thiab daim di ncauj. Muaj kev nce hauv lub plawv dhia mus rau 120 tus neeg ntaus, ua pa ntau zaus mus txog 20 ib feeb, ntshav siab txo qis, oliguria nce. Qhov tsis txaus ntawm CC nce mus rau 30%.
Nyob rau qib peb ntawm hemorrhagic shock, ntshav poob mus txog plaub caug feem pua. Cov neeg mob tsis meej pem, marbling thiab pallor ntawm daim tawv nqaij yog qhov hais tau zoo, lub plawv dhia yog ntau tshaj 130. Hauv cov neeg mob nyob rau hauv cov mob no, oliguria thiab ua tsis taus pa luv (txog peb caug ua pa ib feeb) tau pom, arterial systolic siab tsawg dua. 60 millimeters ntawm mercury.
theem plaub ntawm hemorrhagic shock yog tus cwj pwm los ntawm qhov tsis muaj CK ntau dua 40%, nrog rau kev ua haujlwm ntawm lub neej tseem ceeb: tsis muaj kev nco qab, mem tes thiab venous siab. Tsis tas li ntawd, cov neeg mob muaj qhov ua pa qis, anuria, thiab areflexia.
Mechanisms cuam tshuam kev poob siab hnyav
Cov txheej txheem pathological hauv kev txhim kho hemorrhagic shock nyob rau hauv tib neeg yog raws li qhov txo qis ntawm cov ntshav uas ntws los ntawm cov hlab ntsha. Kev txo qis ntawm cov ntshav tawm los ntawm lub plawv reflexively ua rau vascular spasm nyob rau hauv ntau yam kabmob, nrog rau cov tseem ceeb rau lub neej, xws li lub hlwb, ntsws thiab lub plawv.
ntshav thinning (hemodilution),uas tshwm sim vim kev hloov pauv ntawm cov kua dej mus rau hauv cov hlab ntsha los ntawm cov ntaub so ntswg, hloov pauv cov ntshav rheological (erythrocyte aggregation) thiab ua rau muaj qhov tsis txaus ntseeg ntawm cov hlab ntsha, ua rau muaj kev cuam tshuam tsis zoo hauv microcirculation hauv nruab nrog cev thiab cov ntaub so ntswg..
Kev puas tsuaj loj hloov pauv hauv cov txheej txheem microcirculatory uas tshwm sim tom qab muaj kev kub ntxhov ntawm macrocirculation yog qhov hloov tsis tau, ua rau muaj kev phom sij rau tus neeg mob.
Kev saib xyuas xwm txheej kub ntxhov rau hemorrhagic shock
Lub hom phiaj tseem ceeb ntawm cov txheej txheem xwm txheej ceev yog txhawm rau nrhiav qhov chaw ntawm cov ntshav poob thiab tshem tawm nws, uas feem ntau yuav tsum muaj kev phais. Txhawm rau kom tsis txhob los ntshav ib ntus, siv cov ntaub qhwv, tourniquet lossis endoscopic hemostasis. Cov kauj ruam tom ntej, uas tshem tawm kev poob siab thiab cawm tus neeg mob txoj sia, yog kev rov ua dua tam sim ntawm cov ntshav ncig.
Pab rau hemorrhagic shock yuav tsum tam sim.
Infusion nqi
Tus nqi ntawm cov tshuaj txhaj tshuaj ntawm cov tshuaj yuav tsum yog tsawg kawg 20% siab dua li cov ntshav poob. Txhawm rau txiav txim siab nws, cov ntsuas xws li lub plawv dhia, CVP thiab ntshav siab yog siv. Kev ntsuas ceev kuj tseem suav nrog catheterization ntawm cov hlab ntsha loj, uas muab kev nkag tau zoo rau cov hlab ntsha thiab qhov xav tau ceev ntawm cov teebmeem.
Nyob rau hauv lub davhlau ya nyob twg, infusions rau hauv cov hlab ntsha yog siv. Cov kev ntsuas kub ntxhov tseem ceeb kuj tseem yog: kev ua pa, nqus pa oxygen siv lub npog ntsej muag, kev saib xyuas tus neeg mob (ua kom sov),tshuaj loog kom raug.
Hemorrhagic shock kho mob
Tom qab tso tseg los ntshav thiab venous catheterization, kev kho mob hnyav muaj cov hom phiaj hauv qab no:
- Kev tshem tawm ntawm hypovolemia, nrog rau kev ntxiv ntawm cov nyiaj CK.
- Txhim kho lub plawv kom raug thiab microcirculation.
- Detoxification.
- Kev kho dua tshiab ntawm cov ntsuas yav dhau los ntawm cov pa oxygen thauj cov ntshav muaj peev xwm thiab osmolarity.
- Kev tiv thaiv ntawm cov qe ntshav liab sib sau ua ke (DIC).
- Rebalancing thiab tswj diuresis.
Kom ncav cuag lawv, qhov zoo ntawm kev kho infusion yog muab:
- HES cov kev daws teeb meem (txog li ib thiab ib nrab litres ib hnub twg) thiab normalization ntawm oncotic ntshav siab;
- crystalloid intravenous tov txog li ob litres kom txog thaum cov ntshav siab rov zoo li qub;
- cov tshuaj colloidal (dextrans thiab gelatins) hauv qhov sib piv ntawm 1: 1 rau lub ntim ntim tag nrho;
- erythrocyte daim npog qhov ncauj thiab lwm yam ntshav hloov nrog kev soj ntsuam ntawm CVP mus rau qib hematocrit hauv 32-30%;
- siv cov ntshav pub dawb;
- Y koob tshuaj ntau tshaj ntawm glucocorticosteroids.
trental.
Cov lus pom zoo rau hemorrhagic shock yuav tsumyuav tsum ceev faj.
Kev nyuaj siab
Nyob rau hauv daim ntawv decompensated poob siab, reperfusion syndrome, DIC, asystole, coma, myocardial ischemia, ventricular fibrillation yuav tshwm sim. Tom qab ob peb xyoos, cov kab mob endocrine thiab cov kab mob ntev ntawm cov kab mob hauv nruab nrog cev tuaj yeem txhim kho, ua rau muaj kev tsis taus.
