Cov kws kho mob feem ntau yuav tsum tau daws qhov teeb meem ntawm necrosis. Hom, ua rau thiab kev kho mob ntawm tus kab mob no tuaj yeem muab faib ua cov ntaub ntawv tseem ceeb rau cov neeg niaj hnub no. Tom qab tag nrho, ntau tus neeg zoo tib yam ntsib cov tsos mob ntawm necrosis ntawm cov ntaub so ntswg thiab hlwb. Thiab qee zaum qhov tshwm sim ntawm cov txheej txheem zoo li no tuaj yeem ua rau tuag taus. Yog li ntawd, nws tsim nyog los kawm txog qhov teeb meem no.
YDab tsi yog necrosis
lo lus no qhia txog kev tuag ntawm cov hlwb hauv tib neeg lub cev nrog qhov kawg nres ntawm lawv txoj haujlwm. Ntawd yog, kev ua neej nyob hauv qee qhov ntawm lub cev tom qab ua tiav cov txheej txheem necrotic tsis tuaj yeem ua tau lawm.
Virtually tag nrho cov hom necrosis tshwm sim vim muaj kev cuam tshuam ntawm kev txhawb zog heev. Qee lub sij hawm qhov kev xav tsis muaj zog ua rau muaj lub xeev zoo sib xws. Nyob rau hauv cov ntaub ntawv no, qhov raug yuav tsum tau ntev ua rau kev puas tsuaj loj. Raws li ib qho piv txwv ntawm kev loj hlob qeeb, nws tsim nyog hais txog kev hloov pauv ntawm kev hloov pauv hloov pauv mus rau qhov tsis tuaj yeem hloov pauv. Cov txheej txheem no tau muab faib ua ob peb theem tseem ceeb. Peb tab tom tham txog paranecrosis, thaum cov kev hloov pauv tseem rov qab tau, necrobiosis (qhov kev hloov pauv tsis hloov pauv, tab sis cov hlwb tseem muaj sia nyob) thiab necrosis, uas autolysis tshwm sim.
Hauv qab autolysis sawvnkag siab qhov tseeb ntawm nws tus kheej-kev zom cov ntaub so ntswg thiab cov hlwb uas tuag vim yog kev ua ntawm qee cov enzymes. Qhov tseeb, cov txheej txheem no yog qhov tsim nyog rau lub cev, vim tias nws ua tau kom kho tau tag nrho tom qab necrosis.
Qhov cuam tshuam ntawm ntau yam
Kawm cov ncauj lus no, nws yuav yog qhov laj thawj uas yuav tsum tau ua tib zoo saib xyuas cov xwm txheej vim muaj ntau hom necrosis tshwm sim. Lawv cov npe yog raws li nram no:
- Thermal. Qhov kub thiab txias poob qis dua -10 ° C lossis siab dua +60 ° C.
- Mechanical. Cov no yog ruptures, squeezing, crushing.
- Circulatory. Peb tab tom tham txog kev tso ntshav tawm hauv qee qhov ntawm lub cev vim yog obliteration ntawm cov hlab ntsha los yog ntev spasm. Lub nkoj kuj tseem yuav nruj dhau los ntawm lub tourniquet los yog thaiv los ntawm thrombus. Kev mob qog nqaij hlav tsis tuaj yeem txiav tawm.
- Hluav taws xob. Thaum sib cuag nrog tam sim no, qhov kub tseem ceeb tuaj yeem cuam tshuam rau lub cev, ua rau lub cev tuag.
- Toxic. Qee hom necrosis tuaj yeem tshwm sim los ntawm kev tawg ntawm cov kab mob los yog raug rau lawv cov khoom pov tseg.
- Neurogenic. Cov kab mob trophic yog tsim los ntawm kev puas tsuaj rau cov hlab ntsha ntawm tus txha caj qaum.
- Tshuaj. Cov pab pawg no muaj xws li raug alkalis thiab acids. Cov qub yaj cov proteins thiab yog li ua rau ntub colliquational necrosis. Cov tom kawg yog ua rau cov protein coagulation thiab ua rau kev loj hlob ntawm qhuav coagulation necrosis.
Raws li koj tuaj yeem pom, ntawmKev noj qab haus huv ntawm tes tuaj yeem cuam tshuam los ntawm ntau yam.
Ntau yam ntawm necrosis
Cov necrosis ntawm cov ntaub so ntswg thiab hlwb tuaj yeem tshwm sim nws tus kheej hauv ntau txoj kev. Thiab qhov sib txawv yog qee zaum tseem ceeb. Ntawm no yog cov feem ntau hom necrosis:
- Gangrene. Qhov no yog necrosis ntawm cov ntaub so ntswg uas nyob rau hauv kev sib cuag nrog rau sab nraud ib puag ncig. Nws tuaj yeem qhuav (coagulative necrosis) lossis ntub dej (kev sib tsoo cov ntaub so ntswg). Kuj tseem muaj daim ntawv gaseous vim qhov kev ua ntawm cov kab mob sib kis.
- Kev txiav txim. Qhov no yog thaj chaw necrotic uas nyob rau hauv cov kab noj hniav, sib cais los ntawm cov ntaub so ntswg noj qab haus huv thiab muaj cov kua qaub.
- Lub plawv nres. Kawm txog necrosis, txhais, hom thiab cov yam ntxwv ntawm tus kab mob no, yuav tsum tau them nyiaj rau daim ntawv no yam tsis poob. Peb tab tom tham txog ib ntu ntawm cov khoom nruab nrog cev lossis cov ntaub so ntswg uas tau dhau los ntawm necrosis vim muaj qhov tsis txaus ntawm cov ntshav. Qhov tseeb, peb tab tom tham txog ischemia. Nws yog vim li no, xws li necrosis feem ntau hu ua ischemic.
- Moist, aka colliquational. Hauv lub xeev no, cov ntaub so ntswg tsis tuaj yeem ua haujlwm tau yaj los ntawm cov kab mob putrefactive.
- Qhuav necrosis (coagulative). Nws txoj kev loj hlob yog raws li cov ntaub so ntswg dehydration thiab protein coagulation. Cov ntaub so ntswg lawv tus kheej nrog hom necrosis no ua ntom, wrinkled, atrophic thiab qhuav. Daim ntawv no nyuaj rau hydrolytize thiab feem ntau tshwm sim nyob rau hauv aseptic mob.
Direct and indirect forms of necrosis
Kev tshuaj xyuasnecrosis, ua rau, cov tsos mob, hom thiab cov piv txwv ntawm tus kab mob no, nws yog ib qho tsim nyog yuav tsum tau them sai sai rau ob qho kev tshwm sim ntawm qhov teeb meem no, qhov sib txawv tseem ceeb ntawm qhov tshwm sim los ntawm cov txheej txheem ntawm qhov tshwm sim.
thawj tus yog direct necrosis. Cov txheej txheem no yog tus cwj pwm los ntawm kev tuag ntawm tes ncaj qha rau hauv qhov chaw uas tus neeg ua haujlwm puas tsuaj ua. Qhov no tej zaum yuav yog ib tug neeg kho tshuab lossis tshuaj raug mob, lub zog ntawm hluav taws xob hluav taws xob, cov kab mob, nrog rau cov co toxins uas lawv tsim. Qhov no kuj suav nrog kev ua xua necrosis thiab cov kev raug mob uas yog tshwm sim los ntawm kev puas tsuaj ntawm cov concentrated alkalis thiab acids.
Indirect necrosis zoo li txawv me ntsis. Qhov sib txawv tseem ceeb yog qhov tseeb tias cov txheej txheem ntawm cov ntaub so ntswg thiab cell tuag tuaj yeem tshwm sim ntawm ib qho kev ncua deb ntawm qhov chaw uas tus neeg ua haujlwm puas tsuaj. Nws ua rau kev txiav txim siab suav nrog cov hom necrosis xws li trophoneurotic thiab vascular.
Nws tsim nyog sau cia tias thaum muaj hnub nyoog ntxov, daim ntawv ncaj qha ntawm cov ntaub so ntswg puas ntau dua, uas yog vim kev ua xua thiab ntau yam kab mob microbial.
Qhov cuam tshuam ntawm apoptosis
Qhov no yog ib qho tshwj xeeb ntawm kev tshwm sim ntawm kev puas tsuaj ntawm cov hlwb thiab cov ntaub so ntswg. Nws yuav tsum tau saib xyuas yog tias lub hom phiaj yog los xyuas seb qhov necrosis yog dab tsi. Apoptosis, hom kev puas tsuaj uas tau tham saum toj no, tso tseg vim nws txoj kev loj hlob txawv txawv. Cov kab hauv qab yog tias kev tuag ntawm tes hauv qhov no tshwm sim vim kev ua kom cov noob tshwj xeeb hauv lub nucleus. Qhov tseeb, nws tab tom tua tus kheej. Nws tsis mus ntawm no lawmpeb tab tom tham txog kev cuam tshuam los ntawm sab nraud, kev puas tsuaj yog programmed los ntawm lub cev nws tus kheej.
Yog vim li cas rau qhov suav nrog apoptotic genes yog qhov ua kom cov cytoplasmic protein p53, uas tuaj yeem hloov mus rau ntau yam hauv thaj chaw extracellular. Cov txheej txheem zoo li no tuaj yeem tshwm sim nrog kev hloov pauv hloov pauv ntawm cov noob.
Apoptosis txawv ntawm cov necrosis zoo tib yam uas cov txheej txheem kev puas tsuaj pib tam sim ntawd hauv lub cell nucleus, thiab tsuas yog tom qab ntawd kev tuag ntawm cytoplasm raug kaw. Nyob rau hauv daim ntawv classic, txhua yam tshwm sim nyob rau hauv lwm txoj kev: lub cytoplasm yog thawj theem ntawm kev puas tsuaj, thiab lub nucleus yog kawg.
Lwm qhov txawv yog tias thaum lub sijhawm apoptosis, tib neeg cov hlwb tuag thoob plaws hauv lub cev, thaum necrosis ib txwm cuam tshuam nrog kev ua kom puas tsuaj loj.
Diagnosis
Cov ntaub ntawv hais txog qhov teeb meem xws li necrosis (theem, hom, qhov tshwm sim) yuav tsis coj cov txiaj ntsig zoo yog tias cov necrosis ntawm cov hlwb lossis cov ntaub so ntswg tsis pom nyob rau lub sijhawm. Yog li ntawd, txoj hmoo ntawm tus neeg mob feem ntau nyob ntawm kev kuaj mob.
Yog tias muaj laj thawj xav tias necrosis ntawm cov kabmob sab hauv, ces cov kev kuaj hauv qab no yuav tsum tau ua:
- X-ray;
- MRI;
- radioisotope scan;
- xam tomography.
Ua tsaug rau cov txheej txheem no, nws tuaj yeem txiav txim siab qhov loj thiab qhov chaw ntawm thaj chaw cuam tshuam. Xws li kev ntsuam xyuas kuj tso cai rau koj kho cov kev hloov pauv txaus ntshai hauv cov qauv ntawm cov ntaub so ntswg thiab raugtxiav txim seb tus kab mob, nrog rau nws theem.
Exodus
Ib qho teeb meem zoo li cov ntaub so ntswg necrosis tuaj yeem muaj ntau qhov laj thawj tshwm sim.
Thawj yog qhov resorption ntawm cov ntaub so ntswg necrotic, tom qab ntawd nws rov qab tag nrho. Ib qho piv txwv yog kho qhov chaw me me ntawm necrosis hauv daim siab lossis ntawm daim tawv nqaij.
Xav txog qhov necrosis, theem, hom, tshwm sim thiab qhov tshwm sim ntawm tus kab mob no feem ntau, nws yog ib qho tsim nyog yuav tsum tau ua tib zoo saib xyuas qhov tseeb tias qee zaum cov txheej txheem ntawm cell tuag xaus nrog resorption nrog tsim ntawm caws pliav. Nws tuaj yeem yog caws pliav ntawm daim tawv nqaij tom qab raug thermal lossis tshuaj lom neeg, nrog rau cov cim ntawm cov ntaub so ntswg ntawm lub plawv, tshwj xeeb tshaj yog thaum mob myocardial infarction.
Qee zaum, cov txheej txheem resorption yuav xaus nrog kev tsim cov cyst. Qhov no feem ntau tshwm sim hauv lub hlwb tom qab ischemic stroke uas tau ua rau lub plawv nres.
Lwm qhov tshwm sim ntawm necrosis yog kev tsis lees paub los ntawm hom kev hloov pauv lossis desquamation. Hauv thawj kis, peb txhais tau hais tias cov txheej txheem ntawm kev tsis lees paub lub cev lossis lawv qhov chaw. Ib qho piv txwv yog qhov poob ntawm cov ntiv taw vim gangrene. Lub plab hnyuv epithelium los yog cov kab mob epidermal uas tau tuag tuaj yeem raug tshem tawm.
Cab thiab tag nrho tuag
Encapsulation ntawm cov txheej txheem no tuaj yeem txhais tau tias yog qhov tshwm sim tom ntej ntawm necrosis. Lub xeev no ntawm cov ntaub so ntswg yog pom thaum lawv resorption los yog rejection yog tsis yooj yim sua. Cov txiaj ntsig zoo sib xws tuaj yeem ua rau tuberculosis.
kawg thiab mob hnyav tshajdaim ntawv uas qhov tshwm sim ntawm tus kab mob no tuaj yeem muaj tag nrho kev tuag. Yog vim li cas rau qhov ua tiav ntawm cov txheej txheem ntawm necrosis tuaj yeem yog qee yam ntawm necrosis raws li etiological yam cuam tshuam - los ntawm kev puas tsuaj rau lub plawv nres.
Kev tuag ntawm tag nrho cov kab mob tuaj yeem suav nrog ob theem: kev kho mob thiab lom. Hauv thawj kis, cov txheej txheem tuaj yeem thim rov qab, hauv qhov thib ob tsis muaj lub sijhawm rau qhov txiaj ntsig zoo - ua pa ploj mus, kev ua haujlwm plawv ploj thiab cov ntshav ntws nres.
Kev kho mob tuag tuaj yeem tshwm sim los ntawm kev poob ntshav loj, poob siab thiab mob.
Kev kho mob
Yog tias muaj kev hloov pauv hauv cov ntaub so ntswg tau kuaj pom, ces nws yuav tsum tau mus pw hauv tsev kho mob.
Feem ntau, kom ua tiav qhov xav tau, kev kho tshuaj siv los kho cov ntshav ntws hauv thaj chaw cuam tshuam ntawm lub cev, txawm tias nws yog lub cev lossis cov ntaub so ntswg. Yog tias tsim nyog, kev kho detoxification lossis kev qhia txog tshuaj tua kab mob tuaj yeem ua tiav.
Qee zaum, tsuas yog kev ntsuas tiag tiag yog kev phais, uas txo qis rau kev txiav tawm ntawm cov ntaub so ntswg tuag lossis txiav tawm ntawm ceg ceg.
Tab sis nyob ntawm daim ntawv ntawm tus kab mob, kev kho mob tuaj yeem muaj qhov sib txawv loj. Tshwj xeeb tshaj yog, feem ntau hom necrosis - yog vascular thiab xav tau txoj hauv kev tshwj xeeb vim nws yog lub plawv nres.
Surgery
Nyob rau hauv cov ntaub ntawv ntawm kev kuaj xyuas lub hauv siab necrosis thiabextremities uas cuam tshuam cov khoom noj khoom haus ntawm tes, lymphatic thiab ntshav ncig, nrog rau innervation, necrotomy yog ua. Qhov no yog qhov kev tshem tawm ntawm cov ntaub so ntswg uas tuag vim frostbite, kub hnyiab thiab lwm yam laj thawj. Nrog nws cov kev pab, koj tuaj yeem hloov cov gangrene ntub dej kom qhuav.
Kev txiav tawm thiab tshem tawm cov ntaub so ntswg tuag tsuas yog ua tiav tom qab txiav txim siab ntawm tus ciam teb ntawm necrosis siv lub tshuab ua kom muaj zog. Qhov no tuaj yeem yog kov nrog lub pob hlau, lub cuab yeej phais, lossis rab koob prick ntawm lub koob txhaj tshuaj.
Nyob hauv cov gangrene qhuav, kev phais qee zaum qeeb kom txog thaum cov ntaub so ntswg necrotic demarcated tag. Ua ke nrog qhov no, nws yog ib qho tsim nyog los ua kom muaj peev xwm tiv thaiv kev txhim kho ntawm cov kab mob ntub dej.
Yuav kom tsis txhob ntsib qhov kev kuaj mob txaus ntshai xws li necrosis, koj yuav tsum xub saib xyuas kev tiv thaiv kev cuam tshuam ntawm cov xwm txheej uas tuaj yeem ua rau cov nqaij mos thiab cov hlwb puas, yog li pib cov txheej txheem ntawm lawv cov necrosis.
Results
Tom qab xav txog hom necrosis nyob ntawm qhov ua rau thiab lwm yam, peb tuaj yeem txiav txim siab tias tus kab mob no txaus ntshai heev thiab xav tau kev kuaj mob sai sai. Yog tsis muaj kev kho mob, qhov xwm txheej yuav nyuaj rau hloov. Yog li ntawd, qhov zoo tshaj plaws los ua ntawm thawj cov tsos mob uas qhia tias necrosis yog mus ntsib kws kho mob yam tsis tau ncua.
