Ntawm cov kab mob uas paub txog ntawm lub plawv thiab cov hlab ntsha, cov kws kho mob txheeb xyuas ib pawg uas ua rau muaj kev phom sij loj tshaj plaws rau tib neeg lub neej. Nws suav nrog myocardial infarction thiab aortic aneurysm. Peb yuav tham txog qhov kawg ntawm qhov nthuav dav ntxiv hauv kab lus.
Aortic aneurysm ntawm lub plawv: nws yog dab tsi thiab vim li cas nws thiaj txaus ntshai?
Lub aorta yog ib qho ntawm cov hlab ntsha loj tshaj plaws hauv tib neeg lub cev, nyob ib sab ntawm lub plawv. Los ntawm nws, cov ntshav los ntawm cov leeg tseem ceeb ntws mus rau tag nrho lwm cov hlab ntsha. Ib qho aneurysm ntawm lub plawv aorta yog ib qho pathology nyob rau hauv uas muaj kev nthuav dav ntawm feem ntawm lub aorta vim muaj kev cuam tshuam ntawm ntau yam. Pathology tuaj yeem yog ob qho tib si congenital thiab kis tau.
Tus kab mob pib nrog qhov tseeb tias, nyob rau hauv lub siab ntawm cov ntshav ntws, lub plhaub sab hauv ntawm lub hlab ntsha tawg. Yog li, cov ntshav tau txais lub sijhawm los ntws ncaj qha rau hauv cov leeg nqaij. Hauv qhov xwm txheej no, tus neeg mob feem ntau ntsib qhov mob tsis xis nyob tom qab lub sternum, hauv caj npab sab laug. Cov tawv nqaij tig daj ntseg, lub siab nce, tshwm simxeev siab xav. Saturated nrog ntshav, maj mam phab ntsa ntawm lub aorta yog stretched. Thaum aneurysm ruptures, ib tug neeg yuav tsis nco qab. Qee zaum, muaj kev tuag sai sai los ntawm kev poob ntshav hnyav thiab poob siab.
Pathogenesis ntawm tus kab mob
Lub plawv aortic aneurysm txhim kho li cas? Dab tsi ntawm pathology no tuaj yeem nkag siab yog tias koj paub lub cev nqaij daim tawv ntawm tib neeg lub cev. Lub myocardium muaj cov phab ntsa nyias uas tas li protrude thaum lub sij hawm nqus cov ntshav ntawm ib lub ventricle mus rau lwm qhov. Yog tias ib tug neeg muaj tus kab mob no, kev txwv ntawm phab ntsa maj mam qeeb. Qhov xwm txheej no ua rau cov ntshav tsis tu ncua.
Ntxiv rau qhov kev puas tsuaj rau cov phab ntsa ntawm lub aorta, hemodynamic thiab mechanical yam tseem muaj feem xyuam rau qhov tsim ntawm aneurysm. Pathology feem ntau tshwm sim nyob rau hauv lub functionally stressed thaj chaw, uas yog tas li muaj kev ntxhov siab vim yog cov ntshav txaus tshaj tawm. Kev raug mob ntev ntawm lub aorta thiab kev ua haujlwm ntau dhau ntawm cov enzymes proteolytic provoke kev puas tsuaj ntawm cov txheej txheem elastic thiab cov tsos ntawm cov kev hloov pauv tsis tshwj xeeb ntawm qhov degenerative nyob rau hauv lub nkoj phab ntsa.
Qhov tshwm sim aneurysm tas li nce hauv qhov loj, vim tias lub siab ntawm nws cov phab ntsa tsuas yog nce ntxiv. Ntawm qhov tod tes, cov ntshav ntws hauv lub hnab aneurysmal qeeb qeeb thiab tau txais lub npe hu ua turbulent. Tsuas yog 45% ntawm tag nrho cov ntshav ntim hauv qhov aneurysm nws tus kheej nkag mus rau hauv lub txaj distal. Qhov no yog vim lub fact tias nyob rau hauv nws cov kab noj hniav cov ntshav ntws raws phab ntsa, lub hauv paus ntws yog tas lituav rov qab los ntawm cov txheej txheem ntawm turbulence thiab muaj ntau ntawm cov thrombotic masses.
ua rau ntawm pathology
Cov kws tshawb fawb thoob plaws ntiaj teb txuas ntxiv mus kawm cov kab mob xws li aortic aneurysm ntawm lub plawv, nws yog dab tsi thiab dab tsi ua rau nws txoj kev loj hlob. Nov yog qee qhov ntawm lawv:
- Atherosclerosis. Cov plaques sclerotic uas tsim thaum lub sij hawm tus kab mob no tuaj yeem cuam tshuam cov phab ntsa ntawm lub aorta thiab ua rau lawv tsis muaj zog.
- Kab mob ntawm tus kab mob sib kis. Aortic aneurysm ntawm lub plawv feem ntau tshwm sim ntawm keeb kwm ntawm syphilis lossis tuberculosis.
- Kab mob Congenital (Marfan syndrome, Ehlers-Danlos). Feem ntau, keeb kwm ntawm qhov pib ntawm pathology yog taug qab los ntawm kev tshuaj xyuas tsev neeg keeb kwm.
- Kev raug mob thiab kev puas tsuaj los ntawm tsheb sib tsoo.
- mob plawv mob plawv. Qhov no yog qhov tshwm sim ntawm tus kab mob. 35% ntawm cov neeg uas muaj myocardial infarction raug kuaj pom tias muaj lub plawv aneurysm. Nyob rau hauv cov ntaub ntawv no, nws yog perceived raws li nws direct continuation.
Cov pab pawg uas muaj kev pheej hmoo ntawm kev mob ntshav qab zib muaj xws li cov neeg haus luam yeeb hnyav, cov neeg mob ntshav siab, cov neeg rog rog thiab cov neeg muaj ntshav siab. Raws li kev txheeb cais, aortic aneurysm ntawm lub plawv yog tsib zaug yuav raug kuaj pom hauv cov txiv neej dua li cov poj niam. Raws li txoj cai, cov neeg mob muaj hnub nyoog tshaj 50 xyoo.
YKev faib tawm ntawm pathology
Hauv kev phais vascular, ntau qhov kev faib tawm ntawm aortic aneurysms yog siv, suav nrog lawvTam sim ntawd localization, phab ntsa qauv, zoo thiab etiology.
Raws li segmental typology, muaj: aneurysms ntawm lub qhov ntswg ntawm Valsalva, ascending/descending section, aortic arch thiab plab aorta.
Kev ntsuam xyuas ntawm lub xeev morphological ntawm cov qauv ntawm aneurysms tso cai rau peb faib ua qhov tseeb thiab tsis tseeb. Cov phab ntsa tom kawg yog sawv cev los ntawm cov ntaub so ntswg sib txuas, uas yog tsim los ntawm kev tsim cov pulsating hematoma.
Aneurysms tuaj yeem ua saccular lossis fusiform hauv cov duab.
Cov tsos mob ntawm pathology yog dab tsi?
Feem ntau, tus kab mob no asymptomatic. Nws raug kuaj pom tsis zoo, feem ntau thaum kuaj kev tiv thaiv lossis thaum kuaj xyuas lwm yam kabmob. Kev tsis txaus siab nyob rau hauv cov neeg mob tshwm sim yog hais tias qhov aneurysm yog tus cwj pwm los ntawm kev loj hlob sai los yog twb nyob rau ua ntej ntawm rupture.
Aneurysm ntawm ascending aorta ntawm lub plawv thiab nws cov koov feem ntau yog nrog los ntawm cov duab kho mob tiag tiag, vim li cas qhov no yog qhov chaw tshwj xeeb anatomical. Pathology tuaj yeem tso siab rau ntawm tav thiab tus txha nqaj qaum. Cov neeg mob yws yws ntawm hnoos thiab ua tsis taus pa vim mob bronchial constriction, plawv palpitations, hoarseness.
Kev mob kub hnyiab ntev hauv nraub qaum yog yam ntxwv ntawm pathologies ntawm thoracic aorta ntawm lub plawv. Hauv qhov no, cov neeg mob feem ntau pom qhov tsos ntawm hnoos qhuav, o, kiv taub hau thiab tsis muaj zog thoob plaws lub cev.
Thaum kuaj mob, tus kws kho mob yuav tsum tau saib xyuas tshwj xeeb rau sab nraudtus yam ntxwv ntawm ib tug neeg. Lengthening ntawm xib teg, siab stature, kyphosis, deformity ntawm lub sternum - tag nrho cov cim qhia tau hais tias Marfan's syndrome. Peb twb tau tham txog nws hauv kab lus no.
Hmoov tsis zoo, feem ntau thawj cov cim qhia ntawm pathology yog aortic rupture. Nws yog manifested los ntawm profuse los ntshav nyob rau hauv lub digestive kabmob. Tus neeg mob tau ntuav nrog cov ntshav impurities, mob hnyav tom qab lub sternum, uas kis mus rau tus txha nraub qaum. Tsis muaj kev pab raws sijhawm yuav ua rau tus neeg mob tuag.
Yuav ua li cas thiaj nrhiav tau tus mob aneurysm?
Feem ntau, thaum lub sijhawm kuaj kev tiv thaiv tom ntej, cov kws kho mob kuaj pom "aneurysm ntawm aorta ntawm lub plawv." Nws yog dab tsi, dab tsi yog qhov ua rau ntawm pathology thiab cov txheej txheem tseem ceeb ntawm kev kho mob, tus kws kho mob tshwj xeeb yuav tsum tau qhia ntawm qhov kev teem caij thawj zaug. Kev tshawb fawb ntxaws ntxiv ntawm qhov teeb meem yuav xav tau ntau qhov kev tshawb fawb ntxiv, suav nrog CT, MRI, ultrasound. Raws li cov txiaj ntsig ntawm qhov kev kuaj mob zaum kawg, tus kws kho mob tau txais daim ntawv kho mob tag nrho ntawm tus kab mob.
Thaum kuaj xyuas, nws yog ib qho tseem ceeb uas yuav tsum tau coj mus rau hauv tus account qhov tseeb tias aneurysm hauv nws cov tsos mob zoo ib yam li lwm yam kab mob. Tias yog vim li cas lub luag haujlwm tshwj xeeb hauv kev kuaj mob raug muab rau cov kev tshawb fawb sib txawv.
Kev kuaj kab mob kuj tseem ua tau thaum kuaj. Cov kws tshaj lij pom zoo kom tsis tu ncua rau cov txiv neej tshaj 60 xyoo uas tsis tuaj yeem tso tseg kev quav tshuaj lossis muaj keeb kwm ntawm tus kab mob no.
Aortic aneurysm ntawm lub plawv:kho mob
Ob qho tib si cov tsos mob thiab kev kho tus kab mob cuam tshuam ncaj qha. Tom qab tus kws kho mob pom zoo qhov kev kuaj mob zaum kawg, koj tuaj yeem mus kho.
Nyob rau hauv cov chav kawm asymptomatic ntawm pathology, kev kho yog txwv rau kev saib xyuas tus mob los ntawm tus kws phais mob vascular thiab kev tswj X-ray tas li. Qee cov neeg mob tau muab tshuaj tua kab mob los txo qhov kev pheej hmoo ntawm cov teeb meem.
Kev cuam tshuam kev phais yog qhia rau qhov loj aneurysms (ntau dua 4 cm), nrog rau nws txoj kev loj hlob zuj zus. Cov kev kho mob zoo li no tau pom zoo rau yuav luag txhua tus neeg mob uas tau ntsib nrog cov kab mob hu ua "aortic aneurysm ntawm lub plawv".
Kev ua haujlwm suav nrog kev txiav tawm ntawm thaj chaw cuam tshuam ntawm lub nkoj, suturing qhov tsis xws luag lossis hloov nws nrog vascular prosthesis.
Hmoov tsis zoo, qhov kev cia siab rau tus kab mob no feem ntau yog qhov tsis zoo. Kwv yees li 75% ntawm cov neeg mob tuag los ntawm qhov pib ntawm aneurysm thiab nyob rau hauv tsib xyoos. Ib nrab ntawm lawv tuag los ntawm kev tawg tam sim ntawm lub aorta, thiab cov seem ntawm cov kab mob sib kis (stroke, ischemia).
Aneurysm complications
- Valve kab mob thiab lub plawv tsis ua hauj lwm.
- Rupture ntawm aneurysm. Nyob rau hauv cov ntaub ntawv no, nws kim heev los ntshav tshwm sim nyob rau hauv lub pleural kab noj hniav, ua pa kab mob, lub plawv sac los yog esophagus. Nyob rau hauv cov ntaub ntawv ntawm los ntshav ncaj qha mus rau hauv lub pericardial kab noj hniav, lub plawv tamponade tsim.
- mob thrombosis ntawm aneurysm.
Cov teeb meem saum toj no, yog tias tsis muab kev kho mob raws sij hawm, tuaj yeem ua rau tuag taus rau cov neeg mob uas muaj aortic aneurysm ntawm lub plawv. Kev kho mob ntawm tus kab mob no yog xaiv los ntawm tus kws kho mob, raws li cov xwm txheej ntawm tus neeg mob thiab qhov hnyav ntawm pathology.
ntsuas kev tiv thaiv
Thaum nws los txog rau kev tiv thaiv tus mob hnyav, tag nrho cov lus pom zoo rau kev noj qab haus huv thiab kev tsis lees paub ntawm kev quav tshuaj yuav tsum tau coj mus rau hauv thawj qhov chaw. Raws li twb tau hais lawm, rau lub sijhawm ntev, aneurysm ntawm aorta ntawm lub plawv tuaj yeem ua rau hauv daim ntawv latent. Cov tsos mob hauv qhov no tsis tshwm sim, tus neeg mob tsis paub txog qhov muaj xws li pathology. Yog li ntawd, yog tias ib tug neeg muaj kev pheej hmoo (haus luam yeeb, ntshav siab, muaj cov kab mob aortic dissection hauv tsev neeg keeb kwm), yuav tsum tau ua tiav kev kuaj mob tas li. Rau cov laj thawj no, ultrasound, aortography nrog kev siv tus neeg sawv cev sib txawv thiab MRI feem ntau yog siv. Kev kuaj pom tus mob raws sij hawm tuaj yeem cawm tib neeg txoj sia.
Zoo kawg
Kab lus no qhia txog lub ntsiab lus "Aortic aneurysm ntawm lub plawv: ua rau, tsos mob thiab kev kho mob." Koj yuav tsum tsis txhob ntshai tus kab mob no, txij li kev kuaj mob raws sijhawm thiab kev kho mob muaj peev xwm nyob rau theem pib ua rau nws tuaj yeem hnov qab txog qhov teeb meem yuav luag mus ib txhis.
