Cov hlab ntsha subclavian yog cov hlab ntsha uas nqa ntshav mus rau sab sauv ntawm tib neeg lub cev. Hauv tsab xov xwm no, tag nrho cov ntsiab lus tseem ceeb ntawm lub ncauj lus no yuav tau tham kom ntxaws. Koj yuav kawm paub tias subclavian artery syndrome yog dab tsi thiab cov yam ntxwv ntawm nws txoj kev kho mob muaj nyob.
Dab tsi yog cov hlab ntsha subclavian?
Cov kab mob hauv lub cev yog qhov nyuaj ntawm ntau cov hlab ntsha, cov hlab ntsha, capillaries. Cov hlab ntsha loj uas tau txais cov ntshav los ntawm lub aortic koov - cov hlab ntsha subclavian - belongs rau cov hlab ntsha ntawm cov hlab ntsha ntawm tus neeg. Nws muab cov ntshav mus rau thaj tsam occipital ntawm lub hlwb, lub cerebellum, lub ncauj tsev menyuam ntawm tus txha caj qaum, cov leeg thiab cov leeg ntawm lub caj dab, lub xub pwg nyom thiab sab sauv ceg, thiab qee qhov ntawm lub hauv siab thiab plab.
Topography ntawm cov hlab ntsha subclavian
lo lus "topography" nws tus kheej txhais li cas? Qhov no yog qhov chaw nyob los yog qhov chaw ntawm ib yam dab tsi txheeb ze rau qee yam khoom. Cia peb xav txog ntau yam ntxiv txog qhov topography ntawm cov hlab ntsha subclavian txhais tau tias, hauv lwm lo lus,qhov twg thiab hais txog qhov nws nyob. Nws tshwm sim ntawm ib sab ntawm lub cev brachiocephalic, thiab nyob rau lwm yam - los ntawm lub aortic arch, bypasses lub apex ntawm lub ntsws thiab tawm los ntawm qhib lub hauv siab los ntawm saum toj no. Nyob rau hauv lub caj dab, cov hlab ntsha subclavian pom ib sab ntawm lub brachial plexus thiab nyob rau saum npoo. Qhov kev npaj ntawm lub nkoj no tso cai rau nws siv los txwv tsis pub los ntshav lossis tswj cov tshuaj. Tsis tas li ntawd, cov hlab ntsha subclavian khoov ntawm cov tav, hla hauv qab clavicle thiab nkag mus rau hauv caj dab, qhov twg nws twb dhau los ua axillary. Tom qab ntawd, tom qab hla lub caj dab, nws mus rau lub xub pwg nyom. Lub npe ntawm ntu no yog brachial hlab ntsha. Nyob rau hauv cheeb tsam ntawm lub luj tshib, nws diverges mus rau hauv lub radial thiab ulnar hlab ntsha.
Catheterization ntawm cov hlab ntsha subclavian. Puag
Raws li tau hais los saum toj no, hauv caj dab subclavian leeg (thiab cov hlab ntsha ib yam nkaus) pw ntawm qhov chaw. Nws yog qhov chaw no uas yog siv rau kev txhaj tshuaj, ntxig lub catheter. Dab tsi ua rau qhov kev xaiv ntawm qhov tshwj xeeb ntawm lub nkoj? Muaj ntau yam kev xaiv rau qhov kev xaiv no, cov no yog:
- Anatomical accessibility.
- Txoj haujlwm ruaj khov thiab lumen txoj kab uas hla.
- Ntau lossis loj loj (inch).
- Kev nrawm ntawm cov ntshav siab tshaj qhov ceev ntawm cov ntshav hauv cov leeg ntawm caj dab.
Raws li cov ntaub ntawv hais los saum toj no, lub catheter tso rau hauv cov leeg yuav tsis kov cov phab ntsa ntawm cov hlab ntsha. Cov tshuaj uas txhaj los ntawm nws yuav sai sai mus rau txoj cai atrium thiabventricle, lawv ua rau muaj kev cuam tshuam ntawm hemodynamics. Cov tshuaj txhaj rau hauv cov hlab ntsha subclavian sib tov sai heev nrog cov ntshav yam tsis muaj kev khaus sab hauv ntawm cov hlab ntsha. Qee zaum, muaj contraindications rau punctures thiab catheter insertion.
Sab laug thiab sab xis subclavian artery
Lub nkoj no yog ib qho khoom ua ke, raws li tau hais los saum no: sab xis subclavian hlab ntsha thiab sab laug. Thawj yog qhov kawg ceg ntawm lub cev brachiocephalic, raws li rau sab laug, nws tawm ntawm lub aortic koov. Tsis tas li ntawd, tom kawg yog li 4 cm ntev dua li qub. Txoj cai subclavian hlab ntsha muab ntshav rau qee qhov ntawm sab caj npab, muab nws rau lub taub hau thiab hauv siab. Sab laug subclavian cov hlab ntsha nqa cov kua dej nqa cov khoom siv lub neej mus rau sab laug caj npab.
Kev faib loj ntawm cov hlab ntsha subclavian
Cov hlab ntsha sab laug thiab sab xis subclavian tau muab faib ua ntu zus rau hauv peb lub luag haujlwm tseem ceeb, lossis ntu:
- Los ntawm qhov chaw tsim ntawm cov hlab ntsha subclavian mus rau qhov nkag mus rau qhov chaw nruab nrab.
- Department, uas yog txwv precisely rau qhov chaw interstitial.
- Ntawm qhov tawm ntawm qhov chaw nruab nrab mus rau hauv caj dab.
Txoj kev faib thawj zaug ntawm cov hlab ntsha subclavian
Ib feem ntawm tsab xov xwm no yuav qhia rau koj me ntsis txog seb cov hlab ntsha subclavian thiab nws cov ceg zoo li cas, uas yog, qhov twg cov hlab ntsha no nkag mus rau hauv. Los ntawm nws thawj ntu (qhov chaw nruab nrab ntawm qhov nkag mus rau qhov chaw nruab nrab thiab qhov pib ntawm cov hlab ntsha) ob peb ceg tawm, ntawm no yog cov tseem ceeb:
- Vertebral artery, chav chav. Nws mus dhautransverse txheej txheem ntawm lub ncauj tsev menyuam thib rau vertebra. Tom qab ntawd nws sawv thiab nkag mus rau hauv cov kab noj hniav cranial los ntawm lub nraub qaum ntawm lub taub hau, uas yog, los ntawm nws qhov qhib. Tom qab ntawd nws txuas nrog tib cov hlab ntsha ntawm sab nraud, yog li tsim cov hlab ntsha basilar. Lub luag haujlwm ntawm vertebral artery yog dab tsi? Lub nkoj no muab cov ntshav mus rau qaum qaum, tawv occipital lobes ntawm lub hlwb, thiab cov leeg.
- Cov hlab ntsha hauv mammary pib nyob rau hauv qab ntawm cov hlab ntsha subclavian. Cov channel muab cov ntshav rau cov thyroid caj pas, diaphragm, bronchi, sternum, thiab lwm yam.
- Thyroid pob tw. Nws pib nyob ze rau ntawm ntug ntawm cov nqaij ntshiv, ncav cuag qhov ntev li ntawm 1-2 cm. Cov thyroid caj pas faib ua cov ceg uas muab cov ntshav mus rau cov leeg ntawm lub scapula thiab caj dab, nrog rau lub larynx.
Txoj kev faib thib ob thiab thib peb ntawm cov hlab ntsha subclavian
Ntu thib ob ntawm cov hlab ntsha subclavian, txwv los ntawm qhov chaw nruab nrab, tsuas muaj ib ceg xwb, nws yog hu ua lub pob tw costocervical. Nws pib nyob rau sab nraum qab ntawm cov hlab ntsha subclavian thiab faib ua ob peb ceg:
- Cov hlab ntsha siab tshaj plaws (cov ceg ntoo tom qab tawm ntawm cov hlab ntsha no, ua rau cov ntshav mus rau cov leeg ntawm nraub qaum).
- Spinal hlab ntsha.
- Lub ncauj tsev menyuam tob.
Ntu thib peb ntawm cov hlab ntsha subclavian kuj muaj ib ceg - qhov no yog cov hlab ntsha ntawm lub caj dab. Nws permeates lub xub pwg rooj sib tham thiab muab faib ua:
- Cov hlab ntsha sab nraud uas muab ntshavrov qab nqaij.
- Dorsal artery ntawm scapula. Nws nqes mus rau cov leeg sab nraub qaum, txhawb nqa nws thiab cov leeg me me nyob ze.
- Zaj ceg ntawm cov hlab ntsha subclavian.
Ntawm no, cov ntsiab lus xws li cov hlab ntsha subclavian thiab nws cov ceg tau piav qhia meej txaus, cov ntaub ntawv ntxiv tuaj yeem khaws los ntawm cov ntaub ntawv kho mob.
Cov kab mob tuaj yeem ntawm cov hlab ntsha subclavian
Cov kab mob tseem ceeb uas cuam tshuam rau cov hlab ntsha subclavian thiab nws cov ceg yog qhov nqaim ntawm lumen ntawm cov hlab ntsha, hauv lwm lo lus, stenosis. Qhov laj thawj tseem ceeb ntawm tus kab mob no yog atherosclerosis ntawm cov hlab ntsha subclavian (kev tso cov lipids rau ntawm phab ntsa ntawm cov hlab ntsha) lossis thrombosis. Tus kab mob no feem ntau kis tau, tab sis muaj cov kab mob congenital. Kev pheej hmoo rau atherosclerosis ntawm cov hlab ntsha subclavian yog:
- Hypertension.
- Smoking.
- Ntau tshaj, rog.
- mob ntshav qab zib thiab qee yam kab mob.
Qhov feem ntau ua rau subclavian artery stenosis yog ib qho teeb meem metabolic hauv tib neeg lub cev, neoplasms thiab o. Mob hnyav stenosis ua rau txo qis hauv cov ntshav ntws mus rau cov kab mob tseem ceeb ntawm tus neeg, tsis muaj oxygen thiab cov as-ham hauv cov ntaub so ntswg. Tsis tas li ntawd, stenosis tuaj yeem ua rau muaj kab mob coronary, tshwj xeeb yog mob stroke.
Subclavian artery syndrome
Cov ntshav tsis txaus tuaj yeem tshwm sim tsis yog los ntawm kev cuam tshuam ntawm cov ntshav ntws los ntawm cov kab mob occlusive-stenotic, tab sis kuj los ntawm tus txha caj qaum-subclavian"tub sab". Qhov no syndrome ntawm cov hlab ntsha subclavian, los yog steel syndrome, tsim nyob rau hauv cov kev tshwm sim ntawm ib tug stenosis los yog occlusion nyob rau hauv thawj seem ntawm lub hlab ntsha. Yooj yim hais, cov ntshav hauv cov kwj dej subclavian tsis tuaj ntawm lub aorta, tab sis los ntawm cov hlab ntsha vertebral, uas tuaj yeem ua rau cerebral ischemia. Qhov tshwm sim ntau tshaj plaws ntawm tus kab mob no ua rau muaj kev ntxhov siab rau lub cev ntawm sab sauv.
Cov tsos mob ntawm tus kab mob:
- kiv taub hau.
- Pre-syncope.
- Kev tsis pom kev.
- Muscle tsis muaj zog ntawm sab cuam tshuam.
- Txuag lossis tsis ua tiav ntawm lub plawv dhia ntawm sab cuam tshuam.
Kawm paub ntxiv txog subclavian artery stenosis
Cov nyiaj tso rau ntawm phab ntsa ntawm cov hlab ntsha, ua rau kev nqaim ntawm qhov kawg, muaj cov lipid puag, uas yog, qhov tseeb, lawv yog cov derivatives ntawm cov roj cholesterol. Cov kev tso nyiaj no tuaj yeem nqaim lub lumen ntawm lub nkoj mus txog 80%, qee zaum txawm tias tag nrho txhaws nws. Ntxiv nrog rau cov xwm txheej saum toj no uas ua rau stenosis ntawm cov hlab ntsha subclavian, muaj lwm yam, xws li:
- Irradiation.
- Arteritis.
- Compression syndromes.
- Ntau yam kab mob xws li fibromuscular dysplasia thiab lwm yam.
Ntau zaus hauv cov neeg muaj mob stenosis ntawm cov hlab ntsha subclavian, lwm cov hlab ntsha kuj raug cuam tshuam. Cov no tuaj yeem yog ob qho tib si coronary kwj dej, uas yog, mob plawv, thiab carotid, cov hlab ntsha ntawm qis qis. Yeej, nrog xws li pathology li nqaim ntawm lumen ntawm cov hlab ntsha, sab laug subclavian hlab ntsha raug cuam tshuam. Raws li kev txheeb cais, qhov no tshwm sim ntau zaus ntau duantawm sab xis.
Cov tsos mob Stenosis:
- qaug zog hauv cov leeg.
- Nyob zoo.
- pain sab ceg.
- Necrosis ntawm ntiv tes.
- Kab ntshav ncig ntawm tes.
Tsis tas li ntawd, cov tsos mob ntawm lub paj hlwb tuaj yeem tshwm sim, uas yog, "nyem" tshwm sim: ntshav raug xa los ntawm cov hlab ntsha ib txwm mus rau thaj chaw cuam tshuam. Cov tsos mob ntawm tus kab mob neurological:
- Impaired vision.
- Poob tsis nco qab.
- hais tsis taus.
- Lost balance.
- kiv taub hau.
- Poob siab ntawm lub ntsej muag.
Yuav ua li cas kho subclavian artery stenosis?
Kev kho mob stenosis tuaj yeem kho mob, phais lossis kev cuam tshuam. Txoj hauv kev tseem ceeb ntawm kev kho yog X-ray endovascular stenting ntawm cov hlab ntsha subclavian thiab carotid-subclavian bypass. Txoj kev tom kawg yog pom zoo rau cov neeg uas muaj lub cev hypersthenic, uas nws nyuaj rau cais thawj ntu ntawm cov hlab ntsha. Tsis tas li ntawd, txoj kev kho no raug pom zoo rau stenosis hauv ob lub subclavian artery.
Stenting ntawm cov hlab ntsha subclavian
Stenting yog kev kho mob ntawm cov hlab ntsha subclavian los ntawm kev txiav me me hauv daim tawv nqaij, ntev 2-3 hli, nws yog ua tiav los ntawm lub qhov taub. Txoj kev kho no muaj ntau qhov zoo ntawm kev phais, vim nws ua rau muaj kev raug mob tsawg dua thiab tsis xis nyob. Tsis tas li ntawd, qhov no yog feem ntau sparing thiab organ-preserving txoj kev kho mob, nyob rau hauv uascov hlab ntsha subclavian tau khaws cia hauv nws daim ntawv qub, uas tseem ceeb heev rau tus neeg mob.
Cov txheej txheem stenting yog qhov tsis mob thiab tshwm sim nyob rau hauv cov tshuaj loog hauv zos. Qhov kev ua haujlwm no tso cai rau koj kom nce lub lumen ntawm cov hlab ntsha siv cov catheter tshwj xeeb thiab stents hauv daim ntawv ntawm cov zais pa. Cov tom kawg yog ib lub cylindrical endoprosthesis laser txiav los ntawm cov khoom hlau raj. Cov cuab yeej no txuas nrog lub zais pa catheter tshwj xeeb thiab txav mus rau hauv lub xeev compressed hauv cov hlab ntsha subclavian. Thaum lub stent ncav cuag qhov nqaim ntawm lub nkoj, qee cov txheej txheem tswj tau ua raws li nws qhov chaw raug. Tom qab ntawd, lub cuab yeej qhib nyob rau hauv siab. Yog hais tias lub stent tsis txaus qhib, ces angioplasty ntawm lub stented cheeb tsam yog ua nrog ib tug tshwj xeeb catheter nrog ib tug balloon nyob rau hauv lub kawg kom pom tau zoo. Txog rau hnub tim, nws muaj peev xwm ua qhov haujlwm no dawb, nws tuaj yeem ua tiav los ntawm kev tau txais tsoomfwv quota. Tus neeg mob uas muaj tus kab mob zoo sib xws yuav tsum tau sab laj los ntawm tus kws kho mob.
Muaj peev xwm txaus ntshai ntawm stenting
Cov txheej txheem subclavian artery stenting yuav siv sijhawm li 2 teev. Qhov kev ua haujlwm no yog ua nyob rau hauv lub plawv catheterization department. Tom qab stenting, tshuaj kho mob yog tias tsim nyog, vim qhov mob yuav tshwm sim nyob rau hauv qhov chaw uas cov hlab ntsha subclavian thiab cov ntaub so ntswg incised. Cov teeb meem tom qab cov txheej txheem no yog tsawg heev, raws li tus neeg mob ua ntej nwsyog ua tib zoo kawm thiab saib xyuas. Tab sis tseem, qee qhov tsis txaus siab tuaj yeem tshwm sim, cov no yog:
- Kev tsis haum tshuaj noj.
- Reaction to anesthetics.
- me me los ntshav ntawm qhov chaw phais.
- Kub.
- Headache.
- Kev mob.
- Air embolism.
- Kev raug mob rau ntawm phab ntsa ntawm cov hlab ntsha lossis aorta.
- thrombosis ntawm cov hlab ntsha subclavian.
- Stent migration.
- mob hlwb, thiab lwm yam.
Kev cuam tshuam kev kho mob ntawm subclavian artery stenosis los ntawm balloon angioplasty thiab stenting yog niaj hnub minimally invasive thiab zoo txoj kev kho. Lawv muaj lub sijhawm luv luv tom qab phais thiab pw hauv tsev kho mob.
