Ua tsaug rau kev ua haujlwm ntawm cov hlab ntshav, nws tuaj yeem ua rau tag nrho cov kabmob thiab lub cev ntawm peb lub cev. Nws yog cov ntshav uas thauj cov pa oxygen thiab cov as-ham, tshem tawm cov khoom metabolic thiab carbon dioxide.
Cov hlab ntsha muaj lub plawv thiab ntau cov hlab ntsha, thiab aorta yog cov hlab ntsha loj tshaj plaws hauv lub cev. Thiab tom qab ntawd peb yuav tham txog nws qhov tshwj xeeb - lub thoracic aorta. Raws li koj tuaj yeem twv, nws nyob hauv thaj tsam hauv siab. Lub thoracic aorta originates nyob rau hauv lub plawv. Nws yog lub xeev thiab kev ua haujlwm ntawm qhov no ntawm lub nkoj uas yog lub luag haujlwm rau lub xeev ntawm peb lub cev tag nrho.
Kev tsim kho
Nyob rau hauv tag nrho, 3 ntu ntawm lub aorta yog qhov txawv:
- nce;
- arc;
- descending aorta (thoracic, plab).
Lub hauv siab yog nyob rau hauv lub hauv siab thiab nyob ib sab ntawm tus txha nraub qaum. Los ntawm lub nkoj loj no muaj cov ceg ntawm 2 hom:
- ceg sab hauv;
- wall.
thawj pab pawg suav nrog:
- Esophageal.
- Bronchial.
- Pericardial.
- Mediastinal.
Second group:
- Intercostal.
- Diaphragmatic.
Ua haujlwm
Lub thoracic aorta muab cov ntshav mus rau cov kabmob ntawm lub cev. Cia peb saib luv luv ntawm cov txheej txheem no ntawm cov ceg sab hauv. Yog li, cov khoom noj khoom haus tau koom nrog cov ntshav muab rau cov phab ntsa ntawm txoj hlab pas, bronchial - lub ntsws cov ntaub so ntswg. Cia peb tam sim ntawd xyuam xim rau qhov twg cov ceg ntoo hla dhau - txoj hlab pas, pleura, pericardial sac, bronchial lymph nodes. Peb kuj tau hais txog cov ceg ntoo pericardial, uas muab cov ntshav mus rau lub hnab pericardial, thiab cov ceg ntoo hauv nruab nrab muab khoom noj khoom haus:
- mediastinal organs;
- cov ntaub so ntswg;
- lymph nodes.
Koj tsis tuaj yeem hla cov pab pawg thib ob - cov ceg parietal. Lawv muab zaub mov:
- ncaj thiab dav plab plab;
- paj;
- cov leeg nqaij;
- daim tawv nqaij;
- rov qab tawv;
- cov leeg pob txha;
- qaum qaum.
Kab mob
Tam sim no peb yuav tham txog cov kab mob ntau tshaj plaws ntawm lub thoracic aorta:
- atherosclerosis ntawm thoracic aorta;
- aneurysm.
Ua luv luv nyob ntawm lawv txhua tus. Dab tsi yog atherosclerosis? Qhov no yog ib yam kab mob uas ua rau tsim cov plaques ntawm phab ntsa ntawm cov hlab ntsha. Qhov no tag nrho ua rau deformation thiab circulatory ntshawv siab. Yog li, tsis muaj kev noj haus ntawm cov khoom nruab nrog cev, qhov tshwm sim -cuam tshuam ntawm lawv txoj haujlwm. Feem ntau hais lus, cov plaques uas tsim rau ntawm phab ntsa ntawm cov hlab ntsha cuam tshuam nrog cov ntshav ntws zoo vim tsis muaj zaub mov, ua haujlwm tsis zoo tshwm sim hauv lub cev. Qhov laj thawj tseem ceeb ntawm tus kab mob yog cov rog ntau hauv cov hlab ntsha.
Kab mob thib ob uas tau hais los saum toj no yog qhov teeb meem loj tshaj plaws ntawm atherosclerosis. Nrog aneurysm, koj tuaj yeem soj ntsuam qhov nthuav lossis bulging ntawm lub aorta. Cov kab mob no yog qhov txaus ntshai heev, txij li lub aorta tuaj yeem tawg yooj yim. Cov tom kawg ua rau los ntshav thiab tuag. Yog li ntawd, kev kuaj mob raws sij hawm thiab kho tus kab mob no (kom tiv thaiv kev tawg) yog li tsim nyog. Dab tsi ua rau bulging ntawm cov hlab ntsha? Yog li peb saib cov ntshav siab uas dhau los ntawm qhov chaw tsis muaj zog.
Diagnosis
Cov khoom ntawm kev kuaj mob ntawm cov kab mob ntawm lub thoracic aorta zoo li no:
- sib sau anamnesis;
- kev tshuaj xyuas tus neeg mob;
- ntsuas lub plawv dhia;
- ntsuas ntshav siab tsis yog ntawm ob txhais tes xwb, tab sis kuj ntawm ob txhais ceg;
- palpation ntawm plab;
- carotid auscultation;
- abdominal aortic auscultation;
- x-ray;
- tomography;
- YUltrasound.
Peb tam sim ntawd kos koj lub siab rau qhov tseeb tias cov kws tshaj lij cov lus qhia hauv qhov teeb meem no tsuas yog tsim nyog. Kev kuaj tus kheej yuav tsis ua haujlwm, thiab kev kho tus kheej tuaj yeem ua rau qhov xwm txheej hnyav dua.
Cov tsos mob Aneurysm
NyobNws tseem yog ib qho tseem ceeb kom paub tias qhov aneurysm ntawm lub thoracic aorta, nrog rau nws cov atherosclerosis, pib tsim imperceptibly - tsis muaj tsos mob tshwm sim nyob rau hauv tus neeg mob. Raws li tau hais ua ntej, lub protrusion pib tsim, uas tuaj yeem ncav cuag qhov loj, tab sis tib lub sijhawm tsis cuam tshuam tus neeg mob. Cov tsos mob tuaj yeem tshwm sim tsuas yog thaum lub sijhawm no protrusion pib ua rau cov kabmob uas nyob sib ze. Hauv qhov no, tsawg kawg yog ib qho ntawm cov cim hauv qab no tau pom:
- mob plab;
- mob caj dab;
- mob nraub qaum;
- hnoos;
- ua tsis taus pa;
- suab nrov;
- -Pays hauv cov hnoos qeev;
- nyuaj nqos mov;
- muaj zog pulsation hauv thaj tsam hauv siab.
Thaum koj tawg, koj tuaj yeem hnov qhov mob hnyav hauv nraub qaum, uas yuav ntws mus rau hauv plab, hauv siab thiab caj npab. Kev tawg yuav tsum tsis txhob tso cai vim qhov no tsuas yog 30% ntawm cov neeg mob tuaj yeem cawm tau.
Ua rau kab mob
Raws li tau hais ua ntej, thoracic aortic aneurysm yog qhov tshwm sim txaus ntshai ntawm atherosclerosis. Tab sis qhov no yog deb ntawm qhov tsuas yog ua rau tus kab mob. Pawg no suav nrog:
- kab mob congenital;
- qhov tshwm sim ntawm kev raug mob;
- mycotic lossis syphilitic lesion ntawm phab ntsa hlab ntsha.
Cia tam sim ntawd ua tib zoo saib xyuas qhov tseeb tias feem ntau nws tsis tuaj yeem tsim qhov tseeb ntawm tus kab mob. Tab sis koj tuaj yeem pom tias cov neeg mob feem ntau muaj ntshav siab.
kuaj mob
Thoracic aneurysmqhov chaw ntawm lub aorta, raws li txoj cai, pom tau poob nthav thaum lub sijhawm kuaj. Yog tias koj muaj cov tsos mob ntawm tus kab mob, koj yuav tsum sab laj nrog kws kho mob. Ib qho aneurysm tuaj yeem kuaj pom tseeb nrog cov kev sim hauv qab no:
- radioography;
- x-ray;
- xam tomography;
- magnetic resonance imaging;
- ultrasound;
- aurtography.
Kev kho mob
Tsuas yog tus kws kho mob tshwj xeeb tuaj yeem sau cov kev kho mob txaus rau lub thoracic aortic aneurysm. Kev phais feem ntau yog siv, tab sis kev kho mob kuj tseem ua tau. Rau cov kab mob no, cov hauv qab no tau pom zoo:
- tswj ntshav siab. Cov ntsuas tau tso cai yog 140/90, thiab yog tias muaj cov kab mob sib kis (mob ntshav qab zib mellitus, kab mob raum), ces 130/80.
- Tau kom tau txais α-receptor blockers (piv txwv li, "Fentolamine").
- noj β-receptor blockers (xws li Nebivolol).
- Noj ACE inhibitors (xws li Lisinopril).
- Nws yog ib qho tsim nyog los ua kom cov qib lipid normalize, uas yog, noj statins (piv txwv li, Atorvastatin).
Ntxiv rau tag nrho cov saum toj no, tus neeg mob tau pom zoo kom hloov pauv nws txoj kev ua neej, tshwj xeeb tshaj yog rau cov neeg haus luam yeeb. Qhov no yog tias nws yog kev haus luam yeeb uas provokes qhov nthuav dav ntawm qhov aneurysm.
Kev ua haujlwm
Raws li tau hais dhau los,Txoj kev kho mob tshaj plaws rau lub thoracic aortic aneurysm yog kev phais. Tseeb, nrog rau qhov pathology no, qhov tshwm sim ntawm kev tawg ntawm lub nkoj thiab kev tuag ntawm tus neeg mob yog siab. Txawm li cas los xij, nws yog ib qho tsim nyog yuav tsum tau them sai sai rau qhov tseeb tias kev ua haujlwm tau ua tiav nrog qhov kab mob ntawm qhov ntau tshaj li xya thiab ib nrab centimeters. Qhov tshwj xeeb yog cov neeg mob Marfan Syndrome, uas feem ntau yuav tawg. Nyob rau hauv cov ntaub ntawv no, lub lag luam kuj yog ua nrog ib tug me me txoj kab uas hla ntawm kev puas tsuaj.
Nws yuav tsum tau qhia tam sim vim li cas kev ua haujlwm tsis tiav tam sim ntawd, tab sis lawv tab tom sim kom muaj tus kab mob nrog kev pab ntawm cov tshuaj. Qhov tseeb yog tias txoj kev kho mob no suav hais tias yog qhov nyuaj heev, thiab feem pua ntawm cov neeg tuag thaum nws siv yog li 15%.
Thaum lub sijhawm ua haujlwm, thaj chaw cuam tshuam ntawm lub nkoj raug tshem tawm thiab ib qho khoom tsim tau raug teeb tsa. Yog vim li cas qhov no prosthesis yog zoo:
- Nws tsis yog lub cev tsis lees paub.
- Tsis xav tau rov ua haujlwm dua.
- Cov pob qij txha ua haujlwm ib txwm mus txog thaum kawg ntawm tus neeg mob lub neej.
Post-operative period
Tom qab kev phais rau kev hloov pauv ntawm lub thoracic aortic, koj yuav tsum ua raws li tag nrho koj tus kws kho mob cov lus qhia:
- Kev tawm dag zog lub cev (pib taug kev, tom qab ntawd txav mus rau kev tawm dag zog uas tsis ua rau mob).
- Kev noj haus. Ua ntej koj yuav tsum tau ua raws li kev noj haus naj npawb 0, nws yog siv thaum lub sij hawm kho. Tom ntej no - No. 10, uas yog muab rau tag nrho cov neeg mob uas muaj kab mob ntawm lub plawv system.
- Ua ntej tso tawmtsev kho mob tus neeg mob - pw so.
- Tom qab tso tawm (hauv ib hlis), tsav tsheb, nqa ntau dua kaum kilograms, txwv tsis pub da dej.
- Noj tag nrho cov tshuaj kws kho mob nruj me ntsis raws li koj tus kws kho mob qhia.
- Kev noj qab haus huv. Txhob haus luam yeeb, cawv. Sim kom tsis txhob ntxhov siab. Nqa koj qhov hnyav rov qab mus rau qhov qub, noj kom raug.
Ceev faj txog koj txoj kev noj qab haus huv. Yog tias koj muaj cov tsos mob hauv qab no: lub cev kub ntawm 38 ° C lossis ntau dua, mob ntawm ob txhais ceg, nraub qaum, qhov chaw ua haujlwm, tawm ntawm qhov txhab (thaum qhib kev phais), hu rau lub tsheb thauj neeg mob tam sim.
