Exudative exudative pericarditis yog ib yam kab mob uas tshwm sim los ntawm o ntawm daim nyias nyias nyob rau sab hauv ntawm lub hnab pericardial. Los ntawm qhov xwm txheej, effusion pericarditis yog mob lossis mob ntev.
Tus kab mob tuaj yeem ua rau mob ntshav, hemorrhagic, purulent, fibrinous thiab serous-hemorrhagic. Nrog fibrinous exudative pericarditis, fibrin strands muab tso rau ntawm lub pericardium, thiab qee cov kua dej accumulates nyob rau hauv pericardial kab noj hniav. Feem ntau, lub pericardial kab noj hniav muaj txog 20-40 ml ntawm exudate.
Thaum mob pericarditis, cov tshuaj tiv thaiv ntawm tes yog nrog los ntawm kev nce exudation ntawm cov kua feem ntawm cov ntshav mus rau hauv cov kab noj hniav pericardial. Muaj ntau zaus thaum cov txheej txheem inflammatory tuaj yeem txav mus rau txheej subepicardial, uas ua rau nws ua haujlwm tsis zoo.
Cardiogenic shock
Ntau zaus, tam sim ntawd cov kua hauv cov kab noj hniav tuaj yeem ua rau lub plawv tamponade, uas muaj cov tsos mob ntawm kev poob siab cardiogenic:
- mob siab;
- ua tsis taus pa los ntawm hom ua tsis taus pa;
- nce siab hauv cov hlab ntsha ntawm cov hlab ntsha me thiab loj;
- txo qis hauv cov ntshav siab systolic.
Muaj Teeb Meem
Thaum cov kua exudative resorbed, caws pliav cov ntaub so ntswg uas muaj fibrin tuaj yeem tsim, uas tuaj yeem ua rau ib nrab lossis ua tiav cov kab mob pericardial. Feem ntau cov caws pliav yog tsim nyob rau hauv lub atrial cheeb tsam, nyob rau hauv lub confluence ntawm lub superior thiab inferior vena cava, nyob ze ntawm lub atrioventricular sulcus.
Nrog rau tus cwj pwm no, mob exudative pericarditis tuaj yeem ua rau muaj kev cuam tshuam loj heev, uas yog hu ua "plhaub lub plawv", vim yog calcification ntawm pericardium. Ib qho tseem ceeb hauv cov txheej txheem pathological ntawm exudative pericarditis yog kev ua txhaum ntawm diastolic rov qab los ntawm cov ntshav mus rau ventricles ntawm lub plawv. Accumulated exudate nyob rau hauv lub pericardial kab noj hniav los yog muaj constrictive pericarditis ua rau muaj kev cuam tshuam ntawm subepicardial thiab subendocardial txheej nyob rau hauv lub apex. Muaj tsawg zaus, pericardial fibrosis tuaj yeem tawm hauv thaj chaw tsis sib haum xeeb, vim tias qhov o ntawm lub qhov quav thaum lub sijhawm diastole tso cai rau cov ntshav mus rau lub plawv.
qhov tshwm sim no hu ua fenestration ("qhib qhov rai" nyhuv). Cov theem systolic muab los ntawm cov leeg nqaij txheej feem ntau tsis cuam tshuam. Nrog rau kev ua txhaum ntev ntawm venous rov qab mus rau lub plawv, ntshav stagnation tshwm sim hauv cov hlab ntsha pulmonary. Nrog venous stasis nyob rau hauv lub system ntawm lub voj voog loj ntawm cov ntshav ncigmuaj cov kua dej ntau ntxiv rau hauv cov ntaub so ntswg ncig.
Exudative pericarditis: ua rau (etiological yam tseem ceeb)
Ib qho ntawm feem ntau ua rau exudative pericarditis yog RNA-muaj cov kab mob (A thiab B), ECHO, mob khaub thuas A thiab B, kab mob ntawm ntau yam xwm (pneumococci, staphylococci, streptococci, mycobacterium tuberculosis thiab fungi).
Tus kab mob hauv nqe lus nug tuaj yeem cuam tshuam cov kab mob hauv lub cev (SLE lossis Liebman-Sachs kab mob, rheumatic sib koom ua ke, rheumatism, systemic scleroderma) thiab kab mob ntawm cov kab mob genitourinary (uremic pericarditis). Exudative pericarditis ntawm KSD tuaj yeem yog qhov tshwm sim ntawm postpericardial syndrome uas tshwm sim tom qab pericardiotomy, los yog ua ib qho teeb meem ntxov tom qab myocardial infarction, uas yog hu ua Dressler's syndrome. Feem ntau qhov teeb meem no tshwm sim nyob rau hauv ib lub sij hawm nruj me ntsis, xws li los ntawm 15 hnub mus rau 2 lub hlis.
Qee zaum, exudative-adhesive pericarditis tuaj yeem tshwm sim vim kev noj cov tshuaj qee yam: hydralizine, phenytoin, anticoagulants, vim yog siv ntau zaus ntawm procainamide, kev kho hluav taws xob. Nyob rau hauv cov ntaub ntawv no thaum ib tug loj npaum li cas ntawm effusion pom nyob rau hauv exudative pericarditis, qhov ua rau yuav tsum tau nrhiav nyob rau hauv lub metastasis ntawm cov qog: mob cancer mis, mob ntsws cancer, sarcomas, lymphomas. Hauv cov xwm txheej no, cov exudate feem ntau yog hemorrhagic, tsis tshua muaj serous.
Muaj ib yam tshwj xeeb ntawm exudative pericarditis hu ua hemopericardium. Lub xeev no tshwm simNrog kev nkag mus rau hauv lub hauv siab cheeb tsam nyob rau hauv lub projection ntawm lub plawv, kuj nrog myocardial ruptures nyob rau hauv cov neeg mob uas muaj ib tug myocardial infarction, los yog nrog dissecting aortic aneurysms, vim hais tias cov ntshav nyob rau hauv lub pericardial kab noj hniav. Yog hais tias tus kab mob tau tshwm sim los ntawm incomprehensible etiological yam, ces nws yog cais raws li nonspecific los yog idiopathic.
Tsis tas li ntawd, exudative pericarditis hauv cov menyuam yaus kuj qee zaum tshwm sim. Yog vim li cas rau qhov no yog: kab mob streptococcal thiab staphylococcal, tuberculosis, kab mob HIV, tshuaj tswj tsis tau, mob qog noj ntshav, raug mob ze lub plawv, raum tsis ua haujlwm, phais plawv.
Exudative pericarditis: kev kuaj mob thiab cov yam ntxwv kho mob
Cov exudate nyob rau hauv lub pericardial kab noj hniav yog tshwm sim los ntawm qhov mob ntawm ib tug dull thiab mob qhov chaw ntawm lub plawv, pathological ua pa los ntawm hom ua tsis taus pa luv, uas txo nyob rau hauv ib tug zaum txoj hauj lwm, palpitations. Lub siab tawm los ntawm cov kua dej ntawm lub trachea thiab bronchi ua rau hnoos qhuav.
Qhov kev mob ntawm cov neeg mob yog nyob ntawm tus nqi ntawm kev tsim cov kua hauv lub hnab pericardial, nrog tus nqi qeeb - tus mob yog txaus siab, nrog tus nqi nrawm - nruab nrab thiab hnyav.
Thaum kuaj tus neeg mob, kuaj pom cov tsos mob hauv qab no ntawm exudative pericarditis: daj ntseg ntawm daim tawv nqaij, cyanosis ntawm daim tawv nqaij ntawm daim di ncauj, o ntawm qis extremities, acrocyanosis.
Thaum kuaj xyuas thaj tsam hauv siab, asymmetry tuaj yeem pom, sab laug tuaj yeemKev nce ntxiv, qhov no tsuas yog ua tau nrog kev sib sau ntawm exudate hauv lub hnab pericardial nrog lub ntim ncav cuag ntau dua 1 liter. Ntawm palpation, Jardin lub cim tuaj yeem kuaj pom, thaum lub apical impulse txav mus thiab sab hauv, vim yog lub siab ua haujlwm los ntawm cov kua dej uas muaj nyob hauv.
Percussion tuaj yeem kuaj pom qhov nthuav dav ntawm thaj tsam ntawm kev txheeb ze dullness ntawm lub plawv hauv txhua qhov kev qhia: mus rau sab laug-hauv qab (hauv ntu qis) mus rau sab hauv lossis mus rau kab nruab nrab axillary, hauv qhov thib ob thiab thib peb intercostal qhov chaw mus rau nruab nrab-clavicular kab, mus rau sab xis nyob rau hauv qis qis, mus rau sab xis SCL (mid-clavicular kab), thaum tsim ib tug obtuse lub kaum sab xis, es tsis txhob ntawm ib tug ncaj ib tug nyob rau hauv tus qauv, mus rau kev hloov mus rau ciam teb ntawm lub siab. dullness. Tag nrho cov no yuav qhia tau tias tus neeg mob muaj exudative pericarditis.
Auscultatory daim duab: lub siab tsis muaj zog ntawm lub plawv suab nyob rau hauv cheeb tsam ntawm lub apex ntawm lub plawv, ntawm Botkin-Erb point thiab cov txheej txheem xiphoid. Lub suab nrov tau hnov hauv thaj tsam ntawm lub hauv paus ntawm lub plawv vim qhov tseeb tias lub plawv yog txav los ntawm cov kua dej exudative upwards thiab rov qab. Lub pericardial kev sib txhuam rub, raws li txoj cai, tsis manifest nws tus kheej nyob rau hauv txhua txoj kev ntawm auscultation. Cov ntshav siab nyob rau ntawm qhov poob qis, tiv thaiv qhov tshwm sim ntawm qhov txo qis hauv lub plawv tso zis.
Yog tias qhov sib xyaw ntawm exudate tshwm sim maj mam hauv lub sijhawm, tom qab ntawd lub tshuab ua haujlwm ntawm lub plawv tsis cuam tshuam rau lub sijhawm ntev vim qhov tseeb tias pericardium stretches maj mam hauv qhov no. Nyob rau hauv cov ntaub ntawv ntawm ceev ceev cov kua nyob rau hauv lub pericardial cheeb tsam thiab effusion, tachycardia koom, lub plawv tsis ua hauj lwm lub tsev kho mob nrog cov tsos mob ntawm cov ntshav stagnation nyob rau hauv cov kev (loj thiab me).
NyobRaws li cov ntaub ntawv tshawb fawb ECG rau exudative pericarditis, cov hauv qab no yog ib yam. Nrog rau kev sib sau ntawm cov kua exudative, qhov txo qis ntawm qhov voltage ntawm QRS complex thiab hluav taws xob hloov pauv ntawm lub ventricular complexes suav nrog. Radiologically, muaj qhov nce hauv qhov ntxoov ntxoo ntawm cheeb tsam plawv thiab tsis muaj zog pulsation ntawm contour. Lub vascular pob yog tsis shortened. Qee zaum muaj effusion tuaj yeem pom nyob rau sab laug pleural kab noj hniav.
ECG ncha: nyob rau hauv cov kab noj hniav pericardial, cov kua dej sib sau ua ke tau pom tom qab sab laug ventricle ntawm lub plawv, hauv thaj tsam ntawm nws phab ntsa tom qab. Nrog loj ntim ntawm effusive kua, nws pom nyob rau hauv pem hauv ntej ntawm txoj cai ventricle ntawm lub plawv. Tus nqi ntawm cov kua dej ntau ntxiv hauv lub hnab pericardial yog txiav txim los ntawm lub sijhawm ntawm cov echoes tshwm sim los ntawm epicardium thiab pericardium.
Kev txheeb xyuas qhov xwm txheej uas ua rau muaj tus kabmob
txhawm rau tsim kom muaj qhov cuam tshuam etiological uas coj mus rau exudative daim ntawv ntawm pericarditis, ib qho kev kuaj kab mob virological yog ua, kev ntsuam xyuas rau muaj qee yam tshuaj tiv thaiv kab mob (rau HIV), sowing ntawm cov khoom lom (piv txwv li, ntshav) thiaj li. Txhawm rau tshem tawm qhov kis kab mob ntawm exudative pericarditis, daim tawv nqaij tuberculin qauv, serological kuaj rau kab mob fungal.
Tsis tas li, kev tshawb fawb txog kev tiv thaiv kab mob tau ua tiav nyob rau hauv rooj plaub ntawm cov kab mob sib txuas ntawm cov ntaub so ntswg, lawv txiav txim siab muaj cov tshuaj tiv thaiv kab mob antinuclear, rheumatoid yam, antistreptolysin-O titer, txias agglutinins - nrog mycoplasma kab mob, nrog uremia, lawv saib cov qib ntawm cov ntshav creatinine thiaburea.
Differential diagnosis of exudative pericarditis
Exudative pericarditis yog txawv nrog cov nosological units: mob myocardial infarction, vasogenic mob, mitral valve prolapse, qhuav pleurisy.
Hauv kev mob myocardial infarction, qhov mob mob tshwm sim los ntawm cov khoom lag luam metabolic hauv lub plawv cov leeg (myocardium). Mob syndrome nyob rau hauv myocardial infarction yog nrog los ntawm ib tug xov tooj ntawm cov chaw kho mob thiab kuaj cov cim qhia tias lawv tus kheej yog ib tug ua txhaum ntawm cov txheej txheem ntawm central hemodynamics, plawv arrhythmias, conduction txheej txheem nyob rau hauv lub myocardium, stagnation nyob rau hauv lub pulmonary ncig, hloov nyob rau hauv ECG parameter yam ntxwv ntawm myocardium. infarction. Kev tshuaj xyuas biochemical hauv myocardial infarction qhia txog kev ua haujlwm ntawm lub plawv isoenzymes.
Nrog rau pleurisy qhuav, qhov tseeb ntawm qhov muaj mob ntawm qhov mob thiab nws cov yam ntxwv cuam tshuam nrog kev ua pa, hnoos, lub cev txoj hauj lwm, pleural kev sib txhuam suab nrov thaum kuaj auscultatory yog qhov tseem ceeb, ntxiv rau cov saum toj no, nws yuav tsum tau sau tseg. tias nrog qhuav pleurisy tsis muaj kev hloov pauv ntawm cov yeeb yaj kiab electrocardiogram. Qhov sib txawv ntawm aortic aneurysm thiab exudative pericarditis yog tias nws tshwm sim los ntawm cov kab mob caj ces - Marfan's syndrome lossis atherosclerotic lesion ntawm nws daim nyias nyias. Qee zaum, mob pericarditis ntev tuaj yeem tsim.
Symptomatically, aortic aneurysm manifests nws tus kheej raws li hauv qab no: mobSyndrome nyob rau hauv lub hauv siab, tsis muaj irradiation, dysphagia, hoarse suab, ua tsis taus pa luv, hnoos, tshwm sim los ntawm compression ntawm lub mediastinum. Ib qho aortic aneurysm yog kuaj tau siv lub hauv siab X-ray, echocardiography, thiab aortography.
Nrog rau kev txiav tawm aortic aneurysm, qhov mob tshwm sim tam sim ntawd hauv siab, zoo li tawg raws lub aorta. Nyob rau hauv cov ntaub ntawv no, cov neeg mob yog nyob rau hauv ib tug mob hnyav, feem ntau muaj ib tug ploj ntawm pulsation ntawm ib tug loj hlab ntsha. Auscultation qhia qhov tsis txaus ntawm lub aortic valve. Kev ntsuas ntsuas rau kev txiav aortic aneurysm yuav yog: transesophageal ultrasound thiab xam tomography ntawm lub hauv siab kab mob.
Yuav ua li cas thiaj nrhiav tau
Nws yog ib qho tseem ceeb heev rau kev sib txawv exudative pericarditis ICD 10 nrog diffuse myocarditis, uas yog nrog los ntawm kev nthuav dav ntawm lub plawv kab noj hniav nrog cov tsos mob ntawm cov hlab ntshav tsis ua haujlwm. Symptomatically, myocarditis manifests nws tus kheej raws li nram no: nws yuav ua tau angina pectoris mob, ib tug zoo nkaus li hnyav nyob rau hauv lub plawv cheeb tsam, thiab lub plawv atherosclerosis.
Thaum lub sij hawm auscultation, muffled lub plawv suab tau hnov, thawj thiab thib plaub lub plawv suab yuav ua tau bifurcated, thaum piav txog lub electrocardiogram, cov nram qab no nta yuav pom tau: deformed P yoj, hloov nyob rau hauv R yoj voltage, T yoj tej zaum yuav. flattened. Thaum lub sij hawm echocardiography, kev saib xyuas yog kos rau qhov nthuav dav ntawm lub plawv ntawm lub plawv thiab txo qis hauv kev cog lus ntawm phab ntsa.
Kev ntsuas ntsuas hauv kev kho mob ntawm exudative pericarditis
Yog xav tias mob exudative pericarditis, tus neeg mob yuav tsum tau mus pw hauv tsev kho mob sai. Yog tias muaj qhov mob tshwm sim, nws yuav tsum tau muab tshuaj aspirin hauv daim ntawv ntsiav tshuaj, noj ib gram ntawm qhov ncauj, txhua peb lossis plaub teev. Indomethacin 25-50 mg ntsiav tshuaj tuaj yeem muab ntxiv rau cov tshuaj aspirin nrog dej ntawm ib ntus ntawm txhua 6 teev.
Yog tias muaj cov lus qhia, tom qab ntawd ntxiv cov tshuaj ntawm 50% analgin rau kev txhaj tshuaj intramuscular ntawm 2 ml lossis narcotic analgesic (morphine) nrog rau qhov concentration ntawm 1%, noj ib lossis ib nrab milliliters, txhua 6 teev. Nyob rau hauv cov ntaub ntawv ntawm psychomotor agitation tiv thaiv keeb kwm yav dhau ntawm tus mob uas tau tshwm sim los yog insomnia, "Sibazon" ("Relanium") yog muab tshuaj rau qhov ncauj, ntawm ib koob ntawm 5-10 mg peb los yog plaub zaug ib hnub twg.
Txhawm rau tshem tawm cov txheej txheem inflammatory, "Prednisolone" feem ntau yog siv hauv kev xyaum, nrog rau qhov ntau npaum ntawm 20-80 mg / hnub. hla ob peb kauj ruam. Kev kho mob nrog cov tshuaj hormones glucocorticoid hauv cov koob tshuaj ntau yog ua tiav hauv 7-10 hnub, nrog rau qhov tshwj xeeb uas tom qab noj tshuaj yuav tsum tau txo qis, ob thiab ib nrab milligrams txhua hnub.
Lub Sijhawm Kho Mob
![], cov cim qhia ntawm exudative pericarditis](https://i.medicinehelpful.com/images/045/image-132715-7-j.webp "], cov cim qhia ntawm exudative pericarditis")
Ntev npaum li cas thiaj kho cov kab mob pericarditis? Kev kho mob kav ntev li ob lossis peb lub lis piam, qee zaum nws yuav tsum tau ncua mus txog ob peb lub hlis, nruj me ntsis raws lilus tim khawv. Qhov tshwj xeeb ntawm kev kho mob yog nyob ntawm qhov etiological yam uas ua rau exudative pericarditis.
Thaum kuaj pom tus kab mob etiology, cov tshuaj uas tsis yog-steroidal anti-inflammatory siv tshuaj, cov tshuaj hormones tsis tau sau tseg. Pericarditis tshwm sim los ntawm Streptococcus pneumonia yog kho txawv - cov tshuaj tua kab mob tau sau tseg, piv txwv li, benzylpenicillin ntawm ib koob ntawm 200,000 units / kg / hnub. intravenously, qhov koob tshuaj no tau muab faib ua 6 txhaj tshuaj, lub sijhawm kho yog tsawg kawg kaum hnub.
xeem ntxiv
Ntawm lwm yam, yog kuaj pom exudative pericarditis, ces pericardiocentesis yuav tsum tau ua (ib txheej txheem ntawm kev kho mob thiab kev kuaj mob, qhov tshwj xeeb koob yog punctured rau hauv lub hnab pericardial thiaj li yuav tsum tau ua kua dej rau kev tshuaj xyuas). Tom qab ntawd, kev exudate yog sown nyob rau hauv thiaj li yuav kuaj tau ib hom kev tsom xam ntawm tus kab mob no, nws yog ib qho tseem ceeb kom txiav txim siab qhov kev tsom xam ntawm nws cov kev rhiab rau cov tshuaj tua kab mob. Yog tias pom Staphylococcus aureus, ces cov tshuaj "Vancomycin" feem ntau yog muab tshuaj ntawm ib koob tshuaj ib gram ntawm cov hlab ntsha, txhua kaum ob teev, cov kev kho mob yog los ntawm 14 mus rau 21 hnub.
Qee zaum tus kab mob fungal tuaj yeem ua rau exudative pericarditis. Kev kho mob hauv qhov no yog ua nrog "Amphotericin". Thawj koob tshuaj yog 1 mg, nws yog siv rau parenterally (los ntawm txoj hlab ntsha) hauv cov kua qab zib nrog ib feem ntawm 5 feem pua thiab hauv ib lub ntim ntawm tsib caug milliliters, dripping rau 30 feeb. Yog tias tus neeg mob tau txais cov tshuajtolerates zoo, ces qhov kev siv tshuaj hloov pauv raws li cov qauv hauv qab no: 0.2 mg / kg rau ib teev. Tom qab ntawd, cov koob tshuaj tau nce zuj zus mus rau ib thiab ib nrab lossis ib microgram / hnub. peb los yog plaub teev ua ntej qhov pib muaj txiaj ntsig zoo.
Ib qho kev mob tshwm sim ntawm "Amphotericin", uas tsim nyog yuav tsum tau them rau, yog nephrotoxic, nrog rau qhov no, kev saib xyuas lub raum ua haujlwm yog tsim nyog. Yog hais tias exudative pericarditis tshwm sim vim noj tshuaj, ces nyob rau hauv cov ntaub ntawv no, cov kev kho mob tactics yuav tsom rau kom ntseeg tau hais tias ntxiv siv cov tshuaj no yog tsum tsis tu ncua, thiab ntxiv rau cov tshuaj uas tsis yog-steroidal anti-inflammatory siv nyob rau hauv ua ke nrog nrog corticosteroids, lawv ua ke ua rau. kev rov zoo sai, tshwj xeeb tshaj yog tias lawv tau muab tshuaj los ntawm thawj hnub ntawm qhov pib ntawm tus kab mob.
