Aortic dissection feem ntau cuam tshuam rau cov neeg laus. Tab sis muaj cov xwm txheej thaum kuaj pom tus kab mob no ntawm cov tub ntxhais hluas. Yog li ntawd, txhawm rau tiv thaiv kev txhim kho ntawm cov teeb meem, nws yuav tsum paub tias tus kab mob no tshwm sim li cas.
Thiab rau qhov no koj yuav tsum paub txhua yam txog qhov ua rau, cov tsos mob thiab kev kho mob ntawm aortic dissection.
Dab tsi ua rau mob
Muaj qhov tshwm sim thiab qhov tshwm sim ntawm aortic aneurysm. Cov qub yog txuam nrog lub xub ntiag ntawm pathologies ntawm cov hlab plawv system nyob rau hauv tib neeg, uas manifest lawv tus kheej nyob rau hauv kev loj hlob ntawm lub aortic valve los yog nws nqaim (stenosis) thiab congenital malformations ntawm lub aorta nws tus kheej - tortuosity thiab coarctation. Tsis tas li ntawd, kab mob hauv lub plawv los yog kis tau tuaj yeem ua rau ua rau. Tsis tas li ntawd, cov kab mob hauv qab no cuam tshuam nrog kev sib txuas ntawm cov ntaub so ntswg pathologies cuam tshuam rau kev loj hlob ntawm aneurysms:
- Ehlers-Danlos syndrome;
- annuarticular ectasia;
- polycystic raum kab mob;
- osteogenesis;
- YTurner Syndrome;
- homocystinuria.
Etiopathogenic yam tseem cuam tshuam rau hauv zos nthuav dav ntawm cov hlab ntsha loj,xws li:
- ntshav siab hloov pauv los ntawm ntshav siab
- syphilis;
- mob plab thiab mob plab;
- kev puas tsuaj rau lub aorta los ntawm lub cev txawv teb chaws lossis cov txheej txheem pathological uas nyob ib sab (mob qog noj ntshav, spondylitis, peptic ulcer ntawm txoj hlab pas).
Cov xwm txheej txaus ntshai kuj suav nrog:
- txhaj tshuaj siv;
- smoking;
- mob rwj;
- lig cev xeeb tub;
- aging.
Symptoms
Aortic dissection tuaj yeem mob hnyav lossis mob ntev. Lawv txawv ntawm qhov mob thaum tawm tsam.
Daim ntawv mob hnyav yog tshwm sim los ntawm qhov pib tshwm sim ntawm cov tsos mob ntawm aortic dissection (qhov laj thawj ntawm qhov no tuaj yeem yog ob qho tib si kis tau thiab congenital), uas ua rau mob, thiab tus mob no kav ntev li ob lub lis piam.
Daim ntawv mob ntev kuj yog qhov mob, tab sis lub sijhawm tuaj yeem nyob mus ib txhis yam tsis muaj kev kho mob kom txog thaum tuag. Vim li no
uas ib qho aortic dissection txiav tawm mus rau cov kab mob nyob ze, tej zaum yuav ua rau mob stroke lossis qaug zog, thiab ua rau ua tsis taus pa hnyav thiab tsis muaj zog.
Nyob rau hauv daim ntawv proximal, qhov mob yog compressive los yog stabbing nyob rau hauv lub hauv siab thiab retrosternal qhov chaw. Hauv qhov no, lawv tuaj yeem muab rau hauv qab. Hauv daim ntawv distal, cov tsos mob ntawm plab aortic dissection tshwm sim:mob plab, nraub qaum, uas feem ntau tawm mus rau caj dab.
Nyob rau hauv daim ntawv mob ntawm cov kab mob, ntshav siab thiab nce plawv dhia tau tshwm sim. Yog tias nyob rau theem no tus kab mob tseem tsis tau kho, ces cov tsos mob yuav mob.
Ascending aortic dissections
Kev cuam tshuam hauv ntu ntawm aorta no tau muab faib ua:
- Kev txiav tawm ntawm aortic aneurysm, uas yog, qhov mob ntawm thaj chaw los ntawm lub nplhaib fibrous ntawm lub aortic valve mus rau lub pob zeb sinotubular. Feem ntau qhov kev kuaj mob no yog nrog los ntawm aortic valve insufficiency.
- Tubular dissection ntawm ascending aorta, uas yog, o ntawm cheeb tsam ntawm lub sinotubular ridge mus rau nws koov. Hom kab mob ascending aortic no tsis tuaj nrog lub valve insufficiency.
- Ascending aortic dissection yog kho mob yog tias nws txoj kab uas hla tsis tshaj 45 mm. Yog tias qhov ntsuas no dhau, ces kev phais raug pom zoo. Qhov no yog vim lub fact tias, raws li kev txheeb cais, thaum lub ascending seem yog stratified nrog ib txoj kab uas hla ntawm 55 mm los yog ntau tshaj, qhov kev pheej hmoo ntawm rupture nce.
- Aortic aneurysm dissection ruptures ntau dua li lwm tus. Yog tias pom muaj kev txiav ob sab hauv cheeb tsam no, ces ib feem peb ntawm cov neeg mob uas muaj tus kab mob no tuag.
- Thaum txiav cov ntu nce mus, muaj qhov thim rov qab ntawm tus neeg sawv cev sib txawv ntawm lub aorta mus rau sab laug ventricle. Qhov no yog vim muaj kev nce siab hauv lub aorta.
Descending aorta
Kev txiav tawm aortic feem ntau tshwm sim hauvcov neeg laus uas muaj kab mob plawv.
Rov qab descending aortic dissection tsis tshwm sim, ua rau tsis muaj aortic regurgitation. Thaum lub sij hawm kev phais, cov mem tes carotid thiab lub siab ntawm cov hlab ntsha sab saud tseem tsis hloov pauv.
Thawj cov tsos mob ntawm thawj theem ntawm kev txiav tawm aortic yog qhov pib ntawm qhov mob tshwm sim tom qab lub sternum lossis nruab nrab ntawm lub xub pwg hniav, kis mus rau pem hauv ntej ntawm lub hauv siab. Cov neeg mob uas muaj xws li ib pob khoom, raws li txoj cai, tsis tau sau ntawv kho mob xwm txheej ceev, tab sis kev kho tshuaj yog nqa tawm. Nrog xws li kev kho mob, qhov yuav tsum tau ua ua ntej yog qhov normalization ntawm ntshav siab.
Yog tias txoj kab uas hla mus txog plaub centimeters, ces tus kws kho mob muaj cai sau ntawv kho mob. Qhov no yog vim qhov tseeb tias yog txoj kab uas hla no dhau lawm, qhov kev pheej hmoo yuav nce ntau zaus.
Kev faib tawm
Michael Ellis DeBakey yog tus kws phais mob plawv Asmeskas uas tau kawm txog tus kabmob thiab tau npaj cov kev faib tawm hauv qab no los ntawm hom:
- Thawj - qhov kev txiav tawm pib los ntawm qhov sinus ntawm Valsava thiab txuas ntxiv mus rau qhov khoov ntawm lub aorta, uas yog, nws tuaj yeem tawm ntawm ciam teb ntawm ascending aorta.
- Thib ob - tus kab mob nyob hauv thaj chaw ascending aorta.
- Thib peb yog qhov kev txiav tawm uas nqis los hauv qab lub hauv paus ntawm sab laug subclavian hlab ntsha.
hom thib peb muab faib ua:
- 3A - kev txiav tawm yog nyob rau hauv lub thoracic aorta.
- 3B - tus kab mob nyob hauv qab lub thoracic aorta. Qee zaum hom thib peb tuaj yeem mus rau sab laug subclavianhlab ntsha.
Tsis ntev los no, Stanford University tau tsim cov kev faib tawm yooj yim uas suav nrog ob txoj kev xaiv:
- Aortic dissection type A yog ib yam kab mob uas nyob hauv cheeb tsam ascending aorta.
- Tus kab mob B aortic yog ib qho mob uas nqis los hauv qab lub hauv paus ntawm sab laug subclavian artery.
Kev kho mob phais ib txwm siv ntawm aortic dissection yog qhov kev pom tsis zoo. Nyob rau hauv ib qho xwm txheej tsis tseem ceeb, txoj hauv kev no yog kev puas tsuaj rau tus neeg mob thiab cuam tshuam nrog cov teeb meem loj thaum lub sijhawm ua haujlwm.
Cov txheej txheem kho niaj hnub rau kev kho mob aortic dissection muaj qhov pom zoo dua. Cov thev naus laus zis ntawm qhov kev cuam tshuam no tau txhim kho tas li, uas pab txhawb kev kho mob ntawm tus neeg mob.
Diagnosis
Aortic dissection yog ib qho ntawm cov hlab ntsha loj tshaj plaws, ua rau muaj kev phom sij rau tib neeg lub neej.
Raws li kev txheeb cais, 65-70% ntawm cov neeg mob uas tsis nrhiav kev txhawb nqa tuag los ntawm kev los ntshav. Ntawm cov neeg uas raug phais, kwv yees li 30% ntawm cov neeg mob tuag. Qhov kev kwv yees rau tus kab mob zoo li no yog deb ntawm kev zoo siab. Kev kuaj mob raws sij hawm yog suav tias yog qhov tseem ceeb rau kev muaj sia nyob hauv aortic dissection. Txawm hais tias txoj hauv kev yooj yim ntawm kev nrhiav qhov tsis xws luag, ntu ntawm kev tsis lees paub tsis yog qhov tsis yooj yim.
Lub aorta muaj peb lub npog: sab nrauv, nruab nrab thiab sab hauv. Lub stratification yog ua ke nrog cov inferiority ntawm nruab nrab npog tshaj qhov no los yog qhov chaw tshwj xeeb. Vim yog qhov tsis xws luag, lub kua muag ntawm lub hau sab hauv (intima) yog qhov zoo thiabtxoj kev loj hlob ntawm ib tug yuam kev lumen nyob rau hauv nruab nrab ntawm nws cov epithelium. Lub kua muag yuav nyob ib feem ntawm lub aorta los yog kis mus rau tag nrho cov ntim sab hauv.
Kev txiav tawm, hauv lwm lo lus, qhov kev txiav tawm ntawm cov hlab ntsha, muaj peev xwm tsim nyob rau hauv ib qho kev txiav txim siab ntawm lub aorta thiab xaus nrog lub nkoj tawg txhua lub sijhawm. Cov chaw rhiab heev yog cov thawj ntu ntawm lub aortic arch.
kev kho mob phais
Kev kho mob phais yog qhia rau mob aortic dissection. Thaum lub sij hawm no, qhov kev pheej hmoo ntawm nws rupture yog ua tau. Kev phais kuj tseem siv tau los kho cov mob ntev ntawm cov kab mob, uas tau dhau los ntawm tus mob hnyav.
Nyob rau theem pib ntawm txoj kev loj hlob, kev ua haujlwm ntawm aortic dissection tsis raug cai, vim tias nws muaj peev xwm kho tau. Nyob rau theem no, nws tuaj yeem raug tshuaj tsuas yog tias muaj kev hem thawj ntawm kev puas tsuaj rau lub cev tseem ceeb.
Nyob rau hauv daim ntawv ntev, kev phais yog qhia rau kev txiav tawm ntau tshaj 6 cm inch.
Raws li kev txheeb cais, yog tias kev phais tau ua tiav tam sim tom qab kuaj pom daim ntawv mob, qhov kev pheej hmoo ntawm kev tuag tsuas yog peb feem pua, thiab yog tias kev npaj rau kev phais ntev dua, ces 20 feem pua ntawm kev pheej hmoo ntawm kev tuag.
Kev phais suav nrog:
- resection ntawm aorta ntawm qhov chaw txiav;
- tshem tawm qhov tsis tseeb tseeb;
- restoration ntawm excised fragment ntawm lub aorta.
Kev kho mob
Tshuaj kho mob rau kev phaisaortic aneurysm yog pom zoo rau txhua tus neeg mob uas muaj txhua hom kev loj hlob ntawm aortic aneurysm. Txoj hauv kev no yog qhia kom tsis txhob kis tus kab mob.
Kev kho rau aortic dissection yog txhawm rau txo qhov mob los ntawm kev noj tshuaj tsis yog tshuaj yeeb thiab tshuaj narcotic, tshem tawm kev poob siab thiab txo qis ntshav siab.
Lub sijhawm kho tshuaj, kev saib xyuas lub plawv dhia thiab lub zog siab yog qhov yuav tsum tau ua. Txhawm rau txo lub plawv ntim ntawm cov ntshav ncig thiab txo tus nqi ntawm kev tshem tawm ntawm sab laug ventricle, b thiab p blockers yog siv los txo lub plawv dhia hauv 70 neeg ntaus ib feeb. Nyob rau hauv kev kho mob ntawm aortic dissection, "Propranolol" yog muab intravenously ntawm ib koob ntawm 1 mg txhua 3-5 feeb. Qhov txiaj ntsig zoo tshaj plaws yuav tsum tsis pub tshaj 0.15 mg / kg. Nrog kev saib xyuas kev kho mob, Propranolol yog siv txhua 4-6 teev ntawm koob tshuaj 2 txog 6 mg, uas nyob ntawm lub plawv dhia. Koj tuaj yeem siv Metoprolol 5 mg IV txhua 5 feeb.
Tsis tas li, rau kev kho mob aortic dissection, Labetalol yog siv los ntawm 50 mus rau 200 mg / hnub rau 200 ml ntawm saline.
kev kho neeg zoo
Txhawm rau nkag mus rau pharyngeal abscess thiab kho nws nrog cov tshuaj pej xeem, koj yuav tsum tsis tu ncua siv cov hauv qab no decoctions thiab tinctures hauv:
- Tincture ntawm jaundice. Txhawm rau npaj cov khoom, peb muab ob tablespoons qhuav thiab tws tshuaj ntsuab thiab ncuav nws nrog ib khob ntawm ntxhabboiling dej. Peb qhwv lub resulting sib tov nrog ib tug tuab daim ntaub thiab muab tso rau hauv ib tug sov so qhov chaw, piv txwv li, nyob ze ntawm lub roj teeb. Tom qab ob teev ntawm infusion, qhov sib tov yuav tsum tau lim thiab ib tug tablespoon tuaj yeem noj txog tsib zaug hauv ib hnub. Yog tias koj cov tincture iab, koj tuaj yeem ntxiv qab zib rau nws.
- Tincture ntawm viburnum. Nyob rau hauv lub xub ntiag ntawm kev tawm tsam ntawm suffocation, ib tug infusion ntawm viburnum berries yuav tsum tau siv. Lawv tuaj yeem noj nyoos, sib xyaw nrog zib ntab lossis qab zib.
- Dill tincture. Txhawm rau npaj cov khoom, peb noj ib diav ntawm tshiab los yog qhuav dill, yog tias xav tau, koj tuaj yeem ntxiv nws cov noob. Ib feem ntawm cov zaub ntsuab yuav xav tau txog peb puas milliliters ntawm boiling dej. Tom qab infusion li ib teev, qhov sib tov yog noj peb zaug hauv ib hnub.
- Infusion ntawm hawthorn. Txhawm rau npaj, noj plaub tablespoons qhuav hawthorn txiv hmab txiv ntoo thiab ncuav peb khob ntawm boiling dej. Peb infuse lub resulting sib tov rau ob peb teev, tom qab uas nws yuav tsum tau muab faib ua ob hnub, thiab ib feem yuav tsum tau noj nyob rau hauv peb muab faib nyob rau hauv ib hnub, ib nrab ib teev ua ntej noj mov.
- Decoction ntawm elderberry. Txhawm rau npaj lub decoction, peb muab cov hauv paus qhuav ntawm Siberian elderberry thiab zom nws. Tom qab ntawd ncuav ib spoonful ntawm hmoov nrog ib khob ntawm dill. Peb muab lub resulting sib tov rau infuse, thiab tom qab ntawd ua tiav ua noj los ntawm boiling rau kaum tsib feeb nyob rau hauv ib tug da dej. Peb lim cov sib tov ua tiav thiab noj ib tablespoon txhua.
- Decoction ntawm primrose. Rau kev ua noj, peb muab cov crushed qhuav rhizomes ntawm cov nroj tsuag. Ncuav ib diav ntawm hmoov nrog ib khob ntawm dej kub thiab boil rau ib nrab ib teev nyob rau hauv ib da dej. Decoctionlim, ces nyem tawm cov dej noo los ntawm cov hmoov npaj. Siv cov khoom tiav yuav tsum yog peb zaug ib hnub rau ib tablespoon.
Yog tias nyob rau hauv daim ntawv mob hnyav ntawm cov kab mob muaj qhov kub thiab txias, tom qab ntawd kom txo qis, koj tuaj yeem siv tshuaj ntsuab los ntawm qej thiab nplooj nplooj golden. Ua li no, coj lub peeled qej thiab finely chop. Tom qab ntawd koj yuav tsum tau grind nplooj ntawm golden mustache thiab sib tov nrog qej. Ntxiv peb caug grams zib mu rau lub resulting muaj pes tsawg leeg. Cia qhov sib tov ua tiav rau brew hauv qhov chaw sov. Tom qab ntawd sib tov thiab haus ib tablespoon nrog dej.
Kev nyuaj siab
Ib qho teeb meem ntawm aortic dissection yog nws tag nrho rupture. Kev tuag los ntawm aortic rupture yog txog li 90%. 65-75% ntawm cov neeg mob tuag ua ntej lawv tuaj txog hauv tsev kho mob, thiab tus so ua ntej lawv mus txog chav ua haujlwm. Cov phab ntsa ntawm lub aorta yog cov qauv elastic uas yuav tsum tau ua kom tiav kev ncaj ncees. Qhov sib txawv tshwm sim thaum nws lub zog ploj lawm. Qhov no tuaj yeem tshwm sim thaum lub siab sab hauv lossis sab nraud siab dua li cov phab ntsa tuaj yeem tiv taus.
Kev ntxhov siab tshwm sim thaum lub qog hlav. Los ntshav tuaj yeem ua tau retroperitoneal lossis intraperitoneal thiab tuaj yeem tsim lub fistula ntawm lub aorta thiab cov hnyuv.
Kev Tiv Thaiv
Yuav ceeb toom koj tus kheej tawm tsam tus kab mob no, yuav tsum tau ua kev tiv thaiv, xws li:
- kho atherosclerosis hauv lub sijhawm;
- kuaj ntshav lipid qib;
- ua kom muaj kev noj qab haus huv, kev noj qab haus huv;
- ua kom cov khoom noj kom zoo, tsis muaj cov ntsiab lus ntawm cov khoom kib thiab rog hauv cov ntawv qhia zaub mov. Tsis suav cov zaub mov ua tiav, khoom noj ceev, dej qab zib, cawv, txhua yam khoom noj uas muaj cov roj cholesterol ntau dhau los ntawm kev noj haus;
- muab luam yeeb;
- tswj ntshav siab, ntshav cholesterol;
- txhua xyoo, feem ntau tom qab plaub caug, raug kuaj lub cev kom pom cov hlab plawv tsis zoo;
- teem sijhawm rau kev tawm dag zog, tab sis tsis ua haujlwm dhau.
Yuav ua kom lub siab ntev mus ntev, tseem yuav tsum tiv thaiv kab mob khaub thuas thiab mob khaub thuas, raws li lawv, dhau los, muab teeb meem rau nws.
Khoom noj khoom haus tau pom zoo kom noj me me kom lub plab thiab cov hnyuv tsis txhob nyem lub plawv, uas ua rau cov ntshav khiav tsis zoo ntawm cov hlab ntsha, lub plawv thiab lub plab. Toxins accumulates nyob rau hauv lub cev, uas ua rau kom lub load ntawm lub plawv. Txhawm rau zam qhov no, koj yuav tsum muab cov hnyuv tso rau hauv lub sijhawm.
Txawm hais tias lub cev ua si tau pom zoo, tab sis cov neeg muaj kab mob ntawm cov hlab plawv yuav tsum txo lawv thiab tsis nqa qhov hnyav. Txwv tsis pub, yuav muaj ntau cov hlab ntsha, uas tom qab ntawd ua rau mob stroke thiab plawv nres.
