Pulmonary infarction yog ib yam kab mob tshwm sim los ntawm cov txheej txheem thromboembolic hauv cov hlab ntsha ntawm lub ntsws. Qhov no yog ib qho mob hnyav heev uas tuaj yeem ua rau tuag taus tshwj xeeb tshaj yog mob hnyav.
Ua rau kab mob
Tus kab mob tuaj yeem tshwm sim vim muaj kev cuam tshuam ntawm kev phais, cuam tshuam kev ua haujlwm ntawm lub plawv, pob txha pob txha, qog nqaij hlav, tom qab yug me nyuam, tom qab lub txaj pw ntev. Qhov tshwm sim thrombus kaw lub lumen ntawm lub nkoj, uas ua rau muaj kev nce siab nyob rau hauv cov hlab ntsha pulmonary system thiab hemorrhage tshwm sim nyob rau hauv lub ntsws cov ntaub so ntswg. Cov kab mob pathogenic nkag mus rau thaj tsam cuam tshuam, uas ua rau mob.
Kev txhim kho lub ntsws infarction
Mob ntsws pulmonary hypertension nrog kev nce ntxiv ntawm sab xis ntawm lub plawv tuaj yeem tshwm sim los ntawm kev cuam tshuam ntawm lumen ntawm lub nkoj, vasoconstriction cuam tshuam nrog kev tso tawm ntawm cov tshuaj lom neeg lom neeg: histamine, serotonin, thromboxane, thiab. reflex spasm ntawm pulmonary hlab ntsha. Hauv qhov no, oxygen diffusion ua tsis tiav thiab arterial hypoxemia tshwm sim, uas yog exacerbated los ntawm kev tso tawm ntawm cov ntshav underoxidized los ntawm lub intersystem thiab pulmonary arteriovenous.tshuaj anastomoses. Txoj kev loj hlob ntawm pulmonary infarction tshwm sim tawm tsam keeb kwm yav dhau los uas twb muaj lawm stagnation nyob rau hauv cov hlab ntsha. Ib hnub tom qab qhov kev cuam tshuam ntawm lub ntsws hlab ntsha, qhov tsim ntawm lub plawv nres tshwm sim, nws txoj kev loj hlob tag nrho yuav xaus rau hnub 7th.
Pathological Anatomy
Thaj chaw ntawm lub ntsws cuam tshuam los ntawm lub plawv nres muaj cov duab ntawm lub pyramid tsis xwm yeem, nws lub hauv paus yog coj mus rau qhov chaw. Qhov chaw cuam tshuam tuaj yeem yog ntau qhov ntau thiab tsawg. Qee zaum, exudative pleurisy lossis infarct pneumonia koom nrog. Nyob rau hauv lub microscope, cov ntaub so ntswg cuam tshuam yog liab liab, ruaj rau kov, thiab protrudes saum cov ntaub so ntswg noj qab haus huv. Lub pleura ua npub, npub, feem ntau cov kua sau nyob rau hauv lub pleural kab noj hniav.
Kev mob ntsws ntawm lub ntsws: cov tsos mob ntawm tus kab mob
Qhov tshwm sim thiab qhov hnyav ntawm tus kab mob nyob ntawm qhov loj, tus lej thiab qhov chaw ntawm cov hlab ntsha kaw los ntawm cov ntshav txhaws, nrog rau cov kab mob sib kis ntawm lub plawv thiab lub ntsws. Ib qho me me infarction feem ntau yuav luag tsis muaj cov cim qhia thiab kuaj pom los ntawm kev kuaj X-ray. Ntau lub plawv nres yog tshwm sim los ntawm qhov mob hauv siab, feem ntau tshwm sim tam sim ntawd, ua tsis taus pa, hnoos, hemoptysis. Ib qho kev ntsuam xyuas lub hom phiaj qhia pom qhov ceev ceev thiab ua npaws. Cov tsos mob ntawm lub plawv nres yog: bronchial ua pa nrog noo rales thiab crepitus, dullness ntawm percussion suab. Kuj tseem muaj cov cim xws li:
- paj, nquag ashy tawv tone;
- xiav lub qhov ntswg, daim di ncauj, ntiv tes;
- txo qis ntshav siab;
- pom ntawm atrial fibrillation.
Kev swb ntawm cov ceg loj ntawm cov hlab ntsha ntawm lub ntsws tuaj yeem ua rau txoj cai ventricular tsis ua haujlwm, ua tsis taus pa. Leukocytosis tau kuaj pom hauv cov ntshav, cov tshuaj tiv thaiv erythrocyte sedimentation (ERS) tau nrawm dua.
Diagnosis
Nws yog ib qho nyuaj los tsim kev kuaj mob. Nws yog ib qho tseem ceeb heev los txheeb xyuas cov kab mob uas tuaj yeem ua rau muaj teeb meem pulmonary infarction. Txhawm rau ua qhov no, nws yog ib qho tsim nyog yuav tau kuaj xyuas tus neeg mob kom zoo (tshwj xeeb yog cov ceg qis). Nyob rau hauv lub plawv nres, tsis zoo li mob ntsws, qhov mob tshwm sim ua ntej ua npaws thiab ua daus no, hnoos qeev nrog ntshav kuj tshwm sim tom qab mob hnyav nyob rau sab. Cov hauv qab no yog siv los kuaj tus kab mob:
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X-ray kuaj - txhawm rau txheeb xyuas qhov nthuav dav ntawm lub hauv paus ntawm lub ntsws thiab nws qhov deformation.
- ECG - txhawm rau txheeb xyuas cov cim ntawm lub siab sab xis.
- Echocardiography - qhov tshwm sim ntawm txoj cai ventricular overload tau txiav txim siab.
- Doppler ultrasound kuaj ntawm cov hlab ntsha ntawm qis qis - kuaj mob ntawm cov hlab ntsha sib sib zog nqus.
- Radioisotope ntsws scan - txhawm rau txheeb xyuas thaj chaw ntawm kev txo lub ntsws perfusion.
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Angiopulmonographogronographoghoghographogrography - los kuaj thaiv kab ntawm lub pob txha ntsha ceg ceg, intra-interial filling tsis xws luag.
pulmonary edema tom qab lub plawv nres
ntsws infarction:kev tshwm sim
Tus kab mob no, raws li txoj cai, tsis ua phem rau tib neeg txoj sia. Txawm li cas los xij, tom qab xws li mob xws li mob ntsws infarction, qhov tshwm sim tuaj yeem hnyav heev. Muaj ntau yam teeb meem tshwm sim. Piv txwv li, xws li post-infarction pneumonia, suppuration thiab kis mus rau pleura, pulmonary edema. Tom qab lub plawv nres, muaj kev pheej hmoo siab ntawm purulent embolus (ntshav txhaws) nkag mus rau hauv lub nkoj. Qhov no, nyob rau hauv lem, ua rau ib tug purulent txheej txheem thiab txhawb ib abscess ntawm qhov chaw ntawm infarction. Pulmonary edema nyob rau hauv myocardial infarction tsim, ua ntej ntawm tag nrho cov, nrog ib tug txo nyob rau hauv lub contractility ntawm lub plawv cov leeg thiab nrog ib txhij ntshav tuav nyob rau hauv lub me me lub voj voog. Raws li qhov kev siv ntawm lub plawv contractions txo qis tam sim ntawd, ib qho mob tsis tshua muaj tshwm sim tshwm sim, uas provokes hnyav hypoxia. Nyob rau tib lub sij hawm, muaj excitation ntawm lub paj hlwb, tso tawm ntawm biologically active tshuaj uas ua rau lub permeability ntawm lub alveolar-capillary daim nyias nyias, thiab ib tug nce redistribution ntawm cov ntshav mus rau hauv lub pulmonary ncig ntawm lub loj. Qhov kev tshwm sim ntawm pulmonary infarction nyob ntawm qhov mob hauv qab, qhov loj ntawm thaj chaw cuam tshuam thiab qhov hnyav ntawm qhov tshwm sim.
Kev kho mob
Thaum pom thawj cov cim qhia tias mob ntsws pulmonary infarction, kev kho mob yuav tsum pib tam sim ntawd. Tus neeg mob yuav tsum raug coj mus rau chav saib xyuas mob hnyav ntawm lub tsev kho mob sai li sai tau. Kev kho mob pib nrog kev qhia txog cov tshuaj "Heparin", tus neeg sawv cev no tsis yaj lub thrombus, tab sis nws tiv thaiv.nce thrombus thiab tuaj yeem nres cov txheej txheem thrombotic. Cov tshuaj "Heparin" muaj peev xwm ua rau tsis muaj zog bronchospastic thiab vasoconstrictive nyhuv ntawm platelet histamine thiab serotonin, uas yuav pab txo qis spasm ntawm pulmonary arterioles thiab bronchioles. Kev kho mob heparin yog ua tiav rau 7-10 hnub, thaum saib xyuas lub sijhawm ua haujlwm ib nrab thromboplastin (APTT). Tsawg molecular hnyav heparin kuj tseem siv - d alteparin, enoxaparin, fraxiparin.
Txhawm rau txo qhov mob, txo qhov hnyav ntawm cov hlab ntsws, txo qhov ua tsis taus pa, narcotic analgesics yog siv, piv txwv li, Morphine (1% tshuaj yog txhaj rau hauv cov hlab ntsha). Yog hais tias tus kab mob pulmonary infarction provokes pleural mob, uas yog cuam tshuam los ntawm kev ua pa, lub cev txoj hauj lwm, hnoos, ces nws raug nquahu kom siv cov tshuaj uas tsis yog-narcotic analgesics, xws li Analgin (txhaj tshuaj txhaj tshuaj 50%). Thaum kuaj mob pancreatic tsis txaus lossis poob siab, vasopressors (dopamine, dobutamine) yog siv rau kev kho mob. Yog tias pom bronchospasm (ntawm qhov nruab nrab atmospheric siab), nws yuav tsum maj mam txhaj tshuaj 2.4% ntawm aminophylline intravenously. Yog tias mob plawv mob -mob ntsws ntawm lub ntsws, yuav tsum tau siv tshuaj tua kab mob rau kev kho mob. Calm hypotension thiab hypokinesis ntawm txoj cai ventricle qhia txog kev siv cov tshuaj thrombolytic ("Alteplaz", "Streptokinase"). Qee zaum, kev phais yuav tsum tau uakev cuam tshuam (thrombectomy). Qhov nruab nrab, kev mob plawv me me raug tshem tawm hauv 8-12 hnub.
tiv thaiv kab mob
Txhawm rau tiv thaiv pulmonary infarction, nws yog ib qho tsim nyog ua ntej ntawm tag nrho cov kev tiv thaiv venous congestion nyob rau hauv ob txhais ceg (thrombosis ntawm cov hlab ntsha ntawm qis extremities). Txhawm rau ua qhov no, nws raug nquahu kom zaws cov ceg, rau cov neeg mob uas tau phais mob, myocardial infarction, siv cov ntaub qhwv elastic ntawm sab ceg. Nws kuj tseem pom zoo kom tsis suav nrog kev siv tshuaj uas ua rau kom ntshav txhaws, thiab txwv tsis pub siv cov tshuaj txhaj rau hauv cov hlab ntsha. Raws li cov lus qhia, nws muaj peev xwm sau cov tshuaj uas txo cov ntshav txhaws. Txhawm rau tiv thaiv cov kab mob sib kis tau zoo, cov tshuaj tua kab mob tau sau tseg. Txhawm rau tiv thaiv pulmonary hypertension, kev siv Eufillin raug pom zoo.
