Muaj cov npe kab mob uas tsis muab sijhawm rau cov neeg mob ua neej nyob mus ntxiv. Tawm tsam tam sim ntawd, lawv hloov tag nrho ib tug neeg, thiab nws muaj sij hawm tsawg heev los txuas ntxiv nws lub neej li qub. Ib yam mob zoo li no yog acid aspiration syndrome, tseem hu ua Mendelssohn's syndrome.
Kev piav qhia
Qhov tshwm sim ntawm tus kab mob no cuam tshuam nrog kev noj cov kua qaub ntawm lub plab mus rau hauv txoj hlab ua pa, vim tias tus neeg mob ua rau mob hnyav. Feem ntau ntawm cov tsos mob ntawm tus kab mob pathological paub nyob rau hauv obstetric anesthesiology. Hauv cov neeg mob uas muaj ntau yam kev kuaj mob, uas nyob rau hauv lossis tsis muaj tshuaj loog, cov ntsiab lus acidic ntawm lub plab, nplua nuj nyob hauv cov enzymes, tuaj yeem nkag mus rau hauv cov pa hauv nruab nrog cev.
Mendelssohn's syndrome yog ib qho teeb meem tuag taus ntawm tshuaj loog. Hauv kev xyaum kho mob, yuav luag 60% ntawm cov neeg mob tuag taus. ATobstetric anesthesia, daim duab no nce mus txog 70%.
Yog vim li cas
Qhov tseem ceeb uas ua rau muaj qhov tshwm sim ntawm cov tsos mob acid-aspiration yog regurgitation los yog ntuav uas tshwm sim thaum lub sij hawm tshuaj loog, thaum lub functionality ntawm kev tiv thaiv reflexes ntawm lub larynx yog txo. Mendelssohn's syndrome yog feem ntau tshwm sim los ntawm regurgitation, nrog passive leakage ntawm gastric ntsiab lus rau hauv oropharynx.
Muaj kev pheej hmoo ntawm kev tsim cov teeb meem tshwm sim nrog lub plab tag nrho, kev ntxhov siab tshuaj, haus cawv, qaug zog. Regurgitation tuaj yeem tshwm sim thaum cev xeeb tub (los ntawm 22-23 lub lis piam), thaum cov khoom noj gastrin txo qis vim kev hloov pauv hormonal, uas ua rau muaj kev loj hlob ntawm gastric hypertension. Ntawm lwm yam: nce intragastric thiab intra-abdominal siab, tsam plab, inflammatory txheej txheem nyob rau hauv txoj hlab pas, rog, muaj mob ntawm cov kab mob ntawm lub digestive system. Qhov kev pheej hmoo loj tshaj plaws ntawm tus mob no tshwm sim thaum lub sijhawm ua haujlwm hauv kev yug menyuam lossis hauv kev ua haujlwm ntawm kev phais xwm txheej ceev.
Pathogenesis
Mendelssohn's syndrome muaj ib qho tshwj xeeb ntawm kev txhim kho. Thawj qhov kev xaiv yog thaum cov khoom noj uas tsis tau noj nkag mus rau hauv txoj kev ua pa nrog rau cov kua txiv hmab txiv ntoo. Nyob rau theem ntawm nruab nrab bronchi, mechanical blockage ua rau kev txhim kho ntawm kev ua pa tsis ua haujlwm. Nyob rau hauv rooj plaub thib ob, kua qaub kua qaub heev, yog tias nws nkag mus rau hauv txoj hlab pa, tuaj yeem ua rau muaj tshuaj lom neeg ntawm cov mucous membrane ntawm bronchi thiab trachea. Tsis tas li ntawd, mucosal edema provokes kev loj hlobbronchial obstruction.
Mendelssohn syndrome: cov tsos mob
Daim duab kho mob ntawm tus kab mob yuav luag sib npaug nrog cov tsos mob ntawm kev ua pa hnyav. Tus neeg mob tus mob yog yus muaj los ntawm pulmonary edema, tachycardia, dyspnea, cyanosis, bronchospasm. Tawm tsam keeb kwm yav dhau los ntawm kev hloov pauv thawj zaug, lub plawv nres yuav tshwm sim. Nyob rau hauv tus neeg mob lub cev, lub dav dav thiab pulmonary ntshav txaus yog cuam tshuam, arterial hypertension nce. Ua ke nrog hnyav hypoxemia, lub siab nyob rau hauv cov hlab ntsha ntawm lub ntsws nce nrog ib txhij nce hauv pulmonary vascular resistance. Metabolic acidosis thiab ua pa alkalosis tshwm sim los ntawm cov nqaij mos perfusion.
Kev hloov kho thiab cov kab mob pathophysiological cuam tshuam nrog kev puas tsuaj rau lub ntsws. Qee lub sij hawm cov tsos mob tsis tshua meej. Morphological kev hloov nyob rau hauv cov pa kab mob yog pom meej meej ib hnub tom qab aspiration. Tsuas yog ib hnub lossis ob hnub tom qab qhov pib ntawm Mendelssohn's syndrome, cov tsos mob ntawm kev ua pa tsis ua haujlwm pib. Ib tug neeg tuaj yeem cawm tau tsuas yog tias nws tau txais kev kho mob sai.
Mendelssohn's syndrome hauv obstetrics
Cov poj niam thaum lub sijhawm ua haujlwm obstetric lossis thaum lub sijhawm tshuaj loog ntawm kev yug menyuam feem ntau tsim tus kab mob no. Txhawm rau ua kom lub ntsws mus rau hauv txoj hlab pa, ob qho xwm txheej yuav tsum tau ua. Qhov thib ib yog kev siv tshuaj loog (thaum lub sijhawm ua haujlwm ntawm obstetric, yug menyuam, phais pathology ntawm lub plab), qhov thib ob yog kev ua txhaum ntawm lub plab zom mov hauv coma, regurgitation, ntuav. ATFeem ntau, tus neeg mob yuav tuag yog tias nws muaj Mendelssohn's syndrome. Tias qhov no muab txoj cai tso tus kab mob sib npaug nrog qhov txaus ntshai tshaj plaws, ua rau tuag taus ntawm cov tshuaj loog, tsis muaj qhov tsis ntseeg.
Khoom noj khoom haus hauv plab ntawm cov poj niam tsis muaj hnub nyoog feem ntau yuav nyob twj ywm vim qhov qeeb hauv nws txoj kev thaum cev xeeb tub vim qhov txo qis hauv gastrin thiab nce siab hauv plab. Nws yog gastrin uas tswj lub plab zom mov, thiab qhov tsis txaus ntawm nws ua rau kev txhim kho acid aspiration syndrome thaum siv tshuaj loog.
Kev kub ntxhov
Thawj yam uas tus neeg mob Mendelssohn's syndrome yuav tsum ua yog tshem tawm cov ntsiab lus ntawm lub plab los ntawm txoj hlab pa. Lub qhov ncauj kab noj hniav yog ntxuav nrog suction los yog gauze swab. Tracheal intubation yuav tsum tau ua nyob rau theem prehospital. Tom ntej no, koj yuav tsum tau ua ib qho kev ceev bronchoscopy nyob rau hauv cov tshuaj loog nyob rau hauv ua ke nrog nrog rau kev txhaj tshuaj tiv thaiv cua ntawm lub ntsws. Txhawm rau ntxuav lub bronchi, siv cov tshuaj sodium bicarbonate (2%) nrog rau cov tshuaj "Hydrocortisone" los yog sov isotonic tov ntawm sodium chloride. Tom qab tracheal intubation, lub plab yog ntxuav kom huv si nrog cov tshuaj alkaline los ntawm kev sojntsuam. Cov tshuaj "Atropine" thiab "Eufillin" yog muab tso rau hauv cov hlab ntsha.
Nyob rau hauv rooj plaub thaum tus neeg mob qhov mob me ntsis, lub tshuab ua pa tuaj yeem hloov tau los ntawm kev ua pa tsis zoo nrog exhalation tsis kam. Rau cov txheej txheem no, koj yuav xav tau lub npog ntsej muag tshwj xeeb, yog tias tsis muaj, koj yuav tsum qhia tus neeg mob kom ua pa tawm los ntawm lub raj roj hmab uas txo qis kawg rau hauv dej.
Mendelssohn's syndrome (daim duab saum toj no qhia tau hais tias ib feem ntawm lub cev raug kev txom nyem nyob rau hauv thawj qhov chaw) tuaj yeem ua rau tus neeg mob tuag yog tias nws tsis tau txais kev pab raws sijhawm. Txawm tias muaj kev pab sai sai ntawm laryngo- thiab bronchospasm, tus neeg mob yuav tsum tau mus pw hauv tsev kho mob txhawm rau tiv thaiv kev loj hlob ntawm cov teeb meem loj.
Kev kho mob
Yog tias tus neeg mob tau kuaj pom tias muaj Mendelssohn's syndrome, kev kho mob yuav tsum suav nrog cov kev ntsuas uas yuav pab tiv thaiv kev ua pa tsis ua haujlwm thiab tiv thaiv kev loj hlob ntawm cov kab mob sib kis. Artificial ventilation ntawm lub ntsws yog nqa tawm thaum arterial hypoxia tsis tuaj yeem raug tshem tawm nyob rau hauv cov xwm txheej ntawm kev ua tsis taus pa. Nyob rau hauv ib qho kev mob hnyav heev ntawm tus neeg mob, cov txheej txheem yog nqa tawm rau ob peb hnub, kom txog rau thaum cov ntsuas pulmonary gas exchanger txhim kho. Qee zaum hyperbaric oxygen therapy yog siv, uas qee zaum muab cov txiaj ntsig zoo. Kev kho mob muaj xws li kev siv cov tsos mob, tshuaj tua kab mob thiab koob tshuaj corticosteroids ntau.
Mendelssohn's syndrome hauv 30-60% ntawm cov neeg mob ua rau tus neeg mob tuag. Cov neeg uas tau muaj nws tuaj yeem tsim muaj kev txwv hnyav lossis cuam tshuam rau ntau qib.
Kev Tiv Thaiv
Muaj ntau qhov kev ua uas tuaj yeem tiv thaiv kev txhim kho ntawm qhov teeb meem loj xws li Mendelssohn's syndrome. Kev tiv thaiv muaj ob peb kauj ruam. Thawj qhov yog siv cov tshuaj uas nws qhov kev txiav txim yog txhawm rau txo qis kev zais ciaplab ("Ranitidine", "Cimetidine"). Kev ua kom pom tseeb thiab raug ntawm tus kws tshuaj loog tuaj yeem tiv thaiv qhov tshwm sim ntawm cov teeb meem. Cov tshuaj "Atropine" yuav tsum tau hloov los ntawm cov tshuaj "Metacin", tus neeg mob yuav tsum tau nkag mus rau hauv lub xeev ntawm cov tshuaj loog smoothly thiab sai sai. Tus kws kho mob yuav tsum paub cov txheej txheem ntawm intubation thiab laryngoscopy ntawm lub trachea thiab siv Celica maneuver.
Qee lub sij hawm lub plab hnyuv tau tso, tawm hauv lub sijhawm ua haujlwm kom tsis txhob muaj cov ntsiab lus hauv plab nkag mus rau hauv txoj hlab pa. Qee tus kws tshaj lij tawm tsam cov txheej txheem no, vim tias qhov kev sojntsuam tuaj yeem ua lub luag haujlwm ntawm lub wick thiab ua rau tus mob hnyav dua. Hauv obstetrics, kev tiv thaiv yuav tsum muaj nyob rau hauv qhov tseeb ntawm tus poj niam hauv kev ua haujlwm ntawm lub rooj ua haujlwm, lub taub hau kawg uas yuav tsum tau tsa me ntsis.
