DIC yog ib qho teeb meem ntawm cov txheej txheem hemostasis, uas pab tsim cov ntshav txhaws, thiab ntxiv rau, kev txhim kho ntawm ntau yam microcirculatory thiab hemorrhagic disorders. Lub npe tag nrho ntawm tus kab mob no zoo li nthuav tawm intravascular coagulation, ntxiv rau, muaj xws li lub npe ntawm pathology li thrombohemorrhagic syndrome. Tom ntej no, peb yuav saib seb tus kab mob no kho tau li cas thiab kuaj tau li cas.
Cov ntaub ntawv qhia txog tus kab mob
Tus mob no yog tus cwj pwm los ntawm hemorrhagic diathesis nrog nce ntshav coagulation hauv cov hlab ntsha. Qhov no ua rau kev tsim cov ntshav txhaws. Cov txheej txheem no ua rau muaj kev txhim kho ntawm kev hloov pauv hauv cov kabmob ntawm cov kabmob dystrophic, hypoxic thiab necrotic xwm.
DIC txhais tau tias muaj kev hem thawj rau tus neeg mob lub neej, vim tias muaj kev pheej hmoo los ntshav. Lawv tuaj yeem nthuav dav thiab nyuaj rau nres. ATCov txheej txheem pathological tseem tuaj yeem cuam tshuam nrog cov kabmob hauv nruab nrog cev, uas nws txoj haujlwm tau cuam tshuam tag nrho. Lub raum, tus po, lub ntsws, lub siab thiab cov qog adrenal feem ntau muaj kev pheej hmoo.
Ntau tus neeg xav paub dab tsi ua rau DIC.
Tus kab mob no tuaj yeem tshwm sim hauv ntau yam kab mob, tab sis ib txwm ua rau cov ntshav txhaws thiab cuam tshuam los ntawm cov hlab ntsha. Cov txheej txheem zoo li no tsis sib haum nrog kev ua haujlwm ntawm lub cev. DIC tuaj yeem ua rau xob laim tuag ntawm ib tus neeg lossis ua rau lub sijhawm ntev latent tuag daim ntawv mob.
Cov txheeb cais ntawm tus mob no nyuaj rau xam, vim nws tshwm sim nrog ntau zaus hauv qee yam kab mob. Qee cov kab mob no ib txwm nrog tus mob no, thaum nyob hauv lwm cov kab mob nws muaj tsawg dua.
Rau DIC, cov txheej txheem rau kev kuaj mob thiab kev kho mob yuav raug nthuav tawm hauv qab no.
Cov kab mob no yuav tsum tau suav tias yog kev tiv thaiv tsis zoo ntawm lub cev, uas tau muab rau lawv txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau cov kab mob pathology nws yuav tsum tau saib xyuas kev tiv thaiv tsis zoo ntawm lub cev. Yog li ntawd lub cev sim tiv thaiv nws tus kheej los ntawm cov ntaub so ntswg puas. Cov kab mob no muaj ntau heev hauv kev kho mob ntawm ntau yam tshwj xeeb. Resuscitators, gynecologists, traumatologists, surgeons thiab hematologists paub zoo txog tus mob no.
Cia peb xav txog qhov pathogenesis ntawm DIC.
Yuav ua li cas?
Qhov no qhia txog qhov ua tsis tiav ntawm lub cev cov lus teb uas tau ua rau sim tiv thaiv los ntshav. Cov txheej txheem zoo li no hu uahemostasis. Tawm tsam keeb kwm yav dhau los no, kev ua haujlwm uas yog lub luag haujlwm rau cov ntshav txhaws yog txhawb nqa ntau dhau, thiab cov kab mob fibrinolytic thiab anticoagulant uas sib npaug nws, ntawm qhov tsis sib xws, yog depleted sai heev.
Enzymes uas tsim los ntawm co toxins, kab mob, tiv thaiv kab mob, phospholipids thiab lwm yam uas tau nkag mus rau hauv lub cev tuaj yeem cuam tshuam qhov tshwm sim ntawm tus mob no. Tib lub sijhawm, lawv ncig hauv cov hlab ntsha lossis cuam tshuam rau vascular endothelium.
theem kab mob
Tus mob no feem ntau txhim kho raws li qee cov qauv tshwj xeeb, dhau los ntawm cov theem ua tiav:
- Thaum thawj theem, cov txheej txheem ntawm cov ntshav coagulation ntau dhau tau tshwm sim, nrog rau kev sib sau ntawm tes hauv cov hlab ntsha. Ib qho nyiaj ntau dhau ntawm thromboplastin lossis cov tshuaj uas muaj cov nyhuv zoo sib xws raug tso rau hauv cov ntshav. Cov txheej txheem no ua rau lub rollup. Lub sij hawm ntawm thawj theem sib txawv heev, noj los ntawm ib feeb mus rau ob peb teev yog hais tias tus mob tshwm sim nyob rau hauv ib tug mob daim ntawv. Txog li ob peb lub hlis, cov txheej txheem pathological tuaj yeem tshwm sim yog tias tus mob mob ntev.
- theem thib ob ntawm DIC yog tus cwj pwm los ntawm kev pib ua cov txheej txheem coagulopathy. Tawm tsam keeb kwm yav dhau los no, qhov tsis muaj platelets, fibrogen thiab lwm yam ntshav plasma uas yog lub luag haujlwm rau cov txheej txheem ntshav coagulation nce hauv lub cev.
- theem peb ntawm DIC twb suav tias yog qhov tseem ceeb. Thaum lub sij hawm no, cov txheej txheem ntawm theem nrab fibrinolysis tshwm sim, thiab cov ntshav coagulationncav nws qhov siab tshaj plaws kom txog thaum cov txheej txheem nres kiag li. Tawm tsam keeb kwm yav dhau los no, hemostasis yog qhov tsis sib npaug.
- theem rov qab yog tus cwj pwm los ntawm normalization ntawm hemostasis. Qhov seem dystrophic thiab necrotic hloov pauv tau pom ntawm cov ntaub so ntswg thiab kabmob. Lwm qhov tseem ceeb ntawm tus mob no tuaj yeem yog qhov ua tsis tiav ntawm ib lub cev.
Txoj kev loj hlob ntawm tus kab mob, uas yog, nws qhov hnyav, thiab cov txheej txheem ntawm kev loj hlob feem ntau yog nyob ntawm qib ntawm cov kab mob microcirculation thiab theem ntawm kev puas tsuaj rau lub cev thiab lub cev.
Ib qho ntawm qhov ua rau mob DIC thaum cev xeeb tub thaum lub hnub nyoog gestational yog intrauterine fetal tuag thiab fading ntawm cev xeeb tub. Pathology ntawm qib 4 tuaj yeem ua rau tus poj niam tuag, yog li ntawd, nrog rau cov cim qhia tias muaj peev xwm txiav cev xeeb tub, koj yuav tsum hu rau lub chaw haujlwm ntawm kev ua haujlwm pathology ntawm koog tsev kho mob maternity.
Qhov ua rau DIC hauv kev yug menyuam tuaj yeem yog kis kab mob. Kev kis kab mob ntawm cov dej amniotic, cov kab mob ntev ntev ntawm leej niam lub cev hauv nruab nrog cev, uas ua rau muaj kev pheej hmoo ntawm cov kab mob thiab lawv cov co toxins nkag mus rau hauv cov hlab ntsha - tag nrho cov no tuaj yeem ua rau muaj kab mob hauv lub cev thiab cov kab mob coagulopathy, yog li nws yog ib qho tseem ceeb rau kev kho txhua yam kab mob ntawm cov kab mob sib kis. raws sij hawm thiab ua raws li txhua tus kws kho mob cov tshuaj.
Qhov phom sij ntawm DIC hauv kev kho menyuam yaus yog nyob rau hauv nws qhov yuav luag asymptomatic. Feem ntau, pathology tsuas yog txiav txim siabtom qab kuaj kuaj, uas tuaj yeem txiav txim siab txog cov kab mob hematological (kev hloov pauv hauv cov ntshav chemistry).
Nyob rau me nyuam
DIC hauv cov menyuam mos tuaj yeem tshwm sim los ntawm cov laj thawj hauv qab no:
- kev puas tsuaj rau "cov menyuam yaus lub rooj";
- kev tuag hauv lub cev ntawm ib tus menyuam yaus hauv ntau lub cev xeeb tub;
- kab mob hauv lub cev;
- eclampsia thiab preeclampsia mob;
- Yuterine rupture;
- bubble skid.
Feem ntau, pathology raug kuaj pom hauv cov menyuam mos ntxov ntxov. Tus me nyuam cov ntshav muaj cov procoagulants tsis txaus los yog cov tshuaj tiv thaiv coagulants, uas ua rau kom los ntshav ntau.
DIC hauv tus menyuam mos tuaj yeem tsim muaj ntau yam mob. Tus mob no feem ntau muaj cov chav kawm fulminant, uas yuav tshem tawm qhov ua tau ntawm kev kho mob.
Kev nyuaj siab
Lawv feem ntau hnyav heev tiv thaiv keeb kwm ntawm tus kab mob no thiab tuaj yeem cuam tshuam tsis yog kev noj qab haus huv nkaus xwb, tab sis kuj rau lub neej. Ntau zaus dua li lwm tus, cov neeg mob no nyiam tsim cov kab mob thiab cov mob hauv qab no:
- Kev txhim kho ntawm hemocoagulation shock. Tawm tsam keeb kwm yav dhau los ntawm nws, cov ntaub so ntswg thiab cov kabmob hauv ib tus neeg pib muaj cov pa oxygen tsis txaus, txij li cov ntshav microcirculation cuam tshuam rau hauv cov hlab ntsha uas yog lub luag haujlwm rau lawv cov khoom noj. Tsis tas li ntawd, tus nqi ntawm toxins ncaj qha nyob rau hauv cov ntshav nws tus kheej yog heev tshaj. Vim li ntawd, tus neeg mob lub siab poob qis, poob siab thiab lub cev tsis ua haujlwm koom nrog.
- Kev txhim kho mob hnyavUa pa tsis ua haujlwm hauv DIC. Tus mob no yog ciam teb thiab ua rau muaj kev hem thawj rau tus neeg mob lub neej. Nrog nce hypoxia, kev nco qab yuav ploj mus, convulsions tshwm sim, thiab vim li ntawd, hypoxic coma teeb rau hauv.
- Kev loj hlob ntawm lub raum tsis ua haujlwm yog lwm qhov teeb meem ntawm tus mob no. Tus neeg mob nres tso zis, tso zis tso zis nres. Cov dej-ntsev sib npaug kuj cuam tshuam, thiab qib ntawm nitrogen, urea thiab creatinine nce hauv cov ntshav. Tab sis qhov xwm txheej zoo li no tau muab cais ua qhov muaj peev xwm thim rov qab.
- Kev txhim kho daim siab necrosis.
- Lub plab zom mov tuaj yeem raug cim los ntawm qhov pom ntawm plab rwj, plab hnyuv infarction, pancronecrosis, thiab lwm yam.
- Ischemic stroke yog ua tau los ntawm sab ntawm kev ua haujlwm ntawm lub siab.
- Lub hematopoietic system reacts nrog mob hemorrhagic anemia.
Tom ntej no, peb yuav pom cov kev tshawb fawb twg siv los kuaj xyuas tus kab mob no.
Diagnostics
Kev kuaj mob ntawm tus kab mob yog tsim los ntawm tus kws kho mob thaum kuaj tus neeg mob, thiab ntxiv rau, ua ib feem ntawm kev sau cov anamnesis thiab ntau yam kev kuaj mob. Kev kuaj pom tias:
- Kev kuaj ntshav kuaj.
- Kev tshawb nrhiav tshuaj urinalysis.
- Kev kuaj ntshav.
- Xov ntshav rau coagulogram. Txoj kev tshawb no yog txoj hauv kev tseem ceeb rau kev kuaj mob hemostasis, uas suav nrog fibrogens, platelets thiab lwm yam tseem ceeb ntsuas.
- Enzyme immunoassay, uas tshuaj xyuas cov cim tseem ceeb ntawm cov ntshav coagulation hauv cov hlab ntsha.
- Kev pub ntshav rau kev kuaj kab mob paracoagulation tso cai rau koj los tsis lees lossis, hloov pauv, lees paub qhov kev kuaj mob.
Ua tsaug rau tag nrho cov kev tshawb fawb no, cov kws kho mob pom qhov laj thawj tseem ceeb uas ua rau muaj tus mob. Ntxiv rau, raws li cov kev ntsuas no, theem thiab qhov xwm txheej ntawm tus kab mob tau txiav txim siab.
Kev kuaj mob ntawm DIC yuav tsum tau raws sijhawm.
Nyob rau hauv cov xwm txheej uas cov chav kawm ntawm tus mob yog latent, ces nws yuav muaj peev xwm txiav txim siab hypercoagulability nkaus xwb nyob rau hauv lub hauv paus ntawm kev soj ntsuam kuaj. Tawm tsam keeb kwm yav dhau los no, fragmented erythrocytes yuav raug pom nyob rau hauv smear, lub sij hawm thrombosed yuav nce, thiab cov concentration ntawm fibrin degradation cov khoom yuav nce ntau. Kev kuaj ntshav yuav qhia tias tsis muaj fibrinogen thiab platelets hauv nws. Thaum kuaj pom tus mob no, cov kab mob uas muaj kev phom sij tshaj plaws, xws li ob lub raum, lub plawv, lub ntsws, lub siab, lub hlwb thiab cov qog adrenal, yuav tsum tau kuaj xyuas.
Cov lus pom zoo rau DIC yog dab tsi?
Kev kho mob
Kev kho tus kab mob no yog txheej txheem nyuaj, kev rov zoo ntawm tus neeg mob yuav tsis tshwm sim hauv txhua qhov xwm txheej. Nyob rau hauv cov ntaub ntawv uas ib tug mob ntawm lub chav kawm ntawm tus kab mob tau kuaj, ces kev tuag tshwm sim nyob rau hauv peb caug feem pua ntawm cov neeg mob, uas yog suav hais tias yog ib tug ncaj ncees tus nqi. Tab sis txawm li cas los xij, nws nyob deb ntawm ib txwm muaj peev xwm txiav txim siab qhov ua rau tus neeg mob tuag. Nws tsis yog ib txwm paub meej tam sim ntawd seb tus mob no puas tau txais kev pabmob hnyav, lossis tus neeg mob tuag vim qhov cuam tshuam tsis zoo ntawm lawv cov kab mob hauv qab.
Cov kws kho mob uas soj ntsuam DIC-cov tsos mob ntawm cov ntshav, ua rau lawv siv zog ua ntej kom tshem tawm lossis tsawg kawg txo cov xwm txheej uas ua rau muaj kev txhim kho ntawm tus mob thiab txhawb nws txoj kev loj hlob. Ua ntej tshaj plaws, nws yog ib qho tseem ceeb kom tshem tawm cov kab mob purulent-septic, uas feem ntau provokes kev ua txhaum ntawm hemostasis. Tawm tsam keeb kwm yav dhau los no, nws tsis muaj txiaj ntsig los tos qhov tshwm sim ntawm kev tshawb fawb bacteriological, kev kho yog ua raws li kev kho mob tshwm sim ntawm tus kab mob.
Cov lus qhia kho mob rau DIC yuav tsum ua raws nruj me ntsis.
Thaum twg yog tshuaj tua kab mob qhia?
Kev kho kab mob tua kab mob yog sau rau hauv qee kis hauv qab no:
- Vim kev rho menyuam.
- Tawm tsam keeb kwm yav dhau los ntawm kev tso tawm ntxov ntxov ntawm cov kua amniotic, tshwj xeeb tshaj yog tias lawv tsis pob tshab thiab muaj turbidity.
- Kub nce.
- Ntseev cov tsos mob uas qhia tias mob ntsws, plab hnyuv plab lossis kab mob urinary.
- Kev pom tshwm sim ntawm meningitis.
Raws li ib feem ntawm kev kho mob ntawm DIC, cov kws kho mob siv dav-spectrum antibacterial agents. Tsis tas li ntawd, globulins suav nrog hauv kev kho mob. Txhawm rau tiv thaiv lub xeev ntawm kev poob siab, kev txhaj tshuaj ntawm cov tshuaj ntsev yog siv nrog rau kev tso ntshav ntshav nrog "Heparin" thiab "Prednisolone" intravenously, thiab. Cov tshuaj "Reopoliglyukin" tuaj yeem siv tau. Nyob rau hauv cov xwm txheej uas lub xeev ntawm kev poob siab tau kov yeej raws li lub sijhawm, nws muaj peev xwm muaj sijhawm los nres qhov kev txhim kho ntxiv ntawm DIC, lossis txo qis nws qhov tshwm sim.
Hais txog "Heparin" nws tsim nyog sau cia tias nrog nws cov lus qhia muaj kev pheej hmoo los ntshav. Txoj kev kho no tsis muaj txiaj ntsig zoo yog tias nws siv lig dhau lawm. Nws yuav tsum tau nkag mus sai li sai tau. Nws yog ib qho tseem ceeb uas yuav tsum tau ua raws li cov lus pom zoo. Nyob rau hauv cov ntaub ntawv uas tus neeg mob twb nyob rau hauv lub thib peb theem ntawm txoj kev loj hlob ntawm tus kab mob, ces cov kev taw qhia ntawm "Heparin" yog suav hais tias yog ib tug ncaj contraindications. Cov cim qhia tias txwv tsis pub siv cov tshuaj no yog suav tias yog cov tsos mob hauv daim ntawv ntawm kev poob siab, hemorrhagic vau thiab los ntshav, uas tej zaum yuav zais.
Nyob rau hauv cov xwm txheej uas cov tsos mob yog nyuam qhuav pib tsim, ces nws yog advisable mus qhia adrenoblockers nyob rau hauv daim ntawv ntawm Dibenamine, Phentolamine, Thioproperazine thiab Mazheptil. Cov tshuaj no tau muab tso rau hauv cov hlab ntsha hauv qhov xav tau concentration. Lawv pab normalize microcirculation hauv lub cev, thiab ntxiv rau, lawv tiv thaiv thrombosis hauv cov hlab ntsha. Norepinephrine thiab epinephrine npaj yuav tsum tsis txhob siv raws li lawv yuav ua rau qhov teeb meem no.
Tawm tsam keeb kwm yav dhau los ntawm kev tsim lub raum lossis lub siab tsis ua haujlwm, nyob rau theem pib ntawm kev txhim kho DIC, nws tuaj yeem siv cov tshuaj hauv daim ntawv ntawm "Trental" thiab "Kurantil". Lawv tau muab tso rau hauv cov hlab ntsha.
Nyob rau theem thib peb ntawm kev txhim kho ntawm tus mob no, yuav tsum tau qhia txog cov tshuaj tiv thaiv protease. lub ntsiab tshuajCov tshuaj ntawm kev xaiv nyob rau hauv cov ntaub ntawv no yog Kontrykal, txoj kev ntawm nws cov thawj coj yog intravenously. Yog tias tsim nyog, kev tswj hwm ntawm cov tshuaj tuaj yeem rov ua dua. Kev cuam tshuam hauv zos txo qis rau kev kho mob los ntshav qhov txhab, yaig thiab lwm qhov chaw nrog kev pab los ntawm rau feem pua ntawm Androxon.
kev kho mob nyuaj
Summarizing, nws yuav tsum tau muab sau tseg tias txoj kev kho complex ntawm DIC, raws li txoj cai, los mus rau cov ntsiab lus hauv qab no:
- Tshem tawm lub hauv paus ua rau ua rau muaj kev loj hlob ntawm tus mob.
- Kev kho mob tiv thaiv kev poob siab.
- Cov txheej txheem ntshav ntim ntxiv nrog cov ntshav plasma ntxiv nrog Heparin. Tab sis cov txheej txheem no tuaj yeem ua tau tsuas yog tias tsis muaj contraindications rau qhov no.
- siv sijhawm sijhawm ntawm adrenergic blockers, nrog rau cov tshuaj uas pab txo cov platelets hauv cov ntshav, piv txwv li, Curantil, Trental lossis Ticlodipine.
- Kev tswj hwm "Kontrykal" rau tus neeg mob nrog rau kev tso ntshav platelet kom normalize hematocrit thaum muaj los ntshav hnyav.
- Kev muab plasmacytapheresis rau tus neeg mob yog tias muaj cov lus qhia tsim nyog rau qhov no.
- Raws li ib feem ntawm qhov normalization ntawm cov txheej txheem microcirculation hauv cov kabmob uas cuam tshuam, nootropics yog siv nrog rau cov tshuaj angioprotectors thiab lwm yam tshuaj syndromic.
- Tawm tsam keeb kwm yav dhau los ntawm kev txhim kho lub raum tsis ua haujlwm, hemodiafiltration thiab hemodialysis tau ua tiav.
Cov neeg mob nrog DIC yuav tsum tau uapw hauv tsev kho mob, thiab lawv nyob hauv kev saib xyuas ib puag ncig ntawm cov kws tshaj lij. Lawv feem ntau muab tso rau hauv chav saib xyuas hnyav lossis chav saib xyuas hnyav.
Hais txog qhov kev kwv yees, peb tuaj yeem hais tias nws txawv heev. Rau qhov ntau dua, qhov kev kwv yees nyob ntawm, ua ntej ntawm tag nrho, ntawm dab tsi ua rau kev loj hlob ntawm tus mob no, thiab ntxiv rau, ntawm theem ntawm hemostasis tsis zoo. Nws tseem ceeb npaum li cas qhov kev pab thawj zaug tau sai sai rau tus neeg mob thiab nws txaus npaum li cas thiab ua tau raws li qhov xav tau ntawm tus neeg mob. Qhov tshwm sim tuag taus tawm tsam keeb kwm yav dhau los ntawm tus mob no, hmoov tsis, tsis tuaj yeem txiav txim siab, vim tias nws yuav tshwm sim tawm tsam keeb kwm ntawm kev poob ntshav hnyav, vim kev poob siab lossis lub cev tsis ua haujlwm. Cov kws kho mob yuav tsum tau saib xyuas tshwj xeeb rau cov neeg mob uas muaj kev pheej hmoo, ua ntej ntawm tag nrho cov, cov neeg laus, cov poj niam cev xeeb tub, cov menyuam mos thiab cov neeg mob uas muaj kab mob hauv qab.
prophylaxis
Paub qhov ua rau tus kab mob no ua rau nws muaj peev xwm los tiv thaiv kev tiv thaiv. Tau kawg, nws tsis tuaj yeem pom tseeb txhua yam, tab sis ua raws li ob peb txoj cai hauv qab no yuav pab txo qis kev pheej hmoo ntawm kev tsim cov kab mob hnyav xws li:
- Yog xav tau kev kho mob phais, yuav tsum xaiv cov txheej txheem phais kom zoo tshaj plaws.
- Anticoagulants yuav tsum tau siv rau txhua yam kab mob uas tuaj yeem cuam tshuam los ntawm tus mob no.
- Nab tom thiab txhua yam tshuaj lom neeg yuav tsum zam.
- Tsis muaj lossis tsawg kawg siv cov ntshav tag nrho.
- tshawb nrhiav thiab kho mob qog noj ntshav raws sijhawm.
Cov Lus Qhia
DIC yog ib qho teeb meem loj heev ntawm kev kho mob pathology thiab muaj kev tuag ntau, nyob ntawm qhov ua rau. Hauv qhov no, txog li tsib caug feem pua ntawm cov neeg mob tuag. Qhov no yog vim li cas kev tiv thaiv yog suav tias yog qhov tseem ceeb tshaj li kev ntsuas kho. Yog li ntawd, nws yog ib qho tseem ceeb heev uas yuav tsum tau ua raws li cov lus qhia saum toj no txhawm rau zam kev txhim kho ntawm tus mob no.
Peb saib dab tsi DIC yog cov lus yooj yim.
