Critical ischemia ntawm qis extremities yog ib txheej ntawm manifestations ntawm pathologies uas yog nrog los ntawm kev puas tsuaj rau peripheral hlab ntsha, uas yog txuam nrog ntev insufficiency ntawm cov ntshav mus rau cov nqaij mos ntawm ob txhais ceg. Qhov kev kuaj mob no yog tsim rau cov neeg mob uas muaj mob ntev uas tshwm sim feem ntau thaum hmo ntuj. Tawm tsam keeb kwm yav dhau los no, trophic ulcers, gangrene lossis intermittent claudication yuav muaj.
Kev piav qhia tus kab mob
Critical qis qis ischemia pib thaum cov hlab ntsha nqaim vim spasms lossis ua rau tag nrho. Raws li kev txheeb cais, tus kab mob no tau kuaj pom hauv cov txiv neej uas muaj hnub nyoog tshaj li plaub caug tsib xyoos thiab muaj kev haus luam yeeb thiab cawv. Xws li kev ua txhaum ntawm cov ntshav ntws ua rau qhov tshwm sim ntawm qhov sib txawv ntawm qhov hnyav, tom qab ntawd pathology tshwm sim nws tus kheej.nyob rau hauv mob los yog mob ntev. Tawm tsam keeb kwm yav dhau los ntawm cov ceg ntev ischemia, circulatory tsis ua haujlwm tshwm sim hauv ntau theem.
Tom ntej no, peb yuav nkag siab tias yog vim li cas tus kab mob no tshwm sim thiab nws tshwm sim li cas. Tsis tas li ntawd, peb yuav kawm paub yuav ua li cas txheeb xyuas thiab kho qhov tseem ceeb ntawm ischemia ntawm qis qis (daim duab). Yog li, cia peb pib nrog cov laj thawj uas ua rau kev tsim cov kab mob no.
ua rau ntawm pathology
feem ntau ua rau qhov tseem ceeb hauv qis qis qis ischemia yog atherosclerosis. Thiab feem ntau xws li mob yog provoked los ntawm tus neeg mob haus luam yeeb. Ntawm lwm yam, atherosclerosis tsim tawm tsam keeb kwm ntawm cov hauv qab no:
- kev noj zaub mov tsis zoo ua rau rog rog lossis dyslipidemia.
- Txhim kho cawv lossis ntshav qab zib angiopathy.
- Hypertension.
Nyob rau hauv cov xwm txheej tsis tshua muaj, ischemia provoked los ntawm kev raug mob los yog frostbite.
Cia peb xav txog kev faib tawm ntawm qis qis ischemia.
theem kab mob
Nyob rau hauv lub xub ntiag ntawm tus kab mob mus ntev, plaub theem yog txawv. Pib los ntawm qhov thib peb, qhov no pathology yog tus yam ntxwv tseem ceeb. Kev faib tawm ntawm qhov tseem ceeb hauv qis qis qis ischemia yog nyob ntawm cov ntaub ntawv hais txog qib ntawm qhov tshwm sim ntawm kev sib cuam tshuam claudication.
- Thaum xub thawj theem ua ntej qhov mob tshwm sim, tus neeg mob tuaj yeem taug kev hauv lub cev mus txog li ib mais.
- Thaum thib ob, kev taug kev mob tshwm sim tom qab ob puas mus rau tsib puas meters.
- Nyob rau theem peb, qhov mob tshwm sim thaum so. Thiab ncaj qha thaum taug kev, qhov mob twb tshwm simhauv nees nkaum txog tsib caug meters.
- theem plaub ntawm tus kab mob yog nrog los ntawm cov tsos mob ntawm trophic ulcers, thiab ntxiv rau, kev loj hlob ntawm gangrene.
Pib los ntawm theem thib peb, ceg ischemia yog qhov tseem ceeb. Cov tsos mob uas tau pom nyob rau hauv ob theem kawg qhia txog qhov tshwm sim tsis zoo ntawm cov ntshav tsis txaus, thiab ntxiv rau, muaj peev xwm tsim muaj teeb meem loj thiab xav tau kev kho mob tam sim ntawd. Nws yuav tsum tau hais tias, qhov zoo tshaj plaws, kev kho mob ntawm tus kab mob no yuav tsum pib sai li sai tau, zoo dua los ntawm thawj theem. Ua tsaug rau qhov no, cov neeg mob tswj xyuas kom tsis txhob muaj qhov pib ntawm ischemia tseem ceeb. Txawm li cas los xij, cov neeg mob feem ntau tig mus rau tus kws kho mob lub sijhawm tsis raug thiab ncua kev kho mob kom txog thaum tom qab lossis kho tus kheej. Raws li kev xyaum qhia, feem ntau, thawj zaug mus ntsib kws kho mob vascular twb tau ua tiav thaum qhov mob thiab kev nyuaj ntawm kev taug kev ua rau muaj kev txom nyem loj thiab tsis yooj yim.
Ua ntej txiav txim siab txog kev kho mob qis qis ischemia, cia peb tham txog cov tsos mob ntawm pathology.
Ischemia cov tsos mob
Nyob rau theem pib, cov neeg mob xyaum tsis hnov cov tsos mob ntawm tus kab mob. Cov no tsuas yog qhia tau hais tias tsis xis nyob lossis mob luv luv uas tshwm sim rau qhov tsis paub. Qee zaum cov neeg mob tau txias ob txhais ceg los yog tingling. Nyob rau hauv cov ntaub ntawv ntawm kev loj hlob ntawm ischemia tseem ceeb, uas yog ib tug harbinger ntawm gangrene, cov neeg mob muaj cov nram qab no tsis txaus siab:
- Qhov tshwm sim ntawm khausmob ntawm ob txhais ceg uas cuam tshuam nrog kev txav mus los, cov kev xav zoo li no kav ntev li ob lub lis piam thiab tsis tuaj yeem tshem tawm tom qab siv cov tshuaj tua kab mob.
- Cov neeg mob zoo li no zaum saum txaj thiab rub lawv txhais ceg mob tas li, uas txo qis rau hauv pem teb.
- Qhov tshwm sim ntawm qhov sib cuam tshuam claudication uas tshwm sim tom qab kov yeej tsib caug meters.
- Qhia txo ntshav siab.
- Kev muaj cov leeg tsis muaj zog thiab atrophy.
- Ntawm pallor thiab plaub hau poob.
- Nyob zoo txawm raug mob me.
- Qhov pom pom kev puas tsuaj nyob rau hauv daim ntawv ntawm trophic ulcers, thiab ntxiv rau, cov cim qhia ntawm gangrene.
Thaum qhov tseem ceeb ntawm ischemia ntawm qis extremities (ICD 10 - I70-I79) yog provoked los ntawm occlusion ntawm lub plab aorta, tus neeg mob yuav tsum muaj cov tsos mob ntawm cov ntshav tsis txaus nyob rau hauv lub plab hnyuv siab raum, uas tshwm sim nws tus kheej nyob rau hauv daim ntawv ntawm cov kab mob. Kev quav dej quav cawv, teeb meem tso zis, kev sib deev tsis zoo thiab raws plab.
Muaj Teeb Meem
Yog tias tsis kho, qhov tseem ceeb hauv qis qis ischemia tuaj yeem ua rau muaj teeb meem hauv qab no:
- Gangrene, uas yog, cov ntaub so ntswg necrosis.
- Qhov tshwm sim ntawm sepsis, uas tshwm sim vim tso tawm ntau cov co toxins mus rau hauv cov hlab ntsha.
- Tshuaj mob hnyav edema vim mob raum.
Txhua yam saum toj no tuaj yeem ua rau muaj kev poob siab, nrog rau kev tuag.
Tam sim ua ntej kev kho mob, yuav tsum tau kuaj mob. Cia peb kawm ntxiv seb txoj kev tshawb fawb twg siv rau tus kab mob no.
Diagnosis
txhawm rau txheeb xyuas qhov pathology no, tus kws kho mob tshuaj xyuas tus neeg mob thiab tshuaj xyuas nws cov lus tsis txaus siab. Thaum kuaj cov ceg, cov cim hauv qab no tau tshwm sim:
- Kev hloov ntawm daim tawv nqaij.
- Kev muaj kev cuam tshuam tseem ceeb nrog rau qhov tsis ua tiav ntawm ripple.
- Kev muaj kev sib cuam tshuam claudication.
Kev Tshawb Fawb
Txhawm rau paub meej qhov kev kuaj mob thiab tsim kom muaj qib ntawm cov ntaub so ntswg puas, cov kev tshawb fawb hauv qab no tau ua tiav:
- Doppler ultrasound, uas pom lub xeev ntawm phab ntsa vascular thiab cov ntshav ntws zoo.
- Sib nqus resonance thiab suav tomography tso cai rau tsim cov qib ntawm cov ntaub so ntswg puas nrog qhov raug zoo.
- Kev ua haujlwm ntawm electrothermometry thiab capillary oscillography tso cai rau kev soj ntsuam patency ntawm cov hlab ntsha.
- Arteriography thiab capillarography yog ua los txhawm rau txhawm rau taug qab cov kab mob.
- Kev kuaj ntshav tau ua tiav txhawm rau txheeb xyuas qhov ua rau ntawm atherosclerosis thiab ntsuas ntshav txhaws.
Tom ntej no, xav txog txoj hauv kev tseem ceeb ntawm kev kho mob ntawm qis qis qis ischemia.
Kev kho mob
Kev kho tus kab mob no yuav tsum tau ua hauv kev phais mob angiosurgery. Cov tactics ntawm kev kho yog nyob ntawm qhov hnyav ntawm vascular thiab cov nqaij mos puas. Nws raug xaiv raws li hnub nyoog thiabtus neeg mob txoj kev noj qab haus huv. Nyob rau theem kev npaj, tus neeg mob tau muab tshuaj kho mob thiab kev txwv tsis pub haus luam yeeb thiab haus cawv yog qhia. Tsis tas li ntawd, yuav tsum zam kev tawm dag zog.
Tasks
Lub hom phiaj ntawm kev kho rau cov kab mob vascular no yog tsom rau cov dej num hauv qab no:
- -tshem tawm ntawm excruciating thiab kev puas tsuaj mob.
- Ntau tus neeg mob ua haujlwm.
- Accelerating kho cov tawv nqaij puas.
- zoo dua lub neej.
- Kev tshem tawm lossis tshem tawm kom tiav ntawm qhov xav tau kev txiav tawm ntawm ceg.
Tshuaj
Tshuaj kho mob rau ischemia tseem ceeb yog txhawm rau tiv thaiv kev tsim cov ntshav txhaws. Rau qhov no, anticoagulants yog siv nyob rau hauv daim ntawv ntawm Aspirin, Clopidogrel thiab lwm yam. Kev xaiv cov tshuaj ncaj qha nyob ntawm qhov ntsuas ntawm tus neeg mob qhov kev sim thiab tsuas yog ua los ntawm kws kho mob xwb.
Cov tshuaj noj zoo tshaj plaws yog siv cov tshuaj prostacyclin analogues, xws li tshuaj Iloprost. Cov neeg ua haujlwm zoo li no tuaj yeem tiv thaiv kev tsim cov ntshav txhaws thiab tiv thaiv platelet aggregation, ntxiv rau cov nyhuv vasodilating. Tsis tas li ntawd, cov tshuaj kho mob uas tau txais thaum noj cov tshuaj prostacyclin hloov pauv ua rau kev txhim kho cov ntshav ncig thiab tshem tawm cov tshuaj tiv thaiv hauv zos. Mob mob thaum lub sij hawm kev loj hlob ntawm ischemia yog nres los ntawm cov tshuaj nonsteroidal. Raws li txoj cai, cov tshuaj hauv daim ntawv ntawm Dicloberl lossis Ketorolac yog siv rau qhov no. Lawv tau siv ob qho tib si hauv cov ntsiav tshuaj thiab hauv daim ntawv txhaj tshuaj.
Yog tias tsim nyog, piv txwv li, nrog cov roj (cholesterol) siab, kev kho tshuaj yog ntxiv nrog statins, uas txo cov ntshav txhaws. Qhov ntau npaum li cas ntawm cov tshuaj no yog xaiv los ntawm tus kws kho mob, tshuaj nyob rau hauv daim ntawv ntawm Rosuvostatin los yog Atorvastatin feem ntau siv. Tom qab ua tiav cov kev kho mob, statins raug sau tseg rau lub neej.
Ntxiv rau cov tshuaj uas cuam tshuam rau cov ntshav muaj pes tsawg leeg, txoj kev npaj kho tshuaj yuav suav nrog cov tshuaj vitamin thiab cov tshuaj tsim los ua kom cov ntshav ncig hauv lub cev, xws li Actovegin lossis Pentoxifylline.
Nyob rau hauv tus kab mob no, theem tseem ceeb ntawm kev kho yog revascularization ntawm cov hlab ntsha cuam tshuam. Cov txheej txheem ntawm txoj kev phais vascular no yog siv rau kev puas tsuaj rau cov hlab ntsha. Yog tias qhov kev cuam tshuam zoo li no twb tau ua ua ntej thiab tsis muaj txiaj ntsig, tom qab ntawd qhov kev ua haujlwm tsis ncaj qha rov ua kom rov zoo li qub tau raug sau tseg.
Cov txheej txheem phais mob qog noj ntshav
Cov txheej txheem phais revascular hauv qab no yog siv los kho cov ceg qis qis ischemia:
- Nqa tawm balloon angioplasty ua raws li vascular stenting.
- Kev tshem tawm ib nrab thiab tshem tawm cov hlab ntsha cuam tshuam nrog kev phais bypass.
- Kev txiav txim siab ntawm thaj chaw cuam tshuam ntawm cov hlab ntsha nrog cov pob qij txha.
- Kev tshem tawm cov ntshav txhaws ntawm cov hlab ntsha.
Cov haujlwm no tau ua nyob rau hauv cov chaw tshwj xeeb rau kev kho mob ntawm ischemia tseem ceeb ntawm cov leeg qis. Los ntawmThaum kawg ntawm kev ua haujlwm, cov neeg mob tau muab tshuaj kho mob txhawm rau tiv thaiv kev tsim cov ntshav txhaws, thiab atherosclerosis kuj tau kho, yog tias tsim nyog. Lub cev muaj zog hom nthuav dav zuj zus. Tam sim ntawd tom qab tso tawm, kev soj ntsuam tas li raug pom zoo, uas yog ua los ntawm tus kws phais mob vascular.
Kev mob nkeeg
Tsis muaj kev ua haujlwm raws sijhawm, twb tau ib xyoos tom qab thawj cov tsos mob ntawm ischemia tseem ceeb ntawm sab xis sab xis lossis sab laug, cov neeg mob feem ntau raug txiav tawm vim qhov pib ntawm gangrene. Raws li qhov xwm txheej ntawm kev kho mob endovascular los ntawm angioplasty, hauv cov neeg mob feem ntau, cov tshuaj kho tau tuaj yeem khaws cia rau nees nkaum plaub lub hlis, thiab tsuas yog tom qab ntawd, cov neeg mob yuav tsum tau txais kev cuam tshuam ntxiv ntxiv.
Kev kho mob ntawm qhov tseem ceeb ntawm ischemia los ntawm cov txheej txheem arterial bypass yog ntau lub sij hawm ntev thiab siv tau zoo, txawm tias muaj kev pheej hmoo siab ntawm kev mob tom qab phais thiab kev nyuaj ntawm kev ua haujlwm. Raws li kev xyaum qhia, patency ntawm cov hlab ntsha tiv thaiv keeb kwm yav dhau los ntawm qhov kev cuam tshuam no tuaj yeem tshwm sim rau peb lossis tsib xyoos, thiab qhov kev pheej hmoo ntawm kev rov tshwm sim ntawm ischemia tseem ceeb tsawg heev.
Tus kws kho mob twg kuv yuav tsum pom?
Nws yog ib qho tsim nyog yuav tsum tau thov rau qhov tseem ceeb ntawm ischemia ntawm qis qis mus rau cov chaw tshwj xeeb. Cov no muaj nyob hauv Moscow thiab St. Petersburg, nrog rau lwm lub nroog loj hauv lub tebchaws.
Thaum tshwm simmob hnyav thiab ntev nyob rau hauv ob txhais ceg, thiab nyob rau hauv tas li ntawd, tiv thaiv keeb kwm ntawm blackening ntawm ko taw thiab intermittent lameness, uas tshwm sim tom qab tsuas nees nkaum meters ntawm qhov kev ncua deb mus, nws yog tsim nyog los hu rau ib tug vascular kws phais. Txhawm rau kom paub meej qhov kev kuaj mob, tus kws kho mob yuav kuaj xyuas thiab kuaj lub cev, thiab tag nrho cov kev tshawb fawb tsim nyog yuav raug sau tseg, piv txwv li, hauv daim ntawv ntawm Doppler ultrasound, angiography, thiab lwm yam.
Cov Lus Qhia
Critical qis limb ischemia yog ib qho mob txaus ntshai heev ntawm lub txaj vascular. Nrog rau cov kab mob zoo li no, cov neeg mob yuav tsum tau muab kev kho mob tam sim ntawd, vim tias tsis muaj kev phais thiab kev kho mob tsim nyog, kev pheej hmoo ntawm kev tsim muaj kev phom sij rau lub neej thiab kev noj qab haus huv muaj teeb meem loj, feem ntau lawv yuav tsum tsis txhob muaj.
Tshwj xeeb, qhov tseem ceeb ntawm ischemia feem ntau ua rau gangrene thiab xav tau kev txiav caj dab. Txhua tus neeg mob uas muaj cov kab mob no yuav tsum paub txog cov kev pheej hmoo siab ntawm kev mob plawv thiab mob stroke, thiab ntxiv rau, xav tau kev kuaj mob, uas yuav tsum tau tsom rau kev kuaj cov hlab ntsha.
