Nrog rau kev tsis sib haum xeeb ntawm calcium-phosphorus metabolism uas nrog rau nruab nrab lossis hnyav rickets, 4% ntawm cov menyuam yaus tsim spasmophilia, uas tseem hu ua infantile tetany. Qhov no pathology yog nrog los ntawm ib tug spastic lub xeev ntawm cov nqaij ntshiv ntawm caj npab, lub ntsej muag, lub caj pas, raws li zoo raws li tshwm sim ntawm ib tug general clonic thiab tonic convulsions. Nws raug kuaj pom, raws li txoj cai, nruab nrab ntawm lub hnub nyoog ntawm peb lub hlis thiab txog li ob xyoos. Ib qho ntawm qhov pom tseeb tshaj plaws ntawm kev tsim kab mob yog cov tsos mob ntawm Khvostek, Trousseau thiab Lust, uas pab txiav txim siab qhov mob hnyav. Cov tsos mob no tau txiav txim siab li cas thiab yuav kho li cas yuav tau tham tom qab hauv kab lus.
kuaj mob spasmophilic li cas
Kev kuaj pom muaj tus tsos mob Chvostek, tseem hu ua qhov tshwm sim ntawm lub ntsej muag paj hlwb, tus menyuam tau pw saum txaj tsis muaj lub hauv ncoo. Tib lub sijhawm, ob txhais ceg yuav tsum ncaj, thiab txhais caj npab yuav tsum pw raws lub cev.
Cov tsos mob yog kuaj los ntawm lub teeb tapping nrog rauj percussion lossis ntiv tes ntawm qhov tawm ntawm cov hlab ntsha trigeminal (saum toj nozygomatic arch). Yog tias tus neeg mob tau ntsib qhov tsis tuaj yeem cuam tshuam ntawm daim tawv muag thiab lub ces kaum ntawm daim di ncauj sab sauv, ces cov tsos mob hais txog qhov zoo. Los ntawm txoj kev, nws raug kuaj xyuas ntawm ob lub puab tsaig.
Chvostek cov tsos mob muaj 3 qib kev tshwm sim:
- Cov nqaij leeg thoob plaws thaj tsam ntawm innervation ntawm lub ntsej muag paj hlwb.
- Muscle contraction ntawm lub ces kaum ntawm lub qhov ncauj thiab ntawm lub tis ntawm lub qhov ntswg.
- Muscle contraction tsuas yog hauv kaum lub qhov ncauj xwb.
Nyob rau hauv lub xub ntiag ntawm pom tseeb tetany, tus me nyuam manifests thawj theem ntawm cov tsos mob txawm los ntawm ib tug lub teeb kov nyob rau hauv lub ntsej muag paj hlwb.
Txoj hauv kev ntxiv los kuaj xyuas cov tsos mob spasmolytic
Tsis muaj qhov qhia tsawg dua ntawm kev txiav txim siab qhov hnyav ntawm tus menyuam tus mob yog cov tsos mob ntawm Trousseau thiab Lust.
- Trousseau cov tsos mob tau kuaj pom los ntawm kev sib zog ntawm nruab nrab ntawm tus menyuam lub xub pwg. Nyob rau hauv cov ntaub ntawv no, tus kws kho mob yuav tsum tau sim mus ntes cov ntaub so ntswg ntawm nws txhais tes kom ntau li ntau tau. Yog hais tias, raws li qhov tshwm sim ntawm qhov no (kwv yees li 2-3 feeb tom qab nyem), tus neeg mob tus ntiv tes siv txoj haujlwm yuam kev, hu ua "obstetrician's hands" (uas yog, tus ntiv tes xoo yog coj mus rau xib teg, qhov taw qhia thiab ntiv tes nruab nrab yog unbent., thiab lub nplhaib thiab cov ntiv tes me me yog khoov), ces cov tsos mob pom zoo. Txhawm rau kuaj nws hauv cov menyuam yaus lossis cov neeg laus, koj tuaj yeem siv lub ntsuas ntshav siab los ntawm kev ua kom nws mus txog thaum lub plawv nres.
- Kev xav lub cim yog sim nrog ib qho khoom siv tapping tom qab lub taub hau ntawm lub fibula, los yog los ntawm kev tuav cov leeg nqaij nyuj ntawm Achilles leeg. YogTus neeg mob tau pom tias tsis muaj kev cuam tshuam ntawm ko taw ("ballerina's ceg"), tom qab ntawd cov tsos mob tuaj yeem suav tias yog qhov zoo. Nws tau raug sim ntawm ob ceg ceg.
Cov tsos mob ntawm Khvostek, Trousseau, Kev ntshaw yog suav tias yog spasmophilic. Lawv ua tau zoo yog tias muaj kev hloov pauv ntawm cov calcium hauv cov ntshav ntawm tus menyuam mob, uas yog lub luag haujlwm rau cov leeg nqaij. Qhov no tuaj yeem ua rau tsis yog tsuas yog muaj rickets xwb, tab sis kuj mus rau lwm yam kab mob.
tetany yog dab tsi
Chvostek thiab Trousseau cov tsos mob yog cov cim qhia ntawm spasmophilia (tetany). Tus kab mob no yog tus cwj pwm los ntawm kev nce siab hauv lub paj hlwb, tshwm sim los ntawm cramps nyob rau hauv cov nqaij ntshiv ntawm caj npab los yog lub larynx. Feem ntau, cov kab mob no tau pom hauv cov tub hluas hauv thawj rau lub hlis ntawm lub neej.
Thiab lub hauv paus ntawm tus kab mob no yog qib qis ntawm calcium ionized hauv cov ntshav ntawm tus menyuam.
Cov tsos mob txaus ntshai ntawm Chvostek hauv menyuam yaus yog dab tsi
Cov duab ntawm cov menyuam yaus tetany tso cai rau peb nkag siab tias tus kab mob no yog dab tsi. Qhov tseem ceeb tshaj plaws yog laryngospasm, uas yog qhia los ntawm kev ua pa nyuaj, pallor ntawm lub ntsej muag, tawm hws, thiab qee zaum tsis nco qab. Convulsions ib ntus ntawm ko taw thiab tes (carpopedal spasm) kuj yog yam ntxwv, qee zaum kav ntev li ob peb teev. Spasms ntawm lwm cov leeg nqaij kuj ua tau - ua pa, zom, qhov muag, thiab lwm yam.
Tab sis cov tsos mob hnyav tshaj plaws ntawm tus kab mob yog kev tawm tsam ntawm eclampsia - clonic-tonic convulsions, pib nrog twitching ntawm cov nqaij ntshiv ntawm lub ntsej muag thiab tig mus rau hauv convulsions ntawm nqua thiab laryngospasm. Nyob rau hauv cov ntaub ntawv no, tus me nyuam feem ntau tsis nco qab, ua npuas ncauj tshwm nyob rau hauv daim di ncauj, involuntary tso zis yog pom. Eclampsia yog qhov txaus ntshai vim muaj peev xwm ua pa lossis mob plawv.
Leej twg thiaj tau tetany
Nyob rau hauv thawj hnub ntawm lub neej, convulsive tej yam kev mob thiab hypocalcemia feem ntau tshwm sim nyob rau hauv cov me nyuam yug ntxov ntxov, nyob rau hauv cov menyuam ntxaib, nrog rau cov neeg uas muaj jaundice los yog kis kab mob.
Chvostek cov tsos mob hauv cov menyuam yaus ntawm thawj lub hlis ntawm lub neej tuaj yeem tshwm sim los ntawm ob qho tib si kev txo qis ntawm calcium hauv tus menyuam lub cev thiab nce qhov tso tawm ntawm calcitonin. Cov kws kho mob kuj koom nrog qhov xwm txheej no nrog kev ua txhaum ntawm kev muab phosphorus thiab calcium thaum tus me nyuam hloov mus rau kev pub mis nyuj, thiab (tsis tshua muaj) nrog tsis muaj vitamin D thiab calcium hauv leej niam lub cev.
Feem ntau, cov me nyuam mos uas muaj hypocalcemia tshwm sim nrog neuromuscular irritability, qaug dab peg, ntuav, tachycardia, thiab cov tsos mob ua pa.
Tetany treatment
Eclampsia tawm tsam yuav tsum tau saib xyuas sai rau tus menyuam, thiab thaum ua pa lossis mob plawv, rov ua kom rov zoo.
Yog tias muaj kev tshwm sim ntawm tetany, cov tshuaj tiv thaiv kab mob tau muab rau tus menyuam ("Sibazon" intramuscularly lossis intravenously, "Sodium oxybarbutyrate" intramuscularly, "Phenobarbital" rectally hauv suppositories lossis hauv qhov ncauj, thiab lwm yam). Intravenous tswj ntawm 10% calcium gluconate tov los yog intramuscular 25% magnesium sulfate tov kuj qhia.
Spasmophilia ua rau Chvostek thiab Trousseau cov tsos mob feem ntau muajKev pom zoo nyob rau hauv feem ntau. Qhov phom sij tsuas yog ntev laryngospasm, hem kom tsis txhob ua pa.
Thaum tus menyuam muaj hnub nyoog 2-3 xyoos, cov kab mob pathological raug tshem tawm vim kev ruaj khov ntawm cov calcium thiab phosphorus hauv cov ntshav.
Hypoparathyroidism yog ib yam kab mob uas nrog rau cov tsos mob ntawm Chvostek
Chvostek cov tsos mob kuj yog ib qho kev qhia meej ntawm cov kab mob hu ua hypoparathyroidism, uas muaj qhov txo qis hauv kev ua haujlwm ntawm cov qog parathyroid. Feem ntau, qhov teeb meem no tshwm sim los ntawm kev ua haujlwm rau cov thyroid kab mob lossis yog tias muaj cov txheej txheem inflammatory hauv nws. Thiab qee zaum kev ua haujlwm tsis zoo kuj tuaj yeem tshwm sim los ntawm cov txheej txheem sib kis, xws li qhua pias lossis mob khaub thuas.
Nyob rau hauv cov me nyuam mos, hypoparathyroidism tshwm sim nyob rau hauv cov ntaub ntawv ntawm congenital tsis muaj lub parathyroid glands los yog thaum lawv ua hauj lwm yog suppressed los ntawm ntau secretion ntawm parathyroid hormone nyob rau hauv niam lub cev thaum cev xeeb tub.
Nyob rau hauv cov ntaub ntawv no, raws li txoj cai, ib tug txo nyob rau hauv calcium cov ntsiab lus nyob rau hauv cov ntshav yog pom nyob rau hauv tus neeg mob nyob rau hauv parallel nrog ib tug nce nyob rau hauv lub concentration ntawm phosphorus. Thiab outwardly, qhov no yog manifested los ntawm lub twb piav tetany, plab hnyuv tshwm sim, anomalies nyob rau hauv txoj kev loj hlob ntawm cov hniav, rau tes thiab plaub hau, raws li zoo raws li daim tawv nqaij hloov.
Nyob rau hauv cov xwm txheej zoo li no, cov tsos mob ntawm Chvostek thiab Trousseau, nrog rau kev kuaj sim, pab txheeb xyuas tus mob tetanic tsim thiab kuaj tus neeg mob.
Kev kho mobhypoparathyroidism
Rau kev kho tus kab mob no, nws yog ib qho tseem ceeb uas yuav tau xav txog qhov ua rau nws tshwm sim, nrog rau qhov hnyav ntawm cov tsos mob. Nyob rau hauv cov kev mob hnyav ntawm tus kab mob nrog cov tsos mob ntawm tetany, kev ceev ceev ntawm 10% calcium chloride los yog calcium gluconate intravenously tau pom zoo. Qhov no ua tiav maj mam, suav nrog qhov tseeb tias thawj qhov kev daws teeb meem muaj 27% ntawm cov khoom ntawm tib lub npe, thiab qhov thib ob tsuas muaj 9%.
Feem ntau, txhawm rau txhawm rau tshem tawm cov tsos mob ntawm Chvostek, kev kho mob nrog calcium ntxiv rau yam tsawg 10 hnub yog xav tau. Kev noj cov calcium hauv qhov ncauj muaj txiaj ntsig zoo, thiab cov kws kho mob qhia kom ua qhov no los ntawm kev ua kom cov tshuaj yaj hauv cov mis nyuj kom tsis txhob muaj kab mob gastritis.
Lub xeev ntawm hypoparathyroidism mob ntev yuav tsum tau noj cov vitamin D, pib nrog kev thauj khoom (200-300 txhiab units ib hnub), nrog rau kev tswj hwm cov ntsiab lus ntawm phosphorus thiab calcium hauv cov ntshav, thiab tom qab normalizing. lawv qib, cov koob tshuaj yog txo kom 50 txhiab. units ib hnub hauv cov menyuam yaus txog ib xyoos lossis txog li 125 txhiab units. - hauv cov neeg mob tom qab ib xyoos.
Lwm yam kab mob dab tsi ua rau cov tsos mob ntawm Trousseau thiab Chvostek
Ntxiv rau cov kab mob tshwm sim los ntawm kev txo qis ntawm calcium hauv cov ntshav ntshav rau ib qho laj thawj, cov tsos mob ntawm Chvostek, Trousseau thiab Lust kuj tuaj yeem pom hauv lwm yam kab mob. Cov no suav nrog:
- Neurasthenia nrog lub xeev ntxhov siab thiab tsis txaus ntseeg, tshwm sim raws li tus mob hyperventilation. Tus neeg mob nyob rau tib lub sijhawm muaj kev ua txhaum ntawm lub sijhawm ua pa, simulating suffocation, nrog kev xav ntawm coma hauv caj pas, tsis muaj cua, thiab qee zaum tsis nco qab thiab convulsions.
- DiscirculatoryCov txheej txheem ua ke nrog asthenic lossis astheno-neurotic syndrome, tus cwj pwm los ntawm lub xeev ntawm kev qaug zog tas li thiab ntxhov siab, nrog rau mob taub hau, pw tsaug zog thiab kiv taub hau.
- Hysteria, qaug dab peg thiab lwm yam kab mob.
Tiv thaiv cov calcium uas txawv txav hauv tus menyuam
Raws li koj tau pom lawm, nyob rau hauv cov kab mob uas nrog cov tsos mob Chvostek, hauv cov menyuam yaus, kev kho mob los mus rau qhov tseem ceeb ntawm kev rov qab los ntawm cov calcium thiab phosphorus hauv cov ntshav. Yog li ntawd, kev tiv thaiv ntawm cov pathologies kuj yuav tsum tau, ua ntej ntawm tag nrho cov, kev tswj ntawm concentration ntawm cov tshuaj hais, uas yog nqa tawm los ntawm koog tsev kawm ntawv cov kws kho mob.
Nws yog ib qho tseem ceeb los tsim cov kev mob zoo rau kev loj hlob ntawm fetus hauv tus poj niam cev xeeb tub. Txhawm rau ua qhov no, yog tias tus niam expectant nyob hauv kev tsis txaus siab ntawm kev noj qab haus huv thiab kev noj qab haus huv los yog koom nrog pab pawg muaj kev pheej hmoo (mob ntshav qab zib mellitus, nephropathy, kub siab thiab mob rheumatism), nws raug tshuaj vitamin D hauv 2 lub hlis dhau los ntawm cev xeeb tub.
Thiab rau tus menyuam mos kom loj hlob muaj zog thiab noj qab haus huv, nws yog ib qho tseem ceeb kom pub niam mis, qhia cov khoom noj kom raws sijhawm, raug huab cua tshiab txhua hnub, pub dawb swaddling, massage, gymnastics thiab da dej.
