mob hlab ntsha tsis txaus yog ib qho mob ceev uas yuav tsum tau siv, feem ntau, kev kho phais tam sim. Hauv cov xwm txheej tsis tshua muaj, kev kho kom zoo yog nyiam. Arterial insufficiency ntawm cov leeg nyob rau hauv qis extremities tuaj yeem tshwm sim los ntawm ntau yam laj thawj, tab sis nyob rau hauv txhua rooj plaub nws yog nrog los ntawm ib tug mob ischemic syndrome uas hem tus neeg mob lub neej.
Basic concepts
Kev kuaj mob ntawm cov hlab ntsha tsis txaus qhia txog cov ntsiab lus tseem ceeb hauv qab no:
- Spasm. Nws yog ib qho mob uas muaj compression ntawm arterial lumen nyob rau hauv kev cuam tshuam ntawm sab nraud los yog sab hauv yam. Cov mob no yog cov yam ntxwv ntawm cov leeg nqaij leeg thiab cov hlab ntsha sib xyaw.type.
- mob thrombosis. Nws yog ib qho mob uas tshwm sim los ntawm kev tsim cov thrombus tiv thaiv keeb kwm yav dhau ntawm kev hloov pauv hauv cov phab ntsa vascular. Lub thrombus tuaj yeem kaw lub vascular lumen.
- Embolism. Nws yog ib qho mob uas tshwm sim los ntawm occlusion ntawm arterial lumen los ntawm ib tug thrombotic fragment nqa los ntawm cov hlab ntsha. Nyob rau hauv cov ntaub ntawv no, nws yog kev cai hu rau lub thrombus ib embolus.
Yog vim li cas rau kev txhim kho OAN
Qhov tseem ceeb ntawm qhov tshwm sim ntawm embolism feem ntau yog qhov muaj mob plawv. Nws tuaj yeem yog myocardial infarction, cardiopathy, kab mob rheumatic. Txawm hais tias hom cardiopathology, plawv arrhythmias ua lub luag haujlwm tseem ceeb hauv kev txhim kho embolism.
Qhov laj thawj tseem ceeb ntawm thrombosis, sib piv rau embolism, yog kev hloov pauv atherosclerotic hauv cov phab ntsa vascular. Spasm tuaj yeem tsim nyob rau hauv kev cuam tshuam ntawm lwm yam xws li hypothermia, poob siab, raug mob. Muaj tsawg zaus, spasms tsim tawm tsam keeb kwm yav dhau los ntawm cov txheej txheem inflammatory uas cuam tshuam rau cov ntaub so ntswg ncig ntawm cov hlab ntsha.
Kev kuaj mob OAN ntawm ceg ceg
Nyob rau hauv mob hlab ntsha tsis txaus, cov tsos mob xws li:
- Tsawg kub hauv qhov cuam tshuam limb.
- Tsis muaj arterial pulsation hauv qab qhov txhab. Feem ntau, cov tsos mob no yog qhov tseem ceeb hauv kev txiav txim siab muaj OAN.
- Hloov cov xim ntawm daim tawv nqaij ntawm cov ceg tawv. Nws tuaj yeem nthuav tawm raws li me ntsis pallor, thiab pronouncedcyanosis.
- Kev ua txhaum ntawm kev nkag siab ntawm kev xav. Cov neeg mob feem ntau qhia tias lawv xav tias "goosebumps", zoo li lawv tau pab lawv txhais ceg. Yog tias qhov xwm txheej hnyav dua, tus neeg mob yuav tsis hnov nqhis dej li.
- Npaj pob txha. Cov tsos mob no feem ntau yog thawj tus neeg mob ceeb toom ntawm lawv tus kheej. Cov tsos mob ntawm mob hlab ntsha tsis txaus yuav tsum tsis txhob ignored.
Thaum kuaj mob thiab xam phaj cov neeg mob, nws yog ib qho tseem ceeb uas yuav tsum tau tsom rau lub sijhawm thaum cov tsos mob tshwm sim, nrog rau qhov xwm txheej ntawm lawv qhov kev kawm. Cov keeb kwm sau tseg kom raug tso cai rau koj los tsim kev kuaj mob thiab sau ntawv kho kom zoo ntawm ceg tawv ischemia.
Embolism yog tus yam ntxwv los ntawm qhov pib tshwm sim sai thiab kev kho mob sai sai ntawm cov hlab ntsha tsis txaus. Thrombosis hauv nws txoj kev loj hlob muaj cov tsos mob tsawg dua.
Kev xaiv tsa yuav qhia dab tsi?
Nug tus neeg mob thaum kuaj pom kab mob tuaj yeem qhia tau tias yav dhau los nws tau sau tseg sai sai ntawm ob txhais ceg, mob hauv pob txha taub hau, loog ntawm ob txhais ceg. Cov tsos mob zoo li no yog tus yam ntxwv ntawm tus mob AN thiab tej zaum yuav qhia tau tias qhov mob atherosclerotic ntawm cov hlab ntsha.
Instrumental diagnostics
Kev kuaj mob ntawm cov hlab ntsha tsis txaus suav nrog tsis yog kev kuaj keeb kwm thiab kev kuaj lub cev nkaus xwb, tab sis kuj muaj kev kuaj mob. Txoj kev kuaj mob tseem ceeb hauv qhov no yog Doppler ultrasound. Nrog nws cov kev pab, nws ua tau los ua ib qho kev sib txawvKev kuaj mob ntawm qhov ua rau provoked OAN, kev qhia meej ntawm qhov chaw hauv cheeb tsam ntawm kev puas tsuaj, kev ntsuam xyuas qhov xwm txheej ntawm kev puas tsuaj rau cov phab ntsa ntawm cov hlab ntsha, kev txiav txim siab ntawm kev kho mob ntxiv.
Angiography
Txoj kev kuaj mob zoo sib npaug tom ntej yog angiography. Qhov txawv ntawm txoj kev no yog nyob rau hauv nws invasiveness, xav tau kev siv ntawm radiopaque tshuaj, thiab tshwj xeeb npaj rau tus neeg mob. Qhov no yog vim qhov tseeb tias Dopplerography hauv kev kuaj mob ntawm OAN yog txoj kev nyiam.
Kev faib tawm ntawm cov hlab ntsha tsis txaus
Tom qab kev kuaj mob tau ua tiav thiab qhov kev kuaj mob tau raug tsim kom raug, nws yuav tsum tau txiav txim siab qhov kev puas tsuaj ntawm ischemic. Tam sim no, nws raug lees txais los siv cov kev faib tawm uas tau tsim los ntawm Savelyev V. S.
Ib qho kev qhia meej meej ntawm tus kab mob tso cai rau koj los txiav txim siab cov tswv yim ntawm kev phais mob rau kev kho mob ntawm OAN ntawm qis qis. Tsis tas li ntawd, kev paub txog qib ntawm cov ntshav ntws cuam tshuam tso cai rau tus kws kho mob kom tau txais lub tswv yim ntawm seb qhov kev ua haujlwm ceev lossis tsis yog, txawm tias qhov kev npaj ua ntej ntxiv yog tsim nyog.
theem ntawm ischemia
Yog li, mob ischemia tuaj yeem yog peb theem:
- 1 theem yog qhov tshwm sim ntawm qhov tshwm sim ntawm qhov mob ntawm caj dab, txias, qhov kev xav ntawm paresthesia.
- 2 ib theem yog tus cwj pwm los ntawm kev ua haujlwm tsis zoo.
- 2b theem - tsis muaj kev txav txav txhua.
- 2 hauv theem - pomsubfascial o ntawm extremities.
- 3a theem - ib feem ntawm cov leeg nqaij contracture tau sau tseg.
- 3b theem yog tus yam ntxwv los ntawm cov leeg nqaij ua tiav.
Ntau zaus mob hlab ntsha tsis txaus ua rau mob ntev.
Yog tus neeg mob muaj ischemia nyob rau theem 1 lossis 2a, tus kws kho mob muaj sijhawm ncua kev phais li ib hnub. Lub sijhawm no, kev kuaj xyuas ntxiv lossis kev npaj ntxiv rau kev ua haujlwm tuaj yeem ua tiav. Yog tias ischemia nyob rau theem hnyav dua, kev phais yuav tsum tau ua tam sim ntawd. Theem 2b tso cai rau koj ncua nws tsuas yog 2 teev xwb.
Txhim kho cov ntshav ntws tawm
Nws yuav tsum tau nco ntsoov tias txoj hauv kev tseem ceeb ntawm kev kho cov hlab ntsha tsis txaus, yog tias muaj embolism lossis mob thrombosis tshwm sim, yog los kho cov ntshav hlab ntsha los ntawm kev phais.
Kev txiav txim siab txog txoj kev tshuaj loog, cov tswv yim ntawm kev cuam tshuam thiab nws qhov ntim yuav tsum tau txiav txim siab los ntawm tus kws phais neeg ib leeg hauv kev kho mob ntawm txhua tus neeg mob. Kev phais tuaj yeem qhib: hla kev phais, thrombectomy nrog kev nkag mus, emblectomy.
X-ray endovascular txoj kev kho mob kuj siv tau yog tias lub tsev kho mob muaj cov cuab yeej tsim nyog.
Kev Tiv Thaiv Kev Tiv Thaiv
Nws tsim nyog hais ob peb lo lus txog nws. Conservative kev kho mob ntawm mob arterial insufficiencycaj dab raug tso cai yog tias muaj tshuaj antispasmodic, antiplatelet, anticoagulant kho tau pib raws sijhawm, thiab tus neeg mob muaj cov ntshav txaus txaus.
Nyob rau hauv cov xwm txheej zoo li no, nws tuaj yeem ua rau yaj lub thrombus (lysis) lossis them nyiaj rau cov ntshav uas ploj lawm nrog kev pab ntawm cov khoom lag luam. Qhov tsim nyog ntawm kev kho mob yuav tsum tau txiav txim los ntawm tus kws phais.
Kev kho cov ntshav rov ua tau yog tias tus neeg mob muaj ischemia nyob rau theem 1-2c. Yog tias kuaj pom daim ntawv hnyav dua, tsuas yog daim ntawv kho mob nkaus xwb yog ua tiav kev txiav tawm ntawm ceg.
Technically, muaj peev xwm rov kho cov vascular patency. Txawm li cas los xij, cov khoom lag luam lwj uas tshwm sim los ntawm limb ischemia, nkag mus rau hauv lub cev, tuaj yeem ua rau muaj teeb meem ntau yam, piv txwv li, kev loj hlob ntawm lub raum tsis ua haujlwm. Qhov tshwm sim ntawm cov teeb meem zoo li no yog qhov txaus ntshai tshaj li kev txiav caj dab. Hauv qhov no, qhov muaj feem ntawm qhov tshwm sim tuag tau nce ntxiv.
Cov Lus Qhia
Mob ntshav qab zib tsis txaus tsis yog qhov tshwm sim ntau dhau, piv nrog myocardial infarction lossis stroke.
Txawm li cas los xij, kev paub txog cov tsos mob thiab cov nuances ntawm kev kho mob rau qhov sib txawv yog qhov tseem ceeb, rau tus neeg mob nws tus kheej thiab rau tus neeg ua haujlwm kho mob ntawm ib qho profile. Tom qab tag nrho, lub cev ua si ntawm txhua tus neeg ncaj qha nyob ntawm kev noj qab haus huv ntawm cov pob qij txha, cov hlab ntsha, ob txhais ceg.
Yog tus neeg mob muajnrog cov ntaub ntawv tseem ceeb, nws yuav muaj peev xwm them sai sai rau kev noj qab haus huv ntawm ob txhais ceg ntawm thawj qhov tshwm sim. Nyob rau hauv tas li ntawd, nws yog ib qho tseem ceeb kom tsis txhob ncua mus ntsib kws kho mob thiab tam sim ntawd sab laj nrog nws.
Kev kuaj mob raws sij hawm ntawm cov hlab ntsha tsis txaus ntawm qhov qis qis, kev txiav txim siab ntawm theem ntawm tus kab mob los ntawm Doppler ultrasound yuav txiav txim siab cov kev kho mob uas tsim nyog tshaj plaws thiab ua tiav cov txiaj ntsig siab tshaj plaws, thaum tswj tus neeg mob tsis yog tsuas yog noj qab haus huv, tab sis kuj lub cev. kev ua si puv.
Yog li ntawd, thaum cov tsos mob tshwm sim nyob rau hauv daim ntawv ntawm qhov mob ntawm ob txhais ceg, hnyav, loog, nws yog ib qho tseem ceeb heev uas yuav tsum tau hu mus rau lub chaw kho mob tam sim ntawd.
