Cia peb xav txog dab tsi yog plab hnyuv peritonitis. Lub plab kab noj hniav muaj cov kabmob tseem ceeb, uas cov hnyuv ua haujlwm tshwj xeeb. Lub puab txheej ntawm lub plab kab noj hniav tsim ib tug tsis muaj menyuam kaw system uas yuav ua rau tsis zoo rau cov kab mob, neutralizing lawv. Nyob rau hauv cov ntaub ntawv ntawm kev ua txhaum ntawm txoj kev ncaj ncees ntawm txoj hnyuv los yog lub sterility ntawm lub peritoneum, cov kev haum xeeb yog tsim rau txoj kev loj hlob ntawm inflammatory txheej txheem.
Qhov no yog ib qho kev nthuav tawm lossis cov txheej txheem hauv zos ntawm o ntawm cov serous cover ntawm peritoneum (mob plab kab noj hniav). Cov tsos mob ntawm plab hnyuv peritonitis yog mob plab, cov leeg nro ntawm phab ntsa plab, xeev siab thiab ntuav, hyperthermia, roj thiab cov quav khaws cia, thiab mob hnyav. Kev kuaj mob ntawm pathology yog nyob ntawm cov ntaub ntawv los ntawm anamnesis, kev txiav txim siab ntawm cov tsos mob zoo peritoneal, X-ray cov ntaub ntawv, ultrasound, kev kuaj lub qhov quav thiab qhov chaw mos, thiab kuaj kuaj. Kev kho mob purulent plab hnyuv peritonitis feem ntau yog kev phais (laparotomy, kev huv ntawm lub plab kab noj hniav) nrog rau kev ua ntej thiab tom qab kev ua haujlwm detoxification thiab tshuaj tua kab mob.
Peritonitis yog ib qho teeb meem loj ntawm cov kab mob inflammatory thiab puas tsuaj nyob rau hauv lub plab kab noj hniav, uas yog nrog los ntawm cov tsos mob hnyav thiab hauv zos, tshwm sim ntawm ntau yam kab mob tsis ua hauj lwm. Tag nrho cov neeg tuag los ntawm gastroenterological peritonitis yog kwv yees li 20-30%, thiab nyob rau hauv cov ntaub ntawv hnyav dua - 40-50%. Cia wb mus saib seb lub plab hnyuv peritonitis yog dab tsi.
Ntse ntawm pathology
Cov yam ntxwv tshwj xeeb ntawm cov txheej txheem pathological no yog vim cov qauv ntawm lub plab kab noj hniav. Lub peritoneum yog tsim los ntawm ob daim ntawv serous, dhau mus rau ib leeg - parietal thiab visceral. Lawv npog cov phab ntsa ntawm lub plab kab noj hniav thiab cov kabmob sab hauv. Lub peritoneum yog semipermeable, nquag ua haujlwm membrane uas ua tau ntau yam tseem ceeb:
- thaiv (antimicrobial thiab mechanical tiv thaiv ntawm lub cev sab hauv);
- resorptive (absorption ntawm lysis khoom, exudate, necrotic ntaub so ntswg, kab mob);
- exudative (cov txheej txheem ntawm kev tso tawm ntawm cov kua roj ntsha), thiab lwm yam.
Ib qho khoom tiv thaiv tseem ceeb ntawm peritoneum yog nws lub peev xwm los txo cov txheej txheem inflammatory hauv peritoneum vim fibrous adhesions thiab nti, nrog rau cov cellular thiab humoral mechanisms. Hauv cov kab mob hauv plab, cov kab mob no txhim khopathogenic microflora uas dhau mus dhau nws cov phab ntsa thiab provokes kab mob ntawm peritoneum.
Aseptic type peritonitis yog provoked los ntawm cov nqaij mos khaus los ntawm cov khoom hnyav ntawm lub cev nws tus kheej - tso zis, ntshav, kua tsib, plab lossis kua txiv pancreatic. Nws kis tau tus kab mob sai sai, txij li tom qab ob peb teev cov ntaub so ntswg peritoneal raug rau cov kab mob pathogenic. Ib qho kev hloov pauv ntawm aseptic plab hnyuv peritonitis yog barium peritonitis, uas tshwm sim vim kev tso tawm barium los ntawm txoj hnyuv.
Qhov no tuaj yeem ua tau thaum ua x-ray kev tshawb fawb siv tus neeg sawv cev sib txawv, uas muaj barium. Hom kab mob no tsis tshua muaj, tab sis txhua tus neeg mob thib ob tuag los ntawm nws. Kuj tseem paub tias yog serous peritonitis ntawm txoj hnyuv, uas tshwm sim vim muaj cov kua dej serous.
Vim txoj kev loj hlob
Yuav kom nkag siab tias plab hnyuv peritonitis yog dab tsi, cia peb kawm seb nws ua li cas. Ntawm cov mob feem ntau ntawm txoj kev loj hlob ntawm tus kab mob, tus neeg sawv cev ntawm cov txheej txheem pathological yog kab mob kab mob, uas muaj cov kab mob tsis zoo ntawm lub plab zom mov: Enterobacter, Escherichia coli, Streptococcus, Staphylococcus, thiab lwm yam. Qee zaum, qhov no pathology. tuaj yeem tshwm sim los ntawm ib qho microflora tshwj xeeb: gonococci, Mycobacterium tuberculosis, thiab lwm yam.
Yog tias peritonitis ntawm txoj hnyuv me los yog txoj hnyuv loj pib muaj kab mob ntawm keeb kwm, piv txwv li, tshuaj lom neeg, cesTom qab ib lub sij hawm luv luv, nws kis tau tus kab mob microbial vim qhov txuas ntawm cov kab mob sib kis los ntawm lub lumen ntawm lub plab zom mov.
Feem ntau ua rau mob plab hnyuv peritonitis yog cov kab mob puas thiab mob:
- colon diverticulitis;
- Meckel's diverticulum;
- mob plab hnyuv mob plab;
- Yperforated duodenal ulcers;
- tawg ntawm txoj hnyuv tom qab kev phais lossis raug mob;
- plab hnyuv.
Cov plab hnyuv peritonitis qee zaum tuaj yeem tshwm sim tom qab kev phais plab vim yog anastomotic to, mechanical puas rau peritoneum, ligation defects, thiab lwm yam.
txhawm rau ntsuas tus neeg mob kom raug mus rau hauv tsev kho mob uas xav tias muaj kab mob, tus kws kho mob yuav tsum paub nws tus kheej nrog cov tsos mob thiab txiav txim siab theem ntawm pathology. Qhov ua rau mob plab hnyuv peritonitis kuj yuav tsum tau qhia meej.
theem kab mob
Tus kab mob yuav luag txhua zaus mus sai, hauv daim ntawv mob. Qhov no pathology yog tus cwj pwm los ntawm kev loj hlob sai thiab ceev ceev, ib qho mob hnyav heev ntawm tus neeg mob thiab tuag thaum tsis muaj kev phais zoo. Daim ntawv mob ntev ntawm tus kab mob no tau kuaj pom muaj tsawg heev.
Cov tsos mob ntawm plab hnyuv peritonitis txawv nyob ntawm theem ntawm chav kawm. Hauv tshuaj, 3 theem ntawm kev loj hlob ntawm tus kab mob yog qhov txawv:
- Reactive theem, uas tuaj yeem kav ntev txog 1 hnub.
- Tshuaj lom mus txog li 2-3 hnub.
- Tsev ntu ntu, uas tshwm sim 4-5 hnub tom qab pib cov tsos mob thawj zaug.
Yuav kom nkag siab tag nrho cov kev hloov pauv ntawm txoj kev loj hlob ntawm pathology, cov ncauj lus kom ntxaws yog xav tau ntawm txhua qhov nws tshwm sim, txij li thawj hnub.
Cov tsos mob ntawm plab hnyuv peritonitis
Thaum lub sijhawm rov ua haujlwm, cov tsos mob hauv qab no tshwm sim:
- mob hnyav thiab mob mob tshwm sim hauv thaj tsam ntawm qhov mob;
- tsis nco qab;
- nro ntawm phab ntsa anterior ntawm lub peritoneum;
- hyperthermia;
- pulse qaug zog sai;
- plaque ntawm tus nplaig grey;
- dag ntxias kom tso zis lossis tso quav;
- xeev siab thiab ntuav yam tsis muaj kev pab.
Nyob rau theem ntawm tus kab mob no, ib tus tuaj yeem pom qhov tshwm sim ntau tshaj plaws ntawm cov tsos mob hauv zos tshwm sim los ntawm cov tshuaj tiv thaiv hyperergic los txhim kho peritoneal irritation. Cov tsos mob ntawm plab hnyuv peritonitis yuav txawv.
Nyob rau theem tom ntej, tshuaj lom, uas tuaj yeem kav ntev txog 2-3 hnub, muaj kev nce ntxiv hauv kev qaug dab peg ntawm lub cev. Nyob rau tib lub sijhawm, cov kab mob pathological hauv qab no pib pom lawv tus kheej kom meej:
- kub nce mus rau qhov muaj nuj nqis siab;
- convulsive syndrome;
- txo qis ntshav siab;
- daim tawv nqaij;
- nres ua pa;
- dehydration;
- ntsej muag ntsej muag;
- kev faib tawmmob plab tag nrho;
- tseem tsis hnov tsw ntxhiab tsw.
Yog tias lub sijhawm no tus neeg mob tsis tau txais kev kho mob sai, cov txheej txheem pathological dhau mus rau theem kawg, qhov kawg ntawm nws txoj kev loj hlob. Nws yog tus cwj pwm los ntawm cov tsos mob hauv qab no ntawm plab hnyuv peritonitis hauv cov neeg laus thiab menyuam yaus:
- -bluish daim tawv nqaij tawv;
- tuag tes tuag taw ntawm cov hlab ntsha ntawm lub plab kab noj hniav, uas ua rau txo qis hauv plab thiab mob;
- txo qis hauv lub cev kub;
- -kub taub hau, ua daus no;
- sub qhov muag thiab plhu;
- tsis meej pem vim kev qaug rau lub cev;
- mob-txhais mem tes thiab ntshav siab;
- ua tsis taus pa.
Terminal theem plab hnyuv peritonitis nyob rau hauv cov ntaub ntawv kho mob yog suav tias yog irreversible, inevitably ua rau tus neeg mob tuag.
Primary diagnostics
Yog tias koj xav tias mob plab hnyuv peritonitis, nws yuav tsum tau ua cov kev kuaj mob ib txhij nrog kev kho mob xwm txheej ceev. Txhawm rau kom tsis txhob muaj teeb meem ua rau muaj kev phom sij rau lub neej, kev kuaj pom tseeb ntawm tus neeg mob yuav tsum tau ua tsis pub dhau 2 teev txij li qhov pib muaj tus kab mob.
Nyob rau hauv tus txheej txheem ntawm kev kuaj mob plab hnyuv peritonitis, cov ntaub ntawv hauv qab no yuav tsum raug coj mus rau hauv tus account:
- muaj cov tsos mob peritoneal;
- plab x-ray thiab cov ntaub ntawv ultrasound;
- peritoneal puncture data;
- result of diagnostic laparoscopy;
- lab results.
Kev kuaj pom thawj zaug tuaj yeem ua tau raws li daim duab kho mob dav dav ntawm tus kabmob. Cov kws kho mob tshwj xeeb tshwj xeeb rau qhov mob mob thaum lub sijhawm kuaj thawj tus neeg mob. Rau qhov no, siv ntau txoj hauv kev niaj hnub no (piv txwv li, txoj kev Shchetkin-Blumberg), uas tuaj yeem paub meej tias kev txhim kho plab hnyuv peritonitis hauv tus neeg mob. Nrog kev ywj pheej ntawm qhov mob ntawm qhov mob nrog kev pab los ntawm ntau yam tshuaj kho mob, daim duab kho mob txhim khu kev qha tuaj yeem cuam tshuam zoo heev.
Lab kuaj mob
Hauv kev siv cov tshuaj ntsuam xyuas rau plab hnyuv peritonitis, qhov chaw tseem ceeb yog nyob los ntawm cov txiaj ntsig ntawm kev kuaj ntshav biochemical. Los ntawm qhov kev tshuaj ntsuam no, kev hloov pauv pathological hauv cov ntshav muaj pes tsawg leeg tau txiav txim siab: nce ESR, leukocytosis siab, neutrophilia, purulent-toxic hloov ntawm leukocyte mis rau sab laug. Cov kev hloov no qhia txog kev loj hlob ntawm purulent intoxication hauv lub cev.
Thaum ua fluoroscopy ntawm lub peritoneum nyob rau hauv lub dome ntawm lub diaphragm, huab cua yog pom, muaj kua nyob rau hauv txoj hnyuv, o loops, uas qhia tau hais tias paralytic obstruction. Nrog kev pab ntawm fluoroscopic kev kuaj mob siv tus neeg sawv cev sib txawv, qhov ua tsis tiav ntawm anastomotic sutures tau yooj yim tsim, uas yog feem ntau ua rau mob plab hnyuv peritonitis uas tshwm sim tom qab phais. Cov kua dej dawb hauv cov kab noj hniav peritoneal yog txhais tau zoo los ntawm ultrasound.
Tshawb nrhiav seb puas tau phais rau plab hnyuv peritonitis.
Yog tias cov kev ntsuas ntsuas saum toj no tsis muab cov duab tiav ntawm tus kab mob thiab tsis tso cai rau kev kuaj mob kom raug, cov kws kho mob tshwj xeeb siv ntau txoj hauv kev, tab sis muaj txiaj ntsig zoo, xws li laparocentesis thiab laparoscopy ntawm lub plab kab noj hniav. Siv cov txheej txheem no, koj tuaj yeem txiav txim siab qhov xwm txheej thiab ua rau cov txheej txheem pathological.
Tus neeg mob tus mob hnyav feem ntau xav tau kev kuaj mob xwm txheej ceev. Qee qhov xwm txheej, kev kuaj mob tau ncaj qha thaum muaj kev cuam tshuam tom qab qhib lub peritoneum.
Kev kho mob
Thaum mob plab hnyuv peritonitis, tsuas yog siv kev kho mob xwm txheej ceev hauv tsev kho mob xwb. Hauv tsev, nws tsis tuaj yeem kho xws li pathology. Kev mus ntsib kws kho mob raws sij hawm muab sijhawm rau tus neeg mob rau qhov kev pom zoo ntawm kev phais.
Ua ntej ua haujlwm, nws yuav tsum ua cov txheej txheem npaj:
- stop mob shock;
- khov kho qhov dej- ntsev sib npaug;
- normalize ntshav siab.
Kev phais yog ua raws li kev tshuaj loog. Feem ntau cov kws kho mob siv qhov dav nruab nrab laparotomy. Thaum muaj kev cuam tshuam, kev ua haujlwm ntawm txhua lub cev tseem ceeb yog tswj thiab txhawb nqa. Cov theem tseem ceeb ntawm kev kho mob phais yog:
- tshem tawm ntawm kev tsom mus rau kis;
- kev huv ntawm lub plab kab noj hniav nrog cov tshuaj tua kab mob tshwj xeeb thiab tshuaj tua kab mob;
- peritoneal kua rau kev tswj qhov ncaujtshuaj tua kab mob thiab tshem tawm cov exudate nyob rau hauv nws;
- tshem tawm cov txheej txheem inflammatory;
- tshem tawm ntawm tus kab mob tuag tes tuag taw txhawm rau txhawm rau txhim kho peristalsis ib txwm muaj.
Hauv qhov xwm txheej hnyav, lub peritoneum tau tawm nrog cov tshuaj tshwj xeeb, uas yog hu ua "peritoneal lavage" hauv tshuaj.
kev saib xyuas tom qab
Tom qab kev phais, nws yog qhov yuav tsum tau mus txuas ntxiv kev kho mob, cov lus qhia tseem ceeb ntawm cov no yog:
- sau tshuaj muaj zog tiv thaiv kab mob thiab saline infusions rau tus neeg mob kom tshem tawm kev qaug rau lub cev;
- restoring puas systems;
- kev txhawb siab ntawm plab hnyuv musculature;
- tuav txoj haujlwm ntawm txoj hlab pa, hlab plawv, lub paj hlwb;
- kev tiv thaiv kab mob.
Nyob rau hauv kev kho mob plab hnyuv peritonitis, niaj hnub siv txoj kev ntxiv: plasmapheresis, UV irradiation ntawm ntshav, hemosorption, thiab lwm yam.
Tsis ntev los no, hauv kev kho mob tom qab ntawm cov kab mob xws li mob ntshav qab zib, relaparotomy nquag siv, cov ntsiab lus uas yog kev ntxuav kom huv ntawm cov kab noj hniav nrog ib qho tshwj xeeb muaj pes tsawg leeg. Cov txheej txheem no tuaj yeem ua tiav 2-3 hnub tom qab kev ua haujlwm, uas ncaj qha nyob ntawm tus neeg mob txoj kev noj qab haus huv.
Peritonitis ntawm txoj hnyuv yog dab tsi, tam sim no nws pom tseeb, tab sis qhov kev kuaj mob yog dab tsi?
Huab cua
Kev pom zoo rau kev rov zoo yog nyob ntawm kev siv sijhawm raws sijhawm ntawm kev kho mob, nrog rau cov txiaj ntsig ntawm kev kho mob tom qab phais. Lub luag haujlwm tseem ceeb yog ua los ntawm qhov ua rau ntawm pathology thiab qhov hnyav ntawm nws cov chav kawm. Feem ntau cov kab mob peritonitis nrog plab hnyuv obstruction. Hauv qhov xwm txheej siab, muaj teeb meem loj thiab tuag taus.
Kev ntsuas los tiv thaiv tus kab mob txaus ntshai no suav nrog kev noj qab haus huv, noj zaub mov kom raug, tshuaj xyuas raws sijhawm.
Peb tau saib seb lub plab hnyuv peritonitis yog dab tsi. Cov tsos mob thiab kev kho mob kuj tau piav qhia.
