Ndi chitsanzo Ruvilua-Gregoire chiyani?

Mu dziko muli ambiri matenda, zimene anthu ambiri sakudziwa nkomwe akuganiza. Koma pali milandu pamene iwe mophweka afunika kudziwa zizindikiro za anthu pachimake kuti athe yomweyo kupereka thandizo la wodwalayo. Koma si nthawi zonse matenda kapena kudwala zingadziŵike zowoneka, koma mu nkhani iyi, kuthandiza lamakono njira yodziwira, mwachitsanzo, monga chitsanzo Ruvilua-Gregoire. Koma chifukwa nyemba akhoza mtima, ndipo nthawi zambiri chifukwa kuwunika?

Kuyesa Ruvilua-Gregoire: ndichiyani?

mulandu uwu - izi ndi imodzi mwa njira matenda, kulola mofulumira kwambiri kudziwa ngati magazi intrapleural kapena ayi hemothorax. Zabwino mayeso Ruvilua-Gregoire limanena kuti mwaziwo utapitirira kutuluka mkati pleura, ndi umboni zoipa amasiya wake, kapena kaya, koma si monga yogwira.

Koma kodi hemothorax, mmene tiyenera kuchitira, kodi zotsatira za chosalanga mu chikhalidwe wodwala uyu?

Hemothorax: ndichiyani?

Hemothorax - magazi amenewa amapezeka mkati pleura ndi kumabweretsa mfundo kuti amasonkhana wambirimbiri mwazi limene pamapeto pake limodzi ndi psinjika ya phapo. Kuyesa Ruvilua-Gregoire amalola posachedwapa kudziwa kupezeka kwa magazi ndi mphamvu zake. Kuwonjezera diagnostics, kutaya magazi angadziŵike mwa zizindikiro:

• ululu pachifuwa;
• otsika kuthamanga;
• chizungulire;
• wotumbululuka khungu ndi ena.

Ngati wodwala azipereka zodabwitsa, ziyenera kuchipatala kuti matenda ndi kukhwimitsa onse kuti magazi asiye kutuluka. Koma zimene zingakubweretsereni hemothorax?

kudwala Zoyambitsa

Matenda a hemothorax kungakhale kofunika kwa odwala amene zoopsa pachifuwa, amasangalala pathologies, kapena zimayambitsa iatrogenic magazi.

Pansi madokotala kuvulala kumafuna kuwonongeka kwa thorax zamitundu yosiyanasiyana. Hemothorax ungapezeke chifukwa cha ngozi zapamsewu, gunshot mabala, nthiti wosweka, kugwa kwa kutalika kwambiri ndi zinthu zina.

kuvulala amenewa kungawononge osati mapapo, koma ziwalo zina:

• mtima;
• chiwindi;
• ndulu;
• ndi zakulera;
• intercostal ziwiya;
• thoracic mtsempha wamagazi;
• m'mapapo.

Hemothorax ndipo angathe kuyambitsa matenda a mtima, monga:

• kung'ambika aneurysm;
• chifuwa chachikulu;
• chotupa chija mu m'mapapo kapena pleural;
• m'mapapo abscess;
• hemorrhagic diathesis;
• coagulopathy, ndi ena.

zinthu Iatrogenic zikubweretsa hemothorax (kuti adziwe kupezeka yake adzakhala kuyesa Ruvilua-Gregoire) azaonekera zosokonezeka pambuyo opaleshoni ya m'mapapo kapena pleura, pleural ngalande, mayikidwe a catheter mu mtsempha chapakati.

pathogenesis hemothorax

kudzikundikira magazi pleura ndi zingachititse psinjika a m'mapapo ndi kusamutsidwa a ziwalo, imbaenda kwambiri yafupika pamwamba kupuma ya phapo, pali matenda a m'mapapo ndi hemodynamic. Pachifukwa ichi, hemothorax zambiri akufotokozera ulaliki matenda a hemorrhagic ndi cardio-m'mapapo mwanga mantha yopita ku mtima ndi dongosolo kupuma sizikugwira ntchito bwino.

Mu maola choyamba pambuyo magazi analowa pleura, ndi yamasika akufotokozera ndondomeko yotupa. Pamene hemothorax kudziwa chitsanzo chake Ruvilua-Gregoire (limapezeka edema, leukocytic kusalola, pathupi ndi exfoliated maselo mesothelial). Kwa nthawi yoyamba pachikhalidwe m'dera la magazi pleural kudzera magazi si losiyana kwa magazi zotumphukira, ndipo kenako kuchepetsedwa milingo hemoglobin, zosonyezera erythrocytes ndi leukocytes.

Pamene jekeseni pleura ndi magazi kuundana, koma patapita nthawi yochepa imayamba fibrinolysis, chifukwa chimene liquefies kachiwiri. Zimenezi zimalimbikitsa zinthu anticoagulant. Pali magulu angapo a hemothorax. Kodi ndi kusiyana pakati pawo?

makalasi hemothorax

Ife tanena kale kuti hemothorax akhoza kukhala zoopsa, pathological ndi iatrogenic. Komanso, kutenga nkhani mphamvu ya magazi ake ndi magulu angapo:

• kakang'ono - pali kudzikundikira magazi nkusani, ndi kutaya magazi si zoposa 500 ml;
• sing'anga - mwazi amagwa mlingo wa nthiti 4, ndi buku ake imodzi ndi malita theka;
• subtotal - magazi amagwa mlingo zipsepse m'munsi 2, ndi kuchuluka kwa kutaya magazi ndi za awiri malita;
• okwana - pa x-ray chimaonekadi asiyane ndi kugonjetsedwa kwa pleura, ndi kutaya magazi kwambiri kuposa mzimu wa malita.

Komanso, hemothorax, amene amathandiza kudziwa chitsanzo Ruvilua-Gregoire ndi njira zina matenda akhoza kukhala apical, interlobar, parakostalnym, supradiaphragmatic, paramediastinalnym, zidalira pa kutanthauzira ndi. Inunso kuti, mwaziwo utapitirira kutuluka, hemothorax otchedwa mwapang'onopang'ono, ndipo ngati wasiya - khola. Ngati pleura nthawi yomweyo chimakwirira osati magazi, komanso mpweya, mu nkhani iyi tikulankhula gemopnevmotorakse. Koma kodi zizindikiro angasonyeze hemothorax?

Zizindikiro za hemothorax

Chithunzi matenda zimatengera mwachindunji pa mphamvu ya magazi, wosweka m'mapapo minofu ndi ziwalo kuloza. Small hemothorax sitingazimvetse limodzi ndi zizindikiro, makamaka mtima anadandaula ululu chifuwa, kumene kulimbikitsa pamene kutsokomola, ndi kupuma movutikira angagwe.

Koma pakati ndi mkulu makalasi, sipangakhalenso anatsimikizira ntchito chitsanzo Ruvilua-Gregoire, limodzi ndi matenda kupuma, matenda a mtima, ndi ena. zizindikiro si mmene mfundo Kodi monga ntchito, chifukwa mukalandire ululu umene kumawonjezera ndi kukhosomola, kufooka thupi lonse, yafupika magazi. Ndi kuchita masewera olimbitsa thupi pang'ono thupi onse zizindikiro amakula. Wodwala amasankha omasuka malo - atakhala kapena theka-mosapumira.

Koma hemothorax aakulu pali kufooka, amene salola ngakhale kuwuka, chizungulire, kukhala tachycardia, khungu wotumbululuka, pamaso pa flit ntchentche, amayambira syncope. Koma si nthawi zonse zizindikiro akhoza kuloza hemothorax, choncho ndi bwino kuti ndi dokotala, amene adzamuika maphunziro ambiri a kuphatikizapo nyemba ndi Ruvilua-Gregoire. Pa hemothorax - ichi ndi njira yabwino, amene mu nthawi yochepa adzasonyeza kukhalapo kapena kusapezeka kwa magazi.

diagnostics

Pa molondola matenda dokotala n'chakuti tsatanetsatane wa matenda, amaikidwa ndi njira thupi ndi zina bwinobwino kuphatikizapo zasayansi. Pa hemothorax yomweyo titsimikize ngati pali kwanthawi za mbali zinkakhala pa kayendedwe kupuma, kaya khungu percussion phokoso pa malo pamene madzi amatengedwa, wofooka ngati kupuma pali quavers.

Pachifuwa x-ray limasonyeza kuwala kollabirovanie, pamaso pa madzimadzi (wodwala angathe yopingasa pa phunzirolo) kapena kuundana mu pleura lapansi. Pofuna kulongosola matenda ndi matenda awerenge pleural puncture pa hemothorax, mu nkhani iyi kupeza magazi akutsimikiza matenda. Kuzindikira wosabala ndi kachilombo hemothorax kupanga zitsanzo Petrova ndi Efendiyev, amene ngoziyo chilungamo ndi precipitate aspirate.

mayesero Laboratory magazi adzaona chiwerengero cha leukocytes ndi erythrocytes. Zikhoza kuchitidwa, ndi njira zina matenda monga ultrasound, X-ray, chifuwa CT, matenda thoracoscopy.

Kuti amalola kuti mwachindunji chitsanzo?

Kuti atsimikizire kuti mwaziwo utapitirira kutuluka, kapena kuti kale anasiya, musati kufunikira phunziro monga nyemba Ruvilua-Gregoire. Matenda njira ngati zimenezi kumaphatikizapo magazi zochepa chabe pamalangizo pleura, kenako tayang'anani pa iyo. Ngati mwadzidzidzi mu mayeso chubu kapena syringe, zikutanthauza kuti mwaziwo utapitirira kutuluka, ndipo ngati coagulation palibe, palibe. Ndiye zitsanzo anatumiza kwa zasayansi kwa atafufuza, ndipo kale kuchuluka kwa hemoglobin.

Zabwino mayeso Ruvilua-Gregoire - chizindikiro kwa thoracotomy mwadzidzidzi, zimene zingakuthandizeni kuti magazi asiye kutuluka. Izi nkhani matenda njira, koma ndi bwino kuchita zina ndi zina Kafukufuku, kuti ndikhale wotsimikiza 100% mu matenda. Koma kodi kuchita mayeso?

Njira mpanda puncture pa hemothorax

Khalidwe mayeso ayenera kukhala dokotala woyenera, chifukwa phunziro ili ndi zovuta, ndipo ngati mukhala chitsanzo magazi ndi cholakwika, zingakhale zoipa kwambiri kuti wodwalayo. Puncture pa hemothorax - njira yapadera matenda, yomwe ikuchitika pakati pa nthiti 6 ndi 7 pa sing'anga ndi mzere zadnepodmyshechnoy. Pa nthawi imeneyi, wodwala ayenera kukhala mu malo mosapumira. Magazi anatumiza kuphunzira mankhwala kutumikiridwa njira antibacterial.

mankhwala ndiwofatsa

chithandizo ndiwofatsa zimathandiza ngati haemothorax wofatsa, zimene zinachitikira analgesics ndi wothandizila hemostatic. Komanso zabwino zotsatira m'malo mankhwala ndi mwamsanga magazi, ngati haemothorax zolimbitsa kapena ngakhale aakulu. Zochizira matenda HT ndi kutumikiridwa wothandizila fibrinolytic, iwo anasonyezanso kuti kupewa ndi mankhwala a hemothorax uŵende, ndipo akhoza ntchito immunocorrecting ndi mankhwala symptomatic.

Small hemothorax mwamsanga ndipo popanda zotsatira angathe kuthetsedwa ndi njira ndiwofatsa mankhwala. Koma kuti, ngati kukonzanso bwinobwino anaulula mayeso abwino Ruvilua-Gregoire, ndiye palibe opaleshoni sangachite.

Opaleshoni chithandizo cha hemothorax

Opaleshoni akusonyeza kuti wodwalayo mu Zikatero:

• Ngati mwaziwo utapitirira kutuluka mkati pleura;
• haemothorax litapotanitsidwa ndiponso kupewa kukuza kuti m'mapapo ndi;
• ngati pakhala kachiwiri kudzikundikira magazi pambuyo kutenga puncture;
• magazi udzadutsa kusankha pleural ngalande, ndi buku zake ndi zokhudza 500 mL maola 2-3;
• kuonongeka ziwalo zofunika kwambiri.

hemothorax mankhwala zachokera mbali ya zinthu etiological magazi ndi zovuta hemorrhagic mantha. Open ozama kuwonongeka kwa mapapo ndi zina ziwalo chifuwa amafuna mwamsanga alowererepo opaleshoni pa maziko a bwino mankhwala odana ndi mantha, womwenso zachipatala osati analgesia, komanso kulimbana ndi magazi m'thupi pachimake ndi hypoxia.

Opaleshoni ndi zofunika zothandiza ngati zimenezi:

• magazi asiye kutuluka;
• kuthetsa kuwonongeka kwa ziwalo;
• kuchotsa magazi owonjezera;
• kuyala ngalande kwa inapita kudzifutukula ya phapo;
• chifukwa konzanso wa M'mimbamo pleural ndi antiseptics.

Koma kodi Zoneneratu kupereka madokotala odwala amene opaleshoni pa hemothorax ndi zinachitikadi?

Kuneneratu ndi kupewa hemothorax

Bwino chithandizo hemothorax zimadalira chikhalidwe cha kuvulala kapena matenda, magazi kwambiri ndiponso thandizo yake anapereka. Yabwino madokotala ananena zawo odwala ndi wofatsa kapena zolimbitsa hemothorax. Clotted hemothorax angasokoneze chitukuko cha empyema pleural, koma anapitiriza magazi kapena wosakwatiwa lalikulu imfa ya magazi kungayambitse imfa.

Zotsatira za hemothorax mwina chachikulu mapangidwe adhesions pleural zomwe zimadzetsa Kuchepetsa sayenda wa chifundamtima. Pankhaniyi, izo tikulimbikitsidwa kuti odwala onse amene anali boma kusambira ndi kuchita kupuma kokoka zonse.

Kuteteza hemothorax limapereka chenjezo la kupweteka pachifuwa, dokotala odwala mwakayakaya thoracoabdominal, kulamulira hemostasis mu opaleshoni mapapo ndi mediastinum.

Pomaliza

Kuti adzimvera, tikhoza kunena kuti chitsanzo Ruvilua-Gregoire - ndi imodzi mwa maphunziro ofunika kwambiri pa hemothorax. Magazi kuderalo pleural - chikhalidwe kwambiri kuti amafuna kutumiza mwamsanga dokotala. N'chifukwa chake pa zizindikiro woyamba kapena atangotha zoopsa ndi bwino kupempha thandizo oyenerera, kapena zosiyidwa akhoza kukuphani.