Osler mfundo - ndi chiyani ichi? Zimayambitsa pathogenesis, chithandizo

Endocarditis - kutukusira kwa endocardium, ndi akalowa mkati mwa mtima. Zingayambitse matenda ziwalo zambiri ndi machitidwe a choipa thupi, hypercoagulable ndi ena omwe si opatsirana zimayambitsa. Choncho yokha endocarditis basi matenda awo, pamaso pa zomwe anaigonjetsera mawanga, Osler mfundo ndi zina khalidwe zidzolo pa thupi sizimawoneka. Odwala simukuona kusamva, ndipo kawirikawiri kudandaula ndi musadandaule mtima, malungo. Ndipo ngati kutupa endocardial anachititsa parasitic yaying'ono-zamoyo mu magazi, izo zimakhala matenda osiyana otchedwa opatsirana, bacteriological toyambitsa endocarditis. Osler mfundo - chimodzi cha zizindikiro zake kunja. Anafotokoza 1885, lochititsa chidwi Canada dokotala William Osler. Infective endocarditis - matenda oopsa kwambiri kuti kumabweretsa mapindikidwe sizingasinthe mtima, choncho n'kofunika kudziwa chomwe icho chiri ndi mmene kumaonekera.

Features wa endocarditis infective

matenda oyamba ndi bakiteriya pafupifupi onse tizilombo bowa, ndipo nthawi zina ngakhale mavairasi mogwirizana ali m'magazi a munthu. Kudutsa endocardium May matenda opatsirana kupuma, misempha, periodontitis, zilonda zapakhosi, TB urethral catheterization, dzino kuchotsa ndi mwai wina. Osler mfundo chowala chizindikiro kuti anapatsa matenda chimapangitsa Vuto - infective endocarditis. Nthawi zambiri, kwa chiyambi cha ntchito parasitic tizilombo mu mtima ayenera kuonongeka mu njira iliyonse:

- venous catheters;

- pacemakers;

- mtima ziwalo kapena zingwe mtima;

- zofooka zosiyanasiyana mtima;

- microtrauma;

- opaleshoni.

Nthawi zina mabakiteriya umalowa mu endocardium ndi opanda minofu kuwonongeka isanafike. Kenako anapanga abscesses, fistulas ndi zilema zina.

zizindikiro

Infective endocarditis akhoza mtima komanso momveka kwa bwinobwino, ndipo mwina poyamba kusokoneza kutopa yekha, kung'ung'udza mtima, kufooka ambiri, ndi zizindikiro zoopsa kuonjezera pang'onopang'ono. Njirazi ndi monga:

- malungo;

- kuzizira;

- profuse thukuta;

- minofu chowawa ndi mafupa;

- kulemera imfa;

- kusintha mu khungu (amakhala grayish, pang'ono chikasu);

- totupa pa nembanemba wa mucous.

Osler mfundo kuonekera patatha zizindikiro zakumwamba. Akatswiri ena amawaona kuti chosiyana ndi chofunika mbali ya endocarditis infective, pamene ena n'chosoŵa chiwonetsero cha izo, imene matenda ndi mu maonekedwe subacute.

Osler mfundo, pathogenesis

nyumba amenewa amapezeka pa manja, mosavuta, mapazi chifukwa kutupa chifukwa cha matenda ndi ziwiya ka magazi ndi kuwayimilira adzalowerera. phunziro Histological wa mfundo nawo kuonetsa venules kuzikonzanso ndipo arterioles. Nthawi zina kusokonezedwa ndi totupa thupi lawo siligwirizana kapena septic purpura. Kodi tinatake tozungulira Osler, chithunzi chikusonyeza bwino ndithu. Ndi otukukira kunja, kukula kwa mtola kapena pang'ono pokha mapangidwe mafoni a hue ofiira kapena wofiirira, nthawi zina zopweteka, nthawi zina ayi. Kukhala mofulumira kutha okha, si matenda osiyana, kotero chithandizo mapiritsi kapena mafuta sitingafunikire kutero. Koma ngati munthu waona pa mfundo zimenezi, iye ayenera yomweyo kufunsa dokotala kwa zasayansi zina ndi maphunziro matenda.

mawanga anaigonjetsera a

Kuwonjezera tinatake tozungulira Osler, mu endocarditis infective kumachitika totupa hemorrhagic khalidwe mbali ndi miyendo, magazi pansi mbale msomali mawanga Zhaneve akuwuka komanso Osler mfundo, pa Yakanjedza ndi zidendene. Koma, mosiyana ndi tinatake tozungulira, ndi mawanga awa sabweretsa chisoni mwamtheradi, sizimawoneka ngati mtola ndi amachitika chifukwa cha liwiro magazi capillaries ndi.

Mu endocarditis infective, kuwonjezera pa khungu, maso ndi angakhudzidwe. Ndi chimodzi cha zizindikiro ambiri anachita ndi kutupa ndi mawanga anaigonjetsera. Iye anafotokoza dokotala Swiss anaigonjetsera. Anaigonjetsera mawanga kuimira microbleeds mu diso. Mu mawonekedwe ali chowulungika kapena kuzungulira ndi dontho woyera pakati. Odwala, formations izi zingathe kudzetsa utachepa masomphenya, amene pambuyo mankhwala a matenda amabweretsera wabwezeretsedwa.

Anaigonjetsera mawanga ndi chizindikiro osati wa infective endocarditis, komanso magazi m'thupi, connective minofu matenda. Choncho, kuti matenda ndi zofunika kuchita maphunziro.

Zizindikiro zina za endocarditis infective

Pali zizindikiro dazeni likunena za kutupa endocardium chifukwa oyamba matenda.

Osler mfundo, Lukin mawanga (kapena-chizindikiro Lukin Liebman), zizindikiro za Rock, Dmitrienko, Janeway ndi thandizo madokotala ena oterewa, makamaka milandu pamene ena zizindikiro mmene matendawa ali amaona kapena kwina.

Zizindikiro Lukin-Liebmann Maonekedwe a petechiae mfundo ndi malo yochitidwa pa m'makwinya a zikope ndi conjunctiva.

Rock chizindikiro kumaonekera kukula kwa mwana wa diso kumanzere.

Zizindikiro Janeway - izo erythematous maphunziro, komanso mawanga anaigonjetsera kuchita m'manja ndi mapazi, koma mu nkhani iyi iwo ali wamfupi.

Zizindikiro Dmitrienko tichipeza mu olimbikitsa a kamvekedwe phula ine, ichi ndi chifukwa chake amatchedwa "veleveti kamvekedwe." Tinaona mbali mu magawo oyambirira a matenda.

chithandizo

Kukhazikitsa chifukwa cha chizindikiro iliyonse kungakhale dokotala. Childs, zimenezi zimafuna zasayansi MAGAZI, ECG, echocardiography. Ndi kuvomerezedwa kuchita bakposev magazi kudziwa wothandizila opatsirana. Ngati mayesero asonyeza pamaso pa endocarditis infective wodwalayo, maantibayotiki Kwalamulidwa gulu loyenera. Zikavuta opaleshoni imagwiridwa (pulasitiki, apulasitiki mtima vavu).

Ndi yake matenda zolondola yake wayamba mankhwala 50-90% odwala kukhala zaka zoposa 5. Pofuna kuteteza zosayembekezereka wa endocarditis infective anayamba njira wapadera kwa anthu pangozi. Iwo ali modes angapo kupewa lagona pa phwando mankhwala anasankha zinthu njira.