Mendelson kuti urwere kuratidzwa. Zvakakomba kufema chirwere

A yakawanda yematambudziko munogona varwere vari yevanorwara zvikuru. Rimwe rinoti izvi ndiyo huru Mendelson kuti syndrome.

Imhandoi zvokurwara?

By Mendelson kuti chirwere kakawanda zvaireva obstructive pulmonary chirwere pamwe maronda ari zvemapapu rinenge (pneumonitis), kukura pamusoro pakanyorwa anowira pamusoro gastric muto kupinda Airways. yakatanga ichi ezvinhu anorondedzerwa muna 1946. Zvinonzi kuchengetwa varwere anorwara vakambova kukuvara musoro, abdominal kuvhiya (kunyanya abdominal) uye kusununguka. Kazhinji, muvambi ose zvokurwara mhando iyi anesthetized (nokuda kwayo relaxes mvere tsandanyama). Muchirwisa colour kubva vagadzikana uye kurasikirwa tsandanyama matauriro kunoitika chido (Inhalation) gastric mukati (kazhinji gastric muto chete). Zvinoguma kukundwa sezvo Árbol muti uye zvemapapu tishu. Condition zvikuru chakakomba, vanogona kutungamirira kurufu kana kutadza kupa rubatsiro rwakakodzera. Zviri kunzwisisa zvakadzama sei pane bhowa chirwere chakadaro, uye kuti zvinofanira kuitwa.

zvikonzero

By kukura Mendelssohn kuti chirwere unogona kukonzera zvirwere zvakawanda. Idzi dzinosanganisira:

• Zvokurwara pakati tsinga (zvakakomba Kukuvara uropi, kuvadza glossopharyngeal etsinga, vachisimbisa huta mutemo gastric parietal masero uye motility pakati pamhango nhengo dzose nemudumbu).
• Zvirwere zvomudumbu turakiti (hiatal heniya, achalasia).
• Zvirwere kufema turakiti (trachea pfupi, fistulas pakati yegurokuro uye gurokuro).

Kuwedzera kune zvirwere izvi, kuti pneumonitis kungaita nehosha dzakaipa. Wandei simba pamusoro kukura uye chido vane abdominal Kuvhiya (nemhaka kuderedza tsandanyama inzwi nhengo uye zvinoderedza neizvi mirayiridzo peristaltic mafungu) uye pamuviri (nokuda diaphragm misha). Somuenzaniso, panguva inorwara zvomusejari kupindira 70% nyaya.

Zvisinei, vakawanda kukonzera gastric muto kupinda rezasi kufema turakiti iri pusa yokubvinza nokuda zvakaipa nzvimbo murwere uye kusava nesimba cardiac sphincter.

The pathogenesis kuti chido pneumonitis

The chirwere hwapedyo nokuda maronda ose pulmonary uye Árbol zvinyama hydrochloric asidhi huri mudumbu. Sezvineiwo anovandudza coagulative necrosis (izvo, zvakare, imhaka Zvakaitwa asidhi pamusoro Árbol mucosa). Somugumisiro Árbol secretory okuita ipfupi, iyo inotungamirira issushivaniyu yavo. Parallel asidhi rakapinda mumapapu inokonzera kukura pneumonitis - aseptic kuzvimba zvemapapu tishu. Akaderedza zvemapapu kufema pamusoro, zvinoderedza chizvarwa surfactant. izvi zvose zvinotungamirira kuwedzera nenyama kubva akati muviri (nokuda chimiro ichi uye secrete pathologies maviri: asthmatic - kunyanya kukanganisa bronchus, uye obstructive - aine lesion pamusoro zvemapapu rinenge uye kukura mhingaidzo chirwere). Pamwero iri pakutsvaga ph pamusoro gastric muto (rezasi zviri zvikuru pfungwa yacho acid, zvikuru kukuvadza). Kuchinja zvakakura zvinochengetwa mune Formação de.

Kuratidzwa pamusoro ufanane Formação de

Kakawanda iri kukurukurwa imwe chirwere uye vakabatana Zviratidzo Vaverengi vanokokwa pikicha. Zvirwere zvakadai pneumonitis, kazhinji nevamwe chaiyo zvimwewo zvinhu regai kusiyana. Asi kana imi kutarira njodzi nzvimbo zvinyama kuburikidza maikorosikopu (iyo kunowanzoitwa pamukova), zvinokwanisika kuona zvimwe kuchinja.

Somugumisiro pamusoro pezvakaitwa uye vakadhakwa regiravhiti anodonhedza hydrochloric asidhi kupinda Formação de. Ikoko, nokuda yeko nezvainoita alveolar rinenge paumbwe effusion (kazhinji Hemorrhagic). Somugumisiro, zviri kuva Hemorrhagic pulmonary edema. Achifuridzirwa kudzikisirana ari Formação de vakachengeta kurasikirwa fibrin, uyewo kupinda masero eropa kuburikidza zimba Kamudzira (zvikurukuru leukocytes uye macrophages). Somugumisiro, kugadzirwa makemikari kusimukira necrosis pamusoro alveolar masvingo nokuda zvemapapu mamiriro iyo anonetseka. Mune imwe nzvimbo midziyo zvinochengetwa endothelial kukuvadza uye paumbwe microthrombi. Izvi zvose zvinotungamirira vawedzere exudation emura kuburikidza Kamudzira uye paumbwe atelectasis. Kazhinji ndivo chikonzero zviri kutanga obstructive pulmonary chirwere. Kana asidhi mumapapu kuwana zvidimbu undigested chikafu kana zvimwe miviri vatorwa, kufanana paumbwe Hemorrhagic edema pamwe kukura kunonoka maitiro granuloma inotungamirwa kumativi wakapinda mumuviri. mhando iyi chirwere ari kufambira mberi zvishoma nezvishoma, asi zvikuru.

Clinical Kuratidza chirwere

Sei kuona kuti murwere ane chido pneumonitis? Chaiwo "chirwere photos" rinogona kuratidzirwa sezvinotevera:

• Yokutanga kiriniki achava nokuda zvakananga mugumisiro asidhi pamusoro mucous membrane. Pane kumwe mufananidzo chakasimba uye zvakasimba kufema kukundikana - bronchospasm, kuwedzera cyanosis, kufema kukundikana.
• Cardio-vascular gadziriro iri kuchengetwa tachycardia, donhwe BP. Mune zvimwe zviitiko, zviri mwoyo nokukundikana kana nokuvhiringidzirwa tinakidzwe. Sezvineiwo ungaderedza cardiac goho uye anowedzera kumanikidzwa iri pulmonary arteries. Nokuda gasi mukutsinhana abnormalities vakacherechedza pave kufema uye metabolic alkalosis. The yakakura bhuku zvemapapu rinenge akarova, asi kwakanyanya murwere, uye kuoma zvichava kurapa nayo.
• Kazhinji, maronda uye zviratidzo kufema kukundikana kuonekwa 2 kwemaawa, dzinenge - gare gare. Dzimwe nguva zviratidzo zvinogona kudzimwa, uye dzichipfekeka vanotaura kurege kuitika panguva dzose.

Diagnostics

Nokuzivikanwa Mendelson kuti chirwere - a rakaoma, sezvo zvokurwara hwapedyo kazhinji Varwere zvamuremadza, uye kwete nguva dzose, sezvo takati kumusoro, chiremba mufananidzo zvingaitika. Chinhu chokutanga kuona pamberi kufema kukundikana (kupfupika mweya, wheezing, cyanosis). Zviratidzo izvi havakwanisi kuziva varwere vari zvokuimba kufefetedza nguva dzose. Nzira yakarurama kwazvo diagnosing Mendelson kuti chirwere ari radiography kana fluorography mumapapu. Mumufananidzo haugoni kuona pamberi exudate mumapapu, kuwedzera airiness yavo. Mune zvimwe zviitiko, akanatsiridzwa musiyano pakati principales (chakaipa pamusoro radiograph iri zvakananga fungidziro pakati principales havasi kuoneka, uye iwe unogona kuvati, chete kana kuita divi kwepfuti). Kana chete fluorography murwere vanofungidzirwa rinoita chirwere imhaka kutanga necrosis, tubular bazi trachea vachava kuonekwa uye uri mutsetse radiograph.

chido chirwere kurapwa

Zvisinei, kana, paiva chido pamusoro gastric mukati, kurapwa vanofanira kutanga pakarepo. Danho rokutanga kuti asava kubva kuzodzosera kupinda asidhi munzvimbo dzapasi Airways. Kuita izvi (kana murwere nemamiriro) chinodiwa kusimudza headboard pamubhedha wake. Pakarepo zvakakodzera kuchinja kufefetedza mumapapu uye zvinopa zvakanaka ropa oxygenation. Kazhinji, ushandiswe ventilator pasi inoratidza zvakanaka kumanikidzwa uye hyperbaric okisijeni saturation (kushandiswa ventilator gadziriro, richiona ropa magasi). izvi zvose zvichakubatsira kudzivirira acidosis.

Kuderedza bhuku zvemapapu rinenge lesion yakatarwa glucocorticosteroids nomutsinga duku dose pamusoro - intrabronhialno. Makemikari kubvumira muitiro kuti misa kuparadzira uye kukutadzisa nayo. mishonga (kazhinji cephalosporins uye macrolides) kushandiswa dziviriro. Zvinofanira kuva sympathomimetics (kuitira kuderedza paumbwe secretions ari principales nemapapu).

urwere yematambudziko

Apo nguva atanga kurapwa yematambudziko zvinowa- kudziviswa. Kana uchinonoka chido chirwere kunogona kutungamirira ngozi uye varwadziwe.

Kazhinji pashure maperembudzi kana mberi nokuparara zvazvingava, anogona vakabva kuitika atrial fibrillation kana zvechigarire chimiro kuti ventricular fibrillation. Kana wake asungwa zvisingaiti, asi murwere haasi kunyunyuta, unogona kusiya murwere pasi pokudzora yeko chiremba chete.

Chimwe kuomesa ndiko kukura pulmonary atelectasis kana chirwere mhingaidzo. Panyaya iyi, chirongwa Kudzikamiswa zvichava nani refu, uye kusimbisa kunowanzoitwa pamusoro pakuyamura zviratidzo, sezvo chirwere ichi harirapiki.

Wakakura zvikuru kuomesa rakaipa pneumonitis. Kunyanya kazhinji richiwanika muzviitiko apo kusimukira chido chirwere muna vachangoberekwa vacheche.

Madzivirirwe fungidziro chirwere

Kudzivirira chido nemabayo, anofanira kutakura kubuda kunzwisisa vamwe mabasa. Zvikurukuru, varwere vose nevakadzi basa, izvo zvinoratidza chipingaidzo pasi vakawanda yokutindivadza inofanira kudururwa dumbu ura. Izvi anobvisa chikuru chinokonzera kukura pneumonitis.

yokutindivadza asati inokurudzirwa narwo chipfuva maekisirei kuti hazvibatanidzi zviri gastric muto muna Airways. Intubating murwere yaifanira kunyange kana murwere ari vanoziva. Man vakaisa zvekuti rokumusoro chikamu muviri amutswa zvishoma. Izvi zvinoitwa nokugadzirisa musoro pamubhedha kana uchishandisa tafura (apo ukadzivisa mukana pusa wicking zviri zvomudumbu wemuTesitamende kufema turakiti).

Subject intubation uye zvakakodzera kugadzirira unyanzvi murefu kunorapwa, mukana Mendelson kuti urwere usingashandi.

The fungidziro chirwere ichi sezvinotevera: kazhinji anofa kusvika 56 muzana varwere hwakagadzwa yemweya pneumonitis. Kana remedial matanho kunge akatanga mune nenguva nenzira, mukana yematambudziko uye rufu airarama razero.