Pericardial effusion: Zviratidzo uye zvinokonzera. Kuongorora chirwere uye kurapwa

Exudative pericardial effusion - chirwere hwokuratidza kuzvimba ari Kamudzira lining yomukati pechiso pericardium. By yezvakaita kuerera exudative pericarditis iri rikwanise kana chirwere.

The chirwere zvinogona serous, Hemorrhagic, purulent, fibrinous uye serosanguineous. In exudative fibrinous pericarditis kunoitika deposition kuti fibrin filaments vari pericardium, uye rinoungana imwe yakawanda mvura iri pericardial mhango. Kazhinji, ari pericardial mhango rine anenge 20-40 ml mvura mvura.

Munguva chenjera pericarditis maitiro achabatsirwa kunowedzerwa cellular exudation ari pericardial mhango ane mvura ropa hacho. Nyaya kana kushoma kungaita kuti subepicardial layer izvo zvinoshamisa kuipa kwayo ushande.

cardiogenic kugwinha

Kazhinji nokukurumidza kuunganidza mvura iri pericardial mhango kunogona kukonzera cardiac tamponade, ndiro symptomatic zviratidzo cardiogenic kuvhunduka:

• mwoyo palpitations;
• kufema zvirwere nokuti dyspnea mhando;
• yakawedzera kuomesa munyika venous hurongwa zviduku kutenderera;
• kuderera mune systolic BP.

zvinogoneka yematambudziko

With resorption exudative mvura anogona kuumba Vanga racho rinenge rine fibrin, izvo zvinozoita kungaita kuti haasaruri kana zvakakwana imperforate pericardial mhango. Kazhinji vanga achiumbwa munyika atrial nharaunda, panguva confluence pakati okumusoro vena cava, pedyo atrioventricular paburi.

With yakadaro rikwanise hunhu pericardial effusion kungaita kuti zvikuru matambudziko, unonzi "mwoyo ibwe" somugumisiro calcification yacho pericardium. Chinhu chinokosha mune pathological Nzira exudative pericarditis ari kutyora diastolic ropa rinodzokera mwoyo ventricles. Exudate aunganidza ari pericardial mhango kana kuvapo constrictive pericarditis kunotungamirira nokuvhiringidzirwa subepicardial uye subendocardial akaturikidzana ari chakaderedzwa mutengo. Mune zvisingawanzoitiki Muzviitiko, fibrosis pamusoro pericardium angava expandable chikamu, kuburikidza iyo bulging ventricle panguva diastole nechokwadi zvakajairika chokuendesa ropa pamwoyo.

Fani iyi inonzi fenestration (the "hwindo akazaruka"). Systolic danho, iyo inopa dzeraundi tsandanyama layer kazhinji, asingadi kutambura. With-refu kutyora venous kudzoka mwoyo pane kurega kunotanga ropa iri pulmonary tsinga. Kana venous stasis ari systemic riparadzirwe mamiriro nemvura ndiye extravasation kupinda akapoteredza munyama.

Pericardial effusion: chinokonzera (etiologies)

Chimwe chezvinhu kakawanda zvinokonzera exudative pericarditis vari RNA-tune nemavhairasi (A uye B), echovirus, yokuSpain A uye zvirwere zvinokonzerwa noutachiona zvakasiyana siyana hunhu (pneumococci, staphylococci, streptococci, mycobacteria tibhii uye hunokuvadza).

Viewed chirwere anogona omesa nzira systemic zvirwere (SLE, kana Libman-homwe chirwere, rheumatic majoini, rheumatism, nechirwere chinonzi systemic scleroderma) uye zvinetso zviri genitourinary ino (uremic pericarditis). Pericardial effusion ICD angava kuratidzwa postperikardialnogo chirwere kuti anova pashure pericardiotomy kana sezvo vachiri kuomesa kwakaita myocardial infarction, unonzi Dressler kuti syndrome. Kazhinji, kuomesa ichi ichibudira mumoyo zvachose yakajeka nguva puranga, iko mazuva 15 kusvika 2 months.

Dzimwe nguva exudative namira pericarditis zvinogona kuitika nokuda ingestion nezvimwe zvinodhaka: gidralizin, phenytoin, anticoagulants, nokuda kakawanda chikumbiro procainamide, radiotherapy. Muzviitiko avo apo huru pericardial effusion padzakacherechedza effusion kugutsikana, chikonzero anofanira kutsvaka ari metastasis anomera: zamu kenza, yemapapu, sarcoma, rwekenza yelymphoma. Muzviitiko izvi, kazhinji Hemorrhagic exudates, zvishoma serous.

Pane kuti exudative pericarditis, unonzi hemopericardium chinokosha. Izvi ezvinhu kunoitika apo rakapinza kukuvara chipfuva nharaunda iri mumwoyo fungidziro, sezvazvakaita discontinuities infarction pavarwere pashure myocardial infarction, kana nokupatsanura kutsemuka aneurysm, zvichiita ropa anozadza pericardial mhango. Kana hosha zvakaitika vasingazivikanwi causative zvinhu, zvino ndezvaiye boka nonspecific kana idiopathic.

Uyewo, pericardial effusion nevana, zvakare, dzimwe nguva. Zvikonzero ichi ndiwo: streptococcal uye staphylococcal zvirwere, tibhii, utachiona hweHIV, kudzora mishonga, namamota, kunotevera, pedyo mwoyo, itsvo kukundikana, kuvhiya mwoyo.

Pericardial effusion: chirwere uye zvekuchipatara zvinhu

Exudate aunganidza ari pericardial mhango uye patainzwa marwadzo anoratidza vachirwadziwa nemoyo, zvemamiriro kufema pamusoro mhando kufema, iyo ipfupi ari nokugara chinzvimbo, palpitations. Kumanikidza kunoitwa nemvura nomusi trachea uye principales kuti pakaoma chikosoro.

General nezvevakafa varwere kunoenderana mwero paumbwe nemvura pakuderedza ari pericardium panguva kunonoka kumhanya - inogutsa mamiriro kana kufambira - mwero uye kwazvo.

On kuongororwa, murwere anogona kuonekwa anotevera zvinhu exudative pericarditis: hapana ganda, mucosa cyanotic miromo, edema pamusoro ezasi yayo, acrocyanosis.

Kana kuongorora nharaunda pechipfuva anogona kuonekwa asymmetry, kuruboshwe divi inogona hwakawedzera, zvinokwanisika chete kana zvasangana mu pericardial exudate vhoriyamu rinosvika zvinopfuura 1 fő. Palpation rinogona kuona kuchiitwa huerto kana apical zvairatidza iri misha kumusoro uye ura, nokuda kumanikidza kunoitwa, nemvura akazviunganidzira mukati.

Percussion anogona kuona kukura miganhu iri hama dullness komoyo zvose kumativi: kuruboshwe, nechepasi (mu rezasi mumapoka) mberi kana kuti pakati axillary mutsetse, rechipiri uye rechitatu intercostal dzezvimwe epakati clavicular mutsetse, imo rezasi mumapoka, kurudyi UYU (pemwedzi -klyuchichnoy mutsetse), saka pokubatana obtuse angled pachinzvimbo zvakananga zvakajairika kumuganhu kuchinja hepatic dullness. izvi zvose zvingaratidza kuti murwere ane pericardial effusion.

Auscultatory muenzaniso: rakapinza kwakaderera zviri mwoyo rinonzwika mumwoyo chakaderedzwa mutengo, pana Botkin-Erb uye xiphoid muitiro. In mujinga mwoyo vari vakanzwa ruzha pasi inokonzerwa kuti mwoyo yavo exudative mvura kumusoro uye namanhede. Ruzha pericardial kukweshera, kazhinji auscultation hakuiti unooneka. BP kuri kupera, tikafunga zvinoderedza cardiac goho.

Kana kuunganidza Urume kunoitika zvishoma nezvishoma pamusoro kwenguva zvokuimba basa mwoyo kwenguva refu nguva haisi kunetseka nokuti chokuti pericardium anowedzera zvishoma nezvishoma panyaya iyi. Kana akurumidze kuunganidza mvura iri pericardial effusion uye nzvimbo anobatana tachycardia, chiremba mwoyo kukundikana pamwe kuzara mananara riparadzirwe madenderedzwa (makuru uye diki).

Inobva kuongorora ECG nemashoko inozivikanwa zvinotevera exudative pericarditis. Kana kuzara exudative mvura humwe Change voltage rutapudzo QRS yakaoma uye zvemagetsi shandurudzo ventricular zvivako. Radiographically kuchengetwa yakawedzera mumvuri mwoyo uye kuderera nzvimbo mudunhu ripple. Vascular tsapo haruna kupfupiswa. Dzimwe nguva zvinoita kuona effusion kupinda kuruboshwe pleural mhango.

Echo ECG ari pericardial mhango kuunganidza exudative mvura iri kuchengetwa kubva kumashure rworuboshwe ventricle mwoyo, munzvimbo rwemberi rusvingo. Apo Mavhoriyamu makuru exudative fluid izvozvo kuratidza pamberi rworudyi ventricle mwoyo. On kuwanda vaunganidza mvura iri pericardium haanzverwi pamusoro penguva pakati kunooneka Zvisaririra kubva epicardium uye pericardium.

Pave chinhu akakonzera chirwere

Kuti asimbise etiologic zvinokonzera entailing exudative chimiro pericarditis akatakurwa virological kuongororwa, bvunzo kuvapo dzakananga antibodies (HIV), seeding zvokunyama zvipenyu (semuenzaniso, ropa) kubvisa kutapuriranwa hunhu exudative pericarditis vakatakura tuberculin ganda bvunzo, serological zveBhaibheri fungal chirwere.

Uyewo immunological tsvakurudzo inoitwa systemic zvirwere connective zvinyama, kuona kuvapo Anti-zvenyukireya antibodies, RA chinhu Titre antistreptolysin-O, kutonhora agglutinin - pamwe mycoplasma utachiona, uremia Kutarira serum creatinine uye urea.

Differential chirwere kubva exudative pericarditis

Pericardial effusion iri kusiyaniswa pamwe zvinotevera chirwere masangano: chenjera myocardial infarction, vasogenic marwadzo prollaps mitral vharafu, yakaoma pleurisy.

In chenjera myocardial miokarada marwadzo chirwere kunokonzerwa kuunganidza metabolic zvigadzirwa mumwoyo tsandanyama (myocardium). Marwadzo chirwere myocardial infarction achiperekedzwa vanoverengeka kurapwa uye rabhoritari zviratidzo anozviratidza zvaipesana nechepakati hemodynamics kurongedza arrhythmias, conduction pezvakaitwa mu myocardium, kurega kunotanga mananara duku denderedzwa (pulmonary) wokufambisa hunhu myocardial infarction pamusoro ECG kuchinja. Nemakemikari kuongorora myocardial infarction anoratidza basa cardiac isoenzymes.

Kana yakaoma pleurisy kunokosha chokwadi kuva marwadzo uye zvinhu chokuita kufema, chikosoro, muviri chinzvimbo, ruzha panguva auscultatory kuongororwa kukweshera pleura, vamwe kupfuura pamusoro-kurondedzerwa, zvinofanira kucherechedzwa kuti wakaoma pleurisy hapana nokuchinja firimu electrocardiograms . Kusiyana kutsemuka aneurysm kubva exudative pericarditis inoitwa pakuti mhaka ane majini chirwere - Marfan urwere kana atherosclerotic lesion rayo deko yomukati. Mune zvimwe zviitiko, zvingava kuumba chirwere pericardial effusion.

Symptomatic kutsemuka aneurysm kunoratidza pacharo sezvinotevera: kurwadziwa chokumusoro mubhokisi, pasina irradiation, dysphagia, shoshoma inzwi, dyspnea, chikosoro, kunokonzerwa compression yacho mediastinum. Kutsemuka aneurysms vari panoonekwa kushandisa radiological kuongorora thoracal mhango, echocardiography, uye aortography.

Kana nokupatsanura kutsemuka aneurysm marwadzo kuonekwa pakarepo ari mubhokisi, vane tsika irradiation pamwe yeropa. Panguva iyoyowo, varwere vari chakakomba ezvinhu, kazhinji kunyangarika ripples panyaya hombe tsinga. Auscultation auscultated kutsemuka vharafu insufficiency. Chirwere matanho kana nokupatsanura kutsemuka aneurysm vari: transesophageal Ultrasound uye computed tomography pechipfuva mhango.

Zvaunofanira kuteerera

Zvakakosha kusiyanisa pericardial effusion ICD 10 pamwe diffuse myocarditis, icho pamwe akawedzera mwoyo mhango pamwe zviratidzo kweropa kukundikana. Symptomatic myocarditis kwakaratidzwa mukati zvinotevera nzira: kunogona kurwadziwa anginal hunhu, kunzwa Kutambudzika pamoyo nharaunda, mwoyo mutinhimira nenyonganiso.

Auscultation auscultated muting mwoyo ichirira, kutanga uye chechina mwoyo kurira kunogona bifurcated, iri rondedzero unonzi, electrocardiograph anogona kuona zvinotevera zviri: asi akaremara P chinozunguzirwa, kuchinja muchitokisi voltages zino R, T chinozunguzirwa zvinogona flattened. Panguva echocardiogram zvinokosha akawedzera mwoyo Makamuri kuderera contractility kwemasvingo.

Kuchirapa kupindira pakurapa exudative pericarditis

Vanofungidzirwa chenjera pericardial effusion chinhu chimbi hospitalize kumurwere muchipatara. Kana paine kurwadziwa, hazvo ramakanzi asipurini mune hwendefa chimiro, kuti chipimo chemushonga mumwe giremu mukati penguva ose maawa matatu kana mana. Zvinokwanisika kuwedzera Mahwendefa asipurini indomethacin dose 25 -50 MG, kunwa mvura, kwamaawa matanhatu ose.

Kana zvichiratidza kuti varayire mamwe mhinduro 50% dipyrone nokuda intramuscular vaitarira 2 Rine mamiririta kana marwadzo analgesics (morphine) wevasungwa 1%, dosing kamwe kana hafu milliliters, zvikamu maawa matanhatu ose. Kana psychomotor kugadzikana pamusoro colour ezvinhu kana kushaya hope kugadza "Sibazon" ( "Ini") mukati, kuti chipimo chemushonga pakati 5-10 MG matatu kana mana kanomwe pazuva.

Kubvisa anogumbura pezvakaitwa anowanzodanwa kushandiswa muitiro "Prednisolone" chipimo chemushonga pamusoro 20-80 MG / zuva. mukati nhanho shomanana. Zvipatara pamwe glucocorticoids pamatunhu mishonga rinoitwa mukufamba kwamazuva 7-10, pamwe peculiarity kuti haizopereri chipimo chemushonga inofanira kuderedzwa zvishoma nezvishoma, muna maviri rimwe milligram hafu ose zuva.

panguva kurapwa

refu sei kurapwa pericardial effusion? Marapirwo rinovapo anenge maviri kana matatu vhiki, uye dzimwe nguva unofanira ruoko kuna yakawanda, kunoparirwa yechipupuriro. Specificity kurapwa kunoenderana etiological kuriko kwakaita pericardial effusion.

Panoongororwa nemavhairasi etiology vanotumirwa non-steroidal Anti-anogumbura vamiririri, saka mahormone asina basa. Pericarditis izvo nokuda Streptococcus nemabayo, vari kubatwa zvakasiyana - mishonga inorwisa mabhakitiriya, semuenzaniso, kuti penicillin G chipimo chemushonga 200,000 U / makirogiramu / zuva. nomutsinga kupiwa dose rakakamurwa majekiseni nhanhatu, nguva kurapwa - kwete mazuva asingasviki gumi.

mamwe miedzo

Uyezve, kana akaonekwa pericardial effusion, zvinofanira kuitwa pericardiocentesis (nzira rine kuchirapa uye chirwere zvakasikwa, riri kuitwa panguva chaiyo tsono ponji pericardium kuti yaunodya mvura kuti ongororo). Pashure paizvozvo seeding rinoitwa exudate kuti kuona imwe mhando mutumwa chirwere ichi, zvakakosha kuona kuongorora nehanya zvayo gadziriro antibacterial. Kana akawanikwa anonzi Staphylococcus aureus, kuti idzidziso rinowanzoshandurwa chinotarisirwa "Vancomycin" dose mumwe giremu intravenous zvikamu ose maawa gumi kuchirapa zvazvingava - kubva 14 kusvika 21 mazuva.

Dzimwe nguva, fungal zvirwere zvinogona kukonzera pericardial effusion. Treatment muchiitiko ichi rinoitwa "Amphotericin". The kwokutanga dose yaiva 1 MG, ayo shuga mhinduro ine chikamu akaenzana 5 muzana mashanu milliliters bhuku, dzakabatwa parenterally (via ari tsinga), inodonha kwemaminitsi 30. Kana murwere zvinodhaka zvakanaka akashivirira, ari dosing hurumende shanduko sezvinotevera: 0.2 MG / makirogiramu pamusoro awa rimwe. Zvadaro, mukuru chipimo chemushonga ichiwedzerwa zvishoma nezvishoma kusvika nehafu kana rimwe microgram / zuva. nokuti matatu kana mana maawa pamberi kutanga kunobatsirawo.

Side chaizvoizvo "Amphotericin", izvo zvinofanira kuteerera - nephrotoxic, maererano richiona nezvezvabuda renal nerevane kunokosha. Kana pericardial effusion yakatanga nokuda mishonga, ipapo kurapwa nzira nechinangwa mamwe negashiro nevamiririri ano dzakavharwa uye anowedzera basa kushandisa nonsteroidal Anti-anogumbura yomuchipatara akabatana corticosteroids, ivo pamwe kuguma kufambira kupora, kunyanya kana wanga vakagadzwa kubva pamazuva chirwere mangwanani.