Tsananguro pneumothorax: mhando zvirwere, inokonzera, kuongorora chirwere uye kurapwa

In dzakawanda dzinoti pamusoro vanachiremba uye matikitivha, isu kazhinji kuona mashoko, zvinoreva izvo zvinoreva zvakaipa kana havanzwisisi zvachose. Somuenzaniso, pneumothorax. Chii chinonzi chirwere ichi? Zviratidzo, zviratidzo izvo nechimbichimbi mudonzvo saka zvakarurama kusarudza kuvapo kwayo, uwandu rubatsiro, uye zvimwe nyaya shure nhoroondo dzakawanda. Munyaya ino uchawana mhinduro kuti chichabatsira dzokumabvazuva mune nemamiriro ezvinhu akaoma.

tsananguro

Pneumothorax - ndiko kuunganidza mhepo kana zvimwe gasi munzvimbo thoracal mhango. Kakawanda richiwanika pashure yokukuvara somugumisiro pachena pakakuvara mbabvu kana kukuvadzwa yemapapu banzurwa remafupa, uyewo pamusana atsamwira nokuda zvemapapu pute, kuvhura nzombe kana kubvunda madziro bronchus malignancy. Secondary pneumothorax kunongova kuenderera munhu kwenguva refu pulmonary chirwere.

Clinical zvinoratidza zviratidzo kunoenderana achinyanya nokukurumidza sei mhepo anozadza pleural mhango. Kazhinji, chirwere zvinogoneka pashure pakuongorora murwere panzvimbo. Dzimwe nguva, dzimwe nzira kuongororwa, akadai X-ray.

Treatment Kazhinji zvomusejari. It zvakafanana nokubviswa mhepo kubva chipfuva mhango nokuda abudise kana ponji, nokudzosa mashandiro mapazi ari mediastinum uye kudzokera navo pazvigaro zvavo.

Kukurukurirana pamwe zvekunze zvakatipoteredza

In chimiro pane zvakasiyana zvakawanda pneumothorax. Zvirwere vanovimba iro divi aumba mugomba (kunze kana mukati muviri), uyewo ukuru hwaro uye gasi inflow unodiwa.

• Closed pneumothorax chirwere muzviitiko apo pleural mhango Falls kuduku rakawandawo gasi kuburikidza duku buri, kwete kutaura navo kwokunze kwezvakatipoteredza. The kumanikidzwa ari mubhokisi mhango rwuchiwanzwa zvishoma nezvishoma, uye ndiko kuremara akavharwa woga, pasina rumwe rubatsiro. Air matema zvishoma nezvishoma kuiparadza pakati machira ane pleura, bapu, uye zvinotora zvarakanga chimiro.
• Open pneumothorax hwapedyo kupa rakapinza Maronda pechipfuva rusvingo, kana atsamwira hombe bronchus. Nguva dzose anotaura nemashoko kwokunze kwezvakatipoteredza. Nokuda kufurirwa ichi akaipa munyaya dzomunyika mhango dzichienderana mumhepo muviri iro chiedza collapses, uye mhepo hazvirevi ichiyerera mariri.

• Nezvinonetsa kana pneumothorax vharafu chete anooneka kana akabatanidza kunotevera (muchikuvadza bhokisi rusvingo pleura kuchikuvadza uye atsamwira huru principales), uye inozivikanwa kuti mhepo anopinda muviri mhango pamusoro inhalation, asi haaregi wake exhale. The kumanikidzwa ari pleural mhango iri kutanga zvichienzaniswa mumhepo uye inoramba ichiwedzera. Somugumisiro mediastinal nhengo dziri misha uye compressed.

pathogenesis

Kuti zvakanaka kubatsira, zvinokosha kuziva kuti pneumothorax aumbwa, mhando yayo. Physiology iyi kwacho nhema pakuti mune kuipa pleural mhango mukati akaipa kumanikidzwa. Izvi zvinobatsira chengeta mumapapu iri rakawedzerwa mamiriro, uyewo zvinoita kuti ukurumidze kupanana magasi ari Formação de. Kana chipfuva tightness raputsika uye mhepo rinotanga kuzadza pleural mhango, mapapu kudzikisa inzwi.

It chacho chakaipa mweya, uye somugumisiro munhu anotanga kumudzipa. Mukuwedzera, mhepo anorumanya uye displaces mediastinal zvomukati: moyo, yeropa, yegurokuro, zvichiita kuti zviome kuita basa ravo zvakananga mabasa.

etiology

Kubva dzechimwe mumiririri napo chii chichava pneumothorax. Etiology, mifananidzo, pathogenesis, kurapwa anokuzviratidza uye kurapwa yakatsauka inextricable musoro pachiremera zivo inogona kuponesa upenyu, kunyange kana usina chokuita zvokurapa.

1. espontáneo pneumothorax chinhu pakakoromoka guru bronchus kana zvemapapu parenchyma haina chokuita zvemaziso kukuvara pechipfuva. Rakakamurwa mapoka makuru maviri:

• The chikuru, kana idiopathic, hapana chikonzero pachena. More chinowanzoitwa majaya vakareba kupfuura vakadzi vezera nokuvaka. Izvi zvinogona kutsanangurwa nemashoko anotevera zvinhu zvinoti: Kumwe kuchinja kunotanga ari zvemapapu nokuda nemagene akaremara synthesizing enzayemu Alpha-1-antitrypsin, riri munyaya dzose kushanda Formação de; pleura zvakare dzakaonda, izvo zvinogona kutyora kubva kunyora nezvavo kumanikidzwa inodonha, zvakadai vangakosora kana sneezing; kungoerekana kumanikidzwa donhwe kana achikwira mugomo (gomo chirwere) kana anyatsofukidzwa pasi mvura (caisson chirwere).
• Secondary pneumothorax achiumbwa pasi pakanyorwa hunotovapo zvirwere zvemapapu akadai COPD (chirwere obstructive pulmonary chirwere), cystic fibrosis uye asima.

2. Zvinonyanyozivikanwa zviitiko zvinorwadza pneumothorax. Mhando akuvara vanowira mhando mbiri: rakapinza kukuvara pechipfuva mhango (sliced, wakatemerwa maronda, akazaruka mitswe pakati mbabvu); gomara bhokisi kunotevera (avtotravmy, kupwanya pakati mira zvinhu vanosiyira).

3. Munguva kurapwa uyewo regai haabatanidzi nechitarisiko pneumothorax. Muzviitiko zvakadaro, kunonzi iatrogenic. Njodzi zvinosanganisira pleura kana zvemapapu biopsy, chirwere ponji tigutsikane abscesses uye cysts, inoshandiswa pakutsigira subclavian anobudisa mushonga zvishoma nezvishoma uye barotrauma kubva ALV (chakagadzirwa zvemapapu kufefetedza).

kiriniki

Mushure Kubvunzisisa kuzviongorora murwere chiremba anoteerera nokukundwa muchipfuva marwadzo, kupfupika mweya, nokukurumidza kufema uye mwoyo zvazvingava, yakaoma chikosoro. Chenjera vhunduka angavawo pamusana pneumothorax. Types kukuvara uye hunhu kukuvara, dzimwe nguva kunyange nemaziso detectable, zvichabatsira kupedzisa nechirwere uye kutungamirira murwere kuti kurapwa. Izvi zvinogona kuva zvomusejari kana dzokurapwa kuchipatara kana zvashata dhipatimendi. Zvose zvinoenderana kwokuomerwa mamiriro uye yakananga kukuvadza.

Diagnostics

Sezvo ini ataurwa pamusoro apa, muchiziva mashandiro, iyo yave kunzi pneumothorax, marudzi uye differential. chirwere hakusi nyore. Zviri zvokuti vazvidavirire kwokunze kuongorora chipfuva zvemapapu auscultation zvakafanana, ichibata zvikamu (kuenzaniswa Vakagwinya chikamu murwere). Kana ukaona kukuvadza asingagoni, ipapo kuti ave nechokwadi chose uchida kutumira murwere kuti maekisirei kana CT Scans. Mhepo hazviratidzi radioactive nemwaranzi, uye naizvozvo pachanyatsoonekwa kuoneka mufananidzo.

Sezvi- nzira ungashandisa tsanangudzo gasi ropa (kuitira kuti aone kana pane zvinoshamisa kuchinja yakananga hypercapnia), electrocardiography (kudzivisa matambudziko akadai mwoyo kukundikana), uyewo kushandisa kuvhiya kubvunza (ichi kunowanzoitwa panguva padariro kuongororwa murwere ari zvashata dhipatimendi).

chimbichimbi

Pasinei rakasiyana-siyana pneumothorax, rubatsiro rwekutanga ipfupi kuzodana amburenzi. Sezvo untrained munhu kubata kukuvara mupfungwa, ungangova, ipapo unofanira ruzivo kunotevera chiremba. Chinhu bedzi anogona kuitwa nyaya rakavhurika musiyano wezvinyorwa chirwere - iri kumanikidza rakanamwa gobvu bhandeji paronda. Unogona kushandisa oilcloth, epurasitiki wrap kana gobvu donje-gauze. manipulations izvi zvichabatsira kuumba namahwindo pneumothorax.

Species kukurumidza pre-wezvokurapa rubatsiro uye chepuraimari chirwere chirwere ichi inofanira kusanganisirwa mukati kutsanangurwa ruzivo chero munhu, wokupedzisira gore vadzidzi (vehurumende kudzivirira). Ipapo achakwanisa zvakakwana kuongorora mamiriro ezvinhu uye kusarudza zvakanaka.

mabatiro

Chinhu chokutanga kuziva chaizvoizvo hworudzii pneumothorax mune murwere. Kana kuwanda mhepo pakati pleural machira zvishoma, kubatsirwa chaizvo arege inodiwa. Zvishoma nezvishoma kugadzirisa. In Kana apo uwandu gasi kazhinji chinonditadzisa nyore kuvhura, inofanira aspirated aine sirinji kuburikidza puncturing iri pleural mhango. Izvi zvichabatsira kuti nokukurumidza kubvisa pneumothorax. Types (chimbichimbi kutarisirwa zvinoenderana ichi) zvirwere zvinokosha, nokuti anoda ZVAKASIYANA. A yakawanda kukuvara kungada kugadzwa mumwe-mativi abudise Byulau.

Uyezve, kana hombe makuvaro yaida Kuvhiya kupindira nokuda kuvhara zviri zvemapapu parenchyma, pleura uye Árbol kuremara, uyewo kuvhara kuti rakapinza Maronda pechipfuva.

Sezvo symptomatic kurapa yakarumbidza dzokutindivadza uye yakachena inhalation. Kana pneumothorax Zvikamu inodzokororwa kakawanda, murwere anogona zano kuti vabereke pleurodesis - pokunamatidza pleura pamwe chete.

Matambudziko uye fungidziro

Uyewo pashure chero chirwere, pane nguva dzose mibairo okutambura pneumothorax. Marudzi nawo iyi kutamba zvishoma basa. Panzvimbo yokutanga pakati matambudziko unokosha ropa kana hemothorax. Shure kwake kugara pleurisy (kuzvimba connective zvinyama uye nokuumbwa adhesions pakati pleura) uye subcutaneous emphysema (mhepo kupinda zvinyama pasi ganda). murwere anogona kufira chinokosha nzvimbo kukuvara uye kunonoka rubatsiro.

dziviriro

Kuitira kudzivirira kukura pneumothorax, zvakakwana kuchengeta mashomanana mitemo nyore:

• Zvinoenderana Nenguva uye zvakazara kubata kufema maitiro uye kudzivirira matambudziko ayo, zvichiita kuti paumbwe simba pfungwa iri zvemapapu uye pleura.
• Tipei tsika dzakaipa, zvikurukuru - kubva kusvuta.
• Edza kudzivisa dambudziko pechipfuva.
• Tora matanho kudzivisa apiwa pneumothorax.