Effusion Pericardial: izimpawu kanye izimbangela. Ukuxilongwa kanye nokwelashwa

Exudative effusion pericardial - isifo libhekene ukuvuvukala e ulwelwesi abami ebusweni engaphakathi pericardium. Ngu ubunjalo pericarditis ukugeleza exudative sibi noma ezingamahlalakhona.

Lesi sifo kungaba serous, oluhambisana, ubovu, fibrinous futhi serosanguineous. Ngo exudative pericarditis fibrinous kwenzeka sebethule fibrin sesigcilikisha ku pericardium, futhi aqoqana ethile oketshezini ingaphakathi pericardial. Ngokuvamile, in the ingaphakathi pericardial iqukethe cishe 20-40 ml uketshezi.

Phakathi acute pericarditis ukuphendula kuhambisana sithuthukiswe exudation yeselula ku ingaphakathi pericardial uketshezi igazi ingxenyenamba. Amacala lapho ukuvuvukala kahle angase athuthe ungqimba subepicardial, okuyinto kakhulu liwohloka umsebenzi walo.

ukushaqeka cardiogenic

Ngokuvamile ekuqongeleleni ngokuzumayo oketshezini ingaphakathi pericardial kungabangela tamponade inhliziyo, okuyinto izimpawu lingaze ukushaqeka cardiogenic:

• palpitations inhliziyo;
• iziyaluyalu zokuphefumula ngoba dyspnea uhlobo;
• yokucindezeleka okwandayo ohlelweni emithambo yegazi kwegazi ezincane nezinkulu;
• wehlise e-systolic blood pressure.

yezinkinga kungenzeka

Nge resorption uketshezi exudative bangase bafinyelele isibanda izicubu, ehlanganisa fibrin, nakho kungaholela esinqunyiwe noma ephelele imperforate ingaphakathi pericardial. Lubohlo yesibazi is esifundeni atrial, ngesikhathi confluence le engenhla nengezansi vena cava, eduze inkatho atrioventricular.

Njengoba i nature okukhulu effusion pericardial kungaholela yezinkinga ezinzima, okuthiwa "itshe inhliziyo" ngenxa calcification we pericardium. Iphuzu elibalulekile enqubeni zokucabanga okubangelwa isifo pericarditis exudative kungukuphula we-diastolic blood ubuyela ventricles inhliziyo. Exudate zanqwabelana ingaphakathi pericardial noma khona pericarditis constrictive kuholela ukuphazamiseka izingqimba subepicardial futhi subendocardial e sokudlondlobala. Ezimweni ezingavamile, cystic we pericardium kungenzeka kwesigaba anwebekayo, nokuyiyona ventricle ezinkulu phakathi diastole ukuqinisekisa kwezidingo evamile igazi enhliziyweni.

Lesi senzakalo ngokuthi fenestration (i- "windi livuliwe"). isigaba systole, esinikela isiyingi ungqimba kwemisipha, ngokuvamile, akusho ahlupheke. Nge ukwephulwa eside of the ukubuya emithambo yegazi ukuze inhliziyo kukhona engalulami igazi Umthambo yamaphaphu. Lapho stasis emithambo yegazi in the letindzala Uhlelo kwegazi ketshezi kuyinto extravasation ku izicubu ezizungezile.

effusion Pericardial: izimbangela (etiologies)

Enye yezimbangela njalo iningi pericarditis exudative kukhona amagciwane RNA-aqukethe (A no B), echovirus, Umkhuhlane A no izifo ezibangelwa amagciwane bemvelo ehlukahlukene (pneumococci, staphylococci, streptococci, mycobacteria sofuba nesikhunta).

isifo Okubukwe kungaba izinkinga Yiqiniso izifo letindzala (SLE, noma Libman-Sacks isifo, amalunga rheumatism, rheumatism, scleroderma letindzala) nokuphazamiseka kohlelo genitourinary (uremic pericarditis). Pericardial effusion ICD kungenzeka wawubonakalisa postperikardialnogo syndrome esakheka ngemva pericardiotomy noma njengenhlangano inkinga ekuseni ka isilethikusebenza ebizwe Dressler Syndrome. Ngokuvamile, kuba khona le inkinga ngesikhathi ngokuqinile kuchazwe ohlakeni, okungukuthi, izinsuku ezingu-15 kuya ezinyangeni 2.

Ngezinye izikhathi exudative pericarditis ingcina singenzeka ngenxa ukungenisa imithi ethile: gidralizin, phenytoin, anticoagulants, ngenxa isicelo njalo procainamide, welashwa ngemisebe. Kulezo zimo lapho effusion esikhulu pericardial Kutholwe effusion okuqukethwe, isizathu kufanele khonga ngaphakathi the Ukudlulela izimila: umdlavuza webele, iphaphu, Sarcoma, lymphoma. Kulezi zimo, exudates ngokuvamile oluhambisana, ngaphansi serous.

Kukhona uhlobo olukhethekile pericarditis exudative, okuthiwa hemopericardium. Lesi simo kwenzeka uma ifinyelela inhliziyo ukulimala endaweni esifubeni inhliziyo projection njengakuqala unokungaxhumani infarction iziguli emva isilethikusebenza, noma sokuhlaziya useshonile yomthambo i-aorta, okubangela igazi igcwalisa ngalo ingaphakathi pericardial. Uma lesi sifo kwenzeka engaziwa causative izici, khona-ke kungokwalabo iqembu nonspecific noma idiopathic.

Ngaphezu kwalokho, effusion pericardial ezinganeni, futhi, ngezinye izikhathi. Izizathu zalokhu yilezi: izifo streptococcal futhi staphylococcal, isifo sofuba, HIV, imithi engalawuliwe, izimila, ukuhlukumezeka, eduze inhliziyo, ukungasebenzi kwezinso, ukuhlinzwa kwenhliziyo.

effusion Pericardial: Ukuxilongwa nezici emitholampilo

Exudate zanqwabelana ingaphakathi pericardial futhi zomile ubuhlungu sibonisa ezidabukile ngenhliziyo, ukuphefumula normal ngohlobo yokuphelelwa umoya, okuyinto kuyehla endaweni awulutho, palpitations. Ukucindezela kwendikimba ketshezi phezu kuqhoqhoqho kanye bronchi ukubangela isifuba esomile.

isimo Jikelele iziguli incike izinga ukwakheka ingxenye uketshezi kule pericardium ngesivinini kancane - isimo eyanelisayo lapho okusheshayo - nokulinganisela ezinzima.

On luhlolo, isiguli kungatholakala izici pericarditis exudative ezilandelayo: ayilutho isikhumba, mucosa izindebe cyanotic, edema nemilenze ephansi, acrocyanosis.

Lapho isifunda ukuhlolwa kwesifuba kungenziwa asymmetry itholiwe, ohlangothini lwesobunxele zingandiswa, lokhu kungenzeka kuphela uma cluster e pericardial exudate ivolumu ifinyelela ezingaphezu kuka-1 litre. Palpation kungathola sici Jardin lapho ngiyibona apical is abangenamakhaya phezulu futhi izibilini, ngenxa ukucindezela kwendikimba, uketshezi zanqwabelana ngaphakathi.

Nesigubhu kungathola ukunwetshwa kwemingcele onokuqundeka isihlobo wenhliziyo yonke indawo: kwesobunxele, ezansi (e izigaba ephansi) ukuba phambili noma phakathi umugqa axillary, e eyesibili neyesithathu intercostal izikhala emgqeni maphakathi no-clavicular, khona ukwahlukana aphansi, kuya kwesokudla SCR (maphakathi umugqa -klyuchichnoy), kanjalo zakha i-engela obtuse esikhundleni evamile ngqo ushintsho umngcele onokuqundeka hepatic. Konke lokhu kungase kubonise ukuthi isiguli effusion pericardial.

iphethini Auscultatory: lube buthaka abukhali we inhliziyo umsindo e sokudlondlobala ngenhliziyo Botkin-ERB nokucubungula xiphoid. Ngo base kwenhliziyo wezwa amathoni elikhulu kukhona ngenxa yokuthi inhliziyo dengwane exudative phezulu uketshezi nasemuva. Noise ngomshikisho pericardial, ngokuvamile auscultation akusho ukuzibonakalisa. umfutho wegazi isiyaphela, ngokumelene isizinda lokwehliswa okukhipha inhliziyo.

Uma ekuqongeleleni uketshezi kwenzeka kancane ngokuhamba kwesikhathi, umsebenzi mechanical inhliziyo isikhathi eside akukhona okhathazekile ngenxa yokuthi ukuthi pericardium yandisa kancane kuleli cala. Endabeni olwenzeka okusheshayo oketshezini effusion pericardial futhi endaweni ijoyina tachycardia, emitholampilo inhliziyo ukwehluleka kanye ukuminyana izenzakalo emibuthanweni kwegazi (ezinkulu kanye nezincane).

Ngokusekelwe ukuhlaziya idatha ECG libhekene pericarditis elandelayo exudative. Lapho ukucinana exudative uketshezi ngokwengeziwe Balisisa voltage ukunciphisa QRS eziyinkimbinkimbi kagesi nokuguqulwa ventricular izakhiwo. Radiographically waphawula ukwanda emthunzini inhliziyo futhi endaweni esibuthaka soMbuso yezwakala wesifunda. i-bundle Umhlinzi akuyona mfushane. Ngezinye izikhathi kungenzeka ukuthola effusion ku kwesokunxele ingaphakathi pleural.

ECG Echo ku pericardial ingaphakathi ekuqongeleleni uketshezi exudative siyenzeka kusukela emuva i-ventricle engakwesobunxele kwenhliziyo, endaweni odongeni labaqaphi elingemuva. Lapho lemiqulu emikhulu uketshezi exudative, uvele phambi ventricle yangakwesokudla senhliziyo. On inani uketshezi zanqwabelana pericardium yahlulelwe isikhawu phakathi Echoes kubonakala kusukela epicardium kanye pericardium.

Ukuqala isici ezibangele isifo

Ukusungula izinto etiologic entailing exudative ifomu pericarditis eyenziwa luhlolo virological, ukuhlolwa khona omzimba athile (HIV), seeding a izinto eziphilayo azithathe (isib igazi) ukuqeda isimo esithathelanayo pericarditis exudative eyenziwa tuberculin isikhumba test, izifundo serological ukutheleleka fungal.

Futhi ocwaningweni immunological iqhutshwe letindzala zezinzwa izifo izicubu, ukucacisa khona amasosha omzimba elwisana zenuzi, i-rheumatoid isici Titre antistreptolysin-O, agglutinin abandayo - ne mycoplasma ukutheleleka, uremia ukubukeka serum creatinine kanye urea.

Imiphumela yaloku kuhlola okungenhla Ukwahlukaniswa ka pericarditis exudative

effusion Pericardial is umahluko nalesi sifo izinhlangano elandelayo: acute isilethikusebenza, vasogenic ubuhlungu prollaps valve mitral, pleurisy ezomile.

Ngo-acute esivimba amanzi miokarada ubuhlungu syndrome kubangelwa ekuqongeleleni imikhiqizo umzimba e imisipha yenhliziyo (myocardium). Ubuhlungu syndrome isilethikusebenza ephelezelwa eziningi izimpawu emitholampilo zokucwaninga azibonakali ayephuli hemodynamics emaphakathi icubungula arrhythmias, conduction izinqubo myocardium, yokujama tsi izenzakalo indilinga lencane (yamaphaphu) ukuzungeza nobuntu isilethikusebenza ku izinguquko ECG. ukuhlaziywa kwamakhemikhali isilethikusebenza ibonisa umsebenzi ka isoenzymes inhliziyo.

Lapho pleurisy owomile qiniso elibalulekile kokuba ubuhlungu futhi izici ezihambisana ukuphefumula, ukukhwehlela, isikhundla umzimba, umsindo auscultatory luhlolo ngomshikisho pleura, ngaphandle ngenhla echazwe, kufanele kuphawulwe ukuthi pleurisy ezomile azikho izinguquko ku ifilimu electrocardiograms . Ngokungafani useshonile yomthambo i-aorta kusukela exudative pericarditis liqukethe e yokuthi imbangela isifo esidluliselwa ngofuzo - syndrome-Marfan noma lesion atherosclerotic egobolondweni layo. Kwezinye izimo, kungase akha effusion ezingamahlalakhona pericardial.

Okunezimpawu useshonile yomthambo i-aorta kuzibonakalisa kanje: ubuhlungu esifubeni engenhla, kungekho ngemisebe, dysphagia, izwi hoshozela, dyspnea, ukukhwehlela, kubangelwa kokucindezelwa we mediastinum. aneurysms yomthambo i-aorta uxilongwe usebenzisa luhlolo radiology we thoracic ingaphakathi, echocardiography, futhi aortography.

Lapho ehlukanisa izingxenye zomzimba yomthambo i-aorta useshonile ubuhlungu zavele esifubeni, bathambekele ngemisebe kanye le-aorta. Ngesikhathi esifanayo, iziguli ngisesimweni esibucayi, ngokuvamile ukunyamalala enyakaza phezu Umthambo ezinkulu. Auscultation auscultated yomthambo i-aorta ne-valve esingamahlalakhona. izinyathelo kwesifo uma sokuhlaziya useshonile yomthambo i-aorta yilezi: ultrasound transesophageal futhi computed tomography we umgodi esifubeni.

Lokho kufanele sinake

Kubalulekile ukwehlukanisa pericardial effusion ICD 10 ne myocarditis ehlasela umzimba wonke, okuyinto kuhambisana kweNdikimba ingaphakathi inhliziyo nge izimpawu ukwehluleka kwegazi. myocarditis okunezimpawu ukuvela ngendlela elandelayo: kungaba buhlungu anginal nemvelo, umuzwa wobukhulu endaweni inhliziyo, inhliziyo isigqi thuthuva.

Auscultation auscultated inhliziyo ukuthulisa umsindo, kuqala neyesine inhliziyo umsindo kungenzeka bifurcated, e incazelo electrocardiogram ungakwazi ukuthola izici ezilandelayo: i-sikhubazekile P igagasi, ushintsho kuseli voltages izinyo R, T wave kungenziwa isicaba. Phakathi echocardiogram ukukhulisa Kuyaphawuleka kwamakamelo inhliziyo bese wehlise contractility izindonga.

ezelaphayo ekwelapheni pericarditis exudative

Okusolwayo acute effusion pericardial kuyinto kunesidingo esiphuthumayo hospitalize isiguli esibhedlela. Uma kukhona sebuhlungwini obunzima, aspirin ngempela ebekiwe efomini ithebhulethi, umthamo owodwa igremu ngaphakathi isikhawu njalo ngemva kwamahora amathathu noma amane. Kungenzeka ukwengeza amaphilisi aspirin umthamo indomethacin 25 -50 mg, amanzi okuphuza, esingaba njalo emahoreni ayisithupha.

Uma kunezinkomba zokuthi linqume isixazululo eminye 50% dipyrone kwezokuphatha esicutshini ka 2 ml noma analgesics kwelashwa (morphine) lokuhlushwa 1%, nokushintsha kokudla nokufakwa kanye noma namamililitha nengxenye, ngezikhawu njalo emahoreni ayisithupha. Lapho lengqondo ukuyaluza ngaphansi kwesimo isimo noma ukuqwasha ukhombe "Sibazon" ( "i") ngaphakathi, umthamo 5-10 mg kathathu noma kane ngosuku.

Ukuqeda izinqubo ukuvuvukala avame ukusetshenziswa umkhuba "Prednisolone" umthamo 20-80 mg / usuku. ngaphakathi ngezinyathelo ezimbalwa nje. Ukwelashwa nge glucocorticoids ebulilini Kwenziwa ngokuhamba kwezinsuku 7-10 of, ne engavamile ukuthi umthamo okwalandela kumele kancane kancane, e amabili nesigamu milligram nsuku zonke.

Phakathi ukwelashwa

isikhathi esingakanani iphathwa effusion pericardial? Le nqubo yokwelapha ithatha cishe amasonto amabili noma amathathu, futhi ngezinye izikhathi kuzodingeka ngelule kuya ezinyangeni eziningana, ngokuqinile ngomlomo. Ngokucacile ukwelashwa incike isici etiological oholele effusion pericardial.

Ekukhombeni omsakazo viral babelwa non-steroidal ejenti eqeda ukuvuvukala, ngaleyo ndlela-hormone ayizange inikezwe. Pericarditis okuyizinto ngenxa Streptococcus inyumoniya, baphathwa ngokwehlukile - antibiotic, isib, umthamo penicillin akuzange kusize G 200,000 U / kg / usuku. ngemithambo yegazi umthamo inikezwe sehlukaniswe imijovo eziyisithupha, ubude ukwelashwa - hhayi ezinsukwini ezingaphansi kweziyishumi.

ukuhlolwa okwengeziwe

Ngaphezu kwalokho, uma kutholakala ukuthi uphethwe yini effusion pericardial, kufanele iqhutshwe pericardiocentesis (inqubo kokuba zokwelapha kanye kusebenta kwahulumende ngokwemvelo, okuyinto eyenziwa endaweni ekhethekile inaliti wokubhoboza pericardium ukuze uketshezi eyanele ukuze uthole ukuhlaziya). Ngemva kwalokho zokutshala wenziwa exudate ukuze sithole uhlobo oluthile ejenti yalesi sifo, kubalulekile ukucacisa ukuhlaziya ukuzwela yayo amalungiselelo elwa namagciwane. Uma kutholakala Staphylococcus aureus, ekwakhiweni ngokuvamile iqondiswa "Vancomycin" umthamo owodwa igremu ngezikhawu emthanjeni njalo ngemva kwamahora nambili izinga zokwelapha - kusukela ezinsukwini ezingu-14 kuya kwezingu-21.

Ngezinye izikhathi, izifo fungal kungabangela effusion pericardial. Ukwelashwa kulokhu wenziwa "Amphotericin". Umthamo kokuqala kwaba 1 mg, solution yayo glucose ne amaphesenti alinganayo kwabangamaphesenti angu-5 kanye namamililitha amahlanu ivolumu, iqondiswa parenterally (nge vein), ukuvuza 30 amaminithi. Uma isiguli isidakamizwa kwamukeleka kahle, sokuphuzisa umbuso ushintsho ngendlela elandelayo: 0.2 mg / kg isikhathi esingaphezu kwehora. Ngemva kwalokho, umthamo luyanda kancane kancane kuze kube nengxenye noma omunye microgram / usuku. amahora amathathu noma amane ngaphambi ukuqala nomphumela omuhle.

side effect "Amphotericin", okuyinto kufanele sinake - nephrotoxic, ngokuqondene ukuqapha umsebenzi kwezinso kuyadingeka. Uma effusion pericardial umsuka ngenxa imithi ke isu ukwelashwa kuhloswe ukuba reception okwengeziwe kwala magciwane inqanyuliwe futhi ngaphezu kwalokho nika ukusetshenziswa nonsteroidal ejenti eqeda ukuvuvukala lihambisana corticosteroids, bona bebonke nomphumela ukululama ngokushesha, ikakhulukazi uma bamiswe kusukela ezinsukwini zakuqala sifo.