Kuthiwani uma oketshezini ingaphakathi pleural: Ubangela futhi Ukwelashwa

Uma endaweni pleural iqala buthelela uketshezi (effusion), khona-ke isimo esinjalo sina sokugembula kungase kubonise ukuthi umzimba eba nesifo esithile, futhi ngempela yingozi. Uma sisheshe satholakala zokugula ngezindlela ezihlukahlukene, futhi ngaleso sikhathi udokotela lunquma ukwelashwa okufanele.

Kwezinye izimo, ukuqongelela izinto eziwuketshezi ezinjalo kungase kubangele decompensation nokuvaleka kwemigudu yokuphefumula, ngokuvamile okuholela ekufeni. Ngaphezu kwalokho, lesi sifo kuhambisana eziyingozi kakhulu. Ngakho-ke, ukwelapha lesi sifo kufanele waqala ngokushesha ngangokunokwenzeka.

ulwazi olujwayelekile

emaphashini Human sizungezwe ulwelwesi ezimbili, ebizwa ngokuthi i-pleura. Engaphandle ijoyina odongeni esifubeni wezangaphakathi - emaphashini nezinye izicubu. Kumiswa igebe is phakathi kwawo, ngokuthi ingaphakathi pleural noma ukucindezeleka.

uketshezi Mahhala ku pleural ingaphakathi izenzo njengendlela lubricating ingxenye evele pleural, okuvumela izingqimba ngesikhathi ukuphefumula ngokukhululekile sehla ngokumelene nomunye. Lokhu kunomthelela ukungezwani surface, okuvumela ukuba ugcine kobuso wamaphaphu kanye odongeni kwesifuba. Inani oketshezini ingaphakathi pleural kumele kube 4 amathisipuni. Uma kuwumphumela ukugula iqala buthelela, umthamo yayo ongafinyelela 5-6 amalitha.

Uketshezi zanqwabelana ingaphakathi pleural kungaba nhlobonhlobo:

• igazi, pleural uma izitsha ezilimele;
• isimo sokungakhethi kwesikhwama sokuvuvukala uketshezi (transudate);
• ubomvu noma uketshezi nazo ukuvuvukala pleural (exudate).

Ukubuthelela igazi ngokuvamile kwenzeka ngenxa ukulimala imithambo yegazi, okuyinto eyenzeka ngo-ukulimala. Lymph ingena ngaphakathi komgodi pleural lapho ukulimala uvule imbobo thoracic, okuyinto ama-lymph isitsha ezinkulu.

Transudate angase buthelela iyiphi komgodi uma umzimba is ehlelekile obala kunoma enqubweni yesistimu. Isibonelo, lokhu kungaba ukunciphisa umfutho wabo wegazi ngenxa omkhulu igazi ukulahlekelwa, noma ukusha. Futhi, khona transudate kule ingaphakathi pleural siyenzeka esimweni izitsha kwandisa ingcindezi hydrostatic okungukuthi ukuhluleka inhliziyo.

Uketshezi ingaphakathi pleural, ikakhulukazi exudate aqoqana ukuvuvukala. Lokhu kungaba i-pneumonia, umdlavuza, pleurisy.

izizathu

Lolu ketshezi zanqwabelana ingaphakathi pleural, - ukuphazamiseka okungukuthi yesibili. Lokhu kusho ukuthi ukuthuthukiswa lesi sifo kwenzeka phezu zangokwasemuva zezinhlelo ogeleza yomzimba yomunye isifo.

Kuyini lokhu? Yisiphi isono, uma uketshezi zanqwabelana ingaphakathi pleural? izizathu ezingase kanje:

• Chest ukuhlukumezeka, okuholela imithambo yegazi eziphukile, ngokufanele phakathi izimbambo. Kungase kwenzeke thoracic imbobo ukudabuka.
• isifo besisu, isimo sokuvuvukala esindayo. Exudate iqala buthelela ekuphenduleni isibindi ithumba, pancreatitis, ithumba subdiaphragmatic, peritonitis.
• izifo Oncological kuthinte pleura, hhayi kuphela njengoMhlengi ukugxila okukhulu, kodwa futhi kumiswa metastases. kuphakama izimila Primary kusukela amaseli mesothelium uyohlangana nabantu abasebenza ezinkampanini asbestos. Izibikezelo icala okungekuhle. Uma Ithumba kungavamile ukuba ingozi, onalesi sifo ngokuvamile Kuyakhuthaza.
• ukumelwa inhliziyo, okuyinto enomthelela blood pressure.
• Isifo samaphaphu. Ukuvuvukala kungathatha indawo kokubili we parenchyma wamaphaphu pleura eduze ngokwanele ukuthi kuphakamisa ukuvuvukala ekuqongeleleni uketshezi ukujula.
• Izifo ezithathelwanayo kanye nomzimba.
• Isifo sofuba.
• Myxedema (edema mucosal) umphumela ukuntula umsebenzi yegilo.
• embolism yamaphaphu syndrome imithambo uma kukhona kumiswa infarction yamaphaphu nge ekuqongeleleni alandelayo transudate.
• Uremia, okwenzeka ukwehluleka kwezinso. isimo esinjalo nobuntu kwezitho zomzimba eziningi, glomerulonephritis, sepsis, haemolysis omkhulu kwamangqamuzana egazi abomvu, ukugula ngemisebe.
• Lefundo zezinzwa izifo izicubu: periarteritis nodosa, omzimba izicubu erythematosus, okuyizinto imbangela ekuqongeleleni exudate.

izimpawu

Kungakhathaliseki ukuthi kungani kube khona ekuqongeleleni oketshezini ingaphakathi pleural, nokuvaleka kwemigudu yokuphefumula kungenzeka. It kubonakala ngendlela elandelayo:

• ubuhlungu ohlangothini lwesobunxele noma kwesokudla;
• dyspnea, iphika;
• isifuba esomile lapho kwenzeka ngenxa yokucinana umthamo bronchi enkulu uketshezi;
• nemilenze bluish ngenxa yokuntuleka umoya-mpilo;
• ukwandisa izinga lokushisa emzimbeni ngenxa ukuvuvukala.

Ake sihlole kabanzi izimpawu akhomba ekuqongeleleni oketshezini ingaphakathi pleural e izifo ezithize.

ukulimala

Chest ukuhlukumezeka noma wamaphaphu kuholela ukuthuthukiswa ngokushesha esingamahlalakhona zokuphefumula. Ngakho lapho hemoptysis, umlomo foamy isikhwehlela livela ebomvu. Uye waba ukwephulwa ukwazi, isikhumba kuba tint bluish, umuntu angase awele equlekile.

Ngezinye ukudabuka we thoracic aorta igazi iqala agelezele ingaphakathi pleural, okuholela komfutho ukulahlekelwa futhi oluhambisana ukushaqeka. Londoloza umuntu cishe kungenakwenzeka.

izifo Oncological

Esimeni khona mesothelioma oketshezini ingaphakathi pleural sokugcina ekuthuthukiseni izimila. Singasho ngokuqiniseka okukhulu ukuthi ukufa kuyakuza izinyanga 7-10. Fluid ngoba leso sifo libhekene ukwehla elibukhali ezingeni glucose kulo, viscosity asidi i-hyaluronic, futhi ngokuvamile igazi.

inyumoniya

Izimpawu ezilandelayo pneumonia siyobonisa ukuthi inqubo sokugembula senzeka parenchyma wamaphaphu:

• umkhuhlane;
• ukukhwehlela ezimanzi;
• ubuhlungu yansukuzonke ohlangothini lwakhe;
• iphika;
• crackles;
• ukudakwa ezinzima.

ukuhluleka kwenhliziyo

Uketshezi zanqwabelana ingaphakathi pleural ukuhluleka inhliziyo kuzibonakalisa kanje:

• ngenxa yobuthakathaka;
• ukukhathala;
• inhliziyo iqala ukusebenza ngezikhathi ezithile;
• ukuntula isifiso semisebenzi ngokomzimba;
• ubuhlungu besifuba.

ukuhlola

Kakhulu ulwazi indlela zokuxilonga kubhekwa esifubeni esimweni, kusiza ukuqinisekisa ubukhona zokugula ezifana syndrome oketshezini ingaphakathi pleural, noma ukungezwakali kwawo. Lokhu kakhulu kusiza umsebenzi udokotela ekumisweni ukwelashwa okufanelekile. Radiographs usetha ngokunembile izinga lalolu ketshezi nevolumu eseduze kwayo, khona kanye ukungabikho emoyeni.

Kuyadingeka ukucacisa ubunjalo effusion, futhi kuze kube manje, i-wokubhoboza wenziwa. Ngenxa yale njongo, okuqukethwe ketshezi othathwe ingaphakathi pleural ukuze kutholakale isilinganiso nenani amaprotheni, isisindo othize, umsebenzi dehydrogenase lactate. Feza kwezitshalo ku isikhunta, ama-bacterium, ama-bacterium acid-fast. Uketshezi kungenzeka igazi, ubomvu, serosa. Ukuthola uketshezi igazi ebonwe ukuhlukumezeka, esivimba amanzi umdlavuza wamaphaphu iziguli ezine ukuzibandakanya pleural. exudate ubovu aqoqana ukumelwa inhliziyo, futhi serous - emva izifo ezithathelwanayo.

Libuye kuyindlela enhle ngeso lengqondo emaphashini nasesifubeni-CT scan kubhekwa. Inzuzo yayo itholakala iqiniso ukuthi inqubo ikuvumela ukunquma ngokunembile obusamanzi akhululwa futhi imbangela yalesi simo. Pulmonologists ukuncoma ukuchitha CT scan njalo ngemva kwezinyanga eziyisithupha. Lokhu kuvumela uhlelo ukuhlonza ekuqongeleleni oketshezini pleural ingaphakathi syndrome.

ukwelashwa

Nge ekuqongeleleni okuncane uketshezi belashwa kuphela ezihleli isifo. Inani elikhulu effusion, ikakhulukazi uma kuphakamisa kwesifuba adinga amanzi ukuze kuqedwe lesi sifo. Ngokuvamile ketshezi kuyinto okukhipha nge wokubhoboza, lapho pleural ingaphakathi ipayipi noma inalidi encane. Ngokuvamile, needling Kwenziwa ngezinhloso zokuxilonga, kodwa phakathi nenqubo ethile yokuthola letinjalo ukumpompa angu-1.5 wamalitha effusion. Okuningi wokusula is hhayi Kunconywa, njengoba kwenzeka ingozi edema yamaphaphu.

Ukuze susa zanqwabelana semali uketshezi odongeni esifubeni ngokusebenzisa tube yayo yethulwa. Le nqubo Kwenziwa kanje: emva udokotela izinzwa wenza imbobo bese ifaka ngamapayipi plastic phakathi emaceleni womabili esembatho esifubeni. Ngemva kwalokho, yena uxhuma yona isimiso sokukhuculula, okuyinto ayikuvumeli emoyeni ukuze singene ingaphakathi pleural. Ukusebenzisa uchwepheshe ukulawula-X-ray icacisa lesifanele ukufakwa tube, kusukela amanzi akunakwenzeka ngenye indlela.

Uma oketshezini ingaphakathi pleural zanqwabelana ngenxa sofuba noma coccidioidomycosis, kulesi simo, ke zidinga ukwelashwa eside ngemithi elwa namagciwane. Amanzi afeze eziyinkimbinkimbi ngaphansi ubomvu viscous kakhulu, noma uma kuwukuthi fibrous "ephaketheni", ngakho isimo ezingelapheka kuphela ngokususa ingxenye ubambo ukwethulwa a amanzi ipayipi elikhulu. Akuvamile ukusebenza okudingekayo ukuze asuse olwelwesini pleura.

Isimila Pleural futhi kuholela yokuthi ketshezi uqala buthelela ngaphakathi komgodi pleural. Ukwelashwa kulokhu eside ngempela, njengoba kungaba nzima ukuqeda exudate ngenxa ekuqongeleleni yayo okusheshayo. Zifika amanzi usizo nokwamukela izidakamizwa anticancer. Nokho, uma lezo zindlela kungasebenzi, futhi uketshezi uyaqhubeka buthelela, ukuhlukaniswa Kwenziwa ingaphakathi pleural. Yonke ivolumu exudate isuswe ngokusebenzisa tube, bese iya pleural ingaphakathi therethrough iqondiswa ecasulayo, ezifana talc noma isixazululo doxycycline. Nge umfutho enjalo kwenzeka jointing izingqimba ezimbili pleural, futhi akukho isikhala mahhala ekuqongeleleni ketshezi.

Uma umgodi pleural igcwele igazi, kuze wayeka ukopha, Kwenziwa ngokusebenzisa tube amanzi okuyinto liyasetshenziswa ekuphathweni izidakamizwa ukuthi sokudiliza amahlule. ukopha eqhubekayo noma ukungakwazi ukususa uketshezi ngokusebenzisa ipayipi - izinkomba lokungenela kuhlinzwa.

yezinkinga

Zanqwabelana ingaphakathi pleural uketshezi, ikakhulukazi esiningi, kungaholela uquqaba ukuxakeka. Kungaba acute yamaphaphu esingamahlalakhona, ukuvuvukala isifo imvelaphi, izinkinga ababa nazo kokusebenza kwesibindi, inhliziyo nezinye izitho zangaphakathi wamaphaphu.

Njengoba uketshezi futhi ubomvu babe awokuthi ukusabalalisa ngaphakathi komgodi ongaphakathi kwamathumbu, kufanele kulindeleke yezinkinga kusukela pheshana emathunjini. Lolu hlobo exudate zanqwabelana endaweni pleural kuyisici, ngokuvamile okuholela ekufeni noma ukukhubazeka ethola umuntu. Lokhu kusebenza isidingo resection kwamanyikwe noma ubende.

yezinkinga okunjalo kungavuka kokubili amadoda nabesifazane babo bonke ubudala, ngakho ukwelashwa kufanele iqalwe kusenesikhathi futhi ukusebenzisa izinyathelo.

zokuvimbela

Ukuze ugweme okuvela izifo ukuthi kungabangela ukunqwabelana oketshezini ingaphakathi pleural, kufanele ngokushesha ngayo. Uma yokwelapha ama-antibiotic noma ekumhlinzeni, ukuthuthela izenzo ezengeziwe. Lokhu kungaba ayenqaba imikhuba emibi, enempilo, ukuthatha Vitamin izakhiwo kanye izingxenye ocebile ewusizo izidakamizwa.

Izinyathelo kufanele lifake inhlonipho umsebenzi ngokomzimba futhi uhlobo olukhethekile lokudla. Kufanele kudliwe nsuku zonke ngangokunokwenzeka, izithelo ezithile zonyaka nemifino, amaphrotheni zemvelo, carbohydrate, amafutha, inyama. Odokotela batusa ukuvivinya umzimba nsuku zonke, iqeda uhambe eziningi ngezinyawo. Le ndlela ekugwemeni izifo 100% ngempumelelo.

isiphetho

Ngakho lokho uma uketshezi zitholiwe ingaphakathi pleural? Isizathu sokuba isimo sokugembula sinjalo ukuthuthukiswa lesi sifo, ngokuvamile sina ngempela. Kwezinye izimo, lesi sifo Kwavela kungaholela ekufeni. Qiniseka ukuthi uthintane onguchwepheshe, ngubani emva izinyathelo zokuxilonga uzoqoka ukwelashwa ezifanele futhi abanekhono. Ukuze uvimbele ukuthuthukiswa ekuvimbeleni izifo kufanele ilandelwe.