Mendelson Syndrome ukubonakaliswa. Sinzima nezifo zokuphefumula

Kuningi yezinkinga singenzeka ezigulini egunjini labagula kakhulu. Enye yalezi uthi iyona olunzima Mendelson Syndrome.

Hlobo luni zokugula?

Ngu Mendelson Syndrome uvame kwakusho obstructive isifo samaphaphu kanye izilonda izicubu wamaphaphu (pneumonitis), ukuthuthukisa ku ngemuva falling of juice esiswini ku yomoya. Lesi simo waba owokuqala owachaza lesi ngo-1946. It is ebonwe abagula ngokuhlolisisa abaye wathola ukulimala ekhanda, ukuhlinzwa kwamathumbu (besisu ikakhulukazi) nokubeletha. Ezimweni eziningi, umsunguli lolu hlobo zokugula is izinzwa (ngenxa ke ephumula imisipha bushelelezi). Ngaphansi kwesimo esikhululekile futhi ulahlekelwe imisipha ithoni kwenzeka nenshisekelo (ephefumula) okuqukethwe esiswini (ngokuvamile kuphela juice esiswini). Imiphumela iba yinhlanganisela yokukhandleka ukunqotshwa njengoba isihlahla bronchial kanye wamaphaphu izicubu. Isimo sisibi kakhulu, kungaholela ekufeni uma ukwehluleka ukunikeza usizo olufanele. Kuyinto ukuqonda kabanzi ukuthi kungani kukhona isifo ezimbi ezifana nokuthi kufanele kwenziwe.

izizathu

Ngu ukuthuthukiswa Mendelssohn Syndrome kungabangela izifo eziningana. Lezi zihlanganisa:

• Pathology isimiso sezinzwa (kabi engqondweni ukulimala, umonakalo emsipheni glossopharyngeal, eqinisa isiqondiso sezinzwa of esiswini parietal amaseli motility kwezitho ozwakala pheshana emathunjini).
• Tifo letibangwa ipheshana wokugaya ukudla (hernia hiatal, achalasia).
• Izifo yaleli pheshana zokuphefumula (kuqhoqhoqho esifushane, fistulas phakathi emphinjeni kanye umphimbo).

Ngaphezu lezi zifo, ukuze pneumonitis angabangela izifo ezinzima. nethonya elikhulu ekuthuthukiseni kanye nenshisekelo ahlinzwe besisu (esenziwa ukunciphisa imisipha ithoni izitho kanye nokuncipha isiqondiso reverse amagagasi peristaltic) nokukhulelwa (ngenxa diaphragm ukufuduka). Ngokwesibonelo, ngesikhathi ingxenye ukungenelela kuhlinzwa kufika ku-70% of amacala.

Nokho, imbangela evame kakhulu of juice esiswini ngokufaka aphansi ipheshana zokuphefumula kuyinto liphindele yokwenziwa ngenxa isikhundla okungalungile isiguli kanye ngobuthakathaka sphincter inhliziyo.

I pathogenesis ka nenshisekelo pneumonitis

Lesi sifo eba ngenxa izilonda yamaphaphu futhi bronchial izicubu hydrochloric acid eziqukethwe esiswini. Phela eba necrosis coagulative (okuyinto, futhi, kungenxa isenzo acid phezu mucosa bronchial). Ngenxa bronchial umthamo secretory kuyehla, okuholela issushivaniyu yabo. Parallel acid ukungena emaphashini, kubangela ukuthuthukiswa pneumonitis - ukuvuvukala aseptic ka wamaphaphu izicubu. wamaphaphu encishisiwe ebusweni zokuphefumula, kunciphe isizukulwane surfactant. Konke lokhu kuholela ekwandeni e ukudlala lomzimba wathi (ngenxa leli fomu futhi secrete pathologies ezimbili: somoya - ikakhulukazi ezithinta bronchus, futhi obstructive - nge lesion ijwabu wamaphaphu ukuthuthukiswa isimiso syndrome). Izinga kunqunywa pH of juice esiswini (ephansi kangaka, ngaphezulu bagxila acid, umonakalo ngaphezulu). Izinguquko sina kakhulu nasemkhakheni alveoli.

Izenzo on ezingeni alveoli

Isikhathi esining impela uma kudingidwa isifo esithile futhi ezihambisana nezimpawu Abafundi bamenywa ukuba esithombeni. Izifo ezifana pneumonitis, ngokuvamile ezinye izici ezithile zangaphandle musa ihluke. Kodwa uma ubheka endaweni ethintekile kwezicubu ngokusebenzisa isibonakhulu (okuyinto ngokuvamile kwenziwa ngesikhathi kuvulwa), kungenzeka ukuthola izinguquko ezithile.

Ngenxa izinqubo ngenhla futhi ngaphansi kwethonya gravity lehla hydrochloric acid phakathi alveoli. Lapho, ngenxa yomthelela lendawo ku izicubu alveolar, ukwakheka effusion (ngokuvamile oluhambisana). Ngenxa yalokho, it ukuhlakulela edema yamaphaphu oluhambisana. Ngaphansi kwethonya nokucekelwa ku-alveoli waphawula ukulahlekelwa fibrin, kanye Ukungena kwamangqamuzana egazi ngokusebenzisa ulwelwesi engaphansi (e leukocyte ethile futhi macrophage). Ngenxa yalokho, ukukhiqizwa enzyme ekuthuthukiseni necrosis izindonga alveolar ngenxa wamaphaphu isakhiwo esingagcina kuyaphazamiseka. Endaweni lapho kukhona izitsha kuyagcinwa umonakalo endothelial kanye kumiswa microthrombi. Lokhu konke kuholela exudation anda okusamanzi ngokusebenzisa ulwelwesi kanye kumiswa atelectasis. Ngokuvamile benjalo imbangela yini ukuhlakulela obstructive isifo samaphaphu. Uma i-asidi emaphashini uthole izingcezu ukudla undigested noma kweminye imizimba angaphandle, efana ukwakheka oluhambisana edema kuhlangene ukuthuthukiswa ukusabela slow granuloma kumiswa emhlabeni liye langena umzimba. Lolu hlobo sifo itotoba ngaphezulu, kodwa ezimbi kakhulu.

ukubonakaliswa Clinical yesifo

Unquma kanjani ukuthi isiguli nenshisekelo pneumonitis? Specific "isifo isithombe" kungenziwa elabekwa kanje:

• Umtholampilo wokuqala kuyoba ngenxa umphumela oqondile acid phezu ulwelwesi lwamafinyila. Kukhona isithombe basemtholampilo oyingozi futhi ezinzima nokuvaleka kwemigudu yokuphefumula - bronchospasm, cyanosis okwandisa, nokuvaleka kwemigudu yokuphefumula.
• uhlelo Cardio-semithambo waphawula tachycardia, iconsi wegazi. Kwezinye izimo, kuba ukuhluleka kwenhliziyo noma ukuphazamiseka isigqi. Phela kwehle okukhipha zenhliziyo kwandisa umfutho imithambo yamaphaphu. Ngenxa negesi lokushintshisana kwezinso waphawula ukuthuthukiswa alkalosis zokuphefumula futhi umzimba. I emikhulu ngevolumu wamaphaphu izicubu wamshaya, olunesisindo esikhudlwana lwaluba nesineke, futhi kuyokuba nzima ukwelapha it.
• Ngokuvamile, izilonda nezimpawu nokuvaleka kwemigudu yokuphefumula avele amahora ama-2, okungenani - kamuva. Ngezinye izikhathi izimpawu angase acinywe, nawokuphazamiseka obusebenzayo kungase kungenzeki nhlobo.

ukuhlola

Ubunikazi Mendelson Syndrome - umsebenzi onzima, kusukela zokugula eba ngokuvamile iziguli buthakathaka, futhi ngaso sonke isikhathi, njengoba sishilo ngenhla, isithombe emtholampilo kungenzeka. Into yokuqala ukucacisa khona nokuvaleka kwemigudu yokuphefumula (iphika, kwesifuba, cyanosis). Lezi izimpawu akuzona njalo bakwazi ukukhomba iziguli abaku- ukupholisa lokukhanda. Indlela inembe kakhulu kunazo zonke ekuxilongweni Mendelson sika syndrome yisimo esimweni noma amaphaphu fluorography. Esithombeni ungaboni khona exudate emaphashini, okwandisa airiness yabo. Kwezinye izimo, nika umehluko ethuthukisiwe ze- bronchi (evamile radiograph e projection oqondile ze- bronchi awabonakali, futhi ungakwazi ilebula kubo, kuphela uma wenza isibhamu ohlangothini). Uma nje isiguli fluorography esolwa syndrome asebenzayo kungenxa ukuthuthukisa necrosis, igatsha ijabulise we kuqhoqhoqho kuzobonakala futhi phezu radiograph umugqa.

nenshisekelo ukwelashwa syndrome

Nokho, uma kwakukhona isifiso lokuqukethwe esiswini, ukwelashwa kufanele uqale masinyane. Isinyathelo sokuqala siwukuba ukuwakhipha kusuka kabusha ngokufaka acid ku yomoya aphansi. Ukuze wenze lokhu (uma isimo lesiguli) liyadingeka ukuthi siphakamise headboard embhedeni wakhe. Ngokushesha kudingekile ukulungisa ukupholisa emaphashini futhi ahlinzeke ezinhle igazi oxygenation. Ngokuvamile, ebekiwe mpilo ngaphansi ngakanye ingcindezi omuhle nomoya-mpilo hyperbaric ukugcwaliswa (ukusetshenziswa kohlelo mpilo, ukuqapha wegazi amagesi). Konke lokhu kuzosiza ukuvimbela lactic.

Ukuze wehlise ivolumu wamaphaphu izicubu lesion esimisiwe glucocorticosteroids ngemithambo yegazi kanye umthamo elincane - intrabronhialno. Kuthiwa ama-hormone ukuvumela inqubo ukumisa ukusatshalaliswa futhi zinciphise ke. ngezilapha magciwane (ngokuvamile cephalosporins futhi macrolides) esetshenziselwa zokuvimbela. Kufanele futhi kube sympathomimetics (ukuze kuncishiswe kumiswa uketshezi kule bronchi kanye namaphaphu).

yezinkinga syndrome

Lapho isikhathi kuqalile yezinkinga ukwelashwa zivame kugwenywe. Uma sekudlule isikhathi, isifiso syndrome kungaholela nemiphumela eyingozi futhi ongathandeki.

Ngokuvamile emva isifo uma iqhubeka izinga ukuwohloka, ungakwazi kamuva zenzeka fibrillation atrial noma ifomu unomphela ka ventricular fibrillation. Uma ekuboshweni akunakwenzeka, kodwa isiguli akusho ukukhononda, ungakwazi ushiye isiguli ngaphansi kokuqondisa Umeluleki wasekhaya kuphela.

Enye inkinga ukuthuthukiswa atelectasis yamaphaphu noma ukuvimbela isifo esingamahlalakhona. Kulokhu, inqubo yokululama kuyoba kunalokho eside, futhi ukugcizelela ngokuvamile kwenziwa ekupholiseni izimpawu, kusukela lesi sifo esingelapheki.

I inkinga olunzima kuyinto pneumonitis ebulalayo. Ikakhulukazi ngokuvamile kwenzeka ezimweni lapho asathuthuka nenshisekelo sifo ngo ezisanda kuzalwa.

Izinhlelo ezivimbayo futhi Izibikezelo lesi sifo

Ukuvimbela nenshisekelo inyumoniya, idinga afeze eyinkimbinkimbi eminye imisebenzi. Ngokuyinhloko, zonke iziguli nabesifazane bebeletha, elibonisa ukuphazamiseka ngaphansi izinzwa jikelele kumele akhishwe isisu namathumbu. Lokhu kungabi sengxenyeni isici esiyinhloko kakhulu ekuthuthukeni pneumonitis.

Ngaphambi izinzwa Kunconywa ukuba ibhekane esifubeni X-ray ukuze ukhiphe okuqukethwe juice esiswini e yomoya. Intubating isiguli kumele kwenziwe ngisho nalapho isiguli bayazi. Owambeka ukuze engxenyeni engenhla umzimba uvusiwe kancane. Lokhu kufezwa ngokulungisa ikhanda embhedeni noma etafuleni yokusebenza (ngenkathi kugwenywa kungenzeka lokuqukethwe wicking yokwenziwa wokugaya ukudla ku ipheshana zokuphefumula).

intubation Isifundo efanele ukulungiselela amasu nesineke ukuhlinzwa, ingozi Mendelson Syndrome omncane.

Onalesi sifo yalesi sifo simiswe ngalendlela lelandzelako: ngokuvamile nozifela amaphesenti 56 iziguli esungulwe umgudu pneumonitis. Uma izinyathelo zokulungisa ziye okuqalwe ngendlela esifike ngesikhathi, ingozi yezinkinga ukufa encishisiwe zero.