Mendelson kuti chirwere: zviratidzo, kurapwa, dziviriro

Pane mazita zvirwere kuti musapa varwere mukana mberi hwavo kupengereka. Vakaonekwa Jeff ivo zvachose kushandura munhu, uye iye anowana zvishomanana mukana hwandaiva upenyu mberi. Mumwe ezvinhu pathological ndohwevakadai iine acid chido chirwere, iro rinozivikanwa pasi zita Mendelson raMwari syndrome.

tsananguro

The panowanikwa chirwere nokuda inhalation pakati acidic gastric muto, zvokuti munhu hwapedyo rikwanise kuzvimba. Most zviitiko zvemamiriro ezvinhu anozivikanwa obstetric yokutindivadza. In varwere zvakasiyana diagnoses, vari pasi yokutindivadza kana kwete, mu rezasi kufema hurongwa vanogona kupfuma pamusoro makemikari acidic zviri mudumbu.

Mendelson kuti chirwere chinhu chinouraya kuomesa kwakaita yokutindivadza. The vakawanda tsika 60% nyaya rufu. In obstetric yokutindivadza, nhamba iyi kunosvika 70%.

zvikonzero

Huru chinhu chinokurwadzai asidhi-chido chiratidzo ndiyo regurgitation kana kurutsa, kwakaitika panguva yokutindivadza kana kuderedzwa functionality wokudzivirira hunenge yacho dokeriro. Mendelson kuti chirwere kunyanya akaita regurgitetsiey, ari pusa yapfuura kuti gastric zviri mukati oropharynx.

Mikana yematambudziko kunoitika apo zvizere dumbu, kuora mwoyo zvinodhaka, doro kudhaka, lethargy. Regurgitation anogona kuitika panguva pamuviri (vhiki 22-23 kusvika), apo, nokuda kuchinja kwemakemikari omuviri akazoita kugadzirwa gastrin, zvinoita kuti pave gastric neBP. Pakati pezvimwe zvinhu, kuwedzera intragastric uye intra-abdominal kumanikidzwa, bloating, kuzvimba yegurokuro, kufutisa, kuvapo chakasimba zvomusejari zvirwere zvomudumbu hurongwa. Mukuru nengozi chirwere kunoitika apo kushanda hurukuro iri Obstetrics kana iri tsika pakati kukurumidza kuvhiyiwa.

pathogenesis

Mendelson kuti chirwere ane yakasiyana mashandiro okukura. Tsanangudzo yokutanga ndiyo - apo undigested zvokudya zvacho kupinda kufema turakiti pamwe gastric muto. Pachiyero yechipiri zvokuimba occlusion pamusoro principales zvinoisa kukura kwezvinhu chakasimba kufema kukundikana. Kana yechipiri zviri acidic chaizvo gastric muto kana inhaled kunogona kukonzera makemikari kokutsva pamusoro mucous Kamudzira pamusoro principales uye trachea. Uyezve mucosal edema chinokurwadzai kukura Árbol mhingaidzo.

Mendelson kuti urwere: Zviratidzo

The kunotoda Mufananidzo chirwere pamwe vanenge kufanana kune zviratidzo zvikuru kufema kukundikana. Murwere nemamiriro kunoratidzwa pulmonary edema, tachycardia, dyspnea, cyanosis, bronchospasm. Tikafunga zvikuru vakaratidza kutanga kuchinja kunogona kuitika cardiac kusungwa. Vakawanda muviri murwere raputsika uye ropa riyerere pulmonary, chirwere cheBP mberi. Pamwe chete chakakomba hypoxemia kunowedzera kumanikidzwa iri pulmonary tsinga ane mawa kuwedzera pulmonary vascular nemishonga. Metabolic acidosis uye kufema alkalosis kukura somugumisiro kutyorwa tishu perfusion.

Clinical uye pathophysiological kuchinja chokuita zvinetso zviri zvemapapu tishu maronda. Dzimwe zviratidzo zviri zvishoma raidudzwa. Morphological kuchinja kufema turakiti chaizvo akaratidza zuva pashure chido. Chete zuva kana maviri kubva panguva apo paiva Mendelson kuti urwere, kufema kukundikana zviratidzo dzinotanga kuvandudza. Save murume anogona kuva chete pasi mamiriro ake zvokurapa zvaipa.

Mendelson kuti urwere mu Obstetrics

In vakadzi obstetric akavhiyiwa kana talk yokutindivadza pakukurukura kazhinji zvinoitika chirwere ichi. Chido kupinda yemweya inofanira kuva maviri ezvinhu. Chokutanga - talk yokutindivadza (nokuti obstetric kushandiswa, mwana, kuvhiya zvokurwara mudumbu), wechipiri - kutyora bulbar mashandiro pakoma, regurgitation, kurutsa. Kazhinji, murwere kumirira rufu, kana iye Mendelson kuti syndrome. Kuti kunopa kodzero kuisa chirwere iri ndima pamwe zvikuru ngozi, zvinouraya matambudziko ose yokutindivadza, hapana mubvunzo.

Zvokudya mudumbu vakadzi vane pamuviri vanowanzopedzisira seranonoka yakafanira kuderedza ndima yaro pamuviri nokuda hwakaderera kwevari gastrin uye yakawedzera kuomesa intra-abdominal. It gastrin inodzora motility mudumbu, uye kushomeka akawanda inotungamirira kuvapo iine acid chido chirwere muna yokutindivadza.

chimbichimbi

Chinhu chokutanga unofanira kubata murwere pamwe chirwere pamusoro Mendelssohn - yabviswa kubva Airways aspirated mudumbu mukati. saka Oral mhango akanatsa kubvisa kana gauze. Endotracheal intubation zvinofanira kuitwa kunyange prehospital chokutambudzika. Next, unofanira kuita nokukurumidza bronchoscopy pasi vakawanda yokutindivadza Rakabatanidzwa jekiseni kubata zvemapapu kufefetedza. For Árbol lavage uchishandisa yavaibvisa rehydrogen carbonate mhinduro (2%) ne kugadzirira "hydrocortisone" inodziya kana isotonic yavaibvisa chloride mhinduro. Mushure tracheal intubation, kushambidzwa kwazvo aine alkaline mhinduro dumbu kuburikidza gavage. Nomutsinga raitongwa zvingaitwa "atropine" uye "Eufillin".

In Kana apo murwere nemamiriro mwero, zvokuimba kufefetedza anogona kutsiviwa vaingoerekana kufema nedzinovengwa nemishonga. Nokuti nzira iyi, uchada chaiyo mask kana haapo, zvinokosha kudzidzisa murwere exhales kuburikidza rakavhurika magumo mumvura rabha chubhu.

Mendelson kwakaita syndrome (mufananidzo pamusoro inoratidza chikamu hurongwa kutambura pakutanga) kungaita kuti rufu murwere, kana nguva asingadi kumubatsira. Kunyange kukurumidza kupedza bronchospasm laringo- uye murwere zvinofanira muchipatara kuitira kudzivirira kukura zvakakomba yematambudziko.

mabatiro

Kana murwere akawanikwa Mendelson kuti urwere, kurapwa kunofanira kusanganisira matanho kuti chichabatsira kurega chakasimba kufema kukundikana uye kudzivirira kukura noutachiona yematambudziko. Zvokuimba kufefetedza rinoitwa kana arterial hypoxia hunoramba ezvinhu enyika vaingoerekana kufema. Kana akaoma ezvinhu omurwere nzira rinoitwa kwemazuva, kusvikira zviratidzi pakati pulmonary gasi Exchange haana kuvandudza. Dzimwe nguva achishandisa hyperbaric oxygenation, izvo dzimwe nguva dzova nemigumisiro yakanaka. Drug kurapwa ndiko kushandiswa symptomatic zvinodhaka, mishonga uye corticosteroids huru mishonga.

chirwere Mendelson muna 30-60% nyaya kunotungamirira kurufu murwere. Nokuti vaya vakatambura izvozvo, unogona kuva akaratidza zvinhu kana obstructive nepfungwa pakawanda.

dziviriro

Pane zvinhu zvinoverengeka nezviito zvinogona kutadzisa kukura kwazvo yematambudziko akadai Mendelson kuti syndrome. Kudzivirira ine matanho akawanda. Chokutanga - kushandisa zvinodhaka ane chiito inoendeswa rutapudzo pamusoro gastric secretion ( "Ranitidine", "cimetidine"). Kudzivisa panowanikwa yematambudziko anogona kubvisa uye zvakarurama nezviito mutindivadzi. Drug "Atropine" anofanira kutsiviwa pachishandiswa "Metacin" murwere kuva mamiriro yokutindivadza anofanira kuzviita zvakanaka uye nokukurumidza. Chiremba inofanira kuva nyanzvi magadzirirwo pamusoro intubation uye laryngoscopy uye tracheal kushandisa mutambo Selick.

Dzimwe Kusuma munhu gastric chubhu, tikaisiya yose oparesheni kudzivisa inhalation pamusoro gastric mukati. Dzimwe nyanzvi pamusoro panosvikira yakadaro, nokuti vachiongorora anogona kuita chibani uye kutowedzera ezvinhu. In Obstetrics dziviriro kunofanira zvakarurama nzvimbo pamuviri mukadzi pamusoro uchishandisa patafura, kuguma musoro izvo zvinofanira vachamutswa zvishoma.