Pneumothorax: Zviratidzo, Zvinokonzera neMarapirwo

Pathological ezvinhu umo pleural mhango (yakachekwa serin'i nzvimbo pakati parietal uye visceral pleura dzakapoteredza mumwe zvemapapu) rinoungana mhepo kana zvimwe gasi wemisanganiswa rinozivikanwa pneumothorax. Zviratidzo, zvinokonzera uye vabatwe ichi, funga munyaya.

tsananguro

Nokuti pleural mhango iri kuipa hurumende dzinoratidzwa kunaka kumanikidzwa, ichi chinopa mukana wakakwana kufema mashandiro. Kana machira akakuvadzwa pleura (semuenzaniso, somugumisiro pakakoromoka kunzvimbo zvemapapu kana bronchus) uye rinomupotsa ari pleural mhango mhepo nevezera iri equalized kuti mhepo yakapoteredza kana akapfuudza izvozvo. Mhepo iyo hwapinda mukati ari pleural mhango kunotungamirira compression pamusoro yemapapu, izvozvo chinokurwadzai spadenie uye kubva chiito kufema. With huru Vhoriyamu mhepo yakasimba chiedza kuri pasi kufurirwa simba, mukuwedzera kune izvozvo, pane kuchinja kubva mediastinal nhengo (guru midziyo mwoyo). izvi zvose kunokanganisa kwazvo ropa kuparadzirwa uye afemeruke.

Pneumothorax: chirwere zviratidzo

The chirwere kunoratidzwa anotevera zvinhu:

• Pakarepo yokuvamba marwadzo muchipfuva - chakasimba, kuwedzera panguva kufemerwa. Inorwadza nezvekufadza zvinogona kuparadzira kuita zvakakanganisa divi.

• Pakarepo dzichiri dyspnea - kupfupika mweya, nokukurumidza kudzika kufema.

• Dry chikosoro.

• Rokumuka mwoyo unodiwa.

• The pakuonekwa ganda vari ziya kuchitonhora.

• General simba.

• A pfungwa kutya.

• Cyanosis ganda (kana vakadhakwa kuparadzirwa uye afemeruke iziviswe).

marudzi chirwere

• Open pneumothorax. Zviratidzo izvi ezvinhu vari: rakapinda kupinda pleural mhango dzedenga kuburikidza dzaparadzwa guru principales kana vanga pechipfuva anokurukura zvakatipoteredza panguva inhalation mhepo anopinda pleural mhango uye anodzokera panguva kuregedza kushanda. The kumanikidzwa ari pleural mhango zvichienzaniswa ambient, iyo chinokurwadzai atelectasis uye kubva afemeruke ake.

• Closed pneumothorax anova mudenga kupinda munzvimbo pleural mhango nokuda zvakakanganisika yacho pleura. Pakati pleural mhango uye zvakatipoteredza hapana shoko, uye vakavharirwa mhepo iri vhoriyamu asingadi kuwedzera. up pneumothorax ndiyo nyore kuti chiremba pfungwa maonero. Mhepo duku shoma anogona kuiparadza pachavo. Kana paiva namahwindo pneumothorax, zviratidzo munyika iyi, zvinotevera: marwadzo kubva dzaparadzwa kurutivi muchipfuva, hapana ganda, kupfupika mweya.

• Voltage (vharafu) pneumothorax. Izvi mhando zvokurwara chakaoma. Chiratidzo vharafu pneumothorax - mumwe paumbwe panguva ronda uye kukuvara makuru principales paavhareji kukosha vharuvhu mamiriro kuti anobvumira mhepo kupinda pleural mhango panguva zvokufuridzirwa uye chinonditadzisa mbudo yayo kunze kwezvakatipoteredza. Bhuku mhepo iri pleural mhango paaikura. Izvi chinokurwadzai kuti misha uye compression pamusoro mediastinal nhengo pamwe zvakakomba kusagadzikana kweropa uye afemeruke.

Pneumothorax: Zvinokonzera chirwere

Zvichienderana zvinokonzera hosha kuziva dzinoverengeka rudzi.

vaingoerekana pneumothorax

Zviratidzo imwe zvokurwara kunokonzerwa atsamwira mugove bronchus kana zvemapapu iyo isina chokuita zvokuimba kuzotadzira thorax kana zvemapapu. Vaingoerekana pneumothorax anogona kuva:

1. Primary (idiopathic) yomuka pasina chikonzero. Ko tichikurumidza vagumirwe majaya makore 20-40 soro kukura. zvokurwara kazhinji anovandudza somugumisiro:

• majini akaita kushayikwa pamusoro enzayemu Arifa-1-antitrypsin, uye vakandizvidza Kumwe kuchinja kunotanga ari bapu;

• vachiberekwa kuneta of pleura, izvo zvinogona putika nyore kuseka, chikosoro simba, zvikuru muviri, kufema yakadzika;

• differential kumanikidzwa zvichiguma zvakadzama kunyudza mumvura, mitambo yomumvura ndege mu ndege.

2. Secondary (symptomatic), apo yaitwa hunotovapo zvirwere zvemapapu hwapedyo vaingoerekana pneumothorax. Zviratidzo kuitika nokuda:

• zvirwere kufema Somuenzaniso, kungava chisingaperi obstructive pulmonary chirwere (chirwere anogumbura chirwere ari kufema ino, iyo anova pasi pokudzora siyana zvezvakatipoteredza zvikonzero, chikuru vane - ndiyo fodya, Nokumukira kukura echirwere kufema kukundikana), cystic fibrosis (ane chirwere nhaka iyo hwokuratidza nokuvhiringidzirwa ari exocrine mumasero), zvikuru exacerbation kuti asima;

• zvirwere zviri mumapapu Somuenzaniso, tiibhii (zvirwere zvinokonzerwa mycobacteria), zvemapapu pute (shoma zvatichiri kuzvimba zvemapapu rinenge iyo kunoratidzwa kunyunguduka zvemapapu rinenge uye mhango inotungamirwa akazadzwa purulent kugutsikana), inflammations remapapu (nemabayo) pamusoro HIV;

• zvemapapu zvirwere dzinoratidzwa maronda ose connective zvinyama fibrosing alveolitis, lymphangioleiomyomatosis, sarcoidosis, histiocytosis X;

• systemic pathologies of connective zvinyama pamwe zvirwere zvemapapu: nechirwere chinonzi systemic scleroderma, dzinonzi rheumatoid arthritis, dermatomyositis;

• namamota (kenza yemapapu).

traumatopnea

Zvikonzero Fani ichi - iri kuzotadzira pechipfuva:

• gomara kunotevera;

• rakapinza ronda.

iatrogenic pneumothorax

zvokurwara uyu pamusana kwemamwe maitirwo ezvinhu vezvokurapa:

• pleural kana bapu biopsy;

• kuponjesa;

• Fitting subclavian anobudisa mushonga zvishoma nezvishoma;

• zvokuimba kufefetedza.

Diagnostics

Kuti chirwere "pneumothorax" chirwere zviratidzo zvinofanira vainyatsoongorora ne mududziri kuongorora zvokurapa. Chirwere zvinosanganisira zvinotevera mabasa:

• Patient ongororo: auscultation (auscultation) zvemapapu Kuongorora kuti thorax.

• Chest radiography, hwaishandiswa zvinokwanisika kuona mhepo iri pleural munharaunda. The nzira ndiyo nzira huru diagnosing pneumothorax.

• Blood gasi sezvamunoita.

• Computed tomography, izvo zvinoita kuti kuziva zvinokonzera yechipiri vaingoerekana pneumothorax. Nzira iyi chirwere unoshandiswa apo maekisirei havasi zvakakwana anodzidzisa.

• Electrocardiography, kushandisa iyo zvinokwanisika kuona imwe abnormality mumwoyo vharuvhu (vakabatikana) pneumothorax.

• Consultation thoracal chiremba.

chimbichimbi

Unofanira kuziva sei kupa ruyamuro kuti ichi pathological wakare, sezvo pneumothorax. Zviratidzo kwayo kunofanira kuva chiratidzo kune rwekuchipatara munjodzi chiito. The murwere wokutanga zvakakodzera kuitira wakasununguka kukwanisa reokisijeni kudzikamisa naye pasi uye kudana chiremba pakarepo.

Outdoor pneumothorax kunosanganisira nokuiswa occlusive dressings, izvo sealingly rinogumisa mugove dzaparadzwa pechipfuva rusvingo. Bhandiji chisingafaniri kudarikwa mhepo, anogona kuitwa polyethylene kana cellophane uye gobvu rukoko nedonje-gauze.

Kana vharuvhu pneumothorax kunoda pakarepo kunhaka pamusoro pleural ponji, izvo zvichakubatsira kuti kuparadzira zvemapapu, kubvisa vakasununguka gasi uye kudzivisa misha yacho mediastinal zvomukati.

Matanho kurwisa zvokurwara

Kana nechirwere pneumothorax, kurapwa kunosanganisira zvinotevera mabasa:

• Pleural needling, panguva iyo kubvisa mhepo kubva pleural mhango.

• Kuvhiya suturing Árbol discontinuities, bapu, chipfuva rusvingo makuvaro.

• Zvikasabudiswa ari pleural mhango pakatangwa imwe abudise chubhu kuburikidza iyo kubviswa mhepo kubva pleural mhango kuchaitika.

• Kana marwadzo iziviswe pamwe pathologies akadai pneumothorax, kurapwa angasanganisira kushandiswa dzokutindivadza.

• Okisijeni (kuramba okisijeni wedzerai enyika kubudikidza chaiwo sepombi).

• Pleurodesis - Fusion nzira pleura kushandisa kuvhiyiwa kana jekiseni kupinda pleural mhango mishonga chaiyo (kana akadzokorora kakawanda pneumothorax).

Matambudziko uye migumisiro

Pneumothorax - chakakomba mamiriro anogona kukonzera:

• Intrapleural kubuda ropa.

• Pleurisy - kuzvimba pleura, iyo inozivikanwa nokuva paumbwe adhesions, afunge nenyonganiso zvichiitika chiedza.

• Subcutaneous emphysema - kutanga umo mhepo chinonzvenga munzvimbo subcutaneous mafuta. Kuona mamiriro zvikamu kuzvimba, kuzvimba subcutaneous zvinyama: kana iwe tinya pamusoro pavo, pane nevamwe inzwi, rakafanana crunch rakaoma echando.

• Air vachipinda mediastinal tishu. Muchiitiko chino, pane compression guru midziyo uye mwoyo.

• In kwazvo kacho (ane guru lesion vhoriyamu, yekudyidzana rakapinza Maronda pechipfuva) hauna warambidzwa murufu.

dziviriro

Kudzivirira pneumothorax, vanofanira kuomerera zvimwe mitemo:

• Nguva kurapa zvirwere zvemapapu.

• Kusvuta.

• Dzivisa chipfuva kukuvara.

• Kana pneumothorax zvinoitika kazhinji, zvinokurudzirwa kuti tiite pleurodesis nzira (musono pleura).

mhedziso

Munyaya ino, takakurukura chirwere akadai pneumothorax. Zviratidzo, zvinokonzera uye nhungamiro zvokurwara kurapwa vakanga ndiongororwe nesu. Chero pneumothorax kunoda pakarepo muchipatara murwere kunorapwa. Tiine yakakwana ano kurapa fungidziro pamusoro vaingoerekana pneumothorax rinowanzova zvakanaka. Kubudirira pakurapa dzechimwe pneumothorax kunokanganisa hunhu kukuvara rubatso pechipfuva. Zvichengetedze uye vaine utano!