The kupatsanura pakati kwokuomerwa chiropa cirrhosis maererano Child-Pugh

Cirrhosis chiropa - kwave kune kuwedzera kwezviito connective zvinyama mumuviri nokuda kwenguva refu kuzvimba. A zvakafanana kusvika kuna kupatsanura chirwere ichi hachisi nekuti hakuna tabvumirana iro ari iripo kupfuura akabudirira kuti chirwere matambudziko uye Mabatirwo cirrhosis.

Kupatsanura pakati chiropa cirrhosis maererano Child-Pugh

kupatsanura iri chiropa cirrhosis rinoshandiswa kufungidzira ukuru chirwere kwokuomerwa murwere.

Pahwaro kwayo iwe kubudisa murwere Kupona nechirwere ichi uye chikamu kwevanhu pashure kuvhiyiwa. Kutsunga sezvinodiwa chiropa.

The chirwere rakakamurwa kuva mapoka matatu. The parameters kuti havatsananguri makirasi anoratidza ukuru kwokuomerwa cirrhosis, uyewo chokwadi chii chichava hunotarisira murwere kwevanhu ane cirrhosis upenyu. Maererano Child-Pugh mwero muripo chirwere richinzi:

1. Kirasi A zvinosanganisira ndanyarara hangu cirrhosis.
2. B - subcompensated.
3. C - decompensated cirrhosis.

Sei kupindura?

Kirasi nerimwe Child-Pugh basa dzimwe pfungwa dziri dzaona pachishandiswa mubatanidzwa parameters anoverengeka. Saka, Kirasi A ndezvaiye zvakawanda 5 kusvika 6 pfungwa, B, ukuwo, - kubva 7 kusvika 9 points. Uye yokupedzisira kirasi - mutengo mukuru kubva 10 kusvika 15 points.

Shoma mwero kwokuomerwa cirrhosis nokuda A. In iyi, ya murwere upenyu iri vaifanira - kubva 15 kusvika 20 makore. On wechipiri, ndiwo makore anenge 10. Kirasi C zvinoreva pfupi upenyu hunotarisira varwere cirrhosis chiropa - chete kana kupfuura makore matatu.

Pashure pokuvhiyiwa, chikuru chikamu hwenyama mukirasi C - ndiyo 80%; 30% - azvaitwa, uye A raMwari - chete 10%.

Kudiwa chiropa dzimwe madhigirii siyana nekuomarara akatsunga sezvinotevera:

• High - C;
• mwero - B;
• Low - A.

The parameters kufungwa iri kupatsanura pakati Child-Pugh

Chii parameters kupesvedzera pakugoverwa nemakirasi? Chokutanga, hazvina inorangarira kuvapo:

• bilirubin;
• sealbumin;
• ascites.

Uyewo hepatic encephalopathy, PTI, PTT uye INR.

System nokuti Child-Pugh haagoni anoonekwa somunhu reference, sezvo kuongorora inorangarira kwete yose parameters murwere. The unopinza kuwedzera pamusoro chirwere uye matambudziko ayo kushandura mufananidzo, uye kupatsanura ichi hakuchisina kushandiswa.

Hunorondedzerwawo maitiro uyewo anofunga morphologic uye etiologic Mumagazini cirrhosis.

Kupatsanura pakati etiologic zvinhu

Kune marudzi cirrhosis vanenge makumi maviri. Zvichienderana kana chikonzero rinozivikanwa kana kwete, chirwere rakakamurwa mapoka matatu:

1. Cirrhosis akagadzawo (anozivikanwa) etiology.
2. The zvokurwara umo etiology iri dzichipesana (dzimwe nguva achinzi "zvichibvira etiology").
3. Cirrhosis ne kujeka (vasingazivikanwi) etiology.

akagadzawo etiology

Yaizivikanwa, akasimbisa zvinokonzera hosha achiti zvinotevera nyaya:

• In doro cirrhosis yomuka panguva kushandiswa kwenguva yakareba doro (40-60 giremu panyaya iyi) kuti 15 kana kutopfuura.
• Nemavhairasi kuti hafu nyaya anokonzerwa utachiona echirwere chiropa B, C uye G.
• Mushonga kana mishonga, iyo inoratidza pacharo nokuda kushandisa zvinodhaka zvakafanana mhando kwenguva refu.
• Nesekondari biliary cirrhosis, apo hepatic zvinyama rufu kunoitika uye zvinonyadzisa vanga rinenge aumbwa kuritsiva.
• Vachiberekwa kana nhaka cirrhosis.
• Mira - zviri vakasiyana nevamwe akanyorwa siyana uye nezvechinhu chimwe zvakakwana refu nguva apo ropa wedzerai chiropa yaputswa. Kuchengetwa varwere zvavo kweropa.
• Apo chirwere uye Budd-Chiari chirwere - chirwere chokuita havachanyatsogoni ropa water drainage kubva chiropa (hepatic tsinga thrombosis).
• Exchange-alimentary cirrhosis yomuka kwazvo cheshuga, kufutisa, kana akabatana enteroapocleisis.

Possible uye kujeka etiology

Possible uye kujeka, asingazivikanwi etiology richiratidzwa pamberi:

• zvirwere;
• parasitic zvirwere;
• autoimmune pathologies;
• zvokudya zvinovaka muviri.

Unknown etiologic Zvinhu - kazhinji ndiyo cryptogenic cirrhosis chimiro. In chikuru biliary cirrhosis nevana Indian uyewo kutaura zvisingazivikanwi etiology.

morphological kupatsanura

Morphological kupatsanura kukuvara chiropa - ndiwo wekutanga aronga uye anotenderwa kunobva mashoko kubva biopsies (muviri chidimbu, wakabatwa vivo). Govera zvokurwara 4 siyana:

• MKD cirrhosis dzinoratidzwa nodules diki pamuviri, ane dhayamita iri 1-3 mm;
• krupnouzlovgo cirrhosis - chiropa nodules dhayamita 3 mm kana kupfuura;
• nezvimiro kukwana cirrhosis, kwamakadarika advantageously nedambudziko mezhpechenochnye partition;
• hwakakanyiwa, inozivikanwa nokuda wemishonga ose pamusoro zvinhu.

cirrhosis kurapwa

Anofumurwa Kirasi cirrhosis kuti Child-Pugh rinopa mukana kwete chete kuti chirwere, kuti kufanotaura kupona varwere, asiwo kusarudza zvakakodzera kurapwa uye aitsigira hanya.

Nokudaro, ndanyarara hangu chiropa chirwere (With kirasi A) kunosanganisira chikuru kurapa zvainanga kubvisa honzeri chirwere. Uyezve, iwe unofanira kunhonga anotsigira mishonga. basa ravo - kubvisa fufune. Zvikuru munyika enzayemu ichi vari mhando "pancreatin" "Creon", "mezim". Dosages mureza, akatorwa katatu pazuva, kunyanya pamberi kudya. Ko basa makosi, avhareji vhiki 2-3, iyo inodzokororwa panguva nenguva.

Kana subcompensated cirrhosis (Panguva B cirrhosis vekirasi Child-Pugh) raida ndichibvunza yokuzvigadzirisa marapirwo kugadzwa. Nokuti chinangwa ichi rinoshandiswa kamari munyu kudya (haufaniri kupfuura 2 magiramu munyu pazuva), mamwe yakarambidza mapuroteni. Zvinodhaka ushandiswe "Furosemide" uye "spironolactone". Kugamuchira diuretics constrains kutanga portal neBP uye anoderedza ascites. Zvaiitwa nemudumbu inogona kunatsiridzwa "lactulose" muna 50-70 Rine mamiririta pazuva, asi mabiko kuva kwechigarire.

Kana decompensated chiropa chirwere (apo boka C maererano Child-Pugh) akaratidza upenyu pamutanhiko ezvinhu omurwere. Zvinoda pakarepo yevanorwara zvikuru. Paracentesis rinopa nokubviswa mvura kubva peritoneum, sealbumin nomutsinga achiita uye crystalloids, anozadza achiparadzira ropa vhoriyamu uye mapuroteni mumuviri. Achishingaira kushandiswa diuretics: zvakafanana "spironolactone" uye "Furosemide". Taurira zvokudya mwoyo munyu. Hwakadzikama parenteral zvokudya kuuya hepatic encephalopathy nezvimwe zvirwere zvikuru.

mhedziso

Prophylaxis zvirwere iri inobva kupatsanura pakati kwokuomerwa chiropa cirrhosis pakati Child-Pugh.

Paboka ndanyarara hangu chirwere hakurevi chokudzivirira chinangwa. Kana makirasi B uye C varwere zvingamuka kupererwa, uye saka kakawanda raitongwa erythropoietin. Mukuwedzera, rinowanzogamuchirwa ushandiswe Beta-blockers (akadai "Metoprolol", "Inderal"), izvo zvinogona kudzivisa pakakoromoka esophageal varices.