'O nā'ōpili ma'amau: nā hō'ailona a me nā kumu. Ka hō'ailona a me ka lā'au ho'omalu

'O ke'ano o nā mea'ē a'e he nui ka ma'i i loko o ka enveloppa e ho'opili ana i ka'ao'ao i loko o ke sac pericardial. Ma ke'ano o ka holo'ana o exudate pericarditis he mea nui a i'ole ka hopena.

Hiki ke ma'i, ma'i hemorrhagic, purulent, fibrinous a me ka hemorrhagic. Me ka fibrinous exudative pericarditis, waiho'ia nā filaments o ka fibrin ma ka pericardium, a'o kekahi wai e ulu i loko o ka poho pericardial. 'O ka ma'amau i loko o ka pahu pericardial e pili ana i 20-40 ml o exudate.

I ka wā o ka pericarditis, e hele pū ka hopena pūnaewele me ka ho'onui'ia'ana o ka exudation i loko o ka pohā pericardial o ka haha wai o ke koko. 'A'ole ia he mea ma'amau no ke kahe'ana o ke kīpona e hele i ka papa subepicardial, kahi e ho'omāmā nui ai i kāna hana.

'O ka hopena Cardiogenic

'O ka manawa pinepine i ka ho'ohui koke'ana o ka wai i loko o ka pōpilikia pericardial hiki ke ho'opili i kahi pahū'ana i ka lolohia e loa'a ai nā hō'ailona o ke kāpili cardiogenic:

• Nā palupū na'au;
• Ka hō'ino'ana i ka hanu'ana ma ke'ano o ka dyspnea;
• 'O ka ho'onui'ia o ka ho'onani'ana i nā'ōpū ma'i a me nā kahe nui o ke ka'ahele;
• Ka emi iki o ke ki'eki'e o ke koko.

Nā pilikia

Me ka ho'oku'u'ana o ka wai o nā mea ho'onui, hiki i kahi'ili lehua e hiki ke hana i ka fibrin, a'o ia ho'i ka mea e hiki ai ke alaka'i i kahi'āpana a me ka hopena paha o ka poho pericardial. 'O ka ma'amau, ua ho'onohonoho'ia ka'ili i loko o ka'āpana o ke kola, ma kahi o ka'ae'ana o nā pūpū i luna a me lalo loa, ma kahi kokoke i ka'ōpū o ka wā o ka wā.

Ma muli o ia'ano,'o ka exudative pericarditis nui e hiki ai ke alaka'i i kahi hō'ailona hana, i kapa'ia ka "palpable heart", ma muli o ka helu'ana o ka pericardium. 'O ka manawa nui o ka hana hana o ka exicative pericarditis, he'aha i ke koko diastolic i nā makani ventricles o ka pu'uwai. 'O ka nui i ho'onui'ia i loko o ka pō'ino pericardial a i'ole ke kū'ana o pericarditis māmā e alaka'i i ka hopena o nā papa subepicardial a me subendocardial i ka ape ape. I nā mea ko'iko'i, me nā fibrosis pericardial, hiki ke waiho'ia kekahi wahi kūpono, no ka mea e ho'onui'ia ai ka makani i ka diastole i ka hā'awi'ana i ke koko i ka na'au.

'O kēia'ano i kapa'ia'o ka hō'ailona (ka hopena o ka "puka hāmama"). 'O ke kumu mechanics, ka mea i ho'olako'ia e ka mīkini pa'oki o ka'āpana, e like me ke'ano,'a'ole ia e'eha. Me ka ho'oloihi lō'ihi o ka ho'iho'i'ana i nā mea'ino i ka pu'uwai, hiki ke hō'eha i ke koko i loko o ka pūnaehana hana'āmā. I ka venous stasis i loko o ka systemic holo'ōnaehana o ka wai ka extravasation i loko a puni nā'aʻaʻa.

Nā kūlana pericarditis: nā kumu (kumu aioiological)

'O kekahi o nā kumu ma'amau o ka ulu'ana o exicative pericarditis, he mau huapalapala'o RNA (A a me B), ECHO, ka'ino A a me B, nā ma'i bacteria o ke'ano like'ole (pneumococci, staphylococci, streptococci, mycobacteria a me nā haiki).

'O kēia ma'i e hiki ke ho'opili i ke'ano o nā ma'i ma'i pūnaewele (ka SLE a i'ole ka Liebman-Sachs ma'i, ka hō'eu'eha hopena rheumatic, ka rheumatism, ka scleroderma pūnaewele) a me nā ma'i o ka genitourinary system (uremic pericarditis). Pericardial effusion ICD paha ia he kīnā postperikardialnogo maʻi pale i hoʻomōhala i ka hope o pericardiotomy a me he kakahiaka complication o myocardial infarction, i ua kapaia Dressler ka maʻi pale. 'O ka hana ma'amau kēia pilikia i nā hua'ōlelo pa'a loa, mai 15 mau lā a'elua mahina.

I kekahi manawa,'ike paha kekahi o nā lā'au lapa'au-adicive pericarditis ma ka ho'ohana'ana i kekahi mau lā'au: hydralysin, phenytoin, anticoagulants, no ka ho'ohana pinepine'ana i ka procainamide, radiation therapy. I kēlā mau mea inā hō'ike ka exudative pericarditis i ka nui o ka lūlū'ana, pono ke huli'ia ke kumu i nā metastasis o nā ma'i koko: ka umauma, ka pulumu, ka sarcoma, lymphoma. I loko o kēia mau hihia, he mea ma'amau ke'ano o ka hemorrhagic, a no ka mea ma'amau.

Aia kekahi'ano'ano nui o exudative pericarditis, i kapa'ia he hemopericardium. Ke hana nei kēia'ano me nā'eha i loko o ka pahu i ke ku'i o ka pu'uwai, a me ka hō'oki'ana o ka myocardial i nā ma'i i ho'onāukiuki i ka'elepopo myocardial, ai'ole exfoliating aoric aneurysm, i mea e hopena ai ke koko i ka poho pericardial. Inā ua loa'a kēia ma'i ma muli o nā kumu aiolio e hiki'ole ke ho'omaopopo'ia, a laila hā'awi'ia i kahi hui kūpono'ole a idiopathic paha.

Eia kekahi,'o kekahi manawa e hana ai nā exudative pericarditis i nā keiki. 'O nā kumu o kēia:'o nā ma'i streptococcal a me ke staphylococcal, ka nui o ka ma'i, ka ma'i HIV, ka ho'ohana'ana i ka lā'au lapa'au'ole, ka ma'i kanikau, nā'eha kokoke i ka pu'uwai, ka kīkī kīki'i, ke kuhi'ana o ka na'au.

Nā'ōpala pericarditis: nā hō'ailona a me nā hō'ailona hō'ailona

'O ka nui i loa'a i loko o ka'eha pericardial e hō'ike'ia e ka'eha'eha a me ka'eha mai ka'āpana o ka pu'uwai, ka hanu'ana o ka pāna'i ma ke'ano o ka dyspnea, e ho'ēmi ana i ke kūlana noho, palpitation. 'O ka ho'onomi'ana o ka wai ma ke alahele a me ka moe'ana e ho'onā malo'o.

'O ke kūlana o nā mea ma'i e pili ana i ka nui o ka hana'ana o ka mea wai i loko o ka'eke pericardial, ma ka wikiwiki wikiwiki - maika'i ka moku'āina, me ka wikiwiki a me ke kaumaha.

I ka nānā'ana i ka mea ma'i, hiki iā'oe ke loa'a nā hō'ailona o nā exudative pericarditis: pale ke'oke'o, cyanosis o ka membrane mucous o nā lehelehe, ka pehu'ana o nā piko, acrocyanosis.

I ka nānā'ana i ka pahu, hiki ke'ike'ia ka'āpana, e hiki ke ho'onui'ia ka'ao'ao hema, hiki i kēia wale nō me ka ho'onui'ana o ka exudate i loko o kahi'eke pericardial me ka nui'oi aku o 1 liter. Palpation hiki huai ae hiʻona Jardin ka wā apical impulse ua hoʻoneʻe luna a me ka naau, ka hoʻopiʻi i ka'aloʻahiʻa ka lawe 'ana, i ka wai a hoʻonui loko.

Ke kuhihewa, hiki i kekahi ke'ike i ka ho'onui'ana o nā palena o ka na'aupō o ka na'au ma nā'ao'ao a pau: hema-lalo (i nā'ao'ao lalo) i ka mua a i ka laina axillary waena, i ka'elua a me ke kolu o nā āpau intercostal i ka laina waena waena, i ka'ākau ma nā'ao'ao ha'aha'a, i ka SCL Line line), e hana ana pēlā i loa'a ai ka angle, ma mua o ka pololei i ka mea ma'amau, i ka ho'ololi'ana i ka palena o ka'ele'ele hepic. Hiki i kēia a pau ke hō'ike i ka ma'i o exicative pericarditis.

Auscultatory kumu: heʻoi mea hoʻonāwaliwali maoli nō o ka naʻau kani i loko o ka naʻau apex, ma Botkin-Erb a me xiphoid kaʻina. Ma kahi o ke kumu o ka pu'uwai, lohe'ia nā kani leo kani no ka loiloi'ana o ka na'au i ke kahe o ka wai i luna a me hope. 'O ka leo o ke kāwili o ka pericardium, ma ke'ano he rula,'a'ole ia e hō'ike ana iā ia iho. Ke iho nei ka pā'iku'i, ma muli o ke emi o ka emi'ana o ka huapalapala na'au.

Inā ulu ka lohi o ka exudate i ka manawa, a laila,'a'ole e pihoihoi ka hana mechanical o ka na'au no ka manawa lō'ihi ma muli o ke kahe o ka pericardium i loko o kēia hihia. I ke'ano o ka pi'i wikiwiki'ana o ka wai i loko o ka'āpana pericardial a me ka ho'oulu'ana, kachycardia, kahi kīpikū o ka pau'ole o ka pu'uwai me ka hanana o ke kau'ana o ke koko ma nā kahe puni (nui a li'ili'i).

Ma muli o ka'ike no ka'ike ECG no ka exudative pericarditis, eia ka hi'ohi'ona o kēia. Me ka ho'onui'ia o ka wai o nā mea i ho'ohālike'ia,'o ka emi'ana o ka volta o ka complex complex QRS a me ka ho'ololi'ana i ka ho'ololi'ana o nā complex ventricular. 'O ka Radiographically, aia ka pi'i ma ke aka o ka'āpana'eha a me kahi pulupination palupalu o ke āpau. 'A'ole i pōkole ke kāwili lapa'au. I kekahi manawa, hiki ke'ike i kahi hō'ailona ma ka'ao'ao ha'aha'a hema.

'O ka ECG Echo: i loko o ka pohā, e'ike'ia ka ulu'ana o ka wai exudate ma hope o ka ventricle hema o ka pu'uwai, ma ka'ao'ao o kona pā hope. I nā waihona nui o kahi wai exudate, ua'ike'ia ma mua o ka ventricle pono o ka na'au. Ho'oholo'ia ka nui o ka wai i loa'a i loko o ka'eke pericardial i ka wā ma waena o nā ku'i pūkoho mai ka epicardium a me ka pericardium.

Ka ho'oholo 'ana i ka kumu i kumu ai i ka ma'i

No ka ho'okumu'ana i ke kumu no'ono'o, kahi i alaka'i'ia ai ke'ano o ka pericarditis, ke nānā'ana i nā hua'ōlelo, nā hō'oia no ka hiki'ana o kekahi mau'epa (HIV), ka lūlū'ana i nā mea ola (e like me ke koko), e wehe i ka ma'i o ka exudative pericarditis, ka testicous tuberculin test. 'O ka ma'i Fungal.

Ho'opa'a pū'ia nā hana ho'omau āpau me nā ma'i āpau pūnaewele, ho'oholo i ka hele'ana o nā'epikipiki antineclear, nā kumu hau'oli, anti-streptolysin-o titer, agglutinins malulu - me ka ma'i mycoplasmal, me ka uraemia, ka creatinine serum a me ka nui o ka urula.

Palena pauʻike, o exudative pericarditis

'O ke'ano o ka'ōhula o ka pīkole e like me nā hui kaiapuni ma lalo: ka'eha'eha o ka myocardial, ke kī'aha o ke kino, ka loli valve, ka malo'o malo'o.

I loko o ka hō'ailona o ka myocardial, ua loa'a ka ma'i'eha ma o ka hō'ili'ili'ia'ana o nā hua i ka ma'i ma'amau i loko o ka ma'i musika (myocardium). Pa'a'ia ka ma'i'eha me ka hō'ailona o ka ma'i ma'amau me nā hō'ailona hō'ailona a me nā hō'ailona hō'ike e hō'ike ana iā lākou iho he mea hō'eha i nā hana o ka hemodynamics center, ka ho'opi'i o ka na'au o ke heart, nā ka'ina conduction i ke myocardium, nā hanana stagnation i ka'ōpili li'ili'i (pulmonary), i nā loli kūikawā i nā'āpana ECoc. 'O ka ho'ā'o'ana o ka lā'au'ele'ele o ka myocardial infarction e hō'ike i ka hana o ka isoenzymes na'aupō.

Me ka malo'o malo'o,'o ke'ano o ka ma'i pa'i a me nā hi'ohi'ona e pili ana i ka hanu'ana, ka'ili, ke kūlana o ke kino, i ke kani'ana o ke kani a me ke'ano o ka'enekepeke, he mea nui loa, e like me ka mea i luna, e ho'omaopopo'ia ma ka maloo malo'o'a'ole hiki ke ho'ololi i ke ki'i electrocardiogram . Haʻalele aortic aneurysm mai ka exudative pericarditis ia oia i loko o ka mea ana i ke kumu o ka aaiaoe maʻi - Marfan maʻi pale a atherosclerotic lesion kona pā iwi. I kekahi mau kumu, hiki ke hana i ka pericarditis mau pono.

Hō'ike'ia ka hopena o ke anortysm e like me kēia: ka ma'i'eha ma ka umauma o ka umauma, me ka'ole o ka irradiation, dysphagia, leo leo'ole, dyspnea, pa'akikī no ka ho'opi'i o ka mediastinum. 'Imi'ia o kahi aneurysm o ka aorta ma ka ho'onaninelike X-ray o ka'ōiwi, ka echocardiography, a me ke anōkala.

Me kahi anerysm dissecting, ua'ike koke'ia nā ma'i aortic i loko o ka umauma, kahi i ho'oku'u'ia i ka'ae. I kēia hihia, hiki i nā ma'i ke kūlana ko'iko'i, pinepine i ka nalowale'ana o nā pulsations ma ke ana'eha nui. Ma ke kuhi'ana,'a'ohe kūpono o ka valve aortic. 'O nā diagnostical measures for the dissecting aortic aneurysm:'o ia ka ultrasound spectrasal and calculated tomography o nā mea ho'ohemo o ka'ōpū.

He mea e nānā ai

He nui ke differentiate pericardial effusion ICD 10 me eiei? Myocarditis, i ua pu ma ka hoʻonui o ka naau lua a me na hoailona o ka circulatory ole. Hō'ike'ia ke'ano o ka myocarditis e like me kēia: hiki ke kaumaha i kahi'ano stenocardic, kahi mana'o kaumaha i loko o ka pu'uwai, i ka hō'eha o ka na'au.

Ho'omaopopo ke kumu kula i ka ho'opi'i'ana i nā kani o ka na'au, hiki ke ho'opili'ia ka leo mua a'ehā o ka na'au,'oiai e wehewehe i ka electrocardiogram hiki ke'ike i kēia mau hi'ohi'ona: i kahi niho P, i ka ho'ololi'ana o ka māmā o ka niho R, hiki ke ho'opili'ia ka hawewe T. I ka wā o ka Echo-KG, ua ho'okomo'ia ka no'ono'o i ka ho'onui'ana o nā ke'ena na'au a me ka ho'ēmi'ana o ke ku'ikahi'ana o nā paia.

'O nā mea lapa'au i ka mālama'ana i nā pericarditis exudative

Inā mana'o'ia he'ano exudative pericarditis, pono pono e ho'omaha koke i ka mea ma'i i loko o ka haukapila. Inā loa'a kahi ma'i le'ale'a i'ōlelo'ia, pono ia e kauoha i ka aspirin ma ka papa pālahalaha, me nā'ano o ho'okahi gramme i loko, i kēlā me kēia'ekolu a'ehā paha hora. I ka aspirin, hiki iā'oe ke ho'ohui i nā papa i loko o ka indomethacin me ke'ano o 25-50 mg, holoi'ia me ka wai, i nā hola'eono.

Inā he mau hō'ailona, a laila e ho'okumu i kahi hopena o 50% kānalua no ka hana'ana intramuscular o 2 ml ai'ole ka analgesic (morphine) ka nui o ka 1%, he hapa o ho'okahi a hapalua mileiliters, i nā hola'eono. I ka hihia o psychomotor e kū'ē i ke kūlana o ka ma'i i ulu ai a maule paha paha, e mālama'ia ka "Sibazon" ("Relanium") i loko o 5-10 mg'ekolu a'ehā paha o ka lā.

No ka ho'opau'ana i nā papa hana inflammatory i ho'ohana pinepine'ia i ka hana o "Prednisolone", he'ano o 20-80 mg / lā. No nā'ano ho'opunipuni. Ho'omoe'ia ka ho'omehana me nā hormones glucocorticoid i nā ko'i ki'eki'e me ka papa o 7-10 mau lā, me ka hi'ohi'ona i loko o nā mea hou e pono ai e ho'ēmi iho i ka mālie,'elua a me ka hapalua mileigram i kēlā me kēia lā.

'O ka manawa mālama

Iloko o ka manawa hea ka exudative pericarditis? Ho'olā'au kahi'elua a'ekolu paha mau hebedoma, i kekahi manawa he pono e ho'olālā a hō'ea i nā mahina he nui loa, e like me nā hō'ailona. 'O ke kikowa'ī o ka lā'au ho'omalu ma muli o ka kumu no'ono'o i kumu i ka pericarditis exudative.

Ke'ike'ia ka'ōpiko o ka'ōpiopio, hiki ke ho'ohana'ia nā lā'au lapa'au hō'ailona-steroidal, akā'a'ole i kau'ia nā hormones. Pa'a'ole'ia ka ma'i pīpīpī e Streptococcus pneumonia - e kauoha i nā lā'au antibacterial, e like me ka benzylpenicillin me kahi'ano 200,000 units / kg / lā. I loko o ka'ele'ele, ua māhele'ia kēia'oko'a i'eono mau injections,'o ka lō'ihi o ke kau'ana'a'ole i emi iho i nā lā he'umi.

Nā ho'onui hou

Eia kekahi, inā'ike'ia he exicative pericarditis, pono e hana'ia ka pericardiocentesis (kahi hana e pili ana i ke'ano lapa'au a me ka diagnostical nature, kahi i peni'ia ai ka'alani kūikawā o ka'eke pericardial e huki i kahi wai no ka hō'ailona). Ma hope o kēlā, ua kanu'ia ka exudate no ka'ike'ana i kahi'ano o nā ma'i ma'i o kēia ma'i, he mea nui e ho'oholo i ka hō'ailona o kona'ike i nā lā'au antibacterial. Inā loa'a i ka Staphylococcus aureus,'o ka lā'au'awa'awa "Vancomycin" he mea ma'amau ia i loko o ka hapa ho'okahi i kēlā me kēia manawa, i kēlā me kēia hola he'umikumamālua,'o ka papa ho'ona'auao he 14 a 21 mau lā.

I kekahi manawa, i kahi ma'i ma'i e hiki ai ke hana i ka exicative pericarditis. Ho'oma'a'ia i loko o kēia hihia e "Amphotericin". 'O ka helu mua loa he 1 mg, ua ho'opi'i'ia i ka parenterally (ma o ke ko'iko'i) i loko o ka hopena glucose me ka pakeneka o 5 pakeneka a me ka nui o 50 mau mile militers, e ho'oulu ai no 30 mau minuke. Inā mālama ka mea ho'omana i kēia lā'au lapa'au, e ho'ololi'ia ke ka'ina hana i like'ole: 0.2 mg / kg no ho'okahi hola. Ma hope iho, ua ho'onui mau'ia ka hopena i ho'okahi a me ka hapa ai'ole ho'okahi microgram / lā. No'ekolu a'ehā paha hola ma mua o ka ho'omaka'ana o kahi hopena maika'i.

'O ka hopena o ka "Amphotericin", he mea kūpono e nānā i - nephrotoxic, ma kēia'ano, e nānā i nā hana o nā pu'upa'a. Inā ua kū i ka lā'au exicative pericarditis ma muli o ka ho'ohana'ana i nā lā'au lapa'au, a laila, e ho'ohana'ia nā'ano hana e mālama ai i ka hō'oki hou'ana o kēia mau kālā a hō'ano hou i nā kauā anti-inflammatory non-steroidal i hui pū'ia me nā corticosteroids, ke alaka'i pū nei lākou i ka ho'ōla wikiwiki, Inā lākou i kau'ia mai nā lā mua o ka ho'omaka'ana o ka ma'i.