Edemonic edema ndi matenda omwe amachititsa kuti munthu asalowe m'madzi kuchokera ku mapuloteni a pulmonomiya kupita ku interstitium ndi alveoli. Chifukwa chaichi, kuphwanya kwa mpweya kumakhala koopsa kwambiri, mpweya wa mpweya umayamba, zimatulutsa ziwalo ndi ziwalo.
Mitundu ya edema ya pulmonary
OL ndi chikhalidwe chomwe chithandizo chiyenera kuperekedwa nthawi yomweyo. Ikhoza kuwuka chifukwa cha kuyeserera mwakuthupi, ndipo usiku - kupumula. Nthawi zina mphukira ya pulmona imakhala yovuta, yomwe imayambitsa kutsutsana kwa kufalikira kwa madzi m'thupi. Zakudya sizimalimbana ndi kuchuluka kwa mwazi wopangidwa kuchokera m'magazi a capillaries, ndipo madzi omwe ali pansi pa mavuto aakulu amapita ku alveoli. Chifukwa chaichi, mapapo amasiya molondola ntchito zawo zoyambirira.
Kukula kwa OL kumachitika magawo awiri. Choyamba magazi amalowa mkati mwa interstitium. Matendawa amatchedwa interstitial pulmonary edema. Ndili, parenchyma imapangidwa ndi madzi, koma lumen ya alveoli sichilowa mu transudate. Kuchokera kumalo osakanikirana, ngati kuponderezedwa sikucheperachepera, magazi amalowa mkati mwa alveoli. Pachifukwa ichi, mapulogalamu a almaolar pulema ayamba kupezeka.
Mphungu yokhala ndi mapulogalamu amatha kupangidwanso ndi nthawi ya chitukuko:
- Zovuta zimapezeka m'maola awiri ndi awiri.
- Zimatengera maola angapo kuti pakhale nthawi yayitali. Ikhoza kukhala kwa tsiku limodzi kapena kuposa.
- Mphezi ndi yoopsa kwambiri. Zimayamba mwadzidzidzi, ndipo mphindi zingapo chiyambireni imfa.
Edema yamapiritsi ya mtima
Matenda osiyanasiyana angayambitse vuto la AL. Mapulogalamu a mapaipi a mtima amayikidwa pamene mtima umakhudzidwa ndi ndondomeko ya matenda. Matenda omwe amachititsa kusokonezeka mu ntchito ya systolic ndi diastolic ya ventricle ya kumanzere. Lolani ku vuto makamaka anthu omwe ali ndi matenda a mtima ischemic. Kuonjezera apo, pulmonary edema ndi myocardial infarction, matenda oopsa, matenda a mtima amapezeka. Poonetsetsa kuti OL alidi ndi mtima, muyenera kuyang'ana pulmonary capillary pressure. Iyenera kukhala pamwamba pa 30 mm Hg. Art.
Oscardiogenic pulmonary edema
Mtundu uwu wa OL ukhoza kuyambitsidwa ndi matenda osiyanasiyana, zomwe zimabweretsa vuto limodzi - kuphwanya kusungunuka kwa memphane ya alveolar. Matenda omwe amachititsa kuti asakhale odwala thupi:
- chibayo (zonse mabakiteriya ndi tizilombo);
- Matenda a DIC;
- kupweteka koopsa kwa magazi;
- kupweteka kwa mapapo.
Vuto lalikulu ndilokuti mapiritsi a mtima ndi osagwirizana ndi mapiritsi a mtima ndi ovuta kusiyanitsa pakati pawo. Pofuna kusiyanitsa vutoli, katswiri ayenera kulingalira mbiri yakale yachipatala, kuyang'ana myocardial ischemia, ndi kuyeza pakati pa zamoyo. Muzitsulo, mayesero ena amagwiritsidwanso ntchito-kuyeza kwa kupanikizana kwa kupanikizana. Ngati nambalayi ili pamwamba pa 18 mm Hg. Art. Ndi edema ya mtima. Ndili ndi vuto la chiyambi chosachokera ku mtima, vuto limakhala lofala.
Edema yamadzimadzi owopsa
Dziko limabwera chifukwa cha:
- yonjezerani capillary zovomerezeka;
- kuphwanya ufulu wawo;
- Kuphwanyidwa kwazomwe zimayambira muzitsulo zamagetsi;
- oxygen njala.
Edema ya poizoni ili ndi zovuta zina. Ali ndi nthawi yosiyana. Kuwonjezera apo, zizindikiro za OL zimagwirizanitsidwa ndi zizindikiro za mankhwala otentha a m'mapapo ndi matenda okhudza kupuma. Mankhwala amasiyanitsa nthawi zinayi zazikulu za kukula kwa vuto:
- Kwa oyamba, mawonetseredwe a matenda a reflex ndiwo chikhalidwe: kukokera, dyspnea oopsa, lachrymation losatha. Pazovuta kwambiri, kuyima kwa mtima ndi kupuma kungayambe.
- Pa nthawi yochepetsedwa, zozizwitsa za mkwiyo zinatsika. Amakhala kwa maola angapo mpaka masiku angapo (koma monga lamulo, osapitirira maola 4 mpaka 6). Ngakhale kuti moyo wathanzi wa wodwalayo uli wolimba, zizindikiro zimatha kudziwa zizindikiro za kuyandikira kwa edema: kupuma kumakhala kobwerezabwereza, kuthamanga kumachepetsa.
- Gawo lachitatu likuwonetsa kutupa. Amakhala pafupi tsiku. Panthawi imeneyi, kutentha kumatuluka, neutrophilic leukocytosis imayamba.
- Pomalizira, pali zizindikiro za mavuto, omwe angakhale matenda monga chibayo kapena matenda a pneumosclerosis.
Nchiyani chimayambitsa pulmonary edema?
Zifukwa zomwe mapapo amakula, zambiri. Zina mwazofunikira ndizo:
- sepsis (nthawi zambiri kumakhala motsutsana ndi chiyambi cha kulowa mkati mwa poizoni m'magazi);
- kuledzera kwa mankhwala;
- chibayo ;
- Kuwonjezera pa mankhwala ena (oopsa kwambiri ndi odana ndi zotupa mankhwala ndi mankhwala a cytotoxic);
- Kuwonongeka kwa dzuwa kumapapo;
- poizoni ndi poizoni;
- stasis m'nthawi yoyamba yofalitsidwa (yowona ndi mphumu ya mphumu, imphysema ndi matenda ena a m'mapapo);
- kuperewera kwadzidzidzi kapena mwadzidzidzi muyezo wa mapuloteni m'magazi (monga matenda a chiwindi, matenda a nephrotic ndi matenda ena a impso);
- kusokoneza;
- kupweteka koopsa kwa magazi;
- poizoni ndi mpweya ;
- chilakolako cha mmimba;
- pneumothorax ;
- khalani pamwamba;
- Kutsegula kosalamulirika kwa madzi osakanizidwa mwakuya.
Edema yamaphunziro ndi mtima wolephera
Matendawa ndilo gawo lomaliza la kuwonjezeka kwa magazi m'thupi. Matenda a mtima odwala matenda a mtima amayamba m'mitima yovuta komanso kusokonezeka kwa dongosolo lonse. Edema wa m'magazi amawoneka ndi chifuwa chokhala ndi mtundu wa mtundu wa mtundu wa sputum. Pa milandu yovuta kwambiri, wodwala amakhala ndi kusowa kwakukulu kwa mpweya ndi kutaya chidziwitso. Kupweteka kwa odwala kumangokhala mopanda phindu ndipo sikungatheke, kotero, mpweya wabwino umaperekedwa.
Mapulani a edema pamtunda
Kugonjetsa nsonga zapamwamba ndi masewera owopsa osati chifukwa cha kuopsa kwa kusintha kwa masewera. Kutupa kwa mapapo m'mapiri ndi wamba. Ndipo izo zingakhoze ngakhale kuwuka mwa okwera mmwamba ndi okwera. Pamwamba mutakwera mapiri, thupi lanu limalandira mpweya wochepa. Kumtunda, kukakamiza kumapita pansi, ndipo magazi omwe amapyola m'mapapu sapeza phindu lenileni la gasi. Zotsatira zake, madziwa amapezeka m'mapapu. Ndipo ngati simuthandiza kupuma m'mapapo, munthu akhoza kufa.
Edema wamapuloni odwala bedridden
Thupi la munthu silinasinthidwe kuti likhale malo osakanikirana kwa nthawi yaitali. Choncho, odwala ena omwe amayamba kulandira mankhwala amayamba kukhala ndi mavuto monga OL. Zizindikiro za vutoli ndizofanana ndi zomwe zimayambitsidwa ndi matenda aakulu, koma n'zosavuta kuchiza mpweya woterewu, chifukwa umadziwika bwino chifukwa chake umaonekera.
Ndipo mu odwala bedridden, pulmona edema imayambitsa zifukwa zotsatirazi: mu malo apamwamba kwambiri mpweya umatulutsa. Chifukwa chaichi, magazi akuyenda m'mapapo amachepetsanso, ndipo zowonjezereka zimachitika. Mphungu, yomwe ili ndi ziwalo zotupa, imasonkhanitsa, ndipo imatuluka movutikira. Zotsatira zake, njira zowonjezereka zikupita patsogolo, kudzikuza kumayamba.
Matenda a edema - zizindikiro, zizindikiro
Mawonetseredwe a OL ovuta ndi otha msinkhu amasiyana. Zotsatirazi zimakula pang'onopang'ono. Choyamba "kumeza", chenjezo ponena za vutoli, chimakhala mpweya wochepa. Poyamba zimangochitika pokhapokha panthawi ya thupi, koma m'kupita kwanthawi, kupuma kudzakhala kovuta ngakhale panthawi yopuma. Odwala ambiri, mofanana ndi mpweya wochepa, zizindikiro za mphutsi za m'mapapo zimawonetsedwa mwachitsanzo, kupuma mofulumira, chizungulire, kugona, kufooka kwathunthu. Kuwonetsa ngozi kungakhale njira yothandizira mapapu - zachilendo, kugwedeza ndi phokoso lamkokomo zimamveka mu stethoscope.
Edema yamadzimadzi edema sichivuta kuizindikira. Kawirikawiri imawonekera usiku, pogona. Mwamuna amadzuka ku chiwonongeko chowopsya kwambiri. Zimabweretsa mantha, chifukwa chiwerengerochi chimawonjezeka. Patapita kanthawi, kutsokomola, kupweteka, kutulutsa cyanosis, kutukuta kozizira, kunjenjemera, kupweteka m'mimba pachifuwa kumawonjezeredwa ku zizindikiro zomwe zilipo kale. Pakuwonjezeranso edema, chisokonezo chikhoza kuchitika, kuthamanga kwa magazi kungagwe, kapena kufooketsa - kapena kusagwedezeka konse - ndi kupsa.
Kupatsa mankhwala owonetsa
Thandizo la AL liyenera kukhazikitsidwa pofuna kuchepetsa kuti kuthetsa zonse zomwe zimachititsa kuti zichitike.
Pano pali njira yochizira pulmonary edema:
- Choyamba, zonsezi zingathe kutengedwa kuti kuchepetsa kutaya kwa magazi kumapapo. Kuchita izi kudzathandiza vasodilators, diuretics, ndondomeko ya kutsegula magazi kapena kugwiritsa ntchito maulendo oyendayenda.
- Ngati izi zingatheke, m'pofunika kupereka zofunikira za kutuluka kwa magazi - mwa kupititsa patsogolo mapangidwe a mtima ndi kuchepetsa kupweteka kwa mthupi.
- Thandizo la okosijeni limathandiza kuthetsa zizindikiro za edema ya pulmonary.
- Ndikofunika kupereka wodwalayo mtendere ndi kumuteteza ku zovuta.
- Pa milandu yovuta kwambiri, chisakanizo cha 5 ml cha 96% chakumwa mowa ndi 15 ml ya mankhwala a 5% a shuga mu trachea kapena intravenously amaloledwa.
Edemoni edema - thandizo lachangu, algorithm
Mwamsanga pamene mawonetseredwe oyambirira a AL akuzindikiridwa, munthu ayenera kuthandizidwa musanafike nthawi ya chipatala. Kupanda kutero, chiwonongeko chikhoza kufa.
Kusamalidwa koopsa kwa edema ya pulmonari kumachitika molingana ndi ndondomeko yotsatirayi:
- Wopweteka ayenera kuikidwa pamalo omwe amakhala.
- Sungani tsamba lopumako kuchokera ku chithovu ndi oxygen inhalation.
- Kupweteka kosalekeza kusiya ndi antipsychotics.
- Bweretsani kuchuluka kwa mtima.
- Sakanizani mphamvu ya electrolyte ndi acid-base base.
- Pothandizidwa ndi ma analgesics, bweretsani mphamvu ya hydrostatic mu bwalo laling'ono.
- Lembetsani liwu la ziwiya ndi buku la plasma ya intrathora.
- Chithandizo choyamba cha edema yamapiritsi chimaphatikizapo kuyambika kwa glycosides mtima.
Edema - mankhwala
Chithandizo chachikulu chikupitirira kuchipatala. Kulimbana ndi vuto ngati mankhwala a pulmona edema kudzafuna zotsatirazi:
- Morphine;
- Fentanyl;
- Furosemide ;
- Korglikon;
- Chithunzi;
- Eufillin ;
- Aminophylline;
- maantibayotiki (povutitsa mabakiteriya).
Zotsatira za pulemary edema - zotsatira
OL akhoza kukhala ndi zotsatira zosiyana. Ngati chithandizo chadzidzidzi chaperekedwa pa nthawi komanso molondola ndipo zotsatirazi zikuchitidwa ndi akatswiri oyenerera, ngakhale edema yapamwamba ya mpweya idzaiwala bwinobwino. Hypoxia yautali ingayambitse njira zosasinthika m'katikati mwa mitsempha ya ubongo ndi ubongo. Koma m'milandu yoopsya kwambiri, kusintha kwadzidzidzi kwa edema kwakukulu kumabweretsa mavuto.
Zolemba zapulmonary edema - prognosis
Ndikofunika kumvetsetsa kuti AL ndi vuto limene nthawi zambiri limakhala losavomerezeka. Malingana ndi chiwerengero, pafupifupi 50% mwa odwala amakhalapo. Koma ngati n'kotheka kudziwa kuti chiyambi cha pulmonary edema ndi chiyani, mwayi wowonjezera. Kupweteka, kumayambitsa matenda a myocardial infarction, kumayambitsa imfa mu 90%. Kubwezeretsedwa pambuyo pa kuukira kwa odwala miyezi ingapo ayenera kuwonedwa ndi madokotala.