Ukwahlula ukutshitshiswa, inkcazo yomxholo

Ebomini, kukho iimeko ezininzi ezinokuthi zenzeke. Uninzi lwabantu ludibanisa kuphela ngokuphazamiseka okukhulu, kodwa oku kuyingxenye yinyani. Kwiyeza, kukho ukuhlengahlengiswa, ukubeka i-pathogenesis yayo, ubunzima, ubunjani beenguqu kwizitho kunye nezindlela zokupheliswa kwazo. Ngethuba lokuqala le mqathango ibonakaliswe ngaphezu kweyesi-2 eyiminyaka edlulileyo yi-Hippocrates edumileyo, kwaye igama elithi "ukutshatyalaliswa" kwindlela yokwelapha yenziwa ngo-1737 nguDokotela waseParis uHenri Ledrand. Inqaku elicetywayo lenkcukacha zezizathu zokutshitshiswa, ukuhlenga, ikliniki, uncedo oluphuthumayo xa kwenzeka le meko enzima kunye nezibikezelo.

Umxholo wokutshatyalaliswa

Ukutshatyalaliswa kweNgesi kunokuguqulwa, njengothutho oluphezulu, akusiyo isifo, kungekhona uphawu kwaye alukho ukuxilongwa. Kwindlela yokusebenza kwehlabathi, eli gama liqondwa njengempendulo yendalo kunye neenkqubo zayo ukuvuselela ngamandla (kwangaphandle okanye kwangaphakathi), apho umsebenzi wesistim somnyuba, umonakalo, ukuphefumula kunye nokujikeleza kuphazamiseka. Apha anjalo kumzuzwana unentsingiselo yokutshatyalaliswa. Ukwahlulelwa kwalo mqathango kuyadingeka ukuchonga izizathu zokutshatyalaliswa, iqondo lobunzima kunye nokuqala unyango olululo. Isizaziso siya kulungeleka kuphela ukuxilongwa okufanelekileyo kunye nokuqala ngokukhawuleza kokuvuselelwa.

Ulwahlulo

I-pathologist yaseCanada uSelye yachonga izigaba ezintathu, malunga nokufana kwazo zonke iintlobo zokuphazamiseka:

1.Izinto ezinokuthi zihlawulwe (ihlawulwe), apho igazi elinikezelwa kwingqondo, intliziyo, imiphunga kunye nezinye izitho ziphazamiseka, kodwa zingagqitywanga. I-Forecast kule nqanaba, njengomthetho, efanelekileyo.

2. Ukuhlaziywa ngokusemthethweni (kuhlawulwa). Kule meko, ukuphulwa kwegazi (ukwenziwa komngcipheko) kubalulekile, kodwa ngokungenelela ngonyango oluphuthumayo kunye nethuba lokubuyisela imisebenzi.

3. Ukungahlawulwanga (ukuphela). Le ngongoma kunzima kakhulu, apho ukuphazamiseka emzimbeni kungabuyiswanga khona nangona mpembelelo onamandla kakhulu. Umbono apha i-95% engalunganga.

Olunye udidi luhlukanisa isigaba esicatshulwa ngokukodwa kwi-2 -compensation and compensation. Ngenxa yoko, bane-4:

• I-1 ihlawuliswe (elula, ibe ne-prognosis efanelekileyo).
• I-2 ehlawulisiweyo (i-moderation, idinga ukuvuselelwa ngokukhawuleza.) Ukugxekwa kubangelwa ingxabano.
• I-3rd decompensational (kakhulu enzima, nangona kuphunyezwe ngokukhawuleza kwayo yonke imilinganiselo efunekayo, ukubikezelwa kunzima kakhulu).
• I-4 engenakuphikiswa

I-Pirogov yethu edumileyo ichonge izigaba ezimbini kwimeko yokutshatyalaliswa:

-baluleke kakhulu (isigulane sinqabile okanye sinamandla kakhulu, asiphenduli ukulwa nesicatshulwa, ayiphenduli imibuzo);

-Erectile (isigulane sinomdla kakhulu, sikhankanya, senza ukunyakaza okungenakulawulwa kwezinto ezininzi).

Iintlobo zokuphazamiseka

Ngokuxhomekeke kwizizathu ezibangele ukungalingani kumsebenzi weesistim zomzimba, kukho iintlobo ezahlukeneyo zokuphazamiseka. Ukwahlula ngokwezalathisi zokuphazamiseka kwentshukumo yile ndlela lulandelayo:

-hypovolemic;

-ukunikezela;

-cardiogenic;

-kuvuselela;

-ngcaciso.

Ukwahlula ukutshatyalaliswa yi-pathogenesis ngolu hlobo lulandelayo:

-hypovolemic;

-Traumatic;

-cardiogenic;

-septic;

-anaphylactic;

-iyingozi-inetyhefu;

-itrogenic;

-kuhlanganisiwe.

Tshutshisa i-Hypovolemic

Ixesha eliyinkimbinkimbi lilula ukuqonda, ukwazi ukuba i-hypovolemia yimeko apho igazi lijikeleza ngemithambo yegazi ngaphantsi komthamo ofunekayo. Izizathu:

Ukuxhatshazwa kwamanzi;

Ukutshiswa okukhulu (amaninzi eplasma alahlekile);

Ukuphendula ngokubanzi kwizidakamizwa, umzekelo, ii-vasodilators;

Ukulahleka kwegazi, ngenxa yoko izitho ezingenayo i-oksijeni kunye nezondlo, oko kukuthi, ukuphazamiseka kukuphazamiseka.

Ukuxhatshazwa kwe-Hypovolemic ngenxa yokulahlekelwa kwegazi okuphezulu kunokuthathwa njengotyikisayo . Ukwahlulelwa kwale rhafu kufana noko kuphunyezwe nguSelye, kwaye ngelo xesha iinqanaba zenziwa ngamaqela alahlekileyo egazi. Ukutshatyalaliswa kukuhlala kukukhusela komzimba kwiimeko ezinzima. Oko kukuthi, ivelisa inani leenkqubo ezifuna ukulondoloza umsebenzi wezitho ezibalulekileyo kwaye ngoko kulondoloza ubomi kwenkqubo yonke. Ngokukodwa, ngokulahleka kwegazi kwimithambo yegazi, kugcinwe igazi (malunga ne-10% yenani elipheleleyo) ukusuka esibindi nasenteni. Ukuba oku akwanele, ukunikezelwa kwegazi kwiindawo ezingabalulekiyo zomzimba, umzekelo, ukuya kumida, kunciphisa okanye kumiswa, ukwenzela ukuba igazi elisele lanele ukucoceka kwentliziyo, ingqondo kunye nemiphunga. Ukuhlelwa kokutshitshiswa kukugqiba ezi zigaba zibini, njengoko zibuyiselwa kwaye zibuyiselwa. Ngethuba elifanayo ukuba ixesha lokuthatha isenzo, unokumothukisa umntu kwaye ulondoloze ubomi bakhe.

Umsebenzi omdala kwigazi lokugcina kunye nokuqinisekisa ukuxutywa kwamalungu athile ngeendleko zabanye umzimba awukwazi. Ngoko ke, ukuba awuqali ukuvuselela, isigaba sokugqibela (esingenakuphikiswa) siza. Ukukhubazeka kweempahla kuyabonakala, uxinzelelo kubo luyancipha ngokukhawuleza, igazi ligeleza ukuya kwinqanaba, ukunyuka kubakaki abalulekayo bokungcoliseki kwengqondo, intliziyo nemiphunga.

Ukuditywa kwamanzi

Amanzi emzimbeni womntu, kuxhomekeke kwiminyaka yobudala kunye nesondo, ivela kuma-60 ukuya kuma-80%. Ukulahlekelwa ngu-20% kuphela walo mqulu ungabhubhisa, kwaye ukulahleka kwe-10% kubangele ukutshatyalaliswa kwe-hypovolemic, ekubhekiselwe kulo mzekelo njengokungcoliswa kwamanzi, oku kuthetha ukuhla kwezinga legazi elijikelezayo ngemithambo yegazi ngenxa yokudambisa amanzi. Izizathu:

- izifo ezikhokelela ekurhoxeni, ukuhlanza, rhoqo ukucoca;

-Ukuchaza umzimba wamanzi (nedopivanie) kwiimeko ezimbi kakhulu, umzekelo, ngokushisa okukhulu, ngokukodwa ekusebenziseni okusemgangathweni;

Izidlo ezingenangqiqo.

Ngokukodwa ukwenzeka kokungcoliswa kwamanzi kubantwana abancinci kunye nabantu asebekhulile baphezulu kakhulu.

Ukwahlula kokutshatyalaliswa ngenxa yokungabikho kwamanzi, ukwahlula izigaba:

-invertible;

Kubuyiselwa kwakhona;

I ngavumelekanga.

Ukongezelela, ukukhulelwa kwamanzi kulwahlula kwiintlobo ezintathu:

1.I-Isotonic (ukulahlekelwa kweNa ne Kons). Umkhuhlane emzimbeni wethu ungaphakathi kwe-intracellular kunye ne-intercellular. Ngenxa yokulahlekelwa kwe-isotonic kubangelwa kukurhuda, i-potassium eninzi ikhutshwe emzimbeni, kunye ne-sodium, eyona nto yinkqutyana ebalulekileyo kwi-intercellular fluid, ingena ngaphakathi kweeseli ukwenzela i-potassium elahlekileyo.

2. I-hypotonic, esiphumo se-isotonic. Kule meko, kukho ilahleko eziphezulu kwi-intercellular fluid (emva koko, i-sodium idlulele kwiiseli). Amanqanaba amabini okuqala acinga ukuba ahlaziywe, kuba ukulahlekelwa kwe-electrolyte kunokuhlawulwa. Inxalenye yale nto inokwenzeka xa unikezela isigulane isiselo esininzi, ngokukodwa sibe ne-sodium ions.

3. I-Hypertonic, eyenziwa kwiimeko xa uhudo luhamba kunye nokuhlanza, ukuthintela ukuhamba kwamanzi emzimbeni ngomlomo, okanye ngokugqithiseleka kwemithi ethile eyenza ukwanda kwamanzi. Kule meko, i-liquid kwakhona ukusuka kwiiseli idlula kwisithuba se-intercellular, ezama ukugcina uxinzelelo lwe-osmotic. Amaseli amancinci amancinci aphazamise umsebenzi wawo kwaye anciphise umthamo. Eyona nengozi kakhulu ukunciphisa umthamo weengqondo, okukhokelela ekuhambeni kwegazi.

Iimpawu

Sijonge udidi olulinganisa ukutshitshiswa kwe-hypovolemic. Iklinikhi yale meko, kungakhathaliseki ukuba izizathu ezibangele yona, zifana noko. Kwinqanaba elibuyiselwayo kwisigulane esisekho sikweni, i-symptomatology echazwayo ingasekho. Iimpawu zokuqala kweengxaki zi:

Iintliziyo zentliziyo;

-nciphisa ukunyuka kwegazi;

Ubumba, isikhumba samanzi emilenzeni (ngenxa yokungcoliswa okunciphisisiweyo);

-kukupheliswa kwamanzi, ukutywa komlomo, ukungena emlonyeni, ukungabikho kwembezi.

Kwinqanaba lesithathu lokutshatyalaliswa, iimpawu zokuqala zithethwa ngakumbi.

Izigulane ziphawulwe:

- Tachycardia;

Ukuchithwa kweengcombolo zengcinezelo yegazi apha ngezantsi;

- Ukuphazamiseka kokuphefumla;

-Iliguria;

Kubanda kwi-sikhumba yesikhumba (kungekhona nje imilenze);

- ukukhwabanisa kwesikhumba kunye / okanye ukutshintsha umbala wabo kwinto eqhelekileyo ukuya kwi-cyanotic;

I-pulp-shaped shape;

- Xa ucinezela kwiminwe, zibukhali, kwaye umbala emva kokuba umthwalo ususwe ubuyiselwe kwimigqomo engaphezu kwe-2 efakwe kwisiqhelo. Ukutshatyalaliswa okukhulu kunayo iklinikhi efanayo. Ukuhlelwa kwamanqanaba ayo, kuxhomekeke kumthamo wegazi ojikelezayo kwimithambo yegazi, ukongezelela kubandakanya iimpawu:

Kwinqanaba le-tachycardia elibuyiselwayo ukuya kwi-beat be-110 ngomzuzu;

- i-tachycardia ibe yincinci ukuya kwi-140 ibhokhwe / iminithi;

-ngenakuphikiswa - intliziyo ye-160 kunye neebhondi eziphezulu / iminithi. Kwiindawo ezibalulekileyo, i-pulse ayizwanga, kwaye ukunyanzeliswa kwe-systolic kwehla kuma-60 okanye ngaphantsi kwe-mm Hg. Ikholamu.

Xa ukuphelelwa umdaka kwimeko yokutshatyalaliswa kwe-hypovolemic, iimpawu zongezwa:

-ukumisa kweembrane ezinobumba;

- Ukunciphisa ithoni yeelballs;

Iintsana ziwisa i-fontanel enkulu.

Ezi zonke iimpawu zangaphandle, kodwa ukuchonga ngokuchanekileyo ubungakanani beengxaki, ukuqhuba iimvavanyo zelabhoratri. Isigulane senza ngokukhawuleza ukuhlolwa kwegazi, ukusekwa kwinqanaba le-hematocrit, i-acidosis, kwiimeko eziyinkimbinkimbi, uphando ngobuninzi be-plasma. Ukongezelela, oogqirha bajonga i-potassium, i-electrolytes eyisiseko, i-creatinine, igazi le-urea. Ukuba iimpepha zivumelekile, imizuzu emininzi kunye neyikrakra yentliziyo, kunye neengcinezelo eziphambili zentsholongwane, ziyahlolwa.

Ukutshatyalaliswa ngokukrakra

Olu hlobo lokutshwenyeka lufana neendlela ezininzi zokumisa, kodwa isizathu saso sinokuba ngamanxeba angaphandle (ukugwazwa, ukusika, ukutshitshisa, ukutshisa) okanye ngaphakathi (ukuphuka kwezicubu kunye namalungu, umzekelo, ukusuka ngamandla). Ukutshatyalaliswa ngokukrakra kudla rhoqo kuhamba kunye ne-hard-bearing-bear-syndrome, iqhube ngakumbi imeko yexhoba. Kweminye imithombo, oku kubizwa ngokuba yintlungu, ekhokelela ekufeni. Iqondo lokuxakeka ngokukrakra lugqityiweyo alinakunikwa kakhulu ngexabiso legazi elahlekile njengalomlinganiselo welahleko. Oko kukuthi, ukuba igazi liphuma emzimbeni ngokukhawuleza, ixhoba linamathuba amaninzi okusindiswa. Kwakhona kunyanisa indawo kunye nobuqili bequmrhu elonakalisiweyo lomzimba. Oko kukuthi, ukusinda kwesilonda engengalo kuya kuba lula kunokuba unxeba entloko. Nazi izinto ezinjalo zinokutshatyalaliswa ngokukrakra. Ukwahlula kweli rhulumente ngokwemigaqo yobunzima lulandelayo:

Ukutshatyalaliswa kweprayimari (kwenzeka ngokukhawuleza emva kokulimala);

-kotyhutyana (kubonakala emva kokusebenza, ukususwa kweemfumba, kunye nemithwalo eyongezelelweyo kwixhoba, umzekelo, ukuthutha kwakhe).

Ukongezelela, ngokutshatyalaliswa ngokukrakra, kukho izigaba ezibini - i-erectile kunye nesidenge.

Iimpawu ze-erectile:

-yintlungu;

Ukuziphatha okungonelaneleko (ukumemeza, ukuxhalabisa, ukuxhalabisa, ngamanye amaxesha ubugwenxa);

-iyo;

Ukukhupha;

A bafundi;

- Tachycardia;

-tapeypnea.

Iimpawu zesibetho:

- Isigulane siba nomdla;

-eve, kodwa umntu akaphenduli kuyo;

Uxinzelelo lwe-Arterial uhla ngokukhawuleza;

-Izame zinyama;

-nika amandla isikhumba, i- cyanosis yomlomo;

-Iliguria;

Ubukho beelwimi;

-ukumisa kweembrane ezinobumba;

I-sweat ekhuzileyo ayifuni, kodwa isikhumba silahlekelwa ngumtsalane;

- i-pulse ifana nentambo;

Ubuso buso bubukhali.

Ukutshatyalaliswa okunesifo esichaphazelayo, udidi

Le meko ivela ngenxa yokungena kwintsholongwane, oko kukuthi, ii-virus kunye neebhaktheriya, ezibangela ukuba umsebenzi wabo unxilise. Ngokuqhelekileyo, ukuqala ukutshitshiswa yi-streptococci, staphylococcus, i-salmonella, i-Pseudomonas aeruginosa. Bangena emzimbeni, bobabini ngoncedo lwamanxeba avulekileyo (emva kokutshatyalaliswa, ukutshisa, ukuhlinzwa), ngaphandle kwabo (umkhuhlane we-typhoid, AIDS, tracheitis, sinusitis, pneumonia, influenza nezinye izifo).

Iipathogenic microorganms zivelisa i-superantigens, ezenza i-T-lymphocytes nezinye i-T-cell. Ezo zinto, zenza i-cytokines i-secrete, ngenxa yoko isistim somzimba sesigulane sigxininisekile, kwaye ubuninzi beetekisi obangela ukutshatyalaliswa okutyhilekileyo kukhutshwa kwigazi lakhe. Ukwahlula kweli rhulumente lihlukanisa izigaba ezintathu:

1. Ukuguqulwa. Ngexesha elifanayo, uxinzelelo lwegazi lunokuba luqhelekileyo, ukuqonda kuya kuhlala kucacile, ulusu luba luhlaza okanye lube luhlaza. Isigulane sisoloko sivuya, sikhalaza intlungu emzimbeni okanye kwisisu, isifo sohudo, umkhuhlane, ngezinye izikhathi ukuhlanza kubonakala.

2. Ukubuyiselwa okuyingxenye. Iimpawu: umkhuhlane, ukuphazamiseka kwe-pulse, i-tachycardia, ukunyuka kwengcinezelo, isigulane sinobuqili, ukusabela kwakhe kuvinjelwe.

3. Ukungahlawulwanga. Iimpawu: ukuphefumula okungapheliyo, ukudibanisa, i-cyanosis yesikhumba, i-pulse iyakwazi, ingcinezelo yegazi ingaphantsi kweyona nto ibaluleke kakhulu, isiguli asinakho.

Ukuhlonywa kwe-anaphylactic shock

Eli rhulumente lwenzeka xa ubuhlungu buya emzimbeni ngenxa yokulunywa kweenyoka, izigubungulu, izilwanyana kunye nezinye izinto eziphilayo, ekubeni uthathe iziphuzo ezithile kunye nokutya, kunye nokulawula iziyobisi ezithintela isigulane. Ngokuqhelekileyo le mpendulo ihanjiswa yi-novocaine, i-penicillin kunye ne-organopreparations. Ukutshatyalaka kunokuvela emva kwemizuzwana embalwa emva kokungeniswa kwe-allergen okanye emva kwexesha elide, kwaye kwangaphambili impendulo yenzeke, eyona nto iyingozi. Kukho iindlela ezininzi zokutshatyalaliswa kwe-anaphylactic:

-becific (ubomvu buvela kwisiza se-sting (nyxis) okanye intlungu yesisu, umqala ngomjoqo ngomlomo we-allergen, ukunciphisa uxinzelelo, ukucima phantsi kwembambo, ukurhoxisa okanye ukuhlanza kunokwenzeka);

I-Hemodynamic (kwindawo yokuqala, ukuphazamiseka kwengqondo);

- I-Asphyxia (ukungaphumeleli kokuphefumula, ukuxhatshazwa);

I-cerebral (ukuphulwa komsebenzi we-system central nervous, ukuxineka, ukulahleka kwengqondo, ukuyeka ukuphefumla);

-Abdominal (esiswini esiswini).

Unyango

Ukwamkelwa kwamanyathelo angxamisekileyo, ukulungiswa okuchanekileyo kweentlungu kubaluleke kakhulu. Unonophelo lwengxamiseko lwangxamisekileyo kwimeko nganye luneenkcukacha zalo, kodwa ngokukhawuleza liqala ukuphuma, isiguli sinamathuba amaninzi. Ngenqanaba elingenakuphikiswa, umphumo obulalayo ubonakala kwiimeko ezingaphezu kwama-90%. Xa kukho ukutshatyalaliswa ngokubalulekayo kubalulekile ukukhawuleza ukuvimba ukulahleka kwegazi (sebenzisa i-tourniquet) kwaye uhambise ixhoba esibhedlele. Kukho, iisombululo zetrovenity kunye ne-colloidal zilawulwa, ukuxelwa igazi, i-plasma, i-anesthetize, ukuba kuyimfuneko, ukudibanisa kwisixhobo sokuphefumula.

Ngenxa yokutshatyalaliswa kwe-anaphylactic, i-adrenaline ilawulwa ngokukhawuleza, kunye ne-asphyxia intubating isigulane. Ngaphezulu, i-glucocorticoids kunye ne-antihistamines zilawulwa.

Ukutshatyalaliswa okutyhilekileyo, unyango olukhulu lokunyuswa kwe-infusion lwenziwa ngoncedo lwe-antibiotics ezinamandla, i-immunomodulators, i-glucocorticoids kunye ne-plasma.

Ngenxa yokutshatyalaliswa kwe-hypovolemic, imisebenzi eyona nto kukubuyisela ukunikezelwa kwegazi kuzo zonke izitho, ukuphelisa i-hypoxia, ukulungelelanisa uxinzelelo lwegazi nokusebenza intliziyo. Ngethuba lokutshatyalaliswa okubangelwa kukungcoliswa kwamanzi, ukubuyiswa kwevolumu elahlekileyo yombane kunye nayo yonke i-electrolytes iyadingeka.