Chii mharidzo Ruvilua-Gregoire?

Munyika mune vakawanda zvirwere, pamusoro vanhu vakawanda havatombobvumi chifungidziro. Asi pane zviitiko kana uchingoda kuziva pamusoro zviratidzo rikwanise munhu kuti kukwanisa pakarepo kupa rubatsiro rwekutanga kumurwere. Asi hazvisi nguva dzose chirwere chakakomba kana zvokurwara inogona tsunga nemaziso, asi muchiitiko chino, kubatsira mazuva ano chirwere nzira, Somuenzaniso, akadai mharidzo Ruvilua-Gregoire. Asi nemhaka mharidzo iyi inogona tsunga, uye kuti kazhinji nokuda ongororo?

Muenzaniso Ruvilua-Gregoire: chii?

muedzo uyu - iyi ndiyo imwe nzira nechirwere, vachibvumira nokukurumidza kuona kana intrapleural ropa kana kwete panguva hemothorax. Positive bvunzo Ruvilua-Gregoire anoti ropa mberi mukati pleura, uye kunaka uchapupu chichiita yake, kana kana, asi kwete kutoshanda.

Asi chii chinonzi hemothorax, sei kurapa nayo, chii migumisiro kunyaya iyi romurwere ezvinhu?

Hemothorax: chii?

Hemothorax - kubuda kweropa kuti kunoitika mukati pleura uye zvinotungamirira chokwadi chokuti rinoungana yakawanda ropa, iro pakupedzisira ari pamwe compression yacho yemapapu. Muenzaniso Ruvilua-Gregoire anobvumira nekukurumidza kuziva pamberi ropa rayo zvikuru. Kuwedzera Diagnostics, kurasikirwa neropa vanogona kuzivikanwa zviratidzo:

• bhokisi marwadzo;
• pasi kumanikidzwa;
• dzungu;
• hapana ganda uye nevamwe.

Kana murwere kupa kuratidzwa akadaro, inofanira kuchipatara kuti chirwere uye kutora matanho ose kumisa kubuda kweropa. Asi kuti aigona rinokonzera hemothorax?

zvokurwara Zvinokonzera

Chirwere kuti hemothorax angafanira varwere vakagamuchira bhokisi kunotevera, vanofara kuti pathologies, kana iatrogenic zvinokonzera ropa.

Under vanachiremba Kukuvara dzinosanganisira kuvadza thorax akasiyana-siyana. Hemothorax anogona kuva somugumisiro tsaona dzemotokari, vapfurwa maronda, mbabvu akaputsika, kuwa kubva pakakwirira kukuru, uye zvimwewo.

Kukuvara kwakadaro kunogona kukonzera kwete kukuvadza chete mumapapu, asi dzimwe nhengo:

• mwoyo;
• chiropa;
• chirwatata;
• ari diaphragm;
• intercostal midziyo;
• thoracal tsinga;
• mumapapu.

Hemothorax uye zvinogona kukonzera zvirwere murwere, yakadai se:

• kutsemuka aneurysm;
• tiibhii;
• malignancy ari zvemapapu kana pleural;
• bapu pute;
• Hemorrhagic diathesis;
• coagulopathy, uye vamwe.

Iatrogenic zvinoita zvichitungamirira hemothorax (kusarudza ayo ndimene ndichaenda Yokuenzanisira Ruvilua-Gregoire) kuonekwa yematambudziko pashure pokuvhiyiwa pamusoro zvemapapu kana pleura, pleural abudise, placement zviri anobudisa mushonga zvishoma nezvishoma nechepakati tsinga.

pathogenesis hemothorax

kuunganidza ropa iri pleura kunogona kukonzera compression pamusoro zvemapapu uye misha yose zvomukati, iyo inotungamirira yekudyidzana kwakaderedza kufema pemvura zvemapapu, pane zvinetso zviri kufema uye hemodynamic. Nokuda kwechikonzero ichi, hemothorax kazhinji anovandudza kunotoda mharidzo Hemorrhagic uye cardio-pulmonary kuvhunduka inotungamirira kuti mwoyo uye kufema ezvinhu hadzishandi zvakanaka.

In rokutanga maawa pashure ropa apinda pleura, yokupedzisira hwapedyo ane kushoma. Kana hemothorax kukubatsira kuona mharidzo yacho Ruvilua-Gregoire (sokuti edema, leukocytic infiltration, kuzvimba uye exfoliated masero mesothelial). Kokutanga rakava munzvimbo pleural ropa kuburikidza ropa hakuna rakasiyana peripheral ropa, uye gare gare akaderedza Chizenga yomuropa, Indekisi erythrocytes uye leukocytes.

Kana jekiseni muimba pleura, clots ropa, asi pashure penguva pfupi nguva kunotanga gadziriro fibrinolysis, nokuda iyo liquefies zvakare. Izvi zvinobatsira kuti anticoagulant zvinhu. Pane zvidzidzo zvakawanda hemothorax. Ndezvipi, uye chii musiyano pakati pavo?

makirasi hemothorax

Hatina vakati kare kuti hemothorax zvinogona zvinorwadza, pathological uye iatrogenic. Uyezve, kufungisisa simba ropa rake uye tiri rakakamurwa makirasi akawanda:

• diki - pane kuunganidza ropa iri sinus, uye kurasikirwa neropa haasi kupfuura 500 Rine mamiririta;
• svikiro - ropa aregedza kuti ufanane nerumbabvu 4, uye inzwi racho rimwe nehafu marita;
• subtotal - ropa kwakadonha kuti yakaderera pamwero zvimbi 2, uye uwandu kurasikirwa ropa anenge maviri litres;
• zvachose - on X-ray zvinooneka achiipa pedyo kukundwa pamusoro pleura, uye kurasikirwa neropa riri kupfuura mweya marita.

Uyezve, hemothorax, iyo inobatsira kuziva mharidzo Ruvilua-Gregoire uye dzimwe chirwere nzira inogona apical, interlobar, parakostalnym, supradiaphragmatic, paramediastinalnym, zvose kunobva localization. Uyewo kuti nyaya, kana kubuda kweropa mberi, hemothorax akadana mberi, uye kana yamira - yakatsiga. Kana pleura panguva iyoyowo rinofukidza ropa kwete chete, asiwo mhepo, muchiitiko ichi tiri kutaura pamusoro gemopnevmotorakse. Asi chii Zviratidzo zvinogona kuratidza hemothorax?

Zviratidzo hemothorax

The kunotoda mufananidzo kunobva zvakananga pamusoro kusimba ropa, akapwanyika zvemapapu rinenge uye nhengo dzinofamba. Small hemothorax zvirege achiperekedzwa zviratidzo, kunyanya murwere anonyunyuta muchipfuva marwadzo, izvo zvingazivikanwa yakawedzera kana vangakosora, uye kupfupika kufema zvingaitika.

Asi pakati uye yakakwirira makirasi, izvo zvinogona yasimbiswa muchishandisa muenzaniso Ruvilua-Gregoire, achiperekedzwa kufema zvinetso, zvemwoyo zvirwere, uye vamwe. Zviratidzo vasiri kuzivikanwa panguva chete zvikasashanda, nekuti unogona kugamuchira marwadzo zvikuru kuti kunowedzera vangakosora, kusimba muviri wose, akaderedza BP. With zvishoma kurovedza dzose zviratidzo zviri kuwedzerwa. Murwere anosarudza hwomutambarakede nechinzvimbo - agere kana hafu-kamwe.

Asi zvikuru hemothorax kune utera, izvo haabvumiri kunyange kuwedzera, nzwa dzungu, kuva tachycardia, ganda rakachenuruka, maziso pamberi flit nhunzi, anowanikwa syncope kakawanda. Asi kwete nguva dzose zviratidzo vanogona kuona hemothorax, saka zvakanaka kuona chiremba, ndiani ngaagadze nhamba yezvidzidzo, kusanganisira mharidzo uye Ruvilua-Gregoire. At hemothorax - ndicho chakanakisisa nzira, iyo munguva pfupi nguva zvinoratidza kuvapo kana kusavapo ropa.

Diagnostics

Munguva yakarurama chirwere chiremba kutaura zvose nehosha, vanogadzwa muviri uye nedzimwe nzira kuongororwa, kusanganisira murabhoritari. At hemothorax pakarepo totsunga kana pane lag pakati njodzi divi munguva kufema kufamba, kana rakagomadzwa percussion kurira pamusoro kunzvimbo aunganidzwa mvura, simba kana kufema chiripo quavers.

Chest X-ray inoratidza chiedza kollabirovanie, kuvapo Urume (murwere ari chinjikira nzvimbo pataidzidza) kana clots ari pleura. Kuti kujekesa chirwere uye zvokuongorora anogona kupiwa pleural ponji panguva hemothorax, muchiitiko ichi kuwana ropa inosimbisa chirwere. Kuziva chena uye utachiona hemothorax kuti ivhu Petrova uye Efendiyev, izvo kuongorora pachena uye precipitate aspirate.

miedzo Laboratory ropa achasarudza uwandu leukocytes uye erythrocytes. Rinogonawo kuitwa, uye nezvimwe chirwere nzira dzakadai Ultrasound, maekisirei, muchipfuva CT, chirwere thoracoscopy.

Unokubvumira zvakanyatsonanga mharidzo?

Kuti asimbise kuti ropa mberi, kana kuti wakatosvika akamira, ita chete kwete kudiwa kuti azodzidza akadai wezvaizogona Ruvilua-Gregoire. Chirwere nzira iri mhando kunosanganisira ropa zvakabudiswa pakati pleura, uye ipapo kuitarisa. Kana zvashanduka kure mune bvunzo chubhu kana sirinji, zvinoreva kuti ropa mberi, uye kana coagulation vasipo, ipapo kwete. Ipapo mimwe akatumira murabhoritari kumwe kuongorora, uye akatsunga kare kubudikidza uwandu hemoglobin.

Positive bvunzo Ruvilua-Gregoire - nechiidzo amburenzi thoracotomy, izvo zvichakubatsira kumisa kubuda kweropa. chirwere nzira iyi inodzidzisa, asi zviri nani kuti uite mamwe nemamwe kuongorora, kuva nechokwadi kuti 100% muna nechirwere. Asi sei kuita bvunzo?

Nzira fenzi ponji pa hemothorax

Mufambiro bvunzo inofanira chete kuva chiremba anokwanisa, nekuti kudzidza ichi zvikuru kunzwisisa, uye kana muchichengeta ropa yokuenzanisira kwakaipa, zvinogona kunyanya kukuvadza kumurwere. Kuponjesa panguva hemothorax - rakasiyana nzira nechirwere, iro rinoitwa pakati mbabvu 6 7 pamusoro svikiro uye zadnepodmyshechnoy mutsetse. Panguva iyi, murwere unofanira kuva munhu nokugara chinzvimbo. Ropa rwunotumirwa kudzidza mushonga wakawanda antibacterial mhinduro.

kuchinja kurapa

Kuchinja mabatiro anobatsira kana haemothorax munyoro, umo nyaya analgesics uye hemostatic nevamiririri. Uyewo zvinobatsirawo yokutsiva kurapa pamwe kwokukurumidzira ropa, kana haemothorax mwero kana kunyange zvakakomba. Nokuti kurapa chirwere HT vari kutarisirwa fibrinolytic nevasori, vari Akaratidzawo kuti kudzivirirwa uye kurapa pamusoro coagulated hemothorax, uye zvinogona kushandiswa immunocorrecting uye symptomatic kurapwa.

Small hemothorax nokukurumidza uye pasina nemigumisiro zvinogona kubviswa nokuda kuchinja nzira kurapwa. Asi kuti nyaya, kana apiwa kuongorora kwakaratidza zvakanaka bvunzo Ruvilua-Gregoire, zvino hapana kuvhiya kuita.

Kuvhiya Mabatirwo hemothorax

Kuvhiya inoratidzwa kuti murwere Muzviitiko zvakadaro:

• Kana ropa mberi mukati pleura;
• haemothorax curled uye chinonditadzisa kukura kune bapu;
• kana kwakambovapo kuzodzosera kuunganidza ropa pashure kutora ponji;
• ropa anoenda kuburikidza Kusarudzwa pleural abudise, uye inzwi racho vanenge 500 ML kwemaawa 2-3;
• damage nhengo dzinokosha.

hemothorax kurapwa inobva zvaidiwa etiological zvinokonzera kuti ropa nekuomarara Hemorrhagic nehana. Open rakapinza kuvadza yemapapu uye dzimwe nhengo pechipfuva zvinoda kukurumidzirwa kuvhiya Kupindira pakanyorwa misoro Anti-kuvhunduka kurapa, izvo zvinosanganisira kurapwa analgesia kwete chete, asiwo nokunzwa rikwanise kupererwa neropa uye hypoxia.

Operation anodiwa zvinangwa zvakadaro:

• kumisa kubuda kweropa;
• kubvisa kukuvara zvomukati;
• bvisa zvakawandisa ropa;
• kuti aise abudise kuti nokukurumidza Kuzarurwa ari bapu;
• nokuti vapore of pleural mhango pamwe antiseptics.

Asi chii Zvaifungidzirwa ipai vanachiremba varwere akavhiyiwa panguva hemothorax akanga akatakurwa kunze?

Kufembera uye kudzivirira hemothorax

Kubudirira pakurapa hemothorax kunoenderana yezvakaita yokukuvara kana chirwere, ropa zvakanyanya uye rubatsiro nenguva inopiwa. Yakanaka fungidziro varwere vane nepakati hemothorax. Clotted hemothorax chinogona kukanganisa kukura kwezvinhu pleural empyema, asi akaramba kubuda ropa kana chimwe guru nokurasikirwa neropa kungaita kuti rufu.

Mhedzisiro hemothorax angava muhombe inotungamirwa pleural adhesions zvinozoguma Kuderedza mufambo yacho diaphragm. Muchiitiko chino, Zvinokurudzirwa kuti varwere vose vakambova ezvinhu kushambira uye kuita zviitwa kufema nguva dzose.

Kudzivirira hemothorax rinopa nyevero vaikuvadza muchipfuva, bvunza chiremba varwere thoracoabdominal kunotevera, kudzora hemostasis mu pakuvhiya mumapapu uye mediastinum.

mhedziso

Kuti muchidimbu, tinogona kutaura kuti mharidzo Ruvilua-Gregoire - mumwe zvidzidzo inokosha pa hemothorax. Ropa munzvimbo pleural nzvimbo - chirwere chakakomba zvikuru kuti chinoda kukurumidzirwa zvivabatsire kuna chiremba. Ndokusaka pakutanga zviratidzo kana pakarepo pashure pachiitiko chinotyisa zvakanakisisa kutsvaka rubatsiro anokwanisa, kana dzakasiyiwa kungava kuurayisa.