Dynamic ileus: kupatsanura, zvinokonzera, zviratidzo uye kurapwa

Ileus - Disease, iyo integrates chisinganzwisisiki zviratidzo izvo ne kumhedziso kana kukwana nokurasikirwa bowel urema, zvose mukobvu uye dzakaonda inozivikanwa. Nokuti tinoberekwa kushayikwa kufamba upi mhando yezvokudya, kusanganisira zvikukutu uye mvura guru, uyewo kuvapo chaizvo kuzvimba ari peritoneal mhango. Intestinal mhingaidzo rine simba uye nomuviri.

zviri chirwere

Dynamic ileus - siyanei zvirwere akati mhando uye rinowanikwa muna 10% varwere bowel mhingaidzo. To chirwere ichi vanachiremba kazhinji achisunda kudikanwa kubvisa zvokuimba mhingaidzo, riri kudiwa kuvhiyiwa.

The dzikatadza chirwere ichi kunoratidzwa ndechokuti pathogenesis simba ileus haana dzinoratidzwa kuvapo kutamira nezvipingamupinyi inonzwisisika facial uye zvokudya zvimedu turakiti. Muchiitiko chino, chete pfupi yokusafa rutapudzo pamusoro pezvakaitwa muviri.

Zvisinei, ngozi hosha iri chokwadi kuti zvinogona kukonzera neurohormonal dysfunction murwere, uyewo kukanganisa functionality duku uye makuru ura. Funga zvinhu zvinobatsira panowanikwa chirwere ichi sezvo ane simba intestinal mhingaidzo.

The zvinokonzera chirwere

Kunyange nesayenzi yemazuva huzere zvikuru dhigirii uye nokubudirira mune zvokurapa, asi iye haana kukwanisa kugadzirisa chaizvo zvigadziriswe kuti chirwise pakuonekwa zvirwere mubvunzo. The chidzoke zvinetso zvakadai simba intestinal mhingaidzo anogona kukonzerwa zvinhu zvinotevera:

• peritonitis chinogona kukonzera appendicitis kana pfungwa nomuviri zvemwana asati;
• chenjera mesenteric infarction;
• hunokachidza megacolon (chirwere Crohn vake, Hirschsprung vake, maronda colitis);
• dzepanguva ezvinhu (postoperative ezvinhu, colic, ropa, abdominal kunotevera, musana mitswe sezvo achiipa zvokuimba ileus);
• zvirwere neurogenic hunhu;
• kuchinja kwemakemikari omuviri yomuropa (semuenzaniso, nhumbu);
• metabolic zvirwere (hypokalemia, ketoacidosis, uremia, kudhaka).

Kupatsanura simba ileus

Mukurapa, nechirwere neimwe ine bumbiro rayo, zita uye kazhinji akagamuchira mitemo okurapwa. Hapana Kunze uye zvirwere zvakadai simba intestinal mhingaidzo. ICD-10 (International kupatsanura pakati Zvirwere) classifies hosha iri mubvunzo sezvinotevera:

• Kirasi XI "Zvirwere ari zvomudumbu ino" (K00-K93);
• Ona "Other bowel chirwere" (K55-K63);
• chirwere Bumbiro - K56.6;
• zita - "The Other uye kutaurwa intestinal mhingaidzo."

In okurapa, kusiyanisa pakati nezvemarudzi maviri inokosha guru intestinal mhingaidzo:

• spastic;
• mutezo.

Spastic bowel mhingaidzo

In kurapwa tsika havachamboshandisi, kakawanda akasangana vari peya neimwe chirwere. Kazhinji mhosva chirwere chiri chirwere muviri nehonye kana pilorospazm, sezvo migumisiro yokuberekwa mupfungwa. Pakati zvimwe zvinokonzera ichi mhando chirwere zvinosanganisira: zvirwere tsinga, netsinga, dyskinesia.

Rasa dambudziko iri kunogona kungova pachishandiswa kuchinja nzira, sezvo kushandisa kuvhiya kupindira mune iyi hazvina musoro.

Spastic bowel mhingaidzo: zviratidzo

In vakuru, chirwere kunoitika zvikuru kakawanda kupfuura mune vana, asi zviratidzo ayo chete chero zera. chirwere ichi kunoratidzwa kamwe Pazvinotanga. Murwere anonyunyuta pfupi akararama yokurwiswa abdominal marwadzo, izvo havana imwe localization.

Varwere chirwere ichi akanga aona anotevera zviratidzo:

• skhvatkopodobnye abdominal kurwadziwa;
• gogonera kuzvimba uye kunzwa nokuzara;
• kuda kurutsa, zvinobvira kurutsa, kupatira.

On palpation pakati mudumbu Runonzwika chidimbu anorwara pakati ura duku, mudumbu kwazvo nyoro. Vachivavhiringidza dzimwe gadziriro haina kuchengetwa. The vakawanda ezvinhu omurwere hakukoshi.

Pseudoileus

Atsunga mitezo peristalsis ura, achiperekedzwa pakarepo regression dzichipfekeka vivacity neuromuscular hurongwa. Kusiyanisa dzepanguva uye postoperative mitezo ileus.

Kana chirwere kunoitika sezvo dzepanguva kweiyi aimunzwira tsitsi bazi autonomic tsinga. Postoperative ileus zvikuru kunzwisisa uye anonyanya Genesisi pashure pakuvhiya kwakawanda pamusoro abdominal zvomukati.

Kutsamwisa paumbwe uye kuvandudzika chirwere ne zvinhu zvinotevera:

• anogumbura pezvakaitwa ari abdominal nzvimbo;
• Kukuvadzwa (pute) retroperitoneal nharaunda;
• zvizere ari kuchengetwa pashure kuvhiyiwa akadai laparotomy;
• migumisiro pathological zvirwere zvakadai pleurisy, mabayo, myocardial infarction;
• mesenteric vascular thrombosis;
• zvirwere, kusanganisira muchetura paresis.

Pane matanho anoverengeka chirwere:

I Stage. "Ndanyarara hangu nokuvhunika" - kwakafanana hwokufananidzira postoperative intestinal paresis. Duration zviratidzo kwapedza mazuva 2-3.

Step II. "Subcompensated nokuvhunika" - kunoratidzwa kuti pane chinokosha kuzvimba, pane zviratidzo kudhaka uye pseudoperitonitis muviri. Haateererwi ruzha peristalsis. A-siyana zviratidzo musi radiographs.

Step III. "Decompensated zvirwere" - muviri vachingotya zvikuru kudhaka. Unogona tarisisai bowel simba, kurutsa, intestinal mukati. Pane zviratidzo peritoneal nokushatiriswa dumbu zvimba chaizvo. X-ray ongororo inoratidza muzvizhinji pakati chinjikira kwevari nemvura iri zvishwe muura (zviduku panguva imwe chete).

Step IV. "The kuoma nemudumbu" - Panguva ino pane kutyora zvose zvinokosha zvomukati upenyu hwevanhu gadziriro. Negative maitiro akarwara dzose.

Sezvo mushonga ano hakuwaniki asi-dzakabudirira differential chirwere zviri pathologies siyana zvinoitika muna postoperative nguva, mangwanani saka chirwere chirwere kwakaoma zvisingaiti

Mutezo ileus: Zviratidzo

In vakuru, chirwere pamusoro pakanyorwa vakawanda mamiriro ratowedzera. Anonzwa kugara marwadzo anenge rinoteurwa zvakasikwa. Zvisinei, izvozvo hakusi kukuru sapamazuva mechanically bowel mhingaidzo. Kukurutsai girini kwake. Murwere akacherechedza kuwedzera exsicosis zviratidzo toxicity uye zvemwoyo mwoyo.

Kana mutezo ileus rukazara mudumbu murwere, kuburikidza rwaro pamberi kuonekwa nokuwedzera Vhoriyamu loop neperistaltiruyuschih muura. Kana peritoneal zviratidzo hatisi, zvino mudumbu dzamutswa kuti ikabatwa.

Nekuti chirwere ichi Danho muitiro, pamwe nokuwedzera nguva chirwere mamiriro murwere kuipa. In akazotevera matanho zvinogona kuzivikanwa tachycardia uye kupfupika mweya, bloating, languid peristaltic ruzha kuti kashoma akarova. Kurutsa kuipa.

In okupedzisira matanho, rakapinza kuwanda kwezvinhu morphological kuchinja neuromuscular midziyo. Murwere anonyunyuta kuti magasi uye chetsoka kunonoka ane nguva nenguva weti.

Dynamic intestinal mhingaidzo muvana

Vana aya anonyanya simba chakasimba intestinal mhingaidzo, iyo kakawanda kunoonekwa mutezo chimiro. Zvinotevera Zvikonzero vangazivikanwa, Nokumukira kukura chirwere muuduku:

• obstructive kana strangulation mhingaidzo;
• shoma kana diffuse peritonitis;
• abdominal kunotevera;
• nemabayo;
• empyema;
• kusagadzikana intestinal ushande.

Kazhinji, vakagwinya ileus kukuvadzwa vana postoperative munguva. Anokonzerawo mutezo kuibvisa siyana chirwere zvinogona hypokalemia.

Risk zvirwere pauduku ndiyo zvinobvira kurasikirwa yakawanda Urume uye munyu nokuda kugara kurutsa, kurasikirwa kudya, kubuda potassium itsvo hypoproteinemia. Kwokuomerwa mamiriro anogona kuwedzera nokuti vabereki zvinoitwa rwakashata chepfu uye kwemabhakitiriya ezvinhu.

Dynamic ileus vachangoberekwa zvinogona kukonzerwa zvinoverengeka zvinotevera:

• Prematurity;
• Kupindira kukanganisa;
• kushandisa zvinodhaka (kusanganisira achisununguka panguva pamuviri);
• gipermagniemiya;
• Kushandiswa heroin asununguke;
• kushandisa hexamethonium;
• sepsis;
• enteritis;
• CNS chirwere;
• necrotizing enterocolitis;
• kwemakemikari anobudiswa zvirwere.

Dynamic intestinal mhingaidzo nevana rinowanzoberekera, asi zviri nyore chirwere uye anobvumira mangwanani kurapwa. Kana nokufungirana kuvapo zvakavhara dzakadaro kukosha - rega kusvitsa kuti muedzo dzokuzvirapa, uye pane zvinotaurwa mirayiridzo inopiwa kuMudzidzisi nyanzvi. Zvinouraya Mugumisiro - ingangodaro zviitiko zvakadaro dambudziko somunhu simba intestinal mhingaidzo.

kuongorora chirwere zvirwere

Zviratidzo zviri chirwere-zvakananga uye yakajeka, kuti asingaiti kudzivisa chirongwa nechirwere. Shandisa zvinotevera chirwere nzira:

• Nhoroondo zvokurapa;
• Kuongorora murwere;
• X-ray Kuongorora nhengo iri abdominal nzvimbo (haazobvumiri kuvapo magasi pamusoro mvura pamwero ari ura);
• Ultrassom (hako kudzidza nokuti hazvisi zvakakwana anodzidzisa chakarurama);
• kwakakwana count ropa.

Dynamic intestinal mhingaidzo: kurapwa

Kazhinji, kurapwa nechinangwa kubvisa chirwere kutanga zvikonzero kuti vanotsamwisa kukura kwayo (kutapuriranwa yezvakaita chirwere, mabayo, peritonitis uye vamwe.). Kana hosha iri mugumisiro chepfu kana dzepanguva ezvinhu yakakodzera kuchinja kurapwa randinogara mune zvinodhaka kurapa yakaipa mananara kuti kukonzera zvokurega mureza intestinal peristalsis. kurapa kwakadaro kunogona kupedzwa nokusuma kupinda muviri mishonga akadai yavaibvisa chloride, pamwe shuga. Zvino unoda kugeza ura ane enema, kana zvakakodzera - kuti aite sumo yacho gastric chubhu. At yakakwirira marwadzo nezvekufadza vanogona kugamuchira inonyaradza marwadzo omusoro.

Kana apo kwemaawa matanhatu kurapwa murwere nemamiriro hakuiti kuvandudza, kuvhiya rinoitwa. Uyewo Kuvhiya chimbichimbi rinoitwa mu vachiberekwa bowel mhingaidzo.

Kazhinji, nokushanda chinosanganisira zvishomanana nokubviswa dumbu, izvo asisiri anozadzisa mabasa ayo. unofanira kwazvo Zvikamu kumanikidza colostomy (chakagadzirwa horo ari abdominal rusvingo kuburikidza iyo kufambisa pachituru uye vane mukana kupinda muhomwe chaiyo yakasungwa).

Usabvisa dumbu chidimbu zvinogoneka chete kana intussusception. Mumamiriro ezvinhu akadaro zvinokwanisika kuparadzira ura kuburikidza kurovha Air ura uye zvakare kudzora zvizere uchishandisa X-ray.

Postoperative kurapwa chinosanganisira nomumwe zvokudya, izvo kunoenderana bhuku kuvhiya kupindira. Mazuva maviri okutanga pashure pokuvhiyiwa, murwere inofanira kuva nzvimbo Fowler, vanofanira kuita kurovedza kufema. Uyewo panguva iyi vachatongerwa kwezvinodhaka kurapa, disintoxication kurapa rinosanganisira, normalization pamusoro electrolyte muviri, kushandiswa mishonga inorwisa mabhakitiriya, gastrointestinal nekurukurirano vamiririri kana akaratidza - hormone kurapwa.

Kana matambudziko ari postoperative nguva anogona kudzamisa maronda, ropa, peritonitis, namira chirwere ari peritoneum.

With simba ileus, sezvo nevamwe chirwere chipi, kunokosha kunyange kurapa uyewo kudzivirira dambudziko iri. Kudzivirira nzira dzinosanganisira:

• nokururamiswa electrolyte pachiyero;
• prokinetic mishonga;
• mishonga;
• zvakakodzera Kudya zviri pasi ari mafuta, nomukaka zvinhu uye chirimwa chikafu rurefu kugutsikana yenhengo zvisina ozeyewa ne muviri womunhu.