Waterhouse chirwere - Friderichsen: pathogenesis, nechimbichimbi kutarisirwa, kurapwa

The adrenal mumasero mumuviri kunokosha kwemakemikari anobudiswa nenyere. Makemikari anobudiswa navo zvazvinoita parameters ose kufurirwa uye chitsama achiparadzira fluid padanho chicherwa munyu uye munhu microelements mu metabolic zvazvingava, kunyange pamusoro pituitary shwanu. Uye mumamiriro ezvinhu apo mashandiro izvi diki asi zvakakosha chaizvo shwanu ari kutambura, kutanga mamiriro, kutyisidzira upenyu uye utano.

Definition uye nhoroondo

Waterhouse chirwere - Friderichsen - kusachengeteka kukuru adrenal insufficiency, kunoitika pashure kunotevera nemuviri munhu ropa racho parenchyma. Izvi zvinokonzera rimwe kwazvo kutyorwa dzomunyika kwezvakatipoteredza muviri uye unogona kutungamirira kurufu.

Description ezvinhu wokutanga akazviratidza muna 1894, asi yakanga isina kukwana, uye muna 1911, Waterhouse rinozivisa gumi nyaya, kwakamubatsira kuunganidza zvose nhindi pamwechete. Kufambirana naye, makore manomwe gare gare, muna 1918, Frederiksen zvakare rinobudisa rondedzero pamusoro ichi pathological muitiro.

zvikonzero

Masayendisiti dzinobvumirana kuti chirwere Waterhouse - Friderichsen akaita muhombe ropa panguva iyoyo vari adrenal mumasero vose. contingent nengozi - achangoberekwa, nepwere, vana uye vechidiki. Pasi kana ichi hazvishandi. mamiriro Izvi zvinogona kukonzerwa kwenguva refu delivery, fetus okisijeni nzara kana kuti kufambira mberi kwayo kubudikidza nokuberekwa Canal kushandisa forceps kana Vacuum inofashaira. Uyezve, basa rinokosha nokuda kwazvo vachiberekwa chirwere, uye pamuviri kuomesa vachangobva gestosis.

Waterhouse chirwere - Friderichsen nedzevakuru kakawanda kuonekwa sechinhu kuomesa ane zvirwere zvinotapukira. Kazhinji, pomutumwa ari meningococcus, streptococcus kana anonzi Staphylococcus. Asi kunze izvi, zvinokonzera ropa kunogona kuva nosologies zvakadai gwirikwiti, nezvitsvuku fivha, sefivha, diphtheria, uye akaipa neoplasms, namamota, peritonitis DIC uye thrombosis adrenal mutsinga.

Kukura chirwere

Vanyori vakawanda dzoga chirwere ichi sezvo chikamu adaptive mashandiro kufoira kukura rikwanise sepsis. Asi zvinokwanisika kuti vana uye vakadzi vane pamuviri zvakasiyana zvachose mashandiro iyo anovandudza Waterhouse chirwere - Friderichsen. Pathogenesis chinoratidza pacharo mune dzakawanda Hemorrhagic necrosis pamusoro adrenal cortex. Vakanga vakawanda kuti muviri wose yanyatisa muropa, pane hyperextension pamusoro Kamudzira, uye kunyange atsamwira kwayo.

Kana mukuru pathogenesis, kunoratidzwa muchimiro sepsis:

- dilated capillaries uye arterioles;
- raidudzwa kudhaka chirwere;
- kuvapo concomitant yomumuzongoza kana meningoencephalitis;
- kuwedzera kwematunhu node nodes uye thymus.

symptomatology

Waterhouse chirwere - Friderichsen pamwe meningococcal chirwere zvingamuka pakarepo muna pakanyorwa zvakanaka. Ari mberi nokukurumidza zvokuti munhu anogona kufa mumazuva.

Zvose kunotanga kunyanya excitability, kushatirwa uye nomusoro. Zvadaro kubatana abdominal kurwadziwa, kuda kurutsa, kurutsa uye manyoka. Kana kurwadziwa zvakare kwazvo, chiremba anogona vanofungidzirwa pavarwere vane chakasimba kuvhiya zvokurwara. Pakutanga, nefivha yakaderera wegiredhi, asi maawa mashomanana kuti Pazvinotanga ndiyo 39-40 inegumi. Nokuda kurutsa uye manyoka kubva mumuviri kubuda mvura uye zvicherwa, iyo inotungamirira nokuvhiringidzirwa mwoyo, uropi uye zvimwe zvinokosha nhengo. Pakupedzisira, munhu anorasikirwa kuziva uye rikawira pakoma.

Pane imwe nzira chirwere, iyo kunooneka pacharo mune unopinza kuwa BP kana akawisa. Zvimwe zviratidzo arege zvachose. Munhu wokutanga ndivete, asi sezvo hypoxia mberi nokukurumidza anouya ndivete uye pakoma. Anofa pasina Pandakapengenuka.

Waterhouse chirwere - Friderichsen vana vanokura dzichimhanya kupfuura vanhu vakuru, pasinei chikonzero. Kupiwa dzavo compensatory mano muviri nokukurumidza kwezvinoshandiswa, uye vazhinji hurongwa uye nhengo vachiri nedanho inotungamirwa uye kukura, mugumisiro anouya mazuva pakatanga chirwere wokutanga.

Diagnostics

Waterhouse chirwere - Friderichsen kusimukira nokukurumidza kuitira kuti vanachiremba kazhinji havana nguva kuitisa kuongorora zvizere uye uone zvinoitika munhu. Kana chimbichimbi kamuri basa chiremba chifungidziro zvokurwara ichi, kurapwa kunotanga pakarepo, uye chirwere anobatana pakuitika, nokuti nhoroondo dziri wachi.

Laboratory yekusimbisa nechirwere zvakafanira kuwana mukuru kuongorora ropa:

- leukocytosis uye leftward kuchinja kubva fomura;
- kuderera muropa shuga;
- thrombocytopenia uye vakaderera pakugwamba;
- rutapudzo pamusoro electrolytes;
- kuwedzera ropa urea senitrogen.

Zvisinei, zviratidzo izvi hazvisi yakananga uye angava anoratidza zvakawanda zvomusejari uye systemic zvirwere. Kuti ave nechokwadi, unofanira kunyatsofunga kuunganidza nhoroondo yezvokurapa, uye vaite rimwe lumbar ponji uye kutsanangura neurologic chinzvimbo. Asi izvi zvose zvinoitwa pashure Kudzikamiswa evanhu.

differential kuongorora chirwere

Waterhouse chirwere - Friderichsen kusiyaniswa kubva zvomusejari abdominal ezvinhu akadai rikwanise appendicitis, rikwanise pfungwa nomuviri zvemwana asati, urikanwi perforation mudumbu kana duodenum. Iva nechokwadi chiremba vanofanira kuongorora kuti meningeal zviratidzo, kudzivirira ropa muuropi, cavernous sinus thrombosis. Kana cardiac ECG chimiro kuchakubatsira kunzwisisa kana munhu ane chomwoyo kana kwete.

mabatiro

Pakutanga pashure nechirwere "chirwere Waterhouse - Friderichsen" vanofanira kubhadhara murwere sweated emura electrolytes uye kusarovedza adrenal mahormone. To ichi hunosumwa kuburikidza venous kuwana hafu ity "hydrocortisone" kana 120 milligrams "prednisolone" uye zvitatu magiramu Kweshuga shanu muzana uye milliliters gumi mashanu muzana mhinduro kubva ascorbic acid. Saka isu kuita vawane pathogenesis, zvichikonzera Waterhouse chirwere - Friderichsen. Emergency kutarisirwa panguva kunonatsiridza ropa rheology, dilutes izvozvo anowedzera uwandu ino mvura uye anowedzera kumanikidza. A steroid kemikari yokutsiva kunobatsira kuramba kufurirwa kuruoko chechetere.

Pashure Kudzikamiswa of mahormone kuramba kupiwa intramuscularly, "Hydrocortisone" pakati 50-75 MG maawa ose matanhatu, uye deoxycorticosterone acetate pamusoro milliliters gumi katatu pazuva. Iva nechokwadi kutevera zviratidzo zviri dzvinyiriro uye, kana zvakakodzera, kubayirira kumusoro "Epinephrine," "Mezaton" cardiac glycosides.

Kana mhaka chirwere rava hutachiwana akadai meningococcal, kuwedzera zvikuru kurapa, murwere anopiwa mishonga inorwisa mabhakitiriya. Kana murwere anodzoka kune dzose, mahormone vanotanga zvishoma nezvishoma kuderedza dose. Zvakakosha kuti zvakanaka kugadzira muviri chii vakazvimiririra anofanira kubudisa glucocorticoids. Regai payakakurudzirwa kukanzura zvinodhaka, zvinogona pave nekukurukurirana yechipiri dambudziko.

Zvakakosha kusimbisa kuti murwere aingova Waterhouse chirwere - Friderichsen. Marapirwo pacharo kunogona kuva nengozi sezvo muviri kunyanyisa mafashamo kunokonzera systemic edema, kusanganisira chepfungwa edema, uye makuru mishonga ine mahormone kungamutsawo chirwere chepfungwa. Saka, mamiriro ezvinhu murwere kunokosha chaizvo kuti nguva dzose kuongorora uye kugadziridza pakugadza maererano ake zvavanoda.

mataridzikiro

Waterhouse chirwere - Friderichsen - zvikuru kwazvo zvokurwara, zvinoratidza kuti nguva iri nguva nokuda siyana vasiri zvakananga zviratidzo. The Magumisiro kwete chete sei zvakanaka achazvikudza chiremba mune pakaita dambudziko, asi pamusoro mwero kuparadzwa adrenal omumuviri uye compensatory anokwanisa nhengo. Vachivhura kupedza chirwere ichi rakaipa.

dziviriro

Izvi kunyanya Anti-dambudziko matanho pachoto chirwere umo murwere nechirwere meningococcal chirwere. The chiremba uyo akazivisa murwere yakadaro vanosungirwa kuzivisa utsanana rokuongorora agopfigira murwere. Mumazuva akatevera mazuva matatu, cheki kunyorerana vanhu kuvapo chirwere murwere kwake oga basa munharaunda kana sangano dzidzo kwenguva mazuva gumi. Kuti tizvidzivirire, vanhu vari pedyo vachionana murwere, akarayira pfupi kosi inorwisa mabhakitiriya.

epidemiology

Waterhouse chirwere - Friderichsen zvinosuwisa zvikuru nevakawanda zvokurwara. Munyika dzakabudirira, kuitika meningococcal chirwere 1-3 nyaya por 100 000 vanogara. Uye anopfuura hafu Muzviitiko - vana kuenda kukireshi zera. Uyezve, mumwe gumi akamboona kuwedzera kuitika. Izvi imhaka munhu mutation pakati nayo utachiona vemo uye kuderera kutapata.

nhamba idzi ingangowanikwa asina chokwadi, sezvo zhinji kuenda undiagnosed nokuti zviratidzo muchinjikwa. Waterhouse chirwere - Friderichsen kusimukira nokukurumidza kuitira kuti vanachiremba havana nguva kuti vaite wandei nemiedzo zvakakwana.