Gulu cha zovuta matenda enaake chiwindi malinga Child-Pugh

Matenda a chiwindi - ndi kuchuluka kwa minofu connective m'thupi chifukwa kutupa yaitali. A anthu ambiri ku gulu la matenda si chifukwa palibe kugwirizana pa omwe zilipo bwino kwambiri mavuto matenda ndi mankhwala a matenda enaake.

Gulu la matenda enaake chiwindi malinga Child-Pugh

Gawo ili ndi matenda enaake chiwindi ntchito amanena mlingo wa kusalekerera matenda m'thupi la wodwalayo.

Pamaziko a kuyesa ake kubala kupulumuka mtima ndi matenda ndi kuchuluka kwa imfa pambuyo opaleshoni. Mtima anafunika kumuika chiwindi.

Matendawa alipo magulu atatu. Magawo kuti amaonetsera makalasi amasonyeza mlingo wa kukula kwa matenda enaake, komanso mfundo kodi moyo amayembekezeka wodwala anthu amene ali ndi matenda enaake. Malinga ndi Mwana-Pugh digiri ya malipiro a matenda limanenedwa ngati:

1. Maphunziro A monga kulipidwa matenda enaake.
2. B - subcompensated.
3. C - decompensated matenda enaake.

Kodi ndemanga?

Lililonse gulu la Child-Pugh anatumizidwa mfundo zina kuti mopitirira zochokera Uwerenge magawo angapo. Choncho, Maphunziro A limabweretsa osiyanasiyana mfundo 5 6, B, motero, - 7 mfundo 9. Ndi kalasi lomaliza - phindu lalikulu kwambiri mfundo 10 15.

Mlingo osachepera mwamphamvu ndi matenda enaake chifukwa A. Mu nkhani iyi, nthawi ya moyo wodwalayo ali pa munthu pazipita - kuchokera zaka 15 mpaka 20. Pa wachiwiri, ndi za zaka 10. Maphunziro C zikutanthauza yayifupi moyo amayembekezeka odwala matenda a chiwindi - mmodzi kapena pa zaka zambiri atatu.

Pambuyo pa opaleshoni, ndi apamwamba kuchuluka imfa ya kalasi C - ndi 80%; 30% - motero, ndi A -% 10 okha.

Kufunika kwa kumuika chiwindi pa madigiri zosiyanasiyana kusalekerera akufunitsitsa motere:

• Mkulu - C;
• zolimbitsa - B;
• Low - A.

Magawo n'komwe mu gulu la Child-Pugh

Kodi magawo kulimbikitsa kufalitsa magulu? Choyamba, pamafunika nkhani pamaso pa:

• bilirubin;
• albumin;
• ascites.

Komanso kwa chiwindi encephalopathy, PTI, PTT ndi INR.

System kwa Child-Pugh sangathe kuonedwa buku, kuyambira wounikira amaganizira ayi onse a magawo a wodwalayo. Lakuthwa akuchuluka ya matenda ndiponso mavuto ake kusintha chithunzi, ndipo gulu ili salinso ntchito.

Analoseranso dongosolo komanso amaganizira morphologic ndi mbali etiologic ku matenda enaake.

Gulu la mbali etiologic

Pali za makumi awiri mitundu ndi matenda enaake. Malingana ngati chifukwa umadziwika kapena ayi, nthendayo m'magulu atatu:

1. Matenda enaake anaika (kudziwika) etiology.
2. The kudwala imene etiology ndi maganizo (nthawi zina amatchedwa "etiology zotheka").
3. Matenda enaake ndi bwinobwino (osadziwika) etiology.

anaika etiology

La kudziwika, anakhazikitsa zimayambitsa matenda kunena milandu zotsatirazi:

• Mu matenda enaake mowa akuwuka pa ntchito yaitali mowa (40-60 galamu Mowa) kwa zaka 15 kapena kuposa.
• Atamwa kuti theka milandu amayamba ndi mavairasi cha matenda a chiwindi B, C ndi G.
• Mankhwala kapena mankhwala, amene kumaonekera chifukwa ntchito mankhwala a mtundu womwewo kwa nthawi yaitali.
• Pulayimale ndi sekondale biliary matenda enaake kumene kwa chiwindi minofu munthu amafa ndi coarse minofu yovulazidwa aumbike kuti m'malo.
• Kobadwa nako kapena cholowa matenda enaake.
• Patsogolo - ndi osiyana ndi mitundu ina kutchulidwa ndi akufotokozera nthawi mokwanira yaitali pamene ntchito yobweretsa magazi chiwindi wasweka. Anaona odwala ndi makope ambiri magazi.
• Pamene matenda ndi Budd-Chiari syndrome - matenda kugwirizana ndi mkhutu outflow magazi chiwindi (kwa chiwindi thrombosis mtsempha).
• Kusinthanitsa alimentary matenda enaake akuwuka mu shuga kwambiri, kunenepa, pamene anagwirizana enteroapocleisis.

N'zotheka ndi bwinobwino etiology

N'zotheka ndi zokaikitsa, osadziwika etiology akuwonetseredwa mu kukhalapo kwa:

• matenda opatsirana;
• matenda parasitic;
• autoimmune pathologies;
• kutupikana.

Unknown etiologic zinthu - zambiri cryptogenic matenda enaake mawonekedwe. Mu chachikulu biliary matenda enaake ndi ana Indian amalankhula za etiology osadziwika.

Gawo morphological

Morphological gulu la kuwonongeka chiwindi - uyu ndiye woyamba akufuna ndipo anavomereza zochokera kafukufuku biopsies (thupi chidutswa, anatengedwa mu pompo-pompo). Kuonetsetsa kudwala mitundu 4:

• MKD matenda enaake yodziwika ndi tinatake tozungulira kakang'ono mu thupi, amene m'mimba mwake ndi 1-3 mamilimita;
• krupnouzlovgo matenda enaake - chiwindi tinatake tozungulira awiri a 3 mamilimita kapena zambiri;
• mitundu chosakwanira matenda enaake, umene advantageously anakhudzidwa mezhpechenochnye kugawa;
• osokonezeka, yodziwika ndi kuphatikiza mbali zonse pamwamba.

matenda enaake chithandizo

N'zosavuta kalasi matenda a Child-Pugh amapereka mwayi osati kuti matenda, kulosera kupulumuka kwa odwala, komanso kusankha mankhwala oyenera ndiponso chisamaliro wothandiza.

Choncho, kulipidwa chiwindi matenda (Ndi kalasi A) kumafuna mankhwala zofunika umalimbana kuchotsa muzu wa matenda. Komanso, muyenera kukatenga mankhwala akuthandiza. ntchito yawo - kuthetsa kudzimbidwa. Chofunika kwambiri enzyme awa a mtundu "pancreatin" "Creon", "mezim". Mlingo muyezo anatengedwa katatu pa tsiku, makamaka musanadye. Kodi anatumizidwa maphunziro, avareji masabata 2-3, amene mobwerezabwereza fupipafupi.

Pamene subcompensated matenda enaake (Pa B matenda a kalasi la Child-Pugh) chofunika kwambiri yokonza mankhwala kusankhidwa. Chifukwa chaichi ntchito otsika mchere zakudya (palibe magilamu 2 mchere patsiku), mopitirira womangika mapuloteni. Mankhwala zotchulidwa "Furosemide" ndi "spironolactone". Kulandira okodzetsa chikundikakamiza osauka oopsa zipata ndipo kumachepetsa ascites. Ntchito pa mundawo m'mimba angathe bwino "lactulose" mu 50-70 ml ya patsiku, koma phwando ndi kukhala okhazikika.

Pankhani ya decompensated chiwindi matenda (pamene kalasi C malinga Child-Pugh) kuwonekera moyo pachiswe mmene wodwalayo. Pamafunika nthawi yomweyo odwala mwakayakaya. Paracentesis amapereka kuchotsa madzimadzi ku peritoneum ndi, albumin m'nsinga kutumikiridwa ndi crystalloids, amadzaza kufalitsidwa magazi voliyumu ndi mapuloteni mu thupi. Mwakhama ntchito okodzetsa: yemweyo "spironolactone" ndi "Furosemide". Mankhwala zakudya otsika mu mchere. Kwa zakudya moyenerera parenteral kubwera mu encephalopathy kwa chiwindi ndi mavuto ena aakulu.

Pomaliza

Prophylaxis matenda amadziwikanso zochokera pa gulu cha zovuta chiwindi matenda a Child-Pugh.

Mu kulipidwa Inde matenda sikutanthauza cholinga njira. Pamene makalasi B ndi odwala C angathe kuchepa magazi, choncho nthawi kutumikiridwa erythropoietin. Komanso, ambiri zotchulidwa beta-blockers (monga "Metoprolol", "Inderal"), zomwe zingathandize kusiyana esophageal varices.