Matenda a Mendelssohn: zizindikiro, chithandizo, kapewedwe

Pali mndandanda wa matenda omwe samapatsa odwala mpata wopitilira miyoyo yawo mwachizolowezi. Kuyamba zonse mwakamodzi, zimasintha munthu, ndipo ali ndi mwayi wapang'ono wopitilira moyo wake wamba. Chimodzi mwa matendawa ndi matenda a acid-aspiration, omwe amadziwikanso kuti Matenda a Mendelssohn.

Kufotokozera

Kupezeka kwa matendawa kumagwirizanitsidwa ndi ingress ya acidic chapamimba cha madzi m'kati mwa kupuma, zomwe zimapangitsa munthu kuyamba kutupa kwakukulu. Nthawi zambiri maonekedwe a matendawa amadziwika ndi matenda osokoneza bongo. Odwala omwe ali ndi matenda osiyanasiyana, omwe ali ndi anesthesia kapena opanda, ziwalo zamkati m'mimba zimatha kulowa m'mimba mwapuma.

Matenda a Mendelssohn ndi vuto loopsa la anesthesia. Mwachizoloŵezi chachipatala, pafupifupi 60% mwa milandu ndi opha. Mu matenda osokoneza bongo, chiwerengerochi chikufika pa 70%.

Zimayambitsa

Chofunika chachikulu chomwe chimayambitsa chiwonetsero chotsitsimula ndi kubwezeretsa kapena kusanza komwe kunachitika panthawi ya anesthesia, pamene magwiritsidwe ntchito a zotetezera zotetezera a larynx amatsitsa. Matenda a Mendelssohn amayamba chifukwa cha kubwezeretsedwa, posakhalitsa nthawi yowonongeka.

Kuwonjezeka kwa chiopsezo cha mavuto kumakhala ndi mimba yonse, kusokonezeka kwa mankhwala, kumwa mowa mopitirira muyeso, ndi kulepheretsa. Kubwezeretsa kumachitika pakapita mimba (kuyambira masabata 22 mpaka 23), chifukwa cha kusintha kwa mahomoni kupanga gastrin kuchepa, komwe kumabweretsa chitukuko cha matenda oopsa kwambiri m'mimba. Zina mwazifukwazi: kuwonjezeka kwa intragastric ndi intra-m'mimba kupanikizika, kuphulika, kutukusira m'mimba, kunenepa kwambiri, kukhalapo kwa matenda opatsirana kwambiri a m'mimba. Chiopsezo chachikulu cha matendawa chimachitika ndi kubwezeretsa opaleshoni muzitsulo kapena pochita opaleshoni yachangu.

Pathogenesis

Matenda a Mendelssohn ali ndi njira yapadera yothandizira. Njira yoyamba ndi pamene zidutswa za chakudya chosagwiritsidwa ntchito zimalowetsa m'magulu opumira m'mimba pamodzi ndi madzi a m'mimba. Pa mlingo wachiwiri wa bronchi, kusungunuka kwapangidwe kumayambitsa kukula kwa kupuma kovuta. Pachifukwa chachiwiri, kwambiri acidic chapamimba madzi, ngati inhaled, amachititsa mankhwala kutentha kwa mucous nembanemba wa bronchi ndi trachea. Kuwonjezera pamenepo, kutupa kwa mucosa kumapangitsa kuti chitukuko chisawonongeke.

Matenda a Mendelssohn: zizindikiro

Chithunzi cha kachipatala cha matendawa chikugwirizana kwambiri ndi zizindikiro za kupuma kwakukulu. Matenda a wodwalayo ali ndi pulmonary edema, tachycardia, dyspnoea, cyanosis, bronchospasm. Potsutsana ndi zomwe zinasinthidwa poyamba, kumangidwa kwa mtima kungabwere. Mu thupi la wodwala, magazi ndi mapulaneti amatha kusokonezeka, kuthamanga kwa magazi kumawonjezeka. Pamodzi ndi kutchulidwa kwa hypoxemia, kuponderezedwa kwa mitsempha ya pulmonary kumawonjezeka ndi kuwonjezeka panthaŵi yomweyo ku pulmonary vascular resistance. Mavitamini acidosis ndi kupuma kwa alkalosis zimakhalapo chifukwa cha matenda osokoneza thupi.

Kusintha kwa kachipatala ndi matenda a pathophysiological akukhudzana ndi zilonda za m'mapapo. Nthawi zina zizindikiro zimakhala zochepa. Kusintha kwa maonekedwe mu ziwalo zozizira kumadziwonetsera mwachindunji tsiku limodzi pambuyo pake. Tsiku limodzi kapena awiri kuchokera nthawi yomwe matenda a Mendelssohn adayambira, zizindikiro za kupuma zikuyamba kukula. Munthu akhoza kupulumutsidwa pokhapokha atapatsidwa chithandizo chamankhwala chofulumira.

Matenda a Mendelssohn omwe amavutika maganizo

Azimayi omwe ali ndi matenda osokoneza bongo kapena omwe amatha kubereka, nthawi zambiri amayamba kudwala matendawa. Payenera kukhala zikhalidwe ziwiri za aspiration panjira. Yoyamba ndi anesthesia (chifukwa cha matenda opatsirana, kubereka, matenda operekera m'mimba), chachiwiri ndi matenda a mchitidwe wovuta kuzimitsa, kubwezeretsa, kusanza. Nthaŵi zambiri, wodwalayo amayembekezera kufa ngati ali ndi matenda a Mendelssohn. Kuti izi zimapereka ufulu woika matendawa pangozi yoopsa, yosautsa ya anesthesia, palibe kukayikira.

Chakudya m'mimba mwa amayi omwe ali pachilendo ndi chachilendo kuchepa chifukwa cha kuchepa kwa njira yake pa nthawi ya mimba chifukwa cha kuchepa kwa gastrin ndi kuwonjezeka kwa mtima wa m'mimba. Ndi gastrin yomwe imayambitsa chapamimba motility, ndipo kuchuluka kwakeko kumabweretsa chitukuko cha matenda a acid-aspiration mu anesthesia.

Thandizo loyamba

Chinthu choyamba chimene wodwala ndi matenda a Mendelssohn ayenera kuchita ndichochotsa zomwe zimakhudza m'mimba kuchokera ku mpweya wopuma. Mlomo wamphongo umatsukidwa ndi swab kapena sucze. Kutsegula kwa trachea kuyenera kuchitidwa pa chipatala chisanachitike. Chotsatira, muyenera kuchita zoopsa zamtundu wotchedwa bronchoscopy pansi pa anesthesia kuphatikiza ndi jekeseni yopanga mpweya wabwino. Poyeretsa bronchi, njira yothetsera sodium hydrogencarbonate (2%) imagwiritsidwa ntchito pokonza "Hydrocortisone" kapena kutentha kwa isotonic ya sodium chloride. Pambuyo poyamwa, mankhwalawa amatsukidwa bwino ndi mankhwala amchere pogwiritsa ntchito kafukufuku. Mayendedwe a "Atropine" ndi "Eufillin".

Ngati vutoli likulimbitsa thupi, mpweya wabwino umatha m'malo mwa kupuma kokhazikika. Pochita izi, mukufunikira maski wapadera, ngati sichoncho, muyenera kuphunzitsa wodwalayo kuti atuluke kudzera mu chubu ya raba, yomwe imatsikira kumadzi.

Matenda a Mendelssohn (chithunzi pamwambapa chikuwonetsa mbali ina ya dongosolo likukumana ndi malo oyamba) angapangitse imfa ya wodwala ngati sakuthandizidwa mu nthawi. Ngakhale mofulumira chithandizo cha laryngo- ndi bronchospasm, wodwalayo akuyenera kupita kuchipatala kuti athetse chitukuko cha mavuto aakulu.

Chithandizo

Ngati wodwala atapezeka kuti ali ndi matenda a Mendelssohn, chithandizochi chiyenera kuphatikizapo njira zomwe zingathandize kuletsa kupuma kwapadera komanso kupewa matenda opatsirana. Kupanga mpweya wabwino kumapangidwa pamene mankhwala a hypoxia sangathe kuthetsedwa pamkhalidwe wa kupuma kokha. Mu mkhalidwe wovuta kwambiri wa wodwalayo, ndondomeko ikuchitika kwa masiku angapo mpaka magawo a mpweya wa mpweya amatha kusintha. Nthaŵi zina hyperbaric oxygenation imagwiritsidwa ntchito, yomwe nthawi zambiri imapereka zotsatira zabwino. Mankhwalawa amagwiritsidwa ntchito pogwiritsa ntchito mankhwala osokoneza bongo, antibiotics ndi corticosteroids.

Matenda a Mendelssohn mu 30-60% amachititsa imfa ya wodwalayo. Omwe avutika nawo akhoza kukhala ndi zovuta zolepheretsa kapena zolepheretsa zosiyana.

Kupewa

Pali zochitika zingapo zomwe zingalepheretse chitukuko chachikulu ngati matenda a Mendelssohn. Kupewa kumaphatikizapo masitepe angapo. Choyamba - kugwiritsa ntchito mankhwala osokoneza bongo, omwe zotsatira zake zimatsimikiziridwa kuchepetsa kutseka kwa m'mimba ("Ranitidine", "Cimetidine"). Pofuna kupewa zovuta, zochitika zoyenera ndi zolondola za anesthetist zingapangidwe. Mankhwalawa "Atropin" ayenera kusinthidwa ndi "Metacin", wodwala ayenera kuti adjowe mu mkhalidwe wa anesthesia mofulumira komanso mofulumira. Dokotala ayenera kukhala ndi chidziwitso chabwino cha njira yotsitsimutsira ndi kujambula kwa trachea ndikugwiritsa ntchito njira ya Selik.

Nthaŵi zina amalowa m'katikatikati mwa machitidwe , kuti asiye kugwira ntchito yonseyo kuti ateteze ingress ya chapamimba mkati mwake. Akatswiri ena amatsutsana ndi njira imeneyi, chifukwa kafukufukuyo amatha kukhala ndi chingwe ndipo amawonjezera vutoli. Pogwiritsa ntchito zidole, kupewera kumayenera kukhala pa malo abwino a mkazi wokhala pa tebulo loyendetsera ntchito, yemwe mutu wake uyenera kumakweza pang'ono.