Effusion Pericardial: tohumate me take. Tātaritanga me te maimoatanga

effusion pericardial Exudative - he mate āhuatanga e mumura i roto i te membrane ngohi te te mata i roto o te pericardium. Na roto i te āhua o te pericarditis exudative rere he whakapeka ma'i ranei.

Ka taea e te mate e serous, hemorrhagic, purulent, fibrinous me serosanguineous. I roto i te pericarditis fibrinous exudative puta waipara o kakawaea pūtōtepe i te pericardium, a ka piki te nui etahi o te wai i roto i te kōhao pericardial. Tikanga, i roto i te kōhao pericardial kei āhua 20-40 ml o te wai.

I roto i te tauhohenga pericarditis whakapeka tahi e exudation pūtau whakarei i roto i te kōhao pericardial o te hautanga toto wai. Kēhi kia ka neke te tukanga inflammatory ki paparanga subepicardial, e tino ino roa tona mahi.

ru cardiogenic

E mea pinepine whakaeminga ohorere o te wai i roto i te kōhao pericardial taea meinga tamponade cardiac, i te mea tohu symptomatic o ru cardiogenic:

• palpitations ngakau;
• disorders romahā mō te momo dyspnea;
• nui haere te pēhanga i roto i te pūnaha venous o tohanga iti, me te nui;
• iti i roto i te pēhanga toto systolic.

pōauautanga taea

Ki te resorption inu exudative kia hanga nawe kiko, arā, o te pūtōtepe, e i roto i te tahuri taea arahi ki te kōhao pericardial imperforate wāhanga oti ranei. Ko te tikanga i hanga i te nawe e i roto i te rohe e Atrial, i te kongutu o te iahoki vena cava o runga me raro, e tata ana te haehae atrioventricular.

Ki te taua āhua whakapeka o effusion pericardial taea arahi ki pōauautanga kino, i huaina nei ko te "ngakau kohatu" rite ki te hua o te calcification o te pericardium. He wāhi nui i roto i te tukanga pathological o pericarditis exudative ko te takahi o nga hoki toto diastolic ki te ventricles ngakau. Exudate whiwhi i roto i te kōhao pericardial ranei te aroaro o te pericarditis constrictive arata'i ki te rangirua o ngā papa subepicardial me subendocardial i roto i te tihi. I roto i te wā onge, kakakīrehe o te pericardium kia wāhanga e pūkaha ana, i roto i nei he ana roro kua ngawha i roto i diastole whakarite te tuku noa o toto ki te ngakau.

huaina ana tēnei āhuatanga ko fenestration (te "matapihi tuwhera"). wāhanga Systolic, e whakarato ana paparanga uaua porohita, te tikanga, e kore e tukua e. Ki te takahi o hoki te venous ki te ngakau wā roa-i reira ko te stagnation o toto i roto i te iatuku pūkahukahu. A, no te stasis venous i roto i te pūnaha tohanga nahanaha o te wai, ko te extravasation ki te kopa e karapoti ana.

effusion Pericardial: take (etiologies)

Ko tētahi o nga take tino auau o te pericarditis exudative he huaketo te RNA-kei roto (A me B), echovirus, rewharewha A me mate kitakita o ngā āhua (pneumococci, staphylococci, streptococci, mycobacteria kohi me te harore).

Ka taea e te mate i Tirohia haafifi i te akoranga o mate pūnahanaha (whakamate, ranei mate Libman-Sacks, hononga rūmātiki, rūmātiki, Scleroderma pūnahanaha) me disorders o te pūnaha genitourinary (uremic pericarditis). kia ICD effusion Pericardial te syndrome postperikardialnogo faaiteraa e whanake i muri i pericardiotomy hei pōauautanga wawe o infarction myocardial, e kiia nei ko ranei syndrome o Dressler. Ko te tikanga, whakatika tenei pōauautanga i roto i te tāpare wa tino tautuhia, ara, i te 15 nga ra ki te 2 marama.

I te tahi taime e taea exudative pericarditis piripiri puta tika ki ingestion o etahi raau taero: gidralizin, phenytoin, anticoagulants, e tika ana ki te procainamide tono auau, iraruke. I roto i aua wā ka kitea he effusion nui pericardial ihirangi effusion, kia rapua te take i roto i te metastasis o te pukupuku: mate pukupuku uma, pūkahukahu, sarcoma, lymphoma. I roto i enei take, exudates te tikanga hemorrhagic, iti serous.

He he he ahua motuhake o te pericarditis exudative, e kiia nei ko hemopericardium. Puta ana tēnei huru ka ongó wharanga ki te rohe pouaka i roto i te ngakau o te ngä, pera i discontinuities infarction i roto i te tūroro i muri i infarction myocardial, ranei wāwāhi aneurysm te pūtahi o, meinga te toto whakakiia ana te kōhao pericardial. Ki te puta te mate mo āhuatanga fakatupu unknown, ka no reira ki te rōpū o nonspecific idiopathic ranei.

I tua atu, i te effusion pericardial i roto i ngā tamariki, rawa, i ētahi wā. Ko te take mō tenei ko: mate streptococcal me staphylococcal, mate kohi, HIV mate, rongoā whakakeke, pukupuku, whētuki, e tata ana te ngakau, hēnga o ōna whatukuhu, tafa ngakau.

effusion Pericardial: Te tātaritanga me te āhuatanga haumanu

Exudate whiwhi i roto i te kōhao pericardial me pānui te mamae puhoi maru ki te ngakau, manawa rerekē i runga i te momo o te apnea, heke nei i roto i te tūranga e noho ana, palpitations. Ko te pēhanga ka puta i te wai i runga i te pukorokoro me bronchi ki meinga mare maroke.

huru General o te tūroro, tei runga i te tere o te hanganga o te wāhanga wai i roto i te pericardium i tere puhoi - kāwanatanga pai ka te tere - te āhua, me te kino.

I te whakamātautau, e taea te kitea i te manawanui e whai ake nei ngā āhuatanga pericarditis exudative: koma kiri, mucosa ngutu cyanotic, edema o wahi o raro, acrocyanosis.

A, no te taea te kitea i te rohe tirohanga o te pouaka karawhiti, e taea te nui haere te taha maui, ko te taea tenei anake, ki te te tautau i roto i te rōrahi exudate pericardial tae neke atu i te 1 rita. Ka taea e Palpation kitea āhuatanga Jardin ka hihiko apical ngā te whakarunga me whekau, e tika ana ki te pēhanga ka puta, te wai putu roto.

Ka taea e percussion kitea roha o nga rohe o te pakeke, whanaunga o te ngakau i roto i ahunga katoa: ki te maui, i te raro (i roto i te wehenga o raro) ki te mua ranei ki te raina axillary waenganui, i roto i te wāhi intercostal tuarua, me te tuatoru ki te raina waenganui-clavicular, tika i roto i nga wehenga o raro, ki te matau o SCR (waenganui raina -klyuchichnoy), ko te kupu hanga he koki hāpūpū hei utu o te tonu tika ki te whakawhitinga rohe pakeke, ate. kia tohu tenei katoa e te manawanui he effusion pericardial.

tauira Auscultatory: he paruparu koi o te ngakau tangi i roto i te tihi ngakau, i Botkin-Erb me tukanga xiphoid. I roto i E rongo te turanga o te ngakau e tika ana ki te meka i ngā te ngakau te whakarunga inu exudative me whakamuri pepe nui. Noise te waku pericardial, te tikanga e kore e auscultation faaite mai iho. Ko te pēhanga toto i runga i te heke, ki te whakamārama o te whakaiti i roto i te putanga cardiac.

Ki te puta te haaputuputuraa o te inu āta runga i te wā, e kore he raruraru te mahi pūkaha o te ngakau mo te wa roa e tika ana ki te meka e āta whakawhānui te pericardium i roto i tenei take. I roto i te take o te haaputuputuraa tere o te wai i roto i te effusion pericardial me te rohe hono tachycardia, kore ngakau haumanu ki te ari popoketanga i roto i te porowhita tohanga (nui, me te iti).

I runga anō i te tātaritanga o ngā raraunga ECG āhuatanga e te pericarditis exudative e whai ake nei. A, no te QRS popoketanga exudative inu atu whakaiti Tātaihia ngaohiko complexes whakarereke ventricular matatini, me te hiko. Radiographically kitea hua i roto i te atarangi o te ngakau, me te wāhi whakawarea o te pōkare ara iahiko. kihai i mutua te paihere iaia. I te tahi taime te mea e ahei ki te kitea effusion ki te kōhao pleural maui.

kitea ECG paoro i roto i te haaputuputuraa kōhao pericardial o inu exudative te i te hoki o te mānawanawa maui o te ngakau, i roto i te rohe o te taiepa muri. A, no te pukapuka nui o inu exudative, whakaatu i te reira i roto i mua o te mānawanawa matau o te ngakau. I runga i te maha o te wai putu i roto i te pericardium e whakawakia e te wā i waenganui i te tavevo kitea i te epicardium me te pericardium.

Te whakatū i tētahi take e meinga te mate

Hei whakapumautia te āhuatanga etiologic entailing kawea pericarditis puka exudative whakamātautau virological, whakamātautau hoki te aroaro o paturopi motuhake (HIV), matomato he rauemi koiora (hei tauira, toto) ki te whakakore i te āhua hopuhopu o pericarditis exudative kawea whakamātautau kiri tuberculin, akoranga serological mate fungal.

Hoki rangahau immunological whakahaeretia i roto i te nahanaha mate kiko tūhonohono, te whakatau i te aroaro o paturopi anti-karihi, rheumatoid take ine antistreptolysin-e, agglutinin matao - ki te mycoplasma mate, serum titiro uremia creatinine me te tiomimi.

tātaritanga pārōnaki o pericarditis exudative

rerekëtanga effusion Pericardial te ki te hinonga e whai ake te mate: whakapeka infarction myocardial, prollaps mamae vasogenic piha mitral, kiripūkahu maroke.

I roto i te whakapeka syndrome mamae miokarada myocardial meinga e te haaputuputuraa o ngā hua pūkoro tinana i roto i te uaua ngakau (myocardium). Mamae syndrome infarction myocardial tahi e te maha o haumanu me te taiwhanga tohu e faaite mai ia ratou i roto i te ofatiraa o hemodynamics pokapū tukanga arrhythmias, tukanga āriponga i myocardium, tītohunga stagnation i roto i te porohita iti (pūkahukahu) tohanga āhuatanga o te infarction myocardial i runga i huringa ECG. tātari matüora o infarction myocardial tohu mahi o isoenzymes cardiac.

A, no te kiripūkahu maroke he meka nui o he mamae, me ngā āhuatanga e pā ana ki manawa, mare, tūranga tinana, haruru i auscultatory kiripūkahu whakamātautau waku, te tahi atu atu i te i runga ake-whakaahuatia, kia tuhia te reira e te kiripūkahu maroke i reira he kore huringa i runga i electrocardiograms kiriata . Haunga te aneurysm te pūtahi o i exudative pericarditis ngā reira i roto i te meka i te take ko te mate ira - syndrome Marfan ranei lesion atherosclerotic tona anga i roto. I roto i ētahi wā, kia hanga i te reira i te effusion pericardial ma'i.

faaite symptomatic aneurysm te pūtahi o iho e whai ake: te mamae i roto i te pouaka o runga, ki kore irradiation, dysphagia, reo whango, dyspnea, mare, meinga e kōpeketanga o te mediastinum. E pāngia aneurysms te pūtahi o te whakamahi i whakamātautau radiological o te rei kōhao, echocardiography, me aortography.

A, no te wāwāhi mamae aneurysm te pūtahi o puta ohorere i te pouaka, i te haafifi i ki irradiation haere te haoraora. I te wa ano, he tūroro i roto i te huru taumaha, maha te ngaro o ngā kare i runga i te uaua nui. Auscultation auscultated iti hoki takirere te pūtahi o. mehua Tātaritanga ka wāwāhi aneurysm te pūtahi o e: ultrasound transesophageal me tomography computed o te kōhao pouaka.

He aha kia utua e koe whakarongo ki

He mea nui ki te rerekëtanga pericardial effusion ICD 10 ki myocarditis E ruia ana, haere tahi nei i whakarahi o te kōhao ngakau ki nga tohu o te kore circulatory. whakakitea myocarditis symptomatic iho i roto i te ara e whai ake: taea e te mea he āhua mamae anginal, mana'o o pouri i roto i te rohe ngakau, raruraru manawataki ngakau.

oro Auscultation auscultated ngakau muting, kia bifurcated tangi ngakau tuatahi, me te tuawha, i roto i te whakaahuatanga o te hiko-e taea kitea te āhuatanga e whai ake nei: te ngaru P haka, he huringa i roto i te pūtau ngaohiko niho R, e taea te papatahi poipoi T. I roto i te echocardiogram whakarahi taa'eraa o te ruma ngakau, me te whakaiti contractility o nga taiepa.

wawaotanga haumanu i roto i te maimoatanga o te pericarditis exudative

Whakapae effusion pericardial whakapeka ko te hiahia akiaki ki hospitalize te manawanui i roto i te fare ma'i. Ki te kahore he mamae nui, ahipirini tika whakaritea i roto i te puka papa, te inenga o tetahi karamu roto wā e toru ranei e wha nga haora. Ko taea ki te tāpiri papa ahipirini horopeta indomethacin o 25 -50 mg, te wai inu, he wā o nga haora e ono.

Ki te mea i reira he tohu e whakahau otinga atu o te 50% dipyrone mō te whakahaere intramuscular o 2 ml Pë whakapōauau (rehunanu) kukū o te 1%, dosing kotahi ranei milliliters hawhe ranei, wā katoa haora e ono. A, no te mamae whakamātau tinana ki te puipuitua o te huru ohoroa ranei whakarite "Sibazon" ( "ahau") i roto, te inenga o 5-10 mg toru ranei wha nga wa he ra.

Hei whakakore i te tukanga inflammatory tino whakamahia nuitia i roto i te mahi o "Prednisolone" inenga o 20-80 mg / ra. i roto i te torutoru kaupae. kawea Therapy ki glucocorticoids i roto i pota teitei i roto i te akoranga o 7-10 ra, me te taa e i roto i te inenga muri kia iti āta, i roto i te rua me te he hawhe koma haumano katoa ra.

I roto i te maimoatanga

Kia pehea te roa tukinotia te effusion pericardial? pumau te maimoatanga e pā ana ki e rua ranei e toru wiki, a ētahi wā whai koe ki te totoro ki te maha nga marama, i ata i runga i te whakaaturanga. Pū o te maimoatanga, tei runga i take etiological e meinga effusion pericardial.

I roto i te tāutu etiology viral e whakaritea kore-steroidal māngai anti-inflammatory, e kore te kupu hormones whakaritea. Pericarditis e he tika ki a streptococcus kakā, kua tukinotia rerekē - whakahau paturopi, hei tauira, rongoā paturopi G inenga 200,000 U / kg / ra. pâmuhia te wehea horopeta hoatu ki ono werohanga, roanga o te maimoatanga - e kore e iti iho i tekau nga ra.

whakamātautau atu

I tua atu, ki te pāngia effusion pericardial, kia whakahaere reira pericardiocentesis (tukanga he haumanu, me te tātaritanga i roto i te natura, kawea nei i roto i i te pericardium ngira poka motuhake i roto i te tikanga ki te horomanga wai mo te tātari). I muri i kawea e matomato te exudate i roto i te tikanga ki te kitea i te momo ngā o te māngai o tenei mate, he mea nui ki te whakatau i te tātaritanga o tona tūtohutanga ki taka antibacterial. Ki te mea ka kitea taua Staphylococcus pene, ko te waihanga te tikanga whakahaere "Vancomycin" horopeta o tetahi karamu wā rō-uaua katoa tekau ma rua haora auau whakaora - i 14 ki te 21 nga ra.

I te tahi taime, Ka taea e mate fungal meinga effusion pericardial. kawea te rongoā i roto i tenei take i roto i "Amphotericin". Ko te horopeta tuatahi ko 1 mg, tona otinga kūhuka ki te ōrau e rite ana ki te 5 ōrau me te rima tekau milliliters i rōrahi, whakahaeretia parenterally (mā te rua), maturuturu hoki 30 meneti. Ki te te pai noatia te tarukino he manawanui, te huringa tikanga dosing e whai ake: 0.2 mg / kg mo tetahi haora. I muri, nui haere te inenga e āta ake ki te hawhe ranei kotahi microgram / ra. hoki e toru ranei wha haora i mua i te tīmatanga o te pānga pai.

pānga te taha "Amphotericin", kia e whakarongo - nephrotoxic, i roto i te hononga ki te aroturuki o te mahi tākihi he tika. Ki te ahu effusion pericardial tika ki rongoā, ka hāngai te rautaki maimoatanga te i ki fariiraa atu o enei āpiha kua mutu a ato'a tautapa te whakamahi o nonsteroidal māngai anti-inflammatory i roto i ngā ki corticosteroids, ratou ngātahi hua i roto i te ora tere, rawa ki te mea kua whakaritea e koe mai i te ra wawe o te mate.