Effusion Pericardial: iimpawu noonobangela. Isifo kwaye afumane unyango

Exudative effusion pericardial - isifo esibonakala ukudumba kwi inwebu ngakwimida phezu engaphakathi pericardium. Ngu uhlobo pericarditis flow exudative yondele okanye engapheliyo.

Esi sifo kuba serous, ukopha, ubovu, fibrinous kunye serosanguineous. Xa pericarditis exudative fibrinous kwenzeka yokulahlwa kwe zixhobo fibrin kwi pericardium, kwaye oluhlala isixa esithile kolwelo em- pericardial. Ngokuqhelekileyo, em- pericardial iqulethe malunga 20-40 ml kolwelo.

Ngexesha acute pericarditis reaction lukhatshwa eyomeleziweyo exudation yeselula em- pericardial nakwiqhezu yegazi ulwelo. Iimeko xa inkqubo yokukrala unokushenxela umaleko subepicardial, nto leyo kakhulu iwohloke umsebenzi wayo.

yashiya cardiogenic

Ngokufuthi olwenzeka ngesiquphe ulwelo em- pericardial kungabangela tamponade kwentliziyo, apho iimpawu kwangumqondiso bothukile cardiogenic:

• iyangongoza intliziyo;
• izifo zemiphunga for uhlobo dyspnea;
• ubunzima obungakumbi kwinkqubo lwemithambo ejikeleza ezincinane nezinkulu;
• ukuncipha uxinzelelo lwegazi iSystolic.

iingxaki kunokwenzeka

Nge resorption fluid exudative kuyaba kukuqulungana izihlunu, equka fibrin, nto leyo inokukhokelela kwisisu pericardial imperforate buso okanye epheleleyo. Kudla kukuqulungana luqokelelane apha kummandla atrial, xa intlanganisela eliphezulu aphansi Vena cava, kufuphi emseleni atrioventricular.

Ngenxa uhlobo yayiyazi loo effusion pericardial kungakhokelela kubunzima kakhulu, ekuthiwa 'intliziyo ilitye "ngenxa calcification le pericardium. Enye ingongoma ebalulekileyo kwinkqubo zophendlo lwezifo ze pericarditis exudative kuba kukwaphula ukuzala igazi ubuyela ventricles ngentliziyo. Exudate amaninzi kwisisu pericardial okanye ubukho pericarditis constrictive kukhokelela ukuphazamiseka maleko subepicardial kwaye subendocardial kwi enkcochoyini. Kwiimeko ezinqabileyo, abanesigulo le pericardium inokuba icandelo esongwayo, ekuthe a ventricle equmbile ngexesha diastole ukuqinisekisa unikezelo eqhelekileyo igazi entliziyweni.

Le nto ibizwa ngokuba fenestration (i "window ezivulekileyo"). Isigaba iSystolic, ebonelela umaleko setyhula dystrophy, ngokubanzi, awehlelwa. Nge iphula ixesha elide imbuyekezo lwemithambo entliziyweni kukho ngxi igazi kwi-pulmonary. Xa stasis lwemithambo kwinkqubo yokujikeleza kwegazi le nto ilulwelo extravasation ibe kwizihlunu ezingqongileyo.

effusion Pericardial: izinto (etiologies)

Enye yezinto ezingunobangela rhoqo pericarditis exudative kukho iintsholongwane RNA-equlethe (A and B), echovirus, umkhuhlane A kunye nosulelo iintsholongwane zendalo ezahlukeneyo (pneumococci, staphylococci, streptococci, mycobacteria isifo sephepha kunye nomngundo).

isifo kujongwa kungaba nzima ekuhambeni kwezifo systemic (SLE, okanye isifo Libman-iingxowa, amalungu samathambo, rheumatism, scleroderma systemic) kunye ukuphazamiseka kwenkqubo genitourinary (uremic pericarditis). Pericardial effusion ICD inokuba njengokubonisa postperikardialnogo syndrome ukuvela emva pericardiotomy okanye i ingxaki yokuqala iposi engabalulekanga, ekuthiwa Dressler engqondweni. Ngokuqhelekileyo, kuphakama le ingxaki e kuchaziwe ngokungqongqo kwexesha elibekiweyo, oko kukuthi, ukususela iintsuku ezili-15 ukuya kwiinyanga ezi-2.

Ngamanye amaxesha pericarditis exudative enamathelayo lunokwenzeka ngenxa yokufakwa iziyobisi ezithile: gidralizin, phenytoin, anticoagulants, ngenxa procainamide isicelo rhoqo, radiotherapy. Kwezo meko xa effusion enkulu pericardial elibhaqiweyo umxholo effusion, isizathu kufuneka kucelwa Ukudlulela yamathumba: umhlaza webele, wemiphunga, nee-, lymphoma. Kule meko, exudates ngokuqhelekileyo ukopha, ngaphantsi serous.

Kukho uhlobo olulodwa pericarditis exudative, leyo kuthiwa hemopericardium. Le meko yenzeka xa angena nokwenzakala kummandla esifubeni kwi intliziyo kwelivi, njengoko discontinuities iposi kwi izigulane emva iposi engabalulekanga, okanye sokuhlaziya kwemithambo aortic, ibangela igazi lizele kwisisu pericardial. Ukuba isifo kwenzeka imiba causative unknown, ngoko ube kwiqela nonspecific okanye idiopathic.

Ukongeza, i-effusion pericardial ebantwaneni, kakhulu, ngamanye amaxesha. Izizathu zoku: usulelo streptococcal kwaye staphylococcal, isifo sephepha, usulelo lwe-HIV, amayeza zibunjwe, nangezilonda, kwentlungu, kufuphi intliziyo, ukusilela kwezintso, uqhaqho lwemiphunga yentliziyo.

effusion Pericardial: Ugonyo neempawu clinical

Exudate amaninzi kwisisu pericardial futhi ubonisa intlungu buthuntu iqaqamba ngentliziyo, ukuphefumla okungaqhelekanga kuhlobo umoya, nto leyo lincitshiswe kwindawo ehleli khona, iyangongoza. Uxinzelelo ezwi ulwelo kwi uqhoqhoqho kunye bronchi okubangela ukhohlokhohlo owomileyo.

imeko ngokubanzi izigulana ixhomekeke izinga lokusekwa icandelo ulwelo kwi pericardium ngesantya kade - karhulumente ngokwanelisayo xa okukhawulezayo - eliphakathi kwaye kakhulu.

Ngosuku loviwo, isigulana kungabonwa alandelayo iimpawu pericarditis exudative: lipholi ulusu, isifo imilebe cyanotic, nokudumba of nemilenze, acrocyanosis.

Xa ummandla kuhlolwe esifubeni kungabonwa asymmetry, kwicala lasekhohlo angandiswa, oku kunokwenzeka kuphela xa cluster umthamo exudate pericardial ifikelela ilitha ngaphezulu kwe-1. Ngokucofa bangabhaqa osemqoka Jardin xa ngokwentshukumisa apical asuswa phezulu nezibilini zayo, ngenxa uxinzelelo ezwi, ulwelo efunde ngaphakathi.

Emgama bangabhaqa ukwandiswa imida anozizi isihlobo wentliziyo zonke iindlela: ngasekhohlo, emazantsi (kwi izahlulo asezantsi) ukuya ngaphambili okanye kumgca axillary embindini, kwizikhewu intercostal yesibini neyesithathu ukuya kumgca yee-clavicular, ekunene kwi izahlulo lentendelezo ephantsi, esa ilungelo uhl (mid line -klyuchichnoy), kanjalo zakha i engile obtuse endaweni ngqo eqhelekileyo kumda utshintsho anozizi hepatic. Konke oku kubonisa ukuba ogulayo effusion pericardial.

ipateni Auscultatory: buthathaka usiko intliziyo izandi kwi enkcochoyini intliziyo, kwi Botkin-Erb kunye nenkqubo xiphoid. Xa isiseko kwentliziyo ziyaviwa iithowuni elikhulu ngenxa yokuba intliziyo asuswa phezulu exudative cerebrospinal kunye ngasemva. Ingxolo ukukhuhlana pericardial, ngokuqhelekileyo auscultation akuthethi ukuzibonakalisa. uxinzelelo zinegazi ukuhla, kwimvelaphi ukuncipha kwemveliso intliziyo.

Ukuba sibe ulwelo lwenzeka kancinci ngokuhamba kwexesha, umsebenzi mechanical bentliziyo ixesha elide bangaphazamiseki ngenxa yokuba lo pericardium iyavuleka kancinci kule meko. Kwimeko olwenzeka ngokukhawuleza kolwelo kwi effusion pericardial kwaye ndawo ajoyine tachycardia, ukusilela intliziyo lwezonyango kunye ngezenzeko nokumfixana izangqa ejikeleza (ezinkulu nezincinane).

Ngokusekelwe kuhlalutyo data ECG luphawulwa pericarditis exudative ilandelayo. Xa ukuxinana exudative olunye zokunciphisa Bala ombane fluid QRS izakhiwo utshintsho ventricular entsonkothileyo zombane. Radiographically waphawula ukwanda emthunzini yentliziyo kunye nendawo elibuthathaka yama- wesiphaluka. umqulu semithambo asisifutshane. Ngamanye amaxesha kuyenzeka ukubona effusion kulo kwisisu pleural ekhohlo.

ECG echo kwi pericardial lweHo- sibe ulwelo exudative nto ndazigcina emva ventricle lasekhohlo wentliziyo, kummandla kodonga angasemva. Xa imiqulu ezinkulu ulwelo exudative, sibonisa phambi ventricle tye kwentliziyo. Ngomhla inani ulwelo amaninzi pericardium igwetywe lekhefu phakathi ntlokoma kubonakala ukusuka epicardium kunye pericardium.

Ukumisela into eyabangela isifo

Ukumisela izinto etiologic esizakukhokelela exudative pericarditis eyenziweyo uviwo virological, iimvavanyo ubukho omzimba athile (HIV), elinywayo ukuba izinto eziphilayo (umz, igazi) ukususa uhlobo ezosulelayo of pericarditis exudative bamthwala isikhumba uvavanyo tuberculin, izifundo ze-serological ezinzwaneni.

Kwakhona uphando ngumzimba oluqhutywe izifo systemic kwizicwili, ukuqinisekisa ubukho omzimba okulwa-nuclear, samathambo factor titre antistreptolysin-O, agglutinin ebandayo - nosulelo mycoplasma, uremia jonga serum creatinine kunye urea.

uxilongo mahluko of pericarditis exudative

effusion Pericardial liza kwahlulwa kunye nemibutho ilandelayo sifo: iposi etsolo engabalulekanga, prollaps iintlungu vasogenic umba mitral, unepleurisy owomileyo.

In acute syndrome intlungu miokarada engabalulekanga zibangelwa ukuqokelela lweemveliso pathways entliziyweni kwezihlunu (myocardium). Iintlungu syndrome iposi engabalulekanga sikhatshwe inani iimpawu zonyango kunye elabhoratri nokuba azibonakali besaphula hemodynamics central iinkqubo arrhythmias, iinkqubo Uhanjiso e myocardium, izenzakalo ngxi kwisangqa encinane (pulmonary) ukujikeleza uphawu iposi engabalulekanga malunga notshintsho ECG. Uhlalutyo ezinto of iposi engabalulekanga ibonisa umsebenzi isoenzymes inhliziyo.

Xa unepleurisy owomileyo na into ebalulekileyo yokuba iintlungu kunye neempawu ezinxulumene ukuphefumla, khohlo, amalungu omzimba, yengxolo auscultatory iimviwo zochuku pleura, ngaphandle, kufanele kuqatshelwe ukuba unepleurisy owomileyo akukho lutshintsho kwi electrocardiograms umboniso ezichazwe ngasentla . Ngokungafaniyo kwemithambo aortic ukusuka exudative pericarditis oko sikuko yokuba unobangela sisifo yemfuza - syndrome yiMarfan okanye sisilonda esidumbileyoesingaphakathi atherosclerotic iqokobhe layo ngaphakathi. Kwezinye iimeko, kunokuba ibe effusion ezinganyangekiyo pericardial.

kwemithambo lingaze aortic esizibonakalisa ngolu hlobo lulandelayo: iintlungu esifubeni ephezulu, kungekho zokukhanya, dysphagia, ngelizwi elitshothozayo, dyspnea, ukukhohlela, zibangelwa ucinezelo le mediastinum. aneurysms Aortic abafunyenwe kusetyenziswa uviwo zeradiyoloji le thoracic kwisisu, echocardiography, kunye aortography.

Xa sokuhlaziya iintlungu kwemithambo aortic kuvela ngephanyazo esifubeni, anento zokukhanya ecaleni aorta. Ngelo xesha, izigulane zikwimeko embi, rhoqo yokuduka phamb kwi umthambo enkulu. Auscultation auscultated aortic valve insufficiency. amanyathelo zokuChonga xa sokuhlaziya kwemithambo aortic zezi: ultrasound transesophageal kunye Itomography ayifum le lweHo- esifubeni.

Oko kufuneka sinikele ingqalelo

Kubalulekile ukuba wenze umahluko pericardial effusion ICD-10 kunye myocarditis ehlasela, nto leyo sikhatshwa wawandisa lweHo- intliziyo iimpawu ukusilela kwegazi. myocarditis lingaze wazibonakalisa ndlela ilandelayo: kunokuba intlungu anginal uhlobo, imvakalelo ubunzima ndawo entliziyweni, intliziyo rhythm nokuphazamiseka.

Auscultation auscultated intliziyo Uyeke izandi, isandi intliziyo yokuqala neyesine ukuba bifurcated, xa inkcazo electrocardiogram lunokukhangela izinto mpawu zilandelayo: P yomtshangatshangiso likhubazeke, kukho utshintsho kwiseli yombane izinyo R, T lokutshangatshangisa na atshabalalisa. Ngexesha echocardiogram wawandisa ezibalulekileyo emagumbini sentliziyo nciphisa contractility beendonga.

ungenelelo kwezonyango kwi kunyango pericarditis exudative

Eko effusion etsolo pericardial imfuneko engxamisekileyo hospitalize isigulane esibhedlele. Ukuba kukho intlungu kakhulu, aspirin ngokuyimfuneko emiselweyo azipilisi, ukuba umthamo gram enye ngaphakathi kwisithuba qho kwiiyure ezintathu okanye ezine. Kuyenzeka ukuba ukongeza iipilisi aspirin idosi indomethacin ka-25 -50 mg, amanzi okusela, i lokuphumla emva kweeyure ezintandathu.

Ukuba kukho iimpawu ezibonisa ukuba ukumisela isisombululo ngakumbi ka-50% dipyrone yolawulo intramuscular of ml-2 okanye analgesics ezidakumbisayo (icaffeine) abasuka e-1%, umthamo kanye okanye ngeemililitha enesiqingatha, ekhefu qho kwiiyure ezintandathu. Xa lengqondo ukuphazamiseka sizoku lwisana na imeko okanye ukuphuthelwa kumisela 'Sibazon "(" i ") ngaphakathi, ukuba umthamo 5-10 mg kathathu okanye kane ngemini.

Ukuphelisa iinkqubo ukudumba ezininzi eziqhele ukusetyenziswa kulo mkhuba of "Prednisolone" umthamo 20-80 mg / ngosuku. kwisithuba ezimbalwa. Therapy kunye glucocorticoids ngeedosi eziphezulu oluqhutywa ekuhambeni kweentsuku 7-10, kunye peculiarity ukuba idosi elandelayo kufuneka licuthwa ngokucuthwa, kubini ezinesiqingatha mlligrams yonke imihla.

ngexesha unyango

iphathwa elide kangakanani effusion pericardial? Unyango ithatha malunga neeveki ezimbini okanye ezintathu, kwaye ngamanye amaxesha kufuneka ndisolule iinyanga eziliqela, ngqongqo yesingqino. Ingakumbi unyango ixhomekeke factor etiological eyabangela effusion pericardial.

Ekuchongeni umyalezo viral ababelwe arhente non-steroidal anti-ukudumba, iihomoni ngoko abelwe. Pericarditis ezo ngenxa iStreptococcus inyumoniya, baphathwa ngokwahlukileyo - ukumisela nemithi, umz, penicillin G idosi 200,000 U / kg / ngosuku. yegazi umthamo banikwa yahlulwe lwezitofu emithandathu, ubude unyango - hayi ngaphantsi nje kweentsuku ezilishumi.

iimvavanyo ezongezelelweyo

Ukongeza, ukuba kwafunyaniswa ukuba effusion pericardial, kufuneka ziqhutywe pericardiocentesis (Inkqubo ukuba zonyango kunye diagnostic kwindalo, nto leyo wenziwe inaliti okuhlatywa pericardium ekhethekileyo ukuze ulwelo inani for analysis). Emva koko imbewu kwenziwe exudate ukuze babone uhlobo oluthile arhente kwesi sifo, kubalulekile ukujonga uhlalutyo uvakalelo kwayo kumalungiselelo antibacterial. Ukuba ifunyenwe Staphylococcus aureus, kuqulunqo ke esuke "Vancomycin" ithamo yegram enye ngamathuba efakwa qho kwiiyure ezilishumi rate enyangayo - ukusuka kwiintsuku ezili-14 ukuya kuma-21.

Ngamanye amaxesha, izifo ezinzwaneni kunokubangela effusion pericardial. Unyango kule meko ikhutshwa phandle "amphotericin". Ithamo lokuqala 1 mg, isisombululo iswekile kunye ipesenti elilingana-5 ekhulwini kunye ngeemililitha amahlanu umthamo, elawulwa parenterally (via Kwangale), uvuza imizuzu engama-30. Ukuba isigulane ichiza ukunyamezeleka kakuhle, i nomthamo lenguquko ngolu hlobo lulandelayo: 0.2 mg / kg phezu ngeyure enye. Kamva, umthamo inyuswe ngokuthe ngcembe ukuya kwisiqingatha okanye enye microgram / ngosuku. iiyure ezintathu okanye ezine phambi kokuba kuqala nempembelelo entle.

ukusebenza Side "amphotericin", ekufuneka sinikele ingqalelo - nephrotoxic, ngokunxulumene esweni umsebenzi sezintso kuyimfuneko. Ukuba effusion pericardial yavela ngenxa amayeza, ngoko ke isicwangciso unyango lujoliswe ku yokwamkela ngakumbi kwezi arhente luye lwayekiswa yaye ngaphezu isabelo ukusetyenziswa arhente nonsteroidal anti-ezithintela ukosuleleka kunye corticosteroids, bona ngokudibeneyo kubangela kwakhona ngokukhawuleza, ingakumbi ukuba uthe wamiselwa ukususela kwimihla zokuqala zesi sifo.