Pericardial effusion: matšoao a le bakang. Tepelletse maikutlong le kalafo

Exudative pericardial effusion - lefu le tšoauoa ka ho ruruha ka lera lera holim hare la pericardium ena. Ke mofuta wa phallo exudative pericarditis ke a hlobaetsang le, kapa le sa foleng.

Lefu lena le ka ba serous, hemorrhagic, purulent, fibrinous le serosanguineous. Ka exudative fibrinous pericarditis le hlaha deposition ea linaleli fibrin ka pericardium, 'me bakoang e itseng eo di ea mokelikeli ka cavity pericardial. Ka tloaelo ho, ka cavity pericardial na le hoo e ka bang 20-40 di ml mokelikeli.

Nakong hlobaetsang pericarditis itsoara joang ka e tsamaea le exudation ntlafatsoa lisele ka cavity pericardial ea karoloana mokelikeli mali. Cases ha tsamaiso e hlabang e ka fallela lera subepicardial, eo ka tsela e hlollang oa soahlamana mosebetsi oa eona.

cardiogenic makala

Hangata e ka tšohanyetso bokella mokelikeli ka cavity pericardial ka etsa hore cardiac tamponade, e leng matšoao bontshang matshwao ya makala cardiogenic:

• palpitations pelo;
• mafu a matšoafo tsa mofuta dyspnea;
• eketseha khatello ea tsamaisong ea venous tsa ajoa ka likopi tse nyenyane le tse kholo;
• fokotseha khatello systolic mali.

mathata khoneha

Ka resorption exudative mokelikeli ka 'na theha lebali dinama tse nyenyane tse, e bopilweng ka fibrin, eo le eena ho ka etsa hore a leeme kapa ka ho feletseng imperforate pericardial cavity. Hangata lebali e thehoa ka sebakeng atrial, ka confluence ea ka holimo ka tlaase le e vena cava, haufi le groove ka atrioventricular.

Le jwalo le mofuta hlobaetsang ea effusion pericardial ho ka etsa hore mathata a matla, e leng o bitsoa "lejoe pelo" ka lebaka la calcification tsa pericardium ena. Ntlha ea bohlokoa mosebetsing oa ho pathological tsa pericarditis exudative ke tlōlo ea kgutlang diastolic mali ho ventricles pelo. Exudate bokeletseng ka cavity pericardial kapa ho ba teng ha pericarditis constrictive isang kgoreletsego tsa le dikarolo subepicardial le subendocardial ka tlhorong ea. Maemong a sa tloaelehang, fibrosis tsa pericardium ka 'na ba expandable karolo, eo ka eona le ventricle bulging nakong diastole netefatsa pelehi tloaelehileng ea mali ka ho teba.

ketsahalo ena e bitsoa fenestration (the "bulehileng fensetere"). Systolic mohato, eo e fana ka chitja lera mesifa, ka kakaretso, ha e utloa bohloko. Ka nako e telele khahlanong le ho khutla venous pelong ho na le stagnation mali ka mothapo ho methapo. Ha venous stasis ka systemic oona tsamaisong ajoa ea mokelikeli o extravasation ka lisele tse e potolohileng.

Pericardial effusion: bakang (etiologies)

E 'ngoe ea lisosa tse ngata khafetsa pericarditis exudative ke RNA-e nang le likokoana-hloko (A le B), echovirus, ntaramane A le tšoaetso ea baktheria ea tlhaho e sa tšoaneng (pneumococci, staphylococci, streptococci, mycobacteria lefuba le li-fungus).

lefu o ne a nka ka thatafatsa tsela ea mafu systemic (sle la, kapa lefu Libman-mekotla, rheumatic manonyeletso, rheumatism, systemic scleroderma) le mafu a ea tsamaiso genitourinary (uremic pericarditis). Pericardial effusion ICD a ka ba le ponahalo e postperikardialnogo lefu hore develops ka mor'a pericardiotomy kapa e le complication ea pele ea infarction myocardial, eo e bitsoa lefu Dressler e. Hangata, complication ena hlaha foreime tieo hlalosoa nako, e leng, ho tloha matsatsi a 15 ho ea ho likhoeli tse 2.

Ka linako tse ling exudative sekgomaretsi pericarditis ka etsahala ka lebaka la ho-ja lithethefatsi tse itseng: gidralizin, phenytoin, anticoagulants, ka lebaka la ho kopo khafetsa procainamide, radiotherapy. Maemong tseo ha e le e kholo pericardial effusion lemoha effusion dikahare, lebaka e lokela ho ba ile ba batla ho metastasis ba lihlahala: kankere ea matsoele, ea matšoafo, sarcoma, lymphoma. Maemong ana, hangata hemorrhagic exudates, tlase serous.

Ho na le ke mofuta o khethehileng oa pericarditis exudative, eo e bitsoa hemopericardium. boemo ena ho etsahala ha phunyeletsang likotsi ho sebakeng sefubeng ka pelong ea boqapi ba ea, jwalo ka ha discontinuities infarction bakuli mora infarction myocardial, kapa dissecting aortic aneurysm, a etsa hore mali a tletseng ho ea cavity pericardial. Ha lefu lena le hlahile ho lintlha tsejoeng causative, joale e ke oa sehlopha sa batho ba nonspecific kapa idiopathic.

Ho phaella moo, pericardial effusion ka bana, hape, ka linako tse ling. Mabaka a sena ke tsena: streptococcal le staphylococcal tsoaetsanang, lefuba, tšoaetso ea HIV, meriana sa laoleheng, lihlahala, ho sithabela, haufi le pelo, ho hloleha liphio, opereishene ea pelo.

Pericardial effusion: hlahloba le litšobotsi tsa tleleniki

Exudate bokeletseng ka cavity pericardial le lerootho bohloko iponatsa opeloa ka pelo ea ka, e sa tloaelehang ho hema ka mofuta oa apnea, eo e fokotsehile ka kopano boemo palpitations. Khatello ikitlaetsa ka mokelikeli ho ka trachea le bronchi ho baka khohlela omileng.

Kakaretso boemo ba bakuli ba le itšetlehile ka tekanyo ea sebopeho sa le mokelikeli motsoako ka pericardium ka lebelo lieha - boemo khotsofatsang ha ka potlako - e leka-lekaneng le e matla.

Ka ho hlahloba ka, mamello ea ka lemoha makgetheng exudative pericarditis latelang: palo ea letlalo, mucosa cyanotic molomo, edema ea maoto le matsoho ka tlaase, acrocyanosis.

Ha sebakeng hlahloba sefubeng sa ka lemoha asymmetry, lehlakoreng le letšehali ka e ile ea eketseha, sena se ka etsahala feela haeba lesihleng ka pericardial exudate bophahamo ba modumo fihla litha e le nngwe e fetang 1. Palpation khona ho lemoha tšobotsi Jardin ha apical tšusumetso e tsoang ho e mahae hodimo le supa kahare, ka lebaka la ho inehela khatellong ea ikitlaetsa, ea mokelikeli bokeletseng ka hare.

Percussion khona ho lemoha katoloso ea meeli ea dullness mong ka pelo ho ka 'nģa tsohle: ka ho le letšehali, ha a le ka tlase (ka lihlopha e ka tlaase) ho ka pele kapa ho mola bohareng axillary, ka libaka tse bobeli le la boraro intercostal ho mola bohareng ba bo-clavicular, letona ka lihlopha tse tlaase, ho le letona la SCR (bohareng -klyuchichnoy mola), ka tsela eo eaba ba etsa le hlaha ka lehlakoreng le obtuse sebakeng sa le tloaelehileng ka ho toba ho ea moeling phetoho e amanang le sebete dullness. All ena ka 'na a bontša hore mokuli o pericardial effusion.

Auscultatory paterone: e fokolisang bohale ba pelo e utloahala ka tlhorong pelo, ka Botkin-Erb le thulaganyo xiphoid. Ka e le setsi sa pelo a utloile lentsoe le phahameng li bakoa ke 'nete ea hore pelo e mahae exudative mokelikeli hodimo le morao. Lerata pericardial khohlano, hangata auscultation ha iponahatsa. khatello ea mali e fokotseha, khahlanong le semelo sa ho fokotseha ha khumo cardiac.

Ha bokella mokelikeli le hlaha butle ha nako e ntse, e le mosebetsi ho phetha molao feela ba pelo bakeng sa ho nako e telele ha se khathatseha ka lebaka la 'nete ea hore ho pericardium atolosa butle tabeng ena. Tabeng ea ho bokella e potlakileng ea mokelikeli ka effusion pericardial le sebaka seo oona o kopanela tachycardia, litleleniki tsa ho hloleha pelo le liketsahalo tsubuhlellano ka didikadikwe e ajoa ka likopi (kgolo le tse nyenyane).

E thehiloeng ho hlahloba ECG ya data tšoauoa ka e latelang exudative pericarditis. Ha tsubuhlellano exudative mokelikeli ho eketsehileng balelela gagamalo phokotso QRS rarahaneng le motlakase phetolo ventricular mehahong. Radiographically hlokomela keketseho ea moriti oa pelo le fokola sebakeng sa balebeli ba potoloho ripple. Vascular sosobaneng e sa shortened. Ka linako tse ling ho ka etsahala ho lemoha effusion ka le letšehali mesothelioma cavity.

Echo ECG ka pericardial cavity bokella mokelikeli exudative e hlokometse ho tloha morao tsa ventricle letšehali ba pelo, ka sebaka sa tshebetso sa leboteng ka morao. Ha meqolo e khōlō ea mokelikeli exudative, ho bontša ka pel'a ventricle nepahetseng ba pelo. Ka palo ea bokeletseng mokelikeli ka pericardium e ahloloa ke karohano pakeng tsa senolang histori hlahellang ho tswa epicardium le pericardium.

Ho theha le palokatiso ya e bakileng lefu lena

Ho theha lintlha etiologic entailing exudative foromo pericarditis etsoang ho hlahloba ka virological, liteko tsa ho ba teng ha lisireletsi itseng (HIV), seeding ka lintho tse bonahalang tsa likokoana-hloko (mohlala, mali) ho felisa mofuta tšoaetsanoang tsa pericarditis exudative etsoa tuberculin letlalo teko, lithuto tsa serological fungal tshwaetso.

Hape ho etsa lipatlisiso immunological tšoaroa ka systemic mafu connective dinama tse nyenyane tse, fumana hore na ho ba teng ha lisireletsi-ba khahlanong le libetsa tsa nyutlelie, e ruruhisang Ntlha e titre antistreptolysin-O, batang agglutinin - le tshwaetso mycoplasma, uremia talimela serum creatinine le urea.

Differential phumano ya pericarditis exudative

Pericardial effusion e le farologantswng la le mekhatlo e latelang ea lefu: hlobaetsang myocardial infarction, vasogenic bohloko prollaps mitral phunyang, e omeletseng pleurisy.

Ka a hlobaetsang le myocardial miokarada bohloko lefu le bakoang ke ho bokella lihlahisoa tshilong ya dijo ka mesifa pelo (myocardium). Bohloko lefu myocardial infarction tsamaea le a 'maloa a matšoao tlelenike le laboratori ea hore bonahatsa bona ka bobona ka tlōla hemodynamics bohareng tšebetso arrhythmias, dithulaganyo conduction ka myocardium, stagnation liketsahalo ka lesakaneng e nyenyane (methapo) ajoa bath ya infarction myocardial ka liphetoho ECG. Skeletal ho hlahloba infarction myocardial bontša mosebetsi oa isoenzymes cardiac.

Ka pleurisy omileng ke ea bohlokoa ha e le hantle a bohloko le a likarolo amanang le phefumoloho, khohlela, boemo mele, lerata khohlano pleura nakong tlhlahlobo auscultatory ntle o ile a hlalosa ka holimo, re lokela ho hlokomela hore pleurisy omileng ha ho na liphetoho tse ka electrocardiogram filimi . Ho fapana le aortic aneurysm tloha exudative pericarditis e le bopilwe ka 'nete ea hore sesosa ke liphatsa tsa lefutso lefu - Marfan lefu kapa atherosclerotic lethopa khetla lona ka hare. Maemong a mang, ho ka 'na theha foleng pericardial effusion.

Bontshang matshwao aortic aneurysm bontša ka boeona e ka tsela e latelang: bohloko ka sefubeng ka holimo, le ha ho na ts'ebetso ea ho lelefatsa bophelo ba lijo, dysphagia, lentsoe omeletse, dyspnea, khohlela, a bakoa ke compression ea mediastinum ena. aneurysms Aortic ba fumanoa sebelisa radiological hlahloba thoracic cavity, echocardiography, le aortography.

Ha dissecting aortic aneurysm bohloko hlaha ka tšohanyetso ka sefuba, ba na le tšekamelo ea ho ts'ebetso ea ho lelefatsa bophelo ba lijo hammoho aorta ena. Ka nako e tšoanang, bakuli ba na le le boemong bo tebileng, hangata ho nyamela ha maqhubu a metsi a ka mothapo e kgolo. Auscultation auscultated aortic belofo insufficiency. Diagnostic mehato ha dissecting aortic aneurysm ke: transesophageal oa ultrasound le ea computed tomography ea sefubeng cavity.

Seo u se lokela ho ela hloko ho

Ho bohlokoa ho phapang pericardial effusion ICD 10 le myocarditis diffuse, e leng e tsamaea le kholiso ea cavity pelo le matšoao a ho hloleha ho potoloha ha mali. myocarditis bontshang matshwao a bontša ka boeona e ka tsela e latelang: ho ka ba le lehlaba anginal tlhaho, boikutlo ba ho ba ntho e boima ka sebakeng seo pelo, pelo ea morethetho meferefere.

Auscultation auscultated muting pelo utloahala, pele le ea bone utloahalla pelo ka bifurcated, ka tlhaloso ya electrocardiogram khona ho lemoha litšobotsi tse latelang: ho holofala P tsokoang, phetoho e ka seleng voltages leino R, T tsokoang ka pantshisi-tse. Nakong ea echocardiogram hlokomeleha kholiso ea likamoreng tse ka pelo le ho fokotseha contractility tsa marako.

Phekolo tsereletsi ea ho phekola ba pericarditis exudative

Belaela hlobaetsang pericardial effusion ke le tlhokahalo e potlakileng ho hospitalize mokuli sepetlele. Haeba ho na le utloe bohloko bo boholo, ho hlokahale hore e beuweng aspirini foromo letlapa, e litekanyetso li behoa ea mob mobile mong ka hare karohano mong le e mong lihora tse tharo kapa tse 'nè. Ho ka etsahala ho eketsa matlapa aspirini lethal dose indomethacin la 25 -50 mg,, metsi a nooang, e karohano ea mong le e mong lihora tse tšeletseng.

Haeba ho na le matšoao a hore ho laela tharollo ka ho eketsehileng 50% dipyrone bakeng sa tsamaiso intramuscular 2 di ml kapa analgesics narcotic (morphine e) mahloriso ea 1%, dosing hang kapa dimililitha halofo, dikgao mong le e mong lihora tse tšeletseng. Ha psychomotor pherekano khahlanong le okametsoeng ke la boemo bo kapa lefu la ho hlobaela le beha hore "Sibazon" ( "Ke") ka hare, le litekanyetso li behoa ea 5-10 mg, ka makhetlo a mararo kapa a mane ka letsatsi.

Ho felisa le thulaganyo a hlabang ho fetisisa e atisa ho sebelisoa mokhoa oa ho "Prednisolone" litekanyetso li behoa ea 20-80 mg, / ka letsatsi a. ka hare ho mehato e seng mekae. Phekolo ka glucocorticoids ka tekanyetso e phahameng e etsoa ka mor'a matsatsi a 7-10, le peculiarity hore ka litekanyetso li behoa morago ga moo e lokela ho fokotsoa butle-butle, ka tse peli le ka milligram halofo letsatsi le letsatsi.

Nakong ea kalafo

nka nako e kae e tšoaroa pericardial effusion? The kalafo nka ka libeke tse peli kapa tse tharo, 'me ka linako tse ling u na le ho otlolla ho likhoeli tse' maloa, ka tieo ka bopaki. Khethehileng ea phekolo e itšetlehile ka ntlha e etiological e bakileng pericardial effusion.

Ka ho hlwaya etiology bongata ba kokwanahloko ba abeloa batho bao e seng steroidal mahlahana a khahlanong le a hlabang, lihomone ka tsela eo se abetsoeng. Pericarditis eo li bakoa ke Streptococcus serame sa matšoafo, ba tšoaroa ka tsela e fapaneng - ho laela lithibela-mafu, mohlala, ka penicillin G litekanyetso li behoa 200.000 U / lik'hilograma / ka letsatsi a. entoe fanoeng lethal dose e arotsoe liente tse tšeletseng, bolelele ba nako ea phekolo - ha matsatsi a tlase ho tse leshome.

liteko tse eketsehileng

Ho phaella moo, ha fumanoa hore o tšoeroe pericardial effusion, e lokela ho etswa pericardiocentesis (Tsamaiso le phekolo le tekotshupo tsa tlhaho, e etsoa ka e khethehileng nale puncture pericardium e le hore mokelikeli ho noa ho and analysis). Ka mor'a moo seeding o etsoang exudate e le hore ba khona ho utloa mofuta o itseng oa moemeli oa lefu lena, ke habohlokoa ho fumana hore na ho hlahloba nahanela lona ho lokisetsa antibacterial. Haeba e fumanoa Staphylococcus aureus, paakanyong hangata laolwa "Vancomycin" lethal dose ya e mong a mob mobile intravenous dikgao mong le e mong lihora tse leshome le metso e phekola sekhahla - ho tloha matsatsi a 14 ho a 21.

Ka linako tse ling, tšoaetso fungal ka etsa hore pericardial effusion. Phekolo tabeng ena e etsoa "Amphotericin". The lethal dose ea pele e ne e le 1, mg, tsoekere lona tharollo le karolo e lekanang le karolo ea 5 lekholong le dimililitha mashome a mahlano ka bophahamo ba modumo, laolwa parenterally (ka tsela mothapo ho), a rothele ka metsotso e 30. Ha mokuli lithethefatsi e hantle mameletse, le dosing phetoho puso tjena: 0,2 mg, / lik'hilograma tse fetang hora e 'ngoe. Ka mor'a moo, litekanyetso li behoa ea ea eketseha butle-butle ho fihlela ho halofo kapa e mong microgram / ka letsatsi a. lihora tse tharo kapa tse 'nè pele ho qala ho ea le phello e ntle.

Setlamorao "Amphotericin", e leng lokela ho lefa a lebisa tlhokomelo - nephrotoxic, mabapi le go baya leitlho ea mosebetsi renal hlokahala. Ha pericardial effusion simolohile ka lebaka la ho noa meriana, joale e ntan'o ba lewa kalafo o ikemiseditse ho ho baeti ba fihlelang ho eketsehileng mahlahana tsena e se e khaotsa 'me ekelletsa moo abela tshebediso ya mahlahana nonsteroidal-ba khahlanong le a hlabang hammoho le corticosteroids, ba mmoho fella ka hlaphoheloa ka potlako, haholo-holo haeba u ba 'nile ba khetheloa ho tloha mehleng ea pele ea lefu lena.