Effusion Pericardial: astaamaha iyo sababaha. Cilad-iyo daaweynta

effusion pericardial Exudative - cudur lagu gartaa barar in xuub lasoo dusha hoose oo pericardium ah. By dabiiciga ah ee pericarditis exudative socodka waa daran ama joogtada.

Cudurku wuxuu noqon karaa mid nabarrada, dhiigbaxa, purulent, fibrinous iyo serosanguineous. In pericarditis fibrinous exudative dhacdaa dhigaalka ee filaments fibrin in pericardium ah, oo ururayaa xaddi gaar ah oo dareere in saabka pericardial. Sida caadiga ah, in saabka pericardial ka kooban yahay qiyaastii 20-40 ml of dheecaan.

Inta lagu guda jiro dareen-celin pericarditis ba'an waxaa ku weheliyay wanaajiyey maadoyinka gacanta ee saabka pericardial of a jajab dareeraha dhiiga. Kiisaska marka geedi socodka bararka laga yaabaa inay daaha subepicardial, taas oo si weyn dilaacda ay shaqo u guurto.

lama filaan ah cardiogenic

Inta badan raasamaal lama filaan ah oo ah dheecaan in saabka pericardial keeni kartaa tamponade wadnaha, taas oo ah calaamadaha calaamadaha shoogga cardiogenic:

• wadno,
• xanuunada neefsashada nooca dyspnea;
• cadaadis kordhay nidaamka arooriyaha ah wareegga waaweyn iyo kuwa yaryar,
• hoos u cadaadiska dhiigga systolic.

dhibaatooyin ay suuragal tahay

Iyada oo resorption dheecaan exudative sameyn karaan unugyada nabar, oo ka kooban fibrin, taas oo iyana waxay keeni kartaa in qayb ahaan ama gebi saabka pericardial imperforate. Sida caadiga ah astaantii waxaa la aasaasay gobolka wadne, at kulanka of cava ku vena sare iyo hoose, meel u dhow jeexdin ah atrioventricular.

Iyada oo sida dabeecadda daran oo ku effusion pericardial waxay keeni kartaa dhibaatooyin daran, oo la yiraahdo "qalbigiisa dhagax" iyadoo ay sabab u kalshum pericardium ah. dhibic muhiim ah in geeddi-bahal ee pericarditis exudative waa xadgudub ku ah dhiigga si intraventricular qalbiga ka soo laabtay diastolic. Exudate ururtay in saabka pericardial ama joogitaanka pericarditis constrictive keenaysaa in carqalad ah layers subepicardial iyo subendocardial ee Cardiff. Marar dhif ah, cystic ah pericardium waxaa laga yaabaa in qaybta fideysa, kaas oo ventricle a ferjiga inta lagu guda jiro diastole loo hubiyo in bixinta caadiga ah ee dhiigga wadnaha.

Tani waxay ifafaale waxaa lagu magacaabaa fenestration (the "furan"). wajiga systolic, kaas oo bixiya lakabka muruqa wareeg ah, guud ahaan, ma u xanuunsataan. Iyada oo xadgudub muddada-dheer ee wadnaha laabashada arooriyaha jiro fadhiidka ah ee dhiigga ku dhaca halbowle ah sambabada. Marka Stasis arooriyaha nidaamka wareegga systemic ee dareeraha ah waa extravasation galay unugyada ku wareegsan.

effusion Pericardial: sababaha (etiologies)

Mid ka mid ah sababaha ugu badan ee pericarditis exudative yihiin fayrusyada RNA-ka kooban (A iyo B), echovirus, hargabka A iyo cudurrada bakteeriyada dabiiciga ah ee kala duwan (PNEUMOKOCKER, ✰Malax mid, streptococci, qaaxada dee- iyo fangaska).

cudurka viewed adkayn kartaa dabcan cudurada systemic (uub, ama cudur Libman-Hantaaqaymaha, goysyada rheumatic, laabotooyinka, scleroderma systemic) iyo cudurada of nidaamka genitourinary (pericarditis uremiskt). ICD effusion Pericardial laga yaabaa syndrome postperikardialnogo muujin in uu yeesho ka dib markii pericardiotomy ama sida dhibaatooyin hore ee Wadnaxanuun myocardial, oo la yidhaahdo Dressler ee syndrome. Sida caadiga ah, dhibaato this baxdo in waqti adag lagu qeexay, kuwaas oo, ka 15 maalmood ilaa 2 bilood.

Mararka qaarkood pericarditis koolo exudative dhici karaa sabab u qofku cuno daawooyin gaar ah: gidralizin, phenytoin, xinjirowga lidka ku ah, ay sabab u tahay procainamide codsiga soo noqnoqda, radiotherapy. In kuwa xaaladaha marka effusion pericardial weyn ogaado content effusion, sababta waa in la damcay metastasis ee burooyinka: kansarka naasaha, sambabada, sarcoma, lymphoma. Xaaladahan, exudates inta badan dhiigbaxa, yar nabarrada.

Waxaa jira nooc gaar ah pericarditis exudative, oo la yidhaahdo hemopericardium. Xaaladani waxay dhacdaa marka cabaar dhaawacyo aagga xabadka qalbiga odoroska, sidii markii discontinuities Wadnaxanuun in bukaanka ka dib markii Wadnaxanuun myocardial, ama dissecting aneurysm aortic, sababaya dhiig ku qabanaysa saabka pericardial. Haddii uu cudurku ka dhacay for arrimo sababaya aan la garanayn, ka dibna waxaa iska leh koox ka mid ah nonspecific ama idiopathic.

Intaa waxaa dheer, effusion ku pericardial carruurta, sidoo kale, mararka qaarkood. Sababaha waxa ay kala yihiin: cudurada Streptococcus iyo staphylococcal, qaaxada, cudurka HIV, daawooyinka caasiyoobay, burooyinka, dhaawacyada, meel u dhow wadnaha, kelyaha, qalliinka wadnaha.

effusion Pericardial: Cilad-iyo muuqaalada clinical

Exudate ururtay in saabka pericardial iyo teedu xanuun caajis xanuun la wadnaha, neefsashada oo aan caadi ahayn nooca xibin gal, oo waxaa la yareeyey boos fadhi, wadno. Cadaadiska iyo cunfiga ay dareeraha ku dhuunta oo hawomareenno in ay keeni qufac qalalan.

xaaladda guud ee bukaanka waxay ku xiran tahay heerka of formation of qayb dareeraha ee pericardium ka xawaare gaabis ah - state qanci karo marka degdeg ah - dhexdhexaad ah oo aad u daran.

On baaritaan, bukaanka waxaa lagu ogaan karaa socda muuqaalada pericarditis exudative: caddaan maqaarka, xabka bushimaha CYNOTIC ', barar of addimada hoose, acrocyanosis.

Marka gobolka kormeerka ee xabadka waxaa la ogaan karaa kaqabto, dhanka bidix waa la kordhin karaa, tani waa suuragal ah keliya haddii kooxdu waxaa ay in mugga exudate pericardial gaadho in ka badan 1 litir. Taataabasho lagu ogaan karaa feature Quranka markii Suu Boodaynin waxaa kor iyo uurkujirtiisa barakacay, ay sabab u tahay cadaadiska iyo cunfiga, dareeraha ururtay gudaha.

Durbaanka lagu ogaan karaa ballaarinta xuduudaha dullness qaraabada qalbiga ku jiho oo dhan, xagga bidixda, meesha ugu hooseysa (in kooxihii hoose) horteeda ama si khadka dhexe axillary, ee meelaha labaad iyo saddexaad intercostal inay line bartamihii-clavicular, xaq in kooxihii hoose, si xaq ah SCR (bartamihii line -klyuchichnoy), sidaas sameynta xagal daacsan halkii si toos ah caadi in dullness cagaarshowga guurka soohdinta. Waxaas oo dhan waxay muujin kartaa in bukaan-socodka uu leeyahay effusion pericardial.

hannaankii Auscultatory: daciifaan af badan oo ka mid ah qalbigaygu waa u dhawaaqaa ee Cardiff wadnaha, at Botkin-ERB iyo habka xiphoid. In salka ayaa wadnaha laga maqlay codadka cod weyn waa ay sabab u tahay xaqiiqada ah in wadnaha ayaa ku barokacay kor dheecaan exudative iyo gadaal. Sawaxanka khilaaf pericardial, sida caadiga ah auscultation ma muuqdo. cadaadiska dhiigga waa on hoos u, ka dhanka ah asalka ah oo ah hoos u wax soo saarka wadnaha.

Haddii raasamaal ah ee dareeraha dhacdaa si tartiib tartiib ah muddo ka dib, shaqada farsamo qalbiga ku jira muddo dheer ma aha wareersan ay sabab u tahay xaqiiqada ah in pericardium sii ballaarato si tartiib tartiib ah ay dhacdo in this. In the case of raasamaal degdeg ah ee dareeraha ah ee effusion ku pericardial iyo aagga ku biiray tachycardia, wadnaha caafimaad oo la ifafaale ciriiriga in wareegyada wareegga (waaweyn iyo kuwo yaryar) ee.

Ku salaysan falanqaynta xogta ECG lagu gartaa pericarditis soo socda exudative. Marka ciriiriga exudative dareere dheeraad ah hoos danab xisaabiyaan QRS kaxeynayo ventricular Ebana wax adag iyo korontada. Radiographically arkay kororka hooska waxyaalaha qalbiga ku jira oo meel wiiqay ee uu Cabidkariin Bannaanka. xidhmo Vascular kama gaabna. Mararka qaarkood waxaa suurtagal ah in la ogaado effusion galay saabka pleural bidix.

ECG Echo in raasamaal saabka pericardial of dheecaan exudative lagu arkay ka dambe ee ventricle bidix tan qalbiga, ee ku sugan aagga derbiga gadaal. Marka Muga weyn oo ah dheecaan exudative, tus hore ee ventricle saxda ah ee wadnaha. On tirada dheecaanka ururtay in pericardium ah waa la xukumay by bareeg u dhexeeya u eg yahay ka muuqataa ka epicardium iyo pericardium ah.

Samaynta factor in uu keeno cudurka

In la dhiso arrimood etiologic ku entailing pericarditis foomka exudative qaadeen baaritaanka fayruska, imtixaanada, waayo jiritaanka unugyada gaar ah (HIV), seeding wax nafleyda (tus, dhiigga) si loo baabi'iyo nooca faafa ee pericarditis exudative qaadeen baaritaanka maqaarka ee qaaxada, waxbarashada fuliyo caabuq fangas.

Sidoo kale cilmi-baarista difaaca qabtaa cudurada unugyo systemic, loo ogaado jiritaanka unugyada anti-nuclear, rheumatoid titre factor antistreptolysin-O, agglutinin qabow - qaba infekshanka mycoplasma, uremia eegno kariyaatiniin serum oo HOL.

cudurka kala duwan ee pericarditis exudative

effusion Pericardial waxaa kala la hay'adaha soo socda cudur: Wadnaxanuun myocardial ba'an, prollaps xanuun vasogenic waalka mitral, pleurisy qalalan.

In ba'an syndrome miokarada xanuun myocardial sababa raasamaal ee alaabta dheefshiidka ee muruqa wadnaha (myocardium). Xanuun syndrome Wadnaxanuun myocardial Ulasocto tiro ka mid ah calaamadaha lagu daawayn iyo shaybaarka in isu muujin xadgudub ku ah hemodynamics dhexe ee maaraysa garaaca, geedi socodka tabinta ee myocardium, ifafaale fadhiidka ah ee goobada yar (pulmonary) sifo wareegga of Wadnaxanuun myocardial on isbedel ECG. Falanqaynta lagmamaarmaanna u ah Wadnaxanuun myocardial muujinaysaa hawl of isoenzymes wadnaha.

In pleurisy qalalan waxaa muhiim ah xaqiiqda ah ee xanuunka iyo diraasad la xidhiidha neefta, qufac, meel jirka, qaylada pleura khilaaf inta lagu jiro baaritaanka auscultatory kale oo aan ahayn kor lagu sharaxay, waa in la ogaadaa in pleurisy engegan ma jiraan isbedel ku electrocardiogram filimka . Si ka duwan aneurysm aortic ka exudative pericarditis waxa uu ka kooban yahay in xaqiiqda ah in sababta keentay waa cudur hidde - syndrome Marfan ama nabar atherosclerotic ay qolof hoose. Xaaladaha qaarkood, waxaa laga yaabaa in ay u sameeyaan a effusion pericardial chronic.

aneurysm aortic Astaamaha muuqato sida soo socota: xanuun xabadka sare, la cindiga ku jirin, dysphagia, cod xabeeb leh, dyspnea, qufac, sababa riixo ee mediastinum ah. aneurysms Aortic ayaa lagu ogaadaa iyadoo la isticmaalayo baaritaanka shucaaca ee saabka thoracic, echocardiography, iyo aortography ah.

Marka dissecting xanuun aneurysm aortic si lama filaan ah u muuqdaan in xabadka, u janjeera in ay cindiga ku teedsan quseyo. Isla mar ahaantaana, bukaanka ku jira xaalad halis ah, oo inta badan ka lumay ee cod aqlabiyad ah ku halbowlaha weyn. Auscultation auscultated la'aan waalka aortic. tallaabooyin lagu ogaanayo marka dissecting aneurysm aortic waa: ultrasound transesophageal iyo raajito loogu xisaabiyaa ee saabka xabadka.

Maxay waa in aad lacag bixisid si aad fiiro

Waxaa muhiim ah in la kala saaro effusion pericardial ICD 10 la myocarditis waajihi, kaas oo la Ulasocto wayneeyo ee saabka wadnaha oo leh calaamado ah failure wareegga dhiigga. myocarditis Astaamaha laftiisa muujiyey in jidka soo socda: waxay noqon kartaa nooca xanuun anginal ah, dareen u tiiraanyooday degaanka qalbiga ku jira, rabshooyin garaaca wadnaha.

Auscultation auscultated wadnaha muting codadka, sanqadha wadnaha marka hore iyo kan afraad waa la bifurcated laga yaabaa, in description ee wadnaha ee lagu ogaan karaa sifooyinka soo socda: la ruxruxo P ay maroorsamaan, isbeddel ku dhacay gacanta voltages R ilig, ruxruxo T la simay karo. Inta lagu guda jiro echocardiogram wayneeyo ee xusid mudan, qolladihii wadnaha iyo hoos u contractility ee derbiyada.

waxqabadyada-daweynta ee daaweynta ee pericarditis exudative

Lagu tuhmay effusion pericardial ba'an waa baahi degdeg ah si hospitalize bukaanka isbitaalka. Haddii uu jiro xanuun aad u daran, aspirin daruuri qoray qaab kiniin ah, qiyaasta of hal garaam gudaha bareeg saddex ama afar saacadood kasta saacadood kasta. Waxaa suurto gal ah in aad ku darto kiniin aspirin dose indomethacin 25 -50 mg, biyo la cabbo, bareeg ah lix saacadood kasta.

Haddii ay jiraan calaamado muujinaya in qori xal dheeraad ah 50% dipyrone maamulka muruqyada dhexdooda of 2 ml ama analgesics maandooriyaha (morphine) fiirsashada of 1%, keeneysa in hal mar ama millilitir badh, dura lix saacadood kasta. Marka cadhoodaan psychomotor la tixraacayo xaaladda ama hurdo la'aan magacaabi "Sibazon" ( "I") gudaha, qiyaasta of 5-10 mg saddex ama afar jeer maalintii.

Si aad u baabi'iyo habka bararka inta badan loo isticmaalaa in dhaqanka ee "prednisolone" qiyaasta of 20-80 mg / maalintiiba. gudahood xoogaa tallaabooyin ah. Therapy la glucocorticoids in qaadasho sare waxaa lagu fuliyaa ee koorsada of 7-10 maalmood, iyadoo peculiarity ah in qiyaasta ku xiga waa in si tartiib tartiib ah in la yareeyo, in laba iyo maalin kasta qeybtii milligram ah.

Inta lagu guda jiro daawaynta

Sidee dheer waxaa lagu daaweeyaa effusion pericardial? Waxay daawaynta soconaysaa laba ama saddex toddobaad, oo mararka qaar aad leedahay si aad fidin ilaa dhawr bilood, si adag on maragga. Cayimayo daaweynta ku xiran tahay arrin etiological in uu keeno effusion pericardial.

In la aqoonsado etiology viral loo qoondeeyay wakiilada anti-bararka non-steroidal, hormoonnada sidaas qorin. Pericarditis kuwaas oo ay sabab u tahay pneumonia Streptococcus, waxaa lagu daaweeyaa si ka duwan - kuu qori antibiotics, tus, penicillin G qiyaasta 200,000 U / kg / day. intravenously dose siiyey qaybsan yahay lix irbado, duration of daaweyn - aan ka yarayn toban maalmood.

baaritaan dheeraad ah

Intaa waxaa dheer, haddii cudurka effusion pericardial, waa in la qabtaa pericardiocentesis (nidaamka isagoo ku daweynta iyo ogaanshaha ee dabiiciga ah, kaas oo waxaa lagu fuliyaa at pericardium a irbad dalool gaar ah si ay u dareere qaadashada for falanqaynta). Ka dib markii seeding in la sameeyaa exudate si loo ogaado nooca gaarka ah ee Wakiilka cudurkan, waxaa muhiim ah si loo ogaado falanqaynta ee ay dareen in ay diyaar bakteeriyada. Haddii la helay Staphylococcus aureus, dejinta waxaa badanaa maamula dose "Vancomycin" mid garaam dura xididka laba iyo toban saacadood Heerka kasta daweynta - 14 ilaa 21 maalmood.

Mararka qaarkood, cudurada boqoshaa keeni kartaa effusion pericardial. Daaweynta kiiskan waa la fuliyay "Amphotericin". Qiyaasta hore ahaa 1 mg, xal glucose ay la boqolkiiba siman ilaa 5 boqolkiiba iyo konton millilitir in mugga, maamula parenterally (via arooriyaha), faleebo 30 daqiiqo. Haddii bukaanka ah daawada si fiican loo dulqaatay, isbeddelka nidaam keeneysa in sida soo socota: 0.2 mg / kg ka badan hal saac. Ka dibna, qiyaasta u korodho si tartiib tartiib ah ilaa kala badh ama mid microgram / maalintii. saddex ama afar saac ka hor bilawga ah ee saamayn togan.

saamayn Side "Amphotericin", taas oo waa in fiiro - nephrotoxic, oo xidhiidh la leh la socodka ah ee function kelyaha waa lagama maarmaan. Haddii effusion pericardial asalkiisu ka soo jeedo ay sabab u tahay daawo, ka dibna istaraatijiyad daaweynta waxaa loogu talagalay in ay soo dhaweynta dheeraad ah ee wakiilada, kuwaas oo la joojiyey iyo wixii intaa u yeelaan isticmaalka wakiilada anti-bararka magnyl isku dhafan oo corticosteroids, waxay si wadajir ah waxay keeni in dib u soo kabashada degdeg ah, gaar ahaan haddii lagu magacaabay tan iyo wakhtigii hore ee cudurka.