Ileus Dynamic: ngezigaba, izimbangela, izimpawu kanye nokwelashwa

Ileus - Izifo, okuyinto luhlanganisa eyinkimbinkimbi izimpawu ukuthi zinezikhathi ukulahlekelwa eliphelele noma olungaphelele wamathumbu ukukhubazeka, kokubili ebuhleni nasebubini. Ngoba yokuntuleka esingokwemvelo ukunyakazisa yiluphi uhlobo lokudla, kuhlanganise mass okuqinile kanye ketshezi, futhi khona ukuvuvukala okukhulu ingaphakathi peritoneal. isimiso emathunjini linamandla futhi lokukhanda.

izici isifo

ileus Dynamic - uhlobo ahlukene yesifo wathi futhi kwenzeka e-10% weziguli nge wamathumbu isimiso. Ukuze lokhu sitholakele odokotela bavame odlulela isidingo ukuqeda isimiso mechanical, okuyinto esiphuthumayo ukuhlinzwa.

Ubunzima ekuhlonzweni lesi sifo liqukethe iqiniso lokuthi pathogenesis ka ileus ashukumisayo azinazo lezi zimpawu, khona ezihambayo izithiyo ayo ocacile kanye izingcezu zokudla ipheshana. Kulokhu, kuphela ukuncipha iDemo semvelo sawo izinqubo zomzimba.

Nokho, ingozi lesi sifo itholakala lokuthi ukuthi kungabangela ukungasebenzi neurohormonal Isiguli, kanye nomthelela ukusebenza emathunjini ezincane nezinkulu. Cabanga izinto enomthelela okwenziwe ngaleli isifo njengoba isimiso ashukumisayo emathunjini.

Izimbangela isifo

Nakuba isayensi yesimanje kuphawulwa kokufaneleka omkhulu futhi impumelelo enkulu kwezokwelapha, ezintweni futhi engazange ephethwe ukuxazulula izindlela eziqondile ezibanga ukubukeka kwalesi sifo ngo-mbuzo. Ukuvela izinkinga ezifana ashukumisayo kokuphazanyiswa emathunjini kungase kubangelwe yizici elandelayo:

• peritonitis okungabangela appendicitis noma pancreatitis;
• acute mesenteric infarction;
• megacolon anobuthi (isifo Crohn, , nesifo Hirschsprung sika esidalwa yizilonda emathunjini sibe);
• izimo reflex (isimo nasezinkingeni ezilandela ngemva kokuhlinzwa, colic, ukopha, ukuhlukumezeka besisu, waphuka umgogodla njengoba eziya ziba zimbi ileus mechanical);
• izifo bemvelo neurogenic;
• izinguquko amazinga ama-hormone (isb, ukukhulelwa);
• izifo umzimba (hypokalemia, ketoacidosis, uremia, ukudakwa).

ileus ashukumisayo Ukwahlukanisa

Kwezokwelapha, sitholakele ngamunye has ikhodi yayo, igama kanye namazinga olwamukelwa kwezokulapha. Kuyinto iyathinteka nezifo ezifana ashukumisayo kokuphazanyiswa emathunjini. ICD-10 (International Ukwahlukanisa Diseases) Kuhlelembisa sifo umbuzo ngale ndlela:

• Class XI "Izifo wokugaya ukudla" (K00-K93);
• Bheka "Okunye isifo wamathumbu" (K55-K63);
• Ikhodi uphethwe - K56.6;
• igama - "The Other futhi elingacacisiwe isimiso emathunjini."

Zokwelapha, ukuhlukanisa phakathi kwezinhlobo ezimbili eziyisisekelo ashukumisayo kokuphazanyiswa emathunjini:

• spastic;
• kofé uhlangothi.

Spastic wamathumbu ukuvimbela

Ngo umkhuba emtholampilo kuyinto engavamile, ngokuvamile elalihlangana bhanqa omunye isifo. Ngokuvamile imbangela sifo ukutheleleka ngegciwane emzimbeni izibungu noma pilorospazm phetho lokuzalwa ukuhlukumezeka. Futhi phakathi nezinye izimbangela lolu hlobo sifo zihlanganisa: izifo ezithile zesimiso sezinzwa, nezifo zengqondo, dyskinesia.

Lahla le nkinga kungaba kuphela esebenzisa izindlela ngoludala, njengoba iphendukele kokungenela kuhlinzwa kuleli cala akwenzi mqondo.

Spastic wamathumbu isimiso: izimpawu

Ngo abadala, lesi sifo kwenzeka kakhulu njalo ezingaphezu kuka ezinganeni, kodwa izimpawu zayo ziyefana ngasiphi yobudala. Lesi sifo libhekene kuqala okungazelelwe. Isiguli ekhononda sokuhlaselwa eyesikhashana ka ubuhlungu besisu, okuyinto ungenalo kwasendaweni ethize.

Iziguli nale Ihlahlubo babonakala e zimpawu ezilandelayo:

• skhvatkopodobnye ubuhlungu besisu;
• ukuvuvukala engalingani kanye umuzwa ekugcwaleni;
• isicanucanu, kungenzeka ukuhlanza, ukuqunjelwa.

On palpation esiswini esiyitholayo ingxenye ogulayo emathunjini amancane, esiswini uthambile kakhulu. Thuthuva kusuka kwamanye amasistimu ningagcini. Isimo jikelele isiguli akuyona ezibucayi.

Pseudoileus

Ezimisele palsy peristalsis emathunjini, ephelezelwa ekuhlehleni okungazelelwe vivacity obusebenzayo izakhiwo kwamanyuroni. Hlukanisa reflex kanye nasezinkingeni ezilandela ngemva kokuhlinzwa ileus kofé uhlangothi.

Lapho lesi sifo kwenzeka njengoba ukushukuma reflex kwegatsha nozwela ka autonomic nesimiso sezinzwa. ileus postoperative kuba yinkimbinkimbi futhi genesis kwande kulandela ukugasela ahlukahlukene ezithweni besisu.

Kuvusa ukubunjwa nokuthuthukiswa kwezinhlangano lesi sifo ngokudipha lezi zinto ezilandelayo:

• izinqubo ukuvuvukala endaweni besisu;
• yayiyolimaza (ithumba) endaweni retroperitoneal;
• isithombe esisitholayo siyenzeka emuva kokuhlinzwa ezifana laparotomy;
• imiphumela iziyaluyalu sokugembula ezifana pleurisy, inyumoniya, isilethikusebenza;
• mesenteric thrombosis semithambo;
• izifo ezithathelwanayo, kuhlanganise paresis anobuthi.

Kunezigaba eziningana sifo:

Mina nesigaba. "Ukwephulwa ihlawulelwa" - okulingana ejwayelekile nasezinkingeni ezilandela ngemva kokuhlinzwa paresis emathunjini. Isikhathi izimpawu luthatha izinsuku 2-3.

Isinyathelo II. "Ukwephulwa Subcompensated" - libhekene yokuthi kukhona ukuvuvukala abalulekile, zikhona izimpawu adakwe pseudoperitonitis umzimba. Hhayi walalela imisindo peristalsis. A ezihlukahlukene izimpawu baphawula phezu radiographs.

Isinyathelo III. "Iziyaluyalu Decompensated" - umzimba usesimweni lokudakwa eside. Ungabuka ubuthakathaka wamathumbu, ukuhlanza, okuqukethwe emathunjini. Kukhona izimpawu yokucasuka peritoneal, isisu zingavuvukalanga kakhulu. -X-ray ukuhlaziywa libonisa sebuningini amazinga ovundlile ketshezi ku izihibe amathumbu (ezincane nezinkulu ngesikhathi esifanayo).

Isinyathelo IV. "I ukukhubazeka yokusetshenziswa pheshana emathunjini" - kulesigaba kukhona ukwephulwa zonke izitho ezibalulekile ukuze ukuphila kwabantu izinhlelo. uhlelo Negative ezizwa engaphathekile ngokuqhubekayo.

Njengoba imithi yesimanje alikho izici okwamanje isakhula umehluko lekutfola pathologies ezehlukene ezenzeka esikhathini postoperative, ekuhlonzweni ngakho lesi sifo cishe kungenakwenzeka

ileus kofé uhlangothi: Izimpawu

Ngo abadala, lesi sifo on isizinda abhekisele esimweni esasivamile iyovele ibhebhetheke. Uyabuzwa ubuhlungu njalo ukuthi siye seqa ngokwemvelo. Nokho, akuyona olunzima njengoba e athutha wamathumbu isimiso. Uhlanze okuphothula oluhlaza. Isiguli waphawula izimpawu i ukwanda exsicosis of ubuthi nokucindezeleka zenhliziyo.

Lapho ileus kofé uhlangothi siyakhukhumala esiswini esiguli, ngokusebenzisa phambi nodonga lwawo kungabonwa ukwanda umthamo kwamathumbu iluphu neperistaltiruyuschih. Uma izimpawu peritoneal bengekho ke esiswini kuyinto buthambile.

Ngoba lesi sifo inqubo esiteji, begodu kukhula kwenkathi isimo isifo isiguli liwohloka. Ezigabeni kamuva ingase tachycardia kanye iphika, ukuvuvukala languid imisindo peristaltic ukuthi kuyaqabukela uthephwe kuphawulwe. Ukuhlanza sibi kakhulu.

Ezigabeni yokugcina, kokuziphatha abukhali izinguquko morphological e apharathasi kwamanyuroni. Isiguli ekhononda yamagesi futhi sezinyawo ukubambezeleka has ukuchama ukungasebenzisi.

Dynamic isimiso emathunjini ezinganeni

Izingane ashukumisayo acute isimiso kwande emathunjini, okuyinto evame kakhulu kubonakala ngesimo kofé uhlangothi. Yezizathu ezilandelayo bungabonakala, ingqondo ekuthuthukiseni lesi sifo ebuntwaneni:

• obstructive noma nomaka isimiso;
• elinganiselwe noma ehlasela umzimba peritonitis;
• ukuhlukumezeka besisu;
• i-pneumonia,
• empyema;
• iziyaluyalu umsebenzi emathunjini.

Kaningi, ileus ashukumisayo ubuhlungu izingane esikhathini postoperative. Futhi abangele nokuvuthwa amafomu kofé uhlangothi lesi sifo kungaba hypokalemia.

Ingozi yesifo ebuntwaneni ukushonelwa kungenzeka esiningi uketshezi usawoti ngenxa ukuhlanza njalo, ukungakuthandi ukudla, khulula potassium izinso hypoproteinemia. Kobukhulu isimo kungase zaba zimbi ngu kwethonya kwezimo ezingezinhle esinobuthi virus.

ileus Dynamic e izinsana kungenziwa senziwa eziningi yezizathu ezilandelayo:

• prematurity;
• Ukungenela ukwephulwa;
• ukusetshenziswa kwezidakamizwa (kuhlanganise ebeletha ngesikhathi sokukhulelwa);
• gipermagniemiya;
• Ukusetshenziswa heroin ukupha sokuzalwa;
• usebenzisa hexamethonium;
• sepsis;
• enteritis;
• isifo CNS;
• necrotizing enterocolitis;
• endocrine iziyaluyalu.

Dynamic isimiso emathunjini ezinganeni ngokuvamile kwenzeka, kodwa kalula ukuhlolelwa lesi sifo futhi ivumela ukwelashwa kusenesikhathi. Endabeni izinsolo khona obstructions enjalo okubaluleke - musa lunikezwe esilingweni zokuzelapha, futhi banamathela iziqondiso ezinikezwa onguchwepheshe ezifanele. umphumela Lethal - kuba ngentuthuko kungenzeka nge inkinga efana isimiso ashukumisayo emathunjini.

sitholakele isifo

Izimpawu zesifo eqondene angavamile, okungahambisani kuphazamise inqubo ukuxilongwa. Sebenzisa izindlela ezilandelayo zokuxilonga:

• nemlandvo wetekwelashwa kwakhe;
• Ukuhlola esigulini;
• -X-ray Ukuhlolwa kwezitho endaweni besisu (ibala khona yamagesi ngenhla ezingeni uketshezi emathunjini);
• Ultrasound (Hhayi isifundo ngoba akuyona inkomba ngokwanele ulwazi);
• ephelele kakhulu segazi.

Dynamic isimiso emathunjini: ukwelashwa

Ngokuvamile, ukwelashwa okuhloswe ngalo ukuqeda lesi sifo izizathu kokuqala kuleyo evusa ukuthuthukiswa yayo (imvelo ezithathelwanayo lesi sifo, i-pneumonia, peritonitis nabanye.). Uma kwenzeka isifo is phetho izimo enobuthi noma reflex ukwelashwa okufanele ngoludala, esakhiwa ngo yokwelapha izidakamizwa imihlola ezimbi eziholela kokuma okujwayelekile peristalsis emathunjini. Ukwelapha okunjalo Kungafezani ethula emzimbeni womuntu izidakamizwa ezifana sodium chloride, kanye glucose. Khona-ke ufuna ukugeza emathunjini nge enema, uma kunesidingo - ukwenza ukwethulwa tube esiswini. Ngezinye ubuhlungu okusezingeni eliphezulu ingase emizweni ethola amaphilisi ezinhlungu.

Esimeni lapho ngoba impatho amahora ayisithupha yezokwelapha isimo lesiguli ingakuthuthukisi, ukuhlinzwa wenziwa. Futhi ukuhlinzwa oluphuthumayo lwenziwa azalwa naso wamathumbu isimiso.

Ngokuvamile, ukusebenza siqukethe ukususwa olungaphelele esiswini, engasatholi efeza imisebenzi yayo. Ngo iziqephu ezinzima kumele abeke ipayipi lokukhipha indle (ingquza yokufakelwa odongeni kwamathumbu lapho ukuhambisa sezinyawo kanye nethuba ukuya isikhwama esikhethekile yaboshelwa).

Ungasusi ingxenye esiswini kungenzeka kuphela uma intussusception. Ezimweni ezinjengalezi kungenzeka ukusakaza emathunjini ngu ukweqa Air emathunjini futhi eminye ukulawula konke okuhilelekile usebenzisa ama-X ray.

ukuphathwa postoperative siqukethe Ukudla ngabanye, okuyinto incike ngevolumu kokungenela kuhlinzwa. Izinsuku ezimbili zokuqala ngemva kokuhlinzwa, isiguli kufanele babe sesimweni Fowler, futhi udinga ukwenza ukuphefumula umzimba. Futhi kulesi sigaba ngeke avume ukwelashwa izidakamizwa, ukwelashwa disintoxication ebandakanya, ukuzinza of electrolyte umzimba, ukusetshenziswa imithi ebulala izinhlobonhlobo zamagciwane, emathunjini eqabulayo ejenti uma kuboniswe - ukwelashwa kwama-hormone.

Lapho kuvela izinkinga esikhathini postoperative kungase ushona izilonda, ukopha kwegazi, peritonitis, isifo ingcina we peritoneum.

Nge ileus ashukumisayo, njenganoma yiluphi esinye isifo, akubalulekile ukwelashwa kangaka kanye nokuvinjelwa le nkinga. izindlela Prevention zihlanganisa:

• ukulungiswa electrolyte ibhalansi;
• imithi prokinetic;
• imithi elwa namagciwane;
• Ukudla ezifanele ukuthi liphansi emafutheni, imikhiqizo yobisi ukudla isitshalo nge wokuqukethwe lelisetulu izingxenye ezingavikelekile kugaywe ngu umzimba womuntu.