Uyini isampula Ruvilua-Gregoire?

Ezweni kukhona inqwaba izifo, cishe abantu abaningi musa ngisho usola. Kodwa kukhona izimo uma nje udinga ukwazi izimpawu womuntu acute bakwazi ngokushesha ukunikeza usizo lokuqala esigulini. Kodwa akulona njalo isifo esiyingozi noma zokugula kungaba azimisele zibukeke, kodwa kulokhu, basisize zanamuhla zokupopola, isibonelo, ezifana isampula Ruvilua-Gregoire. Kodwa sibonga lokhu isampula kungaba azimisele, nokuthi ngokuvamile ngenxa ukuhlaziywa?

YeSampuli Ruvilua-Gregoire: kuyini?

Lesi sivivinyo - lena eyodwa yezindlela ukuxilongwa, ukuvumela ngokushesha kakhulu ukunquma ukuthi ukopha intrapleural noma cha ngesikhathi hemothorax. ukuhlolwa Positive Ruvilua-Gregoire uthi ukopha uyaqhubeka ngaphakathi pleura, futhi ubufakazi engakhi stop wakhe, noma ngabe kunjalo, kodwa hhayi njengoba asebenzayo.

Kodwa uyini hemothorax, indlela yokuphatha kulo, ukuthi iyini imiphumela yokungenzi zisesimweni lokhu lesiguli?

Hemothorax: kuyini?

Hemothorax - ukopha okwenzeka ngaphakathi pleura futhi kuholela yokuthi aqoqana semali igazi okwagcina kuhambisana kokucindezelwa yamaphaphu. YeSampuli Ruvilua-Gregoire ivumela ngokushesha ngangokunokwenzeka ukucacisa khona ukopha kakhulu. Ngaphezu ukuhlola, ukulahlekelwa igazi kungenziwa obonwa zimpawu:

• ubuhlungu besifuba;
• ingcindezi ongaphakeme;
• isiyezi;
• ukuphaphatheka isikhumba kanye nabanye.

Uma isiguli ukwethula ezinjalo, kumele iphuthunyiswe esibhedlela lokwenza ukuxilongwa futhi ukuthatha zonke izinyathelo zokunqanda ukopha. Kodwa ezingakufaka hemothorax?

zokugula Izimbangela

Ukuxilongwa hemothorax kungase kudingeke neziguli ezifakelwe esifubeni umuntu elimele, ziyajabula pathologies, noma izimbangela iatrogenic ebangela ukopha.

Ngaphansi odokotela ukulimala ehilela umonakalo thorax ezihlukahlukene. Hemothorax angagcina ngenxa zomgwaqo, okudutshulwa, izimbambo aphukile, bokuwa besuka endaweni ephakeme kakhulu, nezinye izinto.

ukulimala ezinjalo kungabangela umonakalo hhayi kuphela emaphashini, kodwa ezinye izitho zomzimba:

• inhliziyo;
• isibindi;
• ubende;
• diaphragm;
• izitsha intercostal;
• Umthambo thoracic;
• emaphashini.

Hemothorax futhi kungabangela isifo Isiguli, njenge:

• useshonile yomthambo i-aorta;
• sofuba;
• umdlavuza e iphaphu noma pleural;
• wamaphaphu ithumba;
• oluhambisana diathesis;
• coagulopathy, nabanye.

izici Iatrogenic okuholela hemothorax (ukunquma khona yayo ngeke sampula Ruvilua-Gregoire) avele yezinkinga emva kokuhlinzwa ku iphaphu noma pleura, amanzi pleural, nokubekwa ipayipi e vein emaphakathi.

pathogenesis hemothorax

ukunqwabelana igazi pleura kungabangela kokucindezelwa yamaphaphu kanye ukufuduka yezitho zangaphakathi, okuholela kakhulu ziyancipha ebusweni zokuphefumula yamaphaphu, kukhona iziyaluyalu kwemigudu yokuphefumula kanye hemodynamic. Ngenxa yalesi sizathu, hemothorax ngokuvamile eba isethulo basemtholampilo oluhambisana futhi cardio-yamaphaphu ukushaqeka eholela inhliziyo futhi umgudu wokuphefumula zingasebenzi kahle.

Ngo amahora okuqala angu-ngemva igazi wangena pleura, lona wamuva eba i ukuvuvukala. Lapho hemothorax ukusiza ukuthola isampula yayo Ruvilua-Gregoire (ivela edema, kokuziphatha leukocytic, sikhukhumale amaseli mesothelial exfoliated). Ngokokuqala ngqá zibalwa endaweni yegazi pleural ngokusebenzisa ukopha akuhlukile igazi neuropathy, futhi kamuva yehliswa emazingeni elithwala umoya-mpilo, i-Inkomba erythrocyte futhi leukocyte.

Lapho injected singene pleura, amahlule igazi, kodwa emva kwesikhashana iqala inqubo fibrinolysis, ngenxa ngalo liquefies futhi. Le nqubo kunomthelela izici anticoagulant. Kukhona namakilasi amaningana hemothorax. Yiziphi, futhi yini umehluko phakathi kwalokhu?

amakilasi hemothorax

kakade Sithe hemothorax kungase kuhlukumeze impela, sokugembula kanye iatrogenic. Ngaphezu kwalokho, kucatshangelwa amandla ukopha kwakhe futhi zihlukaniswe namakilasi amaningana:

• amancane - kukhona ukunqwabelana igazi itheku, futhi ukopha bengekho ngaphezu kwama-500 ml;
• naphakathi - igazi liye lehla ezingeni ubambo 4, futhi umthamo yayo imayelana elilodwa amalitha isigamu;
• subtotal - igazi lehla ephansi ezingeni amaphiko 2, kanye nenani ukopha imayelana ezimbili amalitha;
• Imininingwane - ku x-ray kubonakale elihlwelwayo ngu kokunqotshwa kwe-pleura, futhi ukopha ingaphezu umoya amalitha.

Ngaphezu kwalokho, hemothorax, esiza ukucacisa isampula Ruvilua-Gregoire nezinye izindlela zokuxilonga kungaba apical, interlobar, parakostalnym, supradiaphragmatic, paramediastinalnym, wonkhe umuntfu kweyeme etinyatselweni kwasendaweni. Futhi endabeni yakhe, inkulumo uma ukopha uyaqhubeka, hemothorax ngokuthi okuqhubekayo, futhi uma ime - esitebeleni. Uma pleura ngesikhathi esifanayo ihlanganisa hhayi kuphela igazi, kodwa futhi emoyeni, kulesi simo sikhuluma gemopnevmotorakse. Kodwa lokho izimpawu kungase kubonise hemothorax?

izimpawu hemothorax

Isithombe emitholampilo kuncike ngqo ukushuba ukopha, ochotshoziwe wamaphaphu izicubu kanye izitho shift. hemothorax Small angeke ephelezelwa izimpawu, ikakhulukazi isiguli ekhononda ka ubuhlungu besifuba, okungase kube zaba zimbi uma ukhwehlela, kanye iphika kungenzeka.

Kodwa amakilasi maphakathi kanye okusezingeni eliphezulu, okuyinto kungaqinisekiswa usebenzisa isampula Ruvilua-Gregoire, ephelezelwa iziyaluyalu zokuphefumula, iziyaluyalu zenhliziyo, kanye nabanye. izimpawu kungukuthi kuphawulwe iphuzu nje akusebenzi, ngoba ungase uthole ubuhlungu obukhulu ukuthi kwandisa ne ukukhwehlela, ubuthaka umzimba wonke, encishisiwe blood pressure. With umsebenzi omncane ngokomzimba babe nazo zonke izimpawu zenziwa nzima. Isiguli ekhetha isikhundla ukhululekile - uhlezi noma isigamu-bayiphendule.

Kodwa ngo hemothorax ezinzima kukhona ubuthakathaka, okuyinto ayikuvumeli ngisho kuyanda, isiyezi, ukuthuthukisa tachycardia, isikhumba ugodo, phambi kwamehlo flit impukane, ngokuvamile kwenzeka nakwisyncope. Kodwa ngaso sonke isikhathi izimpawu obungaveza le hemothorax, ngakho kungcono kakhulu ukubona udokotela, ngubani uzoqoka eziningi izifundo, kuhlanganise isampula kanye Ruvilua-Gregoire. Ngezinye hemothorax - lena indlela engcono, okuyinto ngesikhathi esifushane izobonisa ukuba khona noma ukungabi ebangela ukopha.

ukuhlola

Phakathi udokotela ukusazi ngokunembile isifo esikuphethe icacisa yonke imininingwane lesi sifo, bamiswa izindlela ngokomzimba kanye nezinye luhlolo, kuhlanganise laboratory. Ngezinye hemothorax ngokushesha Kufanele kutholakale ukuthi kukhona lag ka ohlangothini abathintekayo ngesikhathi ukunyakaza zokuphefumula, kungakhathaliseki abathuntubezwe eshaywayo umsindo phezu kwalapho ketshezi eqoqwe, buthaka uma ukuphefumula lapho quavers.

X-reyi yesifuba lembula ukukhanya kollabirovanie, khona uketshezi (nesineke esimweni enezingqimba phakathi nesifundo) noma amahlule kule pleura. Ukuze acacise Ihlahlubo uphethwe angabelwa wokubhoboza pleural at hemothorax, kulesi simo ukuthola igazi kuqinisekisa uphethwe. Ukubona hemothorax luhlanzekile futhi elinegciwane ukwenza amasampula Petrova futhi Efendiyev, okuyinto ukuhlola ukusebenza ngendlela esobala kanye aspirate kwenze.

ukuhlolwa Laboratory wegazi uyombulala ukucacisa inombolo leukocyte futhi erythrocyte. Ingase futhi kwenziwe, kanye nezinye zokupopola ezifana ultrasound, X-ray, esifubeni CT, thoracoscopy zokuxilonga.

Lokho ikuvumela ukuba ucacise isampula?

Ukuze uqinisekise ukuthi ukopha uyaqhubeka, noma ngicabange ukuthi belivele esimisiwe kakade, nje ungalilahli isidingo azokuqhubela isifundo ezifana isampula Ruvilua-Gregoire. izindlela zokuxilonga yalolu hlobo kuhilela igazi ezimbalwa pleura, bese uyibuke. Uma kuvaliwe ngamapayipi yokuhlola noma isipetu, kusho ukuthi ukopha uyaqhubeka, futhi uma coagulation engekho, asikho. Khona-ke amasampula athunyelwe ku-laboratory ukuze kuqhubeke uphenyo, futhi kakade kunqunywa inani elithwala umoya-mpilo.

ukuhlolwa Positive Ruvilua-Gregoire - i inkomba eziphuthumayo thoracotomy, ozokusiza ukopha. Le ndlela ulwazi zokuxilonga, kodwa kungcono ukuba afeze okwengeziwe nezinye survey, ukuze siqiniseke ukuthi 100% uphethwe. Kodwa ungakwenza kanjani ngemva kokubhala isivivinyo?

Indlela kocingo wokubhoboza at hemothorax

Ukuziphatha ukuhlolwa kufanele kuphela udokotela oqeqeshwe ngokuphelele, ngoba lesi sifundo iyinkimbinkimbi kakhulu, futhi uma ubamba isampula yegazi akulungile, kungaba ukulimala nakakhulu esigulini. Lubhoboze at hemothorax - indlela eyingqayizivele ukuxilongwa, okuyinto eyenziwa phakathi izimbambo 6 no-7 ku-medium futhi umugqa zadnepodmyshechnoy. Kuleli qophelo, isiguli kufanele ibe awulutho kuNkulunkulu. Igazi ithunyelwa cwaningo izidakamizwa iqondiswa isixazululo elwa namagciwane.

ukwelashwa okulondoloza

ukwelashwa okulondoloza kuyasiza uma haemothorax omnene, kuleso simo analgesics namanxusa hemostatic. Futhi nomphumela omuhle esikhundleni yokwelapha nge esiphuthumayo igazi, uma haemothorax emaphakathi noma ngisho ezinzima. Ukuze ekwelapheni ukutheleleka HT iphathwa ejenti fibrinolytic, nazo kuboniswe nokuvimbela kanye therapy ye hemothorax coagulated, futhi asengahlatshwa immunocorrecting nokwelashwa lingaze esetshenziswa.

hemothorax Small ngokushesha kakhulu futhi ngaphandle kwemiphumela luqedwe ngu izindlela olandelanayo yokwelashwa. Kodwa endabeni yakhe, uma kabusha luhlolo wembula ukuhlolwa omuhle Ruvilua-Gregoire ke akukho ukuhlinzwa ngeke akwazi ukwenza.

ukuphathwa Steel ka hemothorax

Ukuhlinzwa kuboniswa isiguli ezimweni ezinjalo:

• Uma ukopha uyaqhubeka ngaphakathi pleura;
• haemothorax curled futhi akunqandi ukwandisa kumuntu wamaphaphu;
• uma sekube kabusha inqwaba yegazi ngemuva kokuthatha wokubhoboza;
• igazi udabula Ukukhetha amanzi pleural, futhi umthamo yayo imayelana 500 ml amahora 2-3;
• ezilimele izitho ezibalulekile.

ukwelashwa hemothorax isekelwe izici izici etiological ukopha nobukhali oluhambisana ukushaqeka. Vula umonakalo eyenza umuntu acabange eseZwini kuya wamaphaphu nezinye izinhlaka esifubeni zidinga esiphuthumayo kokungenela kuhlinzwa isizinda esibanzi anti-ukushaqeka yokwelapha, okubandakanya analgesia yezokwelapha nje kuphela, kodwa futhi ulwa ezintula futhi hypoxia.

Ukusebenza kuyadingeka izinjongo ezifana:

• nigweme ukusaphaza;
• ukususa ukulimala kwezitho ezingaphakathi;
• ukususa igazi ngokweqile;
• ukuba abeke amanzi ngoba ukwembuleka yashesha yamaphaphu;
• sokulungiswa kabusha ngalo ingaphakathi pleural nge antiseptics.

Kodwa lokho izibikezelo odokotela ezigulini Ngahlinzwa ngesikhathi hemothorax kwenziwa?

Ukubikezela kanye nokuvinjelwa hemothorax

Impumelelo ukwelashwa hemothorax incike uhlobo ukulimala noma isifo, umfutho ukopha nangosizo olufika ngesikhathi esinikeziwe. Izibikezelo Evumayo iziguli hemothorax okuncane noma okusesilinganisweni. hemothorax Clotted ezingase zisongele ukuthuthukiswa of empyema pleural, kodwa baqhubeka ukopha noma ukulahlekelwa elilodwa emikhulu yegazi kungaholela ekufeni.

Umphumela hemothorax kungenzeka ukwakheka omkhulu ukuvuvukala pleural eziletha nokukhawulela ukuhamba diaphragm. Kulokhu, kunconywa ukuthi zonke iziguli abaye isimo ukubhukuda wenze njalo ukuphefumula umzimba.

Prevention hemothorax inikeza isixwayiso yokulimala esifubeni, xhumana iziguli nodokotela nokuhlukumezeka thoracoabdominal, ukulawula hemostasis ekuhlinzeni emaphashini futhi mediastinum.

isiphetho

Kufinyeta, singasho ukuthi isampuli Ruvilua-Gregoire - ingenye zezifundo ezibaluleke kakhulu ngesikhathi hemothorax. Ukopha endaweni pleural - usesimweni esibucayi kakhulu okudinga yokudluliselwa esiphuthumayo udokotela. Yingakho ngezinye izimpawu zokuqala noma ngokushesha ngemva ukuhlukumezeka kakhulu ukufuna usizo kumuntu ofanelekayo, noma ukungenzi lingakubulala.