Waterhouse syndrome - Friderichsen: pathogenesis, ukunakekelwa okuphuthumayo, ukwelashwa

I nezindlala adrenal emzimbeni kuyinto ebaluleke endocrine isitho. Kuthiwa ama-hormone ekhiqizwa yibo kuthinte kwemigomo ingcindezi kanye nenani uketshezi afundwa, ezingeni nosawoti amaminerali kanye microelements ngamunye rate umzimba, ngisho indlala pituitary. Futhi ezimweni lapho umsebenzi lezi indlala elincane kodwa ibaluleke kakhulu iyahlupheka, ukuthuthukisa isimo, esongela ukuphila impilo.

Incazelo kanye nomlando

Waterhouse syndrome - Friderichsen - i esingamahlalakhona acute adrenal, okuyinto eyenzeka ngemva ukuhlukumezeka emzimbeni ukopha e parenchyma yayo. Lokhu kubangela okunzima kakhulu imvelo komzimba kwangaphakathi futhi lingaholela ekufeni.

Incazelo isimo siqala ngo-1894, kodwa kwaba okunganele, futhi ngo-1911, Waterhouse ikhomba amacala ayishumi nanhlanu, okwamsiza ukuba ukuqoqa wonke izingcezu ndawonye. Ukugcina naye, ngemva kweminyaka elikhomba, ngo-1918, Frederiksen futhi ishicilela indaba mayelana nale nqubo sokugembula.

izizathu

Ososayensi bayavuma ukuthi lesi sifo Waterhouse - Friderichsen okubangelwa kokopha kakhulu ngesikhathi esifanayo kuzo zombili nezindlala adrenal. akuxhomekile yingozi - Usana izinsana, izingane kanye nabantu abasha. Phansi kuleli cala asihlobene. Lesi simo kungenziwa senziwa ukulethwa isikhathi eside, fetus-mpilo yokulamba noma intuthuko yalo ngokusebenzisa emgudwini wokuzala usebenzisa esebenzisa noma cleaner extractor. Ngaphezu kwalokho, indima ebalulekile yesifo azalwa naso kanzima, futhi sokukhulelwa izinkinga zokwenza gestosis ngasekupheleni.

Waterhouse syndrome - Friderichsen e abadala uvame ngimbone njengoba izinkinga zokwenza nezifo ezithelelwanayo angase azithole. Ngokuvamile, i-ejenti kuyinto meningococcus, streptococcus noma Staphylococcus. Kodwa ngaphandle kwalokhu, izimbangela zezinkumbulo ukopha kungaba nosologies ezifana nesimungumungwana, scarlet fever, i-typhoid fever, idiphtheria, futhi neoplasms abulalayo, izimila, peritonitis DIC futhi thrombosis emithanjeni adrenal.

Ukuthuthukiswa lesi sifo

abalobi abaningi baye baphawula yilesi sifo njengengxenye isimiso esikwazi ukuzivumelanisa nesimo of ukwehluleka in ukuthuthukiswa sepsis oyingozi. Kodwa kungenzeka ukuthi izingane ezincane kanye nabesifazane abakhulelwe indlela ehluke ngokuphelele ngawo eba Waterhouse syndrome - Friderichsen. Pathogenesis ke kuzibonakalisa eziningi oluhambisana necrosis we- cortex adrenal. Kwakumelwe eziningi kangaka ukuthi umzimba wonke ofakwe igazi, kukhona hyperextension we capsule, ngisho ukudabuka yayo.

Ngokuqondene pathogenesis Ngokujwayelekile, kubonakala ngesimo sepsis:

- capillary osuke usuvulekile futhi arteriole;
- evelele ukudakwa syndrome;
- khona meningitis concomitant noma meningoencephalitis;
- ukwanda lesifunda lymph node kanye thymus.

symptomatology

Waterhouse syndrome - Friderichsen nge isifo meningococcal angagcina ngokuzumayo isizinda inhlalakahle. Yena uyathuthuka ngokukhulu ukushesha kangangokuba umuntu ungafa zingakapheli izinsuku.

Konke kuqala nge excitability ngokweqile, ukucasuka nekhanda. Khona-ke hamba besisu ubuhlungu, isicanucanu, ukuhlanza, ukukhishwa yisisu. Uma ubuhlungu bukhulu kakhulu, udokotela angase esolwa in iziguli acute zokugula kuhlinzwa. Ekuqaleni, ongaphakeme-ebangeni imfiva, kodwa nje kwamahora ambalwa abantu abaqala ngayo 39-40 degrees. Ngenxa ihlanze noma ikhishwe yisisu kusuka emzimbeni kokushiya amanzi namaminerali, okuholela ukuphazamiseka inhliziyo, ubuchopho nezinye izitho ezibalulekile. Ekugcineni, umuntu ulahlekelwa ukwazi iwela equlekile.

Kukhona olunye uhlobo lesi sifo, esizibonakalisa ukuwa elibukhali wegazi noma nciphisa. Ezinye izimpawu zingase zingabi nhlobo. Umuntu wokuqala stupor, kodwa njengoba hypoxia iqhubeka ngokushesha kuza stupor futhi equlekile. Ufa ngaphandle ngiphaphama.

Waterhouse syndrome - Friderichsen izingane ukuthuthukisa ngokushesha kunokuba e abadala, kungakhathaliseki ukuthi iyini imbangela. Sikhishwe ikhono lazo compensatory umzimba ngokushesha mpilo, futhi izinhlelo eziningi izitho zisengaphansi inqubo ukubunjwa nokuthuthukiswa kwezinhlangano, umphumela iza ezinsukwini zokuqala kuqala lesi sifo.

ukuhlola

Waterhouse syndrome - Friderichsen ithuthuka ngokushesha kakhulu kangangokuthi odokotela ngokuvamile abanalo isikhathi ukuba aqhube luhlolo ngokugcwele futhi sibone ukuthi kwenzekani ku-indoda. Uma egunjini labadinga usizo oluphuthumayo udokotela komsebenzi usola lo zokugula, impatho iqala ngokushesha, futhi uphethwe uyahlanganyela inqubo, ngoba i-akhawunti on iwashi.

Laboratory isiqinisekiso kwesifo kuyadingeka ukuthola ukuhlaziywa jikelele igazi:

- leukocytosis futhi shift leftward formula;
- ukwehla igazi glucose;
- thrombocytopenia futhi ekunqandeni ongaphakeme;
- Ukwehliswa electrolyte;
- ukwanda egazini urea nitrogen.

Nokho, lezi yizinkomba ungacacisi futhi zingase zibe Indlela anhlobonhlobo kuhlinzwa, izifo letindzala. Yebo, kungenzeka ukuba udinga ukuqoqa ngokucophelela nemlandvo wetekwelashwa kwakhe, futhi afeze wokubhoboza lumbar futhi ukuchaza isimo neurologic. Kodwa konke lokhu kwenziwa emva kuqiniswa kwesimo sabantu.

ukuxilongwa umehluko

Waterhouse syndrome - Friderichsen okumelwe ahlukaniswe kusuka izimo kuhlinzwa besisu ezifana appendicitis acute, pancreatitis acute, isilonda perforation isisu noma duodenum. Qiniseka udokotela kufanele uhlole izimpawu meningeal, ukuvimbela ukopha ebuchosheni, cavernous itheku thrombosis. Lapho inhliziyo ECG ifomu kuzokusiza uqonde ukuthi umuntu une wahlaselwa isifo senhliziyo noma cha.

ukwelashwa

Endaweni yokuqala emva ukuxilongwa "syndrome Waterhouse - Friderichsen" kufanele nxephezela isiguli sweated electrolyte ketshezi kanye nokuntuleka hormone adrenal. Ukuze lokhu kwethulwa ngokusebenzisa ukufinyelela emithambo yegazi ukuze isigamu ilitha "hydrocortisone" noma 120 angu "prednisolone" futhi ezintathu amagremu glucose ngamaphesenti amahlanu futhi eziyishumi namamililitha solution yamaphesenti ayisihlanu ascorbic acid. Ngakho sithathele pathogenesis eziyisisekelo, okubangela Waterhouse syndrome - Friderichsen. ukunakekelwa eziphuthumayo ngesikhathi esifanayo kuthuthukisa igazi rheology, dilutes ke kwandisa umthamo uhlelo uketshezi futhi kukhulisa ingcindezi. A steroid hormone lisiza ekulondolozeni ingcindezi ezingeni lelifanele.

Ngemva sinjalo amahomoni uqhubeke esizosingathwa intramuscularly, "Hydrocortisone" of 50-75 mg njalo emahoreni ayisithupha, futhi deoxycorticosterone acetate ku namamililitha eziyishumi kathathu ngosuku. Qiniseka ukuthi ulandela izinkomba ingcindezi futhi, uma kunesidingo, ukuba athunge up "Epinephrine," "Mezaton" glycosides inhliziyo.

Uma imbangela isifo isibe ukutheleleka, ezifana meningococcal, ngaphezu yokwelapha eyinhloko, isiguli unikezwa imithi elwa namagciwane. Uma sibuyela isiguli evamile, ama-hormone aqala ukuba kancane kancane ukunciphisa umthamo. Kubalulekile ukulungiselela kahle emzimbeni ngenxa yalokho kumelwe ngokuzimela ukukhiqiza glucocorticoids. Musa evele ukukhansela izidakamizwa, kwakungase ukuqala crisis yesibili.

Kubalulekile ukuqinisekisa ukuthi lesi siguli nje Waterhouse syndrome - Friderichsen. Le nqubo yokwelapha uqobo kungaba yingozi njengoba izikhukhula somzimba ngokweqile kubangela edema letindzala, kuhlanganise edema-cerebral palsy, futhi ukuphuza amaphilisi amaningi hormone kungase kubangele okuthile engqondweni. Ngakho-ke, isimo isiguli kubaluleke kakhulu sihlale njalo siqaphele futhi ulungise aphoyintimenti kuye ngezidingo zakhe.

ukuba nombono ongafani ngeke

Waterhouse syndrome - Friderichsen - zokugula ogulisa ngokwedlulele, zembula ukuthi ngaso sonke isikhathi ngesikhathi ngenxa ezihlukahlukene izimpawu ze-non-ethize. Umphumela akuxhomekile nje kuphela esimweni kahle kanjani liziphathe udokotela esimweni esiphuthumayo, kodwa futhi ngezinga nolokubhujiswa nezindlala adrenal kanti umthamo compensatory umzimba. Abavamisile ophela lesi sifo esibulalayo.

zokuvimbela

Lokhu kungenxa kakhulu anti-ubhubhane izinyathelo le ukutheleleka lapho isiguli sekutholakele ukuthi sine- isifo meningococcal. Udokotela ngubani ukwambulile isiguli esinjalo aphoqelelwe ukuba azise wokuhlola yenhlanzeko futhi ukuhlukanisa isiguli. Ngo ezinsukwini ezintathu ezizayo, isheke sabantu lokuxhumana khona isifo nokuhlukanisa abantu abanesifo esithelelanayo emphakathini umsebenzi noma isikhungo sakho semfundo isikhathi kwezinsuku eziyishumi. Ukuze bagweme ukubanjwa, abantu sisondelene isiguli, linqume izifundo ezimfushane kwama-antibiotic.

lwezifo

Waterhouse syndrome - Friderichsen, ngeshwa, zokugula ezivamile ngempela. Emazweni athuthukile, tigameko isifo meningococcal kuyinto 1-3 amacala 100 000. Futhi ngaphezu kwesigamu amacala - izingane zasenkulisa yobudala. Ngaphezu kwalokho, eyishumi ngamunye oboné ukunyuka kwezinga lokuhlasela kwesifo. Lokhu kungenxa kuguquka sabantu lwegciwane kanye ekunqabeni amasosha omzimba.

Lezi zibalo zimane cishe ngeke kakhulu zeqiniso, njengoba Ezimweni eziningi hamba akubonakali ngoba izimpawu kwesiphambano. Waterhouse syndrome - Friderichsen ithuthuka ngokushesha kakhulu kangangokuthi odokotela abanayo isikhathi afeze inombolo ezanele ukuhlolwa.