Choyamba thandizo la pachimake kapamba

Akakhazikitsa dokotala wodziwika bwino wa kapamba, dokotala wa ambulansi amakakamizika kutumiza wodwala kuchipatala cha opaleshoni kudzera pachipinda chadzidzidzi ndi ambulansi.

Pa gawo lakubadwa, ndikofunikira kuchita njira zotsatirazi:

  1. Kuletsa kwam'magulu kudya ndi kumwa,
  2. ma paketi oundana padenga lanyumba ndi nthawi yoyendera,
  3. kukhazikitsidwa kwa antispasmodics kuti muchepetse kupindika kwa Oddi spasm (nitroglycerin, 1-2 imatsika pansi pa lilime, nitrosorbide kapena refuac, 2 ml ya yankho la 2% ya papaverine, kapena 2 ml ya palibe-shpa osakanikirana ndi 2 ml ya yankho la 0.2% ya platifillin),
  4. kuyambitsa 1 ml ya 0,1% yankho la atropine kuti achepetse katemera wa pancreatic,
  5. kukhazikitsidwa kwa mtsempha wa magazi 40-60 ml ya 0,5% ya novocaine, womwe umalepheretsa kallikriin ndi antispasmodic,
  6. makonzedwe a antihistamines (2 ml ya yankho la 1% ya diphenhydramine kapena 1 ml ya yankho la 2% ya suprastin),
  7. ndi kugwa, intravenous makonzedwe a 60-90 mg wa prednisone kapena 300-450 mg wa hydrocortisone, kulowetsedwa kwa kuchepa kwa bcc chifukwa cha makristalo,
  8. kukhazikitsidwa kwa intramuscularly 2-4 ml ya Lasix kapena 1 ml ya novurite kuti achepetse mphamvu ndikuwonjezera mphamvu ya ma enzyme kuchokera mthupi. Zotsatira zoyenera kumayambiriro kwa matendawa zimaperekedwa ndi kugwiritsa ntchito njira imodzi ya antienzyme, yomwe imayendetsedwa mwachidwi: trasilol 200000-300000 IU, zalol 200000-300000 IU, kontrikal 100000-200000 IU, pantripin 120-150 IU.

Zithandizo zonse zamankhwala zomwe zimachitika ku prehospital gawo, dokotala ayenera kujambula pepala. Kuphatikiza pa kuyesedwa kwachipatala, kufufuza kwa labotale kwa hyperfermentemia kumachitika mu dipatimenti yodwala odwala kuchipatala, komwe wodwalayo amalowera, zomwe zimatengera kuphunzira kwa zochitika za ma pancreatic enzymes m'magazi (amylase, trypsin, lipase) ndi mkodzo (amylase).

Mkonzi. V. Mikhailovich

"Chisamaliro chadzidzidzi cha pancreatitis pachimake" ndi zolemba zina kuchokera ku gawo la Emergency

3. Pancreatitis pachimake

Zizindikiro Ululu wolimba wamkamwa womwe umachitika pambuyo pakudya kwa mafuta (okazinga) chakudya, mowa. Kubwereza, kusanza kowawa komwe sikubweretsa mpumulo. Intoxication, icteric sclera. Tachycardia, ochepa hypotension. Thupi. Lilime lidayuma. Kutulutsa pang'ono, kupweteka. Zizindikiro zabwino za peritoneal mkwiyo. Leukocytosis yokhala ndi kusintha kosawerengera magazi kumanzere. Magazi ndi mkodzo wa amylase akhoza kukwezedwa.

Thandizo loyamba ndi loyamba. Mtendere. Njala. Ozizira pa dera la epigastric. Kutumizira wachangu kwa dokotala.

Chipatala chadzidzidzi. Chipatala. Mtendere. Njala. Ozizira pamimba.

Kutuluka mwachangu kupita ku OMEDB (chipatala) ndi ambulansi, kugona pamtunda, limodzi ndi a paramedic (dokotala). Musanachokere komanso mkati mwake, onetsetsani kuti muli ndi vuto la chapamimba kudzera pa kafukufuku, kulowetsedwa kwa mchere wa mpaka 800 ml.

OMB, chipatala. Kutsimikizira za matendawa: Ultrum yam'mimba, ziwonetsero za chifuwa ndi pamimba, zowerengera zam'mapapo.

anjala, kulakalaka kwamtumbo kudzera chubu,

chopinga wa pancreatic secretion ndi antienzyme mankhwala (5-fluorouracil, octreatide, contracal)

analgesics ndi antispasmodics intramuscularly, sacrospinal novocaine blockade kapena yaitali epidural blockade,

kulowetsedwa mankhwala pofuna kukonza kapangidwe ka madzi-electrolyte, CBS, BCC, mavuto a hemocoagulation,

maantibayotiki, odana ndi kutupa, antacid ndi antihistamines.

Panthawi yaine komanso pang'onopang'ono pancreatitis yacute, plasmapheresis, endolymphatic ya antibayotiki ndi kukonzekera kwa antienzyme, kukhetsa kwakunja kwa thoracic lymphatic duct, lymph ndi hemosorption akuphatikizidwa mu pulogalamu yayikulu ya chisamaliro. Pankhani ya kukula kwa peritonitis, pamaso pa omentobursitis, laparoscopy imathandizira kuti amvetsetse matenda, kukhetsa omentum sac ndi m'mimba, ndi kuphwanya cholecystostomy.

Mitundu ya ma opaleshoni owononga pancreatitis:

mwadzidzidzi (ndi zizindikiro za kutulutsa magazi mkati kapena kutulutsa magazi kudzera m'mitsetse) - lekani kutulutsa magazi okwanira.

mwachangu (patangopita masiku ochepa atalowa kuchipatala, ndi kupitirira kwa zizindikiro za kapamba, kupangika kwa peritonitis, kuwonjezeka kwa jaundice, kuledzera) - kukonzanso ndikutulutsa kwa peritoneal patsekeke, omental bursa, retroperitoneal space.

gawo lofunikira la opareshoni ndi cholecystostomy.

Kuchedwa (kusinthidwa) - kuchotsedwa kwa malo a necotic a kapamba ndi (kapena) parapancreatic retroperitoneal fiber.

4. Zilonda zam'mimba ndi duodenum

Zizindikiro "Dagger" ululu wam'mimba. Kukakamizidwa kwa wodwalayo (kumanja kwa miyendo kukanikizidwa mpaka m'mimba). Lilime lidayuma. Mpweya wake ndi wochepa. Lakuthwa minofu khoma lakumbuyo yam'mimba. Mimba ndi "yokhala ngati thabwa," yosapumira. Zowawa zakuthwa palpation, zizindikiro za kuyimitsidwa kwa peritoneal. Kuchepa kwa hepatatic sikunatsimikizike. Pa kafukufuku wa radiograph pamimba - kupezeka kwa mpweya m'mimba. Leukocytosis yokhala ndi kusintha kosawerengera magazi kumanzere. Ndi mafuta ophimbidwa, kusinthika kwofananira kungatheke.

Thandizo loyamba ndi loyamba. Mtendere. Njala. Ozizira pa dera la epigastric. Kutumizira wachangu kwa dokotala.

Chipatala chadzidzidzi. Chipatala. Mtendere. Njala. Ozizira pa dera la epigastric.

Kutuluka mwachangu kupita ku OMEDB (chipatala) ndi ambulansi pomwe akugona pamtunda, limodzi ndi othandiza dokotala wothandizira. Kukwera kwa zomwe zili m'mimba kudzera pa kafukufuku.

OMB, chipatala. Kutsimikizira za matendawo: Kafukufuku wa radiology wam'mimba. Palibe mpweya waulere komanso kupezeka kwa zizindikiro za kupsinjika kwamkati, fibroesophagogastroscopy, pneumogastrography, kapena kusiyanitsa gastrography yodziwika mobwerezabwereza x-ray imachitika.

Mulingo wa opaleshoni: ndi kufalitsa kwa peritonitis, nthawi ya mafuta ochulukirapo kwa maola opitilira 6, matenda opanikizika kwambiri, komanso kuperewera kwa opaleshoniyo - kukodza kwa chilonda cha m'mimba kapena zilonda zam'mimba.

Ndi chilonda cham'mimbamo cha duodenal komanso kusapezeka kwa mawonekedwe a kupweteka kwa peritonitis, tsinde la subphrenic stot vagotomy limachitika ndi zilonda za excion ndi pyloroplasty.

Gastric resection imachitika pa gawo la chithandizo chamankhwala chapadera cholowera, kufinya ndi zilonda zam'mimba, komanso zilonda zam'mimba, pakakhala ma data omwe amafufuza omwe amawonetsa kuti magwiridwe antchito amtunduwu ndi otsika.

Pankhani ya zofukiza zofukiza zamatumbo zam'mimba ndi duodenum, njira zopangira opaleshoni zimatsalira.

Etiology ndi pathogenesis

Kukula kwa chifuwa chachikulu cha pancreatitis nthawi zambiri kumalumikizidwa ndi kutukusira kwa ndulu ndi ma ndulu, ndipo pomwe matendawa amalowa ndi kapamba mwina kuchokera ku duct wamba wa bile kupita kukamwa.

Palinso njira ina yopatsira matenda kulowa kapamba - kufalikira kwa ma virus m'matenda osiyanasiyana opatsirana (typhoid fever, mumps, fever, sepsis, etc.). Mtundu wovuta kwambiri wa kapamba wam'mimba ndi pachimake hemorrhagic pancreatitis. Kuchepa kwake ndi njira yoopsa kwambiri, yomwe imatsogolera anthu ambiri kumwalira masiku obwerawa, ndipo nthawi zina mawola atadwala.

Pachimake hemorrhagic pancreatitis amadziwika ndi chitukuko cha pancreatic necrosis, yomwe imaperekedwa motere. Monga mukudziwa, mothandizidwa ndi bile, trypsinogen ya kapamba imasandulika kukhala trypsin yogwira. Izi mwa munthu wathanzi limapezeka m'matumbo lumen.

Madzi a duodenum kapena a bile akamalowerera kapamba, trypsinogen imadutsa mu trypsin mu kapamba palokha (amalingalira kuti kusinthaku ndikothekanso kolimbikitsidwa ndi mabakiteriya). Pamapeto pake, kutulutsidwa kwa puloteni (trypsin) mu kapamba kumapangitsa kukula kwa necrosis komanso kudzimbidwa kwa ndulu.

Pomaliza, mu pathogenesis ya pancreatitis ya pachimake imagwirizanitsa kufunika kwa kuphwanya magazi mu zikondamoyo. Ischemia (vuto la mtima), embolism ndi hemorrhage, yomwe imagwira kwambiri timinyewa, timafotokozera kukula kwa matenda apakhungu a hemorrhagic pancreatitis.

Nthawi zina pancreatitis yovuta kwambiri, njirayi imangokhala kusintha kwamatumbo, mwa ena - mawonekedwe a purulent foci, pamapeto pake, lachitatu - chithunzi cha hemorrhagic necrotic pancreatitis chimayamba.

Nthawi zambiri, chifuwa chachikulu cha m'mimba chimayamba kukhala anthu onenepa kwambiri omwe amadya zakudya zambiri, makamaka zakudya zamafuta, komanso omwe amamwa mowa kwambiri. Nthawi zambiri, matendawa amayambika chakudya chamadzulo chambiri.

Mbiri imanenanso kuti cholecystitis kapena cholangitis.

Matendawa amayamba. Kuuma kwake sikusiyana munthawi zonse. Pali mitundu yodziwika ya pancreatitis pachimake, yomwe imachitika mosavuta komanso osadziwika - pachimake catarrhal pancreatitis. Milandu yayikulu yamatumbo a catarrhal pancreatitis, ululu umapezeka m'chigawo cha epigastric komanso kuzungulira msomali ndipo umafalikira mbali yakumanzere.

Amaphimba theka lamanzere amthupi mwanjira ya lamba-theka kuchokera mchombo kupita ku msana (mkuyu. 17, c ndi b). Nthawi zina, ululu umafalikira kudera lamanzere, ena, limodzi ndi izi, kumanzere kwam'mimba, ndipo chachitatu, kumanzere kumanzere ndimtsempha wamanjenje. Mimba yatupa, koma mukadzimva, kusokonezeka m'mimba sikupezeka.

Kuukira kupweteka nthawi zambiri kumayendetsedwa ndi nseru, kusanza, ndi kusafa. Chizindikiro chofunikira chodziwitsa ndi kuchuluka kwa pancreatic enzyme - diastases yamkodzo ndi magazi (pamwamba pa magawo a 64 Volgemutov).

Mitundu yofinya ya kapamba imatha kuchira, kapena kukhala ndi vuto losatha.

Chithunzi cha kuchipatala

Ngati matendawa sanazindikiridwe, pamatuluka chifuwa cham'mimba ndipo pamayamba kupweteka kwa puritonitis. Milandu yodzipulumutsa imadziwika pamene chikopa chimalowa m'mimba kapena m'matumbo. Kutupa kwakukulu kungayambitse kukakamiza kwa ndulu ya bile ndipo kumayambitsa kukulitsa kwa jaundice.

Choopsa chachikulu ndi pachimake hemorrhagic pancreatitis, pomwe chithunzi choopsa cha "m'mimba chowopsa" (pamimba pamimba) chimayamba. Ndipo mtundu wamatendawa umayamba ndi ululu wam'mimba (epigastrium komanso kuzungulira msomali). Nthawi zina, ululu umapezeka kudera la iliac. Nthawi zina odwala amadandaula za kuphulika kwapweteka kwambiri m'chigawo cha pelvis kapena lumbar.

Thupi lodzidzimutsa limakula msanga: zimachitika pafupipafupi, zochepa, ndipo khungu limakhala lotumbululuka. Nkhope zanu zakuthwa, maso amabwerera kumbuyo. Kusanza, kusanza kowoneka bwino, ndikusokonekera. Posakhalitsa ukufalikira ndi zizindikiro za kutsekeka kumachitika: matumbo amaleka, kutuluka kwa ndowe ndi mpweya umachedwa. Nthawi zina hemorrhagic ascites imayamba, yomwe imadziwika ndi kuboola pamimba kapena pakuchita opareshoni. Mukamayang'ana mkodzo wa diastasis, kuchuluka kwambiri kumatsimikizika.

Imfa ikhoza kuchitika m'maola oyamba matenda kapena tsiku lotsatira. Kukhalapo kwa jaundice, komanso purulent pancreatitis, kumachitika chifukwa cha kuponderezedwa kwa duct wamba wa bile. Kuzindikira kwa pancreatitis pachimake kumabweretsa zovuta zodziwika, chifukwa chakuti matendawa ndi osowa.

Kuzindikiridwa kwa kapamba kumakhazikika pokhudzana ndi kutulutsa kwina kumimba kwakumapeto kwa m'mimba kupweteka komwe kumakhala theka-lamba kapena lamba m'chilengedwe, kukhalapo kwa khungu soreness (hyperalgesia) yokhala ndi mawonekedwe amtundu, ndipo pamapeto pake kuwonjezeka kwa mkodzo ndi magazi. Zowonetsa mbiri ya gallbladder ndi bile duct matenda atchuka.

Zizindikiro zomwezo zimawonedwa ndi purulent pancreatitis, yomwe, kuphatikiza apo, imadziwika ndi zizindikiro za puritis-yotupa yotupa (kutentha mpaka 38-39 °, le neutocophic leukocytosis m'magazi).

Kukula mwachangu kwa pachimake hemorrhagic pancreatitis amafanana ndi pachimake peritonitis chifukwa cha mafuta ophatikizika, opaka pamimba. Mosiyana ndi omaliza, mu kapamba wam'mimba kwambiri, m'mimba mumakhala pang'ono, kusungunuka kwa hepatic kumasungidwa.

Zambiri zam'mimba mu mkodzo ndi magazi ndizofunikira kwambiri pakuwona mitundu yonse ya kapamba.

Kulosera mu pancreatitis pachimake nthawi zonse kumakhala koopsa. Nthawi zonse pakakhala kukayikira kwamphamvu kapamba, wodwala amayenera kupita kuchipatala cha opaleshoni.

Pazipatala zokha pokhapokha funso lingathe kuthana ngati wodwalayo angamuthandize opaleshoni kapena chithandizo chamankhwala chosafunikira.

Ngakhale asanagonekedwe m'chipatala komanso pa mayendedwe, wodwalayo ayenera kukhazikitsa mtendere wathunthu. Popeza odwala omwe ali ndi pancreatitis yovuta kwambiri amakhala ndi vuto la mtima komanso kulephera, njira zochiritsira ziyenera kuwongolera. Ikani Cardiazole, cordiamine kapena camphor. Polimbana ndi vuto ladzidzidzi, morphine (1 ml ya 1% yankho) ndi yankho la sodium chloride kapena 5% shuga (500-1000 ml) amabwera pansi pa khungu limodzi ndi adrenaline (1 ml ya yankho la 0.5%).

Ngati ndi kotheka, kuikidwa magazi (300 ml) kuyenera kuchitidwa. Pa tsiku loyamba, wodwala sayenera kupatsidwa chakudya. Njira zonsezi zimayenera kuchitika pokhapokha ngati wodwala sangathe kunyamula chifukwa chilichonse. Komabe, zitatha izi, wodwalayo amayenera kupita kuchipatala, limodzi ndi adokotala kapena othandizira.

Kusiya Ndemanga Yanu