Zizindikiro zosiyanitsa za atherosulinosis ndi endarteritis yamitsempha yam'manja

Pazindikiritso wa endarteritis, kuphatikiza pa zomwe tafotokozazi pamwambapa, maphunziro othandizira ndiofunikira: oscillography (onani), rheovasography, capillaroscopy (onani), arteriography, kuphunzira kutentha kwa khungu. Kupenda kwa X-ray kwamafupa a miyendo yomwe yakhudzidwa ndikuwonetsa kusokoneza mafupa, kupindika kwa mafupa. Kusiyanitsa kosiyanasiyana kumachitika makamaka ndi zotumphukira zamitsempha yamagazi. Omalizirawo amadziwika ndi zaka za odwala (achikulire kuposa zaka 50), kuchuluka pang'onopang'ono pazizindikiro - kusintha kwa khungu la kumapazi, khungu lowuma, kusintha kwa ma trophic. Ndi atherosulinosis ya zotumphukira ziwiya, miyendo yonse imakhudzidwa kawirikawiri, palibe chosunthira thrombophlebitis. matendawa mwa odwala ambiri amakula pang'onopang'ono, ndikupatsidwa nthawi yayitali. Komabe, atherosulinosis nthawi zambiri imayendera limodzi ndi thrombosis ndi embolism. zomwe zimayambitsa kutsekeka kwakukulu kwa mitsempha yayikulu komanso kusokonezeka kwa ischemic m'malo ambiri a nthambi. Ndi kusokoneza endarteritis, matendawa amapezeka, monga lamulo, kwambiri, zovuta za trophic nthawi zambiri zimachitika mofulumira wodwalayo, makamaka mawonekedwe aubongo a endarteritis omwe amakhala ndi zaka 20-25. Ndiosavuta kusiyanitsa endarteritis ndi matenda ena omwe amaphatikizidwa ndi ululu m'munsi. A aakulu venous kusowa kwa m'munsi malekezero (varicose mitsempha), madandaulo a odwala ululu m'miyendo amayamba chifukwa cha kusayenda kwa magazi a venous, motero ululuwo umakulirakuma poyimirira. Nthawi zina, ndikofunikira kusiyanitsa endarteritis ndi kupweteka m'miyendo chifukwa cha nyamakazi ndi arthrosis, myositis, fasciculitis, radiculitis. phazi lathyathyathya. zotsalira zotsalira pakuvulala. Ndi matenda onsewa, palibe zizindikiro zakuphwanya magazi akulu, mitsempha imayenda bwino, oscillograph ndiyabwinobwino.

Kuzindikira. Mu kuphunzira kwa odwala omwe amasokoneza endarteritis, ochepa oscillometry ndikofunikira. Munthawi yofananira yamitsempha yamagetsi, ma curc oscillometric nthawi zambiri amakhala ndi nsonga yakuthwa, i.e. oscillation okwanira amafanana ndi nambala imodzi ya kukakamizidwa kwakukulu mu cuff. Mu pathological momwe arterial dongosolo la miyendo, chikhalidwe cha oscillometric pamapindikira. Ndi kusiyanasiyana kwathunthu kwa mitsempha, oscillation sawonekeratu.

Chofunika kwambiri ndi capillaroscopy (onani) ndi plethysmography (onani). Kuti mupeze kuphipha kwamitsempha, kuyesa kwamankhwala kumagwiritsidwa ntchito - perirenal novocaine blockade kapena paravertebral blockade of the lumbar ganglia.

Asanafike blockade, capillaroscopy ndi kafukufuku wokhudza kutentha kwa khungu zimachitika, kenako maphunziro awa amabwerezedwa pambuyo pa mphindi 30. pambuyo pa blockade. Ndi vasospasm, blockade nthawi zambiri imasintha mkhalidwe wa capillaries, ndizotheka kuwona ambiri awo, kutentha kwa khungu kumakwera ndi 2-4 °. Kusakhalapo kwa zotere kumatsutsana ndi chiyambi cha ischemia.

Kafukufuku wa X-ray akuwonetsa kusintha kwamphamvu m'mafupa a miyendo yomwe yakhudzidwa - kusokoneza mafupa, kupindika kwa gawo la cortical.

Arteriography imakupatsani mwayi woweruza milandu yamagazi ndi magazi, koma mayeso a vasographic amayenera kuchitika pokhapokha ngati pakufunika, chifukwa sikuti alibe chidwi ndi zotengera zomwe zasinthidwa kale.

Mkuyu. 1. Mawonekedwe wamba.

Mkuyu. 2. Oscillograph yopanga ziwiya zamagawo am'munsi (kutsika kwa oscillation kumapazi).

Mkuyu. 3. Oscillograph pakuwonongeka kwa mtsempha wamiyendo yam'munsi (palibe oscillation pamapazi).

Kusiyanitsa mitundu ikuchitika makamaka ndi zotumphukira mtima atherosulinosis. Otsirizawo amakhala ndi chitukuko zaka zopitilira 50, kuwonjezeka pang'onopang'ono kwa zizindikiro - kusintha kwa khungu la mapazi, khungu louma, kusintha kwa ma trophic. Ndi atherosclerosis ya zotumphukira ziwiya, miyendo zimakhudzidwa symmetrically, palibe thrombophlebitis, makamaka kusunthika, makola amasungabe ntchito yawo kwa nthawi yayitali, kusokonezeka kwa magazi kwa odwala ambiri kumayamba pang'onopang'ono, ndikuchotsedwa nthawi yayitali. Komabe, atherosclerosis nthawi zambiri imayendera limodzi ndi thrombosis ndi embolism, yomwe imayambitsa kutsekeka kwakukulu kwa thunthu lalikulu komanso vuto lachiwopsezo cha ischemic m'dera lalikulu la nthambi. Kuwonongeka kwa endarteritis, monga lamulo, kumapitirira kwambiri, zovuta zimachitika mofulumira wodwalayo, makamaka mawonekedwe aubongo omwe amapezeka pakati pa zaka 20-25.

Sikuti nthawi zonse (makamaka mwa anthu okalamba) kuti ndizotheka kusiyanitsa matenda awiriwa ndi chidaliro chonse, ndizosavuta kusiyanitsa endarteritis kuchokera ku mitundu ina ya nosological, yomwe imatsatana ndi kupweteka m'munsi.

Osakwanira mitsempha ya m'munsi yam'mphepete (kukulira kwa varicose), madandaulo a odwala omwe ali ndi ululu m'miyendo amayanjana ndi kusunthika kwa magazi a venous ndipo kupweteka kumakulirakukhazikika. Nthawi zina, ndikofunikira kusiyanitsa endarteritis ndi ma syndromes a ululu omwe amachitika chifukwa cha zochitika zosinthika, myositis, fasciculitis, radiculoneuritis (mwachitsanzo, ndi osteochondrosis ya lumbar vertebrae), kufooka kwa phazi, kuvulala kwatsalira, etc. Palibe zizindikiro za kusokonezeka kwamagazi kwakukulu. , kusinthasintha kwachibadwa. Ndikosavuta kusiyanitsa endarteritis yakumapeto kumtunda kuchokera kuzinthu zina zomwe ndi gawo la gulu la ululu wamkamwa ndi syndromes yamapewa (onani).

Atherosulinosis ya msempha ndi nthambi zake. Mbiri yazachipatala

Zipangizo / Atherosclerosis ya msempha ndi nthambi zake. Mbiri yazachipatala

Kugawa atherosulinosis yamatumbo am'munsi am'munsi kuyenera kusiyanitsidwa kwa:

- kusokoneza endarteritis. Zotsatira zotsatirazi zimapangitsa kuti pasakhale kupezeka komwe kumayambitsa matenda am'mimba: kuwonongeka kwa mitsempha yoyambirira (yayikulu), kufalikira kwamatenda, kusakhalapo kwa mbiri yotsimikizika ya matendawa, kufalikira kwakanthawi,

- thromboangiitis obliterans. Kuzindikiritsa kwa thromboangiitis obliterans kumalola kupatula kusakhalapo kwa thrombophlebitis ya mitsempha yapamwamba ya mawonekedwe osamukira, kusowa kwachulukitsidwe, limodzi ndi thrombosis yamayendedwe oyambira ndi venous,

- Matenda a Raynaud. Kugonjetsedwa kwa ziwiya zazikulu zokhala m'munsi, kulephera kwamkatikati mwa mitsempha kumapazi, miyendo yotsika, "kulankhulirana kwapang'onopang'ono" kumatipatsa mwayi wodziwikiratu,

- thrombosis ndi embolism wamitsempha yama m'munsi. Kuchulukana kwapang'onopang'ono kwa mawonetseredwe azachipatala (zaka zingapo), kulowetsedwa kwamatumbo a ziwalo zonse ziwiri munjira ya pathological, komanso kusasunthika kwa khungu kumathandizira kuti izi zizindikirike.

- mitsempha yakuya ya m'munsi. Kuzindikira uku kungathetsedwe ndi kusapezeka kwa edema, malungo ndi zilonda zamkati palpation pamodzi ndi mitsempha yayikulu pa ntchafu ndi inguinal dera, chizindikiro chosavomerezeka cha a Gomani.

Zizindikiro zosiyanitsa za matenda am'munsi

(malinga ndi AL Vishnevsky, 1972)

• Zowonekera za matendawa: Kuthana ndi atherosulinosis (OA) - nthawi zambiri pambuyo pa zaka 40, OE - nthawi zambiri mpaka zaka 40

• Kung'ung'udza kwam'mimba chifukwa cha chotupa chachikazi: OA - zimachitika kawirikawiri, OE - sizimachitika kawirikawiri

Matenda oyipa a mtsempha wamtima ndi ubongo: OA - nthawi zambiri, OE - kawirikawiri

- Matenda ofunikira owopsa: OA - nthawi zambiri, OE - kawirikawiri

• Matenda a shuga: OA - pafupifupi 20% ya odwala, OE - nthawi zambiri samapezeka

• Hypercholesterolemia: OA - pafupifupi 20% ya odwala, OE nthawi zambiri sapezekapo

• Kuchepa kwa mawonekedwe amitsempha yayikulu pa angiogram: OA - ayi, OE - nthawi zambiri

• Mitsempha yosagwirizana yamitsempha yamagazi pa angiogram: OA - nthawi zambiri, OE - ayi

• Kulepheretsa kwa gawo lalikulu la mitsempha yayikulu ya m'chiuno ndi m'chiuno: OA - nthawi zambiri, OE - kawirikawiri • Kulepheretsa kwamitsempha ya m'munsi ndi phazi: OA - osati pafupipafupi, makamaka okalamba komanso matenda a shuga.

- Kuwerengera zakunja: OA - nthawi zambiri, OE - kawirikawiri.

Atherosulinosis ya msempha ndi nthambi zake. Kukhazikika kwa OBA kumanja ndi PBA mbali zonse (gawo 3). Zotsatira pambuyo pa prosthetics BOTH kumanja. Mwendo ischemia IIb digiri.

- matenda achilengedwe omwe amakhudza mitsempha ya zotanuka (aorta ndi nthambi zake) komanso minofu-elastic (mitsempha ya mtima, ubongo, ndi zina). Nthawi yomweyo, foci ya lipid, makamaka cholesterol, madipoziti (atheromatous plaques) imapangidwa mkati mwa ziwiya zamkati, zomwe zimayambitsa kupendekera kwapang'onopang'ono kwa lumen kwa ziwiya mpaka zitasakazidwa kwathunthu. Atherosulinosis ndi omwe akuwongolera kwambiri matenda komanso kufa kwa Russia, USA ndi mayiko ambiri Akumadzulo. Zomwe zimapangitsa kuti kufooketsa kosalekeza, pang'onopang'ono, chithunzi cha atherosulinosis ndicho chimapangitsa kuchuluka kwa magazi m'thupi lomwe limadyetsedwa ndi mtsempha wamagetsi.

Mtundu wa atherosulinosis, wodziwika ndi kupendekera kofupika kapena kutsekeka kwathunthu kwa lumen m'mitsempha.

150: 100,000 ali ndi zaka 50.

M'badwo wopambana ndi wokalamba. Amuna ambiri amakhala amuna (5: 1).

Atherosulinosis of the Peripheral Artery

Atherosclerosis ya zotumphukira mitsempha ndi matenda a zotumphukira mitsempha ndi matenda Inde. A gawo la magazi kutsekeka kapena kuyeza kwa lumen kwa msempha ndipo nthambi zake zikuluzikulu, zomwe zimapangitsa kuchepa kwa magazi kapena kuchepa kwa magazi, nthawi zambiri mumalowedwe am'mitsempha. Zotsatira zake, pali kusakhazikika, ischemia, trophic zilonda zam'mimba. Nthawi yomweyo, mitsempha ya mesenteric ndi celiac imatha kuthandizira.

Gulu la osokonezaer a atherosulinosis

Matenda a matenda am'munsi oyenda ndi ochepa aschemia:

4. Kupanga matenda azachipatala:

Mukamayambitsa matenda azachipatala, onetsani 1)matenda oyamba, 2)zovuta za matenda oyamba, 3)zodziwika bwino zam'tsogolo (Ndime 2 ndi 3 - ngati alipo).

Chitsanzo cha kapangidwe kazachipatala:

1) Kwakukulu - Kuwononga atherosulinosis ya ziwiya zamagawo am'munsi, atheroscrotic occlusion yam'manja kwambiri yaimkazi, kumanzere kwamitsempha yamagazi, matenda a ischemia apansi a IIB degree kumanja, IIIA digiri kumanzere,

2) zovuta - pachimake thrombosis wa kumanzere popliteal mtsempha, pachimake ischemia wa III digiri,

3) mnzake– IHD, matenda a mtima, matenda oopsa a IIB Art.

Chithandizo cha odwala HOSAK.

5.1. Kusankhidwa kwa njira zamankhwala mtima ndi mawonekedwe a zotupa (etiology, morphological), gawo la matendawa, m'badwo komanso nthawi zonse wodwala, kukhalapo kwa matenda oyanjana.

Njira zochizira zosagwiritsidwa ntchito masiku onse zimagwiritsidwa ntchito pamatenda amtundu uliwonse am'magazi oyambira - magawo I-II a ischemia yovuta, ngati akukana wodwalayo kuti achite opaleshoni, pakalibe zochitika zogwira ntchito, komanso m'malo ovuta kwambiri.

5.2. Mankhwala othandizira. Iyenera kukhala yokwanira, yolumikizidwa ndi maulalo osiyanasiyana amtundu wa pathogenesis ndikuchotsa zizindikiro za matendawa. Ntchito zake zazikulu:

kupewa kukula kwa matenda oyamba,

kuchotsedwa kwa mphamvu ya zinthu zoyipa (zinthu zoopsa - kusuta, kuziziritsa, kupsinjika, ndi zina).

kusangalatsa kwa chitukuko cha kufalikira kwamgwirizano,

matenda a neurotrophic ndi kagayidwe kachakudya michere mu mbali ya mkono,

kusintha kwa kukoka kwa magazi ndi zinthu zamagazi,

Matenda a matenda a heentatic system,

Zakudya zamafuta ochepa zimaperekedwa kwa odwala

Pofuna kupewa kupitirira kwa njira ya atherosulinotic - kugwiritsa ntchito lipid-kuchepetsa ndi anti-sclerotic mankhwala (lipocaine, methionine, lipostabil, linetol (hemp mafuta), miskleron, diosponin, prodectin, ascorbic acid, kukonzekera kwa ayodini.

M'zaka zaposachedwa, pofuna kupewa komanso kuchiza matenda a atherosulinosis, kuphatikizapo Ndi zotupa za atherosulinotic zam'mitsempha ya miyendo, tikulimbikitsidwa kugwiritsa ntchito ma statins (simvastatin, atorvastatin, etc.), omwe atcha anti-atherogenic katundu - choletsa cholesterol, okhala ndi lipid-kutsitsa, ali ndi zotsatira "zofunikira" - kuchepetsa kuchepa kwamitsempha, kusintha ntchito yam'mimba, komanso kukhala ndi vuto la antithrombotic. Zonsezi zimakonzeratu kuchepa kwa cholesterol, kukhazikika pa atherosulinotic plaque, ndipo kumachepetsa mwamphamvu kutsekeka kwazomwe zikuchitika komanso kukhoma kwa mtima.

Kuthetsa angiospasm ndi kukondoweza kwa chitukuko cha ozungulira kufalitsa mu ischemic nthambi zimatheka ndi zamankhwala, physiotherapeutic ndi balneological njira:

1) kugwiritsa ntchito novocaine blockade (perinephric, chisoni, extradural kulowetsedwa (makonzedwe katatu patsiku kwa masabata awiri 2) ndi catheter wa osakaniza ndi 25 ml ya 0.25% yankho la novocaine, 0,3% yankho la dicaine 2 ml. Vitamini Mu₁ 1 ml, 2-3 ml ya mowa wa 96), womwe umasokoneza kayendedwe ka zotupa komanso zomwe zimakhudza kugwira ntchito kwa mitsempha ndi kutsika kwa magazi,

2) kuyambitsa kwa yankho la novocaine kudzera m'mitsempha (20-30 ml ya yankho la 0,5%) komanso kudzera mu njira ya Elansky - 1% yankho la novocaine 10 ml + 1 ml ya yankho la 1% ya morphine tsiku lililonse kapena tsiku lililonse mpaka nthawi 8-10, chifukwa Njira ya Vishnevsky - 100-150 ml yankho la Ringer + 25 ml ya 0,25% novocaine yankho + 5000-10000 mayunitsi a heparin + 3 ml ya 1% methylene buluu yankho + 0,2 ml ya acetylcholine + 4 ml ya no-shpa 1 nthawi mu 3- Masiku 4 mpaka 6-10 jakisoni)

3) kuyambitsidwa kwa vasodilators a magulu atatu: a) myotropic kanthu (no-spa, papaverine, nikoshpan, nicoverin, halidor, etc.), b) kuchita gawo la zotumphukira za cholinergic machitidwe kudzera mwa dongosolo laumwini la autonomic (kupatol, midcalm, andecalin, calicrein depot, delminal, diprofen, spasmolithin, nicotinic acid, etc.). c) ganglion-blocking action (kutsekereza H-cholinergic machitidwe a mizere yopanda zipatso) - benzohexonium, pentamine, dimecolin, etc., ziyenera kukumbukiridwa kuti pamagawo oyamba a matendawa magulu onse atatu a antispasmodics ndi othandiza, ndipo mu gawo IV - gulu loyamba lokha, chifukwa Kukonzekera kwa gulu lachiwiri ndi lachitatu kumawonjezera ma atomu a capillaries, kukulitsa kusokonezeka kwa miyendo m'gululi.

Matenda a neurotrophic ndi kagayidwe kachakudya njira mu minofu ya dzanja lomwe lakhudzidwa - kugwiritsa ntchito mavitamini ambiri (B₁, Mu_6, Mu₁₅, E, PP).

Kukonzekera solcoseryl ndi actovegin - yambitsa makulidwe a oxidative mu minofu, amathandizira kubwezeretsa katundu wa kukonza minofu, zimakhudza kagayidwe kazakudya ndi minofu ya minyewa ngakhale mu magazi ofooka (8 ml kudzera m'mitsempha, 6-20 ml kudzera mu 250 ml ya saline kapena glucose solution, 4 ml intramuscularly) njira ya mankhwala kuchuluka kwa jakisoni 20-25).

Kupititsa patsogolo kukoka kwa magazi ndi zinthu zina zam'magazi zimatheka ndi ntchito hemocorrector - kukonzekera otsika maselo kulemera dextran (reopoliglukin, rheomacrodex, gelatin, reogluman) ndi zotumphukira za polyvinylpyrrolidone (hemodeis), zomwe zimapangitsa magazi kuyenda, kuchepetsa mamasukidwe ake chifukwa cha hemodilution, kuchepetsa masanjidwe am'magazi, kuletsa ma intravascular charge-in thrombosis magazi, thrombin, fibrin), kuonjezera bcc, kuchulukitsa colloid osmotic kuthamanga ndikulimbikitsa kudutsa kwamadzi mu kama wamitsempha).

Matenda a hemocoagulation (ndi kuchulukitsa kwake) ikuchitika ndikugwiritsa ntchito anticoagulants mwachindunji (heparins) ndi osalunjika (pelentan, phenylin, syncumar, warfarin, etc.), komanso distrregants (acetylsalicylic acid, trental, sermion, dipyridamole).

Tiyenera kudziwa kuyendetsa bwino kwa kulowetsedwa kwa mkati kwa nthawi yayitali ndi zosakaniza zambiri zosakanikirana, zomwe zimaphatikizira mankhwala omwe ali pamwambapa, kugwiritsa ntchito zida zapadera ("Drops" ndi ena) patheterizing mtsempha wama femu kapena nthambi zake (a. Epigastrica apamwamba, etc.), mwa kuchulukitsidwa kwa zigawo. Zomwe zimapangidwira zimayambira A.A.Shalimov: saline, reopoliglyukin, heparin, nicotinic acid, ATP, mavitamini C, B_1, Mu₆, 0.25% novocaine solution, painkiller, maola 6 aliwonse, 2 ml ya palibe-shpa, maantibayotiki, mahomoni a corticosteroid (prednisone 10-15 mg patsiku kwa masiku 4-6, ndiye 5 mg kwa masiku 4-5), diphenhydramine kapena pipolfen.

Chithandizo cha physiotherapeutic - Bernard pakali pano, UHF, electrophoresis yokhala ndi novocaine ndi antispasmodics, komanso barotherapy mu chipinda cha Kravchenko ndi magetsi okwera barotherapy mu chipinda cha Schmidt, HBO.

Chithandizo cha Zizindikiro ndicholinga chothetsa ululu, kutupa, kulimbana ndi matenda, kulimbikitsa kuchiritsa kwa zilonda zam'mimba, ndi zina zambiri.

MALANGIZO A wodwala PAKUTI KWA CHITSITSO.

Pakadutsamo kanthawi kochepa osakhala chifuwa champhamvu ndikutulutsa kochepa kuwala, mucous sputum, popanda zosayera. Ululu wochepa m'munsi mwa theka la chifuwa umadziwika, ululu wa paroxysmal, nthawi zambiri m'mawa, sizimatengera kuyenderera kwa chifuwa, sikukutuluka. Dyspnea yolimbikitsira imadziwika ikudutsa oposa 500 metres. BH = 22 pa mphindi. Kuseka, kutentha thupi sikumawonedwa.

ANAMNАESIS MORBI.

Amadziona ngati wadwala kuyambira Seputembara 2, 2002. atamva kuwawa kummero kwake, kutsokomola kwakanthawi kunawoneka, popanda sputum. Pang'onopang'ono, kutsokomola kwake kudakulirakusewera, ndipo kumapangika kamene kamakhala wobiriwira nthawi ya chifuwa, ndikulimba, ndikuyamba kuyenda bwino. Kupumira kwapang'onopang'ono kunawonekera pakadutsa mphindi 200, adayamba kuwona ululu m'munsi mwa theka la chifuwa, ululu sukulimba, akukoka mwachilengedwe, popanda irradiation, nthawi zambiri m'mawa. Pokhudzana ndi izi, wodwalayo adayitanitsa ogwira nawo ntchito kuchipatala chachikulu, ndikugonekedwa kuchipatala chachipatala cha 7 mapiri. Zipatala pa Seputembara 7, 2002

ANAMNАESIS VITAЕ.

Wobadwa pa Okutobala 21, 1941, mwakuthupi ndi m'maganizo sanasiyire kumbuyo. Anayamba kuyenda nthawi, kuyankhula pa nthawi. Anayamba kupita kusukulu kuyambira azaka 7. Kuchita kwa sukulu ndi avareji. Mikhalidwe yanyumba muubwana ndi unyamata, ndipo pakalipano ndiyokhutiritsa. Chakudya chimakhala chokhazikika, katatu pa tsiku, kuchuluka kwa chakudya kumakhala kokwanira, mtunduwo ndiwokhutiritsa. Imadyera kunyumba. Ulendo wamaphunziro azolimbitsa thupi komanso masewera samakhudzidwa. Anayamba kugwira ntchito ali ndi zaka 17 ngati chosoka. Malo ogwira ntchito aukhondo ndiwokhutiritsa. Tsiku logwira ntchito ndi maola 8, ndikupumira chakudya chamasana komanso nthawi yayifupi yopumira. Panalibe ntchito yosinthana ndi kosinthika, sindinapite paulendo wamabizinesi. Pakadali pano sizikuyenda, ali ndi kulumala.

Matenda akale: chiwindi, chifuwa chachikulu, matenda opatsirana pogonana amakana. Adasunthira SARS, tonsillitis.

Kuvulala, ntchito: lumbar gangliosympatectomy kumanja.

Mbiri yabanja: abambo ake kapena mayi alibe matenda opatsirana.

Mbiri ya Epidemiological: Panalibe kulumikizana ndi odwala matenda opatsirana;

Kuledzera kwodziwika bwino: Kusuta fodya kuyambira wazaka 20, zopitilira mapepala awiri patsiku, pazaka zitatu zapitazi kwachepetsa kuchuluka kwa ndudu imodzi m'masiku atatu. Mowa umatha pa tchuthi chokha.

Mbiri yakale: Palibe zowonetsera zilizonse.

STATUS ANAPEREKA. (POPHUNZITSIRA MALO A HOSPITAL). KULIMBIKITSA KWAMBIRI.

Mkhalidwe wokhutiritsa, kuzindikira pang'ono, malo achangu. Zolimbitsa thupi ndizolondola, ndizofanana ndi zaka komanso jenda. Asthenic, popeza thupi ndi lalitali, dera lachi thoracic limakhazikika pamimba, chifuwa chimakhala chachitali, mbali ya epigastric ndi yovuta. Chakudya cha wodwalayo ndi chokwanira popeza makulidwe amakulidwe kumapeto kwake ndi masentimita 1 pafupi ndi navel 2,5. Chikopa ndichopanda utoto, palibe kuchotsera, turgor imasungidwa, popeza khungu limatengedwa ndi zala ziwiri pakatikati pa dzanja lamanja nthawi yomweyo . Khungu chinyezi ndilabwinobwino. Khungu lowuma, loserera, popanda zotupa. Misomali, tsitsi silisintha. The mucous nembanemba wa conjunctiva, mphuno, milomo, milomo yamkati ndi yapinki, yoyera, yonyowa, yopanda zotupa. Ma occipital, posterior cervical, parotid, submandibular, submental, anterior cervical, supraclavicular, subclavian, axillary, elbow, popliteal, ndi inguinal lymph node si palpated. Thupi lamatumbo limapangidwa mokwanira kwa m'badwo wa wodwalayo; kamvekedwe ka minofu ndi mphamvu zake ndizokwanira. Mafupa a chigaza, chifuwa, pelvis ndi miyendo sizinasinthidwe, palibe ululu panthawi yolumikizira komanso kukhudzika, umphumphu suphwanyika. Malo omwe mafayilowo amakhala akusinthika kwawoko, mayendedwe ake ali omasuka, palibe chowawa.

KUDZIWA MUTU.

Mutu wa mawonekedwe wamba, ubongo ndi nkhope za chigaza ndizofanana. Tsitsi lamtundu wamwamuna, kusowa kwa tsitsi, pali imatsitsi pang'ono (zaka). Kutupa kwa palpebral sikunatalikidwe, ana ndi ofanana ndi mawonekedwe, mawonekedwe a ophunzira pakuwala ndi munthawi yomweyo, yunifolomu. Kugwetsa kulibe. Milomo ndi yotuwa pinki, yowuma, yopanda ming'alu. Khosi limakhala lofanana. Chotupa cha chithokomiro sichachilendo kukula, chimasunthika pakumeza, kusasunthika kosasunthika, kosalala, kopanda ululu pakhungu.

MABODZA A UTHENGA WABWINO.

KUMVETSA KWA MTIMA:

Kukopa kwamtima sikupezeka, mawonekedwe a malo a mtima sanasinthidwe, kutsimikizika kwa apical sikuwonekere, palibe chosinthika cha gawo la malo omwe adalipo pamalowo chifukwa cha kukhudzidwa kwa apical, palibe ma pulological.

Kupusitsa kwa apical kumafotokozedwa mu V intercostal space kumanzere kwa midclavicular mzere womwe uli pafupifupi 2,5 cm. Apical chikoka, kugonjetsedwa, kukwera, kuyambitsa, kulimbikitsidwa. Kukopa kwamtima sikupezeka palpation. Chizindikiro cha "mphaka" paphiri pamtima ndi m'malo a polojekiti ya aortic valve kulibe.

Malire a kubvunda kwa mtima kutsimikiza ndi:

Kumanja pamphepete kwakumanja kwa sternum mu 4 malo oyang'ana, (opangidwa ndi atrium lamanja)

Pamwamba mu malo oyambira atatu (atrium wamanzere).

Kumanzere kumanzere kwa midclavicular mu V intercostal space (yopangidwa ndi mbali yamanzere).

Malire a kutsimikiza kwamtima kwathunthu amatsimikiziridwa ndi:

Kumanja kumanzere kwa sternum pamalo a IV intercostal space (opangidwa ndi atrium yamanja)

Pamwamba IV malo okhala pakati (kumanzere atrium).

Kumanzere mu V intercostal danga 1.5 cm mkati kuchokera kumanzere midclavicular mzere. (wopangidwa ndi kumanzere kwamitseko).

Matsenga amtundu wamtima amatsimikiza ndi:

Kumanja 1, 2 malo oyamba 2,5 cm

3 malo oyamba 3 cm,

4 malo oyambira 3.5 cm kuchokera ku midline kupita kumanja.

Kumanzere 1, 2 malo oyanjana 3 cm,

Malo 4 oyambira 8 cm,

5 malo oyambira 10 cm kuchokera ku midline kupita kumanzere.

Masanjidwe amtima wamba:

Dongosolo la mtima 15cm,

Kutalika kwa mtima 16,5 cm

Kutalika kwa mtima masentimita 9,

M'lifupi mwake masentimita 12,

Kutalika kwa mtolo wam'mimba ndi 5.5 cm.

Amawu ndi omveka, omveka. Nyimbo ziwiri, kupuma kwapawiri kumveka. Kutsindika kwa kamvekedwe kachiwiri pa msempha kumatsimikizika (2nd and 5th auscultation point). Kuyimba mtima kumakhala kolondola. Kugunda kwamtima 86 kumenyedwa / mphindi. Pamalo a I ndi IV okopa chidwi, kamvekedwe kamamveka bwino. Mwachilengedwe, kamvekedwe koyamba ndi kotalikirapo komanso kotsika. Pa II, III, V point of auscultation, kamvekedwe ka II kamamvekedwa bwino, kokwezeka komanso kakafupi. Mitundu ya systolic ndi diastolic kung'ung'udza, phokoso lokokomeza mawu silikhala.

KUSINTHA KWA ZINSINSI ZABWINO.

Mitsempha yakanthawi ndi yoyaka nthawi ya palpation imakhala yolumikizidwa (chizindikiro cha nyongolotsi), yolimba, yosasinthika (zotembenuza zina ndi malo ofunda), pali kusunthika kwakukulu kwa mitsempha iyi.

Palibe kutulutsa kwa mitsempha ya carotid (kuvina kwa carotid), kupindika kwamawonekedwe amitsempha ya m'mimba sikutsimikizika. Palibe mitsempha ya varicose. Kugundika kwamtunduwu ndi kwabwino. Pakusangalatsidwa kwa zotengera zazikuluzo, kung'ung'udza kwa systolic kumatsimikiziridwa pamwamba pa khoma lakunja lam'mimba komanso pamitsempha yachikazi pansi pa ligartic ligament.

KUSINTHA KWA DZIKO LAPANSI.

Kukoka kumakhala chimodzimodzi pamitsempha yamagetsi yonse: ma frequent 86 kumenyedwa / mphindi, kwathunthu, pafupipafupi, kwakukulu, kwakukulu, kwakukulu, kulondola. Kuchepa kwa vuto la mtima sikutsimikizika. Khoma lam'mimba limasindikizidwa. Kupsinjika kwa magazi 160/110 (kuthamanga kwa magazi kunayesedwa ndi tanometer malinga ndi njira yowerengera ya Korotkov-Yanovsky).

Pophunzira pulsation ya ziwiya zazikulu zokhala m'munsi, sizotheka kudziwa zamkati pa. dorsalis pedis, a. tibialis posterior, a. poplitea wa miyendo yonse yotsika komanso pa. femoralis mbali yakumanzere. Pa a. chikopa cha femoralis chapulumutsidwa.

MABODZA OTHANDIZA.

kupuma kudzera m'mphuno ndi mfulu. Palibe nosebleeds.

DZIKO LAPANSI:

Chifuwa ndi asthenic, symmetrical, palibe kutembenuka kwa chifuwa mbali imodzi. Palibe kupindika kwa msana. Ma fossae a supra- ndi subclavian amadziwika bwino, chimodzimodzi mbali zonse ziwiri. Ma phewa ali kumbuyo kwa chifuwa. Njira ya nthiti ndizabwinobwino.

Mtundu wa mpweya - pamimba. Kupumira ndikolondola, kwapamwamba, mopingasa, kupumira kwa 24 / mphindi, theka lakumanzere kwa chifuwa kumbuyo. M'lifupi mwa malo oyambira ndi 1.5 cm, palibe bulging kapena sagging ndi kupuma kwakukuru. Maulendo apamwamba amtundu wautali - 4 cm.

CHITSANZO CHOBWINO BWINO:

Chifuwa ndi chowongolera, umphumphu wa nthiti sunasweka. Palibe chowawa palpation. Palibe kuwonjezeka kwamawu akunjenjemera.

Cell PERCUSSION

Phokoso lomveka bwino la m'mapapo limamveka pamwamba paminda yam'mapapo.

M'malire ochepa a m'mapapu: Mapapu akumanja: Phapu lamanzere:

Lin. parasternalis VI malo oyanjana

Lin. Clavicularis VII malo okhala

Lin. axillaris ant. VIII nthiti ya VIII nthiti

Lin. axillaris med. IX nthiti ya IX nthiti

Kutalika kwa mapapu:

Kukula kwa minda ya Krenig:

Kupumira kwa Vesicular kumveka m'minda yam'mapapo. Kupuma kwa bronchi kumamveka pamwamba pa larynx, trachea ndi bronchi yayikulu. Kupuma kwa bronchovascular sikumveka. Wodzigudubuza, wopanda wowerengeka. Kulimbikitsidwa kwa bronchophony pamitundu yopanda chifuwa sikunapezeke.

MABODZA OGWIRITSIRA NDIPONSO OGWIRA NTCHITO.

Kuyendera kwamlomo wamkamwa.

Nembanemba yamkamwa ndi pharynx ndi pinki, yoyera, yonyowa. Palibe halitosis. Lilime ndi lonyowa, palibe chidikiro, masamba ophatikizidwa amatanthauziridwa bwino, palibe zipsera. Palibe caries, pakamwa patayipitsidwa. Matani samatuluka chifukwa cha zingwe zamtundu wa palatine, mipata ndi yopanda malire, osakhudzika. Milomo yamakona popanda ming'alu.

KUYESA KWA CHIPEMBEDZO CHOKHALA KUKHALA NDI CHIPEMBEDZO NDI CHOLOWA CHA GUZANI - GUARDIAN.

Khoma lakumbuyo lakumbuyo limayenderana, limagwira ntchito yopumira. Zakumimba zimapangidwira moyenera. Kuyenda kwamatumbo kosawoneka sikupezeka. Palibe kukula kwa mitsempha yamimba yam'mimba. Palibe kutulutsa kwa hernial ndikusiyanasiyana kwa minofu yam'mimba. Kutupa kwa m'mimba kumachitika. Zizindikiro zakukutetezedwa kwa minofu (kukhazikika kwa minofu ngati khoma lamkati lakumbuyo) kulibe. Chizindikiro cha Shchetkin-Blumberg (ululu wowonjezereka ndi kukoka kobocha mkono pambuyo poyambitsa kupanikizika) sichinatsimikizidwe. Chizindikiro cha Rowzing (kuwoneka kwa ululu m'dera laleal pomwe mukugwiritsa ntchito kunjenjemera kwa dera la kumanzere kwa colon yotsika) ndi zizindikiro zina za kupsinjika kwa peritoneal ndikosavomerezeka. Chizindikiro cha kusinthasintha (komwe kumagwiritsidwa ntchito kudziwa kutulutsa kwaulere m'mimba) ndi chosavomerezeka.

CHITSITSO CHA DZIKO LAPANSI.

1. Danga lachiguduli limakhazikika m'chigawo chakumanzere mu mawonekedwe a chingwe chosalala, chopondera, chopanda ululu, chosasokosera palpation. 3 cm wandiweyani.

2. Cecum imakhazikika m'chigawo cholondola cha leal mwa mawonekedwe a yosalala silinda 3 cm, osakungika. Kusunthika. Zakumapeto sizothandiza.

3. Gawo lokwera lamatumbo limakhazikika m'mbali yoyenera ya leal mwa njira yopanda chopondera 3 cm mulifupi, zotanuka, zam'manja, osagwedezeka.

4. Gawo lotsika la kolonalo limakhala lachigololo kumanzere kwakumanzere kwamtundu wa mainchesi 3 cm, osapweteka, osayenda, osagwedezeka.

5. Colon yopingasa imakhazikika kudera lamanzere mu mawonekedwe a silika yokhala pakati pamagawo 2 cm, oyenda, osapweteka, osasokosera. Amatsimikiza pambuyo pakupeza kupindika kwam'mimba kwambiri ndi njira za auscultofacilitation, auscultopercussion, inclus, palpation.

6. Kutalika kwam'mimba kwambiri ndi njira za auscultofacilitation, auscultopercussion, exusion, palpation, kutsimikizika 4cm pamwamba pa msuzi. Pa palpation, kupindika kwakukulu kumatsimikiziridwa mu mawonekedwe a kugudubuza kwa zotanuka kusasinthasintha, kopanda ululu, mafoni.

7. Woyang'anira pachipata amawoneka kuti ndi silinda yopyapyala yokhala ndi zotanuka, yokhala ndi mainchesi pafupifupi 2 cm. Sipweteka, sizingunthe, sizigwira ntchito.

Phokoso lalikulu la tympanic lapezeka. Chizindikiro cha Mendel kulibe. Mafuta aufulu omasuka m'matumbo am'mimba sizipezeka.

Phokoso lokhazikika lokhala nawo palibe. Phokoso lamatumbo am'mimba limveka.

CHENJEZO: Palibe chotupa m'chigawo cholondola cha hypochondrium ndi epigastric. Kutaya kwa mitsempha ya khungu ndi anastomoses, telangiectasia kulibe.

Chiwindi chimakhazikika mbali yakumanzere yakumanja, pakati komanso mkati mwazithunzi kutengera njira ya Obraztsov-Strazhesko. Mphepete m'munsi mwa chiwindi ndi chozungulira, chosalala, chosalala.

PERCUSSION: Chapamwamba chimatsimikiziridwa ndi -

kumanzere kwakumanja, midclavicular,

mzere wa axillary wakunja

mzere wapakati wa midclavicular pamalire a m'munsi mwa mtengo wozungulira,

motsatana midline 6 cm pamtunda wa navel.

Kukula kwa chiwindi malinga ndi Kurlov: 10x8x7 cm.

KUSINTHA KWA WABWINO KWAMBIRI:

Mukamayang'ana momwe gawo la ndulu ilili kukhoma kwam'mimba (kumanzere hypochondrium) mu gawo la kudzoza, protrusion ndi fixation, sizinapezeke. Chikhodzodzo ndulu sichothandiza. Chizindikiro cha Ortner-Grekov (kuwawa kwambiri pakumenya mbali yotsika mtengo yoyenera) ndi choyipa. Chizindikiro cha phrenicus (kuchepa kwa ululu m'dera lamanja la supraclavicular, pakati pa miyendo ya minofu ya sternocleidomastoid) ndikosavomerezeka.

Palipation ndulu mu supine udindo ndipo kudzanja lamanja sizikudziwika. Palibe chowawa palpation.

m'mimba mwake - 4 cm.

MABODZA A URINARY.

Mowoneka, dera la impso silinasinthidwe. Ndi palpation yokhala m'malo awiri ndi opingasa, impso sizatsimikizika. Chizindikiro cha kumenya sichabwino. Pa palpation m'mphepete mwa ureter, ululu sunawoneke. Ndi percussion, chikhodzodzo ndi 1.5 masentimita pamwamba pa fupa la pubic. Phokoso pamitsempha yama impso silimveka. Ma testicles amakhala opanga mawonekedwe, osakulitsidwa, osapweteka, osasinthasintha. Ndi kuyeserera kwa digito, kumatsimikiza. Matumbo a prostate ali mozungulira, osasinthika, osapweteka. Zilonda ziwiri ndi poyambira zimveka.

NERVO-MENTAL SPHERE.

Kudziwitsa bwino, nzeru zabwinobwino. Kukumbukira zochitika zenizeni kumachepetsedwa. Malotowa ndi osaya, amafupika, akusowa tulo. Kusinthaku ndikwabwino. Palibe zosokoneza pakulankhula. Palibe kukokana. Mlemewo umakakamizidwa, wodwala amayima poyenda. Reflexes adapulumutsidwa, paresis, palibe ziwalo. Amadziwona ngati munthu wochezeka.