I-edema yepulmonary yimeko yesifo esiyingozi ngenxa yokungena kwe-non-inflammatory fluid kwi-capillaries ye-pulmonary kwi-interstitium ne-alveoli. Ngenxa yoko, kukho ukuphulwa ngokukhawuleza kokutshintshwa kwegesi, i-oksijini yindlala, iqala, izicubu kunye nezitho ezikhuphayo.
Iintlobo ze-edema ye-pulmonary
OL ngumqathango apho kufuneka kunikwe uncedo ngokukhawuleza. Inokuvela ngenxa yokuzikhandla ngokomzimba, kwaye ebusuku - ngokuphumla. Ngamanye amaxesha i-edema ye-pulmonary iba yinkxalabo, eyenza ivela kwimvelaphi yephulo lokusasazwa kwamanzi asemzimbeni. Iinqwelwana azikwazi ukujamelana nokugqithisa kwegazi ezifakwe kwii-capillaries, kwaye utywala ngaphantsi kwengcinezelo ephezulu idlula kwi-alveoli. Ngenxa yoko, imiphunga imise ngokuchanekileyo imisebenzi yawo eyintloko.
Ukuphuhliswa kwe-OL kwenzeka kwizigaba ezimbini. Okokuqala igazi lingena kwi-interstitium. Le meko ibizwa ngokuthi i-edema ye-pulmatic intermacy. Ngalo, i-parenchyma igxininiswe ngokupheleleyo, kodwa i-lumen ye-alveoli ayifaki i-transudate. Ukusuka kwisithuba sendawo, ukuba ingcinezelo ayinciphisi, igazi legazi lingena kwi-alveoli. Kule meko, i-edema ye-alveolar pulmary is diagnostic.
I-edema ye-Lung iyakwazi ukuhlulwa ngexesha lokuphuhlisa:
- I-Acute iyenzeka kwiiyure ezingama-2-4.
- Kuthatha iiyure eziliqela ukuphuhlisa ixesha elide. Unokuhlala usuku okanye ngaphezulu.
- Ukukhanya ngokukhawuleza kuyingozi kakhulu. Iqala ngokukhawuleza, kwaye imizuzu embalwa emva kokuqala kokufa.
I-edema yepalmyd cardiogenic
Izifo ezahlukahlukeneyo zingabangela ingxaki ye-AL. I-edema yepalmy cardiac isetyenziswe xa intliziyo ibandakanyeka kwinkqubo yokugula. Izifo ezibangele ukuphazamiseka kwimisebenzi ye-systolic kunye ne-diastolic ye-ventricle yekhohlo. Bhekane nengxaki enkulu kubantu abanesifo senhliziyo. Ukongezelela, i-edema ye-pulmonary ne-myocardial infarction, ingozi yexinzelelo, isifo senhliziyo senzeke. Ukuze uqiniseke ukuba i-OL iyinyani ye-cardiogenic, kufuneka uhlolisise i-pulillary capillary pressure. Kufanele kube ngaphezu kwe-30 mm Hg. Ubugcisa.
I-edema ye-pulmatic pulmonary
Olu hlobo lwe-OL lunokubangelwa zizifo ezahlukahlukeneyo, ezikhokelela kwingxaki enye - ukuphulwa kobunzima bomlenze we-alveolar. Izifo ezibangela i-edema engeyona ye-cardiogenic:
- i-pneumonia (zombini ibhaktheriya kunye nentsholongwane);
- I-DIC syndrome;
- ifom ye-pancreatitis ephazamisayo;
- ixinzelelo lomphunga.
Ingxaki enkulu kukuba i-edema ye-cardia kunye neyiyo ye-cardiac inzima ukuhlula phakathi komnye. Ukuze ukwazi ukwahlula kakuhle ingxaki, ingcali kufuneka iqwalasele imbali yonyango yesigulane, ihlole i-myocardial ischemia, kwaye imilinganiselo ye-hemodynamics ephakathi. Kwi-diagnostics, uvavanyo oluthile lusetyenziswa-ukulinganisa koxinzelelo lwe-jam. Ukuba amanani angaphezulu kwe-18 mm Hg. Ubugcisa. Ngaba i-edema ye-cardiogenic. Ngengxaki yomsuka ongenawo umphefumlo, uxinzelelo luhlala luqhelekileyo.
I-edema ye-pulmonary
Urhulumente uza ngenxa ye:
- ukwandisa ukunyuswa kwamathambo;
- ukuphulwa kweengqibelelo zabo;
- ukuphulwa kweenkqubo eziphambili ezivela kwi-arc neurovegetative arc;
- indlala yomoya.
I-edema yetyhefu ineempawu ezithile. Unenkqubela ecacileyo. Ukongezelela, iimpawu eziqhelekileyo ze-OL zidibaniswe kunye neempawu zokutshiswa kwamakhemikhali kunye neethambo ezinokuphefumula. Amachiza ayahlula ezine ixesha eliphambili lokuphuhliswa kwengxaki:
- Okokuqala, ukubonakaliswa kweziphazamiso ze-reflex kuyimpawu: ukukhwehlela, i-dyspnea enamandla, i-lachrymation engapheliyo. Kwiimeko ezinzima kakhulu, ukuma kwe-reflex yentliziyo kunye nokuphefumula kungenzeka.
- Ngethuba lexeshana, iimeko zomsindo zancinci. Ihlala kwiiyure ezimbalwa ukuya kwiintsuku eziliqela (kodwa njengomthetho, kungekho ngaphezu kweeyure ezingama-4 ukuya kwe-6). Nangona uphuhliso oluqhelekileyo lwesigulane lubuye luzinzile, amanyathelo okuxilonga anganquma iimpawu zedemema ezayo: ukuphefumla kuya rhoqo, i-pulse iyancipha.
- Isigaba sesithathu sibonisa ukuvuvukala. Ulala malunga nomhla. Ngeli xesha, iqondo lokushisa liphakama, i-leukocytosis engekho neutrophilic ikhula.
- Ekugqibeleni, kukho imiqondiso yeengxaki, ezinokuba zizifo ezinjalo, njenge-pneumonia okanye i-pneumosclerosis.
Yintoni eyenza i-edema ye-pulmonary?
Izizathu zokuthi kungani imiphunga ikhula, eninzi. Phakathi kwazo eziphambili zazo:
- i-sepsis (kwiimeko ezininzi eziphuhliswayo kwimvelaphi yokungena kwe-toxins kwigazi);
- ukugqithisa iziyobisi;
- pneumonia ;
- ukudlula izidakamizwa ezithile (eziyingozi kakhulu iziyobisi ezichasayo nezidakamizwa ze-cytotoxic);
- umonakalo wemisebe kwimiphunga;
- utyhefu ngetyhefu;
- i-stasis kwinqanaba lokuqala lokujikeleza (elibhekiselwe kwi-asthma, i- emphysema nezinye izifo zamaphaphu);
- isifo esingapheliyo okanye ngokukhawuleza kwehla kwinqanaba leprotheni egazini (njengokwi-cirrhosis, nephrotic syndrome kunye nezinye i-pathologies zezintso);
- ukungena;
- ifom ye-pancreatitis ephazamisayo;
- utyhefu nge gesi ;
- isifiso esiswini;
- pneumothorax ;
- kuhlala kwindawo ephakamileyo;
- ukungeniswa okungalawulwayo kokungasebenzisi ukulawula okungenalawulekiyo.
I-edema yePulmonary ene-heart failure
Le ntsholongwane yinqanaba lokugqibela lokunyuka kwengozi kwi-pulmonary circulation. I-edema yepulmonary kwisifo senhliziyo ikhula kwiintlobo ezinzima zokwahluleka kwentliziyo nokuphazamiseka kwenkqubo. I-edema ye-Cardiogenic ibonakala ngumkhuhlane kunye nokukhutshwa kombala we-sputum. Kwiimeko ezinzima kakhulu, isigulane sibhekane nokunqongophala okukhulu kwe-oksijeni kwaye ilahlekelwe yintliziyo. Ukuphefumula kwezigulane kuya kuba yinto engacacanga kwaye ayiphumeli ngokupheleleyo, ngoko ke kufuneka ukuphuphuma umoya kwemiphunga.
I-edema yepulmonari ukuphakama
Ukuwunqoba kweentlanzi kuyimidlalo eyingozi kwaye kungekhona nje ngenxa yengozi yokuguqulwa kwama-avalanche. Ukuvuthwa kwemiphunga kwiintaba kuyaqhelekile. Yaye iyakwazi ukuphakama kubantu abakwaziyo ukunyuka nokunyuka. Ephakamileyo ukhuphuka ezintabeni, i-oksijini encinane umzimba wakho ufumana. Ephakamileyo, uxinzelelo luyahla, kwaye igazi elidlula emiphakeni alifumani inani elifanelekileyo legesi elisebenzayo. Ngenxa yoko, umbane uqokelela kwimiphunga. Kwaye ukuba ungekuncedi ukuvuvukala kwemiphunga, umntu unokufa.
I-edema ye-pulmonary kwizigulane ezilala
Umzimba womntu awuhambiswanga ukuba ube kwindawo engqambileyo ixesha elide. Ngako oko, ezinye izigulane ezithembekileyo ziqala iingxaki ezinjenge-OL. Iimpawu zengxaki zifana neemeko ezibangelwa zizifo ezibi kakhulu, kodwa kulula ukunyanga i-edema yeplmon, ngoba kuba yinto esaziwayo kwangaphambili ukuba kutheni.
Kwaye kwizigulane zokulala, i-edema ye-pulmona ibangela izizathu ezilandelayo: kwindawo ephakamileyo, umoya ongaphantsi kwe-inhaled. Ngenxa yoko, ukuhamba kwegazi emiphakeni kuncipha, kwaye iziganeko eziqhubekayo zikhula. I-Sputum, equkethe izixhobo ezivuthayo, iqokelela, kwaye i-expectorate inzima. Ngenxa yoko, iinkqubo eziqhubekayo ziqhubela phambili, ukukhukhuma kuqhubeka.
Iimpawu ze-edema zempawu, iimpawu
Ukubonakaliswa kwe-OL enzima kunye nexesha elide lihlukile. Olu phuhliso lukhula ngokukhawuleza. Iyokuqala "ukugwinya", isilumkiso malunga neengxaki, iba ngumphefumlo omfutshane. Ekuqaleni kuvela kuphela ngexesha lokuzikhandla komzimba, kodwa ngexesha, ukuphefumula kuya kuba nzima nakwimeko yokuphumla ngokupheleleyo. Kwizigulane ezininzi, ngokuhambelana nokuphefumula okufutshane, iimpawu ze-edema zamapulmoni ziboniswa ngumzekelo, ukuphefumula ngokukhawuleza, ukuzondwa, ukulala, ubuthakathaka jikelele. Ukubonisa ukuba ingozi ingaba yinkqubo yokuphulaphula imiphunga-engaqhelekanga, i-gurgling kunye nezandi ezivuthayo ezivakalayo kwi-stethoscope.
I-edema ye-pulmatic Acute ayinzima ukuyibona. Ngokuqhelekileyo kubonakala ebusuku, ngexesha lokulala. Indoda ivukela ekuhlaselweni kokuxhatshazwa okukhulu. Iphazamisa ukwesaba, ngenxa yoko kuhlaselwa kuphela. Emva kwesikhashana, ukukhwehlela, i-pallor, ibiza i-cyanosis, ukukhupha okubandayo, ukuthuthumela, ukubethelela intlungu kwindawo yesifuba kwongezwa kwiimpawu ezikhoyo. Kwinkqubo yokwandisa i-edema, ukudideka kungahle kwenzeke, uxinzelelo lwegazi lungawela, okanye luthintele
I-edema yonyango yonyango
Ulwaphulo lwe-AL lufanele lujoliswe ekunciphiseni ukwenzela ukuba emva koko luphelise ngokupheleleyo zonke izizathu ezibangela ukuba kwenzeke.
Nantsi indlela yokuphatha i-edema ye-pulmonary:
- Okokuqala, onke amanyathelo afanelekileyo kufuneka athathwe ukunciphisa ukuhamba kwegazi emiphakeni. Ukwenza oku kuya kunceda i-vasodilators, i-diuretics, inkqubo yokuchithwa kwegazi okanye ukusebenzisa i-tourniquet.
- Ukuba oku kunokwenzeka, kubalulekile ukubonelela ngeemeko zokuphuma kwegazi-ngokusebenzisa ukukhawuleza ukunyanyiswa kwemizimba kunye nokunciphisa ukuxhatshazwa kwemisipha ye-peripheral.
- Ulwaphulo lwe-oksijeni lunceda ukuqeda iimpawu ze-edema ye-pulmonary.
- Kubaluleke kakhulu ukubonelela isigulane uxolo kunye nokumkhusela kwiimeko ezixinzeleleyo.
- Kwiimeko ezinzima kakhulu, umxube we-5 ml we-96% yotywala kunye ne-15 ml yesisombululo se-5% se-glucose kwi-trachea okanye nge-intravenously ivumelekile.
I-edema ye-edema - uncedo olungxamisekileyo, i-algorithm
Ngokukhawuleza ukuba ukubonakaliswa kokuqala kwe-AL kuqaphele, umntu kufuneka ancedwe ngaphambi komzuzu wokubhedlelelwa esibhedlele. Ngaphandle koko, ukuhlaselwa kungabangela ukufa.
Inkathalo engxamisekileyo ye-edema ye-pulmona yenziwa ngokulandela le algorithm elandelayo:
- Ixhoba kufuneka lifakwe kwindawo ehleli kuyo.
- Coca iphepheni yokuphefumula ephezulu kwi-foam nge-oxygen inhalation.
- Iintlungu ezibukhali zokuyeka i-antipsychotics.
- Buyisela izinga lentliziyo.
- Ukuqhelanisa i-electrolyte kunye ne-acid-base balance.
- Ngoxa uncedwa ngama-analgesics, ubuyisele uxinzelelo lwe-hydrostatic kwisangqa encinci.
- Nciphisa ixabiso leempahla kunye nomthamo we-plasma ye-intrathoracic.
- Usizo lokuqala lwe-pulmary edema lubandakanya ukuqaliswa kwe-carlyac glycosides.
I-edema ye-edema - unyango
Unyango olunzulu luqhubeka esibhedlele. Ukulwa nale ngxaki njengemithi ye-edema ye-pulema iya kufuna oku kulandelayo:
- Morphine;
- Fentanyl;
- Furosemide ;
- Korglikon;
- Strofantin;
- Eufillin ;
- Aminophylline;
- ii-antibiotics (kwimeko yeengxaki zebhakteria).
Imiphumo ye-edema yemiphumo
OL unokufumana imiphumo eyahlukileyo. Ukuba unonophelo lwengxamiseko lunikezelwe ngexesha kunye ngokuchanekileyo kwaye unyango olulandelayo lwenziwa ngabachwephesha abaqeqeshiweyo, nokuba i-edema yepommatic ekhuselekileyo izakulibala ngokukhuselekileyo. I-hypoxia ehlala ixesha elide inokubangela iinkqubo ezingenakwenzeka kwiinkqubo zesantya zentliziyo kunye nengqondo. Kodwa kwiimeko ezibuhlungu kakhulu, ukuqala ngokukhawuleza kwe-edema eqaqambileyo kubangela umphumo obulalayo.
I-edema ye-edema - iprognosis
Kubalulekile ukuqonda ukuba i-AL yinkinga apho i-prediction ibonakala ingalunganga. Ngokwezibalo, malunga ne-50% yezigulane ziphila. Kodwa ukuba kwakunokwenzeka ukuxilonga i-edema yepommonari yokuqala, amathuba okuphucula. Ukukhukhumeza, ukukhula ngokuchasene nemvelaphi ye-myocardial infarction, kukhokelela ekufeni kwiimeko ezingama-90%. Ukubuyiselwa emva kokuhlaselwa kwezigulane ezinyangeni ezimbalwa kufuneka kugcinwe oogqirha.