Acute Respiratory Distress Syndrome (ARDS): nhungamiro yehutungamiri hwevarwere uye kurapwa

By Cristiano Antonino On Dai 10, 2023

Iyo "Acute Respiratory Distress Syndrome" (yakapfupikiswa neiyo acronym ARDS) maererano netsanangudzo yeWHO (World Health Organisation) "kukuvadzwa kwakapararira kwealveolar capillaries kukonzeresa kutadza kufema kwakanyanya ne arterial hypoxemia refractory to the administration of oxygen"

ARDS naizvozvo mamiriro ezvinhu, anotarirwa nezvikonzero zvakasiyana-siyana, zvinoratidzwa nekuderera kwehuwandu hweokisijeni muropa, iyo inopesana neO2 therapy, kureva kuti iyi yekuisa haimuki kutevera kutungamirirwa kweokisijeni kumurwere.

Aya ma pathologies anofanirwa kurapwa nekuchimbidza munzvimbo dzekuchengetedza zvakanyanya uye, mumatambudziko akakomba, anogona kutungamira kurufu rwemurwere.

ARDS inogona kukura muvarwere vezera ripi neripi, vatova nemhando dzakasiyana dzechirwere chemapapu, kana muzvidzidzo zvine basa remapapu rakajairwa.

Chirwere ichi dzimwe nguva chinonzi sevakuru kufema kunetseka syndrome, kunyangwe chinogona kuitika muvana.

Iyo isinganyanyi kuomesesa fomu yeiyi syndrome inonzi "acute lung kukuvara" (ALI). Panyaya yemurwere wevana, inonzi neonatal Respiratory Distress Syndrome (NRDS).

Mamiriro ezvinhu uye pathologies inofanotaura kutanga kweARDS ndeye

kunyura;
kudzipwa;
aspiration (inhalation) yezvokudya kana zvimwe zvinhu zvekunze mumapapu;
coronary artery bypass operation;
kutsva kwakanyanya;
pulmonary embolism;
chirwere chemabayo;
pulmonary contusion;
kushungurudzika kwemusoro;
kukuvadzwa kwemarudzi akasiyana-siyana;
nemwaranzi;
high altitudes;
inhalation yemagasi ane chepfu;
utachiona nemavhairasi, mabhakitiriya kana fungi;
kuwandisa kwezvinodhaka kana zvimwe zvinhu, zvakadai seheroin, methadone, propoxyphene, kana kuti aspirin;
sepsis (chirwere chakakomba chakapararira);
kuvhunduka (yakareba yakanyanya arterial hypotension);
haematological kuchinja;
zvinetso zvekudzivirira (toxemia, amniotic embolism, postpartum endometritis);
lymphatic obstruction;
extracorporeal circulation;
chirwatata;
uropi sitiroko;
pfari;
kuisirwa ropa kweanopfuura zvikamu gumi nezvishanu zveropa munguva pfupi;
uremia.

Pathogenesis yeARDS

MuARDS, madiki emhepo cavities (alveoli) uye pulmonary capillaries zvinokuvadzwa uye ropa nemvura zvinopinda munzvimbo dziri pakati pemukanwa uye, pakupedzisira, mukati memakomba pachawo.

MuARDS pane kusavapo kana kuderedzwa kwe surfactant (mvura inoputira mukati meiyo alveoli uye inobatsira kuti irambe yakavhurika), iyo inokonzera kuwedzera kusimba kwemapapu akafanana neARDS: kushaikwa kwe surfactant kunokonzera kudonha kwe. yakawanda alveoli (atelectasis).

Kuvapo kwemvura mualveoli uye kuputsika kwavo kunovhiringidza kuendeswa kweokisijeni kubva kumhepo yakafemerwa kuenda kuropa, nekuderera kwakanyanya muropa reokisijeni.

Kufambiswa kwecarbon dioxide kubva muropa kuenda kumhepo yakabuda mumhepo hakuna kukanganiswa, uye mazinga eropa carbon dioxide anosiyana zvishoma.

ARDS inoratidzwa ne

acute kutanga;
bilateral pulmonary infiltrates inoratidza edema;
hapana humbowo hwekusiya atrial hypertension (PCWP <18 mmHg);
PaO2/FiO2 chiyero <200.
Izvo zvakafanana maitiro, asi nePaO2 / FiO2 ratio <300, tsanangura acute lung kukuvara (ALI).

Zviratidzo zveARDS ndizvo

tachypnea (kuwedzera kwekufema kwekufema);
dyspnoea (kunetseka kwekufema ne "nzara yemhepo");
kuputika, mhere-mhere, mhirizhonga dzakapararira pakuputika kwepulmonary;
asthenia (kushaya simba);
general malaise;
kupfupika kwekufema, kukurumidza uye kudzika;
kutadza kufema;
cyanosis (kuonekwa kwezvigamba kana bluish discoloration paganda);
kusashanda zvakanaka kwedzimwe nhengo;
tachycardia (kuwedzera kwemwoyo);
cardiac arrhythmias;
kuvhiringidzika mupfungwa;
kuneta;
hypoxia;
hypercapnia.

Zvimwe zviratidzo zvinogona kunge zviripo zvichienderana nechirwere chinokonzera ARDS.

ARDS inowanzokura mukati memaawa 24-48 ekukuvara kana etiological factor, asi inogona kuitika mazuva 4-5 gare gare.

kuongorora chirwere

Kuongororwa uye kusiyanisa kuongororwa kunobva pakuunganidzwa kwedata (nhoroondo yekurapa), kuongororwa kwemuviri (kunyanya chipfuva auscultation), uye mamwe akasiyana ma laboratory uye ekufungidzira bvunzo, senge:

ropa count;
kuongororwa kwegasi reropa;
spirometry;
mapapu bronchoscopy pamwe biopsy;
chipfuva x-ray.

Kutadza kufema zvakanaka kunokonzeresa kuunganidzwa kwemativi maviri kunoonekwa pachipfuva x-ray uye zvirwere zvinogara zvichipindana zvichikonzera rufu mune zvinopfuura makumi mashanu muzana ezviitiko.

Muchikamu chakaoma, mapapu anowedzera kukura, akatsvuka, akazara uye anorema, ane kupararira kwealveolar kukuvara (histologically, edema, hyaline membranes, kuzvimba kwakanyanya kunoonekwa).

Kuvapo kwemvura kunoonekwa munzvimbo dzinofanirwa kuzadzwa nemhepo.

Muchikamu chekuwedzera uye kurongeka, nzvimbo dzakabatana dze interstitial fibrosis nekuwanda kwerudzi rwechipiri pneumocytes dzinoonekwa.

Bacterial superinfections inowanzoitika muzviitiko zvinouraya. Kuongororwa kwegasi reropa kunoratidza kuderedzwa kweokisijeni muropa.

Kuongororwa kwakasiyana kunosanganisira zvimwe zvirwere zvekufema uye zvemwoyo uye zvingada zvimwe zviedzo, zvakadai se electrocardiogram uye cardiac ultrasound.

Neonatal Respiratory Distress Syndrome (NRDS)

NRDS inogona kuonekwa mu2.5-3% yevana vanobvumirwa kuPediatric Intensive Care Units.

Chiitiko chacho chinopesana nezera rekuzvitakura uye uremu hwekuzvarwa, kureva kuti chirwere ichi chinowanzoitika kana mwana achangoberekwa ari nguva isati yakwana uye uremu hushoma.

Neonatal kushungurudzika kunoratidzwa ne:

hypoxia;
diffuse pulmonary infiltrates pachipfuva X-ray;
occlusion pressure mupulmonary artery;
basa remwoyo rinogara riripo;
cyanosis (bluish ruvara rweganda).

Kana mafambiro ekufema achiitwa nemuromo wakavharwa, zvipingamupinyi zvakakwirira zvinofanirwa kufungidzirwa: muromo unofanirwa kuvhurwa uye maoropharyngeal cavities acheneswe ezvakavanzika nechishuwo chakapfava.

Chinonyanya kukosha ndechekudzivirira kuberekwa kusati kwasvika (kusanganisira kusaita chikamu chisina kufanira kana chisina nguva yekuvhiya), kutungamira kwakakodzera kwepamuviri panjodzi huru uye kurwadziwa, uye kufanotaura uye kurapwa kunobvira kwemapapu kusakura muchibereko.

mabatiro

Sezvo mu70% yezviitiko kufa kwemurwere kunoitika KWETE kwekutadza kufema asi kune mamwe matambudziko ane chekuita nechikonzero chinokonzera (kunyanya matambudziko mazhinji anokonzera renal, hepatic, gastrointestinal kana CNS kukuvara kana sepsis) kurapa kunofanirwa kunangana ne:

shandisa okisijeni kurwisa hypoxia;
kubvisa chikonzero chakakonzera ARDS.

Kana okisijeni yakapihwa pachivhariso chemeso kana nemumhino ikasashanda mukugadzirisa mwero weokisijeni weropa wakaderera (unoitika kazhinji), kana kana madosi makuru eokisijeni akafemerwa achidikanwa, kufefetedza kunofanira kushandiswa. mechanical: chiridzwa chakakosha chinoburitsa mweya wakazara-okisijeni pasi pekumanikidzwa nechubhu iyo, kuburikidza nemuromo, inounzwa mutrachea.

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mhepo pakuwedzera kudzvinyirira panguva yekufemerwa;
mhepo pamhepo yakaderera panguva yekufema (inotsanangurwa seyakanaka kuguma-expiratory pressure) iyo inobatsira kuchengetedza alveoli yakazaruka panguva yekupedzisira-expiratory phase.

Kurapa kunoitika mukamuri yevanorwara zvakanyanya

Kutungamirirwa kweO2 kunoratidza kuti kunobatsira chete mumatanho ekutanga echirwere, zvisinei kuti hazviunzi zvikomborero pane kufungidzira.

Endotracheal instillation ye multiple doses of exogenous surfactant muvacheche vane huremu hunoda 30% okisijeni uye rubatsiro rwemhepo: kupona kunowedzera, asi hakubatsiri zvakanyanya kuitika kwechirwere chisingaperi chemapapu.

Kufungidzira kweARDS: zvekuita?

Kana uchifungira ARDS, usamirire zvakare woendesa munhu wacho kuDepartment of Emergency, kana kubata Single Emergency Number: 112.

Prognosis uye kufa

Pasina kurapwa kunoshanda uye nenguva, ARDS zvinosuwisa kuti inokonzera rufu mu90% yevarwere, zvisinei, nekurapa kwakakwana, vangangoita 75% yevarwere vanorarama.

Zvinhu zvinokanganisa prognosis ndezvi:

zera remurwere;
hutano huzhinji hwemurwere;
comorbidity (kuvapo kwemamwe pathologies akadai arterial hypertension, kufutisa, chirwere cheshuga mellitus, chirwere chakanyanya chemapapu);
kukwanisa kupindura kurapwa;
utsi hwefodya;
kukurumidza kuongororwa uye kupindira;
hunyanzvi hwevashandi vehutano.

Varwere vanopindura nekukurumidza pakurapwa ndeavo vangangoita kwete kungorarama chete, asiwo kuve nekukuvadzwa kushoma kana kusavapo kwenguva refu kwemapapu.

Varwere vasingadaire nekukasira kurapwa, vanoda rubatsiro rwekufemesa kwenguva refu, uye vachembera/vakaremara vari panjodzi huru yekukuvadzwa kwemapapu uye kufa.

Mavanga anogona kuchinja kushanda kwemapapu, chokwadi chinoonekwa nedyspnoea uye kuneta kuri nyore pasi pekuedza (muzviitiko zvisinganyanyi kukosha) kana kunyange pakuzorora (muzviitiko zvakakomba).

Varwere vazhinji vane kukuvara kusingaperi vanogona kuve nekurasikirwa kwakakosha uremu (kuderera kwehuremu hwemuviri) uye tsandanyama toni (kuderera mu% yehuremu huremu) panguva yekurwara.

Kudzoreredza munzvimbo dzakakosha dzekudzoreredza kunogona kubatsira zvakanyanya pakuwanazve simba uye kuzvimiririra panguva yekupora.