Iyo 6 zvikamu zvekiriniki kosi yekutsva: kutungamira kwevarwere

By Cristiano Antonino On Apr 15, 2023

Kliniki yemurwere anopisa: kutsva ironda remukati metishu (ganda uye ganda appendages) rinokonzerwa nekuita kwekupisa, makemikari, magetsi kana radiation.

Kurongwa kwezvikamu zvekutsva

Inogona kuva yezvikamu zvakasiyana-siyana zvichienderana nekusimba kwekushisa, nguva yekubatana uye chimiro chemuviri wechinhu chinopisa (chakasimba, mvura kana gasi); maererano nekuomarara ivo vakakamurwa kuita mapoka (1st, 2nd, 3rd uye 4th degree).

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Kliniki yekutsva inogona kukamurwa kuita 6 nhanho:

chikamu chekuvhunduka kwekutya kubva pakurwadziwa kunotyisa;
hypodynamic chikamu kana chikamu che hypovolemic shock (maawa makumi mana nemasere ekutanga);
catabolic phase (asati apisa kuvhara);
chikamu che exudate absorption toxicosis;
nhanho ye sepsis nehutachiona hwemaronda;
danho resyncratic dystrophy kana convalescence.

1) Nervous shock phase

Inotora maawa mashomanana, uye inoratidzwa ne: psychic excitement, kurwadziwa kwakanyanya, nyota yakasimba, kutuka, polypnoea (kufema kakawanda pamusoro penguva dzose), kushaya hope (dzimwe nguva delirium uye convulsions), zvishoma kana kusina diuresis, gastrointestinal atony, kuchinja kamwe kamwe muropa. pressure.

2) Chikamu che hypovolemic shock

Inoratidzwa ne: kudiki uye kazhinji kupuruzira, kuderera kweropa (kunyanya systolic), peripheral cyanosis, kutonhora dikita, tembiricha yakaderera (36-35 ° C), kudzika uye kufema nguva dzose, kusagadzikana kwekutya kushandurana nenguva yekuora mwoyo nekukotsira, kusava nehanya. , adynamia; kuramba uchida kuita weti nekubuda kwemadonhwe mashoma kana anuria, ura hwakavharwa netsvina uye gasi, haemodynamic dambudziko rinotora kubva maawa mashoma kusvika 3-4 mazuva.

Murwere anogona kufa nekuda kwekushaya simba kwemoyo. Hemodynamic shanduko dzinosanganisira:

tachycardia;
kuderera kweropa;
kuderedza kubuda kwemoyo;
vasoconstriction.

Kubuda kwemoyo kunogona kuderera kusvika 30-50% yezvakajairwa nekuda kwe hypovolemia uye myocardial depressant factor.

Kubuda kwemoyo kunowanzoita kune akajairwa mazinga chete mushure memazuva akati wandei, kunyangwe kana infusion therapy iri chokwadi.

Kuchinja kwerenal function kunokonzerwa ne:

hypovolemia;
vasoconstriction;
kuvhura kwe arteriovenous shunts nekupfuura itsvo;
adrenal imperative.

Masero ejuxtaglomerular eitsvo anoburitsa renin mukutenderera mukupindura kushaikwa kwesodium, kuderera kweropa (hypovolemia), uye kunzwira tsitsi nerve stimulus (nekuda kwe hypovolemia).

Renin inokonzera, kuburikidza neangiotensin, kubudiswa kwehomoni kubva kune adrenal cortex (cortisol, mineralocorticoids eg aldosterone, glucocorticoids, nezvimwewo) iyo inoshanda pane renal reabsorption.

Izvi zvinotevera zvinoitika:

oliguria (zvakanyanya kana zvishoma zvakanyanya);
kuderedza glomerular filtration;
sodium retention (aldosterone);
kuwedzera kubudiswa kwe potassium (aldosterone).

Kana kurapwa kwakaringana, zviratidzo izvi zvingasaonekwa, kana zvisina kudaro, kusakwana kwerenal kwakafanana nehemorrhagic shock inogona kuitika.

Mushure memavhiki 2-3 panogona kunge paine giramu-negative septic shock izvo zvinowedzera kuwedzera kushanda kwetsvo, pamwe nekutanga kunowanzo kuuraya kusingadzoreki kutadza kwerenal kukundikana.

Dzidziso dzinoverengeka dzinotsanangura oliguria, iyo inogona kuve nekuda kwe:

tsinga reflex iyo inokonzera spasm ye afferent arterioles;
sumo mukutenderera kwezvinhu zvine muchetura zvakaburitswa kubva munzvimbo yakatsva izvo zvaizoita pamwero weglomerular kana nekugadzira spasm yeafferent arterioles inovhara kusefa;
kuyedza renal kutsiva hydrometabolic alterations kuburikidza nehukuru tubular reabsorption yesodium nemvura nekudzikisa weti kubviswa. Muchikamu chekutanga, kushandiswa kweiyo renin-angiotensin system yakasimbiswa zvakare, iyo inokonzera kuchengetwa kwesodium.

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3) Catabolic chikamu

Chikamu chechitatu chinoratidzwa ne:

yakaderera general reactivity yezvipenyu;
yakashata nitrogen balance;
kuderera kwekugona kudzivirira.

Kana septic shock ikaitika muchikamu ichi, kutadza kwetsvo kunotungamirira kurufu.

Iyo yakanyanya kuvimbika data yekutarisa renal basa ndeye plasma uye weti osmolarity.

Kana izvi zvikaramba zvichiwedzera (progressive hyperosmolarity) chirevo chinova chisina kunaka.

Zviratidzo zvekuwedzera kwe hyperosmolarity ndezvi: nyota yakanyanyisa, kuchinja kwekuziva, kukanganiswa kwemaitiro, kuona, kuona, coma, kugwinha, kufa.

Iyo yakaipa nitrogen chiyero uye kushomeka kwesimba kune chikamu chine chekuita nekushaikwa kwekuwedzera kwemvura inoputika.

Nguva uye kusimba kweiyo catabolic phase ine hukama ne:

chiyero uye chiyero chekupisa;
kuomarara kwechero nzira dzehutachiona;
chirongwa chekudya;
nguva yechikamu chakazaruka chemaronda.

Muchikamu ichi simba rinodiwa remakoriyori rakakura kupfuura 4000cal / zuva.

Pasinei nekuiswa kwemishonga yakakodzera, iyo positivization yenitrogen balance inowanikwa chete muchikamu chekugadzirisa.

4) Chikamu che toxicosis (autotoxic shock)

Zvinoonekwa mushure memazuva 3-4.

Kudzoreredzwa kwetransudate uye exudates kubva munzvimbo dzakapiswa kunoisa zvinhu zvine chepfu mukutenderera.

Mushure menguva yehutano huri pachena (inozivikanwa nekugadzirisa pulse, kumanikidzwa uye tembiricha), vanoona zviratidzo zvitsva zvakadai se: kupisa kwakanyanya (39-40 ° C), musoro, kusvotwa uye maronda ekubuda ropa.

Ichi chikamu chinogona kutora kubva pamazuva gumi nemashanu kusvika makumi maviri.

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5) Nhanho ye sepsis

Imhaka yehutachiona hwenzvimbo dzakatsva dzinofambiswa ne immunosuppression.

Kupisa kunotanga kukwira zvakare nekuenderera mberi uye kubvisa kupisa kunotangira kana kuperekedzwa nechando, kutemwa nemusoro, kusvotwa.

Kutsikirira kunowanzoitika uye kudzvinyirirwa kunodzikiswa. Iko kune virulence yecutaneous saprophytic germs iyo inosvibisa pamusoro peiyo granulation tissue panguva ye sepsis (iyo gram-negative: Pseudomonas, Serratia, Klebisiella, Candida, etc.)

6) Syncrasic dystrophy phase kana convalescence phase

Pane kupora zvishoma nezvishoma kwezwi rekutenderera kweropa, fivha inonyangarika, diuresis uye tsika yebowel inodzokera kune yakajairika.

Munhu akatsva anenge achiri kucheneruka (anemia), mutete (kurasikirwa neprotein) aine tsandanyama hypotrophy.

Kana nzvimbo dzenecrosis dzasvika dzakadzika, dzisiri-reepithelialized nzvimbo dzine exuberant granulation tissue dzinogona kuchengetwa kwemavhiki kana mwedzi.