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Zviratidzo uye Zviratidzo zvekuvhunduka: sei uye nguva yekupindira

By Cristiano Antonino On Apr 22, 2022

Kuvhunduka kunoreva zvinhu zvakati kuti zvakasiyana munyika yezvokurapa. Kunze kwekuvhunduka kwemagetsi (kunoshandiswa kutangazve moyo) uye izwi rechimiro chepfungwa chakanyanya (zvakafanana ne post traumatic stress disorder), kuvhunduka kunorevawo mamiriro ekuti muviri haukwanise kuwana oxygen yakakwana uye zvinovaka muviri kumitezo yakakosha. uye masisitimu

Shock, mamiriro ekurapa ane chekuita nekuyerera kweropa rakakwana, anotora nzira dzakawanda uye ane maitiro akasiyana ezviratidzo nezviratidzo zvichienderana nekuti ndeupi rudzi rwekuvhunduka kuri kubatwa nemurwere.

Pane zvikamu zvina zvikuru zvekuvhunduka: hypovolemic, cardiogenic, distributive, uye obstructive.1

Chimwe nechimwe chezvikamu zvakasiyana chine zvikonzero zvakawanda, uye chimwe nechimwe chezvikonzero chinouya nezviratidzo zvakasiyana uye zviratidzo.

zviratidzo

Chiratidzo chinonyanyozivikanwa chekuvhunduka kwese-pamwe pakupedzisira-kuderera kweBP.2

Sezvo kuvhunduka kusina kurapwa kunowedzera, BP inoderera. Pakupedzisira, BP inoderera zvakanyanya kuchengetedza hupenyu (inonzi hemodynamic instability) uye kuvhunduka kunouraya.

Zvichienderana nechikonzero, zvinogona kutora nguva yakareba kana kukurumidza.

Nepo kuderera kweBP kuri iko chete chiratidzo chiripo pakupera kwega kwega kwekatyamadzo, mamwe mapoka ekuvhunduka akajairika kupfuura mamwe.

Izvi zvinoreva kuti zviratidzo zvavo zvakare zvakajairika. Heano mapoka ekuvhundutsa mukurongeka kwehuwandu, nezviratidzo zvavo zvakajairika.

Hypovolemic Shock

Kushaya mvura yakakwana kana vhoriyamu yeropa (hypovolemia), ndiyo inonyanya kuzivikanwa mhando yekuvhunduka.

Inogona kubva pakubuda ropa (inozivikanwawo sehemorrhagic shock) kana kubva kune imwe mhando yekurasikirwa kwemvura uye kupera simba.

Sezvo muviri uchiedza kubhadhara kurasikirwa kweropa kana mvura uye kuedza kuchengetedza ropa richikwira, zviratidzo izvi zvinoitika:

Kurumidza kurova kwemoyo (kukurumidza kurova)
Kukurumidza kufema
Dilated vadzidzi
Pale, ganda rinotonhorera
Kudikitira (diaphoresis)

Sezvo hypovolemic shock inowedzera, murwere anopera simba, avhiringika, uye pakupedzisira afenda.

Kana kubuda ropa kunze kuri chikonzero, pachava neropa. Kana kubuda ropa mugastric system iri chikonzero, murwere anogona kurutsa ropa kana kuita manyoka ane ropa.

Kana kuchipisa kana kuti murwere anga achishanda nesimba, funga nezvekubvisa mvura mumuviri.

Distributive Shock

Iri ndiro chikamu chakaomesesa chekuvhunduka kunzwisisa, asi chakajairika.

Kana tsinga dzemumuviri dzikaita zinyekenyeke uye dzisisakwanise kusungirirana zvakanaka, BP inonetsa kudzora uye inodonha.

Zvikonzero zviviri zvinonyanya kukonzeresa rudzi urwu rwekuvhunduka kusawirirana zvakanyanya (anaphylaxis) uye kutapukira kwakanyanya (sepsis).

Zviratidzo zvinosiyana zvichienderana nechikonzero.

Anaphylaxis zviratidzo zvinosanganisira:3

Hives
Itching
Kuzvimba, kunyanya kumeso
Trouble breathing
Ganda kutsvuka
Rapid moyo rate

Sepsis zviratidzo zvinosanganisira:4

Fever (kwete nguva dzose)
Flush, ganda dzvuku
Dry mouth
Kusagadzikana kweganda (turgor), zvinoreva kuti kana ukadzvanya ganda rinoramba rakadzvanywa uye rinodzoka zvishoma nezvishoma kudzokera kune zvakajairika, kana zvachose.

Sepsis inowanzove musanganiswa wekugovera uye hypovolemic shock nekuti varwere ava vanowanzoshaya mvura.

Neurogenic shock (kubva pakatyoka Musipinha cord uye inowanzonzi spinal shock) chikonzero chisingawanzo kukonzeresa kuvhunduka, asi chine chimiro chakasiyana chezviratidzo:5

Kuderera kweropa chiratidzo chekutanga (kusiyana nemamwe marudzi ekuvhunduka)
Kurova kwemoyo kwakajairika (kunogona kukwidziridzwa, asi imhando yekuvhunduka inowanzova neyakajairika mwero)
"Mutsetse" pamuviri apo ganda rakacheneruka pamusoro uye rakatsvuka pazasi

Neurogenic shock inouya mushure meimwe mhando yekushungurudzika, sekudonha kana tsaona yemotokari.

Cargiogenic Shock

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Kana moyo uchinetseka kupomba ropa zvakaringana, inozivikanwa se cardiogenic shock.

Inogona kuitika mushure memyocardial infarction (heart attack), kusashanda kwevharuvhu yemoyo, cardiac arrhythmias, zvirwere zvemoyo, uye kukuvadzwa kwemoyo.1

Zviratidzo zve cardiogenic shock zvinosanganisira:

Vasina simba uye kazhinji pulse isina kukwana
Dzimwe nguva pulse inononoka
Kuoma kufema kufema
Chikosoro chinoburitsa sputum, chena kana dzimwe nguva pink muruvara
Kuzvimba makumbo nezviziso zvemakumbo

Cardiogenic shock inogona kuperekedzwa nezviratidzo uye zviratidzo zvechirwere chemoyo.

Obstructive Shock

Pamwe chikamu chidiki chidiki chekuvhunduka (neurogenic ndiyo isinganyanyi kunyanyozivikanwa mhando chaiyo), kuvhunduka kunobva pane chinhu chinodzvanya patsinga dzeropa mukati memuviri.

Chikonzero chinonyanyozivikanwa chekuvhundutsa kunobva patension pneumothorax (yakadonha mapapu).2

Kuderera kweropa kunogona kuitika nekukurumidza, asi muviri unenge uchiedza kubhadhara (kusiyana neurogenic shock)
Rapid pulse
Kusaenzana kwekufema kunonzwika (kana kunokonzerwa nepneumothorax)
Trouble breathing

Kunze kwetension pneumothorax, chimwe chinonyanya kukonzera kuvhunduka kunobva kucardiac tampenade, mamiriro asingawanzo itika anokonzerwa neropa rakavharirwa musaga pamwoyo, richitsikirira pariri nekurichengeta kubva pakupomba ropa zvakaringana.

Nguva yekuenda kuchipatara

Kuvhunduka idambudziko rechokwadi rekurapa uye rinofanirwa kurapwa nekukurumidza sekunge razivikanwa. Kana uchifungidzira kuvhunduka, fonera 911 kana nhamba yako yechimbichimbi nekukasika uende kuchipatara.2

Chero bedzi muviri uchikwanisa kuchengetedza kukwira kweropa, vezvekurapa vanozviona kwakatsiva kuvhunduka.

Kana BP yadonha — kunyangwe muzviitiko kana izvozvo zvikaitika nekukurumidza, senge neurogenic shock kana obstructive — nharaunda yezvokurapa inotaura nezvayo sekuvhunduka kwakaderedzwa.

Kana decompensated shock ikasiyiwa isina kurapwa, ine mukana mukuru wekuuraya.

References:

Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W. The nomenclature, tsananguro uye musiyano wemhando dzekuvhunduka. Dtsch Arztebl Int. 2018;115(45):757–768. doi:10.3238/arztebl.2018.0757
Haseer Koya H, Paul M. Shock. StatPearls.
American Academy yeAllergy Asthma uye Immunology. Anaphylaxis.
Nzvimbo dzeDaase Control uye Kudzivirira. Chii chinonzi sepsis?
Summers RL, Baker SD, Sterling SA, Porter JM, Jones AE. Unhu hwehuwandu hwehemodynamic profiles mukutambudzika kwevarwere vane acute neurogenic shock. Nyaya yeCritical Care. 2013;28(4):531.e1-531.e5. doi:10.1016/j.jcrc.2013.02.002