Izigaba ezi-6 zekhosi yeklinikhi yokutshisa: ulawulo lwesigulane

By UCristiano Antonino On Ngo-Apr 15, 2023

Inkqubo yeklinikhi yesigulana esitshileyo: ukutsha sisilonda sezicubu zomzimba (isikhumba kunye ne-appendages yesikhumba) okubangelwa isenzo sobushushu, iikhemikhali, umsinga wombane okanye imitha.

Ukuhlelwa kwezigaba zokutsha

Zinokuba ngamaqumrhu ahlukeneyo ngokobunzulu bobushushu, ixesha loqhagamshelwano kunye nesimo somzimba wento evuthayo (eqinile, engamanzi okanye i-gaseous); ngokubhekiselele kubunzima bahlula ngamaqela (1st, 2nd, 3rd and 4th degree).

UKUBALULEKA KOQEQESHO LOKUHLANGULA: TYELELA I-SQUICCIARINI RECUE BOOTH UFUMANE UKUBA UZILUNGISELELA INDLELA EXASEKILEYO.

Ikhosi yeklinikhi yokutsha inokwahlulwa ngokwezigaba ezi-6:

isigaba somothuko we-nervous kwintlungu eyoyikekayo;
isigaba se-hypodynamic okanye isigaba somothuko we-hypovolemic (iiyure ezingama-48 zokuqala);
isigaba se-catabolic (phambi kokuvalwa kokutshisa);
isigaba se-exudate absorption toxicosis;
isigaba se-sepsis ngokusuleleka kwizilonda;
inqanaba le-syncratic dystrophy okanye ukuchacha.

1) Isigaba sothuso lweNervous

Ihlala iiyure ezimbalwa, kwaye ibonakaliswe ngoku: uvuyo lwengqondo, intlungu ebuhlungu, unxano olunamandla, ukubila, i-polypnoea (ixesha lokuphefumla ngaphezu kwesiqhelo), ukulala (ngamanye amaxesha i-delirium kunye nokuxhuzula), i-diuresis encinci okanye ayikho, i-atony yesisu, utshintsho olukhawulezayo egazini. uxinzelelo.

2) Isigaba sokutshatyalaliswa kwe-hypovolemic

Ibonakala ngoku: i-pulse encinci kwaye rhoqo, uxinzelelo lwegazi oluphantsi (ingakumbi i-systolic), i-peripheral cyanosis, ukubila okubandayo, ubushushu obuphantsi (36-35 ° C), ukuphefumla okunzulu kunye nokuphefumla rhoqo, uxinzelelo lwe-nervous hyperexcitability olutshintshana namaxesha oxinzelelo kunye nokozela, ukungakhathali. , adynamia; Isidingo esiqhubekayo sokuchama ngokukhutshwa kwamathontsi ambalwa okanye i-anuria, izibilini ezivalwe ilindle kunye negesi, ingxaki yehaemodynamic ehlala kwiiyure ezimbalwa ukuya kwiintsuku ezi-3-4.

Isigulane sinokufa ngenxa yokuphelelwa yintliziyo. Utshintsho lweHemodynamic lubandakanya:

tachycardia;
uxinzelelo lwegazi;
ukunciphisa imveliso yenhliziyo;
ivasoconstriction.

Ukukhutshwa kwentliziyo kunokuncipha ukuya kwi-30-50% yesiqhelo ngenxa ye-hypovolemia kunye ne-myocardial depressant factor.

Isiphumo sentliziyo sihlala sithandeka kumanqanaba aqhelekileyo kuphela emva kweentsuku ezininzi, nokuba unyango lokutofa luchanekile.

Utshintsho ekusebenzeni kwezintso kungenxa:

hypovolemia;
ivasoconstriction;
ukuvulwa kwee-arteriovenous shunts ezidlula intso;
i-adrenal ibalulekile.

Iiseli ze-juxtaglomerular zezintso zikhupha i-renin kwi-circulation ekuphenduleni ukunqongophala kwe-sodium, uxinzelelo lwegazi oluphantsi (hypovolemia), kunye novelwano lwe-nerve stimulus (ngenxa ye-hypovolemia).

I-Renin ibangela, nge-angiotensin, ukukhutshwa kweehomoni kwi-adrenal cortex (i-cortisol, i-mineralocorticoids umz. i-aldosterone, i-glucocorticoids, njl.) esebenza ekubuyiseleni izintso.

Oku kulandelayo kwenzeka:

i-oliguria (ngaphezulu okanye ngaphantsi kakhulu);
ukunciphisa ukuhluzwa kweglomerular;
ukugcinwa kwe-sodium (aldosterone);
ukwanda kwemfihlo ye potassium (aldosterone).

Ukuba unyango lwanele, ezi zibonakaliso zingabonakali, ngaphandle koko, ukusilela kwezintso okufana nokothuka kwe-hemorrhagic kungenzeka.

Emva kweeveki ezi-2 ukuya kwezi-3 kusenokubakho umothuko we-gram-negative we-septic othi wenze mandundu ngakumbi ukusebenza kwezintso, okunokubakho ukwenzeka kokusilela kwe-renal okuhlala kubulalayo.

Iithiyori ezininzi zichaza i-oliguria, enokuthi ibe ngenxa yoku:

i-nervous reflex eyenza i-spasm ye-arterioles edibeneyo;
ukuqaliswa kumjikelezo wezinto eziyityhefu ezikhutshwe kwindawo etshisiweyo ezinokuthi zisebenze kwinqanaba le-glomerular okanye ngokuvelisa i-spasm ye-afferent arterioles evimbela ukuhluzwa;
umzamo wezintso ukubuyisela ukuguqulwa kwe-hydrometabolic ngokusebenzisa i-tubular reabsorption enkulu ye-sodium kunye namanzi ngokunciphisa ukukhutshwa komchamo. Kwinqanaba lokuqala, ukusetyenziswa kwenkqubo ye-renin-angiotensin nayo ibonakaliswe, ebangela ukugcinwa kwe-sodium.

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3) Isigaba seCatabolic

Inqanaba lesithathu libonakaliswe ngoku:

ukunciphisa ukusebenza kwakhona kwezinto eziphilayo;
ibhalansi yenitrogen engalunganga;
ukuhla kwamandla okuzikhusela.

Ukuba ukothuka kwe-septic kwenzeka kwesi sigaba, ukusilela kwezintso kukhokelela ekufeni.

Idatha ethembekileyo yokubeka iliso ekusebenzeni kwezintso yiplasma kunye ne-osmolarity yomchamo.

Ukuba oku kuqhubeka nokunyuka (i-progressive hyperosmolarity) i-prognosis iba yimbi.

Iimpawu ze-hyperosmolarity eqhubekayo zezi: unxano olunzulu, utshintsho kwingqondo, ukuphazamiseka kokuqhelana, ukubona izinto ezingekhoyo, isiqaqa, ukuxhuzula, ukufa.

Ibhalansi yenitrogen engalunganga kunye nokusilela kwamandla ngokuyinxenye kunxulumene nokunqongophala kokunyuka kwamanzi aphumayo.

Ubude bexesha kunye nokuqina kwesigaba se-catabolic kunxulumene noku:

ubungakanani kunye neqondo lokutsha;
ubuzaza bazo naziphi na iinkqubo ezosulelayo;
irejimeni yesondlo;
ubude besigaba esivulekileyo samanxeba.

Ngeli nqanaba imfuno yamandla yeekhalori ingaphezulu kwe-4000cal / ngosuku.

Nangona ukuqaliswa konyango olufanelekileyo, i-positivization ye-nitrogen balance ifezekiswa kuphela kwisigaba se-convalescent.

4) Isigaba se-toxicosis (i-autotoxic shock)

Ibonakala emva kweentsuku ezi-3-4.

Ukubuyiswa kwakhona kwe-transudate kunye ne-exudates kwiindawo ezitshisiweyo kubeka izinto ezinobuthi kwi-circulation.

Emva kwexesha elibonakalayo lempilo (ebonakala ngokuqheleka kwe-pulse, uxinzelelo kunye nobushushu), bafumanisa iimpawu ezintsha ezifana: nomkhuhlane ophezulu (39-40 ° C), intloko ebuhlungu, isicaphucaphu kunye nezilonda ze-hemorrhagic.

Esi sigaba sinokuhlala kwi-15 ukuya kwiintsuku ze-20.

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5) Inqanaba le-sepsis

Kungenxa yosulelo lweendawo ezitshisiweyo eziququzelelwa yi-immunosuppression.

Ubushushu buqala ukunyuka kwakhona kunye nomkhuhlane oqhubekayo kunye nokuphelisa kwangaphambili okanye ukhatshwa yingqele, intloko ebuhlungu, isicaphucaphu.

Ukubetha rhoqo kwaye uxinzelelo luyancipha. Kukho ubugwenxa beentsholongwane ze-cutaneous saprophytic ezingcolisa umphezulu wezicubu zegranulation ngexesha le-sepsis (ziyigram-negative: Pseudomonas, Serratia, Klebisiella, Candida, njl.

6) Isigaba se-syncrasic dystrophy okanye isigaba sokuphucula

Kukho ukuchacha ngokuthe ngcembe kwethowuni yokujikeleza kwegazi, umkhuhlane uyanyamalala, i-diuresis kwaye umkhwa wamathumbu ubuyela kwisiqhelo.

Ixhoba elitshileyo liselubala (i-anemia), libhityile (ukulahleka kweprotheyini) kunye ne-hypotrophy yezihlunu.

Ukuba iindawo ze-necrosis ziye zafikelela kwiindawo ezinzulu, ezingenazo i-reepithelialized kunye ne-exuberant granulation tissue zingagcinwa iiveki okanye iinyanga.