Ọgwụgwọ nnukwu ọrịa pancreatitis, ụdị edematous

Ahụhụ ụjọ nke pancreatogenic bụ ọnọdụ dị oke mkpa ebe ọrụ nke akụkụ ahụ na sistemụ dị oke njọ na-emebi ngwa ngwa, ọbara mgbali, nsị ọnụ na-ebelata, isi anụ ahụ na anụ ahụ na mmepe nke ọtụtụ akụkụ ahụ (E.S. Savelyev et al., 1983, G.A. Ryabov, 1988, Weil LH., Schubin M., 1957, Becker V. et al., 1981).

Ugboro nke ihe itu ujo di site na 9.4% rue 22% ma obu karia,. Ọtụtụ mgbe, ujo na-adakwasị ndabere nke nnukwu necrotic pancreatitis.

Ejiri njiko dị n'ahụ ọrịa necrotic pancreatitis nke enweghị nsogbu akwara dị oke egwu, yana hypoperfusion system. Site na okike ya, ujo n'ime nnukwu ọrịa pancreatitis bụ endotoxin. Endotoxin ujo bụ ihe kachasị akpata ọnwụ site na nnukwu ọrịa ogbu egbu.

Ckta jijiji na-agbakọta n'ụdị nke pancreatitis siri ike, na-emebi ihe, yana mmeri nke saịtị ndị dị mkpa nke pareatyma necrosis. Olu nke necrosis na-ekwu okwu bụ ihe na-eduga na nkwanye ugwu dị na-ekpebi ohere nke ịmalite ujo endotoxin.

Necrosis Foc pancreatic na-enweghị nsogbu nke ujo pancreatogenic na nsogbu usoro

(na-agafeghị oke oge - pancreatitis nwayọọ, Atlanta, 1992)

1. itgba ụlọ ọgwụ na ngalaba ịwa ahụ

2. Ọ bụrụ na nsogbu adịghị, ọgwụgwọ ịwa ahụ abaghị uru

4. Nasogastric tube

5. Ikpokoro na afọ

6. Nnyocha ọgwụ anaghị ede ude

8. Ngwakọta ọgwụ mgbochi na olu nke 20-30 ml / n'arọ nke ibu, ọgwụ na-ebelata nje nzuzo (atropine, sandostatin, octreotide) ma nwee mmetụta antiprotease, nchịkwa ọnụ nke enzymes pancreatic.

9. Ọgwụ nje na-efe efe nke necrosis

10. Mgbochi nsogbu nke thromboembolic

11. Antacids, ndị na -ebelata ọgbụgba gastric, yana mgbochi mgbochi ọbara ọgbụgba

Njirimara nke ujo panreatogenic

Ahụhụ ụjọ akwara bụ ihe na - akpata ọrịa na - etolite n'ihi oke mmebi nke anụ ahụ, nke a na - ebufe site na nrụgide, mbelata ọbara ole na - aga n'ihu, mgbanwe na - agbanwe agbanwe ọ na - akpata ọrịa n'ihi nhụjuanya nke endotoxins, ịmepụta DIC, na ngwa ngwa gosipụtara nsogbu microcirculatory sistem.

Nrụ ọrụ nke usoro kallikrein-kinin, nke mepụtara histamine, bradykinin, serotonin, bụ ihe nke abụọ na-akpata oke iwe, na-arụ ọrụ dị mkpa na pathogenesis nke ọrịa pancreatic. N'ihi nke ikpeazụ, vaskụla patial na-abawanye, microcirculation nke pancreas na-akpaghasị, nke a na-ebute site na edema peripancreatic, ụba mkpali exudate n'ime akpa synovial, peritoneum.

Ugboro nke ihe itu ujo bu 9.4-22% na ndi ozo. Ọtụtụ mgbe, ọ na-ebilite megide ndabere nke nnukwu necrotic pancreatitis.

Ntọala nke nhazi nke akụrụngwa nke nnukwu pancreatitis bụ:

• ụdị pathologies
• nsogbu nke intraperitoneal na ọdịdị sistemụ, nke enyere necrosis zuru ebe niile.
• paripancreonecrosis nke oghere cellular retroperitoneal (eriri dị na okirikiri nke pancreas ma n'akụkụ ya),
• usoro nke usoro mbufụt.

Na nnukwu edematous pancreatitis, ujo gosiputara site na mgbanwe dị oke egwu, yana hypoperfusion system. Na mmalite ya na oke ọrịa pancreatitis, ọ bụ nke endotoxin. Endotoxin ujo bụ ihe kachasị akpata ọnwụ site na nnukwu ọrịa ogbu egbu.

Ọrịa pancreatic nwere ike ịka njọ n'ụdị nke ọrịa pancreatitis, tinyere mgbanwe na mpaghara oke oke site na necrosis nke anụ ahụ gland.

Ọkpụkpụ nke parenchymal akụkụ ahụ na-etolite na ụbọchị 3-7 site na oge nnukwu ọrịa nke pancreatitis na arụ ọrụ nke imeju, obi, akụrụ, ngụgụ, na sistem ụjọ.

Kedu ihe kpatara ọrịa ji eto?

Ihe ndị na-akpata akpata oyi n'ahụ na-atọ ụtọ n'ị theụbiga mmanya ókè na ị oveụbiga mmanya ókè.

Ọkpụkpụ nke akwara nke ọrịa pancreatic na-ezo aka na ọnya nsí. Ọria pancreatitis pụtara n'ihi mmetụta dị na mpaghara nke enzymes nke ya. N'ihi ojiji nke ngwaahịa na nnukwu olu, akwara hyperstimulation na-etolite, nke na-ezo aka na mwepụta nke ihe ndị na - eme ka ọ bụrụ ihe na - apụ apụ.

Enzymes na - ebido ngwa ngwa n'ihi ihe dị na ntanetị n'ime oghere dị iche iche, n'agbanyeghị na mmadụ nwere ahụike, bile dị na duodenum ma na - emekọrịta ihe na nzuzo.

Hemorrhagic pancreatitis, nke eziokwu ahụ bụ na n'okpuru mmetụta nke enzymes ya, parenchyma nke arịa ọbara na-anwụ ngwa ngwa, bụ ọnya siri ike nke anụ ahụ. Nke a kpalitere mmepe nke:

N'ihi nrụgide siri ike nke ihe mgbu, a na-eme ka usoro nke sympatho-adrenaline rụọ ọrụ. Adrenaline na-eduga n'ịbelata arịa ọbara, akwara nke afọ, na-ebuga ọbịbịa ọbara n'ọtụtụ na obi na ụbụrụ. Mgbe arịa ndị ọzọ dị warara, ụkwara oxygen na --eme nsụ anụ ahụ, nke na - efesa ụzọ ọbara.

1. Ọ bụ ezie na iku ume na-eme ngwa ngwa, na agụụ oxygen, oxygen na-abata olu dị ala n'ihi mgbanwe nke ọbara na-erugharị, nke a na-eduga n'inwe ntakịrị ujo. Odighi ume iku ume na ebute onwu ma oburu na enyereghi ya aka ozugbo.
2. Mgbe akụrụ na-anaraghị ọbara dị mma, ha anaghị emepụta mmamịrị, ma ọ bụ na-eme n'obere olu na ndo gbara ọchịchịrị. A na - akpọ ihe omume a ihe mgbaàmà akụrụ ụjọ.

Ọgwụ ọgbụgba

Ebumnuche ọgwụ ụjọ na pancreatic bụ nke:

• mejupụta mmiri furu efu ma kwụọ ụgwọ maka mbupu site na iwebata ọgwụ mgbochi
• nhọpụta nke ọgwụgwọ zuru oke maka ujo na syndromes nke nsogbu site na iji ihe ndị na - egbochi mkpokọ, mgbochi ihe - Sandostatin, Octreotide, yana enzymes pancreatic,
• mgbe ituchara ujo, a choro iku anya,
• Usoro iji kpochapụ ihe ndị na-egbu egbu,
• A na-eji nyocha iji dechaa traktị ahụ
• A na-eji ọgwụ nje eme ihe iji gbochie necrosis.

Effectivedị irè nke ọgwụgwọ a ga-adabere na oge nlekọta.

Ederede nke ọrụ sayensị na isiokwu "Shock in Nnukwu necrotic pancreatitis"

UDC 617.37 - 005: 616-001.36

V.E. VOLKOV, S.V. Volkov

AKW ATKWỌ AKP ATR AC ACUTE NECROTIC PANCREATITIS

N'etiti nsogbu dị iche iche nke nnukwu ọrịa pancreatitis, ọkachasị na-emetụta nsonaazụ nke ọrịa ahụ, ekwesịrị ikwu okwu banyere ujo. Ugboro nke mmepe ya dị iche - site na 9.4% ruo 22% karịa karịa 1, 2. Ọtụtụ mgbe, ujo na-apụta na ndabere nke nnukwu necrotic pancreatitis.

Ejiri njiko dị n'ahụ ọrịa necrotic pancreatitis nke enweghị nsogbu akwara dị oke egwu, yana hypoperfusion system. Site na okike ya, ujo n’ime nnukwu ọrịa bụ endotoxin-acha anụnụ anụnụ. Endotoxin ujo bụ ihe kachasị akpata ọnwụ site na nnukwu ọrịa ogbu egbu.

Mmepe nke ujo na-ejikarị ụdị ọgwụ mgbu dị egwu, nke na-emebi emebi, na-esonye n'ọtụtụ oge site na mmeri nke saịtị ndị dị mkpa nke pancreatic parenchyma necrosis. Ọ bụ olu nke pancreatic necrosis bụ ihe na-eduga ọkwa pathomorphological nke na-ekpebi ohere nke ịmalite ujo endotoxin na ọtụtụ nsogbu ndị ọzọ siri ike (enzymatic peritonitis, retroperitoneal cellulitis, sepsis, wdg).

Oge nke mmepe nke ujo n’ime nnukwu ọrịa pancreatitis na, ọkachasị, na oncrosis pancreatic, nwere ike ịdị iche, nke na-eme ka o kwe omume ịmata ọdịiche dị na mbido na mbubreyo. Oge mmepe nke ujo na-agbako na oge enzymatic nke nnukwu pancreatitis na-emebi emebi ma a na-ahụkarị ya na izu mbụ nke ọrịa ahụ. Shockgha ujo bidoro megide mmebi oke toxicosis na otutu mmebi akwara. Ya mere, obughi ihe ijuanya na onu ogugu onwu site na ujo ogu ruru 48%.

A na-ahụta ujo mgbe ndị ọrịa tolitere usoro sectial neccrosis ("ọrịa nje a na-ebute ọrịa" dịka nhazi ọkwa nke Atlanta-1992). N'oge a, na mbido (site na izu nke atọ nke ọrịa na-emebi ihe dị na ya), nsogbu ime mmụọ dị na mpaghara na-ebilite (purulent necrotic parapancreatitis, peritonitis, oria na-akpata cyst, wdg), na mgbe e mesịrị (ná nkezi otu ọnwa mgbe mmalite nke ọrịa ahụ), ọrịa jikọtara ọnụ (sepsis) ) Ugboro nke nsogbu mgbanwe purulent n'ụdị na-emebi ihe nke pancreatitis dị iche iche, dịkwa ka ndị edemede dị iche iche si kwuo, sitere na 25 ruo 73%. Mmeghe nke mbubreyo panreatogenic na-etolite n'ọtụtụ ikpe ka ama ama megidere ndabere nke sepsis siri ike. Ihe na - ahụkarị ihe dịkarịsịrị mma nke sepisis nke gram bụ Staphylococcus aureus, gram-nke - Pseudomonas aeruginosa. Dịka iwu, a na-ahụta sepsis na ujo na ndị ọrịa emegoro ihe karịrị ihe ịwa ahụ 2-3 n'ihi oke ọgbụgba nke nnukwu mbibi ọgbụgba.

creatitis, na-egbu oge na / ma ọ bụ na-adịcha ọcha nke retroperitoneal mbibi foci, na ọnụnọ nke ọtụtụ nsogbu nke usoro nke usoro ọrịa na-emebi emebi na-egbu egbu (arrosive na gastroduodenal ọbara ọgbụgba, eriri afọ fistulas, wdg).

A mụọla pathogenesis nke ujo n’ime nnukwu necrotic pancreatitis nke ukwuu n’otu ụbọchị. Isi ihe na-ebute mmepe nke nsogbu a bụ endotoxemia. A kwenyere na enzymes pancreatic na-arụ ọrụ bụ maka ndị isi (toxicosis) na mpaghara (pancreatic necrosis) nke ọrịa ahụ. Ihe nchebe na lipase na-arụ ọrụ, na-arụ ọrụ na endothelium vaskụla, na-eduga n'ịba ụba vaskụla, mkpesa mpaghara na sistem, yana mfu plasma, na-eduga n'ọbara.

Ihe ndị dị mkpa na mmepe nke ujo n'oge enzymatic endotoxemia bụ hypoperfusion systemic na plasma ọnwụ, nke na-atụnye ụtụ na enweghị ike nke akụrụngwa hemodynamic n'ihi ngbanwe nke ike na ụda nke bed vaskụla na olu nke ọbara na-ekesa. Otu ìgwè peptides endogenous, nke dị n'otu aha "vasoactive kinins" (kallikrein, serotonin, bradykinin, wdg), na-ekere òkè na mmezu nke mmetụta pathologies nke enzymes na-eme ka arụ ọrụ. Kinins nwere ihe ndị a dị mkpa: ha na-enye aka na nbuli elu, edema ma na-akpata mgbu, na-eduga na vasodilation, hypotension, ụba vaskụla permeability, na mbelata nke bcc.

Anyị kwenyere na otu n’ime ihe kpatara akpata ujo n’ime ndị ọrịa nwere nnukwu ọrịa ọrịre bụ mbelata olu nke na-ekesa ọbara 2, 3, 4. N’ọrịa pancreatitis, olu nke na-ekesa ọbara (BCC) nwere ike ibelata n’ihi ihe ndị a: 1) imepụta edema n’ime oghere oghere nke pancreas. , 2) impregnation of retroperitoneal space with hemorrhagic fluid, 3) mkpokọta ọbara ọgbụgba (pancreatic "ascites") n'ime oghere afọ (site na 2-3 l ma ọ bụ karịa), 4) mkpokọ mmiri na akwara ime dị na TATUS paresis ma ọ bụ mkpọnwụ, 5) depositing ọbara na portal vaskụla usoro na ndị ọzọ ndi.

Na nyocha nke BCC na nnukwu ọrịa pancreatitis, ọ ga-ekwe omume ịchọpụta nnukwu hypovolemia - site na 1000 ruo 2500. Ekwenyere na ọnwụ mbụ nke plasma sitere na akwara vaskụla na-esote edema nke pancreas na akụkụ ndị ọzọ dị n'ime. N’ọdịnihu, ikekwe n’ihi mbibi nke mkpụrụ ndụ ọbara uhie site na trypsin, ogo nke globular na-ebelata.

Nnukwu ọnwụ nke extracellular mmiri na nnukwu ọrịa pancreatitis na-eduga n'ọbara hemoconcentration, nsogbu nke hemodynamics n'ihi hypovolemia na ujo. Na mmepe nke nsogbu akwara hemodynamic na ujo, ọrụ dị mkpa bụ nke ndị kinins. Ntinye nke usoro kinin na ntinye n'ime ọbara kallikrein, bradykinin, kallidin, histamine na enzymes proteolytic na-eduga na mmụba nke vaskụla permeability, ntọhapụ nke plasma na arịa.

uzo uzo di n'ime oghere intercellular na mmepe nke hypovolemia. Ọtụtụ ihe ndị ọzọ nwere ike itinye aka na mmepe nke ujo: ụjọ, endocrine, cardiac, wdg.

Ihe ujo nke na - eme megide onodu ojoo nke anakpo pancreatitis na - esoro na mmepe nke metabolic acidosis. Agbanyeghị, mmepe nke acidosis na ọrịa a enweghị ike ịkọwapụta nke ọma site na ibelata ọsọ nke ọbara na-agba na ujo. Ihe ndi ozo kwesiri ichebara echiche. Emebere ya na ụfọdụ ihe ewepụtara n'oge mbibi nke pancreas nwere ike iwepu oriri oxygen n'ime ahụ na anụ ahụ, dịka ọmụmaatụ, na imeju, ya mere, n'ihi oke nhọrọ nke metabolism, na-akwalite nnabata acid metabolites.

Ihe ndị na - eme ihe ike n'oge usoro enzymatic na nnukwu necrotic pancreatitis na ujo kwesịrị ịgụnye cytokines-peptides na - emetụta mmeghachi omume mgbochi, ọkachasị na mmeghachi omume nke nnukwu. Ndị a gụnyere interleukins, interferons, ihe ndị na-akpata tumor necrosis, wdg Ahụkarị maka enzymatic frasi nke necrotic pancreatitis na ujo bụ mmụba nke mkpokọta cytokines pro-mkpali (TOTA, IL-6, IL-18, wdg). Enwere ike kpebie ịdị ogo nke ọrịa ahụ site na ọkwa cytokines ọbara na nnukwu pancreatic necrosis na ujo nke pancreatogenic. cytokinemia nwere ike ịbụ akara akara ọrịa ọrịa.

Orgghazi nhazi nke ihe eji arụ ọrụ, arụ ọrụ na metabolism nke anụ ahụ n’akwara nke ukwuu na - eduga n’ịgba mbọ na ntọhapụ nke ọnụ ọgụgụ bara ụba cytokines. Mmetụta sistemụ ha mejupụtara, na aka nke ya, na ntinye nke usoro mmeghachi omume mgbu na, n'aka nke ọzọ, n'ọtụtụ mmebi akụkụ ahụ (nke bụ akpa ume, umeji, akụrụ na myocardium). Ọtụtụ mmebi nke ahụ na-etolite n'otu oge bụ otu n'ime isi ihe kpatara mmepe nke ujo n'oge, nke na-aka njọ, ike nke dysfunctions nke akụkụ ahụ na sistemụ dị mkpa. Oge ujo, nke a na-ahụta na nsogbu dị iche iche nke nnukwu necrotic pancreatitis na sepsis, bụ nke a na-akpata site na mmepe nke cytokinemia nke nje liposaccharides butere site na nzụlite nke cytokine aha na njiri mara mma nke njiko nke sepsis.

Site na ụbọchị mbụ nke mmepe nke ọrịa pancreatitis dị njọ nke gbagwojuru anya site na ujo, a na-ahụ ọtụtụ usoro dị iche iche na njikọta ọnụ: mgbochi nke nzaghachi mgbochi ọrịa (immunodeficiency mbido), enweghi ike nke cytokines n'akụkụ nke nnukwu akara mmiri nke pro-inflammatory, na-eme ka ọtụtụ ihe mgbaàmà nke endotoxemia, ọtụtụ akụkụ ọdịda, oke ma ọ bụ mgbasa mgbasa. na ndị ọzọ

Mmepe nke ujo mmalite na nnukwu necrotic pancreatitis na-abụkarị n'ụbọchị nke 3 nke ọrịa. Ihe ujo na-ebilite megide mmebi nke fermentemia na cytokinemia pro-inflammatory (nsị nke ihu, enweghị mgbatị ahụ, mkpụmkpụ ume, oliguria, peritonitis) ma gosipụta ya site na otu ụdị ihe ịrịba ama atọ:

- tachycardia (obi obi> 120) ma ọ bụ bradycardia (ọnya obi na ahụghị m ihe ịchọrọ? Gbalịa ọrụ nhọrọ akwụkwọ).

- ọnọdụ iku ume> 20 kwa nkeji ma ọ bụ pCO2 10%.

Ihe ịrịba ama abụọ ma ọ bụ karịa nke SIRS gbakwunyere ọnụnọ nke nwapụta na-elekwasị anya na-efe efe na-enye ohere, dabere na ụkpụrụ nke Chicago Protocol, onye ọrịa ga-achọpụta ọrịa sepsis. Sepsis na ọnụnọ nke ọtụtụ akụkụ ahụ (na-ezughi oke akụkụ abụọ ma ọ bụ karịa na sistem) ka akpọrọ "sepsis siri ike", yana sepsis siri ike nke nwere hemodynamics na-ejighị n'aka na-akpọ ya "septi shock."

Ihe ndabere maka igbochi ujo mmalite bu ojiji nke nlekọta nlezianya anya, a na-ejikarị ya maka nnukwu ọrịa necrotic pancreatitis. N'okwu ndị a, ihe mesiri ike ekwesịghị ịdị na antisecretory, kama na ọgwụgwọ anticytokine. Thezọ kachasị dị irè nke mkpochapu extracorporeal nke cytokines nwere ihe iyi egwu nke panreatogenic ujo bụ hemosorption, hemofiltration ogologo na plasmapheresis ọgwụgwọ. Site n'ụdị ujo etolitela, ihe kachasị amasị na nke kachasị njọ maka ọrịa dị oke egwu bụ

oke olu hemofiltration bụ usoro eji arụ ọrụ, ọ dị iche na plasmapheresis, nke a rụrụ nke ọma na mpaghara akụkụ (centrifuge). Okwesiri iburu n’uche na uzo a na - enye plasmapheresis n’enye aka obughi na iwepu aka n’ahu ahu site na ahihia. Na mgbakwunye na mmetụta dị na ya, ụzọ plasmapheresis nwere ihe metụtara emetụta isi iyi nke toxicosis, nke bụ isi ọria na nke abụọ nke toxins (exudates). N'akụkụ a, a ga-atụle plasmapheresis, nke kachasị nke nta ka otu n'ime ụzọ ole na ole dị irè iji kpochapụ endotoxemia n'ime ndị ọrịa nwere nnukwu preaterveitis na ujo.

Ọ bụrụ na ujo bidoro na onye ọrịa anaghị agwọ ọrịa (dịka ọmụmaatụ, mgbe ekwetara n'oge mbubreyo mgbe ọ malitere ịrịa ọrịa pancreatic necrosis), ọgwụgwọ kachasị kwesịrị ịbụ ọgwụ infusion-transfusion site na iji colloidal na nkwadebe kloloid iji chụpụ hypoperfusion system, na-akwụ ụgwọ mmefu protein-electrolyte na mmelite nke rheological egosi. Ọ bụ ihe amamihe dị na ịgbakwunye usoro infusion dị otú a na mmepe nke ujo site na nchịkwa nke hydrocortisone na dose nke 250-500 mg kwa ụbọchị, nke na-enye ohere ka nsogbu ndị na-akpata hemodynamic na-akpata. Iji wepu endotoxemia na-aga n'ihu na ndị ọrịa nwere necrosis pancreatic, ọ dị mkpa iji ọgwụ diuresis na-amanye ya.

Ọ bụrụ na ujo bidoro na onye ọrịa a “lebara anya”, mgbe ahụ, a ga-amata ụdị ọrịa a na - egbu oke egbu dịka ihe siri ike, mmepe nke ọrịa a na - aga n’ihu ngwa ngwa, ọgwụgwọ a etinyerelarị ezughị ezu. N'ọnọdụ ndị a, a chọrọ usoro iku ume na corticosteroid na njikọta nke plasma, reopoliglukin, refortan, wdg Mgbe emesịrị hemodynamics kwụsie ike na ndị ọrịa na-agabiga ngwa ngwa ụjọ ngwa ngwa, ọ dị mkpa iji bulie ajụjụ banyere mkpochapụ extracorporeal. Ofzọ nke ịhọrọ ebe a bụ plasmapheresis. Naanị enwere nsogbu mgbu akụkụ iku ume yana nkwonkwo akwara na okuku ekesa, usoro ịba mma kacha mma. Dabere na A.D. Tolstoy et al. , ihe ndị a chọrọ maka usoro plasmapheresis n'okpuru ihe iyi egwu ga-akpachapụrụ anya:

- akpụkpọ ahụ nke usoro ahụ,

- obere doses (8-10 ml / n'arọ ahụ) e wepụrụ n'oge nnọkọ plasma,

- “nro” nke mkpochapu (200-300 ml / h),

- ntughari nke mwepu plasma "dobe site na dobe”,

- ndikota nke ngwota nke ogha eji eme ihe ohuru na mmetuta nke antioxidant na ihe ndi ozo bara uru na oria (gabexate mesylate, nafamostat, wdg).

Maka ọgwụgwọ nke ụfụfụ septikis nke kpatara necrosis na ọrịa ndị na - akpata ya, a na - atụpụta ọgwụ na - achọ ihe mberede na njikọta na photinomation na - esi ísì ụtọ. Ebe ọ bụ na ọgwụ ọgwụ inotropic eji mee ihe na endotoxin ure na-agbakarị ọgwụ nke ọma n'ọtụtụ anwansi.

ọnụego nke iwebata ha na mbido nke mmanu ga-abawanye site na mbelata nke nwayọ rue ngwụsị usoro a na - ebugharị na ntinye nke mmezi ("renal") doses nke vasopressors. A na - ejikọ usoro nke usoro igbu onwe onye (mkpochapụ + oxidation nke toxins), yabụ, mgbe usoro ọgbụgba ọkụ ahụ dị, ọ dị mkpa iji bulie ọrụ mbufe ọbara site na nsị albumin.

Ekere ke mpụga, na ọgwụgwọ nke septik, ha na-eji jikọtara nke elu-olu hemofiltration na plasmapheresis. Ojiji nke usoro a n’ime ndị ọrịa nwere sepsis ịwa ahụ belatara ọnwụ site na ure septik ruru 28%.

N'ime afọ iri gara aga, iji ọgwụ mgbochi intravenia bụ ọgwụ mgbochi pụrụ iche bụ usoro ọgwụgwọ akọwapụtara n'oge ochie maka ujo. Nkwadebe Immunoglobulin maka nchịkwa esịtidem nwere ọtụtụ ọgwụ mgbochi megide nje na nje. Immunoglobulins, nke nwere IgG kachasị, na-eme ka ịgbalite usoro nke antigen / antibody mejupụtara ya na ntinye ya na Fc iberibe Ig na-anabata ya na mejupụtara nke phagocyte, nke na-abawanye oke arụmọrụ nke igbu egbu na intracellular nke antigens. IgM nwere immunoglobulins mejupụtara ọgwụ nje endotoxins ma na-emekwa ka ọrụ mmezi nke mmeju, phagocytosis na lusha nje. Na mgbakwunye, immunoglobulins megharịrị ngosipụta na ọrụ nke ndị na-anabata cytokine, na-egbochi ihe cytokine pro-inflammatory, ma si otú a gosipụta mmetụta mgbochi mkpali. N'ikpeazụ, immunoglobulins nwere mmetụta nje nje nke ọgwụ nje 1, 9. A chọpụtara mmetụta kachasị elu nke immunoglobulins n'ụzọ dị egwu na septik, nke na-enye ha ohere ịtụle, yana anticytokines (interleukin-2, roncoleukin), dị ka ọgwụ ndị na-egbochi immuno.

Immunoglobulins ndị a kacha mara bụ gụnyere ọgwụ intraglobin (nke nwere IgG), pentaglobin (IgM), venogen-lobulin (France), na sandoglobulin (Switzerland). Immunoglobulins dị n'ime ụlọ nke ọtụtụ ụlọ ọrụ mepụtara (IMBIO na ndị ọzọ) nwere 5% IgG, dị ọcha site na ngwa ọgụ prekallikrein na ụmụ irighiri ihe mejupụtara. Ọgwụ immunoglobulin bụ 25 ml. A na-etinye ọgwụ ahụ na ntụtụ nke 1: 1 - 1: 4 na 5% glucose ma ọ bụ mmiri saline solution na ọnụego nke na-erughị 8 ml / min. Usoro onunu ogwu nke immunoglobulins na ndi oria purulent-septik sitere na ogo oria a na - adi kwa 25 ml rue 100 mil nke pro dosi. Na ujo septik, ubara immunoglobulins kwa ubochi ruru ogo abuo / kilogram nke aru.

A na-egosipụta mmetụta nke immunoglobulins na nkwụsi ike nke hemodynamics, mbelata mkpa ọgwụ vasopressor, ike dị omimi nke usoro nke ọtụtụ akụkụ, mkpochapu nke nje. Ihe nlere ulo oru ihe omimi putara mgbe eweputara immunoglo-

nke bulins na-eje ozi: mmezu nke phagocytosis, mmụba na hemolytic ọrụ nke mmeju na plasma ịta Ig. Tinyere immunoglobulins na septik pancreatogenic ujo, hyperimmune plasma nwekwara ike iji ya mee nke ọma.

Site na mmepe nke ujo endotoxin, ọ dị mkpa ịhapụ ntinye nke ọgwụ nje na-akwado otu n'ime nhọrọ maka hemocorrection (hemosorption ma ọ bụ immunotherapy na immunoglobulins maka nchịkwa intravenous, ma ọ bụ plasma ala nke hyperimmune). Nke a bụ n'ihi ihe egwu nke mmepe nke ọrịa Jarisch-Herxheimer (oke ọnwụ nke microorganisms gram na-adịghị mma na mwepụta nke oke endotoxins). Akụkụ etiotropic nke ọgwụgwọ ọgwụgwọ nwere oke ụjọ endotoxin, nke e mere iji kpochapụ ọrịa ọgbụgba, kwesịrị ịgụnye:

- ultraviolet photomodification ọbara,

- oxidation electromechanical na-apụtaghị ìhè (infusion nke 0.05-0.1% sodium hypochlorite solution),

- nchịkwa intravenous nke antiseptics (dioxidine, chlorophyllipt, wdg).

Ihe omuma ndi di n’elu gosiri ihe ujo di na oke

Ọrịa pancreatitis, nke akọwapụtara dị ka ụkọ akwara dị n'okike na hypoperfusion system, bụ ihe kacha akpata nke endotoxemia. Oge mbubreyo na mbubreyo endotoxin kwekọrọ na oge ase na septic nke nnukwu necrotic pancreatitis. Ofdị ujo ndị a dịgasị iche na usoro mmepe na ụzọ maka mgbazi ha. N'otu oge ahụ, a ga-echekwa ndụmọdụ ndị a na-eji na ọgwụgwọ nke oke etiologies: mkpochapu hypoperfusion (nchịkwa nke ụyọkọ na nhazi nke kloloid), akụkụ okuku ume na vasopressor, nchịkwa homonụ corticosteroid, ọgwụ obi, wdg. ụzọ ezi uche dị na ọgwụgwọ mgbochi ụjọ, na-eburu n'uche ọnọdụ ọnọdụ onye ọrịa a.

1. Tolstoy A.D., Panov V.P., Zakharova E.V., Bekbausov S.A. Oke ure na oji pancreatitis. SPb.: Iflọ Mbipụta Skif, 2004. 64 p.

2. Volkov V.E. Ọrịa pancreatitis. Cheboksary: ​​Publọ obibi Chuvash. Mahadum, 1993.140 s.

3. Nesterenko Yu.A., Shapovalyants S.G., Laptev V.V. Ọrịa necrosis pancreatic (ụlọ ọgwụ, nyocha, ọgwụgwọ). M., 1994.264 s.

4. Ermolov A.S., Turko A.P., Zhdanovsky V.A. Nyocha ọnwụ na ndị ọrịa anaghị arụ ọrụ yana nnukwu ọrịa ọrịa pancreatitis // Nhazi, nyocha, nsogbu ahụike nke ọnọdụ mberede. M., Omsk, 2000.S. 172-176.

5. Savelyev V.S., Buyanov V.M., Ognev Yu.V. Ọrịa pancreatitis. M.: Medicine, 1983. 239 p.

6. Weil M.G., Shubin G. Nchoputa na ọgwụgwọ nke ujo. M.: Medicine, 1971.328 s.

7. Chalenko V.V., Redko A.A. Fluocorrection. St. Petersburg, 2002.581 s.

8. Schmidt J., Haus S., Mohr V.D. Plasmapheresis jikọtara ya na kọntinent anakpo ọbara nke ndị ọrịa na sepsis // Care Med., 2000. Nke 2 (5). R. 532-537.

A mụrụ VOLKOV VLADIMIR EGOROVICH na 1935. Ọ gụsịrị akwụkwọ na thelọ Akwụkwọ Ahụike Kazan. Dọkịta nke sayensị sayensị, Prọfesọ, Isi nke Ngalaba ofwa Ahụ nke Hospitallọ Ọgwụ nke Chuvash State University, Sọpụrụ Sayensị nke Chechen Republic na Russian Federation, onye so na Kọmitii Sayensị maka gerywa Ahụ na Onye so na Kọmitii Nsogbu Ahụ "Ofufe Ọwa Ahụ" RAMS. Onye dere ihe karịrị narị akwụkwọ sayensị isii.

Ọrụ VOLKOV VLADIMIROVICH. Lee p. 42__________________________

Kedụ ihe pịara uja pụtara?

Ọrịa pancreatic bụ ọnọdụ dị ezigbo njọ nke anụ ahụ na - etolite n'ihi nsonso nke ọrịa akwara, ọ na - emegidekarị akwara nke necrosis nke anụ ahụ, ọ na - esobelata mgbata ọbara, mmịnwụ ọbara, na - arụ ọrụ nke akụkụ ndị dị mkpa.

Egosiputa ọnọdụ a n’arụ ọrụ niile dị n’arụ na akwara niile.

Usoro kachasị dị ize ndụ na ujo anụ ahụ bụ ntopute nke ihe na - emerụ nsị nke nje na - abanye n'ọbara, nke a na - ebu ọbara n'ahụ mmadụ niile ma na - eduga n'ọzụ nke endotoxin ujo.

Ọ bụ nhịkọ a ka a na-ewere dị ka ihe na-akpata ọnwụ na akpata ụjọ.

Ckma jijiji na nnukwu ọrịa pancreatitis na-ebutekarị megide nzụlite ọrịa siri ike, nke na-emebi emebi, nke na-esonyere mmebi akwara dị na akwara nke anụ ahụ. A na-ahụta olu nke necrosis bụ isi ihe na ịgbakọ ihe ọghọm nke ịmalite ujo.

Na ọgwụ, a na-amata ụdị mbido na mbubreyo.

Foto eserese

Nnukwu akwara necrotic pancreatic ujo na-eduga na mmepe nke usoro mmebi ahụ niile. Agbanyeghị, ọ na-egosi nke ọma na mgbasa ọbara. Ihe mgbaàmà nke ihe otite ụjọ akwu bu:

1. Asedbawanye (ihe karịrị narị abụọ na narị abụọ / nkeji) ma ọ bụ wedata ala (ihe ruru 70 beats / min) obi.
2. Nrụgide na-aga n'ihu, ọ gaghị enwe ike ọgwụgwọ ọhụụ.
3. Centralization na decentralization nke mgbasa ọbara, mbelata nke olu mgbasa ọbara, hypotension na-achịkwaghị achịkwa.
4. Aka na ukwu oyi, cyanosis nke anụahụ.
5. Nnukwu mgbu n'ime afọ na hypochondrium.
6. Ahụ erughị ala
7. Vom nke na-enyeghị ahụ efe.
8. Ahụ Ikpo Ọkụ.
9. Akpịrị ịkpọ nkụ.
10. Obere mmamịrị.
11. Okpokoro n’ime afọ.

Na mbubreyo ujo, oke (kariri 38) ma obu ala (okpuru 36), enwere ike inyocha hypotension. Ogo iku ume a na-akarị iku ume iku ume 20 kwa nkeji, ọnụego obi karịrị 90 ugboro kwa nkeji. A na-ekwupụta mgbu nke ukwuu, onye ọrịa nwere ike nwetakwa mmụọ.

N'ihe banyere ihe mgbaàmà nke oke ụjọ, ị ga-akpọrịrị ụgbọ ihe mberede, ebe ọnọdụ a dị njọ na ndụ mmadụ.

Usoro nke mmepe nke ọrịa pathological

Shockma jijiji na nnukwu pancreatitis na-etolite n'ihi nsị nke necrotic na nnukwu olu nke anụ ahụ parenchyma, mmetụta na-egbu ahụ n'ahụ enzymes na nje nje na-arụ ọrụ n'ime ya. Ọ na-ahụ kwuru:

1. Site na OP, n'ihi ọzịza, spasm nke pancreas, ijikọ ya na bile, nri enzymes nwere ike ghara ịbanye na eriri afọ ya, ya mere, a na-agbanye ya na gland wee malite ibibi ya. Ka oge na-aga, mkpụrụ ndụ akwara nke mebiri emebi na-anwụ, na-eme ka ọ na-ebute mmepe nke usoro nje, sepsis (nsị ọbara).
2. Ọkpụkpụ pancreatic, enzymatic toxicosis na sepsis na-akpata mgbanwe mbibi dị ukwuu na mgbasa ọbara na ọrụ nke akwara nke usoro akwara obi, nke na-eduga n'ọzụ nke oke ụjọ.
3. Mgbu mgbu, nke na-ebilite n'ihi ogo ihe mgbu na-abawanye, na-eduga na vasoconstriction. Ya mere, ọbara na-amalite ịba ụba n'ụba na ụbụrụ. N'ihi mkpụkọ nke arịa ọbara, akụkụ ahụ na anụ ahụ na - enweghị oxygen, yana ọrụ akpa ume na sistem na - arụ ọrụ.
4. Akụrụ enweghị ike imepụta mmamịrị, nke na-eduga na ọ gbasara akụkụ ahụ niile dị n’ime.

N'ihi mbibi dị ukwuu nke mkpụrụ ndụ akwara, mmiri mmiri dị n'ime ya na-abanye na akụkụ ahụ dị nso, enzymes na-amalite ibibi arịa ọbara:

• Lipase na protease, na-arụ ọrụ na mgbidi nke arịa ọbara, na-eduga n'ịbawanye n'ihe ha na-akpata, mfu plasma, oke ọbara, ọzịza.
• Tripsins na-ebibi mkpụrụ ndụ ọbara uhie.

Ọkpụkpụ ahụ na-efesasị, arịa ọbara na-emechikwa, arịa ọbara. Aguba ụba n'ọbara na-eduga n'ịbelata mkpụkọ ọbara, mbelata ọbara mgbali elu na arụ ọrụ obi.

Ihe kpatara mmepe nke ujo mbubreyo, ihe kachasị egbu ndụ bụ sepsis. Ọkpụkpụ anụ ahụ nwụrụ anwụ na-eduga n'ịzụlite usoro nje. Mgbe nje ụmụ nje na mkpụrụ ọgwụ na - egbu egbu nke ọrụ ha dị mkpa banye na sistem okirikiri, sepsis na - amalite, nke na - eduga n'ị intoụbiga ahụ mmanya ókè. N'ihi ya, mbubreyo endotoxic nke ụjọ jidere.

Ihe enyemaka mbu

Ọ bụrụ na mwakpo nke nkụja hụrụ onye ọrịa n'ụlọ, ọ kwesịrị ịchọpụta udo. A ga-atọgbọ onye ahụ n’elu ụlọ dị larịị ma kpọọ ụgbọ ihe mberede. Tupu ndị dọkịta abịarute, ọ dị mkpa idebe iwu ndị a:

• Ekwesighi inye onye ahụ ihe ọ drinkụ drinkụ ọ foodụ ,ụ, nri, ọgwụ mgbu ma ọ bụ ọgwụ ọ bụla.
• N'elu afọ, ị nwere ike itinye paịlị na-ekpo ọkụ ma ọ bụ karama mmiri oyi, nke ekpuchiri ya na akwa ice. Nke a ga - belata ogo ihe mgbu.
• Ọ dị mkpa iji nyere onye ọrịa aka wetuo obi ma zuo ike, ka nsogbu nke akwara afọ, ahụmịhe akwara na-eme ka ihe mgbu kwụsị ma mebie mgbasa ọbara, ọrụ obi.

Itlọ ọgwụ na nnwere onwe nke mbuso agha

Onye ọrịa nwere ọrịa palọ na-eduga n'ụlọ ọgwụ. Na ngalaba ahụike mberede, ọgwụgwọ nke ọnọdụ a bu ụzọ gbakwunyere na:

1. Na-asachapụ ahụ na ọbara nke toxins.
2. Ntughari mmebi nke mmiri.
3. Mgbake nke nguzogide acid-base.
4. Normalization nke viscosity, acidity, kemịkalụ nke ọbara.
5. Mbelata ogo nke ihe mgbu na mwepu.
6. Mgbochi mmepe nke ọrịa.

Iji jiri nwayọ wepu ihe ndị na-egbu egbu n'ime ahụ, a na-ehiwe sistem. Ọ bụrụ n’ịchọrọ iwepu afọ, a na-eme mkpọtụ. A na-eme ihe iji sachapụ ọbara nke toxins na-eji mgbaasị.

Ọ bụrụ na ọ dị mkpa, enwere ike imepụta:

• hemofiltration (ịmịnye ọbara site na haemofilter na ntinye intravenous nke ihe nnọchi ọzọ),
• plasmapheresis (nlele ọbara, nsacha ya na ịlaghachi azụ).

Ezubere usoro ndị a iji sachapụ ọbara nke nsí. Okwesiri iburu n'uche na a na-eji ihe ojoo mee ihe na ogbo nke pancreatic necrosis, ma site na mmalite nke ujo, a na-eme haemofiltration ma ọ bụ plasmapheresis. Njikọ nke ụzọ ndị a nwere ike belata ọnwụ nke ihe dị ka 28%.

Iji dozie mmiri, nguzozi acid, ihe ndi ozo na ọbara, a na-arunye onye oria ahu otutu ogwu ogwu.

• A na-enweta ụgwọ nchekwa protin-electrolyte site na ụzọ colloidal na crystalloid. Ha na-enyekwa aka n'ịbugharị ọbara.
• Iji belata ịdị njọ nke ihe mgbu, ha na-abanye ọgwụ na-egbu mgbu, ọgwụ antispasmodics.
• Iji gbochie mmepe ma ọ bụ mgbasawanye nke usoro nje, na-enye ọgwụ mgbochi.
• Ọ bụrụ na ọ dị mkpa, a na-enye ndị na-echekwa ọbara na ihe mkpuchi ọbara.

N’oge na-adịbeghị anya, iwepụ ọgbụgba na nchịkwa yiri nke immunoglobulins (dịka ọmụmaatụ, Pentaglobin, Intraglobin, Lobulin) ka a na-ewere ụzọ kachasị dị irè iji gwọọ ujo ụfụ. Immunoglobulins na-ebelata ọrụ dị mkpa nke ọrịa na nje, nke na-enye aka na enyemaka ahụ ngwa ngwa nke usoro ọrịa na-efe efe.

N'oge mbido ọgwụgwọ, onye ọrịa na-egosipụta oke agụụ. N'ọnọdụ ndị siri ike, enwere ike ịfefe ya na nri anụ ọkụ.

Amụma ọzọ

Ọnọdụ ọrịa na - etolite na 9-22% nke ndị ọrịa.

Nnyocha egosila na usoro necrotic na pancreas na-akpata mbelata ngwa ngwa mgbochi. Onu ogugu onwu site na mbido ososo nke panasterogenic ruru onodu 48%, maka onodu ubochi ikpeazu, ubara ihe ojoo bu ihe ejiri mara - site na 24 rue 72%.

• Ojiji nke ego maka ebe obibi ndị mọnk maka ọgwụgwọ nke ọrịa pancreatitis

Ọ ga-eju gị anya ọrịa ahụ ga-alaghachi ngwa ngwa. Na-elekọta pancreas! Ihe karịrị mmadụ 10,000 achọpụtala ọganihu dị ukwuu na ahụike ha nanị site n'ị drinkingụ mmiri n'ụtụtụ ...

Ofzọ eji agwọ ọrịa pancreatitis n'ụlọ ọgwụ na oge ọgwụgwọ na ụlọ ọgwụ

Usoro ọgwụgwọ maka ọrịa pancreatitis na ọnọdụ ụlọ ọgwụ dabere na ọkwa nke ọrịa ebe a nabatara onye ọrịa n'ụlọ ọgwụ, yana ọnụnọ nke nsogbu.

Ihe na - akpata obi mgbawa na ndabere nke pancreatitis na ụzọ dị mma nke ọgwụgwọ ya

Ndị ọkachamara na-ekwusi ike na ọnụnọ ya na onye ọrịa nwere ike ịkpalite ya, na mgbakwunye na pancreatitis, gastritis ma ọ bụ esophagitis.

Ihe na-akpata nnukwu ọrịa ọrịa pancreatitis na atụmatụ nke ụzọ ya

Ogwu mara ihe ruru 200 ihe nwere ike ịkpasu oke iwe. Ndị ọrịa na-eme mkpesa banyere ebe ngosipụta nke ọnya dị iche iche na-enyere aka ikpebi

Kedu ihe na-eme ka iwe na-egbu ya mgbu? Njirimara ọgwụgwọ na nchoputa nke mbuso agha

Site na mwakpo dị nro, ọgwụgwọ n'ụlọ nwere ike ikwe, ma ọ bụrụ na iwe ahụ nwere ụlọ ọgwụ siri ike, ọ dị mkpa ịkpọtụrụ ndị ọkachamara.

Achọpụtara m na mwepu mbụre m. Ọnọdụ okpomọkụ wee ruo ogo 37.5, ọgbụgbọ, ọgbụgbọ, oke mgbu n'ime afọ, ọsụsọ, na-emekpa m ahụ, isi m merụrụ ahụ nke ukwuu site na nrụgide dị ala. Anọrọ m otu izu na ọkara n'ụlọ ọgwụ n'okpuru ndị na-ebugharị ụmụ, achọghịzi m ịdị ndụ ọzọ.