Mgbe ị na-achọpụta nchoputa nke ọrịa pancreatitis nke nnukwu, dọkịta ambulance nwere ikike izigara onye ọrịa n'ụlọ ọgwụ ahụ site na ụlọ mberede ahụ site na ụgbọ ihe mberede na onye na-efegharị.

N'oge usoro ọmụmụ, ọ dị mkpa iji mepụta usoro ọgwụgwọ ndị a:

1. machibidoro ị eatingụ ihe ọ andụ ,ụ na ị drinkingụ ihe ọ ,ụ ,ụ,
2. Mpempe ice na mpaghara epigastric nke ụlọ na n'oge njem,
3. ntinye nke antispasmodics iji belata sphincter nke Oddi spasm (nitroglycerin, 1-2 na-ada n'okpuru ire, nitrosorbide ma ọ bụ sustac, 2 ml nke ihe ngwọta 2% nke papaverine, ma ọ bụ 2 ml nke enweghị-shpa na ngwakọta nke 2 ml nke 0.2% nke platifillin),
4. ntinye nke 1 ml nke 0.1% nke atropine iji belata ihe nzuzo ọria,
5. ntinye nke 40-60 ml nke ọgwụ mgbochi 0,5 nke novocaine, nke bụ ihe na-egbochi kallikriin na antispasmodic,
6. nchịkwa nke antihistamines (2 ml nke 1% ihe ngwọta nke diphenhydramine ma ọ bụ 1 ml nke 2% ngwọta nke suprastin),
7. site na ndakpọ, nchịkwa intravenous nke 60-90 mg nke prednisone ma ọ bụ 300-450 mg nke hydrocortisone, infusion replenishment of bcc ụkọ n'ihi crystalloids,
8. iwebata intramuscularly 2-4 ml nke Lasix ma ọ bụ 1 ml nke novurite iji belata gbaa ụka ma mee ka mpụta ahụ nke enzymes dị n'ahụ. Enwere mmetụta dị mma na mmalite nke ọrịa ahụ site na iji otu n'ime nkwadebe antienzyme, nke a na-eduzi intravenously na usoro onyonyo: trasilol 200000-300000 IU, zalol 200000-300000 IU, kontrikal 100000-200000 IU, pantripin 120-150 IU.

Usoro ọgwụgwọ niile a rụrụ na prehospital ogbo, dọkịta ga-edekọ na mpempe akwụkwọ a. Na mgbakwunye na nyocha ụlọ ọgwụ, a na-eme nchọpụta ụlọ nyocha nke hyperfermentemia na ngalaba nnabata nke ụlọ ọgwụ, ebe onye ọrịa na-abanye, nke dabeere na ọmụmụ banyere ọrụ nke enzymes pancreatic na ọbara (amylase, trypsin, lipase) na mmamịrị (amylase).

Ed. V. Mikhailovich

"Nlekọta ihe mberede maka nnukwu ọrịa metụtara ọrịa" na isiokwu ndị ọzọ sitere na ngalaba Mberede

3. Nnukwu ọrịa a na-eme

Ọrịa Oké ihe mgbu na-eme mgbe nri nke abụba (eghe eghe), mmanya. Ugboro ugboro, na-egbu mgbu nke na-adịghị eweta ahụ efe. Mgbu, oria icteric. Tachycardia, hypotension akwara. Ahụ Ikpo Ọkụ. Ire asat. Atinggba agba ọkara, mgbu. Ezi mgbaàmà nke mgbakasị ahụ peritoneal. Leukocytosis nke nwere mgbanwe n'ọbara na-agụta n'aka ekpe. Enwere ike ibuli ọbara na mmamịrị amylase.

Ihe enyemaka mbu. Udo. Agụụ. Oyi na mpaghara epigastric. Ntugharị dị ngwa nke dọkịta.

Nlekọta ahụike mberede. Ụlọ ọgwụ. Udo. Agụụ. Oyi na afo.

Chụpụ ozigbo ozigbo gaa OMEDB (ụlọ ọgwụ) site na ụgbọ ihe mberede, dina n'elu ihe ndagide, ya na onye ọgwọ ọrịa (dọkịta) so ya. Tupu mkpụpụ ya na n'oge a, hụ na ịchọrọ ọdịnaya nke nnu n'ime ya site na nyocha, nyefee saline (ihe ruru 800 ml).

OMB, ụlọ ọgwụ. Nkwenye nke nchọpụta: ultrasound nke akụkụ ahụ dị n’apata afọ, foto panoramic nke obi na afọ, gbakọrọ tomography nke pancreas.

agụụ, agụụ oge niile nke ihe afọ n'ime na-abịa site na tube,

mgbochi nke pancreatic secretion na antienzyme ọgwụ (5-fluorouracil, octreatide, contracal),

analgesics na antispasmodics intramuscularly, sacrospinal novocaine mgbochi ma ọ bụ mgbochi ogologo nke epidural,

infusion therapy iji dozie ihe mejuputara mmiri-electrolyte, CBS, BCC, oria haemocoagulation,

ọgwụ mgbochi, mgbochi mkpali, antacid na antihistamines.

N'ihe banyere usoro ọgwụgwọ zuru oke na ọganiihu nke nnukwu ọrịa pancreatitis, plasmapheresis, nchịkwa endolymphatic nke ọgwụ mgbochi na mgbochi antienzyme, mwepu mpụga nke thoracic lymphatic duct, lymph na hemosorption na-esonye na mmemme kpụ ọkụ n'ọnụ. N'ihe banyere ntopute nke peritonitis, na ọnụnọ nke omentobursitis, a na-eme laparoscopy iji kọwaa nchoputa, igbapu akwa omentum na oghere afọ, yana cholecystostomy machie.

Ofdị arụmọrụ nke nnukwu pancreatitis na-emebi emebi:

ihe mberede (jiri ihe mgbaàmà nke ọbara ọgbụgba n'ime ma ọ bụ mwepu ọbara site na nsị) - kwusi mmebi ọbara.

ngwa ngwa (n'ime ụbọchị ole na ole ịbanyechara n'ụlọ ọgwụ, ya na ọganihu nke ihe ịrịba ama nke pancreatic necrosis, mmepe nke peritonitis, ịba ụba nke jaundice, mmerụ ahụ) - ntughari na mkpochapu nke oghere peritoneal, omental bursa, oghere retroperitoneal.

ihe dị mkpa iji rụọ ọrụ ahụ bụ cholecystostomy.

gbụrụ oge (mwepu) - mwepu mpaghara akwara ozi nke akwara na (ma ọ bụ) parapancreatic retroperitoneal fiber.

4. Imeju afọ na ala afọ

Ọrịa "Dagger" mgbu afọ. Ọnọdụ ọnọdụ onye ọrịa ahụ (n'akụkụ aka nri ya na ụkwụ ya na afọ ya). Ire asat. Ume a na-emighị emi. Ọkpụkpụ mọzụlụ nke ogịrị akụkụ dị n’afọ. Afọ ahụ dị ka “plank,” adịghị etinye aka na iku ume. Mgbu mgbu na palpation, mgbaàmà nke mgbakasị ahụ peritoneal. Achọghị ịda ahụ ike. Na nyocha a na-eme mkpesa nke afọ - ọnụnọ gas na oghere dị n’afọ. Leukocytosis nke nwere mgbanwe n'ọbara na-agụta n'aka ekpe. Site na mmụcha mkpuchi mkpuchi, enwere ike imeziwanye ọnọdụ zuru oke.

Ihe enyemaka mbu. Udo. Agụụ. Oyi na mpaghara epigastric. Ntugharị dị ngwa nke dọkịta.

Nlekọta ahụike mberede. Ụlọ ọgwụ. Udo. Agụụ. Oyi na mpaghara epigastric.

Chụpụ ya ngwa ngwa na OMEDB (ụlọ ọgwụ) site na ụgbọ ihe mberede ka ọ na-edina n'elu onye na-ehi ụra, onye ọgwụ na-esoro ya. Chọpụta ihe dị n’ime afọ site na nyocha (a na-egbochi afọ iri na ụma).

OMB, ụlọ ọgwụ. Nkwenye nke nchọpụta ahụ: nyochara foto nke oghere nwa. Na enweghị gas na ọnụnọ nke mgbaàmà nke mgbakasị ahụ, a na-eme fibroesophagogastroscopy, pneumogastrography, ma ọ bụ ọdịiche dị na gastrography na x-ray abdominal ugboro ugboro.

Uzo eji arụ ọrụ: na ngbanye peritonitis, oge ịfoụ ihe karịrị awa 6, ọrịa na-adịghị ike, yana ahụmịhe zuru oke nke dọkịta na-awa ahụ, na-eme ka ọnya afọ nke ọnya afọ ma ọ bụ ọnya duodenal.

Site na ọnya ekpomoku na ọnụnọ nke ihe mgbaàmà na-agbasa peritonitis, a na-eji ọgwụ na-eme subphrenic steot vagotomy na ọnya ọnya na pyloroplasty.

A na-ahụ ntụgharị obi na ọkwa nke nlekọta ahụike pụrụ iche maka ịbanye, ọnya afọ na ọnya afọ, yana ọnya afọ, mgbe enwere data nyocha nke na-egosi ịdị nkọ dị ala nke nwanyị.

N'ihe banyere ọnya afọ nke ọnya afọ na nke duodenum, ụzọ ịwa ahụ na-arụ ọrụ ka dị.

Etiology na pathogenesis

Mmepe nke nnukwu ọrịa pancreatitis n'ọtụtụ ikpe metụtara njikọta nke mkpali na ọnya afọ na ọnya, site na ebe oria na-abanye pancreas ma ọ bụ site na njikọta otu ebe na wirsung ma ọ bụ site na akwara mbufụt.

E nwekwara ụzọ ọzọ maka ọrịa ibute n’akporia - mgbasa nke hematogenous nke ụmụ nje n’ọbara dị iche iche (fever fever, mumps, fever uhie, sepsis, wdg). Formdị kachasị njọ nke nnukwu ọrịa pancreatitis bụ nnukwu oria na-enye ọria. Ọdịmma ya bụ usoro dị oke njọ, na-eduga n'ọtụtụ ọnụọgụ ọnwụ na ụbọchị na-abịanụ, mgbe ụfọdụkwa awa mgbe mmalite nke ọrịa ahụ.

A na - amata oke mmebi nke akwara mbufụt, nke a gosiputara dika ndi a. Dị ka ị maara, n'okpuru nduzi nke bile, trypsinogen nke pancreas na-agbanye n'ime enzyme na-arụ ọrụ. Usoro a na ahụike mmadụ na-aputa ihe na eriri afọ.

Mgbe ihe ọ juiceụ ofụ nke duodenum ma ọ bụ bile na-abanye na pancreas, trypsinogen na-abanye na trypsin na pancreas n'onwe ya (ha na-atụ aro na mgbanwe a dịkwa ike n'okpuru mmetụta nke nje). Na ngwụcha, mwepụta nke enzyme (trypsin) na pancreas na-ebute uto mmepe nke necrosis na mgbaze nke gland.

N'ikpeazụ, na pathogenesis nke nnukwu pancreatitis so mkpa imebi ọbara mgbasa na pancreas. Ischemia (nkụchi obi), embolism na ọbara ọbara, nke na - ejide ọtụtụ n'ime gland, na - akọwa mmepe nke nnukwu ọnya ọgbụgba.

N'ọnọdụ ụfọdụ nke nnukwu ọrịa pancreatitis, usoro ahụ bụ maka mgbanwe catarrhal, na ndị ọzọ - ọdịdị nke purulent foci, n'ikpeazụ, na nke atọ - foto nke hemorrhagic necrotic pancreatitis tolitere.

Ọtụtụ mgbe, nnukwu ọrịa akwara na-ebilite n’ahụ́ mmadụ ndị riri ọtụtụ nri, karịchaa, ndị nwere abụba, na ndị na-a alcoholụbiga mmanya ókè. Ọtụtụ mgbe, ọrịa ahụ na-amalite mgbe nri abalị mara abụba.

Akuko egosiputala cholecystitis ma obu cholangitis.

Ọrịa malitere kpam kpam. Ogo ya abụghị otu n’okwu niile. E nwere ụdị ọrịa a na-akpọ nnukwu ọrịa pancreatitis, nke na-aga n'ihu n'ụzọ dị mfe ma na-anọgide na - - nnukwu ọrịa catarrhal pancreatitis. N'ọnọdụ dị oke njọ nke ọrịa akwara catarrhal, ihe mgbu na-eme na mpaghara epigastric na etiti otu ahụ wee gbasaa n'akụkụ aka ekpe.

Ha kpuchitere akụkụ aka ekpe nke anụ ahụ n'ụdị eriri-ukwu site na otua ruo n'ọkpụkpụ (fig 17, c na b). N'ọnọdụ ụfọdụ, mgbu na-apụta na mpaghara nke ubu aka ekpe, na ndị ọzọ, yana nke a, ruo na aka ekpe nke afọ, na nke atọ, gaa n'ụkwụ aka ekpe n'akụkụ akwara nke sciatic. Ọkpụkpụ afọ ya ga-aza aza, mana mgbe ọ bụla ọ dị gị n’obi, ahụghị nsogbu dị n’afọ.

Mwakpo ihe mgbu na-ejikarị ọgbụgbọ, ọgbụgbọ, na salivation. Ihe ịrịba ama nke ịchọpụta ihe dị mkpa bụ ụba ọdịnaya nke enzyme anụ ahụ - a na - a inụ ya na mmamịrị na ọbara (karịa otu 64 Volgemutov).

Pancdị pancreatitis dị ala na-akwụsị na mgbake, ma ọ bụ nwee usoro na-adịghị ala ala.

Foto nyocha

Ọ bụrụ na ọrịa ahụ amataghị, etuto ahụ na-adaba n'ime oghere nke afọ na nnukwu purulent peritonitis malitere. A na - amata ikpe igbu onwe ya na ọnya ọnya na - abanye n'afọ ma ọ bụ eriri afọ. Nnukwu etuto ahụ nwere ike ime ka mkpakọ nke bile ma bute mmepe nke jaundice.

Ihe egwu kasịnụ bụ nnukwu ọrịa n’akwara na - arịa ọbara, nke na - enwe nnukwu onyonyo nke “ọrịa na - akpata afọ”. Udiri oria a bidoro na oke ihe mgbu n’ime afo (n’ime epigastrium na gburugburu otube). N’aka ndị ọzọ, ihe mgbu ahụ bụ mpaghara mpaghara iliac. Mgbe ụfọdụ ndị ọrịa na-eme mkpesa maka oke ihe mgbu nke akụkụ pelvis ma ọ bụ mpaghara lumbar.

Ọnọdụ ujo dị egwu na-etolite ngwa ngwa: ọsịsọ na-adịkarị obere, dị obere, ma akpụkpọ ahụ dị mma n'anya. A na-ahụ ihe ndị dị n’ihu n’anya, anya na-atụgharị n’azụ. Na ọgbụgba, ọgbụgbọ na-enweghị isi, na nnu na - apụta. N’oge na-adịghị anya, iji mkpachapụ nke ihe ọgbụgba amalite, mmegharị nke eriri afọ ga-akwụsị, mwepu nke feces na gas na-egbu oge. Mgbe ụfọdụ ascites nke ọbara ọgbụgba na-amalite, nke a na-achọpụta site na imerime oghere dị n’afọ ma ọ bụ n’oge ịwa ahụ. Mgbe ị na-enyocha mmamịrị maka diastasis, ọnụ ọgụgụ dị ukwuu na-ekpebisi ike.

Ọnwụ nwere ike ibilite n’oge awa ọrịa ahụ ma ọ bụ n’echi ya. Ọnụnọ nke jaundice, yana yana ọrịa purulent na-akpata puselent, bụ n'ihi mkpakọ nke agịga na-emetụta ya. Nchoputa nke oria akwara nke oma n’eweputa ihe isi ike, nihi na oria a adigh obere.

Recomata mmamiri nke puru iche nwere ike dabere na ntughari di na aka ekpe nke ukwu nke ihe mgbu bu nke n’egedechi ma o bu ihe n’egede mmadu, onodu nke akpukpo aru (hyperalgesia) ya na njiri mara ya, ma n’ikpeazụ, mmụba n’ime akwara na ọbara. Ihe ngosiputa maka akuko banyere otiti nke oria Galil na oria bile na arụ di egwu.

A na-ahụta otu ihe mgbaàmà ahụ na puselent pancreatitis, nke, na mgbakwunye, a na-eji ihe ịrịba ama nke usoro purulent-mbufụt (ahụ ọkụ ruo 38-39 Celsius, neutrophilic leukocytosis n'ime ọbara).

Mmepe ngwa ngwa nke nnukwu oria na - eme ala yiri nnukwu peritonitis na - esite na appendicitis perforated, ọnya afọ na-egbu mgbu. N'ụzọ dị iche na nke ikpeazụ, na nnukwu ọrịa pancreatitis, afọ na-adị jụụ, a na-echekwa ịdaji ịba ọcha n'anya.

Onu ogugu ana - eme n’ime mmamiri na obara bu uru di omimi di iche-iche nke ihe otite.

Amụma na nnukwu ọrịa ọ na - eme ọrịa mgbe niile. N'okwu niile mgbe enwere enyo nke nnukwu pancreatitis, a ga-akpọrịrị onye ọrịa ozugbo n'ụlọ ọgwụ na-awa ahụ.

Naanị na ọnọdụ ụlọ ọgwụ ka enwere ike idozi ajụjụ ahụ ma onye ọrịa ahụ ga-awa ahụ ngwa ngwa ma ọ bụ ọgwụgwọ nchedo.

Ọbụna tupu ọ gaa ụlọ ọgwụ na n'oge njem, onye ọrịa ahụ aghaghị ịmepụta udo zuru oke. Ebe ọ bụ na ndị ọrịa nwere nnukwu pancreatitis na-ebute ihe mgbaàmà nke ọdịda akwara umeji na ujo, e kwesịrị ibute usoro ọgwụgwọ megide ha. Denye cardiazole, cordiamine ma ọ bụ camphor. Na ọgụ megide ọnọdụ ujo, a na-ewepụta morphine (1 ml nke 1% ngwọta) na ọgwụgwọ physiological nke sodium chloride ma ọ bụ 5% glucose ngwọta (500-1000 ml) n'okpuru akpụkpọ ahụ yana adrenaline (1 ml nke ihe ngwọta 0,5%).

Ọ bụrụ na enwere ike, ịmịnye ọbara (300 ml). N’ụbọchị mbụ, ekwesighi inye onye ọrịa nri. Ekwesịrị ime usoro ndị a naanị na ọnọdụ ndị ahụ dị ụkọ mgbe enweghị ike ibugharị onye ọrịa maka ihe ọ bụla. Agbanyeghị, ka emechara nke a, a ka ga-akpọga onye ọrịa n'ụlọ ọgwụ, dọkịta na-esonye ya ma ọ bụ onye na-ahụ maka ahụike.