Di ichiche iche banyere atherosclerosis nke ala ala

Maka nchoputa nke endarteritis, na mgbakwunye na akara ngosi ahụ dị n’elu, ọmụmụ ọrụ arụ ọrụ dị mkpa: oscillography (lee), rheovasography, capillaroscopy (lee), arteriography, ọmụmụ banyere akpụkpọ ahụ. Nnyocha nyocha nke ọkpụkpụ nke aka n'ụkwụ metụtara na-ekpughe mgbasa osteoporosis, imechi ọkpụkpụ dị n’ọkpụkpụ ọkpụkpụ. A na-ebu ụzọ mata ọdịiche dị iche iche na mbuala akwara ozi atherosclerosis. Ejiri mara nke afọ ndị ọrịa (karịa afọ 50), mmụba na-eji nwayọ nwayọ - mgbanwe na agba nke akpụkpọ ụkwụ, akpụkpọ akọrọ, mgbanwe trophic. Site na atherosclerosis nke arịa akụkụ, na-emetụtakarị aka ya abụọ, ọ nweghị thrombophlebitis na-efe efe. ọrịa a n'ọtụtụ ndị ọrịa bidoro nwayọ, yana ọrụ ogologo oge. Ma, atherosclerosis na-ejikarị thrombosis na embolism. nke na - ebute nnukwu mgbochi nke akwara ozi na nsogbu ọgbụgba na - arụ nnukwu ọrụ na mpaghara mpaghara ukwu. Site na mkpochasị ọrịa endarteritis, ọrịa a na-amalite, dị ka a na-achịkwa, karịa, ọrịa na-efe efe na-eme ngwa ngwa onye ọrịa, karịchaa ụdị endarteritis nke ntorobịa nke na-eme n'afọ 20-25. Ọ kachasị mfe ịmata ọdịiche dị na endarteritis na ọrịa ndị ọzọ yana mgbu na mpaghara ikpere. Na mkpụkọ mkpụkọ akwara nke ala ikpere (varicose veins), mkpesa nke ndị ọrịa nwere mgbu n'ụkwụ na-akpata site n'ọkwa nke ọbara ọgbụgba, n'ihi ya, ihe mgbu ahụ na-abawanye mgbe ọ na-eguzo. N'ọnọdụ ụfọdụ, ọ dị mkpa iche ọdịiche dị na endarteritis na mgbu na ụkwụ kpatara ọrịa ogbu na nkwonkwo na ọrịa ogbu na nkwonkwo, myositis, fasciculitis, radiculitis. ụkwụ larịị. nsị mmetụta nke mmerụ ahụ. Site na ọrịa ndị a niile, enweghị akara ọ bụla nke imebi mgbasa, isi ahụ na-eme nke ọma, oscillogram bụ ihe kwesịrị.

Nchoputa ya. N'ime nyocha nke ndị ọrịa nwere obstarteritis na-akwụsị, oscillometry arterial dị mkpa. Na steeti nkịtị, akwara oscillometric na-enwekarị ọnụ ọgụgụ dị nkọ, ee, oscillation kachasị kwekọrọ na ọnụọgụ nke nrụgide kachasị na cuff. Na ọnọdụ pathologies nke akwara ike nke aka, ọdịdị oscillometric curve na-agbanwe. Site na ihichapu akwara ozi zuru oke, osomenti ahụ enweghị ike ịchọpụta.

Ihe dị ezigbo mkpa bụ capillaroscopy (lee) na plethysmography (lee). Iji chọpụta akwara vaskụla, a na-eji nnwale arụ ọrụ - mgbochi ngọngọ novocaine ma ọ bụ ihe mgbochi nke lumbar ganglia.

Tupu mgbochi, a na - eme capillaroscopy na ọmụmụ banyere okpukpo anụ, ma emesịa na - amụta ọmụmụ ihe ndị a mgbe nkeji iri atọ gasịrị. mgbe mgbochi. Site na vasospasm, ihe mgbochi na-agbanwe ala nke capillaries, ọ ga - ekwe omume ịhụ ọnụ ọgụgụ ka ukwuu n'ime ha, ọnọdụ akpụkpọ ahụ na - ebili site na 2-4 Celsius. Enweghị mmetụta dị otú ahụ na-ekwu okwu megide mmalite nke ischemia.

Nnyocha X-ray na-ekpughe mgbanwe mgbanwe n'ọkpụkpụ nke ọkpụkpụ aka metụtara - na-agbasa osteoporosis, na-ete nke okpukpu abụọ nke cortical.

Arteriography na-enye gị ohere ikpe ikpe gbasara akwara ọbara na akwara ọbara, mana a ga-eme nyocha vasographic naanị ma ọ bụrụ na ọ dị ezigbo mkpa, maka na ha anaghị eche maka arịa ndị agbanwere.

Fig. 1. Nkịtị ebugharị.

Fig. 2. Oscillogram maka spasm nke arịa nke obere nsọtụ (oscillation n'ụdị ụkwụ).

Fig. 3. Oscillogram n'oge iwere akwara nke ukwu aka ekpe (ọ dịghị oscillation na ụkwụ).

Oria di iche rụrụ na mbụ na akwara vaskụla atherosclerosis. Ejiri mara nke afọ 50, mmụba dị nwayọ n'ihe mgbaàmà - mgbanwe na agba nke akpụkpọ ụkwụ, akpụkpọ akpọnwụ, mgbanwe akpịrịkpa. Na arịa ọrịa atherosclerosis nke akụkụ aka, aka na-emetụta oke, ọ nweghị thrombophlebitis, ọkachasị na mbugharị, ọnya na-ejigide ọrụ ha ogologo oge, nsogbu ọbara na-agbasa n'ọtụtụ ndị ọrịa na-etolite nwayọ, na-enwe oge ogologo oge. Agbanyeghị, atherosclerosis na - ejikarị thrombosis na embolism, nke na - akpata nnukwu mgbochi nke ogwe ukwu na nsogbu nhụjuanya na mpaghara ukwu nke ukwu. Iwepu endarteritis, dị ka a na-achị, si karịa ka ọ na-adị, nsogbu na-abụkarị ngwa ngwa onye ọrịa na-eto eto, ọkachasị ụdị endarteritis nke ntorobịa nke na-eme n'etiti afọ 20-25.

Ọ bụghị mgbe niile (karịchaa ndị agadi) na ọ ga-ekwe omume ịkewapụta ọrịa abụọ a na ntụkwasị obi zuru oke, ọ dị mfe ịmata ọdịiche nke endarteritis na ụdị nosological ndị ọzọ, yana mgbu na nsọtụ ala.

Na erughi ala nke akwara dị ala nke mgbatị ahụ (mgbatị varicose), mkpesa ndị ọrịa nwere mgbu n'ụkwụ na-esite na mgbagwọ ọbara ọbara na mgbu na-akawanye ike. N'ọnọdụ ụfọdụ, ọ dị mkpa iche ọdịiche dị na endarteritis na syndromes mgbu site na ọrịa rheumatic, myositis, fasciculitis, radiculoneuritis (dịka ọmụmaatụ, na osteochondrosis nke lumbar vertebrae), nrụrụ ụkwụ, mbibi azụ, wdg Enweghị ihe ịrịba ama nke isi mgbasa ọbara na-efe efe na ọrịa ndị a niile. , na waveform bụ nkịtị. O siri ike ịmata ọdịiche dị na endarteritis nke akụkụ elu ahụ site n'ụdị ndị ọzọ bụ akụkụ nke otu olu mgbu na ubu olu (lee).

Atherosclerosis nke aorta na alaka ya. Akụkọ banyere ahụike

Akụrụngwa / Atherosclerosis nke aorta na alaka ya. Akụkọ banyere ahụike

Ibepu anherosclerosis nke arịa nke ala akụkụ ahụ ga-adị iche site na:

- wepu endarteritis. Ihe omuma ndi a n’eme ka enwe ike iwepu ihe nchoputa nke endarteritis: mbibi akwara akwara nke buru ibu (nnukwu) akwara, oria na - ebute oria, enweghi akuko nke ihe na - adighi nma.

- thromboangiitis obliterans. Ọrịa nke thromboangiitis obliterans na-enye ohere iwepu enweghị nke thrombophlebitis nke veins elu nke ọdịdị njem, enweghị ọnya iwe, yana thrombosis nke akwara na ọwa mmiri,

- Ọrịa Raynaud. Mmeri nke nnukwu arịa nke akụkụ ala, enweghị ntụpọ nke akwara ụkwụ, ala nke ukwu, "ịkọ nkọ" na-enye ohere iwepu nchoputa a.

- thrombosis na embolism nke akwara ozi nke ala ala. Mmụba nke nwayọ na ngosipụta nke ụlọ ọgwụ (ọtụtụ afọ), ntinye nke arịa abụọ nke aka na usoro, na enweghị ụdọ akpụkpọ ahụ na-ekwe ka ewepu nchoputa a.

- thrombosis nke miri emi nke ala ala. Enwere ike ịchịkwa nchoputa a site na enweghị edema, ahụ ọkụ na ọnya n'oge palpation tinyere isi veins na apata ụkwụ na mpaghara inguinal, mgbaàmà na-adịghị mma nke Gomans.

Ihe mgbaàmà dị iche iche nke ikpochapụ ọrịa nke ala nsọ

(dika AL Vishnevsky, 1972 siri kwuo)

• Nmalite oria: ikagbu atherosclerosis (OA) - na - abụkarị mgbe afọ 40 gasịrị, OE - na - abụkarị afọ 40.

• Ntamu mkpesa na akwara anụ ahụ: OA - na - eme ugboro ugboro, OE - anaghị enwekebe

• Ọrịa na - arịa ọrịa obi na ụbụrụ: OA - ọtụtụ mgbe, OE - adịkarịghị

• ọbara mgbali akwara dị mkpa: OA - ọtụtụ mgbe, OE - adịkarịghị

• Ọrịa shuga mellitus: OA - ihe dị ka 20% nke ndị ọrịa, OE - anaghị anọkarị

• Hypercholesterolemia: OA - ihe dị ka 20% nke ndị ọrịa, OE anaghị anọkarị

• Unin dín of the main arteries on the angiogram: OA - no, OE - Ọtụtụ mgbe

• Uneven coronary contour of the arteries on the angiogram: OA - Ọtụtụ mgbe, OE - no

• Nsogbu mgbochi nke nnukwu akwara ụkwụ nke úkwù na pelvis: OA - ọtụtụ mgbe, OE - adịkarịghị • Ọ na - egbochi mkpụ ụkwụ nke ukwu na ukwu: OA - ọ bụghị oge, ọkachasị ndị agadi na ọria mamelitus, OE - na - ekpebikarị.

• ckpụ olu: OA - ọtụtụ mgbe, OE - adịkarịghị.

Atherosclerosis nke aorta na alaka ya. Ntinye nke OBA n'aka nri na PBA n'akụkụ abụọ (larịị 3). Ọnọdụ na-agba akwụna BOTH n'aka nri. Iskwụ ụkwụ ischemia IIb.

- oria oria na - emetuta akwara nke oru (aorta na alaka ya) na akwara olu (olu nke obi, ụbụrụ, wdg). N'otu oge ahụ, akwara nke lipid, nke kachasị nke cholesterol, nkwụnye ego (mbadamba atheromatous) na-akpụ n'ime arịa nke akwara artery, nke na-eme ka mbelata obere akụkụ nke arịa ahụ ruo mgbe ha ga-apụ kpamkpam. Atherosclerosis bụ ihe kachasị ebute ọrịa na ọnwụ na Russia, USA na ọtụtụ mba ndị dị n'Ebe Ọdịda Anyanwụ. Ihe na-ebute ọrịa na-adịghị ala ala, nke ji nwayọọ nwayọọ na-abawanye, ihe onyonyo nke atherosclerosis na-ekpebi ogo nke ọkọnọ ọbara na-enye akụkụ ahụ nri site na artery emetụta.

Ofdị atherosclerosis, nke nwere mbelata nke ọma ma ọ bụ mmechi akwara nke akwara ozi.

150: 100,000 na afọ iri ise.

Afọ a na-agbakarị afọ. Akparamagwa nwoke kacha bụrụ nwoke (5: 1).

Atherosclerosis nke Peripheral Arteries

Atherosclerosis nke akwara ozi bụ ọrịa nke akwara ozi na -echekarị usoro. Otu ihe mgbochi ọbara ọgbụgba ma ọ bụ warara nke lumụ nke aorta na ngalaba ya bụ akụkụ, na - ebute mbelata ma ọ bụ kwụsịlata mmụba ọbara, ọ na - abụkarị na akpụrụ akpụ na akwara nke ala ala. N'ihi ya, enwere ahụ erughị ala, ischemia, ọnya trophic na gangrene. N'otu oge ahụ, mesenteric na celiac arteries nwere ike itinye aka na usoro ahụ.

Nkewa nke ikpochapu atherosclerosis

Nkewa ogwu putara ala okwu:

4. Usoro nke usoro nyocha:

Mgbe ị na -emepụta nchoputa nke ulo ogwu, gosiputa 1)nchoputa mbu, 2)nhikosi nke oria akpata agha, 3)ogwu mkpi (paragraf nke abụọ na nke atọ - ọ bụrụ na ọ bụla).

Ihe omuma atu banyere uzo ichoputa oria:

1) Isi - Ibepu atherosclerosis nke arịa nke ala akụkụ ala, atherosclerotic occlusion nke aka gbagoro agbatị nke anụ ahụ nke aka ekpe, akwara popliteal art, ischemia nke ala nsọ nwanyị IIB n’aka nri, ogo IIIA n’aka ekpe,

2) nhiko - nnukwu thrombosis nke akwara popliteal artery, nnukwu ischemia nke ogo III,

3) ibe– IHD, akwara obi na akwara obi, IIB Art.

Ọgwụgwọ ndị ọrịa HOSAK.

5.1. Nhọrọ nke usoro ọgwụgwọ kpebisiri ike n'ụdị ọnya (etiology, njirimara morphological), ogbo nke ọrịa ahụ, afọ na ọnọdụ onye ọrịa niile, ọnụnọ nke ọrịa na-efe efe.

A na-eji usoro ọgwụgwọ na - egbochi ọgwụgwọ maka ụdị ọrịa ọ bụla nke ọrịa na - enweghị atụ, na ọkwa I-II nke ischemia na - adịghị ala ala, ọ bụrụ na ọjụjụ nke onye ọrịa ahụ ịwa ahụ, na enweghị ọnọdụ maka ịwa ahụ, yana ọnọdụ ọnọdụ n'ozuzu oke nke onye ọrịa.

5,2. Usoro ọgwụgwọ. Ọ kwesịrị ịbụ nke zuru oke, na-ele anya na njikọ dị iche iche nke pathogenesis na mkpochapu ihe mgbaàmà nke ọrịa ahụ. Ọrụ ya:

mgbochi nke mgbanwe nke ọrịa na-akpata,

iwepu mmetụta nke ihe ojoo (ihe dị egwu - ị smokingụ sịga, jụrụ, nchekasị, wdg),

mkpali nke mmepe nke mgbasa ihe,

normalization nke neurotrophic na metabolic Filiks na akwara nke aka aka emetụtara,

mmelite nke microcirculation na ar rheological Njirimara nke ọbara,

normalisation nke nsogbu nke usoro ihe oke ala,

Nri cholesterol dị obere akwadoro maka ndị ọrịa

Iji gbochie ọganihu nke usoro atherosclerotic - iji ọgwụ ndị na - egbochi lipid na ọgwụ mgbochi sclerotic (lipocaine, methionine, lipostabil, linetol (mmanụ hemp), miskleron, diosponin, prodectin, ascorbic acid, iodine preparations).

N'afọ ndị na-adịbeghị anya, maka mgbochi na ọgwụgwọ nke atherosclerosis, gụnyere site na atherosclerotic ọnya nke akwara akwara nke aka, ọ na-atụ aro iji statins (simvastatin, atorvastatin, wdg)), nke kwupụtarala ihe na - egbochi ọgwụ atherogenic - na - egbochi cholesterol njikọ, na - enwe mmetụta dị ala, na - enwe mmetụta "pleiotropic" dị mkpa - belata mbufụt system, melite ọrụ vaskụla endothelial, ma nwee mmetụta antithrombotic. Ihe ndị a niile na - ebido mbelata nke cholesterol, na - eme ka ncheta nke atherosclerotic ma belata sistemụ okirikiri na mpaghara nke vaskụla vaskụla.

Mwepu angiospasm na mkpali nke mmepe mmeghari onyunyi n'ime ọgwụ ischemic na-enweta ọgwụ, dibia na ọgwụgwọ na usoro balneological:

1) ojiji nke mgbochi novocaine (perinephric, ọmịiko, ịgba mmiri gbakwunyere (nchịkwa 2-3 ugboro n'ụbọchị maka izu 2-3 site na catheter nke ngwakọta na 25 ml nke 0.25% ngwọta nke novocaine, 0.3% ngwọta nke dicaine 2 ml., Vitamin Na₁ 1 ml, 2-3 ml nke 96 mmanya), nke na-akwụsị ịdị na-aga n'ihu ma na-emetụta ọrụ trophic nke sistemụ ụjọ na oke ọbara ọbara,

2) iwebata usoro nke novocaine intravenously (20-30 ml nke ihe 0,5%) na intraarterially (dịka usoro Elansky - 1% nke novocaine 10 ml + 1 ml nke 1% ihe mgbochi morphine kwa ụbọchị ma ọ bụ ụbọchị ọ bụla ruo ugboro 8-10. Vzọ Vishnevsky - 100-150 ml nke ngwọta Ringer + 25 ml nke 0.25% novocaine ngwọta + 5000-10000 nkeji nke heparin + 3 ml nke 1% methylene na-acha anụnụ anụnụ + 0.2 ml nke acetylcholine + 4 ml nke enweghị-shpa 1 oge na 3- Daysbọchị 4 ruo 6-10 ịgba)

3) ntinye nke vasodilaria nke otu atọ: a) myotropic edinam (enweghị-spa, papaverine, nikoshpan, nicoverin, halidor, wdg), b) ịrụ ọrụ na mpaghara nke sistem cholinergic akụkụ site na sistemụ autonomic (bupatol, midcalm, andecalin, calicrein depot, delminal, diprofen, spasmolithin, nicotinic acid, wdg). c) ganglion-igbochi ihe (igbochi H-cholinergic sistemụ nke ahịhịa) - benzohexonium, pentamine, dimecolin, wdg, a ghaghi icheta ya na mbido oria nke oria otu ato nke antispasmodics di irè, na ogbo nke IV - na ndi otu nke mbu, nkwadebe nke otu abụọ na nke atọ na-abawanye ụfụ nke ikechi, na-abawanye nsogbu ọbara na aka.

Normalization nke neurotrophic na metabolic Filiks na anụ ahụ nke aka metụtara - ojiji nke nje vitamin (B₁, Na_6, Na₁₅, E, PP).

Nkwadebe solcoseryl na actovegin - mee ka usoro oxidative dị na anụ ahụ, nyere aka na mweghachi nke akụrụngwa idozi anụ ahụ, na-emetụta ọrụ metabolic na trophic nke anụ ahụ ọbụna n'ọnọdụ nke ọbara ọgbụgba (8 ml intravenously, 6-20 ml intravenously kwa 250 ml saline ma ọ bụ gluu ngwọta, 4 ml intramuscularly usoro ọgwụgwọ n'ime ọnụọgụ nke 20-25).

Mmalite microcirculation na rheological Njirimara nke ọbara nweta site na ngwa hemocorrector - nkwadebe nke dextran molecula pere mpe (reopoliglukin, rheomacrodex, gelatin, reogluman) na usoro nke polyvinylpyrrolidone (hemodesis), nke na-eme ka ọbara na-abawanye, na-ebelata viscosity ya site na hemodilution, belata mkpokọta mkpụrụ ndụ, na-egbochi ụgwọ intravascular intanet na-adịghị mma ihe ọbara, thrombin, fibrin), na - abawanye bcc, na - abawanye oke osmotic colloid ma na - akwalite ụzọ nke mmiri intrstitial n'ime akwa vaskụla).

Normalization nke hemocoagulation (na mmụba ya) a na-ebu site n'iji ọgwụ anticoagulants (heparins) na anọghị (pelentan, phenylin, syncumar, warfarin, wdg), yana ndị nnọchi antiplatelet (acetylsalicylic acid, trental, sermion, dipyridamole).

Okwesiri ighota odi nma nke infusions intra-artate nke ogologo oge nwere ngwakọta infusion nke otutu, nke gunyere ogwu ndia di n’elu, na-eji ngwa ndi puru iche (“Drops” na ndi ozo) site na imechi akwara nwanyi ma obu alaka ya (a. Epigastrica nke di elu, wdg), site na mmanu mpaghara. Ihe mejupụtara nke infusate dị ka A.A.Shalimov: saline, reopoliglyukin, heparin, nicotinic acid, ATP, vitamin C, B_1, Na₆, 0.25% novocaine ngwọta, ndị na-egbu mgbu, awa 6 ọ bụla, 2 ml nke enweghị shpa, ọgwụ nje, homonụ corticosteroid (prednisone 10-15 mg kwa ụbọchị maka ụbọchị 4-6, mgbe ahụ 5 mg maka ụbọchị 4-5), diphenhydramine ma ọ bụ pipolfen.

Usoro ọgwụgwọ anụ ahụ - Bernard dị ugbu a, UHF, electrophoresis nwere novocaine na antispasmodics, yana barotherapy na ụlọ Kravchenko na electro-pulse barotherapy na ụlọ Schmidt, HBO.

A na-eme ọgwụgwọ Symptomatic iji kpochapụ ihe mgbu, mbufụt, ọgụ ọgụ, na-akpali ọgwụgwọ nke ọrịa trophic, wdg.

NSOGBU NKE PATI N’ANYA N’ALAEZE NIILE.

Maka obere mwakpo dị mkpirikpi nke ụkwara siri ike na ịhapụ obere ọkụ, mucous sputum, na-enweghị nsogbu ọ bụla. A na-ahụ obere ihe mgbu na akụkụ ala nke aka ekpe nke obi, mgbu paroxysmal, ọtụtụ oge n'ụtụtụ, ọ dabereghị na njem obi, adịghị anyụ anyụ. A na-achọpụta dyspnea inspiratory mgbe ọ na-agafe ihe karịrị narị 500. BH = 22 kwa nkeji. Chopu, ahu anaghi ahuta oria.

ANAMNАESIS MORBI.

Ọ na-ewere onwe ya dị ka onye na-arịa ọrịa kemgbe ọnwa Septemba 2, 2002. mgbe ọ chere na ọ bụ akịrị na akpịrị ya, ụkwara na-adịte aka pụtara, na-enweghị sputum. Nke nta nke nta, ụkwara ahụ kara njọ, ewepụtara nsị na-acha akwụkwọ ndụ akwụkwọ ndụ n'oge ụkwara, oke, ma ọ na-apụ nke ọma. Mkpirisi nku ume pụtara n’oge ụzọ erughị narị mita abụọ, ọ malitere ịhụ ihe mgbu na mpaghara ala nke aka ekpe aka nri, ihe mgbu adịghị, na-adọkpụpụta okike, na-enweghị irradiation, ọtụtụ mgbe kwa ụtụtụ. Na njikọ a, onye ọrịa ahụ kpọrọ ndị ọrụ nlekọta ahụike mbụ, ma nọrọ n'ụlọ ọgwụ na ngalaba ọgwụgwọ 7 ugwu. Lọ ọgwụ Septemba 7, 2002

ANAMNАESIS VITAЕ.

Amuru ya na abali iri-abuo n’ato n’ato n’aho 1941, n’iru aru na nkpuru obi. Ọ malitere ije ije n’oge, na-ekwu okwu n’oge. Ọ malitere ịga ụlọ akwụkwọ site na afọ 7. Performancerụ ọrụ ụlọ akwụkwọ bụ nkezi. Ọnọdụ ụlọ obibi na nwata na etolite etolite, ma ugbua nwere afọ ojuju. Nri dị kwa ụbọchị, ugboro atọ n’ụbọchị, nri nri ezuola, ọfụma na-eju afọ. Ọ na-eri nri n'ụlọ. Ọ naghị abanye maka agụmakwụkwọ anụ ahụ na egwuregwu. Ọ malitere ọrụ mgbe ọ dị afọ 17 dị ka onye na-eme mkpọchi. Ọnọdụ ọcha na-eju afọ. Thebọchị ọrụ bụ elekere asatọ, yana oge nri ehihie na ezumike abụọ maka izu ike. Enweghị ọrụ mgbanwe na ọrụ mgbanwe, anaghị m aga njem njem azụmahịa. Ugbu a anaghị arụ ọrụ, bụ nkwarụ.

Ọrịa ndị gara aga: ịba ọcha n'anya, ụkwara nta, ọrịa ndị a na-ebute site ná mmekọahụ gọnahụ. ARVI na-efegharị, tonsillitis.

Mmerụ ahụ, arụmọrụ: lumbar gangliosympatectomy n'aka nri.

Akụkọ banyere ezi na ụlọ: ma nna ya ma nne ya enweghị ọrịa na-adịghị ala ala.

Akụkọ banyere ọrịa na-efe efe: enweghị ndị ọrịa ọ bụla na-arịa ọrịa ọ bụla;

X intoụbiga mmanya ókè: Sm Smụ sịga site na afọ 20, karịa ihe ngwugwu abụọ kwa ụbọchị, n'ime afọ atọ gara aga belatara ọnụ ọgụgụ ndị na-atesụ sịga na otu mkpọ ruo ụbọchị 3. A na-a Alụ mmanya na-aba n'anya nanị n’oge ezumike.

Akụkọ banyere ọrịa Allergic: Enweghị ihe ngosi anụ ahụ.

STATUS PRESENS (NA ANY TO NA NSỌ HBỌCH) NSỌ). ANY IN NA-EGO.

Ọnọdụ afọ ojuju, nsụhọ doro anya, ọnọdụ nọ n'ọrụ. Ahụhụ ahụ dị mma, ọ dabara na afọ na okike. Asthenic, ebe ọ bụ na ahụ dị ogologo, mpaghara mpaghara thoracic na-adịkarị n’afọ, obi na-adị ogologo, akụkụ epigastric bụ nnukwu. Nri nri onye ọrịa zuru ezu ebe ọkpụrụkpụ akpụkpọ ahụ dị n’ubu ubu bụ 1 cm n’akụkụ otube ahụ dị sentimita 2,5 .. Akpukpo ahụ adịghị mma, enweghị ntụpọ, a na-edobe turgor ahụ, ebe ọ bụ na ejiri mkpịsị aka abụọ ewee mkpịsị aka abụọ n’elu ime nke aka ekpe ozugbo. . Akpụkpọ ahụ akpụkpọ nkịtị. Akpọnwụ kpọrọ nkụ, na-egbu, enweghị rashes. Ntu, ntutu adịghị agbanwe agbanwe. Igwe mucous nke conjunctiva, imi, egbugbere ọnụ, onu ura bu pink, dị ọcha, uyi, enweghị nhịahụ. Ọkpụkpụ ọgbụgba, akwara azụ, parotid, submandibular, mgbada, ihu nke ukwu, supraclavicular, subclavian, axillary, el el, popliteal, na inguinal lymph nodes na-esighi ike. A na - ewete usoro akwara dị afọ ndụ zuru oke maka afọ onye ọrịa; ụda olu na ike zuru ezu. Ọkpụkpụ nke okpokoro isi, obi, pelvis na aka aka adịghị agbanwe, enweghi ihe mgbu n’oge palpation na perusedion, iguzosi ike n’ezi ihe anaghị agbaji. Nkwonkwo ahụ bụ nhazi dị mma, mmegharị ahụ na nkwonkwo bụ n'efu, enweghị ọnya ahụ.

INWE IWU.

Isi nke ụdị ana - ahụkarị, ụbụrụ ya na akụkụ ya nke okpokoro isi bụ nke kwekọrọ. Hairdị ntutu nwoke, enweghị ntutu, enwere obere ntutu isi (afọ). Ọkpụkpụ palpebral adịghị warara, ụmụ akwụkwọ ahụ nwere otu nha na ụdị ha, mmeghachi omume nke ụmụ akwụkwọ nwere ọkụ n'otu oge, otu. Aringkpụ azụ adịghị. Egbugbere ọnụ na-acha odo odo na-acha uhie uhie, na-enweghị nkụ. Olu na-apụta. Grik thyroid bụ ihe kwesịrị ịdị nha, na-agbanwegharị mgbe a na-elo ihe, na-agbanwe agbanwe, na-eji ire ụtọ, na-enweghị mgbu na palpation.

ANYA AH THE AH..

Obi Uzo Nnoba:

Achọpụtaghị ihe gbasara obi ike, thorax na saịtị nke ntule nke obi abụghị mgbanwe, apical impulse anaghị ahụ anya, ọ nweghị ngwụcha systolic nke mpaghara intercostal na saịtị nke apical impulse, enweghị ntụpọ pathologies.

A na-akọwa ntụpọ apical ahụ na oghere V intercostal na ekpe midclavicular ahịrị na mpaghara ihe dịka cm cm abụọ. Apical impulse, na-eguzogide ọgwụ, elu, mgbasa, ike. Achọpụtaghị ihe gbasara obi ike site na palpation. Ihe nrịba ama nke "cat purr" na njiko nke obi yana ebe ntule nke valvụ aortic adịghị.

A na-ekpebi ókè obi jọrọ njọ nke obi bụ:

N'aka nri aka nri nke sternum n'ime oghere intercostal nke anọ, kpụrụ site n'aka nri atrium)

Nke di elu na oghere intercostal III (aka ekpe atrium).

Aka ekpe ekpe midclavicular ahịrị n’ime oghere oghere intercostal V (nke kpụrụ n’aka ventricle ekpe).

Ekpebi oke obi obi zuru oke site na:

N'aka aka ekpe na sternum n'ime oghere intercostal nke IV (guzobere site na atrium aka nri)

Oghere dị n'etiti intercostal dị elu (aka ekpe atrium).

N'aka ekpe na oghere Vcocostal dị 1.5 cm n’iru site na ahịrị midclavicular ekpe. (nke emere site na ventricle aka ekpe).

A na-ekpebi contours nke ụdọ ụbụrụ.

Aka nri 1, 2 intercostal oghere 2,5 cm

3 intercostal oghere 3 cm,

4 intercostal oghere 3.5 cm site na midline ruo n'aka nri.

N'aka ekpe 1, oghere intercostal 3 cm,

4 intercostal oghere 8 cm,

5 intercostal oghere 10 cm site na midline ruo n'aka ekpe.

Configurationhazi obi nkịtị:

Otiti nke obi 15cm,

Ogologo obi 16.5 cm

Obi ịdị elu 9 cm,

Obi obosara 12 cm,

Ogo nke ogwe vaskụla bụ 5.5 cm.

Toda na-ada ụda, doo anya. Twoda abụọ, kwụsịtụ abụọ. A na-ekpebisie ike na ụda nke abụọ dị na aorta (isi okwu abụọ na nke ise). Oge obi na-adị mma. Obi obi 86 gbagwojuru / min. N'ebe m na IV na-emechi emechi, a na-anụ ụda karịa nke ọma. Site na okike, ụda olu mbụ dị ogologo ma dị ala. Na II, III, V isi okwu nke mkpọtụ, a na-anụ ụda II nke ọma, nke ka elu na mkpụmkpụ. Mkpesa Systolic na diastolic, mkpọtụ esemokwu adịghị.

EGO NA-EKWU NZI EGO.

Ahịrị akwara na radial akwara na palpation (akara nke okpu), na-adagharị, (enweghị akara akwara na akụkụ dị nro), nnukwu ntiwapụ nke akwara ndị a.

Enweghị puls nke akwara carotid (ịgba egwu carotids), anaghị ekpebi ihe a na-ahụ anya nke akwara nke akwara. Enweghị ụdị varicose. Ahụ́ nnụnụ ahụ adịghị mma. N'oge mkpọchi nnukwu arịa, a na-ekpebi ntamu systolic n'elu mgbidi akụkụ ihu yana akwara akwara dị n'okpuru akwara.

Nchọta usoro ihe omumu.

Ọkpụkpụ ahụ bụ otu ihe na akwara radial: ugboro 86 kụrụ / min, zuru ezu, ugboro ugboro, oke, nnukwu, ngwa ngwa, ziri ezi. Ekpebi ụkọ obia n’obi. Emechiri mgbidi akwara. Ọbara ọbara 160/110 (tanometer tụrụ site na tanometer dịka usoro nyocha nke Korotkov-Yanovsky).

Na omumu nke pulsation nke isi arịa nke ala akụkụ ahụ, ọ gaghị ekwe omume ikpebi mkpụrụ ahụ na a. dorsalis pedis, a. tibialis ochie, a. poplitea nke ukwu aka ya abụọ na a. ụkwụ anụ ahụ na aka ekpe. Na a. A zọpụtara ụkwụ anụ nwa.

IKPUKWU EGO.

iku ume site na imi bu n'efu. Enweghị imi.

REBỌCHRE REBỌCHRE:

Obi bụ asthenic, symmetrical, enweghị agbazigharị obi dị n'otu akụkụ. Enweghị akụkụ azụ A na-ekwu okwu supira- na subclavian fossae, otu na akụkụ abụọ ahụ. UM UBARA di n’azu. Ọgịrịga ya na-agagharị nkịtị.

Breathdị nku ume - ime. Iku ume ziri ezi, nke na-esighi ike, nke na -eme ume, na iku ume iku ume 24 / min, ọkara mmụọ aka nri dị n'azụ iku ume. Oghere nke oghere intercostal dị 1.5 cm, ọ nweghị oke ma ọ bụ sagging na iku ume miri emi. Njem ụgbọ ala kachasị - 4 cm.

NKWUPALR THE AH OF BANW BS::

Obi na-agbanwe agbanwe, iguzosi ike n’ezi nke ọgịrịga ya. Onweghị ọnya ọnya. Onweghi mkpu ngbasa ozi.

AKELKỌ CELL

A na-anụ ụda doro anya nke dị na mpaghara pulmonary.

Ókèala ngụgụ: nkuume aka ekpe: nku ume ekpe:

.Nụ Lin. oghere intercostal parasternalis VI

.Nụ Lin. Oghere intercostal nke Clavicularis VII

.Nụ Lin. axillaris ant. VIII ọgịrịga VIII ọgịrịga

.Nụ Lin. axillaris med. IX rib IX rib

Ọdịdị elu nke akpa ume ya:

Ozo nke Krenig ubi:

A na-anụ ume iku ume na mpaghara pulmonary. A na-anụ ume iku ume n’elu akwara, trachea na nnukwu bronchi. Anụghị iku ume ikuku akwara. Wheezing, enweghị crepitus. Achọtaghi imezi ihe akwara ikpa oke.

AKW DKWỌ NA-AH AND ANDB ANDR AB AH AB AHD.

Nnyocha onu.

Akpụkpọ ahụ mucous nke onu ura na pharynx bụ pink, dị ọcha, ooh. Enweghị halitosis. Ire di ura, enweghi odidi, odidi ahu adighi ako nke oma. Ọ nweghị ụgbọ ala, ọnya ọgbụgba juru. Ogwu etinyere archine apughi ihicha ogwugwu, oghere adighi omimi, n’enweghi ike. Ntutu egbugbere ọnụ na-enweghị mgbawa.

AKAMKỌ NSOGBU NKE IME AB ANDỌ NA ỌR P AHUŔ IME IMANỌ NKE SAMU - GUZIAKA.

Mgbidi akuku ime n’afọ bụ ihe atụ, na-ekere òkè na iku ume. A na-azụlite afọ ime obere oge. Achọpụtaghị motali eriri afọ. Enweghi mgbasawanye nke saphenous veins nke afọ. Enweghị protrusions na akụkụ nke urua nke akụkụ ahụ. Ọkpụkpụ nke eriri afọ ga-ahụ. Ihe mgbaàmà nke ike akwara (ụdụ dịka nsogbu akwara dị n'ime oghere ihu) adịghị anọ. Mkpebi nke Shchetkin-Blumberg (mmụba mgbu nke na -eme ogwe aka mgbe mgbagha nke mbụ) anaghị ekpebisi ike. Ihe nrịba ama nke Rowzing (ọdịdị nke ihe mgbu na mpaghara ụlọ aka nri mgbe ị na-etinye ịma jijiji na mpaghara ụlọ aka ekpe na mgbadata agbadata) na akara ndị ọzọ nke mgbakasị ahụ peritoneal adịghị mma. Ọrịa ọgbụgba (a na-eji ekpebi mmiri n’efu na oghere apịrị).

EGO EGO NA-AKWPKWỌ PBPRP MAKA INTESTINE.

1. A na-adọtị ogwe osisi sigmoid n'akụkụ ụlọ aka ekpe n'ụdị eriri eji nwayọ nwayọ, na-enweghị nsogbu, na-enweghị nsogbu. Oke 3 cm.

2. A na-adọghee akwa a na mpaghara ala aka nri n'ụdị eriri sịlịnụ 3 cm buru ibu, ọ bụghị mkpọtụ. Bugharịa. Ihe odide ntụkwasị a palpal.

3. A na-apị akụkụ akụkụ ugwu ahụ n'akụkụ mpaghara ala aka nri n'ụdị eriri olu na-enweghị nhịahụ 3 cm n'obosara, na-agbanwe, mkpanaka, ọ bụghị mkpọtụ.

4. Akụkụ olu ahụ na-agbadata na mpaghara ụlọ aka ekpe n'ụdị eriri olu agbanwe agbanwe 3 cm n'obosara, enweghị mgbu, ekwentị, ọ bụghị mkpọtụ.

5. A na-apịpụ ọgịga transverse na mpaghara ụlọ aka ekpe n'ụdị cylinder nke njulata oke 2 cm buru ibu, mkpanaka, enweghi mgbu. A na-ekpebi mgbe achọtara nnukwu curvature nke afọ site na ụzọ nke auscultofacilitation, auscultopercussion, sucus, palpation.

6. Nnukwu curvature nke afọ site na auscultofacilitation, auscultopercussion, succussion, palpation, kpebisiri ike 4 cm karịa otube. Na palpation, a na-ekpebi nnukwu curvature n'ụdị cha cha nke agbanwe agbanwe, enweghi mgbu, mkpanaka.

7. A na-apị onye na-eche ọnụ ụzọ dị ka obere sịlịnda nke na-agbanwe agbanwe, yana dayameta dị ihe dịka cm 2. Ọ naghị egbu mgbu, ọ naghị asụ nkọ, anaghị arụ ọrụ.

A na-achọpụta ụda ụda tympanic dị elu. Mendel nwere mgbaàmà adịghị. Achọpụtaghị mmiri na-enweghị mmiri ma ọ bụ gas n’olulu afọ.

Mkpọtụ mkpọtụ ahụ adịghị. A na-anụ mkpọtụ nke nrụrụ afọ.

INSPECTION: Enweghị akpụ akpụ na hypochondrium ziri ezi na mpaghara epigastric. Mbelata nke akwara anụ ahụ na anastomoses, telangiectasia adịghị.

Site na usoro ọgwụgwọ Obraztsov-Strazhesko, imeju na-apịa akụkụ aka nri ya. Ala ala imeju bụ ihe gbara agba, dịkwa larịị, na-agbanwe agbanwe.

NKWUPUTA: Ekpebiela oke ala site na -

ziri ezi ezumike, midclavicular,

ahịrị irighiri akwara

ahịrị midclavicular ahịrị na ọkwa nke obere onu ala ihe ọnụ,

ihu n'ihu midline 6 cm n’elu otube.

Ogo imeju ya dabere na Kurlov: 10x8x7 cm.

Nyocha nke BLADDER Gall:

Mgbe ị na-enyocha mpaghara mkpị gallbladder na akuku eriri afọ nke azụ (hypochondrium) na usoro nke mmụọ, protrusion na fixation, achọtaghị ya. Afọ ọbara ezighi ezi. Udiri oria nke Ortner-Grekov (nkọ na-egbu mmụọ mgbe ọ na-akụ njiri ọnụ dị mma) adịghị mma. Akara Symrenicus (irradiation nke ihe mgbu na mpaghara supraclavicular ziri ezi, n'etiti ụkwụ nke sternocleidomastoid muscle) adịghị mma.

Ọ bụghị kpebisiri ike imegharị ahụ ngwa ngwa na akụkụ aka nri. Onweghị ọnya ọnya.

dayameta - 4 cm.

AKW URKWỌ AKINKỌ.

Anya, mpaghara akụrụ anaghị agbanwe agbanwe. Site na palpal palpal n'ụzọ kwụ ọtọ ma kwụ ọtọ, akwara ekwetaghị akụrụ ya. Ọrịa ọjọọ. Achọpụtaghị mgbu na palpal na ureter. Na ntụgharị uche, mkpụrụedemede dị sentimita iteghete dị okirikiri. A nụghị mkpọtụ maka akwara ndị gbasara akụrụngwa. Akpụ ahụ na - eme n'ụdị mgbe niile Site n'inyocha akụkụ akara dijitalụ, a na-ekpebisi ike. prostate gland dị gburugburu, na-agbanwe agbanwe, enweghi mgbu. Mpekere abụọ na uzo dị mma.

NERVO-MENTAL SPHERE.

Nzube doro anya, ọgụgụ isi nkịtị. Icheta ihe n’ezie mere belata. Nrọ ahụ enweghị omimi, dị mkpụmkpụ, enwere ehighị ụra. Ọnọdụ ahụ dị mma. Enweghị nsogbu adịghị n'okwu ọnụ. Enweghị cramps. Nzọ a na - egbochi nsogbu, onye ọrịa na - akwụsị mgbe ọ na - aga ije. Reflexes zọpụtara, paresis, enweghị ahụ mkpọnwụ. Na-ewere onwe ya dị ka onye na-akpakọrịta.