Mea Maluna o ka hawewe ho'ākāka 'ana

I ola ka mea, e hiki mai ana nā haneri o ka wahi, i hiki i hiki i kekahi kŰia. Ka hapanui o kanaka hui ia me ka ikaika ko mākou hopohopo kŰia wale nō, akā, i kēia mea wale nō he oiaio ia mau mea. I ka lapaau, aia no he kŰia Mea Maluna, wā kona pathogenesis, oolea, ke ano o ka loli ma na nā loko, a aoao, e hoʻoponopono 'ia. ho'ākāka 'ia ma mua oi ma mua o 2 tausani makahiki aku nei i kēiaʻano, ka mea kaulana Hippocrates, a me ka manawa "nń" i loko o ka hana o ka lapaau wahahee ma 1737 ma ka Parisian surgeon Henri Ledran. He 'atikala discusses i au mamuli nā kumu i i kŰia, Mea Maluna,? Aaieou, pilikia mālama i loko o ka hanana o kēia debilitating kulana a me Time].

I ka manaʻo o ka hawewe

Me ka kŰia o ka 'ōlelo Pelekānia hiki ke unuhi' ia me kūlana kŰia, i mea ole ka maʻi, i ka symptom, aʻaʻole iʻike,. Ma honua hana i kēia manawa ua haawiia pane o ka meaola a me kona nenoai i ka ikaika stimulus (mawaho a maloko), a interferes me ka hana ana o ke ko mākou hopohopo'ōnaehana, pūnao, ka hanu a me ke koko holo. Eia ka manawa he kŰia paa. Na Mea Maluna o keia moku'āina Pono, e kuhikuhi i ke kumu o nń, ke degere o kona oolea, a hoʻomaka ka hoʻokō hana. Ke kēla E e pono wale ina ka pololeiʻike, a me ka koke hoʻomaka 'ana o ka resuscitation.

Mea Maluna

Junior pathologist Selye hōʻike 'ekolu kahua o ka hoʻonaʻauao,'ōlelo koʻikoʻi akulaʻo ia no nā' ano o ka hawewe:

1.Obratimaya (compensated), ma i ke koko lako i ka lolo, naau, a me ia maʻiʻaʻai me nā loko ua wāwahiʻia, akā,ʻaʻole hoʻi i kāpiliʻia. Ke prognosis no keia kahua mea nui maikaʻi.

2.Chastichno reversible (asthma). Ma ka Ia kue o ke koko lako (perfusion) nui, akā, ka manaʻo a me ka pono 'inikua' uao i ka manawa e hoʻihoʻi functionality.

3.Neobratimaya (maʻi). 'O kēia ka loa loa kahua ma i ka haunaele ma ke kino,ʻaʻole hiki ke hoihoi hou ia a hiki i ka loa loa ola hopena. Ka olelo wanana a laila, 95% noho lakou malaila.

Kekahi Mea Maluna i hookaawale hapa 'ia' reversible mua ma ka 2 - subkompensatsionnuyu a me ka dekompensatsionnuyu. E like me ka hopena, loaa ka mea, 4:

• 1st compensated (ka malamalama me ka maikaʻi prognosis).
• 2nd subcompensated (hapalua like-ke kaupaonaʻana e pono koke resuscitation. Time] controversial).
• Ekolu dekompensatsionnaya (loa kaumaha loa, a hiki ina ka koke hoʻokō 'ana o nā mea a pau i ka mea ana ei ka loa eiiieaena).
• 4th irreversible (Prognosis meaʻilihune).

Mākou kaulana Pirogov anao? Aou i loko o ka moku'āina o kŰia mau kūlana:

-torpidnaya (i ka hoʻomanawanui i loko o ka, nanea ana paha loa sluggish,ʻaʻole ke paneʻana i ka stimuli kaua, 'aʻole e pane i ka nīnau);

-erektilnaya (ka hoʻomanawanui ka loa hauʻoli, kahea ana, e ka hailona o unconscious kipi ka neʻe 'ana).

'ano o ka hawewe

Ke kaumaha ma muli o nā kumu i alakai aku ai i ka imbalance i loko o ke kino o ka 'oihana, ua nui na ano o ka hawewe. Mea Maluna ma ka hua'ōlelo o circulatory kāna hana e like me:

-gipovolemichesky;

-distributivity;

-kardiogenny;

-obstruktivny;

-dissotsiativny.

Mea Maluna o ka pathogenesis o ka hawewe i keia:

-gipovolemichesky;

-travmatichesky;

-kardiogenny;

-septichesky;

-anafilaktichesky;

-infektsionno-ʻawahia;

-neyrogenny;

Paʻa-hoʻohui pū.

hypovolemic kŰia

Complex kau mea oluolu i ka maopopo, ka ike ana hypovolemia - he ano kahi i ke koko circulates ma ka moku i emi ma mua o ka mea koi 'ia ka leo. kumu:

-obezvozhivanie;

-Extensive'ā (lilo ka hailonaʻana o ka wai koko);

-pobochnye lāʻau reactions, e like me vasodilators;

-large koko poho, a ma nā loko loaa emi o oxygen a me ka mahuaola, a laila haʻi perfusion.

Hypovolemic kŰia ma muli o ke kiʻekiʻe koko poho hiki ke ike me hemorrhagic kŰia. Na Mea Maluna o keia ano o ka ia me ia e hoʻomōhala ana i Selye, a ma ka ia ke kahua hoʻoholo ana i ke dala o ke koko, aole ia hookipa ole kino. KŰia mea mau i ke ano o ka hoomalu ana o ke kino i loko o ka lōʻihi kulana home 'ole. Oia hoi, e hoomaka i ka moʻo o keʻano o ka hanaʻana, e imi ana e malama i ka ha awina o ka nui nā loko, a hiki wale nō i ka ola o ka holoʻokoʻa nenoaiu. Ma kekahi, a me ke koko kahe i loko o na moku ke koko hookahe no eiiet koko (ka hola 10% o ka huina) mai ke ake a me ka spleen. Inā keia mea i lawa, a hoemiia koko aɃe e emi nui no ke ola o ke kino o ka oihana, no ka laʻana, a hiki i kaʻaoʻao, no laila, i ua lawa no ka perfusion o ka naau, a me ka lolo maʻiʻaʻai ke koko ka i koe. Mea Maluna kŰia Ho'ākāka 'kēia mau anuu like hapa' ia 'reversible a me ka invertible. Ma keia hihia, ina i ka manawa e lawe hana, e hiki ke hōʻike 'ana i kekahi kanaka mai i ka moku'āina o ka hawewe, a malama aku la ia ia e ola ana.

Lōʻihi hana ma ka papaʻa o ke koko perfusion a me ka hoomakaukau i kekahi mau nā loko ma ka lilo ana o nā meaola hiki ole. No ia mea, ina oe e ole hoʻomaka resuscitation, ke hele mai hope (irreversible) ke kahua. Lōlō malama moku, i ka manaʻo koikoi maloko nui ua hoʻemi, ke koko e kahe ana i ka periphery, piʻi pū i ka noho pilikia pae o ka perfusion nele lolo, naau, a ia maʻiʻaʻai.

dehydration

I ka wai i loko o ke kino o ke kanaka, ke kaumaha ma muli makahiki a me ke keka, mai ka 60 a hiki i 80%. I ka lilo ana o wale 20% o keia dala hiki e lethal, a me na poho ua i 10%, i hypovolemic hawewe, a ma keia hihia ua noʻonoʻo me dehydration, e hoike aku i ka ho'ēmiʻana i ka ai hoʻolahaʻia moku koko aie i ka dehydration kiʻekiʻe. kumu:

-zabolevaniya, e alakai i ka diarrhea, ka luaʻi, pinepine urination nui;

-nedopoluchenie wai kino (nedopivanie) ma lalo loa keia, e like me lōʻihi wela, pakahi aku la ia ma kiʻekiʻe physical exertion;

-nerazumnyeʻai.

No ia paha dehydration i kahi mau keiki liilii, a me ka kūpuna.

Mea Maluna o ka hawewe, hang nei me ka hopena o ka nele o ka wai, o ka Naauao nā kapuwaʻi o ka:

-invertible;

he hapa 'ia' reversible;

-neobratimuyu.

Eia hou kekahi, dehydration ua maheleia i loko o kēia mauʻekolu waeʻano:

1.Izotonicheskoe (poho o Na a me K Ion). Ke loli i loko o mākou kino o ka intracellular a me ka intercellular. I ka isotonic ka pōʻino, kena ae la ia e diarrheaʻano nui excreted hōʻike nui potasiuma a me ka paʻakai, i mea no ka papa kuhikuhiE cation ma extracellular loli ae i loko o na keena e e i ka nalowale potasiuma maloko.

2.Gipotonicheskoe, a mea heʻilihune o ka isotonic. Ua Ua kaulana kiʻekiʻe ka pōʻino ma ka extracellular loli (no ka paʻakai hele i loko o aeee). Ka mua mau kahua o ka hoʻonaʻauao i manaoia e e reversible i hiki e compensate no ka poho ana o electrolytes. Hapa 'ia ka holomua' ana i ka hoʻolako 'ahonui loliʻai ana, o ka oi aku i loaʻa ka paʻakai Ion.

3.Gipertonicheskoe e hoʻomōhala ana i ka wā diarrhea me retching pale loli pele i loko o ke kino hōʻike waha ai overdose o kekahi waiwai e hoonaukiuki hou urination. Ka wai hou ae mai aeee i loko o ka extracellular kahua i mea e malama i ka osmotic puʻe. Menina dehydrated aeee 'aʻe kā lākou hana a me ka hoemi ma ka buke. No pilikia emi ma ka lolo buke, i hiki aku ai i subdural hemorrhage.

symptoms

Mākou Ua noonoo ia nei hōʻike no ka Mea Maluna o hypovolemic kŰia. Ke Kalinika kēia moku'āina, irrespective o na kumu, ka mea, kauoha ae la e pili ana i ka ia. Ma ka reversible ke kahua, i ke ahonui mea i loko o ka supine kulana,'ōlelo ai symptoms i hoi ma kahi ee. e hoomaka ana na hoailona o ka pilikia e:

- palpitations;

-small hakumakuma ke koko;

coldly clammy ili ma luna o nāʻaoʻao (ma muli o ia ka emi perfusion);

-When he mea dehydration ka maloʻoʻana lehelehe, mucous i loko o ka waha, nele o ka waimaka.

Ma ke kolu o ke kahua, hoohikilele loiloi mua symptoms e oi hai.

Nā mea maʻi i kaulana:

-tahikardiya;

-Reduction ke koko ma lalo noho pilikia nā loina;

-Violation hanu;

-oliguriya;

coldly i ka hoʻopā (ole wale na lala);

-mramornost ili a / a hoʻololi i ko lakou ano, mai maʻamau e pale cyanotic;

-nitevidny pāpaʻa;

-with puʻe ma ka fingertips, ka mea, ua haikea a ano hope ana o ka haawe ua hoemi ia e oi aku mamua o 2 kekona i ke kūmau. Ia? Aaieou i hemorrhagic kŰia. Mea Maluna o kona kahua o ka hoʻonaʻauao, ke kaumaha ma muli o ka buke o ke koko ai hoʻolahaʻia i loko o na moku ano hou mai nā ':

-on reversible pae tachycardia i 110 kui iho oe a no minuke;

-on hapa 'ia' reversible - tachycardia o 140 kui iho oe a / min;

-on irreversible - naau ana ma luna o 160 kui iho oe a / min. Ma ka pilikia wahi lāʻau ikiʻai wale hiki ole ke lohe, a me ka systolic ke koko, e hina i ka 60 mm o Hg a emi. kia ao.

I ka dehydration mea hiki ke hypovolemic hawewe symptoms i pākuʻi:

-suhost mucous;

-reduction leo'ōnohi a;

y me keiki ia kāna o ka fontanelle nui.

It a pau mawaho helehelena, akā, no ka pololei hoʻoholo i ka nui o ka pilikia, hoʻomaka keʻena hoʻokolohua noiʻi. Ke hoomanawanui koke ae hana i koko kemika, hooholo i ka nui o ka hematocrit, acidosis, i ka luna 'hoopii, noiʻi ana i ka wai koko nuʻa. Eia kekahi, kauka i potasiuma pae ana, i ka papa kuhikuhiE electrolytes, creatinine, koko urea. Inā keia palapala, hoʻopaʻa 'ana minuke a me ka naau hahau ka leo a me ka Central venous puʻe.

traumatic kŰia

Kēiaʻano o ka hawewe i loko o na aoao like i ka hemorrhagic, akā, kona kumu hiki ke hana wale mawaho eha (stab, gunshot,'ā) a me na (rupture o nā'aʻaʻa a me nā loko, no ka laʻana, mai ka loa ikaika). Traumatic kŰia ua aneane mau pu ma o ka paakiki bearable eha, exacerbates hou i ke kahua o ka nāna. Ma kekahi kumu ka mea, ua kapaʻia he ola kŰia, pinepine alakaʻi ana i ka make. Ke oolea o traumatic kŰia me ka nānā 'ole i ka nui o ke dala o ka nalowale koko, pehea ka nui o keia lilo o ka holo. Ia mea, ina i ke koko koe ke kino mālie, ka luahi he maikaʻi manawa e pakele. Kekahi aggravates i ka pilikia, a me ka degere o ka nui o ka poino hui, a hiki i ke kino. Ia mea, ola ka ua pana mai i loko o ka lima ia, e e aho ma mua i eha ai i ke poo. Mau mea i nā hiʻona o ka traumatic kŰia. Mea Maluna o ka moku'āina o ke oolea like penei:

Primordial hawewe (ia lŘlŘ aneane koke ma hope o ka eha);

-vtorichny hawewe (akaka ma hope oʻoki kino, ana o ka pua, ma lalo o nā haawe ana ma luna o ka loli ana o, no kekahi laʻana, kona amo).

Eia hou kekahi, traumatic kŰia malama mau kūlana - erectile a me torpid.

Symptoms o erectile:

-strong eha;

-neadekvatnoe hana kūpono (e hea ana, overexcitation, uunu nui, i kekahi manawa aggression);

-tremor;

hou coldly;

-Advanced haumana;

-tahikardiya;

-tahipnoe.

Symptoms torpid:

-bolnoy i indifferent;

-Over ma laila, akā, i ke kanaka, aole ia i pane ia mea;

-arterialnoe puʻe ia emi;

-glaza mae;

-poyavlyaetsya paleʻili, cyanosis o nā lehelehe;

-oliguriya;

-oblozhennost ōlelo;

-suhost mucous;

coldly hou 'Aʻole i hana, akā, i kaʻili haalele i kona turgor;

-puls thready;

-cherty maka heʻoiʻoi.

ʻawahia kŰia, Mea Maluna

Keia ano ia lŘlŘ ma muli o ka anal i loko o ke kino o ka maʻiʻaʻai, 'o ia hoʻi, nā mea hoʻomaʻi a me koʻohune mea i loa intoxication o ko lākou mau hanana. More pinepine ma mua ole hewa i loko o ke kaua kŰia streptococcus, staphylococcus, salmonella, Pseudomonas aeruginosa. Lakou e komo aku ai i ke kino, me ka lilo ana o ka hamama eha (puerperal sepsis,'ā,ʻoki kino) a me (typhoid, kōkua iā ia,, tracheitis, sinusitis, pneumonia, maʻi palū, a me nā maʻi).

Pathogenic microorganisms paka superantigens i haʻalele T keena, a me nā T keena. Ka poe, ma ka huli, pee cytokines, e kauoha ana i ke ahonui o ka'ōnaehana paleʻea'ōnaehana ua uhi pū, a me ka nui nui o toxins hoʻokuʻuʻia i loko o kona koko, e kauoha anaʻawahia kŰia. Na Mea Maluna o keia kulana distinguishes ekolu kahua o ka hoʻonaʻauao.

1.Obratimaya. Ma keia ke koko, i e maʻamau, ka mea noho akaka ike paka, ili i nonono aʻulaʻula. Ke hoomanawanui Ua pinepine ka luuluu, ka hoohewa ana o kaʻeha i loko o ke kino a ma ka abdomen,ʻo ia malama diarrhea, kuni, a me kekahi manawa ka luaʻi.

2.Chastichno reversible. Symptoms: wela, nawaliwali pāpaʻa, tachycardia, ua hoʻemi puʻe, i ke ahonui lethargic, i kona naoh inhibited.

3.Neobratimaya. Symptoms: pokole o ka hanu, convulsions, ili cyanosis, pana mea nawaliwali, ke koko ma lalo o ka pilikia, ke hoʻomanawanui nei unconscious.

Mea Maluna o anaphylactic kŰia

Oia ke ano ia lŘlŘ wā kino hoomake iho no hoi mai ka nahesa nahu, punawelewele, wasps a me nā mea ola a pau, he poe, mai lawe kekahi kea a me ka ai, a ma ka hooponopono ana i ai 'i i haawiia mai ai i ka hoʻomanawanui ka allergens. ia he naoh ua loa pinepine haawiia procaine penicillin, ke aloha. KŰia ke'ākoʻakoʻa i loko o kekahi mau kekona hope o hui 'ana me ka allergen ke kino kekahi ma kekahi manawa hou, a me ka koke ia ka naoh ana, o ka loa o ka prognosis. He nui na ano o ka hanana o anaphylactic hawewe:

-tipichnaya (redness ma ka nahu paena (ka pahu kui paena), a abdominal eha, puʻu, ma ku una ha ka leo allergen, decompression, mīkini'opihia o na iwi aoao lalo o hiki diarrhea ole ka luaʻi);

-gemodinamicheskaya (ma ka mua wahi mea'ōnaehana mānowai koko kāna hana);

-asfiksicheskaya (naehana hanu ole, dyspnea);

-tserebralnaya (malfunction o ka Central ko mākou hopohopo'ōnaehana, convulsions, unconsciousness, naehana hopu);

-abdominalnaya (huʻi abdomen).

lapaʻau

No ka manaʻo 'ana, he nui ka pololei Mea Maluna o ka puu hua palaoa. Kaʻenaʻena pilikia mālama i loko o kēlā me kēia hihia i kona iho i Kekahi Mau ', akā, me ka koke ia ka mea i hoʻomaka ia e hoʻolako, ke hoʻomanawanui i ka manawa kūpono i loaʻa. I ka anu u irreversible make ua malama i oi aku mamua o 90% o ka hihia. Traumatic kŰia nui e koke aeie i ke koko poho (tourniquet) a me ka haawi aku i ka poino i ka haukapila. Aia lawe intravenous Saline a me colloidal pāʻoihana, koko transfusion, wai koko, anesthetized, ina he pono, pili i ka respirator.

Ma anaphylactic kŰia koke lawelawe epinephrine, i ka hoʻomanawanui ua intubated me ka asphyxia. A laila lawelawe corticosteroids a me antihistamines.

I kaʻawahia kŰia lawe papakaukau loli Inc me antibiotics ikaika, immunomodulators glucocorticoid wai koko.

I ka hypovolemic kŰia ka papa kuhikuhiE hana mea e hoihoi mai i ke koko lako o nā mea a pau nā loko, hoʻopau o ka hypoxia, a me ka normalization o ka manaʻo koikoi o ka naau. I ka wā o ka hawewe, kena ae la ma ka dehydration, ka mea, ua aiiieieoaeuii koi i ka resumption o ka mea haule ka leo o ka loli a me ka electrolytes a pau.