Pericardial effusion: cov tsos mob thiab ua. Kuaj thiab kho

Exudative pericardial effusion - ib tug kab mob yus o nyob rau hauv daim nyias nyias meem hauv lub puab nto ntawm lub pericardium. Los ntawm qhov xwm ntawm tus khiav exudative pericarditis yog mob los yog mob.

Tus kab mob muaj peev xwm yuav serous, hemorrhagic, purulent, fibrinous thiab serosanguineous. Nyob rau hauv exudative fibrinous pericarditis tshwm sim deposition ntawm fibrin filaments nyob rau hauv lub pericardium, thiab accumulates ib qhov nqi ntawm cov kua nyob rau hauv lub pericardial kab noj hniav. Feem ntau, nyob rau hauv lub pericardial kab noj hniav muaj kwv yees li 20-40 ml ntawm cov kua.

Thaum lub sij hawm mob pericarditis cov tshuaj tiv thaiv yog nrog los ntawm kho kom zoo cellular exudation nyob rau hauv lub pericardial kab noj hniav ntawm ib tug kua ntshav feem. Mob thaum lub inflammatory txheej txheem yuav tsiv mus nyob rau subepicardial txheej, uas dramatically deteriorates nws txoj kev ua.

cardiogenic poob siab

Feem ntau cia li txuam nrog kua nyob rau hauv lub pericardial kab noj hniav yuav ua rau mob tamponade, uas yog symptomatic tej yam tshwm sim ntawm cardiogenic poob siab:

• lub plawv palpitations;
• ua pa mob rau dyspnea hom;
• nce siab nyob rau hauv lub venous system ntawm me me thiab cov loj loj ncig;
• txo nyob rau hauv systolic cov ntshav siab.

tau teeb meem

Nrog resorption exudative kua tej zaum yuav tsim caws pliav nqaij, muaj raws ntawm fibrin, uas nyob rau hauv lem yuav ua tau kom feem los sis tag imperforate pericardial kab noj hniav. Feem ntau yog cov caws pliav yog tsim nyob rau hauv lub atrial cheeb tsam, ntawm lub txuas lub Upper thiab qis vena cava, nyob ze ntawm lub atrioventricular zawj.

Nrog xws li ib mob xwm ntawm pericardial effusion yuav ua tau kom mob, uas yog hu ua tus "pob zeb lub siab" raws li ib tug tshwm sim ntawm calcification ntawm lub pericardium. Ib qho tseem ceeb taw tes rau hauv lub pathological txheej txheem ntawm exudative pericarditis yog ib tug ua txhaum ntawm lub diastolic ntshav rov mus rau lub plawv ventricles. Exudate sau nyob rau hauv pericardial kab noj hniav los yog cov xub ntiag ntawm constrictive pericarditis ua rau muaj kev cuam tshuam ntawm subepicardial thiab subendocardial khaubncaws sab nraud povtseg nyob rau hauv lub apex. Nyob rau hauv tsawg zaus, fibrosis ntawm lub pericardium tej zaum yuav expandable seem, los ntawm kev uas ib tug su ventricle thaum lub sij hawm diastole kom txwm tus me nyuam ntawm cov ntshav mus rau lub plawv.

Qhov no tshwm sim yog hu ua fenestration (tus "qhov rais qhib"). Systolic theem, uas yuav muab ncig npag txheej, feem ntau, tsis raug kev txom nyem. Nrog ntev-lub sij hawm tau ua txhaum ntawm lub venous rov qab mus rau lub plawv muaj ib tug stagnation ntawm cov ntshav nyob rau hauv lub pulmonary leeg. Thaum venous stasis nyob rau hauv lub mauj kev system ntawm cov kua yog extravasation rau hauv ib ncig ntaub so ntswg.

Pericardial effusion: ua (etiologies)

Ib tug ntawm cov feem ntau heev ua rau exudative pericarditis yog RNA-muaj cov kab mob (A thiab B), echovirus, ua npaws A thiab kab mob kab mob los ntawm ntau yam xwm (pneumococci, staphylococci, streptococci, mycobacteria tuberculosis thiab fungi).

Saib kab mob no yuav complicate rau thaum kawg ntawm cov kab mob (SLE, los yog Libman-Sacks kab mob, rheumatic pob qij txha, rheumatism, mauj scleroderma) thiab mob ntawm lub genitourinary system (uremic pericarditis). Pericardial effusion ICD tej zaum yuav ib tug manifestation postperikardialnogo syndrome uas tsim tom qab pericardiotomy los yog raws li ib tug thaum ntxov mob myocardial infarction, uas yog hu ua Dressler lub syndrome. Feem ntau, qhov no yam tab kaum tshwm sim nyob rau hauv nruj me ntsis txhais lub sij hawm, uas yog, los ntawm 15 hnub rau 2 lub hlis.

Tej zaum exudative nplaum pericarditis yuav tshwm sim vim haus ntawm tej yam tshuaj: gidralizin, phenytoin, anticoagulants, vim nquag daim ntawv thov procainamide, radiotherapy. Nyob rau hauv cov neeg mob thaum ib tug loj pericardial effusion kuaj effusion cov ntsiab lus, yog vim li cas yuav tsum tau nrhiav nyob rau hauv lub metastasis ntawm hlav: lub mis mob cancer, mob ntsws, sarcoma, nqaij hlav. Nyob rau hauv cov neeg mob, feem ntau yog hemorrhagic exudates, tsawg serous.

Muaj yog ib tug tshwj xeeb zoo ntawm exudative pericarditis, uas yog hu ua hemopericardium. Qhov no tshwm sim thaum uas tob tob raug mob mus rau lub hauv siab cheeb tsam nyob rau hauv lub plawv ntawm lub projection, raws li nyob rau hauv discontinuities infarction nyob rau hauv cov neeg mob tom qab myocardial infarction, los yog dissecting aortic aneurysm, ua rau cov ntshav nyob rau hauv lub pericardial kab noj hniav. Yog hais tias tus kab mob no tshwm sim rau tsis paub hais tias causative yam, ces nws belongs rau ib pab pawg neeg ntawm nonspecific los yog idiopathic.

Nyob rau hauv tas li ntawd, lub pericardial effusion nyob rau hauv cov me nyuam, dhau lawm, tej zaum. Yog vim li cas rau qhov no yog: streptococcal thiab staphylococcal kab mob, kab mob ntsws, HIV kab mob, uncontrolled tshuaj, hlav, kev poob plig, nyob ze lub plawv, lub raum tsis ua hauj lwm, lub plawv phais.

Pericardial effusion: kuaj thiab soj ntsuam nta

Exudate sau nyob rau hauv pericardial kab noj hniav thiab npub mob manifests mob tej nrog lub plawv, txawv txav ua tsis taus pa rau hauv lub hom apnea, uas yog txo nyob rau hauv ib tug txoj hauj lwm zaum, palpitations. Lub siab sib sib zog tsa los ntawm cov kua rau lub raj cua thiab bronchi ua rau hnoos qhuav.

General mob ntawm tus neeg mob nyob rau tus nqi ntawm tsim ntawm lub kua tivthaiv nyob rau hauv lub pericardium ntawm qeeb ceev - fee lub xeev thaum lub ceev ceev - ntsis thiab sab heev.

Nyob rau kev xeem, tus neeg mob yuav raug kuaj nram qab no nta exudative pericarditis: daj daim tawv nqaij, mucosa cyanotic daim di ncauj, edema ntawm sab nqua, acrocyanosis.

Thaum lub soj ntsuam cheeb tsam ntawm lub hauv siab yuav yuav ntes tau asymmetry, rau sab laug muaj peev xwm muab tau ntau zog, qhov no yog tau yog hais tias cov pawg nyob rau hauv pericardial exudate volume nce mus txog ntau tshaj 1 liter. Palpation yuav ntes feature Jardin thaum apical impulse yog moog upwards thiab sab hauv, vim lub siab sib sib zog tsa, cov kua sau hauv.

Percussion yuav ntes expansion ntawm thaj tsam ntawm lub txheeb ze dullness ntawm lub plawv nyob rau hauv tag nrho cov lus qhia: mus rau sab laug, tom qab (nyob rau hauv lub qis sib cais) rau pem hauv ntej los yog mus rau nruab nrab axillary kab, nyob rau hauv lub thib ob thiab thib peb intercostal tej qhov chaw mus rau lub mid-clavicular kab, txoj cai nyob rau hauv lub qis sib cais, txoj cai ntawm scr (nruab nrab -klyuchichnoy kab), yog li sib sau ib obtuse angle es tsis txhob ntawm ib tug tib neeg ib txwm mus rau lub ciam hloov hepatic dullness. Tag nrho cov no tej zaum yuav qhia tau tias tus neeg mob muaj pericardial effusion.

Auscultatory qauv: ib tug ntse weakening ntawm lub plawv suab nyob rau hauv lub plawv apex, nyob Botkin-Erb thiab xiphoid txheej txheem. Nyob rau hauv lub hauv paus ntawm lub plawv yog hnov nrov tones yog vim lub fact tias lub plawv yog moog exudative kua upwards thiab rov qab. Suab nrov pericardial kev sib txhuam, feem ntau yog auscultation tsis manifest nws tus kheej. ntshav siab yog nyob rau poob, tiv thaiv cov tom qab uas yuav txo tau nyob rau hauv mob tso zis.

Yog hais tias lub hnab khib kua tshwm sim maj mam thaum lub sij hawm, tus neeg kho tshuab ua hauj lwm ntawm lub plawv rau ib ntev lub sij hawm yog tsis disturbed vim lub fact tias cov pericardium expands maj mam nyob rau hauv cov ntaub ntawv no. Nyob rau hauv cov ntaub ntawv ntawm ib tug sai txuam nrog kua nyob rau hauv lub pericardial effusion thiab lub cheeb tsam koom tachycardia, soj ntsuam lub plawv tsis ua hauj lwm nrog congestion phenomena nyob rau hauv lub voj voog ncig (loj loj thiab me me).

Raws li tus tsom xam ntawm ECG cov ntaub ntawv tsiag ntawv los ntawm cov nram qab no exudative pericarditis. Thaum congestion exudative kua ntxiv xam voltage txo QRS complex thiab hluav taws xob hloov ventricular ceg. Radiographically cai nce nyob rau hauv tus duab ntxoov ntxoo ntawm lub plawv thiab ib tug tsis muaj zog txaus qhov chaw ntawm lub Circuit Court ripple. Vascular nras yog tsis zog. Tej zaum nws yog ua tau rau ntes effusion rau hauv rau sab laug pleural kab noj hniav.

Ncha ECG nyob rau hauv lub pericardial kab noj hniav cia hnab khib exudative kua yog pom los ntawm sab nraum qab ntawm lub sab laug ventricle ntawm lub plawv, nyob rau hauv lub cheeb tsam ntawm lub rear phab ntsa. Thaum loj tagnrho cov exudative kua, nws qhia nyob rau hauv pem hauv ntej ntawm txoj cai ventricle ntawm lub plawv. Nyob rau hauv lub xov tooj ntawm sau kua nyob rau hauv lub pericardium yog txiav txim los ntawm lub caij nyoog nruab nrab lub thaws rov los echoes los ntawm cov epicardium thiab cov pericardium.

Tsim kom muaj ib qhov zoo tshaj uas tshwm sim los ntawm tus kab mob

Yuav kom tsim tau lub etiologic yam entailing exudative daim ntawv pericarditis nqa virological kev xeem, kev ntsuam xyuas rau lub xub ntiag ntawm tej tshuaj (HIV), yub ib lom khoom (e.g., cov ntshav) los mus tshem tawm cov kab xwm ntawm exudative pericarditis nqa tuberculin daim tawv nqaij mus kuaj, serological cov kev tshawb fawb fungal kab mob.

Tsis tas li ntawd immunological kev tshawb fawb ua nyob rau hauv mauj connective cov ntaub so ntswg mob, txiav txim seb lub xub ntiag ntawm anti-nuclear tshuaj, rheumatoid tau titre antistreptolysin-O, mob khaub thuas agglutinin - nrog mycoplasma kab mob, uremia saib ntshiab creatinine thiab urea.

Differential mob ntawm exudative pericarditis

Pericardial effusion yog txawv nrog rau cov nram qab no kab mob chaw: mob myocardial infarction, vasogenic mob prollaps mitral valve, qhuav pleurisy.

Nyob rau hauv mob myocardial miokarada mob syndrome tshwm sim los ntawm tsub zuj zuj ntawm metabolic khoom nyob rau hauv lub plawv mob (myocardium). Mob syndrome myocardial infarction nrog los ntawm ib tug xov tooj ntawm cov kev soj ntsuam thiab kuaj cov cim qhia tias manifest lawv tus kheej nyob rau hauv kev ua txhaum ntawm central hemodynamics dab arrhythmias, conduction dab nyob rau hauv myocardium, stagnation phenomena nyob rau hauv ib tug me me lub vajvoog (pulmonary) kev cov yam ntxwv ntawm myocardial infarction rau ECG hloov. Biochemical tsom xam ntawm myocardial infarction qhia kev ua ntawm mob isoenzymes.

Thaum qhuav pleurisy yog ib qho tseem ceeb fact muaj mob thiab nta txuam nrog ua pa, hnoos, lub cev txoj hauj lwm, suab nrov ntawm auscultatory xeem kev sib txhuam pleura, lwm yam tshaj li cov saum toj no-piav, nws yuav tsum tau muab sau tseg tias qhuav pleurisy muaj cov tsis muaj kev hloov rau zaj duab xis electrocardiograms . Tsis zoo li aortic aneurysm los ntawm exudative pericarditis nws muaj nyob rau hauv lub fact tias cov ua yog ib tug kev tshuaj ntsuam genetic kab mob - Marfan syndrome los yog atherosclerotic lesion nws puab plhaub. Nyob rau hauv tej rooj plaub, tej zaum nws yuav tsim ib tug mob pericardial effusion.

Symptomatic aortic aneurysm manifests nws tus kheej raws li nram no: mob nyob rau hauv lub lub hauv siab, uas tsis muaj irradiation, dysphagia, hoarse lub suab, dyspnea, hnoos, tshwm sim los ntawm compression ntawm lub mediastinum. Aortic aneurysms tshuaj mob siv moj kev soj ntsuam ntawm lub thoracic kab noj hniav, echocardiography, thiab aortography.

Thaum dissecting aortic aneurysm mob tshwm sim mam li nco dheev nyob rau hauv lub hauv siab, muaj ib tug ib txwm mus irradiation raws aorta. Nyob rau tib lub sij hawm, cov neeg mob yog nyob rau hauv loj mob, feem ntau cov disappearance ntawm ripples rau ib tug loj leeg. Auscultation auscultated aortic valve insufficiency. Diagnostic ntsuas thaum dissecting aortic aneurysm yog: transesophageal ultrasound thiab xoo tomography ntawm lub hauv siab muaj kab noj hniav.

Yuav ua li cas koj yuav tsum xyuam xim rau

Nws yog ib qho tseem ceeb qha pericardial effusion ICD 10 nrog diffuse myocarditis, uas yog nrog los ntawm o ntawm lub plawv kab noj hniav nrog tej yam tshwm sim ntawm lub plawv tsis ua hauj lwm. Symptomatic myocarditis manifested nws tus kheej nyob rau hauv cov nram qab no txoj kev: nws yuav ua tau ib tug mob anginal xwm, zoo nkaus li ntawm heaviness nyob rau hauv lub plawv cheeb tsam, lub plawv atherosclerosis teeb.

Auscultation auscultated muting lub plawv suab, thawj thiab thib plaub lub plawv suab tej zaum yuav bifurcated, nyob rau hauv qhov kev piav qhia ntawm lub electrocardiogram yuav ntes cov nram qab no nta: lub deformed P yoj, ib tug kev hloov nyob rau hauv cell voltages hniav R, T yoj yuav flattened. Thaum lub sij hawm lub echocardiogram noteworthy o ntawm lub plawv lag thiab txo contractility ntawm cov phab ntsa.

Therapeutic pab nyob rau hauv cov kev kho mob ntawm exudative pericarditis

Xav hais tias nws mob pericardial effusion yog ib qho mob ceev heev yuav tsum tau hospitalize tus neeg mob nyob rau hauv lub tsev kho mob. Yog hais tias muaj yog mob heev, tas cov tshuaj aspirin nyob rau hauv cov ntsiav tshuaj daim ntawv no, ntau npaum ntawm ib tug kab hauv luv txhua txhua peb los yog plaub lub sij hawm. Nws yog ua tau mus ntxiv tshuaj aspirin ntsiav tshuaj indomethacin koob tshuaj ntawm 25 -50 mg, haus dej, ib tug caij nyoog ntawm txhua txhua rau lub sij hawm.

Yog hais tias muaj yog indications uas muab ntxiv cov tshuaj ntawm 50% dipyrone rau intramuscular thawj coj ntawm 2 ml los yog narcotic analgesics (morphine) concentration ntawm 1%, noj ib zaug los yog ib nrab milliliters, Team sib txhua txhua rau lub sij hawm. Thaum psychomotor ntxhov siab tawm tsam lub backdrop ntawm tus mob los yog insomnia taw "Sibazon" ( "Kuv") hauv, ntau npaum ntawm 5-10 mg peb los yog plaub zaug ib hnub twg.

Yuav kom tshem tawm cov inflammatory dab feem ntau siv nyob rau hauv txoj kev xyaum ntawm "Prednisolone" ntau npaum ntawm 20-80 mg / hnub. nyob rau hauv ib ob peb kauj ruam. Therapy nrog glucocorticoids nyob rau hauv siab koob tshuaj yog nqa tawm nyob rau hauv lub chav kawm ntawm 7-10 hnub, nrog rau cov peculiarity tias nyob rau hauv lub tom ntej ntau npaum yuav tsum raug txo maj, nyob rau hauv ob thiab ib tug ib nrab ib milligram txhua txhua hnub.

Thaum lub sij hawm kev kho mob

Yuav ua li cas ntev yog kho pericardial effusion? Cov kev kho mob kav txog ob los yog peb lub lis piam, thiab tej zaum koj yuav tau mus ncab mus rau ob peb lub hlis, nruj me ntsis rau cov lus tim khawv. Tseem ntawm kev kho mob nyob rau etiological yam uas tshwm sim los pericardial effusion.

Nyob rau hauv paub tus kab mob etiology raug tshuaj anti-inflammatory kab mob, cov tshuaj hormones yog li tsis muab. Pericarditis uas yog vim tus kab mob Streptococcus mob ntsws, kho txawv - muab tshuaj tua kab mob, e.g., penicillin G ntau npaum 200,000 U / kg / hnub. intravenously muab koob tshuaj yog muab faib ua rau tib, ntev ntawm kev kho mob - tsis tsawg tshaj li kaum hnub.

ntxiv kev ntsuam xyuas

Nyob rau hauv tas li ntawd, yog tias koj paub hais tias pericardial effusion, nws yuav tsum tau ua pericardiocentesis (txoj kev muaj tshuaj thiab diagnostic nyob rau hauv cov xwm, uas yog nqa tawm ntawm ib tug tshwj xeeb koob tej pericardium nyob rau hauv thiaj li yuav kom tsawg kua rau kev tsom xam). Tom qab ntawd yub yog nqa exudate nyob rau hauv kev txiav txim mus ntes ib tug yam ntawm tus neeg saib xyuas ntawm tus kab mob no, nws yog ib qho tseem ceeb los mus txiav txim tus tsom xam ntawm nws rhiab heev rau antibacterial npaj. Yog hais tias nws yog nyob Staphylococcus aureus, lub formulation yog feem ntau muab "vancomycin" koob tshuaj ntawm ib tug gram tso dej Team sib txhua txhua kaum ob teev kho nqi - los ntawm 14 mus rau 21 hnub.

Tej zaum, fungal kab mob muaj peev xwm ua rau pericardial effusion. Kev kho mob nyob rau hauv cov ntaub ntawv no yog nqa tawm "Amphotericin". Tus koob yog 1 mg, nws glucose tov nrog ib tug feem pua sib npaug zos rau 5 feem pua thiab tsib caug milliliters nyob rau hauv volume, xeem parenterally (ntawm lub hlab ntsha), nrog rau 30 feeb. Yog hais tias ib tug neeg mob cov tshuaj tiv taus, tus noj tsoom fwv hloov raws li nram no: 0.2 mg / kg tshaj li ib teev. Tom qab, cov tshuaj yog nce maj mus rau ib tug ib nrab los yog ib tug microgram / hnub. rau peb los yog plaub lub sij hawm ua ntej qhov pib ntawm ib tug zoo ntxim.

Sab nyhuv "Amphotericin", uas yuav tsum tau them nyiaj mloog - nephrotoxic, nyob rau hauv kev twb kev txuas nrog cov saib xyuas ntawm lub raum muaj nuj nqi yog tsim nyog. Yog hais tias pericardial effusion originated vim cov tshuaj noj, ces cov kev kho mob lub tswv yim yog aimed ntawm mus ntxiv txais tos ntawm cov tshuaj mas siv tau lawm sis txiav thiab ntxiv cob rau siv ntawm nonsteroidal anti-inflammatory kab mob hauv nrog corticosteroids, lawv collectively ua nyob rau hauv lub ceev ceev rov qab, tshwj xeeb tshaj yog yog hais tias koj tau raug tsa txij thaum lub hnub thaum ntxov ntawm tus kab mob no.