SDS - ntev compression syndrome: cov tsos mob, kev kho mob thiab kev tiv thaiv

Yuav luag txhua tus neeg muaj kev ruaj ntseg los ntawm ntau yam xwm txheej. Qhov no yuav ua tau dab tsi los ntawm cov kev huam yuaj los mus thauj mus rau lub av qeeg thiab lub cev qhuav dej ntawm cov mine. Nyob rau hauv ib yam ntawm cov neeg mob tej zaum yuav tsim SDS. Lub syndrome muaj ntau yam ua, pathogenesis, yuav tsum tau yuav tsum tau kev kho mob. Xav txog cov lus nug no ntxiv lawm.

Lub tswvyim ntawm SDS

Raws li ib tug tshwm sim, nqaij mos compression muaj peev xwm tsim SDS. Syndrome nyob rau hauv cov poj niam tshwm sim nrog rau tib zaus li hais tias ntawm cov txiv neej pejxeem. Nws muaj lwm lub npe, xws li crush syndrome, los yog compression raug mob. syndrome, qhov ua rau tej zaum yuav:

• Hlob qhov chaw ntawm lub cev nrog hnyav khoom.
• Muaj xwm ceev.

Tej lub sijhawm feem ntau tshwm sim tom qab muaj av qeeg, raws li ib tug tshwm sim ntawm cov tsheb khiav raug xwm txheej, explosions, collapses nyob rau hauv mines. Lub zog ntawm compression tej zaum yuav tsis yeej ib txwm ua tau zoo kawg, tab sis muaj ib tug luag hauj lwm ua si los ntawm lub caij ntawm xws li ib tug lub xeev. Feem ntau, cov VTS (crush syndrome) tshwm sim thaum cov nyhuv yog ntev nyob rau hauv cov nqaij mos, feem ntau ntau tshaj li 2 teev. Thawj pab yog ib qho tseem ceeb theem uas tib neeg lub neej nyob. Uas yog vim li cas nws yog ib qho tseem ceeb yuav tsum tau paub qhov txawv ntawm lub ces ntawm tus mob no.

ntawm ntau yam SDS

Nyob rau hauv kev kho mob xyaum, muaj ntau ntau le caag los lub faib ntawm compartment syndrome. Muab lub hom compression, xws cais syndromes:

• Tsim raws li ib tug tshwm sim ntawm lub cev qhuav dej ntawm cov av. Nws tshwm sim raws li ib tug tshwm sim ntawm lub caij nyoog nyob rau hauv lub pob zeb slab los yog txawv hnyav khoom.
• SDS txoj hauj lwm muaj vim compression ntawm qhov chaw ntawm nws tus kheej lub cev.

Localization zaum kuj yuav sib txawv, li no cais PIF:

• Nqua.
• Lub taub hau.
• Plab.
• Siab.
• Taza.

Tom qab muaj kev kub ntxhov ntau tsim SDS. Lub syndrome yog feem ntau nrog lwm raug mob, yog li distinguished:

• Compartment syndrome yog nrog los ntawm kev raug mob rau hauv nruab nrog cev.
• Nrog kev puas tsuaj rau lub bony lug ntawm lub cev.
• VTS ua puas tsuaj paj txoj thiab cov hlab ntsha.

Lub degree ntawm heev ntawm lub syndrome tej zaum yuav txawv. Raws li nyob rau hauv no qhov tseeb, emit:

• Ib tug me me daim ntawv ntawm cov syndrome, uas muaj thaum cia li muab cov povtseg rau ib tug luv luv lub sij hawm. Kev ua txhaum ntawm cov hlab plawv system yog feem ntau tsis paub hais tias.

• Yog hais tias lub siab nyob rau hauv cov ntaub yog ntau tshaj li 5-6 xuab moos, qhov nruab nrab zoo npaj SDS uas raum tsis ua hauj lwm tej zaum yuav me me.
• Loj thiaj paub hais tias thaum squeezed tshaj 7 teev. Qhia tej yam tshwm sim ntawm lub raum tsis ua hauj lwm.
• Yog hais tias lub nqaij mos nyob rau hauv siab rau ntau tshaj 8 teev, nws tseem tau mus hais lus txog txoj kev loj hlob ntawm ib tug tsis tshua muaj mob loj SDS. Nws yog ua tau rau kev tshawb nrhiav txhaws lub plawv tsis ua hauj lwm, uas yog feem ntau neeg tuag taus.

Feem ntau, thaum PIF (crush syndrome) nrog ntau yam teeb meem:

• Heart attack myocardial infarction.
• Cov kab mob sib txawv ntawm cov khoom hauv nrog cev systems yog fraught nrog SDS. Ib tug syndrome nyob rau hauv cov poj niam uas muaj feem xyuam rau lub sab ib feem ntawm lub cev, xws li cov pelvic kabmob, txaus ntshai loj muaj teeb meem thiab muaj kev cuam tshuam ntawm lub cev tau hauj lwm ntawm no sector.
• Pyoseptic pathologies.
• Injured povtseg ischemia.

Cov tshwm sim ntawm kev poob plig: SDS

ua rau lub syndrome yog raws li nram no:

• Mob poob siab.

• Poob ntawm ntshav, uas mus los ntawm cov hlab ntsha mus rau hauv lub puas cov ntaub so ntswg. Raws li ib tug tshwm sim, cov ntshav yuav tuab thiab ua thrombosis.
• Lub disintegration ntawm ntaub so ntswg tshwm sim intoxication. Myoglobin, creatine, poov tshuaj thiab phosphorus los ntawm raug mob nqaij mus rau hauv cov ntshav thiab ua hemodynamic teeb. Dawb myoglobin yog hloov dua siab tshiab rau hydrochloric acid hematin thiab provokes tus txoj kev loj hlob ntawm mob raum tsis ua hauj lwm.
• Tag nrho tej yam yuav tsum tau tshem tawm sai li sai tau, yog li ntawd nws tau los ua tau los cawm lub neej.

Lub sij hawm ntawm qhov kev soj ntsuam kev kawm ntawm SDS

Thaum lub sij hawm lub kev sib tsoo syndrome muaj ob peb sij hawm:

• Thawj - nws yog nws tus kheej ncaj qha cia li muab nqaij mos nrog txoj kev loj hlob ntawm kev puas poob siab.
• Nyob rau hauv lub thib ob lub sij hawm muaj lub zos variations nyob rau hauv cov raug mob cheeb tsam thiab pib ntawm intoxication. Yuav mus txog rau peb hnub.
• Qhov thib peb lub sij hawm yog tsiag ntawv los ntawm txoj kev loj hlob ntawm cov teeb meem uas tshwm sim txhab ntawm ntau yam hloov khoom nruab nrog nruab.
• Qhov thib plaub lub sij hawm - so tomqab khomob. Pib los ntawm lub sij hawm uas nws restoration ntawm raum muaj nuj nqi.
• Tom ntej no, tus neeg uas raug sab cov yam tseem ceeb uas hais lus ntawm immunological reactivity, lub bactericidal kev ua si ntawm cov ntshav.

Symptomatology ntawm lub syndrome ntawm compression ntawm cov ntaub so ntswg

Yog hais tias tsis tam sim ntawd tshem tawm ib tug ntau ntawm siab rau cov nqaij mos mos, ces maj mam loj zuj zus SDS. tsos mob ntawm tus syndrome exhibits lub nram qab no:

• Cov tawv nqaij ntawm lub constricted povtseg yuav daj ntseg.
• Nws zoo nkaus li edema, uas thaum lub sij hawm yog ua.
• Tsis detectable vascular mem.
• Tag nrho cov cuam tshuam mob worsens.
• Muaj yog ib tug mob syndrome.
• Nyob rau hauv tib neeg, psycho-kev nyuaj siab.

Kuaj ntshav xyuas qhia tau hais tias ib qho kev nce ntawm fibrinogen tsis fibrinolytic kev ua ntawm cov ntshav coagulation system yog tseem ceev.

Pom nyob rau hauv cov zis protein, cov ntshav liab tshwm sim thiab thooj voos kheej kheej.

Cov no yog cov kev tshwm sim tej zaum yuav SDS. Lub syndrome yog yus muaj los ntawm kuj ib txwm lub xeev cuam tshuam yog tshem tawm cov compression ntawm ntaub so ntswg. Tab sis tom qab ib tug thaum muaj:

• Cyanosis thiab pallor ntawm lub integument.
• Variegated coloring ntawm daim tawv nqaij.
• Nyob rau hauv lub tom ntej no hnub o nce.

• Npuas tej zaum yuav tshwm sim, infiltration, thiab necrosis ntawm lub extremities tshwm sim nyob rau hauv loj heev zaum.
• Tsim plawv insufficiency.
• Kuaj ntshav xyuas qhia tau hais tias nws cov thickening thiab neutrophilic ua haujlwm.
• Propensity rau thrombosis.

Rau ntawm no theem nws yog ib qho tseem ceeb rau raws sij hawm intensive kev lis ntshav txoj kev kho nrog yuam diuresis thiab detoxification.

Symptomatology ntawm peb lub sij hawm

Qhov thib peb theem ntawm kev loj hlob ntawm lub syndrome (VTS) yog tsiag ntawv los ntawm txoj kev loj hlob ntawm cov teeb meem, nws mus los ntawm 2 mus rau 15 hnub.

Tej yam tshwm sim thaum lub sij hawm tej zaum yuav tshwm sim raws li nram no:

• Lub yeej ntawm lub ntau yam hloov khoom nruab nrog nruab.
• Cov kev loj hlob ntawm lub raum tsis ua hauj lwm.
• O ua loj.
• Nyob rau hauv daim tawv nqaij, cov tsos ntawm bubbles tau cai nrog ntshiab los yog hemorrhagic cov ntsiab lus.
• Kaj pib mus rau manifest anemia.
• Tsis tso zis tso zis.
• Yog hais tias cov ntshav mus kuaj, nws yuav tsub kom lub concentration ntawm urea, creatinine thiab poov tshuaj.
• Manifested classical daim duab ntawm uremia nrog hypoproteinemia.
• Muaj yog ib qho kev nce rau hauv lub cev kub ntawm tus neeg mob.
• General mob worsens.
• Muaj yog tsis meej pem thiab nkees.
• Nws tej zaum yuav ntuav.
• Uas tseg tau sclera qhia siab koom tes nyob rau hauv lub pathological txheej txheem.

Txawm intensive kev kho yuav tsis yeej ib txwm txuag ib tug neeg, yog tias koj paub hais tias SDS. Syndrome, yog hais tias nws nce mus txog lub sij hawm no, nyob rau hauv 35% ntawm cov neeg tau nyob rau hauv kev tuag ntawm tus neeg uas raug.

Nyob rau hauv xws li mob, nws tsuas pab extracorporeal detoxification.

Ntxiv txoj kev loj hlob ntawm lub SDS

Qhov thib plaub lub sij hawm - ib tug so tomqab khomob. Nws yuav pib tom qab ob lub raum rov lawv cov hauj lwm. Rau ntawm no theem, lub zos cov kev hloov yeej tshaj lub general.

Cov tsos mob tej zaum yuav muaj xws li:

• Yog hais tias muaj qhib kev raug mob, ces cai kab mob.
• Tej zaum qhov kev loj hlob ntawm sepsis.
• Yog hais tias muaj yog tsis muaj teeb meem, lub o pib zuj zus lawm tso.
• Yuav ua li cas sai sai rov qab sib koom muaj yuav nyob ntawm seb qhov heev ntawm kev puas tsuaj.
• Txij li thaum tej nqaij raug tua, lawv yuav pib mus hloov lub connective ntaub so ntswg, uas tsis muaj lub peev xwm mus txo, yog li cov povtseg Atrophy tsim.
• Anemia kuj tsawv.
• Kuv raug kev txom nyem tsis muaj qab los noj mov.
• Muaj pheej hloov nyob rau hauv homeostasis, thiab yog hais tias koj thov ib qho kev muab siab kho kev lis ntshav-transfusion txoj kev kho, lawv muaj peev xwm yuav tshem tawm tom qab ib lub hlis ntawm intensive kev kho mob.

Thaum lub sij hawm kawg lub sij hawm poob nyob rau hauv casualties qhia cov yam tseem ceeb ntawm tej yam ntuj tso kuj, bactericidal kev ua si ntawm cov ntshav. Leukocyte index ncua sij hawm ntawm lub sij hawm yog hloov.

Ib tug ntev lub sij hawm cov neeg raug txom nyem siab ntsws thiab kev puas hlwb instability. Nquag kev nyuaj siab, psychosis thiab hysteria.

Yuav ua li cas kom paub txog lub SDS?

Syndrome, tus mob uas yuav tsum tau nqa tawm tsuas competent specialist, yuav tsum tau tshwj xeeb mloog thiab kev kho mob. Txiav txim hauv lub xub ntiag ntawm tus kab mob muaj peev xwm ua raws li cov nram qab no ntsuas:

• Nws yuav siv sij hawm mus rau hauv tus account tus soj ntsuam daim duab thiab qhov kev tshwm sim ntawm qhov kev raug mob.
• Tsis txhob nyob twj ywm tsis muaj xim ntawm cov zis tsom xam, cov ntshav.
• Tuav diagnostics cuab tam, uas tso cai rau koj los piv rau puab kuaj cov tsos mob thiab lub raum qauv.

Cov neeg niaj diagnostic mob tej zaum hnov no mob, tab sis tsis yog txhua tus to taub li cas cov syndrome. SDS lub plawv ECG yuav qhia lub xub ntiag ntawm tus kab mob, uas muaj feem xyuam rau lub hauv siab. Yog nyob rau hauv lub rubble yuav ho cuam tshuam rau lub hauj lwm ntawm lub plawv mob.

Kuaj mob yog nqa tawm mus rau:

• Qhia cov theem ntawm myoglobin thiab cov ntshav ntshav, feem ntau yog nyob rau hauv xws li ib tug lub xeev, nws yog ho muaj zog.
• Kev txiav txim concentration ntawm myoglobin nyob rau hauv cov zis. Yog hais tias daim duab nce mus txog rau 1000 ng / mL, nws tseem tau mus hais lus ntawm cov mob raum tsis ua hauj lwm nyob rau hauv lub VTS.
• Lub syndrome yuav manifest nws tus kheej raws li ib qho kev nce nyob rau hauv transaminases nyob rau hauv cov ntshav.
• Nce creatinine thiab urea.

By Ntsuam xyuas zis kws kho mob txiav txim seb cov neeg kawm ntawv ntawm lub raum puas tsuaj. Nyob rau hauv txoj kev tshawb no qhia:

• Nce ntawm leukocytes yog hais tias muaj yog nyuab los ntawm lub VTS.
• Tsub kom lub concentration ntawm ntsev.
• Nce urea cov ntsiab lus.
• Muaj thooj voos kheej kheej.

Yog mob tso cai cov kws kho mob rau muab lub zoo txoj kev kho sai li sai tau los mus pab tus neeg rov qab tag nrho cov kev khiav dej num ntawm lub cev.

Yuav ua li cas muab thawj pab?

Los ntawm thaum muaj xwm ceev nyem nws nyob rau lub xeev ntawm cov raug tsim txom, thiab tej zaum nws lub neej, thaum tsim lub VTS. Lub syndrome, thawj pab yuav tsum tau muab sai li sai tau, yuav tsis ua rau loj teeb meem yog tias pab tus neeg los ntawm cov nram qab no algorithm:

1. Muab tshuaj loog tshuaj.
2. Ces pib tso lub cheeb tsam cov ntawm lub cev.

Raws li cov nyiaj no yog tsim, "Analgin", "Promedol", "morphine". Tag nrho cov tshuaj uas muab tsuas intramuscularly.

Muaj coob tus neeg nug yog vim li cas thaum SDS-thov ib tug tourniquet syndrome? Qhov no yog ua nyob rau hauv lub xub ntiag ntawm mob loj heev arterial los ntshav los yog kim heev povtseg kev puas tsuaj rau tus neeg tuag los ntawm ntshav poob.

• Tshawb xyuas cov puas cheeb tsam.
• Tshem tawm xov.
• Tag nrho cov qhov txhab yuav tsum tau kho antiseptic thiab npog nrog ib tug menyuam tsis taus daim ntaub.
• Mus sim kom txias lub limb.
• Cov raug muab ntev haus, tsim tshuaj yej, dej, kas fes, los yog nrog ib tug ib leeg-saline.
• Sov tus neeg.
• Yog hais tias muaj yog obstructions, cov tib neeg xav tau sai li sai tau los mus pab oxygen.
• Yuav kom tiv thaiv lub plawv tsis ua hauj lwm, sau tus neeg "Prednisolone".

• Xa tus neeg mus rau qhov ze lub tsev kho mob.

Therapy compartment syndrome

Nws yuav ua degrees ntawm heev ntawm SDS. Syndrome, cov kev kho mob uas yuav tsum tau kev, tsis ua loj teeb meem, xav tias lub pathogenesis ntawm txhab. Complex ua hauj lwm - qhov no txhais tau tias:

• Mus nqa tawm kev ua ub no nyob rau lub homeostasis txawv txav.
• Yuav kom kav ib tug kho nyhuv on lub pathological chaw puas tsuaj.
• Normalize lub microflora ntawm cov qhov txhab.

Therapeutic ntsuas yuav tsum tau nqa tawm yuav luag tsis tu ncua, pib los ntawm lub hnub ntawm thawj pab thiab mus rau tag nrho rov qab los ntawm tus neeg mob.

Yog hais tias ntau yam pauv loj raug mob, cov kev kho mob kev kho mob muaj ob peb theem:

• Tus thawj pib tam sim ntawd thaum lub scene.
• Qhov thib ob - yog pab nyob rau hauv ib tug kho mob, uas yuav ua tau heev deb ntawm lub scene ntawm raug xwm txheej, li ntawd, feem ntau siv "ya tsev kho mob", "lub tsev kho mob rau ntawm tej log". Nws yog ib qho tseem ceeb heev kom muaj qhov kev tsim nyog cov khoom los pab nyob rau hauv cov ntaub ntawv ntawm kev puas tsuaj ntawm cov licas thiab hauv nruab nrog cev.

• Nyob rau hauv lub thib peb theem yog tshwj xeeb kev kho mob. Qhov no feem ntau tshwm sim nyob rau hauv ib tug phais los yog kev poob plig center. Muaj tag nrho cov tsim nyog cov khoom rau muab kev pab nyob rau hauv cov ntaub ntawv ntawm loj kev puas tsuaj rau lub licas, los yog hauv nruab nrog cev. Muaj resuscitation kev pab rau tshem tawm ib tug neeg los ntawm ib lub xeev ntawm kev poob siab, sepsis los yog lub raum tsis ua hauj lwm.

tshuaj kho

Cov ua ntej lawm koj pib no theem ntawm txoj kev kho, qhov ntau dua tus neeg mob ciaj sia. Kev kho mob nyob rau ntawm no theem yog raws li nram no:

• Cuam tshuam make Txoj kev lis ntshav sodium tshuaj dawb tov thiab 5% sodium bicarbonate nyob rau hauv ib tug kev faib ua feem ntawm 4: 1.
• Yog hais tias muaj yog ib tug loj heev hauv daim ntawv ntawm cov syndrome, cov neeg raug ib tug anti-poob siab ntsuas tswvcuab 3-4 litres ntawm cov ntshav thiab ntshav hloov.
• Yuav kom tiv thaiv cov kev loj hlob ntawm cov teeb meem, siv diuresis nrog cov kev taw qhia ntawm "Furosemide" los yog "Mannitol".
• Txo kab intoxication tiav los ntawm hloov cov ntshav thiab cov kev siv ntawm thaum ntxov gamma-hydroxybutyric acid. Nws muaj ib tug inhibitory ntxim rau cov Cns thiab muaj ib tug hypertensive nyhuv.

Yog hais tias tag nrho cov conservative kev kho mob tsis txhob muab cov kev kawm, nws yuav tsum tau phais kho mob, uas yog raws li nyob rau kev siv ntawm cov kev ntawm detoxification:

• Sorption txoj kev.
• Lim Ntshav Hauv Lub thiab pom (kev lim ntshav, ultrafiltration).
• Fereticheskie (plasmapheresis).

Thiab tej zaum yuav amputation, uas yog tsis yooj yim sua rau rov qab mus rau ib lub neej zoo.

Puas yuav ua tau kom tsis txhob SDS?

Yog hais tias koj tsis txhob raug mob loj tsis tshwm sim, ces nyob rau hauv feem ntau tsim SDS. Lub syndrome, uas yuav tsum tau tiv thaiv txij nkawm, yuav tsis ua rau disastrous txim, yog hais tias, tam sim ntawd pib mus muab kev txiav txim. Rau no koj yuav tsum tau qhov tshuaj tua kab mob penicillin. Kev siv cov tshuaj tua kab mob tej zaum yuav cawm tsis tau lawv los ntawm festering, tab sis tiv thaiv cov roj gangrene li ntawd nws yog heev sai tau.

Ua ntej extracting cov raug mob los ntawm cov rubble tseem ceeb heev rau pib cov kua kho rau normalize lub BCC. Feem ntau siv rau cov hom phiaj "Mannitol", 4% magnesium bicarbonate tshuaj.

Yog hais tias peb nqa tawm tag nrho cov kev ua ncaj qha rau ntawm qhov chaw, nws puas yuav tau los mus tiv thaiv cov kev loj hlob ntawm loj teeb meem SDS, xws li gas gangrene thiab lub raum tsis ua hauj lwm.

Peb soj ntsuam nyob rau hauv kom meej lub SDS (crush syndrome), hauv nruab nrog cev hnyav ntawm nws tus kheej lub cev, los yog hnyav khoom. Qhov no mob feem ntau tshwm sim thaum lub sij hawm muaj xwm txheej ceev. Nws yuav tsum tau muab sau tseg tias timeliness ntawm kev pab yuav cawm tau lub neej. Tab sis nyob rau hauv cov ntawv nyeem thiab nyob rau hauv cov nplooj ntawv ntawm cov phau ntawv Magazine hnub no koj yuav nrhiav tau ib tug sib txawv heev kev txhais. Nws muaj tib lub npe - SDS syndrome - ib tug poj niam cov kab mob ntawm lub xyoo pua. Cov tswvyim no yog nej ib tug txawv cheeb tsam thiab koj yuav tsum tsis txhob xav yuam kev rau nws nrog xws li ib tug kab mob loj. Qhov no yog ib lub npe rau ib tsab xov xwm nkaus, tab sis nyob rau hauv luv luv nws yuav tsum tau muab sau tseg hais tias qhov no yog hais txog mus rau lub syndrome. nws feem ntau muaj feem xyuam rau cov poj niam uas yog burdened los ntawm tsoom fwv. Qia, tsis muaj ntawm nws tus kheej-kev thuam, prejudice tiv thaiv cov txiv neej, kev ntseeg siab nyob rau hauv nws tus kheej Infallibility thiab zoo sib xws "cov tsos mob" yam ntxwv ntawm cov syndrome nyob rau hauv cov poj niam SDS.