Ukwahlukanisa ukushaqeka definition

Ekuphileni kungase kwenzeke amakhulu izimo ezingase zibangele uyozisola. Abantu abaningi iyihlanganise kuphela ukushaqeka eqinile sezinzwa, kodwa lokhu ngokwengxenye kuphela yeqiniso. Kwezokwelapha, kukhona ngezigaba ukushaqeka, belinganisa pathogenesis yayo, kanzima ubunjalo izinguquko izitho nezindlela ukubhekana nabo. Okokuqala echazwe kulesi simo iminyaka engaphezu kuka-2 yinkulungwane edlule, i-uHippocrates abadumile, futhi igama elithi "ukushaqeka" umkhuba imithi yethulwa ngo-1737 udokotela ohlinza waseParis labangela ukuqala komkhakha Henri Ledran. Lesi sihloko sixoxa ngokuningiliziwe sezizathu esenza ukuba ukushaqeka, ngezigaba, umtholampilo, ukunakekelwa eziphuthumayo uma kwenzeka kulesi simo okuthena amandla futhi izibikezelo.

Umqondo ukushaqeka

Nge shock we ngesiNgisi lingase lihunyushwe ngokuthi ukushaqeka aphakeme, ukuthi akusona isifo, hhayi uphawu hhayi ngoba uyayazi imbangela. Ngo umkhuba izwe leli gama ubizwa impendulo umzimba nezinhlelo zawo ukuze umfutho onamandla (kwangaphandle nangekhatsi), okuyinto ephazamisa umsebenzi isimiso sezinzwa, umzimba, emishinini yokuphefumula kwegazi. Nansi okwamanje ukuzimisela ukushaqeka. Ukwahlukaniswa ngalesi simo kudingeka nithole imbangela ukushaqeka, degree of namandla aso kanye uqale ukwelashwa okuphumelelayo. Isibikezelo kuyozuzisa kuphela uma uphethwe yini futhi ekuqaleni ngokushesha yokusiza umuntu ukuba aphefumule.

ngeengaba

sezifo Canadian Selye ezikhonjwe izigaba ezintathu, cishe zonke izinhlobo ukushaqeka efanayo:

1.Obratimaya (ihlawulelwa), lapho igazi eligciniwe ukuba ubuchopho, inhliziyo, amaphaphu nezinye izitho sinqamukile, kodwa hhayi wayeka. Onalesi sifo isigaba ngokuvamile evumayo.

2.Chastichno esethola (isifuba somoya). Ngesikhathi ukwephulwa efanayo ukuze igazi eligciniwe (perfusion) abalulekile, kodwa kokungenela kokulashwa okusheshayo futhi efanele has a chance ukubuyisela ukusebenza.

3.Neobratimaya (ukuphela). Lona isigaba olunzima lapho thuthuva emzimbeni ngeke ibuyiselwe ngisho ahlaselwe kabi ubhadane lwesifo impilo umthelela. Ukubikezela ke 95% okungekuhle.

Enye ngezigaba uhlukanisa isinyathelo kancane esethola by 2 - subkompensatsionnuyu futhi dekompensatsionnuyu. Ngenxa yalokho, bathola 4:

• 1st ukunxeshezelwa (ukukhanya kokuba Izibikezelo evumayo).
• 2nd subcompensated (maphakathi no-isisindo okudinga umuntu ukuba aphefumule ngokushesha. Ukugxila okuphikisanayo).
• dekompensatsionnaya Okwesithathu (esinzima kakhulu, ngisho noma ekuqalisweni osheshayo kuzo zonke izinyathelo ezidingekile sezulu esiyinkimbinkimbi kakhulu).
• 4th engelapheki (Ukuzibikezela kukadokotela ayiyinhle).

Pirogov yethu abadumile abiwa beshaqekile izigaba ezimbili:

-torpidnaya (esigulini ngesimiso stupor noma abavilaphayo kakhulu, ayiphenduli ezishukumisa lokulwa ingabe ukuphendula, hhayi umbuzo);

-erektilnaya (isiguli ujabule kakhulu, yamemeza yathi: ebanga ukunyakaza equlekile engalawuliwe).

izinhlobo ukushaqeka

Kuye izizathu ezaholela Ukungadli izinhlelo umzimba, kunezinhlobo ezehlukene ukushaqeka. Ukwahlukanisa ngokuya iziyaluyalu kwegazi ezifana:

-gipovolemichesky;

-distributivity;

-kardiogenny;

-obstruktivny;

-dissotsiativny.

Ukwahlukanisa the pathogenesis ukushaqeka lokhu:

-gipovolemichesky;

-travmatichesky;

-kardiogenny;

-septichesky;

-anafilaktichesky;

-infektsionno-anobuthi;

-neyrogenny;

Okungaguquki-inhlanganisela.

ukushaqeka hypovolemic

elithi Complex okulula ukuyiqonda, wazi ukuthi hypovolemia - isimo lapho igazi ukhiphela ngokusebenzisa izitsha esikhathini esingaphansi ivolumu edingekayo. izizathu:

-obezvozhivanie;

ukusha -Extensive (walahlekelwa eziningi plasma);

-pobochnye izidakamizwa ukusabela, ezifana vasodilators;

-large ukopha, lapho izitho ukuthola umoya-mpilo omncane nezakhi ezondla umzimba, isb perfusion eziphukile.

ukushaqeka Hypovolemic ngenxa okusezingeni eliphezulu ukopha kungabhekwa njengokuvikela oluhambisana ukushaqeka. Ukwahlukaniswa kulesi simo kuyafana ukuthi Selye athuthukile, futhi ngasikhathi sinye kunqunywa inani legazi ongawamukeli emizimbeni. Shock uhlale uhlobo lokuvikeleka kwezifiso ezisemqoka ezingumphumela umzimba esimweni kakhulu. Okungukuthi, iqala uchungechunge izinqubo, efuna ukuba alondoloze umsebenzi izitho ezibalulekile futhi ngaleyo ndlela ekusindiseni ukuphila ohlelweni lonke. Ikakhulukazi, ne ukopha e imithambo yegazi lichitheke igazi eyisipele (cishe 10% wenani) kusukela isibindi ubende. Uma lokhu kunganele, noma kwanciphisa ukugeleza kwegazi eyeka kubaluleke ngokufanayo ukondliwa kwesizwe neminyango umzimba, isibonelo, uze ufike emikhawulweni, ukuze Igazi elisele kwakwanele perfusion we inhliziyo, ubuchopho kanye namaphaphu. Ukwahlukanisa ukushaqeka ichaza lezi zinyathelo ezimbili njengoba kancane awushintsheki futhi ayihlanekezeleki. Kulokhu, uma nesikhathi esanele sokuthatha isinyathelo, ungakwazi ukubonisa umuntu beshaqekile, bese ugcine ngaye luphila.

umsebenzi Long isipele wegazi perfusion futhi unikeze abanye izitho ngezithukuthuku nezinye izinto eziphilayo bengayi. Ngakho-ke, uma ungaqali yokusiza umuntu ukuba aphefumule, iza zokugcina (engelapheki) esiteji. Ukukhubazeka waphawula izitsha, ingcindezi kwehle therein kakhulu, igazi eligeleza ukuba azungeze, ukukhuphuka kwamazinga abagxeka perfusion kusilela ubuchopho, inhliziyo namaphaphu.

amanzi emzimbeni

Amanzi emzimbeni womuntu, kuye ngokuthi yobudala kanye ocansini, kusukela 60 kuya ku-80%. Ukulahlekelwa 20% kulesi samba kungawubulala, kanye ukulahlekelwa Usufike 10%, kubangele ukushaqeka hypovolemic, lokukhulunywa ngako kulendzaba kubhekwa njengento amanzi emzimbeni, ukutshengisa nokuncipha afundwa imithambo yegazi ngenxa amanzi emzimbeni okusezingeni eliphezulu. izizathu:

-zabolevaniya, okuholela uhudo, ukuhlanza, ukuchama kaningi echichimayo;

umzimba -nedopoluchenie amanzi (nedopivanie) ngaphansi kwezimo ezimbi kakhulu, ezifana ukushisa okukhulu, ikakhulukazi ngesikhathi ukuzikhandla okusezingeni eliphezulu ngokomzimba;

Ukudla -nerazumnye.

Cishe Ikakhulukazi amanzi emzimbeni ezinganeni ezisencane nasebekhulile.

Ukwahlukanisa ukushaqeka, iphutha ngenxa ukuntuleka kwamanzi, uqokomisa izinyathelo:

-invertible;

a esethola kancane;

-neobratimuyu.

Ngaphezu kwalokho, amanzi emzimbeni sehlukaniswe lezi zigaba ezintathu:

1.Izotonicheskoe (ukulahlekelwa Na futhi K ion). Uketshezi umzimba wethu intracellular kanye intercellular. Lapho ukulahlekelwa isotonic kubangelwa sohudo ikakhulu excreted ukuboniswa potassium okuningi kanye sodium, okungukufa seka lomcoka uketshezi extracellular ludlulele amaseli akha potassium elahlekile therein.

2.Gipotonicheskoe, okuyinto is phetho isotonic. Kuyaqapheleka ukulahlekelwa okusezingeni eliphezulu oketshezini extracellular (ngoba sodium lidlule ku amaseli). Eyokuqala izigaba ezimbili abhekwa esethola ngangokunokwenzeka ukuze uvale isikhala ukulahlekelwa electrolyte. Kancane uyaphumelela ukuhlinzeka isiguli uketshezi eyanele, ikakhulukazi equkethe sodium ion.

3.Gipertonicheskoe esiholela lapho sohudo ephelezelwa retching ekuvimbeleni ukugeleza uketshezi emzimbeni ngomlomo noma ukweqisa izidakamizwa kwamanye izinto ezenza abantu ukuchama ezengeziwe. Lolu ketshezi futhi isuka amaseli esikhaleni extracellular ukuze silondoloze ingcindezi osmotic. amaseli Double emzimbeni nokwephula umsebenzi wabo futhi yehlise ivolumu. ukwehla kuyingozi ikakhulukazi ivolumu ubuchopho, okuholela ukopha subdural.

izimpawu

Sesihlole okukhona echaza Ukwahlukaniswa ukushaqeka hypovolemic. Umtholampilo ngalesi simo, kungakhathalekile ukuthi ziyini izizathu, yavusa mayelana efanayo. On esigabeni esethola, isiguli usesimweni lisalele, izimpawu liphinyiselwe kungenzeka ukuthi ingabi khona. izimpawu ekuqaleni yenkinga yilezi:

- palpitations;

-small ukwehlisa umfutho wegazi;

isikhumba coldly clammy emachosheni (ngenxa perfusion nciphisa);

-Uma kukhona amanzi emzimbeni omiswe izindebe, lwamafinyila emlonyeni, ukungabi izinyembezi.

Ngesikhathi esigabeni sesithathu, ukwethusa izimpawu kokuqala baba evelele.

Iziguli waphawula:

-tahikardiya;

-Reduction blood pressure ngezansi amagugu ezibucayi;

-Violation ukuphefumula;

-oliguriya;

coldly touch (hhayi kuphela izitho);

isikhumba -mramornost kanye / noma ukushintsha umbala walo kusuka evamile kungasho cyanotic;

ishayela -nitevidny;

ingcindezi -ngala phezu kalula, zingabantu okhanyayo nombala emva ukususwa umthwalo kuyehla ezingaphezu kuka-2 imizuzwana ukubeka kuyinsakavukela. Umtholampilo efanayo has oluhambisana ukushaqeka. Ukwahlukanisa ezigabeni, kuya ngevolumu wegazi afundwa ezitsheni izici eminye kuhlanganisa:

-on esethola isigaba tachycardia ukuba 110 ngomzuzu;

-on kancane esethola - tachycardia 140 amabhithi / iminithi;

-on engelapheki - kwenhliziyo ngenhla 160 amabhithi / imiz. Ngesikhathi esibucayi isikhundla ishayela ayikwazi wezwa, futhi-systolic blood pressure uwela 60 mm HG noma ngaphansi. ikholomu.

Lapho amanzi emzimbeni uyakwazi hypovolemic izimpawu ukushaqeka kunezelwa:

lwamafinyila -suhost;

-reduction ithoni zamehlo;

y izingane ukungenzi kwe-fontanelle ezinkulu.

Konke ekubukekeni, kodwa ukunquma ngokunembile ubukhulu bale nkinga, ucwaningo laboratory. Isiguli ngokushesha kwenziwe ngegazi i-chemistry, kutholakale izinga hematocrit, lactic, ezimweni eziyinkimbinkimbi, ukuphenya kwabantu plasma. Ngaphezu kwalokho, odokotela potassium ezingeni control, the electrolyte main, creatinine, igazi urea. Uma izimo zivuma, ngomzuzu ifundelwe futhi inhliziyo unhlangothi ivolumu emaphakathi ingcindezi emithambo yegazi.

ukushaqeka Kwenhlekelele

Lolu hlobo ukushaqeka ngezindlela eziningi afana oluhambisana, kodwa imbangela yayo isinyathelo izilonda kuphela yangaphandle (uhlaba kokudutshulwa, ukusha) noma yangaphakathi (ukudabuka kwezicubu futhi izitho, isibonelo, kusukela buhlungu eqinile). ukushaqeka Obungapheli cishe wayehlale ephelezelwa ubuhlungu kanzima, ngakwazi ukukhuthazela, kwandzisa isimo isisulu. Kwezinye imithombo ubizwa ngokuthi ukushaqeka ubuhlungu, ngokuvamile okuholela ekufeni. Kobukhulu ukushaqeka kuhlasimulise uzimisele kakhulu inani legazi elahlekile, kangakanani lokhu ukulahlekelwa ijubane. Okungukuthi, uma igazi ushiya umzimba kancane, isisulu ithuba elingcono ukubaleka. Futhi eshubisa isimo kanye nezinga ukubaluleka isitho ezilimele emzimbeni. Okungukuthi, usinde Kudutshulwe ingalo kuyoba lula kunaleyo at kwesilonda ekhanda. Lawa izici ukushaqeka esibuhlungu. Ukwahlukanisa isimo kobukhulu kanje:

ukushaqeka primordial (kwenzeka cishe ngokushesha nje ngemva ukulimala);

ukushaqeka -vtorichny (ivela ngemva kokuhlinzwa, ukususwa izinyanda, sithwele okwengeziwe abathintekayo, isibonelo, ezokuthutha yayo).

Ngaphezu kwalokho, ukushaqeka kuhlasimulise waphawula izigaba ezimbili - Erectile futhi torpid.

Izimpawu Erectile:

ubuhlungu -strong;

ukuziphatha -neadekvatnoe (okhalayo, overexcitation, ukukhathazeka, ngezinye izikhathi uchuku);

-tremor;

ujuluke coldly;

abafundi -Advanced;

-tahikardiya;

-tahipnoe.

Izimpawu torpid:

-bolnoy iba ngakhathali

-Over khona, kodwa umuntu akasabeli ke;

ingcindezi -arterialnoe ngokucijile incipha;

-glaza fade;

-poyavlyaetsya ayilutho isikhumba, cyanosis sezindebe;

-oliguriya;

ulimi -oblozhennost;

lwamafinyila -suhost;

coldly umjuluko engathathi isinyathelo, kodwa isikhumba ilahlekelwa turgor yayo;

-puls thready;

ubuso -cherty ngensimbi.

ukushaqeka Toxic, ngezigaba

Lesi simo kwenzeka ngenxa Ukungena emzimbeni ukutheleleka, okungukuthi, amagciwane namagciwane ezibangela ukudakwa okunzima nemisebenzi yabo. Ngokuvamile icala kulokhu kuhlasela ukushaqeka streptococcus, Staphylococcus, salmonella, Pseudomonas aeruginosa. Bangenela umzimba, njengoba esebenzisa amanxeba avulekile (sepsis puerperal, ukusha, ukuhlinzwa) noma ngaphandle (typhoid, ingculaza, tracheitis, sinusitis, pneumonia, imfuluwenza kanye nezinye izifo).

nezilwanyana ezincane Pathogenic ukukhiqiza superantigens ukuthi kusebenze T cell, nezinye-T cell angabasizi. Labo, esikhundleni salokho, secrete cytokines, okubangela izivikeli mzimba lesiguli is bebengaphuzile, futhi omningi ubuthi obuphumela igazi lakhe, okubangela ukushaqeka anobuthi. Ukwahlukaniswa kulesi simo ihlukanisa izigaba ezintathu:

1.Obratimaya. Kulesi wegazi kungenzeka evamile, luhlala ukwazi ecacile, isikhumba kuba pink noma obomvu. Isiguli ngokuvamile Thukuthelani, ukukhononda ubuhlungu emzimbeni noma esiswini, waqaphelisisa uhudo, imfiva kanye ngezinye izikhathi nokuhlanza.

2.Chastichno emuva. Izimpawu: imfiva, ishayela ababuthakathaka, tachycardia, kwehle ingcindezi, isiguli ucobekile, indlela asabela ngayo lapho engasenamahloni.

3.Neobratimaya. Izimpawu: iphika, Ukudlikizela, isikhumba cyanosis, ishayela ibuthakathaka, umfutho wegazi ngezansi ezibucayi, isiguli aquleke.

Ukwahlukanisa ukushaqeka anaphylactic

isimo esinjalo kwenzeka uma udle ubuthi Izinyoka ziyabaluma, izicabucabu, iminyovu nezinye izidalwa, ekuthatheni ezinye iziphuzo kanye nokudla, kanye ngabaphethe izidakamizwa enikezwa nomzimba lesiguli. ukusabela ngaleyo ndlela uvame unikezwa procaine penicillin akuzange kusize, organic. Shock angenzeka hlangana amasekhondi ambalwa ngemva ukuxhumana allergen umzimba noma ngokusebenzisa isikhathi eside, futhi ngokushesha ukusabela kwenzeka, sibi onalesi sifo. Kukhona izinhlobo eziningana nesenzakalo ukushaqeka anaphylactic:

-tipichnaya (ububomvu at bite indawo (umjovo indawo), noma ubuhlungu besisu, umphimbo ku ukuthintana ngomlomo allergen, decompression, kokucindezelwa we izimbambo ngaphansi uhudo kungenzeka noma ukuhlanza);

-gemodinamicheskaya (kwasekuqaleni iziyaluyalu zenhliziyo);

-asfiksicheskaya (nokuvaleka kwemigudu yokuphefumula, dyspnea);

-tserebralnaya (ukungasebenzi ohlelweni sezinzwa, Ukudlikizela, lutho, ukuboshwa zokuphefumula);

-abdominalnaya (esiswini oyingozi).

ukwelashwa

Ngesenzo esiphuthumayo kubalulekile ngezigaba efanele uthuthumele. ukunakekelwa okuphuthumayo eziphuthumayo esimweni ngasinye has imininingwane yayo siqu kodwa uma usheshe uqala ihlinzekwe, isiguli ithuba elingcono. Ngezinye isinyathelo ukufa engelapheki is ebonwe ngaphezulu kuka-90% amacala. ukushaqeka Obungapheli kubalulekile ngokushesha ukuvimba ukopha (tourniquet) ahambise abalimele esibhedlela. Kube eyenziwa nosawoti emthanjeni nezisombululo colloidal, ukumpontshelwa igazi, uketshezi olungenambala olusegazini, izinzwa, uma kunesidingo, exhunywe kwi ngomshini.

Ngo ukushaqeka anaphylactic epinephrine ngokushesha iqondiswa, isiguli intubated nge asphyxia. Ngemva kwalokho iqondiswa corticosteroids futhi antihistamine.

Lapho ukushaqeka anobuthi eyenziwa omkhulu yokwelapha uketshezi ngezilapha magciwane eqinile, immunomodulators glucocorticoid plasma.

Lapho ukushaqeka hypovolemic imisebenzi esemqoka Iwukubuyisela igazi eligciniwe yazo zonke izitho, ukuqedwa hypoxia, kanye ukuzinza yokucindezela inhliziyo. Lapho ukushaqeka okubangelwa ukuphelelwa amanzi emzimbeni, it is ngaphezu kwalokho okudingekayo resumption of ivolumu elahlekile uketshezi futhi electrolyte zonke.