Ib suam ntawm poob siab txhais

Nyob rau hauv lub neej nws yuav tshwm sim pua pua ntawm tej yam uas yuav ua rau ib tug poob siab. Feem ntau cov neeg nyob qib qub nws tsuas nrog ib tug muaj zog paj hlwb poob siab, tiam sis qhov no tsuas yog tej muaj tseeb. Nyob rau hauv tshuaj, yeej muaj ib tug poob siab kev faib tawm, defining nws pathogenesis, heev, qhov xwm ntawm kev hloov nyob rau hauv lub nruab nrog cev thiab txoj kev mus rau qhov lawv. Thawj piav tus mob no ntau tshaj 2 txhiab xyoo dhau los, tus naas ej Hippocrates, thiab lub sij hawm "poob siab" nyob rau hauv txoj kev xyaum ntawm cov tshuaj nkag tau rau hauv 1737 Parisian kws phais neeg Henri Ledran. Qhov tsab xov xwm no tham txog nyob rau hauv kom meej yog vim li cas uas ua rau kev poob siab, kev faib tawm, lub tsev kho mob, thaum muaj xwm ceev kho mob nyob rau hauv cov kev tshwm sim ntawm no ceev nrooj mob thiab forecasts.

Lub tswvyim ntawm poob siab

Nrog cov poob siab ntawm cov lus Askiv yuav tsum txhais raws li superior poob siab, uas tsis yog ib tug kab mob, tsis yog tus tsos mob thiab tsis muaj tus mob. Nyob rau hauv lub ntiaj teb no kev xyaum no lub sij hawm yog xa cov lus teb ntawm tus kab mob thiab lub tshuab mus rau ib tug muaj zog stimulus (lwm los nrog), uas cuam tshuam rau kev ua hauj lwm ntawm poob siab system, metabolism, kev ua pa thiab cov ntshav ncig. Ntawm no yog lub caij ib tug poob siab kev txiav txim. Cov kev faib ntawm lub xeev no yuav tsum qhia hais tias qhov ua rau ntawm kev poob siab, cov neeg kawm ntawv ntawm nws heev thiab pib txoj kev kho. Cov forecast yuav yuav lig xwb yog hais tias tus tseeb mob thiab tam sim ntawd pib ntawm resuscitation.

classifications

Canadian pathologist Selye pom tias peb theem, roughly tib yam rau tag nrho cov hom ntawm poob siab:

1.Obratimaya (compensated), nyob rau hauv uas cov ntshav mov rau lub paj hlwb, lub plawv, lub ntsws thiab lwm yam kabmob lawm, tab sis tsis nres. Cov raug rau qib no yog feem ntau paaj.

2.Chastichno reversible (asthma). Nyob rau tib lub txhaum ntawm cov ntshav mov (perfusion) tseem ceeb, tab sis ceev thiab kom kev kho mob kev pab muaj ib lub caij nyoog los functionality.

3.Neobratimaya (davhlau ya nyob twg). Qhov no yog qhov loj tshaj plaws nyob ntev nyob rau hauv uas ua cuam tshuam nyob rau hauv lub cev yuav tsis tau rov qab los txawm nrog qhov loj tshaj plaws noj qab haus huv tej yam. Twv ua ntej ces 95% unfavorable.

Lwm kev faib faib cov reversible kauj ruam los ntawm 2 - subkompensatsionnuyu thiab dekompensatsionnuyu. Raws li ib tug tshwm sim, lawv tau 4:

• 1 compensated (lub teeb muaj ib cov paaj raug).
• 2nd subcompensated (mid-ceeb thawj uas yuav tsum tau tam sim ntawd resuscitation. Huab cua teeb meem).
• Peb dekompensatsionnaya (hnyav heev, txawm yog hais tias tus tam sim ntawd kev siv ntawm tag nrho cov tsim nyog ntsuas huab cua ib tug heev complex).
• 4 irreversible (raug yog neeg pluag).

Peb nto moo Pirogov faib nyob rau hauv ib lub xeev ntawm poob siab ob theem:

-torpidnaya (tus neeg mob nyob rau hauv ib tug stupor los yog tsis tshua muaj neeg sluggish, tsis teb rau stimuli sib ntaus sib tua, tsis teb cov nqe lus nug);

-erektilnaya (tus neeg mob yog heev siab heev, qw, ua ib tug ntau ntawm cov tsis nco qab uncontrolled taw).

hom ntawm poob siab

Nyob ntawm seb yog vim li cas uas coj mus rau ib tug tsis txaus nyob rau hauv lub cev systems, muaj ntau yam ntawm kev poob siab. Classification nyob rau hauv cov nqe lus ntawm lub plawv mob xws li:

-gipovolemichesky;

-distributivity;

-kardiogenny;

-obstruktivny;

-dissotsiativny.

Suam ntawm cov pathogenesis ntawm poob siab yog li no:

-gipovolemichesky;

-travmatichesky;

-kardiogenny;

-septichesky;

-anafilaktichesky;

-infektsionno-toxic;

-neyrogenny;

Taag-ke.

hypovolemic poob siab

Complex lub sij hawm yog ib qho yooj yim to taub, paub txog tias hypovolemia - ib tug mob nyob qhov twg cov ntshav yeej los ntawm cov hlab ntsha nyob rau hauv tsawg tshaj li qhov yuav tsum tau ntim. Yog vim li cas:

-obezvozhivanie;

-Extensive kub nyhiab (poob lawm ntau ntawm ntshav);

-pobochnye tshuaj tshua, xws li vasodilators;

-large ntshav poob, uas nruab nrog cev tau txais tsawg pa thiab as-ham, i.e. tawg perfusion.

Hypovolemic poob siab vim ntshav tsis muaj peev xwm yuav pom raws li hemorrhagic poob siab. Cov kev faib ntawm tus mob no yog tib yam li hais tias tsim Selye, thiab nyob rau tib lub theem txiav txim los ntawm tus nqi ntawm cov ntshav tsis tau txais lub cev. Shock yog ib txwm ib yam ntawm cov kev tiv thaiv ntawm lub cev nyob rau hauv ib tug huab teeb meem no. Hais tias yog, nws pib ib tug series ntawm cov txheej txheem, nrhiav kom tau khaws cia cov kev ua ntawm kabmob tseem ceeb heev thiab yog li txuag lub neej ntawm lub tag nrho qhov system. Nyob rau hauv kev, nrog ntshav poob nyob rau hauv cov hlab ntsha nchuav backup ntshav (kwv yees li 10% ntawm tag nrho cov) los ntawm lub siab thiab tus po. Yog hais tias qhov no yog tsis txaus, los yog txo cov ntshav khiav tsis mus tsis tseem ceeb rau lub sustenance ntawm lub cev saib xyuas, rau piv txwv, mus rau lub extremities, yog li ntawd cov seem ntshav txaus rau perfusion ntawm lub plawv, lub hlwb thiab lub ntsws. Classification poob siab tias cov ob kauj ruam raws li cov reversible thiab invertible. Nyob rau hauv cov ntaub ntawv no, yog hais tias tus lub sij hawm yuav txiav txim, koj muaj peev xwm tso saib ib tug neeg los ntawm ib lub xeev ntawm kev poob siab, thiab kom nws ciaj sia.

Ntev ua hauj lwm rau tus thaub qab ntawm cov ntshav perfusion thiab muab ib co kabmob ntawm cov nuj nqis ntawm lwm yam kab mob tsis tau. Yog li ntawd, yog tias koj tsis pib resuscitation, los kawg (irreversible) theem. Tuag tes tuag taw cai hlab ntsha, lub siab nyob rau ntawd heev tsis, ntshav ntws mus rau lub periphery, nce mus ib qho tseem ceeb theem ntawm perfusion tshaj lub hlwb, lub plawv thiab lub ntsws.

lub cev qhuav dej

Cov dej nyob rau hauv tib neeg lub cev, nyob ntawm seb muaj hnub nyoog thiab pw ua ke, los ntawm 60 mus rau 80%. Cov tsis tsuas 20% ntawm tus nqi no yuav ua tau tuag, thiab lub losses tau mus txog 10%, ua hypovolemic poob siab, uas nyob rau hauv cov ntaub ntawv no yog xam raws li lub cev qhuav dej, signifying ib tug txo nyob rau hauv circulating cov hlab ntsha vim lub high lub cev qhuav dej. Yog vim li cas:

-zabolevaniya, ua rau raws plab, ntuav, nquag tso zis ntau;

-nedopoluchenie dej lub cev (nedopivanie) nyob rau hauv cov huab tej yam kev mob, xws li huab cua kub, tshwj xeeb yog thaum muaj kev kub cev tom;

-nerazumnye noj cov zaub mov.

Tshwj xeeb tshaj yog yuav cev qhuav dej nyob rau hauv cov me nyuam yaus thiab cov neeg laus.

Ib suam ntawm kev poob siab, tshwm sim raws li ib tug tshwm sim ntawm cov tsis muaj dej, tseem ceeb rau hauv cov kauj ruam ntawm:

-invertible;

ib tug cov reversible;

-neobratimuyu.

Nyob rau hauv tas li ntawd, lub cev qhuav dej yog muab faib ua peb pawg:

1.Izotonicheskoe (tsis Na thiab K ions). Cov kua nyob rau hauv peb lub cev yog lub intracellular thiab intercellular. Thaum isotonic piam sij tshwm sim los ntawm raws plab mas tas tso tawm kom pom ntau npaum li cas poov tshuaj thiab sodium, uas yog lub ntsiab ntawv nyob rau hauv extracellular kua kis rau hauv lub hlwb yuav ua rau mus tau ploj lawm poov tshuaj nyob rau ntawd.

2.Gipotonicheskoe, uas yog ib lub txim ntawm isotonic. Nws yog muab sau siab losses nyob rau hauv lub extracellular kua (vim hais tias sodium dhau mus rau hauv lub hlwb). Thawj ob theem pom tau hais tias yuav reversible li sai tau kom txawm peem rau txoj kev poob ntawm electrolytes. Cov nca muab tsis tau nyob rau hauv muab kev pab tus neeg mob cov kua kom tsawg, tshwj xeeb tshaj yog muaj sodium ions.

3.Gipertonicheskoe uas tsim thaum zawv plab nrog retching tiv thaiv kua txaus hauv lub cev lus los yog overdose ntawm ib co tshuaj uas ntxias ntxiv tso zis. Cov kua dua kis los ntawm lub hlwb mus rau hauv lub extracellular qhov chaw nyob rau hauv thiaj li yuav muaj lub osmotic siab. Ob chav lub cev qhuav dej hlwb ua txhaum lawv cov kev ua hauj lwm thiab txo nyob rau hauv volume. Tshwj xeeb tshaj yog txaus ntshai txo nyob rau hauv lub hlwb ntim, uas ua rau yus subdural hemorrhage.

cov tsos mob

Peb tau xav hais tias tshwm sim piav txog lub faib ntawm hypovolemic poob siab. Clinic lub xeev no, txawm yog yus lub yog vim li cas, nws tshwm sim los txog rau hauv tib lub. Nyob rau reversible theem, tus neeg mob yog nyob rau hauv lub supine txoj hauj lwm, cov lus hais cov tsos mob tej zaum yuav tsis tuaj kawm ntawv. pib tej yam tshwm sim ntawm qhov teeb meem yog:

- palpitations;

-small txos cov ntshav siab;

coldly clammy daim tawv nqaij nyob rau hauv lub extremities (vim ib tug txo perfusion);

-When muaj lub cev qhuav dej qhuav daim di ncauj, txheej nyob rau hauv lub qhov ncauj, tsis muaj kua muag.

Thaum lub thib peb theem, shock thawj zaug tsos mob ua ntau pronounced.

Cov neeg mob muaj sau tseg:

-tahikardiya;

-Reduction ntshav siab hauv qab no tseem ceeb heev qhov tseem ceeb;

-Violation ua tsis taus pa;

-oliguriya;

coldly qhov kov (tsis tsuas cov kev nqua);

-mramornost daim tawv nqaij thiab / los yog hloov lawv cov xim los ntawm ib txwm mus daj cyanotic;

-nitevidny mem tes;

-with siab rau lub ntsis ntiv tes, lawv yog daj ntseg thiab xim tom qab tshem tawm ntawm lub load yog txo los ntawm ntau tshaj li 2 vib nas this muab qhov txhia qhov. Cov tib lub tsev kho mob muaj hemorrhagic poob siab. Ib suam ntawm nws cov theem, nyob ntawm seb qhov ntim ntawm cov ntshav circulating nyob rau hauv cov hlab ntsha yam ntxwv ntxiv xws li:

-on reversible theem tachycardia rau 110 beats per minute;

-on cov reversible - tachycardia ntawm 140 neeg ntaus / min;

-on irreversible - lub plawv dhia saum toj no 160 beats / min. Thaum ib tug tseem ceeb heev txoj hauj lwm mem tes tsis tau hnov, thiab cov systolic ntshav siab poob rau 60 mm Hg los yog tsawg dua. kem.

Thaum lub cev qhuav dej yog tau hypovolemic poob siab mob ntxiv:

-suhost txheej;

-reduction laus eyeballs;

y cov me nyuam mos omission ntawm ib tug loj fontanelle.

Nws tag nrho cov sab nraud tshwm sim, tab sis kom meej seb puas raws li ntawm qhov teeb meem, kev kuaj kev tshawb fawb. Tus neeg mob tam sim ntawd ua ntshav Science News for KIDS, txiav txim qib ntawm hematocrit, acidosis, nyob rau hauv txoj mob, soj ntsuam cov ntshav ceev. Tsis tas li ntawd, cov kws kho mob yog poov tshuaj theem kev tswj, lub ntsiab electrolytes, creatinine, ntshav urea. Yog hais tias tej yam kev mob daim ntawv tso cai, tshawb nrhiav feeb thiab lub plawv mob stroke ntim thiab central venous siab.

puas poob siab

Qhov no hom ntawm kev poob siab nyob rau hauv ntau txoj kev uas zoo xws li cov hemorrhagic, tab sis nws ua tau ua xwb lwm qhov txhab (nkaug, gunshot, kub nyhiab) los nrog (rupture ntawm ntaub so ntswg thiab kabmob, piv txwv li, los ntawm ib tug muaj zog tshuab). Traumatic poob siab yog luag yeej ib txwm nrog ib tug nyuaj bearable mob, ntxiv exacerbates qhov teeb meem ntawm tus neeg mob. Nyob rau hauv ib txhia qhov chaw nws yog hu ua ib tug mob poob siab, feem ntau ua rau txoj kev tuag. Cov heev ntawm kev puas poob siab yog txiav txim tsis yog li ntawd ntau npaum li cas tus nqi ntawm cov poob ntshav, ntau npaum li cas ntawm qhov no tsis ceev. Uas yog, yog tias cov ntshav yoojyim lub cev maj mam, tus neeg ib tug zoo dua lub caij nyoog khiav. Tsis tas li ntawd aggravates qhov teeb meem no thiab cov neeg kawm ntawv uas tseem ceeb ntawm lub puas hloov khoom nruab nrog rau lub cev. Uas yog, muaj sia nyob tus txhaj tshuaj nyob rau hauv lub caj npab nws yuav yooj yim dua nyob rau ntawm lub qhov txhab mus rau lub taub hau. Cov no yog cov yam ntxwv ntawm ib tug puas poob siab. Ib suam ntawm lub xeev ntawm heev raws li nram no:

Primordial poob siab (tshwm sim yuav luag tam sim ntawd tom qab qhov kev raug mob);

-vtorichny poob siab (zoo nkaus li tom qab phais, tshem tawm ntawm bundles, nyob rau hauv ntxiv load rau cov cuam tshuam los, piv txwv li, nws thauj).

Nyob rau hauv tas li ntawd, puas poob siab cai ob theem - erectile thiab torpid.

Cov tsos mob ntawm erectile:

-strong mob;

-neadekvatnoe cwj pwm (quaj, overexcitation, ntxhov siab vim, tej zaum aggression);

-tremor;

hws coldly;

-Advanced tub kawm ntawv;

-tahikardiya;

-tahipnoe.

Cov tsos mob torpid:

-bolnoy yuav tsis muaj ab tsi;

-Over muaj, tiam sis tus neeg tsis teb rau nws;

-arterialnoe siab sharply txo;

-glaza ploj;

-poyavlyaetsya daj daim tawv nqaij, cyanosis ntawm ob daim di ncauj;

-oliguriya;

-oblozhennost hom lus;

-suhost txheej;

coldly hws tsis ua, tab sis daim tawv nqaij loses nws turgor;

-puls thready;

-cherty lub ntsej muag sharpened.

Toxic poob siab, kev faib

Qhov no tshwm sim vim allergic rau hauv lub cev ntawm tus kab mob, xws li, cov kab mob thiab cov kab mob uas ua rau mob loj heev intoxication ntawm cov kev ua ub. Ntau zaus tshaj tsis tau ua txhaum nyob rau hauv lub nres poob siab tus kab mob Streptococcus, Staphylococcus, tus kab mob salmonella, Pseudomonas aeruginosa. Lawv nkag mus rau hauv lub cev, raws li los ntawm txoj kev qhib qhov txhab (puerperal sepsis, kub nyhiab, kev phais) los yog tsis muaj (typhoid, AIDS, tracheitis, sinusitis, mob ntsws, kab mob khaub thuas, thiab lwm yam kab mob).

Pathogenic microorganisms tsim superantigens uas qhib T hlwb, thiab lwm yam T hlwb. Cov neeg, nyob rau hauv lem, paim cytokines, ua rau cov neeg mob lub cev yog suppressed, thiab ib tug lossis loj npaum li cas ntawm toxins tso tawm rau hauv nws cov ntshav, ua tshuaj lom poob siab. Cov kev faib ntawm tus mob no distinguishes peb theem:

1.Obratimaya. Nyob rau hauv no ntshav siab yuav ua tau li qub, nws tseem meej pem, daim tawv nqaij yuav liab los yog liab. Tus neeg mob yog feem ntau agitated, complaining mob nyob rau hauv lub cev los yog nyob rau hauv lub plab mog, nws pom raws plab, kub ib ce thiab tej zaum ntuav.

2.Chastichno reversible. Cov tsos mob: kub taub hau, tsis muaj zog mem tes, tachycardia, tsis siab, tus neeg mob lethargic, nws cov tshuaj tiv thaiv inhibited.

3.Neobratimaya. Cov tsos mob: ua tsis taus pa, convulsions, daim tawv nqaij cyanosis, mem tes tsis muaj zog, cov ntshav siab hauv qab no tseem ceeb heev, tus neeg mob tsis nco qab lawm.

Ib suam ntawm anaphylactic poob siab

Xws li ib tug mob tshwm sim thaum noj tshuaj lom los ntawm snakes tom, kab laug sab, nkawj thiab lwm yam nyob beings, los ntawm kev noj ib co dej qab zib thiab cov khoom noj, thiab los ntawm cov koom haum saib xyuas ntawm cov tshuaj uas muab rau tus neeg mob lub allergens. xws li ib tug tshuaj tiv thaiv yog feem ntau muab procaine penicillin, organic. Shock yuav tshwm sim nyob rau hauv ib ob peb lub vib nas this tom qab kev sib cuag nrog lub allergen lub cev yog los ntawm ib tug ntev lub sij hawm, thiab lub ntxov cov tshuaj tiv thaiv tshwm sim, lub zuj zus rau hauv lub raug. Muaj ntau ntau yam ntaub ntawv ntawm tshwm sim ntawm anaphylactic ceeb:

-tipichnaya (lossis puas liab liab nyob rau tom qhov chaw (txhaj qhov chaw), los yog mob plab mog, caj pas rau qhov ncauj sib chwv allergen, decompression, compression ntawm lub tav nyob rau hauv tau zawv plab los yog ntuav);

-gemodinamicheskaya (nyob rau hauv thawj qhov chaw mob plawv mob);

-asfiksicheskaya (ua pa tsis ua hauj lwm, dyspnea);

-tserebralnaya (malfunction ntawm lub hauv paus poob siab system, convulsions, hnovqab, ua pa raug ntes);

-abdominalnaya (mob plab mog).

kev kho mob

Rau ceev kev txiav txim yog qhov tseem ceeb qhov tseeb kev faib ntawm shocks. Ceev thaum muaj xwm ceev kho mob nyob rau hauv txhua rooj plaub nws muaj nws tus kheej specifics, tab sis lub ntxov nws pib yuav tsum tau muab, tus neeg mob ib tug zoo dua lub caij nyoog. Thaum kauj ruam irreversible tuag yog cai nyob rau hauv ntau tshaj li 90% ntawm cov neeg. Traumatic poob siab ib qho tseem ceeb kom sai li sai thaiv cov ntshav poob (tourniquet) thiab xa cov raug mob rau lub tsev kho mob. Muaj nqa tso dej saline thiab colloidal kev daws teeb meem, ntshav, ntshav, anesthetized, yog tias tsim nyog, kev cob cog rua rau qhov ncauj.

Nyob rau hauv anaphylactic poob siab tam sim ntawd muab epinephrine, tus neeg mob yog intubated nrog asphyxia. Tom qab muab corticosteroids thiab antihistamines.

Thaum lom poob siab nqa loj heev dej kho nrog tshuaj tua kab mob muaj zog, immunomodulators glucocorticoid ntshav.

Thaum hypovolemic poob siab lub ntsiab kev pab raws qib yog rov qab kho cov ntshav mov ntawm tag nrho cov kabmob, tshem tawm ntawm hypoxia, thiab cov normalization ntawm lub siab lub plawv. Thaum lub poob siab tshwm sim los ntawm lub cev qhuav dej, nws yog ntxiv yuav tsum tau resumption ntawm cov poob volume ntawm dej thiab electrolytes tag nrho.