Kev kho mob atherosclerosis obliterans

Kev kho mob rau cov neeg mob obliterating yog ib txoj haujlwm nyuaj kawg. Nws tuaj yeem ua rau sab nraud, tab sis qhov tseeb ntawm kev kuaj mob, kev txiav txim siab ntawm theem thiab qib kev puas tsuaj yog qhov tseem ceeb, uas tsis yog txhua lub tsev kho mob muaj cov mob uas tsim nyog. Hauv qhov no, lub tswv yim ntawm kev tsim cov chaw ntawm vascular kev phais tau muab coj los siv. Tam sim no nyob rau hauv txhua lub chaw haujlwm hauv cheeb tsam thiab hauv cov nroog loj hauv nroog muaj cov tuam tsev ua haujlwm nrog pab pawg ntawm cov neeg mob no. Kuj tseem muaj cov lus nug txog kev sib txawv ntawm cov tuam tsev los ntawm hom kab mob pathology, i.e. tsim cov chaw haujlwm ntawm phlebology thiab arterial pathology.

Ntau tshaj rau pua txoj kev tau npaj siab los kho cov neeg mob uas muaj kab mob liab. Lub sijhawm 30-40 xyoo, ntau pua cov tshuaj sib txawv tau siv: los ntawm cov dej tsis huv mus rau cov ntshav tsis yog pab pawg, los ntawm streptocide mus rau corticosteroids thiab curare. Tam sim no, cov kws tshawb fawb thoob ntiaj teb tau tuaj rau qhov xaus tias tsis tuaj yeem muaj ib qho tshuaj kho rau kev kho mob ntawm cov kab mob obliterating. Raws li polyetiology ntawm tus kab mob, kev kho mob yuav tsum tau muaj kev qhia dav dav. Tsis yog ib txoj hauv kev kho mob uas hais tias yog pathogenetic tuaj yeem yog cov neeg thoob ntiaj teb, ib yam li nws tsis yooj yim sua tam sim no los piav cov ntsiab lus ntawm tus kab mob los ntawm ib qho cuam tshuam. Ua ntej tshaj plaws, kev kho mob yuav tsum yog ua kom tshem tawm cov kev phom sij ntawm ib puag ncig (kev ua haujlwm thiab so, kev nyob ib txwm nyob, kev haus luam yeeb txwv, kev noj zaub mov kom zoo, tshem tawm kev ntxhov siab, txias, thiab lwm yam). Thaum kws kho mob muab tshuaj kho, cov hom dyslipidemia (raws li kev faib tawm ntawm WHO) yuav tsum txiav txim siab.

Nyob rau hauv hom I, nce me ntsis ntawm cov roj (cholesterol) tag nrho, ib qho kev nce hauv triglycerides, qib ib txwm ntawm LDL cov roj cholesterol, ib qho dhau ntawm chylomicron tau pom nyob hauv ntshav ntshav.

II Ib hom - qib ib puag ncig los yog nce qib ntawm cov roj (cholesterol) tag nrho, theem ib ntawm triglycerides, qhov yuav tsum tau nce qib ntawm cov roj cholesterol LDL.

Hom II B - kev ua kom muaj triglycerides, ntau dua ntawm LDL cov roj cholesterol thiab VLDL cov roj (cholesterol).

Hom III - kev hloov pauv yog tib yam li hauv hom I, muaj kev nce ntxiv hauv cov ntsiab lus ntawm cov roj (cholesterol) tsawg dua cov tshuaj (lipoproteins ntau ntom).

Hom IV - tej zaum yuav muaj feem me ntsis ntawm cov roj (cholesterol) tag nrho, qhov nce ntawm triglycerides thiab ntau ntawm VLDL cov cholesterol.

V hom - roj ntau dhau VLDL thiab chylomicron.

Raws li tuaj yeem pom los ntawm cov ntaub ntawv nthuav tawm, feem ntau atherogenic yog II A thiab II B hom dyslipidemia.

Kev txuag tshwj tseg

Kev txuag kho yuav tsum muaj txhij txhua, ib leeg, mus sij hawm ntev thiab tsom mus rau ntau yam kab mob tshwm sim:

normalization ntawm lipid metabolism hauv,
stimulation ntawm cov khoom ຫລັກ thiab kev txhim kho ntawm lawv txoj haujlwm,
tshem tawm ntawm angiospasm,
normalization ntawm neurotrophic thiab metabolic kev nyob rau hauv cov ntaub so ntswg,
txhim kho microcirculation,
normalization ntawm coagulation system,
normalization ntawm cev tsis muaj zog,
kev tiv thaiv ntawm kev muaj mob ntawm cov mob hauv qab,
kev kho thiab mob tus kab mob.

Cov tshuaj siv tau tuaj yeem faib ua cov pab pawg hauv qab no:

1. Kev npaj uas txhim kho microcirculation thiab muaj cov khoom antiplatelet: qis thiab nruab nrab molecular hnyav dextrans (reopoliglyukin, reoglyuman, reokhem, reomakrodeks, hemodes), pentoxifylline (trental, vasonite, flexital), tiklid, plavica (clopulodexidel) , kev qhuas (xavin, sadamine), teonikol, agapurin, nicotinic acid, enduracin, chime (persantine), tshuaj aspirin (thrombo ace, aspirin cardio). Trental raug xaj ntawm 400-1200 mg rau ib hnub, vasonite - ntawm 600-1200 mg, tiklid - 250 mg 2 zaug ib hnub, ua luam dej - 75 mg rau ib hnub. Cov tshuaj no tuaj yeem siv tshuaj aspirin. Kev siv tshuaj txhua txhua hnub ntawm tshuaj aspirin yog 100-300 mg, nyob ntawm qhov xwm txheej mob thiab koob tshuaj concomitant antiplatelet tshuaj. Kev sib xyaw ntawm cov tshuaj aspirin nrog ticlide tsis tau zoo vim tias muaj peev xwm los ntshav. Sulodexide yog muab rau cov tshuaj intramuscularly ntawm 600 LU (2 ml) 2 zaug hauv ib hnub rau 10-24 hnub, tom qab ntawd sab hauv hauv tshuaj ntsiav ntawm 250 LU 2 zaug hauv ib hnub rau 30-70 hnub.

2. Tshuaj yeeb yaj kiab (ua kom rov ua haujlwm reticuloendothelial thiab cov txheej txheem ua haujlwm oxidative hauv cov ntaub so ntswg): hno 8-10 ml ntawm salcoseryl lossis actovegin hauv physiological saline lossis rau hauv cov ntshav qab ntsev lossis 250-500 ml ntawm Actovegin tov rau hnub rau 10-20 hnub.

3. Cov vitamins: ascorbic acid txhim kho cov txheej txheem metabolism hauv cov ntaub so ntswg, ntxiv dag zog rau lub cev tiv thaiv kab mob, vitamin B, yog qhia rau ischemic neuritis thiab trophic ntshawv siab, vitamin B₂ stimulates tsim dua tshiab cov txheej txheem, cov vitamins B₆ thiab B₁₂ cuam tshuam rau cov metabolism ntawm cov ntshav phospholipids, nicotinic acid thiab nws cov thiv thiav muaj antiaggregant thiab antiatherogenic lub zog thiab txhim kho microcirculation, vitamins A thiab E muaj zog antioxidant, vitamin F txhawb kev ua haujlwm ntawm cov qog endocrine, txhim kho oxygen mus rau hauv cov hlwb, plab hnyuv siab raum thiab cov ntaub so ntswg, tiv thaiv kev ua haujlwm ntawm cov cholesterol hauv cov hlab ntsha.

4. Angioprotectors (qhib lub intravascular lysis thiab tiv thaiv kom tsis txhob mob thrombosis, txo cov permeability ntawm lub vascular phab ntsa thiab tiv thaiv kev ua haujlwm ntawm lipids hauv cov hlab ntsa): doxium, vasolastine, parmidin (prodectin, anginin), tanakan, liparoid-200. Parmidin raug xaj 1 ntsiav tshuaj 3-4 zaug hauv ib hnub (750-1500 mg) rau 6-12 lub hlis. Hauv kev mob ntshav qab zib angiopathy, nws raug nquahu kom siv Doxium 0.25 g 3 zaug hauv ib hnub lossis 0.5 g 2 zaug hauv ib hnub rau 3-4 lub lim tiam, tom qab ntawd 1 ntsiav tshuaj ib hnub ntev ntev, nyob ntawm qhov xwm txheej kho mob.

5. Anti-atherogenic los yog lipid-txo tshuaj: statins thiab fibrates. Statins: cholestyramine, leskol (fluvastatin), lipostabil, lipanor, lipostat (pravastatin), lovastatin (mevacor), simvastatin (zokor, vasilip), choletar. Anti-atherogenic lub zog yog muaj los ntawm qej npaj (allicor, alisate), carinate, betinate, enduracin muaj 500 mg ntawm nicotinic acid (inhibit biosynthesis ntawm cholesterol thiab triglycerides). Statins tswj cov roj lipid feem, txo qis ntawm LDL cov cholesterol, cov roj cholesterol VLDL thiab triglycerides (TG) thiab nce qib HDL roj, rov ua hauj lwm endothelial, thiaj li pab txhawb kom cov vasomotor teb ntawm cov hlab ntsha, muaj cov tshuaj tiv thaiv kev cuam tshuam ob leeg nrog aseptic thiab kis mob, tiv thaiv postoperative thrombocytosis, uas yog kev kwv yees ntawm cov teeb meem thrombotic. Fibrates: bezafibrate (bezalip), gemfibrozil (gevilon), fenofibrate (lipantil), micronized fenofibrate (lipantil 200 M), ciprofibrate. Fibrates muaj ntau dua cov lipid-txo cov nyhuv dua li cov statins ntawm triglycerides; lawv muaj peev xwm nce feem ntawm cov roj-tiv thaiv atherogenic HDL. Statins thiab fibrates yog qhov tshwj xeeb tshaj plaws hauv thawj cov kev txiav txim siab tiv thaiv kab mob hyperlipidemia. Txawm li cas los xij, kev teem sij hawm ntawm cov nyiaj no xav kom tus kws kho mob paub txog cov teeb meem tshwj xeeb ntawm kev kho mob lipidology thiab cov hauv paus ntawm kev suav nrog tshuaj. Piv txwv li, statins yuav tsum tsis txhob siv nrog cov tshuaj fibrates thiab nicotinic acid, vim tias lawv txoj kev sib koom tes yuav ua rau myositis. Kev siv ntawm txhua tus statins pib nrog qhov pom zoo tsawg kawg. Cov lipid-txo cov nyhuv ua tiav qhov pom tseeb tom qab 4-6 lub lis piam, yog li ntawd, kev hloov kho koob tshuaj yuav tsum tau nqa tawm tsis dhau los tom qab 4 lub lis piam. Nrog rau qhov txo qis hauv cov roj (cholesterol) qis dua 3.6 mmol / L lossis LDL cov roj (cholesterol) qis dua 1.94 mmol / L, cov koob tshuaj statin tuaj yeem raug txo kom tsawg. Txhua cov statins siv ib zaug ib hnub, thaum tsaus ntuj tom qab noj mov. Cov koob tshuaj ntawm cov fibrates thiab qhov siv ntawm lawv yog qhov sib txawv rau txhua tus. Kev kho cov tshuaj ntawm atherogenic dyslipidemia yuav tsum tau ua rau lub sijhawm ntev heev. Rau feem ntau cov neeg mob - thoob plaws lub neej.

6. Cov tshuaj antioxidant ua si lub luag haujlwm tseem ceeb hauv kev kho mob atherosclerosis los ntawm kev tswj hwm lipid peroxidation (LPO). Cov no suav nrog cov vitamins A, E, C, dalargin, cytochrome c, preductal, emoxipin, neoton, probucol. Cov neeg sawv cev tshaj plaws ntawm cov pab pawg no yog vitamin E (alpha-tocopherol acetate), ntawm 400-600 mg / hnub, muaj cov nyhuv kho mob cuam tshuam nrog hypocoagulation, muaj zog fibrinolysis thiab txhim kho rheological ntawm cov ntshav, inhibition ntawm cov txheej txheem ntawm oxidation thiab ua kom muaj zog ntawm cov antioxidant system. Tam sim no, kev noj zaub mov noj tshuaj nrog cov khoom siv tiv thaiv kab mob antioxidant tau tsim thiab qhia rau hauv kev xyaum ua haujlwm: kev npaj raws li omega-3-poly-unsaturated fatty acids (eikonol, dokanol), kev npaj ntawm hiav txwv kale (clamin), seaweed (splat, spirulina), zaub roj (roj ntawm viburnum, hiav txwv buckthorn).

7. Antispasmodics (papaverine, tsis muaj-shpa, nikoshpan) tuaj yeem raug kho rau qib I thiab II ntawm tus kabmob, thaum leeg tawm los.

8. Cov tshuaj tiv thaiv ncaj qha thiab tsis ncaj yog raug kho raws li kev taw qhia nrog kev hnyav hypercoagulation.

9. Hauv lwm pab pawg yuav tsum muaj cov vazaprostan (prostaglandin E,). Cov tshuaj muaj cov tshuaj antiplatelet, txhim kho cov ntshav txaus los ntawm kev nthuav dav cov hlab ntsha, ua kom cov hlab ntsha ua haujlwm, txhim kho microcirculation, rov qab cov metabolism hauv ib txwm muaj nyob rau hauv cov nqaij mos ischemic, inhibits kev ua haujlwm ntawm neutrophils, yog li tiv thaiv cov nyhuv ntawm cov ntaub so ntswg puas, muaj cov nyhuv antisclerotic. Vazaprostan yog qhia rau cov mob hnyav ntawm obliterating txhab ntawm cov leeg ntu ntawm cov ceg tawv. Nws muab tshuaj rau txoj leeg dej los yog tso ntshav qis ntawm qhov tshuaj ntawm 20-60 μg hauv qhov kev daws teeb meem ntawm 100-200 ml ntawm 0.9% NaCl daws txhua hnub lossis txhua hnub. Lub sijhawm qhia yog 2-3 teev Lub sijhawm ntawm lub sijhawm yog 2-4 lub lis piam. Cov tshuaj yog tus cwj pwm los ntawm kev nce ntxiv hauv txoj kev kho mob, uas tuaj yeem txuas ntxiv rau ib mus rau ob lub lis piam tom qab nws tshem tawm. Cov txiaj ntsig tuaj yeem ua tiav thoob plaws hauv lub xyoo.

Ib qho tseem ceeb yog kev xaiv cov tshuaj ib leeg thiab lawv kev siv lub cev nrog kev txheeb xyuas ntawm cov txiaj ntsig ntawm ib qho yeeb tshuaj twg. Ib qho piv txwv rau kev kho mob sab nrauv: prodectin + trental, prodectin + ticlide, prodectin + plavica, prodectin + tshuaj aspirin, plavica + aspirin, vasonite + prodectin, trental + aspirin, sulodexide, thiab lwm yam. nrog rau qhov sib ntxiv hauv txhua kis ntawm tshuaj tiv thaiv atherogenic. Nws yog ib qho zoo uas yuav tau hloov cov tshuaj no lossis lwm cov tshuaj sib txuas ua ke txhua 2-3 lub hlis twg. Hauv cov theem tom qab thiab hauv tsev kho mob thaj chaw, kwv yees li cov qauv hauv qab no yog siv: ncos dej reopoliglyukin 400 ml + trental 5-10 ml + nicotinic acid 4-6 ml los yog ua raws li 4-6 ml, solcoseryl lossis actovegin 10 ml ib 200 ml dej qab ntsev, hauv li 10-15 hnub lossis ntau dua. Tag nrho cov tshuaj saum toj sau cov tshuaj kho mob qhia tau. Cov kev mob tshwm sim thiab kev kho mob ntawm tus kab mob concomitant yog qhov yuav tsum tau ua thiab tsis muaj kev sib ceg.

Kev saib xyuas (hyperbaric oxygenation - HBO) txhim kho cov kev mob oxygen xa mus rau cov ntaub so ntswg los ntawm kev tsim cov qib siab ntawm oxygen oxygen hauv cov ntaub so ntswg thiab nce cov pa oxygen mus dhau ntawm cov ntaub so ntswg ib feeb. Lub hauv paus tseem ceeb ntawm kev xa cov nyiaj yuav tsum tau ntawm oxygen mus rau cov ntaub so ntswg nrog txo cov ntshav ntws ua rau HBO yog txoj kev tiv thaiv kab mob thiab txoj kev ncaj ncees tshaj plaws hauv kev tawm tsam cov ntaub so ntswg hauv hypoxia. Cov nyhuv nyob ntawm lub xeev ntawm central hemodynamics. Qhov taw qhia ntawm kev txhim kho hauv cov pa oxygen ntawm cov ntaub so ntswg tom qab HBO cov chav kawm yog qhov nce ntawm cov ciaj ciam ntawm cov ntshav nruab nrab thiab hauv cheeb tsam (V.I. Pakhomov, 1985). Nrog tus mob plawv qis, tsis hais txog kev hloov pauv hauv cheeb tsam ntshav txaus, kev xa cov pa oxygen tsis tau muaj txiaj ntsig zoo. Kuv tsis pom qhov kev zaws zaws siv cov khoom siv ntawm Kravchenko thiab Shpilt.

Cov qauv ntawm ultraviolet irradiation ntawm cov ntshav (UV) yog dav, pib los ntawm tus kws phais neeg Czech Gavlicek nyob rau xyoo 1934, nws siv nws rau mob peritonitis. Cov cuab yeej siv roj ntsha ntawm UV hluav taws xob nyob ntawm qhov kev hloov pauv ntawm ib tus neeg uas ib txwm nyob rau kev mob ntawm hnub ci hluav taws xob. Cov txiaj ntsig zoo ntawm UFO nyob rau hauv obliterating kab mob ntawm cov hlab ntsha tau tsim thawj zaug xyoo 1936 los ntawm Kulenkampf. UFO raws li txoj kev Knott tsoos yog ua raws li hauv qab no: 3 ml ntawm ntshav ib 1 kg ntawm tus neeg mob lub cev qhov hnyav yog muab los ntawm txoj hlab ntshav. Cov ntshav tau dhau los ntawm cov khoom siv nrog cov pom ntawm UV-mercury-quartz teeb nrog lub vais ntev ntawm 200-400 nm. Siv sijhawm 5-7 ntu nrog ntu ncua 2-6 hnub. UFO ntshav muaj cov kab mob, tiv thaiv kab mob kho thiab ua kom lub cev muaj zog txaus.

Wisner txoj kev muaj raws li hauv qab no: 45 ml ntshav tau los ntawm txoj hlab ntshav, sib xyaw nrog 5 ml ntawm cov tshuaj tov dej ntawm cov citrate hauv quartz cuvette thiab irradiated rau 5 min nrog HN 4-6 UV teeb nrog ntaj li ntawm 254 nm thiab cov ntshav rov rau hauv tus neeg mob txoj hlab ntshav.

Nws muaj ib txoj hauv kev ntawm kev hu ua hematogenous oskidant therapy - GOT (Verlif). Nyob rau hauv parallel nrog irradiation ntawm cov ntshav nrog xenon teeb nrog lub yoj yoj ntawm 300 nm, nws yog enriched nrog oxygen. Txog rau qhov no, oxygen yog qhov ntxig: 300 cm 3 hauv 1 min rau hauv ib lub vial ntawm cov ntshav. Hoob no yog qhia 8-12 cov txheej txheem.

Gavlicek (1934) tau piav qhia txog kev cuam tshuam los ntawm ultraviolet hluav taws xob los ntawm kev tshwm sim ntawm metabolites, uas, thaum rov qab los rau hauv lub cev, ua zoo li tshuaj. Acidosis txo, microcirculation txhim kho, dej-electrolyte homeostasis yog li qub.

Kev siv dav siv hauv kev kho mob ntawm cov neeg mob tau txais txoj kev ntawm kev tshem tawm. Cov tho kev ntawm kev qhia ntawm hom kev qhia no xyoo 1970 yog tus kws tshaj lij ntawm Academy of Medical Science Yu.M. Lopukhin. Tsis zoo li hemodialysis, qhov twg tsuas yog cov dej-soluble tshuaj raug tshem tawm, hemosorption tuaj yeem tshem tawm yuav luag txhua yam muaj taug, vim tias muaj kev sib chwv cov ntshav nrog tus sorbent.

Yu.M. Lopukhin nyob rau xyoo 1977 tau npaj siab qhia txog hemosorption hauv txoj kev kho mob ntawm txoj kev mob atherosclerosis nrog lub hom phiaj ntawm decholesterolization. Kev ua txhaum ntawm lipid homeostasis tshwm sim nyob rau hauv lub cev lom xenobiotics - cov tshuaj nawj rau lub cev uas ua rau cov kab mob oxidative mob siab. Kev txuam nrog xenobiotics tshwm sim hauv lub hnub nyoog laus, nrog kev rog dhau los, hauv cov neeg haus luam yeeb hnyav. Tsis hais seb puas yog hypercholesterolemia thiab hyperbeta-lipoproteinemia yog qhov ua rau atherosclerosis raws li kev tshawb xav ntawm N.N. Anichkova lossis los ntawm cov tshuaj peroxidation ntawm lipid peroxidation, dyslipoproteinemia nrog atherosclerosis tshwm sim. Hemosorption correlates nws, txo cov ntsiab lus ntawm atherogenic lipoproteins ntawm qes (LDL) thiab qis heev (VLDL).

Peb-khawm hemosorption tshem tawm cov roj cholesterol ntawm cov hlab ntsha phab ntsa los ntawm 30% (Yu.M. Lopukhin, Yu.V. Belousov, S.S. Markin), thiab rau qee lub sijhawm regression ntawm cov txheej txheem atherosclerotic tiav, membrane microviscosity tsawg, ion pauv normalizes, lim tau nce lub peev xwm ntawm ntshav liab, txhim kho microcirculation.

Nyob rau lub sijhawm tseem ceeb ntawm ischemia, ntau ntawm cov endogenous ischemic co toxins, cov tshuaj zoo li histamine, cov khoom lag luam ntawm cov nqaij perverse metabolism thiab cellular necrobiosis ntau ntxiv hauv lub cev. Hemosorption tso cai rau koj tshem tawm albuminotoxin, lipazotoxin tawm ntawm lub cev thiab ua lub luag haujlwm ntawm kev siv tshuaj tiv thaiv kab mob. Hemosorption ib leeg nrog SKN-4M sorbent txo cov ntsiab lus ntawm immunoglobulins G los ntawm 30%, chav kawm A los ntawm 20% thiab chav kawm M txog 10%, cov roj ntsha tiv thaiv kab mob (CEC) raug txo 40%.

Raws li S.G. Osipova thiab V.N. Titova (1982), qhia tawm tias nrog atherosclerotic kev puas tsuaj rau cov hlab ntsha ntawm cov qis qis, kev tiv thaiv kab mob yog qhov tsis taus. Nyob rau tib lub sijhawm, tshuaj tiv thaiv kab mob hlwb - T-suppressors, nrog B-cell kev ua haujlwm thiab ua haujlwm ntau dhau ntawm cov tshuaj immunoglobulins tau raug muab tshem tawm, uas ua rau muaj kev puas tsuaj ntxiv rau vascular endothelium.

Teeb meem (raws li E.A. Luzhnikov, 1984) tau pom muaj hauv 30-40% ntawm cov neeg mob.Cov no suav nrog: kev ua kom raug mob rau cov qe ntshav, kev zam txim ua ke nrog cov pa oxygen toxins thiab lub cev cov protein thiab cov kab tsim. Thaum lub sijhawm ua haujlwm, hypotension, ua daus no, mob plab ntawm lub system, embolism nrog cov pob zeb me me muaj peev xwm ua tau (hais 3-33 microns hauv qhov loj yog pom nyob hauv lub ntsws, hnoos qeev, raum, hlwb). Qhov zoo tshaj plaws sorbents yog granular thiab microfilm coated coals. Tus naj npawb ntawm cov ntshav liab tsawg dua, tab sis lawv cov lus muaj pes tsawg leeg ua tiav ntau dua. Hypoxemia tsim tawm, yog li ntawd, oxygen oxygen ntxiv ntxiv rau lub sijhawm hemoperfusion. Siv tshuaj oxygen oxygen kuj tau siv. Nws paub tias ib qho kev daws teeb meem ntawm 3% ntawm hydrogen peroxide muaj 100 cm 3 ntawm oxygen, qhov no txaus los ntub ntau dua 1.5 liv ntawm cov ntshav txhaws. E.F. Abuhba (1983) qhia txog kev daws teeb meem 0.24% ntawm H₂Oh₂ (250-500 ml) hauv iliac leeg cov ceg thiab tau txais cov txiaj ntsig zoo oxygenating.

Muaj cov haujlwm sau ua ke ntawm cov kev paub ntawm enterosorption hauv kev kho cov kab mob obliterating ntawm qis qis. Rau enterosorption siv:

cov kab carb tsis (IGI, SKT, AUV),
kev ion txauv resins,
qhia kev sib deev sorbents raws glycosides sequestrating exogenous thiab endogenous cov roj (cholesterol).
Ob rau peb hnub ntawm enterosorption zoo sib xws hauv kev ua tau zoo rau ib qho kev kho mob hemosorption. Thaum nkag mus rau qhov ua tiav:
thim rov qab los ntawm cov tshuaj lom neeg los ntawm cov ntshav mus rau txoj hnyuv nrog lawv cov lus txuas ntxiv mus rau sorbent,
ntxuav lub zom ua kua plab zom mov ntawm lub plab zom mov, uas nqa ntau ntawm co toxins,
kev hloov pauv ntawm lipid thiab amino acid spectrum ntawm lub plab hnyuv txheem,
kev tshem tawm ntawm cov khoom lom tsim nyob rau hauv txoj hnyuv nws tus kheej, uas ua rau txo lub nra rau ntawm daim siab.

Kev phais mob siab

Cov txheej txheem kev phais tuaj yeem faib ua ob pawg: 1) kev phais mob ntawm lub paj hlwb, 2) phais ntawm cov hlab ntsha.

Cov nyhuv vasoconstrictor ntawm lub zog ntawm lub cev tsis muaj zog ntawm cov ntshav nruab nrog ntws tau tshawb pom los ntawm Claude Bernard (Claude Bernard, 1851). Tom qab ntawd M. Zhabuley (M. Jaboulay, 1898) tau tshaj tawm txog kev ua tiav ntawm kev kho tus mob trophic mob rau ntawm txhais ko taw nrog tus so ntawm kev mob siab rau sab hauv ntawm lub nkoj. Xyoo 1924, J. Diez tau tsim tus txheej txheem rau lub lumbar sympathectomy los ntawm kev cais tawm cov laib laib los ntawm lub lumbar thib ob mus rau qhov thib peb sacral node. Hauv cov neeg mob feem ntau, cov txiaj ntsig zoo tau txais: vasodilation thiab kev txhim kho hauv chav kho mob ntawm tus kab mob. Hauv tebchaws Russia, thawj tus lumbar sympathectomy tau ua rau xyoo 1926 los ntawm P.A. Herzen. Txoj kev ua haujlwm no tau muaj cov cim qhia nruj, vim tias cov paresis ntawm cov hlab ntsha tuaj yeem ua rau trophic cuam tshuam thiab ua rau tus neeg mob lub cev hnyav.

a) tag nrho - kev rov qab ua tiav ntawm cov kab npoo ciam teb nrog txoj hlua sib txuas ntawm kev xav hla ntev ntev,

b) truncular - rov ua dua ntawm cov kab me me ntawm ob txoj kev khaum laib laib,

c) ganglioectomy - tshem tawm ntawm cov pab pawg txaus siab.

Los ntawm sympathectomy, ib qho kev so tuaj yeem ua tiav ob qho hauv centripetal impulses los ntawm qhov mob tshwm sim thiab ua rau muaj kev tsis txaus siab nyob rau hauv cov leeg txha caj qaum thiab lub hlwb, thiab centrifugal impulses ua rau lossis txhim kho trophic, humoral thiab vasomotor cuam tshuam hauv thaj chaw mob. Txo ntawm vascular spasm, sympathectomy ua rau nce ntawm kev sib nkag ntawm cov khoom cog. Tom qab sympathectomy, pes tsawg ntawm pom capillaries nce ntau. Nrog rau cov tsos mob hnov mob, hauv lub pathogenesis ntawm qhov uas tsis muaj qhov tsis txaus siab los ntawm qhov kev mob tseem ceeb yog qhov tseem ceeb, thiab ischemia tsis tuaj, qhov kev kho mob ntawm sympathectomy tsawg dua. Nrog kev puas tsuaj rau cov hlab ntsha ntawm qhov qis qis tshaj, feem ntau yog qhov thib ob thiab thib peb lub lumbar ganglia raug tshem tawm. Ua ntej kev phais mob, nws raug nquahu kom sim nrog novocaine blockade ntawm cov neeg mob tawm tsam uas tau npaj rau kev tshem tawm.

B.V. Ognev (1956), raws li ontogenesis cov ntaub ntawv, ntseeg hais tias kev sib nkag siab zoo siab ntawm qhov qis qis yog nqa los ntawm cov kab kev hla ciam av sab nraud, yog li tshem tawm sab laug thib peb thoracic sympathetic node yog txaus. Ntau tus kws phais neeg tsis ua raws li txoj cai no thiab ua kev phais mob ntawm sab ntawm cov hlab ntsha. Lub tswv yim tias sympathectomy yuav tsum tau mus rau qhov tsawg kawg yog erroneous. Nws yog nyob rau theem pib nrog kev txheeb ze tsis txaus ntawm kev muab cov ntshav uas sympathectomy muab cov txiaj ntsig sai thiab lub sijhawm ntev.

Lumbar sympathectomy yog qhia rau cov neeg mob uas muaj kev txawv txav ntawm cov hlab ntsha puas tsuaj, thaum rov kho dua tshiab ntawm cov nkoj tsis txaus ntseeg lossis nkag tsis tau los ntawm cov kab mob concomitant. Thaum muaj qhov hloov pauv ntawm ulcerative necrotic, sympathectomy pom zoo kom sib txuas nrog lub sijhawm ntev ntawm txoj leeg ntshav-ntawm txoj kev quav tshuaj thiab kev txiav nyiaj kev lag luam. Sympatectomy yog qhov txiaj ntsig ntxiv rau kev phais mob rov ua dua tshiab. Kev poob qis rau kev tawm tsam thiab qhov kev nce ntxiv hauv cov ntshav txaus vim yog qhov kev tshem tawm ntawm cov hlab ntsha yog qhov kev tiv thaiv ntawm kev rov ua haujlwm rau cov leeg. Nrog retrombiosis, lumbar sympathectomy ua rau mob ischemia tsis tshua muaj suab thiab muaj feem ntau ntawm kev tswj kev them nyiaj circulatory.

Cov txiaj ntsig tsis zoo nrog kev khuv xim tuaj yeem piav qhia los ntawm cov txheej txheem yam ntxwv ntawm lub cev tsis muaj lub siab, qhov xwm ntawm cov chav kawm ntawm tus kabmob, kev nthuav dav ntawm kev puas tsuaj rau cov hlab ntsha tseem ceeb thiab kev hloov pauv tsis tau nyob rau theem ntawm microcirculation.

Nrog sympathectomy, cov teeb meem nram qab no tej zaum yuav tshwm sim:

los ntshav los ntawm cov hlab ntsha thiab leeg ntshav (0.5%),
embolism hauv cov hlab ntsha ntawm qhov qis qis nrog atherosclerotic plaques los ntawm aorta (0.5%),
neuralgia, chaw kuaj mob los ntawm qhov mob tshwm sim los ntawm caj pas anterolateral ncej puab (10%), uas ploj tom qab 1-6 lub hlis,
ejaculation mob tom qab ob tog sympathectomy (0.05%),
kev tuag (tsawg dua 1%, raws li A.N. Filatov - txog 6%). Cov sijhawm ua haujlwm tau yooj yim vim yog kev qhia ntawm tus qauv endoscopic.

R. Lerish npaj siab coj ua desympathization ntawm ob qho ntawm cov poj niam txoj hlab ntsha, tshem tawm adventitia thiab yog li cuam tshuam lub suab ntawm cov hlab ntsha ntawm qhov tsis txaus ntseeg. Lub xib teg (Palma) tsim tawm qhov tso tawm ntawm cov poj niam txoj hlab ntsha los ntawm cov nplaum ib puag ncig thiab cov ntaub so ntswg hauv Tus Saib Xyuas Kev Nyab Xeeb.

Cov haujlwm hauv qab no yog ua rau cov hlab ntsha tawm:

shin txwv (Szyfebbain, Olzewski, 1966). Lub ntsiab ntawm kev ua haujlwm muaj nyob rau hauv kev sib tshuam ntawm cov ceg ntawm lub cev muaj zog ntawm lub sciatic hlab ntsha mus rau ntawm tus kheej thiab cov leeg plab, uas yuav pab tua lub luag haujlwm ntawm qee qhov ntawm cov leeg thaum mus taug kev, yog li txo lawv cov pa oxygen thov,
kev ua haujlwm ntawm kev ntsuas phom sij ntawm qhov txha nraub qaum (A.G. Molotkov, 1928 thiab 1937, thiab lwm yam).

Adrenal caj pas phais tau npaj siab thiab ua los ntawm V.A. Oppel (1921). Cov kev sib tham txog kev pom zoo txog kev siv tshuaj phais mob qog rau cov neeg mob uas muaj kab mob obliterating tau ua rau ntau dua 70 xyoo.

Ntau qhov kev saib xyuas hauv kev kho mob ntawm cov neeg mob no tau muab rau lub caij nyoog ntev ntawm txoj leeg ntshav ntawm cov tshuaj nyob rau hauv ntau yam kev sib txuas ua ke. Cov khoom sib xyaw tau qhia: cov tshuaj ntsev, reopoliglukin, heparin, trental, nicotinic acid, ATP, novocaine tov, tshuaj kho mob, tshuaj tua kab mob. Tam sim no, rau kev tso dej siab thiab ntshav ntawm qhov muag, infusomats siv. Rau kev tswj hwm ntau hnub ntawm cov tshuaj, cannulation ntawm qis epigastric leeg los yog ib qho ntawm cov ceg ntawm femoral artery yog ua.

Lwm txoj hauv kev los kho tus mob nqaj qis ischemia tau npaj tseg:

ncaj qha mus ua kom rov mob tuaj dua (S. Shionga li al., 1973),
arterialization ntawm capillary system siv arterio-pob txha fistulas (R.H. Vetto, 1965),
hloov microvascular ntawm ntau dua omentum (Sh.D. Manrua, 1985),

Cov hau kev no, tsim los txhim kho cov teeb meem sib txuam ua ke, tsis muaj peev xwm ua tau tiav sai sai regression ntawm ischemic cov xwm txheej thiab tsis tuaj yeem siv rau hauv theem IV ntawm kev mob txhaws tsis muaj zog txaus.

Kev sim tau ua rau arterialize ischemic limb los ntawm cov leeg ntshav los ntawm kev siv lub plab txoj leeg fistula rau tus ncej puab (San Martin, 1902, M. Jaboulay, 1903). Tom qab, ntau tus pib nrhiav lwm txoj hauv kev. Xyoo 1977 A.G. Lub plhaub (A.G. Plhaub) siv shunting ntawm sab nraum qab venous koov ntawm ko taw. Tus neeg sau ua tiav 50% zoo nyob rau hauv kev tseem ceeb ischemia. Cov haujlwm zoo sib xws tau qhia los ntawm B.L. Gambarin (1987), A.V. Pokrovsky thiab A.G. Zoov Ntxheb (1988).

Cov ntsiab lus rau kev ua haujlwm rov qab yog txiav txim siab nyob ntawm qhov mob ntawm nqaj ischemia, thaj chaw mob ntawm kev ua haujlwm, thiab qhov kev ntsuas ntawm kev pheej hmoo ntawm kev khiav haujlwm. Cov xwm txheej hauv cheeb tsam yog soj ntsuam raws cov ntaub ntawv aortoarteriography. Cov kev mob zoo tshaj plaws rau cov haujlwm yog tswj hwm patency ntawm lub txaj distal. Cov kev soj ntsuam kuaj pom zoo rau peb tias tsis tuaj yeem ua haujlwm thoob ntiaj teb rau tus kabmob no, tabsis yuav tsum tau ua los ntawm cov kev siv ntawm tus kheej xaiv txoj haujlwm ntawm kev ua haujlwm. Cov lus qhia rau kev siv tus kheej kev rov ua dua tshiab yog txiav txim siab nyob ntawm qhov xwm yeem thiab qhov sib txawv ntawm tus neeg mob, muaj hnub nyoog thiab mob ntawm tus neeg mob, muaj kev pheej hmoo txaus rau kev phais mob thiab ua kom loog. Cov ntsiab lus txwv tsis pub muaj kev qhia txog kev kho mob phais thiab ua rau muaj kev pheej hmoo ntxiv rau kev phais mob yog: mob ntsws ischemic mob plawv, tsis muaj ntshav txaus, lub cev tsis muaj zog, ntshav siab, lub raum thiab lub raum tsis ua haujlwm, mob plab thiab duodenal rwj, decompensated ntshav qab zib mellitus, oncological dab, thiab lub hnub nyoog laus. Nrog rau kev hem thawj tiag tiag ntawm kev tshem tawm siab, qhov tseeb ntawm kev pheej hmoo ntawm kev sim rov qab phais yog lees paub, txij li txawm tias muaj lub duav txo qis, kev tuag ntawm cov neeg mob laus dua 60 xyoo yog 21-28% lossis ntau dua.

Rau kev rov ua haujlwm, ntau yam khoom siv hluavtaws, uas tau hais los saum no, thiab cov tshuaj autogenes tau siv. Lwm hom kev hloov pauv tam sim no tsis tshua muaj siv.

Ntau yam ntawm endarterectomies (qhib, qhib ib nrab, eversion, nrog roj carbodissection, ultrasound) yog siv ob qho tib si raws li kev cuam tshuam ywj pheej rau kev txwv stenosis thiab occlusion, thiab raws li tsim nyog ntxiv rau shunting lossis prosthetics. Ntau tus kws phais neeg xav tias nws tsim nyog los ua ke kev phais mob nrog lumbar sympathectomy.

Hauv Leriche syndrome, nkag mus rau aorta yog nruab nrab laparotomy lossis ntu ntu ntawm Rob (C.G. Rob). Rob ntu pib los ntawm XII tav thiab txuas mus rau qhov nruab nrab 3-4 cm hauv qab ntawm lub ntaws, thaum lub qhov quav tawm ntawm cov leeg nqaij ib nrab lossis tag nrho cov kev sib tshuam, anterolateral phab ntsa leeg yog dissected lossis sib cais raws peritoneum, thiab peritoneum exfoliates thiab raug tshem tawm nrog rau cov hnyuv. Rau qhov kev xaiv dav dav ntawm cov leeg txoj hlab ntsha ntawm qhov rov qab, qhov phais yuav txuas ntxiv nrog txoj kev sib tshuam ntawm lwm qhov quav tawm ntawm cov leeg nqaij. Txoj kev nkag mus no tsis tshua mob siab, yuav luag tsis ua rau mob hnyuv paresis, muab qhov ua tau rau tus neeg mob ua haujlwm ntxov tom qab phais tus mob. Kev nkag mus rau cov leeg o pob txha yog los ntawm txoj kev phais tom qab sawv ntsug hauv qab txoj kab lig leeg. Lub kaum sab sauv txiav yog 1-2 cm saum toj no inguinal quav. Nws raug nquahu kom tshem cov lymph cov leeg mob mus rau (mob ib nrab) yam tsis muaj hla.

Nrog siab siab occlusion ntawm lub plab aorta nyob rau hauv ua ke nrog kev puas tsuaj rau lub raum los yog visceral ceg, thoracophrenolumbotomy yog siv.

Thaum tsuas yog qhov tsis muaj lwm tus sab nrauv txoj hlab ntshav txhaws, hla dhau kev phais mob lossis qhov kawg ntawm qhov txhaws. Feem ntau kev ua haujlwm dhau los ntawm aortic femoral ntu kawg nrog kev suav nrog ntawm cov poj niam txoj hlab ntshav mus rau hauv cov hlab ntshav. Hauv 4-10% ntawm cov neeg mob, ntshav ntws los ntawm kev sib zog ua tus poj niam txoj hlab leeg tsis tuaj yeem them taus rau lim ntshav ischemia, nyob rau hauv cov xwm txheej zoo li no rov qab ua ntu ntawm femoral-popliteal ntu tau qhia. Txhawm rau rov qab ntshav ntshav hauv ntu femoral-popliteal, ib qho autovein siv ntau dua. Kev ua haujlwm rov ua haujlwm ntawm ntu ntu femoral-popliteal ua rau 60-70% ntawm txhua qhov kev ua haujlwm ntawm cov kabmob ntawm cov kabmob (Nielubowicz, 1974). Rau kev nkag mus rau thaj tsam sib txawv ntawm cov ntshav tawm hauv popliteal thiab rau thaj tsam ntawm nws ceg (trifurcation), kev phais mob nruab nrab feem ntau yog siv (tibial nkag raws li M. Conghon, 1958). Txhawm rau nthuav tawm rau ntu nruab nrab lossis tag nrho cov kab mob popliteal leeg, ib qho kev txiav txim siab nruab nrab nrog cov kev sib tshuam ntawm cov nqaij ntshiv pes ansevinus (goose paws) thiab qhov nruab nrab lub taub hau m.gastrocnemius (A.M. Imperato, 1974) tau thov.

Tau txais kev siv ntau ntawm profundoplasty. Hauv tus naj npawb ntawm cov neeg mob uas nthuav tawm tsis zoo rau lub nkoj ntawm ceg, kev tsim kho lub cev ntawm cov poj niam txoj hlab leeg yog kev cuam tshuam nkaus xwb uas tuaj yeem cawm tus ceg ntawm kev txiav tawm. Lub sijhawm ua haujlwm tuaj yeem ua rau hauv tshuaj loog hauv zos lossis hauv qhov chaw ua tshuaj loog ntawm epidural. Profundoplasty txo qhov hnyav ntawm ischemia, tab sis tsis tshem tawm tag nrho sib quas ntus claudication. Kev txhim kho cov ntshav txaus yog txaus los kho cov mob rau qhov ncauj thiab mob tom qab txiav lag luam. Rov tsim kho dua ntawm cov poj niam sib sib zog nqus ntawm lub ischemia hnyav muab kev txhim kho ncaj qha rau cov ntshav ncig hauv cov nqua hauv 65-85% ntawm cov neeg mob (J. Vollmar et al., 1966, A.A. Shalimov, N.F. Dryuk, 1979).

Hauv cov neeg mob ntawm cov hnub nyoog laus dua nrog cov kab mob concomitant hnyav, kev ua haujlwm ncaj qha rau ntawm aorta thiab iliac cov hlab ntsha yog cuam tshuam nrog kev pheej hmoo siab thiab tuag taus. Hauv cov pab pawg ntawm cov neeg mob no, kev tiv thaiv cov poj niam ua haujlwm-poj niam txiv neej poj niam txha caj qaum thiab axillary-femoral bypass grafting tuaj yeem siv tau. Qhov phom sij tshaj plaws ntawm tus mob shunt thrombosis tshwm sim hauv thawj rau lub hlis thiab nce mus txog 28%.

Tom qab 5-7 xyoo, patency ntawm autogenous shunt ntawm femoral-popliteal tsam tseem muaj nyob rau hauv 60-65%, thiab tom qab endarterectomy, patency ntawm cov leeg nyob rau hauv 23% ntawm cov neeg mob. Muaj pov thawj qhia tias tom qab 5 xyoos, ib qho kev sib kis poj niam lub cev yog qhov mob dhau los hauv 73% ntawm tus neeg mob, thiab cov khoom cua hluavtaws hauv 35% ntawm cov neeg mob (D.C. Brewstev, 1982).

Ib theem tshiab hauv kev txhim kho kev tsim kho dua tshiab ntawm cov hlab ntsha ntawm pob ntseg ntawm pob zeb popliteal-pob txha tau siv qhov kev phais rov ua dua tshiab uas yog siv cov txuj ci me me. Qhov nyuaj ntawm kev ua haujlwm ntawm tib txoj hlab ntsha nrog txoj kab uas hla ntawm 1.5-3 hli, cov teeb meem loj heev thiab txawm tias lub cev nqaj qis piv nrog lub sijhawm ua ntej, qhov feem pua ntawm cov mob thaum ntxov thiab mob lig rau hauv daim ntawv ntawm thrombosis thiab pom tau yog lub cim rau qhov pom ntawm cov neeg phais feem ntau uas kev ua haujlwm zoo li no tsuas yog nyob hauv raug ntawm lim hiam loj ischemia, nrog rau kev hem thawj ntawm kev txiav tawm. Cov haujlwm ntawd yog hu ua “kev khiav haujlwm rau qhov kom mus txog qhov kho tsis tau”. Txawm hais tias lub sijhawm, cov haujlwm no tsis mob. Postoperative kev tuag yog tus qis - txij li 1 txog 4%, thaum lub sijhawm txiav txim siab siab ntawm nqaj nws ncav 20-30%. Lub caij txiav txim siab hauv kev txiav txim siab qhov taw qhia rau kev kho mob phais feem ntau tsis muaj kev phom sij, tab sis cov xwm txheej hauv cheeb tsam ntawm kev ua haujlwm, i.e. tswj kev thaj yeeb ntawm tsawg kawg ib ntawm peb txoj ntawm cov hlab ntsha tibial thiab zoo txaus siab rau cov ntshav ntws los ntawm tus kab mob iliac thiab femoral cov hlab ntsha.

Xyoo tsis ntev los no, nrog atherosclerotic stenosis ntawm cov hlab ntsha tseem ceeb, txoj kev ntawm endovascular dilatation thiab stenting tau dhau mus. Xyoo 1964, thawj zaug, ib txoj hauv kev ntawm kev kho "tsis yog phais" ntawm ileo-femoral ntu occlusion siv catheter expanders (Ch. Dotter thiab M. Yudkins) tau piav qhia. Hom qauv no yog hu ua "transluminal dilatation", "transluminal angioplasty", yas endovascular, thiab lwm yam. Xyoo 1971, E. Zeitler (E. Zeitler) tau hais kom tshem tawm qhov txhab tawv nqaij uas siv lub twj tso kua mis Fogarty. Xyoo 1974

A. Gruntzig thiab X. Hopt (A. Gruntzig thiab N.Hopt) npaj siab rau ob lub lumen zais pa catheter, uas ua rau nws muaj peev xwm ua qhov yooj yim "kev ua haujlwm" no thiab ua kom muaj kabmob angioplasty hauv yuav luag txhua lub pas dej vascular nrog qhov feem pua tsawg kawg ntawm cov teeb meem. Nyob rau tam sim no, cov kev paub ntau ntxiv tau dhau los nrog angioplasty ntawm stenotic lesions ntawm cov hlab ntsha. Raws li cov lus zais zais angioplasty, lub taub ntawm txoj hlab ntsha nce vim qhov kev faib tawm ntawm cov khoom atheromatous tsis hloov pauv tuab ntawm phab ntsa arterial. Txhawm rau tiv thaiv spasm ntawm dilated leeg thiab ntev khaws cia ntawm nws lumen, nitinol stent yog tso rau hauv cov leeg. Kev ua lub npe hu ua endovascular prosthetics. Cov txiaj ntsig tau zoo tshaj plaws tau pom nrog segmental stenosis nrog qhov ntev tsis ntau tshaj 10 cm nyob rau hauv ntu aorto-iliac thiab femoral-popliteal ntu, tsis muaj calcification ntawm cov leeg phab ntsa, tsis hais txog theem ntawm tus kab mob. Kev tshawb xyuas ntawm cov txiaj ntsig ntev ntev tau pom tias hom no tsis tuaj yeem sib tw nrog kev tsim kho vascular rov ua haujlwm, tab sis qee qhov nws tau txaus siab ntxiv rau lawv.

10 xyoo dhau los, kev ua haujlwm tau tshwm sim rau kev txhim kho thiab kev coj ua hauv kev kho mob hauv kev kho mob uas tsis tshua muaj kev phais mob ntawm cov pob txha ntawm qhov qis qis - txhawm thiab txha kho (F.N. Zusmanovich, 1996, P.O. Kazanchan, 1997, A.V. Qauv, 1998). Kev rov qab ua haujlwm osteotrepanation (ROT) kev tsim kho yog tsim los ua kom cov hlwb pob txha khiav ntshav, nthuav tawm thiab txhim kho txoj haujlwm ntawm paraossal, cov leeg nqaij thiab daim tawv nqaij ua kom tiav thiab tau qhia rau cov neeg mob uas muaj kev puas tsuaj los ntawm txoj hlab ntshav, thaum tsis muaj kev phais mob ntxiv. Cov sijhawm ua haujlwm yog ua raws li hauv tshuaj loog hauv zos lossis epidural. Perforation qhov nrog ib txoj kab uas hla ntawm 3-5 hli hauv qhov ntau ntawm 8-12 los yog ntau dua yog siv rau tus ncej puab, ceg qis thiab ko taw ntawm qhov kev ua haujlwm biologically. Cov txiaj ntsig zoo tshaj plaws tau los ntawm cov neeg mob theem II B thiab theem III.

Sijhawm Postoperative

Lub luag haujlwm tseem ceeb ntawm lub sijhawm postoperative thaum ntxov yog kev tiv thaiv ntawm thrombosis, los ntshav thiab txhawb nqa ntawm lub qhov txhab. Tswj cov theem siab ntawm qhov dav dav thiab nruab nrab hemodynamics yog qhov tseem ceeb rau kev tiv thaiv ntawm thrombosis. Txawm hais tias lub sijhawm luv luv tso ntshav tawm hauv lub sijhawm no tuaj yeem ua rau cov hlab ntsha txhaws. Rau kev tiv thaiv ntawm kev poob siab yog qhov tseem ceeb:

sau npe thiab hloov cov kua dej thiab cov ntshav poob thaum phais,
kev txhim kho kom raws sijhawm thiab tsim nyog kho ntawm metabolic acidosis, tshwj xeeb tshaj yog tom qab suav nrog cov ischemic povtseg hauv cov hlab ntsha.

Tag nrho cov kua dej ua kom rov qab yuav tsum yog 10-15% siab dua qhov nws poob (tshwj tsis yog rau ntshav). Nws yog ib qho tsim nyog los soj ntsuam thiab tswj kev ua haujlwm zoo kawg ntawm lub raum (tswj cov diuresis, kev qhia ntawm cov roj me me tsis sib luag, aminophylline), txhawm rau kho cov kev cuam tshuam ntawm cov kua qaub-puag qhov sib npaug (ASC), dej-ntsev tshuav thiab metabolic acidosis.

Cov lus nug ntawm kev siv tshuaj anticoagulants yog txiav txim siab ib tus zuj zus, nyob ntawm seb cov yam ntxwv ntawm kev phais kho dua tshiab. Txhawm rau txhim kho cov ntshav hauv cheeb tsam, microcirculation thiab kev tiv thaiv ntawm cov teeb meem thrombotic, cov tshuaj tiv thaiv antiplatelet yog tshuaj: reopoliglyukin, qhuas, trental, fluvide, ticlide, thiab lwm yam. Kev siv tshuaj tua kab mob thiab kev kho mob zoo tshaj li tsis ntseeg. Txhawm rau tiv thaiv plab hnyuv paresis tom qab kev cuam tshuam ntawm aorta thiab iliac cov hlab ntsha hauv thawj 2-3 hnub, kev pom zoo rau niam txiv noj zaub mov kom zoo.

Ntawm qhov teeb meem ntawm lub sijhawm postoperative tam sim ntawd, muaj kev saib xyuas: los ntshav - 12%, thrombosis - 7-10%, kev kis tus mob ntawm qhov mob tom qab - 1-3% (Liekwey, 1977). Nrog rau kev pub ntxiv ntawm cov prosthesis ntawm thaj tsam aortic femoral, kev tuag nkag mus txog 33-37%, kev txiav tawm - 14-23% (A.A. Shalimov, N.F. Dryuk, 1979).

Teeb meem uas tau pom thaum ua hauj lwm tsim kho dua tshiab (H.G. VeeY, 1973) tuaj yeem muab faib ua:

kev puas tsuaj rau cov kabmob ntawm lub plab pob txha, qis qis thiab qhov txhab ntshav, ureter,
kev puas tsuaj rau cov hlab ntsha thaum lub sij hawm tsim los ntawm lub qhov rau prosthesis,
prosthetic thrombosis thaum lub sij hawm clamping ntawm lub aorta,
embolism
los ntshav vim tsis zoo hemostasis,
cov leeg mob (txoj haujlwm tsis zoo ntawm lub plab hu ua pelvic plab hnyuv vim yog txha caj qaum ischemia).

2. Cov kev mob tshwm sim tom qab:

los ntshav
lub raum tsis ua haujlwm (thaj chaw oliguria nyob hauv 48 teev),
thrombosis ntawm prosthesis thiab cov hlab ntsha,
pares paresis,
plab hnyuv ischemia thiab necrosis vim raug mob thiab mesenteric thrombosis,
lymphorrhea thiab txhawb nqa tom qab mob txhab.

3. Cov teeb meem tom qab tuag tas:

thrombosis ntawm cov hlab ntsha thiab prosthesis vim yog kev muaj mob ntawm cov kabmob (atherosclerosis),
dag aneurysms ntawm anastomoses (kab mob kis tau lossis divergence ntawm cov nqaij txuas),
aortic plab hnyuv fistulas
prosthesis kev muaj mob
impotence.

Kev tiv thaiv ntawm cov teeb meem purulent yog qhov tseem ceeb. Cov kab mob purulent tom qab tsim kev ua haujlwm tau pom nyob hauv 3-20% nrog kev muaj lub neej ntawm 25-75%. Qhov nce nyob rau hauv tus naj npawb ntawm postoperative suppuration yog txuam nrog:

qhia txog kev ua haujlwm tshiab thiab siv sijhawm,
hnub nyoog ntawm cov neeg mob
cov kab mob hnyav (xws li mob ntshav qab zib mellitus),
anemia, hypoproteinemia, vitamin tsis txaus,
hypercoagulation
kev kho tus kheej yav dhau los
qhov tsis txaus ntseeg (qhov tsis txaus ntseeg) cov qhov txhab ntawm qhov txhab,
ib daim ntaub qhwv lub cev nrog cov hnav khaub ncaws uas tsis tshua pom zoo, muaj ntau yam ntxim nyiam nrog tshuaj tua kab mob thiab kev tawm tsam ntawm cov kab mob me,
kev nce staphylococcal carriage hauv cov neeg ua haujlwm thiab cov neeg mob,
Kev ua kom tsis muaj zog ntawm kev saib xyuas ntawm cov neeg phais mob mus rau cov kev cai classical ntawm asepsis thiab antiseptics. G.V. Tus Tswv (G.W. Tswv, 1977) faib cov suppuration ntawm prostheses raws li qhov tob ntawm kev kis tus kab mob:
- Kuv kawm ntawv - tawv nqaij mob txhab,
- II degree - kev puas tsuaj rau ntawm daim tawv nqaij thiab cov nqaij mos subcutaneous,
- III degree - kev puas tsuaj rau thaj tsam ntawm kev cog hniav ntawm prosthesis.

Peb ntu ntawm cov kev tiv thaiv ntsuas qhov txawv:

1. Kev tiv thaiv kab mob: tshem tawm cov qhov txhab thiab mob rau qhov ncauj, kho kev txhab ntshav, ntxuav tu ntawm foci ntawm kev kis tus kab mob, ntxuav tu lub plab hnyuv 2-3 hnub ua ntej kev phais mob.

2. Kev Siv Tshuaj: maj mam kho cov tawv nqaij, kev siv tshuab hleas, hloov cov hnab looj tes ntawm cov theem ntawm kev ua haujlwm, ua kua viav vias.

3. Hauv lub sijhawm ua haujlwm tom qab: rov ua kom tiav ntawm cov ntshav poob, ntau cov tshuaj tua kab mob loj txog 7-10 hnub, kho kev kho mob infusion txaus.

Nrog rau qhov ua kom tiav thiab ua kom zoo ntawm lub prosthesis, nws yog qhov yuav tsum tau nquag ntws, kho lub qhov txhab thiab kaw nws thiab cov prosthesis nrog cov leeg nqaij-mob pob txha. Yog tias kev kho mob tsis ua tiav, ib txoj kab ke dhau ntawm kev tshem tawm ntawm lub prosthesis yuav tsum tau ua. Kev ua lub siab tawv thiab ua zoo xav phais yog qhov zoo dua li kev txaj muag, kev txiav txim siab thiab qhov kev ntsuas ib nrab. Txog ntawm qhov teeb meem ntawm kev siv tshuaj tiv thaiv thaum ntxov, ib qho yuav tsum tsom rau kev ua haujlwm ntawm kev ua haujlwm, muaj cov kiav txhab ntawm cov txhab thiab allotransplantation. Kev ua kom tus neeg mob nyob ntawm lawv cov mob thiab qhov ntim ntawm kev phais mob. Kev taug kev feem ntau raug tso cai nyob rau 3-5 hnub, txawm li cas los xij, cov teebmeem no tau txiav txim siab hauv txhua kis.

Tom qab kev phais mob dua tshiab, cov neeg mob yuav tsum tau soj ntsuam tsis tu ncua ntawm cov tshuaj antiplatelet thiab anti-atherogenic, yauv mus ua txoj kev kho kom zoo, thiab raug saib xyuas tas li los ntawm cov tshuaj angiosurgeon.

Yog li, tam sim no, qhov kev paub ntau tau nthuav dav hauv kev txheeb xyuas thiab kev kho mob ntawm cov kab mob ntawm cov hlab ntsha, uas ua rau nws muaj peev xwm nyob rau txhua kis ua qhov kev kuaj mob kom raug thiab xaiv cov kev kho mob zoo tshaj plaws.

Xaiv kab lus qhuab qhia hais txog angiology. E.P. Kohan, I.K. Zavarina

Atherosclerosis obliterans tshaj plaws: cov tsos mob thiab kev kho mob

Cuam tshuam atherosclerosis ntawm qis qis dua yog nrog nrog kev mob plab, uas feem ntau cuam tshuam rau cov neeg laus dua 40 xyoo. Nrog kev tshem tawm me me ntawm cov hlab ntawm ob txhais ceg, cov tsos mob ntawm hypoxia tshwm sim - loog ntawm nqaj, poob ntawm qhov rhiab siab, mob nqaij thaum mus taug kev.

Kev tiv thaiv tsis tu ncua tuaj yeem tiv thaiv kev txhim kho ntawm cov mob necrotic ulcerative, tab sis ntau tus neeg mob muaj kev pheej hmoo:

Kev pham
Rog rog ntxiv,
Kev ua txhaum ntawm cov ntshav mus rau qhov qis qis vim yog varicose leeg.

Atherosclerosis obliterans ntawm lub leeg qis ntawm cov leeg ntshav

Kev hloov pauv hauv cov leeg ntshav ntawm pob txha mos tsis tshwm sim tsis yog nrog cov atherosclerotic plaques. Pathology ntawm lub plab mog plab hnyuv siab raum, kev yug me nyuam, kab mob sib kis yog nrog cov khoom noj tsis haum, oxygenation ntawm cov hlab ntsa. Txhawm rau tiv thaiv vascular atherosclerosis, kev kho mob tsis tu ncua ntawm kev muaj me nyuam yuav tsum muaj.

Qhov ntau zaus ntawm cov quav hniav nyob rau hauv lub voos femoral yog vim muaj qhov bifurcation hauv aorta nyob ze lub nkoj no - qhov chaw sib cais rau 2 qhov chaw. Nyob rau thaj chaw no muaj lub vortex ntawm cov ntshav thaum txav, uas ua rau muaj peev xwm ntawm kev raug mob ntxiv rau ntawm phab ntsa. Ua ntej, cov roj ntau ntau yuav tshwm sim hauv lub aorta, thiab tom qab ntawd poob rau hauv qab.

Sib quas ntus claudication nyob rau hauv atherosclerosis ntawm femoral leeg

Feem ntau pom ntawm nqua ischemia yog sib quas ntus claudication. Pathology ua rau pom kev mob, ua kom loog ntawm nqua. Kev sib txuam ntawm cov leeg ua rau cov leeg mob cia li ploj mus zuj zus.

Nrog pathology, ib tus neeg muaj cov tsos mob pathological. Tus mob yog qhov ua rau tsis xis nyob, mob.

Nrog sib quas ntus claudication, mob tshwm sim ntawm ib leeg. Maj mam, nosology kis zoo sib xws, uas yog nrog los ntawm kev pom ntawm ob tog sib quas ntus claudication. Thaum taug kev, cov leeg mob tshwm hauv cov leeg plab plab, thawj zaug ntawm ib sab, thiab tom qab ntawd rau ob qho.

Qhov mob hnyav heev txiav txim siab los ntawm qhov kev ncua deb uas ib tus neeg taug kev ua ntej pib mob. Hauv cov xwm txheej hnyav, qhov mob pom tsis pub dhau lub sijhawm thaum ncig thaj av ntawm thaj av tsis pub ntau tshaj 10 meters.

Ua raws li kev thaj tsam ntawm kev mob, cov sib quas ntus sib dhos tau muab faib ua 3 pawg:

Nrog rau cov qeb siab, qhov mob tshwm sim hauv zos tau ncaj qha hauv cov leeg nqaij gluteal. Nosology feem ntau ua ke nrog Lerish's syndrome (nrog cov quav hniav ntawm thaj tsam ntawm aortic bifurcation).

Tsis tshua muaj suab nrov yog lub plab hlaub mob. Nws tshwm sim nrog atherosclerotic ua kom pom tseeb hauv qhov kev tsom tawm ntawm qis thib peb ntawm tus ncej puab, lub hauv caug txha.

Kev kuaj mob tsis tu ncua claudication yog yooj yim. Ntxiv nrog rau tus neeg mob qhov kev tsis txaus siab ntawm qhov mob hauv plab cov nqaij ntshiv thaum taug kev, muaj lub palpation ntawm qhov tsis muaj mem tes hauv qhov chaw ntawm lub nkoj cuam tshuam - iliac thiab femoral artery, thiab cov hlab ntsha hauv qab ceg.

Ib qho kev kawm nyuaj yog nrog los ntawm kev ua txhaum ntawm trophic cov leeg, uas pom los ntawm kev txo qis hauv lawv cov ntim, cyanosis ntawm daim tawv nqaij, cyanosis ntawm cov ntiv taw. Caj npab cuam tshuam yog txias rau qhov kov.

Ischemic kev puas tsuaj rau qhov qis qis yog nrog los ntawm kev puas tsuaj rau cov hlab ntsha pob tw, o ntawm ceg, ko taw. Hauv pathology, cov neeg mob muaj lub zog yuam - lawv khaws lawv ob txhais ceg nyob hauv ib lub xeev dai tuag.

Kev faib tawm ntawm obliterating atherosclerosis:

Mob thaum tsiv ntau dua 1 mais. Muaj mob tsuas yog nrog kev ua kom lub cev sib zog. Kev nyob mus ntev yog tsis pom zoo vim tias mob nyhav ceg ischemia,
Theem 1 yog tus cwj pwm los ntawm qhov pom tshwm sim ntawm qhov tsis sib haum thaum hloov mus ntawm 250 meters mus rau 1 kilometer hauv ntev. Hauv cov nroog niaj hnub, cov xwm txheej zoo li no tsis tshua tsim, yog li tus neeg tsis hnov lub suab tsis xis nyob. Cov tib neeg nyob rau hauv cov chaw nyob deb nroog feem ntau yuav ntsib kev txom nyem los ntawm atherosclerosis
Theem 2 yog tus cim los ntawm mob thaum taug kev tshaj 50 meters. Tus mob ua rau yuam kev dag lossis zaum ntawm ib tus neeg thaum taug kev,
Theem 3 - tseem ceeb ischemia, tsim nrog nrog cov lus nqaim ntawm cov hlab ntsha ntawm ob txhais ceg. Pathology yog tus cwj pwm mob los ntawm qhov mob thaum txav mus deb. Tus mob yog tus cwj pwm tsis txaus thiab xiam oob khab. Kev ntxhov siab vim pw los yog mob thaum hmo ntuj,
Theem 4 ntawm kev ua kom tsis meej trophic tshwm sim los ntawm qhov tsim ntawm necrotic foci, kev tshaj tawm hais tias kev ua txhaum ntawm cov ntshav nrog kev txhim kho tom qab ntawm kev ua haujlwm gangrene ntawm qis qis.

Nrog rau kev nthuav dav ntawm kev tsis quav dej tsis sib xws, muaj kev lav phib xaub ntawm aorto-iliac ntu, kev puas tsuaj rau thaj av popliteal-tibial. Nrog pathology, morphologists soj ntsuam qhov thiaj li hu ua "ntau zaj dab neeg kev puas tsuaj rau cov hlab ntsha." Hauv tag nrho cov tuab ntawm qhov khoom tshawb nrhiav, esterified cholesterol plaques yog pom kev.

Kev nthuav dav ntawm atherosclerosis obliterans tau faib ua theem:

Segmental obliteration - tsuas yog ib qho povtseg lub cev ntog tawm ntawm qhov chaw microcirculation,
Common occlusion (qib 2) - ib qho thaiv ntawm cov poj niam txoj hlab ntsha hauv cheeb tsam,
Kev thaiv cov kab mob popliteal thiab femoral cov hlab ntsha nrog qhov tsis muaj peev xwm pom zoo ntawm thaj chaw bifurcation,
Ua kom tiav qhov thaiv ntawm microcirculation hauv popliteal thiab femoral cov hlab ntsha - 4 degree. Nrog pathology, cov ntshav txaus rau cov kab ke ntawm cov poj niam txoj hlab ntshav sib sib zog yog khaws cia,
Kev puas tsuaj rau cov poj niam sib sib zog nqus leeg nrog kev puas tsuaj rau tus poj niam-popliteal cheeb tsam. Qeb 5 pom tus cwj pwm ntawm hypoxia hnyav ntawm qhov qis hauv qab thiab necrosis, mob nqaij hlav trophic gangrene. Qhov mob hnyav ntawm tus neeg mob dag nws tsis yooj yim los kho, yog li kev kho tsuas yog mob.

Hom occlusal stenotic txhab nyob rau hauv atherosclerosis yog sawv cev los ntawm 3 hom:

Kev puas tsuaj rau lub distal ib feem ntawm tibia thiab popliteal hlab ntsha, nyob rau hauv uas cov ntshav mus rau qis ceg yog tshwj tseg,
Plab occlusion ntawm qhov qis ceg. Ua siab ntev rau tibia thiab popliteal cov hlab ntsha raug khaws cia,
Cuam tshuam ntawm txhua lub nkoj ntawm tus ncej puab thiab ceg ceg qis nrog kev tuav tus kheej ntawm cov ceg ntawm nyias cov leeg.

Cov tsos mob ntawm obliterating atherosclerosis ntawm cov hlab ntsha ntawm qhov qis qis

Cov tsos mob ntawm obliteration ntawm qis qis yog multifaceted. Nrog rau txhua qhov kev tshwm sim hauv thawj qhov chaw, sib quas ntus claudication, uas yog lub cim ntawm pathology.

Txhua tus tsos mob ntawm atherosclerotic kev puas tsuaj rau cov hlab ntsha ntawm txhais ceg tau yooj yim muab faib ua qhov pib thiab lig. Pib cov cim ntawm cov rog rog hauv cov hlab ntsha ntawm nqua:

Hypersensitivity rau kev ua ntawm tus mob khaub thuas. Kev yws yws ntawm kev nkag, ntawj txias, kub hnyiab, khaus, hnov mob hauv plab hlaub,
Tus mob Lerish yog nrog kev mob los ntawm caj pas gluteal, thaj tsam sab nraub qaum nrog thaj tsam ntawm cov quav hniav ntawm ntu aortic-iliac,
Atrophy ntawm subcutaneous rog, cov leeg nqaij,
Cov plaub hau poob ntawm ceg thiab ncej puab,
Hyperkeratosis ntawm cov ntsia hlau,
Lamination ntawm daim hlau,
Tsis yog kho qhov mob ntawm qhov ncauj thiav,
Qhov tsim cov pob zeb nyob hauv foci ntawm daim tawv nqaij puas.

Obliterating atherosclerosis yog tus cwj pwm los ntawm kev cuam tshuam loj heev nrog kev hloov ntawm txhais ceg trophic mus txog rau kev zawm caj pas.

Hauv 45% ntawm cov neeg mob, mob yog tsim vim muaj kev mob rov qab tom qab tshem tawm txoj kev kho mob nquag nrog kev hloov mus rau cov txheej txheem tiv thaiv. Kev mus pw rau ib ce ib zaug tau raug pom zoo rau cov neeg uas muaj kev rov huam mob tuaj.

Kev kuaj mob

Yog tias cov tsos mob saum toj no tau txheeb xyuas, tus neeg mob yuav tsum nrhiav cov lus qhia ntawm angiosurgeon, uas tom qab kuaj xyuas tus neeg mob yuav muab tshuaj rau nws ntawm chav kuaj. Txhawm rau soj ntsuam cov kab mob no, yuav tsum muaj kev kuaj ntshav thiab kuaj mob hauv qab no:

kuaj ntshav rau tus qauv ntawm lipids, cov concentration ntawm fibrinogen, qabzib,
tsom xam los txiav txim lub sijhawm los ntshav,
Ultrasound ntawm cov hlab ntsha nrog dopplerography,
cov ntawv sau (angiography) nrog tus sawv cev sib piv,
rheovasography
MRI
CT scan nrog tus neeg sawv cev sib piv.

Tom qab txiav txim theem ntawm tus kab mob, tus neeg mob tau txais kev kho mob kom zoo.

Cov tswv yim ntawm kev kho mob atherosclerosis obliterans ntawm cov hlab ntsha ntawm qhov qis qis yog nyob ntawm theem ntawm kev txhim kho ntawm cov txheej txheem pathological thiab yuav suav nrog kev txuag kho lossis phais kho.

Thaum pib kho, yam uas ua rau muaj kev hloov zuj zus los ntawm tus kabmob raug tshem tawm:

Kev hloov ua kom hnyav.
Txiav kev haus luam yeeb thiab lwm yam cwj pwm tsis zoo.
Kev sib ntaus tawm tsam lub cev tsis ua haujlwm.
Tsis kam noj zaub mov uas muaj cov roj (cholesterol) thiab tsiaj muaj roj (noj cov zaub mov No. 10).
Kev tswj ntshav siab thiab tshem tawm cov tawg.
Txo cov theem ntawm cov "phem" cov cholesterol.
Tshuaj xyuas ntsav qab zib ntawm cov piam thaj hauv ntshav qab zib.

Cov neeg mob uas tau pib nrog tus kab mob pathology tuaj yeem pom zoo kom noj cov tshuaj no:

tshuaj rau txo cov roj cholesterol - Lovastatin, Quantalan, Mevacor, Cholestyramine, Zokor, Cholestid,
tshuaj txo qis triglycerides - clofibrate, bezafibrat,
kev npaj los tswj cov microcirculation kom ruaj khov thiab tiv thaiv kom tsis txhob mob thrombosis - Cilostazol, Pentoxifylline, Clopidogrel, Aspirin, Warfarin, Heparin,
tshuaj rau txo cov ntshav siab - Atenolol, Betalok ZOK, Nebilet,
tshuaj los txhim kho cov nqaij mos trophism - Nicotinic acid, Nikoshpan, B vitamins,
multivitamin ntau ceg.

Cov txheej txheem ntawm lub cev ua haujlwm (microcurrents, kho laser), kev kho cov ntshav tawm thiab cov pa oxygenbar tuaj yeem raug kho rau kev kho mob ntawm arteriosclerosis obliterans ntawm qhov qis qis.

Kev qhia rau kev phais yuav muaj:

cov cim qhia txog kev ua laib
mob siab thaum so,
mob ntsws vwm
kev loj hlob sai lossis theem III-IV ntawm atherosclerosis.

Hauv cov theem pib ntawm tus kab mob, tus neeg mob yuav tau phais mob tsawg kawg:

zais pa angioplasty - lub tshuab raj tshwj xeeb nrog lub zais pa tso rau hauv cov leeg ntawm qhov ntswg, thaum cov pa tau txhaj rau hauv lub zais pa, cov phab ntsa ntawm cov leeg ncaj ncaj,
cryoplasty - qhov kev ntxias no zoo ib yam li lub pob zais pa angioplasty, tab sis nthuav tawm ntawm cov leeg ntshav yog nqa tawm siv cov roj txias, uas tsis tsuas tuaj yeem nthuav cov lumen ntawm lub nkoj, tab sis kuj rhuav tshem atherosclerotic tso nyiaj,
stenting - stents tshwj xeeb yog nkag tau rau hauv lumen ntawm cov leeg ntshav, uas muaj ntau yam kev npaj rau kev rhuav tshem cov phiaj xwm sclerotic.

Thaum ua qhov kev ua haujlwm tsis zoo tsawg, cov duab angiography yog siv los tswj cov txheej txheem uas tau ua. Cov kev cuam tshuam no tuaj yeem ua rau hauv cov tsev kho mob tshwj xeeb. Tom qab lub sijhawm ua haujlwm, tus neeg mob tseem nyob hauv kev saib xyuas kev noj qab haus huv rau ib hnub, nws tuaj yeem mus tsev tom qab hnub.

Nrog txoj kev sib tw tseem ceeb ntawm lub lumen ntawm cov leeg rau kev kho mob phais, xws li cov hau kev qhib tau siv:

shunting - thaum lub sijhawm ua haujlwm, lub nkoj dag yog tsim los ntawm cov khoom siv hluavtaws lossis los ntawm ntu ntawm lwm cov hlab ntsha uas tau txais los ntawm tus neeg mob,
endarterectomy - thaum lub sijhawm ua haujlwm, thaj chaw ntawm cov hlab ntshav cuam tshuam los ntawm cov leeg plooj (atherosclerotic plaque) raug tshem tawm.

Dua li ntawm cov haujlwm uas tau tsim kho dua tshiab, cov txheej txheem phais mob pabcuam tau siv ntxiv:

revascularizing osteotomy - kev loj hlob ntawm cov ntshav me me tshiab yog txhawb los ntawm pob txha puas,
sympathectomy - qhov kev sib tshuam ntawm cov lus xaus ntawm cov hlab uas ua rau ib qho kev sib txig ntawm cov hlab ntsha, yog nqa nrog kev tsim ntawm kev pheej rov txhaws ntawm cov hlab ntsha.

Nrog kev tsim ntawm qhov loj uas tsis ua rau cov nqaij mos lossis mob nrog rau cov leeg nqaij tawv nqaij, kev phais yas tuaj yeem ua nrog kev noj qab haus huv ntawm daim tawv nqaij tom qab tshem tawm thaj chaw necrotic lossis txiav ib feem ntawm cov ceg qis.

Kev twv ua ntej rau kev kho mob ntawm obliterating atherosclerosis ntawm cov hlab ntsha ntawm qhov qis qis dua yog qhov muaj txiaj ntsig nrog tus neeg mob kho thaum ntxov los ntawm angiosurgeon. Tsis pub dhau 10 xyoo ntawm txoj kev loj hlob ntawm tus kab mob no, txoj kev loj hlob ntawm tus mob thrombosis lossis mob caj pas yog pom hauv 8% ntawm cov neeg mob.

Kev Tiv Thaiv

Txhawm rau tiv thaiv kev txhim kho ntawm atherosclerosis ntawm cov hlab ntsha ntawm cov ceg qis, kom muaj cov kev coj ua hauv qab no:

Kev kho tus mob tsis tu ncua.
Saib xyuas kev mob nkeeg tsis tu ncua tom qab 50 xyoo.
Tsis lees paub kev coj tsis zoo.
Kev noj zaub mov zoo.
Kev sib ntaus tawm tsam lub cev tsis ua haujlwm.
Kev cais tawm ntawm cov xwm txheej ntxhov siab.
Ntaus rog dhau hwv.

Dab tsi yog qhov no

Atherosclerosis obliterans yog ib hom kev mob atherosclerosis. Nrog rau tus kab mob no, cov plahaum roj (plaques) ua rau cov phab ntsa ntawm cov hlab ntsha, lawv cuam tshuam cov ntshav khiav mus los, ua rau vasoconstriction (stenosis) lossis nws txhaws tag, hu ua occlusion lossis obliteration, yog li lawv tham txog kab mob occlusal-stenotic ntawm cov leeg ntshav.

Raws li kev txheeb cais, prerogative ntawm lub xub ntiag ntawm pathology belongs rau cov txiv neej laus dua 40 xyoo. Cuam Tshuam atherosclerosis ntawm qis qis tshwm sim hauv 10% ntawm tag nrho cov pej xeem ntawm lub ntiaj teb, thiab tus naj npawb no tau nce zuj zus.

Ua rau

Lub hauv paus tseem ceeb ntawm atherosclerosis yog haus luam yeeb. Nicotine muaj nyob rau hauv cov luam yeeb ua rau cov hlab ntsha mus rau qhov tsis sib xws, thiaj li tiv thaiv kom ntshav tsis txhob txav mus los hauv cov hlab ntsha thiab ua rau muaj ntshav txhaws nyob hauv.

Lwm yam ntxiv provoking atherosclerosis ntawm cov hlab ntsha ntawm qhov qis qis thiab ua rau qhov pib ua ntej thiab mob hnyav ntawm tus mob:

cov roj (cholesterol) siab nrog kev noj zaub mov ntau ntawm cov tsiaj rog,
ntshav siab
thawj
muaj mob muaj keeb predisposition
mob ntshav qab zib mellitus
tsis muaj kev tawm dag zog txaus,
kev ntxhov siab heev.

Frostbite lossis lub caij nyoog txias ntawm txhais ceg, hloov pauv ntawm lub hnub nyoog hluas ntawm frostbite, tuaj yeem dhau los ua kev pheej hmoo.

Kev tsim kho tshuab

Feem ntau cov feem ntau, atherosclerosis ntawm cov hlab ntsha ntawm qhov qis hauv qab ua tau nws tus kheej hauv hnub nyoog laus thiab yog tshwm sim los ntawm cov lipoprotein metabolism tsis zoo hauv lub cev. Cov txheej txheem kev txhim kho mus raws cov theem hauv qab no.

Cov roj thiab triglycerides uas nkag mus rau hauv lub cev (uas tau nqus rau hauv plab hnyuv phab ntsa) yog ntes los ntawm tshwj xeeb thauj cov protein-protein - chylomicrons thiab hloov mus rau hauv cov hlab ntshav.
Cov nplooj siab ua rau cov tshuaj tshwm sim thiab coj los ua cov rog tshwj xeeb - VLDL (cov roj (cholesterol) tsawg heev).
Hauv cov ntshav, lipoproteidlipase enzyme ua rau VLDL lwg me me. Nyob rau thawj theem ntawm cov tshuaj tiv thaiv, VLDLP dhau mus rau hauv nruab nrab ntawm cov lipoproteins (lossis STLPs), thiab tom qab ntawd nyob rau theem ob ntawm kev tawm tsam, VLDLP hloov mus rau LDLA (cov roj (cholesterol) tsawg). LDL yog cov roj ("tsis zoo" cov roj) thiab nws yog qhov atherogenic ntau dua (uas yog nws tuaj yeem ua rau mob atherosclerosis).
Lub cev rog ua haujlwm nkag rau daim siab ua haujlwm ntxiv. Ntawm no, cov roj (cholesterol) ntau ntawm cov roj (HDL) yog tsim los ntawm lipoproteins (LDL thiab HDL), uas muaj cov txiaj ntsig rov qab thiab muaj peev xwm ntxuav tau cov phab ntsa ntawm cov hlab ntshav los ntawm cov roj cholesterol txheej. Qhov no yog cov roj (hmoov av) zoo. Ib feem ntawm cov rog yog ua rau hauv cov kua tsib kua qaub, uas tsim nyog rau kev ua cov zaub mov zoo, thiab xa mus rau cov hnyuv.
Nyob rau theem no, hepatic cells yuav poob (qhov hloov los yog vim muaj hnub nyoog laus dua), vim tias qhov ntawd hloov HDL ntawm qhov tawm, cov roj ntsha muaj roj tsawg yuav nyob tsis hloov thiab nkag mus rau hauv cov hlab ntshav.

Tsis muaj tsawg dua, thiab muaj peev xwm ntau atherogenic, hloov pauv lossis hloov kho lipoproteins. Piv txwv li, oxidized los ntawm kev kis tus kab mob H2O2 (hydrogen peroxide).

Cov roj ntsha uas tsis tshua muaj rog (LDL) nyob ntawm phab ntsa ntawm cov hlab ntsha ntawm qhov qis qis. Lub caij nyoog ntev dhau los ntawm cov tshuaj txawv teb chaws hauv lub lumen ntawm cov hlab ntshav pab txhawb kev mob. Txawm li cas los xij, tsis hais macrophages lossis leukocytes tuaj yeem tiv taus cov roj ntsha feem. Yog tias cov txheej txheem cia rau, txheej ntawm cov qaug cawv - plaques - yog tsim. Cov kev tso nyiaj no muaj qhov ceev heev thiab cuam tshuam nrog cov ntshav ntws li ib txwm.
Kev tso tawm ntawm cov "roj" tsis huv yog encapsulated, thiab cov ntshav txhaws tshwm sim thaum lub dawm lossis puas tsuaj rau lub tshuaj ntsiav. Cov ntshav txhaws muaj cov txiaj ntsig txuas ntxiv thiab txhaws cov hlab ntsha ntau dua.
Maj mam, cov roj txhaws feem nrog ua ke nrog cov ntshav txhaws coj tus qauv nruj, vim tias kev tso nyiaj ntawm cov ntsev calcium. Cov phab ntsa ntawm cov hlab ntsha plam lawv qhov ib txwm sib txuas thiab ua tawv, uas ua rau muaj kev sib tsoo. Ntxiv rau txhua yam, kev pheej ua ischemia thiab necrosis ntawm cov ntaub so ntswg ze yog tsim vim muaj hypoxia thiab tsis muaj cov as-ham.

Thaum lub sij hawm obliterating atherosclerosis ntawm qis qis, hauv qab no cov theem:

Theem I (kev pib ua kom ntshaus) - lub siab ntawm goosebumps, blanching ntawm daim tawv nqaij, zoo li txias thiab chilliness, tawm hws ntau dhau, nkees sai thaum taug kev,
II Ib theem (sib cav sib ceg) - zoo nkaus li qaug zog thiab txhav ntawm cov leeg nqaij nyuj, nias qhov mob thaum sim taug kev ntawm 200 m,
II B theem - qhov mob thiab qhov zoo nkaus li muaj qhov nyuaj ua tsis pub koj mus 200 m,
Theem III - qhov mob ua kom tawv nqaij hauv plab cov nqaij ntshiv tau ntau dua thiab tuaj yeem tshwm sim thaum so,
Qib IV - nyob rau saum npoo ntawm taw muaj cov cim ntawm trophic kev ntxhov siab, ntev ntev uas tsis muaj qhov txhab thiab cov cim qhia txog kev ua laib.

Hauv theem ua tiav ntawm atherosclerosis ntawm qis qis tshaj, kev loj hlob ntawm kev mob caj dab feem ntau ua rau ua tiav lossis ib nrab ntawm cov ceg txhawm. Qhov tsis muaj kev saib xyuas txaus nyob rau hauv cov xwm txheej zoo li no tuaj yeem ua rau tus neeg mob tuag.

Kev nthuav dav ntawm atherosclerosis obliterans tau faib ua theem:

Segmental obliteration - tsuas yog ib qho povtseg lub cev ntog tawm ntawm qhov chaw microcirculation,
Common occlusion (qib 2) - ib qho thaiv ntawm cov poj niam txoj hlab ntsha hauv cheeb tsam,
Kev thaiv cov kab mob popliteal thiab femoral cov hlab ntsha nrog qhov tsis muaj peev xwm pom zoo ntawm thaj chaw bifurcation,
Ua kom tiav qhov thaiv ntawm microcirculation hauv popliteal thiab femoral cov hlab ntsha - 4 degree. Nrog pathology, cov ntshav txaus rau cov kab ke ntawm cov poj niam txoj hlab ntshav sib sib zog yog khaws cia,
Kev puas tsuaj rau cov poj niam sib sib zog nqus leeg nrog kev puas tsuaj rau tus poj niam-popliteal cheeb tsam. Qeb 5 pom tus cwj pwm ntawm hypoxia hnyav ntawm qhov qis hauv qab thiab necrosis, mob nqaij hlav trophic gangrene. Qhov mob hnyav ntawm tus neeg mob dag nws tsis yooj yim los kho, yog li kev kho tsuas yog mob.

Hom occlusal stenotic txhab nyob rau hauv atherosclerosis yog sawv cev los ntawm 3 hom:

Kev puas tsuaj rau lub distal ib feem ntawm tibia thiab popliteal hlab ntsha, nyob rau hauv uas cov ntshav mus rau qis ceg yog tshwj tseg,
Plab occlusion ntawm qhov qis ceg. Ua siab ntev rau tibia thiab popliteal cov hlab ntsha raug khaws cia,
Cuam tshuam ntawm txhua lub nkoj ntawm tus ncej puab thiab ceg ceg qis nrog kev tuav tus kheej ntawm cov ceg ntawm nyias cov leeg.

Cov tsos mob ntawm OASNK hauv cov theem pib, raws li txoj cai, yog qhov muaj lubricated lossis tsis tuaj yeem ua rau nws zoo ib yam nkaus. Yog li, tus kab mob no suav tias yog insidious thiab tsis paub tshaj tawm. Nws yog qhov kev puas tsuaj rau cov hlab ntsha uas yuav ua rau maj mam hlob zuj zus, thiab qhov mob ntawm cov tsos mob hauv tsev kho mob yuav ncaj qha nyob ntawm theem ntawm kev txhim kho tus kab mob.

Thawj cov cim qhia ntawm obliterating atherosclerosis ntawm qis qis (qib ob ntawm tus kab mob):

ob txhais taw pib khov khov tas li
ceg ntau zaus mus loog
o ntawm txhais ceg tshwm sim
yog hais tias tus kab mob cuam tshuam ib txhais ceg, nws ib txwm mob siab tshaj li qhov noj qab haus huv,
mob hauv ceg tom qab taug kev ntev.

Cov kev qhia no pom nyob rau theem ob. Nyob rau theem no ntawm kev txhim kho atherosclerosis, ib tus neeg tuaj yeem taug kev 1000-1500 meters yam tsis muaj mob.

Tib neeg feem ntau tsis txuas qhov tseem ceeb rau cov tsos mob xws li khov, ncig loog, mob thaum taug kev deb. Tab sis nyob rau hauv vain! Tom qab tag nrho, pib kev kho mob rau theem ob ntawm tus kab mob, koj muaj peev xwm 100% tiv thaiv cov teeb meem.

Cov tsos mob uas tshwm sim rau 3 qib:

ntsia hlau loj hlob qeeb dua li yav dhau los
ob txhais ceg pib poob tawm
mob yuav tshwm sim nthawv nruab hnub thiab hmo ntuj,
mob tshwm sim tom qab taug kev ncua kev luv (250-900 m).

Thaum ib tus neeg muaj theem 4 obliterating atherosclerosis ntawm ob txhais ceg, nws tsis tuaj yeem taug kev 50 metres yam tsis muaj mob. Rau cov neeg mob zoo li no, txawm tias kev mus yuav khoom yuav dhau mus ua ib txoj haujlwm hnyav, thiab qee zaus nws tsuas yog mus rau hauv lub tshav puam, thaum nce toj thiab nqis ntaiv hloov mus rau kev tsim txom. Feem ntau, cov neeg mob uas muaj tus kab mob theem 4 tuaj yeem hloov mus los thoob lub tsev xwb. Thiab thaum muaj teeb meem loj tuaj, lawv sawv tsis tau hlo li.

Nyob rau theem no, kev kho mob ntawm tus kabmob obliterating atherosclerosis ntawm qis qis feem ntau ua tsis muaj zog, nws tsuas tuaj yeem txo cov tsos mob rau lub sijhawm luv thiab tiv thaiv cov teeb meem txuas ntxiv, xws li:

tsaus nti ntawm daim tawv nqaij ntawm ob txhais ceg,
mob rwj
kev mob caj dab (nrog rau qhov tshwm sim ntxiv no, txiav tawm ntawm tus nqaj yog tsim nyog).

Cov yam ntxwv ntawm chav kawm

Tag nrho cov tsos mob ntawm tus kab mob no maj mam loj hlob, tab sis, tsis tshua muaj teeb meem, obliterating atherosclerosis ntawm cov hlab ntsha ntawm qhov qis qis manifests nws tus kheej nyob rau hauv daim ntawv ntawm arterial thrombosis. Tom qab ntawd, nyob rau hauv qhov chaw ntawm txoj hlab ntsha stenosis, ib qho kev mob tshwm sim, uas tam sim ntawd thiab kaw nruj lumen ntawm cov leeg. Ib qho kab ke zoo sib xws rau tus neeg mob pib poob nthav, nws xav tias muaj qhov tsis zoo hauv kev ua kom zoo, daim tawv nqaij ntawm txhais ceg tig daj ntseg, nws yuav txias. Hauv qhov xwm txheej no, kev thov rov hais dua (suav lub sijhawm rau qhov xwm txheej tsis tuaj yeem - rau ntau teev) rau tus kws phais vascular tso cai rau koj cawm ib tus neeg ceg.

Nrog tus kab mob concomitant - ntshav qab zib, chav kawm ntawm obliterating atherosclerosis nws muaj nws tus yam ntxwv. Keeb kwm ntawm cov kab mob no tsis yog tsawg, thaum tus kab mob loj hlob sai heev (los ntawm ob peb teev mus rau ntau hnub) uas nyob rau lub sijhawm luv luv nws ua rau tus mob necrosis lossis mob caj dab hauv thaj chaw ntawm qis qis. Hmoov tsis zoo, kws kho mob feem ntau thaum muaj teeb meem tshwm sim los txiav caj dab - qhov no yog tib qhov uas tuaj yeem cawm tib neeg lub neej.

Cov ntaub ntawv dav dav

Atherosclerosis obliterans - mob ntev ntawm cov hlab ntsha txhaws, tus cwj pwm los ntawm lawv qhov ncauj mob thiab ua rau ischemia ntawm cov qis qis. Hauv kev kho plawv thiab vascular kev phais, atherosclerosis obliterans tau suav hais tias yog cov thawj coj hauv chaw kuaj mob ntawm atherosclerosis (feem ntau yog peb tom qab IHD thiab mob hlwb ischemia ntev). Cuam tshuam atherosclerosis ntawm qis qis tshwm sim hauv 3-5% ntawm tus neeg mob, feem ntau hauv cov txiv neej laus dua 40 xyoo. Lub ntsej muag sib daj sib deev feem ntau cuam tshuam rau cov hlab ntsha loj (aorta, iliac hlab ntsha) lossis cov ntshav nruab nrab (popliteal, tibial, femoral). Nrog atherosclerosis obliterans ntawm cov hlab ntsha ntawm cov leeg sab saud, subclavian leeg yog feem ntau cuam tshuam.

Ua rau ntawm obliterating atherosclerosis

Obliterating atherosclerosis yog ib qho kev ua kom pom tseeb ntawm cov kab mob atherosclerosis, yog li nws qhov tshwm sim cuam tshuam nrog tib yam etiological thiab pathogenetic mechanisms uas ua rau atherosclerotic cov txheej txheem ntawm lwm qhov chaw hauv zos.

Raws li cov ntsiab lus niaj hnub, atherosclerotic vascular puas tsuaj yog txhawb los ntawm dyslipidemia, kev hloov pauv hloov hauv lub xeev ntawm vascular phab ntsa, kev ua haujlwm tsis zoo ntawm lub receptor apparatus, thiab muaj keeb ntawm caj ces (caj ces). Lub ntsiab pathological hloov nyob rau hauv obliterating atherosclerosis cuam tshuam rau intima ntawm cov hlab ntsha. Nyob ib ncig ntawm foci ntawm lipoidosis, cov ntaub so ntswg sib txuas thiab loj hlob, uas yog nrog los ntawm kev tsim cov tawv nqaij plaques, txheej txheej ntawm platelets thiab fibrin clots ntawm lawv.

Nrog rau cov ntshav ncig tsis txaus thiab cov quav hniav necrosis, kab noj hniav yog tsim nrog cov ntaub so ntswg detritus thiab atheromatous masses. Cov tom kawg, kua muag mus rau hauv lub lumen ntawm cov leeg, tuaj yeem nkag mus rau hauv cov hlab ntshav distal, ua rau vascular embolism.Cov kev ua haujlwm ntawm cov calcium calcium hauv kev hloov cov xim fibrous plaques ua tiav lub obliterating lesion ntawm cov hlab ntsha, uas ua rau lawv tav kev. Arterial stenosis ntawm ntau dua 70% ntawm lub cheeb qhov qub ua rau muaj qhov hloov ntawm qhov thiab ntshav khiav ceev.

Qhov tseeb tshwm sim rau kev tshwm sim ntawm obliterating atherosclerosis yog kev haus luam yeeb, haus cawv, cov ntshav siab, cov roj ntsha muaj mob, tsis muaj kev qoj ib ce, tsis muaj lub zog ua haujlwm, lub cev tsis ua haujlwm. Atherosclerosis obliterans feem ntau tsim tawm tsam keeb kwm ntawm cov kab mob concomitant - txoj hlab ntshav siab, ntshav qab zib mellitus (mob ntshav qab zib macroangiopathy), rog dhau, hypothyroidism, tuberculosis, rheumatism. Cov xwm txheej hauv cheeb tsam ua rau muaj qhov ua mob txhab nqaij hlav ntawm cov hlab ntshav suav nrog ua ntej dej txhaws, raug mob ceg. Yuav luag txhua tus neeg mob uas muaj atherosclerosis obliterans, kuaj mob ntawm cov hlab ntsha ntawm lub plawv thiab lub paj hlwb.

Kev faib tawm ntawm obliterating atherosclerosis

Thaum lub sij hawm obliterating atherosclerosis ntawm qis qis, 4 theem raug cais:

1 - taug kev tsis mob yog ua tau ntawm qhov deb tshaj 1000 m. Qhov mob tshwm sim tsuas yog nrog kev tawm dag zog lub cev.
2a - tsis mob taug kev ntawm qhov deb ntawm 250-1000 m.
2b - tsis mob taug kev ntawm qhov deb ntawm 50-250 m.
3 - theem ntawm tseem ceeb ischemia. Qhov kev ncua deb ntawm kev taug kev tsis mob yog qis dua 50 m. Mob kuj tshwm sim thaum so thiab thaum tsaus ntuj.
4 - theem ntawm kev cuam tshuam trophic. Ntawm thaj chaw calcaneal thiab ntawm cov ntiv tes muaj thaj chaw ntawm necrosis, uas yav tom ntej tuaj yeem ua rau mob caj dab ntawm nqaj.

Muab cov localization ntawm cov txheej txheem occlusal-stenotic, cov hauv qab no tuaj yeem paub qhov txawv: atherosclerosis obliterans ntawm ntu aorto-iliac, ntu femoral-popliteal, popliteal-tibial ntu, multistory artery puas tsuaj. Los ntawm qhov xwm ntawm qhov txhab, stenosis thiab occlusion yog qhov txawv txav.

Feem ntau ntawm cov mob atherosclerosis obliterans ntawm cov pob txha mos thiab popliteal kom pom qhov sib txawv V hom occlusal stenotic txhab:

Kuv - tsuas (segmental) occlusion,
II - ib qho kev mob siab ntawm lub siab tawv tawv tsis txaus ntseeg,
III - thoob plaws ntawm kev ua rau lub cev nqaij daim tawv thiab thaj chaw ntawm cov leeg ntshav, thaj av ntawm trifurcation ntawm popliteal leeg yog kis tau,
IV - ua tiav obliteration ntawm sab nqaij tawv femoral thiab popliteal leeg, obliteration ntawm bifurcation ntawm popliteal leeg, patency ntawm qhov sib sib zog nqus femoral artery tsis txhim kho,
V - occlusal-stenotic lesion ntawm ntu ntu femoral-popliteal thiab cov poj niam siab leeg.

Cov kab mob sib kis ntawm cov kab mob sib kis rau tib neeg ua rau tib leeg mob ntawm cov kab mob atherosclerosis yog sawv cev los ntawm III hom:

Kuv - obliteration ntawm popliteal leeg nyob rau hauv lub distal ib feem thiab tibial cov hlab ntsha nyob rau hauv thawj tuam tsev, patency ntawm 1, 2 lossis 3 ceg leeg cov hlab ntsha yog tshwj tseg,
II - obliteration ntawm cov hlab ntsha ntawm sab ceg qis, distal ib feem ntawm popliteal thiab tibial cov hlab ntsha yog passable,
III - tshem tawm ntawm cov hlab ntsha popliteal thiab tibial, cov ntu ntawm cov hlab ntsha ntawm sab ceg qis thiab ko taw yog qhov zoo.

Kev kwv yees thiab kev tiv thaiv ntawm obliterating atherosclerosis

Atherosclerosis obliterans yog ib qho mob hnyav uas nyob rau qeb thib 3 hauv cov qauv ntawm kev tuag ntawm cov kab mob plawv. Nrog rau obliterating atherosclerosis, muaj kev phom sij ntawm kev mob caj dab, xav kom muaj kev ncua siab ntawm caj npab. Kev ntsuas ntawm obliterating kab mob ntawm qhov kawg yog kev txiav txim siab loj los ntawm qhov muaj lwm cov qauv ntawm atherosclerosis - cerebral, mob hlab ntsha hlwb. Cov chav kawm ntawm obliterating atherosclerosis, raws li txoj cai, yog tsis muaj txiaj ntsig hauv cov neeg muaj ntshav qab zib.

Cov kev tiv thaiv dav dav suav nrog kev tshem tawm ntawm kev pheej hmoo rau mob atherosclerosis (hypercholesterolemia, rog rog, haus luam yeeb, lub cev tsis ua haujlwm, thiab lwm yam). Nws yog qhov tseem ceeb tshaj plaws los tiv thaiv kev raug mob ko taw, kev tu cev thiab kev tiv thaiv kev mob ko taw, thiab kev rau khau yooj yim. Cov kev kawm kom paub tseeb txog kev kho kom zoo txhawm rau saib xyuas kev ua haujlwm ua paug, nrog rau kev phais mob kom raws sijhawm, cia koj cawm lub caj npab thiab txhim kho lub neej ntawm cov neeg mob kom zoo.