Mob qog (necrosis) ntawm ob txhais ceg hauv ntshav qab zib - cov tsos mob thiab kev kho mob
Tus mob ntshav qab zib yog ib qho necrosis ntawm cov ntaub so ntswg uas tsim vim muaj cov ntshav qab zib ntau ntau. Feem ntau feem ntau, nqaj qis dua yog qhov cuam tshuam, qhov no yog vim peculiarities ntawm cov ntshav ncig. Ntev dhau los, lawv dhau los ua tsaus vim kev sib txuam ntawm cov hlau thiab hlau sulfide. Cov tshuaj no tau muab tso tawm los ntawm cov ntshav vim muaj qhov sib txuam. Necrosis ntawm ob txhais ceg tshwm sim vim yog qhov kev txiav tawm ntawm cov pa oxygen rau cov hlab ntsha. Hauv cov neeg mob ntshav qab zib uas tau ntsib ntau dua 20 xyoo, qhov kev pheej hmoo ntawm kev txhim kho tus mob no nce mus txog 80%.
Qhov tseem ceeb ntawm kev ua laib ntawm qis qis hauv kev mob ntshav qab zib yog cuam tshuam nrog cov tsos ntawm trophic mob. Ntawm lawv yog:
Mob kheesxaws yog mob voos rau qis qis dua qhov sib txuam nrog kev tuag ntawm cov ntaub so ntswg. Nws ua rau mob hnyav, vim tias ib tug neeg plam txoj hauv kev los ua lub neej puv ntoob. Niaj hnub no, cov kws tshaj lij faib ob hom kev ua laib: qhuav thiab ntub.
Kev ua laib qhuav
Kev ua pob txha qhuav yog qhov mob rau ntawm daim tawv nqaij, qhov ua rau ua rau muaj kev ua txhaum hauv cov ntshav ncig. Feem ntau, daim ntawv no ntawm tus kabmob raug kuaj rau cov neeg mob ntshav qab zib nrog lub cev lossis lub cev qhuav dej. Lub qhov txhab tshwm sim qeeb qeeb, ua los ntawm ziab tawm ntawm cov nqaij mos. Sij hawm dhau mus, daim tawv nqaij ntawm ob txhais ceg pib khaus thiab zawm, muab cov xim av los yog xim dub. Tus tib neeg tsis tuaj yeem coj lub neej nyob ib txwm, nws dhau los ua neeg xiam oob khab. Mob khaub thuas qhuav qhawv tuaj yeem lees paub los ntawm:
- Kev mob hnyav rau hauv cov qis qis,
- Txo lossis tsis hnov mob
- Cov tawv nqaij txias ntawm ob txhais ceg,
- Qhov kev ncus tsis tu ncua ntawm loog
- Qhov tsis txaus tsim rau hauv cov ceg, lossis vim nws tsis tuaj,
- Loog ntawm ob txhais ceg
- Pallor ntawm daim tawv nqaij.
Ntub dej ua laib
Kev ntub dej hiav txwv muaj peev xwm lees paub los ntawm yuav luag tib qhov kev pom zoo li qhuav cev. Feem ntau, qhov mob no tshwm rau cov neeg mob ntshav qab zib uas rog dhau. Feem ntau, xws li cov neeg mob tau nquag npuaj ib pliag thiab cov leeg nqig ntawm qhov qis qis. Lub qhov txhab nws tus kheej yog noo, nws tsis muaj sijhawm rau kom qhuav. Xws li daim npog yog tsis tshua muaj kev sib kis ntawm cov kab mob thiab cov kab mob, thiab tseem tuaj yeem ua rau intoxication loj. Kev ntub dej nyab yog qhov ntau dua yuav ua rau neeg tuag taus. Qhov tshwm sim no tuaj yeem lees paub los ntawm cov cim hauv qab no:
- Kev mob hnyav rau hauv cov ceg qis dua,
- Lossi tam sim no ripple,
- Qhov nce hauv lub cev kub,
- Qhov tsis hnov tsw ntawm rot los ntawm qhov qis hauv qab,
- Qhov tsim ntawm ntau cov pob liab liab ntawm daim tawv nqaij,
- Tam sim no pulsation nyob rau hauv ob txhais ceg,
- Discoloration rau qis dua extremities, lawv kis tau ib lub xiav Hawj los yog liab doog,
- Cov nqaj ua kom leeg ntshav ntawm ob txhais ceg.
Cov hau kev kho
Kev kho tus neeg mob ntshav qab zib nrog ntshav qab zib yuav tsum muaj kev sib koom tes. Nws yog ib qho tseem ceeb kom ua raws txhua cov lus qhia ntawm tus kws kho mob koom, vim tias tsis quav ntsej cov lus pom zoo tuaj yeem ua rau muaj kev txhim kho ntawm cov kev mob nyhav heev.
- Angioplasty thiab stenting yog cov txheej txheem uas pab ua yeej ib hom mob ntshav qab zib uas mob ntshav qab zib. Nrog lawv cov kev pab, nws yog ib qho ua tau kom tawm ntawm qhov ceg. Qhov tseem ceeb ntawm cov hau kev yog kev rov ua dua ntawm cov hlab ntsha uas tau tawg, uas ua kom rov qab muaj ntshav. Kev cuam tshuam yog nqa tawm hauv tsev kho mob, tsis muaj tshuaj loog - los ntawm kev mob me, tus kws kho mob nqa tawm txhua qhov tsim nyog siv nrog cov cuab yeej tshwj xeeb. Thaum lub sij hawm tus txheej txheem, ib tug neeg xyaum tsis poob ntshav.
- Kev phais Vascular bypass yog ib qho kev cuam tshuam uas tuaj yeem kho cov ntshav ncig nyob hauv qis qis, nrog rau daws cov ischemia. Qhov qauv no yog radical heev, nqa tawm hauv kev siv tshuaj loog. Lub ntsiab lus ntawm kev cuam tshuam yog los hloov cov hlab ntsha nrog cov coj tshwj xeeb uas ua haujlwm ntawm cov hlab ntsha.
- Kev pleev cov tawv nqaij yog txheej txheem uas tus kws kho mob tswj cov nqaij cuam tshuam thiab tuag. Hloov chaw ntawm thaj chaw cuam tshuam, cov ntaub so ntswg kev kho mob tshwj xeeb tuaj yeem raug xaws. Cov kws kho mob tuaj yeem hloov cov ntaub so ntswg los ntawm lwm qhov ntawm lub cev.
Lwm txoj kev kho mob
Qee cov kws tshaj lij sau tseg tias kev kho mob yoo mov yuav pab kom tsis txhob muaj kab mob ntshav qab zib ntau dua. Nov yog ib txoj kev siv ntawm ib tus kws khomob uas tau siv ntau tshaj plaws yuav tsum tau sojntsuam tas li. Nws yog qhov zoo tshaj plaws los ua qhov no hauv tsev kho mob tshwj xeeb. Ntawm cov theem pib ntawm kev tsim cov qog ntshav, kev tshaib plab muaj peev xwm ua kom tiav qhov kev ua kab mob. Tsis tas li ntawd, kev thauj mus los txhua hnub ntawm ob txhais ceg yuav pab tsim kom muaj ntshav kev khiav haujlwm.
Kev Tiv Thaiv
Ntshav qab zib mellitus yog ib qho kev ua rau endocrine mob hnyav uas ua rau muaj ntau yam kabmob phem. Txhawb cov ntshav qab zib kom cuam tshuam tsis zoo rau kev noj qab haus huv ntawm cov hlab ntshav, uas tuaj yeem ua rau cov ntaub so ntswg puas. Nyob rau hauv rooj plaub ntawm lub sijhawm ntev kev saib xyuas, cov ntshav qab zib ua rau muaj kev mob hnyav uas feem ntau cuam tshuam rau cov qis qis.
Txo qhov kev pheej hmoo ntawm kev txhim kho cov kab mob no, nws yog ib qho tsim nyog yuav tsum ua raws li cov kev tiv thaiv kev coj ua nram no:
- Tsis kam lees los ntawm txhua qhov kev coj ua tsis zoo uas cuam tshuam rau cov ntshav ncig: haus luam yeeb, haus dej haus cawv,
- Nqa rov qab koj lub cev qhov hnyav, uas nce ntshav siab,
- Xaiv koj nkawm khau kom zoo: lawv yuav tsum yog qhov zoo thiab xis,
- Saib xyuas koj cov kev noj haus, yuav tsum tsis muaj cov piam thaj hauv nws,
- Txhua zaus yuav tsum hnav thom khwm - lawv yuav tsum yog ntaub ntawm cov ntaub,
- Muaj ntau nkawm khau - tib nkawm khau tsis tuaj yeem hnav ntev dua 2 hnub,
- Kuaj koj cov ceg qis dua txhua hnub
- Yog hais tias muaj qhov txhab dab tsi tshwm sim nyob rau saum npoo ntawm qis qis, tam sim ntawd kho lawv,
- Tsis txhob hnav cov khau khiab holey, vim tias lawv tuaj yeem ua kom tawv nqaij,
- Thaum pom mob caj dab los yog caj dab, qhwv ob txhais ceg nrog daim ntaub qhwv - ntaub qhwv caj dab tuaj yeem cuam tshuam rau txheej txheej sab saud ntawm daim tawv nqaij,
- Tsis txhob da dej kub uas ceev cov ntshav kev,
- Thaum tsaus ntuj, pleev cov roj rau cov tawv nqaij uas pab ua kom muaj zog thiab rov ua kom cov tawv nqaij tsis huv.
Ua cov kev tiv thaiv yooj yim yuav pab kom koj tiv thaiv los yog nres qhov kev ua laib ntawm qhov qis qis. Yog tias koj pom cov cim qhia thawj hauv koj tus kheej, sab laj nrog kws kho mob.
Dab tsi yog kev lom zem
Mob ntshav qab zib mellitus yog ib yam kab mob ua rau xeeb leej xeeb ntxwv mob ntshav siab los ntshav. Qhov laj thawj yog qhov tsis muaj peev xwm ntawm cov hlwb tsim cov tshuaj insulin lossis thev taus rau nws. Yog tias tsis muaj cov tshuaj insulin, cov piam thaj tsis nkag mus rau hauv cov cell, accumulates hauv cov ntshav thiab ua rau hyperglycemia (nce siab hauv cov piam thaj).
Lub caij nyoog ntev, tsis pom qhov tseeb hyperglycemia ua rau muaj kev phom sij rau lub cev, maj mam rhuav tshem cov hlab ntshav, txoj hlab ntshav. Mob ntshav qab zib yog ib qho mob hnyav hnyav ntshav qab zib.
Kev mob caj dab yog txoj hauv kev pathological ua rau pom ntawm necrosis (necrosis) ntawm cov ntaub so ntswg. Cov kab mob pib tuag vim raug mob, noj tsis txaus, muaj mob.
Nws muaj ntau qhov laj thawj uas ua rau cov txheej txheem no:
- tabkaum ncig,
- kis tau tus mob
- lub cev, tshuaj cuam tshuam rau lub cev.
Kev ua qog ntshav qis dua hauv cov ntshav qab zib yog qhov ua rau txo qis lub neej, poob peev xwm ntawm kev ua haujlwm, thiab xiam oob khab.
Txoj kev pheej hmoo ntawm tus neeg mob ntshav qab zib hauv cov neeg mob ntshav qab zib piv nrog cov neeg muaj kev noj qab haus huv tau nce: hauv cov txiv neej los ntawm 50 npaug, hauv cov poj niam txog 70 zaug.
Kev faib tawm
Mob kheesxaws hauv ntshav qab zib tsis tshwm sim yog kab mob ywj pheej. Nws yog tsim raws li kev txhim kho pathology vim muaj ntshav qab zib.
Cov kab mob nram no yog qhov sib txawv:
Kev tsim kho hauv ntshav qab zib - tsuas yog haus txhua txhua hnub.
- Ischemic - ua txhaum ntawm lub patency ntawm cov ntshav hauv cov hlab ntsha vim qhov nqaim, tsim cov ntshav txhaws. Cov tsos mob: daim tawv yog txias, daj ntseg nrog thaj chaw ntawm hyperpigmentation, mob thaum taug kev, tsis muaj mem tes hauv cov hlab ntsha nrog kev paub zoo.
- Neuropathic - qhov txo qis hauv qhov rhiab vim qhov kev rhuav tshem ntawm cov hlab ntawm cov hlab leeg. Cov tsos mob: daim tawv yog sov, nrog tsaus tsaus, mob thaum tsaus ntuj, txo qis rhiab nrog ib qho tshwj xeeb mem tes rau ntawm cov hlab ntsha,
- Sib xyaw (neuro-ischemic) - cov ntshav tsis txaus thiab txo qis rhiab.
Los ntawm cov khoom ntws tawm, 2 hom kev ua qoj ua si tau txawv.
- Kev ua si qhuav hauv cov ntshav qab zib. Nws tshwm sim hauv lub cev qhuav dej, yuag cov neeg mob yog vim cov ntshav ncig tsis txaus. Nws yog tsiag ntawv los ntawm kev nthuav dav zuj zus. Cov ntaub so ntswg pib qhuav, ua ntaub qhwv, tuab. Maj mam, qhov chaw puas ua rau xim av lossis xim av nrog lub ntsej muag xiav. Nws yog tus cwj pwm hais tias qhuav necrosis tsis ua ntej dhau ntawm qhov chaw cuam tshuam. Cov kab mob pathogenic yuav luag tsis tuaj yeem tsim nyob rau hauv cov ntaub so ntswg qhuav, yog li tsis muaj intoxication ntawm lub cev. Txawm li cas los xij, thaum kis tau tus mob, muaj qhov tuaj yeem hloov mus rau daim ntawv ntub.
- Ntub dej ua kom lom neeg muaj ntshav qab zib. Qhov tseem ceeb vim li cas los xij yog tias cov ntshav cov ntshav muaj kev cuam tshuam loj heev los ntawm kev mob ntawm thrombosis. Cov nqaij mos tau tuag sai, cov txheej txheem sib kis tau txav mus rau thaj chaw ze. Caj npab cuam tshuam los ua qhov xiav xiav-violet hue, thaum koj nias tawv nqaij, lub suab ntxig hnov, hnov ntxhiab ntawm rotting tshwm. Tus neeg mob ntawv tau mob nyhav vim yog intoxication. Yog tias tsis muaj kev kho mob, muaj kev hem thawj ntawm sepsis thiab kev tuag.
Koj tsis tuaj yeem kho nrog kev kho mob ntawm pathology koj tus kheej, nws raug nquahu kom sab laj nrog tus kws kho mob tam sim ntawd.
Ua rau
Kev mob ntshav qab zib yog mob tsis zoo rau cov hlab ntsha thiab leeg ntshav xwb. Nws ua txhaum cov metabolism hauv lub cev, ua kom lub cev tsis muaj zog, ua rau cov neeg mob lub cev tiv thaiv kab mob. Cov piam thaj siab ntau tsim ib qho chaw zoo rau kev tsim cov kab mob me me. Nrog rau cov kab mob vascular, kev mob siab me ntsis, ua txhaum ntawm daim tawv nqaij nrog tus kab mob ua rau ntev ntev tsis kho.
Hauv cov neeg noj qab nyob zoo, lub qhov txhab ua rau nws tus kheej hnov mob. Hauv cov ntshav qab zib, vim tias txo qis rhiab, qhov no tsis tas li tshwm sim thiab qhov mob me ntawm daim tawv nqaij tau dhau los ua mob. Mob taw yog ib qho pathology ua rau mob rau sab hauv thiab mob hlwb.
Ntshav qab zib mob ko taw yog cov txheej txheem pathologies uas tshwm sim hauv cov hlab, cov leeg, pob txha, thiab pob qij txha ntawm ko taw. Rov tshwm sim tawm tsam keeb kwm ntawm qhov ntev ntawm hyperglycemia. Hloov cov pob txha thiab pob txha mos ua rau qhov tseeb tias lub nra thaum taug kev faib tsis ncaj, muaj kev nce siab ntawm ib tus neeg qhov chaw. Daim tawv nqaij coarsens rau lawv, corns tshwm, nyob rau hauv uas tawg thiab mob txhab rau.
Teeb meem los ntawm qhov tseeb tias cov laus dua, cov neeg mob hnyav dua tuaj yeem kuaj tsis tau ntawm txhais taw ntawm lawv tus kheej. Qhov no ua rau muaj kev pheej hmoo kis mob ntawm qhov txhab.
Kev pheej hmoo ntawm txhais ceg txhawm rau mob ntshav qab zib yog nce nyob rau hauv lub xub ntiag ntawm cov yam:
- Lub caij nyoog hyperglycemia,
- atherosclerosis
- keeb kwm txog mob ntshav qab zib,
- leeg mob thrombosis,
- haus luam yeeb thiab cawv
- kev tu cev tsis huv thiab kev tu ko taw tsis zoo.
Cov kab mob ua rau cov roj ntsha ntev ntev hauv 30-40% cov neeg mob ntshav qab zib thoob plaws lub neej. Nyob rau tib lub sijhawm, 20-25% raug pw tsev kho mob vim tias muaj cov mob ntshav qab zib ko taw.
Mob caj dab li cas ceg pib?
Cov theem pib ntawm kev mob ntshav qab zib hauv ntshav qab zib feem ntau nyuaj rau kev txiav txim siab. Qhov tseem ceeb ua rau tus kabmob phom sij no yog vascular ntshaus.
Peb muab cov luv nqi rau cov nyeem ntawm peb lub xaib!
Cov tsos mob qhia tias cov tsos ntawm cov teeb meem:
- Tswm sib. Muaj kev xav so ntau zaus thaum taug kev.
- Nkoog khov txawm nyob hauv lub caij ntuj sov.
- Loog, poob ntawm txoj kev xav.
- Tawv daj, ntsej muag daj, tshwj xeeb tshaj yog ntawm cov ntiv tes.
- Tig taw hauv taw, ntiv tes.
Feem ntau cov neeg mob mus cuag kws kho mob, twb muaj cov tsos mob ntawm kev txhawm rau ntawm qis qis hauv cov ntshav qab zib:
- npaws
- mob ceg siab heev
- xeev siab, tsis muaj zog vim yog intoxication,
- purulent txhab.
Tib leeg ntawm ko taw, ntiv tes - cov chaw uas feem ntau yuav muaj kev mob caj dab los ntawm kev mob ntshav qab zib.
Kev ntshav tsis muaj zog, txo qhov mob rhiab ua rau qhov tseeb tias cov qhov txhab me ua paug thiab loj tuaj mus rau qhov mob txhab.
Kev kuaj mob
Kev ua qog ntshav ntawm qhov qis qis, ua rau mob ntshav qab zib, yog qhov nyuaj rau kho. Nrog lub hnub nyoog, txoj kev pheej hmoo yuav tau txais cov kev nce ntxiv no, nws nyob ntawm lub sijhawm thiab qhov mob ntshav qab zib ntau dua.
Kev kuaj mob yog ib qho tseem ceeb los txheeb xyuas qhov pib ntawm cov txheej txheem pathological. Rau qhov no, nws yog qhov yuav tsum tau mus soj ntsuam ib txwm muaj los ntawm tus kws kho mob endocrinologist, orthopedist, kws kho pob txha, thiab kws phais vascular.
Nws tseem yog qhov yuav tsum tau mus hla txoj kev tshawb fawb ntau:
- kev kuaj ntshav thiab zis rau cov piam thaj,
- ultrasound dopplerography ntawm cov hlab ntsha (Doppler ultrasound) - kev txiav txim siab ntawm kev ua txhaum hauv cov hlab ntshav ntawm cov hlab ntshav,
- angiography - kev kuaj mob ntawm txoj kev nqaim thiab txhaws cov hlab ntshav,
- Xoo hluav taws xob ntawm ko taw, tshawb pom tias muaj kev hloov pauv ntawm tus taw,
- densitometry, kis ntawm cov cim ntawm txha,
- angiography, txiav txim xyuas lub xeev ntawm cov hlab ntsha thiab qhov xwm ntawm ntshav ntshav.
Cov neeg uas muaj ntshav qab zib yuav tsum niaj hnub ua qhov kev pom ntawm lawv ko taw rau tus raug mob me. Nws yog qhov tseem ceeb rau lawv kom paub tias kev ua nruj ua tsiv ntawm qis qis qis tshaj yog li cas thiab nws cov tsos mob.
Kev ua qias neeg ntawm qis qis dua, nyuaj los ntawm ntshav qab zib mellitus, yog qhov nyuaj rau kev kho. Cov kev mob plab zom mov, tiv thaiv kab mob tsis muaj zog, kab mob sib kis ua rau muaj kev tiv thaiv sai.
Kev kho mob zoo sib xws txhawm rau tshem tawm cov laj thawj tseem ceeb ntawm tus kabmob:
- txo hauv cov ntshav qabzib,
- txo ntawm cov txheej txheem inflammatory vim yog tshuaj tua kab mob thiab kev kho mob ntawm qhov txhab,
- tshem tawm ntawm intoxication,
- tshem tawm ntawm ntau yam ua rau ua rau necrosis - tshem tawm ntawm cov ntshav txhaws, kev hla dhau kev phais,
- txo ko taw load.
Nrog kev ua paug dej qhuav, qhov xwm txheej dav dav ntawm tus neeg mob yog qhov ruaj khov heev, tsis muaj kev hem thawj ntawm kev tuag. Yog li ntawd, kev nqis tes ua haujlwm tau muab ncua kom txog thaum pom ib thaj chaw ntshiab uas pom ntawm daim ntaub qhov tuag thiab qhov qub.
Nrog rau qhov kev sib kis sai sai ntawm cov txheej txheem purulent, cov kws kho mob ua kom zoo rau cov ntaub so ntswg uas puas, nrog kev kho ntxiv. Hauv qhov teeb meem tshwj xeeb tshaj yog - txhawm rau tshem tawm ntawm ib qho povtseg.
Raws li kev txheeb cais, txhais tau hais tias txhais ceg ntau dua yog txiav, lub peev xwm ntau dua li kev tuag nyob hauv ob peb xyoos.
Mob ntshav qab zib yog nrog ntau yam mob. Sij hawm dhau mus, cov kab mob pathologies ntawm cov hlab plawv cov ntshav, lub raum tshwm sim, cov metabolism tsis muaj peev xwm, tiv thaiv kab mob tsawg. Qhov no ua rau nyuaj thiab qeeb ntawm cov txheej txheem kev kho mob thiab rov qab ntawm cov neeg mob, piv nrog cov neeg tsis muaj ntshav qab zib.
Yuav luag txhua tus neeg mob ntshav qab zib, tom qab 10 txog 15 xyoos txij li pib muaj tus kabmob, cov tsos mob ntawm cov vascular tshwm sim. Kev tu ncua sijhawm thiab kev phais mob pab kom tshem tawm cov kev mob no zoo thiab tiv thaiv kev ua tub rog ntawm cov qis hauv ntshav qab zib.
Cov cim thiab tsos mob ntawm tus neeg mob ntshav qab zib hauv ntshav qab zib
Nws yog ib qho tseem ceeb kom nco ntsoov tias kev sib deev qhuav tau muaj peev xwm kis tau, uas tuaj yeem ua rau kev txhim kho ntawm txoj kev ntub dej txhaws.
Cov tsos mob ntawm kev ua laib ntub:
- o ntawm qhov chaw cuam tshuam,
- daim tawv liab, uas tom qab ntawd hloov xim rau xim av lossis xim dub,
- cov qhov ncauj tawm, qhov txhab lossis mob ua paug los ntawm qhov uas muaj kua paug,
- tsis hnov tsw tsw ntawm kev zais,
- ua npaws thiab cov tsis muaj zog,
- nrog roj txhaws caj dab, blanching ntawm daim tawv nqaij ntawm thaj chaw cuam tshuam raug pom. Thaum koj nyem rau ntawm daim tawv nqaij, lub suab nrov quaj lossis nqhoo nrov,
- nrog kev ua haujlwm sab hauv, kev mob hnyav hauv lub cev yog pom.
Txawm tias ib qho ntawm cov cim saum toj no tuaj yeem yog qhov tsos mob ntawm qhov pib ntawm tus kab mob, yog li ntawd, yog tias lawv tshwm sim, koj yuav tsum sab laj nrog kws kho mob.
Cov tsos mob ntawm tuag taus septic:
- ntshav siab
- lub plawv dhia,
- npaws
- tsis meej pem,
- txog siav
- kiv taub hau.
