Taimako na farko don girgiza hypovolemic da hanyoyi don magani

Tare da mummunar asarar jini ko rashin ruwa mai tsafta, gazawa na faruwa a cikin halayen sakamako na jiki, kuma rawar jiki na haɓaka. Wannan halin an nuna shi ta hanyar keta dukkan mahimman ayyuka: zagayawa cikin jini yake raguwa, numfashi yana raguwa, ƙwaƙwalwar metabolism tana wahala. Rashin ruwa a cikin jijiyoyin jini na da haɗari musamman ga yara, tsofaffi da kuma mutanen da ke fama da rashin ruwa a jiki sakamakon rashin kula da cututtukan siga da hauhawar jini, da cutar koda.

Hypovolemia a mafi yawan lokuta ana iya rama idan mai haƙuri ya sami taimakon farko, kuma an kawo shi asibiti a kan lokaci. Amma akwai wasu lokuta lokacin da ba zai yiwu a dakatar da asarar ruwa ba, to sai girgizawar hypovolemic ƙare mutuwa.

Dalilin ci gaban rikitarwa

Mahimmancin manufar "rawar jiki cikin rashin tsoro" ya ta'allaka ne da sunan sa. Hypovolemia (hypovolaemia) a cikin fassarar da ta dace - rashi (yawan hipo-) yawan jini (haima). Kalmar "rawar jiki" na nufin rawar jiki, rawar jiki. Don haka, girgizawar hypovolemic babban sakamako ne saboda rashiwar jini a cikin tasoshin jini, yana haifar da rushewar gabobin jiki da lalata jijiyoyin jiki.

Ciwon sukari da hauhawar jini zai zama abin da ya wuce

• Normalization na sukari -95%
• Cirewa kan jijiyoyin mara wuya - 70%
• Cire zuciyar mai karfin zuciya -90%
• Rabu da cutar hawan jini - 92%
• Increasearuwar kuzarin rana, inganta bacci da dare -97%

Daga na duniya rarrabuwakuma pathology ake magana a kai R57, Lambar ICD-10 y - R57.1.

Abubuwan da ke haifar da raguwa a cikin jini ya kasu kashi biyu (saboda zubar jini) da bushewar jini (saboda rashin ruwa).

Jerin abubuwanda suka fi haifar da girgiza kai:

Zubda jini a cikin tsarin narkewa. Dalilansu:

• ciwon ciki;
• kumburi na hanji na daban-daban etiologies;
• varicose veins na esophagus saboda cutar hanta ko matsawa ta hanyar jijiya ta hanji, mafitsara, duwatsu;
• katse bango na esophagus a lokacin wucewar jikin baƙi, saboda ƙonewar sunadarai, yayin da yake hana sha'awar amai;
• neoplasms a ciki da hanji.
• aorto-duodenal fistula - fistula tsakanin aorta da duodenum 12.

Jerin wasu dalilai:

1. Zub da jini na waje saboda lalacewarsa. A wannan yanayin, yawan shakatawa na hypovolemic sau da yawa ana haɗuwa tare da rauni.
2. Zub da ciki na ciki saboda fashewar kasusuwa da ƙashin ƙugu.
3. Rashin jini daga wasu gabobin: katsewa ko daidaitawa da aortic aneurysm, katsewa daga cikin rauni saboda tsananin rauni.
4. Zubda jini a cikin mata yayin daukar ciki da haihuwa, guguwar cysts ko ƙwayoyin ciki, ciwace.
5. Konewa yana haifar da sakin plasma a saman fata. Idan babban yankin ya lalace, asarar ƙwayar cutar plasma yana haifar da bushewa da rawar jiki.
6. Rashin ruwa na jiki saboda tsananin amai da gudawa tare da cututtukan da ke kama da cutar (rotavirus, hepatitis, salmonellosis) da guba.
7. Polyuria a cikin ciwon sukari, cutar koda, amfani da diuretics.
8. Cutar hyperthyroidism mai narkewa ko cututtukan jini tare da gudawa da amai.
9. Yin tiyata tare da zubar jini.

Haɗe da dalilai da yawa za'a iya lura, kowane ɗayan kowannensu ba zai haifar da girgizawar hypovolemic ba. Misali, a cikin cututtukan fata mai tsananin zafi tare da zazzabi mai yawan gaske da kuma maye, girgiza na iya haɓaka ko da saboda asarar ruwa da gumi, musamman idan sauran ƙwayoyi suka raunana jiki, kuma mara lafiya ya ƙi ko kuma ya kasa sha. Hakanan, a cikin 'yan wasa da mutanen da suka saba da yanayin zafi da ƙarancin yanayi, rashin lafiyar ta fara tasowa daga baya.

Pathogenesis na girgiza hypovolemic

Ruwa wani bangare ne na dukkanin ruwa-jiki - jini, lymph, hawaye, yau, ruwan danshi, fitsari, ciki-da-ruwa. Godiya gareshi, ana isar da oxygen da abinci mai gina jiki ga kyallen takarda, ana cire samfuran abubuwan da ba dole ba, ana motsa jijiyoyi, dukkan halayen sunadarai suna faruwa. Abun da aka shirya da kuma yawan taya shi tsayayye ne kuma ana kula dashi koyaushe ta tsarin sarrafawa. Abin da ya sa ke haifar da cututtuka na mutum a cikin gwaje-gwaje na dakin gwaje-gwaje.

Idan matakin ruwa a jiki ya ragu, to yawan jini a cikin jiragen shima yana faduwa. Ga lafiyayyen mutum, asarar da ba ta wuce kashi ɗaya cikin huɗu na jini mai zagayawa ba haɗari, ƙarar saurin dawo da ita nan da nan bayan an cika rashin ruwa. A wannan halin, ba a keta ragarar abubuwan dake gudana ba saboda hanyoyin sarrafa kai.

Lokacin da kashi 10% na jini ya ɓace, jiki yana fara aiki don rama don hypovolemia: kayan jini da aka ajiye a cikin saifa (kimanin 300 ml) ya shiga cikin tasoshin, matsin lamba a cikin abubuwan ƙwanƙwasawa ya ragu, wanda ruwa daga tsokoki ya shiga cikin jini. Ana sake sakin catecholamines. Suna hana jijiyoyi da jijiyoyin jiki har zuciyar ta iya cika jini kwata-kwata. Da farko dai, yana shiga kwakwalwa da huhu. Jinin jini zuwa fata, tsokoki, tsarin narkewa, da kodan na faruwa ne bisa ka'idodin saura. Don riƙe danshi da sodium, urination ya ragu. Godiya ga waɗannan matakan, matsin lamba ya kasance al'ada ko ya faɗi na ɗan gajeren lokaci tare da canji mai ƙarfi a yanayin aiki (orthostatic hypotension).

Lokacin da zubar da jini ya kai 25%, hanyoyin sarrafa kai ba su da ƙarfi. Idan ba a magance ba, tsananin hypovolemia yana haifar da girgiza hypovolemic. Jigilar jini daga zuciya yana raguwa, saukar karfin matsin lamba, gurguwar gurguwa, gurbata bango da sauran kwayoyin jikinsu sun lalace. Sakamakon yunwar oxygen, karancin dukkanin gabobin na faruwa.

Bayyanar cututtuka da alamu

Mai tsananin alamun alamun girgiza ya danganta da asarar ƙwayar ruwa, damar raunin jiki da raguwar ƙarar jini dake yawo a cikin jiragen. Tare da ƙaramar zubar jini, ƙara yawan zubar ruwa a jiki, a cikin tsufa, alamun girgiza haihuwar da farko na iya zama.

Bayyanar cututtuka tare da bambance bambancen matakan asarar jini:

Zub da jini a waje yana da wuya mutum yayi rashin sa'a, amma ana yin gwajin zubar jinni ciki yayin da fargaba ya ginu.

Jinkiri rasa jini daga gabobin ciki ta wadannan alamun:

• tashin zuciya, amai jini, black feces da zubar da jini cikin ciki da esophagus;
• bloating;
• yawan fitar jini da huhun jini;
• ciwon kirji
• Scarlet din alkyabba a cikin fitsari;
• zubar jinin farji yayin haila fiye da kwana 10 ko fiye da yadda aka saba.

Matakan bincike

Bayan isar da shi asibiti, mai haƙuri tare da zargin hypovolemic gigicewa ana ɗaukar jini nan da nan, ƙungiyar da rhesus an ƙaddara, binciken dakin gwaje-gwaje na abubuwan da ya ƙunsa, ciki har da bashin jini da kuma yawan dangi, ana yin su. Don zaɓar maganin da ake buƙata, bincika abin da ya shafi electrolytes da pH na jini.

Idan ba a bayyana dalilin girgizar ba, yi bincike don gano shi:

1. X-ray tare da zargin fashewar hanji.
2. Catar catheterization na mafitsara, idan akwai damar lalacewar tsarin fitsari.
3. Endoscopy don bincika ciki da esophagus.
4. Duban dan tayi na gabobin mahaifa don gano asalin zubar jinni na farji.
5. Laparoscopy, idan akwai tuhuma da cewa jini ya tara a cikin rami na ciki.

Don fayyace matakin GSH, ana lissafta ƙararrawa. Wannan shine kashin rarrabar bugun kwatankwacin minti ɗaya ta hanyar alamar systolic. A yadda aka saba, wannan jigon ya kamata ya zama 0.6 ko lessasa da yawa, tare da matsanancin girgiza - 1.5. Tare da zubar da jini mai yawa ko bushewar rayuwa, barazanar girgiza kai ya fi 1.5.

Eterayyadewa da ƙarar jini rasa ta girgiza index, hematocrit da dangi jini yawa:

Hypovolemic gigicewa an tabbatar dashi ta hanyar gwaji: idan bayan gudanarwar 100 ml na jini a cikin mintina 10 mai karfin jini ya tashi da alamu, to ana ganin cutar ta zama karshe.

Sabis na Tallafi na Farko ga Ma'aikata Janar

Ba shi yiwuwa a shawo kan tsawan hypovolemic ba tare da taimakon likitoci ba. Ko da sanadin lalacewa ne, ba zai yuwu cikin sauri dawo da ƙarar jini ta hanyar shan mai haƙuri ba, yana buƙatar jiko na ciki. Don haka, matakin farko da wasu yakamata su dauka yayin da alamun girgiza ya bayyana kira motar asibiti.

Algorithm na gaggawa kafin isowar likitoci:

1. Lokacin zub da jini, sanya mara lafiya saboda lalacewa ta zama 30 cm sama da zuciya. Idan girgiza ya haifar da wasu dalilai, tabbatar da kwararawar jini zuwa zuciya: sanya mai haƙuri a bayansa, a ƙarƙashin kafafu - abubuwa abin hawa. Idan kuna zargin rauni na kashin baya (alama alama ce rashin hankali a cikin gabar jiki), an haramta canza matsayin jikin.
2. Juya kanka a gefe don mai haƙuri ba ya jin nauyi idan amai ta fara. Idan bai san komai ba, duba don numfashi. Idan ba ta da ƙarfi ko hayaniya, bincika ko hanyoyin da ke cikin iska ba za suwu ba. Don yin wannan, tsaftace bakin ciki, yatsunsu don samun harshen da ke narkewa.
3. Tsaftace farjin rauni. Idan abubuwa na kasashen waje sun shiga cikin kyallen takarda, haramun ne a taɓa su. Yi kokarin dakatar da jinin:

- Idan reshin da ya ji rauni ne sanadin girgizawa, sanya wurin shakatawa ko murza shi sama da rauni. Timeauki lokaci, rubuta shi a wata takarda kuma ku zame shi ƙarƙashin baƙon yawon shakatawa. Kawai sanar da mara lafiya game da lokacin da ake amfani da dandalin ba su isa ba. A lokacin isar da shi zuwa asibiti, zai iya sarance.

- Tare da zubar jinni (alamu - duhu, a ko'ina yana gudan jini) a maimakon haka sai a rufe bandage. Zai fi kyau idan maganin rigakafi ne. Lokacin yin bandaging, yi ƙoƙari ku haɗa gefuna rauni tare.

- Idan ba zai yiwu a yi amfani da bandeji ko kayan shakatawa ba, an tsayar da jini da gawuze swab, kuma a cikin rashi, tare da kowane zane ko ma jakar filastik. Ana amfani da bandeji a yadudduka da yawa ga rauni kuma an matse tare da hannunsa tsawon minti 20. Ba za ku iya cire swab duk wannan lokacin ba, har ma da wasu .an mintuna biyu. Idan an cika shi da jini, ƙara sabon shimfidar bandeji.

4. Rufe mara lafiya, in zai yiwu a kwantar da hankali kuma kar a barshi kafin motar asibiti ta zo.
5. Tare da zub da jini na waje ko tuhuma na ciki, bai kamata ku ba mai haƙuri sha, har ma fiye da haka kada ku ciyar da shi. Wannan hanyar za ku rage yiwuwar asphyxiation.

Yadda ake kulawa da GSH

Aikin likitocin gaggawa shine dakatar da zub da jini, sanya maganin a cikin mahaifa kuma, yayin jigilar zuwa asibiti, fara matakin farko na gyaran hawan jini. Manufar wannan matakin shine samar da ƙarancin samarda jini domin aikin gabobin jiki da inganta haɓakar oxygen zuwa kyallen. Don yin wannan, ɗaga matsin lamba zuwa 70-90.

An cimma wannan burin ta hanyar hanyoyin maganin jiko: ana saka catheter a cikin jijiya da kuma crystalloid (saline ko maganin Ringer) ko colloidal (Polyglukin, Macrodex, Gekodez) ana shigar da mafita kai tsaye zuwa cikin jini. Idan zubar jini yayi nauyi, zaka iya aiwatar da jiko a cikin wurare 2-3. A wannan yanayin, ya zama dole don tabbatar da cewa matsi bai tashi da ƙarfi ba, bai wuce 35 a cikin mintuna 15 na farko ba. Saurin haɓaka matsin lamba yana da haɗari ga zuciya.

Oxygen yunwa na sel an rage shi ta hanyar inhalation tare da cakuda iska tare da akalla oxygen 50%. Idan yanayin mai haƙuri yana da rauni mai ƙarfi, farawa na wucin gadi.

Idan tashin hankalin hypovolemic ya yi tsauri sosai kuma babu amsa ga rashin lafiyar, ana gudanar da hydrocortisone ga mai haƙuri, yana taimakawa jiki ya haɗu da kuma daidaita ƙarfi. Wataƙila gabatarwar magunguna daga ƙungiyar masu juyayi, waɗanda ke tsokanar tashin hankalin adrenaline, vasoconstriction da ƙara matsa lamba.

Ana yin waɗannan matakai na gaba na magani tuni a asibiti. Anan, gabatarwar crystalloids da colloids sun ci gaba. Diyya don asarar tare da samfuran jini ko abubuwanda ke ciki, zubar da jini, an wajabta ne kawai don asarar jini mai ƙarfi, saboda zai iya haifar da baƙin ciki na tsarin rigakafi. Idan karancin jinin ya fi kashi 20%, toshewar sel da aka sa a ciki kuma an saka albumin a cikin maganin farko. Tare da zubar da jini mai yawa da amai mai ƙarfi, ana saka plasma ko jini da aka shirya.

Bayan an fara jujjuyawar farkon adadin jinin jini akan waɗannan ƙididdigar, gyaran halayensa ya ci gaba. Jiyya a wannan lokacin yana ɗayan mutum ne. Ana iya rubcribedta tsarin potassium da magnesium. Don rigakafin thrombosis, ana amfani da heparin, tare da cututtukan zuciya an tallafa shi da digoxin. Don hana rikice rikice, ana wajabta maganin rigakafi. Idan ba a dawo da urination da kanshi ba, ana motsa shi da mannitol.

Yin rigakafin

Tushen rigakafin hypovolemia da firgici na gaba shine rigakafin abubuwanda ke haifar da shi: asarar jini da bushewar jini.

Don yin wannan, dole ne:

1. Saka idanu yawan shan ruwa. Shakuwar Hypovolemic tana haɓaka cikin sauri idan mara lafiya a baya yana da alamun rashin ruwa.
2. Tare da amai da gudawa, mayar da asarar ruwa. Kuna iya sa mafita da kanka - haɗar da teaspoon na sukari da gishiri a gilashin ruwa. Amma ya fi kyau a yi amfani da magunguna na musamman, kamar Regidron ko Trihydron. Yana da mahimmanci musamman game da guba da rotovirus don shayar da yara, tun da rawar jiki na haɓaka da haɓaka na haɓaka da sauri.
3. Ziyarci likita akai-akai, karɓar magani na lokaci-lokaci na cututtukan zuciya da na koda.
4. Sakamakon raunin mellitus na ciwon sukari kuma ci gaba da ƙididdige jini a matakin manufa.
5. Koyi dokoki don dakatar da zub da jini.
6. Idan raunin yana haɗuwa da zubar jini, tabbatar da sauri mai haƙuri zuwa wurin likita.
7. A sha magungunan diuretic kawai a ƙarƙashin kulawar likita, tare da tsawaita amfani da lokaci-lokaci don gwajin jini.
8. Don kula da mummunan guba, nemi likita, kuma kada kuyi ƙoƙarin yin maganin kanku.

Lokacin aiwatar da ayyukan tiyata, rigakafin rawar jiki ana ba da kulawa ta musamman. Kafin aikin, an kawar da anemia, ana kula da cututtukan haɗin gwiwa. A lokacin sa, ana rage zubar jini ta hanyar amfani da yawon shakatawa, ta amfani da kayan aiki na musamman, magungunan vasoconstrictor. Controlledaramar jinin da ya ɓace ana sarrafawa: adiko napkins da tampons suna da nauyi, jinin da mai aspi ɗin ya tattara yana la'akari. An ƙaddara ƙungiyar jini a gaba kuma ana shirye shirye don zub da jini.