Mendelson Syndrome: izimpawu, ukwelashwa, zokuvimbela

Kukhona uhlu izifo ukuthi ungayeki iziguli ithuba ukuqhubeka ezimpilweni zabo ngendlela evamile. Ukuvela ngempela ngokushesha, ngokuphelele ukushintsha umuntu, futhi uthola ithuba kancane kakhulu ukuphila okuvamile baqhubeka. Omunye izimo zokucabanga okubangelwa isifo sinjalo acid nenshisekelo syndrome, okuyinto yaziwa ngaphansi kwegama Mendelson Syndrome.

incazelo

Livela lesi sifo ngenxa ephefumula ka-esidi juice esiswini, kuze kuphumele ekutheni umuntu eba ukuvuvukala oyingozi. Ezimweni eziningi isimo esiphambene owaziwayo izinzwa azoya. In iziguli izifo ezahlukene, okuyizinto ngaphansi izinzwa noma cha, kule aphansi uhlelo lokuphefumula ukuceba ku enzyme okuqukethwe azibukhali esiswini.

Mendelson sika syndrome kwetintfo olubulalayo izinzwa. Umkhuba jikelele cishe u-60% amacala ukufa. Ngo izinzwa azoya, lesi sibalo ifinyelela 70%.

izizathu

Isici esiyinhloko ukuthi kuphakamisa acid-nenshisekelo uphawu kuba regurgitation noma ukuhlanza, owenzeka phakathi izinzwa uma sehliselwe ukusebenza ingqondo ayisivikelo amalaka. Mendelson Syndrome ngokuyinhloko ezibangelwa regurgitetsiey, kokuphela yokwenziwa lokuqukethwe esiswini phakathi oropharynx.

Kwengozi yokuthola kwenzeka uma usuthi, ukucindezeleka zezidakamizwa, utshwala ukudakwa, ukucobeka. Regurgitation singenzeka ngesikhathi sokukhulelwa (kusuka 22-23 amasonto), lapho, ngenxa ukushintsha kwama-hormone kunciphisa ukukhiqizwa gastrin, okuholela ukuthuthukiswa nomfutho wegazi ophezulu esiswini. Phakathi kwezinye izinto: ukwanda intragastric nokucindezelwa naphakathi-besisu, ukuvuvukala, ukuvuvukala emphinjeni, ukukhuluphala, ukuba khona izifo sibi kuhlinzwa wokugaya ukudla. Ubungozi enkulu yalesi sifo kwenzeka uma ukulethwa lisebenza kwa zokubelethisa noma umkhuba ukuhlinzwa esiphuthumayo.

pathogenesis

Mendelson Syndrome has a indlela ehlukile yentuthuko. Inketho yokuqala - kuba lapho undigested izinhlayiyana zokudla faka ipheshana zokuphefumula ne juice esiswini. Ezingeni lesibili occlusion mechanical imikhondo bronchi ekuthuthukiseni of ukwehluleka oyingozi zokuphefumula. Esimeni sesibili kuba azibukhali kakhulu juice esiswini lapho imuncwe kungabangela ezishile amakhemikhali ulwelwesi lwamafinyila we bronchi kanye kuqhoqhoqho. Ngaphezu kwalokho edema mucosal kuphakamisa ukuthuthukiswa isimiso bronchial.

Mendelson Syndrome: Izimpawu

Lwasemtholampilo isithombe lesi sifo nge kucishe izimpawu ukwehluleka ezinzima zokuphefumula. isimo wesiguli libhekene edema yamaphaphu, tachycardia, dyspnea, cyanosis, bronchospasm. Against ngemuva izinguquko uzwakalise kakhulu sokuqala kungenzeka ukuboshwa inhliziyo. Ngokuvamile umzimba lesiguli siphukile kanye yamaphaphu ukugeleza kwegazi, unomfutho wegazi ophakeme iqhubeka. Bekanye hypoxemia ezinzima kwandisa umfutho umfula yamaphaphu nokwanda kwentshiseko kanyekanye e yamaphaphu ukumelana semithambo. lactic umzimba futhi alkalosis zokuphefumula eba ngenxa ukwephula izicubu perfusion.

izinguquko Clinical pathophysiological ezihambisana iziyaluyalu we izilonda wamaphaphu izicubu. Ngezinye izikhathi izimpawu kancane evelele. izinguquko morphological kule ipheshana zokuphefumula ngokuphawulekayo wabonakaliswa ngemva kosuku nenshisekelo. Kuphela usuku olulodwa noma ezimbili kusukela esikhathini lapho kwakukhona Mendelson Syndrome, zokuphefumula izimpawu ukwehluleka baqale ukuthuthukisa. Ukugcina umuntu kungaba kuphela ngaphansi isimo esiphuthumayo lakhe lezempilo.

Mendelson Syndrome e zokubelethisa

Ngo abesifazane nge imisebenzi azoya noma jikelele izinzwa ukulethwa ngokuvamile kwenzeka lesi sifo. Nenshisekelo phakathi umgudu kufanele kube izimo ezimbili. Eyokuqala - jikelele indlela yokubulala izinzwa (imisebenzi azoya, bebeletha, zokugula kuhlinzwa isisu), owesibili - ukuhlukumeza mshini bulbar e ikhoma, regurgitation, ukuhlanza. Ezimweni eziningi, isiguli ulinde ukufa, uma Mendelson Syndrome. Lokho-ke kunikeza ilungelo ukubeka isifo belingana ayingozi kakhulu, ukuxakeka olubulalayo izinzwa, akungabazeki.

Ukudla esiswini abesifazane abakhulelwe bathambekele zephuze ngenxa okwehlisa ndima yayo sokukhulelwa ngenxa emazingeni aphansi gastrin futhi ngakhula ingcindezi naphakathi-besisu. It gastrin ulawula motility esiswini, futhi izinto eziningi enganele kuholela ukuthuthukiswa acid nenshisekelo sifo ngo-izinzwa.

eziphuthumayo

Into yokuqala okudingeka ubambe nesineke sifo ka Mendelssohn - esuswa yomoya aspirated okuqukethwe isisu. ngaleyo ndlela ngalo ingaphakathi ngomlomo nahlanza ukuncela noma gauze. Tracheal intubation kufanele kwenziwe ngisho esigabeni prehospital. Okulandelayo, udinga ukwenza bronchoscopy esiphuthumayo ngaphansi izinzwa jikelele lihambisana umjovo we yokufakelwa wamaphaphu ukupholisa. Ukuze lavage bronchial usebenzisa i-sodium ne-hydrogen carbonate isixazululo (2%) kanye nokulungiselela "hydrocortisone" sodium chloride isixazululo efudumele noma isotonic. Ngemva tracheal intubation, kahle wageza nge ane-alikhali isixazululo esiswini gavage. Ngemithambo yegazi iqondiswa izixazululo "atropine" futhi "Eufillin".

Esimweni lapho isimo lesiguli ngokulinganisela, ukupholisa mechanical ingase ithathelwe indawo ukuphefumula nokuguqulwa okhishwa ngamakhala ukumelana. Ukuze le nqubo, uzodinga buso ekhethekile uma ingekho, kubalulekile ukufundisa exhales nesineke ngokusebenzisa ekupheleni evulekile tube amanzi kuyo izihlahla zenjoloba.

Mendelson Syndrome (isithombe ngaphezulu sibonisa kwesigaba kohlelo ukuhlupheka kwasekuqaleni) kungaholela ekufeni isiguli, uma isikhathi akusizi kuye. Ngisho ne wokusiza ngokushesha we bronchospasm laringo- kanye nesineke badinga ukulaliswa esibhedlela ukuze kuvinjelwe ukuthuthukiswa sengozini yokuthola izifo.

ukwelashwa

Uma isiguli kutholakala Mendelson Syndrome, ukwelashwa kufanele zihlanganisa izinyathelo azosiza ukuyeka ukwehluleka oyingozi zokuphefumula futhi kuvimbele ukuthuthukiswa yezinkinga ezithathelwanayo. ukupholisa Mechanical wenziwa lapho hypoxia lwemithambo iqhubeka ezimweni ukuphefumula nokuguqulwa. Lapho isimo esibucayi inqubo nesineke Kwenziwa izinsuku ezimbalwa, kuze izinkomba yamaphaphu negesi lokushintshisana ayilithuthukisanga. Ngezinye izikhathi usebenzisa oxygenation hyperbaric, nakho ezimweni eziningi kuveza imiphumela emihle. ukwelashwa izidakamizwa ukusetshenziswa kwezidakamizwa lingaze, imithi elwa namagciwane kanye corticosteroids ngemithamo ezinkulu.

Mendelson Syndrome e 30-60% of amacala siholela ekufeni isiguli. Ukuze labo abanesifo ke, ungakwazi ukuba bathuthukise uzwakalise iziyaluyalu elawulayo noma obstructive ngezindlela ezingafani.

zokuvimbela

Kunezindlela Inombolo yezenzo olungavimba ukuthuthukiswa yezinkinga ezinzima ezifana Mendelson Syndrome. Prevention siqukethe izinyathelo eziningana. Eyokuqala - ukusetshenziswa kwezidakamizwa kabani senzo iqondiswe Ukwehla uketshezi esiswini ( "Ranitidine", "cimetidine"). Vimbela okuvela yezinkinga Ungasusa nezenzo ezifanele ongudokotela obulala izinzwa. Izidakamizwa "Atropine" kufanele indawo esebenzisa "Metacin" isiguli ibe isimo izinzwa kufanele sinikezwe kalula futhi ngokushesha. Udokotela kufanele kube kahle inqubo intubation futhi laryngoscopy nokusetshenziswa tracheal reception Selick.

Ngezinye izikhathi ethula ngamapayipi esiswini ukuyishiya lonke operation ukuvimbela ephefumula lokuqukethwe esiswini. Abanye ochwepheshe ngokumelene lokumamukela enjalo, ngoba uphenyo ingaba njengesihluthulelo yefilakisi futhi babhebhethekise isimo. Ngo zokubelethisa zokuvimbela kufanele ibe elungile isikhundla owesifazane okhulelwe etafuleni yokusebenza, ukuphela ikhanda okufanele ephakanyiswe kancane.