Ukwahlukaniswa kobukhulu isibindi sibe sesomile ngokuvumelana Ingane-Pugh

Isifo sokusha kwesibindi - ukwanda kwezindawo ezicutshini emzimbeni ngenxa ukuvuvukala eside. Inkolelo evamile yokusondela Ukwahlukaniswa lesi sifo hhayi ngoba kungekho ukuvumelana ekutheni yiziphi etholakalayo kakhulu yimpumelelo ngezinkinga zokuxilonga kanye nokwelashwa isifo sokusha.

Ukwahlukanisa isibindi sibe sesomile ngokuvumelana Ingane-Pugh

Lokhu kuhlukaniswa ka isibindi sibe sesomile isetshenziswa ukulinganisa degree of isifo kobukhulu esigulini.

Ngesisekelo ukulinganisa balo likhiqize sokusinda asibekezelele lesi sifo futhi iphesenti yokufa emva kokuhlinzwa. Ezimisele njengoba kudingeka ukufakelwa isibindi.

Lesi sifo yizigaba ezintathu. Amapharamitha ezichaza amakilasi ibonisa degree of kobukhulu ngokoma kwesibindi, kanye neqiniso lokho kuyoba isilinganiso sobude bokuphila yesiguli womuntu onesifo sokuqina kwesibindi. Ngokwe-Child-Pugh degree of isinxephezelo lesi sifo kuchazwa njenganoma:

1. Class A zihlanganisa isifo sokusha inzuzo.
2. B - subcompensated.
3. C - isifo sokusha decompensated.

Wenzenjani amazwana?

Ikilasi ngalinye of Child-Pugh babelwe amaphuzu athile ukuthi zibalwa ngokususelwa isamba nemingcele eziningana. Ngakho, Class A kungokwalabo ibanga 5 kuya ku-6 amaphuzu, B, ngokulandelana, - kusuka 7 kuya ku-9 amaphuzu. Futhi isigaba sokugcina - obuyigugu kakhulu kusuka amaphuzu 10 kuya ku-15.

Izinga ubuncane kobukhulu isifo sokusha ngenxa A. Kulokhu, isikhathi sokuphila lesiguli kuyinto ngesikhathi esiphezulu - kusukela engu-15 kuya ku-20. Ngosuku lwesibili, sekuyiminyaka engaba ngu-10. Class C kusho bempilo emfushane iziguli isifo sokusha kwesibindi - eyodwa noma iminyaka kakhulu amazwe amathathu nje.

Ukulandela ukuhlinzwa, onesibalo esikhulu lokufa ekilasini C - kuba 80%; 30% - ngokulandelana, kanye A -% 10 kuphela.

Isidingo ukufakelwa isibindi ngesikhathi degrees ezahlukene kobukhulu uzimisele ngendlela elandelayo:

• High - C;
• ngokulinganisela - B;
• Okuphansi - A.

Amapharamitha kubonelelwe Ukwahlukaniswa Ingane-Pugh

Yini imingcele ukuthonya ukusatshalaliswa amakilasi? Okokuqala, ucabangela khona:

• bilirubin;
• albumin;
• ascites.

Kanye hepatic encephalopathy, pti, PTT futhi INR.

System for Child-Pugh asikwazi kuthathwe ngokuthi kukhulunywa, kusukela kokuhlaziywa uyakucabangela akuwona wonke kwemigomo nesineke. I abukhali eziya ziba zimbi lesi sifo kanye nezinkinga zayo ukushintsha isithombe, futhi lokhu ngezigaba isetshenziswa ayisekho.

uhlelo Futhi echazwe futhi uyakucabangela morphologic nezici etiologic e isifo sokusha.

Ukwahlukanisa izici etiologic

Kukhona cishe abangamashumi amabili izinhlobo isifo sokusha. Kuye ngokuthi imbangela waziwa noma cha, lesi sifo zihlukaniswe amaqembu amathathu:

1. Isifo sokusha efakwe (eyaziwa) omsakazo.
2. I zokugula lapho omsakazo kuyinto impikiswano (ngezinye izikhathi abizwa ngokuthi "omsakazo kungenzeka").
3. Isifo sokusha ne ongacacile (akwaziwa) omsakazo.

omsakazo efakwe

Of aziwayo, wasungula izimbangela zesifo ethi kulezi zimo ezilandelayo:

• Ngo isifo sokusha oludakayo okuvela phakathi nesikhathi ukusetshenziswa isikhathi eside utshwala (40-60 igremu ethanol) iminyaka engu-15 noma ngaphezulu.
• Viral ukuthi isigamu amacala kubangelwa igciwane of kwesibindi kohlobo B, C no G.
• Izidakamizwa noma imithi, esizibonakalisa ngenxa ukusetshenziswa kwezidakamizwa yohlobo olufanayo isikhathi eside.
• kwakhiwa isifo sokusha biliary zamabanga aphansi naphezulu, lapho hepatic izicubu ukufa kwenzeka futhi indawo isibanda izicubu is ukulishintsha.
• isifo sokusha azalwa naso noma sitholwa njengefa.
• Emgodini onomthombo - ke lihlukile nezinye izinhlobo esohlwini bese eba inkathi ngokwanele eside lapho sinqamukile igazi eligciniwe ukuze kwesibindi. Kubonakala iziguli kanye jikelele kwegazi.
• Lapho isifo futhi Budd-Chiari syndrome - isifo elihlobene ne kahle igazi outflow kusukela kwesibindi (hepatic umthambo thrombosis).
• isifo sokusha Exchange-alimentary zingaveli esibi sikashukela, ukukhuluphala ngokweqile, lapho wajoyina enteroapocleisis.

omsakazo Okungenzeka futhi okungacacile

Okungenzeka futhi usithe omsakazo engaziwa esiboniswe khona:

• izifo ezithathelwanayo;
• izifo yisinanakazana;
• pathologies sokuhlasela kwamasosha omzimba;
• ukungondleki.

Ongaziwa etiologic izici - ngokuvamile kuba cryptogenic isifo sokusha fomu. Ngo eyinhloko isifo sokusha biliary nezingane Indian nangezikhathi omsakazo engaziwa.

ngezigaba morphological

ngezigaba morphological ukulimala kwesibindi - lesi esokuqala ehlongozwayo kanye evunyiwe esekelwe idatha kusuka biopsies (umzimba ucezu, kuthathwe vivo). Ukwabela zokugula 4 izinhlobo:

• MKD isifo sokusha libhekene Izigaxana ezincane emzimbeni, ogama ubukhulu kuyinto 1-3 mm;
• krupnouzlovgo isifo sokusha - isibindi Izigaxana ububanzi 3 mm noma ngaphezulu;
• amafomu isifo sokusha akuphelele, lapho advantageously abathintekayo mezhpechenochnye ukwahlukanisa;
• exubile, libhekene inhlanganisela zonke izici ezingenhla.

ukuphathwa isifo sokusha

Ukudalulwa ekilasini isifo sokusha Ingane-Pugh kunikeza ithuba lokwenza ukuxilongwa, ukubikezela sokusinda iziguli, kodwa futhi ukuze ukhethe ukwelashwa okufanele nokunakekela esekelayo.

Ngakho, ihlawulelwa isifo sesibindi (Nge ekilasini A) kuhilela yokwelapha eziyisisekelo okuhloswe ngalo ukuqeda imbangela yalesi sifo. Ngaphezu kwalokho, kumelwe sithathe nemithi asekelayo. Umkhankaso wabo - ukuqeda ukuqunjelwa. Lokubaluleke kakhulu kule enzyme kukhona zezinhlobo "pancreatin" "Creon", "elithi mezim". Imithamo ejwayelekile, kuthathwe kathathu ngosuku, mhlawumbe ngaphambi kokudla. Ingabe izifundo kunikezelwe, okuyisilinganiso sabangu-amasonto 2-3, lapho siphindiwe ngezikhathi ezithile.

Lapho subcompensated isifo sokusha (Ngezinye B isifo sokusha ekilasini Ingane-Pugh) edingekayo olunzulu ukwelashwa yesondlo aphoyintimenti. Ngenxa yale njongo isetshenziswa ephansi usawoti ekudleni (hhayi ningi than 2 amagremu kasawoti ngelanga), amaprotheni okwengeziwe ishintshela kokungavinjelwe. Kulaba imithi "Furosemide" futhi "spironolactone". Ukuthola isisu constrains ekuthuthukiseni nomfutho wegazi ophezulu portal futhi kunciphisa ascites. Umsebenzi we pheshana emathunjini kungathuthukiswa "lactulose" e 50-70 ml ngosuku, kodwa yokwamukela ukuba uhlale njalo.

Endabeni decompensated isibindi isifo (lapho C ekilasini ngokuvumelana Ingane-Pugh) wabonakaliswa isimo esisongela ukuphila isiguli. Kudinga labagula kakhulu ngokushesha. Paracentesis inikeza ukususwa uketshezi peritoneum, albumin ngemithambo yegazi ehanjiswa crystalloids, igcwalisa afundwa igazi ivolumu namaprotheni emzimbeni. Ngezenzo esetshenziswa isisu: i- "spironolactone" efanayo futhi "Furosemide". Linqume ongaphakeme yokudla usawoti. Ukuze uthole ukudla ukudla okunomsoco parenteral beze encephalopathy hepatic nezinye izimo ezinzima.

isiphetho

Prophylaxis izifo lusekelwe futhi Ukwahlukaniswa kobukhulu isibindi isifo sokusha Ingane-Pugh.

Ngo ihlawulelwa isifo Yiqiniso akudingi injongo izifo. Lapho amakilasi B kanye neziguli C angase baba nesifo sokuntuleka kwegazi, ngakho ngokuvamile kakhulu iqondiswa erythropoietin. Ngaphezu kwalokho, ngokuvamile ebekiwe beta-blocker (ezifana "Metoprolol", "Inderal"), okungase kuvimbele igebe varices ngomphimbo.