Usizo lokuqala lokushaqeka kwe-hypovolemic nezindlela zokwelashwa kwalo

Ngokulahlekelwa okukhulu kwegazi noma ukuphuma komzimba okukhulu, ukwehluleka kwenzeka ekuphendukeni komzimba okubuthakathaka, bese kuba ne-hypovolemic shock. Lesi simo sibonisa ukwephulwa kwayo yonke imisebenzi ebalulekile: ukuhamba kwegazi kuyancipha, ukuphefumula kuyancipha, i-metabolism iyahlupheka. Ukuntuleka koketshezi egazini kuyingozi ikakhulukazi ezinganeni, kubantu asebekhulile nakubantu abanokuphelelwa ngamandla komzimba ngenxa yokwelashwa okungafanele kwesifo sikashukela, umfutho wegazi ophakeme nesifo sezinso.

I-Hypovolemia ezimweni eziningi inganxephezelwa uma isiguli sithola usizo lokuqala olunolwazi, futhi silethwe esibhedlela ngesikhathi. Kepha kunezikhathi lapho kungenakwenzeka khona ukuvimba ukulahleka kukamanzi, bese kuthi ukwethuka kwe-hypovolemic kugcina ngokubulawa.

Izizathu zokuthuthukiswa kwezinkinga

Umqondo womqondo "we-hypovolemic shock" usegameni lawo uqobo. I-Hypovolemia (hypovolaemia) ekuhunyushweni okuqondile - ukuntuleka kwe (hipo-) yevolumu yegazi (haima). Igama elithi "ukuthuthumela" lisho ukwethuka, ukwethuka. Ngakho-ke, ukushaqeka kwe-hypovolemic kuwumphumela obangelwa ukuntuleka kwegazi emithanjeni yegazi, okuholela ekuphazanyisweni kwezitho nasekubhujisweni kwezicubu.

Isifo sikashukela nokucindezela kuzoba yinto yesikhathi esedlule

• Ukwehlela ushukela -95%
• Ukuqedwa kwe-vein thrombosis - 70%
• Ukuqedwa kokushaya kwenhliziyo okuqinile -90%
• Ukuqeda umfutho wegazi ophakeme - 92%
• Ukwanda kwamandla ngesikhathi sosuku, ngcono ukulala ebusuku -97%

Ngu zamazwe omhlaba ukuhlukaniswakanye ne-pathology ebhekiswe kusihloko R57, Ikhodi ye-ICD-10 y - R57.1.

Izimbangela zokuncipha kwethamo legazi zihlukaniswe nge-hemorrhagic (ngenxa yokulahleka kwegazi) kanye nokuphelelwa amandla emzimbeni (ngenxa yokuphelelwa ngamanzi emzimbeni).

Uhlu lwezimbangela ezivame kakhulu zokushaqeka kwe-hypovolemic:

Ukopha ohlelweni lokugaya ukudla. Izizathu zabo:

• isilonda sesisu;
• ukuvuvukala kwamathumbu ama-etiologies ahlukahlukene;
• imithambo ye-varicose yesophagus ngenxa yesifo sesibindi noma ukucindezelwa kwethambo le-portal yi-tumor, i-cyst, amatshe;
• ukuqhekeka kodonga lwe-esophagus ngesikhathi sokudlula kwezidumbu zakwamanye amazwe, ngenxa yokushiswa ngamakhemikhali, ngenkathi kuvinjelwa isifiso sokuhlanza;
• ama-neoplasms esiswini namathumbu;
• i-aorto-duodenal fistula - ifistula phakathi kwe-aorta ne-duodenum 12.

Uhla lwezinye izizathu:

1. Ukopha kwangaphandle ngenxa yokulimala kwemithambo. Kulokhu, ukushaqeka kwe-hypovolemic kuvame ukuhlanganiswa nokuhlukumezeka.
2. Ukopha ngaphakathi ngenxa yokuqhekeka izimbambo kanye ne-pelvis.
3. Ukulahleka kwegazi okuvela kwezinye izitho: ukuqhuma noma ukuhlukaniswa kwe-aneuricm ye-aortic, ukuqhekeka komgogodla ngenxa yokulimala kanzima.
4. Ukopha okuvela kwabesifazane ngesikhathi sokukhulelwa nokubeletha, ukuqhuma kwama-cysts noma ama-ovari, isimila.
5. Ukushisa kuholela ekukhishweni kwe-plasma ebusweni besikhumba. Uma indawo enkulu ilimele, ukulahleka kwe-plasma kubangela ukomisa kanye ne-hypovolemic shock.
6. Ukuphelelwa ngamandla komzimba ngenxa yokuhlanza kakhulu nohudo ngezifo ezithathelanayo (i-rotavirus, i-hepatitis, i-salmonellosis) nobuthi.
7. I-Polyuria kwisifo sikashukela, isifo sezinso, ukusetshenziswa kwezicubu zomzimba.
8. I-acute hyperthyroidism noma i-hypocorticism enesifo sohudo nokuhlanza.
9. Ukwelashwa okuhlinzwa ngokulahleka kwegazi okuphezulu.

Ukuhlanganiswa kwezizathu eziningana kungabhekwa, ngasinye sazo ngokungeke kuholele ekushayweni kwe-hypovolemic. Isibonelo, ekungeneni kwezifo ezinomkhuhlane omkhulu nokudakwa isikhathi eside, ukushaqeka kungakhula ngenxa yokuphelelwa uketshezi ngesithukuthuku, ikakhulukazi uma umzimba untekenteke ngenxa yezinye izifo, futhi isiguli senqaba noma singakwazi ukuphuza. Ngakolunye uhlangothi, kubasubathi nakubantu abajwayele isimo sezulu esishisayo nomfutho ophansi wasemkhathini, lesi sifo siqala ukwanda kamuva.

I-pathognisis ye-hypovolemic shock

Amanzi ayingxenye ebalulekile yawo wonke uketshezi lomzimba - igazi, i-lymph, izinyembezi, amathe, amajusi esiswini, umchamo, uketshezi oluphakathi kanye nolungaphakathi. Ngenxa yalokho, umoya-mpilo kanye nokudla okunempilo uhanjiswa emathanjeni, kususwe imikhiqizo engadingekile ye-metabolic, imizwa yezinzwa idlulile, konke kuvela kwamakhemikhali. Ukwakheka kanye nevolumu yotshwala kuzinze futhi kubhekwe njalo ngamasistimu wokulawula. Kungakho imbangela yokugula kumuntu ingatholakala ngokuhlolwa kwelebhu.

Uma izinga lamanzi emzimbeni liyehla, umthamo wegazi emithanjeni nawo wehla. Kumuntu ophilile, ukulahleka kwegazi elingaphezulu kwengxenye eyodwa kwezine akuyona ingozi, umthamo wawo ubuyiselwa ngokushesha ngemuva kokugcwala kwamanzi. Kulokhu, ukubumbana kokuqanjwa kwamamanzi omzimba akuphulwa ngenxa yezindlela zokuzibamba.

Lapho i-10% yegazi ilahlekile, umzimba uqala umsebenzi ukunxephezela i-hypovolemia: ukuhanjiswa kwegazi eligcinwe emthanjeni (cishe ama-300 ml) kungena emithanjeni, ingcindezi kuma-capillaries yehla, ukuze uketshezi olusuka ezicutshini lungene egazini. Ukukhishwa kwama-catecholamines kuyasebenza. Baqinisa imithambo nemithambo ukuze inhliziyo igcwalise ngokujwayelekile ngegazi. Okokuqala, kungena ubuchopho namaphaphu. Ukuhlinzekwa kwegazi esikhunjeni, emisipha, ekugayweni, nasezinso kwenzeka ngokwemigomo esele. Ukugcina umswakama ne-sodium, ukuchama kuyancishiswa. Ngenxa yalezi zinyathelo, ingcindezi ihlala ijwayelekile noma yehla isikhashana ngokushintshwa okubukhali kokuma (i-orthostatic hypotension).

Lapho ukulahleka kwegazi kufinyelela kuma-25%, izindlela zokuzibamba azinamandla. Uma ingalashwa, i-hypovolemia enzima ibangela ukwethuka kwe-hypovolemic. Ukuhamba kwegazi kusuka enhliziyweni kuyancipha, amaconsi okucindezela, i-metabolism ihlanekezelwe, izindonga ze-capillary namanye amaseli omzimba onakele. Ngenxa yendlala ye-oksijini, ukungakwaneli kwazo zonke izitho kwenzeka.

Izimpawu nezimpawu

Ubukhulu bezimpawu zokushaqeka kuya ngesilinganiso sokulahlekelwa uketshezi, amandla okuncipha womzimba kanye nokwehla kwenani lokujikeleza kwegazi emithanjeni. Ukopha okuncane, ukuphuma komzimba okuhlala isikhathi eside, ekukhuleni, izimpawu zokuxhaxha kwe-hypovolemic ekuqaleni zingase zingabikho.

Izimpawu ezinamazinga ehlukene okwehla kwegazi:

Ukopha kwangaphandle kunzima ukukuphuthelwa, kepha ukopha ngaphakathi kutholakala kakhulu lapho i-hypovolemic shock isivele yathuthuka.

Sola ukulahleka kwegazi ezithweni zangaphakathi ngezimpawu ezilandelayo:

• isicanucanu, ukugabha kwegazi, indle emnyama ngokuthululwa kwegazi esiswini naku-esophagus;
• ukuqhakaza;
• ukukhwehlela igazi nge-pulmonary hemorrhage;
• izinhlungu esifubeni
• ukugoba okubomvu emchameni;
• ukopha kowesifazane ngesikhathi sokuya esikhathini izinsuku ezingaphezu kwe-10 noma ngaphezulu kokujwayelekile.

Izindlela zokuxilonga

Ngemuva kokulethwa esibhedlela, isiguli esinokwethuka okusolisayo sithathwa ngokushesha igazi, iqembu laso kanye nama-rhesus kunqunywe, kwenziwa ucwaningo lwelabhoratri yokwakhiwa kwalo, kufaka phakathi i-hematocrit kanye nokuxinana kwezihlobo. Ukukhetha ukwelashwa okudingekayo, hlola ukwakheka kwama-electrolyte ne-pH yegazi.

Uma imbangela yokuthuthumela ingacaci, yenza ucwaningo ukuze ukhombe:

1. I-X-ray enama-fractures okusolwayo.
2. Ukuqedwa kwesibindi, uma kunethuba lomonakalo ohlelweni lomchamo.
3. I-Endoscopy ukuhlola isisu kanye ne-esophagus.
4. I-Ultrasound yezitho zomzimba we-pelvic ukukhomba umthombo wokuphuma kwegazi sowesifazane sangasese.
5. I-Laparoscopy, uma kukhona izinsolo zokuthi igazi liqongelela emgodini wesisu.

Ukucacisa ubungako be-GSH, inkomba yokushaqisa ibalwa. Kungu-quotient wokuhlukanisa ishayela ngomzuzu ngenkomba yokucindezela kwe-systolic. Imvamisa, le nkomba kufanele ibe ngu-0,6 noma ngaphansi, ngesilinganiso esinamandla sokuthuthumela - 1.5. Ngokulahlekelwa okukhulu kwegazi noma ukuphuma komzimba okusongela impilo, inkomba yokuqhaqhazela kwe-hypovolemic ingaphezu kwe-1.5.

Ukunqunywa kwethamo legazi elahlekile yinkomba yokushaqeka, i-hematocrit kanye nokuxinana kwegazi okuhlobene:

Ukwesabeka kwe-Hypovolemic kuqinisekiswa ukwelashwa kwecala: uma ngemuva kokuphathwa kwe-100 ml yesibambiso segazi ngemizuzu eyi-10 umfutho wegazi wesiguli uphakama futhi nezimpawu zinciphile, ukuxilongwa kubhekwa njengokugcina.

Inkonzo Yosizo Lokuqala Yabasebenzi Abajwayelekile

Akunakwenzeka ukubekezelela ukwethuka kwe-hypovolemic ngaphandle kosizo lodokotela. Noma kubangelwa ukuphuma komzimba, ngeke kwenzeke ukubuyisela ngokushesha umthamo wegazi ngokuphuza isiguli, udinga ukumfaka ngaphakathi emzimbeni. Ngakho-ke, isenzo sokuqala okufanele sithathwe abanye lapho kuvela izimpawu zokushaqeka shayela i-ambulensi.

I-algorithm ephuthumayo ngaphambi kokufika kodokotela:

1. Lapho ukopha, beka isiguli ukuze umonakalo ungama-30 cm ngaphezu kwenhliziyo. Uma ukushaqeka kubangelwa ezinye izizathu, qiniseka ukuhamba kwegazi enhliziyweni: beka isiguli emhlane wakhe, ngaphansi kwemilenze - umgibeli wezinto. Uma usola ukulimala komgogodla (isibonakaliso kuwukuntula kokuzwela emilenzeni), ukuguqula isikhundla somzimba akuvunyelwe.
2. Jikisa ikhanda lakho ohlangothini ukuze isiguli singakhungatheki uma kuqala ukuhlanza. Uma engazi lutho, hlola umoya. Uma ibuthakathaka noma inomsindo, thola ukuthi imigwaqo yomoya iyadlula. Ukuze wenze lokhu, hlanza imbobo yomlomo, iminwe ukuze uthole ulimi olushiswe yilanga.
3. Hlanza ingaphezulu lesilonda. Uma izinto zakwamanye amazwe zingena shí kwezicubu, kwenqatshelwe ukuzithinta. Zama ukumisa igazi:

- Uma umlenze olimele uyimbangela yokushaqeka, faka i-tourniquet noma ukusonta ngenhla kwesilonda. Zinike isikhathi, usibhale ephepheni bese ulishutheka ngaphansi komqhudelwano. Ukumane nje ukwazisa isiguli ngesikhathi sokusebenzisa i-tourniquet akwanele. Ngesikhathi sokulethwa esibhedlela, kungenzeka ukuthi usequlekile.

- Ngegazi elibuhlungu (izimpawu - elimnyama, eligeleza ngokulinganayo igazi) amabhandeji aqinile. Kungcono uma kuyi-antiseptic. Lapho ubopha amabhande, zama ukuhlanganisa imiphetho yesilonda ndawonye.

- Uma kungenakwenzeka ukufaka i-bandage noma i-tourniquet, igazi liyamiswa nge-gauze swab, futhi lapho lingekho, ngendwangu noma nesikhwama sepulasitiki. I-bandage engxenyeni eziningana isetshenziswa enxebeni futhi icindezelwe ngesandla sayo imizuzu engama-20. Ungasusa uswidi sonke lesi sikhathi, ngisho nemizuzwana embalwa. Uma ligcwele igazi, engeza izingqimba ezintsha zebhandeji.

4. Mboza isiguli, uma kungenzeka ukuthula futhi ungamshiyi ngaphambi kokuba kufike i-ambulensi.
5. Ngokuphuma kwegazi kwangaphandle noma izinsolo zangaphakathi, akufanele unikeze isiguli isiphuzo, futhi nangaphezulu ngakho-ke ungamondli. Ngale ndlela unciphisa amathuba okuba ne-asphyxiation.

Ungayiphatha kanjani i-GSH

Umsebenzi odokotela abezimo eziphuthumayo ukuvimba ukopha, unestetize isiguli bese kuthi, ngesikhathi sokuhamba esibhedlela, baqale isigaba sokuqala sokulungiswa kwethamo legazi. Inhloso yalesi sigaba ukuhlinzeka ngegazi elincane kakhulu ekusebenzeni kwezitho ezibalulekile nokwenza ngcono ukunikezwa kwe-oksijini kwezicubu. Ukuze wenze lokhu, phakamisa ingcindezi ephezulu ibe ngu-70-90.

Lo mgomo ufinyelelwa ngezindlela zokusebenzisa i-infusion therapy: i-catheter ifakwa emthanjeni kanye ne-crystalloid (isisombululo se-saline noma se-Ringer) noma i-colloid (Polyglukin, Macrodex, Gekodez). Uma ukulahleka kwegazi kusinda, ungafinyelela ukumisa ngasikhathi sinye ezindaweni ezi-2-3. Kulokhu, kuyadingeka ukuthi uqinisekise ukuthi ingcindezi ayikhuphuki kakhulu, ingabi ngaphezu kwama-35 emizuzwini eyi-15 yokuqala. Ukukhula ngokushesha kwengcindezi kuyingozi enhliziyweni.

Indlala yama-oksijini yamaseli incishiswa ngokuphefumula ngengxube yomoya ene-oxygen okungenani engu-50%. Uma isimo sesiguli sinzima, kuphefumula ngokuphefumula kuqala.

Uma ukwethuka kwe-hypovolemic kukhulu kakhulu futhi kungasabeli muntu ekwelashweni, i-hydrocortisone ihanjiswa esigulini, kusiza umzimba ukuthi uhlanganyele futhi uzinze ingcindezi. Mhlawumbe ukwethulwa kwezidakamizwa eqenjini le-sympathomimetics, okuvusa i-adrenaline rush, vasoconstriction kanye nengcindezi ekhuphukayo.

Lezi zinyathelo ezilandelayo zokwelashwa zenziwa kakade esibhedlela. Lapha, ukwethulwa kwama-crystalloids nama-colloids kuyaqhubeka. Isinxephezelo sokulahlekelwa ngemikhiqizo yegazi noma izingxenye zayo, ukumpontshelwa igazi, sinqunyelwe kuphela ekulahlekelweni kwegazi okunzima, ngoba kungadala ukudangala kwamasosha omzimba. Uma ukushoda kwegazi kukhulu kune-20%, ukufakwa kwamangqamuzana egazi abomvu ne-albhamuin kuyengezwa ekwelashweni kokuqala. Ngokulahlekelwa okukhulu kwegazi nokuthuthumela okukhulu, kufakwa i-plasma noma igazi elisanda kulungiswa.

Ngemuva kokuphindwaphindwa kokubuyiselwa kwethamo legazi ngesisekelo salokhu kuhlaziya, ukulungiswa kokuqanjwa kwalo kuyaqhubeka. Ukwelashwa ngalesi sikhathi kumuntu uqobo. Amalungiselelo wePotassium ne-magnesium angabekwa. Ngokuvimbela i-thrombosis, i-heparin iyasetshenziswa, ngezifo zenhliziyo isekelwa nge-digoxin. Ukugwema izinkinga ezithathelwanayo, kunqunywa imithi elwa namagciwane. Uma ukuchama kungabuyiswa ngokwakho, kuvuselelwa nge-mannitol.

Ukuvimbela

Isisekelo sokuvinjwa kwe-hypovolemia kanye nokushaqeka okwalandela ukuvimbela izimbangela zako: ukulahleka kwegazi nokuphelelwa ngamandla komzimba.

Ukuze wenze lokhu, kufanele:

1. Gxila ukudonswa kwamanzi. I-Hypovolemic shock iba ngokushesha uma isiguli sinezimpawu zokuphelelwa ngamandla emzimbeni.
2. Ngokuhlanza nokuhudula, buyisela ukulahleka kukamanzi. Ungenza isixazululo ngokwakho - hlanganisa isipuni sikashukela nosawoti engilazini yamanzi. Kepha kungcono ukusebenzisa izidakamizwa ezikhethekile, njengeRegidron noma i-Trihydron. Kubaluleke kakhulu ezimweni ezinobuthi ne-rotovirus ukuphuza izingane, ngoba ukushaqeka kwazo kwenzeka ngokushesha okukhulu.
3. Vakashela udokotela njalo, uthole ukwelashwa okufika ngesikhathi kwezifo zenhliziyo nezinso.
4. Isinxephezelo sikashukela kanye nokugcina izibalo zegazi zisezingeni elifanele.
5. Funda imithetho yokumisa ukopha.
6. Uma ukulimala kuhambisana nokulahleka kwegazi, qinisekisa ukuthutha okusheshayo kwesiguli kusiwe esikhungweni sezokwelapha.
7. Ukuphuza izidakamizwa ze-diuretic kuphela ngaphansi kokuqondisa kukadokotela, ngokusetshenziswa isikhathi eside zivivinya igazi.
8. Ukwelapha i-toxosis enzima, bonana nodokotela, futhi ungazami ukubhekana nakho wedwa.

Lapho wenza ukungenelela kokuhlinzwa, ukuvimbela ukwethuka kwe-hypovolemic kunikezwa ukunakwa okukhethekile. Ngaphambi kokuhlinzwa, i-anemia iyaqedwa, izifo ezilandelanayo ziyelashwa. Ngesikhathi salo, ukopha kuncishiswa ngokusebenzisa ama-tourniquets, usebenzisa imishini ekhethekile, izidakamizwa ze-vasoconstrictor. Umthamo wegazi elilahlekile uyalawulwa: ama-napkins namathambeka ayasindwa, igazi eliqoqwe ngumphangi liyabhekelelwa. Iqembu legazi linqunywa kusengaphambili futhi amalungiselelo alungiselelwe ukumpontshelwa.