Edulmary Edema ndi matenda omwe amachititsidwa ndi madzi ochulukirapo m'mapweya a mapapo ( alveoli ). Chifukwa chakuti alveoli yodzaza ndi madzi samatha kugwira ntchito bwino, edema yamapiritsi imabweretsa mavuto aakulu, ndipo nthawi zambiri imakhala vuto loopsya.
Chifukwa cha Edema Yamaphunziro Ndi Vuto
Ma alveoli ndi kumene ntchito yamapapu imayambira.
M'magetsi a mpweya, mpweya wabwino umakhala pafupi kwambiri ndi ma capillaries atanyamula oksijeni-osauka magazi m'magazi a thupi. (Magazi osauka a oksijeni ayamba kuponyedwa kuchokera kumanja kwa mtima mpaka kumapapo, kudzera mu mitsempha ya pulmonary. Apa pali zambiri momwe mtima umagwirira ntchito .)
Pogwiritsa ntchito makoma ochepa a alveoli, kusinthanitsa kwa magetsi kumachitika pakati pa mlengalenga m'magazi a alveolar ndi "magazi" omwe ali mkati mwa capillaries. Oxyjeni ya alveoli imatengedwa ndi capillary magazi, ndi carbon dioxide kuchokera m'magazi omwe amasiyana ndi alveoli. Magazi, omwe tsopano akulemera okosijeni, amanyamulidwa kumbali yakumanzere ya mtima, yomwe imamuponyera kumatenda. Mlengalenga "yogwiritsidwa ntchito" umatuluka kumlengalenga, pamene tikupuma.
Moyo wokha umadalira kusintha kwabwino kwa mpweya mkati mwa alveoli.
Ndi edema ya pulmonary, zina za sachetilar zimadzazidwa ndi madzi.
Kusinthanitsa kwakukulu kwa mpweya pakati pa mpweya wovunda ndi magazi yamagazi sikungakhalenso mu alveoli wodzazidwa ndi madzi. Ngati pali alveoli yokwanira, zimakhala zovuta. Ndipo ngati mphukira ya edema imakhala yaikulu, imfa ikhoza kuchitidwa.
Zizindikiro za Edema Yamaphunziro
Edema ya pulmonary imachitika mwachidwi, pamene nthawi zambiri imayambitsa dyspnea (kupuma pang'ono), kuphatikizapo kukoketsa (zomwe nthawi zambiri zimapanga pinki, ntchentche), ndi kupuma.
Edema wamphongo mwadzidzidzi nayenso ikhoza kukhala limodzi ndi nkhawa yochuluka, ndi palpitation. Mpangidwe wa mpweya wa pulmona wam'dzidzidzi umatchedwa "flash pulmonary edema," ndipo nthawi zambiri umasonyeza kuwonjezereka kwa vuto lalikulu la mtima. Mwachitsanzo, matenda aakulu a coronary syndrome amatha kupanga mpweya woipa wa edema, monga momwe amatha kupweteketsa mtima .
Edema ya pulema yodalirika nthawi zonse imakhala yachipatala, ndipo ikhoza kupha.
Edema ya pulmonary, yomwe nthawi zambiri imawoneka ndi mtima wosalimba , imayambitsa zizindikiro kuti sera ndi kupitirira nthawi, ngati alveoli zambiri kapena zochepa zimakhudzidwa. Zizindikiro zofala ndi dyspnea ndi odwala, orthopnea (kupuma mosavuta pamene wagona pansi), dyspnea yotchedwa paroxysmal usiku (kuwuka usiku kupuma pang'ono), kutopa, edema mwendo (kutupa), ndi kupindula kulemera (chifukwa cha kusungunuka kwa madzi).
Nchiyani Chimachititsa Edema Yamaphunziro?
Nthawi zambiri madokotala amagawaniza mpweya wamapope kukhala umodzi mwa mitundu iŵiri: edema ya mapaipi ya mtima, komanso edema yopanda mapaipi ya mtima.
Edema Yamaphunziro a Cardiac
Matenda a mtima ndi omwe amachititsa kuti mapulmasi asinthe. Edema yamapiritsi ya mtima imapezeka chifukwa vuto lalikulu la mtima limayambitsa zovuta kumbali ya kumanzere kwa mtima kuti zikwezeke. Kuthamanga kwakukulu kumeneku kumafalikira kumbuyo, kupyolera mu mitsempha ya pulmonary, kwa capillaries alveolar.
Chifukwa cha kuthamanga kwapulisiyumu yamapuloni, madzi amachokera kumatenda opita m'mlengalenga, ndipo mphukira ya pulmona imapezeka.
Pafupifupi mtundu uliwonse wa matenda a mtima ungathe kutsogolera kumbuyo kwa mtima wa mtima wakumanzere, ndipo motero, ku mpweya wa mpweya. Mitundu yambiri ya matenda a mtima yomwe imayambitsa pulmonary edema ndi:
- matenda amtundu wa matenda (CAD)
- Kulephera kwa mtima pa chifukwa chirichonse
- Matenda a mtima wamagetsi, makamaka mitral stenosis , mitration regurgitation , aortic stenosis , kapena aortic regurgitation
- woopsa kwambiri
Pokhala ndi edema ya mtima wamtima, matenda opambana mkati mwa capillaries amatha kusintha kuti zichitike mu mitsempha ya pulmonary.
Chotsatira chake, mitsempha yapamwamba ya pulmonary ingathe kuchitika, matenda otchedwa pulmonary hypertension . Ngati mbali yeniyeni ya mtima iyenera kupopera magazi motsutsana ndi mitsempha yapamwamba ya pulmonary, kukomoka kwa mtima kumapeto kumatha kuyamba.
Matenda Osati a Cardiac Edulmary Edema
Mu edema yosakhala ya mtima, mpweya umadzaza alveoli chifukwa chosagwirizana ndi kukwera mtima kwa mtima. Izi zikhoza kuchitika pamene ma capillaries m'mapapu akuwonongeka ku matenda ena osakhala a mtima. Zotsatira zake, ma capillaries amakhala "otayika," ndipo amayamba kuyaka madzi mu alveoli.
Chifukwa chofala kwambiri cha mpweya wosachiritsika wam'mimba ndi mpweya woipa (ARDS) , womwe umayamba chifukwa cha kutupa kwakukulu m'mapapu. Kutupa uku kumawononga makoma a alveolar, ndipo amalola kuti madzi asungunuke. ARDS imawoneka kwa odwala odwala kwambiri, ndipo imayambitsidwa ndi matenda, mantha, kupsinjika mtima, ndi zina zambiri.
Kuphatikiza pa ARDS, edema yopanda mapaipi ya mtima ikhoza kupangidwa ndi:
- Chikumbutso cha embolism
- Matenda apamwamba kwambiri
- Mankhwala osokoneza bongo (makamaka heroin ndi cocaine)
- Matenda opatsirana
- Poizoni (mwachitsanzo, kulowetsa chlorine kapena ammonia)
- Matenda a khunyu (monga ubongo wa ubongo kapena kutaya kwa mpweya )
- Kusuta utsi
- Pafupi ndi madzi
Kuzindikira Edema Yamaphunziro
Kupanga msanga kuti matenda a pulema ndi edema ndi ofunikira; ndipo chofunikira kwambiri ndi kupeza bwinobwino chifukwa chomwe chimayambira.
Kuzindikira mpweya wotchedwa pulemaary edema nthawi zambiri kumachitidwa mofulumira mwa kuchita kafukufuku wamthupi, kuyesa magazi okosijeni, ndi kupanga chifuwa cha x-ray.
Kamodzi kowonongeka kamene kapezeka, masitepe ayenera kutengedwa mwamsanga kuti adziwe chifukwa chomwe chimayambira. Mbiri ya zamankhwala ndi yofunika kwambiri pakuchita izi, makamaka ngati pali mbiri ya matenda a mtima (kapena kuwonjezeka kwa mtima), kugwiritsa ntchito mankhwala osokoneza bongo, kuwonetsa poizoni kapena matenda, kapena zoopsa za pulmonary embolus.
Chombo cha electrocardiogram ndi echocardiogram nthawi zambiri zimakhala zothandiza pozindikira matenda a mtima. Ngati matenda amtima amatsutsika koma sangawonetsedwe ndi kuyesedwa kosagwirizana, mtima wodwala mtima ungakhale wofunikira. Zoyezetsa zina zambiri zingayesedwe ngati chifukwa chosakhala cha mtima chikayikiridwa.
Matenda osapanga mapaipi a mtima amapezeka pamene mpweya wamapulmoni ulipo pokhapokha ngati palibe vuto lalikulu la mtima.
Kuchiza kwa Edemoni Yamaphunziro
Zolinga zam'tsogolo zothandizira mpweya wamapulmoni ndi kuchepetsa kutentha kwa madzi m'mapapu ndikubwezeretsa ma okosijeni a magazi kumalo oyenera. Oxygen therapy nthawi zonse amapatsidwa nthawi yomweyo. Ngati zizindikiro za mtima ulipo, ma diuretiki amaperekanso acutely. Mankhwala omwe amatsitsa magazi zitsulo, monga nitrates , amagwiritsidwa ntchito kuchepetsa kupsinjika mkati mwa mtima.
Ngati mpweya wa okosijeni umakhalabe wotsika kwambiri ngakhale mutayesetsa kuchita zimenezi, mutha kutsegula mpweya wabwino. Mpweya wotsegula mpweya ungagwiritsidwe ntchito kuti uwonjezere mavuto mkati mwa alveoli, ndi kuyendetsa ena mwa madzi omwe amapezeka m'madzi a capillaries.
Komabe, Njira yabwino kwambiri yothandizira matenda a mphumu - kaya ndi chifukwa cha matenda a mtima kapena chifukwa chosakhala ndi mtima - imafuna kudziwa ndi kuchiza vuto lachipatala.
Zotsatira:
Wachiwiri LB, Matthay MA. Kuchita zachipatala. Edema ya pulmonary yabwino. N Engl J Med 2005; 353: 2788.
Weintraub NL, Collins SP, Pang PS, et al. Kusokonezeka kwa mtima mtima syndromes: maulendo apadera, madokotala, machitidwe: zamakono komanso zolinga zamtsogolo: sayansi ya American Heart Association. Kuthamanga kwa 2010; 122: 1975.