Kumvetsetsa Pleuritic Chest Pain (Pleurisy)
Ngati muli ndi ululu ndi kupuma, kaya kupuma bwino kapena pamene mukupuma kwambiri, mwina mumakhala mukudandaula. Madokotala akulongosola mtundu wa ululu umene umapezeka pakupuma kwambiri ngati "kupweteka pamfupa" kapena "pleurisy." Dzina limachokera ku chimodzi mwazifukwa zomwe zimayambitsa kupweteka uku: kukwiya kwa pleura, nembanemba yowonjezera m'mapapu.
Koma pali makamaka zowonongeka za mtundu uwu wa ululu. Ndi zifukwa zina ziti, zizindikiro zanu zingakhale zosavuta, ndipo ndi mayesero ati omwe dokotala wanu angakulimbikitseni kuti muzindikire zizindikiro zanu?
Ululu Wopweteka Kwambiri: Pleuritic Chest Pain
Monga taonera kale, madokotala amagwiritsa ntchito mawu akuti "pleuritic chest pain" pofotokozera ululu mu chifuwa chomwe chimapezeka ndi kupuma. Kupweteka kumachitika pokhapokha ngati kupuma kapena kukhalapo nthawi zonse ndipo kumatchulidwa kwambiri pamene mukupuma kwambiri. Pleuritic kupweteka pachifuwa nthawi zambiri zimakhala zolimba, osati zovuta kapena zolemetsa, koma pali zosiyana ndi lamuloli.
Kodi Kupweteka Kumene Kumapweteka N'koopsa?
Musanafotokoze zomwe zingayambitse kupweteka ndi kupuma, nkofunika kudziwa nthawi yomwe muyenera kutchula 911. Ngati muli ndi zizindikiro zotsatirazi ndi kupuma kosavuta, musawerenge mopitilirapo ndikupempha chithandizo chamankhwala mwamsanga:
- Ululu umene uli wovuta kapena umene unabwera mwadzidzidzi
- Kuvuta kukugwira mpweya wanu kapena kupuma kochepa
- Kupweteka, kutupa, kapena kufiira mulimonse mwa miyendo yanu (yomwe ingakhale magazi) ndi ululu ndi kupuma
- Lightheadedness kapena kutaya
- Kuwaza magazi , ngakhale pang'ono (ngakhale supuni ya tiyi imatengedwa ngati yowopsa mwachipatala)
- Kumverera kwa chiwonongeko chomwe chikubwera: Ngati simungathe kufotokoza zomwe mukutanthauza koma kumverera ngati zomwe mukukumanazi ndizidzidzidzi, khulupirirani chibadwa chanu ndi kuitanitsa 911
Chimodzi mwa zifukwa zomwe zimayambitsa kupweteka pachifuwa cha phokoso ndi mapiritsi, mapiritsi a magazi omwe amachoka miyendo ndikupita kumapapo. Izi ndi zoopsa zowopsya ndipo zingayambitse imfa ngati osatengeredwa. Mufukufuku wa 2017 adatchulidwa kuti anthu 5 mpaka 21 peresenti ya anthu amene anapita ku chipinda chodzidzimutsa ndi kupweteka kwa chifuwa chofufumitsa anapezeka kuti ali ndi mapulaneti.
Njira za Pleuritic Chest Pain (Ululu ndi Kupuma)
Musanapite ku zovuta zomwe zingayambitse kupweteka ndi kupuma, ndizothandiza kulankhula za njira zomwe zingayambitse kupweteka kotere. Ululu wokhala ndi kupuma ukhoza kuchitika ndi zinthu zomwe zikukhudza pafupifupi zigawo zonse zomwe ziri mu chifuwa. Izi zikuphatikizapo:
- Nthiti
- Mitsempha, minofu, ndi zida zina zofewa za m'chifuwa
- Mphuno yamtunduwu
- Mapapu ndi chipinda cha mapapo
- Mtima ndi chikhomo cha mtima (pericardium)
- Mtheradi
- Chifuwa
Pafupipafupi Breathing vs Pleuritic Chest Pain vs Pleurisy
Ngati mwakhala mukuwerenga za kupuma kupweteka kapena kupuma kupweteka, mungasokoneze nkhaniyi.
Ichi ndi chifukwa kupuma kupweteka kumatchedwa zinthu zambiri. Mawu akuti "kupweteka kwa chifuwa chachikulu" nthawi zambiri amagwiritsidwa ntchito pofotokoza ululu uliwonse umene umapezeka ndi kupuma. Mosiyana, mawu akuti pleurisy angagwiritsidwe ntchito m'njira zosiyana. Nthawi zina Pleurisy amagwiritsidwa ntchito kufotokoza kupweteka kulikonse kumene kumachitika ndi mpweya wozama, koma nthawi zina amagwiritsidwa ntchito pofotokoza kutentha kwa pleura , zibulu ziwiri zomwe zimayendera ndi kuteteza mapapo panthawi yopuma. Pali kugwiritsidwa ntchito pogwiritsa ntchito mawu awa. Mwachitsanzo, zizindikiro zina monga chibayo zingayambitse vuto la pleurisy (kupsa mtima ndi kutukusira kwa pleura), koma zimapangitsanso kupweteka ndi kupuma chifukwa cha njira zina monga nthiti zomwe zathyoledwa kapena zowonongeka ndi kupweteka kwa minofu kukhwima.
Zomwe Zingatheke Chifukwa Chakumwa Ndi Kupuma
Pali zifukwa zambiri zomwe zimayambitsa ululu ndi kupuma zomwe zimangokhala ngati chokhumudwitsa kwambiri. Zina mwa zifukwa zomwe zimayambitsa zowonongeka zimatsitsidwa pansi ndi dongosolo la thupi.
Zotsatira Zowola Momwe Zimapweteka Kwambiri
Ngakhale mapapo alibe mapepala opweteka, matenda a mapapo amatha kupweteka m'njira zingapo, kuphatikizapo zomwe zimayambitsa chisokonezo cha pleura. Ena mwa awa ndi awa:
- Pleurisy: Monga taonera pamwambapa, kutupa kwa pleura, yotchedwa "pleurisy," ndi chifukwa chofala cha ululu ndi kupuma. Pleurisy ikhoza kupezeka payekha kapena yokhudzana ndi chikhalidwe china monga zomwe tatchulidwa pansipa. Zitha kuchitika pambuyo pa matenda opuma opuma, ndipo zikuwoneka kuti zimakhalapo kwamuyaya.
- Matenda opatsirana pogonana: Mavairasi omwe amatha kupweteka kwambiri pamutu pamaphatikizapo kachilombo ka Coxsackie, kupuma kwa syncytial virus (RSV), fuluwenza, parainfluenza, mumps, adenovirus, cytomegalovirus (CMV), komanso Epstein Barr (yomwe imayambitsa matenda opatsirana a mononucleosis).
- Chibayo : Matenda m'mapapu, makamaka omwe ali kumadera akutali a mapapo pafupi ndi kulala, amatha kupweteka ndi kupuma.
- Khansara ya m'magazi : Zimaganiziridwa kuti pafupifupi theka la anthu omwe amapezeka ndi khansara yamapapu amamva ululu kwinakwake m'chifuwa chawo pa nthawi ya matenda. Sizodabwitsa kuti ululu uwu umasintha ndi kupuma, makamaka ngati chotupa chiri m'madera akutali a mapapo pafupi ndi pleura. Pakali pano, mtundu wambiri wa khansara wamapapo, mapapu adenocarcinoma , umakula kukula kwa mapapo pafupi ndi pleura. Awa ndiwo mtundu wa khansara wamapapu umene umapezeka mwa anthu omwe sanasuta konse, amayi, ndi achinyamata omwe ali ndi kansa ya m'mapapo.
- Chifuwa (TB): TB ndi chifukwa chosavuta kwambiri chakumva kupweteka ndi kupuma ku United States, koma ndizofala kwambiri padziko lonse lapansi.
- Pleural effusions: Magulu okhudzana pakati pa zigawo za pleura, otchedwa pleural effusions, ndiwo amodzi omwe amachititsa ululu ndi kupuma. Komabe, kupwetekedwa ndi kupuma ndi chizindikiro chosadziwika bwino, kupweteka kwakukulu kungafanane ndi nthenda iliyonse ya matenda, kuyambira ku matenda a m'mapapo ndi matenda a mtima kuti zikhale ngati matenda a nyamakazi, ndi khansa. Zowopsya zofufuzira zowopsya ndizochita zowonongeka zomwe zili ndi maselo a khansa. Izi zingachitike mwa anthu omwe ali ndi khansara yamapapu, kansa ya m'mawere, ndi khansa zina zomwe zimafalikira m'mapapu.
- Pneumothorax : Pneumothorax ndi kugwa kwa gawo kapena mapapo. Kugwa kungakhale kochepetseka kwambiri komanso kosamveka bwino, kapena kungakhale kwakukulu ndipo sikuchititsa kupweteka kokha kupuma komanso kupuma kochepa komanso ngakhale kamphindi kakang'ono kamene kamakhala ndi emphysema, chomwe chimakhala ngati khungu la chifuwa chimamveka ngati kutsekemera chifukwa cha kuthawa kwa mpweya kuchokera m'mapapo. Pneumothorax ikhoza kukhala vuto la emphysema, matenda ena amapapu, kapena kupwetekedwa mtima, kapena zingachitike mwadzidzidzi mwa akuluakulu ena okhwima.
- Kuphatikizana : Zomwe zimawopsyeza moyo, mapangidwe am'mimba amapezeka pamene mitsempha imatuluka m'mitsempha ya m'mimba (kupita ku mitsempha ya thrombosis ) ndikupita kumapapo. Mofanana ndi pneumothorax, zizindikiro zikhoza kukhala zochepa kwambiri, ndipo vutoli ndilodzidzidzi. Zowopsa za zojambula zam'mimba zimaphatikizapo opaleshoni yatsopano, matenda ambiri omwe ali ndi matenda, kutenga mimba, ndi kuyenda mtunda wautali ndi galimoto kapena ndege. Monga taonera kale, mgwirizano wa pulmonary ndi wamba mwa anthu omwe amapita ku chipinda chodzidzimutsa ndi ululu wofufuzira pachifuwa.
- Mesothelioma : Mesothelioma ndi khansara yomwe imachitika phokoso lambiri ndipo ndilofala kwambiri kwa anthu omwe akhala akupezeka ndi asibesitosi pa ntchito.
Zotsatira Zokhudza Mtima Zopweteka Kwambiri
Popeza mtima uli pafupi ndi mapapo (ndi pleura) ndipo umayenda ndi kupuma, mtima umatha kupweteka ndi kupuma. Mkhalidwe wina wokhudzana ndi mtima umene umayambitsa kupweteka kwa chifuwa chachikulu ndi:
- Pericarditis : Pericarditis imatanthawuza kutupa kwa nembidzi zomwe zimayika mtima (zojambulajambula) zomwe zimakhala zofanana ndi zomwe zimayikidwa m'mapapu. Pericarditis imayambitsa zifukwa zambiri kuphatikizapo matenda, kansa (kansa ya khansa yambiri ndi kansa ya m'mawere), zomwe zimakhala ngati matenda a lupus, ndi matenda a impso. Pafupifupi 15 peresenti ya anthu omwe ali ndi matenda a mtima amapanga pericarditis.
- Kuthamangitsidwa kwa mtima: Nthawi zambiri, kupweteka komwe kumayambitsa matenda a mtima sikugwirizana ndi kupuma, komabe kuwonjezeka kwa ululu ndi mpweya wambiri ukhoza kuchitika, makamaka ngati matenda a mtima akuphatikiza ndi pericarditis monga taonera pamwambapa.
- Kusokonezeka kwa Aortic: Kuthamangitsidwa kwa aortic ndi chikhalidwe chimene chimafooketsa mwa aorta chimalola kuti magazi alowe mu chipinda "kutsitsa" mkati mwachitsulo cha aorta, ndipo ndizodzidzidzi zamankhwala. Nthawi zambiri zimayambitsa kupweteka kwakukulu komwe kumawoneka m'chifuwa ndi kumbuyo. Kaŵirikaŵiri zimachitika mwa anthu omwe ali ndi matenda a Marfan, nthaŵi zambiri amuna omwe ali aatali komanso otsika.
- Kuchepetsa matenda oopsa : Kuwopsa kwambiri kwa magazi ndi matenda aakulu omwe amachititsa kuti magazi asokonezeke. (Ndizosiyana ndi matenda opatsirana kwambiri omwe anthu ambiri amadziwa nawo ndipo amapezeka ndi echocardiogram kusiyana ndi chifuwa cha magazi.) Mitsempha ya pulmonary ndi yonyamula magazi kuchokera pamtima kupita kumapapu kuti atenge mpweya. Kuchulukanso kwa magazi kungayambitsenso matenda osiyanasiyana a mtima, matenda a m'mapapo, matenda osokoneza bongo, ndi mankhwala ena.
Zosokoneza Mitsempha Yopweteka Kwambiri
Mavuto omwe amapezeka m'kati mwa chifuwa amatha kupweteka omwe amayamba kapena kuwonjezereka ndi kupuma. Ena mwa awa ndi awa:
- Kuphulika kwa chiberekero: Kuphulika kwa nthiti monga chifukwa cha kupweteka ndi kupuma nthawi zambiri kumakhala koonekera, koma nthawi zina izi zimaphulika pochita chifuwa kapena zovuta kwambiri kwa anthu omwe ali ndi matenda odwala matenda a mitsempha. Nthiti ya nthiti yowumitsa , mtundu wa kuvulaza mopitirira muyeso, komabe, sizowonekera. Kupwetekedwa kwa nthiti kukupweteka nthawi zambiri kumakhala pang'onopang'ono ndipo kumakhala koipitsitsa ndi kupuma kwakukulu komanso kukakamira.
- Matenda a Costochondritis ndi Tietze : Matenda a Costochondritis ndi Tietze ndi zinthu zomwe zimaphatikizapo kutupa dera kumene nthitizi zimagwirizanirana ndi / kapena pamene nthiti zimagwirizanitsa ndi sternum (pachifuwa). Ndi coochondritis, pakhoza kukhala kutupa kwa dera lino, pamene matenda a Tietze alibe. Chisoni cha pachifuwa chomwe chimagwirizanitsidwa ndi mikhalidwe imeneyi kawirikawiri chalakwika chifukwa cha matenda a mtima. Kuchokera ku nthiti, choncho nthitizi zimayenda ndi mpweya uliwonse, ululu umakhala wofanana ndi kupuma, makamaka kupuma kwambiri.
Zina Zowonjezera Zomwe Zimayambitsa Kupweteka Kwambiri
- Zilonda : Pamene kachilombo ka nkhuku "kamangobwereza" pakugawidwa kwa mitsempha yomwe imapereka chifuwa, ikhoza kutsitsa kupweteka pachifuwa-malingana ndi malo-ululu ungasinthe ndi kupuma. Ngakhale kuti msuwa amatha kupweteketsa, nthawi zambiri ululu umayamba kutsogolo kwa masiku angapo, zomwe zimapangitsa kuti matendawa asamatsimikizire poyamba.
- Refidx Yamadzi : Ululu umene umapezeka chifukwa cha matenda a reflux (GERD) samagwirizanitsa ndi kupuma, koma ukhoza kuwonjezeka ndi mpweya waukulu.
Zizindikiro Zogwirizana
Pali zizindikiro zambiri zomwe zingachitike pamodzi ndi kupuma kopweteka komwe kungakuthandizeni inu ndi dokotala wanu kudziwa chomwe chimayambitsa ululu wanu. Ena mwa awa ndi awa:
- Chifuwa, kaya chifuwa chachikulu kapena chifuwa chosatha
- Mitundu ina ya ululu wochokera m'mimba ya ululu, kupweteka, kupweteka , kupweteka kwa msana
- Kupuma pang'ono
- Kudula magazi
- Kusokonezeka
- Kupuma
- Kutayika kosayembekezereka
Mafunso Ma Dokotala Wanu Angakufunseni
Kuwonjezera pa kufunsa zokhudzana ndi zizindikiro zowoneka pamwambapa, dokotala wanu angakufunseni kuti:
- Kodi inu, kapena munayamba mwasuta?
- Kodi mwakhala mukuvulala kapena kukhumudwa, kuphatikizapo ngakhale kupweteka pang'ono?
- Kodi mwakhala ndi matenda opuma opuma monga chimfine kapena chimfine?
- Kodi zizindikirozo zinayamba liti, ndipo zakhala zikuchitika liti?
- Kodi munayamba mwakhalapo ndi zizindikiro zofanana m'mbuyomo?
- Ndi mavuto ena ati azachipatala omwe muli nawo?
- Kodi ndi zochitika ziti zamankhwala zomwe zimayendera m'banja lanu?
- Kodi mwayambitsa pulogalamu yatsopano yochita masewera olimbitsa thupi, kapena mukuchita zochitika zina zomwe zingawononge minofu ndi ziwalo zina m'chifuwa chanu?
- Kodi zizindikiro zimachitika nthawi zonse, kapena pa nthawi yeniyeni, monga kupita kunja kutentha?
Ayesa Dokotala Wanu May Order
Malinga ndi zizindikiro zanu, pali mayesero angapo omwe dokotala wanu angakulimbikitseni. Izi zikuphatikizapo:
- Chifuwa cha X-ray: Kumbukirani kuti chifuwa cha x-ray chingakuthandizeni kudziwa kuti muli ndi vuto, koma sizingathetse vuto. Mwachitsanzo, khansa ya pulmonary kapena khansa ya m'mapapo ikhoza kupezeka ngakhale kuti ili ndi chifuwa cha x-ray. Ndipotu, khansa yaing'ono yamapapu imakhala ikusowa pa x-ray ndipo sichidziwika mpaka ikafika pa siteji pamene sichiritsidwe. Kuphatikizika kwapopysi kumakhalanso koopsa, ndipo kungakhale koopsa ngati sikupezeka mwamsanga.
- Lembani mizere.
- Kujambula kwa mpweya wabwino: Ichi ndi chiyeso choyesedwa kuti chifufuze umboni wa pulmonary embolism.
- Chifuwa chachikulu cha CT: Chifuwa chachikulu cha CT chitha kugwiritsidwa ntchito poyesa zikhalidwe zingapo zomwe zili ndi chifuwa. Zitha kuchitanso kuti mupeze chidziwitso chokwanira cha nthiti ndi zida zolimba mu chifuwa.
- CT angiography.
- Electrocardiogram (EKG)
- Echocardiogram: Echocardiogram (yesero ya ultrasound ya mtima wanu) ikhoza kuchitidwa kuti ayang'ane kutupa kapena madzi mu memphane yomwe imalowa mu mtima (pericarditis kapena pericardial effusion).
- Oximetry: Oximetry ndi mayeso omwe amagwiritsidwa ntchito poyeza mlingo wa oksijeni m'magazi anu. Nthawi zina amatha kupereka zizindikiro kwa mapapu kapena mtima wa pansi.
- Kuyesera kochita ntchito.
- Mayeso a D-dimer.
Kuchiza kwa Kupweteka Kwambiri
Njira zopangira kupuma kupweteka zimadalira chifukwa chenicheni. Ndikofunika kumvetsera thupi lanu ngati muli ndi ululu wofufuzira pachifuwa, osati "kusokoneza" zizindikiro zanu pogwiritsa ntchito mankhwala opweteka mpaka mutaphunzira bwinobwino.
Zovuta Pamtundu Wowawa Ndi Kuphulika
Monga tanenera kale, pali zifukwa zambiri zomwe zimayambitsa kupuma kupweteka kapena ululu ndi mpweya waukulu umene umachokera ku zomwe zimakhala zovuta kwa omwe akuopseza moyo. Ndikofunika kukumbukira kuti ululu ndi chizindikiro kuchokera mthupi lathu kutiuza kuti chinachake chalakwika. Zingakhale zokhumudwitsa ngati simukupeza matenda nthawi yomweyo, nthawi zambiri zimakhala zowawa ngati izi, koma pitirizani kukambirana ndi dokotalayo mpaka mutayankha. Afunseni kutumiza kwa katswiri kapena kupeza lingaliro lachiwiri ngati mulibe tsatanetsatane yowonjezera kwanu. Chowonadi ndi kupuma kupweteka ndizochitika pazochitika zilizonse zachipatala-ndikofunika kukhala wothandizira wanu mu chisamaliro chanu kuti akhalebe wathanzi.
> Zotsatira:
> Berchuck, J., ndi S. Patel. Kafukufuku Wofala Kawirikawiri wa Pentiitic Chest Pain. Journal of General Internal Medicine . 2016. 31 (1): 138.
> Jany, B. Zizindikiro Zopangira Chifuwa Chofufumitsa. Lowani . 2017. 58 (1): 22-28.
> Reamy, B., Williams, P., ndi M. Odom. Pleuritic Chest Pain: Kukonzekera Kudzera Kusiyana Kwambiri. American Family Physician . 2017. 96 (5): 306-312.
Yan, G., Littlewood, A., ndi M. Latimer. Chifukwa Chachilendo cha Pentiitic Chest Paint Child. Malipoti a Mlandu wa BMJ . 2016. pii: bcr2016217307.