Edema yepulmonary chirwere chinokonzerwa nehuwandu hwehutachiona mumashandi emhepo emapapu (the alveoli ). Nemhaka yokuti alveoli inokonzerwa nemvura inogona kushanda zvakanaka, edema yemapemmata inowanzokonzera matambudziko makuru ekufema, uye inogona kuve dambudziko rehupenyu.
Chikonzero nei Edema yePulmonary Is problem
Nzvimbo yekumusoro-soro ndiyo inonyanya kuitwa basa remapapu.
MuAlveolar air bags, mweya mutsva tinofema unoswedera pedyo nemapilisiri anotakura okisijeni-varombo ropa kubva mumatumbu emumuviri. (Izvi zvinotapira ropa rinoksijeni zvakangobva kuputirwa kubva kurudyi rwemwoyo kusvika kumapapu, kuburikidza nemapirinari arteri. Pano pane zvakawanda nezvekuti mwoyo unoshanda sei .)
Kuburikidza nemasvingo mashoma e-alveoli, kugoverana kwegasi kunowanzoitika pakati pemhepo mukati megasi realveolar uye "yakashandiswa" ropa mukati memapillaries. Oxygen kubva kuAlveoli inotorwa ne capillary ropa, uye carbon dioxide kubva muropa inopinda mualveoli. Ropa, ikozvino okisijeni-pfuma zvakare, rinotorwa kurutivi rworuboshwe rwemwoyo, urwo runomuputira kumatumbu. Iyo "yakashandiswa" air alveolar inobudiswa kumhepo, sezvatinofema.
Upenyu pachahwo hunoenderana nekushandurwa kwakanaka kwemafuta mukati mearveoli.
Ne pulmonary edema, mamwe emasaga ealveolar anozadzwa nemvura.
Iko kushandiswa kwekutsvaga kwemhepo inoputika mukati memhepo inoputika uye ropa rekudzivirira ropa haigone kuitika mune alveoli inozadza mvura. Kana nhamba yakakwana yealveoli inobatwa, zviratidzo zvinoitika. Uye kana chirongwa chepadema chinowedzera, rufu runogona kugadziriswa.
Zviratidzo zvePulmonary Edema
Edema yepulmonary inogona kuitika zvakanaka, iyo iyo inowanzokonzera dyspnea yakaoma (kufema kufema), pamwe nekukanganiswa (izvo zvinowanzotora pink, frothy sputum), uye kuputika.
Kamwe kamwe-kamwe podema edema inogona kunge iri pamwe chete nekuzvidya mwoyo zvakanyanya, uye palpitations. Nenguva isipi inotanga kupemhemata edema inowanzonzi "flash pulmonary edema," uye inonyanya kuratidzira kuwedzera kukurumidza kwechinetso chepfungwa chepfungwa. Semuenzaniso, acon coronary syndrome inogona kubudisa flash pulmonary edema, sezvo inogona kukonzera kushushikana kwemoyo .
Acute pulmonary edema inogara iri chirwere chekurapa, uye inogona kuuraya.
Chronic pulmonary edema, iyo inowanzoonekwa nemwoyo kusakundikana , inowanzokonzera zviratidzo zvinopisa uye zvinoputika kwenguva, sezvo zvakawanda kana kuti zvishoma zvishoma zvinoshandiswa. Zviratidzo zvakajairika ndezvokuti dyspnea ine simba, orthopnea (kunetseka kufema pavanenge vakavata pasi), paroxysmal nocturnal dyspnea (kumuka usiku usingafemwi kufema), kuneta, mhemberero edema (kupfugama), uye kuwedzerwa kuwedzera (zvichienderana nekuwedzerwa kwemvura).
Chii Chinokonzera Edema Pulmonary?
Vanachiremba vanowanzoparadzanisa chirwere chemapemmia kuva imwe yemhando mbiri: moyo wemapemine edema, uye kwete-cardiac pulmonary edema.
Cardiac Pulmonary Edema
Chirwere chepfungwa ndicho chikonzero chinowanzokonzera chirongwa chepemmonary edema. Cardiac pulmonary edema inoitika nokuti chinetso chepfungwa chinokonzera zvinetso mumumanzere wemoyo kuti uwedzere. Izvi zvinodzvinyirira zvinopfuudzwa zvakapfuurirwa kumashure, kuburikidza nemasuru emapinimoni, kune alveolar capillaries.
Nemhaka yepamusoro yemapurumari inonzi capillary pressure, mvura inotonhorera inobva kunze kwemapapuriri kuenda ku-alveolar air space, uye pulema inonzi edema inoitika.
Anenge chero rudzi rwechirwere chemwoyo runogona kutungamirira kunzvimbo yakakwirira yakasara kumativi ekumanikidzwa kwemwoyo, uye saizvozvo, ku pulmona edema. Mhando dzakawanda dzezvirwere zvepfungwa dzinokonzera mapirmita edema nde:
- coronary artery disease (CAD)
- kukanganiswa kwemoyo kubva pane chimwe chikonzero
- chirwere chemwoyo chinonzi valve, kunyanya mitral stenosis , mitral regurgitation , aortic stenosis , kana kuti aortic kudzoka
- ane ngozi yakanyanya
Nekusingaperi kwepemadhi yemapemine edema, kushungurudzwa kwakakwirira mukati memapillaries kunogona kuita kuti kuchinja kuve kuitika mumishonga ye pulmonary.
Somugumisiro, high pulmonary artery inogona kuitika, chirwere chinonzi pulmonary hypertension . Kana rutivi rworudyi rwemwoyo rwuri kuputira ropa kune iyi yakakwirira yemapirmita arteri kukurudzira, kurudyi-mwoyo mwoyo kusakwanisa kunogona kukura pakupedzisira.
Non-Cardiac Pulmonary Edema
Mune misiyo yemaparimari edema edema, mvura inonaya inozadza alveoli nekuda kwezvikonzero zvisingabatanidzi kukwira kwepfungwa yepamwoyo. Izvi zvinogona kuitika kana ma-capillaries mumapapu akaparara kubva pane imwe chirwere chisina mwoyo. Somugumisiro, ma-capillaries anova "anonhuwa," uye anotanga kuerera mumvura mumagetsi.
Chikonzero chinonyanya kukosha chekuti hachisi-cardiac pulmonary edema inonyanya kuora mwoyo kuparadza (ARDS) , iyo inokonzerwa nekuputika kukuru mukati memapapu. Izvi zvinokuvadza masvingo emasvingo, uye inobvumira kushanduka kwemvura kuunganidza. ARDS inowanzoonekwa nevarwere vanorwara zvakanyanya, uye inogona kukonzerwa nehutachiona, kushungurudzwa, kushungurudzika, uye mamwe mimwe mitemo.
Mukuwedzera kune ARDS, chirwere chisingaiti chemoyo chinonzi edema chinogonawo kubudiswa ne:
- Pulmonary embolism
- High altitude illness
- Zvinodhaka (kunyanya heroin uye cocaine)
- Viral zvirwere
- Uturu (somuenzaniso, kubvisa chlorine kana ammonia)
- Zvinetso zvehutano (zvakadai sehutano hwepfungwa kana hutachiona hwemhepo )
- Smoke inhalation
- Pedyo pedyo kunyura
Kuongororwa Pulmonary Edema
Kurumidza kugadzirisa chirwere chepemmine edema chakakosha; uye kunyanya kukosha ndeyekutsvaga chikonzero chinokonzera.
Kuongorora zvirwere zvepemma zvinowanzoitwa nekukurumidza kuburikidza nekuita kuongorora kwepanyama, kuenzanisa ropa rey oxygen, uye kuita chep x-ray.
Kana imwe yemapurisa edema yakawanikwa, matanho anofanira kutorwa nokukurumidza kuti azive chinokonzera chinokonzera. Nhoroondo yezvokurapa inonyanya kukosha mune izvi, kunyanya kana pane nhoroondo yezvirwere zvepfungwa (kana kuwedzerwa mungozi yemwoyo), kushandiswa kwezvinodhaka, kusvibiswa kune zvinokonzerwa nehupfu kana zvirwere, kana zvinowanzoisa mungozi yeplmonary embolus.
An electrocardiogram uye echocardiogram kazhinji inobatsira pakuona chinangwa chepfungwa chepfungwa. Kana chirwere chemwoyo chichifungidzirwa asi hachigoni kuratidzirwa nekuedza kusingaoneki, catheterization yemwoyo inogona kudiwa. Mhando yeimwe mimwe miedzo inogona kudikanwa kana chikonzero chisingaiti chemoyo chikafungidzirwa.
Kwete-mapaimia emapemine edema anoongororwa kuti kana pulema yemahara edema iripo pakusatadza kwekumanikidzwa kwemwoyo yakasara yakasara.
Kurapa kwePulmonary Edema
Zvinangwa zvinobva mukurapa chirongwa chemapmonic edema ndechokudzikisa hutachidi hwemvura mumapapu uye kudzorera ropa mukati mehutano kumhepo. Oxygen therapy inowanzopiwa nguva pakarepo. Kana zviratidzo zvekushaya kwemoyo zviripo, diuretics inopiwawo zvakajeka. Mishonga inoderedza ropa midziyo, yakadai se nitrates , inowanzoshandiswa kuderedza zvinetso mumoyo.
Kana ropa rey oxygen mazamu richiramba rakanyanyisa pasi pasinei nezviyero zvakadaro, mhepo inopisa inogona kudiwa. Mechanical ventilation inogona kushandiswa kuwedzera kuwedzera mukati mearveoli, uye inotengesa zvimwe zvezvakawanda zvakakonzerwa zvakare mumapillari.
Zvisinei, Iyo yekupedzisira kurapwa kwepermonary edema - ingave inokonzera chirwere chepfungwa kana kuti chisingaiti chikonzero chemoyo - inoda kuziva uye kugadzirisa dambudziko rehutano hwepasi.
Sources:
Ware LB, Matthay MA. Clinical practice. Acute pulmonary edema. N Engl J Med 2005; 353: 2788.
Weintraub NL, Collins SP, Pang PS, et al. Mwoyo wakakundikana kusagadzikana syndromes: dhipatimendi rekukurumidzira dhipatimendi, kurapa, uye mafungiro: maitiro aripo uye zvinangwa zvemangwana: chirevo chesayenzi chinobva kuAmerican Heart Association. Circulation 2010; 122: 1975.