Imithambo mlenze eliphezulu. Iimpahla mlenze eliphezulu

Ukuze unikezele umzimba kunye ioksijini, intloko, imilenze neengalo umzimba womntu enikiweyo inkqubo yonikezelo igazi. Oku kuquka ezininzi iinqanawa. Umthambo Subclavian ezisekupheleni eliphezulu zivela kwi mediastinum kumngcipheko wokuqala ngaphambili. Ekhohlo ixesha elide ngaphezu ekunene kwaye iqala indlela Arch aortic. Ekunene - ngqo esiqwini brachiocephalic.

Ukuwela izihlunu kwentamo, uwele imithambo yegazi ibe emagxeni, eyayizalwa kwingingqi welungu engqinibeni ngeendlela ezimbini. Ngokutsho kulowo wenza igazi ukuba inyuke iye nesandla.

axillary kwemithambo

A. axillaris na inxalenye elandelayo isitya subclavian kba ukusuka kumphezulu kumphandle ubambo asezantsi. Kuthatha indawo kwekhwapha lekhefu kunye nezihlunu zamagxa singqongwe isidanga. Umthambo Axillary eliya emazantsi imisipha zamagxa enxulumene lat. Kuxhomekeka ngegama hlula udonga phambi ukuxinezeleka, kukho amathathu ikhadi axillary aorta.

isebe kwemithambo Brachial

A. brachialis ikwabizwa ngokuba ezahlukeneyo ze-imithambo yomzimba eliphezulu. Isitya isabelo owandulela lo liyaqhuba Umthambo axillary kweqondo eliphezulu (photo ubonisa indawo yayo). Ukuqala ingalandwa ukusuka ezantsi pectoralis enkulu, i nokuqhubekeka coracoid ngaphambili. Umthambo sidlule ukuba ngaphambili esihlunwini egxalabeni liwabe kwimimandla ebabusisakha kunye ulnar.

kwemithambo ziqu

A. radialis asuka kufutshane noqhoqhoqho-nokuvula kwi kokuxhuma umqadi kunye engqinibeni kwanamalungu gqolo iqhubeka kwemithambo yangaphambili udlula phakathi izihlunu kunye pronator. Pulsation ngokulula phakathi inqanawa yasentabeni kwi inxalenye yesithathu emazantsi zengalo, apho igqitha kufutshane kumphezulu kwaye yahlulwa kuphela solusu. Umthambo Further Uvingca styloid iphiramidi ebonisa unxibelelwano kummango isabelo kwaye ibekwe kwi ngebrashi ngasemva, namasundu udlula umsantsa emathanjeni.

Le ulnar kwemithambo isabelo

A. ulnaris, ngathi imizila komzimba esimbaxa alo mlenze eliphezulu isusela inxenye igxalaba kummandla entlanganweni engqinibeni kwi ithambo inkqubo umngxuma coronoid. Okulandelayo, isitya igcinwe phantsi pronator teres kwezihlunu, ngaxeshanye ukunika kwalo ngegazi nge kwamasebe amabini. Ulwalathiso unika amandla flexor digital enzulu ezingekhoyo, ihamba eyayingqalene luvo ulnar. Ngokusebenzisa umsantsa phakathi isiseko kunye izihlunu flexor ngomnwe kwemithambo encinane phezu engaphakathi entendeni kunye nonxulumano ziphethe inxalenye esezantsi isitya iphiramidi. Bebonke bakha i arc brush komhlaba.

igazi flow akananto na imithambo umzimba omzimba eliphezulu xa yokwehlulwa

Movement izibambiso kwegazi senzeka kwimeko apho icandelo lokuqala kwemithambo ukuya lenguqu yayo ebusweni vertebral ebona i stenosis baxa okanye occlusion. Loo imeko sele kuthiwa syndrome subclavian-vertebral ebe. igazi elipheleleyo flow iziphene izandla axillary xa isikhongozeli kusenokwenzeka ukuba kukho anastomoses Umthambo nemilenze kunye nomlenze kwinkqubo spinal.

Ezi ntlobo obambeleyo ziquka anastomoses:

• Phakathi ezinqamlezayo umfula blade isebe ukusuka kwinkqubo phantsi clavicle kunye umsantsa tireotservikalnogo incum acromial isitya axillary inxalenye yenkqubo.
• Phakathi Umthambo wesibeleko ulwalathiso ezinqamlezayo kwindawo yokugqibela yenkqubo subclavian kwaye inwenwa blade silahla.

Xa izilonda Umthambo brachial ukusebenza isitya igxalaba enzulu. amasebe awo yandisa ukuya kummandla ngengqiniba kwi iinkqubo akananto ezantsi kwaye phezulu kwaye enze womnatha oxineneyo anastomoses.

Xa izilonda emithanjeni ngemithambo alo mlenze eliphezulu endaweni ngesa- anastomoses ezininzi kwakhiwa. Endleleni, landela igazi iimpahla kwimimandla periarticular radius kunye ulna ukutya eziququzelelwe ngoncedo eyayizalwa iinkqubo. Bona basebenzisane womnatha, yehlukana ukusuka kwemithambo brachial. Nge arc sisilonda esidumbileyoesingaphakathi nemithambo ibrashi amasebe amaninzi babuyekezwe palmar anastomoses phakathi iingalo ngengqiniba kunye ziqu imithambo.

Anastomoses zithathe inxaxheba kwi izenzo zembuyekezo kuyo nayiphi na iinkqubo, leyo waphazanyiswa igazi flow kwi imithambo kweqondo eliphezulu nengasezantsi. Uhlobo endaweni ejikeleza akananto kuye kwaphucula kakhulu. Basesichengeni kakhulu kule nkalo ingqalelo neenxalenye inxalenye esezantsi axillary kunye imithambo brachial eliphezulu kummandla ukuya kwinqanaba ngemvelaphi isitya enzonzobila. Yingozi ukusuka kwindawo Ngenxa zokubuyiselwa igazi luthathwa yaphula isidima palmar arch phezulu. Zonke ezinye ukulimala kunye izifo ezingcolisa igazi ngokusebenzisa ubonelelo akananto ishenxisa uphuhliso kwezandla ischemia.

Iindlela ukuqhuba uphando

Doppler ultrasound kwemithambo kweqondo eliphezulu yenziwa ukufunda imeko izigulane. axillary Examination kunye aortas brachial ukwenza izixhobo ezisebenzisa amaza kunye rhoqo 4 MHz, yaye imeko ulnar kunye isixhobo iphiramidi ebonisa nemithambo ikhangelwe ngamandla zomsebenzi 8 MHz. Ngokucofa olwenziwe kwemithambo: nshita izitya imilenze, inxalenye engentla inkqubo yokujikeleza kufumaniseka ukuba aba lolu phantse kuzo zonke iindawo:

• axillary kwimithambo komboko imilenze aphezulu zikhawuleze ziyafumaneka kwi misinga;
• Nendlela Gxalaba lwenziwe kwi isabelo elide phakathi emagxeni kunye izo- bone kwezihlunu, xa emngxunyeni engqinibeni, lo pulsation igazi ibanjiwe njalo ummandla radiocarpal yesandla.

Ukuqinisekisa inqanaba ukutshatyalaliswa kwemithambo ezisekupheleni eliphezulu nga audition iindawo ecaleni emasebeni yemithi. Xa kwenzeka isandla amandla karhulumente yesiqhelo kuhlobo engundoqo lenguqu ukuya igazi akananto lwenziwa kwimeko ka stenosis kwemithambo yegazi okanye occlusions.

Ubungqina obubonakalayo buxela ukuba ukuhlinza

Reconstruction kweenqanawa kunye ezinxaxhileyo okubonakalayo umsebenzi wenziwa ngqongqo ngokuhambelana kunye neengcebiso. Imithambo nemilenze ischemia zixhomekeke ngaphantsi kakhulu, oku kubangelwe ifuthe umthwalo obuphantsi kuzo, xa kuthelekiswa ne ubunzima bomzimba kunye umzimba esebenza apha emilenzeni. Ngaphezu koko, igazi akananto iqulunqwa ngcono nakumphezulu umntla, amagxa kunye neengalo ngokumalunga nenkqubo efanayo esingxotyeni salo kunye empontshwa umqolo.

Uphawu engundoqo ibaluleke kakhulu ngoncedo zoqhaqho kwi imithambo kugqalwa ischemia engapheliyo ezingapheliyo kunye ingozi kakhulu ekusebenzeni ngendlela eyiyo kumzimba ongentla. Ngamanye amaxesha imeko ihamba kunye kusisisongelo kubomi umguli. emithanjeni Ngokusekelwe, hemodynamic, iimpawu lwezonyango ezikhethiweyo inani ezibonisa ukuba uqhaqho.

Imithambo kwesebe eliphezulu benithobele ngokutsha ngebhaxa, ukuba ngenxa yomsebenzi wezandla kukho nexesha ukudinwa elide ebantwini, ehamba yokuphila asebenzayo. Le uphawu i nefuthe elibi kwingqesho, kunciphisa umgangatho wobomi isigulane. Ubungqina obubonakalayo buxela ukuba zibe iimpawu ingqalelo ngamnye umzimba, isimbo ukusebenza, kwaye ubukho izifo ezihamba.

Ukuba isigulana akafuni kuva iintlungu nokuphumla, kakubi isikiwe ifuthe jikelele arhente zendawo kwezonyango, eyonyulwe ngokutsha nemithambo. Ngamanye amaxesha imeko iya iba maxongo ngenxa nangezilonda open non-ephilisa namanxeba, eyendawo neminwe esihlahleni. Ngaphambi kokuba ahlinzwe lwenziwa naluphi na unyango kunjalo, ukwakha wabelwa kuphela kwiziphumo zawo zokugqibela.

Buhlungu kwemithambo, kwaye izicwili necrosis izilonda lubonisa imfuneko kotyando, ugqirha sithabathela ingqalelo yokwakheka iparameters ngamnye. Amaxesha amaninzi contraindication ku ngokutsha yi esekhulile yesigulana.

iintlobo zemisebenzi

Anatomy imithambo ezizitho eliphezulu ivumela ukuhla izilonda ezinemigca ngeendlela ezahlukeneyo:

• main esa uninzi kukuba kudala amajelo circuitous phakathi iinxalenye onempilo aorta yokucima isahlulo basis of isitya;
• utshintsho kule aorta axillary proximal kunye buti brachycephalic wenze le nkqubo ibe imikrolo ibhaluni;
• revascularization utyando usebenzisa izixhobo microsurgical eyenziwa alufane.

Technology olujikeleza esa igazi

Olu tyando lwenziwa phantsi zomzimba jikelele okanye wengingqi. Ukuze shunt zisetyenziswa ngokuxhaphakileyo izinto ndlela saphenous femoral. Ukuvinjwa isigulana benqanawa ukuba phantse akukho nafuthe igazi ubonelelo kwesebe asezantsi. Lo kukhetha ndikwenzileyo isekelwe kwinto yokuba yegazi femoral lunqabe wachukunyiswa yamafutha apha zayo ezinkulu ezilungele kakuhle ekudaleni indawo bypass.

Kuba yokucima coronary aortic ukuthatha inkoliso kwemithambo thoracic lwangaphakathi iphiramidi ebonisa unxibelelwano kwicala lasekhohlo. Emva kokuba kusikwa isitya abachaphazelekayo basike kwindawo ukufaka shunt. ujuba sutured ukuya aorta ukubuyisela ukuhamba kwegazi. Emva kwexesha elithile emva kokuba nokusebenza iimviwo ngokuphindaphindiweyo yenziwe.

Ukusebenzisa-x-reyi ukufumanisa imeko iimpahla

Kumda yokudibanisa utyando kunye namayeza yenyukliya luyakhula kwaye kuphuhlisa ingqeqesho entsha, ukubonisa ngokwalo njengoko usebenzela nemithambo ngokusekelwe sesichengeni kwemitha. X-ray uphando amaza zonke ezikhoyo imithambo ezisekupheleni eliphezulu ezamahala, imithambo yegazi kunye amasebe awo, nkovu indlela. Iindlela ukuba isifundo kweenkqubo ezinemigca baba sesichengeni sosasazeko lwemitha:

• radionuclide;
• ultrasound;
• liyenza magnetic;
• X-ray.

Ezi ndlela ukuvumela ekufumanekeni kwephulwa kwisicelo sabo joint thelekisa iinkcukacha ezihlobeneyo, nto leyo eyenza kube lula ukufumana iziphumo ophumelelayo. Morphology ezisekupheleni eliphezulu imithambo liphandisisiwe iindlela ray, ukusetyenziswa elinjalo ngokukodwa olusebenzayo yokuqingqa amaza ukuhamba kwegazi. Phantsi kolawulo nimana X-ray eqhutywa zonyango micro-imisebenzi ezityeni, ebizwa ngokuba yi-ulungiso endovascular, nto leyo imele enye indlela utyando ukuze utshintsho abathile ngemithambo.

ukubetha yophando inkqubo hematopoietic

Intliziyo i olujikeleza le iyonke, ngoko ke ukungasebenzi le aorta ngemithambo luqinisekiswa kakhulu ke ngezifo yale omzimba. Umboko Umthambo uphando ukwenzela ixabiso ngecala eliphezulu izinga ukubetha peripheral kunye noxinzelelo. iimpahla Small ngokuqhelekileyo ekuqaleni kuhlolwa abangaboniyo usebenzisa Ngokucofa ubuchule, iziza ngenxa zibonisa pulsation ezibonakalayo, umzekelo kwingingqi le carotid kwemithambo entanyeni. Nangona kunjalo, ikakhulu kwi saveyi ukumisela amaxabiso izinga intliziyo kwiinqanawa peripheral. Esi salathisi ichazwe iphiramidi, brachial, axillary, femoral, imithambo popliteal ezinyaweni kunye nemilenze. Ixabiso elipheleleyo phinda ukubetha uthathwa ukuba abe phezu imithambo welungu esihlahleni.

Ukulinganiswa index uxinzelelo lwegazi

Ukuba sithetha xi ezahlukeneyo iimpahla, amaxabiso aphezulu ukunika imithambo eziphambili nemilenze. Nasemiphandeni peripheral amancinci kunye nexabiso isalathisi lincitshiswe. uxinzelelo iSystolic nohlulwe (ikukunyula ukubetha umthwalo) kwaye ukuzala (ngexesha ukubola amaza). Umahluko phakathi kwabo luphawu olubalulekileyo kwisaveyi. Iingcali ziqikelela ukuba umphumo uqikelelo igunya kunye ombane ukubetha. Ukuba uphakamile la manani, kungona uxinzelelo lwegazi.

Ukuzimisela xi lwemithambo kunye ukubetha

Le kwanda kokuqukuqela kwamanzi wegazi ezihamba imithambo intendelezo ekunene, ngokulandelelanayo, ukunyuka koxinzelelo engundoqo. Kwimeko yokuhlukunyezwa, eyaziwa ngokuba ukusilela intliziyo, ukudumba kunye nokwandisa imithambo yegazi peripheral, phambi kokuba yonke le nto yenzeka apha entanyeni. Lonyuka xi ukusilela ekunene ventricular, isifo valvular, pericarditis kunye nezinye izinto ezimbi ezininzi inhliziyo. ngemithambo kalanga Ingcali esandleni liqikelela isixa xi Kusenjalo engundoqo.

Ngokweliso iindumbisa ngemithambo esandleni, uyakwazi ukubona ukuba umyeke ngaphantsi kwenqanaba intendelezo ekhohlo. Ukuphakamisa ukuphakama brush ukuba ngaphezu kwe-10 cm ngaphezu kwenqanaba kokugcwaliswa ibonisa izitya ngababuthuntu nokuncitshiswa igazi.

Uphononongo kwemithambo

Ukuphazamiseka benkqubo inyama igazi peripheral kuvumela ukuba ukuthetha nje occlusion kwenxenye ngokuchasene nentsukaphi phambi yegazi. Ngokuqhelekileyo, impatho enjalo negazi ezinxulumene kweminyaka ngenxa ngokonakala supply akananto. Imithambo kwesebe eliphezulu ebonisa ukunyhashwa zabo iimpawu ze claudication ngakanye, nto leyo intwasahlobo yokuqala sifo. Isigulane yaphawula yimbonakalo intlungu xa sihamba amathole, eliseleyo ezi ukuxhuzula umntu ungazihluphi. Ekuhambeni kwexesha, kunciphisa ixesha lokulayisha amanyathelo, nto leyo ethatha indawo ngaphandle intlungu.

iimpawu ezinjalo nakuba kwi ekubulaleni iliac lwangaphakathi kunye nempahla femoral, ukuba le nkqubo iqhubeka, inkantsi kwenzeka nokuba baphumle. Kancinci kunciphisa iimpawu iintlungu yandisa ingalo okanye umlenze kwindawo nkqo, nangona ukwanda koxinzelelo lwemithambo bandiqumbise nokudumba yasekuhlaleni.

isifo lwemithambo

Utyhila olwaphula ukudluliselwa ukuhamba kwegazi emva occlusion ezinxulumene thrombosis, phlebitis okanye uxinzelelo ngaphandle. Le uhlolo yokuqala ikhutshwa phandle esebenzisa Ngokucofa. izitya izibambiso kutshintshwa intshukumo igazi, sibonakale ngaphantsi kwesikhumba, kuxhomekeka kwindawo ukuphazamiseka zaseprayimari. Ukuze ubone indlela ukuhamba kwegazi ukuba amsunduze umthambo anastomosis, yaye emva ukhupha ipatheni umkhondo intshukumo engaphezulu achache.

Olujikeleza Doppler ultrasound Study

Isiseko ukusebenza ifowuni kunye nendlela iimviwo wayifaka physics eyaziwa isiphumo Doppler. effect yalo ukutshintsha amaza uphawu cuke eziveliswa ngokutshintsha indawo eliphakathi zimiselwa ngenxa ukucabanga nezenzo zabo. Le ndlela yesibini intshukumo yesandi umthombo frequency.

Xa iphandwe Umthambo of kweqondo eliphezulu nolusezantsi, iziganeko ezibonakala zithunyelwa ukusuka amasuntswana igazi kunye amaza atshintshe impendulo kubonisa kulwelo bomyinge wamanzi kwimikhumbi. izixhobo Modern wasebenzisa Doppler kuphela isandi emitter mnye, idityaniswe umzingeli kwamaza ziboniswe. Xa izifundo laboratory isekelwe licandelo kumda wesangqa ye intshukumo ecaleni isantya umgca waphawula.

Inkqubo luhlolo

Kuba nkqubo akudingi ekhethekileyo pre-unyango, kodwa ayikwazi ukuhlola isigulana phambi izifo zolusu ubovu, kunye izilonda arhabaxa. ixesha Unyango kungathatha imizuzu engama-40 yexesha.

Human wayibeka phezu emqolo, isikhumba apho imithambo na ummandla igazi kweqondo eliphezulu, waluqaba zamafu gel layer enyibilikayo an zolwelo medium. Oku kufuneka ukuphucula conductivity ngayo imiqondiso cuke kwaye kudala umqobo yokungena komoya kwemfuneko ummandla wophando. Ngu woluvo koxinzelelo kummandla yesifundo, ingcali yenza iintshukumo Buyisela kwaye setyhula apha esikhumbeni.

Isigulane silala, ukuze kungabonakali umfanekiso wesiphumo, ngamanye amaxesha ugqirha unokufuna ukuba uyeke ukuphefumla okwesibini ukuze ufumane umfanekiso ocacileyo. Inkqubo ye-ultrasound ye-arteries yamagqabi angaphantsi angadluli ngokupheleleyo kwaye ayibangeli isigulane nantoni na enye into engeyiyo. Inkqubo ye-gel emva kokuphela isuswe nge-napkin.

Izizathu zokubhalwa kwemithambo yegazi

Ukuze uphononongo olunzulu lwenkqubo yokujikeleza yomzimba, kukho iinombolo:

• Ukubonakala kwentlungu ezandleni ngaphandle kwezinto ezibonakalayo nezibonakalayo, ukuphulwa kobuzwe besikhumba;
• Ngaphambili befumene i-atherosclerosis ehamba phambili ehamba phambili;
• Iintlobo ze-rheumatic pathologies ezihlukahlukeneyo, ngenxa yokuba iziza ezithintekayo zichaphazelekayo;
• I-thrombosis ye-aorta ehamba phambili yomzimba ophezulu, iziphambili, kunye neebhondi;
• Ukuxinwa kwemibhobho yesigxina esiphezulu (iifoto zengingqi ezinengxaki zingabonwa emfanekisweni);
• Ukugxeka kweempawu ezinobungozi kunye nezibi kakhulu emithanjeni;
• Ukungaphumeleli kwamaxesha angama-congenism ye-circulatory system;
• Ukugqithwa kwangaphambili kwendlela ehamba phambili kunye namacandelo esebe.

Iziphumo zophando oluqhutywe

Ukuba ukuhamba kwegazi kuhanjiswe kwi-sensor, ubukhulu beempawu ziba zikhulu, kwaye ukunyuka kwelinye icala kuya kunciphisa ixabiso lezalathisi. I sixhobo siguqula impendulo ebonisiweyo kumpompo wombane, oqhutywe kwidivaysi ye-ultrasonic kwaye iboniswe ukubukela kwesikrini.

Iskrini se-Ultrasound, duplex kunye ne-triplex, esicinga iirridwe kunye nemithanjeni yamalungu angaphezulu, i-anatomy eye yonakaliswe, yenza ukuba kukwazi ukuvavanya isakhiwo sangaphakathi kunye nobukhulu bomda wokuhambisa. Ngokuncediswa kwindlela, ulwazi oluchanekileyo kwi-hemodynamics yenkqubo yokujikeleza, luyakwenza ukuba ubone iimpahla kwiskrini. Uphononongo lunceda ukucacisa isakhiwo kunye nemeko yodonga kunye nendawo ekhoyo ye-cholesterol plaques.

Xa uhlolisisa imithambo yomzimba ophezulu usebenzisa indlela ye-duplex, isixhobo singasetyenzwa kwiimodeli ezimbini. Kulo hlobo lokuqala, ifowuni isebenza njengomshini oqhelekileyo we-ultrasound, ovumela ukuba ukhangelele ngokucacileyo yonke isakhiwo phantsi kokufunda. Ikhetho lesibini isebenzisa indlela engaboniyo yeDoppler kwimodi yokujonga.

Ukuba kusetshenziswe uphando lwe-triplex, indlela yesithathu yokubala imbala yongezwa kwiimodeli ezimbini ezingentla. Le ndlela ibonakalisa ukuhamba kwegazi kwindawo ekubonayo. Enyanisweni, lo ngumfanekiso we-ultrasound, umbala ngokuxhomekeke kubuxininisi bokuhamba kwe-fluid kunye nesivinini sawo.

Ekupheliseni, ku funeka kuqatshelwe ukuba iindlela zamanje zokuhlola izigulane zokufumanisa iimpazamo kunye nomonakalo kwimibhobho kunye nemithanjeni inezinzuzo ezibalulekileyo kwiindlela zokusetyenziswa kweemviwo zangaphambili. Ukuyila kwemithi ye-ultrasound ivumela ukuba zisetyenziswe ngokuthe ngqo kumbhede wesigulane, akukho mijelo enobungozi yesigulane.