Ulwahlulo yengxinano zesibindi kwesibindi njengako Child-Pugh

Ukuqina kwesibindi - ukwanda kwe zomzimba nokuqina umzimba ngenxa yokukrala ixesha elide. Indlela eqhelekileyo ukuba ukuhlelwa esi sifo ayikho ngenxa yokuba kungekho kuvumelana apho okukhona kakhulu nempumelelo iingxaki diagnostic kunye nonyango ngokoma.

Ukuhlelwa kwesibindi kwesibindi njengako Child-Pugh

Le Ulwahlulo kwesibindi kwesibindi isetyenziswa ukuqikelela iqondo ubungnqongqo sifo kumguli.

Ngenxa lokulinganisela yayo ukuvelisa ukusinda nomonde ngale sifo yaye ipesenti yokufa emva kotyando. Ndandizimisele njengoko kufuneka esinye isibindi.

Isifo baziindidi ezintathu. Ipharamitha ezichaza iiklasi zibonisa iqondo ubukhali kwesibindi, ngokunjalo kuya kuba yintoni iminyaka ubomi isigulana ngumntu ukuqina. Ngokutsho Child-Pugh degree imbuyekezo kwesi sifo ichazwa njenge:

1. Class A ziquka kwesibindi babuyekezwe.
2. B - subcompensated.
3. C - ukuqina decompensated.

Njani uphawula?

Iklasi nganye of Child-Pugh eyabelwe iingongoma ezithile ukuba zibalwa ngokusekelwe sum of eziliqela iparameters. Ngenxa yoko, Class A kokwabo kuluhlu amanqaku 5 ukuya 6, B, ngokulandelelana, - ukususela ngowe-7 ukuya ngamanqaku 9. Kwaye udidi lokugqibela - ixabiso kakhulu kumanqaku e-10 ukuya kwi-15.

I degree Ubuncinane sandla kwesibindi ngenxa A. Kulo mzekelo, ubude yobomi yomguli kukuba kwi eliphezulu - ukusuka kwiminyaka eli-15 ukuya kuma-20. Ngomhla wesibini, oko kumalunga-10 iminyaka. Class C kuthetha iminyaka imfutshane ubomi kwezigulane kwesibindi - omnye kuphela okanye ezininzi iminyaka emithathu.

Emva kotyando, ipesenti ephezulu lokufa eklasini C - kuba yi-80%; 30% - ngokulandelelana, kwaye A ka--%-10 kuphela.

Imfuneko esinye isibindi ashushu ezahlukeneyo obubungqongo uzimisele ngolu hlobo lulandelayo:

• High - C;
• eliphakathi - B;
• Low - A.

I parameters kuthathelwa ingqalelo xa lucalulo Child-Pugh

Ziziphi parameters nefuthe kulwabiwo kuso? Okokuqala, sithabathela ingqalelo phambi:

• yibilirubin;
• albumin;
• ascites.

Njengoko ngokunjalo hepatic Encephalopathy, PTI, PTT kunye INR.

System for Child-Pugh asikwazi kuthathwe njengokubhekisa, kuba uvavanyo kuthathela ingqalelo zonke iimeko yesigulana. zisiba I usiko zizifo kwakunye nezigulo yayo utshintshe mfanekiso, yaye le yokuhlela engasekho kusetyenziswa.

inkqubo echazwe Kwakhona ikwaqwalasela ingqalelo morphologic kunye neempawu etiologic in kwesibindi.

Ukwahlukanisa iimpawu etiologic

Kukho malunga namashumi amabini iintlobo ngokoma. Kuxhomekeka ekubeni unobangela yaziwa okanye hayi, esi sifo yahlulwe ngokwamaqela amathathu:

1. Ukuqina ifakiwe (eyaziwa) umyalezo.
2. Le ngezifo apho umyalezo na impikiswano (maxa wambi ebizwa ngokuba 'umyalezo kunokwenzeka ").
3. Ukuqina nangokunikwa (ayaziwa) umyalezo.

umyalezo weimeyile efakwe

Of eyaziwayo, elasekwa unobangela esi sifo uthi kwezi meko zilandelayo:

• Xa kwesibindi ezinxilisayo okuvela phakathi ukusetyenziswa elide utywala (40-60 gram ethanol) kangangeminyaka eli-15 okanye ngaphezulu.
• Wentsholongwane egazini ukuba isiqingatha meko ibangelwa yintsholongwane kohlobo B, C no G.
• Iziyobisi okanye amayeza, esizibonakalisa ngenxa yokusetyenziswa kweziyobisi zohlobo olufanayo ixesha elide.
• ukuqina biliary zamabanga aphakamileyo, apho kwenzeka hepatic inyama ukufa erhabaxa kukuqulungana inyama ezikhandelwa indawo yawo.
• ukuqina yimfuzo okanye azelwe.
• Nda- wonye - ngaba lwahlukile kwezinye iintlobo idwelisiweyo kuphuhlisa ithuba ngokwaneleyo elide xa igazi ukuya isibindi yaphukile. Waphawula kwizigulane kunye nokuhamba kwegazi jikelele.
• Xa izifo Budd-Chiari syndrome - isifo ezinxulumene igazi lokuphuma visually kwesibindi (hepatic vein thrombosis).
• Exchange-alimentary kwesibindi evela kwi seswekile, ukutyeba, xa ujoyina enteroapocleisis.

umyalezo weimeyile kunokwenzeka kwaye akucaci

Kunokwenzeka kwaye usithe, umyalezo engaziwayo abonakale ngoku ebusweni of:

• izifo ezosulelayo;
• izifo olwaye lwamfimfitha;
• ezimbi komzimba;
• ukungondleki.

imiba etiologic Unknown - kudla ifomu kwesibindi cryptogenic. Xa kwesibindi lokuqala biliary kunye nabantwana Indiya kwakhona zithetha umyalezo ezingaziwayo.

yokwahlukanisa morphological

Ukuhlelwa Morphological nomonakalo wesibindi - lo wokuqala ezicetyiweyo zavunywa ngokususela kwidatha esuka biopsies (piece umzimba, labanjiswa vivo). Bekela bucala ngezifo Iifomu 4:

• MKD kwesibindi luphawulwa maqhuqhuva ezincinane emzimbeni, ogama ubukhulu yi 1-3 mm;
• krupnouzlovgo kwesibindi - liver maqhuqhuva sangqa-3 mm okanye ngaphezulu;
• Iifom kwesibindi engaphelelanga, apho advantageously abachaphazelekayo ulwahlulwa mezhpechenochnye;
• ugalelwe, luphawulwa indibanisela zonke iimpawu ngasentla.

unyango ukuqina

Wabhenca kwiklasi ukuqina Child-Pugh inika ithuba kuphela ukuba isifo, ukuqikelela ukusinda izigulane, kodwa ukukhetha unyango olufanelekileyo kunye nokhathalelo inkxaso.

Ngoko ke, lo isifo sesibindi babuyekezwe (Nge udidi A) lubandakanya unyango olusisiseko ejoliswe bayeke ingcambu unobangela sifo. Ukongeza, kufuneka sithathe amayeza axhasayo. Umsebenzi wabo - ukuphelisa ukungacoleki kokutya. Kubaluleke kakhulu kweli enzyme zi ludidi "pancreatin" "Creon", "mezim". Iidosi standard, esithathwe kathathu ngemini, ekukhethwa ukuba phambi izidlo. Ngaba izifundo ababelwe, umlinganiselo kwiiveki 2-3, leyo iphindwe rhoqo.

Xa subcompensated ukuqina (Xa B ukuqina iklasi ka-Child-Pugh) olunzulu efunekayo ukuqeshwa therapy yesondlo. Ukulungiselela le njongo kusetyenziswa ukutya wetyuwa ephantsi (ngaphezu kwe-2 grams ityuwa ngosuku), iiproteins kukhawulelwe. Amachiza emiselweyo "Furosemide" yaye "spironolactone". Ukwamkela womchamo iyayiqhobosha ukuphuhlisa lwegazi portal yaye kunciphisa ascites. Umsebenzi we phecana zesisu nokuba ingaphuculwa "lactulose" kwi ml 50-70 ngosuku, kodwa wonk 'ukuba uhlale ngonaphakade.

Kwimeko isifo sesibindi decompensated (xa iklasi C ngokutsho Child-Pugh) wabonakalisa kwimeko yomguli ubomi emngciphekweni. Oku kufuna unyango ngokukhawuleza kakhulu. Paracentesis inika ukususwa ulwelo ukusuka peritoneum, albumin elawulwa yegazi kunye crystalloids, nenzaliseko ajikelezayo umthamo wegazi kunye iiprothini emzimbeni. Ngenkuthalo kusetyenziswa womchamo: i "spironolactone" efanayo "Furosemide". Amisele ndele yokudla yetyuwa. Kuba ukutya okunezondlo parenteral eza Encephalopathy hepatic kunye nezinye iimeko ezinzima.

isiphelo

Prophylaxis kwezifo kusekelwe ukuhlelwa yengxinano kwesibindi kukudumba Child-Pugh.

Ekuhambeni isifo babuyekezwe ayifuni injongo lokuthintela. Xa iiklasi B kunye nezigulane C inokuphuhlisa anaemia, ngoko rhoqo alawulwa erythropoietin. Ukongeza, i-ngokuqhelekileyo emiselweyo beta-blocker (ezifana "Metoprolol", "Inderal"), nto leyo ethintela umsantsa varices esophageal.