tromboemboliya legochnoy arterii

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tema: tromboemboliya legochnoy arterii prigotovil: student 605 b gruppi raxmonov feruz tromboemboliya legochnoy arterii (tela) – eto: ostraya okklyuziya stvola ili vetvey legochnoy arterii trombom ili embolom, sformirovavshimisya v venax bolshogo kruga krovoobrasheniya ili polostyax pravogo serdtsa chastota tela prodoljaet povsemestno i progressivno uvelichivatsya! v nastoyashee vremya yavlyaetsya tretey po chastote prichinoy vnezapnoy smerti posle ishemicheskoy bolezni serdtsa i insulta. ejegodno yavlyaetsya prichinoy gibeli 0,1% naseleniya v ekonomicheski razvitix stranax. letalnost v statsionarax razlichnogo profilya dostigaet 20%. tela - vajnaya meditsinskaya problema v svyazi s visokoy zabolevaemostyu i smertnostyu chislo sluchaev v god summarnaya zabolevaemost letalnost bolee polovini iz raschetnix 600.000 sluchaev v god ne diagnostiruyutsya okolo 2/3 sluchaev protekayut bessimptomno, ne diagnostiruyutsya ili ne lechatsya ejegodno ot chisla vsex smertey v statsionare ne diagnostiruyutsya bessimptomnie formi tela: 5-10% tromboz glubokix ven (tgv) i tromboemboliya legochnoy arterii (tela) – sereznie i chasto ne diagnostiruemie v ssha zabolevaniya. xotya mnogie vrachi …

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nerskuyu rabotu v oblasti patologicheskoy anatomii. izmenenie svoystv krovi, izmeneniya krovotoka i narushenie tselostnosti sosudistoy stenki, – vot glavnie faktori patogeneza teb. v plane konkretnix faktorov riska triada virxova vklyuchaet: venozniy staz: vozrast starshe 40 let, ojirenie, zastoynaya serdechnaya nedostatochnost, ostriy im, obshaya anesteziya, varikoznaya bolezn, immobilizatsiya povrejdenie sosuda: travma, operatsiya, postoyanniy kateter, teb v anamneze, iskusstvenniy voditel ritma, infektsiya, ximioterapiya, arterialnaya gipotoniya povishennaya svertivaemost krovi: zlokachestvennie novoobrazovaniya, defitsit faktora v leydena, antifosfolipidniy sindrom, priem bolshix doz estrogenov, defitsit belkov s/s, beremennost, defitsit antitrombina (at) iii, defitsit kofaktora geparina ii, istinnaya politsitemiya, gipergomotsisteinemiya, nefroticheskiy sindrom, mutatsiya protrombina 20210 risk razvitiya teb vozrastaet pryamo proportsionalno chislu faktorov riska. patogenez tela a - pervonachalnaya emboliya odnoy iz vetvey legochnoy arterii b - obrazovanie vtorichnogo mestnogo tromba, uvelichivayushego razmeri obstruktsii vetvey legochnoy arterii rekomendatsii amerikanskogo kolledja torakalnix vrachey (accp) i evropeyskoy assotsiatsii kardiologov (esc) pri podozrenii na tela v pervuyu ochered neobxodimo opredelit …

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3 dney nepodvijnoe sidenie (dlitelnaya avtomobilnaya poezdka ili perelet) vozrast laparoskopicheskaya xirurgiya ojirenie beremennost/dorodoviy period varikoznie veni promejutochnie faktori riska (or 2-9) artroskopicheskaya operatsiya na bedre tsentralniy venozniy kateter ximioterapiya xronicheskaya serdechnaya nedostatochnost zamestitelnaya gormonoterapiya onkologicheskie zabolevaniya oralnie kontratseptivi insult s paralichami beremennost/poslerodoviy period tela v proshlom trombofiliya silnie faktori riska (or > 10) perelom (bedro ili golen) zamena tazobedrennogo ili kolennogo sustavov bolshaya operatsiya bolshaya travma povrejdeniya spinnogo mozga chastota klinicheskix sobitiy v zavisimosti ot stepeni riska torbicki a. et al. esc diagnosis and management of acute pulmonary embolism // european heart journal. - 2008. - vol. 29. - № 18. - p. 2276-2315. sobitiya stepen riska nizkaya umerennaya visokaya samaya visokaya tromboz ven goleni, % 2,0 10 - 20 20 - 40 40 - 80 tromboz proksimalnix otdelov ven nijnix konechnostey, % 0,4 2 - 4 4 - 8 10 - 20 klinicheski yavnaya tela, % 0,2 1 …

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t pri tromboembolii krupnix vetvey legochnoy arterii infarkt legkogo pri tromboembolii dolevix i segmentarnix arteriy xronicheskaya legochnaya gipertenziya pri retsidiviruyushey tromboembolii melkix vetvey legochnoy arterii klinicheskaya kartina tela ☝ z a p o m n i t e dlya tela ni odnogo patognomonichnogo simptoma net ! diagnostika tela postanovka diagnoza tela i osnovani na umenii vracha ispolzovat dannie anamneza, ob'ektivnie priznaki, otsenku riska, dannie instrumentalnix issledovaniy i nastorojennosti v otnoshenii tela! naibolee xarakternie klinicheskie priznaki tela vnezapnaya odishka odishka v sochetanii s bolyu v grudnoy kletke taxikardiya tsianoz otsutstvie etix simptomov stavit pod somnenie diagnoz tela! simptomi i priznaki tela jalobi prisutstvuyut narusheniya dixaniya 80% bol (plevralnaya) 52% bol (zagrudinnaya) 12% kashel 20% sinkopalnoe sostoyanie 19% krovoxarkane 11% simptomi prisutstvuyut taxipnoe ≥ 20/min 70% taxikardiya > 100/min 26% prizaki tromboza glubokix ven 15% tsianoz 11% lixoradka (> 38,5°s) 7% chastota simptomov tela po dannim registra icoper, % odishka 82 taxikardiya …

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management of acute pulmonary embolism // european heart journal. - 2008. - vol. 29. - № 18. - p. 2276-2315. k chislu instrumentalnix issledovaniy, kotorie provodyatsya u bolnix s podozreniem na tela, otnosyatsya: issledovanie gazovogo sostava krovi ekg rentgenografiya organov grudnoy kletki exokardiografiya ultrazvukovoe issledovanie magistralnix ven nijnix konechnostey ventilyatsionno-perfuzionnaya stsintigrafiya legkix spiralnaya kompyuternaya tomografiya kateterizatsiya pravix otdelov serdtsa i selektivnaya angiopulmonografiya elektrokardiograficheskie priznaki tela vnezapnoe uglublenie zubtsov qiii i si (priznak qiiisi); pod'em segmenta st v otvedeniyax iii, avf, v1 i v2 i diskordantnoe snijenie segmenta st v otvedeniyax i, avl, v5 i v6; poyavlenie otritsatelnix zubtsov t v otvedeniyax iii, avf, v1 i v2; polnaya ili nepolnaya blokada pravoy nojki puchka gisa. vi – vibuxanie konusa legochnoy arterii po levomu konturu serdechnoy teni i-visokoe i malopodvijnoe stoyanie kupola diafragmi na storone porajeniya rentgenologicheskie priznaki tela ii-obednenie legochnogo risunka (simptom vestermarka) iii-diskovidnie atelektazi iv-infiltrati legochnoy tkani v-rasshirenie teni verxney …

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tema: tromboemboliya legochnoy arterii prigotovil: student 605 b gruppi raxmonov feruz tromboemboliya legochnoy arterii (tela) – eto: ostraya okklyuziya stvola ili vetvey legochnoy arterii trombom ili embolom, sformirovavshimisya v venax bolshogo kruga krovoobrasheniya ili polostyax pravogo serdtsa chastota tela prodoljaet povsemestno i progressivno uvelichivatsya! v nastoyashee vremya yavlyaetsya tretey po chastote prichinoy vnezapnoy smerti posle ishemicheskoy bolezni serdtsa i insulta. ejegodno yavlyaetsya prichinoy gibeli 0,1% naseleniya v ekonomicheski razvitix stranax. letalnost v statsionarax razlichnogo profilya dostigaet 20%. tela - vajnaya meditsinskaya problema v svyazi s visokoy zabolevaemostyu i smertnostyu chislo sluchaev v god summarnaya zabolevaemost letalnost bolee polovin...

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