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priobretennaya kishechnaya neproxodimost u detey. klinika, diagnostika, printsipi lecheniya, oslojneniya

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lektsiya №4 priobretennaya kishechnaya neproxodimost u detey. klinika, diagnostika, printsipi lecheniya, oslojneniya ostrie protsessi jivota poyavlyayutsya neojidanno, vnezapno i rezko, bolshey chastyu porajayut cheloveka sredi polnogo zdorovya, a sostoyanie uje ranee razvivshegosya zabolevaniya bryushnoy polosti uxudshayut, usugublyayut. ix delyat na vospalitelnie, v osnove kotorix lejit vospalitelniy protsess; mexanicheskie, osnovaniem kotorix yavlyaetsya zakuporka prosveta pishevaritelnogo trakta libo strangulyatsiya brijeyki kishechnika; nakonets, na travmaticheskie. nesmotrya na opredelyonnuyu uslovnost takogo deleniya (mnogie zabolevaniya sochetayut elementi vospaleniya, neproxodimosti i travmi), v nastoyashiy moment ono udovletvoryaet bolshinstvo prakticheskix vrachey. sredi ostrix xirurgicheskix zabolevaniy organov bryushnoy polosti priobretennaya neproxodimost kishechnika po chastote zanimaet vtoroe mesto, ustupaya lish ostromu appenditsitu, v to je vremya chislo letalnix isxodov pri ney bolshe, chem pri ostalnix ostrix xirurgicheskix zabolevaniyax organov bryushnoy polosti, vmeste vzyatix. chastota neproxodimosti kishechnika po otnosheniyu k ostrim xirurgicheskim zabolevaniyam bryushnoy polosti mojet dostigat 9,4%. naibolee chasto u detey vstrechaetsya invaginatsiya kishechnika i spaechnaya kishechnaya neproxodimost, gorazdo …
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v 19,5% - strangulyatsionnaya i v 59,0% - smeshannaya forma polnoy kishechnoy neproxodimosti. obshie ponyatiya o sindrome kishechnoy neproxodimosti neproxodimost kishechnika predstavlyaet soboy sindrom, voznikayushiy pri raznoobraznix patologicheskix protsessax, proyavlyayushiysya narusheniyami peristaltiki i evakuatornoy funktsii kishechnika, xarakterizuyushiysya razlichnim klinicheskim techeniem i morfologicheskimi izmeneniyami porajyonnoy chasti kishechnika. bolee prostoe i v to je vremya emkoe opredelenie glasit, chto kishechnaya neproxodimost predstavlyaet soboy narushenie migratsii pishevogo komka po jeludochno-kishechnomu traktu. gradatsii pishevogo komka – izmelchennaya pisha (rotovaya polost, pishevod), pervichno fermentirovanniy pishevoy komok (jeludok), vtorichno fermentirovanniy pishevoy komok (12-perstnaya kishka), ximus (toshaya i podvzdoshnaya kishka); nesformirovanniy, sformirovanniy (tolstaya kishka) i oformlenniy kal (pryamaya kishka). eshyo v pervoy polovine proshlogo stoletiya videlili 2 vida neproxodimosti kishechnika - mexanicheskuyu i dinamicheskuyu. wahl (1889) razdelil mexanicheskuyu kishechnuyu neproxodimost v zavisimosti ot stepeni narusheniya krovoobrasheniya kishechnika na strangulyatsionnuyu i obturatsionnuyu. sredi mnojestva klassifikatsiy, osnovannix na printsipe wahl, naibolee udobnoy dlya prakticheskogo primeneniya okazalas klassifikatsiya d.p.chuxrienko (1958), …
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most po klassifikatsii altshulya a.s. podrazdelyaetsya na spasticheskuyu i paraliticheskuyu. eto delenie osnovano na xaraktere funktsionalnix narusheniy motornoy funktsii kishechnoy muskulaturi. eshe polveka nazad schitalos, chto spasticheskaya i paraliticheskaya kishechnaya neproxodimost predstavlyayut soboy printsipialno raznie patofiziologicheskie ekstsessi. v nastoyashee vremya utverdilos mnenie, chto eto – raznie fazi odnogo patologicheskogo protsessa. etiologiya i patogenez. prichini kishechnoy neproxodimosti – predraspolagayushie i proizvodyashie. soglasno sovremennim dannim, v osnove patogeneza ostroy mexanicheskoy neproxodimosti kishechnika lejat yavleniya shoka. postuplenie i skoplenie bolshix kolichestv jidkosti i elektrolitov v prosvete kishechnika vishe urovnya neproxodimosti s odnovremennim rezkim ugneteniem obratnogo vsasivaniya privodit k rastyajeniyu kishechnoy stenki i usilennoy sekretsii eyu jidkosti. razvivayushiysya odnovremenno s uvelicheniem sekretsii i umensheniem reabsorbtsii staz kishechnogo soderjimogo blagopriyatstvuet rostu mikroorganizmov i meteorizmu. razvivayushayasya pri neproxodimosti mnogokratnaya rvota privodit k eksikozu, gipoelektrolitemii; snijenie soderjaniya natriya vizivaet giperproduktsiyu aldosterona, chto privodit k zaderjke natriya i xlora v organizme i odnovremennomu uvelicheniyu videleniya kaliya s mochoy …
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i obshirnix strangulyatsiyax takie poteri mogut previshat 50% obshego kolichestva eritrotsitov. voznikayushaya v rezultate poter jidkosti gipovolemiya i progressiruyushaya gipoksiya tkaney privodyat k pereklyucheniyu obmena veshestv na anaerobniy glikoliz, chto vedyot k metabolicheskomu atsidozu. gipoksiya i ishemiya kishechnika, vozrastanie proteoliticheskoy aktivnosti sivorotki krovi privodyat k obrazovaniyu i popadaniyu v tok krovi moshnix vazoaktivnix polipeptidov, lizosomalnix fermentov, kotorie vizivayut padenie arterialnogo davleniya, umenshenie minutnogo ob'yoma serdtsa, snijenie koronarnoy perfuzii. obshaya simptomatologiya. klinicheskaya kartina ostroy mexanicheskoy kishechnoy neproxodimosti zavisit ot tselogo ryada prichin: urovnya neproxodimosti, vida i stepeni neproxodimosti, srokov zabolevaniya, a takje ot prichin, vizvavshix ee. osnovnie simptomi kishechnoy neproxodimosti – ostraya sxvatkoobraznaya (periodicheskaya) bol v jivote, dispepsicheskie i disfagicheskie simptomi. simptomi: valya (privodyashaya kishechnaya petlya vzduvaetsya, v rezultate chego nad mestom prepyatstviya voznikaet mestno ogranichenniy fiksirovanniy meteorizm s visokim timpanitom nad nim. palpatorno opredelyaetsya vzdutaya petlya kishki.) sklyarova - shum pleska pri kishechnoy neproxodimosti. kivulya - visokiy timpanit s metallicheskim …
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i, nalichie v ney soderjimogo i ego xarakter (ili ego otsutstvie). k vspomogatelnim metodam issledovaniya v diagnostike neproxodimosti kishechnika u detey otnosyatsya: ro-grafiya, kompyuternaya tomografiya, uzi, laparoskopiya. spaechnaya bolezn, spaechnaya kishechnaya neproxodimost. spaechniy protsess soprovojdaet lyuboe vospalenie ili travmu bryushnoy polosti. vsyakaya laparotomiya, daje provedennaya v asepticheskix usloviyax, mojet yavlyatsya predraspolagayushim momentom k spaykoobrazovaniyu iz-za neizbejnogo povrejdeniya seroznoy obolochki tamponami, xirurgicheskimi instrumentami i t.d. v posleoperatsionnom periode u bolshinstva detey spaechniy protsess protekaet v fiziologicheskix ramkax i ne vizivaet oslojneniy. odnako v nekotorix sluchayax (osobenno pri stoykix parezax kishechnika) mnojestvennie spayki skleivayut kishechnie petli, narushaya passaj soderjimogo i sozdavaya usloviya dlya vozniknoveniya neproxodimosti, kotoraya imeet xarakter obturatsionnoy. podobnoe oslojnenie posleoperatsionnogo perioda nablyudaetsya i pri zapaivanii kishechnix petel v obrazuyushiysya vospalitelniy infiltrat bryushnoy polosti. sformirovavshiesya shnurovidnie spayki obichno ne proyavlyayut sebya, no u chasti detey, spustya mesyatsi ili godi posle perenesennoy operatsii mogut slujit prichinoy strangulyatsionnoy kishechnoy neproxodimosti. takim obrazom, ostruyu …

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lektsiya №4 priobretennaya kishechnaya neproxodimost u detey. klinika, diagnostika, printsipi lecheniya, oslojneniya ostrie protsessi jivota poyavlyayutsya neojidanno, vnezapno i rezko, bolshey chastyu porajayut cheloveka sredi polnogo zdorovya, a sostoyanie uje ranee razvivshegosya zabolevaniya bryushnoy polosti uxudshayut, usugublyayut. ix delyat na vospalitelnie, v osnove kotorix lejit vospalitelniy protsess; mexanicheskie, osnovaniem kotorix yavlyaetsya zakuporka prosveta pishevaritelnogo trakta libo strangulyatsiya brijeyki kishechnika; nakonets, na travmaticheskie. nesmotrya na opredelyonnuyu uslovnost takogo deleniya (mnogie zabolevaniya sochetayut elementi vospaleniya, neproxodimosti i travmi), v nastoyashiy moment ono udovletvoryaet bolshinstvo prakticheskix vrachey. sredi ostrix ...

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