Ke hoʻokū nei i kahi hoʻomākaʻeha ʻana o ke kano pancreatitis, koi ʻia ke kauka kahi ambulance e hoʻouna i ka mea maʻi i ka haukapila ma o ka wahi o ka ulia o ka ambulance ma luna o kahi paʻa.

I ka wā prehospital, he mea pono ia e hana i lalo o kēia ʻano mea lapaʻau:

ka hoʻokaʻawale ʻana i ka ʻai a me ka inu,
kahi pahu hau i ka wahi o ka hale o ka epigastric a i ka wā o ke halihali,
ka hoʻopuka ʻana o ka antispasmodics e hoʻōla i ka sphincter o Oddi spasm (nitroglycerin, 1-2 mau i lalo o ka alalelo, nitrosorbide a sustac paha, 2 ml o kahi hopena o 2% o papaverine, a i ʻole 2 ml o ka no-shpa i hui pū me 2 ml o kahi hopena 0.2% o platifillin).
ka hoʻolauna ʻana i ka 1 ml o kahi hopena o 0.1% o ka atropine e hōʻemi i ka huna ʻana o ka pancreatic,
ka hoʻokomo ʻana i ka intravenous 40-60 ml o kahi hopena o 0.5% o novocaine, ka mea e hoʻokaʻawale i ka kallikriin a me antispasmodic,
ka hoʻokele ʻana o nā antihistamines (2 ml o kahi hopena o 1% o ka diphenhydramine a i ʻole 1 ml o ka hopena o 2% o ka suprastin),
me ka hiolo ʻana, kalepa hoʻokele o 60-90 mg o prednisone a i ka 300-450 mg o ka hydrocortisone, hoʻonui hou i ka infusion hōʻemi ma muli o ka crystalloids,
ka hoʻomaka ʻana o intramuscularly 2-4 ml o Lasix a i ʻole 1 ml o ka novurite e hōʻemi i ka fermentation a hoʻonui i ka excretion o nā enzymes mai ke kino. Hāʻawi ʻia ka hopena maikaʻi i ka hoʻomaka ʻana o ka maʻi ma ka hoʻohana ʻana o kekahi o nā hoʻomākaukau antienzyme, ka mea i lawelawe ʻia ma nā ʻāpana: trasilol 200000-300000 IU, zalol 200000-300000 IU, kontrikal 100000-200000 IU, pantripin 120-150 IU.

ʻO nā lāʻau lapaʻau āpau i hana ʻia i ka wā prehospital, pono ke kauka ke kauka ma ka pale i hoʻopili ʻia. Ma kahi o kahi hoʻokolohua lapaʻau, e mālama ʻia ana ka hoʻokolohua laboratory o ka hyperfermentemia i loko o ka ʻoihana o ka haukapila o ke haukapila, kahi e komo ai ka mea maʻi, ka mea e pili ana i ka noi ʻana o nā hana o nā enzyme pancreatic i ke koko (amylase, trypsin, lipase) a me ka urine (amylase).

Ed. V. Mikhailovich

"Ka mālama o ka mālama ʻana no ka maʻi pancreatitis" a me nā ʻatikala mai ka ʻ Emergkipiki Pilikia

3. ʻO ka pancreatitis acute

Nā Hoʻomaka ʻO ka ʻeha kāʻei koʻikoʻi e ulu ma hope o ka hoʻoilo ʻana o ka momona (ka mea ʻai) i ka meaʻai, ka waiʻona. Hoʻomaʻamaʻa pinepine ʻia ka luaʻi ʻole e lawe mai i ka hoʻomaha. Hoʻopau, icteric sclera. Tachycardia, hypotension arterial. Kūʻai. Pau ke alelo. Hala ʻaʻano, ʻeha. ʻO nā hōʻailona kūpono o ka huhū peritoneal. ʻO Leukocytosis me kahi neʻe ʻana i ka helu koko ma ka hema. E hoʻonui paha ke kiʻekiʻe o ke kō a me ka wai o ka amylase.

ʻO ka kōkua mua a me ka kōkua mua. Aloha. ʻIloli. Kaea ma nā wahi epigastric. Hōʻike wikiwiki i kahi kauka.

ʻO ka mālama lāʻau lapaʻau. Kikowaena lāʻau. Aloha. ʻIloli. Kohi ma ka ʻōpū.

Ke hoʻokuʻu nei i ka OMEDB (ma ka haukapila) ma ke ʻulima, e moe ana ma luna o kahi hākaukau, e hele pū ana me ka kauka (paramedic) ma ke kauka. Ma mua o ka haʻalele ʻana a i ka wā o ia manawa, e hōʻoia i ka minamina o ka ʻili o ka palu ma o ka palapala hoʻāla, intravenous infusion of saline (a i ka 800 ml).

OMB, hale haukapila. ʻO ka hōʻoia ʻana o ka maʻi maʻi: ka ultrasound o nā ʻōpū o ka ʻōpū o ka ʻōpū, ka radiomoro panoramic o ka umauma a me ka ʻōpū, i hoʻohuihui ʻia me ka pancreas.

pōloli, ka wawā mau ʻana o nā ʻōpū pili i loko o kahi uʻi.

pale ʻana i ka huna ʻana o ka pancreatic a me ka lāʻau antienzyme (5-fluorouracil, octreatide, contracal),

analgesics a me antispasmodics intramuscularly, sacrospinal novocaine blockade a lōʻihi loa mau ʻana mai ka pāpā,

infusion therapy e hoʻoponopono ai i ka wai ʻana o ka wai-electrolyte, CBS, BCC, hemocoagulation disorders,

antibiotics, anti-inflammatory, antacid and antihistamines.

Ma ka hihia o ka fulminant a me ka holomua o ka papa pancreatitis, plasmapheresis, ka hoʻokō ʻana o ka endolymphatic o nā antibiotics a me nā hoʻomākaukau antienzyme, ka puna o waho o ka lymphatic luctphic, lymph a me ka hemosorption i hoʻokomo ʻia i ka papahana mālama. Ma kahi o ka holomua o peritonitis, i mua o omentobursitis, hana ʻia ka laparoscopy e hoʻomaʻemaʻe i ka maʻi, hoʻomaʻemaʻe i ka ʻeke omentum a me ka ʻōpū o ka ʻōpū, a uhi ʻia cholecystostomy.

Nā ʻano o nā hana no ka pancreatitis luku kino ʻole:

me ka pōpilikia (me nā hōʻailona o ke kahe koko kū a i ʻole hoʻokahe i ke koko ma o ke kahawai) - hoʻopau i ke koko erosive.

ka piʻi (i loko o kekahi mau lā ma hope o ka komo ʻana i ka haukapila, me ka hoʻomohala ʻana i nā hōʻailona o ka necrosis pancreatic, ka hoʻomohala ʻana o ka peritonitis, hoʻonui nui ʻana i ka ʻuʻina, ka hoʻomāhuʻi) - loiloi a me ka hoʻolele waʻa peritoneal cavity, omental bursa, retroperitoneal luna.

he hana e koi ai i ka hana, ʻo ka cholecystostomy.

lohi (hoʻihoʻi) - ke kāohi nei i nā wahi necrotic o ka pancreas a (a) i ʻole fibancreatic retroperitoneal fiber.

4. Wili ulia o ka ʻōpū a me ka duodenum

Nā Hoʻomaka "ʻEha nui" ʻōpū. Hoʻoikaika i ke kūlana o ka mea maʻi (ma ka ʻaoʻao ʻākau me nā wāwae i ʻoki ʻia i ka ʻōpū). Pau ke alelo. E hāhai ka hanu. Hōʻalihi kūloko loa o ka paia o ka ʻōpū. ʻO ka ʻōpū he “plank-like,” ʻaʻole i komo i ka hana o ka hanu. ʻO ka maʻi ākea ma ka palpation, nā hōʻailona o ka pale o peritoneal. ʻAʻole hoʻoholo ʻia ka puʻe Hepatic. Ma ka hōʻike hōʻike loiloi o ka ʻōpū - ka hiki ʻana o ke kinoea i loko o ka ʻōpū o ka ʻōpū. ʻO Leukocytosis me kahi neʻe ʻana i ka helu koko ma ka hema. Me ka uhi i uhi ʻia, hiki ke hoʻomaikaʻi i ke kūlana maʻamau.

ʻO ka kōkua mua a me ka kōkua mua. Aloha. ʻIloli. Kaea ma nā wahi epigastric. Hōʻike wikiwiki i kahi kauka.

ʻO ka mālama lāʻau lapaʻau. Kikowaena lāʻau. Aloha. ʻIloli. Kaea ma nā wahi epigastric.

Hoʻolaha koke i ka OMEDB (ma ka haukapila) i ka ambulance ʻoiai e moe ana ma luna o kahi aloahi, i hele pū ʻia e ka paramedic (kauka). ʻO ka hopohopo o nā manaʻo o ka ʻōpū ma o ka huluhulu (ua ʻaihue ʻia ka gastric).

OMB, hale haukapila. ʻO ka hōʻoia ʻana o ka maʻi ʻaʻai: huli ka huli ʻana o ka ʻōpū o ka ʻōpū. I ka haʻalele ʻana o ka hau manuahi a me ka hele ʻana mai o nā hōʻailona o ka huhū peritoneal, fibroesophagogastroscopy, pneumogastrography, a i ʻole ʻehā gastrography me ka ʻōpū o ka x-ray ʻōpū e hana.

Kuhi o ka hana: me ka peritonitis diffuse, he manawa o ka perforation o nā ʻoi aku he 6 mau hola, nā maʻi concomitant koʻikoʻi, a me ka ʻike ʻole o ka mea lapaʻau maʻi, e ʻimi ana i ka maʻi o kahi ʻōpū o ka ʻōpū a i ʻole ulia duodenal.

Me ka ulia duodenal perforated a me ka ʻole o nā hōʻailona o ka peritonitis diffuse, hana ʻia kahi subphrenic stem vagotomy me ka ulia ulcer a me ka pyloroplasty.

Hoʻohana ʻia ka ʻōpū Gastric ma ke kahua o ka mālama lāʻau lapaʻau kūikawā no ka komo ʻana, stenosing a me nā ʻeha huhū o ka ʻōpū, a me ka ulia duodenal, inā aia nā ʻike hōʻike noiʻi e hōʻike ana i ka hopena haʻahaʻa o ka vagotomy.

I nā hihia i uhi ʻia i nā ʻōpū o ka ʻōpū a me ka duodenum, noho mau nā kaila maʻi ikaika.

Koi a me nā pathogenesis

ʻO ka hoʻomohala ʻana o ka maʻi pancreatitis ma ka hapanui o ka hapanui e pili ana i ke kaʻina hana ma ke ala o ka gallbladder a me nā kaola baile, mai kahi e komo ai ka maʻi i ka pancreas mai loko mai o ka umauma bile a i loko o ka wirsung a i ʻole ma o ka lymphatic tract.

Eia kekahi ala ʻē aʻe no ka maʻi e komo ai i ka pancreas - ka hoʻomāhuahua ʻana o ka hematogenous i nā microbes i nā maʻi maʻi āpau (ʻo ke ʻano (typhoid fever, mumps, scarlet fever, sepsis, etc.)). ʻO ka puka nui loa e hōʻike ai i ka maʻi pancreatitis kaʻeha ʻo ka pancreatitis hemorrhagic maʻa. He kūlana koʻikoʻi loa kona ʻano, e alakaʻi ana i nā helu he nui i ka make i nā lā e hiki mai ana, a i kekahi mau manawa ma hope o ka hoʻomaka ʻana o ka maʻi.

Hōʻike ʻia ka hemorrhagic pancreatitis e ka hoʻomohala ʻana o ka necrosis pancreatic, ka mea i hōʻike ʻia e like me kēia. E like me ʻoe e ʻike ai, ma lalo o ka mana o ka hua bile, ka trypsinogen o nā pancreas e lilo i ka hoʻoikaika enzyme trypsin. ʻO kēia kaʻina hana i kahi kanaka olakino e hele mai i ka lumen intestinal.

Ke kahe a ka wai o ka duodenum a i ʻole bile i ka pancreas, hele a trypsinogen i loko o ka trypsin i loko o ka pancreas iho (ua manaʻo lākou ua hiki kēia loli i lalo o ka mana o nā maʻi). Ma ka hope loa, ʻo ka hoʻokuʻu ʻana o ka enzyme (trypsin) i loko o ka pancreas e hopena i ka hoʻomohala ʻana o ka necrosis a me ka hoʻokaʻa ʻana pono o ka aila.

ʻO ka mea hope loa, i loko o nā pathogenesis o ka pancreatitis hoʻonā e hoʻopili i ka mea nui i ka hōʻino o ke kahe koko i loko o ka pancreas. Ischemia (puʻuwai puʻuwai), embolism a me ka hemorrhage, ka mea i hopu i ka hapa nui o nā kelopona, e wehewehe i ka hoʻomohala ʻana o ka maʻi pancreatitis hemorrhagic.

I kekahi mau hihia o ka maʻi pancreatitis, ua hana ke kaʻina o nā hoʻololi i ka catarrhal, ma loko ʻē aʻe - ke ʻano o ka fulu purulent, a laila, ma ke kolu - kahi kiʻi o ka pancreatitis hemorrhagic necrotic.

I ka manawa pinepine, hoʻomohala ʻia ka pancreatitis i ka poʻe lelo e ʻai i nā meaʻai he nui, ʻoi aku hoʻi i nā mea momona momona, a nā mea hōʻino i ka waiʻona. Hoʻomaka pinepine, hoʻomaka ka maʻi ma hope o ka pāʻina momona momona.

Ua hōʻike pinepine ʻia ka mōʻaukala cholecystitis a i ʻole cholangitis.

Hoʻomaka ka maʻi maʻi. ʻAʻole i like kona kūʻeha ʻole i nā hanana a pau. Aia kekahi mau ala ʻike e pili ana i ka maʻi pancreatitis, e hele maʻalahi a noho mau ʻole ʻia - keaka catarrhal pancreatitis. I nā hihia koʻikoʻi o ka pancreatitis catarrhal, ua hele ka ʻeha ma ka wahi o ka epigastric a me ka puni o ka pusela a palahalaha i ka ʻaoʻao hema.

Ka uhi lākou i ka hapa hema o ke kino ma ke ano o ka hapalua-kāʻei o ke kolu a ka pōʻai (Fig. 17, c a me b). I kekahi mau pilikia, huli ka ʻili i ka wahi o ka ʻaha poʻohiwi hema, ma kahi ʻē aʻe, me kēia, ma ka ʻaoʻao hema o ka ʻōpū, a ma ke kolu, ma ka ʻaoʻao hema ma ka ʻaoʻao sciatic. Ua palaka ka ʻōpū, akā i kou manaʻo ʻana, ʻaʻole i ʻike ʻia ka ʻōpū o ka ʻōpū.

Hoʻokū pinepine ʻia ka hōʻeha ʻana o ka ʻeha me ka nausea, ka luaʻi, a me ka hoʻōla ʻana. ʻO kahi hōʻailona diagnostic koʻikoʻi kahi ʻoi aku ka hoʻonui ʻia o ka enzyme pancreatic - diastases i ka urine a me ke koko (ma luna o nā hui 64 Volgemutov).

ʻO nā ʻano hana pālua o ka pancreatitis paha i hoʻopau i ke hoʻōla, a loaʻa paha i kahi papa maʻi.

Nā kiʻi haukapila

Inā ʻike ʻole ʻia ka maʻi, eʻe kahi lihi i loko o ka ʻōpū o ka ʻōpū a me ka peritonitis purulent aʻeha. Hoʻomaopopo ʻia nā hihia kūʻokoʻa i ka wā o ka pohihihi i hōʻeha i loko o ka ʻōpū a i loko pū paha. Hiki i ke kīhini nui ke hōʻemi i ka hoʻoneʻe ʻana o ka hua bile a alakaʻi i ka ulu ʻana o ka jaundice obstructive.

ʻO ka mea pōpilikia nui loa ka maʻi pancreatitis hemorrhagic, kahi i loaʻa ai ke kiʻi koʻikoʻi o ka "catastrophe ʻōpū" (ka ʻōpū ʻōpū) e ulu. A ke hoʻomaka nei kēia ʻano maʻi me ka hōʻeha nui ma ka ʻōpū (ma ka epigastrium a me ka pōpolo). I nā hanana ʻē aʻe, hōʻiliʻili ʻia ka ʻeha i ka ili iliac. I kekahi manawa e hoʻopiʻi nā poʻe maʻi i nā hōʻeha ʻeha nui i ka pelvis a i ʻole nā lumbar.

Kūleʻa nui ke ʻano pīhoihoi nui: pinepine ka pulse, liʻiliʻi, a ʻulaʻula ʻia ka ʻili. Hōʻike ʻia nā hiʻohiʻona, huli hope nā maka. Puka, puka anuanu, a hele hou ʻia ka salivation. Hoʻoulu koke ka lūlū ʻana me nā hōʻailona o ka aʻalolo: neʻe ke ʻano o ka ʻawaʻawa, hoʻokuʻu ke hoʻokuʻu i nā feces a me nā poho. I kekahi manawa ua ulu ka hemorrhagic ascites, kahi i ʻike ʻia e ka puncture o ka ʻōpū o ka ʻōpū a i ʻole ke hōʻola. I ka nānāʻana i ka urine no diastasis, nui loa nā helu.

Hiki paha ke make i nā hola mua o ka maʻi a i ʻole aʻe aʻe. ʻO ka hele ʻana o ka jaundice, me ka panculitis purulent, no ka hoʻopiʻi ʻana i ka dile bile maʻamau. ʻO ka hōʻike ʻana o ke kumu maʻi maʻi pancreatitis e hōʻike ana i nā pilikia i ʻike ʻia, ma muli o ka ʻike i ka maʻi maʻamau.

Hiki ke ʻike ʻia ka pancreatitis e pili ana i ke kikowaena hema ma ka hapa hema o ka ʻōpū o ke ʻeha e kūpaʻa ai i ka ʻili a me ke kāʻei i ke kūlohelohe, ka hele ʻana o ka ʻehaʻeha o ka ʻili (hyperalgesia) me kahi hanana lokahi, a hiki hou i ka nui o ka diastase i loko o ka urine a me ke koko. ʻO nā ʻōpana no ka mōʻaukala o ka gallbladder a me ka maʻi bile duct maʻi kahi kūlana koʻikoʻi.

Hōʻike ʻia nā hōʻailona like me ka pancreatitis purulent, ka mea, ʻoiai, ua hōʻike ʻia i nā hōʻailona o ke kaʻina hoʻomaʻemaʻe-purulent-inflammatory (ke ʻano a me ka 38-39 °, leukocytosis neutrophilic i loko o ke koko).

Ka wikiwiki o ka hoʻolālā ʻana o ka pancreatitis hemorrhagic e like me ka peritonitis kūleʻa i hopena ʻia mai ka perendated appendicitis, perforated gastric ulcer. Ma ka hoʻohālikelike ʻana i ka hopena, ma ka pancreatitis maʻa, ʻonanika iki ka ʻōpū, mālama ʻia ka dullness hepatic.

ʻO nā helu helu kiʻekiʻe o nā diastases i loko o ka mimi a me ke koko he waiwai nui o ka diagnostic no nā ʻano āpau o ka pancreatitis.

He mea koʻikoʻi loa ka wānana ma ka pancreatitis maʻa mau. I nā kūlana āpau i ka wā i hala ai ka maʻi pancreatitis maʻa, pono koke ke hāʻawi ʻia ka mea maʻi i ka haukapila maʻi.

Aia wale nō i nā kūlana haukapila hiki ke hoʻonā i ka nīnau inā he hoʻomoʻeha ʻia ka mea maʻi i ka hoʻokū 'ana i ka maʻi conservative paha.

ʻOiai ma mua o ka hoʻokipa ʻana a i ka wā o ka neʻe ʻana, pono e hana ka mea maʻi i ka maluhia holoʻokoʻa. No ka mea e hoʻomanawanui ka poʻe maʻi me ka pancreatitis huaʻī i nā hōʻailona o ka palaka cardiovascular a me ka pīhoihoi, pono ke kuhikuhi ʻia nā mea e pili ana iā lākou. E hoʻopili i ka cardiazole, cordiamine a i ʻole camphor. I ka hakakā ʻana i kahi kūlana pīhoihoi, ka hoʻopiʻi (1 ml o ka hopena o 1%) a me ka hopena o ka physiological o ka sodium chloride a i ʻole 5% glucose i hopena (500-1000 ml) i hoʻoluhi ʻia ma lalo o ka ʻili me ka adrenaline (1 ml o kahi hopena o 0.5%).

Inā hiki, kahi hana koko (300 ml) pono e hana. I ka lā mua, ʻaʻole e hāʻawi ʻia ka mea maʻi i ka meaʻai. Ke lawe wale ʻia kēia mau kaʻina āpau i kēlā mau hihia maʻamau i hiki ʻole ke halihali ʻia ka mea maʻi no kekahi kumu. Eia nō naʻe, ma hope o kēia, pono e lawe ʻia ka mea maʻi i ka haukapila, i ukali pū me kahi kauka a i ʻole nā paramedic.