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Асцит лечение
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#1 Оставлено : 16 марта 2012 г. 19:29:18(UTC)
elya7890

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Асцит лечение


Асцит — это скопление жидкости в брюшной полости, местное проявление расстройства кровообращения при заболеваниях сердца или следствие замедленного оттока крови из брюшной полости при ее застое.


Заболевания, которые сопровождаются асцитом, подразделяются на 5 групп: 


I группа – заболевания печени, а также ее сосудов (веноокклюзионная болезнь, болезнь Бадда-Киари, рак печени, цирроз печени).


II группа – злокачественные заболевания (первичная мезотелиома, лимфома и лейкоз, вторичный карциноматоз).


III группа – болезни брюшины (перитонит туберкулезный, перитонит другой этиологии, в том числе паразитарный, грибковый, панкреатический).


IV группа – болезни сердца (застойная сердечная недостаточность, констриктивный перикардит).


V  группа – другие болезни (микседема, системная красная волчанка, саркоидоз, болезнь Уиппла, киста поджелудочной железы, кисты и опухоли яичников).


В 75 % случаев асцит – это следствие цирроза печени, в 10 % – злокачественных новообразований, на долю  сердечной недостаточности приходится 5 % случаев.


Асцит по количеству жидкости, накопившейся в брюшной полости, классифицируется следующим образом:



  • значительное количество жидкости   до 20-30 л,

  • умеренное количество жидкости       больше 3 л,

  • небольшое количество жидкости       до 3 л.


Асцит по инфицированности содержимого классифицируется:



  • спонтанный бактериальный перитонит инфицированное содержимое,

  • стерильное содержимое.


По медикаментозному ответу асцит подразделяется на                                                                                                                                


рефрактерный асцит и асцит, поддающийся медикаментозной терапии.


Скопление  жидкости (иногда более 20 л)  в полости живота вызывает повышение внутрибрюшного давление,  а также оттеснение в грудную полость диафрагмы. В результате нарушается деятельность сердца, значительно замедляется кровообращение  в органах,  расположенных в брюшной полости, нарушается также их функция, сокращаются дыхательные движения легких. Концентрация белка в жидкости брюшной водянки относительно невелика. При массивном асците общие потери белка могут быть большими, особенно при повторных удалениях жидкости из полости живота путем пункции. Потеря  белка при этом объединяется  с потерей солей, а это вызывает развитие белковой недостаточности.


Важной  диагностической задачей, при наличии асцита, является определение основного заболевания. Для этого необходимо проанализировать признаки асцита. Обнаружить  асцит клинически можно при скоплении в брюшной полости более литра жидкости. Во время осмотра выявляется увеличение живота, при вертикальном положении пациента он выглядит отвисшим, часто отмечается выпячивание пупка; при горизонтальном положении больного, живот распластан, образуется так называемый лягушачий живот. На  коже живота, при выраженном повышенном давлении  в воротной вене, вследствие развития анастомозов образуется расширенная венозная сеть. Располагаясь  вокруг пупка, извитые, набухшие и расширенные венозные сосуды в виде лучей отходят от него, образуя характерную фигуру, которая называется голова медузы.


Лечение направлено на устранение причины заболевания. Начинать  лечение асцита необходимо с ограничения употребления поваренной соли. В  сутки потребление натрия должно составлять не более  одного грамма. Иногда приходится вводить и строгие ограничения. Если  постельный режим  и ограничение приема соли не приносят положительного эффекта, показаны диуретики. Ежедневное  снижение веса у больных, имеющих отеки, на один килограмм служит признаком адекватности лечения диуретиками. Чтобы  вызвать и поддержать достаточный уровень диуреза, каждые 5 суток дозу диуретика нужно увеличивать. Рекомендуемым  препаратом является спиронолактон. Больным, у  которых отмечается его непереносимость, назначают триамтерен или амилорид.  Также могут назначаться петлевые диуретики, это буметанид, этакриновая кислота, фуросемид. Для  предотвращения некупирующейся одышки, кровотечения из желудочно-кишечного тракта, ущемления грыжи при стойком асците возможно удаление жидкости до 5 л за сутки путем пункции. Одновременно с  удалением жидкости для поддержания эффективного кровотока вводят внутривенно раствор альбумина.

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#7 Оставлено : 9 июля 2018 г. 8:31:15(UTC)
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#8 Оставлено : 25 августа 2018 г. 9:12:24(UTC)
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#9 Оставлено : 13 сентября 2018 г. 8:23:04(UTC)
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yaoxuemei Offline
#10 Оставлено : 9 октября 2018 г. 14:53:20(UTC)
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