Waterhouse syndrome - Friderichsen: pathogenesis, thaum muaj xwm ceev kho mob, kev kho mob

Lub adrenal qog nyob rau hauv lub cev yog ib qho tseem ceeb endocrine hloov khoom nruab nrog. Cov tshuaj hormones los ntawm lawv kev cuam tshuam rau qhov tsis muaj siab thiab tus nqi ntawm cov circulating kua, cov theem ntawm mineral ntsev thiab ib tug neeg microelements nyob rau hauv metabolic tus nqi, txawm nyob rau lub pituitary caj pas. Thiab nyob rau hauv lub sij hawm uas cov kev ua ntawm cov me me tab sis tseem ceeb heev caj pas yog kev txom nyem, tsim lub xeev, hem lub neej thiab kev noj qab haus huv.

Lus Txhais thiab keeb kwm

Waterhouse syndrome - Friderichsen - ib tug mob adrenal insufficiency, uas tshwm sim tom qab raug mob rau lub cev ntawm ib tug hemorrhage nyob rau hauv nws cov parenchyma. Qhov no ua rau ib tug heev heev kev ua txhaum ntawm lub sab hauv ib puag ncig ntawm lub cev thiab yuav ua tau kom tuag.

Hauj lwm ntawm tus mob xub tshwm sim nyob rau hauv 1894, tab sis nws yog tsis txaus, thiab nyob rau hauv 1911, Waterhouse qhia kaum tsib mob, uas tau pab nws mus sau tag nrho rau daim ua ke. Ua kom phim li nws, xya xyoo tom qab ntawd, nyob rau hauv 1918, Frederiksen kuj luam tawm ib tsab ntawv hais txog qhov no pathological txheej txheem.

yog vim li cas

Zaum pom zoo hais tias lub syndrome Waterhouse - Friderichsen tshwm sim los loj heev hemorrhage nyob rau tib lub sij hawm nyob rau hauv ob qho tib si adrenal qog. Uas yus contingent - ib tug me nyuam mos, cov me nyuam mos, cov me nyuam thiab tub ntxhais hluas. Hauv pem teb nyob rau hauv cov ntaub ntawv no sob. Lub xeev no muaj peev xwm yuav txhais los ntawm heev me nyuam, me nyuam hauv plab oxygen starvation los yog nws nce qib los ntawm cov me nyuam yug kwj dej siv ncais los yog lub tshuab nqus tsev extractor. Nyob rau hauv tas li ntawd, ib tug tseem ceeb luag hauj lwm loj congenital kab mob, thiab cev xeeb tub mob lig gestosis.

Waterhouse syndrome - Friderichsen rau cov neeg laus yog feem ntau pom raws li ib tug mob ib tug kab mob kis. Feem ntau, tus neeg saib xyuas yog ib tug meningococcus, tus kab mob Streptococcus los yog Staphylococcus. Tab sis dhau li ntawm no, qhov ua rau ntawm hemorrhage yuav ua tau nosologies xws li qhua pias, kub taub hau, typhoid kub taub hau, mob qa hawj foob, thiab phem neoplasms, hlav, peritonitis DIC thiab thrombosis adrenal leeg.

Cov kev loj hlob ntawm tus kab mob no

Muaj ntau sau phau ntawv muaj cais no syndrome raws li ib feem ntawm cov coj mechanism tsis ua hauj lwm nyob rau hauv txoj kev loj hlob ntawm mob sepsis. Tab sis nws yog tau hais tias cov me nyuam yaus thiab cov pojniam xeebtub sib txawv kiag li mechanism uas muaj Waterhouse syndrome - Friderichsen. Pathogenesis nws manifests nws tus kheej nyob rau hauv ntau hemorrhagic necrosis ntawm lub adrenal cortex. Lawv thiaj li muaj ntau hais tias tag nrho lub cev soaked nyob rau hauv cov ntshav, yog hyperextension ntawm lub tshuaj ntsiav, thiab txawm nws rupture.

Raws li rau cov kev pathogenesis, nws yog manifested nyob rau hauv daim ntawv ntawm cov sepsis:

- dilated cov hlab ntsha thiab arterioles;
- pronounced intoxication syndrome;
- lub xub ntiag ntawm concomitant meningitis los yog meningoencephalitis;
- ib qho kev nce nyob rau hauv lub regional cov qog ntshav hauv thiab thymus.

symptomatology

Waterhouse syndrome - Friderichsen nrog meningococcal kab mob tej zaum yuav tsim dheev nyob rau hauv lub keeb kwm yav dhau ntawm lub thaj. Nws yog progressing li ceev ceev hais tias ib tug neeg muaj peev xwm tuag tsis pub dhau hnub.

Nws tag nrho cov pib nrog ntev excitability, irritability thiab mob taub hau. Ces koom mob plab, xeev siab, ntuav thiab raws plab. Yog hais tias tus mob yog ib yam nkaus thiab mob siab heev, tus kws kho mob tej zaum yuav xav tias nyob rau hauv cov neeg mob uas mob phais pathology. Chiv, tsawg-qib kub taub hau, tab sis cia li ob peb teev ntawm pib nws yog 39-40 degrees. Vim ntuav thiab raws plab los ntawm lub cev tawm hauv cov dej thiab minerals, uas ua rau yus muaj kev cuam tshuam rau lub plawv, lub hlwb thiab lwm yam kabmob tseem ceeb heev. Nyob rau hauv lub kawg, tus neeg tsis nco thiab ntog mus rau hauv ib tug coma.

Muaj lwm daim ntawv ntawm tus kab mob, uas manifests nws tus kheej nyob rau hauv ib tug ntse lub caij nplooj zeeg nyob rau hauv cov ntshav siab los yog lub cev qhuav dej. Lwm yam tsos mob tej zaum yuav tsis yuav nyob rau hauv tag nrho cov. Tus txiv neej yog thawj nyob rau hauv ib tug stupor, tab sis raws li hypoxia loj zuj zus sai sai los stupor thiab coma. Dies tsis rov nco qab.

Waterhouse syndrome - Friderichsen cov me nyuam tsim sai dua rau cov neeg laus, tsis hais txog ntawm qhov ua rau. Muab lawv nyiaj muaj peev xwm ntawm tus kab mob sai depleted, thiab ntau systems thiab kabmob yog tseem nyob rau hauv tus txheej txheem ntawm kev tsim thiab kev loj hlob, cov kev tshwm sim los thawj hnub ntawm qhov pib ntawm tus kab mob.

diagnostics

Waterhouse syndrome - Friderichsen tsim kom sai uas cov kws kho mob feem ntau tsis muaj sij hawm mus ua kev cai rau ib tug tag nrho cov kev soj ntsuam thiab saib ua li cas rau ib tug txiv neej. Yog hais tias lub chav xwm txheej ceev cov dej num kws kho mob xav tias qhov no pathology, kev kho mob pib tam sim ntawd, thiab mob koom nyob rau hauv tus txheej txheem, vim hais tias cov account yog nyob rau ntawm lub moos.

Kuaj rau kabke ntawm tus mob yog tsim nyog los nrhiav tau nyob rau hauv cov kev soj ntsuam ntawm cov ntshav:

- leukocytosis thiab leftward ua haujlwm ntawm lub mis;
- txo nyob rau hauv cov ntshav qab zib;
- thrombocytopenia thiab tsawg txhaws;
- yuav txo tau ntawm electrolytes;
- nce nyob rau hauv cov ntshav urea nitrogen.

Txawm li cas los, tej cim no yog tsis meej thiab tej zaum yuav qhia ntawm ib tug ntau ntawm kev phais thiab cov kab mob uas. Nco ntsoov tias, koj yuav tsum ua tib zoo sau kev kho mob yav dhau los, thiab nqa tawm ib tug lumbar tej thiab los mus piav qhia cov hlwb raws li txoj cai. Tab sis tag nrho cov no yog ua li cas tom qab lub stabilization ntawm tus tib neeg mob.

differential mob

Waterhouse syndrome - Friderichsen yuav txawv los ntawm kev phais plab tej yam kev mob xws li mob hnyuv tws, mob pancreatitis, rwj perforation ntawm lub plab los sis duodenum. Nco ntsoov tus kws kho mob yuav tsum tau xyuas rau meningeal cov tsos mob, los mus tiv thaiv los ntshav nyob rau hauv lub hlwb, cavernous qhov ntswg thrombosis. Thaum mob ECG daim ntawv no yuav pab koj to taub seb ib tug neeg muaj ib lub plawv nres los yog tsis.

kev kho mob

Nyob rau hauv thawj qhov chaw tom qab tus mob "syndrome Waterhouse - Friderichsen" yuav tsum them rau tus neeg mob sweated kua electrolytes thiab cov tsis muaj adrenal cov tshuaj hormones. Yuav kom qhov no yog tswvcuab los ntawm lub venous nkag tau mus rau ib nrab ntawm ib liter "hydrocortisone" los yog 120 milligrams "prednisolone" thiab peb grams ntawm zib tsib feem pua thiab kaum milliliters ntawm tsib feem pua cov kua ntawm ascorbic acid. Yog li ntawd peb yuav tsum ua nyob rau theem pib pathogenesis, ua Waterhouse syndrome - Friderichsen. Thaum muaj xwm ceev kho mob nyob rau tib lub sij hawm pab txoj kev ntshav rheology, dilutes nws tsub kom tus nqi ntawm cov system kua thiab tsub kom lub siab. Ib tug steroid hormone hloov yuav pab kom muaj lub siab nyob rau txoj cai theem.

Tom qab stabilization ntawm lub tshuaj hormones tseem yuav muab intramuscularly, "hydrocortisone" ntawm 50-75 mg txhua txhua rau lub sij hawm, thiab deoxycorticosterone acetate rau kaum milliliters peb zaug ib hnub twg. Nco ntsoov ua raws li cov kev ntsuas ntawm siab thiab, yog tias tsim nyog, tus pin mus "epinephrine," "Mezaton" mob glycosides.

Yog hais tias qhov ua rau ntawm tus kab mob no tau ua ib tug kab mob, xws li mob meningococcal, nyob rau hauv tas li ntawd mus rau cov thawj txoj kev kho, tus neeg mob yog muab tshuaj tua kab mob. Thaum tus neeg mob rov qab mus rau li qub, cov tshuaj hormones pib maj mam txo cov tshuaj tsawg. Nws yog ib qho tseem ceeb kom zoo zoo npaj lub cev rau dab tsi nws yuav tsum ntawm nws tus kheej tsim glucocorticoids. Tsis txhob dheev rho cov tshuaj, nws yuav ua ib tug thib ob ntsoog.

Nws yog ib qho tseem ceeb kom paub tseeb tias tus neeg mob yog cia li Waterhouse syndrome - Friderichsen. Cov kev kho mob nws tus kheej yuav ua tau txaus ntshai raws li lub cev ntev uas dej nyab los ua mauj edema, xws li cerebral edema, thiab loj koob tshuaj ntawm cov tshuaj hormones yuav ua rau muaj mob puas siab puas ntsws. Yog li ntawd, tus mob ntawm tus neeg mob yog ib qho tseem ceeb heev rau lossi saib xyuas thiab kho cov kev teem caij raws li nws xav tau kev pab.

outlook

Waterhouse syndrome - Friderichsen - tsis tshua muaj neeg mob loj heev pathology, qhia hais tias tsis yog ib txwm nyob rau lub sij hawm vim hais tias ntawm ntau yam uas tsis yog-kev mob. Lub sij hawm nyob tsis tau tsuas yog nyob rau hauv yuav ua li cas zoo yuav coj tus kws kho mob thaum muaj xwm ceev qhov teeb meem no, tab sis kuj nyob rau hauv lub degree ntawm kev puas tsuaj ntawm cov qog adrenal thiab cov nyiaj muaj peev xwm ntawm tus kab mob. Nquag xaus kab mob no yog neeg tuag taus.

kev tiv thaiv

Qhov no yog tsuas anti-phaum ntsuas nyob rau hauv lub hearth ntawm kab mob nyob rau hauv uas tus neeg mob thiaj paub tias yog nrog kab mob meningococcal. Tus kws kho mob uas tau qhia xws li ib tug neeg mob yog yuam ua hauj lwm kom qhia rau Huv soj ntsuam thiab cais tawm tus neeg mob. Nyob rau hauv lub tom ntej no peb hnub, ib daim tshev ntawm kev sib cuag neeg rau lub xub ntiag ntawm tus kab mob thiab kev cais tawm nyob rau hauv lub chaw ua hauj lwm lub zej lub zos los yog tsev kawm ntawv rau ib lub sij hawm ntawm kaum hnub. Raws li ib tug yuam, cov neeg nyob rau hauv nyob sib ze nrog tus neeg mob, muab ib tug luv luv chav kawm ntawm tshuaj tua kab mob.

Epidemiology

Waterhouse syndrome - Friderichsen, hmoov tsis, heev pathology. Nyob rau hauv tsim lub teb chaws, cov xwm txheej ntawm qhov kab mob meningococcal yog 1-3 tus neeg mob ib 100 000 pejxeem. Thiab ntau tshaj ib nrab ntawm tus neeg mob - cov me nyuam ntawm preschool uas muaj hnub nyoog. Nyob rau hauv tas li ntawd, txhua xyoo caum tau pom ib tug sawv nyob rau hauv cov xwm txheej. Qhov no yog vim muaj ib tug hloov ntawm lub pathogen cov pej xeem thiab koos tiv thaiv.

Cov txheeb cais yog feem ntau tej zaum yuav tsis muaj tseeb, raws li feem ntau mus undiagnosed vim hais tias cov tsos mob ntawm tus ntoo khaub lig. Waterhouse syndrome - Friderichsen tsim kom sai uas cov kws kho mob tsis muaj lub sij hawm mus nqa tawm ib tug txaus tus naj npawb ntawm kev ntsuam xyuas.