Qhov Tseem Ceeb Qhov txawv - Anaphylaxis vs Anaphylactic Shock
Tib neeg lub cev tiv thaiv kab mob feem ntau lees paub cov hlwb thiab cov molecules uas tsim kev puas tsuaj thiab ua haujlwm los tshem tawm lawv ntawm lub cev. Txawm li cas los xij, qee zaus, cov molecules tsis muaj teeb meem thiab cov hlwb kuj raug txheeb xyuas tsis raug raws li cov neeg ua haujlwm raug mob los ntawm lub cev tiv thaiv cov txheej txheem, ua rau muaj kev tiv thaiv kab mob uas tuaj yeem ua rau cov ntaub so ntswg puas thiab tuag. Xws li kev tiv thaiv kab mob tsis txaus ntseeg yog hu ua hypersensitive reactions lossis allergic reactions. Kev tsis haum tshuaj loj heev uas tshwm sim sai sai yog cov npe hu ua anaphylaxis. Yog tias anaphylaxis tsis kho, nws yuav ua rau lub xeev ntawm cov kab mob hypoperfusion ua raws li cov ntaub so ntswg perfusion, uas yog hu ua anaphylactic shock. Yog li ntawd, qhov sib txawv tseem ceeb ntawm anaphylaxis thiab anaphylactic shock yog qhov muaj cov ntaub so ntswg hnyav hypoperfusion hauv lub xeev poob siab uas tuaj yeem ua rau tsis ua haujlwm ntawm lub cev tseem ceeb.
Anaphylaxis yog dab tsi?
Cov tshuaj tiv thaiv tsis haum hnyav uas tshwm sim sai yog hu ua anaphylactic cov tshuaj tiv thaiv. Anaphylaxis tuaj yeem txhais tau tias yog qhov hnyav, ua rau muaj kev phom sij rau lub neej, kev ua haujlwm dav dav lossis cov kab mob tsis txaus ntseeg uas tshwm sim los ntawm kev loj hlob sai, kev cuam tshuam lub neej hloov pauv mus rau txoj hlab pa lossis / thiab ua pa lossis / thiab ncig.
Pathophysiology
Anaphylaxis tshwm sim raws li qhov mob hnyav, Ig-E kho cov tshuaj tiv thaiv kab mob. Feem ntau mast hlwb thiab basophils tau koom nrog hauv kev coj tawm lub cev tiv thaiv kab mob los ntawm cov kab mob sib kis. Cov neeg nruab nrab no ua rau:
- Smooth leeg contraction
- Bronchial spasms
- Ntau vascular permeability
- Edema
Vasodilation Nyob
Systemic absorption of allergen yog tsim nyog rau qhov pib ntawm anaphylaxis. Qhov no tuaj yeem yog los ntawm kev noj tshuaj los yog kev txhaj tshuaj parenteral. Feem ntau pom qhov tshwm sim rau anaphylaxis yog, Khoom noj - Peanut, shellfish, lobsters, mis nyuj, qe
Nyob zoo ib tsoom niam txiv kwv tij neej tsas sawv daws.
Tshuaj - Penicillin's, Cephalosporin's, Suxamethonium, Non-steroidal anti-inflammatory tshuaj (NSAIDs), Angiotensin Converting Enzyme inhibitors (ACEi), Gelatin daws
Tshuaj pleev ib ce - Latex, plaub hau dye
Cov tsos mob thiab cov tsos mob
Cov tsos mob ntawm anaphylaxis tuaj yeem muaj txij li dav urticarial mus rau plawv plawv, laryngeal edema, ua pa tsis ua pa thiab ua pa tsis ua haujlwm ua rau tuag taus. Qhov tshwm sim tam sim ntawd thiab kev loj hlob sai ntawm cov tsos mob no tom qab kis tau tus kab mob antigen yog ib qho tseem ceeb ntawm anaphylaxis.
- Stridor, hoarseness- vim qhov nce capillary permeability, extravasation, thiab edema
- Angioedema
- Rhonchi
- Dyspnea
- YLaryngeal edema
- zawv plab thiab ntuav - vim yog edema thiab tso tawm ntawm plab hnyuv
Qhov tshwm sim hnyav dua ntawm anaphylaxis yog hypotension, bronchospasm, laryngeal edema, thiab plawv arrhythmia. Hypotension tuaj yeem tshwm sim vim vasodilation uas ua rau txo qis tom qab thiab preload, ua rau myocardial kev nyuaj siab. Tsis meej pem yuav tshwm sim los ntawm cerebral hypoxia. Cerebral hypoperfusion thiab hypotension tuaj yeem ua rau syncope.
Daim duab 01: Cov cim qhia thiab cov tsos mob ntawm Anaphylaxis
Kev tswj hwm
Lub hom phiaj ntawm kev tswj hwm ntawm anaphylaxis yog kev kho dua tshiab ntawm oxygenation thiab perfusion ntawm lub hlwb nrog rau kev thim rov qab ntawm kev hloov pauv pathological. Kev ntsuas los tiv thaiv kev kis tus kab mob ntau dua yog qhov tseem ceeb heev. Kev paub ntxov ntxov ntawm anaphylaxis thiab kev kho mob yog qhov tseem ceeb.
- ABCDE txoj hauv kev yog qhov tsim nyog (cua pa, ua pa, ncig, kev tsis taus, raug)
- Ua tus neeg mob pw tsaug zog thiab taw tsa
- Ua pa tsis muaj pa
- High flow oxygen via mask
- ntshav siab yuav tsum
- Npaj nkag mus rau venous
Tshuaj xaiv rau anaphylaxis yog adrenaline. Siv 0.5 mg ntawm Adrenaline intramuscularly (0.5ml ntawm 1: 1000 adrenaline). Txhawm rau tiv thaiv cov lus teb inflammatory, muab 200mg ntawm Hydrocortisone intravenously thiab 10-20mg ntawm chlorphenamine intravenously.
Dab tsi yog Anaphylactic Shock?
Anaphylactic poob siab txhais tau hais tias yog lub xeev ntawm cov ntaub so ntswg hypoperfusion vim qhov txo qis hauv plawv thiab / lossis txo qis cov ntshav ntim. Qhov tshwm sim hypoperfusion yog ua raws li cov ntaub so ntswg perfusion thiab cellular hypoxia. Anaphylaxis tuaj yeem ncav cuag qhov poob siab vim qhov mob hnyav ntawm vasodilation, nce permeability ntawm vasculature, hypoperfusion thiab cellular anoxia. Kev poob siab anaphylactic yog ib qho teeb meem loj zuj zus thiab nws tuaj yeem ua rau tuag taus tshwj tsis yog qhov ua rau raug kho. Cov kab mob tuaj yeem muab faib ua 3 theem xws li; Cov theem tsis tau nce qib, theem nce qib, thiab theem tsis rov qab los.
Ntxhais kawm tsis tau zoo
Nyob rau theem no, reflex compensatory neurohormonal mechanisms tau qhib kom muaj kev sib txuas ntawm lub cev tseem ceeb, tshwj xeeb hauv lub hlwb thiab lub plawv. Lub qog adrenal secretes catecholamines uas ua rau kom peripheral tsis kam, nce ntshav siab. Lub raum secrete renin uas khaws cov sodium thiab yog li dej nce lub preload. Posterior pituitary yuav tso tawm ADH los ua rau cov nephron distal kom khaws sodium thiab dej. Tag nrho cov txheej txheem no tshwm sim txhawm rau txhawm rau kho cov ntaub so ntswg perfusion.
Progressive theem
Yog tias qhov laj thawj tsis raug kho, qhov tsis txaus oxygen tsis tu ncua yuav ua rau lub cev tseem ceeb thiab tsis ua haujlwm.
Stages
- Persistent oxygen deficit
- Aerobic ua pa yog hloov los ntawm anaerobic glycolysis
- Lactic acid ntau lawm
- Cov ntaub so ntswg plasma ua kua qaub
- Vasomotor teb yog blunted
- Arterioles dilate thiab cov hlab ntshav hauv microcirculation
- Lub plawv tso zis heev txo qis
- Kev raug mob Anorexic rau cov hlwb endothelial
- Lub cev tseem ceeb thiab tsis ua haujlwm
Irreversible Stage
Yog qhov hauv paus ua rau kev poob siab anaphylactic tsis raug kho, kev raug mob ntawm tes tsis tuaj yeem tshwm sim.
Cov tsos mob thiab cov tsos mob
- Cov tsos mob ntawm vasodilation loj: sov peripheries, tachycardia, ntshav siab
- YBronchospasm
- Generalized urticaria, angioedema, pallor, erythema
- Edema ntawm pharynx thiab larynx
- Pulmonary edema
- Kab mob plab, xeev siab, ntuav
- Hypovolemia vim dej ntws tawm
Kev tswj hwm
Nyob rau hauv ib qho kev poob siab ntawm tus neeg mob txoj hlab pa, ua pa thiab ncig yuav tsum tswj kom zoo. Kev ncua ntawm kev lees paub ntawm tus neeg mob xav tsis thoob yog cuam tshuam nrog kev tuag ntau ntxiv.
Kev nkag mus rau tus neeg mob txoj hlab pa uas thaiv tau tuaj yeem tau txais los ntawm kev tshem tawm qhov thaiv ntawm txoj hlab pa oropharyngeal, los ntawm lub raj endotracheal lossis siv tracheostomy. Cov pa tuaj yeem muab tau los ntawm kev ua pa zoo txuas ntxiv (CPAP), tsis muaj qhov cua nkag (NIV) lossis tiv thaiv kev ua pa. Kev ua pa thiab ua pa ntawm tus neeg mob yuav tsum tau saib xyuas los ntawm kev suav cov pa ua pa, pulse oximetry, capnography thiab ntshav gases.
Daim duab 02: Tshem tawm tus neeg mob txoj kev ua pa uas siv tracheotomy.
Lub plawv tso zis thiab ntshav siab tuaj yeem coj mus rau qib ib txwm los ntawm kev nthuav dav cov hlab ntshav los ntawm kev muab cov ntshav, colloids lossis crystalloids. Inotropic agents, vasopressors, vasodilators thiab intra-aortic balloon counterpulsation tuaj yeem siv los txhawb kev ua haujlwm ntawm lub plawv. Kev soj ntsuam ntawm lub plawv muaj nuj nqi yog ua los ntawm kev ntsuas ntshav siab, ECG, ntsuas zis tso zis thiab los ntawm kev ntsuas lub hlwb ntawm tus neeg mob.
Dab tsi zoo sib xws ntawm Anaphylaxis thiab Anaphylactic Shock?
- Anaphylaxis thiab anaphylactic shock yog immunologically mediated.
- Ob qho xwm txheej yuav tuag yog tias tsis kho.
Qhov txawv ntawm Anaphylaxis thiab Anaphylactic Shock yog dab tsi?
Anaphylaxis vs Anaphylactic Shock |
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| Cov tshuaj tsis haum loj uas tshwm sim sai yog hu ua anaphylactic reactions lossis anaphylaxix. | Anaphylactic poob siab txhais tau hais tias yog lub xeev ntawm cov ntaub so ntswg hypoperfusion, vim qhov txo qis hauv plawv thiab / lossis txo cov ntshav ntim tau zoo. |
| Tissue Hypoperfusion | |
| Tsis muaj cov ntaub so ntswg hnyav hypoperfusion. | Tissue hypoperfusion yog tus yam ntxwv ntawm kev poob siab anaphylactic. |
Summary – Anaphylaxis vs Anaphylactic Shock
Cov tshuaj tiv thaiv Anaphylactic yog tam sim ntawd, thoob plaws, muaj peev xwm ua rau tuag taus. Yog tias tsis kho, qhov no tuaj yeem ua rau lub xeev ntawm cov kab mob hypoperfusion tom qab los ntawm cov nqaij mos perfusion. Cov mob tom kawg no hu ua anaphylactic shock. Yog li, qhov sib txawv tseem ceeb ntawm anaphylaxis thiab anaphylactic shock yog lawv qhov hnyav.
Download PDF Version of Anaphylaxis vs Anaphylactic Shock
Koj tuaj yeem rub tawm PDF version ntawm kab lus no thiab siv nws rau offline hom phiaj raws li cov ntawv sau tseg. Thov download PDF version ntawm no Qhov txawv Ntawm Anaphylaxis thiab Anaphylactic Shock.
