Ko te whakarōpū o te pakeke o te ate cirrhosis rite ki Child-Pugh

Cirrhosis o te ate - he tini o te kiko tūhonohono i roto i te tinana e tika ana ki te mumura wā roa-. E kore te mea te huarahi noa ki te whakarōpū o tenei mate no te mea kahore he whakaaro i runga i nei o te wātea ana tino angitu mō ngā raruraru tātaritanga me te maimoatanga o te cirrhosis.

Whakarōpū o ate cirrhosis rite ki Child-Pugh

whakamahia tēnei whakarōpū o ate cirrhosis te ki te whakatau tata i te tohu o te mate pakeke i roto i te manawanui.

I runga i te pūtake o tona i whakarite ai hua ora manawanui ki tenei mate, me te ōrau o te tahuti nei i muri i te pokanga. Whakaritea rite hiahiatia he transplant ate.

Kei te wehea te mate ki ngā akomanga e toru. Ko te tawhā e tautuhi i te akomanga tohu te tohu o te pakeke o te cirrhosis, me te te meka aha e waiho te tümanako ora o te manawanui tangata e he cirrhosis. tautuhia E ai ki te tohu Child-Pugh o utu o te mate te rite:

1. Class A ngā cirrhosis utua.
2. B - subcompensated.
3. C - cirrhosis decompensated.

Me pēhea e kōrero koe?

Ia piha haapiiraa o Child-Pugh whakaritea etahi ngā e kua tatau i runga i te moni o te maha tawhā. Ko te kupu, Class A no ki te whānuitanga o te 5 ki te 6 ngā, B, aua, - i 7 ki te 9 ngā. Na te piha haapiiraa whakamutunga - i te uara nui i te 10 ki te 15 ngā.

Ko te tohu iti o te pakeke o te cirrhosis tika ki A. I roto i tenei take, ko te roanga o te ora o te manawanui i te mōrahi - i 15 ki te 20 tau. I runga i te tuarua, ko reira e pā ana ki te 10 nga tau. tikanga Class C te tümanako ora poto o tūroro ki cirrhosis o te ate - kotahi anake i te nuinga e toru nga tau ranei.

I muri i te pokanga, te ōrau teitei o te tahuti nei o te piha haapiiraa C - ko reira 80%; 30% - te whakaatu i, me o te A - 10 anake%.

Ko te hiahia mo te transplant ate i ngā nekehanga o te pakeke he fakapapau'i e whai ake:

• High - C;
• āhua - B;
• Iti - A.

tangohia nga tawhā ki pūkete i roto i te whakarōpū o Tamaiti-Pugh

He aha tawhā whakaawe te tohatoha o te akomanga? Tuatahi o te katoa, e te reira ki pūkete te aroaro o:

• bilirubin;
• albumin;
• ascites.

I tua atu i ate encephalopathy, PTI, TPT me INR.

e kore e taea te whakaaro Pūnaha mo Tamaiti-Pugh rite te tohutoro, mai e te aro mātai ki te pūkete e kore katoa o nga tawhā o te manawanui. Ko te koi ähua o te mate, me ona pōauautanga huri i te pikitia, a kei te kore tenei whakarōpū whakamahia.

e hoki pūnaha whakaahuatia hoki ki pūkete te morphologic me ngā āhuatanga etiologic i roto i cirrhosis.

Whakarōpū o ngā āhuatanga etiologic

He pā ana ki e rua tekau ngā o cirrhosis. Tei runga i ranei mohiotia te take kei te kore ranei, e tahuri iho te mate ki ngā rōpū e toru:

1. Cirrhosis tāuta (mohiotia) etiology.
2. Ko te māuiuitanga i roto i te mea tautohetia te etiology (i ētahi wā ka karangatia e "te etiology taea").
3. Cirrhosis ki mārama (unknown) etiology.

etiology tāuta

O mōhiotia, whakapumautia te take o te mate e mea ana i roto i te wā e whai ake nei:

• I roto i te cirrhosis waipiro puta i roto i te whakamahi roa o te waipiro (40-60 karamu te waihā) mō te 15, neke atu rānei tau.
• Viral e i roto i te hawhe te wā meinga e te huaketo o kakā B, C me te G.
• Drug rongoā ranei, e faaite ake e tika ana ki te whakamahi o te raau taero o te momo kotahi mo te wa roa.
• Paraimere, me te tuarua cirrhosis biliary, te wahi puta kiko mate ate me te kiko nawe pokepoke i hanga te ki te whakakapi i te reira.
• cirrhosis congenital tuku ranei.
• Whakaroau - Ko reira rerekē i te tahi atu mau huru rārangi, me te whanake o te wā he wā ka makona ratou roa ka pakaru te supply toto ki te ate te. Kitea i roto i ngā tūroro ki te tohanga toto whānui.
• A, no te mate me Budd-Chiari syndrome - he mate e pā ana ki matamua toto waimaero i te ate (ate Thrombosis rua).
• cirrhosis Exchange-alimentary puta i roto i te mate huka nui, te mōmona, ka piri enteroapocleisis.

etiology pea me mārama

Taea, me te kerekere, whakakitea etiology mohiotia i roto i te aroaro o:

• mate hopuhopu;
• mate pirinoa;
• pathologies autoimmune;
• pohokore.

āhuatanga etiologic Unknown - he maha puka cirrhosis cryptogenic. I roto i te tuatahi cirrhosis biliary me tamariki Indian hoki te korero o te etiology unknown.

whakarōpū morphological

whakarōpū morphological o te kino ate - ko te tuatahi whakaarohia, ka whakaaetia i runga i ngā raraunga i biopsies (wahi tinana, tangohia i roto i te vivo) tenei. Tohatoha māuiuitanga 4 puka:

• MKD cirrhosis āhuatanga e nodules iti i roto i te tinana, tona diameter ko 1-3 mm;
• krupnouzlovgo cirrhosis - ate nodules diameter 3 mm atu ranei o;
• puka cirrhosis oti, ai pāngia pai io tataitia mezhpechenochnye;
• konatunatua, āhuatanga e te huinga o nga āhuatanga i runga ake katoa.

maimoatanga cirrhosis

Kitea cirrhosis piha haapiiraa o Child-Pugh homai te whai wāhi kore anake ki te hanga i te tātaritanga, ki matapae i te oranga o tūroro, engari ano ki te tīpako maimoatanga tika me te tiaki tautoko.

Ko te kupu, ko te mate ate utua (Ki te piha haapiiraa A) Ko tā te therapy taketake e hāngai ana te whakakore i te take pakiaka o te mate. I tua atu, me tiki e koe ake nga rongoa tautoko. Ratou misioni - ki te whakakore tokopā. O te faufaa rahi i roto i tenei paru kei o momo "pancreatin" "Creon", "mezim". Toketaá paerewa, tangohia toru nga wa te ra, arā i mua kai. He akoranga i faataahia, he toharite o 2-3 wiki, korerotia nei i wā auau.

A, no te subcompensated cirrhosis (I B cirrhosis o te piha haapiiraa o Tamaiti-Pugh) hiahiatia kaha whakarite tiaki therapy. whakamahia hoki tenei whakaaro ko te kai tote iti (kaua e neke atu i te 2 karamu o te tote ia ra), te pūmua whāiti atu. O te raau taero i whakaritea "Furosemide" me "spironolactone". Te fariiraa Diuretics akiakina ana whakawhanake takawhita tomokanga, me te whakaiti ascites. Ka taea te whakapai ake te mahi o te wahi gastrointestinal "lactulose" i roto i te 50-70 ml ia ra, engari te fariiraa ko ki te kia pumau.

I roto i te take o te mate ate decompensated (ka te C piha rite ki Child-Pugh) whakakitea huru ora-te whakawehi o te manawanui. E titau te reira whāomo tonu. whakarato Paracentesis tango o te wai i te peritoneum, e pâmuhia whakahaere albumin me crystalloids, whakakiia komuhumuhu rōrahi toto me te pūmua i roto i te tinana. whakamahia Tino Diuretics: te taua "spironolactone" me "Furosemide". Whakahau i te iti kai i roto i te tote. Hoki te kai tōtika parenteral taurite mai i roto i te encephalopathy ate, me te tahi atu tikanga kino.

mutunga

Kei te hāngai hoki Prophylaxis o mate i runga i te whakarōpū o te pakeke o te ate cirrhosis o Child-Pugh.

I roto i te akoranga mate utua e kore e rapua e whakaaro ārai. A, no te kia whakawhanake akomanga B me ngā tūroro C anemia, a reira rawa maha whakahaere erythropoietin. I tua atu, i te beta-blockers nuitia whakaritea (pērā i "Metoprolol", "Inderal"), e kia aukati i te āputa varices esophageal.