Presentation is loading. Please wait.

Presentation is loading. Please wait.

KuW-nawlavis traqtidan sisxldenebis diagnostikis da mkurnalobis Tanamedrove aspeqtebi.

Similar presentations


Presentation on theme: "KuW-nawlavis traqtidan sisxldenebis diagnostikis da mkurnalobis Tanamedrove aspeqtebi."— Presentation transcript:

1 kuW-nawlavis traqtidan sisxldenebis diagnostikis da mkurnalobis Tanamedrove aspeqtebi

2 sisxldenis gamomwvevi mizezebi 71,2% 10,6% 3,9% 2,9% 10,4%

3 klasifikacia sisxldenis kera: saylapavi mili kuWi Tormetgoja nawlavi wvrili da msxvili nawlavi klinikuri mimdinareoba: mimdinare sisxldena SeCerebuli sisxldena morecidive sisxldena

4 sisxldenis SeCerebis meTodebi 1.diaTermokoagulacia. 2.Termokauterizacia (mowva an siTburi koagulacia). 3.lazeruli fotokoagulacia. 4.argono-plazmuri koagulacia. 5.hemostazis ineqciuri meTodi vazokonstriqtoruli saSualebebiT. (gamoiyeneba adrenalinis 0,005%-iani xsnari. Seiyvaneba sisxlZarRvis fuZesTan paravazalurad 3-4 wertilSi 5-20 ml-is odenobiT). 6.hemostazis ineqciuri meTodi eTanolis gamoyenebiT. (gamoiyeneba 96%-iani eTanoli an 25-30%-iani eTanol-novokainis xsnari. gamokvlevis periodSi mimdinare sisxldenisas, roca ver xerxdeba sisxlmdeni sisxlZarRvis zusti lokalizeba, gamoiyeneba 25-30%-iani eTanoli, romelic Seiyvaneba lorwovanis naxeTqis kideebTan, wylulis fskersa da kideze, eroziis mimdebare lorwqveSa SreSi an simsivnur qsovilSi 4-6 ml-is odenobiT. SeCerebuli sisxldenisas, roca keris fskerze aRiniSneba Trombirebuli sisxlZarRvi, sisxldenis ganmeorebis albaTobis Sesamcireblad sisxlZarRvis irgvliv 3-4 wertilSi Seiyvaneba 96%-iani eTanoli ara umetes 0,8 ml-isa).

5 sisxldenis SeCerebis meTodebi 7.webovani plombirebis meTodi 8.hemostazis meqanikuri meTodebi 9.hemostazis kombinirebuli meTodebis gamoyeneba

6 klasifikacia Forrest I – sisxldena grZeldeba endoskopiuri kvlevisas Forrest Ia – aroziuli sisxldena nakadiT Forrest Ib - kapilaruli sisxldenaQdifuzuri Jonvis saxiT Forrest II – endoskopiuri kvlevis momentSi SeCerebuli sisxldena axlad gadatanili sisxldenis kvaliT keris fskerze da/an kideze Forrest IIa – vizualuri msxvili Trombirebuli sisxlZarRvi Forrest IIb – wylulovan kraterze mkvrivi fiqsirebuli Trombi-kolti Forrest IIc – wvrili Trombirebuli sisxlZarRvebi muqi-yaviseri an muqi- wiTeli laqebis saxiT Forrest III – SeCerebuli sisxldena keris fskerze da kideze kvalis gareSe

7 sisxldenis simZimis xarisxi I xarisxi – sisxldena hemodinamikis umniSvnelo cvlilebiT. zogadi mdgomareoba damakmayofilbelia. pulsi zomierad gaxSirebuli, arteriuli wneva normis farglebSi. ОЦК-s deficiti ara umetes 5%-isa. gemoglobini 100g/l-ze meti. kapilaroskopia: vardisferi foni, 3-4 kapilaruli maryuJi swrafi homogenuri sisxlis nakadiT. II xarisxi – gamoxatuli sisxldena. zogadi mdgomaroba saSualo simZimis, moduneba, Tavbrusxveva, kolaptoiduri mdgomareoba. kani fermkrTali. pulsi mniSvnelovnad gaxSirebuli. arteriuli wneva daqveiTebuli 90 mm/hg. erTjeradi Rebineba an. ОЦК-s deficiti 15%, gemoglobini 80g/l. kapilaroskopia: fermkrTali foni, kapilarebis raodenobis Semcireba, sisxlis nakadi swrafi, homogenuroba darRveulia

8 sisxldenis simZimis xarisxi III xarisxi – zogadi mdgomareoba mZime. kani fermkrTali, dafaruli civi ofliT. lorwovani garsebi fermkrTali. av-fi amTqnarebs, ganicdis wyurvils. pulsi xSiri, Zafiseburi. arteriuli wneva daqveiTebuli 60 mm/hg - mde. ОЦК-s deficiti 30%. gemoglobini 50 g/l. xSiri Rebineba. sisxxldenas axlavs kolaptoiduri mdgomareoba. kapilaroskopia: foni fermkrTali, masze 1-2 kapilari Znelad gasarCevi arteriuli da venuri nawiliT. IV xarisxi – masiuri sisxldena gonebis xangrZlivi dakargviT. zogadi mdgomareoba ukiduresad mZime, esazRvreba agoniurs. pulsi da arteriuli wneva ar isinjeba. ОЦК-s deficiti 30%-ze meti. kapilaroskopia: kapilarebi ar isaxeba

9 ganmeorebiTi sisxldenebis ganviTarebis riskis mixedviT gamoyofen 4 prognozul jgufs, romelic dafuZvnebulia Semdeg faqtorebze: forestis klasifikacia sisxldenis keris zoma da lokalizacia |RviZlis cirozi Catarebuli operacia arteriuli wneva aRniSnuli modelis mgrZnobeloba adreuli ( 48sT) sisxldenebisas - 65%.

10 ganmeorebiTi sisxldenis sixSirisa da sikvdilianobis maCvenebeli riskis jgufebis mixedviT Zalian dabali maRali umaRlesi ganmeorebiTi sisxldenis sixSire % 0%7,9%31,8%67,9% sikvdilianoba 5,9%8,6%13,9%35,7% 48 sT-is Semdeg % 0%3,3%10,4%14,3% riskis jgufebi

11 intraabdominuri maRali wnevis sindromi pirveladi, meoradi da qronikuli Abdominal Compartament Sindrom (ACS) postoperaciuliperitoniti sisxldena nawlavTaA dinamiuri gaualoba pnevmoperitoneumi muclis kedlis moWimva gakervisas posttramvuliposttramvuli hematoma Sinagani organoebis SeSupeba menjis Zvlebis motexiloba ZiriTadi daavadebis garTuleba peritoniti sefsisi RviZlis cirozi ascitiT nawlavTa gaualoba aortis anevrizmis gaskdoma simsivnuri procesebi etiologiuri faqtorebi:

12 muclis Rrus wneva SeiZleba gavzomoT: swor nawlavSi an kuWSi, Sardis buStSi an qvemo Rru venaSi. wnevis gazomvis pirdapiri meTodebi _ invaziuri meTodebi (punqciuri, laparotomiuli da sxva). wnevis gazomvis arapirdapiri meTodebi _ qvemo Rru venaSi, kuWSi an wvril nawlavSi (nazogastruli zondiT). yvelaze popularuli da martivi meTodi muclis Rrus wnevis gasazomad, aris wnevis done Sardis buStSi. Sardis buStiSi wnevis gasazomad saWiroa: foleis kaTeteri, sammaga, gamWvirvale milaki (gadasxmis sistemis), saxazavi an specialuri hidromanometri. fovleris an trndelenburgis mdebareobam SeiZleba Secvalos buStSida wneva, amitom mucelSiga wneva unda ganisazRvros avadmyofis horizontalur mdebareobaSi. Sardis buStSi SehyavT foleis kaTeteri, beraven mis balons. Sardis buStSi (mis daclis Semdeg) SehyavT ml fiziologiuri xsnari. gadaiketeba gazomvis distaluri adgili, da masTan sammagas saSualebiT (nemsiT) uerTdeba sistema. muclis Rrus wnevis cvlileba fasdeba nulovani wertilidan _boqvenis simfizis zeda kide. milSi Sardis svetis simaRle iqneba mucelSiga wneva santimetrebSi wylis svetis (1-sm wy.sv.=0,735 mm verc.wy.sv). Sardis buStidan muclis Rrus wneva ar izomeba misi travmisas da buStze menjis hematomis zewolisas. am SemTxvevaSi fasdeba kuWSida wneva.

13 intraabdominuri hipertenziis 4 xarisxi ( Sugrue M.,Hilman 1998.) I _ muclis Rrus wneva mm wy.sv. II _ muclis Rrus wneva mm wy.sv. III _muclis Rrus wneva mm wy.sv. IV _ muclis Rrus wneva 35–mm wy.sv._ze meti P poliopganuli ukmarobis gaCenis vadebi intraabdominuri hipertenziis sxvadasxva xarisxis dros

14 intraabdominuri maRali wnevis sindromi mkurnaloba mxolod qirurgiulia sxva meTodebiT mkurnaloba - letaloba 100%-ia adreuli dekompresiisas - letaloba 20%-ze naklebia mogvianebiTi dekompresiisas - letaloba aRwevs 65%-s

15 avadmyofobis istoriis ganxilva unda pasuxobdes Semdeg kiTxvebs: 1.Seesabameba Tu ara klinikaSi arsebuli kvlevis SesaZleblobebs Catarebuli kvlevebis moculoba? 2.srulyofilia Tu ara Catarebuli gamokvlevebi? 3.Catarebuli kvlevebis safuZvelze aris Tu ara daSvebuli diagnostikuri Secdoma? 4.moaxdina Tu ara zegavlena diagnostikurma da samkurnalo manipulaciebma daavadebis gamosavalze? 5.gadaaWarba Tu ara dadgenil standarts materialurma danaxarjma?


Download ppt "KuW-nawlavis traqtidan sisxldenebis diagnostikis da mkurnalobis Tanamedrove aspeqtebi."

Similar presentations


Ads by Google