Kala soocidda ee darnaanta beerka cirrhosis sida ay Child-Pugh

Cirrhosis of beerka - badashada ah unugyo ee jirka ku jira ay sabab u tahay caabuq muddo dheer. hab A caadi ah in kala saaridda cudurka tani ma aha, maxaa yeelay, ma jiro iswaafiqitaan on taas oo ka mid ah laga heli karaa ugu guulaha badan dhibaatooyinka ogaanshaha iyo daaweynta cirrhosis.

Qoondaynta beerka cirrhosis sida ay Child-Pugh

Tani dirka beerka cirrhosis waxaa loo isticmaalaa in la qiyaaso heerka uu darnaanta cudur ee bukaanka.

On ku salaysan ay ku qiimaysay soo saaraan badbaadada bukaanka qaba cudurka this iyo boqolleyda dhimashada qalitaanka ka dib. Go'aamiyo sida loogu baahan yahay beerka.

Cudurku wuxuu u qaybsan yahay saddex fasal. Beegyada uu u qeexaan in fasalada waxay muujinayaan heerka darnaanta ee cirrhosis, iyo sidoo kale xaqiiqda ah waxa ay noqon doontaa rajada nolosha ee bukaanka a aadanaha kuwaas oo uu leeyahay cirrhosis ah. Sida laga soo xigtay degree Child-Pugh of magdhow cudurka waxaa lagu qeexaa sida:

1. Class A waxaa ka mid ah magdhow cirrhosis.
2. B - subcompensated.
3. C - decompensated cirrhosis.

Sidee baad ka hadlo?

fasalka kasta oo Child-Pugh xilsaaray dhibcood gaar ah in waxa lagu saleeyaa wadarta dhowr koobin. Sayidka, Class A iska kala duwan oo ka mid ah 5 ilaa 6 dhibcood, B, siday u kala horreeyaan, - laga bilaabo 7 ilaa 9 dhibcood. Iyo fasalka ugu dambeeya - qiimaha weyn laga bilaabo 10 ilaa 15 dhibcood.

Heerka ugu yar ee adkaanta cirrhosis ay sabab u tahay A. Xaaladdan oo kale, duration nolosha bukaanka waa ugu badnaan - min 15 ilaa 20 sano. On labaad, waxa ay ku saabsan 10 sano. Class C waxay ka dhigan tahay rajada ugu gaaban nolosha bukaannada qaba cirrhosis of beerka - mid ka mid ah oo keliya ama ugu badnaan saddex sano.

Ka dib markii qaliin ah, tirada ugu badan ee dhimashada ah ee fasalka C - waa 80%; 30% - siday u kala horreeyaan, iyo A ee - 10%.

Baahida loo qabo beerka at darajo kala duwan ee darnaanta la ogaado sida soo socota:

• High - C,
• dhexdhexaad ah - B;
• Low - A.

xuduudaheedu The xisaabta lagu darsado in soocidda ee Child-Pugh

Waa maxay-beegyada uu saamayn qaybinta fasalada? First of dhan, waxaa la tixgelinayo joogitaanka:

• bilirubin;
• albumin;
• ascites.

Iyo sidoo kale encephalopathy cagaarshowga, PTI, PTT iyo INR.

System for Child-Pugh ma loo arki karaa tixraaca ah, tan iyo qiimeynta tixgelinayo ma dhammaan xuduudaha ka bukaanka. fiiqan oo sii xumaanaysa ee cudurka iyo dhibaatooyinka ay la beddelo sawirka, iyo dirka this waxaa mar dambe loo isticmaalo.

Nidaamka sidoo kale tilmaamay sidoo kale tixgelinayo morphologic iyo muuqaalada etiologic in cirrhosis.

Qoondaynta oo ah muuqaalada etiologic

Waxaa jira ah oo ku saabsan labaatan noocyada cirrhosis. Iyada oo ku xidhan in sababta loo yaqaan ama ma, cudurka waxa loo qaybiyaa saddex kooxood:

1. Cirrhosis rakibay (oo loo yaqaan) etiology.
2. cudurradana taas oo etiology waa lagu muransan yahay (mararka qaarkood loo yaqaan "etiology macquulka ah").
3. Cirrhosis la caddeyn (aan la garaneyn) etiology.

etiology rakibay

Of iyaga ogeysiiyo, aasaasay sababaha cudurka leh in arrimaha soo socda:

• In cirrhosis khamriga timi inta lagu jiro isticmaalka dheer oo aalkolo ah (40-60 ethanol garaam) 15 sano ama ka badan.
• Viral in qeybtii kiisaska waxaa keena fayras cagaarshowga B ee joogtada ah, C iyo G.
• Daroogada ama daawada, taas oo u muuqato sabab u ah isticmaalka daroogada nooca la mid ah muddo dheer.
• Hoose iyo sare cirrhosis biliary, halkaas oo dhimashada unugyada cagaarshowga dhacdaa iyo nudda nabarka dhab ahayn waxaa la aasaasay si ay u bedelo.
• Congenital ama la iska dhaxlo cirrhosis.
• Fadhiya - waa ka soo noocyo kale oo ku qoran oo kala duwan oo uu yeesho muddo dheer waqti dhiigga beerka waxaa loo jebiyey. Lagu arkay bukaanka qaba wareegga dhiigga guud.
• Marka cudurka iyo Budd-Chiari syndrome - cudur la xiriira soo qaxeen oo yaraada dhiig laga soo gooyay beerkii (thrombosis xididka cagaarshowga).
• cirrhosis Exchange-alimentary timi in diabetes daran, cayilka, marka enteroapocleisis biiray.

etiology macquulka ah iyo caddayn

Macquulka ah oo dahsoon, etiology la garanayn muujiyey joogitaanka:

• cudurrada faafa;
• cudurro ka yimid dullin;
• heley, shalalka,
• nafaqo-xumo.

arrimaha etiologic Lama yaqaan - inta badan waa qaab cirrhosis cryptogenic. In cirrhosis biliary hoose iyo caruurta Indian sidoo kale la hadli of etiology aan la garanayn.

kala soocidda morphological

kala soocidda Morphological burburka beerka - taasi waa ugu horeysay ee la soo jeediyay oo la ansixiyey oo ku salaysan xogta laga jarista (piece jirka, qaaday in vivo). Qoondee cudurada 4 nooc:

• MKD cirrhosis lagu gartaa qanjira yar yar ee jirka ku jira, kuwaas oo ballaciisu yahay 1-3 mm,
• krupnouzlovgo cirrhosis - beerka nodules dhexroor of 3 mm ama ka badan;
• Foomamka cirrhosis dhamaystirnayn, dheehan advantageously saameeyeen Risaalo mezhpechenochnye;
• isku qasan, lagu gartaa isku darka dhammaan sifooyinka kor ku xusan.

daaweynta cirrhosis

Kashifay cirrhosis fasalka of Child-Pugh siinayaa fursad ma aha oo kaliya si ay u sameeyaan ogaanshaha, in la saadaaliyo badbaadada bukaanka, laakiin sidoo kale in ay doortaan daaweynta ku haboon iyo daryeel taageero ah.

Sidaas darteed, cudurka beerka magdhow (Iyada oo class A) ku lug therapy aasaasiga ah loogu talagalay baabi'inta sababta asalka u ah cudurka ku. Intaa waxaa dheer, waa in aad soo qaado daawooyinka taageeraya. Ay shaqada - in la baabi'iyo saxarada. Of muhiimadda weyn ee enzyme this waxaa ka mid ah nooca "pancreatin" "Creon", "mezim". Qaadashada caadiga ah, saddex jeer maalintii qaaday, doorbidayaa cuntada ka hor. Koorsooyin loo xilsaaray, celcelis ahaan 2-3 toddobaad, oo lagu celceliyo si joogto ah.

Marka subcompensated cirrhosis (At cirrhosis B ee fasalka of Child-Pugh) looga baahan yahay degdeg ah ballan therapy dayactirka. Ujeedada this waxaa loo isticmaalaa cunto yar oo cusbo (wax ka badan 2 garaam oo cusbo halkii maalin), protein xayiraad kale. Of daawooyinka loo soo qoray "Furosemide" iyo "spironolactone". Qaadashada diuretics qasba horumarinta hypertension portal iyo yaraynaysaa ascites. shaqo ee mareenka caloosha iyo mindhicirka waxaa lagu hagaajin karaa "Lactulose" ee 50-70 ml maalin kasta, laakiin soo dhaweynta waa in ay si joogto ah.

In the case of cudurka beerka decompensated (marka fasalka C sidii Child-Pugh) muujiyey xaalad naf-gooyada ah ee bukaanka ah. Waxay u baahan tahay daryeel degdeg ah oo degdeg ah. Paracentesis bixisaa saarista dheecaan ka peritoneum ah, albumin intravenously maamulo iyo crystalloids, qabanaysa wareegaya mugga dhiigga iyo protein ah ee jirka ku. Si firfircoon loo isticmaalaa diuretics: ka "spironolactone" isku mid ah iyo "Furosemide". Qori yar yahay cunto milixdu. Waayo, nafaqada isku dheeli tiran parenteral iman encephalopathy, cagaarshowga iyo xaaladaha kale ee daran.

gunaanad

Prophylaxis cudurada waxaa sidoo kale ku salaysan kala soocidda ee darnaanta cirrhosis beerka of Child-Pugh.

In koorsada cudurka compensated uma baahna ujeedada ka hortag ah. Marka ay fasalada B iyo C bukaanka waxa dhici karta in dhiig yari, oo sidaas daraaddeed marar aad u badan maamula erythropoietin. Intaa waxaa dheer, ee beta-blockers caadi qoray (sida "Metoprolol", "Inderal"), kaas oo looga hortago waxaa laga yaabaa in farqiga u varices esophageal.