Эмболия

07.04.2012

embolie-3.jpg - kopie
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Эмболия - это заболевание, при котором внезапно щакпоривается сосуд. Эмболия чаще всего бывает спровацирована кровяным сгустком, который оторвется от вены нижней конечности и попадет в легкие, где закупорит один из сосудов. Причиной эмболии могут быть также капли жира при травмах, пузыри воздуха, и очень редко и околоплодные воды

Эмболия

Эмболия – внезапная закупорка сосуда, возникающая в результате заклинения движущегося предмета, то есть эмбола. Эмболом чаще всего бывает тромб, также может быть жировая капля, пузырек воздуха, реже плодовая вода. В результате закупорки сосуда наступает ишемия, то есть малокровие ткани, которую пораженная артерия кровоснабжала. Течение эмболии может быть бессимптомным, а может вести и к смерти пациента.

Виды эмболии

Эмболия – это состояние, представляющее угрозу для жизни пациента, поэтому необходимо как моůно раньше выяснить причину ее возникновения. По характеру эмбола выделяем несколько видов эмболии:

  • Самым частым является так званая тромбоэмболия, здесь эмболом является тромб, возникающий чаще всего в венах нижних конечностей и таза. Опасность тромбоэмболии заключается в том, что тромб, оторвавшись, может переместиться в сердце, а оттуда в легочные вены. Тромб также может образовываться  в сердце, а то в случае неправильного сокращения некоторых его частей, например при фибрилляции предсердий. Впоследствии тромб может оторваться и через левый желудочек попасть в большой круг кровообращения. При попадании тромба в мозг развивается инсульт, в сердце – инфаркт миокарда.
  • Еще одним видом является жировая эмболия, которая развивается в результате повреждения кости, жировой ткани или ожогов. Жировые капли глазом невидимы, могут заклиниться в капиллярах мозга или почек.
  • Воздушная эмболиявозникает при проникновении воздуха в периферические вены, который согласно законом физики может препятствовать току крови в сосуде. Возникает при операциях вен, во время которых пузырек воздуха попадает в периферические вены через заведенную канилу. Сюда же относим Кессонную болезнь, развивающуюся  при погружении и быстром подъеме из воды. Даже самый маленький объем воздуха может быть смертельным.
  • Эмболия околоплодными водами развивается как осложнение при родах. Ее причиной является всасывание околоплодной воды в венозную систему матки во время родов, жидкость так может переместиться в легкие.
  • Эмболия инородным телом возникает при занесении предмета до системы кровообращения. Таким предметом может быть сломанная игла.

Проявление эмболии

Проявления эмболии весьма разнообразны. Считается, что маленькие эмболы не обязательно должны проявиться, но в некоторых случаях их последствия могут быть очень серьезными и даже смертельными. Проявление зависит главным образом от локализации эмбола, то есть важно, возникает ли в венах или артериях.

  • Эмбол, переносящийся венозной системой, скорее всего, попадет в сердце, а оттуда в легкие, вызвав легочную эмболию, которая проявляется болями в груди, одышкой, потением, ускорением дыхания и сердцебиения, кашлем с кровью. Функция легких может быть нарушена настолько, что вызывает смерть.
  • Эмболы, переносящиеся артериями, могут закупорить сосуды разных частей тела, например, в мозге являются причиной инсульта. Подобным образом могут перекрыть доступ кислорода в почки или кишечник, вызвать инфаркт миокарда. Эмбол может также ограничить поступление крови в конечности, что ведет к отмиранию их частей.

Факторы риска эмболии

Существуют различные факторы, вызывающие эмболию. Под  угрозой находятся, главным образом, лежачие пациенты,  пациенты после хирургических операций на нижних конечностях, люди с  сердечной недостаточностью. Фактором риска является и прием гормональных противозачаточных средств.

Диагностика эмболии

Диагностика эмболии основывается, прежде всего, на компьютерных методах. Легочную тромбоэмболию можно выявить с помощью ЦТ-ангиографии. Этот инвазивный  метод заключается во введении внутрь вены катетера, долгой трубочки, с помощью которой в вену впрыскивается контрастное вещество. Потом с помощью компьютерной томографии можем составить полную картину, предоставляющую информацию о локализации закупоренной вены. В случае жировой или воздушной эмболии легких  проводится рентген. Воздушную эмболию можно также исследовать при помощи эхокардиографии, т.е. ультразвукового исследования сердца.

Лечение эмболии

Эмболия может протекать как без симптомов, так и с умеренными или драматическими проявлениями. Говорим о возможном осложнении после ударов или операций. Медицина предоставляет широкую шкалу методов по извлечению, растворению или предупреждению появления эмбола. Лечение зависит от вида эмбола.

  • При лечении тромбоэмболии  прибегают к тромбоэктомии, то есть хирургическому удалению тромба из сосуда или к лечению препаратами, снижающими свёртываемость крови
  • Лечение жировой эмболии включает в себя прем кортикоидных препаратов, то есть лекарств на основе стероидных гормонов, способствующих выделению жидкостей из тела. Оксигенотерапия, лечение кислородом, является незаменимой частью данного лечения.
  • Лечение воздушной эмболии заключается в ингаляции 100% кислорода. В случае нахождения пузырька в сердце, необходимо пациента положить на левый бок головой вниз, для того, чтобы предупредить попадания воздуха в мозг.
  • Эмболия околоплодной водой не требует специального лечения, заключается прежде всего в стабилизации состояния роженицы и быстром очищении матки от плодовой воды.

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