Mgbasa Aortic na mgbawa n'afọ Aortic Aneurysm (AAA) Triage¶

Nnukwu mgbawa aortic na mgbawa nke aortic aneurysm abdominal (AAA) bụ abụọ n'ime ihe mberede obi na-egbu oge na nkà mmụta ọgwụ, nke nwere ike ịkpata ọbara ọgbụgba n'ime ma ọ bụ ọdịda akụkụ ahụ n'ime nkeji. N'ihi na aorta bụ isi akwara dị elu nke na-ebu ọbara oxygenated ozugbo site na obi gaa na ụbụrụ, ogwe aka, akụkụ ahụ, na ụkwụ, akwa akwa ọ bụla dị na mgbidi dị n'ime ya (nkwụsị) ma ọ bụ gbawara n'akụkụ nke adịghị ike (ruptured aneurysm) chọrọ enyemaka mberede ngwa ngwa. Enyemaka mbụ na-elekwasị anya n'ịmata ngwa ngwa nke mgbaàmà ọkọlọtọ ọbara ọbara, na-akpọ ndị ọrụ ahụike mberede na ọkwa vaskụla doro anya, na-edebe onye ahụ kpamkpam ka ọ ghara igbochi mbelata ọbara mgbali, na izere ọgwụ ndị dị ka aspirin na-akawanye njọ ọbara ọgbụgba.

Mee nke a ugbu a¶

1. Kpọọ nọmba mberede nke mpaghara gị ozugbo wee kwupụta "Mkpa Mberede Aortic A na-enyo enyo" ma ọ bụ "Akụkụ Aortic Aneurysm A na-enyo enyo." Kpọọ 911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom, ma ọ bụ lelee ha niile. nọmba mberede. Gwa onye na-ezipụ ya n'ụzọ doro anya ma ọ bụrụ na onye ọrịa nwere ọrịa aortic aneurysm a maara nke ọma, ọrịa Marfan, valve aortic bicuspid, ma ọ bụ na mberede na-adọwa obi, azụ, ma ọ bụ ihe mgbu nke afọ na ịda mbà n'obi, ka ha nwee ike izipu ụgbọ ihe mberede na-akwado ndụ dị elu ma dọọ ụlọ ọgwụ nwere ike ịwa ahụ cardiothoracic ma ọ bụ vaskụla.
2. ** Tinye onye ahụ n'azụ (ma ọ bụ n'ọnọdụ dị jụụ ma ọ bụrụ na ọ dị mkpụmkpụ) ma mee ka izu ike zuru oke.** Ekwela ka onye ahụ guzoro ọtọ, gaa n'ime ụlọ ịsa ahụ, ma ọ bụ gaa na ụgbọ ihe mberede. Mgbakasị ahụ ọ bụla, mgbakasị ahụ, ma ọ bụ guzo na mberede na-akpalite mmụba nke obi na ọbara mgbali elu (nrụgide nrụgide) nke nwere ike ime ka akwa akwa aortic ma ọ bụ hematoma retroperitoneal dị n'ime ya gbajie kpamkpam n'ime obi ma ọ bụ oghere afọ.
3. ** Ejidela nri niile, mmiri, mmiri mmiri na ọgwụ ọnụ, ọkachasị aspirin na nitroglycerin.** Debe onye ahụ ihe ọ bụla site n'ọnụ (NPO) n'ihi na ha ga-achọ ọgwụgwọ mberede mberede ozugbo ọ bịarutere ụlọ ọgwụ. Ejila ọgwụ aspirin, clopidogrel, ma ọ bụ sublingual nitroglycerin ọ gwụla ma onye dibịa bekee nyefere ya ntụziaka doro anya nke na-ewepụ ọrịa aortic pathology.
4. ** Mee ka onye ahụ dị jụụ, gbachie nkịtị, na normothermic mgbe ị na-ebelata ọkụ na-egbuke egbuke ma na-ebelata ụjọ mmetụta uche.** Egwu na oke mgbu na-ahapụ nnukwu ebili mmiri nke adrenaline (epinephrine na norepinephrine) n'ime ọbara, na-eme ka ọbara mgbali systolic na mgbakasị mgbidi aortic dị elu. Na-ekwu okwu n'olu dị nwayọọ, na-emesi obi ike, tọpụ eriri ma ọ bụ olu ike, ma jiri otu blanket kpuchie onye ahụ obere oge ka ọ ghara ịma jijiji na-enweghị ikpo ọkụ.
5. **Leba anya n'ọkpụkpụ n'aka aka abụọ wee rịba ama adịghị ike nke otu akụkụ ọ bụla, adịghị ike, ma ọ bụ esemokwu ọbara mgbali. Jiri nwayọọ na-anụ ụda radial na nkwojiaka abụọ ma ọ bụ chọpụta ma ọ bụrụ na otu ụkwụ ọ chanwụrụ na mberede, oyi, ma ọ bụ kpọnwụrụ akpọnwụ, dị ka mgbawa aortic na-egbochikarị alaka na-enye otu ogwe aka, ụbụrụ, ma ọ bụ ụkwụ.
6. ** Mepee ụzọ, chịkọta ndekọ ahụike ma ọ bụ kaadị ngwaọrụ etinyere, ma kwadebe maka CPR ozugbo ma ọ bụrụ na onye ahụ daa.** Mee ka onye na-ege ntị kpọghee ọnụ ụzọ ihu ma kpochapụ ụzọ maka ebe nchekwa ụgbọ ihe mberede. Ọ bụrụ na onye ahụ anabataghị ya ma kwụsị iku ume, malite ozugbo CPR na mkpakọ obi na 100 ruo 120 iti kwa nkeji.

Mkpebi ihe mberede na osisi dị iche iche¶

Jiri eserese ụlọ ọgwụ a ka ịmata ọdịiche dị n'etiti nnukwu mgbawa akwara thoracic, mgbawa aortic aneurysm abdominal gbawara agbawa, na infarction myocardial ọkọlọtọ ma ọ bụ eriri azụ musculoskeletal n'oge nkeji mbụ nke nsogbu.

flowchart TD
    Start["Obi mberede siri ike, azụ, azụ, <br/> ma ọ bụ mgbu afọ ma ọ bụ mmekọrịta mberede"] --> RedFlags{"Lelee ọkọlọtọ ọbara ọbara ozugbo: <br/>1. Ihe mgbu 'thunderclap' na-agbawa/na-adọwa?<br/>2. Ihe na-egbu mgbu n'afọ + azụ/ mgbu?<br/>3. Mwepu usu ma ọ bụ>20 mmHg BP dị iche n'etiti ogwe aka?<br/>4. Ihe mgbu obi/azụ + ọrịa strok ma ọ bụ oyi/ụkwụ kpọnwụrụ akpọnwụ?<br/>5. Mara AAA, ọrịa Marfan, ma ọ bụ ọrịa valvụ aortic?"}

    RedFlags -->|"EE: Otu ma ọ bụ karịa ọkọlọtọ ọbara ọbara vaskụla"| SuspectAorta["AKWỤKWỌ AORTIC CATASTROPHE<br/>(Disection Aortic or Ruptured AAA)"]

    SuspectAorta --> CallEMS["Kpọọ 911 / 112 / 999 ozugbo: <br/> Kwuwapụta 'Mkpọsa Aortic Anọgidere ma ọ bụ gbajiri AAA' <br/> Rịọ ibuga na Vascular / Cardiothoracic Center"]

    CallEMS --> NoAspirin["NKWUBIOKWU OKWU:<br/>1. enyela Aspirin ma ọ bụ ihe na-ebelata ọbara<br/>2. enyela nri ma ọ bụ mmiri (Nọgidere NPO maka ịwa ahụ)<br/>3. Ekwela ka onye ọrịa guzoro, jee ije, ma ọ bụ nhụsianya"]

    NoAspirin --> LocationCheck{"Ebee ka ihe mgbu nke mbụ dị<br/> na gịnị bụ ihe ịrịba ama?"}

    LocationCheck -->|"Ihu ihu ma ọ bụ elu azụ n'etiti ubu ubu <br/>Unequal ogwe aka pulses / BP ma ọ bụ ọrịa strok akara"| DissectionCare["Nke a na-enyo enyo na-enyo enyo thoracic Aortic Dissection (Ụdị A / B): <br/> - Nọgide na-adị jụụ ma ka (ọkara-nkwakọba ma ọ bụ dị larịị) <br/>- Tulee BP na BOTH aka nri na aka ekpe ma ọ bụrụ na ọ dị n'ọkpụkpụ <br/> - Nyochaa nke ọma maka ọrịa strok, tamponade, ma ọ bụ nkwekọrịta ikuku."]

    LocationCheck -->|"N'etiti afọ, ala azụ, ma ọ bụ akụkụ/ ukwu<br/>Ịcha ọbara ọbara, nfụkasị, isi ọwụwa, hypotensive, ma ọ bụ > 60 afọ ise anwụrụ"| AAACare["Ihe a na-enyo enyo na-agbaji afọ Aortic Aneurysm (AAA): <br/> - Dina ala n'azụ; AKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWASỊAKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWASỊ'- Kwadebe maka ujo hypovolemic na nnyefe ịwa ahụ ngwa ngwa."]

    RedFlags -->|"Mba: Nrụgide nke nta nke nta / mgbu obi na-amanye, <br/> nha nha nha, ọ dịghị mmalite ndọwa."| CheckMI["Nyochaa maka nnukwu ọrịa coronary ọrịa obi / nkụchi obi: <br/>Lee ntuziaka nkụja obi maka ọkọlọtọ EMS & protocol aspirin"]

Ịghọta ihe mberede aortic abụọ na-eyi ndụ egwu¶

Ọ bụ ezie na ọnọdụ abụọ a na-agụnye ọdịda nhazi nke akwara kachasị nke anụ ahụ, ** nnukwu aortic dissection ** na ** ruptured abdominal aortic aneurysm (AAA) ** na-eme site na usoro nhazi dị iche iche, tie profaịlụ onye ọrịa dị iche iche, ma chọọ usoro ụlọ ọgwụ mberede pụrụ iche.

1. Mgbasa Aortic dị oke egwu: akwa akwa akwa dị n'ime¶

Mgbidi nke aorta ahụ dị mma nwere akwa microscopic atọ: mkpuchi dị n'ime dị mkpa (tunica intima), akwa mkpuchi muscular na-agbanwe agbanwe (** tunica media ***), na jaket fibrous mpụta siri ike (tunica adventitia). Na mgbasa ** aortic ***, anya mmiri mberede na-etolite n'ime oghere dị n'ime, na-abụkarị n'ime obi (thoracic aorta) ebe ọbara na-ahapụ obi na oke ọsọ.

Ozugbo ọbara na-esi na anya mmiri dị n'ime a pụta n'okpuru nrụgide systolic, ọ na-ekewa (dissects) oyi akwa dị n'etiti, na-akpụ a " lumen ụgha" (nke abụọ, ọwa ọbara na-adịghị mma) gbadaa ma ọ bụ gbagoo ogologo aorta. Ka ọwa ụgha a na-eji ọbara agba, ọ na-ebute ihe egwu anọ na-eyi ndụ egwu: - ** Mwepu n'ime akpa pericardial (Cardiac Tamponade):** Ọ bụrụ na mgbawa ahụ na-aga azụ azụ n'obi banye n'akpa pericardial gbara akwara obi gburugburu, ọbara na-ejupụta akpa ahụ ma na-amanye obi ruo mgbe ọ nweghị ike ịgbapụta, na-akpata ọnwụ mberede. - ** Mgbanwe valvụ aortic siri ike:** Anya mmiri nwere ike ịtọpụ mpempe akwụkwọ nke valvụ aortic, na-eme ka ọbara wụsa azụ n'ime ventricle aka ekpe wee jupụta ngụgụ na mmiri (flash pulmonary edema). - Mkpuchi akwara akwara: Mpịakọta nke na-ekesa nwere ike ịkpachapụ oghere nke akwara akwara aka nri ma ọ bụ aka ekpe, na-akpalite n'otu oge. nkụchi obi. - ** Ihe na-adịghị mma nke alaka ụlọ ọrụ (stroke, Paraplegia, Visceral Ischemia):** Dị ka lumen ụgha na-agbada n'ime aorta, eriri dị n'ime na-agbapụta nwere ike ịkụcha akwara carotid na-enye ụbụrụ nri (na-akpata ozugbo). ọrịa strok), akwara subclavian na-enye ogwe aka (na-eme ka ọkpụkpụ aka na-efu efu), akwara azụ azụ na-enye eriri afọ (na-akpata ahụ mkpọnwụ nke ụkwụ abụọ na mberede), ma ọ bụ akwara mesenteric na akụrụ na-enye eriri afọ na akụrụ.

Ndị ụlọ ọgwụ na-ekewa dissections aortic site na iji ** Stanford Classification System **, nke na-ekpebi nlekọta nlanarị ozugbo: - ** Ụdị Stanford A Dissection: ** gụnyere ** aorta na-arị elu ** (akụkụ nke mbụ na-esi na obi pụta ozugbo) na / ma ọ bụ oghere aortic, n'agbanyeghị ebe ọ na-aga. Ụdị nkewa A bụ ihe mberede ịwa ahụ nwere ọnụ ọgụgụ ọnwụ nke na-ebili site na ihe dịka pasent 1 ruo 2 maka elekere ọ bụla ** mmezi ịwa ahụ na-egbu oge n'ime awa 48 mbụ. - Stanford Ụdị B Dissection: Na-amalite na ** na-agbadata thoracic aorta ** (n'akụkụ akwara subclavian aka ekpe na-enye nri aka ekpe) wee na-aga ala ruo afọ. A na-ejikwa ụdị B nkewa na mbụ site na ọbara mgbali elu na-eme ihe ike na njikwa obi ("ọgwụ mgbochi mkpali"), gbakwunyere endovascular stent-graft mmezi (TEVAR) ma ọ bụrụ na agụụ na-agụ akụkụ ahụ nke ọbara ma ọ bụ mgbidi na-eyi egwu ịgbawa.

2. Abdominal Aortic Aneurysm gbawara agbawa (AAA): Mgbidi na-agbawa adịghị ike.¶

Ihe aneurysm bụ ihe na-adịgide adịgide, na-agbasawanye mpaghara (ballooning) nke ọkwa atọ nke mgbidi akwara akwara kpatara nbibi na-adịghị ala ala nke eriri lastic na collagen. Ọ bụ ezie na aneurysms nwere ike ime n'ime obi (thoracic aortic aneurysm), ha na-adịkarị na ala ala n'okpuru akwara akụrụ (** infrarenal abdominal aortic aneurysm , ma ọ bụ AAA), ebe aorta okenye na-eme ihe dị ka ** 2.0 centimeters (0.8 inches) ** na dayameta. Mgbe akụkụ ahụ gafere ** 3.0 centimita (1.2 sentimita), a na-akọwa ya dị ka anerysm; ozugbo ọ gafere ** 5.0 ruo 5.5 centimeters (2.0 ruo 2.2 sentimita asatọ)**, ihe ize ndụ nke mgbawa mgbidi na-atụghị anya ya na-arị elu nke ukwuu.

Ọtụtụ afọ aortic aneurysms na-eto nwayọ nwayọ karịa ọtụtụ afọ n'emeghị ka otu mgbaàmà ruo mgbe ha gbasaa na mberede ma ọ bụ meghee (** ruptured AAA**). Mgbe AAA gbawara, ọbara na-esi na aorta pụta n'otu n'ime oghere abụọ: - ** Mwepu intraperitoneal efu:** Mgbidi dị n'ihu nke aneurysm na-agbaba ozugbo n'ime oghere afọ mepere emepe. Nnukwu exsanguination na-eme n'ime nkeji nkeji, na-ebutekarị njide obi ozugbo tupu ụgbọ ihe mberede abịarute. - ** N'ọtụtụ n'ime ndị ọrịa na-adị ndụ ogologo oge ruo n'ụlọ ọgwụ, aneurysm na-agbaji n'ime oghere ** retroperitoneal ** n'azụ oghere afọ (n'akụkụ azụ azụ na akwara psoas). Anụ ahụ gbara ya gburugburu na ọbara mgbali elu na-adaba nwa oge na-egbochi ntanye ahụ maka nkeji 30 ruo ọtụtụ awa. Otú ọ dị, ọ bụrụ na onye ọrịa ahụ na-agbasi mbọ ike, na-agbasi mbọ ike, ma ọ bụ na-anata mmịnye ọbara gabigara ókè nke na-eme ka ọ̀tụ̀tụ̀ ọbara ji erugharị ya dị elu, mkpụkọ retroperitoneal na-esighị ike na-agbapụta, na-eme ka mmiri dị ndụ dị ndụ ghọọ ọbara ọgbụgba na-egbu egbu.

Ntụle zuru oke: Dissection Aortic vs. Ruptured AAA vs. Obi Attack¶

N'ihi na obi, azụ, na mgbu afọ bụ mkpesa nkịtị, ndị na-ezipụ ihe mberede na ndị na-ekiri ihe na-emekarị na-akọwahie ọdachi aortic dị ka nkụchi obi, nkume akụrụ, ma ọ bụ sciatica. Nyochaa tebụl ntụnyere a ka ị hụ njirimara ndị dị iche:

Ịghọta akara ngosi ọkọlọtọ uhie n'ụzọ zuru ezu¶

Omuma na akara ngosi nke Dissection Aortic Acute¶

Dị ka International Registry of Acute Aortic Dissection (IRAD) na ntụziaka ACC / AHA si kwuo, ihe karịrị pasent 90 nke ndị ọrịa nwere nnukwu mgbasa nke aortic na-enweta mgbu mberede, ma ihe ruru pasent 30 na-achọpụta na mbụ. Lelee ụyọkọ ụlọọgwụ ndị a:

1. ** Mberede, maximal-na mmalite "mkpaka" ma ọ bụ "ịdọwa" mgbu: ** N'adịghị ka nkụchi obi nke na-eji nwayọọ nwayọọ na-ewulite ihe karịrị nkeji ole na ole, ihe mgbu aortic na-adaba n'ogo kachasị elu na nke abụọ nke mbụ ka oyi akwa na-agbaji. Ndị ọrịa na-akọwa ya dị ka mmetụta "dị ka ihe gbawara n'ime obi m" ma ọ bụ "dị ka a tụrụ ya n'etiti eriri ubu."
2. Ụzọ mgbu na-akwaga: Ka mgbawa ahụ na-akwada n'ihu aorta site n'obi banye n'ime afọ, ihe mgbu ahụ nwere ike ịmalite n'ihu obi ma ọ bụ akpịrị, gaa n'etiti ubu ubu nkeji 10 ka e mesịrị, wee gbaa ọkụ na azụ azụ ma ọ bụ úkwù.
3. "Mgbu gbakwunyere Otu" (Mgbu obi / Azụ jikọtara ya na Neurological or Limb Symptoms): Mgbe ọ bụla mgbu obi ma ọ bụ azụ na-enwe ụkọ akwara ozi ma ọ bụ akụkụ oyi, chee echiche ** mgbawa aortic mbụ ***:
4. Mgbu obi/azụ + mgbaama ọrịa strok: Mgbatị n'ime akwara carotid na-ebute adịghị ike otu akụkụ na mberede, ọdịda ihu, ma ọ bụ enweghị okwu. (** Ịdọ aka ná ntị ụlọ ọgwụ dị oké mkpa: *** Ịnye ọgwụ ndị na-eme ihe na-eme ka ọkpụkpụ dị ka tPA/tenectepase nye onye ọrịa strok nke ọrịa strok na-akpata site na ụdị Aortic dissection zoro ezo bụ ihe fọrọ nke nta ka ọ bụrụ na ọ na-egbu mmadụ niile.)
5. Mgbu obi/azụ + Paraplegia (ụkwụ kpọnwụrụ akpọnwụ): Ịkpụcha akwara akwara azụ (karịsịa akwara nke Adamkiewicz) na-ebute ahụ mkpọnwụ na mberede na ụkwụ abụọ.
6. ** Mgbu obi/azụ + Nnukwu Ischemia nke ukwu:** Mgbochi nke akwara subclavian ma ọ bụ iliac na-ahapụ otu ogwe aka ma ọ bụ ụkwụ nwụrụ anwụ-ọcha, oyi na-atụ oyi, enweghị isi, na-egbu mgbu.
7. ** Syncope na-enweghị mgbu (ịda mbà n'obi) na pasent 5 ruo 10: *** Ihe dị ka 1 n'ime ndị ọrịa 10 nwere ụdị dissection A na-ada mbà na ntakịrị mgbu obi a na-akọ, na-abụkarị n'ihi na ọbara agbabawo n'ime akpa pericardial (cardiac tamponade) ma ọ bụ na-ebipụ obere ọbara carotid.

Omuma triad na "masquerades" nke Abdominal Aortic Aneurysm gbawara agbawa (AAA)¶

Akwụkwọ ọgụgụ akwụkwọ ọgụgụ oge ochie maka AAA gbawara agbawa nwere ** mgbu afọ / azụ / azụ mgbu na mberede **, ** hypotension ma ọ bụ syncope **, na ** uka afọ pulsatile ***. Otú ọ dị, ọmụmụ sitere na UK National Institute for Health and Care Excellence (NICE) na Society for Vascular Surgery (SVS) na-egosi na ** ihe atọ niile na-emekọ ọnụ na ihe na-erughị pasent 50 nke ndị ọrịa AAA gbawara agbawa. Kama, lelee maka ihe atọ kachasị ewu ewu ** masquerades ụlọ ọgwụ ***:

Kedu onye nọ n'ihe ize ndụ kachasị elu: mkpụrụ ndụ ihe nketa, ahụike, na ụdị ndụ¶

Ịkekọrịta akụkọ ihe egwu dị ize ndụ na onye na-ezipụ 911/112/999 na onye nọọsụ nọ n'ọnụ ụlọ mberede bụ otu n'ime ụzọ kachasị ọsọ iji kpalite ultrasound ma ọ bụ CT angiogram ozugbo.

Enyemaka mbụ nzọụkwụ-site-nzọụkwụ na nlekọta ụlọ ọgwụ mgbe ọ na-eche EMS¶

Mgbe ị na-elekọta onye a na-enyo enyo nke aortic dissection ma ọ bụ gbajie afọ aortic aneurysm tupu ndị ọrụ ahụike abịarute, a na-eme ihe ọ bụla iji mee ka ** belata nchekasị mgbidi aortic *** na ** chekwaa mkpụkọ dị n'ime.

Kwụpụ 1: Ndokwa maka nkwụsi ike hemodynamic¶

• ** A na-enyo enyo nke Thoracic Aortic Dissection (obi / elu azụ mgbu, na-abụkarị ọbara mgbali elu):** Nyere ha aka dinara ala n'ọnọdụ nke na-akpata obere mgbu na iku ume kachasị mfe, na-emekarị ** supine (flat na azụ) ma ọ bụ ọkara Fowler (isi na ubu jiri nwayọọ na-agbanye na 30-degree angle)**. Amanyela onye ọrịa na-adọga iku ume ka ọ dinara ala kpamkpam.
• ** AAA na-enyo enyo gbawara ma ọ bụ akara nke ujo (icha mmirimmiri, oyi, nhịahụ, isi ọwụwa, ike gwụrụ):** Dina ha ** tuo n'azụ ha kpamkpam**. Ebulila ụkwụ ike nke ukwuu ma ọ bụrụ na ọ na-ebute mgbu afọ, ekwekwala ka ha nọdụ ala ma ọ bụ guzoro ọtọ, ebe ịnọdụ ala na-ewepụ ọbara fọdụrụ n'ụbụrụ na obi.
• ** Amaghị ihe ọ bụla ma ọ bụ na-agbọ agbọ:** Jiri nwayọọ tụgharịa ha n'akụkụ ha n'akụkụ ebe mgbake ** akụkụ mgbake** dị ka otu otu (ụdị log-roll, na-enweghị ịgbagọ ọkpụkpụ) yabụ vomit enweghị ike ịbanye na ngụgụ.

Kwụpụ 2: Akụla ọnụ ọnụ ma ọ bụ pịa nke ukwuu n'ime afọ na-afụ ụfụ¶

Ọ bụrụ na ị chọpụta ma ọ bụ chee na ọ na-ada ụda n'etiti afọ onye ahụ, ** etinyela aka n'ime afọ ha iji lelee ya *** ekwela ka ndị na-eguzo n'ebe dị mma kwagide n'afọ. Nrụgide ntuziaka dị omimi n'elu mgbidi dị mkpa, nke na-agbapụta aortic aneurysm nke afọ nwere ike ịkpaghasị mkpụkọ retroperitoneal na-esighi ike ma kpalite mgbawa ozugbo.

Kwụpụ 3: Otu esi eme ọbara mgbali elu ogwe aka abụọ na nlele pulse¶

Ọ bụrụ na nleba anya ọbara mgbali elu ụlọ dijitalụ dị nso na iji ya agaghị egbu oge ịkpọ ọrụ mberede ma ọ bụ kpasuo onye ọrịa ahụ: 1. Tụọ ma detuo ọbara mgbali elu na ọnụọgụ obi n'akụkụ aka nri elu klzzwxh:0011 wee tụmgbali ọbara ebe ahụ. 3. Ihe ọnụọgụgụ pụtara:** N'ime onye ahụ siri ike, ọbara mgbali e systolic n'etiti aka nri na aka ekpe dị iche na ihe na-erughị \(10\text{mmHg}\). Ọdịiche ọbara mgbali elu systolic karịrị \(20\text{mmHg}\) n'etiti aka aka nri na aka ekpe (jikọrọ ya na nnukwu obi mgbu ma ọ bụ azụ mgbu) na-egosi na ọnyà mgbasa aortic nwere ike na-egbochi otu n'ime akwara subclavian. Gwa ndị ọrụ ahụike nọmba abụọ ahụ kpọmkwem ozugbo ha rutere.

Kwụpụ 4: Ịda jụụ anụ ahụ ("Verbal Beta-Blockade")¶

Na ngalaba mberede ụlọ ọgwụ, ọgwụgwọ mbụ maka mgbawa aortic bụ ihe mgbochi beta-blockers (dị ka esmolol ma ọ bụ labetalol) iji mee ka ọnụ ọgụgụ obi dị n'okpuru \(60\text{ beats per minute}\) na ọbara mgbali systolic n'etiti \(100\text{ na }120\text{mmHg}\), na-ebelata mgbidi obi ọ bụla. N'ụlọ, tupu ọgwụ IV abịarute, ** ụjọ na mgbu bụ onye iro ***: - Kpochapụ ìgwè mmadụ ụjọ na-atụ n'ime ụlọ ma kụziere onye ọrịa ka ọ na-eku ume ngwa ngwa, na-ezere iku ume ma ọ bụ ịda mbà (**zere ụzọ Valsalva, nke na-eme ka nrụgide aortic pụta). - Mee ka gburugburu ebe obibi nọrọ jụụ ma mesie ha obi ike na enyemaka dị nkeji ole na ole.

Kwụpụ 5: Ijikwa nchebe ọkụ (na-egbochi Triad na-egbu egbu)¶

N'ime onye ọrịa nwere AAA gbawara agbawa nke na-atụfu ọbara n'ime, okpomọkụ ahụ na-agbada ngwa ngwa. Hypothermia (okpomọkụ ahụ dị n'okpuru \(35^\circ\text{C}\) ma ọ bụ \(95^\circ\text{F}\)) na-eme ka enzymes na-agbakọta ọbara na platelet na-akawanye njọ. Jiri akwa mkpuchi ma ọ bụ mkpuchi kpuchie onye ọrịa site n'agba ruo na mkpịsị ụkwụ, ma tinye blanketị n'okpuru ha ma ọ bụrụ na ha dina n'ala oyi.

Ịghọta ụgbọ ihe mberede na echiche ụlọ ọgwụ: Hypotension na-anabata na njikwa mkpali¶

Ịmara ihe ndị na-ahụ maka ahụike na ndị dọkịta mberede ga-eme ka ndị òtù ezinụlọ na-ekwurịta okwu nke ọma n'oge nsogbu aortic:

1. Gịnị kpatara ndị ọrụ ahụike na-eme "Permissive Hypotension" na Ruptured AAA¶

N'ọtụtụ ọnọdụ mberede ahụike metụtara ọbara mgbali elu, ndị na-ahụ maka ahụike na-ebunye nnukwu akpa saline n'ime intravenous ngwa ngwa iji weghachi ọbara mgbali elu ruo \(120/80\text{mmHg}\). ** N'ime akwara aortic aortic nke afọ gbawara agbawa ma ọ bụ mgbasa ọbara na-agba ọbara, inye nnukwu mmiri mmiri IV iji mee ka ọ̀tụ̀tụ̀ ọbara ji erugharị n'ọbara tupu dọkịta na-awa ahụ na-amachi aorta dị ize ndụ.** - Na-ebuli ọbara mgbali elu systolic karịa \(90\text{ ka }100\text{mmHg}\) na saline na-agbaze ihe ndị na-eme ka ọbara na-agbachi nkịtị, na-eme ka ọbara dị jụụ, na ** na-agbapụ n'ụzọ nke hydraulically clot nwa oge ("popping clot")** nke na-eme ka onye ọrịa dị ndụ. - Ya mere, ụkpụrụ nduzi mba ụwa (NICE NG156 na United Kingdom, Society for Vascular Surgery na United States, na European Society for Vascular Surgery) na-eduzi ndị na-ahụ maka ahụike ka ha na-eme ** hypermissive hypotension **: ọ bụrụhaala na onye ọrịa ahụ na-amụ anya, na-ekwu okwu, na ịnọgide na-enwe ọbara mgbali systolic gburugburu ** $ 70 ederede {ka} 90 sl) na-ezu ike. na-anya ụgbọ ala ozugbo na ụlọ ịwa ahụ vaskụla.

2. Gịnị kpatara ịgafe ụlọ ọgwụ gaa na ebe Aortic Center na-azọpụta ndụ¶

Ọ bụghị ụlọ ọgwụ mpaghara ọ bụla nwere dọkịta na-awa cardiothoracic (maka ụdị A aortic dissection) ma ọ bụ dọkịta na-awa ahụ na-arụ ọrụ ngwakọ endovascular ngwakọ (maka ruptured AAA) na oku 24 kwa ụbọchị. Mgbe ị kwuputara n'ụzọ doro anya "Mkpọsa Aortic A na-enyo enyo" ma ọ bụ "Amara Abdominal Aortic Aneurysm na Mgbu Mgbu na Syncope" n'oge oku mberede mbụ gị, sistemu EMS mpaghara nwere ike rụọ ọrụ ** Direct-to-OR "Code Rupture" ma ọ bụ "Code Aorta" ụzọ **, na-agafe obere ụlọ ọgwụ na-aga n'ihu ruo obere ụlọ ọgwụ.

Ederede nzikọrịta ozi maka 911/112/999 yana nchikota ụlọ ọgwụ¶

Mgbe ị na-agwa onye na-ezipụ ihe mberede ma ọ bụ nọọsụ triage okwu, jiri asụsụ ahụike a kapịrị ọnụ:

• ** Maka Mgbasa Aortic A na-enyo enyo:**

  • "Achọrọ m ụgbọ ihe mberede mberede na [kpọmkwem Address]. Onye ọrịa bụ [Age] dị afọ [nwoke / nwanyị] nke malitere ozugbo, 10-nke-10 na-adọwa [obi / elu azụ] mgbu na [Oge]. Aortic Dissection anyị enyebeghị aspirin."

• Maka onye a na-enyo enyo gbawara AAA:

  • "Achọrọ m ụgbọ ihe mberede mberede na [kpọmkwem Adreesị]. Onye ọrịa bụ [afọ] dị afọ [nwoke / nwanyị] nwere [amara Abdominal Aortic Aneurysm / akụkọ ihe mere eme nke ise siga na ọbara mgbali elu] bụ onye na-etolite na mberede [abdominal / ala azụ / flank] mgbu na [ike gwụrụ / na-acha odo odo, sweaty, na-eche na ọ na-agbaji. Aneurysm anyị na-eme ka [ya] dina ala ma ka dị."

Ndepụta nkwadebe nke triage mgbe ụgbọ ihe mberede na-aga¶

• Edere aha kpọmkwem oge mmalite mgbu: Ndị dọkịta na-awa ahụ kwesịrị ịma kpọmkwem nkeji oge mgbu ma ọ bụ ịda mbà n'obi mere.
• ** A na-edekọ ọbara mgbali ogwe aka abụọ (ma ọ bụrụ na a tụrụ):** Dee ogwe aka aka nri BP na aka ekpe na mpempe akwụkwọ.
• ** Ihe onyonyo aortic mbụ ma ọ bụ kaadị ịwa ahụ dị:** Jidere nchịkọta mwepu ọ bụla na-egosi nha ọnya akwara gara aga (dịka, "4.8 cm infrarenal AAA"), kaadị stent-graft implant, ma ọ bụ kaadị valvụ obi.
• ** Ndepụta zuru ezu nke ndị na-edozi ọbara na-achọpụta:** Gwa ndị dọkịta ozugbo ma ọ bụrụ na onye ọrịa ahụ na-ewere **warfarin, apixaban, rivaroxaban, dabigatran, edoxaban, clopidogrel, ma ọ bụ aspirin kwa ụbọchị **, ya mere ụlọ ọgwụ ahụ nwere ike ịkwadebe ihe mberede mberede (dị ka 4-factor prothrombin complex concentrate [PCC]), ma ọ bụ alphaucidar.
• ** Ọ dịghị ihe ọ bụla site n'ọnụ kwadoro:** Gwa ndị ọrụ ahụike oge nri ma ọ bụ ihe ọṅụṅụ ikpeazụ onye ọrịa maka nhazi nhụsianya dị mma.

Mgbochi na nyocha: ijide aneurysms tupu ha agbawa¶

N'ihi na enwere ike imezi aortic aneurysm na-adịghị mma site na ọnụọgụ ndụ dị pasent 95 ruo 98, ebe aneurysm gbawara agbawa na-ebu ọnụ ọgụgụ ọnwụ nke pasent 70 ruo 80, ** nyocha nke ultrasound na njikwa ọbara mgbali na-azọpụta ndụ **:

1. ** Nnyocha Ultrasound nke afọ otu oge:**
2. ** Na United States (USPSTF & SVS Guidelines):** A na-atụ aro ultrasound otu oge maka ndị niile ** ndị ikom dị afọ 65 ruo 75 bụ ndị aṅụtụla sịga **, na nhọrọ maka ndị ikom na ndị inyom dị afọ 65 ruo 75 nwere ** akụkọ ezinụlọ nke mbụ ** nke AAA.
3. Na United Kingdom (NHS AAA Screening Programme): A na-akpọ ụmụ nwoke niile maka nyocha ultrasound n'efu n'ime afọ ha na-atụgharị ** 65 **, onye ọ bụla gafere 65 na-enyochabeghị ya nwere ike ịkọwa onwe ya.
4. ** Nyocha mkpụrụ ndụ ihe nketa na nke echocardiographic maka aneurysms Thoracic:**
5. Ndị ikwu nke mbụ (nne na nna, ụmụnne, na ụmụaka) nke onye ọ bụla nwere nnukwu thoracic aortic dissection ma ọ bụ nwere valvụ aortic bicuspid kwesịrị ịnata ndụmọdụ mkpụrụ ndụ ihe nketa na ntọala ** echocardiography ma ọ bụ CT / MR angiography ** iji tụọ dayameta mgbọrọgwụ aortic ha.
6. ** Nchekwa ụdị ndụ kwa ụbọchị maka ndị ọrịa Aneurysm ama ama:**
7. ** Kwụsị ise siga kpamkpam** (na-ebelata ọnụego mgbasawanye nke aneurysm na ọkara) wee na-eme ka ọ̀tụ̀tụ̀ ọbara ji erugharị n'okpuru \(130/80 ederede{mmHg}\).
8. ** Zenarị oke Valsalva straining:** Ndị nwere aortic aneurysms a ma ama kwesịrị izere ibuli ibu dị arọ nke isometric (ebe ị na-ejide ume gị na ike dị nso n'ike), nke nwere ike ịbawanye ọbara mgbali intra-aortic karịa \(300\text{mmHg}\). A na-akwado mmega ahụ nke ikuku na-agafeghị oke; nyochaa oke oke ibu site na ọkachamara vaskụla.

Ajụjụ a na-ajụkarị¶

Gịnị mere ịta aspirin ji dị ize ndụ n'oge a na-ekesa aortic mgbe a na-atụ aro ya maka nkụchi obi?¶

Ihe na-akpata nkụchi obi bụ mkpụkọ ọbara na-egbochi akwara akwara, yabụ ịta aspirin na-akwụsị mkpụkọ ahụ ito eto. N'ụzọ dị iche, mgbawa aortic ma ọ bụ aneurysm gbawara agbawa bụ akwa akwa na mgbidi nke aorta; inye aspirin na-emebi platelet, na-egbochi mkpụkọ nke mgbochi, ma na-ebute ọbara ọgbụgba na-egbu egbu n'ime obi, afọ, ma ọ bụ akpa pericardial.

Kedu ka m ga-esi amata ọdịiche dị n'etiti aneurysm abdominal aortic aneurysm gbawara agbawa na nkume akụrụ na onye toro eto?¶

Ha abụọ nwere ike ịkpata mgbu n'akụkụ otu akụkụ mberede na-agbapụta n'ime ukwu n'ihi na ọbara retroperitoneal na-akpasu otu akwara na ureter dị ka nkume. Otú ọ dị, onye ọ bụla toro eto karịa afọ 55 (karịsịa onye na-ese siga ma ọ bụ ọbara mgbali elu) nke na-amalite mbụ mgbu akụrụ na nhụsianya, akpụkpọ ahụ na-acha uhie uhie, ịda mbà n'obi, ma ọ bụ ọbara mgbali elu dị ala ka a ga-emeso ya dị ka aneurysm aortic gbawara agbawa ruo mgbe ultrasound ma ọ bụ CT scan ga-ewepụ ya.

Kedu ihe ọdịiche ọbara mgbali elu dị n'etiti aka ekpe na aka nri pụtara n'oge mgbu obi?¶

N'ime okenye ahụ siri ike, ọbara mgbali systolic n'etiti aka nri na aka ekpe dị iche na ihe na-erughị milimita 10 nke mercury (mmHg). Ọ bụrụ na onye nwere nnukwu obi ma ọ bụ azụ mgbu na mberede nwere ọdịiche ọbara mgbali elu systolic karịa 20 mmHg n'etiti ogwe aka ha (ma ọ bụ mkpịsị aka na-adịghị ike n'otu akụkụ), nnukwu mpịaji aortic nwere ike igbochi akwara subclavian na-enye ogwe aka ahụ.

Ọ bụrụ na onye nwere azụ azụ na mberede ma ọ bụ afọ mgbu na-ada mbà wee teta na-enwe mmetụta nke ọma n'ala, ihe mberede ahụ agwụla?¶

Mba, mgbake nwa oge mgbe ike gwụrụ bụ ihe ama ama nke mgbawa retroperitoneal dị n'ime ya nke akwara aortic aneurysm nke afọ ma ọ bụ mgbasa thoracic. Mgbe ọbara mgbali na-adaba n'oge ike gwụrụ ma onye ọrịa ahụ dinara ala, anụ ahụ retroperitoneal na-etinye ntanye ahụ nwa oge; ọ bụrụ na ha ebili ma ọ bụ na-egbu oge ịkpọ ndị ọrụ mberede, mkpụkọ ahụ na-esighị ike na-adaba na ọbara ọgbụgba n'ime nkeji ruo awa.

enyochara isi mmalite¶

• ** American College of Cardiology (ACC) na American Heart Association (AHA, United States): ** 2022 ACC / AHA Ntuziaka maka Nchọpụta na Nchịkwa nke Ọrịa Aortic * (* Circulation * / * Akwụkwọ akụkọ nke American College of Cardiology *).
• ** National Institute for Health and Care Excellence (NICE, United Kingdom):** Abdominal Aortic Aneurysm: Diagnosis and Management (NICE Guideline NG156, gụnyere mbufe mberede na ikike hypotension protocols).
• Society for Vascular Surgery (SVS, United States) na European Society for Vascular Surgery (ESVS): * Ntuziaka nlekọta ahụike na nlekọta nke ndị ọrịa nwere Abdominal Aortic Aneurysm * (Chaikof et al., * Akwụkwọ akụkọ Vascular Surgery ; Wanhainen et al, Vascular Surgery; Wanhainen et al. 2024).
• ** European Society of Cardiology (ESC): *** Ntuziaka ESC maka njikwa nke akwara akwara na ọrịa aortic * (mmelite 2024 na nnukwu ọrịa aortic thoracic, ụdị Stanford A na ụdị B, na ebumnuche ọbara mgbali).
• ** International Registry of Acute Aortic Dissection (IRAD) & Marfan Foundation / John Ritter Foundation for Aortic Health (United States): *Ritter Iwu maka Triage na Emergency Recognition of Thoracic Aortic Dissection.

Ntuziaka emetụtara¶

• Mmata nkụchi obi na enyemaka mbụ ozugbo
• Nchọpụta ujo na njikwa enyemaka mbụ
• Nchọpụta ọrịa strok (FAST) na nzaghachi mberede
• Ntughari obi obi (CPR) na ntuziaka AED
• Cauda equina syndrome na nnukwu ọgidigi azụ mkpakọ ọkọlọtọ uhie