Dhiig-baxa Pericardial, Xanuunka-ka-dib-u-dhiigfuranka, iyo Tamponade Caafimaad¶

Tamponade-ka caafimaadka wadnaha waa xaalad degdeg ah oo wadnaha ah oo xannibaysa nolosha kaas oo dhiig, dareere barar ah, ama dheecaan xun uu ku ururo gudaha koodhka fibreska ah ee ku wareegsan wadnaha (pericardium), isagoo ka tuujinaya qolalka wadnaha bannaanka si aysan u buuxin karin dhiig u dhexeeya garaacista. Si ka duwan dhaawaca laabta ee gasha (ku daboolan tamponade wadnaha iyo dhaawac laabta oo gala), tamponade aan dhaawac lahayn waxay soo baxdaa saacado, maalmo, ama toddobaadyo ka dib qalliinka wadnaha, qalabka wadnaha garaaca ama kateetarka, kansarka, kelyaha oo hawlgab, ama fayras pericarditis ba'an. Haddii qof uu yeesho neefta gaaban oo ka sii daraysa marka uu si siman u jiifo, xididdada qoorta oo bararsan, madax-furnaan, ama cadaadiska dhiigga oo hoos u dhacaya, wac degaankaaga nambarada degdega ah isla markiiba. Markaad sugayso dhakhaatiirta caafimaadka, dib u eeg tilmaamaha la xidhiidha pericarditis iyo myocarditis, Qalab garaaca wadnaha iyo dhibaatooyinka qalabka ICDiyo aqoonsiga naxdinta leh iyo gargaarka degdegga ah.

Sababtoo ah wadnuhu waxa ku cadaadinaya dareeraha gudaha xuubka xuubka wadnaha waxa uu si buuxda ugu tiirsan yahay cadaadiska dhiigga oo sareeya iyo garaaca wadnaha degdega ah si uu u ilaaliyo dhiigga ku wareegaya maskaxda, badbaadada ka hor dheecaanka isbitaalka degdega ah u digista dhaqaatiirta caafimaadka isla markiiba haddii bukaanku uu dhawaan maray qaliin wadnaha ah ama nidaamka tuubada.

Hadda samee tan¶

1. ** Isla markiiba wac lambarkaaga deg-degga ah.** Wac 911 gudaha Mareykanka iyo Kanada, 112 gudaha Midowga Yurub, 999 gudaha Boqortooyada Midowday, 000 gudaha Australia, ama kala tasho buug-tilmaameedkayaga nambarada degdega ah. Si cad ugu sheeg diraha: "Wadnaha laga shakisan yahay tamponade / pericardial effusion: neefta oo aad u daran, xididdada qoorta oo kala go'a, cadaadis dhiig oo hooseeya, iyo habka wadnaha ee dhowaan (ama taariikhda kansarka / pericarditis)."
2. Bukaanku u ogolow inuu si toosan u fadhiisto oo uu hore ugu tiirsado (ama ku nasto booskiisa ugu raaxada badan) Waligaa ha ku qasbin bukaanka looga shakisan yahay in ay ka soo baxaan xuubka wadnaha ama tamponade inay si siman u jiifsadaan dhabarka haddii ay ku dhibtoonayaan inay neefsadaan (** orthopnea**). Si toosan u fadhiisato oo aad hore ugu tiirsato barkin ama miis sariirta ka badan (** tripod ama booska salaada Mohammedan ***) waxay hore u jiidataa wadnaha waxayna u ogolaataa dareeraha inuu ku ururiyo xagga hoose ee kiish xuubka wadnaha, yaraynta cadaadiska xabadka iyo shaqada neefsashada. Haddii bukaanku daal ka dareemo cadaadis dhiig oo hooseeya, ku taageer iyaga oo toosan 30 ilaa 45 darajo iyadoo lugaha ay si siman u taageerayaan.
3. ** Weligaa ha siin nitroglycerin (glyceryl trinitrate), furosemide (kiniinada biyaha), ama kaniiniyada cadaadiska dhiigga ee dheeriga ah.* Siinta nitroglycerin ama diuretic waxay ballaadhisaa xididdada waxayna daadisaa cadaadiska sare ee xididdada kaas oo hadda ku qasbaya dhiigga dhinaca midig ee wadnaha ee isku cadaadisan, taasoo kicinaysa isla markiiba, burburka wadnaha iyo xididdada dhiigga.
4. **Jooji dhammaan dawooyinka dhiiga khafiifiya ee daawada laguu qoray (anticoagulants) hana siin aspirin. dhiigbaxa ku shubma kiish xuubka wadnaha
5. ** Hubi cadaadiska dhiigga iyo garaaca garaaca wadnaha haddii qalabka guriga la heli karo, oo ogow hoos u dhac kasta oo ballaaran inta lagu jiro neefsashada (pulsus paradoxus).
6. ** Bukaanku isdeji, diirimaad, nasasho jidheed oo dhamaystiran, oo afka si adag u dabool (wax la cuno ama la cabbo)** Xataa u socoshada musqusha waxay kordhin kartaa baahida ogsajiinta ee ka baxsan waxa wadnuhu ku shubmi karo, taasoo keenaysa syncope ama Waxqabadka Korontada (PEA) ee wadnaha oo istaaga. Hayso bukaanka NPO isu diyaarinta degdega ah ee ultrasound uu hago pericardiocentesis ama dareeraha daaqada xuubka wadnaha ee qaliinka.

Geedka go'aanka: qiimaynta dhiigbaxa pericardial, xanuunka post-pericardiotomy syndrome, iyo tamponade¶

flowchart TD
    Start["Neefta oo ku yaraata, Cadaadiska xabadka, ama madax-furnaan leh Taariikhda Qalliinka Wadnaha, Ablation, Pacemaker, Kansarka, Kelyaha oo Fashilmay, ama Pericarditis"] --> RedFlags{"Hubi Calaamadaha Tamponade & Beck Triad: xididdada qoorta oo bararsan (JVD), Systolic BP ee ka hooseeya 100 mmHg, Cadaadiska garaaca wadnaha oo cidhiidhi ah, Tachycardia, Pulsus Paradoxus, ama miyir beelid?"}

    RedFlags -->|"HAA calaamad kasta: TAMPONADE HORJEEDA"| Emergency["TAMPONADE WADNAHA NOLOSHA NOLOSHA UGU HANJABA: Wac Adeegyada Degdegga ah (911/112/999) Isla markiiba"]

    RedFlags -->|"MAYA: Xanuunka laabta oo fiiqan oo si fiican u tiirinaya, BP caadi ah, xidid qoorta oo bararsan ma jiro"| PPS["Pericarditis Aan Walaacsan Oo La Tuhunsan Yahay Ama Ka Dib-Pericardiotomy Syndrome: Raadso qiimayn cusbitaal oo degdeg ah isla maalintaas iyo echocardiogram sariirta dhinaceeda ka hor intaadan bilaabin colchicine ama NSAIDs"]

    Emergency --> Position["1. Meel sare oo toosan ama fadhi hore ugu tiirsan barkin: WALIGAA haku qasbin dhabarka hoose haddii uu dyspneic yahay; Joog nasasho jidheed oo adag"]

    Position --> NoMeds["2. Mamnuucyada dawooyinka adag: MAYA Nitroglycerin ama Nitrate, MAYA Diuretics (Furosemide / Kiniinnada Biyaha), iyo MAYA Aspirin ama qiyaasaha xinjirowga lidka ku ah"]

    NoMeds --> Hospital["3. Kooxda Xanuunka Wadnaha ee Cisbitaalka ee Kahor Digniin: Ultrasound Sariirta Dhakhso ah (POCUS), Dib-u-noqoshada daawada xinjirowga lidka ku ah, iyo Pericardiocentesis-ka degdega ah ee Ultrasound-Hagayo Pericardiocentesis ama daaqad qaliin"]

Pathophysiology: qalooca cadaadiska pericardial-mugga (dhakhso vs. kororka dareeraha tartiib tartiib ah)¶

Wadnuhu waxa uu dhex fadhiyaa kiish fibroserous ah oo laba- gidaar ah oo loo yaqaan pericardium. Inta u dhaxaysa lakabka visceral gudaha ee jilicsan (epicardium) ee ku dheggan muruqa wadnaha iyo dibedda adag ** pericardium fibrous ** waxay jiiftaa ** godka pericardial , kaas oo caadi ahaan ka kooban ** 15 ilaa 50 millilitir (1 ilaa 3 qaado) dareere serous ah oo cad, midab caws leh oo soo saara wadnaha kasta.

Sababtoo ah pericardium-ka fiibka ah ee dibedda wuxuu ka samaysan yahay cufan, fiilooyinka kolajka mawjadaha ah ee ay ku dhejiyeen fiilooyinka laastikada ah, awoodda ay u leedahay inay u fidiso waxay ku xiran tahay sida ugu dhakhsaha badan ee dareeraha u galo koorsada. Xidhiidhkan waxa xukuma kan caadiga ah Spodick J-qaabeeya qalooca cadaadiska pericardial:

Burburka qolka iyo isku-tiirsanaanta hawo-mareenka¶

Marka cadaadiska dareeraha ee gudaha kiishka pericardial uu ka kaco faakiyuumkiisa caadiga ah (-5 ku +5 mmHgIlaa 15 ilaa 25mmHg, waxay si tartiib tartiib ah u burburisaa qolalka wadnaha iyada oo u eegaysa dhumucda darbigooda iyo cadaadiska gudaha:

1. ** Marka hore atrium-ka midig iyo halbowlaha midig ayaa burburay:** Sababtoo ah atrium-ka midig iyo ventricle-ka midig waa gidaar khafiif ah, qolalka cadaadiska hooseeya (cadaadiska diastooliga caadiga ah 3 ilaa 8 mmHg), dheecaanka xuubka xuubka wadnaha ee kor u kaca ayaa si siman u tuujiya inta lagu jiro nasashada (** dumitaanka diastooliga **). Dhiiga xididdada dhiigga ee ka soo noqda jidhka sare iyo kan hoose ee vena cava ayaa ku dhacay albaab xidhan oo dib ugu noqda xididdada qoorta iyo beerka.
2. ** Sinaanta cadaadiska diastooliga:** Tamponade-ka buuxa, cadaadiska gudaha kiishka pericardial, atrium midig, ventricle midig, halbowlaha sambabada diastolic, iyo atrium bidix (cadaadiska xididada sambabada) dhamaantood waxay la siman yihiin qiyaastii **18 ilaa 25 mmHg ***.
3. Isku-tiirsanaanta Ventricular: Sababtoo ah qolofta xuubka xuubka sare wuxuu ku xiran yahay mug go'an, halbowlayaasha midig iyo bidix waa inay ku tartamaan meel isku mid ah oo cidhiidhi ah gudaha sac, oo ay kala soocaan kaliya muruqa ** septum interventricular . Mar kasta oo uu bukaanku neefsado, cadaadiska xabadka taban wuxuu nuugaa dhiig dheeraad ah oo xidid ah oo gala halbowlaha midig; sababtoo ah darbiga kore ee xuubka wadnaha ma ballaarin karo bannaanka, buuxinta hawo-mareenka midig wuxuu ku soo boodaa septum interventricular ** bidix ee halbowlaha bidix, isagoo garaacaya daloolka ventricle-ka bidix wuxuuna keenayaa hoos u dhac lama filaan ah oo ku yimaada dhiig lagu shubo jirka (* pulsus paradoxus**).

Aqoonsiga tamponade caafimaad ee guriga: Beck's triad, pulsus paradoxus, iyo calaamadaha ECG¶

Si ka duwan qalliinka trauma tamponade halkaas oo hypotension iyo xiritaanka wadnaha ay ku dhacaan daqiiqado gudahood, ** daawada (subacute) wadnaha tamponade ** badanaa waxay u ekaataa maalmo sida daalka sii xumaanaya, neefta oo ku yaraata, laabta oo buuxsanto, qufac qallayl, hiccups (ka xanaaqa neerfaha phrenic), xabeeb (laga bilaabo cadaadinta neerfaha hore ee beerka iyo caloosha oo kacsan), kicinta).

1. 5ta calaamadood ee sariirta dhinaceeda wadnaha ee tamponade¶

2. Sida loo hubiyo cadaadiska garaaca wadnaha oo ciriiri ah iyo pulsus paradoxus guriga¶

Halka cabbirka saxda ah ee ** pulsus paradoxus** uu u baahan yahay cufnaanta cadaadiska dhiigga ee gacanta (sphygmomanometer) iyo stethoscope ee ambalaansada ama isbitaalka, kormeeraha cadaadiska dhiigga dhijitaalka ah ee guriga iyo farahaaga ayaa muujin kara saddex calaamadood oo digniin ah inta aad sugeyso kalkaaliyayaasha caafimaadka:

1. ** Hubi "cadaadiska garaaca wadnaha" (Systolic oo laga jaray Diastolic):** Fiiri labada lambar ee cadaadiska dhiigga ee shaashadda. Sida caadiga ah, farqiga u dhexeeya lambarka sare (systolic) iyo lambarka hoose (diastolic) waa 40 ilaa 50 mmHg (tusaale, 120/75 mmHg). Marka la kobcinayo tamponade wadnaha, adrenaline vasoconstriction xoog leh ayaa riixaya lambarka hoose ** kor ** halka mugga istaroogga yar ee wadnaha ee cadaadiska uu riixayo lambarka sare ** hoos , tuujin farqiga u dhexeeya ** in ka yar 25 ilaa 30 mmHg (tusaale, 102/84 mmHg* ama 94/78 mmHg* Cadaadiska garaaca wadnaha oo cidhiidhi ah oo lagu lammaaniyo garaaca wadnaha oo ka sarreeya 100 bpm waa calaamad digniin weyn oo shoog xannibid ah.
2. Dareemi garaaca gacanta shucaaca marka aad neefsanayso: Laba farood si tartiib ah u saar garaaca garaaca curcurka bukaanka marka aad daawanayso laabta oo kacaysa oo dhacaya inta lagu jiro neefsashada caadiga ah, oo aan khasab ahayn (u sheeg ** ha** si qoto dheer u neefsato ama neefta u celiso). Haddii aad dareento garaaca garaaca garaaca garaaca wadnaha oo si muuqata u daciifaya ama si yar u baaba'aya mar kasta oo ay neefsadaan, oo ay dib u soo noqdaan si xoog leh mar kasta oo ay neefsanayaan, ** pulsus paradoxus (caadi ahaan ka badan 20 ilaa 25 mmHg)** ayaa jira.
3. Sida ay dhakhaatiirtu u cabbiraan pulsus paradoxus iyaga oo isticmaalaya katiinado gacanta ah: Dhakhtarka caafimaadka ama dhakhtarku waxa uu kabinayaa cadaadiska dhiigga ee gacanta oo 20 mmHg ka sarreeya cadaadiska systolic oo uu si tartiib ah u dejiyo (2 mmHg ilbiriqsi kasta) marka uu ku dhegaysanayo stethoscope:
4. Qodobka A: Cadaadiska ku qor meesha garaaca wadnaha Korotkoff ee is-goysyada ah ee ugu horreeya laga maqlo kaliya inta lagu jiro neefsashada (aamusnaanta xilliga neefsashada), tusaale ahaan 118 mmHg.
5. Qodobka B: Si tartiib tartiib ah u sii wad ilaa garaaca wadnaha si joogto ah loo maqlo inta la neefsanayo iyo neefsashada labadaba, tusaale 96 mmHg.
6. ** Xisaabinta:** Ka jar dhibicda B barta A (118 - 96 = 22 mmHg). Farqi kasta ka weyn 10 mmHg waa pulsus paradoxus aan caadi ahayn.

3. Saxeexa ECG Classic: beddelka korontada¶

Marka dhakhaatiirta caafimaadku ay ku dhejiyaan 12-lead electrocardiogram (ECG) bukaanka qaba dhiigbax weyn oo xuubka wadnaha ah ama tamponade, waxay raadiyaan helitaanka cudur-maskaxeed loo yaqaan ** alternans koronto ** oo lagu lammaaniyo ** danab QRS hoose *: - Sababtoo ah wadnuhu waxa uu ku xidhan yahay gudaha bac weyn oo dareere ah sida bac feeray oo biyo ku laadlaadsan, wadnuhu jidh ahaan waxa uu u lulaa hore iyo gadaal gudaha kiishashka dareeraha ah iyada oo garaac kasta oo kale ah - Xarigga ECG, luliddaani waxay sababtaa dhererka iyo dhidibka taranka QRS inay beddelaan ** dheer-gaaban-gaaban-gaaban hal garaac ilaa kan xiga. Marka lagu daro tachycardia sinus iyo kuwa yaryar, isku xidhka QRS, beddelka korantada ayaa isla markiiba xaqiijiya dhiigbax weyn oo xuubka wadnaha ah.

Post-pericardiotomy syndrome (PPS / Dressler syndrome) iyo tamponade-ka dambe ee nidaamka¶

Mid ka mid ah kooxaha ugu khatarta badan ee tamponade-ka degdega ah ee wadnaha ee guriga waa bukaan kasta oo maray ** qalliinka wadnaha furan, kateetarka baabi'inta, qalabka wadnaha / ICD implantation, ama wadnaxanuun myocardial 1 maalin ee la soo dhaafay ilaa 8 toddobaad **. Laba hab oo kala duwan ayaa sababi kara dareere ama dhiig inuu buuxiyo pericardium ka dib waxqabadyada wadnaha:

1. Hemopericardium hore ama subacute (dhiigbaxa makaanikada ama xinjirowga lidka ku ah)¶

• 24 ilaa 72 saacadood ee ugu horeeya (ama ilaa 14 maalmood oo ah kuwa dhiiga khafiifiya): Ka dib markii halbowleyaasha xididada xididada la dhaafo (CABG), beddelka wadnaha wadnaha, kateetarka fibrillation ablation, ama meelaynta rasaasta rasaasta, dhiiggu wuxuu ka soo bixi karaa khadka tolida ee qaliinka, gidaarka wadnaha ee dalloola, ama hadhka hadhka saxda ah.
• ** Dabin xinjireedka laabta-tuubada ee qalliinka wadnaha ee post-op: ** Gudaha ICU ama qaybta hoos-u-dhaca ka dib qalliinka wadnaha furan, haddii tuubooyinka xabadka ee dhexdhexaadka ah si lama filaan ah ** u joojiyaan dheecaanka dareeraha ** isla mar ahaantaana bukaanku wuxuu noqdaa tachycardic, hypotensive, iyo neefta oo gaaban, tuubada laabta waxay ku xirtay xinjir dhiig, oo ku xannibaya dhiig cusub oo ku wareegsan xuubka wadnaha.
• ** Bukaan-socodka xinjirowga lidka ku ah:** Bukaan-socodka ayaa laga soo saaray guriga apixaban, rivaroxaban, dabigatran, ama warfarin ka dib qalliinka valve ama ka saarista AFib waxay yeelan kartaa dhiig-bax hoose 5 ilaa 21 maalmood ka dib. Dawakhaad kasta oo cusub, hoos u dhaca cadaadiska dhiigga ee guriga, ama neefta oo gaaban waxay u baahan tahay qaybta degdegga ah ee loo yaqaan 'echocardiogram'.

2. Post-Pericardiotomy Syndrome (PPS) iyo Dressler Syndrome (Furbax iskeed ah)¶

Inta u dhaxaysa ** 1 usbuuc iyo 8 usbuuc kadib qalliinka wadnaha furan (oo ku dhacaya 10 ilaa 30 boqolkiiba bukaannada qalliinka wadnaha), epicardial/catheter ablation, implantation implantation, ama wadne qabad weyn (halkaas oo lagu magacaabo ** Dressler syndrome**), habka difaaca jidhku wuxuu kor u qaadaa dib-u-dhac ku yimaada wadnaha ee wadnaha iyo falcelinta borotiinka ee wadnaha ee ka soo horjeeda pesoli pesoli. meel bannaan.

• Calaamadaha digniinta PPS ee caadiga ah:
• Xun xanuunka laabta ah: fiiqan, xanuun laabta dhabarka ah ama dhinaca bidix oo ka sii dara marka aad si qoto dheer u neefsanayso ama dhabarka u jiifsanayso, oo soo roona marka la fadhiisto oo hore loo tiirsado, inta badan u soo ifbaxaya ** trapezius tiir** ( garabka sare ee garabka).
• ** Qandho hoose oo aan la sharraxin** (sida caadiga ah 38.0 ilaa 39.0 darajo Celsius / 100.4 ilaa 102.2 darajo Fahrenheit) oo soo baxda in ka badan toddobaad qalliinka ka dib iyada oo aan wax nabar ah ama caabuq sambabada ahi dhicin.
• Neefta oo horumarsata, daal, qufac qallalan, iyo xoqid xoqid: Marka dareeraha caabuqa uu ku shubmo pericardium (badanaa ay weheliso dhinaca bidix ** xuubka xuubka** agagaarka sambabada), xoqitaanka xoqitaanka hore ee xuubka xuubka ayaa laga yaabaa inuu baaba'o marka lakabka dareeruhu uu kala saaro xuubka bararsan, iyo ** tamponade wadnaha ayaa ku soo baxa 2 ilaa 5 P.
• Daawaynta isbitaalka ee PPS (ESC Pericardial Disease Guidelines): Daawaynta kahortaga caabuqa ee safka kowaad waa Colchicine oo lagu daray Aspirin ama NSAID (sida ibuprofen) (ama corticosteroids-ka hooseeya haddii ay refractory/contraindicated)************************************

Sababaha caafimaad ee waaweyn ee shubanka xuubka wadnaha ee aan dhaawacnayn iyo tamponade¶

Xitaa haddii bukaanku aanu waligiis samayn qalliinka wadnaha ama nidaamka kateetarka, cudurro badan oo nidaamsan ayaa had iyo jeer u soo baxa waaxda xaaladaha degdegga ah markii ugu horreysay sida tamponade caafimaad oo nafta halis gelisa:

Waa maxay sababta "PRELOAD, RATE, AFTERLOAD" xeerarka physiology ay xukumaan daryeelka degdega ah¶

Tallaabo kasta oo ay qaadaan dadka guriga jooga iyo shaqaalaha caafimaadka ee goobta jooga waxa ay tilmaamayaan sida wadnuhu uu u sii noolaado. Tamponade-ka wadnaha, wadnuhu wuxuu ku xayiran yahay muuqaal: ** mugga istaroogga waa mid go'an oo yar **. Si looga hortago in dhaq-dhaqaaqa korantada ee degdega ah (PEA) istaaga wadnaha, saddex tiir oo jireed waa in la ilaaliyo kharash kasta:

CARDIAC OUTPUT = (HIGH VENOUS PRELOAD) x (FAST HEART RATE) x (INTACT ARTERIAL VASCULAR TONE)

1. Ilaali rarka Venous Preload (Sababta Nitroglycerin iyo Diuretics Diuretics u dilaan): Sababta kaliya ee dhiig kasta u galo atrium midig ee la jajabiyey (halkaas oo cadaadiska dibedda ee xuubka wadnaha uu yahay 20 mmHg) waa in jidhku isku koobay xididdada si uu kor ugu qaado cadaadiska xididdada dhexe ilaa 22 mmHg. Haddii qof siiyo bukaanka sublingual nitroglycerin, isosorbide, furosemide (Lasix), ama morphine, cadaadiska xididku wuxuu hoos uga dhacayaa 22 mmHg ilaa 12 mmHg. Isla markiiba, dareeraha 20 mmHg ee xuubka wadnaha ayaa garaacaya atrium-ka saxda ah gabi ahaanba, wax soo saarka wadnaha ayaa hoos u dhacaya eber, bukaankana waa la xirayaa.
2. ** Ilaali Magdhawga Tachycardia (Sababta ay Beta-blockers u yihiin Halis):** Sababtoo ah wadnuhu cadaadisku waxa uu soo saari karaa oo keliya 20 ilaa 25 millilitir halkii garaaca caadiga ah ee 70 millilitir, garaaca wadnaha ee 110 ilaa 130 garaac daqiiqaddii waa shayga kaliya ee dhiiga ku sii qulqulaya maskaxda. Waligaa ha siin beta-blockers (metoprolol, propranolol, atenolol) ama kuwa aan dihydropyridine calcium channel blockers (diltiazem, verapamil) si ay u gaabiyaan garaaca wadnaha degdega ah ee lagu tuhunsan yahay tamponade.
3. Maxay Sababta Cadaadiska Wanaagsani U Keenin Karto Xadhiga Wadnaha ee degdega ah: Cisbitaalka dhexdiisa, takhaatiirta degdega ah waxay ka fogaadaan in tubbada la gelinayo oo ay dhigaan bukaan tamponade hawo-mareenka KA HOR inta aysan daadin pericardium mar kasta oo ay suurtagal tahay. Labada dawooyin dejineed (kuwaas oo ballaadhiyaa xididdada iyo hoos u dhigista hore) iyo neefsasho farsamaysan oo cadaadis leh (taas oo cadaadis hawo wanaagsan gelinaysa laabta oo sii tuujinaysa xididka xididada iyo atrium-ka midig) waxay inta badan sababaan wadno xanuun degdeg ah oo ku dhaca bareelo. Taa baddalkeeda, dhakhaatiirtu waxay xabadka ugu diyaariyaan jeermiska jeermiska dila inta uu bukaanku weli soo jeedo, waxay sameeyaan ** soo toos suuxdinta gudaha ee ultrasound-ku haga pericardiocentesis** si ay uga baxaan 50 ilaa 100 millilitir ee dareeraha ah (kaas oo isla markiiba dib u soo celiya cadaadiska dhiigga), oo ku shuba ka dib haddii loo baahdo.

Daawaynta cusbitaalka ee qeexan: pericardiocentesis-ku haga ultrasound-ka iyo daaqada qaliinka¶

Marka qaybta gargaarka degdega ah, ** ultrasound bar-barta-daryeelka (POCUS) / echocardiogram** waxay qaadataa wax ka yar 60 ilbiriqsi si loo arko halo dareeraha mugdiga ah ee ku wareegsan wadnaha, xaqiiji burburka diastooliga ee atrium midig iyo ventricle midig, oo uu tuso plethoric (distened, non-burating) vena cava hoose (>2.1 cm dhexroor leh <50% burburka waxyiga leh).

• ** Pericardiocentesis degdeg ah:** Iyada oo la raacayo ultrasound-waqtiga dhabta ah ama hagida fluoroscopic (iyadoo la adeegsanayo habka cirbadaha parasternal, apical, ama subxiphoid ee hoosta lafta naaska ee u janjeerta dhanka garabka bidix), dhakhtarka wadnaha ama dhakhtarka degdega ah wuxuu u hormariyaa irbada booska xuubka, dunta jilicsan Sababtoo ah qalooca cadaadiska-qaabka J-qaabeeya, ** ka saarida kaliya 50 ilaa 100 millilitir ee dareeraha ah isla markiiba waxay hoos u dhigtaa cadaadiska intrapericardial ilaa eber u dhow ***, taasoo soo saarta nafis degdeg ah, neefta oo gaaban iyo soo celinta cadaadiska dhiigga caadiga ah ee miiska.
• Ka digtoonow xanuunka Pericardial Decompression Syndrome (PDS): Bukaannada qaba dhiigbax weyn, daba-dheeraaday (1,000+ mL), daaweeyayaasha waxay iska ilaaliyaan daadinta wax ka badan ** 500 ilaa 1,000 millilitir hal mar**, inta soo hartay si tartiib ah u daadi 24 saacadood iyada oo loo sii marayo kateetarka si daadad sambabada midig ah aysan si lama filaan ah u xakameynin.
• ** Qalliin Subxiphoid Pericardial Window ama Thoracotomy:** Waxa loo isticmaalaa xinjirowga qalliinka ka dib qalliinka hemopericardium (taas oo aan ka gudbi karin irbad dhuuban), pericarditis bakteeriyada purulent, ama dhiigbax xun oo soo noqnoqda.

Lambarada degdega ah ee gobolka iyo borotokoolka wakaalada¶

Tamponade wadnaha ee laga shakisan yahay ama nidaamka wadnaha ka dambeeya ayaa u baahan in ambalaas degdeg ah loo qaado isbitaal leh 24-saac echocardiography degdegga ah, wadnaha, iyo qalliinka wadnaha:

• Mareykanka iyo Kanada: garaac 911. Haddii bukaanku dhawaan lagu sameeyay qalliinka wadnaha, ka saarista, ama qalabka wadnaha wadnaha lagu rakibay, keen soo koobida dheecaanka qalliinkooda iyo kaadhka aqoonsiga qalabka, oo qoysku ha wacaan saaxiibka wadnaha ee wicitaanka inta EMS ku socoto.
• United Kingdom: Wac 999 xaalada degdega ah Qaybta ½ ambalaas cisbitaal wayn oo degdeg ah Waaxda Gurmadka (A&E) ama Wadnaha Xanuunka/Xarunta Wadnaha. Waxaa lagu maareeyaa ESC iyo Golaha Dib-u-soo-nooleynta UK sababaha dib loo rogi karo ee xiritaanka wadnaha ("4 Hs iyo 4 Ts": Tamponade, wadnaha).
• Midowga Yurub: Wac 112. Lagu maareeyo Bulshada Yurub ee Wadnaha (ESC) Tilmaamaha Baarista iyo Maareynta Cudurrada Wadnaha.
• Australia iyo New Zealand: Wac 000 gudaha Australia ama 111 gudaha New Zealand.
• Hindiya iyo Aasiya-Pacific:** garaac 112 (ama 108 gudaha Hindiya), 995 gudaha Singapore, 119 gudaha Japan iyo Kuuriyada Koonfureed, ama 999 gudaha Malaysia iyo Hong Kong. Codso in loo qaado cusbitaal jaamacadeed leh 24-saac shaybaadhka tuubada wadnaha iyo ICU.

Su'aalaha soo noqnoqda¶

Waa maxay faraqa u dhexeeya dhiigbaxa wadnaha iyo tamponade wadnaha?¶

Dhiigbaxa xuubka wadnaha si fudud macnaheedu waa inuu jiro dareere dheeraad ah oo ka sarreeya 15 ilaa 50 millilitir gudaha kiishka ku wareegsan wadnaha; Haddii ay si tartiib ah u korto ama ay yaraato, waxa laga yaabaa in aanay wax cadaadis ah ku keenin qolalka wadnaha haba yaraatee. Wadnaha tamponade waa xaalad degdeg ah oo nafta halis gelisa oo dhacda marka cadaadiska dareerahaasi uu ka bato cadaadiska buuxinta gudaha atrium midig iyo ventricle midig, isagoo jir ahaan burburiya qolalka wadnaha inta lagu jiro nasashada si uusan wadnuhu u buuxin dhiig ama uusan ku shubin oksijiin ku filan jirka.

Waa maxay sababta 150 ml oo yar ay u dhiigi karto ka-saarista ka dib sababta tamponade, halka bukaanka kansarku uu qaadi karo 1,500 mL oo dareere ah?¶

Kiishka xuubka xuubka xuubka xuubka sare wuxuu ka samaysan yahay fiilooyinka kolajka cufan ee iska caabiya fidinta degdega ah. Marka dhiiggu si degdeg ah ugu soo daadanayo kiishashka daqiiqado ka dib marka la iska saaro kateetarka ama habka wadnaha garaaca wadnaha, pericardium ma fidi karo, markaa kaliya 100 ilaa 200 millilitir oo dhiig ah ayaa cadaadiska cirka sare u qaada oo joojiya wadnaha. Marka dheecaanku ku ururo hoos u dhac toddobaadyo ah oo ka yimaada sambabada ama kansarka naasaha, kelyaha oo hawlgab, ama hypothyroidism, fiilooyinka pericardial ayaa si tartiib ah u fidiya oo dib u habeynaya, taas oo u oggolaanaysa kiishku inuu hayo 1 ilaa 2 litir ka hor inta uusan gaarin meeshii uu jabay.

Waa maxay sababta in hore loo tiirsado ay neefta iyo laabta xanuun uga dareento pericarditis iyo dhiigbaxa wadnaha?¶

Marka bukaanku si siman ugu seexdo dhabarka, cufisjiidku waxa uu wadnuhu dib ugu soo celiyaa laf dhabarta waxana uu qaybiyaa dareeraha xuubka wadnaha ee ku wareegsan qolalka dambe iyo boronkii, halka uu ku xoqayo lakabyada pericardial ee bararsan diaphragm iyo pleura. Si toosan u fadhiisato oo hore ugu tiirsato barkin ama miis (booska tripod) waxa ay hakinaysaa wadnuhu hore ee laabta iyo barkadaha dheecaanka xagga jeebka hoose ee hore ee kiishka, yaraynta cadaadiska bronki iyo yaraynta xanuunka pleuritic.

Waa maxay Beck's triad, oo maxaad u sugi la'dahay dhammaan saddexda calaamadood ee tamponade caafimaadka?¶

Beck's triad wuxuu ka kooban yahay saddex calaamadood oo caadi ah oo asal ahaan lagu sifeeyay tamponade qalliinka degdega ah: cadaadis dhiig oo hooseeya (hypotension), xididdada qoorta oo bararsan (mulaaca xididdada jugular), iyo dhawaaqyo wadne oo dhuuban oo fog. Daawada tamponade ee soo baxda maalmo badan, dhammaan saddexda calaamadood waxay si wada jir ah uga muuqdaan in ka yar 30 ilaa 40 boqolkiiba bukaanada, iyo cadaadiska dhiiggu inta badan waa caadi ama xitaa kor u kaca ilaa daqiiqado ka hor xiritaanka wadnaha. Had iyo jeer ku dhaqan calamadaha hore: neefta oo ka sii daraysa oo sambabada saafi ah leh, garaaca wadnaha oo nasanaya in ka badan 100 bpm, farqi cidhiidhi ah oo u dhexeeya dhiig karka systolic iyo diastolic, iyo pulsus paradoxus.

Waa maxay Post-Pericardiotomy Syndrome (PPS) qalliinka wadnaha ka dib?¶

Post-Pericardiotomy Syndrome (oo la xidhiidha Dressler syndrome ka dib wadne qabad) waa falcelin barar ah oo iskiis ah ee pericardium iyo pleura kaas oo soo baxa 1 ilaa 8 toddobaad ka dib qalliinka wadnaha furan, beddelka valve, bedelka kateetarka, ama meelaynta qalabka wadnaha. Waxay keentaa laab xanuun fiiqan oo ka sii dara markaad neefsanayso ama si siman u jiifto, qandho aan la garanayn, daal, iyo dareere ku urura agagaarka wadnaha iyo sambabada. Iyadoo kiisaska intooda badan ay ka jawaabaan colchicine iyo daaweynta ka hortagga bararka, bukaan kasta oo qaba calaamadaha PPS wuxuu u baahan yahay echocardiogram degdeg ah si loo hubiyo in dareeruhu uusan u sii soconin tamponade wadnaha.

Maxay khatar u tahay in la siiyo nitroglycerin ama kaniiniga biyaha (furosemide) qof qaba tamponade wadnaha?¶

Tamponade-ka wadnaha, cadaadiska dareeraha dibadda ayaa tuujinaya dhinaca midig ee wadnaha oo xiran, iyo xoogga kaliya ee dhiigga ku riixaya wadnaha waa cadaadiska xididdada sare ee bukaanka. Nitroglycerin waxay balaadhisaa xididdada waxayna furosemide ka soo saartaa dareeraha dhiigga; Daroogadu waxay keentaa cadaadiska buuxinta xididada inuu hoos u dhaco cadaadiska dareeraha pericardial, taasoo keenaysa halbowlaha midig inuu si buuxda u dumo oo kiciyo isla markiiba wadnaha iyo xididdada dhiigga oo istaaga.

Ilaha iyo hanuuninta rasmiga ah¶

• Bulshada Yurub ee Wadnaha (ESC, Europe):** * Tilmaamaha ESC ee Baadhista iyo Maareynta Cudurrada Pericardial Kala soocida iyo Maareynta Wadnaha Tamponade*.
• ** Ururka Wadnaha Mareykanka (AHA) iyo Kulliyadda Wadnaha ee Mareykanka (ACC, Mareykanka):** * 2020 AHA/ACC Tilmaamaha Taageerada Nolosha Wadnaha ee Sare ee Wadnaha (ACLS)* iyo ASE/AHA Talooyin Caafimaad ee Qaababka Kala Duwan ee Wadnaha Wadnaha ee Bukaannada qaba Cudurka Wadnaha.
• ** Golaha Dib-u-soo-nooleynta UK & Machadka Qaranka ee Caafimaadka iyo Sareynta Daryeelka (NICE, Boqortooyada Ingiriiska):** Taageerada Nolosha Sare (ALS) Tilmaamaha: Sababaha La beddeli karo ee Xadhiga Wadnaha (4 Hs iyo 4 Ts - Tamponade Wadnaha).
• ** Spodick DH (* Joornaalka Caafimaadka ee New England ):
• Xiriirka Caalamiga ah ee Ururada Laanqeyrta Cas iyo Bisha Cas (IFRC) & ANZCOR: * Tilmaamaha Gargaarka Koowaad ee Xanuunka Xabadka Ba'an, Dyspnea, iyo shoogga wareegga wareegga*.

Tilmaamaha la xidhiidha¶

• Tamponade wadnaha iyo kala soocida dhaawaca laabta ee dhexda
• Pericarditis, myocarditis, iyo xanuunka laabta ka dib fayraska ayaa calaamado casaan ah
• Qalab sameeye ama ICD defibrillator shoog duufaan iyo caabuq jeebka qalabka
• Kala-baxa xididada iyo aneurysm-ka aortic-ga caloosha oo dillaacay
• Aqoonsiga naxdinta leh iyo gargaarka degdegga ah