Cov hlab ntsha pulmonary ua lub luag haujlwm tseem ceeb: lawv nqa ntshav los ntawm txoj cai ventricle ntawm lub plawv mus rau pulmonary lobes, qhov twg nws yog oxygenated. Tom qab phlebitis, nws tshwm sim tias cov ntshav txhaws mus rau ntawm cov hlab ntsha thiab lub qhov ncauj: nws yog pulmonary embolism.

Cov hlab ntsha pulmonary pib los ntawm txoj cai ventricle ntawm lub plawv. Tom qab ntawd nws sawv ntawm ib sab ntawm lub aorta, thiab mus txog hauv qab lub koov ntawm lub aorta, faib ua ob ceg: sab xis pulmonary hlab ntsha uas mus rau sab xis ntawm lub ntsws, thiab sab laug pulmonary hlab ntsha ntawm sab laug lub ntsws.

Nyob rau theem ntawm hilum ntawm txhua lub ntsws, cov hlab ntsha pulmonary rov faib ua cov hlab ntsha hu ua lobar:

• nyob rau hauv peb ceg rau txoj cai pulmonary hlab ntsha;
• nyob rau hauv ob ceg rau sab laug pulmonary hlab ntsha.

Cov ceg no tig mus rau hauv cov ceg me me thiab me me, kom txog rau thaum lawv dhau los ua cov hlab ntsha ntawm lub ntsws lobule.

Pulmonary hlab ntsha yog cov hlab ntsha loj. Thawj feem ntawm cov hlab ntsha pulmonary, los yog lub cev, ntsuas kwv yees li 5 cm los ntawm 3,5 cm inch. Txoj cai pulmonary artery yog 5 mus rau 6 cm ntev, tiv thaiv 3 cm rau sab laug pulmonary hlab ntsha.

Lub luag haujlwm ntawm cov hlab ntsha pulmonary yog coj cov ntshav tawm ntawm txoj cai ventricle ntawm lub plawv mus rau lub ntsws. Qhov no hu ua ntshav venous, uas yog hais tias tsis yog-oxygenated, yog ces oxygenated nyob rau hauv lub ntsws.

Pulmonary embolism

Cov hlab ntsha sib sib zog nqus thrombosis (DVT) thiab pulmonary embolism (PE) yog ob qhov kev kho mob ntawm tib lub koom haum, venous thromboembolic disease (VTE).

Pulmonary embolism yog hais txog kev cuam tshuam ntawm cov hlab ntsha pulmonary los ntawm cov ntshav txhaws thaum lub sijhawm phlebitis lossis venous thrombosis, feem ntau hauv ob txhais ceg. Cov hlab ntsha no tawg, taug kev mus rau lub plawv los ntawm cov hlab ntsha, tom qab ntawd raug tshem tawm ntawm txoj cai ventricle mus rau ib qho ntawm cov hlab ntsha pulmonary uas nws xaus rau kev cuam tshuam. Ib feem ntawm lub ntsws yog ces tsis zoo oxygenated. Cov hlab ntsha ua rau lub plawv sab xis mus rau lub zog hnyav, uas tuaj yeem ua rau txoj cai ventricle nthuav dav.

Pulmonary embolism manifests nws tus kheej nyob rau hauv ntau yam mob ntau dua los yog tsawg dua cov tsos mob nyob ntawm nws qhov hnyav: mob hauv siab ntawm ib sab nce ntawm kev tshoov siab, ua tsis taus pa, qee zaum hnoos nrog hnoos qeev nrog ntshav, thiab nyob rau hauv cov mob hnyav tshaj plaws, lub plawv tsis ua haujlwm, arterial hypotension thiab. lub xeev ntawm poob siab, txawm cardio-circulatory ntes.

Pulmonary arterial hypertension (los yog PAH)

Ib yam kab mob uas tsis tshua muaj, pulmonary arterial hypertension (PAH) yog tus cwj pwm los ntawm cov ntshav siab txawv txav hauv cov hlab ntsha me me, vim yog qhov tuab ntawm cov hlab ntsws ntawm cov hlab ntsha pulmonary. Txhawm rau txhawm rau txo cov ntshav ntws, txoj cai ventricle ntawm lub plawv yuav tsum tau siv zog ntxiv. Thaum nws tsis ua tiav lawm, ua pa tsis xis nyob ntawm kev tawm dag zog tshwm sim. Nyob rau theem siab, tus neeg mob yuav ua rau lub plawv tsis ua haujlwm.

Tus kab mob no tuaj yeem tshwm sim tsis tu ncua (idiopathic PAH), hauv tsev neeg cov ntsiab lus (PAH tsev neeg) lossis ua rau nyuaj rau qee yam kab mob (mob plawv, mob ntshav siab, mob HIV).

Chronic thromboembolic pulmonary hypertension (HTPTEC)

Nws yog ib hom kab mob pulmonary hypertension uas tsis tshua muaj tshwm sim, uas tuaj yeem tshwm sim los ntawm kev daws teeb meem pulmonary embolism. Vim yog cov hlab ntsha uas txhaws cov hlab ntsha pulmonary, cov ntshav khiav qis, uas ua rau cov ntshav siab hauv cov hlab ntsha. HPPTEC tshwm sim los ntawm cov tsos mob sib txawv, uas tuaj yeem tshwm sim ntawm 6 lub hlis thiab 2 xyoos tom qab pulmonary embolism: ua tsis taus pa luv, ua tsis taus pa, edema hauv nqua, hnoos nrog ntshav hnoos qeev, qaug zog, mob hauv siab.

Kev kho mob pulmonary embolism

Kev tswj ntawm pulmonary embolism nyob ntawm nws theem ntawm qhov hnyav. Anticoagulant therapy feem ntau yog txaus rau me me pulmonary embolism. Nws yog raws li kev txhaj tshuaj ntawm heparin rau kaum hnub, tom qab ntawd noj cov tshuaj tiv thaiv qhov ncauj ncaj qha. Nyob rau hauv rooj plaub uas muaj kev pheej hmoo siab pulmonary embolism (kev poob siab thiab / lossis kev poob siab), kev txhaj tshuaj heparin ua ke nrog thrombolysis (kev txhaj tshuaj ntawm cov tshuaj uas yuav ua rau cov ntshav txhaws) lossis, yog tias tom kawg yog contraindicated, phais pulmonary embolectomy, kom sai reperfuse lub ntsws.

Kev kho mob pulmonary arterial hypertension

Txawm hais tias kev kho mob tau zoo, tsis muaj kev kho rau PAH. Kev saib xyuas ntau yam yog koom tes los ntawm ib qho ntawm 22 lub chaw muaj peev xwm lees paub rau kev tswj hwm tus kab mob no hauv Fab Kis. Nws yog nyob ntawm ntau yam kev kho mob (tshwj xeeb yog kev txhaj tshuaj tas mus li), kev kawm kho mob thiab kev hloov pauv ntawm txoj kev ua neej.

Kev kho mob thromboembolic pulmonary hypertension

Kev phais pulmonary endarterectomy yog ua. Qhov kev cuam tshuam no yog txhawm rau tshem tawm cov khoom siv fibrotic thrombotic obstructing cov hlab ntsha pulmonary. Kev kho Anticoagulant kuj tau sau tseg, feem ntau rau lub neej.

Kev kuaj mob ntawm pulmonary embolism yog ua raws li kev soj ntsuam tag nrho saib, tshwj xeeb, rau cov tsos mob ntawm phlebitis, cov cim qhia txog kev mob ntsws hnyav (cov ntshav siab qis thiab lub plawv dhia ceev). Ntau yam kev kuaj mob yog tom qab ntawd ua raws li kev soj ntsuam kuaj mob kom paub meej tias qhov kev kuaj mob thiab ntsuas qhov hnyav ntawm pulmonary embolism yog tias tsim nyog: kuaj ntshav rau D-dimers (lawv lub xub ntiag qhia pom tias muaj cov ntshav txhaws, cov hlab ntsha hauv ntshav. CT angiography ntawm lub ntsws yog tus txheej txheem kub rau kev kuaj ntshav thrombosis.

Nyob rau hauv cov ntaub ntawv ntawm kev poob siab ntawm pulmonary hypertension, lub plawv ultrasound yog ua nyob rau hauv thiaj li yuav qhia txog qhov nce nyob rau hauv pulmonary arterial siab thiab tej yam mob plawv. Ua ke nrog Doppler, nws muab kev pom ntawm cov ntshav ncig. Cardiac catheterization tuaj yeem paub meej qhov kev kuaj mob. Ua los ntawm kev siv lub catheter ntev nkag mus rau hauv cov hlab ntsha thiab nce mus rau lub plawv thiab tom qab ntawd mus rau cov hlab ntsha pulmonary, nws ua rau nws tuaj yeem ntsuas cov ntshav siab ntawm theem ntawm lub plawv atria, pulmonary arterial siab thiab cov ntshav ntws.

Mob ntsws ntsws thromboembolic siab yog qee zaum nyuaj rau kev kuaj mob vim nws cov tsos mob tsis sib xws. Nws qhov kev kuaj mob yog nyob ntawm ntau yam kev ntsuam xyuas: echocardiography pib nrog pulmonary scintigraphy thiab thaum kawg ib txoj cai plawv catheterization thiab pulmonary angiography.