Под эмболией понимают не отдельное заболевание, а комплекс симптомов, которые отмечаются при тромбе в сосудах или заносе в них частиц воздуха, крови или лимфы. Такое отклонение является причиной инфарктов, гангрен, инсультов. Тромб может локализоваться в сосудах кишечника, сердца, головного мозга, нижних конечностей или легких. Тромбоэмболия – это острое и возникающее внезапно состояние. Это и является основной причиной высокой смертности и инвалидизации пациентов с таким диагнозом. Для предотвращения последствий врачам важно вовремя оказать пациенту помощь.
Патология тромбоэмболия
Это состояние, при котором тромб отрывается от места своего образования, попадает в кровь и вызывает острую закупорку (эмболию) в области окклюзированного сосуда. В результате в таком месте прекращается кровоток, что ведет к ишемии – местному снижению кровоснабжения. Тромбоэмболии предшествуют замедление кровотока, повышение свертываемости крови, тромбоз. Также она может выступать следствием хирургических вмешательств, осложнений травм и заболеваний, связанных с тромбообразованием. Тромбоэмболия (ТЭ) – опасная патология, угрожающая жизни человека.
Причины
Общей причиной развития тромбоэмболии является оторвавшийся тромб. Он представляет собой сгусток крови, скопившийся в сосуде и нарушающий нормальный кровоток в нем. Тромб может оторваться в результате элементарных процессов – при естественном опорожнении кишечника, сильном кашле, во время родов. Развитие тромбоэмболии проходит четыре этапа:
- Образование в результате определенных отклонений в организме тромба или эмбола (пузырька воздуха, сгустка жировой ткани, лимфы разросшихся колоний микроорганизмов).
- Отрыв тромба от стенки сосуда.
- Эмболия (перемещение) его по кровяному руслу.
- Закупорка тромбом того или иного сосуда, что ведет к развитию тромбоза и тромбоэмболии.
Тромб представляет собой своеобразную «пробку», которая перекрывает кровоток. Он выступает основной причиной развития тромбоэмболии. Факторы риска образования и отрыва тромбов следующие:
- гипертония;
- гипертонический криз;
- прием медикаментов, повышающих свертываемость крови;
- инсульт;
- варикозная болезнь;
- ожоги, обморожения, кровотечения;
- сердечная недостаточность;
- обезвоживание;
- наследственная предрасположенность;
- атеросклероз;
- сахарный диабет;
- опухоли;
- инфаркт;
- избыточный вес;
- курение;
- малоподвижный образ жизни;
- беременность, роды;
- прием оральных контрацептивов;
- длительное нахождение в одном положении и дальнейший резкий подъем.
Классификация
Тромб может образоваться и оторваться в любом сосуде. С учетом этого критерия тромбоэмболия классифицируется на несколько видов. Она может поражать сосуды:
- головного мозга;
- легочной артерии;
- коронарные;
- спинного мозга;
- почечной артерии;
- нижних конечностей;
- мезентеральных (брыжеечных) артерий и вен.
Отдельно выделяют эмболию околоплодными водами. Это попадание амниотической жидкости в систему кровообращения матери, что вызывает у нее анафилактоидную реакцию. По другой классификации тромбоэмболии делят на несколько степеней тяжести. Они отличаются объемом отключенного кровотока. Чем сильнее он закрыт тромбом, тем тяжелее и опаснее состояние пациента. Всего выделяют четыре степени закупорки сосудов:
- Первая (немассивная). Поражено менее 25% от общей пропускной способности кровяного русла. Закупориваются преимущественно небольшие сосуды.
- Вторая (субмассивная). На этой стадии блокируется уже около 30-50% всего кровотока. Поражены чаще долевые артерии или сегментарные сосуды. У пациента проявляются симптомы, указывающие на недостаточность правого желудочка.
- Третья (массивная). Блокируется 50% и более от кровяного русла сосуда. Такая степень поражения характерна для закупорки главной артерии и легочного ствола. Симптомы патологии очевидны: шок, гипотензия системного характера.
- Четвертая. Поражено уже более 75% кровяного русла, что ведет к смертельному исходу.
Симптомы тромбоэмболии
Патология вызывает разные симптомы. Все зависит от локализации тромба и места, где он вызвал закупорку сосуда и последующую ишемию тканей. По статистике, чаще диагностируется тромбоэмболия ног. Сначала развивается тромбофлебит, затем – гангрена, а за ней – недееспособность ног и летальный исход. При закупорке сосудов, питающих брюшную полость, ощущается острая боль в животе. В результате развивается ишемия почки, кишечника или других органов пищеварительного тракта. Блокирование сосудов мозга вызывает инсульт. Все эти состояния проявляются разными симптомам.
Сосудов головного мозга
Тромбоэмболический синдром сосудов головного мозга характерен для пожилых людей. Частыми причинами выступают атеросклероз и гипертония. Другие факторы риска:
- прогрессирующая сердечная недостаточность;
- варикозная болезнь;
- инсульты в анамнезе;
- злокачественные новообразования.
Тромб отрывается во время или после сна. Симптоматика выражена слабо, а у некоторых пациентов вовсе отсутствует. Неврологические признаки нарастают в течение нескольких часов или даже суток. У всех пациентов формируется менингеальный синдром, который вызывает плаксивость, неэластичность шейных мышц, нарушения чувствительности, местные параличи, непереносимость звуковых и световых раздражителей. Другие признаки тромбоэмболии сосудов головного мозга:
- оглушенность;
- повышенная сонливость;
- дезориентация;
- головная боль;
- тошнота;
- рвота;
- боль при движении глазных яблок.
Легочной артерии
Тромбоэмболическая болезнь легочной артерии (ТЭЛА) встречается чаще по сравнению с закупоркой других сосудов. Патология бывает вызвана физической активностью, сильным кашлем и другими нагрузками. Тромб может переместиться в легкие из верхней или нижней полой вены, из сердца. Признаки патологии проявляются моментально и развиваются быстро, из-за чего в большинстве клинических случаев наступает смерть. Основные симптомы эмболии легочной артерии:
- гипертензия;
- гипоксия;
- нарушение сознания;
- дыхательная недостаточность;
- учащение пульса;
- бледность кожи;
- кашель с кровью;
- боль по типу стенокардии;
- аритмия;
- повышение температуры;
- холодный пот на лбу.
Менее яркая клиническая картина характерна для тромбоэмболии мелких ветвей легочной артерии. Симптомы нарастают в течение нескольких часов или даже суток. Характерные признаки:
- тахипноэ;
- одышка;
- снижение артериального давления;
- кровохарканье;
- тахикардия.
Если поражен крупный сосуд, то патология развивается очень быстро, что часто вызывает смерть человека. Такой тромбоэмболический синдром развивается в несколько этапов:
- резкое нарушение сознания;
- нарастающая дыхательная недостаточность;
- гипоксия;
- повышение давления;
- летальный исход.
Мезентеральных артерий и вен
Под мезентерием (брыжейкой) понимают складку брюшины, за счет которой органы внутри нее крепятся к стенкам брюшной полости. За кровообращение в этой области, включая и кишечник, отвечают мезентеральные сосуды – артерии и вены. Их тромбоз является очень опасным состоянием. Тромбоэмболия чаще затрагивает верхнюю мезентеральную артерию. Причины – сепсис, мерцательная аритмия или инфаркт миокарда. Характерные признаки патологии:
- вздутие живота;
- учащение пульса;
- сильные боли в животе;
- выделение кровянистой жидкости из кишечника;
- рвота желчью, пищей, иногда с примесью крови;
- посинение губ и перитонит.
Закупорка эмболом мезентеральных вен характерна для пожилых людей. Патология проявляется менее ярко и быстро. Она вызывает инфаркт кишечника. На это указывают симптомы острого живота, но без проявления напряжения передней брюшной стенки. Сам диагноз устанавливается врачом уже на операционном столе после принятия решения и диагностического исследования органов.
Почечной артерии
По частоте эмболии почки занимают второе место после тромбоэмболии легочной артерии. Самые распространенные причины такой патологии:
- системные васкулиты;
- атеросклероз;
- панартериит;
- гиперплазия почечных артерий;
- инфаркт миокарда.
Эмболия почечной артерии вызывает три основных симптомокомплекса (синдрома), которые у каждого пациента проявляются в разной степени. Первый – гипертонический. Этот синдром представляет собой внезапное повышение артериального давления. Выраженность гипертонического синдрома зависит от степени закупорки артерии и наличия нарушений сердца или легких. Другие симптомокомплексы:
- Мочевой. Сопровождается появлением эритроцитов и белка в моче. Спустя 2 дня после закупорки артерии при мочеиспускании может появиться кровь. Иногда наблюдается задержка мочи и стула.
- Болевой. Характеризуется резкой болью в пояснице, напоминающей почечную колику. Часто сопровождается приступами тошноты и рвоты, запором, повышением температуры до 38 градусов. При очень сильных болях возможна утрата сознания.
Сосудов нижних конечностей
Провоцировать развитие тромбоэмболии ног могут застойные явления, которые развиваются при длительном соблюдении постельного режима, сдавливании кровеносных сосудов извне, хронической венозной недостаточности. В качестве причин флебологи называют и следующие патологии:
- тромбангиит;
- распространенный атеросклероз;
- септический эндокардит;
- облитерирующий эндартериит.
Тромбозы в артериях ног находятся на 4 месте после тромбоэмболических болезней сосудов церебральных, легочных и коронарных артерий. Эмболы закупоривают просвет периферических артерий нижних конечностей. Характерным симптомом является отсутствие пульса по всей поверхности ноги или на определенном уровне в зависимости от того, где тромб перекрыл кровоток. Другие симптомы зависят от степени тяжести:
- Относительная компенсация. Сопровождается болями в конечностях. Они быстро устраняются, а функции и чувствительность в пораженной ноге постепенно восстанавливаются.
- Субкомпенсация. Боли становятся сильнее, а нога – бледной и холодной. Ткани остаются жизнеспособными только за счет сильного напряжения кровотока.
- Декомпенсация. Первыми появляются сильные боли в ноге. Кожа становится бледной, но движения конечности сохранены. Если вовремя не приступить к лечению, то начнутся необратимые изменения: цианотичные пятна, «мраморный рисунок» на ноге, нарушение чувствительности, некроз тканей, гангрена.
Околоплодными водами
Этот специфический вид эмболии провоцирует блокирование сосудов околоплодными водами. Патология опасна как для беременной, так и для ребенка. Причины тромбоэмболии такого типа следующие:
- многоплодная беременность;
- аномальное течение родов;
- неправильная стимуляция родового процесса;
- ригидность шейки матки;
- многоводие.
Такое состояние требует срочного оказания медицинской помощи, поскольку амниотическая жидкость попадает в кровоток беременной женщины. Симптомы этого состояния:
- кашель;
- поверхностное дыхание;
- бледность кожного покрова;
- потеря сознания;
- судороги;
- озноб;
- снижение артериального давления;
- синюшность конечностей, губ;
- массивные кровотечения;
- частый, плохо прослушиваемый пульс.
Чем опасна тромбоэмболия
Самый опасный исход этой патологии – внезапная остановка сердца и, как следствие, смерть пациента. Если организм включил компенсаторные механизмы, то состояние больного постепенно ухудшается. Смерть в таком случае наступает не сразу, поэтому при своевременном лечении человек может выжить. Возможные осложнения тромбоэмболии:
- недостаток кислорода;
- воспалительная реакция снаружи легких;
- пневмония инфарктного характера;
- инсульт;
- хроническое повышенное давление в сосудах легких;
- абсцесс легких;
- ишемия кишечника, почки;
- гангрена.
Диагностика
Первым этапом диагностики является осмотр пациента и сбор анамнеза. Врач определяет основные факторы предрасположенности к ТЭ и выявляет характерные симптомы. Чтобы определить локализацию тромба, назначают:
- Ультразвуковое исследование. Сканирование вен помогает определить сосуд, который стал источников тромба.
- Ультразвуковую допплерографию. Такая процедура необходима для оценки состояния и интенсивности кровотока в исследуемой области.
- Флебографию. Это исследование венозного русла пациента с применением рентгеноконтрастного вещества. Оно точно визуализирует аномалии строения венозной сети.
- Компьютерную томографию. Точно определяет местоположение тромба.
- Ангиографию. Это рентгеноконтрастное исследование, которое проводится посредством введения в легкие контрастного вещества. Методика считается стандартом в диагностике ТЭЛА.
- Перфузионную сцинтиграфию легких. Это исследование выявляет участки легкого, куда поступает воздух, но где нарушен приток крови. Методика используется, если пациенту противопоказана компьютерная томография.
Кроме основного комплекса исследований, пациенту назначают процедуры для дифференциации ТЭ с другими патологиями и заболеваниями. Список таких методик:
- Рентгенография. Назначается для исключения очагов воспаления, механических травм костных тканей, новообразований, пневмоторакса, плеврита.
- Определение уровня d-димеров. Их повышение наблюдается у 90% людей с ТЭЛА. Если уровень d-димеров в норме, то врач исключает тромбоэмболию легочных артерий.
- Ультразвуковое исследование сердца (эхокардиографию – ЭКГ). Эта методика выявляет изменения в структуре сердечной мышцы: выбухание межжелудочковой перегородки, расширение правого желудочка, тромбы в полости предсердий. Процедура дифференцирует ТЭ от инфаркта миокарда, перикардита, сердечной недостаточности.
Лечение тромбоэмболии
Терапию проводят строго в условиях стационара под контролем врача, поскольку ТЭ – опасное состояние, которое может привести к смерти больного. Пациента госпитализируют в реанимационное отделение. После диагностики врач сможет назначить адекватную схему лечения. Оно направлено на восстановление нормального кровотока. Этапы терапии:
- Назначение строгого постельного режима.
- Прием препаратов, улучшающих кровоток: антикоагулянтов (разжижают кровь), фибринолитических ферментов (растворяют тромбы), спазмолитиков (устраняют возникающие спазмы).
- Хирургическое лечение. Если консервативная терапия не принесла результатов, то для устранения тромбоза пациенту назначают операцию.
- Назначение препаратов-антикоагулянтов для длительного применения. Их прописывают по окончанию лечения с целью профилактики рецидивов заболевания.
Тактика лечения определяется разновидностью ТЭ и тяжестью ее течения. В начале врачи пытаются справиться с патологией консервативными методами. При необходимости проводят операцию. Важным условием выздоровления является соблюдение диеты. Ее основные функции:
- нормализация массы тела;
- укрепление стенок венозных сосудов;
- нормализация стула, поскольку при натуживании во время дефекации высок риск отрыва тромба;
- снижение вязкости крови.
Дневная калорийность рациона подбирается с учетом возраста, физиологической нормы и нагрузки. Чтобы уменьшить вязкость крови, необходимо ежедневно выпивать не мене 2-2,5 л свободной жидкости. Дополнительно к чистой воде допускается употреблять:
- натуральные соки;
- некрепкий чай;
- минеральную воду;
- травяные чаи;
- отвар шиповника;
- морсы.
- Бледность кожи
- Боль в грудной клетке
- Боль в нижних конечностях
- Боль за грудиной
- Дезориентация
- Кашель
- Кашель с кровью
- Кровохарканье
- Нарушение сознания
- Одышка
- Озноб
- Отсутствие пульсации в ногах
- Поверхностное дыхание
- Пониженное артериальное давление
- Потеря сознания
- Потеря чувствительности ног
- Синюшность губ
- Синюшность кожи
- Сонливость
- Судороги
- Учащенное сердцебиение
- Холодные нижние конечности
Тромбоэмболия или тромбоэмболический синдром – это не отдельно взятое заболевание, а симптомокомплекс, который развивается при тромбообразовании в сосудах или же заносе в них сгустка крови, лимфы или воздуха. В результате данного патологического состояния развиваются инфаркты, инсульты или же гангрены. Тромбоэмболия может поразить сосуды головного мозга, сердца, кишечника, лёгких или же нижних конечностей.
Тромбоэмболия, как правило, возникает остро и внезапно. Именно эта особенность данного состояния является основной причиной смерти или же инвалидности пациентов, так как иногда врачи просто не успевают оказать необходимую помощь пациенту.
Причины
Основная причина развития этого патологического состояния – тромб, оторвавшийся от стенки сосуда. Он выполняет функцию «пробки» — перекрывает поток крови. В обескровленном месте развивается ишемия.
- приём медикаментозных средств, которые повышают вязкость крови;
- нахождение длительное время в одном положении, после чего наступает резкий подъем. К примеру, длительная поездка, послеоперационный период;
- гипертония;
- инсульт;
- гипертонические кризы;
- сердечная недостаточность;
- варикозная болезнь. В расширенных венах нижних конечностей возникают отличные условия для возникновения сгустков или застоя крови. В этом случае идёт речь о венозной тромбоэмболии;
- различные хирургические вмешательства;
- злокачественные новообразования;
- ожоги, кровотечения и обморожения.
Виды тромбоэмболии
- тромбоэмболия сосудов головного мозга;
- сосудов в лёгких (лёгочных артерий);
- артерий нижних конечностей;
- брыжеечных артерий;
Особой разновидностью является эмболия околоплодными водами.
Тромбоэмболический синдром в сосудах мозга
Наиболее часто встречается тромбоэмболия сосудов мозга. Чаще всего патология поражает пожилых людей. Она прогрессирует на фоне гипертонии, атеросклероза.
Наиболее часто отрыв тромба происходит после сна или же во время него. Признаки прогрессирования патологии выражены слабо или же могут совершенно не проявляться. Пациенты пребывают в сознании, но при этом у них наблюдается:
- дезориентация;
- повышенная сонливость;
- оглушенность.
Очаговая неврологическая симптоматика длительное время никак не проявляется. Симптомы нарастают очень медленно. Порой это занимает от нескольких часов до нескольких суток. Признаки во многом зависят от бассейна сосуда, который был закупорен, состояния кровообращения, а также обширности инсульта. Стоит отметить важный факт, абсолютно во всех случаях при тромбоэмболии сосудов мозга формируется мостомозжечковый и менингеальный синдром.
Тромбоэмболия лёгочных артерий
Первичное формирование тромба в лёгких происходит редко. Как правило, он может переместиться в лёгкие из сердца, верхней или нижней полой вены.
Наиболее опасными для жизни пациента являются флотирующие тромбы, которые соединены с венозной стенкой одни своим концом. Такой тромб может легко оторваться. Чаще всего это случается при физ. нагрузке, кашле и прочее. Симптомы тромбоэмболии проявляются моментально. В большинстве клинических ситуаций наступает смерть.
Основные признаки прогрессирования патологии:
- нарушение сознания;
- дыхательная недостаточность;
- гипоксия;
- гипертензия.
Менее динамично происходит развитие тромбоэмболии мелких ветвей лёгочной артерии. Длительность развития патологического процесса в лёгких составляет от нескольких часов до нескольких суток. Возникают следующие признаки недуга:
- боли, которые по своему характеру напоминают стенокардические. Данный признак важно отличить от истинных стенокардических болей. При развитии тромбоэмболии в лёгких боль не иррадиирует в левую руку и лопатку;
- одышка;
- часто возникает ещё один тревожный признак – кровохарканье;
- тахипноэ;
- АД снижается;
- тахикардия;
- аритмия.
Поражение артерий конечностей
В этом случае происходит перемещение кровяного сгустка в периферические артерии из проксимальных отделов системы кровообращения. Клиническая картина тромбоэмболии верхних и нижних конечностей во многом зависит от состояния кровотока в конечности.
Тромбоэмболия в повздошной артерии приводит к одностороннему поражению конечностей. Отсутствие пульсации может быть по всей поверхности нижних конечностей. Если тромб закупорил сосуд ещё ниже, то в таком случае уровень уточняют по полному отсутствию пульса в определённых местах нижней конечности.
Клиницисты выделяют три степени нарушения кровоснабжения в нижних конечностях:
- относительная компенсация. В данном случае боли довольно быстро исчезают, чувствительность и функциональность нижних конечностей также в скором времени восстанавливается;
- субкомпенсация. Жизнеспособность тканей нижних конечностей поддерживается за счёт предельного напряжения кровотока. Признаки: сильная боль, кожа бледная и холодная;
- декомпенсация. Исход данного состояния зависит от длительности ишемии. Ишемия имеет 3 фазы. На первой все изменения обратимы. Возникают боли в конечностях, которые также скоро и проходят, кожа бледная, движения сохранены. На втором этапе постепенно нарастают необратимые изменения в мягких тканях. К клинике, указанной выше, присоединяется и тугоподвижность суставов. Третий этап – необратимые изменения.
Тромбоэмболия брыжеечных артерий
Такое состояние встречается редко. Диагностировать недуг до операции сложно. Чаще всего пациенты с данным недугом поступают в стационар с диагнозом «перитонит». Основной симптом – появившиеся сильные боли в животе. При этом наблюдается периетальная симптоматика.
Эмболия околоплодными водами
Эмболия околоплодными водами – это также одна из специфических разновидностей тромбоэмболии. В этом случае в качестве субстрата, блокирующего сосуды, выступают околоплодные воды.
Эмболия околоплодными водами – это тяжёлое и опасное осложнение при беременности и родах, развивающееся вследствие попадания амниотической жидкости в кровоток. В данном случае наблюдаются следующие симптомы:
- потеря сознания;
- бледность кожного покрова;
- озноб;
- поверхностное дыхание;
- судороги;
- синюшность губ, кожи, конечностей;
- кашель;
- снижение АД;
- пульс частый, прослушивается с трудом;
- судороги;
- массивные кровотечения.
Эмболия околоплодными водами – чрезвычайно опасное состояние как для матери, так и для плода. Если произошло попадание околоплодных вод в кровоток, пациенту требуется немедленно оказать медицинскую помощь, так как это может привести даже к летальному исходу.
Основными причинами эмболии околоплодными водами являются:
- многоводие (околоплодных вод слишком много);
- многоплодная беременность (частая причина эмболии околоплодными водами);
- аномалии родовой деятельности;
- ригидность шейки матки;
- неправильная стимуляция родовой деятельности.
Лечение
Учитывая то, насколько опасным и сложным является данное состояние, а также те факторы и недуги, которые спровоцировали его появление, лечение проводится строго в стационарных условиях. При появлении первых симптомов пациенту следует незамедлительно обратиться за квалифицированной медицинской помощью. Только врач сможет провести тщательную диагностику и назначить корректный курс лечения.
Лечение врач назначит на основе особенностей протекания недуга, места локализации ишемии. Как правило, сначала прибегают к консервативным методикам лечения. Больного помещают в стационар и назначают строгий постельный режим. Назначаются препараты, улучшающие кровоток – антикоагулянты и тромболитические препараты, а также антиспастические средства, направленные на уменьшение возникающих спазмов.
Если консервативное лечение результатов не принесло, то проводится хирургическое вмешательство.
На самом деле, тромбоэмболия – это опасное заболевание, которое не так легко поддаётся лечению. К примеру, если поражена бедренная артерия, то любое лечение будет неэффективным – проводится только ампутация конечности.
Однако если среагировать довольно быстро и сразу провести грамотное и адекватное лечение, то есть большой шанс того, что в поражённом участке кровообращение восстановится.
Профилактика
Профилактика тромбоэмболии включает в себя следующие мероприятия:
- своевременно лечение недугов сердечно-сосудистой системы;
- укрепление иммунной системы;
- правильный режим дня и режим питания;
- заниматься спортом;
- регулярно проходить профилактические осмотры у специалистов.
Внезапное прекращение артериального кровотока по крупному сосуду может стать причиной для необратимых и крайне опасных изменений в органах и тканях человеческого организма. Особенно если происходит закупорка тромбом жизненно важных артериальных стволов – легочной артерии или брюшной аорты. Чаще всего тромбоэмболия возникает на фоне любых оперативных вмешательств, а симптомы бывают настолько ярко выражены, что необходимость экстренной медицинской помощи не вызывает сомнений. Какие бывают варианты закупорки сосудистых стволов? В чем причина образования тромба в сосудах? Каковы основные симптомы, указывающие на тромбоэмболическую болезнь? Что можно сделать, чтобы предотвратить острую тромбоэмболию?
Что может привести к закупорке артерии
Неожиданное прекращение кровотока по любому сосуду может произойти вследствие следующих причин:
- резкий спазм и уменьшение просвета артерии;
- травматическое повреждение тканей вместе с сосудами;
- формирование и перекрытие сосуда тромбом;
- эмболия артериальных стволов различными видами органических субстратов.
Чаще всего непроходимость крупных артерий вызывают следующие виды эмболов:
- воздушные — при попадании в сосудистую систему любого газа;
- жировые – при закупорке артерий каплями жира;
- микробные – на фоне тяжелых инфекционных болезней;
- тканевой – когда основой эмбола является частички любых тканей человеческого организма, попадающих в сосуды при операции, в родах или травме.
Наиболее часто нарушение кровообращения из-за закупорки возникает в тех случаях, когда имеется тромбоэмболия. Основой эмбола является сгусток крови разных размеров и формы, сформировавшийся в отдаленных сосудах и в силу разных причин переместившийся в крупную артерию. Все проявления и симптомы обусловлены прекращением поступления питания и кислорода к тканям, которые обеспечивает перекрытый сосудистый ствол.
Каковы основные причины тромбоэмболической болезни
Тромбоэмболия никогда не возникает на пустом месте: всегда имеется первичный тромб, который может оторваться от сосудистой стенки, переместиться в другое место и спровоцировать острые симптомы артериальной непроходимости.
К факторам, которые предрасполагают образованию тромбов, относятся:
- хроническая венозная недостаточность и варикозная болезнь ног;
- нарушение обмена липидов с избыточной массой тела;
- малоподвижный образ жизни с перееданием;
- заболевание сердца с повышением артериального давления;
- диабет любого типа;
- поражение сосудов атеросклерозом;
- любое заболевание, приводящее к нарушению свертывания крови;
- наличие в прошлом хотя бы одного случая тромбоза артерий;
- длительное и бесконтрольное применение лекарственных средств, которые могут повысить способность крови к свертыванию.
К факторам, способствующим отрыву и перемещению тромба, или формированию воздушной или жировой эмболии, относятся:
- любой вид операции, как небольшой, малоинвазивной и плановой, выполняемой в условиях поликлиники, так и экстренной с проведением большого хирургического вмешательства;
- серьезные и тяжелые травмы, особенно переломы ног и позвоночника;
- вынашивание плода и роды, как через естественные родовые пути, так и при выполнении кесарева сечения;
- скачки артериального давления, особенно на фоне хронической сердечной недостаточности;
- неожиданная и непривычная физическая нагрузка»
- резко выраженный эмоционально-психический стресс.
Какие бы факторы не стали причиной для образования тромба, если возникла тромбоэмболия, надо вовремя выявить симптомы и попытаться максимально быстро восстановить нормальный кровоток в сосуде.
Какие могут быть признаки острого тромбоза
В некоторых случаях диагноз опытному врачу поставить не составит никакого труда, потому что проявления острого тромбоза бывают настолько типичными и выраженными, что эти проблемы трудно спутать с какой-либо другой болезнью. В зависимости от величины и важности артериального сосуда, тромбоэмболия проявляется разнообразными признаками. Основные симптомы закупорки легочной артерии:
- неожиданное нарушение дыхания в виде одышки, когда больной человек не может вздохнуть, хватая, как рыба, открытым ртом воздух;
- резкие болевые ощущения в груди или животе;
- внезапно появившееся чувство тревоги, возбуждения и страха смерти;
- изменение цвета кожных покровов верхней части тела (цианоз лица);
- выраженное утолщение и увеличение венозных сосудов на шее;
- кашель с хрипами и кровавой мокротой;
- резко выраженное и учащенное сердцебиение;
- неожиданное снижение артериального давления;
- нарушение мочеиспускания вплоть до полного отсутствия мочи;
- обморочное состояние с возможностью потери сознания.
Такая яркая и опасная для жизни картина возникает, когда имеется массивная закупорка просвета легочной артерии, через которую поступает богатая кислородом кровь ко всем жизненно важным органам и системам человеческого организма. Тромбоэмболия других сосудов может иметь другие симптомы, стертые и менее выраженные признаки, которые представлены в таблице.
| Симптомы | Тромбоэмболия | |||
|---|---|---|---|---|
| Легочной артерии | Сосудов брюшной полости | Сосудов ног | Мозговых артерий | |
| Сильная боль в груди | + | |||
| Боль в животе | + | +++ | ||
| Выраженные боли в ногах | +++ | |||
| Одышка, нехватка воздуха | +++ | + | ||
| Обмороки, потеря сознания | + | + | +++ | |
| Резко учащенное сердцебиение | ++ | + | + | |
| Резко учащенное сердцебиение | ++ | + | + | |
| Кашель и кровохарканье | ++ | |||
| Снижение артериального давления | + | + | + | |
| Тревожность, страх | +++ | ++ | + | |
| Сильная слабость | + | + | + | + |
| Потливость, холодный пот | + | |||
| Отсутствие пульса на конечности | +++ | |||
| Потеря чувствительности | +++ | |||
| Рвота | ++ | |||
| Нарушение стула | ++ | |||
| Бледность кожи, цианоз | + | + | ++ | |
| Головная боль | +++ | |||
| Эпилептические припадки | ++ | |||
| Нарушение зрения | ++ | |||
Врачу, обнаружив типичные симптомы, необходимо в кратчайшие сроки поставить диагноз и начать экстренные лечебные мероприятия. Только быстрое восстановление кровотока по крупным сосудам может обеспечить сохранение жизни пациенту, что особенно важно при закупорке легочной артерии.
Как не допустить закупорку сосуда тромбом
В большинстве случаев не надо ждать, когда появятся симптомы, указывающие на нарушение проходимости крупной артерии. Оптимально предотвратить саму возможность осложнения, как на фоне хирургического вмешательства, так и при наличии высокого риска по тромбозу. К основным профилактическим мероприятиям, которые могут предотвратить тромбоэмболию, относятся:
- своевременное выявление и лечение хронических венозных заболеваний;
- коррекция артериальной гипертонии с постоянным приемом лекарственных средств, снижающих давление;
- умеренная физическая нагрузка (ходьба, плаванье, лечебная физкультура);
- прием гормональных и сосудистых препаратов только при постоянном врачебном контроле;
- отказ от курения;
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