Окклюзионное поражение жизненно важных сосудов дыхательной системы может стать причиной внезапной смерти. Легочный тромб закрывает просвет основной артерии, по которой кровь с кислородом течет в сторону сердца: отсутствие нормального сердечно-легочного кровообращения приводит к неминуемому нарушению жизнедеятельности человеческого организма.
Причины артериальной закупорки
Чаще всего появление тромба в легких и окклюзия легочной артерии происходит при определенном стечении неблагоприятных факторов, к которым относятся:
- Формирование сгустка на стенке сосуда в области нижних конечностей или в венозной системе малого таза;
- Создание условий для отрыва тромба;
- Перемещение тромбоэмбола с током венозной крови в сторону лёгочной ткани.
Основными заболеваниями и состояниями, провоцирующими появление венозных тромбов, являются:
- осложненная варикозная болезнь;
- врожденные аномалии и пороки сердца;
- наследственная предрасположенность к сгущению крови (тромбофилия);
- любой вид хирургического вмешательства;
- тяжелые травмы конечностей.
Способствуют тромбообразованию следующие причины:
- метаболический синдром с выраженным ожирением;
- гипертоническая болезнь без лечения;
- малоподвижный образ жизни;
- курение;
- длительная лекарственная терапия с приемом препаратов, действующих свертывающую систему крови;
- длительная неподвижность;
- инфекционные или опухолевые заболевания.
Появление сгустка – это первый этап жизнеугрожающего состояния. Чтобы оторваться и добраться до лёгких, на пристеночный тромб должно быть оказано определенное внешнее или внутреннее воздействие. В любом случае при возникновении закупорки крупного артериального ствола смерть может наступить внезапно (при тромбоэмболии легочной артерии печальный исход бывает у 75% пациентов).
Проявления острого состояния
Если оторвался тромб в легких, и возникла закупорка крупной артерии, то у человека появляются следующие симптомы:
- сильно выраженный болевой синдром в груди;
- нарастающая одышка;
- головокружение со склонностью к потере сознания;
- тахикардия;
- падение сосудистого тонуса;
- изменение окраски кожи (бледность с участками синюшности);
- психоэмоциональные нарушения в виде сильного страха смерти.
Яркие и выраженные симптомы невозможно игнорировать: необходимо незамедлительно вызвать скорую медицинскую помощь и попытаться предотвратить неблагоприятный исход острой закупорки. Чем раньше начаты лечебно-диагностические мероприятия, тем больше шансов для сохранения жизни человека.
Методы обследования
Врач экстренной бригады оценит симптомы, общее состояние больного человека, сделает ЭКГ и максимально быстро доставит пациента в больницу. Если возникло подозрение, что тромб оторвался и имеется риск для жизни, то в условиях стационара необходимо сделать следующие исследования:
- общие анализы с оценкой свертывающей способности крови;
- электрокардиография;
- УЗИ сердца и сосудов (дуплексное сканирование);
- рентгеновский снимок груди;
- специальные сосудистые исследования (флебография, ангиография);
- томографическое обследование с применением контрастных веществ.
На этапе обследования надо обнаружить в сосудах оторвавшиеся тромбы и оценить возможный риск смертельной окклюзии: при неблагоприятном стечении обстоятельств необходимо максимально рано использовать хирургическую операцию. При минимальном риске врач назначит медикаментозную терапию, направленную на рассасывание и безоперационное удаление сгустка из просвета сосуда.
Лечебная тактика
В зависимости от конкретной ситуации врач будет использовать комбинацию из 2 основных вариантов лечения – хирургического и консервативного. Внезапность тромбоэмболии предполагает минимум времени для спасения жизни на фоне окклюзии: прожить более 1 часа после закупорки основного легочного ствола смогут далеко не все люди, даже если вовремя поставлен диагноз и начата экстренная терапия. Лечить острую патологию надо следующими методами:
- внутривенное введение лекарственных препаратов, способствующих рассасыванию тромботических масс внутри сосудов;
- использование препаратов, предотвращающих сгущение крови;
- поддержание нормальной работы сердца и легких;
- коррекция артериального давления;
- проведение операции по восстановлению кровотока по жизненно важным сосудам с применением новейших хирургических технологий;
- профилактические оперативные вмешательства при выявлении тромбоза в нижних конечностях.
При обнаружении тромба в легких, последствия которого для жизни непредсказуемы, необходимо оказывать медицинскую помощь с применением всех современных методик восстановления кровообращения. Прогноз для жизни при тромбоэмболической закупорке ветвей легочной артерии неблагоприятен: процент выживания невысок, особенно при несвоевременной диагностике опасной патологии. Гибель в ближайшее время после окклюзии бывает в 25-30% случаев. Для остальных высок риск осложнений (инфаркт легкого, формирование легочного сердца, прогрессирующая сердечно-легочная недостаточность), крайне негативно влияющих на качество жизни больного человека.
Меры профилактики
Для предотвращения жизнеугрожающих состояний следует использовать рекомендации врача по профилактике тромбоэмболии. Снизить риск появления тромбоза помогут следующие врачебные советы:
- профилактическое лабораторное обследование с выявлением факторов риска по сгущению крови;
- применение курсов лекарственной терапии при тромбофилии;
- медикаментозное или хирургическое лечение при варикозе ног;
- компрессия нижних конечностей при любых оперативных вмешательствах и диагностических исследованиях;
- занятия спортом или регулярная умеренная физическая нагрузка;
- правильное питание и борьба с лишним весом;
- контроль уровня сахара в крови;
- лекарственная коррекция артериальной гипертензии;
- борьба с вредными привычками.
Если в сосудах находится тромб, то следует аккуратно и последовательно выполнять назначения врача по приему таблеток с эффектом тромболизиса. В сложных случаях и при высоком риске опасных осложнений необходимо установить кава-фильтр в венозный ствол. Длительность наблюдения и регулярность посещений определяет специалист: в некоторых случаях потребуется постоянный врачебный контроль с пожизненным приемом лекарственных препаратов.
Тромб в легких – опасное явление, способное привести к летальному исходу. Сгусток препятствует движению крови, становясь причиной нарушения сердечно-легочного кровообращения. Поспособствовать развитию заболевания могут, как независящие от человека факторы (наследственность), так и его образ жизни. Процесс формирования тромба происходит в момент пониженной физической активности. Когда движение возобновляется, тромб отсоединяется от сосудистой стенки и продвигается по легочной артерии. Это может привести к печальным последствиям.
В статье расскажем:
Причины образования тромба в легких
Тромб в легких формируется при создании благоприятных условий в полости сосуда. Главным предрасполагающим фактором является повышенная свертываемость крови. По причине замедленного кровотока она накапливается в определенных участках вены, что приводит к появлению новообразования.
Причины возникновения заболевания у взрослых заключаются в следующем:
- осложненное течение варикоза вен;
- послеоперационный период;
- перенесение тяжелых травм;
- замедленный метаболизм, сопровождающийся лишним весом;
- наследственная тромбофилия;
- длительный прием препаратов, влияющих на свертываемость крови;
- курение и употребление алкогольных напитков.
Статистика показывает, что к тромбозу и тромбофлебиту наиболее расположены люди, имеющие вредные привычки. С возрастом риск появления тромба увеличивается.
Это обусловлено угнетением обменных процессов, что провоцирует изменения сосудистых стенок. В некоторых случаях тромбоз развивается в результате неправильного питания.
Симптоматика
Признаки и симптоматика заболевания на начальных этапах его развития недостаточно выражены. Симптомы становятся заметными, когда процесс разрушения организма уже запущен. Лечение должно быть незамедлительным. После отрывания тромба осложнения и проявления тромбообразований развиваются стремительно.
Существуют признаки, на которые стоит обратить внимание в первую очередь:
- набухание вен на шее;
- кашель с отделением крови;
- побледнение кожных покровов;
- болезненные ощущения в груди;
- повышение температуры тела;
- внезапная отдышка;
- головокружение, за которым следует обморок;
- понижение артериального давления;
- симптомы, характерные для такихардии.
Симптоматика тромбоза появляется лишь в 50% случаев. Именно поэтому диагностика патологического процесса затруднена.
Классификация
Тромбоз легких (ТЭЛА) классифицируют, в зависимости от степени закупорки сосуда, размера тромба, характера кровообращения и степени выраженности симптомов.
С учетом локализации сгустка тромбоз разделяют на следующие типы:
- эмболия, возникшая в области главных легочных артерий и легочного ствола;
- патология на уровне сегментарных артерий;
- сосредоточение сгустка в области промежуточных и долевых артерий.
Также выделяют правый, левый и двусторонний тромбоз, в зависимости от того, какая часть легких поражена.
Тромбоз становится причиной уменьшения либо прекращения кровоснабжения некоторых участков лёгкого, что может привести к инфаркту либо к инфаркт-пневмонии поражённой ткани.
Классификация по типу симптомов заключается в следующем:
- Острое легочное сердце. Патологический процесс поражает крупные и мелкие сосуды легочной артерии. На этой почве появляется сильная отдышка, кардиогенный шок, а также понижается давление.
- Инфарктная пневмония. Болезнь затрагивает только мелкие сосуды легочной артерии. Появляются интенсивные боли в грудине, отдышка усиливается при нахождении человека в вертикальном положении, появляется кровохарканье и повышается частота сердечных сокращений.
- Немотивированная отдышка. Этот тип патологии представляет собой рецидив тромбоза. Он сопровождается ярко выраженной отдышкой и снижением уровня артериального давления.
Неотложная помощь
Состояние пациента напрямую зависит от скорости оказания первой помощи. Это обусловлено тем, что при образовании тромба в легких процент выживания недостаточно высокий. Самым опасным последствием отсоединения тромба является остановка сердца. Если не принять меры, пациент умрет в течение нескольких минут.
Желательно, чтобы в момент приступа больной находился в медицинском учреждении. Для запуска сердца необходим аппарат искусственной вентиляции легких и электрическая дефибрилляция.
Если у пациента наблюдаются симптомы артериальной гипертензии, внутривенно вводят Реополиглюкин. Он нормализует кровообращение в мелких сосудах и оказывает дезинтоксикационое действия, делая кровь менее вязкой.
Современная терапия
Консервативные методы лечения направляются на восстановление перфузии легкого. Также принимаются меры по предотвращению осложнений, одним из которых является хроническая форма легочной гипертензии.
После помещения пациента в реанимацию тромбы в легких устраняют с помощью лекарственных препаратов или хирургическим путем. Также осуществляется контроль над давлением в венах. В случае развития острой дыхательной недостаточности производится интубации трахеи.
Для снижения артериального давления и купирования симптомов тромбоза внутривенно вводят раствор Эуфиллина.
При недостаточной эффективности терапии сгустка подбирается способ хирургического вмешательства. Чаще всего в полость сосудов устанавливают кава-фильтр. Он преграждает тромбу путь к артериям легких. Фильтр вставляется через кожную поверхность в области бедра или почек.
Замедлению венозного кровотока могут поспособствовать длительные путешествия, во время которых человек находится в одном положении. В зоне риска находятся водители, машинисты, путешественники и т.д.
Профилактические меры
Профилактические меры разделяют на вторичные и первичные. В первом случае речь идет о профилактике рецидива заболевания. Под первичными подразумевают меры, осуществляемые при расположенности человека к тромбозу.
В этом случае рекомендуется следовать следующим принципам:
- Необходимо обеспечить подвижный образ жизни: периодически заниматься спортом, осуществлять пешие прогулки, больше бывать на свежем воздухе.
- При повышенной свертываемости крови необходимо принимать препараты для её разжижения.
- Важно отказаться от продуктов с высоким содержанием холестерина. Это позволит избежать ухудшения структуры сосудов.
- Необходимо регулярно контролировать свертываемость крови, уровень глюкозы и холестерина в крови.
- Следует вовремя устранять воспалительные процессы и инфекционные заболевания. Они могут стать толчком к развитию тромбоза.
- Категорически запрещено употреблять крепкие спиртные напитки и курить.
- При варикозном расширении вен нижних конечностей следует выполнять пневмокомпрессию ног, которая помогает устранять отечность.
После лечебной терапии против тромбоэмболии люди живут продолжительное время. Но в этом случае необходимо наблюдаться у врача, чтобы предотвратить рецидив болезни.
Тромбоз лёгких по количеству летальных исходов опережают только ишемия сердца и инсульт.
Крайне важно избавиться от вредных привычек и нормализовать режим питания. Время от времени проводится профилактический курс лечения антикоагулянтами.
При рецидивах заболевания вероятность смертельного исхода увеличивается в несколько раз.
Возможные осложнения и прогнозы
Последствия тромба в легких могут быть плачевными. Если тромб попадает в легкие, повышается риск смерти или получения инвалидности. Шанс на спасение зависит от обширности эмболии.
К возможным осложнениям болезни относят:
- развитие плеврита;
- рецидив тромбоза через 10-12 месяцев;
- внезапная смерть;
- состояние острой гипоксии;
- воспалительный процесс в легком, сопровождающийся некрозом.
При развитии дыхательной недостаточности легочная система перестает снабжать кровь кислородом и выводить из организма излишки углекислого газа. В результате этого развивается гипоксемия и гиперкапния.
Если тромбоэмболия затронула мелкие артериолы и была соблюдена необходимая терапия, прогноз более благоприятен. Согласно статистике, каждый 5 человек, перенесший болезнь, умирает на протяжении первого года после появления симптоматики. И только 20% больных выживают после тромба в легких.
Желательно не допускать состояния, при котором тромб может оторваться и закупорить легочную артерию. Шансы на выживание в этом случае невысокие. Поэтому важно осуществлять профилактику заболевания и проходить регулярные плановые осмотры у флеболога.
Легочный тромб наносит ущерб как легочной ткани, так и нормальному функционированию всех систем организма, с развитием тромбоэмболических изменений в легочной артерии. Тромбы или эмболы являются кровяными сгустками, закупоривающими сосудистую ткань, блокируя путь крови. Обширные образования тромбов при несвоевременном лечении приведут к летальному исходу человека.
Проведение диагностических мероприятий тромбоза легочных артерий проблематично, поскольку симптомы патологии схожи с другими заболеваниями, не выявляются сразу. Поэтому смерть больного возможна на протяжении пары часов после проведённой диагностики.
Что приводит к тромбообразованию
Учёные, занимающиеся вопросами медицины, признают, что тромбоз легких вызывают тромбы. Они формируются в момент, когда течение крови по артериальным сосудам медленное, она сворачивается в момент движения по организму. Зачастую это случается при длительном отсутствии двигательной активности человека. При возобновлении движений эмбол может оторваться, тогда последствия для больного будут серьёзными, вплоть до летального исхода.
Трудно определить из-за чего формируются эмболы. Но существуют обстоятельства, предрасполагающие к формированию лёгочных тромбов. Тромбообразование происходит из-за:
- Прошлых хирургических вмешательств.
- Слишком длительной обездвиженности (при постельном режиме, долгих перелётах).
- Избыточной массы тела.
- Переломов костей.
- Приёма средств, усиливающих сворачиваемость крови.
- Разных других причин.
Другие обстоятельства считаются важными условиями для формирования тромба в легких, образуя симптомы заболевания:
- повреждённая сосудистая сеть лёгких;
- приостановленный или сильно замедленный ток крови по организму;
- высокая сворачиваемость крови.
О симптомах
Зачастую эмболы скрытны, трудно диагностируются. При состоянии, когда оторвался тромб в легких летальный исход, как правило, неожиданный, помочь больному уже невозможно.
Но есть симптомы патологии, при наличии которых человек обязан получить врачебную консультацию и помощь в ближайшие 2 часа, чем быстрее, тем лучше.
Это симптомы, характеризующие острую сердечно-легочную недостаточность, которые проявляются у больного симптомами:
- одышкой, которая раньше никогда не проявлялась;
- болезненностью грудной клетки больного;
- слабостью, резкими головокружениями, обморочным состоянием больного;
- гипотонией;
- сбоем сердечного ритма больного в виде болезненного учащённого сердцебиения, которого раньше не наблюдалось;
- набуханием шейных вен;
- кашлем;
- кровохарканьем;
- бледными кожными покровами больного;
- синюшными кожными покровами верхней части тела больного;
- гипертермией.
Такие симптомы наблюдались у 50 больных, имеющих это заболевание. У других больных патология была незаметной, не доставляла никакого дискомфорта. Поэтому важным является фиксация каждого симптома, поскольку закупоренные маленькие артериальные сосуды покажут слабую симптоматику, что не менее опасно для больного.
Как помочь
Нужно знать, что когда отрывается эмбол в легочной ткани, развитие симптомов будет молниеносным, больной может умереть. Если обнаружены симптомы заболевания, больной должен находиться в спокойной обстановке, больному требуется срочная госпитализация.
Неотложные меры заключаются в следующем:
- район центральной вены экстренно катетеризируют, выполняют введение Реополиглюкина, или смеси из глюкозы и новокаина;
- внутривенное введение Гепарина, Эноксапарина, Дальтепарина;
- Устранение боли наркотиками (Промедолом, Фентанилом, Морином, Лексиром, Дроперидолом);
- проведение оксигенотерапии;
- введение тромболитических препаратов (Урокиназы, Стрептокиназы);
- введение при аритмиях Магния сульфата, Дигоксина, Рамиприла, Панангина, АТФ;
- предотвращение шока путём введения Преднизолона либо Гидрокортизона и спазмолитических средств (Но-шпы, Эуфиллина, Папаверина).
Как лечить
Меры реанимации восстановят кровоснабжение легочной ткани больного, не допустят развиться септическим реакциям, предотвратят легочную гипертонию.
Но после того, как оказана неотложная помощь, больному требуются дальнейшие лечебные мероприятия. Следует предотвратить рецидивы патологии, чтобы не оторвавшиеся эмболы рассосались. В лечении применяют тромболитическую терапию и хирургическое вмешательство.
Больного лечат тромболитиками:
- Гепарином.
- Стрептокиназой.
- Фраксипарином.
- Тканевым плазминогеновым активатором.
- Урокиназой.
С помощью этих средств эмболы растворятся, прекратится формирование новых тромбов.
Внутривенное введение Гепарина должно быть от 7 до 10 суток. Требуется следить за параметром сворачиваемости крови. За 3 или 7 суток до конца лечебных мер пациенту назначается в таблетках приём:
- Варфарина.
- Тромбостопа.
- Кардиомагнила.
- Тромбо АСС.
Продолжают контролировать сворачиваемость крови. После перенесённого заболевания таблетки принимают около 12 месяцев.
При операциях тромболитики запрещены. Также не применяют их при риске кровопотери (язва желудка).
Хирургическая операция показана в случае поражения эмболом обширной зоны. Требуется устранить локализованный в лёгких эмбол, после чего движение крови нормализуется. Операцию проводят если есть закупорка эмболом артериального ствола или крупной ветки.
Как диагностируют
При тромбоэмболии легочной артерии в обязательном порядке проводят:
- Электрокардиографическое обследование, позволяющее увидеть запущенность патологического процесса. При сочетании с анамнезом больного с ЭКГ вероятность подтверждения диагноза высокая.
- Рентгеновское обследование малоинформативно, но отличает это заболевание от других с одинаковыми симптомами.
- Эхокардиографическое обследование выявит точное место расположения эмбола, его параметры размера, объёма и формы.
- Сцинтиграфическое легочное обследование покажет насколько поражены сосуды лёгких, участки, где кровообращение нарушено. Диагностировать заболевание данным методом возможно только при поражении больших сосудов.
- Ультразвуковое обследование венозных сосудов нижних конечностей.
О профилактике
Первичные профилактические меры проводят до появления тромба в лёгких тем больным, кто склонен к тромбозу. Она проводится людям, находящимся на долгом постельном режиме, а также тем, кто подвержен перелётам, больным с высокой массой тела.
Первичные меры профилактики включают следующее:
- надо бинтовать нижние конечности больного эластическими бинтами, особенно при тромбофлебите;
- вести активный образ жизни, нужно восстанавливать двигательную активность больным, перенёсших хирургическое вмешательство или инфаркт миокарда, в дальнейшем сокращать их постельный режим;
- следует проводить ЛФК;
- при сильной сворачиваемости крови врачом назначаются средства для разжижения крови под строгим врачебным контролем;
- проведение хирургического вмешательства по ликвидации имеющихся тромбов, чтобы они не могли отрываться и блокировать ток крови;
- устанавливают специфический хава-фильтр, предотвращающий образование нового эмбола в легочной ткани. Его используют при наличии патологических процессов на ногах, чтобы предотвратить дальнейшее их формирование. Это устройство не пропускает эмболы, зато для движения крови барьеров нет;
- применяют пневмокомпрессионный метод для нижних конечностей в целях уменьшения отёков при варикозных изменениях венозных сосудов. Состояние больного при этом должно улучшиться, тромбообразования постепенно рассосутся, вероятность рецидива снизится;
- следует полностью отказаться от алкогольных напитков, наркотиков, не курить, что влияет на формирование новых эмбол.
Вторичные профилактические меры необходимы в случае, когда больной перенёс тромбоэмболию легочной артерии, а медработниками ведётся борьба за недопущение рецидива.
Основные способы при этом варианте:
- устанавливают кава-фильтр для улавливания сгустков крови;
- больному назначают антикоагулянтные средства для предотвращения быстрой сворачиваемости крови.
Следует полностью отказаться от губительных привычек, питаться сбалансированно продуктами, имеющих необходимую норму для человека макро- и микроэлементов. Повторные рецидивы переносятся тяжело, могут привести к смерти больного.
Какие возможны осложнения
Тромб в лёгких вызывает множество разных проблем, среди которых возможны:
- неожиданная смерть больного;
- инфарктные изменения легочной ткани;
- воспаление плевры;
- кислородное голодание организма;
- рецидивы заболевания.
О прогнозах
Шанс спасти больного при оторванном эмболе зависит от того, насколько обширна тромбоэмболия. Мелкие очаговые участки способны рассосаться сами, кровоснабжение также восстановится.
Если очаги множественные, то легочной инфаркт несёт угрозу для жизни больного.
Если наблюдается дыхательная недостаточность, то лёгкие кровь не насыщает кислородом, излишек углекислоты не устраняется. Появляются гипоксемические и гиперкапнические изменения. При этом возникает нарушение кислотного и щелочного баланса крови, тканевые структуры повреждаются углекислотой. В этом состоянии шанс для выживания больного минимален. Требуется срочная искусственная легочная вентиляция.
Если эмболы образовались на мелких артериях, выполнено адекватное лечение, то исход благоприятный.
Статистические данные утверждают, что каждый пятый больной, который перенёс это заболевание, помирает в течение первых 12 месяцев после проявившейся симптоматики. Только около 20% пациентов живут следующие 4 года.
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