Nce bilirubin thaum cev xeeb tub: cov qauv, ua rau thiab cov tsos mob, kev kho mob, qhov tshwm sim

2024 Tus sau: Priscilla Miln | [email protected]. Kawg hloov kho: 2024-02-18 01:57

Lub xeev ntawm poj niam txoj kev noj qab haus huv cuam tshuam ncaj qha rau lub sijhawm cev xeeb tub thiab qhov tshwm sim ntawm kev yug menyuam. Kev tshuaj xyuas thiab kev tshuaj xyuas thoob plaws tag nrho lub sijhawm cev xeeb tub tso cai rau kev soj ntsuam tas li ntawm cov ntsuas txhawm rau txhawm rau teb raws sijhawm kom pom qhov sib txawv ntawm cov qauv, yog tias tsim nyog. Ib txoj hauv kev los kuaj xyuas tus mob ntawm tus poj niam cev xeeb tub yog kuaj ntshav biochemical. Nws yog nws leej twg tso cai rau koj kuaj xyuas qhov siab bilirubin thaum cev xeeb tub. Qhov ntsuas no txhais li cas thiab nws cov qauv yog dab tsi, peb yuav qhia hauv peb tsab xov xwm. Nco ntsoov nyob ntawm qhov laj thawj ntawm nws qhov nce, cov tsos mob thiab txoj kev kho mob.

YYuav ua li cas yog bilirubin?

Raws li qhov tshwm sim ntawm lub ntuj tawg ntawm hemoglobin, tsim cov kua tsib lub ntsiab xim, uas zoo lidaj-xim av rhombic crystals. Qhov no yog bilirubin. Nws muaj nyob rau hauv cov ntshav cov ntshav thiab cov kua tsib. Yuav luag 80% ntawm cov xim no raug rhuav tshem hauv daim siab, thiab 20% ntxiv rau hauv lwm cov ntaub so ntswg thiab kabmob.

Bilirubin tuaj yeem txuas ncaj qha (direct) thiab tsis ncaj. Muaj qhov sib txawv tseem ceeb ntawm lawv. Ua ke lawv tsim tag nrho bilirubin. Tag nrho peb qhov ntsuas yuav tsum tau qhia hauv kev kuaj ntshav, thiab tsis yog ib qho xwb.

Direct bilirubin tsuas yog 4% ntawm tag nrho. Nws dissolves zoo hauv dej, lim los ntawm ob lub raum thiab tawm hauv cov zis.

Indirect bilirubin suav rau 96% ntawm tag nrho. Nws yog insoluble hauv dej, tshuaj lom rau lub cev, tuaj yeem nkag mus rau hauv cov hlwb yooj yim thiab cuam tshuam lawv cov haujlwm tseem ceeb. Feem ntau thaum cev xeeb tub, qib ntawm bilirubin tsis hloov txhua txoj hauv kev thiab tseem nyob hauv qhov qub. Tus poj niam zoo siab heev thiab kev xeeb tub mus yam tsis muaj "kev xav tsis thoob". Tab sis qee zaum kev sib txawv ntawm cov qauv tsim tau ua tau.

Ua rau nce bilirubin thaum cev xeeb tub

Kev nce ntxiv ntawm cov kua tsib xim hauv cov ntshav ntshav qhia txog kev hloov pauv hauv daim siab lossis lwm yam kabmob thiab cov ntaub so ntswg. Cov bilirubin txawv txav tuaj yeem tshwm sim los ntawm kev xeeb tub thiab lwm yam kab mob: Cov no suav nrog:

• ua txhaum ntawm cov kua tsib, vim nws tsis nkag mus rau hauv plab, tab sis mus rau hauv cov ntshav;
• mob thiab kab mob siab autoimmune;
• kab mob gallstone;
• tshuaj lom kab mob siab thiab tshuaj tua kab mob (xws li tshuaj lom lossistshuaj, suav nrog hormonal);
• biliary cirrhosis;
• mob siab kab mob siab;
• sluggish pathological txheej txheem hauv siab.

Cov txiaj ntsig ntawm kev kuaj ntshav biochemical tsuas tuaj yeem pom qhov nce hauv bilirubin ncaj qha. Tshwj xeeb, lwm hom kev tshawb fawb tau sau tseg, piv txwv li, kuaj lub siab. Kev kuaj ntshav yog ua tiav ob qho tib si thiab biochemical. Pathology tej zaum yuav txuam nrog impaired pigment processing los yog ceev ceev tawg ntawm cov qe ntshav liab. Indirect bilirubin tuaj yeem ua rau pom tsis yooj yim vim nws tsis yaj hauv dej. Cov laj thawj rau nws qhov kev nce ntxiv suav nrog ntau yam kab mob ntshav qab zib (congenital, theem nrab, tshuaj lom neeg, tshuaj lom neeg) thiab kab mob tshwj xeeb (malaria, sepsis, thiab lwm yam).

Nws yog ib qho tseem ceeb los kuaj xyuas cov bilirubin siab hauv lub sijhawm thaum cev xeeb tub. Qhov no yuav zam qhov teeb meem thiab ua kom muaj peev xwm kho tau.

Bilirubin feem ntau nce siab vim yog vim li cas tsis cuam tshuam txog kev xeeb tub. Tab sis qee zaum kev nce qib ntawm cov kua tsib xim yuav tsum tau nrhiav kom meej nyob rau hauv txoj hauj lwm nthuav ntawm tus poj niam. Cov laj thawj no suav nrog:

• mob toxicosis ntxov;
• mob siab mob siab;
• preeclampsia thiab eclampsia;
• Yintrahepatic cholestasis;
• stagnation ntawm cov kua tsib vim yog lub zog fetal siab ntawm daim siab.

Cov tsos mob ntawm siab bilirubin

Yog tias qhov nce ntxiv ntawm cov kua tsib xim yog tshwm sim los ntawm cov txheej txheem pathological hauv lub siab, qhov no ua rauyellowness ntawm daim tawv nqaij thiab darkening ntawm cov zis. Nyob rau tib lub sijhawm, bilirubin hauv cov ntshav thawj zaug nce. Hauv cov zis, txawm li cas los xij, nws tsuas yog kuaj tau tom qab ib ntus.

Yog hais tias nce bilirubin thaum cev xeeb tub yog tshwm sim los ntawm ib qho mob hnyav ntawm eclampsia, qib ntawm cov kua tsib xim hauv cov ntshav siab tshaj qhov ntsuas los ntawm 5-6 zaug. Tib lub sijhawm, tus poj niam muaj cov tsos mob xws li kub taub hau, xeev siab, ntuav, mob plab.

Kev kuaj mob intrahepatic cholestasis yog tshwm sim los ntawm khaus thoob plaws lub cev thiab daj ntawm daim tawv nqaij. Feem ntau, tus mob no tshwm sim ua ntej yug me nyuam raws li cov lus teb rau kev nce hauv cov tshuaj estrogen thiab ploj ntawm nws tus kheej tom qab tus menyuam yug los.

Yog li, cov tsos mob ntawm kev nce bilirubin nyob ntawm seb tus kab mob tshwj xeeb tau kuaj pom hauv tus poj niam. Nyob ntawm qhov no, kev kho mob tsim nyog tau sau tseg.

siab bilirubin thaum cev xeeb tub

Feem ntau cov poj niam uas cev xeeb tub tau ntsib tus mob xws li toxicosis. Nyob rau hauv ib co, nws tshwm sim nyob rau hauv ib tug me me daim ntawv, thaum nyob rau hauv lwm tus neeg nws yog nrog los ntawm excruciating xeev siab thiab ntuav heev, tsis tsuas yog thaum sawv ntxov, tab sis kuj thaum nruab hnub. Complex toxicosis yog ib qho ua rau muaj kev nce bilirubin thaum cev xeeb tub.

Nws yuav tsum tau muab sau tseg tias cov xwm txheej zoo li no thaum ntxov tuaj yeem ua rau muaj kev phom sij. Kev mob hnyav toxicosis feem ntau ua rau lub suab nrov ntawm lub tsev menyuam, uas, dhau los, ua rau muaj kev pheej hmoo ntawm nchuav menyuam. Thaum lub sij hawm no, nws yog ib qho tsim nyog yuav tau sim ua kom tus mob ntawm tus poj niam cev xeeb tub kom sai li sai tau. Tom qab tso tseg cov tsos mob ntawm toxicosis, bilirubin yuav rov zoo li qub tom qab ib ntus.koj tus kheej.

YKev kuaj mob ntawm pathology

Koj tuaj yeem txiav txim siab txog qib bilirubin hauv cov ntshav uas siv biochemical tsom xam ntshav lossis zis. Tab sis qhov kev xaiv kawg tsis yog ib txwm qhia. Piv txwv li, nrog kev nce hauv indirect bilirubin, cov ntsuas yuav zoo li qub. Yog li ntawd, cov poj niam cev xeeb tub raug qhia kom kuaj ntshav biochemical. Tsis txhob txhawj ntau dhau yog tias cov tsos mob tau teev saum toj no tsis tuaj, thiab bilirubin nce siab. Tej zaum cov lus pom zoo kom dhau qhov kev tshuaj ntsuam tsis tau ua raws li:

1. Ntshav yuav tsum nruj me ntsis ntawm lub plab khoob. Noj mov kawg yuav tsum tsis pub dhau 20:00 hnub dhau los.
2. 2-3 hnub ua ntej hnub xav tau ntawm kev sim, koj yuav tsum tsis kam noj ntsim, haus luam yeeb thiab ntsev.
3. Tus niam uas xav tau yuav tsum sim so, tsis txhob ntshai, vim tias kev ntxhov siab tuaj yeem cuam tshuam qhov tshwm sim.

Cov qauv ntawm bilirubin hauv cov ntshav ntawm tus poj niam cev xeeb tub

Yog tias, raws li cov txiaj ntsig ntawm kev tshuaj ntsuam, qib ntawm cov kua tsib xim siab, kev tshuaj xyuas yuav tsum tau rov qab, tab sis suav nrog cov lus pom zoo saum toj no. Cov qauv ntawm bilirubin hauv cov poj niam cev xeeb tub yuav tsum nyob hauv cov kev txwv hauv qab no:

• general - 3, 4-17, 1 µmol/L;
• bound - 0-7.9 µmol/L;
• indirect - qis dua 19.1 µmol/l.

Ib qho kev hloov pauv tseem ceeb ntawm tus qauv txhais tau hais tias bilirubin nce siab thaum cev xeeb tub thiab yuav tsum tau txo qis tam sim ntawd. Ua li no, nws raug nquahu kom sab laj nrog kws kho mob gastroenterologist uas yuav xaivkev kho mob yooj yim haum rau tus poj niam tus mob

Tshuaj rau niam thiab fetus

Feem ntau, kev nce hauv bilirubin hauv cov ntshav tshwm sim hauv peb lub hlis twg ntawm cev xeeb tub. Qhov no yog vim lub load loj ntawm daim siab raws li kev nce hauv qhov loj ntawm lub tsev menyuam. Nyob rau hauv lem, tus mob no ua rau stagnation ntawm cov kua tsib thiab nce nyob rau hauv bilirubin. Qhov tshwm sim rau cev xeeb tub tuaj yeem sib txawv heev:

• Nrog rau cov kua tsib ntxiv me ntsis (hauv 8, 4-20, 5 µmol / l), tsis muaj kev phom sij rau leej niam thiab menyuam. Cov qib bilirubin rov zoo li qub tam sim tom qab yug me nyuam, thaum lub load ntawm daim siab tsawg dua.
• Nrog rau cov xim muaj zog ntxiv, muaj kev hem thawj tiag tiag rau tus mob ntawm tus niam thiab tus menyuam hauv plab. Yog tias qib ntawm bilirubin tsis txo qis rau lub sijhawm, qhov kev pheej hmoo ntawm kev yug ntxov ntxov lossis kev yug menyuam tseem tuaj yeem ua tau. Rau leej niam, qib siab ntawm cov kua tsib xim tuaj yeem txhais tau tias kev loj hlob ntawm hemolytic anemia lossis kab mob siab.

Yuav ua li cas nrog nce bilirubin?

Txhawm rau txo qis cov kua tsib xim hauv cov ntshav thiab zis, nws yog ib qho tsim nyog yuav tsum paub tias vim li cas nws thiaj li nce. Qhov no pathology yog kho los ntawm ib tug gastroenterologist. Txhawm rau kuaj xyuas kom raug, tus poj niam cev xeeb tub yuav tsum tau rov ua dua cov khoom siv rau biochemistry thiab ua ultrasound ntawm lub plab kab noj hniav kom kuaj xyuas lub siab thiab lub gallbladder.

Nrog rau kev nce hauv bilirubin hauv cov ntshav thaum cev xeeb tub, cov kev kho hauv qab no tau muab:

• kev noj zaub mov uas tsis suav cov zaub mov ua rau lub siab;
• tshuaj pub rau cov poj niam cev xeeb tubme nyuam;
• ua raws li kev tswj hwm ntawm ib hnub, noj qab nyob zoo pw tsaug zog ntev 7-8 teev;
• noj chamomile-based tshuaj decoctions (tsuas yog tom qab sab laj nrog kws kho mob);
• kev kho mob infusion.

Kev xaiv cov tshuaj yog nyob ntawm qhov ua rau ua rau nce bilirubin. Txhawm rau txhim kho cov kua tsib thiab ua kom lub siab ua haujlwm, cov tshuaj "Essentiale", "Karsil", "Hofitol" tuaj yeem raug sau tseg. Tab sis nyob rau hauv txhua rooj plaub, tag nrho cov kev pheej hmoo ntawm kev noj lawv yog thawj zaug ntsuas.

ntsuas kev tiv thaiv

Txhawm rau tiv thaiv kom tsis txhob nce tag nrho bilirubin thaum cev xeeb tub, koj yuav tsum ua tib zoo kho koj tus mob. Thiab qhov no txhais tau tias koj yuav tsum tau sim tshem tawm txhua yam uas tuaj yeem ua rau pathology.

Txhawm rau tiv thaiv kev nce hauv bilirubin thaum cev xeeb tub, nws raug pom zoo:

• ua raws li kev noj zaub mov kom raug thiab noj qab nyob zoo;
• ditch caffeine nyiam cov dej huv huv;
• tswj cov kab mob ntev uas tuaj yeem ua rau lub sijhawm cev xeeb tub;
• tsis txhob siv tshuaj uas txwv tsis pub rau cov poj niam cev xeeb tub;
• tsis txhob khaws lossis noj hav zoov nceb, kom tsis txhob ua rau lub cev qaug;
• sau npe raws sijhawm ntawm lub tsev kho mob antenatal thiab ua raws li txhua tus kws kho mob cov lus pom zoo.

Nce bilirubin tsis tshua rov qab los rau nws tus kheej. Yog li ntawd, nyob rau hauv me ntsis suspicion ntawm pathology, nws yog tsim nyog los tam sim ntawdmus ntsib kws kho mob.

Puas muaj bilirubin tsawg txaus ntshai thaum cev xeeb tub

Txog qee lub sijhawm, qib qis ntawm cov kua tsib xim hauv cov ntshav tsis ua rau muaj kev txhawj xeeb ntawm cov kws kho mob. Txawm li cas los xij, kev tshawb fawb tsis ntev los no tau pom tias qis bilirubin tuaj yeem yog ib qho ntawm cov cim qhia ntawm kev txhim kho ntawm cov xwm txheej hauv qab no:

• non-hemolytic anemia;
• mob plawv ischemic;
• kev nyuaj siab.

Nws tsim nyog sau cia tias qhov pathology no tsis tshua muaj thaum cev xeeb tub. Feem ntau, nws raug kuaj pom hauv cov niam txiv uas xav haus luam yeeb.