KARDIOEMBOLIK INSULT KECHISHINING KLINIK VA PATOMORFOLOGIK HUSUSIYATI
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kardioembolik insult, ishemik infarkt, uyqu arteriyasi tizimi, vertebrobazilar tizim, miokard infarkti, bo’lmachalar fibrilatsiyasi, autopsiya##article.abstract##
So’nggi o’n yilliklarda serebrovaskulyar kasalliklar (CVD) zamonaviy jamiyatning dolzarb tibbiy va ijtimoiy muammosi bo’lib qolmoqda. Ishemik insultning asosiy patogenetik kichik turlaridan biri kardioembolik insult (KEI) bo’lib, u barcha insult kichik turlarining 22-39% ni tashkil qiladi. KEI nevrologik simptomlarning tez rivojlanishi (80% hollarda) dastlabki 5 daqiqada maksimal zararlanish (47-74%) va katta va o’rta ishemik infarktlar bilan tavsiflanadi, bu 85% hollarda uyqu arteriyalari sistemasida joylashib, arteriya havzasi ko’pincha chap o’rta miya arteriyasidadir (O’MA).
Tadqiqot maqsadi: Ushbu tadqiqotda kardioembolik insultning patomorfologik va klinik xususiyatlari, masalan, nevrologik belgilar, har bir seksion holatdagi miya va miokard infarktlarining makroskopik va mikroskopik tadqiqotlari o’tkazildi va tahlil qilindi.
Tadqiqot materiali va usullar: Tadqiqot keng qamrovli klinik va patomorfologik tekshiruv natijalarini tahlil qilishga asoslangan. Bemorlar 1 yil muddat davomida saralab olindi. Klinik kuzatuvlar Toshkent tibbiyot akademiyasi birinchi klinikasida intensiv nevrologiya kafedrasida o‘tkazildi. Tanlash mezonlari: 1) o’tkir miokard infarkti va bo’lmachalar fibrilatsiyasi (asosiy guruh) fonida ishemik insult (II) o’tkizgan bemorlar; 2) yurak patalogiyasi bo'lmagan ishemik insult (II) kuzatilgan shaxslar (nazorat guruhi). Miya va koronar arteriyalarning aterostenozi bilan ishemik insult va miokard infarkti kuzatilgan 138 ta seksiyasi tahlili o’tkazildi. Vafot etgan barcha bemorlarning jasadlari Respublika patologik anatomiya markazi laboratoriyasida tahlildan o‘tkazildi. Barcha 138 holatda miyaning makroskopik tekshiruvi har bir miya infarkti turini, hajmini, joylashishini, tashkil etilganlik darajasini va har bir qismli holatda miya infarkti soni aniqlandi. Har bir holatda, aterosklerotik o’zgarishlar bilan miya va miya tomirlarining mikroskopik tekshiruvi ham amalga oshirildi. Mikroskopik tekshirish uchun miya infarkti hududidan, shuningdek, infarkt bilan chegaradosh hududdan namunalar olindi.
Natijalar: II va yurak patologiyasi bo’lgan bemorlar - 120 kishi (I guruh) - 48 yoshdan 77 yoshgacha bo’lgan 65 erkak va 55 ayol (62,6±5,8 yosh).
Yurak patologiyasi bo’lmagan II bilan og’rigan bemorlar - 160 kishi (II guruh). Ulardan 56 yoshdan 81 yoshgacha (68,4±5,4 yosh) 83 nafari erkaklar va 77 nafari ayollardir. Halok boʻlganlar orasida 45 yoshdan 93 yoshgacha boʻlgan (oʻrtacha yoshi 69±11 yosh) 93 nafar erkak va 45 nafar ayol bor. Erkaklar o’rtacha yoshi 60 yosh, ayollar 69 yosh. 113 holatda (82%) otopsiyada aterosklerozning arterial gipertenziya bilan kombinatsiyasi, 9 tasida (6,5%) qandli diabet bilan ateroskleroz aniqlangan. 64 bemorda (47%) o’lim sababi miya infarkti tufayli miya ustuni va miyacha qismlarining foramen magnumga dislokatsiyasi va integratsiyalashuvi bilan og’ir miya shishi bo'lgan. Barcha holatlar 3 guruhga bo’lingan: 1-guruhga uyqu arteriya tizimida lokalizatsiya qilingan infarktlar (68 ta holat), 2-guruhga vertebrobazilar tizimda lokalizatsiya qilingan infarktlar (36 ta holat), 3-guruhga- ikkala tizimning arteriyalarida infarktlarning lokalizatsiyasi bo’lgan holatlar (34 ta holat) infarktlar kiritilgan.
Xulosa. Aterosklerozdagi miya infarktlari turli xil lokalizatsiya bilan tavsiflanadi; tashkil etish darajasi, miqdori; turi; va shuningdek: ularning paydo bo’lishining asosiy omillari. Eng ko’p o’rta infarktlar va kichik chuqur infarktlar aniqlangan bo’lsa, katta infarktlar va kichik yuzaki infarktlar kamroq tarqalgan; Bizning tadqiqotimizda arteriyalarning ichki qatlamini 30-80% ga toraytiruvchi ko’plab aterosklerotik pilaklar 46% hollarda topilgan. Bundan tashqari, 28% hollarda pilakcha IUA ning turli qismlarida – O’UAning miya arteriyalarida joylashgan.
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