Kev kho mob ntawm bronchial hawb pob yog qhov pib ntawm txhua yam kev kho mob rau tus kab mob no. Pathology yog tus cwj pwm los ntawm kev tsim cov mob ntev, uas cuam tshuam nrog eosinophils thiab mast hlwb hauv cov txheej txheem.
Yog tias tus neeg mob ua rau muaj cov tsos mob tsis zoo, qhov kev cuam tshuam ntawm txoj hlab pas tau txais, uas feem ntau thim rov qab vim yog siv tshuaj kho lossis tam sim ntawd. Qhov no tej zaum yuav nrog los ntawm hyperreactivity ntawm lub pa system nyob rau hauv relation mus rau sab hauv thiab sab nrauv manifestations. Cov kev xaiv kho mob rau cov kev kho mob yooj yim ntawm bronchial hawb pob, kev kho mob uas tuaj yeem nqa tawm hauv tsev thiab hauv tsev kho mob, pw hauv kev ua raws li cov tshuaj noj.
Lub hom phiaj ntawm txoj kev kho no yog dab tsi?
Txoj kev tswj hwm thiab kev siv tshuaj xyuas kab mob suav nrog cov haujlwm hauv qab no, uas ua rau nws muaj peev xwm ntsuas qhov ntsuas qhov hnyav ntawm tus mob hawb pob. Cov lus pom zoo rau cov kev kho mob yooj yim ntawm bronchial hawb pob hauv cov neeg laus yuav ua raws li hauv qab no:
- kev ntsuas ntawm kev ua haujlwm ntawm bronchopulmonary system;
- tswj cov tsos mob;
- tshem tawm qhov tshwm sim theem nrab hauv kev kho mob hawb pob;
- txo thiab tshem tawm kev mob hawb pob;
- Qhia tus neeg mob txog kev xaiv kho tus kheej thaum muaj xwm txheej ceev;
- tswj qhov pib ua rau, nrog rau kev tiv thaiv kev sib cuag, uas yog qhov ua rau tsim kev mob hawb pob;
- xaiv cov kev kho mob uas tsim nyog thaum lub sij hawm exacerbation ntawm kev mob hawb pob thiab thaum lub sij hawm tshem tawm;
- Ntxiv rau, ua tib zoo saib xyuas tus neeg mob qhov kev ua thiab cov lus teb rau kev kho tshuaj yog qhov tseem ceeb.
Txhua yam teeb meem saum toj no yog suav tias yog cov tseem ceeb hauv kev kho mob hawb pob. Txhua hom mob hawb pob, tshwj tsis yog daim ntawv mob me me, yog tswj hwm nrog cov tshuaj tshuaj, uas tsis tuaj yeem ua tiav nrog kev loj hlob ntawm cov kab mob cuam tshuam nrog nws.
Diagnosis
Kev kuaj mob feem ntau yog tsim los ntawm kws kho mob pulmonologist raws li kev tsis txaus siab thiab muaj cov tsos mob tshwm sim. Tag nrho lwm txoj hauv kev ntawm kev kuaj mob yog tsom rau kev tsim cov theem ntawm qhov hnyav thiab etiology ntawm tus kab mob.
Spirometry. Pab ntsuam xyuas qib ntawm bronchial obstruction, paub qhov txawv thiab convertibility ntawm obstructive, thiab kom paub tseeb tias qhov kev kuaj mob. Hauv BA, kev ua kom nrawm nrawm tom qab nqus tau nrog bronchodilator nce 12% hauv ib thib ob (200ml) thiab saum toj no. Txawm li cas los xij, kom tau txais cov ntaub ntawv raug ntau dua, spirometry yuav tsum tau ua ob peb zaug.
Peakflowmetry, lossis kev txiav txim siab ntawm qhov siab tshaj plaws ntawm qhov ntws tawm (PSV), ua rau nws muaj peev xwm saib xyuas tus neeg mob tus mob, sib piv cov yam ntxwv nrog cov uas tau txais ua ntej. Kev nce hauv PSV twb tom qab nqus tau los ntawm 20% lossis ntau dua los ntawm PSV ua ntej qhov nqus tau pom tseeb qhia tias muaj mob hawb pob.
Kev kuaj mob ntxiv suav nrog kev kuaj tshuaj tsis haum, ntshav roj, ECG, bronchoscopy, thiab lub ntsws x-rays.
Kev kuaj ntshav hauv chaw kuaj mob ua lub luag haujlwm tseem ceeb hauv kev ua pov thawj qhov kev tsis haum ntawm kev mob ntsws asthma, nrog rau kev kwv yees cov txiaj ntsig ntawm kev kho.
- Kev kuaj ntshav. Eosinophilia thiab nce me ntsis hauv ESR thaum lub sijhawm exacerbation.
- Sputum tsom xam (sputum). Nrog microscopy hauv cov hnoos qeev, nws tuaj yeem txheeb xyuas ntau tus eosinophils, Charcot-Leiden crystals (ci ntsa iab tsis muaj xim uas tshwm sim tom qab kev puas tsuaj ntawm eosinophils thiab muaj cov duab ntawm rhombuses lossis octahedrons), Kurshman's spirals (tshwm sim vim me me convulsive contractions. ntawm lub bronchi thiab zoo li cam khwb cia ntawm cov xim tsis muaj mucus nyob rau hauv spirals).
Cov leukocytes nruab nrab tuaj yeem kuaj pom hauv cov neeg mob nyob rau theem ntawm cov txheej txheem mob hnyav.
Nws kuj tau tsim tsa tias Creole lub cev tau hais tawm thaum lub sijhawm tawm tsam - cov no yog cov txheej txheem sib npaug uas muaj cov hlwb epithelial. Kev kuaj ntshav biochemical tsis suav tias yog txoj kev kuaj mob tseem ceeb, vim tias cov kev hloov pauv yog qhov dav dav thiab zoo sib xwsKev tshuaj xyuas tau raug sau tseg los kwv yees tus neeg mob tus mob thaum lub sijhawm exacerbation. Nws yog ib qho tsim nyog los ua kom paub meej txog kev tiv thaiv kab mob. Nrog rau tus kab mob no, tus naj npawb thiab lub zog ntawm T-suppressors tau txo qis, thiab tus naj npawb ntawm immunoglobulins hauv cov ntshav nce ntxiv. Kev siv cov kev ntsuam xyuas los txiav txim seb tus nqi ntawm immunoglobulins E yog qhov tseem ceeb yog tias tsis muaj sijhawm los ua cov kev tshawb fawb txog kev ua xua.
Tom qab txhua qhov kev tswj hwm, koj tuaj yeem pib kho. Kev kho mob hauv cov kev kho mob yooj yim ntawm bronchial hawb pob suav nrog ntau pab pawg tshuaj. Cov feem ntau yuav muaj npe hauv qab no.
YGlucocorticosteroids
Lub ntsiab lus tseem ceeb ntawm kev kho mob rau kev mob ntsws asthma yog glucocorticosteroids. Cov txiaj ntsig kho mob ntawm cov kws tshuaj feem ntau yog vim muaj qhov ua rau nce cov khoom ntawm adrenoreceptors nrog lawv cov kev pab, uas tuaj yeem tiv thaiv qhov tsis zoo ntawm cov tshuaj tsis haum. Tsis tas li ntawd, corticosteroids tshem tawm tag nrho cov kev tshwm sim sab nraud ntawm tus kab mob, uas yog o. Qhov sib txawv ntawm cov tshuaj no thiab cov kab ke yog lawv cov tshuaj tiv thaiv kab mob thiab qhov tsawg kawg nkaus ntawm qhov tshwm sim thib ob. Cov tshuaj yog muab tshuaj raws li qhov hnyav ntawm tus kab mob thiab tus mob ntawm tus neeg mob.
YSystemic glucocorticosteroids
Cov tshuaj no yog siv los ntawm qhov ncauj lossis los ntawm kev txhaj tshuaj thaum muaj cov txheej txheem kab mob nyuaj hauv ib koob me me (raws li cov txheej txheem ua ntej), vim tias lawv muaj cov txiaj ntsig zoo. Nws yog ntshaw kom muab cov tshuaj npaj no intravenously. Cov tshuaj tsim nyog no raug sau tseg thaum lwm txoj kev kho mob tsis zoo.
Mast Cell Stabilizers
Cov tshuaj no muaj qhov tshwj xeeb zoo uas tiv thaiv kev ua haujlwm degranulation ntawm mast hlwb, tso cov tshuaj histamine. Stabilizers muaj peev xwm txwv tsis pub mob hnyav thiab ntev bronchospastic teb rau kev ua xua. Tsis tas li ntawd, cov tshuaj no txo cov bronchial dynamism thaum nqus tau thiab exhalation ntawm huab cua nyob rau hauv lub caij txias, txo qhov zaus thiab lub sij hawm ntawm qaug dab peg. Nws yuav tsum tsis txhob hnov qab tias kev kho mob nrog cov tshuaj no yuav tsum nyob luv luv, vim tias lawv tuaj yeem ua rau muaj kev phiv.
Leukotriene antagonists
Cov tshuaj no txo qis qhov xav tau ntawm kev siv ceev ceev adrenomimetics. Lawv yog cov tiam tshiab ntawm kev tiv thaiv mob hawb pob thiab cov tshuaj tiv thaiv kab mob uas siv los tiv thaiv bronchospasm.
Kev kho mob yooj yim hauv kev kho menyuam yaus
Lub hauv paus ntsiab lus tseem ceeb ntawm txoj kev kho mob ntawm cov mob ntsws asthma hauv cov menyuam yaus yog qhov ua tiav ntawm kev tso tawm mus ntev thiab ua kom lub neej zoo.
Kev siv cov kev kho mob yooj yim yog txiav txim siab los ntawm qhov cuam tshuam:
- zaus ntawm cov tsos mob bronchial (tsawg dua ob zaug hauv ib lub lis piam);
- ntau zaus ntawm kev qaug dab peg nocturnal;
- txwv lub zog txhua hnub;
- yuav tsum siv kev kho mob xwm txheej ceev;
- muaj peev xwm exacerbations;
- normalization ntawm kev ua pa ua pa.
Pharmacotherapy yog suav tias yog ib qho tseem ceeb hauv kev kho cov kab mob bronchial hauv tus menyuam. Kev nce qib tseem ceeb hauv kev kho mob hawb pob hauv menyuam yaus tuaj yeem ua tiav nrog kev siv cov khoom siv yooj yim tsim los tshem tawm cov mob hauv lub ntsws thiab bronchi.
Nws yuav tsum tau muab sau tseg tias cov tshuaj tiv thaiv kab mob uas siv los ua ib feem ntawm kev kho mob yuav tsum tau siv tsis yog thaum lub sij hawm exacerbation ntawm tus kab mob, tab sis kuj thaum lub sij hawm tshem tawm raws li ib tug exacerbation prophylaxis, uas paub meej tias yuav tsum tau kev kho mob mus ntev..
tshuaj kho mob me me
Thaum muab kev pab ceev thaum muaj mob hawb pob yooj yim, cov tshuaj tau muab rau kev nqus pa hauv kev kho mob ntsws asthma hauv cov menyuam yaus. Cov khoom siv tshuaj no yog qhov zoo tshaj plaws rau cov menyuam yaus hnub nyoog qis dua peb xyoos uas tsis tau teb rau lwm cov tshuaj bronchodilators.
Rau cov hnub nyoog yau, kev siv "Atrovent" lossis "Berodual" raug pom zoo, tab sis tsuas yog nyob rau hauv kev saib xyuas kev kho mob xwb. Cov aerosols no muaj qhov tseem ceeb ntawm kev tiv thaiv thiab tuaj yeem siv thaum muaj mob hawb pob nocturnal. Rau ib tug me nyuam yaus, kev siv cov tshuaj txhaj tshuaj ntsuas nrog lub spacer lossis nebulizer tau pom zoo. Yog tias qhov kev xaiv ntawm cov tshuaj tsis zoo, nws raug nquahu kom muab cov tshuaj bronchodilators nrog cov tshuaj agonists, nrog rau kev nce koob tshuaj ICS tom qab kev sab laj nrog tus kws kho mob.
Nyob ntawm qib hnyavKev mob ntsws asthma rau tus menyuam hnub nyoog ib xyoos tuaj yeem sau "Fluticasone propionate" hauv qhov nqus tau tsawg kawg ob zaug hauv ib hnub. Nrog rau qhov mob me me, kev kho mob yuav tsum tau ua txhua 4-7 teev rau 1-2 hnub.
Kev kho mob ntawm tus kab mob nruab nrab
Nrog rau qib kev mob ntsws asthma hauv tus menyuam, nws raug nquahu kom sau cov kev npaj ua ke rau kev kho mob ntawm cov mob ntsws asthma, bronchospasmolytics hauv daim ntawv tshuaj tsuag ("Berodual"). Yog tias kev kho qhov nqus tsis ua tau, kev tswj hwm txoj hlab ntshav ntawm 2.4% kev daws ntawm "Eupyllin" raug pom zoo, uas yog diluted nrog isotonic sodium chloride tov (hauv qhov kev faib ua feem qhia los ntawm tus kws kho mob).
Intramuscular, inhalation thiab qhov quav (tswj tswm ciab) kev tswj hwm ntawm "Eufillin" hauv tus menyuam nyob rau theem ntawm tus kabmob no tsis siv tau.
Tom qab soj ntsuam tus mob ntawm cov menyuam yaus (tom qab 20 feeb), kev tso cai tau pib kho nrog kev npaj tshwj xeeb txhua 4 teev, nrog rau kev hloov pauv ntawm tus neeg mob mus rau cov tshuaj aerosols sai sai thiab cov tshuaj bronchodilators ntev.
Kev kho mob tiv thaiv kab mob hauv tus menyuam txuas ntxiv nrog kev siv tshuaj hnyav dua nrog kev maj mam nce koob 2 zaug hauv lub lis piam. Tsis tas li ntawd, nws raug pom zoo kom siv cov tshuaj tiv thaiv kab mob Ditek.
Nrog rau qib loj heev ntawm kev tsim cov mob hawb pob bronchial, tsev kho mob xwm txheej ceev ntawm cov menyuam yaus hauv chav saib xyuas mob hnyav nrog kev kho mob hauv tsev kho mob yuav tsum muaj. Tam sim noIb txoj hauv kev "stepwise" yog suav tias yog feem ntau lees txais rau kev kho mob, thaum txo lossis nce qhov loj ntawm qhov kev cuam tshuam kho mob nyob ntawm qhov hnyav ntawm cov tsos mob ntawm tus kab mob.
Ua haujlwm nrog cov neeg mob uas muaj kab mob
Lub luag haujlwm tseem ceeb yog ua los ntawm kev sib cuag ncaj qha nrog tus mob hawb pob. Ib qho txiaj ntsig zoo yog tsim los yog, ntxiv rau kev kho tshwj xeeb ntawm tus kab mob no, tus neeg mob muaj cov ntaub ntawv ntxiv ntawm etiology ntawm nws tus kheej tus kab mob, cov txheej txheem ntawm nws tsim thiab muaj teeb meem tshwm sim.
Rau qhov no, nws raug nquahu kom ua qhov kev sib tham me me nrog tus neeg mob, piav qhia lub ntsiab lus ntawm kev tswj hwm thiab qhov txiaj ntsig zoo los ntawm kev siv. Qhov no ua rau nws muaj peev xwm ua rau nws lub siab xav ua kom nws tus cwj pwm zoo rau kev kho, uas yog qhov tseem ceeb kom tau txais txiaj ntsig zoo.
Qhov no hauv kev kho cov kab mob bronchopulmonary yog qhov tseem ceeb heev rau cov niam txiv ntawm tus menyuam uas muaj mob hawb pob, vim menyuam yaus tsis tuaj yeem txiav txim siab tsim nyog yam tsis muaj kev pab los ntawm lwm tus. Tsuas yog ib tus neeg laus tuaj yeem pab lawv, leej twg yuav tsum nkag siab tias yuav ua li cas kom tus menyuam mos thiab qhia nws siv lub tshuab nqus pa ntawm nws tus kheej thaum muaj xwm txheej ceev.
Kev Tiv Thaiv
Muaj peb hom kev tiv thaiv kab mob:
- Kev tiv thaiv thawj zaug tsom rau pab pawg neeg noj qab haus huv. Kev tiv thaiv muaj nyob rau hauv kev tiv thaiv kev hloov pauv ntawm txoj hlab ntsws pathologies mus rau hauv cov ntaub ntawv ntev (piv txwv li, mob bronchitis), thiab hauvtiv thaiv kev tsis haum tshuaj.
- Kev tiv thaiv ib ntus suav nrog kev ntsuas los tiv thaiv kev tsim cov kab mob hauv cov tib neeg hnov mob lossis hauv cov neeg mob nyob rau lub sijhawm ua ntej mob hawb pob, tab sis tseem tsis tau muaj mob hawb pob. Cov no yog cov tib neeg uas muaj kab mob ua xua, cov neeg uas muaj mob hawb pob (piv txwv li, muaj cov txheeb ze uas muaj mob hawb pob), lossis cov neeg uas nws qhov kev xav tau raug pov thawj los ntawm kev siv tshuaj tiv thaiv kab mob ntawm kev kawm.
- Tertiary tiv thaiv yog tsom rau txo qhov hnyav ntawm chav kawm thiab tiv thaiv kom tsis txhob muaj tus kab mob exacerbations nyob rau hauv cov neeg mob uas muaj tus kab mob no. Txoj kev tseem ceeb ntawm kev tiv thaiv yog cais tus neeg mob los ntawm kev sib cuag nrog cov allergen uas ua rau muaj kev tawm tsam (kev tshem tawm hom).
Lub luag haujlwm tseem ceeb hauv kev kho mob yog muab rau kev mus xyuas sanatoriums. Sanatorium-resort therapy muaj txiaj ntsig zoo tom qab chaw so rau cov neeg mob. Hauv kev xyaum ua thoob ntiaj teb, cov kev paub tseem ceeb tau sau tseg hauv kev kho kom zoo ntawm cov chaw nyob nyab xeeb. Kev ua tau zoo ntawm kev kho spa nyob ntawm qhov raug xaiv ntawm lub chaw so. Tus kws kho mob tuaj koom yuav tsis xav tsis thoob hauv kev xaiv thaj chaw tsim nyog rau kev kho kom rov zoo, leej twg yuav nrhiav tau lub tsev kho mob rau tus neeg mob uas muaj peev xwm kho tau cov kab mob loj thiab sib txuam.
