Raws li ib tug me nyuam, cov niam txiv feem ntau hais rau peb: tsis txhob haus dej txias - koj yuav mob khaub thuas, tsis txhob taug kev nrog koj lub kaus mom - koj yuav mob ntsws, tsis txhob kov koj txhais taw ntub - koj caj pas yuav mob. Tab sis peb tsis mloog thiab mob. Txawm tias tawm ntawm kev tawv ncauj, los yog rau lub hom phiaj ntawm kev tshawb fawb txaus siab, lawv sim lawv lub cev kom muaj zog. Yog li dab tsi ua rau mob ntsws ntsws thiab yog dab tsi?
Acute bronchitis
Bronchitis yog ib yam kab mob ntawm cov kab mob ua pa qis, nrog cov tsos mob uas tib neeg thoob ntiaj teb mus rau tsev kho mob feem ntau. Qhov ua rau mob ntsws ntsws tuaj yeem muaj ntau yam: kab mob, kab mob lossis protozoa.
Nyob rau hauv rooj plaub no, tsis muaj kev puas tsuaj rau lub ntsws cov ntaub so ntswg tshwm sim, thiab cov txheej txheem inflammatory yog localized nkaus xwb nyob rau hauv tsob ntoo bronchial.
Cov kab mob hauv qab no yog qhov txawv:
- mob, thaum lub ntim ntawm bronchial secretion nce thiab hnoos reflex tshwm sim; - mob ntev, thaum lub mucous membrane hloov ntawm cov cellular theem, uas ua rau hypersecretion thiab impaired qhov cua.
Etiology
Raws li tau hais los saum no, qhov ua rau mob ntsws ntsws tuaj yeem yog qhov ntau tshajntau yam. Los ntawm cov kab mob spectrum, cov kab mob feem ntau yog streptococci, mycoplasmas, chlamydia, thiab anaerobic flora. Viral etiology yog sawv cev los ntawm tus mob khaub thuas, parainfluenza thiab rhinovirus.
Tsis tshua muaj tshwm sim yog bronchitis tshwm sim los ntawm tshuaj lom neeg lossis tshuaj lom rau lub cev. Tab sis nyob rau hauv cov ntaub ntawv no, qhov sib ntxiv ntawm ib tug thib ob kab mob yog inevitable. Raws li International Classification of Diseases of the tenth revision, muaj mob bronchitis tshwm sim los ntawm cov kab mob tsim thiab cov kab mob uas tsis tau teev tseg.
Raws li lub sijhawm ntawm tus kab mob, lawv txawv:
- mob (txog peb lub lis piam); - kev kawm ntev (ntau tshaj ib hlis).
Tus mob bronchitis tuaj yeem tshwm sim nrog lossis tsis muaj bronchospasm. Los ntawm localization, ib tug muaj peev xwm paub qhov txawv ntawm tracheobronchitis, thaum inflammatory kev hloov nyob rau hauv lub Upper ib feem ntawm tsob ntoo bronchial, thiab bronchiolitis (cov txheej txheem pathological cuam tshuam rau me me bronchioles thiab alveoli). Purulent, catarrhal thiab necrotic bronchitis yog qhov txawv ntawm qhov exudate.
Pathophysiology
bronchitis tshwm sim li cas? Cov tsos mob thiab kev kho mob nyob rau hauv cov neeg laus ncaj qha nyob ntawm seb lub mechanism ntawm qhov pib ntawm tus kab mob, txij li thaum txoj kev kho yog aimed ntawm kev sib txuas ntawm cov txheej txheem pathological.
Etiological yam ua rau ua rau cov hlwb ntawm lub bronchial mucosa thiab ua rau lawv cov necrosis. Cov "khib nyiab" no hauv kev tiv thaiv tsim cov xwm txheej rau kev nkag mus ntawm cov kab mob. Yog hais tias tus kab mob pib colonized lub epithelium, ces tom qab ob los yog peb hnub ib co kab mob yuav koom nrog nws, xws li.feem ntau pneumococcus.
Cov kab mob ua paug (o, liab liab, nce hauv zos kub thiab ua haujlwm tsis zoo) ua rau cov ntshav tsis txaus hauv lub txaj capillary, compression ntawm cov hlab ntsha xaus thiab tsim cov ntshav txhaws.
Yog tias qhov kev ua haujlwm zoo ntawm cov txheej txheem yog qhov zoo thiab kev kho mob tau teem sijhawm, tom qab ntawd tom qab kev ploj mus, cov mucosa tau rov qab los li ob peb lub hlis. Tab sis nyob rau hauv ib feem me me ntawm cov neeg mob, qhov no tsis tshwm sim. Tom qab ntawd tus kab mob ua rau mob. Yog tias qhov kev hloov pauv cuam tshuam tsuas yog cov mucous membrane xwb, ces qhov no yuav tsis cuam tshuam rau tus neeg lub neej ntau dhau. Tab sis kev puas tsuaj rau tag nrho cov khaubncaws sab nraud povtseg ntawm bronchus tuaj yeem ua rau hemorrhages hauv lub ntsws cov ntaub so ntswg, nrog rau cov hnoos qeev nrog cov ntshav.
Clinic
Ua rau mob bronchitis, xws li cov kab mob lossis kab mob, ua rau cov tsos mob tshwm sim. Nyob rau lub sijhawm prodromal, muaj qhov nce hauv lub cev kub mus rau tus lej febrile, tsis muaj zog, tsaug zog, tsis qab los noj mov, mob taub hau, tawm hws, plawv palpitations.
Cov neeg mob piav txog lawv qhov kev hnov mob los yog mob hauv caj pas thiab tom qab lub sternum, uas ua rau mob hnyav los ntawm kev nqus cua txias. Tsis tas li ntawd, lawv raug cuam tshuam los ntawm qhov hnoos qhuav qhuav uas tsis tuaj yeem ua rau mob. Tom qab ob mus rau peb hnub, cov neeg mob tsim cov hnoos qeev los yog cov kua paug. Kev hnoos tuaj yeem nrog mob hauv siab hauv siab. Qhov no yog vim overexertion ntawm cov leeg pectoral.
Thaum lub sij hawm kev ntsuam xyuas dav dav, kev saib xyuas yog kos rau cov dej noo ntau dhau ntawm daim tawv nqaij, nws liab tawm tsam keeb kwm ntawm cyanosis ntawm daim di ncauj. Cov leeg nrog txhua qhov ua tsis taus pa yog rub mus rau hauv intercostalncua sij hawm, cov leeg pab yog siv ua pa.
Ntawm qhov nruab nrab, qhov mob ntsws tsis zoo yuav kav ntev li ob lub lis piam thiab xaus nrog kev rov zoo tag nrho.
Diagnosis
Qhov ua rau mob ntsws ntsws yog qhov yooj yim los txheeb xyuas yog tias koj siv cov cuab yeej kuaj mob kom raug. Tom qab kev kuaj pom, nws yog ib qho tsim nyog yuav tsum ua raws li lub cev ntawm kev kuaj mob, xws li palpation, percussion thiab auscultation. Kev xav thiab percussion nyob rau hauv cov ntaub ntawv no yuav tsis qhia ib yam dab tsi txawv txawv, tab sis los ntawm lub phonendoscope koj tuaj yeem hnov qhov ua tsis taus pa nyuaj, nrog rau cov hawb pob tawg. Thaum cov hnoos qeev tshwm, cov rales ua moist coarse bubbling.
Hauv kev kuaj ntshav dav dav, qhov nce ntawm cov leukocytes thiab nce ntawm erythrocyte sedimentation rate (ESR) yuav raug pom. Hauv kev tsom xam cov zis, raws li txoj cai, tsis muaj kev hloov pauv, tab sis ntawm qhov siab ntawm qhov kub taub hau, cov protein yuav tshwm sim. Kev kuaj ntshav biochemical tso cai rau koj kom pom cov tsos ntawm C-reactive protein thiab nce hauv alpha feem ntawm cov protein. Fibrin, leukocytes, desquamated bronchial epithelium thiab erythrocytes muaj nyob rau hauv cov hnoos qeev. Tsis tas li ntawd, hauv chav kuaj, cov ntsiab lus bronchial yog kab lis kev cai kom muaj cov kab mob thiab cov kab mob.
Yuav tsis muaj kev hloov pauv tshwj xeeb ntawm lub xov tooj cua, tsuas yog tej zaum tsuas yog nce tus qauv ntawm lub ntsws. Ib qho spirogram yuav ntsuas qhov muaj thiab qib ntawm kev cuam tshuam.
Kev kho mob
Qhov ua rau mob ntsws ntsws txiav txim siab xaiv txoj kev kho mob hauv txhua kis. Nyob ntawm qhov hnyav ntawm cov txheej txheem pathological, mob ntsws bronchitis tuaj yeem khoob tus neeg mob sab nraud thiab tus neeg mob hauv tsev, nyob rau hauv kev saib xyuas kev kho mob ib puag ncig.
Kev kho yuav tsum muaj cov tshuaj tiv thaiv kab mob los yog tshuaj tua kab mob, nrog rau cov tshuaj uas ua rau lub bronchi. Tsis tas li ntawd, nws yog ib qho tsim nyog yuav tau tshem tawm cov xwm txheej uas yuav ua rau muaj kev loj hlob ntawm tus kab mob. Kev kho mob yuav tsum tau ua kom tiav mus txog thaum kawg, tsis hais seb cov tsos mob ntawm tus kab mob puas tseem nyob los yog tsis.
Tam sim no, cov kws kho mob nquag suav nrog kev kho lub cev, zaws, thiab gymnastics hauv kev kho mob. Qhov no yuav pab kom tshem tawm cov zais zis los ntawm lub bronchi, thiab tseem tso cai rau koj hloov txoj kev siv tshuaj nkag mus rau hauv lub cev.
bronchitis ntev
Lub ntsiab yog vim li cas rau kev loj hlob ntawm bronchitis yog kev puas tsuaj rau lub epithelium ntawm lub mucous daim nyias nyias ntawm lub sab ua pa ib ntsuj av. Koj tuaj yeem tham txog mob ntsws ntsws ntev plaub lub lis piam tom qab pib tus kab mob, muab cov duab kho mob thiab cov kev hloov pauv pathomorphological hauv lub ntsws.
Tus mob no yog tus cwj pwm los ntawm qhov mob ntawm cov phab ntsa bronchial, uas cuam tshuam nrog cov txheej txheem inflammatory mus ntev ua rau cov nqaij mos sclerosis. Lub tshuab zais cia ntawm lub bronchi tau dhau los ntawm ntau qhov kev hloov pauv thiab hloov kho kom nce cov hnoos qeev.
Kev faib tawm
Muaj ntau qhov kev faib tawm ntawm cov kab mob ntsws ntev. Cov ntaub ntawv kho mob hauv qab no yog qhov txawv ntawm tus kab mob:
- yooj yim (los yog catarrhal);
- purulent non-obstructive;
- daim ntawv yooj yim nrog qhov tsis taus;
- purulent obstructive; - tshwj xeeb, piv txwv li, fibrous lossishemorrhagic.
Raws li qib kev puas tsuaj, bronchitis ntawm cov bronchi loj thiab me tau muab faib. Lub xub ntiag ntawm cov tsos mob asthmatic complex thiab nws qhov hnyav tau raug coj mus rau hauv tus account. Los ntawm qhov xwm txheej, zoo li lwm yam kab mob inflammatory, bronchitis yog latent, tsis tshua muaj exacerbations, thiab tas li rov tshwm sim.
Cov teeb meem tom qab mob ntsws ntev yog:
- emphysema;
- hemoptysis; - tsim ua pa tsis ua haujlwm; - mob ntsws cor pulmonale.
Yog vim li cas
Cov chav kawm ntev feem ntau yog ua ntej los ntawm mob ntsws ntsws. Qhov ua rau ntawm cov txheej txheem no tuaj yeem ua kom muaj zog hauv lub cev thiab sab nraud. Ua ntej ntawm tag nrho cov, nws yog ib qhov tsim nyog yuav tau coj mus rau hauv tus account qhov kev npaj ntawm kev tiv thaiv. Yog tias nws muaj zog heev lossis tsis muaj zog, nws tuaj yeem ua rau mob lingering thiab cov nqaij mos puas. Tsis tas li ntawd, txo kev tiv thaiv kab mob yuav nyiam cov kab mob thiab kab mob ntau dua, yog li tus kab mob yuav tshwm sim dua.
Ntxiv rau, ncua ntev, ntau xyoo, khaus khaus ntawm lub bronchial mucosa nrog huab cua qhuav thiab txias, haus luam yeeb, plua plav, carbon monoxide thiab lwm yam tshuaj muaj nyob hauv qee qhov kev lag luam tuaj yeem cuam tshuam rau cov kab mob.
Muaj pov thawj tias qee cov kab mob caj ces tuaj yeem ua rau mob ntsws ntev.
Pathogenesis
Qhov ua rau mob ntsws muaj feem cuam tshuam ncaj qha raulub mechanism ntawm kab mob tsim. Ua ntej tshaj plaws, kev tiv thaiv bronchopulmonary hauv zos txo qis, xws li: qeeb ntawm villi ntawm ciliated epithelium, txo qis ntawm surfactant, lysozyme, interferons thiab immunoglobulins A, ntau pawg T-cells thiab alveolar macrophages.
Thib ob, tus kab mob triad tsim nyob rau hauv lub bronchi:
- hyperfunction ntawm cov qog mucous ntawm lub bronchi (hypercrinia);- nce sputum viscosity (discrinia);
- secretion stagnation nyob rau hauv lub bronchi (mucostasis).
Thiab qhov thib peb, kev txhim kho ntawm kev nkag mus rau cov kab mob thiab kev sib cuam tshuam nrog cov hlwb ntawm tus kheej lub cev. Peb yam no xyuas kom meej tias qhov mob tshwm sim ntev dua plaub lub lis piam.
Symptoms
Tus kab mob no tshwm sim los ntawm hnoos hnyav nrog hnoos qeev txog li ib puas thiab tsib caug milliliters ib hnub twg, feem ntau yog thaum sawv ntxov. Nyob rau lub sij hawm ntawm exacerbation ntawm inflammatory kev tshwm sim, tej zaum yuav kub nce, tawm hws, tsis muaj zog.
Nrog rau kev ua pa thiab lub plawv tsis ua haujlwm, ua kom tuab ntawm phalanges ntawm cov ntiv tes ("drumsticks") thiab thickening ntawm cov ntsia hlau phaj ("saib tsom iav") txhim kho. Mob hauv bronchitis tsuas yog tshwm sim yog hais tias lub pleura koom nrog cov txheej txheem inflammatory los yog thaum lub sij hawm hnoos ntev, cov nqaij ntshiv yog nruj heev.
Kev Tshawb Fawb thiab Kev Tshawb Fawb
Kev kuaj mob ntawm "bronchitis" yog tsim los ntawm kev kuaj thiab ntsuas ntsuas. Hauv kev kuaj ntshav dav dav, muaj qhov nce hauv leukocytes, hloov pauv hauv cov mis leukocyterau sab laug, qhov nce ntawm erythrocyte sedimentation tus nqi. Biochemically, tus nqi ntawm sialic acids, seromucoids, alpha thiab gamma globulins hauv cov ntshav yog nce, C-reactive protein tshwm. Sputum mucous los yog purulent, tej zaum yuav streaked nrog ntshav. Nws muaj cov hlwb epithelial, erythrocytes thiab neutrophils.
Rau qhov kev pom zoo morphological ntawm kev kuaj mob, bronchoscopy yog ua. Ntawm cov duab hluav taws xob, qhov nce hauv pulmonary qauv thiab nws cov mesh deformation, nrog rau cov cim qhia ntawm emphysema, yog pom. Spirometry pab qhia tus kws kho mob txog qhov muaj lossis tsis muaj cov cim qhia ntawm bronchial obstruction.
Kev kho mob
Yuav ua li cas tom qab kuaj pom "mob ntsws mob ntsws"? Cov tsos mob thiab kev kho mob hauv cov neeg laus tsis txawv ntau ntawm cov nyob rau hauv daim ntawv mob. Feem ntau, tus kws kho mob tau sau ntau cov tshuaj sib xyaw ua ke hauv kev cia siab ntawm kev cuam tshuam rau etiological yam ntawm cov lus teb inflammatory. Yog tias qhov no ua tsis tiav, ces nws yog qhov tsim nyog los tswj tus neeg mob lub cev. Rau qhov no, cov tshuaj hauv qab no yog siv:
- tshuaj tua kab mob;
- expectorants;
- bronchodilators;
- antihistamines; - inhalations thiab physiotherapy cov txheej txheem.
