Cov tshuaj tiv thaiv tom qab txhaj tshuaj tiv thaiv feem ntau nkag siab tias yog ib qho teeb meem, uas yog qhov tshwm sim tsis zoo ntawm kev txhaj tshuaj tiv thaiv kab mob. Feem ntau, kev ua txhaum cai uas tau tshwm sim los ntawm kev txhaj tshuaj tiv thaiv tshwm sim hauv cov menyuam yaus. Qee zaum, cov tshuaj tiv thaiv tom qab txhaj tshuaj ntawm lub cev tuaj yeem pom tau thiab kev txhaj tshuaj yuav tsum tau tso tseg ua ntej.
Qhov tshwm sim ntawm kev txhaj tshuaj tiv thaiv raws li kev kuaj mob
Hauv Kev faib tawm thoob ntiaj teb ntawm Cov Kab Mob ntawm Kev Kho 10th (ICD-10), cov tshuaj tiv thaiv tom qab tsis muaj cov ncauj lus cais. Txhawm rau txheeb xyuas qhov teeb meem uas tau tsim tawm tsam keeb kwm yav dhau los ntawm kev ua ntawm cov tshuaj tiv thaiv kab mob, cov kws kho mob siv coding T78 lossis T88.
Nyob rau hauv thawj ntu, cov teebmeem tshwm sim tau muab sau tseg uas tsis tau muab cais rau lwm ntu. Raws li ICD, cov tshuaj tiv thaiv tom qab txhaj tshuaj tiv thaiv yog hais txog cov teeb meem tshwm sim los ntawm qhov ua tsis tau qhia lossis tsis meej. Qeb T78 "Cov teebmeem tsis zoo" tsis suav nrog cov teeb meem tshwm sim los ntawm kev phais thiab kev kho mob. Lawv muajLwm tus lej hauv ICD-10. Cov tshuaj tiv thaiv tom qab txhaj tshuaj yog qhia los ntawm tus lej T88.8 thaum cov teeb meem kev noj qab haus huv uas tshwm sim tom qab txhaj tshuaj tiv thaiv tsis tu ncua thiab hnyav. Cov pawg no hais txog cov tshuaj tiv thaiv tom qab txhaj tshuaj xws li anaphylactic shock, urticaria loj heev, angioedema, sepsis, thiab pob khaus.
Yuav tsum tau txhaj tshuaj tiv thaiv
Kev txhaj tshuaj tiv thaiv kab mob hauv cov kev kho mob niaj hnub no thiab kev kho menyuam yaus muaj lub hom phiaj hauv qab no: txhawm rau pab tus neeg mob lub cev tiv thaiv kab mob uas yuav tiv thaiv nws los ntawm tus kab mob tshwj xeeb yog tias muaj kev sib cuag nrog nws. Kev txhaj tshuaj loj tso cai rau koj los tsim tsis tau tsuas yog ib tus neeg tiv thaiv kab mob xwb, tab sis kuj tsim kev sib koom ua ke tiv thaiv kab mob, tsim los tiv thaiv kev kis kab mob thiab kev loj hlob ntawm kev sib kis hauv zej zog.
Nyob hauv peb lub tebchaws muaj daim ntawv qhia hnub National ntawm kev txhaj tshuaj tiv thaiv. Cov ntaub ntawv no tau pom zoo los ntawm Ministry of He alth ntawm Lavxias Federation. Nws tsim ib lub sij hawm rau yuav tsum tau txhaj tshuaj tiv thaiv ntxiv rau cov menyuam yaus ntawm ntau lub hnub nyoog txij thaum yug mus txog rau cov neeg laus.
Hauv cov xwm txheej cais, muaj teeb meem tshwm sim. Yog tias lub cev teb rau cov tshuaj tiv thaiv tsis tau npaj txhij, qhov no suav tias yog qhov tsis zoo tom qab txhaj tshuaj tiv thaiv. Qhov tshwm sim ntawm kev tsim cov teeb meem tom qab txhaj tshuaj tiv thaiv yuav txawv, nyob ntawm seb nws hom thiab cov tshuaj siv. Qhov nyuaj tshaj plaws rau cov menyuam yaus zam yog DPT - tshuaj tiv thaiv kab mob pertussis, diphtheria thiab tetanus (A33-A35 - ICD code). Cov tshuaj tiv thaiv tom qab txhaj tshuaj tiv thaiv uas xaus rau kev tuag tshwm sim li ntawm ib ntawm ib puas txhiab tus neeg.
Ua rau muaj teeb meem tom qab txhaj tshuaj
Lub cev tsis zoo rau cov tshuaj yuav tshwm sim los ntawm nws cov reactogenicity. Tsis muaj qhov xwm txheej twg, tus yam ntxwv ntawm tus neeg mob lub cev thiab qhov tshwm sim ntawm qhov hu ua "tib neeg yam" (piv txwv li, kev ua yuam kev thiab kev ua yuam kev ntawm cov neeg ua haujlwm kho mob thaum txhaj tshuaj tiv thaiv) tsis suav nrog.
Lub peev xwm ntawm cov tshuaj ua rau muaj teeb meem nyob ntawm nws cov khoom. Qhov zoo ntawm cov tshuaj tiv thaiv feem ntau siv hauv cov tshuaj tau piav qhia los ntawm cov ntsiab lus siab ntawm cov kab mob co toxins, preservatives, stabilizers, tshuaj tua kab mob thiab lwm yam tshuaj. Kev tiv thaiv kab mob ntawm cov tshuaj tiv thaiv kuj tseem ceeb heev. Raws li qib ntawm reactogenicity, uas txiav txim siab qhov kev pheej hmoo ntawm kev mob tshwm sim hnyav, DTP thiab BCG suav tias yog qhov txaus ntshai tshaj plaws. Cov tshuaj tiv thaiv tom qab txhaj tshuaj tsis tshua muaj tom qab txhaj tshuaj tiv thaiv kab mob polio, kab mob siab B, mumps, rubella.
Hais txog tus yam ntxwv ntawm lub cev, ua ntej ntawm tag nrho cov, pom muaj tus kab mob keeb kwm yav dhau. Cov txheej txheem pathological txiav txim siab qhov zaus thiab qhov hnyav ntawm cov tshuaj tiv thaiv tom qab txhaj tshuaj. ICD-10 kuj muaj xws li kev ua xua, tawv nqaij rhiab heev, idiosyncrasy.
Raws li cov xwm txheej uas tau tshwm sim hauv kev kho mob, ib qho ua rau muaj teeb meem tom qab txhaj tshuaj tiv thaiv yog tib neeg yuam kev. Cov neeg mob yuav muaj kev cuam tshuam hauv zos thiab dav dav ntawm lub cev, xav tauTom qab kev kho mob lossis kev phais mob, vim yog:
- kev ua txhaum cai ntawm kev tswj hwm tshuaj;
- suav cov tshuaj tsis raug;
- tshuaj tiv thaiv tsis raug;
- tsis saib xyuas aseptic thiab antiseptic cov cai.
Hom mob tom qab txhaj tshuaj tiv thaiv
Qhov tshwm sim ntawm kev txhaj tshuaj tiv thaiv yog ob hom - hauv zos lossis dav dav. Thawj pab pawg ua txhaum cai suav hais tias tsis tshua muaj kev phom sij rau kev noj qab haus huv ntawm tus menyuam. Cov tshuaj tiv thaiv hauv zos tom qab txhaj tshuaj muaj xws li:
- hauv zos hyperemia ntawm daim tawv nqaij;
- o ntawm qhov chaw txhaj tshuaj;
- infiltrate formation;
- abscess;
- purulent lymphadenitis;
- keloid caws pliav.
Nyob rau hauv ib txhia me nyuam, tom qab txhaj tshuaj tiv thaiv, lub cev kub nce, muaj mob nqaij, mob qhua pias zoo li pob liab vog thoob lub cev. Nyob rau hauv cov ntaub ntawv no, cov tshuaj tiv thaiv tom qab txhaj tshuaj tiv thaiv. Cov teeb meem loj tshaj plaws tom qab txhaj tshuaj yog:
- anaphylactic shock;
- ncephalitis;
- meningitis;
- sepsis;
- tshuaj tiv thaiv kab mob polio.
Kev cuam tshuam ntawm lub cev tsis yog hauv zos thiab dav. Cov kws kho mob siv lwm qhov kev faib tawm. Cov teeb meem tau muab faib ua qhov tshwj xeeb, uas yog, cov uas cuam tshuam ncaj qha nrog cov tshuaj tiv thaiv, thiab tsis yog tshwj xeeb, tshwm sim los ntawm tus kheej cov yam ntxwv ntawm lub cev.
Mechanism rau kev txhim kho cov teeb meem
Qhov feem ntau tshwm sim uas ua rau cov txheej txheem tom qab txhaj tshuaj tiv thaiv yog kab mob sib kis. Yog hnub txhaj tshuaj tiv thaiv thiab mob,provoking txoj kev loj hlob ntawm transient immunodeficiency, coincided, qhov yuav muaj teeb meem nce ob peb zaug. Thawj hnub tom qab txhaj tshuaj, cov menyuam yaus tuaj yeem tsim SARS, obstructive bronchitis, mob ntsws, kis kab mob ntawm lub raum thiab lwm yam mob hnyav.
Feem ntau, cov tshuaj tiv thaiv tom qab txhaj tshuaj tiv thaiv thiab cov teeb meem yog cov kab mob tsis ruaj khov uas tshwm sim rau lub sijhawm luv luv thiab tsis cuam tshuam rau cov haujlwm tseem ceeb ntawm lub cev. Lawv qhov kev kho mob tshwm sim yog tib yam thiab, raws li txoj cai, tsis cuam tshuam rau tus menyuam lub cev, ploj tom qab ob lossis peb hnub yam tsis muaj kev kho ntxiv.
Pathology uas yuav tshwm sim
Cov tshuaj lom ntawm lub cev uas tshwm sim thawj peb hnub tom qab txhaj tshuaj tiv thaiv tshwm sim nrog cov cim qhia ntawm kev tsis zoo nyob rau hauv cov xwm txheej ntawm tus menyuam. Feem ntau, cov me nyuam lub cev kub siab tshaj 39.0 ° C, ua daus no, lethargy, insomnia tshwm sim, qab los noj mov ploj, ntuav tshwm, nosebleeds. Feem ntau, cov teeb meem tom qab txhaj tshuaj tiv thaiv tshwm sim tom qab txhaj tshuaj tiv thaiv kab mob hnoos hawb pob, siv tshuaj tiv thaiv kab mob khaub thuas thiab tshuaj tiv thaiv kab mob qhua pias. Qee zaum hyperthermia nrog convulsions thiab hallucinations.
Cov tshuaj tiv thaiv tom qab txhaj tshuaj tiv thaiv uas muaj kev tsis haum xeeb ntawm keeb kwm yog muab faib los ntawm kws kho mob rau hauv dav dav thiab hauv zos. Thawj qeb suav nrog cov teeb meem tom qab txhaj tshuaj tiv thaiv kab mob hauv lub cev, cuam tshuam rau tus mob thiab kev ua haujlwm ntawm lub cev tag nrho:
- anaphylactic shock;
- urticaria;
- Stevens-Johnson syndrome;
- exudative erythema;
- Quicke's edema;
- Lyell's syndrome;
- tawm tsam ntawm bronchial hawb pob;
- Yatopic dermatitis.
Kev qhia txog cov tshuaj tiv thaiv tuaj yeem ua rau muaj kev tiv thaiv kab mob hnyav, uas suav nrog kev mob ntshav qab zib, hemorrhagic vasculitis, periarteritis nodosa, glomerulonephritis. Cov teeb meem hauv zos tom qab txhaj tshuaj tiv thaiv yog liab, mob thiab o ntawm cov ntaub so ntswg uas txuas ntxiv mus rau qhov chaw txhaj tshuaj. Cov tshuaj tiv thaiv hauv zos tom qab txhaj tshuaj tiv thaiv ib txwm ploj tom qab peb hnub. Lub ntsiab tsis haum rau hauv kev npaj rau kev txhaj tshuaj yog aluminium hydroxide sorbent. Cov tshuaj sorbent no muaj nyob rau hauv cov tshuaj tiv thaiv DTP, Tetrakok.
Cov kab mob autoimmune tuaj yeem ua rau muaj teeb meem tom qab txhaj tshuaj tiv thaiv, uas yog tus cwj pwm los ntawm kev puas tsuaj rau lub hauv nruab nrab thiab sab hauv lub paj hlwb, lub plawv, thiab pob qij txha. Kev txhaj tshuaj tiv thaiv tuaj yeem ua rau muaj kev loj hlob ntawm autoimmune hemolytic anemia, kab mob lupus erythematosus, dermatomyositis, scleroderma thiab lwm yam pathologies.
tshuaj tiv thaiv phom sij
Kev txhaj tshuaj tau teem tseg hauv National calendar rau thawj xyoo ntawm lub neej ua rau muaj teeb meem loj tshaj plaws. Qhov mob hnyav tshaj plaws rau cov menyuam yaus hnub nyoog qis dua rau lub hlis yog cov tshuaj uas muaj cov kab mob pertussis. Tom qab txhaj tshuaj tiv thaiv, tus menyuam tuaj yeem qw tho qhov thiab ua rau lub cev ntev li ob peb teev ntxiv. Kev ntxhov siab ntawm cov menyuam yaus ntawm thawj xyoo ntawm lub neej tau piav qhia los ntawm qhov tseeb tias cov tshuaj tiv thaiv no ua rau muaj kev hloov pauv hauv lub sijhawm luv.microcirculation ntawm lub hlwb thiab sai sai nce nyob rau hauv intracranial siab.
Cov kab mob uas cuam tshuam nrog tshuaj tiv thaiv yog qhov mob hnyav tshaj plaws ntawm lawv qhov kev kawm thiab tom qab txhaj tshuaj tiv thaiv qhov tshwm sim, uas tuaj yeem ua rau tuag tes tuag taw, poliomyelitis, o ntawm meninges. Cov teeb meem zoo li no tsis tshua muaj tshwm sim. Qhov kev pheej hmoo ntawm kev tsim lawv nce ntxiv tom qab txhaj tshuaj tiv thaiv kab mob qhua pias, DTP, rubella, mumps (mumps).
Cais, nws tsim nyog sau cia cov tshuaj tiv thaiv tom qab txhaj tshuaj tiv thaiv (cov cai los ntawm ICD-10 tus kws kho mob muaj cai thov ntawm nws qhov kev txiav txim siab) tom qab BCG. Ntawm cov teeb meem, cov kab mob hauv zos tshwm sim los ntawm kev kis kab mob BCG yog qhov ntau tshaj. Tom qab txhaj tshuaj tiv thaiv rau cov menyuam mos hauv cov neeg mob sib cais, lymphadenitis, tawv nqaij ulcerations, abscesses, kab mob ntawm cov nqaij mos thiab tawv (keratitis, osteomyelitis, osteitis) tshwm sim. Cov teeb meem tom qab txhaj tshuaj tiv thaiv tuaj yeem ua rau tuag taus, tshwj xeeb tshaj yog tiv thaiv kab mob.
Kuv yuav tau xeem dab tsi
Qhov kev xav ntawm qhov tshuaj tiv thaiv tom qab tau tshwm sim hauv tus kws kho menyuam yaus thaum qee cov tsos mob tshwm sim thaum lub sijhawm txhaj tshuaj. Txhawm rau kom paub meej qhov tseeb ntawm cov teeb meem tom qab txhaj tshuaj, tus menyuam raug xa mus rau kev kuaj mob. Cov kev tshawb fawb sib txawv ua rau nws muaj peev xwm tshem tawm cov kab mob hauv lub tsev menyuam, ntawm qhov kev hem thawj loj tshaj plaws rau kev noj qab haus huv ntawm tus menyuam hauv plab yog tshwm sim los ntawm cytomegalovirus, herpes, toxoplasmosis, rubella, thiab chlamydia. Yam yuav tsum tau ua kom muaj kev ntsuam xyuas dav yog:
- kev tshuaj ntsuam cov zis thiab ntshav;
- tshawb fawb txog kab mob;
- tshuaj ntsuam kab mob ntawm cov ntshav, zis, quav.
Txhua cov txheej txheem kuaj yog ua los ntawm PCR, RNGA, ELISA, RSK txoj kev. Tsis tas li ntawd, yuav tsum muaj kev tshawb fawb biochemical ntawm cov ntshav thiab zis, tshwj xeeb tshaj yog tias tus menyuam muaj mob tom qab txhaj tshuaj. Cov txiaj ntsig ntawm biochemistry tso cai kom tsis suav nrog rickets thiab hypoglycemia hauv ntshav qab zib mellitus.
Yog tias qhov tshuaj tiv thaiv tom qab tau coj mus rau CNS mob, tus menyuam raug muab tshuaj rau lub lumbar puncture thiab CSF qauv raug coj mus kuaj, electroencephalography, electromyography, neurosonography thiab MRI ntawm lub hlwb raug sau. Cov teeb meem tom qab txhaj tshuaj tiv thaiv hauv lawv qhov tshwm sim zoo ib yam li cov duab kho mob hauv cov mob vwm, hydrocephalus, benign thiab malignant hlwb hlav. Nws tuaj yeem kuaj pom qhov teeb meem tom qab txhaj tshuaj tiv thaiv tsuas yog thaum txhua qhov ua tau ua txhaum cai ntawm tus menyuam tus mob raug lees paub.
Yuav ua li cas thaum muaj teeb meem tom qab txhaj tshuaj tiv thaiv
Txhua yam kev hloov pauv ntawm tus menyuam txoj kev noj qab haus huv tom qab txhaj tshuaj tiv thaiv yuav tsum tau mus ntsib kws kho mob. Nws tsis tuaj yeem muab tshuaj lossis ua lwm yam kev ua ntawm koj tus kheej yam tsis muaj kev tso cai los ntawm kws kho mob. Nyob ntawm seb hom tshuaj tiv thaiv, tus neeg mob yuav raug muab tshuaj kho etiotropic. Cov teeb meem tom qab txhaj tshuaj tiv thaiv yuav tsum muaj lub koom haum ntawm kev tswj hwm kev noj qab haus huv, ua tib zoo saib xyuas qhov chaw txhaj tshuaj thiab ua raws li kev noj zaub mov zoo.
Kev kho mob hauv zos suppuration, caws pliav, abscess yuav tsum tau siv cov tshuaj pleev ib ce thiab teem caij ntawm cov txheej txheem physiotherapy (ultrasound thiab shock yoj therapy). Yog qhov tshwm sim ntawm kev txhaj tshuajyog qhov kub thiab txias, haus dej kom ntau, noj tshuaj tua kab mob, so thiab siv dej khov rau lub cev kom txias lub cev yog pom zoo.
Nyob rau hauv cov xwm txheej tshwm sim tam sim ntawd tom qab txhaj tshuaj tiv thaiv kab mob (hauv 10 tsab ntawm ICD yog qhia los ntawm tus lej T88.7), kev thauj khoom ntawm cov tshuaj tiv thaiv kab mob. Nrog rau mob hnyav, cov tshuaj hormonal, adrenomimetics, cardiac glycosides raug sau tseg. Yog tias pom muaj teeb meem tom qab txhaj tshuaj tiv thaiv kab mob hauv lub paj hlwb, tus me nyuam raug kho cov tsos mob (piv txwv li, anticonvulsants, antiemetics, tshuaj dehydration, thiab adsorbents). Yog tias muaj teeb meem tom qab txhaj tshuaj BCG, kev kho mob yog muab los ntawm tus kws kho mob phthisiatrician.
Yuav ua li cas tiv thaiv qhov mob tshwm sim tom qab txhaj tshuaj
Lub ntsiab lus tseem ceeb rau kev tiv thaiv kev tiv thaiv tom qab txhaj tshuaj tiv thaiv tsis zoo yog qhov tsis muaj peev xwm ntawm kev txhaj tshuaj tiv thaiv thaum muaj contraindications rau kev txhaj tshuaj. Cov kws kho mob yuav tsum tau saib xyuas zoo rau kev xaiv cov menyuam yaus los txhaj tshuaj tiv thaiv. Rau lub hom phiaj no, cov kws kho mob ua ntej kuaj cov neeg mob thiab, yog tias tsim nyog, xa lawv mus rau kev sab laj nrog lwm tus kws kho mob tshwj xeeb (tus kws kho mob ua xua, kws tshuaj tiv thaiv kab mob, neuropathologist, kws kho plawv, nephrologist, pulmonologist, phthisiatrician). Thaum lub sij hawm tom qab txhaj tshuaj tiv thaiv, yuav tsum tau saib xyuas tus menyuam tus mob.
Qhov tseem ceeb sib npaug yog kev tshaj lij ntawm cov neeg ua haujlwm kho mob tau txais kev txhaj tshuaj. Cov menyuam yaus yuav tsum tau txhaj tshuaj tiv thaiv los ntawm tus kws tshaj lij thiab muaj peev xwm. Thaum muaj teeb meem tom qab txhaj tshuaj tiv thaivrov qhia cov tshuaj tiv thaiv tsis raug tso cai txawm tias tom qab ob peb lub hlis. Tib lub sijhawm, lwm hom kev txhaj tshuaj tiv thaiv tsis yog contraindicated rau tus menyuam.
Kev tiv thaiv kev tiv thaiv tom qab txhaj tshuaj tiv thaiv feem ntau yog nyob ntawm seb cov niam txiv lub luag haujlwm li cas rau qhov teeb meem ntawm kev txhaj tshuaj tiv thaiv lawv cov menyuam. Yog tias tus menyuam muaj kev tsis txaus siab ntawm qhov tsis xis nyob, qhov no tsis tuaj yeem nyob twj ywm, nws yuav tsum tau qhia rau tus kws kho mob. Tsis txhob txhaj tshuaj tiv thaiv yog tias koj muaj cov tsos mob ntawm tus mob khaub thuas lossis lwm yam kab mob sib kis. Txhua tus menyuam yuav tsum tau tshuaj xyuas ua ntej txhaj tshuaj tiv thaiv.
Hauv cov neeg mob loj tshaj plaws, muaj teeb meem tshwm sim vim kev ua txhaum cai ntawm kev khaws cia ntawm cov tshuaj tiv thaiv. Nyob rau tib lub sijhawm, qhov tshwm sim ntawm kev tsim cov teeb meem tom qab txhaj tshuaj tiv thaiv vim yog tus kheej tus yam ntxwv ntawm lub cev yog tsawg. Tsis tas li ntawd, peb yuav tsum tsis txhob hnov qab tias qhov kev pheej hmoo ntawm cov menyuam yaus kis tus kab mob txaus ntshai ntau dua li qhov kev pheej hmoo ntawm kev tsim cov tshuaj tiv thaiv tom qab txhaj tshuaj.
Kev txhaj tshuaj tiv thaiv kab mob yog vim li cas mus ntsib kws kho mob. Nyob rau hauv cov ntaub ntawv ntawm cov tshuaj tiv thaiv ntawm me me thiab nruab nrab hnyav, nws yog txaus los muab kev saib xyuas kom zoo rau cov infiltrate thiab saib xyuas lub cev kub, thiab yog hais tias nws siab tshaj 38 ° C, muab ib tug antipyretic rau tus me nyuam. Tom qab txhaj tshuaj tiv thaiv thiab rau peb hnub tom ntej no, tau muab tshuaj tua kab mob rau tus menyuam kom tiv thaiv kev tsis haum tshuaj.
Yog tias muaj qhov tshwm sim tsis zoo tom qab txhaj tshuaj tiv thaiv rau cov tshuaj tiv thaiv, koj tsis tuaj yeem siv lwm txoj hauv kev kho lossis muab tshuaj rau menyuam yaus ntawm koj qhov kev txiav txim siab. Qhov tshwm sim ntawm tus cwj pwm tsis tu ncua ntawm kev txhaj tshuaj tiv thaiv tuaj yeem ua tauua rau kev noj qab haus huv tsis zoo.
