Ib yam ntawm cov kab mob hauv lub raum feem ntau yog pyelonephritis. Pathology yog txheej txheem loj heev. Inflammation npog lub pelvis thiab calyces ntawm lub raum, nrog rau connective (interstitial) cov ntaub so ntswg. Kev kis kab mob tshwm sim los ntawm sab nraud, los ntawm kev tso zis, lossis los ntawm txoj kev hematogenous (nrog rau cov ntshav ntws) los ntawm lwm cov foci. Tom ntej no, peb yuav tshuaj xyuas seb pyelonephritis manifests nws tus kheej li cas. Kev kho mob, tshuaj kom tshem tawm nws kuj yuav piav qhia hauv kab lus.
cov ntaub ntawv dav dav
Cov kab mob tseem ceeb ntawm pyelonephritis yog cov kab mob ntawm pawg staphylococcus, Escherichia thiab Pseudomonas aeruginosa, Proteus, Streptococcus, Enterococcus. Txoj kev loj hlob ntawm pathology nyob rau hauv kev cuam tshuam ntawm fungi los yog kab mob yog tsis tshua muaj ntau. Feem ntau pyelonephritis yog provoked los ntawm microbial cov koom haum los yog cov kab mob ntawm L-forms. Cov tom kawg yog tus cwj pwm los ntawm lub xeev tsis yog lub hnab ntim khoom hloov pauv, tus cwj pwm los ntawm kev ua haujlwm siab rau tshuaj. Qhov no cuam tshuam tsis tau tsuas yog kho, tab sis kuj kuaj mob.kab mob. Tus kab mob no sai dhau los ntawm qhov mob mus rau theem mob. Hauv qhov no, cov tshuaj tua kab mob rau pyelonephritis ntawm lub raum yuav tsum tau muab tshuaj kom sai li sai tau.
Kev cuam tshuam kho mob
Txhua yam tshuaj tua kab mob rau pyelonephritis yuav tsum muaj ntau yam kev kho mob, kev ua kom muaj kab mob siab, tsawg kawg nephrotoxicity. Cov tshuaj yuav tsum tau muab tso rau hauv cov zis nyob rau hauv loj ntim. Cov npe tshuaj tua kab mob uas tau sau tseg rau cov kab mob piav qhia suav nrog aminopenicillins, tiv thaiv penicillins, cephalosporins, carboxypenicillins, aminoglycosides, fluoroquinolones. Tom ntej no, xav txog yam tshuaj tua kab mob rau pyelonephritis feem ntau tau sau.
Aminopenicillins
Cov kws tshaj lij niaj hnub no sim tsis txhob sau cov tshuaj no rau pyelonephritis. Lawv yog cov yam ntxwv los ntawm kev ua kom ntuj tsim tawm tsam Proteus, Escherichia coli, enterococci. Lawv lub ntsiab qhov tsis zoo yog suav tias yog qhov cuam tshuam rau kev cuam tshuam ntawm beta-lactamases - enzymes tsim los ntawm ntau cov kab mob tseem ceeb hauv chaw kho mob. Niaj hnub no, cov tshuaj tua kab mob no tsis pom zoo rau o ntawm lub raum (tshwj tsis yog cov kab mob pathology hauv cov poj niam cev xeeb tub) vim qhov nce qib ntawm resistant (resistant) hom Escherichia coli (ntau dua 30%) rau lawv.
tiv thaiv penicillins
Cov tshuaj tua kab mob rau lub raum mob yog suav tias yog txoj kev xaiv. Cov tshuaj qhia tias muaj kev ua haujlwm siab ob qho tib si rau cov kab mob gram-tsis zoo uas tsim cov beta-lactamase, thiab cov kab mob gram-zoo, suav nrog staphylococci.penicillin-resistant thiab coagulase-tsis zoo. Cov theem ntawm kev tiv thaiv tau nthuav tawm los ntawm cov kab mob E. coli rau cov tshuaj tiv thaiv penicillins yog qhov tsawg. Ib qho tshuaj tua kab mob feem ntau yog tshuaj rau pyelonephritis "Amoxicillin" thiab tshuaj "Clavulanate". Kev sib xyaw ua ke no tau pom zoo los ntawm qhov ncauj ntawm 625 mg / 3 rubles / hnub. los yog parenterally ntawm 1.2 g / 3 rubles / hnub. Duration ntawm kev kho mob - los ntawm xya mus rau kaum hnub. Ib daim ntawv tshiab ntawm kev sib xyaw ua ke no suav tias yog tshuaj tua kab mob rau pyelonephritis "Flemoklav Solutab". Cov tshuaj tau ua pov thawj muaj txiaj ntsig zoo hauv cov kab mob urinary. Txhais tau tias "Flemoklav Solutab" raug tso cai siv los ntawm cov neeg mob los ntawm peb lub hlis thiab cov poj niam cev xeeb tub.
Tshuaj rau cov ntawv nyuaj
Carboxypenicillins tuaj yeem raug sau rau hauv cov mob hnyav thiab yog tias xav tias muaj tus kab mob Pseudomonas aeruginosa. Tshwj xeeb, nws yog xws li tshuaj tua kab mob rau pyelonephritis li "Ticarcillin". Hauv tib pab pawg yog cov tshuaj "Carbenicillin". Ntxiv nrog rau carboxypenicillins, ureidopenicillins yuav raug pom zoo. Cov no suav nrog cov tshuaj xws li Azlocillin, Piperacillin. Txawm li cas los xij, nws yuav tsum tau muab sau tseg tias cov tshuaj antipseudomonal penicillins tsis pom zoo ua cov tshuaj mono. Qhov no yog vim qhov muaj feem ntau ntawm kev txhim kho cov kab mob tsis zoo rau lawv thaum kho. Hauv kev kho mob pyelonephritis, kev sib xyaw ntawm cov tshuaj no thiab beta-lactamase inhibitors yog siv. Tshwj xeeb, kev sib xyaw ua ke ntawm cov neeg sawv cev hauv qab no tau sau tseg:"Ticarcillin" + clavulanic acid, "Tazobactam" + "Piperacillin". Kev sib xyaw ntawm cov tshuaj tua kab mob antipseudomonal nrog fluoroquinolones thiab aminoglycosides kuj tau siv. Cov tshuaj zoo li no kuj raug sau tseg rau hauv tsev kho mob hnyav mob pathologies ntawm cov zis.
YCephalosporins
Cov tshuaj no muaj peev xwm ua rau hauv lub raum parenchyma thiab tso zis hauv qhov muaj siab heev. Cephalosporins yog cov tshuaj nephrotoxic. Cov tshuaj no yog cov thawj coj niaj hnub no nyob rau hauv cov nqe lus ntawm ntau zaus ntawm cov tshuaj nyob rau hauv cov neeg mob nrog pyelonephritis thiab kab mob ntawm cov zis. Muaj ntau tiam neeg ntawm cephalosporins. Lawv muab faib raws li qhov spectrum ntawm kev ua thiab qib ntawm kev tiv thaiv rau beta-lactamase:
- 1st tiam. Cov tshuaj no muaj qhov txwv tsis pub ua haujlwm. Lawv ua feem ntau ntawm cov kab mob gram-zoo cocci thiab tsis siv nyob rau hauv cov kev mob hnyav ntawm pathology.
- 2nd tiam. Cov cephalosporins no muaj qhov dav dav ntawm kev ua. Lawv nquag tawm tsam Escherichia coli thiab lwm tus kab mob enterobacteria. Cov tshuaj ntawm pawg no suav nrog, piv txwv li, tshuaj "Cefuroxime".
- 3rd tiam. Cephalosporins ntawm pab pawg no yog siv rau cov kab mob sib kis. Cov tshuaj tau muab tshuaj rau qhov ncauj (Ceftibuten, Cefixime) thiab parenterally (Ceftriaxone,"cefotaxime"). Nyob rau hauv qhov tseeb, ib nrab-lub neej ntev yog cov yam ntxwv thiab siv ob txoj kev rau excretion ntawm lub cev: nrog rau cov zis thiab cov kua tsib. Hauv pab pawg thib peb tiam cephalosporins, muaj cov tshuaj uas muaj zog tiv thaiv Pseudomonas aeruginosa. Cov no yog, tshwj xeeb, xws li cov tshuaj xws li Cefoperazone, Ceftazidime, nrog rau cov tshuaj inhibitor-tiv thaiv Cefoperazone + Sulbactam.
- 4 tiam. Cephalosporins ntawm pab pawg no muaj tag nrho cov khoom ntawm cov tshuaj ntawm pawg dhau los, tab sis lawv muaj zog dua tiv thaiv kab mob gram-zoo cocci.
Aminoglycosides
Cov tshuaj no tau pom zoo rau cov ntaub ntawv nyuaj ntawm pyelonephritis, nrog rau cov kab mob nosocomial loj. Cov pab pawg ntawm aminoglycosides suav nrog cov tshuaj xws li Amikacin, Tobramycin, Netilmicin, Gentamicin. Hauv cov xwm txheej hnyav, cov tshuaj no tau ua ke nrog cephalosporins thiab penicillins. Aminoglycosides tsis zoo absorbed los ntawm txoj hnyuv. Nyob rau hauv no hais txog, lawv yog tswj mas parenterally. Excretion ntawm cov tshuaj yog nqa tawm tsis hloov nyob rau hauv cov zis. Rau cov neeg mob lub raum tsis txaus, nws yog ib qho tsim nyog yuav tau kho cov tshuaj. Qhov tsis zoo ntawm aminoglycosides suav nrog lawv cov nephro- thiab ototoxicity. Qhov zaus ntawm kev hnov lus tsis zoo nyob rau hauv cov neeg mob nce mus txog 8%, thiab lub raum puas (tshwj xeeb yog neoliguric, feem ntau thim rov qab tsis txaus) - 17%. Qhov no ua rau nws tsim nyog los tswj hwm qib ntawm urea thaum kho,poov tshuaj, creatinine. Vim lub fact tias lub dependence ntawm qhov hnyav ntawm cov teeb meem nyob rau hauv lub concentration ntawm cov tshuaj nyob rau hauv cov ntshav tau raug tsim, ib qho kev tswj ntawm tag nrho cov tshuaj txhua hnub yog siv. Cov tswv yim zoo li no, ntawm lwm yam, pab txo qis qhov tshwm sim ntawm kev tsim cov nyhuv nephrotoxic. Cov yam uas ua rau muaj teeb meem xws li:
- Yuav tshuaj tsawg dua ib xyoos sib nrug.
- Nyob laus.
- Nyob ntev diuretic kho.
- Kev siv tsis yooj yim nrog cov tshuaj los ntawm pawg cephalosporins hauv ntau npaum li cas.
YFluoroquinolones
Cov tshuaj no yog cov tshuaj xaiv nyob rau xyoo tas los no. Lawv raug sau tseg ob qho tib si hauv cov chaw kho mob sab nraud thiab cov neeg mob hauv tsev kho mob. Thawj tiam fluoroquinolones suav nrog cov tshuaj xws li Ciprofloxacin, Pefloxacin, Ofloxacin. Lawv nquag tawm tsam feem ntau cov kab mob hauv lub genitourinary system. Qhov zoo ntawm cov tshuaj yog lawv cov toxicity tsawg, ntev ib nrab-lub neej, uas, nyob rau hauv lem, tso cai rau koj coj lawv ob zaug ib hnub twg. Fluoroquinolones tau txais txiaj ntsig zoo los ntawm cov neeg mob; lawv tsim muaj ntau txaus nyob rau hauv cov zis, lub raum, thiab ntshav. Cov tshuaj yog siv ob qho tib si parenterally thiab hais lus, tshwj tsis yog rau Norfloxacin (nws yog npaj rau kev tswj qhov ncauj). Fluoroquinolones ntawm tiam thib ob (cov tshuaj "Lomefloxacin", "Levofloxacin", "Moxifloxacin" thiab lwm yam)yog cov nquag txheeb ze rau cov kab mob gram-zoo, pneumococci hauv thawj qhov chaw. Nyob rau tib lub sijhawm, lawv muaj cov txiaj ntsig zoo ib yam ntawm cov kab mob gram-tsis zoo (tshwj tsis yog Pseudomonas aeruginosa) nrog rau cov tshuaj ntawm tiam dhau los.
Tiv thaiv pyelonephritis
Txhawm rau kom tsis txhob rov tshwm sim lossis thawj qhov tshwm sim ntawm pathology, nws yog ib qho tsim nyog yuav tsum tshem tawm tag nrho cov kev iab liam ua phem. Kev tiv thaiv pyelonephritis suav nrog ntau yam kev ntsuas. Qhov no suav nrog normalization ntawm kev noj haus, so thiab ua haujlwm, pw tsaug zog thiab wakefulness. Ib qho yuav tsum tau ua ua ntej yog qhov tsis suav nrog hypothermia. Kev saib xyuas tshwj xeeb yuav tsum tau them rau qhov dav dav ntawm lub cev - nws yog ib qho tseem ceeb uas tsis muaj kab mob hauv nws. Hauv qhov no, kev kho mob yuav tsum tau ua: colitis, caries, gastritis thiab lwm yam.
