Kev kho mob pleurisy qhuav yuav pab cov neeg mob tshem tawm qhov txaus ntshai heev tshwm sim ntawm visceral thiab parietal pleura, uas fibrin tso rau ntawm nws qhov chaw. Cov tsos mob ntawm tus kab mob no yog txuam nrog mob hauv siab, uas ua rau ua pa hnyav dua, nrog rau kub taub hau qis, hnoos qhuav, thiab mob plab. Nws tuaj yeem kuaj pom tus mob no nrog kev pab ntawm auscultatory thiab cov ntaub ntawv kho mob, ultrasound ntawm cov kab noj hniav pleural, X-ray. Kev kho mob tseem ceeb ntawm tus kab mob no yog txhawm rau tshem tawm cov thawj pathology - raws li txoj cai, nws yog mob ntsws ntsws lossis mob ntsws, nrog rau cov tsos mob tshwm sim. Nrog rau tus kab mob no, tus kws kho mob yuav muab tshuaj tua kab mob, tshuaj tua kab mob, tshuaj tua kab mob. Cov tswv yim ntawm kev kho mob, cov tsos mob, kev kuaj mob thiab cov yam ntxwv ntawm tus kab mob yuav raug tham hauv kab lus no.
Ntau yam
Kev kho mobqhuav pleurisy yog yuav luag ib txwm sau nruj me ntsis ib tus zuj zus. Ib lo lus dav dav zoo sib xws hauv pulmonology yog siv los xaiv ib pawg ntawm cov kab mob pleura ntawm ntau lub hauv paus.
Qee zaum, pleurisy tuaj yeem yog tus kheej lossis thawj, tab sis feem ntau yog tus kab mob thib ob tiv thaiv keeb kwm yav dhau los ntawm cov txheej txheem mob ntev lossis mob tshwm sim hauv lub ntsws.
Nyob ntawm qhov muaj lossis tsis muaj effusion, muaj ntau hom pleurisy: lawv tuaj yeem qhuav (lossis fibrinous), nrog rau cov exudative (serous-fibrinous, serous, purulent lossis hemorrhagic).
Los ntawm lawv lub hauv paus chiv keeb, muaj cov kab mob pleurisy (lawv tuaj yeem ua tshwj xeeb lossis tsis tshwj xeeb), nrog rau qog, kab mob, mob.
Cas thiab mechanisms ntawm kev txhim kho kab mob
Feem ntau, fibrinous pleurisy nyob rau hauv keeb kwm yog txuam nrog tuberculosis ntawm cov qog ntshav hauv lub hauv siab los yog tuberculosis ntawm lub ntsws. Muaj ib tug tuberculous keeb kwm, qhuav pleurisy yog tsim thaum lub foci nyob subpleurally, nrog rau thaum lawv tawg mus rau hauv lub pleural kab noj hniav, thaum nws yog seeded. Nws kuj tseem tuaj yeem txhim kho vim qhov kev nthuav qhia hematogenous ntawm cov kab mob.
Raws li ua rau pleurisy nyob rau hauv qhov teeb meem no, txhua yam ntawm cov mob ntsws tsis tshwj xeeb hu ua. Cov no tuaj yeem yog bronchiectasis, mob ntsws, abscesses, plawv nres, lossis mob ntsws cancer.
Muaj Teeb Meem
Nrog rau kev txhim kho ntawm cov hlab plawvqhuav pleurisy, lawv tuaj yeem nyuaj los ntawm cov kab mob ntawm lub plab zom mov. Piv txwv li, pancreatitis, cholecystitis, subphrenic abscesses.
Qee zaum, tus kab mob tuaj yeem cuam tshuam los ntawm kev kis kab mob (typhoid lossis typhoid fever, brucellosis, qhua pias, hnoos hawb pob, mob npaws) lossis collagenoses (rheumatism, systemic lupus erythematosus, systemic vasculitis).
Qee lub sij hawm qhuav pleurisy yog nrog uremia los yog noj tsis zoo.
Pathogenesis
Lub hauv paus pathogenic ntawm tus kab mob no yog nyob rau hauv cov kev mob tshwm sim ntawm visceral thiab parietal pleura, uas tshwm sim nrog edema, hyperemia, thickening ntawm cov nplooj pleural. Nyob rau hauv rooj plaub no, tus nqi ntawm exudate yuav tsis tseem ceeb heev uas nws yuav pib reabsorbed los ntawm lub pleura nrog deposition ntawm fibrin strands nyob rau saum npoo ntawm lub pleura. Nws yog tsim nyob rau hauv daim ntawv ntawm cov yam ntxwv pleural overlays, uas zoo heev nyuaj rau zawv zawg cov nplooj ntawv.
Nyob yav tom ntej, qhov no yuav ua rau lub ntsws tsis muaj zog thiab pom cov kab loj loj.
Feem ntau, qhuav pleurisy (tshwj xeeb yog tias tsis kho) txhim kho rau hauv exudative. Tab sis qee zaum, txhua yam tuaj yeem daws tau yam tsis muaj qhov pleural effusion.
Symptoms
Thaum tus nqi pleura raug cuam tshuam los ntawm cov pleurisy qhuav, cov yam ntxwv mob pib nyob rau hauv ib nrab ntawm lub hauv siab. Txhawm rau ua kom muaj txiaj ntsig zoo ntawm cov pleurisy qhuav, cov tsos mob yuav tsum paub txog txhua tus. Tom qab ntawd tus kab mob tuaj yeem txheeb xyuas sai sai txhawm rau sab laj tus kws kho mob kom tau txais kev pab tsim nyog.
Nrog rau qhov nomob pathologies yuav nce rau exhalation, nrog rau thaum straining, hnoos. Tag nrho cov no ua rau tus neeg mob pw tsuas yog ntawm qhov mob, vim qhov kev txav ntawm lub hauv siab yog qhov txwv tsis pub. Qhov yuav tsum tau pib kho pleurisy qhuav los ntawm cov tsos mob tuaj yeem txiav txim tau yooj yim los ntawm ib tus kws kho mob.
Nrog rau tus kab mob no, thaum lub sijhawm ua haujlwm ntawm cov txheej txheem inflammatory, muaj qhov txo qis hauv qhov rhiab heev ntawm cov hlab ntsha ntawm lub pleura. Tag nrho cov no nrog rau qhov tseeb tias qhov mob txo qis.
Sib pom kev mob
Koj tuaj yeem kawm txog cov tsos mob thiab kev kho mob ntawm lub ntsws qhuav ntawm lub ntsws ntawm kev sab laj nrog kws kho mob pulmonologist. Nws yuav tsis yog superfluous kom paub cov yam ntxwv ntawm cov kab mob no.
Nrog rau qhov mob ntawm diaphragmatic pleura, qhov mob yog nyob rau hauv thaj tsam plab. Hauv qhov no, mob pancreatitis, mob cholecystitis, appendicitis tuaj yeem tshwm sim. Nrog qhuav apical pleurisy, qhov mob raug xa mus rau qhov projection ntawm cov leeg trapezius, thiab thaum lub pericardium koom nrog o, pleuropericarditis yog tsim.
Dab tsi yog cov cim qhia ntawm lub ntsws qhuav ntawm lub ntsws hauv cov neeg laus uas kws kho mob sau tseg? Hauv fibrous pleurisy, tus neeg mob tuaj yeem soj ntsuam cov tsos mob ntawm yuav luag txhua qhov mob - tsis qab los noj mov, malaise, tawm hws thaum hmo ntuj, thiab hnoos qhuav. Nyob rau tib lub sijhawm, tus neeg mob lub cev kub nrog qhov mob no tuaj yeem ua rau ob qho tib si ib txwm muaj thiab siab heev, ncav cuag 38-39 degrees. Qhov tshwm sim ua npaws yog nrog tachycardia thiab ua daus no.
Lub sijhawm tag nrho ntawm cov kab mob yog los ntawm ib mus raupeb lub lis piam, nyob ntawm seb lub cev teb rau kev kho mob, qhov hnyav thiab ntau lwm yam cuam tshuam. Nyob rau hauv cov ntaub ntawv no, qhov kawg tshwm sim tej zaum yuav ib tug tag nrho kho los yog hloov ntawm pleurisy mus rau hauv ib tug exudative daim ntawv. Qee qhov xwm txheej, tus kab mob ua rau mob ntev - tom qab ntawd nws tsis tuaj yeem kov yeej nws mus txog thaum kawg ntawm lub neej. Hauv qhov xwm txheej kawg, pleurisy kav ntev li ob peb lub hlis nrog qee zaus exacerbations.
Diagnosis
Nws yog ib qho tsim nyog sau cia tias kev kuaj mob rau kev txiav txim siab qhuav pleurisy yog suav tias tsis txaus. Nws yog ib txwm tsim nyog rau tus kws kho mob los tsim qhov ua rau ntawm tus kab mob, thiab tsis yog tsuas yog tshem tawm nws cov tsos mob. Yog li ntawd, yog tias muaj ib qho kev tsis txaus siab ntawm tus kab mob no, tus neeg mob yuav tsum sab laj nrog ntau tus kws kho mob tshwj xeeb. Qhov no yog kws kho mob rheumatologist, pulmonologist, gastroenterologist, phthisiatrician, kis kab mob tshwj xeeb.
Lub auscultatory, uas yog, lub cev, cov cim qhia ntawm tus kab mob no suav nrog kev ua pa tsis muaj zog ntawm qhov cuam tshuam, qhov dav lossis hauv zos pleural kev sib txhuam suab nrov thaum mloog. Nws yuav tsum tau muab sau tseg tias pleural kev sib txhuam suab nrov tshwm sim thaum cov nplooj pleural ntxhib los rau hauv kev sib cuag ncaj qha. Nws yuav luag tsis pom. Nyob rau hauv tej rooj plaub - sharply qhia. Ntawm palpation, tus kws kho mob tswj xyuas qhov mob thiab mob ntawm cov leeg.
Kev Tshawb Fawb
Txhawm rau pib kho qhov qhuav pleurisy ntawm lub ntsws, ntau yam kev tshawb fawb tau ua tiav. Piv txwv li, ntawm X-ray ntawm lub ntsws thiab fluoroscopymuaj obliteration ntawm cov sinuses, ib qho kev txwv ntawm excursion ntawm lub diaphragm nyob rau sab uas cuam tshuam los ntawm tus kab mob, nrog rau kev hloov nyob rau hauv nws contour los yog siab sawv. Hauv particular, lub contour ntawm lub diaphragm yuav ua atypical - piv txwv li, nrog cov ntsaws ruaj ruaj, pob, bulges. Txhawm rau tshem tawm qhov muaj exudate, ib qho kev kuaj ultrasound ntawm lub dav hlau pleural yog muab. Nov yog txoj kev kuaj mob tseem ceeb uas tso cai rau koj los txiav txim siab txog theem ntawm kev txhim kho tus kab mob no.
Nws yog ib qho tseem ceeb rau kev sib txawv pleurisy qhuav ntawm myositis, intercostal neuralgia, angina nres, tav pob txha, myocardial infarction. Cov kev xaiv tom kawg tuaj yeem raug cais los ntawm kev siv electrocardiogram. Tag nrho cov kab mob no yuav muaj cov tsos mob thiab cov tsos mob zoo sib xws. Nws yog ib qho tseem ceeb los tsim cov teeb meem uas tus neeg mob muaj, uas nws yuav tsum tau kho. Qhov no tsuas yog ua tau los ntawm tus kws kho mob tshwj xeeb raws li cov txiaj ntsig ntawm kev kuaj mob tag nrho. Yog li kev noj tshuaj rau tus kheej yog txwv nruj thaum thawj cov tsos mob tshwm sim. Tsuas yog ib tus kws kho mob tuaj yeem kuaj xyuas qhov tseeb thiab sau ntawv kho kom zoo rau cov pleurisy qhuav.
txoj kev kho
Rau qhov laj thawj uas feem ntau cov kab mob qhuav pleurisy yog txheej txheem thib ob, lub hauv paus ua rau yuav tsum tau tsim. Tsis tas li ntawd, kev kho mob tseem ceeb ntawm qhuav pleurisy yog tsom rau kev tshem tawm cov kab mob tseem ceeb xwb.
Yog tus neeg mob muaj daim ntawv fibrous ntawm tus kab mob no, uas yog los ntawm tuberculosis, ces kev kho mob los tiv thaiv tuberculosis raug pom zoo.nrog kev pab ntawm cov tshuaj. Nws tuaj yeem yog "Tubazid", "Streptomycin", "Rifampicin", thiab lwm yam. Yog hais tias tsis yog tshwj xeeb inflammatorys ntawm extrapulmonary thiab pulmonary localization tshwm sim, ntxiv rau cov tshuaj tiv thaiv, tus neeg mob yuav tsum tau siv tshuaj tua kab mob.
Nyob rau hauv kev kho mob ntawm qhuav pleurisy ntawm lub ntsws, nws yog ib qho tseem ceeb los txo qhov mob syndromes. Txhawm rau ua qhov no, ntxiv rau kev noj cov tshuaj uas tsim nyog, koj yuav tsum siv cov ntaub qhwv lub siab nruj rau ntawm lub hauv siab, nruj me ntsis saib xyuas lub txaj so, muab mustard plasters, ua kom sov compresses. Txhawm rau kom tsis txhob hnoos, uas, raws li txoj cai, ua rau mob hnyav heev, siv cov tshuaj antitussive classic. Cov no yog Ethylmorphine, Codeine thiab lwm yam.
Yog tias tus neeg mob muaj qhov rov ua dua ntawm cov pleurisy qhuav, cov kws kho mob ua pleurectomy, tshem tawm cov visceral thiab parietal pleura, uas ua ke pib tsim cov kab noj hniav.
Tshuaj tiv thaiv kab mob
Feem ntau, kev kho mob ntawm cov ntsws qhuav ntawm lub ntsws yog txaus. Kev kho tshuaj yog ua tau nrog nws tus kab mob. Hauv qhov no, cov tshuaj tua kab mob tau raug sau tseg, qhov kev xaiv uas nyob ntawm tus neeg mob qhov rhiab heev rau ib qho tshuaj tua kab mob thiab hom kab mob.
Zoo nyob ntawm qhov xwm txheej ntawm cov kab mob pathogenic, cov tshuaj tuaj yeem ua raws li:
- cephalosporins ("Ceftriaxone", "Mefoxin", "Latamoxef", "Katen", "Cefepim", "Cefpirome", "Ceftolosan","Zefter");
- penicillins ("Oxamp", "Sultasin", "Amoxiclav");
- glycopeptides ("Targocid", "Vancomycin", "Vibative").
Tseem cov tshuaj nyob rau hauv daim ntawv ntawm fluoroquinolones, carbapenems, macrolides, aminoglycosides, ansamycins, lincosamides, amphenicols, tetracyclines, lwm yam tshuaj tua kab mob siv los kho.
Kev txhim kho ntawm exudative pleurisy
Raws li peb tau sau tseg, qhuav pleurisy feem ntau ntws mus rau hauv exudative. Hauv qhov no, tus neeg mob muaj ob lub hom phiaj thiab cov lus tsis txaus siab. Cov tom kawg muaj xws li kev xav hnyav hauv siab, hnoos qhuav, tawm hws, kub taub hau, mob taub hau.
Nyob rau hauv kev kho ntawm qhuav thiab exudative pleurisy, Traube qhov chaw, uas tau xyaum ploj mus, pib rov zoo. Nws tshwm sim hauv lub hauv siab qis ntawm sab laug.
YYuav ua li cas nrog exudative pleurisy?
Nws tsim nyog sau cia tias kev kho mob ntawm exudative thiab qhuav pleurisy yog qhov zoo sib xws, txawm tias nws muaj qee qhov sib txawv.
Piv txwv li, nyob rau hauv rooj plaub tom kawg, yuav tsum tau kho cov kab mob pathogenetic, exudate evacuation. Kev kho etiological muaj nyob rau hauv kev cuam tshuam lub hauv paus ntawm tus kab mob.
Kuj nyob rau hauv kev kho mob ntawm qhuav thiab exudative pleurisy nyob rau hauv ib tug wedge. cov lus pom zoo tau qhia kom siv kev kho noj haus. Koj yuav tsum muaj cov protein ntau, cov vitamins hauv cov zaub mov, txwv tsis pub noj cov dej thiab ntsev. General ntxiv dag zog rau gymnastics muaj txiaj ntsig zoo. Thaum cov ntse dhau lawmmanifestations ntawm tus kab mob, koj muaj peev xwm ua ua pa ce thiab lub hauv siab massage. Nws yog ib qho tseem ceeb kom nkag siab tias txhua yam kev siv yuav tsum tau ua tom qab kev sab laj nrog tus kws kho mob tshwj xeeb.
