Pneumonia yog ib yam kab mob uas ua rau muaj kev txhim kho ntawm cov txheej txheem inflammatory hauv lub ntsws nrog kev puas tsuaj loj rau cov hlab ntsws. Nws tuaj yeem tshwm sim nws tus kheej los yog tsim ua ib qho teeb meem ntawm lwm yam kab mob. Tus neeg mob tsis kis mus rau lwm tus, tus kab mob tsis kis los ntawm ib tus neeg mus rau lwm tus, tab sis nrog rau tag nrho cov no muaj ib tug kab mob nyob rau hauv nws.
Definition
Lobar pneumonia yog ib qho mob hnyav-kev ua xua uas ntes ib lossis ntau sab ntawm lub ntsws. Feem ntau tshwm sim los ntawm txias txias, pleural thiab mob taub hau, ua npaws, tawm hws, tsis muaj zog, hnoos ntub thiab ua tsis taus pa.
Qhov tshwm sim ntawm cov neeg mob yog qhov siab heev, ntawm tag nrho cov neeg mob, mob ntsws muaj txog 29.3% ntawm cov neeg mob. Qhov no pathology yog tus cwj pwm los ntawm kev swb ntawm ib nrab ntawm lub ntsws thiab kev koom tes ntawm pleura. Tus kab mob no feem ntau cuam tshuam rau cov neeg laus, tsis tshua muaj menyuam yaus.
Etiology
Pathogenpneumococcus tshwm sim, los yog theej, nws ntau hom kab mob, tab sis kev cuam tshuam ntawm lwm cov kab mob pathogenic tsis suav nrog: chlamydia, staphylococci, mycoplasma, streptococci thiab Haemophilus influenzae. Yog tias nws tsis tuaj yeem txheeb xyuas qhov ua rau ntawm tus kab mob, qhov kev kuaj mob tau ua "tsis muaj kab mob lobar pneumonia". Nws yuav tsum raug sau tseg tias tus kab mob tuaj yeem nyob hauv nasopharynx tau ntev yam tsis muaj qhov tshwm sim. Nws kuj tseem ceeb heev uas tus kab mob feem ntau cuam tshuam rau tus neeg noj qab nyob zoo, tab sis nyob rau hauv kev cuam tshuam ntawm qee yam thib ob.
Txoj kev nkag mus rau qhov tseem ceeb:
- thov bronchi;
- chav kawm lymphogenic;
- txoj kev hematogenous.
Pathogenetic daim duab ntawm lobar pneumonia tau piav qhia los ntawm hom mob ntshav siab tam sim ntawd. Kev hloov pauv hauv parenchyma tshwm sim nyob rau hauv txoj kev ua pa, thiab tus kab mob yog tsim nyob rau hauv ib los yog ntau foci los ntawm Kohn's interalveolar pores, thiab ces kis tau los ntawm cov ntaub so ntswg ntawm lub ntsws. Kev puas tsuaj rau cov hlab ntsha lymphatic thiab cov hlab ntsha me ua rau muaj kev puas tsuaj loj ntawm vascular permeability, nrog rau kev tsim ntawm fibrinous exudate.
Kev faib tawm
Muab faib los ntawm qhov chaw:
- qaum lobar;
- qis qis mob ntsws;
- nruab nrab;
- interlobar;
- ob npaug;
- sab laug;
- right tes.
Nyob ntawm qhov ntws:
- protracted - kav ntev tshaj plaub lub lis piam, feem ntau nrog cov tsos mob licked;
- ntse -tsim sai thiab nquag tsim.
Symptoms
- Tus kab mob tsis tshua muaj pib nrog qhov kub thiab txias los yog kub taub hau.
- Cov neeg mob tuaj nrog mob taub hau, tawm hws thiab mob me me nrog kev qaug zog.
- Thaum pib, ua pa luv tshwm sim, uas tom qab ntawd ua rau cov tsos mob tsis zoo hauv thaj chaw cuam tshuam, nyob ntawm lub xeev pleural hauv siab thiab ua pa. Qhov mob yog pronounced, muaj ib tug meej localization, tshwj xeeb tshaj yog nrog active kev tshoov siab. Yog tias koj sim khoov lub cev mus rau qhov chaw ntawm qhov teeb meem, qhov ua pa yuav ua rau lub ntsej muag thiab tsis muaj zog.
- Crupaceous lobar pneumonia yog nrog los ntawm hnoos hnyav thiab ua kom cov hnoos qeev ntau ntxiv, tab sis thaum pib, qhov qhuav qhuav tuaj yeem ua rau mob ua pa.
- Ua npaws feem ntau tsis tuaj rau hauv cov neeg laus thiab cov neeg tsis muaj zog.
- Sputum yog purulent-mucous, muaj xim xeb thiab ntshav.
- Muaj qhov pom tseeb ntawm qhov tsis muaj cua, uas tuaj yeem ua rau muaj teeb meem nrog cov hlab plawv thiab xiav nasolabial daim duab peb sab.
- Kev qaug cawv nrog lobar mob ntsws ua rau muaj teeb meem pw tsaug zog, mob neuralgic, tsis muaj peev xwm txav mus los, arousal, nrog rau delusions thiab hallucinations, yog li cov neeg mob no xav tau kev saib xyuas tas li.
- Icteric manifestations ntawm daim tawv nqaij, dawb ntawm lub qhov muag thiab mucous daim nyias nyias.
- Kev cais cov kua rau hauv cov kab noj hniav pleural, qhov tshwm sim ntawm cov cim qhia ntawm pleurisy.
- Kev mob hauv pob qij txha thiab cov leeg.
- Txuagntshav siab.
- teeb meem plab hnyuv.
Cov kws kho mob hais tias txhua qhov kev hloov pauv ntawm lub ntsws tuaj yeem muab faib ua 4 theem.
- Lub tidal theem uas microbial edema tshwm. Nws tuaj yeem txhim kho raws li qhov tshwm sim ntawm sab xis thiab sab laug-sab mob ntsws lobar los yog nws daim ntawv focal. Lub sijhawm no tsuas yog 1 hnub xwb.
- Nws yog tus cwj pwm los ntawm cov kab mob siab liab, uas qhov swb ntawm tag nrho lub ntsws ntawm lub ntsws pib tshwm. Nws nce qhov loj me thiab tau txais ib qho airless thiab xoob daim ntawv. Pinpoint hemorrhages thiab greyish-dawb txheej tshwm rau ntawm pleura.
- Txij hnub tim 4 mus txog rau hnub 6 ntawm tus kab mob, kev hloov pauv hauv cov xim liab ntawm lub ntsws mus rau grey tshwm sim. Cov ntaub so ntswg ntawm cov kab mob ua pa pib ua nyuaj thiab xoob tib lub sijhawm. Qhov theem no ntawm lobar pneumonia yog hu ua "grey hepatization". Lub alveoli yog tag nrho nrog exudate. Nws yog tsim los ntawm neutrophilic leukocytes thiab filamentous fibrin hais.
- Tsuas yog hnub 9 tus kab mob txav mus rau theem kev daws teeb meem.
Yog vim li cas
Feem ntau, ntau hom kab mob pneumococcus yog cov kab mob ua rau mob, tsis tshua muaj lwm yam kab mob uas nkag mus rau hauv lub cev ntau txoj hauv kev. Kev loj hlob ntawm focal thiab lobar mob ntsws yog cuam tshuam nrog kev pheej hmoo. ntawm pneumococcus nyob rau hauv nasopharynx nyob rau hauv ib tug muaj zog, noj qab nyob zoo tus neeg thiab ua ntej sensitization mob kab mob rau nws antigens.
Tus kab mob pib sai sai tuaj yeem tshwm simtawm tsam keeb kwm ntawm kev noj qab haus huv thiab tsis muaj kev sib cuag nrog cov neeg mob.
Feem ntau lobar pneumonia tshwm nrog cov kab mob xws li:
- tuberculosis;
- mob ntshav qab zib mellitus;
- ARVI (mob ua pa kab mob kis) lossis mob khaub thuas;
- COPD (chronic obstructive pulmonary disease);
- malignant neoplasms hauv qhov ua pa.
Qhov tseem ceeb yog:
- ncua sij hawm raug qhov txias txias ntawm lub cev;
- raug mob hnyav, feem ntau ntawm lub hauv siab;
- tus cwj pwm phem, haus luam yeeb thawj zaug;
- txo qis hauv lub cev tiv thaiv kab mob;
- ua kom lub cev muaj zog;
- kev ntxhov siab tsis ruaj khov thiab cuam tshuam ntawm cov xwm txheej ntxhov siab;
- phem microclimate;
- tsim khoom txaus ntshai.
Lobar pneumonia hauv menyuam yaus
Lub cev ntawm tus menyuam yaus lub cev tsis muaj zog ntau dua li tus neeg laus, yog li kev kis tus kabmob tseem mob hnyav dua thiab sai sai. Nyob rau tib lub sijhawm, qhov kub siab heev, tsis tuaj yeem nres tuaj yeem taug qab. Nyob rau hauv daim duab peb sab nasolabial, ntxiv rau xiav, ib qho pob liab liab tuaj yeem tsim. Cov me nyuam yaus raug rau cov leeg nqaij tsis muaj zog thiab mob taub hau.
Cov cim tseem ceeb ntawm cov kab mob no zoo ib yam li cov neeg laus, txawm hais tias muaj teeb meem tuaj yeem ua rau lawv cov cim ntawm lub paj hlwb, ua rau tus menyuam muaj kev puas siab puas ntsws thaum lub sijhawm thiab tom qab mob, nrog rau kev puas hlwb loj heev. kev ua si. Qhov no tuaj yeem cuam tshuam ntxivme nyuam kev loj hlob.
Diagnosis
Nyuaj hauv kev tshawb pom tus kab mob sai sai hauv cov xwm txheej niaj hnub no cuam tshuam nrog cov duab kho mob sib txawv thiab cov tsos mob tsis pom tseeb.
Txhawm rau kom paub tseeb tias sab laug sab laug lossis sab xis sab xis yog mob ntsws, tus kws kho mob npaj cov lus nug ntawm tus neeg mob (qhov muaj kev tsis txaus siab, kab mob sib kis, muaj feem cuam tshuam) thiab nws qhov kev kuaj mob lub cev. Kev poob siab ntawm tus kab mob no suav nrog cov tsos mob xws li ua npaws hnyav, cov tsos mob ntawm intoxication, hnoos, ua tsis taus pa, mob pleural, cyanosis ntawm lub qhov ntswg thiab daim di ncauj.
Lub ntsiab tseem ceeb ntawm qhov muaj mob thaum lub sijhawm kuaj yog:
- lagging hauv siab thaum lub sijhawm ua pa ntawm sab cuam tshuam;
- nce bronchophony thiab lub suab tshee;
- muaj tachycardia, nrog rau kev ua pa qis dua;
- limited hauv siab tenderness;
- percussion ruam.
Thaum lub sij hawm auscultation thaum lub sij hawm ntawm zej zog tau txais lobar mob ntsws, tus yam ntxwv inspiratory crepitus tau hnov, nrog rau lub suab nrov pleural grazing. Tsis tas li ntawd, kev ua pa ntawm cov hlab ntsws pathological, cov npuas me me lossis cov muffled moist tuaj yeem tshwm sim.
Qhov tseem ceeb rau kev lees paub qhov kev kuaj mob yog cov txiaj ntsig tom qab radiography, uas tau ua tiav hauv 2 qhov kev kwv yees. Nws qhia tau hais tias kev nce hauv cov kab mob pulmonary thiab thaum pib ntawm tus kab mob tsis muaj cov qauv ntawm cov hauv paus hniav hauv thaj tsam cuam tshuam. Thiab tseem muaj homogeneous segmental foci ntawm infiltration ntawm lub ntsws tom qab dhau 4-6.hnub poob.
Kev kuaj ntshav ntawm tus neeg mob qhia tias muaj leukocytosis nrog kev hloov pauv ntawm cov mis mus rau sab laug, thiab hauv cov xwm txheej hnyav heev - leukopenia, hyperfibrinogenemia thiab nce ESR (erythrocyte sedimentation rate). Txhawm rau txheeb xyuas cov kab mob, cov kws kho mob kuaj cov kab mob hnoos qeev los txiav txim siab cov microflora nrog kev kuaj pom ntawm cov tshuaj tua kab mob.
Kev kho mob
Kev kho tus kab mob no tsuas yog ua hauv tsev kho mob nkaus xwb, tshwj xeeb tshaj yog thaum nws los txog rau cov menyuam yaus, muaj mob hnyav thiab yuav tsum tau so hauv txaj. Kev siv tshuaj tua kab mob yuav tsum tshwm sim sai li sai tau tom qab tsim qhov kev txiav txim siab, tsis tas tos rau cov txiaj ntsig ntawm kev kuaj kab lis kev cai rau rhiab heev rau cov tshuaj. Tsis tas li ntawd, cov tshuaj antipyretic thiab antiallergic, immunostimulants thiab cov neeg ua haujlwm uas pab txhim kho cov hnoos qeev tawm tau raug sau tseg.
Kev kho mob ntawm lobar pneumonia yuav tsum tsis txhob ua yam tsis muaj cov txheej txheem physiotherapeutic, vim ua tsaug rau lawv, tus neeg mob txoj kev rov qab tau nrawm dua. Qee lub sij hawm cov neeg mob tau txuas nrog lub tshuab ua pa, ntshav siab nyob ruaj khov, tshuaj bronchoscopy, oxygen barotherapy thiab lwm cov txheej txheem tseem ceeb tau ua.
Kev kho mob tom qab tus kab mob yog qhov nyuaj heev, vim tias feem ntau ntawm cov teeb meem uas tuaj yeem tau txais xaus nrog kev txiav tawm ntawm ib feem ntawm lub ntsws. Rau qhov ntau dua, nws yog raws li pej xeem txoj kev thiab cov txheej txheem kho vajtse.
Physiotherapy
Yuav kom kov yeej tus kab mob, koj yuav tsum siv cov hauv qab nokev kho mob:
- UHF (Ultra High Frequency Therapy);
- tshuaj electrophoresis;
- LFK (kev kho lub cev kab lis kev cai);
- plab massage;
- tshuaj inhalation.
tshuaj ntsuab
Raws li cov txheej txheem pabcuam, cov txheej txheem tsis yog ib txwm siv los kho. Cov tshuaj zoo tshaj plaws rau kev kho mob yog:
- chamomile thiab oregano;
- coltsfoot;
- knotweed;
- aloe nplooj;
- raisins thiab blueberries;
- buckwheat zib mu;
Kev nyuaj siab
Lobar pneumonia piav txog ntau yam teeb meem loj uas feem ntau ua rau muaj kev tsis taus lossis tuag ntxiv.
- mob ua pa tsis ua haujlwm tuaj yeem cuam tshuam nrog tus kab mob nws tus kheej thiab nyob twj ywm tom qab hloov pauv tsis tau uas tau tshwm sim hauv lub ntsws teeb meem.
- Kev txhim kho ntawm abscesses, uas yog purulent tsim nrog cov ntaub so ntswg tuag, uas tsuas yog tshem tawm los ntawm kev phais.
- Gangrene ntawm lub ntsws - purulent putrefactive necrosis kis sai heev.
- Empyema ntawm lub pleura - mob ntawm daim ntawv pleural nrog kua exudate nruab nrab ntawm lub ntsws ntawm lub ntsws, uas muaj cov kua paug.
- Pleurisy yog ib qho mob ntawm cov kab mob hauv lub cev.
- Ntau yam kab mob purulent thaum lub sijhawm kis kab mob hauv cov ntshav: purulent pericarditis, meningitis, hlwb abscesses thiab lwm yam teeb meem zoo sib xws.
- Kev mob plawv, kev loj hlob ntawm lub plawv tsis ua haujlwm thiab aortic valve.
Huab cua
Lobar pneumonia yog suav tias yog kab mob txaus ntshai thiab mob hnyav nrog ntau qhov tshwm sim loj heev thiab muaj teeb meem. Txawm hais tias nrog kev mus ntsib tus kws kho mob raws sij hawm, ntau yam teeb meem tuaj yeem zam tau. Cov kab mob no yog hais txog cov kab mob uas muaj lub ci ntsa iab thiab muaj zog, tab sis kuj tseem nyob hauv chav kawm, yog li yog tias koj ua raws li tag nrho cov kev ntsuas tsim nyog, nws pib sai heev. Qhov kev cia siab rau pawg neeg muaj kev pheej hmoo tsis muaj kev txhawb nqa ntau, cov neeg mob tiv thaiv kab mob, cov neeg laus thiab cov menyuam yaus hnub nyoog qis dua 5 xyoos tsis kam ua tus kab mob no zoo, thiab qhov tshwm sim kuj hnyav heev.
