Nov yog ib yam kab mob txaus ntshai uas yog nrog los ntawm o ntawm cov nplooj pleural nrog ntxiv tsub zuj zuj ntawm purulent masses nyob rau hauv lub pleural kab noj hniav. Tus kab mob yuav tsum tau kho tam sim ntawd thiab ua tiav, txwv tsis pub muaj cov teeb meem loj tuaj.
Cov lus qhia luv luv txog tus kabmob
Empyema ntawm lub pleura (ICD-10 muab tus lej J86 rau cov kab mob no) yog ib yam kab mob loj uas muaj nrog rau qhov mob ntawm lub pleura. Nyob rau tib lub sij hawm, purulent masses pib sau nyob rau hauv lub anatomical kab noj hniav (pleural kab noj hniav nyob rau hauv cov ntaub ntawv no).
Raws li kev txheeb cais, cov txiv neej muaj peb npaug ntau dua yuav muaj tus kab mob zoo li kev sib deev ncaj ncees. Feem ntau, empyema yog ib qho teeb meem ntawm lwm yam pathologies.
Vim li cas thiaj tsim tau tus kab mob
Ua rau pleural empyema tuaj yeem txawv. Yog hais tias peb tham txog lub hom phiaj tseem ceeb ntawm tus kab mob, ces qhov tshwm sim nyob rau hauv cov ntaub ntawv no yog cov kev ua ntawm pathogenic microorganisms, nkag mus rau hauv cov ntshav los yog huab cua rau hauv cov kab noj hniav, raws li zoo raws li ib tug tseem ceeb.txo qis hauv kev tiv thaiv kab mob. Thawj empyema (hauv tshuaj, tus kab mob kuj tshwm sim nyob rau hauv lub npe "purulent pleurisy") tshwm sim thaum:
- kev ua txhaum ntawm lub hauv siab vim raug mob los yog raug mob;
- yav dhau los tau txais kev phais mob, yog tias lawv coj mus rau qhov tsim ntawm bronchial fistulas;
- thoracoabdominal mob hauv siab.
Secondary purulent pleurisy tsim tawm tsam keeb kwm ntawm lwm yam pathologies. Cov npe ntawm lawv yog qhov zoo nkauj heev:
- cov txheej txheem purulent hauv txhua lub cev;
- mob ntsws ntsws;
- abscess tsim nyob rau hauv lub ntsws cov ntaub so ntswg;
- kab mob oncological ntawm txoj hlab pa;
- spontaneous pneumothorax (ua txhaum ntawm kev ncaj ncees ntawm cov kab noj hniav pleural);
- mob khaub thuas appendix;
- peptic rwj ntawm plab thiab plab hnyuv;
- kab mob ntsws;
- cholecystitis;
- peritonitis;
- tsim cov kab mob hauv lub siab;
- sepsis;
- osteomyelitis;
- tawg ntawm txoj hlab pas;
- mob ntawm pericardium;
- cov txheej txheem inflammatory hauv pancreas;
- kab mob sib kis ntawm txoj hlab pa;
- tuberculosis.
Nws tsim nyog sau cia tias tus kab mob tuaj yeem tshwm sim los ntawm kev ua kom muaj qee yam kab mob pathogenic, tshwj xeeb yog pneumococci, streptococci, staphylococci, tubercle bacillus, kab mob fungi thiab kab mob anaerobic. Cov kab mob tuaj yeem nkag mus rau cov ntaub so ntswg ntawm lub ntsws nrog rau cov ntshav thiab cov qog ntshav los ntawm lwm yam kabmob.
Pleural empyema: kev faib tawm
Hnub no, muaj ntau lub tswv yim rau kev faib cov kab mob no, vim tias ntau yam yuav tsum tau coj mus rau hauv tus account.
Piv txwv li, nyob ntawm tus yam ntxwv thiab lub sijhawm ntawm chav kawm, mob thiab mob ntev pleural empyema raug cais tawm. Cov tsos mob ntawm cov qauv no tuaj yeem sib txawv. Piv txwv li, nyob rau hauv tus txheej txheem mob inflammatory-purulent, cov tsos mob ntawm intoxication tuaj rau hauv lub xub ntiag, thaum tus kab mob no kav tsawg tshaj li ib hlis. Yog hais tias peb tham txog cov kab mob ntev, ces cov tsos mob yog qhov muag plooj, tab sis lawv cuam tshuam tus neeg mob ntev (ntau tshaj 3 lub hlis).
Nyob ntawm qhov xwm txheej ntawm exudate, empyema tuaj yeem ua rau purulent, tshwj xeeb, putrefactive thiab sib xyaw. Muaj qhov kaw (purulent masses muaj nyob rau hauv lub pleural kab noj hniav thiab tsis txhob mus sab nraud) thiab qhib daim ntawv ntawm tus kab mob (muaj ib tug tsim ntawm fistulas ntawm lub pleura thiab lub ntsws, bronchi, daim tawv nqaij los ntawm cov exudate circulates).
Lub ntim ntawm cov kua paug kuj tau muab rau hauv tus account:
- small empyema - qhov ntim ntawm purulent masses tsis pub tshaj 250 ml;
- nruab nrab, ntawm qhov ntim ntawm exudate yog 500-1000 ml;
- loj empyema - muaj ntau cov kua paug (ntau tshaj 1 liter).
Nyob ntawm qhov chaw ntawm qhov tsom, cov txheej txheem pathological tuaj yeem yog ib qho lossis ob sab. Tau kawg, tag nrho cov yam ntxwv no tseem ceeb rau kev kho kom zoo.
theem ntawm kev txhim kho kab mob
Hnub no, muaj peb theem hauv kev txhim kho cov kab mob no.
- thawj theem yog serous. Serous effusion pib mus rau hauv cov kab noj hniav pleural. Yog tias nyob rau theem no tus neeg mob tsis tau muab kev pab tsim nyog, ces cov paj pyogenic pib ua kom nquag plias hauv cov kua dej.
- theem ob yog fibro-serous. Lub exudate nyob rau hauv lub pleural kab noj hniav yuav pos huab, uas yog txuam nrog cov kev ua ntawm cov kab mob pathogenic. Fibrinous plaque tsim nyob rau saum npoo ntawm parietal thiab visceral nplooj. Maj mam, adhesions tsim ntawm cov nplooj ntawv. Cov kua qaub tuab sib sau nruab nrab ntawm nplooj.
- Thib peb - fibrous. Nyob rau theem no, qhov tsim ntawm ntom adhesions uas fetter lub ntsws yog pom. Txij li thaum lub ntsws cov ntaub so ntswg tsis ua hauj lwm ib txwm, nws kuj undergoes fibrotic txheej txheem.
Cov tsos mob ntawm pathology
mob ntsws empyema nrog rau cov tsos mob zoo heev.
- Tus neeg mob lub cev kub nce.
- Muaj lwm cov tsos mob ntawm kev qaug cawv, tshwj xeeb, ua daus no, mob thiab mob hauv cov leeg, tsaug zog, tsis muaj zog, tawm hws.
- hnoos yog ib yam tsos mob ntawm empyema. Thaum xub thawj nws qhuav, tab sis maj mam ua khoom. Thaum hnoos, hnoos qeev yog ntsuab-daj, grey los yog rye. Feem ntau, qhov paug tawm muaj qhov tsw tsw qab ntxiag.
- Daim ntawv teev cov tsos mob kuj suav nrog ua tsis taus pa - thaum xub thawj nws tshwm sim thaum lub cev ua si, tab sis tom qab ntawd tus neeg mob tau ntxhov siab thaum so.
- Raws li cov pathology zuj zus, qhov mob hauv lub sternum tshwm sim,uas nce exhalation thiab inhalation.
- Kev hloov pauv hauv kev ua haujlwm ntawm cov pa ua pa kuj cuam tshuam rau kev ua haujlwm ntawm lub plawv, ua rau qee yam cuam tshuam hauv nws lub suab.
- Cov neeg mob yws ntawm qhov tsis muaj zog, qaug zog, ua haujlwm tsis zoo, ntxhov siab, tsis qab los.
- Cov kab mob ua pa yog qee zaum nrog qee cov tsos mob sab nraud. Piv txwv li, daim tawv nqaij ntawm tus neeg mob daim di ncauj thiab lub ntsis ntiv tes ua xim xiav.
Raws li kev txheeb cais, kwv yees li 15% ntawm cov xwm txheej txheej txheem dhau mus ntev. Txawm li cas los xij, daim duab kho mob txawv. Cov tsos mob ntawm intoxication tsis tuaj, nrog rau kub taub hau. hnoos cuam tshuam tus neeg mob tas li. Cov neeg mob kuj yws txog qhov mob taub hau. Yog tias tsis kho, ntau yam deformities ntawm lub hauv siab tsim, nrog rau scoliosis, uas cuam tshuam nrog qee cov txheej txheem them nyiaj.
Muaj Teeb Meem
Raws li kev txheeb cais, kev kho kom raug pab tiv nrog pleural empyema. Txawm li cas los xij, muaj teeb meem. Lawv cov npe yog raws li nram no:
- dystrophic hloov hauv lub raum;
- kev puas tsuaj loj rau myocardium, ob lub raum thiab lwm yam kabmob;
- tsim cov ntshav txhaws, txhaws ntawm cov hlab ntsha;
- ntau lub cev tsis ua haujlwm;
- tsim ntawm bronchopleural fistulas;
- kev txhim kho ntawm amyloidosis;
- thrombo-txog pulmonary embolism (yuav tsum tau phais xwm txheej ceev li lwm yamrooj plaub, muaj feem ntau yuav tuag).
Raws li koj pom, qhov tshwm sim ntawm tus kab mob no txaus ntshai heev. Tias yog vim li cas tsis muaj ib qho xwm txheej twg koj yuav tsum tsis quav ntsej cov tsos mob ntawm tus kab mob thiab tsis kam txais kev pab los ntawm tus kws kho mob tshwj xeeb.
ntsuas ntsuas
Kev kuaj mob ntawm pleural empyema yog qhov tseem ceeb heev. Tus kws kho mob tau ntsib nrog txoj haujlwm tsis yog tsuas yog lees paub tias muaj pyothorax, tab sis kuj txiav txim siab qhov xwm txheej ntawm cov txheej txheem pathological, qib ntawm nws kis, thiab qhov ua rau tshwm sim.
- Pib nrog, sau anamnesis, kev kawm ntawm tus neeg mob cov ntaub ntawv kho mob. Nrog rau kev ntsuam xyuas sab nraud ntawm lub hauv siab, ib lossis lwm qhov ntawm deformation, bulging lossis smoothing ntawm qhov chaw intercostal yuav pom. Yog hais tias peb tham txog mob pleural empyema, ces tus neeg mob muaj scoliosis. Cov yam ntxwv zoo heev yog qhov poob ntawm lub xub pwg nyom thiab qhov protrusion ntawm scapula ntawm sab ntawm qhov txhab.
- Auscultation is mandatory.
- Nyob rau yav tom ntej, tus neeg mob raug xa mus rau ntau yam kev kawm. Yuav tsum tau kuaj ntshav thiab zis, thaum lub sijhawm nws muaj peev xwm txiav txim siab qhov muaj cov txheej txheem inflammatory. Cov hnoos qeev thiab cov kua aspirated raug tshuaj xyuas microscopically.
- Exudate kuaj yog siv rau kab mob kab mob. Cov txheej txheem no tso cai rau koj los txiav txim seb hom thiab hom kab mob, txheeb xyuas qhov ntsuas ntawm nws qhov kev nkag siab zoo rau qee yam tshuaj.
- Cov ntaub ntawv yog fluoroscopy thiab radiography ntawm lub ntsws. Hauv cov duab, thaj chaw cuam tshuam tau tsaus.
- YPleurofistulography- tus txheej txheem uas pab txhawm rau txheeb xyuas fistulas (yog tias muaj).
- Pleural puncture thiab ultrasonography ntawm cov kab noj hniav pleural tseem yuav tau pom dua.
- Qee zaum tus neeg mob raug xa mus rau kev sib nqus resonance thiab/los yog xam tomography. Cov kev tshawb fawb no pab tus kws kho mob soj ntsuam cov qauv thiab kev ua haujlwm ntawm lub ntsws, kuaj xyuas cov exudate thiab ntsuas nws qhov ntim, thiab kuaj pom muaj qee yam teeb meem.
Raws li cov ntaub ntawv tau txais, tus kws kho mob xaiv cov tshuaj tsim nyog thiab kos cov txheej txheem kho kom zoo.
Kev kho mob
Kev kho mob ntawm pleural empyema feem ntau cuam tshuam nrog kev tshem tawm cov pob txha purulent - qhov no tuaj yeem ua tau ob qho tib si thaum lub sijhawm sib tsoo thiab los ntawm qhov qhib tag nrho ntawm lub hauv siab (txoj kev no tsuas yog siv los ua qhov kawg nkaus xwb).
Txij li thaum tsim cov purulent exudate yog rau qee qhov cuam tshuam nrog kev ua haujlwm ntawm cov kab mob pathogenic, cov tshuaj tua kab mob uas muaj ntau yam cuam tshuam hauv daim ntawv ntawm cov ntsiav tshuaj yuav tsum tau nkag mus rau hauv kev kho mob. Cov tshuaj los ntawm cov pab pawg ntawm aminoglycosides, cephalosporins, fluoroquinolones tau pom tias muaj txiaj ntsig. Tsis tas li ntawd, qee zaum cov tshuaj tua kab mob tau txhaj ncaj qha rau hauv cov kab noj hniav pleural kom tau txais txiaj ntsig ntau tshaj plaws.
Qee lub sij hawm cov neeg mob tau txais kev txhaj tshuaj ntawm kev npaj cov protein, piv txwv li, tshwj xeeb hydrolysates, albumin, purified ntshav plasma. Tsis tas li ntawd, kev daws teeb meem ntawm qabzib thiab electrolytes tau qhia, uas pab kho lub cev.
Immunomodulatory therapy yog qhov yuav tsum tau ua, nrog rau kev noj cov vitamin complexes - qhov no yuav pab ntxiv dag zog rau lub cev tiv thaiv kab mob, uas, nyob rau hauv lem, pab txhawb lub cev rov qab sai. Kev kho mob kuj tau ua. Piv txwv li, ua npaws hnyav, cov tshuaj tua kab mob thiab cov tshuaj uas tsis yog-steroidal anti-inflammatory siv.
Tom qab cov tsos mob ntawm empyema ua tsis tau zoo, kev kho lub cev raug pom zoo rau cov neeg mob. Kev ua pa tshwj xeeb pab ntxiv dag zog rau cov leeg nqaij intercostal, normalize lub ntsws ua haujlwm, thiab saturate lub cev nrog oxygen. Kev kho mob zaws kuj tseem yuav pab tau, uas tseem yuav pab tshem tawm cov hnoos qeev, txhim kho kev noj qab haus huv ntawm lub cev. Tsis tas li ntawd, cov kev kho mob gymnastics tau tuav. Ultrasound kho kuj muab tau zoo. Thaum kho dua tshiab, cov kws kho mob pom zoo kom cov neeg mob tau txais kev kho mob spa.
Thaum twg yuav tsum tau phais?
Hmoov tsis zoo, qee zaum tsuas yog phais pab tiv thaiv tus kab mob. Pleural empyema, uas yog tus cwj pwm los ntawm kev mob ntev thiab kev sib sau ntawm cov kua paug ntau, yuav tsum muaj kev phais. Cov kev kho mob zoo li no tso cai rau koj tshem tawm cov tsos mob ntawm intoxication, tshem tawm fistulas thiab kab noj hniav, ncaj lub ntsws cuam tshuam, tshem tawm purulent exudate thiab ntxuav cov kab noj hniav pleural.
Qee lub sij hawm ib qho thoracostomy ua raws li qhib cov kua dej. Qee zaum tus kws kho mob txiav txim siab tshem tawm qee ntu ntawm pleura nrog ntxivdecortication ntawm lub ntsws cuam tshuam. Yog hais tias muaj fistulas ntawm cov ntaub so ntswg ntawm lub pleura, bronchi, ntsws thiab daim tawv nqaij, ces tus kws phais kaw lawv. Yog tias cov txheej txheem pathological tsis tau kis mus rau hauv lub ntsws, tus kws kho mob tuaj yeem txiav txim siab ntawm ib feem lossis ua tiav qhov kev txiav txim siab ntawm lub cev cuam tshuam.
tshuaj ntsuab
Kev kho tus kab mob zoo li no yuav tsum ua kom tiav. Thiab qee zaum kev siv ntau yam tshuaj ntsuab tau tso cai.
- Hnub zoo tib yam suav hais tias siv tau. Kev npaj cov tshuaj yog ib qho yooj yim. Tev ib tug medium-qhov loj qhov dos los ntawm husk, yaug thiab chop. Tom ntej no, koj yuav tsum tau nyem cov kua txiv hmab txiv ntoo thiab sib tov nrog ntuj zib mu (hauv qhov sib npaug). Cov tshuaj yog pom zoo kom noj ob zaug ib hnub twg rau ib tug tablespoon. Nws ntseeg tau tias lub cuab yeej zoo heev ntawm kev tiv thaiv hnoos, ua kom cov hnoos qeev tawm.
- Nyob hauv tsev, koj tuaj yeem npaj cov tshuaj mucolytic zoo. Koj yuav tsum sib tov sib npaug ntawm elecampane rhizomes, coltsfoot tshuaj ntsuab, mint, linden paj thiab licorice paus. 20 g ntawm cov nroj tsuag sib tov yuav tsum tau nchuav nrog ib khob ntawm boiling dej, ces cia nws brew. Kev kho mob tom qab txias los ntawm kev lim dej thiab muab faib ua peb feem sib npaug - lawv yuav tsum tau qaug dej qaug cawv thaum nruab hnub. Cov tshuaj tshiab yuav tsum tau npaj txhua hnub.
- Horsetail kuj suav hais tias siv tau. 20 g ntawm qhuav nyom ntawm cov nroj tsuag (crushed) yuav tsum tau nchuav nrog 0.5 liv ntawm boiling dej. Lub thawv yuav tsum tau npog thiab sab laug rau plaub teev nyob rau hauv ib qho chaw sov so, tom qab uas cov infusion yog lim. Nws raug nquahu kom noj 100 ml plaub zaug hauv ib hnub rau 10-12hnub.
- Nws muaj cov tshuaj sau los ua kom cov txheej txheem ua pa thiab pab tiv thaiv ua pa luv. Nws yog ib qho tsim nyog yuav tau tshem tawm qhov sib npaug ntawm cov nyom immortelle, qhuav calendula paj nrog currant nplooj, tansy thiab noog cherry. Ib tug tablespoon ntawm sib tov yog poured nrog ib khob ntawm boiling dej thiab insisted. Koj yuav tsum noj 2-3 tablespoons peb zaug ib hnub.
- Yog tias muaj teeb meem nrog kev ua haujlwm ntawm lub ntsws, ces koj yuav tsum sib tov sib npaug ntawm cov zib ntab ntuj thiab kua txiv hmab txiv ntoo tshiab. Herbalists pom zoo noj tshuaj nyob rau hauv ib rab diav (lub rooj) peb zaug ib hnub twg.
Tau kawg, koj tuaj yeem siv cov tshuaj hauv tsev tsuas yog kev tso cai los ntawm tus kws tshaj lij.
Empyema ntawm pleura: cov txheej txheem kho mob rau kev tiv thaiv kev txhim kho tus kabmob
Hmoov tsis zoo, tsis muaj kev tiv thaiv tshwj xeeb. Txawm li cas los xij, cov kws kho mob qhia kom ua raws li qee txoj cai:
- tag nrho cov kab mob inflammatory (tshwj xeeb tshaj yog thaum lawv nrog cov txheej txheem purulent) yuav tsum tau kho raws sijhawm;
- nws yog ib qho tseem ceeb los txhawb kev tiv thaiv kab mob, vim qhov no txo qis kev pheej hmoo ntawm kev tsim cov kab mob zoo li no (koj yuav tsum sim kom raug, txhawm rau lub cev, noj cov vitamins, siv sijhawm nyob hauv huab cua ntshiab);
- tsis txhob zam kev kuaj xyuas - qhov pom tus kab mob ua ntej, qhov tsis tshua muaj tshwm sim yuav tshwm sim.
Nws tsim nyog sau cia tias feem ntau, tus kab mob no teb tau zoo rau kev kho. Pleural empyema tsis nyob rau hauv vain xam tau tias yog ib tug txaus ntshai pathology - nws yuav tsum tsis txhob ignored. Raws li kev txheeb cais, kwv yees li20% ntawm cov neeg mob muaj qee yam teeb meem. Kev tuag ntawm tus kab mob no yog li ntawm 5 txog 22%.
