Pleurisy yog ib qho mob ntawm daim ntawv pleural, uas tuaj yeem yog tus kab mob ywj pheej lossis qhov tshwm sim ntawm cov txheej txheem mob ntev lossis mob tshwm sim hauv lub ntsws. Muaj tseeb, nws tsis tshua muaj tshwm sim sib cais los ntawm lwm yam kab mob. Nws yog ib qho tseem ceeb heev uas yuav tsum tau ceev faj tam sim ntawd rau cov tsos mob ntawm pleurisy thiab sab laj nrog kws kho mob, txwv tsis pub koj yuav tau ntsib cov txiaj ntsig tom qab. Cov cim qhia dab tsi qhia tias muaj tus kab mob no? Dab tsi ua rau nws? Yuav kho li cas? Qhov no thiab ntau lwm yam yuav tau tham tam sim no.
Yog vim li cas
Ua ntej xav txog cov tsos mob ntawm pleurisy, nws yog ib qho tsim nyog los kawm txog cov laj thawj vim li cas tus kab mob no tshwm sim. Lawv tuaj yeem kis tau:
- Tuberculosis bacillus. Raws li kev txheeb cais, qhov no yog qhov ua rau muaj qhov tshwm sim hauv 20% ntawm cov neeg mob.
- Bacteria. Cov no feem ntau yog pneumococci, staphylococci, thiab lwm yam.
- Parasites thiab protozoamicroorganisms (echinococcus, amoeba nkag mus rau hauv lub cev).
- kab mob fungal (blastomycosis thiab candidiasis).
- YTyphoid, brucellosis, syphilis.
- Kev kis mob vim nkag mus rau qhov txhab thiab raug mob.
Tsis tas li, tus kab mob feem ntau tshwm sim vim tsis kis kab mob. Cov no suav nrog:
- Pulmonary embolism, tseem hu ua pulmonary infarction.
- Metastases nyob rau hauv lub nruab nrog cev los yog malignant qog uas tau tshwm sim nyob rau hauv lub pleura.
- Pathology ntawm cov ntaub so ntswg sib txuas. Cov no yog vasculitis, kab mob lupus erythematosus, thiab mob caj dab rheumatoid.
- Lub raum tsis ua haujlwm.
- mob plawv mob plawv.
- Lwm yam kab mob (hemorrhagic diathesis, leukemia, pancreatitis, thiab lwm yam).
Ntxiv rau qhov saum toj no, tus kab mob tuaj yeem tshwm sim vim kev mob hauv siab.
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Nws tshwm sim nws tus kheej hauv kev mob tshwm sim ntawm visceral thiab parietal pleura nrog kev tso tawm ntawm fibrin rau ntawm nws qhov chaw - cov protein ntau molecular tsim los ntawm fibrinogen synthesized hauv daim siab. Cov tsos mob ntawm qhuav pleurisy yog raws li nram no:
- Qhia tau tias mob nyob rau hauv ib nrab ntawm lub hauv siab nrog qhov mob. Lawv nce nrog kev sib zog, hnoos, thiab tseem nyob ntawm qhov siab ntawm kev tshoov siab.
- Tom qab qhov chaw ntawm qhov mob hauv plab kab noj hniav. Muaj cov cim qhia zoo ib yam li cov kab mob pancreatitis, appendicitis thiab cholecystitis.
- hnoos qhuav.
- Cov cim qhia ntawm qhov mob, uas suav nrog txo qis qab los noj mov, malaise thiabhmo ntuj sweats.
- Mob hauv qhov projection ntawm cov leeg trapezius.
- Tsov kub rau 39 ° C.
- Ua npaws nrog tachycardia thiab txias.
Tshwj xeeb tshaj yog mob hnyav thiab yog tias tus kab mob tsis quav ntsej, pleuropericarditis tuaj yeem tshwm sim - ib qho mob ntawm cov hlab ntsha ntawm lub plawv. Nws yuav tsum raug sau tseg tias chav kho mob ntawm tus kab mob no yog los ntawm 1 mus rau 3 lub lis piam. Qhov tshwm sim, nyob ntawm qhov kev ua los ntawm tus neeg mob, tej zaum yuav rov zoo los yog hloov mus rau ib qho exudative/chronic form.
Kev kuaj mob ntawm cov hlab ntsha qhuav
Nws tsim nyog hais luv luv txog qhov no. Paub meej tias cov tsos mob ntawm pleurisy tsuas yog kuaj tau thiab kuaj xyuas, thiab ntau tus kws kho mob tshwj xeeb. Ib tug neeg yuav tsum tau tig mus rau tus kws kho mob tshwj xeeb, kws kho mob rheumatologist, pulmonologist, kws kho mob plab thiab kws kho mob phthisiatrician. Vim tias kev kuaj mob tsis txaus - nws yog ib qho tsim nyog los txheeb xyuas qhov ua rau tus kab mob no.
Cov kws tshaj lij siv cov hauv qab no txhawm rau kuaj tus kabmob:
- kuaj ntshav kuaj. Nrog rau tus kab mob no, muaj qhov nce erythrocyte sedimentation tus nqi, nrog rau neutrophilic leukocytosis nrog kev hloov mus rau sab laug.
- X-ray ntawm lub hauv nruab nrog cev. Feem ntau nws tuaj yeem pom qhov txo qis ntawm nws cov npoo qis thiab ib qho tsis tshua pom pom ntawm lub ntsws.
- Kev kuaj zis. Yuav tsum tsis suav nrog kev hloov pauv pathological.
- kuaj ntshav biochemical. Cov tsos mob ntawm pleurisy tau lees paub yog tias nws tuaj yeem txheeb xyuas taunce tus nqi ntawm fibrin, seromucoids, sialic acids thiab lwm yam mob theem ntsuas.
- Ultrasound. Tso cai rau koj los txiav txim siab seb cov phab ntsa ntawm lub plhaub yog thickened thiab yog tias muaj cov txheej txheem ntawm fibrin deposited.
- X-ray thiab fluoroscopy ntawm lub ntsws. Txoj kev no ua rau nws muaj peev xwm txheeb xyuas ntau qhov txhab - los ntawm obliteration ntawm lub sinuses mus rau ib qho kev hloov nyob rau hauv lub contour ntawm lub diaphragm.
Thaum kuaj tactile, tus kws kho mob tuaj yeem qhia qhov mob thiab tawv nqaij. Tus kws kho mob kuj kho qhov ua tsis taus pa tsis muaj zog thiab qhov dav lossis thaj chaw pleural txhuam txhuam. Nws tshwm sim vim kev sib cuag ntawm cov nplooj pleural ntxhib. Nco ntsoov ua kom paub meej txog cov tsos mob ntawm cov pleurisy qhuav. Nws tsis tuaj yeem sau tshuaj kho lwm yam, vim tias cov tsos mob ntawm tus kab mob no zoo ib yam li qee qhov tshwm sim ntawm angina pectoris, intercostal neuralgia, myositis, thiab lwm yam.
Kev kho mob pleurisy qhuav
Yog tias nws tuaj yeem txheeb xyuas tus kab mob thaum ntxov, thaum nws tseem tsis tau dhau mus rau hauv daim ntawv nyuaj, ces kev kho yuav siv li ob mus rau peb lub lis piam. Kev kho kom tshem tawm cov tsos mob ntawm pleurisy ntawm lub ntsws yog kws kho mob tau sau tseg, tab sis, raws li txoj cai, cov tshuaj hauv qab no tau muab rau cov neeg mob:
- Clindamycin. Siv tau zoo bacteriostatic, qhov kev txiav txim ntawm uas yog tsom rau inhibiting protein synthesis, nrog rau kev puas tsuaj ntawm microaerophilic thiab anaerobic parasitic kab mob.
- III tiam cephalosporins. Cov no yog cov tshuaj tua kab mob muaj zog nrog kev ua kom muaj zog tiv thaiv kab mob gram-tsis zoo, kuj cuam tshuamPseudomonas aeruginosa thiab ntau lwm cov kab mob uas cuam tshuam rau lub cev.
- "Amoxicillin". Ib qho tshuaj tua kab mob uas koom nrog pab pawg penicillins nrog ntau qhov kev ua haujlwm. Nws raug sau ua ke nrog clavulanic acid. Cov tshuaj no cuam tshuam nrog cov tshuaj penicillin, txhim kho lawv cov haujlwm.
- Imipenem. Nws yog ib qho tshuaj tua kab mob beta-lactam uas inhibits cov synthesis ntawm cov kab mob ntawm cov phab ntsa ntawm tes, nrog rau kev rhuav tshem cov cab uas muaj nyob hauv ntau pawg.
Cov tshuaj tau teev tseg yog txhawm rau tshem tawm cov tsos mob ntawm pleurisy ntawm lub ntsws thiab kho tus kab mob nws tus kheej. Tab sis nyob rau hauv parallel, nws yog ib qhov tsim nyog yuav tau ua ib qho kev kho ntawm cov protein metabolism. Txhawm rau ua qhov no, tus neeg yuav tsum ua raws li kev noj zaub mov protein. Hauv cov xwm txheej hnyav tshwj xeeb, tus kws kho mob tuaj yeem sau ntawv qhia txog 10% cov tshuaj albumin hauv qhov ntim ntawm 150 ml thiab ntshav ntshav (los ntawm 200 txog 400 ml).
Txhawm rau txo qhov mob, tus neeg mob tau muab tshuaj steroid hormones:
- "Hydrocortisone". Txhawb nqa cov haujlwm ntawm cov ntaub so ntswg macrophages thiab leukocytes, txwv tsis pub lawv tsiv teb tsaws chaw rau thaj tsam ntawm qhov mob thiab txo cov concentration ntawm proteolytic enzymes hauv nws.
- "Prednisolone". Txo cov capillary permeability, inhibits collagen tsim thiab fibroblast kev ua.
- Metipred. Nws muaj cov tshuaj tiv thaiv kab mob, tiv thaiv kev ua xua, thiab tiv thaiv kab mob.
tshuaj tsis yog tshuaj hormonal kuj tau sau tseg. Ntawm cov nto moo tshaj plaws, Movalis, Diclofenac, Voltaren thiab Ibuprofen tuaj yeem raug sau tseg.
Tiv thaiv kev kawmadhesions nyob rau hauv lub pleural dav hlau yog pab los ntawm cov txheej txheem xws li ua pa ce, vibration los yog classical massage, raws li zoo raws li physiotherapy. Tab sis tus kws kho mob yuav pom zoo lawv tus cwj pwm tsuas yog tom qab cov tsos mob ntawm pleurisy ntawm lub ntsws raug tshem tawm, thiab kev kho mob tuaj yeem hloov mus rau hauv daim ntawv sparing. Txij li cov kab mob hauv nqe lus nug muaj qhov nyuaj etiology thiab tuaj yeem tshwm sim los ntawm tuberculosis, tus neeg mob thaum lub sijhawm kho yuav tsum nyob hauv lub tsev kho mob raws li kev saib xyuas ntawm tus kws kho mob thiab tau txais kev kho tshwj xeeb.
Effusion pleurisy
Nws tseem hu ua exudative. Ua ntej sau cov tsos mob ntawm hom pleurisy, nws tsim nyog tham txog yuav ua li cas nws tsim. Tus kab mob yog cov txheej txheem inflammatory nyob rau hauv ob sab phlu ntawm lub ntsws, nrog rau kev tsim ntawm ib tug pleural effusion - dej ntau dhau.
Ntxiv rau cov laj thawj uas tau hais lawm, qhov mob no tuaj yeem tsim los ntawm cov yam ntxwv xws li:
- -parasitic infestations (Parasite infestation).
- Kev tsis haum tshuaj.
- Kab mob nrog rau qhov tsis sib xws ntawm cov ntaub so ntswg sib txuas.
- Tshav kub lossis tshuaj lom neeg kub hnyiab.
- Uremic pleurisy (tshwm sim thaum qhov sib npaug ntawm nitrogen thiab nws cov tebchaw cuam tshuam hauv lub cev).
- Circulatory tsis ua hauj lwm.
Cov tsos mob ntawm hom mob ntsws pleurisy muaj xws li:
- Qhia meej cov tav hauv thaj chaw uas cov kua dej sib sau.
- Ua kom qaug zog thiab tsis muaj zog thoob plaws hauv lub cev, pom txawm tias tsis muajkev tawm dag zog lub cev.
- Xav txog qhov hnyav ntawm qhov chaw.
- Tsis muaj cua, ua rau muaj kev ntshai.
- Acceleration ntawm lub plawv dhia, kev loj hlob ntawm arrhythmia.
- Txoj kev xav mus pw ntawm qhov cuam tshuam. Yog li qhov tsis xis nyob yuav txo qis me ntsis.
Nyob zoo ib tsoom phooj ywg sawv daws.
Tab sis cov tsos mob txaus ntshai tshaj plaws yog kev txav ntawm lub plawv cov leeg mus rau sab noj qab haus huv. Lub inferior vena cava, uas muab cov ntshav mus rau lub plawv, yuav kink. Vim li no, cov ntshav tau raug cuam tshuam, thiab qhov no tuaj yeem ua rau tsis yog qhov tshwm sim loj, tab sis kuj ua rau tuag.
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Yog hais tias cov hau kev saum toj no siv los kuaj tus kab mob, ces nws raug tshem tawm siv lwm txoj kev. Saum toj no tau qhia txog dab tsi pleurisy yog thiab nws cov tsos mob. Kev kho yuav tsum tau ua tib zoo saib tam sim no.
Ntawm no yog cov txheej txheem uas tus neeg mob yuav tsum tau ua:
- Nkauj kho siab. Nws yog ib qho tsim nyog ob qho tib si rau kev kuaj mob thiab rau kev tso dej tawm. Nws yog ua tiav ib zaug, vim tias tom qab ntawd adhesions daim ntawv. Nws tuaj yeem tso tawm mus txog 1.5 litres.
- Noj tshuaj tua kab mob. Nws raug sau tseg yog tus kab mob provoked kev loj hlob ntawm cov kab mob.
- Hnub kawm ntawm cov tshuaj muaj codeine. Qhov no yog tsim nyog rau cov hnoos qeev tawm.
- Noj cov tshuaj tiv thaiv kab mob uas txwv tsis pub cov tshuaj histamine. Qhov nrov tshaj plaws yog cov tshuaj xws li "Diazolin", "Erius" thiab "Cetrin".
- Kev siv tshuaj tua kab mob. Nws nyuaj yog tsis muaj lawvtshem tawm qhov mob. Medsikam thiab Ibuprofen pab tau zoo tshaj plaws.
- Nyob rau qhov mob. Cov tshuaj zoo tshaj plaws yog Nimesil, Cefekon, Tramadol thiab Nise.
- Siv cov tshuaj diuretics. Qhov zoo tshaj plaws yog "Indapamide", "Veroshpiron" thiab "Diakarb".
Nrog kev pab los ntawm cov nyiaj no, cov tsos mob ntawm pleurisy ntawm lub ntsws yog kho rau cov neeg laus thiab cov neeg mob hnub nyoog nruab nrab. Hauv tshwj xeeb yog mob hnyav, tus kws kho mob tuaj yeem sau tshuaj glucocorticosteroids. Lawv muaj ntau yam kev ua ub no. Cov tshuaj no muab antitoxic, immunosuppressive, anti-inflammatory, anti-shock thiab desensitizing teebmeem. Thaum tsis muaj contraindications, tus kws kho mob yuav sau ntawv inductothermy, diathermy, electrophoresis, massage, ultraviolet hluav taws xob ntawm lub hauv siab, av nkos wraps thiab paraffin daim ntaub ntawv.
Purulent pleurisy
Ntawm no yog hom kab mob thib peb uas kuv xav hais txog. Tus kab mob no yog tus cwj pwm los ntawm tsub zuj zuj ntawm cov kua paug nyob rau hauv lub pleural kab noj hniav. Ua ke nrog parietal membrane, pulmonary kuj cuam tshuam. Raws li txoj cai, tus kab mob no yog ib qho teeb meem uas tshwm sim tom qab mob ntsws ntawm tus kab mob khaub thuas lossis croup hom.
Cov tsos mob ntawm pleurisy hauv cov neeg laus hauv qhov no yog:
- tsis muaj peev xwm ua tsis taus pa puv, nyuaj rau txoj haujlwm no.
- Tshuaj mob hauv siab.
- Qhia ua pa luv.
- hnoos nrog phlegm, yog tias tus kab mob tshwm sim tom qab lub ntsws abscesslos yog mob ntsws.
- Nyob rau hauv lub cev kub heev.
- Nyob hauv cheeb tsam sab.
- qaug zog heev.
- hnoos haum thaum hmo ntuj.
Yog tias koj tsis quav ntsej tus kab mob, tom qab lub sijhawm, kub taub hau yuav dhau los ua tus qauv tsis dhau, thiab cov mem tes yuav ruaj khov nyob rau hauv thaj tsam ntawm 120 txog 130 tus neeg ntaus ib feeb. Hauv qhov xwm txheej phem tshaj plaws, kev tso pa tawm ntawm huab cua thiab cov kua paug mus rau hauv cov kab noj hniav pleural yuav tshwm sim. Qhov no yog vim lub ntsws ruptured abscess. Qhov tshwm sim yog pleural shock.
Kev kho mob purulent pleurisy
Nws yuav tsis quav ntsej. Nyob rau hauv cov ntaub ntawv ntawm tus kab mob no, cov tsos mob ntawm pleurisy nyob rau hauv cov neeg laus yog nyuaj rau tshem tawm. Lub luag haujlwm tseem ceeb yog txhawm rau tshem tawm cov kab mob thiab cov cim qhia ntawm intoxication pib tshwm sim nws tus kheej. Koj tseem yuav tau rov qab ua haujlwm tag nrho ntawm cov kabmob uas muaj kabmob.
Ua ntej tshaj plaws, tus kws kho mob tshem tawm qhov ua kom pom tseeb, tom qab ntawd nws kho lub ntsws. Tom qab ntawd koj yuav tsum tau tos me ntsis sij hawm kom lub pleura loj hlob ua ke. Tom qab ntawd, obliteration ntawm kab noj hniav ntawm lub tsom xam yuav tsum tshwm sim. Tsuas yog tom qab ntawd tus kws kho mob tau sau ib qho kev kho mob uas pab tiv thaiv cov tsos ntawm moorings nyob rau hauv lub pleura, uas yuav provoke kev hloov ntawm tus kab mob mus rau hauv ib tug ntev daim ntawv.
Lub hauv paus ntawm kev kho yog cov txheej txheem rau kev tso tawm exudate. Nws yog ua nyob rau hauv parallel nrog intramuscular txhaj tshuaj penicillin rau hauv kab noj hniav. Hauv cov xwm txheej nyuaj tshwj xeeb, tus kws kho mob tau sau cov ntshav liab lossis ntshav ntshav. Yog hais tias tus neeg mob nyob rau hauv ib tug tsis zoo heev mob, ces ib tug phais kev cuam tshuam yog qhia rau resection ntawm tav.
kev kho neeg zoo
Thiab lawv yuav tsum tau hais, vim peb tab tom tham txog cov tsos mob ntawm pleurisy. Kev kho mob nrog pej xeem cov tshuaj yuav yog ib tug zoo concomitant txoj kev kho, tab sis nws yog tso cai rau nqa tawm tsuas yog tom qab sab laj tus kws kho mob, raws li tej zaum yuav muaj contraindications. Nov yog qee cov zaub mov yooj yim thiab ua tau zoo:
- Tom qab noj mov, haus 1/4 khob ntawm cov kua txiv hmab txiv ntoo tshiab tshiab nrog cov pulp.
- Hauv qhov sib npaug, ua tib zoo sib tov zib ntab thiab kua txiv hmab txiv ntoo los ntawm qhov muag teev. Haus cov dej sib tov ob zaug ib hnub tom qab noj mov, 1 tablespoon.
- Sib tov ib khob ntawm aloe kua txiv nrog tib tus nqi ntawm linden zib ntab thiab zaub roj. Ntxiv qhuav birch buds (100 g) thiab txiv qaub paj (50 g). Ua noj tshaj qis cua sov rau 40 feeb. Haus 2 khob tom qab noj mov.
- Sib tov mint nplooj thiab coltsfoot 1 teaspoon txhua. Ncuav ib khob ntawm boiling dej thiab cia nws brew rau peb teev. Faib lub resulting ntim rau hauv peb servings thiab haus tom qab noj tshais, pluas su thiab noj hmo. Txhua hnub, ua ib qho tshiab thiab noj rau ib lub lim tiam.
Kev kho mob pej xeem rau cov tsos mob ntawm pleurisy ntawm lub ntsws thiab nws cov teeb meem yuav ua tau tsuas yog tias tus neeg kuj ua raws li cov lus pom zoo kho mob. Ua li ntawd, cov tshuaj muaj txiaj ntsig zoo tshaj plaws.
Nyob rau cov neeg mob laus
Cov tsos mob thiab kev kho mob ntawm pleurisy ntawm lub ntsws hauv cov neeg laus yuav tsum tau tham sib cais. Nws yog ib qho tseem ceeb los hais tiaslawv yog cov yooj yim tshaj plaws vim lawv lub hnub nyoog. Lawv feem ntau muaj cov txheej txheem tsis tu ncua, thiab cov neeg uas raug yuam kom ua txoj kev ua neej nyob tsis muaj zog kuj muaj qhov o ntawm cov ceg. Tsis tas li ntawd, tus kab mob no feem ntau yog qhov tshwm sim ntawm kev mob caj dab, uas tshwm sim hauv feem coob ntawm cov neeg laus.
Yog tias peb tham txog kev kho mob txhawm rau tshem tawm cov tsos mob ntawm pleurisy hauv cov neeg laus, ces yuav tsis muaj qhov sib txawv tshwj xeeb. Qhov tsuas yog caveat yog tias lawv tau sau tshuaj hormonal hauv koob me me. Ib zaug ntxiv, lub cev, vim muaj hnub nyoog, tsim cov tshuaj hormones tsawg dua, thiab cov txheej txheem rau kev tsim ntawm qee qhov ntawm lawv nres tag nrho.
Txhais tau
Ntau tau hais los saum toj no txog cov tsos mob ntawm pleurisy ntawm lub ntsws, kev kho mob nrog pej xeem tshuaj thiab tshuaj, thiab kev kuaj mob. Thaum kawg, cia peb hais ob peb lo lus hais txog qhov tsis quav ntsej tus kab mob tuaj yeem ua rau muaj mob.
Qhov tshwm sim txawv heev. Feem ntau suav nrog:
- Pom qhov adhesions thiab bronchopleural fistulas.
- Circulatory tsis ua hauj lwm, tig mus rau hauv daim ntawv mob.
- Tsim kom muaj kab noj hniav dawb nyob rau hauv qhov cuam tshuam ntawm kev sib txuam ntawm cov kua paug hauv lub ntsws.
- Scarring ntawm pleura, fraught nrog tag nrho txhaws ntawm ib lub ntsws.
- Tsim cov amyloidosis ntawm parenchymal kab mob. Yuav luag 50% ntawm cov neeg mob uas tau ntsib qhov teeb meem no tau xaus rau hauv kev tuag. Tab sis nws tshwm sim nyob rau hauv tsawg zaus, ntxiv mus, tsuas yog nyob rau hauv cov neeg uas tsis muaj zog tiv thaiv - nyob rau hauv cov me nyuam thiab cov neeg laus.
Nws kuj yuav tsum tau muab sau tseg tias tib neeg, txawmcov uas kho tau tus kab mob no yuav tsum tau sau npe nrog kws kho mob ntev. Koj tseem yuav tsum tsis txhob noj cov zaub mov uas muaj calorie ntau ntau thiab muaj zog, ua haujlwm tiv thaiv kev tiv thaiv tsis tu ncua, tsis txhob ua rau hypothermia thiab tsis ua haujlwm rau cov xwm txheej tshwj xeeb.
