Rheumatic nres yog ib yam kab mob ntawm lub plawv thiab pob qij txha. Nws tshwm sim raws li qhov teeb meem tom qab tus kab mob streptococcal. Txwv tsis pub, tus kab mob no hu ua mob rheumatic fever. Nws feem ntau tshwm sim hauv cov menyuam yaus thiab cov hluas. Cov kab mob tshwm sim kwv yees li 2-4 lub lis piam tom qab cov kab mob tshwm sim los ntawm pawg A streptococcus. Cov kab mob xws li tonsillitis, scarlet fever thiab tonsillitis.
Ua rau kab mob
Streptococcus nws tus kheej tsis yog qhov ua rau mob rheumatic nres. Tus kab mob no tshwm sim los ntawm ib qho tshuaj tiv thaiv autoimmune. Thaum cov kab mob nkag mus rau hauv lub cev, lub cev tiv thaiv kab mob pib tsim cov tshuaj tiv thaiv kab mob rau cov microbes. Txawm li cas los xij, streptococcal proteins zoo sib xws hauv cov qauv rau cov proteins ntawm tib neeg lub hlwb. Yog li ntawd, cov tshuaj tiv thaiv yuam kev pib ua rau lub cev cov ntaub so ntswg. Qhov no ua rau kev puas tsuaj rau lub plawv thiab pob qij txha, uas tshwm sim thaum mob hnyavrheumatic nres.
Txhob Cia Siab
Cov kab mob autoimmune tsis tshwm sim hauv txhua tus neeg mob uas tau mob caj pas lossis ua npaws liab. Muaj qee yam tsis zoo uas ua rau lub cev tsis muaj zog tiv thaiv.
Cov no suav nrog:
- kev hloov pauv rau cov kab mob rheumatic;
- kev puas tsuaj rau lub cev los ntawm qee hom kab mob streptococcus (qee hom kab mob feem ntau ua rau lub cev tsis muaj zog);
- nyob hauv qhov tsis huv.
Nws kuj tau tsim tsa tias cov neeg mob uas tsis kho tus kab mob streptococcal yog qhov ua rau mob kub taub hau ntau dua. Yog hais tias ib tug neeg ua raws li tag nrho cov kws kho mob cov lus pom zoo thaum kho angina los yog scarlet kub taub hau, ces kev puas tsuaj rau lub plawv thiab pob qij txha yog heev tsawg. Qhov kev pheej hmoo ntawm cov teeb meem rheumatic yuav nce yog tias tus neeg mob tau rov muaj cov kab mob streptococcal.
Symptomatics
Raws li tau hais lawm, tus kab mob no tshwm sim ob peb lub lis piam tom qab rov zoo los ntawm tus mob caj pas lossis kub taub hau. Pathology yog nrog los ntawm o ntawm daim nyias nyias ntawm lub plawv thiab pob qij txha. Tus kab mob pib mob heev. Thaum pib, cov tsos mob hauv qab no ntawm tus mob rheumatic tshwm sim:
- kub nce mus rau +39 degrees;
- Kuv muaj ib qho hws uas muaj ntxhiab tsw zoo nkauj;
- nce plawv dhia;
- poob qab los;
- thirst;
- kev qaug zog thiab qaug zog.
Tom qab ntawd muaj cov cim ntawm swbsib koom:
- mob hnyav;
- daim tawv nqaij liab thiab o ntawm thaj chaw cuam tshuam;
- dej tsuj hauv cov kab noj hniav sib koom ua ke;
- thaj chaw kub hnyiab kub rau qhov kov.
Feem ntau muaj qhov txhab ntawm pob taws, lub luj tshib thiab hauv caug pob qij txha, nrog rau dab teg. Cov pob liab liab tshwm rau ntawm daim tawv nqaij. Nws zoo li liab nplhaib nrog dawb thaj ua rau ntawm daim tawv nqaij sab hauv (erythema annulus). Qee zaum me me tsis mob nodules tuaj yeem hnov hauv qab ntawm daim tawv nqaij.
Rheumatic nres yog qhov txaus ntshai tshwj xeeb rau lub plawv. Tus kab mob yog nrog los ntawm o ntawm myocardium, pericardium, thiab qee zaum endocardium. Cov cim qhia hauv qab no ntawm kev puas tsuaj rau cov ntaub so ntswg plawv tshwm sim:
- ua tsis taus pa;
- mob plab;
- nkees heev;
- kiv taub hau.
Pathology tseem cuam tshuam rau hauv nruab nrab paj hlwb. Tus neeg mob muaj cov leeg tsis muaj zog (Sydenham's chorea). Cov kev tswj tsis tau zoo li no cuam tshuam rau cov leeg ntawm lub ntsej muag thiab cov ceg. Yog tias muaj tus tsos mob zoo li no tshwm sim thaum menyuam yaus, cov niam txiv coj nws mus rau qhov qub grimacing ntawm tus menyuam.
Hauv cov menyuam yaus, cov tsos mob ntawm tus kab mob yuav raug tshem tawm. Kev mob pob qij txha feem ntau mob me, cov niam txiv tuaj yeem ua tus cwj pwm no rau tus menyuam loj hlob sai. Nws feem ntau tshwm sim hais tias ib tug neeg raug mob rheumatic kub taub hau thaum yau, uas mus tsis tau pom. Thiab tom qab ntawd, twb nyob rau hauv ib tug hluas lossis hluas, tus neeg mob tau kuaj pom tias muaj kab mob rheumatic. Yog vim li casKoj yuav tsum ua tib zoo saib xyuas kev noj qab haus huv ntawm cov menyuam yaus uas muaj tus kab mob streptococcal.
Kev nyuaj siab
Rheumatic nres tuaj yeem ua rau muaj teeb meem loj yog tias tus kab mob tsis kho raws sijhawm:
- Tus neeg mob yuav tsim kab mob valvular ua rau mob rheumatic mob plawv.
- Feem ntau tsim atrial fibrillation. Kab mob plawv no ua rau muaj kev pheej hmoo mob stroke.
- Nyob rau hauv cov mob siab heev, lub plawv tsis ua hauj lwm tshwm sim.
Txhua yam no qhia tau tias mob rheumatic kub taub hau yuav tsum tau kho tam sim ntawd. Yog hais tias ib tug me nyuam los yog ib tug neeg laus muaj mob pob qij txha tom qab mob caj pas los yog kub taub hau, koj yuav tsum tau mus ntsib kws kho mob tam sim ntawd. Arthralgia feem ntau yog ua raws li kev mob plawv.
Diagnosis
Tus kws kho mob rheumatologist cuam tshuam nrog kev kuaj mob thiab kho mob rheumatic nres. Yog tias tus neeg mob muaj kab mob plawv, ces yuav tsum tau sab laj nrog kws kho plawv.
Yuav kom paub meej qhov kev kuaj mob, tus neeg mob tau sau ntawv tshawb fawb:
- nasopharyngeal swab rau pawg A streptococcus;
- kuaj tshuaj tiv thaiv kab mob titer rau streptococcus;
- kuaj ntshav rau cov protein;
- kev kuaj ntshav thiab zis dav dav (kom pom cov tshuaj tiv thaiv kab mob);
- electrocardiogram;
- sonography ntawm lub siab;
- phonocardiography.
Kev tshuaj xyuas los txiav txim siab titer ntawm cov tshuaj tiv thaiv kab mob streptococcus yuav tsum tau noj ob peb zaug thaum lub sijhawm kho. Nws yuav pabntsuas qhov ua tau zoo ntawm txoj kev kho mob.
Kev kho mob
Kev kho mob tseem ceeb rau mob rheumatic kub taub hau rau cov neeg laus thiab menyuam yaus yog kev kho tshuaj. Nws yog ib qho tsim nyog los txo qhov mob, nrog rau kev rhuav tshem streptococcus. Kev kho mob pib nrog kev teem caij ntawm cov tshuaj tua kab mob. Feem ntau cov tshuaj tua kab mob ntawm cov pab pawg penicillin yog siv: "Bicillin", "Benzylpenicillin". Tsawg siv cephalosporins: Cefadroxil, Cefuroxime.
Cov tshuaj uas tsis yog-steroidal tshuaj tiv thaiv kab mob tau muab tshuaj los txo qhov mob pob qij txha:
- Y "Diclofenac";
- "Celecoxib";
- "Aspirin".
Thaum mob hnyav, cov tshuaj corticosteroid "Prednisolone" raug sau.
Txij li cov kab mob yog los ntawm autoimmune keeb kwm, nws yog ib qho tsim nyog yuav tau sau cov tshuaj uas txwv tsis pub tsim cov tshuaj tiv thaiv. Lawv muaj peev xwm cuam tshuam lub pathogenesis ntawm tus kab mob. Rau lub hom phiaj no, tshuaj siv:
- "Mabthera";
- "Remicade";
- "Orencia".
Kev kho mob ntawm lub plawv mob kuj tau ua. Diuretics, tshuaj tiv thaiv ntshav siab thiab mob plawv glycosides raug sau.
Yog tias tus neeg mob muaj qhov tsis tuaj yeem txav mus los thiab cov leeg pob tw, ces qhov kev teem sijhawm ntawm sedatives thiab antipsychotics raug pom zoo:
- Y "Droperidol";
- "Haloperidol";
- "Phenobarbital";
- "Midazolam".
Kev kho mob phais tsuas yog siv los tsim cov kab mob rheumatic thiab lub valve puas. Hauv qhov no, kev phais plawv yog pom zoo. Kev puas tsuaj sib koom ua ke feem ntau yog kho tau rau kev kho mob, xws li kev hloov pauv pathological yog thim rov qab.
Kev Tiv Thaiv
Tiv thaiv qhov tshwm sim ntawm tus kab mob streptococcal yog kev kho tag nrho ntawm tonsillitis, scarlet fever lossis tonsillitis. Koj yuav tsum noj tag nrho cov tshuaj kws kho mob thiab ua raws li tus kws kho mob cov lus pom zoo. Tom qab muaj tus kab mob streptococcal, nws raug nquahu kom saib xyuas los ntawm kws kho mob rheumatologist thiab kws kho plawv. Yog tias koj muaj cov tsos mob xws li mob pob qij txha, ua tsis taus pa luv, cov leeg pob tw, koj yuav tsum tau kuaj xyuas tam sim ntawd. Cov tsos mob zoo li no tuaj yeem yog cov tsos mob ntawm tus mob rheumatic kub taub hau.
