Pyelonephritis yog ib qho kev tsis txaus siab thiab ua rau cov txheej txheem ntawm o ntawm cov ntaub so ntswg ntawm lub raum, uas muaj cov kab mob tsis tshwj xeeb thiab feem ntau cuam tshuam rau cov ntaub so ntswg interstitial ntawm lub raum parenchyma.
Nws yog ib qho tseem ceeb uas tus kab mob no muaj ntau heev rau cov neeg muaj hnub nyoog sib txawv, thiab raws li cov kws kho mob, pyelonephritis nyob rau hauv qhov chaw siab tshaj plaws nyob rau hauv nws qhov tshwm sim tom qab SARS. Yog li, xyoo dhau los, kwv yees li ib lab tus neeg mob pyelonephritis tau txheeb pom hauv tebchaws Russia.
Nws paub tias tus kab mob no tshwm sim los ntawm qee lub hnub nyoog siab tshaj plaws, thiab tseem nyob ntawm poj niam txiv neej. Thawj kis ntawm pyelonephritis txoj kev loj hlob tshwm sim nyob rau hauv thaum yau thiab hluas, thiab nyob rau hauv cov poj niam nws manifestations tshwm sim ntau dua li cov txiv neej.
Lub ncov kawg hauv kev loj hlob ntawm pyelonephritis tshwm sim thaum laus. Los ntawm txoj kev, nyob rau hauv cov pab pawg neeg no, pyelonephritis overwhelmingly cuam tshuam rau cov txiv neej vim muaj teeb meem nrog lub caj pas prostate.
Dab tsi yog qhov tshwm sim ntawm pyelonephritis hauv cov menyuam yaus thiab cov neeg laus yuav tshwm sim yav tom ntej? Peb yuav tham txog qhov no ntxiv.
Predisposing factors
Qhov muaj peev xwm ntawm tus kab mob no mus rau qhov loj yog nyob ntawm lub xeev ntawm lub cev, thiab qhov ntsuas dab tsi ntawm kev ua haujlwm ntawm tib neeg kev tiv thaiv. Muaj ntau txoj hauv kev paub txog cov kab mob nkag mus rau hauv lub raum: lymphogenous, hematogenous, lossis nce mus, uas cov kab mob nkag mus rau hauv cov kab mob genitourinary, tshwj xeeb tshaj yog thaum muaj reflux hauv cov zis.
Cov kev pheej hmoo hauv qab no tau sau tseg:
- tso zis stasis vim urodynamic cuam tshuam.
- Teeb meem ntawm qhov tawm hauv cov leeg ntawm lub raum.
- Anatomical deficencies ntawm cov zis, uas tej zaum yuav congenital los yog kis tau.
- raum prolapsed.
- Muaj ib qho epicystostomy los tso zis.
- Teeb meem nrog lub innervation ntawm phab ntsa ntawm lub zais zis.
- Kev muaj kab mob bacteriuria, txawm tias nws yog asymptomatic.
- Lwm yam mob uas txo cov kev ua haujlwm tag nrho ntawm lub cev.
Lwm qhov kev pheej hmoo rau kev txhim kho pyelonephritis yog poj niam ua raws li tus kab mob no, vim lawv muaj lub cev tshwj xeeb, uas pab txhawb kev nkag mus rau cov kab mob tsis zoo rau hauv cov ntaub so ntswg.
Symptoms of disease
Qhov tshwj xeeb thiab qhov hnyav ntawm cov tsos mob ntawm tus kab mob no nyob ntawmlos ntawm nws daim ntawv evolving. Mob pyelonephritis muaj qhov pom kev hnyav, thiab txhawm rau kom nkag siab zoo dua cov duab kho mob, cov tsos mob tau muab faib ua pawg hauv qab no:
- Mob mob tuaj yeem muaj qhov sib txawv thiab nce hauv thaj tsam lumbar thiab lub plab.
- Intoxication - tus neeg mob txhawj xeeb txog kev qaug zog, qaug zog ntau dhau, ua npaws rau febrile lossis subfebrile, qis qab los noj mov, tawv nqaij daj, ua daus no thiab tawm hws ntau dhau.
- Qhov tseem ceeb ntawm qhov mob pyelonephritis hauv cov poj niam yog qhov kub thiab txias tuaj yeem hloov mus rau febrile, tus neeg mob txhawj xeeb txog ntuav thiab xeev siab.
- YUrinary Syndrome - nce microproteinuria, bacteriuria thiab leukocyturia. Yog tias ib tug neeg muaj urolithiasis, hematuria thiab crystalluria tuaj yeem tsim.
- Cov kab mob dysuric yog tus cwj pwm los ntawm kev tso zis tsis zoo, kev loj hlob ntawm pollakiuria thiab nocturia.
- Cov tsos mob Extrarenal - tus neeg mob tsim edema thiab arterial hypertension, hloov hauv acid-base tshuav, khaus thiab qhuav tawv nqaij.
Daim ntawv mob pyelonephritis
mob ntev ntawm lub raum parenchyma tuaj yeem txhim kho yam tsis muaj tsos mob, vim tias hom pyelonephritis tuaj yeem kuaj pom lig. Kev kho tsis raug, nrog rau kev cuam tshuam ntawm cov zis tawm, ua rau muaj mob ntev. Nyob rau theem pib, qhov tshwm sim ntawm pyelonephritis thaum cev xeeb tub rau menyuam yaus tsis hnyav, tab sistus kab mob no yuav ua rau tus me nyuam noj qab nyob zoo.
mob o ua rau:
- rov tshwm sim ntawm tus mob pyelonephritis;
- kev puas tsuaj patency ntawm genitourinary system thiab lwm yam kab mob urological;
- mob urinary reflux;
- xaiv tshuaj tua kab mob tsis raug;
- kev txhim kho ntawm extrarenal localization.
Feem ntau hom kev mob ntawm cov ntaub so ntswg ntawm lub raum yog txheej txheem unilateral, uas yog tus cwj pwm los ntawm qhov tshwm sim ntawm qhov mob ntawm lub raum. Tsis tas li ntawd, tus neeg mob muaj mob thaum tso zis.
Thaum lub sij hawm exacerbation, tsuas yog ib feem peb ntawm cov neeg mob muaj xws li tshwm sim ntawm pyelonephritis thaum cev xeeb tub raws li qhov kub thiab txias, leukocytes predominate nyob rau hauv cov zis, thiab cov protein ntau nce. Tom qab qee lub sijhawm, qhov mob hnyav tuaj yeem txo qis, uas tau piav qhia los ntawm wrinkling ntawm lub cev thiab qhov txo qis hauv nws qhov pom.
Txawm li cas los xij, dhau sijhawm, cov txheej txheem inflammatory tuaj yeem kis mus rau cov ntaub so ntswg ntawm ob lub raum, cuam tshuam rau cov tubules ib yam nkaus, ua rau tubular atrophy - wrinkling ntawm lub cev.
Vim vim kev ua haujlwm tsis zoo ntawm lub raum cov ntaub so ntswg, qhov tshwm sim ntawm tus mob pyelonephritis thaum cev xeeb tub rau tus menyuam thiab niam, uas yog ntshav siab, tuaj yeem txhim kho.
Lab kuaj mob
Ua ntej tus neeg mob kuaj tau tus mob pyelonephritis, tus kws kho mob tau sau qee cov lus qhiasoj ntsuam kuaj. Lawv tau ua nyob rau hauv txhua tus neeg uas xav tias muaj tus kab mob, suav nrog cov poj niam cev xeeb tub. Tom qab tag nrho, qhov tshwm sim ntawm pyelonephritis thaum cev xeeb tub rau tus menyuam tuaj yeem sib txawv:
- kab lis kev cai ntawm cov zis.
- Ua tiav urinalysis, thiab nws yuav tsis zoo, yog li kev kuaj mob suav tias tsis ntseeg.
YThaum pyelonephritis nce cov leukocytes - tsim leukocyturia. Cov ntsiab lus ntawm cov protein nyob hauv cov zis tsis dhau qhov kev tso cai, yog li proteinuria yuav tsis raug kuaj pom vim microalbuminuria. Kev ntsuas qhov ceev ntawm cov zis, hypostenuria lossis hyperstenuria feem ntau yog kuaj pom - qhov ua haujlwm tsis zoo hauv lub raum pom, nrog rau qhov txo qis ntawm cov zis tso tawm. Thaum necrosis ntawm glomeruli ntawm ob lub raum tshwm sim, macrohematuria feem ntau txiav txim siab.
Yog tias qhov ntsuas zis tsis zoo, kev tshuaj xyuas Nechiporenko yuav tsum tau ua, uas ua rau nws muaj peev xwm los ntsuas qib ntawm cov av tsis sib xws. Kev tsom xam raws li Zimnitsky, uas ntsuas qhov kev ua haujlwm siab ntawm lub raum, kuj tseem siv tau.
Yog ib tus neeg muaj kev pheej hmoo ntawm pyelonephritis, bakposev tau qhia, uas pab:
- Kev txiav txim siab seb tus kab mob teb li cas rau kev kho mob empiric antimicrobial.
- Suav tus lej ntawm cov kab mob phem.
- Tshaj tawm cov txiaj ntsig ntawm kev kho mob.
Yog tias tsim nyog, cov kev kuaj mob hauv qab no tuaj yeem raug sau ntxiv:
- kuaj ntshav kuaj xyuas qib ntawm leukocytes thiab neurophis.
- Biochemical ntshav kuaj, nrognyob rau hauv uas, nyob rau hauv cov ntaub ntawv ntawm ib tug uncomplicated daim ntawv ntawm tus kab mob no, cov ntsuas tau txais, tab sis kev hloov pauv ntawm electrolyte piv yuav raug sau tseg. Yog tias lub raum tsis ua haujlwm koom nrog pyelonephritis, qib ntawm urea thiab creatinine feem ntau nce hauv cov ntshav los ntawm cov leeg.
Txhawm rau kom paub meej tias muaj pyelonephritis hauv ib tus neeg, cov txheej txheem ntawm kev kuaj mob kuj tseem pab tau: cov kws kho mob tshwj xeeb ua excretory urography, radiography thiab ultrasound. Ntawm ultrasound ntawm lub raum, qhov nthuav ntawm lub plab mog thiab calyces yog pom, lub raum capsule swells thiab thickens, lawv parenchyma hloov.
X-ray qhia qhov loj ntawm lub raum cuam tshuam, urography qhia qee qhov txo qis hauv kev txav ntawm lub raum cuam tshuam thaum kev tshoov siab.
Yog tus neeg mob kub taub hau rau 3 hnub, nrog rau cov tshuaj tua kab mob xaiv kom raug, cov kws kho mob feem ntau muab cov tshuaj tua kab mob sib txuas, uas pab kom tshem tawm lub raum abscess, qog thiab hematomas.
Kev kuaj mob ntev
Vim tias pyelonephritis tsis muaj daim duab kho mob zoo, kev kuaj mob raum mob nyuaj me ntsis. Nws yog ib qho tsim nyog yuav tsum ua tib zoo txheeb xyuas keeb kwm ntawm tus kab mob thiab txiav txim siab muaj Sternheimer-Malbin hlwb thiab "nyob" leukocytes.
txhawm rau kuaj xyuas lawv, cov xim me me tau ntxiv rau cov zis, vim tias cov leukocytes siv tau tuaj yeem muaj qhov sib txawv, lossis tsis muaj xim tag nrho. Cov leukocytes tuag tau stained nyob rau hauv lub teeb liab xim, uas tuaj yeem tig mus rau ntau duantxoov ntxoo.
xiav leukocytes tuaj yeem sib txawv ntawm qhov loj thiab qauv. Nrog rau kev nce ntxiv hauv leukocytes, tsim cov lobulated nucleus, qhov tshwm sim no yog hu ua Sternheimer-Malbin hlwb, muaj qhov qhia tau tias mob ntawm lub genitourinary system nyob rau hauv daim ntawv mob.
Yog xav tias mob pyelonephritis ntev, tab sis tsis pom cov leukocytes nquag, nws raug nquahu kom ua qhov kev ntsuam xyuas kev ntxhov siab los ntawm kev ua cov tshuaj txhaj tshuaj Prednisolone. Qhov tshwm sim yog ntsuas tom qab 1, 2 thiab 3 teev, nrog rau ib hnub tom qab txheej txheem.
Qhov kev sim tuaj yeem suav tias yog qhov zoo yog tias tsawg kawg 400,000 leukocytes tau tawm hauv cov zis tom qab txhaj tshuaj, thiab qhov nyiam yuav tsum yog "nyob", ua haujlwm.
Resistant bacteriuria yog ib qho kev mob ntawm lub genitourinary system. Yog tias kuaj pom cov kab mob hauv cov zis ntau dua 100,00 ib 1 hli, nws yog ib qho tsim nyog los txiav txim siab lawv cov tshuaj tiv thaiv kab mob thiab nrhiav kom paub qhov yuav tsum tau rau kev ntsuas uroseptic.
tshuaj mob
Cov tsos mob kho yog npaj los tshem tawm cov dej tsis txaus, txo qhov mob thiab kho qhov qaug dab peg. Ua npaws tsis pom zoo kom coj los nrog cov tshuaj tiv thaiv kab mob thiab tshuaj tua kab mob vim lawv cov nyhuv nephrotoxic.
Txhawm rau txo qhov mob, cov kws kho mob tau sau tshuaj antispasmodics rau cov neeg mob:
- "Platifillin";
- "Papaverine";
- "Drotaverine".
ThaumHauv kev kho mob hauv tsev kho mob, nws yog qhov zoo dua los siv cov ntaub ntawv parenteral ntawm cov tshuaj no. Kev siv cov ntsiav tshuaj thiab tshuaj ntsiav "Sparex" thiab "No-shpa" kuj zoo.
YKev kho mob pyelonephritis
Rau kev kho mob ntawm daim ntawv mob zoo, nws yog thawj zaug uas yuav tsum tau txo cov kua dej, tshwj xeeb tshaj yog tias tus neeg mob muaj kab mob plawv, arterial hypertension.
Tshuaj ntsuab decoctions thiab dej qab zib txiv hmab txiv ntoo, uas muaj diuretic thiab antiseptic nyhuv, yuav pab tau:
- nqi raum;
- Yrosehip decoctions;
- lingonberries;
- txiv hmab txiv ntoo los ntawm cranberries, thiab lwm yam.
Nyob rau hauv peb lub sijhawm, lub khw muag tshuaj muaj kev xaiv ntau yam tshuaj rau kev kho mob pyelonephritis:
- "Canephron";
- "Brusniver";
- "Cyton".
Tshuaj tua kab mob
Tus neeg mob tau muab tshuaj etiotropic tshuaj tua kab mob rau 5-14 hnub. Hauv cov kab mob pyelonephritis tsis yooj yim, uas, txawm li cas los xij, muaj daim ntawv mob hnyav, cov tshuaj tua kab mob nrog fluoroquinolones raug tshuaj:
- YCiprofloxacin;
- Ofloxacin;
- Levofloxacin
YCephalosporins
Cefalosporins yog siv los ua lwm txoj hauv kev:
- Ceftibuten;
- Ceftriaxone;
- Cefotaxime.
Inhibitor-tiv thaiv penicillins, tshwj xeeb tshaj yog Amoxiclav, kuj muaj txiaj ntsig zoo hauv pyelonephritis.
Hauv kev kho mob hauv tsev kho mob, kev kho yog ua nrog parenteral fluoroquinolones, thaum kawg hloov mus rau ntsiav tshuaj. Tab sis ntawmGram-positive microbes hauv cov zis yog kho nrog inhibitor-tiv thaiv cephalosporins.
Nyob rau hauv daim ntawv mob ntawm tus kab mob, kev kho yuav tsum yog tsom mus rau tshem tawm cov kev cuam tshuam uas tshwm sim nyob rau hauv lub genitourinary system. Nws muaj peev xwm ua ke nrog aminoglycosides nrog fluoroquinolones, uas yuav muaj toxicity tsawg.
YKev kho mob pyelonephritis ntev
Ua ntej pib siv tshuaj tua kab mob rau tus kab mob no, nws yog ib qho tsim nyog yuav tsum tshem tawm foci ntawm tus kab mob sai li sai tau: piv txwv li, kab mob hniav thiab tonsillitis, txij li txawm tias muaj kev kho mob zoo, muaj peev xwm ua tau. ntawm reinfection.
Tshuaj tua kab mob yuav tsum tau xaiv kom raug thiab ua tib zoo, suav nrog cov txiaj ntsig ntawm bakposev, nrog rau kev txiav txim siab rhiab heev rau cov tshuaj siv. Nws tsis pom zoo kom muab tshuaj kho empiric yam tsis muaj exacerbation thiab tej yam kev mob uas yuav ua rau muaj kev phom sij rau lub neej.
Thaum lub sijhawm kho, nws yuav tsum tau saib xyuas kev txhim kho ntawm cov kab mob pathogenic microflora tas li, tsis tu ncua tso zis rau bakposev, txij li cov tshuaj tiv thaiv kab mob tuaj yeem tsim uas yuav tsum tau hloov pauv hauv kev kho mob.
Kev kho tus mob pyelonephritis ntev yuav tsum tau siv nitroxoline, nalidixic acid thiab nitrofurans, hloov lawv ib ntus. Qhov no yog ib txoj haujlwm ntev heev uas tuaj yeem siv sijhawm ntau lub hlis. Cov tsos mob ntawm pyelonephritis feem ntau tshwm sim tom qab 10 hnub ntawm kev kho tshuaj tua kab mob.
Tab sis muaj cov xwm txheej thaum txawm tias muaj kev kho mob zoo, cov kab mob pathogenic tuaj yeem txuas ntxiv mus sown. Nrog xws li ntwskab mob, kev kho mob txuas ntxiv thiab ntev ntev yog qhia, hloov tshuaj txhua lub lim tiam.
Txhawm rau kho pyelonephritis hauv tus neeg mob kom zoo, nws yog ib qho tsim nyog yuav tsum tshem tawm qhov ua kom pom tseeb ntawm tus kab mob, siv cov ntsiav tshuaj ntawm cov tshuaj tua kab mob thiab tshuaj ntsuab npaj. Nyob rau hauv cov mob pyelonephritis, uas tshwm sim nyob rau hauv lub latent theem, tus neeg mob raug pom zoo sanatorium los yog spa kev kho mob.
