Pseudomembranous colitis yog ib qho mob ntawm txoj hnyuv uas tshwm sim thaum siv tshuaj tua kab mob. Cov tshuaj tua kab mob feem ntau ua rau muaj kev ua txhaum ntawm microflora ntawm txoj hnyuv. Vim yog dysbacteriosis, cov txheej txheem inflammatory tshwm sim nyob rau sab laug ntawm txoj hnyuv loj. Qhov no yog nrog los ntawm cov tsos ntawm fibrin films (pseudomembranes). Tus kab mob no yog tus cwj pwm los ntawm kev qaug dej qaug cawv ntawm lub cev, tsis muaj kua dej vim yog mob raws plab thiab ua tsis taus dej- ntsev metabolism. Nyob rau hauv cov ntaub ntawv siab heev, lub pathology yog nyuaj los ntawm perforation ntawm txoj hnyuv phab ntsa.
ua rau ntawm pathology
Lub etiology ntawm pseudomembranous colitis yog txuam nrog kev ua kom nquag plias ntawm cov kab mob Clostridium difficile. Cov kab mob no muaj nyob hauv 3% ntawm cov neeg laus thiab ib nrab ntawm cov menyuam yaus.
Cov kab mob no suav hais tias yog kev siv sijhawm, cesnws ua rau kab mob tsuas yog nyob rau hauv tej yam kev mob tsis zoo. Kev noj tshuaj tua kab mob tuaj yeem ua rau Clostridium difficile coj mus rau hauv plab. Cov kab mob no tso tawm cov tshuaj lom uas muaj kev puas tsuaj rau lub plab zom mov. Qhov tshwm sim yog pseudomembranous colitis. Kev mob ntawm txoj hnyuv tom qab tshuaj tua kab mob feem ntau tshwm sim nrog cov tshuaj noj qhov ncauj. Txawm li cas los xij, qee zaus cov neeg mob tau sau tseg tom qab txhaj tshuaj ntev ntev.
Feem ntau, kev siv mus sij hawm ntev ntawm "Lincomycin" thiab "Clindamycin" ua rau muaj kev txhim kho pathology. Muaj tsawg zaus, qhov ua rau tus kab mob no yog siv "Ampicillin", "Penicillin", "Tetracycline", "Levomycetin", "Erythromycin", thiab cov tshuaj los ntawm pawg cephalosporin.
Cov tshuaj no tsis tsuas yog cuam tshuam cov microflora, tab sis kuj tseem txhim khu kev cuam tshuam ntawm Clostridium difficile co toxins. Muaj pov thawj tias pseudomembranous colitis tuaj yeem tshwm sim nrog kev siv cytostatics ntev thiab nquag siv tshuaj laxatives.
Txawm li cas los xij, tsis yog txhua tus neeg mob tsim dysbacteriosis hnyav thaum lub sijhawm kho nrog tshuaj tua kab mob. Rau qhov tshwm sim ntawm tus kab mob, yuav tsum muaj lwm yam provoking yam. Kev mob ntawm txoj hnyuv feem ntau pom nyob rau hauv pawg neeg mob hauv qab no:
- cov neeg laus (tshaj 65);
- raum tsis txaus;
- neeg mob qog noj ntshav;
- tus neeg mob raug kev phais loj.
Cov neeg no muaj teeb meem ntau dua tom qab siv tshuaj tua kab mob.
Tus kab mob puas kis tau?
Cov kab mob Clostridium difficile nkag mus rau hauv lub cev los ntawm kev sib cuag hauv tsev. Lawv nkag mus rau hauv ib tus neeg los ntawm cov khoom tsis huv los ntawm kev ntxuav tes. Txawm li cas los xij, kev nkag mus ntawm cov kab mob mus rau hauv cov hnyuv tsis tas yuav ua rau muaj kab mob. Feem ntau, ib tug neeg dhau los ua tus kab mob asymptomatic. Thiab tsuas yog nrog kev tsim txom lossis kev kho mob ntev nrog cov tshuaj tua kab mob, cov kab mob ua kom nquag plias thiab ua cov kab mob.
Symptomatics
Cov tsos mob thiab kev kho mob ntawm pseudomembranous colitis nyob rau hauv cov neeg laus thiab cov me nyuam nyob ntawm seb tus mob hnyav. Pathology tuaj yeem tshwm sim hauv cov ntawv me, nruab nrab thiab hnyav.
mob plab me me tshwm sim thaum noj tshuaj tua kab mob. Tom qab cov tshuaj tau txiav lawm, cov quav yuav rov zoo li qub, thiab cov tsos mob ntawm tus kab mob no ploj mus.
Yog tus kab mob nruab nrab lossis hnyav, raws plab yog qhov hnyav. Cov quav yog dej, cov quav zoo li lub decoction ntawm mov hauv qhov tsos. Mob plab rov qab ntau zaus thaum nruab hnub, ib tug neeg poob dej ntau. Lub cev qhuav dej tsim, qhov sib npaug ntawm cov dej thiab ntsev yog cuam tshuam hauv lub cev. Qhov no yog nrog los ntawm cov tsos mob hauv qab no ntawm pseudomembranous colitis:
- mob siab;
- nkag siab "goosebumps" ntawm lub cev;
- txhawj xeeb;
- tsis muaj zognqaij tawv.
Thaum cov nyuv raug mob hnyav, cov ntshav impurities tshwm hauv cov quav. Cov cim qhia ntawm intoxication ntawm lub cev tsim:
- kub nce mus rau +38 degrees;
- tsis muaj zog;
- mob hauv qab sab laug ntawm lub plab;
- poob qab los;
- mob taub hau.
Hauv cov kab mob hnyav, cov tsos mob tsis ploj txawm tias tom qab tshem tawm cov tshuaj tua kab mob tag.
Muaj cov kab mob malignant uas cov tsos mob ntawm pseudomembranous colitis tshwm sim ntawm xob laim. Kev kho mob hauv cov xwm txheej zoo li no feem ntau qeeb, vim tias cov tsos mob ntawm pathology tau loj hlob sai. Xws li cov ntaub ntawv feem ntau xaus rau hauv kev tuag ntawm tus neeg mob vim txoj hnyuv perforation. Nrog rau chav kawm fulminant, cov tsos mob ntawm tus kab mob zoo li cov kab mob cholera. Muaj zog rov qab raws plab, uas ua rau lub cev qhuav dej thiab nce qib ntawm cov poov tshuaj hauv cov ntshav. Qhov no tseem tuaj yeem ua rau mob plawv thiab tuag ntawm tus neeg mob.
Tus yam ntxwv ntawm tus kabmob hauv menyuam yaus
Cov tsos mob tseem ceeb ntawm pseudomembranous colitis hauv cov neeg laus tau piav qhia saum toj no. Cov cim qhia ntawm tus kab mob hauv cov menyuam yaus muaj lawv tus kheej yam ntxwv. Kwv yees li ib nrab ntawm cov me nyuam mos thiab cov me nyuam me hnub nyoog qis dua ib xyoos yog cov kab mob Clostridium difficile. Txawm li cas los xij, tib lub sijhawm, lawv tsis tshua muaj qhov tshwm sim ntawm tus kab mob, txawm tias muaj kev kho mob ntev ntev ntawm cov tshuaj tua kab mob. Qhov no yog vim qhov tseeb tias cov tshuaj tiv thaiv tshwj xeeb los ntawm niam cov kua mis tiv thaiv cov menyuam yaus los ntawm cov kab mob.
Txawm li cas los xij, pseudomembranous colitis tsis tshua muaj, tab sis tseemsau tseg thaum yau. Feem ntau, pathology tau pom hauv cov pab pawg hauv qab no ntawm cov neeg mob me:
- kev txom nyem los ntawm cov kab mob inflammatory ntawm lub plab zom mov ntawm autoimmune keeb kwm;
- neeg mob leukemia;
- menyuam yaus uas muaj qhov tsis xws luag hauv cov qauv ntawm txoj hnyuv loj (Hirschsprung tus kab mob).
Cov kab mob hnyav yog qhov tsawg heev thaum menyuam yaus. Feem ntau colitis tshwm sim nrog mob raws plab, tsis muaj cov tsos mob ntawm intoxication. Qee zaum, muaj cov tsos mob ntawm lub cev qhuav dej.
Muaj Teeb Meem
Qhov teeb meem txaus ntshai tshaj plaws ntawm pseudomembranous colitis yog plab hnyuv nthuav dav, uas feem ntau ua rau perforation ntawm nws phab ntsa.
Cov kab mob pathological tshwm sim los ntawm kev ua ntawm co toxins tawm los ntawm cov kab mob, nrog rau lub cev qhuav dej. Nws yog tus yam ntxwv los ntawm cov tsos mob hauv qab no:
- bloating vim roj tsuj roj;
- kub txog +39…40 degrees;
- txoov raws plab;
- kev puas tsuaj loj zuj zus.
Kev nthuav dav ntawm txoj hnyuv tuaj yeem ua rau muaj kev ua txhaum ntawm kev ncaj ncees ntawm nws cov phab ntsa. Nyob rau hauv cov ntaub ntawv no, daim duab kho mob ntawm peritonitis tshwm sim: mob nyob rau hauv lub plab mog, gas thiab defecation retention, tsis muaj zog heev.
Kev kho mob ntawm cov kab mob pseudomembranous colitis yog ua los ntawm kev phais nkaus xwb. Nyob rau hauv tas li ntawd, nws yog tsim nyog los tshem tawm ib feem ntawm cov hnyuv.
Diagnosis
Kev kuaj mob thiab kho pseudomembranous colitis hauv cov neeg laus yog ua los ntawm kws kho mob plab. Tus kws kho mob tshwj xeeb yuav xav tias tus kab mob twb nyob rau theem ntawm kev sau cov anamnesis. Cov kab mob no muaj cov tsos mob: qhov tshwm sim ntawm raws plab thaum lub sij hawm kho cov tshuaj tua kab mob, ua ke nrog cov tsos mob ntawm intoxication thiab lub cev qhuav dej.
Txhawm rau cais tus kab mob no los ntawm lwm hom kab mob colitis, nrog rau kev mob lom lom, kuaj thiab ntsuas cov txheej txheem tau sau tseg:
- kuaj ntshav dav dav. Kev nce hauv cov qe ntshav dawb thiab ESR qhia o.
- tshuaj ntsuam quav quav (ntuj thiab kab mob). Nrog rau tus kab mob no, cov ntshav pom nyob rau hauv cov quav, nrog rau cov hnoos qeev thiab leukocytes ntau. Kev kuaj kab mob bacteriological txiav txim qhov ua rau tus neeg sawv cev - Clostridium difficile. Txawm li cas los xij, yog tias tsis pom cov kab mob hauv cov quav, qhov no tsis yog ib txwm qhia tias tsis muaj cov kab mob no.
- Sigmoidoscopy. Qhov kev ntsuam xyuas endoscopic no tso cai rau koj los txheeb xyuas qhov chaw mob ntawm cov hnyuv uas npog nrog cov yeeb yaj kiab fibrinous.
Drug therapy
Ua ntej ntawm tag nrho, nws yog ib qho tsim nyog los tshem tawm qhov ua rau pseudomembranous colitis. Cov tshuaj tua kab mob raug txiav tawm sai li sai tau thaum tus neeg mob mob raws plab thaum kho tshuaj tua kab mob.
Tom ntej no, nws yog qhov tsim nyog los cuam tshuam cov kab mob microflora - cov kab mob Clostridium difficile. Cov kab mob kis tau zoo tshaj plaws rau cov tshuaj "Metronidazole". Qhov no yog thawj kab tshuaj rau kev kho mob ntawm pseudomembranous colitis. Yog hais tias tus neeg mob muaj intolerance rau Metronidazole, ces Vancomycin yog tshuaj. Cov tshuaj no kuj yogUa tau zoo cuam tshuam rau tus neeg sawv cev ntawm pseudomembranous colitis. Cov txheej txheem kho mob hu rau kev siv cov tshuaj no rau kev kho mob ntawm cov mob nruab nrab mus rau qhov hnyav.
Nrog cov kab mob asymptomatic, "Metronidazole" thiab "Vancomycin" tsis raug tshuaj. Cov tshuaj no tsis siv rau hauv cov ntaub ntawv me me ntawm pathology. Nyob rau hauv tas li ntawd, kom normalize tus neeg mob tus mob, nws yog txaus kom tsis txhob siv tshuaj tua kab mob thiab cov tsos mob.
Nws tseem yuav tsum tau ua kom lub plab hnyuv microflora. Rau lub hom phiaj no, probiotics raug sau tseg: Bifidumbacterin, Kolibacterin, Bifikol. Cov tshuaj no yuav tsum tau noj tom qab qhov kawg ntawm kev kho tshuaj tua kab mob lossis tom qab zawv plab lawm.
Lub luag haujlwm tseem ceeb hauv kev kho cov kab mob pseudomembranous colitis yog ua los ntawm kev tawm tsam lub cev qhuav dej thiab kev kho mob detoxification. Txhawm rau them nyiaj rau qhov tsis muaj kua dej, cov neeg mob tau muab cov tshuaj tua kab nrog cov tshuaj ntsev. Nrog rau qhov poob ntawm cov protein ntau, cov ntshav plasma tau qhia.
txhawm rau txo kev qaug cawv, cov neeg mob tau muab "Cholestyramine" hauv cov ntsiav tshuaj. Cov tshuaj no neutralizes co toxins uas tsim los ntawm cov kab mob.
Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias nrog tus kab mob no koj tsis tuaj yeem noj tshuaj rau raws plab. Qhov no tuaj yeem ua rau nthuav dav thiab perforation ntawm txoj hnyuv, nrog rau kev ua rau lub cev hnyav dua.
kev kho mob phais
Kev phaisKev cuam tshuam (colonectomy) yog qhia rau kev txhim kho cov teeb meem, nrog rau cov kab mob hnyav. Kev ua haujlwm yog ua nyob rau hauv ob theem. Ua ntej, qhov cuam tshuam ntawm txoj hnyuv loj raug tshem tawm, thiab cov hnyuv me yog coj mus rau phab ntsa plab. Yog li ntawd, tso tawm los ntawm txoj hnyuv tsis tawm ntawm qhov quav, tab sis los ntawm qhov qhib hauv plab (ileostomy).
Tom qab tus mob zoo lawm, theem ob ntawm kev ua haujlwm tau pib. Lub qhov yog kaw, thiab cov hnyuv me yog txuas nrog lub qhov quav. Tom qab ntawd, defecation tshwm sim lawm.
Txoj Cai Noj Mov
Ua raws li kev noj zaub mov hauv pseudomembranous colitis plays lub luag haujlwm tseem ceeb hauv kev kho mob. Nws pab ua kom cov hnyuv mucosa. Cov zaub mov yuav tsum maj mam, yooj yim rau zom thiab tsis ua rau lub plab zom mov.
Yog tias koj mob raws plab hnyav, koj yuav tsum ua raws li kev noj zaub mov tshaib plab thawj ob hnub. Nyob rau lub sijhawm no, koj tuaj yeem haus dej haus huv huv, tshuaj yej tsis muaj qab zib lossis rosehip broth. Cov khoom noj khoom haus yuav tsum zam ib ntus.
Hnub peb, jelly tuaj yeem nkag mus rau hauv kev noj zaub mov tsis tas yuav ntxiv qab zib. Nws raug tso cai haus kefir, nws yuav tsum tsis txhob tshiab, tab sis txog peb hnub. Koj tseem tuaj yeem noj cov tsev cheese ua kua.
Tom ntej no, koj yuav tsum ua raws li kev noj zaub mov 4-a. Xws li ib lub rooj yog pom zoo rau cov neeg mob uas mob o ntawm txoj hnyuv, nrog raws plab. Cov zaub mov hauv qab no tso cai:
- steam cutlets los yog meatballs ua los ntawm nqaij qaib, lean nqaij nyuj los yog ntses;
- porridge los ntawm buckwheat lossis oats hauv daim ntawv pureed;
- -cov nqaij muaj roj tsawg thiab cov kua zaub ntses;
- chav omelette (tsis pub ntau tshaj 1 zaug ibhnub);
- tsev cheese tsis qaub mashed;
- zucchini, taub dag, grated carrots (tsuas yog ntxiv rau cov kua zaub);
- apple puree;
- rosehip broth;
- tshuaj ntsuab;
- tseem muaj dej.
Hauv qhov no, koj yuav tsum tshem tawm tag nrho cov tais diav uas tuaj yeem ua rau raws plab. Cov khoom txwv tsis pub muaj xws li:
- khoom ci;
- porridge los ntawm cereals (tshwj tsis yog buckwheat thiab oats);
- qos;
- sweets;
- baking;
- pasta;
- khoom qab zib;
- nqaij thiab ntses;
- cov khoom noj muaj roj ntau;
- cheeses;
- kvass thiab dej nrog roj;
- zaub tshiab;
- legumes;
- sweet fruits;
- miv.
Nyob rau ntawm cov zaub mov no rau qee lub sijhawm tom qab cov tsos mob ploj mus txog thaum lub plab hnyuv mucosa rov qab ua tiav.
Huab cua
Hauv hom mob me me ntawm tus kab mob, qhov kev cia siab yog qhov zoo. Tom qab tshem tawm cov tshuaj tua kab mob thiab cov kev kho mob, cov kab mob tau kho kom zoo.
kab mob me tuaj yeem ua rau mob ntev thiab rov zoo dua.
Cov kab mob hnyav, txawm tias muaj kev kho kom raug, tuaj yeem xaus rau hauv tus neeg mob tuag vim lub cev qhuav dej thiab cov kab mob metabolic. Nrog rau kev kawm tiav, kev tuag tuaj yeem tshwm sim thawj zaug ntawm tus kabmob.
Nrog rau kev txhim kho ntawm cov teeb meem (dilation thiab perforation ntawm txoj hnyuv), qhov kev tshwm simib txwm loj. Tsuas yog kev ua haujlwm kub ntxhov tuaj yeem cawm tus neeg mob.
Kev Tiv Thaiv
Koj yuav tsum ceev faj thaum noj tshuaj tua kab mob. Nws yog ib qho tsim nyog yuav tsum nruj me ntsis ua raws li cov lus qhia ntawm cov tshuaj tua kab mob. Nws yog qhov tsis tsim nyog rau kev kho tus kheej. Thaum lub sijhawm kho tshuaj tua kab mob, probiotics yuav tsum tau noj los tiv thaiv cov hnyuv microflora thiab tiv thaiv dysbacteriosis.
Cov neeg laus, nrog rau cov neeg mob raum thiab qog nqaij hlav, yuav tsum tsis txhob noj cov tshuaj tua kab mob uas tuaj yeem ua rau mob plab hnyuv. Tsis tas li ntawd, koj yuav tsum tsis txhob noj tshuaj laxatives rau cem quav. Yog tias zawv plab tshwm sim tom qab noj tshuaj tua kab mob, koj yuav tsum mus ntsib kws kho mob tam sim ntawd.
