Ib tug kab mob tsis kaj siab thiab tuag taus, mob ntsws ntsws ntsws tau muaj nyob hauv ntiaj teb rau ntau txhiab xyoo, raws li muaj pov thawj los ntawm archaeological excavations thiab ntau cov ntaub ntawv keeb kwm. Nyob rau hauv lub ntiaj teb niaj hnub no, nws ib xyoos ib zaug coj nws cov neeg raug tsim txom txog 10 lab tus tib neeg, 25% ntawm cov neeg tuag.
Daim ntawv tsis txaus siab tshaj plaws ntawm tus kab mob yog nthuav tawm pulmonary tuberculosis, uas txhais tau tias multifocal, "spilled" thoob plaws hauv lub ntsws. Nws yog ib qho yooj yim mus ntes tus kab mob, txij li txoj hauv kev ntawm nws txoj kev sib kis yog qhov yooj yim heev, thiab cov tsos mob hauv thawj theem yuav luag tsis pom. Qhov tseeb, peb txhua tus muaj kev pheej hmoo kis tus kab mob txhua hnub, tab sis, hmoov zoo, tsis yog txhua lub cev tuaj yeem tsim tus kab mob. Yog tias, txawm li cas los xij, qhov kev kuaj mob hnyav tau ua tiav, tsis tas yuav poob siab, txij li tam sim no kev tshawb fawb tau nce mus txog tam sim no tias nws muaj peev xwm kho tau tag nrho txawm tias muaj kab mob ntsws pulmonary. Tej zaum. Ua li no, koj yuav tsum tsis txhob txaj muag ntawm kev tiv thaiv kev kuaj mob thiab ua kom tiav cov kev teem caij ntawm tus kws kho mob tuaj koom. Lawv hais tias paub qhov muaj zog thiab qhov tsis muaj zog ntawm cov yeeb ncuab twb yog 50% ntawm yeej. Yog li cia peb saib seb tus kab mob yog dab tsi, nws tuaj qhov twg thiab yuav ua li cas nrog nws.
Koch sticks
Disseminated pulmonary tuberculosis yog tshwm sim los ntawm cov kab mob hauv microscopic, lub npe hu ua mycobacteria. Lawv muaj nyob rau hauv lub ntiaj teb rau ntau lab xyoo, tab sis tsuas yog nrhiav tau nyob rau hauv 1882 los ntawm tus kws kho mob thiab kws tshawb fawb Koch, tom qab uas lawv tau hu ua li ntawd - Koch sticks. Nyob rau hauv tag nrho, muaj 74 ntau yam kab mob mycobacteria (cov ntawv luv ICD), 6 ntawm uas muaj peev xwm ua rau mob ntsws rau tib neeg thiab tsiaj txhu. Lawv raug hu ua sticks vim lawv cov tsos, tiag tiag pas nrig. Qee cov kab mob mycobacteria zoo kawg nkaus, qee qhov nkhaus me ntsis, thiab ob qho tib si nyob nruab nrab ntawm 1 micrometer thiab 10 micrometers ntev thiab txog 0.5 micrometers dav.
Qhov tshwj xeeb ntawm lawv yog cov qauv ntawm lawv cov phab ntsa, lossis cov plhaub. Yog tias tsis nkag mus rau hauv cov ntsiab lus, peb nco ntsoov tias hauv Koch cov pas nrig nws tso cai rau lawv hloov pauv ntau zaus, tiv thaiv lawv tus kheej tawm tsam kev ua haujlwm ntawm cov tshuaj tiv thaiv kab mob uas ua rau tuag taus rau lwm yam kab mob, thiab tiv thaiv ib puag ncig tsis zoo. Lawv ntse siv txawm tias bacteriophages, lub ntsiab lus ntawm uas yog los tiv thaiv peb lub cev los ntawm cov kab mob cab. Thaum nqus tau, Koch cov pas nrig tsis tuag, tab sis hloov kho cov macrophages kom lawv nyob ntsiag to ntau ntxiv thiab tib lub sijhawm tsis tuaj yeem nkag mus rau cov kab ke tiv thaiv ntawm lawv.tus tswv. Hauv lwm lo lus, Koch's sticks siv peb lub cev tiv thaiv cellular infiltrate nws.
Ib zaug hauv lub ntsws ntawm tus neeg noj qab haus huv, cov kab mob no ua ntej ib qho foci (tuberculosis thawj zaug), tab sis tom qab ntawd kis nrog cov ntshav thiab / lossis lymph mus rau thaj tsam loj ntawm ib lossis ob lub ntsws thiab lwm yam kab mob ua pa ntawm ib zaug, yog li tsim kev nthuav tawm pulmonary tuberculosis. Raws li qee qhov xwm txheej, nws tuaj yeem txhim kho txawm tias tom qab kho tus kab mob thawj zaug, txij li Koch's bacilli nyob rau hauv daim ntawv tsis muaj zog nyob hauv lub cev tau ntau xyoo.
Txoj kev kis kab mob
Pulmonary tuberculosis hauv tib neeg yog tshwm sim los ntawm peb hom kab mob - M. tuberculosis (tib neeg subspecies), M. africanum (intermediate subspecies) thiab M. bovis (tsiaj subspecies). Cov tom kawg no feem ntau mob hauv nyuj, thiab kis mus rau tib neeg nrog cov mis nyuj tsis muaj kuab lom.
Ntau tus neeg xav paub seb puas kis tus kab mob ntsws pulmonary yog kis los yog tsis. Cov lus teb tsis meej: nws kis tau zoo heev yog tias nws kis tau nrog Koch's bacilli (tuberculous bacteria).
Lawv kis ntawm tus mob mus rau tus neeg noj qab haus huv yog qhov yooj yim txawv:
- lawv nqus tau pa;
- nrog qaub ncaug (piv txwv li, thaum hnoos, hnia);
- dhau ntawm cov tais diav siv los ntawm tus neeg mob;
- dhau ntawm cov khoom hauv tsev;
- ntawm niam mus rau fetus;
- thaum siv cov cuab yeej kho mob tsis txaus.
Raws li koj pom, koj tuaj yeem kis tus kab mob TB nyob qhov twg: hauv kev thauj mus los, hauv cov chaw pej xeemsiv, hauv tsev kawm ntawv, tom haujlwm thiab lwm yam.
Ib qho tseem ceeb: Koch sticks zoo heev tenacious. Lawv khaws lawv cov khoom txaus ntshai sab nraum tib neeg lub cev rau lub sijhawm ntev heev. Nov yog qee qhov piv txwv ntawm ntev npaum li cas Koch sticks nyob hauv ib puag ncig peb ntsib txhua hnub:
- nyob rau qhov tsaus ntuj tsis muaj hnub ci - mus txog 7 xyoo;
- nyob rau hauv cov hnoos qeev qhuav ntawm tus neeg mob (tseem tshuav ntawm txhua yam khoom) - mus txog 1 xyoos;
- hauv cov hmoov av ntawm txoj kev - mus txog 60 hnub;
- ntawm cov ntawv luam tawm - mus txog 3 lub hlis;
- hauv dej - txog 150 hnub;
- nyob rau hauv cov mis nyuj tsis tau boil - kwv yees li 14 hnub;
- hauv cheese (butter) - mus txog ib xyoos.
Nws puas tuaj yeem teb qhov tsis zoo rau cov lus nug ntawm seb puas kis tus kab mob ntsws ntsws kis tau lossis tsis? Tej zaum Koch cov sticks tam sim no nyob rau hauv ib puag ncig puas yooj yim puas tau? Hmoov tsis zoo, cov kab mob mycobacteria tsis yooj yim tua. Vim lawv cov phab ntsa tshwj xeeb ntawm tes, lawv xyaum tsis raug kev txom nyem los ntawm tshav ntuj, hluav taws xob ultraviolet, cawv, acetone, acids, alkalis, ntau cov tshuaj tua kab mob, dihydrates, thiab thaum cov khoom uas muaj cov hnoos qeev yog boiled, lawv tsis tuag ntev li 5 feeb.. Yog tias Koch cov nplaum tuaj yeem txhim kho hauv lub cev ntawm txhua tus neeg, txhua tus neeg nyob hauv lub ntiaj teb yuav raug mob khaub thuas.
Risk pawg
Txawm tias thaum muaj hnub nyoog kawm ntawv preschool, feem ntau cov menyuam yaus tuaj tos Koch tus pas, tab sis kis tus kab mob ntsws ntsws lossis lwm yam kev loj hlob tsuas yog hauv cov menyuam yaus uas tsis muaj zog, mob. Kuj tseem muaj kev pheej hmoo yog:
- cov neeg nyob ze rau lub sijhawm ntevtiv tauj nrog cov neeg mob tuberculosis;
- cov neeg muaj kev tiv thaiv qis;
- HIV positive;
- noj tshuaj tiv thaiv kab mob;
- cov tub ntxhais hluas thiab cov hnub nyoog nruab nrab ntawm lub sijhawm hloov hormonal;
- tshaib plab;
- kev txom nyem los ntawm tuberculosis ntawm daim tawv nqaij thiab lwm yam kabmob;
- cov muaj sia nyob ntawm cov kab mob sib kis;
- cov neeg mob uas muaj tus kabmob pulmonary tuberculosis thawj zaug thiab kho;
- mus sij hawm ntev ib co physiotherapy cov txheej txheem (piv txwv li, quartz).
Kev faib tawm
Disseminated pulmonary tuberculosis tuaj yeem txhim kho raws li hauv qab no:
1. Nrog ntshav khiav (hematogenous). Hauv qhov no, ob lub ntsws raug cuam tshuam. Cov kab mob tuaj yeem nkag mus rau hauv cov hlab ntsha los ntawm cov qog nqaij hlav, Gon's foci, los ntawm sab xis ntawm lub plawv thiab cov hlab ntsha pulmonary.
2. Nrog lymph (lymphogenic). Hauv qhov no, ib lub ntsws raug cuam tshuam.
3. Lymphohematogenous.
Raws li qhov xwm txheej ntawm tus kab mob, kev tshaj tawm pulmonary tuberculosis yog qhov txawv ntawm cov qauv hauv qab no:
- mob (tub rog);
- subacute;
- chronic;
- generalized. Hom kab mob no tau hais tias tshwm sim thaum, rau qee qhov laj thawj, cov ntsiab lus ntawm cov qog ntshav qab zib cuam tshuam los ntawm mycobacteria tawg mus rau hauv cov hlab ntsha, cov qauv uas tau dhau los ua curdled (caseous). Nyob rau hauv cov ntaub ntawv no, ib tug loj tus naj npawb ntawm Koch sticks ib txhij nyob rau hauv cov ntshav. Hmoov zoo, qhov no tsis tshwm sim ntau zaus.
Nyob zoo tuberculosis
Kab mobpib sai sai, dheev, cov tsos mob yog ci heev, me ntsis zoo li mob ntsws. Kev kuaj mob yog tsim los ntawm kev kuaj mob ntawm lub ntsws thiab kuaj cov hnoos qeev hauv microbiological. Mob ntsws ntsws ntsws ntsws yog qhov tshwm sim los ntawm qhov muaj nyob rau hauv lub ntsws cov ntaub so ntswg ntawm ntau me me (li ib millimeter) tubercles zoo li millet nplej. Li no lub npe thib ob - "miliary (miae hauv Latin txhais tau tias "millet") tuberculosis." Nyob rau hauv tus neeg mob, cov qauv ntawm capillaries thawj zaug hloov, collagen raug puas tsuaj nyob rau hauv lawv, thiab cov phab ntsa tau yooj yim permeable, uas ua rau nkag mus rau mycobacteria los ntawm cov hlab ntsha mus rau hauv lub ntsws. Cov tsos mob yog raws li nram no:
- dhia nrawm rau qhov kub txog 39, 5-40 ° C;
- qaug zog, qaug zog, qaug zog siab;
- ceev mem tes;
- tsis qab los;
- cyanosis ntawm daim di ncauj thiab ntiv tes;
- yellowness ntawm daim tawv nqaij;
- xeev siab rau ntuav;
- mob taub hau;
- hnoos qhuav lossis nrog cov hnoos qeev ntau lawm, uas ntxiv rau cov hnoos qeev thiab cov kua paug, muaj cov ntshav tawm;
- ua tsis taus pa.
Qee lub sij hawm muaj qhov hais tawm toxicosis, mus txog qhov tsis nco qab.
Subacute tuberculosis
Nws tshwm sim thaum tus kab mob kis mus rau cov hlab ntsha loj (intralobular veins thiab interlobular hlab ntsha). Nyob rau hauv cov ntaub ntawv no, nrhiav pom foci mus txog 1 cm nyob rau hauv lub cheeb. Lawv nyob hauv cov ntu ntawm lub ntsws, qhov chaw uas muaj ntau cov hlab ntsha thiab cov hlab ntsha lymphatic. Los ntawmxwm foci yog proliferative, tsis muaj o thiab qog, tab sis lawv tuaj yeem ua rau cov txheej txheem inflammatory hauv visceral pleura.
Subacute TB cov tsos mob tuaj yeem zoo li ntau yam kab mob, ua rau nws nyuaj rau kev kuaj mob. Ntawm cov tseem ceeb yog cov hauv qab no:
- qaug zog, qaug zog;
- kub ib ncig ntawm 38 ° C;
- hnoos nrog hnoos qeev.
Ntshav tuberculosis
Tus kab mob no tshwm sim thaum tus neeg mob tsis tau kho tus kab mob thawj (tshiab) tuberculosis. Hauv cov xwm txheej zoo li no, mycobacteria rov nkag mus rau ntu tshiab ntawm lub ntsws nrog kev pab ntawm cov ntshav lossis cov qog ntshav, ua rau ntau lub foci ntawm ntau qhov sib txawv (los ntawm me me mus rau loj loj), cov duab sib txawv thiab cov qauv. Lawv tuaj yeem raug calcified thiab tshiab heev, nrog cov duab ci ntsa iab. Foci muaj nyob rau hauv ob lub ntsws. Daim duab poob siab yog ntxiv los ntawm emphysema, fibrosis ntawm ntau cov ntaub so ntswg hauv lub ntsws, thiab cov nti pleural. Txawm li cas los xij, tus kab mob pulmonary tuberculosis ntev yuav tsis tshwm sim tawm sab nraud, thiab yog li nws feem ntau kuaj pom los ntawm fluorography. Cov tsos mob ntawm tus kab mob ntsws ntev yog:
- nce qaug zog;
- tsis qab los;
- poob phaus;
- mob taub hau tsis tu ncua;
- ua rau tsis muaj qhov kub thiab txias (qee zaus);
- hnoos.
Disseminated tuberculosislub ntsws: theem
Thaum ntxov nws tau ntseeg tias theem I ntawm tus kab mob tshwm sim nyob rau sab sauv ntawm lub ntsws, II - hauv nruab nrab, thiab III twb mus txog qis dua. Nyob rau hauv lub neej yav tom ntej, xws li kev faib tawm tau lees paub tias yog qhov tsis raug, vim tias cov theem ntawm kev loj hlob ntawm tus kab mob no tuaj yeem sib npaug ntawm txhua ntu ntawm lub ntsws. Txog niaj hnub no, cov theem hauv qab no ntawm pulmonary tuberculosis yog qhov txawv:
- focal;
- infiltration;
- tawg;
- MBT+ (qhib daim ntawv ntawm tuberculosis);
- MBT- (kaw).
Disseminated pulmonary tuberculosis nyob rau hauv MBT + infiltration theem txhais tau tias cov kab mob nrog kev tso tawm ntawm mycobacteria rau hauv ib puag ncig. Cov tsos mob tseem ceeb yog hnoos nrog hnoos qeev, tshwj xeeb tshaj yog tias nws muaj cov kua qaub thiab cov ntshav.
theem focal yog cov yam ntxwv tseem ceeb ntawm tus kab mob tshiab lossis kab mob tshiab. Nws yog tus cwj pwm los ntawm qhov tseeb tias tsuas yog ob peb lossis ib ntu tau cuam tshuam. Nyob rau hauv cov ntaub ntawv no, qhov ntev ntawm lub tsom xam yog me me (txog 1 cm nyob rau hauv lub cheeb). Cov theem no tshwm sim yam tsis muaj tsos mob thiab feem ntau kuaj pom thaum kuaj kho lub ntsws (X-ray, fluorography).
Disseminated pulmonary tuberculosis: theem infiltration thiab lwj
Qhov xwm txheej ntawm tus kab mob no tau txais thaum nws tsis pom nyob rau lub sijhawm (tus neeg mob evades qhov yuav tsum tau muaj fluorography txhua xyoo, tsis mus ntsib kws kho mob thaum muaj kev ceeb toom thawj zaug, tshuaj kho tus kheej lossis siv tshuaj kho pej xeem., raws li txoj cai, tsis zoo txaus raws li kev kho mob tseem ceeb). Theem decay txhais tau hais tias lub morphology ntawm qhov txhab nyob rau hauv lub ntsws tau mus txog ib tug degree ntawm uas.cov ntaub so ntswg pib tawg, tsim qhov tiag. Fragments ntawm cov ntaub so ntswg lwj tuaj nrog hnoos. Lawv yog cov hnoos qeev interspersed nrog kua thiab ntshav. Tsis tas li ntawd, cov fragments no poob rau ntu ntawm lub ntsws uas tseem tsis tau muaj tus kab mob, vim tias muaj cov noob tam sim ntawm mycobacteria. Cov neeg mob uas tau kuaj pom tus kab mob ntsws ntsws nyob rau hauv lub sij hawm lwj yog qhov txaus ntshai ntawm kev kis kab mob rau lwm tus thiab yuav tsum tau mus pw hauv tsev kho mob. Lawv yuav tau nyob hauv tsev kho mob ntev mus txog rau lub hlis. Raws li qhov tshwm sim, cov kab mob decayed kho (calcify).
theem ntawm infiltration kuj tau pom nyob rau hauv txoj kev loj hlob ntawm tus kab mob, tab sis qhov no, lub cev qhuav dej ntawm lub ntsws tsis tshwm sim. Feem ntau, ib qho infiltrate yog qhov chaw (center) uas muaj cov txheej txheem inflammatory. Ntau cov lymphocytes thiab leukocytes txav mus rau qhov chaw zoo li no, thiab cov tsos mob zoo li mob ntsws. Disseminated pulmonary tuberculosis nyob rau theem infiltration muaj cov tsos mob hauv qab no:
- qhov kub thiab txias nce mus rau qib siab;
- qaug zog, qaug zog;
- mob hauv siab;
- hnoos;
- Cov cim ntawm kev qaug cawv;
- mob taub hau;
- qee zaum qaug zog ntawm kev nco qab.
Yog tsis muaj kev kho mob sai, cov ntaub so ntswg tawg pib ntawm qhov chaw ntawm infiltrates. Tus neeg mob hnoos lawv tawm los yog, nyob rau hauv tus txheej txheem ntawm hnoos, txav lawv mus rau lub ntsws thib ob, qhov chaw kis kab mob ntawm cov qub nqaij noj qab haus huv tshwm sim sai heev. Tuberculosis nyob rau hauv cov theem ntawm kev lwj thiab infiltration yog fraught tsis tsuas yog muaj kev pheej hmoo ntawm kis rau lwm tus neeg, tab sis kuj.tuag rau tus neeg mob nws tus kheej.
Diagnosis
Nws tsis yog ib qho yooj yim los tsim kom muaj kev sib kis kab mob ntsws hauv tus neeg mob tam sim ntawd. Kev kuaj mob yog qhov nyuaj vim qhov tseeb tias cov tsos mob ntawm tus kab mob no thiab mob ntsws, SARS, txawm tias mob qog noj ntshav metastatic zoo sib xws. Thaum tus neeg mob mus rau hauv tsev kho mob nrog kev tsis txaus siab ntawm qaug zog, hnoos, mob hauv lub ntsws, tsis muaj zog, ua tsis taus pa, tus kws kho mob yuav tsum tau kuaj xyuas ntawm daim tawv nqaij kom pom cov caws pliav uas yuav nyob twj ywm los ntawm yav dhau los paraproctitis, lymphadenitis. Lub symmetry ntawm lub hauv siab kuj raug tshuaj xyuas (nws tsis yog nyob ntawd yog tuberculosis tsim nyob rau hauv ib lub ntsws), mob thiab nqaij nro nyob rau hauv lub xub pwg girdle raug soj ntsuam. Thaum mloog lub ntsws nrog lub stethoscope, nws tau nthuav tawm seb puas muaj hawb pob, lawv qhov chaw thiab qhov xwm txheej yog dab tsi. Nws yog ib qho tsim nyog yuav tsum ua qhov kev sim kuaj cov hnoos qeev kom pom muaj mycobacteria hauv nws. Qee zaum, bronchial lossis gastric lavages raug coj los ntawm cov neeg mob mus kuaj (feem ntau hauv cov menyuam yaus). Tsis tas li ntawd, kev kuaj sim yuav suav nrog:
- bronchoscopy;
- sputum microscopy;
- pleural biopsy;
- thoracoscopy;
- pleural puncture.
Qhov siv dav thiab raug yog cov kev tshawb fawb fluoroscopic.
Yog tus kws kho mob tau kuaj pom tus kab mob ntsws ntsws, kev kho mob yuav ntev thiabntau yam. Qhov kev kwv yees nyob ntawm theem uas tau kuaj pom tus kab mob, thiab tus neeg mob ua raws li cov kws kho mob cov lus qhia. Rau txhua hom kab mob ntsws ntsws hauv MBT + theem, tus neeg mob tau mus pw hauv tsev kho mob. Hauv tsev kho mob, lawv tsuas yog ua cov tshuaj kho mob (chemotherapy), suav nrog tshuaj tiv thaiv kab mob, kho lub cev, thiab cov vitamins uas txhawb kev tiv thaiv kab mob.
Tshuaj kho mob hauv cov neeg mob tshiab tau kuaj pom nyob rau theem mob hnyav ntawm kev kho mob yog ua nrog cov tshuaj tiv thaiv kab mob hauv qab no: "Isiniazid", "Rifampicin", "Pyrazinamide" thiab "Ethambutol", thiab nyob rau theem txuas ntxiv ntawm kev kho mob. - "Isoniazid" thiab "Rifampicin" lossis "Isoniazid" thiab "Ethambutol"
Nyob rau hauv mob kis kab mob, kev siv corticosteroids thiab immunomodulators tau qhia. Feem ntau cov tshuaj yog "Prednisolone" (15-20 mg / hnub rau 6-8 lub lis piam).
Duration ntawm kev kho mob - mus txog 6 lub hlis. Yog tias tsis pub dhau 3 lub hlis tsis muaj qhov yuav tsum tau txhim kho, nrog rau ntau qhov kev qhia, nws muaj peev xwm siv kev phais mob, uas muaj nyob rau hauv kev tshem tawm ib ntu ntawm lub ntsws los yog lub ntsws tag nrho.
Kev kho mob TB tshiab hu ua "valvular bronchoplasty" lossis yooj yim "bronchoblock" tam sim no tau siv los ua lwm txoj hauv kev phais.
Kev Tiv Thaiv
Pulmonary tuberculosis yog suav tias yog ib qho kab mob sib kis, kev sib kis feem ntau nyob ntawm kev ua neej zoo ntawm cov pej xeem (kev ua neej nyob, kev tsiv teb tsaws chaw,ua cov kab lus hauv tsev loj cuj, thiab lwm yam). Raws li kev tiv thaiv kev tiv thaiv, tshwj xeeb tshaj yog rau kev nthuav tawm cov kab mob ntsws pulmonary, ib tus tuaj yeem npe:
- obligatory fluorography;
- ua cov kev ntsuas tiv thaiv kab mob sib kis;
- txhaj tshuaj BCG;
- xeev faib nyiaj rau kev kho cov neeg mob tuberculosis;
- tswj kev ua si (kev ua si), kev ua neej zoo;
- cov neeg mob tau txais kev kho mob puv ntoob rau tuberculosis.
