Endogenous asthma: cov tsos mob, kev kuaj mob thiab kev kho mob

2024 Tus sau: Curtis Blomfield | [email protected]. Kawg hloov kho: 2024-01-02 05:49

Endogenous bronchial hawb pob yog ib qho mob ntev ntawm cov kab mob ua pa, uas yog raws li cov txheej txheem inflammatory. Qhov ua rau ntawm qhov mob no yog qhov siab rhiab heev (hyperreactivity) ntawm bronchi, nrog rau ntau yam kab mob ntawm lub ntsws. Ib qho tshwj xeeb ntawm daim ntawv endogenous yog qhov tsis muaj cov tsos mob ua xua, uas ua rau nyuaj rau kev kho mob.

Forms of hawb pob

Raws li International Classification of Diseases, 10th Revision (ICD-10), mob hawb pob tuaj yeem muab faib ua ntau hom hauv qab no:

Exogenous daim ntawv (feem ntau hu ua atopic nyob rau hauv Lavxias teb sab ntaub ntawv). Ua los ntawm ib qho kev tsis haum rau sab nraud.
Endogenous daim ntawv (nyob rau hauv cov ntaub ntawv Lavxias teb sab nws hu ua infectious-allergic asthma). Provoked los ntawm stimuli ntawm lub cev (pneumonia, SARS, thiab lwm yam).
Kev mob ntsws asthma. Nws yog kev sib xyaw ua ke ntawm cov ntawv exogenous thiab endogenous.
Daim ntawv tsis qhia meej. Ib hom mob hawb pob uas tsis paub qhov ua raukev tshwm sim.

Cov tsos mob ntawm endogenous asthma

Cov tsos mob tseem ceeb yog kev tawm tsam ntawm kev ua pa luv (ua tsis taus pa). Tsis tas li ntawd, muaj ntau cov cim qhia, los ntawm lub xub ntiag ntawm ib tus neeg tuaj yeem txiav txim qhov muaj tus kab mob no. Cov paib zoo li no:

Nyob hauv siab nruj.
ua pa nyuaj.
ua tsis taus pa, hawb pob thiab hnoos.

Cov tsos mob zoo li no feem ntau tshwm sim thaum hmo ntuj, tom qab kev tawm dag zog lub cev, thaum qee yam tshuaj nkag mus rau hauv lub ntsws. Nws yog ib qho tsim nyog yuav tsum tau them sai sai rau kev kho mob tom qab noj cov tshuaj bronchodilator. Ib tug txawv feature ntawm endogenous bronchial hawb pob yog ib tug pronounced nyiam rau kev loj hlob ntawm tus kab mob. Tsis tas li ntawd, tus neeg mob muaj hypersensitivity rau cov khoom ntawm lub luag haujlwm tseem ceeb ntawm cov kab mob, nrog rau cov kab mob lawv tus kheej.

daim duab kho mob ua pa nyuaj

Muaj peb lub sijhawm ntawm kev txhim kho kev mob ntsws asthma hauv endogenous bronchial hawb pob. Ntawm no yog lawv:

Lub sijhawm ntawm harbiners. Nws muaj nyob rau hauv qhov tshwm sim qee lub sij hawm ua ntej qhov kev tawm tsam (los ntawm feeb mus rau teev) ntawm precursors ntawm nws cov tsos. Cov no muaj xws li txham, qhov ntswg congestion, mob caj pas, khaus ntawm daim tawv nqaij nyob ib ncig ntawm lub qhov ntswg, zoo nkaus li xuab zeb nyob rau hauv lub qhov muag. Tej zaum yuav hnoos.
Lub sijhawm siab tshaj. Tiag tiag ib tug nres. Nws yog tus cwj pwm los ntawm kev hnoos qhuav, ua tsis taus pa, hnyav hauv siab, ua tsis taus pa (nws nyuaj rau "ua pa dawb").
Lub sijhawm ntawm kev txhim kho rov qab. Nyob ntawmNyob rau theem no, tus neeg mob ua pa yooj yim dua, cov hnoos qeev pib tawm.

Sab nraud ntawm kev tawm tsam, raws li txoj cai, tus neeg mob tau zoo. Txawm li cas los xij, nrog rau kev txhim kho ntxiv ntawm pathology, tus neeg mob tus mob hnyav zuj zus tuaj, uas tuaj yeem ua rau kev loj hlob ntawm pulmonary thiab tom qab ntawd lub plawv tsis ua haujlwm.

Kev Pab Cuam

Nrog me ntsis nres ntawm kev ua pa, nws raug tso tseg los ntawm tus qauv txhais tau tias. Ntau yam kev cuam tshuam kuj tau siv, xws li tham nrog tus neeg mob, mustard plasters lossis da dej sov so.

Kev tawm tsam hnyav hnyav yog nres los ntawm kev qhia txog adrenaline subcutaneously. Ephedrine tuaj yeem siv tib lub sijhawm.

Thaum muaj kev tawm tsam hnyav, nws yuav tsum tau hu rau lub tsheb thauj neeg mob thiab ib txhij txhaj tshuaj epinephrine thiab glucocorticosteroids.

mob hnyav

Qhov mob hnyav yog txiav txim siab los ntawm kev siv cov tsos mob ua ntej kho. Tsis tas li, ib qho tseem ceeb tshaj plaws ntawm qhov ntsuas qhov hnyav yog FEV_{1- yuam cua ntim hauv 1 thib ob. Niaj hnub no, cov theem hauv qab no ntawm qhov hnyav yog qhov txawv:}

Qhov tsis muaj zog tshaj plaws yog mob hawb pob nrog kev mob me me. Nrog rau daim ntawv no, tsis tshua muaj tshwm sim ntawm cov tsos mob yog yam ntxwv. Yog li, mob hawb pob tshwm sim tsis pub ntau tshaj ib zaug ib lub lim tiam, hmo ntuj cov tsos mob thab tsis ntau tshaj ib hlis ib hlis, exacerbations luv luv, FEV _{1 ncav 80% ntawm kev noj qab haus huv.}

Pathology nrog cov chav kawm tsis tu ncua. Hauv qhov no, kev ua xua tshwm sim ntau dua ib zaug hauv ib lub lis piam (tab sis tsis yog txhua hnub), thaum tsaus ntuj cov tsos mob pib thab txog li 2 zaug hauv ib hlis, exacerbations ua rau.pw tsaug zog thiab txav tsis taus. FEV_{1kuj nce mus txog 80%.}

Nrog mob hawb pob endogenous, cov tsos mob tshwm sim txhua hnub thiab ntau dua ib lub lim tiam thaum hmo ntuj. FEV_{1 is 60-80% noj qab nyob zoo.}

Thaum kawg, thaum mob hawb pob mob hnyav, cov tsos mob tshwm sim txhua hnub. Exacerbations thiab nocturnal manifestations ntawm cov tsos mob tshwm sim ntau zaus, lub cev muaj zog kev ua si yog txwv. FEV_{1hos tsawg dua 60%.}

Diagnosis

Rau qhov kev kuaj mob kom raug, koj yuav tsum xub kawm keeb kwm kho mob. Daim ntawv endogenous ntawm bronchial hawb pob yog feem ntau pom nyob rau hauv cov neeg muaj hnub nyoog 30-40 xyoo, raws li txoj cai, uas twb muaj inflammatory kev hloov nyob rau hauv cov hlab ntsha thiab / los yog tau nyob rau hauv kev sib cuag nrog irrigants ntev.

Muaj ntau txoj hauv kev los kuaj mob hawb pob. Nyob rau tib lub sij hawm, nws yuav tsum tau borne nyob rau hauv lub siab hais tias ib tug tsom xam yuav tsis muab ib tug tag nrho cov duab; ob peb txoj kev yuav tsum tau siv ib txhij. Tsis tas li ntawd, koj yuav tsum tsis txhob koom nrog kev kuaj mob tus kheej, tab sis nws yog qhov zoo dua los tso siab rau cov kws tshaj lij. Ib daim ntawv teev cov txheej txheem, nrog rau cov cim qhia tau pom hauv kev mob ntsws asthma, yog hauv qab no:

suav ntshav kom tiav. Tshawb pom eosinophilia hnyav.
Kev tshuaj xyuas cov hnoos qeev. Cov hnoos qeev muaj Kurschmann cov spirals, Charcot-Leyden crystals, Creole lub cev, nrog rau cov ntsiab lus siab ntawm eosinophils thiab cylindrical epithelial hlwb.
kuaj ntshav biochemical. Muaj kev nce qib ntawm α- thiabβ-globulins.
Immunogram. Qhia txog qhov txo qis hauv kev ua haujlwm thiab tus lej ntawm T-suppressors thiab nce qib ntawm immunogloblin.
X-ray ntawm lub ntsws. Thaum muaj kev tawm tsam thiab / lossis nrog kev mob ntev ntev, cov cim qhia ntawm emphysema ntawm lub ntsws (lub ntsws) pom. Nyob rau theem pib ntawm kev txhim kho, sab nraud ntawm kev tawm tsam, tsis muaj kev hloov pauv.

Spirography. Qhia txo qis peev xwm tseem ceeb thiab FEV_1.
Peakflowometry (ntsuas qhov siab tshaj plaws ntawm qhov ntws tawm). Ib txoj kev tshawb fawb tau ua tsis tau tsuas yog kuaj tus kab mob, tab sis kuj saib xyuas tus neeg mob tus mob. Nws yog nqa tawm ob zaug ib hnub nyob rau hauv cov chav kawm ntawm kev kho mob siv ib tug tshwj xeeb ntaus ntawv - ib tug ncov flow meter.
Kev ntsuas qhov tsis haum. Ntau hom kev ntsuam xyuas nrog kev xav tias tsis haum yog siv. Nrog rau daim ntawv endogenous lawv muab qhov tshwm sim tsis zoo.

Kev kho mob

Ib yam ntawm kev kho mob ntawm endogenous bronchial hawb pob yog qhov tsis muaj cov txheej txheem hyposensitization vim tsis muaj cov tshuaj tsis haum.

Cov txheej txheem kho mob muaj peb yam:

Kev Kawm Txuj Ci. Nws muaj nyob rau hauv kev paub txog cov kev mob ntawm kev tiv thaiv kab mob thiab kev tswj tus kheej ntawm lawv tus mob nrog kev pab los ntawm lub ncov flowmeter.
Kev kho ncaj qha (kev kho mob thiab kho lub cev). Nws muab faib ua ob peb theem.
Kev cais tawm ntawm yam ua rau muaj kev loj hlob ntawm tus kabmob.

siv tshuaj

Kev kho mob ntawm endogenous bronchial hawb pob yog sivCov tshuaj hauv qab no:

nqus tau cov glucocorticosteroids ("Fluticasone", "Budesonide", "Flunisolide", thiab lwm yam). Anti-inflammatory tshuaj.
Y Systemic glucocorticosteroids ("Prednisolone", "Dexamethasone"). Cov tshuaj Hormonal pab txo qhov mob.

β_{2-short-acting agonists ("Salbutamol"). Lawv nres mob hawb pob.}

β_{2-ntev-acting agonists ("Salmeterol", "Formoterol"). Kev pab ntawm bronchospasm thiab tiv thaiv.}
Inhalation M-anticholinergics (ipratropium bromide).
Methylxanthine npaj ("Eufillin", "Teopek", thiab lwm yam). Kho bronchospasm.

Cov pab pawg piav qhia ntawm cov tshuaj rau endogenous bronchial hawb pob (tshwj tsis yog ntawm kab lus 2 thiab 6) raug coj los siv lub tshuab nqus pa tshwj xeeb.

Kev siv tshuaj hauv kev xyaum

Cov lus qhia rau kev siv Budesonide rau kev nqus pa, Salbutamol, Salmeterol thiab lwm yam tshuaj zoo sib xws yog qhov zoo sib xws, yog li qee cov lus pom zoo tuaj yeem ua.

Yog li, txhawm rau kom tsis txhob muaj qhov tshwm sim tom ntej ntawm kev ua pa, ib lossis ob koob tshuaj aerosol tau nqus. Txhawm rau ua qhov no, koj yuav tsum tig lub zais pa nrog lub valve thiab, tuav lub qhov ncauj nrog koj daim di ncauj, ua pa ib los yog ob lub pa tob. Yog tias tsis muaj kev txhim kho li ntawm tsib feeb, cov txheej txheem rov ua dua. Kev sib xyaw ntawm ntau yam tshuaj thiab kev siv tshuaj prophylactic txhua hnub yog xaiv los ntawm tus kws kho mob ib tus zuj zus, raws li hnub nyoogtus neeg mob thiab qhov mob hnyav.

Yog tias cov lus qhia siv rau "Budesonide" rau kev nqus pa lossis lwm yam tshuaj tau ploj lawm, nws tuaj yeem rov qab los siv cov lus nug uas tsim nyog.

Nco ntsoov! Tsis muaj teeb meem koj yuav tsum tau noj tshuaj rau tus kheej thiab noj tshuaj tsis raws li cov lus qhia. Qhov no tuaj yeem ua rau muaj kev phiv (yog tias ntau npaum li cas) thiab teeb meem (yog tias qhov ntau npaum li cas tsawg dhau).

kev kho mob

Cov kauj ruam ntawm kev kho mob hawb pob yog tsim raws li qhov hnyav ntawm tus kab mob, los ntawm qhov mob me tshaj mus rau qhov hnyav tshaj plaws.

Qib 1. Ua rau mob hawb pob me me. Nrog rau qib kev kho mob no, cov neeg mob tau muab tshuaj los ntawm pab pawg ua haujlwm luv luv β _{2 -agonists ("Orciprenaline", "Hexaprenaline", "Salbutamol"). Cov tshuaj tau raug sau tseg rau kev kho mob thiab kev tiv thaiv (piv txwv li, ua ntej kev tawm dag zog lub cev).}

Kauj Ruam 2. Ua rau mob hawb pob nrog kev mob me me. Sodium npaj tau sau tseg, xws li Nedocromil lossis Cromoglycate. Yog tias lawv cov txiaj ntsig tsis txaus, koob tshuaj qis qis hauv nqus tau cov tshuaj glucocorticosteroids, theophylline, lossis tshuaj antileukotriene raug tshuaj. β_{2- agonists qee zaum siv los daws kev mob hawb pob.}

Kauj Ruam 3. Ua raws li qhov mob hnyav ntawm tus kab mob. Inhaled glucocorticosteroids twb tau siv hauv cov koob tshuaj nruab nrab. Feem ntau ua ke nrog β₂-agonistsua haujlwm ntev, theophylline lossis antileukotriene tshuaj. Tsis tas li ntawd, β_{2-agonists tseem siv rau kev qaug dab peg.}

Kauj Ruam 4. Ua raws li qhov hnyav ntawm tus kab mob. Cov koob tshuaj ntau ntawm cov tshuaj nqus tau cov glucocorticosteroids tau siv, thiab tau sau tseg ntev ntawm qhov ncauj corticosteroids.

kev tawm dag zog thiab kis las

Kev kho mob tshwj xeeb feem ntau yog siv los ua kev sib txuas rau cov kev kho mob hawb pob. Lub hom phiaj ntawm kev siv kev tawm dag zog yog los tiv thaiv kev txhim kho ntxiv ntawm tus kab mob.

Nco ntsoov! Kev ua qoj ib ce kho mob tsuas yog tso cai thaum tshem tawm tus kab mob, thaum ib txwm muaj lub tshuab nqus pa rau kev mob hawb pob nrog koj!

Ib qho kev tawm dag zog ua rau 10-30 feeb 1-3 zaug hauv ib hnub thiab muab tso ua ke los ntawm tus kws kho mob.

Kev ua kis las kuj tseem siv tau rau kev mob hawb pob. Txawm li cas los xij, kev nyiam yuav tsum tau muab rau cov kev qhuab qhia uas tsim lub diaphragm thiab lub xub pwg nyom.

Kev nyuaj siab

mob hawb pob feem ntau nyuaj los ntawm pulmonary emphysema thiab lwm yam pulmonary plawv tsis ua haujlwm.

Thaum tsis kho raws sijhawm, tus hu. xwm txheej asthmaticus. Qhov teeb meem no muaj peb theem:

Stage 1. Xa mus rau theem pib them nyiaj. Nws yog, qhov tseeb, kev tawm tsam ntawm kev ua pa ntev ntev (ntau tshaj 12 teev). Nyob rau theem no, cov neeg mob tso tseg cov hnoos qeev thiab txhim kho cov tshuaj bronchodilator (anti-spasm) tshuaj.
Stage2. Kuj tseem hu ua theem decompensation. Nyob rau theem no, muaj kev ua txhaum ntawm kev ua haujlwm ntawm lub bronchi. Vim li no, kev ua txhaum cai tshwm sim - tsis muaj oxygen hauv cov ntshav thiab cov pa roj carbon dioxide ntau dhau.
Stage 3. Theem of hypercapnic coma. Nws yog tus cwj pwm los ntawm kev txo qis hauv cov ntsiab lus oxygen hauv cov ntshav ntxiv thiab nce cov ntsiab lus ntawm carbon dioxide. Vim li no, cov kab mob neuralgic loj heev, hemodynamic ntshawv siab tuaj yeem tshwm sim, qee qhov kev tuag ntawm tus neeg mob tuaj yeem ua tau.

Kev Tiv Thaiv

Rau kev tiv thaiv kab mob hawb pob bronchial, lawv tsuas yog ua haujlwm tiv thaiv kev ua haujlwm, kev coj cwj pwm phem. Koj kuj yuav tsum tiv thaiv kev txhim kho ntawm lwm cov kab mob ntsws, ib txwm nqa lub tshuab nqus pa rau kev mob hawb pob nrog koj thiab ntxuav foci ntawm tus kab mob ntev (tshwj xeeb hauv nasopharynx).