Cov kab mob ntsws rov tshwm sim (raws li ICD-10 code - J 20) yog qhov rov ua kom rov ua haujlwm ntawm cov kab mob bronchial mucosa, uas rov tshwm sim txog li 3 lossis ntau zaus hauv lub xyoo, tab sis tsis ua rau muaj kev cuam tshuam tsis zoo. lub functionality ntawm cov pa system. Tus kab mob feem ntau yog nrog los ntawm tus mob subfebrile, hnoos ntub dej, qee zaum - hawb pob thiab bronchospasm. Kev kuaj mob yog ua raws li bronchography, X-ray ntawm lub ntsws, ua haujlwm ua pa, kuaj kev tsis haum, kab mob kab mob ntawm cov hnoos qeev. Rau kev rov ua haujlwm ntawm cov hlab ntsws, kev kho tshuaj (bronchodilators, mucolytics, antihistamines) thiab kev kho mob (kev vibration massage, ua pa tawm, kev kho lub cev) yog siv. Yog tias tsim nyog, cov tshuaj tiv thaiv kab mob thiab tshuaj tua kab mob raug sau.
yam ntxwv ntawm pathology
Cov bronchitis rov tshwm sim - ntu ntawm bronchitis, rov ua dua (txog 3-4 zaug) thoob plaws xyoo nrog lub sijhawmmus txog 2-3 lub lis piam. Lawv tshwm sim feem ntau nrog cov tsos mob ntawm bronchospasm, tab sis tus kab mob no yuav tsis tuaj nrog ua pa nyuaj. Tsis tas li ntawd, muaj kev hloov pauv hloov hauv lub bronchopulmonary system. Tus mob bronchitis rov tshwm sim ntau dua hauv cov menyuam yaus dua li cov neeg laus. Tus kab mob no feem ntau cuam tshuam rau cov menyuam yaus hnub nyoog preschool. Los ntawm kev loj hlob, cov neeg mob no twb muaj mob bronchitis, uas tshwm sim nrog kev puas tsuaj mus tas li rau cov qauv ntawm cov phab ntsa bronchial thiab lub sij hawm exacerbations.
Nws muaj hnub nyoog li cas?
Cov kab mob bronchitis feem ntau tshwm sim nyob rau xyoo thib ob ntawm lub neej, thiab qhov kev kho mob tshwm sim txog li 1/3 ntawm tag nrho cov kab mob ua pa ntawm lub hnub nyoog ntxov. Qhov tshwm sim ntau tshaj yog pom ntawm cov menyuam yaus hnub nyoog 4-6 xyoo, tom qab ntawd maj mam txo qis hauv lub sijhawm ua ntej thiab pubertal.
Symptoms of obstruction
Tus kab mob no feem ntau tsis ua rau muaj kev cuam tshuam. Muaj bronchitis rov qab nrog obstructive syndrome, tsis kho los ntawm allergens. Kev rov mob ntawm tus kab mob tshwm sim ntau zaus thaum lub caij txias, nrog rau qhov kev xaiv thib ob - txhua lub sijhawm ntawm lub xyoo.
Cov kab mob bronchitis rov tshwm sim tsis zoo zuj zus thiab tsim cov kab mob sclerosis hauv lub ntsws thiab bronchi, tab sis cov txheej txheem pathological no ua rau muaj txiaj ntsig zoo rau kev txhim kho mob ntsws ntev, mob ntsws ntsws thiab mob ntsws asthma.
Yog vim li cas
Kev sib txuas ntawm tus kab mob no nrog mob ua pa nyuaj, kis kab mob, chlamydial,mycoplasma, tsis tshua muaj kab mob tshwm sim ntawm keeb kwm (hhooping hnoos, tuberculosis). Cov kab mob bronchitis feem ntau tshwm sim tawm tsam keeb kwm yav dhau los ntawm tus kab mob kis mob (rhinovirus, parainfluenza, RSV, qhua pias) thiab mob ntsws. Predisposition yog pom nyob rau hauv cov me nyuam mob. Nws yog ib qho tseem ceeb uas yuav tsum paub txog qhov ua rau rov muaj mob bronchitis.
Kev puas tsuaj rau cov mucous daim nyias nyias ntawm tsob ntoo tracheobronchial los ntawm cov kab mob ua rau muaj cov txheej txheem inflammatory, txo qis hauv kev ua haujlwm ntawm ciliated epithelium, neuroregulatory ntshawv siab, tsis txaus mucociliary clearance, thiab kev loj hlob ntawm nonspecific bronchial reactivity. Lawv pib hnov mob pathologically rau cov stimuli uas paub zoo (cua txias, tsis hnov tsw, lub cev ua si).
Predisposing factors
Predisposing yam tseem ceeb hauv kev tsim cov kab mob bronchitis. Cov no yog, ua ntej ntawm tag nrho cov, cov yam ntxwv ntawm tus me nyuam lub cev - lub immaturity ntawm cov qauv ntawm lub bronchi thiab kev tiv thaiv kab mob, nquag pathologies ntawm lymphoid cov ntaub so ntswg, kev tsis haum tshuaj mus rau lub cev, lub xub ntiag ntawm immunodeficiency xeev ntawm kev ua pa ib ntsuj av tsis xws luag (secondary thiab congenital).). Cawv fetopathy, aspiration syndrome, leej niam haus luam yeeb thaum cev xeeb tub thiab thaum pub niam mis, thiab cov tshuab ua pa ua rau muaj kev loj hlob ntawm bronchial hyperreactivity. Cystic fibrosis thiab txawv teb chaws lub cev nyob rau hauv cov hlab ntsws kuj nrog los ntawm cov tsos mob ntawm recurrent bronchitis. Kev rov tshwm sim ntawm bronchitis tuaj yeem tshwm sim los ntawm kev cuam tshuam ntawm huab cua tsis zoo (kub hloov pauv, cov av noo siab), kev ua qias tuaj hauv tsev thiab kev lag luam.air.
70-80% ntawm cov neeg mob menyuam yaus muaj daim ntawv thaiv uas tshwm sim thaum tsis muaj lwm yam kab mob bronchopulmonary. Vim qhov nqaim ntawm lub lumen ntawm cov kwj dej ua pa tau pom nyob rau hauv tus kab mob no hauv cov menyuam yaus, bronchial obstruction yog tshwm sim los ntawm kev hloov pauv hauv cov mucous membrane tawm tsam keeb kwm yav dhau los ntawm SARS. Lub xub ntiag ntawm kev ua xua nyob rau hauv tus neeg mob (kev ntsuam xyuas ntawm daim tawv nqaij zoo, pob khaus ntawm daim tawv nqaij) thiab cov ntaub so ntswg dysplasia ua rau nws muaj peev xwm cais cov neeg mob xws li ib pab pawg muaj kev pheej hmoo rau obstructive bronchitis. Tus kab mob RSV tuaj yeem cuam tshuam qhov tsim ntawm lub cev tiv thaiv kab mob thiab tsim cov tshuaj tiv thaiv kab mob atopic thiab rhiab heev rau huab cua ua xua. Hauv kev mob ntsws ntsws rov qab nrog kev cuam tshuam yam tsis muaj kev ua xua thiab qib qis ntawm Ig E, feem ntau ntawm cov kev cuam tshuam cuam tshuam thaum muaj hnub nyoog 3-4 xyoos.
Symptoms
Nrog rau tus mob bronchitis, ib xyoos ib zaug exacerbations tshwm sim, feem ntau kav 2-4 lub lis piam. Cov tsos mob ntawm tus mob rov qab los, raws li txoj cai, muaj mob me dua li qhov pib mob hnyav, thiab pib nrog cov tsos mob ntawm SARS. Nyob rau tib lub sijhawm, muaj qhov kub thiab txias me ntsis thiab qee qhov tshwm sim catarrhal: rhinitis, qhov ntswg congestion, mob caj pas, mob taub hau. Maj mam, dhau 3-6 hnub, hnoos tshwm sim: thaum xub thawj mob thiab qhuav, tom qab ntub thiab ntxhib, tsis tshua muaj paroxysmal. Nyob rau tib lub sijhawm, viscous mucopurulent hnoos qeev yog secreted. Txhua hnub, tus neeg mob muaj hnoos, uas maj mam dominatesdaim duab kho mob ntawm pathology. Kev hnoos yuav tshwm sim ntawm kev tawm dag zog.
Ua pa tawm
Thaum obstructive bronchitis rov tshwm sim, tus neeg mob ua tsis taus pa yuav hawb pob, thiab hnoos yog obsessive. Nrog sluggish recurrent bronchitis, exacerbation tuaj yeem mus ntev heev (txog 3 lub hlis) nrog cov hnoos qeev tsis zoo thiab qhov kub thiab txias. Thaum lub sij hawm tshem tawm, tus neeg mob noj qab nyob zoo.
Diagnosis
Thaum kuaj pom "Cov kab mob bronchitis rov qab" (raws li ICD-10 code - J 20), anamnesis tau teev tseg, X-ray, bronchography, ua pa ua haujlwm, ua tiav cov ntshav suav, kuaj tawv nqaij, kab mob hnoos qeev. rau cov kab mob flora tau ua. Lub exacerbation ntawm no pathology yog tus cwj pwm los ntawm kev ua tsis taus pa nyuaj, ntub thiab qhuav hawb pob ntawm ntau qhov ntau thiab tsawg, uas muaj tus cwj pwm sib txawv thiab thaj chaw. Paravertebral, koj tuaj yeem txiav txim siab qhov luv ntawm lub suab nrov ntawm ob sab, qhov ntev ntawm exhalation. Thaum lub sij hawm tshem tawm, muaj kev npaj hnoos ntxiv nrog me ntsis hypothermia, ua hauj lwm ntau dhau thiab kev tawm dag zog lub cev.
X-ray ntawm lub ntsws nrog cov kab mob ntsws rov qab ua rau pom kev ruaj khov nyob rau lub sijhawm ntev ntawm cov kab mob ntsws hauv thaj chaw basal, nws khaws cia thaum lub sijhawm tshem tawm thiab maj mam rov qab mus rau qhov qub.
Bronchoscopy tso cai rau koj los ntsuas kev hloov pauv ntawm tsob ntoo bronchial thiab muaj qhov zais cia. Nrog rau rov tshwm sim ntawm bronchitis ntawm phab ntsa ntawm bronchi tsimme ntsis fibrinous deposits los yog elongated threads thiab cais lumps ntawm mucous hnoos qeev. Kev hloov pauv hauv qhov contour ntawm bronchial lumens kuj pom, feem ntau hais nyob rau sab sauv ntawm lub ntsiab bronchi. Nrog FVD, fuzzy obstructive disorders ntawm ib tug reversible xwm, latent bronchospasm, thiab qaug zog bronchial hyperreactivity yuav txiav txim tau.
Yuav kuaj ntshav qhia li cas?
Nyob rau hauv cov ntshav peripheral, me ntsis nce ntawm cov leukocytes, nce ESR, nrog rau kev tsis haum xeeb ntawm keeb kwm ntawm tus mob bronchitis - eosinophilia tuaj yeem kuaj pom. Txhawm rau ntsuas qhov rhiab heev rau cov kab mob sib kis, kev kuaj tawv nqaij nrog cov kab mob (streptococcal thiab staphylococcal) ua xua. Tsis tas li ntawd, tus neeg mob raug xa mus rau kev sab laj nrog tus kws kho mob ua xua thiab pulmonologist. Kev mob bronchitis rov tshwm sim yog pom zoo kom sib txawv ntawm bronchial hawb pob, mob ntsws, cystic fibrosis, tuberculosis, bronchiolitis obliterans, muaj lub cev txawv teb chaws nyob rau hauv lub bronchi..
Kev kho mob thiab cov lus pom zoo rau cov kab mob no
Kev kho mob ntawm tus mob ntsws rov qab yog ua raws li tus neeg mob sab nraud nrog rau kev teem sijhawm ntawm kev haus dej ntau, so, noj zaub mov kom ruaj khov. Nrog cov tsos mob ntawm tus kab mob ua pa nyuaj, cov neeg mob tau muab tshuaj tua kab mob (Umifenovir, Remantadin), nyob rau hauv cov ntaub ntawv ntawm chlamydial los yog mycoplasmal genesis ntawm daim ntawv no ntawm bronchitis, tshuaj tua kab mob (macrolides) ua ke nrog immunomodulators (Tiloron, echinacea) tincture., nrog rau qee cov tshuaj tiv thaiv kab mob("Fenspiride").
Dab tsi yog siv los kho tus mob bronchitis hauv cov menyuam yaus thiab cov neeg laus?
nqus pa
Nrog lub hnoos muaj zog, nqus tau nrog cov tshuaj alkaline thiab cov tshuaj mucolytic (Ambroxol, Carbocisteine), UHF, vibration massage, kho ua pa ce, postural kua yog pom zoo. Thaum lub sij hawm exacerbation ntawm tus kab mob nyob rau hauv lub xub ntiag ntawm cov tsos mob ntawm broncho-obstruction, kev siv ntawm inhaled bronchodilators ("Fenoterol", "Salbutamol") yog pom zoo, nyob rau hauv mob hnyav, glucocorticoids ("Prednisolone", "Dexamethasone") yog. tshuaj systemically los yog aerosolly. Antihistamines yog siv rau cov menyuam yaus uas muaj keeb kwm ntawm kev tsis haum tshuaj. Kev nqus pa nrog lub nebulizer kuj pom zoo. Kev kho tus mob bronchitis rov tshwm sim hauv cov menyuam yaus yuav tsum ua kom tiav thiab raws sijhawm.
Cov neeg uas muaj tus kab mob bronchitis, nws yog ib qho tsim nyog yuav tsum tau ua raws li kev soj ntsuam ntawm lub tsev kho mob kom txog rau thaum qhov kev rov ua dua tshiab tsis pub dhau 2 xyoos, kev kho spa kuj tau qhia. Nrog rau daim ntawv rov tshwm sim ntawm bronchitis, qhov kev tshwm sim yog qhov zoo, vim tias qhov no pathology yog thim rov qab rau feem ntau. Qhov kev pheej hmoo ntawm nws txoj kev hloov mus rau hauv bronchial hawb pob lossis rau hauv daim ntawv asthmatic yog txiav txim siab los ntawm qhov tshwm sim ntawm bronchospasm thiab lub hnub nyoog ntawm tus neeg mob. Cov menyuam yaus muaj kev cuam tshuam rau cov teeb meem no. Relapse tiv thaiv npog tiv thaiv kab mob kis, ntxovKev kho tshuaj tiv thaiv kab mob, tshem tawm qhov ua xua, ua kom lub cev thiab tawv nqaij, nrog rau kev txhaj tshuaj tiv thaiv raws sij hawm tiv thaiv qhua pias, mob npaws thiab kab mob pneumococcal.
Cov menyuam yaus uas muaj lub ntsej muag o ntawm lub bronchi tau pom zoo kom zam kom tsis txhob muaj qhov kub siab, nyob hauv pab pawg thaum lub caij nyoog ntawm cov kab mob ua pa. Tsis tas li ntawd, cov kws kho mob xav txog normalization ntawm txoj kev ua neej, txhim kho cov khoom noj khoom haus, kev ua si ntawm lub cev, thiab kev siv tshuaj tiv thaiv kab mob raws li kev tiv thaiv yuav tsum tau ua. Yog tias thawj cov tsos mob ntawm tus kab mob tshwm sim los yog xav tias yuav tsum tau kho mob sai sai. Peb tau tshuaj xyuas cov txheej txheem kho mob rau cov kab mob bronchitis rov qab rau cov menyuam yaus thiab cov neeg laus.
