Lub ntsws tau nyob ib puag ncig ntawm txhua sab los ntawm cov ntaub so ntswg sib txuas, ua kom cov pa plab zom mov, ua kom lawv lub zog ua kom ncaj qha rau kev tshoov siab thaum lub sijhawm kev tshoov siab. Qhov no yog ib hom ntawm lub hnab uas muaj ob nplooj ntawv, ntawm uas ib txwm muaj ib tug me me npaum li cas ntawm cov kua, vim hais tias cov nplooj ntawv lossi swb.
Hauv qee cov kab mob, qhov ntim ntawm cov kua dej no nce, thiab cov ntaub ntawv effusion hauv cov kab noj hniav pleural. Tus mob no tshwm sim heev. Nws tsis siv rau cov kab mob ywj pheej, tab sis tsuas yog ib qho teeb meem ntawm cov txheej txheem pathological. Yog li ntawd, yuav tsum tau kuaj xyuas thiab kho kom zoo.
Kev xav ntawm lub pleural kab noj hniav
Cov kab noj hniav pleural tau nthuav tawm raws li qhov nqaim hauv ob lub hnab asymmetrical nyob ib puag ncig txhua lub ntsws. Lawv raug cais tawm ntawm ib leeg thiab tsis txhob kov ib leeg. Cov hnab no muaj cov ntaub so ntswg serous thiab yog ib qho ua ke ntawm cov nplooj ntawv sab hauv thiab sab nrauv.
Lub pleura kab hauv siab kab noj hniav thiab yog kiag linpog txhua lub ntsws. Nws qhov lateral smoothly dhau mus rau hauv lub diaphragm. Cov ntsiab lus hloov pauv yog hu ua sinuses, thiab, hauv paus, nws yog nyob rau hauv lawv cov kua accumulates.
Lub siab tsis zoo uas tau tsim nyob rau hauv cov kab noj hniav pleural tso cai rau lub ntsws ua haujlwm, ua kom lawv txoj hauj lwm hauv siab thiab ua haujlwm li qub thaum nqus tau thiab exhalation. Yog tias muaj kev raug mob tshwm sim thiab qhov sib txawv ntawm lub pleural yog kov, ces lub siab sab hauv thiab sab nraud sib npaug, cuam tshuam kev ua haujlwm ntawm lub ntsws.
Cov kua dej ntawm cov kab noj hniav pleural yog rov ua dua los ntawm nws cov khoom tsim los ntawm cov hlab ntsha thiab tshem tawm los ntawm cov kab mob lymphatic. Txij li thaum lub hnab pleural raug cais tawm, cov kua dej los ntawm ib kab noj hniav tsis ntws mus rau lwm qhov.
Kab mob tshwm sim
Effusion nyob rau hauv lub pleural kab noj hniav feem ntau tsim thaum lub sij hawm cov kab mob inflammatory thiab non-inflammatory kab mob. Ntawm cov ntsiab lus uas tuaj yeem sau tau, cov kws kho mob hais txog:
- ntshav;
- transudate;
- hilus;
- exudate;
- pas.
Ntshav yog tsim los ntawm kev raug mob rau lub hauv siab, tshwj xeeb, cov hlab ntsha ntawm lub pleura membranes. Nyob rau hauv lub xub ntiag ntawm cov ntshav, cov kws kho mob hais txog hemothorax. Tus mob no feem ntau tshwm sim tom qab phais hauv lub sternum.
Chylus yog tsim nyob rau hauv rooj plaub ntawm chylothorax. Nws yog cov mis nyuj dawb dawb nrog cov ntsiab lus lipid siab. Chylothorax tshwm sim los ntawm kev raug mob hauv siab kaw vim muaj teeb meem tom qab kev phais, nrog rau cov kab mob ntsws, nrog rau cov txheej txheem oncological hauv lub ntsws. Nws feem ntau ua rau pleural effusion hauvme nyuam mos.
Transudate yog cov kua dej edematous tsim los ntawm cov qog ntshav tsis zoo thiab cov ntshav ncig. Qhov no tuaj yeem ua rau raug mob, ntshav poob, kub hnyiab, nephrotic syndrome.
Exudate yog cov kua dej inflammatory uas tsim los ntawm cov hlab ntsha me thaum lub ntsws mob.
Thaum lub pleura ua rau mob, cov kua paug nkag. Nws kuj tau tsim thaum lub sij hawm kis kab mob thiab cov qog nqaij hlav, thaum raug mob rau lub sternum.
Txoj kev ntawm pleural effusion
Nws yog ib qho tsub zuj zuj ntawm cov kua hauv cov kab noj hniav pleural. Cov xwm txheej zoo li no yuav tsum muaj kev cuam tshuam sai, vim nws ua rau muaj kev hem thawj rau tib neeg kev noj qab haus huv thiab lub neej.
Pleural effusion feem ntau kuaj pom hauv cov neeg mob ntsws thiab lub plawv tsis ua haujlwm. Nws tuaj yeem tshwm sim los ntawm transudate lossis exudate. Cov tom kawg yog tsim los ntawm cov kab mob inflammatory, kab mob thiab kis kab mob ntawm lub ntsws, nrog rau cov qog.
Kev faib tawm tseem ceeb
Nws yog ib qho tseem ceeb heev kom paub meej tias pleurisy yog dab tsi thiab cov cim qhia tias nws yog dab tsi. Qhov no yog ib qho tsub zuj zuj ntawm cov kua dej hauv thaj av pleural, thiab cov tsos mob ntawm tus mob no feem ntau nyob ntawm nws tus nqi. Yog hais tias nws yog ntau tshaj li ib txwm, ces cov kws kho mob tham txog lub exudative daim ntawv ntawm tus kab mob, uas feem ntau tshwm sim thaum pib ntawm lub pathology. Maj mam, cov kua yog absorbed, thiab cov protein deposits yog tsim nyob rau saum npoo ntawm pleura nplooj, uas yog koom nyob rau hauv lub coagulation txheej txheem.ntshav.
Cov kua muaj pes tsawg leeg yuav txawv. Nws raug txiav txim thaum lub sij hawm pleural puncture. Yog vim li cas qhov effusion tuaj yeem yog:
- serous - ntshiab kua;
- serous-fibrinous - nrog impurities ntawm fibrin;
- purulent - muaj cov qe ntshav dawb;
- putrid - nrog cov ntaub so ntswg lwj;
- chile - muaj rog;
- hemorrhagic - nrog ntshav impurities.
Effusion hauv pleural kab noj hniav tuaj yeem txav tau yooj yim lossis txwv ntawm cov nplooj ntawv. Nyob ntawm qhov chaw ntawm kev tsom mus rau pathological, lawv paub qhov txawv:
- apical;
- costal;
- diaphragmatic;
- paramediastinal;
- mixed.
Ntxiv rau, qhov effusion tuaj yeem ua rau ib leeg lossis ob lub ntsws cuam tshuam ib zaug. Nyob ntawm qhov no, cov tsos mob txawv thiab kev kho mob raug xaiv.
Kev tshwm sim
Ua rau effusion hauv pleural kab noj hniav feem ntau cuam tshuam nrog lub hauv siab raug mob lossis kis kab mob ntawm lub pleura. Feem ntau, cov kua dej ntau ntau tshwm sim thaum lub sijhawm muaj ntau yam kab mob ntawm cov kabmob uas nyob hauv lub hauv siab thiab peritoneum lossis tsim muaj teeb meem. Ntawm cov laj thawj feem ntau, ib qho yuav tsum tau hais txog xws li:
- lub plawv tsis ua hauj lwm;
- tuberculosis, mob ntsws, thromboembolism;
- cholecystitis, caj dab phlegmon, peritonitis, pancreatitis;
- Metastasis ntawm malignant qog.
Nyob pleural effusion ntau zauspom nyob rau hauv zes qe menyuam, mob ntsws thiab mob cancer mis. Yog hais tias cov transudates ua raws li provocateurs rau kev tsim cov kua dej ntau dhau, ces chav kho mob ntawm pathology tsis xav tau cov kev tshwj xeeb ntawm kev kuaj mob thiab kev kho mob.
Risk factors
Ib qho me me hauv cov kab noj hniav pleural accumulates vim muaj cov txheej txheem pathological hauv cov hlab ntsha thiab lymphatic. Cov no suav nrog kev ua txhaum cai raws li kev tsim cov tshuaj ntau ntxiv thiab tsis txaus ntawm lawv cov excretion.
Qhov tseem ceeb ntawm kev pheej hmoo yog qhov nyob ntev ntawm tus neeg mob hauv tsev kho mob, uas suav nrog kev pw tsaug zog tas li. Ntau tshaj 10% ntawm cov neeg mob muaj cov kua dej ntau ntxiv hauv cov kab noj hniav pleural. Tsis tas li ntawd, qhov kev pheej hmoo ntawm effusion zoo li muaj teeb meem hauv pathologies xws li:
- lub ntsws ua haujlwm ntev;
- cov txheej txheem mob;
- leukemia thiab mesothelioma;
- malignant neoplasms;
- mob ntshav qab zib;
- kab mob HIV.
Kev txheeb xyuas raws sijhawm ntawm qhov laj thawj thiab kev kho kom raug tuaj yeem ua rau muaj kev ua kom muaj zog ntau ntxiv ntawm cov kua dej hauv lub pleural kab noj hniav.
Kev kho mob tshwm sim
Cov tsos mob ntawm pleural effusion tsis yog ib txwm ci thiab hais tau. Feem ntau, cov tsos mob ntawm pathology raug txiav txim thaum lub sij hawm kuaj mob. Ntawm thawj cov cim qhia, nws yuav tsum tau hais txog xws li:
- ua tsis taus pa;
- mob plab;
- nrhiavyam ntxwv suab thaum tapping;
- ua pa nrov;
- hnoos qhuav.
Nws kuj tseem ceeb heev uas yuav tsum txheeb xyuas cov tsos mob ntawm tus kab mob ntsws pulmonary tuberculosis thaum ntxov, vim tias tus kab mob no feem ntau ua rau cov kua dej ntau dhau. Thawj qhov tsos mob yog qhov tshwm sim ntawm qhov mob tshwm sim.
Diagnostics
Lub hauv paus ntsiab lus ntawm kev kuaj mob effusion hauv cov kab noj hniav pleural yog los txiav txim seb hom khoom puas. Qhov no dhau los ua qhov tseem ceeb rau kev xaiv txoj kev kho mob. Thaum xub thawj, tus neeg mob raug tshuaj xyuas los ntawm kws kho mob, thiab tom qab ntawd muab ntau cov kev kuaj sim. Nov yog kuaj ntshav, hnoos qeev thiab tso zis.
Kev kuaj hnoos qeev tso cai rau koj los txiav txim seb muaj cov kab mob hauv lub pleura thiab xaiv txoj kev kho kom zoo tshaj plaws. Instrumental method yog suav tias yog cov ntaub ntawv ntau dua. Ntawm lawv, nws yog ib qho tsim nyog los qhia txog xws li:
- x-ray;
- spirography;
- CT and MRI.
Nrog kev pab ntawm radiography, koj tuaj yeem txiav txim siab qhov chaw ntawm qhov txhab thiab qib ntawm cov kua dej hauv lub pleura. MRI thiab CT ua rau nws muaj peev xwm kom tau txais cov duab tseeb dua ntawm cov kab mob pathology, thiab tseem yog cov txheej txheem yuav tsum tau ua thaum ua haujlwm. Spirography yog ua rau lub hom phiaj ntawm kev tshuaj xyuas cov bronchi, uas tso cai rau txiav txim siab cov yam ntxwv ntawm pathology thiab qib ntawm nws kis. Lub luag haujlwm tseem ceeb hauv kev kuaj mob yog muab rau kev kuaj histological thiab cytological. Lawv tso cai:
- sib txawv ntawm malignancy ntawm pathology;
- txiav txim siab cov cellular muaj pes tsawg leeg ntawm cov kua;
- nrhiav cov duab thiab ua kom pom tseeb ntawm cov qog nqaij hlav cancer;
- detect metastases.
Kev ua haujlwm histology thiab cytology muab cov lus piav qhia tag nrho ntawm cov kab mob, lees paub lossis tsis lees paub qhov muaj ntawm oncology.
Txoj kev kho mob
Nws yog ib qho tseem ceeb tsis tsuas yog kom paub tias pleurisy yog dab tsi, dab tsi raws nraim qhov kev ua txhaum cai thiab kev kho mob li cas. Kev kho mob feem ntau yog nyob ntawm qhov ua rau ntawm pathology. Tuberculosis xav tau tshuaj tua kab mob, thaum cov qog yuav tsum tau hluav taws xob lossis tshuaj khomob.
Yog tias ib tus neeg muaj pleurisy qhuav, ces cov tsos mob tuaj yeem kho tau los ntawm kev qhwv lub hauv siab nrog cov ntaub qhwv elastic. Lub hauv ncoo me me tuaj yeem siv rau ntawm qhov cuam tshuam rau immobilize qhov khaus pleura.
Yog tias muaj cov effusion hauv pleural kab noj hniav, tshwj xeeb tshaj yog tias muaj ntau, nws raug tshem tawm los ntawm pleural puncture. Thaum noj cov kua rau kev tshuaj xyuas, tag nrho cov txheej txheem tau ua qeeb qeeb kom tsis txhob ua rau lub siab txo qis.
kev kho mob
Yog tias muaj effusion nyob rau sab laug pleural kab noj hniav, yuav tsum tau kho mob. Qhov no yog txoj kev zoo tshaj plaws ntawm kev kho mob, siv los txo qhov mob tshwm sim thiab ua kom tus neeg mob tus mob. Rau kev kho mob, tshuaj tua kab mob thiab tshuaj tua kab mob yog muab.
Nrog kev loj hlob ntawm cov kab mob pathogenic, nws yuav tsum tau uaKev sib xyaw ua ke nrog kev siv Kabapenem, Metronidazole lossis Clidamycin. Ntawm cov tshuaj tua kab mob uas tau nkag mus rau hauv cov kab noj hniav pleural, Metronidazole, Penicillin, Ceftriaxone yog siv. Ib qho yuav tsum tau ua ua ntej yog saib xyuas tus neeg mob thoob plaws hauv chav kho mob thiab saib xyuas tus mob txhua hnub rau rau lub hlis.
offage ntawm tus pleural kab noj hniav
Nyob rau hauv kev kho mob ntawm cov effusions uas nquag rov ua dua, cov kua dej pleural yog siv. Yog tias cov dej sib sau ua ke tsis tseem ceeb, ces 1-2 aspirations ib hnub yuav tsum tau. Nyob rau hauv lub xub ntiag ntawm ib tug loj npaum li cas ntawm purulent effusion los yog nws loj thickening, tubular siphon kua yog siv.
Tom qab tav kev phais, tus neeg mob tau pom cov kua dej qhib rau ob peb lub hlis kom tshem tawm cov exudate. Kev lim dej yog ib txoj hauv kev zoo tshaj plaws ntawm kev kho mob. Cov kua dej ruaj khov ua kom muaj kev tshem tawm tag nrho ntawm cov kua dej nrog nws cov khoom ntim tas li.
Kev ua haujlwm
Yog tias cov tsos mob ntawm tus kab mob ntsws pulmonary tuberculosis nyob rau theem pib raug lees paub raws sijhawm, ces kev kho mob tsuas yog nqa nrog tshuaj xwb. Yog tias muaj teeb meem lossis tsis muaj qhov muaj zog zoo, yuav tsum tau ua haujlwm.
Thaum lub sijhawm cuam tshuam, cov kua dej ntau ntxiv yog nqus tawm ntawm qhov chaw pleural. Txoj kev no suav hais tias yog qhov ua tau zoo tshaj plaws.
Muaj Teeb Meem
Cov teeb meem uas tshwm sim tawm tsam keeb kwm ntawm kev ntws ntawm pleural effusion muaj ntau yam. Lawv manifestationFeem ntau nyob ntawm tus kab mob hauv qab.
Yog tias cov dej ntws hauv lub pleural kab noj hniav pib los ntawm kev mob ntsws los yog tuberculosis, ces cov teeb meem yuav tshwm sim nyob rau hauv daim ntawv ntawm kev ua pa tsis ua hauj lwm los yog emphysema. Hauv kev ua txhaum ntawm kev ua haujlwm ntawm lub plawv, tej zaum yuav muaj kev tsis sib haum xeeb ntawm lub plawv dhia thiab tachycardia. Kev sib sau ntau dhau ntawm cov dej thiab cov teeb meem tuaj yeem ua rau tus neeg mob tuag.
prophylaxis
Kev tiv thaiv kab mob yog qhov tseem ceeb los tiv thaiv effusion. Nws tau nthuav tawm hauv:
- kho raws sijhawm ntawm kev mob ntsws, kab mob ua pa, thiab mob plawv;
- khoom noj khoom haus;
- kom txhob haus luam yeeb thiab haus cawv;
- zoo pw tsaug zog.
Qhov no yuav tiv thaiv kev loj hlob ntawm cov kab mob loj, thiab, yog tias tsim nyog, yuav ua kom rov zoo sai.
