Tus kab mob no muaj ntau lub npe - rheumatism, Sokolsky-Buyo kab mob, rheumatic fever. Cov txheej txheem pathological ua mus ntev, nrog rau kev nyiam rau cov xwm txheej, uas tau pom nyob rau hauv feem ntau ntawm lub caij nplooj zeeg thiab caij nplooj ntoos hlav. Qhov sib koom ntawm cov kab mob rheumatic ntawm cov hlab ntsha thiab lub plawv suav txog li 80% ntawm cov mob plawv tsis zoo. Cov txheej txheem rheumatic feem ntau cuam tshuam nrog pob qij txha, tawv nqaij, serous daim nyias nyias, thiab lub hauv paus paj hlwb. Qhov tshwm sim yog kwv yees li 0.3% -3%. Rheumatism feem ntau tshwm sim thaum hluas thiab menyuam yaus (7-15 xyoo). Cov neeg laus thiab cov menyuam kawm ntawv preschool poob mob tsawg dua, thiab cov ntxhais raug kev txom nyem los ntawm cov kab mob no ntau dua 3 zaug.
Nyob rau hauv tsab xov xwm, peb yuav xav txog cov kev kho mob thiab cov yam ntxwv ntawm kev tiv thaiv rheumatism.
Mechanism thiab ua rau kev loj hlob ntawm pathology
Kev mob rheumatic feem ntau yog ua ntej los ntawm tus kab mob streptococcal los ntawmβ-hemolytic streptococcus pawg A. Cov no yog cov kab mob xws li tonsillitis, scarlet fever, puerperal fever, pharyngitis, mob otitis media, erysipelas. Hauv 97% ntawm cov neeg mob uas yav tas los muaj tus kab mob streptococcal, kev tiv thaiv muaj zog yog tsim los rau tus kab mob no. Hauv lwm tus neeg, qhov kev tiv thaiv kab mob tsis tu ncua tsis tau tsim, thiab kev kis kab mob thib ob nrog β-hemolytic streptococcus ua rau muaj kev cuam tshuam autoimmune.
Txoj kev loj hlob ntawm cov kab mob pathological no tau yooj yim los ntawm: cov hnub nyoog hluas, txo kev tiv thaiv, pab pawg loj (cov tsev kawm ntawv nce qib, tsev kawm ntawv, tsev so), kev ua neej nyob tsis zoo thiab noj zaub mov tsis zoo, mob ntshav qab zib hnyav, anamnesis hnyav hauv tsev neeg.
Nyob rau hauv cov lus teb rau kev nkag mus ntawm β-hemolytic streptococcus, ib tug neeg pib cov txheej txheem ntawm tsim cov tshuaj tiv thaiv kab mob (antistreptolysin-O, antistreptokinase, antistreptohyaluronidase, antideoxyribonuclease B), uas, nrog rau cov kab mob ntawm cov kab mob streptococcal antigens., form immune complexes.
Stages
Cov txheej txheem ntawm kev tsis sib haum xeeb ntawm cov ntaub so ntswg sib txuas thaum lub sij hawm rheumatism tshwm sim hauv ntau theem:
- muag o;
- hloov pauv hauv cov xwm txheej fibrinoid;
- granulomatosis;
- sclerosis.
Nrog rau thaum ntxov, thim rov qab, qib ntawm mucoid o, edema tshwm sim, o thiab maj mam sib cais ntawm collagen fibers. Yog tias nyob rau theem no qhov kev puas tsuaj tsis raug tshem tawm, tom qab ntawd cov kab mob fibrinoid tsis tuaj yeem tshwm sim, uas yog tus cwj pwm los ntawm fibrinoid necrosis.collagen fibers thiab cell. Nyob rau theem garnulomatous ntawm cov txheej txheem rheumatic, tshwj xeeb rheumatic granulomas tsim nyob ib ncig ntawm thaj chaw ntawm necrosis. Cov theem kawg ntawm sclerosis yog suav tias yog qhov tshwm sim ntawm cov txheej txheem granulomatous inflammatory.
Nyob ntawm pathology
Lub sijhawm ntawm txhua theem ntawm cov kab mob rheumatic yog kwv yees li 1-2 lub hlis, thiab tag nrho lub voj voog yog li 6 lub hlis. Relapses ntawm rheumatic tawm tsam ua rau kev loj hlob ntawm cov ntaub so ntswg rov ua dua nyob rau hauv cov cheeb tsam ntawm cov caws pliav uas twb muaj lawm. Nyob rau hauv lub plawv li qub, nyob rau hauv uas rheumatism tau pom, deformation ntawm li qub tshwm sim, lawv fusion nrog ib leeg, uas yog feem ntau ua rau kev loj hlob ntawm lub plawv tsis xws luag, thiab theem nrab rheumatic tawm tsam exacerbate destructive ntshawv siab.
Symptoms of disease
Cov tsos mob ntawm rheumatism yog polymorphic heev thiab nyob ntawm qhov hnyav thiab kev ua haujlwm ntawm cov txheej txheem pathological, nrog rau kev koom tes ntawm ntau yam kabmob hauv nws. Ib lub tsev kho mob raug tus kab mob muaj kev sib raug zoo nrog tus kab mob streptococcal (tonsillitis, scarlet fever, pharyngitis) thiab tsim 1-2 lub lis piam tom qab lub sij hawm mob. Rheumatism pib nrog kub subfebrile (38-39 ° C), mob qaug zog, mob taub hau, qaug zog, tawm hws ntau heev.
Ib qho ntawm thawj qhov tshwm sim ntawm rheumatism yog mob caj dab - mob hauv pob qij txha loj lossis nruab nrab (pob taws, hauv caug, lub luj tshib, xub pwg, dab teg). Arthralgias yog symmetrical, ntau thiab volatile (mob dhau ntawm qee yam thiab tshwm sim hauvlwm cov pob qij txha) cim. Muaj qhov o, o, qhov kub thiab txias hauv zos nce thiab liab, ib qho kev txwv ntawm kev txav ntawm cov pob qij txha. Rheumatic polyarthritis tshwm sim, raws li txoj cai, benignly: qhov hnyav ntawm pathological tshwm sim tom qab ob peb hnub, cov pob qij txha tsis deformed, thiab mob me ntsis mob qee zaum mob ntev heev.
kab mob Rheumatic
Tom qab 1-3 lub lis piam, kab mob rheumatic pib: mob plawv, palpitations, ua tsis taus pa; Tom qab ntawd asthenic syndrome: lethargy, malaise, qaug zog. Lub plawv tsis ua haujlwm tshwm sim hauv 70-85% ntawm cov neeg mob. Nrog tus kab mob rheumatic, tag nrho lossis ib tus neeg cov qauv ntawm lub plawv tuaj yeem ua rau mob. Feem ntau, muaj kev puas tsuaj ib txhij rau myocardium (endomyocarditis) thiab endocardium, qee zaum nrog pericardium (pancarditis), nws tseem tuaj yeem tsim cov kab mob myocardial cais (myocarditis). Muaj ua tsis taus pa luv, cuam tshuam rau hauv lub atherosclerosis thiab mob nyob rau hauv lub plawv, circulatory tsis ua hauj lwm, pulmonary edema los yog mob hawb pob. Pulse yog tachyarrhythmic.
CNS kev puas tsuaj
Nrog rheumatism, lub hauv nruab nrab lub paj hlwb tuaj yeem cuam tshuam, ib qho kev qhia ntawm qhov no yog rheumatic chorea: hyperkinesis tshwm - tsis muaj leeg nqaij twitching, leeg nqaij thiab kev xav tsis muaj zog. Cov tsos mob ntawm daim tawv nqaij tsis tshua muaj tshwm sim: erythema annulare thiab rheumatoid nodules.
Kev koom tes ntawm lub plab kab noj hniav, ob lub raum, ntsws thiab lwm yam kabmob yog qhov tsawg heev hauv cov qauv hnyav.
Nyob hauv qab no, xav txog kev kho thiab tiv thaiv kab mob rheumatism.
Kev kho mob
Y Active stage of rheumatismyuav tsum tau pw hauv tsev kho mob thiab pw tsaug zog. Kev kho mob yog ua los ntawm kws kho plawv thiab kws kho mob rheumatologist. Cov tshuaj tiv thaiv inflammatory thiab hyposensitizing, corticosteroid cov tshuaj hormones, cov tshuaj uas tsis yog-steroidal anti-inflammatory (Indomethacin, Genilbutazone, Diclofenac, Ibuprofen), tshuaj tiv thaiv kab mob (Chloroquine, Hydroxychloroquine, Azathioprine, Chlorbutin) yog siv.
Rehabilitation ntawm foci ntawm tus kab mob
Kev kho mob ntawm foci ntawm tus kab mob (caries, tonsillitis, sinusitis) suav nrog lawv cov tshuaj tua kab mob thiab kev kho mob. Kev siv tshuaj tua kab mob ntawm pab pawg penicillin ("Bicillin") hauv kev kho mob rheumatism yog ntxiv rau hauv cov xwm txheej thiab tau qhia txog kev kis mob los yog pom tseeb cov tsos mob ntawm tus kab mob streptococcal.
Tiv thaiv Rheumatism
Kev tiv thaiv kev tiv thaiv los tiv thaiv kab mob rheumatic cuam tshuam nrog kev kis tus kab mob streptococcal tuaj yeem faib ua thawj thiab theem nrab. Lub luag haujlwm tseem ceeb yuav tsum tau ua los ntawm cov dej num dav dav hauv lub xeev, xws li kev txhawb nqa kev ua neej kom zoo, kev ua kis las, kev ua kom tawv nqaij. Tsis tas li ntawd, qee qhov kev ntsuas yuav tsum tau coj los tiv thaiv cov neeg coob coob hauv kindergartens, tsev kawm ntawv, tsev kho mob thiab lwm lub tsev. Nws yog ib qho tsim nyog yuav tsum ua kom huv si raws sijhawm, tshwj xeeb tshaj yog nyob rau hauv cov chaw muaj neeg coob coob, qhia cov menyuam yaus thiab cov neeg laus hauv kev tiv thaiv rheumatism.
Kev saib xyuas tshwj xeeb yuav tsum tau them rau kev kuaj pom thiab tshem tawm cov kab mob foci. Txhua tus neeg uas muaj tus kab mob no tsuas yog tawm mus rau qhov chaw pej xeem xwbtom qab kev ntsuam xyuas tag. Cov neeg uas muaj cov tsos mob ntawm cov kab mob streptococcal (tonsillitis, pharyngitis, sinusitis, cholangitis, caries) yuav tsum tau kho. Yog li, cov kev ntsuas tseem ceeb txhais tau tias:
- Txoj haujlwm uas tsom rau kev ua kom lub cev tiv thaiv thiab txhim kho kev tiv thaiv.
- Kev ntsuas huv thiab huv.
- Kev kuaj mob raws sijhawm thiab kho tus kab mob streptococcal.
Kev ntsuas uas yog tsom rau kev tiv thaiv ntau yam exacerbations, relapses thiab tom qab kev loj hlob ntawm cov txheej txheem rheumatic yog kev tiv thaiv theem nrab ntawm rheumatism. Nws yuav tsum tau ua los ntawm cov kws kho mob hauv zos lossis rheumatologists. Vim lub fact tias qhov no yog ib tug ntev pathology nrog ib tug nyiam mus relapse, thib ob kev tiv thaiv ntawm rheumatism tau ua ntau xyoo. Yog tias tus neeg mob tsis tau tsim muaj kab mob hauv lub plawv, ces bicillin prophylaxis tau ua txhua xyoo rau 3 xyoos, thiab tom qab ntawd raws caij nyoog prophylaxis rau 2 xyoos.
Kev tiv thaiv thib ob ntawm rheumatism implies:
- Kev kho mob zoo thiab mob siab rau cov neeg mob rheumatism.
- Kev tiv thaiv raws sijhawm thiab kho cov kab mob nasopharyngeal.
- Bicillin prophylaxis, uas tau muab faib ua 3 pawg: xyoo puag ncig, raws caij nyoog thiab tam sim no.
Raws li AI Nesterov, thaum lub sijhawm tiv thaiv kev mob rheumatism, plaub lub luag haujlwm tseem ceeb yuav tsum tau daws:
- Ua kom muaj kev tiv thaiv tib neeg siab, tshwj xeeb tshaj yog cov menyuam yaus thiabcov hluas.
- Kev tshem tawm lossis txo qhov kev pheej hmoo ntawm kev kis tus kab mob streptococcal los ntawm kev ua kom huv thiab huv si, kuaj xyuas thiab kho cov neeg nqa khoom ntawm tus kab mob no.
- Lub koom haum thiab npaj kev coj ua ntawm kev kho mob tsim nyog ntawm tus kab mob uas twb muaj lawm nrog cov tshuaj tsis haum.
- kwv yees siv ntawm streptococcal prophylaxis.
tawm tsam, coj cov neeg no mus rau lub tsev kho mob saib xyuas.
Risk group
Nws yog ib qho tsim nyog yuav tsum tau ua tib zoo saib xyuas tshwj xeeb rau cov neeg uas muaj kev hem thawj ntawm rheumatism, piv txwv li cov neeg uas, nrog rau cov kab mob foci ntev, muaj qhov kub thiab txias subfebrile, qaug zog, arthralgia, kev ua haujlwm tsis zoo hauv cov hlab plawv. Cov neeg mob no tau txais kev tiv thaiv raws caij nyoog ntawm rheumatism nrog "Bicillin" rau 2-3 xyoos.
Bicillin-tshuaj tiv thaiv txoj kev
Tam sim no, txhua tus neeg uas tau ua tiav cov txheej txheem rheumatic hauv 5 xyoos tom ntej no tau txais tshuaj bicillin-tshuaj tiv thaiv, tsis hais txog ntawmhnub nyoog thiab muaj lub plawv tsis xws luag (cov neeg mob uas muaj tus kab mob ntau tshaj tsib xyoos yog muab kev tiv thaiv kev kho mob raws li qhia).
Yog li, txhawm rau tiv thaiv kab mob rheumatism, cov tshuaj "Bicillin" yog siv.
Sib txawv ntawm lub caij nyoog, xyoo puag ncig thiab tiv thaiv tam sim no. Txhua xyoo yog ua nrog kev pab ntawm bicillin-1 lossis bicillin-5 (bicillin-3 tsis yog siv rau lub hom phiaj no).
Rau cov neeg laus thiab cov menyuam kawm ntawv, cov tshuaj tua kab mob rau kev tiv thaiv kab mob rheumatism bicillin-5 yog muab tshuaj intramuscularly ntawm ib koob ntawm 1,500,000 IU ib hlis ib zaug, rau cov menyuam kawm ntawv preschool - ib zaug txhua 2-3 lub lis piam ntawm ib koob ntawm 750,000 IU. Bicillin-1 yog siv intramuscularly rau cov neeg laus thiab cov menyuam yaus hnub nyoog kawm ntawv ib zaug txhua 3 lub lis piam ntawm koob tshuaj 1,200,000 IU, rau cov menyuam kawm ntawv preschool - ntawm koob tshuaj 600,000 IU ib zaug txhua 2 lub lis piam.
Yuav siv tshuaj dab tsi los tiv thaiv rheumatism?
Ntxiv rau, 2 zaug hauv ib xyoos rau 1-1.5 lub hlis, cov kev kawm ntawm kev kho mob rov qab los nrog kev npaj salicylic acid tau ua tiav. Kev siv "Bicillin" yog ua tiav nrog cov vitamins, tshwj xeeb tshaj yog ascorbic acid.
Caij prophylaxis yog ua nyob rau lub caij nplooj zeeg thiab caij nplooj ntoos hlav, thiab tam sim no kev tiv thaiv ntawm rheumatism yog rau cov neeg uas muaj kev pheej hmoo ntawm no pathology.
