Pulmonary tiibhii neakangwara: Zviratidzo neMarapirwo

Very kusingafadzi uye chirwere chinouraya tiibhii iripo paNyika zvemakore, sezvinoratidzwa vakawanda matongo zvakawanikwa pakuchera matongo zvinyorwa. Munyika yanhasi ose gore zvinotora panhengo vakaurayiwa vanhu vanenge mamiriyoni 10, 25% vacho vanofa.

The kupfuura chisingafadzi chimiro chirwere - pulmonary tiibhii neakangwara, izvo zvinoreva multifocal, "akadurura" vose nyore. Nhongai utachiona zviri nyore chaizvo, sezvo nzira yedzimudzangara kwayo zvemariro nyore, uye zviratidzo mukutanga mumatanho anenge asingaoneki. Kutaura zvazviri, pedambudziko roku- mumwe nomumwe wedu ari pachena kuti zuva nezuva, asi sezvinei, kwete muviri wose anokwanisa dzichiri tibhii. Kana uchiri kuisa anotyisa nechirwere, muite mwoyo kwete, nekuti ikozvino sainzi akawedzera pakuvatambu- zvachose kurapa kunyange neakangwara pulmonary tiibhii zvinogoneka. It haachafaniri kuzeza yokungoitawo inspections uye kuti agare kunyatsochengeta kuburikidza nokubata TB nyanzvi. Vanoti kuti zivo uye zvaasingagoni nomuvengi - ndicho kukunda 50%. Saka ngatichionai chii tibhii, kwainobva uye sei kurwisa.

tubercle bacillus

Neakangwara tiibhii of mapapu anokonzerwa nemaziso zvinenge, rinonzi mycobacteria. Iripo Pasi ichi kwemamiriyoni emakore, asi vakanga chete yakawanikwa 1882 nachiremba uye musayendisiti Koch, uyo nokukudzwa uye zita navo saka - the Koch bacillus. pathogenic mycobacteria All (rakapfupikiswa sezvo MKB), pane 74 marudzi, 6 izvo zvinogona kukonzera tiibhii muvanhu nemhuka. Chopusitiki vakadanwa nokuda pakuonekwa, zvechokwadi tsvimbo serin'i. Vamwe mycobacteria vari zvakakwana dzichienderana, vamwe zvishoma curved, uye vose vane kureba kubva 1 kusvika 10 micrometers, uye upamhi - anenge 0.5 microns.

A yakasiyana chinoratidza pavo maumbirwo masvingo dzavo, kana membranes. Pasina vachipinda mashoko, tinoona kuti zviri tsotso Koch dzinovabvumira mutate parinogumira kanoverengeka, kuti vazvidzivirire kubva zvinouraya tupukanana zvimwe antibodies kushanda uye ainyatsoshandisa muchidzivisa noutsinye kwezvakatipoteredza. Vakatosvika bacteriophages kushandiswa zvinobudirira, inova raison d'être - kudzivirira muviri parasitic tusingaoneki. Zvaakanga kunyura, Koch kwakaita bacillus haufi, uye yokugadziridza macrophages ivo nyore kuitira kuti bereka uye nokudaro zvingasabuda kuti kuchengeteka mugadziriro wayo. Nemamwe mashoko, bacillus Koch kuti kushandisa cellular kudzivirira muviri wedu kuti dzika zvakanaka.

Kamwe mumapapu utano munhu, tupukanana izvi vanoumba foci rokutanga chete (chikuru tiibhii), asi mushure ropa uye / kana node vakagovera inopfuura hombe munzvimbo mumwe kana vaviri mapapu nedzimwe kufema saka kutanga neakangwara pulmonary tibhii. Zvadai zvinogona kuva kunyange mushure kubatwa chikuru tibhii, sezvo bacillus Koch ari munhu akaneta muchimiro garai muviri kwemakore akawanda.

Nzira chirwere

Pulmonary tiibhii muvanhu kukonzera mhando nhatu utachiona - M. tibhii (human subspecies), M. africanum (subspecies zvenguva) uye M. bovis (a subspecies hwemhuka). The yokupedzisira iri mombe zvikuru achirwara, uye kuti munhu zvinonzi chinopfuudzwa kubva unpasteurized mukaka.

Vakawanda vanofarira, neakangwara pulmonary tibhii kunoitawo kuti vamwe vashingaire kana kwete. Mhinduro iri nyore: zviri chinotapuriranwa chaizvo, kana vakabata pamwe nokubudiswa Koha tsotso (tubercle bacilli).

Vanobva munhu anorwara kuti utano asi nyore zvinoshamisa:

- vanogona inhaled kubva mumhepo;

- ne mate (semuenzaniso, kubudikidza vangakosora, kisi);

- kuburikidza midziyo yaishandiswa murwere;

- kuburikidza zvemumba;

- kubva mai - mudumbu;

- kana kushandisa insufficiently sterilized zvokurapa zviridzwa.

Sezvaunogona kuona, unogona kuwana TB pose: paruzhinji chokufambisa, paruzhinji, muzvikoro, kubasa uye zvichingodaro.

Inokosha: Koch bacillus naka akaoma musoro. Vane ehupfumi dzavo ngozi kunze muviri kwenguva refu. Heino mienzaniso mishomanana inoratidza Koch bacillus vanogara munharaunda patinotarisana ose zuva:

- munzvimbo ine rima isina chiedza chezuva - kusvika makore 7;

- in yaoma murwere sputum (kuruboshwe panyaya dzose) - kusvika 1 gore;

- muguruva mumugwagwa - kusvikira mazuva 60;

- on zvidimbu typographic Shanduro - kusvika 3 months;

- water - anenge 150 mazuva;

- mu unboiled mukaka - anenge 14 days;

- in chizi (mafuta) - kuti gore.

Zvinoita here isakarurama kupindura mubvunzo neakangwara pulmonary tiibhii iri chinotapuriranwa kana kwete? Zvimwe Koch bacillus ndiripo zvakatipoteredza, nyore kuparadza? Zvinosuruvarisa mycobacteria izvi kwakaoma chaizvo kuuraya. Nemhaka ayo rakasiyana muchitokisi rusvingo, ivo zvakaoma kukanganiswa chezuva, ultraviolet nemwaranzi, doro, acetone, acids, alkalis, mishonga yokuuraya utachiona zhinji, dihydrate, uye kana yakabikwa nevanhu neutachiona sputum haana kufa sezvaiitwa 5 maminitsi. Kana Koch kwakaita bacillus aigona kuva mumuviri munhu, tiibhii dzaikuvadza vose vagere Nyika.

mapoka njodzi

chikoro zera asati, vana vakawanda vanonhonga tsotso Koch, asi neakangwara pulmonary tiibhii kana mumwe anovandudza chete simba vana, airwara. Panewo boka pangozi zvinosanganisira:

- vanhu vari zvachose mune pedyo kuonana TB nevarwere;

- Vanhu pasi kutapata;

- HIV-utachiona;

- kupinza immunosuppressants;

- kuyaruka uye repakati vanhu munguva hormone kuchinja;

- nenzara;

- achitambura tibhii ganda uye dzimwe nhengo;

- kunge Kutamiswa zvirwere;

- bolevshie zvepuraimari pulmonary tibhii uye kubatwa;

- pakukoka vamwe refu physiotherapeutic nzira (semuenzaniso, Goldstone).

kupatsanura

Pulmonary tiibhii angatanga neakangwara nenzira dzinotevera:

1. muropa (hematogenous). Muchiitiko chino, zvose mapapu vanokanganiswa. Kupinda muropa mabhakitiriya anogona kuva kuburikidza node nodes, Gon muhomwe, kuburikidza rworudyi mwoyo uye pulmonary tsinga.

2. node (lymphogenous). Panyaya iyi, iyo kwakakanganisa mumwe zvemapapu.

3. Limfogematogenny.

By yezvakaita chirwere kusiyanisa pulmonary tiibhii neakangwara zvinotevera siyana:

- chenjera (miliary);

- subacute;

- chisingaperi;

- generalized. About chimiro ichi chirwere richiti apo, nokuti chero kwezvikonzero, midziyo ropa kunoitika budiriro zviri njodzi node raiva pedyo nebundu Mycobacterium, sechivako yaiva cheesy (caseous). Panyaya iyi, panguva imwe chete riri guru yakawanda ropa iri tsotso Koch. Sezvineiwo, zvinoitika Kazhinji.

The chenjera chimiro tibhii

The chirwere kunotanga pakarepo, pakarepo, zviratidzo yakajeka zvikuru, zvishoma akafanana nemabayo. Chirwere kunobva Hardware kuti yemapapu uye microbiological kuongorora sputum. Chenjera neakangwara pulmonary tiibhii kunoratidzwa nokuvapo iri zvemapapu rinenge vazhinji duku (pamusoro millimeter) hillocks chakatodzana mapfunde zviyo. Nokudaro, chechipiri zita - "miliary (milae muchiLatin rinoreva" mapfunde ") tibhii." Murwere achinja yokutanga rirambe richibvira chivako umo collagen yaparadzwa, uye masvingo vari legkopronitsaemymi, zvinoita kuti kupinda rimwe mycobacteria neropa nokuyerera mumapapu. Zviratidzo izvi zvinosanganisira:

- rakapinza kusvetuka kupisa kusvika 39,5-40 ° C mavanga;

- utera, kurukutika, mukuru kuneta;

- nokukurumidza kufamba kweropa;

- kushaya havi;

- blueness nemiromo uye nemimwe;

- yellowness ganda;

- svoto kuti kurutsa;

- nomusoro;

- yakaoma chikosoro kana sputum kugadzirwa, izvo kuwedzera madzihwa uye pus vane ropa mitaro;

- kupfupika mweya.

Dzimwe nguva pane raidudzwa mangwanani kurwara, kusvikira iye ndafenda.

Subacute chimiro tibhii

It kunoitika apo hosha anopararira kusvika guru midziyo ropa (tsinga uye intralobular interlobular arteries). Muchiitiko chino, padzakacherechedza maronda kusvika 1 masendimita ari dhayamita. Ivo dziri kunyanya mapazi eumambo mumapapu, apo vazhinji capillaries uye node midziyo. By yezvakaita proliferative maronda, inflammations uye mapundu pasina, asi vanogona kuita kuti kuzvimba ari visceral pleura.

Zviratidzo subacute siyana TB anogona kufanana nezvimwe zvirwere zvakawanda kuti omesa kunotoda kuongorora chirwere. Pakati huru chipo ndeinotevera:

- kuneta, utera;

- tembiricha pachiyero 38 ° C;

- mumwe chikosoro pamwe sputum.

chisingaperi tiibhii

Ichi chimiro chirwere kunoitika apo murwere anoporeswa chose chikuru (itsva) tibhii. Muzviitiko zvakadaro, Mycobacterium akaramba vachishandisa muropa kana node kubva chikuru foci vanowira zvikamu mutsva zvemapapu, zvichiguma navo pane vakawanda foci kuti hukuru siyana (kubvira chaizvo duku zvikuru guru) akasiyana zvitarisiko uye mapatani. Vangave calcified uye yakachena chaizvo, inopenya anogumbura mufananidzo. Dzakaonekwa maronda ose mumapapu. Mwoyo mufananidzo akawedzera emphysema, fibrosis kuti munyama siyana mumapapu, pleural scarring. Kunyange zvakadaro, chisingaperi neakangwara pulmonary tiibhii anogona kunze hakuiti unooneka, maererano nayo kakawanda panguva fluoroscopy. Symptomatology pamusoro pemamiriro chimiro tibhii riri sezvinotevera:

- nekuneta;

- kurasikirwa havi;

- emaciation;

- kakawanda nomusoro;

- musoro kuwedzera tembiricha (episodically);

- chikosoro.

Neakangwara tiibhii: danho

Kare zvaifungwa kuti chirwere Pasika I kumbowanikwa okumusoro lobes pakati mumapapu, II - pakati, uye III, uye atova anouya tikarega. Naizvozvo kupatsanura ichi kuzivikanwa kururama, sezvo danho chirwere ichi kunogona zvakafanana kuitika muzvikamu dzose yemapapu. Pari kusiyana zvinotevera maitikiro ose pulmonary tiibhii:

- Alopecia;

- infiltration;

- akoromoke;

- Office + (rakazaruka muchimiro tibhii);

- MBT- (yakavharwa).

Neakangwara tiibhii kuyaruka infiltration MBT + kunoreva kosi chirwere pakabudiswa kupinda hwaiitwa mycobacteria. The huru chiratidzo - mumwe chikosoro pamwe sputum kugadzira, kunyanya kana rine pus uye ropa.

Alopecia danho kunyanya yo chikuru kana yakanaka tibhii. It kunoratidzwa yokuti sei chete nemudzimai kana kunyange chidimbu chimwe. In Kamuri iri diki kukura (kusvika 1 masendimita ari dhayamita). danho iri kunoitika pasina zviratidzo uye kuona, yemanyorero ane zvakaoma kudzidza chiedza (x-ray, fluoroscopy).

Neakangwara tiibhii: Pasika kuti infiltration uye manyowa

tsika yakadaro chirwere inotengwa nevanhu Detective kwayo rwaikurumidza kuuya (murwere haambotauri fanira wepagore kwokugara fluorography, kwete vanokwezvwa vanachiremba kana zviratidzo mwoyo rokutanga, vaiita kuzvidzora medicate kana anoshandisa chevarwere mishonga vanowanzova insufficiently vanobudirira sezvo chikuru kurapwa). disintegration danho zvinoreva kuti Morphology kuti maronda zvemapapu yakasvika pfungwa uko zvinyama akatanga dziparare, pova buri chaiyo. Zvimedu Zvaparara zvinyama pamwe chikosoro kuenda panze. Vari yaiteverwa pamwe madzihwa pus uye ropa. Uyewo, zvidimbu izvi inowira asati pachena kuti chirwere zvemapapu zvikamu, zvichiguma pakarepo seeding pamusoro mycobacteria. Varwere vane chirwere kubva neakangwara pulmonary tiibhii ari chehupenyu disintegration, mune chirwere vamwe ngozi, uye vari pasi zvairayirwa muchipatara. Kurapwa muchipatara vane refu, kusvikira mwedzi mitanhatu. Somugumisiro, Zvaparara maronda Poresai (calcined).

infiltration danho iri kuchengetwa kunofambira mberi nzira chirwere, asi muchiitiko chino chiedza hachisi pokuwa munyama kunoitika. Kazhinji infiltration - mugove (pakati), umo kuzvimba. nzvimbo kwakadaro zvinofamba zvakawanda leukocytes uye lymphocytes, uye zviratidzo nowenyika kusachengeteka kukuru nemabayo. Neakangwara pulmonary tiibhii ari chokutambudzika infiltration ane zvinotevera zviratidzo:

- rakapinza kuwedzera kupisa yakakwirira kwakadzikira;

- muutera, nekuneta;

- bhokisi marwadzo;

- chikosoro;

- zviratidzo toxicity;

- nomusoro;

- dzimwe nguva kwakaderera chavanoziva.

Pasina anokurumidza kurapwa anosarudza pa nzvimbo zvinyama infiltration vakatanga dziparare. Murwere kukosora kunze kana muitiro vangakosora inofamba ichienda chiedza wechipiri, iyo nokukurumidza kuti utachiona ekare tishu utano. Tiibhii mu maitikiro iri kuparara uye infiltration kwete chete hwakazara mukuru mukana wokutapukirwa vamwe, asiwo dzinouraya kuti murwere.

Diagnostics

Hazvisi nyore pakarepo kumisa murwere chete neakangwara tibhii. Chirwere zvakaoma nokuti zviratidzo chirwere ichi uye nemabayo, SARS, kunyange metastatic kenza akafanana chaizvo. Kana modaidza murwere kukiriniki pakunyunyuta nokuneta, chikosoro, kwazvo huro, utera, kupfupika mweya chiremba vanosungirwa aongorore ganda kuvapo scarring kuti ugare kubva yapfuura myocardial pute, lymphadenitis. Uyewo amutsvaka symmetry pechipfuva (hazvisi, kana TB anova mumwe zvemapapu), ndakaongorora marwadzo uye tsandanyama makakatanwa pamafudzi nebhanhire. Kana tichiteerera stethoscope inoratidza zvemapapu, kana wheezing iri, chii nzvimbo dzavo uye tsika. Zviri fanira kuita rabhoritari pakuongorora sputum kuvapo mycobacteria. Mune zvimwe zviitiko, varwere achitora mukudzidza Árbol Kusuka, kana dumbu mvura (Kazhinji vana). Uyezve, rabhoritari miedzo zvingasanganisira:

- bronchoscopy;

- sputum zodzera microscopy;

- biopsy of pleura;

- thoracoscopy;

- pleural ponji.

The kushandiswa dzakawanda uye kwakakwana fluoroscopic zvidzidzo.

Treatment uye fungidziro

Kana chiremba asina chirwere "neakangwara pulmonary tiibhii", mishonga irefu uye chinoumbwa nezvinhu zvakawanda. The fungidziro kunobva Pasika umo hosha iri kuona, uye sei tsime murwere anoita chiremba mushonga. Chero mhando pulmonary danho + ari MWT murwere muchipatara. Muchipatara kunyanya vakatakura zvinodhaka kurapa (mishonga) zvinosanganisira Anti-tiibhii madhiragi, panyama kurapa, mavhitaminzi, anowedzera kutapata.

Mishonga pavarwere richangobva chirwere ari ndichibvunza chokutambudzika kurapwa rinoitwa kutevera Anti-TB zvinodhaka, "Iziniazidom", "rifampicin", "pyrazinamide" uye "ethambutol", uye ari kuenderera chehupenyu kurapwa - "isoniazid" uye "Rifampicin" kana "isoniazid" uye "ethambutol ".

In chenjera neakangwara tiibhii inoratidza kushandisa corticosteroids uye immunomodulators. Inonyanyoshandiswa ushandiswe "prednisolone" (15-20 MG / zuva kwevhiki 6-8).

Duration kurapwa - anosvika 6 mwedzi. Kana mukati 3 months ndisina kuona Kuwanzoda kuvandudza, uyewo zvimwe zvairatidza angashandisa kuvhiyiwa kunosanganisira kubviswa rimwe zvemapapu chidimbu kana chiedza zvavo.

Ndiani anoshandisa achangobuda kurapa tibhii, inonzi "vharafu bronchoblocation", kana kungoti "bronchoblocation", iro rinogona kutsiva kuvhiyiwa.

dziviriro

Pulmonary tiibhii anoonekwa pasocial chirwere, kupararira riri zvikurukuru novimba mararamiro (Magariro, kutama, kushumira mutongo wake mujeri, uye zvichingodaro). Sezvo matanho, kunyanya nokuti neakangwara pulmonary tibhii, zvinogona kunzi:

- kwairayirwa Kufamba x-mwaranzi;

- kuita kudzora matanho;

- BCG kubaya;

- the yavaive wehurumende mari kurapa varwere tibhii;

- kuramba achishingaira (mitambo), mararamiro utano;

- kwemutemo varwere kwakakwana mishonga zvatichiri tibhii.