M'mapapo mwanga TB mwiniwakeyo: Zizindikiro ndi Chithandizo

zosasangalatsa kwambiri ndi wakupha matenda TB alipo pa zaka Earth, umboni ndi zofukulidwa ambiri ofukula zinthu zakale ndi mbiri yakale. Masiku ano chaka chilichonse zimatengera kagulu ka anthu amene akhudzidwa ndi anthu pafupifupi mamiliyoni 10, 25% amene kufa.

Mawonekedwe zosautsa za matenda - TB m'mapapo mwanga mwiniwakeyo, kutanthauza multifocal, "..anathira" pa onse mosavuta. Kunyamula matenda ndi zosavuta, monga njira ya HIV ake zodabwitsa kumva, ndiponso zizindikiro mu magawo oyambirira pafupifupi wosaoneka. Ndipotu angathe kutenga aliyense wa ife poyera kuti tsiku lililonse, koma mwamwayi, si thupi amatha kudwala TB. Ngati inu kuika matenda oopsa, musadandaule, chifukwa tsopano sayansi analowa mpaka kuchiza kwathunthu ngakhale mwiniwakeyo m'mapapo mwanga TB n'zotheka. Sizikusoweka kuti manyazi chiphasochi nthawi ndi Kutsatila ankasunga ndi kuchitiridwa katswiri TB. Iwo amanena kuti chidziwitso cha mphamvu komanso zofooka za mdani - ndizo 50% kupambana. Choncho tiyeni tiwone chimene icho chiri TB, kumene ikuchokera ndi mmene nkhondo izo.

tubercle Bacillus

Mwiniwakeyo TB ya m'mapapo chifukwa cha tizilombo tosaoneka ndi maso, wotchedwa mycobacteria. Alipo pa dziko lino lapansi kwa zaka mamiliyoni ambiri, koma okhawo anapeza mu 1882 ndi sing'anga ndi wasayansi Koch, amene ulemu ndi dzina lake iwo - ndi Koch Bacillus. Onse mycobacteria tizilombo (chidule monga MKB), pali 74 mitundu, 6 zimenezi zingachititse chifuwa anthu ndi nyama. Timitengo ankatchedwa chifukwa cha maonekedwe, kwenikweni ndodo-mphako. Ena mycobacteria ali mwangwiro limagwirizana, ena pang'ono yokhota kumapeto, ndipo iwo onse ndi kutalika micrometers kuchokera 1 mpaka 10, ndipo m'lifupi - za 0,5 microns.

Mbali yapadera iwo ndi kapangidwe ka makoma awo, kapena zimagwira ntchito zosiyanasiyana. Popanda kupita tsatanetsatane, tiona kuti ndi mu timitengo Koch zimawathandiza mutate wopandamalire kangapo, kudziteteza ku tizilombo wakupha kwa chitetezo ena ntchito ndi mokhazikika kupewa kotentha. Iwo ngakhale bacteriophages ntchito bwinobwino, ndilo raison d'être - kuteteza thupi ndi tizilombo parasitic. Popeza odzipereka, Bacillus Koch alibe kufa, ndi kukweza macrophages moti mosavuta kubereka, osati kupezeka kwa ndondomeko zotchinjiriza moyo wa mwiniwake. M'mawu ena, Bacillus Koch a ntchito chitetezo ma cha thupi lathu kugwiritsa bwino.

Kamodzi mu mapapo munthu wathanzi, majeremusi izi kupanga loyamba umodzi foci (chachikulu TB), koma magazi ndi / kapena lymph anagawira dera lalikulu la munthu kapena m'mapapo komanso kupuma ena Izi zinachititsa mwiniwakeyo m'mapapo mwanga TB. Mulimonse mmene anthu ena angathe ngakhale pambuyo ankachitira TB chachikulu, monga Bacillus Koch mu maonekedwe anafooka kukhalabe m'thupi kwa zaka zambiri.

Njira kachilombo

M'mapapo mwanga TB anthu chifukwa mitundu itatu ya mabakiteriya - M. TB (subspecies anthu), M. africanum (subspecies wapakatikati) ndi M. bovis (a subspecies wa nyama). Yotsirizira ndi ng'ombe zambiri odwala, ndipo munthu imafalikira ku mkaka unpasteurized.

Ambiri amachita chidwi, mwiniwakeyo m'mapapo mwanga TB Amapatsirana kapena ayi. Yankho lake ndi losavuta: ndi opatsirana kwambiri, ngati adali ndi kutulutsidwa kwa Koha timitengo (tubercle oyambitsa).

Iwo amabwera kuchokera munthu wodwala wathanzi koma modziwika losavuta:

- iwo akhoza Mpweya mpweya;

- ndi malovu (mwachitsanzo, ndi kutsokomola, kukupsopsonani);

- kudzera ziwiya ntchito ndi wodwalayo;

- kudzera katundu wa m'nyumba;

- kuchokera mayi - wosabadwa;

- pamene ntchito insufficiently chosawilitsidwa zida zamankhwala.

Monga mukuonera, ndipo mukhoza kupeza TB kulikonse: mu mabasi ndi magalimoto, mu malo onse, m'masukulu, kuntchito ndi zina zotero.

Zofunika: Koch Bacillus wosangalatsa olimbikira. Iwo kusunga katundu wawo oopsa kunja kwa thupi la munthu kwa nthawi yaitali. Nazi zitsanzo zingapo za mmene Koch Bacillus amakhala m'mabanja amene timakumana nawo tsiku ndi tsiku:

- m'malo a mdima popanda dzuwa - zaka 7;

- mu zouma sputum mtima (kumanzere pa nkhani onse) - mpaka 1 chaka;

- mu fumbi pa msewu - masiku 60;

- pa minyala Mabaibulo typographic - kwa miyezi 3;

- madzi - pafupifupi 150 masiku;

- mu mkaka unboiled - 14 masiku;

- mu tchizi (mafuta) - chaka.

Kodi n'zotheka zoipa kuyankha funso la mwiniwakeyo m'mapapo mwanga TB ndi opatsirana kapena ayi? Mwina Koch Bacillus analipo chilengedwe, zosavuta kuwononga? Mwatsoka, mycobacteria awa ndi kovuta kuti amuphe. Ndiyamika mpanda wake wapadera khungu, iwo nkomwe anakhudzidwa ndi dzuwa cheza ultraviolet, mowa, acetone, zidulo, alkalis, disinfectants ambiri, dihydrate, ndipo pamene yophika ndi nkhani sputum kachilombo sanafe mphindi monga mmene 5. Ngati Bacillus Koch sikungakhoze kukhala mu thupi la munthu aliyense, TB amasokoneza anthu onse a dziko lapansi.

anthu okhudzidwa

Asanafike zaka sukulu, ana ambiri kukatenga timitengo Koch, koma mwiniwakeyo TB m'mapapo mwanga kapena akufotokozera ofooka yekha, ana wodwaladwala. Pali gulu chiopsezo zikuphatikizapo:

- amakhala kalekale mogwirizana ndi odwala TB;

- Anthu ndi chitetezo chokwanira otsika;

- kachirombo ka HIV;

- kutenga immunosuppressants;

- achinyamata ndi anthu wazaka zapakati pa nthawi ya kusintha m'thupi;

- njala;

- akudwala chifuwa chachikulu cha khungu ndi ziwalo zina;

- kuti anasamutsa matenda opatsirana;

- bolevshie chachikulu m'mapapo mwanga TB ndipo amachiritsidwa;

- anakafika zina njira yaitali physiotherapeutic (mwachitsanzo, khwatsi).

Gawo

M'mapapo mwanga TB angathe mwiniwakeyo m'njira zotsatirazi:

1. m'magazi (hematogenous). Pankhaniyi, mapapo onse akhudzidwa. Lowani m'magazi mabakiteriya kungakhale kudzera mwanabele, Gon matumba, mwa mtima lamanja ndi mtsempha m'mapapo mwanga.

2. lymph (lymphogenous). Pankhaniyi, bwanji m'mapapo wina.

3. Limfogematogenny.

Ndi chikhalidwe cha matenda kusiyanitsa TB m'mapapo mwanga mwiniwakeyo mitundu zotsatirazi:

- pachimake (miliary);

- subacute;

- aakulu;

- zowombetsa mkota. Za mawonekedwe matenda kunena pamene, pa zifukwa zosiyanasiyana, ziwiya magazi kumachitika zili yojambula wa akhudzidwa Mycobacterium lymph mfundo, matabwa amene anali wowumitsa (caseous). Pankhaniyi, nthawi yomweyo ndi kuchuluka yaikulu magazi timitengo Koch. Mwamwayi, chimachitika infrequently.

The pachimake mawonekedwe a chifuwa chachikulu

Matendawa amayamba mwadzidzidzi, mosayembekezereka, zizindikiro chowala kwambiri, pang'ono ngati chibayo. Matendawa zachokera hardware ya m'mapapo ndi microbiological kusanthula sputum. Pachimake mwiniwakeyo m'mapapo mwanga TB amakhala ndi kukhalapo mu m'mapapo minofu ambiri hillocks yaing'ono (za millimeter a) chokhala mapira tirigu. Choncho, dzina chachiwiri - "miliary (milae ku Latin zikutanthauza" mapira ") TB." Wodwala anasintha woyamba dongosolo capillary imene kolajeni anawonongedwa, ndipo malinga ndi legkopronitsaemymi, imbaenda malowedwe a mycobacteria kwa magazi mu mapapo. Zizindikiro izi zikuphatikiza:

- kulumpha lakuthwa kutentha kwa 39,5-40 ° C zizindikiro;

- kufooka, kutopa, mkulu kutopa;

- zimachitika mofulumira;

- kusafuna kudya;

- blueness milomo ndi zala;

- yellowness wa khungu;

- nseru ndi kusanza;

- mutu;

- youma chifuwa kapena kupanga sputum, amene kuwonjezera mamina ndi mafinya ndi wamagazi milozo;

- kupuma movutikira.

Nthawi zina pali kutchulidwa m'mawa matenda, mpaka anakomoka.

Subacute mawonekedwe a chifuwa chachikulu

Kumachitika pamene matendawa akufalikira kwa ziwiya lalikulu magazi (mitsempha ndi intralobular mitsempha interlobular). Pankhaniyi, wapezeka zotupa ku 1 masentimita awiri. Iwo zili makamaka zigawo za mapapo, kumene ambiri capillaries ndi ziwiya lymph. Ndi chikhalidwe cha zotupa proliferative, inflammations ndi zotupa popanda, koma iwo kungayambitse kutupa mu pleura choipidwa.

Zizindikiro za mitundu subacute cha TB, amakhala ngati matenda ena ambiri kuti kusokoneza matenda matenda. Pakati pa pano waukulu ali motere:

- kutopa, kufooka;

- kutentha pa mlingo wa 38 ° C;

- chifuwa ndi sputum.

TB aakulu

Izi mawonekedwe a matenda kumachitika pamene wodwala kwathunthu anachiritsa chachikulu (atsopano) TB. Zikatero, Mycobacterium mobwerezabwereza kudzera m'magazi kapena lymph ku foci chachikulu kugwera mu zigawo atsopano a m'mapapo, chifukwa mwa iwo pali angapo foci zamitundu yosiyanasiyana (kuyambira wamng'ono kwambiri lalikulu) mosiyanasiyana osiyana ndi dongosolo. Iwo akhoza kukhala calcified ndi watsopano kwambiri, ndi yowala yotupa chithunzi. Wapezeka zotupa mu mapapo onse. Zokhumudwitsa chithunzi anawonjezera ndiko kumayambitsa fibrosis wa zimakhala zosiyanasiyana mu mapapo, pleural amamuyambitsa timabala. Komabe, aakulu mwiniwakeyo m'mapapo mwanga TB akhoza kunja alibe kuonekera, mogwirizana ndi imene nthawi zambiri anapeza fluoroscopy. Symptomatology wa mawonekedwe aakulu TB chiri motere:

- kutopa;

- kusowa chilakolako;

- emaciation;

- pafupipafupi mutu;

- wodzikweza kuwuka kwa kutentha (episodically);

- chifuwa.

Mwiniwakeyo TB: gawo

Poyamba ankaganiza kuti matenda gawo Ine amapezeka mu lobes magombe a m'mapapo, II - pakati, ndi III, ndi kale akubwera kuchepetsa. Kenako gulu ili anazindikira wolakwika, kuyambira gawo la matenda mwina mofanana zimachitika zigawo zonse phapo. Pakali pano, chimasiyanitsa mbali zotsatirazi TB m'mapapo mwanga:

- Alopecia;

- kusalola;

- kugwa;

- Office + (lotseguka mawonekedwe a chifuwa chachikulu);

- MBT- (anatseka).

Mwiniwakeyo TB mu gawo kusalola MBT + zikutanthauza Inde matenda ndi kutulutsidwa mu malo a mycobacteria. The chizindikiro chachikulu - chifuwa ndi kupanga sputum, makamaka ngati muli mafinya ndi magazi.

gawo Alopecia makamaka khalidwe la TB yaikulu kapena mwatsopano. Iwo amakhala ndi chakuti anakhudzidwa yekha angapo kapena ngakhale gawo limodzi. Mu ichi miyeso yaing'ono chipinda (kwa 1 masentimita awiri). gawo Izi zimachitika popanda zizindikiro ndi wapezeka, amangoona ndi zovuta kuphunzira kuwala (x-ray, fluoroscopy).

Mwiniwakeyo TB: gawo la kusalola ndi kuwonongeka

khalidwe lotero la nthendayo akamagwira kupeza mwadzidzidzi ake (wodwala amapewa kuvomerezedwa pachaka zochita fluorography, simukopeka madokotala pamene zizindikiro loyamba nkhawa, chinkhoswe kudziletsa medicate kapena amagwiritsa mankhwala wowerengeka zambiri insufficiently mogwira mtima mankhwala yaikulu). azingokhala gawo zikutanthauza kuti kafukufuku wakapangidwe kazachilengedwe a zotupa mu m'mapapo anafika pa zomwe minofu anayamba udzangotha, n'kupanga dzenje chenicheni. Makombo a minofu ndisungunuka ndi chifuwa kupita kunja. Iwo interspersed ndi ntchofu mafinya ndi magazi. Komanso, zidutswa awa agwere mu ayi koma timakumana ndi matenda a zigawo m'mapapo, chifukwa mu seeding atangochimwa mycobacteria. Odwala ndi matenda a mwiniwakeyo m'mapapo mwanga TB mu gawo la chiwonongeko, timapeza yoopsa matenda ena, ndipo imvera hospitalization mokakamizidwa. Chithandizo kuchipatala ali yaitali, mpaka miyezi isanu ndi umodzi. Chifukwa, ndisungunuka zotupa kuchiritsa (calcined).

kusalola gawo ndi anatinso mu njira pang'onopang'ono kwa matenda, koma mu nkhani iyi kuwala si kugwa zimakhala kumachitika. Nthawi zambiri kusalola - gawo (pakati), mmene muli kutupa. Chotero malo ikuyenda zambiri leukocytes ndi lymphocytes, ndi zizindikiro amatikumbutsa ndi chibayo pachimake. Mwiniwakeyo m'mapapo mwanga TB mu gawo la kusalola ali ndi zizindikiro zotsatirazi:

- nyamuka lakuthwa kutentha kwa okwera mkulu;

- kufooka, kutopa;

- chifuwa ululu;

- chifuwa;

- zizindikiro za kawopsedwe;

- mutu;

- zina chifooke kutsitsimuka.

Popanda mankhwala mwamsanga anayambitsa pa malo a minofu kusalola anayamba udzangotha. Wodwalayo akutsokomola iwo kapena m'kati kutsokomola chimachititsa kuti kuwala chachiwiri, amene mwamsanga kachilomboko minofu kale athanzi. TB mu magawo kugwa ndi kusalola osati zinadzala ndi chiopsezo cha matenda ena, komanso amapha wodwalayo.

diagnostics

Si kophweka kwa yomweyo kukhazikitsa mtima ndi mwiniwakeyo TB. Matenda ndi zovuta chifukwa zizindikiro za matenda ndi chibayo, SARS, ngakhale khansara metastatic ofanana kwambiri. Pamene mukundiitana wodwala ku chipatala kudandaula za kutopa, chifuwa, zilonda zapakhosi, kufooka, kufupika kwa mpweya dokotala ayenera kuyendera khungu pamaso pa amamuyambitsa timabala kuti zikhale ku abscess yapita m'mnyewa wamtima, lymphadenitis. Komanso anafufuza chosokonekera a chifuwa (izo siziri, ngati TB akufotokozera mu mapapo amodzi), kufufuzidwa ululu ndi minofu mavuto lamba phewa. Akamalankhula stethoscope ndipo zimenezi m'mapapo, kaya wheezing uli, chomwe malo awo ndi khalidwe. Ndi kuvomerezedwa kuchita zasayansi Kupenda sputum pamaso pa mycobacteria. Nthawi zina, odwala kutenga kuphunzira washings bronchial, kapena m'mimba mwa madzi (zambiri ana). Mayesero zasayansi ingakhale monga iyi:

- bronchoscopy;

- sputum kuipitsa mbiri wamamamayikirosikopu;

- biopsy wa pleura ya;

- thoracoscopy;

- pleural puncture.

Ambiri ntchito molondola ndi maphunziro fluoroscopic.

Kuchiza ndi madokotala ananena zawo

Ngati dokotala wanena anapezeka "mwiniwakeyo m'mapapo mwanga TB", mankhwala adzakhala yaitali ndi m'zigawozigawo. Kuti madokotala ananena zawo zimadalira gawo limene nthendayo wapezeka, ndi mmene wodwalayo amachita mankhwala dokotala. Mu mtundu uliwonse wa m'mapapo mwanga gawo + mu MWT wodwala kuchipatala. M'chipatala makamaka anagwira mankhwala mankhwala (Morning) wopangidwa mwa mankhwala a chifuwachi a mitundu mankhwala thupi, mavitamini, ikuthandizira chitetezo chokwanira.

Morning odwala kumene anapezeka mu gawo tima mankhwala ikuchitika zotsatirazi mankhwala odana ndi TB, "Iziniazidom", "rifampicin", "pyrazinamide wokhala" ndi "wa ethambutol," ndipo mu gawo kupitiriza mankhwala - "isoniazid wa" ndi "Rifampicin" kapena "isoniazid wa" ndi "wa ethambutol ".

Mu pachimake mwiniwakeyo TB limasonyeza ntchito corticosteroids ndi immunomodulators. Kwambiri kawirikawiri Kwalamulidwa "prednisolone" (15-20 mg / tsiku kwa masabata 6-8).

Nthawi chithandizo - mpaka miyezi 6. Ngati m'miyezi 3 sakuona khalidwe lomwe bwino, komanso nambala ya nkhani zina angagwiritse ntchito opaleshoni ikukhudza kuchotsa limodzi gawo m'mapapo kapena kuwala ambiri.

Amene amagwiritsa ntchito mankhwala atsopano a chifuwachi, amatchedwa "vavu bronchoblocation" kapena kungoti "bronchoblocation", chomwe ndi zina opaleshoni.

kupewa

M'mapapo mwanga TB imatengedwa matenda chikhalidwe, kufalikira kwa amene mwachuluka amadalira mkhalidwe wa moyo (osauka, kusamuka, m'ndende m'ndende, ndi zina zotero). Monga zodzitetezera, makamaka mwiniwakeyo m'mapapo mwanga TB, angatchedwe:

- lamulo ndime ya x-ray;

- wozengereza miyeso ulamuliro;

- BCG katemera;

- pa Kugawilidwa kwanthaka ndalama boma zochizira odwala TB;

- kukhala yogwira (masewera), moyo wathanzi;

- Ndime odwala wathunthu chithandizo cha focal TB.