Isifuba somoya ezinjeni

I-asthma ye-bronchial ezinjeni yisifo esingapheli sokuvuvukala kwepheshana lokuphefumula, okuthi, ngeshwa, sivame kakhulu ezinjeni minyaka yonke. Isifuba somoya ezinjeni sibonakala ngeziqephu zokuphefumula kanzima okuhambisana nokukhwehlela kanye/noma ukuklinywa ngenxa yokuncipha kwendlela yokuphefumula. Ngeshwa, ngokuvamile abanikazi abazinaki izimpawu zokuqala zesifo futhi baya emtholampilo nesilwane esivele sigula kakhulu. Nakuba lapho betholakala ezinyathelweni zakuqala futhi bechaza ukwelashwa okufanele, abanikazi abaningi bayakwazi ukuzuza ukulawula okuzinzile phezu kwesifo sesilwane esifuywayo futhi balondoloze izinga lokuphila elenelisayo lezinja ezingabangane, kanye nezinja zokusebenza nezinkonzo - amandla okusebenza.

Kulesi sihloko, sizohlaziya izimbangela, izimpawu, ukuxilongwa, ukwelashwa kanye ne-prognosis ezinjeni ezine-asthma ye-bronchial.

Izinkinga Zesifuba Somoya

Isifuba somoya ezinjeni yisifo esingalapheki esingezwani nomzimba. Ziningi izimbangela ezingase ziholele kulesi sifo, kodwa, ngeshwa, imbangela ethile akuvamile ukunqunywa.

Kunoma yikuphi, uma isilwane sakho esifuywayo kutholwe ukuthi sinesifuba somoya, udinga ukunaka lezi zici ezilandelayo zokugcina isilwane:

• amakhemikhali asendlini (abahlanza phansi, abaqabulayo bomoya, ama-aerosol ahlukahlukene, ama-deodorants);
• izimpushana zokuwasha, ezisetshenziselwa ukugeza izingubo zokulala inja elala kuzo, ama-ovaroli ayo (nezingubo zakho zokulala, uma inja ilele nawe);
• uthuli luyi-allergen enamandla;
• ukubhema ugwayi;
• izitshalo zendlu eziqhakazayo;
• ezinye izinto ezingcolisa umoya okungenzeka.

Kukholakala ukuthi ukungezwani komzimba nezinto ezithile kungenzeka ezimpapheni, enqwabeni yokhaphethi, uboya bezinye izinhlobo zezilwane, njll. Akuvamile ukuthi isifuba somoya sibe khona ngesikhathi sokulungiswa kwamafulethi.

Njengomphumela wesenzo se-allergen, ukuvuvukala okuphindaphindiwe kwe-airways kukhula. Ukuvuvukala okuvamile kuhambisana noshintsho ku-epithelium yezindonga ze-trachea ne-bronchi. Ukwanda kokukhiqizwa kwamafinyila. Umphumela uba ukuminyana komzila womoya, ukwanda kokungazweli kwamaphaphu, nokuncipha komoya okhishwa umoya, futhi inja iveza izimpawu zomtholampilo zesifuba somoya. Imbangela yokuhlaselwa yisifuba somoya ezinjeni ukwehluleka ukuphefumula okunamandla.

Kodwa kungani i-asthma ikhula ngokuphendula isenzo se-allergen kuphela kumaphesenti amancane ezinja, kuyilapho ezinye izilwane ezifuywayo, ezinye izinto zilingana, zingaqali ukugula? Ayikabi khona impendulo yalo mbuzo. Kunenkolelo yokuthi isici sofuzo sibalulekile. Iminyaka yobudala nobulili akuzona izici ezisongelayo. Kodwa-ke, izilwane ezincane zinamathuba amaningi okuthuthukisa izifo zokuphefumula, okubangela ukubonakaliswa kwesifo esivele sikhona se-bronchial obstructive. Izimpawu ngokuvamile zivela ezinjeni ezineminyaka ephakathi kanye nezikhulile.

Kumele kuqashelwe ukuthi izici eziyingozi zokuthuthukiswa kwalesi sifo zihlanganisa izifo eziphindaphindiwe zebhaktheriya, ukuhogela isikhathi eside kokucasuka, kanye nesisindo esiningi.

Izimpawu Zesifuba Somoya Ezinjeni

Uphawu oluyinhloko lwesifuba somoya ezinjeni ukukhwehlela ngezikhathi ezithile. Ukukhwehlela ngokuvamile komile, futhi ukuhlanza ngemva kokukhwehlela nakho kuyisici sesifuba somoya. Ezinye izimpawu ezinjeni zingabandakanya:

• ukukhathala;
• ukuhlaselwa yisifuba somoya;
• ukozela;
• ukuba khona kwe-wheezing;
• isifiso sokuhlanza;
• ukungabekezelelani emsebenzini womzimba;
• Ezinye izilwane ezifuywayo zingaquleka.

Ukubonakaliswa komtholampilo okungenhla kungenxa yokuphazamiseka kwe-patency yomoya ngenxa yezinto eziyinkimbinkimbi: ukwanda kokukhiqizwa kwamafinyila, i-mucosal edema kanye ne-spasm yemisipha ebushelelezi ye-bronchial. Futhi, imbangela yokukhwehlela ingase ibe nokucasuka kwama-receptors aphefumulayo ngenxa yokuvuvukala noma i-spasm. Ngaphezu kokubonakaliswa okuyinhloko kwe-asthma ngokwayo, lesi sifo, ngenxa yokuntuleka kwe-oksijini emzimbeni, singaholela enkingeni ngendlela yokungasebenzi kahle kwenhliziyo, okungabonakaliswa ukuphefumula, i-tachycardia, i-cyanosis yenhliziyo. ulwelwesi lwamafinyila kanye nokukhathala okukhulu kwezilwane ezifuywayo.

Isici esihlukile sesifuba somoya ezinjeni ukuthi kungase kube khona izimpawu zokuphumula. Futhi, kwezinye izilwane ezifuywayo, inkathi ethile yesifo iyaphawulwa.

Diagnostics

Isifuba somoya ezinjeni singasoleka ekuqaleni ngezimpawu zesici: ukukhwehlela isikhathi eside, kuyilapho inhlalakahle evamile yesilwane esifuywayo ngokuvamile kuhle, futhi akukho ukwanda kokushisa komzimba. Futhi, abanikazi bangase baqaphele ukukhathala kwenja, ukunciphisa umsebenzi womzimba, ukuphefumula, ukushaywa umoya, iziqephu zokuphelelwa amandla, ukuhlasela kwe-asthma. Ekuqaleni kwalesi sifo, umnikazi oqaphile angase anake ukunyakaziswa okuqondile kodonga lwesisu ekupheleni kokukhipha umoya nokuphefumula.

I-Palpation of the trachea ngokuvamile ibangela ukukhwehlela, okuhambisana nokuzwela okwenyuka kuqhoqhoqho.

Ukuze wenze ukuxilongwa okufanele futhi ukhiphe izifo ezihambisanayo (ngokwesibonelo, isifuba somoya singenzeka kanye ne-bronchitis ye-bacterial etiology!) Kuyadingeka ukwenza ukuxilongwa okuphelele, okuhlanganisa:

• i-auscultation;
• i-x-ray yesifuba;
• ukuhlolwa kwegazi (kulokhu, ukuhlolwa kwegazi jikelele okuyinkomba);
• i-echo kanye ne-electrocardiography;
• i-bronchoscopy.

Ukuxilongwa kwe-asthma kwenziwa kuphela ngemuva kokukhishwa kwezinye izimbangela zokukhwehlela - i-pneumonia, ukutheleleka kwe-parasitic, ama-neoplasms emgodini wesifuba, ukungena komzimba wangaphandle ohlelweni lokuphefumula, i-pathology yenhliziyo.

Okokuqala, ngesikhathi sokuqokwa, udokotela uzokwenza indlovukazi kuyisinyathelo esibalulekile ekuxilongeni okuhlukile kwesifo se-pulmonary kanye nokuhluleka kwenhliziyo okungapheli. Ngaphandle kwemisindo yesici, udokotela ngokuqinisekile uzobala izinga lokushaya kwenhliziyo - ngokuhluleka kwenhliziyo, ukwanda kwenhliziyo (i-tachycardia) kuyoba yisici, futhi nge-asthma, njengomthetho, ukushaya kwenhliziyo kuyoba okujwayelekile.

On ukuhlolwa kwegazi jikelele ngokuvamile ukwanda kwenani lama-eosinophil kutholwa - esiphethweni kuzobhalwa mayelana ne-eosinophilia ehlobene noma ephelele. Kodwa-ke, kufanele kuqashelwe ukuthi le nkomba ingase ibe esimweni sezinye izifo ezingahlotshaniswa nenqubo yokungezwani komzimba, isibonelo, ngokuhlasela kwe-helminthic. Ngakho-ke, kuzo zonke izimo zokuthola ukwanda kwama-eosinophils egazini lesilwane esifuywayo, udokotela nakanjani uzonikeza ukwelashwa kwe-antiparasite. Kodwa inani elivamile lama-eosinophil egazini alibandakanyi ukuba khona kwesifuba somoya!

Ukuhlolwa kwe-X-ray yomgodi wethoracic ithuluzi eliyinhloko ekuxilongweni. Ama-X-rays kufanele enziwe ngezilinganiso ezintathu ukuze akhiphe izinto zobuciko kanye nama-pathologies afihliwe - isilwane sithwetshulwa ohlangothini olungakwesokunxele, ngakwesokudla futhi kuhloswe ngokuqondile. Kuma-x-reyi ezinja ezinesifuba somoya, udokotela angase aphawule ukwanda kwamaphaphu obala, ukwanda kwephethini yamaphaphu ngenxa yezinguquko ezivuvukalayo ku-bronchi, kanye nokugudluka nokugudluka kwe-caudal kwe-diaphragm ngenxa yokwanda kwamaphaphu ngenxa yokuvinjelwa.

Futhi, kwezinye izimo, ikakhulukazi ukukhipha inqubo yesimila, ngaphezu kwama-x-ray, kungase kudingeke ukuba kwenziwe. CT – i-computed tomography – okuyindinganiso yegolide yokungabandakanyi ukuba khona kwama-neoplasms.

Ukuze ukhiphe isifo senhliziyo, okungaba kokubili okuyimbangela eyinhloko yokukhwehlela (ukuhluleka kwenhliziyo okungapheli) kanye nenkinga ebangelwa ukwehluleka ukuphefumula isikhathi eside (lokho okubizwa ngokuthi i-cor pulmonale), kuyalulekwa ukuba kwenziwe. electrocardiography (ECG) kanye i-echocardiography (i-ultrasound yenhliziyo).

Esinye sezigaba ezibaluleke kakhulu zokuxilonga, okuyinto, ngeshwa, evame ukunganakwa ngabanikazi ngenxa yesidingo sokunikeza i-anesthesia yesilwane, i-bronchoscopy nge-bronchoalveolar lavage ukuze uthole ama-swabs kuqhoqhoqho kanye ne-bronchi. Ama-swabs atholakele ayadingeka ekuhlolweni kwe-cytological kanye ne-microflora inoculation ngokunqunywa kokuzwela kwe-antibacterial. I-Cytology yenziwa ukuze ikhiphe inqubo yokungezwani komzimba (ngesifuba somoya, inani elikhulayo lama-eosinophil lizotholakala) ezifweni zebhaktheriya nesikhunta (kuzotholwa inani elikhulayo lama-neutrophils). Ngeshwa, kufanele kukhunjulwe ukuthi inani elikhulu lama-eosinophil kanye/noma ama-neutrophils nawo angatholakala lapho kukhona inqubo yesimila. Kuyafiseleka futhi ukwenza inani lenani lamaseli ebhaktheriya ukuhlukanisa ukungcoliswa kwe-microflora evamile ekuthelelekeni kwangempela komgudu wokuphefumula, kanye nokwenza ukuxilongwa kwe-PCR ngokuba khona kwe-Mycoplasma (Mycoplasma) ne-Bordetella (Bordetella bronchiseptica).

Ukwelapha Isifuba Somoya Ezinjeni

Ukwelapha isifuba somoya ezinjeni kudinga indlela ephelele. Ngaphezu kokuqokwa kwezidakamizwa ezithile, udinga ukulawula ukuhlanzeka kwemvelo, isisindo sesilwane esifuywayo, kanye nokuba khona kwemiphumela emibi evela ekwelapheni okunqunyiwe.

Ngokuvamile asikho isidingo sokwelashwa kweziguli, ngaphandle kwalapho ukwelashwa komoyampilo, imishanguzo ye-intravenous, nezinye izinqubo kudingeka abanikazi abangakwazi ukuzenzela ekhaya.

Uma kunezimpawu zokuthikamezeka komzila womoya ophansi ngenxa yokuzivocavoca, kufanele kukhawulelwe. Kodwa-ke, ukuvivinya umzimba okulinganiselwe kungase kube usizo uma kudingekile ukwenza lula ukudlula kwe-bronchial secretions nokunciphisa isisindo somzimba ezilwaneni ezifuywayo ezikhuluphele. Umthetho oyinhloko ukuthi umthwalo kufanele ulinganiselwe kuze kube yilapho umzamo womzimba ungabangeli ukukhwehlela.

Izilwane ezifuywayo ezikhuluphele zinconywa ukudla okukhethekile okunekhalori ephansi, ngoba kuye kwafakazelwa ukuthi isisindo esiningi sithinta kabi inkambo yesifo. Kubalulekile ukuthi abanikazi baqonde ukuthi ukulahlekelwa isisindo kuyisici esibalulekile sokwelashwa, okwenza buthaka ukubonakaliswa kwesifo, okungahlali kuphulukisiwe ngokuphelele.

Isisekelo sokwelashwa isikhathi eside izidakamizwa ze-hormonal (glucocorticoids). Umthamo wokuqala womuthi unganqunywa udokotela kuphela. Njengoba ukuqina kwezimpawu kuncipha, umthamo kanye nenani lemithamo liyehla kancane kancane phakathi nezinyanga ezi-2-4. Ezimweni eziningi, umthamo omncane wesondlo osebenzayo unqunyelwe ukusetshenziswa okuqhubekayo, noma kunjalo, ukukhethwa komthamo kwenziwa ngokuqondene nomuntu ngamunye. Ngeshwa, kufanele kukhunjulwe ukuthi ukusetshenziswa isikhathi eside kwezidakamizwa ze-hormonal kungaholela ekuthuthukisweni kwenani lezinkinga. Izilwane ezicatshangelwe kusengaphambili zingase zibe nesifo sikashukela, ukuhluleka kwenhliziyo ukucinana, ukutheleleka komchamo, iatrogenic hyperadenocorticism (Cushing’s syndrome). Kulokhu, iziguli ezithola ukwelashwa kwe-hormone kufanele zihlolwe njalo udokotela futhi zithathe ukuhlolwa kwegazi (okujwayelekile kanye ne-biochemistry) ukuqapha ukuthuthukiswa kwezinkinga.

Ama-antibiotic asetshenziswa ekuhlukaniseni i-microflora ekuphumeni komgudu wokuphefumula. Inkambo yokwelashwa yizinsuku ezingu-10-14 ngokuhambisana nemiphumela yesiko lesikhwehlela esitholwe ngenxa ye-bronchoscopy, ukucacisa ukuzwela kwe-microflora. Uma i-antimicrobial susceptibility isiko lingenakwenzeka, ama-antibiotic abanzi ane-bioavailability ephezulu kanye nobuthi obuncane (isb., i-synulox) iyakhethwa.

Kanye nokwelashwa kwe-hormonal kanye ne-antibacterial, udokotela angase anikeze ama-bronchodilators - okungukuthi, izidakamizwa ezisiza ukwandisa i-airways, ukuthuthukisa ukuhamba kwe-diaphragm, nokunciphisa ingcindezi emgudwini we-pulmonary. Njengomthetho, lezi zidakamizwa zinqunywe ngendlela ye-inhalations.

Kwezinye izimo, lapho kukhona ukukhwehlela okude, okomile, okuphazamisayo, izidakamizwa ze-antitussive zinqunywe.

isibikezelo

Ukubikezelwa kwe-asthma eqinisekisiwe enjeni kuncike ekuqineni kwesifo, ubunzima bezimpawu, ukubekezelelwa kokwelashwa, ukusabela ezidakamizweni, nokuba khona kwezifo ezihambisanayo.

Kubalulekile ukuba umnikazi aqonde ukuthi isifuba somoya esibangelwa yi-bronchial ngokuvamile siqhubeka ngokuhamba kwesikhathi futhi ukuphulukiswa okuphelele akuvamile ukwenzeka (kuphela uma imbangela yalesi sifo ingabonakala futhi iqedwe). Kungenzeka ukunciphisa imvamisa yokuhlaselwa, kodwa azikwazi ukuqedwa ngokuphelele.

Izinja kufanele zihlolwe njalo ezinyangeni ezi-3-6 ukuze kutholwe izimpawu zokuwohloka ngesikhathi. Ngokushesha nje lapho kuvela izimpawu zokuphefumula noma ezinye izimpawu zokuphefumula kokuphefumula, umnikazi kufanele axhumane nodokotela wezilwane.

I-athikili ayikona ukubizela esenzweni!

Ukuze uthole ukucwaninga okuningiliziwe kwenkinga, sincoma ukuthi uxhumane nochwepheshe.

Buza udokotela wezilwane

16 September 2020

Kubuyekezwe: February 13, 2021