Isifo sofuba yamaphaphu eqonda: Izimpawu kanye Ukwelashwa

kubuhlungu ngempela futhi ebulalayo isifo sofuba ukhona Emhlabeni zeminyaka, njengoba kufakazelwa imivubukulo eminingi ngemivubukulo kanye izincwadi zomlando. Kuleli zwe lanamuhla minyaka kuthatha kwababusi izisulu abantu abangaba izigidi ezingu-10, engu-25% babo bafe.

Ifomu ezingemnandi neze lesi sifo - isifo sofuba yamaphaphu eqonda, okusho multifocal, "" phezu kwayo yonke lula. Sithathe ukutheleleka kulula kakhulu, njengoba indlela yokudlulisela yayo kokuvamile elula, futhi izimpawu kusaqalwa cishe ezingabonakali. Eqinisweni, ingozi yokuthola igciwane ngamunye wethu echayeke nsuku zonke, kodwa okuhle, hhayi wonke umzimba okwazi ukuthuthukisa sofuba. Uma namanje wafaka le uphethwe esabekayo, ungalilahli ithemba, ngoba manje isayensi uye wangenela waze ukwelapha ngokuphelele ngisho eqonda isifo sofuba yamaphaphu kungenzeka. It akadingi ukuba anqikaze ukuhlolwa isimiso ukusigcina aqikelele ukuthi yi-ekwelapheni TB onguchwepheshe. Bathi ulwazi kahle izimfanelo ezinhle nobuthakathaka babantu isitha - yilokho 50% ukunqoba. Ngakho ake sibone ukuthi yini ngayo isifo sofuba, uvelaphi futhi kanjani ukulwa naso.

tubercle imbewu eletha

sofuba eqonda kwamaphaphu kubangelwa eziphilayo ezincane, okuthiwa mycobacteria. Bona ezikhona kule planethi izigidi zeminyaka, kodwa kuphela esaqala ngo 1882 udokotela kanye nososayensi Koch obubusa udumo wasebiza ibizo labo ngakho - the Koch imbewu eletha. Zonke mycobacteria pathogenic (esifushanisiwe njengoba MKB), kukhona 74 zilwane, 6 okungabangela isifo sofuba kubantu nasezilwaneni. Chopsticks nabizelwa ngenxa ukubukeka, induku okwenyanga ngempela. Ezinye mycobacteria ahambelana kahle, abanye athe lwalugobile, futhi bobabili babe ubude kusuka 1 kuya 10 micrometer, ububanzi - mayelana 0.5 microns.

Isici eyingqayizivele wabo isakhiwo ngaphakathi kwezindonga zabo, noma ulwelwesi. Ngaphandle kokuya imininingwane, siphawula ukuthi kuba izinti Koch ebavumela ukuba ishintshe inombolo okungenamkhawulo izikhathi, ukuze bazivikele izimuncagazi ebulalayo yezinye amasosha omzimba asebenze steadfastly simelane ezingezinhle. Baze bacteriophages esetshenziswa ngempumelelo, okuyinto raison d'être - ukuvikela umzimba ekulweni nezilwanyana ezincane yisinanakazana. Matasa, imbewu eletha Koch sika awufi futhi ushintshe macrophage ukuze kalula ukukhiqiza kabusha futhi ngaleyo ndlela kungatholakali zokuvikela womnikazi wayo. Ngamanye amazwi, imbewu eletha Koch sika usebenzisa ukuzivikela yeselula ilungu elithile lomzimba wethu ukuze lelisu kahle ke.

Uma emaphashini lomuntu enempilo, lezi izimuncagazi akha foci olulodwa yokuqala (sofuba okuyinhloko), kodwa ngemva yegazi kanye / noma i-lymph basakaza phezu indawo enkulu esisodwa noma zombili amaphaphu kanye nezinye zokuphefumula beba eqonda isifo sofuba yamaphaphu. Ngaphansi kwezimo ezithile kungase ukuthuthukisa ngisho nangemva kokuba ziphathwe sofuba eyinhloko, njengoba imbewu eletha Koch sika ngendlela ngasebenzi ahlale emzimbeni iminyaka eminingi.

Izindlela ukutheleleka

isifo sofuba yamaphaphu kubantu kubangele ezintathu zama-bacterium - M. sofuba (zenyathi womuntu), M. africanum (zenyathi Lesisemkhatsini) kanye M. bovis (a zenyathi isilwane). Lesi sakamuva izinkomo bagula, futhi umuntu ke sisuka ubisi unpasteurized.

Abaningi banesithakazelo, eqonda isifo sofuba yamaphaphu iyathelelwana yini noma cha. Impendulo ilula: ke iyathelelwana kakhulu, uma ibanjwe ukukhululwa Koha izinti (tubercle bacilli).

Bavela umuntu ogulayo ukuba enempilo kodwa ngokuphawulekayo elula:

- bangathumela imuncwe kusukela emoyeni;

- ngamathe (isib ukukhwehlela, kiss);

- ngokusebenzisa izinto esetshenziswa esigulini;

- ngokusebenzisa izinto zasekhaya;

- elivela kumama - umbungu;

- uma usebenzisa insufficiently inzalo amathuluzi yezokwelapha.

Njengoba ubona, ungathola TB noma yikuphi: izithuthi zomphakathi, ezindaweni zomphakathi, ezikoleni, emsebenzini kanye nokunye.

Okubalulekile: Koch imbewu eletha kumnandi bayaphikelela. Bona ukugcina izakhiwo zabo eziyingozi ngaphandle komzimba womuntu isikhathi eside. Nazi izibonelo ezimbalwa ezibonisa indlela imbewu eletha Koch bahlala ezindaweni esibhekana nazo nsuku zonke:

- endaweni emnyama ngaphandle elangeni - kuze iminyaka 7;

- in the omisiwe isikhwehlela nesineke (oshiywe tonkhe tifundvo) - enyakeni 1;

- othulini emgwaqeni - kufikela kuzinsuku ezingu-60;

- ezicucwini yezinhlobo typographic - izinyanga 3;

- amanzi - mayelana 150 izinsuku;

- ngobisi unboiled - mayelana 14 izinsuku;

- in the ushizi (uwoyela) - ukuze ngonyaka.

Kungenzeka yini ukuphendula omubi umbuzo eqonda isifo sofuba yamaphaphu is esithathelwanayo noma cha? Mhlawumbe Koch imbewu eletha asendaweni, kulula ukuchitha Ngeshwa, lezi mycobacteria kunzima ngempela ukubulala. Siyabonga kuseli odongeni layo eliyingqayizivele, basuke neze ehlaselwe kwelanga, emisebeni yelanga, utshwala, acetone, acid, alkalis, izibulali-magciwane eziningi, dihydrate, nalapho abilisiwe nezikhonzi isikhwehlela itheleleke akafelanga kakhulu ngendlela 5 imizuzu. Uma imbewu eletha Koch sika kungaqala emzimbeni noma yimuphi umuntu, isifo sofuba zazibalimaza bonke abakhileyo kuyo yonke iplanethi ewuMhlaba.

amaqembu ingozi

Ngaphambi abasesikoleni, izingane eziningi sithathe izinduku Koch, kodwa eqonda isifo sofuba yamaphaphu noma yimuphi omunye eba ababuthakathaka kuphela, izingane ogulayo. Kukhona iqembu ingozi kuhlanganisa:

- lwabantu unaphakade sisondelene TB;

- Abantu abane ukungatheleleki ongaphakeme;

- abanegciwane;

- Ukuthatha immunosuppressants;

- intsha nabantu oseqinile nje inkathi ukushintsha kwama-hormone;

- silambile;

- abaphethwe isifo sofuba kwesikhumba kanye nezinye izitho;

- ziye zanikeza izifo ezithathelwanayo;

- bolevshie eyinhloko isifo sofuba yamaphaphu futhi iphathwa;

- kuyoshaya ezinye izinqubo physiotherapeutic eside (isib asebenza ngebhethri).

ngezigaba

isifo sofuba yamaphaphu ungakwazi ukuba bathuthukise eqonda ngezindlela ezilandelayo:

1. egazini (hematogenous). Kulokhu, kokubili emaphashini ayaphazamiseka. Faka egazini amabhaktheriya kungaba ngokusebenzisa-lymph, Gon emaphaketheni, ngokusebenzisa senhliziyo futhi vein yamaphaphu.

2. lymph (lymphogenous). Kulokhu, zithinteka eyodwa wamaphaphu.

3. Limfogematogenny.

Ngu ubunjalo isifo ukuhlukanisa isifo sofuba yamaphaphu eqonda amafomu alandelayo:

- acute (miliary);

- subacute;

- ezingamahlalakhona;

- generalized. Mayelana lolu hlobo sifo ethi lapho, ngoba noma ngabe yisiphi isizathu, imithambo yegazi kwenzeka okuqukethwe ukufohla we ethintekile lymph node Mycobacterium, isakhiwo owawungumnyaka nokunjengoshizi (caseous). Kulokhu, ngesikhathi esifanayo kuyinto omningi igazi izinti Koch. Ngenhlanhla, kwenzeka njalo.

Ifomu acute isifo sofuba

Lesi sifo iqala ngokuzumayo, kungazelelwe, izimpawu elikhanyayo kakhulu, kancane like nenyumoniya. Sifo kusekelwe ihadiwe ye wamaphaphu microbiological ukuhlaziya isikhwehlela. Acute eqonda isifo sofuba yamaphaphu libhekene khona kule izicubu wamaphaphu kwabaningi ezincane (mayelana milimitha) hillocks efana unyaluthi okusanhlamvu. Ngakho, igama lesibili - "miliary (milae ngesiLatini kusho" amabele ") sofuba." Isiguli washintsha capillary isakhiwo sokuqala lapho collagen uyabhujiswa, futhi izindonga legkopronitsaemymi, okuholela kwema- mycobacteria kusukela ukugeleza kwegazi emaphashini. Izimpawu zalokhu zihlanganisa:

- gxuma elibukhali lokushisa ukuze 39,5-40 ° C izimpawu;

- ubuthakathaka, ukukhathala, ukukhathala okusezingeni eliphezulu;

- ishayela okusheshayo;

- yokuntuleka esesuthi;

- blueness sezindebe neminwe;

- yellowness kwesikhumba;

- ukucanuzelelwa inhliziyo ukuba ukuhlanza;

- ikhanda;

- isifuba esomile noma ukukhiqizwa isikhwehlela, okuyinto ngaphezu isikhwehlela futhi ubomvu kukhona streaks igazi;

- iphika.

Ngezinye izikhathi kukhona evelele ekuseni ukugula, aze ngaquleka.

ifomu Subacute isifo sofuba

Kwenzeka lapho isifo ezitsheni ezinkulu igazi (emithanjeni intralobular imithambo interlobular). Kulokhu, itholiwe izilonda engafinyelela kwengu-1 cm ububanzi. Basuke etholakala ikakhulukazi izingxenye emaphashini, lapho abaningi capillary kanye lymph. Ngu ubunjalo izilonda proliferative, inflammations kanye izimila ngaphandle, kodwa kungabangela nezilonda kule pleura visceral.

Izimpawu subacute izinhlobo ze-TB zingase zifane nezinye izifo eziningi izinkinga uphethwe emtholampilo. Phakathi okwamanje esemqoka imi kanje:

- ukukhathala, ngenxa yobuthakathaka;

- lokushisa ezingeni 38 ° C;

- ukukhwehlela ne isikhwehlela.

sofuba esingelapheki

Le ndlela lesi sifo kwenzeka uma isiguli esesindile ngokuphelele oyinhloko (fresh) sofuba. Ezimweni ezinjalo, Mycobacterium ngokuphindaphindiwe nge yegazi noma lymph kusukela foci eyinhloko awela izingxenye ezintsha yamaphaphu, okuholela kwabo kukhona foci amaningi ezinobukhulu obuhlukahlukene (kusukela komncane kakhulu mikhulu) tabobunjwa futhi amaphethini. Kungenzeka calcified futhi fresh kakhulu, nge elikhanyayo isithombe ukuvuvukala. izilonda Kutholwe kuzo zombili emaphashini. isithombe esidumazayo ungeze emphysema, cystic kwezicubu ahlukahlukene emaphashini, nezibazi pleural. Noma kunjalo, ezingamahlalakhona eqonda isifo sofuba yamaphaphu ithi ayifuni ukuzibonakalisa, ngokuqondene ngalo uvame kutholakele phakathi fluoroscopy. Symptomatology yefomu ezingamahlalakhona sofuba simiswe ngalendlela lelandzelako:

- ukukhathala;

- ukungakuthandi ukudla;

- emaciation;

- ikhanda njalo;

- kuyanda engafanele lokushisa (episodically);

- ukukhwehlela.

sofuba eqonda: isigaba

Ngaphambili kwakucatshangwa ukuthi esigabeni ukutheleleka mina kwenzeka iyizingxenye engenhla kwamaphaphu, II - phakathi, no-III, futhi kakade iza ukwehlisa. Ngemva kwalokho lo ngezigaba neyaziwayo ayilungile, kusukela esigabeni lesi sifo kungenzeka ngokulinganayo kuzo zonke izingxenye yamaphaphu. Kuze kube manje, ehlukanisa izigaba ezilandelayo isifo sofuba yamaphaphu:

- Alopecia;

- kokuziphatha;

- wokugoqa;

- Ihhovisi + (ifomu evulekile isifo sofuba);

- MBT- (ivaliwe).

sofuba eqonda isigaba kokuziphatha MBT + kusho Yiqiniso isifo nge ikhiphela imvelo mycobacteria. The main uphawu - ukukhwehlela lokukhiqiza isikhwehlela, ikakhulukazi uma iqukethe ubomvu negazi.

Alopecia isigaba ikakhulu kwavama sofuba eyinhloko noma fresh. It libhekene yokuthi nomthelela ambalwa noma ngisho ingxenye eyodwa. Kulesi Ubukhulu encane ekamelweni (kufika ku 1 cm ububanzi). Lesi sigaba kwenzeka ngaphandle izimpawu kanye itholiwe, ngokuvamile isifundo kanzima ukukhanya (x-ray, fluoroscopy).

sofuba eqonda: isigaba kokuziphatha kanye noqhekeko

uhlamvu lesi sifo okunjalo kutholakala uzingela kwesikhathi yayo (nesineke ugwema saziso yonyaka abacula fluorography, awathandi odokotela lapho izimpawu zokuqala yokukhathazeka, wahlanganyela self-medicate noma isebenzisa amakhambi abantu ngokuvamile insufficiently ngempumelelo njengoba yokwelapha eyinhloko). nokwahlukana isigaba kusho ukuthi morphology we izilonda ephashini izikhathi eziningana zafinyelela eqophelweni lapho izicubu waqala iba yingxenye yomhlabathi, ukwakha umgodi ngempela. Fragments kwezicubu isihlakazeka ne ukukhwehlela ukuphumela phandle. Basuke okufakwe izimbici ubomvu negazi. Futhi, lezi izingcezu awela okwamanje obala isifo samaphaphu izingxenye, okuholela zokutshala ngokushesha mycobacteria. Iziguli kwathiwa unesifo eqonda isifo sofuba yamaphaphu ngo lwesigaba lokubola, iwumthombo esiyingozi ukutheleleka kwabanye, futhi kuncike esibhedlela ayimpoqo. Ukwelashwa esibhedlela banalo isikhathi eside, kuze kufinyelele ezinyangeni eziyisithupha. Ngenxa yalokho, isihlakazeka izilonda ukuphulukisa (calcined).

kokuziphatha isigaba yaphawula ngokuhamba phambili lesi sifo, kodwa kulokhu ukukhanya akukho ngokuwa kwezicubu kwenzeka. Ngokuvamile kokuziphatha - ingxenye (phakathi nendawo), lapho kukhona ukuvuvukala. endaweni enjalo ihamba eziningi leukocyte nama-lymphocyte, futhi izimpawu asikhumbuza pneumonia oyingozi. Eqonda isifo sofuba yamaphaphu esigabeni ka kokuziphatha has zimpawu ezilandelayo:

- ukwanda elibukhali lokushisa ukuze eziphakeme;

- ubuthakathaka, ukukhathala;

- ubuhlungu besifuba;

- ukukhwehlela;

- izimpawu ubuthi;

- ikhanda;

- ngezinye izikhathi buthakathaka ukwazi.

Ngaphandle kokwelashwa okusheshayo okuqalwe endaweni izicubu kokuziphatha waqala iba yingxenye yomhlabathi. Isiguli ekhwehlela wabakhipha noma inqubo ukhwehlela liya ukukhanya yesibili, okuyinto ngokushesha okukhulu ungenwe wangaphambili inyama ephilile. Isifo sofuba e izigaba wokugoqa futhi kokuziphatha hhayi kuphela kubabangele isengozini enkulu yokutheleleka ngegciwane kwabanye, kodwa futhi ebulalayo isiguli.

ukuhlola

Akukhona njalo kulula ukuba ngokushesha ukusungula isiguli sofuba eqonda. Sifo kunzima ngoba izimpawu zalesi sifo kanye nenyumoniya, SARS, ngisho nomdlavuza metastatic zifana kakhulu. Uma ushayele isiguli emtholampilo ukukhononda ukukhathala, ukukhwehlela, umphimbo obuhlungu, ubuthakathaka, iphika udokotela ubophekile ukuba ahlole isikhumba ngoba khona nezibazi ukuthi angahlala kusukela ithumba odlule esivimba amanzi, lymphadenitis. Futhi bahlola wesimethri kwesifuba (akusiwona, uma TB eba kwelinye wamaphaphu), ihlolwe ubuhlungu futhi imisipha ukungezwani e kwebhande ehlombe. Lapho belalele IselulekoSesihenqo lembula wamaphaphu, kungakhathaliseki kwesifuba, ukuthi iyini indawo yabo futhi uhlamvu. Kuphoqelekile ukwenza laboratory Ukuhlola isikhwehlela ngokuba khona mycobacteria. Kwezinye izimo, iziguli ukuthatha ekutadisheni nokugeza bronchial, noma isisu yamanzi (ngokuvamile izingane). Ngaphezu kwalokho, ezikhungweni zocwaningo kungabandakanya:

- bronchoscopy;

- isikhwehlela smear microscopy;

- biopsy we pleura;

- thoracoscopy;

- wokubhoboza pleural.

I kabanzi kunazo futhi olunembile izifundo fluoroscopic.

Ukwelashwa futhi Izibikezelo

Uma udokotela uye kwatholakala ukuthi unesifo "eqonda isifo sofuba yamaphaphu", ukuphathwa kuyoba eside futhi enezici. Onalesi sifo kuncike esigabeni lapho lesi sifo lutholwa, kanti isiguli wenza udokotela kahle kanjani. Kunoma yikuphi uhlobo yamaphaphu isigaba + e MWT isiguli esibhedlela. Esibhedlela ikakhulu eyenziwa yokwelapha izidakamizwa (nokwelashwa ngamakhemikhali) eyakhiwa anti-sofuba izidakamizwa, ukubhucunga nokunyakazisa umzimba, amavithamini, gcizelela amasosha omzimba.

Ukwelashwa ngamakhemikhali nokushiswa ezigulini esanda kutholakala esigabeni kakhulu ukwelashwa wenziwa elandelayo elwa ne-TB, "Iziniazidom", "rifampicin", "pyrazinamide" futhi "ethambutol", futhi esigabeni ukuqhubeka yokwelashwa - "isoniazid" futhi "rifampicin" noma "i-isoniazid" futhi "ethambutol ".

Ngo-acute sofuba eqonda ikhombisa ukusetshenziswa corticosteroids futhi immunomodulators. The njalo ebekiwe kakhulu "prednisolone" (15-20 mg / ngosuku amasonto 6-8).

Ubude besikhathi sokwelashwa - izinyanga 6. Uma ezinyangeni ezingu-3 angaboni nokuyinto ngcono, kanye eziningi nezinye izinkomba zingasebenzisa ukuhlinzwa kuhilela ukususwa olulodwa wamaphaphu ingxenye noma ukukhanya ngokuvamile.

Obani abasebenzisa imithi yakamuva sofuba, ngokuthi "umphini bronchoblocation", noma nje "bronchoblocation", okuyinto esikhundleni ukuhlinzwa.

zokuvimbela

isifo sofuba yamaphaphu kubhekwa isifo kwezenhlalo, ukusabalala okuyinto incike izinga lempilo (izimo zokuphila, ukufuduka, ukudonsa isigwebo sakhe ejele, nokunye). Njengoba izinyathelo zokuvimbela, ikakhulukazi eqonda isifo sofuba yamaphaphu, angabizwa ngokuthi:

- ndima oyisibopho-x-reyi,

- enifeza zokulawula;

- BCG lokugoma;

- ukwabiwa kwezimali isimo for the nokwelashwa kweziguli sofuba;

- silondoloze esebenzayo (ezemidlalo), enempilo;

- ukudlula ukwelapha ephelele sofuba eqondile.