Pyelonephritis umuntu ngemithi elwa namagciwane. Pyelonephritis: ukuphathwa (izidakamizwa)

Omunye ezivamile isifo sezinso pyelonephritis kubhekwa. I zokugula kuyinto inqubo ebanzi. Ukuvuvukala kuhlanganisa ukhalo kwezinso kanye nesitsha, nokuba kwalapho (interstitial) izicubu. Ukutheleleka kwenzeka noma ngaphandle ngokusebenzisa uhlelo urinary umzila hematogenous (ngemithambo yegazi) kusuka kwamanye nokuqubuka. Ngaphezu kwalokho hlaziya njengoba pyelonephritis kuboniswe. Ukwelashwa, amalungiselelo ukuqedwa yayo nayo izofakwa echazwe esihlokweni.

Uhlolojikelele

I Amagciwane main ezibhekwa pyelonephritis iqembu staphylococci igciwane, Escherichia futhi Pseudomonas aeruginosa, Proteus, streptococci, enterococci. Okuningi mancane amathuba okuthi abonile ukuthuthukiswa zokugula wadalula isikhunta noma ama-virus. Pyelonephritis ngokuvamile esibangelwa amagciwane abe nenkani izinhlangano Amagciwane noma L-amafomu. Lesi sakamuva kuhluke igobolondo-kancane isimo oluhambelana libhekene ukumelana nemithi. Lokhu kwenza kube nzima yini ukwelashwa kuphela, kodwa futhi ukuxilonga izifo. Lesi sifo eba ngokushesha impela kusukela acute esigabeni ezingamahlalakhona. Ngakho-ke, imithi pyelonephritis izinso kufanele aqokwe ngokushesha ngangokunokwenzeka.

izinyathelo zokwelapha

Yimaphi ama-antibiotic e pyelonephritis kufanele abe spectrum ezibanzi umsebenzi zokwelapha, okusezingeni eliphezulu isinyathelo amagciwane, nephrotoxicity ubuncane. Imithi kufanele futhi excreted ku umchamo e esiningi. Uhlu kwamaphilisi ukuthi engamiswanga zokugula echazwe kuhlanganisa aminopenicillin elivikelwe penicillins, cephalosporins, karboksipenitsilliny, aminoglycosides, fluoroquinolones. Ngokulandelayo, cabanga ngalokho imithi ngokweqile zifana nokuthela avame engabelwe pyelonephritis.

aminopenicillin

manje Ochwepheshe ozama engamiswanga le mithi pyelonephritis. Basuke izimpawu okusezingeni eliphezulu umsebenzi yemvelo ngokumelene Proteus, E. coli, enterococci. ethile yabo eyinhloko kubhekwa ukuba singathonywa ukuchayeka beta-lactamases - enzyme ezivezwa ezihlukahlukene Amagciwane emtholampilo efanele. Namuhla alama-antibiotic at yisishiso izinso akunconywa (ngaphandle zokugula yokukhulelwa) ngenxa amazinga anda ukumelana (ukumelana) zakulezi E. coli (30%) nalokho.

penicillins evikelwe

Lezi imithi nephritis ezibhekwa Ukukhetha indlela. Ukuthaka imithi abonise umsebenzi okusezingeni eliphezulu nezilwanyana ezincane kuqhathaniswa ezingezinhle okuyinto ukukhiqiza beta-lactamase, kanye amagciwane igramu-HIV, kuhlanganise i-penicillin ukumelana futhi coagulase-negative staphylococci. Izinga ukuzinza, okuyinto umbukiso zakulezi Escherichia coli ukuba penicillins evikelwe, kuqhathaniswa ongaphakeme. -antibiotic ngokuvamile ezinqunyiwe pyelonephritis "Amoxicillin" futhi lisho "clavulanate". Le nhlanganisela Kunconywa ngaphakathi 625 mg / 3 k. / Day. noma parenterally at 1.2 g / 3 k. / usuku. Ubude besikhathi sokwelashwa - kusukela izinsuku eziyisikhombisa kuya kweziyishumi. ifomu innovative wathi inhlanganisela antibiotic kubhekwe e pyelonephritis "Flemoklav Soljutab". Umuthi ikufakazele ukusebenza nge pheshana urinary nezifo. Kusho "Flemoklav Soljutab" uvunyelwe ukusetshenziswa in iziguli izinyanga ezintathu ekhulelwe.

Imithi amafomu kuyinkimbinkimbi

Ezimweni ezimbi kakhulu, futhi ezimweni ukutheleleka esolwa cuphuluza Pseudomonas aeruginosa, angaqokwa karboksipenitsilliny. Ikakhulukazi, kuba i-antibiotic anjalo pyelonephritis, njengoba "ticarcillin". Ngo iqembu elifanayo, futhi kuyindlela yokuthola "Carbenicillin". Ngaphezu kwalokho karboksipenitsillinov kungenzeka ureidopenitsilliny Kunconywa. Lezi zihlanganisa izidakamizwa ezifana "azlocillin", "Piperacillin". Kufanele kuphawulwe nokho, ukuthi penicillins pseudomonas akunconywa monosredstva. Lokhu kungenxa awokuthi amagciwane abe nenkani kubo ngokuhamba yokwelapha. Ekwelapheni pyelonephritis esetshenziswa inhlanganisela yalezi mithi ne-beta-lactamase inhibitor. Ikakhulukazi, inhlanganisela ebekiwe izindlela ezilandelayo: "ticarcillin" + acid Clavulanic, "tazobactam" + "piperacillin". Futhi esetshenzisiwe inhlanganisela antipseudomonal imithi elwa namagciwane fluoroquinolones futhi aminoglycosides. ukuthaka imithi anjalo abelwa, futhi pathologies ezinzima nosocomial esithathelanayo uhlelo urinary.

cephalosporins

Le mithi unekhono buthelela ku parenchyma kwezinso futhi umchamo e lokuhlushwa sezingeni eliphezulu. Cephalosporins kuhluke nephrotoxicity ngokulinganisela. Lezi imithi endaweni ehamba phambili namuhla imvamisa uya khona in iziguli pyelonephritis kanye pheshana urinary ukutheleleka. Kukhona ezizukulwane eziningana cephalosporins. Bahlukene ngokuvumelana nomkhakha we umsebenzi kanye degree of ukumelana ukuze beta-lactamases:

• isizukulwane 1st. Lezi amalungiselelo abe spectrum kuqhathaniswa elilinganiselwe umsebenzi. Zenza ngokuncanyelwayo ku cocci Gram-HIV futhi sokugembula Yiqiniso acute alusebenzi.
• isizukulwane 2nd. Lezi cephalosporins abe omningi senzo. Bahlale abakhuthele maqondana E. coli nezinye Enterobacteriaceae ezithile. Ukuze izidakamizwa kuleli qembu zihlanganisa, isibonelo, kusho "Cefuroxime."
• isizukulwane 3rd. Cephalosporins yaleli qembu asetshenziswa izifo eziyinkimbinkimbi. Imithi njengoba ngaphakathi (elisho ukuthi "ceftibuten," "Cefixime"), futhi parenterally (izidakamizwa "Ceftriaxone", "cefotaxime"). Kulo mBhalo isici kuyinto eside nesigamu zempilo ukusetshenziswa ngezindlela ezimbili ekususeni umzimba: umchamo kanye Bile. Esikhathini iqembu oyisizukulwane sesithathu cephalosporins imithi ekhona, bembonisa umsebenzi ngokumelene Pseudomonas aeruginosa. Lokhu, ikakhulukazi, kusho ezifana "Cefoperazone" "Ceftazidime" kanye nokulungiselela ingibitorzaschischenny "Cefoperazone" + "Sulbactam".
• yesizukulwane esingu-4. Cephalosporins yaleli qembu babe zonke izakhiwo izidakamizwa izigaba odlule, kodwa esebenzayo ebantwini cocci Gram-HIV.

aminoglycosides

Le mishanguzo Kunconywa amafomu eyinkimbinkimbi yama pyelonephritis, kanye sina izifo nosocomial. Iqembu aminoglycosides zihlanganisa izindlela ezifana "Amikacin," "Tobramycin", "netilmicin", "gentamicin." Ezimweni ezimbi kakhulu, le mithi ehlangana cephalosporins futhi penicillins. Aminoglycosides kabi ugxile kusukela pheshana emathunjini. Kule ndaba, bayobizwa iqondiswa okungcono parenterally. Excretion izidakamizwa Kwenziwa ezingaguquliwe umchamo. Ezigulini ezine-ukwehluleka kwezinso kuyadingeka ukuze ulungise umthamo. I nemibi aminoglycosides kuzomele sifake nephrotoxicity yabo liphinyiselwe futhi ototoxicity. imvamisa ubuthulu in iziguli-8%, nokulimala kwezinso (obonakala njengenhlangano neoliguricheskoy ukwehluleka ngokuvamile esethola) - 17%. Lokhu kwenza ukuthi kube nesidingo ukuba babanikeze ukwelashwa ku control inqubo ezingeni urea, potassium, creatinine. Ngoba amazwi ukwencika inkinga we lokuhlushwa igazi ukuthaka imithi esetshenziswa ukuphatha olulodwa Isikali Imininingwane nsuku zonke. isikimu okunjalo, phakathi kwezinye izinto, kusiza ukunciphisa amathuba wokuthuthukisa nephrotoxicity. Izinto nesenzakalo yezinkinga zihlanganisa:

• Ukulisebenzisa ngokuphindaphindiwe igama izidakamizwa nge break esingaphansi konyaka.
• Ukuguga.
• ukwelashwa eside ne isisu.
• isicelo Complex ne esebenzisa iqembu cephalosporins e imithamo ephezulu.

fluoroquinolones

Lezi imithi, eminyakeni yamuva nje ekwelapheni okukhethayo. Basuke ebekiwe sinenkonzo yokunakekela iziguli emakhaya kanye inpatient izilungiselelo. Ukuze-lokuqala isizukulwane fluoroquinolones zihlanganisa izidakamizwa ezifana "Ciprofloxacin", "pefloxacin," "Ofloxacin". Bahlale abakhuthele emagciwaneni kakhulu ohlelweni urogenital. Buhle izidakamizwa ubuthi babo ongaphakeme, eside isigamu-nokuphila, nakho, ikuvumela ukuba uzithatha kabili ngosuku. Fluoroquinolones ngokugculisayo ibekezelelwe kwefomu umchamo, izicubu izinso, igazi lokuhlushwa sezingeni eliphezulu. Imithi lusetjentiswe kuto parenterally futhi ngaphakathi kodwa kusho "Norfloxacin" (it senzelwe abaphathi temlomo). the fluoroquinolones isizukulwane sesibili (izidakamizwa "lomefloxacin", "Levofloxacin", "moxifloxacin", njll) ezisuke zimatasa ngaso ngokuphathelene Gram-HIV ezincane, ikakhulukazi pneumococci. Ngesikhathi esifanayo banayo iyafana isizukulwane esedlule sakwa-izidakamizwa, isinyathelo esiqatha ku amagciwane igramu-negative (ngaphandle Pseudomonas aeruginosa).

prophylaxis of pyelonephritis

Ukuze ugweme kokwehluleka noma eyinhloko zokugula kuyadingeka ukuqeda wonke ama-trigger bakuthathe. Prophylaxis ka pyelonephritis zihlanganisa uhla izinyathelo. Lokhu kungabandakanya i-ukuzinza yokudla, umsebenzi kanye nokuphumula, ukulala futhi sihlale siphapheme. Isimo ezidingekayo ukukhishwa eliphelele hypothermia. Ngokukhethekile kufanele kukhokhelwe isimo jikelele zomzimba - kubalulekile ukuthi zazingekho izifo. Kule ndaba, kufanele kwenzeke ukuba ukuqhuba yokwelapha izifo: nesifo, caries, kolwelwesi nabanye.