Koj muaj teebmeem kev tuberculosis disseminated: Cov tsos mob thiab kev kho mob

Heev tsis kaj siab thiab cov kab mob tuberculosis tshwm sim rau lub ntiaj teb millennia, raws li muaj tim khawv los heev heev archaeological excavations thiab keeb kwm ntaub ntawv. Nyob rau hauv hnub no lub ntiaj teb no txhua txhua xyoo nws yuav siv sij hawm lub zoo ibyam ntawm cov neeg raug txog 10 lab cov neeg, 25% ntawm cov neeg uas tuag.

Cov feem ntau tsis kaj hauv daim ntawv ntawm tus kab mob - pulmonary tuberculosis disseminated, uas txhais tau tias multifocal, "nchuav tawm" rau tag nrho cov yooj yim. Yuav tsum khaws cov kab mob yog yooj yim heev, raws li txoj kev ntawm nws kis tau tus mob extraordinarily yooj yim, thiab cov tsos mob nyob rau hauv thaum ntxov ua sawv yog luag pom. Nyob rau hauv qhov tseeb, txoj kev pheej hmoo ntawm kev cog lus peb txhua tus yog raug txhua txhua hnub, tab sis zoo hmoo, tsis yog txhua tus lub cev muaj peev xwm sawv ntawm cov kab mob ntsws. Yog hais tias koj tseem muab tso rau qhov txaus ntshai mob, ua tsis tau tag kev cia siab, vim hais tias tam sim no science tau tshaj kom deb li deb kiag li kho tau txawm disseminated pulmonary tuberculosis yog tau. Nws tsis yuav tsum txaj muag deb ntawm niaj hnub tuaj kuaj thiab ua raws nraim li scrupulously los ntawm tus kws TB tshwj xeeb. Lawv hais tias kev txawj ntse kev muaj zog thiab kev qaug ntawm tus yeeb ncuab - uas yog 50% yeej. Yog li ntawd cia saib dab tsi nws yog tuberculosis, qhov twg nws tawm los ntawm thiab yuav ua li cas sib ntaus nws.

tubercle Bacillus

Disseminated tuberculosis ntawm lub ntsws tshwm sim los ntawm me me kab, hu ua mycobacteria. Lawv muaj nyob rau ntawm no ntiaj chaw rau tsheej lab ntawm xyoo, tab sis tsuas pheej nrhiav tau nyob rau hauv 1882 los ntawm ib tug kws kho mob thiab paub txog Koch, nyob rau hauv uas nws yawm thiab muaj npe lawv thiaj li - cov Koch Bacillus. Tag nrho cov pathogenic mycobacteria (abbreviated li MKB), muaj 74 hom, 6 uas yuav ua rau tus kab mob ntsws nyob rau hauv tib neeg thiab tsiaj. Rawg raug hu ua vim hais tias ntawm cov tsos, tiag tiag pas nrig-zoo li tus. Ib txhia mycobacteria yog zoo kawg nkaus mus raws li lub, ib co me ntsis nkhaus, thiab nkawd ob leeg muaj ib tug ntev ntawm los ntawm 1 mus rau 10 micrometers, thiab cov dav - hais txog 0.5 microns.

Ib cim feature ntawm lawv yog cov qauv ntawm lawv phab ntsa, los yog lub week. Tsis tas yuav mus rau hauv cov ntsiab lus, peb nco ntsoov hais tias nws yog nyob rau hauv lub nrog Koch tso cai rau lawv mus mutate infinite tooj ntawm lub sij hawm, los tiv thaiv lawv tus kheej los ntawm cov cab rau lwm cov tshuaj ua hauj lwm thiab steadfastly thaum nws cov hostile ib puag ncig. Lawv txawm bacteriophages siv ntse, uas yog cov raison d'être - los mus tiv thaiv lub cev tiv thaiv cab microorganisms. Tau absorbed, Koch lub Bacillus tsis tuag, thiab hloov cov macrophages kom lawv tau yooj yim cov me nyuam thiab li tsis muaj kev ruaj ntseg tshuab ntawm nws tus tswv. Nyob rau hauv lwm yam lus, Koch lub Bacillus siv cellular tiv thaiv ntawm peb lub cev siv nws zoo.

Ib zaug nyob rau hauv lub ntsws noj qab nyob zoo tus neeg, cov cab tsim ib tug thawj zaug xwb foci (thawj tuberculosis), tab sis tom qab cov ntshav thiab / los yog cov qog faib nyob ib cheeb tsam loj ntawm ib tug los yog ob qho tib si ntsws thiab lwm yam pa li tsim disseminated pulmonary tuberculosis. Nyob rau hauv tej yam tshwm sim tej zaum nws yuav tsim txawm tom qab lub kho thawj tuberculosis, raws li Koch lub Bacillus nyob rau hauv ib tug tsis nquag daim ntawv nyob twj ywm nyob rau hauv lub cev rau ntau xyoo.

Txoj kev uas kab mob

Koj muaj teebmeem kev tuberculosis nyob rau hauv tib neeg ua peb hom kab mob - M. tuberculosis (tib neeg subspecies), M. africanum (subspecies intermediate) thiab M. bovis (a subspecies ntawm cov tsiaj). Cov yav tas yog ntau mob nyuj, thiab mus rau tus neeg nws yog kis tau los ntawm unpasteurized mis nyuj.

Muaj ntau cov xav nyob rau hauv, disseminated pulmonary tuberculosis yog kis tau los yog tsis. Cov lus teb yog yooj yim: nws yog kis tau rau lwm, Yog hais tias muaj nrog qhov kev tso tawm ntawm Koha sticks (tubercle bacilli).

Lawv tuaj ntawm ib tug neeg mob mus rau ib tug noj qab nyob zoo tsis tau remarkably yooj yim:

- lawv yuav tsum tau nqus tau cov pa los ntawm cov huab cua;

- nrog qaub ncaug (e.g., los ntawm kev hnoos, hnia);

- los ntawm cov tais diav uas siv los ntawm tus neeg mob;

- los ntawm tsev neeg cov khoom;

- los ntawm leej niam - fetus;

- thaum uas siv cov insufficiently sterilized kho mob seev.

Raws li koj tau pom, koj yuav tau txais tus kab mob TB nyob qhov twg: nyob rau hauv pej xeem thauj, nyob rau hauv pej xeem qhov chaw, nyob rau hauv cov tsev kawm ntawv, tom hauj lwm thiab thiaj li nyob.

Tseem ceeb: Koch Bacillus zoo heev tenacious. Lawv khaws lawv txaus ntshai zog sab nraum tib neeg lub cev rau ib tug ntev lub sij hawm. Ntawm no yog ib co piv txwv ntawm yuav ua li cas lub Koch Bacillus nyob rau hauv tej kev kawm uas peb fim txhua txhua hnub:

- nyob rau hauv ib tug maub qhov chaw tsis muaj tshav ntuj - txog li 7 xyoo;

- nyob rau hauv lub qhuav neeg mob hnoos qeev (sab laug rau tag nrho cov kev kawm) - txog li 1 xyoo;

- nyob rau hauv cov hmoov av nyob rau hauv txoj kev - mus txog rau 60 hnub;

- rau daim ntawm typographic khoom - txog li 3 lub hlis;

- dej - txog 150 hnub;

- nyob rau hauv unboiled mis nyuj - txog 14 hnub;

- nyob rau hauv lub cheese (roj) - ib xyoo.

Yog nws ua tau rau tsis zoo teb rau lo lus nug ntawm disseminated pulmonary tuberculosis yog kis tau rau lwm los yog tsis? Tej zaum qhov Koch Bacillus tam sim no nyob rau hauv lub cheeb tsam, ib qho yooj yim ua kom puas? Tu siab, cov mycobacteria yog heev yooj yim mus tua. Tsaug rau nws cov cim cell phab ntsa, lawv tsis yog cuam tshuam los ntawm tshav ntuj, ultraviolet hluav taws xob, dej cawv, acetone, acids, alkalis, ntau disinfectants, dihydrate, thiab thaum boiled nrog kawm tau tus kab mob hnoos qeev tsis tuag ntau li ntau raws li 5 feeb. Yog hais tias Koch lub Bacillus yuav tsim nyob rau hauv lub cev ntawm ib tug neeg twg, tuberculosis yuav mob tag nrho cov inhabitants ntawm ntiaj chaw lub ntiaj teb.

rau tej pab

Ua ntej hnub nyoog kawm ntawv, feem ntau cov me nyuam tuaj tos nrog Koch, tab sis disseminated pulmonary mob ntsws los sis lwm yam kev xwb tsis muaj zog, sickly cov me nyuam. Muaj kuj yog ib tug uas muaj feem yuav pab pawg neeg no muaj xws li:

- cov neeg muaj mus tas li nyob rau hauv nyob sib ze nrog tus kab mob TB cov neeg mob;

- Cov neeg uas muaj tsawg tiv thaiv;

- kab mob HIV kis mob;

- kev immunosuppressants;

- hluas thiab nruab nrab-hnub nyoog cov neeg nyob rau hauv lub sij hawm ntawm hormonal hloov;

- starving;

- kev txom nyem los ntawm tus kab mob ntsws ntawm daim tawv nqaij thiab lwm yam kabmob;

- tau kis kab mob;

- bolevshie thawj pulmonary tuberculosis thiab kho;

- txuas ib co ntev physiotherapeutic cov txheej txheem (e.g., quartz).

kev faib

Koj muaj teebmeem kev tuberculosis muaj peev xwm tsim disseminated nyob rau hauv lub nram qab no:

1. hlab ntsha (hematogenous). Nyob rau hauv cov ntaub ntawv no, ob leeg lub ntsws uas cuam tshuam. Sau cov hlab ntsha cov kab mob yuav ua tau los ntawm cov qog ntshav, Gon twb, los ntawm cov muaj lub siab thiab lub pulmonary hlab ntsha.

2. qog (lymphogenous). Nyob rau hauv cov ntaub ntawv no, lub cuam tshuam ib tug mob ntsws.

3. Limfogematogenny.

Los ntawm qhov xwm ntawm tus kab mob txawv pulmonary tuberculosis disseminated li nram qab no ntaub ntawv:

- mob (miliary);

- subacute;

- mob;

- generalized. Hais txog daim ntawv no ntawm tus kab mob no hais tias thaum twg, txawm yog vim li cas, cov hlab ntsha tshwm sim txhob txheem ntawm lub cov qog Mycobacterium, cov qauv ntawm cov uas yog lub cheesy (caseous). Nyob rau hauv cov ntaub ntawv no, nyob rau tib lub sij hawm yog ib tug lossis loj npaum li cas ntawm cov ntshav nyob rau hauv lub nrog Koch. Qhov zoo ces, nws tshwm sim ncaw.

Cov mob hauv daim ntawv ntawm tuberculosis

Tus kab mob pib dheev, mam li nco dheev, cov tsos mob yog heev ci, ib tug me ntsis zoo li mob ntsws muaj dej. Kuaj raws li nyob rau hauv cov kev kho vajtse mob thiab microbiological tsom xam ntawm hnoos qeev. Mob disseminated pulmonary tuberculosis yog tsiag ntawv los ntawm muaj nyob rau hauv lub ntsws cov ntaub so ntswg ntawm ntau me me (hais txog ib tug millimeter) hillocks li pias grain. Li no, lub thib ob lub npe - "miliary (milae nyob rau hauv Latin txhais tau tias" pias ") tuberculosis." Tus neeg mob hloov thawj capillary qauv nyob rau hauv uas collagen puas lawm, thiab cov phab ntsa yog legkopronitsaemymi, uas ua rau yus lub allergic ntawm mycobacteria los ntawm cov ntshav khiav mus rau hauv lub ntsws. Cov tsos mob ntawm no muaj xws li:

- ib tug ntse dhia nyob rau hauv kub mus 39,5-40 ° C tias;

- tsis muaj zog, qaug zog, siab qaug zog;

- ceev mem tes;

- tsis qab los noj mov;

- blueness ntawm ob daim di ncauj thiab cov ntiv tes;

- yellowness ntawm daim tawv nqaij;

- xeev siab rau ntuav;

- mob taub hau;

- hnoos qhuav los yog hnoos qeev ntau lawm, uas nyob rau hauv tas li ntawd mus hnoos qeev thiab kua paug yog ntshav streaks;

- ua tsis taus pa.

Tej zaum kuj muaj yog ib tug qhia thaum sawv ntxov kev mob kev nkeeg, kom txog thaum nws poob nco qab.

Subacute daim ntawv ntawm tuberculosis

Nws tshwm sim thaum uas tus kab mob no kis tau mus rau lub loj cov hlab ntsha (leeg thiab intralobular interlobular cov hlab ntsha). Nyob rau hauv cov ntaub ntawv no, kuaj txhab mus txog 1 cm nyob rau hauv txoj kab uas hla. Lawv nyob tsuas yog nyob rau theem ntawm lub ntsws, qhov chaw uas muaj ntau yam ntawm cov hlab ntsha thiab cov qog cov hlab ntsha. Los ntawm qhov xwm ntawm tus proliferative txhab, inflammations thiab hlav tsis muaj, tab sis lawv muaj peev xwm ua rau mob nyob rau hauv lub visceral pleura.

Cov tsos mob ntawm subacute ntaub ntawv ntawm tus kab mob TB tej zaum yuav zoo li ntau lwm yam kab mob uas complicate soj ntsuam kuaj mob. Ntawm cov ntsiab tam sim no muaj raws li nram no:

- qaug zog, tsis muaj zog;

- kub nyob rau theem ntawm 38 ° C;

- ib tug hnoos uas hnoos qeev.

mob tuberculosis

Qhov no daim ntawv ntawm tus kab mob tshwm sim thaum tus neeg mob yog kiag li kho thawj (tshiab) tuberculosis. Nyob rau hauv xws li mob, Mycobacterium pheej ntawm cov hlab ntsha los yog qog los ntawm tus thawj foci poob mus rau hauv tshiab feem ntawm lub ntsws, uas ua nyob rau hauv lawv muaj ntau yam foci ntawm ntau ntau thiab tsawg (los ntawm heev me me mus rau loj heev) ntawm ntau daim thiab cov qauv. Tej zaum lawv yuav calcified thiab heev tshiab, nrog ci inflammatory daim duab. Kuaj txhab nyob rau hauv ob qho tib si ntsws. Disappointing daim duab ntxiv emphysema, fibrosis ntawm ntau yam ntaub so ntswg nyob rau hauv lub ntsws, pleural cirrhosis. Cuaj kaum, mob disseminated pulmonary tuberculosis yuav outwardly tsis manifest nws tus kheej, nyob rau hauv kev twb kev txuas nrog cov uas nws yog feem ntau pom muaj thaum lub sij hawm fluoroscopy. Symptomatology ntawm tus mob hauv daim ntawv ntawm tuberculosis yog raws li nram no:

- qaug zog;

- tsis qab los noj mov;

- emaciation;

- heev mob taub hau;

- tsis yog zoo caij sawv ntawm kub (episodically);

- hnoos.

Disseminated tuberculosis: theem

Yav tas los nws twb xav hais tias tau tus kab mob theem kuv tshwm sim rau hauv lub Upper lobes ntawm lub ntsws, II - nyob rau hauv nruab nrab, thiab III, thiab twb los txog rau txo. Tom qab no cais paub tias nws tsis muaj tseeb, txij li thaum lub sij hawm ntawm tus kab mob no tej zaum yuav sib npaug tshwm sim nyob rau hauv tag nrho cov feem ntawm lub ntsws. Rau hnub tim, distinguishes lub nram qab no theem ntawm pulmonary tuberculosis:

- Alopecia;

- infiltration;

- lub cev qhuav dej;

- chaw ua hauj lwm + (qhib daim ntawv ntawm tuberculosis);

- MBT- (kaw).

Disseminated tuberculosis nyob rau hauv theem infiltration MBT + txhais tau tias tus kab mob no thaum kawg nrog qhov kev tso tawm mus rau hauv lub cheeb tsam ntawm mycobacteria. Lub ntsiab mob - ib tug hnoos uas hnoos qeev ntau lawm, tshwj xeeb tshaj yog yog hais tias nws muaj kua paug thiab ntshav.

Alopecia theem mas cov yam ntxwv ntawm thawj los yog tshiab tuberculosis. Nws yog tsiag ntawv los ntawm qhov tseeb hais tias cuam tshuam tsuas yog ib ob peb los yog txawm ib ntu. Nyob rau hauv no me me chamber ntev (txog li 1 cm nyob rau hauv txoj kab uas hla). Qhov no theem no tshwm sim tsis muaj cov tsos mob thiab kuaj tau, feem ntau nrog rau ib tug nyuaj kev tshawb teeb (x-ray, fluoroscopy).

Disseminated tuberculosis: lub sij hawm ntawm infiltration thiab decomposition

Xws li ib tug cim ntawm tus kab mob yog tau los ntawm tebchaws nws untimely (tus neeg mob txhob yuav tsum tau txhua xyoo ua tau zoo fluorography, tsis twv rau cov kws kho mob thaum thawj cov tsos mob ntawm kev ntxhov siab vim, koom nws tus kheej-medicate los yog siv pej xeem tshuaj yog feem ntau insufficiently zoo li cov thawj kev kho mob). disintegration theem txhais tau tias lub morphology ntawm txhab nyob rau hauv lub ntsws mus txog ib tug taw tes thaum uas cov ntaub so ntswg pib tawg ua me me, txoj kev ua ib tug heev tiag tiag qhov. Tawg tsam ntawm disintegrated cov ntaub so ntswg nrog hnoos tawm nraum zoov. Lawv interspersed nrog hnoos qeev kua paug thiab ntshav. Tsis tas li ntawd, cov pieces poob mus rau hauv lub tseem tsis tau raug tus kab mob ntawm lub ntsws theem, ua rau tam sim ntawd yub ntawm mycobacteria. Cov neeg mob uas muaj tus mob ntawm disseminated pulmonary tuberculosis nyob rau hauv ib theem ntawm disintegration, yog ib tug txaus ntshai qhov chaw ntawm kab mob mus rau lwm tus, thiab yog raug rau yuav tsum pw tsev kho mob. Kev kho mob nyob rau hauv tsev kho mob lawv muaj ib tug ntev, mus txog rau lub hlis. Raws li ib tug tshwm sim, disintegrated txhab kho (calcined).

infiltration theem kuj cai nyob rau hauv lub hnyav kawg ntawm tus kab mob, tab sis nyob rau hauv rooj plaub no tus teeb tsis yog lub cev qhuav dej ntawm cov ntaub so ntswg tshwm sim. Feem ntau infiltration - ib feem (center), nyob rau hauv uas muaj yog o. Xws li ib tug qhov chaw yog mus ib tug ntau ntawm leukocytes thiab lymphocytes, thiab cov tsos mob reminiscent ntawm ib tug mob ua mob ntsws dej. Disseminated pulmonary tuberculosis nyob rau hauv lub sij hawm ntawm infiltration muaj cov nram qab cov tsos mob:

- ib tug ntse sawv nyob rau hauv kub mus rau high elevations;

- tsis muaj zog, qaug zog;

- mob hauv siab;

- hnoos;

- tej yam tshwm sim ntawm toxicity;

- mob taub hau;

- tej zaum cov weakening nco qab.

Tsis ceev kev kho mob pib ntawm qhov chaw ntawm cov ntaub so ntswg infiltration pib tawg ua me me. Tus neeg mob hnoos lawv tawm los yog nyob rau hauv tus txheej txheem ntawm kev hnoos tsiv mus rau lub thib ob lub teeb, uas yog heev sai sai kis tus kab mob qub noj nqaij. Mob Ntsws nyob rau hauv cov theem ntawm lub cev qhuav dej thiab infiltration ntawm tsis tsuas yog fraught nrog yuav muaj kab mob rau lwm tus neeg, tab sis kuj tuag rau tus neeg mob.

diagnostics

Nws tsis yog ib qho yooj yim rau tam sim ntawd tsim kom muaj ib tus neeg mob nrog disseminated tuberculosis. Mob yog ib qhov nyuaj vim hais tias cov tsos mob ntawm tus kab mob no thiab mob ntsws muaj dej, SARS, txawm metastatic cancer yog heev uas zoo sib xws. Thaum koj hu xov tooj rau tus neeg mob mus rau lub tsev kho mob complaining nkees, hnoos, mob caj pas, tsis muaj zog, txog siav tus kws kho mob yog yuam ua hauj lwm los soj ntsuam daim tawv nqaij rau lub xub ntiag ntawm cirrhosis uas tej zaum yuav nyob twj ywm los ntawm yav dhau los myocardial rwj, lymphadenitis. Tsis tas li ntawd maum kuaj cov symmetry ntawm lub hauv siab (nws tsis yog, yog tias tus kab mob TB muaj nyob rau hauv ib tug mob ntsws), soj ntsuam mob thiab mob nro nyob rau hauv lub xub pwg nws daim siv sia. Thaum mloog mus rau ib tug mloog plawv mloog ntsws qhia ntsws, seb hawb pob yog, dab tsi lawv qhov chaw nyob thiab cov ua cim. Nws yog yuav tsum tau ua laboratory kev soj ntsuam ntawm hnoos qeev rau hauv lub xub ntiag ntawm mycobacteria. Nyob rau hauv tej rooj plaub, cov neeg mob noj txoj kev tshawb no ntawm bronchial ntxuav, los yog plab ntawm cov dej (feem ntau yog nyob rau hauv cov me nyuam). Nyob rau hauv tas li ntawd, kuaj ntsuam xyuas tej zaum yuav muaj xws li:

- bronchoscopy;

- hnoos qeev smear microscopy;

- me ntawm lub pleura;

- thoracoscopy;

- pleural tej.

Cov feem ntau lug siv thiab yog yog fluoroscopic kev tshawb fawb.

Kev Kho Mob thiab raug

Yog hais tias tus kws kho mob tau hais tias mob "disseminated pulmonary tuberculosis", cov kev kho mob yuav tsum ntev thiab multifaceted. Cov raug nyob rau hauv lub theem nyob rau hauv uas tus kab mob no yog kuaj, thiab yuav ua li cas zoo rau tus neeg mob ua ib tug kws kho mob tshuaj. Nyob rau hauv txhua yam uas koj muaj teebmeem kev theem + nyob rau hauv MWT neeg mob pw tsev kho mob. Nyob rau hauv ib lub tsev kho mob tsuas yog nqa tshuaj kho (kws khomob) muaj anti-tuberculosis tshuaj, lub cev txoj kev kho, vitamins, reinforcing tiv thaiv.

Kws khomob nyob rau hauv tshiab khiv paub hais tias cov neeg mob nyob rau hauv lub intensive theem ntawm kev kho mob yog nqa tawm raws li nram no anti-tus kab mob TB tshuaj, "Iziniazidom", "rifampicin", "pyrazinamide" thiab "ethambutol", thiab nyob rau hauv lub continuation theem ntawm kev kho mob - "Isoniazid" thiab "Rifampicin" los yog "Isoniazid" thiab "ethambutol ".

Nyob rau hauv mob disseminated tuberculosis qhia tau hais tias kev siv ntawm corticosteroids thiab immunomodulators. Cov ntau cov tshuaj "prednisolone" (15-20 mg / hnub rau 6-8 lub lis piam).

Duration ntawm kev kho mob - txog li 6 lub hlis. Yog hais tias tsis pub dhau 3 lub hlis tsis pom ib tug qauv rau txoj kev txhim kho, raws li tau zoo raws li ib tug xov tooj ntawm lwm yam tej zaum yuav siv phais yuav qhov kev tshem tawm ntawm ib tug mob ntsws ya los yog lub teeb nyob rau hauv feem ntau.

Leej twg yuav siv qhov tseeb kev kho mob rau tuberculosis, hu ua "valve bronchoblocation", los yog tsuas yog "bronchoblocation", uas yog ib qho lwm txoj mus hlais.

kev tiv thaiv

Koj muaj teebmeem kev tuberculosis yog suav tias yog ib tug social kab mob, tus kab uas yog lom zem ntau nyob rau qhov zoo ntawm lub neej (nyob tej yam kev mob, tsiv teb tsaws, hauj lwm pab nws kab lus nyob rau hauv tsev lojcuj, thiab thiaj li nyob). Raws li kev tiv thaiv, tshwj xeeb tshaj yog rau disseminated pulmonary tuberculosis, yuav hu ua:

- obligatory tso cai ntawm lub x-rays;

- nqa tawm tswj ntsuas;

- xav koob tshuaj BCG txhaj tshuaj tiv thaiv;

- qhov qee ntawm lub xeev cov nyiaj rau cov kev kho mob ntawm cov neeg mob nrog tus kab mob ntsws;

- muaj ib tug active (kev ua si), noj qab nyob zoo txoj kev ua neej;

- cov zaj ntawm cov neeg mob kom tiav kev kho mob ntawm focal tuberculosis.