Tshuaj tua kab mob pyelonephritis. Pyelonephritis: cov kev kho mob (tshuaj)

Ib qho ntawm feem ntau raum tus kab mob pyelonephritis yog suav hais tias. Lub pathology yog ib tug uas nws kim heev kev. O muaj xws li lub raum plab mog thiab hauv lub khob, thiab muaj ib tug hlws ris (interstitial) cov ntaub so ntswg. Kab mob tshwm sim los yog externally los ntawm cov urinary system los yog hematogenous lawv (los ntawm cov hlab ntsha) los ntawm lwm yam kab mob. Ntxiv tsom xam raws li qhia pyelonephritis. Kev kho mob, kev npaj rau nws tshem tawm yuav tau piav nyob rau hauv tsab xov xwm.

Txheej txheem cej luam

Lub ntsiab pathogens yog xam tau tias yog pyelonephritis pab pawg neeg staphylococci kab mob, Escherichia thiab Pseudomonas aeruginosa, Proteus, streptococci, Enterococci. Ntau tsawg yuav tau pom txoj kev loj hlob ntawm pathology raug fungi los yog viruses. Pyelonephritis yog feem ntau txhais los ntawm microbial pathogens koom haum ua teb los yog L-cov ntaub ntawv. Cov yav tas txawv plhaub-tsawg adaptive xeev yus siab kuj mus tshuaj. Qhov no ua rau nws tsis yooj yim tsis tau tsuas yog kev kho mob, tab sis kuj yuav kuaj tus kab mob. Tus kab mob yuav sai heev los ntawm cov mob rau tus mob tsis nyob ntev. Yog li ntawd, tshuaj tua kab mob rau pyelonephritis raum yuav tsum tau tsa raws li sai li sai tau.

kho ntsuas

Tej tshuaj tua kab mob nyob rau hauv pyelonephritis yuav tsum tau muaj ib tug broad spectrum ntawm kho ua si, siab bactericidal kev txiav txim, yam tsawg kawg nkaus nephrotoxicity. Tshuaj yuav tsum tau tas nyob hauv cov zis nyob rau hauv loj nyiaj. Daim ntawv teev cov tshuaj tua kab mob uas cov kws kho nyob rau hauv lub piav pathology muaj xws li aminopenicillin tiv thaiv penicillins, cephalosporins, karboksipenitsilliny, aminoglycosides, fluoroquinolones. Tom ntej no, xav txog dab tsi tshuaj tua kab mob feem ntau kws kho rau pyelonephritis.

aminopenicillin

Kws txawj yog tam sim no ua rau tsis tshuaj cov tshuaj nyob rau hauv pyelonephritis. Lawv tsiag ntawv los ntawm high ntuj ua si tiv thaiv Proteus, E. coli, Enterococci. Lawv lub ntsiab drawback yog pom tias yuav muaj cuam tshuam los ntawm raug beta-lactamases - enzymes uas ua los ntawm ib tug ntau yam ntawm clinically cov pathogens. Niaj hnub no cov tshuaj tua kab mob nyob rau ntawm ib o ntawm ob lub raum tsis pom zoo (tsuas yog pathology ntawm cev xeeb tub) vim hais tias ntawm lub nce theem ntawm resistant (resistant) kab mob los ntawm E. coli (30%) thereto.

kev tiv thaiv penicillins

Cov tshuaj tua kab mob rau nephritis yog xam tau tias yog kev xaiv txhais tau tias. Medicaments muaj siab ua si kuj tsis zoo kab mob uas tsim ib tug beta-lactamase, raws li zoo raws li gram-zoo cov kab mob, xws li penicillin-resistant thiab coagulase-tsis zoo staphylococci. Cov theem ntawm stability, uas sau kab mob los ntawm Escherichia coli rau penicillins kev tiv thaiv, yog tus uas tsis muaj. tshuaj tua kab mob feem ntau kws kho rau pyelonephritis "Amoxicillin" thiab txhais tau tias "clavulanate". No thaum lawv tseem yog pom zoo inwardly 625 mg / 3 p. / Hnub. los yog parenterally ntawm 1.2 g / 3 p. / hnub. Duration ntawm kev kho mob - los ntawm xya mus rau kaum hnub. Lub daim ntawv ntawm hais tias tshuaj tua kab mob thaum lawv tseem yog suav tias yog nyob rau hauv pyelonephritis "Flemoklav Soljutab". Cov tshuaj muaj proven hauj lwm zoo nrog mob txeeb zig. Txhais tau hais tias "Flemoklav Soljutab" yog tso cai rau siv nyob rau hauv cov neeg mob uas peb lub hlis lawm.

Tshuaj nyob rau hauv nyuab ntaub ntawv

Nyob rau hauv loj heev zaum, thiab nyob rau hauv tus neeg mob uas xav tias kab mob provoked los ntawm Pseudomonas aeruginosa, tej zaum yuav tau tsa karboksipenitsilliny. Nyob rau hauv kev, nws yog xws li ib tug tshuaj tua kab mob nyob rau hauv pyelonephritis, raws li "ticarcillin". Nyob rau hauv tib pab pawg neeg, thiab nws yog ib tug txhais tau tias ntawm "Carbenicillin". Tsis tas li ntawd karboksipenitsillinov tej zaum yuav pom zoo ureidopenitsilliny. Cov no muaj xws tshuaj xws li "azlocillin", "Piperacillin". Nws yuav tsum tau muab sau tseg, txawm li cas los, hais tias cov Pseudomonas penicillins yog tsis pom zoo raws li monosredstva. Qhov no yog vim lub high yuav microbial kuj rau lawv nyob rau hauv lub chav kawm ntawm kev kho mob. Nyob rau hauv cov kev kho mob ntawm pyelonephritis siv ob peb ua ke ntawm cov tshuaj thiab beta-lactamase inhibitors. Nyob rau hauv kev, lub tshuaj ua ke ntawm cov nram qab no txhais tau tias: "ticarcillin" + acid Clavulanic, "tazobactam" + "piperacillin". Kuj siv yog ob peb ua ke antipseudomonal tshuaj tua kab mob fluoroquinolones thiab aminoglycosides. Tej medicaments raug, thiab nyob rau hauv mob loj heev nosocomial kab pathologies ntawm lub urinary system.

cephalosporins

Cov tshuaj muaj lub peev xwm los noog nyob rau hauv lub raum parenchyma thiab zis nyob rau hauv ib tug txaus siab concentration. Cephalosporins txawv tsawv nephrotoxicity. Cov tshuaj no rau lub leading qhov chaw hnub no nyob rau lo lus uas peb zaus nyob rau hauv cov neeg mob uas pyelonephritis thiab mob txeeb zig. Muaj ob peb tiam ntawm cephalosporins. Lawv muab faib raws li lub spectrum ntawm kev ua si thiab lub degree ntawm kam rau beta-lactamases:

• 1 tiam. Cov kev npaj muaj ib tus limited spectrum ntawm kev ua si. Lawv ua preferentially rau Gram-zoo cocci thiab pathological mob kawg tsis muaj feem xyuam.
• 2nd tiam. Cov cephalosporins muaj ib tug dav heev spectrum ntawm kev txiav txim. Lawv yog cov active txoj E. coli thiab lwm yam Enterobacteriaceae. Rau cov tshuaj nyob rau hauv pab pawg neeg no muaj xws li, piv txwv li, txhais tau tias "Cefuroxime."
• Koob thib 3 tiam. Cephalosporins ntawm no pab pawg neeg yog siv nyob rau hauv nyuab kab mob. Cov tshuaj kho raws li hauv (txhais tau tias "ceftibuten," "Cefixime"), thiab parenterally (tshuaj "Ceftriaxone", "cefotaxime"). Nyob rau hauv lub caij nyoog kawg no cov ntaub ntawv tus yam ntxwv yog ib tug ntev ib nrab-lub neej thiab kev siv ntawm ob txoj kev rau kev tshem tawm ntawm lub cev: qhov zis thiab bile. Nyob rau hauv cov pab pawg neeg ntawm peb-tiam cephalosporins tshuaj tam sim no, seeb ua si tiv thaiv Pseudomonas aeruginosa. Qhov no, nyob rau hauv particular, txhais tau tias xws li "Cefoperazone" "Ceftazidime" thiab ingibitorzaschischenny npaj "Cefoperazone" + "Sulbactam".
• 4 tiam. Cephalosporins ntawm no pab pawg neeg muaj tag nrho cov khoom ntawm tshuaj ntawm yav tas los no, tab sis lawv muaj ntau yam kom nquag plias tiv thaiv Gram-zoo cocci.

aminoglycosides

Cov tshuaj uas tau pom zoo nyob rau hauv nyuab ntaub ntawv ntawm pyelonephritis, raws li zoo raws li loj nosocomial kab mob. Cov pab pawg neeg ntawm aminoglycosides muaj xws li xws li "Amikacin," "Tobramycin", "netilmicin", "gentamicin." Nyob rau hauv loj heev zaum, cov tshuaj yog ua ke nrog cephalosporins thiab penicillins. Aminoglycosides yog tsis zoo yaim los ntawm lub hnyuv ib ntsuj av. Nyob rau hauv no hais txog, lawv yuav tsum tau muab dua parenterally. Feem ntawm cov tshuaj yog nqa tawm unchanged nyob rau hauv cov zis. Rau cov neeg mob uas raum tsis ua hauj lwm yog tsim nyog yuav tau kho cov tshuaj. Qhov tsis zoo ntawm aminoglycosides yuav tsum muaj xws li lawv cov lus hais nephrotoxicity thiab ototoxicity. zaus tsis hnov nyob rau hauv cov neeg mob mus txog 8%, thiab lub raum puas tsuaj (manifested raws li neoliguricheskoy feem ntau reversible tsis ua hauj lwm) - 17%. Qhov no ua rau nws tsim nyog los muab kev kho mob nyob rau hauv tus txheej txheem kev tswj ntawm lub theem ntawm urea, poov tshuaj, creatinine. Vim hais tias cov kev qhia txog lub dependence ntawm mob lub concentration nyob rau hauv cov ntshav medicaments siv ib koom haum saib xyuas tag nrho cov hnub ntau npaum. Xws li ib tug tswvyim, cov lwm yam, pab txo cov yuav ua rau muaj kev loj hlob nephrotoxicity. Cov yam tseem ceeb ntawm tshwm sim ntawm teeb meem muaj xws li:

• Ua kev siv ntawm cov tshuaj nrog ib tug so ntawm tsawg tshaj li ib xyoo.
• Laus lub hnub nyoog.
• Long-term kev kho mob nrog diuretics.
• Complex daim ntawv thov nrog rau cov txhais tau tias ntawm cov pab pawg neeg ntawm cephalosporins nyob rau hauv siab noj tshuaj npaum cas.

fluoroquinolones

Cov tshuaj no, nyob rau hauv tsis ntev los no xyoo cov kev kho mob ntawm kev xaiv. Lawv cov kws kho nyob rau hauv pw thiab pw chaw. Rau thawj-tiam fluoroquinolones muaj xws li tshuaj xws li "Ciprofloxacin", "pefloxacin," "Ofloxacin". Lawv yog cov active tiv thaiv feem ntau pathogens nyob rau hauv lub urogenital system. Qhov kom zoo dua cov tshuaj yog lawv tsis muaj toxicity, ntev ib nrab-lub neej, uas nyob rau hauv lem, tso cai rau koj nqa mus siv rau lawv ob zaug ib hnub twg. Fluoroquinolones satisfactorily taus daim ntawv nyob rau hauv cov zis, mob raum cov ntaub so ntswg, cov ntshav txaus siab concentration. Tshuaj thov ob parenterally thiab inwardly tab sis txhais tau tias "Norfloxacin" (nws yog npaj rau qhov ncauj thawj coj). ob tiam fluoroquinolones (tshuaj "lomefloxacin", "Levofloxacin", "Moxifloxacin", thiab lwm yam) muaj ntau yam kom nquag plias txoj kev kab-zoo kab mob, tshwj xeeb tshaj yog pneumococci. Nyob rau tib lub sij hawm lawv muaj tib yam li yav dhau los tiam ntawm cov tshuaj, muaj zog ua dab tsi rau gram-tsis zoo kab mob (tsuas yog Pseudomonas aeruginosa).

prophylaxis ntawm pyelonephritis

Nyob rau hauv kev txiav txim kom tsis txhob muaj relapse los yog thawj ntawm lub pathology yog tsim nyog los tshem tawm tag nrho cov neeg tham lwm yam. Prophylaxis ntawm pyelonephritis muaj xws li ib tug ntau yam ntawm kev ntsuas. Qhov no yuav muaj xws li cov normalization ntawm noj cov zaub mov, chaw ua hauj lwm thiab kev so, pw tsaug zog thiab wakefulness. Ib tug tsim nyog mob yog tus tsis cais tawm ntawm hypothermia. Kev mloog yuav tsum tau them mus rau lub xeev ntawm lub cev - nws yog ib qho tseem ceeb uas muaj tsis muaj kab mob. Nyob rau hauv no kev twb kev txuas, nws yuav tsum tau rau kev txoj kev kho ntawm cov kab mob: mob plab, caries, gastritis thiab lwm tus neeg.