Bronchiectasis yog dilations thiab kev puas tsuaj ntawm bronchi vim yog kis kab mob thiab mob ntev. Feem ntau cov ua rau muaj xws li cystic fibrosis, lub cev tsis muaj zog, thiab cov kab mob rov tshwm sim. Cov tsos mob tshwm sim feem ntau yog hnoos ntev, hnoos hnoos qeev, ua npaws, thiab ua tsis taus pa. Kev kho mob thiab kev tiv thaiv kev tawm tsam hnyav suav nrog kev tswj hwm cov tshuaj bronchodilators thiab tshuaj tua kab mob, tshem tawm cov kua qaub, thiab kev tswj xyuas cov teeb meem xws li hemoptysis thiab lwm yam kev puas ntsws ntsws vim muaj kev tiv thaiv kab mob los yog kev kis kab mob.

Bronchiectasias yog irreversible morphological hloov (nthuav dav, deformation) thiab ua hauj lwm inferiority ntawm lub bronchi, ua rau mob suppurative ntsws kab mob. Tag nrho cov txheej txheem ntawm pulmonary thiab extrapulmonary hloov nyob rau hauv lub xub ntiag ntawm bronchiectasis yog hu ua bronchiectasis.

Bronchiectasis yuav raug txheeb xyuas thawj zaug hauv xyoo 1819, los ntawm Tus Kws Kho Mob René-Théophile-Hyacinthe Laennec, tus tsim ntawm lub stethoscope. Qhov no yog ib qho txawv txav ntawm ib feem ntawm lub bronchi, vim qhov tshwm sim ntawm kev puas tsuaj rau cov phab ntsa ntawm cov hlab ntsha, ua rau muaj cov hnoos qeev uas ua rau muaj kev pheej hmoo ntawm kev mob ntsws. Qhov no dilation ntawm bronchi tuaj yeem cuam tshuam:

• ntau thaj tsam ntawm lub ntsws: qhov no yog hu ua diffuse bronchiectasis;
• ib lossis ob thaj tsam ntawm lub ntsws: qhov no yog hu ua focal bronchiectasis.

Bronchiectasis tuaj yeem tshwm sim rau txhua lub hnub nyoog. Nws qhov kev nthuav dav nce ntxiv nrog lub hnub nyoog thiab poj niam txiv neej. Txhua lub hnub nyoog ua ke, nws yog los ntawm 53 mus rau 556 tus neeg ntawm 100 tus neeg nyob hauv thiab ntau dua 000 tus neeg mob ntawm 200 tus neeg nyob hauv cov neeg muaj hnub nyoog tshaj 100 xyoo.

Cov prognosis sib txawv. Nrog rau kev kho mob tsim nyog thiab kev soj ntsuam, cov neeg mob bronchiectasis muaj lub neej expectancy. Nyob rau hauv sib piv, cov neeg uas muaj mob loj bronchiectasis, concomitant tej yam kev mob xws li mob ntsws bronchitis los yog emphysema, los yog cov teeb meem xws li pulmonary hypertension los yog cor pulmonale yuav muaj ib tug tsis tshua pom zoo prognosis. Qhov kev kwv yees rau cov neeg mob uas muaj cystic fibrosis yog qhov tsis zoo tshaj plaws, nrog kev muaj sia nyob nruab nrab ntawm 36 xyoo.

Cov tshuaj tua kab mob thiab kev txhaj tshuaj tiv thaiv tau txo qis qhov tshwm sim ntawm bronchiectasis hauv cov teb chaws uas muaj kev lag luam, thaum tus kab mob no tseem muaj nyob hauv cov teb chaws txom nyem.

Bronchiectasis, congenital thiab kis tau

Congenital bronchiectasis yog qhov tsis tshua muaj thiab txhim kho vim tsis muaj qhov tsim ntawm tsob ntoo bronchial. Cov cim histological ntawm congenital bronchiectasis yog ib qho kev tsis sib haum xeeb ntawm cov txheej txheem ntawm bronchi hauv lawv cov phab ntsa.

Lub ntsiab etiological yam ntawm tau txais bronchiectasis yog ib tug genetic txiav txim siab inferiority ntawm tsob ntoo bronchial (underdevelopment ntawm lub ntsiab ntawm lub bronchial phab ntsa), uas, nyob rau hauv ua ke nrog nrog impaired bronchial patency thiab cov tsos ntawm o, ua rau mus tas li deformation ntawm lub bronchi.

Kev tsim ntawm bronchiectasis feem ntau txhawb nqa los ntawm kev hnoos hawb pob, mob ua pa nyuaj, mob qhua pias, mob ntsws, mob ntsws, mob ntsws, mob ntsws, mob ntsws, txawv teb chaws hauv tsob ntoo tracheobronchial.

Cov kev tsis txaus siab tseem ceeb: hnoos nrog cov hnoos qeev ntau, hemoptysis, mob hauv siab, ua tsis taus pa, ua npaws, tawm hws, poob phaus thiab ua haujlwm tsis zoo. Tus nqi thiab qhov tshwm sim ntawm cov hnoos qeev nyob ntawm seb qhov kev puas tsuaj ntawm bronchial. Nws yuav muaj impurities ntawm cov ntshav thiab cov kua paug, ib qho tsis kaj siab tsw.

Tus kab mob no tshwm sim los ntawm exacerbations thiab remissions. Thaum exacerbations, kub nce, ua tsis taus pa luv, hawb pob hauv siab, thiab daim di ncauj xiav tshwm. Tawm tsam keeb kwm yav dhau los ntawm kev kawm ntev, tus neeg mob tus ntiv tes tau txais cov yam ntxwv zoo ntawm drumsticks, thiab cov rau tes - ntawm lub iav saib. Maj mam, qhov xwm txheej ntawm tus neeg mob hnyav zuj zus.

Bronchiectasis feem ntau nyuaj los ntawm pulmonary los ntshav, abscess tsim, kev loj hlob ntawm pulmonary fibrosis thiab emphysema, "cor pulmonale", amyloidosis.

Qhov ua tau ntawm bronchiectasis yog ntau haiv neeg. Qhov tshwm sim feem ntau yog mob ntev lossis rov tshwm sim, tshwm sim los ntawm kev tiv thaiv kab mob los yog kev yug me nyuam uas cuam tshuam rau cov qauv lossis kev ua haujlwm ntawm txoj hlab pas thiab ua rau lawv muaj kev cuam tshuam.

Cov kab mob ua pa (diffuse lossis focal bronchiectasis)

Cov muaj xws li:

• hnoos hawb pob;
• mob qhua pias;
• khaub thuas;
• tuberculosis;
• kab mob ua pa syncytial kab mob, thiab lwm yam.

Mechanical obstructions ntawm cov hlab cua (focal bronchiectasis)

Raws li:

• mob ntsws;
• broncholithiasis;
• mob ntev ntawm cov qog lymphatic;
• inhaled txawv teb chaws lub cev;
• hloov tom qab phais mob ntsws;
• qog ym.

Cov kab mob caj ces (diffuse bronchiectasis)

Kom paub:

• cystic fibrosis;
• thawj ciliary dyskinesia (PCD), ib tus kab mob ntev uas tshwm sim los ntawm kev loj hlob ntawm lub ntsws tsis zoo thaum yug los;
• alpha-1-antitrypsin deficiency, kab mob cuam tshuam rau lub ntsws thiab daim siab.

Immunodeficiencies (diffuse lossis focal bronchiectasis)

Raws li:

• tiv thaiv kab mob tsis muaj zog xws li AIDS;
• l'hypogammaglobulinémie, thiab lwm yam.

Cov kab mob hauv lub cev (diffuse bronchiectasis)

Cov muaj xws li:

• rheumatoid kev mob caj dab;
• mob plab hlaub;
• Crohn's mob;
• Sjögren syndrome;
• systemic lupus erythematosus, thiab lwm yam.

Immun-allergic (diffuse lossis focal bronchiectasis)

Kom paub:

• allergic bronchopulmonary aspergillosis (ABPA), kev ua xua rau cov kab mob hu ua fungus Aspergillus, feem ntau tshwm sim rau cov neeg uas muaj mob hawb pob lossis cystic fibrosis, tuaj yeem ua rau cov hnoos qeev uas thaiv txoj hlab pa.

Bronchiectasis tuaj yeem tshwm sim los ntawm kev nqus cov tshuaj lom uas ua rau muaj kev puas tsuaj rau lub bronchi:

• vapors ntawm cov pa tsis zoo, cov pa luam yeeb (nrog rau cov pa luam yeeb) lossis cov plua plav tsis zoo xws li silica lossis carbon plua plav;
• zaub mov los yog plab acid.

Cov tsos mob feem ntau pib insidiously thiab zoo li yuav maj mam zuj zus nyob rau hauv lub xyoo, nrog rau lub sij hawm ntawm mob hnyav zuj zus.

Cov muaj xws li:

• hnoos ntev, feem ntau cov tsos mob, uas feem ntau tshwm sim thaum sawv ntxov thiab yav tsaus ntuj nyob rau hauv nruab hnub thiab ua kom tuab, profuse thiab feem ntau purulent hnoos qeev. Qhov ntim ntawm cov hnoos qeev tuaj yeem sib txawv, nrog rau nws cov xim (dawb, daj, ntsuab, tsaus ntsuab lossis xim av);
• ua tsis taus pa (dyspnea);
• txog siav;
• lub suab nrov uas tsim los ntawm kev txav ntawm huab cua hauv txoj hlab pa (hheezing);
• pleural zoo li mob hauv siab;
• rov ua npaws;
• qaug zog heev;
• txo qis ntawm cov pa oxygen hauv cov ntshav (hypoxemia);
• pulmonary arterial hypertension;
• txoj cai tsis ua hauj lwm;
• hnoos ntshav (hemoptysis).

Kev mob hnyav yog tshwm sim thiab tej zaum yuav yog vim muaj tus kab mob tshiab los yog ua rau muaj kev kis tus kab mob uas twb muaj lawm zuj zus lawm. Tus kab mob kis tau tus kab mob yog cim los ntawm kev hnoos hnyav zuj zus, ua pa nyuaj, nrog rau qhov ntim thiab purulence ntawm hnoos qeev. Yog hais tias tus kab mob bronchiectasis hnyav thiab ntev, feem ntau poob phaus.

Nrog txoj kev kho mob zoo, cov neeg mob bronchiectasis tuaj yeem nyob ruaj khov rau ntau xyoo thiab tswj lawv cov tsos mob zoo. Kev kho mob ntawm bronchiectasis aims rau:

• tiv thaiv exacerbations;
• kho cov tsos mob;
• txhim kho lub neej zoo;
• tiv thaiv kom tsis txhob kis tus kab mob.

Tiv thaiv exacerbations

• Kev txhaj tshuaj tiv thaiv tsis tu ncua xws li mob khaub thuas txhua xyoo thiab kev txhaj tshuaj tiv thaiv kab mob pneumococcal uas muab kev tiv thaiv tiv thaiv kab mob feem ntau ua rau mob ntsws;
• Kev ntsuas kev dav dav;
• tshuaj tua kab mob macrolides.

Kev kho cov tsos mob

• tshuaj tua kab mob;
• nqus tau bronchodilators;
• Kev ntsuas kev ua pa (mucolytic tshuaj);
• nqus tau los yog qhov ncauj corticosteroids;
• tsawg zaus, kev phais tshem tawm ntawm ib feem ntawm lub ntsws yog tias tus kab mob bronchiectasis cuam tshuam tsuas yog ib feem me ntawm lub ntsws los yog ib feem ntawm lub ntsws muaj qhov mob hnyav uas ua rau muaj kab mob rov qab los yog tso ntshav ntau thaum hnoos;
• kev kho cov pa oxygen yog tias tsim nyog kom tsis txhob muaj teeb meem xws li cor pulmonale;
• embolization ntawm cov hlab ntsha bronchial thaum muaj hemoptysis.

Txhim kho lub neej zoo

• ua pa physiotherapy (postural drainage, lub hauv siab percussion) los txhawb cov kua dej ntawm cov kua qaub thiab mucus;
• kev ua lub cev tsis tu ncua kom tshem tawm cov hnoos qeev thiab txhawb nqa lub ntsws ua haujlwm zoo dua;
• Noj qab nyob zoo;
• humidifying huab cua thiab nqus dej ntsev kom txo qhov mob thiab hnoos qeev;
• Kev ua pa ua pa ua haujlwm rov ua haujlwm tau zoo los txhim kho lub cev tiv thaiv thiab txo qhov cuam tshuam ntawm cov tsos mob thiab cuam tshuam rau lub cev thiab kev xav ntawm lub neej niaj hnub.

Tiv thaiv kom tsis txhob kis tus kab mob

• pab txiav luam yeeb;
• txhaj tshuaj tiv thaiv;
• tshuaj tua kab mob.

Advanced bronchiectasis hauv qee cov neeg, feem ntau yog cov neeg mob cystic fibrosis, tuaj yeem kho nrog lub ntsws hloov pauv. 5-xyoo kev ciaj sia yog nyob nruab nrab ntawm 65% thiab 75% rau kev hloov pauv lub plawv-lub ntsws lossis ob lub ntsws hloov pauv. Lub ntsws ua haujlwm feem ntau txhim kho hauv 6 lub hlis thiab kev txhim kho tuaj yeem txuas ntxiv mus ntev li 5 xyoos.

Kev kho mob niaj hnub tactics

При бронхоэктазе назначают современные антибиотики класса макролидов, чтобы подавить патогенную макролидов, чтобы подавить патогенную ликрокр ранения рефлекторных спазмов мелких бронхов. Также эффективны муколитики, разжижающие слизь и облегчающие ее откашливание. Чтобы купировать воспаление, при лечении бронхоэктаза показаны гормональные средства. Для активизации собственных защитных сил организма в терапевтическую схему включают иммуностимуля.

Ключевая процедура консервативного лечения бронхоэктаза — санация бронхиального древа (очистка прострос с последующим введением антибиотиков). При признаках кислородной недостаточности назначают кислородотерапию. Больному также назначают комплекс упражнений, способствующих эвакуации бронхиальной мокроты, и вибраций tsi. Для общего укрепления организма показаны:

• cov calorie ntau ntau - 3000 kcal ib hnub;
• kev noj zaub mov - kev noj zaub mov zoo uas muaj cov khoom noj muaj txiaj ntsig zoo;
• vitamin kev kho mob.

Muab qhov irreversibility ntawm cov txheej txheem, thiab, yog li ntawd, lub futility ntawm conservative txoj kev kho, tsuas yog radical txoj kev kho mob bronchiectasis yuav tsum tau txiav txim siab phais, qhov ntim ntawm uas nyob ntawm qhov kev sib kis ntawm bronchiectasis.

Rehabilitation, tiv thaiv, muaj peev xwm txaus ntshai

Ib qho tseem ceeb ntawm kev kho kom rov zoo rau bronchiectasis yog kev kho lub neej. Tus neeg mob yuav tsum tau taug kev hauv huab cua ntshiab, tsis txhob haus luam yeeb thiab tsis txhob haus luam yeeb, noj zaub mov kom zoo, ua kom muaj zog, thiab ua pa ua pa tsis tu ncua.

Nws yog ib qho tseem ceeb uas yuav tsum tau sau npe nrog tus kws kho mob pulmonologist, koom nrog kev tiv thaiv kev teem caij nrog ntau zaus los ntawm tus kws kho mob, thiab, yog tias tsim nyog, kawm cov kev kho lub cev. Kev tiv thaiv zoo muab kev kho mob raws sij hawm ntawm cov kab mob ua pa thiab ua kom tawv.

Yog tsis muaj kev kho mob txaus ntawm bronchiectasis, bronchitis ntev, pulmonary thiab plawv tsis ua hauj lwm, cor pulmonale, thiab bronchial hawb pob. Cov neeg mob tau txo qis kev ua haujlwm thiab lub neej tsis zoo. Nws yog ib qho tseem ceeb heev uas yuav tau sab laj nrog kws kho mob raws sij hawm kom ua tiav qhov kev tso cai mus ntev.