Ko te mate pukupuku o te mate ka horahia: nga tohu me te maimoatanga

vai Tino kino, me te whakamate kohi mate i runga i te manomano tau whenua, kia rite ki kitea e maha ngā whaipara tangata, me ngā tuhinga o mua. I roto i te ao i teie mahana ia tau e te reira te rarangi o nga patunga o e pā ana ki 10 miriona iwi, 25% o nei mate.

Ko te puka tino kino o te mate - mate kohi pūkahukahu tohatohaina, e te tikanga multifocal, "ringihia atu" i runga i ngāwari katoa. Tangohia ake te mate ko te tino ngāwari, rite te ara o tona tuku extraordinarily ohie, a he tata e kitea tohu i roto i te tīmatanga o te wāhanga. I roto i te meka, kitea te mōrea o kirimana ia o tatou te ki nga ra, engari Waimarie, Ko te ahei o te whakawhanake mate kohi e kore nga tinana. Ki te hoatu tonu koe i te tātaritanga whakamataku, e kore te mahi hepohepo, no te mea kua takahia pūtaiao inaianei kia tae noa ki ki te whakaora rawa he taea noa tohatohaina kohi pūkahukahu. e kore e hiahia ana te reira ki te nunumi atu i inspections mahi, me te ki te noho fakamākukanga i te mātanga TB te rongoā. mea ratou i taua matauranga o nga pakaritanga me ngā ngoikoretanga o te hoariri - e te 50% wikitoria. Na kia kite a he aha te mea te reira kohi, te wahi i haere mai ai i a pehea ki te whawhai i te reira.

Bacillus tubercle

kohi tohatohaina o te pūkahukahu meinga e kaiao mōkitokito, ka karanga mycobacteria. tīari ratou i runga i tenei ao mō ngā miriona o nga tau, engari i anake kitea i roto i te 1882 e te rata, me te pūtaiao Koch, i roto i tona honore, a huaina ratou pera - te Bacillus Koch. mycobacteria pathogenic katoa (haapotohia rite MKB), i reira e 74 ngā momo, 6 o e taea meinga kohi i roto i te tangata, me te kararehe. i huaina haohao no o te ahua, tino tokotoko-ahuahu. Kei te tino hāngai ētahi mycobacteria, etahi paku kōpiko, a to ratou tokorua i te roa o i te 1 ki te 10 micrometers, me te whanui - e pā ana ki 0.5 microns.

He āhuatanga ahurei o ratou ko te hanganga o ratou taiepa, kiriuhi ranei. Te kore te haere ki kōrero, mōhio tatou e ko te reira i roto i te rakau taea Koch ki a ratou mutate maha mure o ngā wā, ki te tiaki ia ratou i pirinoa whakamate hoki te mahi i ētahi atu paturopi me matatau te tu atu i te taiao kaikiri. whakamahia angitu ratou ara bacteriophages, e ko te raison d'être - ki te tiaki i te tinana ki microorganisms pirinoa. He whenumi, e kore e Bacillus o Koch mate, ka whakarerekē i te macrophages kia ratou ngāwari tā me te kupu e kore e wātea mō ngā pūnaha haumaru o tona rangatira. I roto i te mau parau te tahi atu, Bacillus o Koch ki te whakamahi i korero pūtau o to tatou tinana whakatinana reira pai.

Kia i te pūkahukahu o te tangata hauora, enei pirinoa hanga he aronga kotahi tuatahi (kohi tuatahi), engari i muri i te toto tīpona me / ranei tohaina ki runga i te wāhi nui o tetahi ranei pūkahukahu e rua, me te tahi atu romahā kupu whakawhanake tohatohaina kohi pūkahukahu. I raro i etahi huru kia whakawhanake i te reira noa i muri i te mate kohi tuatahi tukinotia, rite Bacillus o Koch i roto i te puka tautauā noho i roto i te tinana mō ngā tau e maha.

Te ara o te mate

kohi pūkahukahu i roto i te tangata meinga toru ngā momo o te huakita - M. kohi (momo tangata), M. africanum (momo takawaenga) ko M. bovis (he momo o te kararehe). Ko te whakamutunga, ko te kararehe atu mate, ka ki te tangata e tuku i te reira i te waiu unpasteurized.

He tokomaha e hiahia i roto i, he ma'i pee e kore ranei tohatohaina kohi pūkahukahu. Ko ohie te whakahoki: ko reira rawa ma'i pee, ki te puritia ki te tuku o rakau Koha (tubercle bacilli).

haere mai ratou i te tangata e mate ana ki te hauora ano faahiahia ohie:

- Ka taea e te hau ratou i te rangi;

- ki te huware (hei tauira, mā te maremare, kihi);

- i roto i oko whakamahia e te manawanui;

- i roto i ngā tūemi whare;

- i te whaea - kukune;

- ka whakamahi i iti rawa te oneone mea hauora.

Ka rite ki a koutou e taea te kite, e taea te whiwhi koe TB ki hea: i roto i te waka tūmatanui, i roto i nga wahi tūmatanui, i roto i ngā kura, i te mahi, me te pera i runga i.

Nui: Koch Bacillus fantastic tenacious. pupuri ratou o ratou āhuatanga mōrearea i waho te tinana tangata mo te wa roa. Tenei ko te torutoru tauira o te āhua o te Bacillus Koch ora i roto i ngā taiao e fehangahangai tatou i nga ra:

- i roto i te wahi pouri, kahore hoki te rā - ki runga ki te 7 tau;

- i roto i te sputum manawanui maroke (mahue i runga i ngā kaupapa katoa) - ki runga ki te 1 tau;

- i roto i te puehu i runga i te huarahi - ki runga ki te 60 nga ra;

- i runga i nga wahi o putanga te nene◊iraa - ki runga ki te 3 marama;

- wai - e pā ana ki 150 nga ra;

- i roto i te waiu unboiled - e pā ana ki 14 ra;

- i roto i te tīhi (hinu) - ki te tau.

He reira taea ki tōraro whakahoki te pātai o tohatohaina kohi pūkahukahu te ma'i e kore ranei? Pea ki te Bacillus reira Koch i te taiao, ngāwari whakangaro? Kia aroha mai, Ko te tino uaua ki te whakamatea enei mycobacteria. Ngā mihi ki tona taiepa pūtau ahurei, e whakauaua pāngia ratou i te rā, hihi katinga radiation, waipiro, hauwaiwaro, waikawa, kawakore, he maha disinfectants, dihydrate, a ka kohua ki ngā kaupapa e kore sputum huaketo i mate rite nui rite 5 meneti. Ki te taea e whakawhanake Bacillus o Koch i te tinana o tetahi tangata, e kino ia kohi nga tangata katoa o te ao whenua.

rōpū mōrearea

I mua i tau kura, tangohia te nuinga o ngā tamariki ki runga rakau Koch, engari ueue kohi pūkahukahu ranei tetahi atu whanake ngoikore anake, tamariki e mate ana. He he ano hoki ngā te rōpū mōrearea:

- He tūturu tangata i roto i te whakapā tata ki te tūroro TB;

- Iwi ki wātea i te mate iti;

- HIV-huaketo;

- immunosuppressants tango;

- taiohi me te iwi waenganui-koroheke i roto i te wā o ngā huringa hormonal;

- fiekaia;

- e mate ana i kohi o te kiri, me te tahi atu whēkau;

- Kua whakawhiti mate hopuhopu;

- bolevshie kohi pūkahukahu tuatahi, me te tukinotia;

- whakawhānui etahi ngā tukanga physiotherapeutic roa (hei tauira, kiripaka).

whakarōpū

Ka taea e te whakawhanake tohaina kohi pūkahukahu i roto i te ara e whai ake nei:

1. bloodstream (hematogenous). I roto i tenei take, kua pāngia pūkahukahu e rua. E tomo te bloodstream taea e te huakita i roto i te taikiri, gon whitiki, i roto i te ngakau tika me te iahoki pūkahukahu.

2. waitinana (lymphogenous). I roto i tenei take, te pāngia tetahi tana pukapuka.

3. Limfogematogenny.

Na roto i te āhua o te mate wehewehe kohi pūkahukahu ueue te puka e whai ake nei:

- koi (miliary);

- subacute;

- ma'i;

- te whakatakiruatanga o. Mō tenei puka o te mate e mea ana ka, hoki mea katoa take, nga oko toto puta tirotiro pakaruhanga o te Mycobacterium tīpona kōpuku pā, te hanganga o nei ko te cheesy (caseous). I roto i tenei take, i te wa ano ko te nui nui o te toto i roto i nga rakau Koch. Aua'e, tupu te reira pinepine.

Ko te puka whakapeka o mate kohi

tīmata te mate koimutu, kitea rawatia ake, he tino kanapa nga tohu, he bit rite kakā. hāngai ana tātaritanga te i runga i te taputapu o te pukapuka, me te microbiological tātaritanga o sputum. āhuatanga koi tohatohaina kohi pūkahukahu e te aroaro i roto i te kiko pūkahukahu o maha iti (e pā ana ki te mirimita) hillocks Ahakoa witi rai. No reira, ko te ingoa tuarua - "miliary (milae i Latin te tikanga" rai ") kohi." Te manawanui ke hanganga capillary tuatahi i roto i nei ngaro collagen te, a he legkopronitsaemymi nga taiepa, e tika ana ki te kătahi o mycobacteria i rere toto ki te pūkahukahu. Tohu o tenei ngā:

- he peke koi i roto i te pāmahana ki te 39,5-40 tohu ° C;

- ngoikore, rohirohi, rohirohi tiketike;

- pini tere;

- kore o hiahia;

- karawarawa o te ngutu, me maihao;

- yellowness o te kiri;

- whakapairuaki ki ruaki;

- ānini;

- mare maroke sputum production, i roto i te tua ki hūpē me te pirau he koputaputa toto ranei;

- hāhā o te manawa.

I te tahi taime i reira he he mate te ata korerotia, noa ngaro ia mahara.

puka Subacute o kohi

Puta reira ka horahia te mate ki nga oko nui toto (uaua, me te intralobular pera interlobular). I roto i tenei take, kitea pāpaka ake ki te 1 cm te whānui. E tū ana te nuinga i roto i te wāhanga o te pūkahukahu, i reira e rave rahi o te tōiti me oko waitinana. Na roto i te āhua o te pāpaka proliferative, inflammations me pukupuku waho, engari ratou e taea e arahi ki te mumura i roto i te kiripūkahu visceral.

kia rite Tohu o momo subacute o TB maha atu mate e haafifi i tātaritanga haumanu. I roto i te hakari matua e whai ake nei:

- rohirohi, ngoikore;

- pāmahana i te taumata o 38 ° C;

- he mare ki sputum.

kohi ma'i

Ko tēnei puka o te mate puta ina te tino ora te manawanui tuatahi (hou) kohi. I roto i ngā take pēnei i, Mycobacterium toutou mā te bloodstream tīpona ranei i te aronga tuatahi taka ki wāhanga hou o te pūkahukahu, hua i roto ia ratou i reira he aronga maha o ngā rahi (i te iti rawa ki rawa nui) o ngā āhua rerekē me ngā tauira. kia waiho ratou calcified me te tino hou, ki te pikitia kanapa inflammatory. pāpaka Kitea i roto i pūkahukahu e rua. pikitia matekiri tāpiri emphysema, kakakīrehe o te kopa ngā i roto i te pūkahukahu, scarring pleural. Otiia, ma'i kohi pūkahukahu tohatohaina kia waho e kore e whakaatu ake, i roto i te hononga ki nei tino maha kitea reira i roto i fluoroscopy. Tohutanga o te puka ma'i o te mate kohi ko e whai ake:

- rohirohi;

- mate o hiahia;

- emaciation;

- pāhoahoa auau;

- ara poauau o te pāmahana (episodically);

- mare.

kohi tohatohaina: wā

Mua i whakaaro ai e te wā mate ahau puta i roto i nga matamata o runga o te pūkahukahu, II - i roto i te waenganui, ko III, a kua tae mai ki te raro. Muri mohio hē tenei whakarōpū, mai te wāhanga o tenei mate kia rite puta i roto i wāhanga katoa o te pukapuka. Ki te rā, titore te wāhanga e whai ake nei o te mate kohi pūkahukahu:

- Alopecia;

- kookuhutanga;

- te tiango;

- Office + (puka tuwhera o kohi);

- MBT- (katia).

mate kohi tohaina i roto i te wāhanga kookuhutanga MBT + tikanga te akoranga mate ki te tuku ki te taiao o te mycobacteria. Ko te tohu matua - he mare ki production sputum, rawa, ki te kei reira pirau, me te toto.

wāhanga Alopecia te nuinga huru o te mate kohi tuatahi hou ranei. Kei te āhuatanga i te reira e te meka i pā ki te anake tokorua ara kotahi wāhanga ranei. I roto i tenei āhuatanga ruma iti (ki runga, ki te 1 cm te whānui). puta tenei wāhanga, kahore tohu me kitea, nuinga ki te pakeke ako marama (x-ray, fluoroscopy).

kohi tohatohaina: te wāhanga o te kookuhutanga me te whāwehe

whiwhi te huru taua o te mate e kimi ona materoto (manawanui mawehe whakahauanga fluorography mahinga ā-tau, e kore unu ki ngā tākuta, ka te tohu tuatahi o te manukanuka, whai wāhi whaiaro medicate-ranei whakamahi e te tikanga rongoā iwi rawaka te whai hua rite te maimoatanga tuatahi). te tikanga mimiti wāhanga e tae te Morphology o pāpaka i roto i te pūkahukahu i te wāhi i ai timata te kikokiko ki te fatifati i, hanga he poka rawa tūturu. Kongakonga o te kiko nofo ki mare e haere ki waho. E whakauruurutia ratou ki hūpē pirau, me te toto. Ano, taka enei mongamonga ki te kore ano kitea ki te mate o wāhanga pukapuka, hua i roto i te matomato tonu o te mycobacteria. Tūroro ki te tātaritanga o tohaina kohi pūkahukahu i roto i te wāhanga o te mimiti, ko te puna kino o te mate ki ētahi atu, ka riro nei ki raro ki te hohipera herea. Maimoatanga i roto i te hōhipera i ratou i te roa, ki runga ki te ono marama. Ka rite ki te hua, nofo pāpaka rongoatia (calcined).

Kei te kitea kookuhutanga wāhanga hoki i roto i te akoranga whakamua o te mate, engari i roto i tenei take i te marama ko kore te parariraa o te kopa puta. Ko te tikanga kookuhutanga - he wahi (pokapū), i roto i nei i reira ko te mumura. Kei te neke i te wahi taua te rota o leukocytes me lymphocytes, me tohu haamana'oraa o te kakā whakapeka. Tohaina kohi pūkahukahu i te wāhanga o te kookuhutanga kua nga tohu e whai ake nei:

- he ara koi i roto i te pāmahana ki teiteiraa teitei;

- ngoikore, rohirohi;

- mamae pouaka;

- mare;

- tohu o te tāoke;

- ānini;

- te tahi mau taime te vaivai o te mahara.

Te kore maimoatanga tere tīmataria i te pae o te kiko kookuhutanga timata ki te fatifati i. coughs atu ratou i te manawanui ranei i te tukanga o te maremare nuku ki te marama tuarua, e te tino hohoro kia huaketo kiko hauora mua. Kohi i roto i te wāhanga o te tiango me kookuhutanga o kahore anake mahi wehe mōrea tiketike o te mate ki etahi atu, engari ano hoki mate mo te manawanui.

tātaringa

Ehara i te mea ohie ki te whakapumautia tonu te manawanui ki te mate kohi tohatohaina. he uaua tātaritanga no te mea he tino rite nga tohu o tenei mate, me te kakā, te mahaha, ara mate pukupuku metastatic. A, no te karanga koutou ki te manawanui ki te whare hauora amuamu o rohirohi, mare, nui korokoro, ngoikore, hāhā o te manawa takoto te tākuta kei te ki tirotiro i te kiri mo te aroaro o te scarring e kia noho i whēwhē myocardial o mua, lymphadenitis. te korenga i hoki te hangarite o te pouaka (kore te reira, ki te whakawhanake i TB i roto i te kotahi pūkahukahu), tirohia te mamae me te uaua mānukanuka i roto i te whitiki pokohiwi. A, no te whakarongo ki te pūoko whakaroto heheu pukapuka, ahakoa wheezing ko, he aha ratou wāhi me te huru. Ko reira whakahauanga ki te mahi i taiwhanga whakamātautau o sputum mo te aroaro o mycobacteria. I roto i ētahi wā, tūroro tango i te ako o horoinga arahau, puku o te wai (te tikanga i roto i ngā tamariki) ranei. I tua atu, kia ngā whakamātautau taiwhanga:

- bronchoscopy;

- sputum pani Microscopy;

- unuhanga o te kiripūkahu;

- thoracoscopy;

- poka pleural.

Ko te tino whānui whakamahia me he tika rangahau fluoroscopic.

Treatment me te waitohunga

Ki te mea kua pāngia te tākuta "mate kohi pūkahukahu tohatohaina", ka waiho i te maimoatanga roa, me te matamaha. Tei te waitohunga i runga i te wāhanga i roto i i kitea te mate te, me pehea te pai te manawanui mahi whakahaunga o te tākuta. I roto i tetahi momo o te + wāhanga pūkahukahu i roto i MWT manawanui falemahaki te. I roto i te hōhipera nuinga kawea therapy tarukino (hahau) arā, o taero anti-kohi, therapy tinana, huaora, whakaū wātea i te mate.

kawea hahau i roto i tūroro hou pāngia i roto i te wāhanga kaha o te maimoatanga i roto e whai ake taero anti-TB, "Iziniazidom", "rifampicin", "pyrazinamide" me "ethambutol", me i roto i te wāhanga tonu o te maimoatanga - "isoniazid" me "Rifampicin" ranei "isoniazid" me "ethambutol ".

I roto i te koi whakaatu kohi parareraa te whakamahi o corticosteroids me immunomodulators. Ko te tino pinepine whakaritea "prednisolone" (15-20 mg / ra hoki 6-8 wiki).

Duration o te maimoatanga - ki runga ki te 6 marama. Ki te i roto i te 3 marama o kore e kite i te au ki te whakapai ake, me te he maha o te tahi atu tohu e whakamahi pokanga tā te tango o te wāhanga pūkahukahu kotahi ranei te marama i roto i te whānui.

Ko wai ka whakamahi i te maimoatanga hou mo te mate kohi, ka karanga "bronchoblocation piha", ranei noa "bronchoblocation", i te mea he rerekē ki te pokanga.

ārai

whakaaro kohi pūkahukahu te he mate pāpori, te horapa o te mea te nuinga ti'aturi i runga i te kounga o te ora (tikanga ora, hekenga, te taviniraa i tona whiu i roto i te whare herehere, a na i runga i). Ka rite ki āraihia, rawa hoki te mate kohi pūkahukahu tohatohaina, e taea te huaina:

- irava obligatory o x-hihi;

- e mau ana i roto i mehua mana;

- werohanga BCG;

- te tohatoha o moni kāwanatanga mo te maimoatanga o te tūroro ki te kohi;

- mau tonu te kaha (hākinakina), āhua hauora;

- te wahi o tūroro oti maimoatanga o te mate kohi rahi.