Utano, Zvirwere uye Conditions
History of COPD chirwere. Kupatsanura pakati COPD. Chisingaperi bapu chirwere
Pari, zvirwere kufema ino kuwedzera zvakajairika. mamiriro ezvinhu aya Zvechokwadi, vanachiremba anovhundutsa. Ivo vanoti kuti vanhu ihombe pamusoro utano hwavo.
Mana COPD
Nyanzvi International iri kufambira mberi COPD kusiyanisa nzendo dzakawanda:
- Grade 0 (haisati chirwere). Ndiyo kutanga kwekupwanyiwa iyo pane mukuru pangozi COPD, asi kutya hakusi anoruramiswa. Kazhinji Man vangakosora uye vangakosora kukwira phlegm. In kupatsanura iri COPD ari ichangotanga. Chii chinotevera?
- Degree I (nyoro weboka chirwere). Dzinoratidzwa duku obstructive kuchinja, kuramba chikosoro uye expectoration kuti sputum.
- Degree III (kwazvo nzira chirwere). Anowedzera mhepo kuyerera akavarambidza kana munhu exhales. Murwere achiri zvakawanda kudzipwa panguva mumuviri nesimba uye exacerbations kuitika kakawanda. Panguva iyi kufema vanhu maitiro kunogona kuva nengozi zvikuru.
- Degree IV (kwazvo nzira chirwere). Dzinoratidzwa kunzwisisa mufananidzo Árbol mhingaidzo, izvo kazhinji vaityisidzirwa norufu. Pane kufema kukundikana, pane pulmonary mwoyo.
Mabatirwo COPD
Zvipatara urwere pakutsvaga mwero kwayo kunzwisisa. Zvinofanira kunzwisiswa pachena kuti mishonga anobvumira chete sipidhi kuchinja kuti chirwere, uyewo kuti panguva yakatsiga. Kana musingadi kubvisa zvinokonzera kuchiita chirwere (somuenzaniso, midzanga), mishonga urege kuuyisa unodikanwa zvabuda. A pamazita mishonga, nokuwanda uye mukana tichibatanidza nevamwe pharmacological nzira anosarudza chiremba. On zvirwere zvemapapu unyanzvi pulmonologist. Zvikurukuru, inozivikanwa kuti kupatsanura pakati COPD, sezvo anoziva kubata zvirwere izvi.
Zvipatara mwero chirwere nekuomarara
Kana kuonekwa zviratidzo breathlessness murwere angada kushandisa inhaled bronchodilators. Chiremba anogona mishonga zvinotevera mishonga: "Salbutamol" "Ventolin", "Berotek", "terbutaline", "fenoterol". Asi havagoni kutora vane tachyarrhythmias, UPU, decompensated cheshuga, yemaziso, myocarditis, kutsemuka stenosis, uyewo hyperthyroidism. Murwere haagoni mushonga kupfuura nguva mana pazuva. Unofanira kuzviita kakawanda. COPD chirwere, mishonga rinoitwa kusvikira pakufa murwere, zvinoda mutoro mafungiro.
Zvakakodzera zvakanaka kuita inhalation. Kana vakanyorwa kekutanga kurapwa ino, unofanira kuita kwokutanga nzira pamwe chiremba kuitira kuti iye nezvengozi zvichibvira zvakaipa. inhaled Medicament chinodiwa mumuromo (Kubayiwawo jekiseni) chaizvo pamukova pamwero: nokuti zvasvika chaiyo principales, uye kwete kuwira huro. Mushure nzira, unofanira kubata mweya wako kuti mweya uye ugare sezvo 5-10 seconds.
Zvokuita kana uine mwero zvikuru chirwere?
Pano hakuzovipo mishonga yakakwana nachiremba zvine mwero COPD. Kunze kwavari, unofanira kutora mishonga hunowedzera principales uye refu nokuita. Nguva dzose unofanira kutenga kwavari. Broncho-pulmonary chirwere rinowanzova dzinodhura.
Kunyanya, zvinodhaka "Serevent" riri basa. It anogadzirwa muchimiro metered dose inhaler. The optimum daily chipimo chemushonga nevakura - 50-100 MG kaviri pazuva. Inhalation zvinofanira kuitwa achiita zvaidiwa mirau yose.
zvakakomba chirwere
Panguva iyi, munhu anoda kuramba Anti-anogumbura kurapa. Nyora kunze mwero uye yakakwirira dosages ose glucocorticosteroids kuti inhalation. Raakapiwa anotevera mishonga :. "Beclason", "benacort", "Fliksotid", "bekotid" "Pulmicort", etc. vari kugadzirwa muchimiro metered aerosols kana inhalation zvinogadzirisa jekiseni kupinda huro kubudikidza nebulizer. Zviya, iri nyore chaizvo zano. Kana uine pulmonary chirwere (COPD), unogona kutenga nayo.
Uyezve, panguva iyi chirwere mishonga vakavhengana anogona kupiwa, izvo zvinosanganisira refu-kuita zvinodhaka uye kuti anonzwira principales uye corticosteroid nokuda inhalation. Chiremba wenyu anogona kushandisa mishonga "Symbicort" kana "Seretide". zvinodhaka Mixed pari vaiona inonyatsobudirira mishonga kuti kurapwa kwezvirwere zvemapapu chaipo. Chaizvo kutarisirwa. Chirwere zvirwere zvemapapu chingamise kukura dzavo kushandiswa.
Kwazvo pavaipfuura COPD: zvokuita?
Kuwedzera kune zvinodhaka ushandiswe nokuda kwazvo padariro chirwere, zviri akawedzera okisijeni kurapa (inhalation mhepo ine yakawanda okisijeni, kuitwa nguva dzose). Nokuti nzira iyi, muzvitoro kuti kutengesa mishonga, kana ari makuru Pharmacies zvinogona kutengwa sechinhu panzvimbo yakakura mudziyo nokuda akazvimirira kuvhiyiwa, uye magaba diki. Ekupedzisira anogona kutora newe mumugwagwa uye kushandisa, kana rwunotanga hakutombonzwiki kuperevedza mhepo. Asthma - COPD, uye upenyu pamutanhiko, saka iwe nguva dzose kutakura anozvigona.
Kana munhu haasi akwegura kwazvo uye vari inogutsa chimiro, zvinokwanisika kuita kuvhiyiwa. Panguva yakaoma ezvinhu omurwere vangada zvokuimba kufefetedza.
How kudzivirira kukura COPD?
Kudzivirira zvirwere kufema hurongwa kunokosha chaizvo. Wokutanga zvakakura chiito zvainanga kudzivirira zvirwere zvemapapu ndiyo kubviswa kwayo upenyu midzanga. chiyero Izvi zvakabatsirawo kudzivirira zvirwere, uye kumisa kukura chirwere vakatotanga. Kana basa rako riri chokuita chero firimu, apo nguva dzose kuenda ikoko chaizvo nesimbi aerosol kana maindasitiri guruva, iva nechokwadi kushandisa kushandisa unodzivirira michina. Asi inonyatsobudirira nechiyero kudzivirira chirwere - kudzingwa inokuvadza basa. In zvirwere zviri kufema ezvinhu, unofanira kubva nguva nenguva kuenda chiremba uye aongororwe.
Example chirwere nhoroondo
Vaya vanofarira COPD, nhoroondo yezvokurapa yokurapa zvingaita kuziva. Ngatimboonai muenzaniso.
I. Information kubva pasipoti
1. Yomurwere zita: Sergeev Vladimir Kuzmich.
2. Patient Gender: Male.
3. Age: '53.
4. Location: Omsk, Ul. Red Road, 18/7.
5. Cumview.
6. nhamba uye nguva yokusvika kuchipatara: 19.02.2014 pa 14:55.
7. Musi kusiya muchipatara kana kune imwe kiriniki -.
8. Ndiani akatuma murwere: nevaye amburenzi vashandi.
9. Dambudziko iri tsika kuti kurwira murwere: munharaunda-vakatodzidza zvakanaka madziro lobar nemabayo.
10. chirwere ari kubvuma: kufema insufficiency wokutanga Danho. Right madziro lobar nemabayo, munharaunda yakawanikwa.
II. The chikuru zvichemo murwere
Murwere inoshuma kuti ake tembiricha muviri rinosvika 39,5 ° C. Uyewo, nguva yose kukosora uye anonyunyuta kuti serous madzihwa kuti chinonetsa otharknut. Izvi zvinogona kuva chiratidzo kune kufema hurongwa.
III. Secondary murwere kunyunyuta
Murwere hanya prostration, zvakawanda zvive, muviri nekubvunda, nekusagona zvakanaka basa ravo, vangadikitira, migraine.
Yakaitwa of kufema hurongwa
Dyspnea: kunoitika kana kurovedza muviri unobatanidzwa hunhu.
Chikosoro haagumiri yose zuva, mune mwero dzinounzwa mucous expectoration. Zvakaoma otharknut.
Sputum: ipapo, slimy, rinorema expectoration, ¼ mukombe zuva, haina kuvimba nenzvimbo murwere, munhuwi wake unremarkable (sezvo kwakaratidzwa zvirwere zvakawanda kufema).
IV. nhoroondo zvokurapa
The chirwere vakatanga pakarepo February 13, 2014 pashure refu vari chando apo tembiricha murwere akasimuka 39,5ºS uye paiva yakaoma chikosoro. Murwere haana kunwa mishonga. Mazuva maviri gare gare chikosoro akanga atova nyoro uye rinorema sputum expectorated. The tembiricha zvakare kumbochinja kwamazuva mana. February 19, 2014 murwere akadana amburenzi uye akaiswa kuna Omsk guta centre chipatara. Akanga nechirwere munharaunda vakatodzidza zvakanaka madziro lobar nemabayo. Murwere hazvina kunyoreswa. Akati kuti kare haana chero zvirwere kufema ezvinhu, kuwedzera chakasimba kufema chaikonzerwa noutachiona. Izvi rinogumisa nhoroondo mwero COPD chirwere.
V. Patient Life
Sergeev Vladimir Kuzmich akaberekwa muna 1961 muguta Omsk. Aiva mwana nevabereki vake vokutanga. uremu Its pashure pokuberekwa kwakanga 2700 Amai murwere panguva yaakaberekwa aiva nemakore 20 okuberekwa, uye baba vake - 28. The murwere akanga breastfed. In kirasi yokutanga akaenda paakanga 6 nemakore. Ndakadzidza ainyanya mana. Pashure chikoro akapinda kukoreji. Akadzidzisa somunhu muvaki.
Information pamusoro basa. Murwere akatora basa pazera 22, akava muvaki. Njodzi: basa mumugwagwa, guruva, uye mumuviri nomupfungwa zadzisa. Kasiri kare, akarega basa rake.
ezvinhu zvipenyu zviri muupenyu. The pfuma ndiyo murwere yokurara mufurati muchivako kubva chidhinha. Pamberi chidzoke ari kufema ezvinhu, akagara ikoko chinyararire uye haana kutarisira dambudziko.
Vairwara somwana, haachayeuki. Mishumo kuti kamwe vakatambura chakasimba kufema kutapukirwa noutachiona. Kutaura kuti havasi kurwara kana tibhii kana pabonde kana kana hepatitis.
VI. The kudzidza muviri
The vakawanda ezvinhu omurwere anganzi mwero, zviri kushingaira chinzvimbo, uye kuziva - kwete zvikanganiswe chinhu. Zvaanoita chiso chake dzose, kuratidzirwa paranoia uye schizophrenia havasi kuchengetwa. Easy gait. Vaka inogutsa. Maererano bumbiro iri normostenik. Kukura pamutsipa, maoko nemakumbo vari Proportional kuti muviri urefu. Urefu - 165 cm; uremu - 73 makirogiramu. Murwere ane muviri yakawandisa uremu, kufutisa kungava pasina kutanga.
System inooneka mucous membranes uye ganda
Leather chiedza vaaleanpunainen Hue, mucous membranes, kuwanika rokuongorora (meso, miromo, mhuno, muromo) zvimwe ruvara. Chinorwadza pigmentation kuwanikwa. Skin zvakakwana kwakavharwa nenyama. Pane imwe turgor. mwando ganda kunowanikwa. Zvaive munguva kuferefeta nezvokukanganisa vakawanda edema yakawanikwa. Muviri hapana rashes, hapana mavanga, hapana peeling, hapana anoratidza kubudikidza ganda capillaries.
Kuongorora pechipfuva
Thorax rinoreva normostenicheskaya mhando. Epigastric angled ndiyo yakarurama. Held zvakasimba ake pachipfuva mashizha. Zvekufamba micheto ndiyo yakarurama. Kuoneka nemaburi pavo. Bondo pamwe kunotsanangurwa, muduku vanooneka makomba pamusoro uye pazasi pavo. On chipfuva pachena hapana asymmetrical anorovera kana concavities. Scoliosis hazvitaurwi.
Nhema abdominal palpation
Pamusoro pemvura, inoda kufunga murwere tisina kusanzwa, mudumbu dzamutswa, kwete kuchengetwa chero pavanenge tsandanyama kana heniya bulges. Chiratidzo Shchetkina-Blumberg haina yasimbiswa. Inguinal uye achiine rukuvhute mhete anowanzoitwa.
The pakuonekwa mudumbu pamwe murwere avete shure kwake
Mudumbu sokuti yakakura nokuda zvakakora subcutaneous zvinyama, chimiro chayo romuzvarirwo, zviri symmetric, apo kufema rinobuda. pakanga pasina kuti munhu peristalsis kuwanikwa. Pane venous samambure pasi ganda kumativi mudumbu uye vakakomberedza guvhu. Kusabvumirana rectus tsandanyama uye hernias kuwanikwa. The umbilicus kwaswedera.
VII. A presumptive kuongorora chirwere
Pahwaro nyaya murwere, nhoroondo chirwere, mashoko pamusoro upenyu uye chinangwa pakutsvakurudza murwere inogona kuisa inotevera presumptive chirwere nemabayo repasi mugove rwerudyi zvemapapu, inova munharaunda-yakawanikwa. The chirwere zvine mwero. Panewo kuomesa, kureva munhu wokutanga Danho kufema kukundikana. Uyezve, nhoroondo COPD chirwere kunogona kuita zvakawanda mhedziso inokosha.
VIII. The kutevedzana nokushivirira kuongorora
1. Complete count ropa.
2. Ultrassom kuongorora nhengo dziri mukati abdominal mhango.
3. Kuongororwa nemakemikari omuviri ropa (mapuroteni, urea, shuga, creatinine).
4. Total weti.
5. Blood Wasserman.
6. Electrocardiogram.
7. Radiography nhengo iri pachipfuva.
8. mutsvina yadzo kuvapo honye.
9. Bacteriological kuongorora sputum.
XI. Yokupedzisira chirwere chacho tsananguro
Pahwaro nyaya murwere, nhau chirwere, richishanda uye rabhoritari miedzo inogona kuiswa pedyo murwere nechirwere nemabayo ezasi mugove rwerudyi zvemapapu, inova munharaunda-yakawanikwa. The chirwere zvine mwero. Present kufema insufficiency Danho rokutanga.
XII. rwaidiwa kurapa
1. Febrile nguva zvinoda mubhedha kuzviomesera zororo.
2. Murwere anofanira kunwa zvinwiwa zvakawanda uye zvokudya nhamba 15 ne Pevsner.
3. Causal treatment - mishonga yacho mhando "+ chipatapata mumazuva 5-7."
Mumwe muenzaniso nezvenhoroondo COPD chirwere
Funga imwe nyaya kare, hachisi zvishoma zvinonakidza. vanachiremba ruzivo richava rinokosha kwaari kuverenga uye ongorora.
I. Personal Information
1. Yomurwere zita: Ivanova, Pyotr Ilyich.
2. Patient Gender: Male.
3. Date rokuberekwa: 1958 (Makore 56 okuberekwa).
4. Basa: Bricklayer.
5. Education: yekosi.
6. Location: Omsk, Ul. Marx, 23/2.
7. nhamba uye nguva yokusvika kuchipatara: 15.04.2014 pa 20:15.
8. chirwere: rikwanise exacerbation echirwere bronchitis. Respiratoria kukundikana wokutanga pechikuva.
9. Other zvirwere: BP, votadza ini, ngozi II.
II. Information pamusoro murwere basa
The vakawanda Zvakaitika - makore 40 basa iri dzakagadzirirwa - 27.
Description yokushanda ezvinhu. Nguva yose kushanda zuva - 8 maawa nokuputsa - maminitsi 60. Murwere anogona kuenda pazororo nenguva nenzira. The chikuru dzakagadzirirwa - Mason.
III. Nyaya yake romurwere nemamiriro
Paanosvika pachipatara, murwere akashuma kuti akanga fivha, anonzwa kurwara, ari vakatambudzwa sputum uye chikosoro, uye anotanga kuti kuvhunga panguva kurovedza muviri. Munhoroondo iyi COPD chirwere hazvishamisi, zviri zvikuru zvemo.
IV. Information pamusoro murwere upenyu
Murwere rinoti haasi kurwara chero STD kana chirwere cheshuga kana nhaka abnormalities kana zvirwere chepfungwa. Akatiwo akanga asina namamota uye neoplasms. Kubva mashoko murwere, hama dzake uyewo vasina zvirwere kubva pasi rino. Murwere yakataura kuti somwana yaitirwa chirwere (kureva gwirikwiti), mukuwedzera, aiva chando uye mabayo muna 2008. Ngozi muropa: kusvuta, nguva nenguva zvinotora doro (nokuti mazuva anokosha). Akaberekerwa muna 1958. Aiva mwana wechipiri mumhuri. Ndakakurira uye vakava pakurarama zvakanaka uye magariro evanhu. Akadzidza pachikoro, I kudzidza kukoreji aine dhigirii masonry. Akatanga kushanda muna 1985.
V. Patient Survey
Kurema - 95 kg, kureba - 188 cm.Zvose zvinowanikwa murwere ndeyezvakanaka, nzvimbo yacho inoshanda, uye kuziva hazvikanganisi.
Ganda rinopenya mumvuri, inodziya. Turgor uye elasticity zvakajairika. Mafuta pasi subcutaneous layer anogona kunzi anonyoresa, anogoverwa zvakaenzana. Mucous membrane inowanika kuongororwa haina kana kusakanganiswa. Lymphatic peripheral nodes: inoputika, yakawedzerwa, isina kutengeswa nemasukisi anenge akavapoteredza. Panguva yekuongororwa, murwere haana kunzwa kushamwaridzana.
Chimiro chemasaga ematambudziko haana kuwanikwa. Masangano acho anowanzoitika, kufamba kwavo hakuna kukwana, hakuna marwadzo. Dhigirii rekusimudzira misuli, inzwi ravo, uyewo simba rinogutsa.
Kana iri yehutano yekotori, inenge yakakura zvakasvibirira, haisati yakatengeswa kumasumbu anenge akaipoteredza, iyo inofamba, yakashata, haina kuoneka painoongorora kusuruvara kusingafadzi. Iko kuongorora kunokosha kuti kuongororwa, chete nhoroondo yeCOPD yega ingadai isina kukwana.
Bodies inotarisira kufema
Iyo thorax inofananidzwa, yehupenyu hwakajairika, mativi ose maviri ari pamwe nekushingaira anobatanidzwa mukuita kufema. Kuongororwa kwemapango pamusoro uye pasi pejekvicles kwakaitwa. Izvo zvakanyatsoratidzwa uye zvakaenzaniswa. Mavhinga pakati pembabvu anonyatsotsanangurwa, anoreka, apo kusuruvara kusina kunaka kunobata iwo, murwere haasimuke.
Digestive organ
Mimba ndeyomuitiro wakajairika. Pakati peimba kuongorora zvishoma. Ikoko hakuna marwadzo. Munguva yakadzika midzi, hapana kuipa kwaionekwa. Chiropa chine uswa hwakaenzana, hahwuyambuki pamucheto wemari inodhura. Pakurwadziwa kwekutambudzika hakumuka. Apo pachitarisa kuKurlov, miganhu haina kukura. Iyo gallbladder uye spleen haigoni kufungidzirwa. Murwere anoenda kuchivanze nguva dzose, kamwe kamwe pazuva, chiito che defecation chinowanzoitika.
VI. Preliminary diagnosis
Kubva pane nhau yemurwere iyo inopedza simba panguva yekuita basa (kukwira makwidza kusvika kumatanho 3-4) kuti ine mavara asina kuchena mucous sputum uye kukwezva, kusagadzikana kunzwisiswa mubhokisi, ruzivo kubva kune annesnesis (murwere akaongororwa mubazi rezvemishonga, Ikoko kwawanikwa kuti akanga ane chirwere chisingagumi) uye kutsvakurudza kwemuviri (kana zvichienzanisa kuongororwa kwepamusoro pamusoro pepamusoro pamapapu bhokisi rinzwi rinonzwika, panguva yekufema kunopisa kunopfuurwa kunopfuura nhengo dzose , kune vanhu vakaoma E mavhiri) zvinogona kukonzerwa kuti Ivanov kuwedzera kwechirwere chisingagumi. Nokudaro, mafungiro echiremba anosimbiswa. Kana kudzivirira kwezvirwere zvepemonta kwaiva, ipapo murwere haana kumubatsira.
VII. Survey chirongwa
1. Kuratidza urinini yakawanda: inogutsa.
2. Kuongororwa kweropa kwehupenyu hwemagetsi: hunowanzoitika.
3. Spirography: kuderera muTiffno index.
4. Kuongorora ropa rose: zvinogutsa.
5. X-ray yezvikamu zviri mubhokisi: zvakare zvakajeka pamapurmonary pattern.
Kuongororwa kwe "kuwedzera kwechirwere chisingagumi" kunobva pane zvinotevera:
1. Nyaya yemurwere iyo ine chirwere chinoputika, chifuva uye kusava nemhepo nemabasa ekuita.
2. Ruzivo nezvehupenyu hwomurwere: anoputa, ane chirwere chisingaperi.
3. Kuongororwa kwemurwere, panguva iyo miitiro yakaoma inoratidzwa, pamwe nekufemerwa zvakaoma.
4. Zvidzidzo zverabhurasi, panguva iyo kuderera kweTiffno index, kuderera kwepamusoro pekufema kwemafuro ekuyerera, pa-X-ray, nzira yakajeka yemapurmonary yakagadzirwa.
VIII. Kurapa
1. Nzira inofanirwa: yakawanda.
2. Zvokudya: № 15.
3. Mishonga "Macropen" - imwe piritsi katatu pazuva. 400 mg.
4. Sirasi "Khaliksol" - imwe kapu huru katatu pazuva.
5. Vitamine "Revit" - mapiritsi maviri kaviri.
6. Matethe "Bromhexine" - katatu pazuva pane 0.008 g.
7. Physiotherapy: quartz mubhokisi, uye iontophoresis.
Iko nguva dzose inokosha kuti uyeuke kuti COPD ine ngozi. Nhoroondo yezvokurapa zvechirwere ichiratidza zvakazara izvi.
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