Mob purulent rhinosinusitis: ua, cov tsos mob, mob, kev kho mob

Heev feem ntau ENT tus kws kho mob txo nws hwj nws cov neeg mob thiaj paub hais tias xws li mob rhinosinusitis, uas yog ib tug kab mob ntawm lub Upper pa ib ntsuj av. Tus kab mob no yog kho nrog tshuaj tua kab mob. Feem ntau nws ua rau cov teeb meem, uas ua nyob rau hauv ib tug mob Daim ntawv no yuav purulent los yog mob. Tej zaum kev muag khoom yuav tsum phais. Cia peb xav txog ntau nyob rau hauv kom meej ib tug kab mob raws li rhinosinusitis, cov tsos mob thiab kev kho mob ntawm no pathology.

zoo

Nyob ntawm qhov chaw uas nyob rau hauv no muaj tus kab mob yog distinguished:

• sinusitis (maxillary sinusitis);
• ethmoiditis (o ntawm lub ethmoid pob txha) ;
• sphenoiditis (o ntawm lub sphenoid qhov ntswg);
• pansinusitis thiab polisinusit (tsis ib co los yog tag nrho cov sinuses);
• sinusitis (frontal qhov ntswg yog kub lug).

Tag nrho cov kab mob no yog hu ua los ntawm ib tug lub sij hawm - "rhinosinusitis".

ua rau

Mob rhinosinusitis yuav tshwm sim rau cov nram qab yog vim li cas:

• vim kab mob;
• nyob rau hauv tus ntawm allergens.

Feem ntau cov feem ntau tus kab mob no yog tshwm sim los ntawm ib tug mob khaub thuas. Kab mob nkag mus rau cov sinuses thiab txhawb lawv cov o. Feem ntau, yog hais tias tus kab mob penetrates mus rau hauv lub qhov ntswg kab noj hniav, lub cev tam sim ntawd teb no tiv thaiv kab mob teb, muaj zog hnoos qeev thiab edema tsim. Qhov no ua rau lub fact tias vim lub paranasal sinuses cov ntsiab lus pib yuav tsum tau tso tawm uas muaj teeb meem, thiab tsim tej yam kev mob dej siab rau tom ntej hais tawm ntawm cov teeb meem kab mob thiab cov tsim ntawm kua paug.

Cov tib neeg lub cev tas li yog ib co hom ntawm cov kab mob nyob rau hauv tsawg heev ntau, tsis txhob ntxias qhov tshwm sim ntawm inflammatory dab. Los ntawm kev txo qhov kev tiv thaiv kev khiav dej num ntawm lub cev, lawv pib proliferate, feem ntau ua mob purulent rhinosinusitis.

Nyob rau hauv tas li ntawd, muaj pathological tej yam kev mob uas yog predisposing yam rau txoj kev loj hlob ntawm tus kab mob:

• anatomical lug ntawm lub qhov ntswg (tsam turbinate, septum deformation, etc ...);
• immunodeficiency;
• lub xub ntiag ntawm cov kab mob xws li cystic fibrosis, allergic rhinitis, adenoids, thiab lwm leej lwm tus;
• nws txo qis kev tiv thaiv.

cov tsos mob

Nco ntsoov cov nram no thawj cim ntawm o ntawm lub sinuses:

• kub taub hau;
• mob taub hau;
• kev hloov nyob rau hauv cov ntshav;
• tsis muaj zog thiab malaise;
• txhaws ntswg.

Tom qab ib co sij hawm, mob rhinosinusitis yog muaj raws li nram no:

• kub taub hau;
• txawv txav tawm hauv qhov ntswg kab noj hniav;
• o ntawm lub muag daj los yog lub puab tsaig;
• halitosis;
• hnoos, feem ntau zuj zus thaum hmo ntuj;
• hindered qhov ntswg ua tsis taus pa;
• teeb meem ntawm kev nkag siab ntawm tsis hnov tsw;
• nro thiab siab nyob rau hauv cuam tshuam sinuses;
• kev xav ntawm qhov qaug zog;
• mob hniav, yog feem ntau mob thaum lub sij hawm zom.

Mob purulent rhinosinusitis yuav muaj ib tug loj ntau yam ntawm lub tuam thiab lub zos cov tsos mob. Cov tsos mob ntawm nws nyob rau qhov ua rau ntawm nws tshwm sim, lub xub ntiag ntawm lwm yam kab mob, thiab muaj hnub nyoog ntawm tus neeg mob. Thiab cov me nyuam yog nyuaj rau tso tus kab mob no.

Polypoid rhinosinusitis muaj yuav luag tib yam tsos mob li mob daim ntawv. Vim qhov no daim ntawv ntawm tus kab mob no yog mob hnyav dua, rau nws cov kev kho mob ntawm endoscopic phais yog siv nyob rau hauv ua ke nrog anti-tsis haum kho mob.

diagnostics

Sai li sai tau raws li thawj cov cim qhia ntawm rhinosinusitis, uas tsis tsuas yog kis tau rau hauv ib tug ob peb hnub, tab sis kuj kho kom zoo, koj yuav tsum nco ntsoov sab laj ib tug kws kho mob. Rau ib tug muaj tseeb mob tus kws txiav txim qhov chaw ntawm localization ntawm tus kab mob, nws zoo thiab lub hom ntawm cov kab mob los yog kab mob uas tshwm sim los ntawm txoj kev loj hlob ntawm kab mob.

Cov nram qab no yog nqa tawm kom paub meej tias cov kev soj ntsuam ces mob rhinosinusitis:

• cov kev mob ntawm tus neeg mob;
• lees paub ntsuam;
• nqa tawm instrumental tshawb fawb txoj kev.

ENT xeem

Kev soj ntsuam ntawm tus neeg mob yuav pib nrog tus sau los ntawm nws kev kho mob yav dhau los. Ua li no, tus neeg mob qhia txog cov tsos mob, lub caij ntawm tawm hauv lub qhov ntswg thiab lawv qhov, lub xub ntiag ntawm mob nyob rau hauv lub taub hau thiab lub ntsej muag, thiab lawv qhov chaw nyob. Nws yuav tsum qhia rau koj tus kws kho mob txog tej yam kev tsis haum tshuaj thiab nyuam qhuav kis mob khaub thuas.

Tus kab mob yuav pab tau txawm cov lus qhia txog kev kho hniav ua, noj tshuaj, kev poob plig neeg immunocompromised.

Tom qab ntawd, tus kws kho mob ua ib lub cev kev soj ntsuam ntawm tus neeg mob, ua palpation ntawm lub puab tsaig thiab lub hauv pliaj, los mus txiav txim lub rhiab ntawm lub sinuses. Siv ENT xeem yuav ntes tsis xws luag nyob rau hauv lub qhov ntswg kab noj hniav.

laboratory kev ntsuam xyuas

Lub xub ntiag ntawm lub inflammatory txheej txheem thiab qhov xwm ntawm nws cov hoob kawm yuav pab txiav txim seb cov ntshav suav. Nyob rau hauv rooj plaub no tus tsom xam ntawm cov ntshav thiab tus piv ntawm lawv cov ntaub ntawv.

Nyob rau hauv tas li ntawd, nyob rau hauv vitro kuaj pathogenic txheem kis tus kab mob sinuses. Nrog kev pab los ntawm microbiological kev tshawb fawb tsim kom muaj lub hom yav thiab nws rhiab heev rau ntau yam antibacterial nrog. Tab sis nws yuav tsum tau nco ntsoov tias kev soj ntsuam ntawm xws seev nyob rau hauv lub mob daim ntawv no yeej tsuas 3-4 hnub tom qab qhov pib ntawm thawj cov cim qhia ntawm tus kab mob. Yog li ntawd, lawv feem ntau poob lawv qhov tseeb.

instrumental txoj kev tshawb no

Tshwj xeeb cov cuab yeej yuav siv los kawm ib qho tseeb mob:

• Qhov ntswg endoscopy - rau nws siv ntawm fiber-optic lub raj, qhov kawg ntawm uas yog ib lub teeb qhov chaw. Nrog xws li ib tug kev tshawb no yuav ntes txawm lub slightest sib txawv nyob rau hauv lub qhov ntswg kab noj hniav, thiab tseem mus kwv yees septal defect thiab muaj cov qog, xws li polyps.
• Xoo tomography - yog suav tias yog qhov zoo tshaj plaws txoj kev rau ib tug kev soj ntsuam ntawm lub qhov ntswg sinuses. Nws yog dua li nqa tawm nyob rau hauv cov kev tshwm sim ntawm teeb meem.
• Radiography - twb lug siv kom txog thaum lub endoscopy thiab xoo tomography. Tam sim no, nws tau los ua ntau tsawg yuav mus rau chaw uasi.
• Sib Nqus resonance tomography - yog ib qho zoo heev txoj kev mob ntawm inflammatory mob nyob rau hauv lub pob txha taub hau, malignant qog. Maxillary sinusitis yog manifested nyob rau hauv daim ntawv ntawm ib tug darkening ntawm lub maxillary sinuses.

kev kho mob

Mob rhinosinusitis yog kho raws li kev kho mob thiab kev phais txoj kev. Cov hauj lwm zoo txhua txoj kev yog suav hais tias yog tus kws kho mob rau txhua tus neeg mob ib lub zuj zus. Xaiv txoj kev ntawm txoj kev kho yog nyob ntawm ntau yam: hnub nyoog ntawm tus neeg mob, daim ntawv ntawm tus kab mob thiab qhov xwm ntawm nws cov hoob kawm, tus tau kev tsis haum tshuaj, thiab lwm yam Tiam sis yog dab tsis kho regimen yuav xaiv, nws yuav tsum tau xa tawm mus rau ..:

• tshem tawm tej yam tshwm sim ntawm o;
• rov qab kho cov patency ntawm nqe vaj lug kub uas txuas lub qhov ntswg nqe vaj lug kub qhov ntswg;
• tshem tawm los ntawm axils ntawm lub pathogenic cov ntsiab lus;
• tshem tawm ntawm qhov chaw ntawm kab mob.

rhinosinusitis rau cov neeg laus kho mob yuav tsum tau nyob rau hauv cov nruj kev saib xyuas ntawm ib tug kws kho mob, txij li thaum uncontrolled tshuaj feem ntau ua rau cov teeb meem. Ib tug tseem ceeb lub hom phiaj ntawm kev kho mob - tshem tawm ntawm lub kab neeg sawv cev thiab rov qab kho cov muaj peev xwm ntawm cov paranasal sinuses ib leeg ntxuav.

tshuaj

Mob purulent rhinosinusitis kho cov nram qab no cov tshuaj:

• decongestants;
• immunocorrectors;
• tshuaj tua kab mob;
• ntxiv symptomatic tshuaj.

Decongestants thiab decongestants no feem ntau yog tshuaj nyob rau hauv thawj qhov chaw thiab siv lawv yuav tsum tsis muaj ntau tshaj li 4-5 hnub, vim hais tias sij hawm ntev siv xwb tsub kom edema thiab qhov ntswg congestion. Cov tshuaj xws li "Ephedrine", "Nazivin", "Sanorin", "Galazolin", "Naphthyzinum" thiab thiaj on. N. Tej cov tshuaj mas siv kho tsis tau tus kab mob no, thiab ib ntus tshem tawm cov tsos mob.

Nyob rau hauv tej yam ntaub ntawv ntawm tus kab mob xws li rhinosinusitis, kho tsuas nrog tshuaj tua kab mob tej zaum yuav muab rau ob lub lis piam. Lawv pab mus tshem tawm tag nrho cov tsos mob, tab sis lawv txais tos yuav tsum tau ua xwb nyob rau hauv lub saib xyuas ntawm ib tug tshwj xeeb. Cov ntau cov tshuaj tshuaj tua kab mob xws li "Amoxicillin". Tiam sis yog tias peb hnub tom qab nws txais mus kawm kev txhim kho tsis tau tshwm sim, nws yuav tsum tau hloov los ntawm cov tshuaj muaj tus nquag muaj, raws li tetracycline los yog cephalosporin. Tsis tas li ntawd zoo tsim nyog tau txais cov tshuaj tua kab mob "clarithromycin", "Azithromycin" thiab "Roxithromycin".

Dua li ntawm qhov ntau ntawm cov sib txawv tshuaj siv los kho mob rhinosinusitis, lawv tsis yog ib txwm zoo. Qhov no yog vim lub fact tias muaj ntau tus kab mob uas ua rau o ntawm lub Upper pa ib ntsuj av tau, ntse tawv tshuaj tua kab mob. Uas yog vim li cas nyob rau hauv mob rhinosinusitis, tshwj xeeb tshaj yog thaum kub lug frontal qhov ntswg, siv lub stimulation ntawm tus tib neeg lub cev tiv thaiv.

Rau lub hom phiaj no, siv immunomodulators thiab immunomodulators. Lawv muaj xws tshuaj uas rov qab kho cov nuj nqi ntawm lub cev tiv thaiv. Hoob no ntawm kev kho mob yog feem ntau 1.5-2 lub lis piam.

Yog hais tias daim ntawv no ntawm tus kab mob nyob raws li polypoid rhinosinusitis thiab yuav tsum tau kho siv mucolytic tshuaj ( "myrtol," "Sinupret", "Acetylcysteine"). Lawv pab mus rau thinning ntawm tuab thiab khov txheem ntawm lub sinuses, ua nyob rau hauv ib tug outflow ntawm kua paug pib. Tsis tas li ntawd, qhov no tshuaj tej zaum yuav muaj pharmacological pab pawg neeg thiab antibacterial kev txiav txim.

Yog hais tias lub cev kub zog, tus neeg mob yuav tsum tau ua raws li nrog pw so. Ua li no nws muab antipyretics xws li "Amidopyrine" thiab "aspirin". Raws li analgesic tshuaj no feem ntau yog tshuaj "Paracetamol", "Ibuprofen". Muaj zog ua hauj lawm yog tsis tshua muaj siv, thiab lawv yuav tsum tsis muaj ntau tshaj 7 hnub.

Cov kev tsis haum rhinosinusitis kho nrog antihistamine dauv thiab ntsiav tshuaj. Koj kuj siv tau ointments thiab cream, tab sis lub hormonal tshuaj cov kws kho ntau heev.

Kuv yuav tsum tau ntxiv hais tias, nyob rau hauv tas li ntawd mus tshuaj kho mob, cov nram qab no kev kho mob:

• ntxuav qhov ntswg qhov ntswg antiseptic kev daws teeb meem kev tshem tawm cov ib qho txawv txav rau cov ntsiab lus;
• nws yog pom zoo kom haus dej haus kom ntau sov kua: txiv hmab txiv ntoo dej qab zib, stewed txiv hmab txiv ntoo, txiv hmab txiv ntoo kua, tsis muaj zog tshuaj yej, broth lub duav;
• siv physiotherapeutic txoj kev: microwave txoj kev kho, ultrasound, UHF.

Yog hais tias cov kev tsis coj kom zoo tshwm sim, lawv chaw uasi mus rau kev phais.

phais kev pab

Yog hais tias koj tsis pab tshuaj txoj kev kho ntawm xws kab mob raws li rhinosinusitis, kev kho mob nyob rau hauv cov ntaub ntawv no nws yog nqa tawm surgically. Feem ntau cov feem ntau, thaum nws xaiv ib tug tej, uas yuav pab tau:

• sai sai kawm tau los ntawm lub paranasal sinuses kua paug;
• ncaj qha kev cuam tshuam rau lub mucosa ntawm lub paranasal sinuses antiseptic, anti-inflammatory thiab antibacterial tshuaj.

Tab sis muaj yog xws li ib tug kho thiab disadvantages. Tau muaj kev pheej hmoo ntawm cov ntshav lom, tsis pom kev, thiab thiaj li nyob. N. Yog li ntawd, feem ntau ntawm nws yog tsis pom zoo.

Cov yam ntxwv ntawm tus kab mob nyob rau hauv cov me nyuam

Rhinosinusitis nyob rau hauv cov me nyuam yog hom kab mob, vim nws tso nyiaj rau ib feem peb ntawm tag nrho cov kab mob uas yog txuam nrog rau Upper pa ib ntsuj av. Thiab raws li cov laus, ib nrab ntawm cov me nyuam tseem raug kev txom nyem rau lawv.

Nyob rau hauv xws li ib tug kab mob yuav loj teeb meem. Cov feem ntau txaus ntshai yog pyoseptic orbital yam tab kaum uas ua rau yus impaired lub zeem muag, thiab nyob rau hauv 2% ntawm cov neeg tshwm sim intracranial hloov. Yog hais tias lub sij hawm tsis kuaj tus kab mob thiab kho nws, tsim mob ntsws dej.

Mob rhinosinusitis nyob rau hauv cov me nyuam manifests nws tus kheej raws li nram no:

• excruciating heev hnoos;
• ua pa nyuaj los ntawm lub qhov ntswg;
• qaug zog;
• general malaise;
• qhov ntswg suab;
• kom nyob rau hauv lub cev kub.

Lub ntsiab kev kho mob yog pom tias yuav tau antimicrobial txoj kev kho tiv thaiv lub keeb kwm yav dhau zuj zus kev tiv thaiv.

Nta ntawm tus kab mob thaum lub sij hawm cev xeeb tub

Heev feem ntau muaj yog ib tug mob purulent rhinosinusitis thaum lub sij hawm cev xeeb tub, tshaj tej ntawm, nws yuav tsum tau nrog los ntawm cov teeb meem, raws li nyob rau hauv no lub sij hawm yog tag rau tej kev kho mob.

Tsuas yog ib tug kws kho mob yuav muab tshuaj rau tshuaj tua kab mob, uas muaj peev xwm ua mob rau cov poj niam thiab cov me nyuam yog coj uncontrollably. Yog hais tias phem penicillin pab pawg neeg yog kis thiab cephalosporins, macrolides siv. Tej zaum nws yuav "Moxifloxacin", "levofloxacin" thiab "sparfloxacin". Nyob rau hauv lawv cov cawv yog kev puas tsuaj ntawm cov protein synthesis nyob rau hauv lub hlwb ntawm pathogenic microorganisms. Cov tshuaj no yog yuav tsum tau qhov zoo tshaj thiab muaj kev nyab xeeb nyob rau hauv cov kev kho mob ntawm cev xeeb tub cov poj niam.

kev tiv thaiv

Nyob rau hauv kev txiav txim kom tsis txhob muaj xws kab mob raws li mob rhinosinusitis, koj yuav tsum coj raws li nram no tiv thaiv kev ntsuas:

• Tsis txhob drafts thiab hypothermia;
• ib tug ntau ntawm taug kev nraum zoov, yuav tsum muab active;
• quenched;
• koom nyob rau hauv cov kev ua si;
• lub sij hawm los kho SARS thiab los ntswg qhov ntswg;
• lub sij hawm qhov chaw nyob rau tus kws kho hniav los kho cov hniav nyob rau hauv lub qaum puab tsaig;
• ntshaw kom ua luam dej nyob rau hauv lub hiav txwv dej thiab cov hiav txwv cua nqus zoo.

xaus

Yog li, mob purulent rhinosinusitis tas yuav kho nyob rau hauv kev kho mob saib xyuas, thiaj li tsis muaj tej zoo nkauj txaus ntshai teeb meem uas muaj peev xwm txawm yuav tuag taus. Nws yog tsim nyog yuav tsum tsis txhob provoking tus kab mob no yam, tsawg siv sij hawm nyob rau hauv ceev thiab muaj plua tshauv tej kev kawm, kom tsis txhob haus luam yeeb. Nrog txaus thiab raws sij hawm kev kho mob ntawm rhinosinusitis yog kiag li kho tau zoo.