I-Bronchiectasis yi-dilations kanye nokubhujiswa kwe-bronchi ngenxa yokutheleleka nokuvuvukala okungapheli. Izimbangela ezivame kakhulu zihlanganisa i-cystic fibrosis, ukukhubazeka komzimba, kanye nezifo eziphindaphindiwe. Izimpawu ezivame kakhulu ukukhwehlela okungapheli, ukukhwehlela isikhwehlela esiqhumayo, imfiva, nokuphefumula kanzima. Ukwelashwa nokuvimbela ukuhlasela okunamandla kuhlanganisa ukulawulwa kwama-bronchodilator nama-antibiotics, ukususwa koketshezi, nokulawulwa kwezinkinga ezifana ne-hemoptysis kanye nokunye ukulimala kwamaphaphu ngenxa yokungazweli noma izifo ezingosomathuba.

I-Bronchiectasias yizinguquko ze-morphological ezingenakuhlehliswa (ukunwetshwa, ukuguquguquka) kanye nokusebenza okuphansi kwe-bronchi, okuholela ekuguleni okungapheli kwamaphaphu. Yonke inkimbinkimbi yezinguquko ze-pulmonary kanye ne-extrapulmonary phambi kwe-bronchiectasis ibizwa ngokuthi i-bronchiectasis.

I-bronchiectasis yayizobonakala okokuqala ngo-1819, nguDokotela René-Théophile-Hyacinthe Laennec, umsunguli we-stethoscope. Lokhu ukunwebeka okungavamile kwengxenye ye-bronchi, ngenxa yomonakalo ongenakulungiseka ezindongeni zemigudu yomoya, okubangela ukunqwabelana kwamafinyila okwandisa ingozi yokutheleleka ngamaphaphu. Lokhu kunwetshwa kwe-bronchi kungathinta:

• izifunda eziningi zamaphaphu: lokhu kubizwa ngokuthi i-diffuse bronchiectasis;
• isifunda esisodwa noma ezimbili zephaphu: lokhu kubizwa ngokuthi i-focal bronchiectasis.

I-bronchiectasis ingakhula kunoma iyiphi iminyaka. Ukusabalala kwayo kuyanda ngeminyaka kanye nobulili besifazane. Iminyaka yonke ihlangene, isukela ku-53 kuye ku-556 kubantu abayikhulu futhi ingaphezu kuka-100 ezakhamuzini ezingama-000 phakathi kwalezo ezineminyaka engaphezu kweyikhulu ubudala.

I-prognosis iyahlukahluka kakhulu. Ngokwelashwa okufanele nokulandelwa, abantu abane-bronchiectasis banesikhathi sokuphila esivamile. Ngokuphambene, abantu abane-bronchiectasis enzima, izimo ezihambisanayo ezifana ne-bronchitis engapheli noma i-emphysema, noma izinkinga ezifana nomfutho wegazi ophakeme wamaphaphu noma i-cor pulmonale bavame ukuba nokubikezela okungathandeki. I-prognosis yeziguli ezine-cystic fibrosis yisona esingathandeki kakhulu, esinokuphila okuphakathi kweminyaka engama-36.

Imithi elwa namagciwane kanye nezinhlelo zokugoma ziye zanciphisa kakhulu ukwenzeka kwe-bronchiectasis emazweni anezimboni, kuyilapho lesi sifo sisavamile emazweni ampofu.

I-bronchiectasis, i-congenital futhi itholwe

I-Congenital bronchiectasis ayivamile futhi iqala ngenxa yokukhubazeka kokwakheka kwesihlahla se-bronchi. Isibonakaliso se-histological se-bronchiectasis yokuzalwa kuwuhlelo oluhlelekile lwezakhi zesakhiwo se-bronchi odongeni lwazo.

Isici esiyinhloko se-etiological ye-bronchiectasis etholakalayo iwukwehla okunqunywe ngokofuzo kwesihlahla se-bronchial (ukungathuthuki kahle kwezakhi zodonga lwe-bronchi), okuthi, kuhlanganiswe nokukhubazeka kwe-bronchial patency kanye nokubukeka kokuvuvukala, kuholela ekuguquguqukeni okuqhubekayo kwe-bronchi.

Ukwakheka kwe-bronchiectasis kugqugquzelwa kakhulu ukukhwehlela, izifo ezinzima zokuphefumula, isimungumungwane, i-bronchitis, inyumoniya, amathumba amaphaphu, isifo sofuba, imizimba yangaphandle esihlahleni se-tracheobronchial.

Izikhalazo eziyinhloko: ukukhwehlela ngenani elikhulu le-sputum e-purulent, i-hemoptysis, ubuhlungu besifuba, ukuphefumula, umkhuhlane, ukujuluka, ukulahlekelwa isisindo kanye nokwehla kokusebenza. Inani kanye nemvelo yesikhwehlela incike ezingeni lomonakalo we-bronchial. Ingase iqukethe ukungcola kwegazi nobomvu, iphunga elibi.

Lesi sifo sibonakala ngokwanda kanye nokukhululwa. Ngesikhathi sokukhushulwa, izinga lokushisa liyakhuphuka, ukuphefumula kanzima, ukushaywa kwesifuba esifubeni, nezindebe eziluhlaza okwesibhakabhaka zivela. Ngokumelene nesizinda senkambo ende, iminwe yesiguli ithola isimo se-drumsticks, nezinzipho - zengilazi yewashi. Kancane kancane, isimo esijwayelekile sesiguli siba sibi.

I-Bronchiectasis ivame ukuba nzima ngenxa yokopha kwe-pulmonary, ukwakheka kwethumba, ukuthuthukiswa kwe-pulmonary fibrosis kanye ne-emphysema, "cor pulmonale", i-amyloidosis.

Izimbangela ezingenzeka ze-bronchiectasis zihluke kakhulu. Isizathu esivame kakhulu ukutheleleka okungapheli noma okuphindaphindayo, okubangelwa ukuphazamiseka kwamasosha omzimba noma ukukhubazeka kokuzalwa okuthinta ukwakheka noma ukusebenza kwemigudu yomoya futhi kunomthelela ekuvinjweni kwabo.

Izifo zokuphefumula (i-diffuse noma i-focal bronchiectasis)

Lezi zihlanganisa:

• ukukhohlela okubi ;
• isimungumungwane;
• umkhuhlane;
• isifo sofuba;
• izifo ze-syncytial virus zokuphefumula, njll.

Ukuvinjwa kwemishini yemigudu yokuphefumula (focal bronchiectasis)

Njengo:

• isimila samaphaphu;
• i-broncholithiasis;
• ukwanda okungapheli kwezindlala ze-lymphatic;
• umzimba wangaphandle ophefumulelwe;
• izinguquko ngemva kokuhlinzwa kwamaphaphu;
• amafinyila njll.

Izifo zofuzo (i-bronchiectasis esakaza)

Ukwazi :

• I-cystic fibrosis;
• i-primary ciliary dyskinesia (PCD), isifo esingelapheki esibonakala ngokukhula okungavamile kwamaphaphu kusukela ekuzalweni;
• Ukushoda kwe-alpha-1-antitrypsin, isifo esithinta amaphaphu nesibindi.

I-Immunodeficiencies (i-diffuse noma i-focal bronchiectasis)

Njengo:

• izifo zokuntuleka kokuzivikela komzimba njenge-AIDS;
• i-hypogammaglobulinémie, njll.

Izifo zesistimu (i-bronchiectasis)

Lezi zihlanganisa:

• isifo samathambo;
• izilonda emathunjini;
• Isifo sikaCrohn;
• i-Sjögren syndrome;
• i-systemic lupus erythematosus, njll.

I-Immun-allergic (i-diffuse noma i-focal bronchiectasis)

Ukwazi :

• i-allergic bronchopulmonary aspergillosis (ABPA), ukusabela okweqile kufungus okuthiwa I-Aspergillus, evame ukwenzeka kubantu abanesifuba somoya noma i-cystic fibrosis, ingabangela amapulaki amafinyila avimbela imigudu yokuphefumula.

I-bronchiectasis ingase futhi ibangele ukuhogela izinto ezinobuthi ezidala umonakalo ku-bronchi:

• umhwamuko wamagesi ayingozi, intuthu (kuhlanganise nentuthu kagwayi) noma uthuli oluyingozi njenge-silica noma uthuli lwekhabhoni;
• ukudla noma i-asidi yesisu.

Izimpawu ngokuvamile ziqala ngobuqili futhi zivame ukuba zimbi kancane kancane ngokuhamba kweminyaka, zihambisane neziqephu zokubhebhetheka okukhulu.

Lezi zihlanganisa:

• ukukhwehlela okungapheli, uphawu oluvame kakhulu, oluvame ukwenzeka ekuseni nasekuseni kakhulu emini futhi lukhiqize isikhwehlela esiwugqinsi, esigcwele futhi esivame ukuvuvukala. Umthamo walesi sikhwehlela ungahluka kakhulu, kanye nombala waso (omhlophe, ophuzi, oluhlaza okotshani, oluhlaza okotshani noma onsundu);
• ukuphefumula kanzima (i-dyspnea);
• ukuphelelwa umoya;
• umsindo oheyizayo okhiqizwa ukuhamba komoya emigwaqweni yomoya (ukuphefumula);
• ubuhlungu besifuba obufana ne-pleural;
• i-relapsing fever;
• ukukhathala okukhulu;
• ukwehla kwenani le-oxygen ethwalwa egazini (hypoxemia);
• umfutho wegazi ophakeme we-pulmonary;
• ukuhluleka kwenhliziyo kwesokudla;
• ukukhwehlela igazi (hemoptysis).

Ukwanda okunamandla kuvamile futhi kungase kubangelwe ukutheleleka okusha noma ukwanda kokutheleleka okukhona. Ukuqubuka okukhulu kwalesi sifo kubonakala ngokukhwehlela okubi kakhulu, ukwanda kwe-dyspnea, kanye nomthamo kanye nokuphuma kwesikhwehlela. Uma i-bronchiectasis inzima futhi ingapheli, kuvame ukwehla kwesisindo.

Ngokwelashwa okufanele, abantu abane-bronchiectasis bangakwazi ukuhlala bezinzile iminyaka eminingi futhi balawule izimpawu zabo kahle. Ukwelashwa kwe-bronchiectasis kuhloswe:

• ukuvimbela exacerbations;
• phatha izimpawu;
• ngcono izinga lempilo;
• ukuvimbela ukubhebhetheka kwesifo.

Ukuvimbela ama-exacerbations

• ukugoma njalo okufana nokugoma umkhuhlane waminyaka yonke kanye nokugoma i-pneumococcal okunikeza isivikelo esibangelwa amagciwane e-pneumonia;
• izinyathelo zokususa umoya;
• ama-macrolide antibiotics.

Ukwelashwa kwezimpawu

• ama-antibiotic;
• ama-bronchodilators aphefumulelwe;
• izinyathelo zokususa umoya (izidakamizwa ze-mucolytic);
• i-corticosteroids ephefumulayo noma yomlomo;
• ezimweni ezingavamile, ukususwa kokuhlinzwa kwengxenye yamaphaphu uma i-bronchiectasis ithinta ingxenye encane yamaphaphu kuphela noma uma ingxenye yamaphaphu inezilonda ezinzima eziholela ekuthelelekeni okuphindaphindiwe noma ukukhipha inani elikhulu legazi lapho ukhwehlela;
• ukwelashwa kwe-oxygen uma kunesidingo ukugwema izinkinga ezifana ne-cor pulmonale;
• ukuhlanganiswa kwe-bronchial artery uma kwenzeka i-hemoptysis.

Izinga lempilo elithuthukisiwe

• i-physiotherapy yokuphefumula (i-postural drainage, i-chest percussion) ukuze kuthuthukiswe ukuphuma kwemfihlo kanye namafinyila;
• umsebenzi ojwayelekile womzimba ukuze kuqedwe isikhwehlela nokukhuthaza ukusebenza okungcono kwamaphaphu;
• Ukudla okunempilo;
• ukuthambisa umoya futhi uhogele amanzi anosawoti ukuze ukhulule ukuvuvukala nokwakheka kwamafinyila;
• izikhathi zokuvuselela ukusebenza kokuphefumula ukuze kuthuthukiswe ukumelana komzimba nokunciphisa imiphumela yezimpawu kanye nomthelela ongokomzimba nongokomzwelo ekuphileni kwansuku zonke.

Vimbela ukubhebhetheka kwesifo

• izinsiza zokuyeka ukubhema;
• ukugoma;
• ama-antibiotics.

I-bronchiectasis ethuthukisiwe kwabanye abantu, ikakhulukazi labo abane-cystic fibrosis ethuthukisiwe, bangelashwa ngokufakelwa kwamaphaphu. Izinga lokusinda leminyaka emi-5 liphakathi kuka-65% no-75% wokufakelwa kwenhliziyo namaphaphu noma kokubili ukufakelwa kwamaphaphu. Ukusebenza kwamaphaphu kuvame ukuba ngcono phakathi nezinyanga eziyisi-6 kanti ukuthuthukiswa kungaqhubeka okungenani iminyaka emi-5.

Amasu okwelapha esimanje

При бронхоэктазе назначают современные антибиотики класса макролидов, чтобы подавить патогенную микрофлору, kanye ne-β2-агонистустенные лких 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 иммуностимуляторы.

Ключевая процедура консервативного лечения бронхоэктаза — санация бронщиального древа (очистка просвета бронбов от гнойной мокнимроты в мокроты в). При признаках кислородной недостаточности назначают кислородотерапию. Больному также назначают комплекс упражнений, способствующих эвакуации бронхиальной мокроты, and вибрационный массаж грусаж. Для общего укрепления организма показаны:

• ukudla okunekhalori ephezulu - 3000 kcal ngosuku;
• ukwelashwa kokudla - umsoco osebenzayo ocebile ngezakhi;
• ukwelashwa kwamavithamini.

Njengoba kunikezwe ukungahlehliseki kwenqubo, futhi, ngenxa yalokho, ubuze bokwelapha okulondolozayo, okuwukuphela kwendlela eqinile yokwelapha i-bronchiectasis kufanele kubhekwe njengokuhlinza, umthamo wayo oncike ekusakazekeni kwe-bronchiectasis.

Ukuvuselelwa, ukuvimbela, izingozi ezingenzeka

Ingxenye ebalulekile yokuvuselela okuyinkimbinkimbi kwe-bronchiectasis ukulungiswa kwendlela yokuphila. Isiguli kudingeka sihambe emoyeni ohlanzekile, siyeke ukubhema futhi sigweme ukubhema, sidle ukudla okulinganiselayo, sivocavoce umzimba futhi senze izivivinyo zokuphefumula njalo.

Kubalulekile ukubhaliswa ne-pulmonologist, ukuya ekuqokweni kokuvimbela kanye nemvamisa enqunywe udokotela, futhi, uma kunesidingo, thatha izifundo ze-physiotherapy. Ukuvimbela okuphelele kunikeza ukwelashwa okufika ngesikhathi kwezifo zokuphefumula kanye nokuqina.

Ngaphandle kokwelashwa okwanele kwe-bronchiectasis, i-bronchitis engapheli, ukuhluleka kwamaphaphu nenhliziyo, i-cor pulmonale, kanye ne-asthma ye-bronchial. Iziguli zithola ukusebenza okuncishisiwe nezinga lempilo eliphansi. Kubaluleke kakhulu ukubonisana nodokotela ngesikhathi ukuze uzuze ukuxolelwa okuzinzile kwesikhathi eside.