differentsialniy diagnoz bronxoobstruktivnogo sindroma. neotlojnaya pomosh. taktika vop.

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slayd 1 «differentsialniy diagnoz bronxoobstruktivnogo sindroma. neotlojnaya pomosh. taktika vop.» vrach obshey praktiki doljen znat osnovnie prichini vozniknoveniya sindroma, doljen umet provesti otsenku izmeneniy klinicheskix, laboratorno-instrumentalnix dannix. vop doljen znat i viyavit diagnosticheskie kriterii, provesti differentsialnuyu diagnostiku, umet lechit dannoe zabolevanie. «bronxoobstruktivniy sindrom - sobiratelnoe ponyatie, ob'edinyayushee xronicheskie vospalitelnie zabolevaniya respiratornoy sistemi s preimushestvennim porajeniem distalnix otdelov dixatelnix putey s chastichno obratimoy bronxialnoy obstruktsiey, kotorie xarakterizuyutsya progressirovaniem i narastayushey xronicheskoy dixatelnoy nedostatochnostyu». geteroallergicheskiy variant (anafilakticheskiy shok, lekarstvennaya bolezn) autoimmunniy variant (dbst, postransplantatsionniy sindrom, sindrom dresslera, parazitoz, pnevmokoniozi, berillioz). infektsionno-vospalitelniy variant (bronxopnevmoniya, mikozi, tuberkulyoz legkix i bronxov) obturatsionniy variant (bronxokartsinoma, bronxoadenoma, obturatsiya bronxov inorodnimi chastitsami) irritativniy variant (intratraxealniy narkoz, termicheskiy i ingalyatsionniy ojog bronxov). gemodinamicheskiy variant (zastoynaya levojeludochkovaya nedostatochnost, pervichnaya lg, tela , mitralniy stenoz) endokrinno-obmenniy variant – (gipoparatireoz, gipotalamicheskiy sindrom, kartsinoidnaya opuxol ) nevrogenniy variant: a) tsentralniy (nervno-psixicheskiy, postkontuzionniy sindrom, entsefalit). v) vegetativniy (mexanicheskoe razdrajenie blujdayushego nerva). toksicheskiy variant (otravlenie …

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gribov, piltsi rasteniy, perxot, komponenti slyuni i mochi nekotorix jivotnix, ptichiy pux, allergeni tarakanov, pishevie i lekarstvennie allergeni. iii. provotsiruyushie faktori: infektsii dixatelnix putey, priyom beta-blokatorov, vozdushnie pollyutanti, xolodniy vozdux, fizicheskaya nagruzka, ask i drugie npvs, ekologicheskie i professionalnie faktori, rezkie zapaxi, kurenie, soputstvuyushie zabolevaniya (dtz, gerb, sinusiti). * do spazma cherez 10 minut posle vozdeystviya allergena * bronchoscopic view of an airway before and 10 minutes after allergen challenge. following allergen challenge, the airway lumen rapidly and markedly narrows. * pikfloumetriya - izmerenie pikovoy skorosti vidoxa, naibolee vajnaya metodika v diagnostike i kontrole obstruktsii bronxov u bolnix ba. pikfloumetr doljen bit u kajdogo bolnogo ba. issledovanie fvd: vajniy diagnosticheskiy kriteriy - uvelichenie ofv1 na 12% i psv bolee chem na 15% ot doljnix velichin posle ingalyatsii v2-adrenomimetikov korotkogo deystviya (salbutamol, fenoterol) stupen 1: lyogkaya intermittiruyu-shaya ba simptomi (kashel, odishka, svictyashie xripi) otmechayut reje 1 raza v nedelyu. nochnie pristupi …

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t doljnix velichin, kolebaniya psv previshayut 30%. stupen 4: tyajyolaya persistiruyushaya ba postoyannie simptomi v techenie dnya. obostreniya i narusheniya sna chastie. proyavleniya bolezni ogranichivayut fizicheskuyu aktivnost. psv i ofv1 nije 60% ot doljnix velichin daje vne pristupa, a sutochnie kolebaniya psv previshayut 30%. * kriterii pristup ba pristup serdechnoy astmi anamnez bronxolyogochnie zab-ya, vazomotorniy rinit i dr.all.zab-ya ag, piks, pps prichini pristupa vospalenie dixatelnix putey, kontakt s allergenom fizicheskoe i umstvennoe perenapryajenie xarakter udushya ekspiratornaya inspiratornaya xarakter tsianoza tsentralniy akrotsianoz auskultatsiya legkix suxie svistyashie xripi, udlinenie vidoxa melkopuzirchatie nezvuchnie xripi v n/o. otyoki i gepatomegaliya ne xarakterno xarakterni xarakternie osobennosti mokroti gustaya, vyazkaya, v malom kol-ve, trudnootdelyamaya jidkaya, penistaya, rozovogo tsveta puls taxikardiya, pravilniy ritm taxikardiya, aritmiya ekg peregruzka pravix otdelov serdtsa ishemiya miokarda, priznaki rubtsovix izmeneniy effektivnost ot diuretikov i glikozidov net da effekt ot bronxolitikov est net mexanizm deystviya ingalyatsionnix gks priyom gks v ingalyatsiyax yavlyaetsya vajneyshey …

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ov, faktora agregatsii trombotsitov. mexanizm deystviya stabilizatorov tuchnix kletok stabiliziruyut membranu tuchnix kletok, preduprejdaya ix degranulyatsiyu i videlenie mediatorov vospaleniya i bronxospazma (gistamina, leykotrienov). etot mexanizm obuslovlen podavleniem aktivnosti fosfodiesterazi, chto privodit k nakopleniyu v kletke tsamf. v svoyu ochered, eto sposobstvuet ugneteniyu toka kaltsiya v kletku ili daje stimuliruet ego videlenie i umenshaet aktivnost tuchnix kletok. mexanizm deystviya m-xolinolitiki parasimpaticheskaya nervnaya sistema i xolinergicheskie retseptori igrayut bolshuyu rol v formirovanii giperreaktivnosti bronxov i ba. giperstimulyatsiya xolinergicheskix retseptorov privodit k usileniyu degranulyatsii tuchnix kletok s vixodom bolshogo kolichestva mediatorov vospaleniya, chto sposobstvuet razvitiyu v bronxax vospalitelnoy i bronxospasticheskoy reaktsii. m-xolinolitiki blokiruyut m-xolinoreaktivnie strukturi i tem samim umenshayut bronxosujivayushee vliyanie blujdayushego nerva. mexanizm deystviya ß2-agonistov . mexanizm rasshireniya bronxov sleduyushiy: stimulyatori ß2-adrenoretseptorov povishayut aktivnost adeniltsiklazi, eto vedet k uvelicheniyu soderjaniya tsamf, on v svoyu ochered, sposobstvuet transportu kaltsiya iz miofibrill v sarkoplazmaticheskiy retikulum, chto zaderjivaet vzaimodeystvie aktina i miozina v muskulature …

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rasheniya, uluchshaet funktsiyu dixatelnix mishts i diafragmi. mexanizm deystviya antagonistov leykotrienovix retseptorov leykotrieni – eto biologicheski aktivnie veshestva, otnosyashiesya k chislu mediatorov allergicheskogo vospaleniya, kotorie predstavlyayut soboy jirnie kisloti, obrazuyushiesya iz araxidonovoy kisloti pri uchastii fermenta 5-lipooksigenazi. leykotrieni indutsiruyut bronxospazm, povishayut pronitsaemost melkix sosudov, vizivayut gipersekretsiyu slizi, infiltratsiyu stenok bronxov kletkami vospaleniya, proliferatsiyu volokon gladkoy muskulaturi bronxov. antagonisti leykotrienovix retseptorov blokiruyut tsisteinil leykotrienovie retseptori (zafirlukast i montelukast) i ugnetayut aktivnost fermenta 5-lipooksigenazi (zileyton), kataliziruyushego protsess obrazovaniya leykotrienov iz araxidonovoy kisloti. v rezultate snijaetsya reaktivnost bronxov pri vdixanii allergenov, umenshaetsya bronxospazm, uluchshaetsya funktsiya legkix. bronxodilyatatori: salbutamol ili berodual po 2 vdoxa 3-4 r/sut ili salmeterol 25-50 mkg 2 r/sut metilksantini: eufillin 2,4% 10 ml v/v struyno 2 r/sut 3 dnya s perexodom na prolongirovannie formi 100-300 mg 2 r/sut ingalyatsionnie gks: beklometazon 500-1000 mkg/sut ili flyutikazon 250-500 mkg sut salmeterol+flyutikazon (seretayd) peroralnie gks po intermittiruyushey sxeme: pervie 3 dnya po 30 …

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slayd 1 «differentsialniy diagnoz bronxoobstruktivnogo sindroma. neotlojnaya pomosh. taktika vop.» vrach obshey praktiki doljen znat osnovnie prichini vozniknoveniya sindroma, doljen umet provesti otsenku izmeneniy klinicheskix, laboratorno-instrumentalnix dannix. vop doljen znat i viyavit diagnosticheskie kriterii, provesti differentsialnuyu diagnostiku, umet lechit dannoe zabolevanie. «bronxoobstruktivniy sindrom - sobiratelnoe ponyatie, ob'edinyayushee xronicheskie vospalitelnie zabolevaniya respiratornoy sistemi s preimushestvennim porajeniem distalnix otdelov dixatelnix putey s chastichno obratimoy bronxialnoy obstruktsiey, kotorie xarakterizuyutsya progressirovaniem i narastayushey xronicheskoy dixatelnoy nedostatochnostyu». geteroallergicheskiy variant (anafilakticheskiy shok, lekar...

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