vnebolnichnaya pnevmoniya: diagnostika i lechenie

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pnevmoniya vnebolnichnaya pnevmoniya: diagnostika i lechenie i.u.abdulxakov buxarskiy gosudarstvenniy meditsinskiy institut * opredelenie pnevmoniya –– pnevmonii – gruppa razlichnix po etiologii, patogenezu, morfologicheskoy xarakteristike ostrix infektsionnix (preimushestvenno bakterialnix) zabolevaniy, xarakterizuyushixsya ochagovim porajeniem respiratornix otdelov legkix s obyazatelnim nalichiem vnutrialveolyarnoy ekssudatsii. poskolku eto ostroe infektsionnoe zabolevanie, to opredelenie «ostraya» pered diagnozom «pnevmoniya» yavlyaetsya izlishnim, tem bolee, chto diagnoz «xronicheskaya pnevmoniya» yavlyaetsya patogeneticheski ne obosnovannim, a sootvetstvuyushiy termin - ustarevshim. * …porajenie respiratornix otdelov legkix s obyazatelnim nalichiem vnutrialveolyarnoy ekssudatsii… * http://catalog.nucleusinc.com/enlargeexhibit.php?id=1406&tc=&a=2 * klassifikatsiya bronxopnevmoniya / krupoznaya pnevmoniya vnebolnichnaya (priobretennaya vne lechebnogo uchrejdeniya) pnevmoniya (sinonimi: domashnyaya, ambulatornaya). nozokomialnaya (priobretennaya v lechebnom uchrejdenii) pnevmoniya (sinonimi: gospitalnaya, vnutribolnichnaya). aspiratsionnaya pnevmoniya pnevmoniya u lits s tyajelimi narusheniyami immuniteta (vrojdenniy immunodefitsit, vich-infektsiya, yatrogennaya immunosupressiya). klassifikatsiya, uchitivayushaya usloviya, v kotorix razvilos zabolevanie. vajna dlya empiricheskogo podxoda k startovoy terapii. * vnebolnichnaya pnevmoniya ostroe zabolevanie, voznikshee vo vnebolnichnix usloviyax, soprovojdayusheesya simptomami infektsii nijnix otdelov dixatelnix putey (lixoradka, kashel, …

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zumnoe primenenie jaroponijayushix i protivovospalitelnix sredstv kvalifitsirovannie deystviya medrabotnika viyavlenie pnevmonii nalichie odishki otsenka saturatsii auskultatsiya i perkussiya – nalichie lokalnix izmeneniy (krepitatsiya na vdoxe, prituplenie) dostupnost luchevogo issledovaniya (tsifrovaya texnika, bez plyonki) dostupnost pervichnix analizov guidelines for the management of adult lower respiratory tract infections, erj 2005 doljni li vrachi pervichnogo zvena naznachit i provesti mikrobiologicheskoe issledovanie vozmojnoy prichini infektsii nijnix dixatelnix putey? obichno mikrobiologicheskie issledovaniya ne rekomendovani na urovne vracha pervichnogo zvena zdravooxraneniya.[c1 – c3] lechenie vne gospitalya diagnostika * mokrota, prigodnaya dlya issledovaniy * serologicheskaya diagnostika pnevmonii viyavlenie antigena pnevmokokka v moche (chuvstvitelnost do 94%). serodiagnostika krovi m. pneumoniae: chuvstvitelnost igm v pervie 6 dney 7-23%, a posle 16 dnya — do 86%. viyavlenie antigena legionelli v moche (chuvstvitelnost bolee 90%) * diagnostika rentgenografiya organov grudnoy kletki yavlyaetsya obyazatelnim metodom issledovaniya pri pnevmonii, pozvolyaet vizualizirovat pnevmonicheskiy infiltrat, otsenit dinamiku protsessa. rasprostranyonost infiltratsii, nalichie plevralniy vipota, priznakov destruktsii …

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eykotsitoza bolee 10x109/l i/ili palochkoyadernogo sdviga bolee 10%. * pravostoronnyaya verxnedolevaya pnevmoniya * pravostoronnyaya nijnedolevaya pnevmoniya http://www.indyrad.iupui.edu/public/stalexan/sol2000/virthospblack.html * tyajyolaya pnevmoniya termin "krupoznaya pnevmoniya" vstrechaetsya tolko v russkoy meditsinskoy literature i vvel ego sergey petrovich botkin dlya videleniya bolnix s tyajelim techeniem dolevoy pnevmonii so stonushim dixaniem, krupom. * marshrutizatsiya patsienta tyajyoloe sostoyanie patsienta absolyutnie pokazanie k gospitalizatsii – dixatelnaya nedostatochnost (sa02<90) ugroza shoka (gipotoniya, taxikardiya) chdd bolee 30 v minutu porajenie bolee odnoy doli narusheniya soznaniya leykopeniya menee 4 trombotsitopeniya menee 100 gipotermiya soputstvuyushie zabolevaniya pojiloy vozrast differentsialnaya diagnostika provoditsya s tuberkulyozom, infarktom lyogkogo (tela), eozinofilnim infiltratom, opuxolyami lyogkix i drugimi sostoyaniyami, sposobnimi vizivat sindrom infiltratsii na rentgenogrammax organov grudnoy kletki (naprimer, sistemnie vaskuliti, volchanochniy pnevmonit, okrugliy atelektaz i dr.). * infiltrativniy tuberkulyoz lyogkix dvuxstoronnyaya verxnedolevaya infiltratsiya * polostnie obrazovaniya v s1-2-6 (reje – s10). * lokalizatsiya v verxne-zadnix smegmentax 1-2-6 * tuberkulyoz lyogkix u vzroslix: rentgenologiya 1-2-6, reje 10-y …

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tsin, amikatsin, streptomitsin, ftorxinoloni… * esli vrach ne uveren v diagnoze pnevmoniya, esli ne isklyuchaet tuberkulyoz, to mojno primenyat beta-laktami (penitsillin, ampitsillin, amoksitsillin, oksatsillin, tsefazolin, tseftriakson), makrolidi (azitromitsin, klaritromitsin,eritromitsin), tetratsiklini i ix sochetaniya… * vremya vvedeniya pervoy dozi antibiotika eksperti schitayut netselesoobraznim ukazivat konkretnoe «vremennoe okno» kak chetkiy orientir nachala antibakterialnoy terapii. vmeste s tem, eksperti rekomenduyut nachinat lechenie kak mojno ranshe posle ustanovleniya diagnoza pnevmonii * osobennost rekomendatsiy po lecheniyu vp otsutstvie tsefalosporinov pervoy generatsii, linkomitsina, gentamitsina, ko-trimoksazola, otxarkivayushix, bronxolitikov, antigistaminnix, nspvs immunostimulyatorov narkoticheskix analgetikov * materinstvo pri beremennosti dopustimo primenenie antibiotikov beta-laktamnogo ryada, makrolidov, metronidazol, protivopokazani ftorxinoloni, tetratsiklini, aminoglikozidi, linkosamidi, ko-trimoksazol. pri grudnom vskarmlivanii dopustimi s ostorojnostyu penitsillini, tsefalosporini, ne rekomenduyutsya makrolidi, ftorxinoloni, karbapenemi, tetratsiklini, linkosamidi, ko-trimoksazol. * prodoljitelnost antibakterialnoy terapii pri netyajyoloy vp – 7-10 dney pri tyajyoloy vp ne menee 14 dney pri mikoplazmennoy, legionellyoznoy ili xlamidiynoy vp 14 dney kriteriy otmeni stoykaya normalizatsiya temperaturi tela …

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pnevmoniya vnebolnichnaya pnevmoniya: diagnostika i lechenie i.u.abdulxakov buxarskiy gosudarstvenniy meditsinskiy institut * opredelenie pnevmoniya –– pnevmonii – gruppa razlichnix po etiologii, patogenezu, morfologicheskoy xarakteristike ostrix infektsionnix (preimushestvenno bakterialnix) zabolevaniy, xarakterizuyushixsya ochagovim porajeniem respiratornix otdelov legkix s obyazatelnim nalichiem vnutrialveolyarnoy ekssudatsii. poskolku eto ostroe infektsionnoe zabolevanie, to opredelenie «ostraya» pered diagnozom «pnevmoniya» yavlyaetsya izlishnim, tem bolee, chto diagnoz «xronicheskaya pnevmoniya» yavlyaetsya patogeneticheski ne obosnovannim, a sootvetstvuyushiy termin - ustarevshim. * …porajenie respiratornix otdelov legkix s obyazatelnim nalichiem vnutrialveolyarnoy ekssudatsii… * ht...

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