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CLASSIFICATION OF BRONCHEKTASES
(A.I. Borokhov, N.R. Paleev, 1990)
1. By origin:
1.1. Primary (congenital cysts) bronchiectasis.
1.1.1. Single (solitary).
1.1.2. Multiple. l..l-Z. Cystic lung.
1.2. Secondary (acquired) bronchiectasis.
2. In the form of bronchial enlargement:
3. The severity of the course (clinical forms):
3.2. Pronounced form.
3.3. Severe form.
3.4. Complicated form.
4. Dry bronchiectasis.
5. By prevalence:
5.1. Unilateral bronchiectasis (indicating the exact localization of the process by segments).
5.2. Bilateral bronchiectasis.
6. According to the phases of the disease:
7. The presence of complications:
2) pulmonary heart;
4) pulmonary heart failure.
EXAMPLE FORMULATION OF DIAGNOSIS
1. Bronchiectatic disease in the acute stage with a primary lesion of the right lung by saccular bronchiectasis, expressed form.
2. Bronchiectatic disease with damage to the left lung with dry bronchiectasis, complicated by bronchiectasis.
CLINIC. The disease is recognized at the age of 5 to 25 years, men are sick more often.
The most characteristic complaint of patients is a cough with sputum in large quantities, mainly in the morning, purulent or mucopurulent. During an exacerbation, the amount of sputum released can reach a liter or more with an unpleasant putrefactive odor. Periodically, many patients have hemoptysis and streaks of blood in the sputum. Shortness of breath occurs with moderate physical exertion. Pain in the chest is dull. Patients complain of lethargy, irritability, decreased performance. In the period of exacerbation, the temperature rises to subfebrile digits mainly in the evening.
During an external examination of patients with bronchiectasis, there is a certain delay in the development and growth of children and adolescents, delayed sexual development of secondary sexual characteristics, amenorrhea in girls. With total lung damage, the patient has a decrease in the volume of one half of the chest and a restriction in respiratory excursions. In patients with bronchiectasis with a widespread lesion, an earthy color of the skin is observed, the fingers take the form of “drumsticks” and the nails are deformed in the form of “watch glasses”.
These percussion of the chest with bronchiectasis are not very characteristic.
During auscultation over the affected, often posterior lower lung sections, sonorous large and medium bubbling rales are heard. After coughing up sputum, the number of wheezing decreases, and sometimes they completely disappear. In the area of altered areas, hard or bronchial breathing is heard with atelectatic bronchiectasis.
DIAGNOSTICS. The severity of x-ray manifestations in bronchiectasis depends on the prevalence of bronchiectasis, the degree of development of changes in the bronchi and surrounding tissue.
On conventional radiographs and tomograms, bronchiectasis is not always possible to detect.
Indirect signs of bronchiectasis:
1. A decrease in the volume of the affected parts of the lung.
2. Increasing transparency above - or downstream segments.
3. The appearance of peribronchial sclerosis. •four. Pulling up.
Against the background of a rough and enhanced pulmonary pattern, cellularity can be detected. The decisive diagnostic method is bronchography.
With the saccular form of bronchiectasis, pathologically altered bronchi look club-shaped expanded, a cellular pattern is determined. With cylindrical bronchiectasis, the bronchi are evenly expanded.
Antibacterial therapy is carried out during an exacerbation of the disease (preferably after determining the sensitivity of pathogens to antibiotics). The intrabronchial route of administration of drugs through a bronchoscope is preferred.
Broad-spectrum antibiotics are prescribed: semisynthetic penicillins, cephalosporins, aminoglycosides, tetracyclines, quinolones. Endobronchial administration of drugs is advisable to combine with intramuscular or intravenous administration. For endobronchial administration, dioxidine, derivatives of nitrofurans (furatsilin, furagin) and antiseptics of natural origin (chlorophyllipt) are used.
Remediation of the bronchial tree, removal of purulent bronchial contents and sputum, is carried out using instillations through a nasal catheter or by bronchoscopy, introducing therapeutic solutions of antiseptics, mucolytics (mucosolvin, acetylcysteine). In order to rehabilitate the bronchial tree, the following are used: postural drainage several times a day, expectorants, bronchodilators, chest massage.
Detoxification therapy. Drink plenty of water up to 2-3 liters per day. Hemodez, isotonic sodium chloride solution, 5% glucose solution are administered intravenously.
Immunomodulating therapy. For treatment, leva-misol, diuciphon, thymalin, T-activin are used. To normalize general and pulmonary reactivity, ginseng tincture, Eleutherococcus extract, Pantocrine, etc. are used.
Sanitation of the upper respiratory tract. Thorough treatment of teeth, chronic tonsillitis, pharyngitis, diseases of the nasal cavity.
Exercise therapy, respiratory gymnastics, massage, physiotherapy, sanatorium spa treatment. Exercise therapy and breathing exercises are carried out regularly. Massage of the chest improves drainage function, sputum discharge. Physiotherapy is performed when the phenomena of exacerbation of the disease subside. The patient is prescribed electrophoresis with calcium chloride, potassium iodide, inductothermy, microwave therapy. Sanatorium-resort treatment is carried out in the inactive phase of the disease in the warm season, best of all in the sanatoriums of the southern coast of Crimea.
Surgery. Indication: limited within individual segments or lobes of bronchiectasis without pronounced chronic obstructive bronchitis. Contraindication: 1) decompensated pulmonary heart; 2) renal amyloidosis with renal failure.
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