Mob ntsws yog ib qho kab mob ua pa qis uas cuam tshuam rau lub ntsws cov nqaij. Kev kis kab mob ua pa hauv qab yog tus lej ua rau tuag los ntawm cov kab mob sib kis hauv Tebchaws Meskas. Kev kho mob ntsws me me yuav tsum tau kho mob sab nrauv nrog tshuaj tua kab mob thiab so kom txaus. Lub caij no, thaum muaj mob ntsws me ntsis, tus neeg mob yuav tsum tau mus pw hauv tsev kho mob thiab siv tshuaj tua kab mob hauv lub qhov txhab. Cov neeg mob uas muaj mob ntsws loj yuav tsum tau mus pw hauv tsev kho mob thiab siv tshuaj tua kab mob tso rau hauv lub cev, tseem tau siv lub tshuab nqus dej thiab siv lub tshuab ua pa kom pab ua pa. Txawm hais tias nws hnyav npaum li cas, mob ntsws yog ib yam mob hnyav heev uas yuav tsum tau kho sai thiab kom huv.
Kauj ruam
Txoj Kev 1 ntawm 4: Kho Mob ntsws
Kauj Ruam 1. Tau txais kev kho mob me me
Yog tias koj muaj mob ntsws me me, koj yuav raug kho raws li tus neeg mob sab nrauv. Txawm li cas los xij, yog tias tus neeg mob uas mob ntsws yog menyuam yaus, nws lossis nws yuav tau mus pw hauv tsev kho mob yog tias cov kws kho mob xav tias nws tus mob yuav loj tuaj. Koj tus kws kho mob yuav sau tshuaj tua kab mob rau koj. Tus kws kho mob tseem yuav hais kom koj so thiab ua kom koj lub sijhawm pw tsaug zog kom koj zoo sai sai. Txawm tias mob me me, koj yuav tsum tsis txhob mus kawm ntawv lossis ua haujlwm kom txog thaum koj tus kws kho mob tso cai. Lub sijhawm ua kom rov zoo los ntawm kev mob ntsws feem ntau yog li 7-10 hnub.
- Qee hom mob ntsws yog kis tau yooj yim, thaum lwm hom mob ntsws yuav tsuas kis mus rau lwm tus neeg raws li qhov xwm txheej zoo. Thaum koj tus kws kho mob kuaj mob, nug txog qib kev kis tus mob ntsws uas koj muaj, thiab ntev npaum li cas koj xav tias koj tuaj yeem kis tau nws.
- Koj cov tsos mob yuav tsum pib txhim kho tsis pub dhau 48 teev ntawm kev kho. Qhov no txhais tau tias koj yuav tsum tsis muaj kub taub hau ntxiv thiab koj lub cev yuav muaj zog dua.
- Tsis tas yuav ntsuas tshwj xeeb thaum ntxuav cov khoom siv los ntawm cov neeg mob ntsws. Cov kab mob uas ua rau mob ntsws tsis tuaj yeem nyob ntawm cov khoom uas tsis muaj sia nyob ntev, thiab tuaj yeem ntxuav los ntawm kev ntxuav ib txwm muaj.
Kauj Ruam 2. Kho tus mob hnoos qeev me ntsis
Cov neeg mob ntsws me me tau nrog los ntawm kev ua pa nyuaj heev kom thiaj li tswj tau cov pa oxygen ntawm tus neeg mob, xav tau cov tshuaj ntxiv oxygen. Cov neeg mob uas mob ntsws me ntsis kuj tseem yuav ua npaws thiab zoo li qaug zog. Yog tias koj mob ntsws zoo li no, koj yuav tsum tau mus pw hauv tsev kho mob rau tshuaj tua kab mob. Hom tshuaj tua kab mob uas muab rau koj yuav tsis hloov pauv, tab sis tsuas yog nyob rau hauv daim ntawv ntawm kev npaj txhaj tshuaj kom lawv nkag mus rau hauv lub cev sai dua.
- Cov tshuaj tua kab mob uas koj tab tom noj yuav raug hloov mus rau kev npaj qhov ncauj thaum koj kub taub hau tau poob thiab koj lub cev tau teb zoo dua rau kev kho. Feem ntau, nws siv sijhawm tsis tshaj 48 teev.
- Kev kho tom qab ntawd zoo ib yam li ntawm mob ntsws me me vim tias qhov mob hnyav tau hloov pauv los ntawm qhov nruab nrab mus rau mob khaub thuas.
Kauj Ruam 3. Nrhiav kev pab thaum muaj mob hnyav
Cov neeg mob ntsws loj tuaj nrog ua pa tsis ua haujlwm. Qhov xwm txheej no xav tau kev nqus dej thiab siv lub tshuab nqus cua. Ib qho ntxiv, cov neeg mob uas raug nws kuj tseem yuav tau mus pw hauv tsev kho mob hauv ICU.
- Ib yam li nyob rau kis mob hnyav, yuav tsum tau siv tshuaj tua kab mob hauv lub cev. Thaum muaj mob ntsws loj, siv tshuaj vasopressor (tshuaj kom ua kom ntshav siab) kuj tseem xav tau los tiv thaiv qhov tshwm sim ntawm septic poob siab.
- Thaum nyob hauv tsev kho mob, koj tseem yuav xav tau kev saib xyuas txhawb nqa txhawm rau txhim kho koj txoj kev noj qab haus huv thaum siv tshuaj kho mob ntsws. Tom qab koj txoj kev noj qab haus huv txhim kho, kev kho mob yuav zoo ib yam li mob ntsws me ntsis mus rau mob ntsws. Qhov ntev ntawm kev mus pw hauv tsev kho mob uas koj yuav tsum tau mus ntsib yog txiav txim siab los ntawm qib kev puas tsuaj hauv lub ntsws thiab qhov mob hnyav ntawm tus mob ntsws uas koj raug mob.
- Cov kws kho mob tuaj yeem siv lub tshuab ua pa zoo (bilevel positive airway pressure (BiPAP) hauv qee tus neeg mob kom tsis txhob nqus dej thiab siv lub tshuab ua pa ib txwm siv. BiPAP yog cov txheej txheem tsis cuam tshuam rau xa cov cua nrawm rau cov neeg mob uas feem ntau kuj tseem siv los kho pw tsaug zog apnea.
Kauj Ruam 4. Siv tshuaj tua kab mob kom raug
Muaj ntau hom tshuaj tua kab mob sib txawv uas koj tuaj yeem siv tau yog tias koj muaj mob ntsws. Tus kws kho mob yuav txiav txim siab hom kab mob ua rau koj mob ntsws tshwj xeeb los txiav txim siab txog cov tshuaj tsim nyog. Hauv ntau hom mob ntsws, tshuaj tua kab mob muab suav nrog zithromax lossis doxycycline ua ke nrog amoxicillin, augmentin, ampicillin, cefaclor, lossis cefotaxime. Qhov koob tshuaj tua kab mob yog txiav txim siab los ntawm koj lub hnub nyoog thiab qhov hnyav ntawm koj kis, nrog rau koj qhov kev tsis haum tshuaj thiab kev coj noj coj ua xeem.
- Koj tus kws kho mob yuav sau ntawv siv tsawg dua tab sis siv tshuaj tua kab mob zoo, quinolone tshuaj tua kab mob xws li Levaquin lossis Avelox rau cov laus. Quinolones tsis tau qhia rau cov menyuam yaus.
- Hauv qhov mob hnyav thiab me me, tab sis yuav luag xav kom tus neeg mob mus pw hauv tsev kho mob, tus kws kho mob tuaj yeem muab cov tshuaj rocephin tso rau tom qab noj tshuaj tua kab mob hauv qhov ncauj.
- Hauv txhua kis mob ntsws, koj tus kws kho mob yuav muab tshuaj rau koj tom qab ob peb hnub txhawm rau tshuaj xyuas koj cov tsos mob.
Kauj Ruam 5. Kho nosocomial pneumonia (tsev kho mob tau txais mob ntsws (HAP)
Cov neeg mob nosocomial pneumonia twb muaj teeb meem kev noj qab haus huv lawm. Qhov no ua rau kev saib xyuas rau lawv txawv me ntsis rau cov tib neeg uas muaj mob ntsws (Community-acquired pneumonia (CAP)). Txawm li cas los xij, saib xyuas cov neeg mob nosocomial pneumonia kuj tseem tuaj yeem siv rau qhov mob hnyav thiab mob hnyav hauv zej zog. Nosocomial pneumonia tuaj yeem tshwm sim los ntawm ntau hom kab mob. Yog li, tus kws kho mob yuav txiav txim siab tus kab mob uas tawm tsam koj lub cev thiab tom qab ntawd muab cov tshuaj tua kab mob tsim nyog. Raug kho yog:
- Rau Klebsiella thiab E. Coli, txhaj tshuaj tua kab mob xws li quinolones, ceftazidime, lossis ceftriaxone.
- Rau Pseudomonas, txhaj tshuaj tua kab mob xws li imipenem, piperacillin, lossis cefepime.
- Rau S. aureus lossis MRSA, txhaj tshuaj tua kab mob xws li vancomycin.
- Txog rau mob ntsws ntsws, txhaj tshuaj tua kab mob xws li Amphotericin B lossis Diflucan IV
- Rau vancomycin-resistant enterococci: txhaj tshuaj tua kab mob xws li ceftarolin
Txoj Kev 2 ntawm 4: Tiv Thaiv Mob Ntsws
Kauj Ruam 1. Tau txhaj tshuaj tiv thaiv khaub thuas
Mob ntsws tuaj yeem tshwm sim los ntawm kev mob khaub thuas hnyav. Yog li, nws raug nquahu kom koj txhaj tshuaj tiv thaiv khaub thuas ib xyoos ib zaug. Txij li nws tuaj yeem pab lub cev tiv thaiv kab mob khaub thuas, nws tseem yuav pab tiv thaiv mob ntsws.
- Cov tshuaj tiv thaiv khaub thuas tuaj yeem muab rau txhua tus neeg laus dua 6 lub hlis.
- Muaj cov tshuaj tiv thaiv tshwj xeeb uas tuaj yeem muab rau menyuam yaus hnub nyoog qis dua 2 xyoos thiab tseem yog menyuam yaus hnub nyoog 2-5 xyoos uas muaj kev pheej hmoo mob ntsws ntau dua. Cov menyuam yaus uas tau saib xyuas hauv chaw zov menyuam yuav tsum tau txhaj tshuaj tiv thaiv no.
- Kuj tseem muaj tshuaj tiv thaiv rau cov neeg uas tsis muaj tus mob hnoos qeev, muaj hnub nyoog tshaj 65 xyoos, muaj kab mob ntsws xws li mob hawb pob thiab COPD, thiab mob ntshav tsis txaus ntawm tes.
Kauj Ruam 2. Ntxuav koj txhais tes ntau zaus
Txhawm rau zam kev mob ntsws, koj yuav tsum zam kev sib cuag nrog cov kab mob thiab kab mob uas ua rau nws. Txog qhov ntawd, ntxuav koj txhais tes kom raug. Yog tias koj nyob hauv ib puag ncig ntawm cov neeg muaj kab mob, ntxuav koj txhais tes ntau li ntau tau. Ib qho ntxiv, zam kev tso tes qias neeg nyob ib ncig ntawm lub ntsej muag kom tiv thaiv kev kis kab mob los ntawm txhais tes mus rau hauv lub cev. Txhawm rau ntxuav koj txhais tes kom raug:
- Qhib tus kais dej thiab ntub koj txhais tes.
- Ncuav cov xab npum rau hauv koj txhais tes thiab txhuam koj cov ntiv tes, suav nrog thaj chaw hauv qab koj cov rau tes, nraub qaum ntawm koj txhais tes, thiab ntawm koj cov ntiv tes.
- Ntxuav koj ob txhais tes tsawg kawg 20 vib nas this, lossis tsuav koj hu nkauj "Zoo Siab Hnub Yug" ob zaug.
- Yaug tes nrog dej kom tshem xab npum. Siv dej sov los pab tshem tawm xab npum thiab kab mob.
- Qhuav koj ob txhais tes nrog daim ntaub huv.
Kauj Ruam 3. Saib xyuas koj lub cev
Ib txoj hauv kev muaj zog los tiv thaiv kab mob ntsws yog tswj hwm kev noj qab haus huv zoo tshaj plaws ntawm lub cev li sai tau. Qhov no txhais tau tias, koj yuav tsum tswj lub cev thiab lub paj hlwb kom zoo. Sim ua kom ib ce muaj zog txhua hnub, noj zaub mov zoo thiab noj qab nyob zoo, thiab tsaug zog txaus. Txhua yam uas yuav tau txais txiaj ntsig zoo rau koj kev noj qab haus huv thaum ua kom koj lub cev tiv thaiv kab mob muaj zog li sai tau.
Coob leej xav tias lawv tuaj yeem pw tsaug zog zoo thiab nyob zoo. Qhov tseeb, muaj cov kev tshawb fawb uas tau pom muaj kev sib raug zoo ntawm qib tiv thaiv kab mob thiab pw tsaug zog thaum hmo ntuj. Qhov ntau koj tau txais txiaj ntsig zoo, tsis muaj kev cuam tshuam pw tsaug zog hauv ib puag ncig thaum hmo ntuj, kev noj qab haus huv koj lub cev tiv thaiv kab mob yuav zoo dua
Kauj Ruam 4. Sim siv cov vitamins thiab minerals
Muaj ntau qhov tshuaj ntxiv uas koj tuaj yeem siv los txhawb koj qhov kev tiv thaiv tag nrho. Ib ntawm cov vitamins zoo tshaj plaws los tiv thaiv kab mob ntsws yog vitamin C. Sim haus 1000-2000 mg ntawm vitamin C txhua hnub. Koj tuaj yeem tau txais nws los ntawm txiv hmab txiv ntoo citrus, kua txiv kab ntxwv, zaub paj, dib liab, melon daj, thiab ntau lwm yam zaub thiab txiv hmab txiv ntoo.
Zinc (zinc) kuj tseem muaj txiaj ntsig yog tias koj muaj khaub thuas uas tuaj yeem ua rau mob ntsws. Thaum pib mob khaub thuas, noj 150 mg ntawm zinc peb zaug ib hnub
Kauj Ruam 5. Tau txhaj tshuaj tiv thaiv kab mob ntsws yog tias koj lub cev tiv thaiv tsis muaj zog
Thaum txhaj tshuaj tiv thaiv kab mob khaub thuas ua haujlwm rau yuav luag txhua tus, kev txhaj tshuaj tiv thaiv kab mob ntsws yuav tsim nyog rau qee leej. Rau cov neeg laus noj qab haus huv nruab nrab ntawm hnub nyoog 18-64, kev txhaj tshuaj tiv thaiv kab mob ntsws yuav tsis tsim nyog. Txawm li cas los xij, xav txog kev txhaj tshuaj no yog tias koj muaj hnub nyoog tshaj 65 xyoos, muaj kab mob uas ua rau koj lub cev tsis muaj zog, haus luam yeeb lossis haus ntau, lossis rov zoo los ntawm kev raug mob, mob, lossis phais loj.
- Muaj ob hom tshuaj tiv thaiv kab mob ntsws, uas yog: txhaj tshuaj tiv thaiv kab mob pneumococcal (PCV13 lossis Prevnar 13) uas tiv thaiv lub cev los ntawm 13 hom kab mob pneumococcal thiab pneumococcal polysaccharide txhaj tshuaj (PPSV23 lossis Pneumovax) uas tiv thaiv lub cev los ntawm 23 hom kab mob pneumococcal.
- Hmoov tsis zoo, kev txhaj tshuaj tiv thaiv kab mob ntsws tsis tau lees tias koj yuav tsis kis mob ntsws. Txawm li cas los xij, kev txhaj tshuaj tiv thaiv kab mob no yuav txo koj txoj kev pheej hmoo mob ntsws. Yog tias koj kis tus kab mob ntsws tom qab txhaj tshuaj tiv thaiv kab mob ntsws, feem ntau nws yuav kis tau me me.
Txoj Kev 3 ntawm 4: Nkag Siab Lub Zej Zos Tau Txais Kev Mob Ntsws
Kauj Ruam 1. Txheeb xyuas hom mob ntsws
Mob ntsws tau muab cais ua ob yam raws li qhov ua rau thiab txheej txheem kev kho mob, uas yog, mob ntsws tau txais los ntawm zej zog (CAP) thiab nosocomial pneumonia (tsev kho mob tau mob ntsws (HAP), uas yuav tham txog hauv ntu tom ntej. Kev mob ntsws hauv zej zog yog tshwm sim los ntawm cov kab mob tsis sib xws, thiab kab mob ua pa.
Kev mob ntsws hauv zej zog yog hom mob ntsws uas kis rau tib neeg feem coob hauv lawv lub neej txhua hnub. Mob ntsws yog qhov txaus ntshai tshaj rau cov neeg laus, menyuam mos thiab menyuam yaus, nrog rau cov uas muaj kev tiv thaiv kab mob tsis zoo xws li ntshav qab zib, cov neeg muaj tus kabmob HIV, lossis cov uas tau siv tshuaj kho mob thiab siv tshuaj steroid. Qhov mob hnyav ntawm zej zog mob ntsws yog los ntawm kis mob me me (thiab tuaj yeem kho nyob hauv tsev) mus rau cov neeg ua pa nyuaj ua pa thiab tuag
Kauj Ruam 2. Paub txog cov tsos mob ntawm mob ntsws
Cov tsos mob ntawm tus mob ntsws tuaj yeem sib txawv los ntawm me me mus rau mob hnyav, nyob ntawm tus kab mob ua rau nws thiab qhov mob hnyav ntawm tus neeg mob. Yog tias koj tau ntsib ib qho ntawm cov tsos mob no, mus ntsib koj tus kws kho mob tam sim rau kev kho mob. Qhov koj ncua sijhawm ntev dua, qhov cuam tshuam loj dua. Cov tsos mob ntawm kev mob ntsws hauv zej zog suav nrog:
- Quav nrog phlegm
- Phlegm tuab uas tej zaum yuav ntsuab, daj, lossis liab
- Mob hauv siab hnyav thaum ua pa tob
- Ua npaws ntau dua 38 ° C, tab sis feem ntau ntawm 38, 3-38, 9 ° C.
- Tshee los yog co tsis pom
- Ua tsis taus pa hnyav heev
- Ua pa nrawm uas feem ntau tshwm sim thaum menyuam yaus
- Txo cov pa oxygen hauv lub ntsws
Kauj Ruam 3. Tshaj tawm kev kuaj mob ntsws hauv zej zog
Thaum koj mus ntsib koj tus kws kho mob, tag nrho koj cov tsos mob yuav raug tshuaj xyuas. Ib qho ntxiv, tus kws kho mob kuj tseem yuav ua lub hauv siab radiograph uas yuav qhia qhov cuam tshuam ntawm tus kab mob rau koj lub ntsws. Yog tias koj tus kws kho mob ceeb toom txog thaj ua rau thaj ntawm koj lub ntsws, uas feem ntau yog xim dub, koj yuav muaj mob ntsws. Ib qho ntxiv, kuj tseem yuav muaj qhov mob parapneumonic effusion, lossis cov kua dej nyob ib puag ncig thaj tsam muaj tus kab mob.
Feem ntau tsis xav kuaj ntshav thaum muaj mob ntsws me me. Txawm li cas los xij, yog tias koj mob ntsws hnyav dua, koj tus kws kho mob yuav xaj kom koj suav cov ntshav kom tiav, cov txheej txheem txheej txheem zom zaub mov, cov hnoos qeev, thiab kab mob kab mob
Kauj Ruam 4. Nrhiav kev kho mob tam sim
Hauv qee qhov xwm txheej, koj yuav tsum tau mus ntsib kws kho mob tam sim. Txawm hais tias koj tau kho yav dhau los, mus ntsib kws kho mob tam sim yog tias koj cov tsos mob hnyav zuj zus. Mus ntsib kws kho mob lossis chav kho mob tam sim yog tias:
- Koj tsis meej pem los txiav txim lub sijhawm, paub txog tib neeg lossis chaw
- Xuav thiab ntuav tiv thaiv koj los ntawm kev nqos cov tshuaj tua kab mob hauv qhov ncauj
- Koj cov ntshav siab poob qis
- Koj cov pa ua pa nrawm
- Koj xav tau kev pab ua pa
- Koj lub cev kub tshaj 38.9 ° C.
- Koj lub cev kub tsawg dua li ib txwm
Txoj Kev 4 ntawm 4: Nkag Siab Nosocomial Pneumonia
Kauj Ruam 1. Txheeb xyuas nosocomial pneumonia (tsev kho mob tau txais mob ntsws (HAP)
Nosocomial pneumonia kis rau cov neeg mob thaum lawv nyob hauv tsev kho mob. Qhov mob ntsws no feem ntau hnyav heev, muaj neeg tuag coob, thiab muaj lub luag haujlwm rau 2% ntawm tsev kho mob. Nosocomial mob ntsws tuaj yeem cuam tshuam rau txhua tus neeg mob hauv tsev kho mob, los ntawm cov uas yuav tau phais mob rau cov uas twb muaj mob hnyav lawm. Nosocomial mob ntsws tuaj yeem ua rau mob sepsis thiab ntau yam tsis ua haujlwm, nrog rau kev tuag.
Cov tsos mob ntawm nosocomial pneumonia zoo ib yam li mob ntsws hauv zej zog vim tias lawv ib txwm muaj kab mob tib yam
Kauj Ruam 2. Paub qhov pheej hmoo ntawm nosocomial pneumonia
Kev mob ntsws hauv zej zog yog kis los ntawm kev kis kab mob sib kis. Lub caij no, nosocomial pneumonia tau kis thoob plaws hauv tsev kho mob ib puag ncig. Txawm hais tias txhua tus neeg mob hauv tsev kho mob tuaj yeem kis tus mob nosocomial pneumonia, muaj qee tus neeg mob uas muaj feem pheej hmoo tsim nws. Cov teeb meem no muaj xws li:
- Kev kho mob hauv ICU
- Siv cov tshuab nqus cua rau 48 teev lossis ntau dua
- Kev kho mob hauv tsev kho mob lossis ICU ntev
- Cov uas twb tau raug mob hnyav thaum raug kho tom tsev kho mob
- Cov neeg mob uas muaj lub plawv tsis ua haujlwm, lub raum tsis ua haujlwm, lub siab tsis ua haujlwm, COPD, thiab ntshav qab zib
Kauj Ruam 3. Nkag siab qhov ua rau nosocomial pneumonia
Nosocomial pneumonia tuaj yeem tshwm sim los ntawm teeb meem tom qab phais xws li mob ntsws tom qab phais lossis tsis ua pa tob tob vim qhov mob. Nws kuj tseem tuaj yeem tshwm sim los ntawm kev tu cev tsis zoo ntawm cov neeg ua haujlwm kho mob hauv tsev kho mob, tshwj xeeb tshaj yog thaum lub sijhawm lawv muab kev saib xyuas rau cov neeg mob ntawm cov raj, lub tshuab ua pa, thiab lub raj ua pa.
Kauj Ruam 4. Tsis txhob nosocomial pneumonia
Nosocomial mob ntsws tuaj yeem zam tau yog tias cov neeg ua haujlwm noj qab haus huv hauv tsev kho mob ua kom huv si ntau li ntau tau, saib xyuas lub tshuab ua pa kom zoo, thiab siv lub tshuab ntsuas ntshav siab tom qab ua haujlwm los txhawb kev ua pa ntev hauv cov neeg mob tom qab phais. Kev mob ntsws kuj tseem tuaj yeem zam tau yog tias tus neeg mob tuaj yeem tawm hauv txaj sai dua tom qab phais thiab yog tias lub qhov ncauj tawm sai li sai tau.
