How to treat bronchiectasis?
The disease is a common purulent inflammation of respiratory system. The main pathogenic factors are infection, obstruction and traction of bronchus, which leads to irreversible expansion of bronchus. Some patients have congenital genetic factors, and most of them have childhood measles, whooping cough or bronchopneumonia.
Clinical manifestations: 1, chronic cough, coughing up a lot of thick phlegm. 2, repeatedly coughing up blood. 3. Common clubbed fingers (toes),
4. Repeated lung infections. 5, emaciation and anemia.
About half of the patients have chronic cough, yellow sticky sputum or thick sputum, with the range of 100-500ML. After several hours, it can be seen that the vitreous sputum is divided into three layers, the upper layer is foam and middle mucus, and the lower layer is purulent material and necrotic tissue. Such as Pseudomonas aeruginosa infection, yellow and green. When there is anaerobic bacteria infection, the smell is unpleasant. Some patients have prominent hemoptysis symptoms, less cough and less sputum, which is "bronchiectasis sicca".
There were no signs in the early stage, and only wet rales were smelled in the corresponding parts of the back. After repeated infection, dry and wet rales increased. About13 patients have clubbed fingers, and hypoxemia may occur in the later stage, and the clinical manifestation is cyanosis.
Etiology and pathogenesis
The main cause of bronchiectasis is the congestion and edema of lumen mucosa caused by infection of bronchial-lung tissue and bronchial obstruction, which makes the secretion of lumen stenosis easy to block the lumen, leading to poor drainage and aggravating infection. Bronchial obstruction and poor drainage can induce lung infection. Therefore, the interaction between them promotes the occurrence and development of bronchiectasis. Most patients have a history of persistent measles, whooping cough or bronchopneumonia in childhood, and often have repeated respiratory infections in the future.
Trachea and main bronchiectasis are rare, and bronchioles below lung segment and sub-lung segment are weak and small in diameter, which is easy to cause sputum retention and obstruction, leading to bronchiectasis. The disease presents irreversible expansion and deformation in the anatomical structure of bronchial tissue. Macroscopic examination of bronchiectasis shows that the bronchial wall is obviously thickened and deformed to varying degrees, and the lumen can be cystic, columnar or spindle-shaped. The dilated lumen is often filled with mucus, the mucosa has obvious inflammation and ulcer, the bronchial wall is damaged to varying degrees, and fibrous tissue proliferates. Microscopically, lymphocyte infiltration or lymph nodules can be seen in the bronchial wall, and mucus glands and lymphocytes are very obvious. The columnar epithelium of bronchial mucosa is often squamous metaplasia. The bronchial wall was damaged to varying degrees, and even the normal structure was not seen, only a small amount of muscle and cartilage fragments were seen. There is neutrophil infiltration in the wall of the tube, and pathological changes such as fibrosis, collapse or pneumonia often appear in the surrounding lung tissue. Finally, it can be complicated with pulmonary heart disease and even heart failure.
Complications of bronchiectasis: pleurisy, empyema, pericarditis, cor pulmonale and even heart failure.
The disease grade is 1, mild, and the lesion is limited to one or more lung segments, but not more than one lung lobe. Cough, expectoration with white sputum, occasional yellow sputum or blood in sputum, X-ray chest film only shows local nonspecific texture thickening, physical examination is often negative or only local wet rales.
2, moderate, the lesion can be more than one leaf, but only one lung; Cough, expectoration, sometimes varying degrees of hemoptysis, repeated lung infections, X-ray chest film shows some honeycomb shadows of lung lesions, auscultation can be heard and wet rales, even after systematic antibacterial treatment, local wet rales will not completely disappear.
3. In severe cases, lesions may appear in both lungs, such as fever, cough, expectoration and yellow pus. When there is Pseudomonas aeruginosa infection, yellow-green pus may be coughed up, chest tightness, shortness of breath, clubbed fingers (toes), hemoptysis to varying degrees, even massive hemoptysis, repeated lung infections, and moderate damage to lung function. X-ray films can identify the condition.
Treat 1 and promote expectoration.
2. Anti-infection.
3. Hemostatic treatment of hemoptysis.
4. Surgical treatment. The elderly and people with cardiopulmonary insufficiency are not suitable for surgery.
Prescription 1. According to the etiological examination, choose reasonable and effective antibiotics for symptomatic treatment.
2, palliative drugs: Zhike Huatan Pill, defibrase.
Therapeutic drugs: Changchun Baotai Pill/Baihe Gujin Pill (syndrome differentiation of yin and yang deficiency)
Clinical use: Ruyi Dingchuan Pill/Cordyceps Lily Pill.
3. Take Yunnan Baiyao regularly.
4. The application of drugs for promoting blood circulation and removing blood stasis can improve the immunity of patients.
Prevention and care
A, strengthen protection, improve the surrounding environment, avoid smoke and other harmful gases to stimulate the respiratory tract.
B, strengthen physical exercise and improve disease resistance. For example, running, walking, playing Tai Chi or practicing Qigong.
C. prevent colds.
D, diet care: eat more fresh fruits such as radish, pear, loquat, melon and watermelon, mainly to nourish the lungs, clear away heat and resolve phlegm. Avoid raw, cold, hard, sour and spicy foods.
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