chronic pneumonia
Introduction
Introduction to chronic pneumonia The disease duration of more than 3 months is chronic pneumonia. In recent years, the acute death rate of children with acute pneumonia is decreasing, but children with severe pneumonia sometimes fail to recover completely. It is quite uncommon for people to relapse and become chronic pneumonia. Inflammatory lesions can invade bronchial tubes at all levels. Alveolar, interstitial tissue and blood vessels. Especially in the inflammation of the interstitial tissue, every time there is progress, the bronchial wall elastic fibers are destroyed, and the lumen is narrowed due to fibrosis. At the same time, due to secretions blocking the lumen, atelectasis occurs, eventually leading to bronchiectasis. Due to the destruction of the bronchial wall and the alveolar wall, air is scattered through the lymphatic vessels and enters the interstitial space, which can form interstitial emphysema. Proliferative inflammation also occurs in local blood vessels and lymphatic vessels, the wall is thickened, and the lumen is narrow. Therefore, timely prevention and treatment of chronic pneumonia is very important. basic knowledge The proportion of sickness: 1.2% Susceptible people: no specific population Mode of infection: non-infectious Complications: sepsis, arrhythmia, heart failure, respiratory failure, multiple system organ failure
Cause
Cause of chronic pneumonia
Virus infection (25%):
Viral infection caused interstitial pneumonia, which easily evolved into chronic pneumonia. The Capital Institute of Pediatrics had followed up to 103 cases of adenovirus pneumonia 1 to 5 years after the disease, and found that 30.1% of chronic pneumonia with varying severity and severity on X-ray examination Lung insufficiency, individual children also have bronchiectasis, 13 cases of measles complicated with adenovirus pneumonia were followed up 2 to 3 years after the disease, of which 6 cases have become chronic pneumonia.
Recurrent upper respiratory tract infection or bronchitis (30%):
Repeated upper respiratory tract infections or bronchitis and chronic sinusitis are all causes of chronic pneumonia. Foreign bodies deep into the bronchus, especially foreign bodies that lack irritating and do not produce acute fever (such as jujube nucleus), can be ignored and remain in the lungs for a long time, forming chronic pneumonia.
Immunization (15%):
Immunodeficient children, including humoral and cellular immunodeficiency, complement deficiency and defects in leukocyte phagocytosis can cause recurrent pneumonia and eventually become chronic. Primary or secondary respiratory cilia morphology and dysfunction can cause chronic inflammation of the lungs.
Malnutrition, rickets, congenital heart disease or tuberculosis in children with pneumonia, prone to prolonged disease.
Inflammatory lesions can invade bronchial, alveolar, interstitial tissues and blood vessels at all levels, especially in the inflammation of the interstitial tissue. Each episode has progressed, causing the bronchial wall to break the elastic fibers and eventually causing stenosis due to fibrosis. At the same time, due to secretions blocking the lumen, atelectasis occurs, resulting in bronchiectasis. Due to the destruction of the bronchial wall and alveolar wall, air is scattered through the lymphatic vessels and enters the interstitial space, which can form interstitial emphysema and local blood vessels. Proliferative inflammation also occurs in the lymphatic vessels, the wall is thickened, and the lumen is narrow.
Prevention
Chronic pneumonia prevention
The recovery of pathology of acute pneumonia is later than that of clinical recovery. Therefore, during the recovery period of severe pneumonia, physical therapy and gymnastics should be carried out, and rickets and malnutrition should be actively treated, and follow-up and continued treatment after discharge should be completed until it is completely cured. In addition, infants In early childhood, we should try to prevent measles, hundred cough, flu and adenovirus infection. For diffuse sinusitis and recurrent bronchitis, we should actively prevent and treat it. Children with immunodeficiency can use immune-boosting therapy, depending on the situation. Human blood gamma globulin, transfer factor, thymosin or traditional Chinese medicine can be used. If necessary, bone marrow transplantation can be used to reconstruct immune function and prevent repeated infection and chronic pneumonia.
Complication
Chronic pneumonia complications Complications sepsis arrhythmia heart failure respiratory failure multisystem organ failure
Sepsis or sepsis, arrhythmia and heart failure, respiratory failure and multiple organ failure.
1. Septicemia is a systemic infection caused by pathogenic bacteria invading the blood circulation and growing in it, producing toxins, which is easy to occur in the case of reduced body resistance. Clinically, the main manifestations are chills, hyperthermia, symptoms of toxemia, rash, joint pain, hepatosplenomegaly, septic shock, migratory lesions, etc. The vast majority of patients have acute course of disease, serious condition, poor prognosis, and now further consider sepsis It is a series of chain reaction processes caused by pathogens and their toxins and metabolites that activate and release inflammation mesons after entering the bloodstream.
2, arrhythmia (cardiac arrhythmia) is due to sinus node dysfunction or excitement generated outside the sinus node, stimulating conduction slow, block or conduction through abnormal channels, that is, the origin of cardiac activity and / or conduction disorders lead to the heart Abnormal frequency and/or rhythm of pulsation, an arrhythmia is an important group of diseases in cardiovascular disease. It can be associated with cardiovascular disease alone or in combination with cardiovascular disease. Sudden onset and sudden death, can also continue to affect the heart and fail.
3, heart failure, also known as "myocardial failure", refers to the heart can not beat the same blood supply as the venous return and body tissue metabolism.
4. Respiratory failure is a clinical synthesis of a series of pathophysiological disorders caused by various causes of severe respiratory dysfunction, causing a decrease in arterial partial pressure of oxygen (PaO2), accompanied by or without increased arterial blood carbon dioxide partial pressure (PaCO2). Sign.
Symptom
Chronic pneumonia symptoms Common symptoms Bronchial purulent secretion increased lemon color dyspnea fever fever edema extremely severe mental retardation hyperventilation multi-ventricular hypertrophy
Chronic pneumonia is characterized by periodic recurrence and deterioration. It is a wavy type. Due to the age of the lesion, age and individual, the symptoms are various. During the quiescent period, the body temperature is normal, no obvious signs, almost no cough, but running. It is easy to pant when going upstairs, often accompanied by pulmonary insufficiency during the deterioration, cyanosis and difficulty in breathing, and due to decreased vital capacity and respiratory reserve and shortened breath holding time, the external respiratory dysfunction caused by hyperventilation, the improvement is slow after the deterioration , often cough, and even facial edema, cyanosis, thoracic deformation and clubbing, toe, due to emphysema, pulmonary insufficiency caused by increased pulmonary circulation resistance, increased pulmonary artery pressure, increased right heart burden, can be within six months to two years Pulmonary heart disease occurs, there may be liver dysfunction, white blood cells increase, and erythrocyte sedimentation rate increases moderately.
Examine
Chronic pneumonia
X-ray films showed that the lungs in the lower and lung areas of the two lungs could be honeycombed, with vesicular emphysema, and also with substantial inflammatory lesions. X-ray signs of bronchial dilatation, right ventricular hypertrophy and pulmonary artery segmentation may occur with the development of the lesion. When there is pulmonary heart disease, the electrocardiogram shows a clockwise transposition, P wave is high and sharp, QRS Most of the composite waves showed changes in the pattern of right ventricular hypertrophy.
Diagnosis
Diagnosis and identification of chronic pneumonia
diagnosis
The history of the disease is extremely important, often with sinusitis, bronchitis or pneumonia, or measles, whooping cough, influenza or adenovirus pneumonia. The diagnosis needs to be combined with medical history, symptoms and silk examination.
Differential diagnosis
Special attention should be paid to the identification of tuberculosis, repeated history of upper and lower respiratory tract infections or post-infectious diseases, and the discharge of pus-like sputum, etc., more common in chronic pneumonia, tuberculin test and X-ray examination, hilar And paratracheal lymphadenopathy can help diagnose.
Tuberculosis (TB) is a common and fatal infectious disease caused by mycobacteria, also known as Mycobacterium tuberculosis. Tuberculosis usually infects and destroys the lungs and lymphatic system, but other organs such as the brain, central nervous system, circulatory system, urinary system, bones, joints, and even the skin can also be infected. Other mycobacteria, such as M. bovis, M. africanum, M. kawaii, M. voles, can also cause tuberculosis, but usually do not infect healthy adults.
