acute tracheobronchitis
Introduction
Introduction to acute tracheobronchitis Acute tracheobronchitis (acutetracheobronchitis) is an acute inflammation of the bronchial tree mucosa caused by biological or abiotic pathogenic factors. It is an independent disease, and there is no intrinsic relationship with chronic bronchitis. It is also a disease-free distinction. Acute tracheobronchial Inflammation is quite common, 20 times more in outpatients than in pneumonia and 10 times more than bronchial asthma. basic knowledge Sickness ratio: 10%-15% Susceptible people: no special people Mode of infection: non-infectious Complications: pneumonia, rib fracture, syncope, urinary incontinence
Cause
Cause of acute tracheobronchitis
(1) Causes of the disease
The most important biological causes of acute tracheobronchitis are viral infections, including adenovirus, coronavirus, influenza A and B, parainfluenza virus, respiratory syncytial virus, coxsackievirus A2l, rhinovirus, etc., Mycoplasma pneumoniae, Chlamydia pneumoniae and Bordetella pertussis can also be the pathogen of this disease. It is common in young adults. In the early years, whooping cough was considered a childhood disease, but in the United States and other countries since the 1980s, the disease has increased in older children and young people. A study showed that 12% of 153 adults with cough 2 weeks proved to be B. pertussis infection, and common pathogens of respiratory infections such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus and Moraxella catarrh It is the causative agent of this disease, but there is no definitive evidence of "bacterial bronchitis" until it is in neonates, artificial airways or immunosuppressed patients.
Non-biological virulence factors are minerals, plant dust, irritating gases (strong acids, ammonia, certain volatile solvents, chlorine, hydrogen sulfide, sulfur dioxide and bromide, etc.), environmental irritants including ozone, nitrogen dioxide, cigarettes and Smoke, etc.
(two) pathogenesis
Pathological changes are mainly tracheal-bronchial mucosal congestion, edema, increased secretion, submucosal edema, lymphocytes and neutrophil infiltration, lesions are generally limited to the trachea, total bronchi and bronchial mucosa of the lung, severe cases can spread to the bronchioles And alveolar, causing microvascular necrosis and hemorrhage, severe mucosal cilia function decreased, ciliated epithelial cells damaged, shedding, inflammation, subsided, tracheal-bronchial mucosa structure and function can return to normal.
In recent years, attention has been paid to the relationship between acute bronchitis and airway hyperresponsiveness. Patients with recurrent acute bronchitis have more episodes of mild bronchial asthma than normal people. Conversely, patients with acute bronchitis have bronchial asthma in the past. Or a history of idiopathic quality suggests that bronchospasm may be one of the causes of coughing and unhealing in patients with acute bronchitis.
Prevention
Acute tracheobronchitis prevention
Actively carry out physical exercise, enhance physical fitness, pay attention to keep warm in winter, avoid upper respiratory tract infection, quit smoking, do environmental protection work, control air pollution, improve labor hygiene conditions, and prevent harmful gases, acid mist and dust from being discharged from the production workshop. Those with susceptibility to chronic heart disease or lung disease may try immunopotentiators.
Complication
Complications of acute tracheobronchitis Complications, pneumonia, rib fracture, syncope, urinary incontinence
Serious complications of acute tracheobronchitis are rare, and only a relatively small number of patients develop pneumonia. Occasionally, severe cough can cause rib fractures, sometimes syncope, vomiting, urinary incontinence, and elevated creatine kinase.
Symptom
Acute tracheobronchial symptoms Common symptoms Sore throat, weak nasal congestion, dyspnea, bacterial infection, hoarseness, nausea, vomiting, dry cough, wheezing, snoring
Onset usually has symptoms of upper respiratory tract infection, such as nasal congestion, runny nose, sore throat, hoarseness, etc. In adults, influenza, adenovirus and Mycoplasma pneumoniae infection may have fever, with fatigue, headache, body aches and other systemic toxicities Symptoms of inflammation, and acute bronchitis caused by rhinovirus, coronavirus, etc. often do not have these manifestations. When inflammation involves the bronchial mucosa, coughing, coughing, and coughing are the main manifestations of acute bronchitis, starting with irritating dry cough, 3 After 4 days, the symptoms of the nasopharynx are relieved, and the cough becomes persistent and becomes a prominent symptom. It is cold, inhaled cold air, and the cough is aggravated when sleeping late in the morning or during physical activity. The cough can be paroxysmal or persistent. Nausea, vomiting and chest, abdominal muscle pain, cough can last for 2 to 3 weeks, smokers are longer, half of the patients have cough, sputum is mucinous, can be converted to purulent sputum as the disease progresses, even in the middle With blood, tracheal involvement, deep breathing and cough can have post-sternal pain, accompanied by bronchospasm, may have wheezing, shortness of breath and varying degrees of chest tightness, chronic obstructive disease And other basic diseases that impair lung function may have cyanosis and dyspnea. Chest physical examination revealed that the lungs have thick breath sounds, mucus secretions can be heard in the larger bronchi, and the dry dry voice can be heard. After coughing, the arpeggio disappears. When the bronchospasm is sputum, the wheezing sound can be heard. The uncomplicated person does not involve the lung parenchyma, and the chest imaging examination has no abnormality or only the lung texture is deepened.
Examine
Examination of acute tracheobronchitis
1. Peripheral blood: In most cases, there is no significant change in white blood cell count and classification. When bacterial infection is severe, the total number of white blood cells and neutrophils may increase.
2. Sputum examination: pathogens can be found in sputum smear and culture.
3. Most of the chest X-ray showed thickening of the lung texture, and there were no abnormalities in a few cases.
Diagnosis
Diagnosis and diagnosis of acute tracheobronchitis
Diagnostic criteria
The diagnosis of acute bronchitis is not difficult, usually according to symptoms, signs, X-ray findings, blood routine examination can make a clinical diagnosis, the relevant laboratory tests can make a pathogenic diagnosis, the lower respiratory secretions can be sent to the influenza virus, Mycoplasma pneumoniae and pertussis, etc., because of the high cost of these pathogens, it is not necessary for routine examination of mild and moderate patients. For severe cases, secondary bacterial infections should be actively carried out for bacteriological examination and drug sensitivity test to guide clinical correctness. Use antibacterial drugs.
Many serious lower respiratory diseases such as tuberculosis, lung abscess, mycoplasmal pneumonia, lung cancer and various acute infectious diseases such as measles, whooping cough, acute tonsillitis, etc. are often accompanied by symptoms of acute tracheobronchitis, which can cause coughing. Carefully ask about the medical history, such as whether it is exposed to toxic substances, whether there is a history of smoking, whether there are other systemic symptoms, the history of vaccination, etc., combined with epidemiological data, and detailed examination according to the characteristics of each disease to identify.
The symptoms of influenza are quite similar to those of acute bronchitis, but the former often have epidemic outbreaks of varying sizes, rapid onset, obvious systemic symptoms, high fever, headache and body muscle aches, according to virus isolation and complement fixation test. Can be diagnosed.
A small number of children have recurrent episodes of acute bronchitis, and should be noted to exclude cystic pulmonary fibrosis and hypogammaglobulinemia.
