Specially the clinical manifestation of the fiber sending lung and _'s symptom of the diagnosis

Specially the clinical manifestation of the fiber sending lung and _'s symptom of the diagnosis
First, clinical manifestation
About 15% person who send the intersection of lung and the intersection of fiber and case of taking present acute to pass, find because of going to a doctor in upper airway infection often specially, the going on has difficulty in breathing and aggravates, exceed and die from and breathe circulatory failure in 6 months. The hopeless great number IPF is for being chronic type (may still lie between middle subnormal temperature types) ,Although it is chronic to call, there are only 3.2 years to survive for time on average. It does not seem acute type and develop that chronic type, does not still understand the precise relation.
Main symptom is as follows, have difficulty in breathing: Labour have difficulty in breathing and person who go on aggravate, breathe shallow speed, can have wing of nose work up with the auxiliary skin participating in breathing, but not mostly sat up straight and breathed. Cough, expectoration: Not coughing in early days, there can be dry cough or a small amount of mucus phlegm later. It is apt to have then send and infect, the mucus suppuration phlegm or suppuration phlegm appears, the phlegm of accidental blood. Whole body symptom: There is becoming thin, weak, losing the appetite, joint that aches etc., generally relatively rare. Acute type can generate heat.
Common physical sign: Dyspnea and cyanosis. The thoracic cage expands and the movable degree of reducing of diaphragm skin. Two lung lower part Velcro rales, have certain characteristics. The poke means the toe. Breathe depleted and depleted corresponding sign of the right heart in latter stage in end.
Second, diagnose
(1) Diagnose technology
1,The image learns to check
(1)Regular the intersection of X-ray and the intersection of chest and slice take a photograph of slices of technology, must pay attention to, penetrate terms to be appropriate, employ intermediate to increase the sense to reject, focus should be small. Early alveolus inflammation can't reveal unusually on the X line; Up to the progress of pathological change, the X-ray demonstrates the cloud can see the small and point-like filling the air shade vaporifically and indistinctly, like rubing the glass. Develop, see fiber take, become obvious, knit form, knit form from very thin network to thick network further, or take the form of the network and weave the tubercle. Have bag not of uniform size that changes even more in later period, namely honeycomb lung. The lung volume shrinks, lift on the skin of diaphragm, split and shift among the leaves.
(2)CT compares with the resolution ratio and is superior to the X-ray, employs and distinguishes CT (HRCT) high Can raise the intersection of space and resolution ratio further, as to specially the intersection of lung and diagnosis that fiber take of taking place etc., especially early alveolus inflammation and fiber distinguish and the discovery of the honeycomb lung is extremely helpful.
(3)Nuclide person who take place the intersection of lung and fiber take, have the intersection of alveolus and the intersection of capillary and the intersection of membrane and penetrating increase often specially. Nuclide technology sucks 99mTc-DTPA aerosol to determine the peel is penetrating (LEP) at the lung It is obvious T1/2 shortens, contributes to finding and diagnosing a quality pulmonary tuberculosis in early days, has no specificity as to specially sending lung fiber.
2,The lung function is checked
Person who send the intersection of lung and typical the intersection of lung and function that fiber take change, include person who restrain from keep in touch with damage, lung capacity dwindle and lung comply with sex reduce and diffusing capacity reduce specially. The serious one increases widely PaO2 decline and PA-aO2. Lung function check with image learning, contributing to, diagnosing especially sport test in image learning, having diffusing capacity reducing and hypoxemia disease promptly appearing unusually, in early days by technology. The lung function is checked and can be observed dynamically, it is very helpful to appraise the condition, it may be useful too to be used in the curative effect of the examination. Likewise, specially the sending lung fiber lung function unusually has no specificity, there is no value of differential diagnosis.
3,The bronchus alveolus is irritated and washed
Retrieve the intersection of liquid and the intersection of cell and total number, increase, and neutral grains of cell proportion person who take place the intersection of lung and fiber take typical change specially in increase, to diagnosing helpfully. Still used mainly for studying at present.
4,The lung is examined vivid
Person who send the intersection of lung and fiber take early changing have certain characteristic by histology of middle period specially, and among quality a lot of including there is cause of disease person who can seeks clear to a lot of in pulmonary tuberculosis cause of disease, so lung live examine to the intersection of disease and make a definite diagnosis of and active the intersection of appraisal and very much inclined justice this. First choose to employ finely to prop up the mirror and make TBLB, but the sample is small, diagnoses that there is the fashion that has difficulty in. Should cut open the chest and live and examine if necessary.
(2) Setting-up that is diagnosed
Check while being above-mentioned according to typical clinical manifestation, person who send the intersection of lung and fiber take, diagnose, can establish specially. Key question quality pulmonary tuberculosis include reason already bright or clear get rid of other. " specially sending " Or " latent and original " Used to show the reason is not clear, but not all reasons are unidentified and display lung fiber disease and specially taking place lung fiber, such as tubercle. Specially the sending lung fiber is whole a particular disease, it is possible it is not a homogeneous and single disease. So lung live examine until lung of taking place etc. diagnosis that fiber take essential specially. But is connecting (able to bear) Receive wound examiner, have the intersection of evidence and quality pulmonary tuberculosis get rid of other, specially set up the sending fiber clinical diagnosis of lung is also able to accept.
(3) Active judgement
Although many were studied at present, have not confirmed indication yet. Except that lung examine histology, appraise while being living, according to thinking 67Ga scanning, the intersection of skin and penetrating the intersection of and determination, the intersection of bronchus and alveolus irritate lotion cell count especially lymphocyte count and medium determine to estimate pathological change activity have important reference value on the lung. Though clinical manifestation, X-ray, CT sign, lung function change and activity are not totally parallel, but the size of course of disease, fiber intensity and honeycomb lungs, lung function damage the weight etc., estimate correctly activity is still helpful.
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