Internal illnesses. Pneumonia (diagnosis, treatment, prognosis, prevention) (most important)

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Internal illnesses. Pneumonia (diagnosis, treatment, prognosis, prevention) (most important)

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27. PNEUMONIA (DIAGNOSTICS, TREATMENT, PROGNOSIS, PREVENTION)

Diagnostic research. A general blood test is performed (leukocytosis, increased ESR). A biochemical study of blood is determined by dysproteinemia.

A bacterioscopy with Gram staining and culture of sputum obtained during deep coughing and determination of antigens by polymerase chain reaction are performed. The pleural fluid is examined (counting leukocytes with a leukocyte formula, determining pH, LDH activity, protein content, Gram smear, culture for aerobes, anaerobes, mycobacteria). Fibrobronchoscopy is also performed with a quantitative assessment of microbial contamination (to exclude pulmonary tuberculosis) and chest radiography.

Treatment. Provides for active and early impact on the pathogen, the use of rational antibacterial therapy, anti-inflammatory treatment through the complex use of physiotherapeutic treatment and medications (NSAIDs), the elimination of toxemia, correction of dysfunction of the lungs and other systems (rehabilitation), pathogenetic and symptomatic therapy. Bronchodilators are used in combination with mucolytics to improve the drainage function of the lungs (ambroxol, mucodin, bromhexine, bronchicum, etc.); for bronchial obstruction - bronchodilators with an anticholinergic effect (Atrovent, Berodual). Patients are indicated for early therapeutic breathing exercises (if the temperature drops to low-grade and there are no hemodynamic disturbances), physiotherapeutic treatment (microwave field to the area of the pneumonic focus) in the absence of contraindications (abscess formation, hemoptysis, suspicion of a tumor or specific process, the presence of severe cardiac pathology). At the end of the course of antibacterial therapy, in the absence of contraindications from the gastrointestinal tract, NSAIDs are prescribed.

Antibacterial therapy for non-severe pneumonia can be completed upon reaching a stable temperature normalization (within 3-4 days); the duration of treatment is usually 7-10 days. In severe pneumonia, a two-stage method of using antibiotics is used, the transition from parenteral to oral administration should be carried out as soon as possible, taking into account the clinical condition.

The criteria for the sufficiency of antibiotic therapy are body temperature below 37,5 ° C, no intoxication, no respiratory failure, no purulent sputum, normalization of blood parameters: leukocytes below 10 l, neutrophils below 80%, young people below 6, no negative dynamics on the radiograph.

Transition criteria (on average 2-3 days after the start of treatment): normalization of temperature (below 37,5 °C) with two consecutive measurements at an interval of 8 hours, reduction of shortness of breath, absence of impairment of consciousness, positive dynamics of other symptoms of the disease, absence of gastrointestinal absorption disorders , patient consent to oral treatment.

Flow. Acute, protracted and chronic.

Forecast. In the absence of complications - favorable, in the presence of complications it is determined by them.

Prevention. Hardening of the body, smoking cessation, dispensary observation of those who have been ill.

Author: Myshkina A.K.

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