Monday, 10 December 2007

 

 


Ο ΛΕΙΤΟΥΡΓΙΚΟΣ ΕΛΕΓΧΟΣ ΤΗΣ ΑΝΑΠΝΟΗΣ

    Μπορεί να ανιχνεύσει ή να επιβεβαιώσει  κλινικές υπόνοιες  για πνευμονοπάθεια,
   και μπορεί –ίσως-να  απαντήσει στα ΠΡΟΒΛΗΜΑΤΑ:

 •       παρατεινόμενος βήχας,

         δύσπνοια

         δύσπνοια προσπάθειας,

         παρατεινόμενη απόχρεμψη,

         εκπνευστκοί συριγμοί,

        συχνά «κρυολογήματα»,

        παθολογική ακτινογραφία θώρακος,

        Η' πώς πηγαίνει ο ασθενής μου...κλπ

 

         Όμως πάντα ΜΕΤΑ

από λεπτομερή συζήτηση-ανάλυση του ιστορικού , την προσεκτική φυσική εξέταση , την ακτινογραφία θώρακος, τις εξετάσεις αίματος..κλπ

      ΝΑ ΓΝΩΡΙΖΟΥΜΕ ΤΙ ΖΗΤΟΥΜΕ  ΝΑ ΜΑΘΟΥΜΕ..

        Ποιες εργαστηριακές εξετάσεις θα απαντήσουν στα προβλήματά μας;

       Ποια η πιθανή διάγνωση;

        Ο ασθενής μπορεί να συνεργαστεί ;

        Έλεγχος αξιοπιστίας εργαστηρίου (βαθμονόμηση κλπ..)


ΣΤΑ ΑΠΟΦΡΑΚΤΙΚΑ ΝΟΣΗΜΑΤΑ

Περιμένουμε:

        ΑΥΞΗΣΗ ΑΝΤΙΣΤΑΣΗΣ ΑΕΡΑΓΩΓΩΝ

Από:

α) βλάβες τοιχώματος,

β) αυλού,

γ) περιβάλλοντος ιστού

 

α) Βλάβες τοιχώματος

        Οίδημα άσθματος-βρογχίτιδας

        Υπερτροφία υποβλ/νιων αδένων

        Σύσπαση λείων μυϊκών ινών

        Υποβλεννογόνια ίνωση

β) Βλάβες αυλού

        Πληθώρα εκκρίσεων (βρογχίτιδα- άσθμα)

        Εισρόφηση (υγρών, γαστρικού υγρού, ξένου σώματος)

        Πνευμονικό οίδημα

γ) Περιβάλλοντος παρεγχύματος

        Μείωση της έλξης επί των αεραγωγών

        Πνευμονικό εμφύσημα

     •     Πίεση εκ των έξω

        Λεμφαδένες, νεοπλασία..

ΑΠΟ ΛΕΙΤΟΥΡΓΙΚΟ ΕΛΕΓΧΟ ΑΝΑΠΝΟΗΣ
έχουμε ΕΚΤΙΜΗΣΗ ΤΗΣ ΑΠΟΦΡΑΞΗΣ

         Από τον λόγο FEV1/FVC

        Από αντιστάσεις αεραγωγών

        Από μεσοεκπνευστική ροή


Ο λόγος FEV1/FVC (δείκτης Tiffeneau) δηλ. το ποσοστό του FVC που εκπνέεται στο πρώτο δευτερόλεπτο,  μας επιτρέπει,  τη διάκριση σε καθ’ υπεροχήν αποφρακτικά νοσήματα

 

          η MEEF 75/25  εάν <65%

Από μέτρηση αντίστασης αεραγωγών
προ και μετά βρογχοδιαστολή

        Η ολική αντίσταση πόση είναι κι αν ανταποκρίνεται στη βρογχοδιαστολή.

        Η Ταλαντωσιμετρία: αντίσταση κεντρικού αεραγωγού και περιφερικού. Πιθανή ανταπόκριση στη βρογχοσπασμόλυση.              

Αποφρακτικά νοσήματα είναι:

         Βρογχικό άσθμα

         Χρόνια βρογχίτιδα

         Χαπ

         Πνευμονικό εμφύσημα

 

 


ΠΕΡΙΟΡΙΣΤΙΚΑ ΝΟΣΗΜΑΤΑ

 

    1.  Βλάβη       (ή ελάττωση) Πνευμονικού ιστού

 2 .Υπεζωκότα

3  . Θωρακικού τοιχώματος

4. νευρομυικού συστήματος

 

Πνευμονικού ιστού

        Ίνωση διάμεσου ιστού

         (Ιδιοπαθής πνευμονική ίνωση, σαρκοείδωση, πνευμονίτιδες υπερευαισθησίας,ίνωση από ακτινοβολία, φάρμακα ..κολαγονοπάθειες, διήθηση λεμφαγγείων, )

 

               εκτομή πνεύμονος

         Πνευμονεκτομή ή λοβεκτομή κλπ

Βλάβη υπεζωκοτικού χώρου

         (πνευμοθώρακας, υπεζωκοτική συλλογή, πάχυνση υπεζωκότα)

Θωρακικό τοίχωμα

         (σκολείωση, κύφωση,  αγκυλοποιητική σπονδυλίτιδα)

 

 

 


Νευρομυικα

 

        Πολυομυελίτιδα

        Μυασθένεια

        Μυικές δυστροφίες

Η μέτρηση στατικών όγκων

       TLC, FRC, RV     είναι ενδεικτική.

επικρατεί η περιοριστική συνδρομή


ΜΙΚΤΟΥ ΤΥΠΟΥ ΔΙΑΤΑΡΑΧΗ

         Αποφρακτική και

         Περιοριστική συνδρομή (ακρίβεια στην μέτρηση πνευμονικών όγκων

ΔΙΑΜΕΣΑ ΝΟΣΗΜΑΤΑ

 






* τμήμα εισήγησης στο 16ο Πανελλήνιο Συνέδριο Νοσημάτων Θώρακος (2007)

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