The Bronkhoektatichesky disease at children (BEB) is the acquired chronic pathology of respiratory system which is followed by irreversible expansion and deformation of bronchial tubes and pyoinflammatory process. Clinically it is shown by damp cough with a phlegm, respiratory insufficiency, deformation of a thorax, frequent bronchitis. Diagnostics of BEB includes a X-ray analysis, a bronkhoskopiya and KT of a thorax. Treatment of a bronkhoektatichesky disease at children conservative: antibiotics, mucolytics, bronchial spasmolytics, inhalation glucocorticosteroids, physical therapy. If necessary surgery can be carried out.
Bronkhoektatichesky disease at children
The Bronkhoektatichesky disease at children is a heterogeneous chronic disease of bronchopulmonary system which is characterized by irreversible deformation and pyoinflammatory changes of a bronchial tree and is shown by recurrent bronchitis. For the first time this nosology was described by the French doctor and the anatomist Rene Laennek in 1819. The general prevalence of BEB makes from 1,5 to 15 children on 1 000 population. The disease meets in ecologically adverse regions more often, and also in families of smokers. The male is more inclined to development of BEB – boys are ill 1,5-2 times more often than girls. In the last decades reduction of prevalence of a bronkhoektatichesky disease at children is observed. It is connected with decrease in frequency of infectious incidence and efficiency of the carried-out antibacterial treatment.
The reasons of a bronkhoektatichesky disease at children
The Bronkhoektatichesky disease at children is a polietiologichesky disease. As a rule, primary bronkhoektaza are formed against the background of earlier postponed serious or recurrent bacterial or viral diseases – bronchitis, pneumonia, measles, flu, whooping cough. At children against the background of morphological immaturity of pulmonary fabric of a bronkhoektaza can arise in only 24-48 hours. At separate cases the bronkhoektatichesky disease at children turns out to be consequence of hit of a foreign matter in a bronchial tube. At a massive obturation structural deformation can be created already several hours later. At children respiratory viral diseases can provoke an exacerbation of a bronkhoektatichesky disease (adenovirus, a virus of flu and paraflu, a rhinovirus, etc.). Chronic bronchitis which can be caused by a hemophilic stick, some types of stafilokokk and pneumococci aggravates a current of BEB, is more rare – a β-hemolytic streptococcus.
Besides the main reason for a bronkhoektatichesky disease children, have contributing factors against the background of which the risk of development of a disease significantly increases. The use by mother of alcohol, drugs and tobacco products concern to them hereditary tendency in the form of genetically caused defect of walls of a bronchial tree, during pregnancy, a gastroezofagealny reflux disease, decrease in immunity, atelektaza of various etiology, passive smoking, the polluted atmosphere. Also important role is played by localization of the center of an inflammation in basal departments of lungs at potentially dangerous diseases and inadequately carried out treatment.
At children two major factors – an inflammation of bronchial tubes and violation of their passability are the cornerstone of pathogenesis of a bronkhoektatichesky disease. The first causes a metaplaziya and an ulceration of an epithelium of a mucous membrane, destruction of elastichesky and gladkomyshechny fibers and cartilaginous rings, sklerozirovany walls. All this becomes the reason of loss of elasticity and resistance of bronchial tubes to "a kashlevy push", then – to emergence of deformation and violation of mukotsiliarny clearance. In such conditions the intra bronchial pressure which causes expansion of a bronchial tube and development of a bronkhoektatichesky disease in children increases. Passability violation completely blocks the air which remained in disteel departments of bronchial tubes which at an exhalation also provokes intra bronchial hypertensia. It promotes development of an inflammation distalny places of obstruction that closes "vicious circle".
Classification and symptoms of a bronkhoektatichesky disease at children
In domestic pediatrics the following classification of a bronkhoektatichesky disease at children is accepted:
- In a form of deformation of bronchial tubes: cylindrical, meshotchaty, kistovidny, spindle-shaped, mixed.
- On severity of BEB: easy, medium-weight, heavy.
- On the disease period: aggravation, remission.
- On prevalence: segmentary, polysegmentary, share, total.
The main emergence of a bronkhoektatichesky disease in children – chronic bronchitis. Initial symptoms can be observed at the age of 3-4 years. In this period the course of a disease often has continuous recidivous character. At children of advanced age of an aggravation arise with a frequency of 3-5 times a year. The main clinical symptom during remission – damp cough with allocation of a phlegm. The office of the last occurs mainly in the mornings, in certain cases – in a large number ("a full mouth"). Part of children has a hypovitaminosis which is shown by dryness of skin, fragility of hair and nails, cracks in corners of a mouth and glossity. Sometimes there is a deformation of a thorax. The general physical development suffers seldom. In the period of an exacerbation of a bronkhoektatichesky disease at children the astenovegetativny syndrome, the expressed expiratory short wind can be observed, both at physical activity, and at rest, an oral krepitation, impurity of pus and blood in a phlegm, fever, it is very rare – a blood spitting.
Diagnosis of a bronkhoektatichesky disease at children
Diagnosis of a bronkhoektatichesky disease at children is based on collecting anamnestichesky data, fizikalny inspection, laboratory and tool researches. When collecting the anamnesis by the pediatrician special attention is paid to earlier postponed viral and bacterial diseases of bronchopulmonary system, existence of the possible contributing factors. At visual survey depending on weight various signs of BEB can come to light. At an auskultation rigid breath, mixed damp rattles, amforichesky noise is listened. Laboratory analyses at an exacerbation of a bronkhoektatichesky disease at children are not specific and indicate existence of the center of an inflammation in an organism. Increase in SOE, , shift of a blood count is found to the left. For the purpose of definition of the pathogenic agents who caused an aggravation bacteriological, bakterioskopichesky analyses of a phlegm, serological blood tests can be used.
The leading role in diagnosis of a bronkhoektatichesky disease at children is played by tool inspection – a thorax X-ray analysis, a bronkhoskopiya and a computer tomography. On the roentgenogram it is possible to define reduction of volume of a lung, its shift, deformation and a yacheistost of the pulmonary drawing. More often the left lung is surprised. Bronkhoskopiya gives the chance to reveal violation of mukotsiliarny clearance, inflammatory and structural changes in a bronchial tube gleam. Direct symptoms of a bronkhoektatichesky disease at children on KT are expansion of bronchial tubes, lack of narrowing of disteel departments of a bronchial tree and deterioration in its visibility in regional sites easy.
Differential diagnosis of a bronkhoektatichesky disease at children as independent disease is carried out with other nozologiya which are followed by expansion of bronchial tubes. Here the pulmonary form of a mukovistsidoz, Munye-Kuhn's syndrome, Williams-Campbell's syndrome, allergic bronchopulmonary aspergillomycosis, congenital tsiliarny dyskinesia and congenital malformations of a bronchial tree belong.
Treatment of a bronkhoektatichesky disease at children
Treatment of exacerbations of a bronkhoektatichesky disease at children conservative. Mode bed or semi-bed. The diet of the child is saturated with vitamins A, With, proteinaceous food and fats. Carbohydrates and salt are limited. A basis of drug treatment – the antibacterial medicines chosen according to sensitivity of the microflora sowed from a phlegm. Also depending on a clinical situation mucolytics, bronchial spasmolytics and inhalation corticosteroids can be applied. If necessary carry out a medical bronkhoskopiya for the purpose of sanitation of a bronchial tree. From physical therapy at a bronkhoektatichesky disease at children appoint massage, a position drainage, UVCh-, DMV-, SMV-therapy, an electrophoresis, laser therapy, applications of paraffin and ozokerite.
In hard cases of a bronkhoektatichesky disease at children expeditious treatment in the form of mono - or a polysegmentary resection of a lung is carried out. As the main indications to operation are considered inefficiency of the appointed conservative treatment against the background of a steady focal infection and development of zhizneugrozhayushchy states, including pulmonary bleedings.
The forecast and prevention of a bronkhoektatichesky disease at children
The forecast at a bronkhoektatichesky disease at children against the background of early diagnostics and treatment favorable. Further progressing and distribution on intact sites of a bronchial tree on condition of adequately picked up therapy is not observed. In the subsequent patients keep working capacity, completely adapt in society. Primary prevention of a bronkhoektatichesky disease at children is directed to prevention of development of this pathology. It includes antenatalny protection of a fruit, the prevention and rational treatment of respiratory infections, an exception of all potential etiologichesky factors. The essence of secondary prevention of BEB consists in decrease in frequency of aggravations and formation of permanent clinical remission. Sanatorium treatment, good nutrition, an exception of provocative factors, physical therapy and LFK concern to her.