Emphysema of lungs – a chronic nonspecific disease of lungs which cornerstone permanent, irreversible expansion of pneumatic spaces and the raised swelling of pulmonary fabric distalny trailer bronchioles is. Emphysema of lungs is shown by expiratory short wind, cough with a small amount of a mucous phlegm, signs of respiratory insufficiency, recurrent spontaneous pheumothoraxes. Diagnosis of pathology is carried out taking into account data of an auskultation, X-ray analysis and KT of lungs, the spirography, the analysis of gas composition of blood. Conservative treatment of emphysema of lungs includes reception of bronchial spasmolytics, glucocorticoids, a kislorodoterapiya; intervention is in certain cases shown rezektsionny surgical.
Emphysema of lungs
Emphysema of lungs (from Greek emphysema - swelling) – the pathological change of pulmonary fabric which is characterized by its increased lightness owing to expansion of alveoluses and destruction of alveolar walls. Emphysema of lungs comes to light at 4% of patients, and occurs at men twice more often than at women. The risk of development of emphysema of lungs is higher at patients with chronic obstructive diseases of lungs, especially after 60 years. The clinical and social importance of emphysema of lungs in pulmonology is defined by high percent of development of warm and pulmonary complications, disability, an invalidization of patients and the increasing lethality.
Reasons and mechanism of development of emphysema of lungs
Any reasons leading to a chronic inflammation of alveoluses stimulate development of emphysematous changes. The probability of development of emphysema of lungs increases in the presence of the following factors:
- congenital insufficiency α-1 anti-trypsin, the alveolar tissue of lungs leading to destruction by proteolytic enzymes;
- inhalation of tobacco smoke, toxic substances and polyutant;
- violations of microcirculation in tissues of lungs;
- bronchial asthma and chronic obstructive diseases of lungs;
- inflammatory processes in respiratory bronchial tubes and alveoluses;
- the features of professional activity connected with continuous increase in pressure of air in bronchial tubes and alveolar fabric.
Under the influence of these factors there is a damage of elastichesky tissue of lungs, decrease and loss of its ability to airfilling and fall. The lungs overflowed with air lead to adhesion of small bronchial tubes at an exhalation and to violations of pulmonary ventilation on obstructive type. Formation of the valvate mechanism at emphysema of lungs causes swelling and restretching of tissues of lung and formation of air cysts – bulls. Ruptures of bulls can cause episodes of recurrent spontaneous pheumothorax.
Emphysema of lungs is followed by significant increase in lungs in sizes which macroscopically become similar to a krupnoporisty sponge. At a research of emphysematous pulmonary fabric under a microscope destruction of alveolar partitions is observed.
Classification of emphysema of lungs
Emphysema of lungs is subdivided on primary or congenital, developing as independent pathology, and secondary, arisen against the background of other diseases of lungs (is more often than bronchitis with an obstructive syndrome).
On prevalence degree in pulmonary fabric allocate the localized and diffusion forms of emphysema of lungs.
On extent of involvement in pathological process of an atsinus (the structurally functional unit of lungs providing gas exchange, and consisting of a branching of a terminal bronchiole with the alveolar courses, alveolar bags and alveoluses) distinguish the following types of emphysema of lungs:
- panlobulyarny (panatsinarny) - with defeat of the whole atsinus;
- tsentrilobulyarny (tsentriatsinarny) – with defeat of respiratory alveoluses in the central part of an atsinus;
- perilobulyarny (periatsinarny) – with defeat of a disteel part of an atsinus;
- okolorubtsovy (irregular or uneven);
- bullous (in the presence of bulls).
Symptoms of emphysema of lungs
The leading symptom of emphysema of lungs is expiratory short wind with the complicated air exhalation. Short wind has the progressing character, arising at first at loading, and then and in a quiet state, and depends on degree of respiratory insufficiency. Patients with emphysema of lungs do an exhalation through close lips, at the same time inflating cheeks (as if "puff"). Short wind is accompanied by cough about allocation of a poor mucous phlegm. Cyanosis, puffiness of the person, swelling of veins of a neck testify to the expressed degree of respiratory insufficiency.
Patients with emphysema of lungs considerably lose flesh, have a kakhektichny appearance. Loss of body weight at emphysema of lungs is explained by the big energy consumption spent for hard work of respiratory muscles. At a bullous form of emphysema of lungs there are repeated episodes of spontaneous pheumothorax.
Complications of emphysema of lungs
The progressing course of emphysema of lungs leads to development of irreversible pathophysiological changes in warm and pulmonary system. Fall of small bronchioles on an exhalation leads to violations of pulmonary ventilation on obstructive type. Destruction of alveoluses causes reduction of a functional pulmonary surface and phenomenon of the expressed respiratory insufficiency.
The reduction of network of capillaries in lungs involves development of pulmonary hypertensia and increase of load of the right departments of heart. At the increasing right ventricular insufficiency there are hypostases of the lower extremities, ascites, a gepatomegaliya. Medical emergency at emphysema of lungs is the development of spontaneous pheumothorax demanding drainage of a pleural cavity and aspiration of air.
Diagnosis of emphysema of lungs
In the anamnesis of patients with emphysema of lungs chronic or hereditary diseases of lungs are noted a long standing of smoking, professional harm. At survey of patients with emphysema of lungs the thorax, expanded intercostal intervals and an epigastralny corner (stupid), protrusion of supraclavicular poles, superficial breath with participation of auxiliary respiratory muscles pays attention increased, barrel-shaped (a cylindrical form).
Perkutorno is defined the shift of the lower bounds of lungs on 1-2 edges from top to bottom, a box sound by all surface of a thorax. Auskultativno at emphysema of lungs is listened the weakened vesicular ("wadded") breath, deafs warm tone. In blood at the expressed respiratory insufficiency also increase in hemoglobin comes to light .
At a X-ray analysis of lungs increase in transparency of pulmonary fields, the grown poor vascular drawing, restriction of mobility of a dome of a diaphragm and its low arrangement (in front of lower than the level VI of an edge), almost horizontal position of edges, narrowing of a warm shadow, expansion of zagrudinny space is defined. By means of KT of lungs existence and an arrangement of bulls at bullous emphysema of lungs is specified.
Vysokoinformativno at emphysema of lungs a research of function of external breath: spirometry, pikfloumetriya, etc. At early stages of development of emphysema of lungs obstruction of disteel pieces of airways comes to light. Test with inhalers bronchodilators shows the irreversibility of obstruction characteristic of emphysema of lungs. Also at FVD decrease in ZhEL and Tiffno's test is defined.
The analysis of gas composition of blood reveals a gipoksemiya and a giperkapniya, the clinical analysis – a politsitemiya (increase in Hb, erythrocytes, viscosity of blood). It is necessary to include the analysis in the plan of inspection on α - 1 inhibitor of trypsin.
Treatment of emphysema of lungs
Specific treatment of emphysema of lungs is absent. Elimination of the factor contributing to emphysema is paramount (smoking, inhalations of gases, toxic substances, treatment of chronic diseases of respiratory organs).
Medicinal therapy at emphysema of lungs symptomatic. Lifelong use of the inhalation and tableted bronchial spasmolytics (salbutamol, a fenoterol, a teofillin, etc.) and glucocorticoids is shown (a budesonida, Prednisolonum). At heart and respiratory failure carry out oxygenotherapy, appoint diuretics. Include respiratory gymnastics in a complex of treatment of emphysema of lungs.
Surgical treatment of emphysema of lungs consists in carrying out operation on reduction of volume of lungs (a torakoskopichesky bullektomiya). The essence of a method comes down to a resection of peripheral sites of pulmonary fabric that causes "decompression" of other part of a lung. Observations of patients after the postponed bullektomiya show improvement of functional indicators of lungs. Transplantation of lungs is shown to patients with emphysema of lungs.
Forecast and prevention of emphysema of lungs
Lack of adequate therapy of emphysema of lungs leads to progressing of a disease, disability and an early invalidization owing to development of respiratory and heart failure. In spite of the fact that at emphysema of lungs there are irreversible processes, quality of life of patients can be increased constantly applying inhalation medicines. Expeditious treatment of bullous emphysema of lungs stabilizes process a little and saves patients from recurrent spontaneous pheumothoraxes.
The essential moment of prevention of emphysema of lungs is the antismoking promotion directed to the prevention and fight against smoking. Early identification and treatment of patients with chronic obstructive bronchitis are also necessary. The patients suffering from HOBL are subject to observation of the pulmonologist.