bronchiectasis

Bronchiectasis is a chronic suppurative disease, which leads to destruction, deformation and dilatation of bronchi due to repeated infection, secretion obstruction or congenital developmental defects.

Bronchiectasis symptom

1, the main symptoms are cough, excessive phlegm, more or less phlegm, thick pus and mild smell. Children are prone to lower respiratory tract infection, often suffering from pneumonia repeatedly, and even complicated with lung abscess, which is often confined to the same focus.

2. Chest symptoms are similar to pneumonia, but the severity is different. Sometimes auscultation is nothing, but most of them can smell the moist rales at the bottom of the lungs, and the position is relatively fixed. If the lesion area is wide, the mediastinum and heart often shift to the affected side due to atelectasis or fibrous lesions. The child's nutritional development is backward and his chest is deformed. Clubbed fingers and toes appear at different times, the earliest can appear in 1 ~ 2 months, and can disappear naturally after surgical resection of the diseased lung. Maxillary sinusitis is more common. If the disease continues to develop, hepatomegaly and proteinuria may occur, and amyloidosis and pulmonary hypertrophic osteoarthropathy may also be complicated.

No obvious symptoms were found in the early stage, and the diagnosis was difficult. In the progressive stage of chronic infection, there are symptoms such as persistent cough, excessive phlegm and hemoptysis, which are easy to identify. The following points should be noted:

1. Patients with pneumonia, whooping cough and measles, long-term cough and repeated expectoration should all be suspected of bronchiectasis. Patients with tuberculosis of bronchial lymph nodes and persistent atelectasis may have bronchiectasis at this site.

2. Clinical features: repeated lung infections, fixed focus, general bronchitis or pneumonia that is difficult to explain, unexplained hemoptysis and atelectasis caused by various reasons, and the primary disease has been relieved. The possibility of bronchiectasis should be considered.

3. If the lung X-ray plain film shows an enlarged bronchial shadow, or there is a triangular dense shadow near the heart shadow at the bottom of the lung, it is likely to be bronchiectasis. In any of the above cases, it is recommended to use deep exposure photos or bronchography and high-resolution CT to diagnose the disease.

Causes of bronchiectasis

Branching expansion is an acquired disease in childhood, and it may also be the result of some congenital dysplasia diseases or genetic defects. The main causes of acquired lesions are infection and bronchial obstruction. Now most infections are cured by antibiotics, so the proportion of bronchiectasis caused by congenital or genetic factors is relatively increasing.

Bronchiectasis in children can be divided into congenital and acquired types:

1. Congenital bronchiectasis is rare, and the cause may be the development defect of bronchial cartilage.

2. Acquired bronchiectasis is common in measles, whooping cough, bronchiolitis and severe pneumonia, mostly bilateral diffuse bronchiectasis. It is most common in patients with humoral immunodeficiency. In addition, benign or malignant tumors and hyperosteogeny of ribs can also lead to bronchiectasis.

pathogenesis

Infection and bronchial obstruction are two basic pathogenic factors and they promote each other. Due to bronchial obstruction, the stagnant secretions in the cavity exert pressure on the damaged and softened bronchial wall affected by inflammation, which will cause obstruction and distal bronchiectasis for a long time. At the same time, infection causes severe cough, increases endobronchial pressure and promotes bronchiectasis. In addition, lung consolidation or atelectasis exists for a long time, and lung tissue fibrosis and scar contraction cause the bronchi to be pulled, twisted and displaced, which is also a factor leading to bronchiectasis.

Bronchiectasis examination

The diagnosis of bronchiectasis is mainly based on bronchography, because this film can show the degree, location and scope of the lesion from different angles. Generally, it can be divided into three types: columnar, cystic and cystic-columnar. X-ray plain film showed increased lung texture or decreased lung volume. If there are bronchial stones, calcification can be seen. Bronchoscopy is of great significance for emergency patients with hemoptysis to determine the bleeding site and determine the surgical treatment plan.

There are several examination methods for bronchiectasis:

1, X-ray examination: when the disease is mild, only the lung texture is aggravated. When the disease worsens, the middle and lower lungs can be seen with large and small rings, which are curly or honeycomb-shaped, often accompanied by atelectasis and inflammatory infiltration of lung segments or lobes, and the heart and mediastinum can be displaced. X-rays show bronchiectasis and deformation.

2. Bronchography: If the thickness of the bronchus is uneven after filling, there is local next week or dilatation, the bronchus is fixed rigidly, gathered and twisted, and the contrast agent is delayed, it may be bronchiectasis. Preoperative preparation should be made during angiography to prevent accidental asphyxia. Before the operation, we must fast to avoid vomiting. After the operation, we should give magnesium sulfate and expel iodine oil from the stomach to avoid iodine poisoning.

3.CT examination: Now high-resolution CT has gradually replaced bronchography. CT examination is safe, reliable and simple, and has become the main examination method for diagnosing bronchiectasis.

4. Blood test

5, lung function examination

6. Fiberoptic bronchoscopy: It can determine the bleeding, dilatation or obstruction site, or perform local lavage, and obtain lavage fluid for smear Gram staining, cytological examination or bacterial culture, which is also helpful for diagnosis and treatment.

Treatment of bronchiectasis

1, general treatment: drainage and expectoration and immunotherapy. Sputum can be coughed up in different places in different wards twice a day for 20 minutes each time. If the secretion is too thick, it is advisable to take potassium iodide or ipecac syrup or Chinese and western medicines for resolving phlegm, or to wet the respiratory tract by atomizing inhalation first, and then discharge sputum in order, patting the back and sucking sputum, and the sputum is easy to be discharged.

2, the treatment of complicated hemoptysis: bronchiectasis is often complicated with hemoptysis, and the amount of hemoptysis varies from sputum, a few mouthfuls to more than a dozen mouthfuls or large hemoptysis. The definition of massive hemoptysis is inconclusive. The diagnosis should be based on the patient's physical condition, such as complexion, pulse, respiration, blood pressure and cyanosis.

3. Control infection: choose antibiotics according to symptoms, sputum properties and bacterial culture structure, and pay attention to the infection of fungi and anaerobic bacteria when using drugs.

4. Children with chronic sinusitis, gingivitis and tonsils should be treated at the same time.

5. Operation: Recurrent massive hemoptysis, lung infection is ineffective after long-term medical treatment, the focus is no more than 2 lobes, and there is no serious damage to the center of gravity and lung function, so surgical resection can be considered.

6, enhance immunity: weak body, the virus is easy to invade, enhance the child's own immunity, make the body stronger, in order to resist the virus. Children need to do more outdoor sports, don't go to crowded places, and keep a comfortable and optimistic mood.

What is good for bronchiectasis?

Moistening the lungs should be eaten:

1, eat more foods that nourish yin and moisten dryness.

2. Eat more foods that nourish the body and nourish the lungs.

3. Eat sweet and sour food and fruit.

The ingredients for moistening lung are pear, tremella, lily, white radish, persimmon, houttuynia cordata, citrus, yam, sesame and honey.

Runfei recipe:

First, Runfei Zhike Syrup

Ingredients: pear, licorice, fritillary bulb, hawthorn, medlar, crystal sugar.

working methods

1. First crush Fritillaria cirrhosa, peel the pear and cut it into small pieces.

2. Put licorice, crushed Bulbus Fritillariae Cirrhosae, Fructus Crataegi, Fructus Lycii and crystal sugar into a casserole and add a little water to boil for five minutes.

3. Cook the pears in the pot for two minutes, then turn off the heat. This syrup is especially delicious when it is cold. Don't put too much medicine.

Second, Runfei Qiuli Ointment

Ingredients: 3 autumn pears, 40g dried red dates, 75g rock sugar, 0/0g ginger/kloc, 40ml honey.

working methods

1. Wash the dried jujube, remove the core, peel the ginger, cut into filaments, peel the pear, put a wiping board on the pot, and rub the pear into pear paste and juice.

2. Put the pitted red dates, shredded ginger and rock sugar into the pot and cook them with pear paste and pear juice; Cover the pot and simmer for about 30 minutes.

3. Then pick up the pear paste with a colander and press it with another spoon to squeeze out more pear juice.

4. Throw away the squeezed pear dregs, red dates and shredded ginger, leaving only pear juice in the pot, and continue to cook with minimum fire for about 1 hour until the pear pulp is sticky, turn off the fire and let it cool.

5. Add honey into the cooled pear pulp, stir it evenly, and then put it in a sealed jar for storage.

Prevention of bronchiectasis

1, treat tuberculosis of bronchial lymph nodes in time and take out bronchial foreign bodies as soon as possible.

2. Prevention and treatment of acute and chronic respiratory infections such as measles, whooping cough, bronchopneumonia and tuberculosis is of great significance to the prevention of bronchiectasis.

3. Patients with bronchiectasis should actively prevent respiratory tract infection, adhere to the posture of expectoration, enhance the body's immune function and improve the body's disease resistance.

4. Use eggs, fresh milk and dairy products with caution: Eggs, duck eggs, quail eggs, milk, goat's milk and dairy products contain a lot of protein, but they are foreign proteins. A considerable number of people will have allergic reactions after eating foreign proteins, thus inducing asthma. Therefore, people with a history of bronchial asthma should be careful when choosing food and try not to eat such food.

5, the diet is mainly flat, avoid overheating and cooling: bronchiectasis patients mostly belong to heart, spleen and lung yang deficiency, water and dampness are unfavorable, resulting in phlegm and obstruction of collaterals. Therefore, you can't eat spicy food, in case semen is phlegm, which will aggravate airway inflammation and affect airway patency; You can't overeat cold food, so as not to affect the transport function of the spleen and stomach, cause endogenous phlegm, block the airway and aggravate asthma. In addition, cold stimulation is one of the common causes of bronchial asthma, so the diet should be cold and moderate, not dry and cold.

In addition, vaccination against pertussis and measles in childhood and extensive use of antibiotics to improve living conditions and nutritional status will help reduce the incidence and mortality of bronchiectasis. Vaccination with influenza and pneumococcal vaccine once a year (repeated vaccination for high-risk and susceptible people after 6 years) may help prevent bronchiectasis.