Kúrùpù
Kúrùpù (tabi laringotrakiobronkaitis) jẹ arun nipa mimi ti o lewu gan-an ti o maa nwaye nipa aisan ọ̀nà-atẹgun oke. Arun yii maa nfa wiwu ninu ọ̀nàfun. Wiwu yii maa nfa idiwọ fun mimi deede; awọn aami aisan Kúrùpù ni ikọ́ "gbígbó", idiwọ ọnafun (mimi ti o ngbọn ti ìró rẹ lọ soke), ati ohùn kíkẹ̀. Awọn aami aisan kúrùpù le ma nira, mọ niwọnba, tabi lewu, ti o si le nira ni òru. Fifun ni oògùn sitẹriodu lẹẹkan lati ẹnu le ṣe abojuto arun naa. Nigba miiran epinifini ni a maa nlo fun awọn iṣẹlẹ ti o lewu gan-an. Kii saba nilo ki a da ni duro ni ile-iwosan.
| Croup Classification and external resources | |
 | |
|---|---|
| The steeple sign as seen on an AP neck X-ray of a child with croup | |
| ICD-10 | J05.0 |
| ICD-9 | 464.4 |
| DiseasesDB | 13233 |
| MedlinePlus | 000959 |
| eMedicine | ped/510 emerg/370 radio/199 |
| MeSH | D003440 |
A maa nda kúrùpù mọ nipa iṣẹ iwadi iṣegun oyinbo, ni kete ti a ba ti ya awọn okunfa aami aisan ti o lewu gan-an sọtọ (fun apẹẹrẹ, epiglottitis tabi nkan ti o ṣe ajẹji si oju-ọ̀nà atẹgun). Awọn iwadi siwaju sii—bii awọn ayẹwo ẹjẹ, X-rays, ati mimu kokoro dagba nipa amu nkan dagba ni yara iwadi—ni a ko nilo. Kúrùpù jẹ iṣẹlẹ ti o wọpọ ti a maa nri ninu ida marundinlogun ninu ọgọrun (15%)awọn ọmọde, ti ọjọ ori wọn jẹ oṣu mẹfa (6 months)si ọdun marun si mẹfa (5–6 years). Awọn ogo-wẹrẹ tabi agbalagba kii saba ni kúrùpù.
Awọn aami aisan
àtúnṣe
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Awọn aami aisan kúrùpù ni ninu ikọ́"gbígbó", idiwọ ọnafun(mimi ti o ngbọn), ohun kíkẹ̀, ati mimi ti o nira eyiti o maa nnira ni òru.[1] Ikọ́ "gbígbó" naa ni a maa nsaba ṣ’apejuwe wipe o jọ ìpè erinmi tabi kiniun okun.[2] Si sọkun le mu ki mimi ti o ngbọn naa ki o buru si; mimi ti o ngbọn le tunmọ si wipe ọ̀nà-atẹgun ti dinku. Bi kúrùpù ba ṣe nburu sii, mimi ti o ngbọn le dinku gan-an.[1]
Awọn aami aisan miiran ni ninu ibà, coryza (awọn aami aisan to wọpọ fun otutu), ati egungun igbaya ti o sa wọle.[1][3] Dida itọ́ lẹnu tabi ìwò alaisan nṣe afihan awọn ipo aisan miiran.[3]
Awọn okunfa
àtúnṣeFairọsi le fa kúrùpù.[1][4] Awọn eniyan kan lo ọrọ naa lati ni ninularingotrakiaitisiti o lewu, kúrùpù ti o ṣẹlẹ logiji fun igba diẹ, laringeal diphtheria, trakiatisi ti bakiteriali fa, laringotrakiobronkaitisi, ati laringotrakiaobronkoneumonitisi. Ipo meji akọkọ ni ninu fairọsi kan ti o si ni aami aisan ti ko nira; awọn mẹrin ti o kẹyin maa nwaye lati ọwọ bakiteria wọn si maa nlewu gan-an.[2]
Ti o niiṣe pẹlu fairọsi
àtúnṣeNinu ida marundinlọgọrin (75%) iṣẹlẹ parainfluensa fairọsi, oriṣi 1 ati 2, ni fairọsi ti o nfa kúrùpù/laringotrakiatisi ti o lewu gan-an.[5] Awọn fairọsi miiran ti o le fa kúrùpù ni influenza A ati B, measles, adenofairọsi ati respiratory syncytial virus (RSV).[2] Kúrùpù ti o ṣẹlẹ logiji fun igba diẹ (kúrùpù ti o ni gbígbó) maa nwaye nitori iru ẹgbẹ fairọsi kanna bii ti o lewu gan-an laryngotracheitis, ṣugbọn kii saba ni awọn aami arun ti o wọpọ (bii iba, ọ̀nà-ọfun ti o ndun ni, ati sẹẹli ẹjẹ funfun ti o lọ silẹ) ninu.[2] Abojuto, ati idahun si abojuto naa tun jọra.[5]
Ti o niiṣe pẹlu Bakiteria
àtúnṣeKúrùpù ti o niiṣe pẹlu bakiteria ṣee pin si laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, ati laringotrakiobronkopneumonitisi.[2] Laringeal diphtheria maa nwaye nitori Corynebacterium diphtheriae nigbati bakiteria trakitisi, laringotrackiobronkaitisi, ati laringotrakobronkopneumonitisi maa nwaye nitori fairọsi, pẹlu bakiteria ti o lọwọ sii. Awọn bakiteria ti o wọpọ julọ niStaphylococcus aureus, Streptococcus pneumoniae, Hemophilus influenzae, ati Moraxella catarrhalis.[2]
Abajade ti o niiṣe pẹlu aisan
àtúnṣeArun fairọsi maa nwo inu awọn sẹẹli ẹjẹ funfun ti o si ma nfa wiwu larynx, trachea, ati ẹ̀dọ̀-f ọ́ọ́rọ́ nla[4] (ọ̀nà-atẹgun ). Wiwu le jẹ ki mi i ki o nira.[4]
Ṣiṣe ayẹwo
àtúnṣe| Feature | Number of points assigned for this feature | |||||
|---|---|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 | 5 | |
| Chest wall retraction |
None | Mild | Moderate | Severe | ||
| Stridor | None | With agitation |
At rest | |||
| Cyanosis | None | With agitation |
At rest | |||
| Ipele iwalaaye |
Normal | Disoriented | ||||
| Air entry | Normal | Decreased | Markedly decreased | |||
Kúrùpù jẹ eyiti a maa nmọ nipa iṣẹ iwadi iṣegun oyinbo.[4] Igbese akoko ni lati yo kuro awọn iṣẹlẹ idiwo ni ọ̀nà-atẹgun oke, papa julọ epiglottitis, oju-ọ̀nà atẹgun nkan ajẹji, subglottic stenosis, angioedema, retropharyngeal abscess, andbacterial tracheitis.[2][4]
A o kii saba ṣe ayẹwo X-ray ti orun,[4] ṣugbọn bi a ba ṣee, o le ṣe afihan abuda didiku trachea, ti a npe ni aami sonso ori òrùlé, nitori bi nkan naa ti ri dabi sonso ori òrùlé ti sọọsi sonso. Aami sonso ori òrùlé kii farahan ninu ilaji awọn iṣẹlẹ.[3]
Awọn Ayẹwo ẹjẹ ati viral culture (awọn ayẹwo fairọsi) le fa irira ti ko nilo fun oju-ọ̀nà atẹgun.[4] Nigbati awọn viral mimu kokoro dagba nipa amu nkan dagba ni yara iwadi, ti a gba nipase ilepa nasopharyngeal (ọ̀nà kan ti a nlo rọba ti o ni alafo ninu lati fa ikun imu jade ninu imu), ṣee lo lati jẹrisi ni pato ohun ti o ṣe okunfa. A maa ndekun lilo awọn mimu kokoro dagba nipa amu nkan dagba ni yara iwadi yii l’ọpọ igba fun awọn eto iṣẹ iwadi.[1] Bi nkan ko ba gberu pẹlu abojuto ti o kun oju oṣunwọn, a le ṣe awọn ayẹwo siwaju sii lati ṣayẹwo fun bakiteria.[2]
- Severity
Idiye Westley ni ọ̀nà eto ti o wọpọ julọ lati sọ bi kúrùpù ṣe lewu si. A maa nlo ayẹwo yii fun awọn ète iwadi dipo iṣẹ iṣegun oyinbo.[2] O jẹ akọjọ iye awọn aami ti a yan fun awọn abuda marun: ipele imolara, ti o ni àwọ̀-bulu, idiwọ ọnafun, bi atẹgun ṣe nwọle, ati si sunki.[2] Iye aami ti a fi fun ọkọọkan awọn abuda ni a ṣe akọjọ ninu tabili ti o wa lọwọ ọtun, ati iye abajade aami wa laarin oodo si ẹẹtadinlogun (0 to 17).[6]
- A total score of ≤ 2 indicates mild croup. The person can have barking cough and hoarseness, but there is no stridor (wheezing) at rest.[5]
- A total score of 3–5 is classified as moderate croup — the person has wheezing, with few other signs.[5]
- A total score of 6–11 is severe croup. It also presents with obvious idiwọ ọnafun, but also features marked chest wall indrawing.[5]
- A total score of ≥ 12 means respiratory failureis possible. The barking cough and wheezing may no longer be prominent at this stage.[5]
Ida 85% awọn ọmọde ti o nlọ si ẹka pajawiri ni aisan ti ko le, kúrùpù ti o lewu sọwọn (<1%).[5]
Didẹkun
àtúnṣeAbẹrẹ ajẹsara (oogun abẹrẹ ajẹsara) fun influenza ati diphtheria le dẹkun kúrùpù. [2]
Abojuto
àtúnṣeAwọn ọmọde ti o ni kúrùpù ni a gbọdọ jẹ ki ara wọn balẹ bi o ba ṣee ṣe si.[4] A le fun ni awọn sitẹroidi loorekoore, pẹlu ẹfinifirini ni a nlo fun awọn iṣẹlẹ ti o lewu.[4] Awọn ọmọde ti atẹgun ti o to (iye atẹgun ti a nmi sinu ti o wa ninu ẹjẹ) ti ko to 92% gbọdọ gba atẹgun ti a nmi simu,[2] awọn eniyan ti o ni kúrùpù ti o lewu ni a le da duro si ile-iwosan lati bojuto wọn.[3] Bi atẹgun ti a nmi simu ba nilo, a gba ni niyanju lati lo "blow-by" (mimu orisun atẹgun ti a nmi simu kan sunmọ oju ọmọ naa), nitori kii fa rukerudo bi lilo iboju.[2] Pẹlu abojuto, iye eniyan ti o kere si 0.2% ni o nilo endotracheal intubation(rọba kan ti a maa nfi sinu ọ̀nà-atẹgun .[6]
Awọn sitẹrọidi
àtúnṣeAwọn kotikositẹrọidi, bii desamẹtasone ati budesonide, ṣee lo lati ṣe abojuto kúrùpù awọn ọmọde.[7] A maa nri itura to ni apẹẹrẹ ni bii wakati mẹfa lẹyin abojuto.[7] Bi o ti le jẹ wipe awọn ogun yii nṣiṣẹ nigbati a ba fun ni lati ẹnu (nipasẹ ẹnu), parenteral (nipasẹ abẹrẹ), tabi fi fa si imu, ọ̀nà ti a yan laayo ni nipasẹ ẹnu.[4] Fi fun ni lẹẹkan jẹ gbogbo nkan ti a nilo, eyiti ọpọ si fi ara mọ wipe ko lewu.[4] Desamẹtasone ni idiwọn 0.15, 0.3 ati 0.6 mg/kg tun jọ wipe ohun naa muna doko.[8]
Efinifirini
àtúnṣeKúrùpù ti o mọ niwọnba tabi ti o lewu ṣee ran lọwọ pẹlu nebulized efinifirini(nkan olomi ti a nfa simu lati jẹ ki ọ̀nà-atẹgun le fẹ)[4] Nigbati efinifirine lọpọ igba maa ndin ewu kúrùpù ku laarin iṣẹju mẹwa si ọgbọn (10–30 minutes), awọn anfaani maa npẹ fun bii wakati meji.[1][4] Bi ipo ba tẹsiwaju lati gberu fun wakati 2–4 lẹyin abojuto ti ti nkan ti ko rọgbọ kankan ko si ṣẹlẹ, omo naa le fi ile-iwosan silẹ.[1][4]
Omiiran
àtúnṣeA ti ṣe iwadi fun awọn abojuto miiran fun kúrùpù, ṣugbọn ko ti si ẹri ti o to lati ṣe atilẹyin fun lilo wọn. Mimi ikuuku gbigbona simu tabi atẹgun jẹ ọ̀nà atọwọdọwọ lati ṣe abojuto ṣe abojuto ara-ẹni, ṣugbọn awọn ẹkọ iwadi iṣegun oyinbo kuna lati fi mumunadoko mulẹ[2][4] ati lọwọlọwọ a kii saba lo o.[9] Lilo awọn oogun ikọ́, eyi ti o maa ni dextromethorphan ninu ati/tabi guiafenesin, ni a ko gba ni niyanju lati lo.[1] Nigbati fifa heliox simu (idapọ helium ati oxygen) lati din iṣẹ mimi ku ni a ti lo ni atẹyin wa, ṣugbọn ẹri ti o kere jọjọ lo wa lati ṣe atilẹyin fun lilo rẹ.[10] Nitori kúrùpù lọpọ igba jẹ arun ti fairọsi nfa,awọn oogun apakokoro ni a kii lo a fi bi a ba fura si bakiteria.[1] Apakokoro vancomycin ati cefotaxime ni a gba ni niyanju fun awọn arun bakiteria.[2] Ni awọn iṣẹlẹ ti o lewu ti o rọ mọ ọfinki A tabi B, agbogun ti fairọsi neuraminidase inhibitors ṣee lo.[2]
Awọn okunfa
àtúnṣeKúrùpù ti o niiṣẹ pẹlu fairọsi jẹ lọpọ igba self-limited arun (fun saa diẹ); kúrùpù kii saba fa iku lati owo ikuna mimi ati/tabicardiac arrest.[1] Awọn aami aisan maa nsaba ngberu laarin ọjọ meji, ṣugbọn eyi le wa fun bii ọjọn meji.[5] Awọn ewu miiran ti ko wọpọ ni ninu bacterial tracheitis, pneumonia, ati pulmonary edema.[5]
Ẹkọ nipa ajakalẹ arun
àtúnṣeBi ida marundinlogun ninu ọgọrun (15%) awọn ọmọde, ti ọjọ ori wọn wa laarin oṣu mẹfa ati ọdun marun si mẹfa (6 months and 5–6 years), yoo ni kúrùpù.[2][4] Kúrùpù lo maa nfa bi ida marun ninu ọgọrun (5)% awọn ti a gba si ile-iwosan fun ẹgbẹ ti ọjọ ori wọn wa ninu eyi.[5] Ni iṣẹlẹ ti o ṣọwọn, awọn ọmọde ti o kere to oṣu mẹta (3 months) ati ti o dagba to ọdun marundinlogun (15 years) ni kúrùpù.[5] Awọn ọkunrin maa nni idojukọ ida aadọta ninu ọgọrun (50%) ju awọn obinrin lọ; kúrùpù wọpọ ni igba autumn (fall).[2]
Itan
àtúnṣeỌrọ naa kúrùpù wa lati ọrọ-ìṣe croup, Ede Gẹẹsi Igbalode ti ati ibẹrẹ ti o tumọ si "lati sọkun pẹlu ohùn kíkẹ̀"; akọkọ lo orukọ naa fun aisan naa ni orile-ede Sikotilandi ti o si wa gbajumọ ni ẹgbẹrun ọdun kejidinlọgun (18th century).[11] A ti mọ kúrùpù diphtheritic lati igba Homer Giriki Atijọ. Ni ọdun 1826, Bretonneau da mọ yatọ kúrùpù ti fairọsi fa ati kúrùpù ti o waye lati ọwọ diphtheria.[12] Awọn Faranse npe kúrùpù ti fairọsi fa ni "faux-croup," nipa lilo "kúrùpù" fun arun ti bakiteria diphtheria fa.[9] Kúrùpù ti diphtheria fa ni o fẹẹ jẹ wipe a ko mọ nitori imunadoko abẹrẹ ajẹsara.[12]
Awọn itọkasi
àtúnṣe- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 Rajapaksa S, Starr M (May 2010). "Croup – assessment and management". Aust Fam Physician 39 (5): 280–2. PMID 20485713.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 Cherry JD (2008). "Clinical practice. Croup". N. Engl. J. Med. 358 (4): 384–91. doi:10.1056/NEJMcp072022. PMID 18216359. Archived from the original on 2010-01-05. https://web.archive.org/web/20100105072145/http://content.nejm.org/cgi/content/full/358/4/384. Retrieved 2014-01-03.
- ↑ 3.0 3.1 3.2 3.3 "Diagnosis and Management of Croup" (PDF). BC Children’s Hospital Division of Pediatric Emergency Medicine Clinical Practice Guidelines.
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 4.15 Everard ML (February 2009). "Ti o lewu gan-an bronchiolitis and croup". Pediatr. Clin. North Am. 56 (1): 119–33, x–xi. doi:10.1016/j.pcl.2008.10.007. PMID 19135584.
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 Johnson D (2009). "Croup". Clin Evid (Online) 2009. PMC 2907784. PMID 19445760. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2907784.
- ↑ 6.0 6.1 6.2 Klassen TP (December 1999). "Croup. A current perspective". Pediatr. Clin. North Am. 46 (6): 1167–78. doi:10.1016/S0031-3955(05)70180-2. PMID 10629679.
- ↑ 7.0 7.1 Russell KF, Liang Y, O'Gorman K, Johnson DW, Klassen TP (2011). Klassen, Terry P. ed. "Glucocorticoids for croup". Cochrane Database Syst Rev 1 (1): CD001955. doi:10.1002/14651858.CD001955.pub3. PMID 21249651.
- ↑ Port C (April 2009). "Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4. Dose of dexamethasone in croup". Emerg Med J 26 (4): 291–2. doi:10.1136/emj.2009.072090. PMID 19307398.
- ↑ 9.0 9.1 Marchessault V (November 2001). "Historical review of croup". Can J Infect Dis 12 (6): 337–9. PMC 2094841. PMID 18159359. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2094841.
- ↑ Vorwerk C, Coats T (2010). Vorwerk, Christiane. ed. "Heliox for croup in children". Cochrane Database Syst Rev 2 (2): CD006822. doi:10.1002/14651858.CD006822.pub2. PMID 20166089.
- ↑ Online Etymological Dictiọ̀nàry, croup. Accessed 2010-09-13.
- ↑ 12.0 12.1 Feigin, Ralph D. (2004). Textbook of pediatric infectious diseases. Philadelphia: Saunders. p. 252. ISBN 0-7216-9329-6.