Ukulimala kwamaphaphu acute

ngu-Katherina Baranova MD kanye no-Matthew J. Cecchini MD PhD FRCPC
June 2, 2023

Kuyini ukulimala kwamaphaphu acute?

Ukulimala okunamandla kwamaphaphu kuyisimo esisongela ukuphila esihambisana nokuvuvukala emaphashini. Izazi ze-pathologists zihlukanisa ukulimala okukhulu kwamaphaphu kube amaphethini amabili okulimala: ukuhlela i-pneumonia kanye nokusabalalisa ukulimala kwe-alveolar (DAD). Lawa maphethini amabili ahluke ngobukhulu bokulimala kanye nezimpawu ezihambisanayo.

Ukuhlela inyumoniya

Yiziphi izimpawu zokuhlela inyumoniya?

Izimpawu zokuhlela inyumoniya zingabandakanya ukukhwehlela okomile, ukuphefumula kanzima, imfiva, nokuncipha kwesisindo.

Yini ebangela ukuhlela inyumoniya?

Ukuhlela inyumoniya kuyiphethini yokulimala kanzima kwamaphaphu enezimbangela eziningi. Izimbangela ezivame kakhulu zokuhlela inyumoniya zihlanganisa ukutheleleka ngamagciwane, amagciwane, isikhunta, nezimuncagazi, izidakamizwa, imisebe esifubeni, ukuphazamiseka kwezicubu ezixhumeneyo kanye nokuphazamiseka kokuvuvukala, kanye nokulangazelela okuqukethwe yisisu emaphashini.

Udokotela wakho uzocabangela izimpawu zakho, umlando wezokwelapha, uhambo lwakamuva, kanye nemithi ethathiwe ukuze athole imbangela yokuhlela inyumoniya. Uma kungekho sizathu esingatholakala, ukuxilongwa kwe-"cryptogenic organising pneumonia" kwenziwa. I-Cryptogenic pneumonia yokuhlela ngokuvamile ihlotshaniswa nokuhle isibikezelo futhi isabela kahle kuma-corticosteroids, njenge-prednisone.

I-pneumonia yokuhlela ibukeka kanjani ngaphansi kwesibonakhulu?

Lapho izicubu zamaphaphu ezinenyumoniya ehlelayo zihlolwa ngaphansi kwesibonakhulu, iqoqo lamaseli akhethekile abizwa ngokuthi ama-fibroblasts lingabonakala ngaphakathi kwezikhala zomoya. Okukhethekile amangqamuzana okuvuvukala njenge i-lymphocytes kungase kubonakale nasezindongeni ze-alveolar.

Ukuhlela inyumoniya kuvame ukuthikameza izingxenye zamaphaphu kuphela kuyilapho ezinye izingxenye zihlala zivamile futhi zinempilo. Amaqembu ama-fibroblasts ngaphakathi kwezindawo ezithintekile zamaphaphu avimbela umoya ekugcwaliseni i-alveoli. Ngenxa yalokho, iziguli ezine-pneumonia yokuhlela zingazizwa ziphefumula. Imibiko ye-Radiology ivamise ukuchaza lezi zindawo zamaphaphu njengama-opacities engilazi ephansi.

Sabalalisa ukulimala kwe-alveolar

Yiziphi izimpawu zokulimala kwe-alveolar esabalele?

Iziguli ezinokulimala kwe-alveolar esabalele zingagula kakhulu futhi zingangeniswa egunjini labagula kakhulu. Egunjini labagula kakhulu, inhloso wukusekela ukuphefumula njengoba iziguli zingase zibe nzima ukuthola umoya-mpilo owanele. Lokhu ngezinye izikhathi kudinga intubation, okuhlanganisa ukufaka ishubhu kuqhoqhoqho ukuze iphushe umoya owengeziwe emaphashini. Ukulimala kwe-alveolar (DAD) kubonakala ku-acute Respiratory Distress Syndrome (ARDS), okuyigama lomtholampilo elisetshenziselwa ukuchaza abantu abanokuphefumula kanzima, amazinga aphansi omoya-mpilo egazini, kanye noketshezi olusezikhaleni zomoya zamaphaphu.

Yini ebangela ukulimala kwe-alveolar?

UBABA uyiphethini yokulimala kabi kwamaphaphu enezimbangela eziningi. Izimbangela ezivame kakhulu ze-DAD zihlanganisa izifo eziholela inyumoniya; ukutheleleka okukhulu kwegazi (i-sepsis); eduze kokuminza; ukulimala kokuhogela umoya, njengokuhogela igesi enobuthi, ukulimala kwamaphaphu okubangwa yi-vaping, noma intuthu; ukusabela kwezidakamizwa; isifiso sokuqukethwe kwesisu noma ezinye izinto zangaphandle; ezinye izinhlobo zokushaqeka, njengokusha okukhulu; kanye nokuhlukumezeka esifubeni noma emaphashini.

Udokotela wakho uzocabangela izimpawu zakho, umlando wezokwelapha, uhambo lwakamuva, kanye nemithi oyithathile ukuze athole imbangela ye-DAD. Uma kungekho sizathu esingatholakala, ukuxilongwa "kwe-acute interstitial pneumonia" kwenziwa. Ukubikezela kweziguli ezinenyumoniya ye-interstitial acute kubi futhi azikho izindlela zokwelapha eziqondile ezitholakalayo njengamanje.

Ubonakala kanjani umonakalo we-alveolar ngaphansi kwesibonakhulu?

Lapho isampula yezicubu zamaphaphu ihlolwa ngaphansi kwesibonakhulu izinguquko ezihambisana nomonakalo we-alveolar osabalele zihlanganisa ukwakheka kolwelwesi lwe-hyaline, ukushintshwa kohlobo 1 lwama-pneumocyte ngohlobo 2 lwama-pneumocyte, kanye nezindonga ze-alveolar ezijiyile.

Lezi zinguquko zivimba amaphaphu ekusebenzeni ngendlela evamile ngokuvimbela ukushintshaniswa komoya-mpilo kanye nesikhutha ku-alveoli. Lokhu kungaholela ekuphefumuleni okukhulu nokwehluleka ukuphefumula.

Yiziphi izivivinyo ezingenziwa ukuze kutholwe imbangela yokulimala okukhulu kwamaphaphu?

Uma udokotela wakho esola ukuthi ulimele kakhulu emaphashini, angenza inqubo ebizwa ngokuthi a i-biopsy ekhipha isampula lethishu elincane ukuze lihlolwe udokotela wezifo. I-pathologist yakho izobheka isampula yethishu ngaphansi kwesibonakhulu futhi ingase i-ode ukuhlolwa okwengeziwe ukusiza ukuthola imbangela.

Lezi zivivinyo ezengeziwe zingabandakanya a ibala elikhethekile ebizwa ngokuthi i-Grocott's methenamine silver stain (ebuye ibizwe ngokuthi i-GMS) ukubheka ama-micro-organisms esikhunta kanye i-immunohistochemistry ukubheka izinhlobo ezithile ze amagciwane. Uma kungekho sizathu esiqondile esingatholakala, udokotela wakho wezifo uzochaza izinguquko ezibonwa ku-biopsy yakho futhi uzophakamisa ukuthi udokotela wakho acabangele lezi zinguquko kanye nolunye ulwazi ngawe ukuze enze ukuxilongwa kokugcina. Le nhlanganisela yolwazi ibizwa nge-clinical correlation.