the treatment method of senile bronchiectasis, how to do senile bronchiectasis, senile bronchiectasis medication
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Visiting department: geriatrics department of respiratory medicine. Treatment cost: about (5000-10000 yuan) in the top three hospitals in the city. Cure rate: treatment cycle: treatment method: drugs and surgeryGeneral treatment of bronchiectasis in the elderly
The treatment principle of bronchiectasis is: remove the cause, promote sputum discharge, control infection, and remove it surgically when necessary.
1. Keep respiratory tract unobstructed
Postural drainage can eliminate phlegm accumulation, reduce secondary infection and relieve systemic poisoning symptoms. For patients with excessive pus and sputum and poor drainage, its effect is sometimes no less than the application of antibiotics. Dilute sputum with expectorant and bronchodilator, and then remove sputum by postural drainage to reduce secondary infection and relieve systemic poisoning symptoms.
For example, ammonium chloride 0.3 ~ 0.6 g and bromhexine 8 ~ 16mg, 3 times a day, were taken orally. Ultrasonic atomization inhalation of chymotrypsin 5mg or normal saline. Make sputum thin and facilitate discharge. Some patients may have bronchoconstriction spasm due to increased bronchial reactivity or inflammatory stimulation, which affects sputum discharge. Therefore, theophylline preparation can be taken, and bronchodilators such as β 2 receptor agonists can be added when necessary.
(2) Postural drainage:
According to the lesion site, different body positions should be taken, and the high position of the lesion bronchus should be taken to make the drainage bronchus open downward, so as to facilitate sputum outflow. 2 ~ 3 times/d, each time about 15min. If postural drainage is still difficult to discharge, sputum can be sucked by fiberoptic bronchoscope, and sucked out after washing and diluting sputum with normal saline. If necessary, 1: 1000 epinephrine is dripped on bronchial mucosa to eliminate edema, so as to reduce obstruction and facilitate sputum discharge. Antibiotics can also be dripped locally.
2. Infection control is the main treatment for bronchiectasis in acute infection period
Antibiotics should be selected according to symptoms, signs, sputum color and bacterial culture results. The dosage of antibiotics should be determined according to the severity of illness, and whether combined medication is needed. At the same time, attention should be paid to fungal and anaerobic infection. For mild diseases, oral amoxicillin 0.5 g or cefadroxil 0.5 g, 4 times a day; Fluoroquinolones such as levofloxacin 0.2 g, 3 times a day. Severe patients often need intravenous combination medication, and penicillins and the third generation cephalosporins can have synergistic effect with aminoglycosides respectively. If there is anaerobic infection, metronidazole or tinidazole can be added. Antibiotics can also be applied locally, such as adding antibiotics to atomized inhalation solution, or dripping antibiotics locally through fiberoptic bronchoscope.
3. Surgical treatment
Patients with recurrent respiratory tract infection or massive hemoptysis, if the lesion scope is limited to one lobe or one lung tissue, which cannot be controlled by drug treatment, the whole body is in good condition, and there is no insufficiency of important organs, can undergo lobectomy or segmental resection according to the lesion scope.
4. Interventional therapy is a new treatment method
With the advantage of small trauma and quick recovery, bleeding focus can be found by selective bronchial arteriography and local arterial embolization can be given.
5. Choose the best scheme
Bronchiectasis is mainly treated conservatively by internal medicine, with a small amount of repeated massive hemoptysis and limited lesions. If the medical treatment is ineffective, surgery or interventional therapy should be performed.
The principle of medical treatment is to control respiratory tract infection as soon as possible and reduce the damage of inflammation to respiratory tract under the condition of keeping respiratory tract drainage unobstructed. Due to repeated infection, sputum accumulation in bronchus and decreased bronchial defense function, many pathogens are mixed, conditional pathogenic bacteria are increased, and bacteria are resistant to drugs. Pathogens include bacteria, fungi, viruses, mycoplasma and chlamydia. Most of them are bacteria.
Most of the community infections were Gram-positive bacteria, and pneumococci were common. Gram-negative bacteria are mostly Klebsiella pneumoniae, Legionella, Pseudomonas aeruginosa, Anaerobic bacteria, Staphylococcus aureus, etc. Aerobic Gram-negative bacilli are more common in nosocomial infection, including Pseudomonas aeruginosa, Klebsiella pneumoniae, Haemophilus influenzae, Enterobacter, etc. Followed by Staphylococcus aureus, fungi and viruses. Therefore, broad-spectrum antibiotics, large dose, long course of treatment and combination should be given during treatment.
Experience treatment: Mild infection is mostly community infection, which can be given penicillin-G or semi-synthetic penicillin such as piperacillin and amoxicillin, fluquinolones such as ciprofloxacin and ofloxacin, and macrolides such as erythromycin. Moderate and severe infections, including nosocomial infections, can be combined with aminoglycosides and other antibiotics such as amikacin, netilmicin and tobramycin, or second and third generation cephalosporins such as cefuroxime, ceftazidime, cefoperazone, imipenem-cilastatin sodium combined with aminoglycosides. However, attention should be paid to the renal and ototoxicity of aminoglycoside antibiotics, which should be used with caution for the elderly and renal insufficiency. Fluconazole (Dafukang) or amphotericin B can be added for fungal infection. Sputum has bad smell, indicating anaerobic infection, metronidazole or tinidazole should be added.
Bacterial culture and drug sensitivity test should be carried out at the same time of treatment, and antibiotic types should be adjusted at any time according to the results.
Second, the prognosis
Bronchiectasis complicated with pulmonary heart disease, which is the main cause of death of bronchiectasis, should beActive prevention.
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