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14.08.2014, 18:27 | |
Резюме Рецензент: д.мед.н., проф. Л.М. Іванова УДК 616.24-002+616.36-036 ДЗ «Луганський державний медичний університет» ГЗ «Луганский государственный медицинский университет» State Establishment "Lugansk State Medical University" pulmon@mail.ru The goal of the research was determination of clinical progression features of community-acquired pneumonia (CAP) in combination with liver steatosis (LS). There were 164 patients with CAP in combination with LS under our supervision. Clinical observation consisted in the analysis of complaints, anamnestic data and pathological c hanges that were revealed by physical methods of research. The diagnosis of CAP (code j18 after IKD- 10) was set according to the requirements of clinical protocol of health care delivery according specialty "Pulmonology" (2007); LS (code К76.0) in accordance with existent recommendations. In the acuity of CAP the examined by us patients had subjective clinical symptoms and syndromes that were given in the table 1. So, more often it appeared productive cough with defluvium of mainly mucopurulent sputum, sense of discomfort and/or thoracodynia from the side of pulmonary tissue lesion at the deep breathing and/or cough, promiscuity labored breathing at moderate physical activity, and also displays of infectious intoxication syndrome as complaints of asthenic and partly asthenoneurotic character. The subjective evidences of LS were discomfort, feeling of weight, aching pain in the right hypochondrium and evidences of dyspeptic syndrome. Among the objective evidences of CAP for patients with comorbide pathology were chill, hyperhidrosis, signs of syndrome of indurated pulmonary tissue, such as dullness of percussion sound and limitation of pulmonary fimbria on the side of lension (it was marked mainly at localization of inflammatory process in the foot lung), weak (very weakened) breathing above the focus of pneumonic infiltration (mainly at partial pneumonia), presence of small- or medium moist rales on the side of pulmonary tissue lension, rarer (mainly for patients with heavy progression of CAP) pleural friction rub and also signs of pulmonary insufficiency. The objective evidences of LS for patients with CAP were subicteritiousness scleras, coated tongue with white or dirty grey plaque accumulation, hepatomegalia, sensation of hepatic fimbria at palpation and induration, in single cases it were telangiectasia and palmar erythema. The symptoms of Kehr, Ortner, Raukhbe for the patients of both groups were negative that testified to absence at the moment of examination recrudescence of chronic inflammatory process in a gall-bladder. Conclusions 1. Clinical presentation of community-acquired pneumonia in combination with liver steatosis was characterized by the presence of general intoxication, respiratory and asthenoneurotic syndromes and also mildly expressed signs of chronic liver involvement. 2. In future we plan to study the features of basic pathogenetic links of community-acquired pneumonia in combination with liver steatosis. Література 1. Авдеев С.Н. Тяжелая внебольничная пневмония / С.Н. Авдеев, А.Г Чучалин // РМЖ. - 2001. - Т. 9, № 5. - С. 1-11. | |
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