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ISHOLI HUNIN

isholi-khuninISHOLI HUNIN (Dysenteria), dizenteriya, shigellez, bemorii siroyati buda, bar asari shigellaho paydo meshavad. I. kh. bo padidahoi zahroludi va osebi rudai gafs jarayon megirad. Angezai I. kh. ba jinsi Shigella mansub ast. SHigellaho 4 namud dorand:
Sh. dysenteria (bakteriyahoi Grigorev – SHig, SHtutser – SHmits va Larj – Saks), Sh.flexneri, Sh.boydi va Sh. sonnei.
SHigellaho az jihati morfologi ba hamdigar monand meboshand. Andozai onho 0,3 – 0,6 × 1 – 3 mkm ast; harakat namekunand, spora va kapsula nadorand, dar muhiti gizoi khub rushd menamoyand. SHigellaho hangomi tajziya shudan, endotoksin khorij karda, boisi zahroludi megardand. Onho qobiliyati hosil kardani ekzotoksin niz dorand, mas., enterotoksinho (tarashshuhi moe va namakhoro ba javfi ruda metezonand), sitotoksin (ba membranai hujayrahoi epiteliya oseb merasonad). Bakteriyahoi Grigorev – SHig dar barobari in neyrotoksin niz hosil menamoyand. Vobasta ba harorat, namnoki, pH-i muhit, namud va miqdori mikroorganizmho bakteriyahoi I. kh. az chand soat to chand moh zindagi mekunand. Onho dar mahsuloti khurokvori behtar mezihand.
Bakteriyahoi I. kh. az tasiri antibiotikho (tetrasiklinho, levomitsetin, ampitsillin), doruhoi nitrofurani va biseptol mahv meshavand. Mavodi gandzudo (gipokhloridho, khloraminho, lizol va g.) shigellahoro dar muddati chand daqiqa nobud mesozad.
Manbai siroyati angezandahoi I. kh. odam ast. Hususan ashkhosi mubtaloi shaklhoi sabuk va nihonii I. kh.-i shadid, hamchunin odamoni giriftori I. kh.-i muzmin khavfnokand. CHunin odamon khudro solim his karda, ba dukhtur nameravand. Vale onho pahnkunandai asosii bakteriyahoand.
Angezandai I. kh. ba vositai gizo, nushokiho (shir, kompot, salat), ob, dasti iflos, bozichaho siroyat menamoyad. Dar pahn kardani angezandai bemori maqomi magasho kalon ast. Ba I. kh. odamoni sinnu soli gunogun, vale beshtar kudakon giriftor meshavand. Marizi beshtar mohhoi iyul – sent. khuruj meyobad.
Ba paydoishi I. kh.-i shadid toksemiya tasiri kalon merasonad. Angezandaho ba organizmi odam faqat az dahon dokhil meshavand. Onho dar rohi boloi uzvhoi hozima zeri tasiri shirai meda va florai ruda qisman mahv megardand. Bakteriyahoi zinda az in saddi fiziologi meguzarand va ba paydoishi bemori musoidat mekunand. Onho saravval ba rudai borik dokhil meshavand va meafzoyand.
Zahre, ki binobar tajziyai bakteriyaho ikhroj megardad, ba khun meguzarad. Zahr dar khun gardish karda, ba uzvu boftaho va silsilai asab tasir merasonad. Dar natija mariz tablarza mekunad, harorati badan baland, ishtiho kam meshavad. Endotoksin ba raghoi devorai ruda oseb merasonad (hiperemiya, varam, khunshori). SHigellahoi zinda ba hujayrahoi ruda meguzarand va dar onho meafzoyand. Onho hujayrahoro mahv karda, saddi tabiii luobpardahoro bartaraf mesozand, baroi ba uzvu boftaho guzashtani zahr roh mekushoyand. Dar natijai afzoishu tajziyai minbadai shigellaho miqdori zahr (endotoksin) dar ruda va khun ziyod meshavad. Mushakhoi suftai rudai gafs tashannuj (spazm) meyoband; hiperemiya, ikhtiloli guzaronishi ragho, afzudani luobhosilshavi, paydoishi zakhm ba nazar merasand, faoliyati jabbandagii on khalaldor meshavad. Nishonahoi hamai in dard kardanu toftani shikam, darunravi, qabziyat, najosati khunolud meboshand.
Jihati khosi I. kh. inkishofi disbakterioz (tagyir yoftani tanosubi bayni bakteriyahoi mufidi ruda va namudhoi digari bakteriyaho) ast. Dar ruda afzoish yoftani bakteriyahoi ufuni (pusishovar) va dig. mikrobho boisi zahroludii organizm va iltihobi luobparda megardad.
Hangomi I. kh. dar barobari zahroludii silsilai asab va ikhtiloli faoliyati rudaho amali gadudhoi azoi hozima, gadudi zeri meda, ruda, hamchunin jigar khele sust megardad. Mubodilai obu namak, karbogidratho, safedaho, vitaminho khalal meyobad.
Hini I. kh. tagyiroti morfologi asosan dar qismi poyoni rudai gafs rukh menamoyad. Ravandi iltihobii khunrez (gemorragi) bisyor vaqt dar dastgohi folikulavi niz ba mushohida merasad. Dar natija baze qismhoi luobpardavu folikullaho duchori nekroz megardand. Binobar in, yarachahoi gunogunshakl paydo meshavand, ki onho badi shifo yoftanashon karakhsh namebandand. Dar jigar, miokard, gadudi boloi gurda va gurdaho purkhuni, varam, tagyiroti distrofii hujayraho ba nazar merasand. CHi qadare, ki zahroludi vozeh boshad, faoliyati uzvho hamon qadar beshtar khalal meyobad.
Davrai nihonii I. kh. 1 – 7 (beshtar 2 – 3) ruz ast. Bemori mamulan ba tavri shadid ogoz meyobad. Dar padidahoi sariri (kliniki)-i I. kh. metavon du aloim (sindrom)-i asosiro farq kard: zahroludii umumi va illati rudai gafs. Zuhurot va muhlati paydoishi onho yak khel nest. Baland shudani harorati badan, tablarza, kamishtihoi, sardard, beholi, bradikardiya (dilzanii ohista), past shudani fishori khun nishonahoi zahroludii umumi meboshand. Onho metavonand qabl az alomathoi ikhtiloli ruda ba vujud oyand.
Nishonai illat yoftani rohi medavu ruda dard kardani on ast. Avval dard doimi va sust buda, ba shikam pahn meshavad; bad on shiddat meyobad, ba zeri shikam (beshtar az chap yo zeri nof, goho az rost) meguzarad. Dard, odatan, pesh az qazoi hojat avj megirad. Dardi tobdihanda (tenezmaho) niz mavjud ast. On az mavzei rudai rost ogoz yofta, ba chorband meguzarad. Dardi tobdihanda dar vaqti qazoi hojat va 5 – 15 daq. badi on mushohida meshavad. Sababi chunin dard iltihobi qismi ampulavii rudai rost ast. Tob dodani shikam, zud-zud khohishi qazoi hojat paydo shudan, bisyor nishastan, ehsosi nopurragii qazoi hojat va g. dalel bar osebi qismi kanori (distali)-i rudai gafs meboshad. Hangomi molidanu zer kardani shikam, rudai gafs, khususan mavzei rudai sigmashakl, dard mekunad. Najosati bemor yakjoya bo luobu khun meoyad (odatan khun bo luob omekhta nameshavad).
Vobasta ba alomathoi bolini I. kh.-ro ba chunin shaklho judo kardan mumkin ast: shadid (muqarrari yo koliti, gayrimuqarrari yo gastroenterokoliti, zersariri), muzmin (takrorshavanda, bardavom), nosomoni (disfunksiya)-i badidizenteriyavii ruda.
Isholi khunini shadid. SHakli sabuki on dar 70 – 80%-i bemoron mushohida meshavad. Vazi mariz bad nest, harorati badan mutadil yo ruzhoi avval andake baland (37, 1 – 37,8°S) ast, shikam sakht dard namekunad va tob namedihad. Bemor dar yak shaboruz 3 – 5 (bisyorash 10) marotiba ba qazoi hojat meravad; najosat omekhta bo luobu khun ast. CHunin odamon binobar solimu bardam budan, ba dukhtur murojiat namekunand. Vale onhoro zud oshkor kardan lozim ast (bo rohi pursish, muoina, tadqiqi bakteriologii najosat), chunki homili angezandai marizi meboshand.
Dar asnoi miyona budani darajai vazninii bemori (dar 20 – 25%-i marizon) salomati taboh megardad, shikam va sar dard mekunad, tablarza ba vujud meoyad, harorati badan baland, khob va ishtiho gum meshavad. Goho alomathoi zahroludii umumi 12 – 24 soat qabl az ogozi nosomonihoi ruda padid meoyand. Bisyor bemoron 2 – 5 soat peshtar az ogozi bemori zud-zud (dar yak shaboruz to 10 marotiba) ba qazoi hojat meravand; najosat obaki buda, bo luobu khun meoyad, shikam sakht tob medihad; zabon khushk ast (onro halolati khokistarrang mepushad), rudai gafs dard mekunad.
Dar mavridi vaznin budani bemori (dar 3 – 5%-i bemoron) harorat ba 39 – 40°S (va ziyodtar) merasad; shakhs tasf mekunad yo baraks, khunuk mekhurad, behol meshavad, harakat karda nametavonad. Ishtiho batamom nest shuda, rangi ruy meparad, nabz tez, fishori sharayon past megardad. Bemor dar yak shaboruz 30 – 50 marotiba qazoi hojat mekunad, goho dar joi khob darun meravad.
SHakli gayrimuqarrarii I. kh.-i shadid chun gastroenterit yo gastroenterokolit jarayon megirad. Beshtar hangomi siroyat yoftan az shigellahoi Zonn ba nazar merasad. Bemor tabu tasf mekunad (38 – 39°S), dilbehuzuri va qay paydo meshavad, darun meravad (najosati luobu khunolud).
SHakli zersariri (subkliniki)-i I. kh. biduni alomathoi zahroludi va nosomonihoi vozehi ruda paydo meshavad. In tarzi I. kh.-ro, odatan, zimni sanjishi bakteriologi az rui malumoti epidemiologi muqarrar mekunand. CHunin ashkhos ba nazar «solim» menamoyand, ammo dar surati muoinai aniq, dar onho nishonahoi I. kh.-ro oshkor kardan mumkin ast.
Isholi khunini muzmin. Badi 2 mohi az bemorkhona baromadani mariz (goho badi 6 moh) khuruj mekunad. Ba jarayoni muzmin kasb kardani I. kh. omilhoe musoidat menamoyand, ki boisi zafi muqovamati organizm va tagyiri qobiliyati vokunishi (reaktiviyat) megardand, mas., bemorihoi digar, kamkhuroki, gizoi kamvitamin, ikhtiloli faoliyati tarashshuhii medavu ruda, der ba bemorkhona ovardani mariz, muolijai nodurust va g. Dar natija zakhmi ruda der shifo meyobad, faoliyati ruda va jigar muddati ziyod sust meshavad.
I. kh.-i muzmin goho khususiyati takrorshavi dorad. On bazan khuruj mekunad, goho muddati ziyod az khud darak namedihad. CHunin bemoron khiratab buda, zud ba khashm meoyand, bekhobi mekashand, shikamashon dard mekunad, kharob meshavand. Huruj va jarayoni bemorii mazkur, odatan, ba misli I. kh.-i shadid ast. Badi 2 – 3 hafta mariz ofiyat meyobad. Sababi darunravii beist hamesha osebi amiqi rohi medavu ruda nest. On binobar ikhtiloli faoliyati dig. uzvhoi hozima – gadudi zeri meda va talkhadon niz inkishof meyobad. Hususiyati asosii takroryobii I. kh.-i muzmin yakbora ba mushohida narasidani zahroludi va aksulamali varajavii onho ast. Dar bayni davrahoi ofiyatyobi holati bemor khub meboshad, u qobili kor ast, vale faoliyati rudaho nomurattaband.
I. kh.-i muzmin goho beist jarayon megirad, bemor az damishi shikam, zud-zud qazoi hojat kardan (najosat bo luob omekhta meoyad), beishtihoi shikoyat mekunad. Az had ziyod kharob shudan, gipovitaminoz va obvarami besafeda mumkin ast bo favti mariz anjom pazirand.
Farjomi I. kh. ba sinnu soli mariz, darajai vaznini, amrozi hamrohshuda, orizaho va muhlati ogozi muolija vobasta ast. Umuman, onro metavon bemorii nekfarjom shumurd.
I. kh.-ro dar asosi alomathoi bolini tashkhis mekunand. Dar in mavrid shaklhoi gayrimuqarrari va nihonii onro niz naboyad faromush kard. Hosa pursishi mariz, dar najosat vujud doshtani luobu khun, malumoti epidemiologi muhimand.
Sanjishi bakteriologii najosat imkon medihad, ki ba kishti angezandahoi I. kh. noil gardem. Kishti angezandaho usuli nisbatan sahehi tashkhis ast. Baroi sanjish najosati bemorro (to antibiotik tayin kardan) dar muhithoi Ploskirev, Myuller va seleniti nigoh medorand. Haror. termostat boyad 37°S va muhlati nigahdosht 24 soat boshad. Dar mavridi musbat budani malumot mikrobhoi (koloniyahoi) berang mesabzand (minbad khususiyathoi biokhimiyavi va hassosiyati onho ba antibiotikho sanjida khohad shud). Usuli tadqiqi koprologii najosat niz muhim ast. Hangomi on dar tarkibi akhlot luob, fasod, khun va dar tarkibi molishak (mazok) hujayrahoi rashh (ekssudat)-i iltihobi (leykositho, eritrositho)-ro oshkor sokhtan mumkin ast.
Sanjishi rektoromanoskopii luobpardai rudai rost (sigmashakl) imkon medihad, ki tarzi tagyiroti iltihobii qismi kanori (distali)-i ruda muayyan karda shavand. Usuli mazkur baroi muqarrar sokhtani digar bemorihoi ruda – saratoni rudai rost, polipoz, bavosir niz mufid ast.
Vokunishi allergi (sanjishi Suverkalov) ba jumlai on usulhoi tashkhise mansub ast, ki tavassuti dizenterin amali gardonda meshavad. Doruro (0,1 ml) ba zeri pusti soid mefiristand. Natijai sanjish badi 24 soat muqarrar karda meshavad. Mavjudiyati paysavu surkhlakkaho (papulayu eritema)-i diametrashon 10 × 20 mm dalel ba aksulamali musbati sust (+), az 20 to 35 mm – musbat (++) va az 35 mm kalon – musbati shadid (+++) meboshad. Ba andozai 10 – 15 mm surkh gashtani pust va nabudani paysaho alomati manfi mahsub meshavad. Istifodai usuli mazkur dar mavridi bemorii sil, bemorihoi allergi, amrozi virusii rohi nafas, logari joiz nest.
Usuli serologi (vokunishi agglyutinatsiya)-ro, ki baroi dar zardobi khuni mariz oshkor sokhtani podtanhoi makhsus istifoda meshavad, dar haftai 2 – 3 bemori kor mefarmoyand. Soliyoni okhir beshtar az vokunishi gemagglyutinatsiyai gayrimustaqim (RNGA) istifoda mebarand. Ba natijahoi musbati RNGA az ruzi 5-umi bemori metavon noil gasht. Haftai duyum titri podtanho (antitelaho) afzuda, az haftahoi 4 – 5 ru ba kamshavi menihand. Titri aqalli (kamtarin)-i tashkhisii RNGA 1:200 ast.
Tashkhisi tafriqi (differensiali)-i I. kh.-ro boyad ba nisbati salmonellyoz, esherikhiozho, zahroludi az gizo, vabo, amyobiaz, balantidiaz, lyamblioz, trikhomoniazi ruda, baze gelmintozho, kandidoz guzarond. Alomathoi zahroludi az zanburugho, namaki metallhoi vaznin, kolit, sili ruda, enterokoliti muzmin va koliti zakhmi ba nishonahoi I. kh. monand meboshand. Goho zarurati az bemorihoi shadidi jarrohitalab – appenditsiti shadid, suddati (trombozi) raghoi masoriqai (mezenteriyavi), basta shudani ruda, hamchunin az bemorihoi shadidi ginekologi (homilagii khorijibachadoni, adneksit, pelveoperitonit) farq kardani I. kh. pesh meoyad. Malumoti aniq va muoinai daqiqonai bemor bahri sarivaqt va durust oshkor kardani I. kh. sharoiti musoid faroham meovard.
I. kh.-ro ba tavri kompleksi tabobat kardan lozim ast. Az doruhoe, ki ba angezandai bemori tasir merasonand, antibiotikho va davojoti sulfanilamidi mufid meboshand. Doruhoi mazkurro faqat badi muqarrar kardani hassosiyati angezandai I. kh. kor farmudan mumkin ast. Az sulfanilamidho on doruhoero tain mekunand, ki az ruda ba khun nagz jabbida nameshavand (ftalazol, sulgin). Hosa yakjoya istifoda burdani antibiotikhoi gunogun, antibiotikho bo sulfanilamidho naf dorad; istifodai mushtaraki antibiotikhoi qatori tetrasiklini yo levomisetin bo ftalazol yo sulgin niz natijai dilkhoh medihad.
Muolijai I. kh.-i muzmin boyad duru daroz va zina ba zina boshad. Doruhoi khimiyaviro faqat dar mavridi takror shudani bemori yo khuruji on kor mefarmoyand. Muolijai ziddi bakteriyavi boyad az 7 ruz kam idoma nayobad va yakjoya bo vaksinoterapiya yo istifodai vasoiti muqavvi guzaronidani khun, plazma, gammaglobulin, immunogen va doruhoi digar), vitaminshifoi va fizioterapiya surat girad.
Bemoroni I. kh. boyad ba parhez duru daroz rioya kunand. Dar mavridi tul kashidani bemori va zud shifo nayoftani zakhmi luobpardai ruda istifodai gormonhoi anaboli naf dorad.
Sarivaqt oshkor sokhtan va dar bemorkhona bistari kardani mariz, gandzudoi (dezinfeksiya)-i utoqi khobi bemor, nazorati jiddii manbahoi ob, muassisahoi khurokvori, nest kardani magasho, gandzudoii najosat az jumlai tadbirhoi asosii peshgirii I. kh. meboshand. Oshkor kardani bemoroni I. kh.-i muzmin, homiloni bakteriya va dar muassisahoi khurokvori ba kor roh nadodani onho muhim ast.
Odamoni shifoyoftaro az bemorkhona badi se natijai manfii sanjishi bakteriologii najosat javob medihand. Agar onho dar muassisahoi khurokvori kor kunand, yo robita doshta boshand, pas panj natijai manfii sanjishi bakteriologii najosat zarur ast.
Badi az bemorkhona baromadan, marizro baroi mushohidai dispanseri ba kabineti bemorihoi siroyati mefiristand. Kormandoni muassisahoi khurokvori va ashkhosi kasbu korashon ba onho monand, badi az bemorkhona baromadan, 5 ruz ba kor roh doda nameshavand. Dar in muddat du marotiba sanjishi bakteriologii najosat va yak marotiba tadqiqi koprologi guzaronda khohad shud. Badi ba kor baromadan, chunin ashkhos 6 moh (odamone, ki bemori I. kh.-i muzmin budand 9 moh) zeri nazorati dispanseri qaror megirand.

E. R. Rahmonov.

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