Atelectasis

Atelectasis of a lung is called morbid condition at which lightness loss by the site of a lung (a segment, a share) or all lung is observed. In translation from Greek "atelectasis" means incomplete or cancelled extension of fabric.

Are observed inborn (not raspravleny parts of a lung) or the acquired disease forms. The acquired atelectases are subdivided on compression and obturatsionny.

The prelum of bronchial tubes outside is an origin of a compression atelectasis. The Obturatsionny atelectasis develops owing to obstruction of a gleam of the bringing bronchial tube.

Etiology and pathogeny of an atelectasis of a lung

Can lead the following reasons to development of an atelectasis:

• Pathology of an internal mucous membrane of walls of a bronchial tube – deformation, a bronkhomalyation, hypostasis, a tumor;
• The increase in surface intention on walls of alveoluses caused by lung hypostasis (cardiogenic and not cardiogenic genesis), infectious processes or a lack of surfactant;
• Obstruction (obstruction) of a gleam of a bronchial tube a foreign body, caseous masses at tuberculosis, slime, hypostasis of a mucous membrane;
• The prelum of a lung and/or respiratory tracts caused by various external factors (tumors of a mediastinum, a limfoadenopatiya, anomaly of development of large blood vessels, a myocardium hypertrophy, etc.);
• Increase in pressure in a pleural cavity (a hemothorax, a hydrothorax, an empyema, pheumothorax);
• The disturbances of a normal excursion of a thorax arising owing to the general anesthesia, paralysis of a phrenic nerve, neuromuscular diseases, scoliosis;
• The massive acute collapse of a lung arising as a postoperative complication owing to a long immovability of the patient, overdose of oxygen in respiratory mix, uses of high doses of sedative drugs and opiates, vasodilators, hypothermias.

Risk factors of development of an atelectasis of a lung are obesity, smoking. In addition this disease meets at the people having bronchial asthma and a mucoviscidosis more often.

Patomorfologiya of a disease

Insufficient intake of air leads to developing of a fabric hypoxia of an affected area of pulmonary fabric. It leads to the fact that the internal space of alveoluses begins to be filled with transudate (vypotny liquid), desquamated cells of an epithelium and a bronchial secret. Very quickly in the struck zone there are infectious processes leading to development of fibrosis and emergence of bronchiectasias.

Clinical picture of an atelectasis

The atelectasis symptomatology, generally is defined by the nature of the main process which led to developing of a disease. So at an obturatsionny atelectasis in most cases the doctor without effort can find signs of obstruction of lungs, and at a compression atelectasis most of patients has symptoms of a tumor of lungs or a mediastinum.

Extensive atelectases are followed by disturbance of frequency and the nature of breath, emergence of tachycardia and cyanochroic (bluish) coloring of integuments.

Over the site of an atelectasis (more than 1 - 2 segments) quite often it is possible to catch the weakened breath and shortening of a percussion sound.

When carrying out X-ray inspection on roentgenograms the shadow having clear concave boundary is defined. When carrying out roentgenoscopy at patients with an atelectasis of a lung it is possible to reveal Jacobson-Gelznechta's symptom (the tolchkoobrazny shifts of a shadow of a mediastinum directed towards defeat).

Current and forecast

At preservation of the reason which led to development of an atelectasis, the disease proceeds is long. At accession of inflammatory process gives an impetus to development of pneumonia. At preservation of the site of an atelectasis of a lung more than half a year there is a pneumosclerosis, and further chronic pneumonia.

Atelectasis: treatment

Therapy of an atelectasis of a lung first of all has to be directed to elimination of the reason of its development. At an obturatsionny atelectasis resort to a bronkhoskopiya during which make removal from a gleam of a bronchial tube of a foreign body or caseous masses. After recovery of passability of the bringing bronchial tube in bystry terms the atelectasis is allowed.

Treatment of atelectases of reflex genesis or the bronchial tubes tied with obstruction of a gleam slime consists in use of methods of the bronchial tubes (stimulation of cough, massage, a postural drainage) accelerating clarification.

The compression atelectasis when it is caused by a tumor or a hyperadenosis demands performing surgical treatment.

In hard cases of an atelectasis treatment of a disease quite often begins with transfer of the patient into the managed artificial ventilation of the lungs.

Atelectasis at newborns

or an underdevelopment of a respiratory center, an underdevelopment of pulmonary and bronchial fabric (The Main reasons not for a raspravleniye of the site of pulmonary fabric and emergence of an atelectasis at newborns are decrease in excitability more often at premature children) and obturation of respiratory tracts slime, blood or amniotic waters.

The clinical picture of an atelectasis at newborns is shown by short wind, tachycardia, cyanosis.

In most cases sites of not straightened pulmonary fabric independently finish within the first week of life of the child. The forecast of a disease considerably worsens at accession of an edematous and hemorrhagic syndrome, infectious and inflammatory processes or formations of hyaline membranes.

Treatment of an atelectasis at newborns consists in carrying out an oxygenotherapy or, in especially hard cases, artificial ventilation of the lungs. Carry out infusional therapy by glyukozo-alkaline mixes, appoint cardiovascular drugs and vitamins.