Kúrùpù

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Croup
Classification and external resources
Croup steeple sign.jpg
The steeple sign as seen on an AP neck X-ray of a child with croup
ICD-10 J05.0
ICD-9 464.4
DiseasesDB 13233
MedlinePlus 000959
eMedicine ped/510  emerg/370 radio/199
MeSH D003440

Kúrùpù (tabi laringotrakiobronkaitis) jẹ arun nipa mimi ti o lewu gan-an ti o maa nwaye nipa aisan ọ̀nà-atẹgun oke. Arun yii maa nfa wiwu ninu ọ̀nàfun. Wiwu yii maa nfa idiwọ fun mimi deede; awọn aami aisan Kúrùpù ni ikọ́ "gbígbó", idiwọ ọnafun (mimi ti o ngbọn ti ìró rẹ lọ soke), ati ohùn kíkẹ̀. Awọn aami aisan kúrùpù le ma nira, mọ niwọnba, tabi lewu, ti o si le nira ni òru. Fifun ni oògùn sitẹriodu lẹẹkan lati ẹnu le ṣe abojuto arun naa. Nigba miiran epinifini ni a maa nlo fun awọn iṣẹlẹ ti o lewu gan-an. Kii saba nilo ki a da ni duro ni ile-iwosan.

A maa nda kúrùpù mọ nipa iṣẹ iwadi iṣegun oyinbo, ni kete ti a ba ti ya awọn okunfa aami aisan ti o lewu gan-an sọtọ (fun apẹẹrẹ, epiglottitis tabi nkan ti o ṣe ajẹji si oju-ọ̀nà atẹgun). Awọn iwadi siwaju sii—bii awọn ayẹwo ẹjẹ, X-rays, ati mimu kokoro dagba nipa amu nkan dagba ni yara iwadi—ni a ko nilo. Kúrùpù jẹ iṣẹlẹ ti o wọpọ ti a maa nri ninu ida marundinlogun ninu ọgọrun (15%)awọn ọmọde, ti ọjọ ori wọn jẹ oṣu mẹfa (6 months)si ọdun marun si mẹfa (5–6 years). Awọn ogo-wẹrẹ tabi agbalagba kii saba ni kúrùpù.

Awọn aami aisan[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Awọn aami aisan kúrùpù ni ninu ikọ́"gbígbó", idiwọ ọnafun(mimi ti o ngbọn), ohun kíkẹ̀, ati mimi ti o nira eyiti o maa nnira ni òru.[1] Ikọ́ "gbígbó" naa ni a maa nsaba ṣ’apejuwe wipe o jọ ìpè erinmi tabi kiniun okun.[2] Si sọkun le mu ki mimi ti o ngbọn naa ki o buru si; mimi ti o ngbọn le tunmọ si wipe ọ̀nà-atẹgun ti dinku. Bi kúrùpù ba ṣe nburu sii, mimi ti o ngbọn le dinku gan-an.[1]

Awọn aami aisan miiran ni ninu ibà, coryza (awọn aami aisan to wọpọ fun otutu), ati egungun igbaya ti o sa wọle.[1][3] Dida itọ́ lẹnu tabi ìwò alaisan nṣe afihan awọn ipo aisan miiran.[3]

Awọn okunfa[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Fairọsi le fa kúrùpù.[1][4] Awọn eniyan kan lo ọrọ naa lati ni ninularingotrakiaitisiti o lewu, kúrùpù ti o ṣẹlẹ logiji fun igba diẹ, laringeal diphtheria, trakiatisi ti bakiteriali fa, laringotrakiobronkaitisi, ati laringotrakiaobronkoneumonitisi. Ipo meji akọkọ ni ninu fairọsi kan ti o si ni aami aisan ti ko nira; awọn mẹrin ti o kẹyin maa nwaye lati ọwọ bakiteria wọn si maa nlewu gan-an.[2]

Ti o niiṣe pẹlu fairọsi[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Ninu ida marundinlọgọrin (75%) iṣẹlẹ parainfluensa fairọsi, oriṣi 1 ati 2, ni fairọsi ti o nfa kúrùpù/laringotrakiatisi ti o lewu gan-an.[5] Awọn fairọsi miiran ti o le fa kúrùpù ni influenza A ati B, measles, adenofairọsi ati respiratory syncytial virus (RSV).[2] Kúrùpù ti o ṣẹlẹ logiji fun igba diẹ (kúrùpù ti o ni gbígbó) maa nwaye nitori iru ẹgbẹ fairọsi kanna bii ti o lewu gan-an laryngotracheitis, ṣugbọn kii saba ni awọn aami arun ti o wọpọ (bii iba, ọ̀nà-ọfun ti o ndun ni, ati sẹẹli ẹjẹ funfun ti o lọ silẹ) ninu.[2] Abojuto, ati idahun si abojuto naa tun jọra.[5]

Ti o niiṣe pẹlu Bakiteria[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Kúrùpù ti o niiṣe pẹlu bakiteria ṣee pin si laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, ati laringotrakiobronkopneumonitisi.[2] Laringeal diphtheria maa nwaye nitori Corynebacterium diphtheriae nigbati bakiteria trakitisi, laringotrackiobronkaitisi, ati laringotrakobronkopneumonitisi maa nwaye nitori fairọsi, pẹlu bakiteria ti o lọwọ sii. Awọn bakiteria ti o wọpọ julọ niStaphylococcus aureus, Streptococcus pneumoniae, Hemophilus influenzae, ati Moraxella catarrhalis.[2]

Abajade ti o niiṣe pẹlu aisan[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Arun fairọsi maa nwo inu awọn sẹẹli ẹjẹ funfun ti o si ma nfa wiwu larynx, trachea, ati ẹ̀dọ̀-f ọ́ọ́rọ́ nla[4] (ọ̀nà-atẹgun ). Wiwu le jẹ ki mi i ki o nira.[4]

Ṣiṣe ayẹwo[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

The Westley Score: Classification of croup severity[5][6]
Feature Number of points assigned for this feature
0 1 2 3 4 5
Chest wall
retraction
None Mild Moderate Severe
Stridor None With
agitation
At rest
Cyanosis None With
agitation
At rest
Ipele
iwalaaye
Normal Disoriented
Air entry Normal Decreased Markedly decreased

Kúrùpù jẹ eyiti a maa nmọ nipa iṣẹ iwadi iṣegun oyinbo.[4] Igbese akoko ni lati yo kuro awọn iṣẹlẹ idiwo ni ọ̀nà-atẹgun oke, papa julọ epiglottitis, oju-ọ̀nà atẹgun nkan ajẹji, subglottic stenosis, angioedema, retropharyngeal abscess, andbacterial tracheitis.[2][4]

A o kii saba ṣe ayẹwo X-ray ti orun,[4] ṣugbọn bi a ba ṣee, o le ṣe afihan abuda didiku trachea, ti a npe ni aami sonso ori òrùlé, nitori bi nkan naa ti ri dabi sonso ori òrùlé ti sọọsi sonso. Aami sonso ori òrùlé kii farahan ninu ilaji awọn iṣẹlẹ.[3]

Awọn Ayẹwo ẹjẹ ati viral culture (awọn ayẹwo fairọsi) le fa irira ti ko nilo fun oju-ọ̀nà atẹgun.[4] Nigbati awọn viral mimu kokoro dagba nipa amu nkan dagba ni yara iwadi, ti a gba nipase ilepa nasopharyngeal (ọ̀nà kan ti a nlo rọba ti o ni alafo ninu lati fa ikun imu jade ninu imu), ṣee lo lati jẹrisi ni pato ohun ti o ṣe okunfa. A maa ndekun lilo awọn mimu kokoro dagba nipa amu nkan dagba ni yara iwadi yii l’ọpọ igba fun awọn eto iṣẹ iwadi.[1] Bi nkan ko ba gberu pẹlu abojuto ti o kun oju oṣunwọn, a le ṣe awọn ayẹwo siwaju sii lati ṣayẹwo fun bakiteria.[2]

Severity

Idiye Westley ni ọ̀nà eto ti o wọpọ julọ lati sọ bi kúrùpù ṣe lewu si. A maa nlo ayẹwo yii fun awọn ète iwadi dipo iṣẹ iṣegun oyinbo.[2] O jẹ akọjọ iye awọn aami ti a yan fun awọn abuda marun: ipele imolara, ti o ni àwọ̀-bulu, idiwọ ọnafun, bi atẹgun ṣe nwọle, ati si sunki.[2] Iye aami ti a fi fun ọkọọkan awọn abuda ni a ṣe akọjọ ninu tabili ti o wa lọwọ ọtun, ati iye abajade aami wa laarin oodo si ẹẹtadinlogun (0 to 17).[6]

  • A total score of ≤ 2 indicates mild croup. The person can have barking cough and hoarseness, but there is no stridor (wheezing) at rest.[5]
  • A total score of 3–5 is classified as moderate croup — the person has wheezing, with few other signs.[5]
  • A total score of 6–11 is severe croup. It also presents with obvious idiwọ ọnafun, but also features marked chest wall indrawing.[5]
  • A total score of ≥ 12 means respiratory failureis possible. The barking cough and wheezing may no longer be prominent at this stage.[5]

Ida 85% awọn ọmọde ti o nlọ si ẹka pajawiri ni aisan ti ko le, kúrùpù ti o lewu sọwọn (<1%).[5]

Didẹkun[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Abẹrẹ ajẹsara (oogun abẹrẹ ajẹsara) fun influenza ati diphtheria le dẹkun kúrùpù. [2]

Abojuto[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Awọn ọmọde ti o ni kúrùpù ni a gbọdọ jẹ ki ara wọn balẹ bi o ba ṣee ṣe si.[4] A le fun ni awọn sitẹroidi loorekoore, pẹlu ẹfinifirini ni a nlo fun awọn iṣẹlẹ ti o lewu.[4] Awọn ọmọde ti atẹgun ti o to (iye atẹgun ti a nmi sinu ti o wa ninu ẹjẹ) ti ko to 92% gbọdọ gba atẹgun ti a nmi simu,[2] awọn eniyan ti o ni kúrùpù ti o lewu ni a le da duro si ile-iwosan lati bojuto wọn.[3] Bi atẹgun ti a nmi simu ba nilo, a gba ni niyanju lati lo "blow-by" (mimu orisun atẹgun ti a nmi simu kan sunmọ oju ọmọ naa), nitori kii fa rukerudo bi lilo iboju.[2] Pẹlu abojuto, iye eniyan ti o kere si 0.2% ni o nilo endotracheal intubation(rọba kan ti a maa nfi sinu ọ̀nà-atẹgun .[6]

Awọn sitẹrọidi[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Awọn kotikositẹrọidi, bii desamẹtasone ati budesonide, ṣee lo lati ṣe abojuto kúrùpù awọn ọmọde.[7] A maa nri itura to ni apẹẹrẹ ni bii wakati mẹfa lẹyin abojuto.[7] Bi o ti le jẹ wipe awọn ogun yii nṣiṣẹ nigbati a ba fun ni lati ẹnu (nipasẹ ẹnu), parenteral (nipasẹ abẹrẹ), tabi fi fa si imu, ọ̀nà ti a yan laayo ni nipasẹ ẹnu.[4] Fi fun ni lẹẹkan jẹ gbogbo nkan ti a nilo, eyiti ọpọ si fi ara mọ wipe ko lewu.[4] Desamẹtasone ni idiwọn 0.15, 0.3 ati 0.6 mg/kg tun jọ wipe ohun naa muna doko.[8]

Efinifirini[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Kúrùpù ti o mọ niwọnba tabi ti o lewu ṣee ran lọwọ pẹlu nebulized efinifirini(nkan olomi ti a nfa simu lati jẹ ki ọ̀nà-atẹgun le fẹ)[4] Nigbati efinifirine lọpọ igba maa ndin ewu kúrùpù ku laarin iṣẹju mẹwa si ọgbọn (10–30 minutes), awọn anfaani maa npẹ fun bii wakati meji.[1][4] Bi ipo ba tẹsiwaju lati gberu fun wakati 2–4 lẹyin abojuto ti ti nkan ti ko rọgbọ kankan ko si ṣẹlẹ, omo naa le fi ile-iwosan silẹ.[1][4]

Omiiran[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

A ti ṣe iwadi fun awọn abojuto miiran fun kúrùpù, ṣugbọn ko ti si ẹri ti o to lati ṣe atilẹyin fun lilo wọn. Mimi ikuuku gbigbona simu tabi atẹgun jẹ ọ̀nà atọwọdọwọ lati ṣe abojuto ṣe abojuto ara-ẹni, ṣugbọn awọn ẹkọ iwadi iṣegun oyinbo kuna lati fi mumunadoko mulẹ[2][4] ati lọwọlọwọ a kii saba lo o.[9] Lilo awọn oogun ikọ́, eyi ti o maa ni dextromethorphan ninu ati/tabi guiafenesin, ni a ko gba ni niyanju lati lo.[1] Nigbati fifa heliox simu (idapọ helium ati oxygen) lati din iṣẹ mimi ku ni a ti lo ni atẹyin wa, ṣugbọn ẹri ti o kere jọjọ lo wa lati ṣe atilẹyin fun lilo rẹ.[10] Nitori kúrùpù lọpọ igba jẹ arun ti fairọsi nfa,awọn oogun apakokoro ni a kii lo a fi bi a ba fura si bakiteria.[1] Apakokoro vancomycin ati cefotaxime ni a gba ni niyanju fun awọn arun bakiteria.[2] Ni awọn iṣẹlẹ ti o lewu ti o rọ mọ ọfinki A tabi B, agbogun ti fairọsi neuraminidase inhibitors ṣee lo.[2]

Awọn okunfa[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Kúrùpù ti o niiṣẹ pẹlu fairọsi jẹ lọpọ igba self-limited arun (fun saa diẹ); kúrùpù kii saba fa iku lati owo ikuna mimi ati/tabicardiac arrest.[1] Awọn aami aisan maa nsaba ngberu laarin ọjọ  meji, ṣugbọn eyi le wa fun bii ọjọn meji.[5] Awọn ewu miiran ti ko wọpọ ni ninu bacterial tracheitis, pneumonia, ati pulmonary edema.[5]

Ẹkọ nipa ajakalẹ arun[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Bi ida marundinlogun ninu ọgọrun (15%) awọn ọmọde, ti ọjọ ori wọn wa laarin oṣu mẹfa ati ọdun marun si mẹfa (6 months and 5–6 years), yoo ni kúrùpù.[2][4] Kúrùpù lo maa nfa bi ida marun ninu ọgọrun (5)% awọn ti a gba si ile-iwosan fun ẹgbẹ ti ọjọ ori wọn wa ninu eyi.[5] Ni iṣẹlẹ ti o ṣọwọn, awọn ọmọde ti o kere to oṣu mẹta (3 months) ati ti o dagba to ọdun marundinlogun (15 years) ni kúrùpù.[5] Awọn ọkunrin maa nni idojukọ ida aadọta ninu ọgọrun (50%) ju awọn obinrin lọ; kúrùpù wọpọ ni igba autumn (fall).[2]

Itan[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Ọrọ naa kúrùpù wa lati ọrọ-ìṣe croup, Ede Gẹẹsi Igbalode ti ati ibẹrẹ ti o tumọ si "lati sọkun pẹlu ohùn kíkẹ̀"; akọkọ lo orukọ naa fun aisan naa ni orile-ede Sikotilandi ti o si wa gbajumọ ni ẹgbẹrun ọdun kejidinlọgun (18th century).[11] A ti mọ kúrùpù diphtheritic lati igba Homer Giriki Atijọ. Ni ọdun 1826, Bretonneau da mọ yatọ kúrùpù ti fairọsi fa ati kúrùpù ti o waye lati ọwọ diphtheria.[12] Awọn Faranse npe kúrùpù ti fairọsi fa ni "faux-croup," nipa lilo "kúrùpù" fun arun ti bakiteria diphtheria fa.[9] Kúrùpù ti diphtheria fa ni o fẹẹ jẹ wipe a ko mọ nitori imunadoko abẹrẹ ajẹsara.[12]

Awọn itọkasi[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Rajapaksa S, Starr M (May 2010). "Croup – assessment and management". Aust Fam Physician 39 (5): 280–2. PMID 20485713. 
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 Cherry JD (2008). "Clinical practice. Croup". N. Engl. J. Med. 358 (4): 384–91. doi:10.1056/NEJMcp072022. PMID 18216359. http://content.nejm.org/cgi/content/full/358/4/384. 
  3. 3.0 3.1 3.2 3.3 "Diagnosis and Management of Croup" (PDF). BC Children’s Hospital Division of Pediatric Emergency Medicine Clinical Practice Guidelines. http://www.childhealthbc.ca/resources/category/5-croup?download=13%3Acroup-guideline. 
  4. 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 4.15 Everard ML (February 2009). "Ti o lewu gan-an bronchiolitis and croup". Pediatr. Clin. North Am. 56 (1): 119–33, x–xi. doi:10.1016/j.pcl.2008.10.007. PMID 19135584. 
  5. 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 Johnson D (2009). "Croup". Clin Evid (Online) 2009. PMC 2907784. PMID 19445760. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2907784. 
  6. 6.0 6.1 6.2 Klassen TP (December 1999). "Croup. A current perspective". Pediatr. Clin. North Am. 46 (6): 1167–78. doi:10.1016/S0031-3955(05)70180-2. PMID 10629679. 
  7. 7.0 7.1 Russell KF, Liang Y, O'Gorman K, Johnson DW, Klassen TP (2011). Klassen, Terry P. ed. "Glucocorticoids for croup". Cochrane Database Syst Rev 1 (1): CD001955. doi:10.1002/14651858.CD001955.pub3. PMID 21249651. 
  8. Port C (April 2009). "Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4. Dose of dexamethasone in croup". Emerg Med J 26 (4): 291–2. doi:10.1136/emj.2009.072090. PMID 19307398. 
  9. 9.0 9.1 Marchessault V (November 2001). "Historical review of croup". Can J Infect Dis 12 (6): 337–9. PMC 2094841. PMID 18159359. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2094841. 
  10. Vorwerk C, Coats T (2010). Vorwerk, Christiane. ed. "Heliox for croup in children". Cochrane Database Syst Rev 2 (2): CD006822. doi:10.1002/14651858.CD006822.pub2. PMID 20166089. 
  11. Online Etymological Dictiọ̀nàry, croup. Accessed 2010-09-13.
  12. 12.0 12.1 Feigin, Ralph D. (2004). Textbook of pediatric infectious diseases. Philadelphia: Saunders. p. 252. ISBN 0-7216-9329-6.