{"id":13345,"date":"2008-11-12T20:00:00","date_gmt":"2008-11-12T20:00:00","guid":{"rendered":""},"modified":"2016-03-24T20:20:11","modified_gmt":"2016-03-24T20:20:11","slug":"umines-lor-ligos-seimos-gydytojo-praktikoje","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/umines-lor-ligos-seimos-gydytojo-praktikoje\/13345\/","title":{"rendered":"\u016amin\u0117s LOR ligos \u0161eimos gydytojo praktikoje"},"content":{"rendered":"

Kas tre\u010dias pacientas<\/span><\/b><\/span><\/p>\n

\u00a0<\/p>\n

Aus\u0173, nosies ir gerkl\u0117s (vadinamosios LOR organ\u0173) u\u017edegimin\u0117s ligos yra vienos labiausiai paplitusi\u0173 pirmin\u0117je ambulatorin\u0117je praktikoje. Vilniaus \u0160e\u0161kin\u0117s poliklinikos I \u0160eimos medicinos centro gydytoja Nameda Tautavi\u010dien\u0117 (nuotr.) sako, kad \u0161ioms ligoms tenka ne ma\u017eiau kaip tre\u010ddalis vis\u0173 pacient\u0173 kreipim\u0173si \u012f pirmin\u0117s grandies specialistus. <\/span><\/span><\/span><\/p>\n

Sergamumui LOR ligomis b\u016bdingi sezoniniai pakilimai (\u0161altuoju, dr\u0117gnuoju met\u0173 periodu), nors \u017emon\u0117s jomis serga visus metus, da\u017eniau vaikai.<\/span><\/span><\/span><\/p>\n

\u00a0<\/p>\n

LOR patologijai priskiriami:<\/span><\/b><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>rinosinusitas; <\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>vidurinis otitas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>tonzilitas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>laringitas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>faringitas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>tracheitas.<\/span><\/span><\/span><\/p>\n

Klinikin\u0117je praktikoje da\u017enai pasitaiko \u0161i\u0173 lig\u0173 \u201ederini\u0173\u201c, kaip antai nazofaringitas, laringotracheitas, o ypa\u010d rinosinusitas (izoliuot\u0173 rinito arba sinusito prakti\u0161kai neb\u016bna). Tai paai\u0161kinama LOR sistemai priklausan\u010di\u0173 organ\u0173 anatominiu ir funkciniu bendrumu.<\/span><\/span><\/span><\/p>\n

\u00a0<\/p>\n

Prie\u017eastys<\/span><\/b><\/span><\/p>\n

\u00a0<\/p>\n

\u016amines LOR organ\u0173 ligas da\u017eniausiai sukelia virusai (adeno, rinosincitinis, paragripo, gripo ir kt.), re\u010diau bakterijos (streptokokai, chlamidijos<\/a>, stafilokokai ir kt.).U\u017edegim\u0105 da\u017enai predisponuoja, paskatina per\u0161alimas. Svarb\u016bs ir kiti nepalank\u016bs veiksniai: bendrojo ir lokalaus, gleivini\u0173, imuniteto nepakankamumas (IgA deficitas),atsparum\u0105 infekcijoms silpninan\u010dios l\u0117tin\u0117s ligos (pavyzd\u017eiui, diabetas) ir kt. Asmenys, turintys imuniteto defekt\u0173, link\u0119 da\u017eniau sirgti per\u0161alimo ligomis.<\/span><\/span><\/span><\/p>\n

\u00a0<\/p>\n

Klinika<\/span><\/b><\/span><\/p>\n

\u00a0<\/p>\n

\u016amini\u0173 LOR lig\u0173 simptomai priklauso nuo u\u017edegimo lokalizacijos, patogeno virulenti\u0161kumo, ligonio organizmo reaktyvumo, imuniteto. \u0160ioms ligoms b\u016bdingas bendras negalavimas, kar\u0161\u010diavimas (da\u017eniausiai subfebrilus), pa\u017eeisto organo skausmas, funkcijos sutrikimas, gyvenimo kokyb\u0117s pablog\u0117jimas.<\/span><\/span><\/span><\/p>\n

\u00a0<\/p>\n

Tonzilito simptomai:<\/span><\/b><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>stiprus gerkl\u0117s skausmas; <\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>skausmas ryjant; <\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>silpnumas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>apetito pablog\u0117jimas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>pakilusi k\u016bno temperat\u016bra;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>tonzili\u0173 paraudimas, paburkimas (gali b\u016bti p\u016blinuk\u0173);<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>padid\u0117j\u0119 ir skausmingi kaklo ar po\u017eandikauliniai limfmazgiai.<\/span><\/span><\/span><\/p>\n

\u016aminiu tonzilitu sergantys ma\u017ei vaikai atsisako valgyti, kartais vemia.<\/span><\/span><\/span><\/p>\n

Bakteriniam tonzilitui b\u016bdinga ry\u0161kesn\u0117 intoksikacija, auk\u0161tesn\u0117 k\u016bno temperat\u016bra.<\/span><\/span><\/span><\/p>\n

\u00a0<\/p>\n

\u016aminio sinusito (rinosinusito) simptomai:<\/span><\/b><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>kosulys;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>\u010diaudulys;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>i\u0161skyros i\u0161 nosies; nosies u\u017egulimas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>silpnumas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>galvos skausmas (ypa\u010d rytais), jis gali b\u016bti labai stiprus, jei sutrinka u\u017edegiminio sekreto nutek\u0117jimas i\u0161 sinus\u0173;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>intoksikacija;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>kar\u0161\u010diavimas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>gali skaud\u0117ti gerkl\u0119, rykl\u0119;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>miego sutrikimai<\/a>.<\/span><\/span><\/span><\/p>\n

Simptomai priklauso ir nuo pa\u017eeisto sinuso (maksiliarinis, frontalinis, etmoidalinis ar sfenoi-dalinis).<\/span><\/span><\/span><\/p>\n

Faringito simptomai:<\/span><\/b><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>paraudusi, skaudanti rykl\u0117;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>skausmas ryjant; <\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>kar\u0161\u010diavimas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>galvos skausmas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>padid\u0117j\u0119 regioniniai limfmazgiai.<\/span><\/span><\/span><\/p>\n

Vidurin\u0117s ausies u\u017edegimu <\/span><\/b><\/span>da\u017eniau serga k\u016bdikiai ir ma\u017ei vaikai. Viduriniu otitu gali komplikuotis sloga<\/a>, gripas<\/a>, nazofaringitas ar tonzilitas, plau\u010di\u0173 ar adenoid\u0173 infekcija, \u0161ienlig\u0117, tymai<\/a>, sinusitas<\/a>.<\/span><\/span><\/span><\/p>\n

Simptomai:<\/span><\/b><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>aus\u0173 skausmas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>kar\u0161\u010diavimas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>klausos susilpn\u0117jimas;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>kartais \u2013 pusiausvyros sutrikimai; <\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>\u016b\u017eimas ausyje.<\/span><\/span><\/span><\/p>\n

Gydymo principai<\/span><\/b><\/span><\/p>\n

Gyd. Nameda Tautavi\u010dien\u0117 sako, kad \u016bmin\u0117s u\u017edegimin\u0117s LOR ligos tur\u0117t\u0173 b\u016bti gydomos labai aktyviai ir atsakingai, nes jos:<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>sukelia pacientui varginan\u010di\u0173 simptom\u0173;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>ma\u017eina darbingum\u0105, blogina gyvenimo kokyb\u0119;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>gali komplikuotis (ypa\u010d bakterinis vidinis otitas, rinosinusitas, streptokokinis tonzilitas).<\/span><\/span><\/span><\/p>\n

Net jei n\u0117ra auk\u0161tos temperat\u016bros ir ry\u0161kios intoksikacijos, pacientui patariama bent kelet\u0105 dien\u0173 pagul\u0117ti (neiti \u012f mokykl\u0105, darb\u0105).<\/span><\/span><\/span><\/p>\n

Virusin\u0117s etiologijos u\u017edegimas trunka apie 5\u20136 dienas. Bakterin\u0119 superinfekcij\u0105 reik\u0117t\u0173 \u012ftarti, jei:<\/b><\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>u\u017edegimas nepraeina per savait\u0119 ir netgi sunk\u0117ja;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>kyla temperat\u016bra, ry\u0161k\u0117ja intoksikacija, kiti simptomai;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>tipi\u0161kai pakinta kraujo rodikliai (i\u0161ry\u0161k\u0117ja neutrofilin\u0117leukocitoz\u0117,padid\u0117jaeritrocit\u0173nus\u0117dimo greitis, CRB ir kt.). Prasid\u0117jus bakteriniam rinosinusitui, pakinta nosies i\u0161skyr\u0173 pob\u016bdis: i\u0161 skaidri\u0173 ar balzgan\u0173 (vandening\u0173) jos tampa tir\u0161tos, gelsvos ar gelsvai \u017ealsvos.<\/span><\/span><\/span><\/p>\n

Pasak gyd. N. Tautavi\u010dien\u0117s, \u016bmini\u0173 LOR lig\u0173 gydymas pirmin\u0117je ambulatorin\u0117je grandyje paremtas bendrais principais.<\/span><\/span><\/span><\/p>\n

Virusinis u\u017edegimas neturi etiotropinio gydymo (i\u0161skyrus gripo ar Herpes). Esant bakterinei infekcijai, skiriama veikli\u0173 antibiotik\u0173. Ligoniui duodama gerti pakankamai skys\u010di\u0173 (jei n\u0117ra kontraindikacij\u0173).<\/span><\/span><\/span><\/p>\n

\u00a0<\/p>\n

Sergant \u016bmine LOR infekcija beveik visada tenka skirti u\u017edegim\u0105 ir k\u016bno temperat\u016br\u0105 ma\u017einam\u0173j\u0173 vaist\u0173<\/span><\/b><\/span>. Jie slopina ir skausm\u0105 \u2013 da\u017en\u0105 ir varginant\u012f \u0161i\u0173 lig\u0173 simptom\u0105, pagerina paciento gyvenimo kokyb\u0119.<\/span><\/span><\/span><\/p>\n

Gyd. N. Tautavi\u010dien\u0117s teigimu, aspirino sergant \u016bmine kv\u0117pavimo tak\u0173 ar LOR infekcija beveik nebeskiriama. Esant virusinei infekcijai aspirinas (ypa\u010d vaikams ir paaugliams) netgi kontraindikuotinas (d\u0117l galvos smegen\u0173 pa\u017eeidimo pavojaus), be to, neretai sukelia gastrointestini\u0173 simptom\u0173. Geriau toleruojamas paracetamolis (acetamofenas), ta\u010diau jo prie\u0161u\u017edegiminis poveikis silpnas.<\/span><\/span><\/span><\/p>\n

Esant ry\u0161kesni\u0173 simptom\u0173, indikuotini nesteroidiniai vaistai nuo u\u017edegimo. Anot gyd. N.Tautavi\u010dien\u0117s, pasirinktini preparatai, kurie:<\/b><\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>veiksmingai ma\u017eina skausm\u0105, u\u017edegim\u0105 ir pakilusi\u0105 k\u016bno temperat\u016br\u0105;<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>gerai toleruojami (nedirgina vir\u0161kinimo trakto);<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>patog\u016bs vartoti (geriami 1\u20132 kartus per par\u0105);<\/span><\/span><\/span><\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>\u00a0<\/span>malonaus skonio.<\/span><\/span><\/span><\/p>\n

Tokio vaisto kriterijus atitinka nimesulidas (\u201eNimesil<\/a>\u201c<\/b>). Tai vienas moderniausi\u0173 nesteroidini\u0173 vaist\u0173 nuo u\u017edegimo klas\u0117s atstov\u0173, selektyvus u\u017edegimo izofermento ciklooksigenaz\u0117s-2 inhibitorius. D\u0117l selektyvaus poveikio COX-2 fermentinei sistemai nimesulidas (Nimesil<\/a><\/b>) prakti\u0161kai nesukelia gastrointestini\u0173 simptom\u0173, nedaro neigiamo poveikio inkstams, ligoni\u0173 gerai toleruojamas. D\u0117l farmakokinetikos ypatum\u0173 nimesulidas, vartojamas du kartus per par\u0105, u\u017etikrina stipr\u0173 prie\u0161u\u017edegimin\u012f ir analgezin\u012f efekt\u0105.<\/span><\/span><\/span><\/p>\n

\u201eNimesil<\/a>\u201c <\/span><\/b><\/span>i\u0161leid\u017eiamas malonaus citrin\u0173 skonio milteli\u0173 pavidalo. Milteliai i\u0161tirpinami stiklin\u0117je vandens ir i\u0161geriami, tod\u0117l \u0161\u012f vaist\u0105 pacientai noriai vartoja. Nimesulidas Lietuvoje ir kai kuriose kitose \u0161alyse pagal pardavimus jau kelet\u0105 met\u0173 yra nesteroidini\u0173 vaist\u0173 nuo u\u017edegimo rinkos lyderis. Nimesulido neskiriama jaunesniems kaip 12 met\u0173 asmenims.<\/span><\/span><\/span><\/p>\n

\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"

\u016amin\u0117s LOR ligos <\/span><\/span><\/span><\/strong>\u0161eimos gydytojo praktikoje<\/span><\/span><\/span><\/strong><\/p>\n

Vilniaus \u0160e\u0161kin\u0117s poliklinikos I \u0160eimos medicinos centro gydytoja Nameda Tautavi\u010dien\u0117 <\/span><\/span><\/span><\/p>\n

\u00a0<\/p>\n

Kas tre\u010dias pacientas<\/span><\/b><\/span><\/p>\n

Aus\u0173, nosies ir gerkl\u0117s (vadinamosios LOR organ\u0173) u\u017edegimin\u0117s ligos yra vienos labiausiai paplitusi\u0173 pirmin\u0117je ambulatorin\u0117je praktikoje. Vilniaus \u0160e\u0161kin\u0117s poliklinikos I \u0160eimos medicinos centro gydytoja Nameda Tautavi\u010dien\u0117 (nuotr.) sako, kad \u0161ioms ligoms tenka ne ma\u017eiau kaip tre\u010ddalis vis\u0173 pacient\u0173 kreipim\u0173si \u012f pirmin\u0117s grandies specialistus. <\/span><\/span><\/span><\/p>\n

Sergamumui LOR ligomis b\u016bdingi sezoniniai pakilimai (\u0161altuoju, dr\u0117gnuoju met\u0173 periodu), nors \u017emon\u0117s jomis serga visus metus, da\u017eniau vaikai.<\/span><\/span><\/span><\/p>\n

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