Restoration of the drainage function of the bronchi. Normalization of the tone of the bronchial muscles

Improving the drainage function of the bronchi is one of the most important conditions for the affective treatment of patients with pneumonia. Violation of bronchial patency in atom disease is due to several mechanisms:

A significant volume of viscous purulent exudate coming from the alma to the bronchi;

Inflammatory edema of the bronchial mucosa, draining the focus of inflammation of the lung tissue;

Damage to the ciliated epithelium of the bronchial mucosa and disruption of the mechanism of mucociliary transport;

An increase in the production of bronchial secretions due to the involvement of the bronchial mucosa in the inflammatory process (gnpercrinia);

A significant increase in the viscosity of sputum (discria); ... an increase in the tone of the smooth muscles of the small bronchi and a tendency to brop-

hospasm, which makes it even more difficult to separate sputum.

Thus, violations of bronchial patency in large pneumonia are associated only with the natural drainage of the inflammation focus and the entry of viscous alveolar exudate into the bronchi, along and with the frequent involvement of the bronchi themselves in the inflammatory process. This mechanism is of particular importance in patients with bronchopneumonia of various origins,as well as in patients with concomitant chronic bronchial diseases (chronic obstructive bronchitis, brochiectomy, cystic fibrosis, etc.).

The deterioration of bronchial patency, observed in at least some patients with pneumonia, contributes to an even greater disruption of local processes, including immunological, protection, re-seeding of the airways refl and prevents the healing of the inflammatory focus in lung tissue and restoration of pulmonary ventilation. A decrease in bronchial patency contributes to the aggravation of the formation of ventilation-perfusion relationships in the lungs and progressive failure. therefore complex treatment patients with pneumonia includes the mandatory appointment of drugs with expectorant, mucolytic and broicholytic action.

It is known that the sputum present in the lumen of the bronchi in patients with pneumonia consists of two layers: the upper, more viscous and dense (gel),lying) ration with cilia, and the lower liquid layer (sol),in which, as it were, the cilia float and contract. The gel consists of macromolecules of glycoproteins linked by disulfide and hydrogen bonds, which gives it viscous and elastic properties. With a decrease in the water content in the gel, the viscosity of the sputum increases and the movement of bronchial secretions slows down or even stops in the direction *, and towards the oropharynx. The speed of such movement becomes even less if you thin! a layer of a liquid layer (sol), which to a certain extent prevents sputum from adhering to the walls of the bronchi. As a result, mucous and mucous-mucus plugs are formed in the lumen of the small bronchi, which are removed with great difficulty only by a strong expiratory air flow during attacks of a painful hacking cough.

Thus, the ability to easily remove phlegm from respiratory tract, first of all, is determined by its rheological properties, water content in both phases of bronchial secretions (gel and sol), as well as the intensity and coordination of the activity of cilia of the ciliated epithelium. The use of mucolytic and mucoregulatory agents is precisely aimed at restoring the ratio of sol and gel, liquefying sputum, rehydrating it, and also stimulating the activity of cilia of the ciliated epithelium.

TACTICS OF RESTORING PROTECTIVE AND CLEANING FUNCTIONS OF THE RESPIRATORY SYSTEM

At the very beginning of this part, we identified four main strategic tasks that need to be solved in the process of cleansing the lungs in order to return them to their Lost physiological purity and health. Now it’s time to decide how and by what means the assigned tasks will be solved.

So let's start in order.

1. Restoration of protective barriers of the upper respiratory tract

To restore the protective mechanisms of the upper respiratory tract, it is advisable to use water extracts from medicinal plant raw materials (herbal raw materials) that enhance the formation and secretion of protective secretions, containing essential oils and phytoncides: infusion of birch buds, poplar, wild rosemary herb, heather, oregano, mint, lemon balm, thyme, eucalyptus leaves, sage, etc.; decoctions of calamus rhizomes, rhizomes with elecampane roots, coriander fruits, thyme, fennel, onion juices, garlic, honey and propolis can also be used.

To enhance the secretion of the resulting secretion, juices of Kalanchoe, aloe and beet can be used. They are diluted in boiled water 10-20 times and instilled in one drop in each nostril. They are mildly irritating and intensify sneezing by promoting secretion.

2. Restoration of the drainage function of the bronchi

The bronchial drainage function is restored:
a) expectorant plants that provide sputum discharge - calamus, marshmallow, anise, veronica, elecampane, oregano, mullein, coltsfoot, lungwort, primrose, cyanosis, licorice, thermopsis, thyme, violet, etc.;
b) mucolytics, i.e. those with the ability to dissolve mucus - marshmallow, wild rosemary, valerian, veronica, sweet clover, hyssop, istod, flax, Icelandic moss, pine buds, etc.

3. Fighting infection

The success of antimicrobial therapy is determined the right choice means to which the pathogen is sensitive infectious disease... Wherein:
a) it is necessary to combine, i.e. joint, use of medicinal plants with antimicrobial and antiviral properties;
b) combining plants with various active substances, which not only allows achieving a bactericidal effect, but also prevents the emergence of strains resistant (immune) to herbal medicine;
c) for oral administration, it is advisable to use collections and rinses, a constant alternation of various groups of antimicrobial active substances that have been identified in calamus, geraniums, oregano, erect cinquefoil, onions, raspberries (leaves), lemon balm, sage, garlic, eucalyptus.

4. Correction of anti-infectious immunity

This direction is preferable to implement using the following groups of medicinal plants:
a) interferon stimulants: mother-and-stepmother, plantain, Icelandic tsetraria;
b) activators of phagocytic activity of the alveolar: mountain arnica, astragalus, borage, buckwheat, stinging nettle;
c) stimulants of local immunity: anise, arnica, watch, highlander bird, birch, sage, etc.

It should be noted that all the way to restore the normal functioning of the respiratory system, it is necessary to constantly and purposefully use anti-inflammatory and antihypoxic drugs of plant origin: linden leaves, calendula and chamomile flowers, string herb, horsetail, sage, etc.

From the first day of cleansing, it is also necessary to use highly effective vitamin complexes, since they contain enzymes and trace elements that significantly increase the bioavailability of vitamins. In this case, medicinal plants rich in vitamins, which include lingonberry, cranberry, strawberry, blackberry, red mountain ash, sea buckthorn, dandelion leaves, nettle, primrose, should be added to the main collection or taken additionally in the form of tea.
Considering that effective cleansing is impossible without increased water load, it is necessary to increase the volume of drinking to 2.5-3 liters per day, unless, of course, there are contraindications from the cardiovascular and urinary systems.

And in conclusion of this chapter, I want to remind once again that many diseases are much easier to prevent than to cure, therefore it is advisable to gradually increase the resistance of the respiratory system to colds and infections by general hardening of the body and, if there is enough willpower and sanity, to refuse or at least stop abuse alcohol and tobacco. Both habits are closely related to breathing. Indeed, in addition to the general harmful effect on the body, causing deep disturbances in the functions of the nervous system and many other organs, alcohol has a detrimental effect directly on the lung tissue and mucous membranes of the respiratory tract, because through them it and its oxidation products, aldehydes and ketones, are excreted from the body. This, among other things, explains the characteristic disgusting breath after drinking alcoholic beverages.

As for smoking, its harmful effect on the respiratory organs is perhaps even worse than alcohol, since, among other things, tobacco smoke inhibits surfactant production and thereby increases the surface tension of the alveoli. Because of this, the smoker, in comparison with non-smokers, has to make more effort to inhale.

But we have already talked about the dangers of smoking. Now it's the turn to talk about the main thing.

a). filtration of air in the nasal cavity;

b) mucociliary transport of tracheo-bronchial secretions (escalator mechanism)

c). cough and sneezing reflexes;

d). active and passive peristalsis of the bronchi;

e). kinetic energy of air movement;

g). the surfactant system of the lungs

3. Neuroreflex and humoral mechanisms that maintain the tone of the bronchial muscles in an adequate state.

4. Endocytosis of bronchial contents by epithelial cells of the respiratory tract;

5. Action of local nonspecific factors of lung protection;

a). the system of alveolar macrophages, which carry out phagocytosis and transport foreign particles that have entered the lung during respiration;

b) .antiviral and antibacterial action non-specific factors humoral link of local lung protection (lysozyme, lactoferin, fibronectin, interferon, proteolytic and antiproteolytic factors, etc.).

6. Mucosal the immune systemwhich works independently of general (systemic immunity).

7. Factors of local immunity (T - lymphocytes, secretory Ig).

Considering that the main pathogenetic mechanism of diseases of the bronchopulmonary system is a violation of the drainage function of the bronchi, we decided to briefly dwell on the physiological mechanisms of mucociliary clearance of bronchopulmonary secretions (escalator mechanism), which together with immunological mechanisms plays one of the leading roles in the pathogenesis of bronchopulmonary diseases.

Mucociliary transport (clearance) of tracheo-bronchial secretion

(escalator mechanism)

Among the factors of local protection of the lungs that carry out tracheobronchial clearance, the ciliary apparatus is of great importance.

The entire surface of the mucous membrane of the bronchi, up to the bronchioles, is a continuous layer of ciliated epithelium. The trachea and large bronchi are lined with stratified ciliated epithelium, medium and small - with two-layer epithelium. In the terminal bronchioles, some of the cells lose cilia. Islets of cells of the alveolar epithelium appear in this area. In the epithelium of respiratory bronchioles of 1-3 orders of magnitude, the cells of the ciliated epithelium are almost absent.

The ciliated epithelium consists of 4 types of cells with different functions:

a) cells with mobile cilia, which assist in the release of foreign particles from the respiratory tract (ciliated cells),

b) goblet (mucoid) cells that produce mucus,

c) intermediate and basal.

Each ciliated cell of the ciliated epithelium has about 200 cilia on its surface, which carry out up to 250 vibrations per minute (4 - vibration in 1 sec. ). The movement of the cilia resembles the wave of a swimmer's hand. From a horizontal position, it quickly turns into a vertical one (strike phase), then slowly returns to its original position (reverse movement phase). Oscillation of cilia in the entire epithelial layer occurs in the appropriate sequence. The movement begins in the distal parts of the bronchi, then it is transmitted in a wave-like manner to the proximal parts.

Goblet cells are located between the ciliated cells (on average, 1 goblet to 5 ciliate cells).

In the mucous membrane of the trachea and bronchi there are tubular - acinous bronchial glands. Their greatest number is located in the membrane part of the trachea, above its bifurcation and in the division of the main bronchi into lobar.

Goblet cells and bronchial glands secrete mucus, which covers the bronchial mucosa (cilia) in a thin layer. The study of the structure of this secret showed that it has 2 layers, which differ in composition and viscosity.

Gel The bottom layer, 2 µm thick, is a rare low viscosity substrate. This layer is formed mainly by a secret that is secreted by goblet cells. It is immobile and its main function is to facilitate the vibration of the cilia, and to protect the ciliated epithelium from drying out and damage.

Sol -the top layer is mobile, it has a high degree of viscosity and pronounced adhesive properties. This upper (movable) layer, like a blanket (blanket), lies on the lower one. During the impact phase, the cilia from below push the upper layer of mucus, which completely covers the entire ciliated epithelium. Various finely dispersed foreign particles and microorganisms easily adhere to the upper layer, which, like on an escalator, move from the bottom up and are removed from the body. This layer can hold on its surface and transport particles weighing up to 12 μg. The speed of movement of mucus in the trachea and large bronchi is 10-15 mm / min, and in the partial bronchi - 1 mm / min. Normally, this flow is continuous. Throughout the day, imperceptibly, without the participation of the cough reflex, about 50-100 ml is released (depending on the child's age). sputum. In this case, microbial particles can pass in 1 s. a path that is equal to the length of 10 mucosal epithelial cells. Those. the time of possible contact of the microorganism with each epithelial cell does not exceed 0.1 sec. In such a short period of time (during which the contact of the microorganism with the cells of the mucous membrane occurs), the microorganism does not have time to attach to the cell and cause inflammation. Per day through the lungsventilated about 10,000 liters of air.

Thus, the normal function of the ciliated apparatus and the secretion of mucous secretions of a certain viscosity and in a certain amount provide sufficient mucositic clearance, which does not allow the pathogen to penetrate into the respiratory bronchioles and alveoli, thereby protecting the broncho-pulmonary system from inflammation. The mechanism of mucociliary clearance in pathology will be analyzed below.

Among the mechanisms of development of COPD are bronchitogenic, pneumoniogenic and pneumonitogenic.

The bronchitogenic mechanism of CNPD is based on a violation of the drainage function of the bronchi and bronchial patency. Diseases combined by this mechanism are represented by chronic bronchitis, bronchiectasis (bronchiectasis), bronchial asthma and pulmonary emphysema (especially chronic diffuse obstructive).

The pneumoniogenic mechanism of COPD is associated with acute pneumonia and its complications. It leads to the development of a group of chronic non-obstructive lung diseases, for example, chronic lung abscess, chronic pneumonia.

The pneumonitogenic mechanism of COPD determines the development of chronic interstitial lung diseases, represented by various forms of fibrous (fibrosing) alveolitis, or pneumonitis. In the end, all three mechanisms of CNPD lead to the development of pneumosclerosis (pneumocirrhosis), buronchiectasis, secondary pulmonary hypertension, right ventricular hypertrophy and cardiopulmonary insufficiency.

BRONCHITIS CHRONIC - diffuse progressive inflammation of the bronchi, not associated with local or generalized lung damage and manifested by cough. It is customary to talk about the chronic nature of the process if the cough continues for at least 3 months in 1 year for 2 years in a row. Chronic bronchitis is the most common form of chronic nonspecific lung disease (COPD), with a tendency to increase.
Etiology, pathogenesis. The disease is associated with prolonged irritation of the bronchi with various harmful factors (smoking, inhalation of air contaminated with dust, smoke, carbon monoxide, sulfur dioxide, nitrogen oxides and other chemical compounds) and recurrent respiratory infection (the main role belongs to respiratory viruses, Pfeiffer's bacillus, pneumococci), less often occurs in cystic fibrosis, alpha (one) -antitrypsin deficiency. Predisposing factors are chronic inflammatory and suppurative processes in the lungs, chronic foci of infection in the upper respiratory tract, decreased reactivity of the body, hereditary factors. The main pathogenetic mechanisms include hypertrophy and hyperfunction of the bronchial glands with an increase in mucus secretion, a relative decrease in serous secretion, a change in the composition of secretion - a significant increase in acidic mucopolysaccharides in it, which increases the viscosity of sputum. Under these conditions, the ciliated epithelium does not provide the emptying of the bronchial tree and the normal renewal of the entire layer of secretion (emptying of the bronchi occurs only when coughing). Long-term hyperfunction leads to depletion of the mucociliary apparatus of the bronchi, dystrophy and atrophy of the epithelium. Violation of the drainage function of the bronchi contributes to the emergence of a bronchogenic infection, the activity and relapses of which largely depend on the local immunity of the bronchi and the development of secondary immunological insufficiency.
Severe manifestation of the disease - the development of bronchial obstruction due to hyperplasia of the epithelium of the mucous glands, edema and inflammatory infiltration of the bronchial wall, fibrotic wall changes with stenosis or obliteration of the bronchi, obstruction of the bronchi with excess viscous bronchial secretions, bronchospasm and expiratory collapse of the bronchial walls of the trachea and tracheal walls. Obstruction of small bronchi leads to overstretching of the alveoli on exhalation and disruption of the elastic structures of the alveolar walls, as well as the appearance of hypoventilated and completely unventilated zones that function as an arteriovenous shunt; due to the fact that the blood passing through them is not oxygenated, arterial hypoxemia develops. In response to alveolar hypoxia, pulmonary arterioles spasm occurs with an increase in total pulmonary and pulmonary arteriolar resistance; there is precapillary pulmonary hypertension. Chronic hypoxemia leads to polycythemia and an increase in blood viscosity, accompanied by metabolic acidosis, which further intensifies vasoconstriction in the pulmonary circulation.
Inflammatory infiltration, superficial in large bronchi, in medium and small bronchi, as well as bronchioles, can be deep with the development of erosions, ulcerations and the formation of meso- and panbronchitis. The remission phase is characterized by a decrease in inflammation in general, a significant decrease in exudation, proliferation of connective tissue and epithelium, especially with ulceration of the mucous membrane. The outcome of the chronic inflammatory process of the bronchi is sclerosis of the bronchial wall, peribronchial sclerosis, atrophy of glands, muscles, elastic fibers, cartilage. Perhaps stenosis of the lumen of the bronchus or its expansion with the formation of bronchiectasis.
Symptoms, course. The beginning is gradual. The first symptom is cough in the morning with mucous expectoration. Gradually, the cough begins to occur both at night and during the day, getting worse in cold weather, over the years it becomes constant. The amount of sputum increases, it becomes mucopurulent or purulent. Shortness of breath appears and progresses. There are 4 forms of chronic bronchitis. In a simple, uncomplicated form, bronchitis proceeds with the release of mucous sputum without bronchial obstruction. With purulent bronchitis, purulent sputum is constantly or periodically secreted, but bronchial obstruction is not pronounced. Obstructive chronic bronchitis is characterized by persistent obstructive disorders. Purulent obstructive bronchitis proceeds with the release of purulent sputum and obstructive ventilation disorders. During an exacerbation, with any form of chronic bronchitis, bronchospastic syndrome can develop.
Frequent exacerbations are typical, especially during periods of cold damp weather: coughing and shortness of breath increase, the amount of sputum increases, malaise, sweat at night, and fatigue appear. Body temperature is normal or subfebrile, hard breathing and dry wheezing over the entire surface of the lungs can be determined. Leukocyte count and ESR often remain normal;
a slight leukocytosis with a stab shift in the leukocyte formula is possible. Only with exacerbation of purulent bronchitis do they slightly change biochemical parameters inflammation (C-reactive protein, sialic acids, seromucoid, fibrinogen, etc.). In the diagnosis of the activity of chronic bronchitis, the study of sputum is of comparatively great importance: macroscopic, cytological, biochemical. So, with a pronounced exacerbation, a purulent character of sputum is found, mainly neutrophilic leukocytes, an increase in the content of acidic mucopolysaccharides and DNA fibers that increase the viscosity of the sputum, a decrease in the content of lysozyme, etc. blood circulation.
Significant assistance in the recognition of chronic bronchitis is provided by bronchoscopy, in which the endobronchial manifestations of the inflammatory process (catarrhal, purulent, atrophic, hypertrophic, hemorrhagic, fibrinous-ulcerative endobronchitis) and its severity (but only to the level of subsegmental bronchi) are visually assessed. Bronchoscopy makes it possible to biopsy the mucous membrane and histologically clarify the nature of the lesion, as well as to reveal tracheobronchial hypotonic dyskinesia (an increase in the mobility of the trachea and bronchial walls during breathing up to expiratory collapse of the trachea and main bronchi walls) and static retraction (change in the configuration and decrease in the lumen of the trachea and bronchi ), which can complicate chronic bronchitis and be one of the causes of bronchial obstruction.
However, in chronic bronchitis, the main lesion is localized most often in the smaller branches of the bronchial tree; therefore, in the diagnosis of chronic bronchitis, broncho- and radiography is used. In the early stages of chronic bronchitis, changes on the bronchograms are absent in most patients. With long-term chronic bronchitis, bronchograms can reveal breaks in the bronchi of medium caliber and the absence of filling of small branches (due to obstruction), which creates a picture of a "dead tree". In the peripheral parts, bronchiectasis can be found in the form of small cavity formations filled with contrast, up to 5 mm in diameter, connected to small bronchial branches. On roentgenograms, deformation and strengthening of the pulmonary pattern of the type of diffuse reticular pneumosclerosis, often with concomitant emphysema, can be detected.
Symptoms of impaired bronchial patency (bronchial obstruction) are important criteria for the diagnosis, selection of adequate therapy, determining its effectiveness and prognosis in chronic bronchitis: 1) the appearance of shortness of breath in physical activity and leaving a warm room to the cold; 2) sputum production after a long, exhausting cough; 3) the presence of wheezing dry rales on forced expiration; 4) lengthening the expiratory phase;
5) data of methods of functional diagnostics. Improvement in ventilation and respiratory mechanics when using bronchodilators indicates the presence of bronchospasm and reversibility of bronchial obstruction. In the late period of the disease, violations of ventilation-perfusion ratios, diffusion capacity of the lungs, and blood gas composition join.
Often it becomes necessary to differentiate chronic bronchitis from chronic pneumonia, bronchial asthma, tuberculosis and lung cancer. In contrast to chronic pneumonia, chronic bronchitis is always a diffuse disease with the gradual development of widespread bronchial obstruction and often emphysema, respiratory failure and pulmonary hypertension (chronic pulmonary heart disease); X-ray changes are also diffuse in nature: peribronchial sclerosis, increased transparency of the pulmonary fields in connection with emphysema, expansion of the branches of the pulmonary artery. Chronic bronchitis is distinguished from bronchial asthma by the absence of asthma attacks. The differential diagnosis of chronic bronchitis and pulmonary tuberculosis is based on the presence or absence of signs of tuberculosis intoxication, mycobacteria and uberculosis in sputum, data from X-ray and bronchoscopic examination, tuberculin tests. Early recognition of lung cancer on the background of chronic bronchitis is very important. Harsh cough, hemoptysis, chest pain are signs that are suspicious and in relation to the tumor, and require urgent X-ray and bronchological examination of the patient; the most informative are tomography and bronchography. A cytological examination of sputum and bronchial contents for antipyretic cells is necessary.
Treatment, prevention. In the phase of exacerbation of chronic bronchitis, therapy should be aimed at eliminating the inflammatory process in the bronchi, improving bronchial patency, restoring impaired general and local immunological reactivity. Antibiotics and sulfonamides are prescribed in courses sufficient to suppress the activity of the infection. The duration of antibiotic therapy is individual. The antibiotic is selected taking into account the sensitivity of the sputum microflora (bronchial secretions), administered orally or parenterally, sometimes combined with intratracheal administration. Shown inhalation of phytoncides of garlic or onions (juice of garlic and onion is prepared before inhalation, mixed with 0.25% novocaine solution or isotonic sodium chloride solution in the proportion
1 part juice to 3 parts solvent). Inhalation is carried out
2 times a day; for a course of 20 inhalations. Simultaneously with the therapy of active infection of the bronchi, conservative sanitation of foci of nasopharyngeal infection is performed.
Restoration or improvement of bronchial patency is an important link in the complex therapy of chronic bronchitis, both in exacerbation and in remission; use expectorant, mucolytic and bronchospasmolytic drugs, drinking plenty of fluids. Expectorant effect is possessed by potassium iodide, infusion of thermopsis, marshmallow root, leaves of coltsfoot, plantain, as well as mucolytics and cysteine \u200b\u200bderivatives. Proteolytic enzymes (trypsin, chymotrypsin, chymopsin) reduce the viscosity of sputum, but are now being used less and less due to the threat of hemoptysis and development allergic reactions... Acetylcysteine \u200b\u200b(mucomist, mucosolvin, fluimucil, mistabren) has the ability to break disulfide bonds of mucus proteins and causes a strong and rapid dilution of sputum. Apply in the form of an aerosol of a 20% solution of 3-5 ml 2-3 times a day. Bronchial drainage is improved with the use of mucoregulators, which affect both the secretion and the synthesis of glycoproteins in the bronchial epithelium (bromhexine, or bisolvone). Bromhexine (bisolvon) is prescribed 8 mg (2 tablets) 3-4 times a day for 7 days by mouth, 4 mg (2 ml) 2-3 times a day subcutaneously or by inhalation (2 ml of bromhexine solution is diluted with 2 ml distilled water) 2-3 times a day. Before inhalation of expectorants in aerosols, bronchodilators are used to prevent bronchospasm and enhance the effect of the drugs used. After inhalation, positional drainage is performed, which is mandatory for viscous sputum and incompetent coughing (2 times a day with a preliminary intake of expectorants and 400-600 ml of warm tea).
In case of insufficiency of bronchial drainage and the presence of symptoms of bronchial obstruction, bronchospasmolytic agents are added to therapy: aminophylline rectally (or intravenously) 2-3 times a day, anticholinergics (atropine, latifilline orally, n / a; atrovent in aerosols), adrenostimulants ( ephedrine, izadrin, novodrin, euspiran, alupent, perbutaline, albutamol, berotec). In a hospital setting, intratracheal lavage for purulent bronchitis is combined with sanitation bronchoscopy (3-4 sanitation bronchoscopy with an interval of 3-7 days). The restoration of the drainage function of the bronchi is also facilitated by physiotherapy exercises, massage chest, physiotherapy. When allergic syndromes occur, calcium chloride is prescribed by mouth and intravenous antihistamines; in the absence of effect, it is possible to carry out a short (until the removal of the allergic syndrome) course of glucocorticoids (the daily dose should not exceed 30 mg). The danger of activation of the infection does not allow recommending long-term administration of glucocorticoids.
With the development of a syndrome of bronchial obstruction in a patient with chronic bronchitis, etymizole (0.05-0.1 g 2 times a day orally for 1 month) and heparin (5000 IU 4 times a day s / c for 3-4 weeks) with the gradual withdrawal of the drug. In addition to antiallergic effect, heparin at a dose of 40,000 U / day has a mucolytic effect. In patients with chronic bronchitis complicated by respiratory failure and chronic cor pulmonale, the use of veroshpiron (up to 150-200 mg / day) is indicated.
The diet of patients should be high in calories, fortified. Prescribe ascorbic acid in a daily dose of 1 g, B vitamins, nicotinic acid; if necessary, levamisole, aloe, methyluracil. Due to the known role in the pathogenesis of chronic bronchitis, a number of biologically active substances (histamine, acetylcholine, kinins, serotonin, prostaglandins) indications are being developed for the inclusion of inhibitors of these systems in complex therapy. In case of complications of the disease of pulmonary and pulmonary heart failure, oxygen therapy, auxiliary artificial ventilation of the lungs are used. Oxygen therapy includes inhalation of 30-40% oxygen mixed with air, it should be intermittent. This position is based on the fact that with a pronounced increase in the concentration of carbon dioxide, the respiratory center is stimulated by arterial hypoxemia. Elimination of it by intensive and prolonged inhalation of oxygen leads to a decrease in the function of the respiratory center, an increase in alveolar hypoventilation and hypercapnic coma. With stable pulmonary hypertension, prolonged nitrates, calcium ion antagonists (verapamil, fenigidin) are used for a long time. Cardiac glycosides and saluretics are prescribed for congestive heart failure.
Anti-relapse and supportive therapy begins in the phase of subsiding exacerbation, can be carried out in local and climatic sanatoriums, it is also prescribed during medical examination. It is recommended to distinguish 3 groups of dispensary patients. The first group includes patients with severe respiratory failure, cor pulmonale and other complications of the disease, with disability; patients need systematic supportive therapy, which is carried out in a hospital or a local doctor. The goal of therapy is to combat the progression of pulmonary heart failure, amyloidosis and others possible complications disease. These patients are examined at least once a month. The second group consists of patients with frequent exacerbations of chronic bronchitis and moderate respiratory impairment. Examination of patients is carried out by a pulmonologist 3-4 times a year, anti-relapse courses are prescribed in spring and autumn, as well as after acute respiratory diseases. A convenient method of administering drugs is inhalation; according to indications, the bronchial tree is sanitized by intratracheal lavages, sanitizing bronchoscopy. With active infection, antibacterial drugs are used. An important place in the complex of anti-relapse drugs is taken by measures aimed at normalizing the body's reactivity: referral to sanatoriums, dispensaries, exclusion of occupational hazards, bad habits and so on. The third group consists of patients in whom anti-relapse therapy led to the subsiding of the process and the absence of its relapses for 2 years. They are shown seasonal preventive therapy, including funds aimed at improving bronchial drainage and increasing reactivity.

Improving the drainage function of the bronchi is one of the most important conditions for the affective treatment of patients with pneumonia. Violation of bronchial patency in atom disease is due to several mechanisms:

A significant volume of viscous purulent exudate coming from the alma to the bronchi;

Inflammatory edema of the bronchial mucosa, draining the focus of inflammation of the lung tissue;

Damage to the ciliated epithelium of the bronchial mucosa and disruption of the mechanism of mucociliary transport;

An increase in the production of bronchial secretions due to the involvement of the bronchial mucosa in the inflammatory process (gnpercrinia);

A significant increase in the viscosity of sputum (discria); ... an increase in the tone of the smooth muscles of the small bronchi and a tendency to brop-

hospasm, which makes it even more difficult to separate sputum.

Thus, violations of bronchial patency in large pneumonia are associated only with the natural drainage of the inflammation focus and the entry of viscous alveolar exudate into the bronchi, along and with the frequent involvement of the bronchi themselves in the inflammatory process. This mechanism is of particular importance in patients with bronchopneumonia of various origins,as well as in patients with concomitant chronic bronchial diseases (chronic obstructive bronchitis, brochiectomy, cystic fibrosis, etc.).

Deterioration of bronchial patency, observed in at least some patients with pneumonia, contributes to an even greater disruption of local processes, including immunological, protection, re-seeding of airways refl and prevents the healing of the inflammatory focus in the lung tissue and the restoration of pulmonary ventilation. A decrease in bronchial patency contributes to the aggravation of the formation of ventilation-perfusion relations in the lungs and progressive failure. Therefore, the complex treatment of patients with pneumonia includes the mandatory appointment of drugs with expectorant, mucolytic and broicholytic action.

It is known that the sputum present in the lumen of the bronchi in patients with pneumonia consists of two layers: the upper, more viscous and dense (gel),lying) ration with cilia, and the lower liquid layer (sol),in which, as it were, the cilia float and contract. The gel consists of macromolecules of glycoproteins linked by disulfide and hydrogen bonds, which gives it viscous and elastic properties. With a decrease in the water content in the gel, the viscosity of the sputum increases and the movement of bronchial secretion slows down or even stops in the direction *, and to the oropharynx.
The intensity of such a movement becomes even less if you thin! a layer of a liquid layer (sol), which to a certain extent prevents sputum from adhering to the walls of the bronchi. As a result, mucous and mucous-mucus plugs are formed in the lumen of the small bronchi, which are removed with great difficulty only by a strong expiratory air flow during bouts of painful hacking cough.

Thus, the ability to freely remove sputum from the respiratory tract is primarily determined by its rheological properties, the water content in both phases of bronchial secretions (gel and sol), as well as the intensity and coordination of the activity of the cilia of the ciliated epithelium. The use of mucolytic and mucoregulatory agents is precisely aimed at restoring the ratio of sol and gel, liquefying sputum, rehydrating it, and also stimulating the activity of cilia of the ciliated epithelium.

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General information

Drainage in medicine is a medical method, which consists in removing the contents of wounds, hollow organs, abscesses, and pathological or natural body cavities outside.

Complete and correct drainage can ensure a sufficient outflow of exudate and create the best conditions for the fastest rejection of dead tissues with the transition of the healing process to the regeneration phase.

Drainage in medicine has practically no contraindications. By the way, this method has another indisputable advantage in the process of purulent antibacterial or surgical therapy, which consists in the possibility of a targeted fight against infection of wounds.

Conditions for effective drainage

In order to produce effective drainage (in medicine), experts determine its nature, choose the optimal drainage method for each case, as well as use medications for washing cavities (according to microflora). An important role in this practice is played by the proper maintenance of the drainage system and compliance with the rules of asepsis.

With what is it carried out?

Drainage in medicine is carried out using glass, rubber or plastic tubes of various diameters and sizes. In addition, sometimes glove graduates, specially made plastic strips, gauze swabs, as well as catheters and soft probes, which are inserted into the drained cavity or wound, are required.

How is it produced?

You already know what drainage is. However, not everyone knows how this procedure is carried out. It should be noted that the methods of its implementation are always different and depend on the type of wounds formed and the device used. So, for the treatment of deep and large wounds, drainage with gauze swabs is used. For this, a square piece of gauze is introduced into the purulent cavity, which is stitched with silk thread in the center. It is carefully straightened, and then all the walls and bottom of the wound are covered. Further, the cavity is loosely tamponed with gauze tampons, previously soaked in a hypertonic sodium chloride solution. At the same time, it is recommended to change them every 4-6 hours in order to prevent tissue damage. At the end, the gauze should be removed from the wound by pulling up the silk thread.

Other drainage methods

It should be especially noted that gauze tampons and rubber graduates are used quite rarely for the treatment of purulent cavities. For example, the latter device has no suction properties at all. It becomes clogged with detritus and pus, becomes covered with mucus, thereby causing inflammatory processes in the surrounding tissues.

Thus, in order to carry out the correct drainage of purulent wounds, specialists began to use special tubular devices. They can be single and multiple, double, complex, etc.

Drainage after surgery ( surgical wounds) involves the use of silicone tubing. In terms of their elastic-elastic properties, transparency and hardness, they occupy an intermediate position between PVC and latex devices. Moreover, they are significantly superior to them in biological inertness. This fact allows to increase the duration of the drainage stay in postoperative wounds. It should also be noted that they can be sterilized multiple times with hot air and autoclaving.

Drainage requirements

This process must be carried out in compliance with all the prescribed rules, namely:

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Why is drainage needed?

What is drainage? Drainage definition is a special system of pipes, wells or channels that allows groundwater to be diverted away from a site, house or any building structure. For most of Russia - especially for the middle zone - good drainage is simply vital. And this applies not only to clearly marshy areas.

Only a specialist will be able to determine exactly at what level the groundwater lies, whether and what type of drainage is needed, and how best to install it. However, the simplest drainage work can be done independently - we will tell you how to do this at the end of the article.

Of course, a lot depends on the type of area where your house or summer cottage - or other structure is located. Various options are possible:

• - a house on clay soil (that is, the waterproof layer is close);
• - a house in the lowlands;
• - a house on sandy soil (far from groundwater);
• - a house on a hillside;
• - a house in a swampy area or near a river / water body.

In each case - its own approach and its own drainage system. In lowlands, for example, groundwater is always closer, on slopes too. But on the hills, drainage may also be needed - in particular, for the drainage of rainwater, an excess of which in your area is completely useless.

Prior to the design of the drainage system, a site survey is carried out. First of all, the purposes for which it is necessary to drain the soil are determined, for which drainage is installed. So, drainage may be needed for agrotechnical purposes - excess moisture harms individual plants, leads to decay of roots and death of seedlings.

Most often, however, the adjoining and adjoining areas are drained to protect the foundation and prevent the water from creating unpleasant dampness inside the room.

Types of drainage systems

In what cases do surface drainage be done? Practically in any - and preferably in conjunction with the deep. Surface drainage is of several types:

• - point drainage,
• - linear drainage system,
• - combined drainage system.

Drain lines are usually grooves with small containers to collect excess debris and sand. With the help of such channels, it is possible to remove excess water from a rather large area - but care must be taken that the sand traps (garbage containers) do not overflow and the lines do not clog.

Point drainage elements are usually made where it is necessary to locally drain excess water - for example, such drainage systems are provided near gutters, at doors, at terraces. True, most often they are supplemented with linear elements - this makes it easier, faster and more efficient to drain water. The combination of different parts, moreover, allows you to optimize the drainage and storm sewer system, make it cheaper and better.

The main subspecies of deep drainage

In addition, the following main types of drainage are distinguished:

• - reservoir,
• - wall-mounted,
• - circular.

Reservoir drainage helps to remove from the structure not only groundwater, but also small droplets of any other moisture. The fact is that parts of such a system lie directly on the aquifer - the soil inside which underground water flows - forming a complex structure, which also includes pipes for removing moisture from the foundations.

The base of the structure to be protected - that is, the foundation and the basement - is reliably isolated from unnecessary moisture. Reservoir drainage is in great demand in the construction of heating systems and chimneys. True, such a drainage option must be planned even before the construction of the house - since the pipes must be laid simultaneously with the foundation.

In the construction of wall-type drains, the main part is a pipe system with a special filtering pad, which is laid on a waterproof soil (soil that almost does not allow moisture to pass even lower). Of course, the structure to be protected must stand on this type of ground - if the waterproof soil is deep, then wall drainage is not done.

Do you need a ring-type drainage, you can decide even in the case when the house or cottage is already completely ready and the owners suddenly realized that the room is too damp. The advantages of such a system are that it is placed at a relative distance from the walls. Ring drainage lowers the groundwater level within its perimeter - in this, its effect is similar to the reservoir type. The drains (system elements) are at a slope.

In some cases, deep drainage can be abandoned - but this requires a specialist assessment. However, if the soil is sandy, the house is on a hill, then the groundwater is hardly located close to the surface. The main recommendations for abandoning a deep drainage system - the water should be one and a half meters below ground level.

In this case, the costs turn out to be incomparable with the benefits - the depth of drainage on the site should be very large, and the effect from it is practically not noticeable.

The types of drainage systems differ in terms of the main design features. Everything is simple here - drainage happens:

• - horizontal,
• - vertical,
• - combined.

The first is the most popular and easiest of all - for example, surface drainage is precisely related to horizontal systems. Vertical structures most often include several wells, water from which is pumped out by pumps. You cannot create such a system on your own, special knowledge is needed here, therefore vertical drainage is a rare phenomenon that requires the intervention of a specialist and large financial investments.

The combined system includes elements of horizontal and vertical drainage - both wells and pipes. It is used mainly in difficult conditions where it is impossible to do with dehumidification more simply. Installing a combined drainage is also not a cheap pleasure.

How does the drainage system work?

The principle of drainage is such that it cannot do without a slight slope - and in Russia, for example, the plots on which houses are built are too flat for the natural outflow of water. In this case, when laying pipes, you need to organize a small artificial drainage slope - but do not overdo it, so as not to inadvertently increase the volume of earthwork. For each type of soil, the minimum drainage slope is different:

• for clay soils - 0.02,
• for sandy soils - 0.03.

At a lower value, water, of course, will also flow, but this will increase the likelihood of clogging the pipes, silting them up with soil particles - and you will not have any sense from the clogged system.

The optimal depth of laying drainage pipes also depends on the type of soil - and, of course, on the level of occurrence of groundwater: the lower you want to lower their level, the deeper you need to place the elements of the drainage system.

What are drainage pipes? Usually these are corrugated pipes made of polyvinyl chloride. Inside, they are smooth, with holes from one and a half to five millimeters, thanks to which water gets inside. Most often, pipes of 100 mm internal diameter are taken for engineering structures and drainage of areas.

Their features allow you to safely lay drainage at a depth of five meters, without fear of malfunction and destruction. In addition, they are quite light, they are easy to deliver to the installation site and it is quite easy to handle them yourself. However, it is better to calculate the diameter of the pipes taking into account the characteristics of a particular section, namely:

• the amount (volume) of groundwater flowing through its territory;
• plot area;
• soil type;
• location of the site (lowland, hill, etc.).

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Lymphatic system functions

Below are the important facts about the lymphatic system and its role in the body.

The lymph node is small, resembling a pea in shape and size. Their size can increase significantly if more power needs to be developed to fight bacteria and viruses. If happened increase lymph nodes , which means they are fighting infection.

In a survey of lymph nodes, only 39% of those surveyed were aware of some of their functions. Lymph nodes are actually filters of the lymphatic system, which are responsible for cleansing the lymph fluid and lymphocytes, removing bacteria, viruses, etc. The nodes are also responsible for the production and storage of lymphocytes, cells of the lymphatic system that fight infection.

Lymph nodes can be found anywhere, but they predominate in areas of the body where bacteria are most common.

Lymph nodes are often incorrectly referred to as "glands" or " lymph glands". They do not actually secrete anything and therefore are not glands. They act as filters in the internal connective tissue filled with lymphocytes, which collect and destroy bacteria and viruses.

The lymphatic system looks like a tree. It contains many branches called lymphatic vessels that act as channels containing colorless lymphatic fluid.

The human tonsils - the most famous part of the lymphatic system - are actually lymphatic organsthat work with the immune system to help prevent infections.

Despite the fact that our lymphatic system plays a vital role in maintaining general condition health, it remains the most misunderstood and neglected system in the body, with the exception of our liver!

The lymphatic system is a complex network of vessels that permeate the entire body (with the exception of the central nervous system). The lymphatic system is a drainage system that cleanses the fluid that surrounds cells in our body, removing impurities and waste products to protect us from toxins that can cause irreparable harm to the body.

Unlike the blood system, lymph is a one-way street. There is a drainage and filtration of lymph from the tissues and intestines and its return in a purified form into the blood. Lymphatic fluids are composed of water, proteins, salt, glucose, urea, lymphocytes (white blood cells), and other substances. Major lymphatic components include bone marrow, lymph nodes, spleen, and thymus gland. Lymph nodes, as chemical treatment stations, are strategically located throughout the lymphatic system and are especially concentrated in the armpits, abdomen and neck. The lymphatic vessels protect the body from disease by producing lymphocytes and by absorbing lipids (fats) from the gastrointestinal tract and delivering them to the blood.

Poor or congested lymphatic function is associated with many conditions, but especially fibromyalgia. multiple sclerosis, syndrome chronic fatigue, muscle pain, bloating, poor digestion, cellulite, body fat, obesity, and lymphoma (cancer).

Since the lymph fluid flows to the fluid returning to the blood from the body tissues, the excess fluid cannot return to the blood, the tissues swell. The enlargement of the lymph nodes occurs because the lymphatic vessels collect this excess fluid and carry it in the veins through the lymphatic system. This inflammation compromises health as waste, proteins, and other molecules continually flow from tiny blood capillaries into the surrounding tissues of the body.

We cannot live without a lymphatic system. Yet most people are unaware of the vital role of the lymphatic system in improving health and improving immune responses.

The circulatory and lymphatic are two vascular systems in the body

The lymphatic system is closely related to cardiovascular system and is sometimes referred to as the body's secondary circulatory system. The lymphatic system includes lymphatic vessels (four times more than blood vessels), lymph nodes, tonsils, spleen and thymus gland. Lymph is a colorless fluid containing white blood cells that washes the tissues and drains through the lymphatic system.

The role of the lymphatic system in the disposal of cellular waste

Substances formed as a result of cellular metabolism pass from the cells into the lymphatic fluid for removal. In other words, the lymphatic system gets rid of cellular waste. The blood also flushes toxins from the gastrointestinal tract to the lymphatic system through the liver. When the lymphatic system becomes overloaded, its filtration and neutralizing functions are sharply reduced, an increase in toxin levels creates an increased risk of inflammation, a decrease in the immune response, and in the future, cancer (lymphoma) may develop.

The deposition of fat in the body

In addition, when toxins are formed faster than the body can process and excrete them, the body traps these toxins by depositing fat in the interstitial spaces in an attempt to protect organs. The accumulation of toxins leads to inflammation and further disorders (such as fibromyalgia). These are the results of toxic accumulation in the soft and connective tissues of inflammation and excessive accumulation of lymphatic fluid. This leads to a variety of immune system disorders. Therefore, lymph congestion should be considered as the main cause of pain and inflammation.

Unlike the blood system, which uses the heart as a pump, the lymphatic system relies on skeletal muscle for pumping. Below are methods that can help improve lymph flow and cleanse the lymphatic system, as well as boost the overall immune response.

1) Dry skin cleaning is a very effective method of cleansing the lymphatic system. A sedentary lifestyle, lack of exercise, and the use of antiperspirants all block sweating. As a result, toxins and metabolic waste are trapped in the body (instead of being released in sweat). Dry skin brushing stimulates the sweat glands and opens the pores, allowing your body to breathe and increase the proper functioning of the organs, as well as improve blood circulation in the lower organs and tissues of the body. In addition, dry skin brushing reduces cellulite and promotes weight loss.

Use a dry natural bristle brush. Massage gently on the skin, starting from the limbs towards the center of the body. Best results are obtained by brushing twice a day and before bathing or showering. You will feel an invigorating tingling sensation. As a bonus, the skin will become softer and more elastic, with a healthy glow. To sterilize the brush, put it in the microwave for 3-4 minutes. Make sure the brush does not contain metal or plastic; it should be made of wood and natural bristles!

Dry skin cleansing is good to do along with bowel cleansing (with the help of dietary fiber). The skin is estimated to have the ability to eliminate over 370 grams of waste per day, not counting the excess toxins from a sluggish colon.

2) Lymphatic massage is done in the same way as dry cleaning of the skin, only with gentle kneading movements, starting from the outer points and working inward. At home, you can lift your legs for five minutes every day, and gently massage the lymph node areas. Lymphatic massage should be done by a professional massage therapist.

3) Jump on the trampoline! Jump gently for 3-6 minutes without toes or walk on your heels only. The best results are achieved if these exercises are performed 2-4 times a day. Learn the principles of deep breathing, which helps release toxins and improves circulation.

4) Avoid food preservatives and additives. In addition to being toxic, these substances also cause swelling and fluid retention. Be especially careful if foods contain monosodium glutamate. Neurologists classify this substance as a neurotoxin because it has degenerative and deadly effects on the brain and nervous system; leads to overstimulation of neurons, resulting in cell death. Avoid all hydrolyzed, natural flavors, commercial condiments, soups, spices, broths, gelatin, and aluminum cookware.

5) Products for cleansing the lymphatic system. Squeeze 0.5 fresh lemon juice into a cup of warm clean water and drink every morning. This remedy helps to cleanse the blood and alkalize the body.

Include fresh vegetables and potassium-rich foods (broccoli, cabbage, and bananas) in your diet. Drink 8 to 10 glasses of pure water daily. Here is an article about complex cleansing of the lymphatic system... Also possible cleansing lymph with licorice.

Supporting the lymphatic system is vital to good health and is a natural way to help prevent pain, inflammation, circulation and immune disorders. A healthy lymphatic system boosts the body's overall immune responses.

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System purpose

Drainage waters - moisture accumulating in the local area due to heavy precipitation, floods in spring, location land plot near groundwater or streams from neighbors. For a long service life of the adjoining foundation and preservation appearance area, accumulating water must be removed. To solve this problem, drainage systems are used.

Drainage is the removal of excess water from or below the earth's surface.

Competent calculation, as well as correct installation of structural elements will eliminate the occurrence of several problems at once:

1. Excess moisture will not accumulate on the ground, as a result of which there will be no puddles, dirt and stains on the soil. There will be fewer amphibians, mosquitoes and other water-loving insects, and the site will take on a neat and well-groomed appearance.
2. The house foundation will be protected from the effects of capillary and pressure moisture, which will significantly extend its service life, exclude shifts, erosion of the base, and protect the basement from flooding and high humidity.
3. The roots of fruit shrubs and trees will not rot due to excess moisture, the plants will not die and will hurt less, the yield will increase.
4. Working and relaxing on the ground will be more enjoyable, since you will not need to travel by water and mud to parts of the site.

House drainage is especially relevant for people who want to embody landscape design ideas on earth with the help of green spaces. Without an adequate drainage system, such projects will be washed away by the first rains or floods.

The price for such work, as well as the cost of materials, is high. But the result will be pleasing: there will always be cleanliness around, and the house will become a kingdom of comfort.

Types of drainage by purpose

To decide what kind of drainage to use, you need to consider all its varieties.

By purpose, drainage systems are divided into three types:

• Ring - represents a closed, organized structure that encircles the house or the ground around it, in need of protection from moisture. This type is used in most cases for the preservation of residential buildings, utility buildings or garages.
• Back-to-wall - used if the base of the house is on a soil that has waterproof properties. Drainage pipes are laid on the outer sides of the walls and sprinkled with a special filter mixture. The pipes are laid directly on the waterproof soil layer.

• Stratal - a type of drainage that is laid on an aquiferous earth layer at the base of a building, which must be protected from moisture. The pipes of the structure are laid in the basement of the house under the concrete floor. The collection tube is led into a collection well, which is connected to the ring drainage system.

Types of drainages by design features

Drainage of water by design features is divided into three types:

• Horizontal - differs in the location of pipes, trays, channels, etc. on the ground surface. This type is the most common. It is used in deep and surface drainage structures, as well as in storm sewers.
• Vertical - characterized by a set of interconnected wells. They can pump water from the upper layer or dump it into the lower layer under the waterproof layer. It is mainly used in private houses due to its high cost.
• Combined - it is distinguished by a set of vertical wells that throw water upward, as well as a horizontal system of pipes that conduct fluid into reservoirs or reservoirs.

Deep drainage

Deep drainage is one of the structures designed to lower the ground water level. Such a system protects underground structures and the foundation of the house from corrosion or destruction, and the roots of trees and other plants from decay.

It is best to install the structure of the deep view already at the stage of laying the house.

A ground drainage system should be installed by homeowners whose plots meet the following criteria:

1. Groundwater is located closer than one and a half meters from the soil surface.
2. Water stagnation is constantly occurring on the land.
3. The property is located in a lowland, which is why water flows there from higher located neighbors.
4. The site has walls that are retaining (for example, for various water bodies).

Deep type drainage device

Deep-type structures are necessary for all low-lying areas (this is especially true for the area of \u200b\u200bcentral Russia).

When installing deep drainage along the entire perimeter of the site, they dig trenches, fill them with rubble and sand. Then each of the perforated pipes is laid along the perimeter of the entire area, wrapped in a special geotextile, then covered with soil, and sod on top.

With standard drainage, the main pipe is placed in the center of the site and several pipes are brought in at an angle with respect to it in the form of a herringbone on each side. At the same time, the central pipe is located lower than the others. The slope in the direction of movement of the water mass should be from one to five centimeters.

After installation, the main pipe is directed at a slope to a collector made of rings (reinforced concrete) or pipe (corrugated) made of HDPE, PVC or other large diameter polymers. The liquid entering the collector must be pumped over the territory of the site.

Since the calculations for installing a deep structure are quite complex, it is best to entrust its installation to professionals so as not to destroy the plants or flood the site.

Surface drainage

Surface drainage is a system of drainage and drainage of excess moisture from the surface of the land plot, which appeared from floods, excessive watering, etc.

The surface structure removes moisture from the site, which is absorbed into the soil due to human actions or atmospheric precipitation. In addition, it helps to protect the site from the formation of puddles.

Surface drainage tasks are:

• drainage of moisture from the roof;
• drainage from sites, paths, parking lots, etc .;
• collection of moisture from the garden, lawns.

Surface drainage is easy enough to install, so you can build it yourself.

Local type of drainage

A local type of drainage is an open drainage system associated with a sewer. In another way, it is called point. This type is intended for catchment and drainage in places of the greatest accumulation of moisture.

Places of increased water accumulation include the following: drains from roofs, recesses and depressions near doors, an area under an irrigation tap, and others. Local drainage systems are presented in the form of ladders in parking lots, lawns, roofs, etc.

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a). filtration of air in the nasal cavity;

b) mucociliary transport of tracheo-bronchial secretions (escalator mechanism)

c). cough and sneezing reflexes;

d). active and passive peristalsis of the bronchi;

e). kinetic energy of air movement;

g). the surfactant system of the lungs

3. Neuroreflex and humoral mechanisms that maintain the tone of the bronchial muscles in an adequate state.

4. Endocytosis of bronchial contents by epithelial cells of the respiratory tract;

5. Action of local nonspecific factors of lung protection;

a) the system of alveolar macrophages, which carry out phagocytosis and transport foreign particles that have entered the lung during breathing;

b). antiviral and antibacterial effect of nonspecific factors of the humoral link of local lung protection (lysozyme, lactoferin, fibronectin, interferon, proteolytic and antiproteolytic factors, etc.).

6. Mucosal immune system, which works independently of general (systemic immunity).

7. Factors of local immunity (T - lymphocytes, secretory Ig).

Considering that the main pathogenetic mechanism of diseases of the bronchopulmonary system is a violation of the drainage function of the bronchi, we decided to briefly dwell on the physiological mechanisms of mucociliary clearance of bronchopulmonary secretions (escalator mechanism), which, together with immunological mechanisms, plays one of the leading roles in the pathogenesis of bronchopulmonary diseases.

Mucociliary transport (clearance) of tracheo-bronchial secretion

(escalator mechanism)

Among the factors of local protection of the lungs that carry out tracheobronchial clearance, the ciliary apparatus is of great importance.

The entire surface of the bronchial mucosa, up to the bronchioles, is a continuous layer of ciliated epithelium. The trachea and large bronchi are lined with stratified ciliated epithelium, medium and small - with two-layer epithelium. In the terminal bronchioles, some of the cells lose cilia. Islets of cells of the alveolar epithelium appear in this area. In the epithelium of respiratory bronchioles of 1-3 orders of magnitude, the cells of the ciliated epithelium are almost absent.

The ciliated epithelium consists of 4 types of cells with different functions:

a) cells with mobile cilia, which assist in the release of foreign particles from the respiratory tract (ciliated cells),

b) goblet (mucoid) cells that produce mucus,

c) intermediate and basal.

Each ciliated cell of the ciliated epithelium has about 200 cilia on its surface, which carry out up to 250 vibrations per minute (4 - vibration in 1 sec. ). The movement of the cilia resembles the wave of a swimmer's hand. From a horizontal position, it quickly turns into a vertical one (strike phase), then slowly returns to its original position (reverse movement phase). Oscillation of cilia in the entire epithelial layer occurs in the appropriate sequence. The movement begins in the distal parts of the bronchi, then it is transmitted in a wave-like manner to the proximal parts.

Goblet cells are located between the ciliated cells (on average, 1 goblet to 5 ciliated).

In the mucous membrane of the trachea and bronchi there are tubular - acinous bronchial glands. Their greatest number is located in the membrane part of the trachea, above its bifurcation and in the division of the main bronchi into lobar.

Goblet cells and bronchial glands secrete mucus, which covers the bronchial mucosa (cilia) in a thin layer. The study of the structure of this secret showed that it has 2 layers, which differ in composition and viscosity.

Gel The bottom layer, 2 µm thick, is a rare low viscosity substrate. This layer is formed mainly by a secret that is secreted by goblet cells. It is immobile and its main function is to facilitate the vibration of the cilia, and to protect the ciliated epithelium from drying out and damage.

Sol -the top layer is mobile, it has a high degree of viscosity and pronounced adhesive properties. This upper (movable) layer, like a blanket (blanket), lies on the lower one. During the impact phase, the cilia from below push the upper layer of mucus, which completely covers the entire ciliated epithelium. Various finely dispersed foreign particles and microorganisms easily adhere to the upper layer, which, like on an escalator, move from the bottom up and are removed from the body. This layer can hold on its surface and transport particles weighing up to 12 μg. The speed of movement of mucus in the trachea and large bronchi is 10-15 mm / min, and in the partial bronchi - 1 mm / min. Normally, this flow is continuous. Throughout the day, imperceptibly, without the participation of the cough reflex, about 50-100 ml is released (depending on the child's age). sputum. In this case, microbial particles can pass in 1 s. a path that is equal to the length of 10 mucosal epithelial cells. Those. the time of possible contact of the microorganism with each epithelial cell does not exceed 0.1 sec. In such a short period of time (during which the contact of the microorganism with the cells of the mucous membrane occurs), the microorganism does not have time to attach to the cell and cause inflammation. Per day through the lungsventilated about 10,000 liters of air.

Thus, the normal function of the ciliated apparatus and the secretion of mucous secretions of a certain viscosity and in a certain amount provide sufficient mucositic clearance, which does not allow the pathogen to penetrate into the respiratory bronchioles and alveoli, thereby protecting the broncho-pulmonary system from inflammation. The mechanism of mucociliary clearance in pathology will be analyzed below.

Among the mechanisms of development of COPD are bronchitogenic, pneumoniogenic and pneumonitogenic.

The bronchitogenic mechanism of CNPD is based on a violation of the drainage function of the bronchi and bronchial patency. Diseases combined by this mechanism are represented by chronic bronchitis, bronchiectasis (bronchiectasis), bronchial asthma and pulmonary emphysema (especially chronic diffuse obstructive).

The pneumoniogenic mechanism of COPD is associated with acute pneumonia and its complications. It leads to the development of a group of chronic non-obstructive lung diseases, for example, chronic lung abscess, chronic pneumonia.

The pneumonitogenic mechanism of COPD determines the development of chronic interstitial lung diseases, represented by various forms of fibrous (fibrosing) alveolitis, or pneumonitis. In the end, all three mechanisms of CNPD lead to the development of pneumosclerosis (pneumocirrhosis), buronchiectasis, secondary pulmonary hypertension, right ventricular hypertrophy and cardiopulmonary insufficiency.