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Nhufng benh phoi thirirng gap
(Xep theo thiitvt a, b, c)
AP XE PHOI
Djnh nghJa
Ap xe phoi la mot o mu tich tu trong mot hang mdi hinh thanh cl nhu mo phoi.
Chan doan
Lam sang
- Ho ra nhieu ddm mu, ho ra mau, ddm va hdi thd hoi, kho thd, dau ngiic.
- Sot, ret run, ngon tay dui trong, thieu mau, suy mon.
- Co the co bien chting viem mu mang phoi hoac mot ap xe di can d xa.
- Kham phoi: hoi chting dong dac, doi khi kem theo ran am. Han htiu, co hoi chting hang.
Can lam sang
- Mau: tang bach cau va bach cau da nhan. Toe do mau ling tang.
- Ddm: BK am tinh; tim thay vi khuan ai khi hoac yem khi.
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- Soi phe quan ong mem nhat loat de tim can nguyen cuc bo thuan ldi gay benh (u lanh tinh hoac u ac tinh, di v&t phe quan).
- X quang phoi: hinh anh khi - ntfdc nam gitia mot vung dong dac, co the thay nhieu mile ntfdc neu co nhieu o ap xe. Cac hinh nay thay doi nhanh qua moi lAn chup.
- Chup CT scan phoi: tuy ttfng trtfdng hdp.
Chan doan phan biet
- Lao phoi (hang lao). Ung thtf phoi (hang ung thtf). Tran dich mang phoi lien thu£. Ken khf ho&c ken phe quan nhiem khu^n. Gian phe quan.
Nguyen nhan
- Di vat phe quan. Hep phe quan. Nhiem khu&n.
- Vi khuan hoc: cac mam benh thong thtfdng vung h£u hong, vi khuan vem khf, ai khf (tu diu vang, phe diu khuAo, vi khu&n gram am nhtf Klebsiella pneumoniae, Pseudomonas aeruginosa); nam (aspergillus, blastomyces); amip.
Dieu tri
Noi khoa
- Khang sinh ddn thuan: khi chtfa co ket qua khang sinh do, chon cac khang sinh sau: penicillin G, clindamycin, erythromycin, metronidazol. Thdi gian dung khang sinh ttf 4-6 tuan.
- Din ltfu o ap xe: vo long ngtfc, n&m ttf the din ltfu, soi phe quan hut mu ap xe, din ltfu qua da doi vdi ap xe ldn d ngoai vi phoi.
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Ngoai khoa
- Chi djnh phau thuat: + Ho ra mau nang.
+ Ap xe phoi man tinh: trieu chting ton tai dai dang (sot, ho ra mau keo dai, o ap xe to len) dii da dieu trj dung cach bang cac bien phap noi khoa trong 4-6 tuin.
+ Co bien chting mu mang phoi hoac ro phe quan -mang phoi.
B$NH PHOI TAC NGHEN MAN TINH
Djnh nghJa
- Benh phoi tSc nghen man tinh (BPTNMT) la benh tic nghen cac dtfdng thci. Benh nhan dtfdc chia thanh hai nhom ldn:
+ Tim tai phu (Blue bloaters) la nhting benh nhan viem phe quan man tfnh vdi nUdc da hdi xanh (do giam oxy mau man tfnh va tang C02mau) va phu ngoai bien (do tam phe man), ho man tfnh, khac nhieu ddm.
+ Kho thd moi hong (Pink puffers) la nhting benh nhan gian phe nang ngifdi gay nhUng da hong (khong co roi loan bao hoa oxy), kho thd.
- Tti dong nghia: Gian phe nang. Viem phe quan man tinh
Chan doan
Lam sang
- Tim tai phu (viem phe quan man tinh): tim tai ngoai bien, ho co ddm, kho thd nhanh, nhip tim nhanh.
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- Kho thd moi hong (gian phe nang): kho thd. nghe phoi thay giam ri rao phe nang.
- 0 ca hai nhom tren deu co the co co cii (wheezing).
- Nhieu benh nhan BPTNMT co ca benh canh cua viem phe quan man tinh \kn gian phe nang.
Can lam sang
- Dem mau: tang bach cau trong giai doan c&p tinh.
- Co the ddm mu do nhilm khu&n ho hap.
- Do khi trong mau: C02 mau binh thtfdng; giam oxy mau ttf nhe den trung binh.
- a-1 antitrypsin th&`p d nhtfng benh nhan co suy giam a-1 antitrypsin (khong nen l&m xet nghiem nay mot cach thtfdng quy).
- Thti chtic n&ng phoi: roi loan kha nfing khuech tan, dung tich toan phoi va/hoac the tich khi ckn tang, thi tich thci ra ging stic trong giay dau tien (FEVl) giam co dinh <3 benh nhan gian phe nang, kha nang khuech tan binh thtfdng, FEVl giam d benh nhan viem phe quan man tfnh.
- X quang phoi: phoi tang sang, vom hoanh det, khoang sau xtfdng tfc rong. Cac nhanh huyet quan thtfa thclt, hinh bong bong d benh nhan gian phe nang. Bd phe quan d&y, bd phai cua tim nd d benh nhan viem phe quan man tinh.
Chan doan phan biet
Suy tim sung huyet. Hen phe quan. Nhiem khu^n ho h&p Gian phe quan. Benh nhay nhdt. Ung thtf. Nghen mach phoi Hoi chting ngting thd khi ngu. Nhtfdc giap.
Nguyen nhan
Nghien thuoc la. Moi trtfdng 6 nhiim. Giam a-1 antitrypsir (hiem).
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Dieu tri
Muc dich dieu tri l£:
- Cai thien toi da chtic nang phoi.
- Giti khong de chtic nang phoi suy giam.
Cu th&
- Benh nhan viem phe quan man ti`nh phai lam giam can n&ng (neu thtia can). Bo thuoc la, loai bo cac chat gay o nhiem dtfdng thd. Thd oxy, neu thay can.
- Dieu tri benh d giai doan c£p tinh:
+ Khi dung thuoc beta - chu van ho&c tiem dtfdi da epinephrin hay terbutalin.
+ Xit dung dich ipratropium.
+ Tiem tinh mach aminophyllin.
+ Tiem tinh mach methylprednisolon
+ Can nhac viec dung oxy (sau khi thd oxy ltfu ltfdng cao co the xuat hien tang C02mau va ton thtfdng ho hap); dung mat na Venturi cung cap ltfdng oxy trong khi thd vao ttf 24% den 28%; cach dung nay dtfdc tfa chuong hdn la dung canun mui.
+ Dung mat na co thong khf ap ltfc dtfdng de dieu tri benh long ngtfc han che man tfnh co the tranh cho benh nhan khoi phai dat noi khf quan.
- Neu nghi co nhidm khuan ho hap, dung khang sinh:
+ Hemophilus influenzae, Streptococcus pneumoniae rat hay gay viem phe quan cap tfnh.
+ Khang sinh dtfdc tfa dung la: ampicillin, bactrim, doxyciclin, cefutoxim hay cefaclor, tac dung tot doi vdi nhtfng benh nhan BPTNMT dang d giai doan cap co kho thd nhieu, ddm mu va sot.
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