AÙP XE PHOÅI
description
Transcript of AÙP XE PHOÅI
![Page 1: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/1.jpg)
1
AÙP XE PHOÅI
BS. Nguyeãn Vaên Thoï
![Page 2: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/2.jpg)
2
MUÏC TIEÂU
(1) Trình baøy ñònh nghóa cuûa aùp xe phoåi vaø phaân loaïi aùp xe phoåi
(2) Trình baøy sinh lyù beänh cuûa aùp xe phoåi
(3) Trình baøy ñaëc ñieåm laâm saøng vaø caän laâm saøng cuûa aùp xe phoåi
(4) Neâu chaån ñoaùn phaân bieät cuûa aùp xe phoåi
(5) Trình baøy bieän phaùp ñieàu trò noäi khoa aùp xe phoåi
(6) Neâu caùch phoøng traùnh aùp xe phoåi
![Page 3: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/3.jpg)
3
1. ÑÒNH NGHÓA
Aùp xe phoåi laø tình traïng hoại tử nhu moâ phoåi vaø thaønh lập hang chứa chất hoại tử hoặc dịch, do vi truøng gaây ra.
Sự thaønh laäp nhieàu oå aùp xe nhoû (< 2cm) : vieâm phoåi hoaïi töû.
Aùp xe phoåi caáp tính: 4-6 tuaàn leã. Aùp xe phoåi maïn tính : > 4-6 tuaàn.
Aùp xe phoåi nguyeân phaùt: do hít hoaëc vieâm phoåi
Aùp xe phoåi thöù phaùt: taéc ngheõn (u, dò vaät), töø ngoaøi phoåi, giaõn pheá quaûn vaø/hoaëc SGMD
![Page 4: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/4.jpg)
4
2. BEÄNH NGUYEÂN
Vi truøng kî khí : 89% ; 46%: chæ coù vi truøng kî khí; 43%: phoái hôïp caû vi truøng kî khí vaø hieáu khí.
Vi truøng kî khí thöôøng gaëp : Peptostreptococcus, Bacteroides, Fusobacterium species, vaø Microaerophilic streptococcus.
Caùc taùc nhaân khaùc: Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, amíp (Entamoeba).
![Page 5: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/5.jpg)
5
3. SINH LYÙ BEÄNH Vi truøng raêng
mieäng
Ñöôøng hoâ haáp döôùi
Vieâm phoåi hít
Hoaïi töû nhu moâ
AÙp xe phoåi
CƠ CHẾ BẢO VỆ
![Page 6: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/6.jpg)
6
4.TRIEÄU CHÖÙNG HOÏC4.1 Trieäu chöùng cô naêng: Trieäu chöùng aâm æ Soát, ho khaïc ñaøm, ñoå moà hoâi
ñeâm, bieáng aên vaø suït caân Ñaøm raát hoâi vaø beänh nhaân
coù hôi thôû hoâi Ho ra maùu hoaëc khaïc ra nhu moâ
phoåi hoaïi töû hoaëc ñau ngöïc kieåu maøng phoåi
Yeáu toá thuaän lôïi gaây hít saëc
![Page 7: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/7.jpg)
7
4.2 Trieäu chöùng thöïc theå:
Vi truøng kî khí: soát nheï;ï vi truøng khaùc: soát > 38,5oC
Ñoâng ñaëc phoåi TDMP, muû maøng phoåi hoaëc
traøn khí traøn muû maøng phoåi Ngoùn tay duøi troáng Beänh cuûa nöôùu raêng
![Page 8: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/8.jpg)
8
4.3 Caän laâm saøng:
4.3.1 Coâng thöùc maùu : Baïch caàu taêng cao
4.3.2 Xquang phoåi : Hình hang coù möïc nöôùc hôi beân trong Thaønh oå aùp xe tieán trieån töø daày
ñeán moûng daàn Hình baàu duïc, hình troøn. Chung quanh:
môø khoâng ñoàng nhaát, giôùi haïn khoâng roõ
1/3 keøm muû maøng phoåi
![Page 9: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/9.jpg)
9
AÙp xe phoåi
![Page 10: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/10.jpg)
10
17/12/1990
![Page 11: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/11.jpg)
11
24/12/1990
![Page 12: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/12.jpg)
12
26/12/1990
![Page 13: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/13.jpg)
1304/01/1991
![Page 14: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/14.jpg)
14
04/01/1991
![Page 15: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/15.jpg)
15
14/01/1991
![Page 16: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/16.jpg)
16
4.3.3 CT scan
Chæ ñònh: nghi ngôø u phoåi, dò vaät hoaëc aùp xe coù bieåu hieän khoâng ñieån hình.
Phaùt hieän muû maøng phoåi hoaëc nhoài maùu phoåi
Treân CT, oå aùp xe laø moät sang thöông taêng saùng thöôøng laø hình troøn coù thaønh daày vaø giôùi haïn khoâng roõ.
Caùc maïch maùu vaø pheá quaûn khoâng bò ñaåy leäch nhö trong muû maøng phoåi.
OÅ aùp xe naèm trong nhu moâ phoåi, neáu naèm gaàn maøng phoåi thì seõ taïo moät goùc nhoïn vôùi thaønh ngöïc.
![Page 17: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/17.jpg)
17
• 4.3.4 Vi truøng hoïc : Ñaøm: nhuoäm, caáy vaø laøm
khaùng sinh ñoà Caáy dòch maøng phoåi, caáy
maùu chaån ñoaùn taùc nhaân• 4.3.5 Noäi soi pheá quaûn : • Chæ ñònh: aùp xe chaäm hoài
phuïc, thaát baïi vôùi khaùng sinh, nghi ngôø hít dò vaät hay beänh aùc tính
![Page 18: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/18.jpg)
18
5. CHAÅN ÑOAÙN
5.1 Chaån ñoaùn xaùc ñònh Khaïc ñaøm muû Muøi hoâi cuûa ñaøm hay hôi thôû Hình aûnh oå aùp xe
![Page 19: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/19.jpg)
19
5.2 Chaån ñoaùn phaân bieät
Keùn khí boäi nhieãm
![Page 20: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/20.jpg)
20
![Page 21: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/21.jpg)
21
![Page 22: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/22.jpg)
22
Hang lao
![Page 23: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/23.jpg)
23Hang lao
![Page 24: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/24.jpg)
24U phoåi hoaïi töû
![Page 25: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/25.jpg)
25
![Page 26: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/26.jpg)
26U naám
![Page 27: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/27.jpg)
27
5.3 Caùc theå laâm saøng:
• AÙp xe phoåi do Staphylococcus : Thöôøng gaëp ôû treû em vaø nhuõ nhi Thöù phaùt töø nhieãm truøng ngoaøi
phoåi (thöôøng da, cô) X-quang : hình aûnh nhieàu boùng khí
khoâng keøm ñoâng ñaëc phoåi. Caùc boùng khí naøy coù kích thöôùc khaù ñoàng nhaát, coù bôø vieàn roõ, khoâng coù möùc nöôùc hôi, thöôøng coù bieán chöùng traøn muû traøn khí maøng phoåi.
Caáy maùu giuùp chaån ñoaùn xaùc ñònh
![Page 28: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/28.jpg)
28
AÙp xe phoåi do Amibe
![Page 29: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/29.jpg)
29
![Page 30: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/30.jpg)
30
![Page 31: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/31.jpg)
31
5.4 Ñaùnh giaù cô ñòa beänh nhaân vaø yeáu toá thuaän lôïi :
Nhuõ nhi, treû nhoû, tieåu ñöôøng: Staphylococcus aureus
Nghieän röôïu : Klebsiella pneumoniae, kî khí
Giaõn pheá quaûn, nhieãm truøng beänh vieän: Pseudomonas
Tình traïng raêng mieäng xaáu: kî khí hay ña vi truøng…
![Page 32: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/32.jpg)
32
6. ÑIEÀU TRÒ
6.1Ñieàu trò noäi khoa 6.1.1 Khaùng sinh lieäu phaùp 6.1.2 Daãn löu oå aùp xe 6.1.3 Ñieàu trò caùc yeáu toá thuaän
lôïi
6.2. Chæ ñònh ñieàu trò ngoaïi
![Page 33: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/33.jpg)
33
Khaùng sinh lieäu phaùp
• Nguyeân taéc chung : Caàn phoái hôïp khaùng sinh Söû duïng caùc loaïi dieät khuaån vaø
neân coù khaùng sinh coù taùc duïng treân vi truøng kî khí
Cho sôùm, ngay sau khi laáy maãu beänh phaåm xeùt nghieäm
Vieäc löïa choïn khaùng sinh ban ñaàu laø theo kinh nghieäm
Khôûi ñaàu neân duøng ñöôøng chích
![Page 34: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/34.jpg)
34
Löïa choïn khaùng sinh ban ñaàu
• Vi truøng kî khí: Clindamycin ± Cephalosporin theá
heä 2 hoaëc 3 Metronidazole + -lactam keøm
chaát öùc cheá -lactamase hoaëc Cephalosporin theá heä 2 hoaëc 3 hoaëc Penicillin G
![Page 35: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/35.jpg)
35
Caùc tröôøng hôïp khaùc: • Ñieàu trò caùc taùc nhaân gaây beänh
+ ñieàu trò theâm vi truøng kî khí. Enterobacter:
Cephalosporin theá heä thöù 3 + Aminoglycozides.
Staphylococcus:Penicillin M + Aminoglycozides hoaëc Vancomycin + Aminoglycozides
Amíp: Secnidazole (FlagentylR) 2 g/ngaøy x 5 ngaøy (30 mg/kg/ngaøy)
![Page 36: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/36.jpg)
36
Thôøi gian ñieàu trò
4-6 tuaàn leã X-quang phoåi thaáy oå aùp xe hoài
phuïc hoaøn toaøn hoaëc chæ coøn moät sang thöông nhoû oån ñònh hoaëc moät keùn khí thaønh moûng
![Page 37: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/37.jpg)
37
Daãn löu oå aùp xe
• (1) Vaät lyù trò lieäu daãn löu tö theá, taäp ho khaïc chuû ñoäng.
• (2) Noäi soi röûa pheá quaûn • (3) Choïc huùt xuyeân thaønh
ngöïc
•Ñieàu trò caùc yeáu toá thuaän lôïi
![Page 38: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/38.jpg)
38
Chæ ñònh ñieàu trò ngoaïi
• Ñieàu trò noäi khoa thaát baïi, nghi ngôø u phoåi, dò daïng phoåi baåm sinh
Ñaùp öùng ñieàu trò :• Ñaùp öùng ñieàu trò laø khi soát
giaûm sau 3-4 ngaøy ñieàu trò, heát soát sau 7-10 ngaøy
![Page 39: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/39.jpg)
39
7. TIEÂN LÖÔÏNG
Tæ leä thaønh coâng töø 75-90%. Nhöõng tình huoáng laøm taêng tæ
leä töû vong: thöù phaùt do u phoåi laøm taéc pheá quaûn, oå aùp xe quaù lôùn (> 6cm), roái loaïn tri giaùc, do caùc loaïi vi truøng nhö S. aureus, K. pneumoniae, ñaëc bieät laø P. aeruginosa
![Page 40: AÙP XE PHOÅI](https://reader035.fdocument.pub/reader035/viewer/2022070412/56814903550346895db637d4/html5/thumbnails/40.jpg)
40
8. PHOØNG NGÖØA
Traùnh hít saëc. Caàn phaûi sôùm ñaët noäi khí quaûn vaø baûo veä ñöôøng hoâ haáp cho nhöõng beänh nhaân maát phaûn xaï ho.
Ñaët beänh nhaân naèm ôû tö theá ñaàu cao 300. Beänh nhaân oùi möûa neân cho naèm nghieâng moät beân.
Veä sinh vaø chaêm soùc raêng mieäng cho ngöôøi giaø hay ngöôøi bò taøn taät.