CHƯƠNG 2 - HỆ HÔ HẤP
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Transcript of CHƯƠNG 2 - HỆ HÔ HẤP
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8/13/2019 CHNG 2 - H H HP
1/90
H H HP
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8/13/2019 CHNG 2 - H H HP
2/90
MC TIU
K c cc thnh phn ca h h hp
M t cu to c bn ca cc phn trongh h hp
Hiu c hot ng h hp v s traoi kh t ph nang qua mu
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8/13/2019 CHNG 2 - H H HP
3/90
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8/13/2019 CHNG 2 - H H HP
4/90
H h hp bao gm
ng h hp trn Mi Hu
Thanh qun ng h hp di
Kh qun
Cy ph qun Ph nang
Mng phi
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8/13/2019 CHNG 2 - H H HP
5/90
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8/13/2019 CHNG 2 - H H HP
6/90
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8/13/2019 CHNG 2 - H H HP
7/90
Mi
C vch ngn gia chia lm 2 hc mi:tri v phi
Mi bn c 3 xon mi: trn gia di
Nim mc ph hc mi xon mi c hthng mao mch mu phong ph
Trn ca hc mi c biu m khu gic
cm nhn mi CN: lc, si m v lm m khng kh,
khu gic
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8/13/2019 CHNG 2 - H H HP
8/90
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8/13/2019 CHNG 2 - H H HP
9/90
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8/13/2019 CHNG 2 - H H HP
10/90
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8/13/2019 CHNG 2 - H H HP
11/90
Thanh qun
Sn thanh qun, np thanh qun, dythanh m, mt s c
CN: dn kh, pht m
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8/13/2019 CHNG 2 - H H HP
12/90
Mt trc thanh qunMt sau thanh qun
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8/13/2019 CHNG 2 - H H HP
13/90Mt bn thanh qun
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8/13/2019 CHNG 2 - H H HP
14/90
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8/13/2019 CHNG 2 - H H HP
15/90
Hnh soi thanh qun
Thanh mn m Thanh mn ng
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8/13/2019 CHNG 2 - H H HP
16/90
Kh qun
Ni tip thanh qun
Khung: sn hnh ch C
Nm trc thc qun BM: tr gi tng c lng chuyn
CN: dn kh
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8/13/2019 CHNG 2 - H H HP
17/90
Kh qun
Ph qun
gc
Ph qunthy
C honh
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8/13/2019 CHNG 2 - H H HP
18/90Cc thnh phn vng rn phi
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8/13/2019 CHNG 2 - H H HP
19/90
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8/13/2019 CHNG 2 - H H HP
20/90
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8/13/2019 CHNG 2 - H H HP
21/90
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8/13/2019 CHNG 2 - H H HP
22/90
Cy ph qun
T ph qun gc (th h I)
20-23 th h
ph nang
Ph qun thy gian tiu thy tiu phqun tiu ph qun tn tiu ph qun hhp ph nang
T tiu ph qun ph nang: khng c khungsn bn ngoi.
Cu to: c c trn hng vng nm di lpm, biu m
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8/13/2019 CHNG 2 - H H HP
23/90
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8/13/2019 CHNG 2 - H H HP
24/90
Carina (Carne)
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8/13/2019 CHNG 2 - H H HP
25/90
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8/13/2019 CHNG 2 - H H HP
26/90
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8/13/2019 CHNG 2 - H H HP
27/90
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8/13/2019 CHNG 2 - H H HP
28/90
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8/13/2019 CHNG 2 - H H HP
29/90
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8/13/2019 CHNG 2 - H H HP
30/90
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8/13/2019 CHNG 2 - H H HP
31/90
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8/13/2019 CHNG 2 - H H HP
32/90
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8/13/2019 CHNG 2 - H H HP
33/90
Phi Phn thy phi
Phi phi c 3 thy Phi tri c 2 thy
C 2 phi u c 10 phn thy
Rn phi: M phi, TM phi, ph qun gc
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8/13/2019 CHNG 2 - H H HP
34/90
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8/13/2019 CHNG 2 - H H HP
35/90
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8/13/2019 CHNG 2 - H H HP
36/90
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8/13/2019 CHNG 2 - H H HP
37/90
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8/13/2019 CHNG 2 - H H HP
38/90
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8/13/2019 CHNG 2 - H H HP
39/90
Cc b phn tham gia h hp
Phi
Lng ngc
C h hp: c lin sn, c c nchm, c honh, c ngc
Mng phi
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8/13/2019 CHNG 2 - H H HP
40/90
Chu k h hp
Ht vo: khng kh i t ngoi phi Cc dy TK vn ng hng phn k cc c hh thnh ngc v c honh co li
(phi dn ra, c honh h xung, lng ngc tng th tch)
Khi ch ng c s tham gia 1 s c hh ph ( c ngc, c rng ca)
Th ra: khng kh t phi ngoi
Cc dy TK vn ng b c ch, cc c gin ra (phi xp, c honh nng ln,lng ngc gim th tch)
Ngng 1 khong ngn chu k k tip
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8/13/2019 CHNG 2 - H H HP
41/90
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8/13/2019 CHNG 2 - H H HP
42/90
S trao i kh ph nang
KK trong lng ph nang (phn p O2 caohn trong mu mao mch) ph bo I mng y ph nang mng y mao
mch t bo ni m mao mch (gnvi HC)
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8/13/2019 CHNG 2 - H H HP
43/90
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8/13/2019 CHNG 2 - H H HP
44/90
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8/13/2019 CHNG 2 - H H HP
45/90
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8/13/2019 CHNG 2 - H H HP
46/90
Cc thng s h hp
Nhp th: gm 1 ln ht vo, 1 ln th ra S ln th:
Bnh thng: 16-20 ln (>16t)26 ln ( 5-15t)
L triu chng quan trng chn on vimphi tr em
VP tr < 2 thng: >60ln/ph
VP tr 2-12 thng: >50ln/ph
VP tr 1-5 tui: >40ln/ph
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8/13/2019 CHNG 2 - H H HP
47/90
Cc thng s h hp
Dung lng phi: 4,5 5l ngi ln.Gm: Dung tch sng: khong 3,5l
V kh lu thng: ~ 0,5l vi sc th bnh thng V kh b sung: ~ 1,5l khi ht vo gng sc
V kh d tr: ~ 1,5l khi th ra gng sc
Th tch cn: ~ 1l 1,5l. L kh cn li trongphi sau khi th ra gng sc
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8/13/2019 CHNG 2 - H H HP
48/90
C ch iu ha h hp
C ch ha hc Vai tr ca CO2 trong mu rt quan trng
Nng CO2 tng s kch thch trung tm h
hp, nhng nu tng qu cao s c ch gyngng th
CO2 gim s lm gim nhp th, nu gimqu nhiu c th gy ngng th
iu ha ca v no: lm thay i tn s, su ca nhp th
iu ha ca phn x ngoi bin
Dy thn kinh X
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8/13/2019 CHNG 2 - H H HP
49/90
Bnh l h hp
Vim ng h hp trn Vim ph qun Vim phi
Lao phi Hen ph qun COPD (Chronic Obstructive Pulmonary Disease) Ph phi cp Bi phi Ung th
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8/13/2019 CHNG 2 - H H HP
50/90
BNH HC H H HP
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8/13/2019 CHNG 2 - H H HP
51/90
NI DUNG
Hen ph qun Bnh phi tc nghn mn (COPD) Trn kh mng phi
Vim phi cng ng Lao phi p xe phi
Suy h hp cp
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8/13/2019 CHNG 2 - H H HP
52/90
HEN PH QUN
Khi nim: Phn ng co tht, ph n, tit nhy ca ph qun
do nhiu kch thch khc nhau.
Biu hin c trng: kh th th th ra. Nguyn nhn ph bin: d ng
Triu chng:
Tin triu: ht hi, s mi, ho, nga mt Cn kh th c trng + kh kh, gim sau khi ho
v khc m.
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8/13/2019 CHNG 2 - H H HP
53/90
CLS: X quang, o chc nng h hp, kh mung mch, xt nghim m, in tim.
iu tr: ct cn Thng ng th (dn ph qun, ht m nht)
Th oxy
iu tr lu di Gii mm cm c hiu vi d ng
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8/13/2019 CHNG 2 - H H HP
54/90
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8/13/2019 CHNG 2 - H H HP
55/90
Hen ph qun
Co tht Ph n
Tng tit
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8/13/2019 CHNG 2 - H H HP
56/90
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8/13/2019 CHNG 2 - H H HP
57/90
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8/13/2019 CHNG 2 - H H HP
58/90
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8/13/2019 CHNG 2 - H H HP
59/90
BNH PHI TC NGHN MN
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8/13/2019 CHNG 2 - H H HP
60/90
BNH PHI TC NGHN MNTNH (COPD)
nh ngha: Ri lon thng kh tc nghn khng c kh nng hi
phc hoc phc hi rt km.
Lin quan n: kh ph thng v vim ph qun mn.
Yu t nguy c: Ht thuc l
nhim mi trng
Nhim trng h hp C a : thiu alpha-1 antitrypsin
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8/13/2019 CHNG 2 - H H HP
61/90
C ch sinh bnh Tn thng t ph qun ln n cc ph
qun tn
ng th nh tn thng vim mn tnh
Triu chng
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8/13/2019 CHNG 2 - H H HP
62/90
g Tin s ht thuc/ tip xc vi khi bi nhim
Ho khc m + kh th
Khm thy phi kh, tng p lc ng mch phi,ran m, n.
Lng ngc hnh thng
Kh th rt lm c h hp, k gian sn, hm c Cn lm sng (CLS)
Xquang
Chc nng h hp: tiu chun quan trng Kh mu ng mch
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8/13/2019 CHNG 2 - H H HP
63/90
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8/13/2019 CHNG 2 - H H HP
64/90
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8/13/2019 CHNG 2 - H H HP
65/90
iu tr Trnh cc yu t nguy c
V sinh mi hng thng xuyn
Thuc: dn ph qun, corticoid (xem xt li) Khng sinh: theo KS
Th oxy
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8/13/2019 CHNG 2 - H H HP
66/90
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8/13/2019 CHNG 2 - H H HP
67/90
TRN KH MNG PHI
TKMP: xut hin kh trong khoang mng phi. Nguyn nhn: v cn, bnh COPD, gin PQ,
hen, vim phi, ung th PQ
Triu chng: au ngc
Kh th, th nhanh nng
Ho khan
CLS: X quang
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8/13/2019 CHNG 2 - H H HP
68/90
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8/13/2019 CHNG 2 - H H HP
69/90
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8/13/2019 CHNG 2 - H H HP
70/90
iu tr: M mng phi, t ng dn lu p lc -20cm
nc.
iu tr nguyn nhn (nu c).
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8/13/2019 CHNG 2 - H H HP
71/90
VIM PHI MC PHI CNG NG
Khi nim: Nhim khun xy ra ngoi bnh vin Vim phi thy hoc vim phi khng in hnh
Nguyn nhn: vi khun, nm, virus Triu chng:
St cao > 39 C
au ngc vng tn thng Ho khan m c mu vng hoc xanh, mu gst
Triu chng khng rm r ngi gi yu, suy
gim min dch, ngi nghin ru. CLS: X quang, cy m tm nguyn nhn
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8/13/2019 CHNG 2 - H H HP
72/90
Bin chng: Trn kh, trn dch mng phi
Suy h hp, shock nhim trng
Xp phi
p xe phi, vim phi mn
Vim mng ngoi tim
iu tr: khng sinh + h tr
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8/13/2019 CHNG 2 - H H HP
73/90
Vim phi
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8/13/2019 CHNG 2 - H H HP
74/90
Vim phi
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8/13/2019 CHNG 2 - H H HP
75/90
Vim phi thy
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8/13/2019 CHNG 2 - H H HP
76/90
Ph qun ph vim
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8/13/2019 CHNG 2 - H H HP
77/90
LAO PHI
Bnh do trc khun lao ngi gy ra(Mycobacterium tuberculosis)
Do Robert Koch pht hin ra nm 1882
Ngun ly: ch yu l m ca bnh nhn
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8/13/2019 CHNG 2 - H H HP
78/90
Trc khun lao
VK lao ngi v VK lao b L loi trc khun, khng c nha bo, khng cn, khng
acid
u kh tuyt i, pht trin tt mi trng c phn p
Oxy cao Kh nng gy bnh ph thuc vo s lng BK v sc
khng ca c th
C kh nng t bin khng thuc
C sc khng cao vi cc thuc kh trng
B h i h l hi
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8/13/2019 CHNG 2 - H H HP
79/90
Bnh sinh lao phi
Ngun bnh: Ngi b lao phi c BK (+) Yu t nguy c
Suy gim min dch
Sau chn thng v sau phu thut
ng ly: ng h hp
ng tiu ha
42 %: khng ho
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8/13/2019 CHNG 2 - H H HP
80/90
26 %: khng triu chng
Triu chng St nh ko di (thng v chiu hoc m)
St cn, mt mi, chn n, ra m hi m.
Ho khan ko di ho m trng
Ho ra mu Kh th
CLS: X quang, cy m, xt nghim sinh hc
phn t (PCR) iu tr: khng sinh theo pht
Khng sinh thng dng iu tr lao:
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8/13/2019 CHNG 2 - H H HP
81/90
Streptomycin (S)
Izoniazid (H)
Rifampicin (R) Pyrazinamid (Z)
Ethambutol (E)
Cycloserin (CYC) Phc
2RHZ/4RH
2SHRZ/4RH 2ERHZ/4RH
D h
-
8/13/2019 CHNG 2 - H H HP
82/90
Phng lao cho cng ng Phng lao cho c nhn
Loi b ngun ly
Vaccin BCG
D phng
P XE PHI
-
8/13/2019 CHNG 2 - H H HP
83/90
nh ngha:
L m trong phi hoi t (cp tnh/ mn tnh) Khng do vi khun lao
Nguyn nhn:
Vi khun ym kh v i kh Nm, amip
Triu chng (lm sng v cn lm sng)
St, mt mi, st cn, thiu mu Ho, khc m c m/ ln mu, au ngc
Khm: g c, ting c mng phi
Cn lm sng:
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8/13/2019 CHNG 2 - H H HP
84/90
Cn lm sng: X quang: cho hnh nh p xe phi (k ~ 4-6cm)
Xt nghim m m tm nguyn nhn CTM: BC tng cao
Tc mu lng tng cao
iu tr Dng khng sinh
Dn lu p xe
Ch dinh dng y Cn bng nc, in gii
Gim au, h st
S h h
-
8/13/2019 CHNG 2 - H H HP
85/90
Suy h hp cp
L tnh trng t ngt suy gim chc nngh hp, dn n thiu Oxy mu, c hockhng tng CO2
tiu chun: Pa O2 < 60 mmHg
Pa CO2 > 50 mmHg
-
8/13/2019 CHNG 2 - H H HP
86/90
Nguyn nhn Tn thng thn kinh
Tn thng thnh ngc
Tc ng th Tn thng phi
-
8/13/2019 CHNG 2 - H H HP
87/90
Lm sng Kh th
Xanh tm u chi
Cc biu hin tim mch, thn kinh, cc duhiu ton thn
Cc bnh l km theo
-
8/13/2019 CHNG 2 - H H HP
88/90
CLS Kh mu
Sa O2 50 mmHg
XQ: vim phi, trn dch, trn kh mng phi,
ph phi,. ECG: lon nhp tim
Siu m: suy tim, TDMP
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8/13/2019 CHNG 2 - H H HP
89/90
iu tr: m bo tt thng kh v oxy mu
Duy tr kh nng chuyn ch oxy
Cung cp nng lng iu tr nguyn nhn
HT
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8/13/2019 CHNG 2 - H H HP
90/90
HT
