Asthma Day presentation template

H HP KY Bo co vin: ThS L Th Huyn TrangB mn Ni -i hc Y Dc TPHCM

NI DUNG TRNH BYGii thiu phng php o h hp knh gi kt qu h hp k.Phn tch kt qu h hp k.

NI DUNG TRNH BYGii thiu phng php o h hp knh gi kt qu h hp k.Phn tch kt qu h hp k.

H HP K (Spirometry)

NH NGHAHo hap ky la xet nghiem nham anh gia chc nang ho hap trong o benh nhan se thoi vao ong co bo phan nhan cam- noi vi may tnh- o lng khuynh ap t o tnh ra lu lng va the tch.

MY H HP K KOKO

MY O PH THN K

THC HIN O H HP K

KT QU H HP K

My Vmax Encore

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Ch nh h hp kAmerican Thoracic Society 1994Chn on: lng gi cc triu chng, du hiu lm sng hay cc xt nghim cn lm sng bt thngTriu chng: Kh th, kh kh, ngi th, ho, m, au ngcDu hiu lm sng: gim m th, lng ngc phnh, th ra chm, tm ti, d dng lng ngc, ran n khng gii thch c.Xt nghim cn lm sng: Gim Oxy mu, tng CO2 mu, a hng cu, X-quang lng ngc bt thng

Ch nh h hp kAmerican Thoracic Society 1994o nh hng ca bnh ln chc nng h hpKhm pht hin trn i tng c nguy c caoNgi ht thucNgi lm vic ni c cht c hiKhm sc khe nh kLng gi nguy c trc khi phu thutXc nh tin lng (ghp phi )Lng gi sc khe trc khi tp luyn

Ch nh h hp kAmerican Thoracic Society 1994Theo diLng gi tc dng tr liu:+ Dn ph qun+ Steroid trong suyn, bnh m k phi + Suy tim huyt+ Cc cas khc (khng sinh trong cystic fibrosis)Din tin bnh nh hng ln chc nng phi+ Bnh phi: bnh tc nghn ng dn kh mn tnh, bnh m k phi+ Bnh tim: Suy tim huyt+ Bnh c thn kinh: Hi chng Guillain-BarrTheo di ngi lm vic ni c cht c hiTheo di thuc c tc dng c hi vi phi

Ch nh h hp kAmerican Thoracic Society 1994Lng gi mc thng ttLng gi trong chng trnh phc hi y khoa, k ngh, pht mLng gi nguy c trong bo himLng gi c th trong gim nh y khoa+ Bo him x hi+ Lng gi thng ttSc khe cng ng+ iu tra dch t hc So snh tnh trng sc khe cc qun th dn cXc nh li than phin v mi trng hay ngh nghipLp cc phng trnh tham kho

Chng ch nh h hp kHo ra mu khng r ngun gc: th thut FVC c th lm tnh trng ny nng hnTrn kh mng phiTnh trng tim mch khng n nh, mi b nhi mu c tim hay thuyn tc phi: th thut FVC c th lm cn au tht ngc xu hn v lm thay i huyt pTi phng ng mch thnh ngc, bng hay no: nguy c v mch lu do tng p lng ngcMi phu thut mt: p lc nhn cu gia tng trong th thut FVCNhng ri lon cp lm nh hng n vic thc hin test nh nn, bun nnMi phu thut bng hay lng ngc

CC THNG S QUAN TRNGGin th tch theo thi gian

FEV1 (Forced expiratory volume in 1 second)Th tch th ra gng sc trong 1 giy u: ch s quan trng dng xc nh tc nghn, nh gi mc tc nghn v tin lng

FVC (Forced vital capacity)Dung tch sng gng sc. ngi khe mnh s bng VC (dung tch sng), nh hn VC nu BN b tc nghn ng dn kh

www.spiro-webCard.de

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CC THNG S QUAN TRNGVC ( vital capacity )Dung tch sng VC= VT+IRV+ERVCh s quan trng xc nh hi chng hn chIC (Inspiratory capacity )Dung tch ht voFEV1 (Forced expiratory volume in first second)Th tch th ra gng sc trong 1 giy u.Ch s quan trng xc nh tc nghn, phn mc v tin lng.

www.spiro-webCard.de

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CC THNG S QUAN TRNGng cong lu lng th tch

PEF (Peak expiratory flow)Lu lng th ra nhGip chn on, phn v theo di HPQ

FEF25, FEF50, FEF75 ( Forced expiratory flow at 25 %, 50%, 75% of the expiratory FVC).

FEV1www.spiro-webCard.de

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CC THNG S QUAN TRNG

FEF25-75 Lu lng th ra gng sc trong khong 25%-75% ca dung tch sng gng scCh s pht hin sm tc nghn bt u ng dn kh nh c k< 2mm.FIF 50 (Forced inspiratory flow at 50% of FVC)Lu lng ht vo gng sc trongkhong 50% ca dung tch sng gng sc.Thng dng nh gi tc nghn ng h hp trn

FEV1www.spiro-webCard.de

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CC THNG S QUAN TRNGCh s Tiffeneau : FEV1/VCL ch s quan trng xc nh HC tc nghnCh s Gaensler : FEV1/FVCc dng nh ch s Tiffeneau

Ga tr bnh thng ca cc thng s h hp chnh Vit ttTnTr s VCVital capacity : Dung tch sng> 80%FVCForced vital capacity : Dung tch sng gng sc> 80%FEV1Forced Expiratory Volume during 1st second: Th tch th ra gng sc trong giy u> 80%FEV1/VCCh s Tiffeneau> 70%FEV1/FVCCh s Gaensler> 70%FEF25-75Forced expiratory flow during the middle half of FVC: lu lng th ra khong gia ca dung tch sng gng sc> 60%PEFPeak expiratory flow: lu lng th ra nh> 80%MVVMaximal voluntary ventilation : thng kh t ti a> 60%

NI DUNG TRNH BYGii thiu phng php o h hp knh gi kt qu h hp k.Phn tch kt qu h hp k.

NH GI CHT LNG GIN Tiu chun chp nhnTnh lp liMurray & Nadels Textbook of Respiratory Medicine. 2010; vol 1; 522 553.

Tiu chun chp nhn c Khi u tt: Th tich ngoai suy < 5% FVC hoc 150 ml Kt thuc tt: Thi gian th ra > 6s (> 10 tui); > 3s (< 10 tui); hay ng th ra co binh nguyn > 1 s Khng co cac li ky thut khac:Ho trong giy u tin khi th raong np thanh mnGng sc khng lin tucKt thuc th ra smH khi qua mingng ngm bi tc khi ang th ra

Murray & Nadels Textbook of Respiratory Medicine. 2010; vol 1; 522 553.

A. PHN TICH GIAN Matthew J. Hegewald, Robert O. Crapo. Murray & Nadels Textbook of Respiratory Medicine. 2010; vol 1; 522 553.Gian th tich thi gian khng chp nhn c: khi u khng ttGian lu lng th tich khng chp nhn c: khi u khng ttGIAN CO KHI U TT KHNG ?

A. PHN TICH GIAN Matthew J. Hegewald, Robert O. Crapo. Murray & Nadels Textbook of Respiratory Medicine. 2010; vol 1; 522 553.Gian th tich thi gian khng chp nhn c: kt thuc khng ttGIAN CO KT THUC TT KHNG ?

A. PHN TICH GIAN Matthew J. Hegewald, Robert O. Crapo. Murray & Nadels Textbook of Respiratory Medicine. 2010; vol 1; 522 553.

Gian th tich thi gian khng chp nhn c: Ho trong thi th ra:Gian lu lng th tich khng chp nhn c: Ho trong thi th ra:ATS. Standardisation of Spirometry. Am J Rcspir Crit Care Med 1995; Vol 152; 1107-1136. CO HO, C BIT TRONG GIY U TIN KHNG ?

A. PHN TICH GIAN Matthew J. Hegewald, Robert O. Crapo. Murray & Nadels Textbook of Respiratory Medicine. 2010; vol 1; 522 553.Gian th tich thi gian khng chp nhn c: ong np thanh mnGian lu lng th tich khng chp nhn c: ong np thanh mnATS. Standardisation of Spirometry. Am J Rcspir Crit Care Med 1995; Vol 152; 1107-1136. CO ONG NP THANH MN KHNG ?

A. PHN TICH GIAN Gian th tich thi gian khng chp nhn c: gng sc khng lin tuc va kt thuc sm Gian lu lng th tich khng chp nhn c: gng sc khng lin tuc va kt thuc smATS. Standardisation of Spirometry. Am J Rcspir Crit Care Med 1995; Vol 152; 1107-1136. CO GNG SC KHNG LIN TUC KT THUC SM ?

A. PHN TICH GIAN Matthew J. Hegewald, Robert O. Crapo. Murray & Nadels Textbook of Respiratory Medicine. 2010; vol 1; 522 553.Gian th tich thi gian khng chp nhn c: H khi qua mingGian lu lng th tich khng chp nhn c: H khi qua mingATS. Standardisation of Spirometry. Am J Rcspir Crit Care Med 1995; Vol 152; 1107-1136. CO H KHI QUA MING KHNG ?

A. PHN TICH GIAN Matthew J. Hegewald, Robert O. Crapo. Murray & Nadels Textbook of Respiratory Medicine. 2010; vol 1; 522 553.Gian th tich thi gian khng chp nhn c: ng ngm bi tc do rng giaGian lu lng th tich khng chp nhn c: ng ngm bi tc do li chenNG NGM CO BI TC KHNG ?

Tiu chun lp lai c (sau khi at tiu chun chp nhn c)Sai bit gia hai FVC ln nht 150 ml hay 5%Sai bit gia hai FEV1 ln nht 150 ml hay 5%S ln thc hin khng qu 4 lnThi gian ngh gia 2 ln khng qu 1 pht

Murray & Nadels Textbook of Respiratory Medicine. 2010; vol 1; 522 553.

A. PHN TICH GIAN Gian th tich thi gian khng lp lai cGian lu lng th tich khng chp nhn cGIAN CO LP LAI C KHNG ?

ATS. Standardisation of Spirometry. AJRCCM 1995; Vol 152; 1107-1136

NI DUNG TRNH BYI. Gii thiu phng php o h hp kII. nh gi kt qu h hp ky.III. Phn tch kt qu h hp ky.

MC TIU C H HP KC ng k thut khng ? Kt qu c bnh thng khng ?X 20%x 1,64 Thuc loi ri lon no ?

Hn ch: TLC gim (F)VC < 80% d onFEV1 > 80% d onFEV1/(F)VC bnh thng hay tng% (F)VC d onBc hn ch < 80 601 nh < 60 402 trung bnh < 403 nng

CC NGUYN NHN CA HI CHNG HN CH PAINTP. Bnh mng phi:Trn kh mng phiTrn dch mng phiDy mng phi

Bnh Nhu m phiSarcoidosisVim phi qu mnX phi do :Thuc: busulfan (K), nitrofurantoin (AB), amidarone (chng lon nhp), bleomycin (K) v cc thuc chng K khcOxygen liu cao ng c, ha xParaquat: x phi nhanh, t vongX tr vng phiBnh collagen:Systemic sclerosis (scleroderma)Lupus Vim khp dng thpLymphangitis carcinomatosaCC NGUYN NHN CA HI CHNG HN CH PAINT

I.X phi m k lan taN. Bnh c thn kinh: Vim ty sng, h/c Guillain-Barr, nhc c nng, teo cT.Bnh lng ngc Vo ct sngVim ct sng dnh khp (Ankylosing Spondylitis)

CC NGUYN NHN CA HI CHNG HN CH PAINT

Nghn tc: FEV1/(F)VC < 70%% FEV1 d onBc nghn tc < 80 601nh < 60 402 trung bnh < 403 nng

PHN GIAI ON THEO GOLD

Bnh nhn vi FEV1/FVC < 0,70GOLD 1: nhFEV1 80% tr s d on

GOLD 2: trung bnh50% FEV1 < 80%

GOLD 3: nng30% FEV1 < 50%

GOLD 4: rt nng30% < FEV1 tr s d on

NGUYN NHN CA HI CHNG TC NGHN OWLO. Bn ngoi ph qunPh hy nhu m phi lm gim lc ko gin n ph qunB hch hay khi u pPh quanh ph qun

W. Do thnh ph qunDy ln trong vim phi, vim ph qun do ph i cc tuyn.Co tht c trn trong suynVim: COPD, vim ph qun mn, suynX, so: COPD

NGUYN NHN CA HI CHNG TC NGHN OWL

L. Do bn trong lng ng ph qunBt tc do qu nhiu cht tit:Vim ph qun mnHen suynCOPDPh phiHt phi vt l ng cht tit hu phu

NGUYN NHN CA HI CHNG TC NGHN OWL

ng cong gi tc nghn ng h hp ln

Tc nghn ngoi lng ngcTc nghn trong lng ngcTc nghn c nh

Robert E.H, Paul D.C Interpretation of pulmonary function test. 2003

Tc nghen thay i ng h hp trn trong lng ngcM.R. Miller, J. Hankinson, V. Brusasco. Standardisation of spirometry. ERJ 2005; 26: 319338. GIAN CO GI Y BNH GI KHNG ?

Tc nghen thay i ng h hp trn ngoai lng ngcTc nghen c inh ng h hp trn

Bc 1FVC hay VC MVV cng tuy nhin khng cn ng theo t l trnKhi FEV1 bt, MVV th c th:Hp tc khng tt: khng gng sc, ho, yu cBnh thn kinh cTn thng ng h hp lnBo phRobert E.H, Paul D.C Interpretation of pulmonary function test. 2003

Bc 5nh gi test dn ph qun:Bnh nhn c xt 400g Salbutamol , 15 pht sau o li h hp kC p ng test dn ph qun khi bnh nhn c 1 trong 3 tiu ch sau:

FEV1 12% v 200 ml (ATS)

FVC hay VC 12% v 200 ml (ATS)

PEF > 20% (GINA)

Robert E.H, Paul D.C Interpretation of pulmonary function test. 2003

Bc 6nh gi kh nng khuch tn qua mng ph nang mao mch DLCODLCO DLCO btDLCO Phi btHenTn thng ng hh lnBo phHenXut huyt ph nanga hng cuShunt T-PPh i mm phiHn ch Kh ph thngBt thng mm phiVPQMSuy timHen Robert E.H, Paul D.C Interpretation of pulmonary function test. 2003

H Hp K Bnh Thng

HEN

COPD

Tc nghen thay i ng h hp trn trong lng ngcM.R. Miller, J. Hankinson, V. Brusasco. Standardisation of spirometry. ERJ 2005; 26: 319338. GIAN CO GI Y BNH GI KHNG ?

Tc nghen thay i ng h hp trn ngoai lng ngcTc nghen c inh ng h hp trn

Hp kh qun do d dng ph qun

Hp kh qun do d dng ph qun

Hp kh qun do vng mch mu

Hp kh qun do bu gip chn p

Hp kh qun do bu gip chn p

Mm sn kh qun

Hp kh qun sau t NKQ

Hp kh qun sau t ng KQ

So hp kh qun cch dy thanh 5cm lm hp gn hon ton lng kh qun

CHN THNH CM N