1.3 Tinh chat - Ho nhieu hay it - Ho ban dem hay ban _ TV nhien ho hay nhiem lanh r6i ho - Ho lien t\1Chay tung con, - Ho khan hay co dorn _ Ho khan hay 6ng 6ng (am s~c cua tieng ho) 1.4 fJi!c diem b~nh Iy _ Ho kern thea ngua hong g~p viern hong, viern amidan, phe quan, lao quan, _ Eo khan kh6ng co dorn: g~p benh viern quan, viern ph6i giai dean d~u, tran mang ph6i viern quan, viern khf _ Ho khan: g~p viem - quan _ Ho kh6ng tieng: g~p bach h~u quan _ Ho hit vao nhu ga gay: g~p ho gao _ Ho kern thea khac mau do: g~p lao ph6i, gian phe' quan, ung thu ph6i,.ung thu phe quan, hep van lao _ Ho kern thea khac mau mall h6ng 1~n bot va kh6 thd du doi: g~p hen tim, phu ph6i cap _ Ho mau set danh khac luong mau nhieu tu 1-2 lit g~p lao ph6i Kh~c dam 2.1 fJinh nghia Ddm 1a chflt dich nh~y tiet tu dtioi n~p quan, ph6i du, _ Ph6i hoi due g~p viern mang ph6i, day dinh rnang ph6i _ Ph6i qua trong: g~p tran mang ph6i, gian phe nang, lao hang Nghe ph6i N ghe b&ng ong nghe ho~c ap sat tai VaGngl,tc 4.1 Binh thU'd'ng Ri rao phe nang em diu thd VaGva thd 4.2 B?nh Iy _ Ri rao phe nang giam ho~'c mat g~p tran d~ch mang ph6i, tran - ,-~- mung ph6i .= ~''_ -~- N~ = ~ -~~"=-==:: - :=='] -c:=-= -= =-ghe tieng th6i d ph6i -== _= _ _" -==-~==~==J._= -_ - 73 + 'I'ieng' th6i ang: viem ph6i thuy, + Tieng th6i hang: lao hang, ap xe ph6i + 'I'ierig' th6i vo: lao hang 9c mau rnu + 1'ieng th6i marig ph6i: tran dich mang ph6i Chu y: brnh thVdng: di qua khf quan quan va phe' quan gac se phat tieng th6i quan, tieng khong truyen qua 16ng nguc co hien tuong ph6i dong dac, tran djch mang ph6i, hang to d ph6i Tieng' th6i quan truyen l6ng nguc tieng th6i Nghe tieng C9 mung ph6i Do 1li thauh 18.tang cua mang ph6i C9 sat vao gay nen tieng co marig ph6i - Nghe tieng ran , + Ran kh6 gom ran rft, ran ngay, ran n6 g~p hen phe' quan, + Ran vat: gam ran Vat, ran ~m III PHUONG PHAp THAM DO CAN LAM SANG BO MAy HO HAP ' Xet nghi~m Xet nghiern dorn 'tim vi khuan bang phuong phap soi ddm ho~cnu6i cay Xet nghi~m dich chQc mimg ph6i ChI;JpXquang ph6i Soi phe quan Chyp phe quan co born thuoc cim quang Sinh thiet nhu rna ph6i, soi te bilO IV SUY HO HAP Djnh nghia Suy h6 hap lit tinh tr9-ng b¢nh 1y cua h 30 _g£_J_ li_~t 84 _ Nguyen nhan 2.1 Nguyen nhan nguyen phat Do vi khu~n gay benh d mang ph6i: phe' cau ho~c tu cAu, lien c~u, vi kh uan yern Ramosusfotidis 2.2 Nguyen nhan h~u phat - Do nhiern khuan duong ho hap: ap xe ph6i vd van mang ph6i - Benh duoi co hoanh: ap xe gan vd len mang ph6i - Sau phjiu thuat 15ng nguc bi b9i nhiem Tri~u chang 3.1 Trieu chLi'ng lam sang 'I'rieu chung tcan than: h9i chung nhiern khuan - Sot cao d9t ngct, - Nhiet d9 tang tu 39°C - 40°C - Th~ trang g:1Ysut, an kern, nguoi met moi Trieu chung co nang - Dau nguc: + Ben mang ph6i viern + Vi tri dau: sau xucng uc hoac duoi vu hcac dudi nacho + Dau tang ho va thd sau - Kh6 tho: + Kh6 thd hai thi: bao g5m ca thi tho va hit vao, + Kh6 thd phu thuoc van muc d9 tran dich, ne'u tran dich nhieu kh6 thd nhieu, tran dich it kh6 thd it - Ho: + Ho khan kh6ng c6 ddm + Ho tang thay d6i tu the' Tri~u chung th\iC th~: (kham ph6i c6 h9i chung giam) - Nhin: + L5ng ng\ic ben tran dich nh6 cao + Khoang lien ·sltdn gian r9ng -. .-~~~~ -~-. - 85 + Co hoanh kh6ng di d9ng theo nhip tho So: rung giarn hO:IlCmat - Go: due, - Nghe: ri rao phe nang giarn hoac mat 3.2 Trieu chUng c~n lam sang Chup X quang ph6i: rnuc d9 tran dich, a Tran dich it: gee suon hoanh til va rno d day ph6i b Tran dich trung binh: rno 2/3 ph6i co duong' cong rna phfa lorn quay len tren c Tran dich nhieu: rno deu toan b9 ph6i ; a Tran djch nhe c Tran dich nhieu b Tran dich trung binh Hinh 22 Hinh anh x quang ella tran djch mang ph6i Choc mang ph6i - XN dich ehoe do: dich due la rnu ,: - Xet nghiern sinh hoa: albumin> 30g/ lit - Xet nghiern te bao: bach cau da nhan trung tfnh tang - Xet nghiern vi khuan: tim phe eftu, tu cftu hoac lien cau khuan yem gay hoai tv rnang ph6i Ramosusfotidis Mau: h6ng cau giam, b?ch ellu tang, toe d9 mau lAng tang Tien tri~n - Ch~n doan sdm dieu trftieh tuA:n· -·r ". 86 e1.Jcb~nh tien tri~n tot khoi b~nh tu - _ Chan dean dieu tri muon benh keo dai, lau khoi d~ l:;ti di chung day dinh mang ph6i - Benh nang ttl: vong suy h6 hap va bien chung Bien chung - 5.1 Bien chUng t~i chO (T~i phDt) - Viern day dinh mang ph6i - Xep ph6i - Viern phoi, _ Thung Ia tang (gay 16 ro mang ph6i phe' quan til d6 gay khai mu) _ Thung la (gay tui mu tren nguc til d6 ro mu ngoai), 5.2 Bien chUng xa ,'; Ap xe nao ' - Viern mang nao mu, Viern mang ngoai tim Dieu tr] 6.1 f)hj'u tri 119i Dieu tri trieu chung _ Choc thaomu giiip b~n1i nhan d~ thd, h1n choc til,300ml - 500 ml Tuan choc - lfin Born rtl:a rnang ph6i b{lng dung dich natriclorua 9%0 _ Ha sot, giarn dau nguc: analgin 0,50g x v/ngay ho~c Paracetamol - vienl Giam ho - An thfin Dieu tri nguyen nhan - Khang sinh lieu cao tac d\lng di~t vi khufln: + Penicillin: 15000.000 - 20.000.000 UII24h, ket h