D VT NG TH

I-

I CNG:
D vt ng th l nhng vt khng phi l khng kh ri vo thanh kh ph qun gy
ra nhiu bin chng nguy him.
D vt ng th l mt cp cu TMH thng gp, nu chn on v x tr khng kp
thi d gy t vong. Loi d vt l:
- Ht: u phng, mng cu, saboche,..
- Xng c, vy c, vy c,.
- Np bt,.
IILM SNG:
in hnh ca d vt ng th l hi chng xm nhp. l mt phn x bo v ca
c th tm cch tng d vt ra ngoi (bnh nhn kh th, tm ti, ho sc sa).
1. D vt thanh qun:
- Kh th thanh qun:
+ Kh th chm
+ Kh th ht vo
+ Kh th c ting rt
- Khn ting hay mt ting
2. D vt kh qun:
- Kh th c 2 th
- C th to nn ting lt pht c bay
3. D vt ph qun:
- Tc ngc, au ngc
- Cm gic kh th mt bn phi
4. D vt b qun:
Triu chng ging vim ph qun mn tnh hoc lao phi
III- CHN ON:
Ty theo tnh cht ca d vt, v tr ca d vt, bnh nhn n sm hay mun m c cc xquang phi thng, nghing
IV- IU TR:
1. Soi thanh kh - ph qun:
- Gy m tnh mch km s dng thuc gin c
- Soi bng ng cng ngun sng lnh
- Kim gp d vt cc c
- Ngay sau khi soi ly c d vt, cn phi soi li ngay kim tra

Ch dng que bng tm Adrenalin cm mu v lm co nim mc kh ph qun

trc v sau khi ly d vt
2. iu tr v theo di ton thn:
- Chy mu trong lng kh - ph qun: cn soi li kim tra
- Kh th
- Theo di bin chng
- Corticoide liu cao ng tnh mch
- Cephalosporin - Th h III: Cefotaxim, Cefpodoxim, Cefixim, Cefetamet
- Gim au
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3. Vn m kh qun:
c ch nh c kh th thanh qun II, III
Kt lun:
- Bnh thng gp tr em hn ngi ln
- y l bnh nguy him cn x tr ng lc, kp thi
- Bnh c th phng nga c, cn ch khi cho tr n cc loi tri cy c ht, thc
phm c xng, khng ngm vt trong khi lm vic.

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D VT THC QUN
I- I CNG:
D vt thc qun l mt cp cu thng gp. Nu khng c chn on v iu tr
sm d gy nn cc bin chng nguy him.
D vt thng l:
- ng vt: xng c, xng g, xng heo,
- Thc vt: cc loi ht
- Kim loi: kim ty, inh, hm rng gi
II- LM SNG:
-Ty theo bn cht ca d vt m cc bnh l thc qun s khc nhau
- Ty theo bnh nhn n sm hay mun m bnh cnh lm sng s khc nhau:
1. Giai on u:
Ngay sau khi nut phi d vt, kh nut, nut au. Triu chng tc nghn l chnh.
2. Giai oan th hai:
Viem thc quan abcess di niem mac thc quan. Thng xuat hien sau 24gi.
Trieu chng: sot, nuot au, chay nc mieng nhieu
3. Giai oan th ba: ( giai oan bien chng )
Viem tay quanh thc quan, co tui mu ngoai thc quan, abcess canh co, viem trung
that, thung ong mach ln,. Thng xuat hien muon hn, sau 5-7 ngay.
III- CHAN OAN:
- Da vao trieu chng lam sang thi gian en sm hay muon
ma xac nh chan oan cac giai oan co dau hieu nang nhe khac nhau
- Trieu chng x-quang:chup co thang, co nghieng, phoi, quan sat o cong sinh ly, cot
song co, khoang HenKe, tm hnh anh can quang cua d vat, quan sat trung that
- CT scanner co-ngc oi vi nhng trng hp nang va kho quan sat c d vat
- Noi soi thanh quan ong cng , noi soi thc quan ong mem kiem tra
IV- IEU TR:
1. Giai oan sm:
- Soi thc quan trc tiep di gay me hoac gay te e gap d vat, sau khi lay c d
vat ra ngoai, kiem tra lai long thc quan, neu thay bnh thng th cho benh nhan
xuat vien khong can dung thuoc.
- Neu niem mac thc quan tray sc nghi ng thung th at tube levin, nhap vien theo
doi trong 3 ngay. Thuoc:
+ Cephalosporin Th h III: Cefotaxim, Cefpodoxim, Cefixim, Cefetamet
+ Giam au.
+ Sinh to.
D vat thc quan vao theo ng t nhien cung co the lay qua ng t nhien. Tuy
nhien van co th co nh ng trng hp khong lay c d vat nh trng hp ham
rang gia ln co moc kim loai, khi o phai can thiep phau thuat.
- D vat oan co: mo canh co, boc lo thc quan, rach thc quan tm lay d vat.
- D vat oan ngc: phoi hp vi phau thuat long ngc.
2. Giai oan muon :

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Ngha la co abces canh co. Phai tien hanh phau thuat m canh co e dan lu mu
ong thi tm lay d vat ni thung thc quan, sau khi mo e vet thng h, at
Tube levin, thay bang vet thng hang ngay thuoc.
+ Cephalosporin - The he III: Cefotaxim, Cefpodoxim, Cefixim, Cefetamet 3g
6g/ ngay tnh mach
+ Corticoide
+ Giam au
+ Sinh to
- Khi abces qua ln chen ep thanh kh quan th nen m kh quan trc o e kiem
soat ng th.
- Thng ong da vet thng th 2 sau 1 tuan ong thi rut tube levin va soi kiem tra
lai thc quan.
- Bien chng nang hn khi abcess canh co a lan xuong trung that. Ton thng mach
mau ln trong trng hp nay phai phoi hp vi phau thuat long ngc hoac ngoai
mach mau.
- Theo doi dien bien cua benh nhan:
+ X-quang phoi va th cong thc mau thc hien 2 ngay/1 lan
+ Lam sang

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CHAN THNG THANH KH QUAN

I-

I CNG:
Chan thng thanh kh quan la do mot vat the tac ong trc tiep vao vung thanh
kh quan hoac do ht phai khong kh co nhiet o khong bnh thng ( qua nong, qua
lanh ) hoac hi hoa chat lam ton thng en cac to chc sun cua vung nay.
II- TIEU CHUAN CHAN OAN:
1.
Tieu chuan lam sang:
a) Tham kham lam sang:
Tat ca nhng benh nhan co benh s chan thng vung co trc nen c
tham kham va chu y tm thng ton thanh kh quan.
Trieu chng thng co la: khan tieng hay oi giong, kho nuot, nuot au,
kho th hay au vung co trc. Nhng benh nhan nay neu co kho th nhieu th cho
biet co nhng ton thng nang.
Nhng dau hieu tham kham thc the nh: th rt, tran kh di da, khac
mau, nhay au vung thanh quan, mat o loi cua sun giap, tu mau hay phu ne da
ben ngoai. Th rt th ht vao lien quan vi tac nghen thng thanh mon va th rt
th th ra thng tac nghen ha thanh mon. Trong khi th rt 2 th ton thng la
ngang ngng hai day thanh.
b) Noi soi thanh kh quan:
Khi ng th on nh nen soi thanh quan bang ong mem e anh gia
mc o ton thng thanh kh quan nh: o c ong cua day thanh, phu ne, rach, tu mau
niem mac. Nhng chan thng i kem nh: ton thng cot song co, ton thng thc
quan, ton thng mach mau phai c xem xet va anh gia ky.
2. Tieu chuan can lam sang:
a) X-quang:
X-quang co t the thang, nghieng
b) CT scanner:
CT scan co li trong cac trng hp ma soi ong mem b gii han do phu ne. Ngi ta
co the s dung CT scan trong hau het cac trng hp hoac ch s dung khi ket qua lam
sang khac vi ke hoach ieu tr.
Co the khong chup CT scan trong nhng trng hp chan thng thanh quan nang ma
can mo m ra xem va m kh quan hay nhng trng hp nhe ma khong co dau hieu
thc the. Hau het trng hp mc o trung bnh nen khuyen cao chup CT scan, chup
baryte thc quan hay chup mach mau can quang neu co ch nh c.
III- IEU TR:
1. ieu tr noi khoa:
Khi au co the ieu tr noi khoa hay phau thuat c ban da tren phan loai thng
ton c xac nh da tren tham kham thc the va CT scan.
Mot benh nhan c ieu tr noi khoa neu thng ton hoi phuc c ma khong can
can thiep phau thuat va thng la benh nhan co ng th on nh.
- Thng ton thng co:
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1. Phu ne
2. Tu mau t, niem mac con nguyen ven
3. Rach nhe thng thanh mon hay thanh mon. Khong lien quan b t do cua day
thanh hay mep trc khong boc lo sun.
4. V sun giap n gian khong di lech, chu y ngay khi v gap goc khong di lech,
n gian co the tao nen thay oi day thanh tinh te.
ieu tr noi khoa theo trnh t:
+ Theo doi sat tnh trng ng th 24gi
+ Khong noi chuyen, gap co, th oxy am
+ Khang sinh dung khi co xe rach niem mac thanh quan: Cephalosporine th h II:
Cefuroxim
+ c che Histamin H2 lam giam mc o thng ton t phan xa trao ngc dch v
da day
+ S dung steroid toan than giai oan sm e giam phu ne niem mac.
2. ieu tr phau thuat:
Chan thng h la can mo m rong hn la chan thng kn.
Nhng benh nhan co thng ton nang c a vao phong mo e soi thanh kh phe
thc quan trc tiep. M kh quan neu co ch nh.
Nhng thng ton can phai mo va m thanh quan e tai tao lai bao gom:
1. Rach lien quan b t do day thanh hay mep trc.
2. Rach niem mac nhieu, boc lo sun
3. V sun di lech nhieu
4. Di lech sun pheu
5. Bat ong day thanh
Khi mo boc lo thanh quan nen c thc hien ngay 24gi sau chan thng.
IV- BIEN CHNG:
Hnh thanh mo hat la 1 bien chng ngay tc th pho bien nhat.
Dnh thanh mon mep trc.
Chan vt mep sau hay seo lien pheu.
Hep thanh kh quan
Hep ha thanh mon.
Liet vnh vien tao nen giong noi khong u.
V- KET LUAN:
Viec xac nh ton thng thanh quan quan trong la chan thng kn, chan thng
h.
Mot benh s chan thng vung co kem vi khan tieng, au, th rt, mau tu hay
tran kh di da nen kiem soat ng th va anh gia chan thng thanh quan.
Chuan b nay gom soi thanh quan phe quan bang ong cng va soi thc quan.
ieu tr da tren v tr va mc o cua ton thng.
La chon ieu tr bao gom ieu tr bang noi khoa vi theo doi sat va ieu tr phau
thuat m co at stent hoac co khong at stent.

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KHO TH THANH QUAN NGI LN

I- I CNG:
La tnh trang kho th xay ra th ht vao co the co kem theo tieng rt vung thanh
quan, co lom vung hom c, thng on do s gang sc cua cac c ho hap phu. Tuy
mc o nang khac nhau nhng co the co anh hng en tnh mang cua ngi benh neu
khong can thiep kp thi.
II- TIEU CHUAN CHAN OAN:
1. Tieu chuan lam sang:
- kho th th ht vao co rt, nhng bieu hien co lom tren hom c, tren xng on,
khong lien sn.
- Giong noi thay oi: khan, re
- Kho nuot, chay nc bot.
- S thay dau hieu v thanh quan
- Tran kh di da
- Phu Quink
- U vung co (hach)
- Tham kham cac dau hieu benh ly cua phoi.
2. Tieu chuan can lam sang:
Sau khi a am bao cho benh nhan s ho hap tam on nh
- Kh mau
- Cong thc mau
- Chup phoi thang
- CT scan thanh quan nham phat hien ra nhng benh ly bat thng
3. Dau hieu benh nang:
- Xanh tai, tim ap nhanh, chay mo hoi
- Phai t the ngoi
- Th co keo tren 1 gi
- Xanh tm: dau hieu muon
- Neu co chay nc mieng = viem thanh thiet
- Disphagie fabrile
III- CHAN OAN NGUYEN NHAN:
- Viem va nhiem trung, ac biet la viem thanh thiet cap: thng xay ra ngi tre,
tong trang nhiem trung, giong noi ngam hot th, kho nuot, chay nc mieng ra
mieng.
- U bu (lanh hay ac tnh): thng xay ra, vi nhng khoi u ac tnh thng la
nhng ngi ln tuoi (55 60) nghien ru va hut thuoc la vi bieu hien kho th
tien trien t t nhieu ngay hay nhieu thang. Kham tong quat phat hien benh nhan
thay oi suy sup tong trang, kho noi, kho nuot va kho th ngay cang tang dan, xuat
hien hach co.
- Nguyen nhan chan thng: Chan thng t ben ngoai, sau at noi kh quan, sau xa
tr
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- Thng ton than kinh: liet than kinh hoi qui ngoai bien 2 ben, liet thanh quan
trung ng (hoi chng Gerhart) thng la roi loan than kinh cua cau nao.
- Co that c tren mot so c a: tetanie, hysterie, cng giap
- D vat thanh quan
Luon phai kham tai mui hong e chan oan chnh xac can nguyen trc mot benh
nhan co trieu chng kho th thanh quan.
IV- IEU TR:
- Cho benh nhan th oxy
- Dung corticoide:
+ 150mg Methyl Prednisolon hoc Hydrocortisone tiem tnh mach, co the dung lai
30 phut neu cha ap ng u
+ Hoac Depersolone 30mg: 1 ong tiem bap
- Neu benh nhan khong giam kho th nen chuyen en cap cu benh vien
- am bao s lu thong ng th: nen lam trong ieu kien phong mo, co u cac
dung cu can thiet nh ong noi kh quan, ong soi thanh kh quan, dung cu m kh
quan.
- Luon luon nen at ong noi kh quan trc, neu nh tac nghen en mc nghiem
trong khong at c th phai m kh quan.
- Choc kim so 12 vao gia mang giap nhan: cung co gia tr giup benh nhan th
trong khoang 10 phut trc khi tien hanh c m kh quan.
Mot so ieu can nen tranh:
- Trng hp kho th nang hay a keo dai, moi thao tac vung hong can nen tranh
(e li), cung nh nhng thay oi t the co kha nang dan en ngng tim ngng th
- Khong nen bat benh nhan nam, nen e ho t the na nam na ngoi sao cho de
chu nhat, khong keo dai cac xet nghiem.

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VIEM THANH THIET CAP

I- I CNG:
Viem thanh thiet cap la mot tnh trang viem mo te bao cap tnh nguy hiem tnh mang
vung tren thanh mon. Benh co the xay ra tren moi la tuoi nhng thng gap nhat tre
em t 1 6 tuoi, tien trien nhanh trong vong 12- 24 gi, nhng trng hp noi bac la:
sot, tnh trang nhiem oc, au hong, bt rt, kho noi, kho nuot, chay nc mieng, co
the co nhng dau hieu ngng ho hap. ngi ln benh nhan kho nuot va au hong,
cac dau hieu lam sang khong tng hp vi chan oan ban au. Kho th co the xay ra
nhng t gap.
II- KHAM LAM SANG:
- Kham bang e li: nhn thay b cua thanh thiet day, o. Thanh thiet to che khuat
ca thanh mon, tren be mat co the co mu va mong, phu ne (hnh anh mom ca me)
- Cung co the kham benh nhan bang gng nhn gian tiep hay kham bang optic cung
co nhng hnh anh tng t.
III- CAN LAM SANG:
Phim co nghieng: thay thanh thiet day len bat thng.
IV- IEU TR:
- Cho benh nhan t the ngoi. Nhap vien
- Theo doi chat che tnh trang tri giac, ho hap, dau hieu sinh ton.
- am bao ng ho hap
- Th oxy 4 6 lt/phut
- at ong noi kh quan, mot so trng hp phai m kh quan cap cu.
- Corticoid: Hydrocortisone hoc Depersolone 30mg x 2 ong
- Khang sinh:
+ Cephalosporine: - Th h II: Cefuroxim 1,5g IV moi 8 gi
- Th h III: Cefpodoxim, Cefetamet ung 1g x 2/ngy
+ Hay Ceftriaxone 2g IV trong 24 gi
Thi gian dung khang sinh t nhat la 7 8 ngay
I- TIEN TRIEN VA TIEN LNG:
- Tien trien tot neu cac dau hieu lam sang giam dan.
- CTM tr ve bnh thng, benh nhan co the ra vien sau 7 10 ngay.
- Neu benh tien trien nhanh va khong c theo doi sat cua y te benh nhan co the t
vong.

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P XE QUANH AMIDAN
I. I CNG:
-

p xe quanh amidan l s nung m ca t chc lien k lng lo bn ngoi bc amidan.

Tc nhn: + Vi khun ym kh c t l cao (75%)

+ Vi khun hiu kh: Streptococcus pneumonie, Hemophilus influenza,
Staphylococcus aureus.
I. LM SNG:
1. Chn on:

Khi u bng au hng, au lan ln tai

St 39 400C, b mt nhim trng.

Chy nc bt, ging ngm ht th.

Hi th hi.

H ming hn ch.

Khm: hng , li g b y lch 1 bn, tr trc amidan sng phng v amidan to y vo

trong.
2. Cn lm sng:

Xt nghim mu: bch cu tng

Pht hng hay chc ht m tm vi khun v lm khng sinh .

III. IU TR:

Khng sinh ph rng: ty theo mc ca bnh la chn khng sinh cho ph hp

+ Curam 1g 1 l x2 TMC
+ Cephalosporine th h II, III:
Th h II: Viciroxim (Cefuroxim) 1,5g 1 l x 2 TMC/ngy
Th h III: - Cefotaxim 1g 1 l x2TMC/ngy
- Ceftriazon 1g 1 l x 2 TMC/ngy
- Thi gian iu tr 5 7 ngy
- Kt hp thm Metronidazole 500mg/100ml 1chai x2 truyn tnh mch/ngy
- Khng vim chng ph n: Corticoid dng ung hoc tim tnh mch.
- Gim au, h st: Paracetamol 30 40mg/kg/ngy ung hoc truyn tnh mch.
- Rch dn lu m.
- Nng tng trng.
- Ct amidan sau 3 thng.

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NHIEM TRUNG CO SAU

I. I CNG:
La nhiem trung cua cac khoang co tao nen bi can co sau, gay hau qua nghiem trong
nh nhiem trung huyet, nhiem oc, chen ep cap tnh ng th, viem tac cac mach mau
va ac biet nhiem trung co the lan rong gay nen viem trung that, tran mu trung that,
mang phoi va la benh co ty le t vong cao.
II. NGUYEN NHAN:
Do tap trung, ca vi trung gram (+), vi trung gram (-) va vi trung k kh. Cac vi trung
thng xuyen co trong hong, ap xe rang li, amidan, viem xoang, chan thng vung hau
hong, nhiem trung hach co hay t cac khoang co ben canh
Cac loai vi trung thng gay benh: Staphycocci, streptococci, H.Influenzae va cac vi
trung k kh.
III. HOI VA KHAM LAM SANG:
- Benh s co tien can nhiem trung:
+ O nhiem trung t rang (thng rang ham 2-3 di)
+ Nhiem trung t amidan
+ T cac nguon khac: tuyen mang tai, tuyen giap, viem xng chum, viem hong,
nhiem trung t cot song co, viem hach co
+ Chan thng vung co mat
- Nhn g dau hieu lam sang:
+ Tong trang nhiem trung nhiem oc
+ Sng cac vung co mat co lien quan (khoang ben hong va di cam thng hay b
anh hng nhat). S kho phat hien tnh trang co tch tu mu ben di.
+ Kho th neu ng th b chen ep
+ kho noi, nuot au, chay nc bot
+ Kht ham, xoay co kho khan
+ Tim ap nhanh, co the ri vao tnh trang choang
V- CAN LAM SANG:
- Cong thc mau: bach cau tang > 10.000
- X-quang t the co thang va nghieng: xem d vat trong thc quan va chieu day
khoang Henke (can trc cot song co)
- Sieu am: giup chan oan va nh v choc do
- CT scan co can quang : rat co gia tr
- MRI: giup xem ton thng phan mem
VI- IEU TR:
- Benh nhan can c nhap vien ieu tr sm theo doi sat (che o san soc ac
biet)
- ap ng ieu tr noi n thuan: ch 10-20% benh nhan, hau het can ket hp ieu tr
ngoai khoa
- Choc hut mu co gia tr chan oan chnh xac, nhng khong co gia tr thay the cho
ieu tr phau thuat rach rong dan lu.
- Khang sinh: phai da tren khang sinh o
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Trong trng hp cha co khang sinh o nen dung khang sinh pho rong nh sau:
+ Amox/Acid clavulanic: Augtipha 562,5mg, claminate 625mg
+Hoac Cephalosporin the he III: Cefpodoxim, cetamet hoc Ceftriaxone (2g x2 lan
tiem tnh mach trong 24 gi)
+Luon luon dung phoi hp vi Metronydazol 500mg (100ml) x 2 lan/ngay
Thi gian s dung khang sinh: 3-4 tuan
+ Duy tr ng ho hap
+ at noi kh quan < 24 gi
+ M kh quan: han che tnh toan
+Can bang nc va ien giai
- Phau thuat: trong trng hp o nhiem trung ln gay chen ep va bien chng hay
dung khang sinh trong 24 gi ma khong hieu qua
- Phau thuat dan lu va lam sach o nhiem trung: rach rong (hnh canh cung hay hnh
ch U i qua 2 mom chum) M rong cac khoang va cat het cac mo hoai t dan lu ap
xe, dan lu trung that ti ra lien tuc bang nc co pha nuc oxy gia (H2O2). e h
vet thng va thay bang hang ngay.
- Phau thuat tao hnh khi benh on va mat chat nhieu.
VII- TIEN LNG:
- La benh ly nhiem trung co tien lng song con
- Tien trien rat nhanh
*Tien lng tot:
- Benh nhan giam cac trieu chng trong vong 24-36 gi
- Bt sot
- Giam au
- Cong thc mau bach cau giam ve gan bnh thng
*Khong tot:
- Viem hoai t cac lp can mac, tac cac mach mau => Lan rong + t vong
- Viem trung that
- Sot cao, au nhoi ngc
- Sng ne, s lao xao vung xng c
- Kho th, nhp tim nhanh
VII- CHAN OAN PHAN BIET:
- Nang khe mang boi nhiem
- Cac khoi u vung co (mach mau, than kinh)
- Boi nhiem t cac khoi u, hach, ung th di can.

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IEC OT NGOT
I- I CNG:
iec ot ngot la s xuat hien thnh lnh iec tiep nhan thng la mot ben tai khong co
nguyen do ro rang. ay la mot cap cu noi khoa. Benh thng xay ra ngi trung
nien khoang 40-55 tuoi nam hoac n.
II- CAN NGUYEN:
Hien cha biet ro, co 2 gia thuyet c neu ra:
1. Gia thuyet mach mau:
Tac hoac co that mach mau tai trong, nhanh tan cung cua ong mach tieu nao di
trc.
2. Gia thuyet virus:
Ton thng hach xoan cua oc tai, co 3 ly le benh vc gia thuyet nay:
- Benh canh dch te, s xuat hien theo mua
- S xuat hien nhiem trung ng ho hap tren trc giai oan chong mat, iec
- Cac xet nghiem huyet thanh hoc cho thay khang the khang virus trong dch nao tuy
III- CHAN OAN:
1. Lam sang:
iec ot ngot thng xay ra n oc. Tuy nhien co the kem theo u tai, cam giac ay
tai, chong mat nhng benh nhan khong b liet mat va khong co dau than kinh khu tru
Soi tai: bnh thng
2. Can lam sang:
Thnh lc o cho thay iec tiep nhan
*X tr:
- Nen tm nguyen nhan can can thiep phau thuat
- MRI xng a co can quang, PEA e loai tr u day than kinh VIII
- CT scan xng a e phat hien do ngoai dch
- Lam cac xet nghiem tm yeu to nguy c mach mau: cao HA, tieu ng, roi loan m
trong mau, tang uree
IV- IEU TR:
1. Piracetam (Nootropyl) 10g/24 gi pha trong 200ml Glucose 5% truyen tnh mach
nhanh trong 15 phut
2. Prednisolone: 40-60mg/ngay tiem tnh mach cham
3. Natidrofuryl Oxalate (Praxilene) 600mg/ngay uong chia lam 3 lan
4. Ngh ngi, thi gian ieu tr la 5 ngay
I1.
2.
3.
4.
5.

TIEN LNG: tot neu

iec nhe
iec tan so thap
Khong co dau hieu tien nh
ieu tr sm trong vong 3 ngay sau khoi benh
Khong co cac yeu to nguy c mach mau

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X TR CHAY MAU MUI

I- NH NGHA:
Chay mau mui la mot benh ly cap cu do rat nhieu nguyen nhan khac nhau.
II- NGUYEN NHAN:
1. Nguyen nhan tai cho:
a. Chan thng: thoi quen ngoai mui la mot trong nhng nguyen nhan pho bien
nhat cua chay mau mui, tuy nhien hau het eu co the t cam, khong ang lo
ngai nh chan thng ap trc tiep vo mat va mui mi thc s nguy hiem v oi
khi co the gay nguy hai en tnh mang ngi benh.
b. Viem nhiem: viem ng ho hap tren, viem xoang, d ng, cac cuoc khao cu
cho thay rang nhng benh nhan b viem nhiem tai phat thng xuyen thng de
chay mau mui do nhiem loai vi trung tiet ra enzyme tieu protein nh:
streptokinase, staphylokinase dan en chay mau mui keo dai, tai phat.
Chay mau do ht phai hi oc: nh ht phai cocaine gay huy hoai niem mac tai
cho va thung vach ngan dan en chay mau.
*Lech vach ngan: gay anh hng en thong kh qua ng mui dan en niem mac
mui de b kho, tao vay, khi vay bong ra gay chay mau
*D vat: Neu mot a tre b chay mu hoac chay mau mot ben mui th nen nghi ng
d vat, d vat co the la: hon bi, nut ao, hoac vat xop ac biet d vat la con vat (a)
chang han, thng gap vung trung du, mien nui.
*U bu: gom nhng ton thng lanh va ac tnh vung hoc mui.
- U mau vung vach ngan (Septal hemangioma)
- U te bao ngoai mach (hemangio pericytoma)
- U nhu (Papilloma)
- Ung th nang tuyen (Adenoid cystic carcinoma)
- Ung th te bao vay (Squamous cell carcinoma)
- Ung th dang tuyen (Adenocarcinoma)
- U hac bao (Melanoma)
Nhng ton thng tren t gay chay mau tram trong tr u x vom (Juvenile
angiofibroma) co the gay chay mau nhieu, loai nay phai c ngh en khi benh
nhan la a tre trai vi bieu hien lam sang la nghet mui va chay mau mui.
*Phnh mach (Aneurysms): trc kia hiem khi xay ra, tuy nhien van gap nhng
phnh mach ngoai mang cng (Extradural) hoac xoang hang (Cavern-ous sinus),
hien nay chung toi gap nhieu do ty le chan thng nang nhieu oi khi cung gay
tham hoa ln e doa tnh mang benh nhan.
*Chu y:
Neu khai thac tien s th co the c them chi tiet nh benh nhan co chan thng so
nao, mo so nao, chan thng mat hoac tren benh nhan chan thng au co kem
theo b mu mot ben, liet cac day than kinh so II, IV, V, VI. Viec ieu tr can ket hp
ngoai than kinh.
2. Nguyen nhan toan than:
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A. Cao huyet ap do x mach (Arteriosclerosis Hypertension): thng gap ngi

ln tuoi, chay mau t phan sau mui ma nguyen nhan tren c giai thch la lp
ao c cua thanh ong mach nh ong mach sang, ong mach ham b thay the bi
dang si va collagen ket hp vi calci hoa -> lam cho thanh mach yeu rat de
gay hep long mach cao huyet ap -> gay chay mau.
B. Benh ly ve qua trnh ong mau:
- t khi gay chay mau mui, tuy vay cung co bao cao ghi nhan ve benh ly nay lien
quan en chay mau mui.
- Khiem khuyet yeu to ong mau (yeu to VIII) gap trong Hemophilia hoac VonWillebrand (Von-Willebrands disease) benh tan si huyet
- Do ung th mau (Leukemia), u tuy (Myeloma)
- Nhng benh ly khong phai do u tan sinh nh thieu mau bat san (aplastic anemia).
- Xuat huyet giam tieu cau: tai phong cap cu BVCR chung toi gap nhng trng
hp tieu cau ch con 15000-25000, gay xuat huyet nao va chay mau mui o at.
- Do thuoc: gom cac th thuoc c che cyclo-oxygenase (nh aspirin), thuoc lien
quan en vitamin k (Coumarin) hoac ve Heparin eu anh hng en qua trnh
chuyen Prothrombin -> thrombin.
C. Benh dan mach xuat huyet di truyen:
Nh benh Osler-Weber-Rendu, benh ly do ong hp troi o la co s bat thng
di bieu b long mach mau, thng xay ra li di da, niem mac mieng, da
day, ai trang, phoi, mui co the gay xuat huyet o at, rat nguy hiem.
D. Chay mau do nguyen nhan noi tiet nh: suy gan, suy than hoac ti ky kinh
nguyet chang han, thc te tai khoa chung toi van gap nhng trng hp ky kinh
nguyet trung thi gian mo xoang nhng benh nhan khong bao, gay chay mau
nhieu sau mo.
E. Chay mau mui khong ro nguyen nhan: co 10% benh nhan chay mau mui ma
khong ro nguyen nhan ro ret.
Chung toi phan A, B, C la nhom nguyen nhan da tren mc o tram trong khac
nhau.
- Nhom A gom: Tat ca cac benh nhan tren ch chay mau r ra, khi co khi khong va co
the t cam, co the cam c va khong can nhap vien.
- Nhom B: bao gom hau het nhng benh nhan tren ma khong the t cam mau c tai
nha ma phai nhap vien.
- Nhom C: nhng trng hp nang bao gom chu yeu nhng benh nhan b chan thng
nang vung mat hoac lien quan en dan mach gay xuat huyet do di truyen, cao huyet
ap (hiem hn).
- Thc te tai BV Ch Ray nhng chan thng nang thng do tai nan giao thong, ac
biet nhng cas b chan thng trc o t 5 7 ngay nay ot nhien chay mau lai va
nhng ton thng cua ong mach nh: phnh ong mach ham trong b v (chiem >
60%), ton thng ong mach canh trong, do ong mach canh trong xoang hang o
co the gay t vong cho benh nhan.
IX TR:
Khi nhap vien:
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Viec au tien: cam mau thng la nhet meches mui trc va theo doi cac dau hieu
sinh ton nh: mach, nhiet o, huyet ap, nhp th.
- Sau o lam moi xet nghiem can thiet ve mau, t ay bac s co thong tin ban au ve
tnh trang mau mat thong qua ch so Hematocrit, HA
- Bu nc va ien giai can thiet, khang sinh d phong va giam au .
- Hai ngay sau (48 gi nhet meches):
+ Meches phai c rut ra, viec rut meches co the tien hanh ca buoi (2 4 tieng) e
tranh tnh trang chay mau do rach niem mac mui do rut ot ngot.
+ Khang sinh d phong trong giai oan nay thng la nhng loai thong thng nh
nhom Beta-lactam (ampicillin, Amoxicillin) cho cac loi vi khuan Gram (+), hoac
nhom Aminoglycoside (Gentamycin, Nebcin) ngoai ra con co the dung cac thuoc
giam au ho Acetaminophen (paracetamol, Efferalgan..).
+ Neu con chay sau rut meches, th viec au tien phai nhet meches lai (lan 2) co hoac
khong ket hp vi at ong Foley, tuy thuoc vao mc o chay mau.
+ Neu khong chay lai th viec kham bang noi soi thi iem thch hp phai c tien
hanh nham tm nguyen nhan.
Hai ngay sau rut meches va xa mot phan trong ong foley, sau 24 gi na rut het (ca
meches trc va ong foley)
- Viec dung khang sinh, giam au tiep tuc nh nhng ngay au tien tr khi co phat
sinh nh benh nhan khang thuoc hoac khong giam au.
- Truyen mau phai c tnh en da tren cac ch so cua xet nghiem a cho thong
thng khi ch so Hematocrit (Hct) < 20% la can truyen mau, viec truyen mau phai
c hoi chan vi chuyen khoa huyet hoc, thong thng mat mau nhieu sau chan
thng th can truyen mau ti cung loai, nhng trong nhng thieu mau man (keo
dai, t t) th can truyen hong cau lang e tranh tnh trang khang cheo trong cac
thanh phan mau chung toi nhan thay rang nhng trng hp co tien s chan
thng rat can phai c lu y v co the chay mau o at bat c luc nao.
- Neu con chay th viec nhet lai (lan 3) va at ong foley la can thiet e tranh tnh
trang mat them mau, tren thc te giai oan nay thng la mau ngng chay trong
hau het trng hp nhng co chay lai th thng la nhng trng hp chay nhieu va
tham ch chay o at.
- Viec chup mach xoa nen (DSA) e chan oan nguyen nhan va iem chay la vo
cung can thiet trong luc ang chay mau va viec chup mach co the co 2 ket qua sau:
+ Phat hien ra iem chay mau: Cac bac s khoa chan oan hnh anh se thc hien cong
viec nay, luc nay y lenh se lam tac mach hoac ch ra ni bat thng ma bac s tai mui
hong phai thc hien tiep theo nh mo that ong mach sang hoac that he canh hoac
phai phoi hp vi chuyen khoa khac cung giai quyet nh khoa phau thuat ham mat,
ngoai than kinh, huyet hoc
+ Khong tm ra nguyen nhan ma mau van chay th viec that mach phai c tien hanh
theo th t sau:
1. That ong mach ham trong (a so cac trng hp t 60% tr len)
2. That ong mach sang trc
3. That ong mach canh ngoai
4. That ong mach canh chung
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PHAC O X TR CHAY MAU MUI

CHAYMAU MUI
Vi lng t
(r ra)

Ep canh mui 2 ben hoac be(B)

n chay va
(A)

Nhet mache mui trc

hoac at ong foley
(B)
(lan1)

(C)

Nhap vien

gi t 5-10phut

Ngng chay

vi lng nhiu
(chy t)

vi lng va
(chay thanh dong)

Rut meche

Con chay

Nhet mui trc lan 2

2 ngava
y sau
(sau 48h)
at ong Foley
Tm nguyen nhan

Ngng chay

Con chay
Sau 48h

ieu tr nguyen nhan

Rut meche tng phan va xa

bong
Sau 24h
Rut het ong va meche

Ngng chay
Con chay

Chup he mach canh xoa nen (DSA)

X bong khi lam DSA

Xac nh c nguyen nhan

Khong xac nh c nguyen nhan

Mau van chay

1. Lam tac nghen chon loc.

2. That ong mach qua ng mo
ngoai.
3. Phoi hp vi chuyen khoa khac.

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BIEN CHNG NOI SO DO TAI

I. I CNG:
La s lan truyen cua nhiem trung ra khoi khoang thong bao va niem mac cua xng
chum va tai gia vao noi so.
II. TRIEU CHNG LAM SANG - CAN LAM SANG & CAC THE LAM SANG:
+ Trieu chng tai

Viem xng chum cap.

Viem tai xng chum man tnh hoi viem (co the co cholesteatome)

+ Hoi chng nhiem trung

Sot cao, moi kho, li d, tieu t.

Bach cau tang cao, chu yeu la a nhan trung tnh.

1. Viem mang nao

- Tam chng mang nao : Nhc au, non vot, tao bon.
- Dau mang nao:

Co gng, Kernig (+), Brudzinki (+), dau vach mang nao (+)

Benh nhan nam t the co sung, s anh nang, tang cam giac au.

- Dch nao tuy: Ap lc tang, mau uc, am tang, ng giam, te bao tang, nhat la a
nhan trung tnh.
2. Abces ngoai mang cng
Thng khong co trieu chng ac hieu va c phat hien trong luc mo.
3. Abces ai nao
- Hoi chng tang ap lc noi so:

au au, non oi, tinh than tr tre.

Mach cham

Phu gai th.

- Hoi chng than kinh khu tru:

Mat ngon ng kieu Wernicke

Liet VII oi ben, liet 1 hoac 2 chi oi ben.

Tang phan xa gan xng, Babinski (+)

- CT.Scan:

Xac nh v tr, kch thc cua o abces

4. Abces tieu nao

- Hoi chng tang ap lc noi so:

au au, non oi, tinh than tr tre.

Mach cham

Phu gai th.

- Hoi chng than kinh khu tru:

Mat thang bang, qua tam, mat ong van, mat lien ong, rung hu y

Chong mat, ong mat ap ve ben benh

Phan xa Babinski (+)

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- CT.Scan: xac nh v tr, kch thc cua o abces

5. Viem tac xoang tnh mach ben
- Sot cao, kem theo cn lanh run.
- An b sau xng chum: benh nhan au choi (Griesingers sign).
- Quay co kho khan.
- Vung mang canh sng va au.
- Cay mau (+).
- CT.Scan, MRI
6. Thuy thung mang nao
- Phu gai
- Liet VI cung ben.
- Dch nao tuy: ap lc tang rat nhieu nhng bnh thng ve mat sinh hoa, te bao va vi
trung.
7. Abces di mang cng
- Khiem khuyet ve than kinh kieu kch thch, co giat.
- Tang ap lc noi so.
- CT.Scan. MRI.
3. IEU TR
3.1. ieu tr ngoai khoa
- Khoet rong a chum toan phan m rong, e h da sau tai. Chnh hnh vanh tai ong tai
va khau da sau tai th 2 khi lam sang on nh va ho mo len mo hat tot.
- Cac trng hp abces nao: phoi hp vi chuyen khoa ngoai than kinh:

Tiep can o abces: hut ra, dan lu.

Khi benh nhan tng oi on nh, KRC m rong lay sach benh tch.

- That tnh mach canh trong neu can.

3.2. ieu tr noi khoa
a. Khang sinh: da vao khang sinh o

Trc khi co ket qua khang sinh o :

Metronidazol
(Servizol 0,5g/100ml):
1chai x 2-3 lan /24gi.
+
Gentamycine 0,08g/2ml
-Tre em: 20-40mg/10kg /24gi.
-Ngi ln: 1-2ong /24gi.

Cefuroxime (Viciroxim 1,5g; Zinacef

0,75g):
-Tre em: 30mg-100mg/kg/ x 3lan/24 gi
(Tiem TM)
-Ngi ln: 0,75g x 2-3 lan/24gi (Tiem TM)
hoac: Cefotaxime (Shintaxime 1g;
Opetaxime 1g)
-Tre em: 150-200 mg/kg/24 gi (Tiem TM)
-Ngi ln: 1-3g x 2-4 lan /24gi (Tiem TM)
hoac: -Ceftazidime (Fortum 1g; Opeceftri 1g
hoac Ceftriaxone
+Tre em: 25-150mg/kg/ngay
+ Ngi ln:1g -2g x 2-3lan / ngay

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Sau khi co ket qua khang sinh o: oi khang sinh thch hp theo khang sinh o

b. Chong tang ap lc noi so:

- Th oxy
- Manitol 20% x 250ml TTM nhanh (hoac glucose 30%).
- Corticoid (Solumedrol 40mg/ong, Depersolone 30mg/ong) duy tr trong 4 ngay.
c. ieu tr ho tr:
- Giam au, ha sot:

Paracetamol: 30 -40mg/kg/24gi, co the s dung di dang:

+ TTM: Perfalgan 10mg/ml x 100ml

+ at hau mon : Dafalgan 0,5g : 3-4 ngay.
+ Uong: Acemol, Paracetamol, Panadol, Efferalgan
- Bu nc va ien giai:

Lactate Ringer 500ml TTM.

Glucose 5% 500ml TTM

d. Theo doi dch nao tuy:

Dch nao tuy c theo doi moi 2 ngay, 4 ngay, 6ngay cho en khi ket qua dch nao tuy
tr ve bnh thng.

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CHAN THNG MUI XOANG

1. M AU
Ch khu tru vao chan thng lam v xng chnh mui va xng ham tren.
2. TRIEU CHNG VA THE LAM SANG
2.1. Gay xng chnh mui
- Thap mui bien dang.
- S co cho mat lien tuc va au choi.
- Co dau lao xao xng va co tran kh di da.
- Vach ngan thng veo sang mot ben.
2.2. V xng go ma
- Mat sng ne, bien dang, ket mac mat xuat huyet.
- B di o mat mat lien tuc, cung go ma mat lien tuc, oi khi co dau tran kh di da.
Trc benh nhan v xng go ma phai kham ky: th lc, van nhan, khp can.
3. CAN LAM SANG
- Chup mui nghieng trong trng hp nghi ng gay xng chnh mui: xng chnh mui
b mat lien tuc va di lech.
- Chup Blondeau va Hirtz rong: thay mat lien tuc b di o mat, than xng go ma,
cung Zygoma.
- Chup CT Scan neu can
4. IEU TR
4.1. ieu tr noi khoa
- Cho benh nhan nam au cao.
- Khang sinh toan than pho rong, 1 trong cac loai sau: Cephaclosporine the he I hoac II
chch
hoac
uong
(Cefadroxil,Cefuroxim,Ceclor)
Giam au: Paracetamol 60mg / kg / ngay.
- Chong phu ne: Loai enzym 1-2 vien x3 lan/ ngay (Serratio peptidase, Lysozym, AlphaChymo trypsine)
4.2. Ngoai khoa
- Gay xng chnh mui:

Nang xng chnh mui neu gay co di lech nhieu va thap mui t sng ne.

Loai tr tu mau vach ngan. Neu co phai rach dan lu tranh ap xe vach ngan
sau nay.

Neu thap mui sng ne nhieu: ieu tr noi khoa 3 ngay, tai kham va se nang
xng chnh mui neu can thiet.

Cho benh nhan nam au cao.

Tai kham sau 1 2 tuan, sau o 1 2 thang.

- Gay xng go ma:

Gay co di lech nhng khong phc tap: nang xng go ma bang moc Ginestet
sm.

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Gay co di lech nhng phc tap, phu ne nhieu: ieu tr noi khoa va phau thuat
chnh hnh xng go ma bang phng phap ket hp xng cang sm cang tot.

Gay xng go ma khong di lech hoac ch di lech t: ieu tr noi khoa.

4.3. ieu tr sau mo

- Nam au cao.
- Khang sinh toan than, pho rong, loai tiem: Cephalosporine the he I hoac II (Cefadroxil,
Cefuroxim, Viciroxim)
- Giam au: Paracetamol 60mg / kg / ngay.
- Khang viem, chong phu ne: trong 3 4 ngay.
Depersolone 30mg, 1 ong x 2/ngay (TMC) hoac Solumedrol 40mg, 1ong x 2/ngay
(TMC)

Hoac dung loai enzym nh: 1-2vien x 3lan/ngay (Serratio peptidase,

Alphachymotrypsin, Lysozym)

- Choc xoang hay hut mau tu trong xoang qua noi soi neu can thiet.
- Chup lai X quang sau 4 tuan.

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V XOANG TRAN
II CNG:
- V xoang tran xay ra do mot chan thng manh vao vung tran lam v xng thanh
trc hoac thanh sau xoang tran.
- Chan thng xoang tran chiem 5 15% trong tong cac chan thng mat (May, 1970;
Mcgraw-Wall, 1998; Gerbino 2000). Ty le chan thng la 9 trng hp tren 100.000
ngi ln (Wirgh 1992).
- Tuy nhien do vung tran tao nen 1 phan cua hop so nen ty le t vong do ton thng
vung nay cao hn nhng chan thng mat khac. a so nguyen nhan cua cac chan
thng nay la do tai nan giao thong va do anh nhau.
II. TIEU CHUAN CHAN OAN:
1. Tieu chuan lam sang:
- Kham toan dien:
V xoang tran phai c xem nh chan thng au. a so nhng benh nhan nay la
nan nhan cua tai nan giao thong vi nhieu thng ton oi hoi phai c kham va anh
gia toan dien bi 1 oi ngu a chuyen khoa. Nhng phat o x tr chan thng chuan
nhan manh tren viec am bao ng th, ho hap, tuan hoan, he than kinh trung ng
va cot song. Bat c thng ton nao e doa tnh mang benh nhan can phai c xem
xet trc khi anh gia v xoang. Cac ton thng ngc, bung, t chi t khi phoi hp vi
ton thng au mat nhng cung khong nen bo sot, kham lam sang va ieu tr thch hp
cung phai anh gia theo th t u tien.
- Kham cac dau hieu cua v xoang tran:
+ sng vung tran: la 1 trong nhng dau hieu ngh en ton thng xoang tran ben
di. Tuy nhien neu sng mo mem hoac tu mau nhieu co the che lap dau hieu v
xng ben di.
+ Lom vung tran: chng to co v xoang tran di lech nhieu. Phu ne hoac tu mau se tan
bien sau vai ngay giup anh gia chnh xac hn.
+ Rach da tran: nhng trng hp rach da tran can phai c kham trong ieu kien vo
trung e anh gia tnh nguyen ven cua thanh trc, thanh sau va mang cng.
+ Dau hieu gay xng chnh mui: s nan xng mui e tm dau hieu lao xao va v
vun. V v xoang tran cung thng hay ket hp vi gay xng mui.
+ Chay nc mui: lam sach va kham hoc mui tm s hien dien cua do dch nao tuy.
Hoi tat ca nhng benh nhan con tnh tao xem co s hien dien cua chay nc mui hoac
chay dch man pha sau mui xuong hong khong.
- Kham khu giac: tm cac roi loan khu giac.
- Phan loai: roi loan khu giac co the c phan loai nh sau:
+ Anosmia: mat khu
+ Partial anosmia: mat khu giac 1 phan
+ Hypomia or microsmia: giam khu
+ Hyperosmia: tang chc nang khu giac cap bat thng
+ Dysosmia: (cacosmia or parosmia): loan khu giac. Meo mo hoac sai lac cam nhan
khu giac hoac kch thch mui.
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+ Phantosmia: ao khu, cam nhan roi loan khu giac trong trng hp khong co kch
thch mui.
+ Olfactory agnosia: mat kha nang nhan thc mui.
- Ve c che: xep roi loan khu giac thanh 3 nhom ln:
+ Giam dan truyen khu giac: do tac nghen ng truyen i qua mui (th du: sup song
mui, gay veo vach ngan, phu ne, sung huyet, tu mau, s thanh lap seo dnh, viem
xoang sau cha thng). Roi loan chc nang dan truyen khu giac co kha nang ieu tr
c. Thong thng lam giam phu ne niem mac, sa cha gay chnh mui, lam giam
tac nghen dong kh, hoac ieu tr viem xoang co the cai thien khu giac.
+ Giam tiep nhan than kinh: do pha huy bieu mo than kinh, ton thong xe rach cac si
than kinh khu giac, rach hanh khu. Si truc cua cac te bao thu the khu giac i cac
lo nho cua manh sang ay so va khp noi trc tiep vi hanh khu. Bat c s rach
hoac xe cua si truc trong qua trnh chan thng co the a en roi loan khu giac.
ieu nay co the xay ra vi v sang o mat mui (NOE), anh hng en manh sang hoac
do hien tng dch chuyen nhanh chong trong nao th phat sau 1 lc hoac oi lc c
tao ra bi chan thng cung au.
+ Giam than kinh khu giac trung ng: t s pha huy he than kinh trung ng (th
du: dap nao, xuat huyet nao ac biet la vung hanh khu, thai dng, thuy tran)
2.Tieu chuan can lam sang:
- X-quang: trc ay chup x-quang thong thng la hnh anh c ban e chan oan
v xoang tran (May 1970). Chup x-quang thong thng co the phat hien m xoang
tran va dau hieu mat lien tuc xng. Tuy nhien hnh anh thng khong ro do nhieu
ng net chong len nhau. Nh a c tha nhan, o nhay cam cua phim x-quang
qui c khong cao (May 1970). ieu nay co the a en chan oan khong het mc
o lan rong cua ton thng va cung khong giup ch g ac biet cho viec anh gia
mc o nghiem trong cua ton thng thanh sau va khong co gia tr g trong viec tien
oan ton thng ngach tran (Harris 1978)
- Chup CT scan: chup CT scan a tr thanh nghien cu hnh anh c chon la e
anh gia v xoang tran va vung gia mat (Johnson 1984; Schatz 1984; Har-ris
1987), la tieu chuan e chan oan v xoang tran. Phim CT cung cap cac chi tiet v
n gian hay phc tap cua v thanh trc, thanh sau cua xoang tran cung nh cac
v khac cua xng mat. Nhng trng hp di lech t hoac di lech nhieu cung nh d
vat eu co the phat hien de dang. Chup CT scan cung cap thong tin tiet nieu ong
thi oi vi mo mem mat, mat va cac ton thng noi so. Nen chup ca 2 t the
coronal va axial cat lp mong 1,5 mach mau
Cac hnh anh theo t the Axial phat hien v tr, o nang va mc o v vun cua v
xng thanh trc va thanh sau.
T the Coronal phat hien v cua san o mat va san xoang tran.
IIIEU TR:
1. ieu tr noi khoa:
Ch nh: v xoang tran khong di lech hoac t di lech.
2. ieu tr ngoai khoa:
- Ch nh: v xoang tran co di lech anh hng ve tham my hoac co kha nang thanh
lap u nhay ve sau.
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Cac phng phap ieu tr ngoai khoa:

+ Neu ch co v thanh trc thuoc pham vi cua bac s tai mui hong, phau thuat nham
muc ch nang lai thanh trc xoang va tai lap thong kh trong xoang.
+ Neu co ton thng thanh sau, oi hoi phai co s can thiep hoac ho tr cua bac s
ngoai than kinh. Neu co rach mang cng hoac do dch nao tuy oi khi oi hoi phai
triet tieu xoang, bt tac xoang tran hoac so hoa xoang tran.
III- KET LUAN:
V xoang tran co kha nang i kem ton thng noi so e doa tnh mang, bien dang
tham my va kha nang co bien chng do dch nao tuy, viem mang nao, thanh lap u
nhay ve sau. Muc tieu co bien chng cua v xoang tran la chan oan chnh xac,
nang chnh phan xng b lom, tai lap thong kh trong xoang tran, phuc hoi lai ng
net khuon mat trc khi b thng, tranh cac bien chng sm va bien chng lau dai.

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VIEM TAI GIA CAP VA MAN

II- VIEM TAI GIA CAP:
1. nh ngha:
ay la tnh trang viem nhiem cap tnh niem mac tai gia, tien trien trong khoang 3
tuan vi cac trieu chng tieu bieu cua mot qua trnh viem cap: sot, au tai, mang nh
o, benh hay gap tre em.
Thng xay ra sau viem nhiem mui hong do virus va s tac voi Eustache la yeu to
gay viem tai gia.
2. Tieu chuan chan oan:
a. Tieu chuan lam sang:
- Trieu chng gi y tre nhu nhi rat a dang, khong ro rang, co khi ch la kch thch,
quay khoc, bu kem hoac bo bu. Cho nen soi tai co he thong la can thiet tre sot
lanh run, trieu chng tieu hoa, nhat la trong khung canh viem mui hong. Kham tai
tre nho kho v ong tai nho thng thay mang nh viem o khong ro cac moc giai
phau
- tre ln hn au tai thng kem theo sot 38 38,50C, trong benh canh viem mui
hong va hnh anh mang nh thng thay oi theo giai oan:
+ Giai oan viem tai xung huyet: mang nh co mach mau o noi len i t can bua
toa ra xung quanh
+ Giai oan viem tai gia xuat tiet: mang nh day, o toan bo, kho thay nhng moc
giai phau
+ Giai oan tu mu: nhng moc giai phau khong thay na, mang nh phong chu yeu
trong sau di cua mang nh. giai oan nay co the tien trien t nhien t thung
nh chay mu ra ngoai.
- ngi ln thng 1 ben, chan oan thng de: benh nhan au tai mot ben, theo
mach ap, giam thnh lc, sot > 380C. Soi tai thng thay mang nh o, khong co
cac moc xng con. giai oan tu mu thay mang nh phong pha sau di ro.
b. Tieu chuan can lam sang:
- Cong thc mau tang cao: chu yeu la bach cau a nhan trung tnh
- X-quang: schuller 2 tai co the co hnh anh m xng thong bao xng chum
- Lay dch tai gia cay mu va phan lap vi trung
- Vi trung thng la vi trung cua vom mui hong: Haemophilus Influenza,
Streptococcus Pneumoniae, Pseudomonas Aeruginosa, Moraxella Catarhalis. Ngoai
ra con gap: streptococcus pyogenes, Streptococcus viridans, Staphylococcus Aureus.
- Thnh lc o: iec dan truyen o I hoac II
- Chup CT scan, MRI trong trng hp nghi ng co bien chng noi so
3. Ch nh ieu tr:
a. ieu tr noi khoa:
- Khang sinh toan than:Cephalosporin the he th II, III (Cefuroxim, Cefpodoxim,
Cetamet,) trong 10 ngay en 14 ngay
Augementin: Ngi ln 1g, 2 lan/ngay. Tre em 50mg/kg can nang/ngay
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Cefuroxim: Ngi ln 500mg, 2 lan/ngay trong 2 tuan. Tre em 250mg, 2 lan/ngay

trong 2 tuan
Ciproloxacin: Ngi ln 500mg, 2 lan/ngay. Khong dung Cephalosporin cho tre em
di 15 tuoi
- Ngoai ra con dung kem theo nhng thuoc cha trieu chng nh: giam sot, giam au.
Mot so trng hp phai dung corticoid
- Trong trng hp au nhieu, dung thuoc nho tai giam au tai cho nh Otypax, nhat
la trong nhng trng hp viem mang nh bong nc hoac xung huyet mang nh cap
- Trong viem tai gia cap do Pyocyanique, nhat la tre di 3 thang can nhap vien,
khang sinh tnh mach (Cephalosporin nh: Viciroxim, Ceftazidine).
- Tien trien thng thuan li khi co ieu tr ung. Trieu chng cai thien sau 4 ngay,
mang nh tr ve bnh thng sau 8 ngay
- Khi khong c ieu tr co the co bien chng nh: viem xng chum cap, liet mat,
viem me nh, viem mang nao, abces nao
b. ieu tr ngoai khoa:
- Rach mang nh hien nay t dung do khang sinh tot co the khong che c benh, ch
nh cho trng hp khang ieu tr vi khang sinh hay viem tai gia cap bien chng
(benh canh viem nhiem nang, viem xng chum, viem mang nao, liet mat) hoac tre
di 3 thang. Rach mang nh sau di cua mang nh muc ch dan lu mu va
cay mu
- Khoet xng chum: c thc hien trong trng hp bien chng va khong ap ng
vi khang sinh
III- VIEM TAI GIA MAN TNH:
1. nh ngha:
Viem tai gia man c xem nh tnh trang viem niem mac tai gia tren 3 thang.
Bao gom nhieu the lam sang, hay gap nhat la viem tai gia man mang nh h
2. Tieu chuan chan oan:
a. Tieu chuan lam sang:
- Benh s:
+ Benh nhan thng co tien s viem tai gia cap, chay mu tai tai i tai lai hoac keo
dai, co the co tien can chan thng.
+ Khong sot, khong au tr trng hp hoi viem va bien chng
+ Nghe kem ben tai benh
- Kham tai: ong tai ngoai co the bnh thng hoac viem tay o, polype ong tai
Co the chay mu: mu nhay trong VTGM nhay, dch trong loang trong VTGM xuat
tiet, hay mu hoi thoi trong VTGM cholesteatome
- Kham mang nh: neu co lo thung can anh gia mc o nang nhe cua thung nh;
con ra hoac sat ra, thung mang cang hoac mang trung.
- Kham hom nh: anh gia niem mac hom nh, viem, polype, chuoi xng con.
- Tm benh ly nguyen nhan t mui xoang hoac hom mui hong
b. Tieu chuan can lam sang:
- X-quang schuller 2 tai: co hnh anh m te bao xng chum ben benh, hnh anh huy
xng hoac hnh anh cholesteatome trong VTGM Cholestea-tome
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CT scan: chup CT scan trong trng hp VTGM khong ap ng ieu tr noi khoa, co
cholesteatome, bien chng
- MRI: chup MRI trong trng hp nghi ng co bien chng noi so
- Thnh lc o: iec dan truyen. Neu > 30dB co ton thng chuoi xng con, neu co
iec hon hp th can ngh en benh a lan rong va huy me nh
- Vi trung: VTGM ieu tr noi khoa thng khong can cay mu tr trng hp co bien
chng. Vi trung thng gap Haemophylus Influenza, Streptococcus Pneumoniae,
Pseudomonas, Moraxella Catarhalis
3.Bien chng:
- Xuat ngoai
- Liet VII mang nao
- Viem me nh
- Abces ai nao, tieu nao
- Viem xoang tnh mach ben, nhiem trung huyet
4. ieu tr:
a. ieu tr noi khoa:
- ieu tr tai cho la quan trong: hut ra tai, nho tai loai khang sinh diet va Gr (-) va
Gr (+): Polydexa, Ciplox
- Khang sinh toan than: khang sinh uong hoac chch ho Cephalosporin hoac
Quinolone nh: Zinnat (Cefuroxim) ngi ln 500mg, 2 lan/ngay trong 2 tuan. Tre
em 250mg, 2 lan/ngay. Ciprobay ngi ln 500mg, 2 lan/ngay. Khong dung
Quinolone cho tre em di 15 tuoi
b. ieu tr ngoai khoa:
VTGM thung nh a ieu tr noi khoa, VTGM khong ap ng vi ieu tr noi khoa
can phau thuat.

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D VAT TAI
1. NH NGHA
D vat tai la vat la trong ong tai hay hom nh thng gap tre em hn ngi ln.
2. PHAN LOAI
2.1. D vat vo c hay hu c
Hat lua, cuc bong
2.2. D vat song
- Con trung : gay ra trieu chng kho chu nh tieng sot soat, au, chong mat.
- D vat co the ong tai ngoai hay hom nh.
3. IEU TR
- D vat vo c hay hu c :

Bm nc lay ra.

Lay d vat bang curette phu hp.

- D vat song: Nen nho thuoc te tai cho hay glycerine borate e 10 cho con trung chet
ngat, sau o lay ra bang kep khuyu. Neu benh nhan khong hp tac: gay me lay d vat
ra.
- Neu d vat trong hom nh hay ong tai ngoai phu ne khong the lay qua ng t nhien
th co the lay qua ng sau tai.
- Neu sau khi lay d vat khong lam ton thng ong tai, mang nh, khong co nguy c
nhiem trung th khong can dung thuoc.
- Neu co dau hieu hay nguy c nhiem trung nen s dung khang sinh, khang viem, giam
au.
Khang sinh

-Augtipha 20mg-50mg/kg/ngay

(1 trong cac loai -Cefuroxim 25mg-100mg/kg/ngay

sau)
-Dalacin, Neotacin, Neumomicid
-Rovamycin 3M 1vx2 lan/ngay
Khang viem

-Steroide (Prednisolon 5mg, Medrol 16mg) hoac Non-steroide (Alaxan,

Zycel100mg) 1-2v x 2 lan/ngay
Enzyme (alphachymotrypsin, Noflux 90mg) 2v x 2 lan/ngay

Giam au

Paracetamol 30mg-40mg/kg/ngay

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IU TR T DCH VNH TAI BNG PHNG PHP

CHC HT KHU P
I. I C NG:
T dch vnh tai l mt bnh lnh tnh,
tnh, t pht,
pht, khng thng gp.
gp.Biu hin
lm sng in hnh l khi nang gi c to lp di mng sn trn,
trn, trn,
khng vim,
,
khng
triu
chng,
,
thng
gp

mt
trc
vnh
tai.
vim
chng
tai.Kch thc
khi t dch thay i khong 1 n 5cm,
cm,bn trong cha dch nh vng hoc
nu.
nu.
II . T IU CHUN CHN ON:
Chn on bnh da vo cc c im:
im: khi sng,
sng, mm vng mt trc vnh tai
kch thc ln hn 1cm,
cm, khi chc ht ra dch vng trong hoc nu.
nu.
III. CHN ON N GUYN N HN :
Ton b u l nam gii,
Cc nghin cu khc t nc
gii, chim t l 100%.
100%.Cc
ngoi chim 9 0 93 %. Cu hi a ra l,
l, v c ch bnh sinh phi chng c
mi lin h gia gii tnh vi bnh t dch vnh tai.
tai.
Bnh thng gp nhng thanh nin khe mnh,
mnh, la tui 26 45 tui chim
trn 80%.
80%. y l tui lao ng nn c nhiu kh nng vnh tai b va chm
nhiu dn n bnh l.
l.
Thi gian bnh thng gp nht l t 1 tun n 4 tun.
tun.Khng c trng
hp no di 1 tun.
tun. iu ny cho thy bnh nhn thng ch pht hin khi
khi t dch ln.
ln.Do triu chng ca bnh ngho nn nn ngi bnh
khng ch .
.

IV . IU TR :
Bnh nhn nm nga,
nga, u quay sang 1 bn, hng tai bnh ln trn.
trn.
St trng da bng dung dch Betadine,
Betadine, tri khn l,
l, t ti ch 2 mt da vnh tai
bng lidocain 2 %.
Dng bm tim 10ml
10ml c kim s 18 chc ht khi t dch.
dch.
Dng tai p cht 2 mt da vnh tai ni chc ht bng gc.
gc.
Khu bng ch Nylon 4 .0 xuyn qua vnh tai,
tai, vnh tai gia v gc cun trn
c c nh bng ch khu mt trc v sau vnh tai.
tai. Khu 1 n 3 mi ty
kch thc khi t dch.
dch.
Thuc sau th thut:
thut:
- Khng sinh : + Cip rofloxacin 0 .5g
+ Cefuroxim 250mg
+ Claminat 625 mg
- Gim au : Acetaminophen 500mg
- Khng vim : Alphachymotryp sin
Bnh nhn c iu tr ngoi tr,
tr, khng cn nm vin.
vin. Chm sc nh 1
trng hp tiu phu thng thng:
thng: thay bng ngoi mi ngy,
ngy, khm li sau 3
ngy,
ngy, ct ch sau 1 tun.
tun.
Ngi bnh
h
c
theo
di sau 10 ngy,
bn
ngy, 1 thng,
thng, 3 thng.
thng.
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 Hnh minh ha:

ha:

V . C HM SC:
Bnh nhn ch cn gi vnh tai kh sch.
sch. Vt thng khng au
au lm v dng
thuc.
thuc. C th sinh hot bnh thng,
thng, khng phi nm vin.
vin. Gc cun v ch khu
nm st gn 2 mt vnh tai,
,
d
chu,
,
thm
m
hn
so
vi bng p,
tai
chu
p, khng cn tr
sinh hot hng ngy.
ngy.
V I. TIN LNG :
Tiu chun khi bnh:
bnh: Sau ct ch khu,
khu, vng t dch xp,
xp, khng du vim
nhim ti ch,
ch, hnh dng vnh tai bn ngoi bnh thng (so snh vi tai
khng bnh)
bnh)
Tiu chun ti pht:
pht: Khi t dch xp 1 phn,
phn, khng xp (nh ban u)
u) (so
snh vi bn bnh)
bnh).
Bin chng:
:
nhim
trng ti ch,
chng
ch, vim mng sn,
sn, vim sn vnh tai.
tai.

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XOP X TAI
I. AI CNG:
1. nh ngha
Xop x tai la1 tnh trang ton thng bao xng me ao va xng con gay nen iec tang
dan do s cng dnh t t xng ban ap vao ca so bau duc.
2. O xop x tai
- Thng gap vung ca so bau duc, cc trc vung khp ban ap tien nh.
- Co the gap : u nho, ong Fallope, long bao xng me ao.
- Hiem gap vung ca so tron.
3. Dch te hoc
- Yeu to gia nh va di truyen.
- N > nam.
- Lien quan thai ky.
- Thng gap la tuoi 20 30.
II. TRIEU CHNG LAM SANG CAN LAM SANG:
- 90% khong co bieu hien lam sang.
- 10% bieu hien lam sang:
1. iec
- 80% iec dan truyen co ien, the tai gia.
- 5% iec tiep nhan n thuan, type tai trong
- iec tien trien t t, luc au 1 tai sau o co the ca 2 tai.
2. Trieu chng kem theo
Bang thnh, u tai, roi loan tien nh nhe.
3. Khong co trieu chng
au tai, chay dch tai, roi loan voi nh.
4. Kham tai: mang nh bnh thng
5. o sc nghe n gian
- Tam chng co ien:

Thi gian dan truyen xng tang.

Rinne (-)

Ngng nghe toi thieu tang.

- Nghiem phap Gelle (-)

- o sc nghe n am va o sc nghe tieng noi.
- Nh lng o: Ap lc hom nh bnh thng.
- Phan xa c xng ban ap (-)
6. CT scan
Co the thay dau hieu Double rings sign nhng rat hiem
III. IEU TR
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1. ieu tr noi khoa

- Nham lam cham s tien trien cua benh xop x tai (khong cai thien c iec)
- Ch nh trong nhng trng hp chong ch nh phau thuat.
- Thuoc: Sodium-Fluoride: 1v 25mg/ngay trong 1 thang.
2. Phau thuat
- La phng phap ieu tr c la chon.
- D tr oc tai + bieu hien me ao hoa la yeu to tien lng rat quan trong cho ket qua
phau thuat.
- Ngay nay thng phau thuat Stapedectomy

Tieu chuan chon benh:

+ Chc nang nghe:

-Nghe kem > 30dB.
-Rinne (-) (2 trong 3 tan so hoi thoai)
-Kha nang phan biet tieng noi tot.
+ Tuoi:
-Tot nhat la ngi ln tuoi
- < 20 tuoi de b bt tac ca so sau mo.
- Tre em: cau truc giai phau con thay oi de b roi loan voi, viem tai gia
+ Nghe nghiep va ieu kien song: tranh on.

Ky thuat:

+ Tao Prothese:
-Tru dan c lam bang thep khong g:
-Dai # 3 4mm
-Uon cong thanh moc 1 au
-au kia buoc 1 mau m t than
+ng rach : thng rach da ng trong ong tai hnh ch U t 6 12gi, cach
khung nh # 5mm
+ Boc lo vung ca so bau duc: thay ro:
-Nganh xuong xng e.
-Khp e ap, gan c ban ap
-Xng ban ap.
+ Giai phong cau truc tren ban ap.
+ Tao ca so me ao.
+ at Prothese:
-Tru dan om vao canh xuong xng e
-Manh ghep (m): at len ca so me ao a m.
+ Kiem tra s di ong cua he thon g (cham vao xng bua Prothese di ong.)
+ Phu lai vat da ong tai va man g nh
IV. CHAM SOC HAU PHAU:
- Benh nhan nam au cao (Fowler) trong phong hoan toan yen tnh.
- Han che nghe ben tai va mo.
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- Tranh x mui manh.

- Thay bang, cham soc vet mo moi ngay.
1. Theo doi va ieu tr cac bien chng
- Chan thng thng nh: roi loan v giac.
- Liet than kinh VII ngoai bien:

Thng xuat hien 10 ngay au

Hoi phuc t t vi Corticoide lieu cao

Neu nang: mo giai ap day VII

- Thung mang nh, viem tai gia, viem me ao :khang sinh, khang viem tch cc
- Do me ao : mo lai
- Thuoc:
Khang sinh :
+ Co the s dung 1 trong
cac loai sau:

-Augmentine 1g:
+Tre em: 30mg/kg x 2-4lan/ngay

+Ngi ln: 1g x 2-4 lan/ngay

+ Co the phoi hp them -Cefuroxime (Viciroxim 1,5g; Zinacef 0,75g)
Getamycine 0,08g
+Tre em: 30 100mg/kg/ngay
-Tre em: 20mg/10kg/ngay
+Ngi ln: 0,75g x 23 lan / ngay
(TB)
-Cefotaxime (Shintaxime 1g ; Opetaxime 1g)
-Ngi ln: 1-2 ong/ngay
+Tre em: 50 -150 mg/kg/ngay
(TB)
+Ngi ln:1 g x 2-3 lan /ngay
-Ceftazidime (Fortum 1g; Opeceftri 1g hoac
Ceftriaxone
+Tre em: 25-150mg/kg/ngay
+ Ngi ln:1g -2g x 2-3lan / ngay
Khang viem:

-Steroid: co the s dung dang tiem trong 3-5

Co the s dung mot trong ngay au sau o chuyen sang dang uong va
giam lieu dan :
cac thuoc sau
+Mazipredone (Depersolone 0,03g)
Tre em: 1-2mg/kg/ngay
Ngi ln: 1ong x 1-3lan/ ngay
+Methylprednisolone (Solumedrol 40mg)
Tre em: 1-2mg/kg/ngay
Ngi ln: 1ong x 1-3lan/ngay
+Prednisolone 5mg
-Non-Steroid:
+Diclofenac (Neo-pyrazone 50mg) 1v x23lan /24gi
-Enzyme:
+Lysozyme (Noflux 90mg): 1-2v x 2-3 lan
/ngay
+Serratiopeptidase (Garzen 10mg): 1-2v x
2,3lan /ngay
Giam au:

-Paracetamol: 30 -40mg/kg/ngay, co the s

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dung di dang:
+ Perfalgan 10mg/ml x 100ml (TTM)
+ Panadol, Efferalgan, Dafalgan, Acemol
Hoac Di-antalvic: 1v x 3-4lan/24 gi
Khang Histamine:

-Chlorpheniramine 4mg: 1v x 1-2lan /ngay

Hoac Fexofenadine (Telfast 60mg): 1v x 2
lan/ngay

Chong non oi:

Metoclopramide (Primperan 10mg): 1ong x 1

-2 lan/ngay

- Rut meche tai vao ngay 7.

- Xuat vien vao ngay 8 ngay 10
4.2. Theo doi sau xuat vien
- Tai kham sau 1 tuan tai phong khm TMH: anh gia tnh trang ong tai, mang nh
- o kiem tra sc nghe n am sau 2 4 tuan
- o kiem tra sc nghe n am tot nhat la sau 3 thang
XXX

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CHAM SOC SAU PHAU THUAT

SAO BAO THNG NH VA NH
Ngay 1 - 2

-Thay bang ngoai.

-Rut meche sau tai neu co.
-Khong can bang kn vet mo.

Ngay 3 - 8

-Neu meche trong tai kho: khong can x tr

-Neu co dch tiet, hut qua meche trong tai (dung ong hut
nho, hut nhe)

Ngay 7

Cat ch vet mo

Ngay 9-10

-Rut mech tai.

-anh gia ong tai.

Ngay 11-12

-Xuat vien

THUOC
Khang sinh :
+ Co the s dung 1 trong
cac loai sau:

-Augmentine 1g:
+Tre em: 30mg/kg x 2-4lan/ngay

+Ngi ln: 1g x 2-4 lan/ngay

+ Co the phoi hp them -Cefuroxime (Viciroxim 1,5g; Zinacef
Getamycine 0,08g
0,75g):
-Tre em: 20mg/10kg/ngay
+Tre em: 30 100mg/kg/ngay
(TB)
+Ngi ln: 0,75g x 23 lan / ngay
-Ngi ln: 1-2 ong/ngay
-Cefotaxime (Shintaxime 1g ; Opetaxime
(TB)
1g)
+Tre em: 50 -150 mg/kg/ngay
+Ngi ln:1 g x 2-3 lan /ngay
-Ceftazidime (Fortum 1g; Opeceftri 1g hoac
Ceftriaxone
+ Tre em: 25-150mg/kg/ngay
+ Ngi ln:1g -2g x 2-3lan / ngay
-Steroid: co the s dung dang tiem trong 3-5
Co the s dung mot trong ngay au sau o chuyen sang dang uong va
giam lieu dan :
cac thuoc sau
+Mazipredone (Depersolone 0,03g)
Tre em: 1-2mg/kg/ngay
Ngi ln: 1ong x 1-3lan/ ngay
+Methylprednisolone (Solumedrol 40mg)
Tre em: 1-2mg/kg/ngay
Ngi ln: 1ong x 1-3lan/ngay
+Prednisolone 5mg
-Non-Steroid:
+Diclofenac (Neo-pyrazone 50mg) 1v x23lan /24gi
-Enzyme:
Khang viem:

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+Lysozyme (Noflux 90mg): 1-2v x 2 lan

/ngay
+Serratiopeptidase (Garzen 10mg): 1-2v x
2,3lan /ngay
Giam au: (co the dung
mot trong cac thuoc sau)

-Paracetamol: 30-40mg/kg/ngay, co the s

dung di dang:
+ Perfalgan 10mg/ml x 100ml (TTM)
+ Panadol, Efferalgan, Dafalgan, Acemol
-Di-antalvic: 1v x 3-4lan/24 gi

Khang Histamine:

-Chlorpheniramine 4mg: 1v x 1-2lan /ngay

Hoac Fexofenadine (Telfast 60mg): 1v x 2
lan/ngay

Chong non oi:

Metoclopramide (Primperan 10mg): 1ong x

1 -2 lan/ngay

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VIEM MUI D NG
I. NH NGHA:
La phan ng toan than gia khang nguyen, khang the sinh ra hoa chat trung gian
histamin va serotonin bieu hien bang qua trnh viem mui.
II. TRIEU CHNG:
C nang
-nga mui
-hat hi

Thc the
niem mac nht nhat,
xuat tiet nhay trong.

-so mui
-nghet mui

III. THE LAM SANG:

- VMDU quanh nam: xay ra quanh nam
- VMDU theo mua: xay ra theo mua ro ret
IV. CAN LAM SANG:
- Cong thc mau: bnh thng, IgE trong mau tang.
- Dch mui co nhieu te bao ai toan.
- Xquang: khong co g bat thng.
V. IEU TR:
ieu tr noi khoa la chu yeu.
- Giai man cam: lam phan ng noi b e xac nh khang nguyen, sau o chch giai man
cam.
- ieu tr trieu chng: dung mot trong cac thuoc Pheramin 4mg, Actifed, Polaramin
hoac Cetirizin 10mg (Zyrtec, Cetrin) 1v/ngay, Loratadine (Clarityne, Alertin) hoac
Fexofenadine (Telfast, Alerfast) 60mg 1v x2 lan/ngay
- ieu tr tai cho:

Xong mui bang corticoide.

Xt mui bang corticoide: (Flixonase, Rhinocort, Pivalon)

- Khang sinh khi co boi nhiem

Amox + A.Clavu (Augmentin, Ofmantine) 0,625g: 1v x2/ngay

Cefadroxil (Biodroxil) 0,5g: 2v x2 /ngay

Cefuroxim (Zinmax, Zinnat, Ceroxim) 0,25g-0,5g/ngay

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VIEM MUI XOANG CAP TNH

I. NH NGHA:
La qua trnh viem cap xay ra tai niem mac cac xoang.
II. TRIEU CHNG:
C nang
-Sot
Nhc au

Kham

Noi soi

Niem mac mui sung Cac lo thong xoang phu ne, xuat tiet
huyet, co xuat tiet.

-So mui
-Nghet mui
-Hat hi

III. CAN LAM SANG:

- Xquang: niem mac xoang co phan ng viem
- Cong thc mau: bach cau tang nhe
IV. THE LAM SANG:
1. Viem xoang nguyen nhan t mui
ieu tr

Thuoc

Khang sinh (dung 1 +Amox+A.Clavu (Augmentin, Curam, Ofmantine) 0,625g: 1v x2-3

lan/ngay
trong cac loai sau)
Thng dung trong 15 +Cefadroxil (Biodroxil) 0.5g:2v x2 /ngay
+Cefuroxim (Zinnat, Zinmax, Ceroxim) 0,25g-0,5g : 1v x2 lan/ngay
ngay
-Khi co nhiem k kh:
+Metronidazol (uong hoac chch) Flagyl 0,25g 2v x 2 / ngay, hoac 500mg/
100ml x 2/ ngay
Khang viem

-Chong viem loai enzym: Alphachymotrypsine ( 21K), hoac lysozyme

(nh Noflux 90mg) 2v x 2 lan/ngay trong 5 ngay

Chong sung huyet va

chay mui

Actifed 1v x2-3 lan/ngay

Khang Histamine

Cetirizine 10mg (Zyrtec, Cetrin) 1v/Ngay Hoac Loratadine (Clarityne,

Alertin) Hoac Fexofenadine (Telfast, Alerfast) 60mg 1v x2 lan/ngay hay
Pheramine 4mg (Allerfar) 1v x2 lan/ngay

Giam au

Paracetamol (Panadol, Efferalgan) 0,5g 1vx2 lan/ngay trong 3ngay

2. Viem xoang ham do rang (rang 5,6 ,7 ham tren)

- ieu tr: nho rang, choc ra xoang
ieu tr

Thuoc

Khang sinh (dung 1 trong cac loai Giong nh tren, nhng kem them Metronidazol nh
sau)
Flagyl 0,5g 1vx4 trong 10 ngay, hoac Rodogyl 1vx4
trong 10 ngay
Thng dung trong 15 ngay

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Khang viem

-Chong viem loai enzym: Alphachymotrypsine (

21K), hoac lysozyme (nh Noflux 90mg) 2vx2
lan/ngay trong 5 ngay

Giam au

Paracetamol (Panadol, Efferalgan) 0,5g 1vx2 lan/ngay

trong 3ngay

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VIEM MUI XOANG MAN TNH

I. NH NGHA:
La tnh trang viem tai niem mac mui xoang keo dai > 2 thang hoc tai i tai lai nhieu lan
lam phu ne, bt tac lo thong xoang.
II. CAC THE LAM SANG:
1. Viem xoang ham man
Trieu chng

Noi soi mui

X quang

-Nghet mui

Khe gia phu ne, co M xoang dang niem mac day, hoac co
mc nc hi,
-So mui nhay vang hoac xanh co khi nhay.
kem nhc au

- ieu tr:
ieu tr

Thuoc

Khang sinh (dung 1 trong cac loai sau)

+Chon la u tin l nhm Quinolone ( Ciprobay 0,5g 1v x2

ln/ ngy hay Tavanic 0,4g 1 v ngy 1 ln)
+Amox+A.Clavu (Augmentin, Curam, Ofmantine) 0,625g: 1v
x2-3 lan/ngay
+Cefadroxil (Biodroxil) 0.5g 2v x2 /ngay
+Cefuroxim (Zinnat, Zinmax, Ceroxim) 0,25-0,5g 1v x2
lan/ngay
-Khi co nhiem k kh:
+Metronidazol: Flagyl 0,25g: 2v x 2lan / ngay,
hoac chch 500mg/ 100ml x 2lan/ ngay

Chong d ng

Cetirizine 10mg (Zyrtec, Cetrin) 1v/Ngay Hoac Loratadine

(Clarityne, Alertin) Hoac Fexofenadine (Telfast, Alerfast)
60mg 1v x2 lan/ngay, Levocetirizin 5mg 1-2v/ngy hay
Pheramine 4mg (Allerfar) 1v x2 lan/ngay

Choc ra XH

Cach 2 ngay 1 lan

2. Viem xoang tran

Trieu chng

Noi soi mui

X quang

Nhc au, chay mui

Khe gia phu ne, co nhay

M xoang tran

- ieu tr:
ieu tr

Thuoc

Khang sinh (dung 1 trong +Amox+A.Clavu (Augmentin, Curam, Ofmantine) 0,625g: 1v x2-3
cac loai sau)
lan/ngay
+Cefadroxil (Biodroxil) 0.5g 2v x2 /ngay
+Cefuroxim (Zinnat, Zinmax, Ceroxim) 0,25-0,5g 1v x2 lan/ngay
-Khi co nhiem k kh:
+Metronidazol: Flagyl 0,25g: 2v x 2lan / ngay,
hoac chch 500mg/ 100ml x 2lan/ ngay

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-Chong viem loai enzym: Alphachymotrypsine ( 21K), hoac

lysozyme (nh Noflux 90mg):

Khang viem

2vx2 lan/ngay trong 5 ngay

Khang histamin

-Pheramin 4mg : 1v x2 lan/ ngay

(Dung mot trong cac thuoc -Cetirizin (Zyrtec, Cetrin) 10mg:1v/ngay

sau)
-Loratadin (Clarytin, Alertin) 10mg: 1v/ngay
-Levocetirizin 5mg: 1v/ngy
Chong sung huyet va chay Actifed 1v x2-3 lan/ngay trong 10 ngay
mui
Giam au

Paracetamol (Panadol, Efferalgan) 0,5g 1vx2 lan/ngay trong 3ngay

Kh dung mui

Dexacol va Melyptol moi ngay

3. Viem xoang sang

Trieu chng

Noi soi mui

X quang

-Nghet mui

Khe gia va khe tren co nhay. M xoang sang

-Nhc au
-Moi gay
-So mui
-Nhay hong

- ieu tr: nh viem xoang tran, ngoai ra co lam them phng phap Proezt
4. Viem xoang bm
Trieu chng
-au au

Noi soi mui

X quang

Thanh hong nhay, khe tren co Kho

mu nhay
nh.

-Moi gay, moi vai

CT scan

xac M
bm

xoang

-Nhay vng hong, hay kht mui,

ang hang

- Thi gian iu tr vim xoang mn tnh ti thiu l 4 tun, sau mi 2 tun, bnh nhn
cn c ni soi mi xoang nh gi p ng iu tr ( mi bt nhy c, khe gia
khng cn m.)
Sau 4 tun nn kim tra XQ ln 2 ( trong trng hp vim xoang hm v xoang sng)
ty theo tnh trng p ng m chng ta s ngng thuc hay ko di thi gian iu tr
thm 1- 2 tun na)
CT Scan l tiu chun vng nh gi xoang trc v sau iu tr.
- Sau thi gian trn m cc xoang vn cn vim th xem nh iu tr ni khoa khng
hiu qu, cn tin hnh phu thut.
5. Viem xoang thoai hoa polype
Trieu chng

Noi soi mui

-Nghet mui ngay cang tang

Cuon gia qua phat, niem mac nht.

-Nang au

Khe gia co polype (trong, mong nc,

bong, nhan).

-Mat khu

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-So mui
-Hat hi

III. IEU TR:

Chu yeu la ngoai khoa.
- Phng phap mo tuy benh tch phat hien c qua noi soi va CT scan.
- Viem xoang ham va sang trc: m khe mui gia va bong sang
- Viem xoang sang trc va sau : nao sang
- Viem xoang trn: m ngach tran

Viem xoang bm: m thong xoang bm

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SAN SOC SAU PHAU THUAT

CHNH HNH VACH NGAN
- Theo doi sinh hieu M, HA, T0, 4 lan/ngay au.
- Theo doi tnh trang chay mau:

R t qua meche mui trc ; theo doi nam au cao, chm lanh.
Chay xuong thanh sau hong khien benh nhan khac nho nhieu, nhet them
meche mui trc. Neu can co the rut ra nhet lai.
Theo doi tut meche xuong hong :

+ Neu dai th cat bo bt

+ Neu ngan th dung ngon tay ay meche len.
+ Neu tut meche lam chay mau nhieu th rut meche ra het, at lai meche mi.
- Hau phau :

Ngay 1-2: nho nc muoi sinh ly lien tuc vao meche.

Ngay 2 en ngay 3: rut het meche mui t t, neu thay chay mau nhieu th
ngng rut, e mai rut tiep.
Ngay 4 : Noi soi mui kiem tra vet mo

- Thuoc sau mo:

ieu tr

Thuoc

Khang sinh (dung 1 trong

cac loai sau)

+Aminoglycoside (Amikaye 500mg) 15mg/kg (TB) 1 lieu trong ngay duy

nhat
+Cefotaxim (Opetaxim, Shintaxime) 1g x 2 -3lan (TM)/ ngay
+Amox+A.Clavu (Augmentin, Curam, Moxiclav) 1g x2-4 lan/ngay (TB)
+Cefuroxim (Zinacef, Viciroxim):
0,75gx2-3 lan/ngay (TB, TM)
+Ceftriaxone (Opeceftri)1g: 1-3 lan/ngay (TM)
+Clindamycine (Dalacin C) 600mg: x2-3lan/ ngay (TB, TM)

Khang viem (Chon 1 khi +Mazipredone (Depersolone) 30mg 1-2 ong/ngay (sang)
khong chong ch nh) +Hydrocortison 100mg 1-2 lo/ngay (sang)
dung trong 3-5 ngay
-Sau o dung khang viem dang men: Alphachymotrypsine ( 21K),
hoac lysozyme (nh Noflux 90mg) 2v x 2 lan/ngay
Khang Histamine

+Pheramine 4mg (Allerfar) 1v x2 lan/ngay hay Cetirizine 10mg (Zyrtec,

Cetrin) 1v/ngay hoac Loratadine (Clarityne, Alertin) Hoac Fexofenadine
(Telfast, Alerfast) 60mg 1v x2 lan/ngay hoc Levocetirizin 5mg 12v/ngy

Giam au (chch)

Paracetamol (Panadol, Efferalgan) 0,5g 1vx2 lan/ngay trong 3ngay

Thuoc cam mau

-Adona 25mg 2-4 ong/ ngay

-Vitamin K1 10mg 2-4 ong / ngay

- Theo doi : Moi ngay trong tuan au e hut sach mau ong va vay. Moi tuan trong 1
thang e tranh seo dnh.
- Lu y: kiem tra chc nang gan, than trc khi cho thuoc

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SAU PHAU THUAT

NOI SOI MUI XOANG
Mo NSMX gom co: m khe gia, kiem tra xoang ham va bong sang, m xoang sang
trc, kiem tra xoang sang sau, nao sang toan bo, mo xoang bm, cat polyp mui bang
wizardac biet la dan lu u nhay qua noi soi, lay u xng nho xoang sang, phau tran
qua noi soi, lay u mach mau trong hoc mui.
- Trong thi gian hau phau phai theo doi sat tnh trang benh nhan: chay mau, M, To, HA 3
lan/ngay au. Neu Hct<25% phai truyen mau ngay.
- Hau phau: Dung khang sinh, khang viem, giam au, khang Histamin.
ieu tr

Thuoc

Khang sinh (dung 1 trong

cac loai sau)

+Aminoglycoside (Amikaye 500mg) 15mg/kg (TB) 1 lieu trong ngay duy

nhat
+Cefotaxim (Opetaxim, Shintaxime):
1g x 2 -3lan (TM)/ ngay
+Amox+A.Clavu (Augmentin, Curam, Moxiclav) 1g x 2-4 lan/ngay (TB)
+Cefuroxim (Zinacef, Viciroxim):
0,75gx2-3 lan/ngay (TB, TM)
+Ceftriaxone (Opeceftri)1g: 1-3 lan/ngay (TM)
+Clindamycine (Dalacin C) 600mg: x2-3lan/ ngay (TB, TM)

Khang viem (Chon 1 khi +Mazipredone (Depersolone) 30mg 1-2 ong/ngay (sang)
khong chong ch nh) +Hydrocortison 100mg 1-2 lo/ngay (sang)
dung trong 3-5 ngay
-Sau o dung khang viem dang men: Alphachymotrypsine ( 21K),
hoac lysozyme (nh Noflux 90mg) 2v x 2 lan/ngay
Khang Histamine

+Pheramine 4mg (Allerfar) 1v x2 lan/ngay hay Cetirizine 10mg (Zyrtec,

Cetrin) 1v/ngay hoac Loratadine (Clarityne, Alertin) Hoac Fexofenadine
(Telfast, Alerfast) 60mg 1v x2 lan/ngay hoc Levocetirizin 5mg 12v/ngy

Giam au (chch)

Paracetamol (Panadol, Efferalgan) 0,5g 1vx2 lan/ngay trong 3ngay

Thuoc cam mau

-Adona 25mg 2-4 ong/ ngay

-Vitamin K1 10mg 2-4 ong / ngay

Nho nc muoi sinh ly lien tuc vao meche mui 4 lan/ngay.

Nang tong trang bang dch truyen khi can thiet.

Ngay th 2 rut meche mui t t, neu chay mau nhieu th ngng rut, e ngay sau rut tiep.
Cho them thuoc cam mau khi can (Dicynone 0,5g 1v x 2-3lan/ngay, Adona 25mg 1-2ong
x 2 TM/ngay).

Sau khi rut het meche mui, cho benh nhan noi soi mui xoang lai, e hut mau ong va lay
vay trong cac ngoc ngach mui xoang.

Theo doi cho benh nhan tai kham thng xuyen 2 tuan/lan trong thang au tien. Sau o
1 thang 1 lan / 2 thang ke va 3 thang /1lan trong nhng thang sau, cho en 1 nam e phat
hien benh tai phat.

Lu y: kiem tra chc nang gan, than trc khi cho thuoc

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VIEM HONG
I. NH NGHA:
Viem niem mac hong trong o co lp lien bao, co tuyen nhay, co nang lympho, cac
nang nay co the rai rac hoac tap trung tng khoi.
1. VIEM HONG O
1.1. Trieu chng
- C nang: Sot cao 390C ot ngot kem n lanh, nhc au, au rat hong, khat nc, au
mnh may, tieng noi trong.
- Thc the: o toan bo niem mac hong man hau, tru trc va tru sau Amian, thanh sau
hong.
- Can lam sang: Bach cau khong tang.
1.2. The lam sang
- Viem hong cum: sot cao, nhc au, au c, sung huyet thanh hong.
-

Viem hong do virus APC tre em: so mui, viem hong o, viem mang tiep hp, hach co
sng.

Viem hong o do vi trung (lien cau): viem hong o, thap khp, bach cau tang, sng
hach co.

- Viem hong mui tre em nho (viem VA): sot cao, co giat, nghet mui, non, benh keo
dai.
1.3. ieu tr
- ieu tr trieu chng la chnh.
- Chong sot: Paracetamol 20-30mg/kg/ngay.
- Suc hong.
- Kh dung hong.
2. VIEM HONG BA TRANG (viem hong do vi trung)
Benh thng do lien cau
2.1. Trieu chng
- Khi phat: n lanh, au mnh, sot, nhc au, rat hong.
- Toan phat: Sot 38-390c, au rat hong, au nhoi len tai.
- Kham hong:

Hai amian sng to, o, co gia mac (ch khu tru amian).

Tru trc va sau Amian, li ga, man hau sung huyet.

Hach goc ham to, au.

- Can lam sang: Bach cau 10000-12000

2.2. ieu tr
- Khang sinh rat cong hieu: benh rut lui sau 24h
- Amoxicillin + Acid clavulanic
50mg/kg/ngay hay Cefuroxim.

(Augetipha562,5mg

hoc

Ofmantine

625mg)

- Suc hong.
- Kh dung
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VIEM AMIDAN
I. I CNG:
Amidan la mot to chc tan bao thuoc vong tan bao Waldeyer (bao gom to chc tan
bao vom hong, quanh voi nh va ay li). Viem amidan la mot benh ly kha pho bien
thng gp mi la tui, tr em nhiu hn ngi ln.
Vi khun gy bnh ch yu l gram (+), c th tm thy vi nm, vi trng k kh v c
siu vi trng.
II. TRIU CHNG:
1. Vim amidan cp:
- St cao 39 40 0C.
- au hng, nut kh.
- Ging ni thay i v hi th hi.
- Khm hng: 2 Amidan to, . Nim mc hng .
- Din bin thng th khi sau 1 tun.
- Cn lm sang: XN cng thc mu, pht hng.
2.Vim amidan mn:
- Nut vng, ho khan.
- Hi th hi.
- Khm hng: Amidan to hoc hc b u.
III. IEU TR:
ieu tr viem amidan chu yeu la noi khoa, thuoc chu yeu la giam au va khang sinh
neu do vi trung
1. ieu tr noi khoa:
- Ngh ngi neu ch do nhiem sieu vi.
- V sinh rng ming.
- Suc hong nc muoi am hoc ra mi, kh dung hng (corticoid v khng sinh)
- Dung thuoc ngam co cha benzocaine.
- Khng sinh: thi gian iu tr 10 14 ngy
*Nhm Betalactam:
+ Amoxicillin+Acid Clavulanic (Augtipha 562,5mg) 50mg/kg x 2 ln/ngy
+ Cephalosporine: ty theo mc bnh c th chn khng sinh ung hoc tim.
.Th h I: Cephalexin, Cephadroxil: 50mg/kg x 3 ln/ngy.
.Th h II: Cefuroxim (Zinnat) 30mg/kg x 3 ln/ngy.
.Th h III: Cefpodoxim, Cetamet 10mg/kg x 2 ln/ngy.
*Nhm Macrolide: Azithromycin 10-20mg/kg ln duy nht/ngy x 3 5 ngy.
- Gim au, h st: Paracetamol 30-40mg/kg/ngy.
- Khng vim chng ph n:
+ Corticoid dng ung hoc tim tnh mch.
+ Hoc khng vim dng men: Alphachymotrypsin,
-Gim ho
-Nng tng trng
Lu y: Khong dung aspirin tre em neu viem la do sieu vi v co the gay hoi chng
Reye
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2. ieu tr ngoai khoa:

*Ch nh tuyt i:
- Amidan ph i gy tc nghn ng h hp trn, nut au nhiu, ri lon gic ng,
hoc km theo cc bin chng tim mch.
- Abces quanh amidan khng p ng vi iu tr ni khoa v th thut dn lu ngoi
khoa, tr khi phu thut c tin hnh trong giai on cp ca bnh.
- Vim amidan gy bin chng st cao co git, vim tai gia, vim xoang..
- Amidan cn sinh thit xc nh gii phu bnh.
*Ch nh tng i:
- Vim nhim amidan t 3 t tr ln mi nm d c iu tr ni khoa tch cc.
- Hi th v v gic hi ko di do vim amidan mn khng p ng vi iu tr ni
khoa.
- Vim amidan mn hoc ti pht trn mt bnh nhn mang mm bnh Streptococcus
khng p ng vi cc khng sinh khng beta-lactamse.
- Ph i amidan mt bn nghi ng khi u tn sinh.
* Hien khoa TMH bv KKV tnh An Giang cat amidan bang phng phap dung
dao ien cao tan lng cc ket hp cot ch cam mau ho mo.
3.Chuan b benh nhan trc mo:
- Lam xet nghiem tien phau + noi soi Tai Mui Hong
4.Thuoc dung sau phau thuat cat amidan:
- Khang sinh: Cefuroxim 1,5mg x2 ln/ngy (TMC)
- Khang viem (dung Hydro cortisone 100mg en hau phau ngay th 3)
- Giam au, ha sot
- SAN SOC SAU CAT AMIDAN:
- Khong c ong noi ngay sau khi cat , nen ni lai t hau phau ngay 2 tr i
- Hau phau ngay 1-2 sa lanh, hau phau ngay 3 4 chao long e nguoi, hau phau
ngay 5-6 chao c, hau phau ngay 7-10 n cm nho, sau an cm bnh thng.
- C nhng chat chua, cay, cng va nong t 10 14 ngay sau khi mo
- Khong nen en nhng cho ong ngi trong tuan au sau mo v rat de nhiem trung
ng ho hap t ngi khac
- Hay uong nhieu nc, hoac uong nhng chat giau chat dinh dng nh nc trai
cay, sa, sup, nhng ng qua lanh.
- Khong hut thuoc hoac uong ru, bia v rat de gay kch thch vung hong. Thong
thng sau mot tuan benh nhan co the tr ve lam viec bnh thng cua mnh ma
khong gap tr ngai do cuoc mo va qua.
- Trc khi xuat vien noi soi hong kiem tra tnh trang ho mo amidan.

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VIEM VA
I.I CNG:
VA l 2 ch vit tt ca cm t ting php Vgtations Adnoides. VA l t chc
lymph nm vm mi hng thuc vng bch huyt Waldayer. Bnh thng mi tr em u c
VA t khi sinh ra, VA pht trin mnh t 1-5 tui, sau teo i khi tr ln ln.
Vim VA l bnh l thng gp tr nh t 1 - 5 tui, t l vim VA chim khong 2030% nhim khun h hp trn.
Bnh hay ti pht v thng gy bin chng nh vim tai gia, vim mi xoang, vim ph
qun, gy tc nghn ng th ko di nh hng n s pht trin s mt ca tr.
Bnh tuy khng nguy him n tnh mng nhng gy nhiu phin phc v nh hng n
sc khe, sinh hot v n ung ca tr em.
II.TRIU CHNG:
-Vim VA cp: Tr thng biu hin st trn 380C, c trng hp st cao 39 400C, c th km
biu hin kch thch hoc co git, tr quy khc, kh chu. Tr b ngt tc mi v thng ngt hai
bn, ngt tng khi nm, tr phi h ming th, b n, b b, nn tr.
- Sau tr xut hin chy mi c hai bn, lc u chy dch nhy sau chy dch c dn, trng
c, s lng tng nhiu hn.
- Mt s b c biu hin ri lon tiu ho nh au bng, nn tr v i ngoi phn lng. Khi thm
khm thy mi nhiu m, nim mc mi sung huyt , khm hng thy nim mc hng , c
nhiu m nhy trng chy t vm xung thnh sau hng.
- Khm tai thng thy mng tai sung huyt, chng ta cn ch v vim tai gia l mt bin
chng thng gp ca vim VA, cn phi theo di lin tc cc du hiu v tai.
- Vim VA mn tnh: L tnh trng qu pht hoc x ho ca VA sau nhiu ln vim bn cp
tnh. Tr chy mi thng xuyn, nhiu hoc t, dch khi trong khi c, nhiu khi chy mi xanh
ko di.
- Tr thng ngt mi phi th bng ming, ng khng ngon gic, hay hong ht, git mnh. C
trng hp tr ng ngy v c nhng cn ngng th khi ng, c th st nh hoc khng st.
- Thm khm thy mi c nhiu dch nhy c hoc vng xanh, VA to che kn ca mi sau hoc
nh hn nhng vim v c nhiu dch nhy bm, hng c nhiu dch nhy. Khm tai mng tai
thng dy, c hoc biu hin r rng ca mt trng hp vim tai thanh dch.
- Ni soi mi thy khi VA qu pht, c khi c m
III.IU TR:
- Amoxicillin + Acid clavulanic (Augetipha, Ofmantine) 50mg/kg/ngay hay Cefuroxim.
- Suc hong.
- Kh dung

IV.BIN CHNG:
- Bin chng tai l nhm bin chng thng gp nht nh vim tai gia cp, vim xng chm
cp, vim tai thanh dch do qu trnh vim lan vo tai thng qua l vi tai.
- Bnh thng tin trin m thm, vi tr nh kh pht hin du hiu nghe km v tr khng au
tai do vy bnh c th b b qua lm nh hng n pht trin ngn ng, hc tp ca tr do nghe
km v bnh lu dn s chuyn thnh vim tai xp, nh hng nhiu n sc nghe.
- Bin chng mi xoang: gy vim mi xoang. Vim xoang sng cp xut ngoi l mt th nng
ca vim xoang tr nh, qu trnh vim xoang sng cp c th lan vo mt gy cc bin chng
mt, nu khng iu tr kp thi c th gy m.
- Gy vim thanh qun, kh qun, ph qun, vim phi tr thng phi nhp vin iu tr.
- Gy ng ngy v ngng th khi ng thng phi hp vi vim amidan qu pht. Nu tr ng
ngy v c nhiu cn ngng th, bnh ko di c th dn n suy tim v sau c th gy ngng
th v t vong khi ng.
- Tr c b mt VA: Do ri lon pht trin khi xng mt v lng ngc. Biu hin: mt di,
hm trn vu, rng hm trn mc lm chm, hm di hp, lun h ming, xng c d ra trc,
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xng sn lp, ngc khng n.

V.CH NH NO VA:
Tr c ch nh no VA khi: vim VA mn tnh c nhiu t vim bn cp trong nm; vim VA
gy bin chng nh vim tai gia, vim tai thanh dch, vim nhim ng h hp; vim VA
gy ng ngy, c cn ngng th khi ng. Thng no VA khi tr trn 1 tui.

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VIEM THANH QUAN CAP TRE EM

I. NH NGHA:
La tnh trang viem cap thanh thiet, sun pheu, thanh thiet, day thanh, niem mac ha
thanh mon, co the ke ca kh quan.
1. The lam sang
- Viem thanh thiet cap (supraglotitis hay Epiglotitis)
- Viem thanh kh quan co rt (spasmodic laryngotracheitis)
2. Dch te
- Tuoi : 2-6 tuoi
- Mua : lanh hoac khi giao mua
- Khi phat ot ngot
- Ve sinh dinh dng kem
II. TRIEU CHNG:
- Kho nuot: bo an, chay nc mieng
- Khan tieng : co the nhe en mat tieng
- Kho th: kieu thanh quan (xem kho th thanh quan)
- Cac trieu chng khac co the khong ay u: sot cao, viem hong man, ho (ong ong), th
co tieng rt.
- Lu y khi kham

Khong co gang e li.

Nen thc hien soi thanh quan phong mo.

Chan oan phan biet vi hen phe quan (the viem thanh quan co rt)

Viem mang nao (the viem thanh thiet cap)

II. IEU TR:

Khang sinh Neu BC tang (> 10.000) hoac benh > 5 ngay bang: (mot trong cac loai thuoc)
-Amox + A.Clavu (Augmentin, Curam, Ofmantine ..)
-Cefadroxil (Biodroxil) 0.5g 2v x2 /ngay
-Cefuroxim (Zinnat, Ceroxim)
Khang
viem

-Corticoid (Dexamethasone, Prednison, Depersolone, Solumedrol) 0,5-1,5mg/Kg/ngay Chch hoac uong

Ha sot

Paracetamol, tuy theo benh nhi co the uong hoac nhet hau mon:
-<3thang : 40 mg/ngay
-1-2 tuoi: 80-120 mg/ngay
-3-6 tuoi : 160-320 mg/ngay

An than

Diazepam 5mg

Cham soc

-Lau mat
-Nam au cao th Oxy
-Kho th nang, co the nam phong cham soc ac biet va m kh quan.

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VIEM THANH QUAN MAN TNH

I. NH NGHA:
Trieu chng chc nang chnh: Khan tieng keo dai, khong co xu hng t khoi va phu
thuoc vao qua trnh viem thong thng, khong ac hieu.
Khong ke cac benh: lao thanh quan, giang mai thanh quan, nam thanh quan.
II. TRIEU CHNG:
1. C nang
- Khan giong keo dai tng t.
- Tang tiet nhay, nhat la buoi sang.
- Cam giac nga, kho rat.
2. Thc the
- Tiet nhay ong 1/3 trc va 1/3 gia cua day thanh
- Ton thng day thanh

Nhe: Niem mac day thanh, sung huyet o.

Nang: Qua san day thanh nh si day thng, niem mac hong, mat bong.

III. THE LAM SANG:

- Viem TQ man tnh , xuat tiet thong thng
- Viem TQ qua phat
- Bach san TQ
- Viem TQ teo
- Viem TQ nghe nghiep
- Lon thanh that gia
- Viem TQ man tnh tre em
IV. IEU TR:
- ieu tr nguyen nhan:

ieu tr o viem nhiem : Mui, xoang, hong

Tranh: hi hoa chat, bui

Noi t, noi nho, ngng ca hat.

- ieu tr tai cho: Kh dung hong.

- ieu tr toan than: Khang sinh, khang viem neu can.
- Luyen giong.

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CHAM SOC SAU KHI M KH QUAN

I. NH NGHA:
M kh quan la tao 1 ng th ra ngoai co khong qua mui va hong.
II. CH NH:
- Cac trng hp tac nghen ng ho hap tren.
- Giam khoang chet cho ng ho hap.
III. CAC KIEU M KH QUAN:
- Cao: Tren eo tuyen giap
- Trung bnh: Ngay eo tuyen giap
- Thap: Di eo tuyen giap
IV. CHAM SOC:
1. Cham soc canule
- Cot day co nh canule va u chat va that nut khoa.
- Th oxy am am (neu can)
- Hut am nht thng xuyen, nho nc muoi sinh ly, hoac cac loai thuoc lam loang
am nht ( chymotrypsine, Mistabron) e tranh kho ac am nht.
- Thay ra nong trong cua canule t nhat 2 lan/ngay
- Tap ho, vo lng cho benh nhan thng xuyen, nhat la vao buoi sang.
- Lam mang che e tranh bui va khong kh lanh vao ng th.
2. Theo doi bien chng
- Chay mau vet mo: Khau hoac bang ep.
- Tran kh di da: Cat bt ch may da.
- Tran kh mang phoi:

Lng t: Co the t hap thu -> theo doi.

Lng va: Choc hut, hoac dan lu mang phoi.

Lng nhieu: Dan lu mang phoi.

- Nhiem trung:

Vet mo:

+ Cay mu Khang sinh o

+ Ra, thay bang, cham soc vet mo moi ngay

Nhiem trung ho hap di:

+ Cham soc canule

+ Khang sinh.
- Thuoc:
Khang sinh: co the s dung -Augmentine 1g; Augmentine 0,625g
dang uong hoac tiem, 1
Tre em: 30mg/kg x 2-4lan/ngay
trong cac loai sau:
Ngi ln: 1g x 2-4 lan/ngay
-Co the phoi hp them
-Cefuroxime :
Getamycine 0,08g:
+Viciroxim 1,5g; Zinacef 0,75g
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+Tre em: 20mg/10kg/ngay

(TB)
+Ngi ln: 1-2 ong/ngay
(TB)

Tre em: 30-100mg/kg/ngay

Ngi ln: 0,75g x 2-3 lan / ngay
+Zinmax 0,5g; Zinnat 0,5g
Tre em: 10-15mg/kg x 2 lan/ngay
Ngi ln : 250-500mgx 2 lan/ngay
-Cefotaxime (Shintaxime 1g ; Opetaxime 1g)
Tre em: 50 -100 mg/kg/ngay
Ngi ln: 1g x 2-3 lan /ngay
-Cephadroxil (Biodroxil 0,5g):2v x2lan/ngay
-Cefaclor (Ceclor CD 0,375g): 1v x 2 lan/ngay

Khang viem:

-Steroid: co the s dung dang tiem trong 3-5 ngay

Co the s dung mot trong au sau o chuyen sang dang uong va giam lieu
dan
cac thuoc sau
+Mazipredone (Depersolone 0,03g)
Tre em : 1-2mg/kg/ngay
Ngi ln: 1ong x 1-3lan/ ngay
+Methylprednisolone (Solumedrol 40mg)
Tre em: 1-2mg/kg/ngay
Ngi ln: 1ong x 1-3lan/ngay
+Prednisolone 5mg
-Non-Steroid:
+ Diclofenac (Neo-pyrazone 50mg) 1v x 2 -3lan
/24gi
-Enzyme:
+Lysozyme (Noflux 90mg): 1-2v x 2 lan /ngay
+Serratiopeptidase (Garzen 10mg): 1-2v x 2, 3lan
/ngay hoc Alphachymotrypsin 1v x3 ln/ngy
Giam au:

-Paracetamol: 30 -40mg/kg/ngay, co the s dung

Co the s dung mot trong di dang:
cac thuoc sau
+Perfalgan10mg/ml x100ml (TTM)
+Panadol, Efferalgan, Dafalgan, Acemol
-Di-antalvic: 1v x 3-4lan/24 gi
Long am:

Acetylcysteine (Muxystine 200mg)

1goi x 3lan/ngay.

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CHAM SOC HAU PHAU SAU NAO V.A

Nao V.A la nao to chc Lympho viem va qua phat vung vom mui hong.

1. Thuc sau m :
- Khang sinh Cephalosporin the he II, III (Cefuroxim, Cefpodoxim, Cetamet,)
- Giam au
2. Cham soc hau phau:
Theo doi chay mau:

Neu benh nhan a nho ra nc bot trong, cho uong sa lanh.

Neu con mau ra ca mui trc hoac nho ra qua mieng > Chuyen benh nhan
vao phong cat Amygdale, hut sach mau mui hong, kiem tra hong neu thay
nhng dai niem mac long thong phai cat bo.

Neu van con chay mau, at bong cau vao vung noc vom ch khoang 3 phut.

3.Hau phau ngay 4 :

- Noi soi mui kiem tra vet mo
5. Dan do khi xuat vien :
- Uong thuoc va nho mui ( NaCl 0.9%) theo toa bac s.
- Tai kham sau 1 tuan tai phong kham.
- Neu ve nha be chay mau hoac sot cao, a be en tai kham ngay.

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CHAM SOC HAU PHAU

SAU CAT AMIAN
nh ngha:
Cat Amygdale la cat bo Amygdale khau cai b viem hoac qua phat to anh hng en sc
khoe va nang suat lam viec cua benh nhan.
1. Thuoc sau mo:
- Khang sinh Cephalosporin the he II, III (Cefuroxim 1,5g liu 0,75g x 3 ln/ngy) hoc
Cefotaxim 1g x2 ln/ngy
- Giam au
- Hydrocortison 100mg 1 lo/ ngay
Theo doi chay mau:

Neu co chay mau nhe, kiem tra lai ho Amian va cam mau bang cach tiem thuoc
te tai ho Amian, buoc cam mau, ot cam mau, cat amian con sot (chu y cc
di amian)

Neu chay mau nhieu, hoac r ra keo dai hoac oi ra mau en cho theo doi mach,
huyet ap, nhiet o moi 30 phut. ong thi cho xet nghiem lai mau.

Tuy theo tnh trang benh nhan ma truyen nuc ien giai hoac mau neu can thiet, va
cho them thuoc an than (seduxen 5mg en 10mg IV hoac IM), Dicynon 250mg t
2ong en 3ong/ 24 gi IV.

Neu van chay mau nhieu chuyen vao phong mo kiem tra lai va that ong mach canh
ngoai neu can. Chu y bao am ng th cho benh nhan.

2. Hau phau ngay 4

Noi soi hong kiem tra ho mo
3. Dan do benh nhan :
- 03 ngay au:

An thc an long va nguoi nh chao, sa, sup.

- T ngay th 3 en ngay th 7 :

An thc an mem nh m, mien, ph.

- T ngay th 8 co the an bnh thng.

- Bao trc cho benh nhan biet co the chay mau t vao ngay th 6 hoac 7 do troc gia mac
va neu chay nhieu mau ti, sot nhap vien ngay.

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CHAM SOC SAU PHAU THUAT

CAT POLYP-HAT DAY THANH
1. NH NGHA
Sau cat polyp, hat day thanh nham tai tao niem mac day thanh. Phuc hoi chc nang phat am
2. CHAM SOC HAU PHAU
2.1. Noi khoa
Khang sinh uong
(1 trong cac loai sau)
Khang viem
(1 trong cac loai sau)

-Amoxicilline + A. clavulanat (Augmentiny) 30-50mg/kg/ngay

-Cefuroxim (Zinnat, Zinmax) 30-100mg/kg/ngay
-Corticoid dang chch (trong 2-3 ngay), Depersolon: 2-3mg/kg/ngay
-Dang men (trong 5-7 ngay), Garzen 10mg, Noflux 90mg: 2v x 2 lan/ngay

2.2. Tai cho : Xong hong bang Dexacol va Melyptol

2.3. Dan do: (trong tuan au)
- Han che noi to va dai hi.
- Tranh thc an qua nong, chua, lanh.
- Nen noi ngay sau phau thuat nhng noi nho ngan hi
3 TAI KHAM
- Soi thanh quan kiem tra sau 2 tuan
- Neu can co the ke hp luyen giong.

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