IEU TR BENH LAO

PGS.TS. BS. QUANG VAN

TR

MUC TIEU (1)

1.Biet lch s benh lao
2.Phan tch 3 yeu to ac trng cua vi trung
lao, 3 giai oan cua sang thng.
3.Trnh bay 2 muc tieu, 4 nguyen tac trong
ieu tr.
4.Trnh bay 3 nhom thuoc khang lao
5.Phac o ieu tr lao tren the gii & tai
Viet Nam
6.oc c cac phim X-quang c ban

LCH S BENH LAO

Bogota, Colombia - lao ot song ngc

Benh Pott

+ Hippocrates (460 BC):

Ton thng lao au tien la
Phthisis
+ Aristotle (384-322 BC):
Phthisis la mot benh truyen
nhiem
(Thay thuoc Hy Lap: Phthisis la
benh di truyen)
+ Clarissimus Galen (131 201 AD):
Phthisis la mot benh co

ieu tr lao co xa:

(th nghiem

va sai lam)

+ Caelius Aurelianus (The ky 5th

AD):
Heliotherapy (cha tr bang
anh sang)
+ Thay thuoc Y: Tam trong
nc tieu ngi
- An gan cho soi - Uong

+ Chau Au: The ky 17th au TK

20th: dch lao bung phat va gay
t vong hang au (Great White
Plaque); sau o lan en Bac My do
di dan.
+ Chau phi: Lao bung phat do
tiep xuc vi ngi Chau Au.
+ Chau A: Co t thi ngi
tien s - Bung phat vao cuoi TK

Franciscus Sylvius (1614-1672), Ha

Lan: au tien xac nh u lao
(tubercle) va tien trien cua sang
thng t u lao loet hoai t
hang.
Richard Morton (1637-1698): Anh
Xac nh u lao luon luon hien
dien phoi nhng ngi mac
lao.

Robert Koch (18431910):

+ 24/3/1882: tm ra vi
trung lao MT
+ 1890: cong bo
ieu che thanh
cong Tuberculin

Wilhelm Konrad
von Rontgen
(1845-1923):
1895: phat hien
ra tia X

Trung tam phong nga benh

lao (Central Bureau for the
Prevention of Tuberculosis): (1902Berlin)
Dr. Gilbert
Sirsiron: gii
thieu bieu tng
chong benh lao
nh la mot cuoc

Nam 1920: Thanh lap Lien

oan chong lao va Benh
phoi quoc te
(International Union Against
Tuberculosis and Lung Disease,
IUATLD)

Albert Calmette (1863-1933)

Camille Guerin (1872-19

T 1908 en 1919: sau 230 lan canh cay

trc khuan lao bo (M. bovis), che tao
thanh cong vaccine Bacille Calmette
Guerin (BCG) (ng dung cho ngi:

Vien ieu dng (Sanatorium)

ieu tr lao au tien:
Hermann Brehmer (1826-1889):
au tien a ra pp ieu tr lao
bang sanatorium (dinh dng tot +
ht th khong kh trong lanh)
Edward Livingston Trudeau (18481915):
+ Phat trien Sanatorium My
+ Lap ra phong xet nghiem tm vi

Sanatorium tai Y

Mot so ieu tr can thiep

khac:
+ Carlo Forlanini (1847-1918):
Gay TKMP nhan tao
+ Samson (1950):
Cat xng sn e lam xep
nhu mo phoi b
lao
+ Holger Mollgaard (1885-1973):

Selman A. Waksman (1888-1973)

Albert Shatz (1920-200

1943: Streptomycin (t nam Streptomyces

griseus)
1944: Streptomycin (s dung ieu tr lao

Cuoi 1944: Jorgen Lehmann (18981989)

Para-Amino-Salicylic acid, (PAS)
1944-1948:
-Nicotinamide tac ong ieu tr
lao (?)
-Dang tong hp cua
Thiosemicarbazone
Isoniazid (INH)
-1912: c phat hien ra

+ John Crofton (1912-): a ra phac

o ieu tr lao phoi hp au tien:
SM + PAS + INH
+ 1967: Ethambutol c dung thay
the PAS
+ RIF + INH + EMB (SM): rut gang
thi gian ieu tr lao t 18 24
thang giam con 6 9 thang.
+ Dickinson et al: RIF + INH + SM at
c s tiet trung tot.

1983, tm ra HIV
1984, benh lao tang tr lai tai MY
1991: ieu tr lao co kiem soat
Directly Observed Treatment, Shortcourse
(DOTS)
1998: Stop TB initiative

2000: WHO a ra lo trnh cham

dt benh lao
+ 2005: 70% benh lao c chan
oan va
85% c ieu tr khoi
+ 2015: Ganh nang toan cau
cua benh lao
giam xuong con 50% so
vi 1990

AI CNG (1)
BENH LAO LA BENH :
- HE THONG
- TRUYEN NHIEM
- LAY QUA NG HO HAP (+++)
- DO M.TUBERCULOSIS

AI CNG (2)
CAC YEU TO TAC ONG
EN IEU TR LAO
- YEU TO VI TRUNG LAO
- TIEN TRIEN CUA SANG THNG
LAO
- TAC DUNG CUA THUOC KHANG
LAO TREN VI TRUNG LAO

AI CNG (3)
YEU TO VI TRUNG LAO :
- HIEU KH TUYET OI
- SINH SAN CHAM
- T LE OT BIEN KHANG
THUOC

AI CNG (4)
TIEN TRIEN SANG THNG
LAO :
- GIAI OAN I
- GIAI OAN II
- GIAI OAN III

CAC YEU TO VI
TRUNG HOC
A. TRC KHUAN LAO
Hieu kh tuyet oi
Sinh san cham
T le ot bien khang thuoc

B. TIEN TRIEN SANG

THNG LAO
GIAI OAN I:
Hien tng thc bao
Hien tng viem: tham nhiem

GIAI OAN II:

Hien tng ba au hoa

GIAI OAN III:

S thanh lap hang

CAC NHOM TRC

KHUAN LAO
NHOM I:
Nhom sinh san nhanh moi
trng kiem (hang lao)

NHOM II:
Noi bao moi trng acid

NHOM III:
Trong cac ai thc bao hoai
t o ba au ac

CHU TRNH SINH SAN CUA VI

TRUNG LAO
ai thc bao 105 BK
(Moi trng acid)
au ac 105 BK

Ba au hoa

Thc bao

Hang lao 108 BK

(Moi trng kiem)

Hoa mem

Ba

CAC THUOC KHANG LAO CO

IEN (1)
RIFAMPICIN
ISONIAZID
ETHAMBUTOL
PYRAZINAMIDE
STREPTOMYCIN

CAC THUOC KHANG LAO CO

IEN (2)
THIOAMID :
ETHIONAMIDE
PROTHIONAMIDE
KANAMYCIN - AMIKACIN
VIOMYCIN
CAPREOMYCIN
CYCLOSERINE
P.A.S
THIOACETONE (Tb1)

CAC THUOC KHANG LAO

MI
Nhom Quinolone
Ciprofloxacin, Ofloxacin, Sparfloxacin
Moxifloxacin, Levofloxacin
Nhom Macrolide
Azithromycin, Roxithromycin,
Clarithromycin
Nhom Amoxicilline/clavulanic

TAC DUNG KHONG ONG

BO CUA CAC THUOC
KHANG LAO
THUOC
pH KIEM

Rifampicin
Isoniazid
Streptomycin
Pyrazinamide

NGOAI BAO

+
+
+
-

+
+
+

pH ACID

+
+

MUC TIEU IEU TR LAO

Ngan nga chon loc ot
bien khang thuoc
Tiet trung trong sang thng
NGUYEN TAC CAN BAN
Phoi hp thuoc
ung lieu lng
u thi gian
Lien tuc

TNG TAC
RIFAMPICIN
THUO
C

TA
C DUNG NGOA
I YMUO
N

-Thuoc chong ong ma

u
-Thuoc nga thai
-Digitoxine-Digitalin
-Cortisone
-Talbutamid

-Gia
m ta
c dung
-Gia
m ta
c dung nga thai
-Gia
m 50% ham lng
-Gia
m thigian ba
n huy Cortisone.
-Gia
m 50% ham lng

-Novobiocin
-Trileanclomycine
-Phenobarbital
-Benzodiazepine
-Probenecid

-Nguy c vang da
-Nguy c vang da
-Tang nong oRifampicine
-Tang nong oRifampicine
-Tang oc tnh Rifampicine

CA
CH O
I PHO
-ieu ch
nh ham lng
-Thay oithuoc khac
-ieu ch
nh ham lng
-ieu ch
nh Cortisone
-Lam Glycemic, ieu ch
nh
ham lng
Khong phoihp
Khong phoihp
Khong phoihp
Khong phoihp
Khong phoihp

TNG TAC
ISONIAZID
-Thuoc
giam acid
da day
vi chat
Aluminium
Disulfurance

-Mat tac
dung H

Khong
phoi hp

-Buon ba,
khong nh
hng c
-Tang oc
tnh H

Khong
phoi hp

-Chuyen
chat
Salicylic
-Nguy c
-Thuoc me vang da

Khong
phoi hp
Ngng 15
ngay H

TNG TAC
ETAMBUTOL
THUO
C

-Disulfurance
-Chloramphenicol

TA
C DUNG NGOA
I Y CA
CH O
I PHO
MUO
N
-Ta
ng nguy c vie
m Kho
ng pho
i hp
tha
n kinh ma
t
-Ta
ng nguy c vie
m Kho
ng pho
i hp
tha
n kinh ma
t

PHAN LOAI CAC THUOC

Nho
m thnha
t
Nho
m thhai
KHANG
LAO
Ca
n thie
t
Isoniazide
Rifampicin

New
Rifamycin
Rifabutin
Rifapentine

Kha
c

Cu

M
i

Pyrazinamide Ethionamide Quinolones

Ethambutol
Cycloserine
Ofloxacin
Streptomycin Capreomycin Ciprofloxacin
Amikacin
Macrolides
Kanamycin
Clarithromycin
P AS
Clofazimine
Thiocetazone Amoxicillin&
Clavulanic acid

Sparfloxacin
v.v

PHAC O IEU TR
LAO
THEO
KY
PHACHOA
O 6 THANG:
INH + RIF + PZA ( HANG NGAY 2
THANG)
INH + RIF (HANG NGAY 2 3 LAN/TUAN
4 THANG)

PHAC O 9 THANG:
INH + RIF ( HANG NGAY 9 THANG)
HOAC
INH + RIF ( HANG NGAY 1
THANG)
INH + RIF ( 2 LAN/TUAN 8 THANG)

PHAC O IEU TR
LAO
THEO CTCL QUOC GIA (1)
LAO PHOI MI BK(+), BK (-):
2 SRHZ/ 6 HE (hoac 6 RH)

LAO PHOI TAI PHAT:

2 SRHZE/ 1 RHEZ/ 5 R3H3E3 (hoac 5

RHE)

LAO PHOI/ HIV:

BK(-): 2 RHZ/ 4 RH
BK(+): 2 RHEZ/ 4-6 RH (hoac HE)
TAI TR:
2 SRHEZ/ 1 RHEZ/ 5 RHE

PHAC O IEU TR
LAO
THEO
TT.PNT
(2)
LAO MANG NAO
3 SRHZ/ 6 RH (hoac HE)

LAO MANG NAO TRE EM:

BK(-): 2 RHZ/ 4 RH
BK(+): 2 SRHZ/ 4 RH

TAI TR:
2 SRHEZ/ 1 RHEZ/ 5 RHE

KET LUAN (1)

Benh lao la mot benh ieu tr
c va ket qua chac chan.
Khang thuoc la moi quan tam va
trach nhiem hang au cua ngi
thay thuoc, nhan vien y te va
benh nhan.
Di chng bat hoi phuc do ieu tr
cham tre la ieu khong the
tranh c.

KET LUAN (2)

Dch HIV ang lam tang tan suat lao.
Phong nga lao trong cham soc sc
khoe ban au phai c tuan thu
triet e.
Vi tat ca nhng hieu biet va
trach nhiem, chung ta chac chan
se lam giam c tan suat lao
trong cong ong va mot ngay
khong xa se khong che c benh
lao.

Hang Lao

Sau khi ieu tr

Tran dch mang p

Hang lao

Tran dch mang phoi

Het TDMP