Vim ph qun cp

BS L Thng V

Giai phau Sinh ly hoc

ng ho hap tren:
mui,
mui hau, hau hong, hau
thanh quan,
tien nh thanh quan.

ng ho hap di:
thanh quan,
kh quan,
phe quan goc phai va
trai tng ng hai phoi
phai trai,
cac phe quan thuy: 3
thuy tren, gia va di
phai; hai thuy tren va
di trai;
cac phe quan phan
thuytieu phe quan tan.

Giai phau Sinh ly hoc

chc nang: thc
hien qua trnh trao
oi kh (oxy va CO2)
cho toan c the.
qua mang phe nang
mao mach tai cac
phe nang, tui phe
nang, tieu phe
quan ho hap.

nh ngha
vim kh ph qun
cp (thng di 3 tun, di 8 tun)
t gii hn v lnh, hi phc chc nng
hon ton

Dch t

VPQC ngi bnh thng:

l mt phn ca nhim trng h hp trn (sau
cm lnh hoc nhim siu vi h hp trn v
kh ph qun).
thng gp ~5% dn s Hoa K b t nht 1
ln trong nm.
thng vo ma lnh (thng 10-thng 3).

Nguyn nhn
nguyn nhn 16-29% trng hp
Cc siu vi h hp thng gp: 80%

Influenza v parainfluenza virus: 75%93%

Adenovirus: 45%90%
Rhinovirus: 32%60%
Coronavirus: 10%50%
Khc: si, RSV, human metapneumovirus

Vi trng (trong khong 20%):

Nguyn nhn
Vi trng (trong khong 20%):
Mycoplasma (0.5 - 11%)
Chlamydia (0 -18%)
Pertussis (0 - 7%) (trong 20% bn ho >2-3 tun)
Pneumococci (2 - 30%)
Haemophilus (2 - 8%)
Streptococcus pneumoniae, Haemophilus influenzae,
Staphylococcus aureus, Moraxella catarrhalis, hay vi khun
Gram m khi c bt thng ph qun t trc (nh m
kh qun, t ni kh qun hoc vim ph qun mn) hoc
th pht sau mt vim ph qun siu vi.

Bnh hc

Sung huyt nim mc

Trc, ph, thm nhp bch cu lp di
nim
Cht tit nhy m, c dnh.

Bnh hc

Chc nng bo v ca cc lng chuyn ph

qun, s thc bo v h lympho b ri lon
vi khun c th pht trin cc ph qun bnh
thng l v trng
Ho l thit yu loi tr cht tit ph qun.
Tc nghn kh o c th hin din do ph
thnh ph qun, ng cht tit v trong mt
vi trng hp l co tht ph qun

Triu chng lm sng

C nng
Triu chng VHHTSV: au hng, chy mi
khng th phn bit trong nhng ngy
u.
Ho, thng nng, nhiu, ko di hn, trung
bnh 1-3 tun; 50% VPQC ht ho sau ngy
18.
Ho khan, ri m trong, nhy sau vi gi
n vi ngy; sau m nhiu hn trng,
nhy hoc nhy m. m m 50% bn m
khng c nhim trng

Triu chng lm sng

C nng
Kh kh, c bit khi ho hoc lm FVC;
him khi km kh th.
Triu chng ton thn trong 10 - 50%: au
c, mt mi.
Thng ch nng nh hoc n lnh; <10%
st 38.3 to 38.8 C (101-102 F) trong 3 ti
5 ngy. St nu c xy ra phi coi chng
cm hoc vim phi.

Triu chng lm sng

Thc th - Khm c
th pht hin

Ran m, to ht: m
Ran ngy: ri rc

Khng c hiu
Khng nhy

Triu chng lm sng

Cm: t l mc rt cao/c tr liu c

hiu
Ho, m m, st v triu chng tan thn
(nhc u, au c...) trong ma cm.
Yu t dch t qua s ly lan rt quan trng
trong chn on.

Triu chng lm sng

Mycoplasma
thng gp

pneumoniae

ngi tr
vim hng (pharyngitis)
triu chng tan thn
ho, m thng nhy
c th ko di 4-6 tun

tng

Triu chng lm sng

C. pneumoniae
5% trong 63 sinh vin VPQ
Lm sng bao gm vim hng, vim thanh
qun v vim ph qun
Khn ting, st nh v ho ko di l cc c
im rt gi nhng khng phi lc no
cng c.

Triu chng lm sng

Ho g Pertussis
Bordetella pertussis v B. parapertussis
Rt thng gp gy mc bnh v t vong
nhng nm 40 khi cha c vc xin
Trn 153 bn San Francisco, 12% ho trn 2
tun c chn on ho g qua xt nghim
d khng bc s no ngh ti trn lm sng

Triu chng lm sng

Ho g Pertussis

Chng nga hiu qu cao, bo v khi bnh nng

95% trng hp.
Nhng trng hp chng nga khng vn c
th mc bnh
Nhng bnh nhn c min dch mt phn
thng biu hin khng in hnh ging vim ph
qun do siu vi nhng ho ko di hn.
Him hn, vn cn c gp vi biu hin lm
sng l ho ng ng nh ch sa, nng, thnh cn,
ko di v thng gy nn

Ho g Pertussis

Ho g Pertussis

Cn lm sng

Thng BC khng tng, c th gim BC

trung tnh v/hoc tng lympho.
CRP thng thp.

Cn lm sng

X quang bnh thng

CNHH:
40% VPQ cp c FEV1 80% d on.
Phn ng tnh ph qun vn tng trong
vng 5 tun sau t vim ph qun

Cn lm sng

Thng khng cn X quang, ch chp

khi:
Nguy c cao vim phi: gi (trn 75), nghin
ru, tng b vim phi trong nm qua
Khng in hnh: ho trn 3 tun, khng c
triu chng ng h hp trn, bnh nhn
nng
Nghi ng vim phi khi khm v d mch
>100/pht, nhp th >24, hoc nhit
>39C, nghe ran n phi
Dch t nghi cm, SARS

Chn on xc nh
#1 Ho m cp (<3 tun).
#2 Khng bnh phi trc
#3 Khng bt thng khi khm gi vim
phi
in hnh khng cn o oxy, chc nng
h hp, th m hoc chp X quang
phi

Chn on phn bit

Ho cp:
Nhim siu vi h hp trn: thng ho qu 5
ngy cn ch VPQ; trn 14 ngy th
c hiu cao hn (ho mt trong vng 14
ngy bnh nhn c nhim siu vi h
hp trn). Thng khng m.
Cc trng hp vim hng in hnh do
Streptococcus beta hemolytic group A
thng khng ho (tiu chun Centor: hng
vim xut tit, hch c, st, khng ho).

Chn on phn bit

Ho cp:
Vim xoang: nhim siu vi h hp trn ko
di vi cc triu chng nhc u, au rng
hm trn, chy mi m

Chn on phn bit

Ho cp:
Vim phi nu T>39C hoc
ko di, nhp tim>100, nhp
th>24, au ngc khu tr,
hi chng ng c hoc ran
n, khng biu hin chy
mi/au hng v tn thng
vim phi trn X quang.
Hen: Thng c bnh s ho,
kh kh, kh th mn trn
cc bn c c a d ng.

Chn on phn bit

Cc loi VPQ khc

Vim ph qun cp kch thch do tip xc
vi ha cht, khi bi c hi...
t bng pht vim ph qun mn hoc t
bng pht bnh phi tc nghn mn tnh
Vim ph qun mn: ho hu ht cc ngy
trong thng trn 3 thng/nm trong 2 nm
lin tip

Chn on phn bit

Nhn bit cc VPQ cn iu tr c hiu

Da trn cc bnh cnh lm sng chuyn
bit m t.

M. pneumoniae vi ho 4-6 tun km au hng;

C. pneumoniae vi khn ting;
Ho g: tng cn d di, c hoc khng i sau
ho, ho >2-3 tun (20%);
Cm: nhiu triu chng ton thn, dch t cm

Chn on phn bit

Nhn bit cc VPQ cn iu tr c hiu

Ho g chn on

Ly dch hu mi sau (ly bng cch pht hu

mi sau hoc ht mi hu).
PCR v cy

Tuy vy thc t thng khng xc nh

c nguyn nhn

iu tr
Nguyn nhn
Bn nhim cm A iu tr hiu qu ch
nu khi u trong vng 48 gi u c
triu chng. Thuc c ch
neuraminidase: zanamivir ht and
oseltamivir ung
Cc nghin cu cho thy khng c
hiu qu khi dng khng sinh thng
quy v d erythromycin, azithromycin...
tr khi iu tr ho g.

iu tr

Nguyn nhn
Ho g c th c iu tr bng
erythromycin, dng cng sm cng tt, 250500 mg bn ln/ngy cho bnh nhn ho g
hoc tip xc ho g.
Khi lm sng gi M. pneumoniae hoc C.
pneumoniae vi ho ko di v nhng biu
hin c trng ng hp trn;
tetracyclin, doxycyclin, macrolid, and
fluoroquinolon c th c s dng

iu tr

Khng cho khng sinh tr

CRP > 50 mg/l
Vim ph qun rt nng
St trn 1 tun hoc t khng st chuyn
qua st
C yu t dch t
Bn suy gim min dch

iu tr

iu tr triu chng gip bn chu ng

c triu chng v v vy c th lm
gim nhu cu dng khng sinh.
Ngh ngi, ung nhiu nc khi st.
Gim au, h st:

ngi ln, aspirin 650 mg, ibuprofen 200-400mg

hoc acetaminophen 650 mg mi 4-6 gi;
tr em, acetaminophen 10-15 mg/kg hoc
ibuprofen 10mg/kg mi 4-6 gi) gim mt mi,
st.

iu tr

iu tr triu chng
Ho ci thin ng k khi dng gi dc.
Khng c hiu qu: codeine,
dextromethorphan hoc salbutamol khi so
snh vi gi dc.
Dn ph qun ch nn cho dng khi c
nghn tc/kh kh v/hoc ho trn 4 tun
(nhng phi lu tc dng ph nh tim
nhanh, run tay, vp b).

iu tr

iu tr triu chng
Cc triu chng vim h hp trn km theo
c th iu tr triu chng bng ipratropium
(anticholinergics), v/hoc thuc chng sung
huyt mi (ng vn giao cm).
Vim mi d ng nn cho corticosteroid
ng mi v/hoc khng histamin.