VIM KHP

T 6 Nhm 2 D4A

Nguyn Quc Vit

V Nh Vinh
H Quc Vng
Siu Hi Nhi
H Th Hng
 VIM KHP
1. Bnh: Vim khp

1.1. nh ngha
- Vim khp l tnh trng vim ca
mt hoc nhiu khp xng, chng
hn nh 1 hoc c 2 u gi hoc
c tay, hoc mt phn ca ct sng.

1.2. Phn loi:

Hai loi thng gp nht ca vim khp l vim xng khp v vim
khp dng thp. au khp v cng khp l cc triu chng chnh ca
vim khp.
1.3. Nguyn nhn
Vim xng khp.
Trong vim xng khp, thit hi sn c th dn n xng mi trc tip trn xng, gy
au n v hn ch vn dng. Hao mn ny c th xy ra trong nhiu nm, hoc n c th
c y nhanh hn bi chn thng khp hoc nhim trng.

Vim khp dng thp.

Trong vim khp dng thp, h thng min dch ca c th tn cng cc khp v vim
sng ty mng hot dch, gy sng, ty v au khp. Cui cng bnh c th ph hy
sn v xng trong khp.
1.4 Yu t nguy c

Cc yu t ri ro cho vim khp bao gm:

Lch s gia nh. Mt s loi vim khp c lch s gia nh, v vy c th c

nhiu kh nng pht trin vim khp nu cha m hoc anh ch em c cc ri
lon
Tui. Nguy c ca nhiu loi vim khp tng theo tui.
Gii. Ph n c nhiu kh nng hn l nam gii pht trin vim khp dng
thp
Thng tch. Nhng ngi b thng, nhiu kh nng cui cng pht
trin vim khp
Bnh bo ph. Trng lng vt qu t p lc vo cc khp, c bit l
u gi, hng v ct sng. ngi bo ph c nguy c cao pht trin vim
khp.
1.5. Cc XNCLS chun on

1.5.1. Cc xet nghim chung

Xt nghim huyt hc:
Xt nghim mu ton b bao gm: s lng hng cu, hemoglobin,
hematocrit, s lng bch cu, cng thc bch cu, s lng tiu cu l
nhng xt nghim c bn trong cc bnh khp.
Xt nghim nc tiu:
nh lng protein, m t bo c ngha quan trng trong chn on luput
ban h thng (SLE). Cc xt nghim ny chun on phn bit vi lupus
ban h thng v theo di tc dng ph ca thuc iu tr vim khp.

1.5.2. Xt nghim sinh ho mu: l nhng xt nghim cn thit bao gm: xt

nghim chc nng gan, chc nng thn, chuyn ho mui, cc cht in gii.
1.5.3. Cc xt nghim huyt thanh
T khng th (autoantibodies): t khng th l globulin min dch trc
tip phn ng vi cc protein bnh thng hoc cc thnh phn t bo c
th. T khng th thng gp trong vim khp dng thp, luput ban v
cc bnh t chc lin kt lan to
Yu t thp (Rheumatoid factor):
Yu t thp l t khng th khng trc tip globulin min dch
Yu t thp khng c gi tr c hiu chn on vim khp dng thp v c th
(+) mt s bnh ni khoa khc. Yu t thp (+) 80% s bnh nhn vim
khp dng thp, nhng giai on sm nhiu bnh nhn yu t thp m tnh
Khng th khng nhn (antinuclear antibody: ANA)
Khng th khng nhn thng dng tnh trong cc bnh khp, khng th
khng nhn khng c gi tr chn on c hiu cc bnh t chc lin kt
Khng nguyn HLA:
Khng nguyn HLA B27 (+) 95% s bnh nhn vim ct sng dnh khp
1.5.4. Xt nghim dch khp.
- Chc ht dch khp v xt nghim dch khp l bin php c gi tr chn
on bnh khp v theo di kt qu iu tr. S thay i v mu sc, th
tch v thnh phn t bo dch khp c gi tr trong chn on bnh khp.
- Da trn trong sut, mu sc, dch khp c chia lm 4 nhm:
. Nhm I : dch khng vim.
. Nhm II : dch vim.
. Nhm III: dch m.
. Nhm IV: dch mu.
1.6. Triu chng lm sng-Bin chng
Cc du hiu v triu chng thng gp nht ca vim khp lin quan n
cc khp, bao gm: au, Cng khp, Sng, , Hn ch vn ng.
C km theo du hiu v triu chng lin quan n cc b phn khc ca c
th: St, mt mi, pht ban, gim trng lng, kh th, kh mt ming,
m v m

Bin chng
Trong cc vim khp nghim trng, c th gy kh khn vi cc sinh hot hng ngy.
Vim khp ca cc khp mang trng lng c th nh hng ti i b thoi mi
hoc ngi thng. Trong mt s trng hp, cc khp c th b xon v bin dng.
2. Cc ch s XNCLS
- Cc ch s bt thng trn bnh n
Huyt hc:
Tc lng mu
- Sau 1h: 50mm (BT: 3-7) (mm)
- Sau 2h: 94mm (BT: 7-16) (mm)
-> Tng phn nh trng hp vim, nhim trng
HCT (Khi hng cu Hematocrit)
- KQ: 45,88 (BT: 38-45) (%)
->Trong trng hp vim thot dch gy tng khi hng cu,ht thuc l, bnh mch
vnh, COPD, tuy nhin tng nh cha phn nh r c ngha
RDW (Di phn b kch thc hng cu)
- KQ: 14,5 (12-15) (%)
-> Tng phn nh kch thc hng cu thay i nhiu
PLT (S lng tiu cu)
- KQ: 401 (150-400) (G/l)
->> Tng nh phn nh tnh trng nhim trng v vim
Sinh ha
Xt nghim Protein phn ng C (CRP)
KQ: 20,10 (BT: 0-5) (mg/l)
Bnh thng khng hoc xut hin mt lng nh trong mu. Tnh trng nhim
trng, vim cp vi ph hy m trong c th s kch thch sn xut protein ny v
gy tng nhanh nng protein phn ng C trong huyt thanh.
 Xt nghim vi sinh

Dch vng m, m, cn lng nhiu, pH=8

Bch cu tng cao (bch cu a nhn chim u th)
Cha tm thy vi khun
3. Thuc ch nh trong ca lm sng.
3.1 Sullacilline (Ampicillin+Sulbactam)
Ch nh:
- Nhim khun do vk nhy cm vi thuc, nhim khun mu vim mng no, vim
phc mc, nhim khun dg mt v ng tiu ha, xng khp, da v m mm;nhim
trng h hp thn niu, sinh dc, lu..d phng
Chng ch nh:
- Qu mn vi cc thnh phn ca thuc hay penicillin
ADR: Tiu chy, d ng, vim i trng, my ay, au ni tim
3.2. Meditrypsine (Chymotrypsine)
Ch nh:
- iu tr cc trng hp ph n do chn thng, lm gim v mt cc bc mu da
- Cc trng hp bong gn, cc chng vim tai kt dnh, vim xoang
CC: Qu mn vi cc thnh phn ca thuc
ADR: C th gy ra cc triu chng qu mn
3.2. Efferalgan (Paracetamol)
Ch nh: iu tr triu chng cc cn au va v nh, cc trng th st
CC: Mn cm vi thuc, suy t bo gan; ngi thiu mu nhiu ln, c bnh tim phi
thn gan, ngi thiu men G6PD
ADR: Bun nn v nn, gim BC trung tnh, thiu mu, c thn khi lm dng nhiu
ngy. Tn thng gan nu dng liu cao ko di. Him gp: gim tiu cu, cc phn ng
d ng nh ban , m ay..
3.4. Kerola (Ketorolac)
Ch nh: iu tr ngn ngy, au va n nng sau phu thut, dng thay th cc sn
phm opioid
CC: Tin s vi lot d dy chy mu ng tiu ha, xut huyt no, c a chy
mu, ri lon ng mu. Ngi bnh phu thut ang dng thuc chng ng. Qu
mn vi Ketorolac v cc thuc khng vim khng steroid khc.
Hi chng polyp mi ph mch co tht ph qun, gim chc nng thn va v
nng, ngi mang thai cho con b tr em di 16 tui.
ADR: Ph, au u, chng mt, bun nn kh chu, ra m hi, au bng tiu chy
3.5 Vancomycine
Ch nh: Vim rut kt do t cu, vim i trng do khng sinh, vim i
trng gi mc; ch nh trong cc trng hp nhim trng gram dng
nng khng vi ks thng thng, bnh nhn d ng vi penicilline
CC: K s dng cho BN c tin s mn cm vi thuc
ADR: St nn, n lnh, mn ; c tnh trn tai thn, ban c, c th
xy ra kt hp vi chng kh th; hi chng gim HA, gim p lc tm
thu

3.6. Ofloxacine
Ch nh: Nhim trng ng tiu, da v m mm, vim tuyn tin lit,
vim phi; nhim trung mt
CC: BN nhy cm vi Ofloxacine hay bt k dn xut no ca Quinolone
ADR: Bun nn, i ma tiu chy au bng; phn ng da nhy cm nh
sng, nga vim mch mu, pht ban da; chng mt hay qun, co git,
nhy cm; suy thun cp th pht, nhn m tng BC a axit, gim BC a
nhn trung tnh, gim tiu cu, v to.
Cm n cc bn nh!!!