BENHCHUYEN KHOA

7/25/2019 BENHCHUYEN KHOA

1/185

TRNG TRUNG CAP Y TE TAY NINH

GI O TRNH

CHNG TRNH TRUNG C P


2/185

TRNG TRUNG CAP Y TE TAY NINH

BOMON Y HOC C S

GIAO TRNH

CHNG TRNH TRUNG CAP

CHU BIEN

BS. Nguyen Van Thnh

BIEN SOAN

BS. Nguyen Sanh Tam

BS. Nguyen Kim Ngan

TRNH BAY

BS. Nguyen Van Thnh


3/185

Muc luc.

Trang 1 Giao trnh Benh chuyen khoa.

MUC LUC

Trang1.

Li noi au 12.

Chng trnh benh chuyen khoa 23.

ai cng ve benh tam than 34.

Cac trieu chng, hoi chng tam than 155.

Benh ong kinh, tam than phan liet 336. Giai phau sinh ly va cach kham tai mui hong 497. Mot so benh ly viem nhiem vung hau hong 578.

Viem tai gia, viem xng chum 639.

Chay mau mui 6710.

D vat vung hau hong11.

Giai phau sinh ly va cach kham rang ham mat12. Sau rang13. Benh viem nha chu14.

D tat bam sinh va chan thng vung ham-mat

15. Benh lao 3316.

Chng trnh chong lao. 4917.

Cac ton thng c ban cach kham ngi benh da lieu 6318. Benh phong va chng trnh phong chong phong. 6719. Benh lau20.

Benh cham, vay nen21.

Benh ghe, hac lao

22.

Giai phau sinh ly va cach kham chc nang th lc23.

Viem ket mac, viem loet giac mac, mat hot24. Benh uc thuy tinh the25. Benh tang nhan ap26. Sang chan, bong mat27.

Tai lieu tham khao


4/185

Li noi au.

Giao trnh Benh chuyen khoa. Trang 2

LI NOI AU

T nam 2008, c s chap thuan cua Bo Y te va Bo Giao duc-aotao, Trng trung cap y te Tay Ninh tien hanh ao tao loai hnh Y sy nhhng chuyen khoa.

Vi muc tieu hoan thien noi dung ao tao theo muc tieu chng trnhkhung va hoan chnh bo cong cu lng gia, am bao hoc sinh co nguon tailieu thong nhat va sat hp vi thc te tai Tay Ninh. Phong ao tao a tienhanh cong tac bien soan giao trnh benh chuyen khoa.

Sau hai nam to chc bien soan tng phan, nam hoc 2010 2011

chung toi tong hp cac tai lieu phat tay e hoan chnh bo giao trnh Benhchuyen khoa danh cho oi tng Y sy nh hng chuyen khoa.

Trong bo giao trnh nay, chung toi co gang co ong noi dung tngthch vi thi lng phan bo cua chng trnh, am bao bam sat muc tieu, yeucau va trnh o cua oi tng y sy, chu trong mo ta ky nhng ac iem lamsang, am bao hoc sinh co kha nang nhan nh va chan oan c mot sobenh ly chuyen khoa thng gap.

Do c bien soan lan au nen kho tranh khoi nhng thieu sot, mongquy ong nghiep va cac ban hoc sinh gop y e bo giao trnh ngay cang hoanthien hn.

Nhom giao vien bien soan


5/185

Chng trnh benh chuyen khoa.


BENH CHUYEN KHOA- Ma so mon hoc: C.01.06- So hoc phan: 01- So n v hoc trnh: 04 (4/0)- So tiet: 60 tiet (60/0)- Thi iem thc hien: Hoc ky 3- Phan bo thi gian: 08 tiet/tuan, tong so: 08 tuan

IEU KIEN:

- Hoc sinh a hoc xong mon benh hoc Noi, Ngoai.

MUC TIEU MON HOC:1. Mo ta trieu chng, tien trien, bien chng mot so benh thng gap thuoc chuyen

khoa Mat, RHM, Tai-Mui-Hong, Da lieu, Lao va Tam - Than kinh.

2. Kham va ieu tr cac mot so benh chuyen khoa thong thng.

3. Tuyen truyen GDSK ve phong, cha cac benh chuyen khoa thng gap.

NOI DUNG MON HOC:

Tt Noi dung bai hocSo tiet

Tong LT THCHUYEN KHOA TAM THAN 10 10 0

1. ai cng ve benh tam than 3 3 02.

Cac trieu chng, hoi chng tam than 4 4 03. Benh ong kinh, tam than phan liet 3 3 0

CHUYEN KHOA TAI-MUI-HONG 12 12 04. Giai phau sinh ly va cach kham tai mui hong 4 4 0

5. Viem mui, viem xoang, viem VA, viem hong, viem Amidan 4 4 06. Viem tai gia, viem xng chum 2 2 07. Chay mau mui 1 1 08. D vat vung hau hong 1 1 0

CHUYEN KHOA RANG HAM MAT 10 10 09.

Giai phau sinh ly va cach kham rang ham mat 4 4 010. Sau rang 2 2 011. Benh viem nha chu 2 2 0

12. D tat bam sinh va chan thng vung ham-mat 2 2 0


6/185

Chng trnh Benh chuyen khoa.


Tt Noi dung bai hocSo tiet

Tong LT THCHUYEN KHOA LAO 6 6 0

13. Benh lao 3 3 014. Chng trnh chong lao. 3 3 0

CHUYEN KHOA DA LIEU 11 11 015.

Cac ton thng c ban cach kham ngi benh da lieu 3 3 016.

Benh phong va chng trnh phong chong phong. 2 2 017. Benh lau 2 2 018. Benh cham, vay nen 2 2 019.

Benh ghe, hac lao 2 2 0

CHUYEN KHOA MAT 11 11 020. Giai phau sinh ly va cach kham chc nang th lc 4 4 021. Viem ket mac, viem loet giac mac, mat hot 3 3 022. Benh uc thuy tinh the 1 1 023.

Benh tang nhan ap 1 1 024.

Sang chan, bong mat 2 2 0

Cong 60 60 0

HNG DAN THC HIEN: Yeu cau giao vien:

- Giao vien co chuyen mon la Bac sy hoac C nhan ieu dng.

Phng phap giang day:

- Thuyet trnh, ap dung cac phng phap giang day tch cc.

Trang thiet b day hoc:

- Co the s dung may Overhead, Projector ... anh gia:

- Kiem tra thng xuyen: 02 cot iem bai viet dang cau hoi nho.

- Kiem tra nh ky: 02 cot iem bai viet dang x ly tnh huong.

- Thi ket thuc mon hoc: bai thi 90 cau trac nghiem trong thi gian 60 phut.


7/185

ai cng benh tam than.


AI CNG VE BENH TAM THANBS. Nguyen Van Thnh

MUC TIEU HOC TAP1.Neu khai niem va noi dung cua tam than hoc.2.Mo ta phan loai va nguyen nhan gay ra cac roi loan tam than.3.Trnh bay mot so nguy c ve sc khoe tam than hien nay.

AI CNG TAM THAN HOC

Tam than hoc dch t tieng hy lap Psychiatria: Psyche la tam than, iatria

la cha benh. Tam than hoc la mon hoc nghien cu cac bieu hien lam sang,benh nguyen, benh sinh cac benh tam than va cac bien phap ieu tr va dphong cac benh nay.

Do kien thc ve tam than hoc cha pho bien rong rai nen van con nhieungi nham lan gia benh tam than va benh than kinh.

- a so ngi benh than kinh khong co cac y ngh, cam xuc, tac phong, hanhvi ky d, kho hieu nhng lai co cac trieu chng khu tru nh liet na ngi, teoc, i ng kho khan, roi loan giac quan ...

- a so ngi benh tam than co the i lai bnh thng nhng lai co nhng yngh, cam xuc, hanh vi ky d.

Benh than kinh thng co thng ton ve mat hnh thai he than kinh,trong khi benh tam than thng khong tm c thng ton ro ret.

Sc khoe cho moi ngi la muc tieu ln, muc tieu chien lc cua to chcy te the gii (WHO), cua nhieu quoc gia phat trien va cua ca nganh y te ncta; va cung la thc o chung cua moi xa hoi van minh, nhan ban. Khong the

chia cat sc khoe the chat vi sc khoe tam than xa hoi va ngay cang phaikhang nh vai tro quan trong cua sc khoe tam than trong mot no lc chung enang cao chat lng song cho moi ngi trong mot xa hoi phat trien.

Chnh v vay, oi tng cua tam than hoc ngay nay khong ch ongkhung trong khuon kho bon bc tng cua benh vien - ch tap trung vao nhngngi benh tam than nang nh ngi benh tam than phan liet, roi loan camxuc lng cc, sa sut tr tue, thuoc pham vi tam than hoc truyen thong. Matam than hoc hien ai ang phan au v sc khoe toan dien ca the chat va tam

than - v s thoai mai cho tat ca moi ngi song trong cong ong.


8/185

BS. Nguyen Van Thnh.


KHAI NIEM VE SC KHOE TAM THAN

Trong khi sc khoe ve the chat a c dan tng bc xa hoi at ungvao v tr cua no, th sc khoe tam than con phai ben b phan au e thay oi

dan nhan thc van con nhieu lech lac, nhieu mac cam.Sc khoe tam than khong ch la mot trang thai khong co roi loan hay d

tat ve tam than, ma con la mot trang thai tam than hoan toan thoai mai.

Muon co mot trang thai tam than hoan toan thoai mai th can phai cochat lng nuoi song tot, co c s can bang va hoa hp gia cac ca nhan,moi trng xung quanh va moi trng xa hoi.

Nh vay, thc chat sc khoe tam than cong ong la:

- Mot cuoc song that s thoai mai.- at c niem tin vao gia tr ban than, vao pham chat va gia tr cua ngi

khac.

- Co kha nang ng x bang cam xuc, hanh vi hp ly trc moi tnh huong.

- Co kha nang tao dng, duy tr va phat trien thoa ang cac moi quan he.

- Co kha nang t han gan e duy tr can bang khi co cac s co gay mat thangbang, cang thang (stress).

Cham soc bao ve sc khoe tam than cho moi ngi la mot muc tieu ratcu the, mang tnh xa hoi, nhng cung rat cao, rat ly tng va phai phan aulien tuc e tien dan tng bc, cuoi cung at c muc tieu Nang cao chatlng cuoc song cua con ngi Viet Nam.

NOI DUNG CUA TAM THAN HOC

1. Tam than hoc truyen thong:

1.1. Tam than hoc ai cng:

- Lch s phat trien tam than hoc.

- Trieu chng hoc, hoi chng hoc.

- Moi lien quan gia tam than hoc va cac mon khoa hoc khac.

- Phan loai cac benh, cac roi loan tam than.

- Benh nguyen, benh sinh cua mot so benh va cac roi loan tam than.

- Tam than hoc xuyen van hoa.


9/185



1.2. Benh hoc tam than:

- Loan than thc ton (roi loan tam than lien quan cac benh noi tiet, chanthng, thoai trien nao: Alzheimer, Pick ).

- Loan than noi sinh (tam than phan liet, ong kinh, roi loan cam xuc )

- Cac roi loan tam than lien quan en stress (tam can, roi loan c the tamsinh, trang thai phan ng).

- Cac roi loan tam than do cau tao the chat bat thng va s phat trien tamthan benh ly (nhan cach benh, cham phat trien tam than ).

- Cac roi loan tap tnh hanh vi thanh thieu nien (hanh vi bao lc, xampham, roi loan s hoc tap ...).

- Roi loan an uong.

- Loan chc nang tnh duc khong thc ton.

- Cac roi loan lo au, am anh s.

- Cac roi loan phan nh gii tnh.

- Lam dung va nghien chat (Lam dung ru, nghien ru, loan than do ru,lam dung ma tuy, nghien ma tuy, thuoc la ...).

1.3. Cac phng phap ieu tr va phuc hoi chc nang tam ly xa hoi:- Lieu phap sinh hoc (Dc l tam than, lieu phap soc ien ...).

- Lieu phap tam ly (Lieu phap tam ly trc tiep, gian tiep, lieu phap nhan thc,lieu phap hanh vi ...).

- Lieu phap lao ong, phuc hoi chc nang tam ly xa hoi.

- Am nhac lieu phap.

1.4. Quan ly benh tam than:

- He thong dch vu cham soc sc khoe tam than.- T van sc khoe tam than cong ong.

1.5. Giam nh y phap tam than.

2. Tam than hoc hien ai:

2.1. Tam than hoc truyen thong.

2.2. Tam than hoc cong ong.

- Ve sinh phong benh va cac roi loan tam than.


10/185



- Tam than hoc xa hoi (nghien cu anh hng cua moi trng, ac biet moitrng tam ly xa hoi va sc khoe tam than).

- Giao duc sc khoe tam than cho gia nh, nha trng va cong ong.

- Phuc hoi chc nang tam ly xa hoi.

- Cac hnh thai hoat ong ren luyen the chat, tham my.

- Cac ky nang ng x, giao tiep.

PHAN LOAI CAC ROI LOAN TAM THAN

Da theo bang phan loai benh quoc te 10 (ICD-10). Cum t ay u cuaICD la International Statistical Classification of Diseases and Related Health

Problems. ay la bang phan loai benh quoc te, phien ban 10. Phan loai ay utat ca cac benh, trong o co benh tam than.

Trc ay khi cha co phan loai quoc te ve cac benh va cac roi loan lienquan en sc khoe tam than, cac trng phai tam than hoc khac nhau eu conhng bang phan loai rieng khong giong nhau, a gay kho khan cho s thongnhat mang tnh chat quoc gia va quoc te trong pham vi nhan thc va thc hanhchan oan tam than hoc.

Co the tom tat mot so iem chnh trong bang phan loai ICD.10 oi vi

cac benh tam than nh sau:- Roi loan tam than thc the bao gom roi loan tam than trieu chng (F00-F09)

- Roi loan tam than va hanh vi do dung cac chat tac ong tam than (F10-19).

- Tam than phan liet, roi loan dang phan liet va roi loan hoang tng (F20-29)

- Roi loan kh sac (cam xuc) (F30-F39)

- Loan than kinh, roi loan lien quan en stress va roi loan dang c the (F40-F48)

- Hoi chng hanh vi ket hp vi roi loan sinh ly va yeu to the chat (F50-F59)

- Roi loan nhan cach va hanh vi ngi trng thanh (F60-F69)

- Cham phat trien tam than (F70-F79)

- Roi loan phat trien tam ly (F80-F89)

- Roi loan ve hanh vi va cam xuc vi s khi benh thng xay ra la tuoi treem va thieu nien (F90-F98)

- Roi loan tam than khong xac nh (F99)


11/185



NGUYEN NHAN GAY ROI LOAN TAM THAN

Cac nguyen nhan chu yeu thng c neu ra bao gom:

1. Cac nguyen nhan thc ton:- Chan thng so nao.

- Nhiem khuan than kinh: viem nao, giang mai than kinh ...

- Nhiem oc than kinh: nghien cac chat, nhiem oc nghe nghiep ...

- Cac benh mach mau nao.

- Cac ton thng nao khac: u nao, teo nao, x rai rac ...

- Cac benh c the anh hng en hoat ong cua nao: benh noi khoa, noi tiet,

cac benh chuyen hoa ...2. Cac nguyen nhan tam ly:

Chu yeu cac stress tam ly - xa hoi tac ong vao cac nhan cach co aciem rieng, gay ra:

- Cac roi loan tam can.

- Cac roi loan lien quan en stress.

- Cac roi loan dang c the.

3. Cac nguyen nhan cau tao the chat:

- Cham phat trien tam than.

- Nhan cach benh.

4. Cac nguyen nhan cha ro rang (hay cac nguyen nhan noi sinh):

Do co s ket hp phc tap cua nhieu nguyen nhan khac nhau (ditruyen, chuyen hoa, mien dch, cau tao the chat, ...) nen kho xac nh nguyen

nhan chu yeu. Cac roi loan tam than thng goi la noi sinh nh:- Benh tam than phan liet.

- Roi loan cam xuc lng cc.

- ong kinh nguyen phat.

Cac roi loan tam than noi sinh noi tren khong may lai la nhng roi loantam than nang va thng gap. Do nguyen nhan cha xac nh ro rang nen congtac d phong va ieu tr gap nhieu kho khan, roi loan tam than thng keo dai

va tai phat.


12/185



Chng trnh phong chong cac roi loan tam than noi sinh phai lau dai,can phan biet cac giai oan khac nhau cua roi loan, moi giai oan can ket hpnhieu bien phap thch hp.

Cac nguyen nhan tam ly xa hoi (Stress) cu the hn, de thay hn. Tuynhien, c che gay benh cua cac stress tam ly khong gian n nh cac stress vatly tren c the. V stress tam ly ap vao mot nhan cach va phng thc phanng cua nhan cach oi vi stress rat a dang va phc tap. Chnh v the ICD-10khong goi la roi loan do stress ma de dat goi la roi loan lien quan en stress.

Nh vay trong lam sang, xac nh nguyen nhan cua mot roi loan tamthan phai het sc than trong v co xac nh ung nguyen nhan th mi hy vongieu tr co ket qua.

CAC NGUY C VE SC KHOE TAM THAN HIEN NAY

1. Roi loan hanh vi hanh thieu nien (Conductive Disorders of Aldolescence):

Roi loan hanh vi c xep muc F.91 bang phan loai quoc te 10 (ICD-10) o la nhng hanh vi xam pham, bao lc, gay thng tch, am chem, canquay, ... do nhng nguyen c khong tng xng ...

Khi phan tch nguon goc roi loan hanh vi thanh thieu nien ngoai vai trosinh hoc, nhieu nha tam than, tam ly va giao duc hoc rat chu y en roi loanhanh vi do tap nhiem chu anh hng moi trng sinh trng cua tre em (Gianh, trng hoc va xa hoi), theo c che:

- Bat chc hanh vi xam pham va ngc ai cua ngi ln (Cha me, anh ch,thay co giao, ...) anh ap lan nhau, ngc ai tre em.

- Anh hng phim anh bao lc va sach bao bao dam.

- Do anh hng cua nhom tre em xau.

- Do phan ng bat toai vi nhng bac cha me, trc cang thang trong c checanh tranh nhieu ru ro cua c che th trng.

2. T sat (suicide):

La mot cap cu trong Y hoc va cung la mot cap cu rat ac thu trong tamthan hoc. Tm hieu nguyen nhan t sat, nhieu tac gia trong nc va ngoai ncnhan thay nh sau:

- S gia tang tiem an cac roi loan tam than cha phat hien c sm, kp thinh tram cam (depression), lo au (anxiety), hoang loan (panic disorder),

nghien ma tuy, roi loan hanh vi ...


13/185



- Nhan to tam ly xa hoi khong thuan li (stress):

That bai, o be trong lam an, canh tranh thua lo.

Mau thuan keo dai trong gia nh khong giai quyet c. Cau truc gia nh b ao lon: ly than, ly hon, cac thanh vien trong gia nh

thieu gan bo, khong co iem ta, ngi than cha hoac me nghien ru.

Co n nhng ngi cao tuoi.

Do khong c quan ly tot cac phng tien de dang gay t sat nh hoachat tr sau diet co, hung kh ...

3. Lam dung chat (Substance abuse):

Lam dung chat trong o co lam dung ru va ac biet nghien ma tuy atr thanh hiem hoa cua nhan loai va cung la nguon goc chnh cua cac cuocbao lc cuc bo va quoc te ang co xu hng gia tang ca cac nc ang phattrien va ca cac nc phat trien, trong o co nc ta.

4. Tram cam (Depression):

Tram cam co moi lien quan rat phc tap vi cac yeu to sinh hoc va conchu tac ong rat manh va trc tiep cua ieu kien kinh te-xa hoi, tam ly khongthuan li.


14/185



T LNG GIA

Chon tra li hp ly nhat:1.

iem khac biet ln nhat gia benh than kinh va benh tam than la:

A. Co ton thng he than kinhB. Co roi loan hanh viC. Co roi loan cam xucD. Co roi loan nhan cach

2.

Theo ICD.10, noi dung cua F70-F79 la:A. Roi loan lien quan en stress.B. Roi loan nhan cach va hanh vi.C. Cham phat trien tam than.

D. Hoi chng hanh vi ket hp vi roi loan sinh ly va yeu to the chat.3.

Nguyen nhan thc the cua roi loan tam than:A. Roi loan tam can.B. Cham phat trien tam than.C. Chan thng so nao.D. Nhan cach benh.

4.

Nguyen nhan cha ro rang cua benh tam than:A. Cham phat trien tam than.B. ong kinh nguyen phat.C. Nhan cach benh.D. Roi loan tam can.

5. Noi dung nao thuoc tam than benh hoc:A. Roi loan an uong.B. Tam than hoc xuyen van hoa.C. Benh sinh tam than.D. T van sc khoe tam than.

6.

Lieu phap soc ien la phng phap ieu tr va PHCN thuoc nhom lieu phap:

A. Tam ly.B. Sinh hoc.C. Lao ong.D. Phuc hoi chc nang.


15/185

Cac trieu chng hoi chng tam than.


CAC TRIEU CHNG HOI CHNG TAM THANBS. Nguyen Van Thnh

MUC TIEU HOC TAP1.Trnh bay cach phan loai mot so roi loan tam than thng gap.

2.Nhan nh mot so trieu chng roi loan tam than thng gap.

3.Mo ta mot so hoi chng roi loan tam than thng gap.

AI CNG

Cac trieu chng va hoi chng tam than rat phong phu va a dang. Nhieu

trieu chng rieng biet ket hp vi nhau thanh hoi chng. S phan chia cac roiloan tam than thanh trieu chng va hoi chng ch la mot quy c v chung luonbien oi va tuy thuoc vao giai oan benh.

Viec phat hien va anh gia trieu chng, hoi chng tam than gap nhieukho khan v phu thuoc vao kinh nghiem cua thay thuoc, vao nghe thuat tiepxuc ngi benh va hoan canh, trang thai ngi benh khi tiep xuc. Mc o phathien phu thuoc vao cach hoi benh va s tin cay cua gia nh ngi benh vaothay thuoc. V vay, viec khai thac trieu chng phai lam nhieu lan va phai co

thi gian theo doi mi tong hp c.Cac trieu chng tam than noi chung c chia thanh 2 nhom:

- Cac trieu chng am tnh: tien trien t t, cham nhng lam tan ra nhan cachngi benh nang ne. Nhom nay gom: t duy ngheo nan, cam xuc kho lanh,bang quan, giam tr nh va tr nang ...

- Cac trieu chng dng tnh: the hien ro net, on ao, co ve nang ne nhngthng ch tam thi va t khi e lai di chng. Nhom nay gom: ao giac, hoangtng, kch ong

CAC ROI LOAN CAM GIAC VA TRI GIAC

1. Tang cam giac:

Ngi benh tang tnh thu cam vi nhng kch thch ben ngoai, thnggap trong cac benh loan tam than cap tnh, trang thai moi met.

- Anh sang bnh thng cung lam loa mat.

- Mau sac s vat tr nen rc r.

-Tieng ap ca giong tieng sung no


16/185



2. Giam cam giac:

Ngi benh giam o thu cam vi nhng kch thch ben ngoai, tiep thu svat mot cach l m, khong ro ret, xa xam Thng gap trong tram cam.

- Tieng ong nghe xa xoi.

- Khong nhan nh c tieng noi ngi than.

- Thc an nhat nheo

3. Loan cam giac ban the:

Nhng cam giac a dang het sc kho chu va nang ne nh nong rantrong ngi, cau xe trong ruot, ien giat trong oc ...

4. Ao tng:La nhng tri giac sai lam ve cac oi tng co that.

4.1. Ao tng giac quan:

- Ao tng th giac: nhn chiec ao treo tren tng tng la co ngi ngi, nhnsi day thng ngh la con ran ...

- Ao tng thnh giac: nghe tieng on ao tng ban tan noi xau mnh, nghetieng nc chay tng tieng ngi noi

-Ao tng khu giac, v giac, xuc giac

4.2. Ao tng benh ly:

- Ao tng cam xuc: ang lo lang, s hai nghe tieng bat a cham nhau tngtieng xieng xch ...

- Ao tng li noi: nghe chuyen xung quanh tng li to cao

- Ao tng ky la: nhn nhng hnh anh thong thng lien tng en quai vat,chuyen than thoai thng gap trong loan tam than cap tnh.

5. Ao giac:La tri giac co that ve mot s vat, hien tng khong he co trong thc te.

- Ao giac that: ngi benh tiep nhan ao giac nh mot s vat co that trong thctai, khong phan biet ao giac vi s vat that.

- Ao giac gia: hnh anh ao giac c nhan thc bang y ngh.

- Ao giac luc gi thc gi ngu: xuat hien trc khi ngu.

-

Ao giac chc nang: ch xuat hien khi co kch thch ben ngoai.


17/185



CAC ROI LOAN CAM XUC

1. Giam va mat cam xuc:

-

Giam kh sac: buon rau, u ru. La bieu hien cua chng tram cam.- Cam xuc bang quan: giam phan ng, t bieu hien ra net mat, t hoat ong.

- Vo cam: dng dng vi tat ca moi viec, nam l tren ging thng gaptrong tam than phan liet.

- Mat cam giac tam than: mat het cam xuc (ngoai tr cam xuc au kho).

2. Tang cam xuc:

- Cam xuc khong on nh: de chuyen t cam xuc nay en cam xuc khac.

- Cam xuc say am: trang thai tang cam xuc manh co tnh nhat thi.- Khoai cam: vui ve mot cach ngay ngo, ci noi mot mnh, ci ho ho suot

ngay. Thng gap trong loan tam than sau chan thng.

3. Cac roi loan khac:

- Cam xuc hai chieu: va yeu va ghet, va gian va thng ...

- Cam xuc trai ngc: nhan tin vui nhng lai buon, nghe tin buon lai ci vui

- Lo au: cam giac luon b e doa.

CAC ROI LOAN T DUY

1. Roi loan hnh thc t duy:

- T duy phi tan: noi thao thoa bat tuyet, khong co chu e nhat nh.

- Noi ho lon: noi luon mieng, linh tinh, noi dung vo ngha.

- Noi mot mnh: lam bam nhng noi dung khong lien quan en hoan canh.

- Tra li ben canh: hoi mot ang, tra li mot neo.

- Nhai li: khong tra li cau hoi ma lap lai cau hoi.

- Noi lap lai: lap i lap lai mot so t, cau.

- Ngon ng phan liet: gia cac cau khong co moi lien quan vi nhau.

- Suy luan benh ly: luon noi ve mot van e nhat nh, tap trung vao nhng caivun vat, b hiem.

- T duy t ky: tach ri thc te, luon noi en the gii ben trong ky la.

- T duy hai chieu: co nhng suy ngh cau noi hoan toan trai ngc nhau.


18/185



2. Roi loan noi dung t duy:

- nh kien: goi la y tng qua ang. La nhng nhan nh xuat phat t thc tenhng b chi phoi bi cam xuc manh liet lam sai lech thc te. Khac vi

hoang tng, nh kien khong kem theo bien oi nhan cach.- Hoang tng: nhng y tng phan oan sai lam khong phu hp thc te. o

la s tin tng vng chac vao cac y tng sai lam, tnh chat lap luan sai lam,logic quanh co, mau thuan vi thc te.

- Am anh: nhng y ngh, hoi c co tnh cng bc. Ngi benh biet la sainhng khong xua uoi c.

CAC ROI LOAN TR NH

1. Giam nh:

Kem nh nhng s viec mi xay ra hay s viec cu. Thng gap trong tamthan tuoi gia, loan than kinh suy nhc.

2. Tang nh:

Nh lai rat ro nhng s viec rat cu, ca nhng s viec khong co y nghahay nhng chi tiet vun vat. Thng gap trong trang thai hng cam.

3. Quen:

- Quen toan bo: quen tat ca moi viec. Gap trong sau sut tr tue nang.

- Quen tng phan: quen mot so ky niem, quen thao tac nghe nghiep gaptrong ton thng khu tru hay cam xuc qua manh.

- Quen thuan chieu: quen nhng s viec xay ra ngay sau khi benh mot thigian. Gap trong chan thng so nao.

- Quen ngc chieu: quen nhng s viec xay ra trc khi benh. Gap trongchan thng so nao.

4. Loan nh:

- Nh gia: nh ung s viec nhng nham sang mot thi iem, khong giankhac. Gap trong benh thc the nao.

- Ba chuyen: quen cac s viec va thay vao o la s viec cha he xay ra nhngban than khong biet la mnh ba chuyen. Gap trong benh thc the nao.

- Nh nham: nh viec cua mnh thanh viec cua ngi khac hoac ngc lai.Gap trong benh ong kinh.


19/185



CAC ROI LOAN HOAT ONG

1. Roi loan hoat ong co y ch:

-

Giam van ong, giam ong tac: gap trong trang thai lu lan.- Mat van ong, mat ong tac: gap trong trang thai bat ong trong loan than

kinh hysteria, tam than phan liet.

- Tang van ong, tang ong tac: co nhng ong tac tha, t ong nh run,nhay mat, may moi, nhun vai ... gap trong trang thai hng cam, tam thanphan liet ...

- ong tac d thng: nhng ong tac khong co y ngha nh siet manh tay,nga mat nhn trng trng gap trong tam than phan liet.

2. Roi loan hoat ong ban nang:

- Hanh vi xung ong: cac hanh vi vo ngha, vo c, xay ra manh liet nh anhap tui bui, xe quan ao, la het thng xuat hien ot ngot, khong co s autranh e kem che.

- Say me xung ong: khac vong xam chiem ly tr, che ng toan bo tac phongngi benh. Thng xay ra tng cn.

CAC ROI LOAN Y THC

1. Roi loan y thc ban than:

Thay oi tnh cam, mat i cai toi, khong con biet vui, buon. Xay ratrong moi benh tam than.

- a nhan cach: co nhieu con ngi khac nhau song song ton tai trong banthan ngi benh.

- Giai the nhan cach: y ngha, hanh vi cua ai o ang xuat hien trong mnhch khong phai cua mnh.

2. Tri giac sai thc tai:

Cam giac xung quanh khong co thc. Ngi benh tri giac the gii xungquanh mot cach m ho, xa xoi, cng nhac, khong mau sac, thap thoang nh cobc man tha che phu ...

3. Trang thai boi roi:

Ngi benh thay ban than va xung quanh bien oi bat thng, khong thegiai thch c. Ngi benh lo ve bang khoan, lo lang, tm kiem ...


20/185



CAC ROI LOAN GIAC NGU

1. Roi loan luc bat au ngu:

Ngi benh len ging nam, tran troc mai en na em, gan sang mingu c. Co khi thc suot ca em.

2. Roi loan o dai giac ngu:

Co trng hp ngu nhanh va sau nhng sau vai gi a thc va khong thengu lai c.

Co trng hp ngu lien tuc 12-16 gi trong ngay. Cn buon ngu cht apen, khong cng lai c.

3. Roi loan o sau giac ngu:Ngi benh khong ngu sau ma ch m mang, nhan thc c l m moiviec xung quanh. Giac ngu kem theo nhieu mong m.

4. Chng i trong giac ngu:

Con goi la mien hanh. Trong luc ang ngu ngi ra khoi ging, macquan ao, i lang thang trong nha hoac co nhng hanh ong khac roi len gingngu tiep. Sang hom sau thc day khong biet g ve s viec toi hom qua.

5. ong kinh trong giac ngu:

Trong khi ngu ngi benh len cn co giat, trn mat, gong cng, phan ngs hai ...

CAC HOI CHNG TAM THAN

1. Hoi chng tam than thc the:

Thng gap trong cac benh ton thng thc the hoac roi loan hoat ongnao. Hoi chng co the khi au cap tnh trong cac benh chan thng so nao,

nhiem trung hoac tien trien t t trong cac benh u nao, teo nao Hoi chng bieu hien bang s suy yeu hoat ong tam than vi 3 trieu

chng c ban goi la tam chng Walther-Buel.

- Tr nh roi loan: kha nang ghi nh kem, ang tr, quen ca nhng s kien ganay nhat.

- Tr nang giam sut: sa sut trong hoc tap, tnh toan, hieu biet ...

- Cam xuc khong on nh: de chuyen t trang thai nay sang trang thai khac.

ang buon bong tr nen vui ve hoac gian d, oi khi tr nen khoai cam ...


21/185



2. Hoi chng Korsakov:

Thng gap ngi nghien ru hoac co tn thng nao nh u nao, taibien, chan thng Ngi benh thng l , vo cam, mau kiet sc.

- Quen thuan chieu: mat nh hng khong gian va thi gian, quen tat ca moiviec.

- Loan nh: nh nhng s viec thi iem, khong gian nay sang thi iem,khong gian khac.

Mac du quen tat ca nhng ieu mi xay ra sau khi benh nhng lai nhrat chnh xac nhng nhng viec cu.

3. Hoi chng roi loan y thc:

Gom 3 nhom trieu chng chnh.

3.1. Mc o tnh tao suy giam:

- Y thc u am: con nang lc nh hng thi gian, khong gian nhng tra licham chap.

- Ngu ga: ngi benh lim dim, ngu ga. Nang lc nh hng thi gian, khonggian khi con, khi mat, phai lay manh, goi to mi tnh.

- Ban hon me: mat nang lc nh hng, giam phan xa nhng cha xuat hienphan xa benh ly.

- Hon me: mat y thc, mat toan bo phan ng va phan xa va co the xuat hienphan xa benh ly.

3.2. Cac hoi chng lu lan tam than:

- Hoi chng sng s: au oc trong rong, t duy ngheo nan, khong bieu lo camxuc, hanh vi cham chap. Tuy nhien, khong co ao giac hay hoang tng.

- Hoi chng me sang: ao tng, ao anh ky la, ao th nhngcon nh hngve ban than. Cac bieu hien thng tang len vao buoi chieu toi.

- Hon loan tam than: t duy ri rac, trang thai bang hoang ng ngac. Mat hoantoan nh hng.

3.3. Cac trang thai roi loan y thc ac biet:

- Hoi chng hoanh hon: trang thai y thc b thu hep, xuat hien trong thi gianngan va mat ot ngot. Thng co ao th ghe rn va hoang tng.

- Hoi chng m mong: ngi benh nh va song that, va chiem bao, noi dung

ky quai.


22/185



4. Hoi chng ao giac hoang tng:

- Trang thai ao giac: noi mot mnh, noi tay oi, noi vi nhieu ngi ... thngkem theo lo au, s hai, kch ong, me sang. Gap trong ngo oc ru.

- Hoi chng Paranoia: ch co duy nhat mot hoang tng tien phat nh ghentuong, phat minh, b hai ngi benh khong co ao giac, khong roi loan ythc, khong co trieu chng tam than t ong.

- Hoi chng hoang tng:

Hoang tng cap tnh: hoang tng tam thi, bieu hien bang s hai, lo au,ao giac li noi, hoang tng b hai

Hoi chng Kandinski Clerambault: con goi la hoi chng tam than t

ong. Gom co tam chng t ong la t duy t ong, cam giac t ong vavan ong t ong. Gap trong tam than phan liet, loan tam than phan ng.

- Hoi chng hoang tng ky quai:la s ket hp gia hoang tng b theo doi vahoang tng b chi phoi: t cao ky quai, cho rang mnh co sc manh toithng, co quyen nang sieu nhien gap trong tam than phan liet.

- Hoi chng nghi benh: qua lo lang, qua chu y en sc khoe cua mnh, chorang mnh b mot benh nao o rat nang.

5. Hoi chng cam xuc:- Hoi chng hng cam: gom 3 ac iem chnh: cam xuc hng phan, t duy phi

tan va van ong tang cng. Gap trong tam than hng tram cam.

- Hoi chng tram cam: gom 3 ac iem chnh: cam xuc buon rau, t duycham chap va van ong c che. Gap trong tam than hng tram cam.

- Hoi chng vo cam: ket hp s lanh am, bang quan vi mat hoat ong hoantoan va bat lc.

-

Hoi chng loan cam: kh sac u sau, han hoc, bat man, de noi cn gian d 6. Hoi chng cang trng lc:

- Kch ong cang trng lc: ban au ngi benh phan khi, noi nhieu, noidung ri rac, vo ngha. Khi trang thai kch ong tang len th xuat hien nhnghanh vi ky d, kch 6ong hon loan.

- Sng s cang trng lc: thng xuat hien sau kch ong cang trng lc.Ngi benh khong noi, khong tra li, khong ap ng, gi nguyen t the trongmot thi gian dai.


23/185



7. Hoi chng roi loan tr tue:

- Hoi chng sa sut tam than bam sinh: con goi la cham phat trien tam than.

-

Hoi chng sa sut tam than mac phai: la trang thai cuoi cung cua nhieu benhkhac nhau vi cac ac iem:

Giam hoac mat nang lc phan oan.

Suy yeu va roi loan tr nh.

Khong on nh ve cam xuc.

Bien oi nhan cach nang ne, mat kha nang thch ng vi cuoc song.

8. Cac hoi chng loan than kinh:

- Trang thai am anh: kh sac buon rau, cam giac ban than hen kem, trang thainghi benh.

- Trang thai hysteria: net mat, c ch, hanh vi gia tao, cng ieu, de b am thva t am th, len cn gao khoc, xe quan ao, ngat xu

- Cac hoi chng suy nhc: tang nhay cam, de noi nong, mat t chu v nhngchuyen vun vat, de ong long, a sau, a cam

9. Cac trang thai nhan cach benh:

Bieu hien bang s mat hoa hp, mat thang bang, khong on nh cuanhan cach. Hay noi nong, vo ky luat, kho hoa mnh vi tap the, giam thch ngvi nhng bien oi cua cuoc song.

Benh co the do bam sinh hoac mac phai nh trong benh ong kinh, tamthan phan liet, liet tien trien


24/185



T LNG GIA


A.B.C.D.

2.

A.B.C.

D.3.

A.B.C.D.

4.

A.B.C.D.

5.A.B.C.D.

6.

A.B.C.D.


25/185

Benh ong kinh va tam than phan liet.


BENH ONG KINH VA TAM THAN PHAN LIETBS. Nguyen Van Thnh

MUC TIEU HOC TAP1.Trnh bay khai niem va phan loai benh ong kinh, tam than phan liet.

2.Mo ta trieu chng benh ong kinh, tam than phan liet.

3.Neu cac bien phap quan ly ngi benh ong kinh, tam than phan liet.

BENH ONG KINH

Benh ong kinh la mot benh cua nao, co ac iem gay ra cho ngibenh nhng cn co giat tai i tai lai nhieu lan.

1. Phan loai:

Benh ong kinh co nhieu the, vi nhng trieu chng hi khac nhau.

1.1. Da vao ton thng thc the nao bo, chia lam 2 nhom:

- ong kinh nguyen phat.

- ong kinh th phat.

1.2. Da vao bieu hien lam sang, chia lam 4 nhom:

- ong kinh cn ln.

- ong kinh cn nho.

- ong kinh cuc bo.

- ong kinh tam than van ong.

Tuy nhien tren thc te nc ta co 3 the chu yeu hay gap nhat: the ong

kinh toan than, the ong kinh cuc bo va the ong kinh kch phat Rolando.2. Lam sang:

2.1. The ong kinh toan than:

Rat hay gap. Cn ong kinh nay thng tien trien qua 3 giai oan:

2.1.1. Giai oan trng lc:

La giai oan khi au, ngi benh ot nhien nga xuong ngat i, trong khio chan tay cng lai, ngc khong th c na, ngi xanh tai, hai ham rang

nghien chat, mat trn ngc, giai oan nay thng keo dai khoang na phut.


26/185


27/185



2. Nguyen nhan:

Benh ong kinh la benh cua nao, do cac ton thng nao gay ra, v thetat ca cac nguyen nhan gay ton thng nao eu la nguyen nhan gay ong kinh:

2.1. e kho:

Chuyen da e lau phai can thiep bang foocxep, giac hut. Co tre khi sinhb ngat, neu keo dai lam cho mot bo phan nao thieu oxy gay ton thng, neuton thng khong hoi phuc c th co the gay ra benh ong kinh sau nay.

2.2. Benh cua nao va mang nao:

Mot so tre b viem nao hoac viem mang nao, benh nang lai cha chaymuon, co the khoi nhng co the e lai di chng nh mot cai seo nao hoac

mang nao, cai seo o cung co kha nang gay benh ong kinh sau nay. - Chan thng au: do b nga ap au vao vat cng hoac nen gach cng,

hoac tre ngu tren ging ngu m lan xuong at ap au xuong at gay chanthng au. Nhng chan thng o luon gay ton thng cho nao va cung languyen nhan hay gap cua benh ong kinh.

- Bu nao (u nao): mot so tre khi sinh ra co mot hay vai bu trong nao, bunay ngay cang ln, va cuoi cung gay nen cac cn ong kinh. Trong nhieutrng hp, khoa hoc cha tm c nguyen nhan cua cac bu nay.

- Di truyen: trong gia nh co ong ba cha me... cung b ong kinh. Tuy nhiennhieu khi s di truyen nay rat kn ao, quan sat ben ngoai khong thay c.Nhng khi lam xet nghiem ien nao o th lai thay ngi cha hoac me codau hieu ton thng nao giong nh benh ong kinh, nhng cac ton thngo cha nang ne en mc gay ra cac cn ong kinh.

3. Cach phong tranh va cham soc:

Noi chung benh ong kinh la mot benh nguy hiem, luon luon co the gay

chet ngi: co ngi chet ngay trong cn ong kinh nang do ngat th, chet donhieu cn ong kinh keo dai, lien tuc gay suy tim cap.

Rat nhieu trng hp cac em nho b tai nan chet ngi do cn ong kinhxay ra ot ngot tren ng i, ang cau ca, ang treo cay... Phan ln cac trnghp nay do gia nh khong trong nom, giao duc cac em chu ao.

Benh ong kinh co the cha khoi hoan toan, ngha la sau mot thi giandai cha tr, benh thuyen giam dan va hoan toan cac cn ma khong can dungthuoc na. ieu chu yeu va quan trong la benh nhan va gia nh benh nhan

can het sc kien nhan.


28/185



Trong viec cha tr benh ong kinh, s hp tac gia gia nh va thaythuoc la vo cung can thiet. Gia nh can luon luon ong vien tre, khch le tinhthan tre, khi tam hon tre c an bnh, t tng vui ve th cac cn ong kinh se

tha dan.Trai lai, phai tranh cac thai o gian d, lanh nhat vi tre, v s lo s,

buon chan, gian doi se lam cac cn ong kinh de xuat hien...

Cho tre an uong ieu o, u chat dinh dng, khong cho tre dung cacchat kch thch nh ca phe, ru bia, thuoc la.

Can trong nom giao duc tre, tranh cho tre cac nguy hiem co the xay rakhi len cn ma khong co ngi ln ben canh nh khong cho tre ra ao motmnh, khong cho tre treo cay, lai xe mot mnh ra ng..., cung khong nen chotre i lau di nang to v nhiet o cao rat de lam xuat hien cn ong kinh.

Gia nh can cho tre dung thuoc ung, uong thuoc eu an, khong cquen cho tre uong thuoc, du ch quen mot ngay mot lan cung co the lam cnong kinh tai phat, va khi o viec ieu tr se tr nen kho khan hn.

Phai xac nh benh ong kinh la mot benh cha tr lau dai, neu nong voise dan en nhieu hau qua tai hai va chac chan se that bai trong ieu tr.

BENH TAM THAN PHAN LIET

Tam than phan liet la mot benh tam than nang, tien trien t t, lam bienoi nhan cach ngi benh theo kieu phan liet, tc la lam cho ho dan tach khoicuoc song cong ong, thu dan vao the gii ben trong (the gii t ky).

Benh tam than phan liet khong phai la mot benh do ma qu gay ra, cungkhong phai do "i cha an man, i con khat nc", ma la mot benh ly cuanao, co nhng bien oi sinh hoc phc tap, chu tac ong manh cua moi trngtam ly xa hoi khong thuan li.

Benh tam than phan liet la mot benh pho bien tren the gii va nc taty le t 0,3 - 1% dan so. Benh co the cha c hoac thuyen giam tot neu cphat hien sm, cha tr kp thi, hp l.

1. Bieu hien lam sang:

Hai ac iem chnh cua tam than phan liet la tnh t ky, thieu hoa hpva s giam sut hoat ong tam than. Bieu hien lam sang cua benh rat a dang:

- Benh nhan cho rang y ngh cua mnh b phat thanh, y ngh cua mnh b

ngi khac biet, hoac ho oc c y ngh cua mnh.


29/185



- Nghi ng co ngi ieu khien chi phoi, kiem tra; b theo doi, am hai hay auoc mnh, ghen tuong vo ly.

- Cho mnh co kha nang ac biet, co quyen lc nh sieu nhan co kha nang

lam c nhng viec ky la, la ngi nha tri, ieu khien c ma gio ...- Nghi ng mnh mac benh nang nh ung th, lao, HIV, giang mai, tim mach,

ma thc te khong b benh g.

- Ngh rang mnh co nhng khuyet iem ln, co toi phai b trng phat nang.

- Benh nhan nghe, nhn, ngi hoac cam thay nhng g ma ngi khac khongthay (khong co trong thc te): nghe thay tieng noi trong au hoac tieng noiphat ra t mot bo phan nao o cua c the ...

- Cac bat thng ve hanh vi cam xuc. Kch ong, ap pha, ho het vo c, hanh hung vi ngi xung quanh.

t noi, hoi gang cung khong noi, khong an, thu mnh lai, tnh tnh kho lanhkhong muon tiep xuc vi ngi than.

Tnh kh vui buon, gian d that thng.

2. Cac the lam sang:

Co 4 the lam sang chnh:

- The n thuan: dien tien t t, cac trieu chng am tnh xuat hien ro net.Ngi benh ue oai, l , th vi moi viec, khong chu y ve sinh c the,ngay cang thu hep vao the gii t ky.

- The thanh xuan: kch ong, lo lang, ro daio, t duy ri rac, cau ch kho hieu.Benh thn gap ngi tre di 20 tuoi.

- The hoang tng: la the thng gap nhat. Noi bat la hoi chng hoang tngva ao giac.

- The cang trng lc: thng ot ngot trang thai cang trng lc kch onghay sng s.

Ngoai ra con co cac the:

- Tam than phan liet cap.

- Tam than phan liet tiem tang.

- Tam than phan liet the cam xuc phan liet.

-

Tam than phan liet the di chng ...


30/185



3. Chan oan:

Blueler, cha e cua thuat ng tam than phan liet e ngh chan oan davao 4 tieu chuan chnh:

- Roi loan lien tng.

- Roi loan cam xuc.

- T ky.

- Hai chieu.

3. Quan ly ngi benh tam than phan liet:

Do so ngi benh tam than phan liet ong, benh phat sinh tuoi thanh

thieu nien, ket qua ieu tr han che nhat la sau khi benh a i vao giai oanman tnh nen viec phong benh va quan ly rat can thiet.

3.1. Gia nh:

- Phat hien sm nhng thay oi bat thng ke tren.

- a ngi benh en vi cac dch vu cham soc sc khoe tam than e nhanc t van can thiet cua thay thuoc.

- Quan ly va cho uong thuoc eu an, ung lieu lng, gi giac theo ch nh.

- Benh tam than phan liet tai phat phan ln la do khong uong thuoc eu anhoac t y cat thuoc.

- Benh se thuyen giam va on nh tet neu c gia nh quan tam, tao moitrng thch ng, dung nap tot.

- Nhng hieu biet sai lam can tranh:

Cho rang thuoc tam than la loai thuoc ngu, nay benh nhan a ngu tot thkhong can dung na.

Cho rang thuoc cha benh tam than la thuoc oc, e ngai khong s dung

mac du a co ch nh cua bac s.

3.2. Cong ong:

- Can thong cam, chia se vi benh nhan va gia nh, khong mac cam, rieu cttreu troc, ngc ai.

- Giup benh nhan co viec lam.

- Giup benh nhan va gia nh khi gap tnh huong kho khan.


31/185



3.3. Can bo y te:

- nh ky kiem tra benh, t van ve ieu tr va tai phuc hoi chc nang tam l xahoi, cap phat thuoc ay u cho benh nhan.

- Hng dan gia nh quan ly va cho uong thuoc eu.

- Hng dan gia nh phat hien kp thi cac bieu hien tai phat benh va nhngtac dung phu khi uong thuoc an than kinh.

3.4. Cac c s quan ly, cham soc ngi benh tam than phan liet:

- Benh vien Tam than tnh hoac thanh pho.

- Tram sc khoe Tam than tnh.

- Phong kham Tam than tai cac quan.- Tram y te xa, phng.

Cac benh nhan tam than phan liet c ieu tr ngoai tru mien ph theokhu vc c tru.


32/185



T LNG GIA


Giai oan th 3 cua ong kinh toan than la:

A. Hoi tnh.B. Hon me.C. Trng lc.D. Giat rung.

2.

Tieu trong quan, sui bot mep, meo mieng la nhng bieu hien ac trngcua ong kinh giai oan:

A. Hoi tnh.B. Hon me.

C. Trng lc.D. Giat rung.3.

The ong kinh thng gap tre nho, xay ra trong giac ngu:A. ong kinh toan than.B. ong kinh cuc bo.C. ong kinh keo dai.D. ong kinh kch phat Rolando

4.

Bieu hien lam sang ve cam xuc cua tam than phan liet:A. Nghe thay tieng noi trong au.B. Nghi ng co ngi ieu khien, chi phoi.C. Kch ong, ap pha.D. Nghi ng b theo doi, am hai.

5.

Benh tam than phan liet tai phat phan ln la do:A. Lam viec tr oc qua mc.B. Lao ong the lc qua mc.C. Dung thuoc khong ung ch dan.D. Gia nh khong quan tam.

6. Quan ly ngi benh tam than phan liet:A. Bat buoc ieu tr tai benh vien tam than.B. Phai tap trung ieu tr tai tram sc khoe tam than tnh.C. Tap trung ieu tr tai phong kham tam than huyen.D. ieu tr ngoai tru theo khu vc.


33/185

GPSL va cach kham tai mui hong.


GIAI PHAU SINH LY VA CACH KHAM TAI MUI HONGBS. Nguyen Van Thnh

MUC TIEU HOC TAP1.Mo ta ac iem giai phau mot so c quan vung tai mui hong.2.Neu chc nang sinh ly mot so c quan vung tai mui hong.3.Trnh bay mot so ky thuat chnh trong kham tai mui hong.

GIAI PHAU VA CHC NANG VUNG HAU HONG1. Giai phau vung hau hong:1.1. Cau tao vung hau hong:

Hong la mot ong c va mang trc cot song co. i t mom nen ti otsong co th IV, la nga t cua ng an va ng th, noi lien mui pha tren,mieng pha trc vi thanh quan va thc quan pha di. Giong nh mot caipheu phan tren loe rong, phan di thu hep. Thanh hong c cau truc bi lpcan, c, niem mac. Hong chia lam 3 phan:

- Hong mui (t hau): cao nhat,lap sau man hau, sau dicua hai lo mui sau. Tren noc co

amidan vom. Hai thanh ben coloa voi Eustachi thong len homnh va ho Rosenmuler.

- Hong mieng (khau hau): phatren thong vi hong mui, phadi thong vi hong thanhquan, pha trc thong vikhoang mieng va c man

hau phan cach. Thanh sauhong mieng lien tiep vi thanhsau hong mui va bao gom caclp niem mac, can va cac ckht hong. Hai thanh ben coamidan hong hay amidan khaucai nam trong hoc amidan.

- Hong thanh quan (thanh hau): i t ngang tam xng mong xuong en miengthc quan, co hnh nh cai pheu, mieng to m thong vi hong mieng, ay

pheu la mieng thc quan phan hong di.

Hnh 8.2: Cau tao cua hoc mui1. Xoang tran 2. Xoan mui tren3. Xoan mui gia 4. Xoan mui di5. Tien nh mui 6. Khau cai cng7. Xng bm 8. Xoang bm

1


34/185



Thanh sau lien tiep vi thanh sau hong mieng. Thanh trc pha tren laay li, di la sun thanh thiet va hai sun pheu cua thanh quan. Thanh bennh mot mang hep dan t tren xuong di.

Nep pheu-thanh thiet cua thanh quan hp vi thanh ben hong tao nenmang hong-thanh quan hay xoang le.

1.2. Vong waldeyer:Hong co cac to chc lympho tao thanh mot vong bao quanh goi la vong

Waldeyer. Cac to chc amidan giong nh cau truc hach bach huyet. Cacamidan co chc nang sinh ra cac khang the e bao ve c the. Cac to chcamidan gom:

-

Amidan khau cai: la to chc lympho ln nhat gom hai khoi hai thanh benhong va c nam trong hoc amidan. Hoc nay co vo boc phan cach vi tochc ben hong, pha trc co tru trc, pha sau co tru sau che phu, ch comat pha trong va di thay c trc tiep, goi la mat t do cua cua amidan.Mat t do nay co cac khe an lom sau vao to chc amidan va c che phubi lp bieu b. Chnh cac khe hoc nay dien ra hoat ong mien dch cuaamidan.

- Amidan li: la nhng to chc lympho nam ay li sau V li, thng co

t 5 en 9 am mo lympho. Amidan li lien quan chat che vi amidanhong.

- Amidan vom (Luschka): la to chc lympho nam noc vom mui-hong ngayca mui sau, khong co vo boc nh amidan khau cai, mat t do thng co 5kha sui doc. Do v tr cua amidan vom nen no thng la nguyen nhan gayviem nhiem tai, mui, hong.

- Amidan voi (Gerlach): la nhng to chc lympho nho nam ho Rosenmulerquanh lo voi Eustachi.

1.3. Khoang quanh hong:Quanh hong co cac khoang cha cac to chc can, c, mach mau, than

kinh, hach bach huyet va cac khoang nay co lien quan mat thiet vi hong.

- Khoang ben hong (Sebileau): cac c tram-hong, tram-li, tram-mong va daychang tram-mong, tram-ham lam thanh mot dai hay bo (bo hoa Rioland)chia khoang nay thanh hai phan:

Khoang trc tram hay trc di mang tai.

Khoang sau tram hay sau di mang tai.


35/185



- Khoang sau hong (Henke): nam gia can bao hong va c trc cot song.Trong khoang co hach bach huyet ln la hach Gillette, hach nay ch co trenho, no se teo i khi tre 5 tuoi. Khoang Henke keo dai t hong-mieng xuong

en hong-thanh quan.1.4. Mach mau:

Mach nuoi dng thuoc nganh ong mach canh ngoai: ong mach haulen, ong mach giap trang tren, ong mach khau cai len.

1.5. Than kinh:

- Than kinh cam giac thuoc day IX, X. Day IX chi phoi nen li va 1/3 diamidan. Day X chi phoi thanh sau hong va man hau.

- Than kinh van ong chu yeu do nhanh trong cua day IX va day XI.1.6. Mach bach huyet:

Mach bach huyet o vao cac hach sau hong, hach Gillette, hach di cnh than va hach day canh.

2. Sinh ly cua hau hong:

Hong la nga t gia ng an va ng th: khong kh i qua phan muiva mieng cua con thc an i qua phan mieng va thanh quan.

Phan mui va mieng c ngan cach bi khau cai mem va li ga (tieuthiet) co tac dung nh cac van.

Bnh thng tieu thiet bat ra sau, luong khong kh ht vao t mui i quahau thanh quan, en kh quan, vao phoi. Khi an, tieu thiet bat ra trc, ay knvung hau thanh quan, thc an i vao thc quan. Nh c che t ong nay mathc an khong lot vao phoi va khong kh khong i vao da day.

Hong am nhan cac chc nang sau:

- Chc nang nuot: sau khi thc an a c nhai, nhao tron mieng c ayvao hong e thc hien qua trnh nuot: a thc an xuong mieng thc quan.

- Chc nang th.

- Chc nang phat am.

- Chc nang nghe.

- Chc nang v giac.

- Chc nang bao ve c the.


36/185



GIAI PHAU VA SINH LY THANH QUAN

1. Giai phau thanh quan:

Thanh quan la c quan phat am va th, nam trc thanh hau, t otsong C3-C6, noi hau vi kh quan.

Thanh quan di ong ngay di da vung co trc khi nuot hoac khi cuixuong hoac ngang len.

Thanh quan phat trien cung vi s phat trien cua bo may sinh duc, nenkhi trng thanh th giong noi cung thay oi (v giong), nam gii phat trienmanh hn v vay giong noi cua nam tram uc, n trong cao.

Thanh quan c cau tao bi cac to chc sun, si va c.

1.1. Khung sun:

- Sun thanh thiet hay sun nap, nam cao pha trc lo tren cua thanh quan, khiha xuong no se ay thanh quan lai.

- Sun giap gom 2 manh tao thanh mot goc m ve pha sau, trong o pha trenco sun nap.

- Sun nhan la mot vong tron nh cai nhan nam di thap ma tren no la sungiap.

- Hai sun pheu ng thang, goi tren b sau cua sun nhan. Khi hai sun pheuquay len, thanh mon se m hay khep lai.

Ngoai ra con co co cac sun nho khong quan trong nh: sun Santorini vasun Wrisberg.

1.2. Cac c thanh quan:

- Nhom c lam hep thanh mon: c nhan pheu ben, c giap pheu, c pheucheo va ngang, c pheu nap thanh hau.

- Nhom c lam rong thanh mon: c nhan pheu sau, c giap nap thanh hau.- Nhom c lam cang va chung day thanh am: c nhan giap, c thanh am.

1.3. Cac mang va day chang:

Noi cac sun vi nhau va vi cac to chc xung quanh chu yeu la:

- Mang giap mong: noi sun giap vi xng mong.

- Mang giap nhan: noi sun giap vi sun nhan.

- Day chang nhan-pheu: noi sun nhan vi sun pheu.


37/185



1.4. Cau truc trong cua thanh quan:

Mat trong thanh quan lat bang te bao tru ho hap, i t b t do day thanhla te bao malpighi. T tren xuong gom:

- Tien nh thanh quan la khoang m ve pha tren.

- Bang thanh that.

- Buong Morgagni.

- Thanh mon la khoang gia hai day thanh.

- Ha thanh mon la khoang m ve pha di vung kh quan.

- Hai xoang le pha ngoai m len tren vao vung ha hong.

1.5. Mach mau.- ong mach: cac ong mach thanh quan tren va di la nganh cua ong

mach giap trang tren va giap trang di. Nhn chung, cuong mach than kinhcua tuyen giap trang cung la cuong mach than kinh cua thanh quan.

- Tnh mach: i theo ong mach o ve tnh mach giap li va di on.

1.6. Than kinh:

Do hai day than kinh thanh quan tren va di, tach t day than kinh X.

- Day thanh quan tren: cam giac cho thanh quan pha tren nep thanh am vavan ong c nhan giap.

- Day thanh quan di: hay day quat ngc van ong cho hau het cac c cuathanh quan va cam giac t nep thanh am tr xuong. Than kinh giao cam cuathanh quan tach hach giao cam co gia va co tren.

2. Sinh ly thanh quan:

2.1. Th:

- Khi th hai day thanh am c keo xa khoi ng gia lam thanh mon cm rong e khong kh i qua.

- ong tac tren c thc hien bi c m (c nhan pheu).

- Hai day thanh m ra va khep lai theo nhp th c ieu chnh bi hanh tuy.

2.2. Phat am:

- Li noi phat ra do luong khong kh t phoi tac ong len cac nep thanh am.

-

S cang va v tr cua nep thanh am anh hng en tan so am thanh.


38/185



- Am thanh thay oi la do s cong hng cua cac xoang mui, hoc mui, mieng,hau va s tr giup cua moi, li, c man hau.

2.3. Thoi:

Nh co s c ong cua long ngc, tao nen mot luong khong kh i tphoi, kh, phe quan len, tao ra luong khong kh co ap lc va trong khoang thigian nhat nh.

2.4. Rung.

- Hai day thanh c khep lai.

- Niem mac day thanh rung ong nh luong kh thoi tao ap lc di thanhmon a gay nen o cang day thanh.

- o cang day thanh do cac c cang day thanh ma chu yeu la la c giap-pheu.

- Cac am thanh tram hoac bong phu thuoc o cang nhieu hay t cua daythanh.

2.5. Cong hng:

Nh vao cac hoc tren thanh mon (thanh quan, hong, mieng, mui).

GIAI PHAU SINH LY TAI

1. Giai phau tai:Cau truc giai phau tai gom 3 phan: tai ngoai, tai gia va tai trong.

S o cau tao cua tai

Tai ngoai Tai gia Tai trong


39/185



- Tai ngoai: gom loa tai (vanh tai), ong tai.

- Tai gia: mang nh. Chuoi xng con (xng bua, xng e, xng ban ap)cac xng nay lien ket vi nhau bi cac khp. Cac te bao chum. Voi

Eustache la ong thong gia hom nh vi thanh sau hong. Voi nh co chcnang ieu hoa can bang ap lc trong hom nh va moi trng ben ngoai mangnh.

- Tai trong: gom me ao xng tien nh va cac ong ban khuyen co chc nanggi thang bang cho c the. Oc tai co hnh dang nh con oc co nhiem vu tiepnhan am thanh sau o ma hoa va chuyen len nao.

2. Sinh ly tai:

Tai co cac chc nang chnh:2.1. Dan truyen am thanh:

C che nghe: song am thanh ap vao mang nh lan truyen qua chuoixng con, oc tai en c quan thu cam am thanh sau o theo than kinh oc tailen nao.

2.2. Gi thang bang c the, nh hng trong khong gian:

C quan tien nh co chc nang gi cho c the luon trang thai can

bang trong khong gian ba chieu.Khi roi loan chc nang sinh ly nghe dan en giam hay mat kha nang

nghe. Roi loan chc nang thang bang bieu hien benh ly chong mat, mat thangbang.

CACH KHAM BENH TAI MUI HONG

1. T the thay thuoc:

Thay thuoc ngoi trc mat ngi benh. Ghe ngoi khong ta, cao hn ghe

ngi benh mot t. au eo en clar e trong t the kham, hai chan e sangben trai ngi benh. Cach ngi benh khoang 30cm.

2. T the ngi benh:

Ngi benh ngoi thang, lng khong ta vao ghe, mat oi dien vi thaythuoc. Khi kham tai ch nen quay au ngi benh ch khong xoay ghe. e sanmot cai chau e ngi benh nho.

Tre em de bao co the ngoi vao long me. Tre hieu ong, hay giay dua nen

co y ta, ieu dng ngoi kem e gi.


40/185



3. Th t kham:

Khi kham can tuan thu nguyen tac: nhng thao tac kham gay kho chunen tien hanh sau cung.

au tien kham mui, tiep o en thao tac at Ephedrin 3% vao 2 lo mui.Trong khi i niem mac mui co ta chuyen sang kham hong, kham thanh quanva kham tai. Cuoi cung tr lai kham mui lan hai.

Kham tai mui hong can phai nghe phoi, nghe tim hoac s gan, lach. Vvay, thay thuoc phai am hieu ve noi khoa.

Lu y, trong khi ngoay mui, ngoay tai ngi benh co the ngat. V vay phaiat san ben canh ghe kham mot chiec ging e ngi benh nam ngh.

4. Mot so ky thuat thng ap dung khi kham benh tai mui hong:4.1. Xong mui:

4.1.1. Dung cu:

- 1 pheu xong.

- 1 ong nho giot.

4.1.2. Cach xong:

- o nc am vao pheu.- Nho 4-5 giot thuoc xong vao, bao ngi benh ht hi thuoc bang mui va

mieng qua lo pheu.

- Khi nc nguoi th o them nc vao.

- Xong t 5-10 phut.

- Xong xong khuyen ngi benh ngh trong nha khoang 10 phut e tranh sthay oi nong lanh ot ngot.

4.2. Nho thuoc vao mui:Ngi benh nam nga, au e ngoai canh ging, thap hn mat ging

va nga toi a ve sau e 2 lo mui nhn len tren.

- Nho moi ben mui 3 giot Ephedrin.

- i 3 phut.

- Nho vao moi ben 3 giot Argyrol 3%.

- i 3 phut sau mi cho ngi benh ngoi.


41/185



4.3. Ra tai:

4.3.1. Chuan b:

-

Thuoc ra tai va nho tai.- Ong nho giot.

- Mot t que tam bong a tiet trung va kho.

4.3.2. Cach ra:

- Ngi benh nam nghieng, tai b au hng len tren. Tre em phai co ngiln gi.

- Dung ong nho giot nho thuoc vao vach tai (khong nho vao gia lo tai).

- Day i day lai trc lo tai cho mu long ra.- Lay que tam bong lau sach.

- Lap lai 3-4 lan.

- Nghieng doc tai ve pha di cho nc chay ra het.

- Tham kho tai.

4.3.3. Cach nho thuoc:

- Nho Con Boric hoac Glycerin borat vao vach ong tai.- Nut bong gon.


42/185



T LNG GIA


Cau truc co hai ben thanh hong, thong vi hom nh:

A. Amidan.B. Waldeyer.C. Eustachi.D. Luschka.

2.

Gerlach la:A. Amidan khau cai.B. Amidan li.C. Amidan vom.

D. Amidan voi.3.

Khoang gia hai day thanh la:A. Bang thanh that.B. Thanh mon.C. Ha thanh mon.D. Xoang le.

4.

ay la nhng cau truc thuoc tai gia, NGOAI TR:A. Xng bua.B. Tien nh.C. Te bao chum.D. Voi nh.

5. Khuech ai am thanh la chc nang cua:A. Vanh tai.B. Mang nh.C. Tien nh.D. Oc tai.

6.

T the ngi benh khi ra tai:

A. Nam nga.B. Nam sap.C. Nam nghieng ben tai au.D. Nam nghieng ben tai lanh.

7. Theo trnh t, noi dung nao can thc hien au tien khi kham tai mui hong:A. at Ephedrin.B. Kham hong.C. Kham mui.D. Kham tai.


43/185

Mot so benh ly viem nhiem vung mui hong.


MOT SO BENH LY VIEM NHIEM VUNG MUI HONG

BS. Nguyen Van Thnh

MUC TIEU HOC TAP1.Neu nguyen nhan cua mot so benh viem nhiem vung mui hong.2.Mo ta trieu chng va bien chng cua mot so benh vung mui hong.3.Trnh bay bien phap ieu tr cua mot so benh vung mui hong.

VIEM MUI XOANG D NG

Benh d ng, trong o co viem mui xoang, la mot trong nhng benh gayton kem nhat ca ve thi gian, chi ph ieu tr lan hieu suat lao ong. Ty le macbenh nay tang nhanh do moi trng ngay cang o nhiem.

Benh bieu hien bang 2 hnh thai: viem mui d ng theo mua hoac viemmui d ng quanh nam.

1. Nguyen nhan:Viem mui xoang d ng xuat hien khi tiep xuc vi cac d nguyen nh bui

nha, thc pham (trng, sa, cac loai hai san...), thuoc, phan hoa, s thay oi

cac yeu to cua moi trng (o am, nhiet o), tinh than cang thang, noi tiet to,vi khuan, virus...

2. Trieu chng:Ngi b viem mui d ng rat nhay ben vi cac bien oi trong mui.

- Nga ngay, buon buon trong mui roi hat hi hang trang.

- Chay nc mui trong.

- Ngat tac mui.

- Cam giac kho th.

- Noi giong mui.

- Suy giam khu giac, co khi mat khu giac.

Viec chan oan benh chu yeu da vao tien s d ng cua ngi benhcung nh gia nh ho. Ngoai ra, can lam mot so xet nghiem nh:

- Tm te bao ai toan trong dch mui.

- Test tham do vung ngoai ra nh test lay da, test noi b...


44/185



4.ieu tr:Chu yeu la d phong bang cach thay oi moi trng song neu tm c

yeu to d nguyen (phng phap nay thng kho thc hien), gi nha ca luon

thoang mat, sach se.Nang cao sc e khang t nhien cua c the bang cac yeu to vi khoang

chat, kh hau lieu phap, tam suoi nc nong, cham cu, tap the duc thngxuyen ...

Co the ieu tr trieu chng bang thuoc khang histamin, corticoid toanthan va tai cho...

Hien a co phng phap ieu tr ac hieu, o la giai man cam. Ngi

benh c a d nguyen vao c the vi lieu nho va tang dan e tao khang thebao vay, thay oi cach ap ng cua c the vi d nguyen va v the lam mattrieu chng d ng. Thi gian ieu tr thng keo dai t 6 thang en 5 nam.

VIEM XOANGXoang la cac hoc trong xng chung quanh mui. Co bon cap xoang:

xoang tran tran, xoang bm gia oi mat, xoang sang nam sau trong aupha sau mat va xoang ham nam sau go ma, di hoc mat. Cac xoang nay cong nho an thong vao mui. Khong kh ra vao va cac chat nhay trong xoang

theo cac ong nay o ra mui.1.Nguyen nhan:

Co the la do vi trung, sieu vi hoac do vi nam, thng thay nhat la sau khib cam cum hoac do viem mui d ng keo dai hoac do tnh trang veo vachngan, co trng hp viem xoang la hau qua cua sau rang, nhiem trung rangham tren.

2.Trieu chng:

Cac trieu chng cua viem xoang c chia thanh 2 nhom:2.1. Cac trieu chng chnh:- Nhc au.

- Nghet mui.

- Chay nc mui:

Chay ra trc: thng co mau xanh uc.

Chay ra sau: gay nga hong va kch thch ho , kht, khac


45/185



- Ngi kem, mat mui.

- au nhc vung mui mat: an au cac iem au cua xoang: goc mui mat, vungma, thai dng, vung tran, vung cham, au sau trong ho mat.

- Sot: thng gap trong viem xoang cap.

2.2. Cac trieu chng phu:- Chong mat, au au vung nh, thai dng, cham gay.

- Ho dai dang nhng khong co nguyen nhan hong hoac kh phe quan.

- au tai hay cam giac ay, cang, nang trong tai.

- Nhc rang.

- Hi th hoi.- Met moi, ue oai, ngi benh thng khong tap trung suy ngh c.

Viem xoang gay kho chu cho ngi benh nhng hiem khi co the e doati sc khoe, neu b tai phat nhieu lan hoac khong ieu tr, viem xoang trthanh benh man tnh, rat kho cha tr.

3.Bien chng:- Viem phe quan man tnh hay lao phoi gia do mu t xoang viem chay xuong

hong. Ngi benh co ho, khac m oi khi lan mau, sot nhe ve chieu...- Viem hong man: rat hong, vng hong, thng phai nuot lien tuc nen oi khi

co cam giac nghen th.

- Viem day than kinh th giac sau nhan cau: co the do viem xoang cap hayman. Mat b m, th lc giam rat nhanh.

- Viem tay o mat, viem m mat, viem tui le

- Viem xng so, viem mang nao, viem nao, ap xe nao: ngi benh nhc au,

cng gay, non ...- Viem tac tnh mach hang: sot cao, ret run, nhc au, cng gay, loi mat, dan

tnh mach vung tran va m mat ...

4.ieu tr:- Dung thuoc giam au n gian: Paracetamol, mot so NSAIDs

- Xong hi, ra mui bang nc muoi sinh ly am, uong nc nhieu e lamloang cac chat tiet.


46/185



- Dung thuoc chong sung huyet mui: Pseudoephedrine, Phenylpropanolamin Thuoc chong so mui co the giup mu va chat nhay thoat ra, nhng cung phaican than khi dung v co the gay hai nhieu hn li khi lam kho mui qua mc

va cac chat khong thoat ra ngoai c- Khang sinh: thng dung cac khang sinh ho Macrolid, -lactam the he II

hoac III, Quinolon the he II Mot t khang sinh t 10 - 14 ngay.

Kem theo ieu tr bang thuoc, co the gay te va choc ra xoang bangphng phap Proetz. Phng phap nay rat hieu qua, ngi benh cam thay dechu sau vai lan ra. Choc ra xoang ham c ch nh trong mot so trnghp viem ban cap va viem man co tac dung giai thoat cac chat ong.

Mot so trng hp viem xoang man hoac veo vach ngan can c phauthuat khi ngi benh khong ap ng vi ieu tr noi khoa. Tuy nhien, sau phauthuat van co 30-40% ngi benh tai phat. Viec tai phat viem xoang tuy theo ca, tuy loai viem xoang ngi benh mac phai va tuy thuoc viec ngi benh cotuan thu cac hng dan ieu tr, theo doi cua bac s hay khong.

Ngay nay, thiet b noi soi xoang co the biet c ro rang cho b tacnghen va co the ap dung ky thuat cao cap e phau thuat thay v phai mo theokieu cu nen ket qua ieu tr tot hn.

VIEM V.AV.A (Vegetations Adenoides) la mot to chc lympho giong nh amidan

nam tai vom mui hong, khong the nhn thay qua ng mui, do vay ch quansat ro khi noi soi. tre bnh thng VA ch la lp niem mac vom hi day. Treem t 6 thang en 4 tuoi do khang the t me bat au giam, khang the cua trecha u, mot so em co bat thng trong hoc mui nh veo xng, cuon mui ln,d ng, kem theo ieu kien moi trng song o nhiem nen hay b viem muihong, viem VA.


47/185



Khi VA b viem nhieu lan, se phat trien qua mc che kn ca mui sau,gay ra tac nghen ng th, lam cho tre thng xuyen nghet mui, khi ngukhong th c bang mui, phai ha mom th, ngu ngay, giac ngu khong sau,

thng xuyen gay viem tai gia, viem ng ho hap tren.1.Trieu chng:- Sot cao 39 400, oi khi gay ra co giat.

- Nghet mui: be khong th c bang mui do VA ln.

- Ngu ngay: thng ha mom th, hep ng th, ngu ngay.

- Chay mui: luc au chay mui trong sau o chay mui co mau trang, vang, tanh,thng xuyen chay mui (dau hieu mui thoi lo).

- Tieu chay: do be nuot am, dch, mu t VA chay xuong nen bung thng khotieu, hay b tieu chay.

- Chan an: do bung thng xuyen roi loan tieu hoa nen chan an.

- Quay khoc, giac ngu chap chn khong sau: do nghet mui, kho th nen nguchap chn, hay giat mnh va quay khoc ve em.

- Bo mat sui vom: rang ho, tran nho, rang moc khong eu.

- Noi soi: VA ln nam vom mui hong, san sui, che kn ca mui sau.

2.Bien chng:- Viem tai gia.

- Phe quan phe viem.

- Viem thanh quan cap.


48/185



- Roi loan tieu hoa.

- D dang vung so mat.

-

Nghet mui va ngng th khi ngu.3.ieu tr:

3.1. ieu tr noi khoa:

- Gi ve sinh rang mieng.

- Cho tre an u dinh dng.

- Gi ve sinh mui, hong: ra mui, nho mui bang dung dch nc muoi 9%0,xuc hong nc sach sau khi an.

- Dung thuoc khang sinh: Macrolid, beta lactam - Dung thuoc khang viem.

3.1. ieu tr ngoai khoa:Nao VA bang Coblator.

VIEM AMIDANAmidan la hang rao mien dch vung hong mieng, hoat ong manh t 4 -

10 tuoi, sau o en tuoi dayth mc o mien dch cuaamidan giam ro va khong conhoat ong manh na. Amidanb viem i viem lai nhieu lando cac o viem nam trongamidan thng la ni khiphat cho nhng t viem vunghong. Viem amidan chiem ty

le cao tre em, thng do vikhuan gay ra.

1.Nguyen nhan:

- Do lien cau tan huyet beta nhom A hay gay ra bien chng viem khp cap,viem noi tam mac, benh van tim va gay ra viem cau than.

- Do vi khuan bach hau gay ra giai mac lam nghe ng th va tao ra oc to.

- Viem amidan do nam ngi suy giam mien dch.


49/185



- Do viem ng ho hap tren anh hng en viem amidan.

- Viem amidan do nhiem sieu vi.

2.Trieu chng:

- Sot cao: thng sot cao 39 400C kem theo kho co, au co, kho nuot.

- Nghet mui: thng xuat hien cham hn so vi sot, ngi benh nghet mui sauo chay mui.

- Nhc au: thng nhc au vung hai ben thai dng.

- Kham hong: hai amidan sng o, oi khi co gia mac trang bam vao amidan.

- Xet nghiem mau thng bach cau tang cao.3.Bien chng:

3.1. Benh tinh hong nhiet:

Do oc to cua lien cau trung gay ra, ngi benh noi ban, noi hach, auhong, nhc au, oi ma, sot cao, amidan sng to, hong o, li o, nhp timnhanh. Amidan co gia mac. Benh nay dan en bien chng viem tai gia hoait cac xng con.

3.2. Viem khp cap:Ngi benh b cac trieu chng sng, nong, o au cac khp co tay, au

goi, cac ngon tay, ngon chan, ngi met moi, ue oai. Sau bien chng viemkhp thng dan en benh ly mang tim.

3.3. Viem cau than:

Tan xuat benh viem cau than sau viem amidan khong 24%, va chuyenthanh viem than cap sau o. Ngi benh co hien tng phu chan, phu matnhat la khi ngu day.


50/185



3.4. Ap xe quanh amidan:

Trng hp viem amidan nhieu lan thng dan en ap xe quanh amidan.Ngi benh au hong, kho nuot, sng hong noi khong ra tieng, au au, sot

cao, hi th hoi, chay nc dai do khong nuot c.Kham hong phat hien khau cai mem ben ap xe b ay ra trc, s mem.

Khi rach dan lu nhieu mu ac rat thoi trong o ap xe.

4.ieu tr:

- ieu tr noi khoa: khang sinh nhom Penicillin c u tien la chon. Sinh to,ha sot giam au, ieu tr 7 10 ngay.

- ieu tr ngoai khoa: cat amidan uc ch nh nhng ngi mot nam viem

amidan tren 4 lan, nhng ngi co bien chng viem khp, viem than vathng viem ng ho hap tren.

VIEM HONGViem hong la thuat ng y hoc ch tnh trang viem va sng cua cuong

hong. Hau het nhng nguyen nhan cua viem hong (nh nhiem virus thongthng hoac s dung giong noi qua mc) eu khong nghiem trong. Tuy nhientrong mot t nguyen nhan khac co the can phai can thiep chuyen mon.

Viem hong cap tnh la loai benh kha pho bien, thng xuat hien vi cacbenh viem VA, viem amidan.

1. Trieu chng:Benh thng khi phat ot ngot vi cac dau hieu sau:

- Sot cao 39-400C.

- Nuot au, rat hong. Luc au, ngi benh thay kho nong trong hong, dan danthanh cam giac au rat, tang len khi nuot, khi ho va khi noi. Ngi benh

thay au len tai va au nhoi khi nuot.- Hai amidan viem to, tren be mat amidan co chat nhay trong, co khi co ba

trang nh nc chao phu tren be mat, hach co b sng.

Cac trieu chng kem theo la sut st, tac mui va chay nc mui nhay,tieng noi khan nhe va ho khan.

Benh thng dien bien trong 3-4 ngay, neu sc e khang tot, benh se luidan, cac trieu chng tren se mat i rat nhanh. Neu co boi nhiem co the, ngibenh co the gap cac bien chng nh viem tai, viem mui, viem phe quan...


51/185



2. ieu tr:Ve ieu tr, cha trieu chng la chnh.

- Dung thuoc ha sot khi ngi benh sot cao.

- Giam au hong bang cach suc hong hang ngay bang nc muoi loang.

- Tre em boi hong bang glyxerin borat 5%, nho mui bang thuoc argyrol 1%.

- Dung khang sinh khi co bien chng nh viem than, viem khp, viem phequan, viem tai gia ... Cac khang sinh thng dung gom: Amoxycillin,Erythromycin, Cephalexin

Neu b viem hong cap tai phat nhieu lan kem theo co albumin trong nctieu th nen cat amidan.

e d phong, nen nho mui bang dau go-me-non hoac toi pha loang khixung quanh co nhieu ngi viem hong.


52/185



T LNG GIA


Dau hieu thng gap nhat trong viem mui d ng:

A. Nga mui, hat hi.B. Chay nc mui.C. Nghet, tac mui.D. Noi giong mui.

2.

ay la nhng trieu chng chnh cua viem xoang, NGOAI TR:A. Chong mat.B. au au.C. Nghet mui.

D. Ngi kem, mat mui.3.

Bieu hien ac trng nhat cua viem VA tre nho:A. Sot rat cao.B. Ngu ngay.C. Mui tho lo.D. Rang ho.

4.

Dau hieu xuat hien au tien trong viem amydan:A. Sot cao.B. Kho co.C. Nghet mui.D. Chay mui.

5. ay la nhng ch nh cat amydan, NGOAI TR:A. Tai phat.B. Qua phat.C. Bien chng viem khp.D. Bien chng viem than.

6.

ac iem cua au hong trong viem hong:

A. Rat hong la trieu chng xuat hien sm nhat.B. au hong giam khi nuot, khi an.C. Thng khong lan en tai.D. Khi ho, noi bt au hn.


53/185

Viem tai gia Viem xng chum.


VIEM TAI GIA VIEM XNG CHUM

BS. Nguyen Van Thnh

MUC TIEU HOC TAP1.Neu mot so hnh thai benh ly thng gap tai.2.Mo ta trieu chng va bien chng cua viem tai gia va viem xng chum.3.Trnh bay bien phap ieu tr cua viem tai gia va viem xng chum.

VIEM TAI GIA

Viem tai gia la mot benh co the gay bien chng tram trong co the gayt vong. Trc khi co khang sinh ty le t vong do bien chng noi so do tai ratcao. Ngay nay vi s phat trien cua khang sinh, cua cac phng tien chan oanva ieu tr, ty le t vong nay a giam xuong rat nhieu so vi trc kia. Tuynhien bien chng noi so do tai van la bien chng nguy hiem co the e doa entnh mang ngi benh.

Viem tai gia c chia lam 3 nhom:

- Viem tai gia cap tnh xuat tiet dch tham.

- Viem tai gia cap tnh xung huyet.- Viem tai gia cap tnh co mu.

Viem tai gia cap co mu la benh canh ien hnh nhat. V vay, bai naytap trung mo ta benh canh viem tai gia cap co mu.

1. Nguyen nhan:1.1. Do viem nhiem cap tnh mui hong:

- Xuat hien sau cac benh nh: cum, si hoac sau cac benh nh viem mui,viem xoang, viem V.A, viem amidan, u vom mui hong ...

- Nhet meche mui sau e qua lau.

- Can nguyen vi khuan: thng do S. pneumoniae, H. influenzae, M.catarrhalis, S. aureus.

1.2. Sau chan thng:

- Gay rach, thung mang nh nh ngoay tai bang vat cng.

-

Chan thng do tieng no, sc ep...


54/185



2. Trieu chng:Trieu chng cua viem tai gia cap tnh thay oi nhieu tuy theo nguyen

nhan gay benh, tnh trang c the.

The ien hnh cua viem tai gia cap tnh co mu tre em, dien bien quahai giai oan:

2.1. Giai oan khi phat:

2.1.1. Toan than:

- Trc o may ngay ang b viem mui hong.

- Chay mui va ngat mui.

-

ot nhien b sot cao 390

- 400

C.2.1.2. C nang:

- Luc au nga, tc tai.

- Sau au tai d doi.

- Nghe kem.

2.1.3. Thc the:

Mang nh b xung huyet o cac v tr:

- Goc sau tren.

- Doc can xng bua.

- Vung mang chung (Shrapnell).

2.2. Giai oan toan phat:

2.2.1. Thi ky mu (mang nh cha v):

- Sot cao 390C- 400C keo dai, the trang met moi, kho ngu, sut can... co the co

giat, met la.- Roi loan tieu hoa:la trieu chng thng gap. tre a chay, song phan hoac

non tr, ay bung. Thuoc chong roi loan tieu hoa t co ket qua ch khoi khigiai quyet nguyen nhan viem tai gia.

- au tai: au tai d doi ngay cang tang, au sau trong tai, theo nhp ap, lanra vung thai dng va sau tai lam cho be khong ngu c, quay khoc, bo an,bo bu, vat va, tay ngoay vao tai au, hoac lac au.


55/185



- Kham mang nh: toan bo mang nh ne o, khong nhn thay can xng bua,mau ngan xng bua va non sang. mc o nang hn mang nh phong lennh mat knh ong ho. iem phong nhat thng khu tru pha sau.

- Kham mui hong: ngi benh ang co viem mui hong cap tnh.2.2.2. Thi ky v mu (mang nh b v): thng xuat hien vao ngay th 4.

- Trieu chng c nang: giam dan, het au tai, nhiet o toan than giam, em bechu chi, het quay khoc.

- Trieu chng thc the: ong tai ay mu, lau sach thay lo thung mang nh, lothung se khac nhau tuy theo mang nh co c chch rach hay khong?

Neu chch: lo thung se rong va goc sau di mang nh se het phong.

Neu khong chch e mang nh t v th lo thung co the bat c cho nao,b day nham nh.

Mot so hnh anh noi soi trong viem tai gia:

Mang nh sung huyet Mang nh phong kieu vu bo

Mang nh lom Thung mang nh


56/185



2. Bien chng:- Viem tai gia thanh dch.

- Viem tai gia man tnh mang nh thung. Neu khong c ieu tr se viem taixng chum.

- Giam thnh lc: ngay cang tang theo thi gian.

- Bien chng noi so: viem mang nao, viem nao, ap xe nao do tai. Neu khongc ieu tr tch cc, ngi benh t vong.

3. ieu tr:3.1. Giai oan khi phat:3.1.1. Nho mui:

- Dung cac thuoc co mach lam cho mui thong thoang. Cac thuoc thng dung:Ephedrin, Napthasolin, dau Gomenon ...

- Trc khi nho mui can x mui e tong cac chat xuat tiet ong trong mui.

- Ngay nho t 5-10 lan.

3.1.2. Xong thuoc:

- Bang cach hit hi nc nong co mang thuoc, hi nong co tac dung giam

xung huyet niem mac mui, tao ieu kien cho thuoc co the tham vao cac kheke cua mui va co the tham vao xoang qua cac lo thong mui xoang.

- Cac thuoc dung e xong la dau khuynh diep, dau Gomenon, dau gio ...

- Thi gian xong t 5-10 phut.

3.1.3. Kh dung mui:

- Phai co may kh dung.

- May tac ong phan tan dung dch thuoc thanh nhng hat nho (t 1-10mm)

hoa tan trong khong kh.- Thuoc a vao c the theo ng kh dung co tac dung gap 5 lan so vi

ng uong hoac ng tiem, do o dung lieu lng co the giam xuong, khoilng dung la 5ml.

3.1.4. Ly lieu phap:

Co the s dung cac phng phap:

- Tia hong ngoai.

- Song ngan.


57/185



3.1.5. Khang sinh:

a so vi khuan thuoc loai gram (+), s dung cac khang sinh sau:

-

Nhom beta lactam: Amoxicyllin, Augmentin ...- Nhom Sulfamid: Co-trimazole.

- Nhom macrolid: Erythromycin.

- Co the dung phoi hp nhom PNC va Aminosid.

3.1.6. Mot so phng phap khac:

- Chong viem, giam au.

- Nang d c the bang cac loai sinh to

- Nho tai Glyxerin borat 3%, Otipax...

3.2. Giai oan toan phat:- Luon theo doi va chch mang nh ung luc.

- Trng hp mang nh phong kieu vu bo nen chch rach mang nh.

- Nhng be co VA nen nao VA cho tre sau khi ieu tr on nh 1-2 tuan.

- Neu ngi benh en a v mu th phai lam thuoc tai hang ngay: lau sach mu

va ro thuoc khang sinh ket hp vi ieu tr mui, hong.- Dung khang sinh toan than.

- Cac thuoc chong viem.

- Nang c the.

VIEM XNG CHUMViem xng chum thng la hau qua cua viem tai gia. ay la benh ly

kha nang v nguy c gay ra cac bien chng noi so.

1. Phan loai:1.1. Viem xng chum cap:

1.1.1. Viem xng chum cap tnh khong xuat ngoai:

- Viem tai gia cap tnh a 1 vai tuan.

- Trieu chng toan than va c nang van con: sot keo dai, van chay tai, auvung chum, an vao rat au.

- Tren phim X quang Schuller: m te bao xng chum.


58/185



1.1.2. Viem xng chum cap tnh xuat ngoai:

- Sng sau tai, vung xng chum lam venh tai ra pha trc va xuong di.

-

Sng tren tai lan ra vung thai dng, co the lam kht ham hoac phu ne mimat.

- Sng vung mom chum lan ra phan tren co...

1.1.3. Viem xng chum tiem an:

- Viem tai gia cap tnh tai phat nhieu lan.

- Mac du a nao V.A tre van om vat, khong len can... khong co ly do naokhac.

- Kham tai: mang nh day uc, khong tr lai bnh thng.- tre em co trng hp bieu hien bang trang thai nhiem oc than kinh.

1.2. Viem xng chum man:

Bao gom cac dang:

- Viem xng chum man tnh.

- Viem xng chum man tnh hoi viem.

- Viem xng chum man tnh hoi viem xuat ngoai.

Mot so trieu chng chnh thng gap:

- Chay nc tai lau ngay.

- Nghe kem.

- Mang nh b thung, he xng con b h hong, te bao chum b viem.

- Neu co cholesteatome th de dang gay bien chng va tai phat.

- Chup phim X-quang xng chum co the thay cac hnh anh benh ly.

Viem tai xng chum man tnh hoi viem la t viem cap tnh vi cacbieu hien giong nh viem xng chum cap tnh, de gay ra cac bien chng nguyhiem.2. Trieu chng:- Sot cao keo dai, the trang suy nhc, met moi, nhiem trung, nhiem oc sot

cao 390C- 400c (viem tai gia chay mu qua 2 tuan khong thay khoi cac trieuchng tham ch con co dien bien nghiem trong hn nh sot cao hn, au taihn, mu chay ac hn va co mui thoi).


59/185



- hai nhi co the thay co giat, thop phong giong nh viem mang nao.

- au tai: la trieu chng chnh, au tang d doi, au sau trong tai lan ra vungchum va vung thai dng.

- Nghe kem kieu dan truyen.

- U tai.

- Chong mat nhe.

- Mat chum thng ne o, an vao au.

- Mu tai: ac co mui thoi kham, co mau xanh hoac vang oi khi co tia mau.

- Mang nh: (quan sat c sau khi lau sach mu tai) ne o, lo thung thng sat

thanh ong tai xng, b nham nh, ay lo thung phu ne xung huyet, goc sautren oi khi b xoa. Trng hp viem man co the thay polype trong homnh hoac thay cholesteatome. Co nhieu mu thoi, co the co cac manh trangcua cholesteatome.

- X-quang: t the Schuller: cac vach thong bao cua cac nhom thong bao day,b m do s pha huy cac nhom te bao xng chum, co nhng am b matvach bien thanh cac hoc rong. Khi viem man xng chum b mat cac thongbao, hnh anh ac xng hoac tieu xng (hnh tron a vong: trong viem

xng chum man tnh co cholesteatome).3. Bien chng:- Viem xng hay cot tuy viem xng thai dng, xng a hay xng cham

vi hoi chng nhiem khuan nang.

- Liet mat ngoai bien do ton thng day than kinh so VII.

- Viem me nh.

- Bien chng noi so nh: viem mang nao, ap xe nao hay viem tnh mach ben.

4.ieu tr:4.1.

Viem xng chum cap:- Mo cap cu la phng phap duy nhat.

- Khang sinh lieu cao toan than bang ng tiem truyen ch lam giam trieuchng.

4.2.

Viem xng chum man:Khuynh hng hien nay la lam phau thuat sm e bao ton sc nghe va

tranh cac bien chng.


60/185



T LNG GIA


Bien chng nguy hiem nhat cua viem tai gia:

A. Viem xng chum.B. Bien chng noi so.C. Thung mang nh.D. Giam thnh lc.

2.

Bieu hien au tien cua viem tai gia:A. Nga tai.B. Chay mau, nghet mui.C. Sot cao.

D. Met moi.3. Dau hieu cua viem tai gia giai oan mu:A. au tai d doi.B. Chay mui, nghet mui.C. Ong tai ay mu.D. Sot giam.

4.

Sng au tai vung thai dng lam phu ne mi mat la bieu hien cua:A. Viem tai xng chum.B. Viem xng chum cap xuat ngoai.C. Viem xng chum cap khong xuat ngoai.D. Viem xng chum tiem an.

5.

Trieu chng chnh cua viem xng chum la:A. Nghe kem.B. U tai.C. au tai.D. Mu tai thoi kham.

6. Phng phap ieu tr chnh oi vi viem xng chum cap:

A. Phau thuat cap cu.B. Dung khang sinh lieu cao.C. Khang viem manh.D. Nang the trang.


61/185

Chay mau mui.


CHAY MAU MUI

BS. Nguyen Van Thnh

MUC TIEU HOC TAP1.Neu khai niem va phan loai cac trng hp chay mau mui.2.Trnh bay mot so nguyen nhan thng gap gay chay mau mui.3.Mo ta cach x tr trng hp chay mau mui.

AI CNG

Niem mac mui co rat nhieu mach mau va mang li mao mach giongcac mui qua cam nen rat de chay mau goi la chay mau cam.

Theo c tnh cua cac nha chuyen mon, khoang 60% dan so the gii bchay mau cam t nhat 1 lan. Trong mot so trng hp chay mau cam do tai nangiao thong, tai nan lao ong mau chay ra co the lam tac nghen ng ho hap,gay nguy hiem en tnh mang.

Trong moi trng hp chay mau mui, x tr au tien la cam mau, khi aon nh mi tm hieu nguyen nhan.

Nam gii hay b chay mau cam hn n. ngi tre tuoi, iem chay mauthng xuat phat t phan trc cua mui, thng do chan thng hoac viemng ho hap tren. La tuoi tren 40, iem chay mau lai xuat phat t phansau mui, thng do cac benh x cng ong mach, cao huyet ap, u bu ...

PHAN LOAI1.Chay mau mui do vet Kisselbach:

Cac ong mach vach ngan mui thng quy tu vao mot iem cach ca

mui khoang 15 mm goi la vet mach Kisselbach. Cac mao mach nay rat mongnen de chay mau.

Nhom nay thng do cac chan thng nhe nh ngoay mui, do mot sobenh ly nhiem trung nh nhiem sieu vi cum, benh thng han hoac oi khit nhien chay mau.

Soi mui thay mau chay ra t vet Kisselbach hoac ong mach mui. Mauchay tng giot va co khuynh hng t cam. Benh hay tai dien nhieu lan.Thng gap tren tre em, tien lng nhe.


62/185



2.Chay mau mui do ong mach:Vach ngan mui co nhieu ong mach va b v trong cac trng hp nh

tang huyet ap, x ong mach, suy gan So lng mau chay nhieu nhng t

nguy hiem.3.Chay mau mui do lan toa mao mach:

Mau chay r ra khap niem mac mui. Loai nay thng gap trong cacbenh ban xuat huyet, sot xuat huyet, benh a chay mau, benh bach cau cap,thng han ...

NGUYEN NHAN

Nhn chung, chay mau mui thng do cac nguyen nhan sau ay:

- Chan thng nho nh lay tay ngoay mui hoac chan thng manh va ap trctiep vao mui do tai nan, te nga ...

- Viem ng ho hap tren nh cum, viem xoang, ht hi oc dan en viemmui ...

- Lech vach ngan mui, ung bu nh u x vom, ung th vom mui hong, benhphnh mach.

- Tang huyet ap hoac benh do roi loan qua trnh ong mau.

- D vat: khi thay chay mau va mu mot ben mui, can ngh en tnh trang co dvat ng th.

- Khong kh qua kho do o am thap.

Mot so trng hp mau cam chay khong ro nguyen nhan, mau ot ngotchay va t cam.

X TR

1.Cam mau tam thi:- ieu can lam au tien la dung hai ngon tay an chat vao hai ben canh mui

trong vong 10 phut va nghieng au ve pha trc.

- e ngi benh cam thay de chu hn, nen cho ngi benh chong khuyu taylen mat ban hoac len tay vn ghe ta.

- Co the dung bong gac cam mau va lam lien seo ep vao ni chay mau.

- Dung mot cuc nc a at vao goc mui cung co tac dung lam cho maungng chay.


63/185

Chay mau mui.


Neu nguyen nhan cua viec chay mau cam la khong kh kho, co the dungcac thiet b lam tang o am trong phong. Tuy nhien, theo cac nha chuyen mon,ay ch la giai phap tnh the.

2.Cam mau tai c s y te:Dung bac tham antipyrin 20% nhet chac ho mui va tien nh.

Trng hp cam mau tam thi khong hieu qua th tien hanh thu thuatnhet mui trc hay nhet mui sau.

Sau o ieu tra nguyen nhan e giai quyet triet e.

Khong nen e bac mui qua 48 gi. Thng lay ra sau 24 gi neu co sot.Khi thao bac phai thao that cham, tng oan mot, moi oan khong qua 5cm.

sau moi oan ngh 5 phut roi lay tiep. Neu mau ra nhieu th cat bt oan ngoaicach mui khoang 5cm roi nhet tr lai, hom sau thao tiep.

3.Nhng viec can tranh:- Nhat nh khong c e ngi benh nam hoac e ngi benh nga au ra

ang sau. Trong t the nay, mau se chay ngc vao trong hong, gay non mava khong lam ong mau.

- Viec boi kem, vaselin, xt thuoc hoac nc muoi vao trong mui khong phai lagiai phap lau dai v khong giup phuc hoi o am cua niem mac, con co thekhien mui kho hn.


64/185



T LNG GIA


X tr u tien hang au khi chay mau mui:

A. Tm nguyen nhan.B. Cam mau.C. Dung thuoc ong mau.D. Khang sinh nga boi nhiem.

2.

ac iem nao ung vi chay mau mui:A. Nam thng b nhieu hn n.B. Ngi tre thng b phan sau mui.C. Ngi ln thng do benh mach mau.

D. t khi do viem.3. ac iem nao ung vi vet mach Kisselbach:A. Mao mach nau kha day.B. Cach ca mui khoang 15cm.C. Mau thng chay tng giot.D. Rat t khi t cam.

4.

Nguyen nhan thng gap cua chay mau mui do ong mach:A. Ban xuat huyet.B. Benh a chay mau.C. Tang huyet ap.D. Nhiem sieu vi.

5.

Trng hp nao ngh en chay mau mui do d vat:A. Chay mau r ra.B. Chay mau mot ben.C. Chay mau o at.D. Chay mau t cam.

6. ieu nao KHONG UNG khi thao bac mui sau:

A. Lay ra sau 24 gi.B. Thao tng oan, moi oan di 5cm.C. Thao nhanh, dt khoat.D. Khong e qua 48 gi.


65/185

D vat vung hau hong.


D VAT VUNG HAU HONG

BS. Nguyen Van Thnh

MUC TIEU HOC TAP

1.Neu mot so nguyen nhan gay d vat vung hau hong.2.Mo ta trieu chng cua d vat vung hau hong.3.Trnh bay bien phap x tr d vat vung hau hong.

AI CNG

D vat thng lot vao hong trong nhng tai nan nh: thc an trao ngc tda day len hong khi non, rang gia tut sau vao hong, hoc phai hat cay, vien bi,trong luc chi ua ( tre em)... oi vi moi oi tng, trong tng hoan canh,cac ong tac s cu phai c thc hien khac nhau.

1. D vat ng th:

Ngi b d vat lot vao ng th co nhng trieu chng nh ho sac sua,kho th, mat tm tai hoac o bng. Cac nha nghien cu chia d vat lam 2nhom:

- Nhom d vat cap: ien hnh la hat lac, rat de v trong ng th. Trongnhng trng hp nay, ngi benh phai en benh vien ngay trong vong 24gi. Bac s se lay d vat ra bang noi soi roi cho ngi benh xuat vien ngay.

- Nhom d vat man (thng goi la d vat bo quen): cac trieu chng thng tcap tnh nh ho keo dai, sot vat. Ngi benh hay

BENHCHUYEN KHOA

Documents

Transcript of BENHCHUYEN KHOA