BO CO CA LM SNG

NHM THC HIN:

Nguyn Ngc Ngha Nguyn Th Tuyt Minh L Th Xoan

Ca lm sng
Bnh nhn nam, 52 tui. Cch y hn 10 ngy th bnh nhn t ngt st cao ti 40C, c lc rt run. Ho khc m xanh, tc ngc kh th. Bnh nhn vo vin a khoa HB khm v iu tr. Khm thy: tc ngc, kh th, mi kh tm, li bn, nhp th 25 L/ph, khng co ko c h hp ph, phi nhiu ran m, ran n. Bnh nhn c tin s ho khc m 10 nm nay.

Cu hi
1.T nhng triu chng trn c th chn on s b bnh nhn mc bnh g trong cc bnh sau? V sao? a. Hen ph qun b. Vim ph qun mn c. Vim ph qun cp d. Vim phi

p n C1
Bnh nhn c th mt trong hai bnh sau: Vim ph qun mn Vim phi V: - Bn khng th mc HPQ v bn khng c tin s hen v d ng, khng c nhiu cn kh th. - Bn khng th mc VPQC v bn c cc tr/ch nhim khun nng phi rt him thy trong VPQC.

Ti bnh vin BM
Bnh nhn iu tr ti bnh vin HB, bnh ngy cng nng hn nn c chuyn xung BM. Ti BM bnh nhn vn ho khc m xanh, au tc ngc 2 bn: bn phi nng hn bn tri, st cao 39,5C, rt run v chiu, th trng gy st, tm hi nh, kh th, co ko c h hp ph, nhp th 27 ln/ph. Khm phi: Rung thanh tng bn phi, g c bn phi, r ro ph nang gim bn phi, ran m ran n bn phi.

Cn lm sng
X- quang phi: Ngy 28/10:

Cng thc mu:

BCTT: 10,7510^9 g/l 91,7% (bt: 50%-75%). Lympho: 0,510^9 g/l 4,3% (bt: 20% - 45% ). Mono: 0,4310^9 g/l 3,7% (bt: 0%- 8%). BC a acid: 0,0210^9 g/l 0,2% (bt: 0%- 8% ). BC a base: 0,0110^9 g/l 0,1% (bt: 0%- 8%).

Cc xt nghim khc
Sinh ho: Billirubin ton phn: 19,2 umol/l (bt:< 17,1) Kali: 3,0 mmol/l (bt: 3,4 4,5) ASAT: 129 U/l (bt <37 ) ALAT: 103 U/l (bt <41 ) CK: 452 U/l (bt: 38-174) CRP: 21,7 mg/dl (bt: <0,5) Cy m: Candida albicans HIV, HBsAg , AFB ( 3 ln): m tnh

Cu hi
2) C th chun on xc nh bnh nhn mc bnh g? V sao? 3)Trong nhng xt nghim trn nhng xt nghim no c gi tr khng nh bn mc vim phi thu phi? 4) C th khng nh bn mc vim phi thu phi do nhim nm Candida albicans khng? V sao? 5) Hng iu tr cho bnh nhn

p n C2
Bnh nhn mc vim phi thu phi. V: Hi chng ng c ch c vim phi thu, hi chng biu hin r phi phi (ran n, ran m bn phi phi) . Ngoi ra trn hnh nh X-quang phi thy r m m lan to 2 phi. c bit bn phi.

p n C3
Trong cc xt nghim trn th X-quang phi l xt nghim c gi tr nht khng nh bnh nhn mc vm phi thu phi. V trn hnh nh X-quang thy r m m c 2 phi c bit m m tp trung nhiu bn phi phi.

p n 4
Cha th khng nh c. V: Candida c trong mi trng rt ph bin v l vi nm cng sinh vi con ngi. Mt s rt ng trn tri t ny mang trn ngi nhng bo t nm Candida, nhng khng phi ai cng b mc bnh. Nhng bo t nm y ch pht trin trn nhng c th yu.Do vic bnh nhn xt nghim cy m c tm thy nm C.albicans ch c th nghi ng bn VP do nm C.albicans ch cha th khng nh chc chn c. Tuy nhin CRP l xt nghim protein C v ch s ny tng trong trng hp nhim khun nn kh nng bn mc bnh VP do C.anbican l rt cao.Mun khng nh mt cch chc chn nn th phc iu tr VP do C.albicans.

p n C5
iu tr triu chng:
St: chm mt, dng thuc h st, gim au: Efferagan 500mg1vin/ln, truyn dch sinh t, dd NaCl 9 . Dng thuc lm long m: Mucomyst: 0.2g3 gi chia 2 ln/ngy Do bnh nhn ho khc m nhiu nm nn c th nut phi m do dng cc thuc bo v ng tiu ha v gan: Hepolive:2 ng/ ngy v Eganin 4 vin/ ngy. Th oxy: 3 ln/ph. B in gii: truyn dung dch kaliclorua: 2g 2gi/ ngy.

Dng khng sinh: Lemibet:6,5g5 l/ ngy

( Truyn tnh mch).

Cravit:0.5g1 l/ngy.

Ch chm sc:
n nh, dinh dng. Ch nh nm vin do suy h hp.

Efferagan
C ch: c tc dng h st do c ch qu trnh tngg sinh nhit, tng qu trnh thi nhit, lp li cn bng ca trung tm iu nhit. Thnh phn: paracetamol. Ch nh: gim au, h st. Liu dng: 500mg1vin/ln, cch 4-6 gi.

Mucomyst
Hot cht l N-acetylcystein c tc dng gim ho long m vi c ch: lm tiu cht nhy, gim qunh ca m phi bng cch tch i cu ni disulfua trong mucoprotein v to thun li tng ra ngoi bng ho. C ch: long m. Thn trng khng dng chung vi cht chng ho hoc cht lm kh cht tit v ngi b hen.. Liu dng:0,2g3gi/ 2 ln.

Hepolive
Thnh phn:L- ornithine, L- aspartate Ch nh: - tr chng tng amoniac huyt trong cc bnh gan cp hoc mn tnh nh x gan, gan nhim m, vim gan siu virus. - tr cc ri lon khi pht tin hn m gan, bnh no gan. Tc dng ph: c th gp cm gic nng thanh qun, bun nn. Liu dng: Tim tnh mch 1-2 ng/ ngy.Trng hp nng c th dng 4 ng/ ngy.

Eganin
Thnh phn: Arginine Ch nh: - tr h tr cc bnh l gan mt lm suy gan do cc nguyn nhn. -Dng phi hp vi cc thuc c c tnh trn gan gip bo v t bo gan. - Phng nga x gan thng tn gan ngi nghin ru. Liu dng: ngi ln 1-2 vin / ngy, sau n.

Lemibet
Thuc nhm thuc tr KST,chng nhim khun. Thnh phn c Imipenem,Cilastatin C ch Ch nh: nhim trng ng h hp di.Chng ch nh vi qu mn cm vi thuc. phng vi ngi tin s ri lon tiu ho.Nu c triu chng ri lon TKTW phi gim liu hoc ngng dng. Tng tc thuc vi ganciclovir v d ng cho 1 phn vi khng sinh h beta-lactam khc. Ph Tc dng khng mong mun: Vim tnh mch huyt khi, au cng hng ban v au nhy ti ch vim. Liu dng: 500mg tim truyn trong 20-30 pht. Ngi ln 1-2g/ngy c th tng ln 2-3g/ngy.khong cch gia cc liu l 6,8 n 12 gi.

Cravit
Thuc nhm Dc l: Thuc tr KST, chng nhim khun.Vi hot cht l Levofloxacine C ch Ch nh: iu tr nhim trng nh,trung bnh v nng ngi ln: VP mc ti cng ng.Chng ch nh vi ngi qu mn nhm quimolone. Thn trng vi bn suy thn nng, ngi gi, ngi tin s co git. Ph Tc dng khng mong mun: thnh thong bun nn,tiu chy,tng men gan. Him khi chn n, au bng, kh tiu nhc u chng mt. Liu dng:Dung dch tim truyn 500mg/1-2 ln/ngy10-14 ngy

Ti liu tham kho

1. Bi ging bnh hc Trng i hc Dc H Ni. 2. Bnh hc ni khoa Trng i hc Y khoa H Ni. 3. Dc th quc gia. 4. Phn mm Drug interaction 5.Internet

Xin chn thnh cm n s quan tm lng nghe ca thy, c v cc bn!