VlFM FHOl SO SlNH

l. Al CONG.
Viem phoi la mot benh nhiem trung thng gap giai oan s sinh, mot trong
cac nguyen nhan hang au gay t vong s sinh.
Viem phoi s sinh chia lam 3 loai:
! Viem phoi bam sinh: xay ra trc khi sinh, vao nhng thang cuoi thai ky, vi
khuan qua nhau vao bao thai gay viem phoi sm sau sanh. Cac vi khuan
thng gap la Trcponcma |adum, L|cra monoc,|ogcnc, \,cobac|crum
|ubcrcuo hoac virus Rubca, Hcrpc Smpcx, C,|omcgaovru (CMV).
! Viem phoi xay ra trong luc sanh: thng do me b viem nhiem ng sinh
duc hoac v oi sm, vi khuan thng gap la S|rcp|ococcu nhom B, L|cra
monoc,|ogcnc, L. Co, Kcbca, |ro|cu, Ln|crobac|cr. Viem phoi ht
phan xu la trng hp nang can phai x tr kp thi ngay sau khi sanh.
! Viem phoi sau sinh: lay nhiem do moi trng xung quanh nhat la khi tre nam
vien hoac do ba me ve sinh kem. Vi khuan thong gap la: S. |ncumona, H.
nfucn2ac, S. urcu, |cudomona, Kcbca.
ll. CHAN OAN.
1. Cong vicc cban doan
a) Hoi bcnb
! Me:
- Thi gian chuyen da, Thi gian v oi
- Sot luc sanh
- Viem nhiem ng sinh duc
- Benh ly trong thi gian mang thai
! Con:
- Sanh ngat, sanh mo, sanh non
- Da nhuom phan xu
b) kbam Iam sang:
! Dau hieu nhiem trung: (xem bai Nhiem trung huyet s sinh)
! Dau hieu suy ho hap:
- Th nhanh " 60 lan/ph, Cn ngng th > 20
- Co lom ngc, phap phong canh mui, tm tai
- SaO
2
giam < 90%
! Kham phoi: ran phoi, phe am
c) c ngb| xct ngbicm:
! Cong thc mau, XQ tim phoi
! Kh mau ong mach: khi suy ho hap
2. Cban doan xac d|nb
! Th nhanh / hoac co lom ngc nang / hoac ran phoi
! Hnh anh XQ co ton thng nhu mo phoi
3. Cban doan pban bict
! Tran dch hoac tran kh mang phoi
! Thoat v hoanh
! Tt mui sau
! Teo thc quan co do thc quan kh quan
! Tim bam sinh
! Cn th nhanh thoang qua
lll. lF Tk].
1. Ngoycn tac dico tr|:
! Ho tr ho hap
! Khang sinh
! ieu tr ho tr va bien chng
2. ico tr| soy bo bap:
! Th O
2
: ch nh khi co suy ho hap + SaO
2
# 90%
Lieu lng: 0,5 1lt /ph qua cannula
! Th NCPAP
Ch nh khi that bai vi th O
2
qua cannula (xem bai NCPAP)
3. kbang sinb: thi gian ieu tr 10 14 ngay
a) cnh nhan chua dcu |r |hang nh:
- Ampicillin + Gentamycin
- Hoac: Ampicillin + Cefotaxim
- Hoac: Ampicillin + Cefotaxim + Gentamycin
b) cnh nh da dcu |r cac |hang nh |rcn |hong hcu qua hoac ngh ngo
do nhcm |rung bcnh vcn, c |ha, do |hang nh |u, |hco |ruong hop.
4. ico tr| bo tro:
! Thong ng th: hut am nht, xoay tr
! Gi am
! Cung cap ay u dinh dng, nc, ien giai
! ieu chnh can bang kiem toan
! Tap vat ly tr lieu
S. ico tr| bicn cbong:
! Tran kh mang phoi: Tre ot ngot kho th do tm tai khong ap ng vi oxy,
chup XQ phoi $ chan oan xac nh $ x tr: choc do mang phoi giai ap
hoac dan lu mang phoi.
Xep phoi: Tap vat ly tr lieu va / hoac th NCPAP.