H H HP

MC TIU
K c cc thnh phn ca h h hp M t cu to c bn ca cc phn trong h h hp Hiu c hot ng h hp v s trao i kh t ph nang qua mu

H h hp bao gm
ng h hp trn
Mi Hu Thanh qun

ng h hp di
Kh qun Cy ph qun Ph nang

Mng phi

Mi
C vch ngn gia chia lm 2 hc mi: tri v phi Mi bn c 3 xon mi: trn gia di Nim mc ph hc mi xon mi c h thng mao mch mu phong ph Trn ca hc mi c biu m khu gic cm nhn mi CN: lc, si m v lm m khng kh, khu gic

Thanh qun
Sn thanh qun, np thanh qun, dy thanh m, mt s c CN: dn kh, pht m

Mt trc thanh qun

Mt sau thanh qun

Mt bn thanh qun

Hnh soi thanh qun

Thanh mn m

Thanh mn ng

Kh qun
Ni tip thanh qun Khung: sn hnh ch C Nm trc thc qun BM: tr gi tng c lng chuyn CN: dn kh

Kh qun
Ph qun gc

Ph qun thy

C honh

Cc thnh phn vng rn phi

Cy ph qun
T ph qun gc (th h I) 20-23 th h ph nang Ph qun thy gian tiu thy tiu ph qun tiu ph qun tn tiu ph qun h hp ph nang T tiu ph qun ph nang: khng c khung sn bn ngoi. Cu to: c c trn hng vng nm di lp m, biu m

Carina (Carne)

Phi Phn thy phi

Phi phi c 3 thy Phi tri c 2 thy C 2 phi u c 10 phn thy Rn phi: M phi, TM phi, ph qun gc

Cc b phn tham gia h hp

Phi Lng ngc C h hp: c lin sn, c c n chm, c honh, c ngc Mng phi

Chu k h hp
Ht vo: khng kh i t ngoi phi
Cc dy TK vn ng hng phn k cc c hh thnh ngc v c honh co li (phi dn ra, c honh h xung, lng ngc tng th tch) Khi ch ng c s tham gia 1 s c hh ph ( c ngc, c rng ca)

Th ra: khng kh t phi ngoi

Cc dy TK vn ng b c ch, cc c gin ra (phi xp, c honh nng ln, lng ngc gim th tch)

Ngng 1 khong ngn chu k k tip

S trao i kh ph nang
KK trong lng ph nang (phn p O2 cao hn trong mu mao mch) ph bo I mng y ph nang mng y mao mch t bo ni m mao mch (gn vi HC)

Cc thng s h hp
Nhp th: gm 1 ln ht vo, 1 ln th ra S ln th:
Bnh thng: 16-20 ln (>16t)
26 ln ( 5-15t)

L triu chng quan trng chn on vim phi tr em

VP tr < 2 thng: >60ln/ph VP tr 2-12 thng: >50ln/ph VP tr 1-5 tui: >40ln/ph

Cc thng s h hp
Dung lng phi: 4,5 5l ngi ln. Gm:
Dung tch sng: khong 3,5l
V kh lu thng: ~ 0,5l vi sc th bnh thng V kh b sung: ~ 1,5l khi ht vo gng sc V kh d tr: ~ 1,5l khi th ra gng sc

Th tch cn: ~ 1l 1,5l. L kh cn li trong phi sau khi th ra gng sc

C ch iu ha h hp
C ch ha hc Vai tr ca CO2 trong mu rt quan trng Nng CO2 tng s kch thch trung tm h hp, nhng nu tng qu cao s c ch gy ngng th CO2 gim s lm gim nhp th, nu gim qu nhiu c th gy ngng th iu ha ca v no: lm thay i tn s, su ca nhp th iu ha ca phn x ngoi bin Dy thn kinh X

Bnh l h hp
Vim ng h hp trn Vim ph qun Vim phi Lao phi Hen ph qun COPD (Chronic Obstructive Pulmonary Disease) Ph phi cp Bi phi Ung th

BNH HC H H HP

NI DUNG
Hen ph qun Bnh phi tc nghn mn (COPD) Trn kh mng phi Vim phi cng ng Lao phi p xe phi Suy h hp cp

HEN PH QUN
Khi nim:
Phn ng co tht, ph n, tit nhy ca ph qun do nhiu kch thch khc nhau. Biu hin c trng: kh th th th ra.

Nguyn nhn ph bin: d ng Triu chng:

Tin triu: ht hi, s mi, ho, nga mt Cn kh th c trng + kh kh, gim sau khi ho v khc m.

 CLS: X quang, o chc nng h hp, kh mu ng mch, xt nghim m, in tim. iu tr: ct cn

Thng ng th (dn ph qun, ht m nht) Th oxy

iu tr lu di
Gii mm cm c hiu vi d ng

Hen ph qun
Co tht Ph n Tng tit

BNH PHI TC NGHN MN TNH (COPD)

nh ngha:
Ri lon thng kh tc nghn khng c kh nng hi phc hoc phc hi rt km. Lin quan n: kh ph thng v vim ph qun mn.

Yu t nguy c:
Ht thuc l nhim mi trng Nhim trng h hp C a : thiu alpha-1 antitrypsin

 C ch sinh bnh
Tn thng t ph qun ln n cc ph qun tn ng th nh tn thng vim mn tnh

 Triu chng
Tin s ht thuc/ tip xc vi khi bi nhim Ho khc m + kh th Khm thy phi kh, tng p lc ng mch phi, ran m, n. Lng ngc hnh thng Kh th rt lm c h hp, k gian sn, hm c

Cn lm sng (CLS)
Xquang Chc nng h hp: tiu chun quan trng Kh mu ng mch

 iu tr
Trnh cc yu t nguy c V sinh mi hng thng xuyn Thuc: dn ph qun, corticoid (xem xt li) Khng sinh: theo KS Th oxy

TRN KH MNG PHI

TKMP: xut hin kh trong khoang mng phi. Nguyn nhn: v cn, bnh COPD, gin PQ, hen, vim phi, ung th PQ Triu chng:
au ngc Kh th, th nhanh nng Ho khan

CLS: X quang

 iu tr:
M mng phi, t ng dn lu p lc -20cm nc. iu tr nguyn nhn (nu c).

VIM PHI MC PHI CNG NG

Khi nim:
Nhim khun xy ra ngoi bnh vin Vim phi thy hoc vim phi khng in hnh

Nguyn nhn: vi khun, nm, virus Triu chng:

St cao > 39 C au ngc vng tn thng Ho khan m c mu vng hoc xanh, mu g st Triu chng khng rm r ngi gi yu, suy gim min dch, ngi nghin ru.

 CLS: X quang, cy m tm nguyn nhn Bin chng:

Trn kh, trn dch mng phi Suy h hp, shock nhim trng Xp phi p xe phi, vim phi mn Vim mng ngoi tim

iu tr: khng sinh + h tr

Vim phi

Vim phi

Vim phi thy

Ph qun ph vim

LAO PHI
Bnh do trc khun lao ngi gy ra (Mycobacterium tuberculosis) Do Robert Koch pht hin ra nm 1882 Ngun ly: ch yu l m ca bnh nhn

Trc khun lao

VK lao ngi v VK lao b L loi trc khun, khng c nha bo, khng cn, khng acid u kh tuyt i, pht trin tt mi trng c phn p Oxy cao Kh nng gy bnh ph thuc vo s lng BK v sc khng ca c th C kh nng t bin khng thuc C sc khng cao vi cc thuc kh trng

Bnh sinh lao phi

Ngun bnh: Ngi b lao phi c BK (+) Yu t nguy c
Suy gim min dch Sau chn thng v sau phu thut

ng ly:
ng h hp ng tiu ha

 42 %: khng ho 26 %: khng triu chng Triu chng

St nh ko di (thng v chiu hoc m) St cn, mt mi, chn n, ra m hi m. Ho khan ko di ho m trng Ho ra mu Kh th

CLS: X quang, cy m, xt nghim sinh hc phn t (PCR) iu tr: khng sinh theo pht

 Khng sinh thng dng iu tr lao:

Streptomycin (S) Izoniazid (H) Rifampicin (R) Pyrazinamid (Z) Ethambutol (E) Cycloserin (CYC)

Phc
2RHZ/4RH 2SHRZ/4RH 2ERHZ/4RH

D phng
Phng lao cho cng ng Phng lao cho c nhn Loi b ngun ly Vaccin BCG

P XE PHI
nh ngha:
L m trong phi hoi t (cp tnh/ mn tnh) Khng do vi khun lao

Nguyn nhn:
Vi khun ym kh v i kh Nm, amip

Triu chng (lm sng v cn lm sng)

St, mt mi, st cn, thiu mu Ho, khc m c m/ ln mu, au ngc Khm: g c, ting c mng phi

 Cn lm sng:
X quang: cho hnh nh p xe phi (k ~ 4-6cm) Xt nghim m m tm nguyn nhn CTM: BC tng cao Tc mu lng tng cao

iu tr
Dng khng sinh Dn lu p xe Ch dinh dng y Cn bng nc, in gii Gim au, h st

Suy h hp cp
L tnh trng t ngt suy gim chc nng h hp, dn n thiu Oxy mu, c hoc khng tng CO2 tiu chun:
Pa O2 < 60 mmHg Pa CO2 > 50 mmHg

 Nguyn nhn
Tn thng thn kinh Tn thng thnh ngc Tc ng th Tn thng phi

 Lm sng
Kh th Xanh tm u chi Cc biu hin tim mch, thn kinh, cc du hiu ton thn Cc bnh l km theo

 CLS
Kh mu Sa O2 <90% pH mu gim, Pa O2 < 60 mmHg hoc Pa CO2 > 50 mmHg XQ: vim phi, trn dch, trn kh mng phi, ph phi,. ECG: lon nhp tim Siu m: suy tim, TDMP

 iu tr:
m bo tt thng kh v oxy mu Duy tr kh nng chuyn ch oxy Cung cp nng lng iu tr nguyn nhn

HT