bài giảng Áp xe phổi ThS BS Trần Thị Tố Quyên

Áp xe phổi ThS BS Trần Thị Tố Quyên Bộ môn Nội- Đại học Y Khoa Phạm Ngọc Thạch Mục Tiêu của Y3 và CT3:     !"##$%  &'()*'(*!  "$%  +%,-(./!) 1. Đại cương: 1.1. Định nghĩa: 01&234(5678*5(&1 %9"%$* 054,:5;<!7&= >.?5(%,8-88!%72 !@=&A %(:B • C,4*A",4DE) • FGH- • I • : • J(##9(56! • J%!(E(## • KL!!%(%(## 1.2 . Nguyên nhân và đường xâm nhập: 1.2.1- Nguyên nhân: Các tác nhân thường gặp có thể tổng kết trong bảng sau: Tác nhân Thường gặp M,4 Burkholderia pseudomalleiN Klebsiella pneumoniaN Nocardia#O Pseudomonas aeruginosaN Staphylococcus aureusP Streptococcus milleriP Q!#!((P R,4 Actinomyces#O Bacteroides#N Clostridium#O Fusobacterium#N Peptostreptococcus#P Prevotella#N 3 Aspergillus# S%#!(##T Blastomyces dermatitidis S%#((##T Coccidioides immitis S(E(E((##T Cryptococcus neoformans S!(((##T Histoplasma capsulatum S#(%#(##T Pneumocystis jiroveci Rhizomucor S(!(##T Rhizopus# S(!(##T Sporothrix schenckii S#(!(!(##T U(%!% SV,' ,8  WT Mycobacterium avium- cellulare Mycobacterium kansasii Mycobacterium tuberculosis X#!@ Entamoeba histolytica S%%##T Echinococcus granulosus S(((##T Echinococcus multilocularis S(((##T Paragonimus westermani S%!%(%##T N+!Y,'Z!%= O+!Y,'Z!%E?= P>.,'Z!%E?= [B54*!**#-2E)*#%&*7,4H-* !\*]E%*E)^7*4_H-E(*:*3?Y= 1.2.2. Đường xâm nhập: M4,';`%a3*(!%,';2,';%A  H%^(a^S%*E9?(T= 2. Lâm sàng và cận lâm sàng: 2.1. Lâm sàng: NW !&#A A!"?\(*,5*#*G:8*ba2!@* ,3!W!(%-*1"8a%!E)*Y.*!%=^ a!&AX!\%!(5!4#a%,A N>A c%(5 Z%(5$,4B-#&3= Z%(51$B dJ%efg11(\&*%\&=M(EhE11!%!3/$S!\ T*$aH(a.*hi$!j@8=VG:8* -=J%A#*E2)*\$=Z%(51$./j$!(^757= d>A (!%(a,5!%4$/.!(S,$T=k%#5 $,5!% #?1 A'(&= U$B+^E(i.l$%B^E(&.= U$J((%B]l$Ahi(56B,',R,4= Z%(5$89H-Bm(E%En3,%,5$# 4?=A 31"%  2.2 Cận lâm sàng: Bao gồm • oH% • >+J%:YS.T • >3S, -33(%!%T • 1#(H-,.-'((5!; 2. 2.1 X-Quang:  0^-!%!&4#aE(A!(5X"(a",A' ()7oH%Y=+!(2!@,R,4E(4*ioH%Y !( %(5$,431A^,8.3*,!1*^^*%Ap7h%(5 #%31(a/%E5!j*^E.*H%"8a*!(%A",4* 9*)!4i1,7qS+^7-)!4@#%$%@!& %@!&(a@&$%@E9T=MW-r,R,4; &,$%5(%*&*A 7/s%%(^5( %7t 2.2.2 CT Scan lồng ngựcB +^,8.A h4,oH%t31?5(%(a,^ A1,A W--A% . 2.2.3 Soi phế quản u8,Y (5!;%,^AE(a .,^* n53= Áp xe phổi 2.2.4 Cấy đàm: >,',R,4,E5,3W!3,Am',8)(5 2#%,H%@.`.j43,',R,4^,8= >vA A$*#%A912,R,4=+&*A!$W3E) W!@,R,4^E2E? #4^A,-\2!@,R,4*W.-W!@,4*3*(a (%!%=>3*rE)H-H%G1#(*3vA @Y ) E%= 2.3. Tiến triển và biến chứng: 2. 3.1. Tiến triển: du/!),w((#%1^% 5#_(W8#%(= du/!),854S!&<*AA%E@!T(a 5%E"= 2.3.2.Biến chứng: dZGH-H%=U$*SE(xT= d0G(*&G(= da= d+((E51?H%= dy! 3]#!#!(%E"= 3. Chẩn đoán: 3.1. Chẩn đoán xác định: z#B,7.11#*(,5^*1$(a,%4$*^?7*%Y= A1"8a*1"%= oC%rK>\%(*\*VJ\= oH%BW-A",49*%a7{E9-= oC^W3,',4(a,4*3SdT4= 0E(%B^$J88%*^7&-*(%#%E@|%* (*}= 3.2 Chẩn đoán phân biệt: ZGH-B#654*,5^$/#loH%B/!j#7{E9=>' ()qiUJ>+J%:Y= U$89H-B1/$*oH%AW-!E)*!,4  C,4)2,'B%!/w*H%,8A8a*/!),#,8w= +/#6A%;!9= M%B((7!*^E.*:/*/!),#,8,H-= M%%(2,'BE2.954=J(*X^KSdT4*A27 H%%*/!),#,8,H-== 4. Điều trị: 4.1. Điều tri nội khoa: +3EY%(,#:=8,#:W{(!"#* oH%*43$A9)\&,'`=&<c,#=J6Ei ,#q/^=!/~5,9&#%A&,9^= +^%/!)e•.%A ?(,oH%3W-= >A `,#(!@ d+i.BU*>%(#(!*z(*V%(= dz&.ByZ= d#%BZ%*k((= d]B}*|%= U8,#%,-(/!)(,B >E%Be€€&~5se•^Y%`7WAA(54!& J!((#,R,4=>A %q#Y,•%%‚•%%%#"S4Ei*%‚ #%%f<&~5se*%!‚%%%ce&~5se*!%‚ %ƒ(%%c&~5se U!(E%ƒ(Bg€€&~5s•A #6Ei-,9 <=€€€=€€€?)&~5se= K4&!`A (,#E%c€€se(a %(‚%%%•„g‚f<gsf<= u92!@!3&!`&H%+i.,U*/!)3V%( %zƒ(E Fm$B+^,8,(WEmA !j!t2(H-, …34= %A#83*7,4H-A .= M,1#(H- ($ =+!$A Em$!(,(-f€†!(AA?,8 "9,#=9/!),#^a39#!\9"592 !@!&E)= 4.2.Điều trị ngoại khoa: >t)B d054*/!)1,(%!&<,8A,H-= dM(!%aE(545= dM%E"= y?B{(a{= Tài liệu tham khảo 1. Pneumonia. The Merck Manuals: 00The Merck Manual for Healthcare Professionals. hp://www.merck.com/mmpe/sec05/ch052/ch052a.html. Accessed March 25, 2009. 2. Pneumonia fact sheet. American Lung Associa%on. hp://www.lungusa.org/site/apps/nlnet/content3.aspx? c=dvLUK9O0E&b=2060321&content_id={08C669B0-E845-4C9C-8B1E-285348BC83BD}¬oc=1. Accessed March 28, 2009. 3. Durrington H, et al. Recent changes in the management of community-acquired pneumonia in adults. Bri%sh Medical Journal. 2008;336:1429. 4. Pneumonia. American Lung Associa%on. hp://www.lungusa.org/site/apps/nlnet/content3.aspx? c=dvLUK9O0E&b=4294229&ct=3052571. Accessed March 28, 2009. 5. Menendez R, et al. Treatment failure in community-acquired pneumonia. Chest. 2007;132:1348. 6. Singh S, et al. Long-term use of inhaled cor%costeroids and the risk of pneumonia in chronic obstruc%ve pulmonary disease: A meta-analysis. Archives of Internal Medicine. 2009;169;219. 7. Chong C, et al. Pneumonia in the elderly: A review of the epidemiology, pathogenesis, microbiology and clinical features. Southern Medical Journal. 2008;101;1141. 8. Chong C, et al. Pneumonia in the elderly: A review of severity assessment, prognosis, mortality, preven%on and treatment. Southern Medical Journal. 2008;101;1134. . Áp xe phổi ThS BS Trần Thị Tố Quyên Bộ môn Nội- Đại học Y Khoa Phạm Ngọc Thạch Mục Tiêu của Y3 và CT3:   . (5!;%,^AE(a .,^* n53= Áp xe phổi 2.2.4 Cấy đàm: >,',R,4,E5,3W!3,Am',8)(5 2#%,H%@.`.j43,',R,4^,8= >vA. gặp có thể tổng kết trong bảng sau: Tác nhân Thường gặp M,4 Burkholderia pseudomalleiN Klebsiella pneumoniaN Nocardia#O Pseudomonas aeruginosaN Staphylococcus aureusP Streptococcus milleriP Q!#!((P R,4