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Kho tho va nhung benh lien quan

Kho tho la mot cam giac kho chiu dac biet khi ho hap. Nguoi benh mo ta nhieu trang thai nhu: khong du khong khi, khong khi khong vao phoi ngay, nguc bi bo chat hay cam giac nghet tho... Kho tho phai ngoi day hoac tu the nua nam nua ngoi, nam tay vao chan song cua so hoac thanh giuong. Nhip tho nhanh nong (binh thuong 12-16 lan/phut). Co the chia ra kho tho cap va kho tho tu tu chua den muc do cap.

Nguyen nhan kho tho cap

Lao ke gay kho tho cap tinh. 

Con hen phe quan: Kho tho ra, xuat hien dot ngot, gap khi thoi tiet thay doi, nguoi benh cam thay ngot ngat, thuong phai vin tay vao thanh giuong de tho. Co tien su di ung va tai phat nhieu lan. Sau con kho tho co ho hoac khong ho va khac ra nhieu dom, dom co the ran, keo lai nhu tep buoi. Chup Xquang hai truong phoi sang hon binh thuong. Can lam chuc nang ho hap de xac dinh them.

Tran khi mang phoi: Kho tho du doi sau mot con dau nguc, goi la “tieng set danh giua troi quang”. Kho tho khi hit vao, mat nhot nhat, tran va mo hoi, co khi buon non. Go phoi vang, ri rao phe nang giam, rung thanh giam. Xay ra tren nhung nguoi gian phe nang, ho ga, ken hoi o phoi hay sau mot dong tac lam viec gang suc. Xquang thay nhu mo phoi bi ep lai thanh mot cum o ron phoi

Di vat vao duong tho: Con kho tho xay ra dot ngot, mat moi tim den, co tieng co cu, ngat tho du doi, va mo hoi, nua gio sau di vat xuong thap hon thi kho tho nhe dan. Neu di vat nam o thanh khi quan, khong xuong duoc, mat, moi benh nhan tim tai. Di vat lon bit kin duong tho, neu khong duoc cap cuu kip thoi co the chet.

Lao ke: Kho tho dan dan, doi khi kho tho du doi, nguoi gay xanh, co the sot ve chieu. Chup Xquang thay co nhieu not mo nho nhu hat ke deu nhau nam rai rac khap hai phe truong.

Viem phe quan phoi: Viem phe quan phoi gap o tre em va nguoi gia. Nguoi benh sot 39o- 40oC. Kho tho xuat hien dan dan, tho nhanh, nong ngay cang tang, canh mui phap phong. Nghe phoi hai ben co nhieu ran am, ran no, ran rit. Ho co nhieu dom, dich nhay. Chup Xquang thay dam mo khong deu, rai rac hai phe truong. Xet nghiem mau bach cau da nhan trung tinh tang cao.

Dot cap cua benh phoi tac nghen man tinh: Thuong gap o nguoi co tuoi, tien su hut thuoc. Tong cong mot nam ho khac dom tren duoi 3 thang/lan, co the co sot, ho nhieu, dom dac mau vang, xanh. Kho tho lien tuc hoac tung con, nhip nhanh nong, nghe phoi nhieu ran am, ran ngay. Benh nhan thay ngot ngat, thieu khong khi, bun run chan tay, moi tim, va mo hoi.

Phu phoi cap: Kho tho xay ra dot ngot, hay gap ve ban dem, kho tho nhanh, nong, mat moi tim ngat, khac ra bot mau hong. Kho tho tren mot nguoi bi hep van hai la, ho dong mach chu, tang huyet ap, suy tim trai, viem than cap, man. Nghe phoi co tieng ran no hai thi. Luc dau nghe o day phoi, sau tieng ran nghe cao dan len phia tren, goi la dau hieu “nuoc thuy trieu dang”. Chup Xquang phoi thay hai phe truong mo lan toa, vung ron phoi tang dam.

Ure mau cao: Nhip tho nhanh nong, neu nang co nhip tho Sen-stoc, kem theo nhuc dau, non, di long, gap o nguoi viem than cap hoac man tinh, soi than. Can lam xet nghiem chuc nang than va nuoc tieu.

Toan mau: Kho tho nhanh nong, giai doan cuoi chuyen sang nhip tho Cuxmon, kem theo nhuc dau, non mua, di long, met moi, xay ra o nguoi dai thao duong khong duoc dieu tri. Can xet nghiem nuoc tieu tim the Cetonnic va duong, xet nghiem du tru kiem giam.

Liet co ho hap: Do dut tuy song co, do nhuoc co (benh tuyen hung), chan thuong long nguc, ngat tho vi hit phai hoi doc, hoa chat, khoi...

Kho tho it, chua den muc cap cuu

Viem phoi: Benh nhan sot cao 39- 40o, mieng co cac not nhiet, ho ra dom mau ri sat. Dau nguc, kho tho tu tu. Kham thay ben phoi bi benh rung thanh tang, go duc, co ran no mot thi. Chup Xquang thay hinh tam giac mo dong deu, dinh quay vao trong, day ra ngoai. Xet nghiem thay bach cau da nhan trung tinh tang. Gap o nguoi khoe manh.

Tran khi mang phoi.
Tran dich mang phoi: Kho tho nhieu, hit vao kho, co the co ho khan, sot dau nguc ben tran dich. Doi khi nam nghieng ve ben tran dich thi de tho. Chup Xquang phoi co hinh mo o day phoi, co duong cong Damoiseau. Choc mang phoi thay dich mau trong, vang chanh, mau hay mu. Can xet nghiem dich mang phoi ve luong protein, te bao va vi khuan.

Kho tho do cac benh tai, mui, hong nhu viem mui, viem sung amidan, viem phu ne thanh quan, can kham chuyen khoa tai mui hong.

Suy tim: Kho tho khi gang suc, nhu mang vac vat nang 5-10kg len thang gac. Co khi chi can mac quan ao, di ve sinh, tro minh la da kho tho. Di tieu it, co the phu hai chan, mat xanh tim. Can chup Xquang, lam dien tam do, sieu am tim va kham chuyen khoa tim mach. Suy tim thuong xay ra tren benh nhan mac cac benh van tim, benh tam phe man, tran dich mang ngoai tim, thieu B1 (nay it gap). Giai doan suy tim mat bu thi kho tho tro thanh cap cuu.

Kho tho do mot so nguyen nhan khac

Dau nguc do than kinh lien suon: Moi lan hit tho thi nguc dau choi, nen co cam giac kho tho. Kho tho o nhung nguoi roi loan than kinh thuc vat, kham khong thay cac bieu hien benh ly ve tim phoi. Gu veo cot song gay roi loan thong khi dua den tam phe man va suy ho hap, benh nhan thay kho tho. Kho tho do chan thuong long nguc, do gay xuong suon hay dung dap phan mem cua long nguc. Kho tho do liet co ho hap khi bi dut tuy song co, do nhuoc co (benh tuyen hung). Ngat tho do hit phai hoi doc hoa chat, khoi...

Truoc mot truong hop kho tho cap tinh can chuyen gap nguoi benh den trung tam cap cuu co du thuoc, thiet bi y te cap cuu nhu dung cu dat noi khi quan, mo khi quan (khi can), may Xquang, may tho oxy va kip thay thuoc chuyen trach. Neu khong phai benh cap cuu thi dua nguoi benh di kham o co so y te chuyen khoa.

TS. Dao Ky Hung