NGOAI -YHCT
BENH TANG SAN LANH TINH TUYEN TIEN LIET-BPH
I-YHHD
1-Trieu chung
1.1- Co nang
-Cac trieu chung kich thich: dai nhieu lan,dai voi , khongnhin duoc ,dai son
-cac trieu chung do chen ep: dai kho , phai ran dai , dung lau moi dai het, tia nuoc tieu yeu va nho
-Trong giai doan co bien chung:bidai hoan toan hoac khong , dai duc,dai buot khi co nhiem khuan ,.Dai ra mau , do soi bang quang ,hay viem nhiem nang o bang quang
-Cac roi loan ve chuc nang tinh duc : liet duong , roi loan xuat tinh ,
-Tinh trang toan than : mat ngu , met moi
1.2-Cac trieu chung thuc the
tham truc trang de xac dinh mat do ,ranh gioi , uoc luong trong luong ...
1.3-Cac phuong phap dieu tri
- Phong benh : an uong dieu do , tranh ruou , thuoc la .Tranh nhiem trung duong nieu ...
-Dieu tri noi khoa : de lam giam ap luc co tron co bang quang va lam nho TTL
-Dieu tri ngoai : chi dinh
+bi dai hoan toan va ngay sau khi rut ong thong benh nhan van khong dai duoc
+bi dai khong hoan toan ,voi muc do u do ng trongbang quang tren 100ml
+Nhiem khuan
+Soi tiet nieu, tui thua bang quan g
+Dai ra mau
+Suy than do u phi dai tuyen tien liet
-Phau thuat kinh dien boc u khi u qua lon, phau thuat noi soi qua duong nieu dao ,
-Cac bien chung : chay mau , nhiem khuan , vo nieu , xuat tinh nguoc dong....
II-YHCT : Dong y xep vao loai long be
1-Nguyen nhan
-Do roi loan chuc nang cua tang : ty ,phe ,than, tamtieu , bang quang , vi 1 so nguyen nhan:
+Do that tinh: mat dieu hoa , noi thuong khi co mat dieu hoa , kinhlac khong thong , chuc nang khi hoa cua ty , phe , than , tam tieu , bang quang bi roi loan ,lam thuy dao bi nghen tac
+Do met nhoc lam ton ty hoac phong tung ,dam duc qua suc lam ty hu , than hu , hoac ty than luong hu , khi hoa bat cap , su thong loi cua bang quang bi ngan tro ma sinh benh
+Su xam nhap cuangoai ta lam phe khi mat chuc nang tuc giang khong thong dieu duoc thuy dao
+AM thuc sinh ra noi thuong : an uong khong dieu do, an nhieu do beo ngot , nuoc ran.... bo qua sinh thap nhiet do xuongbang quang an do song lanh lam ton thuong ty vi ,
2-Trieu chung
2.1-Bang quang hu han ,than duog hu
- Bang quang hu han la thoi ki dau cua benh
-Trieu chung : Tieu dem , tieu nhieu lan ban ngay nang thi dai vat , tieu khong tu chu , dai son , daumoi lung , luoi nhat, reu trang ,mach vo luc
-Giai doan sau khi than duong hu: lung dau , chan lanh, tinhthan ue oai , so lanh , matt rang nhat, tieu co lan tinh , liet duong, tao tinh, luoi nhat beu , mach tramm nhuoc
*Phap : On than hoa khi hanh thuy
*Phuong duoc : chu tuyen hoan hop THo ty tu hoan gia giam
-Neu di nieu nang phai dung Phuc bon tu , Kim anh tu
-Cac vi thuoc hay dug : ba kich , do trong , khiem thuc , lien tu , long cot , mau le , tho ty tu , nhuc que, tang tieu phieu , ich tri nhan , phuc than, o duoc ,
-Than duong hu : te sinhthan khi hoan gia giam , hop tu than hoan
+On cham : menh mon , than du , quan nguyen , thai khe , am coc , dung tuyen
2.The can khi uat ket
-TRieu chung: tieu kho ,tieu son , hoac di nieu , dau nhuc chuong bung duoi ,kem tinhthan uat uc , hay noi cac\u hoac da phien , mieng dang hong kho ,nguc suon day tuc , reu luoi mong , mach huyen hoat
-Phap;' so can giai uat,hanh khi loi nieu
-Phuong : Saiho so can thang
cac vi thuoc hay dung: sai ho,tru linh, bach thuoc , ich mau, dan sm . chich thao ,trau co , phuc linh ,.bach hoa xa thiet thao , sa tien tu , tam that ,huong phu
2.3-Nieu lo uc tac:
Khi huyet u tro , huyet u , u tro bang quang , dam ngung u tro ...
-TRieu chung : tieu kho tieu nho giot , tieu dau , day chuong bung duoi ,dau choi khong di chuyen , mieng luoi tim, co diem u huyet, mach sap
-Phap: Hanh u tan ket ,loi nieu
-Phuong : huyet phu truc u thang
cac vi thuo c hay dung : haong ba , xuyen son giap , tam lang, nga truat , ,hoang ky , trach ta, dan bi, nguu tat , ich mau ,dao nhan , tri mau
-Neu tuyent ien liet co cang gia tam lang, nga truat , neu khi hu gia hoang ky . dang sam , thuong uong kem tam that .
-Cham : Hop coc , tam am giao, khuc tri, trung cuc , tuc tam ly
2.4-Ty khi hu
-Trieu chung : sac mat khong tuoi , khong co suc,hoi hopp hoi tho ngan , tay chanlanh, tu ra mo hoi , tieu tien phai gang suc , ra nho giot , sot rot dam de ,lao dong thi benh nang hon, vungho iam nang tuc , luoi nhat, ria luoico nep han rang ,mach te nhuoc .
-Phap : ich khi kien ty , loi nieu
-Phuong : bo trung ich khi thang hop voi tho ty tu hoan : tho ty tu , phuc linh ,son duoc , lien nhuc , ,ky tu , hoang ky, dang sam,cam thao , bach truat , thang ma , sai ho , suong quy ,tran bi
2.5-The than am hu
-Trieu chung : mot tieu ma di khong ra , lung dau , cahn moi ,dau vang , hoa mat, ngu tam phien nhiet, di tinh ,roi loan sinh duc , vung hoi am co cam giac nang tuc , luoi do , mach tram te sac
-Phap: ich than tu am , thanh tiet tuong hoa
-Phuong: Tri ba dia hoang hoan , luc vi dia hoang hoan
-Cham : than du , quan nguyen du , tam am giao, thai khe trung cuc
2.6-bang quang thap nhiet
-Trieu chung: tieu nhieu, tieu dat, tieu buot ,tieu duc , tieu ra mau , duong tieu nong, vung hoi am chuong tieu, dau lan rong bung duoi , xuong xuong cung, am hanh va dui ,toan than luc nong luc lanh , nuoc tieu vang , do hoac dau, tao bon, mieng kho, dang , luoi do, reu luoi vang beu , mach hoat sac
-Phap : Thanh nhiet loi nieu
-Phuong duoc : Bat chinh tan gia giam : cu mach , xa tien tu , bien suc , hoat thach , dang tam , chi tu , dai hoang m cam thao , sac uong
-Cham : trung cuc, am lang tuyen , tam am giao
II-Quy Trinh Cham soc nguoi benh BPH
1- Nhan dinh
-Hoi : tinh trang roi loan tieu tien cua nguoi benh , tinhtrang toan than , tinhtrang tinh duc....
-Kham thuc the de xac dinh mat do , ranh gioi , trong luong cua TTL
-Dung thang diem IPSS de danh gia muc do nang nhe cua cac trieu chung cung nhu theo doi khi duoc dieu tri ...
2-Chan doan va can thiep dieu duong
2.1-Nguoi benh tieu nhieu lan ,tieu dem, tieu kho
- Chuan bi nguoi benh giup bac si tham kham truc trang , lam cac xet nghiem
-Huong dan benh nhan cach xoa bop , chuom nong vung bung duoi phia tren xuong mu , tang sinh mon hoac ngam nuoc am
-Thuc hien xoa bop va cham cac huyet : dung tuyen , huyet hai , , tam am giao , khuc cot , quan nguyen, khi hai.... theo y lenh. huong dan benh nhan uong thuoc theo y lenh
2.2-Nguoi benh nhiem trung duong tieu nieu : tieu duc , tieu buot ,tieu rat
- theo doi nhiet do , thuc hien khang sinh va uong thuoc theo y lenh ,thuc hien cac ky thuat cham soc vo trung , rua tay truoc va sau khi cham soc nguoi benh
2.3-Nguoi benh bi dai hoan toan hoac khong hoan toan
-Thuc hien xoa bop , chuom nong vung bung duoi phia tren xuong mu , tang sinh mon hoac ngam nuoc am , cham cuu theo y lenh
-Tien hanh thong tieu khi cac phuong phap tren that bai
- Sau khi luu sonde bang quang , theo doi so luong , mau sac nuoc tieu , lam cac xet nghiem
-Tinh trang benh nhan truoc , trong va sau khi dat sonde
III-CSNB mo BPH
-1-chuan bi benh nhan truoc mo
- theo doi DHST : mach, njhiet do ,huyet ap theo quy dinh
-Do can nang ,chieu cao ,
-Lam dien tim do ,
-CHieu XQ tim , phoi
-THuc hien cac xet nghiem : HIV, HbsAg , cong thuc mau , mauchay mau dong ,,nhom mau
-Coi bo tu trang ,thao rnag gia
-Ve sinh : VS sach se , VS vungmo bang xabong , co the khong can cao long ma sat khuan bang dung dich Savon
-An uong : Chieu truoc mo an nhe loang , toi truoc mo nhin an hoan toan ( toi thieu 8h) Ngung uong toi thieu 4h
-Thut thao : toi hom truoc va sang hom mo uong thuoc xo
-Tam ly: cho benh n hangap nguoi n ha , ngu som , co the dung thuoc an than
2-CSBN sau mo BPH
-theo doi benh nhan da tinh chua khi benh nhan duoc gay me
-Benhnhan nam dau thap trong 24h dau sau mo doi voi gay te tuy song
-Mach, nhiet do ,huyet ap 2h/lan cho den khi on dinh , sau do 4h /lan de theo doi chay mau sau mo
-Neu mo mo : theo doi ong sonde dich chaymau ra co mau hoac khong , co dich chay ra khong ,Theo doi tinh trang vet mo,thay bang vet mo hang ngay
-Mo noi soi : rua bang sorbitol 20% , 20l/ngay qua ong sonde, rua lientuc trong 3 ngay ,theo doi luong nuoc vao ra xem co tac ong thong khong
-Dung khang sinh , giam dau theo y lenh
BENH CHAM
I-YHHD
1-Nguyen nhan
-Benh cham phat sinh do 2 yeu to : co dia va di nguyen
a- Co dia : co tinhchat gia dinh , , di truyen , co tien su trong gia dinhco nguoi bi cham, bi di ung,hen suyen
-co cac tac nhan kich thich ben trong , co thuyet cho rang do roi loan than kinh TV
b- Di nguyen : cac thuoc gay phan ung, hoa chat, cac san pham vi sinh co co che di ung (vi khuan , nam ,sieu vi .), cac yeu to moi truong song ( khoi , bui ,lanh ,nong ,am ),yeu to tam than kinh
2-Phan loai tien trien va dieu tri
-Cham uot : khi ton thuong la nhung mun nuoc hoac dang ri dich, rat ngua , de boi nhiem
-Cham kho nut ne : thuong xuat hien o ban tay , banchan ,nag len khi troi lanh hoac khi tiep xuc hoa chat , xa phong,chat tay rua ...
*Cham khong the tri dut han duoc , chi co the ngan ngua su tai phat va tram trong cua benh
-Tranh thay doi nhiet do dot ngot , mot so thuc an , thuoc uong , my pham ,trang suc , xa phong,chat tay rua , thuoc nhuom ,... dong thoi cung can biet cach che ngu stress
-Ben canh do , ta can thuong xuyen thoa cac chat giu am ,lam mem da ,va nen chon cac chat khong mau
-Voi truong hop cham uot : thuoc tim pha loang de ngam rua thuongton ,xanh methylen, do eosine, tim gentian ....
-Voi nhung nguoi bi cham lam nut ne banchan ,got thoa lien tuc cac chat giu am -an than giam ngua , giam man cam ,khang sinh hoac cac loai thuoc thoa co chua corticosteroid ..
II-YHCT
Benh nay thuoc chung Phong chan cua YHCT
1- Nguyen nhan -phac dieu tri (toan than )
-Do an uong khong dieu do uong ruou , an cay , an tanh qua nhieu lam ton thuong den ty vi .Ty mat kien van se lam hap nhiet noi sinh a u tre dong thoi ngoai cam hai phong thap ,nhiet ta .Noi ngoai ta tuong tac voi nhau u tre lai o bi phu ma sinh ra benh
-Cung co khi vi co the hu nhuoc ,ty bi thap lam khon ,khien ho co nhuc khong duoc nuoi duong roi sinh benh
-CUng co khi vi thap nhiet uat lau ngay lam hao ton phan amhuyet , huyet hu hoa tao roi sinh phong tao len chung huyet hu phong tao lam cho bi phu khong duoc nuoi duong ma thanh benh
1.1- The thap nhiet
-The nay thuong gap o giai doan cham cap tinh
-Benh phat cap ,dien bien ngan<Tonthuong da do va nong , phu ne nhieu .Tam phien ,mieng khat ,dai tien tao ,m tieu tien it va do , reu luoi vang .Tinh trang nay do htp nhiet cung thinh , xam nhap vao bi phu roi gay nen benh
-Phap dieu tri : Thanh nhiet loi thap , luong huyet giai doc
-Bai thuoc : LOng dom ta can than gia giam
+Long dom thao , hoang cam,chi tu , moc thong ,xa tien tu , sai ho (8g)
+Sinh dia , trach ta -12g
+Thuyen thoai - 6g
+Cam thao - 4g
-nhiet thinh gia bach mao can , thah cao ,nhiet doc gia dai thanh diep
1.2- The Ty hu thap thinh
-Benh keo dai lam ton thuong da tho va day co the co xuat tiet nhe , thuong co vay da , dai tien khong kho hoac long , chat luoi nhot ,beu co ngan rang , reu luoi trang nhot ,mach tram hoan hoac hoat
-,Tinh trang nay do ty hu thap thinh lam cho bi phu khong duoc nuoi duong ma sinh benh
-Phac dieu tri : Kien ty tao thap ,duong huyet nhuan phu
-Bai thuoc : Tru thap vi linh thang gia giam
+Hau phac , Phuc linh , Tru linh, Bach tien bi - 12g
+Nhan tran -20g
+Trach ta -16g
+Tran bi- 8g
-Thap thinh xuat tiet nhieu thi gia Ty giai , Xa tien
1.3-The huyet hu phong tao
-The nay hay gap o giai doan cham man tinh
-Benh dien bien man tinh, ton thuong da day , nut ne , hay co vay mau , chat luo nhot , reu luoi trang mmach tram tehoac atramhoan
-Tinh trang nay do benh lau ngay lam hao ton am huyet ,huyet hu phong tao gay nen
-Phac dieu tri : Duong huyet so phong ,tru htap nhuan tao
-Bai thuoc : Tieu phong tan hoac Tu vat tieu phong tan gia giam
+Kinh gioi , phong phong, Nguu bang tu , Kho sam , Moc thong - 12g
+Sinh dia -16g
+Tri mau-8g
+Thuyen thoai -6g
+Thach cao -20g
-Thap thinh gia Xa tien tu, trach lan
-Ngua nhieu gia bach tat le , kho sam
2-Dieu tri bang Cham cuu
-Tru phong : hop coc -Tru thap : tuc tam ly -Hoat huyet: huyet hai
-Tuy vi tri cham o co the ,a chon huyet cho phu hop :
+ vung tay : Khuc tri , hop coc
+vung chan: tam am giao , duong lang tuyen
-DUng cham va cuu (nhat la cuu dap ) o cac diem quanh vung bi dau
3-Dieu tri tai cho
3.1-Giai doan cap tinh
-Khi benh moi chi phat chi do tai cho ,san va mun nuoc chua vo ,chua xuat tiet thi nen dung cac thoc on hoa tieu viem, tranh kich thich chin cach dap uot cac thuoc nhu Lo cam thach
-Khi cac mun nuoc da vo va xuat tiet nhieu thu liem ,tieu viem ...nham muc dich thuc day da hoi phuc ,co the sac lay nuoc dac dap uot (rau sam 60g, hoang ba ,sinh dia -30g, bo cong anh ,long dom thao ,cuc hoa -30g_)
-Khi co boi nhiem co the them vao nuoc dap : xuyen tam lien, sai ho .
-Khi xuat tiet nhieu : dung tam dieu tan ( hoang ba , nguu tat ,thuong truat) hoac tru thap tan ( dai hoag ,hoang cam, han thuy thach -30g, thanh dai -3g)tron voi Glycerin thanh cao long boi len ton thuong
3.2-Giai doan cuoicua cap tinh
-La giai doan bong vay neu xu ly khong tot de rat de lam cho benh keo daiva chuyen thanh man tinh
-Luc nay nen dung cac thuoc bao ve ton thuong tranh cac kich thich tu ben ngoai thuc daylop sung tai sinh vagiai quyet tinh trang viem con sot lai
-Thuoc nen dung cac bai : Cao thanh luong (Duong quy-30g, tu thao -6g, Daihoang 4-5g , dau thuc vat 480g, sapong -120g)
-Hoac dung cao hoang lien : Hoang lien -20g, vaselin -80g
3.3-Giai doan ban cap
- Nguyen tac dieu tri luc nay la tieu viem tru ngua thu liem , co the dung mo oxit kem, tru thap tan c (Dai hoang - 30g, hoang cam - 30g, han thuy thach - 30g, thanh dai -3g, ) Tam tam dieu tran ( hoang ba- 10g , han thuy thach -5g , thanh dai -1g) Luyen voi dau thuc vat thanh cao , dau tu thao 5% , dau dia du -oxitkem 10%
3.4-Cham man tinh
- Nguyen tac dieu tri la chua ngua , uc che su tang sinh cua bieu bi tieu tru tinh trang viem tham nhiem trong lop chan bi co the dung cao hoang lien (hoang lien -20g, vaselin-80g) hoac cao dau dau den 10-20%
BENH VAY NEN
I-YHHD
1- Nguyen nhan
- Bieu hien chu yeu o benh vay nen la tang nhanh lop thuong bi ( roi loan chuyen hoa lanhtinh cua te bao thuong bi )
-Cho den nay van chua lkhang dinh ro rang nguyen nhan , nhung nta biet chac chan 5 yeu to sau day lam nen co che sinh benh :
+Di truyen : khoang 30% beh nhan co yeu to gia dinh (cha , me anh chi em ruot hoac ho hang truc he )70% cac cap song sinh cung mac
+Nhiem khuan :
+Stress ; lam benh tai phat hoac dot ngot nang len
+Thuoc : chen Beta keodai , lithium dac biet saukhi sudung corticoid
+Hien tuong Kobner
2-Vi tri
-Vay nen o da, vay nen mong : mong day , lo nho , tren ben mat mong
-Vay nen o khop : cac khop bibien dang , benh nhan kho van dong
-Vay nen the mu : tren da co cac mun mu kho va nong
-Vay nen the do da toan than
3-Nhung dieu can tranh
-Tranh cang thang
-=Tranh ky co va boc da
-Tranh chat co tinh bazo cao nhu xa phong , chat tay rua , voi
-Can than khi dung thuoc neumac them cac benh ve timmach
-Tranh nhiem khuan : dac biet la nhiem khuan tai , mui , hong
-TRANH ruou vi ruou lam benh nang len va tuong ki voi thuoc dieu tri
-Nen lac quan voi benh tat
-Tranh gay tray xuoc da o vung nay , se gay nhiem trung , vet thuong tro nen dau don .Can than khi su dung cac loai thuoc boi duong da , can phai xem ky cac loai thuoc boi duong da co anh huong den vung da bi benh hay khong
4-DIEU TRI
4.1- Dieu tri tai cho
-Dung cac loai mo , kem, dung dich , vo imuc dich bong vay , tieu sung nhanh chong vay da nhu : mo Salicyle 5%, 10%, vitamD3 va cac dan hat, han che tiep xuc voi xa phong
4.2 Dieu tri toan than
-Acitretine( Soriatane
-Cyclosporin( Neoral)
-Methotrexate
-Quang tri lieu : UVB pho hep , PUVA
II-YHCT
1-KHAI NIEM: benh vay nen hay "tungbi tien ", "Nguu bi tien "" trong Bi phu benh , nghia la chung ngua , san oda , theo yly yhct la benhman tinh , tai phat lien tuc ,da phan phat sinh o tu chi ,mat ben dui , dau goi , cang chan , mat ngoai tay , chan va vung dau
-Tom thuong chu yeu la nhung san com , dam hoac mang , do hoac ,trang moc nhu sap nen co ngua hoac khong ngua
2- NGUYENNHAN
-Benh thuoc ban tang ,khoi phat do yeu to thuan loi phong ta , nhiet ta ket tu o bi phu ma dan den ta khi uat tu, tre lau ngay sinh ra nhiet ,(bieu hien la not san do ,vay)
-KHi huyet khong luu thong ,nen da khong duoc nuoi duong day du sinh ra san do , vay nhieu hon , ngua lien tuc
3-BIEN CHUG- THE LAM SANG
- Thoi ki dau cua benh chu yeu la so phong thanh nhiet thi thuongphai chon dung cac loai thuoc luong huyet giai doc ,BEnh lau ngay , khi - huyet bat tuc sinh ra phong hoa tao thi phai lay duong huyet tru phong
3.1- The benh phong huyet nhiet
-Mat da noi len san do hoac co the nho nhu dinh ghim ,o the tulai thanh tung dam , mang , be mat da tang sinh nhieu tang trang nhu sap nen ,,ngua nhieu , sau khi bong di de lai lop da do va co diem xuat huyet nho ,
-chat luoi do , reu luoi vang , mach huyen sac
-Phuong thuoc :
+cuc hoa - 12g
+thuongnhi tu - 12g
+kho sam - 12g
+kim ngan hoa -16g
+Xich thuoc - 12g
+Tho phuc linh -20g
+Dan bi - 8g
+Sinh dia - 16g
+Cam thao -8g
3.2- The huyet hu phong tao
- Cac ton thuong thanh da, mang san com , thuong co mau hong do hoac tim nhot , co the co sac hong xam tham ,thoi ky nay , ngua giam
-reu luoi vang mong , chat luoi hong nhot ,mach doi huyen hoac huyen ma te
-Phap dieu tri: duong huyet , nhuan tao , khu phong
-Bai thuoc :
+Duong qui- 12g
+Thu o do - 16g
+Dan bi - 12g
+Sinh dia - 16g
+Thuyen thoai - 8g
+bach tat le - 12g
+Phong phong - 12g
+O tieu xa-16g
-Boi cao mem thach luu bi : bot thach luu bi 1 phan, dau vung 3 phan , luyen thuoc thanh dang ho de boi
4- Cham cuu
- Cham cac huyet o chi tren : khuc tri , noi quan , than mon
-cac huyet chi duoi : huyet hai , phi duong, tam am giao
-Moi ngayy 1 lan, moi lan 3-5 huyet , 15 lan /lieu trinh
-Nhi cham : thuong dung cac diem nhu : thanmon ,phe, noi tiet, giao cam
BENH LY HAU MON TRUC TRANG
I-YHHD
1-KHAI NIEM : TRI la 1 he thong dam roi tinh mach sinh ly binhthuong nam o hau mon truc trang , do 1 nguyen nhan co hoi nao day lam cho he thong tmach sa gian ko hoi phuc, kh ido goi la benh tri
2-Nguyen nhan va yeu to thuan loi
-Tao bon kinh nien
-Hoi chung ly
-Tang ap luc o bung: nhung
Bạn đang đọc truyện trên: Truyen2U.Net