CHN ON V IU TR

LAO PHI

HYK PHM NGC THCH

1
 I CNG
c im vi trng lao:
- Hiu kh tuyt i
- S sinh sn chm
- T l t bin khng thuc cao
- Vi sinh vt ni bo : nh hng n thc
bo n nhn (i thc bo)
- Vi sinh k nc v khng acid

2
 M. tuberculosis (ngi)
Vi khun lao Mycobacterium tuberculosis M. bovis (b)
in hnh complex M. africanum (Chu Phi)
M.ulcerans

Vi khun Nhm sinh sc t ngoi nh M. kansasii, M. marinum, M. simiae,

mycobacteria sng (Photochromogens) M. genavense, M. asiaticum..
khng lao
Nhm sinh sc t trong M. scrofulaceum, M. szulgai, M.
(atypical
bng ti (Scotochromogens) xenopi, M. celatum, M. gordonae, M.
organism,
flavescens..
MOTT) theo
RUNYON vo Nhm khng sinh sc t M. avium-intracellulare complex, M.
cui nhng nm (Nonphotochromogens) paratuberculosis, M. terrae, M.
1950, NTM shimoidae.

Nhm vi khun sinh trng M. fortuitum, M. chelonae, M.

nhanh (Rapid growers) abscessus, M. thermoresistible.

3

nh ngha: Lao nguyn pht l tng hp
cc biu l, lm sng v sinh hc ca mt
c th sau ln tip nhim u tin trc
khun lao.
Dch t hc:
- Lao nguyn pht thng xy ra tr em v
thiu nin. Hin nay ang c xu hng gia
tng ngi ln.
- Ngun ly lao ch yu xut pht trong gia
nh ni trng hc, nh tr, nh t, tri 4

gio dng

Nguyn nhn: do trc khun lao Mycobacterium
Tuberculosis. Ngoi ra c th phn lp c mt
s chng lao khc nh M.bovis, v cc Non TM
Ngun ly:
- Tip xc vi nhng ngi b lao ho khc, c
bit c BK trong m, t l ly lao cao.
- Tr em d b ly lao nhng t khi l ngun ly.
ng ly: ch yu l ng h hp do ht phi
cht tit c cha BK khi khc, ht hi, ni
chuyn. Ngoi ra c th ly qua cc con ng
khc nh tiu ho, da nim 5

Giai on 1 : ( ngy th 1-7 sau nhim)
- Ngy 1: bch cu a nhn trung tnh nut vi
khun lao nhng khng dit c.
- Ngy 2 : i thc bo ph nang tn cng vi sinh
vt qua hin tng thc bo.
- Vi trng c th b git thi im ny lm bnh
ngng tin trin
- Hay vi trng phng thch t i thc bo bt u
giai an 2.
Giai on 2 : ( ngy th 7-21) symbiosis
- i thc bo t mu vo m phi.
- C lao c to thnh.
- Vi khun lao sng st phn chia v pht trin. 6

Giai on 3:
- Pht trin vi trng din tin chm do hat ng min
dch qua trung gian t bo v p ng tng nhy
cm.
- C lao tr thnh sang thng b u chc.
- S phn chia gim trong cht b u do thiu xy :
nhiu c lao tr thnh v trng, calci v x ha, mt
s khc c th cha nhng vi sinh vt sng tim n.
Giai on 4:
- Cht b u ha: iu ny cho php vi sinh vt nhn
va xy bt u phn chia li. p ng min
dch khng hiu qu vi s lng ln vi trng lao.
Hang c to thnh pht tn vi trng lao
7
Cc tin trin sau khi nhim lao c th l:
- Hnh thnh phc hp nguyn thu
- Tn thng v vo khoang mng phi
- Hnh thnh thng tn hang lao
- Ph i hch v cc bin chng ca n
nh chn p, d ph qun.
- Gieo rc BK n cc c quan khc
8

Hi bnh s:
- chng BCG cha ?
- Tm ngun ly lao trong gia nh, ni lm vic, nh tr,
trng hc, tr s nhim lao ngun ly thng t
cha m hoc ngi thn trong gia nh
- Lao nguyn pht thng khng c triu chng lm sng.
Tuy nhin cng c nhng du hiu ca tnh trng nhim
trng.
C th c cc triu chng nhim lao chung:
- Mt mi, chn n, st cn.
- St nh v chiu, thnh thong c st cao
- Kh tp trung t tng, hc hnh km hiu qu
9
- C th c ho khan, khc m, au ngc, kh th
 LM SNG

Cc bnh cnh kh c trng him gp trong lao

nguyn pht
- Lao ban: st cao c th ln 40oC, st ring r vi
li sch. Cy mu thng m tnh.
- Hng ban nt: cc nt hng ban nm su trong
da v lp di da, khu tr mt trong cng chn,
nm st b xng, thng km st au nhc
xng khp, cn chn on phn bit vi
sarcodosis v nhim streptococcus hay mt d
ng thuc.
- Vim kt mc mt phng t gp 10
 LM SNG

Khm thc th:

- Khm ton din: nhm pht hin cc
bnh phi hp nh tiu ng, tim
mch, tiu hohoc pht hin cc
bin chng ca lao nguyn pht.
- Khm phi: phn nhiu triu chng
thc th m tnh, mt s t c th
nghe ran n ri rc hoc ran nghn
ph qun. 11
 CN LM SNG: X QUANG PHI THNG

- Lao nguyn pht tn thng lao c th gp bt

k vng no ca phi nhng thng gp
thu trn khc vi trong lao th pht thng
gp phn thu nh v sau ca thu trn.
- ng c thu phi l mt vng m ng
nht c b r rng, him khi to hang tr
trong suy dinh dng v suy gim min dch.
- Hnh nh k t gp v thng thy tr di 3
tui.
- Trn dch mng phi mc nh n trung
bnh nhng t gp. 12
- Hnh nh ng c thu phi (50%): mt vng m
ng nht c b r rng, him khi to hang tr trong
suy dinh dng v suy gim min dch.
Biu hin l nhng nt m nh (4-10 mm), tng
ng vi mt tiu thu c gii hn khng r, lc

HYK PHM NGC THCH

u ri rc, v sau c th tin trin dnh vo nhau to
ra nhng m m khu tr (10-70 mm).
ng c ph nang c th chim ton b
mt phn thu hoc mt thu phi to hnh nh vim
phi thu (cn phi chn on phn bit vi vim
phi thu do vi trng thng).
Tn thng c th xa sch hon ton sau khi bt
u iu tr khng lao.
13
- Hnh nh k t gp v thng thy tr di 3 tui hoc
ngi suy gim min dch (6%).
Biu hin l nhng ht nh, ng knh khong 2-3 mm,
b r, c cng kch thc, phn b u 2 ph trng hay
u trong mt thu phi (thng l thu trn). Ban u
ht k rt m phi trn n c phim v ng st

HYK PHM NGC THCH

phim mi c c, sau ht k m dn ln. Ban u
ht k ri rc, nu khng iu tr, ht k c th to ln,
dnh vi nhau.
CT : c kh nng pht hin ht k sm hn d
cha thy trn X-quang phi, c biu hin l hng ngn
ht trn nh nh u kim, c cng kch thc, phn b
u.
Khi iu tr, ht k xa sch hon ton khng li di
chng, tc xo nhanh hn cc dng tn thng lao
14
khc.
- Ph i hch cnh kh qun hoc vng rn phi l du hiu
c trng thng gp trong lao nguyn pht, gip phn bit
lao nguyn pht vi th pht (35%). Trong 85% trng
hp b ph i hch 1 bn, 15% cn li b c 2 bn.
Nghi ng c ph i hch rn phi khi trn X-quang thng
thy hnh nh rn phi bt thng (mt bn rn to hn hay

HYK PHM NGC THCH

m hn bn kia, rn mt hnh cong lm bnh thng).
Hch ph i rn phi hoc cnh kh qun thng c b
ngoi r, dng a cung (phn bit vi mch mu: b trn
lng, lin tc; K ph qun trung tm: b khng r, dng chn
cua hay nhiu gai).
Phc hp nguyn thy: gm tn thng nhu m ngoi vi
v ph i hch trung tht cng bn, tn thng kinh in ca
lao nguyn pht.
Khi iu tr, hch trung tht s nh dn cng vi vic xa tn 15
thng nhu m phi v s hi phc tnh trng xp phi nu
c. Mt s trng hp (36%) s li nt vi ha rn phi.
Hnh nh xp thu hoc phn thu phi c th l do bin
chng hch rn phi ph i hay hch v vo ph qun
gy chn p (18%).
Bn phi nhiu gp 2 ln bn tri.

HYK PHM NGC THCH

Tr em: thng gp phn thu trc ca thu trn hoc
phn thu trong ca thu gia. Ngi ln: thng gp
phn thu trc ca thu trn.
Biu hin l mt m m ng nht, gii hn r, co ko
cc cu trc gn k v pha bnh l (v d ko kh qun,
rn phi, rnh lin thu). Trong trng hp c vim phi
tc nghn km theo, th tch ca vng b tn thng c
th gim khng ng k, cc cu trc gn k c th
khng b ko lch.
16
Kh ph thng phi v gin ph qun sau tc
nghn l di chng khng phc hi ca lao
(12%).
Kh ph thng hay tng thng kh kh tr do tc

HYK PHM NGC THCH

nghn c th xy ra trc hin tng xp phi.
Tn thng c th xa sch sau khi iu tr
bng thuc khng lao nhng thng li di
chng gin ph qun, c bit l nhng trng
hp pht hin tr.
Trn dch mng phi mc nh n trung bnh,
thng gp la tui 13-30 tui (24%). 17
 CN LM SNG

18
 CN LM SNG
Tm BK: thng m tnh, nu dng tnh th l ca s
nhim lao.
Tng phn tch t bo mu: thng trong gii hn bnh thng
ngoi tr tc lng mu (VS) v Lymphocytes tng.
Tm s lan to ca BK: tu theo biu hin lm sng ca c
quan tn thng c th lm:
- Soi y mt
- Chc d dch no tu
- Chp X-qung xng khp
- Khm tit niu sinh dc
- Khm hch ngoi vi
Soi ph qun
19
Mt s XN lin quan n vn iu tr lao: ng huyt,
AST/ALT, Bun- Creatinine,
 CHN ON LAO NGUYN PHT











20
 DIN TIN

21
 LAO TH PHT

Lao th pht:
- L giai on hai ca bnh lao, xy ra khi c s mt
cn bng gia kh nng gy bnh ca trc khun lao
v sc khng ca c th.
- a s cc trng hp lao phi ngi ln l do trc
khun lao t tn thng s nhim cn tn ti v ti
trin
Lm sng:
- Hi bnh s
- Ging lao nguyn pht, lao th pht c th khng
triu chng ch pht hin qua chp X quang phi
nh k hay tm sat bnh. 22
 LAO TH PHT
Din tin ca mt lao ti nhim ni sinh:
Mt nt lao nguyn thu di dng tim n cng t
ho mm thun li cho s sinh sn ca vi khun lao.
- B u ho mm v t thot ra ngoi hnh thnh mt
hang.
- Hang thng thng vi bn ngoi bng mt ph qun
dn gip vi khun lao sinh sn nhanh chng v ly lan
ra ngoi.
- Vim xung quanh lao khng c trng chng t c s
hot ng ca lao. C th c nhng sang thng c
trng hay khng c trng ph qun v mch mu
cnh lao.
- Nhng sang thng ny ko di nu bnh lao tn ti v 23
s tr thnh di chng khi lnh bnh lao.
 LAO TH PHT
Cc triu chng lm sng :
- Ho: triu chng thng dng nht l ho. Ho kch thch v
lin tc, ban u c th ho khan khi bnh tin trin v
hin tng b u ha xy ra to hang trong nhu m
phi, bnh nhn c th ho c m.
- Ho ra mu : khi sang thng lao xm ln lm v mch
mu gy ho ra mu, t khi bnh lao gy t vong do ho ra
mu lng nhiu. C 4 mc ho ra mu : nh (ho khc
m vng mu n di 50ml mu trong 24 gi), va
(ho ra mu t 50-200 ml trong 24 gi), nng ( ho ra mu
trn 200 ml trong 24 gi), rt nng hay ho ra mu st
nh ( trn 1000 ml mu trong 24 gi).
- Mt mi : khi pht dn dn cho n sau vi tun bnh
nhn hu nh ch mun ngh ngi khng hat ng.
24
 LAO TH PHT
- St : thng nh, him khi cao trn 40C , khuynh
hng thp vo bui sng v cao vo bui chiu.
- Mt cn : dn dn nhng nu khng iu tr s suy sp
nhanh trong vng vi thng. Bnh nhn c th mt
50% trng lng c th hay hn.
- m hi nhiu : c th tip tc vi thng sau khi bt
u iu tr.
- Kh th : thng giai on nng khi hn 20% nhu m
phi b hy hai. Trong nhng bnh nhn c bnh phi
trc nh bnh phi mn tnh triu chng kh th
c th xut hin sm hn.
- au ngc m h c th do tn thng nm b mt phi. 25
 LAO TH PHT

Khm :
- Du hiu chung : mt cn, xanh xao do thiu mu v
st. Ngn tay di trng c th c khi bnh lu v nng.
- Du chng h hp : lc u c th nghe phi khng c
g bt thng. C th nghe c vi ran n khi ht su.
Ran ph qun hay ting thi ng c th nghe c.
- Cn thit chn an sm trong vng 4 tun nu lu
bnh tin trin nhanh v hy hai nhu m phi nhiu.
- Theo mt nghin cu tn sut cc triu chng thng
gp nh sau : ho (78%), st cn (74%), mt (68%), st
(60%). m hi (55%), ho ra mu (33%).
26
 CN LM SNG
Xt nghim vi trng lao :

- Xt nghim m tm vi trng lao, cn ly 3 mu m

( mu 1 bnh nhn n ln u, mu 2 a l m
cho bnh nhn sng hm sau bnh nhn khc vo v
l 3 bnh nhn khc vo khi n khm ln hai vo
sng hm sau).

- Soi lam : nhy 50-60%, c hiu >98%, thi

gian c kt qu nhanh 1 ngy.
27
 Quy nh ghi kt qu xt nghim AFB nhum ZN
S lng AFB Kt qu Phn loi
0 AFB / 100 vi trng m tnh

1 - 9 AFB / 100 vi Dng tnh Ghi s lng AFB c

trng th

HYK PHM NGC THCH

10 - 99 AFB / 100 vi Dng tnh 1+
trng
Dng tnh 2+
1 -10 AFB /1 vi trng
(soi t nht 50 vi
trng)

Dng tnh 3+
>10 AFB / 1 vi trng
(soi t nht 20 vi
trng)
28
 Quy nh ghi kt qu xt nghim AFB nhum
hunh quang
S lng AFB
quan st bng vt Kt qu Kt qu
knh 20 X

HYK PHM NGC THCH

0 AFB/ 1 dng m tnh m tnh
129 AFB/ 1 dng Dng tnh Ghi s lng AFB
c th
30299 AFB/ 1 dng Dng tnh 1+
10100 AFB/ 1
VT Dng tnh 2+
(soi t nht 10 VT)
>100 AFB/ 1 VT
(soi t nht 4 VT) Dng tnh 3+
29
 So snh ghi kt qu xt nghim AFB 2
phng php nhum
Nhum ZN (phng Nhum hunh quang Nhum hunh quang

Kt qu i 1000 ln) (phng i 200 ln) (phng i 400 ln)

HYK PHM NGC THCH

1 dng = 2cm = 1 dng = 2cm = 20VT 1 dng = 2cm = 40VT
100VT
m tnh 0 AFB / 100 VT 0 AFB/ 20 VT 0 AFB / t nht 40 VT
Ghi s
lng AFB 1 - 9 AFB / 100 VT 129 AFB/ 20 VT 1-19 AFB / 40 VT
c th
20-199 AFB/ 40 VT
1+ 10 - 99 AFB / 100 VT 30299 AFB/ 20 VT (Soi t nht 40 VT)
1 -10 AFB /1 VT 10100 AFB/ 1 VT 5-50 AFB/ 1 VT
2+ (soi t nht 50 VT) (soi t nht 10 VT) (Soi t nht 20 VT)
>10 AFB / 1 VT >100 AFB/ 1 VT >50 AFB/ 1 VT
3+ (soi t nht 20 VT) (soi t nht 4 VT) (Soi t nht 8 VT) 30
 CN LM SNG
Xt nghim vi trng lao (tt) :
- Cy khng sinh : MT c LJ (Lowenstein Jensen)
l tiu chun vng cn 4-8 tun c kt qu hay MT
lng (MGIT: Mycobacterial Growth Indicator Tube)
vi nhy l 81%, c hiu 99,6% cn 2 tun c
kt qu.

- PCR (Polymerase Chain Reaction): dng pht hin

DNA ca vi khun lao. PCR lao c th c thc hin
i vi nhng bnh phm l m, dch ph qun qua 31

ni soi,dch mng phi, dch no ty.

KHUN LC VI KHUN LAO TRN
MI TRNG LJ

32
 CN LM SNG
- Chn an sinh hc phn t khc :
+ Xc nh kiu gien (Genotyping) nh IS6110 RFLP ( Restriction
Fragment Length Polymorphism), VNTR-MIRU (variable-
number tandem-repeat - Mycobacterium Intespersed Repetitive
Units), Spoligotyping.
+ Test Khng sinh nh Mutiplex PCR, Genotype MTBDRplus
(HAIN test) gip chn an sm lao khng thuc v iu tr lao.
- Xpert MTB/RIF : l mt test phn t t ng xc nh lao v
khng RiF. Test c kh nng xc nh 98,2% bnh nhn lao phi
m soi trc tip dng tnh v 72,5% bnh nhn lao phi m
m. c hiu ca test ny l 99,2%. So vi test khng sinh ,
test ny c kh nng pht hin 97,6% bnh nhn lao khng RiF
v 98,1% vi trng nhy cm RiF.
- TST (Tuberculin skin test)
- Interferon- 33
 CN LM SNG
X quang phi thng :
- Cc hnh nh thng gp trong lao : tn thng nt, thm nhim,
bng m, hang, bng m ca u lao, ng m...
- C th gp cc hnh nh khc km theo lao phi nh trn dch
mng phi, trn kh mng phi, vi ha, hch trung tht...

CT scan ngc : Cc sang thng trung tm thy (centri-lobular),

phn nhnh (tree-in-bud), hang v nt ln 5-8mm ng knh
thng gp nht trong lao hat tnh. Cc sang thng x, xon
cu trc mch mu-ph qun, kh ph thng, dn ph qun l
nhng hnh nh thng thy trong lao phi c.

Soi ph qun :
- Trong nhng trng hp chn an kh hay cn chn on phn
bit vi cc bnh khc.
- Soi ph qun qua c th ht dch ph qun hay sinh thit tn
thng gi gii phu bnh. 34
HYK PHM NGC THCH
35
HYK PHM NGC THCH
36
HYK PHM NGC THCH
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HYK PHM NGC THCH
38
HYK PHM NGC THCH
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HYK PHM NGC THCH
40
HYK PHM NGC THCH
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Tn thng ng c to hang

HYK PHM NGC THCH

42
43
44
24/11/2005 45
 46
19/12/2005
01/03/2006
47
48
49
30/03/2006 50
51
HYK PHM NGC THCH
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HYK PHM NGC THCH
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HYK PHM NGC THCH
54
 CN LM SNG
Xt nghim mu:

- Cng thc mu : thng bch cu bnh thng hay

tng nh, thnh phn Lymph tng. Tng vn tc lng
mu, c th > 5 ln bnh thng. C th c thiu mu
vi hng cu, Hct v Hb gim. Nu lao din tin lu
ngy xm ln vo ty c th gim 3 dng mu.

- Cc xt nghim mu: glycemie, creatinin/mu, BUN,

SGOT/SGPT, Bilirubin TP/TT/GT, Ion , tng phn
tch nc tiu, acid uric... 55

- Xt nghim HIV
 CHN ON
Theo kt qu soi m trc tip :
1. Lao phi AFB(+): C t nht 1 mu m hoc dch ph
qun, dch d dy c kt qu soi trc tip AFB(+) ti cc
phng xt nghim c kim chun bi Chng trnh chng
lao Quc gia.
2. Lao phi AFB(-): Khi c t nht 2 mu m AFB(-), ngi
bnh cn c thc hin quy trnh chn on lao phi AFB(-
).
Ngi bnh c chn on lao phi AFB(-) cn tho mn 1 trong 2 iu
kin sau:
- C bng chng vi khun lao trong m, dch ph qun, dch d dy bng
phng php nui cy hoc cc k thut mi nh Xpert MTB/RIF.
- c thy thuc chuyn khoa chn on v ch nh mt phc iu tr
lao y da trn (1) lm sng, (2) bt thng nghi lao trn Xquang
56
phi v (3) thm 1 trong 2 tiu chun sau: HIV(+) hoc khng p ng
vi iu tr khng sinh ph rng.
 CHN ON LAO KHNG THUC
Cc i tng nguy c mc lao khng thuc:
-Ngi bnh lao tht bi iu tr phc II.

-Ngi nghi lao hoc ngi bnh lao mi c tip xc vi ngi bnh lao
khng thuc.
-Ngi bnh lao tht bi iu tr phc I.

HYK PHM NGC THCH

-Ngi bnh lao khng m ha m sau 2 hoc 3 thng iu tr phc I
hoc II.
-Ngi nghi lao ti pht hoc ngi bnh lao ti pht (phc I hoc II).

-Ngi nghi lao iu tr li sau b tr hoc ngi bnh lao iu tr li sau

b tr (phc I hoc II).
-Ngi bnh lao mi pht hin c HIV (+).

-Cc trng hp khc: bao gm ngi nghi lao hoc ngi bnh lao c
tin s dng thuc lao trn 1 thng, ngi nghi lao hoc ngi bnh lao
c tin s iu tr lao y t t nhng khng r kt qu iu tr.
-Ngi bnh lao mi (HIV m tnh hoc khng r). 57
 Lm sng:
- Ngi bnh khi ang iu tr lao nhng cc triu chng st, ho, khc m
khng thuyn gim hoc thuyn gim mt thi gian ri li xut hin tr li
vi cc triu chng tng ln, ngi bnh tip tc st cn.
- Tuy nhin bnh lao khng thuc c th c chn on ngi cha bao gi
mc lao v triu chng lm sng ca lao a khng c th khng khc bit so
vi bnh lao thng thng.

HYK PHM NGC THCH

Cn lm sng:
- Xt nghim AFB, nui cy dng tnh lin tc hoc m tnh mt thi gian ri
dng tnh tr li hoc m tnh, dng tnh xen k ngi ang iu tr lao.
- Xt nghim khng sinh cho kt qu khng vi cc thuc chng lao hng 1,
hng 2.
- Cc k thut sinh hc phn t c th chn on nhanh lao a khng thuc:
Hain test, Xpert MTB/RIF.
- Hnh nh tn thng trn phim Xquang phi khng thay i hoc xut hin
thm tn thng mi trong qu trnh iu tr ng phc c kim sot.
Trng hp lao khng thuc pht hin ngi cha bao gi mc lao, hnh
nh tn thng trn phim Xquang c th khng khc bit so vi bnh lao 58
thng thng
 Chn on xc nh lao khng thuc:
- Cn c vo kt qu khng sinh hoc cc xt
nghim chn on nhanh c WHO chng thc
(Hain test, Xpert MTB/RIF), tiu chun chn
on cho cc th bnh lao khng thuc c xc

HYK PHM NGC THCH

nh nh sau:
- Khng n thuc: Ch khng vi duy nht mt
thuc chng lao hng mt khc Rifampicin.
- Khng nhiu thuc: Khng vi t hai thuc chng
lao hng mt tr ln m khng cng ng thi
khng vi Isoniazid v Rifampicin.
- a khng thuc: Khng ng thi vi t nht hai
thuc chng lao l Isoniazid v Rifampicin. 59
- Tin siu khng: Lao a khng c khng thm vi hoc
bt c thuc no thuc nhm Fluoroquinolone hoc vi t
nht mt trong ba thuc hng hai dng tim (Capreomycin,
Kanamycin, Amikacin) (ch khng ng thi c 2 loi
thm).
Siu khng thuc: Lao a khng c khng thm vi bt c
thuc no thuc nhm Fluoroquinolone v vi t nht mt

HYK PHM NGC THCH

trong ba thuc hng hai dng tim (Capreomycin,
Kanamycin, Amikacin).
- Lao khng Rifampicin: Khng vi Rifampicin, c hoc
khng khng thm vi cc thuc lao khc km theo (c th
l khng n thuc, khng nhiu thuc, a khng thuc
hoc siu khng thuc). Tuy nhin Vit Nam hin nay,
cc chng khng vi Rifampicin th c ti trn 90% c
km theo khng Isoniazid, v vy khi pht hin khng
Rifampicin ngi bnh c coi nh a khng thuc v 60
thu nhn iu tr phc IV.
 PHN LOI THEO TIN S IU TR LAO
- Mi: Ngi bnh cha bao gi dng thuc chng lao hoc
mi dng thuc chng lao di 1 thng.
- Ti pht: Ngi bnh c iu tr lao v c thy
thuc xc nh l khi bnh, hay hon thnh iu tr nay
mc bnh tr li vi kt qu AFB(+).
- Tht bi iu tr: Ngi bnh c AFB(+) t thng iu tr
th 5 tr i, phi chuyn phc iu tr, ngi bnh
AFB(-) sau 2 thng iu tr c AFB(+), ngi bnh lao
ngoi phi xut hin lao phi AFB(+) sau 2 thng iu tr,
ngi bnh trong bt k thi im iu tr no vi thuc
chng lao hng 1 c kt qu xc nh chng vi khun lao
khng a thuc.
- iu tr li sau b tr: Ngi bnh khng dng thuc lin
tc t 2 thng tr ln trong qu trnh iu tr, sau quay 61
tr li iu tr vi kt qu AFB(+).
 PHN LOI THEO TIN S IU TR LAO (TT)
- Khc:
Lao phi AFB(+) khc: L ngi bnh iu tr thuc lao
trc y vi thi gian ko di trn 1 thng nhng khng
xc nh c phc v kt qu iu tr hoc khng r
tin s iu tr, nay chn on l lao phi AFB(+).

HYK PHM NGC THCH

Lao phi AFB (-) v lao ngoi phi khc: L ngi bnh
iu tr thuc lao trc y vi thi gian ko di trn 1
thng nhng khng xc nh c phc v kt qu iu
tr hoc c iu tr theo phc vi nh gi l hon
thnh iu tr, hoc khng r tin s iu tr, nay c
chn on lao phi AFB(-) hoc lao ngoi phi.
- Chuyn n: Ngi bnh c chuyn t n v iu tr khc
n tip tc iu tr (lu : nhng ngi bnh ny khng
thng k trong bo co Tnh hnh thu nhn ngi bnh lao
v Bo co kt qu iu tr lao, nhng phi phn hi kt qu
62
iu tr cui cng cho n v chuyn i)
 PHN LOI THEO TIN S IU TR LAO MI
- Phn loi ngi bnh lao theo tin s iu tr (theo phn loi mi ca
TCYTTG) Lu : Hin nay CTCLQG ang chnh sa biu mu theo phn
loi mi ca WHO, v vy phn loi sau y ch p dng khi c biu mu mi.
-Laomi: ngi bnh cha bao gi dng thuc chng lao hoc mi dng thuc
chng lao di 1 thng.
-Ngi bnh iu tr li: l ngi bnh dng thuc chng lao t 1 thng tr

HYK PHM NGC THCH

ln. Ngi bnh iu tr li bao gm:
-Tipht: ngi bnh c iu tr lao trc y v c xc nh l khi
bnh, hay hon thnh iu tr ln iu tr gn y nht, nay c chn on l
mc lao tr li.
-Tht bi: ngi bnh c iu tr lao trc y v c xc nh tht bi
iu tr ln iu tr gn y nht.
-iu tr li sau b tr: ngi bnh iu tr lao trc y v c xc nh b
tr ln iu tr gn y nht.
-iu tr li khc: cc trng hp tng iu tr lao trc y nhng khng xc
nh c kt qu iu tr.
-Ngi bnh khng r v tin s iu tr: l cc ngi bnh khng r tin s iu 63
tr, khng th xp vo mt trong cc loi trn.
 Phn loi ngi bnh theo tnh trng
nhim HIV
- Ngi bnh lao/HIV(+): Ngi bnh lao c kt
qu xt nghim HIV(+).
- Ngi bnh lao/HIV(-): Ngi bnh lao c kt
qu xt nghim HIV(-), cc ngi bnh lc u kt
qu HIV(-) nhng sau xt nghim li c kt qu
HIV dng tnh cn c phn loi li.
- Ngi bnh lao khng r tnh trng HIV: Ngi
bnh lao khng c kt qu xt nghim HIV, nhng
ngi bnh ny sau khi c kt qu xt nghim HIV
cn c phn loi li.
64
 CHN ON PHN BIT

Chn an phn bit lao phi vi cc bnh sau:

1. Vim phi: cc vi trng to hang (Staphylococcus,
Klebsiella...) , virus, bnh k sinh trng, nang hyatid.
2. Bnh l c tnh
3. Bi phi.
4. Vim mch: bnh l u ht Wegener, bnh l
Rheumatoid nodule, vim phi tc nghn.
5. X ha phi.
6. Nhi mu phi.
7. Vim ph nang d ng ngai sinh.
8. Sarcoidosis
65
BIN CHNG LAO TH PHT
Bin chng sm:

- Lao hu v lao thanh qun

- Vim mng ngai tim

- Ho ra mu

- Bin chng mng phi

- Lao ni ph qun
- Bnh l khp Poncet
- T vong
66
 BIN CHNG LAO TH PHT

Bin chng mun :

1. Tc nghn ng dn kh: X ha t lao ni ph
qun c th gy tc nghn ng dn kh ging bnh
cnh bnh phi tc nghn mn tnh.
2. Tn thng phi nng: X lan ta a n hy hai
nhiu v a n tm ph mn. Suy h hp c th do
bnh gii hn gy nn bi m mng phi lan ta v
bnh l mng phi...
3. Amyloid: y l bin chng him do iu tr lao
sm.
4. Carcinoma phi: T l ung th phi sau lao phi
c bo co trong y vn.
67
 IU TR LAO
Mc tiu ca vic iu tr lao l :
1. Cha lnh bnh nhn v em li cht lng cuc sng cho bnh
nhn.
2. Trnh t vong trong cc trng hp lao tin trin hay cc bin
chng ca lao gy nn.
3. Trnh ti pht lao.
4. Gim ly truyn lao cho nhng ngi khc
5. Ngn chn pht trin v gim ly truyn lao khng thuc.
Nguyn tc cn bn trong iu tr lao :
1. Phi hp thuc : phi phi hp t nht 3 th thuc trnh hin
tng chn lc vi trng khng thuc.
2. ng liu lng: Liu lng thuc cn dit vi trng lao,
liu cao s gy ng c v liu thp s khng c tc dng dn
n khng thuc
3. Thi gian : thi gian ti thu 6 thng trong giai on tn cng
ko di hai hay ba thng.
4. Dng thuc phi lin tc mi ngy nu khng s gy tht bi 68
iu tr.
 CAC LOAI THUOC CHA LAO

Thuc hng 1 Thuc hng 2

Isoniazid Fluoquinolones
Rifampicin Aminoglycosides
Pyrazinamide Ethionamide
Ethambutol P-Amino salicylic acid
(PAS)
Streptomycin Cycloserine

69