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.