Bnh n VIM CU THN MN

NG Y IU TR BNH VIM CU THN MN

BNH N MU
I.PHN CHUNG
H v tn bnh nhn: Nguyn Th L. Tui: 36 Gii: N
Ngh nghip: Nng dn
i ch: Khu 8 H Lng ng Hi Hi An Hi Phng
H tn, i ch ngi nh khi cn bo tin: L H H(/c trn)
in thoi: 01263305164
Vo vin: 14/6/2010
Chn on:
-YHCT: Lm chng
-YHH: Vim cu thn mn. TD Hi chng thn h
II.PHN BNH N
A. YHH.
1. L do vo vin: Ph, mt mi, n ng km
2. Qa trnh bnh l:
Khong thng 1/2010 BN b ZONA , vim da nhiu m ri rc, iu tr Vim da Zona
khng kp thi, ngay sau xut hin ph to ton thn, i tBN c chn on Vim
cu thn v iu tr ti PK t bng Corticoid, Li tiu, truyn m liu cao...Kt qu sau
3 thng iu tr, BN tng i, n nhp vin YHCT. iu tr ta BV t 17/5/2010 n
9/6/2010. Khi vo vin BN n ng km, ph nh ton thn, ph nng cng bn chn 2
bn, tng huyt p (160/100 mmHg); bng chng cng; nc tiu 24h khong 500ml.
XN: HC: 3,7 M/uL, BC:6,2K/uL, Hb:7,2 g/l; Ptp: 42 mmol/l;GOP,GOT u tng trn 80
UL. Nc ti: P 5g/l, c HC,BC.
BN c iu tr kt hp YHH v YHCT: L tiu 2 nhm c kim sot cht ch in
gii , truyn b sung in gii, truyn m c hiu thn, phc hi chc nng Gan
Cu t iu tr dng 1 li trnh Corticoid. ng Y dng 2 bi; lc u thanh nhit, tiu
tch, kh ho BQ b kh, kin t (i php lp phng). Cu t iu tr dng bi Lc v
gia v.Kt qu, sau t iu tr ny, BN n ng tt, ph cn khng ng k, ht y
chng, nc tiu 24h c 1,5l; men gan tr li bnh thng, cc thng s sinh ho u
c ci thin. Tuy nhin vn cn tng huyt p v i Protein.
BN nhp vin li ngy 14/6/2010 vi cc triu chng: Ph nh, n lm 2 mu chn, au
u, h hp,chng mt, ming kht, hng kh, nc tiu t, gt, .
3. Tin s:
-Bn thn: ZONA, Vim cu thn cp
-Gia nh: Bnh thng
4. Khm bnh
- Ton thn: da xanh xm, nim mc km hng, v gng mt gi nc (Cushing); hch
ngoi bin, tuyn gip khng to.
Mch: 100l/pht;Huyt p: 140/90mmHg;Nhit : 36,8oC; Nhp th: 23l/pht

-B phn:
+Tun hon: Nhp tim nhanh u, TS 100ln/pht; T1 T2 bnh thng, khng c ting
bnh l
+H hp: Lng ngc cn i, di ng u, Nhp th hi nhanh; TS 23l/1
+Tit niu: H tht lng 2 bn bt, Chm thn(-), bp bnh thn(-), cc im niu qun
trn, gi khng au, khng c cu BQ.
+Tiu ho: Bng chng hi, khng tun hon bng h, khng c trng, khng im
au, khng du hiu ngoi khoa.
4. Cn lm sng.
+ Huyt hc: HC 3,23 M/uL; BC 3,6K/uL; N55,5%; L34,8%
+Sinh ho: G 4,42mmol/l; Ure 6,68mmol/l; Creatinin 89,7mmol/l; P 49,3 Al 19,5
GOT 32,5 UL; GPT41,6 UL.TRI3,5MMOL/L;CHO 7,1mmol/l LDL 3,5mmol/l; HDL
1,1mmol/l
in gii: Na+139,1; K+2,92 Ca++1,9 Cl-110,1
+Nc ti: Protein 5g/l; HC 300/l; BC 75/l
Cn Adis 3gi: 150ml, 883HC/pht; BC 2088BC/pht.
+T: Nhp xoang TS 96l/ph; trc trung gian.
+Chp XQ tim phi: m 2 rn phi, hnh tim bt.
+Siu m: Gan Mt Tu bt.
SA mu thn: Thn 2 bn nhu m c nhng vng gim m khng ng nht. Ranh gi
nhu m v xoang thn khng r do c tn thng gim m vng thp Malpighi.
BQ: Dung tch bnh thng, thnh mng, nc ti trong, khng c si
TC-PP: khng kho st c do cc quai rut che khut.
C dch t do trong bng mc va, hnh nh quai rut ni.
5. Tm tt v chn on:
BN c tin s vim da ZONA, bin chng vim cu thn cp, iu tr nhiu thng,
bnh tng gim tng t. Ln ny v/v c cc triu chng cu vim cu thn mn v bin
chng tng huyt p.Cc XN cn lm sng ph hp vi lm sng.
Chn on: Vim cu thn mn/ TD HC thn h
Chn on phn bit: HC Thn h
A. YHCT
1.T chn:
1.1.Vng:Thn tnh, da xanh, kh, ngi gy; li ph bu cht , ru vng mng
1.2.Vn chn: Ting ni nh, yu; hi th nhanh, ngn, yu; khng ho
1.3.Vn chn:Ngi bt rt, hi hp, nh trng ngc, thch mt; au u di chuyn, au
khng lin tc;hoa mt chng mt, tai hng kh, c vai lng mi, m, bng nng, y
chng, m ch, chn tay bun phin. n mt, ung mt, ung nhu nc. i tin phn
lng. i khi kh ng. Khng hnh kinh.
Nguyn nhn: Ni nhn, Ngoi nhn, Bt ni ngoi nhn.
1.4.Thit chn: Da kh, nng, rm rp m hi, c nhc mm nho.Bng chng hi, c
trng khng r rng.
Mch: Hai bn u huyn sc.
2.Tm tt t chn v bin chng lun tr:

Lc u phong t xm nhp, Ph kh khng tuyn thng, thp nhit tch t ti h tiu gy

tr nga cng nng kh ho cu BQ, bnh lu ngy thp nhit lm tn thng chnh kh
gy ra t h h hm ko di lm thn m h tn, ho bc. Lm sng thuc chng h cu
huyt lm.
3.Chn on:
3.1. Bnh danh: Lm chng (Chng h cu huyt lm).Th bnh: m h dng xung
3.2.Chn on bt cng: L h nhit
3.3.Chn on tng ph, kinh lc: T Ph Thn
3.4.Nguyn nhn: N nhn, Ngoi nhn, Bt ni ngoi nhn.
C. iu tr
1.Kt hp YHH v YHCT:
1.1. Php iu tr: T m, thanh nhit, hot huyt, ho , l thu.
1.2.Phng thuc: Lc v gia v
Thc i: 20g
Hoi sn: 15g
an b: 10g
Sn th:10g
Bch linh: 15g
Trch t: 15g
Hong k 20g
an sm: 15g
Hng hoa:10g
o nhn:10g
ch mu: 10g.
1.3. Kt hp YHH:
L tiu, b sung dinh dng (Truyn m c hi thn).
2.Ch n: n nht, tng m (t nht 300gam tht/ngy)
3.Ch chm sc: Cp III
4.Tin lng: Rt kh khn. Bnh din bin mn tnh, ko di, thuyn gim v ti pht
bin ho bt nh. Nu khng p ng iu tr s dn ti suy thn.
III. S kt: Qua cc t iu tr kt hp YHH v YHCT, trn BN thy c ci thin kh
v lm sng: n ng tt ln, mt mi, tnh trng chung c ci thin, lng nc tiu
24 gi m bo trn di 1,5l; huyt p duy tr mc 120 n 130 /80-90 mmHg; thuc li
tiu ty y dng t hn khi cha iu tr ng Y. Bi thuc YHCT nu trn l bi c
phng thng dng, dung np tt hiu qu v d s dng.