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PHC HI CHC NNG BNH KHP

PHC HI CHC NNG BNH KHPThS Tn Tht Minh tBM VLTL- PHCN

Mc tiu:Trnh by c cc triu chng chung ca bnh khp. Nu c cc nguyn tc iu tr bnh khp v mc ch ca PHCN trong bnh khp.Trnh by c cc phng php PHCN bnh khp.Rehab Dept, Hue College of Medicine and Pharmacology2

I. i cngBnh khp l nhm bnh l rt thng gp v l mt trong nhng nguyn nhn hng u gy tn ph ngi mc bnh. Hu qu v kinh t, x hi do cc bnh khp gy ra hng nm rt ln.Rehab Dept, Hue College of Medicine and Pharmacology3

Cc nghin cu c lp cho thy, vo mt thi im, c 30-40% dn s c cc du hiu v triu chng ca bnh c xng, nh l au, sng n hoc gii hn vn ng.Hu ht nhng ngi ln trn 70 tui c cc triu chng bnh khp mn tnh hoc ti pht.Nghin cu B o Nha v cc nc khc cho thy 25% bnh nhn n khm BS thc hnh l do cc triu chng c xng, v 40% bn khm BS gia nh c cc vn v c xng.

Bnh khp nh hng n mi la tui. Ph n chim khong 2/3 bnh nhn bnh khp. C trn 100 dng bnh khp khc nhau. C dng do qu trnh bo mn t nhin khp, c dng li xut hin t ngt ri li bin mt, ti pht sau nu khng iu tr. Nhiu dng c biu hin mn tnh v tin trin.

Rehab Dept, Hue College of Medicine and Pharmacology5

Phn loi bnh khpBnh khp huyt thanh dng tnhCc bnh m lin kt: vim a khp dng thp, lupus ban h thng, vim da cCc bnh vim mch: vim ng mch t bo khng l, vim nt a ng mch, bnh u ht Wegener, vim mch qu mnBnh khp huyt thanh m tnhVim dnh t sng, vim khp phn ng, vim khp vy nn, bnh khp vim rut (crohn) Bnh khp do tinh th: gout (monosodium urate), gi gout (CPPD)Bnh khp nhim khunThoi haBnh thp khng nh hng khp


V tr tn thng thoi ha khp

Bn tay (DIP, PIP, 1st CMC)Khp hngKhp giKhp bn t ngn ciCt sng tht lng (L4-L5, L5-S1)Ct sng ct gp: c chn, vai, khuu, khp bn t, c tayRehab Dept, Hue College of Medicine and Pharmacology7

V tr tn thng vim a khp dng thp

Lin t gn (PIP)Bn ngn tay (MCP)C tayKhuuVaiGiC chnMTP (bn ngn chn)



Thoi ha khp Vim a khp dng thp

Vim ct sng dnh khp

Khp cng chu (SI)Vim t sngKhp hngKhp vaiRehab Dept, Hue College of Medicine and Pharmacology10

Bnh gout

Khp bn t ngn chn ciC chnKhp giRehab Dept, Hue College of Medicine and Pharmacology11

Nguyn nhn ca bnh khp hu ht khng r. Ngi ta a ra nhng nguyn nhn hoc yu t gy bnh nh chn thng, t vn ng, bo ph, d tt, tui tc, di truyn, mi trng, nhim trng, mt cn bng men...Chnh v vy nn iu tr bnh khp rt kh khn v nhiu khi khng th cha lnh c. sng chung vi bnh, gim nh bnh, phng nga bin chng, duy tr chc nngRehab Dept, Hue College of Medicine and Pharmacology12

Cc triu chng chung ca bnh khpauYu v teo cRi lon chc nng khpGim chc nngRehab Dept, Hue College of Medicine and Pharmacology13

1. au

L triu chng chnh v thng l nguyn nhn gy gim hoc mt chc nng nhng ngi b vim khp mn.


au au l mt kinh nghim cm gic v cm xc kh chu - nh ngha ca Hip hi Nghin cu au Quc t (IASP).Nh vy, au l mt hin tng kt hp va cm gic (v d nh v tr, cng , tnh cht)cm xc (v d nh trm cm, lo lng), nhn thc (v d nh cc suy ngh v nguyn nhn v ngha ca au). Rehab Dept, Hue College of Medicine and Pharmacology15

au Rehab Dept, Hue College of Medicine and Pharmacology16

Mi trng x hiHnh vi bnh ttStress Tm lCc thi V nim tinau

Lng gi auThang im Li (Verbal Rating Scale: VRS), Khng au au nh au va au nhiu au khng chu ni Thang im Nhn (Visual Analog Scale: VAS), Khng au au khng chu ni

Thang im Hnh


Khng Hi au au nhiu au nhiu au rt au nhiu au hn mt t hn t na nhiu ht mc

2.Yu v teo cThng xy ra do nguyn nhn khng dng n (v au hoc bt ng). yu au- o chu vi - nh gi c lc

nh hng chc nng vn ng


3.Ri lon chc nng khpHn ch tm hot ng ca khp, c ng khp kh khn v/hoc Lng lo khp (khp khng vng). Hu qu cui cng l bin dng, cng v trt khp.Rehab Dept, Hue College of Medicine and Pharmacology19

Rehab Dept, Hue College of Medicine and Pharmacology20Hnh 1. Bin dng khp do bnh vim a khp dng thp.



Bin dng bn tay in hnh ca thoi ha khp nngBin dng gi vo trong in hnh ca thoi ha khp

4. Gim chc nngHot ng sinh hot hng ngy (ADL)Gia nhCng vic, Quan h x hi, Tnh dc, Tm l. Lng gi chc nng


II. Nguyn tc iu tr bnh khpiu tr bnh khp cng sm cng tt.Thit lp mt k hoch iu tr ring theo c nhniu tr bnh khp cn phi ton din c thc hin bng mt i (ton) iu tr kt hp nhiu chuyn khoa.Rehab Dept, Hue College of Medicine and Pharmacology24

Ton din: gio dc bnh nhn, chm sc v tm l, iu tr bng thuc ton thn v ti ch (y hc hin i v y hc c truyn), phc hi chc nng, v phu thut trong nhng trng hp cn thit.


Tn thng d dy bnh nhn dng thuc KVKS

III. PHCN bnh khpMc ch PHCNCc phng php PHCNRehab Dept, Hue College of Medicine and Pharmacology27

1. Mc ch PHCN trong bnh khpGim au.Bo v cc khp khi b tn thng thm hay bin dng.Duy tr v phc hi tm vn ng cc khp.Duy tr sc mnh v sc bn cc c quanh khp.Ci thin chc nng, sc khe v sc bn (s do dai) ca ngi bnh. Nng cao cht lng cuc sng ca BNRehab Dept, Hue College of Medicine and Pharmacology28

2. Cc phng php phc hi:Gi t th tt (ng)Cc phng php iu tr vt lTp luyn (vn ng tr liu)Bo v khpPH v mt tm l


Gi t th tt (ng)Rt quan trng i vi mi dng bnh khp.Khi nm: Nn nm ging cng, nm mng, gi thp gi t th thng c, thng lng. Khng dng gi chm di hai giKhi ngi: Ngi trn gh cao va tm, mt gh cng c lng ta thng, 2 bn chn t st mt nn, vai v hng ta ra sau thnh gh, gi u c v lng thng. Trnh ngi gh thp, ngi xm.Khi i: Dng i nh nhng v 2 tay u a thoi mi bn thn mnh. Gi thn mnh thng khi i. Khng i vi khp hng v khp gi gp.


T th ng khi ng


Cc phng php iu tr vt l:c s dng ch yu vi mc ch lm gim au cp hoc mn tnh.Lnh tr liu: Chm hoc xoa bp bng ccNhit tr liu: chm nng, p sp, tm nc nng, dng n hng ngoi, laser nhit, sng ngn, siu m...in tr liu: Cc k thut in phn (in dn thuc) hoc in kch thch Thy tr liu: vn ng hoc ngm mnh trong nc, c bit l nc khong nng, bn khong.Rehab Dept, Hue College of Medicine and Pharmacology32

Bo v khpBo v khp l hn ch ti a s sang chn ln cc khp b tn thng bng cch Trnh cc t th gy bin dng khp. Thc hin cc ng tc ng t th, ng cch. Trnh cc hot ng gy tn thng khp do p ln mt khp Tit kim nng lng tiu hao khi thc hin cc hot ng v ngh ngi hp l.S dng cc loi dng c chnh hnh, dng c tr gip thch hpRehab Dept, Hue College of Medicine and Pharmacology33

Bo v khpThc hin ng cc hot ng hng ngy:Thc hin cc ng tc ng t th, ng cch. Nn khi u vn ng mt cch t t, trnh nhng ng tc git cc. Trnh cc t th gy bin dng, tn thng khp. V d gp gi vi ngi au khp gi, nm tay qu cht vi ngi au khp ngn tay, gp cng c tay vi ngi au c tay...iu chnh mc vn ng theo cn au. Trnh hot ng qu mc khi khp b chn thng hay vim trm trng.


Bo v khpNgh ngi hp l tit kim nng lngNgh ngi bao gm ngh ngi cc b (khp vim) v ngh ngi ton thn. Hng dn ngi bnh bit cch gi cn bng gia hot ng v ngh ngi trnh qu mt mi hoc au. Nguyn tc l ngh ngi trc khi qu mt. ng gng hoc lm qu nhng lc khng c khe.


Bo v khpS ng cc loi dng c chnh hnh, dng c tr gip:Vi chi trn: Np ngn tay, Mng c tay Thay i cc vt dng thng s dng hoc s dng nhng dng c tr gip hot ng d dng hn. V d nh s dng tha mung c tay cm to, dng dao ch L...Rehab Dept, Hue College of Medicine and Pharmacology36

Bo v khp


Np bt ng c tay v gi bn tayngh ngi ban mNp c tay chc nng

Bo v khp

Rehab Dept, Hue College of Medicine and Pharmacology38Mt loi np iu chnh bin dng ngn tay bnh nhn vim khp


Bo v khpVi chi di: Dng c chnh hnh (np, giy chnh hnh...) bo v khp khi i li. Gy chng, nng khi i li (gy gim ti chi di khong 25% nn khng hiu qu lm so vi nng) Giy dp phi va chn, khng b p cc ngn chn. i khi ngi bnh cn ming lt c bit vo bn trong giy dp.Rehab Dept, Hue College of Medicine and Pharmacology40

Bo v khp


Chnh vo c chn (phi) bng ming m nng cung gan chn

Bo v khp


Bo v khpVi thn mnh: np c, ai tht lng


Gim ti ln khp tn thng Gim ti ln khp (mang vc nng). Gim cn cng l mt cch bo v khp hu hiu, gip lm gim lc ti qu mc v sang chn ln khp vim (gim 1-kg s gim ti t 3- n 4-kg khp hng). C th gim cn bng ch dinh dng tt v tp th dc thch hp.


Tp luynMc ch ca cc bi tp:Duy tr v ci thin tm vn ng (hot ng) ca cc khp.Lm mnh cc c quanh khp vim gip chng nng , bo v khp tt hn.Tng cng sc chu ng ca khp v ca c th ngi bnh.Ci thin cc hot ng chc nng ca ngi bnh. Gim mt mi, nng cao th trng, gim cn, gip ngi bnh ng ngon hn v cm thy khe hn.Rehab Dept, Hue College of Medicine and Pharmacology45

Tp luynNguyn tc thc hin cc bi tp: Cc bi tp c s dng ng vi giai on ca bnh.Cc bi tp phi tng tin t tm vn ng c lc chc nngTrnh gy tn hi thm cho cc khp b tn thng.


Tp luynPhng php tp: trnh gim tm vn ng khp v cc co rt, bin dng khp: tp cc ng tc theo tm vn ng khp hng ngy, mi khp t nht 4-5 ln, ngy 2 ln. duy tr v tng cng c lc quanh khp, gip bo v khp v lm khp mnh hn: cn tp cc bi tp c lc, tt nht l tp gng c tnh. tng sc bn ca h tim mch v sc chu ng ton thn, chng mt mi: cn tp cc bi tp cc c ln nh tp i b, bi li, p xe. Trnh cc bi tp mnh nh chy, nhy...C th p dng ch li ca nc trong tp luyn (tp di nc)



Tp luyn di ncTp m ngn tay

Tp vn ng vai

Video tp bn tay/vim khp dng thp

Trnh t bc thang ca chng trnh tp luyn

Rehab Dept, Hue College of Medicine and Pharmacology50Vui chi, hot ngBi tp TV v mm do/ko dnBi tp gng c tnhBi tp ngBi tp aerobic

Tp luynBa giai an ca mt bui tp:

Lm nng Tp luynLm ngui Warm-up Exercise Cool-down


Nhng hng dn chung cho ngi bnh khi t tp luynCc bi tp phi c ch nh ph hp vi tnh trng bnh, sau khi c thm khm v lng gi cn thn.Bi tp phi c hng dn c th v chnh xc. Thc hin cc bi tp u n nh l mt phn ca cng vic hng ngy.La chn thi gian tp luyn thch hp, khng nn tp ngay sau khi n.Trang b tp luyn ph hp.

Nhng hng dn chung cho ngi bnh khi t tp luynTrc khi tp: C th dng mt s thuc gim au theo n ca bc s iu tr hoc dng nhit (nc nng, ti nng, n hng ngoi....) lm tng tnh gin ca cc m mm quanh khp, tng th gin v gim au.

Nhng hng dn chung cho ngi bnh khi t tp luynTrong khi tp: Th u, khng c nn th khi tp.i vi nhng khp b au hoc b yu cn s tr gip thc hin ng tc tp: s tr gip phi nh nhng, trnh dng sc gng p, nht l i vi ngi bnh c tui hoc nhng ngi bnh nm mt thi gian qu lu trn ging.Cc bi tp phi c thc hin nh nhng. Tp phi xen ln vi ngh ngi trnh lm mt ngi bnh. Nn tp hai ln mi ngy. Mi ln 15-30 pht. Lc u mi ng tc c lp i lp li 2-3 ln, sau tng dn ti 5-6 ln.

Nhng hng dn chung cho ngi bnh khi t tp luynSau khi tp: Th gin, th u, c th tm nc nng hoc tm hi.Theo di cn au theo ch dn ca ngi iu tr. Sau tp luyn, cn au sau tp khng c ko di qu mt gi. Nu au ko di trn mt gi l tp qu mc.Cn thay i chng trnh tp luyn khi thy cc triu chng ca bnh nng thm, v phi bo co cho bc s iu tr bit c hng x l.

S dng cc hot ng sinh hot hng ngy duy tr v tng cngtm vn ng khpRehab Dept, Hue College of Medicine and Pharmacology56


Tp luyn theo nhm

Cc phng php cn y hcChm cuThuc bcThuc nam, l cyYoga, kh cng, thi cc quyn Xoa bp, s, th ginAyurveda (n )Ko nn,ng phn tr liuThi min, thin, tng tng, cu nguynThc dng, nhn neo vng, ong, rn, mo, gu, hRehab Dept, Hue College of Medicine and Pharmacology58

kt thc: Mc ch cui cng vi bnh khp9 Ds: death, distress, disease, disability, dysfunction, debt, dissatisfaction, disharmony, disposition . Disease: Phng nga tn thng thm (bao hot dch)Distress: triu chng (kim sot au,cng khp)Disability: ci thin sinh hot hng ngy (ADL).Dysfunction: ci thin chc nng tm l-x hi, bao gm c vic lm.Disharmony: nng cao hiu bit v nng t gia nh.Debt: tr li lm vic.Dissatisfaction: t vn v cc cm gic, mong i.Rehab Dept, Hue College of Medicine and Pharmacology59

Kt lunPHCN bnh khp l mt qu trnh lu di, lin tc v phi bt u sm song song vi qu trnh iu tr nhm phc hi, duy tr chc nng ngi bnh mc tt nht c th c.Rehab Dept, Hue College of Medicine and Pharmacology60