TIN TỨC

Viêm phổi

 

Viêm phổi là nguyên nhân hàng đầu dẫn đến tình trạng nhập viện và tử vong ở trẻ nhỏ, người già, người có bệnh nền. Trong bối cảnh làn sóng mới Covid-19 đe doạ, việc bảo vệ lá phổi và hệ hô hấp một lần nữa trở nên cấp thiết hơn bao giờ hết.

Viêm phổi là tình trạng viêm ở nhu mô phổi thường do vi khuẩn, virus, nấm hoặc các tác nhân khác gây ra. Viêm phổi là vấn đề đặc biệt đáng lo ngại đối với người cao tuổi, người có bệnh mạn tính hoặc bị suy giảm miễn dịch, nhưng cũng có thể xảy ra ở người trẻ khỏe. 

Sốt, ho khạc đờm, đau ngực, khó thở là những triệu chứng hay gặp. Triệu chứng có thể khác nhau tùy theo nguyên nhân gây viêm phổi.

Viêm phổi
Viêm phổi

1. Nguyên nhân viêm phổi

 Do vi khuẩn

Vi khuẩn là nguyên nhân gây viêm phổi thường gặp nhất ở trẻ em và người lớn. Viêm phổi do vi khuẩn nếu không nhận biết sớm và điều trị kịp thời sẽ dễ dẫn đến hậu quả khó lường, thậm chí tử vong. Các loại vi khuẩn thường gặp gồm: Streptococcus pneumoniae, Legionella pneumophila, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae,…

Theo thống kê, phế cầu khuẩn (Streptococcus pneumoniae) là “thủ phạm” nguy hiểm và thường gặp nhất gây viêm phổi ở nhóm này. Bệnh gây tử vong từ 10-20% và 50% ở nhóm đối tượng có nguy cơ cao như trẻ nhỏ, người già. 

 Do virus (bao gồm Covid-19)

Hiện nay, virus SARS-CoV-2 là tác nhân nguy hiểm nhất gây viêm phổi xâm lấn, trong đó, virus có thể làm hỏng phế nang và khiến chất lỏng tích tụ trong phổi, có thể dẫn đến sự phát triển của hội chứng suy hô hấp cấp tính (ARDS) – một dạng suy hô hấp nghiêm trọng, khiến người bệnh phải can thiệp điều trị khẩn cấp, chạy ECMO (tim – phổi nhân tạo), thậm chí gây tử vong nhanh chóng.

Trước bối cảnh cao điểm dịch bệnh về đường hô hấp hiện nay, viêm phổi do Covid-19 có xu hướng nặng hơn các dạng viêm phổi khác, gây viêm nhiễm nghiêm trọng hơn, biến chứng nặng nề và kéo dài ở một số người.

 2. Đối tượng dễ mắc bệnh viêm phổi

Nhiều tổ chức về sức khỏe cộng đồng quốc tế gọi bệnh viêm phổi là “dịch bệnh bị lãng quên” vì đang có hàng triệu người chủ quan hoặc lầm tưởng về mức độ nguy hiểm của bệnh. Bất kỳ ai cũng có nguy cơ bị viêm phổi, trong đó trẻ nhỏ, người cao tuổi, phụ nữ mang thai,… là nhóm đối tượng dễ bị tổn thương nên có tỷ lệ lây nhiễm viêm phổi rất cao, biến chứng nặng nề, điều trị kéo dài, với tỷ lệ tử vong cao. BS.CKI Bạch Thị Chính đã đưa ra các nhóm đối tượng có nguy cơ cao, dễ bị đe dọa bởi viêm phổi nhiều nhất:

. Trẻ em

Trẻ dưới 5 tuổi, đặc biệt là đối tượng dưới 2 tháng tuổi với hệ hô hấp và hệ miễn dịch còn non nớt, chưa hoàn thiện nên có nguy cơ mắc và tử vong do viêm phổi cao nhất. Thống kê của WHO, viêm phổi trẻ em gây ra cái chết của gần 800.000 trẻ trên thế giới, trong đó có đến 22% là trẻ từ 1-5 tuổi, đây là con số đáng báo động khi trẻ em hoàn toàn có thể được bảo vệ khỏi bệnh viêm phổi bằng các biện pháp can thiệp đơn giản như chủng ngừa vắc xin, được điều trị bằng thuốc và chăm sóc công nghệ thấp, chi phí thấp.

Viêm phổi ở trẻ em
Viêm phổi ở trẻ em

. Người cao tuổi

Người già, người lớn tuổi hội tụ rất nhiều các yếu tố nguy cơ đặc thù thúc đẩy và làm tăng tỷ lệ mắc bệnh viêm phổi như sức khỏe và hệ thống miễn dịch suy yếu, đồng mắc nhiều bệnh lý mãn tính (COPD, hen suyễn, đái tháo đường, tim mạch,…), chức năng phổi giảm theo tuổi tác, khả năng thích nghi kém và sự tác động của nhiều có yếu tố có hại (nghiện thuốc lá, thuốc lào, bia rượu). Người lớn tuổi mắc viêm phổi nếu không phát hiện sớm, điều trị kịp thời rất dễ gặp biến chứng nặng nề, điển hình là suy hô hấp, thở máy, chạy ECMO và tử vong nhanh chóng.

. Phụ nữ mang thai

Trong thai kỳ, hệ miễn dịch của phụ nữ mang thai suy yếu, chức năng tim – phổi cũng bị suy giảm nên dễ bị virus, vi khuẩn tấn công gây viêm phổi cao hơn người bình thường nhiều lần. Nếu mẹ bầu mắc viêm phổi có thể ảnh hưởng nghiêm trọng đến sức khỏe của bà bầu và thai nhi, làm tăng nguy cơ biến chứng thai kỳ, sinh non, sảy thai.

Phụ nữ mang thai nếu mắc Covid-19, đặc biệt biến chứng viêm phổi thật là điều rất tồi tệ. Gánh nặng bệnh tật cho mẹ bầu lớn hơn gấp cả trăm lần so với người bình thường khi người mẹ phải thở máy, chạy ECMO, dùng kháng sinh liều cao, em bé có nguy cơ sinh non, lây nhiễm bệnh,… thậm chí đe dọa tính mạng.

. Các yếu tố rủi ro khác

  • Bệnh nhân đang ở trong phòng chăm sóc đặc biệt của bệnh viện, đặc biệt nếu đang sử dụng máy thở,…
  • Người mắc bệnh mãn tính như hen suyễn, phổi tắc nghẽn mãn tính (COPD), tim mạch,…
  • Người có hệ miễn dịch suy yếu hoặc bị ức chế như: người bị nhiễm HIV/AIDS, đã được ghép tạng, hoặc người được hóa trị hoặc dùng steroid dài hạn,…
  • Người bị nghiện thuốc lá, thuốc lào, người làm việc, sinh sống ở môi trường bị ô nhiễm, khói bụi,…

Các yếu tố làm tăng nguy cơ mắc bệnh

 Các yếu tố dưới đây có thể là “mồi lửa” thúc đẩy tăng nguy cơ mắc viêm phổi và biến chứng nặng, khó điều trị như:

  • Trẻ em dưới 5 tuổi;
  • Người trên 65 tuổi;
  • Người dễ mắc các bệnh nhiễm trùng đường hô hấp như: cảm lạnh, cảm cúm hoặc viêm thanh quản;
  • Người có tiền sử hoặc đang mắc các bệnh về gan, tim mạch, đái tháo đường, hen suyễn…;
  • Người bị suy giảm miễn dịch như: người có cơ quan nội tạng được cấy ghép, người bị bệnh bạch cầu hoặc HIV/AIDS hoặc đang điều trị ung thư;
  • Người hút thuốc lá, sinh sống ở nơi nhiều khói bụi, khói bếp…
  • Người đang nằm ở bệnh viện, hoặc đang thở máy,…

3. Dấu hiệu thường gặp

 

  • Đau ngực khi thở hoặc ho;
  • Ho, ho khan, ho có đờm;
  • Sốt trên 38 độ, đổ mồ hôi và ớn lạnh;
  • Mệt mỏi, uể oải và chán ăn;
  • Thở nhanh, khó thở khi gắng sức;
  • Buồn nôn, nôn mửa hoặc tiêu chảy;

20200225 144712 685190 viem phoi hit do di.max 1800x1800 1

4. Biểu hiện 

Biểu hiện viêm phổi ít phổ biến có thể xuất phát từ các ca viêm phổi cấp tính phát hiện trễ hoặc không được can thiệp kịp thời sau hơn 2 tuần trở lên. Những biểu hiện gần như tương tự thể cấp tính nhưng kéo dài và gây ra nhiều ảnh hưởng hơn đến sức khỏe và quá trình sinh hoạt hàng ngày như.

  • Ho ra máu;
  • Đau đầu;
  • Đau cơ và đau khớp;
  • Ở người cao tuổi có thể bị lú lẫn hoặc thay đổi ý thức;

Người bình thường mắc viêm phổi có triệu chứng nhẹ có thể điều trị tại nhà và có thể hoàn toàn tự khỏi trong khoảng 2-3 tuần. Đối với phụ nữ mang thai, nếu nghi ngờ mắc viêm phổi cần lập tức đi khám và điều trị ngay theo chỉ định của bác sĩ để tránh ảnh hưởng sức khỏe và tính mạng của mẹ và thai nhi.

Biến chứng 

Viêm phổi là bệnh lý dễ chuyển biến xấu và tiên lượng nặng khi xảy ra các biến chứng. Theo thống kê của Bộ Y tế Việt Nam, khoảng 25% người trên 65 tuổi mắc viêm phổi có nguy cơ tử vong; 30-50% người bệnh phải gánh chịu những biến chứng viêm phổi nặng nề như:

  • Nhiễm trùng huyết;
  • Suy hô hấp nặng;
  • Tràn dịch màng phổi;
  • Áp xe phổi;
  • Viêm màng ngoài tim;
  • Các biến chứng ở các cơ quan khác: Viêm nội tâm mạc, viêm khớp, viêm phúc mạc, viêm màng não, áp xe não,…

Thời tiết thất thường khiến nhiều người lớn, người cao tuổi mắc viêm phổi nặng do phế cầu khuẩn dẫn đến suy hô hấp phải cấp cứu. Đồng thời mùa hè, việc nằm điều hòa quá lạnh có thể làm tăng nguy cơ mắc viêm phổi ở người già.

 Phương pháp điều trị 

Viêm phổi cần được phát hiện sớm, can thiệp điều trị kịp thời để ngăn ngừa nhiễm trùng và chặn đứng các biến chứng. Phương pháp điều trị bệnh viêm phổi cần phù hợp với từng triệu chứng và diễn tiến của bệnh. Với một số trường hợp khi bệnh đã chuyển biến nặng, việc điều trị sẽ hết sức khó khăn. Theo các chuyên gia y tế, những phương pháp điều trị bệnh viêm phổi bao gồm:

Điều trị triệu chứng

Sử dụng các loại thuốc như: thuốc hạ sốt/thuốc giảm đau (Paracetamol), thuốc ho, thuốc long đờm, thuốc giãn phế quản,… nhằm kiểm soát tốt triệu chứng viêm phổi, giảm bớt cảm giác khó chịu cho người bệnh.

Điều trị nguyên nhân

Tùy theo tác nhân gây bệnh cũng như mức độ nghiêm trọng có thể áp dụng các phương pháp điều trị khác nhau:

  • Do vi khuẩn: Dùng các loại thuốc kháng sinh: Aspirin, Ibuprofen (Advil, Motrin IB, những loại khác) và acetaminophen (Tylenol). Nếu tình trạng không cải thiện, bác sĩ có thể đề nghị một loại kháng sinh khác.
  • Do virus: Không có hiệu quả khi dùng kháng sinh để điều trị. Người bệnh cần có chế độ dinh dưỡng và nghỉ ngơi hợp lý, uống nhiều nước nhằm làm loãng đờm và chất nhầy trong cơ thể. Uống thuốc hạ sốt khi bị sốt cao trên 38.5 độ C.
  • Do nhiễm nấm: Có thể điều trị tận gốc bằng cách dùng thuốc chống nấm thích hợp.

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