{"id":1066,"date":"2023-04-08T12:55:19","date_gmt":"2023-04-08T05:55:19","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=1066"},"modified":"2023-04-17T16:55:25","modified_gmt":"2023-04-17T09:55:25","slug":"viem-phoi-cong-dong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/08\/viem-phoi-cong-dong\/","title":{"rendered":"Vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng: G\u00eda tr\u1ecb c\u1ee7a c\u00e1c thang \u0111i\u1ec3m"},"content":{"rendered":"<p>Vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd ph\u1ed5 bi\u1ebfn \u1edf m\u1ecdi \u0111\u1ed9 tu\u1ed5i v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng. \u0110\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh v\u00e0 \u0111\u01b0a ra ph\u01b0\u01a1ng \u00e1n \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p, c\u00e1c thang \u0111i\u1ec3m nh\u01b0 CURB-65, PSI, SMART &#8211; COP hay IDSA\/ATS \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. S\u1eed d\u1ee5ng c\u00e1c thang \u0111i\u1ec3m n\u00e0y c\u00f3 th\u1ec3 gi\u00fap \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n m\u1ed9t c\u00e1ch ch\u00ednh x\u00e1c v\u00e0 k\u1ecbp th\u1eddi.<\/p>\n<h2><strong>1. Thang \u0111i\u1ec3m CURB-65 trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/strong><\/h2>\n<p>CURB-65 l\u00e0 m\u1ed9t thang \u0111i\u1ec3m d\u00f9ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng \u0111\u01b0\u1ee3c x\u00e2y d\u1ef1ng b\u1edfi H\u1ed9i l\u1ed3ng ng\u1ef1c Anh Qu\u1ed1c (BTS) v\u00e0o n\u0103m 2002 . M\u1ed7i y\u1ebfu t\u1ed1 \u0111\u01b0\u1ee3c \u0111\u00e1nh \u0111i\u1ec3m t\u1eeb 0 \u0111\u1ebfn 2, v\u00e0 \u0111i\u1ec3m t\u1ed5ng c\u1ed9ng t\u1eeb 0 \u0111\u1ebfn 10. \u0110i\u1ec3m s\u1ed1 c\u00e0ng cao, b\u1ec7nh nh\u00e2n c\u00e0ng n\u1eb7ng.<\/p>\n<ul>\n<li><strong>Confusion<\/strong> <strong>(Tri gi\u00e1c)<\/strong>: B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c xem\u00a0 nh\u01b0 l\u00e0 thay \u0111\u1ed5i \u00fd th\u1ee9c khi \u0111i\u1ec3m ki\u1ec3m tra sa s\u00fat tr\u00ed tu\u1ec7 Abbreviated Mental Test Score\u00a0 \u2264 8. Tr\u00ean th\u1ef1c t\u1ebf, t\u00ecnh tr\u1ea1ng thay \u0111\u1ed5i \u00fd th\u1ee9c \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 khi th\u0103m kh\u00e1m tr\u1ef1c ti\u1ebfp b\u1ec7nh nh\u00e2n, th\u01b0\u1eddng kh\u00f4ng c\u1ea7n d\u00f9ng thang \u0111i\u1ec3m AMTS.<\/li>\n<li><strong>Urea<\/strong>: BUN &gt; 20 mg\/dL (7 mmol\/L).<\/li>\n<li><strong>Respiratory (Nh\u1ecbp th\u1edf)<\/strong>: Nh\u1ecbp th\u1edf \u2265 30 l\u1ea7n\/ph\u00fat.<\/li>\n<li><strong>Blood pressure (Huy\u1ebft \u00e1p)<\/strong>: Huy\u1ebft \u00e1p t\u00e2m thu &lt; 90 mmHg ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng \u2264 60 mmHg.<\/li>\n<li><strong>Age<\/strong> <strong>(Tu\u1ed5i)<\/strong>: Tu\u1ed5i \u2265 65.<\/li>\n<\/ul>\n<p>Khi CURB-65 0-1 \u0111i\u1ec3m: c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa.<\/p>\n<p>Khi CURB-65 \u2265 2: \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa.<\/p>\n<p>Khi CURB-65 t\u1eeb 3-5 \u0111i\u1ec3m: c\u1ea7n nh\u1eadp vi\u1ec7n v\u00e0 c\u00e2n nh\u1eafc vi\u1ec7c \u0111i\u1ec1u tr\u1ecb t\u1ea1i khoa ICU.<\/p>\n<p>Ngo\u00e0i ra, thang \u0111i\u1ec3m CURB-65 c\u00f2n c\u00f3 \u00fd ngh\u0129a trong ti\u00ean l\u01b0\u1ee3ng t\u1eed vong trong 30 ng\u00e0y tr\u00ean b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng m\u1eafc ph\u1ea3i.<\/p>\n<ul>\n<li>0 \u0111i\u1ec3m: Ti\u00ean l\u01b0\u1ee3ng t\u1eed vong\u00a0 l\u00e0 0.7%<\/li>\n<li>1 \u0111i\u1ec3m: Ti\u00ean l\u01b0\u1ee3ng t\u1eed vong l\u00e0 2.1%<\/li>\n<li>2 \u0111i\u1ec3m: Ti\u00ean l\u01b0\u1ee3ng t\u1eed vong l\u00e0 9.2%<\/li>\n<li>3 \u0111i\u1ec3m: Ti\u00ean l\u01b0\u1ee3ng t\u1eed vong l\u00e0 14.5%<\/li>\n<li>4 \u0111i\u1ec3m: Ti\u00ean l\u01b0\u1ee3ng t\u1eed vong l\u00e0 40%<\/li>\n<li>5 \u0111i\u1ec3m: Ti\u00ean l\u01b0\u1ee3ng t\u1eed vong l\u00e0 57%<\/li>\n<\/ul>\n<p>Thang \u0111i\u1ec3m CURB-65 th\u00ec d\u1ec5 s\u1eed d\u1ee5ng nh\u01b0ng kh\u00f4ng \u0111\u00e1nh gi\u00e1 b\u1ec7nh \u0111i k\u00e8m; kh\u00f4ng \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng oxy m\u00f4; HA t\u00e2m tr\u01b0\u01a1ng &lt; 60mmHg v\u00e0 Urea m\u00e1u &gt; 7mmol\/l th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi gi\u00e0; th\u00f4ng tin t\u0129nh, kh\u00f4ng ti\u00ean l\u01b0\u1ee3ng khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb; c\u00f3 h\u1ea1n ch\u1ebf khi h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh theo kinh nghi\u1ec7m.<\/p>\n<p>Lim WS v\u00e0 c\u1ed9ng s\u1ef1, \u0111\u00e3 \u0111\u01a1n gi\u1ea3n b\u1eb1ng c\u00e1ch ch\u1ec9 s\u1eed d\u1ee5ng CRB-65 c\u0169ng cho th\u1ea5y hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng CURB-65, CRB-65 th\u01b0\u1eddng r\u1ea5t h\u1eefu \u00edch \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa.<\/p>\n<h2>2. <strong>Thang \u0111i\u1ec3m PSI (Pneumonia Severity Index) trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/strong><\/h2>\n<p>Thang \u0111i\u1ec3m PSI (c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 thang \u0111i\u1ec3m PORT hay thang \u0111i\u1ec3m FINE) l\u00e0 h\u1ec7 th\u1ed1ng t\u00ednh \u0111i\u1ec3m \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh t\u1eeb nghi\u00ean c\u1ee9u c\u1ee7a Fine v\u00e0 c\u1ed9ng s\u1ef1 ph\u00e2n t\u00edch h\u1ed3i c\u1ee9u tr\u00ean 14.199 b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng n\u0103m 1989 v\u00e0 sau \u0111\u00f3 \u0111\u01b0\u1ee3c ki\u1ec3m \u0111\u1ecbnh tr\u1edf l\u1ea1i tr\u00ean 38.039 b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng v\u00e0o n\u0103m 1991. Thang \u0111i\u1ec3m n\u00e0y d\u1ef1a tr\u00ean 20 y\u1ebfu t\u1ed1 kh\u00e1c nhau, bao g\u1ed3m tu\u1ed5i, b\u1ec7nh l\u00fd n\u1ec1n, c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 k\u1ebft qu\u1ea3 c\u00e1c x\u00e9t nghi\u1ec7m.<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone size-full wp-image-1077\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/8.jpg\" alt=\"\" width=\"1500\" height=\"1041\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/8.jpg 1500w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/8-300x208.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/8-1024x711.jpg 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/8-768x533.jpg 768w\" sizes=\"(max-width: 1500px) 100vw, 1500px\" \/><\/p>\n<p style=\"text-align: left;\">Thang \u0111i\u1ec3m PSI th\u00ec c\u1ea7n nhi\u1ec1u bi\u1ebfn s\u1ed1, nh\u1ea5t l\u00e0 kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch; b\u1ecf s\u00f3t vi\u00eam ph\u1ed5i n\u1eb7ng\/ b\u1ec7nh nh\u00e2n tr\u1ebb v\u00e0 kh\u00f4ng c\u00f3 b\u1ec7nh \u0111i k\u00e8m; gi\u1ea3m oxy m\u00e1u l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 t\u1eed vong quan tr\u1ecdng, nh\u01b0ng ch\u1ec9 cho +10;\u00a0 th\u00f4ng tin t\u0129nh, kh\u00f4ng ti\u00ean l\u01b0\u1ee3ng khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb; kh\u00f4ng ti\u00ean l\u01b0\u1ee3ng t\u1eed vong cho t\u1eebng c\u00e1 th\u1ec3 nh\u01b0ng cho nhi\u1ec1u b\u1ec7nh nh\u00e2 n trong c\u00f9ng nh\u00f3m nguy c\u01a1. Ngo\u00e0i ra, thang \u0111i\u1ec3m PSI c\u0169ng kh\u00f4ng ph\u1ea3n \u00e1nh t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n sau khi \u0111i\u1ec1u tr\u1ecb, do \u0111\u00f3, c\u1ea7n k\u1ebft h\u1ee3p v\u1edbi c\u00e1c th\u00f4ng tin kh\u00e1c \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n<h2>3. <strong>Thang \u0111i\u1ec3m SMART-COP trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/strong><\/h2>\n<p>SMART-COP l\u00e0 c\u00f4ng c\u1ee5 \u0111\u01a1n gi\u1ea3n, d\u1ec5 th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng \u0111\u1ec3 ti\u00ean \u0111o\u00e1n ch\u00ednh x\u00e1c nhu c\u1ea7u c\u1ea7n h\u1ed3i s\u1ee9c\/ s\u1eed d\u1ee5ng v\u1eadn m\u1ea1ch, \u00a0v\u00e0 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 n\u1eb7ng vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng. Tuy nhi\u00ean SMART-COP c\u0169ng c\u00f3 m\u1ed9t s\u1ed1 gi\u1edbi h\u1ea1n. C\u00f3 nhi\u1ec1u gi\u00e1 tr\u1ecb ng\u01b0\u1ee1ng cho nhi\u1ec1u nh\u00f3m tu\u1ed5i kh\u00e1c nhau trong h\u1ec7 th\u1ed1ng n\u00e0y l\u00e0m kh\u00f3 kh\u0103n khi quy\u1ebft \u0111\u1ecbnh, v\u00e0 c\u1ea7n x\u00e9t nghi\u1ec7m albumin n\u00ean l\u00e0m ch\u1eadm tr\u1ec5 nh\u1eefng quy\u1ebft \u0111\u1ecbnh kh\u1ea9n c\u1ea5p.<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone size-full wp-image-1075\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/6.png\" alt=\"\" width=\"692\" height=\"714\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/6.png 692w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/6-291x300.png 291w\" sizes=\"(max-width: 692px) 100vw, 692px\" \/><\/p>\n<h2>4. Thang \u0111i\u1ec3m nh\u1eadp khoa ICU c\u1ee7a H\u1ed9i b\u1ec7nh nhi\u1ec5m Hoa K\u1ef3\/H\u1ed9i l\u1ed3ng ng\u1ef1c Hoa K\u1ef3 (IDSA\/ATS)<\/h2>\n<p>H\u01b0\u1edbng d\u1eabn c\u1ee7a IDSA\/ATS li\u1ec7t k\u00ea m\u1ed9t lo\u1ea1t c\u00e1c ti\u00eau ch\u00ed ch\u00ednh v\u00e0 ti\u00eau ch\u00ed ph\u1ee5 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 vi\u00eam ph\u1ed5i n\u1eb7ng, v\u00e0 x\u00e1c \u0111\u1ecbnh nh\u1eefng b\u1ec7nh nh\u00e2n nghi ng\u1edd CAP c\u1ea7n nh\u1eadp ICU.<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone size-full wp-image-1076\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/7.png\" alt=\"\" width=\"732\" height=\"502\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/7.png 732w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/7-300x206.png 300w\" sizes=\"(max-width: 732px) 100vw, 732px\" \/><\/p>\n<p>Thang \u0111i\u1ec3m nh\u1eadn v\u00e0o ICU c\u1ee7a IDSA\/ATS \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i trong c\u00e1c nghi\u00ean c\u1ee9u v\u00e0 th\u1ef1c ti\u1ec5n l\u00e2m s\u00e0ng \u0111\u1ec3 gi\u00fap c\u00e1c b\u00e1c s\u0129 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh ch\u0103m s\u00f3c v\u00e0 \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng. N\u00f3 c\u0169ng c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m thi\u1ec3u s\u1ef1 chuy\u1ec3n \u0111\u1ed5i kh\u00f4ng c\u1ea7n thi\u1ebft \u0111\u1ebfn ICU v\u00e0 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n.<\/p>\n<p>C\u00e1c thang \u0111i\u1ec3m CURB-65, PSI, SMART-COP hay thang \u0111i\u1ec3m nh\u1eadp khoa ICU c\u1ee7a H\u1ed9i b\u1ec7nh nhi\u1ec5m Hoa K\u1ef3\/H\u1ed9i l\u1ed3ng ng\u1ef1c Hoa K\u1ef3 (IDSA\/ATS) \u0111\u1ec1u c\u00f3 t\u00ednh \u1ee9ng d\u1ee5ng cao trong th\u1ef1c ti\u1ec5n l\u00e2m s\u00e0ng v\u00e0 gi\u00fap \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh ch\u0103m s\u00f3c v\u00e0 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p cho b\u1ec7nh nh\u00e2n CAP. Tuy nhi\u00ean, c\u00e1c b\u00e1c s\u0129 c\u1ea7n l\u01b0u \u00fd r\u1eb1ng thang \u0111i\u1ec3m ch\u1ec9 l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1ed7 tr\u1ee3 trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 v\u00e0 kh\u00f4ng th\u1ec3 thay th\u1ebf cho s\u1ef1 theo d\u00f5i, \u0111\u00e1nh gi\u00e1 v\u00e0 quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u00e1c s\u0129.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd ph\u1ed5 bi\u1ebfn \u1edf m\u1ecdi \u0111\u1ed9 tu\u1ed5i v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng. \u0110\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh v\u00e0 \u0111\u01b0a ra ph\u01b0\u01a1ng \u00e1n \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p, c\u00e1c thang \u0111i\u1ec3m nh\u01b0 CURB-65, PSI, SMART &#8211; COP hay IDSA\/ATS [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - 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