{"id":1648,"date":"2023-04-13T16:01:47","date_gmt":"2023-04-13T09:01:47","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=1648"},"modified":"2023-04-13T19:03:12","modified_gmt":"2023-04-13T12:03:12","slug":"che-do-tho-may-co-ban","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/che-do-tho-may-co-ban\/","title":{"rendered":"\u0110\u1eb7c \u0111i\u1ec3m m\u1ed9t s\u1ed1 ch\u1ebf \u0111\u1ed9 th\u1edf m\u00e1y c\u01a1 b\u1ea3n"},"content":{"rendered":"<p><strong>Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p y t\u1ebf \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i \u0111\u1ec3 h\u1ed7 tr\u1ee3 qu\u00e1 tr\u00ecnh th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n. M\u00e1y th\u1edf ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch cung c\u1ea5p kh\u00f4ng kh\u00ed ho\u1eb7c oxy v\u1edbi \u00e1p l\u1ef1c ph\u00f9 h\u1ee3p th\u00f4ng qua \u1ed1ng th\u1edf \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n, th\u01b0\u1eddng l\u00e0 qua mi\u1ec7ng ho\u1eb7c m\u0169i ho\u1eb7c th\u00f4ng qua ch\u1ed5 m\u1edf kh\u00ed qu\u1ea3n. Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, v\u1edbi nhi\u1ec1u th\u00f4ng s\u1ed1 v\u00e0 ch\u1ebf \u0111\u1ed9 th\u1edf m\u00e1y c\u01a1 b\u1ea3n kh\u00e1c nhau \u0111\u1ec3 ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c b\u1ec7nh c\u1ea3nh nh\u1ea5t \u0111\u1ecbnh.<\/strong><\/p>\n<h2>1. Ch\u1ec9 \u0111\u1ecbnh c\u1ee7a th\u1edf m\u00e1y<\/h2>\n<p>M\u00e1y th\u1edf th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u trong c\u00e1c khoa ch\u0103m s\u00f3c t\u00edch c\u1ef1c, ph\u00f2ng c\u1ea5p c\u1ee9u v\u00e0 trong ph\u00f2ng ph\u1eabu thu\u1eadt. N\u00f3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec1u lo\u1ea1i b\u1ec7nh li\u00ean quan \u0111\u1ebfn h\u00f4 h\u1ea5p, ch\u1eb3ng h\u1ea1n nh\u01b0 h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p (ARDS), vi\u00eam ph\u1ed5i, b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD) v\u00e0 suy h\u00f4 h\u1ea5p. M\u1ed9t s\u1ed1 ch\u1ec9 \u0111\u1ecbnh c\u1ee7a m\u00e1y th\u1edf g\u1ed3m:<\/p>\n<ul>\n<li><strong>Suy h\u00f4 h\u1ea5p c\u1ea5p<\/strong><\/li>\n<li><strong>H\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (ARDS)<\/strong><\/li>\n<li><strong>B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD)<\/strong><\/li>\n<li><strong>T\u00ecnh tr\u1ea1ng suy tim<\/strong><\/li>\n<li><strong>B\u1ec7nh nh\u00e2n m\u1eafc COVID-19<\/strong><\/li>\n<li><strong>B\u1ec7nh nh\u00e2n h\u00f4n m\u00ea ho\u1eb7c r\u1ed1i lo\u1ea1n tri gi\u00e1c<\/strong><\/li>\n<li><strong>C\u01a1n hen n\u1eb7ng<\/strong><\/li>\n<li><strong>Ch\u1ea5n th\u01b0\u01a1ng ho\u1eb7c ph\u1eabu thu\u1eadt<\/strong><\/li>\n<\/ul>\n<figure style=\"width: 454px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/vinmec-prod.s3.amazonaws.com\/images\/20190930_073050_808635_tho-may.max-1800x1800.png\" alt=\"mot-so-che-do-tho-may-co-ban\" width=\"454\" height=\"284\" \/><figcaption class=\"wp-caption-text\">M\u1ed9t s\u1ed1 ch\u1ebf \u0111\u1ed9 th\u1edf m\u00e1y c\u01a1 b\u1ea3n<\/figcaption><\/figure>\n<h2>2. M\u1ed9t s\u1ed1 th\u00f4ng s\u1ed1 c\u01a1 b\u1ea3n c\u1ee7a m\u00e1y th\u1edf<\/h2>\n<p>M\u00e1y th\u1edf c\u00f3 nhi\u1ec1u th\u00f4ng s\u1ed1 \u0111\u1ec3 \u0111o l\u01b0\u1eddng v\u00e0 ki\u1ec3m so\u00e1t qu\u00e1 tr\u00ecnh h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n. M\u1ed9t s\u1ed1 th\u00f4ng s\u1ed1 ti\u00eau bi\u1ec3u g\u1ed3m:<\/p>\n<ul>\n<li><strong>Th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng (VT)<\/strong>:\u00a0 l\u01b0\u1ee3ng kh\u00ed \u0111\u01b0\u1ee3c cung c\u1ea5p cho m\u1ed7i h\u01a1i th\u1edf v\u00e0 th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111o b\u1eb1ng \u0111\u01a1n v\u1ecb mililit (mL).<\/li>\n<li><strong>T\u1ea7n s\u1ed1 th\u1edf (RR):<\/strong> s\u1ed1 nh\u1ecbp th\u1edf m\u1ed7i ph\u00fat c\u1ee7a b\u1ec7nh nh\u00e2n<\/li>\n<li><strong>N\u1ed3ng \u0111\u1ed9 oxy h\u00edt v\u00e0o (FiO2):<\/strong>\u00a0 n\u1ed3ng \u0111\u1ed9 oxy \u0111\u01b0\u1ee3c cung c\u1ea5p b\u1edfi m\u00e1y th\u1edf v\u00e0 th\u01b0\u1eddng \u0111\u01b0\u1ee3c bi\u1ec3u di\u1ec5n d\u01b0\u1edbi d\u1ea1ng ph\u1ea7n tr\u0103m.<\/li>\n<li><strong>\u00c1p l\u1ef1c d\u01b0\u01a1ng cu\u1ed1i khi th\u1edf ra (PEEP)<\/strong>:\u00e1p l\u1ef1c \u0111\u01b0\u1ee3c gi\u1eef \u1edf trong ph\u1ed5i \u1edf cu\u1ed1i khi th\u1edf ra \u0111\u1ec3 ng\u0103n ng\u1eeba \u0111\u00f3ng s\u1eadp c\u1ee7a ph\u1ebf nang v\u00e0 c\u1ea3i thi\u1ec7n s\u1ef1 oxy h\u00f3a<\/li>\n<li><strong>\u00c1p l\u1ef1c h\u00edt v\u00e0o (IP):<\/strong>\u00a0\u00c1p l\u1ef1c \u0111\u01b0\u1ee3c cung c\u1ea5p b\u1edfi m\u00e1y th\u1edf trong giai \u0111o\u1ea1n h\u00edt v\u00e0o.<\/li>\n<\/ul>\n<h2>3. M\u1ed9t s\u1ed1 ch\u1ebf \u0111\u1ed9 th\u1edf m\u00e1y c\u01a1 b\u1ea3n<\/h2>\n<h3>\u00a0Assist-control (AC)<\/h3>\n<p>Trong ch\u1ebf \u0111\u1ed9 AC, b\u00e1c s\u0129 x\u00e1c \u0111\u1ecbnh l\u01b0\u1ee3ng th\u00f4ng kh\u00ed t\u1ed1i thi\u1ec3u b\u1eb1ng c\u00e1ch thi\u1ebft l\u1eadp RR v\u00e0 VT. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 t\u0103ng l\u01b0\u1ee3ng th\u00f4ng kh\u00ed b\u1eb1ng c\u00e1ch k\u00edch ho\u1ea1t th\u00eam c\u00e1c nh\u1ecbp th\u1edf t\u1ef1 th\u00e2n. M\u1ed7i nh\u1ecbp th\u1edf do b\u1ec7nh nh\u00e2n kh\u1edfi \u0111\u1ed9ng s\u1ebd nh\u1eadn \u0111\u01b0\u1ee3c l\u01b0\u1ee3ng VT \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp tr\u01b0\u1edbc. \u0110\u00e2y l\u00e0 ch\u1ebf \u0111\u1ed9\u00a0 th\u1edf m\u00e1y c\u01a1 b\u1ea3n, \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn.<\/p>\n<p>V\u00ed d\u1ee5, n\u1ebfu b\u00e1c s\u0129 thi\u1ebft l\u1eadp t\u1ea7n s\u1ed1 th\u1edf l\u00e0 20 l\u1ea7n m\u1ed7i ph\u00fat v\u00e0 VT l\u00e0 500 mL, l\u01b0\u1ee3ng th\u00f4ng kh\u00ed t\u1ed1i thi\u1ec3u c\u00f3 th\u1ec3 l\u00e0 10 L m\u1ed7i ph\u00fat (20 l\u1ea7n th\u1edf m\u1ed7i ph\u00fat nh\u00e2n v\u1edbi 500 mL m\u1ed7i l\u1ea7n th\u1edf). N\u1ebfu b\u1ec7nh nh\u00e2n k\u00edch ho\u1ea1t th\u00eam 5 l\u1ea7n th\u1edf ngo\u00e0i 20 l\u1ea7n \u0111\u00e3 \u0111\u1eb7t tr\u01b0\u1edbc \u0111\u00f3, m\u00e1y th\u1edf s\u1ebd cung c\u1ea5p 500 mL cho m\u1ed7i l\u1ea7n th\u1edf v\u00e0 l\u01b0\u1ee3ng th\u00f4ng kh\u00ed m\u1ed7i ph\u00fat s\u1ebd l\u00e0 12,5 L (25 l\u1ea7n th\u1edf m\u1ed7i ph\u00fat nh\u00e2n v\u1edbi 500 mL m\u1ed7i l\u1ea7n th\u1edf).<\/p>\n<h3>Synchronized Intermittent mandatory ventilation (SIMV)<\/h3>\n<p>Trong ch\u1ebf \u0111\u1ed9 SIMV, ma\u0301y th\u01a1\u0309 cung c\u00e2\u0301p ca\u0301c nhi\u0323p th\u01a1\u0309 b\u1eaft bu\u1ed9c theo t\u00e2\u0300n s\u00f4\u0301 ca\u0300i \u0111\u1ea1\u0306t tr\u01b0\u1edbc nhu\u031bng \u0111\u00f4\u0300ng b\u1ecd\u0302 v\u01a1\u0301i\u00a0 nh\u1ecbp th\u1edf t\u1ef1 ph\u00e1t c\u1ee7a b\u1eb9\u0302nh nha\u0302n. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 th\u1edf t\u1ef1 do gi\u1eefa c\u00e1c nh\u1ecbp th\u1edf b\u1eaft bu\u1ed9c. N\u1ebfu b\u1ec7nh nh\u00e2n kh\u1edfi \u0111\u1ed9ng m\u1ed9t h\u01a1i th\u1edf trong kho\u1ea3ng th\u1eddi gian gi\u1eefa hai l\u1ea7n h\u00f4 h\u1ea5p \u0111\u01b0\u1ee3c cung c\u1ea5p b\u1edfi m\u00e1y th\u1edf, m\u00e1y th\u1edf s\u1ebd \u0111\u1ed3ng b\u1ed9 v\u1edbi h\u01a1i th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 cung c\u1ea5p m\u1ed9t m\u1ee9c VT ho\u1eb7c \u00e1p l\u1ef1c t\u01b0\u01a1ng \u1ee9ng v\u1edbi gi\u00e1 tr\u1ecb \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp tr\u00ean m\u00e1y th\u1edf. C\u00e1c nh\u1ecbp th\u1edf do m\u00e1y kh\u1edfi ph\u00e1t trong ch\u1ebf \u0111\u1ed9 SIMV c\u00f3 th\u1ec3 \u00a0\u0111\u01b0\u1ee3c c\u00e0i \u0111\u1eb7t tr\u01b0\u1edbc \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ed9t m\u1ee9c \u00e1p l\u1ef1c (c\u00f2n g\u1ecdi l\u00e0 pressure-controlled) hay m\u1ed9t m\u1ee9c th\u1ec3 t\u00edch l\u01b0u th\u00f4ng (volume-controlled) c\u00e0i tr\u01b0\u1edbc. Ch\u1ebf \u0111\u1ed9 th\u1edf m\u00e1y n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong qu\u00e1 tr\u00ecnh cai m\u00e1y th\u1edf, gi\u00fap b\u1ec7nh nh\u00e2n th\u00edch nghi v\u1edbi vi\u1ec7c th\u1edf t\u1ef1 do v\u00e0 gi\u1ea3m thi\u1ec3u t\u00ecnh tr\u1ea1ng ph\u1ee5 thu\u1ed9c v\u00e0o m\u00e1y th\u1edf.<\/p>\n<h3>Pressure-support ventilation (PSV)<\/h3>\n<p>Trong ch\u1ebf \u0111\u1ed9 n\u00e0y, m\u00e1y th\u1edf cung c\u1ea5p \u00e1p l\u1ef1c b\u1ed5 sung \u0111\u1ec3 h\u1ed7 tr\u1ee3 cho qu\u00e1 tr\u00ecnh th\u1edf t\u1ef1 nhi\u00ean c\u1ee7a b\u1ec7nh nh\u00e2n. Nh\u1ecbp th\u1edf \u0111\u01b0\u1ee3c kh\u1edfi ph\u00e1t b\u1edfi b\u1ec7nh nh\u00e2n v\u00e0 m\u00e1y th\u1edf ch\u1ec9 cung c\u1ea5p \u00e1p l\u1ef1c b\u1ed5 sung theo gi\u00e1 tr\u1ecb \u0111\u01b0\u1ee3c c\u00e0i tr\u01b0\u1edbc \u0111\u1ec3 gi\u1ea3m c\u00f4ng th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n. PSV th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 th\u1edf t\u1ef1 nhi\u00ean, nh\u01b0ng c\u1ea7n th\u00eam h\u1ed7 tr\u1ee3 \u0111\u1ec3 v\u01b0\u1ee3t qua s\u1ef1 kh\u00e1ng c\u1ef1 c\u1ee7a \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p v\u00e0 ph\u1ed5i. Khi b\u1ec7nh nh\u00e2n kh\u1edfi \u0111\u1ed9ng m\u1ed9t h\u01a1i th\u1edf, m\u00e1y th\u1edf cung c\u1ea5p m\u1ed9t m\u1ee9c \u0111\u1ed9 \u00e1p l\u1ef1c h\u1ed7 tr\u1ee3 \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp s\u1eb5n \u0111\u1ec3 h\u1ed7 tr\u1ee3 cho c\u00f4ng th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n, gi\u00fap c\u1ea3i thi\u1ec7n th\u00f4ng kh\u00ed v\u00e0 oxy h\u00f3a m\u00e1u. PSV th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi c\u00e1c ch\u1ebf \u0111\u1ed9 m\u00e1y th\u1edf kh\u00e1c nh\u01b0 SIMV. N\u00f3 c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong qu\u00e1 tr\u00ecnh cai m\u00e1y th\u1edf. Ch\u1ebf \u0111\u1ed9 PSV v\u1edbi m\u1ee9c \u00e1p l\u1ef1c h\u1ed7 tr\u1ee3 th\u1ea5p (t\u1eeb 5-10 cmH2O) th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 gi\u00fap b\u1ec7nh nh\u00e2n kh\u00e1ng tr\u1edf c\u1ee7a \u0111\u01b0\u1eddng d\u1eabn kh\u00ed nh\u00e2n t\u1ea1o trong qu\u00e1 tr\u00ecnh c\u00e1i m\u00e1y<\/p>\n<p>Ngo\u00e0i ra c\u00f2n nhi\u1ec1u ch\u1ebf \u0111\u1ed9 th\u00f4ng kh\u00ed kh\u00e1c nh\u01b0: IMV, CPAP, PRCV&#8230; Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c ch\u1ebf \u0111\u1ed9 th\u1edf n\u00e0y \u0111\u00f2i h\u1ecfi nh\u00e2n vi\u00ean y t\u1ebf c\u00f3 kinh nghi\u1ec7m v\u00e0 \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o \u0111\u1ea7y \u0111\u1ee7. \u0110i\u1ec1u n\u00e0y b\u1edfi v\u00ec m\u1ed7i ch\u1ebf \u0111\u1ed9 th\u1edf \u0111\u1ec1u c\u00f3 nh\u1eefng th\u00f4ng s\u1ed1 v\u00e0 thi\u1ebft l\u1eadp ri\u00eang, v\u00e0 vi\u1ec7c thi\u1ebft l\u1eadp sai c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn h\u00f4 h\u1ea5p v\u00e0 th\u1eadm ch\u00ed g\u00e2y nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n. Khi s\u1eed d\u1ee5ng m\u00e1y th\u1edf c\u01a1 kh\u00ed, c\u00e1c chuy\u00ean gia y t\u1ebf t\u1ea1i <a href=\"https:\/\/vinmec.com\/vi\/dangkykham\/\">Vinmec<\/a> lu\u00f4n c\u1eadp nh\u1eadt ki\u1ebfn th\u1ee9c v\u00e0 k\u1ef9 n\u0103ng \u0111\u1ec3 \u00e1p d\u1ee5ng c\u00e1c ch\u1ebf \u0111\u1ed9 ph\u00f9 h\u1ee3p v\u00e0 cung c\u1ea5p ch\u0103m s\u00f3c t\u1ed1t nh\u1ea5t cho b\u1ec7nh nh\u00e2n.<\/p>\n<p>Ngu\u1ed3n tham kh\u1ea3o: Uptodate<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p y t\u1ebf \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i \u0111\u1ec3 h\u1ed7 tr\u1ee3 qu\u00e1 tr\u00ecnh th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n. M\u00e1y th\u1edf ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch cung c\u1ea5p kh\u00f4ng kh\u00ed ho\u1eb7c oxy v\u1edbi \u00e1p l\u1ef1c ph\u00f9 h\u1ee3p th\u00f4ng qua \u1ed1ng th\u1edf \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n, th\u01b0\u1eddng [&hellip;]<\/p>\n","protected":false},"author":37,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[23,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>\u0110\u1eb7c \u0111i\u1ec3m m\u1ed9t s\u1ed1 ch\u1ebf \u0111\u1ed9 th\u1edf m\u00e1y c\u01a1 b\u1ea3n - Vinmec<\/title>\n<meta name=\"description\" content=\"Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, v\u1edbi nhi\u1ec1u th\u00f4ng s\u1ed1 v\u00e0 ch\u1ebf \u0111\u1ed9 th\u1edf m\u00e1y kh\u00e1c nhau \u0111\u1ec3 ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c b\u1ec7nh c\u1ea3nh nh\u1ea5t \u0111\u1ecbnh.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u0110\u1eb7c \u0111i\u1ec3m m\u1ed9t s\u1ed1 ch\u1ebf \u0111\u1ed9 th\u1edf m\u00e1y c\u01a1 b\u1ea3n - 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