{"id":17726,"date":"2023-04-11T18:03:44","date_gmt":"2023-04-11T11:03:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=17726"},"modified":"2023-04-18T15:34:44","modified_gmt":"2023-04-18T08:34:44","slug":"chan-doan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/11\/chan-doan\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn theo B\u1ed9 Y t\u1ebf 2020"},"content":{"rendered":"

B\u1ed9 Y t\u1ebf \u0111\u00e3 ban h\u00e0nh Quy\u1ebft \u0111\u1ecbnh s\u1ed1 4815\/Q\u0110-BYT v\u00e0o 22\/11\/2020 v\u1ec1 vi\u1ec7c ban h\u00e0nh t\u00e0i li\u1ec7u chuy\u00ean m\u00f4n \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn\u201d. H\u01b0\u1edbng d\u1eabn nh\u1ea5n m\u1ea1nh, ti\u00eam ph\u00f2ng c\u00fam \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c ph\u00f2ng b\u1ec7nh vi\u00eam ph\u1ed5i, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i c\u00f3 suy gi\u1ea3m mi\u1ec5n d\u1ecbch…D\u01b0\u1edbi \u0111\u00e2y l\u00e0 tr\u00edch d\u1eabn h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn \u0111\u01b0\u1ee3c ban h\u00e0nh b\u1edfi B\u1ed9 Y t\u1ebf n\u0103m 2020.<\/p>\n

1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh vi\u00eam ph\u1ed5i theo B\u1ed9 Y t\u1ebf2020<\/strong><\/h1>\n

1.1. L\u00e2m s\u00e0ng<\/strong><\/p>\n

– Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:<\/p>\n

+ Xu\u1ea5t hi\u1ec7n c\u1ea5p t\u00ednh trong v\u00e0i ng\u00e0y.<\/p>\n

+ Tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh: s\u1ed1t cao, r\u00e9t run, ho kh\u1ea1c \u0111\u1eddm m\u1ee7, \u0111au ng\u1ef1c ki\u1ec3u m\u00e0ng ph\u1ed5i (n\u1ebfu c\u00f3 t\u1ed5n th\u01b0\u01a1ng m\u00e0ng ph\u1ed5i).<\/p>\n

– Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:<\/p>\n

+ H\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng: s\u1ed1t, m\u00f4i kh\u00f4, l\u01b0\u1ee1i b\u1ea9n… Tr\u00ean b\u1ec7nh nh\u00e2n cao tu\u1ed5i, b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch c\u00e1c bi\u1ec3u hi\u1ec7n ban \u0111\u1ea7u c\u1ee7a vi\u00eam ph\u1ed5i c\u00f3 th\u1ec3 kh\u00f4ng r\u1ea7m r\u1ed9.<\/p>\n

+ H\u1ed9i ch\u1ee9ng \u0111\u00f4ng \u0111\u1eb7c (rung thanh t\u0103ng, g\u00f5 \u0111\u1ee5c, r\u00ec r\u00e0o ph\u1ebf nang gi\u1ea3m), c\u00f3 th\u1ec3 c\u00f3 nghe th\u1ea5y ran n\u1ed5 n\u1ebfu t\u1ed5n th\u01b0\u01a1ng nhi\u1ec1u \u1edf ph\u1ed5i.<\/p>\n

+ Vi\u00eam ph\u1ed5i do t\u00e1c nh\u00e2n vi khu\u1ea9n \u0111i\u1ec3n h\u00ecnh: ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n s\u1ed1t cao >390C, r\u00e9t run k\u00e8m theo b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n ho khan l\u00fac \u0111\u1ea7u sau ho kh\u1ea1c \u0111\u1eddm m\u1ee7, c\u00f3 th\u1ec3 kh\u1ea1c \u0111\u1eddm m\u00e0u r\u1ec9 s\u1eaft v\u00e0 \u0111au ng\u1ef1c v\u00f9ng t\u1ed5n th\u01b0\u01a1ng. Tuy nhi\u00ean ng\u01b0\u1eddi l\u1edbn tu\u1ed5i c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 s\u1ed1t; b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 bi\u1ec3u hi\u1ec7n t\u00edm t\u00e1i, kh\u00f3 th\u1edf, nh\u1ecbp th\u1edf nhanh > 30 l\u1ea7n\/ph\u00fat…<\/p>\n

+ Vi\u00eam ph\u1ed5i do t\u00e1c nh\u00e2n vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh: ph\u1ea7n l\u1edbn x\u1ea3y ra tr\u00ean ng\u01b0\u1eddi l\u1edbn tu\u1ed5i v\u00e0 tr\u1ebb em v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng \u00e2m th\u1ea7m h\u01a1n bao g\u1ed3m: s\u1ed1t nh\u1eb9, \u0111au \u0111\u1ea7u, ho khan, c\u1ea3m gi\u00e1c m\u1ec7t m\u1ecfi nh\u01b0 tri\u1ec7u ch\u1ee9ng nhi\u1ec5m virus. Kh\u00e1m kh\u00f4ng r\u00f5 h\u1ed9i ch\u1ee9ng \u0111\u00f4ng \u0111\u1eb7c, th\u1ea5y r\u1ea3i r\u00e1c ran n\u1ed5. Tuy nhi\u00ean c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u cho th\u1ec3 b\u1ec7nh.<\/p>\n

1.2. X\u00e9t nghi\u1ec7m m\u00e1u<\/strong><\/p>\n

– C\u00f4ng th\u1ee9c m\u00e1u c\u00f3 t\u0103ng s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u (> 10 Giga\/l\u00edt), t\u0103ng \u01b0u th\u1ebf t\u1ebf b\u00e0o \u0111a nh\u00e2n trung t\u00ednh. Ho\u1eb7c s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u gi\u1ea3m (< 4,4 Giga\/l\u00edt). T\u1ed1c \u0111\u1ed9 m\u00e1u l\u1eafng t\u0103ng.<\/p>\n

– D\u1ea5u \u1ea5n vi\u00eam: t\u0103ng CRP, t\u0103ng procalcitonin<\/p>\n

1.3. X-quang ph\u1ed5i<\/strong><\/p>\n

– X-quang ph\u1ed5i l\u00e0 c\u1eadn l\u00e2m s\u00e0ng quan tr\u1ecdng trong b\u1ec7nh vi\u00eam ph\u1ed5i. H\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng tr\u00ean X-quang ph\u1ed5i c\u1ee7a VPMPC\u0110:<\/p>\n

+ T\u1ed5n th\u01b0\u01a1ng ph\u1ebf nang: h\u00ecnh m\u1edd t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ed3ng nh\u1ea5t chi\u1ebfm m\u1ed9t th\u00f9y ho\u1eb7c ph\u00e2n th\u00f9y ph\u1ed5i v\u00e0 c\u00f3 h\u00ecnh \u1ea3nh ph\u1ebf qu\u1ea3n h\u01a1i. C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u00edt \u0111i\u1ec3n h\u00ecnh h\u01a1n cho th\u1ea5y c\u00e1c h\u00ecnh m\u1edd n\u00e0y kh\u00f4ng chi\u1ebfm m\u1ed9t th\u00f9y ho\u1eb7c ph\u00e2n th\u00f9y ho\u1eb7c c\u00f3 th\u1ec3 k\u00e8m theo x\u1eb9p ph\u1ed5i do d\u1ecbch ti\u1ebft g\u00e2y t\u1eafc ngh\u1ebdn c\u00e1c ph\u1ebf qu\u1ea3n.<\/p>\n

+ T\u1ed5n th\u01b0\u01a1ng ph\u1ebf qu\u1ea3n ph\u1ed5i: t\u1ed5n th\u01b0\u01a1ng m\u1edd r\u1ea3i r\u00e1c, kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t, nh\u1eefng t\u1ed5n th\u01b0\u01a1ng m\u1edd n\u00e0y c\u00f3 th\u1ec3 ch\u1ed3ng l\u00ean nhau t\u1ea1o th\u00e0nh nh\u1eefng h\u00ecnh m\u1edd \u0111\u1eadm h\u01a1n.<\/p>\n

+ T\u1ed5n th\u01b0\u01a1ng m\u00f4 k\u1ebd: h\u00ecnh \u1ea3nh m\u1edd d\u1ea1ng l\u01b0\u1edbi ho\u1eb7c l\u01b0\u1edbi n\u1ed1t kh\u1eafp c\u1ea3 hai b\u00ean ph\u1ed5i, \u0111\u00f4i khi ti\u1ebfn tri\u1ec3n th\u00e0nh nh\u1eefng h\u00ecnh m\u1edd r\u1ea3i r\u00e1c th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf th\u00f9y d\u01b0\u1edbi.<\/p>\n

+ Th\u00e2m nhi\u1ec5m d\u1ea1ng n\u1ed1t: h\u00ecnh m\u1edd tr\u00f2n gi\u1edbi h\u1ea1n r\u00f5 v\u1edbi \u0111\u01b0\u1eddng k\u00ednh l\u1edbn h\u01a1n 1 cm tr\u00ean phim X-quang ph\u1ed5i.<\/p>\n

– Tr\u00ean l\u00e2m s\u00e0ng c\u00f3 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p vi\u00eam ph\u1ed5i kh\u00f4ng ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng tr\u00ean X- quang ph\u1ed5i, ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nh\u1eefng tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ph\u00f9 h\u1ee3p v\u00e0 c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh ch\u1ee5p X-quang ph\u1ed5i l\u1ea7n hai sau 24 – 48 gi\u1edd.<\/p>\n

– H\u00ecnh \u1ea3nh tr\u00ean X-quang ph\u1ed5i c\u0169ng c\u00f3 gi\u1edbi h\u1ea1n trong ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i.<\/p>\n

+ Ch\u1ea9n \u0111o\u00e1n d\u01b0\u1edbi m\u1ee9c vi\u00eam ph\u1ed5i hay th\u1eadm ch\u00ed \u00e2m t\u00ednh gi\u1ea3: (1) B\u00e9o ph\u00ec, kh\u00ed ph\u1ebf th\u0169ng, b\u1ea5t th\u01b0\u1eddng c\u1ea5u tr\u00fac ph\u1ed5i l\u00e0m che m\u1edd t\u1ed5n th\u01b0\u01a1ng vi\u00eam ph\u1ed5i; (2) Vi\u00eam ph\u1ed5i giai \u0111o\u1ea1n qu\u00e1 s\u1edbm; (3) M\u1ea5t n\u01b0\u1edbc n\u1eb7ng, gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t n\u1eb7ng l\u00e0m t\u1ed5n th\u01b0\u01a1ng vi\u00eam kh\u00f4ng th\u1ec3 l\u1ed9 r\u00f5; (4) Nhi\u1ec5m P. jijovecii tr\u00ean b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch v\u00ec t\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu m\u00f4 k\u1ebd ph\u1ed5i n\u00ean c\u00f3 th\u1ec3 kh\u00f4ng th\u1ec3 hi\u1ec7n r\u00f5 tr\u00ean X-quang ph\u1ed5i.<\/p>\n

+ Ch\u1ea9n \u0111o\u00e1n qu\u00e1 m\u1ee9c vi\u00eam ph\u1ed5i hay th\u1eadm ch\u00ed l\u00e0 d\u01b0\u01a1ng t\u00ednh gi\u1ea3: (1) Ph\u00f9 ph\u1ed5i trong suy tim \u1ee9 huy\u1ebft, h\u1eb9p hai l\u00e1; (2) Nh\u1ed3i m\u00e1u ph\u1ed5i; (3) H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh ARDS; (4) Ch\u1ea3y m\u00e1u ph\u1ebf nang; (5) Ung th\u01b0 ph\u1ebf qu\u1ea3n ho\u1eb7c ung th\u01b0 di c\u0103n ph\u1ed5i; (6) X\u1eb9p ph\u1ed5i; (7) Vi\u00eam ph\u1ed5i sau x\u1ea1 tr\u1ecb; (8) Vi\u00eam nhu m\u00f4 ph\u1ed5i kh\u00f4ng do nhi\u1ec5m tr\u00f9ng (vi\u00eam m\u1ea1ch m\u00e1u ph\u1ed5i, vi\u00eam ph\u1ebf nang do d\u1ecb \u1ee9ng, vi\u00eam m\u00f4 k\u1ebd ph\u1ed5i do mi\u1ec5n d\u1ecbch bao g\u1ed3m ph\u1ea3n \u1ee9ng thu\u1ed1c); (9) T\u0103ng t\u1ebf b\u00e0o \u00e1i toan \u1edf ph\u1ed5i; (10) Vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n t\u1eafc ngh\u1ebdn.<\/p>\n

1.4. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ng\u1ef1c<\/strong><\/p>\n

– Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ng\u1ef1c \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n VPMPC\u0110 trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p sau:<\/p>\n

+ Vi\u00eam ph\u1ed5i n\u1eb7ng v\u00e0 di\u1ec5n bi\u1ebfn ph\u1ee9c t\u1ea1p.<\/p>\n

+ Vi\u00eam ph\u1ed5i \u1edf b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch.<\/p>\n

+ Vi\u00eam ph\u1ed5i t\u00e1i ph\u00e1t ho\u1eb7c kh\u00f4ng \u0111i\u1ec1u tr\u1ecb d\u1ee9t \u0111i\u1ec3m \u0111\u01b0\u1ee3c.<\/p>\n

+ B\u1ec7nh nh\u00e2n nghi ng\u1edd m\u1eafc vi\u00eam ph\u1ed5i tr\u00ean l\u00e2m s\u00e0ng nh\u01b0ng h\u00ecnh \u1ea3nh X quang ph\u1ed5i kh\u00f4ng r\u00f5 t\u1ed5n th\u01b0\u01a1ng.<\/p>\n

\"\"
\u1ea2nh minh h\u1ecda CT scan ng\u1ef1c trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/figcaption><\/figure>\n

– C\u00e1c d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng c\u1ee7a VPMPC\u0110 tr\u00ean phim ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh<\/p>\n

+ T\u1ed5n th\u01b0\u01a1ng ph\u1ebf nang: c\u00e1c \u0111\u00e1m m\u1edd \u0111\u1ed3ng nh\u1ea5t \u1edf nhi\u1ec1u ph\u00e2n th\u00f9y ho\u1eb7c to\u00e0n b\u1ed9 th\u00f9y ph\u1ed5i, c\u00f3 d\u1ea5u hi\u1ec7u ph\u1ebf qu\u1ea3n h\u01a1i (d\u1ea1ng vi\u00eam ph\u1ed5i th\u00f9y). C\u00f3 th\u1ec3 g\u1eb7p h\u00ecnh \u1ea3nh x\u1eb9p c\u00e1c ph\u00e2n th\u00f9y v\u00e0 h\u1ea1 ph\u00e2n th\u00f9y do t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng d\u1eabn kh\u00ed c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf.<\/p>\n

+ T\u1ed5n th\u01b0\u01a1ng ph\u1ebf qu\u1ea3n ph\u1ed5i: nhi\u1ec1u \u0111\u00e1m m\u1edd th\u00e2m nhi\u1ec5m v\u00e0 r\u1ea3i r\u00e1c \u1edf c\u00e1c ph\u00e2n th\u00f9y ph\u1ed5i, ph\u00e2n b\u1ed1 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t xen l\u1eabn nhau gi\u1eefa ph\u1ea7n ph\u1ed5i l\u00e0nh v\u00e0 v\u00f9ng ph\u1ed5i t\u1ed5n th\u01b0\u01a1ng (d\u1ea1ng ph\u1ebf qu\u1ea3n ph\u1ebf vi\u00eam).<\/p>\n

+ T\u1ed5n th\u01b0\u01a1ng m\u00f4 k\u1ebd: T\u1ed5n th\u01b0\u01a1ng d\u00e0y th\u00e0nh ph\u1ebf qu\u1ea3n, t\u1ed5n th\u01b0\u01a1ng m\u00f4 k\u1ebd d\u1ea1ng n\u1ed1t kh\u00f4ng \u0111\u1ec1u ho\u1eb7c d\u1ea1ng l\u01b0\u1edbi.<\/p>\n

– M\u1ed9t s\u1ed1 h\u00ecnh \u1ea3nh \u0111\u1eb7c bi\u1ec7t t\u1ed5n th\u01b0\u01a1ng tr\u00ean phim ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ng\u1ef1c theo c\u0103n nguy\u00ean vi sinh<\/p>\n

+ Vi\u00eam ph\u1ed5i do\u00a0S. pneumoniae<\/em>: t\u1ed5n th\u01b0\u01a1ng l\u00e0 c\u00e1c v\u00f9ng \u0111\u00f4ng \u0111\u1eb7c \u0111\u1ed3ng nh\u1ea5t, c\u00f3 h\u00ecnh ph\u1ebf qu\u1ea3n h\u01a1i, gi\u1edbi h\u1ea1n \u1edf m\u1ed9t th\u00f9y ph\u1ed5i, c\u00f3 th\u1ec3 k\u00e8m theo tr\u00e0n d\u1ecbch v\u00e0 tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i.<\/p>\n

+ Vi\u00eam ph\u1ed5i do S.\u00a0aureus\u00a0<\/em>g\u00e2y c\u00e1c t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng vi\u00eam ph\u1ebf qu\u1ea3n ph\u1ed5i v\u1edbi h\u00ecnh \u1ea3nh nhi\u1ec1u \u0111\u00e1m m\u1edd \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i. T\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p d\u1ea1ng hang, c\u00f3 th\u1ec3 k\u00e8m theo tr\u00e0n d\u1ecbch v\u00e0 tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i.<\/p>\n

+ Vi\u00eam ph\u1ed5i do\u00a0Klebsiella<\/em>: th\u01b0\u1eddng g\u1eb7p \u1edf th\u00f9y tr\u00ean, c\u00f3 h\u00ecnh \u1ea3nh \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i, c\u00f3 h\u00ecnh \u1ea3nh ph\u1ebf qu\u1ea3n h\u01a1i, t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u00e2y xu\u1ea5t ti\u1ebft nhi\u1ec1u \u0111\u1ea9y l\u1ed3i r\u00e3nh li\u00ean th\u00f9y v\u1ec1 ph\u00eda ph\u1ed5i l\u00e0nh, th\u01b0\u1eddng t\u1ea1o hang, c\u00f3 k\u00e8m theo tr\u00e0n d\u1ecbch v\u00e0 tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i nhi\u1ec1u h\u01a1n so v\u1edbi\u00a0S. pneumoniae<\/em>.<\/p>\n

+ Vi\u00eam ph\u1ed5i do\u00a0Legionella<\/em>: c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u00f4ng \u0111\u1eb7c lan t\u1ecfa, \u1edf m\u1ed9t th\u00f9y ho\u1eb7c nhi\u1ec1u th\u00f9y ph\u1ed5i th\u01b0\u1eddng k\u00e8m tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i \u00edt, hi\u1ebfm khi g\u1eb7p t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng \u00e1p xe.<\/p>\n

+ Vi\u00eam ph\u1ed5i do\u00a0Hemophilus influenza<\/em>: t\u1ed5n th\u01b0\u01a1ng d\u01b0\u1edbi d\u1ea1ng vi\u00eam ph\u1ebf qu\u1ea3n ph\u1ed5i r\u1ea3i r\u00e1c nhi\u1ec1u ph\u00e2n th\u00f9y ph\u1ed5i hai b\u00ean.<\/p>\n

+ Vi\u00eam ph\u1ed5i do virut: \u1ede ng\u01b0\u1eddi l\u1edbn, t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng \u0111\u00e1m m\u1edd ph\u1ebf nang \u1edf th\u00f9y d\u01b0\u1edbi hai b\u00ean hay d\u1ea1ng k\u00ednh m\u1edd. \u1ede tr\u1ebb em g\u1eb7p d\u1ea1ng n\u1ed1t l\u01b0\u1edbi lan t\u1ecfa. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i ti\u1ebfn tri\u1ec3n r\u1ea5t nhanh g\u00e2y suy h\u00f4 h\u1ea5p c\u1ea5p.<\/p>\n

+ Vi\u00eam ph\u1ed5i do virus SARS CoV2: t\u1ed5n th\u01b0\u01a1ng xu\u1ea5t hi\u1ec7n hai b\u00ean ph\u1ed5i, th\u01b0\u1eddng g\u1eb7p nhi\u1ec1u \u1ed5, ph\u00e2n b\u1ed1 nhi\u1ec1u \u1edf ngo\u1ea1i vi, d\u01b0\u1edbi m\u00e0ng ph\u1ed5i v\u00e0 \u0111\u00e1y ph\u1ed5i (t\u1eadp chung nhi\u1ec1u \u1edf ph\u00e2n th\u00f9y sau). T\u1ed5n th\u01b0\u01a1ng d\u1ea1ng k\u00ednh m\u1edd t\u0103ng d\u1ea7n, ti\u1ebfn tri\u1ec3n \u0111\u00e1m m\u1edd k\u00e8m theo d\u00e0y v\u00e1ch li\u00ean th\u00f9y, v\u00e1ch trong ti\u1ec3u th\u00f9y v\u00e0 d\u00e0y d\u1ea1ng l\u01b0\u1edbi Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ng\u1ef1c c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng v\u00e0 theo d\u00f5i ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh nh\u00e2n m\u1eafc VPMPC\u0110 do virus SARS CoV2.<\/p>\n

1.5. Si\u00eau \u00e2m l\u1ed3ng ng\u1ef1c<\/strong><\/p>\n

Ng\u00e0y nay, si\u00eau \u00e2m l\u1ed3ng ng\u1ef1c \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn l\u00e0 x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i v\u00ec t\u00ednh ch\u00ednh x\u00e1c trong ch\u1ea9n \u0111o\u00e1n, thu\u1eadn ti\u1ec7n v\u00e0 chi ph\u00ed th\u1ea5p.<\/p>\n

Nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a vi\u00eam ph\u1ed5i tr\u00ean si\u00eau \u00e2m l\u1ed3ng ng\u1ef1c l\u00e0 c\u00e1c h\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng \u0111\u00f4ng \u0111\u1eb7c c\u00f3 di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf, c\u00f3 th\u1ec3 th\u1ea5y h\u00ecnh \u1ea3nh kh\u00ed trong ph\u1ebf qu\u1ea3n v\u00e0 h\u00ecnh \u1ea3nh tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i. Si\u00eau \u00e2m l\u1ed3ng ng\u1ef1c c\u00f2n c\u00f3 vai tr\u00f2 trong theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, nh\u01b0 b\u1ec7nh thuy\u00ean gi\u1ea3m n\u1ebfu nh\u1eefng h\u00ecnh \u1ea3nh \u0111\u00f4ng \u0111\u1eb7c nh\u1ecf h\u01a1n v\u00e0 gi\u1ea3m d\u1ea7n s\u1ef1 hi\u1ec7n di\u1ec7n v\u00e0 s\u1ed1 l\u01b0\u1ee3ng c\u1ee7a d\u1ecbch khoang m\u00e0ng ph\u1ed5i trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n

\"\"
\u1ea2nh minh h\u1ecda si\u00eau \u00e2m trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed9ng.<\/figcaption><\/figure>\n

2. Ch\u1ea9n \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 n\u1eb7ng VPC\u0110 theo B\u1ed9 Y t\u1ebf 2020<\/strong><\/h2>\n

– M\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a vi\u00eam ph\u1ed5i c\u00f3 \u00fd ngh\u0129a quy\u1ebft \u0111\u1ecbnh:<\/p>\n

+ N\u01a1i \u0111i\u1ec1u tr\u1ecb: Ngo\u1ea1i tr\u00fa; khoa N\u1ed9i ho\u1eb7c khoa H\u00f4 h\u1ea5p; Khoa \u0110i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c<\/p>\n

+ Ch\u1ecdn ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh theo kinh nghi\u1ec7m.<\/p>\n

2.1. Thang \u0111i\u1ec3m CURB-65 c\u1ee7a BTS<\/strong><\/p>\n

– C\u00e1c ch\u1ec9 s\u1ed1 trong thang \u0111i\u1ec3m:<\/p>\n

+\u00a0C<\/strong>onfusion \u2013 L\u00fa l\u1eabn;<\/p>\n

+\u00a0U<\/strong>remia \u2013 Ure m\u00e1u > 7 mmol\/L;<\/p>\n

+\u00a0R<\/strong>espiratory rate \u2013 T\u1ea7n s\u1ed1 th\u1edf > 30 l\u1ea7n\/ph\u00fat;<\/p>\n

+\u00a0B<\/strong>lood pressure \u2013 Huy\u1ebft \u00e1p < 90\/60 mmHg;<\/p>\n

+\u00a0A<\/strong>ge \u2013 Tu\u1ed5i >\u00a065<\/strong>.<\/p>\n

– \u00dd ngh\u0129a l\u00e2m s\u00e0ng thang \u0111i\u1ec3m CURB \u2013 65:<\/p>\n

+ Ti\u00ean l\u01b0\u1ee3ng t\u1eed vong trong 30 ng\u00e0y cho b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m s\u1ed1 CURB-65 l\u1ea7n l\u01b0\u1ee3t l\u00e0: nh\u00f3m 1 (0 \u2013 1 \u0111i\u1ec3m): 1,5%; nh\u00f3m 2 (2 \u0111i\u1ec3m): 9,2%; nh\u00f3m 3 (3 \u2013 5 \u0111i\u1ec3m): 22%.<\/p>\n

+ \u0110i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nh\u00f3m 1; \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa ng\u1eafn h\u1ea1n ho\u1eb7c \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa c\u00f3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nh\u00f3m 2; \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nh\u00f3m 3 trong \u0111\u00f3 \u0111i\u1ec1u tr\u1ecb t\u1ea1i khoa ICU \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nh\u00f3m 3 nh\u01b0ng c\u00f3 \u0111i\u1ec3m CURB-65 t\u1eeb 4 – 5.<\/p>\n

+ Thang \u0111i\u1ec3m CURB\u201365 \u0111\u01a1n gi\u1ea3n, d\u1ec5 nh\u1edb, ch\u1ec9 c\u00f3 m\u1ed9t th\u00f4ng s\u1ed1 c\u1eadn l\u00e2m s\u00e0ng l\u00e0 Ure v\u00ec th\u1ebf r\u1ea5t ti\u1ec7n d\u1ee5ng \u0111\u1ec3 s\u1eed d\u1ee5ng trong ch\u1ea9n \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 n\u1eb7ng VPMPC\u0110 t\u1ea1i l\u1ea7n kh\u00e1m \u0111\u1ea7u ti\u00ean t\u1ea1i ph\u00f2ng kh\u00e1m ngo\u1ea1i tr\u00fa.<\/p>\n

2.2. Ch\u1ec9 s\u1ed1 ti\u00ean l\u01b0\u1ee3ng n\u1eb7ng vi\u00eam ph\u1ed5i PSI (Pneumonia Severity Index)<\/strong><\/p>\n

– C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng (B\u1ea3ng 2.1) g\u1ed3m:<\/p>\n

+ (1) Tu\u1ed5i;<\/p>\n

+ (2) \u0110\u1eb7c \u0111i\u1ec3m d\u00e2n s\u1ed1 h\u1ecdc (gi\u1edbi t\u00ednh, n\u01a1i \u1edf);<\/p>\n

+ (3) B\u1ec7nh \u0111\u1ed3ng m\u1eafc (ung th\u01b0, b\u1ec7nh gan, suy tim \u1ee9 huy\u1ebft, b\u1ec7nh m\u1ea1ch m\u00e1u n\u00e3o, b\u1ec7nh th\u1eadn);<\/p>\n

+ (4) \u0110\u1eb7c \u0111i\u1ec3m kh\u00e1m l\u00e2m s\u00e0ng (tri gi\u00e1c, t\u1ea7n s\u1ed1 th\u1edf, huy\u1ebft \u00e1p, th\u00e2n nhi\u1ec7t, m\u1ea1ch);<\/p>\n

+ (5) K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m (pH m\u00e1u, BUN, natri m\u00e1u, \u0111\u01b0\u1eddng m\u00e1u, Hct, PaO2, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i tr\u00ean X-quang hay si\u00eau \u00e2m).<\/p>\n

B\u1ea3ng 2.1. Ch\u1ec9 s\u1ed1 ti\u00ean l\u01b0\u1ee3ng n\u1eb7ng vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng (PSI)<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Ti\u00eau ch\u00ed<\/strong><\/td>\n\u0110i\u1ec3m<\/strong><\/td>\n<\/tr>\n
\u0110\u1eb7c \u0111i\u1ec3m d\u00e2n s\u1ed1 h\u1ecdc<\/strong><\/td>\n<\/tr>\n
Nam<\/td>\nTu\u1ed5i (t\u00ednh b\u1eb1ng n\u0103m)<\/td>\n<\/tr>\n
N\u1eef<\/td>\nTu\u1ed5i (t\u00ednh b\u1eb1ng n\u0103m) \u2013 10<\/td>\n<\/tr>\n
N\u1eb1m \u1edf nh\u00e0 d\u01b0\u1ee1ng l\u00e3o\/\u0111i\u1ec1u d\u01b0\u1ee1ng<\/td>\nTu\u1ed5i (t\u00ednh b\u1eb1ng n\u0103m) + 10<\/td>\n<\/tr>\n
B\u1ec7nh \u0111\u1ed3ng m\u1eafc<\/strong><\/td>\n<\/tr>\n
B\u1ec7nh ung th\u01b0<\/td>\n+ 30<\/td>\n<\/tr>\n
B\u1ec7nh gan<\/td>\n+ 20<\/td>\n<\/tr>\n
Suy tim \u1ee9 huy\u1ebft<\/td>\n+ 10<\/td>\n<\/tr>\n
B\u1ec7nh m\u1ea1ch m\u00e1u n\u00e3o<\/td>\n+ 10<\/td>\n<\/tr>\n
B\u1ec7nh th\u1eadn<\/td>\n+ 10<\/td>\n<\/tr>\n
Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3<\/strong><\/td>\n<\/tr>\n
Thay \u0111\u1ed5i tri gi\u00e1c<\/td>\n+ 20<\/td>\n<\/tr>\n
T\u1ea7n s\u1ed1 th\u1edf \u2265 30 l\u1ea7n\/ph\u00fat<\/td>\n+ 20<\/td>\n<\/tr>\n
Huy\u1ebft \u00e1p t\u00e2m thu < 90 mmHg<\/td>\n+ 20<\/td>\n<\/tr>\n
Th\u00e2n nhi\u1ec7t < 35o<\/sup>C ho\u1eb7c \u2265 40o<\/sup>C<\/td>\n+ 15<\/td>\n<\/tr>\n
M\u1ea1ch \u2265 125 l\u1ea7n\/ph\u00fat<\/td>\n+ 10<\/td>\n<\/tr>\n
K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m<\/strong><\/td>\n<\/tr>\n
pH < 7,35<\/td>\n+ 30<\/td>\n<\/tr>\n
BUN > 10,7 mmol\/L<\/td>\n+ 20<\/td>\n<\/tr>\n
Hematocrit< 30%<\/td>\n+ 10<\/td>\n<\/tr>\n
Na+ m\u00e1u < 130 mEq\/L<\/td>\n+ 20<\/td>\n<\/tr>\n
\u0110\u01b0\u1eddng m\u00e1u > 13,9 mmol\/L<\/td>\n+ 10<\/td>\n<\/tr>\n
PaO2<\/sub>< 60 mmHg ho\u1eb7c SpO2<\/sub>< 90%<\/td>\n+ 10<\/td>\n<\/tr>\n
Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i<\/td>\n+ 10<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

– \u00dd ngh\u0129a l\u00e2m s\u00e0ng thang \u0111i\u1ec3m PSI:<\/p>\n\n\n\n\n\n\n\n
PSI<\/strong><\/td>\nFINE<\/strong><\/td>\nTi\u00ean l\u01b0\u1ee3ng t\u1eed vong 30 ng\u00e0y<\/strong><\/td>\n\u0110i\u1ec1u tr\u1ecb<\/strong><\/td>\n<\/tr>\n
<70<\/td>\nI-II<\/td>\n<1%<\/td>\nNgo\u1ea1i tr\u00fa<\/td>\n<\/tr>\n
71-90<\/td>\nIII<\/td>\n2,8%<\/td>\nN\u1ed9i tr\u00fa ng\u1eafn h\u1ea1n<\/td>\n<\/tr>\n
91-130<\/td>\nIV<\/td>\n8,2-9,3%<\/td>\nN\u1ed9i tr\u00fa<\/td>\n<\/tr>\n
>130<\/td>\nV<\/td>\n27-31,3%<\/td>\nICU<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

+ Ti\u00eau chu\u1ea9n PSI nh\u00ecn chung ph\u1ee9c t\u1ea1p, c\u1ea7n nhi\u1ec1u th\u00f4ng s\u1ed1 c\u1eadn l\u00e2m s\u00e0ng, \u0111i\u1ec3m t\u1ed5ng c\u1ed9ng \u0111\u00f2i h\u1ecfi ph\u1ea3i t\u00ednh to\u00e1n ph\u1ee9c t\u1ea1p v\u00ec th\u1ebf tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng kh\u00f4ng \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng nhi\u1ec1u b\u1eb1ng thang \u0111i\u1ec3m CURB-65.<\/p>\n

2.3. Ti\u00eau chu\u1ea9n nh\u1eadp khoa \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c c\u1ee7a ATS<\/strong><\/p>\n

– C\u00e1c ti\u00eau ch\u00ed d\u00f9ng trong \u0111\u00e1nh gi\u00e1 nh\u1eadp khoa \u0110i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c c\u1ee7a VPMPC\u0110 g\u1ed3m 2 ti\u00eau chu\u1ea9n ch\u00ednh v\u00e0 9 ti\u00eau chu\u1ea9n ph\u1ee5:<\/p>\n

+ Ti\u00eau chu\u1ea9n ch\u00ednh: (1) suy h\u00f4 h\u1ea5p c\u1ea7n ph\u1ea3i th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc, (2) s\u1ed1c nhi\u1ec5m khu\u1ea9n c\u1ea7n ph\u1ea3i d\u00f9ng thu\u1ed1c v\u1eadn m\u1ea1ch.<\/p>\n

+ Ti\u00eau chu\u1ea9n ph\u1ee5: (1) T\u1ea7n s\u1ed1 th\u1edf > 30 l\u1ea7n\/ph\u00fat, (2) PaO2\/ FiO2< 250, (3) t\u1ed5n th\u01b0\u01a1ng nhi\u1ec1u th\u00f9y ph\u1ed5i tr\u00ean phim X-quang, (4) L\u00fa l\u1eabn, m\u1ea5t \u0111\u1ecbnh h\u01b0\u1edbng, (5) Ure m\u00e1u (BUN > 20 mg\/dL), (6) B\u1ea1ch c\u1ea7u m\u00e1u < 4000\/ mm3; (7) Gi\u1ea3m ti\u1ec3u c\u1ea7u (< 100.000\/ mm3); (8) H\u1ea1 th\u00e2n nhi\u1ec7t (< 36oC); (9) H\u1ea1 huy\u1ebft \u00e1p c\u1ea7n ph\u1ea3i b\u00f9 d\u1ecbch t\u00edch c\u1ef1c.<\/p>\n

+ \u00dd ngh\u0129a l\u00e2m s\u00e0ng thang \u0111i\u1ec3m ATS: Ch\u1ec9 \u0111\u1ecbnh nh\u1eadp khoa \u0110i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c cho b\u1ec7nh nh\u00e2n c\u00f3 \u2265 3 ti\u00eau chu\u1ea9n ph\u1ee5 hay \u2265 1 ti\u00eau chu\u1ea9n ch\u00ednh.<\/p>\n

Ngu\u1ed3n<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn c\u1ee7a B\u1ed9 Y t\u1ebf 2020.<\/p>\n","protected":false},"excerpt":{"rendered":"

B\u1ed9 Y t\u1ebf \u0111\u00e3 ban h\u00e0nh Quy\u1ebft \u0111\u1ecbnh s\u1ed1 4815\/Q\u0110-BYT v\u00e0o 22\/11\/2020 v\u1ec1 vi\u1ec7c ban h\u00e0nh t\u00e0i li\u1ec7u chuy\u00ean m\u00f4n \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn\u201d. H\u01b0\u1edbng d\u1eabn nh\u1ea5n m\u1ea1nh, ti\u00eam ph\u00f2ng c\u00fam \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c ph\u00f2ng b\u1ec7nh vi\u00eam ph\u1ed5i, \u0111\u1eb7c […]<\/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":"\nCh\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn theo B\u1ed9 Y t\u1ebf 2020<\/title>\n<meta name=\"description\" content=\"T\u00e0i li\u1ec7u \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn\u201d \u0111\u01b0\u1ee3c B\u1ed9 Y t\u1ebf cho ph\u00e9p \u00e1p d\u1ee5ng t\u1ea1i c\u00e1c c\u01a1 s\u1edf kh\u00e1m b\u1ec7nh\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, 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