{"id":18166,"date":"2023-04-13T16:19:24","date_gmt":"2023-04-13T09:19:24","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=18166"},"modified":"2023-04-13T18:55:56","modified_gmt":"2023-04-13T11:55:56","slug":"chi-dinh-tu-the-nam-sap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/chi-dinh-tu-the-nam-sap\/","title":{"rendered":"Th\u00f4ng kh\u00ed t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p: Ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 bi\u1ebfn ch\u1ee9ng"},"content":{"rendered":"<p><strong>Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc n\u1eb1m s\u1ea5p l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng kh\u00ed \u0111\u01b0\u1ee3c cung c\u1ea5p khi b\u1ec7nh nh\u00e2n trong t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p. \u0110\u00e2y l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (ARDS) nh\u1eb1m c\u1ea3i thi\u1ec7n s\u1ef1 oxy h\u00f3a khi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng kh\u00ed truy\u1ec1n th\u1ed1ng kh\u00f4ng \u0111\u1ee7 hi\u1ec7u qu\u1ea3 (v\u00ed d\u1ee5: th\u00f4ng kh\u00ed \u00a0b\u1ea3o v\u1ec7 ph\u1ed5i). C\u00e1c ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 m\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng li\u00ean quan \u0111\u1ebfn ph\u01b0\u01a1ng ph\u00e1p n\u00e0y s\u1ebd gi\u1edbi thi\u1ec7u trong b\u00e0i vi\u1ebft.<\/strong><\/p>\n<h2>1. Ch\u1ec9 \u0111\u1ecbnh t\u01b0 th\u1ec3 n\u1eb1m s\u1ea5p trong \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p<\/h2>\n<figure style=\"width: 521px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"\" src=\"https:\/\/cafefcdn.com\/2020\/4\/17\/photo-1-15871290544611664576153.jpg\" alt=\"Tu-the-nam-sap-trong-dieu-tri-ARDS\" width=\"521\" height=\"293\" \/><figcaption class=\"wp-caption-text\">T\u01b0 th\u1ebf n\u1eb1m s\u1ea5p trong \u0111i\u1ec1u tr\u1ecb ARDS<\/figcaption><\/figure>\n<p>Trong \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (ARDS), vi\u1ec7c kh\u1edfi \u0111\u1ed9ng chi\u1ebfn l\u01b0\u1ee3c th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i l\u00e0 b\u01b0\u1edbc n\u1ec1n t\u1ea3ng \u0111\u1ea7u ti\u00ean \u0111\u1ec3 gi\u1ea3m thi\u1ec3u t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i v\u00e0 c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng h\u00f4 h\u1ea5p. Tuy nhi\u00ean, n\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng ho\u1eb7c th\u1ea5t b\u1ea1i trong vi\u1ec7c t\u1ed1i \u01b0u h\u00f3a c\u00e0i \u0111\u1eb7t th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i, th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc n\u1eb1m s\u1ea5p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung, mi\u1ec5n l\u00e0 kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. T\u01b0 th\u1ebf n\u1eb1m s\u1ea5p c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ea5t nhi\u1ec1u trong \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh nh\u00e2n suy h\u00f4 h\u1ea5p n\u1eb7ng do SARS-CoV-2 \u1edf nhi\u1ec1u n\u01b0\u1edbc tr\u00ean th\u1ebf gi\u1edbi trong \u0111\u00f3 c\u00f3 Vi\u1ec7t Nam. T\u01b0 th\u1ebf n\u00e0y \u0111\u01b0\u1ee3c \u0111\u1eb7c bi\u1ec7t s\u1eed d\u1ee5ng nhi\u1ec1u trong b\u1ed1i c\u1ea3nh b\u1ec7nh nh\u00e2n nguy k\u1ecbch h\u00f4 h\u1ea5p n\u1eb7ng khi \u0111i\u1ec1u ki\u1ec7n c\u1ee7a c\u01a1 s\u1edf y t\u1ebf c\u00f3 gi\u1edbi h\u1ea1n, kh\u00f4ng th\u1ec3 kh\u1edfi \u0111\u1ed9ng c\u00e1c can thi\u1ec7p t\u00edch c\u1ef1c h\u01a1n nh\u01b0 ECMO.<\/p>\n<p>Nh\u01b0 v\u1eady, ch\u1ec9 \u0111\u1ecbnh ch\u1ee7 y\u1ebfu c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng kh\u00ed n\u1eb1m s\u1ea5p l\u00e0 ARDS m\u1ee9c \u0111\u1ed9 n\u1eb7ng, kh\u00f4ng th\u00e0nh c\u00f4ng v\u1edbi chi\u1ebfn l\u01b0\u1ee3c th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i. T\u01b0 th\u1ebf n\u1eb1m s\u1ea5p kh\u00f4ng \u00a0gi\u00fap \u00edch \u0111\u00e1ng k\u1ec3 cho nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc ARDS nh\u1eb9 ho\u1eb7c v\u1eeba. M\u1ed9t s\u1ed1 \u00a0d\u1ea5u hi\u1ec7u m\u00e0 t\u01b0 th\u1ebf \u00a0n\u1eb1m s\u1ea5p c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i:<\/p>\n<ul>\n<li>H\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p n\u1eb7ng &#8211; PROSEVA \u0111\u1ecbnh ngh\u0129a h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p n\u1eb7ng l\u00e0 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u1ef7 l\u1ec7 ph\u00e2n \u00e1p oxy \u0111\u1ed9ng m\u1ea1ch\/n\u1ed3ng \u0111\u1ed9 oxy trong kh\u00ed h\u00edt v\u00e0o (PaO2:FiO2) &lt;150 mmHg v\u1edbi FiO2 \u22650,6 v\u00e0 PEEP \u22655 cm H2O; t\u1ea1i th\u1eddi \u0111i\u1ec3m nh\u1eadp vi\u1ec7n, PaO2 trung b\u00ecnh l\u00e0 80 mmHg, FiO2 l\u00e0 0.8 \u00a0v\u00e0 t\u1ef7 l\u1ec7 PaO2: FiO2 l\u00e0 100 mmHg.<\/li>\n<li>Gi\u1ea3m oxy m\u00e1u kh\u00f3 \u0111i\u1ec1u tr\u1ecb do ARDS &#8211; \u0111\u1ecbnh ngh\u0129a \u00a0l\u00e0 t\u1ef7 l\u1ec7 PaO2: FiO2 \u2264100 mmHg v\u1edbi PaO2 \u226460 mmHg m\u1eb7c d\u00f9 c\u00e1c thi\u1ebft l\u1eadp th\u00f4ng kh\u00ed \u0111\u00e3 \u0111\u01b0\u1ee3c t\u1ed1i \u01b0u h\u00f3a \u1edf FiO2=1<\/li>\n<li>\u0110\u00f4i khi t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1edd \u0111\u1ee3i thi\u1ebft l\u1eadp ECMO khi \u0111\u00e3 c\u00f3 ch\u1ec9 \u0111\u1ecbnh c\u1ee7a ECMO.<\/li>\n<\/ul>\n<h2>2. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p<\/h2>\n<h3>2.1 Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i<\/h3>\n<ul>\n<li>Ch\u1ea3y m\u00e1u c\u1ea5p t\u00ednh nh\u01b0 s\u1ed1c ch\u1ea3y m\u00e1u ho\u1eb7c cho ra m\u00e1u, v\u00ec t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p c\u00f3 th\u1ec3 l\u00e0m t\u0103ng ch\u1ea3y m\u00e1u v\u00e0 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng kh\u00e1c.<\/li>\n<li>\u0110a ch\u1ea5n th\u01b0\u01a1ng ho\u1eb7c g\u00e3y x\u01b0\u01a1ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c g\u00e3y x\u01b0\u01a1ng kh\u00f4ng v\u1eefng \u1edf c\u00e1c v\u1ecb tr\u00ed nh\u01b0: \u0111\u00f9i, ch\u1eadu ho\u1eb7c m\u1eb7t, v\u00ec t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p c\u00f3 th\u1ec3 g\u00e2y ra th\u00eam t\u1ed5n th\u01b0\u01a1ng cho c\u00e1c v\u00f9ng n\u00e0y v\u00e0 l\u00e0m tr\u1ea7m tr\u1ecdng t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n<li>C\u1ed9t s\u1ed1ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh, v\u00ec t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u1ed5n th\u01b0\u01a1ng cho t\u1ee7y s\u1ed1ng ho\u1eb7c c\u1ed9t s\u1ed1ng v\u00e0 d\u1eabn \u0111\u1ebfn y\u1ebfu li\u1ec7t ho\u1eb7c c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng kh\u00e1c.<\/li>\n<li>\u00c1p l\u1ef1c n\u1ed9i s\u1ecd t\u0103ng h\u01a1n 30 mmHg ho\u1eb7c \u00e1p l\u1ef1c t\u01b0\u1edbi m\u00e1u n\u00e3o th\u1ea5p h\u01a1n 60 mmHg, v\u00ec t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p c\u00f3 th\u1ec3 l\u00e0m t\u0103ng \u00e1p l\u1ef1c trong s\u1ecd v\u00e0 l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c t\u01b0\u1edbi m\u00e1u n\u00e3o<\/li>\n<li>Ph\u1eabu thu\u1eadt kh\u00ed qu\u1ea3n ho\u1eb7c c\u1eaft x\u01b0\u01a1ng \u1ee9c trong v\u00f2ng hai tu\u1ea7n, v\u00ec t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p c\u00f3 th\u1ec3 l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn qu\u00e1 tr\u00ecnh h\u1ed3i ph\u1ee5c v\u00e0 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng.<\/li>\n<\/ul>\n<h3>2.2 Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i<\/h3>\n<ul>\n<li>S\u1ed1c (v\u00ed d\u1ee5: \u00e1p su\u1ea5t \u0111\u1ed9ng m\u1ea1ch trung b\u00ecnh &lt;65 mmHg k\u00e9o d\u00e0i)<\/li>\n<li>Ph\u1eabu thu\u1eadt v\u00f9ng b\u1ee5ng g\u1ea7n \u0111\u00e2y<\/li>\n<li>G\u1eafn m\u00e1y t\u1ea1o nh\u1ecbp tim g\u1ea7n \u0111\u00e2y<\/li>\n<li>B\u1ecfng n\u1eb7ng<\/li>\n<li>C\u00e1c tr\u01b0\u1eddng h\u1ee3p tri\u1ec3n v\u1ecdng s\u1ed1ng gi\u1edbi h\u1ea1n \u0111\u00e1ng k\u1ec3 (suy h\u00f4 h\u1ea5p ph\u1ee5 thu\u1ed9c oxy hay m\u00e1y th\u1edf)<\/li>\n<\/ul>\n<h2>3. Bi\u1ebfn ch\u1ee9ng c\u1ee7a th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc t\u01b0 th\u1ec3 n\u1eb1m s\u1ea5p<\/h2>\n<ul>\n<li>Ch\u00e8n \u00e9p th\u1ea7n kinh (v\u00ed d\u1ee5 nh\u01b0 \u0111\u00e1m r\u1ed1i c\u00e1nh tay)<\/li>\n<li>T\u1eafc ngh\u1ebdn l\u01b0u th\u00f4ng t\u0129nh m\u1ea1ch (g\u00e2y ph\u00f9 m\u1eb7t)<\/li>\n<li>L\u1ec7ch \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n<\/li>\n<li>Lo\u00e9t do t\u1ef3 \u0111\u00e8<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng m\u1eaft<\/li>\n<li>N\u00f4n \u00f3i<\/li>\n<li>Lo\u1ea1n nh\u1ecbp tho\u00e1ng qua<\/li>\n<li>Gi\u1ea3m oxy m\u00e1u tho\u00e1ng qua<\/li>\n<\/ul>\n<p>C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i c\u1ee7a th\u00f4ng kh\u00ed t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n v\u1eabn ch\u01b0a \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 th\u1ed1ng nh\u1ea5t. C\u00e1c b\u1eb1ng ch\u1ee9ng \u0111\u01b0\u1ee3c \u0111\u01b0a ra hi\u1ec7n t\u1ea1i ch\u01b0a th\u1ec3 k\u1ebft lu\u1eadn v\u1ec1 c\u00e1c t\u00e1c \u0111\u1ed9ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p so s\u00e1nh v\u1edbi t\u01b0 th\u1ebf n\u1eb1m ng\u1eeda truy\u1ec1n th\u1ed1ng. Do \u0111\u00f3, vi\u1ec7c quy\u1ebft \u0111\u1ecbnh s\u1eed d\u1ee5ng t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p cho b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u01b0a ra sau khi \u0111\u00e1nh gi\u00e1 k\u1ef9 l\u01b0\u1ee1ng c\u00e1c y\u1ebfu t\u1ed1 r\u1ee7i ro v\u00e0 l\u1ee3i \u00edch li\u00ean quan \u0111\u1ebfn t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3.<\/p>\n<p>T\u00f3m l\u1ea1i, t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n m\u1eafc ARDS n\u1eb7ng v\u00e0 kh\u00f3 \u0111i\u1ec1u tr\u1ecb. Tuy nhi\u00ean, c\u1ea7n l\u01b0u \u00fd r\u1eb1ng t\u01b0 th\u1ebf n\u00e0y c\u00f3 nhi\u1ec1u ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00f4ng mong mu\u1ed1n. B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 k\u1ef9 l\u01b0\u1ee1ng \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh s\u1eed d\u1ee5ng t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p v\u00e0 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 c\u00f3.<\/p>\n<p>Khi s\u1eed d\u1ee5ng m\u00e1y th\u1edf nh\u00e2n t\u1ea1o, 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 k\u1ef9 thu\u1eadt ti\u1ebfn b\u1ed9 v\u00e0 cung c\u1ea5p ch\u0103m s\u00f3c t\u1ed1t nh\u1ea5t cho b\u1ec7nh nh\u00e2n.<\/p>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/p>\n<p>Douglas WW, Rehder K, Beynen FM, Sessler AD, Marsh HM. Improved oxygenation in patients with acute respiratory failure: the prone position. Am Rev Respir Dis. 1977 Apr;115(4):559-66. doi: 10.1164\/arrd.1977.115.4.559.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc n\u1eb1m s\u1ea5p l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng kh\u00ed \u0111\u01b0\u1ee3c cung c\u1ea5p khi b\u1ec7nh nh\u00e2n trong t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p. \u0110\u00e2y l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (ARDS) nh\u1eb1m c\u1ea3i thi\u1ec7n s\u1ef1 oxy h\u00f3a khi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng kh\u00ed truy\u1ec1n th\u1ed1ng [&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>Th\u00f4ng kh\u00ed t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p: Ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 bi\u1ebfn ch\u1ee9ng -<\/title>\n<meta name=\"description\" content=\"Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc n\u1eb1m s\u1ea5p l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng kh\u00ed \u0111\u01b0\u1ee3c cung c\u1ea5p khi b\u1ec7nh nh\u00e2n trong t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p. 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