{"id":19049,"date":"2023-04-13T15:56:05","date_gmt":"2023-04-13T08:56:05","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19049"},"modified":"2023-04-13T18:07:43","modified_gmt":"2023-04-13T11:07:43","slug":"tieu-chuan-berlin-trong-chan-doan-hoi-chung-nguy-kich-ho-hap-cap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/tieu-chuan-berlin-trong-chan-doan-hoi-chung-nguy-kich-ho-hap-cap\/","title":{"rendered":"Ti\u00eau chu\u1ea9n Berlin trong ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p"},"content":{"rendered":"<p><strong>H\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (ARDS) l\u00e0 m\u1ed9t d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i n\u1eb7ng v\u00e0 nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c g\u00e2y ra b\u1edfi nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau. B\u1ec7nh l\u00fd n\u00e0y \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u1ed5n th\u01b0\u01a1ng vi\u00eam lan r\u1ed9ng trong ph\u1ed5i, d\u1eabn \u0111\u1ebfn s\u1ef1 suy gi\u1ea3m trao \u0111\u1ed5i kh\u00ed v\u00e0 suy h\u00f4 h\u1ea5p. Nh\u1eadn bi\u1ebft v\u00e0 \u0111i\u1ec1u tr\u1ecb ARDS k\u1ecbp th\u1eddi l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong li\u00ean quan \u0111\u1ebfn b\u1ec7nh l\u00fd n\u00e0y. C\u00e1c nh\u00e0 l\u00e2m s\u00e0ng th\u01b0\u1eddng d\u00f9ng b\u1ed9 ti\u00eau chu\u1ea9n Berlin \u0111\u1ec3 ch\u1ea5n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 c\u1ee7a ARDS.\u00a0<\/strong><\/p>\n<h2>1. Nguy\u00ean nh\u00e2n c\u1ee7a ARDS<\/h2>\n<p>H\u01a1n 60 nguy\u00ean nh\u00e2n kh\u1ea3 d\u0129 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ARDS \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. C\u00e1c nguy\u00ean nh\u00e2n ti\u1ec1m n\u0103ng kh\u00e1c ti\u1ebfp t\u1ee5c xu\u1ea5t hi\u1ec7n khi c\u00e0ng ng\u00e0y c\u00e0ng c\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb m\u1edbi b\u1eaft \u0111\u1ea7u \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng v\u00e0 t\u00e1c \u0111\u1ed9ng x\u1ea5u l\u00ean h\u1ec7 h\u00f4 h\u1ea5p c\u1ee7a nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p n\u00e0y b\u1eaft \u0111\u1ea7u \u0111\u01b0\u1ee3c ghi nh\u1eadn. Tuy nhi\u00ean, c\u00f3 m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn gi\u1ea3i th\u00edch cho ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p ARDS. Ngo\u00e0i ra c\u00f2n c\u00f3 nh\u1eefng y\u1ebfu t\u1ed1 b\u1ec7nh l\u00fd kh\u00e1c \u0111\u00f3ng vai tr\u00f2 l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y c\u1ee7a ARDS. M\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a ARDS \u0111\u01b0\u1ee3c ch\u1ecdn l\u1ecdc \u0111\u1ec3 gi\u1edbi thi\u1ec7u trong b\u00e0i vi\u1ebft n\u00e0y:<\/p>\n<ul>\n<li>Nhi\u1ec5m tr\u00f9ng huy\u1ebft &#8211; \u0110\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a ARDS. C\u00e1c t\u00ednh tr\u1ea1ng li\u00ean quan \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng n\u1eb7ng n\u00ean lu\u00f4n l\u00e0 nguy\u00ean nh\u00e2n \u0111\u1ea7u ti\u00ean c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t khi ARDS ph\u00e1t tri\u1ec3n \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 nhi\u1ec5m tr\u00f9ng nghi\u00eam ho\u1eb7c li\u00ean quan \u0111\u1ebfn s\u1ed1t m\u1edbi xu\u1ea5t hi\u1ec7n. Nguy c\u01a1 ti\u1ebfn tri\u1ec3n ARDS \u0111\u1eb7c bi\u1ec7t cao \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m tr\u00f9ng n\u1eb7ng v\u00e0 ti\u1ec1n s\u1eed nghi\u1ec7n r\u01b0\u1ee3u.<\/li>\n<li>H\u00edt s\u1eb7c &#8211; Nghi\u00ean c\u1ee9u kinh \u0111i\u1ec3n c\u1ee7a Mendelson cho th\u1ea5y h\u00edt ph\u1ea3i c\u00e1c ch\u1ea5t ti\u1ebft t\u1eeb d\u1ea1 d\u00e0y c\u00f3 pH&lt;2.5 c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y t\u1ed5n th\u01b0\u01a1ng r\u1ed9ng r\u00e3i nhu m\u00f4 ph\u1ed5i v\u00e0 d\u1eabn \u0111\u1ebfn ARDS. \u00a0G\u1ea7n c\u00e1c nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt ti\u1ebfp t\u1ee5c cho th\u1ea5y h\u00edt ph\u1ea3i c\u00e1c ch\u1ea5t d\u1ecbch t\u1eeb d\u1ea1 d\u00e0y kh\u00f4ng c\u00f3 ho\u1eb7c \u00edt c\u00f3 t\u00ednh axit c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra t\u1ed5n th\u01b0\u01a1ng r\u1ed9ng r\u00e3i \u0111\u1ebfn ph\u1ed5i. \u0110i\u1ec1u n\u00e0y ch\u1ee9ng t\u1ecf c\u00e1c men ti\u00eau h\u00f3a \u1edf d\u1ea1 d\u00e0y v\u00e0 c\u00e1c h\u1ea1t th\u1ee9c \u0103n nh\u1ecf c\u0169ng \u0111\u00f3ng g\u00f3p v\u00e0o t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i. \u00a0C\u00e1c d\u1eef ki\u1ec7n t\u1eeb c\u00e1c nguy\u00ean c\u1ee9u quan s\u00e1t ch\u1ec9 ra r\u1eb1ng ARDS xu\u1ea5t hi\u1ec7n \u1edf kho\u1ea3ng 1\/3 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e0 c\u00f3 c\u00e1c \u0111\u1ee3t h\u00edt s\u1eb7c ch\u1ea5t d\u1ecbch t\u1eeb d\u1ea1 d\u00e0y.<\/li>\n<li>Vi\u00eam ph\u1ed5i &#8211; \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p ARDS xu\u1ea5t hi\u1ec7n t\u1eeb b\u00ean ngo\u00e0i b\u1ec7nh vi\u1ec7n, vi\u00eam ph\u1ed5i c\u00f3 l\u1ebd l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t. C\u00e1c t\u00e1c nh\u00e2n g\u00e2y vi\u00eam ph\u1ed5i c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ARDS c\u0169ng r\u1ea5t \u0111a d\u1ea1ng, b\u00e0o g\u1ed3m t\u1eeb ph\u1ebf c\u1ea7u kinh \u0111i\u1ec3n, t\u1ee5 c\u1ea7u v\u00e0ng,<em> Legionella pneumophila, \u00a0Pneumocystis jirovecii,<\/em> c\u00e1c tr\u1ef1c khu\u1ea9n Gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t hay c\u00e1c vi r\u00fat \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p (\u0111\u1eb7c bi\u1ec7t l\u00e0 SARS-CoV-2 trong nh\u1eefng n\u0103m \u0111\u1ea1i d\u1ecbch g\u1ea7n \u0111\u00e2y). \u0110\u1ed1i v\u1edbi vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i \u1edf b\u1ec7nh vi\u1ec7n di\u1ec5n ti\u1ebfn \u0111\u1ebfn ARDS, c\u00e1c t\u00e1c nh\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0 t\u1ee5 c\u1ea7u v\u00e0ng, tr\u1ef1c khu\u1ea9n m\u1ee7 xanh v\u00e0 c\u00e1c tr\u1ef1c khu\u1ea9n Gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t kh\u00e1c.<\/li>\n<li>Ch\u1ea5n th\u01b0\u01a1ng n\u1eb7ng &#8211; ARDS l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng n\u1eb7ng \u00a0v\u1edbi t\u1ef7 l\u1ec7 xu\u1ea5t hi\u1ec7n kho\u1ea3ng 10%. M\u1ed9t s\u1ed1 t\u00ecnh hu\u1ed1ng th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn ARDS li\u00ean quan ch\u1ea5n th\u01b0\u01a1ng nh\u01b0: D\u1eadp ph\u1ed5i hai b\u00ean do ch\u1ea5n th\u01b0\u01a1ng ng\u1ef1c k\u00edn, thuy\u00ean t\u1eafc m\u1ee1 do g\u00e3y x\u01b0\u01a1ng d\u00e0i, nhi\u1ec5m tr\u00f9ng v\u1ebft th\u01b0\u01a1ng hay v\u1ebft b\u1ecfng<\/li>\n<li>Truy\u1ec1n m\u00e1u &#8211; Truy\u1ec1n nhi\u1ec1u ch\u1ebf ph\u1ea9m m\u00e1u c\u0169ng l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y ARDS.<\/li>\n<\/ul>\n<h2>2. Ti\u00eau chu\u1ea9n Berlin trong ch\u1ea9n \u0111o\u00e1n ARDS<\/h2>\n<p>N\u0103m 2011, Hi\u00eap h\u1ed9i h\u1ed3i s\u1ee9c Ch\u00e2u \u00c2u (European Society of Intensive Care Medicine) x\u00e2y d\u1ef1ng b\u1ed9 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n ARDS v\u00e0 gi\u1edbi thi\u1ec7u t\u1ea1i H\u1ed9i ngh\u1ecb \u00c2u &#8211; M\u1ef9 th\u1ed1ng nh\u1ea5t v\u1ec1 ARDS t\u1ea1i Berlin n\u0103m 2012. B\u1ed9 ti\u00eau chu\u1ea9n g\u1ed3m 4 ti\u00eau ch\u1ec9 chu\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n \u0111\u1ed9 ARDS d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 thi\u1ebfu oxy m\u00e1u.<\/p>\n<h3>2.1 Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n<\/h3>\n<p>Theo ti\u00eau chu\u1ea9n Berlin n\u0103m 2012, H\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (ARDS) \u0111\u01b0\u1ee3c chu\u1ea9n \u0111o\u00e1n khi \u0111\u00e1p \u1ee9ng \u0111\u1ee7 c\u1ea3 04 ti\u00eau ch\u00ed sau:<\/p>\n<ul>\n<li>C\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p ph\u1ea3i b\u1eaft \u0111\u1ea7u trong v\u00f2ng m\u1ed9t tu\u1ea7n sau m\u1ed9t s\u1ef1 t\u1ed5n th\u01b0\u01a1ng \u0111\u00e3 bi\u1ebft tr\u01b0\u1edbc tr\u00ean l\u00e2m s\u00e0ng ho\u1eb7c b\u1ec7nh nh\u00e2n ph\u1ea3i c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng m\u1edbi ho\u1eb7c tri\u1ec7u ch\u1ee9ng tr\u1edf n\u00ean n\u1eb7ng h\u01a1n trong tu\u1ea7n qua.<\/li>\n<li>C\u1ea3 hai ph\u1ebf tr\u01b0\u1eddng c\u00f3 h\u00ecnh \u1ea3nh th\u00e2m nhi\u1ec5m m\u1edd tr\u00ean X-quang ho\u1eb7c phim CT m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch ho\u00e0n to\u00e0n b\u1edfi tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, x\u1eb9p th\u00f9y ph\u1ed5i, x\u1eb9p ph\u1ed5i hay c\u00e1c n\u1ed1t \u1edf ph\u1ed5i.<\/li>\n<li>Suy h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch ho\u00e0n to\u00e0n b\u1edfi suy tim ho\u1eb7c qu\u00e1 t\u1ea3i d\u1ecbch.<\/li>\n<li>B\u1ec7nh nh\u00e2n ph\u1ea3i c\u00f3 s\u1ef1 suy gi\u1ea3m kh\u1ea3 n\u0103ng oxy h\u00f3a m\u00e1u c\u1ee7a ph\u1ed5i, theo \u0111\u1ecbnh ngh\u0129a c\u1ee7a t\u1ec9 l\u1ec7 ph\u00e2n \u00e1p oxy \u0111\u1ed9ng m\u1ea1ch\/n\u1ed3ng \u0111\u1ed9 oxy kh\u00ed h\u00edt v\u00e0o (PaO2\/FiO2) \u2264 300 khi th\u1edf v\u1edbi \u00e1p l\u1ef1c d\u01b0\u01a1ng cu\u1ed1i th\u00ec th\u1edf ra \u00a0(PEEP) \u2265 \u00a05 cmH2O.<\/li>\n<\/ul>\n<figure style=\"width: 291px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"r48jcc pT0Scc iPVvYb\" src=\"https:\/\/vinmec-prod.s3.amazonaws.com\/images\/20201226_023352_281218_ARDS.max-800x800.jpg\" alt=\"Minh-hoa-hoi-chung-ARDS\" width=\"291\" height=\"281\" \/><figcaption class=\"wp-caption-text\">Minh h\u1ecda h\u1ed9i ch\u1ee9ng ARDS<\/figcaption><\/figure>\n<h3>2.2 Ph\u00e2n \u0111\u1ed9 ARDS<\/h3>\n<p>ARDS \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh 3 m\u1ee9c \u0111\u1ed9 nh\u1eb9 &#8211; trung b\u00ecnh &#8211; n\u1eb7ng d\u1ef1a tr\u00ean t\u1ef7 s\u00f3 PaO2\/FiO2 v\u1edbi PEEP \u2265 \u00a05 cmH2O. \u0110\u1ec3 x\u00e1c \u0111\u1ecbnh t\u1ec9 l\u1ec7 PaO2\/FiO2, c\u1ea7n ph\u1ea3i ph\u00e2n t\u00edch kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch. \u0110\u1ec3 t\u00ednh to\u00e1n t\u1ec9 l\u1ec7 PaO2\/FiO2, c\u1ea7n \u0111o PaO2 t\u00ednh b\u1eb1ng mmHg v\u00e0 FiO2 \u0111\u01b0\u1ee3c bi\u1ec3u th\u1ecb d\u01b0\u1edbi d\u1ea1ng m\u1ed9t s\u1ed1 th\u1eadp ph\u00e2n c\u00f3 gi\u00e1 tr\u1ecb t\u1eeb 0,21 \u0111\u1ebfn 1.<\/p>\n<ul>\n<li>Nh\u1eb9: \u00a0 200 &lt; PaO2\/FiO2 \u2264 300 v\u1edbi PEEP \u2265 \u00a05 cmH2O<\/li>\n<li>Trung b\u00ecnh: 100&lt; PaO2\/FiO2 \u2264 200 v\u1edbi PEEP \u2265 \u00a05 cmH2O<\/li>\n<li>N\u1eb7ng: PaO2\/FiO2 &lt; 100 v\u1edbi PEEP \u2265 \u00a05 cmH2O<\/li>\n<\/ul>\n<p>Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n s\u1edbm ARDS l\u00e0 v\u00f4 c\u00f9ng quan tr\u1ecdng \u0111\u1ec3 \u0111\u01b0a ra li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 v\u00e0 gi\u1ea3m thi\u1ec3u t\u1ef7 l\u1ec7 t\u1eed vong. T\u1ea1i B\u1ec7nh vi\u1ec7n \u0110a khoa qu\u1ed1c t\u1ebf <a href=\"https:\/\/www.vinmec.com\/vi\/dangkykham\/\">Vinmec<\/a>, ch\u00fang t\u00f4i c\u00f3 \u0111\u1ed9i ng\u0169 b\u00e1c s\u0129 chuy\u00ean m\u00f4n v\u00e0 gi\u00e0u kinh nghi\u1ec7m trong vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ARDS, \u0111\u1ea3m b\u1ea3o t\u1ed1i \u0111a kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/p>\n<p>The ARDS Definition Task Force*. Acute Respiratory Distress Syndrome<span class=\"subtitle\"><span class=\"colon-for-citation-subtitle\">: <\/span>The Berlin Definition<\/span>. <em>JAMA<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>H\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (ARDS) l\u00e0 m\u1ed9t d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i n\u1eb7ng v\u00e0 nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c g\u00e2y ra b\u1edfi nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau. B\u1ec7nh l\u00fd n\u00e0y \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u1ed5n th\u01b0\u01a1ng vi\u00eam lan r\u1ed9ng trong ph\u1ed5i, d\u1eabn \u0111\u1ebfn s\u1ef1 suy gi\u1ea3m trao \u0111\u1ed5i kh\u00ed v\u00e0 [&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>Ti\u00eau chu\u1ea9n Berlin trong ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p - Vinmec<\/title>\n<meta name=\"description\" content=\"Nh\u1eadn bi\u1ebft v\u00e0 \u0111i\u1ec1u tr\u1ecb ARDS k\u1ecbp th\u1eddi l\u00e0 r\u1ea5t quan tr\u1ecdng . 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