{"id":1987,"date":"2023-04-12T18:18:35","date_gmt":"2023-04-12T11:18:35","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=1987"},"modified":"2023-04-13T16:01:40","modified_gmt":"2023-04-13T09:01:40","slug":"auto-peep-trong-tho-may","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/auto-peep-trong-tho-may\/","title":{"rendered":"T\u00ecnh tr\u1ea1ng Auto-PEEP trong th\u1edf m\u00e1y: Nguy\u00ean nh\u00e2n, h\u1eadu qu\u1ea3 v\u00e0 x\u1eed tr\u00ed"},"content":{"rendered":"<div class=\"mceTemp\"><\/div>\n<p><strong>Auto-PEEP, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 intrinsic PEEP ho\u1eb7c PEEPi, l\u00e0 t\u00ecnh tr\u1ea1ng x\u1ea3y ra khi kh\u00f4ng th\u1edf h\u1ebft kh\u00f4ng kh\u00ed ra kh\u1ecfi ph\u1ed5i trong th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o, d\u1eabn \u0111\u1ebfn s\u1ef1 t\u00edch t\u1ee5 c\u1ee7a \u00e1p su\u1ea5t d\u01b0\u01a1ng cu\u1ed1i th\u00ec th\u1edf ra (PEEP) b\u00ean trong \u0111\u01b0\u1eddng th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng, bao g\u1ed3m t\u1ed5n th\u01b0\u01a1ng h\u00f4 h\u1ea5p do \u00e1p l\u1ef1c , gi\u1ea3m h\u1ed3i l\u01b0u t\u0129nh m\u1ea1ch v\u1ec1 tim v\u00e0 gi\u1ea3m l\u01b0\u1ee3ng oxy cung c\u1ea5p cho c\u00e1c m\u00f4. V\u00ec v\u1eady, c\u1ea7n ph\u1ea3i hi\u1ec3u r\u00f5 nguy\u00ean nh\u00e2n, c\u00e1c ch\u1ea9n \u0111o\u00e1n v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p qu\u1ea3n l\u00fd auto-PEEP.<\/strong><\/p>\n<figure style=\"width: 532px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"r48jcc pT0Scc iPVvYb\" src=\"https:\/\/rc.rcjournal.com\/content\/respcare\/59\/11\/1773\/F2.large.jpg\" alt=\"Minh-hoa-auto-PEEP\" width=\"532\" height=\"416\" \/><figcaption class=\"wp-caption-text\">Auto-PEEP trong th\u1edf m\u00e1y<\/figcaption><\/figure>\n<h2>1. Nguy\u00ean nh\u00e2n c\u1ee7a auto-PEEP<\/h2>\n<p>C\u00f3 nhi\u1ec1u l\u00fd do khi\u1ebfn b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o \u00e1p l\u1ef1c d\u01b0\u01a1ng h\u00ecnh th\u00e0nh t\u00ecnh tr\u1ea1ng auto-PEEP<\/p>\n<ul>\n<li>Th\u1ec3 t\u00edch th\u00f4ng kh\u00ed ph\u00fat (Minute ventilation) qu\u00e1 l\u1edbn: Th\u1edf m\u00e1y v\u1edbi th\u1ec3 t\u00edch th\u00f4ng kh\u00ed ph\u00fat qu\u00e1 \u00a0l\u1edbn x\u1ea3y ra khi c\u00f3 th\u1ec3 t\u00edch l\u01b0u th\u00f4ng (th\u1ec3 t\u00edch kh\u00ed trao \u0111\u1ed5i trong m\u1ed7i nh\u1ecbp th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n hay Tidal volume &#8211; VT) l\u1edbn kh\u00f4ng ph\u00f9 h\u1ee3p (l\u1edbn h\u01a1n dung t\u00edch c\u1eb7n ch\u1ee9c n\u0103ng c\u1ee7a b\u1ec7nh nh\u00e2n) ho\u1eb7c t\u1ea7n s\u1ed1 th\u1edf qu\u00e1 cao ho\u1eb7c c\u1ea3 hai.<\/li>\n<li>Th\u1eddi gian h\u00edt v\u00e0o (IT) k\u00e9o d\u00e0i: K\u00e9o d\u00e0i th\u1eddi gian c\u1ee7a th\u00ec h\u00edt v\u00e0o c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng oxy h\u00f3a m\u00e1u \u1edf b\u1ec7nh nh\u00e2n b\u1ecb suy h\u00f4 h\u1ea5p kh\u00f3 \u0111i\u1ec1u tr\u1ecb. Khi th\u1eddi gian h\u00edt v\u00e0o t\u0103ng, th\u1eddi gian th\u1edf ra ph\u1ea3i gi\u1ea3m b\u1eaft bu\u1ed9c. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn kh\u00f4ng th\u1edf h\u1ebft th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng ra ngo\u00e0i v\u00e0 d\u1eabn t\u1edbi auto-PEEP<\/li>\n<li>Kh\u00e1ng tr\u1edf cao \u0111\u1ed1i v\u1edbi d\u00f2ng kh\u00ed th\u1edf ra: \u00a0Kh\u00e1ng tr\u1edf l\u01b0u th\u00f4ng d\u00f2ng kh\u00ed (v\u00ed d\u1ee5 nh\u01b0 \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n h\u1eb9p) c\u00f3 th\u1ec3 g\u00e2y ra auto-PEEP b\u1eb1ng c\u00e1ch l\u00e0m suy gi\u1ea3m hay c\u1ea3n tr\u1edf d\u00f2ng kh\u00ed th\u1edf ra.<\/li>\n<li>T\u1ed1c \u0111\u1ed9 d\u00f2ng kh\u00ed th\u1edf ra b\u1ecb gi\u1edbi h\u1ea1n: M\u1ed9t s\u1ed1 b\u1ec7nh c\u1ea3nh l\u00e0m t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng d\u1eabn kh\u00ed trong ph\u1ed5i c\u00f3 th\u1ec3 l\u00e0m gi\u1edbi h\u1ea1n kh\u1ea3 n\u0103ng t\u1ed1ng xu\u1ea5t kh\u00ed b\u00ean trong ph\u1ed5i ra ngo\u00e0i l\u00e0m v\u1eadn t\u1ed1c kh\u00ed th\u1edf ra b\u1ecb gi\u1edbi h\u1ea1n nghi\u00eam tr\u1ecdng. Thay \u0111\u1ed5i su\u1ea5t \u0111\u00e0n (compliance) c\u1ee7a h\u1ec7 h\u00f4 h\u1ea5p (b\u1ec7nh l\u00fd th\u1ea7n kinh c\u01a1 li\u00ean quan c\u00e1c c\u01a1 th\u1edf ra g\u1eafn s\u1ee9c) c\u0169ng c\u00f3 th\u1ec3 gi\u1edbi h\u1ea1n d\u00f2ng kh\u00ed th\u1edf ra<\/li>\n<\/ul>\n<h2>2. H\u1eadu qu\u1ea3 c\u1ee7a auto-PEEP<\/h2>\n<p>C\u00f9ng c\u01a1 ch\u1ebf v\u1edbi PEEP \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ch\u1ee7 \u0111\u1ed9ng, auto-PEEP g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 ti\u00eau c\u1ef1c kh\u00f4ng \u0111\u01a1n thu\u1ea7n ch\u1ec9 ph\u1ee5 thu\u1ed9c v\u00e0o gi\u00e1 tr\u1ecb c\u1ee7a m\u1ee9c PEEP, m\u00e0 l\u00e0 n\u1eb1m \u1edf t\u00e1c \u0111\u1ed9ng c\u1ee7a PEEP l\u00ean \u00e1p l\u1ef1c ph\u1ebf nang cu\u1ed1i th\u00ec h\u00edt v\u00e0o (end-inspiratory alveolar pressure) v\u00e0 \u00e1p l\u1ef1c trung b\u00ecnh trong l\u1ed3ng ng\u1ef1c.<\/p>\n<p>C\u00e1c m\u1ee9c PEEP l\u00e0m t\u0103ng \u00e1p l\u1ef1c b\u00ean trong l\u1ed3ng ng\u1ef1c, nh\u01b0 v\u1eady l\u00e0m c\u1ea3n tr\u1edf qu\u00e1 tr\u00ecnh tr\u1edf v\u1ec1 c\u1ee7a m\u00e1u t\u0129nh m\u1ea1ch (h\u1ed3i l\u01b0u t\u0129nh m\u1ea1ch) v\u00e0 l\u00e0m gi\u1ea3m cung l\u01b0\u1ee3ng tim. \u00a0Auto-PEEP c\u0169ng l\u00e0m t\u0103ng \u00e1p l\u1ef1c ph\u1ebf nang cu\u1ed1i th\u00ec h\u00edt v\u00e0o khi\u1ebfn ph\u1ed5i t\u0103ng nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng do v\u1ee1 ph\u1ebf nang.<\/p>\n<p>Auto-PEEP l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn hi\u1ec7u qu\u1ea3 l\u00ean huy\u1ebft \u0111\u1ed9ng c\u1ee7a th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o \u00e1p l\u1ef1c d\u01b0\u01a1ng, t\u0103ng nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do \u00e1p su\u1ea5t v\u00e0 l\u00e0m cho vi\u1ec7c k\u00edch ho\u1ea1t nh\u1ecbp th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n th\u00f4ng qua m\u00e1y th\u1edf tr\u1edf n\u00ean kh\u00f3 kh\u0103n h\u01a1n. Ngo\u00e0i ra, auto-PEEP c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn \u01b0\u1edbc t\u00ednh sai v\u1ec1 \u00e1p su\u1ea5t ph\u1ebf nang trung b\u00ecnh v\u00e0 kh\u1ea3 n\u0103ng d\u00e3n n\u1edf c\u1ee7a ph\u1ed5i d\u1eabn t\u1edbi nh\u1eefng can thi\u1ec7p kh\u00f4ng ph\u00f9 h\u1ee3p.<\/p>\n<p>Theo m\u1ed9t b\u00e0i b\u00e1o nghi\u00ean c\u1ee9u tr\u00ean t\u1ea1p ch\u00ed American Journal of Respiratory and <a class=\"Markdown_link__9ACHA MarkdownLink_linkifiedLink__KxC9G\">Critical Care Medicine<\/a>, c\u00e1c b\u1ec7nh nh\u00e2n th\u1edf m\u00e1y r\u01a1i v\u00e0o auto-PEEP s\u1ebd d\u1ec5 m\u1eafc c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 gi\u1ea3m kh\u1ea3 n\u0103ng dung n\u1ea1p v\u1edbi th\u1edf m\u00e1y, gi\u1ea3m kh\u1ea3 n\u0103ng oxy h\u00f3a m\u00e1u c\u1ee7a h\u1ec7 h\u00f4 h\u1ea5p, v\u00e0 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i. \u00a0Do \u0111\u00f3, vi\u1ec7c ph\u00e1t hi\u1ec7n v\u00e0 can thi\u1ec7p l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 auto-PEEP \u1edf b\u1ec7nh nh\u00e2n th\u1edf m\u00e1y l\u00e0 r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c duy tr\u00ec s\u1ef1 tho\u1ea3i m\u00e1i v\u00e0 s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n<h2>3. X\u00e1c \u0111\u1ecbnh auto-PEEP<\/h2>\n<p>Auto-PEEP c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng c\u00e1ch th\u1ef1c hi\u1ec7n nghi\u1ec7m ph\u00e1p t\u1ea1m ng\u01b0ng th\u00ec th\u1edf ra (th\u01b0\u1eddng l\u00e0 0,5 \u0111\u1ebfn 1 gi\u00e2y) v\u00e0 sau \u0111\u00f3 \u0111o tr\u1ef1c ti\u1ebfp \u00e1p su\u1ea5t \u0111\u01b0\u1eddng th\u1edf \u1edf cu\u1ed1i th\u00ec th\u1edf ra n\u00e0y. Ngo\u00e0i ra, auto-PEE c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi c\u00e1c d\u1ea1ng s\u00f3ng c\u1ee7a m\u00e1y th\u1edf, nghe ho\u1eb7c s\u1edd (palpation) cho th\u1ea5y l\u01b0u l\u01b0\u1ee3ng kh\u00ed th\u1edf ra v\u1eabn \u0111ang c\u00f2n ti\u1ebfp t\u1ee5c m\u00e0 ch\u01b0a k\u1ebft th\u00fac h\u1eb3n tr\u01b0\u1edbc khi nh\u1ecbp th\u1edf k\u1ebf ti\u1ebfp \u0111\u01b0\u1ee3c k\u00edch ho\u1ea1t. Trong m\u1ed9t nghi\u00ean c\u1ee9u, th\u0103m kh\u00e1m l\u00e2m s\u00e0ng gi\u00fap x\u00e1c \u0111\u1ecbnh auto-PEEP v\u1edbi gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n d\u01b0\u01a1ng v\u00e0 \u00e2m l\u1ea7n l\u01b0\u1ee3t l\u00e0 95% v\u00e0 58%. \u0110i\u1ec1u n\u00e0y cho th\u1ea5y th\u0103m kh\u00e1m l\u00e2m s\u00e0ng r\u1ea5t h\u1eefu \u00edch \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh auto-PEEP \u00a0nh\u01b0ng kh\u00f4ng ph\u1ea3i \u0111\u1ec3 lo\u1ea1i tr\u1eeb auto-PEEP.<\/p>\n<h2>4. X\u1eed tr\u00ed auto-PEEP<\/h2>\n<p>Can thi\u1ec7p ngay l\u1eadp t\u1ee9c l\u00e0 c\u1ea7n thi\u1ebft n\u1ebfu ph\u00e1t hi\u1ec7n auto-PEEP \u0111\u00e1ng k\u1ec3, m\u1ed9t s\u1ed1 bi\u1ec7n ph\u00e1p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc nh\u01b0:<br \/>\n\u25cf Thay \u0111\u1ed5i c\u00e0i \u0111\u1eb7t m\u00e1y th\u1edf: C\u00e1c c\u00e0i \u0111\u1eb7t m\u00e1y th\u1edf n\u00ean \u0111\u01b0\u1ee3c thay \u0111\u1ed5i \u0111\u1ec3 gi\u1ea3m ho\u1eb7c lo\u1ea1i b\u1ecf auto-PEEP. Nh\u1eefng t\u00e1c \u0111\u1ed9ng t\u00e1c gi\u00fap l\u00e0m t\u0103ng th\u1eddi gian c\u1ee7a th\u00ec th\u1edf ra c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i: t\u0103ng t\u1ed1c \u0111\u1ed9 d\u00f2ng kh\u00ed h\u00edt v\u00e0o, gi\u1ea3m t\u1ea7n s\u1ed1 h\u00f4 h\u1ea5p ho\u1eb7c c\u1ea3 hai. Gi\u1ea3m th\u1ec3 t\u00edch th\u1edf ra ho\u1eb7c s\u1eed d\u1ee5ng applied-PEEP \u0111\u1ec3 v\u01b0\u1ee3t qua auto-PEEP c\u0169ng c\u00f3 th\u1ec3 h\u1eefu \u00edch.<br \/>\n\u25cf Gi\u1ea3m nhu c\u1ea7u kh\u00ed th\u1edf: Nhu c\u1ea7u th\u1edf c\u00f3 th\u1ec3 gi\u1ea3m b\u1eb1ng c\u00e1ch gi\u1ea3m l\u01b0\u1ee3ng carbohydrate, lo \u00e2u, \u0111au \u0111\u1edbn ho\u1eb7c s\u1ed1t. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 gi\u1ea3m nhu c\u1ea7u kh\u00ed \u00a0th\u1edf tr\u00ean ph\u00fat, c\u00f3 ngh\u0129a l\u00e0 th\u1ec3 t\u00edch kh\u00ed th\u1edf ra cho m\u1ed7i nh\u1ecbp th\u1edf, do \u0111\u00f3 c\u00f3 \u00a0gi\u1ea3m auto-PEEP.<br \/>\n\u25cf Gi\u1ea3m kh\u00e1ng tr\u1edf v\u1edbi d\u00f2ng kh\u00ed th\u1edf ra: Gi\u1ea3m kh\u00e1ng d\u00f2ng kh\u00ed th\u1edf ra b\u1eb1ng c\u00e1ch h\u00fat d\u1ecbch, s\u1eed d\u1ee5ng thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n v\u00e0 s\u1eed d\u1ee5ng \u1ed1ng th\u00f4ng kh\u00ed \u0111\u01b0\u1eddng d\u1eabn r\u1ed9ng c\u00f3 th\u1ec3 gi\u1ea3m auto-PEEP.<\/p>\n<p>X\u00e1c \u0111\u1ecbnh v\u00e0 x\u1eed tr\u00ed auto-PEEP l\u00e0 r\u1ea5t quan tr\u1ecdng trong b\u1ed1i c\u1ea3nh b\u1ec7nh nh\u00e2n \u0111ang th\u1edf m\u00e1y. T\u1ea1i <a href=\"https:\/\/vinmec.com\/vi\/huong-dan-khach-hang\/huong-dan-dat-lich-kham-tai-vinmec\/#\">Vinmec<\/a>, v\u1edbi kinh nghi\u1ec7m v\u00e0 tay ngh\u1ec1 chuy\u00ean m\u00f4n, c\u00e1c chuy\u00ean gia c\u1ee7a ch\u00fang t\u00f4i s\u1ebd \u0111\u01b0a ra c\u00e1c gi\u1ea3i ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 ph\u00e1t tri\u1ec3n auto-PEEP v\u00e0 n\u00e2ng cao hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Auto-PEEP, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 intrinsic PEEP ho\u1eb7c PEEPi, l\u00e0 t\u00ecnh tr\u1ea1ng x\u1ea3y ra khi kh\u00f4ng th\u1edf h\u1ebft kh\u00f4ng kh\u00ed ra kh\u1ecfi ph\u1ed5i trong th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o, d\u1eabn \u0111\u1ebfn s\u1ef1 t\u00edch t\u1ee5 c\u1ee7a \u00e1p su\u1ea5t d\u01b0\u01a1ng cu\u1ed1i th\u00ec th\u1edf ra (PEEP) b\u00ean trong \u0111\u01b0\u1eddng th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra [&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 - 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