{"id":21513,"date":"2023-04-16T08:51:52","date_gmt":"2023-04-16T01:51:52","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21513"},"modified":"2023-04-17T13:00:17","modified_gmt":"2023-04-17T06:00:17","slug":"dieu-tri-bien-chung","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/dieu-tri-bien-chung\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh COVID 19"},"content":{"rendered":"

COVID-19 l\u00e0 m\u1ed9t b\u1ec7nh truy\u1ec1n nhi\u1ec5m do virus corona m\u1edbi (SARS-CoV-2) g\u00e2y ra. Bi\u1ebfn ch\u1ee9ng COVID-19 l\u00e0 c\u00e1c t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd ph\u1ee9c t\u1ea1p ho\u1eb7c n\u1eb7ng h\u01a1n so v\u1edbi b\u1ec7nh COVID-19 th\u00f4ng th\u01b0\u1eddng, v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng cho s\u1ee9c kh\u1ecfe v\u00e0 t\u00ednh m\u1ea1ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. C\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 suy h\u00f4 h\u1ea5p, suy tu\u1ea7n ho\u00e0n kh\u00e1 th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n COVID 19 n\u1eb7ng \u0111\u00e3 \u0111\u1eb7t ra c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng\u00a0 b\u1eb1ng nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p nh\u01b0 thu\u1ed1c, ECMO, \u0111i\u1ec1u tr\u1ecb Corticoid,..Trong b\u00e0i n\u00e0y s\u1ebd tr\u00ecnh b\u00e0y v\u1ec1 c\u00e1ch \u0111i\u1ec1u \u0111i\u1ec1u tr\u1ecb suy h\u00f4 h\u1ea5p, suy tu\u1ea7n h\u00f2a, d\u00f9ng ECMO c\u0169ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Corticoid.<\/strong><\/p>\n

1. \u0110i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng suy h\u00f4 h\u1ea5p<\/strong><\/h1>\n

1.1. Ng\u01b0\u1eddi nhi\u1ec5m kh\u00f4ng tri\u1ec7u ch\u1ee9ng, ng\u01b0\u1eddi b\u1ec7nh m\u1ee9c \u0111\u1ed9 nh\u1eb9\u00a0<\/strong><\/p>\n

– X\u1eed tr\u00ed:<\/p>\n

+ Theo d\u00f5i, \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng: gi\u1ea3m ho, gi\u1ea3m \u0111au (n\u1ebfu \u0111au ng\u1ef1c, \u0111au \u0111\u1ea7u nhi\u1ec1u).<\/p>\n

+ Ho\u1eb7c SpO2\u00a0<\/sub>> 96%, nh\u1ecbp th\u1edf < 20 l\u1ea7n\/ph\u00fat nh\u01b0ng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 b\u1ec7nh l\u00fd n\u1ec1n: suy tim, b\u1ec7nh l\u00fd m\u1ea1ch v\u00e0nh c\u00f3 kh\u00f3 th\u1edf th\u00ec xem x\u00e9t th\u1edf oxy k\u00ednh 1-2 l\/ph\u00fat. K\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng.<\/p>\n

1.2. Ng\u01b0\u1eddi b\u1ec7nh m\u1ee9c \u0111\u1ed9 trung b\u00ecnh<\/strong><\/p>\n

– X\u1eed tr\u00ed: oxy k\u00ednh: 2-5 l\u00edt\/ph\u00fat, n\u1eb1m s\u1ea5p n\u1ebfu c\u00f3 th\u1ec3.<\/p>\n

– M\u1ee5c ti\u00eau:<\/p>\n

+ Duy tr\u00ec nh\u1ecbp th\u1edf < 25 l\u1ea7n\/ph\u00fat v\u00e0 SpO2\u00a0<\/sub>trong kho\u1ea3ng 92- 96%.<\/p>\n

+ N\u1ebfu ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng \u0111\u00e1p \u1ee9ng chuy\u1ec3n oxy m\u1eb7t n\u1ea1 kh\u00f4ng t\u00fai 5-10 l\u00edt\/ph\u00fat v\u00e0 n\u1eb1m s\u1ea5p n\u1ebfu c\u00f3 th\u1ec3.<\/p>\n

\u2192 n\u1ebfu kh\u00f4ng \u0111\u1ea1t m\u1ee5c ti\u00eau chuy\u1ec3n th\u1edf m\u1eb7t n\u1ea1 c\u00f3 t\u00fai oxy 10-15 l\u00edt\/ph\u00fat ho\u1eb7c HFNC\/CPAP\/BiPAP.<\/p>\n

1.3. Ng\u01b0\u1eddi b\u1ec7nh m\u1ee9c \u0111\u1ed9 n\u1eb7ng\/nguy k\u1ecbch<\/strong><\/p>\n

1.3.1. M\u1ee9c \u0111\u1ed9 n\u1eb7ng<\/em><\/strong><\/p>\n

– X\u1eed tr\u00ed: HFNC (\u01b0u ti\u00ean ng\u01b0\u1eddi b\u1ec7nh 200 < P\/F < 300) ho\u1eb7c CPAP\/BiPAP (\u01b0u ti\u00ean ng\u01b0\u1eddi b\u1ec7nh P\/F < 200) ho\u1eb7c oxy m\u1eb7t n\u1ea1 c\u00f3 t\u00fai (n\u1ebfu kh\u00f4ng c\u00f3 HFNC ho\u1eb7c CPAP\/BiPAP v\u00e0 n\u1eb1m s\u1ea5p n\u1ebfu c\u00f3 th\u1ec3.<\/p>\n

– M\u1ee5c ti\u00eau<\/p>\n

+ Nh\u1ecbp th\u1edf < 30 l\u1ea7n\/ph\u00fat v\u00e0 SpO2\u00a0<\/sub>t\u1eeb 92-96%.<\/p>\n

+ Ho\u1eb7c theo ch\u1ec9 s\u1ed1 ROX (th\u1edf HFNC ho\u1eb7c CPAP\/BiPAP).<\/em><\/p>\n

* Ch\u00fa \u00fd:<\/em><\/strong><\/p>\n

– N\u1ebfu SpO2\u00a0<\/sub>> 92%, ROX < 4,88 t\u0103ng h\u1ed7 tr\u1ee3 m\u00e1y l\u00ean.<\/p>\n

– SpO2\u00a0<\/sub>kh\u00f4ng \u0111\u1ea1t \u2192 \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n.<\/p>\n

– Kh\u00f4ng th\u1edf HFNC v\u1edbi FiO2\u00a0<\/sub>> 60% ho\u1eb7c flow > 60 l\u00edt\/ph\u00fat \u2192 c\u00e2n nh\u1eafc chuy\u1ec3n sang BiPAP.<\/p>\n

1.3.2. Ng\u01b0\u1eddi b\u1ec7nh nguy k\u1ecbch<\/em><\/strong><\/p>\n

– X\u1eed tr\u00ed<\/strong>: Th\u1edf m\u00e1y x\u00e2m nh\u1eadp<\/p>\n

+ C\u00e0i \u0111\u1eb7t ban \u0111\u1ea7u<\/strong>: Vt 6 ml\/kg l\u00fd t\u01b0\u1edfng, FiO2\u00a0<\/sub>100 %, PEEP 8-10 cmH2<\/sub>O, t\u1ea7n s\u1ed1 14-16, I\/E=1\/1,5.<\/p>\n

+ Sau \u0111\u00f3<\/p>\n

N\u1ebfu compliance\u00a0<\/em>\u2265\u00a040 mL\/cmH2<\/sub><\/em>O\u00a0\u2192 gi\u1ea3m oxy m\u00e1u type L: Vt 6-8 l\u00edt\/ph\u00fat. T\u1ea7n s\u1ed1 duy tr\u00ec pH > 7,25. PEEP t\u1ed1i \u0111a 10.<\/p>\n

N\u1ebfu compliance\u00a0<\/em><\u00a040 mL\/cmH2<\/sub><\/em>O\u00a0\u2192 gi\u1ea3m oxy m\u00e1u type H (ARDS th\u1ef1c s\u1ef1).<\/p>\n

C\u00e0i \u0111\u1eb7t m\u00e1y theo chi\u1ebfn l\u01b0\u1ee3c th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i.<\/p>\n

    \n
  • Huy \u0111\u1ed9ng ph\u1ebf nang CPAP 40\/40.<\/li>\n
  • N\u1eb1m s\u1ea5p (n\u1ebfu c\u00f3 th\u1ec3).<\/li>\n<\/ul>\n
    \"\"
    Q\u00faa tr\u00ecnh t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i th\u00f4ng qua th\u1ee5 th\u1ec3 ACE2. Ngu\u1ed3n<\/strong>: Prediction of repurposed drugs for treating lung injury in COVID-19<\/em><\/figcaption><\/figure>\n

    2. \u0110i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng suy tu\u1ea7n ho\u00e0n<\/strong><\/h2>\n

    2.1. C\u00e1c nguy\u00ean nh\u00e2n suy tu\u1ea7n ho\u00e0n \u1edf ng\u01b0\u1eddi b\u1ec7nh COVID-19<\/strong><\/p>\n

    – T\u1ed5n th\u01b0\u01a1ng c\u01a1 tim do c\u00e1c cytokin g\u00e2y vi\u00eam, do vi r\u00fat.<\/p>\n

    – T\u00ecnh tr\u1ea1ng thi\u1ebfu oxy, t\u1ee5t HA k\u00e9o d\u00e0i c\u0169ng g\u00e2y ra t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o c\u01a1 tim.<\/p>\n

    – T\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u1edbn.<\/p>\n

    – R\u1ed1i lo\u1ea1n nh\u1ecbp tim do r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i nh\u01b0 K+<\/sup>, Mg2+\u00a0<\/sup>m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c theo d\u00f5i v\u00e0 x\u1eed tr\u00ed k\u1ecbp th\u1eddi.<\/p>\n

    – S\u1ed1c nhi\u1ec5m khu\u1ea9n.<\/p>\n

    2.2. B\u1ed3i ho\u00e0n th\u1ec3 t\u00edch d\u1ecbch<\/strong><\/p>\n

    – M\u1ee5c ti\u00eau: duy tr\u00ec huy\u1ebft \u00e1p trung b\u00ecnh (HATB) \u2265 65 mmHg, n\u01b0\u1edbc ti\u1ec3u > 1ml\/kg\/gi\u1edd.<\/p>\n

    – L\u1ef1a ch\u1ecdn d\u1ecbch: \u01b0u ti\u00ean dung d\u1ecbch tinh th\u1ec3 NaCl 0,9% ho\u1eb7c ringer lactat, 30ml\/kg truy\u1ec1n nhanh. N\u1ebfu \u0111\u00e3 truy\u1ec1n nhi\u1ec1u dung d\u1ecbch tinh th\u1ec3 n\u00ean truy\u1ec1n th\u00eam dung d\u1ecbch keo gelatin. Duy tr\u00ec albumin m\u00e1u > 30 g\/l.<\/p>\n

    – \u0110\u00e1nh gi\u00e1 l\u1ea1i sau m\u1ed7i l\u1ea7n b\u00f9 d\u1ecbch, tr\u00e1nh qu\u00e1 t\u1ea3i d\u1ecbch g\u00e2y ph\u00f9 ph\u1ed5i.<\/p>\n

    – S\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p th\u0103m d\u00f2 huy\u1ebft \u0111\u1ed9ng s\u1eb5n c\u00f3:<\/p>\n

    + Nh\u1ecbp tim, HA (t\u1ed1t nh\u1ea5t l\u00e0 HA \u0111\u1ed9ng m\u1ea1ch x\u00e2m l\u1ea5n).<\/p>\n

    + S\u1ef1 bi\u1ebfn thi\u00ean c\u1ee7a th\u1ec3 t\u00edch nh\u00e1t b\u00f3p (SVV), \u00e1p l\u1ef1c s\u00f3ng m\u1ea1ch (PPV) ho\u1eb7c th\u1ec3 t\u00edch nh\u00e1t b\u00f3p (SV) sau m\u1ed7i l\u1ea7n truy\u1ec1n d\u1ecbch ho\u1eb7c n\u00e2ng ch\u00e2n th\u1ee5 \u0111\u1ed9ng\u2026<\/p>\n

    + Theo d\u00f5i lactat m\u00e1u 2 gi\u1edd\/l\u1ea7n, ho\u1eb7c nghi\u1ec7m ph\u00e1p l\u00e0m \u0111\u1ea7y mao m\u1ea1ch (capillary refill testing CRT) sau m\u1ed7i 30 ph\u00fat (b\u00ecnh th\u01b0\u1eddng < 2 gi\u00e2y).<\/p>\n

    + Theo d\u00f5i CVP: duy tr\u00ec \u1edf ng\u01b0\u1eddi b\u1ec7nh t\u1ef1 th\u1edf (8 – 12 cmH2O), ng\u01b0\u1eddi b\u1ec7nh \u0111ang th\u1edf m\u00e1y (CVP 12 – 15 cmH2O).<\/p>\n

    – Si\u00eau \u00e2m \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng tim, \u0111\u01b0\u1eddng k\u00ednh t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi.<\/p>\n

    2.3. Thu\u1ed1c v\u1eadn m\u1ea1ch<\/strong><\/p>\n

    – Noradrenalin: li\u1ec1u kh\u1edfi \u0111\u1ea7u 0,1 \u03bcg\/kg\/ph\u00fat, t\u0103ng d\u1ea7n li\u1ec1u 0,1 \u03bcg\/kg\/ph\u00fat m\u1ed7i 5 – 10 ph\u00fat \u0111\u1ebfn khi \u0111\u1ea1t \u0111\u01b0\u1ee3c huy\u1ebft \u00e1p m\u1ee5c ti\u00eau.<\/p>\n

    – N\u1ebfu kh\u00f4ng c\u00f3 noradrenalin, c\u00f3 th\u1ec3 thay th\u1ebf b\u1eb1ng vasopressin (ch\u00fa \u00fd nguy c\u01a1 ho\u1ea1i t\u1eed ng\u1ecdn chi) ho\u1eb7c adrenalin (ch\u00fa \u00fd nguy c\u01a1 m\u1ea1ch nhanh).<\/p>\n

    – Kh\u00f4ng s\u1eed d\u1ee5ng dopamin do t\u0103ng nguy c\u01a1 r\u1ed1i lo\u1ea1n nh\u1ecbp.<\/p>\n

    – N\u1ebfu d\u00f9ng noradrenalin li\u1ec1u cao m\u00e0 huy\u1ebft \u00e1p kh\u00f4ng \u0111\u1ea1t m\u1ee5c ti\u00eau, d\u00f9ng th\u00eam vasopressin ho\u1eb7c adrenalin.<\/p>\n

    – Dobutamin: khi \u0111\u00e3 b\u00f9 \u0111\u1ee7 d\u1ecbch v\u1edbi noradrenalin li\u1ec1u cao nh\u01b0ng v\u1eabn t\u1ee5t huy\u1ebft \u00e1p. V\u00e0 c\u00f3 b\u1eb1ng ch\u1ee9ng suy gi\u1ea3m ch\u1ee9c n\u0103ng co b\u00f3p c\u01a1 tim. Li\u1ec1u kh\u1edfi \u0111\u1ea7u 5 \u03bcg\/kg\/ph\u00fat, t\u0103ng d\u1ea7n 5 \u03bcg\/kg\/ph\u00fat\/l\u1ea7n, sau m\u1ed7i 5-10 ph\u00fat, li\u1ec1u t\u1ed1i \u0111a 20 \u03bcg\/kg\/ph\u00fat.<\/p>\n

    – Trong tr\u01b0\u1eddng h\u1ee3p s\u1ed1c tr\u01a1: d\u00f9ng th\u00eam li\u1ec7u ph\u00e1p corticoid v\u1edbi li\u1ec1u th\u1ea5p (hydrocortison 200- 300 mg\/ng\u00e0y).<\/p>\n

    2.4. \u0110i\u1ec1u tr\u1ecb lo\u1ea1n nh\u1ecbp<\/strong><\/p>\n

    – \u0110i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i K+\u00a0<\/sup>, Mg2+<\/sup>.<\/p>\n

    – S\u1eed d\u1ee5ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp.<\/p>\n

    – S\u1ed1c \u0111i\u1ec7n khi c\u01a1n nh\u1ecbp nhanh g\u00e2y n\u00ean t\u1ee5t huy\u1ebft \u00e1p.<\/p>\n

    – Nh\u1ecbp ch\u1eadm k\u00e9o d\u00e0i, kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c: \u0111\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp.<\/p>\n

    2.5. Tim ph\u1ed5i nh\u00e2n t\u1ea1o (ECMO)<\/strong><\/p>\n

    VA-ECMO khi c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp nguy hi\u1ec3m, s\u1ed1c tim n\u1eb7ng kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb tr\u00ean.<\/p>\n

    \"\"
    Nguy\u00ean nh\u00e2n t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim trong COVID 19. Ngu\u1ed3n:<\/strong> COVID-19 and Cardiovascular Disease<\/em><\/figcaption><\/figure>\n

     <\/p>\n

    3. ECMO<\/strong><\/h3>\n

    3.1. Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n

    3.1.1. Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ch\u1ec9 \u0111\u1ecbnh VV ECMO khi c\u00f3 1 trong c\u00e1c ti\u00eau chu\u1ea9n sau:<\/em><\/strong><\/p>\n

    – P\/F < 50 mmHg trong > 3 gi\u1edd.<\/p>\n

    – P\/F < 80 mmHg trong > 6 gi\u1edd.<\/p>\n

    – pH < 7,25 v\u1edbi PaCO2\u00a0<\/sub>\u2265 60 mmHg trong > 6 gi\u1edd \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau c\u00e0i \u0111\u1eb7t m\u00e1y th\u1edf \u0111\u1ec3 gi\u1eef Pplat \u2264 32 cmH2<\/sub>O, m\u1eb7c d\u00f9 \u0111\u00e3 t\u0103ng t\u1ea7n s\u1ed1 th\u1edf \u0111\u1ebfn 35 l\u1ea7n\/ph\u00fat.<\/p>\n

    3.1.2. Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ch\u1ec9 \u0111\u1ecbnh VA-ECMO<\/em><\/strong><\/p>\n

    Khi c\u00f3 t\u00ecnh tr\u1ea1ng s\u1ed1c tim kh\u00e1ng tr\u1ecb (gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4 dai d\u1eb3ng, HATT < 90 mmHg, CI < 2,2 L\/ph\u00fat\/m2\u00a0<\/sup>v\u1edbi noradrenalin > 0,2 mcg\/kg\/ph\u00fat, dobutamin > 10 mcg\/kg\/ph\u00fat ho\u1eb7c li\u1ec1u v\u1eadn m\u1ea1ch t\u01b0\u01a1ng \u0111\u01b0\u01a1ng).<\/p>\n

    3.2. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n

    3.2.1. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i<\/em><\/strong><\/p>\n

    – Th\u1eddi gian th\u1edf m\u00e1y \u2265 11 ng\u00e0y;<\/p>\n

    – Tu\u1ed5i \u2265 71 tu\u1ed5i;<\/p>\n

    – C\u00f3 b\u1ec7nh \u0111\u1ed3ng m\u1eafc n\u1eb7ng: b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n \u2265 3, x\u01a1 gan, sa s\u00fat tr\u00ed tu\u1ec7, b\u1ec7nh l\u00fd th\u1ea7n kinh tr\u01b0\u1edbc \u0111\u00f3 kh\u00f4ng th\u1ec3 h\u1ed3i ph\u1ee5c ch\u1ee9c n\u0103ng, ung th\u01b0 ti\u1ebfn tri\u1ec3n, b\u1ec7nh ph\u1ed5i di\u1ec5n ti\u1ebfn kh\u00f4ng h\u1ed3i ph\u1ee5c, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng kh\u00f4ng ki\u1ec3m so\u00e1t v\u1edbi bi\u1ebfn ch\u1ee9ng nhi\u1ec1u c\u01a1 quan, suy ki\u1ec7t n\u1eb7ng, b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean n\u1eb7ng, kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng sinh ho\u1ea1t b\u00ecnh th\u01b0\u1eddng;<\/p>\n

    – Suy \u0111a c\u01a1 quan n\u1eb7ng;<\/p>\n

    – T\u1ed5n th\u01b0\u01a1ng n\u00e3o c\u1ea5p t\u00ednh n\u1eb7ng (\u0111\u1ed9t qu\u1ef5, t\u1ed5n th\u01b0\u01a1ng s\u1ee3i tr\u1ee5c,\u2026);<\/p>\n

    – Suy gi\u1ea3m mi\u1ec5n d\u1ecbch n\u1eb7ng (WBC < 0,4 x 109<\/sup>\/L);<\/p>\n

    – Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi thu\u1ed1c kh\u00e1ng \u0111\u00f4ng: ch\u1ea3y m\u00e1u kh\u00f4ng ki\u1ec3m so\u00e1t, suy gan c\u00f3 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u n\u1eb7ng, xu\u1ea5t huy\u1ebft n\u00e3o di\u1ec7n r\u1ed9ng ho\u1eb7c x\u1ea3y ra g\u1ea7n \u0111\u00e2y;<\/p>\n

    – Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u1ea5p ho\u1eb7c h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u1eb7ng (\u0111\u1ed1i v\u1edbi VA-ECMO);<\/p>\n

    – Kh\u00f4ng th\u1ec3 truy\u1ec1n m\u00e1u kh\u1ea9n c\u1ea5p;<\/p>\n

    – Ng\u01b0\u1eddi b\u1ec7nh \u0111ang th\u1ef1c hi\u1ec7n h\u1ed3i s\u1ee9c tim ph\u1ed5i.<\/p>\n

    3.2.2. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i<\/em><\/strong><\/p>\n

    Khi ng\u01b0\u1eddi b\u1ec7nh c\u00f3 1 trong c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i d\u01b0\u1edbi \u0111\u00e2y, c\u1ea7n h\u1ed9i ch\u1ea9n v\u1edbi c\u00e1c chuy\u00ean gia v\u1ec1 ECMO \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh.<\/em><\/strong><\/p>\n

    – Th\u1eddi gian th\u1edf m\u00e1y \u2265 7 ng\u00e0y;<\/p>\n

    – Tu\u1ed5i \u2265 65 tu\u1ed5i;<\/p>\n

    – BMI \u2265 40;<\/p>\n

    – V\u1eadn m\u1ea1ch li\u1ec1u cao (\u0111\u1ed1i v\u1edbi VV ECMO);<\/p>\n

    – Suy tim c\u1ea5p ti\u1ebfn tri\u1ec3n tr\u00ean n\u1ec1n suy tim m\u1ea1n t\u00ednh.<\/p>\n

    \"\"
    Ngu\u1ed3n<\/strong>: ECMO in COVID-19: do not blame the tool<\/em><\/figcaption><\/figure>\n

    4. \u0110i\u1ec1u tr\u1ecb corticoid<\/strong><\/h4>\n

    4.1. Ng\u01b0\u1eddi nhi\u1ec5m kh\u00f4ng tri\u1ec7u ch\u1ee9ng, m\u1ee9c \u0111\u1ed9 nh\u1eb9<\/strong><\/p>\n

    Ch\u01b0a d\u00f9ng.<\/p>\n

    4.2. M\u1ee9c \u0111\u1ed9 trung b\u00ecnh<\/strong><\/p>\n

    – Dexamethason 6mg\/24gi\u1edd x 7-10 ng\u00e0y (\u0111\u01b0\u1eddng ti\u00eam ho\u1eb7c \u0111\u01b0\u1eddng u\u1ed1ng);<\/p>\n

    – Ho\u1eb7c methylprednisolon 16mg: u\u1ed1ng 1 vi\u00ean x 2 l\u1ea7n\/ng\u00e0y x 7-10 ng\u00e0y.<\/p>\n

    4.3. M\u1ee9c \u0111\u1ed9 n\u1eb7ng<\/strong><\/p>\n

    – Dexamethason 6-12 mg\/ng\u00e0y ti\u00eam t\u0129nh m\u1ea1ch x 5 ng\u00e0y, sau \u0111\u00f3 gi\u1ea3m \u00bd li\u1ec1u trong 5 ng\u00e0y.<\/p>\n

    – Ho\u1eb7c methylprednisolon 1- 2 mg\/kg\/ng\u00e0y ti\u00eam t\u0129nh m\u1ea1ch x 5 ng\u00e0y, sau \u0111\u00f3 gi\u1ea3m \u00bd li\u1ec1u trong 5 ng\u00e0y.<\/p>\n

    4.4. M\u1ee9c \u0111\u1ed9 nguy k\u1ecbch<\/strong><\/p>\n

    – Dexamethason 12-20 mg\/ng\u00e0y ti\u00eam t\u0129nh m\u1ea1ch x 5 ng\u00e0y, sau \u0111\u00f3 gi\u1ea3m \u00bd li\u1ec1u trong 5 ng\u00e0y).<\/p>\n

    – Ho\u1eb7c methylprednisolon 2-3 mg\/kg\/ng\u00e0y ti\u00eam t\u0129nh m\u1ea1ch x 5 ng\u00e0y, sau \u0111\u00f3 gi\u1ea3m \u00bd li\u1ec1u trong 5 ng\u00e0y.<\/p>\n

    * Ch\u00fa \u00fd trong \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng c\u01a1n b\u00e3o cytokin<\/em><\/strong><\/p>\n

    – Kh\u1edfi \u0111\u1ea7u t\u0103ng li\u1ec1u ngay khi c\u00f3 d\u1ea5u hi\u1ec7u chuy\u1ec3n \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh.<\/p>\n

    – S\u1eed d\u1ee5ng corticoid li\u1ec1u cao n\u00ean duy tr\u00ec < 7 ng\u00e0y v\u00e0 gi\u1ea3m li\u1ec1u ngay khi c\u00f3 c\u1ea3i thi\u1ec7n l\u00e2m s\u00e0ng \u0111\u1ec3 tr\u00e1nh c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a thu\u1ed1c.<\/p>\n

    – Theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb: tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ea3i thi\u1ec7n, k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m c\u00e1c ch\u1ec9 s\u1ed1 vi\u00eam (CRP, IL-6, LDH, Ferritin\u2026). N\u1ebfu kh\u00f4ng c\u1ea3i thi\u1ec7n, ph\u1ed1i h\u1ee3p s\u1eed d\u1ee5ng kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng \u1ee9c ch\u1ebf IL-6, l\u1ecdc m\u00e1u.<\/p>\n

    – Ch\u00fa \u00fd t\u1ea7m so\u00e1t nhi\u1ec5m khu\u1ea9n, n\u1ea5m th\u1ee9 ph\u00e1t.<\/p>\n

    – Ch\u00fa \u00fd \u0111i\u1ec1u ch\u1ec9nh \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 \u0111i\u1ec7n gi\u1ea3i.<\/p>\n

    – C\u00f3 th\u1ec3 d\u00f9ng c\u00f9ng l\u00fac v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng, kh\u00e1ng IL-6 ho\u1eb7c remdesivir<\/p>\n

    Ngu\u1ed3n<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb COVID 19 c\u1ee7a B\u1ed9 Y t\u1ebf 2022<\/p>\n","protected":false},"excerpt":{"rendered":"

    COVID-19 l\u00e0 m\u1ed9t b\u1ec7nh truy\u1ec1n nhi\u1ec5m do virus corona m\u1edbi (SARS-CoV-2) g\u00e2y ra. Bi\u1ebfn ch\u1ee9ng COVID-19 l\u00e0 c\u00e1c t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd ph\u1ee9c t\u1ea1p ho\u1eb7c n\u1eb7ng h\u01a1n so v\u1edbi b\u1ec7nh COVID-19 th\u00f4ng th\u01b0\u1eddng, v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng cho s\u1ee9c kh\u1ecfe v\u00e0 t\u00ednh m\u1ea1ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. C\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 […]<\/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":"\n\u0110i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh COVID 19 - Vinmec<\/title>\n<meta name=\"description\" content=\"C\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 suy h\u00f4 h\u1ea5p, suy tu\u1ea7n ho\u00e0n kh\u00e1 th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n COVID 19 n\u1eb7ng \u0111\u00e3 \u0111\u1eb7t ra c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng\" \/>\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=\"\u0110i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh COVID 19 - 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