{"id":21730,"date":"2023-04-16T13:54:22","date_gmt":"2023-04-16T06:54:22","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21730"},"modified":"2023-04-17T12:49:53","modified_gmt":"2023-04-17T05:49:53","slug":"chan-doan-va-dieu-tri-benh-kawasaki","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/chan-doan-va-dieu-tri-benh-kawasaki\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Kawasaki"},"content":{"rendered":"

B\u1ec7nh Kawasaki<\/a>\u00a0 (Kawasaki disease : KD) l\u00e0 b\u1ec7nh l\u00fd vi\u00eam m\u1ea1ch m\u00e1u h\u1ec7 th\u1ed1ng c\u1ea5p t\u00ednh, x\u1ea3y ra \u1edf tr\u1ebb s\u01a1 sinh v\u00e0 tr\u1ebb nh\u1ecf. T\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu tr\u00ean c\u00e1c m\u1ea1ch m\u00e1u c\u00f3 k\u00edch th\u01b0\u1edbc trung b\u00ecnh v\u00e0 nh\u1ecf. B\u1ec7nh hay g\u00e2y t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (\u0110MV), 20 \u2013 25% tr\u1ebb b\u1ec7nh kh\u00f4ng \u0111i\u1ec1u tr\u1ecb s\u1ebd di\u1ec5n ti\u1ebfn ph\u00ecnh m\u1ea1ch v\u00e0nh. V\u1edbi ph\u01b0\u01a1ng ti\u1ec7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng IVIG v\u00e0 Aspirin \u0111\u00e3 l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 n\u00e0y c\u00f2n <5%. Tuy nhi\u00ean v\u1eabn l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y b\u1ec7nh tim m\u1eafc ph\u1ea3i \u1edf tr\u1ebb em B\u1eafc M\u1ef9 v\u00e0 \u1edf Nh\u1eadt B\u1ea3n. H\u01a1n n\u1eefa c\u0103n nguy\u00ean c\u1ee7a b\u1ec7nh v\u1eabn c\u00f2n ch\u01b0a r\u00f5 r\u00e0ng, \u0111\u00e3 c\u1ea3n tr\u1edf s\u1ef1 x\u00e2y d\u1ef1ng chi\u1ebfn l\u01b0\u1ee3c t\u1ed1t nh\u1ea5t cho ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh.<\/strong><\/p>\n

1. \u0110\u1eb7c \u0111i\u1ec3m d\u1ecbch t\u1ec5 b\u1ec7nh Kawasaki:<\/h2>\n

– Tu\u1ed5i: tr\u00ean 80% c\u00e1c tr\u01b0\u1eddng h\u1ee3p x\u1ea3y ra \u1edf tr\u1ebb d\u01b0\u1edbi 4 tu\u1ed5i, 60% \u1edf tr\u1ebb d\u01b0\u1edbi 2 tu\u1ed5i, th\u01b0\u1eddng g\u1eb7p t\u1eeb 9 \u0111\u1ebfn 11 th\u00e1ng tu\u1ed5i. Tr\u1ebb d\u01b0\u1edbi 6 th\u00e1ng v\u00e0 tr\u00ean 8 tu\u1ed5i \u00edt b\u1ec7nh nh\u01b0ng t\u1ec9 l\u1ec7 t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch v\u00e0nh \u1edf nh\u00f3m n\u00e0y cao h\u01a1n so v\u1edbi t\u1ec9 l\u1ec7 chung.<\/p>\n

– Gi\u1edbi: tr\u1ebb trai m\u1eafc b\u1ec7nh nhi\u1ec1u h\u01a1n tr\u1ebb g\u00e1i v\u1edbi t\u1ec9 l\u1ec7 nam\/n\u1eef l\u00e0 1,5-1,7\/1.<\/p>\n

– Y\u1ebfu t\u1ed1 gia \u0111\u00ecnh: ti\u1ec1n c\u0103n gia \u0111\u00ecnh \u0111\u01b0\u1ee3c ghi nh\u1eadn trong 1% tr\u01b0\u1eddng h\u1ee3p.<\/p>\n

2. Sinh b\u1ec7nh h\u1ecdc<\/h2>\n

T\u1eed thi\u1ebft th\u01b0\u1eddng th\u1ea5y tim to. R\u1ea5t nhi\u1ec1u h\u1ea1t d\u1ea1ng nh\u01b0 h\u1ea1t c\u01b0\u1eddm ho\u1eb7c ph\u00ecnh m\u1ea1ch h\u00ecnh thoi \u1edf \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u00e0 nh\u1eefng nh\u00e1nh.<\/p>\n

    \n
  • Vi\u00eam m\u1ea1ch m\u00e1u: T\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u di\u1ec5n ti\u1ebfn nh\u01b0 sau:<\/li>\n<\/ul>\n

    Ng\u00e0y 1 \u2013 Ng\u00e0y 9: c\u00f3 t\u00ecnh tr\u1ea1ng vi\u00eam quanh m\u1ea1ch v\u00e0nh v\u00e0 endarteritis (vi\u00eam \u0111o\u1ea1n cu\u1ed1i \u0111\u1ed9ng m\u1ea1ch). T\u1ea9m nhu\u1eadn c\u00e1c t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n g\u00e2y vi\u00eam m\u00e0ng ngo\u00e0i tim, vi\u00eam c\u01a1 tim, vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c, vi\u00eam van tim v\u00e0 vi\u00eam h\u1ec7 d\u1eabn truy\u1ec1n.<\/p>\n

    Ng\u00e0y 12 \u2013 Ng\u00e0y 25: vi\u00eam to\u00e0n b\u1ed9 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u00e0 t\u1ea1o ph\u00ecnh m\u1ea1ch v\u1edbi vi\u00eam v\u00e0 ho\u1ea1i t\u1eed l\u1edbp gi\u1eefa. T\u1eeb tu\u1ea7n th\u1ee9 2 vi\u00eam ti\u1ebfn tri\u1ec3n v\u00e0o t\u1ebf b\u00e0o lympho v\u00e0 t\u01b0\u01a1ng b\u00e0o \u01b0u th\u1ebf.<\/p>\n

    S\u1ef1 ti\u00eau gi\u1ea3i vi\u00eam \u0111\u1ed9ng m\u1ea1ch v\u00e0nh x\u1ea3y ra kho\u1ea3ng ng\u00e0y 30 v\u1edbi t\u1ea1o h\u1ea1t sau \u0111\u00f3 th\u00e0nh s\u1eb9o \u1edf \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, h\u1eb9p v\u00e0 x\u01a1 h\u00f3a m\u00f4 \u0111\u00e0n h\u1ed3i n\u1ed9i m\u1ea1c tim xu\u1ea5t hi\u1ec7n sau N40. C\u00f3 th\u1ec3 th\u1ea5y ph\u00ecnh m\u1ea1ch \u1edf nh\u1eefng \u0111\u1ed9ng m\u1ea1ch kh\u00e1c nh\u01b0: \u0111\u1ed9ng m\u1ea1ch th\u1eadn, ch\u1eadu, c\u00e1nh tay. Vi\u00eam t\u1eafc t\u0129nh m\u1ea1ch (phlebitis) th\u01b0\u1eddng g\u1eb7p nh\u1ea5t v\u00e0 n\u1eb7ng nh\u1ea5t \u1edf ph\u1ed5i, t\u1ee5y, l\u00e1ch, th\u1eadn, tinh ho\u00e0n, m\u1ea1c treo, tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn v\u00e0 \u1ed1ng ti\u00eau h\u00f3a.<\/p>\n

      \n
    • T\u1ed5n th\u01b0\u01a1ng c\u01a1 tim:<\/li>\n<\/ul>\n

      + Giai \u0111o\u1ea1n c\u1ea5p: vi\u00eam tim to\u00e0n b\u1ed9: bi\u1ec3u hi\u1ec7n ch\u00ednh l\u00e0 suy tim sung huy\u1ebft v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 tim, nh\u01b0ng t\u1eed vong giai \u0111o\u1ea1n n\u00e0y th\u01b0\u1eddng l\u00e0 \u0111\u1ed9t t\u1eed do r\u1ed1i lo\u1ea1n nh\u1ecbp.<\/p>\n

      + Giai \u0111o\u1ea1n b\u00e1n c\u1ea5p (12 \u2013 25N): qu\u00e1 tr\u00ecnh vi\u00eam c\u01a1 tim, m\u00e0ng ngo\u00e0i tim v\u00e0 n\u1ed9i m\u1ea1c gi\u1ea3m d\u1ea7n. Nguy\u00ean nh\u00e2n t\u1eed vong giai \u0111o\u1ea1n n\u00e0y do t\u1ea1o huy\u1ebft kh\u1ed1i c\u1ea5p t\u00ednh trong l\u00f2ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh g\u00e2y nh\u1ed3i m\u00e1u c\u01a1 tim.<\/p>\n

      + Giai \u0111o\u1ea1n m\u1ea1n: C\u01a1 tim c\u00f3 nh\u1eefng v\u00f9ng x\u01a1 h\u00f3a t\u1ea1i nh\u1eefng n\u01a1i b\u1ecb nh\u1ed3i m\u00e1u c\u0169. T\u1eed vong giai \u0111o\u1ea1n n\u00e0y th\u01b0\u1eddng do nh\u1ed3i m\u00e1u c\u01a1 tim ho\u1eb7c thi\u1ebfu m\u00e1u c\u01a1 tim m\u1ea1n t\u00ednh.<\/p>\n

        \n
      • T\u1ed5n th\u01b0\u01a1ng n\u1ed9i m\u1ea1c: t\u1ebf b\u00e0o n\u1ed9i m\u00f4 b\u1ecb ph\u00f9 n\u1ec1 v\u00e0 tho\u00e1i h\u00f3a nh\u00e2n<\/li>\n<\/ul>\n

        3. Nguy\u00ean nh\u00e2n b\u1ec7nh Kawasaki<\/h2>\n

        M\u1eb7c d\u00f9 \u0111\u00e3 c\u00f3 r\u1ea5t nhi\u1ec1u nghi\u00ean c\u1ee9u, c\u0103n nguy\u00ean b\u1ec7nh v\u1eabn c\u00f2n ch\u01b0a bi\u1ebft r\u00f5. R\u1ea5t nhi\u1ec1u h\u00ecnh th\u1ee9c b\u1ec7nh bao g\u1ed3m nhi\u1ec5m tr\u00f9ng l\u00e0 y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t sinh b\u1ec7nh h\u1ecdc. KD l\u00e0 b\u1ec7nh tr\u1ebb em, hi\u1ebfm x\u1ea3y ra \u1edf ng\u01b0\u1eddi l\u1edbn hay tr\u1ebb < 2 th\u00e1ng tu\u1ed5i. Kh\u00f4ng x\u1ea3y ra kh\u1eafp n\u01a1i g\u1ee3i \u00fd t\u0103ng t\u1ea7n su\u1ea5t \u1edf 1 s\u1ed1 v\u00f9ng \u0111\u1ecba l\u00fd. R\u1ea5t nhi\u1ec1u \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng t\u01b0\u01a1ng t\u1ef1 b\u1ec7nh nhi\u1ec5m tr\u00f9ng tr\u1ebb em c\u00f3 ph\u00e1t ban. Tuy nhi\u00ean kh\u00f4ng c\u00f3 c\u0103n nguy\u00ean \u0111\u01a1n \u0111\u1ed9c n\u00e0o n\u1ed5i b\u1eadt l\u00e0 th\u1ee7 ph\u1ea1m r\u00f5 r\u00e0ng.<\/p>\n

          \n
        • T\u00e1c nh\u00e2n nhi\u1ec5m tr\u00f9ng: c\u00f3 th\u1ec3 l\u00e0 vi khu\u1ea9n ( Leptospira, Propionibacterium acnes, Streptococci, Staphylococci, Clamydia), Rickettsia, Virut (Retrovirus, Epstein- Barr virus, Parvovirus, Parainfluenza 2 ho\u1eb7c 3, Coronavirus NL-63\u2026) v\u00e0 N\u00e2\u0301m.<\/li>\n
        • T\u00e1c nh\u00e2n kh\u00f4ng nhi\u00eam tr\u00f9ng\u00a0 : c\u00f3 m\u00f4\u0323t s\u1ed1 gi\u1ea3 thuy\u1ebft kh\u00e1c \u0111\u01b0a ra nh\u01b0 thu\u1ed1c tr\u01b0\u0300 s\u00e2u , ho\u00e1 ch\u1ea5t, kim loai\u0323 n\u0103n\u0323g hay ph\u00e2\u0301n hoa<\/li>\n<\/ul>\n

          S\u1ef1 t\u01b0\u01a1ng \u0111\u1ed3ng gi\u1eefa KD v\u00e0 b\u1ec7nh do \u0111\u1ed9c t\u1ed1 ch\u1eb3ng h\u1ea1n nh\u01b0 h\u1ed9i ch\u1ee9ng s\u1ed1c nhi\u1ec5m \u0111\u1ed9c TSS (Toxic shock syndrome) do y\u1ebfu t\u1ed1 TSST (Toxic shock syndrome toxin). TSST l\u00e0m ph\u00f3ng th\u00edch c\u00e1c IL-1, TNF-\u03b1 v\u00e0 ho\u1ea1t h\u00f3a lympho T t\u1ea1o ra c\u00e1c th\u1ee5 th\u1ec3 \u0111\u1eb7c hi\u1ec7u c\u1ee7a t\u1ebf b\u00e0o T d\u1eabn \u0111\u1ebfn g\u1ee3i \u00fd qua trung gian si\u00eau kh\u00e1ng nguy\u00ean superantigen. Tuy nhi\u00ean nghi\u00ean c\u1ee9u T cell v\u00e0 n\u1ed7 l\u1ef1c ph\u00e2n l\u1eadp vi tr\u00f9ng s\u1ea3n xu\u1ea5t si\u00eau kh\u00e1ng nguy\u00ean trong b\u1ec7nh KD \u0111\u1ec1u ch\u01b0a c\u00f3 \u00fd ngh\u0129a.<\/p>\n

          4. L\u00e2m s\u00e0ng<\/h2>\n\n\n\n\n
          L\u00c2M S\u00c0NG<\/strong><\/td>\nC\u1eacN L\u00c2M S\u00c0NG<\/strong><\/td>\n<\/tr>\n
          Ti\u00eau chu\u1ea9n kinh \u0111i\u1ec3n<\/p>\n

          +\u00a0\u00a0 S\u1ed1t \u2265 5N<\/p>\n

          +\u00a0\u00a0 \u2265 4 tri\u1ec7u ch\u1ee9ng: \u0110\u1ecf m\u1eaft, Thay \u0111\u1ed5i \u1edf chi, H\u1ed3ng ban \u0111a d\u1ea1ng, Thay \u0111\u1ed5i \u1edf m\u00f4i v\u00e0 mi\u1ec7ng, H\u1ea1ch c\u1ed5 l\u1edbn.<\/p>\n

          +\u00a0\u00a0 Lo\u1ea1i tr\u1eeb nh\u1eefng b\u1ec7nh t\u01b0\u01a1ng t\u1ef1<\/p>\n

          D\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng kh\u00e1c:<\/p>\n

          +\u00a0\u00a0 Tim m\u1ea1ch<\/strong>: Suy tim \u1ee9 huy\u1ebft, vi\u00eam c\u01a1 tim, vi\u00eam m\u00e0ng ngo\u00e0i tim ho\u1eb7c h\u1edf van, b\u1ea5t th\u01b0\u1eddng m\u1ea1ch v\u00e0nh.<\/p>\n

          +\u00a0\u00a0 H\u1ec7 c\u01a1 x\u01b0\u01a1ng<\/strong>: Vi\u00eam kh\u1edbp, \u0111au kh\u1edbp.<\/p>\n

          +\u00a0\u00a0 \u1ed0ng ti\u00eau h\u00f3a<\/strong>: Ti\u00eau ch\u1ea3y, n\u00f4n \u00f3i, \u0111au b\u1ee5ng, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan, s\u01b0ng t\u00fai m\u1eadt (t\u00fai m\u1eadt c\u0103ng, n\u01b0\u1edbc)<\/p>\n

          +\u00a0\u00a0 H\u00f4 h\u1ea5p<\/strong>: Th\u00e2m nhi\u1ec5m h\u1ea1t, m\u00f4 k\u1ebd, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i.<\/p>\n

          +\u00a0\u00a0 Th\u1ea7n kinh trung \u01b0\u01a1ng:<\/strong> K\u00edch th\u00edch, VMN v\u00f4 tr\u00f9ng.<\/p>\n

          +\u00a0\u00a0 Sinh d\u1ee5c<\/strong>: Vi\u00eam ni\u1ec7u \u0111\u1ea1o, s\u01b0ng tinh ho\u00e0n.<\/p>\n

          +\u00a0\u00a0 Kh\u00e1c: <\/strong>\u0110\u1ecf da, s\u01b0ng bong tr\u00f3c t\u1ea1i v\u1ebft ti\u00eam BCG, vi\u00eam m\u1eaft (uveitis anterior), \u0111\u1ecf, bong da v\u00f9ng b\u1eb9n.<\/td>\n

          		T\u0103ng N v\u1edbi BC non<\/p>\n

          T\u0103ng VS<\/p>\n

          T\u0103ng CRP<\/p>\n

          Thi\u1ebfu m\u00e1u<\/p>\n

          B\u1ea5t th\u01b0\u1eddng lipid huy\u1ebft thanh<\/p>\n

          Gi\u1ea3m albumin m\u00e1u<\/p>\n

          T\u0103ng BC sau tu\u1ea7n \u0111\u1ea7u<\/p>\n

          N\u01b0\u1edbc ti\u1ec3u c\u00f3 protein \/ ni\u1ec7u, c\u00f3 BC \/ n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

          T\u0103ng transaminase m\u00e1u<\/p>\n

          T\u0103ng t\u1ebf b\u00e0o \/ DNT<\/p>\n

          T\u0103ng BC\/d\u1ecbch kh\u1edbp<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

          \"minh-hoa-benh-kawasaki\"
          Tri\u1ec7u ch\u1ee9ng b\u1ec7nh Kawasaki<\/figcaption><\/figure>\n

          5. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t b<\/strong>\u1ec7nh Kawasaki<\/h2>\n
            \n
          • S\u1ed1t tinh h\u1ed3ng nhi\u1ec7t.<\/li>\n
          • Nhi\u1ec5m tr\u00f9ng huy\u1ebft t\u1ee5 c\u1ea7u.<\/li>\n
          • H\u1ed9i ch\u1ee9ng Stevens Johnson.<\/li>\n
          • Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p th\u1ec3 thi\u1ebfu ni\u00ean giai \u0111o\u1ea1n c\u1ea5p.<\/li>\n
          • B\u1ec7nh ph\u00e1t ban kh\u00e1c: Adenovirus, Enterovirus, S\u1edfi, EBV<\/li>\n<\/ul>\n

            6. Bi\u1ebfn ch\u1ee9ng<\/strong><\/h2>\n

            6.1 T\u1ed5n th\u01b0\u01a1ng \u0110MV<\/strong><\/p>\n

            T\u1eeb N 7 \u2013 4 tu\u1ea7n, trung b\u00ecnh l\u00e0 10 ng\u00e0y sau kh\u1edfi b\u1ec7nh. D\u00e3n \u0110MV th\u01b0\u1eddng d\u1ea1ng t\u00fai ho\u1eb7c d\u1ea1ng thoi xu\u1ea5t hi\u1ec7n t\u1eeb ng\u00e0y 18 \u2013 25 c\u1ee7a b\u1ec7nh. T\u1ed5n th\u01b0\u01a1ng \u0110MV c\u00f3 th\u1ec3 tho\u00e1i lui theo th\u1eddi gian. Sau 5 \u2013 18 th\u00e1ng kho\u1ea3ng 50% b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ebfn ch\u1ee9ng \u0110MV s\u1ebd tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng, s\u1ed1 c\u00f2n l\u1ea1i c\u00f3 th\u1ec3 di\u1ec5n ti\u1ebfn b\u1edbt d\u00e3n ho\u1eb7c th\u00e0nh h\u1eb9p \u0110MV. V\u00ec k\u00edch th\u01b0\u1edbc \u0110MV thay \u0111\u1ed5i theo tu\u1ed5i n\u00ean khuy\u1ebfn c\u00e1o d\u00f9ng ti\u00eau chu\u1ea9n x\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng \u0110MV v\u00e0 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng \u0110MV.<\/p>\n

            Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng \u0110MV: (theo BYT Nh\u1eadt b\u1ea3n 1984): \u0110MV b\u1ecb t\u1ed5n th\u01b0\u01a1ng khi c\u00f3 \u2265 1 bi\u1ec3u hi\u1ec7n sau:<\/p>\n

              \n
            • K\u00edch th\u01b0\u1edbc \u0110MV > 3mm (< 5 tu\u1ed5i) ho\u1eb7c > 4mm (> 5 tu\u1ed5i).<\/li>\n
            • \u0110\u01b0\u1eddng k\u00ednh trong c\u1ee7a 1 \u0111o\u1ea1n \u0110MV > 1,5 l\u1ea7n \u0111o\u1ea1n k\u1ebf c\u1eadn<\/li>\n
            • L\u00f2ng \u0110MV c\u00f3 b\u1ea5t th\u01b0\u1eddng r\u00f5 r\u1ec7t.<\/li>\n<\/ul>\n

              M\u1ee9c \u0111\u1ed9 d\u00e3n m\u1ea1ch v\u00e0nh:<\/p>\n

                \n
              • Nh\u1eb9: 3 \u2013 5mm.<\/li>\n
              • Trung b\u00ecnh: 5 \u2013 7mm<\/li>\n
              • N\u1eb7ng: \u2265 8mm<\/li>\n<\/ul>\n

                Ph\u00e2n lo\u1ea1i nguy c\u01a1 theo di\u1ec5n ti\u1ebfn t\u1ed5n th\u01b0\u01a1ng \u0110MV theo Hi\u1ec7p H\u1ed9i Tim m\u1ea1ch Hoa k\u1ef3:<\/p>\n

                  \n
                • Nh\u00f3m nguy c\u01a1 1: kh\u00f4ng thay \u0111\u1ed5i \u0110MV tr\u00ean si\u00eau \u00e2m trong su\u1ed1t qu\u00e1 tr\u00ecnh b\u1ec7nh.<\/li>\n
                • Nh\u00f3m nguy c\u01a1 2: d\u00e3n \u0110MV tho\u00e1ng qua tr\u00ean si\u00eau \u00e2m.<\/li>\n
                • Nh\u00f3m nguy c\u01a1 3: D\u00e3n nh\u1eb9 \u0110MV nh\u1eb9 – trung b\u00ecnh.<\/li>\n
                • Nh\u00f3m nguy c\u01a1 4: D\u00e3n l\u1edbn m\u1ed9t ho\u1eb7c nhi\u1ec1u \u0110MV ho\u1eb7c d\u00e3n nhi\u1ec1u n\u01a1i t\u1eeb nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh nh\u01b0ng kh\u00f4ng b\u1ecb t\u1eafc ngh\u1ebdn.<\/li>\n
                • Nh\u00f3m nguy c\u01a1 5: b\u1ecb t\u1eafc \u0110MV (ch\u1ee5p \u0110MV)<\/li>\n<\/ul>\n

                  6.2. Nh\u1ed3i m\u00e1u c\u01a1 tim:<\/strong> Th\u01b0\u1eddng x\u1ea3y ra trong n\u0103m \u0111\u1ea7u ti\u00ean khi c\u00f3 d\u00e3n \u0110MV n\u1eb7ng (D>8mm). K\u00edch th\u01b0\u1edbc \u0110MV c\u00e0ng l\u1edbn nguy c\u01a1 huy\u1ebft kh\u1ed1i c\u00e0ng nhi\u1ec1u. N\u1ebfu s\u1ed1ng tr\u00ean 5 n\u0103m th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn h\u1eb9p \u0110MV.<\/p>\n

                  6.3 T\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean:<\/strong> M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111i\u1ec1u tr\u1ecb b\u1ecb d\u00e3n m\u1ea1ch m\u00e1u h\u1ec7 th\u1ed1ng. C\u00e1c \u0111\u1ed9ng m\u1ea1ch th\u01b0\u1eddng b\u1ecb l\u00e0 m\u1ea1ch th\u1eadn, m\u1ea1ch m\u00e1u quanh bu\u1ed3ng tr\u1ee9ng ho\u1eb7c tinh ho\u00e0n, m\u1ea1ch m\u1ea1c treo, t\u1ee5y, h\u1ed3i tr\u00e0ng, gan, l\u00e1ch, n\u00e1ch.<\/p>\n

                  6.4 Bi\u1ebfn ch\u1ee9ng tim m\u1ea1ch kh\u00e1c:<\/strong> Suy tim, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng van tim, r\u1ed1i lo\u1ea1n nh\u1ecbp. Th\u01b0\u1eddng th\u1ea5y trong giai \u0111o\u1ea1n c\u1ea5p c\u1ee7a b\u1ec7nh.<\/p>\n

                  6.5. Bi\u1ebfn ch\u1ee9ng kh\u00e1c:<\/strong> R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan, vi\u00eam t\u00fai m\u1eadt c\u1ea5p, vi\u00eam kh\u1edbp, ti\u00eau ch\u1ea3y, \u0111au b\u1ee5ng.<\/p>\n

                  7. Ti\u00ean l\u01b0\u1ee3ng<\/strong><\/h2>\n

                  B\u1ec7nh c\u1ea5p t\u00ednh, t\u1ef1 gi\u1edbi h\u1ea1n nh\u01b0ng v\u1ea5n \u0111\u1ec1 quan t\u00e2m l\u00e0 l\u00e0m sao ti\u00ean \u0111o\u00e1n nguy c\u01a1 b\u1ecb t\u1ed5n th\u01b0\u01a1ng \u0110MV \u1edf tr\u1ebb b\u1ec7nh Kawasaki \u0111\u1ec3 t\u1eeb \u0111\u00f3 c\u00f3 h\u01b0\u1edbng x\u1eed tr\u00ed t\u00edch c\u1ef1c. \u0110\u00e1nh gi\u00e1 nguy c\u01a1 cao d\u1ef1a tr\u00ean c\u00e1c ti\u00eau chu\u1ea9n:<\/p>\n

                    \n
                  • Ti\u00eau chu\u1ea9n ASAI ti\u00ean \u0111o\u00e1n nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng \u0110MV<\/strong><\/li>\n<\/ul>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
                    <\/td>\n0<\/td>\n1<\/td>\n2<\/td>\n<\/tr>\n
                    1.\u00a0\u00a0\u00a0\u00a0 Gi\u1edbi<\/td>\nN\u1eef<\/td>\nNam<\/td>\n<\/td>\n<\/tr>\n
                    2.\u00a0\u00a0\u00a0\u00a0 Tu\u1ed5i<\/td>\n\u2264 1<\/td>\n>1<\/td>\n<\/td>\n<\/tr>\n
                    3.\u00a0\u00a0\u00a0\u00a0 Th\u1eddi gian s\u1ed1t (ng\u00e0y)<\/td>\n< 14<\/td>\n14 – 15<\/td>\n>15<\/td>\n<\/tr>\n
                    4.\u00a0\u00a0\u00a0\u00a0 S\u1ed1t t\u00e1i ph\u00e1t<\/td>\nKh\u00f4ng<\/td>\n<\/td>\nC\u00f3<\/td>\n<\/tr>\n
                    5.\u00a0\u00a0\u00a0\u00a0 Ban t\u00e1i ph\u00e1t<\/td>\nKh\u00f4ng<\/td>\n<\/td>\nC\u00f3<\/td>\n<\/tr>\n
                    6.\u00a0\u00a0\u00a0\u00a0 B\u1ea1ch c\u1ea7u\/mm3<\/sup><\/td>\n< 26.000<\/td>\n26.000 \u2013 30.000<\/td>\n> 30.000<\/td>\n<\/tr>\n
                    7.\u00a0\u00a0\u00a0\u00a0 Hb \u226410g\/dl<\/td>\nKh\u00f4ng<\/td>\nC\u00f3<\/td>\n<\/td>\n<\/tr>\n
                    8.\u00a0\u00a0\u00a0\u00a0 VS gi\u1edd \u0111\u1ea7u (mm)<\/td>\n<60<\/td>\n60 \u2013 100<\/td>\n>100<\/td>\n<\/tr>\n
                    9.\u00a0\u00a0\u00a0\u00a0 VS\/CRP t\u0103ng k\u00e9o d\u00e0i<\/td>\n\u2264 1 th\u00e1ng<\/td>\n<\/td>\n>1 th\u00e1ng<\/td>\n<\/tr>\n
                    10.\u00a0 Tim to<\/td>\nKh\u00f4ng<\/td>\nC\u00f3<\/td>\n<\/td>\n<\/tr>\n
                    11.\u00a0 Lo\u1ea1n nh\u1ecbp<\/td>\nKh\u00f4ng<\/td>\nC\u00f3<\/td>\n<\/td>\n<\/tr>\n
                    12.\u00a0 D\u1ea5u hi\u1ec7u thi\u1ebfu m\u00e1u c\u01a1 tim<\/td>\nKh\u00f4ng<\/td>\n<\/td>\nC\u00f3<\/td>\n<\/tr>\n
                    13.\u00a0 Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/td>\nKh\u00f4ng<\/td>\nC\u00f3<\/td>\nTr\u00e0n d\u1ecbch<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                    N\u1ebfu > 9 \u0111i\u1ec3m: nguy c\u01a1 cao b\u1ecb t\u1ed5n th\u01b0\u01a1ng \u0110MV<\/p>\n

                      \n
                    • Ti\u00eau chu\u1ea9n Harada ti\u00ean \u0111o\u00e1n nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng \u0110MV<\/strong><\/li>\n
                    • B\u1ea1ch c\u1ea7u > 12.000mm3<\/li>\n
                    • Ti\u1ec3u c\u1ea7u < 350.000\/mm3<\/li>\n
                    • CRP t\u0103ng > +++<\/li>\n
                    • HCT < 35%<\/li>\n
                    • Albumin huy\u1ebft thanh < 35g\/dl<\/li>\n
                    • Tu\u1ed5i < 12 th\u00e1ng<\/li>\n
                    • Tr\u1ebb trai<\/li>\n<\/ul>\n

                      N\u1ebfu \u2265 4 ti\u00eau chu\u1ea9n \u0111\u01b0\u1ee3c x\u1ebfp v\u00e0o nh\u00f3m c\u00f3 nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng \u0110MV cao.<\/p>\n

                      8. \u0110i\u1ec1u tr\u1ecb b<\/strong>\u1ec7nh Kawasaki<\/h2>\n
                        \n
                      1. Giai \u0111o\u1ea1n c\u1ea5p:<\/strong><\/li>\n<\/ol>\n
                          \n
                        • Aspirin 80 \u2013 100mg\/kg\/ng\u00e0y cho \u0111\u1ebfn khi h\u1ebft s\u1ed1t.<\/li>\n
                        • Gamma globulin: 2g\/kg li\u1ec1u duy nh\u1ea5t. TTM trong 10 \u2013 12 gi\u1edd.<\/li>\n<\/ul>\n

                          Theo d\u00f5i c\u1ea9n th\u1eadn M, HA v\u00e0o c\u00e1c th\u1eddi \u0111i\u1ec3m: b\u1eaft \u0111\u1ea7u truy\u1ec1n, 30 ph\u00fat v\u00e0 1 gi\u1edd sau truy\u1ec1n. Sau \u0111\u00f3 m\u1ed7i 2 gi\u1edd \u0111\u1ebfn khi ng\u1eebng truy\u1ec1n.<\/p>\n

                            \n
                          1. Giai \u0111o\u1ea1n b\u00e1n c\u1ea5p<\/li>\n<\/ol>\n
                              \n
                            • Aspirin 3 \u2013 5mg\/kg\/ng\u00e0y trong 6 tu\u1ea7n n\u1ebfu kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch v\u00e0nh ho\u1eb7c \u0111\u1ebfn khi h\u1ebft d\u00e3n m\u1ea1ch v\u00e0nh tr\u00ean si\u00eau \u00e2m.<\/li>\n<\/ul>\n

                              9. Theo d\u00f5i<\/strong><\/h2>\n
                                \n
                              • Kh\u00f4ng d\u00e3n m\u1ea1ch v\u00e0nh: \u0111\u1ebfm ti\u1ec3u c\u1ea7u v\u00e0 si\u00eau \u00e2m tim ki\u1ec3m tra l\u00fac 6 \u2013 8 tu\u1ea7n, kh\u00f4ng c\u1ea7n theo d\u00f5i qu\u00e1 8 tu\u1ea7n.<\/li>\n
                              • C\u00f3 d\u00e3n m\u1ea1ch v\u00e0nh: \u0111\u1ebfm ti\u1ec3u c\u1ea7u v\u00e0 si\u00eau \u00e2m tim ki\u1ec3m tra l\u00fac 6 \u2013 8 tu\u1ea7n v\u00e0 m\u1ed7i 6 th\u00e1ng \u2013 1 n\u0103m. H\u01b0\u1edbng d\u1eabn h\u1ea1n ch\u1ebf ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c n\u1ebfu d\u00e3n m\u1ea1ch v\u00e0nh l\u1edbn ho\u1eb7c nhi\u1ec1u n\u01a1i.<\/li>\n
                              • Tr\u1ebb d\u00f9ng Gamma globulin n\u00ean tr\u00ec ho\u00e3n ti\u00eam ch\u1ee7ng c\u00e1c vaccine virus s\u1ed1ng gi\u1ea3m \u0111\u1ed9c l\u1ef1c nh\u01b0 s\u1edfi, quai b\u1ecb, rubella v\u00e0 th\u1ee7y \u0111\u1eadu trong th\u1eddi gian 6 \u2013 11 th\u00e1ng t\u00ednh t\u1eeb khi d\u00f9ng thu\u1ed1c.<\/li>\n<\/ul>\n

                                T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n

                                  \n
                                1. B\u1ec7nh vi\u1ec7n Nhi \u0110\u1ed3ng 1, B\u1ec7nh Kawasaki, Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb Nhi Khoa 2013, t592 -595.<\/li>\n
                                2. \u0110HYD TP HCM, B\u1ec7nh Kawasaki, Nhi khoa ch\u01b0\u01a1ng tr\u00ecnh \u0111\u1ea1i h\u1ecdc, t.118 \u2013 130.<\/li>\n
                                3. Mary Beth F.Son, Kawasaki disease, Nelson texbook of Pediatrics, 19th<\/sup> E, 2011, p. 862 \u2013 867.<\/li>\n<\/ol>\n
                                    \n
                                  1. Mary Beth Son and Jane W. Newburger, Kawasaki disease, Rudolph\u2019s Pediatrics, 22nd<\/sup> E, 2011, p.1855 \u2013 1858.<\/li>\n
                                  2. B\u1ec7nh Kawasaki, BSCK2. Nguy\u1ec5n Th\u1ecb Kim Thoa<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

                                    B\u1ec7nh Kawasaki\u00a0 (Kawasaki disease : KD) l\u00e0 b\u1ec7nh l\u00fd vi\u00eam m\u1ea1ch m\u00e1u h\u1ec7 th\u1ed1ng c\u1ea5p t\u00ednh, x\u1ea3y ra \u1edf tr\u1ebb s\u01a1 sinh v\u00e0 tr\u1ebb nh\u1ecf. T\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu tr\u00ean c\u00e1c m\u1ea1ch m\u00e1u c\u00f3 k\u00edch th\u01b0\u1edbc trung b\u00ecnh v\u00e0 nh\u1ecf. B\u1ec7nh hay g\u00e2y t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (\u0110MV), 20 \u2013 25% tr\u1ebb b\u1ec7nh kh\u00f4ng […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15,33],"tags":[3],"yoast_head":"\nCh\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Kawasaki - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh Kawasaki l\u00e0 b\u1ec7nh l\u00fd vi\u00eam m\u1ea1ch m\u00e1u h\u1ec7 th\u1ed1ng c\u1ea5p t\u00ednh, x\u1ea3y ra \u1edf tr\u1ebb nh\u1ecf. T\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu tr\u00ean c\u00e1c m\u1ea1ch m\u00e1u c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf.\" \/>\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=\"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Kawasaki - Vinmec\" \/>\n<meta property=\"og:description\" content=\"B\u1ec7nh Kawasaki l\u00e0 b\u1ec7nh l\u00fd vi\u00eam m\u1ea1ch m\u00e1u h\u1ec7 th\u1ed1ng c\u1ea5p t\u00ednh, x\u1ea3y ra \u1edf tr\u1ebb nh\u1ecf. 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