{"id":21802,"date":"2023-04-16T14:00:48","date_gmt":"2023-04-16T07:00:48","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21802"},"modified":"2023-04-17T12:48:26","modified_gmt":"2023-04-17T05:48:26","slug":"sinh-benh-hoc-va-lam-sang-nhiem-trung-tieu-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/sinh-benh-hoc-va-lam-sang-nhiem-trung-tieu-tre-em\/","title":{"rendered":"Sinh b\u1ec7nh h\u1ecdc v\u00e0 l\u00e2m s\u00e0ng nhi\u1ec5m tr\u00f9ng ti\u1ec3u tr\u1ebb em"},"content":{"rendered":"

Nhi\u1ec5m tr\u00f9ng ti\u1ec3u l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p v\u00e0 quan tr\u1ecdng \u1edf tr\u1ebb em. Nhi\u1ec5m tr\u00f9ng ti\u1ec3u tr\u00ean (vi\u00eam \u0111\u00e0i b\u1ec3 th\u1eadn c\u1ea5p) c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1eb9o th\u1eadn, suy th\u1eadn v\u00e0 b\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i. M\u1eb7c d\u00f9 tr\u1ebb vi\u00eam \u0111\u00e0i b\u1ec3 th\u1eadn c\u00f3 khuynh h\u01b0\u1edbng bi\u1ec3u hi\u1ec7n s\u1ed1t, ph\u00e2n bi\u1ec7t gi\u1eeda vi\u00eam \u0111\u00e0i b\u1ec3 th\u1eadn c\u1ea5p v\u00e0 vi\u00eam b\u00e0ng quang tr\u00ean l\u00e2m s\u00e0ng th\u01b0\u1eddng kh\u00f3, \u0111\u1eb7c bi\u1ec7t \u1edf tr\u1ebb < 2 tu\u1ed5i.<\/strong><\/p>\n

1. D\u1ecbch t\u1ec5 h\u1ecdc nhi\u1ec5m tr\u00f9ng ti\u1ec3u:<\/h2>\n

T\u1ea7n su\u1ea5t b\u1ec7nh to\u00e0n b\u1ed9:<\/h3>\n

Tr\u1ebb nh\u1ecf c\u00f3 s\u1ed1t: t\u1ea7n su\u1ea5t chung kho\u1ea3ng 7%, thay \u0111\u1ed5i theo tu\u1ed5i, ch\u1ee7ng t\u1ed9c, gi\u1edbi v\u00e0 t\u00ecnh tr\u1ea1ng da quy \u0111\u1ea7u: tr\u1ebb da tr\u1eafng c\u00f3 t\u1ea7n su\u1ea5t g\u1ea5p 2 \u2013 4 l\u1ea7n tr\u1ebb da \u0111en, tr\u1ebb g\u00e1i c\u00f3 t\u1ea7n su\u1ea5t 2 \u2013 4 l\u1ea7n tr\u1ebb trai \u0111\u00e3 c\u1eaft da quy \u0111\u1ea7u, tr\u1ebb g\u00e1i s\u1ed1t \u2265 390<\/sup>C c\u00f3 t\u1ea7n su\u1ea5t nhi\u1ec5m tr\u00f9ng ti\u1ec3u l\u00e0 16%.<\/p>\n

Tr\u1ebb l\u1edbn: tr\u1ebb 2 \u2013 19 tu\u1ed5i c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1eddng ti\u1ec3u v\u00e0 ho\u1eb7c s\u1ed1t, tu\u1ea7n su\u1ea5t nhi\u1ec5m tr\u00f9ng ti\u1ec3u l\u00e0 7.8%.<\/p>\n

Vi tr\u00f9ng h\u1ecdc:<\/h3>\n

80% c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng ti\u1ec3u \u1edf tr\u1ebb em l\u00e0 do E. coli. C\u00e1c vi tr\u00f9ng Gram \u00e2m kh\u00e1c g\u1ed3m Klebsiella, Proteus, Enterobacter v\u00e0 Citrobacter. C\u00e1c vi tr\u00f9ng Gram d\u01b0\u01a1ng g\u1ed3m Staphylococcus saphrophyticus, Enterococcus v\u00e0 hi\u1ebfm g\u1eb7p Staphylococcus aureus. C\u00e1c nhi\u1ec5m tr\u00f9ng ti\u1ec3u do c\u00e1c vi tr\u00f9ng kh\u00f4ng ph\u1ea3i E. coli li\u00ean quan v\u1edbi nguy c\u01a1 cao s\u1eb9o th\u1eadn.<\/p>\n

Si\u00eau vi ( adenovirus, enterovirus, coxackievirus, echovirus ) v\u00e0 n\u1ea5m ( Candida spp, Aspergillus spp, Cryptococcus neoforman ) l\u00e0 c\u00e1c t\u00e1c nh\u00e2n kh\u00f4ng th\u01b0\u1eddng g\u1eb7p g\u00e2y nhi\u1ec5m tr\u00f9ng ti\u1ec3u tr\u1ebb em. Nhi\u1ec5m tr\u00f9ng ti\u1ec3u do virus th\u01b0\u1eddng gi\u1edbi h\u1ea1n \u1edf \u0111\u01b0\u1eddng ti\u1ec3u d\u01b0\u1edbi. C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a nhi\u1ec5m n\u1ea5m bao g\u1ed3m t\u00ecnh tr\u1ea1ng \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng k\u00e9o\u00a0 d\u00e0i v\u00e0 \u0111\u1eb7t th\u00f4ng ti\u1ec3u.<\/p>\n

2. B\u1ec7nh sinh nhi\u1ec5m tr\u00f9ng ti\u1ec3u<\/h2>\n

S\u1ef1 x\u00e2m l\u1ea5n c\u1ee7a c\u00e1c t\u00e1c nh\u00e2n \u0111\u01b0\u1eddng ru\u1ed9t \u1edf v\u00f9ng quanh ni\u1ec7u \u0111\u1ea1o l\u00e0 b\u01b0\u1edbc kh\u1edfi \u0111\u1ea7u c\u1ee7a nhi\u1ec5m tr\u00f9ng ti\u1ec3u. Tuy nhi\u00ean, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh \u1edf ni\u1ec7u \u0111\u1ea1o l\u00e0 kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 g\u00e2y nhi\u1ec5m tr\u00f9ng ti\u1ec3u. C\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh b\u00e1m v\u00e0o t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 ni\u1ec7u \u0111\u1ea1o qua m\u1ed9t qu\u00e1 tr\u00ecnh ch\u1ee7 \u0111\u1ed9ng \u0111\u01b0\u1ee3c t\u1ea1o b\u1edfi c\u00e1c th\u1ee5 th\u1ec3 glycosphingolipid tr\u00ean b\u1ec1 m\u1eb7t t\u1ebf b\u00e0o bi\u1ec3u m\u00f4. S\u1ef1 b\u00e1m d\u00ednh c\u1ee7a vi khu\u1ea9n s\u1ebd tuy\u1ec3n ch\u1ecdn c\u00e1c th\u1ee5 th\u1ec3 toll-like, li\u00ean quan trong vi\u1ec7c nh\u1eadn di\u1ec7n c\u00e1c d\u1ea1ng protein \u0111i k\u00e8m t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh. G\u1eafn th\u1ee5 th\u1ec3 toll-like k\u00edch ho\u1ea1t m\u1ed9t \u0111\u00e1p \u1ee9ng cytokine \u0111\u1ec3 t\u1ea1o ra m\u1ed9t \u0111\u00e1p \u1ee9ng vi\u00eam t\u1ea1i ch\u1ed5.<\/p>\n

Nhi\u1ec1u y\u1ebfu t\u1ed1 \u0111\u1ed9c l\u1ef1c h\u1ed5 tr\u1ee3 vi khu\u1ea9n \u0111i l\u00ean b\u00e0ng quang v\u00e0 th\u1eadn. C\u00e1c y\u1ebfu t\u1ed1 \u0111\u1ed9c l\u1ef1c \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u t\u1ed1t nh\u1ea5t \u1edf E. coli l\u00e0 c\u00e1c l\u00f4ng mao tr\u00ean b\u1ec1 m\u1eb7c t\u1ebf b\u00e0o. C\u00e1c vi khu\u1ea9n c\u00f3 l\u00f4ng c\u00f3 th\u1ec3 g\u1eafn hi\u1ec7u qu\u1ea3 v\u00e0o t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 \u0111\u01b0\u1eddng ni\u1ec7u v\u00e0 \u0111i l\u00ean th\u1eadn ngay c\u1ea3 \u1edf tr\u1ebb kh\u00f4ng c\u00f3 tr\u00e0o ng\u01b0\u1ee3c b\u00e0ng quang ni\u1ec7u qu\u1ea3n. \u1ede th\u1eadn, c\u00e1c vi khu\u1ea9n t\u1ea1o ra m\u1ed9t \u0111\u00e1p \u1ee9ng vi\u00eam m\u1ea1nh, cu\u1ed1i c\u00f9ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1eb9o th\u1eadn.<\/p>\n

C\u00e1c y\u1ebfu t\u1ed1 k\u00fd ch\u1ee7 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 thu\u1eadn l\u1ee3i cho nhi\u1ec5m tr\u00f9ng ti\u1ec3u \u1edf tr\u1ebb em: tu\u1ed5i nh\u1ecf, h\u1eb9p da quy \u0111\u1ea7u, tr\u1ebb nh\u0169 nhi g\u00e1i, tr\u1ebb da tr\u1eafng, cha m\u1eb9 ho\u1eb7c anh em ru\u1ed9t b\u1ecb nhi\u1ec5m tr\u00f9ng ti\u1ec3u, t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ti\u1ec3u, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng ru\u1ed9t b\u00e0ng quang, tr\u00e0o ng\u01b0\u1ee3c b\u00e0ng quang ni\u1ec7u qu\u1ea3n, ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c, \u0111\u1eb7t th\u00f4ng b\u00e0ng quang. Thay \u0111\u1ed5i c\u00e1c vi khu\u1ea9n th\u01b0\u1eddng tr\u00fa b\u00ecnh th\u01b0\u1eddng \u1edf quanh ni\u1ec7u \u0111\u1ea1o th\u00fac \u0111\u1ea9y s\u1ef1 b\u00e1m d\u00ednh c\u1ee7a c\u00e1c vi khu\u1ea9n g\u00e2y b\u1ec7nh.<\/p>\n

C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 t\u1ea1o s\u1eb9o th\u1eadn: nhi\u1ec5m tr\u00f9ng ti\u1ec3u c\u00f3 s\u1ed1t t\u00e1i ph\u00e1t, ch\u1eadm tr\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng c\u1ea5p, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng ru\u1ed9t b\u00e0ng quang, d\u1ecb d\u1ea1ng t\u1eaft ngh\u1ebdn \u0111\u01b0\u1eddng ti\u1ec3u v\u00e0 tr\u00e0o ng\u01b0\u1ee3c b\u00e0ng quang ni\u1ec7u qu\u1ea3n.<\/p>\n

3.\u00a0 C\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng nhi\u1ec5m tr\u00f9ng ti\u1ec3u tr\u1ebb em:<\/h2>\n

Nhi\u1ec5m tr\u00f9ng ti\u1ec3u c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n<\/a> b\u1eb1ng c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u kh\u00f4ng chuy\u00ean bi\u1ec7t, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u0169 nhi v\u00e0 tr\u1ebb nh\u1ecf.<\/p>\n

Tr\u1ebb nh\u1ecf:<\/h2>\n

S\u1ed1t: c\u00f3 th\u1ec3 l\u00e0 bi\u1ec3u hi\u1ec7n \u0111\u01a1n \u0111\u1ed9c c\u1ee7a nhi\u1ec5m tr\u00f9ng ti\u1ec3u \u1edf tr\u1ebb nh\u1ee7 nhi v\u00e0 tr\u1ebb < 2 tu\u1ed5i. S\u1ed1t > 390<\/sup>C k\u00e9o d\u00e0i \u2265 48 gi\u1edd m\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n g\u00e2y s\u1ed1t kh\u00e1c, t\u1ef7 s\u1ed1 nguy c\u01a1 nhi\u1ec5m tr\u00f9ng ti\u1ec3u l\u00e0 4. S\u1ed1t < 390<\/sup>C v\u1edbi s\u1ef1 hi\u1ec7n di\u1ec7n m\u1ed9t nguy\u00ean nh\u00e2n nhi\u1ec5m tr\u00f9ng kh\u00e1c, t\u1ef7 s\u1ed1 nguy c\u01a1 nhi\u1ec5m tr\u00f9ng ti\u1ec3u l\u00e0 0,37. S\u1ef1 hi\u1ec7n c\u1ee7a m\u1ed9t nguy\u00ean nh\u00e2n g\u00e2y s\u1ed1t ti\u1ec1m n\u0103ng (nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p tr\u00ean, vi\u00eam tai\u00a0 gi\u1eeda c\u1ea5p, vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t c\u1ea5p) kh\u00f4ng lo\u1ea1i tr\u1eeb kh\u1ea3 n\u0103ng c\u1ee7a nhi\u1ec5m tr\u00f9ng ti\u1ec3u. Trong c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 nhi\u1ec5m tr\u00f9ng ti\u1ec3u \u1edf tr\u1ebb nh\u1ecf nh\u1eadp khoa c\u1ea5p c\u1ee9u v\u00ec s\u1ed1t, t\u1ef7 l\u1ec7 b\u1ec7nh to\u00e0n b\u1ed9 c\u1ee7a nhi\u1ec5m tr\u00f9ng ti\u1ec3u \u1edf tr\u1ebb c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 m\u1ed9t nguy\u00ean nh\u00e2n ti\u1ec1m n\u0103ng g\u00e2y s\u1ed1t kh\u00e1c l\u1ea7n l\u01b0\u1ee3t l\u00e0 2 \u2013 3% v\u00e0 6 \u2013 8%. C\u1ea5y n\u01b0\u1edbc ti\u1ec3u \u1edf tr\u1ebb nh\u1ee7 nhi v\u00e0 tr\u1ebb nh\u1ecf c\u00f3 s\u1ed1t m\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n x\u00e1c \u0111\u1ecbnh c\u1ee7a s\u1ed1t c\u00f3 vai tr\u00f2 quan tr\u1ecdng.<\/p>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c g\u1ed3m t\u0103ng bilirubin tr\u1ef1c ti\u1ebfp, k\u00edch th\u00edch, b\u00fa k\u00e9m ho\u1eb7c kh\u00f4ng t\u0103ng tr\u01b0\u1edfng.<\/p>\n

Tr\u1ebb l\u1edbn: <\/em><\/strong>s\u1ed1t, c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1eddng ti\u1ec3u (ti\u1ec3u \u0111au, ti\u1ec3u g\u1ea5p, ti\u1ec3u l\u1eaft nh\u1eaft, s\u00f3n ti\u1ec3u, ti\u1ec3u m\u00e1u \u0111\u1ea1i th\u1ec3) v\u00e0 \u0111au b\u1ee5ng. S\u1ed1t l\u1ea1nh run v\u00e0 \u0111au h\u00f4ng l\u01b0ng l\u00e0 g\u1ee3i \u00fd c\u1ee7a vi\u00eam \u0111\u00e0i b\u1ec3 th\u1eadn \u1edf tr\u1ebb l\u1edbn. Th\u1ec9nh tho\u1ea3ng, nh\u1eefng tr\u1ebb l\u1edbn c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n b\u1eb1ng l\u00f9n, ch\u1eadm t\u0103ng c\u00e2n ho\u1eb7c cao huy\u1ebft \u00e1p th\u1ee9 ph\u00e1t do s\u1eb9o th\u1eadn t\u1eeb nh\u1eefng \u0111\u1ee3t nhi\u1ec5m tr\u00f9ng ti\u1ec3u kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n

4. Ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m tr\u00f9ng ti\u1ec3u tr\u1ebb em<\/h1>\n

4.1 \u0110\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng nhi\u1ec5m tr\u00f9ng ti\u1ec3u:<\/strong><\/h2>\n
    \n
  • B\u1ec7nh s\u1eed: ghi nh\u1eadn m\u1ee9c \u0111\u1ed9 v\u00e0 kho\u1ea3ng th\u1eddi gian s\u1ed1t, c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a \u0111\u01b0\u1eddng ti\u1ec3u, \u0111au b\u1ee5ng, \u0111au l\u01b0ng, kh\u00f3 ch\u1ecbu tr\u00ean x\u01b0\u01a1ng mu,n\u00f4n \u00f3i, c\u00e1c b\u1ec7nh g\u1ea7n \u0111\u00e2y v\u00e0 s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng sinh.<\/li>\n
  • Ti\u1ec1n s\u1eed, ghi nh\u1eadn c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a nhi\u1ec5m tr\u00f9ng ti\u1ec3u: c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1eddng ti\u1ec3u k\u00e9o d\u00e0i g\u1ee3i \u00fd r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng b\u00e0ng quang, t\u00e1o b\u00f3n k\u00e9o d\u00e0i, nhi\u1ec5m tr\u00f9ng ti\u1ec3u ho\u1eb7c c\u00e1c \u0111\u1ee3t s\u1ed1t kh\u00f4ng r\u1ecf ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc \u0111\u00f3, tr\u00e0o ng\u01b0\u1ee3c b\u00e0ng quang ni\u1ec7u \u0111\u1ea1o, c\u00e1c b\u1ea5t th\u01b0\u1eddng th\u1eadn ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc sanh, ti\u1ec1n s\u1eed gia \u0111\u00ecnh nhi\u1ec5m tr\u00f9ng ti\u1ec3u ho\u1eb7c b\u1ea5t th\u01b0\u1eddng ni\u1ec7u sinh d\u1ee5c.<\/li>\n
  • Kh\u00e1m th\u1ef1c th\u1ec3: ghi nh\u1eadn nhi\u1ec7t \u0111\u1ed9, huy\u1ebft \u00e1p, c\u00e1c th\u00f4ng s\u1ed1 ph\u00e1t tri\u1ec3n. Kh\u00e1m b\u1ee5ng t\u00ecm c\u00e1c \u0111i\u1ec3m nh\u1ea1y \u0111au, c\u00e1c kh\u1ed1i b\u1ea5t th\u01b0\u1eddng (c\u1ea7u b\u00e0ng quang, th\u1eadn to do t\u1eaft ngh\u1ebdn\u00a0 \u0111\u01b0\u1eddng ti\u1ec3u, kh\u1ed1i ph\u00e2n), c\u00e1c d\u1ecb d\u1ea1ng gi\u1ea3i ph\u1eabu c\u1ee7a c\u01a1 quan sinh d\u1ee5c ngo\u00e0i, \u0111\u00e1nh gi\u00e1 c\u1ed9t s\u1ed1ng th\u1eaft l\u01b0ng t\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u tho\u00e1t v\u1ecb t\u1ee7y m\u00e0ng t\u1ee7y. \u0110\u00e1nh gi\u00e1 c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c c\u1ee7a s\u1ed1t; m\u1ed9t nguy\u00ean nh\u00e2n g\u00e2y s\u1ed1t kh\u00e1c l\u00e0m gi\u1ea3m nguy c\u01a1 nhi\u1ec5m tr\u00f9ng ti\u1ec3u nh\u01b0ng kh\u00f4ng lo\u1ea1i tr\u1eeb n\u00f3 c\u00f9ng t\u1ed3n t\u1ea1i.<\/li>\n<\/ul>\n

    4.2.\u00a0 \u0110\u00e1nh gi\u00e1 c\u1eadn l\u00e2m s\u00e0ng:<\/h3>\n

    + N\u01b0\u1edbu ti\u1ec3u: <\/strong>thu th\u1eadp b\u1eb1ng c\u00e1ch l\u1ea5y n\u01b0\u1edbc ti\u1ec3u s\u1ea1ch gi\u1eeda d\u00f2ng \u1edf nh\u1eefng tr\u1ebb \u0111\u00e3 \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n \u0111i ti\u1ec3u v\u00e0 \u0111\u1eb7t th\u00f4ng ti\u1ec3u s\u1ea1ch ho\u1eb7c ch\u1ecdc h\u00fat qua x\u01b0\u01a1ng mu \u1edf nh\u1eefng tr\u1ebb nh\u1ee7 nhi v\u00e0 tr\u1ebb ch\u01b0a \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n \u0111i ti\u1ec3u. Kh\u00f4ng s\u1eed d\u1ee5ng t\u00fai d\u00e1n \u0111\u1ec3 l\u1ea5y n\u01b0\u1edbc ti\u1ec3u c\u1ea5y v\u00ec nguy c\u01a1 ngo\u1ea1i nhi\u1ec5m cao. M\u1eabu n\u01b0\u1edbc ti\u1ec3u n\u00ean \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t sau khi l\u1ea5y \u0111\u1ec3 tr\u00e1nh t\u1ef7 l\u1ec7 \u00e2m t\u00ednh gi\u1ea3 v\u00e0 d\u01b0\u01a1ng t\u00ednh gi\u1ea3 \u0111\u00e1ng k\u1ec3.<\/p>\n

    Gi\u1ea5y nh\u00fang n\u01b0\u1edbc ti\u1ec3u:<\/em><\/p>\n

    Leukocyte esterase: g\u1ee3i \u00fd nhi\u1ec5m tr\u00f9ng ti\u1ec3u. Leukocyte esterase d\u01b0\u01a1ng c\u00f3 th\u1ec3 hi\u1ec7n di\u1ec7n trong<\/p>\n

    n\u01b0\u1edbc ti\u1ec3u trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00e1c kh\u00f4ng ph\u1ea3i nhi\u1ec5m tr\u00f9ng ti\u1ec3u.<\/p>\n

    Nitrite: d\u01b0\u01a1ng, tr\u1ebb c\u00f3 kh\u1ea3 n\u0103ng nhi\u1ec5m tr\u00f9ng ti\u1ec3u. Nitrit c\u00f3 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao v\u1edbi t\u1ef7 l\u1ec7 d\u01b0\u01a1ng gi\u1ea3 th\u1ea5p. \u00c2m t\u00ednh gi\u1ea3 l\u00e0 th\u01b0\u1eddng g\u1eb7p v\u00ec n\u01b0\u1edbc ti\u1ec3u c\u1ea7n t\u1ed3n t\u1ea1i trong b\u00e0ng quang \u00edt nh\u1ea5t l\u00e0 4 gi\u1edd \u0111\u1ec3 t\u00edch t\u1ee5 \u0111\u1ee7 t\u1edbi l\u01b0\u1ee3ng nitrit c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n.<\/p>\n

    Soi d\u01b0\u1edbi k\u00ednh hi\u1ec3n vi:<\/em><\/p>\n

    Ph\u01b0\u01a1ng ph\u00e1p chu\u1ea9n: m\u1eabu n\u01b0\u1edbc ti\u1ec3u ly t\u00e2m, kh\u00f4ng nhu\u1ed9m, ph\u00e1t hi\u1ec7n b\u1ea1ch c\u1ea7u (\u2265 5 b\u1ea1ch c\u1ea7u \/ QT40) v\u00e0 vi khu\u1ea9n (s\u1ef1 hi\u1ec7n di\u1ec7n b\u1ea5t k\u1ef3 vi khu\u1ea9n \/ QT40).<\/p>\n

    Ph\u01b0\u01a1ng ph\u00e1p gia t\u0103ng: n\u01b0\u1edbc ti\u1ec3u kh\u00f4ng ly t\u00e2m, m\u00e1y \u0111o t\u1ebf b\u00e0o m\u00e1u (hemocytometer), ph\u1ebft nhu\u1ed9m gram c\u1ea3i thi\u1ec7n \u0111\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a ph\u00e2n t\u00edch vi th\u1ec3 n\u01b0\u1edbc ti\u1ec3u. Ti\u1ec3u BC khi \u2265 10 BC\/mm3<\/sup> v\u00e0 vi khu\u1ea9n ni\u1ec7u khi hi\u1ec7n di\u1ec7n b\u1ea5t k\u1ef3 vi khu\u1ea9n tr\u00ean 10 quang tr\u01b0\u1eddng nh\u00fang d\u1ea7u c\u1ee7a ph\u1ebft nhu\u1ed9m gram.<\/p>\n

    C\u1ea5y n\u01b0\u1edbc ti\u1ec3u: <\/em>c\u1ea5y n\u01b0\u1edbc ti\u1ec3u \u0111\u1ecbnh l\u01b0\u1ee3ng l\u00e0 x\u00e9t nghi\u1ec7m chu\u1ea9n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m tr\u00f9ng ti\u1ec3u.<\/p>\n

    + C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c:<\/h3>\n

    C\u00e1c ch\u1ea5t ch\u1ec9 \u0111i\u1ec3m ph\u1ea3n \u1ee9ng vi\u00eam: TPTTBM, VS, CRP, Procalcitonin. Kh\u00f4ng gi\u00fap ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t tin c\u1eady gi\u1eeda vi\u00eam b\u00e0ng quang v\u00e0 vi\u00eam \u0111\u00e0i b\u1ec3 th\u1eadn v\u00ec \u0111\u1ed9 nh\u1ea1y v\u00e0\/ho\u1eb7c \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u th\u1ea5p.<\/p>\n

    Creatinin m\u00e1u: tr\u1ebb b\u1ecb nhi\u1ec5m tr\u00f9ng ti\u1ec3u nhi\u1ec1u l\u1ea7n v\u00e0 khi nghi ng\u1edd c\u00f3 \u1ea3nh h\u01b0\u1edfng th\u1eadn.<\/p>\n

    + Ch\u1ea9n \u0111\u00f3an h\u00ecnh \u1ea3nh: <\/strong>x\u00e1c \u0111\u1ecbnh c\u00e1c b\u1ea5t th\u01b0\u1eddng c\u1ea5u tr\u00fac th\u1eadn, \u0111\u1eb7c bi\u1ec7t b\u1ec7nh th\u1eadn t\u1eaft ngh\u1ebdn c\u1ea7n ph\u1eabu thu\u1eadt, x\u00e1c \u0111\u1ecbnh c\u00e1c y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m tr\u00f9ng ti\u1ec3u t\u00e1i ph\u00e1t, x\u00e1c \u0111\u1ecbnh nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng ch\u1ee7 m\u00f4 th\u1eadn c\u00f3 nguy c\u01a1 cao b\u1ecb cao huy\u1ebft \u00e1p, ti\u1ec1n s\u1ea3n gi\u1eadt trong thai k\u1ef3.<\/p>\n

      \n
    • SA th\u1eadn v\u00e0 b\u00e0ng quang<\/em>: x\u00e9t nghi\u1ec7m kh\u00f4ng x\u00e2m l\u1ea5n, \u0111\u00e1nh gi\u00e1 k\u00edch th\u01b0\u1edbc v\u00e0 h\u00ecnh d\u1ea1ng c\u1ee7a th\u1eadn, ni\u1ec7u qu\u1ea3n \u0111\u00f4i ho\u1eb7c d\u00e3n, t\u1ed3n t\u1ea1i c\u00e1c b\u1ea5t th\u01b0\u1eddng gi\u1ea3i ph\u1eabu l\u1edbn, bi\u1ebfn ch\u1ee9ng c\u1ee7a nhi\u1ec5m tr\u00f9ng ti\u1ec3u nh\u01b0 apxe quanh th\u1eadn ho\u1eb7c th\u1eadn \u1ee9 m\u1ee7, gi\u00fap ti\u00ean \u0111o\u00e1n nguy c\u01a1 s\u1eb9o th\u1eadn.<\/li>\n<\/ul>\n

      + Ch\u1ec9 \u0111\u1ecbnh: tr\u1ebb \u2264 2 tu\u1ed5i v\u1edbi nhi\u1ec5m tr\u00f9ng ti\u1ec3u c\u00f3 s\u1ed1t l\u1ea7n \u0111\u1ea7u, nhi\u1ec5m tr\u00f9ng ti\u1ec3u c\u00f3 s\u1ed1t t\u00e1i ph\u00e1t, tr\u1ebb nhi\u1ec5m tr\u00f9ng ti\u1ec3u c\u00f3 b\u1ec7nh s\u1eed gia \u0111\u00ecnh c\u00f3 b\u1ec7nh th\u1eadn ho\u1eb7c ni\u1ec7u, ch\u1eadm ph\u00e1t tri\u1ec3n ho\u1eb7c cao HA, tr\u1ebb kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh th\u00edch h\u1ee3p.<\/p>\n

        \n
      • Ch\u1ee5p b\u00e0ng quang ni\u1ec7u \u0111\u1ea1o trong khi ti\u1ec3u (VCUG): <\/em>\u0111\u00e1nh gi\u00e1 c\u00e1c sang th\u01b0\u01a1ng b\u00e0ng quang, van ni\u1ec7u \u0111\u1ea1o sau \u1edf tr\u1ebb trai, s\u1ef1 hi\u1ec7n di\u1ec7n v\u00e0 m\u1ee9c \u0111\u1ed9 tr\u00e0o ng\u01b0\u1ee3c b\u00e0ng quang ni\u1ec7u qu\u1ea3n. Tr\u00e0o ng\u01b0\u1ee3c b\u00e0ng quang ni\u1ec7u qu\u1ea3n l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a s\u1eb9o th\u1eadn, g\u1eb7p kho\u1ea3ng 25 \u2013 30% tr\u1ebb t\u1eeb 0 \u2013 18 tu\u1ed5i b\u1ecb nhi\u1ec5m tr\u00f9ng ti\u1ec3u l\u1ea7n \u0111\u1ea7u.<\/li>\n<\/ul>\n

        \"minh-hoa-nhiem-trung-tieu\"<\/p>\n

         <\/p>\n

        + Ch\u1ec9 \u0111\u1ecbnh:<\/p>\n

          \n
        • Tr\u1ebb b\u1ea5t k\u1ef3 tu\u1ed5i n\u00e0o c\u00f3 \u2265 2 l\u1ea7n nhi\u1ec5m tr\u00f9ng ti\u1ec3u c\u00f3 s\u1ed1t<\/li>\n
        • Tr\u1ebb b\u1ea5t k\u1ef3 tu\u1ed5i n\u00e0o v\u1edbi nhi\u1ec5m tr\u00f9ng ti\u1ec3u l\u1ea7n \u0111\u1ea7u c\u00f3 s\u1ed1t v\u00e0: b\u1ea5t k\u1ef3 b\u1ea5t th\u01b0\u1eddng tr\u00ean SA th\u1eadn ho\u1eb7c k\u1ebft h\u1ee3p s\u1ed1t > 390<\/sup>C v\u00e0 t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh kh\u00e1c E.coli ho\u1eb7c ch\u1eadm ph\u00e1t tri\u1ec3n ho\u1eb7c c\u00f3 cao Huy\u1ebft \u00e1p.<\/li>\n<\/ul>\n
            \n
          • VCUG c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n s\u1edbm ngay khi b\u1ec7nh nh\u00e2n kh\u00f4ng tri\u1ec7u ch\u1ee9ng. Th\u1ef1c hi\u1ec7n s\u1edbm kh\u00f4ng l\u00e0m t\u0103ng gi\u1ea3 t\u1ef7 l\u1ec7 ph\u00e1t hi\u1ec7n tr\u00e0o ng\u01b0\u1ee3c v\u00e0 c\u00f3 th\u1ec3 tr\u00e1nh \u0111\u01b0\u1ee3c vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u1edf tr\u1ebb kh\u00f4ng c\u00f3 tr\u00e0o ng\u01b0\u1ee3c.<\/li>\n<\/ul>\n

            -X\u1ea1 h\u00ecnh th\u1eadn: <\/em>X\u1ea1 h\u00ecnh th\u1eadn v\u1edbi DMSA ph\u00e1t hi\u1ec7n c\u00e1c v\u00f9ng gi\u1ea3m b\u1eaft ph\u00f3ng x\u1ea1 \u1edf th\u1eadn do vi\u00eam \u0111\u00e0i b\u1ec3 th\u1eadn c\u1ea5p ho\u1eb7c s\u1eb9o th\u1eadn (4 \u2013 6 th\u00e1ng sau nhi\u1ec5m tr\u00f9ng ti\u1ec3u c\u1ea5p). Trong m\u1ed9t ph\u00e2n t\u00edch h\u1ed3i c\u1ee9u 33 nghi\u00ean c\u1ee9u, 60% tr\u1ebb v\u1edbi nhi\u1ec5m tr\u00f9ng ti\u1ec3u l\u1ea7n \u0111\u1ea7u c\u00f3 DMSA ph\u00f9 h\u1ee3p v\u1edbi vi\u00eam \u0111\u00e0i b\u1ec3 th\u1eadn c\u1ea5p trong giai \u0111o\u1ea1n c\u1ea5p c\u1ee7a b\u1ec7nh nh\u01b0ng ch\u1ec9 15% c\u00f3 s\u1eb9o th\u1eadn v\u00e0o l\u00fac theo d\u00f5i. DMSA l\u00e0 x\u00e9t nghi\u1ec7m m\u1eafc ti\u1ec1n, ti\u1ebfp x\u00fac l\u01b0\u1ee3ng l\u1edbn ph\u00f3ng x\u1ea1, n\u00ean kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh DMSA \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 th\u01b0\u1eddng quy tr\u1ebb nhi\u1ec5m tr\u00f9ng ti\u1ec3u l\u1ea7n \u0111\u1ea7u.<\/p>\n

            Ch\u1ec9 \u0111\u1ecbnh: th\u1ef1c hi\u1ec7n DMSA 4 \u2013 6 th\u00e1ng sau nhi\u1ec5m tr\u00f9ng ti\u1ec3u c\u1ea5p:<\/p>\n

              \n
            • Tr\u1ebb < 3 tu\u1ed5i v\u1edbi nhi\u1ec5m tr\u00f9ng ti\u1ec3u kh\u00f4ng \u0111i\u1ec3n h\u00ecnh (b\u1ec7nh nghi\u00eam tr\u1ecdng, nhi\u1ec5m tr\u00f9ng huy\u1ebft, t\u1eaft ngh\u1ebdn d\u00f2ng n\u01b0\u1edbc ti\u1ec3u, kh\u1ed1i b\u00e0ng quang ho\u1eb7c b\u1ee5ng, t\u0103ng creatinin m\u00e1u, nhi\u1ec5m tr\u00f9ng ti\u1ec3udo c\u00e1c vi tr\u00f9ng kh\u00e1c E.coli,kh\u00f4ng \u0111\u00e1p \u1ee9ng kh\u00e1ng sinh sau 48 gi\u1edd) ho\u1eb7c nhi\u1ec5m tr\u00f9ng ti\u1ec3u t\u00e1i ph\u00e1t<\/li>\n
            • Tr\u1ebb \u2265 3 tu\u1ed5i c\u00f3 nhi\u1ec5m tr\u00f9ng ti\u1ec3u t\u00e1i ph\u00e1t.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

              Nhi\u1ec5m tr\u00f9ng ti\u1ec3u l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p v\u00e0 quan tr\u1ecdng \u1edf tr\u1ebb em. Nhi\u1ec5m tr\u00f9ng ti\u1ec3u tr\u00ean (vi\u00eam \u0111\u00e0i b\u1ec3 th\u1eadn c\u1ea5p) c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1eb9o th\u1eadn, suy th\u1eadn v\u00e0 b\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i. M\u1eb7c d\u00f9 tr\u1ebb vi\u00eam \u0111\u00e0i b\u1ec3 th\u1eadn c\u00f3 khuynh h\u01b0\u1edbng bi\u1ec3u hi\u1ec7n s\u1ed1t, ph\u00e2n bi\u1ec7t […]<\/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":"\nSinh b\u1ec7nh h\u1ecdc v\u00e0 l\u00e2m s\u00e0ng nhi\u1ec5m tr\u00f9ng ti\u1ec3u tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"Nhi\u1ec5m tr\u00f9ng ti\u1ec3u (NTT) l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p v\u00e0 quan tr\u1ecdng \u1edf tr\u1ebb em. NTT tr\u00ean c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1eb9o th\u1eadn, b\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i.\" \/>\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=\"Sinh b\u1ec7nh h\u1ecdc v\u00e0 l\u00e2m s\u00e0ng nhi\u1ec5m tr\u00f9ng ti\u1ec3u tr\u1ebb em - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Nhi\u1ec5m tr\u00f9ng ti\u1ec3u (NTT) l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p v\u00e0 quan tr\u1ecdng \u1edf tr\u1ebb em. 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