{"id":22221,"date":"2023-04-17T11:25:37","date_gmt":"2023-04-17T04:25:37","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22221"},"modified":"2023-04-17T12:35:31","modified_gmt":"2023-04-17T05:35:31","slug":"tieu-chuan-chan-doan-dot-cap-copd","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/tieu-chuan-chan-doan-dot-cap-copd\/","title":{"rendered":"Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n \u0111\u1ee3t c\u1ea5p COPD"},"content":{"rendered":"

\u0110\u1ee3t c\u1ea5p COPD l\u00e0 t\u00ecnh tr\u1ea1ng thay \u0111\u1ed5i c\u1ea5p t\u00ednh c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng: kh\u00f3 th\u1edf t\u0103ng, ho t\u0103ng, kh\u1ea1c \u0111\u1eddm t\u0103ng v\u00e0 ho\u1eb7c thay \u0111\u1ed5i m\u00e0u s\u1eafc c\u1ee7a \u0111\u1eddm. Nh\u1eefng bi\u1ebfn \u0111\u1ed5i n\u00e0y \u0111\u00f2i h\u1ecfi ph\u1ea3i c\u00f3 thay \u0111\u1ed5i trong \u0111i\u1ec1u tr\u1ecb. Theo th\u1ed1ng k\u00ea trung b\u00ecnh m\u1ed7i n\u0103m m\u1ed9t b\u1ec7nh nh\u00e2n COPD c\u00f3 t\u1eeb 1,5 – 2,5 \u0111\u1ee3t c\u1ea5p\/n\u0103m. B\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y s\u1ebd tr\u00ecnh b\u00e0y c\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n \u0111\u1ee3t c\u1ea5p COPD theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 Y t\u1ebf.<\/strong><\/p>\n

\"\u0110\u1ee3t
\u0110\u1ee3t c\u1ea5p COPD l\u00e0 t\u00ecnh tr\u1ea1ng thay \u0111\u1ed5i c\u1ea5p t\u00ednh c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng nh\u01b0 kh\u00f3 th\u1edf t\u0103ng<\/figcaption><\/figure>\n

1. Nguy\u00ean nh\u00e2n<\/b><\/h2>\n

– Nguy\u00ean nh\u00e2n do nhi\u1ec5m tr\u00f9ng: \u0111\u00e2y l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, chi\u1ebfm t\u1edbi 70-80% nguy\u00ean nh\u00e2n g\u00e2y \u0111\u1ee3t c\u1ea5p.<\/p>\n

+ Vi khu\u1ea9n:\u00a0Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, Pseudomonas aeruginosa\u2026<\/p>\n

+ Virus: c\u00fam, \u00e1 c\u00fam, rhinovirus, virus h\u1ee3p b\u00e0o h\u00f4 h\u1ea5p.<\/p>\n

– Kh\u00f4ng do nhi\u1ec5m tr\u00f9ng:<\/p>\n

+ \u00d4 nhi\u1ec5m kh\u00f4ng kh\u00ed (kh\u00f3i thu\u1ed1c, ti\u1ebfp x\u00fac kh\u00f3i b\u1ee5i ngh\u1ec1 nghi\u1ec7p, ozone\u2026).<\/p>\n

+ Gi\u1ea3m nhi\u1ec7t \u0111\u1ed9 m\u00f4i tr\u01b0\u1eddng (trong v\u00e0 ngo\u00e0i nh\u00e0) \u0111\u1ed9t ng\u1ed9t; vi\u00eam c\u00f3 t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan; d\u00f9ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb kh\u00f4ng \u0111\u00fang, b\u1ecf \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9t ng\u1ed9t.<\/p>\n

+ D\u00f9ng thu\u1ed1c an th\u1ea7n, thu\u1ed1c ng\u1ee7.<\/p>\n

– M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 \u0111\u1ee3t c\u1ea5p kh\u00f4ng r\u00f5 c\u0103n nguy\u00ean.<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n<\/b><\/h2>\n

2.1. Ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a \u0111\u1ee3t c\u1ea5p COPD t\u1ea1i y t\u1ebf c\u01a1 s\u1edf (x\u00e3\/ph\u01b0\u1eddng, huy\u1ec7n)<\/b><\/h3>\n

B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n COPD xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng n\u1eb7ng h\u01a1n th\u01b0\u1eddng ng\u00e0y, ho\u1eb7c c\u00e1c tr\u01b0\u1eddng h\u1ee3p tu\u1ed5i trung ni\u00ean ch\u01b0a c\u00f3 ch\u1ea9n \u0111o\u00e1n, nh\u01b0ng xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng:<\/p>\n

– Tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p:<\/p>\n

+ Ho t\u0103ng.<\/p>\n

+ Kh\u00f3 th\u1edf t\u0103ng.<\/p>\n

+ Kh\u1ea1c \u0111\u1eddm t\u0103ng v\u00e0\/ho\u1eb7c thay \u0111\u1ed5i m\u00e0u s\u1eafc c\u1ee7a \u0111\u1eddm: \u0111\u1eddm chuy\u1ec3n th\u00e0nh \u0111\u1eddm m\u1ee7.<\/p>\n

+ Nghe ph\u1ed5i th\u1ea5y r\u00ec r\u00e0o ph\u1ebf nang gi\u1ea3m, c\u00f3 th\u1ec3 th\u1ea5y ran r\u00edt, ng\u00e1y, ran \u1ea9m, ran n\u1ed5.<\/p>\n

– C\u00e1c bi\u1ec3u hi\u1ec7n kh\u00e1c c\u00f3 th\u1ec3 c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh:<\/p>\n

+ Tim m\u1ea1ch: n\u1eb7ng ng\u1ef1c, nh\u1ecbp nhanh, lo\u1ea1n nh\u1ecbp. C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a t\u00e2m ph\u1ebf m\u1ea1n (ph\u00f9, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, gan to\u2026).<\/p>\n

+ Tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n c\u00f3 th\u1ec3 c\u00f3: s\u1ed1t, r\u1ed1i lo\u1ea1n tri gi\u00e1c, tr\u1ea7m c\u1ea3m, m\u1ea5t ng\u1ee7, gi\u1ea3m kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c\u2026<\/p>\n

+ Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 d\u1ea5u hi\u1ec7u suy h\u00f4 h\u1ea5p c\u1ea5p: th\u1edf nhanh n\u00f4ng ho\u1eb7c th\u1edf ch\u1eadm, t\u00edm m\u00f4i \u0111\u1ea7u chi, n\u00f3i ng\u1eaft qu\u00e3ng, co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5, v\u00e3 m\u1ed3 h\u00f4i\u2026<\/p>\n

2.2. C\u00e1c th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n cho \u0111\u1ee3t c\u1ea5p COPD t\u1ea1i b\u1ec7nh vi\u1ec7n<\/b><\/h3>\n

V\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng nh\u01b0 \u0111\u00e3 m\u00f4 t\u1ea3 \u1edf tr\u00ean, b\u1ec7nh nh\u00e2n s\u1ebd \u0111\u01b0\u1ee3c l\u00e0m m\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m c\u1ea7n thi\u1ebft \u0111\u1ec3 h\u1ed7 tr\u1ee3 cho ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb:<\/p>\n

B\u1ea3ng 1. <\/b>Gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n c\u1ee7a c\u00e1c th\u0103m d\u00f2 trong \u0111\u00e1nh gi\u00e1 \u0111\u1ee3t c\u1ea5p COPD<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

X\u00e9t nghi\u1ec7m th\u0103m d\u00f2<\/b><\/p>\n<\/td>\n

\n

C\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n<\/b><\/p>\n<\/td>\n<\/tr>\n

\u0110o Sp<\/b>O<\/b>2<\/sub><\/b><\/td>\nGi\u1ea3m oxy m\u00e1u<\/td>\n<\/tr>\n
Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch<\/b><\/td>\nT\u0103ng CO2\u00a0<\/sub>m\u00e1u, gi\u1ea3m oxy m\u00e1u<\/p>\n

Toan m\u00e1u, ki\u1ec1m m\u00e1u<\/td>\n<\/tr>\n

Ch\u1ee5p X-quang ph\u1ed5i<\/b><\/td>\nGi\u00fap ph\u00e2n bi\u1ec7t vi\u00eam ph\u1ed5i, ph\u00e1t hi\u1ec7n bi\u1ebfn ch\u1ee9ng<\/td>\n<\/tr>\n
C\u00f4ng th\u1ee9c m\u00e1u<\/b><\/td>\nThi\u1ebfu m\u00e1u, \u0111a h\u1ed3ng c\u1ea7u<\/p>\n

T\u0103ng b\u1ea1ch c\u1ea7u<\/td>\n<\/tr>\n

X\u00e9t nghi\u1ec7m \u0111\u1eddm<\/b><\/td>\nNhu\u1ed9m Gram<\/p>\n

C\u1ea5y \u0111\u1eddm<\/td>\n<\/tr>\n

\u0110i\u1ec7n tim<\/b><\/td>\nR\u1ed1i lo\u1ea1n nh\u1ecbp tim: nh\u1ecbp nhanh, ngo\u1ea1i t\u00e2m thu, rung nh\u0129\u2026<\/p>\n

Thi\u1ebfu m\u00e1u c\u01a1 tim c\u1ee5c b\u1ed9<\/p>\n

D\u1ea5u hi\u1ec7u suy tim ph\u1ea3i, suy tim tr\u00e1i<\/td>\n<\/tr>\n

Si\u00eau \u00e2m tim<\/b><\/td>\nGi\u00e3n th\u1ea5t ph\u1ea3i<\/p>\n

T\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/td>\n<\/tr>\n

Sinh h\u00f3a m\u00e1u<\/b><\/td>\nR\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i<\/p>\n

R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan, th\u1eadn; t\u0103ng ho\u1eb7c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, c\u00e1c r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a<\/p>\n

T\u0103ng BNP, Pro-BNP: suy tim<\/p>\n

T\u0103ng D Dimer: Huy\u1ebft kh\u1ed1i – t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/p>\n

T\u0103ng c\u00e1c d\u1ea5u \u1ea5n vi\u00eam: protein ph\u1ea3n \u1ee9ng C (CRP)<\/p>\n

T\u0103ng Procalcitonin<\/td>\n<\/tr>\n

Ch\u1ee9c n\u0103ng th\u00f4ng kh\u00ed<\/b><\/td>\nR\u1ed1i lo\u1ea1n th\u00f4ng kh\u00ed t\u1eafc ngh\u1ebdn kh\u00f4ng h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n: \u0111o ch\u1ee9c n\u0103ng th\u00f4ng kh\u00ed sau khi \u0111\u1ee3t c\u1ea5p \u1ed5n \u0111\u1ecbnh<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

2.3. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh \u0111\u1ee3t c\u1ea5p COPD<\/b><\/h3>\n

B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n COPD v\u00e0 c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111\u1ee3t c\u1ea5p theo ti\u00eau chu\u1ea9n Anthonisen (1987):<\/p>\n

– Kh\u00f3 th\u1edf t\u0103ng.<\/p>\n

– Kh\u1ea1c \u0111\u1eddm t\u0103ng.<\/p>\n

– Thay \u0111\u1ed5i m\u00e0u s\u1eafc c\u1ee7a \u0111\u1eddm, \u0111\u1eddm chuy\u1ec3n th\u00e0nh \u0111\u1eddm m\u1ee7.<\/p>\n

2.4. \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a b\u1ec7nh<\/b><\/h3>\n

\u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng \u0111\u1ee3t c\u1ea5p COPD theo tri\u1ec7u ch\u1ee9ng<\/p>\n

B\u1ea3ng 2. <\/b>\u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a \u0111\u1ee3t c\u1ea5p COPD<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
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C\u00e1c ch\u1ec9 s\u1ed1<\/b><\/p>\n<\/td>\n

\n

N\u1eb7ng<\/b><\/p>\n<\/td>\n

\n

Nguy k\u1ecbch<\/b><\/p>\n<\/td>\n<\/tr>\n

L\u1eddi n\u00f3i<\/b><\/td>\nT\u1eebng t\u1eeb<\/td>\nKh\u00f4ng n\u00f3i \u0111\u01b0\u1ee3c<\/td>\n<\/tr>\n
Tri gi\u00e1c<\/b><\/td>\nNg\u1ee7 g\u00e0, l\u1eabn l\u1ed9n<\/td>\nH\u00f4n m\u00ea<\/td>\n<\/tr>\n
Co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p<\/b><\/td>\nR\u1ea5t nhi\u1ec1u<\/td>\nTh\u1edf ngh\u1ecbch th\u01b0\u1eddng<\/td>\n<\/tr>\n
T\u1ea7n s\u1ed1 th\u1edf\/ph\u00fat<\/b><\/td>\n25 – 35<\/td>\nTh\u1edf ch\u1eadm, ng\u1eebng th\u1edf<\/td>\n<\/tr>\n
Kh\u00f3 th\u1edf<\/b><\/td>\nLi\u00ean t\u1ee5c<\/td>\nLi\u00ean t\u1ee5c<\/td>\n<\/tr>\n
T\u00ednh ch\u1ea5t \u0111\u1eddm:<\/b><\/p>\n

– Thay \u0111\u1ed5i m\u00e0u s\u1eafc<\/b><\/p>\n

– T\u0103ng s\u1ed1 l\u01b0\u1ee3ng<\/b><\/p>\n

– K\u00e8m theo s\u1ed1t<\/b><\/p>\n

– K\u00e8m theo t\u00edm v\u00e0 ph\u00f9 m\u1edbi xu\u1ea5t hi\u1ec7n<\/b><\/td>\n

C\u00f3 3 trong 4 \u0111\u1eb7c \u0111i\u1ec3m<\/td>\nC\u00f3 th\u1ec3 c\u1ea3 4, nh\u01b0ng th\u01b0\u1eddng b\u1ec7nh nh\u00e2n kh\u00f4ng ho kh\u1ea1c \u0111\u01b0\u1ee3c n\u1eefa<\/td>\n<\/tr>\n
M\u1ea1ch\/ph\u00fat<\/b><\/td>\n> 120<\/td>\nCh\u1eadm, lo\u1ea1n nh\u1ecbp<\/td>\n<\/tr>\n
SpO<\/b>2\u00a0<\/sub><\/b>%<\/b><\/td>\n87 – 85<\/td>\n< 85<\/td>\n<\/tr>\n
PaO<\/b>2\u00a0<\/sub><\/b>mmHg<\/b><\/td>\n40 – 50<\/td>\n< 40<\/td>\n<\/tr>\n
PaCO<\/b>2\u00a0<\/sub><\/b>mmHg<\/b><\/td>\n55 – 65<\/td>\n> 65<\/td>\n<\/tr>\n
pH m\u00e1u<\/b><\/td>\n7.25 – 7.30<\/td>\n< 7.25<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Ch\u00fa \u00fd:\u00a0<\/b>c\u00f3 t\u1eeb \u2265 2 ti\u00eau chu\u1ea9n c\u1ee7a m\u1ed9t m\u1ee9c \u0111\u1ed9 th\u00ec \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 \u1edf m\u1ee9c \u0111\u1ed9 \u0111\u00f3.<\/p>\n

Ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng theo ti\u00eau chu\u1ea9n Anthonisen:<\/p>\n

– M\u1ee9c \u0111\u1ed9 n\u1eb7ng: kh\u00f3 th\u1edf t\u0103ng, s\u1ed1 l\u01b0\u1ee3ng \u0111\u1eddm t\u0103ng v\u00e0 \u0111\u1eddm chuy\u1ec3n th\u00e0nh \u0111\u1eddm m\u1ee7.<\/p>\n

– M\u1ee9c \u0111\u1ed9 trung b\u00ecnh: c\u00f3 2 trong s\u1ed1 3 tri\u1ec7u ch\u1ee9ng c\u1ee7a m\u1ee9c \u0111\u1ed9 n\u1eb7ng.<\/p>\n

– M\u1ee9c \u0111\u1ed9 nh\u1eb9: c\u00f3 1 trong s\u1ed1 tri\u1ec7u ch\u1ee9ng c\u1ee7a m\u1ee9c \u0111\u1ed9 n\u1eb7ng v\u00e0 c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c: ho, ti\u1ebfng r\u00edt, s\u1ed1t kh\u00f4ng v\u00ec m\u1ed9t nguy\u00ean nh\u00e2n n\u00e0o kh\u00e1c, c\u00f3 nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean 5 ng\u00e0y tr\u01b0\u1edbc, nh\u1ecbp th\u1edf, nh\u1ecbp tim t\u0103ng > 20% so v\u1edbi ban \u0111\u1ea7u.<\/p>\n

\u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p<\/b><\/p>\n

–\u00a0Kh\u00f4ng suy h\u00f4 h\u1ea5p<\/b>: nh\u1ecbp th\u1edf 20 – 30 l\u1ea7n\/ph\u00fat; kh\u00f4ng co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5; kh\u00f4ng r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c; t\u00ecnh tr\u1ea1ng oxy ho\u00e1 m\u00e1u \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n khi \u0111\u01b0\u1ee3c th\u1edf oxy v\u1edbi FiO2<\/sub>: 28 – 35%; kh\u00f4ng t\u0103ng PaCO2<\/sub>.<\/p>\n

–\u00a0Suy h\u00f4 h\u1ea5p c\u1ea5p – Kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u \u0111e do\u1ea1 t\u00ednh m\u1ea1ng<\/b>: nh\u1ecbp th\u1edf > 30 l\u1ea7n\/ph\u00fat; co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p; kh\u00f4ng r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c; t\u00ecnh tr\u1ea1ng gi\u1ea3m oxy m\u00e1u c\u1ea3i thi\u1ec7n khi th\u1edf oxy v\u1edbi FiO2<\/sub>: 35 – 40%; PaCO2<\/sub>: 50 – 60mmHg;<\/p>\n

–\u00a0Suy h\u00f4 h\u1ea5p c\u1ea5p – C\u00f3 d\u1ea5u hi\u1ec7u \u0111e do\u1ea1 t\u00ednh m\u1ea1ng<\/b>: nh\u1ecbp th\u1edf > 30 l\u1ea7n\/ph\u00fat; co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5; r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c c\u1ea5p t\u00ednh; t\u00ecnh tr\u1ea1ng gi\u1ea3m oxy m\u00e1u c\u1ea3i thi\u1ec7n khi \u0111\u01b0\u1ee3c th\u1edf oxy v\u1edbi FiO2\u00a0<\/sub>> 40%; PaCO2\u00a0<\/sub>> 60mmHg, ho\u1eb7c c\u00f3 toan ho\u00e1 m\u00e1u (pH < 7,25).<\/p>\n

*\u00a0C\u00e1c y\u1ebfu t\u1ed1 l\u00e0m t\u0103ng m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a \u0111\u1ee3t c\u1ea5p COPD:<\/p>\n

– R\u1ed1i lo\u1ea1n \u00fd th\u1ee9c.<\/p>\n

– \u0110\u1ee3t c\u1ea5p \u0111\u00e3 th\u1ea5t b\u1ea1i v\u1edbi \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u.<\/p>\n

– C\u00f3 \u2265 3 \u0111\u1ee3t c\u1ea5p COPD trong n\u0103m tr\u01b0\u1edbc.<\/p>\n

– \u0110\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n COPD m\u1ee9c \u0111\u1ed9 n\u1eb7ng ho\u1eb7c r\u1ea5t n\u1eb7ng.<\/p>\n

– \u0110\u00e3 t\u1eebng ph\u1ea3i \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n v\u00ec \u0111\u1ee3t c\u1ea5p.<\/p>\n

– \u0110\u00e3 c\u00f3 ch\u1ec9 \u0111\u1ecbnh th\u1edf oxy d\u00e0i h\u1ea1n, th\u1edf m\u00e1y kh\u00f4ng x\u00e2m nh\u1eadp t\u1ea1i nh\u00e0.<\/p>\n

– B\u1ec7nh m\u1ea1n t\u00ednh k\u00e8m theo (b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, suy tim sung huy\u1ebft, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, suy th\u1eadn, suy gan).<\/p>\n

– Ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3 (BMI) \u2264 20 kg\/m2<\/sup>.<\/p>\n

– Kh\u00f4ng c\u00f3 tr\u1ee3 gi\u00fap c\u1ee7a gia \u0111\u00ecnh v\u00e0 x\u00e3 h\u1ed9i.<\/p>\n

*\u00a0C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 nhi\u1ec5m Pseudomonas aeruginosa:<\/p>\n

– C\u00f3 b\u1eb1ng ch\u1ee9ng COPD n\u1eb7ng, FEV1\u00a0<\/sub>ban \u0111\u1ea7u < 50%.<\/p>\n

– \u0110\u00e3 ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c\u00a0Pseudomonas aeruginosa\u00a0trong \u0111\u1eddm t\u1eeb l\u1ea7n kh\u00e1m, \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc.<\/p>\n

– C\u00f3 gi\u00e3n ph\u1ebf qu\u1ea3n k\u00e8m theo.<\/p>\n

– D\u00f9ng kh\u00e1ng sinh th\u01b0\u1eddng xuy\u00ean.<\/p>\n

– Nh\u1eadp vi\u1ec7n th\u01b0\u1eddng xuy\u00ean.<\/p>\n

– C\u00f3 d\u00f9ng th\u01b0\u1eddng xuy\u00ean corticoid to\u00e0n th\u00e2n.<\/p>\n

T\u00f3m l\u1ea1i, n\u1eafm \u0111\u01b0\u1ee3c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n \u0111\u1ee3t c\u1ea5p c\u1ee7a b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD) l\u00e0 r\u1ea5t quan tr\u1ecdng v\u00ec \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh l\u00fd ph\u1ed5i ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

\u0110\u1ee3t c\u1ea5p COPD l\u00e0 t\u00ecnh tr\u1ea1ng thay \u0111\u1ed5i c\u1ea5p t\u00ednh c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng: kh\u00f3 th\u1edf t\u0103ng, ho t\u0103ng, kh\u1ea1c \u0111\u1eddm t\u0103ng v\u00e0 ho\u1eb7c thay \u0111\u1ed5i m\u00e0u s\u1eafc c\u1ee7a \u0111\u1eddm. Nh\u1eefng bi\u1ebfn \u0111\u1ed5i n\u00e0y \u0111\u00f2i h\u1ecfi ph\u1ea3i c\u00f3 thay \u0111\u1ed5i trong \u0111i\u1ec1u tr\u1ecb. Theo th\u1ed1ng k\u00ea trung b\u00ecnh m\u1ed7i n\u0103m m\u1ed9t b\u1ec7nh nh\u00e2n COPD […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[3],"yoast_head":"\nTi\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n \u0111\u1ee3t c\u1ea5p COPD - Vinmec<\/title>\n<meta name=\"description\" content=\"Theo th\u1ed1ng k\u00ea trung b\u00ecnh m\u1ed7i n\u0103m m\u1ed9t b\u1ec7nh nh\u00e2n COPD c\u00f3 t\u1eeb 1,5 - 2,5 \u0111\u1ee3t c\u1ea5p\/n\u0103m. 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