{"id":22224,"date":"2023-04-16T21:25:19","date_gmt":"2023-04-16T14:25:19","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22224"},"modified":"2023-04-17T14:07:54","modified_gmt":"2023-04-17T07:07:54","slug":"huong-dan-dieu-tri-dot-cap-copd","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/huong-dan-dieu-tri-dot-cap-copd\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb \u0111\u1ee3t c\u1ea5p COPD"},"content":{"rendered":"

\u0110i\u1ec1u tr\u1ecb \u0111\u1ee3t c\u1ea5p COPD gi\u00fap ki\u1ec3m so\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi v\u00e0 \u0111\u1ea7y \u0111\u1ee7, \u0111\u1ee3t c\u1ea5p COPD c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u1ec7c suy gi\u1ea3m ch\u1ee9c n\u0103ng ph\u1ed5i<\/a> ho\u1eb7c c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng kh\u00e1c nh\u01b0 suy tim, suy gan, nhi\u1ec5m tr\u00f9ng huy\u1ebft v\u00e0 \u0111\u1ed9t qu\u1ef5. Do \u0111\u00f3, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111\u1ee3t c\u1ea5p COPD l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/strong><\/p>\n

1. Ti\u00eau chu\u1ea9n nh\u1eadp vi\u1ec7n:<\/b><\/h2>\n

– C\u00e1c tri\u1ec7u ch\u1ee9ng n\u1eb7ng \u0111\u1ed9t ng\u1ed9t nh\u01b0 kh\u00f3 th\u1edf, t\u1ea7n s\u1ed1 th\u1edf t\u0103ng, \u0111\u1ed9 b\u00e3o h\u00f2a oxy gi\u1ea3m, r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c.<\/p>\n

– Suy h\u00f4 h\u1ea5p.<\/p>\n

– Kh\u1edfi ph\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 m\u1edbi (ph\u00f9 ngo\u1ea1i vi, xanh t\u00edm).<\/p>\n

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

– C\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc n\u1eb7ng (suy tim, lo\u1ea1n nh\u1ecbp tim m\u1edbi xu\u1ea5t hi\u1ec7n \u2026).<\/p>\n

– Thi\u1ebfu ngu\u1ed3n l\u1ef1c h\u1ed7 tr\u1ee3 t\u1ea1i nh\u00e0.<\/p>\n

\"Suy
Suy h\u00f4 h\u1ea5p l\u00e0 ti\u00eau chu\u1ea9n nh\u1eadp vi\u1ec7n c\u1ee7a b\u1ec7nh nh\u00e2n COPD<\/figcaption><\/figure>\n

2. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 \u0111\u1ee3t c\u1ea5p m\u1ee9c \u0111\u1ed9 nh\u1eb9<\/b><\/h2>\n

– Nguy\u00ean t\u1eafc<\/p>\n

+ B\u1ed5 sung th\u00eam thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n nh\u00f3m c\u01b0\u1eddng beta 2, d\u1ea1ng phun h\u00edt, t\u00e1c d\u1ee5ng nhanh d\u00f9ng \u0111\u01a1n thu\u1ea7n ho\u1eb7c d\u1ea1ng k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c kh\u00e1ng cholinergic t\u00e1c d\u1ee5ng nhanh;<\/p>\n

+ V\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 th\u1edf oxy t\u1ea1i nh\u00e0: th\u1edf oxy 1-3 l\u00edt\/ph\u00fat, duy tr\u00ec SpO2\u00a0<\/sub>\u1edf m\u1ee9c 90-92%;<\/p>\n

+ V\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 th\u1edf m\u00e1y kh\u00f4ng x\u00e2m nh\u1eadp t\u1ea1i nh\u00e0: \u0111i\u1ec1u ch\u1ec9nh \u00e1p l\u1ef1c ph\u00f9 h\u1ee3p;<\/p>\n

+ D\u00f9ng s\u1edbm thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i.<\/p>\n

– Thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n<\/p>\n

+ Nh\u00f3m c\u01b0\u1eddng beta 2 adrenergic: Salbutamol, Terbutalin. D\u00f9ng \u0111\u01b0\u1eddng phun h\u00edt, kh\u00ed dung ho\u1eb7c \u0111\u01b0\u1eddng u\u1ed1ng.<\/p>\n

+ Nh\u00f3m kh\u00e1ng cholinergic t\u00e1c d\u1ee5ng ng\u1eafn: Ipratropium kh\u00ed dung.<\/p>\n

+\u00a0K\u1ebft h\u1ee3p kh\u00e1ng cholinergic v\u00e0 thu\u1ed1c c\u01b0\u1eddng beta 2 adrenergic: Fenoterol\/ Ipratropium ho\u1eb7c Salbutamol\/Ipratropium; d\u00f9ng \u0111\u01b0\u1eddng phun h\u00edt, kh\u00ed dung.<\/p>\n

+\u00a0Ti\u1ebfp t\u1ee5c d\u00f9ng, ho\u1eb7c b\u1eaft \u0111\u1ea7u d\u00f9ng s\u1edbm c\u00e1c thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i: LAMA, LABA, ho\u1eb7c d\u1ea1ng k\u1ebft h\u1ee3p LAMA + LABA.<\/p>\n

–\u00a0Corticosteroid:\u00a0<\/b>Budesonid, Fluticason (kh\u00ed dung);<\/p>\n

–\u00a0Thu\u1ed1c d\u1ea1ng k\u1ebft h\u1ee3p lo\u1ea1i c\u01b0\u1eddng beta 2 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i v\u00e0 corticoid d\u1ea1ng phun, h\u00edt:\u00a0<\/b>Budesonid + Formoterol; Fluticason + Salmeterol, fluticason furoate + vilaterol, \u2026<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 \u0111\u1ee3t c\u1ea5p m\u1ee9c \u0111\u1ed9 trung b\u00ecnh\u00a0<\/b><\/h2>\n

– Nguy\u00ean t\u1eafc:<\/p>\n

+ C\u00e1c \u0111i\u1ec1u tr\u1ecb nh\u01b0 \u0111\u1ee3t c\u1ea5p m\u1ee9c \u0111\u1ed9 nh\u1eb9.<\/p>\n

+ Ch\u1ec9 \u0111\u1ecbnh kh\u00e1ng sinh khi b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ea9n \u0111o\u00e1n \u0111\u1ee3t c\u1ea5p Anthonisen m\u1ee9c \u0111\u1ed9 n\u1eb7ng ho\u1eb7c trung b\u00ecnh (c\u00f3 d\u1ea5u hi\u1ec7u \u0111\u1eddm m\u1ee7).<\/p>\n

+ Th\u00eam corticoid u\u1ed1ng, ho\u1eb7c t\u0129nh m\u1ea1ch, li\u1ec1u: 1mg\/kg\/ng\u00e0y. Th\u1eddi gian d\u00f9ng corticoid: th\u01b0\u1eddng kh\u00f4ng qu\u00e1 5-7 ng\u00e0y.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3:<\/p>\n

+ Corticoid: prednisolon (u\u1ed1ng) 1mg\/kg\/ng\u00e0y; ho\u1eb7c methylprednisolon: 1mg\/kg\/ng\u00e0y, u\u1ed1ng ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch.<\/p>\n

+\u00a0Kh\u00e1ng sinh (bi\u1ec3u \u0111\u1ed3 3.2):\u00a0<\/b>beta lactam\/kh\u00e1ng betalactamase (amoxicilline\/acid clavuanic; ampicillin\/sulbactam) 3g\/ng\u00e0y ho\u1eb7c cefuroxim 1,5g\/ng\u00e0y ho\u1eb7c moxifloxacin 400mg\/ng\u00e0y ho\u1eb7c levofloxacin 750mg\/ng\u00e0y.<\/p>\n

<\/p>\n

Bi\u1ec3u \u0111\u1ed3 1. <\/b>H\u01b0\u1edbng d\u1eabn d\u00f9ng kh\u00e1ng sinh cho \u0111\u1ee3t c\u1ea5p COPD m\u1ee9c \u0111\u1ed9 trung b\u00ecnh<\/p>\n

4. \u0110i\u1ec1u tr\u1ecb \u0111\u1ee3t c\u1ea5p m\u1ee9c \u0111\u1ed9 n\u1eb7ng<\/b><\/h2>\n

– Ti\u1ebfp t\u1ee5c c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 n\u00eau \u1edf tr\u00ean. Theo d\u00f5i m\u1ea1ch huy\u1ebft \u00e1p, nh\u1ecbp th\u1edf, SpO2<\/sub>.<\/p>\n

– Th\u1edf oxy 1 – 2 l\u00edt\/ph\u00fat sao cho SpO2\u00a0<\/sub>\u0111\u1ea1t 90 – 92%. N\u00ean l\u00e0m kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch \u0111\u1ec3 l\u00e0m c\u01a1 s\u1edf \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u oxy:<\/p>\n

+ Khi SaO2<\/sub>: 90 – 92%; PaCO2\u00a0<\/sub>< 45mmHg: gi\u1eef nguy\u00ean li\u1ec1u oxy \u0111ang d\u00f9ng.<\/p>\n

+ Khi SaO2\u00a0<\/sub>< 90%, PaCO2\u00a0<\/sub>< 45mmHg: th\u1ef1c hi\u1ec7n t\u0103ng li\u1ec1u oxy, t\u1ed1i \u0111a kh\u00f4ng qu\u00e1 3 l\u00edt\/ ph\u00fat.<\/p>\n

+ Khi SaO2\u00a0<\/sub>> 92%, PaCO2\u00a0<\/sub>> 45mmHg: th\u1ef1c hi\u1ec7n gi\u1ea3m li\u1ec1u oxy, v\u00e0 l\u00e0m l\u1ea1i kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch sau 30 ph\u00fat.<\/p>\n

+ Khi SaO2\u00a0<\/sub>< 90%, PaCO2\u00a0<\/sub>> 55mmHg v\u00e0\/ho\u1eb7c pH \u2264 7,35: ch\u1ec9 \u0111\u1ecbnh th\u1edf m\u00e1y kh\u00f4ng x\u00e2m nh\u1eadp.<\/p>\n

– Kh\u00ed dung thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n nh\u00f3m c\u01b0\u1eddng beta 2 adrenergic ho\u1eb7c d\u1ea1ng k\u1ebft h\u1ee3p c\u01b0\u1eddng beta 2 adrenergic v\u1edbi kh\u00e1ng cholinergic.<\/p>\n

– N\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c thu\u1ed1c kh\u00ed dung th\u00ec d\u00f9ng salbutamol, terbutaline truy\u1ec1n t\u0129nh m\u1ea1ch v\u1edbi li\u1ec1u 0,5 – 2mg\/gi\u1edd, \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u thu\u1ed1c theo \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n. Truy\u1ec1n b\u1eb1ng b\u01a1m ti\u00eam \u0111i\u1ec7n ho\u1eb7c m\u00e1y truy\u1ec1n d\u1ecbch.<\/p>\n

– Methylprednisolon 1-2 mg\/kg\/ng\u00e0y ti\u00eam t\u0129nh m\u1ea1ch. Th\u1eddi gian d\u00f9ng th\u00f4ng th\u01b0\u1eddng kh\u00f4ng qu\u00e1 5-7 ng\u00e0y.<\/p>\n

–\u00a0Kh\u00e1ng sinh (bi\u1ec3u \u0111\u1ed3 2<\/b>) cefotaxim 1-2g x 3 l\u1ea7n\/ng\u00e0y ho\u1eb7c ceftriaxon 2g\/ l\u1ea7n x 1-2 l\u1ea7n\/ng\u00e0y ho\u1eb7c ceftazidim 1-2g x 3 l\u1ea7n\/ng\u00e0y; ph\u1ed1i h\u1ee3p v\u1edbi nh\u00f3m aminoglycosid 15mg\/kg\/ng\u00e0y ho\u1eb7c quinolon (levofloxacin 750mg\/ng\u00e0y, moxifloxacin 400mg\/ng\u00e0y…).<\/p>\n

<\/b><\/p>\n

Bi\u1ec3u \u0111\u1ed3 2. <\/b>\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh cho b\u1ec7nh nh\u00e2n \u0111\u1ee3t c\u1ea5p BPTNMT nh\u1eadp vi\u1ec7n<\/p>\n

Ghi ch\u00fa: Carbapenem nh\u00f3m 1 (Ertapenem) d\u00f9ng cho nhi\u1ec5m khu\u1ea9n kh\u00f4ng do\u00a0Pseudomonas. N\u1ebfu kh\u00f4ng lo\u1ea1i tr\u1eeb\u00a0Pseudomonas\u00a0th\u00ec n\u00ean d\u00f9ng Carbapenem nh\u00f3m 2 (Imipenem, Meropenem).<\/p>\n

Khuy\u1ebfn c\u00e1o th\u1eddi gian s\u1eed d\u1ee5ng kh\u00e1ng sinh trong \u0111\u1ee3t c\u1ea5p COPD:<\/b><\/p>\n

– \u0110\u1ee3t c\u1ea5p m\u1ee9c \u0111\u1ed9 nh\u1eb9, \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa: th\u1eddi gian \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh trung b\u00ecnh 5-7 ng\u00e0y.<\/p>\n

– \u0110\u1ee3t c\u1ea5p m\u1ee9c \u0111\u1ed9 trung b\u00ecnh v\u00e0 n\u1eb7ng: th\u1eddi gian trung b\u00ecnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh t\u1eeb 7-10 ng\u00e0y.<\/p>\n

– Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh c\u1ee5 th\u1ec3 tu\u1ef3 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a \u0111\u1ee3t c\u1ea5p v\u00e0 \u0111\u00e1p \u1ee9ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

Th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o kh\u00f4ng x\u00e2m nh\u1eadp\u00a0<\/b>(BiPAP) khi c\u00f3 \u00edt nh\u1ea5t 2 ti\u00eau chu\u1ea9n sau:<\/p>\n

+ Kh\u00f3 th\u1edf v\u1eeba t\u1edbi n\u1eb7ng c\u00f3 co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5 v\u00e0 h\u00f4 h\u1ea5p ngh\u1ecbch th\u01b0\u1eddng.<\/p>\n

+ Toan h\u00f4 h\u1ea5p: pH \u2264 7,35 v\u00e0\/ho\u1eb7c PaCO2\u00a0<\/sub>\u2265 45mmHg.<\/p>\n

+ T\u1ea7n s\u1ed1 th\u1edf > 25 l\u1ea7n\/ph\u00fat.<\/p>\n

N\u1ebfu sau 60 ph\u00fat th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o kh\u00f4ng x\u00e2m nh\u1eadp, c\u00e1c th\u00f4ng s\u1ed1 PaCO2\u00a0<\/sub>ti\u1ebfp t\u1ee5c t\u0103ng v\u00e0 PaO2\u00a0<\/sub>ti\u1ebfp t\u1ee5c gi\u1ea3m ho\u1eb7c c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ti\u1ebfp t\u1ee5c x\u1ea5u \u0111i th\u00ec c\u1ea7n chuy\u1ec3n sang th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o x\u00e2m nh\u1eadp.<\/p>\n

– Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o kh\u00f4ng x\u00e2m nh\u1eadp:<\/p>\n

+ Ng\u1eebng th\u1edf, ng\u1ee7 g\u00e0, r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c, kh\u00f4ng h\u1ee3p t\u00e1c.<\/p>\n

+ R\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng: t\u1ee5t huy\u1ebft \u00e1p, lo\u1ea1n nh\u1ecbp tim, nh\u1ed3i m\u00e1u c\u01a1 tim.<\/p>\n

+ Nguy c\u01a1 h\u00edt ph\u1ea3i d\u1ecbch d\u1ea1 d\u00e0y, \u0111\u1eddm nhi\u1ec1u, d\u00ednh.<\/p>\n

+ M\u1edbi ph\u1eabu thu\u1eadt r\u0103ng h\u00e0m m\u1eb7t ho\u1eb7c m\u1ed5 d\u1ea1 d\u00e0y.<\/p>\n

+ B\u1ecfng, ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u, m\u1eb7t, b\u00e9o ph\u00ec qu\u00e1 nhi\u1ec1u.<\/p>\n

– Th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o x\u00e2m nh\u1eadp khi c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u sau:<\/p>\n

+ Kh\u00f3 th\u1edf n\u1eb7ng, c\u00f3 co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p v\u00e0 di \u0111\u1ed9ng c\u01a1 th\u00e0nh b\u1ee5ng ngh\u1ecbch th\u01b0\u1eddng.<\/p>\n

+ Th\u1edf > 35 l\u1ea7n\/ph\u00fat ho\u1eb7c th\u1edf ch\u1eadm.<\/p>\n

+ Thi\u1ebfu oxy m\u00e1u \u0111e do\u1ea1 t\u1eed vong: PaO2\u00a0<\/sub>< 40mmHg.<\/p>\n

+ pH < 7,25, PaCO2\u00a0<\/sub>> 60mmHg.<\/p>\n

+ Ng\u1ee7 g\u00e0, r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c, ng\u1eebng th\u1edf.<\/p>\n

+ Bi\u1ebfn ch\u1ee9ng tim m\u1ea1ch: h\u1ea1 huy\u1ebft \u00e1p, s\u1ed1c, suy tim.<\/p>\n

+ R\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1, nhi\u1ec5m khu\u1ea9n, vi\u00eam ph\u1ed5i, t\u1eafc m\u1ea1ch ph\u1ed5i.<\/p>\n

+ Th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o kh\u00f4ng x\u00e2m nh\u1eadp th\u1ea5t b\u1ea1i.<\/p>\n

– \u0110\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi ra vi\u1ec7n v\u00e0 khuy\u1ebfn c\u00e1o theo d\u00f5i<\/p>\n

+ Xem x\u00e9t \u0111\u1ea7y \u0111\u1ee7 c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m.<\/p>\n

+ Ki\u1ec3m tra ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb duy tr\u00ec v\u00e0 hi\u1ec3u bi\u1ebft c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

+ \u0110\u00e1nh gi\u00e1 l\u1ea1i c\u00e1c k\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng c\u00e1c d\u1ee5ng c\u1ee5 ph\u00e2n ph\u1ed1i thu\u1ed1c.<\/p>\n

+ H\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng thu\u1ed1c trong \u0111\u1ee3t c\u1ea5p (steroid v\u00e0 thu\u1ed1c kh\u00e1ng sinh).<\/p>\n

+ \u0110\u00e1nh gi\u00e1 nhu c\u1ea7u \u0111i\u1ec1u tr\u1ecb duy tr\u00ec v\u00e0 oxy d\u00e0i h\u1ea1n.<\/p>\n

+ C\u00f3 k\u1ebf ho\u1ea1ch qu\u1ea3n l\u00fd v\u00e0 theo d\u00f5i c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc.<\/p>\n

+ \u0110\u1ea3m b\u1ea3o theo d\u00f5i: t\u00e1i kh\u00e1m s\u1edbm < 4 tu\u1ea7n v\u00e0 mu\u1ed9n nh\u1ea5t < 12 tu\u1ea7n.<\/p>\n

+ Nh\u1eadn bi\u1ebft \u0111\u01b0\u1ee3c c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng b\u1ea5t th\u01b0\u1eddng.<\/p>\n

– Kh\u00e1m l\u1ea1i sau xu\u1ea5t vi\u1ec7n 1 th\u00e1ng<\/p>\n

+ Kh\u1ea3 n\u0103ng t\u00e1i ho\u00e0 nh\u1eadp trong m\u00f4i tr\u01b0\u1eddng x\u00e3 h\u1ed9i b\u00ecnh th\u01b0\u1eddng.<\/p>\n

+ \u0110\u1ecdc v\u00e0 hi\u1ec3u r\u00f5 v\u1ec1 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

+ \u0110\u00e1nh gi\u00e1 l\u1ea1i k\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng c\u00e1c d\u1ee5ng c\u1ee5 ph\u00e2n ph\u1ed1i thu\u1ed1c.<\/p>\n

+ \u0110\u00e1nh gi\u00e1 l\u1ea1i nhu c\u1ea7u \u0111i\u1ec1u tr\u1ecb oxy d\u00e0i h\u1ea1n.<\/p>\n

+ Kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t v\u00e0 sinh ho\u1ea1t h\u00e0ng ng\u00e0y.<\/p>\n

+ \u0110\u00e1nh gi\u00e1 \u0111i\u1ec3m CAT ho\u1eb7c mMRC.<\/p>\n

+ X\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc.<\/p>\n

– Kh\u00e1m l\u1ea1i sau xu\u1ea5t vi\u1ec7n 3 th\u00e1ng<\/p>\n

+ Kh\u1ea3 n\u0103ng t\u00e1i ho\u00e0 nh\u1eadp trong m\u00f4i tr\u01b0\u1eddng x\u00e3 h\u1ed9i b\u00ecnh th\u01b0\u1eddng.<\/p>\n

+ Hi\u1ec3u bi\u1ebft v\u1ec1 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

+ \u0110\u00e1nh gi\u00e1 l\u1ea1i k\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng c\u00e1c d\u1ee5ng c\u1ee5 ph\u00e2n ph\u1ed1i thu\u1ed1c.<\/p>\n

+ \u0110\u00e1nh gi\u00e1 l\u1ea1i nhu c\u1ea7u \u0111i\u1ec1u tr\u1ecb oxy d\u00e0i h\u1ea1n v\u00e0\/ho\u1eb7c kh\u00ed dung t\u1ea1i nh\u00e0.<\/p>\n

+ Kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t v\u00e0 sinh ho\u1ea1t h\u00e0ng ng\u00e0y.<\/p>\n

+ \u0110o FEV1<\/sub>.<\/p>\n

+ \u0110\u00e1nh gi\u00e1 \u0111i\u1ec3m CAT ho\u1eb7c mMRC.<\/p>\n

+ T\u00ecnh tr\u1ea1ng c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc.<\/p>\n

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

\u0110i\u1ec1u tr\u1ecb \u0111\u1ee3t c\u1ea5p COPD gi\u00fap ki\u1ec3m so\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi v\u00e0 \u0111\u1ea7y \u0111\u1ee7, \u0111\u1ee3t c\u1ea5p COPD c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u1ec7c suy gi\u1ea3m ch\u1ee9c n\u0103ng ph\u1ed5i ho\u1eb7c c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng kh\u00e1c nh\u01b0 suy tim, suy gan, nhi\u1ec5m […]<\/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":"\nH\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb \u0111\u1ee3t c\u1ea5p COPD - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb \u0111\u1ee3t c\u1ea5p COPD gi\u00fap ki\u1ec3m so\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng. 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