{"id":22234,"date":"2023-04-16T17:54:41","date_gmt":"2023-04-16T10:54:41","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22234"},"modified":"2023-04-17T14:11:46","modified_gmt":"2023-04-17T07:11:46","slug":"cham-soc-giam-nhe-cho-benh-nhan-copd","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/cham-soc-giam-nhe-cho-benh-nhan-copd\/","title":{"rendered":"Ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 cho b\u1ec7nh nh\u00e2n COPD"},"content":{"rendered":"

B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd ph\u1ed5i m\u00e3n t\u00ednh, th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi h\u00fat thu\u1ed1c l\u00e1 ho\u1eb7c c\u00f3 ti\u1ebfp x\u00fac v\u1edbi c\u00e1c ch\u1ea5t \u0111\u1ed9c h\u1ea1i kh\u00e1c. B\u1ec7nh c\u00f3 th\u1ec3 g\u00e2y kh\u00f3 th\u1edf, ho, v\u00e0 gi\u1ea3m kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n c\u00e1c ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y. Ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 \u0111\u00f3ng vai tr\u00f2 r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c qu\u1ea3n l\u00fd b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 m\u1ed9t s\u1ed1 ph\u01b0\u01a1ng ph\u00e1p ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 cho b\u1ec7nh nh\u00e2n COPD.<\/strong><\/p>\n

1. H\u1ed7 tr\u1ee3 dinh d\u01b0\u1ee1ng<\/b><\/h2>\n

1.1. \u0110\u00e1nh gi\u00e1 dinh d\u01b0\u1ee1ng<\/h3>\n

– D\u1ef1a v\u00e0o c\u00e2n n\u1eb7ng ho\u1eb7c BMI<\/a>: suy dinh d\u01b0\u1ee1ng khi BMI < 21 kg\/m2<\/sup>, ho\u1eb7c s\u1ee5t c\u00e2n ngo\u00e0i \u00fd mu\u1ed1n > 1% c\u00e2n n\u1eb7ng trong 6 th\u00e1ng g\u1ea7n \u0111\u00e2y, ho\u1eb7c s\u1ee5t c\u00e2n ngo\u00e0i \u00fd mu\u1ed1n > 5% c\u00e2n n\u1eb7ng trong 1 th\u00e1ng g\u1ea7n \u0111\u00e2y.<\/p>\n

– D\u1ef1a v\u00e0o ch\u1ec9 s\u1ed1 kh\u1ed1i kh\u00f4ng m\u1ee1 FFMI (Fat free mass index): kh\u1ed1i kh\u00f4ng m\u1ee1 bao g\u1ed3m c\u00e1c c\u01a1 quan, c\u01a1, x\u01b0\u01a1ng v\u00e0 n\u01b0\u1edbc, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u01b0\u1edbc t\u00ednh b\u1eb1ng \u0111o b\u1ec1 d\u00e0y n\u1ebfp g\u1ea5p da, \u0111o kh\u00e1ng tr\u1edf \u0111i\u1ec7n sinh h\u1ecdc (bio – electric impedance). FFMI \u0111\u01b0\u1ee3c t\u00ednh b\u1edfi c\u00f4ng th\u1ee9c FFM \/ chi\u1ec1u cao2<\/sup>; g\u1ecdi l\u00e0 g\u1ea7y \u0111\u00e9t khi FFMI < 16kg\/m2\u00a0<\/sup>\u1edf nam v\u00e0 < 15kg\/m2\u00a0<\/sup>\u1edf n\u1eef.<\/p>\n

1.2. \u0110i\u1ec1u ch\u1ec9nh suy dinh d\u01b0\u1ee1ng<\/h3>\n

– Ch\u1ebf \u0111\u1ed9 \u0103n: t\u00ednh to\u00e1n nhu c\u1ea7u n\u0103ng l\u01b0\u1ee3ng c\u01a1 b\u1ea3n (nam 24 kcal\/kg\/24h, n\u1eef 22kcal\/kg\/24h), c\u00f3 hi\u1ec7u ch\u1ec9nh c\u00e1c h\u1ec7 s\u1ed1 ho\u1ea1t \u0111\u1ed9ng, m\u1ee9c \u0111\u1ed9 t\u1eafc ngh\u1ebdn, ph\u00e2n b\u1ed1 kh\u1ea9u ph\u1ea7n theo t\u1ec9 l\u1ec7 \u0111\u1ea1m 1g\/kg\/ng\u00e0y; b\u00e9o 20 – 30 % v\u00e0 carbohydrat: 40 – 50 % t\u1ed5ng n\u0103ng l\u01b0\u1ee3ng h\u00e0ng ng\u00e0y. N\u00ean d\u00f9ng kh\u1ea9u ph\u1ea7n gi\u00e0u ch\u1ea5t b\u00e9o \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n COPD c\u00f3 t\u0103ng th\u00e1n kh\u00ed trong m\u00e1u v\u1edbi paCO2\u00a0<\/sub>> 50mmHg.<\/p>\n

– D\u00f9ng thu\u1ed1c: d\u00f9ng steroids \u0111\u1ed3ng h\u00f3a k\u1ebft h\u1ee3p v\u1edbi t\u1eadp v\u1eadn \u0111\u1ed9ng, u\u1ed1ng ho\u1eb7c ti\u00eam b\u1eafp, t\u1eeb 2 – 6 th\u00e1ng c\u00f3 th\u1ec3 gi\u00fap t\u0103ng kh\u1ed1i kh\u00f4ng m\u1ee1 m\u00e0 kh\u00f4ng t\u0103ng kh\u1ed1i m\u1ee1.<\/p>\n

2. H\u1ed7 tr\u1ee3 t\u00e2m l\u00fd<\/b><\/h2>\n

COPD\u00a0 th\u01b0\u1eddng k\u00e8m theo t\u0103ng nguy c\u01a1 lo \u00e2u, tr\u1ea7m c\u1ea3m v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n kh\u00e1c, nh\u01b0ng th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c nh\u1eadn bi\u1ebft v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang m\u1ee9c. C\u00e1c b\u1ec7nh l\u00fd t\u00e2m th\u1ea7n kinh c\u00f3 s\u1eb5n c\u0169ng th\u01b0\u1eddng l\u00e0m cho c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m l\u00fd n\u1eb7ng n\u1ec1 h\u01a1n.<\/p>\n

2.1. T\u1ea7m so\u00e1t<\/h3>\n

\u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng t\u00e2m l\u00fd x\u00e3 h\u1ed9i b\u1eb1ng c\u00e1c b\u1ea3ng c\u00e2u h\u1ecfi t\u1ea7m so\u00e1t (Hospital Anxiety and Depression Questionnaire hay Beck Depression Inventory) v\u00e0 nh\u1eadn bi\u1ebft c\u00e1c tr\u1ea1ng th\u00e1i t\u00e2m l\u00fd \u0111a d\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n nh\u01b0 lo l\u1eafng, s\u1ee3 h\u00e3i, gi\u1eadn d\u1eef, t\u1ed9i l\u1ed7i, b\u1ea5t ch\u1ea5p, o\u00e1n gi\u1eadn, bu\u1ed3n phi\u1ec1n, s\u1ea7u kh\u1ed5, v\u00f4 d\u1ee5ng, t\u1ef1 c\u00f4 l\u1eadp, th\u1ea5t v\u1ecdng\u2026<\/p>\n

2.2. X\u1eed tr\u00ed<\/h3>\n

Nh\u1eefng b\u1ec7nh nh\u00e2n r\u1ed1i lo\u1ea1n t\u00e2m l\u00fd trung b\u00ecnh v\u00e0 n\u1eb7ng n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb chuy\u00ean khoa. C\u00e1c b\u1ec7nh nh\u00e2n c\u00f2n l\u1ea1i n\u00ean \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n h\u1ed7 tr\u1ee3, h\u01b0\u1edbng d\u1eabn c\u00e1c k\u1ef9 n\u0103ng \u0111\u1ed1i ph\u00f3 v\u1edbi stress: t\u1eadp th\u01b0 gi\u00e3n, th\u1ea3 l\u1ecfng c\u01a1, yoga\u2026<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb gi\u1ea3m nh\u1eb9 kh\u00f3 th\u1edf<\/b><\/h2>\n

Kh\u00f3 th\u1edf kh\u00e1ng tr\u1ecb v\u1edbi \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng kh\u00e1 th\u01b0\u1eddng g\u1eb7p, chi\u1ebfm t\u1ec9 l\u1ec7 50% \u1edf giai \u0111o\u1ea1n n\u1eb7ng, nh\u1ea5t l\u00e0 nh\u1eefng n\u0103m cu\u1ed1i \u0111\u1eddi, \u1ea3nh h\u01b0\u1edfng n\u1eb7ng n\u1ec1 \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng v\u00e0 khi\u1ebfn cho ng\u01b0\u1eddi b\u1ec7nh h\u1ea7u nh\u01b0 t\u00e0n ph\u1ebf. Ngo\u00e0i c\u00e1c thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n kinh \u0111i\u1ec3n, \u0111i\u1ec1u tr\u1ecb gi\u1ea3m nh\u1eb9 ho\u1eb7c xoa d\u1ecbu kh\u00f3 th\u1edf bao g\u1ed3m c\u1ea3 bi\u1ec7n ph\u00e1p d\u00f9ng thu\u1ed1c v\u00e0 kh\u00f4ng d\u00f9ng thu\u1ed1c.<\/p>\n

3.1. Oxy li\u1ec7u ph\u00e1p<\/h3>\n

Th\u1edf oxy li\u00ean t\u1ee5c \u1edf b\u1ec7nh nh\u00e2n COPD n\u1eb7ng c\u00f3 h\u1ea1 oxy m\u00e1u l\u00fac ngh\u1ec9 gi\u00fap gi\u1ea3m kh\u00f3 th\u1edf, gi\u1ea3m t\u1eed vong v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng; kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng th\u1edf oxy gi\u1ea3m kh\u00f3 th\u1edf \u1edf b\u1ec7nh nh\u00e2n COPD n\u1eb7ng kh\u00f4ng c\u00f3 h\u1ea1 oxy m\u00e1u.<\/p>\n

\"Ch\u0103m
Ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 cho b\u1ec7nh nh\u00e2n COPD b\u1eb1ng li\u1ec7u ph\u00e1p oxy<\/figcaption><\/figure>\n

3.2. Th\u1edf m\u00e1y kh\u00f4ng x\u00e2m nh\u1eadp<\/h3>\n

Th\u1edf m\u00e1y kh\u00f4ng x\u00e2m nh\u1eadp \u00e1p l\u1ef1c d\u01b0\u01a1ng t\u1ea1i nh\u00e0 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n t\u0103ng CO2\u00a0<\/sub>m\u00e1u m\u1ea1n t\u00ednh (paCO2\u00a0<\/sub>\u2265 52 mmHg) c\u00f3 th\u1ec3 gi\u00fap c\u1ea3i thi\u1ec7n th\u1eddi gian s\u1ed1ng c\u00f2n.<\/p>\n

3.3. Morphin<\/h3>\n

Th\u01b0\u1eddng d\u00f9ng Morphin d\u1ea1ng vi\u00ean u\u1ed1ng ph\u00f3ng th\u00edch ch\u1eadm li\u1ec1u trung b\u00ecnh 20mg\/ ng\u00e0y, \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u m\u1ed7i tu\u1ea7n trong 4 – 6 tu\u1ea7n \u0111\u1ea7u (B\u1ea3ng 5.3), l\u01b0u \u00fd d\u1ea1ng Morphin phun kh\u00ed dung kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3.<\/p>\n

B\u1ea3ng. <\/b>Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb kh\u00f3 th\u1edf b\u1eb1ng Morphin \u1edf b\u1ec7nh nh\u00e2n BPTNMT giai \u0111o\u1ea1n cu\u1ed1i \u0111\u1eddi<\/p>\n\n\n\n\n\n\n
Ph\u00e1c \u0111\u1ed3<\/b><\/td>\nLi\u1ec1u d\u00f9ng<\/b><\/td>\n<\/tr>\n
Kh\u1edfi \u0111\u1ea7u<\/b><\/td>\n+\u00a0Kh\u1edfi \u0111\u1ea7u v\u1edbi Morphin u\u1ed1ng 0,5mg 2 l\u1ea7n\/ng\u00e0y x 2 ng\u00e0y, sau \u0111\u00f3 t\u0103ng l\u00ean 0,5mg u\u1ed1ng m\u1ed7i 4 gi\u1edd \u0111\u1ebfn h\u1ebft tu\u1ea7n 1.<\/td>\n<\/tr>\n
T\u0103ng li\u1ec1u<\/b><\/td>\n+\u00a0N\u1ebfu dung n\u1ea1p, t\u0103ng li\u1ec1u l\u00ean 1mg u\u1ed1ng m\u1ed7i 4 gi\u1edd trong tu\u1ea7n 2; sau \u0111\u00f3 t\u0103ng th\u00eam 1mg\/ tu\u1ea7n cho \u0111\u1ebfn khi \u0111\u1ea1t li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3 gi\u1ea3m kh\u00f3 th\u1edf.<\/p>\n

+\u00a0Khi li\u1ec1u \u1ed5n \u0111\u1ecbnh \u0111\u00e3 \u0111\u1ea1t \u0111\u01b0\u1ee3c (vd: kh\u00f4ng thay \u0111\u1ed5i li\u1ec1u \u0111\u00e1ng k\u1ec3 trong<\/p>\n

2 tu\u1ea7n v\u00e0 gi\u1ea3m kh\u00f3 th\u1edf), thay b\u1eb1ng Morphin d\u1ea1ng ph\u00f3ng th\u00edch<\/p>\n

ch\u1eadm v\u1edbi li\u1ec1u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng.<\/td>\n<\/tr>\n

T\u00e1c d\u1ee5ng ph\u1ee5<\/b><\/td>\n+\u00a0N\u1ebfu b\u1ecb nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a Morphin (n\u00f4n \u00f3i, l\u00fa l\u1eabn..), c\u00f3 th\u1ec3 thay th\u1ebf b\u1eb1ng Hydromorphin u\u1ed1ng v\u1edbi li\u1ec1u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng (1mg Hydromorphin = 5mg Morphin).<\/p>\n

+\u00a0Cho thu\u1ed1c ch\u1ed1ng t\u00e1o b\u00f3n v\u00e0 thu\u1ed1c l\u00e0m m\u1ec1m ph\u00e2n \u0111\u1ec3 tr\u00e1nh t\u00e1o b\u00f3n do morphin.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

3.4. C\u00e1c bi\u1ec7n ph\u00e1p kh\u00f4ng d\u00f9ng thu\u1ed1c<\/h3>\n

C\u00e1c bi\u1ec7n ph\u00e1p c\u00f3 hi\u1ec7u qu\u1ea3 gi\u1ea3m kh\u00f3 th\u1edf bao g\u1ed3m v\u1ed7 rung th\u00e0nh ng\u1ef1c, th\u1edf ch\u00fam m\u00f4i…<\/p>\n

T\u00f3m l\u1ea1i, ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 cho b\u1ec7nh nh\u00e2n COPD bao g\u1ed3m c\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 cho b\u1ec7nh nh\u00e2n m\u1ed9t c\u00e1ch t\u1ed1t nh\u1ea5t. Vi\u1ec7c \u0111\u01b0a ra ch\u1ebf \u0111\u1ed9 ch\u0103m s\u00f3c ph\u00f9 h\u1ee3p ph\u1ea3i d\u1ef1a tr\u00ean t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee5 th\u1ec3 c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t c\u1ee7a b\u00e1c s\u1ef9 chuy\u00ean khoa h\u00f4 h\u1ea5p.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n