{"id":22395,"date":"2023-04-21T23:17:17","date_gmt":"2023-04-21T16:17:17","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22395"},"modified":"2023-04-21T23:17:17","modified_gmt":"2023-04-21T16:17:17","slug":"benh-viem-mang-nao-nhiem-khuan-huong-dan-chan-doan-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/benh-viem-mang-nao-nhiem-khuan-huong-dan-chan-doan-dieu-tri\/","title":{"rendered":"Vi\u00eam ma\u0300ng na\u0303o nhi\u00ea\u0303m khu\u00e2\u0309n – H\u01b0\u01a1\u0301ng d\u00e2\u0303n ch\u00e2\u0309n \u0111oa\u0301n va\u0300 \u0111i\u00ea\u0300u tri\u0323"},"content":{"rendered":"

Vi\u00eam ma\u0300ng na\u0303o nhi\u00ea\u0303m khu\u00e2\u0309n<\/strong> l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nghi\u00eam tr\u1ecdng do s\u1ef1 l\u00e2y lan c\u1ee7a c\u00e1c lo\u1ea1i vi khu\u1ea9n nh\u01b0 Streptococcus pneumoniae, Neisseria meningitidis, v\u00e0 Haemophilus influenzae. B\u1ec7nh th\u01b0\u1eddng x\u1ea3y ra \u1edf tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean, tuy nhi\u00ean, c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf b\u1ea5t k\u1ef3 \u0111\u1ed9 tu\u1ed5i n\u00e0o. Vi\u1ec7c ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 v\u00e0 t\u1ed1i \u0111a h\u00f3a kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i c\u1ee7a b\u1ec7nh nh\u00e2n. Ngo\u00e0i ra, vi\u1ec7c ti\u00eam ch\u1ee7ng ph\u00f2ng ng\u1eeba c\u0169ng l\u00e0 m\u1ed9t bi\u1ec7n ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 ng\u0103n ng\u1eeba b\u1ec7nh vi\u00eam m\u00e0ng n\u00e3o nhi\u1ec5m khu\u1ea9n.<\/p>\n

1.\u00a0 \u0110i\u0323nh nghi\u0303a vi\u00eam ma\u0300ng na\u0303o nhi\u00ea\u0303m khu\u00e2\u0309n<\/h2>\n

Vi\u00eam m\u00e0ng n\u00e3o nhi\u1ec5m khu\u1ea9n (VMNNK)<\/a> l\u00e0 t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n c\u1ea5p t\u00ednh c\u1ee7a m\u00e0ng n\u00e3o do m\u1ed9t s\u1ed1 lo\u1ea1i vi khu\u1ea9n g\u00e2y n\u00ean.<\/p>\n

Tr\u00ean l\u00e2m s\u00e0ng, b\u1ec7nh bi\u1ec3u hi\u1ec7n b\u1eb1ng tri\u1ec7u ch\u1ee9ng s\u1ed1t v\u00e0 c\u00f3 h\u1ed9i ch\u1ee9ng\u00a0 m\u00e0ng n\u00e3o, \u0111\u00f4i khi c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a \u1ed5 nhi\u1ec5m tr\u00f9ng kh\u1edfi \u0111i\u1ec3m (\u0111\u01b0\u1eddng v\u00e0o). Hi\u1ec7n nay, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb VMNNK v\u1eabn c\u00f2n ph\u1ee9c t\u1ea1p v\u00e0 ti\u00ean l\u01b0\u1ee3ng d\u00e8 d\u1eb7t.<\/p>\n

\"B\u00ea\u0323nh
B\u00ea\u0323nh vi\u00eam ma\u0300ng na\u0303o nhi\u00ea\u0303m khu\u00e2\u0309n<\/figcaption><\/figure>\n

2.\u00a0 Nguy\u00ean nh\u00e2n vi\u00eam ma\u0300ng na\u0303o nhi\u00ea\u0303m khu\u00e2\u0309n<\/h2>\n

C\u00f3 \u00edt nh\u1ea5t 14 c\u0103n nguy\u00ean g\u00e2y VMNNK. Hi\u1ec7n nay t\u1ea1i Vi\u1ec7t Nam, c\u0103n nguy\u00ean hay g\u1eb7p \u1edf tr\u1ebb em l\u00e0 Hemophilus influenza typ B (Hib)<\/em>, ph\u1ebf c\u1ea7u v\u00e0 n\u00e3o m\u00f4 c\u1ea7u, \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh l\u00e0 li\u00ean c\u1ea7u (\u0111\u1eb7c bi\u1ec7t l\u00e0 Streptococcus suis<\/em>), ph\u1ebf c\u1ea7u v\u00e0 n\u00e3o m\u00f4 c\u1ea7u. Ngo\u00e0i ra, c\u1ea7n ch\u00fa \u00fd c\u0103n nguy\u00ean Listeria monocytogenes <\/em>c\u00f3 th\u1ec3 g\u1eb7p \u1edf tr\u1ebb s\u01a1 sinh, ph\u1ee5 n\u1eef c\u00f3\u00a0 thai v\u00e0 ng\u01b0\u1eddi gi\u00e0.<\/p>\n

3.\u00a0 Ch\u00e2\u0309n \u0111oa\u0301n vi\u00eam ma\u0300ng na\u0303o nhi\u00ea\u0303m khu\u00e2\u0309n<\/h2>\n

3.1. L\u00e2m s\u00e0ng<\/strong><\/h3>\n

B\u1ec7nh kh\u1edfi ph\u00e1t v\u00e0 di\u1ec5n bi\u1ebfn t\u1eeb v\u00e0i gi\u1edd \u0111\u1ebfn v\u00e0i ng\u00e0y, v\u1edbi bi\u1ec3u hi\u1ec7n:<\/p>\n

    \n
  • S\u1ed1t.<\/li>\n
  • H\u1ed9i ch\u1ee9ng m\u00e0ng n\u00e3o:\n
      \n
    • C\u01a1 n\u0103ng: nh\u1ee9c \u0111\u1ea7u, n\u00f4n v\u1ecdt, t\u00e1o b\u00f3n (tr\u1ebb em th\u01b0\u1eddng ti\u00eau ch\u1ea3y).<\/li>\n
    • Th\u1ef1c th\u1ec3: c\u00f3 m\u1ed9t ho\u1eb7c nhi\u1ec1u c\u00e1c d\u1ea5u hi\u1ec7u g\u00e1y c\u1ee9ng, Kernig (ho\u1eb7c brudzinski), t\u0103ng c\u1ea3m gi\u00e1c (s\u1ee3 \u00e1nh s\u00e1ng – n\u1eb1m t\u01b0 th\u1ebf c\u00f2 s\u00fang), thay \u0111\u1ed5i \u00fd th\u1ee9c (k\u00edch th\u00edch, ng\u1ee7 g\u00e0, l\u00fa l\u1eabn ).<\/li>\n
    • C\u00e1c d\u1ea5u hi\u1ec7u \u00edt g\u1eb7p h\u01a1n: li\u1ec7t khu tr\u00fa, co gi\u1eadt, ph\u00f9 gai th\u1ecb, t\u0103ng huy\u1ebft \u00e1p, nh\u1ecbp tim ch\u1eadm (li\u00ean quan v\u1edbi ph\u00f9 n\u00e3o n\u1eb7ng).<\/li>\n<\/ul>\n<\/li>\n
    • D\u1ea5u hi\u1ec7u g\u1ee3i \u00fd c\u0103n nguy\u00ean: ban ho\u1ea1i t\u1eed, ch\u1ea5n th\u01b0\u01a1ng ho\u1eb7c ph\u1eabu thu\u1eadt s\u1ecd n\u00e3o, khuy\u1ebft t\u1eadt tai – m\u0169i – h\u1ecdng.<\/li>\n<\/ul>\n

      C\u00e1c c\u01a1 \u0111\u1ecba \u0111\u1eb7c bi\u1ec7t nh\u01b0 tr\u1ebb s\u01a1 sinh, suy gi\u1ea3m mi\u1ec5n d\u1ecbch, ki\u1ec7t b\u1ea1ch c\u1ea7u, c\u00f3 b\u1ec7nh k\u00e8m theo, th\u01b0\u1eddng c\u00f3 b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng n\u1eb7ng h\u01a1n.<\/p>\n

      3.2.\u00a0\u00a0 C\u1eadn l\u00e2m s\u00e0ng<\/h3>\n
        \n
      • X\u00e9t nghi\u1ec7m m\u00e1u: c\u00e1c ch\u1ec9 s\u1ed1 vi\u00eam t\u0103ng (b\u1ea1ch c\u1ea7u, procalcitonin v\u00e0 CRP).<\/li>\n
      • D\u1ecbch n\u00e3o t\u1ee7y (DNT):\n
          \n
        • M\u00e0u s\u1eafc \u0111\u1ee5c ho\u1eb7c \u00e1m kh\u00f3i v\u00e0 \u00e1p l\u1ef1c t\u0103ng.<\/li>\n
        • S\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u v\u00e0 t\u1ef7 l\u1ec7 b\u1ea1ch c\u1ea7u trung t\u00ednh t\u0103ng, c\u00f3 th\u1ec3 c\u00f3 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n tho\u00e1i h\u00f3a.<\/li>\n
        • Protein th\u01b0\u1eddng t\u0103ng cao (> 1 g\/l), Glucose gi\u1ea3m; t\u1ef7 l\u1ec7 Glucose DNT\/m\u00e1u th\u01b0\u1eddng < 0,5.<\/li>\n
        • X\u00e1c \u0111\u1ecbnh vi khu\u1ea9n: d\u1ef1a v\u00e0o k\u1ebft qu\u1ea3 nhu\u1ed9m Gram, nu\u00f4i c\u1ea5y t\u00ecm vi khu\u1ea9n ho\u1eb7c PCR t\u1eeb b\u1ec7nh ph\u1ea9m DNT.<\/li>\n<\/ul>\n<\/li>\n
        • X\u00e9t nghi\u1ec7m \u0111\u1ec3 h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n: XQ ph\u1ed5i, ch\u1ee5p CT v\u00e0 MRI s\u1ecd n\u00e3o, c\u1ea5y m\u00e1u, sinh h\u00f3a m\u00e1u v\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c t\u00f9y thu\u1ed9c v\u00e0o c\u01a1 \u0111\u1ecba ng\u01b0\u1eddi b\u1ec7nh v\u00e0 c\u00e1c b\u1ec7nh k\u00e8m theo….<\/li>\n<\/ul>\n

          3.3. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh khi co\u0301 ca\u0301c bi\u00ea\u0309u hi\u00ea\u0323n sau:<\/strong><\/h3>\n
            \n
          • C\u00f3 h\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng: s\u1ed1t, c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, c\u00e1c ch\u1ec9 s\u1ed1 vi\u00eam t\u0103ng.<\/li>\n
          • C\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a h\u1ed9i ch\u1ee9ng m\u00e0ng n\u00e3o.<\/li>\n
          • D\u1ecbch n\u00e3o t\u1ee7y: thay \u0111\u1ed5i nh\u01b0 m\u00f4 t\u1ea3 \u1edf ph\u1ea7n tr\u00ean.<\/li>\n
          • K\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y ho\u1eb7c PCR x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c c\u00e1c c\u0103n nguy\u00ean vi khu\u1ea9n.<\/li>\n<\/ul>\n

            3.4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t: <\/strong>khi kh\u00f4ng c\u00f3 k\u1ebft qu\u1ea3 vi sinh c\u1ea7n ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c b\u1ec7nh sau:<\/h3>\n
              \n
            • Vi\u00eam m\u00e0ng n\u00e3o do vi khu\u1ea9n lao: th\u01b0\u1eddng b\u1ec7nh di\u1ec5n bi\u1ebfn k\u00e9o d\u00e0i, c\u00e1c ch\u1ec9 s\u1ed1 vi\u00eam kh\u00f4ng t\u0103ng, d\u1ecbch n\u00e3o t\u1ee7y c\u00f3 m\u00e0u v\u00e0ng chanh ho\u1eb7c \u00e1nh v\u00e0ng, protein t\u0103ng cao >1 g\/l, b\u1ea1ch c\u1ea7u t\u0103ng cao, b\u1ea1ch c\u1ea7u lympho th\u01b0\u1eddng chi\u1ebfm \u01b0u th\u1ebf.<\/li>\n
            • Vi\u00eam n\u00e3o – m\u00e0ng n\u00e3o do virus: ch\u1ec9 s\u1ed1 vi\u00eam kh\u00f4ng t\u0103ng, DNT trong, protein t\u0103ng nh\u1eb9 < 1 g\/l, b\u1ea1ch c\u1ea7u t\u0103ng, b\u1ea1ch c\u1ea7u lympho th\u01b0\u1eddng chi\u1ebfm \u01b0u th\u1ebf.<\/li>\n<\/ul>\n

              4.\u00a0 \u0110i\u00ea\u0300u tri\u0323 vi\u00eam ma\u0300ng na\u0303o nhi\u00ea\u0303m khu\u00e2\u0309n<\/h2>\n

              4.1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/strong><\/h3>\n

              L\u00e0 m\u1ed9t b\u1ec7nh c\u1ea5p c\u1ee9u, c\u1ea7n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh k\u1ecbp th\u1eddi theo ph\u00e1c \u0111\u1ed3 kinh nghi\u1ec7m v\u00e0 \u0111\u1ed5i kh\u00e1ng sinh th\u00edch h\u1ee3p khi c\u00f3 k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3.<\/p>\n

              \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 t\u00edch c\u1ef1c.<\/p>\n

              Ph\u00e1t hi\u1ec7n v\u00e0 x\u1eed tr\u00ed s\u1edbm c\u00e1c bi\u1ebfn ch\u1ee9ng.<\/p>\n

              4.2.\u00a0\u00a0 \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3<\/h3>\n

              4.2.1. \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u<\/em><\/h4>\n

              Kh\u00e1ng sinh: d\u00f9ng theo ph\u00e1c \u0111\u1ed3 kinh nghi\u1ec7m khi ch\u01b0a c\u00f3 k\u1ebft qu\u1ea3 vi sinh.<\/p>\n\n\n\n\n\n\n\n\n\n\n
              L\u1ee9a tu\u1ed5i<\/strong><\/td>\nC\u0103n nguy\u00ean th\u01b0\u1eddng g\u1eb7p<\/strong><\/td>\nKh\u00e1ng sinh \u01b0u ti\u00ean<\/strong><\/td>\nKh\u00e1ng sinh thay th\u1ebf<\/strong><\/td>\n<\/tr>\n
              0 \u2013 4 tu\u1ea7n tu\u1ed5i<\/td>\nVi khu\u1ea9n \u0111\u01b0\u1eddng ru\u1ed9t,<\/p>\n

              S. agalactiae, Listeria.<\/em><\/td>\n

              		Cefotaxime + ampixilin<\/td>\nAmpixilin* + aminoglycoside<\/td>\n<\/tr>\n
              1 th\u00e1ng \u2013 3 th\u00e1ng<\/td>\nHI<\/em>, ph\u1ebf c\u1ea7u, n\u00e3o m\u00f4 c\u1ea7u, S.agalactiae, E.coli, Listeria.<\/em><\/td>\nAmpixilin* + ceftriaxone (ho\u1eb7c cefotaxime)<\/td>\nVancomycin + ceftriaxone (ho\u1eb7c cefotaxime)<\/td>\n<\/tr>\n
              3 th\u00e1ng \u2013 18 tu\u1ed5i<\/td>\nHI<\/em>, ph\u1ebf c\u1ea7u, n\u00e3o m\u00f4 c\u1ea7u.<\/td>\nCeftriaxone (ho\u1eb7c cefotaxime)<\/td>\nVancomycin + ceftriaxone (ho\u1eb7c cefotaxime)<\/td>\n<\/tr>\n
              18 \u2013 50 tu\u1ed5i<\/td>\nPh\u1ebf c\u1ea7u, li\u00ean c\u1ea7u, n\u00e3o m\u00f4 c\u1ea7u<\/td>\nCeftriaxone (ho\u1eb7c cefotaxime)<\/td>\nVancomycin + ceftriaxone (ho\u1eb7c cefotaxime)<\/td>\n<\/tr>\n
              Tr\u00ean 50 tu\u1ed5i<\/td>\nPh\u1ebf c\u1ea7u, n\u00e3o m\u00f4 c\u1ea7u, Listeria, <\/em>k\u1ecb kh\u00ed Gram \u00e2m<\/td>\nCeftriaxone (ho\u1eb7c cefotaxime)<\/td>\nAmpicillin* + ceftriaxone (ho\u1eb7c cefotaxime)<\/td>\n<\/tr>\n
              Suy gi\u1ea3m mi\u1ec5n d\u1ecbch<\/td>\nPh\u1ebf c\u1ea7u, n\u00e3o m\u00f4 c\u1ea7u, Listeria, k\u1ecb kh\u00ed Gram \u00e2m<\/td>\nAmpixilin + ceftazidime<\/td>\nVancomycin + ampixilin* + ceftazidime<\/td>\n<\/tr>\n
              Ch\u1ea5n th\u01b0\u01a1ng, ph\u1eabu thu\u1eadt, d\u00f2 DNT<\/td>\nPh\u1ebf c\u1ea7u, t\u1ee5 c\u1ea7u, k\u1ecb kh\u00ed Gram \u00e2m<\/td>\nCeftazidim + vancomycin<\/td>\nCeftazidim + vancomycin<\/p>\n

              meropenem<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

              Ch\u00fa \u00fd: * ch\u1ecdn ampicillin khi nghi ng\u1edd Listeria. <\/em>**Aminoglycoside (gentamicin ho\u1eb7c amikacin).<\/p>\n

              Li\u1ec1u kh\u00e1ng sinh khi ch\u1ee9c n\u0103ng gan, th\u1eadn b\u00ecnh th\u01b0\u1eddng (li\u1ec1u th\u1ea5p \u00e1p d\u1ee5ng \u1edf tr\u1ebb d\u01b0\u1edbi 7 ng\u00e0y tu\u1ed5i).<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
              Kh\u00e1ng sinh<\/strong><\/td>\nT\u1ed5ng li\u1ec1u\/kg\/ng\u00e0y<\/strong><\/td>\nChia theo gi\u1edd\/l\u1ea7n<\/strong><\/td>\n<\/tr>\n
              Amikacin (c)<\/td>\n20 – 30 mg\/kg<\/td>\n12<\/td>\n<\/tr>\n
              Gentamicin<\/td>\n5 mg\/kg<\/td>\n12<\/td>\n<\/tr>\n
              Ampicilin<\/td>\n150 – 300 mg\/kg<\/td>\n6<\/td>\n<\/tr>\n
              Cefotaxim<\/td>\n100 – 200 mg\/kg<\/td>\n8<\/td>\n<\/tr>\n
              Ceftazidim<\/td>\n60 – 150 mg\/kg<\/td>\n8<\/td>\n<\/tr>\n
              Ceftriazon<\/td>\n80 – 100 mg\/kg<\/td>\n12<\/td>\n<\/tr>\n
              Penicillin G<\/td>\n150.000 – 250.000 \u0111v\/kg<\/td>\n6<\/td>\n<\/tr>\n
              Rifampin<\/td>\n10 – 20 mg\/kg<\/td>\n12<\/td>\n<\/tr>\n
              Vancomycin<\/td>\n20 – 60 mg\/kg<\/td>\n6<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

              H\u1ea1 nhi\u1ec7t: b\u1eb1ng paracetamon 15 mg\/kg\/l\u1ea7n, kh\u00f4ng qu\u00e1 60 mg\/kg\/ng\u00e0y.<\/p>\n

              Dexamethason 0,4 mg\/kg\/ng\u00e0y, ti\u00eam t\u0129nh m\u1ea1ch ch\u00e2m, d\u00f9ng 4 ng\u00e0y (c\u00f9ng ho\u1eb7c tr\u01b0\u1edbc kh\u00e1ng sinh 15 ph\u00fat).<\/p>\n

              Ch\u1ed1ng ph\u00f9 n\u00e3o (Manitol 1g\/kg\/6gi\u1edd, n\u1eb1m \u0111\u1ea7u cao 300), b\u00f9 n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i.<\/p>\n

              Ph\u00f2ng co gi\u1eadt b\u1eb1ng barbituric 5 – 20 mg\/kg\/ng\u00e0y, u\u1ed1ng. C\u1eaft c\u01a1n gi\u1eadt b\u1eb1ng seduxen 0,1 mg\/kg (pha v\u1edbi 2 ml NaCl 0,9%) ti\u00eam TM \u0111\u1ebfn khi ng\u1eebng gi\u1eadt.<\/p>\n

              4.2.2. Theo d\u00f5i \u0111i\u1ec1u tr\u1ecb<\/em><\/h4>\n

              Khi c\u00f3 k\u1ebft qu\u1ea3 nhu\u1ed9m Gram c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh ngay kh\u00e1ng sinh ph\u00f9 h\u1ee3p: C\u1ea7u khu\u1ea9n Gram d\u01b0\u01a1ng: ceftriazon ho\u1eb7c cefotaxim + vancomycin.<\/p>\n

              Song c\u1ea7u khu\u1ea9n Gram \u00e2m: penicillin G ho\u1eb7c ceftriaxon. Tr\u1ef1c khu\u1ea9n Gram d\u01b0\u01a1ng: ampicillin – aminoglycosid.<\/p>\n

              Tr\u1ef1c khu\u1ea9n Gram \u00e2m: ceftriaxon – aminoglycosid.<\/p>\n

              Khi c\u00f3 k\u1ebft qu\u1ea3 c\u1ea5y: thay \u0111\u1ed5i kh\u00e1ng sinh theo kh\u00e1ng sinh \u0111\u1ed3.<\/p>\n

              N\u1ebfu kh\u00f4ng c\u00f3 k\u1ebft qu\u1ea3 c\u1ea5y, ho\u1eb7c l\u00e2m s\u00e0ng kh\u00f4ng c\u1ea3i thi\u1ec7n c\u1ea7n x\u00e9t nghi\u1ec7m l\u1ea1i DNT sau 48 gi\u1edd \u0111i\u1ec1u tr\u1ecb. DNT kh\u00f4ng c\u1ea3i thi\u1ec7n c\u1ea7n \u0111\u1ed5i sang ph\u00e1c \u0111\u1ed3 thay th\u1ebf.<\/p>\n

              5.\u00a0 Ti\u00ea\u0301n tri\u00ea\u0309n va\u0300 bi\u00ea\u0301n ch\u01b0\u0301ng vi\u00eam ma\u0300ng na\u0303o nhi\u00ea\u0303m khu\u00e2\u0309n<\/h3>\n

              5.1. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb<\/strong><\/h3>\n

              N\u00e3o m\u00f4 c\u1ea7u l\u00e0 7 ng\u00e0y, Hib <\/em>l\u00e0 10 ng\u00e0y, ph\u1ebf c\u1ea7u l\u00e0 14 ng\u00e0y, c\u00e1c tr\u1ef1c khu\u1ea9n v\u00e0 vi khu\u1ea9n k\u1ecb kh\u00ed Gram \u00e2m, li\u00ean c\u1ea7u, t\u1ee5 c\u1ea7u l\u00e0 3 tu\u1ea7n.<\/p>\n

              Ho\u1eb7c trung b\u00ecnh: \u0111\u1ee7 10 – 14 ng\u00e0y v\u00e0 \u0111\u00e3 h\u1ebft s\u1ed1t 3 ng\u00e0y.<\/p>\n

              5.2. Bi\u1ebfn ch\u1ee9ng<\/h3>\n

              C\u00e1c bi\u1ebfn ch\u1ee9ng hay g\u1eb7p g\u1ed3m: t\u1eed vong (t\u1eeb 7 – 25%); ho\u1eb7c tr\u00e0n d\u1ecbch d\u01b0\u1edbi m\u00e0ng c\u1ee9ng, v\u00e1ch h\u00f3a d\u1eabn \u0111\u1ebfn t\u1eafc ngh\u1ebdn l\u01b0u th\u00f4ng DNT (tr\u1ebb nh\u1ecf bi\u1ec3u hi\u1ec7n b\u1eb1ng n\u00e3o \u00fang th\u1ee7y), \u00e1p xe n\u00e3o, vi\u00eam n\u00e3o th\u1ea5t… c\u1ea7n x\u00e1c \u0111\u1ecbnh b\u1eb1ng ch\u1ee5p CT, MRI.\u00a0 N\u1ebfu kh\u00f4ng x\u1eed\u00a0 tr\u00ed th\u00edch h\u1ee3p s\u1ebd c\u00f3 di ch\u1ee9ng v\u1ec1 tinh th\u1ea7n (tr\u00ec tr\u1ec7 tinh th\u1ea7n, \u0111\u1ed9ng kinh, m\u1ea5t kh\u1ea3 n\u0103ng h\u1ecdc t\u1eadp – lao \u0111\u1ed9ng…) v\u00e0 v\u1eadn \u0111\u1ed9ng.<\/p>\n

              Bi\u1ebfn ch\u1ee9ng sau VMNNK li\u00ean quan v\u1edbi nhi\u1ec1u nguy\u00ean nh\u00e2n nh\u01b0 \u0111i\u1ec1u tr\u1ecb s\u1edbm, ch\u1ecdn kh\u00e1ng sinh h\u1ee3p l\u00fd, tu\u1ed5i c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh, c\u00f3 b\u1ec7nh c\u01a1 \u0111\u1ecba, c\u00f3 nhi\u1ec5m tr\u00f9ng huy\u1ebft k\u00e8m theo, suy gi\u1ea3m mi\u1ec5n d\u1ecbch, kh\u1ea3 n\u0103ng h\u1ed3i s\u1ee9c ban \u0111\u1ea7u.<\/p>\n

              C\u1ea7n h\u1ed9i ch\u1ea9n ngo\u1ea1i: n\u1ebfu c\u00f3 khuy\u1ebft t\u1eadt, bi\u1ebfn ch\u1ee9ng (khi b\u1ec7nh \u0111\u00e3 \u1ed5n \u0111\u1ecbnh), ho\u1eb7c ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n

              6.\u00a0 Pho\u0300ng b\u00ea\u0323nh vi\u00eam ma\u0300ng na\u0303o nhi\u00ea\u0303m khu\u00e2\u0309n<\/h2>\n

              6.1. H\u00f3a d\u1ef1 ph\u00f2ng: <\/strong>cho ng\u01b0\u1eddi ch\u0103m s\u00f3c tr\u1ef1c ti\u1ebfp ng\u01b0\u1eddi b\u1ec7nh.<\/h3>\n

              Haemophilus influenzae: <\/em>u\u1ed1ng rifampicin 20\u00a0 mg\/kg\/ng\u00e0y x 4\u00a0 ng\u00e0y (tr\u1ebb s\u01a1 sinh\u00a0 10 mg\/kg\/ng\u00e0y), ho\u1eb7c ti\u00eam b\u1eafp ceftriaxone 125mg\/ng\u00e0y X 2 ng\u00e0y (ng\u01b0\u1eddi l\u1edbn 250mg\/ng\u00e0y).<\/p>\n

              N\u00e3o m\u00f4 c\u1ea7u: rifampicin 10 mg\/kg\/ng\u00e0y x 2 ng\u00e0y, ho\u1eb7c ti\u00eam b\u1eafp ceftriaxon 125 mg m\u1ed9t l\u1ea7n duy nh\u1ea5t (ng\u01b0\u1eddi l\u1edbn 250 mg).<\/p>\n

              Ch\u00fa \u00fd: <\/em><\/strong>kh\u00f4ng d\u00f9ng rifampicin cho ph\u1ee5 n\u1eef c\u00f3 thai.<\/p>\n

              6.2. Ti\u00eam ph\u00f2ng<\/h3>\n

              V\u1eafc xin Hib<\/em>: tr\u1ebb < 1 tu\u1ed5i: ti\u00eam 2 li\u1ec1u c\u00e1ch 2 th\u00e1ng; 1 – 5 tu\u1ed5i: ti\u00eam 1 li\u1ec1u. N\u00e3o m\u00f4 c\u1ea7u nh\u00f3m A v\u00e0 C: ti\u00eam trong v\u00f9ng \u0111ang c\u00f3 d\u1ecbch x\u1ea3y ra.<\/p>\n

              T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/h3>\n
                \n
              1. Allan R., Tunkel W., Michael Scheld (2005) \u201cAcute Meningitis\u201d, Mandell, Bennett, & Dolin: Principles and Practice of Infectious Diseases, <\/em>6th ed. Churchill Livingstone, An Imprint of<\/li>\n
              2. \u0110\u0103ng \u0110\u1ee9c Anh, Paule E. K., William K.,..et all. (2006) \u201cHemophilus influenzae typ B meningitis among children in Ha Noi, Vi\u1ec7t Nam: Epidemiologic patterns and estimates of H. Influenzae type B disease burden<\/em>\u201d. Am. J. Trop. Med. Hyg., 74(3), pp. 509-515.<\/li>\n
              3. B\u00f9i V\u0169 Huy (2010). \u201cNghi\u00ean c\u1ee9u c\u0103n nguy\u00ean g\u00e2y vi\u00eam m\u00e0ng n\u00e3o nhi\u1ec5m khu\u1ea9n \u1edf tr\u1ebb em<\/em>\u201d, T\u1ea1p ch\u00ed Y h\u1ecdc D\u1ef1 ph\u00f2ng, XX, 7(115), tr 45-49.<\/li>\n
              4. B\u00f9i V\u0169 Huy (2010). \u201cNghi\u00ean c\u1ee9u \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u00e0ng n\u00e3o do ph\u1ebf c\u1ea7u \u1edf tr\u1ebb em<\/em>\u201d, T\u1ea1p ch\u00ed Y h\u1ecdc D\u1ef1 ph\u00f2ng XX, 7(115), tr 50-55.<\/li>\n
              5. B\u00f9i V\u0169 Huy (2010), \u201c\u0110\u1eb7c \u0111i\u1ec3m <\/em>l\u00e2m <\/em>s\u00e0ng <\/em>v\u00e0 <\/em>k\u1ebft <\/em>qu\u1ea3 <\/em>\u0111i\u1ec1u tr\u1ecb <\/em>vi\u00eam m\u00e0ng <\/em>na\u00f5 <\/em>do <\/em>Hemophilus<\/em> influenza<\/em> \u1edf tr\u1ebb em<\/em>\u201d, T\u1ea1p ch\u00ed Y h\u1ecdc D\u1ef1 ph\u00f2ng, XX, 10(118), tr 95-101.<\/li>\n
              6. B\u00f9i V\u0169 Huy, Nguy\u1ec5n Thanh Li\u00eam (2008), \u201cNghi\u00ean c\u1ee9u c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 tr\u1ebb em b\u1eb1ng ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh<\/em>\u201d. T\u1ea1p ch\u00ed nghi\u00ean c\u1ee9u Y h\u1ecdc. Ph\u1ee5 tr\u01b0\u01a1ng 57(4), tr 233-238.<\/li>\n
              7. B\u00f9i V\u0169 Huy (2010). \u201cNghi\u00ean c\u1ee9u c\u00e1c y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng t\u1eed vong v\u00e0 di ch\u1ee9ng trong vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 tr\u1ebb em<\/em>\u201d, T\u1ea1p ch\u00ed Y h\u1ecdc D\u1ef1 ph\u00f2ng, XX, 10 (118), tr 89-94.<\/li>\n
              8. H\u1ed3 \u0110\u1eb7ng Trung Ngh\u0129a, Ho\u00e0ng Th\u1ecb Thanh H\u1eb1ng, L\u00ea Th\u1ecb Ph\u01b0\u01a1ng T\u00fa v\u00e0 CS (2013). \u201cD\u1ecbch t\u1ec5 h\u1ecdc vi\u00eam m\u00e0ng n\u00e3o do Streptococcus suis t\u1ea1i khu v\u1ef1c ph\u00eda Nam Vi\u1ec7t Nam<\/em>\u201d, Truy\u1ec1n nhi\u1ec5m Vi\u1ec7t Nam, s\u1ed1 3, tr 7 -12.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

                Vi\u00eam ma\u0300ng na\u0303o nhi\u00ea\u0303m khu\u00e2\u0309n l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nghi\u00eam tr\u1ecdng do s\u1ef1 l\u00e2y lan c\u1ee7a c\u00e1c lo\u1ea1i vi khu\u1ea9n nh\u01b0 Streptococcus pneumoniae, Neisseria meningitidis, v\u00e0 Haemophilus influenzae. B\u1ec7nh th\u01b0\u1eddng x\u1ea3y ra \u1edf tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean, tuy nhi\u00ean, c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf b\u1ea5t k\u1ef3 \u0111\u1ed9 tu\u1ed5i n\u00e0o. Vi\u1ec7c ph\u00e1t hi\u1ec7n v\u00e0 […]<\/p>\n","protected":false},"author":42,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"\nVi\u00eam ma\u0300ng na\u0303o nhi\u00ea\u0303m khu\u00e2\u0309n - H\u01b0\u01a1\u0301ng d\u00e2\u0303n ch\u00e2\u0309n \u0111oa\u0301n va\u0300 \u0111i\u00ea\u0300u tri\u0323<\/title>\n<meta name=\"description\" content=\"B\u00ea\u0323nh vi\u00eam m\u00e0ng n\u00e3o nhi\u1ec5m khu\u1ea9n th\u01b0\u1eddng x\u1ea3y ra \u1edf tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean, tuy nhi\u00ean, c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf b\u1ea5t k\u1ef3 \u0111\u1ed9 tu\u1ed5i n\u00e0o.\" \/>\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=\"Vi\u00eam ma\u0300ng na\u0303o nhi\u00ea\u0303m khu\u00e2\u0309n - 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