{"id":22847,"date":"2023-04-19T13:38:20","date_gmt":"2023-04-19T06:38:20","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22847"},"modified":"2023-04-19T14:46:35","modified_gmt":"2023-04-19T07:46:35","slug":"bien-chung-cua-nhiem-adenovirus-la-gi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/bien-chung-cua-nhiem-adenovirus-la-gi\/","title":{"rendered":"Bi\u1ebfn ch\u1ee9ng c\u1ee7a nhi\u1ec5m Adenovirus"},"content":{"rendered":"

Adenovirus c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng kh\u00e1c nhau, t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 nhi\u1ec5m tr\u00f9ng. Vi\u1ec7c nh\u1eadn di\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a nhi\u1ec5m Adenovirus s\u1edbm l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong. Do \u0111\u00f3, t\u00ecm hi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a nhi\u1ec5m Adenovirus l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 cung c\u1ea5p cho b\u00e1c s\u0129 th\u00f4ng tin c\u1ea7n thi\u1ebft \u0111\u1ec3 gi\u00e1m s\u00e1t v\u00e0 qu\u1ea3n l\u00fd b\u1ec7nh t\u1ed1t h\u01a1n.<\/strong><\/p>\n

1. Y\u1ebfu t\u1ed1 nguy c\u01a1 b\u1ec7nh di\u1ec5n bi\u1ebfn n\u1eb7ng<\/span><\/b><\/h2>\n

– Tr\u1ebb \u0111\u1ebb non, suy dinh d\u01b0\u1ee1ng.<\/span><\/p>\n

– Lo\u1ea1n s\u1ea3n ph\u1ebf qu\u1ea3n ph\u1ed5i v\u00e0 c\u00e1c b\u1ec7nh l\u00fd ph\u1ed5i m\u1ea1n t\u00ednh kh\u00e1c.<\/span><\/p>\n

– C\u00e1c b\u1ec7nh l\u00fd suy gi\u1ea3m mi\u1ec5n d\u1ecbch b\u1ea9m sinh hay m\u1eafc ph\u1ea3i.<\/span><\/p>\n

– C\u00e1c b\u1ec7nh l\u00fd v\u1ec1 nhi\u1ec5m s\u1eafc th\u1ec3, gen v\u00e0 r\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1.<\/span><\/p>\n

– Ung th\u01b0 (\u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c kh\u1ed1i u \u00e1c t\u00ednh v\u1ec1 huy\u1ebft h\u1ecdc, ung th\u01b0 ph\u1ed5i…).<\/span><\/p>\n

– Gh\u00e9p t\u1ea1ng ho\u1eb7c c\u1ea5y gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c t\u1ea1o m\u00e1u.<\/span><\/p>\n

– B\u1ec7nh tim m\u1ea1ch (tim b\u1ea9m sinh, suy tim, t\u0103ng \u00e1p ph\u1ed5i, b\u1ec7nh c\u01a1 tim).<\/span><\/p>\n

– B\u1ec7nh l\u00fd th\u1ea7n kinh, th\u1ea7n kinh c\u01a1: B\u1ea1i n\u00e3o, tho\u00e1i h\u00f3a c\u01a1 t\u1ee7y.<\/span><\/p>\n

– B\u1ec7nh h\u1ed3ng c\u1ea7u h\u00ecnh li\u1ec1m, b\u1ec7nh thalassemia, sau c\u1eaft l\u00e1ch, teo l\u00e1ch.<\/span><\/p>\n

– \u0110ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c corticoid ho\u1eb7c c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c.<\/span><\/p>\n

– B\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh, x\u01a1 gan.<\/span><\/p>\n

2. Bi\u1ebfn ch\u1ee9ng n\u1eb7ng c\u1ee7a b\u1ec7nh<\/span><\/b><\/h2>\n

2.1. Bi<\/span><\/b>\u1ebf<\/b>n ch\u1ee9ng s\u1edbm<\/span><\/b><\/h3>\n

2.1.1. H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p ti\u1ebfn tri\u1ec3n (ARDS)<\/span><\/h4>\n
\"H\u1ed9i
H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p ti\u1ebfn tri\u1ec3n (ARDS) l\u00e0 bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m c\u1ee7a nhi\u1ec5m Adenovirus<\/figcaption><\/figure>\n

– Kh\u1edfi ph\u00e1t: c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p m\u1edbi ho\u1eb7c x\u1ea5u \u0111i trong v\u00f2ng m\u1ed9t tu\u1ea7n k\u1ec3 t\u1eeb khi c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.<\/span><\/p>\n

– Xquang tim ph\u1ed5i, CT scan ph\u1ed5i ho\u1eb7c si\u00eau \u00e2m ph\u1ed5i: h\u00ecnh \u1ea3nh m\u1edd hai ph\u1ebf tr\u01b0\u1eddng m\u00e0 kh\u00f4ng ph\u1ea3i do tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, x\u1eb9p th\u00f9y ph<\/span>\u1ed5i ho\u1eb7c c\u00e1c n<\/span>\u1ed1t \u1edf ph\u1ed5i.<\/span><\/p>\n

– Ngu\u1ed3n g\u1ed1c c\u1ee7a ph\u00f9 ph\u1ed5i kh\u00f4ng ph\u1ea3i do suy tim ho\u1eb7c qu\u00e1 t\u1ea3i d\u1ecbch<\/span>.\u00a0C\u1ea7n \u0111\u00e1nh gi\u00e1 kh\u00e1ch quan (si\u00eau \u00e2m tim) \u0111\u1ec3 lo\u1ea1i tr\u1eeb ph\u00f9 ph\u1ed5i do \u00e1p l\u1ef1c th\u1ee7y t\u0129nh n<\/span>\u1ebfu kh\u00f4ng th\u1ea5y c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1.<\/span><\/p>\n

– Thi\u1ebfu oxy m\u00e1u: \u1ede tr\u1ebb em tham kh\u1ea3o c\u00e1c ch\u1ec9 s\u1ed1 OI (Oxygenation Index)= MAPxFi<\/span>O2<\/sub>x100\/Pa<\/span>O2<\/span><\/sub>); OSI (ch\u1ec9 s\u1ed1 Oxygen h\u00f3a s\u1eed d\u1ee5ng Sp<\/span>O2<\/sub>) = MAPxFi<\/span>O2<\/sub>x100\/SpO2<\/sub>) cho ng\u01b0\u1eddi b\u1ec7nh th\u1edf m\u00e1y x\u00e2m nh\u1eadp; v\u00e0 Pa<\/span>O2<\/span><\/sub>\/Fi<\/span>O2<\/sub>\u00a0hay SPO2<\/sub>\/Fi<\/span>O2<\/sub>\u00a0cho th\u1edf CPAP hay th\u1edf m\u00e1y kh\u00f4ng x\u00e2m nh\u1eadp; NIV BiLevel ho\u1eb7c CPAP \u2265 5 cm<\/span>H2<\/sub>O qua m\u1eb7t n\u1ea1: Pa<\/span>O2<\/span><\/sub>\/Fi<\/span>O2<\/sub>\u00a0\u2264 300 mmHg ho\u1eb7c\u00a0<\/span>SpO2<\/span><\/sub>\/Fi<\/span>O2<\/sub>\u00a0\u2264 264.<\/span><\/p>\n

+ ARDS nh\u1eb9 (th\u1edf m\u00e1y x\u00e2m nh\u1eadp): 4 \u2264 OI < 8 ho\u1eb7c 5 \u2264 OSI < 7,5<\/span><\/p>\n

+ ARDS v\u1eeba (th\u1edf m\u00e1y x\u00e2m nh\u1eadp): 8 \u2264 OI < 16 ho\u1eb7c 7,5 \u2264 OSI < 12,3<\/span><\/p>\n

+ ARDS n\u1eb7ng (th\u1edf m\u00e1y x\u00e2m nh\u1eadp): OI \u2265 16 ho\u1eb7c OSI \u2265 12,3<\/span><\/p>\n

Ch\u00fa \u00fd: l\u00e2m s\u00e0ng nghi ng\u1edd ARDS khi th\u1edf \u00f4 xy m\u1eb7t n\u1ea1 ho\u1eb7c th\u1edf kh\u00f4ng x\u00e2m l\u1ea5n (NCPAP\/HFNC)\u00a0<\/span>v\u1edbi\u00a0F<\/span>iO2<\/sub>\u00a0> 40% m\u1edbi gi\u1eef Sp<\/span>O2<\/span><\/sub>\u00a088 – 97%.<\/span><\/p>\n

2.1.2. B\u00e3o cytokin<\/span><\/h4>\n

– T\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p di\u1ec5n bi\u1ebfn nhanh Sp<\/span>O2<\/span><\/sub>\u00a0\u2264 93% khi th\u1edf kh\u00ed tr\u1eddi ho\u1eb7c nhu c\u1ea7u oxy > 6 l\u00ed<\/span>t\/ph\u00fat; Xquang, CT scan ph\u1ed5i t\u1ed5n th\u01b0\u01a1ng m\u1edd lan t\u1ecfa, ti\u1ebfn tri\u1ec3n nhanh.<\/span><\/p>\n

– Ferritin ><\/span>\u00a0<\/span>300\u00a0<\/span>ug\/L g\u1ea5p \u0111\u00f4i trong v\u00f2ng 24 gi\u1edd, Ferritin > 600\u00a0<\/span>ug\/L t\u1ea1i th\u1eddi \u0111i\u1ec3m l\u00e0m x\u00e9t nghi\u1ec7m.<\/span><\/p>\n

– CRP > 100 mg\/L, LDH > 250 U\/L v\u00e0 t\u0103ng D-dimer (> 1000 mcg\/L).<\/span><\/h4>\n

2.1.3. Nhi\u1ec5m tr\u00f9ng huy\u1ebft, s\u1ed1c nhi\u1ec5m tr\u00f9ng v\u00e0 suy \u0111a t\u1ea1ng<\/span><\/h4>\n

– Nhi\u1ec5m tr\u00f9ng huy\u1ebft: khi nghi ng\u1edd ho\u1eb7c kh\u1eb3ng \u0111\u1ecbnh do nhi\u1ec5m tr\u00f9ng v\u00e0 c\u00f3 \u00edt nh<\/span>\u1ea5t 2 ti\u00eau chu\u1ea9n c\u1ee7a h\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam h\u1ec7 th\u1ed1ng (SIRS) v\u00e0 m\u1ed9t trong s\u1ed1 \u0111\u00f3 ph\u1ea3i l\u00e0 thay \u0111\u1ed5i th\u00e2n nhi\u1ec7t ho\u1eb7c s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u b<\/span>\u1ea5t th\u01b0\u1eddng.<\/span><\/p>\n

– S\u1ed1c nhi\u1ec5m tr\u00f9ng: x\u00e1c \u0111\u1ecbnh khi c\u00f3<\/span><\/p>\n

+ B\u1ea5t k\u1ef3 t\u00ecnh tr\u1ea1ng h\u1ea1 huy\u1ebft \u00e1p n\u00e0o: khi huy\u1ebft \u00e1p t\u00e2m thu < 5 b\u00e1ch ph\u00e2n v\u1ecb ho\u1eb7c > 2SD d\u01b0\u1edbi ng\u01b0\u1ee1ng b\u00ecnh th\u01b0\u1eddng theo l\u1ee9a tu\u1ed5i, ho\u1eb7c (tr\u1ebb < 1 tu<\/span>\u1ed5i < 70 mmHg; tr\u1ebb t\u1eeb 1-10 tu\u1ed5i < 70 + 2 * tu\u1ed5i; tr\u1ebb > 10 tu\u1ed5i < 90 mmHg).<\/span><\/p>\n

+ Ho\u1eb7c c\u00f3 b\u1ea5t k\u1ef3 2-3 d\u1ea5u hi\u1ec7u sau:<\/span><\/p>\n

\u221a\u00a0Thay \u0111\u1ed5i \u00fd th\u1ee9c<\/span><\/p>\n

\u221a\u00a0Nh\u1ecbp tim nhanh ho\u1eb7c ch\u1eadm (< 90 nh\u1ecbp\/ph\u00fat ho\u1eb7c ><\/span>\u00a0<\/span>160 l\u1ea7n\/ph\u00fat \u1edf tr\u1ebb nh\u0169 nhi, v\u00e0 < 70 l\u1ea7n\/ph\u00fat ho\u1eb7c ><\/span>\u00a0<\/span>150 l\u1ea7n\/ph\u00fat \u1edf tr\u1ebb nh\u1ecf).<\/span><\/p>\n

\u221a\u00a0Th\u1eddi gian l\u00e0m \u0111\u1ea7y mao m\u1ea1ch k\u00e9o d\u00e0i (> 2 gi\u00e2y).<\/span><\/p>\n

\u221a\u00a0Ho\u1eb7c gi\u00e3n m\u1ea1ch \u1ea5m\/m\u1ea1ch n\u1ea9y; th\u1edf nhanh; da n\u1ed5i v\u00e2n t\u00edm<\/span><\/p>\n

\u221a\u00a0Ho\u1eb7c c\u00f3 ch\u1ea5m xu\u1ea5t huy\u1ebft ho\u1eb7c ban xu\u1ea5t huy\u1ebft<\/span><\/p>\n

\u221a\u00a0T\u0103ng n\u1ed3ng \u0111\u1ed9 lactate, thi\u1ec3u ni\u1ec7u, t\u0103ng ho\u1eb7c h\u1ea1 th\u00e2n nhi\u1ec7t.<\/span><\/p>\n

2.2. Bi<\/span><\/b>\u1ebf<\/b>n ch\u1ee9ng xa<\/span><\/b><\/h3>\n

C\u00e1c t\u1ed5n th\u01b0\u01a1ng ho\u1ea1i t\u1eed bi\u1ec3u m\u00f4, th\u00e2m nhi\u1ec5m vi\u00eam g\u00e2y x\u01a1 h\u00f3a ph\u1ed5i v\u00e0 t\u0103ng sinh m\u00f4 h\u1ea1t g\u00e2y t\u1eafc ngh\u1ebdn ti\u1ec3u ph\u1ebf qu\u1ea3n t\u1eeb \u0111\u00f3 l\u00e0m bi\u1ebfn d\u1ea1ng, \u1ee9 m\u1ee7 v\u00e0 gi\u00e3n ph<\/span>\u1ebf\u00a0qu\u1ea3n l\u00e0 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng m\u00f4 b\u1ec7nh h\u1ecdc \u0111\u1eb7c tr\u01b0ng trong vi\u00eam ti\u1ec3u ph<\/span>\u1ebf\u00a0qu\u1ea3n t\u1eafc ngh\u1ebdn sau vi\u00eam ph\u1ed5i do vi r\u00fat adeno \u1edf tr\u1ebb em.<\/span><\/p>\n

Sau giai \u0111o\u1ea1n vi\u00eam c\u1ea5p t\u00ednh, tr\u1ebb c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf dai d\u1eb3ng nh\u01b0 ho \u0111\u1eddm, kh\u00f2 kh\u00e8, th\u1edf nhanh, kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c v\u00e0 khi ngh\u1ec9, nghe ph\u1ed5i c\u00f3 ran r\u00edt, ran \u1ea9m khu tr\u00fa hay lan t\u1ecfa, suy h\u00f4 h\u1ea5p m\u1ea1n t\u00ednh. B\u1ec7nh k\u00e9o d\u00e0i c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n ng\u00f3n tay d\u00f9i tr\u1ed1ng, l\u1ed3ng ng\u1ef1c bi\u1ebfn d\u1ea1ng, ch\u1eadm ph\u00e1t tri\u1ec3n th\u1ec3 ch\u1ea5t. \u0110o ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p th\u1ea5y c\u00f3 h\u1ed9i ch\u1ee9ng r\u1ed1i lo\u1ea1n th\u00f4ng kh\u00ed t<\/span>\u1eafc ngh\u1ebdn. C\u00e1c bi\u1ec3u hi\u1ec7n n\u00e0y kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi corticoid to\u00e0n th\u00e2n, d\u1ea1ng h\u00edt hay thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n sau \u00edt nh\u1ea5t 2 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb. Xquang ng\u1ef1c th\u1ea5y h\u00ecnh \u1ea3nh \u1ee9 kh\u00ed, x\u1eb9p ph\u1ed5i, d\u00e0y ph\u1ebf qu\u1ea3n hay gi\u00e3n ph\u1ebf qu\u1ea3n. Ch\u1ee5p c<\/span>\u1eaft l\u1edbp vi t\u00ednh l<\/span>\u1ed3ng ng\u1ef1c cho th<\/span>\u1ea5y h\u00ecnh<\/span>\u00a0<\/span>\u1ea3nh t\u1ed5n th\u01b0\u01a1ng k\u00ednh m\u1edd xen l\u1eabn v\u00f9ng \u1ee9 kh\u00ed, c\u00f3 th\u1ec3 k\u00e8m d\u00e0y th\u00e0nh ph\u1ebf qu\u1ea3n, gi\u00e3n ph\u1ebf qu\u1ea3n, x\u1eb9p ph\u1ed5i hay \u0111\u00f4ng \u0111\u1eb7c t\u1eebng v\u00f9ng.<\/span><\/p>\n

T\u00f3m l\u1ea1i, vi\u1ec7c t\u00ecm hi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a nhi\u1ec5m Adenovirus l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 cung c\u1ea5p cho b\u1ec7nh nh\u00e2n v\u00e0 c\u00e1c b\u00e1c s\u0129 th\u00f4ng tin c\u1ea7n thi\u1ebft \u0111\u1ec3 gi\u00e1m s\u00e1t v\u00e0 qu\u1ea3n l\u00fd b\u1ec7nh t\u1ed1t h\u01a1n, \u0111\u1ed3ng th\u1eddi gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong.<\/p>\n

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

Adenovirus c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng kh\u00e1c nhau, t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 nhi\u1ec5m tr\u00f9ng. Vi\u1ec7c nh\u1eadn di\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a nhi\u1ec5m Adenovirus s\u1edbm l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong. Do \u0111\u00f3, t\u00ecm hi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng […]<\/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":"\nBi\u1ebfn ch\u1ee9ng c\u1ee7a nhi\u1ec5m Adenovirus - Vinmec<\/title>\n<meta name=\"description\" content=\"Adenovirus c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng kh\u00e1c nhau, t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 nhi\u1ec5m tr\u00f9ng. Vi\u1ec7c nh\u1eadn di\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng ...\" \/>\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=\"Bi\u1ebfn ch\u1ee9ng c\u1ee7a nhi\u1ec5m Adenovirus - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Adenovirus c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng kh\u00e1c nhau, t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 nhi\u1ec5m tr\u00f9ng. 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