{"id":22851,"date":"2023-04-18T22:33:07","date_gmt":"2023-04-18T15:33:07","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22851"},"modified":"2023-04-19T09:59:10","modified_gmt":"2023-04-19T02:59:10","slug":"phac-do-dieu-tri-nhiem-adenovirus-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/phac-do-dieu-tri-nhiem-adenovirus-o-tre-em\/","title":{"rendered":"Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m Adenovirus \u1edf tr\u1ebb em"},"content":{"rendered":"

Virus Adeno g\u00e2y b\u1ec7nh \u1edf ng\u01b0\u1eddi (HadV<\/a>) l\u00e2y truy\u1ec1n tr\u1ef1c ti\u1ebfp t\u1eeb ng\u01b0\u1eddi sang ng\u01b0\u1eddi qua \u0111\u01b0\u1eddng h\u00f4 h<\/span>\u1ea5p trong ph\u1ea1m vi g<\/span>\u1ea7n, ho\u1eb7c gi\u00e1n ti\u1ebfp qua ti\u1ebfp x\u00fac v\u1edbi d\u1ecbch c\u01a1 th\u1ec3 c\u00f3 ch\u1ee9a vi r\u00fat. Nguy c\u01a1 l\u00e2y nhi\u1ec5m gi\u1ed1ng nh\u01b0 m\u1ed9t s\u1ed1 vi r\u00fat c\u1ea3m l\u1ea1nh th\u00f4ng th\u01b0\u1eddng\u00a0(rhinov<\/i><\/span>i<\/i>rus)<\/span><\/i>, \u00e1 c\u00fam\u00a0(parainfluenza)<\/i>\u00a0nh\u01b0ng th\u1ea5p h\u01a1n vi r\u00fat h\u1ee3p b\u00e0o h\u00f4 h<\/span>\u1ea5p (RSV), c\u00fam m\u00f9a, SARS-CoV-2. V\u00ec v\u1eady, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nhi\u1ec5m Adenovirus \u1edf tr\u1ebb em l\u00e0 r\u1ea5t quan tr\u1ecdng.<\/span><\/strong><\/p>\n

\"Virus
Virus Adeno g\u00e2y b\u1ec7nh \u1edf ng\u01b0\u1eddi (HadV) l\u00e2y truy\u1ec1n tr\u1ef1c ti\u1ebfp t\u1eeb ng\u01b0\u1eddi sang ng\u01b0\u1eddi qua \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p<\/figcaption><\/figure>\n

1. Ti\u00eau chu\u1ea9n nh\u1eadp b\u1ec7nh vi\u1ec7n<\/span><\/b><\/h2>\n

– B\u1ec7nh m\u1ee9c \u0111\u1ed9 nh\u1eb9 v\u00e0 c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 b\u1ec7nh di\u1ec5n bi\u1ebfn n\u1eb7ng.<\/span><\/p>\n

– B\u1ec7nh m\u1ee9c \u0111\u1ed9 trung b\u00ecnh.<\/span><\/p>\n

– \u0110\u1ed1i v\u1edbi c\u00e1c m\u1ee9c \u0111\u1ed9 n\u1eb7ng, nguy k\u1ecbch c\u1ea7n \u0111\u01b0\u1ee3c v\u00e0o \u0111i\u1ec1u tr\u1ecb t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb c\u1ea5p c\u1ee9u, h\u1ed3i s\u1ee9c.<\/span><\/p>\n

2. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/span><\/b><\/h2>\n

– \u00c1p d\u1ee5ng bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba l\u00e2y nhi\u1ec5m chu\u1ea9n tr\u01b0\u1edbc v\u00e0 trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb, ch\u0103m s\u00f3c.<\/span><\/p>\n

– Ph\u00e2n lo\u1ea1i v\u00e0 \u0111i\u1ec1u tr\u1ecb theo c\u00e1c m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh.<\/span><\/p>\n

– \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng: h\u1ea1 s\u1ed1t gi\u1ea3m ho, gi\u1ea3m \u0111au…<\/span><\/p>\n

– \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 kh\u00e1c: \u0111\u1ea3m b\u1ea3o tr\u1ebb \u0111\u01b0\u1ee3c b\u00fa m\u1eb9 v\u00e0 dinh d\u01b0\u1ee1ng h\u1ee3p l\u00fd theo m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh, b\u00f9 n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i, dinh d\u01b0\u1ee1ng…<\/span><\/p>\n

– Lu\u00f4n tu\u00e2n th\u1ee7 nguy\u00ean t\u1eafc c\u1ea5p c\u1ee9u A-B-C: ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng th\u1edf, th\u1edf, tu\u1ea7n ho\u00e0n.<\/span><\/p>\n

– C\u00e1 th\u1ec3 h\u00f3a c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c ca b\u1ec7nh n\u1eb7ng nguy k\u1ecbch.<\/span><\/p>\n

– Kh\u00e1ng sinh\/kh\u00e1ng n\u1ea5m: Ch\u1ec9 s\u1eed d\u1ee5ng khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/span><\/p>\n

– \u0110i\u1ec1u tr\u1ecb b\u1ec7nh n\u1ec1n, b\u1ec7nh k\u00e8m theo n\u1ebfu c\u00f3.<\/span><\/p>\n

3. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh m\u1ee9c \u0111\u1ed9 nh\u1eb9<\/span><\/b><\/h2>\n

\u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng t\u1ea1i nh\u00e0, theo d\u00f5i v\u00e0 ph\u00e1t hi\u1ec7n d\u1ea5u hi\u1ec7u n\u1eb7ng \u0111\u1ec3 \u0111\u01b0a tr\u1ebb \u0111\u1ebfn vi\u1ec7n k\u1ecbp th\u1eddi.<\/span><\/p>\n

– H\u1ea1 s\u1ed1t: paracetamol li\u1ec1u 10<\/span>\u00a0<\/span>–<\/span>\u00a0<\/span>15 mg\/kg\/l\u1ea7n n\u1ebfu s\u1ed1t \u2265 38,5\u00b0C c\u00e1ch 4-6\/gi\u1edd n\u1ebfu tr\u1ebb s\u1ed1t l\u1ea1i \u2265 38,5\u00b0C.<\/span><\/p>\n

– Cho tr\u1ebb m\u1eb7c tho\u00e1ng, ph\u00f2ng tho\u00e1ng kh\u00ed, khi s\u1ed1t ngo\u00e0i u\u1ed1ng h\u1ea1 s\u1ed1t c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p k\u00e8m ch\u01b0\u1eddm n\u01b0\u1edbc \u1ea5m (nhi\u1ec7t \u0111\u1ed9 n\u01b0\u1edbc th<\/span>\u1ea5p h\u01a1n nhi\u1ec7t \u0111\u1ed9 c\u01a1 th<\/span>\u1ec3\u00a03-5\u00b0C).<\/span><\/p>\n

– Cho tr\u1ebb u\u1ed1ng th\u00eam dung d\u1ecbch \u0111i\u1ec7n gi\u1ea3i oresol, \u0103n nhi\u1ec1u b\u1eefa, \u0103n l\u1ecfng.<\/span><\/p>\n

– V\u1ec7 sinh th\u00e2n th\u1ec3, r\u0103ng mi\u1ec7ng, m\u0169i h\u1ecdng.<\/span><\/p>\n

– Theo d\u00f5i ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u n\u1eb7ng nh\u01b0: s\u1ed1t cao li\u00ean t\u1ee5c kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c h\u1ea1 s\u1ed1t; th\u1edf nhanh theo tu\u1ed5i, kh\u00f4ng \u0103n u\u1ed1ng \u0111\u01b0\u1ee3c, n\u00f4n m\u1ecdi th\u1ee9, li b\u00ec ho\u1eb7c k\u00edch th\u00edch…<\/span><\/p>\n

4. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh m\u1ee9c \u0111\u1ed9 trung b\u00ecnh<\/span><\/b><\/h2>\n

4.1. H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p<\/span><\/b><\/h3>\n

– Theo d\u00f5i s\u00e1t c\u00e1c d\u1ea5u hi\u1ec7u sinh t\u1ed3n, ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c d\u1ea5u hi\u1ec7u n\u1eb7ng.<\/span><\/p>\n

– N\u1ebfu Sp<\/span>O2<\/span><\/sub>\u00a0< 96%, \u00f4 xy li\u1ec7u ph\u00e1p: th\u1edf \u00f4 xy qua g\u1ecdng m\u0169i ho\u1eb7c qua mask.<\/span><\/p>\n

– M\u1ee5c ti\u00eau c\u1ea7n \u0111\u1ea1t Sp<\/span>O2<\/span><\/sub>\u00a0\u2265 96%.<\/span><\/p>\n

4.2. Thu\u1ed1c kh\u00e1ng vi rus<\/span><\/b><\/h3>\n

Hi\u1ec7n nay ch\u01b0a c\u00f3 c\u00e1c thu\u1ed1c kh\u00e1ng virus \u0111\u1eb7c hi\u1ec7u v\u1edbi HAdV, m\u1ed9t s\u1ed1 thu\u1ed1c kh\u00e1ng vi r\u00fat \u0111ang trong qu\u00e1 tr\u00ecnh nghi\u00ean c\u1ee9u nh\u01b0 cidofovir. Thu\u1ed1c hi\u1ec7n ch\u01b0a c\u00f3 tr\u00ean th\u1ecb tr\u01b0\u1eddng Vi\u1ec7t Nam.<\/span><\/p>\n

4.3. Kh\u00e1ng sinh<\/span><\/b><\/h3>\n

Khi c\u00f3 vi\u00eam ph\u1ed5i, ho\u1eb7c khi tr\u00ean l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m c\u00f3 b\u1eb1ng ch\u1ee9ng b\u1ed9i nhi\u1ec5m vi khu\u1ea9n (CRP > 10 mg\/dl, ho\u1eb7c t\u1ed1t h\u01a1n d\u1ef1a v\u00e0o procalcitonin tr\u00ean 0,5 ng\/ml).<\/span><\/p>\n

L\u1ef1a ch\u1ecdn kh\u00e1ng sinh theo ph\u00e1c \u0111\u1ed3 h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng kh\u00e1ng sinh. Sau 48 – 72 gi\u1edd s\u1eed d\u1ee5ng kh\u00e1ng sinh, c\u1ea7n \u0111\u00e1nh gi\u00e1 ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi kh\u00e1ng sinh qua \u0111\u00e1nh gi\u00e1 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng t\u1ed1t h\u01a1n, v\u00e0 c\u00e1c ch\u1ec9 s\u1ed1 vi\u00eam gi\u1ea3m r\u00f5 r\u1ec7t (b\u1ea1ch c\u1ea7u, CRP ho\u1eb7c procalcitonin)<\/span><\/p>\n

5. \u0110i\u1ec1u tr\u1ecb m\u1ee9c \u0111\u1ed9 n\u1eb7ng<\/span><\/b><\/h2>\n

5.1. H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p<\/span><\/b><\/h3>\n

* \u0110\u00edch \u0111i\u1ec1u tr\u1ecb c\u1ea7n \u0111\u1ea1t: Sp<\/span>O2<\/span><\/sub>\u00a0\u2265 95% khi \u0111\u01b0\u1ee3c th\u1edf \u00f4 xy b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c nhau.<\/span><\/p>\n

* C\u00e1c ph\u01b0\u01a1ng ph\u00e1p cung c\u1ea5p \u00f4 xy:<\/span><\/p>\n

– Th\u1edf oxy g\u1ecdng m\u0169i (\u0111\u01b0\u1ee3c \u01b0a d\u00f9ng \u1edf tr\u1ebb v\u00ec d\u1ec5 dung n\u1ea1p h\u01a1n): l\u01b0u l\u01b0\u1ee3ng t\u1eeb th\u1edf t\u1eeb: 0,5 – 6 L\/ph, n\u1ebfu oxy cung c\u1ea5p v\u1edbi l\u01b0u l\u01b0\u1ee3ng \u2265 2 L\/ph, nh\u01b0ng Sp<\/span>O2<\/span><\/sub>\u00a0< 92% c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf d\u01b0\u1edbi \u0111\u00e2y:<\/span><\/p>\n

– Oxy qua mask v\u1edbi l\u01b0u l\u01b0\u1ee3ng > 5 l\u00edt\/ph (F<\/span>iO2<\/sub>: 40 – 60%).<\/span><\/p>\n

– Oxy l\u1ec1u v\u1edbi l\u01b0u l\u01b0\u1ee3ng 5 l\u00edt\/ph (F<\/span>iO2<\/sub>: 30-90%).<\/span><\/p>\n

– Oxy qua h\u1ec7 th\u1ed1ng Mask venturi (F<\/span>iO2<\/sub>: 28-60%).<\/span><\/p>\n

– Oxy qua h\u1ec7 th\u1ed1ng Mask kh\u00f4ng th\u1edf l\u1ea1i v\u1edbi l\u01b0u l\u01b0\u1ee3ng 10<\/span>\u00a0<\/span>–<\/span>\u00a0<\/span>15 l\u00edt\/ph (F<\/span>iO2<\/sub>: 80 – 90%).<\/span><\/p>\n

5.2. T\u01b0 th\u1ebf<\/span><\/b><\/h3>\n

Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 n\u1eb1m s\u1ea5p 30 – 120 ph\u00fat, sau \u0111\u00f3 30 – 120 ph\u00fat n\u1eb1m nghi\u00eang tr\u00e1i, nghi\u00eang ph\u1ea3i v\u00e0 t\u01b0 th<\/span>\u1ebf\u00a0ng\u1ed3i th\u1eb3ng.<\/span><\/p>\n

5.3. Corticosteroid<\/span><\/b><\/h3>\n

\u0110<\/span>\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam ph<\/span>\u1ed5i n\u1eb7ng c\u00f3 t\u0103ng ph\u1ea3n \u1ee9ng vi\u00eam kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, c\u00e2n nh\u1eafc ch\u1ec9 \u0111\u1ecbnh corticosteroid t\u00f9y theo t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3.<\/span><\/p>\n

5.4. Immunoglobulin \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (IVIG)<\/span><\/b><\/h3>\n

5.5. Thu\u1ed1c kh\u00e1ng vi r\u00fat:<\/span><\/b>\u00a0<\/span><\/h3>\n

5.6. Kh\u00e1ng sinh\/kh\u00e1ng n\u1ea5m<\/span><\/b><\/h3>\n

D\u00f9ng kh\u00e1ng sinh khi:<\/span><\/p>\n

– Vi\u00eam ph\u1ed5i<\/span><\/p>\n

– ho\u1eb7c Nhi\u1ec5m khu\u1ea9n huy\u1ebft<\/span><\/p>\n

– ho\u1eb7c khi tr\u00ean l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m c\u00f3 b\u1eb1ng ch\u1ee9ng b\u1ed9i nhi\u1ec5m vi khu\u1ea9n (CRP > 10 mg\/dl ho\u1eb7c t\u1ed1t h\u01a1n d\u1ef1a v\u00e0o procalcitonin 0,5 ng\/ml).<\/span><\/p>\n

Sau 48 – 72 gi\u1edd s\u1eed d\u1ee5ng kh\u00e1ng sinh, c\u1ea7n \u0111\u00e1nh gi\u00e1 ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi kh\u00e1ng sinh, qua \u0111\u00e1nh gi\u00e1 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng t\u1ed1t h\u01a1n v\u00e0 c\u00e1c ch\u1ec9 s\u1ed1 vi\u00eam gi\u1ea3m r\u00f5 r\u1ec7t (b\u1ea1ch c\u1ea7u, CRP ho\u1eb7c procalcitonin).<\/span><\/p>\n

5.7. Theo d\u00f5i<\/span><\/b><\/h3>\n

Theo d\u00f5i c\u00e1c d\u1ea5u hi\u1ec7u h\u00f4 h\u1ea5p nh\u01b0: tr\u1ebb kh\u00f3 th\u1edf h\u01a1n, co r\u00fat l\u1ed3ng ng\u1ef1c, co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p…, t\u0103ng nhu c\u1ea7u \u00f4 xy ho\u1eb7c c\u00f3 d\u1ea5u hi\u1ec7u s\u1ed1c (da l\u1ea1nh, nh\u1ecbp tim nhanh h\u01a1n so v\u1edbi tu\u1ed5i, re<\/span>fil >2\u2019, l\u1ea1nh ngo\u1ea1i bi\u00ean) tr\u1ebb k\u00edch th\u00edch, qu<\/span>\u1ea5y kh\u00f3c…Sp<\/span>O2<\/span><\/sub> < 95%, l\u00e0 nh\u1eefng d\u1ea5u hi\u1ec7u n\u1eb7ng c\u1ea7n chuy\u1ec3n th\u1edf NCPAP, th\u1edf m\u00e1y kh\u00f4ng x\u00e2m nh\u1eadp, HFNC ho\u1eb7c x\u00e2m nh\u1eadp.<\/span><\/span><\/p>\n

6. \u0110i\u1ec1u tr\u1ecb m\u1ee9c \u0111\u1ed9 nguy k\u1ecbch<\/span><\/b><\/h2>\n

6.1. N\u01a1i \u0111i\u1ec1u tr\u1ecb<\/span><\/b><\/h3>\n

a) \u0110i\u1ec1u tr\u1ecb t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb h\u1ed3i\u00a0<\/span><\/b>s<\/b>\u1ee9c c\u1ea5p c\u1ee9u:<\/span><\/b><\/p>\n

– Tr\u1ebb suy h\u00f4 h\u1ea5p n\u1eb7ng th\u1edf g\u1eafng s\u1ee9c v\u1edbi SpO2<\/sub>\u00a0< 94, kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi th\u1edf \u00f4 xy, c\u1ea7n h\u1ed7 tr\u1ee3 th\u1edf kh\u00f4ng x\u00e2m nh\u1eadp tr\u1edf l\u00ean (CPAP, NIV HFNC..).<\/span><\/p>\n

– Th\u1edf m\u00e1y x\u00e2m nh\u1eadp.<\/span><\/p>\n

– ARDS trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng (P\/F < 200, OI > 8, OSI > 7,5 khi th\u1edf NCPAP t\u1ed1i thi\u1ec3u 5 cm<\/span>H2<\/sub>O).<\/span><\/p>\n

– S\u1ed1c<\/span><\/p>\n

– Suy \u0111a t\u1ea1ng.<\/span><\/p>\n

– Suy tim t\u1ed1i c\u1ea5p<\/span><\/p>\n

b) X\u00e9t nghi\u1ec7m:<\/span><\/b>\u00a0<\/span><\/p>\n

Ch\u1ec9 \u0111\u1ecbnh x\u00e9t nghi\u1ec7m v\u00e0 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh theo di\u1ec5n bi\u1ebfn c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh v\u00e0 \u0111i\u1ec1u ki\u1ec7n c\u1ee7a c\u01a1 s\u1edf \u0111i\u1ec1u tr\u1ecb.<\/span><\/p>\n

c) Theo d\u00f5i s\u00e1t h\u00e0ng gi\u1edd:<\/span><\/b><\/p>\n

– C\u00e1c d\u1ea5u hi\u1ec7u sinh t\u1ed3n: nh\u1ecbp tim, nh\u1ecbp th\u1edf, SpO2<\/sub>, huy\u1ebft \u00e1p, c\u00e1c d\u1ea5u hi\u1ec7u suy h\u00f4 h\u1ea5p: th\u1edf nhanh, r\u00fat l\u00f5m l\u1ed3ng ng\u1ef1c, th\u1edf r\u00ean.<\/span><\/p>\n

– Nhu c\u1ea7u \u00f4 xy: theo d\u00f5i nhu c\u1ea7u \u00f4 xy v\u00e0 cung c\u1ea5p \u00f4 xy li\u1ec7u ph\u00e1p ph\u00f9 h\u1ee3p. \u0110\u00edch SpO2<\/sub>\u00a0c\u1ea7n \u0111\u1ea1t l\u00e0 \u2265 95%.<\/span><\/p>\n

– Theo d\u00f5i ph\u00e1t hi\u1ec7n s\u1edbm m\u1ed9t s\u1ed1 h\u1ed9i ch\u1ee9ng n\u1eb7ng nh\u01b0 h\u1ed9i ch\u1ee9ng t\u0103ng ph\u1ea3n \u1ee9ng vi\u00eam ho\u1eb7c b\u00e3o cytokine.<\/span><\/p>\n

6.2. H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p<\/span><\/b><\/h3>\n

6.2.1. Th\u1edf kh\u00f4ng x\u00e2m nh\u1eadp (NCPAP, NIV v\u00e0 HFNC)<\/span><\/h4>\n

a) Ch\u1ec9 \u0111\u1ecbnh<\/span><\/b><\/p>\n

– Khi ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c th\u1edf \u00f4 xy b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p th\u1edf \u00f4 xy qua g\u1ecdng, mask… v\u1edbi nhu c\u1ea7u \u00f4 xy > 6 l\u00ed<\/span>t\/ph.<\/span><\/p>\n

– SpO2<\/sub>\u00a0\u2264 94%,<\/span><\/p>\n

– Ho\u1eb7c th\u1edf g\u1eafng s\u1ee9c co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5, r\u00fat l\u00f5m l\u1ed3ng ng\u1ef1c m\u1ea1nh.<\/span><\/p>\n

– \u0110\u00edch \u0111i\u1ec1u tr\u1ecb c\u1ea7n \u0111\u1ea1t SpO2<\/sub>\u00a0\u2265 95%<\/span><\/p>\n

b) Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/span><\/b><\/p>\n

– Tr\u1ebb c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng.<\/span><\/p>\n

– Tr\u1ebb c\u00f3 r\u1ed1i lo\u1ea1n tri gi\u00e1c.<\/span><\/p>\n

– Suy \u0111a c\u01a1 quan.<\/span><\/p>\n

6.2.2. Th\u1edf m\u00e1y x\u00e2m nh\u1eadp<\/span><\/h4>\n

a) Th\u1edf m\u00e1y th\u00f4ng th\u01b0\u1eddng<\/span><\/b><\/p>\n

* Ch\u1ec9 \u0111\u1ecbnh<\/span><\/b><\/p>\n

– B\u1ec7nh nhi c\u00f3 r\u1ed1i lo\u1ea1n nh<\/span>\u1ecbp th\u1edf: th\u1edf ngh\u1ecbch b\u1ee5ng, th\u1edf ng\u00e1p, c\u01a1n ng\u01b0ng th\u1edf.<\/span><\/p>\n

– S\u1ed1c kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb.<\/span><\/p>\n

– Thay \u0111\u1ed5i tri gi\u00e1c.<\/span><\/p>\n

– Suy h\u00f4 h\u1ea5p n\u1eb7ng kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi th\u1edf HFNC, NCPAP, NIV<\/span><\/p>\n

+ Sp<\/span>O2<\/span><\/sub>\u00a0< 90%.<\/span><\/p>\n

+ T\u1ef7 s\u1ed1 P\/F < 150.<\/span><\/p>\n

+ Vt cao > 9,5 ml\/kg khi th\u1edf NIV.<\/span><\/p>\n

+ Toan h\u00f4 h\u1ea5p do \u1ee9 CO2<\/sub>.<\/span><\/p>\n

b) Th\u1edf m\u00e1y cao t\u1ea7n (HFO)<\/span><\/b><\/p>\n

* Ch\u1ec9 \u0111\u1ecbnh:<\/span><\/b><\/p>\n

– ARDS th\u1ea5t b\u1ea1i v\u1edbi th\u1edf m\u00e1y th\u00f4ng th\u01b0\u1eddng v\u00e0 th\u1ee7 thu\u1eadt huy \u0111\u1ed9ng ph\u1ebf nang ho\u1eb7c Pplateau > 28 mmHg.<\/span><\/p>\n

– Ho\u1eb7c c\u00f3 tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, tr\u00e0n kh\u00ed trung th\u1ea5t hay h\u1ed9i ch\u1ee9ng tho\u00e1t kh\u00ed m\u00f4 k\u1ebd.<\/span><\/p>\n

c) T\u01b0 th\u1ebf n\u1eb1m s\u1ea5p:<\/span><\/b>\u00a0c\u00e2n nh\u1eafc n\u1eb1m s\u1ea5p n\u1ebfu P\/F < 150, khi ng\u01b0\u1eddi b\u1ec7nh th\u1edf m\u00e1y v\u1edbi FiO2<\/sub>\u00a0> 0,6 v\u00e0 PEEP > 5 cm H2<\/sub>O. Gi\u1eef n\u1eb1m s\u1ea5p trong 12-18 gi\u1edd n\u1ebfu c\u00f3 th\u1ec3.<\/span><\/p>\n

d) Ch\u0103m s\u00f3c h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p khi th\u1edf m\u00e1y<\/span><\/b><\/p>\n

– T\u01b0 th\u1ebf \u0111\u1ea7u cao 30\u00b0.<\/span><\/p>\n

– D\u1ef1 ph\u00f2ng lo\u00e9t d\u1ea1 d\u00e0y h\u00e0nh t\u00e1 tr\u00e0ng do stress b\u1eb1ng sucrafate ho\u1eb7c thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m proton khi c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u.<\/span><\/p>\n

– Thay \u0111\u1ed5i b\u1ed9 l\u00e0m \u1ea5m l\u00e0m \u1ea9m 5-7 ng\u00e0y\/l\u1ea7n, ho\u1eb7c khi b\u00e1o l\u1ed7i.<\/span><\/p>\n

– B\u1ed9 l\u1ecdc HME kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng \u1edf tr\u1ebb nh\u1ecf v\u00ec n\u00f3 l\u00e0m t\u0103ng kho\u1ea3ng ch\u1ebft.<\/span><\/p>\n

6.3. Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb<\/span><\/b><\/h3>\n

6.3.1. Corticosteroid:<\/span><\/h4>\n

6.3.2. IVIG<\/span><\/h4>\n

6.3.3. Thu\u1ed1c kh\u00e1ng vi r\u00fat<\/span><\/h4>\n

6.3.4. Kh\u00e1ng s<\/span>inh\/kh\u00e1ng n\u1ea5m<\/span><\/h4>\n

6.3.5. Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng:<\/span>\u00a0n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh, \u0111i\u1ec1u tr\u1ecb theo ph\u00e1c \u0111\u1ed3 ch\u1ed1ng<\/span>\u00a0<\/span>\u0111\u00f4ng<\/span><\/h4>\n

6.4. \u0110i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng huy\u1ebft v\u00e0 s\u1ed1c nhi\u1ec5m tr\u00f9ng<\/span><\/b><\/h3>\n

\u00c1p d\u1ee5ng theo ph\u00e1c \u0111\u1ed3 s\u1ed1c nhi\u1ec5m tr\u00f9ng \u1edf tr\u1ebb em. H\u1ed3i s\u1ee9c d\u1ecbch c\u1ee5 th\u1ec3 nh\u01b0<\/span>\u00a0<\/span>sau:<\/span><\/p>\n

– S\u1eed d\u1ee5ng dung d\u1ecbch tinh th\u1ec3 \u0111\u1eb3ng tr\u01b0\u01a1ng Ringer Lactat ho\u1eb7c n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng Albumin 5% trong tr\u01b0\u1eddng h\u1ee3p Albumin m\u00e1u th\u1ea5p. Tr\u00e1nh d\u00f9ng c\u00e1c dung d\u1ecbch tinh th\u1ec3 nh\u01b0\u1ee3c tr\u01b0\u01a1ng, dung d\u1ecbch cao ph\u00e2n t\u1eed \u0111\u1ec3 h\u1ed3i s\u1ee9c d\u1ecbch.<\/span><\/p>\n

– Li\u1ec1u d\u00f9ng: 10-20 ml\/kg\/15 ph\u00fat \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng sau m\u1ed7i l\u1ea7n b\u00f9 d\u1ecbch.<\/span><\/p>\n

– T\u1ed5ng l\u01b0\u1ee3ng d\u1ecbch 20-40 ml\/kg, khi qu\u00e1 l\u01b0\u1ee3ng d\u1ecbch n\u00e0y c\u1ea7n c\u1ea9n th\u1eadn theo d\u00f5i c\u00e1c d\u1ea5u hi\u1ec7u qu\u00e1 t\u1ea3i d\u1ecbch nh\u01b0: suy h\u00f4 h\u1ea5p n\u1eb7ng h\u01a1n, gan to, nh\u1ecbp tim nhanh, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, ph\u1ed5i c\u00f3 ran \u1ea9m, ph\u00f9 ph\u1ed5i…n\u1ebfu xu\u1ea5t hi\u1ec7n, c\u1ea7n ng\u1eebng truy\u1ec1n d\u1ecbch.<\/span><\/p>\n

– Theo d\u00f5i c\u00e1c d\u1ea5u hi\u1ec7u c\u1ea3i thi\u1ec7n t\u01b0\u1edbi m\u00e1u: huy\u1ebft \u00e1p trung b\u00ecnh \u0111\u1ea1t 60-75 mgHg; l\u01b0\u1ee3n<\/span>g\u00a0n\u01b0\u1edbc ti\u1ec3u \u2265 1 ml\/kg\/gi\u1edd; m\u1ee9c c\u1ea3i thi\u1ec7n th\u1eddi gian l\u00e0m \u0111<\/span>\u1ea7y mao m\u1ea1ch, m\u00e0u s<\/span>\u1eafc da, t\u00ecnh tr\u1ea1ng \u00fd th\u1ee9c v\u00e0 n\u1ed3ng \u0111\u1ed9 lactat trong m\u00e1u.<\/span><\/p>\n

– S\u1eed d\u1ee5ng v\u1eadn m\u1ea1ch: adrenalin li\u1ec1u t\u1eeb 0,05-0,5 mcg\/kg\/ph v\u00e0 noradrenalin 0,05-1 mcg\/kg\/ph \u0111\u01b0\u1ee3c cho s\u1edbm nh\u1eb1m duy tr\u00ec huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch trung b\u00ecnh t\u1eeb 65-75 mmHg, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc d\u00f9ng dobutamin (3-10 mcg\/kg\/ph), dopamin (5-10 mcg\/kg\/ph).<\/span><\/p>\n

– Truy\u1ec1n m\u00e1u gi\u1eef Hb \u2265 10 G\/L.<\/span><\/p>\n

– Kh\u00e1ng sinh: d\u00f9n<\/span>g\u00a0kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng s\u1edbm trong gi\u1edd \u0111\u1ea7u v\u1edbi m\u1ed9t ho\u1eb7c nhi<\/span>\u1ec1u lo\u1ea1i kh\u00e1ng sinh \u0111<\/span>\u1ec3\u00a0ph\u1ee7 h\u1ebft t\u1ea5t c\u1ea3 c\u00e1c c\u0103n nguy\u00ean vi khu\u1ea9n, l\u1ef1a ch\u1ecdn kh\u00e1ng sinh theo kinh nghi\u1ec7m v\u00e0 \u0111i\u1ec1u ch\u1ec9nh theo k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 n\u1ebfu c\u00f3. Sau 48 – 72 gi\u1edd s\u1eed d\u1ee5ng kh\u00e1ng sinh, c\u1ea7n \u0111\u00e1nh gi\u00e1 ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi kh\u00e1ng sinh qua \u0111\u00e1nh gi\u00e1 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng t\u1ed1t h<\/span>\u01a1n v\u00e0 c\u00e1c ch\u1ec9 s\u1ed1 vi\u00eam gi\u1ea3m r\u00f5 r\u1ec7t (b\u1ea1ch c\u1ea7u, CRP ho\u1eb7c procalcitonin).<\/span><\/p>\n

6.5. L\u1ecdc m\u00e1u (t\u1ea1i c\u00e1c c\u01a1 s\u1edf<\/span><\/b>\u00a0<\/span><\/b>y t\u1ebf c\u00f3 kh\u1ea3 n\u0103ng)<\/span><\/b><\/h3>\n

6.5.1. Ch\u1ec9 \u0111\u1ecbnh l\u1ecdc m\u00e1u li\u00ean t\u1ee5c khi c\u00f3 m\u1ed9t trong nh\u1eefng d\u1ea5u hi\u1ec7u sau<\/span><\/h4>\n

– Ng\u01b0\u1eddi b\u1ec7nh n\u1eb7ng th\u1edf m\u00e1y c\u00f3 t\u00ecnh tr\u1ea1ng qu\u00e1 t\u1ea3i d\u1ecbch t\u1eeb \u2265 15% (dao \u0111\u1ed9ng 10 – 20%) kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi l\u1ee3i ti\u1ec3u \u0111\u1ec3 duy tr\u00ec c\u00e2n b\u1eb1ng d\u1ecbch.<\/span><\/p>\n

– S\u1ed1c nhi\u1ec5m tr\u00f9ng s\u1eed d\u1ee5ng 02 thu\u1ed1c v\u1eadn m\u1ea1ch, nh\u01b0ng t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh.<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh th\u1edf m\u00e1y t\u1ea1i ICU c\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p m\u1ee9c \u0111\u1ed9 I (theo ph\u00e2n lo\u1ea1i pRIFLE).<\/span><\/p>\n

–<\/span>\u00a0<\/span>BUN ><\/span>\u00a0<\/span>80<\/span>\u00a0<\/span>–<\/span>\u00a0<\/span>100 mg\/dl.<\/span><\/p>\n

– T\u0103ng kali m\u00e1u > 6,5 mmol\/L kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/span><\/p>\n

– T\u0103ng ho\u1eb7c gi\u1ea3m natri m\u00e1u n\u1eb7ng kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/span><\/p>\n

– Suy \u0111a t\u1ea1ng.<\/span><\/p>\n

6.5.2. Ch\u1ec9 \u0111\u1ecbnh l\u1ecdc m\u00e1u h\u1ea5p ph\u1ee5<\/span><\/h4>\n

L\u1ecdc m\u00e1u h\u1ea5p ph\u1ee5 b\u1eb1ng qu\u1ea3 l\u1ecdc Oxiris cho tr\u1ebb l\u1edbn c\u00f3 c\u00e2n n\u1eb7ng \u2265 30 kg khi nghi ng\u1edd c\u00f3 c\u01a1n b\u00e3o cytokin (do hi\u1ec7n t\u1ea1i ch\u01b0a c\u00f3 c\u00e1c qu\u1ea3 l\u1ecdc h\u1ea5p ph\u1ee5 cho tr\u1ebb d\u01b0\u1edbi 30 kg) m\u1ed7i ng\u00e0y 1 qu\u1ea3, th\u1eddi gian l\u1ecdc t\u1eeb 3-5 ng\u00e0y.<\/span><\/p>\n

6.6. ECMO<\/span><\/b><\/h3>\n

Ch\u1ec9 \u00e1p d\u1ee5ng t\u1ea1i c\u00e1c Trung t\u00e2m H\u1ed3i s\u1ee9c c\u00f3 kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n ECMO<\/span><\/p>\n

6.7. Dinh d\u01b0\u1ee1ng<\/span><\/b><\/h3>\n

Cho \u0103n s\u1edbm qua \u0111\u01b0\u1eddng mi\u1ec7ng trong v\u00f2ng 24 \u0111\u1ebfn 48 gi\u1edd \u0111\u1ea7u v\u1edbi ch\u1ebf \u0111\u1ed9 \u00edt calo, sau \u0111\u00f3 t\u0103ng ch\u1eadm \u0111\u1ebfn ch\u1ebf \u0111\u1ed9 \u0103n \u0111\u1ea7y \u0111\u1ee7 calo, \u0111\u1ea3m b\u1ea3o trong 7 \u0111\u1ebfn 10 ng\u00e0y ph\u1ea3i \u0111\u1ea1t 2\/3 n\u0103ng l\u01b0\u1ee3ng chuy\u1ec3n h\u00f3a c\u01a1 b\u1ea3n.<\/span><\/p>\n

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

Virus Adeno g\u00e2y b\u1ec7nh \u1edf ng\u01b0\u1eddi (HadV) l\u00e2y truy\u1ec1n tr\u1ef1c ti\u1ebfp t\u1eeb ng\u01b0\u1eddi sang ng\u01b0\u1eddi qua \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p trong ph\u1ea1m vi g\u1ea7n, ho\u1eb7c gi\u00e1n ti\u1ebfp qua ti\u1ebfp x\u00fac v\u1edbi d\u1ecbch c\u01a1 th\u1ec3 c\u00f3 ch\u1ee9a vi r\u00fat. Nguy c\u01a1 l\u00e2y nhi\u1ec5m gi\u1ed1ng nh\u01b0 m\u1ed9t s\u1ed1 vi r\u00fat c\u1ea3m l\u1ea1nh th\u00f4ng th\u01b0\u1eddng\u00a0(rhinovirus), \u00e1 c\u00fam\u00a0(parainfluenza)\u00a0nh\u01b0ng th\u1ea5p h\u01a1n […]<\/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":"\nPh\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m Adenovirus \u1edf tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"Virus Adeno g\u00e2y b\u1ec7nh \u1edf ng\u01b0\u1eddi (HadV) l\u00e2y truy\u1ec1n tr\u1ef1c ti\u1ebfp t\u1eeb ng\u01b0\u1eddi sang ng\u01b0\u1eddi qua \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p trong ph\u1ea1m vi g\u1ea7n. 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