{"id":22877,"date":"2023-04-18T18:13:10","date_gmt":"2023-04-18T11:13:10","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22877"},"modified":"2023-04-19T11:46:24","modified_gmt":"2023-04-19T04:46:24","slug":"cap-nhap-dieu-tri-benh-ta-theo-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/cap-nhap-dieu-tri-benh-ta-theo-bo-y-te\/","title":{"rendered":"C\u1eadp nh\u1eadp \u0111i\u1ec1u tr\u1ecb b\u1ec7nh t\u1ea3 theo B\u1ed9 Y t\u1ebf"},"content":{"rendered":"

B\u1ec7nh t\u1ea3 l\u00e0 m\u1ed9t b\u1ec7nh truy\u1ec1n nhi\u1ec5m c\u1ea5p t\u00ednh \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111\u01b0\u1eddng ti\u00eau ho\u00e1, do vi khu\u1ea9n Vibrio cholerae g\u00e2y ra. B\u1ec7nh n\u00e0y th\u01b0\u1eddng x\u1ea3y ra \u1edf c\u00e1c n\u01b0\u1edbc \u0111ang ph\u00e1t tri\u1ec3n ho\u1eb7c \u1edf nh\u1eefng n\u01a1i c\u00f3 \u0111i\u1ec1u ki\u1ec7n v\u1ec7 sinh k\u00e9m. B\u1ec7nh t\u1ea3 c\u00f3 th\u1ec3 l\u00e2y lan nhanh ch\u00f3ng qua n\u01b0\u1edbc u\u1ed1ng ho\u1eb7c th\u1ef1c ph\u1ea9m b\u1ecb nhi\u1ec5m b\u1ea9n b\u1edfi ph\u00e2n c\u1ee7a ng\u01b0\u1eddi m\u1eafc b\u1ec7nh. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nhanh ch\u00f3ng v\u00e0 k\u1ecbp th\u1eddi gi\u00fap gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng<\/a> b\u1ec7nh v\u00e0 ph\u1ee5c h\u1ed3i s\u1ee9c kh\u1ecfe cho b\u1ec7nh nh\u00e2n.<\/strong><\/p>\n

1. Nguy\u00ean t\u1eafc<\/b><\/h2>\n

– C\u00e1ch ly b\u1ec7nh nh\u00e2n.<\/p>\n

– B\u1ed3i ph\u1ee5 n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i nhanh ch\u00f3ng v\u00e0 \u0111\u1ea7y \u0111\u1ee7.<\/p>\n

– D\u00f9ng kh\u00e1ng sinh \u0111\u1ec3 di\u1ec7t vi khu\u1ea9n.<\/p>\n

\"Ng\u01b0\u1eddi
Ng\u01b0\u1eddi b\u1ec7nh t\u1ea3 c\u1ea7n \u0111\u01b0\u1ee3c b\u1ed3i ph\u1ee5 n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i nhanh ch\u00f3ng<\/figcaption><\/figure>\n

2. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3<\/b><\/h2>\n

2.1. B\u1ed3i ph\u1ee5 n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i<\/h3>\n

– B\u00f9 n\u01b0\u1edbc b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng: \u00c1p d\u1ee5ng cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nh\u1eb9, giai \u0111o\u1ea1n \u0111\u1ea7u ch\u01b0a m\u1ea5t n\u01b0\u1edbc nhi\u1ec1u v\u00e0 giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c. C\u00f3 th\u1ec3 \u00e1p d\u1ee5ng t\u1ea1i nh\u00e0 ho\u1eb7c \u1edf c\u00e1c c\u01a1 s\u1edf y t\u1ebf.<\/p>\n

+ C\u00e1c lo\u1ea1i d\u1ecbch d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng: Oresol (ORS) (g\u1ed3m NaCl 3,5g, NaHCO3<\/sub>\u00a02,5g, KCl 1,5g v\u00e0 glucose 20g) pha v\u1edbi m\u1ed9t l\u00edt n\u01b0\u1edbc \u0111un s\u00f4i \u0111\u1ec3 ngu\u1ed9i.<\/p>\n

C\u00f3 th\u1ec3 pha d\u1ecbch thay th\u1ebf: 8 th\u00eca nh\u1ecf (th\u00eca c\u00e0-ph\u00ea) \u0111\u01b0\u1eddng, 1 th\u00eca nh\u1ecf mu\u1ed1i pha trong 1 l\u00edt n\u01b0\u1edbc; ho\u1eb7c n\u01b0\u1edbc ch\u00e1o 50g g\u1ea1o v\u00e0 m\u1ed9t nh\u00fam (3,5g) mu\u1ed1i ho\u1eb7c n\u01b0\u1edbc d\u1eeba non c\u00f3 pha m\u1ed9t nh\u00fam mu\u1ed1i.<\/p>\n

+ N\u00ean cho u\u1ed1ng theo nhu c\u1ea7u. N\u1ebfu n\u00f4n nhi\u1ec1u n\u00ean u\u1ed1ng t\u1eebng ng\u1ee5m nh\u1ecf.<\/p>\n

– B\u1ed3i ph\u1ee5 kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n b\u1eb1ng truy\u1ec1n t\u0129nh m\u1ea1ch:<\/p>\n

+ T\u1ed5ng l\u01b0\u1ee3ng d\u1ecbch truy\u1ec1n trong ng\u00e0y:<\/p>\n

T\u1ed5ng l\u01b0\u1ee3ng d\u1ecbch truy\u1ec1n trong ng\u00e0y = A + B + M<\/p>\n

Trong \u0111\u00f3:<\/p>\n

A: L\u01b0\u1ee3ng d\u1ecbch m\u1ea5t tr\u01b0\u1edbc khi \u0111\u1ebfn vi\u1ec7n (theo m\u1ee9c \u0111\u1ed9 m\u1ea5t n\u01b0\u1edbc).<\/p>\n

B: L\u01b0\u1ee3ng ph\u00e2n v\u00e0 ch\u1ea5t n\u00f4n m\u1ea5t ti\u1ebfp khi n\u1eb1m vi\u1ec7n.<\/p>\n

M: L\u01b0\u1ee3ng n\u01b0\u1edbc duy tr\u00ec trong ng\u00e0y.<\/p>\n

+ C\u00e1c lo\u1ea1i d\u1ecbch truy\u1ec1n:<\/p>\n

Natri clorid 0,9% ho\u1eb7c Ringer lactat (4 ph\u1ea7n)<\/p>\n

Natri bicarbonat 1,4% (1 ph\u1ea7n)<\/p>\n

Glucose 5% (1 ph\u1ea7n)<\/p>\n

+ B\u1ed5 sung th\u00eam kali clorid (KCl): m\u1ed7i 1 l\u00edt d\u1ecbch truy\u1ec1n pha th\u00eam 1g KCl. Khi b\u1ec7nh nh\u00e2n u\u1ed1ng \u0111\u01b0\u1ee3c thay b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng.<\/p>\n

– C\u00e1ch th\u1ee9c truy\u1ec1n d\u1ecbch:<\/p>\n

+ Giai \u0111o\u1ea1n 1: T\u1eeb 4-6 gi\u1edd \u0111\u1ea7u b\u00f9 n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i \u0111\u00e3 m\u1ea5t tr\u01b0\u1edbc khi \u0111\u1ebfn b\u1ec7nh vi\u1ec7n, d\u1ef1a v\u00e0o m\u1ee9c \u0111\u1ed9 m\u1ea5t n\u01b0\u1edbc.<\/p>\n

+ Giai \u0111o\u1ea1n 2: B\u00f9 n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i \u0111\u00e3 m\u1ea5t trong khi n\u1eb1m vi\u1ec7n v\u00e0 l\u01b0\u1ee3ng d\u1ecbch duy tr\u00ec.<\/p>\n

+ C\u1ea7n ph\u1ea3i truy\u1ec1n nhanh b\u1eb1ng nhi\u1ec1u t\u0129nh m\u1ea1ch l\u1edbn ho\u1eb7c truy\u1ec1n v\u00e0o t\u0129nh m\u1ea1ch trung t\u00e2m.<\/p>\n

+ C\u1ea7n theo d\u00f5i c\u00e1c d\u1ea5u hi\u1ec7u sinh t\u1ed3n, hematocrit, \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch trung t\u00e2m (n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n) \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh t\u1ed1c \u0111\u1ed9 truy\u1ec1n d\u1ecbch cho th\u00edch h\u1ee3p. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u1ea7n theo d\u00f5i \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh cho ph\u00f9 h\u1ee3p.<\/p>\n

+ Khi h\u1ebft n\u00f4n v\u00e0 u\u1ed1ng \u0111\u01b0\u1ee3c th\u00ec d\u00f9ng dung d\u1ecbch u\u1ed1ng.<\/p>\n

2.2. \u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh<\/h3>\n

– Thu\u1ed1c \u0111\u01b0\u1ee3c d\u00f9ng \u01b0u ti\u00ean:<\/p>\n

+ Nh\u00f3m fluoroquinolon (Ciprofloxacin 1g\/ng\u00e0y, Norfloxacin 800mg\/ng\u00e0y, Ofloxacin 400mg\/ng\u00e0y) u\u1ed1ng chia hai l\u1ea7n\/ng\u00e0y, trong 3 ng\u00e0y (Kh\u00f4ng d\u00f9ng cho tr\u1ebb em d\u01b0\u1edbi 12 tu\u1ed5i, ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa. Th\u1eadn tr\u1ecdng khi d\u00f9ng cho tr\u1ebb t\u1eeb 12 \u0111\u1ebfn 18 tu\u1ed5i).<\/p>\n

+ Azithromycin 10 mg\/kg\/ng\u00e0y u\u1ed1ng trong 3 ng\u00e0y.<\/p>\n

+ Cloramphenicol 30 mg\/kg\/ng\u00e0y u\u1ed1ng chia 3 l\u1ea7n, d\u00f9ng trong 3 ng\u00e0y.<\/p>\n

– \u0110\u1ed1i v\u1edbi tr\u1ebb em < 12 tu\u1ed5i, ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa: D\u00f9ng azithromycin.<\/p>\n

– N\u1ebfu kh\u00f4ng c\u00f3 s\u1eb5n c\u00e1c thu\u1ed1c tr\u00ean c\u00f3 th\u1ec3 d\u00f9ng:<\/p>\n

+ Erythromycin 1g\/ng\u00e0y u\u1ed1ng chia 4 l\u1ea7n\/ng\u00e0y (tr\u1ebb em 40 mg\/kg\/ng\u00e0y), d\u00f9ng trong 3 ng\u00e0y; ho\u1eb7c<\/p>\n

+ Doxycyclin 300 mg u\u1ed1ng 1 li\u1ec1u (d\u00f9ng trong tr\u01b0\u1eddng h\u1ee3p vi khu\u1ea9n c\u00f2n nh\u1ea1y c\u1ea3m).<\/p>\n

CH\u00da \u00dd: Kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng c\u00e1c thu\u1ed1c l\u00e0m gi\u1ea3m nhu \u0111\u1ed9ng ru\u1ed9t nh\u01b0 morphin, opizoic, atropin, loperamide…<\/p>\n

c) Dinh d\u01b0\u1ee1ng<\/p>\n

– N\u00ean cho b\u1ec7nh nh\u00e2n \u0103n s\u1edbm, \u0103n th\u1ee9c \u0103n l\u1ecfng, d\u1ec5 ti\u00eau. Tr\u1ebb c\u00f2n b\u00fa t\u0103ng c\u01b0\u1eddng b\u00e0 m\u1eb9.<\/p>\n

3. Ph\u00e2n lo\u1ea1i b\u1ec7nh nh\u00e2n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb<\/b><\/h2>\n

– C\u0103n c\u1ee9 v\u00e0o l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 x\u1ebfp th\u00e0nh 4 lo\u1ea1i \u0111\u1ec3 x\u1eed tr\u00ed.<\/p>\n

\u00a0B\u1ea3ng ph\u00e2n lo\u1ea1i b\u1ec7nh nh\u00e2n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n\n\n\n\n\n\n\n
\n

Lo\u1ea1i<\/p>\n<\/td>\n

\n

C\u00e1c tri\u1ec7u ch\u1ee9ng ch\u00ednh<\/p>\n<\/td>\n

\n

N\u01a1i \u0111i\u1ec1u tr\u1ecb<\/p>\n<\/td>\n

\n

Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb<\/p>\n<\/td>\n<\/tr>\n

\n

I<\/p>\n<\/td>\n

– Ti\u00eau ch\u1ea3y v\u00e0i l\u1ea7n, ph\u00e2n \u00edt, nh\u00e3o<\/p>\n

– Kh\u00f4ng n\u00f4n<\/p>\n

– M\u1ea1ch, huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng, ch\u01b0a c\u00f3 d\u1ea5u hi\u1ec7u m\u1ea5t n\u01b0\u1edbc<\/td>\n

T\u1ea1i tuy\u1ebfn c\u01a1 s\u1edf (x\u00e3, ph\u01b0\u1eddng ho\u1eb7c t\u1ea1i nh\u00e0)<\/td>\n– U\u1ed1ng kh\u00e1ng sinh<\/p>\n

– U\u1ed1ng dung d\u1ecbch Oresol<\/td>\n<\/tr>\n

\n

II<\/p>\n<\/td>\n

– Ti\u00eau ch\u1ea3y nhi\u1ec1u nh\u01b0ng t\u1ef1 ch\u1ee7 \u0111\u01b0\u1ee3c<\/p>\n

– Kh\u00f4ng n\u00f4n t\u1ef1 nhi\u00ean<\/p>\n

– M\u1ea5t n\u01b0\u1edbc nh\u1eb9<\/p>\n

– M\u1ea1ch, huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng<\/td>\n

T\u1ea1i tr\u1ea1m y t\u1ebf x\u00e3, ph\u01b0\u1eddng ho\u1eb7c trung t\u00e2m y t\u1ebf qu\u1eadn\/huy\u1ec7n<\/td>\n– U\u1ed1ng kh\u00e1ng sinh<\/p>\n

– U\u1ed1ng dung d\u1ecbch Oresol<\/p>\n

– Truy\u1ec1n d\u1ecbch<\/td>\n<\/tr>\n

\n

III<\/p>\n<\/td>\n

– Ti\u00eau ch\u1ea3y nhi\u1ec1u<\/p>\n

– N\u00f4n d\u1ec5 d\u00e0ng<\/p>\n

– C\u00f3 tri\u1ec7u ch\u1ee9ng m\u1ea5t n\u01b0\u1edbc trung b\u00ecnh<\/p>\n

– Huy\u1ebft \u00e1p h\u01a1i h\u1ea1<\/p>\n

– M\u1ea1ch nhanh, y\u1ebfu<\/p>\n

– M\u1ec7t l\u1ea3<\/td>\n

T\u1ea1i trung t\u00e2m y t\u1ebf qu\u1eadn\/huy\u1ec7n ho\u1eb7c tuy\u1ebfn t\u1ec9nh. N\u1ebfu t\u1ea1i tr\u1ea1m y t\u1ebf x\u00e3 c\u1ea7n c\u00f3 s\u1ef1 h\u1ed7 tr\u1ee3 c\u1ee7a b\u00e1c s\u1ef9 v\u00e0 \u0111i\u1ec1u d\u01b0\u1ee1ng tuy\u1ebfn tr\u00ean<\/td>\n– Truy\u1ec1n d\u1ecbch l\u00e0 ch\u00ednh. N\u1ebfu m\u1ea1ch v\u00e0 huy\u1ebft \u00e1p tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng, b\u00e0i ni\u1ec7u t\u1ed1t, c\u00f2n ti\u00eau ch\u1ea3y nh\u1eb9 c\u1ea7n duy tr\u00ec b\u1eb1ng dung d\u1ecbch u\u1ed1ng (ORS)<\/p>\n

– U\u1ed1ng kh\u00e1ng sinh<\/td>\n<\/tr>\n

\n

IV<\/p>\n<\/td>\n

– Ti\u00eau ch\u1ea3y v\u00e0 n\u00f4n nhi\u1ec1u g\u00e2y n\u00ean m\u1ea5t n\u01b0\u1edbc n\u1eb7ng, thi\u1ec3u ni\u1ec7u ho\u1eb7c v\u00f4 ni\u1ec7u<\/p>\n

– Tru\u1ef5 m\u1ea1ch: Huy\u1ebft \u00e1p kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c, m\u1ea1ch nh\u1ecf kh\u00f3 b\u1eaft<\/td>\n

B\u1ec7nh vi\u1ec7n tuy\u1ebfn t\u1ec9nh ho\u1eb7c trung \u01b0\u01a1ng. C\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u1ea1i tuy\u1ebfn huy\u1ec7n nh\u01b0ng c\u1ea7n c\u00f3 b\u00e1c s\u1ef9 tuy\u1ebfn t\u1ec9nh h\u1ed7 tr\u1ee3<\/td>\n– Truy\u1ec1n d\u1ecbch v\u1edbi t\u1ed1c \u0111\u1ed9 nhanh<\/p>\n

– Theo d\u00f5i m\u1ea1ch, huy\u1ebft \u00e1p, l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u, \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch trung t\u00e2m<\/p>\n

– U\u1ed1ng kh\u00e1ng sinh<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

– Khi c\u00f3 d\u1ecbch t\u1ea3 x\u1ea3y ra, s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n \u0111\u00f4ng, vi\u1ec7c ph\u00e2n lo\u1ea1i b\u1ec7nh nh\u00e2n \u0111\u1ec3 c\u00f3 th\u00e1i \u0111\u1ed9 x\u1eed tr\u00ed \u0111\u00fang \u0111\u1eafn s\u1ebd l\u00e0m gi\u1ea3m \u0111\u01b0\u1ee3c t\u1ed5n ph\u00ed v\u00e0 h\u1ea1 \u0111\u01b0\u1ee3c t\u1ef7 l\u1ec7 t\u1eed vong.<\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh t\u1ea3 n\u1eb7ng, m\u1ea1ch huy\u1ebft \u00e1p kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c ph\u1ea3i c\u1ea5p c\u1ee9u t\u1ea1i ch\u1ed7 (tuy\u1ebfn x\u00e3, tuy\u1ebfn huy\u1ec7n). N\u1ebfu trong t\u00ecnh tr\u1ea1ng n\u00e0y m\u00e0 v\u1eadn chuy\u1ec3n l\u00ean b\u1ec7nh vi\u1ec7n tuy\u1ebfn tr\u00ean qu\u00e1 xa th\u00ec ti\u00ean l\u01b0\u1ee3ng c\u00e0ng n\u1eb7ng th\u00eam. Do \u0111\u00f3 khi c\u00f3 d\u1ecbch t\u1ea3 x\u1ea3y ra t\u1ea1i c\u01a1 s\u1edf n\u00ean t\u1ed5 ch\u1ee9c c\u1ea5p c\u1ee9u t\u1ea1i ch\u1ed7, c\u1ea7n t\u0103ng c\u01b0\u1eddng b\u00e1c s\u1ef9 v\u00e0 \u0111i\u1ec1u d\u01b0\u1ee1ng tuy\u1ebfn tr\u00ean h\u1ed7 tr\u1ee3, chu\u1ea9n b\u1ecb \u0111\u1ea7y \u0111\u1ee7 thu\u1ed1c men, d\u1ecbch truy\u1ec1n, d\u00e2y truy\u1ec1n…<\/p>\n

4. Ti\u00eau chu\u1ea9n ra vi\u1ec7n<\/b><\/h2>\n

– H\u1ebft ti\u00eau ch\u1ea3y.<\/p>\n

– T\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng \u1ed5n \u0111\u1ecbnh.<\/p>\n

– K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m c\u1ea5y ph\u00e2n \u00e2m t\u00ednh 3 l\u1ea7n li\u00ean ti\u1ebfp. \u1ede nh\u1eefng c\u01a1 s\u1edf kh\u00f4ng c\u00f3 \u0111i\u1ec1u ki\u1ec7n c\u1ea5y ph\u00e2n th\u00ec cho b\u1ec7nh nh\u00e2n ra vi\u1ec7n sau khi \u1ed5n \u0111\u1ecbnh v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c 1 tu\u1ea7n.<\/p>\n

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

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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