{"id":2322,"date":"2023-04-12T18:14:42","date_gmt":"2023-04-12T11:14:42","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2322"},"modified":"2023-04-13T18:09:41","modified_gmt":"2023-04-13T11:09:41","slug":"ton-thuong-phoi-do-may-tho-co-che","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/ton-thuong-phoi-do-may-tho-co-che\/","title":{"rendered":"T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf: \u0110\u1eb7c \u0111i\u1ec3m v\u00e0 C\u01a1 ch\u1ebf"},"content":{"rendered":"

T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf (ventilator-induced lung injury – VILI) l\u00e0 m\u1ed9t t\u00e1c \u0111\u1ed9ng kh\u00f4ng mong mu\u1ed1n c\u00f3 th\u1ec3 c\u00f3 c\u1ee7a th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o. VILI c\u00f3 th\u1ec3 g\u00e2y ra th\u00eam t\u1ed5n th\u01b0\u01a1ng cho m\u00f4 ph\u1ed5i v\u00e0 l\u00e0m t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n tr\u1edf n\u00ean nghi\u00eam tr\u1ecdng h\u01a1n, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1eed vong. Do \u0111\u00f3, hi\u1ec3u c\u01a1 ch\u1ebf c\u1ee7a VILI v\u00e0 c\u00f3 \u00a0c\u00e1c chi\u1ebfn l\u01b0\u1ee3c \u0111\u1ec3 ng\u0103n ng\u1eeba c\u00f3 vai tr\u00f2 r\u1ea5t quan tr\u1ecdng trong chi\u1ebfn l\u01b0\u1ee3c can thi\u1ec7p th\u00f4ng kh\u00ed b\u1eb1ng m\u00e1y h\u1ed7 tr\u1ee3.<\/strong><\/p>\n

1. \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf<\/h2>\n

T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf th\u01b0\u1eddng \u0111\u01b0\u1ee3c quan s\u00e1t \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u1edf m\u00e1y v\u00ec h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (Acute respiratory distres syndrome – ARDS), nh\u01b0ng trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, r\u00f5 r\u00e0ng r\u1eb1ng n\u00f3 c\u0169ng c\u0169ng c\u00f3 th\u1ec3 \u00a0x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u1edf m\u00e1y v\u00ec c\u00e1c l\u00fd do kh\u00e1c ngo\u00e0i ARDS.<\/p>\n

\u1ede b\u1ec7nh nh\u00e2n ARDS, b\u1edfi v\u00ec c\u00e1c bi\u1ec3u hi\u1ec7n c\u1ee7a VILI g\u1ea7n nh\u01b0 kh\u00f4ng th\u1ec3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c v\u1edbi ARDS, n\u00ean t\u1ea7n su\u1ea5t x\u1ea3y ra th\u1ef1c s\u1ef1 kh\u00f4ng r\u00f5 r\u00e0ng nh\u01b0ng \u0111\u01b0\u1ee3c cho l\u00e0 cao h\u01a1n so v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ARDS. B\u1ec7nh nh\u00e2n ARDS c\u00f3 nguy c\u01a1 ch\u1ea5n th\u01b0\u01a1ng ph\u1ed5i ti\u1ebfp t\u1ee5c v\u00ec ph\u1ed5i \u0111\u00e3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng (“\u0111\u01b0\u1ee3c m\u1ed3i tr\u01b0\u1edbc”). Ngo\u00e0i ra, c\u01a1 ch\u1ebf b\u1ec7nh l\u00fd n\u1ec1n t\u1ea3ng c\u1ee7a b\u1ed1i c\u1ea3nh ARDS c\u00e0ng khi\u1ebfn ph\u1ed5i d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng do c\u0103ng ph\u1ed3ng (do m\u1ed9t ph\u1ea7n l\u1edbn c\u1ee7a ph\u1ed5i kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 th\u00f4ng kh\u00ed) v\u00e0 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do x\u1eb9p ph\u1ebf nang (atelectrauma).<\/p>\n

\u1ede b\u1ec7nh nh\u00e2n suy h\u00f4 h\u1ea5p kh\u00f4ng ph\u1ea3i do ARDS, t\u1ea7n su\u1ea5t x\u1ea3y ra VILI \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u1edf m\u00e1y kh\u00f4ng ph\u1ea3i ARDS c\u0169ng ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn. Trong m\u1ed9t nghi\u00ean c\u1ee9u quan s\u00e1t c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u1edf m\u00e1y v\u00ec nh\u1eefng nguy\u00ean nh\u00e2n kh\u00f4ng ph\u1ea3i ARDS, c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 cho VILI bao g\u1ed3m th\u1ec3 t\u00edch d\u00f2ng kh\u00ed cao (> 6 mL tr\u00ean kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 d\u1ef1 \u0111o\u00e1n), truy\u1ec1n c\u00e1c s\u1ea3n ph\u1ea9m m\u00e1u, toan h\u00f3a m\u00e1u (pH <7,35) v\u00e0 c\u00e1c b\u1ec7nh l\u00fd ph\u1ed5i l\u00e0m h\u1ea1n ch\u1ebf d\u00f2ng kh\u00ed l\u01b0u th\u00f4ng. C\u0169ng c\u00f3 kh\u1ea3 n\u0103ng r\u1eb1ng nguy c\u01a1 t\u01b0\u01a1ng t\u1ef1 c\u0169ng t\u1ed3n t\u1ea1i \u1edf b\u1ec7nh nh\u00e2n ARDS.<\/p>\n

\"minh-hoa-ton-thuong-phoi-do-may-tho\"
Minh h\u1ecda t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf.<\/figcaption><\/figure>\n

2. M\u1ed9t s\u1ed1 c\u01a1 ch\u1ebf g\u00e2y t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf<\/h2>\n

C\u0103ng ph\u1ed3ng ph\u1ebf nang qu\u00e1 m\u1ee9c, x\u1eb9p ph\u1ed5i v\u00e0 t\u1ed5n th\u01b0\u01a1ng sinh h\u1ecdc ( s\u1ef1 vi\u00eam) l\u00e0 c\u00e1c c\u01a1 ch\u1ebf ch\u00ednh g\u00e2y ra ch\u1ea5n th\u01b0\u01a1ng ph\u1ed5i trong qu\u00e1 tr\u00ecnh th\u1edf m\u00e1y c\u01a1 h\u1ecdc, tuy nhi\u00ean t\u1ea7m quan tr\u1ecdng c\u1ee7a m\u1ed7i c\u01a1 ch\u1ebf n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c l\u00e0m r\u00f5. T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i c\u00e0ng n\u1eb7ng n\u1ec1 khi\u1ebfn \u0111\u1ed9 th\u1ea5m c\u1ee7a ph\u1ebf nang c\u00e0ng cao, ph\u00f9 n\u1ec1 ph\u1ebf nang v\u00e0 m\u00f4 k\u1ebd, xu\u1ea5t huy\u1ebft v\u00e0o l\u00f2ng ph\u1ebf nang, h\u00ecnh th\u00e0nh m\u00e0ng trong, m\u1ea5t ch\u1ee9c n\u0103ng ch\u1ea5t ho\u1ea1t \u0111\u1ed9ng b\u1ec1 m\u1eb7t (surfactant) v\u00e0 x\u1eb9p ph\u1ebf nang (t\u1ee9c l\u00e0 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m t\u01b0\u01a1ng t\u1ef1 nh\u01b0 trong h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p).<\/p>\n

T\u1ed5n th\u01b0\u01a1ng do th\u1ec3 t\u00edch (volutrauma)<\/strong> \u0111\u1ea1i di\u1ec7n cho nh\u00f3m c\u01a1 ch\u1ebf g\u00e2y t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do c\u00e1c \u0111\u01a1n v\u1ecb ph\u1ebf nang ph\u1ed5i b\u1ecb c\u0103ng ph\u1ed3ng do \u00e1p su\u1ea5t b\u00ean trong t\u0103ng cao. C\u00e1c m\u00f4 h\u00ecnh nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng th\u1ec3 t\u00edch d\u00f2ng kh\u00ed cao (ho\u1eb7c th\u1ec3 t\u00edch ph\u1ebf nang cao do \u1ee9 kh\u00ed ph\u1ebf nang), ch\u1ee9 kh\u00f4ng ph\u1ea3i do \u00e1p su\u1ea5t \u0111\u01b0\u1eddng th\u1edf cao m\u00e0 g\u00e2y ra ch\u1ea5n th\u01b0\u01a1ng ph\u1ed5i. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n v\u00ec c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c ngo\u00e0i ARDS, c\u0103ng ph\u1ed3ng t\u1eeb th\u1ec3 t\u00edch d\u00f2ng kh\u00ed cao c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 t\u0103ng nguy c\u01a1 VILI (odd ratio 1,3, 95% CI 1,12-1,51, cho m\u1ed7i mL tr\u00ean 6 mL tr\u00ean kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 l\u00fd t\u01b0\u1edfng). Ngo\u00e0i ra, tr\u00e1nh c\u0103ng ph\u1ed3ng b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng chi\u1ebfn l\u01b0\u1ee3c th\u1ec3 t\u00edch l\u01b0u th\u00f4ng kh\u00ed th\u1ea5p \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 \u00a0c\u00f3 l\u1ee3i cho b\u1ec7nh nh\u00e2n ARDS.<\/p>\n

Kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng c\u1ea7n th\u1ec3 t\u00edch l\u01b0u th\u00f4ng qu\u00e1 l\u1edbn \u0111\u1ec3 g\u00e2y ra c\u0103ng ph\u1ed3ng ph\u1ebf nang. Khi c\u00f3 t\u00ecnh tr\u1ea1ng th\u00f4ng kh\u00ed kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u ho\u1eb7c x\u1eb9p (v\u00ed d\u1ee5: b\u1ec7nh nh\u00e2n v\u1edbi ARDS), th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng trong m\u1ed7i nh\u1ecbp th\u1edf c\u00f3 th\u1ec3 ph\u00e2n chia m\u1ed9t c\u00e1c kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u \u0111\u1ebfn c\u00e1c v\u00f9ng ph\u1ed5i. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra c\u0103ng ph\u1ed3ng ph\u1ebf nang t\u1eebng khu v\u1ef1c c\u1ee7a ph\u1ed5i v\u00e0 g\u00e2y ra VILI m\u1eb7c d\u00f9 cung c\u1ea5p th\u1ec3 t\u00edch l\u01b0u th\u00f4ng th\u00f4ng th\u01b0\u1eddng d\u1ef1a tr\u00ean c\u00e2n n\u1eb7ng c\u01a1 th\u1ec3. M\u1ed9t qu\u00e1 tr\u00ecnh t\u01b0\u01a1ng t\u1ef1 x\u1ea3y ra khi \u0111\u1ed9 \u0111\u00e0n h\u1ed3i ph\u1ed5i gi\u1ea3m nh\u01b0 x\u01a1 h\u00f3a ph\u1ed5i n\u1eb7ng ho\u1eb7c th\u00f4ng kh\u00ed m\u1ed9t b\u00ean ph\u1ed5i thay v\u00ec l\u00e0 hai.<\/p>\n

T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do \u00e1p l\u1ef1c (barotrauma)<\/strong> l\u00e0 d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do c\u00e1c m\u1ee9c \u00e1p l\u1ef1c kh\u00f4ng ph\u00f9 h\u1ee3p t\u00e1c \u0111\u1ed9ng l\u00ean ph\u1ebf nang v\u00e0 \u0111\u01b0\u1eddng d\u1eabn kh\u00ed. T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u1edf m\u00e1y \u0111\u1ec1u c\u00f3 nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do \u00e1p l\u1ef1c. Chu k\u1ef3 h\u00f4 h\u1ea5p b\u00ecnh th\u01b0\u1eddng, nh\u1ecbp th\u1edf t\u1ef1 ph\u00e1t ph\u1ee5 thu\u1ed9c v\u00e0o \u00e1p su\u1ea5t \u00e2m. Tuy nhi\u00ean, th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc x\u00e2m nh\u1eadp th\u1ef1c hi\u1ec7n c\u00e1c nh\u1ecbp th\u1edf h\u1ed7 tr\u1ee3 hay b\u1eaft bu\u1ed9c b\u1eb1ng c\u00e1ch cung c\u1ea5p c\u00e1c m\u1ee9c \u0103p l\u1ef1c d\u01b0\u01a1ng. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra v\u1ee1 ph\u1ebf nang ho\u1eb7c th\u1eadp ch\u00ed l\u00e0 tr\u00e0n kh\u00ed v\u00e0o khoang m\u00e0ng ph\u1ed5i.<\/p>\n

T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do x\u1eb9p ph\u1ebf nang (atelectrauma)<\/strong> l\u00e0 thu\u1eadt ng\u1eef ch\u1ec9 t\u1ed5n th\u01b0\u01a1ng do s\u1ef1 c\u0103ng ph\u1ed3ng v\u00e0 \u0111\u00f3ng x\u1eb9p l\u1eadp \u0111i l\u1eadp l\u1ea1i c\u1ee7a c\u00e1c ph\u1ebf nang trong qu\u00e1 tr\u00ecnh th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc. Qu\u00e1 tr\u00ecnh n\u00e0y t\u1ea1o ra “shear force” (\u00e1p l\u1ef1c g\u00e2y ra b\u1edfi \u1ee9ng su\u1ea5t c\u1eaft) c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng cho c\u00e1c ph\u1ebf qu\u1ea3n v\u00e0 ph\u1ebf nang k\u1ebf c\u1eadn. Qu\u00e1 tr\u00ecnh n\u00e0y c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 x\u1eb9p ph\u1ebf nang chu k\u1ef3 (cyclical atelectasis), hay atelectrauma. S\u1ef1 thi\u1ebfu h\u1ee5t ho\u1eb7c m\u1ea5t ch\u1ee9c n\u0103ng c\u1ee7a l\u1edbp surfactanat c\u00f3 th\u1ec3 \u0111\u00f3ng vai tr\u00f2 trong atelectrauma.<\/p>\n

T\u1ed5n th\u01b0\u01a1ng sinh h\u1ecdc (Biotrauma)<\/strong> \u00a0\u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 gi\u1ea3i ph\u00f3ng c\u00e1c ch\u1ea5t trung gian g\u00e2y vi\u00eam t\u1eeb c\u00e1c t\u1ebf b\u00e0o c\u1ee7a ph\u1ed5i b\u1ecb t\u1ed5n th\u01b0\u01a1ng trong qu\u00e1 tr\u00ecnh th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc. \u00a0C\u1ea3 s\u1ef1 c\u0103ng ph\u1ed3ng ph\u1ebf nang v\u00e0 atelectrauma \u0111\u1ec1u \u0111\u01b0\u1ee3c ch\u1ee9ng minh trong c\u00e1c nghi\u00ean c\u1ee9u \u0111\u1ed9ng v\u1eadt g\u00e2y ra t\u0103ng s\u1ea3n sinh c\u00e1c ch\u1ea5t trung gian c\u1ee7a qu\u00e1 tr\u00ecnh vi\u00eam, bao g\u1ed3m TNF-alpha, IL-6, IL-8, matrix metalloproteinase -9 v\u00e0 \u00a0NF-kB<\/p>\n

Khi s\u1eed d\u1ee5ng m\u00e1y th\u1edf nh\u00e2n t\u1ea1o, c\u00e1c chuy\u00ean gia y t\u1ebf t\u1ea1i Vinmec<\/a> lu\u00f4n c\u1eadp nh\u1eadt ki\u1ebfn th\u1ee9c v\u00e0 k\u1ef9 n\u0103ng \u0111\u1ec3 \u00e1p d\u1ee5ng c\u00e1c k\u1ef9 thu\u1eadt ti\u1ebfn b\u1ed9 v\u00e0 cung c\u1ea5p ch\u0103m s\u00f3c t\u1ed1t nh\u1ea5t cho b\u1ec7nh nh\u00e2n..<\/p>\n

Tham kh\u1ea3o:<\/p>\n

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Gajic O, Dara SI, Mendez JL, et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med 2004; 32:1817.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf (ventilator-induced lung injury – VILI) l\u00e0 m\u1ed9t t\u00e1c \u0111\u1ed9ng kh\u00f4ng mong mu\u1ed1n c\u00f3 th\u1ec3 c\u00f3 c\u1ee7a th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o. VILI c\u00f3 th\u1ec3 g\u00e2y ra th\u00eam t\u1ed5n th\u01b0\u01a1ng cho m\u00f4 ph\u1ed5i v\u00e0 l\u00e0m t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n tr\u1edf n\u00ean nghi\u00eam tr\u1ecdng h\u01a1n, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1eed vong. 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