{"id":23648,"date":"2023-04-18T11:18:49","date_gmt":"2023-04-18T04:18:49","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=23648"},"modified":"2023-04-18T15:45:01","modified_gmt":"2023-04-18T08:45:01","slug":"chan-doan-va-dieu-tri-viem-mang-nao-mu-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/chan-doan-va-dieu-tri-viem-mang-nao-mu-tre-em\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 tr\u1ebb em"},"content":{"rendered":"

Vi\u00eam m\u00e0ng n\u00e3o (VMN) l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam \u1edf m\u00e0ng nu\u00f4i, m\u00e0ng nh\u1ec7n v\u00e0 khoang d\u01b0\u1edbi nh\u1ec7n su\u1ed1t t\u1eeb n\u00e3o b\u1ed9 \u0111\u1ebfn t\u1ee7y s\u1ed1ng. T\u1ea7n su\u1ea5t m\u1eafc b\u1ec7nh c\u00f2n kh\u00e1 ph\u1ed5 bi\u1ebfn, t\u1ef7 l\u1ec7 t\u1eed vong, c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 di ch\u1ee9ng t\u00e2m th\u1ea7n kinh c\u00f2n n\u1eb7ng n\u1ec1 do \u0111\u00f3 b\u1ec7nh c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n s\u1edbm, x\u1eed tr\u00ed k\u1ecbp th\u1eddi v\u00e0 t\u00edch c\u1ef1c \u0111\u1ec3 h\u1ea1n ch\u1ebf t\u1eed vong c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 di ch\u1ee9ng.<\/strong><\/p>\n

1. L\u00e2m s\u00e0ng vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 tr\u1ebb em\u00a0<\/a><\/strong><\/h2>\n
    \n
  • \u00a0 \u00a0 \u00a0 <\/span>B\u1ec7nh s\u1eed: kh\u1edfi ph\u00e1t hai ki\u1ec3u ch\u00ednh<\/span><\/li>\n<\/ul>\n

    –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t, di\u1ec5n ti\u1ebfn nhanh: s\u1ed1c, DIC, v\u00e0 gi\u1ea3m tri gi\u00e1c d\u1ea7n d\u1ea7n d\u1eabn \u0111\u1ebfn\u00a0 h\u00f4n m\u00ea v\u00e0 t\u1eed vong.<\/span><\/p>\n

    –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Kh\u1edfi ph\u00e1t VMN\u00a0 v\u1edbi s\u1ed1t nhi\u1ec1u ng\u00e0y tr\u01b0\u1edbc \u0111\u00f3 ho\u1eb7c k\u00e8m theo tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p tr\u00ean ho\u1eb7c tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng nh\u01b0 ng\u1ee7 g\u00e0 hay k\u00edch th\u00edch.<\/span><\/p>\n

    Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:<\/span><\/p>\n

      \n
    • \u00a0 \u00a0 \u00a0 <\/span>S\u01a1 sinh v\u00e0 nh\u0169 nhi:<\/span><\/li>\n<\/ul>\n

      + Th\u00f3p ph\u1ed3ng.<\/span><\/p>\n

      + Th\u00e2n nhi\u1ec7t kh\u00f4ng \u1ed5n \u0111\u1ecbnh: s\u1ed1t ho\u1eb7c h\u1ea1 th\u00e2n nhi\u1ec7t (60%)<\/span><\/p>\n

      + Gi\u1ea3m v\u1eadn \u0111\u1ed9ng v\u00e0 ch\u00fa \u00fd.<\/span><\/p>\n

      + N\u00f4n, b\u00fa k\u00e9m, qu\u1ea5y kh\u00f3c v\u00f4 c\u1edb, li b\u00ec, y\u1ebfu chi, gi\u1eadt m\u00ecnh.<\/span><\/p>\n

      + Co gi\u1eadt: 20-50%<\/span><\/p>\n

      + Y\u1ebfu t\u1ed1 nguy c\u01a1: sinh non, c\u00e2n n\u1eb7ng l\u00fac sinh th\u1ea5p, vi\u00eam m\u00e0ng \u1ed1i, nhi\u1ec5m GBS \u00e2m \u0111\u1ea1o, \u1ed1i v\u1ee1 l\u00e2u, sang ch\u1ea5n, thai suy, b\u1ecb Galactosemia, b\u1ea5t th\u01b0\u1eddng ni\u1ec7u\u2026<\/span><\/p>\n

        \n
      • \u00a0 <\/span> Kh\u00e1m:<\/span><\/li>\n<\/ul>\n

        + R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a: b\u1ecf b\u00fa, \u1ecdc s\u1eefa, b\u1ee5ng ch\u01b0\u1edbng.<\/span><\/p>\n

        + V\u00e0ng da, ban xu\u1ea5t huy\u1ebft, gan l\u00e1ch to, thi\u1ebfu m\u00e1u.<\/span><\/p>\n

        + R\u1ed1i lo\u1ea1n th\u1ea7n kinh: co gi\u1eadt, li b\u00ec, h\u00f4n m\u00ea, r\u1ed1i lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1, ph\u1ea3n x\u1ea1 nguy\u00ean ph\u00e1t.<\/span><\/p>\n

        + R\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p: Th\u1edf nhanh, th\u1edf kh\u00f4ng \u0111\u1ec1u, c\u01a1n ng\u01b0ng th\u1edf.<\/span><\/p>\n

        + R\u1ed1i lo\u1ea1n tu\u1ea7n ho\u00e0n: Tim nhanh, m\u1ea1ch nh\u1eb9, CRT>2s.<\/span><\/p>\n

          \n
        • \u00a0 \u00a0 \u00a0 <\/span>Tr\u1ebb l\u1edbn:<\/span><\/li>\n<\/ul>\n

          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Tam ch\u1ee9ng m\u00e0ng n\u00e3o: s\u1ed1t, \u0111au \u0111\u1ea7u, c\u1ed5 g\u01b0\u1ee3ng.<\/span><\/p>\n

          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Ng\u1ee7 g\u00e0, k\u00edch th\u00edch, l\u1eabn l\u1ed9n, s\u1ee3 \u00e1nh s\u00e1ng, bu\u1ed3n n\u00f4n, n\u00f4n.<\/span><\/p>\n

          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Co gi\u1eadt.<\/span><\/p>\n

          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Y\u1ebfu t\u1ed1 nguy c\u01a1: V\u00f4 l\u00e1ch, suy gi\u1ea3m mi\u1ec5n d\u1ecbch, Thi\u1ebfu m\u00e1u h\u1ed3ng c\u1ea7u h\u00ecnh li\u1ec1m, c\u1ea5y \u1ed1c tai, , nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p tr\u00ean, Ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o h\u1edf, ch\u1ee7ng ng\u1eeba kh\u00f4ng \u0111\u1ee7..<\/span><\/p>\n

          * Kh\u00e1m:<\/span><\/p>\n

          + Tri\u1ec7u ch\u1ee9ng nhi\u1ec5m tr\u00f9ng huy\u1ebft, s\u1ed1c nhi\u1ec5m khu\u1ea9n: S\u1ed1t cao, l\u1ea1nh run, \u0111au c\u01a1, v\u1ebb m\u1eb7t nhi\u1ec5m tr\u00f9ng, m\u00f4i kh\u00f4, l\u01b0\u1ee1i d\u01a1.<\/span><\/p>\n

          + Nh\u00f3m tri\u1ec7u ch\u1ee9ng m\u00e0ng n\u00e3o: c\u1ed5 g\u01b0\u1ee3ng, Kernig, Brudzinski.<\/span><\/p>\n

          \"minh-hoa-viem-mang-nao\"<\/p>\n

          + Tam ch\u1ee9ng cushing: Huy\u1ebft \u00e1p t\u0103ng, m\u1ea1ch nhanh, r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1edf.<\/span><\/p>\n

          + D\u1ea5u hi\u1ec7u kh\u00e1c: Ph\u00f9 gai th\u1ecb, song th\u1ecb, li\u1ec7t d\u00e2y th\u1ea7n kinh s\u1ecd,<\/span><\/p>\n

          2. Ch\u1ea9n \u0111o\u00e1n c\u1eadn l\u00e2m s\u00e0ng vi\u00eam m\u00e0ng n\u00e3o m\u1ee7<\/strong><\/h2>\n

          2.1 D\u1ecbch n\u00e3o t\u1ee7y<\/strong><\/p>\n

          Ch\u1ec9 \u0111\u1ecbnh: <\/b>t\u1ea5t c\u1ea3 nh\u1eefng tr\u1ebb nghi ng\u1edd vi\u00eam m\u00e0ng n\u00e3o<\/span><\/p>\n

            \n
          • \u00a0<\/span>S\u1ed1t + b\u1ea5t k\u1ef3 tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh n\u00e0o<\/span><\/li>\n
          • H\u1ed9i ch\u1ee9ng m\u00e0ng n\u00e3o<\/span><\/li>\n
          • H\u1ed9i ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng n\u00e3o<\/span><\/li>\n
          • Co gi\u1eadt: ko ph\u1ea3i co gi\u1eadt l\u00e0nh t\u00ednh<\/span><\/li>\n
          • R\u1ed1i lo\u1ea1n tri gi\u00e1c<\/li>\n
          • D\u1ea5u t hi\u1ec7u th\u1ea7n kinh khu tr\u00fa<\/li>\n<\/ul>\n
              \n
            • H\u1ed9i ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng t\u1ee7y: y\u1ebfu li\u1ec7t m\u1ed9t hay nhi\u1ec1u chi<\/span><\/li>\n
            • \u00a0 \u00a0 \u00a0 <\/span>Tr\u1ebb s\u01a1 sinh c\u00f3 b\u1ec7nh c\u1ea3nh nhi\u1ec5m tr\u00f9ng huy\u1ebft<\/span><\/li>\n
            • \u00a0 \u00a0 \u00a0 <\/span>S\u1ed1t k\u00e9o d\u00e0i kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n<\/span><\/li>\n<\/ul>\n

              Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n

                \n
              • \u00a0 \u00a0 \u00a0 <\/strong><\/span>Tuy\u1ec7t \u0111\u1ed1i:<\/strong><\/li>\n<\/ul>\n

                –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Tho\u00e1t v\u1ecb n\u00e3o<\/span><\/p>\n

                –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Kh\u1ed1i cho\u00e1n ch\u1ed7 khu tr\u00fa<\/span><\/p>\n

                –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Suy h\u00f4 h\u1ea5p, s\u1ed1c<\/span><\/p>\n

                –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Nhi\u1ec5m tr\u00f9ng da n\u01a1i ch\u1ecdc d\u00f2.<\/span><\/p>\n

                –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u n\u1eb7ng<\/span><\/p>\n

                –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>T\u1ed5n th\u01b0\u01a1ng c\u1ed9t s\u1ed1ng c\u1ed5<\/span><\/p>\n

                  \n
                • \u00a0 \u00a0 \u00a0 T\u01b0\u01a1ng \u0111\u1ed1i<\/strong><\/li>\n<\/ul>\n

                  –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Nghi ng\u1edd c\u00f3 kh\u1ed1i cho\u00e1n ch\u1ed7 khu tr\u00fa<\/span><\/p>\n

                  –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>B\u1ec7nh Hemophilia, gi\u1ea3m ti\u1ec3u c\u1ea7u ho\u1eb7c b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng.<\/span><\/p>\n

                  Bi\u1ec7n lu\u1eadn k\u1ebft qu\u1ea3<\/strong><\/p>\n\n\n\n\n\n\n\n\n
                  \u00a0<\/span><\/td>\nS\u01a1 sinh<\/span><\/td>\nNgo\u00e0i s\u01a1 sinh<\/span><\/td>\nVMN vi khu\u1ea9n<\/span><\/td>\nVNMN virus<\/span><\/td>\nVMN lao<\/span><\/td>\nVMN do n\u1ea5m<\/span><\/td>\n<\/tr>\n
                  M\u00e0u<\/span><\/td>\nTr\u1eafng trong; v\u00e0ng trong;<\/span><\/td>\nTr\u1eafng trong<\/span><\/td>\nM\u1edd<\/span><\/td>\nTrong<\/span><\/td>\nV\u00e0ng chanh<\/span><\/td>\ntrong<\/span><\/td>\n<\/tr>\n
                  T\u1ebf b\u00e0o<\/span><\/td>\n< 30<\/span><\/td>\n< 5<\/span><\/td>\n100-10000, \u0111a nh\u00e2n<\/span><\/td>\n10-1000, lympho<\/span><\/td>\n10-500, lympho<\/span><\/td>\n5-500<\/span><\/td>\n<\/tr>\n
                  Glu<\/span><\/td>\n30-120mg\/dl<\/span><\/td>\n40-80 mg\/dl<\/span><\/td>\n<1\/2 m\u00e1u<\/span><\/td>\n Bt<\/span><\/td>\nGi\u1ea3m<\/span><\/td>\n Gi\u1ea3m<\/span><\/td>\n<\/tr>\n
                  Lactat<\/span><\/td>\n\u00a0–<\/span><\/td>\n\u00a0–<\/span><\/td>\n>3 (4)<\/span><\/td>\nT\u0103ng nh\u1eb9 or bt<\/span><\/td>\nT\u0103ng nh\u1eb9<\/span><\/td>\nT\u0103ng nh\u1eb9 or bt<\/span><\/td>\n<\/tr>\n
                  Protein<\/span><\/td>\n0,3-1.5 g\/l<\/span><\/td>\n0.2-0.45 g\/dl<\/span><\/td>\n1-5 g\/l<\/span><\/td>\n0.5-2<\/span><\/td>\n1-30<\/span><\/td>\n0.25-5<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                  \u00a0<\/span><\/p>\n

                    \n
                  • \u00a0 \u00a0 \u00a0 <\/span>Vi sinh: gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh vi\u00eam m\u00e0ng n\u00e3o<\/span><\/li>\n<\/ul>\n

                    Nhu\u1ed9m Gram<\/span><\/p>\n

                    \u00d8<\/span>\u00a0 <\/span>Ph\u1ebf c\u1ea7u: song c\u1ea7u gram (+)<\/span><\/p>\n

                    \u00d8<\/span>\u00a0 <\/span>N\u00e3o m\u00f4 c\u1ea7u: song c\u1ea7u gram ( -)<\/span><\/p>\n

                    \u00d8<\/span>\u00a0 <\/span>Hib: c\u1ea7u tr\u1ef1c khu\u1ea9n gram ( \u2013)<\/span><\/p>\n

                    \u00d8<\/span>\u00a0 <\/span>T\u1ee5 c\u1ea7u: Li\u00ean c\u1ea7u gram (+) d\u1ea1ng ch\u00f9m<\/span><\/p>\n

                    \u00d8<\/span>\u00a0 <\/span>E.coli: tr\u1ef1c tr\u00f9ng gram (\u2013)<\/span><\/p>\n

                    \u00d8<\/span>\u00a0 <\/span>Streptococcus nh\u00f3m B: li\u00ean c\u1ea7u gram (+)<\/span><\/p>\n

                      \n
                    • C\u1ea5y DNT<\/span><\/li>\n
                    • Latex : n\u00e3o m\u00f4 c\u1ea7u, ph\u1ebf c\u1ea7u, Hib, Strep B, E.coli;(c\u00f3 k\u1ebft qu\u1ea3 sau 6-12h)<\/span><\/li>\n
                    • PCR, t\u00ecm kh\u00e1ng th\u1ec3 trong DNT<\/span><\/li>\n<\/ul>\n

                      2.2 X\u00e9t nghi\u1ec7m kh\u00e1c<\/span><\/h3>\n
                        \n
                      • \u00a0 \u00a0 \u00a0 <\/span>C\u00f4ng th\u1ee9c m\u00e1u: B\u1ea1ch c\u1ea7u t\u0103ng, Hct gi\u1ea3m, Ti\u1ec3u c\u1ea7u t\u0103ng\u00a0 (khi ph\u1ea3n \u1ee9ng vi\u00eam m\u1ea1nh) v\u00e0 gi\u1ea3m khi c\u00f3 nhi\u1ec5m khu\u1ea9n n\u1eb7ng + ch\u1ea5m xu\u1ea5t huy\u1ebft \u00e0 l\u01b0u \u00fd \u0111\u00f4ng m\u00e1u n\u1ed9i m\u1ea1ch lan t\u1ecfa.<\/span><\/li>\n
                      • \u00a0 \u00a0 \u00a0 <\/span>C\u1ea5y m\u00e1u: T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n nghi ng\u1edd. C\u1ea5y m\u00e1u c\u00f3 gi\u00e1 tr\u1ecb l\u1ef1a ch\u1ecdn kh\u00e1ng sinh thay th\u1ebf khi kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u.<\/span><\/li>\n
                      • \u00a0 \u00a0 \u00a0 <\/span>Sinh h\u00f3a m\u00e1u:<\/span><\/li>\n<\/ul>\n

                        + Ion \u0111\u1ed3, Ure, Creatinin, \u0111\u01b0\u1eddng m\u00e1u n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 SIADH, qu\u1ea3n l\u00fd d\u1ecbch xu\u1ea5t nh\u1eadp, so s\u00e1nh \u0111\u01b0\u1eddng m\u00e1u\/DNT.<\/span><\/p>\n

                        + PCT, CRP c\u00f3 gi\u00e1 tr\u1ecb g\u1ee3i \u00fd, CRP h\u1ed7 tr\u1ee3 theo d\u00f5i \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng.<\/span><\/p>\n

                        2.3 H\u00ecnh \u1ea3nh h\u1ecdc s\u1ecd n\u00e3o<\/strong><\/h3>\n

                        –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Si\u00eau \u00e2m xuy\u00ean th\u00f3p: ch\u1ea9n \u0111o\u00e1n lo\u1ea1i tr\u1eeb v\u00e0 theo d\u00f5i bi\u1ebfn ch\u1ee9ng.<\/span><\/p>\n

                        –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>CT n\u00e3o:<\/span><\/p>\n

                        \u00a0Ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n

                        + C\u00f3 d\u1ea5u th\u1ea7n kinh khu tr\u00fa, nghi ng\u1edd c\u00f3 bi\u1ebfn ch\u1ee9ng n\u1ed9i s\u1ecd.<\/span><\/p>\n

                        + C\u01a1n co gi\u1eadt kh\u1edfi ph\u00e1t m\u1edbi.<\/span><\/p>\n

                        + Tri gi\u00e1c b\u1ec7nh nh\u00e2n x\u1ea5u d\u1ea7n<\/span><\/p>\n

                        + B\u1ec7nh nhi suy gi\u1ea3m mi\u1ec5n d\u1ecbch n\u1eb7ng.<\/span><\/p>\n

                        3. Ch\u1ea9n \u0111o\u00e1n vi\u00eam m\u00e0ng n\u00e3o<\/strong><\/h2>\n

                        3.1 Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/b><\/h3>\n
                          \n
                        • S\u1ed1t + d\u1ea5u m\u00e0ng n\u00e3o<\/span><\/li>\n
                        • B\u1ea5t th\u01b0\u1eddng D\u1ecbch n\u00e3o t\u1ee7y:\u00a0\u00a0<\/span><\/li>\n<\/ul>\n

                          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>M\u1edd hay \u0111\u1ee5c nh\u01b0 n\u01b0\u1edbc vo g\u1ea1o<\/span><\/p>\n

                          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>\u0110\u1ea1m t\u0103ng, \u0111\u01b0\u1eddng gi\u1ea3m (\u00bd \u0111\u01b0\u1eddng m\u00e1u, th\u1eed c\u00f9ng l\u00fac), lactate > 3 mmol\/l, t\u1ebf b\u00e0o t\u0103ng, \u0111a s\u1ed1 l\u00e0 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n(50%) .<\/span><\/p>\n

                          3.2 Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/b><\/h3>\n

                          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>\u2022 Vi\u00eam m\u00e0ng n\u00e3o si\u00eau vi<\/span><\/p>\n

                          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>\u2022 Lao m\u00e0ng n\u00e3o<\/span><\/p>\n

                          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>\u2022 Xu\u1ea5t huy\u1ebft n\u00e3o \u2013 m\u00e0ng n\u00e3o: h\u00ecnh \u1ea3nh xu\u1ea5t huy\u1ebft n\u00e3o tr\u00ean si\u00eau \u00e2m, khi ch\u1ecdc d\u00f2 D\u1ecbch n\u00e3o t\u1ee7y h\u1ed3ng c\u1ea7u kh\u00f4ng \u0111\u00f4ng, CT scan gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh.<\/span><\/p>\n

                          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>\u2022 U n\u00e3o, \u00e1p xe n\u00e3o: khi c\u00f3 d\u1ea5u th\u1ea7n kinh \u0111\u1ecbnh v\u1ecb, si\u00eau \u00e2m nghi ng\u1edd c\u00f3 kh\u1ed1i cho\u00e1n ch\u1ed7, CT scan gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh.<\/span><\/p>\n

                          3.3 Ch\u1ea9n \u0111o\u00e1n bi\u1ebfn ch\u1ee9ng<\/b><\/h3>\n

                          Bi\u1ebfn ch\u1ee9ng s\u1edbm:<\/span><\/i><\/p>\n

                          \u25aa Shock nhi\u1ec5m khu\u1ea9n.<\/span><\/p>\n

                          \u25aa H\u00f4n m\u00ea s\u00e2u, r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, tu\u1ea7n ho\u00e0n<\/span><\/p>\n

                          \u25aa Li\u1ec7t \u00bd ng\u01b0\u1eddi,\u00a0 li\u1ec7t c\u00e1c d\u00e2y th\u1ea7n kinh s\u1ecd.<\/span><\/p>\n

                          \u25aa Tr\u00e0n d\u1ecbch d\u01b0\u1edbi m\u00e0ng c\u1ee9ng, \u00e1p xe n\u00e3o, nh\u1ed3i m\u00e1u n\u00e3o, xu\u1ea5t huy\u1ebft n\u00e3o.<\/span><\/p>\n

                          \u25aa T\u1eafc m\u1ea1ch n\u00e3o, vi\u00eam d\u00ednh n\u00e3o th\u1ea5t\u2026<\/span><\/p>\n

                          Bi\u1ebfn ch\u1ee9ng mu\u1ed9n:<\/span><\/i><\/p>\n

                          \u25aa \u0110i\u1ebfc: 20-30% VMN do ph\u1ebf c\u1ea7u<\/span><\/p>\n

                          \u25aa N\u00e3o \u00fang th\u1ee7y: v\u00f2ng \u0111\u1ea7u to, kh\u1edbp s\u1ecd gi\u00e3n<\/span><\/p>\n

                          \u25aa Ch\u1eadm ph\u00e1t tri\u1ec3n v\u1eadn \u0111\u1ed9ng, tr\u00ed tu\u1ec7, t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1, r\u1ed1i lo\u1ea1n ngo\u1ea1i th\u00e1p<\/span><\/p>\n

                          \u25aa \u0110\u1ed9ng kinh<\/span><\/p>\n

                          4. \u0110i\u1ec1u tr\u1ecb vi\u00eam m\u00e0ng n\u00e3o m\u1ee7<\/h2>\n

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

                          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>\u0110i\u1ec1u tr\u1ecb suy h\u00f4 h\u1ea5p, s\u1ed1c (n\u1ebfu c\u00f3).<\/p>\n

                          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Kh\u00e1ng sinh ph\u00f9 h\u1ee3p: S\u1edbm, Nh\u1ea1y c\u1ea3m, Di\u1ec7t khu\u1ea9n, \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 c\u1ea7n thi\u1ebft (Li\u1ec1u cao, IV, \u0111\u1ee7 th\u1eddi gian).<\/p>\n

                          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>Ch\u1ed1ng ph\u00f9 n\u00e3o<\/p>\n

                          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>X\u1eed tr\u00ed bi\u1ebfn ch\u1ee9ng.<\/p>\n

                          –<\/span>\u00a0 \u00a0 \u00a0 \u00a0 <\/span>\u0110\u1ea3m b\u1ea3o dinh d\u01b0\u1ee1ng \u0111\u1ea7y \u0111\u1ee7<\/p>\n

                          4.2 Kh\u00e1ng sinh<\/h3>\n

                          Ch\u1ecdn kh\u00e1ng sinh theo t\u00e1c nh\u00e2n<\/b><\/p>\n\n\n\n\n\n\n
                          T\u00e1c nh\u00e2n<\/strong><\/td>\nKh\u00e1ng sinh l\u1ef1a ch\u1ecdn<\/strong><\/td>\nKh\u00e1ng sinh thay th\u1ebf<\/strong><\/td>\n<\/tr>\n
                          Streptococus nh\u00f3m B<\/strong><\/td>\nPenicilin G ho\u1eb7c<\/strong><\/p>\n

                          Ampicilin <\/strong>\u00b1 Gentamycin<\/strong><\/td>\n

                          		Cefotaxim ho\u1eb7c Ceftriasone<\/strong><\/td>\n<\/tr>\n
                          E. Coli<\/strong><\/td>\nCefotaxim ho\u1eb7c Ceftriasone <\/strong>\u00b1 gentamycin<\/strong><\/td>\nCefepim ho\u1eb7c Meropenem<\/strong><\/td>\n<\/tr>\n
                          Neisseria menigitidis <\/strong><\/td>\n–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nh\u1ea1y Penicilin: <\/strong><\/p>\n

                          Penicilin G ho\u1eb7c<\/strong><\/p>\n

                          Ampicilin <\/strong>\u00b1 Gentamycin<\/strong><\/p>\n

                          –\u00a0\u00a0 Kh\u00f4ng nh\u1ea1y Penicilin:<\/strong><\/p>\n

                          Cefotaxim ho\u1eb7c Ceftriasone<\/strong><\/td>\n

                          		Cefotaxim ho\u1eb7c Ceftriasone<\/strong><\/p>\n

                          \u00a0<\/strong><\/p>\n

                          Cefepim ho\u1eb7c Meropenem<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                           <\/p>\n

                           <\/p>\n

                           <\/p>\n

                          Ch\u1ecdn kh\u00e1ng sinh theo l\u1ee9a tu\u1ed5i<\/span><\/p>\n

                            \n
                          • \u00a0 \u00a0 \u00a0 <\/span>S\u01a1 sinh \u2013 3th: Ph\u1ed1i h\u1ee3p 3 lo\u1ea1i kh\u00e1ng sinh:<\/span><\/li>\n<\/ul>\n

                            Cefotaxim (ho\u1eb7c ceftriaxone) + Ampicillin + Gentamycin.<\/span><\/p>\n

                              \n
                            • \u00a0 \u00a0 \u00a0 <\/span>>3 th: Cefotaxim (ho\u1eb7c ceftriaxone) + Vancomycin<\/span><\/li>\n<\/ul>\n

                              \u0110\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng sau 48 gi\u1edd<\/span><\/p>\n

                                \n
                              • \u00a0 \u00a0 \u00a0 <\/span>\u0110\u00e1nh gi\u00e1 nh\u1ea1y c\u1ea3m kh\u00e1ng sinh<\/span><\/li>\n<\/ul>\n

                                + Di\u1ec5n ti\u1ebfn l\u00e2m s\u00e0ng<\/span><\/p>\n

                                + Thay \u0111\u1ed5i v\u1ec1 DNT<\/span><\/p>\n

                                + S\u1ef1 xu\u1ea5t hi\u1ec7n v\u00e0 di\u1ec5n ti\u1ebfn c\u1ee7a bi\u1ebfn ch\u1ee9ng.<\/span><\/p>\n

                                \u00de<\/span>\u00a0 \u00a0 <\/span>Ch\u1ec9 \u0111\u1ecbnh ch\u1ecdc d\u00f2 DNT sau 24-48h (Nelson)<\/span><\/p>\n

                                  \n
                                • \u00a0 \u00a0 \u00a0 <\/span>S\u01a1 sinh (<2 th\u00e1ng)<\/span><\/li>\n
                                • \u00a0 \u00a0 \u00a0 <\/span>Kh\u00f4ng \u0111\u00e1p \u1ee9ng sau 48h (\u0110\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng: \u0110\u01b0\u1eddng > lactate > T\u1ebf b\u00e0o > \u0111\u1ea1m)<\/span><\/li>\n
                                • \u00a0 \u00a0 \u00a0 <\/span>Vi\u00eam m\u00e0ng n\u00e3o do t\u00e1c nh\u00e2n n\u1eb7ng: Ph\u1ebf c\u1ea7u kh\u00e1ng \u03b2 \u2013 lactam, E.coli, t\u1ee5 c\u1ea7u.<\/span><\/li>\n<\/ul>\n

                                  4.3 \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3<\/strong><\/p>\n

                                    \n
                                  • \u00a0 \u00a0 \u00a0 <\/span>\u0110\u1ea3m b\u1ea3o th\u00f4ng kh\u00ed.<\/span><\/li>\n
                                  • \u00a0 \u00a0 \u00a0 <\/span>H\u1ea1 s\u1ed1t<\/span><\/li>\n
                                  • \u00a0 \u00a0 \u00a0 <\/span>Duy tr\u00ec n\u01b0\u1edbc, \u0111i\u1ec7n gi\u1ea3i, nghi ng\u1edd SIADH v\u00e0 theo d\u00f5i n\u1ed3ng \u0111\u1ed9 th\u1ea9m th\u1ea5u m\u00e1u v\u00e0 ni\u1ec7u<\/span><\/li>\n
                                  • \u00a0 \u00a0 \u00a0 <\/span>Ch\u1ed1ng ph\u00f9 n\u00e3o, t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd: N\u1eb1m \u0111\u1ea7u cao, Manitol, h\u1ea1n ch\u1ebf n\u01b0\u1edbc nh\u1eadp.<\/span><\/li>\n
                                  • \u00a0 \u00a0 \u00a0 <\/span>Ch\u1ed1ng co gi\u1eadt t\u00edch c\u1ef1c: Phenobarbital.<\/span><\/li>\n
                                  • \u00a0 \u00a0 \u00a0 <\/span>Ph\u00f2ng ng\u1eeba h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.<\/span><\/li>\n
                                  • \u00a0 \u00a0 \u00a0 <\/span>Corticoid :Latex (+) HiB, gi\u1ea3m bi\u1ebfn ch\u1ee9ng \u0111i\u1ebfc, gi\u1ea3m ph\u00f9 n\u00e3o, gi\u1ea3m t\u1ed5ng h\u1ee3p Cytokine. Th\u01b0\u1eddng d\u00f9ng Dexamethason (0.15mg\/kg m\u1ed7i 6 gi\u1edd x 4 ng\u00e0y).<\/span><\/li>\n
                                  • \u00a0 \u00a0 \u00a0 <\/span>Theo d\u00f5i, x\u1eed tr\u00ed c\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c.<\/span><\/li>\n<\/ul>\n

                                    4.4 Theo d\u00f5i<\/strong><\/h3>\n
                                      \n
                                    • \u00a0 \u00a0 \u00a0 <\/span>L\u00e2m s\u00e0ng:<\/span><\/li>\n<\/ul>\n

                                      – Sinh hi\u1ec7u: M, HA, nhi\u1ec7t \u0111\u1ed9, nh\u1ecbp th\u1edf<\/span><\/p>\n

                                      – Th\u1ea7n kinh: tri gi\u00e1c, co gi\u1eadt, co g\u1ed3ng, d\u1ea5u T\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd,\u00a0 d\u1ea5u th\u1ea7n kinh \u0111\u1ecbnh v\u1ecb \u0111\u1ec3 ph\u00e1t hi\u1ec7n k\u1ecbp th\u1eddi d\u1ea5u hi\u1ec7u t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c<\/span><\/p>\n

                                      – S\u01a1 sinh v\u00e0 nh\u0169 nhi: v\u00f2ng \u0111\u1ea7u (theo d\u00f5i n\u00e3o \u00fang th\u1ee7y), c\u00e2n n\u1eb7ng (theo d\u00f5i t\u00ecnh tr\u1ea1ng gi\u1eef n\u01b0\u1edbc trong h\u1ed9i ch\u1ee9ng t\u0103ng ti\u1ebft ADH kh\u00f4ng th\u00edch h\u1ee3p) m\u1ed7i ng\u00e0y.<\/span><\/p>\n

                                        \n
                                      • \u00a0 \u00a0 \u00a0 <\/span>C\u1eadn l\u00e2m s\u00e0ng:<\/span><\/li>\n<\/ul>\n

                                        – Sau 36-48 gi\u1edd: DNT, c\u00f4ng th\u1ee9c m\u00e1u, CRP \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb<\/span><\/p>\n

                                        – N\u1ebfu c\u00f3 r\u1ed1i lo\u1ea1n tri gi\u00e1c: ion \u0111\u1ed3 m\u00e1u, Na ni\u1ec7u m\u1ed7i ng\u00e0y.<\/span><\/p>\n

                                        T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong>
                                        \n<\/strong>1. Tr\u01b0\u1eddng \u0110\u1ea1i H\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh – B\u1ed9 M\u00f4n Nhi. Vi\u00eam m\u00e0ng n\u00e3o Vi Khu\u1ea9n. Gi\u00e1o tr\u00ecnh Nhi khoa t\u1eadp 2.<\/p>\n","protected":false},"excerpt":{"rendered":"

                                        Vi\u00eam m\u00e0ng n\u00e3o (VMN) l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam \u1edf m\u00e0ng nu\u00f4i, m\u00e0ng nh\u1ec7n v\u00e0 khoang d\u01b0\u1edbi nh\u1ec7n su\u1ed1t t\u1eeb n\u00e3o b\u1ed9 \u0111\u1ebfn t\u1ee7y s\u1ed1ng. T\u1ea7n su\u1ea5t m\u1eafc b\u1ec7nh c\u00f2n kh\u00e1 ph\u1ed5 bi\u1ebfn, t\u1ef7 l\u1ec7 t\u1eed vong, c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 di ch\u1ee9ng t\u00e2m th\u1ea7n kinh c\u00f2n n\u1eb7ng n\u1ec1 do \u0111\u00f3 b\u1ec7nh c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15,33],"tags":[3],"yoast_head":"\nCh\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam \u1edf m\u00e0ng nu\u00f4i, m\u00e0ng nh\u1ec7n v\u00e0 khoang d\u01b0\u1edbi nh\u1ec7n su\u1ed1t t\u1eeb n\u00e3o b\u1ed9 \u0111\u1ebfn t\u1ee7y s\u1ed1ng.\" \/>\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=\"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 tr\u1ebb em - 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