{"id":24198,"date":"2023-04-18T17:13:29","date_gmt":"2023-04-18T10:13:29","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24198"},"modified":"2023-04-19T11:48:57","modified_gmt":"2023-04-19T04:48:57","slug":"dieu-tri-va-du-phong-benh-tay-chan-mieng-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/dieu-tri-va-du-phong-benh-tay-chan-mieng-bo-y-te\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng b\u1ec7nh tay ch\u00e2n mi\u1ec7ng – B\u1ed9 Y t\u1ebf"},"content":{"rendered":"

B\u1ec7nh tay ch\u00e2n mi\u1ec7ng<\/a> l\u00e0 b\u1ec7nh truy\u1ec1n nhi\u1ec5m l\u00e2y t\u1eeb ng\u01b0\u1eddi sang ng\u01b0\u1eddi, d\u1ec5 g\u00e2y th\u00e0nh d\u1ecbch do vi r\u00fat \u0111\u01b0\u1eddng ru\u1ed9t g\u00e2y ra. Hai nh\u00f3m t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh th\u01b0\u1eddng g\u1eb7p l\u00e0 Coxsackie virus A16 v\u00e0 Enterovirus 71 (EV71). Bi\u1ec3u hi\u1ec7n ch\u00ednh l\u00e0 t\u1ed5n th\u01b0\u01a1ng da, ni\u00eam m\u1ea1c d\u01b0\u1edbi d\u1ea1ng ph\u1ecfng n\u01b0\u1edbc \u1edf c\u00e1c v\u1ecb tr\u00ed \u0111\u1eb7c bi\u1ec7t nh\u01b0 ni\u00eam m\u1ea1c mi\u1ec7ng, l\u00f2ng b\u00e0n tay, l\u00f2ng b\u00e0n ch\u00e2n, m\u00f4ng, g\u1ed1i. B\u1ec7nh c\u00f3 th\u1ec3 g\u00e2y nhi\u1ec1u bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u01b0 vi\u00eam n\u00e3o-m\u00e0ng n\u00e3o, vi\u00eam c\u01a1 tim, ph\u00f9 ph\u1ed5i c\u1ea5p d\u1eabn \u0111\u1ebfn t\u1eed vong n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 x\u1eed tr\u00ed k\u1ecbp th\u1eddi.<\/strong><\/p>\n

\"minh-hoa-tay-chan-mieng\"<\/p>\n

1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tay ch\u00e2n mi\u1ec7ng:<\/strong><\/h2>\n

– Hi\u1ec7n nay ch\u01b0a c\u00f3 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u, ch\u1ec9 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 (kh\u00f4ng d\u00f9ng kh\u00e1ng sinh khi kh\u00f4ng c\u00f3 b\u1ed9i nhi\u1ec5m).<\/p>\n

– Theo d\u00f5i s\u00e1t, ph\u00e1t hi\u1ec7n s\u1edbm, ph\u00e2n \u0111\u1ed9 \u0111\u00fang v\u00e0 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<\/p>\n

– \u0110\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng ph\u1ea3i \u0111\u1ea3m b\u1ea3o x\u1eed tr\u00ed theo nguy\u00ean t\u1eafc h\u1ed3i s\u1ee9c c\u1ea5p c\u1ee9u (ABC…)<\/p>\n

– B\u1ea3o \u0111\u1ea3m dinh d\u01b0\u1ee1ng \u0111\u1ea7y \u0111\u1ee7, n\u00e2ng cao th\u1ec3 tr\u1ea1ng.<\/p>\n

2. Ph\u00e2n tuy\u1ebfn \u0111i\u1ec1u tr\u1ecb tay ch\u00e2n mi\u1ec7ng:<\/strong><\/h2>\n

2.1. Tr\u1ea1m y t\u1ebf x\u00e3 v\u00e0 ph\u00f2ng kh\u00e1m t\u01b0 nh\u00e2n:<\/h3>\n

– Kh\u00e1m v\u00e0 \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa b\u1ec7nh tay ch\u00e2n mi\u1ec7ng \u0111\u1ed9 1<\/p>\n

– Chuy\u1ec3n tuy\u1ebfn: \u0111\u1ed1i v\u1edbi b\u1ec7nh tay ch\u00e2n mi\u1ec7ng \u0111\u1ed9 2a tr\u1edf l\u00ean ho\u1eb7c \u0111\u1ed9 1 v\u1edbi tr\u1ebb d\u01b0\u1edbi 12 th\u00e1ng ho\u1eb7c c\u00f3 b\u1ec7nh ph\u1ed1i h\u1ee3p k\u00e8m theo.<\/p>\n

– \u0110i\u1ec1u ki\u1ec7n: B\u00e1c s\u1ef9, \u0111i\u1ec1u d\u01b0\u1ee1ng \u0111\u00e3 \u0111\u01b0\u1ee3c t\u1eadp hu\u1ea5n ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tay ch\u00e2n mi\u1ec7ng.<\/p>\n

2.2. B\u1ec7nh vi\u1ec7n huy\u1ec7n, b\u1ec7nh vi\u1ec7n t\u01b0 nh\u00e2n.<\/h3>\n

– Kh\u00e1m, \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tay ch\u00e2n mi\u1ec7ng \u0111\u1ed9 1 v\u00e0 2a.<\/p>\n

– Chuy\u1ec3n tuy\u1ebfn: \u0111\u1ed1i v\u1edbi b\u1ec7nh tay ch\u00e2n mi\u1ec7ng \u0111\u1ed9 2b tr\u1edf l\u00ean ho\u1eb7c \u0111\u1ed9 2a c\u00f3 b\u1ec7nh ph\u1ed1i h\u1ee3p k\u00e8m theo.<\/p>\n

– \u0110i\u1ec1u ki\u1ec7n: B\u00e1c s\u1ef9, \u0111i\u1ec1u d\u01b0\u1ee1ng \u0111\u00e3 \u0111\u01b0\u1ee3c t\u1eadp hu\u1ea5n ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tay ch\u00e2n mi\u1ec7ng.<\/p>\n

2.3. B\u1ec7nh vi\u1ec7n \u0111a khoa, \u0111a khoa khu v\u1ef1c, chuy\u00ean khoa Nhi tuy\u1ebfn t\u1ec9nh.<\/h3>\n

– Kh\u00e1m, \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tay ch\u00e2n mi\u1ec7ng t\u1ea5t c\u1ea3 c\u00e1c \u0111\u1ed9.<\/p>\n

– Chuy\u1ec3n tuy\u1ebfn: \u0110\u1ed1i v\u1edbi b\u1ec7nh tay ch\u00e2n mi\u1ec7ng \u0111\u1ed9 3,4 khi kh\u00f4ng c\u00f3 \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c Nhi, \u0111\u1ea3m b\u1ea3o chuy\u1ec3n tuy\u1ebfn an to\u00e0n.<\/p>\n

– \u0110i\u1ec1u ki\u1ec7n:<\/p>\n

+ B\u00e1c s\u1ef9, \u0111i\u1ec1u d\u01b0\u1ee1ng \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n n\u00e2ng cao v\u1ec1 \u0111i\u1ec1u tr\u1ecb v\u00e0 h\u1ed3i s\u1ee9c b\u1ec7nh tay ch\u00e2n mi\u1ec7ng.<\/p>\n

+ C\u00f3 \u0111\u01a1n nguy\u00ean \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tay ch\u00e2n mi\u1ec7ng.<\/p>\n

2.4. B\u1ec7nh vi\u1ec7n Nhi, Truy\u1ec1n nhi\u1ec5m v\u00e0 c\u00e1c b\u1ec7nh vi\u1ec7n \u0111\u01b0\u1ee3c B\u1ed9 Y t\u1ebf ph\u00e2n c\u00f4ng l\u00e0 b\u1ec7nh vi\u1ec7n tuy\u1ebfn cu\u1ed1i c\u1ee7a c\u00e1c khu v\u1ef1c.<\/h3>\n

– Kh\u00e1m, \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tay ch\u00e2n mi\u1ec7ng t\u1ea5t c\u1ea3 c\u00e1c \u0111\u1ed9.<\/p>\n

– \u0110i\u1ec1u ki\u1ec7n:<\/p>\n

+ B\u00e1c s\u1ef9, \u0111i\u1ec1u d\u01b0\u1ee1ng \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n n\u00e2ng cao v\u1ec1 \u0111i\u1ec1u tr\u1ecb v\u00e0 h\u1ed3i s\u1ee9c b\u1ec7nh tay ch\u00e2n mi\u1ec7ng.<\/p>\n

+ C\u00f3 \u0111\u1ea7y \u0111\u1ee7 trang thi\u1ebft b\u1ecb c\u1ea5p c\u1ee9u, h\u1ed3i s\u1ee9c b\u1ec7nh tay ch\u00e2n mi\u1ec7ng.<\/p>\n

+ C\u00f3 \u0111\u01a1n v\u1ecb hu\u1ea5n luy\u1ec7n b\u1ec7nh tay ch\u00e2n mi\u1ec7ng.<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 b\u1ec7nh tay ch\u00e2n mi\u1ec7ng:<\/strong><\/h2>\n

3.1. \u0110\u1ed9 1: \u0110i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa v\u00e0 theo d\u00f5i t\u1ea1i y t\u1ebf c\u01a1 s\u1edf.<\/h3>\n

– Dinh d\u01b0\u1ee1ng \u0111\u1ea7y \u0111\u1ee7 theo tu\u1ed5i. Tr\u1ebb c\u00f2n b\u00fa c\u1ea7n ti\u1ebfp t\u1ee5c cho \u0103n s\u1eefa m\u1eb9.<\/p>\n

– H\u1ea1 s\u1ed1t khi s\u1ed1t cao b\u1eb1ng Paracetamol li\u1ec1u 10 mg\/kg\/l\u1ea7n (u\u1ed1ng) ho\u1eb7c 15 mg\/kg\/l\u1ea7n (to\u1ea1 d\u01b0\u1ee3c) m\u1ed7i 6 gi\u1edd.<\/p>\n

– V\u1ec7 sinh r\u0103ng mi\u1ec7ng.<\/p>\n

– Ngh\u1ec9 ng\u01a1i, tr\u00e1nh k\u00edch th\u00edch.<\/p>\n

– T\u00e1i kh\u00e1m m\u1ed7i 1-2 ng\u00e0y trong 8-10 ng\u00e0y \u0111\u1ea7u c\u1ee7a b\u1ec7nh. Tr\u1ebb c\u00f3 s\u1ed1t ph\u1ea3i t\u00e1i kh\u00e1m m\u1ed7i ng\u00e0y cho \u0111\u1ebfn khi h\u1ebft s\u1ed1t \u00edt nh\u1ea5t 48 gi\u1edd.<\/p>\n

– C\u1ea7n t\u00e1i kh\u00e1m ngay khi c\u00f3 d\u1ea5u hi\u1ec7u t\u1eeb \u0111\u1ed9 2a tr\u1edf l\u00ean nh\u01b0:<\/p>\n

+ S\u1ed1t cao \u2265 39oC.<\/p>\n

+ Th\u1edf nhanh, kh\u00f3 th\u1edf.<\/p>\n

+ Gi\u1eadt m\u00ecnh, l\u1eeb \u0111\u1eeb, run chi, qu\u1ea5y kh\u00f3c, b\u1ee9t r\u1ee9t kh\u00f3 ng\u1ee7, n\u00f4n nhi\u1ec1u.<\/p>\n

+ \u0110i lo\u1ea1ng cho\u1ea1ng.<\/p>\n

+ Da n\u1ed5i v\u00e2n t\u00edm, v\u00e3 m\u1ed3 h\u00f4i, tay ch\u00e2n l\u1ea1nh.<\/p>\n

+ Co gi\u1eadt, h\u00f4n m\u00ea.<\/p>\n

3.2. \u0110\u1ed9 2: \u0110i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa t\u1ea1i b\u1ec7nh vi\u1ec7n<\/h3>\n

3.2.1. \u0110\u1ed9 2a:<\/h4>\n

– \u0110i\u1ec1u tr\u1ecb nh\u01b0 \u0111\u1ed9 1. Tr\u01b0\u1eddng h\u1ee3p tr\u1ebb s\u1ed1t cao kh\u00f4ng \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi paracetamol c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p v\u1edbi ibuprofen 5-10 mg\/kg\/l\u1ea7n l\u1eb7p l\u1ea1i m\u1ed7i 6-8 gi\u1edd n\u1ebfu c\u1ea7n (d\u00f9ng xen k\u1ebd v\u1edbi c\u00e1c l\u1ea7n s\u1eed d\u1ee5ng paracetamol, kh\u00f4ng d\u00f9ng thu\u1ed1c h\u1ea1 s\u1ed1t nh\u00f3m aspirin). T\u1ed5ng li\u1ec1u t\u1ed1i \u0111a c\u1ee7a ibuprofen l\u00e0 40 mg\/kg\/ng\u00e0y.<\/p>\n

– Thu\u1ed1c: Phenobarbital 5 – 7 mg\/kg\/ng\u00e0y, u\u1ed1ng.<\/p>\n

– Theo d\u00f5i s\u00e1t \u0111\u1ec3 ph\u00e1t hi\u1ec7n d\u1ea5u hi\u1ec7u chuy\u1ec3n \u0111\u1ed9.<\/p>\n

3.2.2. \u0110\u1ed9 2b: \u0110i\u1ec1u tr\u1ecb t\u1ea1i ph\u00f2ng c\u1ea5p c\u1ee9u ho\u1eb7c h\u1ed3i s\u1ee9c<\/h4>\n

– N\u1eb1m \u0111\u1ea7u cao 30\u00b0.<\/p>\n

– Th\u1edf oxy qua m\u0169i 3-6 l\u00edt\/ph\u00fat.<\/p>\n

– H\u1ea1 s\u1ed1t t\u00edch c\u1ef1c n\u1ebfu tr\u1ebb c\u00f3 s\u1ed1t.<\/p>\n

– Thu\u1ed1c:<\/p>\n

+ Phenobarbital 10 – 20 mg\/kg truy\u1ec1n t\u0129nh m\u1ea1ch. L\u1eb7p l\u1ea1i sau 8-12 gi\u1edd khi c\u1ea7n.<\/p>\n

+ Immunoglobulin:<\/p>\n

\u221a Nh\u00f3m 2<\/em>: 1g\/kg\/ng\u00e0y truy\u1ec1n t\u0129nh m\u1ea1ch ch\u1eadm trong 6-8 gi\u1edd. Sau 24 gi\u1edd n\u1ebfu c\u00f2n d\u1ea5u hi\u1ec7u \u0111\u1ed9 2b: D\u00f9ng li\u1ec1u th\u1ee9 2<\/p>\n

\u221a Nh\u00f3m 1<\/em>: Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh Immunoglobulin th\u01b0\u1eddng quy. N\u1ebfu tri\u1ec7u ch\u1ee9ng kh\u00f4ng gi\u1ea3m sau 6 gi\u1edd \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Phenobarbital th\u00ec c\u1ea7n ch\u1ec9 \u0111\u1ecbnh Immunoglobulin. Sau 24 gi\u1edd \u0111\u00e1nh gi\u00e1 l\u1ea1i \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh li\u1ec1u th\u1ee9 2 nh\u01b0 nh\u00f3m 2.<\/p>\n

– Theo d\u00f5i m\u1ea1ch, nhi\u1ec7t \u0111\u1ed9, huy\u1ebft \u00e1p, nh\u1ecbp th\u1edf, ki\u1ec3u th\u1edf, tri gi\u00e1c, ran ph\u1ed5i m\u1ed7i 1- 3 gi\u1edd trong 6 gi\u1edd \u0111\u1ea7u, sau \u0111\u00f3 theo chu k\u1ef3 4-5 gi\u1edd.<\/p>\n

– \u0110o \u0111\u1ed9 b\u00e3o h\u00f2a oxy SpO2 v\u00e0 theo d\u00f5i m\u1ea1ch li\u00ean t\u1ee5c (n\u1ebfu c\u00f3 m\u00e1y).<\/p>\n

3.3. \u0110\u1ed9 3: \u0110i\u1ec1u tr\u1ecb t\u1ea1i \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c<\/h3>\n

– Th\u1edf oxy qua m\u0169i 3-6 l\u00edt\/ph\u00fat, sau 30 \u2013 60 ph\u00fat n\u1ebfu \u0111\u00e1p \u1ee9ng k\u00e9m n\u00ean \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n gi\u00fap th\u1edf s\u1edbm.<\/p>\n

– Ch\u1ed1ng ph\u00f9 n\u00e3o: n\u1eb1m \u0111\u1ea7u cao 30 , h\u1ea1n ch\u1ebf d\u1ecbch (t\u1ed5ng d\u1ecbch b\u1eb1ng 1\/2-3\/4 nhu c\u1ea7u b\u00ecnh th\u01b0\u1eddng), th\u1edf m\u00e1y t\u0103ng th\u00f4ng kh\u00ed gi\u1eef PaCO2 t\u1eeb 30-35 mmHg v\u00e0 duy tr\u00ec PaO2 t\u1eeb 90-100 mmHg.<\/p>\n

– Phenobarbital 10 – 20 mg\/kg truy\u1ec1n t\u0129nh m\u1ea1ch. L\u1eb7p l\u1ea1i sau 8-12 gi\u1edd khi c\u1ea7n. Li\u1ec1u t\u1ed1i \u0111a: 30 mg\/kg\/24 gi\u1edd.<\/p>\n

– Immunoglobulin (Gammaglobulin): 1g\/kg\/ng\u00e0y truy\u1ec1n t\u0129nh m\u1ea1ch ch\u1eadm trong 6-8 gi\u1edd, d\u00f9ng trong 2 ng\u00e0y li\u00ean t\u1ee5c.<\/p>\n

– Dobutamin \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi suy tim m\u1ea1ch > 170 l\u1ea7n\/ph\u00fat, li\u1ec1u kh\u1edfi \u0111\u1ea7u 5\u00b5g\/kg\/ph\u00fat truy\u1ec1n t\u0129nh m\u1ea1ch, t\u0103ng d\u1ea7n 1-2,5\u00b5g\/kg\/ph\u00fat m\u1ed7i 15 ph\u00fat cho \u0111\u1ebfn khi c\u00f3 c\u1ea3i thi\u1ec7n l\u00e2m s\u00e0ng; li\u1ec1u t\u1ed1i \u0111a 20\u00b5g\/kg\/ph\u00fat (kh\u00f4ng d\u00f9ng Dopamin).<\/p>\n

– Milrinone truy\u1ec1n t\u0129nh m\u1ea1ch 0,4 \u2013 0,75 \u00b5g\/kg\/ph\u00fat ch\u1ec9 d\u00f9ng khi HA cao, trong 24-72 gi\u1edd. N\u1ebfu huy\u1ebft \u00e1p \u1ed5n \u0111\u1ecbnh trong 12-24 gi\u1edd, gi\u1ea3m d\u1ea7n li\u1ec1u milrinone 0,1 \u00b5g\/kg\/ph\u00fat m\u1ed7i 30-60 ph\u00fat cho \u0111\u1ebfn li\u1ec1u t\u1ed1i thi\u1ec3u 0,25 \u00b5g\/kg\/ph\u00fat. N\u1ebfu huy\u1ebft \u00e1p \u1ed5n \u0111\u1ecbnh \u1edf li\u1ec1u t\u1ed1i thi\u1ec3u n\u00e0y trong \u00edt nh\u1ea5t 6 gi\u1edd th\u00ec xem x\u00e9t ng\u01b0ng milrinone.<\/p>\n

– \u0110i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n n\u01b0\u1edbc, \u0111i\u1ec7n gi\u1ea3i, toan ki\u1ec1m, \u0111i\u1ec1u tr\u1ecb h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n

– H\u1ea1 s\u1ed1t t\u00edch c\u1ef1c.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb co gi\u1eadt n\u1ebfu c\u00f3: Midazolam 0,15 mg\/kg\/l\u1ea7n ho\u1eb7c Diazepam 0,2-0,3 mg\/kg truy\u1ec1n t\u0129nh m\u1ea1ch ch\u1eadm, l\u1eadp l\u1ea1i sau 10 ph\u00fat n\u1ebfu c\u00f2n co gi\u1eadt (t\u1ed1i \u0111a 3 l\u1ea7n).<\/p>\n

– Theo d\u00f5i m\u1ea1ch, nhi\u1ec7t \u0111\u1ed9, huy\u1ebft \u00e1p, nh\u1ecbp th\u1edf, tri gi\u00e1c, ran ph\u1ed5i, SpO2, m\u1ed7i 1- 2 gi\u1edd. N\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n n\u00ean theo d\u00f5i huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch x\u00e2m l\u1ea5n.<\/p>\n

3.4. \u0110\u1ed9 4: \u0110i\u1ec1u tr\u1ecb t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c<\/h3>\n

– \u0110\u1eb7t N\u1ed9i kh\u00ed qu\u1ea3n th\u1edf m\u00e1y: T\u0103ng th\u00f4ng kh\u00ed gi\u1eef PaCO2 t\u1eeb 30-35 mmHg v\u00e0 duy tr\u00ec PaO2 t\u1eeb 90-100 mmHg.<\/p>\n

– Ch\u1ed1ng s\u1ed1c: S\u1ed1c do vi\u00eam c\u01a1 tim ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng trung t\u00e2m v\u1eadn m\u1ea1ch \u1edf th\u00e2n n\u00e3o.<\/p>\n

+ N\u1ebfu kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng c\u1ee7a ph\u00f9 ph\u1ed5i ho\u1eb7c suy tim: Truy\u1ec1n d\u1ecbch Natri clorua 0,9% ho\u1eb7c Ringer lactat: 5 ml\/kg\/15 ph\u00fat, \u0111i\u1ec1u ch\u1ec9nh t\u1ed1c \u0111\u1ed9 theo h\u01b0\u1edbng d\u1eabn CVP v\u00e0 \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng. Tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 CVP c\u1ea7n theo d\u00f5i s\u00e1t d\u1ea5u hi\u1ec7u qu\u00e1 t\u1ea3i, ph\u00f9 ph\u1ed5i c\u1ea5p.<\/p>\n

+ \u0110o v\u00e0 theo d\u00f5i \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch trung \u01b0\u01a1ng.<\/p>\n

+ Dobutamin li\u1ec1u kh\u1edfi \u0111\u1ea7u 5\u00b5g\/kg\/ph\u00fat, t\u0103ng d\u1ea7n 2- 3\u00b5g\/kg\/ph\u00fat m\u1ed7i 15 ph\u00fat cho \u0111\u1ebfn khi c\u00f3 hi\u1ec7u qu\u1ea3, li\u1ec1u t\u1ed1i \u0111a 20 \u00b5g\/kg\/ph\u00fat.<\/p>\n

– Ph\u00f9 ph\u1ed5i c\u1ea5p:<\/p>\n

+ Ng\u1eebng ngay d\u1ecbch truy\u1ec1n n\u1ebfu \u0111ang truy\u1ec1n d\u1ecbch.<\/p>\n

+ D\u00f9ng Dobutamin li\u1ec1u 5-20 \u00b5g\/kg\/ph\u00fat.<\/p>\n

+ Furosemide 1-2 mg\/kg\/l\u1ea7n ti\u00eam t\u0129nh m\u1ea1ch ch\u1ec9 \u0111\u1ecbnh khi qu\u00e1 t\u1ea3i d\u1ecbch.<\/p>\n

– \u0110i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n ki\u1ec1m toan, \u0111i\u1ec7n gi\u1ea3i, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 ch\u1ed1ng ph\u00f9 n\u00e3o:<\/p>\n

– L\u1ecdc m\u00e1u li\u00ean t\u1ee5c hay ECMO (n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n).<\/p>\n

– Immunoglobulin: Ch\u1ec9 \u0111\u1ecbnh khi HA trung b\u00ecnh \u2265 50mmHg<\/p>\n

– Kh\u00e1ng sinh: Ch\u1ec9 d\u00f9ng kh\u00e1ng sinh khi c\u00f3 b\u1ed9i nhi\u1ec5m ho\u1eb7c ch\u01b0a lo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh nhi\u1ec5m khu\u1ea9n n\u1eb7ng kh\u00e1c<\/p>\n

– Theo d\u00f5i m\u1ea1ch, nhi\u1ec7t \u0111\u1ed9, huy\u1ebft \u00e1p, nh\u1ecbp th\u1edf, tri gi\u00e1c, ran ph\u1ed5i, SpO2, n\u01b0\u1edbc ti\u1ec3u m\u1ed7i 30 ph\u00fat trong 6 gi\u1edd \u0111\u1ea7u, sau \u0111\u00f3 \u0111i\u1ec1u ch\u1ec9nh theo \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng;<\/p>\n

\u00c1p l\u1ef1c t\u0129nh m\u1ea1ch trung t\u00e2m m\u1ed7i gi\u1edd, n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n n\u00ean theo d\u00f5i huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch x\u00e2m l\u1ea5n.<\/p>\n

4. Ti\u00eau chu\u1ea9n xu\u1ea5t vi\u1ec7n:<\/strong><\/h2>\n

Ng\u01b0\u1eddi b\u1ec7nh tay ch\u00e2n mi\u1ec7ng c\u00f3 bi\u1ebfn ch\u1ee9ng n\u1eb7ng (\u0111\u1ed9 3, 4) \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh xu\u1ea5t vi\u1ec7n kh\u00f4ng ch\u1ec9 \u1ed5n \u0111\u1ecbnh v\u1ec1 l\u00e2m s\u00e0ng m\u00e0 c\u00f2n ph\u1ea3i \u1ed5n \u0111\u1ecbnh v\u1ec1 c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 di ch\u1ee9ng. \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh tay ch\u00e2n mi\u1ec7ng \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa kh\u00e1c c\u00f3 th\u1ec3 xu\u1ea5t vi\u1ec7n khi c\u00f3 \u0111\u1ee7 4 \u0111i\u1ec1u ki\u1ec7n sau:<\/p>\n

– Kh\u00f4ng s\u1ed1t \u00edt nh\u1ea5t 24 gi\u1edd li\u00ean t\u1ee5c (kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c h\u1ea1 s\u1ed1t)<\/p>\n

– Kh\u00f4ng c\u00f2n c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ph\u00e2n \u0111\u1ed9 n\u1eb7ng t\u1eeb \u0111\u1ed9 2a tr\u1edf l\u00ean \u00edt nh\u1ea5t trong 48 gi\u1edd.<\/p>\n

– C\u00f3 \u0111i\u1ec1u ki\u1ec7n theo d\u00f5i t\u1ea1i nh\u00e0 v\u00e0 t\u00e1i kh\u00e1m ngay n\u1ebfu c\u00f3 di\u1ec5n ti\u1ebfn n\u1eb7ng<\/p>\n

(n\u1ebfu ch\u01b0a \u0111\u1ebfn ng\u00e0y th\u1ee9 8 c\u1ee7a b\u1ec7nh, t\u00ednh t\u1eeb l\u00fac kh\u1edfi ph\u00e1t).<\/p>\n

– C\u00e1c di ch\u1ee9ng (n\u1ebfu c\u00f3) \u0111\u00e3 \u1ed5n \u0111\u1ecbnh: kh\u00f4ng c\u1ea7n h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p, \u0103n \u0111\u01b0\u1ee3c qua \u0111\u01b0\u1eddng mi\u1ec7ng.<\/p>\n

5. Ph\u00f2ng b\u1ec7nh tay ch\u00e2n mi\u1ec7ng<\/h2>\n

5.<\/strong>1. Nguy\u00ean t\u1eafc ph\u00f2ng b\u1ec7nh:<\/strong><\/p>\n

– Hi\u1ec7n ch\u01b0a c\u00f3 v\u1eafc xin ph\u00f2ng b\u1ec7nh \u0111\u1eb7c hi\u1ec7u.<\/p>\n

– \u00c1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba chu\u1ea9n v\u00e0 ph\u00f2ng ng\u1eeba \u0111\u1ed1i v\u1edbi b\u1ec7nh l\u00e2y qua \u0111\u01b0\u1eddng ti\u00eau ho\u00e1, \u0111\u1eb7c bi\u1ec7t ch\u00fa \u00fd ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp v\u1edbi ngu\u1ed3n l\u00e2y.<\/p>\n

5.<\/strong>2. Ph\u00f2ng b\u1ec7nh t\u1ea1i c\u00e1c c\u01a1 s\u1edf y t\u1ebf:<\/strong><\/p>\n

– C\u00e1ch ly theo nh\u00f3m b\u1ec7nh.<\/p>\n

– Nh\u00e2n vi\u00ean y t\u1ebf: Mang kh\u1ea9u trang, r\u1eeda, s\u00e1t khu\u1ea9n tay tr\u01b0\u1edbc v\u00e0 sau khi ch\u0103m s\u00f3c.<\/p>\n

– Kh\u1eed khu\u1ea9n b\u1ec1 m\u1eb7t, gi\u01b0\u1eddng b\u1ec7nh, bu\u1ed3ng b\u1ec7nh b\u1eb1ng Cloramin B 2%. L\u01b0u \u00fd kh\u1eed khu\u1ea9n c\u00e1c gh\u1ebf ng\u1ed3i c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 th\u00e2n nh\u00e2n t\u1ea1i khu kh\u00e1m b\u1ec7nh.<\/p>\n

– X\u1eed l\u00fd ch\u1ea5t th\u1ea3i, qu\u1ea7n \u00e1o, kh\u0103n tr\u1ea3i gi\u01b0\u1eddng c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 d\u1ee5ng c\u1ee5 ch\u0103m s\u00f3c s\u1eed d\u1ee5ng l\u1ea1i theo quy tr\u00ecnh ph\u00f2ng b\u1ec7nh l\u00e2y qua \u0111\u01b0\u1eddng ti\u00eau ho\u00e1.<\/p>\n

5.<\/strong>3. Ph\u00f2ng b\u1ec7nh t\u1ea1i c\u1ed9ng \u0111\u1ed3ng:<\/strong><\/p>\n

– V\u1ec7 sinh c\u00e1 nh\u00e2n, r\u1eeda tay b\u1eb1ng x\u00e0 ph\u00f2ng (\u0111\u1eb7c bi\u1ec7t sau khi thay qu\u1ea7n \u00e1o, t\u00e3, sau khi ti\u1ebfp x\u00fac v\u1edbi ph\u00e2n, n\u01b0\u1edbc b\u1ecdt).- R\u1eeda s\u1ea1ch \u0111\u1ed3 ch\u01a1i, v\u1eadt d\u1ee5ng, s\u00e0n nh\u00e0.<\/p>\n

– Lau s\u00e0n nh\u00e0 b\u1eb1ng dung d\u1ecbch kh\u1eed khu\u1ea9n Cloramin B 2% ho\u1eb7c c\u00e1c dung d\u1ecbch kh\u1eed khu\u1ea9n kh\u00e1c.<\/p>\n

– C\u00e1ch ly tr\u1ebb b\u1ec7nh t\u1ea1i nh\u00e0. Kh\u00f4ng \u0111\u1ebfn nh\u00e0 tr\u1ebb, tr\u01b0\u1eddng h\u1ecdc, n\u01a1i c\u00e1c tr\u1ebb ch\u01a1i t\u1eadp trung trong 10 \u2013 14 ng\u00e0y \u0111\u1ea7u c\u1ee7a b\u1ec7nh.<\/p>\n

Ngu\u1ed3n: H<\/strong>\u01b0\u1edbng d\u1eabn<\/strong> ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tay – ch\u00e2n – mi\u1ec7ng (Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 1003\/Q\u0110-BYT ng\u00e0y 30 th\u00e1ng 3 n\u0103m 2012 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf)<\/em><\/p>\n

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

B\u1ec7nh tay ch\u00e2n mi\u1ec7ng l\u00e0 b\u1ec7nh truy\u1ec1n nhi\u1ec5m l\u00e2y t\u1eeb ng\u01b0\u1eddi sang ng\u01b0\u1eddi, d\u1ec5 g\u00e2y th\u00e0nh d\u1ecbch do vi r\u00fat \u0111\u01b0\u1eddng ru\u1ed9t g\u00e2y ra. Hai nh\u00f3m t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh th\u01b0\u1eddng g\u1eb7p l\u00e0 Coxsackie virus A16 v\u00e0 Enterovirus 71 (EV71). Bi\u1ec3u hi\u1ec7n ch\u00ednh l\u00e0 t\u1ed5n th\u01b0\u01a1ng da, ni\u00eam m\u1ea1c d\u01b0\u1edbi d\u1ea1ng ph\u1ecfng n\u01b0\u1edbc \u1edf c\u00e1c […]<\/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":"\n\u0110i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng b\u1ec7nh tay ch\u00e2n mi\u1ec7ng - B\u1ed9 Y t\u1ebf - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh tay ch\u00e2n mi\u1ec7ng l\u00e0 b\u1ec7nh truy\u1ec1n nhi\u1ec5m l\u00e2y t\u1eeb ng\u01b0\u1eddi sang ng\u01b0\u1eddi, d\u1ec5 g\u00e2y th\u00e0nh d\u1ecbch do vi r\u00fat \u0111\u01b0\u1eddng ru\u1ed9t g\u00e2y ra.\" \/>\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=\"\u0110i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng b\u1ec7nh tay ch\u00e2n mi\u1ec7ng - 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