{"id":24407,"date":"2023-04-18T22:30:10","date_gmt":"2023-04-18T15:30:10","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24407"},"modified":"2023-04-19T10:00:50","modified_gmt":"2023-04-19T03:00:50","slug":"tiep-can-shock-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/tiep-can-shock-o-tre-em\/","title":{"rendered":"Ti\u1ebfp c\u1eadn shock \u1edf tr\u1ebb em"},"content":{"rendered":"

Shock l\u00e0 t\u00ecnh tr\u1ea1ng suy tu\u1ea7n ho\u00e0n c\u1ea5p g\u00e2y gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4 so v\u1edbi nhu c\u1ea7u, h\u1eadu qu\u1ea3 gi\u1ea3m cung c\u1ea5p oxygen v\u00e0 glucose c\u0169ng nh\u01b0 gi\u1ea3m l\u1ea5y nh\u1eefng ch\u1ea5t bi\u1ebfn d\u01b0\u1ee1ng t\u1ebf b\u00e0o: acid lactic, CO2. N\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi s\u1ebd di\u1ec5n ti\u1ebfn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o, t\u1ed5n th\u01b0\u01a1ng \u0111a c\u01a1 quan, th\u1eadm ch\u00ed t\u1eed vong.<\/strong><\/p>\n

\"minh-hoa-shock\"<\/p>\n

1. B\u1ec7nh sinh shock:<\/strong><\/h2>\n

Cung oxy gi\u1ea3m, c\u01a1 th\u1ec3 s\u1ebd t\u0103ng ly tr\u00edch oxy t\u1eeb HGB n\u00ean \u0111\u1ed9 b\u00e3o h\u00f2a oxy m\u00e1u t\u0129nh m\u1ea1ch trung t\u00e2m th\u1ea5p.<\/p>\n

Cung oxy gi\u1ea3m h\u01a1n n\u1eefa, t\u1ebf b\u00e0o chuy\u1ec3n h\u00f3a y\u1ebfm kh\u00ed \u0111\u1ec3 duy tr\u00ec s\u1ef1 s\u1ed1ng t\u1ed1i thi\u1ec3u.<\/p>\n

Cung oxy gi\u1ea3m kh\u00f4ng ph\u1ee5c h\u1ed3i \u0111\u01b0\u1ee3c, ho\u1ea1t \u0111\u1ed9ng c\u00e1c t\u1ebf b\u00e0o b\u1ecb r\u1ed1i lo\u1ea1n d\u1eabn \u0111\u1ebfn ch\u1ebft t\u1ebf b\u00e0o, suy \u0111a c\u01a1 quan.<\/p>\n

Ph\u1ea3n \u1ee9ng c\u1ee7a c\u01a1 th\u1ec3 v\u1edbi vi\u1ec7c thi\u1ebfu cung oxy:<\/p>\n

    \n
  • Pha c\u00f2n b\u00f9:<\/li>\n
  • Ph\u1ea3n x\u1ea1 th\u1ea7n kinh giao c\u1ea3m + th\u1ec3 d\u1ecbch Angiotensin v\u00e0 Vasopressin.<\/li>\n
  • T\u0103ng nh\u1ecbp tim.<\/li>\n
  • T\u0103ng kh\u00e1ng l\u1ef1c m\u1ea1ch m\u00e1u h\u1ec7 th\u1ed1ng (chuy\u1ec3n d\u00f2ng ch\u1ea3y c\u1ee7a m\u00e1u \u0111\u1ebfn nh\u1eefng c\u01a1 quan quan tr\u1ecdng).<\/li>\n
  • T\u0103ng s\u1ee9c co b\u00f3p c\u01a1<\/li>\n
  • T\u0103ng tr\u01b0\u01a1ng l\u1ef1c t\u0129nh m\u1ea1ch.<\/li>\n
  • Huy\u1ebft \u00e1p t\u00e2m thu v\u1eabn c\u00f2n b\u00ecnh th<\/strong>\u01b0\u1eddng<\/strong>.<\/strong><\/li>\n
  • Pha m\u1ea5t b\u00f9:<\/li>\n
  • C\u01a1 ch\u1ebf b\u1ea3o v\u1ec7 c\u1ee7a c\u01a1 th\u1ec3 suy s\u1ee5p \u00e0 HA k\u1eb9p (<25 mmHg) ho\u1eb7c t\u1ee5t (theo tu\u1ed5i)<\/li>\n
  • Nhi\u1ec5m toan (lactate + \u1ee9 CO2 do chuy\u1ec3n h\u00f3a y\u1ebfm kh\u00ed).<\/li>\n
  • R\u1ed1i lo\u1ea1n b\u01a1m Na \u2013 K (thi\u1ebfu n\u0103ng l\u01b0\u1ee3ng).<\/li>\n
  • R\u1ed1i lo\u1ea1n h\u1ec7 kinin-\u0111\u00f4ng m\u00e1u (l\u01b0u th\u00f4ng m\u00e1u ch\u1eadm + bi\u1ebfn \u0111\u1ed5i h\u00f3a h\u1ecdc t\u1ea1i ch\u1ed7 m\u1ea1ch m\u00e1u nh\u1ecf).<\/li>\n
  • H\u00f3a ch\u1ea5t trung gian, y\u1ebfu t\u1ed1 \u0111\u00f4ng ti\u1ec3u c\u1ea7u, \u0111\u1ed9c t\u1ed1 vi khu\u1ea9n.<\/li>\n
  • Gi\u1ea3m th\u1ec3 t\u00edch m\u00e1u l\u01b0u th\u00f4ng (\u1ee9 tr\u1ec7 m\u00e1u + t\u0103ng t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch).<\/li>\n
  • V\u00f2ng xo\u1eafn b\u1ec7nh l\u00fd.<\/strong><\/li>\n<\/ul>\n

    Shock b\u1ea5t h\u1ed3i ph\u1ee5c:<\/p>\n

      \n
    • C\u00e1c c\u01a1 quan b\u1ecb t\u1ed5n th\u01b0\u01a1ng nghi\u00eam tr\u1ecdng (n\u00e3o, tim,\u2026). D\u00f9 h\u1ec7 tu\u1ea7n ho\u00e0n c\u00f3 kh\u00f4i ph\u1ee5c l\u1ea1i ho\u1ea1t \u0111\u1ed9ng th\u00ec c\u00e1c c\u01a1 quan n\u00e0y c\u0169ng \u0111\u00e3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng \u0111\u1ebfn m\u1ee9c kh\u00f4ng th\u1ec3 ho\u1ea1t \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng \u0111\u01b0\u1ee3c n\u1eefa.<\/li>\n<\/ul>\n\n\n\n\n\n\n\n
      Nguy\u00ean nh\u00e2n<\/strong><\/td>\nTi\u1ec1n t\u1ea3i<\/strong><\/td>\nCo b\u00f3p c<\/strong>\u01a1<\/strong> tim<\/strong><\/td>\nH\u1eadu t\u1ea3i<\/strong><\/td>\n<\/tr>\n
      Shock gi\u1ea3m th\u1ec3 t\u00edch<\/td>\nGi\u1ea3m<\/td>\nB\u00ecnh th\u01b0\u1eddng \/ T\u0103ng<\/td>\nT\u0103ng<\/td>\n<\/tr>\n
      Shock ph\u00e2n b\u1ed1<\/td>\nB\u00ecnh th\u01b0\u1eddng \/ Gi\u1ea3m<\/td>\nB\u00ecnh th\u01b0\u1eddng \/ Gi\u1ea3m<\/td>\nGi\u1ea3m<\/td>\n<\/tr>\n
      Shock nhi\u1ec5m tr\u00f9ng<\/td>\nGi\u1ea3m<\/td>\nB\u00ecnh th\u01b0\u1eddng \/ Gi\u1ea3m<\/td>\nThay \u0111\u1ed5i<\/td>\n<\/tr>\n
      Shock tim<\/td>\nTh\u01b0\u1eddng t\u0103ng<\/td>\nGi\u1ea3m<\/td>\nT\u0103ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      2. Ph\u00e2n lo\u1ea1i shock theo nguy\u00ean nh\u00e2n:<\/strong><\/h2>\n
        \n
      • Shock gi\u1ea3m th\u1ec3 t\u00edch: th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf tr\u1ebb em. C\u00e1c nguy\u00ean nh\u00e2n nh\u01b0 m\u1ea5t m\u00e1u, ti\u00eau ch\u1ea3y, ph\u1ecfng, \u0111a ni\u1ec7u ho\u1eb7c bi\u1ebfn ch\u1ee9ng c\u1ee7a \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng nh\u01b0 HHS ho\u1eb7c DKA l\u00e0m gi\u1ea3m ti\u1ec1n t\u1ea3i.<\/li>\n
      • Shock tim: \u00edt g\u1eb7p \u1edf tr\u1ebb em. Ch\u1ee7 y\u1ebfu do gi\u1ea3m ch\u1ee9c n\u0103ng co b\u00f3p c\u1ee7a c\u01a1 tim. Nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 g\u1eb7p l\u00e0 tim b\u1ea9m sinh, vi\u00eam c\u01a1 tim, r\u1ed1i lo\u1ea1n nh\u1ecbp tim, ch\u1eb9n tim c\u1ea5p.<\/li>\n
      • Shock t\u1eafc ngh\u1ebdn: c\u00f3 th\u1ec3 do tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i \u00e1p l\u1ef1c, u trung th\u1ea5t,\u2026<\/li>\n
      • Shock ph\u00e2n b\u1ed1: ch\u1ee7 y\u1ebfu do d\u00e3n m\u1ea1ch, g\u00e2y gi\u1ea3m kh\u00e1ng l\u1ef1c m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean, khi\u1ebfn cung l\u01b0\u1ee3ng tim ph\u1ea3i t\u0103ng l\u00ean \u0111\u1ec3 b\u00f9 tr\u1eeb. N\u1ebfu b\u00f9 kh\u00f4ng n\u1ed5i s\u1ebd d\u1eabn \u0111\u1ebfn shock. C\u00e1c nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0 shock nhi\u1ec5m tr\u00f9ng, shock ph\u1ea3n v\u1ec7, shock th\u1ea7n kinh.<\/li>\n
      • Shock ph\u00e2n ly: B\u1ec7nh Methemoglobin, ng\u1ed9 \u0111\u1ed9c kh\u00ed CO.<\/li>\n<\/ul>\n

        3. L\u00e2m s\u00e0ng:<\/strong><\/h2>\n

        H\u1ecfi b\u1ec7nh s\u1eed nhanh, c\u1ea7n ch\u00fa \u00fd:<\/strong><\/p>\n

          \n
        • Ti\u1ec1n s\u1eed tim b\u1ea9m sinh, th\u1ea5p tim.<\/li>\n
        • Ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng v\u00e0 c\u00e1c thu\u1ed1c d\u00f9ng tr\u01b0\u1edbc \u0111\u00f3, c\u00f4n tr\u00f9ng c\u1eafn. X\u1ea3y ra \u0111\u1ed9t ng\u1ed9t sau ti\u00eam ho\u1eb7c u\u1ed1ng thu\u1ed1c.<\/li>\n
        • B\u1ec7nh s\u1eed c\u00f3 ch\u1ea5n th\u01b0\u01a1ng, s\u1ed1t, r\u1ed1i lo\u1ea1n tri gi\u00e1c, ti\u00eau ch\u1ea3y, \u00f3i, \u0111au \u0111\u1ea7u \u0111\u1ea7u (tr\u1ebb l\u1edbn), xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a\u2026<\/li>\n<\/ul>\n

          Kh\u00e1m l\u00e2m s\u00e0ng:<\/strong><\/p>\n

            \n
          • Sinh hi\u1ec7u, th\u1eddi gian \u0111\u1ed5 \u0111\u1ea7y mao m\u1ea1ch.<\/li>\n
          • T\u00ecnh tr\u1ea1ng tri gi\u00e1c AVPU.<\/li>\n
          • H\u00f4 h\u1ea5p: t\u00edm, th\u1edf r\u00edt, th\u1edf nhanh, r\u00fat l\u00f5m ng\u1ef1c, ki\u1ec3u th\u1edf Kussmal hay Cheynstoke, SpO2<\/sub>.<\/li>\n
          • Tim m\u1ea1ch: v\u1ecb tr\u00ed m\u1ecfm tim, di\u1ec7n \u0111\u1eadp b\u1ea5t th\u01b0\u1eddng, Gallop T3, Hardzar, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, gan to, \u00e2m th\u1ed5i b\u1ea5t th\u01b0\u1eddng c\u1ee7a tim.<\/li>\n
          • D\u1ea5u m\u1ea5t n\u01b0\u1edbc (n\u1ebfu b\u1ec7nh s\u1eed nghi ng\u1edd): m\u1eaft tr\u0169ng, d\u1ea5u v\u00e9o da, u\u1ed1ng n\u01b0\u1edbc h\u00e1o h\u1ee9c\/kh\u00f4ng u\u1ed1ng n\u01b0\u1edbc, b\u1ee9t r\u1ee9t\/li b\u00ec, m\u00f4i kh\u00f4, da kh\u00f4,\u2026<\/li>\n
          • V\u1ebft c\u00f4n tr\u00f9ng \u0111\u1ed1t tr\u00ean c\u01a1 th\u1ec3, s\u1ea9n h\u1ed3ng ban ki\u1ec3u d\u1ecb \u1ee9ng,\u2026<\/li>\n<\/ul>\n

            C\u1eadn l\u00e2m s\u00e0ng:<\/strong><\/p>\n

              \n
            • T\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u.<\/li>\n
            • Ion \u0111\u1ed3, Dextrostix.<\/li>\n
            • Ure, Creatinine m\u00e1u, AST, ALT.<\/li>\n
            • Nh\u00f3m x\u00e9t nghi\u1ec7m g\u1ee3i \u00fd nguy\u00ean nh\u00e2n:<\/li>\n
            • Hct kh\u1ea9n khi nghi ng\u1edd shock gi\u1ea3m th\u1ec3 t\u00edch.<\/li>\n
            • CRPhs, c\u1ea5y m\u00e1u + Kh\u00e1ng sinh \u0111\u1ed3 khi nghi ng\u1edd shock nhi\u1ec5m tr\u00f9ng.<\/li>\n
            • TPTNT, Soi c\u1ea5y ph\u00e2n, Ch\u1ecdc d\u00f2 th\u1eaft l\u01b0ng, XQ ph\u1ed5i th\u1eb3ng t\u00ecm \u1ed5 nhi\u1ec5m tr\u00f9ng.<\/li>\n
            • XQ ph\u1ed5i th\u1eb3ng (b\u00f3ng tim to), ECG, Si\u00eau \u00e2m tim n\u1ebfu nghi ng\u1edd shock tim.<\/li>\n
            • Nh\u00f3m x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 h\u1eadu qu\u1ea3 shock:<\/li>\n
            • Lactate m\u00e1u.<\/li>\n
            • Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch (c\u00f3 th\u1ec3 l\u00e0m KMTM khi kh\u00f4ng l\u1ea5y \u0111\u01b0\u1ee3c KM\u0110M, nh\u01b0ng k\u1ebft qu\u1ea3 ch\u1ec9 \u0111\u1ecdc toan ki\u1ec1m m\u00e0 kh\u00f4ng \u0111\u1ecdc oxy m\u00e1u).<\/li>\n
            • Ch\u1ee9c n\u0103ng \u0111\u00f4ng m\u00e1u<\/li>\n<\/ul>\n

              4.\u00a0 Ch\u1ea9n \u0111o\u00e1n:<\/strong><\/h2>\n

              4.1 Ch\u1ea9n \u0111o\u00e1n shock:<\/strong><\/h3>\n

              + Tay ch\u00e2n l\u1ea1nh<\/p>\n

              + M\u1ea1ch nhanh<\/p>\n

              + Th\u1eddi gian \u0111\u1ed5 \u0111\u1ea7y mao m\u1ea1ch (CRT \u2013 Capillary refill test) \u00b3 3 gi\u00e2y<\/p>\n

              + Huy\u1ebft \u00e1p k\u1eb9p (hi\u1ec7u \u00e1p < 25 mmHg) ho\u1eb7c t\u1ee5t.<\/p>\n

              + Huy\u1ebft \u00e1p t\u1ee5t khi huy\u1ebft \u00e1p t\u00e2m thu:<\/p>\n

                \n
              • S\u01a1 sinh: < 60 mmHg.<\/li>\n
              • Nh\u0169 nhi: < 70 mmHg.<\/li>\n
              • Tr\u1ebb 1-10 tu\u1ed5i: < 70 + (tu\u1ed5i x 2) mmHg.<\/li>\n
              • Tr\u1ebb >10 tu\u1ed5i: <90 mmHg<\/li>\n<\/ul>\n

                + B\u1ee9t r\u1ee9t\/L\u1eeb \u0111\u1eeb<\/p>\n

                + Ti\u1ec3u \u00edt (n\u01b0\u1edbc ti\u1ec3u <1 ml\/kg\/gi\u1edd)<\/p>\n

                + Shock n\u1eb7ng khi:<\/p>\n

                + Tay ch\u00e2n l\u1ea1nh, c\u00f3 ho\u1eb7c kh\u00f4ng n\u1ed5i b\u00f4ng.<\/p>\n

                + M\u1ea1ch = 0, Huy\u1ebft \u00e1p = 0<\/p>\n

                + V\u1eadt v\u00e3, h\u00f4n m\u00ea.<\/p>\n

                + Ti\u1ec3u \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 n\u01b0\u1edbc ti\u1ec3u<\/p>\n

                4.2 Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n shock:<\/strong><\/h3>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
                Nguy\u00ean nh\u00e2n<\/td>\nL\u00e2m s\u00e0ng<\/td>\nX\u00e9t nghi\u1ec7m<\/td>\n<\/tr>\n
                Shock \u00e2 th\u1ec3 t\u00edch<\/td>\nDo<\/p>\n

                m\u1ea5t d\u1ecbch<\/td>\n

                		\u00d3i nhi\u1ec1u, ti\u00eau ch\u1ea3y, ti\u1ec3u nhi\u1ec1u c\u00f3 th\u1ec3 k\u00e8m d\u1ea5u m\u1ea5t n\u01b0\u1edbc n\u1eb7ng.<\/p>\n

                Ph\u1ecfng n\u1eb7ng<\/td>\n

                		Hct t\u0103ng<\/td>\n<\/tr>\n
                Do<\/p>\n

                m\u1ea5t m\u00e1u<\/td>\n

                		B\u1ec7nh s\u1eed c\u00f3 ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n

                Nh\u00ecn th\u1ea5y v\u1ebft th\u01b0\u01a1ng ch\u1ea3y m\u00e1u.<\/p>\n

                \u00d3i m\u00e1u, ti\u00eau ph\u00e2n \u0111en.<\/td>\n

                		Hct gi\u1ea3m<\/p>\n

                TPTTBM: thi\u1ebfu m\u00e1u \u0111\u1eb3ng s\u1eafc \u0111\u1eb3ng b\u00e0o<\/td>\n<\/tr>\n

                Shock tim<\/td>\nTi\u1ec1n s\u1eed tim b\u1ea9m sinh, th\u1ea5p tim.<\/p>\n

                D\u1ea5u hi\u1ec7u suy tim .<\/td>\n

                		XQ ng\u1ef1c th\u1eb3ng th\u1ea5y b\u00f3ng tim to.<\/p>\n

                ECG g\u1ee3i \u00fd d\u00e0y th\u1ea5t, d\u1ea7y nh\u0129 ho\u1eb7c r\u1ed1i lo\u1ea1n nh\u1ecbp.<\/p>\n

                Si\u00eau \u00e2m tim: b\u1ec7nh c\u01a1 tim, van tim, v\u00e1ch tim, EF gi\u1ea3m.<\/td>\n<\/tr>\n

                Shock t\u1eafc ngh\u1ebdn<\/td>\nD\u1ea5u hi\u1ec7u ch\u1eb9n tim c\u1ea5p.<\/p>\n

                D\u1ea5u hi\u1ec7u tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i \u00e1p l\u1ef1c<\/td>\n

                		XQ ng\u1ef1c th\u1eb3ng: b\u00f3ng tim h\u00ecnh c\u1ea7u<\/p>\n

                ECG nh\u1ecbp xoang, gi\u1ea3m \u0111i\u1ec7n th\u1ebf QRS, QRS b\u1ea5t th\u01b0\u1eddng<\/p>\n

                S\u00c2 tim.<\/td>\n<\/tr>\n

                Shock ph\u00e2n b\u1ed1<\/td>\nShock ph\u1ea3n v\u1ec7<\/td>\nShock ngay sau ti\u00eam truy\u1ec1n thu\u1ed1c, m\u00e1u v\u00e0 ch\u1ebf ph\u1ea9m m\u00e1u.<\/p>\n

                N\u1ed5i m\u1ec1 \u0111ay<\/td>\n

                		<\/td>\n<\/tr>\n
                Shock nhi\u1ec5m tr\u00f9ng<\/td>\nS\u1ed1t<\/p>\n

                V\u1ebb m\u1eb7t nhi\u1ec5m tr\u00f9ng, nhi\u1ec5m \u0111\u1ed9c<\/p>\n

                T\u1eed ban (N\u00e3o m\u00f4 c\u1ea7u)<\/p>\n

                C\u00f3 \u1ed5 nhi\u1ec5m tr\u00f9ng g\u1ee3i \u00fd<\/td>\n

                		WBC t\u0103ng, Neutrophil t\u0103ng (n\u1ebfu c\u1ea3 hai c\u00f9ng gi\u1ea3m l\u00e0 nhi\u1ec5m tr\u00f9ng n\u1eb7ng)<\/p>\n

                CRP-hs t\u0103ng<\/p>\n

                Soi c\u1ea5y b\u1ec7nh ph\u1ea9m<\/td>\n<\/tr>\n

                Shock th\u1ea7n kinh<\/td>\nCh\u1ea5n th\u01b0\u01a1ng t\u1ee7y, vi\u00eam t\u1ee7y,\u2026<\/td>\nMRI t\u1ee7y<\/td>\n<\/tr>\n
                Shock SXH<\/td>\nS\u1ed1t cao li\u00ean t\u1ee5c 2-7 ng\u00e0y<\/p>\n

                D\u1ea5u xu\u1ea5t huy\u1ebft<\/p>\n

                Hct t\u0103ng, PLT gi\u1ea3m<\/td>\n

                		NS1Ag trong v\u00f2ng 5 ng\u00e0y \u0111\u1ea7u<\/p>\n

                Elisa IgM t\u1eeb ng\u00e0y 5 tr\u1edf \u0111i<\/td>\n<\/tr>\n

                Shock ph\u00e2n ly<\/td>\nB\u1ec7nh s\u1eed ti\u1ebfp x\u00fac kh\u00f3i ng\u1ea1t<\/p>\n

                Da \u0111\u1ecf<\/td>\n

                		Methemoglobin<\/p>\n

                CO<\/td>\n<\/tr>\n

                <\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                5. \u0110i\u1ec1u tr\u1ecb shock:<\/strong><\/h2>\n

                5.1 Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb:<\/em><\/strong><\/p>\n

                  \n
                • Ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm shock.<\/li>\n
                • Nhanh ch\u00f3ng \u0111\u01b0a b\u1ec7nh nh\u00e2n ra kh\u1ecfi shock.<\/li>\n
                • \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n shock.<\/li>\n
                • \u0110i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng shock.<\/li>\n<\/ul>\n

                  5.2 \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u:<\/em><\/strong><\/p>\n

                    \n
                  • N\u1eb1m \u0111\u1ea7u b\u1eb1ng.<\/li>\n
                  • C\u1ea7m m\u00e1u v\u1ebft th\u01b0\u01a1ng \u0111ang ch\u1ea3y m\u00e1u n\u1ebfu c\u00f3.<\/li>\n
                  • Th\u00f4ng \u0111\u01b0\u1eddng th\u1edf.<\/li>\n
                  • H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p Oxy cannulla \u1ea9m 1 \u2013 2 l\/ph \u0111\u1ed1i v\u1edbi tr\u1ebb s\u01a1 sinh v\u00e0 3 \u2013 4 l\/ph \u0111\u1ed1i v\u1edbi tr\u1ebb nh\u0169 nhi v\u00e0 tr\u1ebb l\u1edbn h\u01a1n, mi\u1ec5n sao gi\u1eef SpO2 <\/sub>95% – 97%. \u0110\u1eb7t NKQ th\u1edf m\u00e1y s\u1edbm khi th\u1ea5t b\u1ea1i th\u1edf cannulla sau 1 \u2013 2 gi\u1edd \u0111\u1ea7u (SpO2 <92% ho\u1eb7c SpO2 >92% nh\u01b0ng b\u1ec7nh nh\u00e2n v\u1eabn ph\u1ea3i th\u1edf m\u1ed9t c\u00e1ch g\u1eafng s\u1ee9c).<\/li>\n
                  • Thi\u1ebft l\u1eadp 2 \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch kim lu\u1ed3n \u0111\u1ec3 truy\u1ec1n d\u1ecbch v\u00e0 l\u1ea5y m\u00e1u x\u00e9t nghi\u1ec7m. Tr\u1ebb d\u01b0\u1edbi 6 tu\u1ed5i, n\u1ebfu sau 5 ph\u00fat v\u1eabn kh\u00f4ng l\u1ea5y \u0111\u01b0\u1ee3c \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch, b\u00e1c s\u1ef9 s\u1ebd ti\u1ebfn h\u00e0nh ti\u00eam qua t\u1ee7y x\u01b0\u01a1ng (v\u1ecb tr\u00ed tr\u01b0\u1edbc trong x\u01b0\u01a1ng ch\u00e0y, d\u01b0\u1edbi l\u1ed3i c\u1ee7 ch\u00e0y 2 kho\u00e1t ng\u00f3n tay). Kh\u00f4ng \u0111\u1ec3 kim \u1edf t\u1ee7y x\u01b0\u01a1ng >24 gi\u1edd, khi l\u1ea5y \u0111\u01b0\u1ee3c \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch, r\u00fat kim \u1edf t\u1ee7y x\u01b0\u01a1ng ngay.<\/li>\n
                  • N\u1ebfu l\u00e0 shock tim th\u00ec kh\u00f4ng truy\u1ec1n d\u1ecbch m\u00e0 d\u00f9ng Dobutamine 3-10 mg\/kg\/ph\u00fat.<\/li>\n
                  • N\u1ebfu l\u00e0 shock ph\u1ea3n v\u1ec7 th\u00ec ng\u1eebng ngay thu\u1ed1c \u0111ang ti\u00eam truy\u1ec1n (n\u1ebfu c\u00f3), Adrenaline 0,01 ml\/kg (max 0,3 ml) TDD ho\u1eb7c TB (m\u1eb7t tr\u01b0\u1edbc \u0111\u00f9i), \u0111\u01b0\u1ee3c ph\u00e9p l\u1eb7p l\u1ea1i sau m\u1ed7i 10-15 ph\u00fat n\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng, t\u1ed1i \u0111a 3 l\u1ea7n. Ph\u1ed1i h\u1ee3p v\u1edbi Hydrocortisone 5 mg\/kg m\u1ed7i 4-6 gi\u1edd ho\u1eb7c Methylprednisolone 1-2 mg\/kg TMC. Sau 3 li\u1ec1u TDD\/TB m\u00e0 th\u1ea5t b\u1ea1i s\u1ebd truy\u1ec1n t\u0129nh m\u1ea1ch Adrenaline ph\u1ed1i h\u1ee3p truy\u1ec1n d\u1ecbch Lactate Ringer\/NS 20 ml\/kg\/gi\u1edd, n\u1ebfu huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh gi\u1ea3m c\u00f2n 10 ml\/kg\/gi\u1edd.<\/li>\n
                  • C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t sau \u0111\u00e2y c\u1ea7n truy\u1ec1n Lactate Ringer\/NS t\u1ed1c \u0111\u1ed9 20 ml\/kg\/15 ph\u00fat:<\/li>\n
                  • M\u1ea1ch = 0, HA = 0<\/li>\n
                  • Shock nhi\u1ec5m tr\u00f9ng<\/li>\n
                  • Shock gi\u1ea3m th\u1ec3 t\u00edch do ti\u00eau ch\u1ea3y c\u1ea5p m\u1ea5t n\u01b0\u1edbc n\u1eb7ng<\/li>\n
                  • Shock ph\u1ecfng<\/li>\n
                  • C\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f2n l\u1ea1i, LR\/NS n\u00ean truy\u1ec1n v\u1edbi t\u1ed1c \u0111\u1ed9 20 ml\/kg\/gi\u1edd.<\/li>\n
                  • N\u1ebfu shock m\u1ea5t m\u00e1u th\u00ec c\u00f3 th\u1ec3 truy\u1ec1n LR\/NS 20 ml\/kg\/gi\u1edd. Trong th\u1eddi gian \u0111\u00f3, \u0111\u0103ng k\u00fd m\u00e1u to\u00e0n ph\u1ea7n \/ h\u1ed3ng c\u1ea7u l\u1eafng v\u00e0 truy\u1ec1n m\u00e1u 10-20 ml\/kg\/gi\u1edd gi\u1eef Hct \u00b3 30%.<\/li>\n
                  • N\u1ebfu th\u1ea5t b\u1ea1i v\u1edbi LR\/NS c\u00f3 th\u1ec3 chuy\u1ec3n qua dung d\u1ecbch cao ph\u00e2n t\u1eed nh\u01b0 HES, Dextran70 10-20 ml\/kg\/gi\u1edd. Th\u1eddi \u0111i\u1ec3m chuy\u1ec3n \u0111\u1ed5i dung d\u1ecbch v\u00e0 t\u1ed1c \u0111\u1ed9 truy\u1ec1n t\u00f9y v\u00e0o t\u1eebng lo\u1ea1i shock c\u1ee5 th\u1ec3.<\/li>\n
                  • N\u1ebfu huy\u1ebft \u0111\u1ed9ng h\u1ecdc \u1ed5n \u0111\u1ecbnh, duy tr\u00ec b\u1eb1ng Dextrose saline ho\u1eb7c Dextrose \u00bd saline 10 ml\/kg\/gi\u1edd r\u1ed3i d\u1ea7n d\u1ea7n gi\u1ea3m t\u1ed1c \u0111\u1ed9 v\u00e0 d\u1eebng h\u1eb3n (c\u1ea7n duy tr\u00ec b\u1eb1ng dung d\u1ecbch n\u00e0y v\u00ec b\u1ec7nh nh\u00e2n shock v\u1ed1n kh\u00f4ng \u0103n u\u1ed1ng g\u00ec, l\u1ea1i ph\u1ea3i ch\u1ecbu stress n\u1eb7ng c\u1ee7a shock, n\u1ebfu ch\u1ec9 cho truy\u1ec1n dung d\u1ecbch mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u01a1ng th\u00f4i th\u00ec c\u00f3 kh\u1ea3 n\u0103ng b\u1ec7nh nh\u00e2n s\u1ebd h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft sau nhi\u1ec1u gi\u1edd li\u1ec1n).<\/li>\n
                  • N\u1ebfu t\u1ed5ng l\u01b0\u1ee3ng d\u1ecbch g\u1ea7n 60 ml\/kg r\u1ed3i m\u00e0 huy\u1ebft \u0111\u1ed9ng v\u1eabn kh\u00f4ng \u1ed5n, kh\u00f4ng \u0111\u00e1p \u1ee9ng th\u00ec n\u00ean \u0111o CVP \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u1ec9 d\u1ecbch ch\u01b0a tr\u01b0\u1edbc khi cho v\u1eadn m\u1ea1ch. CVP n\u00ean gi\u1eef 10-15 cmH2<\/sub><\/li>\n<\/ul>\n

                    + N\u1ebfu CVP < 10 cmH2O, ch\u1ee9ng t\u1ecf b\u1ec7nh nh\u00e2n c\u00f2n thi\u1ebfu d\u1ecbch: ti\u1ebfp t\u1ee5c dung d\u1ecbch cao ph\u00e2n t\u1eed HES\/Dextran70 10-20 ml\/kg\/gi\u1edd.<\/p>\n

                    + N\u1ebfu CVP >15 cmH2O ho\u1eb7c \u0111ang l\u00fac b\u00f9 d\u1ecbch m\u00e0 xu\u1ea5t hi\u1ec7n d\u1ea5u hi\u1ec7u qu\u00e1 t\u1ea3i nh\u01b0 kh\u00f3 th\u1edf, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, gan to nhanh, Gallop T3, ran \u1ea9m \u1edf ph\u1ed5i, n\u00ean ng\u1eebng b\u00f9 d\u1ecbch v\u00e0 x\u1eed tr\u00ed nh\u01b0 m\u1ed9t ph\u00f9 ph\u1ed5i c\u1ea5p v\u1edbi Dobutamine 3-5 mg\/kg\/ph\u00fat.<\/p>\n

                    + N\u1ebfu 10<CVP<15 cmH2O v\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u qu\u00e1 t\u1ea3i, n\u00ean test d\u1ecbch truy\u1ec1n v\u1edbi Dextran70 t\u1ed1c \u0111\u1ed9 5 ml\/kg\/30 ph\u00fat.<\/p>\n

                    5.3 \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n:<\/em><\/strong><\/p>\n

                      \n
                    • Shock m\u1ea5t m\u00e1u: n\u1ebfu v\u1eabn ti\u1ebfp t\u1ee5c ch\u1ea3y nhi\u1ec1u m\u00e1u, c\u00e2n nh\u1eafc ph\u1eabu thu\u1eadt c\u1ea7m m\u00e1u.<\/li>\n
                    • Ch\u1eb9n tim c\u1ea5p: Ch\u1ecdc h\u00fat m\u00e0ng tim gi\u1ea3i \u00e1p; TKMP \u00e1p l\u1ef1c: d\u1eabn l\u01b0u m\u00e0ng ph\u1ed5i<\/li>\n
                    • \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp.<\/li>\n
                    • Shock nhi\u1ec5m tr\u00f9ng: kh\u00e1ng sinh.<\/li>\n
                    • \u0110i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng:<\/li>\n
                    • Suy h\u00f4 h\u1ea5p c\u1ea5p: h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p.<\/li>\n
                    • Toan chuy\u1ec3n h\u00f3a: b\u00f9 toan khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/li>\n
                    • Suy \u0111a c\u01a1 quan: l\u1ecdc m\u00e1u li\u00ean t\u1ee5c.<\/li>\n<\/ul>\n

                      \u00a0<\/em><\/p>\n

                      Ngu\u1ed3n: ThS.BS. \u0110\u1ed7 Minh H\u00f9ng, B\u1ed9 m\u00f4n Nhi, Khoa Y \u2013 \u0110\u1ea1i h\u1ecdc Qu\u1ed1c Gia TP.HCM<\/em><\/p>\n

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

                      Shock l\u00e0 t\u00ecnh tr\u1ea1ng suy tu\u1ea7n ho\u00e0n c\u1ea5p g\u00e2y gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4 so v\u1edbi nhu c\u1ea7u, h\u1eadu qu\u1ea3 gi\u1ea3m cung c\u1ea5p oxygen v\u00e0 glucose c\u0169ng nh\u01b0 gi\u1ea3m l\u1ea5y nh\u1eefng ch\u1ea5t bi\u1ebfn d\u01b0\u1ee1ng t\u1ebf b\u00e0o: acid lactic, CO2. N\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi s\u1ebd di\u1ec5n ti\u1ebfn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o, t\u1ed5n th\u01b0\u01a1ng \u0111a […]<\/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":"\nTi\u1ebfp c\u1eadn shock \u1edf tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"Shock l\u00e0 t\u00ecnh tr\u1ea1ng suy tu\u1ea7n ho\u00e0n c\u1ea5p g\u00e2y gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4 so v\u1edbi nhu c\u1ea7u, h\u1eadu qu\u1ea3 gi\u1ea3m cung c\u1ea5p oxygen v\u00e0 glucose cho t\u1ebf b\u00e0o.\" \/>\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=\"Ti\u1ebfp c\u1eadn shock \u1edf tr\u1ebb em - 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