{"id":24433,"date":"2023-04-19T11:55:09","date_gmt":"2023-04-19T04:55:09","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24433"},"modified":"2023-04-19T14:42:41","modified_gmt":"2023-04-19T07:42:41","slug":"tiep-can-hoi-chung-viem-da-he-thong-lien-quan-covid-19-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/tiep-can-hoi-chung-viem-da-he-thong-lien-quan-covid-19-o-tre-em\/","title":{"rendered":"Ti\u1ebfp c\u1eadn h\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng li\u00ean quan COVID-19 \u1edf tr\u1ebb em"},"content":{"rendered":"

H\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng li\u00ean quan COVID-19 \u1edf tr\u1ebb em (Multisystem inflammatory syndrome in children – MIS-C) ho\u1eb7c \u1edf tr\u1ebb s\u01a1 sinh (MIS-N), b\u1ec7nh x\u1ea3y ra ch\u1ee7 y\u1ebfu 2-6 tu\u1ea7n sau nhi\u1ec5m SARS-CoV-2. Tr\u1ebb s\u01a1 sinh c\u1ea7n ngh\u0129 \u0111\u1ebfn MIS- N khi tr\u1ebb c\u00f3 bi\u1ec3u hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng \u0111a c\u01a1 quan v\u00e0 m\u1eb9 t\u1eebng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n hay nghi ng\u1edd nhi\u1ec5m SARS-CoV-2. M\u1eb7c d\u00f9 h\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng<\/a> \u00edt g\u1eb7p, nh\u01b0ng th\u01b0\u1eddng di\u1ec5n ti\u1ebfn n\u1eb7ng c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong.<\/strong><\/p>\n

1. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng<\/strong><\/h2>\n

1.1 H\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng \u1edf tr\u1ebb s\u01a1 sinh<\/strong><\/h3>\n

+ Tr\u1ebb < 28 ng\u00e0y tu\u1ed5i.<\/p>\n

+ Ng\u01b0\u1eddi m\u1eb9 c\u00f3 b\u1eb1ng ch\u1ee9ng nhi\u1ec5m hay nghi nhi\u1ec5m SARS-CoV-2:<\/p>\n

    \n
  • X\u00e9t nghi\u1ec7m SARS-CoV-2: Real-time RT-PCR d\u01b0\u01a1ng t\u00ednh v\u1edbi SARS- CoV-2, test nhanh kh\u00e1ng nguy\u00ean d\u01b0\u01a1ng t\u00ednh, ho\u1eb7c tetst kh\u00e1ng th\u1ec3 d\u01b0\u01a1ng t\u00ednh trong th\u1eddi k\u1ef3 mang thai;<\/li>\n
  • C\u00f3 ti\u1ec1n s\u1eed ti\u1ebfp x\u00fac v\u1edbi ng\u01b0\u1eddi kh\u1eb3ng \u0111\u1ecbnh nhi\u1ec5m SARS-CoV-2 trong th\u1eddi k\u1ef3 mang thai.<\/li>\n
  • Tr\u1ebb c\u00f3 x\u00e9t nghi\u1ec7m IgG v\u1edbi SARS-CoV-2 d\u01b0\u01a1ng t\u00ednh, IgM (-).<\/li>\n<\/ul>\n

    * L\u00e2m s\u00e0ng<\/strong> tr\u1ebb th\u01b0\u1eddng c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u n\u1eb7ng c\u1ea7n ph\u1ea3i nh\u1eadp vi\u1ec7n \u0111i\u1ec1u tr\u1ecb V\u00c0<\/strong><\/p>\n

    c\u00f3:<\/p>\n

    + T\u1ed5n th\u01b0\u01a1ng \u2265 2 c\u01a1 quan: tim m\u1ea1ch, h\u00f4 h\u1ea5p, huy\u1ebft h\u1ecdc, ti\u00eau h\u00f3a, th\u1ea7n kinh, da hay thay \u0111\u1ed5i th\u00e2n nhi\u1ec7t (s\u1ed1t ho\u1eb7c h\u1ea1 nhi\u1ec7t \u0111\u1ed9) HO\u1eb6C<\/strong><\/p>\n

    + R\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n c\u1ee7a tim, HO\u1eb6C <\/strong>gi\u00e3n m\u1ea1ch v\u00e0nh, HO\u1eb6C <\/strong>ph\u00ecnh m\u1ea1ch (kh\u00f4ng c\u1ea7n c\u00f3 t\u1ed5n th\u01b0\u01a1ng 2 h\u1ec7 th\u1ed1ng c\u01a1 quan).<\/p>\n

    + C\u00f3 b\u1eb1ng ch\u1ee9ng c\u1eadn l\u00e2m s\u00e0ng c\u1ee7a \u0111\u00e1p \u1ee9ng vi\u00eam.<\/p>\n

      \n
    • C\u00f3 m\u1ed9t ho\u1eb7c nhi\u1ec1u ch\u1ec9 s\u1ed1 vi\u00eam t\u0103ng: CRP, procalcitonin, m\u00e1u l\u1eafng, ferritin, LDH, IL-6, t\u0103ng b\u1ea1ch c\u1ea7u trung t\u00ednh ho\u1eb7c gi\u1ea3m lympho v\u00e0 gi\u1ea3m albumin.<\/li>\n<\/ul>\n

      + Lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh n\u1eb7ng kh\u00e1c nh\u01b0: ng\u1ea1t s\u01a1 sinh (pH < 7,0 v\u00e0 Apgar < 3 \u1edf ph\u00fat th\u1ee9 5), nhi\u1ec5m tr\u00f9ng huy\u1ebft, nhi\u1ec5m vi r\u00fat kh\u00e1c, lupus b\u1ea9m sinh c\u00f3 t\u1ed5n th\u01b0\u01a1ng tim\u2026).<\/p>\n

      1.2 H\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng \u1edf tr\u1ebb \u2265 1 th\u00e1ng tu\u1ed5i<\/strong><\/h3>\n

      Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh khi<\/strong> c\u00f3 c\u00e1c ti\u00eau chu\u1ea9n sau:<\/p>\n

      Ng\u01b0\u1eddi b\u1ec7nh t\u1eeb 1 th\u00e1ng tu\u1ed5i – < 21 tu\u1ed5i c\u00f3 bi\u1ec3u hi\u1ec7n s\u1ed1t \u2265 380<\/sup>C, s\u1ed1t cao li\u00ean t\u1ee5c \u2265 1 ng\u00e0y V\u00c0 <\/strong>c\u00f3 2 trong c\u00e1c d\u1ea5u hi\u1ec7u sau:<\/p>\n

        \n
      • Ban \u0111\u1ecf ho\u1eb7c xung huy\u1ebft gi\u00e1c m\u1ea1c ho\u1eb7c ph\u00f9 n\u1ec1 ni\u00eam m\u1ea1c mi\u1ec7ng, b\u00e0n tay, ch\u00e2n.<\/li>\n
      • H\u1ea1 huy\u1ebft \u00e1p ho\u1eb7c s\u1ed1c;<\/li>\n
      • Suy gi\u1ea3m ch\u1ee9c n\u0103ng tim, t\u1ed5n th\u01b0\u01a1ng m\u00e0ng tim, vi\u00eam m\u00e0ng ngo\u00e0i tim, b\u1ea5t th\u01b0\u1eddng m\u1ea1ch v\u00e0nh x\u00e1c \u0111\u1ecbnh qua si\u00eau \u00e2m, t\u0103ng proBNP, Troponin;<\/li>\n<\/ul>\n
          \n
        • R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u (PT, APTT, D-dimer cao);<\/li>\n
        • R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a c\u1ea5p t\u00ednh (ti\u00eau ch\u1ea3y, \u0111au b\u1ee5ng, n\u00f4n)<\/li>\n<\/ul>\n
            \n
          • V\u00c0 <\/strong>c\u00f3 t\u0103ng c\u00e1c ch\u1ec9 s\u1ed1 vi\u00eam (CRP \u2265 5 mg\/L, m\u00e1u l\u1eafng, procalcitonin)<\/li>\n
          • V\u00c0 <\/strong>kh\u00f4ng do c\u00e1c c\u0103n nguy\u00ean nhi\u1ec5m tr\u00f9ng kh\u00e1c<\/li>\n
          • V\u00c0 <\/strong>c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a nhi\u1ec5m vi r\u00fat SARS-CoV-2 ho\u1eb7c ti\u1ebfp x\u00fac g\u1ea7n v\u1edbi ng\u01b0\u1eddi m\u1eafc COVID-19 trong v\u00f2ng 2-6 tu\u1ea7n (x\u00e9t nghi\u1ec7m RT-PCR ho\u1eb7c kh\u00e1ng th\u1ec3 kh\u00e1ng SARS-CoV-2 d\u01b0\u01a1ng t\u00ednh).<\/li>\n<\/ul>\n

            Ngh\u0129 \u0111\u1ebfn h\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng khi c\u00f3 \u2265 1 d\u1ea5u hi\u1ec7u:<\/h3>\n
              \n
            • Tr\u1ebb s\u1ed1t cao li\u00ean t\u1ee5c > 5 ng\u00e0y<\/li>\n
            • Tri\u1ec7u ch\u1ee9ng r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a n\u1eb7ng: \u0111au b\u1ee5ng nhi\u1ec1u, ti\u00eau ch\u1ea3y<\/li>\n
            • CRP ho\u1eb7c Procalcitonin t\u0103ng cao<\/li>\n
            • R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u: PT, APTT, D-dimer cao<\/li>\n
            • S\u1ed1c<\/li>\n
            • Ban \u0111\u1ecf ho\u1eb7c xung huy\u1ebft gi\u00e1c m\u1ea1c ho\u1eb7c ph\u00f9 n\u1ec1 ni\u00eam m\u1ea1c mi\u1ec7ng, b\u00e0n tay, ch\u00e2n<\/li>\n<\/ul>\n

              V\u00c0 <\/strong>kh\u00f4ng t\u00ecm th\u1ea5y nguy\u00ean nh\u00e2n nhi\u1ec5m tr\u00f9ng n\u00e0o gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c. <\/strong>H\u1ed9i ch\u1ea9n \u0111\u1ec3 l\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<\/p>\n

              2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/strong><\/h2>\n
                \n
              • B\u1ec7nh Kawasaki<\/li>\n
              • S\u1ed1t ph\u00e1t ban (s\u1edfi, Rubella)<\/li>\n
              • S\u1ed1t xu\u1ea5t huy\u1ebft dengue<\/li>\n
              • Nhi\u1ec5m tr\u00f9ng huy\u1ebft (t\u1ee5 c\u1ea7u, li\u00ean c\u1ea7u, mycoplasma,\u2026)<\/li>\n
              • H\u1ed9i ch\u1ee9ng s\u1ed1c \u0111\u1ed9c t\u1ed1<\/li>\n
              • Vi\u00eam ru\u1ed9t th\u1eeba<\/li>\n
              • B\u1ec7nh tay ch\u00e2n mi\u1ec7ng<\/li>\n
              • H\u1ed9i ch\u1ee9ng Stevens Johnson<\/li>\n
              • H\u1ed9i ch\u1ee9ng HLH<\/li>\n<\/ul>\n

                Th\u1ec3 l\u00e2m s\u00e0ng<\/strong><\/p>\n

                  \n
                • H\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng k\u00e8m s\u1ed1c ho\u1eb7c suy \u0111a c\u01a1 quan<\/li>\n
                • H\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng gi\u1ed1ng b\u1ec7nh Kawasaki<\/li>\n
                • H\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng \u0111\u01a1n thu\u1ea7n<\/li>\n<\/ul>\n

                  3. \u0110i\u1ec1u tr\u1ecb\u00a0<\/strong><\/h2>\n

                  3.1 H\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng k\u00e8m s\u1ed1c ho\u1eb7c suy \u0111a c\u01a1 quan<\/strong><\/h3>\n

                  + Immunoglobulin (IVIG) li\u1ec1u 2g\/kg (t\u1ed1i \u0111a kh\u00f4ng qu\u00e1 100g) c\u00f3 th\u1ec3 d\u00f9ng 1 l\u1ea7n ho\u1eb7c chia 2 l\u1ea7n, truy\u1ec1n t\u0129nh m\u1ea1ch v\u1edbi t\u1ed1c \u0111\u1ed9 kh\u1edfi \u0111\u1ea7u l\u00e0 0,01- 0,02 mL\/kg\/ph\u00fat trong 30 ph\u00fat \u0111\u1ea7u ti\u00ean. N\u1ebfu dung n\u1ea1p t\u1ed1t, c\u00f3 th\u1ec3 t\u0103ng d\u1ea7n cho t\u1ed1c \u0111\u1ed9 truy\u1ec1n \u0111\u1ebfn khi \u0111\u1ea1t li\u1ec1u t\u1ed1i \u0111a 0,1 mL\/kg\/ph\u00fat (c\u00f3 th\u1ec3 ch\u1eadm h\u01a1n n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh suy tim n\u1eb7ng) V\u00c0 <\/strong>ph\u1ed1i h\u1ee3p v\u1edbi:<\/p>\n

                  + Methylprednisolon li\u1ec1u kh\u1edfi \u0111\u1ea7u 10 mg\/kg\/ng\u00e0y (t\u1ed1i \u0111a 1000 mg) (ti\u00eam TM 1 l\u1ea7n ho\u1eb7c chia 2 l\u1ea7n) x 1-3 ng\u00e0y, n\u1ebfu kh\u00f4ng \u0111\u1ee1 t\u0103ng li\u1ec1u 30 mg\/kg\/ng\u00e0y (t\u1ed1i \u0111a 1000mg) theo d\u00f5i ti\u1ebfp sau 48-72h n\u1ebfu \u0111\u00e1p \u1ee9ng gi\u1ea3m li\u1ec1u c\u00f2n 2mg\/kg\/ng\u00e0y (t\u1ed1i \u0111a 60mg) chia l\u00e0m 2 l\u1ea7n x 5 ng\u00e0y sau \u0111\u00f3 gi\u1ea3m li\u1ec1u d\u1ea7n trong 4-6 tu\u1ea7n.<\/p>\n

                  + Theo d\u00f5i n\u1ebfu sau 48 – 72 gi\u1edd truy\u1ec1n IVIG v\u00e0 methylprednisolon n\u1ebfu l\u00e2m s\u00e0ng kh\u00f4ng c\u1ea3i thi\u1ec7n \u2192 h\u1ed9i ch\u1ea9n chuy\u00ean khoa \u0111\u1ec3 d\u00f9ng:<\/p>\n

                    \n
                  • IVIG li\u1ec1u 2<\/strong><\/li>\n
                  • Ho\u1eb7c d\u00f9ng thu\u1ed1c sinh h\u1ecdc:<\/strong><\/li>\n<\/ul>\n

                    * Anakina li\u1ec1u kh\u1edfi \u0111\u1ea7u 4-6 mg\/kg\/ng\u00e0y chia 2 l\u1ea7n m\u1ed7i 12 gi\u1edd, ti\u00eam d\u01b0\u1edbi da n\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng t\u0103ng th\u00eam 2 mg\/kg\/ng\u00e0y (t\u1ed1i \u0111a 400 mg\/ng\u00e0y) ho\u1eb7c<\/p>\n

                    * Tocilizumab:<\/p>\n

                      \n
                    • C\u00e2n n\u1eb7ng < 30kg: 12mg\/kg pha v\u1edbi 50 -100ml natriclorua 0,9% ti\u00eam t\u0129nh m\u1ea1ch trong 60 ph\u00fat.<\/li>\n
                    • C\u00e2n n\u1eb7ng \u2265 30 kg: 8mg\/kg ti\u00eam t\u0129nh m\u1ea1ch trong 60 ph\u00fat (t\u1ed1i \u0111a 800mg).<\/li>\n<\/ul>\n

                      + Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng heparin TLPT th\u1ea5p li\u1ec1u d\u1ef1 ph\u00f2ng n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft kh\u1ed1i ho\u1eb7c gi\u00e3n \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u1edbn: \u0111\u01b0\u1eddng k\u00ednh \u0110M v\u00e0nh \u2265 8 mm ho\u1eb7c Zscore \u2265 10 ho\u1eb7c LVEF < 35% (Xem M\u1ee5c 6.8. \u0110i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng<\/u><\/em>)<\/p>\n

                      + Aspirin li\u1ec1u 3-5 mg\/kg\/ng\u00e0y, ng\u1eebng n\u1ebfu ti\u1ec3u c\u1ea7u < 80 G\/L.<\/p>\n

                      + Kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng theo kinh nghi\u1ec7m nh\u01b0 s\u1ed1c nhi\u1ec5m tr\u00f9ng, xem x\u00e9t xu\u1ed1ng thang n\u1ebfu l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m c\u1ea3i thi\u1ec7n r\u00f5 ho\u1eb7c c\u1eaft kh\u00e1ng sinh n\u1ebfu lo\u1ea1i tr\u1eeb nguy\u00ean nh\u00e2n nhi\u1ec5m khu\u1ea9n.<\/p>\n

                      3.2 H\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng gi\u1ed1ng b\u1ec7nh Kawasaki<\/strong><\/h3>\n

                      + Immunoglobulin (IVIG) li\u1ec1u 1- 2 g\/kg, truy\u1ec1n t\u0129nh m\u1ea1ch 1 l\u1ea7n ho\u1eb7c chia 2 l\u1ea7n theo t\u1ed1c \u0111\u1ed9 m\u1ee5c 4.1) V\u00c0 <\/strong>ph\u1ed1i h\u1ee3p v\u1edbi<\/p>\n

                      + Prednisolon 2 mg\/kg\/ng\u00e0y ho\u1eb7c methylprednisolon 2mg\/kg\/ng (t\u1ed1i \u0111a 60 mg) theo d\u00f5i sau 24-48h n\u1ebfu d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng c\u1eadn l\u00e2m s\u00e0ng kh\u00f4ng c\u1ea3i thi\u1ec7n ho\u1eb7c n\u1ebfu tr\u1ebb c\u00f3 gi\u00e3n m\u1ea1ch v\u00e0nh ho\u1eb7c gi\u1ea3 ph\u00ecnh m\u1ea1ch v\u00e0nh.<\/p>\n

                      + Aspirin li\u1ec1u 3-5 mg\/kg\/ng\u00e0y (t\u1ed1i \u0111a 100 mg) u\u1ed1ng.<\/p>\n

                      + Theo d\u00f5i sau 48 – 72 gi\u1edd truy\u1ec1n IVIG n\u1ebfu l\u00e2m s\u00e0ng kh\u00f4ng c\u1ea3i thi\u1ec7n: tr\u1ebb kh\u00f4ng h\u1ebft s\u1ed1t, c\u00e1c ch\u1ec9 vi\u00eam kh\u00f4ng thay \u0111\u1ed5i nhi\u1ec1u ho\u1eb7c n\u1eb7ng h\u01a1n th\u00ec:<\/p>\n

                        \n
                      • D\u00f9ng l\u1ea1i IVIG li\u1ec1u 2<\/li>\n
                      • Ho\u1eb7c h\u1ed9i ch\u1ea9n chuy\u00ean khoa d\u00f9ng thu\u1ed1c sinh h\u1ecdc (nh\u01b0 th\u1ec3 c\u00f3 s\u1ed1c)<\/li>\n<\/ul>\n

                        + Kh\u00e1ng sinh: kh\u00f4ng s\u1eed d\u1ee5ng tr\u1eeb khi c\u00f3 k\u00e8m b\u1eb1ng ch\u1ee9ng c\u1ee7a nhi\u1ec5m khu\u1ea9n<\/p>\n

                        \"minh-hoa-viem-da-he-thong\"
                        Kawasaki-like Inflammatory Disease Affects Children With COVID-19<\/figcaption><\/figure>\n

                        3.3 H\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng \u0111\u01a1n thu\u1ea7n<\/strong><\/h3>\n
                          \n
                        • \n
                            \n
                          • Methylprednisolon 2 mg\/kg\/ng\u00e0y (ti\u00eam TM).<\/li>\n
                          • Theo d\u00f5i sau 48 – 72 gi\u1edd n\u1ebfu l\u00e2m s\u00e0ng kh\u00f4ng c\u1ea3i thi\u1ec7n: tr\u1ebb kh\u00f4ng h\u1ebft s\u1ed1t, c\u00e1c ch\u1ec9 s\u1ed1 vi\u00eam kh\u00f4ng thay \u0111\u1ed5i nhi\u1ec1u ho\u1eb7c n\u1eb7ng h\u01a1n, \u0111i\u1ec1u tr\u1ecb nh\u01b0 th\u1ec3 gi\u1ed1ng Kawasaki.<\/li>\n
                          • Ch\u1ed1ng \u0111\u00f4ng: kh\u00f4ng s\u1eed d\u1ee5ng, t\u1eeb khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
                              \n
                            • Kh\u00e1ng sinh: kh\u00f4ng s\u1eed d\u1ee5ng tr\u1eeb khi c\u00f3 k\u00e8m d\u1ea5u hi\u1ec7u c\u1ee7a nhi\u1ec5m khu\u1ea9n.<\/li>\n<\/ul>\n
                                \n
                              • Ch\u00fa \u00fd v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng methylprednisolon<\/strong><\/li>\n<\/ul>\n

                                * Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 \u0111i\u1ec1u ki\u1ec7n s\u1eed d\u1ee5ng IVIG: <\/strong>th\u00ec c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng methylprednisolon li\u1ec1u cao t\u1eeb \u0111\u1ea7u c\u1ee5 th\u1ec3 nh\u01b0 sau:<\/p>\n

                                  \n
                                • Th\u1ec3 c\u00f3 s\u1ed1c ho\u1eb7c th\u1ec3 suy \u0111a c\u01a1 quan: d\u00f9ng li\u1ec1u 10-30mg\/kg\/ng\u00e0y ti\u00eam TM (t\u1ed1i \u0111a li\u1ec1u 1000mg) c\u00f3 th\u1ec3 d\u00f9ng 1 l\u1ea7n ho\u1eb7c chia 2 l\u1ea7n x 3 ng\u00e0y sau \u0111\u00f3 gi\u1ea3m li\u1ec1u d\u1ea7n.<\/li>\n
                                • \u1ede th\u1ec3 c\u00f3 s\u1ed1c ho\u1eb7c k\u00e8m suy \u0111a c\u01a1 quan, th\u1ec3 gi\u1ed1ng Kawasaki th\u1ec3 vi\u00eam \u0111a h\u1ec7 th\u1ed1ng \u0111\u01a1n thu\u1ea7n n\u1ebfu c\u00f3 ph\u1ea3n \u1ee9ng vi\u00eam m\u1ea1nh v\u1edbi 2 trong c\u00e1c d\u1ea5u hi\u1ec7u sau: m\u00e1u l\u1eafng > 50, CRP > 100mg\/L, PCT > 10 mcg\/L, LDH > 1000 \u0111v\/L, Ferritin > 600mcg\/L, d-dimer > 1500mcg\/L, Fibrinogen > 4,5g\/L, Triglycerid > 260mg\/dl ho\u1eb7c > 3mmol\/L). Li\u1ec1u d\u00f9ng: 10mg\/kg\/ng\u00e0y x 3- 5 ng\u00e0y, sau \u0111\u00f3 gi\u1ea3m li\u1ec1u d\u1ea7n.<\/li>\n<\/ul>\n
                                    \n
                                  • C\u00e1ch gi\u1ea3m li\u1ec1u<\/strong>: khi t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ea3i thi\u1ec7n, x\u00e9t nghi\u1ec7m ph\u1ea3n \u1ee9ng vi\u00eam gi\u1ea3m, gi\u1ea3m d\u1ea7n li\u1ec1u corticoid m\u1ed7i 5-7 ng\u00e0y (2 mg\/kg\/ng\u00e0y trong 5-7 ng\u00e0y \u0111\u1ea7u, 1 mg\/kg\/ng\u00e0y trong 5-7 ng\u00e0y ti\u1ebfp theo, 0,5 mg\/kg\/ng\u00e0y trong 5-7 ng\u00e0y cu\u1ed1i r\u1ed3i ng\u1eebng thu\u1ed1c, kho\u1ea3ng 2-3 tu\u1ea7n). N\u1ebfu d\u00f9ng li\u1ec1u cao 10-30mg\/kg\/ng\u00e0y x 3-5 ng\u00e0y, gi\u1ea3m xu\u1ed1ng li\u1ec1u 1-2mg\/kg\/ng\u00e0y theo c\u00e1ch tr\u00ean.<\/li>\n
                                  • Th\u1eddi gian s\u1eed d\u1ee5ng corticoid<\/strong>: kho\u1ea3ng 3-4 tu\u1ea7n.<\/li>\n<\/ul>\n

                                    4. Theo d\u00f5i, ra vi\u1ec7n v\u00e0 t\u00e1i kh\u00e1m<\/strong><\/h2>\n
                                      \n
                                    • L\u00e2m s\u00e0ng: M, HA, CRT, SpO2, n\u01b0\u1edbc ti\u1ec3u, tinh th\u1ea7n d\u1ea5u hi\u1ec7u qu\u00e1 t\u1ea3i d\u1ecbch, CVP, d\u1ecbch xu\u1ea5t nh\u1eadp h\u00e0ng gi\u1edd trong 6 gi\u1edd \u0111\u1ea7u, khi \u1ed5n \u0111\u1ecbnh 3-4 gi\u1edd\/l\u1ea7n, 6-8 gi\u1edd\/l\u1ea7n<\/li>\n
                                    • X\u00e9t nghi\u1ec7m: CTM, Albumine m\u00e1u, Lactate m\u00e1u, kh\u00ed m\u00e1u, \u0111\u01b0\u1eddng huy\u1ebft, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, ch\u1ee9c n\u0103ng gan th\u1eadn, ch\u1ee9c n\u0103ng \u0111\u00f4ng m\u00e1u, ch\u1ec9 s\u1ed1 vi\u00eam (m\u00e1u l\u1eafng, CRP, procalcitonine, Ferritin…) m\u1ed7i 1-3 ng\u00e0y t\u00f9y m\u1ee9c \u0111\u1ed9. Si\u00eau \u00e2m tim \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng tim, m\u1ea1ch v\u00e0nh.<\/li>\n
                                    • Ra vi\u1ec7n khi l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m \u1ed5n \u0111\u1ecbnh.<\/li>\n
                                    • T\u00e1i kh\u00e1m l\u1ea1i t\u1ea1i chuy\u00ean khoa tim m\u1ea1ch m\u1ed7i 2 tu\u1ea7n, \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb tr\u00ean l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng (x\u00e9t nghi\u1ec7m m\u00e1u, si\u00eau \u00e2m tim) trong 1 th\u00e1ng \u0111\u1ea7u, sau \u0111\u00f3 m\u1ed7i th\u00e1ng trong 6-12 th\u00e1ng.<\/li>\n<\/ul>\n

                                      Ngu\u1ed3n: Quy\u00ea\u0301t \u0111i\u0323nh s\u00f4\u0301 405\/Q\u0110-BYT nga\u0300y 22 tha\u0301ng 02 n\u0103m 2022<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

                                      H\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng li\u00ean quan COVID-19 \u1edf tr\u1ebb em (Multisystem inflammatory syndrome in children – MIS-C) ho\u1eb7c \u1edf tr\u1ebb s\u01a1 sinh (MIS-N), b\u1ec7nh x\u1ea3y ra ch\u1ee7 y\u1ebfu 2-6 tu\u1ea7n sau nhi\u1ec5m SARS-CoV-2. Tr\u1ebb s\u01a1 sinh c\u1ea7n ngh\u0129 \u0111\u1ebfn MIS- N khi tr\u1ebb c\u00f3 bi\u1ec3u hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng \u0111a c\u01a1 quan v\u00e0 m\u1eb9 […]<\/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 h\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng li\u00ean quan COVID-19 \u1edf tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng li\u00ean quan COVID-19 \u1edf tr\u1ebb em (Multisystem inflammatory syndrome in children - MIS-C) ho\u1eb7c \u1edf tr\u1ebb s\u01a1 sinh (MIS-N).\" \/>\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 h\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng li\u00ean quan COVID-19 \u1edf tr\u1ebb em - 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