{"id":24537,"date":"2023-04-23T10:43:30","date_gmt":"2023-04-23T03:43:30","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24537"},"modified":"2023-04-23T10:43:30","modified_gmt":"2023-04-23T03:43:30","slug":"chan-doan-va-dieu-tri-ap-xe-gan-do-vi-khuan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/chan-doan-va-dieu-tri-ap-xe-gan-do-vi-khuan\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u00e1p xe gan do vi khu\u1ea9n"},"content":{"rendered":"\r\n<p><strong>\u00c1p <\/strong><strong>xe gan l\u00e0 khi t\u1ed5 ch\u1ee9c t\u1ebf b\u00e0o gan b\u1ecb ph\u00e1 hu\u1ef7 t\u1ea1o th\u00e0nh \u1ed5 m\u1ee7 trong nhu m\u00f4 gan. Vi khu\u1ea9n \u0111\u01b0\u1ee3c cho l\u00e0 g\u00e2y ra nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p \u00e1p xe gan do vi khu\u1ea9n l\u00e0 Escherichia coli v\u00e0 Klebsiella pneumoniae.Nam th\u01b0\u1eddng g\u1eb7p nhi\u1ec1u h\u01a1n n\u1eef. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u00e1p xe gan do vi khu\u1ea9n l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 ng\u0103n ng\u1eeba nh\u1eefng bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng.<\/strong> <br \/><br \/><\/p>\r\n<h2><strong>1. \u0110\u1ea1i c\u01b0\u01a1ng v\u1ec1 \u00e1p xe gan do vi khu\u1ea9n<\/strong><\/h2>\r\n<p>Vi khu\u1ea9n th\u01b0\u1eddng g\u1eb7p trong \u00e1p xe gan l\u00e0: Escherichia coli, Enterobacteriaceae, \u00a0Klebsiella pneumonia,\u2026 \u00a0<\/p>\r\n<h3><span style=\"font-weight: 400;\"><strong>1.1.\u0110\u01b0\u1eddng v\u00e0o c\u1ee7a vi khu\u1ea9n<\/strong><\/span><\/h3>\r\n<ul>\r\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110\u01b0\u1eddng m\u1eadt: c\u00e1c b\u1ec7nh l\u00ed g\u00e2y t\u1eafc m\u1eadt, ch\u00edt h\u1eb9p \u0111\u01b0\u1eddng m\u1eadt,s\u1ecfi m\u1eadt, giun chui \u1ed1ng m\u1eadt<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110\u01b0\u1eddng t\u0129nh m\u1ea1ch c\u1eeda: nhi\u1ec5m khu\u1ea9n \u1ed5 b\u1ee5ng<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110\u01b0\u1eddng B\u1ea1ch huy\u1ebft v\u00e0 \u0111\u1ed9ng m\u1ea1ch gan: Nhi\u1ec5m khu\u1ea9n g\u00e2y nhi\u1ec5m khu\u1ea9n huy\u1ebft-&gt; theo \u0111\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch v\u00e0 b\u1ea1ch huy\u1ebft \u0111\u1ebfn gan<\/span><\/li>\r\n<\/ul>\r\n<h3>1.2. Y\u1ebfu t\u1ed1 nguy c\u01a1<\/h3>\r\n<ul>\r\n<li>\u00a0\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng, suy gi\u1ea3m mi\u1ec5n d\u1ecbch, x\u01a1 gan<\/li>\r\n<li>S\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m Proton<\/li>\r\n<li>B\u1ec7nh l\u00fd \u00e1c t\u00ednh hay l\u00e0nh t\u00ednh c\u1ee7a \u0111\u01b0\u1eddng m\u1eadt<\/li>\r\n<li>Vi\u00eam t\u00fai th\u1eeba \u0111\u1ea1i tr\u00e0ng<\/li>\r\n<li>Crohn \u0111\u1ea1i tr\u00e0ng<\/li>\r\n<li>K gan ho\u1eb7c K t\u1ee5y c\u00f3 x\u00e2m l\u1ea5n \u0111\u01b0\u1eddng m\u1eadt \u0111\u01b0\u1ee3c l\u00e0m stent \u0111\u01b0\u1eddng m\u1eadt, m\u1edf c\u01a1 Oddi, huy\u1ebft kh\u1ed1i, sau \u0111i\u1ec1u tr\u1ecb PEI, RFA.<\/li>\r\n<\/ul>\r\n<h3>1.3.Sinh l\u00fd b\u1ec7nh \u00e1p xe gan do vi khu\u1ea9n<\/h3>\r\n<p>VK v\u00e0o nhu m\u00f4 gan \u2014&gt; ti\u1ebft ra n\u1ed9i \u0111\u1ed9c t\u1ed1, b\u1ea1ch c\u1ea7u trung t\u00ednh v\u00e0 ti\u1ec3u c\u1ea7u x\u00e2m nh\u1eadp v\u00e0o m\u00f4 \u2014&gt; ho\u1ea1t h\u00f3a c\u00e1c cytokin g\u00e2y vi\u00eam v\u00e0 ho\u1ea1t h\u00f3a qu\u00e1 tr\u00ecnh oxy h\u00f3a \u2014&gt; t\u1ed5n th\u01b0\u01a1ng m\u00f4<\/p>\r\n<h2>2. L\u00e2m s\u00e0ng<\/h2>\r\n<p>BN th\u01b0\u1eddng c\u00f3 bi\u1ec3u hi\u1ec7n kh\u00f3 ch\u1ecbu, bu\u1ed3n n\u00f4n tr\u01b0\u1edbc \u0111\u00f3 kho\u1ea3ng 2 tu\u1ea7n<br \/><br \/>Tam ch\u1ee9ng Fontan:<\/p>\r\n<ul>\r\n<li>\u00a0S\u1ed1t: s\u1ed1t x\u1ea3y ra v\u00e0i ng\u00e0y tr\u01b0\u1edbc sau \u0111\u00f3 m\u1edbi xu\u1ea5t hi\u1ec7n \u0111au h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, gan to, c\u00f3 gai r\u00e9t<\/li>\r\n<li>\u00a0\u0110au h\u1ea1 s\u01b0\u1eddn ph\u1ea3i:m\u1ee9c \u0111\u1ed9 \u0111au \u00e2m \u1ec9 ho\u1eb7c t\u1ee9c n\u1eb7ng, li\u00ean t\u1ee5c ho\u1eb7c t\u1eebng c\u01a1n ( \u0111\u00f4i khi \u0111au qu\u1eb7n d\u1eef d\u1ed9i), \u0111au khu tr\u00fa h\u1ea1 s\u01b0\u1eddn ph\u1ea3i hay v\u00f9ng th\u01b0\u1ee3ng v\u1ecb xuy\u00ean l\u00ean vai, k\u00e9o d\u00e0i nhi\u1ec1u ng\u00e0y \u0111\u00eam<\/li>\r\n<li>\u00a0Gan to: m\u1eadt \u0111\u1ed9 m\u1ec1m, b\u1edd t\u00f9, b\u1ec1 m\u1eb7t nh\u00e1m, \u1ea5n \u0111au. \u1ea4n k\u1ebd s\u01b0\u1eddn (+)<\/li>\r\n<\/ul>\r\n<p>Ch\u00e1n \u0103n<\/p>\r\n<p>V\u00e0ng da: ph\u00e2n bi\u1ec7t v\u1edbi <a href=\"https:\/\/www.vinmec.com\/vi\/benh\/ap-xe-gan-do-amip-4748\/\">\u00e1p xe gan do amip<\/a><\/p>\r\n<p>Ngo\u00e0i ra c\u00f3 th\u1ec3 g\u1eb7p m\u1ed9t s\u1ed1 tri\u1ec7u ch\u1ee9ng kh\u00e1c nh\u01b0ng kh\u00f4ng th\u01b0\u1eddng xuy\u00ean:<\/p>\r\n<ul>\r\n<li>\u00a0Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i: \u1ed5 \u00e1p xe v\u1ee1 v\u00e0o m\u00e0ng ph\u1ed5i g\u00e2y tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i<\/li>\r\n<li>\u00a0R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a: \u1ec9a l\u1ecfng hay ph\u00e2n nh\u1ea7y m\u00e1u m\u0169i gi\u1ed1ng l\u1ef5<\/li>\r\n<li>Ph\u00f9: do dinh d\u01b0\u1ee1ng k\u00e9m v\u00e0 \u1ed5 nung m\u1ee7 s\u00e2u k\u00e9o d\u00e0i d\u1eabn \u0111\u1ebfn h\u1ea1 protein m\u00e1u<\/li>\r\n<li>G\u1ea7y s\u00fat c\u00e2n: do c\u00f3 \u1ed5 m\u1ee7 trong gan v\u00e0 b\u1ec7nh nh\u00e2n m\u1ec7t m\u1ecfi ch\u00e1n \u0103n.<\/li>\r\n<\/ul>\r\n<h2><br \/>3.C\u1eadn l\u00e2m s\u00e0ng<\/h2>\r\n<ul>\r\n<li>B\u1ea1ch c\u1ea7u t\u0103ng, BCTT t\u0103ng<\/li>\r\n<li>M\u00e1u l\u1eafng, CRP t\u0103ng<\/li>\r\n<li>Thi\u1ebfu m\u00e1u<\/li>\r\n<li>T\u0103ng ALP<\/li>\r\n<li>ELISA amip (-)<\/li>\r\n<li>D\u1ea5u hi\u1ec7u kh\u00e1c : Gi\u1ea3m albumin m\u00e1u, t\u0103ng bilirubin, Pt k\u00e9o d\u00e0i<\/li>\r\n<li>Nu\u00f4i c\u1ea5y \u1ed5 m\u1ee7 \u00e1p xe : x\u00e9t nghi\u1ec7m quan tr\u1ecdng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n c\u0103n nguy\u00ean v\u00e0 l\u00e0m kh\u00e1ng sinh \u0111\u1ed3<\/li>\r\n<li>Xquang ph\u1ed5i: c\u01a1 ho\u00e0nh b\u1ecb \u0111\u1ea9y l\u00ean cao, di \u0111\u1ed9ng k\u00e9m, c\u00f3 th\u1ec3 g\u1eb7p tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i.<\/li>\r\n<li>Si\u00eau \u00e2m<br \/>Kh\u1ed1i \u0111\u1ed3ng nh\u1ea5t gi\u1ea3m \u00e2m, ranh gi\u1edbi r\u00f5 ( c\u00f3 v\u1ecf th\u00ec ph\u1ea3i c\u1ea3nh gi\u00e1c c\u00f3 ph\u1ea3i nang gan kh\u00f4ng, c\u00f3 kh\u00ed th\u00ec th\u01b0\u1eddng l\u00e0 \u00e1p xe gan do vi khu\u1ea9n k\u1ecb kh\u00ed).<br \/>M\u1ee7 c\u00e0ng lo\u00e3ng \u1ed5 \u00e1p xe c\u00e0ng gi\u1ea3m \u00e2m\/ tr\u1ed1ng \u00e2m<br \/><br \/><\/li>\r\n<\/ul>\r\n<figure id=\"attachment_27236\" aria-describedby=\"caption-attachment-27236\" style=\"width: 300px\" class=\"wp-caption alignnone\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-27236\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/F998AABC-5353-4104-961B-A24F3D9B5595-300x214.jpeg\" alt=\"\" width=\"300\" height=\"214\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/F998AABC-5353-4104-961B-A24F3D9B5595-300x214.jpeg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/F998AABC-5353-4104-961B-A24F3D9B5595.jpeg 647w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-27236\" class=\"wp-caption-text\">\u00c1p xe gan do vi khu\u1ea9n ( ngu\u1ed3n: Cambrige University Press)<\/figcaption><\/figure>\r\n<ul>\r\n<li>Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh gan m\u1eadt: khi si\u00eau \u00e2m kh\u00f4ng ph\u00e2n bi\u1ec7t r\u00f5 u gan hay \u00e1p xe gan. T\u1ed5n th\u01b0\u01a1ng l\u00e0 t\u1ed5 ch\u1ee9c gi\u1ea3m \u00e2m, kh\u00f4ng ng\u1ea5m thu\u1ed1c c\u1ea3n quang. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh gan gi\u00fap ch\u1ea7n \u0111o\u00e1n chinh x\u00e1c v\u1ecb tr\u00ed \u1ed5 \u00e1p xe, ch\u1ea7n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi u gan, \u0111\u1eb7c bi\u1ec7t l\u00e0 h\u00ecnh \u1ea3nh di c\u0103n gan.<\/li>\r\n<\/ul>\r\n<h2>4. Ch\u1ea9n \u0111o\u00e1n \u00e1p xe gan do vi khu\u1ea9n<\/h2>\r\n<h3>4.1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/h3>\r\n<ul>\r\n<li>Tam ch\u1ee9ng Fontan: s\u1ed1t, \u0111au h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, gan to<\/li>\r\n<li>X\u00e9t nghi\u1ec7m m\u00e1u: b\u1ea1ch c\u1ea7u t\u0103ng, m\u00e1u l\u1eafng t\u0103ng, CRP t\u0103ng<\/li>\r\n<li>Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh:<br \/>&#8211; XQ ph\u1ed5i: c\u01a1 ho\u00e0nh b\u1ecb \u0111\u1ea9y l\u00ean cao, di \u0111\u1ed9ng k\u00e9m, c\u00f3 th\u1ec3 g\u1eb7p tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i<br \/><br \/>&#8211; Si\u00eau \u00e2m: \u1ed5 gi\u1ea3m \u00e2m, ranh gi\u1edbi r\u00f5<\/li>\r\n<\/ul>\r\n<p>&nbsp;<\/p>\r\n<h3><strong>4.2. Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n<\/strong><\/h3>\r\n<p>T\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng l\u00e0 nhi\u1ec1u \u1ed5 nh\u1ecf, ch\u1ecdc h\u00fat m\u1ee7 c\u00f3 m\u00e0u xanh ho\u1eb7c v\u00e0ng,c\u1ea5y c\u00f3 vi khu\u1ea9n m\u1ecdc.<\/p>\r\n<p>&nbsp;<\/p>\r\n<h3><strong>4.3. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/strong><\/h3>\r\n<p>\u00c1p xe gan do s\u00e1n l\u00e1 gan l\u1edbn<br \/>\u00c1p xe gan do n\u1ea5m<\/p>\r\n<p>Ung th\u01b0 gan<br \/>Vi\u00eam t\u00fai m\u1eadt<br \/>Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do b\u1ec7nh ph\u1ed5i<\/p>\r\n<h2><br \/>5. Bi\u1ebfn ch\u1ee9ng c\u1ee7a \u00e1p xe gan do vi khu\u1ea9n<\/h2>\r\n<ul>\r\n<li>V\u1ee1 \u1ed5 \u00e1p xe: v\u00e0o m\u00e0ng ph\u1ed5i, ph\u1ed5i, m\u00e0ng ngo\u00e0i tim ( th\u01b0\u1eddng x\u1ea3y ra \u00e1p xe gan tr\u00e1i), \u1ed5 b\u1ee5ng, c\u01a1 ho\u00e0nh, th\u00e0nh b\u1ee5ng<\/li>\r\n<li>Ch\u1ea3y m\u00e1u: trong \u1ed5 \u00e1p xe, \u1ed5 b\u1ee5ng<\/li>\r\n<li>Bi\u1ebfn ch\u1ee9ng do m\u1ee7 s\u00e2u k\u00e9o d\u00e0i: k\u00e9o d\u00e0i t\u1eeb 2 tu\u1ea7n &#8211; 1 th\u00e1ng<\/li>\r\n<\/ul>\r\n<h2>6. \u0110i\u1ec1u tr\u1ecb \u00e1p xe gan do vi khu\u1ea9n<\/h2>\r\n<h3>6.1. Nguy\u00ean t\u1eafc ch\u1ecdn kh\u00e1ng sinh<\/h3>\r\n<p style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">T\u1ed1t nh\u1ea5t l\u00e0 l\u1ef1a ch\u1ecdn theo kh\u00e1ng sinh \u0111\u1ed3.<\/span><\/p>\r\n<p style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Trong khi ch\u1edd \u0111\u1ee3i n\u00ean d\u00f9ng kh\u00e1ng sinh c\u00f3 ho\u1ea1t ph\u1ed5 r\u1ed9ng, n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh n\u1eb7ng s\u1eed d\u1ee5ng ngay kh\u00e1ng sinh c\u00f3 t\u00e1c d\u1ee5ng m\u1ea1nh v\u00e0 c\u00f3 ho\u1ea1t ph\u1ed5 r\u1ed9ng nh\u01b0 carbapenem.<\/span><\/p>\r\n<p style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Kh\u00e1ng sinh cephalosporin th\u1ebf h\u1ec7 ba v\u00e0 aminoglycosid c\u00f3 t\u00e1c d\u1ee5ng t\u1ed1t v\u1edbi c\u00e1c vi khu\u1ea9n Gram-\u00e2m.<\/span><\/p>\r\n<p style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Kh\u00e1ng sinh metronidazol c\u00f3 t\u00e1c d\u1ee5ng t\u1ed1t v\u1edbi vi khu\u1ea9n k\u1ef5 kh\u00ed.<\/span><\/p>\r\n<p style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Th\u1eddi gian d\u00f9ng kh\u00e1ng sinh t\u1eeb 2 \u2013 4 tu\u1ea7n.<\/span><\/p>\r\n<p style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">\u0110i\u1ec1u tr\u1ecb \u1ed5 vi khu\u1ea9n nguy\u00ean ph\u00e1t n\u1ebfu c\u00f3.<\/span><\/p>\r\n<h3><strong>6.2. Kh\u00e1ng sinh c\u1ee5 th\u1ec3<\/strong><\/h3>\r\n<p>C\u00e1c kh\u00e1ng sinh \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u00e1p xe gan do vi khu\u1ea9n \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n \u1edf B\u1ea3ng<\/p>\r\n<p>\u00a0C\u00e1c l\u1ef1a ch\u1ecdn kh\u00e1ng sinh trong \u00e1p xe gan do vi khu\u1ea9n<\/p>\r\n<table width=\"574\">\r\n<tbody>\r\n<tr>\r\n<td width=\"147\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<td width=\"427\">\r\n<p><strong>L\u1ef1a ch\u1ecdn s\u1ed1 1 <\/strong><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"147\">\r\n<p>Kh\u00e1ng sinh penicillin k\u1ebft h\u1ee3p v\u1edbi ch\u1ea5t \u1ee9c ch\u1ebf beta-lactamase c\u00f3 ho\u1ea1t ph\u1ed5 r\u1ed9ng<\/p>\r\n<\/td>\r\n<td width=\"427\">\r\n<p>Ampicilin-sulbactam \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (TM) 1,5-3 g\/6 gi\u1edd.\u00a0\u00a0<\/p>\r\n<p>Piperacilin-tazobactam TM 4,5 g\/6 gi\u1edd.\u00a0<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"147\">\r\n<p>Aminoglycosid<\/p>\r\n<\/td>\r\n<td width=\"427\">\r\n<p>Gentamycin ti\u00eam b\u1eafp (TB) ho\u1eb7c pha lo\u00e3ng ti\u00eam t\u0129nh m\u1ea1ch 80 mg\/8 gi\u1edd.<\/p>\r\n<p>Amikacin TB ho\u1eb7c TM 5 mg\/kg\/8 gi\u1edd.<\/p>\r\n<p>Tobramycin TB ho\u1eb7c TM 1 mg\/kg\/8 gi\u1edd.<\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<table width=\"574\">\r\n<tbody>\r\n<tr>\r\n<td width=\"147\">\r\n<p>C\u00e1c cephalosporin th\u1ebf h\u1ec7\u00a0 3,4<\/p>\r\n<\/td>\r\n<td width=\"427\">\r\n<p>Cefoperazon-sulbactam TM 2g\/12 gi\u1edd.\u00a0<\/p>\r\n<p>Ceftriaxon TM 2-4 g\/1 l\u1ea7n\/24 gi\u1edd.<\/p>\r\n<p>Ceftazidim TM 1-2 g\/12 gi\u1edd.<\/p>\r\n<p>Cefepim TM 1-2g\/12 gi\u1edd.<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"147\">\r\n<p>Monobactam<\/p>\r\n<\/td>\r\n<td width=\"427\">\r\n<p>Aztreonam 1-2 g\/12 gi\u1edd.\u00a0<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"2\" width=\"574\">\r\n<p>N\u1ebfu c\u00f3 nhi\u1ec5m khu\u1ea9n k\u1ef5 kh\u00ed d\u00f9ng m\u1ed9t trong b\u1ed1n lo\u1ea1i kh\u00e1ng sinh tr\u00ean + metronidazol TM 500 mg\/8 gi\u1edd.<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"2\" width=\"574\">\r\n<p><strong>L\u1ef1a ch\u1ecdn s\u1ed1 2 <\/strong><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"147\">\r\n<p>Fluoroquinolon<\/p>\r\n<\/td>\r\n<td width=\"427\">\r\n<p>Ciprofloxacin 500mg u\u1ed1ng ho\u1eb7c TM\/12 gi\u1edd. Levofloxacin 500mg u\u1ed1ng ho\u1eb7c TM\/24 gi\u1edd.<\/p>\r\n<p>Moxifloxacin u\u1ed1ng ho\u1eb7c TM 400 mg\/24 gi\u1edd.<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"2\" width=\"574\">\r\n<p>N\u1ebfu c\u00f3 nhi\u1ec5m khu\u1ea9n k\u1ef5 kh\u00ed d\u00f9ng m\u1ed9t trong ba lo\u1ea1i fluoroquinolon tr\u00ean + metronidazol TM 500 mg\/8 gi\u1edd.<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"147\">\r\n<p>Carbapenem<\/p>\r\n<\/td>\r\n<td width=\"427\">\r\n<p>Meropenem\u00a0 TM 1g\/8 gi\u1edd.<\/p>\r\n<p>Imipenem-cilastatin TM 1-2 g\/12 gi\u1edd.<\/p>\r\n<p>Doripenem TM 0,5 g\/8 gi\u1edd.<\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h3 style=\"font-weight: 400;\"><strong>6.3.Ch\u1ecdc h\u00fat m\u1ee7 \u00e1p xe qua da\u00a0<\/strong><\/h3>\r\n<p style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">\u1ed4 \u00e1p xe 3-5 cm: \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh k\u1ebft h\u1ee3p ch\u1ecdc h\u00fat m\u1ee7 \u1ed5 \u00e1p xe<\/span><\/p>\r\n<p style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">D\u1eabn l\u01b0u khi \u1ed5 \u00e1p xe k\u00edch th\u01b0\u1edbc l\u1edbn, nhi\u1ec1u v\u00e1ch, ch\u01b0a h\u00f3a m\u1ee7 ho\u00e0n to\u00e0n<\/span><\/p>\r\n<p style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ch\u1ecdc h\u00fat m\u1ee7 \u00e1p xe qua da khi c\u00f3 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u m\u1ee9c \u0111\u1ed9 n\u1eb7ng, kh\u00f4ng c\u00f3 \u0111\u01b0\u1eddng ti\u1ebfp c\u1eadn \u1ed5 \u00e1p xe an to\u00e0n v\u00e0 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng h\u1ee3p t\u00e1c.<\/span><\/p>\r\n<p>&nbsp;<\/p>\r\n<h3 style=\"font-weight: 400;\"><strong>6.4.\u0110i\u1ec1u tr\u1ecb ngo\u1ea1i khoa<\/strong><\/h3>\r\n<p style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt khi:<\/span><\/p>\r\n<ul>\r\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">\u1ed4 \u00e1p xe l\u1edbn h\u01a1n 5 cm<\/span><\/li>\r\n<li style=\"font-weight: 400;\">\u1ed4 \u00e1p xe kh\u00f4ng th\u1ec3 ch\u1ecdc h\u00fat qua da<\/li>\r\n<li style=\"font-weight: 400;\">Th\u1ea5t b\u1ea1i trong \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh<\/li>\r\n<li style=\"font-weight: 400;\">Th\u1ea5t b\u1ea1i c\u1ee7a d\u1eabn l\u01b0u qua da<\/li>\r\n<li style=\"font-weight: 400;\">\u1ed4 \u00e1p xe gan v\u1ee1 g\u00e2y vi\u00eam ph\u00fac m\u1ea1c<\/li>\r\n<\/ul>\r\n<p>Tham kh\u1ea3o: H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb \u00e1p xe gan B\u1ed9 y t\u1ebf<\/p>\r\n<p><a href=\"https:\/\/aasldpubs.onlinelibrary.wiley.com\/doi\/10.1002\/cld.1128\">https:\/\/aasldpubs.onlinelibrary.wiley.com\/doi\/10.1002\/cld.1128<\/a><\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>\u00c1p xe gan l\u00e0 khi t\u1ed5 ch\u1ee9c t\u1ebf b\u00e0o gan b\u1ecb ph\u00e1 hu\u1ef7 t\u1ea1o th\u00e0nh \u1ed5 m\u1ee7 trong nhu m\u00f4 gan. Vi khu\u1ea9n \u0111\u01b0\u1ee3c cho l\u00e0 g\u00e2y ra nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p \u00e1p xe gan do vi khu\u1ea9n l\u00e0 Escherichia coli v\u00e0 Klebsiella pneumoniae.Nam th\u01b0\u1eddng g\u1eb7p nhi\u1ec1u h\u01a1n n\u1eef. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u00e1p [&hellip;]<\/p>\n","protected":false},"author":38,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u00e1p xe gan do vi khu\u1ea9n - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi khu\u1ea9n \u0111\u01b0\u1ee3c cho l\u00e0 g\u00e2y ra nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p \u00e1p xe gan do vi khu\u1ea9n l\u00e0 Escherichia coli v\u00e0 Klebsiella pneumoniae\" \/>\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 \u00e1p xe gan do vi khu\u1ea9n - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Vi khu\u1ea9n \u0111\u01b0\u1ee3c cho l\u00e0 g\u00e2y ra nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p \u00e1p xe gan do vi khu\u1ea9n l\u00e0 Escherichia coli v\u00e0 Klebsiella pneumoniae\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/chan-doan-va-dieu-tri-ap-xe-gan-do-vi-khuan\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-23T03:43:30+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/F998AABC-5353-4104-961B-A24F3D9B5595-300x214.jpeg\" \/>\n<meta name=\"author\" content=\"Thuy Le\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Thuy Le\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/chan-doan-va-dieu-tri-ap-xe-gan-do-vi-khuan\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/chan-doan-va-dieu-tri-ap-xe-gan-do-vi-khuan\/\",\"name\":\"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u00e1p xe gan do vi khu\u1ea9n - 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