{"id":24733,"date":"2023-04-19T13:47:59","date_gmt":"2023-04-19T06:47:59","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24733"},"modified":"2023-04-19T14:26:46","modified_gmt":"2023-04-19T07:26:46","slug":"chan-doan-va-dieu-tri-viem-phoi-so-sinh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/chan-doan-va-dieu-tri-viem-phoi-so-sinh\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i s\u01a1 sinh"},"content":{"rendered":"

Vi\u00eam ph\u1ed5i s\u01a1 sinh (VPSS) l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam ho\u1eb7c nhi\u1ec5m tr\u00f9ng \u1edf nhu m\u00f4 ph\u1ed5i, th\u01b0\u1eddng g\u1eb7p \u1edf giai \u0111o\u1ea1n s\u01a1 sinh, c\u00f3 th\u1ec3 x\u1ea3y ra tr\u01b0\u1edbc, trong ho\u1eb7c sau khi sanh. Vi\u00eam ph\u1ed5i s\u01a1 sinh \u0111\u01b0\u1ee3c chia hai lo\u1ea1i: vi\u00eam ph\u1ed5i kh\u1edfi ph\u00e1t s\u1edbm (\u2264 3 ng\u00e0y sau sinh) v\u00e0 vi\u00eam ph\u1ed5i kh\u1edfi ph\u00e1t tr\u1ec5 (> 3 ng\u00e0y sau sinh).<\/strong><\/p>\n

1. Nguy\u00ean nh\u00e2n vi\u00eam ph\u1ed5i s\u01a1 sinh<\/strong><\/h2>\n
    \n
  • Vi\u00eam ph\u1ed5i kh\u1edfi ph\u00e1t s\u1edbm\u00a0<\/strong><\/li>\n<\/ul>\n

    Vi\u00eam ph\u1ed5i kh\u1edfi ph\u00e1t s\u1edbm <\/strong>g\u1ed3m vi\u00eam ph\u1ed5i b\u1ea9m sinh x\u1ea3y ra do c\u00e1c t\u00e1c nh\u00e2n truy\u1ec1n qua nhau thai trong qu\u00e1 tr\u00ecnh mang thai g\u1ed3m L. monocytogenes, lao, giang mai, CMV, HSV, Rubella, Adenovirus, Influenza A virus v\u00e0 vi\u00eam ph\u1ed5i x\u1ea3y ra trong l\u00fac sanh do nhi\u1ec5m tr\u00f9ng \u0111i l\u00ean t\u1eeb \u0111\u01b0\u1eddng sinh d\u1ee5c m\u1eb9 khi c\u00f3 v\u1ee1 \u1ed1i s\u1edbm, tr\u1ebb h\u00edt \u1ed1i hay m\u1eb9 b\u1ecb nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng sinh d\u1ee5c g\u1ed3m S.agalactae, E.coli, L.monocytogenes, S.pneumonia, H.influenza, Klebsiella, CMV, HSV.<\/p>\n

      \n
    • Vi\u00eam ph\u1ed5i kh\u1edfi ph\u00e1t tr\u1ec5<\/strong><\/li>\n
    • \n
        \n
      • Vi\u00eam ph\u1ed5i kh\u1edfi ph\u00e1t tr\u1ec5\u00a0 x\u1ea3y ra sau sanh do l\u00e2y nhi\u1ec5m t\u1eeb m\u00f4i tr\u01b0\u1eddng xung<\/li>\n
      • C\u00e1c t\u00e1c nh\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0 Staphylococci coagulase (-), S.aureus, tr\u1ef1c khu\u1ea9n gram (-) nh \u01b0 Klebsiella, coli, Pseudomonas, Acinetobacter. C\u00e1c virus c\u0169ng c\u00f3 th\u1ec3 g\u00e2y VP tr\u1ec5 nh\u01b0 RSV, Influenza virus, Parainfluenza virus, Adenovirus.<\/li>\n
      • N\u1ea5m c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra n\u1ebfu tr\u1ebb c\u00f3 s\u1eed d\u1ee5ng kh\u00e1ng sinh k\u00e9o d\u00e0i.<\/li>\n<\/ul>\n<\/li>\n
      • C\u00e1c t\u00e1c nh\u00e2n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh<\/strong><\/li>\n<\/ul>\n

        Chlamydia trachomatis c\u0169ng l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p VPKPT \u1edf c\u00e1c n\u01b0\u1edbc c\u00f3 t\u1ec9 l\u1ec7 cao nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng sinh d\u1ee5c m\u00e0 kh\u00f4ng \u0111i\u1ec1u tr\u1ecb.<\/p>\n

        \"minh-hoa-viem-phoi-so-sinh\"<\/p>\n

        2. Ch\u1ea9n \u0111o\u00e1n<\/strong><\/h2>\n
          \n
        • H\u1ecfi b\u1ec7nh:<\/strong><\/li>\n<\/ul>\n

          Y\u1ebfu t\u1ed1 nguy c\u01a1 t\u1eeb m\u1eb9:<\/p>\n

            \n
          • S\u1ed1t l\u00fac sanh<\/li>\n
          • Vi\u00eam nhi\u1ec5m \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u, sinh d\u1ee5c<\/li>\n
          • \u1ed0i v\u1ee1 k\u00e9o d\u00e0i > 18 gi\u1edd, n\u01b0\u1edbc \u1ed1i t\u1ea9m ph\u00e2n su<\/li>\n
          • N\u1eb1m vi\u1ec7n d\u00e0i ng\u00e0y<\/li>\n
          • B\u1ec7nh l\u00fd nhi\u1ec5m tr\u00f9ng trong th\u1eddi gian mang thai Y\u1ebfu t\u1ed1 nguy c\u01a1 t\u1eeb con:<\/li>\n
          • Tu\u1ed5i thai: non th\u00e1ng<\/li>\n
          • B\u1ec7nh t\u1eadt \u0111i k\u00e8m: tim b\u1ea9m sinh, suy gi\u1ea3m mi\u1ec5n d\u1ecbch,\u2026<\/li>\n
          • Sanh ng\u1ea1t, sanh m\u1ed5.<\/li>\n<\/ul>\n

            Y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn m\u00f4i tr\u01b0\u1eddng:<\/p>\n

              \n
            • \u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n, th\u1edf m\u00e1y<\/li>\n
            • Th\u1eddi gian n\u1eb1m vi\u1ec7n l\u00e2u<\/li>\n
            • Ph\u00f2ng b\u1ec7nh \u0111\u00f4ng \u0111\u00fac\n
                \n
              • Kh\u00e1m l\u00e2m s\u00e0ng<\/strong><\/li>\n<\/ul>\n<\/li>\n
              • D\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng: b\u00fa k\u00e9m, b\u1ecf b\u00fa, n\u00f4n \u00f3i, ch\u01b0\u1edbng b\u1ee5ng, s\u1ed1t ho\u1eb7c h\u1ea1 th\u00e2n nhi\u1ec7t, gi\u1ea3m ph\u1ea3n x\u1ea1, l\u1eeb \u0111\u1eeb, s\u1ed1c,…<\/li>\n
              • D\u1ea5u hi\u1ec7u h\u00f4 h\u1ea5p: ho, kh\u00f2 kh\u00e8, ran ph\u1ed5i, kh\u00f3 th\u1edf, nh\u1ecbp th\u1edf \u1edf co l\u00f5m ng\u1ef1c, th\u1edf r\u00ean, c\u01a1n ng\u01b0ng th\u1edf > 20 gi\u00e2y, t\u00edm t\u00e1i.\n
                  \n
                • C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                  –\u00a0 X\u00e9t nghi\u1ec7m t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng:<\/p>\n

                  + CTM: s\u1ed1 l\u01b0\u1ee3ng BC t\u0103ng, thi\u1ebfu m\u00e1u, gi\u1ea3m TC<\/p>\n

                  + CRP, VS c\u00f3 th\u1ec3 t\u0103ng.<\/p>\n

                  + Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch khi c\u00f3 suy h\u00f4 h\u1ea5p.<\/p>\n

                    \n
                  • X-quang ph\u1ed5i: h\u00ecnh \u1ea3nh c\u1ee7a VPSS \u0111a d\u1ea1ng g\u1ed3m: th\u00e2m nhi\u1ec5m nhu m\u00f4 ph\u1ed5i, h\u00ecnh \u1ea3nh l\u01b0\u1edbi h\u1ea1t, ph\u1ebf qu\u1ea3n \u0111\u1ed3, m\u1edd to\u00e0n b\u1ed9 th\u00f9y hay ph\u00e2n th\u00f9y.<\/li>\n
                  • X\u00e9t nghi\u1ec7m t\u00ecm nguy\u00ean nh\u00e2n:<\/li>\n<\/ul>\n

                    + Soi c\u1ea5y \u0111\u00e0m, d\u1ecbch d\u1ea1 d\u00e0y<\/p>\n

                    + C\u1ea5y m\u00e1u<\/p>\n

                    + Huy\u1ebft thanh ch\u1ea9n \u0111o\u00e1n: giang mai, Herpes, CMV, Rubella,<\/p>\n

                    *Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/p>\n

                    Ch\u1ea9n \u0111o\u00e1n VPSS khi tr\u1ebb c\u00f3 tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p v\u00e0\/ho\u1eb7c tri\u1ec7u ch\u1ee9ng nhi\u1ec5m tr\u00f9ng v\u00e0 X-quang ph\u1ed5i c\u00f3 t\u1ed5n th\u01b0\u01a1ng.<\/p>\n

                    3. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/strong><\/p>\n

                    + B\u1ec7nh m\u00e0ng trong<\/p>\n

                    + C\u01a1n kh\u00f3 th\u1edf nhanh tho\u00e1ng qua<\/p>\n

                    + T\u1eafc m\u0169i sau<\/p>\n

                    + Tr\u00e0n kh\u00ed ho\u1eb7c tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i<\/p>\n

                    + Tim b\u1ea9m sinh<\/p>\n

                    + Tho\u00e1t v\u1ecb ho\u00e0nh<\/p>\n

                    + Teo th\u1ef1c qu\u1ea3n c\u00f3 r\u00f2 kh\u00ed th\u1ef1c qu\u1ea3n.<\/p>\n

                    4. \u0110i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i s\u01a1 sinh<\/strong><\/p>\n

                    4.1 Nguy\u00ean t\u1eafc<\/strong><\/p>\n

                      \n
                    • H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p<\/li>\n
                    • Kh\u00e1ng sinh<\/li>\n
                    • \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 v\u00e0 bi\u1ebfn ch\u1ee9ng<\/li>\n<\/ul>\n

                      4.2 \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u<\/strong><\/p>\n

                        \n
                      • \n
                          \n
                        • \n
                            \n
                          • H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p<\/strong><\/li>\n<\/ul>\n<\/li>\n
                          • Th\u00f4ng \u0111\u01b0\u1eddng th\u1edf<\/li>\n
                          • H\u00fat \u0111\u00e0m mi\u1ec7ng, m\u0169i<\/li>\n
                          • Ng\u1eeda \u0111\u1ea7u\/n\u00e2ng c\u1eb1m, \u1ea5n h\u00e0m, nghi\u1ec7m ph\u00e1p sellick<\/li>\n
                          • D\u1eabn l\u01b0u d\u1ea1 d\u00e0y.<\/li>\n
                          • Suy h\u00f4 h\u1ea5p nh\u1eb9: th\u1edf oxy<\/li>\n
                          • Suy h\u00f4 h\u1ea5p v\u1eeba ho\u1eb7c n\u1eb7ng: th\u1edf NCPAP, kh\u00f4ng c\u1ea3i thi\u1ec7n -> th\u1edf m\u00e1y\n
                              \n
                            • Kh\u00e1ng sinh: Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1eeb 7-14 ng\u00e0y<\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n
                            • Vi\u00eam ph\u1ed5i s\u01a1 sinh l\u00e0 b\u1ec7nh c\u1ea3nh c\u00f3 th\u1ec3 di\u1ec5n ti\u1ebfn n\u1eb7ng nhanh ch\u00f3ng n\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. Do \u0111\u00f3, c\u1ea7n cho kh\u00e1ng sinh ngay khi nghi ng\u1edd \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng tr\u1ebb c\u00f3 suy h\u00f4 h\u1ea5p cho \u0111\u1ebfn khi c\u00f3 b\u1eb1ng ch\u1ee9ng ng\u01b0\u1ee3c l\u1ea1i.<\/li>\n
                            • Vi\u00eam ph\u1ed5i kh\u1edfi ph\u00e1t s\u1edbm: Ampicillin + Gentamycin<\/li>\n
                            • Vi\u00eam ph\u1ed5i kh\u1edfi ph\u00e1t tr\u1ec5: Ampicillin + cefotaxim ho\u1eb7c ampicillin + cefotaxim + gentamycin n\u1ebfu t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng n\u1eb7ng.<\/li>\n
                            • Khi kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, ho\u1eb7c vi\u00eam ph\u1ed5i b\u1ec7nh vi\u1ec7n, \u0111\u1ed5i kh\u00e1ng sinh theo kh\u00e1ng sinh \u0111\u1ed3 hay theo kinh nghi\u1ec7m \u0111i\u1ec1u tr\u1ecb t\u00f9y vi tr\u00f9ng g\u00e2y nhi\u1ec5m tr\u00f9ng b\u1ec7nh vi\u1ec7n \u1edf m\u1ed7i trung t\u00e2m s\u01a1 sinh. C\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam ph\u1ed5i b\u1ec7nh vi\u1ec7n do Klebsiella pneumonia \u0111a kh\u00e1ng (ti\u1ebft men carbapenemase) ho\u1eb7c Acinetobacter baumannii, c\u1ea7n ph\u1ed1i h\u1ee3p Imipenem ho\u1eb7c Meropenem v\u1edbi kh\u00e1ng sinh Polymyxin B.<\/li>\n<\/ul>\n

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

                                \n
                              • Gi\u1eef th\u00f4ng \u0111\u01b0\u1eddng th\u1edf: h\u00fat \u0111\u00e0m nh\u1edbt, v\u1eadt l\u00fd tr\u1ecb li\u1ec7u h\u00f4 h\u1ea5p.<\/li>\n
                              • Tr\u00e1nh h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, h\u1ea1 th\u00e2n nhi\u1ec7t v\u00e0 h\u1ea1 calci m\u00e1u r\u1ea5t d\u1ec5 x\u1ea3y ra \u1edf tr\u1ebb non th\u00e1ng.<\/li>\n
                              • Cung c\u1ea5p \u0111\u1ea7y \u0111\u1ee7 ch\u1ea5t dinh d\u01b0\u1ee1ng, n\u01b0\u1edbc, \u0111i\u1ec7n gi\u1ea3i: giai \u0111o\u1ea1n c\u1ea5p c\u1ee9u c\u00f3 th\u1ec3 nu\u00f4i \u0103n b\u1eb1ng t\u0129nh m\u1ea1ch ng\u1eafn ng\u00e0y, khi \u1ed5n \u0111\u1ecbnh cho \u0103n s\u1eefa qua sonde d\u1ea1 d\u00e0y.<\/li>\n
                              • \u0110i\u1ec1u ch\u1ec9nh c\u00e2n b\u1eb1ng ki\u1ec1m<\/li>\n
                              • \u0110i\u1ec1u tr\u1ecb tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n \u1edf nh\u1eefng tr\u1ebb nghi vi\u00eam ph\u1ed5i do h\u00edt.<\/li>\n<\/ul>\n

                                4.4 \u0110i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng<\/strong><\/p>\n

                                  \n
                                • Tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i nhi\u1ec1u: ch\u1ecdc d\u00f2 m\u00e0ng ph\u1ed5i gi\u1ea3i \u00e1p ho\u1eb7c d\u1eabn l\u01b0u.<\/li>\n
                                • X\u1eb9p ph\u1ed5i: v\u1eadt l\u00fd tr\u1ecb li\u1ec7u h\u00f4 h\u1ea5p, th\u1edf<\/li>\n<\/ul>\n

                                  T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n

                                    \n
                                  1. Noal H, Hillman MD, Hugh Simon Lam MBBChir, MD (2019), Respiratory Disorders In The Newborn, Kendig and Chernicks disorders of the respiratory tract in children 9th ed, Elsivier.<\/li>\n
                                  2. Michael E Speer, Joseph A Garcia-Prats, Morven S Edwards (2019), Neonatal Pneumonia, Up ToDate.<\/li>\n
                                  3. H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd s\u01a1 sinh, B\u1ec7nh vi\u1ec7n Nhi \u0110\u1ed3ng 2 n\u0103m 2015<\/li>\n
                                  4. Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb Nhi khoa, B\u1ec7nh vi\u1ec7n Nhii \u0110\u1ed3ng 1 n\u0103m 2013<\/li>\n<\/ol>\n

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

                                    Vi\u00eam ph\u1ed5i s\u01a1 sinh (VPSS) l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam ho\u1eb7c nhi\u1ec5m tr\u00f9ng \u1edf nhu m\u00f4 ph\u1ed5i, th\u01b0\u1eddng g\u1eb7p \u1edf giai \u0111o\u1ea1n s\u01a1 sinh, c\u00f3 th\u1ec3 x\u1ea3y ra tr\u01b0\u1edbc, trong ho\u1eb7c sau khi sanh. Vi\u00eam ph\u1ed5i s\u01a1 sinh \u0111\u01b0\u1ee3c chia hai lo\u1ea1i: vi\u00eam ph\u1ed5i kh\u1edfi ph\u00e1t s\u1edbm (\u2264 3 ng\u00e0y sau sinh) v\u00e0 vi\u00eam ph\u1ed5i kh\u1edfi […]<\/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 ph\u1ed5i s\u01a1 sinh - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam ph\u1ed5i s\u01a1 sinh l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam ho\u1eb7c nhi\u1ec5m tr\u00f9ng \u1edf nhu m\u00f4 ph\u1ed5i, g\u1eb7p \u1edf giai \u0111o\u1ea1n s\u01a1 sinh, c\u00f3 th\u1ec3 x\u1ea3y ra tr\u01b0\u1edbc, trong ho\u1eb7c sau khi sanh.\" \/>\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 ph\u1ed5i s\u01a1 sinh - 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