{"id":24826,"date":"2023-04-19T16:54:18","date_gmt":"2023-04-19T09:54:18","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24826"},"modified":"2023-04-20T16:32:45","modified_gmt":"2023-04-20T09:32:45","slug":"tiep-can-chan-doan-lam-sang-sot-xuat-huyet-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/tiep-can-chan-doan-lam-sang-sot-xuat-huyet-bo-y-te\/","title":{"rendered":"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng S\u1ed1t xu\u1ea5t huy\u1ebft \u2013 B\u1ed9 Y t\u1ebf"},"content":{"rendered":"

S\u1ed1t xu\u1ea5t huy\u1ebft Dengue l\u00e0 b\u1ec7nh truy\u1ec1n nhi\u1ec5m g\u00e2y d\u1ecbch do vi r\u00fat Dengue g\u00e2y n\u00ean. Vi r\u00fat Dengue c\u00f3 4 type huy\u1ebft thanh l\u00e0 DEN-1, DEN-2, DEN-3 v\u00e0 DEN-4. Vi r\u00fat truy\u1ec1n t\u1eeb ng\u01b0\u1eddi b\u1ec7nh sang ng\u01b0\u1eddi l\u00e0nh do mu\u1ed7i \u0111\u1ed1t. Mu\u1ed7i Aedes aegypti l\u00e0 c\u00f4n tr\u00f9ng trung gian truy\u1ec1n b\u1ec7nh ch\u1ee7 y\u1ebfu.<\/strong><\/p>\n

\"minh-hoa-sot-xuat-huyet\"<\/p>\n

B\u1ec7nh x\u1ea3y ra quanh n\u0103m, th\u01b0\u1eddng gia t\u0103ng v\u00e0o m\u00f9a m\u01b0a. B\u1ec7nh g\u1eb7p \u1edf c\u1ea3 tr\u1ebb em v\u00e0 ng\u01b0\u1eddi l\u1edbn. \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a s\u1ed1t xu\u1ea5t huy\u1ebft Dengue<\/a> l\u00e0 s\u1ed1t, xu\u1ea5t huy\u1ebft v\u00e0 tho\u00e1t huy\u1ebft t\u01b0\u01a1ng, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1ed1c gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, suy t\u1ea1ng, n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 x\u1eed tr\u00ed k\u1ecbp th\u1eddi d\u1ec5 d\u1eabn \u0111\u1ebfn t\u1eed vong.<\/strong><\/p>\n

1. Di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng s\u1ed1t xu\u1ea5t huy\u1ebft Dengue<\/strong><\/h2>\n

B\u1ec7nh s\u1ed1t xu\u1ea5t huy\u1ebft Dengue c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng \u0111a d\u1ea1ng, di\u1ec5n bi\u1ebfn nhanh ch\u00f3ng t\u1eeb nh\u1eb9 \u0111\u1ebfn n\u1eb7ng. B\u1ec7nh th\u01b0\u1eddng kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t v\u00e0 di\u1ec5n bi\u1ebfn qua ba giai \u0111o\u1ea1n: giai \u0111o\u1ea1n s\u1ed1t, giai \u0111o\u1ea1n nguy hi\u1ec3m v\u00e0 giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c. Ph\u00e1t hi\u1ec7n s\u1edbm b\u1ec7nh v\u00e0 hi\u1ec3u r\u00f5 nh\u1eefng v\u1ea5n \u0111\u1ec1\u00a0l\u00e2m s\u00e0ng trong t\u1eebng giai \u0111o\u1ea1n c\u1ee7a b\u1ec7nh gi\u00fap ch\u1ea9n \u0111o\u00e1n s\u1edbm, \u0111i\u1ec1u tr\u1ecb \u0111\u00fang v\u00e0 k\u1ecbp th\u1eddi, nh\u1eb1m c\u1ee9u s\u1ed1ng ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

1.<\/strong>1. Giai \u0111o\u1ea1n s\u1ed1t<\/strong><\/h3>\n

1.1.1 L\u00e2m s\u00e0ng<\/p>\n

– S\u1ed1t cao \u0111\u1ed9t ng\u1ed9t, li\u00ean t\u1ee5c.<\/p>\n

– Nh\u1ee9c \u0111\u1ea7u, ch\u00e1n \u0103n, bu\u1ed3n n\u00f4n.<\/p>\n

– Da xung huy\u1ebft.<\/p>\n

– \u0110au c\u01a1, \u0111au kh\u1edbp, nh\u1ee9c hai h\u1ed1 m\u1eaft.<\/p>\n

– Nghi\u1ec7m ph\u00e1p d\u00e2y th\u1eaft d\u01b0\u01a1ng t\u00ednh.<\/p>\n

– Th\u01b0\u1eddng c\u00f3 ch\u1ea5m xu\u1ea5t huy\u1ebft \u1edf d\u01b0\u1edbi da, ch\u1ea3y m\u00e1u ch\u00e2n r\u0103ng ho\u1eb7c ch\u1ea3y m\u00e1u m\u0169i.<\/p>\n

1.1.2. C\u1eadn l\u00e2m s\u00e0ng<\/p>\n

– Hematocrit (Hct) b\u00ecnh th\u01b0\u1eddng.<\/p>\n

– S\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u1ea3m d\u1ea7n (nh\u01b0ng c\u00f2n tr\u00ean 100.000\/mm3<\/sup>).<\/p>\n

– S\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u th\u01b0\u1eddng gi\u1ea3m.<\/p>\n

1.<\/strong>2. Giai \u0111o\u1ea1n nguy hi\u1ec3m:<\/strong><\/h3>\n

Th\u01b0\u1eddng v\u00e0o ng\u00e0y th\u1ee9 3-7 c\u1ee7a b\u1ec7nh<\/p>\n

1.2.1. L\u00e2m s\u00e0ng<\/p>\n

    \n
  1. a) Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 c\u00f2n s\u1ed1t ho\u1eb7c \u0111\u00e3 gi\u1ea3m s\u1ed1t.<\/li>\n
  2. b) C\u00f3 th\u1ec3 c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n sau:<\/li>\n<\/ol>\n

    – \u0110au b\u1ee5ng nhi\u1ec1u: \u0111au b\u1ee5ng nhi\u1ec1u v\u00e0 li\u00ean t\u1ee5c ho\u1eb7c t\u0103ng c\u1ea3m gi\u00e1c \u0111au nh\u1ea5t l\u00e0 \u1edf v\u00f9ng gan.<\/p>\n

    – V\u1eadt v\u00e3, l\u1eeb \u0111\u1eeb, li b\u00ec.<\/p>\n

    – Gan to > 2cm d\u01b0\u1edbi b\u1edd s\u01b0\u1eddn, c\u00f3 th\u1ec3\u00a0\u0111au.<\/p>\n

    – N\u00f4n \u00f3i.<\/p>\n

    – Bi\u1ec3u hi\u1ec7n tho\u00e1t huy\u1ebft t\u01b0\u01a1ng do t\u0103ng t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch (th\u01b0\u1eddng k\u00e9o d\u00e0i 24-48 gi\u1edd).<\/p>\n

    + Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, m\u00f4 k\u1ebd (c\u00f3 th\u1ec3 g\u00e2y suy h\u00f4 h\u1ea5p), m\u00e0ng b\u1ee5ng, ph\u00f9 n\u1ec1 mi m\u1eaft.<\/p>\n

    + N\u1ebfu tho\u00e1t huy\u1ebft t\u01b0\u01a1ng nhi\u1ec1u s\u1ebd d\u1eabn \u0111\u1ebfn s\u1ed1c v\u1edbi c\u00e1c bi\u1ec3u hi\u1ec7n v\u1eadt v\u00e3, b\u1ee9t r\u1ee9t ho\u1eb7c li b\u00ec, l\u1ea1nh \u0111\u1ea7u chi, m\u1ea1ch nhanh nh\u1ecf, huy\u1ebft \u00e1p k\u1eb9t (hi\u1ec7u s\u1ed1 huy\u1ebft \u00e1p t\u1ed1i \u0111a v\u00e0 t\u1ed1i thi\u1ec3u \u2264 20mmHg ho\u1eb7c t\u1ee5t huy\u1ebft \u00e1p, kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c huy\u1ebft \u00e1p, m\u1ea1ch kh\u00f4ng b\u1eaft \u0111\u01b0\u1ee3c, da l\u1ea1nh, n\u1ed5i v\u00e2n t\u00edm (s\u1ed1c n\u1eb7ng), ti\u1ec3u \u00edt.<\/p>\n

    – Xu\u1ea5t huy\u1ebft.<\/p>\n

    + Xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da: N\u1ed1t xu\u1ea5t huy\u1ebft r\u1ea3i r\u00e1c ho\u1eb7c ch\u1ea5m xu\u1ea5t huy\u1ebft th\u01b0\u1eddng \u1edf m\u1eb7t tr\u01b0\u1edbc hai c\u1eb3ng ch\u00e2n v\u00e0 m\u1eb7t trong hai c\u00e1nh tay, b\u1ee5ng, \u0111\u00f9i, m\u1ea1n s\u01b0\u1eddn ho\u1eb7c m\u1ea3ng b\u1ea7m t\u00edm.<\/p>\n

    + Xu\u1ea5t huy\u1ebft ni\u00eam m\u1ea1c nh\u01b0 ch\u1ea3y m\u00e1u ch\u00e2n r\u0103ng, ch\u1ea3y m\u00e1u m\u0169i, n\u00f4n ra m\u00e1u, ti\u00eau ph\u00e2n \u0111en ho\u1eb7c m\u00e1u, xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o ho\u1eb7c ti\u1ec3u m\u00e1u.<\/p>\n

    + Xu\u1ea5t huy\u1ebft n\u1eb7ng: ch\u1ea3y m\u00e1u m\u0169i n\u1eb7ng (c\u1ea7n nh\u00e9t b\u1ea5c ho\u1eb7c g\u1ea1c c\u1ea7m m\u00e1u), xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o n\u1eb7ng, xu\u1ea5t huy\u1ebft trong c\u01a1 v\u00e0 ph\u1ea7n m\u1ec1m, xu\u1ea5t huy\u1ebft \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00e0 n\u1ed9i t\u1ea1ng (ph\u1ed5i, n\u00e3o, gan, l\u00e1ch, th\u1eadn), th\u01b0\u1eddng k\u00e8m theo t\u00ecnh tr\u1ea1ng s\u1ed1c, gi\u1ea3m ti\u1ec3u c\u1ea7u, thi\u1ebfu oxy m\u00f4 v\u00e0 toan chuy\u1ec3n h\u00f3a c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy \u0111a ph\u1ee7 t\u1ea1ng v\u00e0 \u0111\u00f4ng m\u00e1u n\u1ed9i m\u1ea1ch n\u1eb7ng. Xu\u1ea5t huy\u1ebft n\u1eb7ng c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf ng\u01b0\u1eddi b\u1ec7nh d\u00f9ng c\u00e1c thu\u1ed1c kh\u00e1ng vi\u00eam nh\u01b0 acetylsalicylic acid (aspirin), ibuprofen ho\u1eb7c d\u00f9ng corticoid, ti\u1ec1n s\u1eed\u00a0lo\u00e9t d\u1ea1 d\u00e0y-t\u00e1 tr\u00e0ng, vi\u00eam gan m\u1ea1n.<\/p>\n

    – M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 th\u1ec3\u00a0c\u00f3 bi\u1ec3u hi\u1ec7n suy t\u1ea1ng nh\u01b0 t\u1ed5n th\u01b0\u01a1ng gan n\u1eb7ng\/suy gan, th\u1eadn, tim, ph\u1ed5i, n\u00e3o. Nh\u1eefng bi\u1ec3u hi\u1ec7n n\u1eb7ng n\u00e0y c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 s\u1ed1c do tho\u00e1t huy\u1ebft t\u01b0\u01a1ng.<\/p>\n

    + T\u1ed5n th\u01b0\u01a1ng gan n\u1eb7ng\/suy gan c\u1ea5p, men gan AST, ALT \u2265 1000U\/L.<\/p>\n

    + T\u1ed5n th\u01b0\u01a1ng\/suy th\u1eadn c\u1ea5p.<\/p>\n

    + R\u1ed1i lo\u1ea1n tri gi\u00e1c (s\u1ed1t xu\u1ea5t huy\u1ebft Dengue th\u1ec3\u00a0n\u00e3o).<\/p>\n

    + Vi\u00eam c\u01a1 tim, suy tim, ho\u1eb7c suy ch\u1ee9c n\u0103ng c\u00e1c c\u01a1 quan kh\u00e1c.<\/p>\n

    1.2.2. C\u1eadn l\u00e2m s\u00e0ng<\/p>\n

    – C\u00f4 \u0111\u1eb7c m\u00e1u khi Hematocrit t\u0103ng > 20% so v\u1edbi gi\u00e1 tr\u1ecb ban \u0111\u1ea7u c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh ho\u1eb7c so v\u1edbi gi\u00e1 tr\u1ecb trung b\u00ecnh c\u1ee7a d\u00e2n s\u1ed1 \u1edf c\u00f9ng l\u1ee9a tu\u1ed5i.<\/p>\n

    V\u00ed d\u1ee5: Hct ban \u0111\u1ea7u l\u00e0 35%, SXHD c\u00f3 t\u00ecnh tr\u1ea1ng c\u00f4 \u0111\u1eb7c m\u00e1u khi Hct hi\u1ec7n t\u1ea1i \u0111o \u0111\u01b0\u1ee3c l\u00e0 42% (t\u0103ng 20% so v\u1edbi ban \u0111\u1ea7u).<\/p>\n

    – S\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u gi\u1ea3m (<100.000\/mm3<\/sup>)<\/p>\n

    – AST, ALT th\u01b0\u1eddng t\u0103ng.<\/p>\n

    – Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 th\u1ec3 c\u00f3 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u.<\/p>\n

    – Si\u00eau \u00e2m ho\u1eb7c X quang c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n tr\u00e0n d\u1ecbch m\u00e0ng b\u1ee5ng, m\u00e0ng ph\u1ed5i.<\/p>\n

    1.<\/strong>3. Giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c:<\/strong><\/h3>\n

    Th\u01b0\u1eddng v\u00e0o ng\u00e0y th\u1ee9 7-10 c\u1ee7a b\u1ec7nh<\/p>\n

    1.3.1. L\u00e2m s\u00e0ng<\/p>\n

    – Ng\u01b0\u1eddi b\u1ec7nh h\u1ebft s\u1ed1t, to\u00e0n tr\u1ea1ng t\u1ed1t l\u00ean, th\u00e8m \u0103n, huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh v\u00e0 ti\u1ec3u nhi\u1ec1u.<\/p>\n

    – C\u00f3 th\u1ec3\u00a0ph\u00e1t ban h\u1ed3i ph\u1ee5c ho\u1eb7c ng\u1ee9a ngo\u00e0i da.<\/p>\n

    – C\u00f3 th\u1ec3 c\u00f3 nh\u1ecbp tim ch\u1eadm, kh\u00f4ng \u0111\u1ec1u, c\u00f3 th\u1ec3 c\u00f3 suy h\u00f4 h\u1ea5p do qu\u00e1 t\u1ea3i d\u1ecbch truy\u1ec1n.<\/p>\n

    1.3.2. C\u1eadn l\u00e2m s\u00e0ng<\/p>\n

    – Hematocrit tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c c\u00f3 th\u1ec3 th\u1ea5p h\u01a1n do hi\u1ec7n t\u01b0\u1ee3ng pha\u00a0lo\u00e3ng m\u00e1u khi d\u1ecbch \u0111\u01b0\u1ee3c t\u00e1i h\u1ea5p thu tr\u1edf l\u1ea1i.<\/p>\n

    – S\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u m\u00e1u th\u01b0\u1eddng t\u0103ng l\u00ean s\u1edbm sau giai \u0111o\u1ea1n h\u1ea1 s\u1ed1t.<\/p>\n

    – S\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u d\u1ea7n tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng, mu\u1ed9n h\u01a1n so v\u1edbi s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u.<\/p>\n

    – AST, ALT c\u00f3 khuynh h\u01b0\u1edbng gi\u1ea3m.<\/p>\n

    2. Ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n \u0111\u1ed9 s\u1ed1t xu\u1ea5t huy\u1ebft<\/b><\/h2>\n

    2.1. B\u1ec7nh s\u1ed1t xu\u1ea5t huy\u1ebft Dengue \u0111\u01b0\u1ee3c chia l\u00e0m 3 m\u1ee9c \u0111\u1ed9 (theo T\u1ed5 ch\u1ee9c Y t\u1ebf th\u1ebf gi\u1edbi n\u0103m 2009)<\/h3>\n

    – S\u1ed1t xu\u1ea5t huy\u1ebft Dengue.<\/p>\n

    – S\u1ed1t xu\u1ea5t huy\u1ebft Dengue c\u00f3 d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o.<\/p>\n

    – S\u1ed1t xu\u1ea5t huy\u1ebft Dengue n\u1eb7ng.<\/p>\n

    Ph\u1ee5 l\u1ee5c 2:<\/em><\/strong>\u00a0Ph\u00e2n \u0111\u1ed9 s\u1ed1t xu\u1ea5t huy\u1ebft Dengue.<\/p>\n

    L\u01b0u \u00fd:<\/em>\u00a0Trong qu\u00e1 tr\u00ecnh di\u1ec5n bi\u1ebfn, b\u1ec7nh c\u00f3 th\u1ec3 chuy\u1ec3n t\u1eeb m\u1ee9c \u0111\u1ed9 nh\u1eb9 sang m\u1ee9c \u0111\u1ed9 n\u1eb7ng, v\u00ec v\u1eady khi th\u0103m kh\u00e1m c\u1ea7n ph\u00e2n \u0111\u1ed9 l\u00e2m s\u00e0ng \u0111\u1ec3 ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh v\u00e0 c\u00f3 k\u1ebf ho\u1ea1ch x\u1eed tr\u00ed th\u00edch h\u1ee3p.<\/p>\n

    2.2. Ch\u1ea9n \u0111o\u00e1n c\u0103n nguy\u00ean vi r\u00fat Dengue<\/h3>\n

    2.2.1. X\u00e9t nghi\u1ec7m huy\u1ebft thanh<\/p>\n

    – X\u00e9t nghi\u1ec7m nhanh: t\u00ecm kh\u00e1ng nguy\u00ean NS1<\/p>\n

    – X\u00e9t nghi\u1ec7m ELISA: t\u00ecm kh\u00e1ng th\u1ec3 IgM, IgG t\u1eeb ng\u00e0y th\u1ee9 5 c\u1ee7a b\u1ec7nh.<\/p>\n

    2.2.2. X\u00e9t nghi\u1ec7m PCR, ph\u00e2n l\u1eadp vi r\u00fat: l\u1ea5y m\u00e1u trong giai \u0111o\u1ea1n s\u1ed1t (th\u1ef1c hi\u1ec7n \u1edf c\u00e1c c\u01a1 s\u1edf x\u00e9t nghi\u1ec7m c\u00f3 \u0111i\u1ec1u ki\u1ec7n).<\/p>\n

    2.3. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h3>\n

    – S\u1ed1t ph\u00e1t ban do vi r\u00fat.<\/p>\n

    – Tay ch\u00e2n mi\u1ec7ng.<\/p>\n

    – S\u1ed1t m\u00f2.<\/p>\n

    – S\u1ed1t r\u00e9t.<\/p>\n

    – Nhi\u1ec5m khu\u1ea9n huy\u1ebft do li\u00ean c\u1ea7u l\u1ee3n, n\u00e3o m\u00f4 c\u1ea7u, vi khu\u1ea9n gram \u00e2m, …<\/p>\n

    – S\u1ed1c nhi\u1ec5m khu\u1ea9n.<\/p>\n

    – C\u00e1c b\u1ec7nh m\u00e1u.<\/p>\n

    – B\u1ec7nh l\u00fd \u1ed5 b\u1ee5ng c\u1ea5p,…<\/p>\n

     <\/p>\n

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

      \n
    1. Quy\u1ebft \u0111\u1ecbnh s\u1ed1 3705\/Q\u0110-BYT ng\u00e0y 22 th\u00e1ng 8 n\u0103m 2019 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf<\/em><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

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