{"id":24846,"date":"2023-04-19T16:53:51","date_gmt":"2023-04-19T09:53:51","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24846"},"modified":"2023-04-20T16:32:58","modified_gmt":"2023-04-20T09:32:58","slug":"dieu-tri-sot-xuat-huyet-co-dau-hieu-canh-bao-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/dieu-tri-sot-xuat-huyet-co-dau-hieu-canh-bao-bo-y-te\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb s\u1ed1t xu\u1ea5t huy\u1ebft c\u00f3 d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o \u2013 B\u1ed9 Y t\u1ebf"},"content":{"rendered":"

S\u1ed1t xu\u1ea5t huy\u1ebft Dengue<\/a> 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

1. \u0110i\u1ec1u tr\u1ecb s\u1ed1t xu\u1ea5t huy\u1ebft Dengue<\/strong><\/h2>\n

Ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec1u \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa v\u00e0 theo d\u00f5i t\u1ea1i y t\u1ebf c\u01a1 s\u1edf, ch\u1ee7 y\u1ebfu l\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng v\u00e0 ph\u1ea3i theo d\u00f5i ch\u1eb7t ch\u1ebd ph\u00e1t hi\u1ec7n s\u1edbm s\u1ed1c x\u1ea3y ra \u0111\u1ec3\u00a0x\u1eed tr\u00ed k\u1ecbp th\u1eddi.<\/p>\n

* Xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh nh\u1eadp vi\u1ec7n trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p sau<\/p>\n

– S\u1ed1ng m\u1ed9t m\u00ecnh.<\/p>\n

– Nh\u00e0 xa c\u01a1 s\u1edf y t\u1ebf, kh\u00f4ng th\u1ec3 nh\u1eadp vi\u1ec7n k\u1ecbp th\u1eddi khi b\u1ec7nh tr\u1edf n\u1eb7ng.<\/p>\n

– Gia \u0111\u00ecnh kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng theo d\u00f5i s\u00e1t.<\/p>\n

– Tr\u1ebb nh\u0169 nhi.<\/p>\n

– D\u01b0 c\u00e2n, b\u00e9o ph\u00ec.<\/p>\n

– Ph\u1ee5 n\u1eef c\u00f3 thai.<\/p>\n

– Ng\u01b0\u1eddi l\u1edbn tu\u1ed5i (\u226560 tu\u1ed5i).<\/p>\n

– B\u1ec7nh m\u1ea1n t\u00ednh \u0111i k\u00e8m (th\u1eadn, tim, gan, hen, COPD k\u00e9m ki\u1ec3m so\u00e1t, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, thi\u1ebfu m\u00e1u tan m\u00e1u…).<\/p>\n

1.1. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng<\/h3>\n

– N\u1ebfu s\u1ed1t cao \u2265 38,5\u00b0C, cho thu\u1ed1c h\u1ea1 nhi\u1ec7t, n\u1edbi l\u1ecfng qu\u1ea7n \u00e1o v\u00e0 lau m\u00e1t b\u1eb1ng n\u01b0\u1edbc \u1ea5m.<\/p>\n

– Thu\u1ed1c h\u1ea1 nhi\u1ec7t ch\u1ec9 \u0111\u01b0\u1ee3c d\u00f9ng l\u00e0 paracetamol \u0111\u01a1n ch\u1ea5t, li\u1ec1u d\u00f9ng t\u1eeb 10-15mg\/kg c\u00e2n n\u1eb7ng\/l\u1ea7n, c\u00e1ch nhau m\u1ed7i 4-6 gi\u1edd.<\/p>\n

–\u00a0Ch\u00fa\u00a0\u00fd:<\/em><\/p>\n

+ T\u1ed5ng li\u1ec1u paracetamol kh\u00f4ng qu\u00e1 60mg\/kg c\u00e2n n\u1eb7ng\/24 gi\u1edd.<\/p>\n

+ Kh\u00f4ng d\u00f9ng aspirin (acetylsalicylic acid), analgin, ibuprofen \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb v\u00ec c\u00f3 th\u1ec3 g\u00e2y xu\u1ea5t huy\u1ebft, toan m\u00e1u.<\/p>\n

1.2. B\u00f9 d\u1ecbch s\u1edbm b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng:<\/h3>\n

Khuy\u1ebfn kh\u00edch ng\u01b0\u1eddi b\u1ec7nh u\u1ed1ng nhi\u1ec1u n\u01b0\u1edbc oresol ho\u1eb7c n\u01b0\u1edbc tr\u00e1i c\u00e2y (n\u01b0\u1edbc d\u1eeba, cam, chanh, …) ho\u1eb7c n\u01b0\u1edbc ch\u00e1o\u00a0lo\u00e3ng v\u1edbi mu\u1ed1i.<\/p>\n

– Kh\u00f4ng \u0103n u\u1ed1ng nh\u1eefng th\u1ef1c ph\u1ea9m c\u00f3 m\u00e0u n\u00e2u ho\u1eb7c \u0111\u1ecf nh\u01b0 x\u00e1 x\u1ecb, s\u00f4 c\u00f4 la,…<\/p>\n

– L\u01b0\u1ee3ng d\u1ecbch khuy\u1ebfn c\u00e1o: u\u1ed1ng theo nhu c\u1ea7u c\u01a1 b\u1ea3n, khuy\u1ebfn kh\u00edch u\u1ed1ng nhi\u1ec1u.<\/p>\n

1.3. Theo d\u00f5i s\u1ed1t xu\u1ea5t huy\u1ebft<\/h3>\n
    \n
  1. a) T\u00e1i kh\u00e1m v\u00e0 l\u00e0m x\u00e9t nghi\u1ec7m h\u00e0ng ng\u00e0y. N\u1ebfu xu\u1ea5t hi\u1ec7n d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o cho nh\u1eadp vi\u1ec7n \u0111i\u1ec1u tr\u1ecb.<\/li>\n
  2. b) Ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ebfn kh\u00e1m l\u1ea1i ngay khi c\u00f3 m\u1ed9t trong c\u00e1c d\u1ea5u hi\u1ec7u sau<\/li>\n<\/ol>\n

    – Ng\u01b0\u1eddi b\u1ec7nh th\u1ea5y kh\u00f3 ch\u1ecbu h\u01a1n m\u1eb7c d\u00f9 s\u1ed1t gi\u1ea3m ho\u1eb7c h\u1ebft s\u1ed1t.<\/p>\n

    – Kh\u00f4ng \u0103n, u\u1ed1ng \u0111\u01b0\u1ee3c.<\/p>\n

    – N\u00f4n \u00f3i nhi\u1ec1u.<\/p>\n

    – \u0110au b\u1ee5ng nhi\u1ec1u.<\/p>\n

    – Tay ch\u00e2n l\u1ea1nh, \u1ea9m.<\/p>\n

    – M\u1ec7t l\u1ea3, b\u1ee9t r\u1ee9t.<\/p>\n

    – Ch\u1ea3y m\u00e1u m\u0169i, mi\u1ec7ng ho\u1eb7c xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o.<\/p>\n

    – Kh\u00f4ng ti\u1ec3u tr\u00ean 6 gi\u1edd.<\/p>\n

    – Bi\u1ec3u hi\u1ec7n h\u00e0nh vi thay \u0111\u1ed5i nh\u01b0 l\u00fa l\u1eabn, t\u0103ng k\u00edch th\u00edch, v\u1eadt v\u00e3 ho\u1eb7c li b\u00ec.<\/p>\n

    2. \u0110i\u1ec1u tr\u1ecb s\u1ed1t xu\u1ea5t huy\u1ebft Dengue c\u00f3 d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o<\/strong><\/h2>\n

    2.1. \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi b\u1ec7nh tr\u1ebb em (< 16 tu\u1ed5i)<\/strong><\/h3>\n

    \u0110i\u1ec1u tr\u1ecb s\u1ed1t xu\u1ea5t huy\u1ebft Dengue c\u00f3 d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o: Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c cho nh\u1eadp vi\u1ec7n \u0111i\u1ec1u tr\u1ecb.<\/p>\n

    2.1.1. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng:<\/strong> h\u1ea1 s\u1ed1t<\/p>\n

    2.1.2. B\u00f9 d\u1ecbch s\u1edbm b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng<\/strong> n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f2n kh\u1ea3 n\u0103ng u\u1ed1ng \u0111\u01b0\u1ee3c.<\/p>\n

    2.1.3. Theo d\u00f5i<\/strong> m\u1ea1ch, HA, nh\u1eefng d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o, l\u01b0\u1ee3ng d\u1ecbch \u0111\u01b0a v\u00e0o, n\u01b0\u1edbc ti\u1ec3u v\u00e0 Hct m\u1ed7i 4-6 gi\u1edd.<\/p>\n

    2.1.4. Ch\u1ec9 \u0111\u1ecbnh truy\u1ec1n d\u1ecbch trong s\u1ed1t xu\u1ea5t huy\u1ebft Dengue<\/strong><\/p>\n

    a) Khi c\u00f3 \u00edt nh\u1ea5t 1 trong c\u00e1c d\u1ea5u hi\u1ec7u sau<\/p>\n

    – L\u1eeb \u0111\u1eeb.<\/p>\n

    – Kh\u00f4ng u\u1ed1ng \u0111\u01b0\u1ee3c n\u01b0\u1edbc.<\/p>\n

    – N\u00f4n \u00f3i nhi\u1ec1u.<\/p>\n

    – \u0110au b\u1ee5ng nhi\u1ec1u.<\/p>\n

    – C\u00f3 d\u1ea5u hi\u1ec7u m\u1ea5t n\u01b0\u1edbc.<\/p>\n

    – Hct t\u0103ng cao.<\/p>\n

    b) D\u1ecbch truy\u1ec1n bao g\u1ed3m: Ringer lactate, Ringer acetate, NaCl\u00a00,9%.<\/p>\n

    2.1.5. Ph\u01b0\u01a1ng th\u1ee9c truy\u1ec1n d\u1ecbch<\/strong><\/p>\n

    – Truy\u1ec1n Ringer lactate, Ringer acetate ho\u1eb7c NaCl 0,9% 6-7ml\/kg\/gi\u1edd trong 1-3 gi\u1edd, sau \u0111\u00f3 5ml\/kg\/gi\u1edd trong 2-4 gi\u1edd. Theo d\u00f5i l\u00e2m s\u00e0ng, Hct m\u1ed7i 2-4 gi\u1edd.<\/p>\n

    – N\u1ebfu m\u1ea1ch, HA \u1ed5n \u0111\u1ecbnh, Hct gi\u1ea3m, n\u01b0\u1edbc ti\u1ec3u \u2265 0,5-1ml\/kg\/gi\u1edd, gi\u1ea3m t\u1ed1c \u0111\u1ed9 truy\u1ec1n Ringer lactate, Ringer acetate ho\u1eb7c NaCl 0,9% 3ml\/kg\/gi\u1edd trong 2-4 gi\u1edd. N\u1ebfu l\u00e2m s\u00e0ng ti\u1ebfp t\u1ee5c c\u1ea3i thi\u1ec7n, c\u00f3 th\u1ec3 ng\u01b0ng d\u1ecbch sau 24-48 gi\u1edd.<\/p>\n

    – N\u1ebfu m\u1ea1ch nhanh, HA t\u1ee5t ho\u1eb7c k\u1eb9t, Hct t\u0103ng: \u0110i\u1ec1u tr\u1ecb toan, xu\u1ea5t huy\u1ebft, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, h\u1ea1 calci huy\u1ebft n\u1ebfu c\u00f3 v\u00e0 truy\u1ec1n d\u1ecbch ti\u1ebfp t\u1ee5c nh\u01b0 sau:<\/p>\n

    + Khi t\u1ed5ng d\u1ecbch truy\u1ec1n > 60ml\/kg: chuy\u1ec3n sang cao ph\u00e2n t\u1eed truy\u1ec1n t\u0129nh m\u1ea1ch 10-20ml\/kg\/gi\u1edd trong 1 gi\u1edd. Sau \u0111\u00f3 ti\u1ebfp t\u1ee5c truy\u1ec1n d\u1ecbch theo ph\u00e1c \u0111\u1ed3\u00a0\u0111i\u1ec1u tr\u1ecb nh\u01b0 s\u1ed1c SXHD.<\/p>\n

    + Khi t\u1ed5ng d\u1ecbch truy\u1ec1n \u2264 60ml\/kg: t\u0103ng t\u1ed1c \u0111\u1ed9 truy\u1ec1n Ringer lactate, Ringer acetate ho\u1eb7c NaCl 0,9% 10-20ml\/kg\/gi\u1edd trong 1 gi\u1edd. Sau \u0111\u00f3 ti\u1ebfp t\u1ee5c truy\u1ec1n d\u1ecbch theo ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb nh\u01b0 s\u1ed1c SXHD.<\/p>\n

    * L\u01b0u \u00fd<\/em><\/p>\n

    – N\u1ebfu SXHD c\u1ea3nh b\u00e1o k\u00e8m chi l\u1ea1nh, \u1ea9m, th\u1eddi gian l\u00e0m \u0111\u1ea7y mao m\u1ea1ch \u2265 3 gi\u00e2y, l\u1eeb \u0111\u1eeb hay v\u1eadt v\u00e3, b\u1ee9t r\u1ee9t; huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng ho\u1eb7c hi\u1ec7u \u00e1p = 25 mmHg:<\/strong>\u00a0\u0111i\u1ec1u tr\u1ecb nh\u01b0 s\u1ed1c SXHD.<\/p>\n

    – N\u1ebfu SXHD c\u1ea3nh b\u00e1o k\u00e8m chi l\u1ea1nh (m\u00e1t), m\u1ea1ch nhanh, HA b\u00ecnh th\u01b0\u1eddng:<\/strong>\u00a0Truy\u1ec1n Ringer lactate, Ringer acetate ho\u1eb7c NaCl 0,9%\u00a010ml\/kg\/gi\u1edd\u00a0trong 1 gi\u1edd, sau \u0111\u00f3 \u0111\u00e1nh gi\u00e1 l\u1ea1i.<\/p>\n

    + N\u1ebfu c\u1ea3i thi\u1ec7n l\u00e2m s\u00e0ng, tay ch\u00e2n \u1ea5m, m\u1ea1ch ch\u1eadm l\u1ea1i, HA b\u00ecnh th\u01b0\u1eddng: ti\u1ebfp t\u1ee5c Ringer lactate, Ringer acetate ho\u1eb7c NaCl 0,9% t\u1ed1c \u0111\u1ed9 6-7ml\/kg\/gi\u1edd\u00a0x\u00a01-3 gi\u1edd\u00a0\u2192\u00a05ml\/kg\/gi\u1edd\u00a0x\u00a02-4 gi\u1edd v\u00e0 x\u1eed tr\u00ed ti\u1ebfp theo nh\u01b0 ph\u00e1c \u0111\u1ed3\u00a0SXHD c\u1ea3nh b\u00e1o.<\/p>\n

    + N\u1ebfu c\u00f3 s\u1ed1c truy\u1ec1n Ringer lactate, Ringer acetate ho\u1eb7c NaCl 0,9% 20ml\/kg\/gi\u1edd trong 1 gi\u1edd v\u00e0 x\u1eed tr\u00ed ti\u1ebfp sau \u0111\u00f3 nh\u01b0 ph\u00e1c \u0111\u1ed3\u00a0s\u1ed1c SXHD.<\/p>\n

    – Th\u1eddi gian truy\u1ec1n d\u1ecbch: th\u01b0\u1eddng l\u00e0 kh\u00f4ng qu\u00e1 24-48 gi\u1edd.<\/p>\n

    2.2. \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi b\u1ec7nh ng\u01b0\u1eddi l\u1edbn (\u2265 16 tu\u1ed5i)<\/strong><\/h3>\n

    \u0110i\u1ec1u tr\u1ecb s\u1ed1t xu\u1ea5t huy\u1ebft Dengue c\u00f3 d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o: ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c cho nh\u1eadp vi\u1ec7n \u0111i\u1ec1u tr\u1ecb.<\/p>\n

    2.2.1. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng: h\u1ea1 s\u1ed1t<\/p>\n

    2.2.2 B\u00f9 d\u1ecbch s\u1edbm b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f2n kh\u1ea3 n\u0103ng u\u1ed1ng \u0111\u01b0\u1ee3c.<\/p>\n

    2.2.3. Theo d\u00f5i m\u1ea1ch, HA, nh\u1eefng d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o, l\u01b0\u1ee3ng d\u1ecbch \u0111\u01b0a v\u00e0o, n\u01b0\u1edbc ti\u1ec3u v\u00e0 Hct m\u1ed7i 4-6 gi\u1edd.<\/p>\n

    2.2.4. Ch\u1ec9 \u0111\u1ecbnh truy\u1ec1n d\u1ecbch: xem x\u00e9t truy\u1ec1n d\u1ecbch khi ng\u01b0\u1eddi b\u1ec7nh n\u00f4n nhi\u1ec1u, kh\u00f4ng u\u1ed1ng \u0111\u01b0\u1ee3c v\u00e0 Hct cao ho\u1eb7c c\u00f3 d\u1ea5u m\u1ea5t n\u01b0\u1edbc.<\/p>\n

    2.2.5. Ph\u01b0\u01a1ng th\u1ee9c truy\u1ec1n d\u1ecbch<\/p>\n

    Truy\u1ec1n Ringer lactate, Ringer acetate ho\u1eb7c NaCl 0,9% 6ml\/kg\/gi\u1edd trong 1-2 gi\u1edd, sau \u0111\u00f3 3ml\/kg\/gi\u1edd trong 2-4 gi\u1edd. Theo d\u00f5i l\u00e2m s\u00e0ng, Hct m\u1ed7i 2-4 gi\u1edd. Trong qu\u00e1 tr\u00ecnh theo d\u00f5i:<\/p>\n

    – N\u1ebfu m\u1ea1ch, HA \u1ed5n \u0111\u1ecbnh, Hct gi\u1ea3m, n\u01b0\u1edbc ti\u1ec3u \u2265 0,5-1ml\/kg\/gi\u1edd, gi\u1ea3m t\u1ed1c \u0111\u1ed9 truy\u1ec1n Ringer lactate, Ringer acetate ho\u1eb7c NaCl 0,9%\u00a01,5ml\/kg\/gi\u1edd trong 6-18 gi\u1edd. N\u1ebfu l\u00e2m s\u00e0ng ti\u1ebfp t\u1ee5c c\u1ea3i thi\u1ec7n, c\u00f3 th\u1ec3 ng\u01b0ng d\u1ecbch sau 12-24 gi\u1edd.<\/p>\n

    – N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n s\u1ed1c (m\u1ea1ch nhanh, nh\u1eb9, kh\u00f3 b\u1eaft, huy\u1ebft \u00e1p k\u1eb9t, t\u1ee5t, kh\u00f3 \u0111o v\u00e0 Hct t\u0103ng): truy\u1ec1n d\u1ecbch ch\u1ed1ng s\u1ed1c nh\u01b0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb s\u1ed1c SXHD \u1edf ng\u01b0\u1eddi l\u1edbn v\u1edbi li\u1ec1u ch\u1ed1ng s\u1ed1c \u0111\u1ea7u ti\u00ean l\u00e0 cao ph\u00e2n t\u1eed 10-15ml\/kg\/gi\u1edd. Ch\u00fa \u00fd \u0111i\u1ec1u tr\u1ecb toan h\u00f3a m\u00e1u, xu\u1ea5t huy\u1ebft, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, h\u1ea1 calci huy\u1ebft n\u1ebfu c\u00f3.<\/p>\n

    NGU\u1ed2N T\u00c0I LI\u1ec6U: <\/strong>Quy\u1ebft \u0111\u1ecbnh s\u1ed1 3705\/Q\u0110-BYT<\/strong> ng\u00e0y 22 th\u00e1ng 8 n\u0103m 2019 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf<\/em><\/p>\n

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

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