{"id":24874,"date":"2023-04-19T16:52:47","date_gmt":"2023-04-19T09:52:47","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24874"},"modified":"2023-04-20T16:33:54","modified_gmt":"2023-04-20T09:33:54","slug":"xu-tri-bien-chung-trong-sot-xuat-huyet-dengue-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/xu-tri-bien-chung-trong-sot-xuat-huyet-dengue-bo-y-te\/","title":{"rendered":"X\u1eed tr\u00ed bi\u1ebfn ch\u1ee9ng trong s\u1ed1t xu\u1ea5t huy\u1ebft Dengue \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 t\u00fdp huy\u1ebft thanh l\u00e0 DEN-1, DEN-2, DEN-3 v\u00e0 DEN-4. 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.<\/p>\n

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

1. \u0110i\u1ec1u tr\u1ecb xu\u1ea5t huy\u1ebft n\u1eb7ng<\/strong><\/h2>\n

– Nh\u1ecbn \u0103n u\u1ed1ng.<\/p>\n

– Tr\u00e1nh \u0111\u1eb7t sonde d\u1ea1 d\u00e0y ngo\u1ea1i tr\u1eeb xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a\u00a0\u1ed3\u00a0\u1ea1t th\u00ec n\u00ean \u0111\u1eb7t qua \u0111\u01b0\u1eddng mi\u1ec7ng.<\/p>\n

– Vitamine K1\u00a0t\u0129nh m\u1ea1ch li\u1ec1u\u00a01mg\/kg\/ng\u00e0y, t\u1ed1i \u0111a 20mg\/ng\u00e0y.<\/p>\n

– Omeprazole 1 mg\/kg truy\u1ec1n t\u0129nh m\u1ea1ch ho\u1eb7c c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m Proton kh\u00e1c (PPI): Pantoprazol, Esomeprazol n\u1ebfu nghi vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y.<\/p>\n

– Truy\u1ec1n m\u00e1u v\u00e0 ch\u1ebf ph\u1ea9m m\u00e1u.<\/p>\n

1.1 \u00a0Truy\u1ec1n m\u00e1u<\/h3>\n

– Khi ng\u01b0\u1eddi b\u1ec7nh c\u00f3 s\u1ed1c nghi m\u1ea5t m\u00e1u c\u1ea7n ph\u1ea3i ti\u1ebfn h\u00e0nh x\u00e1c \u0111\u1ecbnh nh\u00f3m m\u00e1u \u0111\u1ec3\u00a0truy\u1ec1n m\u00e1u khi c\u1ea7n.<\/p>\n

– Ch\u1ec9 \u0111\u1ecbnh truy\u1ec1n m\u00e1u.<\/p>\n

+ Hct \u2264 35% k\u00e8m s\u1ed1c th\u1ea5t b\u1ea1i ho\u1eb7c \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi b\u00f9 d\u1ecbch \u2265 40ml\/kg.<\/p>\n

+ Hct gi\u1ea3m nhanh\u00a0>\u00a020% k\u00e8m s\u1ed1c th\u1ea5t b\u1ea1i ho\u1eb7c \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi b\u00f9 d\u1ecbch.<\/p>\n

+ Hct \u2264 40% k\u00e8m \u0111ang xu\u1ea5t huy\u1ebft \u1ed3 \u1ea1t.<\/p>\n

– Truy\u1ec1n h\u1ed3ng c\u1ea7u l\u1eafng ho\u1eb7c m\u00e1u to\u00e0n ph\u1ea7n trong \u0111\u00f3 \u01b0u ti\u00ean h\u1ed3ng c\u1ea7u l\u1eafng.<\/p>\n

+ H\u1ed3ng c\u1ea7u l\u1eafng 5 – 10ml\/kg, ho\u1eb7c<\/p>\n

+ M\u00e1u to\u00e0n ph\u1ea7n (m\u1edbi l\u1ea5y < 7 ng\u00e0y) 10 – 20ml\/kg.<\/p>\n

1.2 Truy\u1ec1n huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i \u0111\u00f4ng l\u1ea1nh<\/h3>\n

– Ch\u1ec9 \u0111\u1ecbnh truy\u1ec1n huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i \u0111\u00f4ng l\u1ea1nh: r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u n\u1eb7ng (PT > 2 l\u1ea7n b\u00ecnh th\u01b0\u1eddng ho\u1eb7c INR > 1,5) k\u00e8m \u00edt nh\u1ea5t 1 ti\u00eau chu\u1ea9n:<\/p>\n

+ \u0110ang xu\u1ea5t huy\u1ebft n\u1eb7ng.<\/p>\n

+ C\u00f3 ch\u1ec9 \u0111\u1ecbnh ch\u1ecdc m\u00e0ng ph\u1ed5i, m\u00e0ng b\u1ee5ng.<\/p>\n

+ Truy\u1ec1n m\u00e1u kh\u1ed1i l\u01b0\u1ee3ng l\u1edbn (\u2265\u00a01\/2\u00a0th\u1ec3 t\u00edch m\u00e1u).<\/p>\n

– Li\u1ec1u: 10-20ml\/kg\/2-4 gi\u1edd.<\/p>\n

1.3 Truy\u1ec1n k\u1ebft t\u1ee7a l\u1ea1nh<\/h3>\n

– Ch\u1ec9 \u0111\u1ecbnh truy\u1ec1n k\u1ebft t\u1ee7a l\u1ea1nh: \u0111ang xu\u1ea5t huy\u1ebft n\u1eb7ng k\u00e8m Fibrinogen < 1 g\/L.<\/p>\n

– Li\u1ec1u: 1 t\u00fai\/6kg (1 t\u00fai ch\u1ee9a 150mg Fibrinogen).<\/p>\n

1.4 Truy\u1ec1n ti\u1ec3u c\u1ea7u<\/h3>\n

– Ch\u1ec9 \u0111\u1ecbnh truy\u1ec1n ti\u1ec3u c\u1ea7u:<\/p>\n

+ Ti\u1ec3u c\u1ea7u < 5.000\/mm3<\/sup>\u00a0(xem x\u00e9t t\u00f9y t\u1eebng tr\u01b0\u1eddng h\u1ee3p).<\/p>\n

+ Ti\u1ec3u c\u1ea7u < 50.000\/mm3<\/sup>\u00a0k\u00e8m \u0111ang xu\u1ea5t huy\u1ebft n\u1eb7ng ho\u1eb7c c\u00f3 ch\u1ec9 \u0111\u1ecbnh ch\u1ecdc m\u00e0ng ph\u1ed5i, m\u00e0ng b\u1ee5ng.<\/p>\n

– Li\u1ec1u: 1 \u0111\u01a1n v\u1ecb ti\u1ec3u c\u1ea7u \u0111\u1eadm \u0111\u1eb7c\/5kg ho\u1eb7c 1 \u0111\u01a1n v\u1ecb ti\u1ec3u c\u1ea7u chi\u1ebft t\u00e1ch\/10kg truy\u1ec1n trong 1-2 gi\u1edd.<\/p>\n

2. \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n toan ki\u1ec1m trong s\u1ed1t xu\u1ea5t huy\u1ebft<\/strong>\u00a0.<\/strong><\/h2>\n

– Toan chuy\u1ec3n h\u00f3a (pH < 7,35 v\u00e0\/ho\u1eb7c HCO3<\/sub>–<\/sup>\u00a0< 17): Natri bicarbonate 4,2% 2ml\/kg t\u0129nh m\u1ea1ch ch\u1eadm.<\/p>\n

– H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft (\u0111\u01b0\u1eddng huy\u1ebft < 40mg\/dl): Dextrose 30%\u00a01-2ml\/kg t\u0129nh m\u1ea1ch ch\u1eadm.<\/p>\n

– H\u1ea1 Calci huy\u1ebft (Calci ion h\u00f3a <\u00a01mmol\/L): Calci clorua 10% 0,1-0,2 ml\/kg (t\u1ed1i \u0111a 2-5ml\/li\u1ec1u), pha lo\u00e3ng trong Dextrose 5% 10-20ml t\u0129nh m\u1ea1ch ch\u1eadm 5-10 ph\u00fat.<\/p>\n

– H\u1ea1 Natri m\u00e1u n\u1eb7ng k\u00e8m r\u1ed1i lo\u1ea1n tri gi\u00e1c (Natri m\u00e1u <\u00a0125mEq\/l): Natriclorua 3% 4ml\/kg truy\u1ec1n t\u0129nh m\u1ea1ch trong 30 ph\u00fat, l\u1eb7p l\u1ea1i khi c\u1ea7n.<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb <\/strong>s\u1ed1t xu\u1ea5t huy\u1ebft c\u00f3 <\/strong>suy t\u1ea1ng n\u1eb7ng<\/strong><\/h2>\n

3.1 \u00a0T\u1ed5n th\u01b0\u01a1ng gan, suy gan c\u1ea5p<\/h3>\n

* Ph\u00e2n \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng gan c\u1ea5p trong SXHD.<\/p>\n

+ (1) Nh\u1eb9: AST, ALT 120 – < 400U\/L.<\/p>\n

+ (2) Trung b\u00ecnh: AST, ALT 400 – < 1000U\/L.<\/p>\n

+ (3) N\u1eb7ng ho\u1eb7c suy gan c\u1ea5p: AST, ALT \u2265 1000U\/L, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 b\u1ec7nh l\u00fd n\u00e3o gan.<\/p>\n

* \u0110i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng gan c\u1ea5p trung b\u00ecnh<\/p>\n

– Nh\u1eadp vi\u1ec7n \u0111i\u1ec1u tr\u1ecb.<\/p>\n

– Tr\u00e1nh d\u00f9ng c\u00e1c thu\u1ed1c h\u1ea1i gan.<\/p>\n

– Truy\u1ec1n d\u1ecbch n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

+ Tr\u00e1nh d\u00f9ng dung d\u1ecbch Ringer lactate, paracetamol trong tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng gan m\u1ee9c \u0111\u1ed9 trung b\u00ecnh, n\u1eb7ng.<\/p>\n

+ Dung d\u1ecbch \u0111\u01b0\u1ee3c ch\u1ecdn: NaCl 0,9% ho\u1eb7c Ringer acetate, Dextrosaline. H\u1ea1n ch\u1ebf d\u00f9ng dung d\u1ecbch HES.<\/p>\n

* \u0110i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng gan n\u1eb7ng, suy gan c\u1ea5p. \u0110i\u1ec1u tr\u1ecb t\u01b0\u01a1ng t\u1ef1 t\u1ed5n th\u01b0\u01a1ng gan trung b\u00ecnh k\u00e8m.<\/p>\n

– H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p khi c\u1ea7n.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft n\u1ebfu c\u00f3.<\/p>\n

– H\u1ea1n ch\u1ebf d\u1ecbch 2\/3-3\/4 nhu c\u1ea7u.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i n\u1ebfu c\u00f3.<\/p>\n

– Vitamin K1\u00a01mg\/kg t\u0129nh m\u1ea1ch ch\u1eadm, t\u1ed1i \u0111a 20mg\/ng\u00e0y.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u: truy\u1ec1n huy\u1ebft t\u01b0\u01a1ng \u0111\u00f4ng l\u1ea1nh.<\/p>\n

– Kh\u00e1ng sinh khi nghi ng\u1edd nhi\u1ec5m khu\u1ea9n.<\/p>\n

* Trong b\u1ec7nh l\u00fd n\u00e3o gan.<\/p>\n

– Xem x\u00e9t truy\u1ec1n t\u0129nh m\u1ea1ch N Acetyl Cystein khi suy gan c\u1ea5p n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n.<\/p>\n

+ T\u1ea5n c\u00f4ng: 150mg\/kg truy\u1ec1n t\u0129nh m\u1ea1ch (TTM) trong 1 gi\u1edd.<\/p>\n

+ Duy tr\u00ec: 50mg\/kg TTM trong 4 gi\u1edd, sau \u0111\u00f3 100mg\/kg TTM trong 16 gi\u1edd. Sau \u0111\u00f3 ti\u1ebfp t\u1ee5c TTM 6,25mg\/kg\/gi\u1edd trong 48-72 gi\u1edd.<\/p>\n

– Lactulose.<\/p>\n

– Th\u1ee5t th\u00e1o.<\/p>\n

– L\u1ecdc m\u00e1u li\u00ean t\u1ee5c \u00b1 thay huy\u1ebft t\u01b0\u01a1ng khi c\u00f3 suy \u0111a c\u01a1 quan ho\u1eb7c th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd (n\u1ebfu c\u00f3): Mannitol 20% li\u1ec1u 0,5g\/kg\/l\u1ea7n TTM nhanh 30 ph\u00fat, l\u1eb7p l\u1ea1i m\u1ed7i 8 gi\u1edd, c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p xen k\u1ebd Natri chlorua 3% 4ml\/kg\/30 ph\u00fat, l\u1eb7p l\u1ea1i m\u1ed7i 8 gi\u1edd.<\/p>\n

–\u00a0L\u01b0u \u00fd:<\/em>\u00a0\u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 t\u1ed5n th\u01b0\u01a1ng gan c\u1ea7n l\u01b0u \u00fd ch\u1ed1ng s\u1ed1c t\u00edch c\u1ef1c n\u1ebfu c\u00f3, h\u00f4 h\u1ea5p h\u1ed7 tr\u1ee3 s\u1edbm n\u1ebfu s\u1ed1c kh\u00f4ng c\u1ea3i thi\u1ec7n, theo d\u00f5i \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, \u0111\u01b0\u1eddng huy\u1ebft nhanh, kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch, amoniac m\u00e1u, lactate m\u00e1u, \u0111\u00f4ng m\u00e1u to\u00e0n b\u1ed9 m\u1ed7i 4-6 gi\u1edd \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh k\u1ecbp th\u1eddi c\u00e1c b\u1ea5t th\u01b0\u1eddng n\u1ebfu c\u00f3.<\/p>\n

3.2 \u00a0T\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p.<\/h3>\n

– Ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p:<\/p>\n

+ Ti\u1ec3u \u00edt < 0,5ml\/kg\/gi\u1edd, v\u00e0<\/p>\n

+ Creatinine m\u00e1u t\u0103ng \u2265 1,5-2 l\u1ea7n tr\u1ecb s\u1ed1 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c \u0111\u1ed9 thanh th\u1ea3i Creatinine (eCrCl) gi\u1ea3m \u2265 50%.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb:<\/p>\n

+ Ch\u1ed1ng s\u1ed1c: d\u1ecbch truy\u1ec1n, v\u1eadn m\u1ea1ch, h\u1ea1n ch\u1ebf d\u00f9ng HES, xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh d\u00f9ng albumin.<\/p>\n

+ \u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n t\u1ed5n th\u01b0\u01a1ng th\u1eadn: h\u1ea1n ch\u1ebf d\u1ecbch nh\u1eadp, tr\u00e1nh thu\u1ed1c t\u1ed5n th\u01b0\u01a1ng th\u1eadn.<\/p>\n

+ Theo d\u00f5i c\u00e2n n\u1eb7ng v\u00e0 c\u00e2n b\u1eb1ng d\u1ecbch xu\u1ea5t – nh\u1eadp.<\/p>\n

+ Xem x\u00e9t ch\u1ecdc d\u1eabn l\u01b0u \u1ed5 b\u1ee5ng khi c\u00f3 t\u0103ng \u00e1p l\u1ef1c \u1ed5 b\u1ee5ng n\u1eb7ng (\u00e1p l\u1ef1c b\u00e0ng quang > 27cmH2<\/sub>O).<\/p>\n

+ Th\u1eadn nh\u00e2n t\u1ea1o (l\u1ecdc m\u00e1u chu k\u1ef3) khi suy th\u1eadn c\u1ea5p k\u00e8m qu\u00e1 t\u1ea3i ho\u1eb7c h\u1ed9i ch\u1ee9ng ure huy\u1ebft, toan chuy\u1ec3n h\u00f3a n\u1eb7ng, t\u0103ng kali m\u00e1u th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa \u1edf b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh.<\/p>\n

+ L\u1ecdc m\u00e1u li\u00ean t\u1ee5c khi suy th\u1eadn c\u1ea5p ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng \u0111a c\u01a1 quan \u1edf b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh.<\/p>\n

3.3 S\u1ed1t xu\u1ea5t huy\u1ebft Dengue th\u1ec3 n\u00e3o.<\/h3>\n

– Ch\u1ea9n \u0111o\u00e1n: r\u1ed1i lo\u1ea1n tri gi\u00e1c, co gi\u1eadt ho\u1eb7c c\u00f3 d\u1ea5u th\u1ea7n kinh khu tr\u00fa, lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c: h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i, ki\u1ec1m toan, gi\u1ea3m oxy m\u00e1u n\u1eb7ng, xu\u1ea5t huy\u1ebft n\u00e3o, m\u00e0ng n\u00e3o, vi\u00eam n\u00e3o, m\u00e0ng n\u00e3o do nguy\u00ean nh\u00e2n kh\u00e1c.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb:<\/p>\n

+ \u0110\u1ea7u cao 30\u00b0.<\/p>\n

+ Th\u1edf oxy.<\/p>\n

+ Ch\u1ed1ng co gi\u1eadt (n\u1ebfu c\u00f3): Diazepam 0,2mg\/kg t\u0129nh m\u1ea1ch ch\u1eadm, c\u00f3 th\u1ec3 b\u01a1m qua \u0111\u01b0\u1eddng h\u1eadu m\u00f4n 0,5mg\/kg khi kh\u00f4ng ti\u00eam t\u0129nh m\u1ea1ch \u0111\u01b0\u1ee3c. N\u1ebfu kh\u00f4ng hi\u1ec7u qu\u1ea3 l\u1eb7p l\u1ea1i li\u1ec1u th\u1ee9 2 sau 10 ph\u00fat, t\u1ed1i \u0111a 3 li\u1ec1u. N\u1ebfu th\u1ea5t b\u1ea1i th\u00eam Phenobarbital 10-20mg\/kg TTM trong 15-30 ph\u00fat.<\/p>\n

+ \u0110i\u1ec1u tr\u1ecb h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft (n\u1ebfu c\u00f3): Dextrose 30%\u00a01-2ml\/kg (tr\u1ebb < 1 tu\u1ed5i Dextrose 10% 2ml\/kg).<\/p>\n

+ \u0110i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i – toan ki\u1ec1m.<\/p>\n

+ Ch\u1ed1ng ph\u00f9 n\u00e3o, ch\u1ec9 \u0111\u1ecbnh khi l\u00e2m s\u00e0ng b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd: ph\u1ea3n x\u1ea1 m\u1eaft b\u00fap b\u00ea, d\u1ea5u hi\u1ec7u m\u1ea5t v\u1ecf (tay co ch\u00e2n du\u1ed7i) ho\u1eb7c m\u1ea5t n\u00e3o (du\u1ed7i t\u1ee9 chi), \u0111\u1ed3ng t\u1eed d\u00e3n m\u1ed9t ho\u1eb7c hai b\u00ean, ph\u00f9 gai th\u1ecb, th\u1edf Cheynes-Stokes hay c\u01a1n ng\u1eebng th\u1edf ho\u1eb7c tam ch\u1ee9ng Cushing (m\u1ea1ch ch\u1eadm, huy\u1ebft \u00e1p cao, nh\u1ecbp th\u1edf b\u1ea5t th\u01b0\u1eddng).<\/p>\n

– \u0110i\u1ec1u tr\u1ecb t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd: Mannitol 20% li\u1ec1u 0,5g\/kg\/l\u1ea7n TTM nhanh 30 ph\u00fat, l\u1eb7p l\u1ea1i m\u1ed7i 8 gi\u1edd, c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p xen k\u1ebd Natri chlorua 3% 4ml\/kg\/30 ph\u00fat, l\u1eb7p l\u1ea1i m\u1ed7i 8 gi\u1edd.<\/p>\n

+ \u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n th\u1edf m\u00e1y: t\u0103ng th\u00f4ng kh\u00ed gi\u1eef PaCO2<\/sub>\u00a030 – 35mmHg.<\/p>\n

+ Thu\u1ed1c h\u1ea1 nhi\u1ec7t \u0111\u1eb7t h\u1eadu m\u00f4n paracetamol 10-15mg\/kg\/l\u1ea7n, ng\u00e0y 4 l\u1ea7n n\u1ebfu c\u00f3 s\u1ed1t.<\/p>\n

3.4\u00a0 Vi\u00eam c\u01a1 tim, suy tim.<\/h3>\n

– \u0110o CVP \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n.<\/p>\n

– X\u00e9t nghi\u1ec7m: X quang ng\u1ef1c, \u0111o \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, si\u00eau \u00e2m tim, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb: v\u1eadn m\u1ea1ch noradrenalin, dobutamin, dopamine, adrenalin, milrinon. Xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh ECMO.<\/p>\n

4. D\u01b0 d\u1ecbch<\/strong> trong s\u1ed1t xu\u1ea5t huy\u1ebft<\/strong><\/h2>\n

4.1\u00a0 Ch\u1ea9n \u0111o\u00e1n<\/strong>: kh\u00e1m l\u00e2m s\u00e0ng t\u00ecm d\u1ea5u hi\u1ec7u<\/p>\n

– D\u01b0 d\u1ecbch ngo\u00e0i l\u00f2ng m\u1ea1ch: ph\u00f9 nh\u1eb9 mi m\u1eaft, m\u1eb7t, chi, b\u1ee5ng b\u00e1ng, kh\u00f4ng ph\u00f9 ph\u1ed5i.<\/p>\n

– D\u01b0 d\u1ecbch trong v\u00e0 ngo\u00e0i l\u00f2ng m\u1ea1ch k\u00e8m qu\u00e1 t\u1ea3i d\u1ecbch, ho\u1eb7c ph\u00f9 ph\u1ed5i: ph\u00f9 nh\u1eb9 mi m\u1eaft, m\u1eb7t, chi, b\u1ee5ng b\u00e1ng to, th\u1edf nhanh, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, gan to, c\u00f3 th\u1ec3 k\u00e8m ph\u00f9 ph\u1ed5i: kh\u00f3 th\u1edf, ran r\u00edt, tr\u00e0o b\u1ecdt h\u1ed3ng, ph\u1ed5i c\u00f3 ran \u1ea9m, n\u1ed5, nh\u1ecbp tim Gallop.<\/p>\n

– X quang ph\u1ed5i, \u0111o v\u00e0 theo d\u00f5i \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch trung t\u00e2m.<\/p>\n

4.2\u00a0 \u0110i\u1ec1u tr\u1ecb<\/strong><\/p>\n

* D\u01b0 d\u1ecbch, kh\u00f4ng ph\u00f9 ph\u1ed5i, k\u00e8m s\u1ed1c N4-N5.<\/p>\n

– Hct cao: truy\u1ec1n cao ph\u00e2n t\u1eed ho\u1eb7c albumine 5% 10ml\/kg\/1-2 gi\u1edd.<\/p>\n

– Hct b\u00ecnh th\u01b0\u1eddng ho\u1eb7c th\u1ea5p: truy\u1ec1n m\u00e1u, h\u1ed3ng c\u1ea7u l\u1eafng 5ml\/kg\/1\u00a0gi\u1edd.<\/p>\n

* Qu\u00e1 t\u1ea3i d\u1ecbch, kh\u00f4ng ph\u00f9 ph\u1ed5i k\u00e8m huy\u1ebft \u0111\u1ed9ng h\u1ecdc b\u00ecnh th\u01b0\u1eddng v\u00e0 Hct b\u00ecnh th\u01b0\u1eddng ho\u1eb7c th\u1ea5p \u1edf ng\u00e0y t\u00e1i h\u1ea5p thu (N6-N7).<\/p>\n

– Th\u01b0\u1eddng do Hct b\u1ecb pha lo\u00e3ng do t\u00e1i h\u1ea5p thu.<\/p>\n

– Gi\u1ea3m t\u1ed1c \u0111\u1ed9 d\u1ecbch truy\u1ec1n.<\/p>\n

– N\u1eb1m \u0111\u1ea7u cao th\u1edf NCPAP ho\u1eb7c th\u1edf m\u00e1y kh\u00f4ng x\u00e2m l\u1ea5n.<\/p>\n

– S\u1eed d\u1ee5ng v\u1eadn m\u1ea1ch dopamine ho\u1eb7c dobutamine.<\/p>\n

– Xem x\u00e9t furosemide v\u00e0o N7 c\u1ee7a b\u1ec7nh, li\u1ec1u th\u1ea5p 0,5mg\/kg t\u0129nh m\u1ea1ch ch\u1eadm sau \u0111\u00f3 xem x\u00e9t truy\u1ec1n furosemide li\u00ean t\u1ee5c.<\/p>\n

– Theo d\u00f5i s\u00e1t, xem x\u00e9t ng\u01b0ng d\u1ecbch.<\/p>\n

* Ph\u00f9 ph\u1ed5i<\/p>\n

– Ng\u01b0ng d\u1ecbch.<\/p>\n

– N\u1eb1m \u0111\u1ea7u cao th\u1edf NCPAP ho\u1eb7c th\u1edf m\u00e1y kh\u00f4ng x\u00e2m l\u1ea5n ho\u1eb7c x\u00e2m l\u1ea5n.<\/p>\n

– Dobutamine 5-10\u03bcg\/kg\/ph\u00fat.<\/p>\n

– Furosemide 0,5-1mg\/kg t\u0129nh m\u1ea1ch ch\u1eadm l\u1eb7p l\u1ea1i sau 1 gi\u1edd khi c\u1ea7n v\u00e0 t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng cho ph\u00e9p.<\/p>\n

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

Khi c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng b\u1ee5ng, m\u00e0ng ph\u1ed5i g\u00e2y kh\u00f3 th\u1edf, SpO2<\/sub>\u00a0gi\u1ea3m xu\u1ed1ng d\u01b0\u1edbi 92%, n\u00ean cho ng\u01b0\u1eddi b\u1ec7nh th\u1edf NCPAP tr\u01b0\u1edbc. N\u1ebfu kh\u00f4ng c\u1ea3i thi\u1ec7n m\u1edbi xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh ch\u1ecdc h\u00fat \u0111\u1ec3 gi\u1ea3m b\u1edbt d\u1ecbch m\u00e0ng b\u1ee5ng, m\u00e0ng ph\u1ed5i.<\/p>\n

NGU\u1ed2N T\u00c0I LI\u1ec6U<\/strong><\/p>\n

    \n
  1. Quy\u1ebft \u0111\u1ecbnh s\u1ed1 3705\/Q\u0110-BYT ng\u00e0y22\u00a0th\u00e1ng\u00a08\u00a0n\u0103m 2019 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf<\/em><\/li>\n<\/ol>\n

     <\/p>\n

     <\/p>\n","protected":false},"excerpt":{"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 t\u00fdp huy\u1ebft thanh l\u00e0 DEN-1, DEN-2, DEN-3 v\u00e0 DEN-4. 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 […]<\/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":"\nX\u1eed tr\u00ed bi\u1ebfn ch\u1ee9ng trong s\u1ed1t xu\u1ea5t huy\u1ebft Dengue \u2013 B\u1ed9 Y t\u1ebf - Vinmec<\/title>\n<meta name=\"description\" content=\"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. 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