{"id":25138,"date":"2023-04-19T21:59:11","date_gmt":"2023-04-19T14:59:11","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25138"},"modified":"2023-04-22T13:10:20","modified_gmt":"2023-04-22T06:10:20","slug":"gentamicin-trong-viem-noi-tam-mac-nhiem-khuan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/gentamicin-trong-viem-noi-tam-mac-nhiem-khuan\/","title":{"rendered":"Gentamicin trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n"},"content":{"rendered":"

Gentamicin \u0111\u01b0\u1ee3c nh\u00f3m nghi\u00ean c\u1ee9u c\u1ee7a Weinstein ph\u00e1t hi\u1ec7n khi l\u00ean men Micromonospora purpurea. C\u00e1c vi khu\u1ea9n Micromonospora s\u1ed1ng ho\u1ea1i sinh ph\u1ed5 bi\u1ebfn trong \u0111\u1ea5t v\u00e0 n\u01b0\u1edbc.<\/strong><\/p>\n

1. L\u1ecbch s\u1eed<\/strong><\/h2>\n

Gentamicin \u0111\u01b0\u1ee3c nh\u00f3m nghi\u00ean c\u1ee9u c\u1ee7a Weinstein ph\u00e1t hi\u1ec7n khi l\u00ean men Micromonospora purpurea. C\u00e1c vi khu\u1ea9n Micromonospora s\u1ed1ng ho\u1ea1i sinh ph\u1ed5 bi\u1ebfn trong \u0111\u1ea5t v\u00e0 n\u01b0\u1edbc. Sau khi \u0111\u01b0\u1ee3c tinh ch\u1ebf v\u00e0 s\u1ea3n xu\u1ea5t ch\u1ebf ph\u1ea9m s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u00e0o n\u0103m 1971, gentamicin \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i tr\u00ean l\u00e2m s\u00e0ng.
\nTh\u1ef1c ch\u1ea5t gentamicin l\u00e0 h\u1ed7n h\u1ee3p v\u1edbi ba th\u00e0nh ph\u1ea7n bao g\u1ed3m gentamicin C1, gentamicin C2 v\u00e0 gentamicin C1a. Ba th\u00e0nh ph\u1ea7n n\u00e0y c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t nh\u1ecf v\u1ec1 c\u1ea5u tr\u00fac v\u1edbi s\u1ef1 thay th\u1ebf nguy\u00ean t\u1eed H v\u00e0 g\u1ed1c CH3 \u1edf m\u1ed9t s\u1ed1 v\u1ecb tr\u00ed nh\u01b0ng \u0111\u1ec1u c\u00f3 chung b\u1ed9 khung gi\u1ed1ng nhau v\u00e0 kh\u00e1 nh\u1ea5t tr\u00ed v\u1ec1 hi\u1ec7u l\u1ef1c di\u1ec7t khu\u1ea9n.<\/p>\n

\"Vi\u00eam<\/p>\n

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/a> tr\u00ean si\u00eau \u00e2m<\/strong><\/p>\n

2. D\u01b0\u1ee3c l\u1ef1c h\u1ecdc v\u00e0 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/h2>\n

Gentamicin g\u1eafn v\u00e0o ti\u1ec3u ph\u1ea7n 30S c\u1ee7a ribosom g\u00e2y sai l\u1ea1c qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p protein c\u1ee7a vi khu\u1ea9n. Hi\u1ec7u l\u1ef1c di\u1ec7t khu\u1ea9n l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1 t\u00edch t\u1ee5 c\u00e1c peptid v\u00f4 ngh\u0129a, s\u1ef1 g\u1eafn kh\u00f4ng h\u1ed3i ph\u1ee5c c\u1ee7a thu\u1ed1c v\u1edbi ribosom v\u00e0 qu\u00e1 tr\u00ecnh t\u01b0\u01a1ng t\u00e1c v\u1edbi m\u00e0ng t\u1ebf b\u00e0o vi khu\u1ea9n.
\nPh\u1ed5 kh\u00e1ng khu\u1ea9n c\u1ee7a gentamicin l\u00e0 c\u00e1c vi khu\u1ea9n hi\u1ebfu kh\u00ed, trong \u0111\u00f3 ch\u1ee7 y\u1ebfu l\u00e0 tr\u1ef1c khu\u1ea9n Gram \u00e2m. Thu\u1ed1c c\u00f3 hi\u1ec7u l\u1ef1c k\u00e9m h\u01a1n v\u1edbi vi khu\u1ea9n Gram d\u01b0\u01a1ng hi\u1ebfu kh\u00ed m\u1eb7c d\u00f9 c\u00f3 t\u00e1c d\u1ee5ng hi\u1ec7p \u0111\u1ed3ng v\u1edbi kh\u00e1ng sinh t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn v\u00e1ch t\u1ebf b\u00e0o vi khu\u1ea9n. Vi khu\u1ea9n nh\u1ea1y c\u1ea3m th\u01b0\u1eddng l\u00e0 Bartonella sp., Francisella tularensis. Thu\u1ed1c h\u1ea5p thu nhanh v\u00e0 ho\u00e0n to\u00e0n sau ti\u00eam b\u1eafp. Th\u1eddi gian \u0111\u1ea1t \u0111\u1ec9nh n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft thanh l\u00e0 30-90 ph\u00fat sau ti\u00eam b\u1eafp, 30 ph\u00fat sau truy\u1ec1n t\u0129nh m\u1ea1ch. Ph\u00e2n b\u1ed1 ch\u1ee7 y\u1ebfu \u1edf d\u1ecbch ngo\u1ea1i b\u00e0o (r\u1ea5t \u01b0a n\u01b0\u1edbc) v\u1edbi n\u1ed3ng \u0111\u1ed9 cao \u1edf v\u1ecf th\u1eadn. T\u1ef7 l\u1ec7 ng\u1ea5m v\u00e0o d\u1ecbch n\u00e3o t\u1ee7y v\u00e0 m\u00f4 m\u1eaft r\u1ea5t th\u1ea5p, k\u1ec3 c\u1ea3 khi d\u00f9ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. T\u1ef7 s\u1ed1 n\u1ed3ng \u0111\u1ed9 d\u1ecbch n\u00e3o t\u1ee7y: m\u00e1u \u0111\u1ed1i v\u1edbi m\u00e0ng n\u00e3o b\u00ecnh th\u01b0\u1eddng l\u00e0 < 10%, khi m\u00e0ng n\u00e3o vi\u00eam l\u00e0 \u2264 25%. T\u1ef7 l\u1ec7 g\u1eafn protein huy\u1ebft thanh l\u00e0 < 30%.
\nTh\u1eddi gian b\u00e1n th\u1ea3i dao \u0111\u1ed9ng quanh kho\u1ea3ng 2h. \u1ede tr\u1ebb s\u01a1 sinh d\u01b0\u1edbi 1 tu\u1ea7n tu\u1ed5i th\u1eddi gian b\u00e1n th\u1ea3i l\u00e0 3-11,5h, tr\u00ean 1 tu\u1ea7n tu\u1ed5i l\u00e0 3-6h. \u1ede tr\u1ebb c\u00f2n b\u00fa th\u1eddi gian b\u00e1n th\u1ea3i kho\u1ea3ng 4h. Khi suy th\u1eadn th\u1eddi gian b\u00e1n th\u1ea3i k\u00e9o d\u00e0i t\u1eeb 6-127h. Thu\u1ed1c th\u1ea3i tr\u1eeb qua th\u1eadn v\u1edbi > 70% \u1edf d\u1ea1ng kh\u00f4ng bi\u1ebfn \u0111\u1ed5i. \u0110\u1ed9 thanh th\u1ea3i gi\u1ea3m khi suy th\u1eadn.<\/p>\n

3. Ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, li\u1ec1u d\u00f9ng, c\u00e1ch d\u00f9ng<\/h2>\n
    \n
  • Trong VNTMNK, gentamicin \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c kh\u00e1ng sinh kh\u00e1c, th\u01b0\u1eddng l\u00e0 v\u1edbi kh\u00e1ng sinh nh\u00f3m beta-lactam \u0111\u1ec3 t\u0103ng c\u01b0\u1eddng hi\u1ec7u qu\u1ea3 di\u1ec7t khu\u1ea9n. Thu\u1ed1c c\u00f3 th\u1ec3 ti\u00eam b\u1eafp s\u00e2u ho\u1eb7c pha truy\u1ec1n trong 30-120 ph\u00fat.<\/li>\n
  • VNTMNK do Bartonella sp: 3 mg\/kg\/24h truy\u1ec1n t\u0129nh m\u1ea1ch 1 l\u1ea7n ho\u1eb7c c\u00f3 th\u1ec3 chia 3 l\u1ea7n, k\u1ebft h\u1ee3p v\u1edbi doxycyclin trong 2 tu\u1ea7n, sau \u0111\u00f3 duy tr\u00ec b\u1eb1ng \u0111\u01a1n tr\u1ecb li\u1ec7u doxycyclin. VNTMNK do Enterococcus sp: 1 mg\/kg\/8h ti\u00eam b\u1eafp ho\u1eb7c truy\u1ec1n t\u0129nh m\u1ea1ch trong ph\u00e1c \u0111\u1ed3 k\u1ebft h\u1ee3p. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb 4-6 tu\u1ea7n.<\/li>\n
  • VNTMNK do Staphylococcus sp (van nh\u00e2n t\u1ea1o): 1 mg\/kg\/8h ti\u00eam b\u1eafp ho\u1eb7c truy\u1ec1n t\u0129nh m\u1ea1ch trong ph\u00e1c \u0111\u1ed3 k\u1ebft h\u1ee3p. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb 2 tu\u1ea7n \u0111\u1ea7u, sau \u0111\u00f3 v\u1eabn duy tr\u00ec c\u00e1c th\u00e0nh ph\u1ea7n k\u1ebft h\u1ee3p kh\u00e1c cho \u0111\u1ebfn \u00edt nh\u1ea5t 6 tu\u1ea7n.<\/li>\n
  • VNTMNK do li\u00ean c\u1ea7u nh\u00f3m viridans v\u00e0 S. bovis: 3 mg\/kg\/24h ti\u00eam b\u1eafp ho\u1eb7c truy\u1ec1n t\u0129nh m\u1ea1ch 1 l\u1ea7n ho\u1eb7c c\u00f3 th\u1ec3 chia 3 l\u1ea7n, k\u1ebft h\u1ee3p v\u1edbi m\u1ed9t beta-lactam. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb gentamicin l\u00e0 2 tu\u1ea7n trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p van t\u1ef1 nhi\u00ean v\u00e0\/ho\u1eb7c vi khu\u1ea9n nh\u1ea1y penicillin. Ri\u00eang tr\u01b0\u1eddng h\u1ee3p van nh\u00e2n t\u1ea1o v\u1edbi vi khu\u1ea9n kh\u00e1ng penicillin (MIC t\u1eeb 0,12 \u03bcg\/mL tr\u1edf l\u00ean) th\u00ec th\u1eddi gian \u0111i\u1ec1u tr\u1ecb gentamicin l\u00e0 6 tu\u1ea7n.<\/li>\n
  • \u0110i\u1ec1u tr\u1ecb theo kinh nghi\u1ec7m VNTMNK: 1 mg\/kg\/8h truy\u1ec1n t\u0129nh m\u1ea1ch, k\u1ebft h\u1ee3p v\u1edbi vancomycin (van t\u1ef1 nhi\u00ean) ho\u1eb7c vancomycin v\u00e0 rifampicin (van nh\u00e2n t\u1ea1o).<\/li>\n
  • Gi\u1ea3m li\u1ec1u khi suy th\u1eadn:
    \nM\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn > 50 mL\/ph\u00fat: kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u.
    \nM\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn 10-50 mL\/ph\u00fat: gi\u00e3n kho\u1ea3ng c\u00e1ch li\u1ec1u d\u00f9ng m\u1ed7i 12-48h.
    \nM\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 10 mL\/ph\u00fat: gi\u00e3n kho\u1ea3ng c\u00e1ch li\u1ec1u d\u00f9ng m\u1ed7i 48-72h.<\/li>\n<\/ul>\n

    4. T\u00e1c d\u1ee5ng ph\u1ee5 v\u00e0 x\u1eed tr\u00ed<\/h2>\n

    Nh\u01b0 c\u00e1c aminoglycosid kh\u00e1c, gentamicin c\u00f3 th\u1ec3 g\u00e2y ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn v\u00e0 suy th\u1eadn, \u0111i\u1ebfc do \u0111\u1ed9c th\u1ea7n kinh \u1ed1c tai, ch\u00f3ng m\u1eb7t do t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan ti\u1ec1n \u0111\u00ecnh v\u00e0 hi\u1ebfm g\u1eb7p h\u01a1n l\u00e0 li\u1ec7t do ngh\u1ebdn d\u1eabn truy\u1ec1n th\u1ea7n kinh c\u01a1. \u0110\u1ed9c t\u00ednh th\u1eadn v\u00e0 \u1ed1c tai li\u00ean quan \u0111\u1ebfn hi\u1ec7n t\u01b0\u1ee3ng t\u00edch l\u0169y li\u1ec1u n\u00ean nguy\u00ean t\u1eafc chung l\u00e0 tr\u00e1nh d\u00f9ng li\u1ec1u cao k\u00e9o d\u00e0i v\u00e0 ph\u1ea3i gi\u1ea3m li\u1ec1u \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n suy th\u1eadn. Nguy c\u01a1 \u0111\u1ed9c t\u00ednh tr\u00ean th\u1eadn v\u00e0 tai t\u0103ng l\u00ean khi d\u00f9ng gentamicin \u0111\u1ed3ng th\u1eddi v\u1edbi cyclosporine, vancomycin, amphotericin B, thu\u1ed1c c\u1ea3n quang. Nguy c\u01a1 n\u00e0y gi\u1ea3m xu\u1ed1ng khi d\u00f9ng c\u00f9ng penicillin ch\u1ed1ng Pseudomonas v\u00e0 s\u1eed d\u1ee5ng 1 l\u1ea7n\/24h.<\/p>\n

    \u0110\u1ed9c t\u00ednh \u1ed1c tai ban \u0111\u1ea7u g\u00e2y th\u01b0\u01a1ng t\u1ed5n t\u1ebf b\u00e0o l\u00f4ng truy\u1ec1n \u00e2m t\u1ea7n s\u1ed1 cao n\u00ean ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 kh\u00f4ng ph\u00e1t hi\u1ec7n th\u1ea5y thay \u0111\u1ed5i g\u00ec. B\u1ed5 sung aspirin 3g\/24h gi\u00fap gi\u1ea3m nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng \u1ed1c tai do gentamicin. \u0110\u1ed9c t\u00ednh ti\u1ec1n \u0111\u00ecnh c\u00f3 th\u1ec3 g\u1eb7p nhi\u1ec1u h\u01a1n m\u1ea5t nghe nh\u01b0ng kh\u00f4ng ph\u00e1t hi\u1ec7n ra do th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u0111\u1ed1i x\u1ee9ng hai b\u00ean. N\u1ebfu t\u1ed5n th\u01b0\u01a1ng m\u1ed9t b\u00ean th\u00ec ch\u00f3ng m\u1eb7t, c\u00f2n
    \nn\u1ebfu t\u1ed5n th\u01b0\u01a1ng hai b\u00ean th\u00ec m\u1ea5t th\u0103ng b\u1eb1ng v\u00e0 nh\u00ecn m\u1ecdi th\u1ee9 quay khi chuy\u1ec3n \u0111\u1ed9ng \u0111\u1ea7u. \u0110\u1ed9c t\u00ednh ti\u1ec1n \u0111\u00ecnh kh\u00f4ng li\u00ean quan \u0111\u1ebfn li\u1ec1u c\u0169ng nh\u01b0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb.<\/p>\n

    5. \u00dd ngh\u0129a l\u00e2m s\u00e0ng<\/h2>\n

    Nhi\u1ec1u vi khu\u1ea9n \u0111\u00e3 sinh \u0111\u1ec1 kh\u00e1ng gentamicin ngay t\u1eeb nh\u1eefng n\u0103m 1970, c\u1ed9ng v\u1edbi c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean th\u1eadn v\u00e0 tai \u0111\u00e3 khi\u1ebfn cho c\u00f3 th\u1eddi gian d\u00e0i gentamicin kh\u00f4ng c\u00f2n \u0111\u01b0\u1ee3c \u01b0a chu\u1ed9ng. Tuy nhi\u00ean, vi\u1ec7c xu\u1ea5t hi\u1ec7n l\u1ea1i c\u00e1c ch\u1ee7ng vi khu\u1ea9n \u01b0u th\u1ebf nh\u1ea1y c\u1ea3m gentamicin, c\u1ed9ng v\u1edbi t\u00e1c d\u1ee5ng hi\u1ec7p \u0111\u1ed3ng c\u1ee7a gentamicin v\u1edbi kh\u00e1ng sinh nh\u00f3m beta-lactam \u0111\u00e3 duy tr\u00ec v\u1ecb tr\u00ed c\u1ee7a gentamicin trong c\u00e1c ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb VNTMNK.
    \nM\u1ed9t trong c\u00e1c c\u0103n nguy\u00ean vi khu\u1ea9n trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p VNTMNK c\u1ea5y m\u00e1u \u00e2m t\u00ednh c\u00f3 th\u1ec3 l\u00e0 Bartonella sp. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00fd gi\u1ea3i hi\u1ec7u qu\u1ea3 ngo\u1ea1n m\u1ee5c c\u1ee7a gentamicin khi \u0111i\u1ec1u tr\u1ecb nh\u1eefng tr\u01b0\u1eddng h\u1ee3p VNTMNK c\u1ea5y m\u00e1u \u00e2m t\u00ednh.<\/p>\n

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

    Gentamicin \u0111\u01b0\u1ee3c nh\u00f3m nghi\u00ean c\u1ee9u c\u1ee7a Weinstein ph\u00e1t hi\u1ec7n khi l\u00ean men Micromonospora purpurea. C\u00e1c vi khu\u1ea9n Micromonospora s\u1ed1ng ho\u1ea1i sinh ph\u1ed5 bi\u1ebfn trong \u0111\u1ea5t v\u00e0 n\u01b0\u1edbc. 1. L\u1ecbch s\u1eed Gentamicin \u0111\u01b0\u1ee3c nh\u00f3m nghi\u00ean c\u1ee9u c\u1ee7a Weinstein ph\u00e1t hi\u1ec7n khi l\u00ean men Micromonospora purpurea. C\u00e1c vi khu\u1ea9n Micromonospora s\u1ed1ng ho\u1ea1i sinh ph\u1ed5 bi\u1ebfn trong \u0111\u1ea5t […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[],"yoast_head":"\nGentamicin trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n - Vinmec<\/title>\n<meta name=\"description\" content=\"Gentamicin trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n l\u00e0 kh\u00e1ng sinh \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. 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