{"id":25168,"date":"2023-04-19T22:03:41","date_gmt":"2023-04-19T15:03:41","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25168"},"modified":"2023-04-22T13:12:01","modified_gmt":"2023-04-22T06:12:01","slug":"dieu-tri-khang-sinh-trong-viem-noi-tam-mac-nhiem-khuan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/dieu-tri-khang-sinh-trong-viem-noi-tam-mac-nhiem-khuan\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n"},"content":{"rendered":"

\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/a> nh\u1eb1m v\u00e0o c\u0103n nguy\u00ean vi khu\u1ea9n g\u00e2y b\u1ec7nh v\u00e0 m\u1ee9c \u0111\u1ed9 \u0111\u1ec1 kh\u00e1ng c\u1ee7a vi khu\u1ea9n t\u1ea1i t\u1eebng c\u01a1 s\u1edf. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c vi khu\u1ea9n g\u00e2y b\u1ec7nh r\u1ea5t quan tr\u1ecdng, c\u00f3 \u1ea3nh h\u01b0\u1edfng r\u1ea5t l\u1edbn \u0111\u1ebfn di\u1ec5n bi\u1ebfn qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/strong><\/p>\n

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

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n d\u01b0\u1edbi si\u00eau \u00e2m<\/strong><\/p>\n

1.Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh<\/h2>\n

\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh nh\u1eb1m v\u00e0o c\u0103n nguy\u00ean vi khu\u1ea9n g\u00e2y b\u1ec7nh v\u00e0 m\u1ee9c \u0111\u1ed9 \u0111\u1ec1 kh\u00e1ng c\u1ee7a vi khu\u1ea9n t\u1ea1i t\u1eebng c\u01a1 s\u1edf. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c vi khu\u1ea9n g\u00e2y b\u1ec7nh r\u1ea5t quan tr\u1ecdng, c\u00f3 \u1ea3nh h\u01b0\u1edfng r\u1ea5t l\u1edbn \u0111\u1ebfn di\u1ec5n bi\u1ebfn qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. Y\u00eau c\u1ea7u l\u1ea5y m\u00e1u v\u00e0\/ho\u1eb7c c\u00e1c b\u1ec7nh ph\u1ea9m v\u00f4 tr\u00f9ng kh\u00e1c \u0111\u1ec3 ph\u00e2n l\u1eadp vi khu\u1ea9n tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng kh\u00e1ng sinh. C\u1ea7n l\u1ea5y \u00edt nh\u1ea5t 3 m\u1eabu c\u1ea5y m\u00e1u t\u1ea1i c\u00e1c v\u1ecb tr\u00ed t\u0129nh m\u1ea1ch kh\u00e1c nhau, m\u1ed7i m\u1eabu c\u00e1ch nhau 30 ph\u00fat.
\nNh\u1eefng tr\u01b0\u1eddng h\u1ee3p di\u1ec5n bi\u1ebfn b\u1ec7nh kh\u00f4ng c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 tr\u00ec ho\u00e3n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh cho \u0111\u1ebfn khi c\u00f3 k\u1ebft qu\u1ea3 c\u1ea5y m\u00e1u. N\u1ebfu di\u1ec5n bi\u1ebfn b\u1ec7nh c\u1ea5p t\u00ednh th\u00ec c\u1ea7n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh ngay. Trong khi ch\u01b0a c\u00f3 k\u1ebft qu\u1ea3 ph\u00e2n l\u1eadp vi khu\u1ea9n t\u1eeb m\u00e1u v\u00e0\/ho\u1eb7c t\u1eeb c\u00e1c b\u1ec7nh ph\u1ea9m v\u00f4 tr\u00f9ng kh\u00e1c th\u00ec c\u1ea7n ph\u1ecfng \u0111o\u00e1n m\u1ea7m b\u1ec7nh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh theo kinh nghi\u1ec7m. Nh\u00ecn chung kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb kinh nghi\u1ec7m c\u1ea7n bao v\u00e2y \u0111\u01b0\u1ee3c t\u1ee5 c\u1ea7u (c\u1ea3 nh\u1ea1y v\u00e0 kh\u00e1ng methicillin), ph\u1ebf c\u1ea7u v\u00e0 c\u00e1c Enterococcus.
\n\u01afu ti\u00ean: S\u1eed d\u1ee5ng kh\u00e1ng sinh di\u1ec7t khu\u1ea9n h\u01a1n l\u00e0 kh\u00e1ng sinh k\u00ecm khu\u1ea9n, d\u00f9ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch h\u01a1n l\u00e0 \u0111\u01b0\u1eddng u\u1ed1ng v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i.
\nTh\u1eddi gian \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh: \u00edt nh\u1ea5t 4 \u2013 6 tu\u1ea7n \u0111\u1ed1i v\u1edbi vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n tr\u00ean van t\u1ef1 nhi\u00ean v\u00e0 6 tu\u1ea7n \u0111\u1ed1i v\u1edbi van nh\u00e2n t\u1ea1o. Th\u1eddi gian li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh n\u00ean \u0111\u01b0\u1ee3c t\u00ednh t\u1eeb ng\u00e0y li\u1ec7u ph\u00e1p kh\u00e1ng sinh c\u00f3 hi\u1ec7u qu\u1ea3. T\u1ee9c l\u00e0 n\u1ebfu ban \u0111\u1ea7u b\u1ec7nh nh\u00e2n c\u00f3 k\u1ebft qu\u1ea3 c\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh, th\u1eddi gian li\u1ec7u tr\u00ecnh\u00a0 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh n\u00ean \u0111\u01b0\u1ee3c t\u00ednh t\u1eeb ng\u00e0y k\u1ebft qu\u1ea3 c\u1ea5y m\u00e1u chuy\u1ec3n sang \u00e2m t\u00ednh. Sau ph\u1eabu thu\u1eadt, m\u1ed9t li\u1ec7u tr\u00ecnh kh\u00e1ng sinh m\u1edbi \u0111\u1ea7y \u0111\u1ee7 ch\u1ec9 n\u00ean \u00e1p d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh ph\u1ea9m nu\u00f4i c\u1ea5y van d\u01b0\u01a1ng t\u00ednh.
\nTheo d\u00f5i hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh d\u1ef1a tr\u00ean s\u1ef1 bi\u1ebfn \u0111\u1ed5i c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 ch\u1ec9 d\u1ea5u sinh h\u1ecdc ch\u1ec9 \u0111i\u1ec3m t\u00ecnh tr\u1ea1ng ph\u1ea3n \u1ee9ng vi\u00eam. C\u1ea7n \u0111\u1ecbnh k\u1ef3 c\u1ea5y m\u00e1u theo d\u00f5i, c\u00e1ch 1 \u2013 2 ng\u00e0y l\u1ea1i c\u1ea5y hai m\u1eabu m\u00e1u cho \u0111\u1ebfn khi k\u1ebft qu\u1ea3 tr\u1edf v\u1ec1 \u00e2m t\u00ednh.
\n<\/strong><\/p>\n

2. Benzylpenicillin (penicillin G)<\/h2>\n

2.1. L\u1ecbch s\u1eed<\/h3>\n

Penicillin \u0111\u01b0\u1ee3c Fleming ph\u00e2n l\u1eadp t\u1eeb n\u1ea5m Penicillium notatum n\u0103m 1928 v\u00e0 \u0111\u01b0\u1ee3c Florey, Chain v\u00e0 \u0111\u1ed3ng s\u1ef1 s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng t\u1eeb n\u0103m 1941. V\u1edbi \u0111\u00f3ng g\u00f3p to l\u1edbn n\u00e0y cho y h\u1ecdc, Fleming, Florey v\u00e0 Chain \u0111\u00e3 \u0111\u01b0\u1ee3c trao gi\u1ea3i th\u01b0\u1edfng Nobel n\u0103m 1945.
\nBan \u0111\u1ea7u vi\u1ec7c s\u1ea3n xu\u1ea5t penicillin t\u1eeb l\u00ean men n\u1ea5m cho ra nhi\u1ec1u lo\u1ea1i penicillin \u0111\u01b0\u1ee3c \u0111\u1eb7t theo c\u00e1c ch\u1eef c\u00e1i nh\u01b0 F, G, X, K\u2026 trong \u0111\u00f3 penicillin G c\u00f3 hi\u1ec7u l\u1ef1c cao nh\u1ea5t. Hi\u1ec7n nay penicillin G \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t c\u00f4ng nghi\u1ec7p c\u00f3 \u0111\u1ed9 tinh khi\u1ebft r\u1ea5t cao. Ngo\u00e0i d\u1ea1ng mu\u1ed1i Na v\u00e0 K c\u00f3 \u0111\u1ed9 h\u00f2a tan r\u1ea5t cao c\u00f2n c\u00f3 procaine benzylpenicillin v\u00e0 benzathine penicillin G duy tr\u00ec k\u00e9o d\u00e0i n\u1ed3ng \u0111\u1ed9 penicillin trong huy\u1ebft thanh.<\/p>\n

2.2. D\u01b0\u1ee3c l\u1ef1c h\u1ecdc v\u00e0 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/h3>\n

Thu\u1ed1c t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn s\u1ef1 t\u1ed5ng h\u1ee3p v\u00e1ch t\u1ebf b\u00e0o vi khu\u1ea9n khi vi khu\u1ea9n nh\u00e2n l\u00ean khi\u1ebfn cho vi khu\u1ea9n kh\u00f4ng t\u1ed5ng h\u1ee3p \u0111\u01b0\u1ee3c v\u00e1ch t\u1ebf b\u00e0o, d\u1eabn \u0111\u1ebfn ch\u1ebft t\u1ebf b\u00e0o vi khu\u1ea9n. Hi\u1ec7u l\u1ef1c di\u1ec7t khu\u1ea9n tr\u00ean nh\u1eefng vi khu\u1ea9n nh\u1ea1y c\u1ea3m bao g\u1ed3m c\u1ea3 vi khu\u1ea9n Gram d\u01b0\u01a1ng v\u00e0 Gram \u00e2m. \u0110\u00e2y l\u00e0 l\u1ef1a ch\u1ecdn c\u01a1 b\u1ea3n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb li\u00ean c\u1ea7u, ph\u1ebf c\u1ea7u, t\u1ee5 c\u1ea7u v\u00e0ng kh\u00f4ng sinh penicillinase, vi khu\u1ea9n k\u1ef5 kh\u00ed Clostridium perfringens, vi khu\u1ea9n giang mai Treponema pallidum v\u00e0 nh\u1eefng vi khu\u1ea9n \u00edt g\u1eb7p nh\u01b0 Actinomyces sp., vi khu\u1ea9n b\u1ea1ch h\u1ea7u, Enterococcus faecalis, Leptospira sp., P. acnes, P. multocida, Peptostreptococci. T\u1ee5 c\u1ea7u v\u00e0ng v\u00e0 nhi\u1ec1u vi khu\u1ea9n kh\u00e1c c\u00f3 th\u1ec3 sinh penicillinase l\u00e0m b\u1ea5t ho\u1ea1t penicillin G.
\nThu\u1ed1c s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng ti\u00eam (ti\u00eam b\u1eafp s\u00e2u, ti\u00eam\/truy\u1ec1n t\u0129nh m\u1ea1ch), \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh huy\u1ebft thanh ngay sau ti\u00eam\/truy\u1ec1n t\u0129nh m\u1ea1ch.<\/p>\n

Ph\u00e2n b\u1ed1: Thu\u1ed1c ng\u1ea5m k\u00e9m qua h\u00e0ng r\u00e0o m\u00e1u n\u00e3o, k\u1ec3 c\u1ea3 trong tr\u01b0\u1eddng h\u1ee3p vi\u00eam m\u00e0ng n\u00e3o. T\u1ef7 s\u1ed1 n\u1ed3ng \u0111\u1ed9 d\u1ecbch n\u00e3o t\u1ee7y: m\u00e1u khi vi\u00eam m\u00e0ng n\u00e3o dao \u0111\u1ed9ng t\u1eeb 2% \u0111\u1ebfn 6%.
\nTh\u1eddi gian b\u00e1n th\u1ea3i \u1edf tr\u1ebb s\u01a1 sinh d\u01b0\u1edbi 6 ng\u00e0y tu\u1ed5i l\u00e0 3,1h, \u1edf tr\u1ebb s\u01a1 sinh tr\u00ean 14 ng\u00e0y tu\u1ed5i l\u00e0 1,4h, \u1edf ng\u01b0\u1eddi l\u1edbn c\u00f3 ch\u1ee9c n\u0103ng th\u1eadn b\u00ecnh th\u01b0\u1eddng l\u00e0 31 \u0111\u1ebfn 50 ph\u00fat, c\u00f2n \u1edf b\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i l\u00e0 t\u1eeb 6 \u0111\u1ebfn 20h.
\nTh\u1ea3i tr\u1eeb qua n\u01b0\u1edbc ti\u1ec3u c\u00f3 t\u1edbi 58-85% thu\u1ed1c \u1edf d\u1ea1ng kh\u00f4ng bi\u1ebfn \u0111\u1ed5i.<\/p>\n

2.3. Ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, li\u1ec1u d\u00f9ng, c\u00e1ch d\u00f9ng<\/h3>\n
    \n
  • Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n do Enterococcus nh\u1ea1y penicillin:<\/li>\n<\/ul>\n

    18 \u0111\u1ebfn 30 tri\u1ec7u \u0111\u01a1n v\u1ecb\/24h truy\u1ec1n li\u00ean t\u1ee5c ho\u1eb7c ti\u00eam c\u00e1ch qu\u00e3ng m\u1ed7i 4h, ph\u1ed1i h\u1ee3p gentamicin ho\u1eb7c streptomycin. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb 4-6 tu\u1ea7n. VNTMNK do Erysipelothrix rhusiopathiae: 12 \u0111\u1ebfn 20 tri\u1ec7u \u0111\u01a1n v\u1ecb\/24h ti\u00eam c\u00e1ch qu\u00e3ng m\u1ed7i 4-6h trong 4-6 tu\u1ea7n.
    \nVNTMNK do Listeria monocytogenes: 15 \u0111\u1ebfn 20 tri\u1ec7u \u0111\u01a1n v\u1ecb\/24h ti\u00eam c\u00e1ch qu\u00e3ng m\u1ed7i 4-6h trong 4 tu\u1ea7n.<\/p>\n

      \n
    • Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n do li\u00ean c\u1ea7u viridans v\u00e0 S. bovis:<\/li>\n<\/ul>\n

      Van t\u1ef1 nhi\u00ean: N\u1ebfu vi khu\u1ea9n nh\u1ea1y c\u1ea3m penicillin (MIC \u2264 0,12 \u03bcg\/mL) d\u00f9ng 12 \u0111\u1ebfn 18 tri\u1ec7u \u0111\u01a1n v\u1ecb\/24h truy\u1ec1n li\u00ean t\u1ee5c ho\u1eb7c ti\u00eam c\u00e1ch qu\u00e3ng m\u1ed7i 4-6h trong 4 tu\u1ea7n, ho\u1eb7c d\u00f9ng trong 2 tu\u1ea7n khi k\u1ebft h\u1ee3p v\u1edbi gentamicin. N\u1ebfu vi khu\u1ea9n t\u01b0\u01a1ng \u0111\u1ed1i kh\u00e1ng penicillin (MIC t\u1eeb 0,12 \u0111\u1ebfn d\u01b0\u1edbi 0,5 \u03bcg\/ml) d\u00f9ng 24 tri\u1ec7u \u0111\u01a1n v\u1ecb\/24h truy\u1ec1n li\u00ean t\u1ee5c ho\u1eb7c ti\u00eam c\u00e1ch qu\u00e3ng m\u1ed7i 4-6 gi\u1edd trong 4 tu\u1ea7n, trong \u0111\u00f3 2 tu\u1ea7n \u0111\u1ea7u d\u00f9ng k\u1ebft h\u1ee3p v\u1edbi gentamicin.Van nh\u00e2n t\u1ea1o: N\u1ebfu vi khu\u1ea9n nh\u1ea1y c\u1ea3m penicillin (MIC \u2264 0,12 \u03bcg\/ml) d\u00f9ng 24 tri\u1ec7u \u0111\u01a1n v\u1ecb\/24h truy\u1ec1n li\u00ean t\u1ee5c ho\u1eb7c ti\u00eam c\u00e1ch qu\u00e3ng m\u1ed7i 4-6 gi\u1edd trong 6 tu\u1ea7n (c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi gentamicin trong 2 tu\u1ea7n \u0111\u1ea7u). N\u1ebfu vi khu\u1ea9n kh\u00e1ng penicillin (MIC > 0,12 \u03bcg\/mL) d\u00f9ng 24 tri\u1ec7u \u0111\u01a1n v\u1ecb\/24h truy\u1ec1n li\u00ean t\u1ee5c ho\u1eb7c ti\u00eam c\u00e1ch qu\u00e3ng m\u1ed7i 4-6h trong 6 tu\u1ea7n, k\u1ebft h\u1ee3p v\u1edbi gentamicin trong 6 tu\u1ea7n.<\/p>\n

      2.4. T\u00e1c d\u1ee5ng ph\u1ee5 v\u00e0 x\u1eed tr\u00ed<\/h3>\n

      Ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng:<\/h4>\n

      M\u1eb7c d\u00f9 c\u00f3 t\u1edbi 10% ng\u01b0\u1eddi b\u1ec7nh k\u1ec3 ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng penicillin nh\u01b0ng 85-90% s\u1ed1 b\u1ec7nh nh\u00e2n n\u00e0y kh\u00f4ng xu\u1ea5t hi\u1ec7n d\u1ecb \u1ee9ng khi d\u00f9ng penicillin. Khi ng\u01b0\u1eddi b\u1ec7nh t\u0103ng b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n nhi\u1ec5m tr\u00f9ng do virus Epstein-Barr d\u00f9ng penicillin th\u00ec c\u00f3 t\u1edbi 90% xu\u1ea5t hi\u1ec7n ph\u00e1t ban, nh\u01b0ng sau \u0111\u1ee3t b\u1ec7nh \u0111\u00f3 d\u00f9ng l\u1ea1i penicillin th\u00ec kh\u00f4ng x\u1ea3y ra d\u1ecb \u1ee9ng. Khi s\u1eed d\u1ee5ng procaine penicillin th\u00ec d\u1ecb \u1ee9ng c\u0169ng c\u00f3 th\u1ec3 do procaine ch\u1ee9 kh\u00f4ng nh\u1ea5t thi\u1ebft l\u00e0 do penicillin. D\u1ecb \u1ee9ng ch\u00e9o gi\u1eefa penicillin v\u1edbi c\u00e1c cephalosporine v\u00e0 carbapenem v\u00e0o kho\u1ea3ng 10%. D\u1ecb \u1ee9ng nguy hi\u1ec3m nh\u1ea5t l\u00e0 ph\u1ea3n v\u1ec7 qua trung gian IgE. M\u1eb7c d\u00f9 ph\u1ea3n v\u1ec7 g\u1eb7p ch\u1ec9 0,05% nh\u01b0ng nguy c\u01a1 t\u1eed vong t\u1edbi 5-10%. C\u00e1c bi\u1ec3u hi\u1ec7n kh\u00e1c c\u0169ng qua trung gian IgE l\u00e0 m\u00e0y \u0111ay, ph\u00f9 m\u1ea1ch, ph\u00f9 thanh qu\u1ea3n, co th\u1eaft ph\u1ebf qu\u1ea3n.
      \nPh\u00e1t ban d\u1ea1ng s\u1edfi xu\u1ea5t hi\u1ec7n sau 72h kh\u00f4ng ph\u1ea3i qua trung gian IgE v\u00e0 kh\u00f4ng nghi\u00eam tr\u1ecdng. Nh\u1eefng ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng mu\u1ed9n nghi\u00eam tr\u1ecdng bao g\u1ed3m thi\u1ebfu m\u00e1u huy\u1ebft t\u00e1n, gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh, gi\u1ea3m ti\u1ec3u c\u1ea7u, b\u1ec7nh huy\u1ebft thanh, vi\u00eam th\u1eadn k\u1ebd, vi\u00eam gan, t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan, s\u1ed1t do thu\u1ed1c.
      \nN\u1ebfu ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng penicillin ho\u1eb7c thu\u1ed1c kh\u00e1ng sinh betalactam ho\u1eb7c c\u00f3 ti\u1ec1n s\u1eed ph\u1ea3n v\u1ec7 v\u1edbi nhi\u1ec1u d\u1ecb nguy\u00ean kh\u00e1c nhau th\u00ec c\u1ea7n test da tr\u01b0\u1edbc khi d\u00f9ng penicillin. Gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n \u00e2m t\u00ednh c\u1ee7a test da \u0111\u1ed1i v\u1edbi d\u1ecb \u1ee9ng penicillin l\u00e0 97-99%. Nguy c\u01a1 ph\u1ea3n \u1ee9ng to\u00e0n th\u00e2n khi l\u00e0m test da l\u00e0 d\u01b0\u1edbi 1%.
      \nN\u1ebfu v\u1eabn b\u1eaft bu\u1ed9c ph\u1ea3i d\u00f9ng penicillin khi test da d\u01b0\u01a1ng t\u00ednh th\u00ec c\u1ea7n ti\u1ebfn h\u00e0nh gi\u1ea3i m\u1eabn c\u1ea3m. Pha lo\u00e3ng penicillin, ti\u00eam b\u1eaft \u0111\u1ea7u t\u1eeb li\u1ec1u 20 \u0111\u01a1n v\u1ecb\/0,2 mL t\u0103ng d\u1ea7n qua 15 b\u01b0\u1edbc cho \u0111\u1ebfn khi l\u00ean \u0111\u1ebfn li\u1ec1u 800.000 \u0111\u01a1n v\u1ecb\/0,8 mL m\u00e0 kh\u00f4ng c\u00f3 ph\u1ea3n \u1ee9ng \u0111\u00e1ng k\u1ec3 th\u00ec gi\u1ea3i m\u1eabn c\u1ea3m th\u00e0nh c\u00f4ng. L\u01b0u \u00fd gi\u1ea3i m\u1eabn c\u1ea3m ph\u1ea3i ti\u1ebfn h\u00e0nh \u1edf c\u00e1c \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c c\u1ea5p c\u1ee9u c\u00f3 s\u1eb5n ph\u01b0\u01a1ng ti\u1ec7n x\u1eed tr\u00ed c\u1ea5p c\u1ee9u n\u1ebfu xu\u1ea5t hi\u1ec7n t\u00ecnh tr\u1ea1ng ph\u1ea3n v\u1ec7. Th\u1eadn tr\u1ecdng khi d\u00f9ng penicillin cho ng\u01b0\u1eddi b\u1ec7nh hen ph\u1ebf qu\u1ea3n.
      \nN\u1ed3ng \u0111\u1ed9 cao trong d\u1ecbch n\u00e3o t\u1ee7y c\u00f3 th\u1ec3 g\u00e2y co gi\u1eadt. C\u1ea7n ch\u00fa \u00fd 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: cho d\u00f9ng 75% li\u1ec1u th\u00f4ng th\u01b0\u1eddng.
      \nM\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 10 mL\/ph\u00fat: cho d\u00f9ng 20-50% li\u1ec1u th\u00f4ng th\u01b0\u1eddng.<\/p>\n

      R\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i:<\/h4>\n

      D\u1ea1ng ch\u1ebf ph\u1ea9m ch\u1ee9a mu\u1ed1i Na, K khi d\u00f9ng li\u1ec1u cao \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch c\u00f3 th\u1ec3 g\u00e2y thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 c\u00e1c mu\u1ed1i n\u00e0y trong huy\u1ebft thanh. Khi li\u1ec1u d\u00f9ng tr\u00ean 10 tri\u1ec7u \u0111\u01a1n v\u1ecb c\u1ea7n truy\u1ec1n t\u0129nh m\u1ea1ch ch\u1eadm trong h\u01a1n 30 ph\u00fat.
      \nPenicillin c\u00f3 th\u1ec3 t\u0103ng t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng m\u00e1u c\u1ee7a c\u00e1c thu\u1ed1c kh\u00e1ng vitamin K (v\u00ed d\u1ee5 nh\u01b0 acenocoumarol). Do \u0111\u00f3 khi \u0111i\u1ec1u tr\u1ecb penicillin c\u1ea7n l\u01b0u \u00fd theo d\u00f5i INR \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u thu\u1ed1c kh\u00e1ng vitamin K n\u1ebfu c\u1ea7n.<\/p>\n

      2.5. \u00dd ngh\u0129a l\u00e2m s\u00e0ng<\/h3>\n

      Trong b\u1ed1i c\u1ea3nh s\u1eed d\u1ee5ng kh\u00e1ng sinh c\u00f3 xu h\u01b0\u1edbng l\u1ea1m d\u1ee5ng v\u00e0 leo thang nh\u01b0 hi\u1ec7n nay th\u00ec vi\u1ec7c ch\u1ec9 \u0111\u1ecbnh \u0111\u00fang \u0111\u1eafn c\u00e1c kh\u00e1ng sinh c\u1ed5 \u0111i\u1ec3n nh\u01b0 penicillin c\u00f3 \u00fd ngh\u0129a h\u1ebft s\u1ee9c quan tr\u1ecdng. R\u00e0o c\u1ea3n l\u1edbn h\u1ea1n ch\u1ebf vi\u1ec7c s\u1eed d\u1ee5ng penicillin ch\u00ednh l\u00e0 nh\u1eadn th\u1ee9c v\u1ec1 nguy c\u01a1 d\u1ecb \u1ee9ng penicillin. Khai th\u00e1c ch\u00ednh x\u00e1c ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng c\u00f9ng v\u1edbi vi\u1ec7c th\u1eed test da penicillin s\u1ebd gi\u00fap ng\u01b0\u1eddi th\u1ea7y thu\u1ed1c c\u00f3 th\u00eam c\u0103n c\u1ee9 x\u00e1c \u0111\u00e1ng \u0111\u1ec3 ch\u1ec9 \u0111\u1ecbnh kh\u00e1ng sinh n\u00e0y. Vi\u1ec7c th\u1ef1c hi\u1ec7n y l\u1ec7nh truy\u1ec1n li\u00ean t\u1ee5c c\u0169ng nh\u01b0 ti\u00eam c\u00e1ch qu\u00e3ng penicillin \u0111\u00f2i h\u1ecfi c\u01a1 s\u1edf y t\u1ebf ph\u1ea3i c\u00f3 s\u1ef1 chu\u1ea9n b\u1ecb nh\u1ea5t \u0111\u1ecbnh v\u1ec1 trang thi\u1ebft b\u1ecb c\u0169ng nh\u01b0 nh\u00e2n l\u1ef1c.<\/p>\n","protected":false},"excerpt":{"rendered":"

      \u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n nh\u1eb1m v\u00e0o c\u0103n nguy\u00ean vi khu\u1ea9n g\u00e2y b\u1ec7nh v\u00e0 m\u1ee9c \u0111\u1ed9 \u0111\u1ec1 kh\u00e1ng c\u1ee7a vi khu\u1ea9n t\u1ea1i t\u1eebng c\u01a1 s\u1edf. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c vi khu\u1ea9n g\u00e2y b\u1ec7nh r\u1ea5t quan tr\u1ecdng, c\u00f3 \u1ea3nh h\u01b0\u1edfng r\u1ea5t l\u1edbn \u0111\u1ebfn di\u1ec5n bi\u1ebfn qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. […]<\/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":"\n\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m. 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