{"id":25191,"date":"2023-04-25T12:32:35","date_gmt":"2023-04-25T05:32:35","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25191"},"modified":"2023-04-29T10:25:26","modified_gmt":"2023-04-29T03:25:26","slug":"viem-tieu-phe-quan-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/25\/viem-tieu-phe-quan-o-tre-em\/","title":{"rendered":"Vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n \u1edf tr\u1ebb em"},"content":{"rendered":"

Vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n l\u00e0 b\u1ec7nh h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh r\u1ea5t hay g\u1eb7p \u1edf tr\u1ebb c\u00f2n b\u00fa, v\u00e0o m\u00f9a \u0111\u00f4ng xu\u00e2n, th\u1eddi ti\u1ebft \u1ea9m. T\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n c\u1ee7a vi\u00eam ph\u1ebf qu\u1ea3n c\u1ea5p t\u00ednh l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam xu\u1ea5t ti\u1ebft, ph\u00f9 n\u1ec1 ni\u00eam m\u1ea1c ph\u1ebf qu\u1ea3n lan r\u1ed9ng v\u00e0 h\u1eadu qu\u1ea3 l\u00e0 t\u1eafc h\u1eb9p \u0111\u01b0\u1eddng th\u1edf nh\u1ecf c\u00f3 \u0111\u01b0\u1eddng k\u00ednh <2mm l\u00e0m tr\u1ebb kh\u00f3 th\u1edf, t\u00edm t\u00e1i, n\u1ebfu kh\u00f4ng ph\u00e1t hi\u1ec7n k\u1ecbp th\u1eddi, \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c tr\u1ebb c\u00f3 th\u1ec3 t\u1eed vong.<\/strong><\/p>\n

1. Nguy\u00ean nh\u00e2n vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n<\/h2>\n

1.1. T\u00e1c nh\u00e2n nhi\u1ec5m tr\u00f9ng<\/h3>\n
    \n
  • Virus h\u1ee3p b\u00e0o h\u00f4 h\u1ea5p (RSV) chi\u1ebfm 30-50% c\u00e1c tr\u01b0\u1eddng h\u1ee3p.<\/li>\n
  • Virus c\u00fam v\u00e0 \u00e1 c\u00fam (25%)<\/li>\n
  • Virus Adenovirus (10%)<\/li>\n
  • Virus Entero<\/li>\n
  • Virus Rhino<\/li>\n<\/ul>\n

    N\u1ebfu b\u1ecb b\u1ed9i nhi\u1ec5m th\u00eam c\u00e1c vi khu\u1ea9n, b\u1ec7nh c\u00e0ng n\u1eb7ng h\u01a1n<\/p>\n

    1.2. Y\u1ebfu t\u1ed1 nguy c\u01a1<\/h3>\n
      \n
    • Tr\u1ebb n\u1eb1m trong v\u1ee5 d\u1ecbch c\u00fam hay vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean do VRS.<\/span><\/li>\n
    • Tr\u1ebb b\u1ecb \u1ed1m do nhi\u1ec5m virus tr\u01b0\u1edbc \u0111\u00f3 (vi\u00eam m\u0169i h\u1ecdng, amydal, vi\u00eam VA v.v…)<\/li>\n
    • Tu\u1ed5i nh\u1ecf < 6 th\u00e1ng<\/li>\n
    • Tr\u1ebb \u0111\u1ebb non<\/li>\n
    • Tr\u1ebb kh\u00f4ng \u0111\u01b0\u1ee3c b\u00fa m\u1eb9 \u0111\u1ea7y \u0111\u1ee7<\/li>\n
    • Tr\u1ebb b\u1ecb suy dinh d\u01b0\u1ee1ng<\/li>\n
    • H\u00fat thu\u1ed1c l\u00e1 b\u1ecb \u0111\u1ed9ng<\/li>\n
    • B\u1ec7nh\u00a0tim b\u1ea9m sinh<\/li>\n
    • B\u1ec7nh ph\u1ed5i b\u1ea9m sinh, B\u1ec7nh x\u01a1 nang, lo\u1ea1n s\u1ea3n ph\u1ebf qu\u1ea3n ph\u1ed5i<\/li>\n
    • Suy gi\u1ea3m mi\u1ec5n d\u1ecbch<\/li>\n<\/ul>\n

      2. C\u01a1 ch\u1ebf b\u1ec7nh sinh vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n<\/h2>\n

      T\u1ed5n th\u01b0\u01a1ng ch\u00ednh l\u00e0 vi\u00eam t\u1eafc c\u00e1c ph\u1ebf qu\u1ea3n nh\u1ecf, th\u00e0nh ph\u1ebf qu\u1ea3n nh\u1ecf, th\u00e0nh ph\u1ebf qu\u1ea3n d\u00e0y l\u00ean ( do ph\u00f9 n\u1ec1, th\u00e2m nhi\u1ec5m t\u1ebf b\u00e0o lympho, c\u00f3 th\u1ec3 do s\u1ef1 sinh s\u1ea3n mau ch\u00f3ng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o), c\u00e1c ph\u1ebf qu\u1ea3n b\u1ecb t\u1eafc h\u1eb9p.<\/p>\n

      Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 th\u1ec3 t\u1ed5n th\u01b0\u01a1ng c\u00e1c bi\u1ec3u m\u00f4 ph\u1ebf nang. Nh\u1eefng t\u1ed5n th\u01b0\u01a1ng n\u00e0y th\u01b0\u1eddng c\u00f3 \u0111\u1eb7c t\u00ednh lan to\u1ea3 to\u00e0n c\u00e1c v\u00f9ng ph\u1ed5i. Ngo\u00e0i ra do t\u1eafc h\u1eb9p c\u00e1c ph\u1ebf qu\u1ea3n nh\u1ecf n\u00ean khi tr\u1ebb g\u1eafng s\u1ee9c th\u1edf v\u00e0o, kh\u00f4ng kh\u00ed c\u00f3 th\u1ec3 v\u00e0o \u0111\u01b0\u1ee3c c\u00e1c ph\u1ebf nang, nh\u01b0ng \u1edf th\u00ec th\u1edf ra \u0111\u01b0\u1eddng th\u1edf h\u1eb9p, th\u1edf y\u1ebfu kh\u00f4ng kh\u00ed b\u1ecb \u1ee9 \u0111\u1ecdng trong ph\u1ebf nang nhi\u1ec1u g\u00e2y hi\u1ec7n t\u01b0\u1ee3ng kh\u00ed ph\u1ebf th\u0169ng.<\/p>\n

      C\u00f3 nh\u1eefng v\u00f9ng khi th\u1edf v\u00e0o kh\u00f4ng qua \u0111\u01b0\u1ee3c do b\u1ecb t\u1eafc ngh\u1ebdn nhi\u1ec1u v\u00e0 g\u00e2y x\u1eb9p ph\u1ed5i.<\/p>\n

      Nh\u01b0 v\u1eady, ngo\u00e0i hi\u1ec7n t\u01b0\u1ee3ng vi\u00eam t\u1eafc ph\u1ebf qu\u1ea3n, t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu b\u1ec7nh c\u00f2n th\u1ea5y kh\u00ed ph\u1ebf th\u0169ng v\u00e0 x\u1eb9p ph\u1ed5i.<\/p>\n

      \"C\u01a1
      C\u01a1 ch\u1ebf b\u1ec7nh sinh vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n<\/figcaption><\/figure>\n

      3. Ch\u1ea9n \u0111o\u00e1n vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n<\/h2>\n

      L\u00e2m s\u00e0ng c\u00f3 gi\u00e1 tr\u1ecb g\u1ee3i \u00fd, kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n d\u1ef1a tr\u00ean nu\u00f4i c\u1ea5y ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c virus.<\/p>\n

      3.1. Ti\u00eau chu\u1ea9n l\u00e2m s\u00e0ng<\/h3>\n

      – Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng v\u00e0 to\u00e0n th\u00e2n<\/p>\n

        \n
      • Ho, ch\u1ea3y n\u01b0\u1edbc m\u0169i trong, s\u1ed1t v\u1eeba ho\u1eb7c cao.<\/li>\n
      • Th\u1ec3 nh\u1eb9: nh\u1eefng bi\u1ec3u hi\u1ec7n vi\u00eam long thuy\u00ean gi\u1ea3m sau v\u00e0i ba ng\u00e0y.<\/li>\n
      • Th\u1ec3 n\u1eb7ng: kh\u00f2 kh\u00e8 t\u0103ng, kh\u00f4ng b\u00fa \u0111\u01b0\u1ee3c, d\u1ec5 ki\u1ec7t s\u1ee9c.<\/li>\n
      • Sau 3-5 ng\u00e0y ho t\u0103ng l\u00ean, xu\u1ea5t hi\u1ec7n kh\u00f3 th\u1edf, th\u1edf r\u00edt, c\u00f3 th\u1ec3 n\u1eb7ng th\u00ec t\u00edm t\u00e1i, ng\u1eebng th\u1edf.<\/li>\n<\/ul>\n

        – Th\u0103m kh\u00e1m<\/p>\n

          \n
        • Nh\u1ecbp th\u1edf nhanh<\/li>\n
        • S\u1ed1t v\u1eeba<\/li>\n
        • Co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p, r\u00fat l\u00f5m l\u1ed3ng ng\u1ef1c, th\u1edf r\u00ean<\/li>\n
        • Ran r\u00edt, ran ng\u00e1y, th\u00f4ng kh\u00ed ph\u1ed5i k\u00e9m<\/li>\n
        • Hi\u1ec7n t\u01b0\u1ee3ng \u1ee9 kh\u00ed, l\u1ed3ng ng\u1ef1c c\u0103ng \u0111\u1ea9y c\u01a1 ho\u00e0nh xu\u1ed1ng th\u1ea5p, c\u00f3 th\u1ec3 s\u1edd th\u1ea5y gan l\u00e1ch.<\/li>\n<\/ul>\n

          3.2. Ti\u00eau chu\u1ea9n c\u1eadn l\u00e2m s\u00e0ng<\/h3>\n
            \n
          • C\u00f4ng th\u1ee9c m\u00e1u ngo\u1ea1i vi: s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u gi\u1ea3m ho\u1eb7c b\u00ecnh th\u01b0\u1eddng, hay t\u0103ng t\u1ef7 l\u1ec7 lympho.<\/li>\n
          • Kh\u00ed m\u00e1u: PaO2 gi\u1ea3m; PaCO2 t\u0103ng; Nhi\u1ec5m toan h\u00f4 h\u1ea5p k\u00e8m theo, c\u00f3 gi\u00e1 tr\u1ecb \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a suy h\u00f4 h\u1ea5p.<\/li>\n
          • X-quang ph\u1ed5i: h\u00ecnh \u1ea3nh m\u1edd lan t\u1ecfa, \u1ee9 kh\u00ed, x\u1eb9p ph\u1ed5i t\u1eebng v\u00f9ng v.v…<\/li>\n
          • X\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n virus: trong d\u1ecbch ti\u1ebft \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p ho\u1eb7c trong t\u1ed5 ch\u1ee9c ph\u1ed5i ho\u1eb7c ph\u1ea3n \u1ee9ng huy\u1ebft thanh (ELISA).<\/li>\n<\/ul>\n

            3.3. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h3>\n
              \n
            • Hen ph\u1ebf qu\u1ea3n: r\u1ea5t kh\u00f3 ph\u00e2n bi\u1ec7t v\u1edbi nh\u1eefng c\u01a1n hen \u0111\u1ea7u<\/li>\n
            • Vi\u00eam ph\u1ed5i do vi khu\u1ea9n ho\u1eb7c virus<\/li>\n
            • M\u1ec1m s\u1ee5n thanh kh\u00ed qu\u1ea3n<\/li>\n
            • Ch\u00e8n \u00e9p kh\u00ed ph\u1ebf qu\u1ea3n t\u1eeb ngo\u00e0i v\u00e0o (m\u1ea1ch m\u00e1u)<\/li>\n
            • T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p \u1edf trong: u, u m\u1ea1ch m\u00e1u, h\u1eb9p kh\u00ed qu\u1ea3n<\/li>\n
            • D\u1ecb v\u1eadt \u0111\u01b0\u1eddng th\u1edf<\/li>\n
            • Tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n<\/li>\n
            • Kh\u00f3 th\u1edf th\u1ee9 ph\u00e1t sau nhi\u1ec5m virus.<\/li>\n<\/ul>\n

              4. Bi\u1ebfn ch\u1ee9ng<\/h2>\n

              4.1. Bi\u1ebfn ch\u1ee9ng g\u1ea7n<\/h3>\n
                \n
              • Suy th\u1edf c\u1ea5p<\/li>\n
              • Tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i<\/li>\n
              • Vi\u00eam ph\u1ed5i – trung th\u1ea5t – X\u1eb9p ph\u1ed5i<\/li>\n
              • T\u1eed vong<\/li>\n<\/ul>\n

                4.2. Bi\u1ebfn ch\u1ee9ng xa<\/h3>\n
                  \n
                • R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p<\/li>\n
                • Xu\u1ea5t hi\u1ec7n t\u1eebng c\u01a1n kh\u00f3 th\u1edf ra t\u00e1i ph\u00e1t<\/li>\n
                • Vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n lan t\u1ecfa<\/li>\n<\/ul>\n

                  5. X\u1eed tr\u00ed vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n<\/h2>\n

                  5.1. X\u1eed tr\u00ed c\u1ea5p c\u1ee9u th\u1ec3 n\u1eb7ng (C\u00f3 suy h\u00f4 h\u1ea5p c\u1ea5p)<\/h3>\n

                  – Li\u1ec7u ph\u00e1p Oxygen (FiO2 100% sau \u0111\u00f3 gi\u1ea3m d\u1ea7n)
                  \n– H\u00fat th\u00f4ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean, t\u01b0\u00a0th\u1ebf fowler
                  \n– Thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n \u0111\u01b0\u1eddng kh\u00ed dung \u1ea9m (thu\u1ed1c nh\u00f3m k\u00edch th\u00edch Adrenergic nh\u01b0 Salbutamol. Li\u1ec1u 0,15 mg\/kg\/l\u1ea7n) ho\u1eb7c Adrenalin 0,4-0,5 ml\/kg\/ l\u1ea7n.
                  \n– Truy\u1ec1n n\u01b0\u1edbc, \u0111i\u1ec7n gi\u1ea3i, cung c\u1ea5p \u0111\u1ee7 theo nhu c\u1ea7u b\u00f9 l\u01b0\u1ee3ng b\u1ecb thi\u1ebfu h\u1ee5t.
                  \n– Khi suy th\u1edf kh\u00f4ng c\u1ea3i thi\u1ec7n: th\u1edf NCPAP, \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n, h\u00f4 h\u1ea5p h\u1ed7 tr\u1ee3 – theo d\u00f5i \u1edf trung t\u00e2m h\u1ed3i s\u1ee9c.
                  \n– Ph\u1ed1i h\u1ee3p v\u1eadt l\u00fd tr\u1ecb li\u1ec7u h\u00f4 h\u1ea5p, v\u1ed7 rung gi\u1ea3i tho\u00e1t \u0111\u1eddm khi kh\u00f4ng c\u00f3 suy th\u1edf.
                  \n– Ch\u1ec9 s\u1eed d\u1ee5ng kh\u00e1ng sinh tr\u01b0\u1eddng h\u1ee3p c\u00f3 bi\u1ec3u hi\u1ec7n nhi\u1ec5m vi khu\u1ea9n th\u1ee9 ph\u00e1t.
                  \n– \u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u antivirus b\u1eb1ng Ribavirin (n\u1ebfu c\u00f3).
                  \n– C\u00e2n nh\u1eafc khi s\u1eed d\u1ee5ng Corticoid n\u1ebfu c\u1ea7n thi\u1ebft c\u00f3 th\u1ec3 d\u00f9ng Methylprenisolon 2 mg\/kg\/24h.<\/p>\n

                  5.2. \u0110i\u1ec1u tr\u1ecb c\u00e1c th\u1ec3 th\u00f4ng th\u01b0\u1eddng: (Kh\u00f4ng c\u00f3 suy h\u00f4 h\u1ea5p)<\/h3>\n

                  – H\u00fat th\u00f4ng \u0111\u01b0\u1eddng th\u1edf, gi\u1ea3i ph\u00f3ng c\u00e1c ch\u1ea5t xu\u1ea5t ti\u1ebft.
                  \n– Kh\u00ed dung \u1ea9m thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n t\u00e1c d\u1ee5ng nhanh nh\u01b0 salbutamol (0,15 mg l\u1ea7n\/kg) khi c\u00f3 co th\u1eaft ph\u1ebf qu\u1ea3n hay th\u1edf r\u00edt.
                  \n– B\u00f9 \u0111\u1ee7 d\u1ecbch v\u00e0 \u0111i\u1ec7n gi\u1ea3i theo nhu c\u1ea7u v\u00e0 thi\u1ebfu h\u1ee5t do th\u1edf nhanh, s\u1ed1t, n\u00f4n – V\u1eadt l\u00fd tr\u1ecb li\u1ec7u h\u00f4 h\u1ea5p, v\u1ed7 rung, h\u00fat \u0111\u1eddm.
                  \n– \u0102n u\u1ed1ng \u0111\u1ee7 ch\u1ea5t.
                  \n– R\u1ea5t c\u00e2n nh\u1eafc khi s\u1eed d\u1ee5ng kh\u00e1ng sinh.<\/p>\n

                  6. D\u1ef1 ph\u00f2ng<\/h2>\n

                  – Ch\u01b0a c\u00f3 vaccin \u0111\u1eb7c hi\u1ec7u cho t\u1ea5t c\u1ea3 c\u00e1c c\u0103n nguy\u00ean. Tuy nhi\u00ean c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng m\u1ed9t s\u1ed1 ch\u1ebf ph\u1ea9m kh\u00e1ng th\u1ec3 kh\u00e1ng virus nh\u01b0: Respigam (Intravenons Gamma Globulin), synagis l\u00e0 kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng, ti\u00eam b\u1eafp, kh\u00e1ng RSV.
                  \n– C\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba kh\u00f4ng \u0111\u1eb7c hi\u1ec7u.
                  \n– H\u1ea1n ch\u1ebf ti\u1ebfp x\u00fac ng\u01b0\u1eddi b\u1ec7nh, bi\u1ec7n ph\u00e1p c\u00e1ch ly khi c\u00f3 b\u1ec7nh.
                  \n– R\u1eeda tay th\u01b0\u1eddng xuy\u00ean, kh\u00f4ng h\u00fat thu\u1ed1c l\u00e1.
                  \n– B\u00fa m\u1eb9 \u0111\u1ea7y \u0111\u1ee7.<\/p>\n","protected":false},"excerpt":{"rendered":"

                  Vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n l\u00e0 b\u1ec7nh h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh r\u1ea5t hay g\u1eb7p \u1edf tr\u1ebb c\u00f2n b\u00fa, v\u00e0o m\u00f9a \u0111\u00f4ng xu\u00e2n, th\u1eddi ti\u1ebft \u1ea9m. T\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n c\u1ee7a vi\u00eam ph\u1ebf qu\u1ea3n c\u1ea5p t\u00ednh l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam xu\u1ea5t ti\u1ebft, ph\u00f9 n\u1ec1 ni\u00eam m\u1ea1c ph\u1ebf qu\u1ea3n lan r\u1ed9ng v\u00e0 h\u1eadu qu\u1ea3 l\u00e0 t\u1eafc h\u1eb9p \u0111\u01b0\u1eddng […]<\/p>\n","protected":false},"author":39,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1,15,33],"tags":[],"yoast_head":"\nVi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n \u1edf tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n l\u00e0 b\u1ec7nh h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh r\u1ea5t hay g\u1eb7p \u1edf tr\u1ebb c\u00f2n b\u00fa, v\u00e0o m\u00f9a \u0111\u00f4ng xu\u00e2n, th\u1eddi ti\u1ebft \u1ea9m. 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