{"id":25725,"date":"2023-04-21T12:15:37","date_gmt":"2023-04-21T05:15:37","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25725"},"modified":"2023-04-21T12:22:54","modified_gmt":"2023-04-21T05:22:54","slug":"cap-nhat-dieu-tri-hoi-suc-benh-nhan-viem-tuy-cap-nang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/cap-nhat-dieu-tri-hoi-suc-benh-nhan-viem-tuy-cap-nang\/","title":{"rendered":"C\u1eadp nh\u1eadt \u0111i\u1ec1u tr\u1ecb h\u1ed3i s\u1ee9c b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng"},"content":{"rendered":"<p><strong>Vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 b\u1ec7nh l\u00fd vi\u00eam c\u1ee7a tuy\u1ebfn t\u1ee5y ngo\u1ea1i ti\u1ebft, c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n t\u1eeb ph\u00f9 n\u1ec1 nh\u1eb9 t\u1edbi vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed n\u1eb7ng. Vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n n\u1ed9i vi\u1ec7n v\u1edbi t\u1ec9 l\u1ec7 m\u1eafc m\u1edbi kho\u1ea3ng 34 tr\u00ean 100,000 ng\u01b0\u1eddi tr\u00ean to\u00e0n c\u1ea7u. Vi\u00eam t\u1ee5y c\u1ea5p nh\u1eb9 c\u00f3 th\u1ec3 t\u1ef1 kh\u1ecfi trong v\u00f2ng v\u00e0i ng\u00e0y t\u1edbi 1 tu\u1ea7n, chi\u1ebfm 80% b\u1ec7nh nh\u00e2n, ch\u1ec9 15 &#8211; 20% di\u1ec5n ti\u1ebfn n\u1eb7ng. Suy t\u1ea1ng tho\u00e1ng qua v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng t\u1ea1i ch\u1ed7 ch\u1ec9 x\u1ea3y ra v\u1edbi vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng v\u1eeba.\u00a0<\/strong><\/p>\n<h2>1. Ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u1ee5y c\u1ea5p.<\/h2>\n<p>Ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u1ee5y c\u1ea5p khi th\u1ecfa 2\/3 ti\u00eau chu\u1ea9n:<\/p>\n<ul>\n<li>\u0110au b\u1ee5ng<\/li>\n<li>T\u0103ng amylase v\u00e0\/ho\u1eb7c lipase g\u1ea5p 3 l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean.<\/li>\n<li><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/chan-doan-viem-tuy-cap-can-lam-nhung-xet-nghiem-nao\/\">H\u00ecnh \u1ea3nh h\u1ecdc g\u1ee3i \u00fd vi\u00eam t\u1ee5y c\u1ea5p<\/a>.<\/li>\n<\/ul>\n<p>Tri\u1ec7u ch\u1ee9ng \u0111au \u0111i\u1ec3n h\u00ecnh c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 \u0111au \u0111\u1ed9t ng\u1ed9t, d\u1eef d\u1ed9i, li\u00ean t\u1ee5c v\u00f9ng th\u01b0\u1ee3ng v\u1ecb lan ra sau l\u01b0ng. C\u00f3 th\u1ec3 k\u00e8m theo bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n. T\u01b0 th\u1ebf g\u1eadp ng\u01b0\u1eddi v\u00e0o th\u00e2n (c\u00f2 s\u00fang) l\u00e0m gi\u1ea3m \u0111au. Kh\u1edfi ph\u00e1t sau m\u1ed9t b\u1eefa \u0103n th\u1ecbnh so\u1ea1n ho\u1eb7c u\u1ed1ng nhi\u1ec1u r\u01b0\u1ee3u.<\/p>\n<p>Kh\u00e1m l\u00e2m s\u00e0ng: c\u00f3 th\u1ec3 \u0111\u1ec1 kh\u00e1ng th\u00e0nh b\u1ee5ng, d\u1ea5u Cullen v\u00e0 Grey Turner g\u1ee3i \u00fd vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng v\u00e0 t\u1ec9 l\u1ec7 t\u1eed vong t\u1edbi 37%.<\/p>\n<p>Amylase v\u00e0 lipase l\u00e0 marker vi\u00eam t\u1ee5y c\u1ea5p th\u01b0\u1eddng d\u00f9ng trong l\u00e2m s\u00e0ng nh\u1ea5t. Gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a amylase t\u1eeb 100 &#8211; 300 U\/L, c\u1ee7a lipase t\u1eeb 50 &#8211; 160 U\/L. Amylase th\u01b0\u1eddng t\u0103ng trong v\u00f2ng v\u00e0i gi\u1edd sau kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng v\u00e0 v\u1ec1 b\u00ecnh th\u01b0\u1eddng trong 3 &#8211; 5 ng\u00e0y. C\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng \u1edf 1\/5 b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p. Lipase huy\u1ebft thanh \u0111\u1eb7c hi\u1ec7u h\u01a1n v\u00e0 t\u0103ng k\u00e9o d\u00e0i h\u01a1n so v\u1edbi amylase trong vi\u00eam t\u1ee5y c\u1ea5p.<\/p>\n<ul>\n<li>Amylase c\u00f3 th\u1ec3 t\u0103ng gi\u1ea3 trong th\u1ee7ng ru\u1ed9t, nh\u1ed3i m\u00e1u m\u1ea1c treo, t\u1eafc ru\u1ed9t, ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng, vi\u00eam ru\u1ed9t th\u1eeba, vi\u00eam t\u00fai m\u1eadt, lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng, t\u1eafc m\u1eadt, b\u1ec7nh tuy\u1ebfn n\u01b0\u1edbc b\u1ecdt, b\u1ec7nh ph\u1ee5 khoa.<\/li>\n<li>Lipase c\u00f3 th\u1ec3 t\u0103ng gi\u1ea3 trong c\u00e1c b\u1ec7nh l\u00fd ru\u1ed9t, t\u00fai m\u1eadt, vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng, v\u00e0 b\u1ec7nh th\u1eadn.<\/li>\n<\/ul>\n<p>C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c nh\u01b0 c\u00f4ng th\u1ee9c m\u00e1u, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, BUN, creatinine huy\u1ebft thanh, men gan, \u0111\u00f4ng m\u00e1u, albumin, calci m\u00e1u, triglycerid gi\u00fap ph\u00e2n bi\u1ec7t c\u00e1c nguy\u00ean nh\u00e2n t\u0103ng men t\u1ee5y.<\/p>\n<h2>2. Ph\u00e2n \u0111\u1ed9 n\u1eb7ng m\u1ee9c \u0111\u1ed9 vi\u00eam t\u1ee5y c\u1ea5p.<\/h2>\n<p>Hi\u1ec7n nay c\u00f3 t\u1edbi 20 thang \u0111i\u1ec3m kh\u00e1c nhau \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n \u0111\u1ec3 ti\u00ean l\u01b0\u1ee3ng m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p.<\/p>\n<ul>\n<li>M\u1ed9t trong c\u00e1c thang th\u01b0\u1eddng d\u00f9ng nh\u1ea5t l\u00e0 ti\u00eau chu\u1ea9n Ranson, gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n d\u01b0\u01a1ng l\u00e0 49%, \u0111\u1ed9 nh\u1ea1y 75%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 77% v\u00e0 gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n \u00e2m t\u00ednh 91% trong d\u1ef1 \u0111o\u00e1n vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng. \u0110i\u1ec3m y\u1ebfu ch\u00ednh c\u1ee7a Ranson l\u00e0 ch\u1ec9 t\u00ednh \u0111\u01b0\u1ee3c sau 48h nh\u1eadp vi\u1ec7n, c\u00e1c quy\u1ebft \u0111\u1ecbnh l\u00e2m s\u00e0ng \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a ra r\u1ed3i.<\/li>\n<li>Thang \u0111i\u1ec3m APACHE l\u00e0 thang \u0111i\u1ec3m ti\u00ean l\u01b0\u1ee3ng t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n ICU n\u00f3i chung. Phi\u00ean b\u1ea3n ch\u00ednh x\u00e1c nh\u1ea5t l\u00e0 APACHE IV, g\u1ed3m 52 bi\u1ebfn s\u1ed1, bao g\u1ed3m: bilirubin, albumin, tr\u1ea1ng th\u00e1i an th\u1ea7n, c\u00e1c v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe m\u1ea1n t\u00ednh.<\/li>\n<li>BISAP: gi\u00fap ti\u00ean l\u01b0\u1ee3ng nguy c\u01a1 t\u1eed vong trong v\u00f2ng 24h nh\u1eadp vi\u1ec7n.<\/li>\n<li>Balthazar&#8217;s: d\u1ef1a v\u00e0o h\u00ecnh \u1ea3nh CT scan.<\/li>\n<li>CRP &gt;150mg\/L trong 72h \u0111\u1ea7u li\u00ean quan v\u1edbi ho\u1ea1i t\u1eed t\u1ee5y.<\/li>\n<\/ul>\n<h2>3. X\u1ee9 tr\u00ed h\u1ed3i s\u1ee9c ng\u01b0\u1eddi b\u1ec7nh vi\u00eam t\u1ee5y c\u1ea5p.<\/h2>\n<h3>3.1. H\u1ed7 tr\u1ee3 to\u00e0n th\u00e2n.<\/h3>\n<p>Theo Hi\u1ec7p h\u1ed9i h\u1ed3i s\u1ee9c c\u1ea5p c\u1ee9u SCCM, ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n nh\u1eadp ICU khi c\u00f3 1 trong c\u00e1c ti\u00eau chu\u1ea9n: t\u1ea7n s\u1ed1 tim &lt;40 ho\u1eb7c &gt;150 l\u1ea7n\/ph\u00fat, huy\u1ebft \u00e1p (HA) t\u00e2m thu &lt;80mmHg, HA trung b\u00ecnh &lt;60mmHg, HA t\u00e2m tr\u01b0\u01a1ng &gt;120mmHg, t\u1ea7n s\u1ed1 th\u1edf &gt;35 l\u1ea7n\/ph\u00fat, Na &lt;110mmol\/L ho\u1eb7c &gt;170, K &lt;2 ho\u1eb7c &gt;7 mmol\/L, PaO2 &lt;50 mmHg, pH &lt;7.1 ho\u1eb7c &gt;7.7, glucose &gt;800mg\/dL, Ca &gt;15mg\/dL, v\u00f4 ni\u1ec7u ho\u1eb7c h\u00f4n m\u00ea. B\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng theo Atlanta 2012 c\u0169ng c\u1ea7n nh\u1eadp ICU.<\/p>\n<p>H\u1ed3i s\u1ee9c d\u1ecbch l\u00e0 n\u1ec1n t\u1ea3ng trong x\u1eed tr\u00ed vi\u00eam t\u1ee5y c\u1ea5p v\u00ec c\u00f3 gi\u1ea3m th\u1ec3 t\u00edch do m\u1ea5t d\u1ecbch v\u00e0o khoang th\u1ee9 3, n\u00f4n, gi\u1ea3m \u0103n u\u1ed1ng, t\u0103ng m\u1ea5t qua h\u00f4 h\u1ea5p. M\u1ee5c ti\u00eau b\u00f9 d\u1ecbch ban \u0111\u1ea7u 5 &#8211; 10 mL\/kg\/h. \u1ede ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n, t\u1ed5ng 2.5 &#8211; 4L trong 24h \u0111\u1ea7u c\u00f3 th\u1ec3 b\u00f9 \u0111\u1ee7 d\u1ecbch ch\u1ecd b\u1ec7nh nh\u00e2n. Nhu c\u1ea7u d\u1ecbch c\u1ea7n \u0111\u00e1nh gi\u00e1 6h \u0111\u1ea7u v\u00e0 m\u1ed7i 24 &#8211; 48h sau nh\u1eadp vi\u1ec7n.<\/p>\n<p>\u0110\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng b\u00f9 d\u1ecbch b\u1eb1ng th\u00f4ng s\u1ed1 l\u00e2m s\u00e0ng nh\u01b0 t\u1ea7n s\u1ed1 tim &lt;120 l\u1ea7n\/ph\u00fat, MAP 65 &#8211; 85mmHg, n\u01b0\u1edbc ti\u1ec3u &gt; 0.5 &#8211; 1 mL\/kg\/h, hematocrit 35 &#8211; 44%, gi\u1ea3m BUN, b\u00ecnh th\u01b0\u1eddng h\u00f3a creatinine.<\/p>\n<p>Lactate Ringer&#8217;s \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o nhi\u1ec1u h\u01a1n n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd.<\/p>\n<h3>3.2. X\u1eed tr\u00ed suy ch\u1ee9c n\u0103ng ph\u1ed5i.<\/h3>\n<p>T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i c\u1ea5p (ALI) v\u00e0 h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (ARDS) x\u1ea3y ra \u1edf 10 &#8211; 25% tr\u01b0\u1eddng h\u1ee3p vi\u00eam t\u1ee5y c\u1ea5p v\u00e0 li\u00ean quan t\u1edbi 60% t\u1eed vong. Bi\u1ebfn ch\u1ee9ng ph\u1ed5i th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong vi\u00eam t\u1ee5y c\u1ea5p. H\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n (SIRS) g\u00e2y t\u0103ng t\u00ednh th\u1ea5m n\u1ed9i m\u00f4 mao m\u1ea1ch ph\u1ed5i, xu\u1ea5t ti\u1ebft d\u1ecbch v\u00e0o ph\u1ebf nang v\u00e0 m\u00f4 k\u1ebd, d\u1eabn t\u1edbi ph\u00f9 ph\u1ebf nang, gi\u1ea3i ph\u00f3ng cytokine th\u1ea5m nh\u1eadp b\u1ea1ch c\u1ea7u d\u1eabn t\u1edbi t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 ph\u1ed5i. Nhi\u1ec5m khu\u1ea9n c\u0169ng c\u00f3 th\u1ec3 th\u00fac \u0111\u1ea9y ARDS.<\/p>\n<p>X\u1eed tr\u00ed: Theo d\u00f5i t\u00ecnh tr\u1ea1ng oxy m\u00e1u v\u00e0 cho th\u1edf oxy khi c\u1ea7n. \u0110i\u1ec1u tr\u1ecb tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i khi c\u00f3 tri\u1ec7u ch\u1ee9ng (ch\u1ecdc th\u00e1o d\u1ecbch ho\u1eb7c \u0111\u1eb7t d\u1eabn l\u01b0u khoang m\u00e0ng ph\u1ed5i). N\u1ebfu di\u1ec5n ti\u1ebfn sang ARDS c\u1ea7n \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 th\u1edf m\u00e1y. Th\u1edf m\u00e1y \u00e1p l\u1ef1c d\u01b0\u01a1ng kh\u00f4ng x\u00e2m nh\u1eadp c\u00f3 th\u1ec3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb ARDS do vi\u00eam t\u1ee5y c\u1ea5p.<\/p>\n<h3>3.3. Gi\u1ea3m \u0111au.<\/h3>\n<p>\u0110au l\u00e0 tri\u1ec7u ch\u1ee9ng ch\u00ednh c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p v\u00e0 n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t hi\u1ec7u qu\u1ea3. B<span class=\"fontstyle0\">uprenorphine, pentazocine v\u00e0 metamizole<\/span> trong m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p cho th\u1ea5y hi\u1ec7u qu\u1ea3 v\u01b0\u1ee3t tr\u1ed9i. Morphine v\u1ec1 l\u00fd thuy\u1ebft g\u00e2y co c\u01a1 Oddi. NSAIDs t\u01b0\u01a1ng \u0111\u1ed1i an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3. \u0110au n\u1eb7ng c\u00f3 th\u1ec3 truy\u1ec1n t\u0129nh m\u1ea1ch thu\u1ed1c gi\u1ea3m \u0111au ho\u1eb7c gi\u1ea3m \u0111au ngo\u00e0i m\u00e0ng c\u1ee9ng.<\/p>\n<h3>3.4. Dinh d\u01b0\u1ee1ng cho ng\u01b0\u1eddi b\u1ec7nh vi\u00eam t\u1ee5y c\u1ea5p.<\/h3>\n<p>Quan ni\u1ec7m truy\u1ec1n th\u1ed1ng cho r\u1eb1ng b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p kh\u00f4ng n\u00ean cho th\u1ee9 g\u00ec v\u00e0o mi\u1ec7ng \u0111\u1ec3 c\u01a1 quan vi\u00eam h\u1ed3i ph\u1ee5c. Tuy nhi\u00ean c\u00e1c nghi\u00ean c\u1ee9u ch\u1ec9 ra duy tr\u00ec dinh d\u01b0\u1ee1ng \u0111\u01b0\u1eddng mi\u1ec7ng gi\u00fap b\u1ea3o v\u1ec7 ni\u00eam m\u1ea1c ru\u1ed9t. C\u00e1c khuy\u1ebfn c\u00e1o hi\u1ec7n nay cho r\u1eb1ng n\u00ean cho \u0103n s\u1edbm \u1edf b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p. Theo IAP\/APA, nu\u00f4i \u0103n \u0111\u01b0\u1eddng mi\u1ec7ng n\u00ean b\u1eaft \u0111\u1ea7u trong vi\u00eam t\u1ee5y c\u1ea5p nh\u1eb9 khi c\u1ea3i thi\u1ec7n \u0111au b\u1ee5ng v\u00e0 gi\u1ea3m marker vi\u00eam, kh\u00f4ng c\u1ea7n ch\u1edd b\u00ecnh th\u01b0\u1eddng l\u1ea1i; ch\u1ebf \u0111\u1ed9 \u0103n c\u1ee9ng l\u00e0 an to\u00e0n v\u00e0 r\u00fat ng\u1eafn th\u1eddi gian n\u1eb1m vi\u1ec7n. AGA khuy\u1ebfn c\u00e1o cho \u0103n trong 24 gi\u1edd nh\u1eadp vi\u00ean.<\/p>\n<p>B\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea7n h\u1ed7 tr\u1ee3 dinh d\u01b0\u1ee1ng, cho \u0103n \u0111\u01b0\u1eddng ru\u1ed9t \u01b0u ti\u00ean h\u01a1n \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Do \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch g\u00e2y teo ru\u1ed9t v\u00e0 t\u0103ng t\u00ednh th\u1ea5m ni\u00eam m\u1ea1c; gi\u1ea3m nhu \u0111\u1ed9ng g\u00e2y r\u1ed1i lo\u1ea1n vi khu\u1ea9n ch\u00ed. \u0110\u01b0\u1eddng ru\u1ed9t c\u00f3 th\u1ec3 qua sonde m\u0169i &#8211; d\u1ea1 d\u00e0y ho\u1eb7c m\u0169i &#8211; t\u00e1 tr\u00e0ng.<\/p>\n<h3>3.5. Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng.<\/h3>\n<p>Ph\u1ea7n l\u1edbn t\u00e1c nh\u00e2n nhi\u1ec5m tr\u00f9ng trong vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 c\u00e1c vi khu\u1ea9n gram \u00e2m nh\u01b0 <span class=\"fontstyle0\">Escherichia coli,<br \/>\nPseudomonas, Proteus, <\/span><span class=\"fontstyle0\">Klebseilla, c\u0169ng c\u00f3 th\u1ec3 nhi\u1ec5m t\u00e1c nh\u00e2n kh\u00e1c nh\u01b0 Staphylococcus aureus, Streptococcus faecalis, Enterococcus, k\u1ecb kh\u00ed v\u00e0 n\u1ea5m.\u00a0<\/span><\/p>\n<p>Nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t c\u00f3 th\u1ec3 t\u1eeb \u0111\u01b0\u1eddng m\u00e1u, t\u1eeb t\u00e1 tr\u00e0ng v\u00e0 \u0111\u01b0\u1eddng m\u1eadt ho\u1eb7c th\u1ea5m qua ru\u1ed9t.<\/p>\n<p>Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o th\u01b0\u1eddng quy, n\u00ean d\u00f9ng ngay khi nghi ng\u1edd c\u00f3 nhi\u1ec5m tr\u00f9ng.<\/p>\n<h3>3.6. X\u1eed tr\u00ed ho\u1ea1i t\u1eed v\u00e0 abscess t\u1ee5y.<\/h3>\n<p>Ho\u1ea1i t\u1eed t\u1ee5y nhi\u1ec5m tr\u00f9ng c\u00f3 th\u1ec3 nghi ng\u1edd d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng (l\u00e2m s\u00e0ng x\u1ea5u \u0111i, s\u1ed1t k\u00e9o d\u00e0i, t\u0103ng marker vi\u00eam, c\u00f3 vi khu\u1ea9n trong m\u00e1u) v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc (kh\u00ed trong t\u1ee5 d\u1ecbch trong t\u1ee5y ho\u1eb7c quanh t\u1ee5y tr\u00ean CT c\u1ea3n quang).<\/p>\n<p>Khi c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f3 c\u1ea7n d\u00f9ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng nh\u01b0 quinolones, metronidazole, carbapenem, cephalosporin t\u1eeb th\u1ebf h\u1ec7 th\u1ee9 3. Ch\u1ecdc h\u00fat b\u1eb1ng kim nh\u1ecf, c\u1ea5y \u0111\u1ecbnh danh v\u00e0 l\u00e0m kh\u00e1ng sinh \u0111\u1ed3 c\u00f3 th\u1ec3 gi\u00fap h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb (kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o th\u01b0\u1eddng quy).<\/p>\n<h3><strong>3.7. Th\u1ee7 thu\u1eadt can thi\u1ec7p.<\/strong><\/h3>\n<p>Khi c\u00f3 ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng, chi\u1ebfn l\u01b0\u1ee3c can thi\u1ec7p ban \u0111\u1ea7u t\u1ed1i \u01b0u l\u00e0 d\u1eabn l\u01b0u qua da b\u1eb1ng catheter. N\u1ebfu th\u1ea5t b\u1ea1i chuy\u1ec3n sang ph\u1eabu thu\u1eadt c\u1eaft l\u1ecdc ho\u1ea1i t\u1eed sau ph\u00fac m\u1ea1c x\u00e2m l\u1ea5n t\u1ed1i thi\u1ec3u.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>T\u00e0i li\u1ec7u tham kh\u1ea3o:\u00a0<\/strong><\/p>\n<p>Textbook of critical care, 8th edition, Elsevier.<\/p>\n<div id=\"disease-detail-page-title\">\n<div class=\"mask\">\n<div class=\"container\">\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/benh\/viem-tuy-cap-3005\/\">Vi\u00eam t\u1ee5y c\u1ea5p: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"disease-detail\">\n<div id=\"sticky-wrapper\" class=\"sticky-wrapper\">\n<nav class=\"sticky-nav smooth-scroll-link\">\n<div class=\"container\">\n<p class=\"inner\">\n<\/div>\n<\/nav>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 b\u1ec7nh l\u00fd vi\u00eam c\u1ee7a tuy\u1ebfn t\u1ee5y ngo\u1ea1i ti\u1ebft, c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n t\u1eeb ph\u00f9 n\u1ec1 nh\u1eb9 t\u1edbi vi\u00eam t\u1ee5y ho\u1ea1i t\u1eed n\u1eb7ng. Vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n n\u1ed9i vi\u1ec7n v\u1edbi t\u1ec9 l\u1ec7 m\u1eafc m\u1edbi kho\u1ea3ng 34 tr\u00ean 100,000 ng\u01b0\u1eddi tr\u00ean to\u00e0n c\u1ea7u. [&hellip;]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>C\u1eadp nh\u1eadt \u0111i\u1ec1u tr\u1ecb h\u1ed3i s\u1ee9c b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng - Vinmec<\/title>\n<meta name=\"description\" content=\"80% vi\u00eam t\u1ee5y c\u1ea5p nh\u1eb9 t\u1ef1 v\u00e0 t\u1ef1 kh\u1ecfi, ch\u1ec9 15-20% di\u1ec5n ti\u1ebfn \u0111\u1ebfn vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng. 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