{"id":2610,"date":"2023-04-13T16:00:12","date_gmt":"2023-04-13T09:00:12","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2610"},"modified":"2023-04-13T16:14:42","modified_gmt":"2023-04-13T09:14:42","slug":"chan-doan-ton-thuong-phoi-do-may-tho","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/chan-doan-ton-thuong-phoi-do-may-tho\/","title":{"rendered":"Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf"},"content":{"rendered":"<p><strong>T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf th\u01b0\u1eddng \u0111\u01b0\u1ee3c quan s\u00e1t \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u1edf m\u00e1y v\u00ec h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (Acute respiratory distres syndrome &#8211; ARDS), nh\u01b0ng trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, r\u00f5 r\u00e0ng r\u1eb1ng n\u00f3 c\u0169ng c\u0169ng c\u00f3 th\u1ec3 \u00a0x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u1edf m\u00e1y v\u00ec c\u00e1c l\u00fd do kh\u00e1c ngo\u00e0i ARDS. Do \u0111\u00f3, hi\u1ec3u c\u01a1 ch\u1ebf \u00a0v\u00e0 s\u1edbm c\u00f3 c\u00e1c chi\u1ebfn l\u01b0\u1ee3c \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf c\u00f3 vai tr\u00f2 r\u1ea5t quan tr\u1ecdng trong chi\u1ebfn l\u01b0\u1ee3c can thi\u1ec7p th\u00f4ng kh\u00ed b\u1eb1ng m\u00e1y h\u1ed7 tr\u1ee3.<\/strong><\/p>\n<p>T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf (ventilator-induced lung injury &#8211; VILI) l\u00e0 m\u1ed9t t\u00e1c \u0111\u1ed9ng kh\u00f4ng mong mu\u1ed1n c\u00f3 th\u1ec3 c\u00f3 c\u1ee7a th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o. Th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o \u00e1p l\u1ef1c d\u01b0\u01a1ng t\u1ea1o ra m\u1ed9t m\u1ee9c \u00e1p su\u1ea5t l\u1edbn h\u01a1n \u00e1p su\u1ea5t kh\u00ed quy\u1ec3n v\u00e0 \u0111\u1ea9y kh\u00ed v\u00e0o ph\u1ed5i. \u0110i\u1ec1u n\u00e0y g\u00e2y n\u00ean nh\u1eefng \u00e1p l\u1ef1c kh\u00f4ng sinh l\u00fd l\u00ean h\u1ec7 h\u00f4 h\u1ea5p c\u00f3 th\u1ec3 l\u00e0m h\u01b0 h\u1ecfng c\u1ea5u tr\u00fac c\u1ee7a ph\u1ed5i, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng l\u00e1 ph\u1ed5i b\u1ec7nh l\u00fd. VILI c\u00f3 th\u1ec3 g\u00e2y ra th\u00eam t\u1ed5n th\u01b0\u01a1ng cho m\u00f4 ph\u1ed5i v\u00e0 l\u00e0m t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n tr\u1edf n\u00ean nghi\u00eam tr\u1ecdng h\u01a1n, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1eed vong.<\/p>\n<h2>1. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf<\/h2>\n<p>T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf \u00a0v\u00e0 h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p ti\u1ebfn tri\u1ec3n \u00a0c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng r\u1ea5t gi\u1ed1ng nhau. Trong c\u1ea3 hai tr\u01b0\u1eddng h\u1ee3p, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 tri\u1ec7u ch\u1ee9ng gi\u1ea3m oxy \u00a0m\u00e1u, th\u1edf nhanh v\u00e0 nh\u1ecbp tim nhanh h\u01a1n. \u0110i\u1ec3m kh\u00e1c bi\u1ec7t ch\u00ednh gi\u1eefa VILI v\u00e0 ARDS l\u00e0 VILI ph\u00e1t tri\u1ec3n trong khi b\u1ec7nh nh\u00e2n \u0111ang \u0111\u01b0\u1ee3c th\u1edf m\u00e1y, trong khi ARDS c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau. Tuy nhi\u00ean, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i nh\u1eadn di\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb VILI k\u1ecbp th\u1eddi \u0111\u1ec3 gi\u1ea3m thi\u1ec3u t\u1ed1i \u0111a nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i v\u00e0 c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n n\u00f3i ri\u00eang, s\u1ee9c kh\u1ecfe b\u1ec7nh nh\u00e2n n\u00f3i chung.<\/p>\n<p>B\u1ed1i c\u1ea3nh c\u1ee7a VILI th\u01b0\u1eddng l\u00e0 b\u1ec7nh nh\u00e2n \u0111ang th\u1edf m\u00e1y c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p ti\u1ebfn tri\u1ec3n x\u1ea5u h\u01a1n. Bi\u1ec3u hi\u1ec7n c\u00f3 th\u1ec3 l\u00e0 nhu c\u1ea7u t\u0103ng n\u1ed3ng \u0111\u1ed9 oxy trong kh\u00ed th\u1edf v\u00e0o (FiO2) \u0111\u1ec3 duy tr\u00ec m\u1ee9c oxy m\u00e1u \u0111\u1ea3m b\u1ea3o ch\u1ee9c n\u0103ng c\u1ee7a c\u01a1 th\u1ec3, \u0111o l\u01b0\u1eddng b\u1eb1ng \u0111\u1ed9 b\u00e3o h\u00f2a kh\u00ed oxy trong m\u1ea1ch n\u1ea9y (SpO2) hay \u0111\u1ed9ng m\u1ea1ch (SaO2) ho\u1eb7c \u00e1p l\u1ef1c ri\u00eang ph\u1ea7n c\u1ee7a oxy trong \u0111\u1ed9ng m\u1ea1ch (PaO2). Bi\u1ec3u hi\u1ec7n c\u00f3 th\u1ec3 l\u00e0 t\u0103ng nh\u1ecbp tim kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c hay t\u0103ng nh\u1ecbp th\u1edf \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n cho ph\u00e9p c\u00f3 c\u00e1c nh\u1ecbp th\u1edf t\u1ef1 ph\u00e1t. \u00a0Tr\u00ean phim X-quang ng\u1ef1c, c\u00f3 th\u1ec3 cho th\u1ea5y s\u1ef1 xu\u1ea5t hi\u1ec7n m\u1edbi ho\u1eb7c t\u0103ng l\u00ean c\u1ee7a c\u00e1c v\u00f9ng m\u1edd m\u00f4 k\u1ebd hay c\u00e1c v\u00f9ng ph\u1ed5. D\u1ea5u hi\u1ec7u c\u1ee7a VILI tr\u00ean ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT) r\u1ea5t \u0111a d\u1ea1ng, c\u00f3 th\u1ec3 l\u00e0 h\u00ecnh \u1ea3nh \u0111\u00f4ng \u0111\u1eb7c kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t, x\u1eb9p ph\u1ed5i hay t\u0103ng th\u1ea5u quang do s\u1ef1 c\u0103ng ph\u1ed3ng qu\u00e1 m\u1ee9c c\u1ee7a ph\u1ebf nang. VILI c\u0169ng c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n kh\u1edfi ph\u00e1t g\u00e2y suy t\u1ea1ng m\u1edbi xu\u1ea5t hi\u1ec7n tr\u00ean b\u1ec7nh nh\u00e2n th\u1edf m\u00e1y.<\/p>\n<figure style=\"width: 406px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/pneumoniaresearchnews.com\/wp-content\/uploads\/2017\/03\/shutterstock_158642774-760x475@2x.jpeg\" alt=\"minh-hoa-ton-thuong-phoi-do-may-tho\" width=\"406\" height=\"271\" \/><figcaption class=\"wp-caption-text\">Minh h\u1ecda t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf<\/figcaption><\/figure>\n<h2>2. Ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i tr\u00ean b\u1ec7nh nh\u00e2n th\u1edf m\u00e1y<\/h2>\n<p>T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf l\u00e0 m\u1ed9t ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng, ch\u1ee7 y\u1ebfu d\u1ef1a tr\u00ean c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u1edf tr\u00ean, c\u00f9ng v\u1edbi k\u1ef9 l\u01b0\u1ee3ng lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c c\u00f3 th\u1ec3 g\u00e2y n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p \u1edf b\u1ec7nh nh\u00e2n \u0111ang \u0111\u01b0\u1ee3c th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o \u00e1p l\u1ef1c d\u01b0\u01a1ng. Nh\u01b0 v\u1eady, vi\u1ec7c ti\u1ebfp c\u1eadn n\u00e0y c\u0169ng t\u01b0\u01a1ng t\u1ef1 r\u1ea5t nhi\u1ec1u v\u1edbi ti\u1ebfp c\u1eadn m\u1ed9t b\u1ec7nh nh\u00e2n nghi ng\u1edd ARDS. C\u00e1c nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 g\u00e2y b\u1ed1i c\u1ea3nh l\u00e2m s\u00e0ng t\u01b0\u01a1ng t\u1ef1 c\u1ea7n \u0111\u01b0\u1ee3c ch\u00fa tr\u1ecdng lo\u1ea1i tr\u1eeb l\u00e0, vi\u00eam ph\u1ed5i li\u00ean quan \u0111\u1ebfn m\u00e1y th\u1edf (VAP) v\u00e0 ph\u00f9 ph\u1ed5i. C\u00e1c nguy\u00ean nh\u00e2n hi\u1ebfm g\u1eb7p h\u01a1n nh\u1eefng c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c quan t\u00e2m lo\u1ea1i tr\u1eeb g\u1ed3m nhi\u1ec5m tr\u00f9ng huy\u1ebft, h\u00edt s\u1eb7c, tr\u00e0n kh\u00ed, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, auto-PEEP, ph\u1ea3n \u1ee9ng li\u00ean quan \u0111\u1ebfn truy\u1ec1n m\u00e1u, thuy\u00ean t\u1eafc m\u1ee1, thuy\u00ean t\u1eafc kh\u00ed, thuy\u00ean t\u1eafc n\u01b0\u1edbc \u1ed1i, l\u1ec7ch \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n, x\u1eb9p th\u00f9y ph\u1ed5i hay h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p. \u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n VILI, c\u1ea7n th\u1ef1c hi\u1ec7n \u0111\u00e1nh gi\u00e1 m\u1ed9t c\u00e1ch to\u00e0n di\u1ec7n:<\/p>\n<ul>\n<li>B\u1ec7nh nh\u00e2n nghi ng\u1edd VILI c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u1ea1i t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng, co th\u1eaft \u0111\u01b0\u1eddng th\u1edf, tri\u1ec7u ch\u1ee9ng qu\u00e1 t\u1ea3i d\u1ecbch (ph\u00f9, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i hay rale \u1ea9m ph\u1ed5i), tri\u1ec7u ch\u1ee9ng thuy\u00ean t\u1eafc t\u0129nh m\u1ea1ch chi d\u01b0\u1edbi (s\u01b0ng \u0111\u1ecf chi d\u01b0\u1edbi), s\u1ef1 th\u00f4ng kh\u00ed kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u (l\u1ed3ng ng\u1ef1c d\u00e3n n\u1edf kh\u00f4ng \u0111\u1ec1u, ph\u1ebf \u00e2m \u1edf hai ph\u1ebf tr\u01b0\u1eddng kh\u00f4ng c\u00e2n x\u1ee9ng, g\u00f5 vang hay g\u00f5 \u0111\u1ee5c m\u1ed9t b\u00ean ph\u1ed5i).<\/li>\n<li>Ki\u1ec3m tra ch\u1ebf \u0111\u1ed9 th\u00f4ng kh\u00ed v\u00e0 c\u00e1c th\u00f4ng s\u1ed1 c\u00e0i \u0111\u1eb7t c\u00f3 nguy c\u01a1 g\u00e2y t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i cho b\u1ec7nh nh\u00e2n hay kh\u00f4ng. M\u1ed9t s\u1ed1 th\u00f4ng s\u1ed1 c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i nh\u01b0 th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng qu\u00e1 cao (th\u01b0\u1eddng v\u01b0\u1ee3t m\u1ee9c 6mL tr\u00ean kg c\u00e2n n\u1eb7ng \u01b0\u1edbc t\u00ednh), \u00e1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf \u0111\u1ec9nh v\u00e0 b\u00ecnh nguy\u00ean qu\u00e1 cao, xu\u1ea5t hi\u1ec7n auto-PEEP. \u0110\u1ed3ng th\u1eddi c\u0169ng ph\u1ea3i ki\u1ec3m tra s\u1ef1 th\u00f4ng tho\u00e1ng c\u1ee7a \u1ed1ng th\u1edf, ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c valve th\u00f4ng kh\u00ed hay \u1ea9m \u0111\u1ed9 c\u1ee7a kh\u00ed th\u1edf cung c\u1ea5p cho b\u1ec7nh nh\u00e2n<\/li>\n<li>Ki\u1ec3m tra c\u00e1c thu\u1ed1c \u0111\u00e3 s\u1eed d\u1ee5ng bao g\u1ed3m c\u00e1c ch\u1ebf ph\u1ea9m m\u00e1u \u0111\u00e3 truy\u1ec1n cho b\u1ec7nh nh\u00e2n, c\u00e2n nh\u1eafc c\u00e1c ph\u1ea3n \u1ee9ng do d\u01b0\u1ee3c ph\u1ea9m v\u00e0 c\u00e1c ph\u1ea3n \u1ee9ng qu\u00e1 m\u1ea9n.<\/li>\n<li>\u0110\u1ec1 ngh\u1ecb c\u00e1c c\u1eadn l\u00e2m s\u00e0ng ph\u00f9 h\u1ee3p gi\u00fap ch\u1ea9n \u0111o\u00e1n d\u1ef1a tr\u00ean c\u00e1c d\u1eef ki\u1ec7n l\u00e2m s\u00e0ng thu th\u1eadp \u0111\u01b0\u1ee3c c\u00f3 th\u1ec3 l\u00e0 c\u00e1c test h\u00f3a sinh (men tim, men t\u1ee5y, \u0111\u00f4ng c\u1ea7m m\u00e1u, marker nhi\u1ec5m tr\u00f9ng, D-Dimer&#8230;) hay h\u00ecnh \u1ea3nh h\u1ecdc (X quang ng\u1ef1c hay CT n\u1ebfu c\u1ea7n thi\u1ebft) v\u00e0 \u0111i\u1ec7n tim.<\/li>\n<\/ul>\n<p>Khi s\u1eed d\u1ee5ng m\u00e1y th\u1edf nh\u00e2n t\u1ea1o, c\u00e1c chuy\u00ean gia y t\u1ebf t\u1ea1i <a href=\"https:\/\/vinmec.com\/vi\/dangkykham\/\">Vinmec<\/a> lu\u00f4n c\u1eadp nh\u1eadt ki\u1ebfn th\u1ee9c v\u00e0 k\u1ef9 n\u0103ng \u0111\u1ec3 \u00e1p d\u1ee5ng c\u00e1c k\u1ef9 thu\u1eadt ti\u1ebfn b\u1ed9 v\u00e0 cung c\u1ea5p ch\u0103m s\u00f3c t\u1ed1t nh\u1ea5t cho b\u1ec7nh nh\u00e2n.<\/p>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o: <i>UpToDate\u00a0<\/i><\/p>\n","protected":false},"excerpt":{"rendered":"<p>T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do m\u00e1y th\u1edf th\u01b0\u1eddng \u0111\u01b0\u1ee3c quan s\u00e1t \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u1edf m\u00e1y v\u00ec h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (Acute respiratory distres syndrome &#8211; ARDS), nh\u01b0ng trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, r\u00f5 r\u00e0ng r\u1eb1ng n\u00f3 c\u0169ng c\u0169ng c\u00f3 th\u1ec3 \u00a0x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u1edf m\u00e1y v\u00ec c\u00e1c [&hellip;]<\/p>\n","protected":false},"author":37,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[23,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - 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