{"id":26481,"date":"2023-04-25T12:25:41","date_gmt":"2023-04-25T05:25:41","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26481"},"modified":"2023-04-29T20:27:27","modified_gmt":"2023-04-29T13:27:27","slug":"nhiem-khuan-huyet-o-tre-em-chan-doan-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/25\/nhiem-khuan-huyet-o-tre-em-chan-doan-va-dieu-tri\/","title":{"rendered":"Nhi\u1ec5m khu\u1ea9n huy\u1ebft \u1edf tr\u1ebb em: ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Nhi\u1ec5m khu\u1ea9n huy\u1ebft l\u00e0 t\u00ecnh tr\u1ea1ng c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a vi khu\u1ea9n trong d\u00f2ng m\u00e1u k\u00e8m theo bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a nhi\u1ec5m tr\u00f9ng. Bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p v\u00e0 nguy hi\u1ec3m l\u00e0 s\u1ed1c nhi\u1ec5m tr\u00f9ng.<\/strong><\/p>\n

1. T\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh nhi\u1ec5m khu\u1ea9n<\/h2>\n

1.1 T\u00e1c nh\u00e2n nhi\u1ec5m khu\u1ea9n c\u1ed9ng \u0111\u1ed3ng th\u01b0\u1eddng g\u1eb7p<\/h3>\n

– Vi khu\u1ea9n:<\/p>\n

    \n
  • Gram d\u01b0\u01a1ng: Li\u00ean c\u1ea7u nh\u00f3m B, ph\u1ebf c\u1ea7u, t\u1ee5 c\u1ea7u v\u00e0ng.<\/li>\n
  • Gram \u00e2m: Hemophilus influenzae<\/li>\n<\/ul>\n

    – Vi khu\u1ea9n th\u01b0\u1eddng g\u1eb7p theo nh\u00f3m tu\u1ed5i:<\/p>\n

    \"\"<\/p>\n

    1.2.Nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n<\/h3>\n

    – Vi khu\u1ea9n, Klebsiella, Pseudomonas, Acinetobacter
    \n– N\u1ea5m: Candida albican<\/p>\n

    1.3.Y\u1ebfu t\u1ed1 nguy c\u01a1:<\/h3>\n

    – S\u01a1 sinh
    \n– Suy dinh d\u01b0\u1ee1ng, b\u00e9o ph\u00ec
    \n– Gi\u1ea3m b\u1ea1ch c\u1ea7u
    \n– \u0110i\u1ec1u tr\u1ecb corticoide
    \n– N\u1eb1m vi\u1ec7n
    \n– Th\u1ee7 thu\u1eadt x\u00e2m l\u1ea5n<\/p>\n

    2. Ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m khu\u1ea9n huy\u1ebft<\/h2>\n

    2.1. Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n<\/h3>\n

    – H\u1ecfi b\u1ec7nh:<\/p>\n

      \n
    • Tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t: gi\u00fap x\u00e1c \u0111\u1ecbnh \u1ed5 nhi\u1ec5m tr\u00f9ng nguy\u00ean ph\u00e1t v\u00e0 \u0111\u1ecbnh h\u01b0\u1edbng t\u00e1c nh\u00e2n.<\/li>\n
    • Ti\u1ec3u bu\u1ed1t, s\u00f3n ti\u1ec3u, ti\u1ec3u nhi\u1ec1u l\u1ea7n (nhi\u1ec5m tr\u00f9ng ti\u1ec3u).<\/li>\n
    • Ti\u00eau ch\u1ea3y, ph\u00e2n m\u00e1u (nhi\u1ec5m tr\u00f9ng ti\u00eau h\u00f3a).<\/li>\n
    • Nh\u1ecdt da, \u00e1p xe (t\u1ee5 c\u1ea7u).<\/li>\n
    • S\u1ed1t, ho (vi\u00eam ph\u1ed5i).<\/li>\n
    • T\u00ecnh tr\u1ea1ng ti\u00eam ch\u1ee7ng: Hemophilus, n\u00e3o m\u00f4 c\u1ea7u.<\/li>\n
    • Ti\u1ec1n c\u0103n y\u1ebfu t\u1ed1 nguy c\u01a1:
      \n+ S\u01a1 sinh thi\u1ebfu th\u00e1ng.
      \n+ Suy dinh d\u01b0\u1ee1ng, b\u00e9o ph\u00ec.
      \n+ Suy gi\u1ea3m mi\u1ec5n d\u1ecbch, \u0111ang \u0111i\u1ec1u tr\u1ecb corticoide.
      \n+ B\u1ec7nh m\u00e3n t\u00ednh: ti\u1ec3u \u0111\u01b0\u1eddng, b\u1ec7nh tim, gan, th\u1eadn<\/li>\n<\/ul>\n

      – Kh\u00e1m l\u00e2m s\u00e0ng:<\/p>\n

        \n
      • D\u1ea5u hi\u1ec7u sinh t\u1ed3n: m\u1ea1ch, huy\u1ebft \u00e1p, nhi\u1ec7t \u0111\u1ed9, nh\u1ecbp th\u1edf, n\u01b0\u1edbc ti\u1ec3u.<\/li>\n
      • M\u1ee9c \u0111\u1ed9 tri gi\u00e1c.<\/li>\n
      • \u1ed4 nhi\u1ec5m tr\u00f9ng: da, v\u1ebft m\u1ed5, ph\u1ed5i.<\/li>\n
      • Ban xu\u1ea5t huy\u1ebft, h\u1ed3ng ban.<\/li>\n
      • Tim m\u1ea1ch: ph\u00e1t hi\u1ec7n b\u1ec7nh tim b\u1ea9m sinh<\/li>\n
      • Ph\u1ed5i: ph\u00e1t hi\u1ec7n b\u1ea5t th\u01b0\u1eddng<\/li>\n
      • B\u1ee5ng: ph\u00e1t hi\u1ec7n \u0111i\u1ec3m \u0111au khu tr\u00fa ph\u1ea3n \u1ee9ng th\u00e0nh b\u1ee5ng.<\/li>\n<\/ul>\n

        – C\u1eadn l\u00e2m s\u00e0ng:<\/p>\n

          \n
        • C\u00f4ng th\u1ee9c b\u1ea1ch c\u1ea7u, d\u1ea1ng huy\u1ebft c\u1ea7u.<\/li>\n
        • CRP ho\u1eb7c Procalcitonine n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n.<\/li>\n
        • C\u1ea5y m\u00e1u: tr\u01b0\u1edbc khi ti\u00eam kh\u00e1ng sinh.<\/li>\n
        • \u0110i\u1ec7n gi\u1ea3i \u0111\u1ed3, \u0111\u01b0\u1eddng huy\u1ebft.<\/li>\n
        • Ch\u1ee9c n\u0103ng \u0111\u00f4ng m\u00e1u, ch\u1ee9c n\u0103ng gan, th\u1eadn<\/li>\n
        • Xquang ph\u1ed5i<\/li>\n
        • C\u1ea5y m\u1eabu b\u1ec7nh ph\u1ea9m \u1ed5 nhi\u1ec5m tr\u00f9ng nghi ng\u1edd: m\u1ee7, n\u01b0\u1edbc ti\u1ec3u, ph\u00e2n.<\/li>\n
        • Si\u00eau \u00e2m b\u1ee5ng t\u00ecm \u1ed5 nhi\u1ec5m tr\u00f9ng, \u00e1p xe s\u00e2u.<\/li>\n
        • Si\u00eau \u00e2m tim: t\u00ecm tim b\u1ea9m sinh, Osler.<\/li>\n<\/ul>\n

          2.2. Ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3<\/h3>\n

          Nghi ng\u1edd nhi\u1ec5m tr\u00f9ng huy\u1ebft khi c\u00f3 tr\u00ean hai d\u1ea5u hi\u1ec7u sau:
          \n– S\u1ed1t cao ho\u1eb7c h\u1ea1 th\u00e2n nhi\u1ec7t.
          \n– Tim nhanh.
          \n– Th\u1edf nhanh.
          \n– B\u1ea1ch c\u1ea7u >12.000\/mm3 hay < 4.000\/mm3<\/p>\n

          2.3. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/h3>\n

          C\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng k\u1ec3 tr\u00ean k\u00e8m c\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh.<\/p>\n

          2.4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/h3>\n

          – S\u1ed1t r\u00e9t, s\u1ed1ng ho\u1eb7c \u0111\u1ebfn v\u00f9ng d\u1ecbch t\u1ec3 s\u1ed1t r\u00e9t, s\u1ed1t cao k\u00e8m r\u00e9t run v\u00e3 m\u1ed3 h\u00f4i, t\u00ecm th\u1ea5y k\u00fd sinh tr\u00f9ng s\u1ed1t r\u00e9t trong m\u00e1u .
          \n– Lao to\u00e0n th\u1ec3: Ti\u1ebfp x\u00fac ho\u1eb7c lao tr\u01b0\u1edbc \u0111\u00f3, s\u1ed1t k\u00e8m ho, kh\u00f3 th\u1edf, X quang ph\u1ed5i c\u00f3 t\u1ed5n th\u01b0\u01a1ng\u00a0lao, x\u00e9t nghi\u1ec7m \u0111\u1eddm c\u00f3 vi khu\u1ea9n lao.<\/p>\n

          3. \u0110i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n huy\u1ebft<\/h2>\n

          3.1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/h3>\n

          – \u0110i\u1ec1u tr\u1ecb s\u1ed1c n\u1ebfu c\u00f3.
          \n– \u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh ban \u0111\u1ea7u s\u1edbm v\u00e0 ph\u00f9 h\u1ee3p, ti\u1ebfp theo t\u00f9y \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng v\u00e0 k\u1ebft qu\u1ea3 vi sinh.
          \n– C\u1ea5y m\u00e1u tr\u01b0\u1edbc khi cho kh\u00e1ng sinh
          \n– \u0110i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng.<\/p>\n

          3.2. B\u00f9 d\u1ecbch \u0111i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m tr\u00f9ng n\u1ebfu c\u00f3<\/h3>\n

          – \u0110\u01b0a b\u1ec7nh nh\u00e2n ra s\u1ed1c trong gi\u1edd \u0111\u1ea7u
          \n– Nhanh ch\u00f3ng kh\u00f4i ph\u1ee5c th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n b\u1eb1ng dung d\u1ecbch \u0111i\u1ec7n gi\u1ea3i, cao ph\u00e2n t\u1eed, li\u1ec1u 20ml\/kg truy\u1ec1n TM nhanh. Trong tr\u01b0\u1eddng h\u1ee3p s\u1ed1c n\u1eb7ng c\u00f3 th\u1ec3 t\u1ed1i \u0111a 60 ml\/kg\/gi\u1edd v\u00e0 xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh \u0111o \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch trung t\u00e2m (CVP).
          \n– C\u1ea7n duy tr\u00ec CVP \u1edf m\u1ee9c 10-15 cmH2O
          \n– N\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u00e0 CVP b\u00ecnh th\u01b0\u1eddng ho\u1eb7c cao th\u00ec d\u00f9ng thu\u1ed1c v\u1eadn m\u1ea1ch: Dopamine v\u00e0 Dobutamine. Li\u1ec1u Dopamine 5-10\u00b5g\/kg\/ph\u00fat t\u1ed1i \u0111a 10 \u00b5g\/kg\/ph\u00fat. Dobutamine 5 -15 \u00b5g\/kg\/ph\u00fat.
          \n– Trong tr\u01b0\u1eddng h\u1ee3p th\u1ea5t b\u1ea1i v\u1edbi Dopamin, Dobutamin c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p Dobutamin li\u1ec1u 05 \u00b5g\/kg\/ph\u00fat v\u1edbi Noradrenalin 0,02 – 0,05 \u00b5g\/kg\/ph\u00fat t\u1ed1i \u0111a 5 \u00b5g\/kg\/ph\u00fat.<\/p>\n

          3.3. Kh\u00e1ng sinh<\/h3>\n

          D\u00f9ng kh\u00e1ng sinh ban \u0111\u1ea7u tr\u01b0\u1edbc khi c\u00f3 k\u1ebft qu\u1ea3 ph\u00e2n l\u1eadp vi khu\u1ea9n. C\u1ea7n d\u00f9ng kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch s\u1edbm ngay sau khi c\u1ea5y m\u00e1u. Ch\u1ecdn l\u1ef1a kh\u00e1ng sinh t\u1ed1t nh\u1ea5t l\u00e0 t\u00f9y theo t\u00e1c nh\u00e2n. Nh\u01b0ng k\u1ebft qu\u1ea3 c\u1ea5y m\u00e1u cho k\u1ebft qu\u1ea3 ch\u1eadm, do \u0111\u00f3 tr\u00ean th\u1ef1c t\u1ebf ch\u1ecdn kh\u00e1ng sinh ban \u0111\u1ea7u d\u1ef1a v\u00e0o kinh nghi\u1ec7m.
          \nC\u00e1c y\u1ebfu t\u1ed1 \u0111\u1ec3 ch\u1ecdn l\u1ef1a kh\u00e1ng sinh ban \u0111\u1ea7u:<\/p>\n

            \n
          • \u1ed4 nhi\u1ec5m khu\u1ea9n ho\u1eb7c nghi ng\u1edd<\/li>\n
          • Nhi\u1ec5m khu\u1ea9n c\u1ed9ng \u0111\u1ed3ng hay b\u1ec7nh vi\u1ec7n (nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n th\u01b0\u1eddng do vi khu\u1ea9n \u0111a kh\u00e1ng).<\/li>\n
          • K\u1ebft qu\u1ea3 soi v\u00e0 nhu\u1ed9m Gram m\u1eabu b\u1ec7nh ph\u1ea9m.<\/li>\n
          • M\u1ee9c \u0111\u1ed9 \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh t\u1ea1i \u0111\u1ecba ph\u01b0\u01a1ng, b\u1ec7nh vi\u1ec7n, khoa<\/li>\n<\/ul>\n

            3.4. D\u1ef1a v\u00e0o \u1ed5 nhi\u1ec5m khu\u1ea9n t\u00ecm th\u1ea5y ho\u1eb7c nghi ng\u1edd<\/h3>\n

            \"\"<\/p>\n

            3.5. Nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n:<\/h3>\n

            – Th\u01b0\u1eddng do vi khu\u1ea9n \u0111a kh\u00e1ng<\/p>\n

            – \u00c1p d\u1ee5ng li\u1ec7u ph\u00e1p xu\u1ed1ng thang b\u1eaft \u0111\u1ea7u v\u1edbi kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng. Sau 48 – 72 gi\u1edd t\u00f9y \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng v\u00e0 k\u1ebft qu\u1ea3 vi sinh s\u1ebd ch\u1ecdn l\u1ef1a kh\u00e1ng sinh ph\u1ed5 h\u1eb9p ph\u00f9 h\u1ee3p.Th\u01b0\u1eddng\u00a0k\u1ebft h\u1ee3p kh\u00e1ng sinh \u0111\u1ec3 t\u0103ng m\u1ee9c \u0111\u1ed9 di\u1ec7t khu\u1ea9n<\/p>\n

            – Kh\u00e1ng sinh: Imipenem\/meropenem ho\u1eb7c Quinolone ho\u1eb7c Ticarcillin \u2013\u00a0clavuclinic acid ho\u1eb7c Cefoperazone-Sulbactam \u00b1\u00a0Amikacin. Ph\u1ed1i\u00a0h\u1ee3p th\u00eam Vancomycine n\u1ebfu nghi do t\u1ee5 c\u1ea7u<\/p>\n

            3.6. Nhi\u1ec5m khu\u1ea9n c\u1ed9ng \u0111\u1ed3ng kh\u00f4ng t\u00ecm th\u1ea5y \u1ed5 nhi\u1ec5m khu\u1ea9n:<\/h3>\n

            Tr\u1ebb tr\u01b0\u1edbc \u0111\u00f3 b\u00ecnh th\u01b0\u1eddng:
            \n– Tr\u1ebb < 2 th\u00e1ng tu\u1ed5i:<\/p>\n

              \n
            • Ampicilline + Gentamycine + Cefotaxime.<\/li>\n
            • N\u1ebfu c\u00f3 k\u00e8m s\u1ed1c: Quinolone ho\u1eb7c Ceftazidime ho\u1eb7c Cefepim ho\u1eb7c Imipenem\/meropenem.<\/li>\n
            • N\u1ebfu nghi t\u1ee5 c\u1ea7u: Cefotaxime + Oxacillin \u00b1\u00a0Gentamycine. N\u1ebfu c\u00f3 s\u1ed1c thay Oxacillin b\u1eb1ng Vancomycin.<\/li>\n<\/ul>\n

              – Tr\u1ebb > 2 th\u00e1ng tu\u1ed5i:<\/p>\n

                \n
              • \u00a0Cefotaxime ho\u1eb7c Ceftriaxone ho\u1eb7c Quinolone \u00b1\u00a0Gentamycine.<\/li>\n
              • N\u1ebfu c\u00f3 k\u00e8m s\u1ed1c: Quinolone ho\u1eb7c Ceftazidime ho\u1eb7c Cefepim ho\u1eb7c Imipenem\/meropenem.<\/li>\n
              • N\u1ebfu nghi t\u1ee5 c\u1ea7u: Th\u00eam Oxacillin ho\u1eb7c Vancomycin khi c\u00f3 s\u1ed1c<\/li>\n<\/ul>\n

                Tr\u00ean c\u01a1 \u0111\u1ecba suy gi\u1ea3m mi\u1ec5n d\u1ecbch ho\u1eb7c gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t:<\/p>\n

                  \n
                • Cefotaxime ho\u1eb7c Ceftriaxone ho\u1eb7c Ceftazidime ho\u1eb7c Fluoroquinolones \u00b1\u00a0Amikacin<\/li>\n
                • N\u1ebfu c\u00f3 k\u00e8m s\u1ed1c: d\u00f9ng Imipenem\/meropenem \u00b1\u00a0Amikacin<\/li>\n
                • Nghi t\u1ee5 c\u1ea7u: th\u00eam Oxacillin ho\u1eb7c Vancomycin khi c\u00f3 s\u1ed1c.<\/li>\n<\/ul>\n

                  4. Kh\u00e1ng sinh ti\u1ebfp theo sau khi c\u00f3 k\u1ebft qu\u1ea3 vi sinh<\/h2>\n

                  Sau 48 -72 gi\u1edd \u0111\u00e1nh gi\u00e1 l\u1ea1i \u0111\u00e1p \u1ee9ng kh\u00e1ng sinh d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng v\u00e0 k\u1ebft qu\u1ea3 vi sinh.<\/p>\n

                  Ph\u1ea7n l\u1edbn k\u1ebft h\u1ee3p kh\u00e1ng sinh ch\u1ec9 c\u1ea7n thi\u1ebft \u1edf 3-5 ng\u00e0y \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 t\u0103ng kh\u1ea3 n\u0103ng di\u1ec7t khu\u1ea9n, gi\u1ea3m \u0111\u1ec1 kh\u00e1ng.<\/p>\n

                  Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh trung b\u00ecnh 10 \u2013 14 ng\u00e0y ho\u1eb7c k\u00e9o d\u00e0i h\u01a1n t\u00f9y \u1ed5 nhi\u1ec5m khu\u1ea9n, t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh ho\u1eb7c \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n

                  Ng\u01b0ng kh\u00e1ng sinh sau khi \u0111\u1ee7 ng\u00e0y \u0111i\u1ec1u tr\u1ecb k\u00e8m b\u1ec7nh nh\u00e2n h\u1ebft s\u1ed1t, t\u1ed5ng tr\u1ea1ng t\u1ed1t, ch\u1ec9 s\u1ed1 x\u00e9t nghi\u1ec7m nhi\u1ec5m khu\u1ea9n tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng.<\/p>\n

                  4.1. C\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh:<\/h3>\n

                  Vi\u1ec7c ti\u1ebfp t\u1ee5c kh\u00e1ng sinh \u0111ang d\u00f9ng hay thay \u0111\u1ed5i kh\u00e1ng sinh t\u00f9y thu\u1ed9c v\u00e0o \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng v\u00e0 k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3, trong \u0111\u00f3 \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng l\u00e0 quan tr\u1ecdng nh\u1ea5t.
                  \n– \u0110\u00e1p \u1ee9ng l\u00e2m s\u00e0ng t\u1ed1t: ti\u1ebfp t\u1ee5c kh\u00e1ng sinh \u0111ang d\u00f9ng \u0111\u1ee7 10-14 ng\u00e0y.
                  \n– L\u00e2m s\u00e0ng kh\u00f4ng c\u1ea3i thi\u1ec7n: \u0111\u1ed5i kh\u00e1ng sinh theo kh\u00e1ng sinh \u0111\u1ed3.<\/p>\n

                  L\u1ef1a ch\u1ecdn kh\u00e1ng sinh ban \u0111\u1ea7u:<\/p>\n

                  – Nhi\u1ec5m khu\u1ea9n c\u1ed9ng \u0111\u1ed3ng:<\/p>\n

                    \n
                  • Hemophilus influenza: Cefotaxime\/ Cetriaxone<\/li>\n
                  • N meningitidis: Cefotaxime\/ Ceftriaxon<\/li>\n
                  • S. pneumoniae: Cefotaxime\/ Ceftriaxone<\/li>\n
                  • Salmonella: Cefotaxime\/ Cetriaxone<\/li>\n
                  • Shigella: Ciprofloxacin<\/li>\n
                  • Staphylococcus aureus: Oxacilline<\/li>\n<\/ul>\n

                    – Nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n:<\/p>\n

                      \n
                    • Enterobacter, Pseudomonas: Cefotaxime\/Ceftazidime \/Ciprofloxacin\/ Pefloxacine\/\u00a0Ticarcillin \u2013 clavuclinic acid\/ Cefoperazone- Subactam ph\u1ed1i h\u1ee3p v\u1edbi Amikacin<\/li>\n
                    • Enterococcus: Ampiciline ho\u1eb7c Peniciline\u00a0ph\u1ed1i h\u1ee3p v\u1edbi Amikacin<\/li>\n
                    • Escherichia coli: Cefotaxime ho\u1eb7c Ceftazidime ho\u1eb7c Ticarcillin \u2013 clavuclinic acid ho\u1eb7c Cefoperazone-Sulbactam ho\u1eb7c Ciprofloxacin\u00a0ph\u1ed1i h\u1ee3p v\u1edbi Amikacin<\/li>\n
                    • Klebsiella: Cefotaxime ho\u1eb7c Ceftazidime ho\u1eb7c Ticarcillin \u2013 clavuclinic acid ho\u1eb7c Cefoperazone- Sulbactam ho\u1eb7c Ciprofloxacin<\/li>\n
                    • Enterobacter: Imipenem\/Meropenem\/ Ertapenem ho\u1eb7c Ticarcillin \u2013 clavuclinic acid\/ Cefoperazone- Sulbactam k\u00e8m Amikacin<\/li>\n
                    • Acinetobacter: Imipenem\/Meropenem\/ Ertapenem ho\u1eb7c Cefoperazone- Sulbactam\/ Ticarcillin \u2013 clavuclinic acid<\/li>\n
                    • VK Gram (-) ti\u1ebft ESBL: Ertapenem\/Imipenem\/ Meropenem ho\u1eb7c Ciprofloxacin ho\u1eb7c Cefoperazone- Sulbactam<\/li>\n
                    • Staphylococcus aureus nh\u1ea1y\u00a0Methiciline\u00a0( MSSA): Oxaciline<\/li>\n
                    • Staphylococcus aureus kh\u00e1ng\u00a0Methiciline\u00a0( MRSA ): Vancomycine<\/li>\n
                    • Staphylococcus coagulase negative: Vancomycine<\/li>\n<\/ul>\n

                      4. 2. C\u1ea5y m\u00e1u \u00e2m t\u00ednh:<\/h3>\n

                      – \u0110\u00e1p \u1ee9ng l\u00e2m s\u00e0ng t\u1ed1t: ti\u1ebfp t\u1ee5c kh\u00e1ng sinh \u0111ang d\u00f9ng \u0111\u1ee7 10-14 ng\u00e0y.
                      \n– L\u00e2m s\u00e0ng kh\u00f4ng t\u1ed1t: \u0111\u1ed5i kh\u00e1ng sinh t\u00f9y theo \u1ed5 nhi\u1ec5m tr\u00f9ng nguy\u00ean ph\u00e1t nghi ng\u1edd.
                      \n– T\u1eeb nhi\u1ec5m tr\u00f9ng ti\u1ec3u: Ciprofloxacin \/ Pefloxacin + Amikacin
                      \n– T\u1eeb vi\u00eam ph\u1ed5i: Ceftazidime\/ Pefloxacin \/ Ciprofloxacin + Amikacin. N\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng: Cefepim\/ Imipenem \/ Meropenem+ Amikacin. N\u1ebfu nghi t\u1ee5 c\u1ea7u kh\u00e1ng thu\u1ed1c: th\u00eam Vancomycin
                      \n– T\u1eeb nhi\u1ec5m tr\u00f9ng da: Vancomycin
                      \n– N\u1ebfu c\u00f3 ban xu\u1ea5t huy\u1ebft: Ciprofloxacin \/ Pefloxacin
                      \n– Li\u00ean quan \u0111\u1eb7t catheter t\u0129nh m\u1ea1ch: Vancomycin
                      \n– Nghi nhi\u1ec5m tr\u00f9ng b\u1ec7nh vi\u1ec7n<\/p>\n

                        \n
                      • Nghi do gram (-): Cefepim \/ Imipenem\/ meropenem \u00b1\u00a0Amikacin<\/li>\n
                      • C\u01a1 \u0111\u1ecba suy gi\u1ea3m mi\u1ec5n d\u1ecbch: Ciprofloxacin \/ Pefloxacin (n\u1ebfu ch\u01b0a d\u00f9ng) ho\u1eb7c Cefepim\/ Imipenem + Amikacin.<\/li>\n
                      • Nghi t\u1ee5 c\u1ea7u kh\u00e1ng Methicillin: D\u00f9ng Vancomycin.<\/li>\n
                      • Nghi n\u1ea5m: th\u00eam Fluconazole ho\u1eb7c Amphotericin B.<\/li>\n<\/ul>\n

                        5. \u0110i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng nhi\u1ec5m khu\u1ea9n huy\u1ebft<\/h2>\n

                        – R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u: truy\u1ec1n ti\u1ec3u c\u1ea7u v\u00e0 huy\u1ebft t\u01b0\u01a1ng \u0111\u00f4ng l\u1ea1nh, k\u1ebft t\u1ee7a l\u1ea1nh.<\/p>\n

                        – Toan chuy\u1ec3n h\u00f3a: th\u01b0\u1eddng l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a s\u1ed1c n\u00ean c\u1ea7n \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c s\u1ed1c nhi\u1ec5m tr\u00f9ng tr\u00e1nh \u0111\u1ec3 s\u1ed1c k\u00e9o d\u00e0i. Trong tr\u01b0\u1eddng h\u1ee3p toan h\u00f3a m\u00e1u n\u1eb7ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh b\u1eb1ng Bicarbonate.<\/p>\n

                        – Kh\u00f4ng khuy\u1ebfn c\u00e1o.<\/p>\n

                          \n
                        • Dopamine li\u1ec1u th\u1ea5p \u0111\u1ec3 ng\u1eeba suy th\u1eadn c\u1ea5p v\u00ec kh\u00f4ng t\u00e1c d\u1ee5ng<\/li>\n
                        • Corticoides t\u0129nh m\u1ea1ch: nhi\u1ec1u nghi\u00ean c\u1ee9u cho th\u1ea5y hi\u1ec7u qu\u1ea3 ch\u01b0a r\u00f5 r\u00e0ng\u00a0v\u00e0 c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 b\u1ed9i nhi\u1ec5m, xu\u1ea5t huy\u1ebft.<\/li>\n
                        • Immunoglobuline ch\u01b0a th\u1ea5y hi\u1ec7u qu\u1ea3 gi\u1ea3m t\u1eed vong.<\/li>\n<\/ul>\n

                          6. L\u1ecdc m\u00e1u li\u00ean t\u1ee5c<\/h2>\n

                          – L\u1ecdc m\u00e1u li\u00ean t\u1ee5c: Ngo\u00e0i \u0111i\u1ec1u tr\u1ecb suy th\u1eadn c\u1ea5p l\u1ecdc m\u00e1u c\u00f2n gi\u00fap lo\u1ea1i b\u1ecf\u00a0Cytokine v\u00e0 c\u00e1c h\u00f3a ch\u1ea5t trung gian.<\/p>\n

                          – Ch\u1ec9 \u0111\u1ecbnh:<\/p>\n

                            \n
                          • Suy th\u1eadn c\u1ea5p k\u00e8m huy\u1ebft \u0111\u1ed9ng h\u1ecdc kh\u00f4ng \u1ed5n \u0111\u1ecbnh (suy th\u1eadn c\u1ea5p: thi\u1ec3u ni\u1ec7u \u2265\u00a024 gi\u1edd ho\u1eb7c Creatinin > 0,4 mmol\/L ho\u1eb7c t\u0103ng > 0,1mmol\/L\/ng\u00e0y)<\/li>\n
                          • Suy \u0111a c\u01a1 quan<\/li>\n<\/ul>\n

                            7. Ph\u1eabu thu\u1eadt<\/h2>\n

                            C\u1ea7n c\u00f3 ch\u1ec9 \u0111\u1ecbnh s\u1edbm ph\u1ea9u thu\u1eadt lo\u1ea1i b\u1ecf \u1ed5 m\u1ee7 trong tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng v\u1eeba\u00a0h\u1ed3i s\u1ee9c v\u1eeba can thi\u1ec7p ngo\u1ea1i khoa.<\/p>\n

                              \n
                            • D\u1eabn l\u01b0u \u1ed5 m\u1ee7<\/li>\n
                            • Ph\u1eabu thu\u1eadt lo\u1ea1i b\u1ecf \u1ed5 nhi\u1ec5m tr\u00f9ng.<\/li>\n<\/ul>\n

                              Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n

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

                              Nhi\u1ec5m khu\u1ea9n huy\u1ebft l\u00e0 t\u00ecnh tr\u1ea1ng c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a vi khu\u1ea9n trong d\u00f2ng m\u00e1u k\u00e8m theo bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a nhi\u1ec5m tr\u00f9ng. Bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p v\u00e0 nguy hi\u1ec3m l\u00e0 s\u1ed1c nhi\u1ec5m tr\u00f9ng. 1. T\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh nhi\u1ec5m khu\u1ea9n 1.1 T\u00e1c nh\u00e2n nhi\u1ec5m khu\u1ea9n c\u1ed9ng \u0111\u1ed3ng th\u01b0\u1eddng g\u1eb7p – Vi khu\u1ea9n: […]<\/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":"\nNhi\u1ec5m khu\u1ea9n huy\u1ebft \u1edf tr\u1ebb em: ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Nhi\u1ec5m khu\u1ea9n huy\u1ebft l\u00e0 t\u00ecnh tr\u1ea1ng c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a vi khu\u1ea9n trong d\u00f2ng m\u00e1u k\u00e8m theo bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a nhi\u1ec5m tr\u00f9ng\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Nhi\u1ec5m khu\u1ea9n huy\u1ebft \u1edf tr\u1ebb em: ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - 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