{"id":27354,"date":"2023-04-25T12:35:05","date_gmt":"2023-04-25T05:35:05","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27354"},"modified":"2023-04-29T20:21:13","modified_gmt":"2023-04-29T13:21:13","slug":"chan-doan-va-dieu-tri-soc-nhiem-khuan-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/25\/chan-doan-va-dieu-tri-soc-nhiem-khuan-o-tre-em\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m  khu\u1ea9n \u1edf tr\u1ebb em"},"content":{"rendered":"<p><strong>S\u1ed1c nhi\u1ec5m khu\u1ea9n l\u00e0 t\u00ecnh tr\u1ea1ng s\u1ed1c x\u1ea3y ra nh\u01b0 l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng n\u1eb7ng c\u1ee7a nhi\u1ec5m tr\u00f9ng huy\u1ebft, n\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p, k\u1ecbp th\u1eddi s\u1ebd d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o, t\u1ed5n th\u01b0\u01a1ng \u0111a c\u01a1 quan \u0111\u01b0a \u0111\u1ebfn t\u1eed vong<\/strong>.<\/p>\n<h2>1. C\u00e1c \u0111\u1ecbnh ngh\u0129a<\/h2>\n<p>&#8211; Nhi\u1ec5m khu\u1ea9n (infection): \u0111\u00e1p \u1ee9ng vi\u00eam c\u1ee7a c\u01a1 th\u1ec3 \u0111\u1ed1i v\u1edbi t\u00e1c nh\u00e2n vi sinh v\u1eadt<\/p>\n<p>&#8211; H\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n (Systemic Inflammatory Response Syndrome \u2013 SIRS): hi\u1ec7n di\u1ec7n \u00edt nh\u1ea5t 2 trong 4 ti\u00eau chu\u1ea9n sau (trong \u0111\u00f3 \u00edt nh\u1ea5t c\u00f3 m\u1ed9t ti\u00eau chu\u1ea9n v\u1ec1 nhi\u1ec7t \u0111\u1ed9 hay s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u):<\/p>\n<ul>\n<li>S\u1ed1t &gt; 38,5oC ho\u1eb7c h\u1ea1 th\u00e2n nhi\u1ec7t &lt; 36oC (theo d\u00f5i nhi\u1ec7t \u0111\u1ed9 trung t\u00e2m)<\/li>\n<li>Tim nhanh theo tu\u1ed5i (*) ho\u1eb7c tim ch\u1eadm \u1edf tr\u1ebb d\u01b0\u1edbi 1 tu\u1ed5i (**).<\/li>\n<li>Th\u1edf nhanh theo tu\u1ed5i (***).<\/li>\n<li>B\u1ea1ch c\u1ea7u t\u0103ng ho\u1eb7c gi\u1ea3m theo tu\u1ed5i (*****) (ng\u01b0\u1eddi l\u1edbn &gt;12.000\/mm3 hay &lt; 4.000\/mm3) hay b\u1ea1ch c\u1ea7u non &gt; 10%.<\/li>\n<\/ul>\n<figure id=\"attachment_27371\" aria-describedby=\"caption-attachment-27371\" style=\"width: 1150px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-27371\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1783F7F7-C2B3-423F-AE8C-725014959A27.jpeg\" alt=\"Tie\u0302u chu\u00e2\u0309n cu\u0309a h\u1ecd\u0302i ch\u01b0\u0301ng \u0111a\u0301p \u01b0\u0301ng vie\u0302m toa\u0300n tha\u0302n\" width=\"1150\" height=\"598\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1783F7F7-C2B3-423F-AE8C-725014959A27.jpeg 1150w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1783F7F7-C2B3-423F-AE8C-725014959A27-300x156.jpeg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1783F7F7-C2B3-423F-AE8C-725014959A27-1024x532.jpeg 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1783F7F7-C2B3-423F-AE8C-725014959A27-768x399.jpeg 768w\" sizes=\"(max-width: 1150px) 100vw, 1150px\" \/><figcaption id=\"caption-attachment-27371\" class=\"wp-caption-text\">Tie\u0302u chu\u00e2\u0309n cu\u0309a h\u1ecd\u0302i ch\u01b0\u0301ng \u0111a\u0301p \u01b0\u0301ng vie\u0302m toa\u0300n tha\u0302n<\/figcaption><\/figure>\n<p>&#8211; Nhi\u1ec5m khu\u1ea9n huy\u1ebft (sepsis) hay nhi\u1ec5m khu\u1ea9n to\u00e0n th\u00e2n: h\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n, nguy\u00ean nh\u00e2n do nhi\u1ec5m khu\u1ea9n<\/p>\n<p>&#8211; Nhi\u1ec5m khu\u1ea9n n\u1eb7ng (severe sepsis): nhi\u1ec5m khu\u1ea9n huy\u1ebft k\u00e8m r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 quan tim m\u1ea1ch ho\u1eb7c h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng \u00edt nh\u1ea5t 2 c\u01a1 quan c\u00f2n l\u1ea1i.<\/p>\n<p>&#8211; S\u1ed1c nhi\u1ec5m khu\u1ea9n (septic shock): nhi\u1ec5m khu\u1ea9n huy\u1ebft k\u00e8m r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 quan tim m\u1ea1ch<\/p>\n<p>&#8211; \u0110\u1ecbnh ngh\u0129a v\u1ec1 m\u1eb7t huy\u1ebft \u0111\u1ed9ng c\u1ee7a s\u1ed1c nhi\u1ec5m khu\u1ea9n<\/p>\n<p>+ S\u1ed1c n\u00f3ng: gi\u1ea3m t\u01b0\u1edbi m\u00e1u bi\u1ec3u hi\u1ec7n b\u1eb1ng thay \u0111\u1ed5i tri gi\u00e1c, ph\u1ee5c h\u1ed3i da (refill) m\u1ea5t nhanh (flash), m\u1ea1ch ngo\u1ea1i bi\u00ean n\u1ea3y v\u1ecdt, ch\u00ecm nhanh (bounding), gi\u1ea3m th\u1ec3 t\u00edch n\u01b0\u1edbc ti\u1ec3u &lt; 1 ml\/kg\/gi\u1edd.<br \/>\n+ S\u1ed1c l\u1ea1nh: gi\u1ea3m t\u01b0\u1edbi m\u00e1u bi\u1ec3u hi\u1ec7n b\u1eb1ng thay \u0111\u1ed5i tri gi\u00e1c, refill &gt; 2gi\u00e2y, m\u1ea1ch ngo\u1ea1i bi\u00ean gi\u1ea3m, chi l\u1ea1nh \u1ea9m. Th\u01b0\u1eddng l\u00e0 giai \u0111o\u1ea1n cu\u1ed1i c\u1ee7a b\u1ec7nh.<br \/>\n+ S\u1ed1c kh\u00e1ng d\u1ecbch\/s\u1ed1c kh\u00e1ng dopamin: s\u1ed1c v\u1eabn c\u00f2n m\u1eb7c d\u00f9 \u0111\u00e3 truy\u1ec1n &gt; 60 ml\/kg (th\u1eddi gian th\u00edch h\u1ee3p) \/ khi s\u1ed1c v\u1eabn c\u00f2n d\u00f9 d\u00f9ng dopamin \u0111\u1ebfn 10 \u03bcg\/kg\/ph\u00fat.<br \/>\n+ S\u1ed1c kh\u00e1ng catecholamin: s\u1ed1c v\u1eabn c\u00f2n m\u1eb7c d\u00f9 \u0111\u00e3 d\u00f9ng norepinephrin hay epinephrin (li\u1ec1u norepinephrin &gt; 0,1 \u03bcg\/kg\/ph\u00fat)<br \/>\n+ S\u1ed1c tr\u01a1: s\u1ed1c v\u1eabn ti\u1ebfp di\u1ec5n m\u1eb7c d\u00f9 \u0111\u00e3 d\u00f9ng thu\u1ed1c t\u0103ng s\u1ee9c co b\u00f3p, thu\u1ed1c v\u1eadn m\u1ea1ch, thu\u1ed1c d\u00e3n m\u1ea1ch, \u0111i\u1ec1u ch\u1ec9nh \u0111\u01b0\u1eddng huy\u1ebft, can xi, \u0111i\u1ec1u tr\u1ecb thay th\u1ebf hormon (tuy\u1ebfn gi\u00e1p, corticoid v\u00e0 insulin)<\/p>\n<p>&#8211; H\u1ed9i ch\u1ee9ng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng \u0111a c\u01a1 quan: khi c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng 2 c\u01a1 quan tr\u1edf l\u00ean. Ti\u00eau chu\u1ea9n r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u00e1c c\u01a1 quan \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a nh\u01b0 sau:<\/p>\n<p>+ R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim m\u1ea1ch: khi b\u1ec7nh nhi \u0111\u01b0\u1ee3c truy\u1ec1n NaCl 0,9% v\u1edbi li\u1ec1u \u2265 40ml\/kg\/gi\u1edd nh\u01b0ng HA v\u1eabn gi\u1ea3m ho\u1eb7c c\u1ea7n d\u00f9ng v\u1eadn m\u1ea1ch \u0111\u1ec3 duy tr\u00ec HA trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng (Dopamin &gt; 5 \u03bcg\/kg\/ph ho\u1eb7c Dobutamin, Epinephrine \u1edf b\u1ea5t c\u1ee9 li\u1ec1u n\u00e0o) ho\u1eb7c c\u00f3 2 ti\u00eau chu\u1ea9n (gi\u1ea3m t\u01b0\u1edbi m\u00e1u) trong c\u00e1c ti\u00eau chu\u1ea9n d\u01b0\u1edbi \u0111\u00e2y:<\/p>\n<ul>\n<li>Toan chuy\u1ec3n h\u00f3a (BE &lt; &#8211; 5 mEq\/l) kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c<\/li>\n<li>\u00a0Lactate m\u00e1u \u0111\u1ed9ng m\u1ea1ch &gt; 2 l\u1ea7n tr\u1ecb s\u1ed1 b\u00ecnh th\u01b0\u1eddng (&gt; 4mmol\/l)<\/li>\n<li>Thi\u1ec3u ni\u1ec7u: &lt; 0,5 ml\/kg\/h<\/li>\n<li>Refill &gt;5 gi\u00e2y<\/li>\n<li>Nhi\u1ec7t \u0111\u1ed9 ngo\u1ea1i bi\u00ean th\u1ea5p h\u01a1n nhi\u1ec7t \u0111\u1ed9 trung t\u00e2m &gt; 30C<\/li>\n<\/ul>\n<p>+ R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p: c\u00f3 m\u1ed9t trong c\u00e1c ti\u00eau chu\u1ea9n sau:<\/p>\n<ul>\n<li>PaO2\/FIO2 &lt; 300 (kh\u00f4ng c\u00f3 tim b\u1ea9m sinh t\u00edm ho\u1eb7c b\u1ec7nh ph\u1ed5i tr\u01b0\u1edbc \u0111\u00f3)<\/li>\n<li>PaCO2 &gt; 65 mmHg ho\u1eb7c t\u0103ng &gt; 20 mmHg so v\u1edbi chu\u1ea9n<\/li>\n<li>\u00a0C\u1ea7n FiO2 &gt; 50% \u0111\u1ec3 duy tr\u00ec SaO2 &gt; 92% ho\u1eb7c c\u1ea7n th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc<\/li>\n<\/ul>\n<p>+ R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea7n kinh: Glasgow &lt; 11\u0111 ho\u1eb7c Glasgow gi\u1ea3m \u2265 3 \u0111i\u1ec3m so v\u1edbi tr\u01b0\u1edbc \u0111\u00f3<\/p>\n<p>+ R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng huy\u1ebft h\u1ecdc: Ti\u1ec3u c\u1ea7u &lt; 80.000\/mm3 ho\u1eb7c INR &gt; 2<\/p>\n<p>+ R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn: Creatinin \u2265\u00a02 l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean theo tu\u1ed5i<\/p>\n<p>+ R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan: Bilirubin &gt; 4 mg\/dl (kh\u00f4ng \u00e1p d\u1ee5ng cho s\u01a1 sinh) ho\u1eb7c ALT &gt; 2 l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean theo tu\u1ed5i.<\/p>\n<h2>2. Ch\u1ea9n \u0111o\u00e1n s\u1ed1c nhi\u1ec5m khu\u1ea9n<\/h2>\n<h3>2.1. C\u00e1c b\u01b0\u1edbc ch\u1ea9n \u0111o\u00e1n<\/h3>\n<h4>2.1.1 . H\u1ecfi b\u1ec7nh<\/h4>\n<p>&#8211; 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<\/p>\n<ul>\n<li>Ti\u1ec3u bu\u1ed1t, s\u00f3n ti\u1ec3u, ti\u1ec3u nhi\u1ec1u l\u1ea7n (nhi\u1ec5m tr\u00f9ng ti\u1ec3u).<\/li>\n<li>\u1ec8a ch\u1ea3y, ph\u00e2n c\u00f3 nh\u00e0y m\u00e1u (nhi\u1ec5m tr\u00f9ng ti\u00eau h\u00f3a).<\/li>\n<li>Nh\u1ecdt da, \u00e1p xe (T\u1ee5 c\u1ea7u).<\/li>\n<li>S\u1ed1t, ho (vi\u00eam ph\u1ed5i).<\/li>\n<\/ul>\n<p>&#8211; Ti\u1ec1n s\u1eed ti\u00eam ph\u00f2ng: Hemophilus, n\u00e3o m\u00f4 c\u1ea7u.<\/p>\n<p>&#8211; C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1:<\/p>\n<ul>\n<li>S\u01a1 sinh thi\u1ebfu th\u00e1ng\/ tr\u1ebb &lt; 1 th\u00e1ng tu\u1ed5i<\/li>\n<li>Suy dinh d\u01b0\u1ee1ng<\/li>\n<li>Ch\u1ea5n th\u01b0\u01a1ng n\u1eb7ng\/ ph\u1eabu thu\u1eadt l\u1edbn\/ b\u1ec7nh nhi c\u00f3 c\u00e1c d\u1eabn l\u01b0u ho\u1eb7c th\u1ee7 thu\u1eadt can thi\u1ec7p (\u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n, catheter t\u0129nh m\u1ea1ch trung t\u00e2m, d\u1eabn l\u01b0u m\u00e0ng ph\u1ed5i)<\/li>\n<li>Suy gi\u1ea3m mi\u1ec5n d\u1ecbch, \u0111ang \u0111i\u1ec1u tr\u1ecb corticoide.<\/li>\n<li>B\u1ec7nh m\u00e3n t\u00ednh: ti\u1ec3u \u0111\u01b0\u1eddng, b\u1ec7nh tim, gan, th\u1eadn.<\/li>\n<\/ul>\n<h4>2.1.2. Kh\u00e1m l\u00e2m s\u00e0ng<\/h4>\n<p>&#8211; Ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a h\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n: nhi\u1ec7t \u0111\u1ed9, m\u1ea1ch, huy\u1ebft \u00e1p, nh\u1ecbp th\u1edf<\/p>\n<p>&#8211; D\u1ea5u hi\u1ec7u s\u1ed1c: r\u1ea5t quan tr\u1ecdng n\u1ebfu nh\u1eadn bi\u1ebft \u0111\u01b0\u1ee3c c\u00e1c d\u1ea5u hi\u1ec7u s\u1edbm c\u1ee7a s\u1ed1c (s\u1ed1c c\u00f2n b\u00f9): thay \u0111\u1ed5i v\u1ec1 tinh th\u1ea7n (k\u00edch th\u00edch qu\u1ea5y kh\u00f3c, m\u1ec7t m\u1ecfi nh\u01b0ng v\u1eabn t\u1ec9nh), m\u1ea1ch nhanh nh\u1eb9 ho\u1eb7c b\u00ecnh th\u01b0\u1eddng, huy\u1ebft \u00e1p t\u0103ng nh\u1eb9 ho\u1eb7c trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng, ti\u1ec3u gi\u1ea3m &lt; 1 ml\/kg\/h, refill &lt; 2 gi\u00e2y).<\/p>\n<p>&#8211; Ph\u00e1t hi\u1ec7n c\u00e1c \u1ed5 nhi\u1ec5m khu\u1ea9n: da, v\u1ebft m\u1ed5, tai m\u0169i h\u1ecdng, ph\u1ed5i, n\u01b0\u1edbc ti\u1ec3u<\/p>\n<p>&#8211; Ban ch\u1ec9 \u0111i\u1ec3m c\u1ee7a nhi\u1ec5m khu\u1ea9n: ban xu\u1ea5t huy\u1ebft ho\u1ea1i t\u1eed, b\u1ea7m m\u00e1u, h\u1ed3ng ban.<\/p>\n<h4>2.1.3. C\u1eadn l\u00e2m s\u00e0ng<\/h4>\n<p>&#8211; C\u00f4ng th\u1ee9c m\u00e1u: c\u00f4ng th\u1ee9c b\u1ea1ch c\u1ea7u, Hb, ti\u1ec3u c\u1ea7u<br \/>\n&#8211; \u0110\u00f4ng m\u00e1u<br \/>\n&#8211; \u0110\u01b0\u1eddng m\u00e1u, lactat, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, kh\u00ed m\u00e1u,<br \/>\n&#8211; CRP\/ procalcitonin<br \/>\n&#8211; C\u1ea5y m\u00e1u: tr\u01b0\u1edbc khi ti\u00eam kh\u00e1ng sinh.<br \/>\n&#8211; Ch\u1ee9c n\u0103ng \u0111\u00f4ng m\u00e1u, ch\u1ee9c n\u0103ng gan, th\u1eadn<br \/>\n&#8211; Xquang ph\u1ed5i<br \/>\n&#8211; C\u1ea5y m\u1eabu b\u1ec7nh ph\u1ea9m \u1ed5 nhi\u1ec5m khu\u1ea9n nghi ng\u1edd: m\u1ee7,<strong>\u00a0<\/strong>n\u01b0\u1edbc ti\u1ec3u, ph\u00e2n.<br \/>\n&#8211; Si\u00eau \u00e2m \u1ed5 b\u1ee5ng t\u00ecm \u1ed5 nhi\u1ec5m tr\u00f9ng, \u00e1p xe s\u00e2u<\/p>\n<h3>2.2. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/h3>\n<p>D\u1ea5u hi\u1ec7u s\u1ed1c + h\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n + c\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh<\/p>\n<h3>2.3. Ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3<\/h3>\n<p>D\u1ea5u hi\u1ec7u s\u1ed1c + h\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n + d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd \u1ed5 nhi\u1ec5m tr\u00f9ng<\/p>\n<h2>3. \u0110i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m khu\u1ea9n<\/h2>\n<h3>3.1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/h3>\n<p>&#8211; Ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb theo ABCD<\/p>\n<p>&#8211; \u0110i\u1ec1u tr\u1ecb s\u1ed1c theo m\u1ee5c ti\u00eau<\/p>\n<p>&#8211; Kh\u00e1ng sinh<\/p>\n<p>&#8211; \u0110i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng<\/p>\n<h3>3.2. \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u s\u1ed1c nhi\u1ec5m khu\u1ea9n<\/h3>\n<h4>3.2.1. \u0110i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m khu\u1ea9n<\/h4>\n<p>* M\u1ee5c ti\u00eau c\u1ea7n \u0111\u1ea1t trong gi\u1edd \u0111\u1ea7u<\/p>\n<p>&#8211; T\u01b0\u1edbi m\u00e1u ngo\u1ea1i bi\u00ean v\u1ec1 b\u00ecnh th\u01b0\u1eddng: refill &lt; 2 gi\u00e2y, chi \u1ea5m, m\u1ea1ch b\u1eaft r\u00f5 v\u1ec1 b\u00ecnh th\u01b0\u1eddng theo tu\u1ed5i, tinh th\u1ea7n tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng<br \/>\n&#8211; CVP 8 -12 cmH2O, \u00a0ScvO2 \u2265 70%, Lactate &lt; 2mmol<\/p>\n<p>* \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3:<\/p>\n<p>&#8211; 0 &#8211; 5 ph\u00fat: nh\u1eadn bi\u1ebft t\u00ecnh tr\u1ea1ng gi\u1ea3m \u00fd th\u1ee9c v\u00e0 t\u01b0\u1edbi m\u00e1u, th\u1edf \u00f4 xy l\u01b0u l\u01b0\u1ee3ng cao, thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch ho\u1eb7c truy\u1ec1n qua x\u01b0\u01a1ng n\u1ebfu l\u1ea5y t\u0129nh m\u1ea1ch th\u1ea5t b\u1ea1i, x\u00e9t nghi\u1ec7m m\u00e1u.<\/p>\n<p>&#8211; 5 &#8211; 15 ph\u00fat: truy\u1ec1n d\u1ecbch Natriclorua 0,9% ho\u1eb7c Lactate Ringer ho\u1eb7c v\u1edbi li\u1ec1u 20ml\/kg\/15 ph\u00fat ho\u1eb7c dung d\u1ecbch cao ph\u00e2n t\u1eed c\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i \u0111\u1ebfn 60ml\/kg cho t\u1edbi khi t\u00ecnh tr\u1ea1ng t\u01b0\u1edbi m\u00e1u c\u1ea3i thi\u1ec7n. \u0110\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng sau m\u1ed7i l\u1ea7n b\u00f9 d\u1ecbch, ph\u00e1t hi\u1ec7n t\u00ecnh tr\u1ea1ng qu\u00e1 t\u1ea3i d\u1ecbch (ran ph\u1ed5i, t\u0129nh m\u1ea1ch c\u1ed5, k\u00edch th\u01b0\u1edbc gan, s\u1eafc m\u00f4i, s\u1eed d\u1ee5ng c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5). \u0110i\u1ec1u tr\u1ecb h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, h\u1ea1 can xi m\u00e1u n\u1ebfu c\u00f3. B\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng kh\u00e1ng sinh.<\/p>\n<p>&#8211; T\u1eeb 15 &#8211; 60 ph\u00fat: \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng s\u1ed1c v\u1edbi li\u1ec7u ph\u00e1p truy\u1ec1n d\u1ecbch n\u1ebfu th\u1ea5y:<\/p>\n<ul>\n<li>\u0110\u00e1p \u1ee9ng t\u1ed1t: c\u1ea3i thi\u1ec7n m\u1ea1ch, HA v\u1ec1 b\u00ecnh th\u01b0\u1eddng, CVP t\u1eeb 8 -12 cmH2O refill &lt; 2 gi\u00e2y, tinh th\u1ea7n, ti\u1ec3u &gt; 1ml\/kg\/h, ti\u1ebfp t\u1ee5c truy\u1ec1n d\u1ecbch duy tr\u00ec.<\/li>\n<li>Kh\u00f4ng \u0111\u00e1p \u1ee9ng (s\u1ed1c kh\u00e1ng truy\u1ec1n d\u1ecbch): n\u1ebfu sau 2 l\u1ea7n b\u00f9 d\u1ecbch (40 ml\/kg) s\u1ed1c ch\u01b0a c\u1ea3i thi\u1ec7n s\u1eed d\u1ee5ng Dopamine s\u1edbm truy\u1ec1n TM (c\u00f3 th\u1ec3 d\u00f9ng \u0111\u01b0\u1eddng ngo\u1ea1i bi\u00ean\/truy\u1ec1n trong x\u01b0\u01a1ng) li\u1ec1u kh\u1edfi \u0111\u1ea7u 5\u03bcg\/kg\/ph\u00fat, t\u0103ng nhanh \u0111\u1ebfn 10\u03bcg\/kg\/ph\u00fat trong v\u00f2ng 5-10 ph\u00fat. C\u1ea7n \u0111\u1eb7t CVP, v\u00e0 h\u00f4 h\u1ea5p h\u1ed7 tr\u1ee3 n\u1ebfu c\u1ea7n thi\u1ebft. \u0110\u00e1nh gi\u00e1 l\u1ea1i n\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng:<\/li>\n<li>S\u1ed1c l\u1ea1nh: truy\u1ec1n Adrenaline li\u1ec1u t\u1eeb 0,05 &#8211; 0,3\u03bcg\/kg\/ph\u00fat.<\/li>\n<li>S\u1ed1c n\u00f3ng: truy\u1ec1n Noradrenaline li\u1ec1u t\u1eeb 0,05 &#8211; 0,3\u03bcg\/kg\/ph\u00fat.<\/li>\n<\/ul>\n<p>\u2192 N\u1ebfu v\u1eabn kh\u00f4ng \u0111\u00e1p \u1ee9ng (s\u1ed1c kh\u00e1ng v\u1edbi catecholamine)<\/p>\n<ul>\n<li>Huy\u1ebft \u00e1p t\u00e2m thu b\u00ecnh th\u01b0\u1eddng ho\u1eb7c \u00a0huy\u1ebft \u00e1p trung b\u00ecnh \u2265 50-60mmHg, ScvO2 &lt;70%, truy\u1ec1n Dobutamine 5-15\u03bcg\/kg\/ph\u00fat. Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 dobutamine, c\u00f3 th\u1ec3 d\u00f9ng milrinone 0,25-1\u03bcg\/kg\/ph\u00fat. T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a milrinone: t\u1ee5t huy\u1ebft \u00e1p, r\u1ed1i lo\u1ea1n nh\u1ecbp tim, bu\u1ed3n n\u00f4n, n\u00f4n, \u0111au b\u1ee5ng, t\u1ed5n th\u01b0\u01a1ng gan, gi\u1ea3m ti\u1ec3u c\u1ea7u, h\u1ea1 kali m\u00e1u. Gi\u1ea3m li\u1ec1u khi suy th\u1eadn. Kh\u00f4ng d\u00f9ng chung \u1ed1ng ti\u00eam hay \u0111\u01b0\u1eddng ti\u00eam truy\u1ec1n v\u1edbi furosemide v\u00ec g\u00e2y k\u1ebft t\u1ee7a.<\/li>\n<li>HA t\u00e2m thu gi\u1ea3m ho\u1eb7c huy\u1ebft \u00e1p trung b\u00ecnh &lt; 50 mmHg:<br \/>\n+ ScvO2 &lt;70%: t\u0103ng li\u1ec1u Adrenaline (0,4-1\u03bcg\/kg\/ph\u00fat),<br \/>\n+ ScvO2 \u226570%: truy\u1ec1n Noradrenaline li\u1ec1u 0,1-1\u03bcg\/kg\/ph\u00fat.<\/li>\n<li>Hydrocortisone li\u1ec1u 50 mg\/ m2\/ng\u00e0y ho\u1eb7c 2 mg\/kg\/ng\u00e0y ti\u00eam t\u0129nh m\u1ea1ch ch\u1eadm chia 4 l\u1ea7n.<\/li>\n<\/ul>\n<p>\u2192 N\u1ebfu t\u00ecnh tr\u1ea1ng s\u1ed1c v\u1eabn kh\u00f4ng c\u1ea3i thi\u1ec7n (s\u1ed1c kh\u00e1ng catecholamine k\u00e9o d\u00e0i) c\u1ea7n kh\u00e1m ph\u00e1t hi\u1ec7n v\u00e0 s\u1eed tr\u00ed tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim, tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i v\u00e0 l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c \u1ed5 b\u1ee5ng (n\u1ebfu &gt; 12 mmHg). \u0110o cung l\u01b0\u1ee3ng tim (CO: cardiac output), kh\u00e1ng l\u1ef1c m\u1ea1ch m\u00e1u h\u1ec7 th\u1ed1ng (SVR: systemic vascular resistance) \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn d\u00f9ng thu\u1ed1c v\u1eadn m\u1ea1ch th\u00edch h\u1ee3p ngo\u00e0i c\u00e1c cathecholamine nh\u01b0 vasopressin, terlipressin, levosimendan.<\/p>\n<h4>3.2.2. Kh\u00e1ng sinh<\/h4>\n<p>D\u00f9ng kh\u00e1ng sinh s\u1edbm trong gi\u1edd \u0111\u1ea7u n\u1ebfu ngh\u0129 \u0111\u1ebfn s\u1ed1c nhi\u1ec5m khu\u1ea9n, tr\u01b0\u1edbc khi c\u1ea5y m\u00e1u. L\u1ef1a ch\u1ecdn kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng, bao ph\u1ee7 to\u00e0n b\u1ed9 t\u00e1c nh\u00e2n nghi ng\u1edd. C\u00e1c h\u01b0\u1edbng d\u1eabn ch\u1ecdn kh\u00e1ng sinh trong nhi\u1ec5m khu\u1ea9n huy\u1ebft d\u1ef1a tr\u00ean ch\u1ee9ng c\u1ee9.<\/p>\n<h4>3.2.3. \u0110i\u1ec1u tr\u1ecb kh\u00e1c<\/h4>\n<p>&#8211; Truy\u1ec1n m\u00e1u v\u00e0 ch\u1ebf ph\u1ea9m m\u00e1u: truy\u1ec1n kh\u1ed1i h\u1ed3ng c\u1ea7u n\u1ebfu Hb &lt; 10 g\/dl \u0111\u1ec3 gi\u1eef Hb \u2265 10 g\/dl, hematocrit &gt;= 30%. Truy\u1ec1n kh\u1ed1i ti\u1ec3u c\u1ea7u n\u1ebfu ti\u1ec3u c\u1ea7u &lt; 10.000\/mm3, ho\u1eb7c ti\u1ec3u c\u1ea7u &lt; 20.000\/mm3 n\u1ebfu c\u00f3 ch\u1ea3y m\u00e1u tr\u00ean l\u00e2m s\u00e0ng, n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p th\u1ee7 thu\u1eadt\/ph\u1eabu thu\u1eadt truy\u1ec1n kh\u1ed1i ti\u1ec3u c\u1ea7u \u0111\u1ec3 \u0111\u01b0a ti\u1ec3u c\u1ea7u \u2265 50.000\/mm3.<\/p>\n<p>&#8211; \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n \u0111\u01b0\u1eddng m\u00e1u: gi\u1eef \u0111\u01b0\u1eddng m\u00e1u trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng (180 mg\/dl). N\u1ebfu \u0111\u01b0\u1eddng m\u00e1u h\u1ea1 &lt; 180 mg\/dl truy\u1ec1n dung d\u1ecbch glucose 10% trong natriclorua 0,9% v\u1edbi t\u1ef7 l\u1ec7 1\/1. N\u1ebfu t\u0103ng \u0111\u01b0\u1eddng m\u00e1u c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng Insulin.<\/p>\n<p>&#8211; \u0110i\u1ec1u ch\u1ec9nh toan chuy\u1ec3n h\u00f3a: khi pH m\u00e1u&lt;7,15. S\u1eed d\u1ee5ng natribicacbonat 4,2%\/8,4% v\u1edbi li\u1ec1u 1- 2 mmol\/kg.<\/p>\n<p>&#8211; S\u1eed d\u1ee5ng corticoid: khi s\u1ed1c nhi\u1ec5m khu\u1ea9n do n\u00e3o m\u00f4 c\u1ea7u ho\u1eb7c s\u1ed1c kh\u00e1ng catecholamine. Thu\u1ed1c s\u1eed d\u1ee5ng l\u00e0 hydrocotisol v\u1edbi li\u1ec1u 50 mg\/m2\/ng\u00e0y ho\u1eb7c 2 mg\/kg\/ng\u00e0y chia 4 l\u1ea7n c\u00e1ch 6 gi\u1edd ti\u00eam t\u0129nh m\u1ea1ch.<\/p>\n<h3>3.3. \u0110i\u1ec1u tr\u1ecb b\u01b0\u1edbc 2 (sau khi tho\u00e1t s\u1ed1c)<\/h3>\n<p>&#8211; Theo d\u00f5i ph\u00e1t hi\u1ec7n lo\u1ea1i b\u1ecf \u1ed5 nhi\u1ec5m khu\u1ea9n (\u1ed5 \u00e1p xe, ho\u1eb7c \u0111\u01b0\u1eddng v\u00e0o m\u1ea1ch m\u00e1u nghi nhi\u1ec5m khu\u1ea9n nh\u01b0 catheter)<br \/>\n&#8211; \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u00e1c c\u01a1 quan<br \/>\n&#8211; \u0110\u1ea3m b\u1ea3o ch\u1ebf \u0111\u1ed9 dinh d\u01b0\u1ee1ng, th\u1ef1c hi\u1ec7n v\u00f4 khu\u1ea9n khi ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n (th\u1edf m\u00e1y, c\u00e1c \u0111\u01b0\u1eddng truy\u1ec1n, c\u00e1c th\u1ee7 thu\u1eadt can thi\u1ec7p) ph\u00f2ng nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n.<\/p>\n<p>Ngu\u1ed3n tham kh\u1ea3o:<\/p>\n<ol>\n<li>B\u1ed9 Y T\u1ebf<\/li>\n<li>Goldstein B, Giroir B, Randolph A v\u00e0 CS, Internaltional pediatric sepsis consensus conference: Definitions for sepsis and organ dysfuntion in pediatrics. Pediatr Cri Care Med 2005<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>S\u1ed1c nhi\u1ec5m khu\u1ea9n l\u00e0 t\u00ecnh tr\u1ea1ng s\u1ed1c x\u1ea3y ra nh\u01b0 l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng n\u1eb7ng c\u1ee7a nhi\u1ec5m tr\u00f9ng huy\u1ebft, n\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p, k\u1ecbp th\u1eddi s\u1ebd d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o, t\u1ed5n th\u01b0\u01a1ng \u0111a c\u01a1 quan \u0111\u01b0a \u0111\u1ebfn t\u1eed vong. 1. C\u00e1c \u0111\u1ecbnh ngh\u0129a &#8211; Nhi\u1ec5m khu\u1ea9n (infection): \u0111\u00e1p \u1ee9ng vi\u00eam c\u1ee7a [&hellip;]<\/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":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m khu\u1ea9n \u1edf tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"S\u1ed1c nhi\u1ec5m khu\u1ea9n l\u00e0 t\u00ecnh tr\u1ea1ng s\u1ed1c x\u1ea3y ra nh\u01b0 l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng n\u1eb7ng c\u1ee7a nhi\u1ec5m tr\u00f9ng huy\u1ebft, n\u1ebfu kh\u00f4ng \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi c\u00f3 th\u1ec3 t\u1eed vong\" \/>\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=\"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m khu\u1ea9n \u1edf tr\u1ebb em - 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