{"id":27395,"date":"2023-04-23T15:11:12","date_gmt":"2023-04-23T08:11:12","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27395"},"modified":"2023-04-24T15:15:24","modified_gmt":"2023-04-24T08:15:24","slug":"viem-phoi-nang-do-virus-cum-a-huong-dan-chan-doan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/viem-phoi-nang-do-virus-cum-a-huong-dan-chan-doan\/","title":{"rendered":"Vi\u00eam ph\u1ed5i n\u1eb7ng do virus c\u00fam A: h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n"},"content":{"rendered":"<p><strong>Vi\u00eam ph\u1ed5i n\u1eb7ng l\u00e0 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i g\u00e2y suy h\u00f4 h\u1ea5p ti\u1ebfn tri\u1ec3n nhanh c\u0103n nguy\u00ean do c\u00e1c virut c\u00fam A g\u00e2y ra. Di\u1ec5n bi\u1ebfn n\u1eb7ng c\u00f3 li\u00ean quan m\u1ed9t s\u1ed1 nh\u00f3m ng\u01b0\u1eddi b\u1ec7nh nh\u01b0: suy gi\u1ea3m mi\u1ec5n d\u1ecbch (c\u00f3 thai ho\u1eb7c d\u00f9ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch); ng\u01b0\u1eddi b\u1ec7nh th\u01b0\u1eddng tr\u1ebb tu\u1ed5i, ph\u1ea7n l\u1edbn \u0111ang trong \u0111\u1ed9 tu\u1ed5i lao \u0111\u1ed9ng; c\u00f3 nhi\u1ec1u b\u1ec7nh m\u1ea1n t\u00ednh ph\u1ed1i h\u1ee3p.\u00a0\u00a0Ph\u1ea7n l\u1edbn ng\u01b0\u1eddi b\u1ec7nh t\u1eed vong v\u00ec suy h\u00f4 h\u1ea5p do c\u00f3 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i n\u1eb7ng ho\u1eb7c do suy \u0111a ph\u1ee7 t\u1ea1ng, nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n ph\u1ed1i h\u1ee3p.\u00a0<\/strong><\/p>\n<h2><strong>1. T\u1ed5ng quan v\u1ec1 vi r\u00fat c\u00fam A.<\/strong><\/h2>\n<p>Th\u01b0\u1eddng g\u1eb7p do vi r\u00fat c\u00fam A (H<sub>5<\/sub>N<sub>1<\/sub>), c\u00fam A (H<sub>1<\/sub>N<sub>1<\/sub>), c\u00fam A (H<sub>3<\/sub>N<sub>2<\/sub>), c\u00fam A\u00a0(H<sub>7<\/sub>N<sub>9<\/sub>)\u2026<\/p>\n<ul>\n<li><strong>Vi r\u00fat c\u00fam A H<sub>5<\/sub>N<sub>1<\/sub>. <\/strong>\n<ul>\n<li>C\u00fam A (H<sub>5<\/sub>N1) c\u00f2n g\u1ecdi l\u00e0 c\u00fam gia c\u1ea7m v\u00ec g\u00e2y b\u1ec7nh cho gia c\u1ea7m v\u00e0 try\u1ec1n b\u1ec7nh sang ng\u01b0\u1eddi.<\/li>\n<li>Hay g\u00e2y b\u1ec7nh cho l\u1ee9a tu\u1ed5i \u0111ang trong \u0111\u1ed9 tu\u1ed5i lao \u0111\u1ed9ng v\u00e0 c\u00e1c ng\u01b0\u1eddi b\u1ec7nh c\u00f3 suy gi\u1ea3m suy gi\u1ea3m mi\u1ec5n d\u1ecbch nh\u01b0 nghi\u1ec7n r\u01b0\u1ee3u, c\u00f3 thai \u2026<\/li>\n<li>Vi r\u00fat c\u00f3 \u0111\u1ed9c l\u1ef1c cao, khi x\u00e2m nh\u1eadp v\u00e0o c\u01a1 th\u1ec3 ng\u01b0\u1eddi g\u00e2y t\u1ed5n th\u01b0\u01a1ng qua 2 c\u01a1 ch\u1ebf:<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>+ <strong>Tr\u1ef1c ti\u1ebfp:<\/strong> t\u1ea1i ph\u1ed5i \u0111\u00f3 l\u00e0 vi r\u00fat nh\u00e2n l\u00ean t\u1ea1i t\u1ebf b\u00e0o ph\u1ebf b\u00e0o II c\u1ee7a ph\u1ebf nang v\u00e0 ph\u00e1 h\u1ee7y tr\u1ef1c ti\u1ebfp c\u00e1c ph\u1ebf nang c\u00f3 t\u00ednh ch\u1ea5t lan t\u1ecfa.<\/p>\n<p>+ <strong>Gi\u00e1n ti\u1ebfp<\/strong> l\u00e0 c\u00e1c vi r\u00fat k\u00edch th\u00edch h\u1ec7 th\u1ed1ng b\u1ea3o v\u1ec7 c\u1ee7a c\u01a1 th\u1ec3 g\u00e2y ra c\u00e1c ph\u1ea3n \u1ee9ng vi\u00eam qu\u00e1 m\u1ee9c (c\u00e1c c\u01a1n b\u00e3o cytokine) v\u00e0 g\u00e2y ra h\u1ed9i ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng ph\u1ebf nang lan t\u1ecfa (Diffuse Alveolar Damage &#8211; DAD ), l\u00e0m m\u1ea5t kh\u1ea3 n\u0103ng trao \u0111\u1ed5i kh\u00ed\u00a0 d\u1eabn \u0111\u1ebfn thi\u1ebfu oxy m\u00e1u n\u1eb7ng v\u00e0 k\u00e9o d\u00e0i, t\u1ed5n th\u01b0\u01a1ng suy \u0111a t\u1ea1ng.<\/p>\n<p>Hay g\u1eb7p v\u00f9ng \u0110\u00f4ng Nam \u00c1 nh\u01b0 Indonesia, Vi\u1ec7t Nam \u2026<\/p>\n<p>T\u1ec9 l\u1ec7 t\u1eed vong cao 60 -80%<\/p>\n<ul>\n<li><strong>Vi r\u00fat c\u00fam A H<sub>1<\/sub>N<sub>1<\/sub>. <\/strong>\n<ul>\n<li>L\u00e0 c\u00fam g\u00e2y b\u1ec7nh tr\u1ef1c ti\u1ebfp cho ng\u01b0\u1eddi, m\u1ee9c \u0111\u1ed9 l\u00e2y lan ra c\u1ed9ng \u0111\u1ed3ng nhanh nh\u01b0ng \u0111\u1ed9c l\u1ef1c vi r\u00fat y\u1ebfu h\u01a1n vi r\u00fat c\u00fam A (H<sub>5<\/sub>N<sub>1<\/sub>).<\/li>\n<li>C\u00e1c nguy c\u01a1 di\u1ec5n bi\u1ebfn n\u1eb7ng: suy gi\u1ea3m mi\u1ec5n d\u1ecbch, ph\u1ee5 n\u1eef c\u00f3 thai, tr\u1ebb em d\u01b0\u1edbi 5 tu\u1ed5i, c\u00f3 b\u1ec7nh tim m\u1ea1ch m\u1ea1n t\u00ednh, b\u1ec7nh ph\u1ed5i ph\u1ed5i m\u1ea1n t\u00ednh, b\u00e9o ph\u00ec\u2026<\/li>\n<li>T\u1ec9 l\u1ec7 t\u1eed vong thay \u0111\u1ed5i theo t\u1eebng qu\u1ed1c gia; 0,048% t\u1ea1i M\u1ef9 v\u00e0 t\u1ea1i Anh l\u00e0 0,026%.<\/li>\n<li>Nguy\u00ean nh\u00e2n d\u1eabn \u0111\u1ebfn t\u1eed vong ch\u1ee7 y\u1ebfu do suy h\u00f4 h\u1ea5p do ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb mu\u1ed9n, t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i n\u1eb7ng, suy \u0111a t\u1ea1ng v\u00e0 nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Vi r\u00fat c\u00fam A H<sub>3<\/sub>N<sub>2<\/sub>.<\/strong><\/li>\n<\/ul>\n<p>C\u0169ng c\u00f3 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m g\u00e2y b\u1ec7nh t\u01b0\u01a1ng t\u1ef1 vi r\u00fat c\u00fam A H<sub>1<\/sub>N<sub>1<\/sub>.<\/p>\n<ul>\n<li><strong>Viruts c\u00fam A H<sub>7<\/sub>N <\/strong><\/li>\n<\/ul>\n<p>C\u00e1c b\u00e1o c\u00e1o t\u1ea1i Trung qu\u1ed1c c\u0169ng cho th\u1ea5y \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7a c\u00fam A H<sub>7<\/sub>N<sub>9<\/sub> c\u0169ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c lo\u1ea1i c\u00fam kh\u00e1c, v\u00e0 t\u1eed vong do \u0111i\u1ec1u tr\u1ecb mu\u1ed9n (sau 6 ng\u00e0y) suy h\u00f4 h\u1ea5p c\u1ea5p n\u1eb7ng, th\u1edf m\u00e1y kh\u00f4ng k\u1ebft qu\u1ea3 v\u00e0 suy \u0111a t\u1ea1ng.<\/p>\n<h2><strong>2. Tri\u1ec7u ch\u1ee9ng c\u1ee7a vi\u00eam ph\u1ed5i do vi r\u00fat c\u00fam A <\/strong><\/h2>\n<h3><strong>2.1. L\u00e2m s\u00e0ng <\/strong><\/h3>\n<p><strong>Th\u1eddi k\u1ef3 kh\u1edfi ph\u00e1t<\/strong><\/p>\n<ul>\n<li>Bi\u1ec3u hi\u1ec7n h\u1ed9i ch\u1ee9ng c\u00fam chung: m\u1ec7t, s\u1ed1t, \u0111au \u0111\u1ea7u, \u0111au h\u1ecdng, s\u1ed5 m\u0169i, ho khan<\/li>\n<li>Bi\u1ec3u hi\u1ec7n suy h\u00f4 h\u1ea5p tr\u00ean n\u1ec1n ng\u01b0\u1eddi b\u1ec7nh c\u00f3 bi\u1ec3u hi\u1ec7n h\u1ed9i ch\u1ee9ng c\u00fam, tuy nhi\u00ean di\u1ec5n bi\u1ebfn b\u1ec7nh kh\u00e1c nhau t\u00f9y thu\u1ed9c v\u00e0o t\u1eebng c\u0103n nguy\u00ean g\u00e2y b\u1ec7nh v\u00e0 xu\u1ea5t hi\u1ec7n th\u00eam m\u1ed9t s\u1ed1 tri\u1ec7u ch\u1ee9ng ngo\u00e0i \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p do vi r\u00fat c\u00fam A (H<sub>5<\/sub>N<sub>1<\/sub>). a) Th\u1eddi gian \u1ee7 b\u1ec7nh: t\u00f9y theo t\u1eebng lo\u1ea1i vi r\u00fat<\/li>\n<li>Do c\u00fam A (H<sub>5<\/sub>N<sub>1<\/sub>) th\u1eddi gian \u1ee7 b\u1ec7nh kho\u1ea3ng 1 tu\u1ea7n sau khi ti\u1ebfp x\u00fac v\u1edbi gia c\u1ea7m ch\u1ebft, \u1ed1m ho\u1eb7c b\u1ecb b\u1ec7nh.<\/li>\n<li>Do virut c\u00fam A (H<sub>1<\/sub>N<sub>1<\/sub>) th\u01b0\u1eddng t\u1eeb 1,5 \u0111\u1ebfn 3 ng\u00e0y ho\u1eb7c l\u00e2u h\u01a1n.<\/li>\n<li>Do c\u00fam A ( H<sub>7<\/sub>N<sub>9<\/sub>) kho\u1ea3ng t\u00f9 3-7 ng\u00e0y.<\/li>\n<\/ul>\n<p><strong>Th\u1eddi k\u1ef3 to\u00e0n ph\u00e1t <\/strong><\/p>\n<ul>\n<li>Bi\u1ec3u hi\u1ec7n nhi\u1ec5m c\u00fam chung nh\u01b0: \u0111au r\u00e1t h\u1ecdng, s\u1ed1t, \u0111au \u0111\u1ea7u, \u0111au m\u00ecnh m\u1ea9y, ho khan, ch\u1ea3y m\u0169i\u2026 , n\u1ebfu do c\u00fam A (H<sub>5<\/sub>N<sub>1<\/sub>).<\/li>\n<li>C\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n th\u00eam c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ec7 th\u1ea7n kinh: l\u00fa l\u1eabn, n\u00f4n bu\u1ed3n n\u00f4n, r\u1ed1i lo\u1ea1n c\u01a1 tr\u00f2n v\u00e0 h\u1ed9i ch\u1ee9ng n\u00e3o v\u00e0 m\u00e0ng n\u00e3o\u2026<\/li>\n<li>C\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ec1 ti\u00eau h\u00f3a nh\u01b0 vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t v\u1edbi bi\u1ec3u hi\u1ec7n \u1ec9a ch\u1ea3y, xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a \u2026<\/li>\n<li>H\u00f4 h\u1ea5p: \u0111au ng\u1ef1c, ho, kh\u00f3 th\u1edf t\u0103ng l\u00ean, suy h\u00f4 h\u1ea5p ti\u1ebfn tri\u1ec3n nhanh, th\u1edf nhanh, m\u1ea1ch nhanh, SpO<sub>2<\/sub> gi\u1ea3m, t\u00edm m\u00f4i \u0111\u1ea7u chi, kh\u00e1m ph\u1ed5i nhi\u1ec1u ran n\u1ed5 ho\u1eb7c th\u1ed5i \u1ed1ng.<\/li>\n<li>C\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n suy \u0111a t\u1ea1ng nh\u01b0: suy h\u00f4 h\u1ea5p, tu\u1ea7n ho\u00e0n, t\u0103ng bilirubin to\u00e0n ph\u1ea7n v\u00e0 tr\u1ef1c ti\u1ebfp, suy th\u1eadn, gi\u1ea3m ti\u1ec3u c\u1ea7u \u2026<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2><strong>3. C\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i do vi r\u00fat c\u00fam A.<\/strong><\/h2>\n<ul>\n<li><strong>C\u00f4ng th\u1ee9c m\u00e1u:\u00a0 <\/strong><\/li>\n<\/ul>\n<p>+ B\u1ea1ch c\u1ea7u v\u00e0 ti\u1ec3u c\u1ea7u b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u1ea3m, t\u1ec9 l\u1ec7 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh c\u0169ng gi\u1ea3m, tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng b\u1ea1ch c\u1ea7u gi\u1ea3m d\u01b0\u1edbi 1000 t\u1ebf b\u00e0o\/ml.<\/p>\n<p>+ Giai \u0111o\u1ea1n sau c\u00f3 nhi\u1ec5m khu\u1ea9n th\u1ee9 ph\u00e1t s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u t\u0103ng cao.<\/p>\n<ul>\n<li>T\u01b0\u01a1ng t\u1ef1 v\u1edbi c\u00e1c marker ch\u1ec9 th\u1ecb vi\u00eam kh\u00e1c nh\u01b0 <strong>CRP<\/strong>, <strong>procalcitolin<\/strong> trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng, giai \u0111o\u1ea1n c\u00f3 nhi\u1ec5m khu\u1ea9n th\u1ee9 ph\u00e1t CRP v\u00e0 Procalcitolin s\u1ebd t\u0103ng.<\/li>\n<li><strong>X quang tim ph\u1ed5i:<\/strong><\/li>\n<\/ul>\n<p>+ T\u1ed5n th\u01b0\u01a1ng th\u00e2m nhi\u1ec5m khu tr\u00fa m\u1ed9t th\u00f9y ph\u1ed5i sau \u0111\u00f3 lan t\u1ecfa nhanh ra to\u00e0n b\u1ed9 ph\u1ed5i th\u1eadm ch\u00ed lan t\u1ecfa nhanh c\u1ea3 hai ph\u1ed5i (ph\u1ed5i tr\u1eafng).<\/p>\n<p>+ C\u00f3 th\u1ec3 g\u1eb7p h\u00ecnh \u1ea3nh tr\u00e0n d\u1ecbch ho\u1eb7c\/v\u00e0 tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i.<\/p>\n<ul>\n<li><strong>Kh\u00ed m\u00e1u<\/strong>: bi\u1ec3u hi\u1ec7n \u0111i\u1ec3n h\u00ecnh gi\u1ea3m oxy h\u00f3a m\u00e1u m\u1ee9c \u0111\u1ed9 v\u1eeba \u0111\u1ebfn n\u1eb7ng, t\u1ec9 l\u1ec7 PaO2\/FiO2 &lt; 300, c\u00f3 th\u1ec3 g\u1eb7p t\u0103ng th\u00f4ng kh\u00ed ph\u1ebf nang (PaCO2 gi\u1ea3m &lt; 35 mmHg) \u1edf giai \u0111o\u1ea1n \u0111\u1ea7u do ng\u01b0\u1eddi b\u1ec7nh th\u1edf nhanh, khi ng\u01b0\u1eddi b\u1ec7nh c\u00f3 suy h\u00f4 h\u1ea5p n\u1eb7ng ph\u1ea3i th\u1edf m\u00e1y v\u1edbi PEEP cao th\u01b0\u1eddng c\u00f3 t\u0103ng CO2 m\u00e1u (&gt; 45 mmHg) do gi\u1ea3m th\u00f4ng kh\u00ed ph\u1ebf nang.<\/li>\n<li>K\u1ebft qu\u1ea3 <strong>x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n nhanh<\/strong> c\u00fam A (+) v\u1edbi d\u1ecbch t\u1ef5 h\u1ea7u ho\u1eb7c d\u1ecbch ph\u1ebf qu\u1ea3n, v\u1edbi c\u00fam A (H5N1) b\u1eaft bu\u1ed9c ph\u1ea3i l\u1ea5y d\u1ecbch h\u00fat \u0111\u1eddm s\u00e2u th\u00f4ng qua d\u1ecbch h\u00fat ph\u1ebf qu\u1ea3n ho\u1eb7c d\u1ecbch \u0111\u1eddm sau khi \u0111\u01b0\u1ee3c kh\u00ed dung n\u01b0\u1edbc mu\u1ed1i \u01b0u tr\u01b0\u01a1ng 10%. X\u00e9t nghi\u1ec7m nhanh cho k\u1ebft qu\u1ea3 15-30 ph\u00fat, th\u01b0\u1eddng t\u1ec9 l\u1ec7 \u00e2m t\u00ednh gi\u1ea3 cao do vi r\u00fat \u0111\u1ed9t bi\u1ebfn nhanh, n\u00ean hi\u1ec7n nay gi\u00e1 tr\u1ecb c\u1ee7a x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n nhanh \u00edt \u00fd ngh\u0129a.<\/li>\n<li><strong>PCR<\/strong> v\u1edbi b\u1ec7nh ph\u1ea9m \u0111\u1eddm ho\u1eb7c d\u1ecbch ph\u1ebf qu\u1ea3n ch\u1ea9n \u0111o\u00e1n c\u00fam A (H<sub>5<\/sub>N<sub>1<\/sub>) ho\u1eb7c c\u00fam A (H<sub>1<\/sub>N<sub>1<\/sub>) \u2026 c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao nh\u01b0ng nh\u01b0ng c\u1ea7n th\u1eddi gian \u00edt nh\u1ea5t 12- 24 gi\u1edd, c\u00f3 th\u1ec3 t\u00ecm th\u1ea5y vi r\u00fat c\u00fam A (H<sub>5<\/sub>N<sub>1<\/sub>) trong ph\u00e2n v\u00e0 d\u1ecbch n\u00e3o t\u1ee7y.<\/li>\n<li><strong>C\u1ea5y d\u1ecbch ph\u1ebf qu\u1ea3n<\/strong> c\u00f3 th\u1ec3 g\u1eb7p c\u00e1c vi khu\u1ea9n b\u1ed9i nhi\u1ec5m nh\u01b0 <em>Klebsiella pneumonia, A. baumanii, Pseudomonas aeruginosa \u2026<\/em><\/li>\n<li>C\u00e1c x\u00e9t nghi\u1ec7m ch\u1ea9n gi\u00fap ch\u1ea9n \u0111o\u00e1n suy \u0111a t\u1ea1ng v\u00e0 theo d\u00f5i di\u1ebfn bi\u1ebfn suy \u0111a t\u1ea1ng.<\/li>\n<\/ul>\n<h2><strong>4. Ch\u1ea9n \u0111o\u00e1n b\u1ec7nh vi\u00eam ph\u1ed5i do vi r\u00fat c\u00fam A.<\/strong><\/h2>\n<h3><strong>4.1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/strong>:<\/h3>\n<ul>\n<li><strong>Y\u1ebfu t\u1ed1 d\u1ecbch t\u1ec5<\/strong>: ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u1ec1n s\u1eed ti\u1ebfp x\u00fac v\u1edbi gia c\u1ea7m \u1ed1m ho\u1eb7c ch\u1ebft n\u1ebfu do c\u00fam A(H<sub>5<\/sub>N<sub>1<\/sub>) ho\u1eb7c ti\u1ebfp x\u00fac v\u1edbi ng\u01b0\u1eddi t\u1eeb v\u00f9ng d\u1ecbch tr\u1edf v\u1ec1 ( c\u00fam A H<sub>1<\/sub>N<sub>1<\/sub>, H<sub>7<\/sub>N<sub>9<\/sub>).<\/li>\n<li><strong>L\u00e2m s\u00e0ng<\/strong>: bi\u1ec3u hi\u1ec7n 2 h\u1ed9i ch\u1ee9ng:<\/li>\n<\/ul>\n<p>+ H\u1ed9i ch\u1ee9ng c\u00fam.<\/p>\n<p>+ H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p.<\/p>\n<ul>\n<li><strong>C\u1eadn l\u00e2m s\u00e0ng:<\/strong><\/li>\n<\/ul>\n<p>+ C\u00f4ng th\u1ee9c m\u00e1u b\u1ea1ch c\u1ea7u v\u00e0 ti\u1ec3u c\u1ea7u b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u1ea3m, CRP v\u00e0\/ho\u1eb7c procalcitonin trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng n\u1ebfu ch\u01b0a c\u00f3 b\u1ed9i nhi\u1ec5m.<\/p>\n<p>+ X quang tim ph\u1ed5i: t\u1ed5n th\u01b0\u01a1ng th\u00e2m nhi\u1ec5m khu tr\u00fa m\u1ed9t b\u00ean ph\u1ed5i ho\u1eb7c lan t\u1ecfa hai ph\u1ed5i.<\/p>\n<p>+ Kh\u00ed m\u00e1u: gi\u1ea3m oxy h\u00f3a m\u00e1u m\u1ee9c \u0111\u1ed9 v\u1eeba \u0111\u1ebfn n\u1eb7ng, t\u1ec9 l\u1ec7 PaO<sub>2<\/sub>\/FiO<sub>2<\/sub>&lt; 300.<\/p>\n<p>+ PCR d\u1ecbch ph\u1ebf qu\u1ea3n d\u01b0\u01a1ng t\u00ednh v\u1edbi vi r\u00fat c\u00fam A (H<sub>5<\/sub>N<sub>1<\/sub>) ho\u1eb7c A (H<sub>1<\/sub>N<sub>1<\/sub>).<\/p>\n<h3><strong>4.2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t <\/strong><\/h3>\n<ul>\n<li>V\u1edbi vi\u00eam ph\u1ed5i do vi khu\u1ea9n nh\u01b0 ph\u1ebf c\u1ea7u, <em>hemophilus influenza<\/em> \u2026. th\u01b0\u1eddng c\u00f3 b\u1ea1ch c\u1ea7u t\u0103ng, procalcitonin t\u0103ng, c\u1ea5y b\u1ec7nh ph\u1ea9m h\u00f4 h\u1ea5p c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n c\u0103n nguy\u00ean vi khu\u1ea9n g\u00e2y b\u1ec7nh.<\/li>\n<li>Vi\u00eam ph\u1ed5i n\u1eb7ng do m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.<\/li>\n<\/ul>\n<h3><strong>4.3. Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n <\/strong><\/h3>\n<ul>\n<li>L\u1ea5y b\u1ec7nh ph\u1ea9m \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p t\u1ed1t nh\u1ea5t l\u00e0 \u0111\u1eddm s\u00e2u n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n.<\/li>\n<li>N\u1ebfu ng\u01b0\u1eddi b\u1ec7nh ch\u01b0a \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n: l\u1ea5y \u0111\u1eddmy\u00eau c\u1ea7u ng\u01b0\u1eddi b\u1ec7nh kh\u1ea1c \u0111\u1eddm (sau khi \u0111\u00e3 l\u00e0m kh\u00ed dung v\u1edbi n\u01b0\u1edbc mu\u1ed1i \u01b0u tr\u01b0\u01a1ng) ho\u1eb7c l\u1ea5y qua d\u1ecbch ngo\u00e1y h\u1ecdng ho\u1eb7c d\u1ecbch t\u1ef5 h\u1ea7u.<\/li>\n<\/ul>\n<h3><strong>4.4. Ch\u1ea9n \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 <\/strong><\/h3>\n<p>D\u1ef1a theo m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i v\u00e0 m\u1ee9c \u0111\u1ed9 suy h\u00f4 h\u1ea5p chia ra c\u00e1c m\u1ee9c \u0111\u1ed9:<\/p>\n<ul>\n<li>M\u1ee9c \u0111\u1ed9 n\u1eb7ng.<\/li>\n<li>M\u1ee9c \u0111\u1ed9 nguy k\u1ecbch.<\/li>\n<\/ul>\n<p>Ngu\u1ed3n: B\u1ed9 Y t\u1ebf 2015, H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c.<\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/vac-xin\/kien-thuc-tiem-chung\/nhung-dieu-can-biet-ve-benh-cum\/\">Nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft v\u1ec1 b\u1ec7nh c\u00fam<\/a><\/p>\n<div class=\"share\"><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Vi\u00eam ph\u1ed5i n\u1eb7ng l\u00e0 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i g\u00e2y suy h\u00f4 h\u1ea5p ti\u1ebfn tri\u1ec3n nhanh c\u0103n nguy\u00ean do c\u00e1c virut c\u00fam A g\u00e2y ra. Di\u1ec5n bi\u1ebfn n\u1eb7ng c\u00f3 li\u00ean quan m\u1ed9t s\u1ed1 nh\u00f3m ng\u01b0\u1eddi b\u1ec7nh nh\u01b0: suy gi\u1ea3m mi\u1ec5n d\u1ecbch (c\u00f3 thai ho\u1eb7c d\u00f9ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch); ng\u01b0\u1eddi b\u1ec7nh th\u01b0\u1eddng tr\u1ebb tu\u1ed5i, ph\u1ea7n [&hellip;]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Vi\u00eam ph\u1ed5i n\u1eb7ng do virus c\u00fam A: h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi r\u00fat c\u00fam A g\u00e2y b\u1ec7nh l\u00e0 c\u00fam A (H5N1), H1N1, H3N2, H7N9, g\u00e2y nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p. 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C\u00f3 th\u1ec3 g\u00e2y b\u1ec7nh c\u1ea3nh vi\u00eam ph\u1ed5i n\u1eb7ng, t\u1ec9 l\u1ec7 t\u1eed vong cao.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/viem-phoi-nang-do-virus-cum-a-huong-dan-chan-doan\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-23T08:11:12+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-24T08:15:24+00:00\" \/>\n<meta name=\"author\" content=\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/viem-phoi-nang-do-virus-cum-a-huong-dan-chan-doan\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/viem-phoi-nang-do-virus-cum-a-huong-dan-chan-doan\/\",\"name\":\"Vi\u00eam ph\u1ed5i n\u1eb7ng do virus c\u00fam A: h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n - Vinmec\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-23T08:11:12+00:00\",\"dateModified\":\"2023-04-24T08:15:24+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e\"},\"description\":\"Vi r\u00fat c\u00fam A g\u00e2y b\u1ec7nh l\u00e0 c\u00fam A (H5N1), H1N1, H3N2, H7N9, g\u00e2y nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p. 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