{"id":27420,"date":"2023-04-23T22:54:20","date_gmt":"2023-04-23T15:54:20","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27420"},"modified":"2023-04-23T22:54:20","modified_gmt":"2023-04-23T15:54:20","slug":"viem-mang-nao-do-streptococcus-suis-chan-doan-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/viem-mang-nao-do-streptococcus-suis-chan-doan-va-dieu-tri\/","title":{"rendered":"Vi\u00eam m\u00e0ng n\u00e3o do Streptococcus suis: Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Li\u00ean c\u1ea7u l\u1ee3n c\u00f3 t\u00ean khoa h\u1ecdc l\u00e0\u00a0Streptococcus suis<\/i><\/a>\u00a0l\u00e0 t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh \u1edf l\u1ee3n v\u00e0 m\u1ed9t s\u1ed1 gia s\u00fac kh\u00e1c (tr\u00e2u, b\u00f2, d\u00ea, ng\u1ef1a, …) mang m\u1ea7m b\u1ec7nh, \u0111\u00f4i khi g\u00e2y b\u1ec7nh tr\u00ean ng\u01b0\u1eddi. <\/span>Th\u00f4ng th\u01b0\u1eddng ng\u01b0\u1eddi b\u1ecb nhi\u1ec5m vi khu\u1ea9n do ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp v\u1edbi l\u1ee3n \u1ed1m, l\u1ee3n ch\u1ebft ho\u1eb7c \u0103n ti\u1ebft canh, th\u1ecbt l\u1ee3n \u1ed1m, th\u1ecbt l\u1ee3n ch\u1ebft ch\u01b0a n\u1ea5u ch\u00edn. <\/span>\u1ede ng\u01b0\u1eddi, vi khu\u1ea9n g\u00e2y hai b\u1ec7nh c\u1ea3nh ch\u00ednh l\u00e0 vi\u00eam m\u00e0ng n\u00e3o v\u00e0 nhi\u1ec5m khu\u1ea9n huy\u1ebft, c\u00f3 th\u1ec3 g\u00e2y s\u1ed1c nhi\u1ec5m khu\u1ea9n. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1ec7nh s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi th\u00ec ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 t\u1eed vong.<\/span><\/strong><\/p>\n

\"\"<\/p>\n

 <\/p>\n

1. Ch\u1ea9n \u0111o\u00e1n vi\u00eam m\u00e0ng n\u00e3o do Streptococcus suis<\/h2>\n

Ch\u1ea9n \u0111o\u00e1n d\u1ef1a tr\u00ean c\u00e1c y\u1ebfu t\u1ed1 d\u1ecbch t\u1ec5 h\u1ecdc, b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m<\/span><\/p>\n

1.1. C\u00e1c y\u1ebfu t\u1ed1 d\u1ecbch t\u1ec5 h\u1ecdc:<\/span><\/b>\u00a0<\/span><\/h3>\n

Khai th\u00e1c ti\u1ec1n s\u1eed c\u00f3 ph\u01a1i nhi\u1ec5m trong v\u00f2ng 10 ng\u00e0y tr\u01b0\u1edbc khi b\u1ec7nh kh\u1edfi ph\u00e1t:<\/span><\/p>\n

a) Ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp v\u1edbi l\u1ee3n \u1ed1m, l\u1ee3n ch\u1ebft ho\u1eb7c l\u1ee3n kh\u00f4ng r\u00f5 ngu\u1ed3n g\u1ed1c trong qu\u00e1 tr\u00ecnh ch\u0103n nu\u00f4i, v\u1eadn chuy\u1ec3n bu\u00f4n b\u00e1n, gi\u1ebft m\u1ed5, ch\u1ebf bi\u1ebfn th\u1ecbt s\u1ed1ng.<\/span><\/p>\n

b) \u0102n th\u1ecbt l\u1ee3n \u1ed1m, l\u1ee3n ch\u1ebft ho\u1eb7c th\u1ecbt l\u1ee3n kh\u00f4ng r\u00f5 ngu\u1ed3n g\u1ed1c ch\u01b0a \u0111\u01b0\u1ee3c n\u1ea5u ch\u00edn nh\u01b0 th\u1ecbt th\u1ee7 lu\u1ed9c t\u00e1i, l\u00f2ng l\u1ee3n v\u00e0 n\u1ed9i t\u1ea1ng tr\u1ea7n, ti\u1ebft canh, nem ch\u1ea1o, nem chua, … .<\/span><\/p>\n

c) S\u1ed1ng trong khu v\u1ef1c c\u00f3 d\u1ecbch b\u1ec7nh \u1edf l\u1ee3n v\u00e0 gia s\u00fac.<\/span><\/p>\n

1.2. L\u00e2m s\u00e0ng<\/span><\/b><\/h3>\n

a) Th\u1eddi gian \u1ee7 b\u1ec7nh: 1-3 ng\u00e0y, c\u00f3 th\u1ec3 k\u00e9o d\u00e0i t\u1edbi 10 ng\u00e0y.<\/span><\/p>\n

b) Kh\u1edfi ph\u00e1t c\u1ea5p t\u00ednh v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng<\/span><\/p>\n

– S\u1ed1t cao c\u00f3 th\u1ec3 k\u00e8m theo r\u00e9t run.<\/p>\n

– M\u1ec7t, \u0111au m\u1ecfi ng\u01b0\u1eddi.<\/p>\n

– \u0110au \u0111\u1ea7u, bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n.<\/p>\n

– \u0110au b\u1ee5ng, ti\u00eau ch\u1ea3y.<\/p>\n

– C\u00f3 th\u1ec3 m\u00ea s\u1ea3ng, ng\u1ee7 g\u00e0, h\u00f4n m\u00ea.<\/p>\n

– Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m khu\u1ea9n huy\u1ebft c\u00f3 th\u1ec3 xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da, ban xu\u1ea5t huy\u1ebft ho\u1ea1i t\u1eed lan r\u1ed9ng \u1edf m\u1eb7t, ng\u1ef1c, ch\u00e2n, tay, ho\u1ea1i t\u1eed \u0111\u1ea7u chi.<\/p>\n

c) To\u00e0n ph\u00e1t: B\u1ec7nh bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi 2 th\u1ec3 l\u00e2m s\u00e0ng ch\u00ednh:<\/p>\n

– Vi\u00eam m\u00e0ng n\u00e3o m\u1ee7:<\/p>\n

+ H\u1ed9i ch\u1ee9ng m\u00e0ng n\u00e3o: \u0110au \u0111\u1ea7u, n\u00f4n, c\u1ee9ng g\u00e1y, d\u1ea5u hi\u1ec7u Kernig d\u01b0\u01a1ng t\u00ednh.<\/p>\n

+ Ch\u1eadm ch\u1ea1p, l\u00fa l\u1eabn, h\u00f4n m\u00ea ho\u1eb7c k\u00edch \u0111\u1ed9ng, co gi\u1eadt.<\/p>\n

+ D\u1ecbch n\u00e3o tu\u1ef7 \u0111\u1ee5c.<\/p>\n

– Nhi\u1ec5m khu\u1ea9n huy\u1ebft c\u00f3 s\u1ed1c nhi\u1ec5m khu\u1ea9n:<\/p>\n

+ Huy\u1ebft \u00e1p t\u1ee5t (huy\u1ebft \u00e1p t\u1ed1i \u0111a < 90 mmHg ho\u1eb7c gi\u1ea3m 40 mmHg so v\u1edbi b\u00ecnh th\u01b0\u1eddng) ho\u1eb7c k\u1eb9t (hi\u1ec7u s\u1ed1 gi\u1eefa huy\u1ebft \u00e1p t\u1ed1i \u0111a v\u00e0 huy\u1ebft \u00e1p t\u1ed1i thi\u1ec3u \u2264 20 mmHg).<\/p>\n

+ Nh\u1ecbp tim nhanh tr\u00ean 100 l\u1ea7n\/ph\u00fat, m\u1ea1ch nh\u1ecf, kh\u00f3 b\u1eaft.<\/p>\n

+ V\u00e3 m\u1ed3 h\u00f4i, l\u1ea1nh \u0111\u1ea7u chi, n\u1ed5i v\u00e2n t\u00edm tr\u00ean da.<\/p>\n

+ Thi\u1ec3u ni\u1ec7u ho\u1eb7c v\u00f4 ni\u1ec7u.<\/p>\n

+ C\u00e1c bi\u1ec3u hi\u1ec7n kh\u00e1c c\u00f3 th\u1ec3 g\u1eb7p:<\/p>\n

* Xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da, ni\u00eam m\u1ea1c, n\u1ed9i t\u1ea1ng.<\/p>\n

* Suy th\u1eadn c\u1ea5p.<\/p>\n

* Suy h\u00f4 h\u1ea5p c\u1ea5p ti\u1ebfn tri\u1ec3n (ARDS).<\/p>\n

* V\u00e0ng da, gan to.<\/p>\n

* Vi\u00eam m\u00f4 t\u1ebf b\u00e0o, t\u1eafc m\u1ea1ch \u0111\u1ea7u chi.<\/p>\n

1.3. C\u1eadn l\u00e2m s\u00e0ng<\/b><\/h3>\n

a) X\u00e9t nghi\u1ec7m m\u00e1u<\/p>\n

– C\u00f4ng th\u1ee9c m\u00e1u:<\/p>\n

+ S\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u m\u00e1u ngo\u1ea1i vi t\u0103ng, ch\u1ee7 y\u1ebfu l\u00e0 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh.<\/p>\n

+ Ti\u1ec3u c\u1ea7u c\u00f3 th\u1ec3 h\u1ea1 trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng.<\/p>\n

– X\u00e9t nghi\u1ec7m \u0111\u00f4ng m\u00e1u: Trong th\u1ec3 nhi\u1ec5m khu\u1ea9n huy\u1ebft c\u00f3 s\u1ed1c nhi\u1ec5m khu\u1ea9n c\u00f3 th\u1ec3 th\u1ea5y:<\/p>\n

+ T\u1ef7 l\u1ec7 prothrombin gi\u1ea3m.<\/p>\n

+ Fibrinogen gi\u1ea3m.<\/p>\n

+ APTT k\u00e9o d\u00e0i.<\/p>\n

+ C\u00f3 th\u1ec3 c\u00f3 t\u00ecnh tr\u1ea1ng \u0111\u00f4ng m\u00e1u n\u1ed9i m\u1ea1ch r\u1ea3i r\u00e1c (DIC): t\u0103ng FDP ho\u1eb7c D-dimer, ti\u1ec3u c\u1ea7u gi\u1ea3m < 100.000\/mm3<\/sup>, fibrinogen < 1 g\/l\u00edt.<\/p>\n

– Sinh ho\u00e1 m\u00e1u: Trong th\u1ec3 nhi\u1ec5m khu\u1ea9n huy\u1ebft c\u00f3 s\u1ed1c nhi\u1ec5m khu\u1ea9n c\u00f3 th\u1ec3 th\u1ea5y:<\/p>\n

+ T\u0103ng ur\u00ea, t\u0103ng creatinin.<\/p>\n

+ T\u0103ng men gan (AST, ALT), CK.<\/p>\n

+ T\u0103ng bilirubin.<\/p>\n

+ Gi\u1ea3m albumin.<\/p>\n

+ Toan chuy\u1ec3n ho\u00e1 (pH gi\u1ea3m, HCO3<\/sub>–<\/sup>\u00a0gi\u1ea3m), t\u0103ng lactat.<\/p>\n

b) X\u00e9t nghi\u1ec7m d\u1ecbch n\u00e3o tu\u1ef7<\/p>\n

– Sinh ho\u00e1: Protein t\u0103ng, th\u01b0\u1eddng tr\u00ean 1g\/l\u00edt, glucose gi\u1ea3m, ph\u1ea3n \u1ee9ng Pandy d\u01b0\u01a1ng t\u00ednh.<\/p>\n

– T\u1ebf b\u00e0o: T\u0103ng cao, th\u01b0\u1eddng tr\u00ean 500 t\u1ebf b\u00e0o\/mm3<\/sup>, ch\u1ee7 y\u1ebfu b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh.<\/p>\n

c) X\u00e9t nghi\u1ec7m vi khu\u1ea9n<\/p>\n

– Nhu\u1ed9m Gram soi tr\u1ef1c ti\u1ebfp: C\u1ea7u khu\u1ea9n Gram d\u01b0\u01a1ng x\u1ebfp \u0111\u00f4i ho\u1eb7c x\u1ebfp chu\u1ed7i.<\/p>\n

– Nu\u00f4i c\u1ea5y, ph\u00e2n l\u1eadp v\u00e0 l\u00e0m kh\u00e1ng sinh \u0111\u1ed3 d\u1ecbch c\u01a1 th\u1ec3 (m\u00e1u, d\u1ecbch n\u00e3o tu\u1ef7,…).<\/p>\n

– K\u1ef9 thu\u1eadt PCR t\u00ecm c\u00e1c y\u1ebfu t\u1ed1 \u0111\u1ed9c l\u1ef1c \u0111\u1eb7c hi\u1ec7u (cps2A, mrp, gapdh, sly, ef…) d\u01b0\u01a1ng t\u00ednh.<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h2>\n

2.1. B\u1ec7nh do n\u00e3o m\u00f4 c\u1ea7u.<\/h3>\n

2.2. Vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 do c\u00e1c c\u0103n nguy\u00ean kh\u00e1c: Ph\u1ebf c\u1ea7u, t\u1ee5 c\u1ea7u, c\u00e1c li\u00ean c\u1ea7u kh\u00e1c.<\/h3>\n

2.3. Vi\u00eam n\u00e3o vi r\u00fat.<\/h3>\n

2.4. Nhi\u1ec5m khu\u1ea9n huy\u1ebft v\u00e0 s\u1ed1c nhi\u1ec5m khu\u1ea9n do c\u00e1c c\u0103n nguy\u00ean kh\u00e1c.<\/h3>\n

2.5. S\u1ed1t xu\u1ea5t huy\u1ebft Dengue.<\/h3>\n

2.6. C\u00e1c b\u1ec7nh m\u00e1u \u00e1c t\u00ednh.<\/h3>\n

3. \u0110i\u1ec1u tr\u1ecb vi\u00eam m\u00e0ng n\u00e3o do Streptococcus suis<\/h2>\n

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

a) K\u1ebft h\u1ee3p ch\u1eb7t ch\u1ebd gi\u1eefa \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3.<\/p>\n

b) Ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c bi\u1ec3u hi\u1ec7n n\u1eb7ng nh\u01b0 s\u1ed1c, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, suy \u0111a ph\u1ee7 t\u1ea1ng \u0111\u1ec3 x\u1eed tr\u00ed k\u1ecbp th\u1eddi.<\/p>\n

c) C\u00e1ch ly b\u1ec7nh nh\u00e2n.<\/p>\n

3.2. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3<\/b><\/h3>\n

a) Th\u1ec3 vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 \u0111\u01a1n thu\u1ea7n:<\/p>\n

– Kh\u00e1ng sinh: Vi khu\u1ea9n c\u00f2n nh\u1ea1y c\u1ea3m v\u1edbi nhi\u1ec1u kh\u00e1ng sinh nh\u00f3m \u03b2lactam nh\u01b0 Penicillin G, Ampicillin, c\u00e1c Cephalosporin th\u1ebf h\u1ec7 III, … .<\/p>\n

Kh\u00e1ng sinh c\u00f3 th\u1ec3 d\u00f9ng ban \u0111\u1ea7u l\u00e0:<\/p>\n

+ Ampicillin 2g\/l\u1ea7n x 6 l\u1ea7n, ti\u00eam t\u0129nh m\u1ea1ch, c\u00e1ch 4 gi\u1edd m\u1ed9t l\u1ea7n (tr\u1ebb em: 200mg\/kg\/24 gi\u1edd), ho\u1eb7c\/v\u00e0<\/p>\n

+ Ceftriaxon 2g\/l\u1ea7n x 2 l\u1ea7n, ti\u00eam ho\u1eb7c truy\u1ec1n t\u0129nh m\u1ea1ch, c\u00e1ch 12 gi\u1edd m\u1ed9t l\u1ea7n (tr\u1ebb em: 100mg\/kg\/24 gi\u1edd).<\/p>\n

Sau 2-3 ng\u00e0y n\u00ean ch\u1ecdc d\u00f2 d\u1ecbch n\u00e3o tu\u1ef7 l\u1ea1i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb. \u0110i\u1ec1u ch\u1ec9nh kh\u00e1ng sinh theo k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 v\u00e0 \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n

D\u00f9ng kh\u00e1ng sinh cho \u0111\u1ebfn khi x\u00e9t nghi\u1ec7m d\u1ecbch n\u00e3o tu\u1ef7 tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c cho \u0111\u1ee7 3 tu\u1ea7n.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3:<\/p>\n

+ H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p: Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p h\u00f4n m\u00ea n\u00ean \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n s\u1edbm \u0111\u1ec3 b\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf v\u00e0 \u0111\u1ec3 th\u1edf m\u00e1y khi c\u1ea7n.<\/p>\n

+ Ch\u1ed1ng ph\u00f9 n\u00e3o: Mannitol 20% 0,5-1 g\/kg truy\u1ec1n t\u0129nh m\u1ea1ch trong 20-30 ph\u00fat, nh\u1eafc l\u1ea1i sau 6 gi\u1edd v\u00e0 c\u1ea7n theo d\u00f5i s\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n

+ Ch\u1ed1ng co gi\u1eadt: D\u00f9ng Diazepam 0,1 mg\/kg\/l\u1ea7n ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c th\u1ee5t h\u1eadu m\u00f4n (\u0111\u1ed1i v\u1edbi tr\u1ebb em). Sau 15 ph\u00fat, n\u1ebfu c\u00f2n co gi\u1eadt th\u00ec d\u00f9ng nh\u1eafc l\u1ea1i.<\/p>\n

+ Ch\u1ed1ng vi\u00eam: C\u00f3 th\u1ec3 d\u00f9ng Methylprednisolone 0,5- 1 mg\/kg\/24 gi\u1edd ho\u1eb7c m\u1ed9t corticosteroid t\u01b0\u01a1ng t\u1ef1 v\u00e0 n\u00ean d\u00f9ng ngay tr\u01b0\u1edbc khi d\u00f9ng kh\u00e1ng sinh.<\/p>\n

b) Th\u1ec3 nhi\u1ec5m khu\u1ea9n huy\u1ebft c\u00f3 s\u1ed1c nhi\u1ec5m khu\u1ea9n:<\/p>\n

– Kh\u00e1ng sinh:<\/p>\n

+ S\u1eed d\u1ee5ng kh\u00e1ng sinh nh\u01b0 trong th\u1ec3 vi\u00eam m\u00e0ng n\u00e3o m\u1ee7.<\/p>\n

+ Ch\u00fa \u00fd \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u kh\u00e1ng sinh theo m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn.<\/p>\n

\u0110i\u1ec1u ch\u1ec9nh kh\u00e1ng sinh theo k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 v\u00e0 \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng. C\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p th\u00eam kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng kh\u00e1c tu\u1ef3 t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3.<\/p>\n

\u0110\u1ea3m b\u1ea3o th\u1eddi gian d\u00f9ng kh\u00e1ng sinh t\u1ed1i thi\u1ec3u l\u00e0 trong 3 tu\u1ea7n.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3:<\/p>\n

+ H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p: \u0110\u1ea3m b\u1ea3o oxy ho\u00e1 m\u00e1u (SpO2<\/sub>\u00a0> 92%) b\u1eb1ng th\u1edf oxy ho\u1eb7c th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o.<\/p>\n

+ \u0110\u1ea3m b\u1ea3o kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n b\u1eb1ng truy\u1ec1n d\u1ecbch: C\u00e1c d\u1ecbch tinh th\u1ec3 (NaCl 0,9% ; …) v\u00e0\/ho\u1eb7c d\u1ecbch keo (Haesteril 6% ; …), \u0111\u1ea3m b\u1ea3o albumin m\u00e1u tr\u00ean 35 g\/l\u00edt.<\/p>\n

+ \u0110i\u1ec1u ch\u1ec9nh \u0111i\u1ec7n gi\u1ea3i v\u00e0 th\u0103ng b\u1eb1ng ki\u1ec1m toan.<\/p>\n

+ Khi \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch trung t\u00e2m (CVP) > 12 cmH2<\/sub>O m\u00e0 huy\u1ebft \u00e1p c\u00f2n th\u1ea5p (Huy\u1ebft \u00e1p t\u00e2m thu d\u01b0\u1edbi 90 mmHg) th\u00ec d\u00f9ng th\u00eam c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch nh\u01b0 Dopamin (ho\u1eb7c Noradrenalin), Dobutamin.<\/p>\n

+ C\u00f3 th\u1ec3 d\u00f9ng Methylprednisolone v\u1edbi h\u00e0m l\u01b0\u1ee3ng nh\u01b0 tr\u00ean. C\u1ea7n theo d\u00f5i \u0111\u01b0\u1eddng m\u00e1u v\u00e0 t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft ti\u00eau ho\u00e1.<\/p>\n

+ \u1ede nh\u1eefng n\u01a1i c\u00f3 \u0111i\u1ec1u ki\u1ec7n n\u00ean ch\u1ec9 \u0111\u1ecbnh l\u1ecdc m\u00e1u li\u00ean t\u1ee5c s\u1edbm.<\/p>\n

+ Suy th\u1eadn: D\u00f9ng thu\u1ed1c l\u1ee3i ni\u1ec7u nh\u01b0 furosemid khi duy tr\u00ec \u0111\u01b0\u1ee3c huy\u1ebft \u00e1p t\u1ed1i \u0111a > 90 mmHg, ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

+ \u1ed4n \u0111\u1ecbnh \u0111\u01b0\u1eddng huy\u1ebft 6-7 mmol\/l.<\/p>\n

+ D\u1ef1 ph\u00f2ng lo\u00e9t stress: D\u00f9ng thu\u1ed1c gi\u1ea3m ti\u1ebft acid d\u1ecbch v\u1ecb k\u1ebft h\u1ee3p thu\u1ed1c b\u0103ng ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y.<\/p>\n

+ Truy\u1ec1n plasma t\u01b0\u01a1i v\u00e0 kh\u1ed1i ti\u1ec3u c\u1ea7u khi c\u1ea7n thi\u1ebft. Duy tr\u00ec t\u1ef7 l\u1ec7 prothrombin > 50% v\u00e0 s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u > 60.000\/mm3<\/sup>.<\/p>\n

+ Khi c\u00f3 xu\u1ea5t huy\u1ebft m\u1ee9c \u0111\u1ed9 n\u1eb7ng, hemoglobin < 70 g\/l c\u1ea7n truy\u1ec1n kh\u1ed1i h\u1ed3ng c\u1ea7u.<\/p>\n

+ Th\u1eadn tr\u1ecdng d\u00f9ng thu\u1ed1c h\u1ea1 s\u1ed1t \u1edf b\u1ec7nh nh\u00e2n t\u0103ng men gan.<\/p>\n

3.3. Theo d\u00f5i v\u00e0 ch\u0103m s\u00f3c<\/b><\/h3>\n

a) Theo d\u00f5i<\/p>\n

– C\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng ph\u1ea3i theo d\u00f5i \u0111i\u1ec1u tr\u1ecb t\u1ea1i bu\u1ed3ng c\u1ea5p c\u1ee9u.<\/p>\n

– Theo d\u00f5i c\u00e1c d\u1ea5u hi\u1ec7u: M\u1ea1ch, nhi\u1ec7t \u0111\u1ed9, huy\u1ebft \u00e1p, nh\u1ecbp th\u1edf, SpO2<\/sub>, n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

– Theo d\u00f5i tri gi\u00e1c b\u1eb1ng thang \u0111i\u1ec3m Glasgow.<\/p>\n

– Theo d\u00f5i t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft ni\u00eam m\u1ea1c v\u00e0 n\u1ed9i t\u1ea1ng.<\/p>\n

– \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam m\u00e0ng n\u00e3o, c\u1ea7n theo d\u00f5i c\u00e1c d\u1ea5u hi\u1ec7u t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd: \u0110au \u0111\u1ea7u, n\u00f4n v\u1ecdt, tri gi\u00e1c x\u1ea5u \u0111i, m\u1ea1ch ch\u1eadm, huy\u1ebft \u00e1p t\u0103ng, \u0111\u1ed3ng t\u1eed co gi\u00e3n b\u1ea5t th\u01b0\u1eddng.<\/p>\n

b) Ch\u0103m s\u00f3c<\/p>\n

– T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n: B\u1ec7nh nh\u00e2n vi\u00eam m\u00e0ng n\u00e3o n\u00ean \u0111\u1ec3 \u1edf t\u01b0 th\u1ebf \u0111\u1ea7u cao ch\u1ebfch 300<\/sup>\u00a0so v\u1edbi th\u00e2n. B\u1ec7nh nh\u00e2n s\u1ed1c c\u1ea7n \u0111\u1ec3 \u1edf t\u01b0 th\u1ebf n\u1eb1m \u0111\u1ea7u ngang b\u1eb1ng so v\u1edbi th\u00e2n.<\/p>\n

– \u0110\u1ea3m b\u1ea3o h\u00f4 h\u1ea5p: Cho b\u1ec7nh nh\u00e2n th\u1edf oxy n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh. H\u00fat \u0111\u1eddm d\u00e3i \u0111\u1ea3m b\u1ea3o th\u00f4ng tho\u00e1ng \u0111\u01b0\u1eddng th\u1edf.<\/p>\n

– \u0110\u1ea3m b\u1ea3o dinh d\u01b0\u1ee1ng: N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng \u0103n \u0111\u01b0\u1ee3c c\u1ea7n ch\u1ee7 \u0111\u1ed9ng cho \u0103n qua \u1ed1ng th\u00f4ng d\u1ea1 d\u00e0y, \u0111\u1ee7 n\u0103ng l\u01b0\u1ee3ng v\u00e0 c\u00e2n \u0111\u1ed1i vi ch\u1ea5t.<\/p>\n

– V\u1ec7 sinh c\u00e1c h\u1ed1c t\u1ef1 nhi\u00ean v\u00e0 thay \u0111\u1ed5i t\u01b0 th\u1ebf n\u1eb1m, v\u1eadn \u0111\u1ed9ng tr\u1ecb li\u1ec7u, ch\u1ed1ng lo\u00e9t.<\/p>\n

4. Ph\u00f2ng b\u1ec7nh vi\u00eam m\u00e0ng n\u00e3o do Streptococcus suis<\/h2>\n

– Ph\u1ed1i h\u1ee3p v\u1edbi ng\u00e0nh th\u00fa y ki\u1ec3m so\u00e1t b\u1ec7nh tr\u00ean l\u1ee3n, ki\u1ec3m so\u00e1t ch\u0103n nu\u00f4i v\u00e0 gi\u1ebft m\u1ed5 l\u1ee3n.<\/p>\n

– Ng\u01b0\u1eddi c\u00f3 v\u1ebft th\u01b0\u01a1ng \u1edf ch\u00e2n, tay kh\u00f4ng \u0111\u01b0\u1ee3c tham gia gi\u1ebft m\u1ed5 l\u1ee3n.<\/p>\n

– Sau khi tham gia gi\u1ebft m\u1ed5 l\u1ee3n ph\u1ea3i r\u1eeda s\u1ea1ch tay b\u1eb1ng c\u00e1c lo\u1ea1i dung d\u1ecbch s\u00e1t khu\u1ea9n.<\/p>\n

– Kh\u00f4ng ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp v\u1edbi l\u1ee3n \u1ed1m ho\u1eb7c l\u1ee3n ch\u1ebft.<\/p>\n

+ Khi x\u1eed l\u00fd l\u1ee3n \u1ed1m, l\u1ee3n ch\u1ebft ph\u1ea3i s\u1eed d\u1ee5ng trang b\u1ecb ph\u00f2ng h\u1ed9: g\u0103ng tay, \u1ee7ng, kh\u1ea9u trang, … .<\/p>\n

+ Kh\u00f4ng ch\u1ebf bi\u1ebfn \u0111\u1ec3 \u0103n th\u1ecbt l\u1ee3n \u1ed1m, th\u1ecbt l\u1ee3n ch\u1ebft v\u00e0 th\u1ecbt l\u1ee3n kh\u00f4ng r\u00f5 ngu\u1ed3n g\u1ed1c.<\/p>\n

– Kh\u00f4ng \u0103n th\u1ecbt l\u1ee3n ch\u01b0a \u0111\u01b0\u1ee3c n\u1ea5u ch\u00edn nh\u01b0 th\u1ecbt th\u1ee7 lu\u1ed9c t\u00e1i, l\u00f2ng l\u1ee3n v\u00e0 n\u1ed9i t\u1ea1ng tr\u1ea7n, ti\u1ebft canh, nem chua, nem ch\u1ea1o, … .<\/p>\n

– Hi\u1ec7n ch\u01b0a c\u00f3 v\u1eafc xin ph\u00f2ng b\u1ec7nh cho ng\u01b0\u1eddi. Kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng kh\u00e1ng sinh d\u1ef1 ph\u00f2ng.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

Li\u00ean c\u1ea7u l\u1ee3n c\u00f3 t\u00ean khoa h\u1ecdc l\u00e0\u00a0Streptococcus suis\u00a0l\u00e0 t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh \u1edf l\u1ee3n v\u00e0 m\u1ed9t s\u1ed1 gia s\u00fac kh\u00e1c (tr\u00e2u, b\u00f2, d\u00ea, ng\u1ef1a, …) mang m\u1ea7m b\u1ec7nh, \u0111\u00f4i khi g\u00e2y b\u1ec7nh tr\u00ean ng\u01b0\u1eddi. Th\u00f4ng th\u01b0\u1eddng ng\u01b0\u1eddi b\u1ecb nhi\u1ec5m vi khu\u1ea9n do ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp v\u1edbi l\u1ee3n \u1ed1m, l\u1ee3n ch\u1ebft ho\u1eb7c \u0103n ti\u1ebft […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"\nVi\u00eam m\u00e0ng n\u00e3o do Streptococcus suis: Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/title>\n<meta name=\"description\" content=\"\u1ede ng\u01b0\u1eddi, vi khu\u1ea9n Streptococcus suis g\u00e2y hai b\u1ec7nh c\u1ea3nh ch\u00ednh l\u00e0 vi\u00eam m\u00e0ng n\u00e3o v\u00e0 nhi\u1ec5m khu\u1ea9n huy\u1ebft, c\u00f3 th\u1ec3 g\u00e2y s\u1ed1c nhi\u1ec5m khu\u1ea9n ...\" \/>\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 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