{"id":28406,"date":"2023-04-27T15:34:19","date_gmt":"2023-04-27T08:34:19","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28406"},"modified":"2023-05-07T09:20:10","modified_gmt":"2023-05-07T02:20:10","slug":"viem-than-be-than","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/viem-than-be-than\/","title":{"rendered":"Vi\u00eam th\u1eadn b\u1ec3 th\u1eadn c\u1ea5p: ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng"},"content":{"rendered":"<p><strong>B\u1ec7nh vi\u00eam th\u1eadn b\u1ec3 th\u1eadn c\u1ea5p l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p trong h\u1ec7 th\u1ed1ng ti\u1ebft ni\u1ec7u, g\u00e2y ra s\u1ef1 vi\u00eam nhi\u1ec5m v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u00e1c m\u00f4 v\u00e0 c\u01a1 quan trong th\u1eadn. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n b\u1ec7nh n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00f4ng qua c\u00e1c ph\u01b0\u01a1ng ph\u00e1p nh\u01b0 x\u00e9t nghi\u1ec7m m\u00e1u v\u00e0 n\u01b0\u1edbc ti\u1ec3u, si\u00eau \u00e2m v\u00e0 ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh. \u0110\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam th\u1eadn b\u1ec3 th\u1eadn c\u1ea5p, c\u00e1c B\u00e1c s\u0129 th\u01b0\u1eddng k\u00ea \u0111\u01a1n thu\u1ed1c kh\u00e1ng sinh ho\u1eb7c kh\u00e1ng vi\u00eam \u0111\u1ec3 gi\u1ea3m \u0111au v\u00e0 l\u00e0m gi\u1ea3m s\u1ef1 vi\u00eam nhi\u1ec5m trong c\u01a1 th\u1ec3.<\/strong><\/p>\n<h1><strong>1. \u0110\u1ea1i c\u01b0\u01a1ng<\/strong><\/h1>\n<p>Vi\u00eam th\u1eadn b\u1ec3 th\u1eadn c\u1ea5p (VTBT c\u1ea5p) l\u00e0 t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n c\u1ea5p t\u00ednh c\u00e1c \u0111\u00e0i th\u1eadn, b\u1ec3 th\u1eadn, ni\u1ec7u qu\u1ea3n v\u00e0 nhu m\u00f4 th\u1eadn hay c\u00f2n g\u1ecdi l\u00e0 nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u tr\u00ean.<\/p>\n<p>Nhi\u1ec5m khu\u1ea9n c\u1ea5p t\u00ednh do vi khu\u1ea9n g\u00e2y n\u00ean theo \u0111\u01b0\u1eddng ng\u01b0\u1ee3c d\u00f2ng t\u1eeb b\u00e0ng quang l\u00ean ni\u1ec7u qu\u1ea3n r\u1ed3i \u0111\u1ebfn \u0111\u00e0i b\u1ec3 th\u1eadn, ho\u1eb7c do \u0111\u01b0\u1eddng m\u00e1u \u0111\u01b0a \u0111\u1ebfn khi c\u00f3 nhi\u1ec5m tr\u00f9ng huy\u1ebft. Vi khu\u1ea9n g\u00e2y b\u1ec7nh th\u01b0\u1eddng g\u1eb7p l\u00e0 Gram \u00e2m&#8230;<\/p>\n<p><em>* Vi khu\u1ea9n g\u00e2y b\u1ec7nh:<\/em><\/p>\n<p>+ Vi khu\u1ea9n Gram (-): th\u01b0\u1eddng g\u1eb7p nh\u1ea5t\u00a0<em>E. Coli<\/em>, sau \u0111\u00f3 l\u00e0\u00a0<em>Klebsiella, Proteus mirabilis, Enterobacter&#8230;<\/em><\/p>\n<p>+ Vi khu\u1ea9n Gram (+): \u00edt g\u1eb7p d\u01b0\u1edbi 10%:\u00a0<em>Enterococcus, Staphylococcus<\/em>&#8230;<\/p>\n<p><em>* Y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i:<\/em><\/p>\n<p>&#8211; Nhi\u1ec5m khu\u1ea9n ti\u1ebft ni\u1ec7u ng\u01b0\u1ee3c d\u00f2ng trong tr\u01b0\u1eddng h\u1ee3p tr\u00e0o ng\u01b0\u1ee3c b\u00e0ng quang &#8211; ni\u1ec7u qu\u1ea3n, sau khi soi b\u00e0ng quang &#8211; ni\u1ec7u qu\u1ea3n, ch\u1ee5p th\u1eadn ng\u01b0\u1ee3c d\u00f2ng (UPR).<\/p>\n<p>&#8211; Sau ph\u1eabu thu\u1eadt h\u1ec7 ti\u1ebft ni\u1ec7u<\/p>\n<p>&#8211; T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u do s\u1ecfi, kh\u1ed1i u, h\u1ed9i ch\u1ee9ng ch\u1ed7 n\u1ed1i, x\u01a1 sau ph\u00fac m\u1ea1c, h\u1eb9p b\u1ec3 th\u1eadn ni\u1ec7u qu\u1ea3n v\u00e0 c\u00f3 thai\u2026<\/p>\n<p>&#8211; C\u00f3 \u1ed5 vi\u00eam khu tr\u00fa: vi\u00eam b\u00e0ng quang, vi\u00eam tuy\u1ebfn ti\u1ec1n li\u1ec7t, vi\u00eam tr\u1ef1c tr\u00e0ng, vi\u00eam ru\u1ed9t th\u1eeba, vi\u00eam ph\u1ea7n ph\u1ee5&#8230;<\/p>\n<h2><strong>2. C<\/strong><strong>h\u1ea9n \u0111o\u00e1n<\/strong><\/h2>\n<p><strong>Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/strong><\/p>\n<p><strong>&#8211; L\u00e2m s\u00e0ng:<\/strong><\/p>\n<p>B\u1ec7nh th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u0111\u1ed9t ng\u1ed9t v\u1edbi nh\u1eefng bi\u1ec3u hi\u1ec7n sau:<\/p>\n<p>+ H\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng: s\u1ed1t cao r\u00e9t run, c\u00f3 th\u1ec3 th\u00e0nh c\u01a1n 39 &#8211; 40<sup>o<\/sup>C, k\u00e8m theo \u0111au \u0111\u1ea7u v\u00e0 m\u1ec7t m\u1ecfi, m\u00f4i kh\u00f4 l\u01b0\u1ee1i b\u1ea9n, c\u00f3 th\u1ec3 m\u1ea5t n\u01b0\u1edbc do s\u1ed1t cao. N\u1ebfu kh\u00f4ng ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi s\u1ebd b\u1ecb s\u1ed1c nhi\u1ec5m khu\u1ea9n.<\/p>\n<p>+ H\u1ed9i ch\u1ee9ng b\u00e0ng quang c\u1ea5p: ti\u1ec3u bu\u1ed1t, ti\u1ec3u d\u1eaft, ti\u1ec3u kh\u00f3, ti\u1ec3u m\u00e1u, ti\u1ec3u \u0111\u1ee5c, ti\u1ec3u m\u1ee7 l\u00e0 nh\u1eefng d\u1ea5u hi\u1ec7u s\u1edbm tr\u01b0\u1edbc khi c\u00f3 bi\u1ec3u hi\u1ec7n VTBT c\u1ea5p.<\/p>\n<p>+ \u0110au: \u0110au h\u00f4ng l\u01b0ng, m\u1ea1ng s\u01b0\u1eddn nhi\u1ec1u, c\u00f3 c\u1ea3m \u1ee9ng khi s\u1edd v\u00e0o, th\u01b0\u1eddng \u0111au m\u1ed9t b\u00ean, hi\u1ebfm khi hai b\u00ean . C\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n c\u01a1n \u0111au qu\u1eb7n th\u1eadn.<\/p>\n<p>+ V\u1ed7 h\u00f4ng l\u01b0ng (+): d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng hay g\u1eb7p trong VTBT c\u1ea5p.<\/p>\n<p>+ Ch\u1ea1m th\u1eadn b\u1eadp b\u1ec7nh th\u1eadn (+\/-), c\u00f3 th\u1ebf s\u1edd th\u1ea5y th\u1eadn to.<\/p>\n<p><strong>&#8211; C\u1eadn l\u00e2m s\u00e0ng:<\/strong><\/p>\n<p>+ C\u00f4ng th\u1ee9c m\u00e1u: s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u t\u0103ng r\u00f5 r\u1ec7t, \u0111\u1eb7c bi\u1ec7t t\u0103ng b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh.<\/p>\n<p>+ C\u1ea5y m\u00e1u c\u1ea5p: n\u1ebfu s\u1ed1t cao &gt; 39 &#8211; 40<sup>o<\/sup>C k\u00e8m theo r\u00e9t run. Kho\u1ea3ng 80% c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng ti\u1ebft ni\u1ec7u do vi khu\u1ea9n Gram (-) E. Coli, \u00edt g\u1eb7p h\u01a1n l\u00e0 Enterobacter, Klebsiella, Proteus v\u00e0 Pseudomonas.<\/p>\n<p>+ Protein ni\u1ec7u &lt;1g\/24h<\/p>\n<p>+ T\u1ebf b\u00e0o ni\u1ec7u: c\u00f3 t\u1ebf b\u00e0o m\u1ee7, nhi\u1ec1u t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u, h\u1ed3ng c\u1ea7u<\/p>\n<p>+ C\u1ea5y VK ni\u1ec7u (+) \u2265 100.000 VK\/ml n\u01b0\u1edbc ti\u1ec3u, c\u0169ng c\u00f3 khi (-). Trong tr\u01b0\u1eddng h\u1ee3p c\u01a1n \u0111au kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, c\u1ea7n ph\u1ea3i c\u1ea5y VK ni\u1ec7u \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n v\u00e0 c\u00f3 kh\u00e1ng sinh \u0111\u1ed3 cho \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>+ Si\u00eau \u00e2m: d\u1ea5u hi\u1ec7u gi\u00e3n \u0111\u00e0i b\u1ec3 th\u1eadn, gi\u00e3n ni\u1ec7u qu\u1ea3n, h\u00ecnh \u1ea3nh s\u1ecfi th\u1eadn &#8211; ti\u1ebft ni\u1ec7u, kh\u1ed1i u ch\u00e8n \u00e9p&#8230; l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y VTBT c\u1ea5p s\u1ebd \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n d\u1ec5 d\u00e0ng.<\/p>\n<p>+ Ch\u1ee5p b\u1ee5ng kh\u00f4ng chu\u1ea9n b\u1ecb: n\u1ebfu nghi ng\u1edd c\u00f3 s\u1ecfi th\u1eadn ti\u1ebft ni\u1ec7u.<\/p>\n<p>+ UIV: ti\u1ebfn h\u00e0nh sau khi t\u00ecnh tr\u1ea1ng s\u1ed1t nhi\u1ec5m tr\u00f9ng \u0111\u00e3 \u1ed5n \u0111\u1ecbnh \u0111\u1ec3 t\u00ecm ki\u1ebfm nguy\u00ean nh\u00e2n.<\/p>\n<p>+ Ch\u1ee5p b\u00e0ng quang: ti\u1ebfn h\u00e0nh sau khi t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft n\u1ebfu nghi ng\u1edd c\u00f3 tr\u00e0o ng\u01b0\u1ee3c b\u00e0ng quang &#8211; th\u1eadn.<\/p>\n<figure id=\"attachment_28411\" aria-describedby=\"caption-attachment-28411\" style=\"width: 700px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-28411\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/2-7.webp\" alt=\"\" width=\"700\" height=\"700\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/2-7.webp 442w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/2-7-300x300.webp 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/2-7-150x150.webp 150w\" sizes=\"(max-width: 700px) 100vw, 700px\" \/><figcaption id=\"caption-attachment-28411\" class=\"wp-caption-text\"><strong>Acute pyelonephritis <\/strong><\/figcaption><\/figure>\n<h2><strong>3. \u0110<\/strong><strong>i\u1ec1u tr\u1ecb vi\u00eam th\u1eadn b\u1ec3 th\u1eadn c\u1ea5p<\/strong><\/h2>\n<h3><strong><em>3.1. <\/em><\/strong><strong><em>Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb:<\/em><\/strong><\/h3>\n<p>N\u1ebfu s\u1ed1t cao r\u00e9t run c\u1ea7n \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa. C\u00e1c tr\u01b0\u1eddng h\u1ee3p nh\u1eb9 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i ngo\u1ea1i tr\u00fa. C\u1ea7n c\u1ea5y vi khu\u1ea9n ni\u1ec7u, m\u00e1u (n\u1ebfu c\u00f3 s\u1ed1t cao) tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u d\u00f9ng kh\u00e1ng sinh. Trong khi ch\u1edd \u0111\u1ee3i k\u1ebft qu\u1ea3 c\u1ea5y vi khu\u1ea9n c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u d\u00f9ng kh\u00e1ng sinh ngay. N\u1ebfu sau 3 &#8211; 5 ng\u00e0y \u0111i\u1ec1u tr\u1ecb, tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng kh\u00f4ng \u0111\u1ee1 c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh kh\u00e1ng sinh theo k\u1ebft qu\u1ea3 c\u1ea5y vi khu\u1ea9n v\u00e0 kh\u00e1ng sinh \u0111\u1ed3.<\/p>\n<p><strong><em>* \u0110\u1ed1i v\u1edbi VTBT kh\u00f4ng bi\u1ebfn ch\u1ee9ng: KS\u00a0<\/em><\/strong>trong 7 &#8211; 14 ng\u00e0y b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng n\u1ebfu tri\u1ec7u ch\u1ee9ng kh\u00f4ng n\u1eb7ng:<\/p>\n<p>+\u00a0Amoxicilin + acid clavulanic (\u1ee9c ch\u1ebf Beta &#8211; lactamase): 500 mg x 3 vi\u00ean\/ ng\u00e0y, chia 3 l\u1ea7n. N\u1ebfu t\u00ecnh tr\u1ea1ng n\u1eb7ng chuy\u1ec3n \u0111\u01b0\u1eddng ti\u00eam TM: 1 g x 2 l\u1ecd\/ ng\u00e0y, chia 2 l\u1ea7n.<\/p>\n<p>+<strong>\u00a0<\/strong>Cephalosporin (th\u1ebf h\u1ec7 2, th\u1ebf h\u1ec7 3): Cefuroxime 250mg x 2 vi\u00ean\/ ng\u00e0y, chia 2 l\u1ea7n c\u00e1ch nhau 12h.<\/p>\n<p>+\u00a0Trimethoprim &#8211; sulfamethoxazol: 480 mg x 4 vi\u00ean chia 2 l\u1ea7n c\u00e1ch nhau 12 h.<\/p>\n<p>+<strong>\u00a0<\/strong>Fluoroquinolone: nh\u00f3m n\u00e0y c\u1ea7n l\u01b0u \u00fd kh\u00f4ng cho ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 \u0111ang cho con b\u00fa, kh\u00f4ng cho tr\u1ebb em &lt; 15 tu\u1ed5i, c\u1ea7n gi\u1ea3m li\u1ec1u \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn. Th\u1eadn tr\u1ecdng v\u1edbi b\u1ec7nh nh\u00e2n suy gan:<\/p>\n<p>Norfloxacin 400 mg x 2 vi\u00ean chia 2 l\u1ea7n ho\u1eb7c<\/p>\n<p>Ofloxacin 200mg x 2 vi\u00ean chia 2 l\u1ea7n.<\/p>\n<p>&#8211; K\u1ebft h\u1ee3p gi\u1ea3m \u0111au ch\u1ed1ng co th\u1eaft: Nospa, Buscopan, Baralgin..<\/p>\n<p>&#8211; U\u1ed1ng nhi\u1ec1u n\u01b0\u1edbc ho\u1eb7c truy\u1ec1n d\u1ecbch \u0111\u1ee7 \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u nhi\u1ec1u \u2265 1500 &#8211; 2000 ml\/24h.<\/p>\n<p>N\u1ebfu t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng kh\u00f4ng ti\u1ebfn tri\u1ec3n t\u1ed1t (h\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng r\u00f5, v\u1eabn s\u1ed1t, ti\u1ec3u \u0111\u1ee5c, \u0111au, m\u1ea5t n\u01b0\u1edbc&#8230;\u2026) n\u00ean chuy\u1ec3n v\u00e0o \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa ho\u1eb7c l\u00ean tuy\u1ebfn tr\u00ean.<\/p>\n<p><strong><em>Kh\u00e1ng sinh \u0111\u01b0\u1eddng ti\u00eam: khi n\u1eb7ng<\/em><\/strong><\/p>\n<p>+ Amoxy\/ ho\u1eb7c Ampicillin 1 g x 4 l\u1ecd\/ ng\u00e0y chia 4 l\u1ea7n ti\u00eam t\u0129nh m\u1ea1ch x 10 &#8211; 14 ng\u00e0y. Ho\u1eb7c:<\/p>\n<p>+ Cephalosporin (th\u1ebf h\u1ec7 2, th\u1ebf h\u1ec7 3): 10 &#8211; 14 ng\u00e0y<\/p>\n<p>Cefuroxime 750 mg x 3 l\u1ecd chia 3 l\u1ea7n\/ng\u00e0y ti\u00eam TM, ho\u1eb7c:<\/p>\n<p>Cefotaxime 1g x 3 l\u1ea7n\/ ng\u00e0y chia 3 l\u1ea7n ti\u00eam TM, ho\u1eb7c:<\/p>\n<p>Ceftriaxone 1g \/ ng\u00e0y ti\u00eam TM, ho\u1eb7c:<\/p>\n<p>Cefoperazone 1-2g x 2 l\u1ea7n\/ng\u00e0y ti\u00eam TM Ho\u1eb7c:<\/p>\n<p>+ Fluoroquinolone \u0111\u01b0\u1eddng u\u1ed1ng: trong 3 &#8211; 7 ng\u00e0y, c\u00f3 th\u1ec3<\/p>\n<p>Norfloxacin 400 mg x 2 vi\u00ean chia 2 l\u1ea7n\/ ho\u1eb7c<\/p>\n<p>Ofloxacin 200mg x 2 vi\u00ean chia 2 l\u1ea7n trong .<\/p>\n<p>C\u00f3 th\u1ec3 truy\u1ec1n 3 ng\u00e0y, sau \u0111\u00f3 chuy\u1ec3n sang \u0111\u01b0\u1eddng u\u1ed1ng ti\u1ebfp.<\/p>\n<p><strong><em>C\u1ea7n l\u01b0u \u00fd:\u00a0<\/em><\/strong>thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y ra r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a nh\u01b0 n\u00f4n, bu\u1ed3n n\u00f4n v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng cho ph\u1ee5 n\u1eef c\u00f3 thai, tr\u1ebb em d\u01b0\u1edbi 15 tu\u1ed5i.<\/p>\n<p>+ K\u1ebft h\u1ee3p v\u1edbi 1 thu\u1ed1c trong c\u00e1c thu\u1ed1c tr\u00ean v\u1edbi Aminoglycoside ti\u00eam t\u0129nh m\u1ea1ch (TM) ho\u1eb7c ti\u00eam b\u1eafp (TB): 4 &#8211; 6 mg\/kg\/24h. Th\u1eadn trong v\u1edbi ng\u01b0\u1eddi gi\u00e0, c\u1ea7n gi\u1ea3m 1\/2 li\u1ec1u \u1edf ng\u01b0\u1eddi suy th\u1eadn c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn d\u01b0\u1edbi 30ml\/ph.<\/p>\n<p><strong>+ N\u1ebfu c\u1ea5y n\u01b0\u1edbc ti\u1ec3u c\u00f3 tr\u1ef1c khu\u1ea9n Gram \u00e2m (-):\u00a0<\/strong>Cephalosporin th\u1ebf h\u1ec7 3 ho\u1eb7c fluoroquinolone.<\/p>\n<p><strong>+ N\u1ebfu c\u1ea5y n\u01b0\u1edbc ti\u1ec3u c\u00f3 vi khu\u1ea9n Gram d\u01b0\u01a1ng (+):\u00a0<\/strong>Ampcillin 1g x 6 l\u1ea7n\/ m\u1ed7i 4 h ti\u00eam TM.<\/p>\n<p><strong>+ N\u1ebfu kh\u00f4ng c\u00f3 bi\u1ebfn ch\u1ee9ng<\/strong>, h\u1ebft s\u1ed1t, t\u1eeb ng\u00e0y th\u1ee9 10 \u0111\u1ebfn ng\u00e0y th\u1ee9 14 chuy\u1ec3n sang kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng. Kh\u00e1ng sinh duy tr\u00ec trong 3 tu\u1ea7n k\u1ec3 c\u1ea3 khi di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n nhanh ch\u00f3ng. C\u1ea7n c\u1ea5y n\u01b0\u1edbc ti\u1ec3u ki\u1ec3m tra l\u1ea1i sau 1 tu\u1ea7n ng\u1eebng thu\u1ed1c.<\/p>\n<p><strong>+ N\u1ebfu v\u1eabn s\u1ed1t<\/strong>, VK ni\u1ec7u t\u1ed3n t\u1ea1i 48h \u0111\u1ebfn 72h, ho\u1eb7c ti\u1ebfp t\u1ee5c c\u00f3 d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng sau 3 ng\u00e0y \u0111i\u1ec1u tr\u1ecb, c\u1ea7n t\u00ecm ki\u1ebfm t\u1eafc ngh\u1ebdn, \u1ed5 nhi\u1ec5m tr\u00f9ng lan r\u1ed9ng ho\u1eb7c h\u00ecnh th\u00e0nh \u1ed5 \u00e1p xe th\u1eadn. Si\u00eau \u00e2m, ch\u1ee5p c\u1eaft l\u1edbp (CT) th\u1eadn c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c v\u1ecb tr\u00ed t\u1eafc ngh\u1ebdn v\u00e0 \u1ed5 \u00e1p xe quanh th\u1eadn \u0111\u1ec3 c\u00f3 ch\u1ec9 \u0111\u1ecbnh ngo\u1ea1i khoa d\u1eabn l\u01b0u.<\/p>\n<p>&#8211;\u00a0<strong><em>Ngo\u00e0i c\u00e1c thu\u1ed1c kh\u00e1ng sinh c\u1ea7n ph\u1ed1i h\u1ee3p th\u00eam:<\/em><\/strong><\/p>\n<p>+<strong>\u00a0<\/strong>B\u00f9 \u0111\u1ee7 d\u1ecbch b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng v\u00e0 ho\u1eb7c \u0111\u01b0\u1eddng truy\u1ec1n TM: NaCl 9\u2030 ho\u1eb7c Ringer 5%, Glucose 5% \u0111\u1ea3m b\u1ea3o l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u &gt; 50 ml\/h.<\/p>\n<p>+\u00a0Gi\u1ea3m \u0111au, gi\u00e3n c\u01a1 tr\u01a1n khi \u0111au:<\/p>\n<p>Phloroglucinol hydrate, trimethylphloroglucinol: spasfon vi\u00ean u\u1ed1ng &#8211; \u0111\u1eb7t, \u1ed1ng ti\u00eam x 4 l\u1ea7n\/ng\u00e0y .<\/p>\n<p>Papaverine hydrochloride vi\u00ean u\u1ed1ng, \u1ed1ng ti\u00eam x 2-3 l\u1ea7n\/ng\u00e0y.<\/p>\n<p>Tiemonium metylsulfate: Visceralgine vi\u00ean u\u1ed1ng, \u1ed1ng ti\u00eam x 1 &#8211; 3 l\u1ea7n\/ng\u00e0y<\/p>\n<h3><strong>3.2. <\/strong><strong>M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111i\u1ec3n h\u00ecnh:<\/strong><\/h3>\n<p>&#8211; C\u1ea5y VK kh\u00f4ng m\u1ecdc: do t\u1eafc ngh\u1ebdn n\u01b0\u1edbc ti\u1ec3u ho\u00e0n to\u00e0n VK kh\u00f4ng di chuy\u1ec3n \u0111\u01b0\u1ee3c ho\u1eb7c \u0111\u00e3 d\u00f9ng kh\u00e1ng sinh tr\u01b0\u1edbc \u0111\u00f3. Ch\u1ec9 \u0111\u1ecbnh ch\u1ee5p UIV c\u1ea5p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u1eb7t ra \u0111\u1ec3 x\u00e1c minh ch\u1ea9n \u0111o\u00e1n.<\/p>\n<p>&#8211; Di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng kh\u00f4ng thu\u1eadn l\u1ee3i m\u1eb7c d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb: t\u00ecnh tr\u1ea1ng to\u00e0n th\u00e2n kh\u00f4ng c\u1ea3i thi\u1ec7n h\u01a1n, ch\u01b0a c\u1eaft s\u1ed1t c\u00f3 ch\u1ec9 \u0111\u1ecbnh ch\u1ee5p UIV c\u1ea5p \u0111\u1ec3 xem x\u00e9t \u0111i\u1ec1u tr\u1ecb can thi\u1ec7p ngo\u1ea1i khoa.<\/p>\n<h3><strong>3.3. <\/strong><strong>M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u1ea7n l\u01b0u \u00fd:<\/strong><\/h3>\n<p><strong><em>&#8211; VTBT c\u1ea5p \u1edf ng\u01b0\u1eddi c\u00f3 thai<\/em><\/strong>:<\/p>\n<p>+ Th\u01b0\u1eddng g\u1eb7p \u1edf 3 th\u00e1ng cu\u1ed1i.<\/p>\n<p>+ Th\u1eadn trong khi s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng sinh. C\u00f3 th\u1ec3 d\u00f9ng nh\u00f3m Sulfamide, penicilline (amoxicillin).<\/p>\n<p>+ Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh ch\u1ee5p X quang,<\/p>\n<p>+ Tr\u01b0\u1eddng h\u1ee3p \u0111\u00e0i b\u1ec3 th\u1eadn gi\u00e3n k\u00e8m theo kh\u00f4ng \u0111\u00e1p \u1ee9ng thu\u1ed1c c\u1ea7n xem x\u00e9t ch\u1ee5p UIV \u0111\u1ec3 t\u00ecm nguy\u00ean nh\u00e2n g\u00e2y t\u1eafc ngh\u1ebdn c\u01a1 gi\u1edbi v\u00e0 th\u1eadn tr\u1ecdng ch\u1ec9 \u0111\u1ecbnh ngo\u1ea1i khoa.<\/p>\n<p>+ M\u1ecdi th\u0103m d\u00f2 h\u00ecnh th\u00e1i kh\u00e1c ch\u1ec9 ti\u1ebfn h\u00e0nh sau khi \u0111\u1ebb.<\/p>\n<p><em>&#8211; <strong>VTBT c\u1ea5p\u00a0t\u00e1i ph\u00e1t nhi\u1ec1u l\u1ea7n:<\/strong><\/em><\/p>\n<p><em>+<strong>\u00a0<\/strong><\/em>M\u1ed7i l\u1ea7n t\u00e1i ph\u00e1t s\u1ebd l\u00e0m bi\u1ebfn d\u1ea1ng \u0111\u00e0i th\u1eadn, t\u00e1i ph\u00e1t nhi\u1ec1u l\u1ea7n s\u1ebd g\u00e2y x\u01a1 h\u00f3a v\u00e0 teo nhu m\u00f4 th\u1eadn.<\/p>\n<p>+ N\u00ean \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh k\u00e9o d\u00e0i \u0111\u1ec3 d\u1ef1 ph\u00f2ng t\u00e1i ph\u00e1t v\u00e0 t\u00ecm nguy\u00ean nh\u00e2n<\/p>\n<p><strong><em>&#8211; VTBT c\u1ea5p v\u00f4 ni\u1ec7u<\/em><\/strong>:<\/p>\n<p>+ c\u00f3 th\u1ec3 do t\u1eafc ngh\u1ebdn \u1edf th\u1eadn duy nh\u1ea5t c\u00f3 ch\u1ee9c n\u0103ng ho\u1ea1t \u0111\u1ed9ng ho\u1eb7c do s\u1ed1c nhi\u1ec5m khu\u1ea9n.<\/p>\n<p>+ C\u1ea3 hai tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec1u r\u1ea5t n\u1eb7ng v\u00e0 ti\u00ean l\u01b0\u1ee3ng t\u1eed vong cao.<\/p>\n<p>+ Gi\u1ea3i quy\u1ebft nguy\u00ean nh\u00e2n t\u1eafc ngh\u1ebdn l\u00e0 ch\u1ec9 \u0111\u1ecbnh c\u1ea5p c\u1ee9u.<\/p>\n<p><strong>* Theo d\u00f5i sau giai \u0111o\u1ea1n \u0111i\u1ec1u tr\u1ecb:<\/strong><\/p>\n<p>&#8211; N\u1ebfu \u0111\u00e1p \u1ee9ng thu\u1ed1c t\u1ed1t v\u00e0 kh\u00f4ng c\u00f2n tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, c\u1ea5y VK sau 5 ng\u00e0y ng\u1eebng thu\u1ed1c n\u1ebfu kh\u00f4ng m\u1ecdc coi nh\u01b0 \u0111\u00e3 kh\u1ecfi.<\/p>\n<p>&#8211; N\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng t\u1ed1t, sau 2 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb c\u1ea7n thi\u1ebft: X-quang, c\u1ea5y l\u1ea1i n\u01b0\u1edbc ti\u1ec3u \u0111\u1ec3 x\u00e9t can thi\u1ec7p s\u1ecfi v\u00e0 \u00e1p xe quanh th\u1eadn n\u1ebfu c\u00f3.<\/p>\n<p>&#8211; N\u1ebfu kh\u00f4ng c\u00f3 b\u1ea5t th\u01b0\u1eddng \u1edf h\u1ec7 ti\u1ebft ni\u1ec7u: \u0111i\u1ec1u tr\u1ecb l\u1ea1i b\u1eb1ng kh\u00e1ng sinh kh\u00e1c ph\u1ed1i h\u1ee3p trong 2 tu\u1ea7n.<\/p>\n<p>&#8211; N\u1ebfu b\u1ec7nh nh\u00e2n t\u00e1i ph\u00e1t v\u1edbi VK c\u00f9ng lo\u1ea1i: ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb 6 tu\u1ea7n.<\/p>\n<h2><strong>4. \u0110<\/strong><strong>i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng vi\u00eam th\u1eadn b\u1ec3 th\u1eadn<\/strong><\/h2>\n<p>&#8211; C\u1ea7n \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 khi c\u00f3 nhi\u1ec5m khu\u1ea9n ti\u1ebft ni\u1ec7u d\u01b0\u1edbi<\/p>\n<p>&#8211; \u0110i\u1ec1u tr\u1ecb s\u1edbm c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y nghi\u1ec5m khu\u1ea9n ti\u1ebft ni\u1ec7u, g\u00e2y t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u.<\/p>\n<p>&#8211; U\u1ed1ng \u0111\u1ee7 n\u01b0\u1edbc h\u00e0ng ng\u00e0y, kh\u00f4ng nh\u1ecbn ti\u1ec3u<\/p>\n<p><strong>Ngu\u1ed3n tham kh\u1ea3o<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 b\u1ec7nh v\u1ec1 th\u1eadn \u2013 ti\u1ebft ni\u1ec7u theo B\u1ed9 Y t\u1ebf 2015.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>B\u1ec7nh vi\u00eam th\u1eadn b\u1ec3 th\u1eadn c\u1ea5p l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p trong h\u1ec7 th\u1ed1ng ti\u1ebft ni\u1ec7u, g\u00e2y ra s\u1ef1 vi\u00eam nhi\u1ec5m v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u00e1c m\u00f4 v\u00e0 c\u01a1 quan trong th\u1eadn. 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