{"id":28471,"date":"2023-04-27T15:35:22","date_gmt":"2023-04-27T08:35:22","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28471"},"modified":"2023-05-07T09:10:21","modified_gmt":"2023-05-07T02:10:21","slug":"viem-ong-than-ke","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/viem-ong-than-ke\/","title":{"rendered":"Kh\u00e1i qu\u00e1t v\u1ec1 vi\u00eam \u1ed1ng th\u1eadn k\u1ebd c\u1ea5p"},"content":{"rendered":"

Vi\u00eam \u1ed1ng th\u1eadn k\u1ebd c\u1ea5p l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf c\u1ea3 nam v\u00e0 n\u1eef, l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng vi\u00eam nhi\u1ec5m c\u1ee7a c\u00e1c \u1ed1ng th\u1eadn k\u1ebd. B\u00e0i vi\u1ebft s\u1ebd tr\u00ecnh b\u00e0y nh\u1eefng tri\u1ec7u ch\u1ee9ng ph\u1ed5 bi\u1ebfn c\u1ee7a vi\u00eam \u1ed1ng th\u1eadn k\u1ebd c\u1ea5p nh\u01b0 \u0111au l\u01b0ng, s\u1ed1t, bu\u1ed3n n\u00f4n, n\u00f4n m\u1eeda v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c. Nguy\u00ean nh\u00e2n c\u1ee7a b\u1ec7nh n\u00e0y c\u00f3 th\u1ec3 do nhi\u1ec5m khu\u1ea9n, t\u1eafc ngh\u1ebdn \u1ed1ng th\u1eadn, s\u1eed d\u1ee5ng thu\u1ed1c kh\u00f4ng \u0111\u00fang c\u00e1ch, v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c.<\/strong><\/p>\n

1. \u0110<\/strong>\u1ea1i c\u01b0\u01a1ng<\/strong><\/h1>\n

Vi\u00eam \u1ed1ng k\u1ebd th\u1eadn c\u1ea5p l\u00e0 b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p g\u00e2y n\u00ean suy th\u1eadn c\u1ea5p, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p (acute tubular necrosis) ho\u1eb7c l\u00e0 vi\u00eam k\u1ebd th\u1eadn c\u1ea5p (acute interstitial nephritis). T\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu c\u1ee7a b\u1ec7nh l\u00fd n\u00e0y l\u00e0 ho\u1ea1i t\u1eed li\u00ean b\u00e0o \u1ed1ng th\u1eadn, l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd n\u1eb7ng v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong c\u00f2n r\u1ea5t cao n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c x\u1eed tr\u00ed m\u1ed9t c\u00e1ch k\u1ecbp th\u1eddi v\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3.<\/p>\n

2. N<\/strong>guy\u00ean nh\u00e2n c\u1ee7a vi\u00eam \u1ed1ng th\u1eadn k\u1ebd<\/strong><\/h2>\n

C\u00f3 r\u1ea5t nhi\u1ec1u nguy\u00ean nh\u00e2n g\u00e2y n\u00ean vi\u00eam \u1ed1ng k\u1ebd th\u1eadn c\u1ea5p nh\u01b0ng t\u1eadp trung c\u00f3 th\u1ec3 chia l\u00e0m 3 nh\u00f3m l\u1edbn:<\/p>\n

2.1. <\/strong>Ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p sau thi\u1ebfu m\u00e1u.<\/strong><\/h3>\n

T\u1ea5t c\u1ea3 nh\u1eefng nguy\u00ean nh\u00e2n n\u00e0o m\u00e0 l\u00e0m cho s\u1ef1 t\u01b0\u1edbi m\u00e1u th\u1eadn gi\u1ea3m s\u00fat k\u00e9o d\u00e0i \u0111\u1ec1u c\u00f3 th\u1ec3 l\u00e0m cho th\u1eadn thi\u1ebfu m\u00e1u v\u00e0 g\u00e2y n\u00ean th\u01b0\u01a1ng t\u1ed5n d\u01b0\u1edbi d\u1ea1ng ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn.<\/p>\n

Nguy\u00ean nh\u00e2n gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn \u0111\u01b0\u1ee3c chia l\u00e0m 2 nh\u00f3m:<\/p>\n

* Ngu\u1ed3n g\u1ed1c tr\u01b0\u1edbc th\u1eadn<\/em><\/strong><\/p>\n

– S\u1ed1c gi\u1ea3m th\u1ec3 t\u00edch m\u00e1u: sau m\u1ed5, sau ch\u1ea5n th\u01b0\u01a1ng, b\u1ecfng, s\u1ea9y n\u1ea1o thai, m\u1ea5t n\u01b0\u1edbc, m\u1ea5t mu\u1ed1i.<\/p>\n

– S\u1ed1c nhi\u1ec5m khu\u1ea9n, nhi\u1ec5m \u0111\u1ed9c.<\/p>\n

– S\u1ed1c tim.<\/p>\n

* Ngu\u1ed3n g\u1ed1c t\u1ea1i th\u1eadn<\/em><\/strong><\/p>\n

Th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 do nh\u1eefng t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd c\u1ee7a m\u1ed9t s\u1ed1 thu\u1ed1c khi s\u1eed d\u1ee5ng tr\u00ean m\u1ed9t s\u1ed1 c\u01a1 \u0111\u1ecba \u0111\u1eb7c bi\u1ec7t nh\u01b0 thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng st\u00e9roids, thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n khi s\u1eed d\u1ee5ng \u1edf ng\u01b0\u1eddi b\u1ec7nh h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn hai b\u00ean.<\/p>\n

2.2. <\/strong>Ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p do ng\u1ed9 \u0111\u1ed9c<\/strong><\/h3>\n

C\u00f3 th\u1ec3 tr\u1ef1c ti\u1ebfp l\u00ean t\u1ebf b\u00e0o \u1ed1ng th\u1eadn ho\u1eb7c gi\u00e1n ti\u1ebfp l\u00ean c\u01a1 ch\u1ebf m\u1ea1ch m\u00e1u v\u00e0 t\u1eeb \u0111\u00f3 g\u00e2y thi\u1ebfu m\u00e1u th\u1eadn.<\/p>\n

* Thu\u1ed1c<\/em><\/strong><\/p>\n

– C\u00e1c thu\u1ed1c kh\u00e1ng sinh, nh\u1ea5t l\u00e0 nh\u00f3m Aminosides.<\/p>\n

– C\u00e1c s\u1ea3n ph\u1ea9m iod c\u1ea3n quang.<\/p>\n

– C\u00e1c thu\u1ed1c ch\u1ed1ng U: Ciplastine, Cyclosporine, Interf\u00e9ron.<\/p>\n

– M\u1ed9t s\u1ed1 thu\u1ed1c kh\u00e1c nh\u01b0 Phenylbutazone c\u00e1c thu\u1ed1c g\u00e2y m\u00ea (methoxyfluzan).<\/p>\n

* M\u1ed9t v\u00e0i s\u1eafc t\u1ed1 n\u1ed9i sinh nh\u01b0 huy\u1ebft s\u1eafc t\u1ed1 (Hb), s\u1eafc t\u1ed1 c\u01a1 (myoglobin)<\/em><\/strong><\/p>\n

* C\u00e1c\u00a0h\u00f3a\u00a0ch\u1ea5t th\u01b0\u1eddng d\u00f9ng nh\u01b0 T\u00e9tra Cloruacarbon (CCl4), c\u1ed3n M\u00eatylic.<\/em><\/strong><\/p>\n

* \u0110\u1ed9c t\u1ed1 c\u1ee7a sinh v\u1eadt:<\/em><\/strong><\/p>\n

– M\u1eadt c\u00e1 tr\u1eafm, c\u00e1 m\u00e8, c\u00e1 ch\u00e9p.<\/p>\n

– M\u1eadt c\u00f3c.<\/p>\n

2.3. <\/strong>D\u1ecb \u1ee9ng<\/strong><\/h3>\n

C\u00f2n g\u1ecdi l\u00e0 vi\u00eam th\u1eadn k\u1ebb c\u1ea5p d\u1ecb \u1ee9ng (NIA immuno-allergique) nguy\u00ean nh\u00e2n do thu\u1ed1c l\u00e0 th\u01b0\u1eddng g\u1eb7p: M\u00e9thicilline, P\u00e9nicilline, kh\u00e1ng vi\u00eam kh\u00f4ng St\u00e9roides, thu\u1ed1c l\u1ee3i ti\u1ec3u, Cim\u00e9tidine.<\/p>\n

3. L<\/strong>\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng<\/strong><\/h2>\n

3.1. <\/strong>L\u00e2m s\u00e0ng c\u1ee7a vi\u00eam \u1ed1ng th\u1eadn k\u1ebd<\/strong><\/h3>\n

L\u00e2m s\u00e0ng c\u1ee7a vi\u00eam \u1ed1ng k\u1ebd th\u1eadn c\u1ea5p bi\u1ec3u hi\u1ec7n l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng suy th\u1eadn c\u1ea5p \u0111\u00f4i khi k\u00e8m theo v\u1edbi b\u1ec7nh c\u1ea3nh c\u1ee7a m\u1ed9t vi\u00eam gan c\u1ea5p (g\u1eb7p trong b\u1ec7nh nguy\u00ean ng\u1ed9 \u0111\u1ed9c).<\/p>\n

T\u00ecnh hu\u1ed1ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n b\u1ec7nh vi\u00eam \u1ed1ng th\u1eadn c\u1ea5p r\u1ea5t kh\u00e1c nhau: th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n l\u00e0 tri\u1ec7u ch\u1ee9ng thi\u1ec3u, v\u00f4 ni\u1ec7u, \u0111\u00f4i khi \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n qua m\u1ed9t bi\u1ebfn ch\u1ee9ng n\u1eb7ng nh\u01b0 \u1ee9 d\u1ecbch ngo\u1ea1i b\u00e0o (t\u0103ng huy\u1ebft \u00e1p, ph\u00f9 ph\u1ed5i) ho\u1eb7c nh\u1eefng r\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i kh\u00e1c ho\u1eb7c b\u1ec7nh c\u1ea3nh c\u1ee7a h\u1ed9i ch\u1ee9ng t\u0103ng ur\u00ea m\u00e1u.<\/p>\n

L\u00e2m s\u00e0ng tr\u1ea3i qua 5 giai \u0111o\u1ea1n:<\/p>\n

* Giai \u0111o\u1ea1n t\u1ea5n c\u00f4ng th\u1eadn<\/em><\/strong><\/p>\n

Th\u1eddi gian c\u1ee7a giai \u0111o\u1ea1n n\u00e0y t\u00f9y thu\u1ed9c v\u00e0o nguy\u00ean nh\u00e2n: c\u1ea5p v\u00e0 \u0111\u1ed9t ng\u1ed9t (s\u1ed1c, xu\u1ea5t huy\u1ebft) ho\u1eb7c ch\u1eadm v\u00e0 k\u00e9o d\u00e0i (kh\u00e1ng sinh \u0111\u1ed9c v\u1edbi th\u1eadn).<\/p>\n

* Giai \u0111o\u1ea1n thi\u1ec3u, v\u00f4 ni\u1ec7u ban \u0111\u1ea7u<\/em><\/strong><\/p>\n

Xu\u1ea5t hi\u1ec7n trong 24 \u0111\u1ebfn 72 gi\u1edd sau \u0111\u00f3. L\u00e2m s\u00e0ng bi\u1ec3u hi\u1ec7n:<\/p>\n

– \u1ee8 d\u1ecbch ngo\u1ea1i b\u00e0o (t\u0103ng c\u00e2n, ph\u00f9 ngo\u1ea1i bi\u00ean, kh\u00f3 th\u1edf g\u1eafng s\u1ee9c)<\/p>\n

– T\u0103ng nit\u01a1 phi protein: d\u1ea5u hi\u1ec7u to\u00e0n th\u00e2n, r\u1ed1i lo\u1ea1n ti\u00eau\u00a0h\u00f3a, \u0111\u00f4i khi l\u00e0 nh\u1eefng ch\u1ea5m xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da.<\/p>\n

* Giai \u0111o\u1ea1n thi\u1ec3u v\u00f4 ni\u1ec7u th\u1eadt s\u1ef1<\/em><\/strong><\/p>\n

Th\u1eddi gian thay \u0111\u1ed5i t\u1eeb 7 \u0111\u1ebfn 21 ng\u00e0y. L\u00e2m s\u00e0ng c\u1ee7a giai \u0111o\u1ea1n n\u00e0y l\u00e0 h\u1ed9i ch\u1ee9ng t\u0103ng ur\u00ea m\u00e1u c\u1ea5p \u0111i\u1ec3n h\u00ecnh.<\/p>\n

* Giai \u0111o\u1ea1n ti\u1ec3u nhi\u1ec1u<\/em><\/strong><\/p>\n

Th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n kho\u1ea3ng tu\u1ea7n th\u1ee9 ba c\u1ee7a v\u00f4 ni\u1ec7u, c\u00f3 khi s\u1edbm h\u01a1n, l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u t\u0103ng l\u00ean d\u1ea7n. Trong giai \u0111o\u1ea1n n\u00e0y \u0111\u00f4i khi c\u00f2n c\u1ea7n thi\u1ebft ph\u1ea3i l\u1ecdc m\u00e1u, nh\u01b0ng quan tr\u1ecdng h\u01a1n l\u00e0 b\u00f9 l\u1ea1i l\u01b0\u1ee3ng d\u1ecbch, \u0111i\u1ec7n gi\u1ea3i m\u1ea5t.<\/p>\n

* Giai \u0111o\u1ea1n ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng th\u1eadn.<\/em><\/strong><\/p>\n

Ur\u00ea, cr\u00e9atinine m\u00e1u tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng ho\u1eb7c tr\u1edf l\u1ea1i v\u1edbi tr\u1ecb s\u1ed1 tr\u01b0\u1edbc \u0111\u00e2y ch\u01b0a c\u00f3 suy th\u1eadn c\u1ea5p.<\/p>\n

Ngo\u00e0i ra tr\u00ean l\u00e2m s\u00e0ng c\u1ee7a vi\u00eam \u1ed1ng k\u1ebd th\u1eadn c\u1ea5p c\u0169ng c\u1ea7n l\u01b0u \u00fd nh\u1eefng th\u1ec3 v\u1eabn c\u00f3 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u, kh\u00f4ng thi\u1ec3u v\u00e0 v\u00f4 ni\u1ec7u, \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a th\u1ec3 n\u00e0y l\u00e0:<\/p>\n

– Ch\u1ea9n \u0111o\u00e1n th\u01b0\u1eddng ch\u1eadm.<\/p>\n

– Th\u01b0\u01a1ng t\u1ed5n th\u1eadn th\u01b0\u1eddng \u00edt n\u1eb7ng, ti\u00ean l\u01b0\u1ee3ng th\u01b0\u1eddng t\u1ed1t.<\/p>\n

– \u0110\u00e2y l\u00e0 th\u1ec3 th\u01b0\u1eddng g\u1eb7p khi s\u1eed d\u1ee5ng s\u1edbm l\u1ee3i ti\u1ec3u Furos\u00e9mide v\u00e0 ho\u1eb7c d\u00e3n m\u1ea1ch.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb l\u1ecdc m\u00e1u, dinh d\u01b0\u1ee1ng c\u0169ng gi\u1ed1ng nh\u01b0 th\u1ec3 v\u00f4 ni\u1ec7u.<\/p>\n

3.2. <\/strong>C\u1eadn l\u00e2m s\u00e0ng c\u1ee7a vi\u00eam \u1ed1ng th\u1eadn k\u1ebd<\/strong><\/h3>\n

Ngo\u00e0i nh\u1eefng x\u00e9t nghi\u1ec7m t\u00ecm nguy\u00ean nh\u00e2n c\u00f2n c\u00f3 nh\u1eefng x\u00e9t nghi\u1ec7m \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh suy th\u1eadn c\u1ea5p, bao g\u1ed3m:<\/p>\n

-T\u0103ng ur\u00ea, cr\u00e9atinin m\u00e1u.<\/p>\n

– R\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i: t\u0103ng Kali m\u00e1u, h\u1ea1 Natri m\u00e1u, h\u1ea1 Calci m\u00e1u, t\u0103ng phosphat m\u00e1u l\u00e0 nh\u1eefng r\u1ed1i lo\u1ea1n th\u01b0\u1eddng g\u1eb7p trong suy th\u1eadn c\u1ea5p.<\/p>\n

– R\u1ed1i lo\u1ea1n toan ki\u1ec1m: nhi\u1ec5m toan.<\/p>\n

\"\"
Acute Interstitial Nephritis<\/strong><\/figcaption><\/figure>\n

4. C<\/strong>h\u1ea9n \u0111o\u00e1n c\u1ee7a vi\u00eam \u1ed1ng th\u1eadn k\u1ebd<\/strong><\/h2>\n

4.1. <\/strong>Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh d\u1ef1a v\u00e0o<\/strong><\/h3>\n

– Kh\u1edfi ph\u00e1t b\u1ec7nh c\u1ea5p t\u00ednh.<\/p>\n

– C\u00f3 y\u1ebfu t\u1ed1 nguy\u00ean nh\u00e2n c\u1ee7a vi\u00eam \u1ed1ng k\u1ebd th\u1eadn c\u1ea5p.<\/p>\n

– L\u00e2m s\u00e0ng v\u1edbi thi\u1ec3u, v\u00f4 ni\u1ec7u l\u00fac kh\u1edfi \u0111\u1ea7u v\u00e0 c\u00f3 giai \u0111o\u1ea1n ti\u1ec3u nhi\u1ec1u sau \u0111\u00f3.<\/p>\n

-X\u00e9t nghi\u1ec7m ur\u00ea, cr\u00e9atinin, kali m\u00e1u t\u0103ng d\u1ea7n.<\/p>\n

4.2. <\/strong>Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/strong><\/h3>\n

C\u1ea7n ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y suy th\u1eadn c\u1ea5p kh\u00e1c nh\u01b0 vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p, s\u1ecfi t\u1eafc ni\u1ec7u qu\u1ea3n.<\/p>\n

5. \u0110<\/strong>i\u1ec1u tr\u1ecb c\u1ee7a vi\u00eam \u1ed1ng th\u1eadn k\u1ebd<\/strong><\/h2>\n

Bao g\u1ed3m \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng, \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n v\u00e0 bi\u1ebfn ch\u1ee9ng c\u1ee7a vi\u00eam \u1ed1ng k\u1ebd th\u1eadn c\u1ea5p (t\u00f9y\u00a0thu\u1ed9c v\u00e0o giai \u0111o\u1ea1n c\u1ee7a vi\u00eam \u1ed1ng k\u1ebd th\u1eadn c\u1ea5p \u0111\u1ec3 \u00e1p d\u1ee5ng c\u1ee5 th\u1ec3).<\/p>\n

5.1. <\/strong>Trong giai \u0111o\u1ea1n s\u1edbm<\/strong><\/h3>\n

X\u1eed tr\u00ed ngay c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam \u1ed1ng th\u1eadn c\u1ea5p:<\/p>\n

– Lo\u1ea1i b\u1ecf ch\u1ea5t \u0111\u1ed9c trong nguy\u00ean nh\u00e2n do ng\u1ed9 \u0111\u1ed9c.<\/p>\n

– B\u00f9 d\u1ecbch, b\u00f9 m\u00e1u trong ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p sau thi\u1ebfu m\u00e1u, b\u1eb1ng c\u00e1ch:<\/p>\n

+ \u0110i\u1ec1u ch\u1ec9nh ngay h\u1ea1 huy\u1ebft \u00e1p b\u1eb1ng c\u00e1ch truy\u1ec1n c\u00e1c d\u1ecbch keo (albumin, plasma) ho\u1eb7c mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u01a1ng.<\/p>\n

+ C\u00e1c thu\u1ed1c t\u00e1c d\u1ee5ng v\u1eadn m\u1ea1ch: dopamin li\u1ec1u 3\u00b5g\/kg\/ph\u00fat \u0111\u1ec3 c\u1ea3i thi\u1ec7n d\u00f2ng m\u00e1u th\u1eadn.<\/p>\n

5.2. <\/strong>Giai \u0111o\u1ea1n \u0111\u00e1i \u00edt v\u00f4 ni\u1ec7u<\/strong><\/h3>\n

M\u1ee5c \u0111\u00edch c\u01a1 b\u1ea3n trong giai \u0111o\u1ea1n n\u00e0y l\u00e0:<\/p>\n

– Gi\u1eef c\u00e2n b\u1eb1ng n\u1ed9i m\u00f4i<\/p>\n

– H\u1ea1n ch\u1ebf t\u0103ng kali m\u00e1u<\/p>\n

– H\u1ea1n ch\u1ebf t\u0103ng ur\u00ea m\u00e1u<\/p>\n

* N\u01b0\u1edbc<\/em><\/strong><\/p>\n

\u1ede ng\u01b0\u1eddi b\u1ec7nh v\u00f4 ni\u1ec7u \u0111\u1ea3m b\u1ea3o c\u00e2n b\u1eb1ng \u00e2m ngh\u0129a l\u00e0 l\u01b0\u1ee3ng n\u01b0\u1edbc v\u00e0o \u00edt h\u01a1n l\u01b0\u1ee3ng n\u01b0\u1edbc ra. Th\u00f4ng th\u01b0\u1eddng cho kho\u1ea3ng 500ml n\u01b0\u1edbc k\u1ec3 c\u1ea3 \u0103n l\u1eabn u\u1ed1ng. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p v\u00f4 ni\u1ec7u do m\u1ea5t n\u01b0\u1edbc m\u1ea5t mu\u1ed1i th\u00ec ph\u1ea3i b\u00f9 d\u1ecbch.<\/p>\n

* \u0110i\u1ec7n gi\u1ea3i v\u00e0 toan m\u00e1u<\/em><\/strong><\/p>\n

– \u0110i\u1ec1u tr\u1ecb t\u0103ng Kali m\u00e1u<\/p>\n

+ H\u1ea1n ch\u1ebf \u0111\u01b0a Kali t\u1eeb ngo\u00e0i v\u00e0o: rau qu\u1ea3 nhi\u1ec1u kali, thu\u1ed1c d\u1ecbch truy\u1ec1n c\u00f3 kali<\/p>\n

+ Lo\u1ea1i b\u1ecf c\u00e1c \u1ed5 ho\u1ea1i ho\u1ea1i t\u1eed, ch\u1ed1ng nhi\u1ec5m khu\u1ea9n.<\/p>\n

+ L\u1ee3i ti\u1ec3u: nh\u1eb1m \u0111\u00e0o th\u1ea3i n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i, \u0111\u1eb7c bi\u1ec7t l\u00e0 kali, \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng c\u00f3 t\u1eafc ngh\u1ebbn sau th\u1eadn, b\u1eaft \u0111\u1ea7u c\u00f3 th\u1ec3 d\u00f2 li\u1ec1u b\u1eb1ng Lasix 20mg x 4 \u1ed1ng ti\u00eam t\u0129nh m\u1ea1ch, c\u00f3 th\u1ec3 cho li\u1ec1u cao 200mg – 500mg\/ 24 gi\u1edd.Li\u1ec1u r\u1ea5t cao c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh nh\u01b0 Furos\u00e9mide 1000mg\/24 gi\u1edd b\u1eb1ng truy\u1ec1n ch\u1eadm qua b\u01a1m ti\u00eam \u0111i\u1ec7n. Ngo\u00e0i furosemide c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng bum\u00e9tamide ho\u1eb7c acide etacrynic.<\/p>\n

+ Truy\u1ec1n natribicacbonat<\/p>\n

C\u00f3 th\u1ec3 truy\u1ec1n natribicacbonat 1,4% ho\u1eb7c 4,2% khi ng\u01b0\u1eddi b\u1ec7nh c\u00f2n c\u00f3 n\u01b0\u1edbc ti\u1ec3u. C\u00f3 th\u1ec3 ti\u00eam, truy\u1ec1n t\u0129nh m\u1ea1ch natribicacbonat 8,4% trong tr\u01b0\u1eddng h\u1ee3p c\u1ea7n h\u1ea1n ch\u1ebf l\u01b0\u1ee3ng n\u01b0\u1edbc \u0111\u01b0a v\u00e0o cho ng\u01b0\u1eddi b\u1ec7nh. B\u00f9 Natri bicacbonat gi\u00fap c\u1ea3i thi\u1ec7n toan m\u00e1u, t\u1eeb \u0111\u00f3 h\u1ea1n ch\u1ebf vi\u1ec7c di chuy\u1ec3n kali t\u1eeb n\u1ed9i b\u00e0o ra ngo\u1ea1i b\u00e0o.<\/p>\n

+ Truy\u1ec1n glucose \u01b0u tr\u01b0\u01a1ng k\u00e8m insulin t\u00e1c d\u1ee5ng nhanh nh\u1eb1m \u0111\u1ea9y kali v\u00e0o khu v\u1ef1c n\u1ed9i b\u00e0o.<\/p>\n

+ Cho Canxi ti\u00eam t\u0129nh m\u1ea1ch ch\u1eadm trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u0103ng kali m\u00e1u n\u1eb7ng, c\u1ea5p c\u1ee9u (nh\u1ea5t l\u00e0 c\u00f3 bi\u1ec3u hi\u1ec7n tim m\u1ea1ch).<\/p>\n

+ R\u00e9sin trao \u0111\u1ed5i ion nh\u01b0 resonium, Kayexalat (30 gam\/24 gi\u1edd) \u0111\u1ec3 th\u1ea3i kali qua \u0111\u01b0\u1eddng ph\u00e2n.<\/p>\n

+ N\u1ebfu kali m\u00e1u \u2265 6,5 mmol\/l th\u00ec c\u1ea7n ch\u1ec9 \u0111\u1ecbnh l\u1ecdc m\u00e1u ngo\u00e0i th\u1eadn.<\/p>\n

* \u0110i\u1ec1u tr\u1ecb c\u00e1c r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i kh\u00e1c<\/em><\/strong><\/p>\n

+ Natri v\u00e0 clo: Natri m\u00e1u h\u1ea1 th\u01b0\u1eddng l\u00e0 do \u1ee9 n\u01b0\u1edbc. T\u1ed1t nh\u1ea5t l\u00e0 h\u1ea1n ch\u1ebf n\u01b0\u1edbc. Khi Natri m\u00e1u h\u1ea1 nhi\u1ec1u c\u1ea7n ph\u1ea3i b\u00f9 Natri.<\/p>\n

+ Canxi: Trong vi\u00eam \u1ed1ng k\u1ebd th\u1eadn c\u1ea5p \u00edt khi c\u00f3 h\u1ea1 Canxi m\u00e1u. N\u1ebfu c\u00f3 xu\u1ea5t hi\u1ec7n T\u00e9tani do h\u1ea1 Canxi m\u00e1u c\u00f3 th\u1ec3 cho Canxi clorua ho\u1eb7c Canxi gluconate.<\/p>\n

* \u0110i\u1ec1u tr\u1ecb t\u0103ng ur\u00ea m\u00e1u<\/em><\/strong><\/p>\n

– Ch\u1ebf \u0111\u1ed9 \u0103n gi\u1ea3m \u0111\u1ea1m, \u0111\u1ee7 calo \u00edt nh\u1ea5t l\u00e0 35 kcalo\/kg \/ 24 gi\u1edd, \u0111\u1ee7 vitamin.<\/p>\n

– C\u00e1c thu\u1ed1c t\u0103ng \u0111\u1ed3ng h\u00f3a pr\u00f4tide nh\u01b0 Durabolin 25mg\/ng\u00e0y, Testosteron 25mg\/ng\u00e0y.<\/p>\n

– B\u1ed5 sung th\u00eam vi\u00ean ketosteril: 1 vi\u00ean 600mg cho 5 kg c\u00e2n n\u1eb7ng\/ ng\u00e0y.<\/p>\n

– Lo\u1ea1i b\u1ecf c\u00e1c \u1ed5 nhi\u1ec5m khu\u1ea9n<\/p>\n

– Ch\u1ec9 \u0111\u1ecbnh l\u1ecdc m\u00e1u: n\u00ean ch\u1ec9 \u0111\u1ecbnh l\u1ecdc m\u00e1u s\u1edbm b\u1eb1ng th\u1eadn nh\u00e2n t\u1ea1o ho\u1eb7c th\u1ea9m ph\u00e2n m\u00e0ng b\u1ee5ng. Ch\u1ec9 \u0111\u1ecbnh l\u1ecdc m\u00e1u khi:<\/p>\n

+ Kali m\u00e1u \u2265 6,5 mmol\/<\/p>\n

+ Ur\u00ea m\u00e1u > 35mmol\/l<\/p>\n

+ Cr\u00e9atinin m\u00e1u > 600 \u00b5mol\/l.<\/p>\n

+ C\u00f3 bi\u1ec3u hi\u1ec7n toan m\u00e1u.<\/p>\n

5.3. <\/strong>Trong giai \u0111o\u1ea1n ti\u1ec3u nhi\u1ec1u<\/strong><\/h3>\n

\u1ede giai \u0111o\u1ea1n n\u00e0y, tuy ti\u1ec3u nhi\u1ec1u nh\u01b0ng ch\u1ee9c n\u0103ng th\u1eadn ch\u01b0a h\u1ed3i ph\u1ee5c. Nh\u1eefng ng\u00e0y \u0111\u1ea7u c\u1ee7a giai \u0111o\u1ea1n ti\u1ec3u nhi\u1ec1u n\u1ed3ng \u0111\u1ed9 ur\u00ea, cr\u00e9atinin m\u00e1u c\u00f2n t\u0103ng n\u00ean \u0111i\u1ec1u tr\u1ecb t\u0103ng ur\u00ea m\u00e1u gi\u1ed1ng nh\u01b0 giai \u0111o\u1ea1n ti\u1ec3u \u00edt v\u00e0 v\u00f4 ni\u1ec7u.Trong giai \u0111o\u1ea1n n\u00e0y, v\u00ec ti\u1ec3u nhi\u1ec1u n\u00ean g\u00e2y m\u1ea5t n\u01b0\u1edbc m\u1ea5t \u0111i\u1ec7n gi\u1ea3i. \u0110i\u1ec1u tr\u1ecb nh\u1eb1m:<\/p>\n

– Ti\u1ebfp t\u1ee5c h\u1ea1n ch\u1ebf pr\u00f4tid trong th\u1ee9c \u0103n, ch\u1ec9 t\u0103ng pr\u00f4tid khi ur\u00ea m\u00e1u \u0111\u00e3 gi\u1ea3m \u1edf m\u1ee9c an to\u00e0n (10 mmol\/l).Cho ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng c\u00f3 kali (hoa qu\u1ea3) khi kali m\u00e1u b\u00ecnh th\u01b0\u1eddng.<\/p>\n

– Truy\u1ec1n d\u1ecbch ho\u1eb7c u\u1ed1ng \u0111\u1ec3 ch\u1ed1ng m\u1ea5t n\u01b0\u1edbc, m\u1ea5t \u0111i\u1ec7n gi\u1ea3i. Trong tr\u01b0\u1eddng h\u1ee3p l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u > 3l\u00edt\/24 gi\u1edd c\u1ea7n b\u00f9 b\u1eb1ng \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch. L\u01b0\u1ee3ng d\u1ecbch b\u00f9\u00a0t\u00f9y\u00a0theo l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u. Sau 5 – 7 ng\u00e0y ti\u1ec3u nhi\u1ec1u c\u00f3 th\u1ec3 h\u1ea1n ch\u1ebf d\u1ea7n l\u01b0\u1ee3ng d\u1ecbch truy\u1ec1n v\u00e0 theo d\u1ecfi v\u00ec l\u00fac n\u00e0y th\u1eadn \u0111\u00e3 b\u1eaft \u0111\u1ea7u h\u1ed3i ph\u1ee5c ch\u1ee9c n\u0103ng c\u00f4 \u0111\u1eb7c.<\/p>\n

5.4. <\/strong>Trong giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c<\/strong><\/h3>\n

– Trung b\u00ecnh sau 4 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb th\u00ec ch\u1ee9c n\u0103ng th\u1eadn b\u1eaft \u0111\u1ea7u h\u1ed3i ph\u1ee5c t\u1ed1t v\u00e0 ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 xu\u1ea5t vi\u1ec7n.<\/p>\n

– C\u1ea7n theo d\u00f5i \u0111\u1ecbnh k\u1ef3 h\u00e0ng th\u00e1ng cho \u0111\u1ebfn khi ch\u1ee9c n\u0103ng th\u1eadn h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n.<\/p>\n

– Khi ur\u00ea m\u00e1u tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng th\u00ec t\u0103ng d\u1ea7n kh\u1ea9u ph\u1ea7n pr\u00f4tid, \u0111\u1ea3m \u0111\u1ee7 calo, vitamin \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o h\u1ed3i ph\u1ee5c s\u1ee9c\u00a0kh\u1ecfe\u00a0t\u1ed1t.<\/p>\n

5.5. <\/strong>\u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n<\/strong><\/h3>\n

T\u00f9y thu\u1ed9c v\u00e0o nguy\u00ean nh\u00e2n g\u00e2y ra vi\u00eam \u1ed1ng k\u1ebd th\u1eadn c\u1ea5p.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh trong nguy\u00ean nh\u00e2n nhi\u1ec5m khu\u1ea9n.<\/p>\n

– Lo\u1ea1i b\u1ecf ch\u1ea5t \u0111\u1ed9c trong nguy\u00ean nh\u00e2n ng\u1ed9 \u0111\u1ed9c.<\/p>\n

– Ng\u1eebng c\u00e1c thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng st\u00e9roids, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n,<\/p>\n

C\u00e1c thu\u1ed1c kh\u00e1ng sinh, C\u00e1c s\u1ea3n ph\u1ea9m iod c\u1ea3n quang, C\u00e1c thu\u1ed1c ch\u1ed1ng U: Ciplastine, Cyclosporine, Interf\u00e9ron, Phenylbutazone… n\u1ebfu nguy\u00ean nh\u00e2n do thu\u1ed1c.<\/p>\n

– \u0110i\u1ec1u tri s\u1ed1t r\u00e9t trong s\u1ed1t r\u00e9t ti\u1ec3u huy\u1ebft s\u1eafc t\u1ed1….<\/p>\n

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 c\u1ee7a B\u1ed9 Y t\u1ebf 2015.<\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam \u1ed1ng th\u1eadn k\u1ebd c\u1ea5p l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf c\u1ea3 nam v\u00e0 n\u1eef, l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng vi\u00eam nhi\u1ec5m c\u1ee7a c\u00e1c \u1ed1ng th\u1eadn k\u1ebd. B\u00e0i vi\u1ebft s\u1ebd tr\u00ecnh b\u00e0y nh\u1eefng tri\u1ec7u ch\u1ee9ng ph\u1ed5 bi\u1ebfn c\u1ee7a vi\u00eam \u1ed1ng th\u1eadn k\u1ebd c\u1ea5p nh\u01b0 \u0111au l\u01b0ng, s\u1ed1t, bu\u1ed3n n\u00f4n, n\u00f4n m\u1eeda v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[],"yoast_head":"\nKh\u00e1i qu\u00e1t v\u1ec1 vi\u00eam \u1ed1ng th\u1eadn k\u1ebd c\u1ea5p<\/title>\n<meta name=\"description\" content=\"Vi\u00eam \u1ed1ng th\u1eadn k\u1ebd c\u1ea5p l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf c\u1ea3 nam v\u00e0 n\u1eef, l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng vi\u00eam nhi\u1ec5m c\u1ee7a c\u00e1c \u1ed1ng th\u1eadn k\u1ebd\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta 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