{"id":28777,"date":"2023-05-06T20:38:17","date_gmt":"2023-05-06T13:38:17","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28777"},"modified":"2023-05-06T20:38:17","modified_gmt":"2023-05-06T13:38:17","slug":"soc-phan-ve-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/soc-phan-ve-o-tre-em\/","title":{"rendered":"S\u1ed1c ph\u1ea3n v\u1ec7 \u1edf tr\u1ebb em"},"content":{"rendered":"

S\u1ed1c ph\u1ea3n v\u1ec7 (SPV) l\u00e0 ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn t\u1ee9c th\u00ec ph\u00e1t sinh khi c\u00f3 s\u1ef1 x\u00e2m nh\u1eadp l\u1ea7n th\u1ee9 hai c\u1ee7a d\u1ecb nguy\u00ean v\u00e0o c\u01a1 th\u1ec3. S\u1ed1c ph\u1ea3n v\u1ec7 c\u00f3 bi\u1ec3u hi\u1ec7n h\u1ea1 huy\u1ebft \u00e1p, tr\u1ee5y tim m\u1ea1ch, suy h\u00f4 h\u1ea5p c\u1ea5p do t\u0103ng t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch v\u00e0 co th\u1eaft c\u01a1 tr\u01a1n ph\u1ebf qu\u1ea3n. S\u1ed1c ph\u1ea3n v\u1ec7 (SPV) l\u00e0 tai bi\u1ebfn d\u1ecb \u1ee9ng nghi\u00eam tr\u1ecdng nh\u1ea5t d\u1ec5 g\u00e2y t\u1eed vong n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed k\u1ecbp th\u1eddi.<\/strong><\/p>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng s\u1ed1c ph\u1ea3n v\u1ec7:<\/h2>\n

S\u1ed1c ph\u1ea3n v\u1ec7 (SPV) l\u00e0 ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn t\u1ee9c th\u00ec ph\u00e1t sinh khi c\u00f3 s\u1ef1 x\u00e2m nh\u1eadp l\u1ea7n th\u1ee9 hai c\u1ee7a d\u1ecb nguy\u00ean v\u00e0o c\u01a1 th\u1ec3. B\u1ec7nh xu\u1ea5t hi\u1ec7n nhanh, ngay l\u1eadp t\u1ee9c ho\u1eb7c sau 30 ph\u00fat sau khi ti\u1ebfp x\u00fac d\u1ecb nguy\u00ean. Tri\u1ec7u ch\u1ee9ng xu\u1ea5t hi\u1ec7n c\u00e0ng s\u1edbm b\u1ec7nh c\u00e0ng n\u1eb7ng, t\u1ef7 l\u1ec7 t\u1eed vong c\u00e0ng cao.<\/p>\n

\u0110\u01b0\u1eddng \u0111\u01b0a thu\u1ed1c v\u00e0o c\u01a1 th\u1ec3: ti\u00eam t\u0129nh m\u1ea1ch, ti\u00eam b\u1eafp, d\u01b0\u1edbi da, trong da, u\u1ed1ng, b\u00f4i ngo\u00e0i da, nh\u1ecf m\u1eaft,…. \u0111\u1ec1u c\u00f3 th\u1ec3 g\u00e2y s\u1ed1c ph\u1ea3n v\u1ec7.<\/p>\n

\"S\u1ed1c
S\u1ed1c ph\u1ea3n v\u1ec7<\/figcaption><\/figure>\n

2. Nguy\u00ean nh\u00e2n s\u1ed1c ph\u1ea3n v\u1ec7:<\/h2>\n

S\u1ed1c ph\u1ea3n v\u1ec7 c\u00f3 nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau, trong \u0111\u00f3 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u l\u00e0 thu\u1ed1c, ti\u1ebfp \u0111\u1ebfn l\u00e0 th\u1ee9c \u0103n v\u00e0 n\u1ecdc c\u00f4n tr\u00f9ng. C\u00e1c lo\u1ea1i thu\u1ed1c g\u00e2y s\u1ed1c ph\u1ea3n v\u1ec7 v\u00e0 tai bi\u1ebfn d\u1ecb \u1ee9ng do thu\u1ed1c ng\u00e0y c\u00e0ng nhi\u1ec1u, trong \u0111\u00f3 c\u00f3 c\u00e1c kh\u00e1ng sinh nh\u01b0 Penicillin, Streptomycin, Ampicillin, Vancomycin, Cephalosporin, Chloramphenicol, Kanamycin; c\u00e1c thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid nh\u01b0 Salicylat, Mofen, Indomethacin; c\u00e1c vitamin nh\u01b0 vitamin C ti\u00eam truy\u1ec1n t\u0129nh m\u1ea1ch, vitamin B1; glucose, dung d\u1ecbch acid amin; c\u00e1c thu\u1ed1c g\u00e2y t\u00ea nh\u01b0 Procain, Novocain, c\u00e1c thu\u1ed1c c\u1ea3n quang c\u00f3 iot; c\u00e1c vaccin, huy\u1ebft thanh nh\u01b0 vaccin ph\u00f2ng d\u1ea1i, u\u1ed1n v\u00e1n; c\u00e1c hormone nh\u01b0 Insulin, ACTH, Vasopressin; v\u00e0 c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c nh\u01b0 Paracetamol, Aminazin…<\/p>\n

Ngo\u00e0i ra, th\u1ee9c \u0103n c\u0169ng c\u00f3 th\u1ec3 g\u00e2y s\u1ed1c ph\u1ea3n v\u1ec7: c\u00e1c ngu\u1ed3n g\u1ed1c \u0111\u1ed9ng v\u1eadt nh\u01b0 c\u00e1 thu, c\u00e1 ng\u1eeb, t\u00f4m \u1ed1c, tr\u1ee9ng, s\u1eefa, nh\u1ed9ng v\u00e0 c\u00e1c ngu\u1ed3n g\u1ed1c th\u1ef1c v\u1eadt nh\u01b0 d\u1ee9a, l\u1ea1c, \u0111\u1eadu n\u00e0nh.<\/p>\n

N\u1ecdc c\u00f4n tr\u00f9ng c\u0169ng l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n g\u00e2y s\u1ed1c ph\u1ea3n v\u1ec7, bao g\u1ed3m c\u00e1c con ong \u0111\u1ed1t, r\u1eafn, nh\u1ec7n, v\u00e0 b\u00f2 c\u1ea1p c\u1eafn.<\/p>\n

3. Ch\u1ea9n \u0111o\u00e1n:<\/h2>\n

3.1. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng:<\/i><\/h3>\n
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Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng th\u01b0\u1eddng kh\u1edfi ph\u00e1t r\u1ea5t nhanh, trong v\u00f2ng 5-30 ph\u00fat sau ti\u1ebfp x\u00fac v\u1edbi d\u1ecb nguy\u00ean, v\u00e0 bao g\u1ed3m c\u00e1c d\u1ea5u hi\u1ec7u s\u1edbm nh\u01b0 b\u1ed3n ch\u1ed3n, h\u1ed1t ho\u1ea3ng, kh\u00f3 th\u1edf, v\u00e3 m\u1ed3 h\u00f4i, nh\u1ecbp tim nhanh, ng\u1ee9a ch\u00e2n tay…<\/p>\n

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  • H\u1ec7 h\u00f4 h\u1ea5p: ngh\u1eb9t m\u0169i, h\u1eaft h\u01a1i, kh\u00e0n ti\u1ebfng, kh\u00f2 kh\u00e8, ph\u00f9 thanh qu\u1ea3n, ho, t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf. C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c bao g\u1ed3m kh\u00f3 th\u1edf, th\u1edf nhanh, co th\u1eaft ph\u1ebf qu\u1ea3n, co r\u00fat c\u01a1 h\u00f4 h\u1ea5p, t\u00edm t\u00e1i v\u00e0 ng\u1eebng th\u1edf.<\/li>\n
  • H\u1ec7 tim m\u1ea1ch: nh\u1ecbp tim nhanh, h\u1ea1 huy\u1ebft \u00e1p, lo\u1ea1n nh\u1ecbp v\u00e0 ng\u1eebng tim.<\/li>\n
  • H\u1ec7 th\u1ea7n kinh: \u0111au \u0111\u1ea7u, ch\u00f3ng m\u1eb7t, run ch\u00e2n tay, v\u1eadt v\u00e3 l\u01a1 m\u01a1, co gi\u1eadt, ng\u1ea5t x\u1ec9u v\u00e0 h\u00f4n m\u00ea.<\/li>\n
  • H\u1ec7 ti\u00eau h\u00f3a: \u0111au b\u1ee5ng, bu\u1ed3n n\u00f4n, ti\u00eau ch\u1ea3y, c\u00f3 th\u1ec3 \u0111i ngo\u00e0i v\u1edbi m\u00e1u.<\/li>\n
  • H\u1ec7 da: m\u00e0y \u0111ay, ph\u00f9 Quincke v\u00e0 ban \u0111\u1ecf ng\u1ee9a.<\/li>\n
  • To\u00e0n th\u00e2n: v\u00e3 m\u1ed3 h\u00f4i, r\u00e9t run, m\u1ec7t l\u1ea3 v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n

    3.2. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/h3>\n
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    Theo Hi\u1ec7p h\u1ed9i Hen, D\u1ecb \u1ee9ng Mi\u1ec5n d\u1ecbch Hoa K\u1ef3 n\u0103m 2006, \u0111\u1ed1i v\u1edbi ch\u1ea9n \u0111o\u00e1n ph\u1ea3n v\u1ec7, c\u1ea7n tu\u00e2n th\u1ee7 m\u1ed9t trong c\u00e1c ti\u00eau chu\u1ea9n sau:<\/p>\n

    Ti\u00eau chu\u1ea9n 1:<\/strong> Ph\u1ea3n \u1ee9ng xu\u1ea5t hi\u1ec7n c\u1ea5p t\u00ednh (v\u00e0i ph\u00fat \u0111\u1ebfn v\u00e0i gi\u1edd) v\u1edbi c\u00e1c bi\u1ec3u hi\u1ec7n tr\u00ean da ho\u1eb7c ni\u00eam m\u1ea1c (m\u1ea9n ng\u1ee9a, n\u00f3ng b\u1eebng, ph\u00f9 n\u1ec1 m\u00f4i, l\u01b0\u1ee1i, h\u1ea7u h\u1ecdng) v\u00e0 \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c d\u1ea5u hi\u1ec7u sau:<\/p>\n

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    • Bi\u1ec3u hi\u1ec7n h\u00f4 h\u1ea5p (v\u00ed d\u1ee5: kh\u00f3 th\u1edf, kh\u00f2 kh\u00e8\/co th\u1eaft ph\u1ebf qu\u1ea3n, th\u1edf r\u00edt, gi\u1ea3m PEF, thi\u1ebfu oxy).<\/li>\n
    • H\u1ea1 huy\u1ebft \u00e1p ho\u1eb7c c\u00e1c d\u1ea5u hi\u1ec7u thi\u1ebfu m\u00e1u c\u01a1 quan (v\u00ed d\u1ee5: gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u01a1, ng\u1ea5t, m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c).<\/li>\n<\/ul>\n

      Ti\u00eau chu\u1ea9n 2:<\/strong> C\u00f3 hai ho\u1eb7c nhi\u1ec1u h\u01a1n c\u00e1c bi\u1ec3u hi\u1ec7n sau \u0111\u00e2y xu\u1ea5t hi\u1ec7n nhanh ch\u00f3ng (v\u00e0i ph\u00fat \u0111\u1ebfn v\u00e0i gi\u1edd) sau khi ti\u1ebfp x\u00fac v\u1edbi ch\u1ea5t c\u00f3 th\u1ec3 l\u00e0 d\u1ecb nguy\u00ean v\u1edbi ng\u01b0\u1eddi \u0111\u00f3:<\/p>\n

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      • Bi\u1ec3u hi\u1ec7n tr\u00ean da v\u00e0 ni\u00eam m\u1ea1c (m\u1ea9n ng\u1ee9a, n\u00f3ng b\u1eebng, ph\u00f9 n\u1ec1 l\u01b0\u1ee1i, m\u00f4i, mang h\u1ea7u).<\/li>\n
      • Bi\u1ec3u hi\u1ec7n h\u00f4 h\u1ea5p (kh\u00f3 th\u1edf, kh\u00f2 kh\u00e8\/co th\u1eaft ph\u1ebf qu\u1ea3n, th\u1edf r\u00edt, gi\u1ea3m PEF, thi\u1ebfu oxy).<\/li>\n
      • H\u1ea1 huy\u1ebft \u00e1p ho\u1eb7c c\u00e1c d\u1ea5u hi\u1ec7u thi\u1ebfu m\u00e1u c\u01a1 quan (v\u00ed d\u1ee5: gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u01a1, ng\u1ea5t, m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c).<\/li>\n
      • C\u00e1c tri\u1ec7u ch\u1ee9ng ti\u00eau h\u00f3a dai d\u1eb3ng (\u0111au qu\u1eb7n b\u1ee5ng, bu\u1ed3n n\u00f4n…).<\/li>\n<\/ul>\n

        Ti\u00eau chu\u1ea9n 3:<\/strong> H\u1ea1 huy\u1ebft \u00e1p nhanh ch\u00f3ng (v\u00e0i ph\u00fat \u0111\u1ebfn v\u00e0i gi\u1edd) sau khi ti\u1ebfp x\u00fac v\u1edbi d\u1ecb nguy\u00ean \u0111\u00e3 bi\u1ebft tr\u01b0\u1edbc v\u1edbi ng\u01b0\u1eddi \u0111\u00f3.<\/p>\n

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        • Tr\u1ebb em v\u00e0 s\u01a1 sinh: huy\u1ebft \u00e1p t\u00e2m thu th\u1ea5p (theo tu\u1ed5i) ho\u1eb7c gi\u1ea3m >30% so v\u1edbi huy\u1ebft \u00e1p t\u00e2m thu b\u00ecnh th\u01b0\u1eddng.<\/li>\n
        • Ng\u01b0\u1eddi l\u1edbn: huy\u1ebft \u00e1p t\u00e2m thu <90 mmHg ho\u1eb7c gi\u1ea3m >30% so v\u1edbi huy\u1ebft \u00e1p t\u00e2m thu b\u00ecnh th\u01b0\u1eddng.<\/li>\n<\/ul>\n

          \u1ede tr\u1ebb em, h\u1ea1 huy\u1ebft \u00e1p t\u00e2m thu x\u00e1c \u0111\u1ecbnh b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng gi\u00e1 tr\u1ecb <70 mmHg cho tr\u1ebb t\u1eeb 1 th\u00e1ng \u0111\u1ebfn 1 tu\u1ed5i, gi\u00e1 tr\u1ecb th\u1ea5p h\u01a1n (70 mmHg + [2 x tu\u1ed5i]) cho tr\u1ebb t\u1eeb 1 \u0111\u1ebfn 10 tu\u1ed5i v\u00e0 <90 mmHg cho tr\u1ebb t\u1eeb 11 \u0111\u1ebfn 17 tu\u1ed5i.<\/p>\n<\/div>\n<\/div>\n

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

          – Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.<\/p>\n

          + Hen ph\u1ebf qu\u1ea3n n\u1eb7ng, d\u1ecb v\u1eadt \u0111\u01b0\u1eddng th\u1edf.<\/p>\n

          + U th\u1ea7n kinh giao c\u1ea3m (pheochromocytoma)<\/p>\n

          + H\u1ed9i ch\u1ee9ng t\u0103ng th\u00f4ng kh\u00ed (Hyperventilation syndrome)<\/p>\n

          + Ph\u1ea3n x\u1ea1 d\u00e2y ph\u1ebf v\u1ecb (Vasovagal response)<\/p>\n

          – S\u1ef1 kh\u00e1c bi\u1ec7t c\u01a1 b\u1ea3n l\u00e0: tri\u1ec7u ch\u1ee9ng tr\u1ee5y m\u1ea1ch, HA gi\u1ea3m x\u1ea9y ra ngay sau khi \u0111\u01b0a thu\u1ed1c ho\u1eb7c d\u1ecb nguy\u00ean v\u00e0o c\u01a1 th\u1ec3 trong SPV.<\/p>\n

          3.4. Th\u1ec3 l\u00e2m s\u00e0ng:<\/h3>\n

          Theo m\u1ee9c \u0111\u1ed9 bi\u1ec3u hi\u1ec7n v\u00e0 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh, s\u1ed1c ph\u1ea3n v\u1ec7 \u0111\u01b0\u1ee3c chia l\u00e0m 3 m\u1ee9c \u0111\u1ed9.<\/p>\n

          – Th\u1ec3 nh\u1eb9: v\u1edbi tri\u1ec7u ch\u1ee9ng \u0111au \u0111\u1ea7u, ch\u00f3ng m\u1eb7t, s\u1ee3 h\u00e3i c\u00f3 th\u1ec3 n\u1ed5i m\u00e0y \u0111ay, m\u1ea9n ng\u1ee9a, ph\u00f9 Quincke, bu\u1ed3n n\u00f4n, n\u00f4n \u0111au b\u1ee5ng, \u0111\u00e1i \u1ec9a kh\u00f4ng t\u1ef1 ch\u1ee7, nh\u1ecbp tim nhanh, HA gi\u1ea3m, kh\u00f3 th\u1edf.<\/p>\n

          – Th\u1ec3 trung b\u00ecnh: b\u1ec7nh nh\u00e2n h\u1ed1t ho\u1ea3ng, c\u1ea3m gi\u00e1c s\u1eafp ch\u1ebft \u0111\u1ebfn n\u01a1i cho\u00e1ng v\u00e1ng, m\u00e0y \u0111ay kh\u1eafp ng\u01b0\u1eddi, ngh\u1eb9t th\u1edf, co gi\u1eadt c\u00f3 khi h\u00f4n m\u00ea, da t\u00edm, t\u00e1i nh\u1ee3t, m\u1ea1ch nh\u1ecf, HA h\u1ea1.<\/p>\n

          – Th\u1ec3 n\u1eb7ng: X\u1ea9y ra ngay trong nh\u1eefng ph\u00fat \u0111\u1ea7u v\u1edbi t\u1ed1c \u0111\u1ed9 ch\u1edbp nho\u00e1ng. B\u1ec7nh nh\u00e2n h\u00f4n m\u00ea, co gi\u1eadt, lo\u1ea1n nh\u1ecbp tim, HA kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c, ng\u1eebng th\u1edf t\u00edm t\u00e1i to\u00e0n th\u00e2n, t\u1eed vong nhanh sau v\u00e0i ph\u00fat, h\u00e3n h\u1eefu k\u00e9o d\u00e0i v\u00e0i gi\u1edd.<\/p>\n

          4. X\u1eed tr\u00ed s\u1ed1c ph\u1ea3n v\u1ec7:<\/h2>\n

          4.1. Nguy\u00ean t\u1eafc: kh\u1ea9n c\u1ea5p, t\u1ea1i ch\u1ed7 v\u00e0 d\u00f9ng ngay Adrenalin.<\/h3>\n

          – Adrenalin d\u00f9ng ngay c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t v\u00ec thay \u0111\u1ed5i ngay c\u00e1c d\u1ea5u hi\u1ec7u n\u1eb7ng do s\u1ed1c ph\u1ea3n v\u1ec7 g\u00e2y ra nh\u01b0 co th\u1eaft ph\u1ebf qu\u1ea3n v\u00e0 t\u1ee5t HA do Adrenalin l\u00e0m t\u0103ng cAMP trong t\u1ebf b\u00e0o mast v\u00e0 basephil s\u1ebd \u1ee9c ch\u1ebf gi\u1ea3i ph\u00f3ng c\u00e1c ch\u1ea5t trung gian h\u00f3a h\u1ecdc.<\/p>\n

          – Adrenalin c\u00f2n k\u00edch th\u00edch tr\u00ean h\u1ec7 giao c\u1ea3m v\u00e0 ph\u00f3 giao c\u1ea3m l\u00e0m t\u0103ng co b\u00f3p c\u01a1 tim t\u0103ng s\u1ee9c c\u1ea3n m\u1ea1ch ngo\u1ea1i vi, l\u00e0m t\u0103ng HA, t\u0103ng t\u01b0\u1edbi m\u00e1u c\u00e1c c\u01a1 quan.<\/p>\n

          4.2. Ph\u00e1c \u0111\u1ed3 c\u1ea5p c\u1ee9u s\u1ed1c ph\u1ea3n v\u1ec7.<\/h3>\n

          4.2.1. X\u1eed tr\u00ed ban \u0111\u1ea7u:<\/i><\/h4>\n

          Trong tr\u01b0\u1eddng h\u1ee3p ph\u1ea3n v\u1ec7, c\u00e1c bi\u1ec7n ph\u00e1p x\u1eed tr\u00ed ban \u0111\u1ea7u c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u01b0 sau:<\/p>\n

            \n
          • Cho b\u1ec7nh nh\u00e2n n\u1eb1m nghi\u00eang, \u0111\u1ea7u th\u1ea5p, \u1ee7 \u1ea5m v\u00e0 \u0111o huy\u1ebft \u00e1p m\u1ed7i 10 ph\u00fat m\u1ed9t l\u1ea7n.<\/li>\n
          • Ng\u1eebng ngay ti\u1ebfp x\u00fac v\u1edbi d\u1ecb nguy\u00ean (thu\u1ed1c \u0111ang ti\u00eam, u\u1ed1ng…).<\/li>\n
          • Duy tr\u00ec \u0111\u01b0\u1eddng th\u1edf b\u1eb1ng t\u01b0 th\u1ebf \u0111\u01b0\u1eddng th\u1edf m\u1edf, h\u00fat \u0111\u1eddm d\u00e3i v\u00e0 cung c\u1ea5p oxy.<\/li>\n
          • N\u1ebfu t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf n\u1eb7ng v\u00e0 tr\u1ebb b\u1ecb t\u00edm, \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n (NKQ) \u0111\u1ec3 h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p.<\/li>\n
          • Ti\u00eam b\u1eafp Adrenalin 1\/1000 (0,01 mg\/kg) ho\u1eb7c Adrenalin 1\u2030 0,3 ml \u0111\u1ec3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng s\u1ed1c ph\u1ea3n v\u1ec7. Li\u1ec1u ti\u00eam b\u1eafp n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1eb7p l\u1ea1i sau m\u1ed7i 5-10 ph\u00fat cho \u0111\u1ebfn khi huy\u1ebft \u00e1p tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng. L\u01b0u \u00fd r\u1eb1ng, n\u00ean ti\u00eam thu\u1ed1c v\u00e0o c\u01a1 l\u1edbn (TB m\u1eb7t tr\u01b0\u1edbc \u0111\u00f9i) \u0111\u1ec3 thu\u1ed1c h\u1ea5p thu v\u00e0 \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 cao h\u01a1n so v\u1edbi vi\u1ec7c ti\u00eam c\u01a1 nh\u1ecf ho\u1eb7c ti\u00eam d\u01b0\u1edbi da. Kh\u00f4ng s\u1eed d\u1ee5ng ti\u00eam tr\u1ef1c ti\u1ebfp t\u0129nh m\u1ea1ch tr\u1eeb tr\u01b0\u1eddng h\u1ee3p c\u1ea5p c\u1ee9u ng\u1eebng tu\u1ea7n ho\u00e0n v\u00ec c\u00f3 th\u1ec3 g\u00e2y lo\u1ea1n nh\u1ecbp.<\/li>\n
          • N\u1ebfu huy\u1ebft \u00e1p h\u1ea1 ho\u1eb7c kh\u00f4ng \u0111\u00e1p \u1ee9ng li\u1ec1u ban \u0111\u1ea7u, ti\u00eam Adrenalin 1\/10.000 li\u1ec1u 0,1 mg\/kg (0,1 ml\/kg) ho\u1eb7c truy\u1ec1n Adrenalin theo li\u1ec1u b\u1eaft \u0111\u1ea7u 0,1 \u03bcg\/kg\/ph v\u00e0 t\u0103ng d\u1ea7n \u0111\u1ebfn khi \u0111\u1ea1t hi\u1ec7u qu\u1ea3 t\u1ed1i \u0111a 0,5 \u03bcg\/kg\/ph. N\u1ebfu c\u1ea7n, c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi Dopamin li\u1ec1u b\u1eaft \u0111\u1ea7u 0,3 \u03bcg\/kg\/ph v\u00e0 t\u0103ng li\u1ec1u m\u1ed7i 10-15 ph\u00fat \u0111\u1ebfn khi \u0111\u1ea1t hi\u1ec7u qu\u1ea3 t\u1ed1i \u0111a 10 \u03bcg\/kg\/ph. C\u1ea7n theo d\u00f5i s\u00e1t v\u00e0 gi\u00e1m s\u00e1t \u0111i\u1ec7n tim \u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 x\u1eed tr\u00ed k\u1ecbp th\u1eddi r\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/li>\n
          • Truy\u1ec1n dung d\u1ecbch Lactate Ringer ho\u1eb7c Normal Saline 20 ml\/kg\/gi\u1edd. N\u1ebfu huy\u1ebft \u0111\u1ed9ng h\u1ecdc c\u1ea3i thi\u1ec7n, gi\u1ea3m li\u1ec1u Lactate Ringer c\u00f2n 10 ml\/kg\/gi\u1edd. N\u00ean truy\u1ec1n trong 1 gi\u1edd thay v\u00ec b\u01a1m \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 ph\u00f9 ph\u1ed5i.<\/li>\n
          • \u0110o v\u00e0 theo d\u00f5i \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch trung b\u00ecnh (CVP).<\/li>\n
          • N\u1ebfu b\u1ec7nh nh\u00e2n v\u1eabn c\u00f2n s\u1ed1c sau khi truy\u1ec1n dung d\u1ecbch, \u0111o \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch tr\u1ef1c ti\u1ebfp v\u00e0 truy\u1ec1n dung d\u1ecbch cao ph\u00e2n t\u1eed (Haesteril 6% 200\/0,5 ho\u1eb7c Dextran 70) 10-20 ml\/kg\/gi\u1edd v\u00e0 \u0111i\u1ec1u ch\u1ec9nh t\u1ed1c \u0111\u1ed9 truy\u1ec1n theo CVP. Trong tr\u01b0\u1eddng h\u1ee3p s\u1ed1c n\u1eb7ng, t\u1ed5ng th\u1ec3 t\u00edch dung d\u1ecbch c\u00f3 th\u1ec3 l\u00ean \u0111\u1ebfn 60-80 ml\/kg.<\/li>\n
          • C\u1ea7n k\u1ebft h\u1ee3p truy\u1ec1n Adrenalin v\u00e0 Dopamin khi c\u1ea7n thi\u1ebft.<\/li>\n
          • Theo d\u00f5i s\u00e1t CVP \u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 x\u1eed tr\u00ed k\u1ecbp th\u1eddi bi\u1ebfn ch\u1ee9ng ph\u00f9 ph\u1ed5i, \u0111\u1eb7c bi\u1ec7t khi b\u1ec7nh nh\u00e2n h\u1ebft giai \u0111o\u1ea1n d\u00e3n m\u1ea1ch.<\/li>\n<\/ul>\n

            4.2.2. C\u00e1c bi\u1ec7n ph\u00e1p kh\u00e1c<\/i>:<\/h4>\n

            Ch\u1ed1ng suy h\u00f4 h\u1ea5p:<\/strong><\/p>\n

              \n
            • L\u00e0m th\u00f4ng \u0111\u01b0\u1eddng th\u1edf, cung c\u1ea5p oxy v\u00e0 th\u1ed5i ng\u1ea1t.<\/li>\n
            • \u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n b\u00f3p b\u00f3ng oxy ho\u1eb7c s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o.<\/li>\n
            • M\u1edf kh\u00ed qu\u1ea3n n\u1ebfu c\u1ea7n thi\u1ebft \u0111\u1ec3 gi\u1ea3m ph\u00f9 thanh m\u00f4n.<\/li>\n
            • Truy\u1ec1n t\u0129nh m\u1ea1ch Aminophylin 1mg\/kg\/gi\u1edd ho\u1eb7c terbutalin 0,2 mcg\/kg\/ph\u00fat. N\u1ebfu c\u1ea7n thi\u1ebft, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng terbutalin 0,2 ml\/10 kg ti\u00eam d\u01b0\u1edbi da ho\u1eb7c x\u1ecbt h\u1ecdng terbutalin\/salbutamol 2,5mg-5mg\/l\u1ea7n x 4-5 l\u1ea7n\/ng\u00e0y.<\/li>\n<\/ul>\n

              Ch\u1ed1ng suy tu\u1ea7n ho\u00e0n:<\/strong><\/p>\n

                \n
              • Thi\u1ebft l\u1eadp hai \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch: m\u1ed9t \u0111\u01b0\u1eddng truy\u1ec1n d\u1ecbch \u0111i\u1ec7n gi\u1ea3i \u0111\u1ec3 duy tr\u00ec ti\u1ec1n g\u00e1nh v\u00e0 m\u1ed9t \u0111\u01b0\u1eddng truy\u1ec1n thu\u1ed1c v\u1eadn m\u1ea1ch.<\/li>\n
              • Truy\u1ec1n Adrenalin \u0111\u1ec3 duy tr\u00ec huy\u1ebft \u00e1p: li\u1ec1u b\u1eaft \u0111\u1ea7u 0,1 mcg\/kg\/ph\u00fat v\u00e0 \u0111i\u1ec1u ch\u1ec9nh theo huy\u1ebft \u00e1p, li\u1ec1u t\u1ed1i \u0111a 2 mcg\/kg\/ph\u00fat.<\/li>\n<\/ul>\n

                S\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c:<\/strong><\/p>\n

                  \n
                • Methylprednisolon 1-2 mg\/kg\/l\u1ea7n t\u0129nh m\u1ea1ch c\u00e1ch 4 gi\u1edd ho\u1eb7c ti\u00eam b\u1eafp.<\/li>\n
                • Hydrocortison hemisuccinat 5 mg\/kg\/gi\u1edd t\u0129nh m\u1ea1ch ho\u1eb7c ti\u00eam b\u1eafp t\u1ea1i tuy\u1ebfn c\u01a1 s\u1edf. Li\u1ec1u c\u00f3 th\u1ec3 t\u0103ng l\u00ean n\u1ebfu ph\u1ea3n v\u1ec7 n\u1eb7ng.<\/li>\n
                • Diphenylhydramin 1-2 mg\/kg\/l\u1ea7n t\u0129nh m\u1ea1ch ho\u1eb7c prometazin 1 mg\/kg\/l\u1ea7n ti\u00eam b\u1eafp c\u00e1ch nhau 6-8 gi\u1edd.<\/li>\n
                • Ranitidin 1-2 mg\/kg\/l\u1ea7n c\u00e1ch nhau 6-8 gi\u1edd trong tr\u01b0\u1eddng h\u1ee3p ph\u1ea3n v\u1ec7 n\u1eb7ng ho\u1eb7c s\u1eed d\u1ee5ng t\u0129nh m\u1ea1ch.<\/li>\n
                • Theo d\u00f5i c\u00e1c ch\u1ec9 s\u1ed1: nh\u1ecbp tim, huy\u1ebft \u00e1p, nh\u1ecbp th\u1edf, SpO2, \u00fd th\u1ee9c, v\u00e0 s\u1ea3n l\u01b0\u1ee3ng b\u00e0i ti\u1ec3u. Theo d\u00f5i t\u1eeb 30 ph\u00fat \u0111\u1ebfn 1 gi\u1edd m\u1ed9t l\u1ea7n.<\/li>\n<\/ul>\n

                  4.2.3. \u0110i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p v\u00e0 theo d\u00f5i<\/i><\/h4>\n

                  – Theo d\u00f5i \u00edt nh\u1ea5t 24 gi\u1edd sau khi HA \u0111\u00e3 \u1ed5n \u0111\u1ecbnh: gi\u00e1m s\u00e1t: m\u1ea1ch, HA, nh\u1ecbp th\u1edf, SpO2<\/sub>, \u00fd th\u1ee9c, b\u00e0i ni\u1ec7u, 30 ph\u00fat – 1 gi\u1edd\/1 l\u1ea7n<\/p>\n

                  – N\u1ebfu HA kh\u00f4ng \u1ed5n \u0111\u1ecbnh c\u00f3 th\u1ec3 d\u00f9ng dung d\u1ecbch cao ph\u00e2n t\u1eed: plasma, Human albumin, ph\u1ed1i h\u1ee3p v\u1eadn m\u1ea1ch<\/p>\n

                  – \u0110i\u1ec1u d\u01b0\u1ee1ng c\u00f3 th\u1ec3 ti\u00eam Adrenalin theo ph\u00e1c \u0111\u1ed3 tr\u00ean khi b\u00e1c s\u1ef9 ch\u01b0a k\u1ecbp c\u00f3\u00a0 m\u1eb7t.<\/p>\n

                  – H\u1ecfi k\u1ef9 ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng, trang b\u1ecb h\u1ed9p thu\u1ed1c c\u1ea5p c\u1ee9u SPV l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft.<\/p>\n

                  5. Nh\u1eefng bi\u1ec7n ph\u00e1p h\u1ea1n ch\u1ebf s\u1ed1c ph\u1ea3n v\u1ec7:<\/h2>\n

                  – Tuy\u00ean truy\u1ec1n d\u00f9ng thu\u1ed1c \u0111\u00fang ch\u1ec9 \u0111\u1ecbnh, h\u1ee3p l\u00fd, an to\u00e0n.<\/p>\n

                  – Tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c th\u1ea7y thu\u1ed1c ph\u1ea3i khai th\u00e1c ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n. Tr\u00ean ng\u01b0\u1eddi b\u1ec7nh c\u00f3 m\u1eabn c\u1ea3m ph\u1ea3i c\u00e2n nh\u1eafc li\u1ec1u l\u01b0\u1ee3ng, \u0111\u01b0\u1eddng d\u00f9ng … tr\u00e1nh d\u00f9ng l\u1ea1i thu\u1ed1c g\u00e2y s\u1ed1c ph\u1ea3n v\u1ec7 tr\u01b0\u1edbc \u0111\u00f3 d\u00f9 nh\u1eb9, l\u01b0u \u00fd thu\u1ed1c c\u00f3 ph\u1ea3n \u1ee9ng ch\u00e9o.<\/p>\n

                  – Tr\u01b0\u1edbc khi ti\u00eam kh\u00e1ng sinh theo qui \u0111inh ph\u1ea3i th\u1eed test l\u1ea9y da, test \u00e2m t\u00ednh m\u1edbi \u0111\u01b0\u1ee3c ti\u00eam. Ph\u1ea3i chu\u1ea9n b\u1ecb s\u1eb5n thu\u1ed1c v\u00e0 d\u1ee5ng c\u1ee5 c\u1ea5p c\u1ee9u s\u1ed1c ph\u1ea3n v\u1ec7.<\/p>\n

                  – Khi \u0111ang ti\u00eam thu\u1ed1c, n\u1ebfu th\u1ea5y c\u00f3 c\u1ea3m gi\u00e1c kh\u00e1c th\u01b0\u1eddng: b\u1ed3n ch\u1ed3n, h\u1ed1t ho\u1ea3ng, s\u1ee3 h\u00e3i … ph\u1ea3i ng\u1eebng ti\u00eam v\u00e0 x\u1eed l\u00fd k\u1ecbp th\u1eddi nh\u01b0 s\u1ed1c ph\u1ea3n v\u1ec7.<\/p>\n

                  – Sau khi ti\u00eam thu\u1ed1c \u0111\u1ec3 ng\u01b0\u1eddi b\u1ec7nh ch\u1edd 10 – 15 ph\u00fat \u0111\u1ec3 \u0111\u1ec1 ph\u00f2ng s\u1ed1c ph\u1ea3n v\u1ec7 x\u1ea3y ra mu\u1ed9n.<\/p>\n

                  Ngu\u1ed3n: T\u1ed5ng h\u1ee3p<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

                  S\u1ed1c ph\u1ea3n v\u1ec7 (SPV) l\u00e0 ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn t\u1ee9c th\u00ec ph\u00e1t sinh khi c\u00f3 s\u1ef1 x\u00e2m nh\u1eadp l\u1ea7n th\u1ee9 hai c\u1ee7a d\u1ecb nguy\u00ean v\u00e0o c\u01a1 th\u1ec3. S\u1ed1c ph\u1ea3n v\u1ec7 c\u00f3 bi\u1ec3u hi\u1ec7n h\u1ea1 huy\u1ebft \u00e1p, tr\u1ee5y tim m\u1ea1ch, suy h\u00f4 h\u1ea5p c\u1ea5p do t\u0103ng t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch v\u00e0 co th\u1eaft c\u01a1 tr\u01a1n ph\u1ebf […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15],"tags":[],"yoast_head":"\nS\u1ed1c ph\u1ea3n v\u1ec7 \u1edf tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"S\u1ed1c ph\u1ea3n v\u1ec7 (SPV) l\u00e0 ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn t\u1ee9c th\u00ec ph\u00e1t sinh khi c\u00f3 s\u1ef1 x\u00e2m nh\u1eadp l\u1ea7n th\u1ee9 hai c\u1ee7a d\u1ecb nguy\u00ean v\u00e0o c\u01a1 th\u1ec3.\" \/>\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=\"S\u1ed1c ph\u1ea3n v\u1ec7 \u1edf tr\u1ebb em - 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