{"id":28869,"date":"2023-04-27T17:28:30","date_gmt":"2023-04-27T10:28:30","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28869"},"modified":"2023-04-27T18:58:52","modified_gmt":"2023-04-27T11:58:52","slug":"tiep-can-lam-sang-va-can-lam-sang-vang-da-so-sinh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/tiep-can-lam-sang-va-can-lam-sang-vang-da-so-sinh\/","title":{"rendered":"Ti\u1ebfp c\u1eadn l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng v\u00e0ng da s\u01a1 sinh"},"content":{"rendered":"

\u1ede giai \u0111o\u1ea1n s\u01a1 sinh, v\u00e0ng da l\u00e0 m\u1ed9t bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p. Th\u00f4ng th\u01b0\u1eddng, t\u00ecnh tr\u1ea1ng v\u00e0ng da s\u01a1 sinh l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng sinh l\u00fd. Tuy nhi\u00ean, trong kh\u00f4ng \u00edt tr\u01b0\u1eddng h\u1ee3p, v\u00e0ng da s\u01a1 sinh c\u00f3 th\u1ec3 l\u00e0 bi\u1ec3u hi\u1ec7n chung c\u1ee7a r\u1ea5t nhi\u1ec1u b\u1ec7nh l\u00fd kh\u00e1c nhau, c\u00f3 chung \u0111\u1eb7c \u0111i\u1ec3m l\u00e0 t\u00e1n huy\u1ebft. <\/strong>V\u00e0ng da s\u01a1 sinh r\u1ea5t thay \u0111\u1ed5i, t\u1eeb r\u1ea5t \u0111\u01a1n gi\u1ea3n nh\u01b0 v\u00e0ng da sinh l\u00fd \u0111\u1ebfn r\u1ea5t tr\u1ea7m tr\u1ecdng nh\u01b0 trong b\u1ec7nh n\u00e3o bilirubin.\u00a0<\/strong><\/p>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng v\u00e0ng da s\u01a1 sinh<\/h2>\n

V\u00e0ng da \u1edf tr\u1ebb s\u01a1 sinh do s\u1ef1 gia t\u0103ng Bilirubin trong m\u00e1u t\u0103ng g\u00e2y v\u00e0ng da v\u00e0 k\u1ebft m\u1ea1c m\u1eaft. V\u00e0ng da tr\u00ean l\u00e2m s\u00e0ng khi ng\u01b0\u1eddi l\u1edbn Bilirubin \u2265 2mg\/dL, tr\u1ebb s\u01a1 sinh Bilirubin \u2265 6mg\/dL.
\n– T\u1ef7 l\u1ec7 v\u00e0ng da s\u01a1 sinh: > 60% tr\u1ebb \u0111\u1ee7 th\u00e1ng, cao h\u01a1n \u1edf tr\u1ebb non th\u00e1ng.
\n– X\u00e1c \u0111\u1ecbnh tr\u1ebb c\u00f3 v\u00e0ng da:
\n+ Quan s\u00e1t m\u00e0u da tr\u1ebb d\u01b0\u1edbi \u00e1nh s\u00e1ng m\u1eb7t tr\u1eddi.
\n+ Tr\u1ebb s\u01a1 sinh s\u1ebd v\u00e0ng da t\u1eeb \u0111\u1ea7u xu\u1ed1ng ch\u00e2n.
\n+ D\u00f9ng ng\u00f3n tay \u1ea5n v\u00e0o v\u00f9ng da nghi ng\u1edd v\u00e0ng da \u0111\u1ec3 kho\u1ea3ng 5s, bu\u00f4ng ra quan s\u00e1t xem c\u00f3 v\u00e0ng kh\u00f4ng.<\/p>\n

2. Ph\u00e2n lo\u1ea1i:<\/strong><\/h2>\n

2.1. V\u00e0ng da sinh l\u00fd (v\u00e0ng da kh\u00f4ng b\u1ec7nh l\u00fd):<\/strong>
\n– C\u01a1 ch\u1ebf: do t\u0103ng l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u, \u0111\u1eddi s\u1ed1ng h\u1ed3ng c\u1ea7u ng\u1eafn, s\u1ef1 ti\u1ebfp nh\u1eadn v\u00e0 k\u1ebft h\u1ee3p \u1edf gan ch\u01b0a tr\u01b0\u1edfng th\u00e0nh, t\u0103ng chu tr\u00ecnh ru\u1ed9t gan.
\n– \u0110\u1eb7c \u0111i\u1ec3m: g\u1ed3m 6 \u00fd
\n+ Tr\u1ebb kh\u1ecfe: b\u00fa, c\u1eed \u0111\u1ed9ng v\u00e0 ti\u1ebfp x\u00fac b\u00ecnh th\u01b0\u1eddng.
\n+ V\u00e0ng da xu\u1ea5t hi\u1ec7n sau N2.
\n+ V\u00e0ng da gi\u1ea3m d\u1ea7n sau 1 tu\u1ea7n \u1edf tr\u1ebb \u0111\u1ee7 th\u00e1ng, sau 2 tu\u1ea7n \u1edf tr\u1ebb non th\u00e1ng.
\n+ M\u1ee9c \u0111\u1ed9 v\u00e0ng da kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 ng\u01b0\u1ee1ng chi\u1ebfu \u0111\u00e8n: Bilirubin < 12 mg\/dL \u1edf tr\u1ebb \u0111\u1ee7 th\u00e1ng, < 15 mg\/dL \u1edf tr\u1ebb non th\u00e1ng.<\/p>\n

+ T\u1ed1c \u0111\u1ed9 t\u0103ng Bilirubin m\u00e1u \u2264 5 mg\/dL\/ng\u00e0y hay \u2264 0,2 mg\/dL\/gi\u1edd.
\n– \u1ede tr\u1ebb r\u1ea5t nh\u1eb9 c\u00e2n < 1500 gr, m\u1ee9c Bilirubin m\u00e1u \u1edf trong gi\u1edbi h\u1ea1n sinh l\u00fd nh\u01b0ng v\u1eabn nguy hi\u1ec3m, \u0111\u00f4i khi c\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb chi\u1ebfu \u0111\u00e8n.<\/p>\n

2.2. V\u00e0ng da b\u1ec7nh l\u00fd:<\/strong><\/p>\n

– \u0110\u1eb7c \u0111i\u1ec3m:
\n+ Xu\u1ea5t hi\u1ec7n ng\u00e0y \u0111\u1ea7u ti\u00ean sau sanh.
\n+ V\u00e0ng da c\u1ea7n chi\u1ebfu \u0111\u00e8n.
\n+ Bilirubin t\u0103ng nhanh > 0,2 mg\/dL\/gi\u1edd.
\n+ V\u00e0ng da > 1 tu\u1ea7n \u1edf tr\u1ebb \u0111\u1ee7 th\u00e1ng, > 2 tu\u1ea7n \u1edf tr\u1ebb non th\u00e1ng.
\n+ Tr\u1ebb c\u00f3 d\u1ea5u hi\u1ec7u b\u1ec7nh l\u00fd: l\u1eeb \u0111\u1eeb, b\u00fa k\u00e9m, ng\u01b0ng th\u1edf, th\u1edf nhanh, th\u00e2n nhi\u1ec7t thay \u0111\u1ed5i.
\n+ Gan l\u00e1ch to hay c\u00f3 thi\u1ebfu m\u00e1u.
\n– V\u00e0ng da n\u1eb7ng khi:
\n+ Ng\u00e0y 1, \u0111\u00e3 th\u1ea5y v\u00e0ng da.
\n+ Ng\u00e0y 2, v\u00e0ng da \u0111\u1ebfn c\u1eb3ng tay v\u00e0 c\u1eb3ng ch\u00e2n.
\n+ T\u1eeb ng\u00e0y 3 tr\u1edf \u0111i, v\u00e0ng da \u0111\u1ebfn b\u00e0n tay, b\u00e0n ch\u00e2n.
\n+ V\u00e0ng da k\u00e8m d\u1ea5u hi\u1ec7u th\u1ea7n kinh: li b\u00ec, m\u1ea5t ph\u1ea3n x\u1ea1 b\u00fa, g\u1ed3ng \u01b0\u1ee1n ng\u1ef1c (v\u00e0ng da nh\u00e2n \u2013 Bilirubin > 20 mg\/dL).
\n– C\u00e1c y\u1ebfu t\u1ed1 g\u00f3p ph\u1ea7n v\u00e0ng da n\u1eb7ng h\u01a1n:
\n+ Non th\u00e1ng.
\n+ M\u00e1u t\u1ee5, b\u01b0\u1edbu huy\u1ebft thanh.<\/p>\n

+ Da \u1eedng \u0111\u1ecf do \u0111a h\u1ed3ng c\u1ea7u.
\n+ Nhi\u1ec5m tr\u00f9ng.
\n+ Ch\u01b0\u1edbng b\u1ee5ng do ch\u1eadm ti\u00eau ph\u00e2n su, t\u1eafc ru\u1ed9t<\/p>\n

3. Quy t\u1eafc Kramer:<\/h2>\n
\"vang-da-so-sinh\"
Quy t\u1eafc Kramer<\/figcaption><\/figure>\n

4. V\u00e0ng da nh\u00e2n:<\/h2>\n

L\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh n\u00e3o bilirubin tr\u1ea3i qua 4 giai \u0111o\u1ea1n, v\u1edbi di ch\u1ee9ng n\u1eb7ng n\u1ec1 \u2219<\/p>\n

Giai \u0111o\u1ea1n 1:<\/strong> Ph\u1ea3n x\u1ea1 nguy\u00ean th\u1ee7y gi\u1ea3mho\u1eb7c m\u1ea5t, b\u1ecf b\u00fa, li b\u00ec, n\u00f4n, gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u01a1, kh\u00f3c th\u00e9t.<\/p>\n

Giai \u0111o\u1ea1n 2:<\/strong> K\u00edch th\u00edch th\u1ea7n kinh, c\u1ed5 ng\u1eeda, co c\u1ee9ng ng\u01b0\u1eddi, \u0111i d\u1ea7n \u0111\u1ebfn h\u00f4n m\u00ea v\u00e0 t\u1eed vong trong c\u01a1n ng\u1eebng th\u1edf.<\/p>\n

Giai \u0111o\u1ea1n 3<\/strong>: Co c\u1ee9ng gi\u1ea3m d\u1ea7n trong kho\u1ea3ng 1 tu\u1ea7n.<\/p>\n

Giai \u0111o\u1ea1n 4:<\/strong> \u0110\u1ec3 l\u1ea1i di ch\u1ee9ng tinh th\u1ea7n v\u00e0 v\u1eadn \u0111\u1ed9ng: co c\u1ee9ng, \u0111i\u1ebfc, li\u1ec7t, ch\u1eadm ph\u00e1t tri\u1ec3n tinh th\u1ea7n, n\u00f3i kh\u00f3<\/p>\n

– C\u00e1c y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i t\u0103ng nguy c\u01a1 v\u00e0ng da nh\u00e2n:
\n+ Thi\u1ebfu oxy, ng\u1ea1t.
\n+ Toan m\u00e1u.
\n+ H\u1ea1 \u0111\u01b0\u1eddng m\u00e1u.
\n+ H\u1ea1 th\u00e2n nhi\u1ec7t.
\n+ H\u1ea1 albumin m\u00e1u.
\n+ Sanh non.
\n+ Nhi\u1ec5m tr\u00f9ng.<\/p>\n

5. Nguy\u00ean nh\u00e2n v\u00e0ng da s\u01a1 sinh (ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t):<\/h3>\n

5.1. S\u1edbm (Ng\u00e0y 1 \u2013 2<\/strong>): \u00edt g\u1eb7p, th\u01b0\u1eddng do t\u00e1n huy\u1ebft.
\n– B\u1ea5t \u0111\u1ed3ng nh\u00f3m m\u00e1u ABO: m\u1eb9 m\u00e1u O, con m\u00e1u A ho\u1eb7c B.
\n– B\u1ea5t \u0111\u1ed3ng nh\u00f3m m\u00e1u Rhesus: m\u1eb9 Rh (-), con Rh (+).
\n– T\u00e1n huy\u1ebft mi\u1ec5n d\u1ecbch: t\u1ef1 kh\u00e1ng th\u1ec3 t\u1eeb m\u1eb9.
\n5.2. Ng\u00e0y 3 \u2013 10<\/strong>: r\u1ea5t th\u01b0\u1eddng g\u1eb7p.
\n– Nhi\u1ec5m tr\u00f9ng: r\u1ed1n, da, nhi\u1ec5m tr\u00f9ng huy\u1ebft.
\n– \u0110a h\u1ed3ng c\u1ea7u, b\u01b0\u1edbu huy\u1ebft thanh to, \u1ed5 t\u1ee5 m\u00e1u.
\n– Ch\u1eadm ti\u00eau ph\u00e2n su, teo t\u1eafc ru\u1ed9t.
\n– Thi\u1ebfu men G6PD.
\n5.3. Mu\u1ed9n (sau Ng\u00e0y 14):<\/strong>
\n– Do s\u1eefa m\u1eb9 (th\u01b0\u1eddng g\u1eb7p).<\/p>\n

– B\u1ec7nh gan.
\n– T\u1eafc m\u1eadt.
\n– Suy gi\u00e1p b\u1ea9m sinh.
\n– B\u1ec7nh chuy\u1ec3n h\u00f3a.<\/p>\n

6. L\u00e2m s\u00e0ng v\u00e0ng da s\u01a1 sinh<\/h2>\n

Th\u1eddi \u0111i\u1ec3m xu\u1ea5t hi\u1ec7n v\u00e0ng da, m\u1ee9c \u0111\u1ed9 v\u00e0 di\u1ec5n ti\u1ebfn c\u1ee7a v\u00e0ng da l\u00e0 nh\u1eefng d\u1eef ki\u1ec7n l\u00e2m s\u00e0ng quan tr\u1ecdng c\u1ea7n l\u01b0u \u00fd.<\/p>\n

Khi c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng v\u00e0ng da, vi\u1ec7c nh\u1eadn di\u1ec7n c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a v\u00e0ng da c\u00f3 th\u1ec3 gi\u00fap nh\u1eadn di\u1ec7n nguy\u00ean nh\u00e2n v\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng c\u1ee7a v\u00e0ng da.<\/p>\n

N\u1ebfu c\u0103n c\u1ee9 theo th\u1eddi \u0111i\u1ec3m xu\u1ea5t hi\u1ec7n k\u1ec3 t\u1eeb sau sinh, ta c\u00f3 v\u00e0ng da xu\u1ea5t hi\u1ec7n s\u1edbm (tr\u01b0\u1edbc 36 gi\u1edd tu\u1ed5i) hay v\u00e0ng da xu\u1ea5t hi\u1ec7n mu\u1ed9n (sau 36 gi\u1edd tu\u1ed5i). N\u1ebfu mu\u1ed9n, c\u1ea7n x\u00e1c \u0111\u1ecbnh l\u00e0 ng\u00e0y th\u1ee9 m\u1ea5y.<\/p>\n

M\u00e0u s\u1eafc c\u1ee7a v\u00e0ng da thay \u0111\u1ed5i theo lo\u1ea1i bilirubin.<\/p>\n

\u2219 M\u00e0u v\u00e0ng s\u00e1ng, t\u01b0\u01a1i, v\u00e0ng ngh\u1ec7 li\u00ean quan \u0111\u1ebfn t\u0103ng bilirubin gi\u00e1n ti\u1ebfp. M\u00e0u da v\u00e0ng x\u1ea1m, kh\u00f4ng t\u01b0\u01a1i, v\u00e0ng chanh li\u00ean quan \u0111\u1ebfn t\u0103ng bilirubin tr\u1ef1c ti\u1ebfp. C\u0169ng ph\u1ea3i quan t\u00e2m\u0111\u1ebfn<\/p>\n

\u2219 V\u1ecb tr\u00ed: t\u1eeb m\u1eb7t, \u0111\u1ebfn tr\u00ean r\u1ed1n, \u0111\u1ebfn \u0111\u00f9i, \u0111\u1ebfn c\u1eb3ng ch\u00e2n-c\u1eb3ng tay, \u0111\u1ebfn b\u00e0n ch\u00e2n-b\u00e0n tay \u2219 M\u1ee9c \u0111\u1ed9: t\u1eeb nh\u1eb9, v\u1eeba \u0111\u1ebfn r\u00f5 \u0111\u1eadm<\/p>\n

\u2219 Th\u1eddi gian k\u00e9o d\u00e0i: k\u1ec3 t\u1eeb sau sinh bao nhi\u00eau ng\u00e0y<\/p>\n

\u2219 Di\u1ec5n ti\u1ebfn c\u1ee7a v\u00e0ng da t\u0103ng v\u1edbi t\u1ed1c \u0111\u1ed9 nhanh hay ch\u1eadm; v\u00e0ng da gi\u1ea3mnh\u01b0 th\u1ebf n\u00e0o M\u00e0u n\u01b0\u1edbc ti\u1ec3u tr\u1ebb v\u00e0ng da thay \u0111\u1ed5i t\u00f9y lo\u1ea1i t\u0103ng bilirubin.<\/p>\n

\u2219 N\u01b0\u1edbc ti\u1ec3u s\u1ebd kh\u00f4ng v\u00e0ng trong t\u0103ng bilirubin gi\u00e1n ti\u1ebfp<\/p>\n

\u2219 Ng\u01b0\u1ee3c l\u1ea1i n\u01b0\u1edbc ti\u1ec3u s\u1ebd c\u00f3 m\u00e0u v\u00e0ng \u0111\u1eadmtrong t\u0103ng bilirubin tr\u1ef1c ti\u1ebfp. Ph\u00e2n c\u1ee7a tr\u1ebb v\u00e0ng da c\u00f3 m\u00e0u s\u1eafc thay \u0111\u1ed5i t\u00f9y theo lo\u1ea1i t\u0103ng bilirubin. \u2219 Ph\u00e2n s\u1ebd v\u00e0ng trong t\u0103ng bilirubin gi\u00e1n ti\u1ebfp<\/p>\n

\u2219 Ph\u00e2n s\u1ebd nh\u1ea1t m\u00e0u trong t\u0103ng bilirubin tr\u1ef1c ti\u1ebfp<\/p>\n

C\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c k\u00e8mtheo v\u00e0ng da c\u00f3 \u00fd ngh\u0129a ch\u1ec9 b\u00e1o m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u0169ng nh\u01b0 nguy\u00ean nh\u00e2n c\u1ee7a v\u00e0ng da<\/p>\n

7. C\u1eadn l\u00e2m s\u00e0ng:<\/h2>\n

– V\u00e0ng da nh\u1eb9 (v\u00f9ng 1 \u2013 2) xu\u1ea5t hi\u1ec7n t\u1eeb ng\u00e0y 3 \u2013 10, kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n th\u1ea7n kinh: kh\u00f4ng c\u1ea7n x\u00e9t nghi\u1ec7m.
\n– Bilirubin m\u00e1u: t\u0103ng Bilirubin gi\u00e1n ti\u1ebfp.
\n– C\u00f4ng th\u1ee9c m\u00e1u, Hct, ph\u1ebft m\u00e1u ngo\u1ea1i bi\u00ean, CRP.
\n– Nh\u00f3m m\u00e1u ABO, Rh m\u1eb9 – con.
\n– Test Coombs tr\u1ef1c ti\u1ebfp.
\n– \u0110\u1ecbnh l\u01b0\u1ee3ng G6PD.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u1ede giai \u0111o\u1ea1n s\u01a1 sinh, v\u00e0ng da l\u00e0 m\u1ed9t bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p. Th\u00f4ng th\u01b0\u1eddng, t\u00ecnh tr\u1ea1ng v\u00e0ng da s\u01a1 sinh l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng sinh l\u00fd. Tuy nhi\u00ean, trong kh\u00f4ng \u00edt tr\u01b0\u1eddng h\u1ee3p, v\u00e0ng da s\u01a1 sinh c\u00f3 th\u1ec3 l\u00e0 bi\u1ec3u hi\u1ec7n chung c\u1ee7a r\u1ea5t nhi\u1ec1u b\u1ec7nh l\u00fd kh\u00e1c nhau, c\u00f3 chung \u0111\u1eb7c \u0111i\u1ec3m […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15,33],"tags":[],"yoast_head":"\nTi\u1ebfp c\u1eadn l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng v\u00e0ng da s\u01a1 sinh - Vinmec<\/title>\n<meta name=\"description\" content=\"\u1ede giai \u0111o\u1ea1n s\u01a1 sinh, v\u00e0ng da l\u00e0 m\u1ed9t bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p. 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