{"id":28883,"date":"2023-04-27T21:38:39","date_gmt":"2023-04-27T14:38:39","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28883"},"modified":"2023-04-27T21:38:58","modified_gmt":"2023-04-27T14:38:58","slug":"vang-da-so-sinh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/vang-da-so-sinh\/","title":{"rendered":"C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb 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. \u00c1nh s\u00e1ng li\u1ec7u ph\u00e1p trong v\u00e0ng da s\u01a1 sinh<\/h2>\n

Li\u1ec7u ph\u00e1p \u00e1nh s\u00e1ng (quang tr\u1ecb li\u1ec7u) (phototherapy) l\u00e0 can thi\u1ec7p \u01b0u ti\u00ean \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn, do hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n.<\/p>\n

M\u1ee5c \u0111\u00edch ch\u00ednh c\u1ee7a li\u1ec7u ph\u00e1p n\u00e0y l\u00e0 nh\u1eb1m chuy\u1ec3n bilirubin t\u1ef1 do th\u00e0nh bilirubin tan trong n\u01b0\u1edbc v\u00e0 \u0111\u01b0\u1ee3c th\u1ea3i ra ngo\u00e0i.<\/p>\n

Ch\u1ec9 \u0111\u1ecbnh \u0111\u01b0\u1ee3c c\u0103n c\u1ee9 v\u00e0o to\u00e1n \u0111\u1ed3. C\u00e1c s\u01a1 sinh c\u00f3 n\u1ed3ng \u0111\u1ed9 bilirubin v\u01b0\u1ee3t ng\u01b0\u1ee1ng cho ph\u00e9p theo gi\u1edd tu\u1ed5i, c\u00f3 hi\u1ec7u ch\u1ec9nh b\u1eb1ng y\u1ebfu t\u1ed1 nguy c\u01a1 l\u00e0 c\u00e1c tr\u1ebb ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb. \u2219 To\u00e1n \u0111\u1ed3 n\u00e0y d\u00f9ng Bilirubin huy\u1ebft thanh to\u00e0n ph\u1ea7n (Total Serum Bilirubin) (TSB) t\u00ednh b\u1eb1ng mg\/dLho\u1eb7c b\u1eb1ng \u00b5mol\/L.<\/p>\n

\u2219 Tu\u1ed5i c\u1ee7a s\u01a1 sinh t\u00ednh b\u1eb1ng gi\u1edd tu\u1ed5i t\u1eeb khi sanh.<\/p>\n

\u2219 C\u00e1c y\u1ebfu nguy c\u01a1 g\u1ed3m: b\u1ec7nh l\u00fd huy\u1ebft t\u00e1n mi\u1ec5n d\u1ecbch, thi\u1ebfu G6<\/sub>PD, l\u1eeb \u0111\u1eeb, ng\u1ea1t, b\u1ea5t \u1ed5n th\u00e2n nhi\u1ec7t, nhi\u1ec5m tr\u00f9ng, toan h\u00f3a m\u00e1u, hay albumin huy\u1ebft t\u01b0\u01a1ng th\u1ea5p d\u01b0\u1edbi 3.0 g\/L\u00a0 \u00a0 \u00a0 \u2219 V\u1edbi c\u00e1c tr\u1ebb kh\u1ecfe m\u1ea1nh c\u00f3 \u0111\u1ed9 tu\u1ed5i khi sanh t\u1eeb 35 \u0111\u1ebfn h\u1ebft 37 tu\u1ea7n v\u00e0 6 ng\u00e0y, c\u00f3 th\u1ec3 hi\u1ec7u ch\u1ec9nh m\u1ee9c can thi\u1ec7p chung quanh \u0111\u01b0\u1eddng nguy c\u01a1 trung b\u00ecnh. C\u00f3 th\u1ec3 d\u00f9ng c\u00e1c m\u1ee9c can thi\u1ec7p s\u1edbm (th\u1ea5p) n\u1ebfu tr\u1ebb non nhi\u1ec1u, v\u00e0 m\u1ee9c can thi\u1ec7p mu\u1ed9n (cao) n\u1ebfu tr\u1ebb g\u1ea7n \u0111\u01b0\u1ee3c 37 tu\u1ea7n v\u00e0 6 ng\u00e0y.<\/p>\n

\u00c1nh s\u00e1ng l\u00fd t\u01b0\u1edfng l\u00e0 \u00e1nh s\u00e1ng xanh v\u1edbi b\u01b0\u1edbc s\u00f3ng 420-490 nm. \u0110\u00e2y l\u00e0 d\u00e3y b\u01b0\u1edbc s\u00f3ng t\u1ed1t nh\u1ea5t \u0111\u1ec3 c\u00f3 hi\u1ec7u qu\u1ea3. Ngu\u1ed3n s\u00e1ng c\u00f3 th\u1ec3 l\u00e0 \u0111\u00e8n hu\u1ef3nh quang ho\u1eb7c LED. B\u1ec7nh nhi \u0111\u01b0\u1ee3c c\u1edfi tr\u1ea7n v\u00e0 ph\u1ea3i che m\u1eaft. Nhi\u1ec1u n\u01a1i khuy\u1ebfn c\u00e1o v\u1eabn th\u1ef1c hi\u1ec7n m\u1eb7c t\u00e3 khi chi\u1ebfu \u0111\u00e8n.Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p v\u00e0ng da kh\u00f4ng n\u1eb7ng, vi\u1ec7c chi\u1ebfu li\u00ean t\u1ee5c hay c\u00e1ch qu\u00e3ng (12 gi\u1edd chi\u1ebfu -12 gi\u1edd ngh\u1ec9) kh\u00f4ng kh\u00e1c bi\u1ec7t v\u1ec1 hi\u1ec7u qu\u1ea3.<\/p>\n

– C\u00e1c lo\u1ea1i \u0111\u00e8n:
\n+ \u0110\u00e8n hu\u1ef3nh quang \u00e1nh s\u00e1ng tr\u1eafng, \u00e1nh s\u00e1ng xanh.
\n+ \u0110\u00e8n \u00e1nh s\u00e1ng xanh LED (NeoBlue).
\n+ \u0110\u00e8n biliblanket.
\n+ \u0110\u00e8n Halogen.<\/p>\n

+ \u0110\u00e8n compact.
\n– Ch\u1ec9 \u0111\u1ecbnh chi\u1ebfu \u0111\u00e8n d\u1ef1a tr\u00ean l\u00e2m s\u00e0ng:<\/p>\n\n\n\n\n\n\n\n\n
C\u00e2n n\u1eb7ng<\/td>\nChi\u1ebfu \u0111\u00e8n khi v\u00e0ng da lan \u0111\u1ebfn<\/td>\n<\/tr>\n
< 1500g<\/td>\nChi\u1ebfu \u0111\u00e8n d\u1ef1 ph\u00f2ng<\/td>\n<\/tr>\n
1500 \u2013 2000g<\/td>\n\u0110\u1ea7u, m\u1eb7t, ng\u1ef1c (v\u00f9ng 1, 2)<\/td>\n<\/tr>\n
2000 \u2013 2500g<\/td>\nNg\u1ef1c, b\u1ee5ng, \u0111\u00f9i (v\u00f9ng 3)<\/td>\n<\/tr>\n
> 2500g<\/td>\nC\u00e1nh tay, \u0111\u00f9i, c\u1eb3ng ch\u00e2n (v\u00f9ng 4)<\/td>\n<\/tr>\n
V\u00e0ng da b\u00e0n tay, b\u00e0n ch\u00e2n: chi\u1ebfu \u0111\u00e8n + thay m\u00e1u<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

– Ch\u1ec9 \u0111\u1ecbnh chi\u1ebfu \u0111\u00e8n d\u1ef1a tr\u00ean Bilirubin gi\u00e1n ti\u1ebfp (mg\/dL) \u1edf tr\u1ebb \u0111\u1ee7 \u00a0th\u00e1ng:<\/p>\n\n\n\n\n\n\n\n\n
Tu\u1ed5i (gi\u1edd)<\/td>\nTr\u1ebb kh\u1ecfe m\u1ea1nh<\/td>\nTr\u1ebb b\u1ec7nh (*)<\/td>\n<\/tr>\n
Chi\u1ebfu \u0111\u00e8n<\/td>\nThay m\u00e1u<\/td>\nChi\u1ebfu \u0111\u00e8n<\/td>\nThay m\u00e1u<\/td>\n<\/tr>\n
24<\/td>\n\u2265 10<\/td>\n20<\/td>\n7 \u2013 10<\/td>\n18<\/td>\n<\/tr>\n
25 \u2013 48<\/td>\n\u2265 12<\/td>\n20 \u2013 25<\/td>\n10 \u2013 12<\/td>\n20<\/td>\n<\/tr>\n
49 \u2013 72<\/td>\n\u2265 15<\/td>\n25 \u2013 30<\/td>\n12 \u2013 15<\/td>\n20<\/td>\n<\/tr>\n
> 72<\/td>\n\u2265 17<\/td>\n25 \u2013 30<\/td>\n12 \u2013 15<\/td>\n20<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

(*: tr\u1ebb c\u00f3 b\u1ec7nh l\u00fd t\u00e1n huy\u1ebft, nhi\u1ec5m tr\u00f9ng, thi\u1ebfu oxy m\u00e1u, acidosis)
\nThay m\u00e1u khi Bilirubin gi\u00e1n ti\u1ebfp \u2265 20 mg\/dL.
\n– K\u1ef9 thu\u1eadt chi\u1ebfu \u0111\u00e8n:
\n<\/strong>\u2022 Chu\u1ea9n b\u1ecb b\u1ec7nh nh\u00e2n: c\u1edfi tr\u1ea7n, che m\u1eaft tr\u1ebb.
\n\u2022 BN n\u1eb1m ngay v\u00f9ng trung t\u00e2m c\u1ee7a \u0111\u00e8n.
\n\u2022 B\u01b0\u1edbc s\u00f3ng: 420 \u2013 480 nm (AS xanh > AS tr\u1eafng), ch\u1ea5t l\u01b0\u1ee3ng \u00e1nh s\u00e1ng (li\u00ean t\u1ee5c > gi\u00e1n \u0111o\u1ea1n, thay b\u00f3ng m\u1ed7i 2000 gi\u1edd).
\n\u2022 Kho\u1ea3ng c\u00e1ch t\u1eeb \u0111\u00e8n \u0111\u1ebfn BN 30 \u2013 40 cm.
\n\u2022 Chi\u1ebfu \u0111\u00e8n 24\/24, ch\u1ec9 ng\u01b0ng khi tr\u1ebb c\u00f3 ch\u1ec9 \u0111\u1ecbnh b\u00fa hay l\u00e0m th\u1ee7 thu\u1eadt.<\/p>\n

\"vang-da-so-sinh\"
To\u00e1n \u0111\u1ed3 Bhutani<\/figcaption><\/figure>\n

Xoay tr\u1edf BN m\u1ed7i 2 gi\u1edd.
\n\u2022 Che k\u00edn m\u1eaft khi chi\u1ebfu \u0111\u00e8n.
\n\u2022 Theo d\u00f5i nhi\u1ec7t \u0111\u1ed9 tr\u1ebb.
\n\u2022 T\u0103ng nhu c\u1ea7u n\u01b0\u1edbc m\u1ed7i ng\u00e0y cho tr\u1ebb 15 \u2013 20%.
\n– Gi\u1ea3m Bilirubin khi:
\n<\/strong>+ Gi\u1ea3m 6 \u2013 20% trong 24 gi\u1edd v\u1edbi h\u1ec7 th\u1ed1ng chi\u1ebfu \u0111\u00e8n chu\u1ea9n.
\n<\/strong>+ Gi\u1ea3m 32% trong 18 gi\u1edd v\u1edbi \u0111\u00e8n \u00e1nh s\u00e1ng xanh + fiberoptic.
\n<\/strong>+ Gi\u1ea3m 43% trong 24 gi\u1edd v\u1edbi \u0111\u00e8n \u00e1nh s\u00e1ng xanh tr\u00ean d\u01b0\u1edbi.
\n<\/strong>– T\u00e1c d\u1ee5ng ph\u1ee5 chi\u1ebfu \u0111\u00e8n:
\n\u2022 T\u0103ng m\u1ea5t n\u01b0\u1edbc qua da ->\u00a0 m\u1ea5t n\u01b0\u1edbc.
\n\u2022 T\u0103ng hay h\u1ea1 th\u00e2n nhi\u1ec7t.
\n\u2022 Ph\u00e1t ban da.
\n\u2022 Che d\u1ea5u hi\u1ec7u t\u00edm t\u00e1i.
\n\u2022 T\u1eafc m\u0169i do b\u0103ng che m\u1eaft.
\n\u2022 T\u1ed5n th\u01b0\u01a1ng v\u00f5ng m\u1ea1c.
\n\u2022 Da m\u00e0u \u0111\u1ed3ng.<\/p>\n

2. Thay m\u00e1u trong v\u00e0ng da s\u01a1 sinh<\/h2>\n

M\u1ee5c \u0111\u00edch \u0111\u1ec3 nhanh ch\u00f3ng \u0111\u01b0a b\u1edbt Bilirubin t\u1ef1 do ra ngo\u00e0i c\u01a1 th\u1ec3 v\u00e0 ngo\u00e0i ra c\u00f2n \u0111\u1ec3 lo\u1ea1i b\u1edbt kh\u00e1ng th\u1ec3 kh\u00e1ng h\u1ed3ng c\u1ea7u con trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 b\u1ea5t \u0111\u1ed3ng nh\u00f3m m\u00e1u.<\/p>\n

– Ch\u1ec9 \u0111\u1ecbnh:<\/strong>
\n+ Thay m\u00e1u to\u00e0n ph\u1ea7n: V\u00e0ng da t\u0103ng Bilirubin gi\u00e1n ti\u1ebfp c\u00f3 tri\u1ec7u ch\u1ee9ng v\u00e0ng da nh\u00e2n ho\u1eb7c Bilirubin gi\u00e1n ti\u1ebfp t\u0103ng d\u1ea7n \u0111\u1ebfn gi\u1edbi h\u1ea1n c\u1ea7n thay m\u00e1u.
\n+ Thay m\u00e1u m\u1ed9t ph\u1ea7n: \u0110a h\u1ed3ng c\u1ea7u (Hct t\u0129nh m\u1ea1ch tr\u00ean 65%) c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.
\n– Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n

+ \u0110ang s\u1ed1c.
\n+ \u0110ang suy h\u00f4 h\u1ea5p n\u1eb7ng.
\n-> Ch\u1ec9 ti\u1ebfn h\u00e0nh thay m\u00e1u khi t\u00ecnh tr\u1ea1ng s\u1ed1c v\u00e0 suy h\u00f4 h\u1ea5p \u1ed5n \u0111\u1ecbnh.
\n– Bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb thay th\u1ebf: chi\u1ebfu \u0111\u00e8n 2 m\u1eb7t li\u00ean t\u1ee5c, c\u00f3 th\u1ec3 truy\u1ec1n th\u00eam Albumin.<\/p>\n

Ti\u1ebfn tr\u00ecnh thay m\u00e1u: m\u00e1y \u0111\u01b0\u1ee3c thay qua t\u0129nh m\u1ea1ch r\u1ed1n hay t\u0129nh m\u1ea1ch b\u1eb9n. Qua van ch\u1ebb 4, r\u00fat v\u00e0 b\u01a1m m\u00e1u m\u1ed7i l\u1ea7n 5 mL (tr\u1ebb c\u00f3 c\u00e2n n\u1eb7ng d\u01b0\u1edbi 1500 gram) \/ m\u1ed7i l\u1ea7n 10 mL (tr\u1ebb c\u00f3 c\u00e2n n\u1eb7ng 1500-2500 gram) \/ m\u1ed7i l\u1ea7n 15 mL (tr\u1ebb c\u00f3 c\u00e2n n\u1eb7ng 2500-3500 gram) \/ 20 mL (tr\u1ebb c\u00f3 c\u00e2n n\u1eb7ng tr\u00ean > 3500 gram). Sau khi r\u00fat m\u1ed7i 100 mL, c\u1ea7n ti\u00eam ch\u1eadm 1mL Gluconate canxi 10%. Tr\u01b0\u1edbc khi k\u1ebft th\u00fac, c\u1ea7n ti\u00eam kh\u00e1ng sinh.<\/p>\n

\u00a03. \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3:<\/h2>\n

– Cung c\u1ea5p \u0111\u1ee7 d\u1ecbch (t\u0103ng 15 \u2013 20% nhu c\u1ea7u).
\n– Ch\u1ed1ng co gi\u1eadt b\u1eb1ng Phenobarbital.
\n– Cho b\u00fa m\u1eb9 ho\u1eb7c cho \u0103n qua \u1ed1ng th\u00f4ng d\u1ea1 d\u00e0y s\u1edbm.
\n– Tr\u1ebb non th\u00e1ng c\u00f3 ch\u1eadm ti\u00eau ph\u00e2n su: th\u1ee5t th\u00e1o nh\u1eb9 b\u1eb1ng NaCl 0,9%.
\n– V\u1eadt l\u00fd tr\u1ecb li\u1ec7u n\u1ebfu v\u00e0ng da nh\u00e2n qua giai \u0111o\u1ea1n nguy hi\u1ec3m.<\/p>\n

    \n
  • C\u00e1c ph\u01b0\u01a1ng th\u1ee9c h\u1ed7 tr\u1ee3 kh\u00e1c c\u00f3 vai tr\u00f2 nh\u1ea5t \u0111\u1ecbnh trong \u0111i\u1ec1u tr\u1ecb v\u00e0ng da<\/li>\n
  • Nu\u00f4i d\u01b0\u1ee1ng s\u1edbm: cho b\u00fa s\u1eefa s\u1edbm sau sinh.<\/li>\n
  • Tr\u00e1nh v\u00e0ng da do nu\u00f4i con b\u1eb1ng s\u1eefa m\u1eb9 sai c\u00e1ch.<\/li>\n
  • \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n: T\u00f9y theo t\u1eebng nguy\u00ean nh\u00e2n g\u00e2y v\u00e0ng da \u0111\u1ec3 c\u00f3 nh\u1eefng ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u b\u1eb1ng thu\u1ed1c (nh\u01b0 Intravenous immune globulin – IVIG, kh\u00e1ng sinh trong v\u00e0ng da nhi\u1ec5m khu\u1ea9n\u2026) hay ph\u1eabu thu\u1eadt (t\u1eafc m\u1eadt b\u1ea9m sinh) m\u1ed9t c\u00e1ch th\u00edch h\u1ee3p.<\/li>\n<\/ul>\n

    Theo d\u00f5i:<\/strong>
    \n– Trong th\u1eddi gian n\u1eb1m vi\u1ec7n:
    \n+ M\u1ee9c \u0111\u1ed9 v\u00e0ng da, bi\u1ec3u hi\u1ec7n th\u1ea7n kinh m\u1ed7i 4 \u2013 6 gi\u1edd n\u1ebfu v\u00e0ng da
    \nn\u1eb7ng, m\u1ed7i 24 gi\u1edd n\u1ebfu v\u00e0ng da nh\u1eb9.
    \n+ L\u01b0\u1ee3ng xu\u1ea5t nh\u1eadp \u2013 c\u00e2n n\u1eb7ng m\u1ed7i ng\u00e0y.
    \n+ Kh\u00f4ng nh\u1ea5t thi\u1ebft ph\u1ea3i \u0111o Bilirubin m\u1ed7i ng\u00e0y tr\u1eeb TH v\u00e0ng da \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi \u0111i\u1ec1u tr\u1ecb (v\u00e0ng da kh\u00f4ng gi\u1ea3m, c\u00f3 bi\u1ec3u hi\u1ec7n th\u1ea7n kinh).
    \n– T\u00e1i kh\u00e1m m\u1ed7i th\u00e1ng<\/p>\n

    T\u00c0I LI\u1ec6U THAM KH\u1ea2O\u00a0<\/strong><\/p>\n

      \n
    1. NICE. Jaundice in newborn babies under 28 days. NICE guidelines [CG98]. May 2016.<\/li>\n
    2. AAP.\u00a0Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation.<\/li>\n
    3. \u00a0<\/sub>Nguy\u1ec5n Duy Ho\u00e0ng Minh T\u00e2m, Nguy\u1ec5n H\u1ed3ng Ch\u00e2u, B\u1ed9 m\u00f4n Ph\u1ee5 S\u1ea3n, Khoa Y, \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh.<\/li>\n<\/ol>\n

       <\/p>\n

       <\/p>\n","protected":false},"excerpt":{"rendered":"

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