{"id":29142,"date":"2023-05-03T21:48:35","date_gmt":"2023-05-03T14:48:35","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29142"},"modified":"2023-05-17T00:02:30","modified_gmt":"2023-05-16T17:02:30","slug":"phac-do-chan-doan-va-dieu-tri-suy-ho-hap-cap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/phac-do-chan-doan-va-dieu-tri-suy-ho-hap-cap\/","title":{"rendered":"Ph\u00e1c \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb suy h\u00f4 h\u1ea5p c\u1ea5p"},"content":{"rendered":"<p><b>Suy h\u00f4 h\u1ea5p l\u00e0 m\u1ed9t trong nh\u1eefng t\u00ecnh tr\u1ea1ng nguy hi\u1ec3m v\u00e0 kh\u00f3 l\u01b0\u1eddng nh\u1ea5t hi\u1ec7n nay. N\u00f3 c\u00f3 th\u1ec3 x\u1ea3y ra m\u1ed9t c\u00e1ch \u0111\u1ed9t ng\u1ed9t, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u b\u00e1o tr\u01b0\u1edbc nh\u01b0ng c\u0169ng c\u00f3 khi n\u00f3 x\u1ea3y ra m\u1ed9t c\u00e1ch t\u1eeb t\u1eeb n\u00ean nhi\u1ec1u ng\u01b0\u1eddi b\u1ec7nh ch\u1ee7 quan cho \u0111\u1ebfn khi c\u00e1c tri\u1ec7u ch\u1ee9ng tr\u1edf n\u00ean r\u00f5 r\u00e0ng h\u01a1n.<\/b><\/p>\n<figure id=\"attachment_29145\" aria-describedby=\"caption-attachment-29145\" style=\"width: 462px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\" wp-image-29145\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Figure_39_03_04.jpg\" alt=\"anh-mo-ta-cau-truc-phoi-binh-thuong\" width=\"462\" height=\"582\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Figure_39_03_04.jpg 544w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Figure_39_03_04-238x300.jpg 238w\" sizes=\"(max-width: 462px) 100vw, 462px\" \/><figcaption id=\"caption-attachment-29145\" class=\"wp-caption-text\">\u1ea2nh m\u00f4 t\u1ea3 c\u1ea5u tr\u00fac ph\u1ed5i b\u00ecnh th\u01b0\u1eddng \u1edf ng\u01b0\u1eddi<\/figcaption><\/figure>\n<h2>1. \u0110\u1ea1i c\u01b0\u01a1ng<\/h2>\n<ul>\n<li><span style=\"font-weight: 400;\">Suy h\u00f4 h\u1ea5p ( SHH) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a khi h\u1ec7 th\u1ed1ng h\u00f4 h\u1ea5p kh\u00f4ng c\u00f2n \u0111\u1ea3m b\u1ea3o 1 trong 2 ch\u1ee9c n\u0103ng c\u1ee7a n\u00f3, ch\u1ee9c n\u0103ng cung c\u1ea5p oxy v\u00e0 \u0111\u00e0o th\u1ea3i CO2.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">SHH \u0111\u01b0\u1ee3c xem l\u00e0 1 h\u1ed9i ch\u1ee9ng ch\u1ee9 kh\u00f4ng ph\u1ea3i l\u00e0 1 b\u1ec7nh.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u00a0SHH c\u00f3 th\u1ec3 l\u00e0 c\u1ea5p hay m\u1ea1n v\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ho\u00e0n to\u00e0n kh\u00e1c nhau. Trong suy h\u00f4 h\u1ea5p c\u1ea5p c\u00f3 s\u1ef1 r\u1ed1i lo\u1ea1n kh\u00ed m\u00e1u v\u00e0 toan ki\u1ec1m \u0111e do\u1ea1 t\u00ednh m\u1ea1ng c\u00f2n SHH m\u1ea1n bi\u1ec3u hi\u1ec7n kh\u00f4ng r\u00f5 v\u00e0 y\u00ean l\u1eb7ng. Ph\u00e2n bi\u1ec7t SHH gi\u1ea3m O2 c\u1ea5p v\u00e0 m\u1ea1n kh\u00f4ng th\u1ec3 d\u1ef1a tr\u00ean \u0111\u01a1n thu\u1ea5n KM\u0110M. Trong SHH m\u1ea1n c\u00f3 th\u1ec3 th\u1ea5y \u0111a h\u1ed3ng c\u1ea7u hay t\u00e2m ph\u1ebf m\u1ea1n, c\u00f2n n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 s\u1ef1 thay \u0111\u1ed5i tri gi\u00e1c \u0111\u1ed9t ng\u1ed9t g\u1ee3i \u00fd \u0111\u1ebfn SHH c\u1ea5p.<\/span><\/li>\n<\/ul>\n<h2><strong>2. Ph\u00e2n lo\u1ea1i suy h\u00f4 h\u1ea5p c\u1ea5p\u00a0<\/strong><\/h2>\n<p><span style=\"font-weight: 400;\">C\u00f3 nhi\u1ec1u c\u00e1ch ph\u00e2n lo\u1ea1i SHHC: theo nguy\u00ean nh\u00e2n, theo b\u1ec7nh sinh, theo l\u00e2m s\u00e0ng\u2026<\/span><\/p>\n<h3><strong>\u00a02.1. Ph\u00e2n lo\u1ea1i theo nguy\u00ean nh\u00e2n g\u00e2y suy h\u00f4 h\u1ea5p<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0\u2212 SHHC do nh\u1eefng nguy\u00ean nh\u00e2n t\u1ea1i ph\u1ed5i (t\u1ea1i \u0111\u01a1n v\u1ecb h\u00f4 h\u1ea5p):<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0+ C\u00e1c r\u1ed1i lo\u1ea1n \u1edf \u0111\u01b0\u1eddng th\u1edf (airways): c\u00e1c b\u1ec7nh l\u00fd t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf tr\u00ean (b\u1ea1ch h\u1ea7u, h\u00edt ph\u1ea3i d\u1ecb v\u1eadt, vi\u00eam ph\u00f9 thanh m\u00f4n, h\u1eb9p thanh qu\u1ea3n&#8230;) ho\u1eb7c \u0111\u01b0\u1eddng th\u1edf d\u01b0\u1edbi (COPD, hen ph\u1ebf qu\u1ea3n, &#8230;)<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0+ C\u00e1c t\u1ed5n th\u01b0\u01a1ng ph\u1ebf nang v\u00e0 m\u00f4 k\u1ebd ph\u1ed5i: vi\u00eam ph\u1ed5i, ph\u00f9 ph\u1ed5i c\u1ea5p, ARDS, ng\u1ea1t n\u01b0\u1edbc, \u0111\u1ee5ng d\u1eadp ph\u1ed5i, vi\u00eam k\u1ebd ph\u1ed5i, tr\u00e0n d\u1ecbch ho\u1eb7c tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i&#8230;\u00a0<\/span><\/p>\n<figure id=\"attachment_29146\" aria-describedby=\"caption-attachment-29146\" style=\"width: 543px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\" wp-image-29146\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Pulmonary-Edema.jpg\" alt=\"phu-phoi\" width=\"543\" height=\"284\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Pulmonary-Edema.jpg 1200w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Pulmonary-Edema-300x157.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Pulmonary-Edema-1024x536.jpg 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Pulmonary-Edema-768x402.jpg 768w\" sizes=\"(max-width: 543px) 100vw, 543px\" \/><figcaption id=\"caption-attachment-29146\" class=\"wp-caption-text\">\u1ea2nh m\u00f4 t\u1ea3 t\u00ecnh tr\u1ea1ng ph\u00f9 ph\u1ed5i g\u00e2y suy h\u00f4 h\u1ea5p<\/figcaption><\/figure>\n<p><span style=\"font-weight: 400;\">+ C\u00e1c b\u1ea5t th\u01b0\u1eddng t\u1ea1i mao m\u1ea1ch ph\u1ed5i: thuy\u00ean t\u1eafc m\u1ea1ch ph\u1ed5i \u2212 SHHC do c\u00e1c nguy\u00ean nh\u00e2n ngo\u00e0i ph\u1ed5i (t\u1ea1i b\u01a1m h\u00f4 h\u1ea5p):\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ T\u1ed5n th\u01b0\u01a1ng trung t\u00e2m h\u00f4 h\u1ea5p: tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o, ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o, ng\u1ed9 \u0111\u1ed9c thu\u1ed1c, h\u00f4n m\u00ea chuy\u1ec3n h\u00f3a&#8230; + R\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n th\u1ea7n kinh &#8211; c\u01a1: b\u1ec7nh nh\u01b0\u1ee3c c\u01a1, H\/C Guillain Barr\u00e9, vi\u00eam \u0111a r\u1ec5 th\u1ea7n kinh, ch\u1ea5n th\u01b0\u01a1ng c\u1ed9t s\u1ed1ng &#8211; t\u1ee7y s\u1ed1ng, &#8230;\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ B\u1ea5t th\u01b0\u1eddng v\u1ec1 c\u01a1 x\u01b0\u01a1ng th\u00e0nh ng\u1ef1c: g\u00e3y nhi\u1ec1u x\u01b0\u01a1ng s\u01b0\u1eddn, g\u00f9 v\u1eb9o c\u1ed9t s\u1ed1ng, g\u00e3y x\u01b0\u01a1ng \u1ee9c, m\u1ec7t m\u1ecfi c\u01a1 h\u00f4 h\u1ea5p, b\u1ec7nh c\u01a1 chuy\u1ec3n h\u00f3a, d\u00f9ng thu\u1ed1c gi\u00e3n c\u01a1, ph\u1eabu thu\u1eadt v\u00f9ng b\u1ee5ng cao, &#8230;\u00a0<\/span><\/p>\n<h3><strong>2.2 Ph\u00e2n lo\u1ea1i theo l\u00e2m s\u00e0ng\u00a0<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">Tr\u00ean l\u00e2m s\u00e0ng, \u0111\u1eb7c bi\u1ec7t trong c\u00f4ng t\u00e1c H<strong>\u1ed3i S\u1ee9c C\u1ea5p C\u1ee9u<\/strong>, vi\u1ec7c ph\u00e2n lo\u1ea1i SHHC theo nh\u00f3m nguy\u00ean nh\u00e2n hay theo b\u1ec7nh sinh th\u01b0\u1eddng kh\u00f4ng gi\u00fap \u00edch \u0111\u00e1ng k\u1ec3 cho can thi\u1ec7p c\u1ea5p c\u1ee9u.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0SHHC th\u00e0nh hai lo\u1ea1i:\u00a0<\/span><\/p>\n<p><em><span style=\"font-weight: 400;\">2.2.1. SHHC lo\u1ea1i n\u1eb7ng:<\/span><\/em><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0\u2212 BN c\u00f3 b\u1ec7nh c\u1ea3nh SHHC nh\u01b0ng ch\u01b0a c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u \u0111e d\u1ecda sinh m\u1ea1ng.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2212 Can thi\u1ec7p b\u1eb1ng thu\u1ed1c v\u00e0 oxy li\u1ec7u ph\u00e1p l\u00e0 ch\u1ee7 y\u1ebfu, c\u00f3 th\u1ec3 gi\u1ea3i quy\u1ebft \u0111\u01b0\u1ee3c b\u1eb1ng thu\u1ed1c ho\u1eb7c b\u1eb1ng m\u1ed9t s\u1ed1 th\u1ee7 thu\u1eadt kh\u00f4ng \u0111\u00e1ng k\u1ec3 nh\u01b0 h\u00fat \u0111\u1eddm, ch\u1ed1ng t\u1ee5t l\u01b0\u1ee1i\u2026\u00a0<\/span><\/p>\n<p><em><span style=\"font-weight: 400;\">2.2.2. SHHC lo\u1ea1i nguy k\u1ecbch:\u00a0<\/span><\/em><\/p>\n<p><span style=\"font-weight: 400;\">\u2212 BN c\u00f3 b\u1ec7nh c\u1ea3nh SHHC n\u1eb7ng v\u00e0 c\u00f3 th\u00eam nh\u1eefng d\u1ea5u hi\u1ec7u \u0111e d\u1ecda sinh m\u1ea1ng nh\u01b0:\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ <a href=\"https:\/\/vinmec.com\/vi\/chu-de\/roi-loan-nhip-tho\/\">R\u1ed1i lo\u1ea1n nh\u1ecbp th\u1edf<\/a> nghi\u00eam tr\u1ecdng: th\u1edf &gt;40 l\/p ho\u1eb7c &lt;10 l\/p.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0+ <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/cac-roi-loan-huyet-dong-dac-trung-trong-soc-tim\/\">R\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng<\/a> r\u00f5: t\u1ee5t huy\u1ebft \u00e1p.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0+ <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/roi-loan-y-thuc-la-gi\/\">R\u1ed1i lo\u1ea1n \u00fd th\u1ee9c<\/a> r\u00f5: v\u1eadt v\u00e3 ho\u1eb7c l\u01a1 m\u01a1 th\u1eadm ch\u00ed h\u00f4n m\u00ea.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2212 Ph\u1ea3i can thi\u1ec7p ngay b\u1eb1ng c\u00e1c th\u1ee7 thu\u1eadt, sau \u0111\u00f3 m\u1edbi d\u00f9ng thu\u1ed1c ho\u1eb7c s\u1eed d\u1ee5ng song song (\u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n, b\u00f3p b\u00f3ng, th\u1edf m\u00e1y&#8230;) <\/span><\/p>\n<h2><strong>3. Ch\u1ea9n \u0111o\u00e1n suy h\u00f4 h\u1ea5p c\u1ea5p:\u00a0<\/strong><\/h2>\n<h3><strong>3.1. Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng SHHC<\/strong><\/h3>\n<ul>\n<li><span style=\"font-weight: 400;\">Ch\u1ea9n \u0111o\u00e1n SHH c\u1ea5p hay m\u00e3n b\u1eaft \u0111\u1ea7u t\u1eeb s\u1ef1 nghi ng\u1edd tr\u1ec7n l\u00e2m s\u00e0ng v\u00e0 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh b\u1eb1ng \u0111o KM\u0110M. C\u1ea7n ch\u1ea9n \u0111o\u00e1n s\u1edbm nguy\u00ean nh\u00e2n g\u00e2y suy h\u00f4 h\u1ea5p c\u00f9ng l\u00fac \u0111i\u1ec1u tr\u1ecb SHH. Trong khi SHH m\u00e3n th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n d\u1ef1a tr\u00ean nh\u1eefng d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng c\u1ee7a gi\u1ea3m oxy m\u00e1u m\u00e3n, c\u00f3 th\u1ec3 k\u00e8m theo d\u1ea5u hi\u1ec7u t\u0103ng th\u00e1n hay kh\u00f4ng th\u00ec ch\u1ea9n \u0111o\u00e1n SHH c\u1ea5p c\u1ea7n ph\u00e2n t\u00edch c\u1ea9n th\u1eadn h\u01a1n.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Nguy\u00ean nh\u00e2n SHH c\u1ea5p c\u00f3 th\u1ec3 khu tr\u00fa r\u00f5 r\u1ec7t \u1edf c\u01a1 quan h\u00f4 h\u1ea5p (vi\u00eam ph\u1ed5i, ph\u00f9 ph\u1ed5i, hen, COPD \u2026), c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n to\u00e0n th\u00e2n (t\u1ee5t HA) hay ngo\u00e0i c\u01a1 quan h\u00f4 h\u1ea5p (vi\u00eam t\u1ee5y c\u1ea5p, g\u00e3y x\u01b0\u01a1ng\u2026).\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Ch\u1ea9n \u0111o\u00e1n BN b\u1ecb SHHC tr\u00ean th\u1ef1c t\u1ebf bao gi\u1edd c\u0169ng c\u0103n c\u1ee9 v\u00e0o nh\u1eefng bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng g\u1ee3i \u00fd:<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0<em>3.1.1. Kh\u00f3 th\u1edf:\u00a0<\/em><\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">SHHC r\u1ea5t th\u01b0\u1eddng c\u00f3 kh\u00f3 th\u1edf, c\u00f3 th\u1ec3 kh\u00f3 th\u1edf nhanh, r\u00fat l\u00f5m co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5 trong ph\u1ebf qu\u1ea3n ph\u1ebf vi\u00eam nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 kh\u00f3 th\u1edf ch\u1eadm v\u00e0 ho\u00e0n to\u00e0n kh\u00f4ng c\u00f3 r\u00fat l\u00f5m co k\u00e9o trong ng\u1ed9 \u0111\u1ed9c thu\u1ed1c ng\u1ee7. \u0110\u00f4i khi BN ch\u1ec9 c\u00f3 kh\u00f3 th\u1edf l\u00e0 bi\u1ec3u hi\u1ec7n duy nh\u1ea5t (Vd: gi\u1ea3m oxy m\u00e1u do nh\u1ed3i m\u00e1u ph\u1ed5i )\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u00a0M\u1ee9c \u0111\u1ed9 kh\u00f3 th\u1edf v\u00e0 ki\u1ec3u r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1edf l\u1ea1i kh\u00f4ng t\u01b0\u01a1ng x\u1ee9ng v\u1edbi m\u1ee9c \u0111\u1ed9 SHHC. Nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p t\u0103ng th\u00f4ng kh\u00ed hay g\u1eb7p trong toan chuy\u1ec3n h\u00f3a, t\u1ed5n th\u01b0\u01a1ng th\u00e2n n\u00e3o, suy th\u1eadn c\u1ea5p ho\u1eb7c suy tim \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n nh\u1ea7m l\u00e0 SHHC. Nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p kh\u00e1c nh\u1ecbp th\u1edf ch\u1eadm d\u01b0\u1edbi 10 nh\u1ecbp\/ph\u00fat nh\u01b0 ng\u1ed9 \u0111\u1ed9c Heroin, thu\u1ed1c ng\u1ee7 th\u00ec l\u1ea1i b\u1ecb b\u1ecf qua.\u00a0<\/span><\/li>\n<\/ul>\n<p><em><span style=\"font-weight: 400;\">3.1.2. Xanh t\u00edm:<\/span><\/em><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">\u00a0 Th\u01b0\u1eddng c\u00f3 xanh t\u00edm \u1edf \u0111\u1ea7u chi trong SHHC th\u1ec3 gi\u1ea3m oxy h\u00f3a m\u00e1u khi SaO2 &lt; 85%, nh\u01b0ng v\u1edbi th\u1ec3 hypercapnia th\u01b0\u1eddng l\u1ea1i c\u00f3 da \u0111\u1ecf t\u00eda.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u00a0Xanh t\u00edm v\u00e0 kh\u00f3 th\u1edf c\u0169ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u cho SHHC, c\u00f3 th\u1ec3 th\u1ea5y c\u1ea3 trong s\u1ed1c, suy tim, tr\u00e0n d\u1ecbch m\u00e0ng tim, thi\u1ebfu vitamin B1\u2026<\/span><\/li>\n<\/ul>\n<p><em><span style=\"font-weight: 400;\">\u00a03.1.3. Ran \u1edf ph\u1ed5i:\u00a0<\/span><\/em><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">SHHC do c\u00e1c b\u1ec7nh \u1edf ph\u1ed5i th\u01b0\u1eddng d\u1ec5 d\u00e0ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c ran c\u00e1c lo\u1ea1i t\u01b0\u01a1ng x\u1ee9ng khi ti\u1ebfn h\u00e0nh th\u0103m kh\u00e1m, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 c\u00f3 SHHC m\u00e0 ho\u00e0n to\u00e0n kh\u00f4ng c\u00f3 ran ph\u1ed5i nh\u01b0 trong c\u00e1c l\u1ecdai SHHC do nguy\u00ean nh\u00e2n ngo\u00e0i ph\u1ed5i.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">M\u1ee9c \u0111\u1ed9 v\u00e0 ki\u1ec3u lo\u1ea1i ran ch\u1ec9 gi\u00fap \u00edch cho vi\u1ec7c truy t\u00ecm nguy\u00ean nh\u00e2n h\u01a1n l\u00e0 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 SHHC.<\/span><\/li>\n<\/ul>\n<p><em><span style=\"font-weight: 400;\">\u00a03.1.4. C\u00e1c bi\u1ec3u hi\u1ec7n to\u00e0n th\u00e2n:\u00a0<\/span><\/em><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">C\u00e1c bi\u1ec3u hi\u1ec7n to\u00e0n th\u00e2n nh\u01b0 tim m\u1ea1ch, th\u1ea7n kinh ( th\u01b0\u1eddng g\u1eb7p nh\u01b0 tim nhanh, r\u1ed1i lo\u1ea1n nh\u1ecbp, b\u1ee9t r\u1ee9t, lo l\u1eafng, l\u00fa l\u1eabn, co gi\u1eadt hay h\u00f4n m\u00ea\u2026) c\u00f3 gi\u00e1 tr\u1ecb r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 SHHC. Khi BN c\u00f3 kh\u00f3 th\u1edf, t\u00edm t\u00e1i, v\u00e3 m\u1ed3 h\u00f4i, c\u00f3 nhi\u1ec1u ran&#8230;, c\u00f3 xu\u1ea5t hi\u1ec7n d\u1ea5u hi\u1ec7u r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng, ho\u1eb7c r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c nghi\u00eam tr\u1ecdng th\u00ec ch\u1eafc ch\u1eafn t\u00ednh m\u1ea1ng BN \u0111ang b\u1ecb \u0111e d\u1ecda t\u1eebng ph\u00fat do b\u1ecb SHHC m\u1ee9c \u0111\u1ed9 nguy k\u1ecbch.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u00a0Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p th\u1eadm ch\u00ed BN kh\u00f4ng c\u00f3 ho\u1eb7c r\u1ea5t \u00edt nh\u1eefng than phi\u1ec1n kh\u00f3 th\u1edf nh\u01b0ng BN \u0111\u00f3 \u0111\u00e3 b\u1ecb SHHC nguy k\u1ecbch.\u00a0<\/span><\/li>\n<\/ul>\n<h3><strong>3.2. C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0M\u1ed9t khi SHHC \u0111\u01b0\u1ee3c ngh\u0129 \u0111\u1ebfn d\u1ef1a tr\u00ean b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng, c\u1ea7n thi\u1ebft ph\u1ea3i l\u00e0m x\u00e9t nghi\u1ec7m v\u00e0 ph\u00e2n t\u00edch k\u1ebft qu\u1ea3 kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n, gi\u00fap ph\u00e2n bi\u1ec7t th\u1ec3 lo\u1ea1i SHHC, \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng, t\u00e1c \u0111\u1ed9ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn chuy\u1ec3n h\u00f3a v\u00e0 quan tr\u1ecdng h\u01a1n l\u00e0 gi\u00fap h\u01b0\u1edbng d\u1eabn c\u00e1ch \u0111i\u1ec1u tr\u1ecb, x\u1eed tr\u00ed SHHC.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><em>3.2.1. Ph\u00e2n t\u00edch k\u1ebft qu\u1ea3 kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch<\/em>:\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2212 pH v\u00e0 PaCO2:\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ B\u00ecnh th\u01b0\u1eddng pH = 7,40 \u00b1 0,05; PaCO2 = 40 \u00b1 5 mmHg.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ Khi BN c\u00f3 l\u00e2m s\u00e0ng c\u1ee7a SHHC, c\u00f3 pH&lt; 7,35 v\u00e0 PaCO2 &gt; 45mmHg \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 SHHC m\u1ee9c \u0111\u1ed9 n\u1eb7ng, th\u1ec3 t\u0103ng cacbonic g\u00e2y nhi\u1ec5m toan h\u00f4 h\u1ea5p m\u1ea5t b\u00f9.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ N\u1ebfu pH&lt; 7,20 ch\u1ee9ng t\u1ecf BN b\u1ecb SHHC m\u1ee9c \u0111\u1ed9 nguy k\u1ecbch \u0111e d\u1ecda t\u00ednh m\u1ea1ng c\u1ea7n \u0111\u01b0\u1ee3c can thi\u1ec7p h\u1ebft s\u1ee9c kh\u1ea9n tr\u01b0\u01a1ng b\u1eb1ng th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0\u2212 PaO2 :\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ B\u00ecnh th\u01b0\u1eddng PaO2 = 60 &#8211; 90 mmHg.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ Khi BN c\u00f3 l\u00e2m s\u00e0ng c\u1ee7a SHHC v\u00e0 c\u00f3 PaO 2 &lt; 55mmHg v\u1edbi PaO 2 \/FiO 2 &lt; 300 \u0111\u01b0\u1ee3c coi l\u00e0 b\u1ecb SHHC c\u00f3 gi\u1ea3m oxy h\u00f3a m\u00e1u n\u1eb7ng.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ N\u1ebfu PaO 2 \/FiO 2 &lt; 200 th\u00ec c\u00f3 gi\u1ea3m oxy h\u00f3a m\u00e1u nghi\u00eam tr\u1ecdng.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2212 HCO 3 &#8211;\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0+ B\u00ecnh th\u01b0\u1eddng HCO3 &#8211; = 24 \u00b1 4 mmol\/l.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ N\u1ebfu BN b\u1ecb SHHC th\u1ec3 t\u0103ng cacbonic m\u00e1u (pH &lt; 7,35 v\u00e0 PaCO2 &gt; 45mmHg) c\u00f3 HCO3 &#8211; &gt;30 mmol\/l \u0111\u01b0\u1ee3c coi l\u00e0 SHHC tr\u00ean n\u1ec1n m\u1ea1n v\u00e0 th\u1eadn \u0111\u00e3 c\u00f3 \u0111\u00e1p \u1ee9ng b\u00f9 tr\u1eeb b\u1eb1ng c\u00e1ch t\u0103ng t\u00e1i h\u1ea5p thu HCO3 &#8211; .<\/span><\/p>\n<p><em><span style=\"font-weight: 400;\">\u00a03.2.2. Ch\u1ee5p X Quang ph\u1ed5i:<\/span><\/em><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0\u2212 C\u1ea7n ph\u1ea3i l\u00e0m ngay t\u1ea1i gi\u01b0\u1eddng cho t\u1ea5t c\u1ea3 c\u00e1c BN b\u1ecb SHHC.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2212 Phim X quang l\u1ed3ng ng\u1ef1c th\u1eb3ng gi\u00fap ph\u00e1t hi\u1ec7n nguy\u00ean nh\u00e2n, lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng t\u1ea1i ph\u1ed5i g\u00e2y SHHC, t\u1eeb \u0111\u00f3 h\u01b0\u1edbng d\u1eabn c\u00e1ch x\u1eed tr\u00ed th\u00edch h\u1ee3p.\u00a0<\/span><\/p>\n<h2><strong>4. \u0110i\u1ec1u tr\u1ecb suy h\u00f4 h\u1ea5p c\u1ea5p<\/strong><\/h2>\n<h3><strong>\u00a04.1. X\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 tr\u1ea7m tr\u1ecdng c\u1ee7a SHHC v\u00e0 quy\u1ebft \u0111\u1ecbnh tr\u00ecnh t\u1ef1 x\u1eed tr\u00ed\u00a0<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u2212 X\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 tr\u1ea7m tr\u1ecdng c\u1ee7a SHHC d\u1ef1a v\u00e0o:\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ M\u1ee9c \u0111\u1ed9 c\u1ea5p t\u00ednh c\u1ee7a SHH.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ M\u1ee9c \u0111\u1ed9 c\u1ee7a gi\u00e1m oxy m\u00e1u, t\u0103ng CO2 v\u00e0 toan m\u00e1u\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ M\u1ee9c \u0111\u1ed9 c\u1ee7a c\u00e1c r\u1ed1i lo\u1ea1n sinh t\u1ed3n xu\u1ea5t hi\u1ec7n c\u00f9ng v\u1edbi SHHC: tim m\u1ea1ch, th\u1ea7n kinh&#8230;\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2212 \u0110\u1ec3 quy\u1ebft \u0111\u1ecbnh ch\u1ecdn l\u1ef1a: d\u00f9ng thu\u1ed1c ho\u1eb7c th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc ngay ?\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ N\u1ebfu b\u1ec7nh nh\u00e2n ch\u1ec9 b\u1ecb SHHC m\u1ee9c \u0111\u1ed9 n\u1eb7ng (ch\u01b0a c\u00f3 c\u00e1c r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng v\u00e0 th\u1ea7n kinh nghi\u00eam tr\u1ecdng) th\u00ec ch\u1ec9 c\u1ea7n \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1eddng th\u1edf, s\u1eed d\u1ee5ng thu\u1ed1c, oxy li\u1ec7u ph\u00e1p v\u00e0 theo d\u00f5i s\u00e1t s\u1ef1 ti\u1ebfn tri\u1ec3n.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ N\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecb SHHC m\u1ee9c \u0111\u1ed9 nguy k\u1ecbch th\u00ec c\u1ea7n nhanh ch\u00f3ng thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng th\u1edf c\u1ea5p c\u1ee9u v\u00e0 ti\u1ebfn h\u00e0nh th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc ngay, sau \u0111\u00f3 m\u1edbi d\u00f9ng thu\u1ed1c ho\u1eb7c ph\u1ea3i s\u1eed d\u1ee5ng song song.\u00a0<\/span><\/p>\n<p><strong>4.2. \u0110\u1ea3m b\u1ea3o \u0111\u01b0\u1eddng th\u1edf<\/strong><\/p>\n<p><span style=\"font-weight: 400;\">L\u00e0 <strong>&#8220;ch\u00eca kh\u00f3a&#8221;<\/strong>, l\u00e0 c\u00f4ng vi\u1ec7c \u0111\u1ea7u ti\u00ean ph\u1ea3i l\u00e0m, ph\u1ea3i xem x\u00e9t cho t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n c\u1ea5p c\u1ee9u, \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi SHHC ngay t\u1eeb gi\u00e2y ph\u00fat \u0111\u1ea7u ti\u00ean khi ti\u1ebfp x\u00fac.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0\u2212 \u0110\u1eb7t b\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf thu\u1eadn l\u1ee3i cho vi\u1ec7c h\u1ed3i s\u1ee9c v\u00e0 l\u01b0u th\u00f4ng \u0111\u01b0\u1eddng th\u1edf:\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ N\u1eb1m nghi\u00eang an to\u00e0n cho b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea ch\u01b0a \u0111\u01b0\u1ee3c can thi\u1ec7p.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ N\u1eb1m ng\u1eeda, c\u1ed5 \u01b0\u1ee1n cho b\u1ec7nh nh\u00e2n ng\u01b0ng th\u1edf ng\u01b0ng tim.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ <a href=\"https:\/\/vinmec.com\/vi\/chu-de\/tu-the-fowler\/\">N\u1eb1m Fowler<\/a> cho b\u1ec7nh nh\u00e2n ph\u00f9 ph\u1ed5i, ph\u00f9 n\u00e3o v\u00e0 ph\u1ea7n l\u1edbn c\u00e1c b\u1ec7nh nh\u00e2n SHHC.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0\u2212 Khai th\u00f4ng kh\u00ed \u0111\u1ea1o hay thi\u1ebft <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/dat-noi-khi-quan-cap-cuu-duong-tho-kho\/\">l\u1eadp \u0111\u01b0\u1eddng th\u1edf c\u1ea5p c\u1ee9u:<\/a>\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ <a href=\"https:\/\/www.vinmec.com\/vi\/chu-de\/nghiem-phap-heimlich\/\">Nghi\u1ec7m ph\u00e1p Heimlich<\/a> cho b\u1ec7nh nh\u00e2n b\u1ecb d\u1ecb v\u1eadt \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0+ \u0110\u1eb7t canule Guedel hay Mayo cho b\u1ec7nh nh\u00e2n t\u1ee5t l\u01b0\u1ee1i.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ H\u00fat s\u1ea1ch \u0111\u00e0m nh\u1edbt, th\u1ee9c \u0103n \u1edf mi\u1ec7ng &#8211; h\u1ecdng khi b\u1ec7nh nh\u00e2n b\u1ecb t\u1eafc \u0111\u00e0m hay \u00f3i, h\u00edt s\u1eb7c.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ \u0110\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n hay m\u1edf kh\u00ed qu\u1ea3n, ho\u1eb7c ch\u1ecdc kim l\u1edbn qua m\u00e0ng gi\u00e1p nh\u1eabn.\u00a0<\/span><\/p>\n<h3><strong>4.3. \u0110i\u1ec1u tr\u1ecb gi\u1ea3m oxy m\u00e1u<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0+ L\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay s\u1ef1 gi\u1ea3m O2 m\u00e1u do b\u1ea5t k\u1ef3 c\u01a1 ch\u1ebf n\u00e0o, c\u1ea7n \u0111i\u1ec1u tr\u1ecb O2 ngay n\u1ebfu c\u00f3 gi\u1ea3m O2 m\u00e1u n\u1eb7ng hay nghi ng\u1edd gi\u1ea3m O2 m\u00f4. PaO2 m\u1ee9c \u0111\u1ed9 n\u00e0o c\u00f3 th\u1ec3 g\u00e2y gi\u1ea3m O2 m\u00f4 kh\u00f4ng th\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c \u0111\u01b0\u1ee3c do c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng nh\u01b0 [Hb], \u00e1i l\u1ef1c HbO2, CO t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn s\u1ef1 cung c\u1ea5p O2 cho m\u00f4. Gi\u1ea3m O2 m\u00f4 nh\u1eb9 khi c\u00f3 gi\u1ea3m O2 m\u00e1u n\u1eb7ng (&lt;45 mmHg), PaO2 45- 59 mmHg c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi gi\u1ea3m O2 m\u00f4 n\u1ebfu h\u1ec7 th\u1ed1ng tim m\u1ea1ch kh\u00f4ng th\u1ec3 b\u00f9 tr\u1eeb. PaO2 &gt; 60 mmHg th\u01b0\u1eddng kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi gi\u1ea3m O2 m\u00f4. \u0110i\u1ec1u tr\u1ecb O2 khi PaO2 &lt; 60mmHg hay SaO2 &lt; 90%. \u0110i\u1ec1u tr\u1ecb O2 l\u00e2u d\u00e0i th\u01b0\u1eddng kh\u00f4ng c\u1ea7n thi\u1ebft tr\u1eeb khi PaO2 &lt; 55 mmHg (k\u1ec3 c\u1ea3 trong l\u00fac ng\u1ee7 hay g\u1eafng s\u1ee9c). B\u1ec7nh nh\u00e2n COPD, PaO2 gi\u1ea3m # 13mmHg l\u00fac ng\u1ee7.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ M\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb l\u00e0 duy tr\u00ec PaO2 v\u00e0 ng\u0103n ng\u1eeba gi\u1ea3m O2 m\u00f4. PaO2 = 60 mmHg l\u00e0 \u0111\u1ee7 v\u1edbi \u0111i\u1ec1u ki\u1ec7n Hct v\u00e0 cung l\u01b0\u1ee3ng tim \u0111\u1ea7y \u0111\u1ee7. BN b\u1ec7nh m\u1ea1ch v\u00e0nh hay m\u1ea1ch n\u00e3o c\u00f3 th\u1ec3 c\u1ea7n oxy m\u00e1u h\u01a1i cao h\u01a1n 1 ch\u00fat.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0\u2212 N\u1ebfu b\u1eaft \u0111\u1ea7u c\u00f3 gi\u1ea3m oxy h\u00f3a m\u00e1u nh\u1eb9 \u0111\u1ebfn v\u1eeba (PaO2 = 45 \u2013 59 mmHg v\u1edbi kh\u00ed tr\u1eddi) th\u00ec ch\u1ec9 c\u1ea7n s\u1eed d\u1ee5ng oxy li\u1ec7u ph\u00e1p qua th\u00f4ng kh\u00ed t\u1ef1 nhi\u00ean v\u1edbi c\u00e1c d\u1ee5ng c\u1ee5 th\u00f4ng th\u01b0\u1eddng: qua cannula, catheter m\u0169i, mask oxy th\u00f4ng th\u01b0\u1eddng gi\u00fap t\u0103ng n\u1ed3ng \u0111\u1ed9 oxy trong kh\u00ed h\u00edt v\u00e0o (FiO2 = 24 \u2013 40 %).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2212 \u0110\u1ed1i v\u1edbi \u0111\u1ee3t c\u1ea5p m\u1ea5t b\u00f9 c\u1ee7a SHH m\u1ea1n th\u00ec m\u1ee5c ti\u00eau l\u00e0 \u0111\u1ea3m b\u1ea3o PaO2 \u2248 60 mmHg hay SaO2\u2248 90% tr\u00e1nh l\u00e0m n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng toan h\u00f4 h\u1ea5p b\u1eb1ng c\u00e1ch b\u1eaft \u0111\u1ea7u t\u1eeb l\u01b0u l\u01b0\u1ee3ng th\u1ea5p nh\u1ea5t r\u1ed3i t\u0103ng d\u1ea7n c\u00f3 \u0111\u00e1nh gi\u00e1, theo d\u00f5i kh\u00ed m\u00e1u tr\u01b0\u1edbc khi quy\u1ebft \u0111\u1ecbnh t\u0103ng FiO2, n\u1ebfu to\u00e0n tr\u1ea1ng x\u1ea5u d\u1ea7n ho\u1eb7c pH&lt; 7,30 th\u00ec c\u1ea7n xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh th\u1edf m\u00e1y.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2212 Khi c\u00f3 gi\u1ea3m oxy h\u00f3a m\u00e1u n\u1eb7ng (PaO2\/FiO2 &lt; 300), c\u1ea7n s\u1eed d\u1ee5ng mask kh\u00f4ng th\u1edf l\u1ea1i (FiO2 = 60 \u2013 90 %), n\u1ebfu kh\u00f4ng hi\u1ec7u qu\u1ea3 c\u1ea7n ch\u1ec9 \u0111\u1ecbnh oxy li\u1ec7u ph\u00e1p qua th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o (th\u1edf m\u00e1y) kh\u00f4ng x\u00e2m nh\u1eadp (qua mask) ho\u1eb7c x\u00e2m nh\u1eadp (c\u00f3 \u0111\u1eb7t NKQ) cho ph\u00e9p v\u1eeba t\u0103ng n\u1ed3ng \u0111\u1ed9 oxy trong kh\u00ed th\u1edf v\u00e0o v\u1eeba c\u00f3 th\u1ec3 d\u00f9ng bi\u1ec7n ph\u00e1p \u0111\u1eb7c bi\u1ec7t l\u00e0 \u00e1p l\u1ef1c d\u01b0\u01a1ng cu\u1ed1i k\u1ef3 th\u1edf ra (PEEP).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2212 Khi c\u00f3 gi\u1ea3m oxy h\u00f3a m\u00e1u nghi\u00eam tr\u1ecdng (PaO2\/FiO2 &lt; 200) c\u1ea7n th\u1edf m\u00e1y x\u00e2m nh\u1eadp v\u1edbi c\u00e1c ph\u01b0\u01a1ng th\u1ee9c \u0111\u1eb7c bi\u1ec7t nh\u01b0 PEEP t\u1ed1i \u01b0u, huy \u0111\u1ed9ng ph\u1ebf nang, \u0111\u1ea3o ng\u01b0\u1ee3c t\u1ef7 l\u1ec7 I\/E (IRV), ch\u1ea5p nh\u1eadn t\u0103ng cacbonic\u2026\u00a0<\/span><\/p>\n<p><em><span style=\"font-weight: 400;\">4.3.1. C\u00e1c d\u1ee5ng c\u1ee5 cung c\u1ea5p O2:<\/span><\/em><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0C\u00f3<strong> 2<\/strong> h\u1ec7 th\u1ed1ng cung c\u1ea5p O2:\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; H\u1ec7 th\u1ed1ng l\u01b0u l\u01b0\u1ee3ng cao: l\u01b0u l\u01b0\u1ee3ng \u0111\u1ee7 th\u1ecfa m\u00e3n nhu c\u1ea7u h\u00edt v\u00e0o c\u1ee7a b\u1ec7nh nh\u00e2n. H\u1ec7 th\u1ed1ng l\u01b0u l\u01b0\u1ee3ng cao cung c\u1ea5p FiO2 ch\u00ednh x\u00e1c, ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c nhi\u1ec7t \u0111\u1ed9, \u0111\u1ed9 \u1ea9m c\u1ee7a kh\u00ed h\u00edt v\u00e0o. B\u1ea5t l\u1ee3i l\u00e0 \u1ed3n \u00e0o, kh\u00f4ng ti\u1ec7n d\u1ee5ng.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0&#8211; H\u1ec7 th\u1ed1ng l\u01b0u l\u01b0\u1ee3ng th\u1ea5p: L\u01b0u l\u01b0\u1ee3ng th\u1ea5p h\u01a1n nhu c\u1ea7u h\u00edt v\u00e0o c\u1ee7a b\u1ec7nh nh\u00e2n (\u1ed1ng th\u00f4ng m\u0169i, mask \u0111\u01a1n gi\u1ea3n, mask th\u1edf l\u1ea1i m\u1ed9t ph\u1ea7n hay kh\u00f4ng th\u1edf l\u1ea1i). Thu\u1eadn l\u1ee3i l\u00e0 \u0111\u01a1n gi\u1ea3n v\u00e0 b\u1ec7nh nh\u00e2n d\u1ec5 ch\u1ea5p nh\u1eadn. B\u1ea5t l\u1ee3i l\u00e0 ki\u1ec3m so\u00e1t kh\u00f4ng ch\u00ednh x\u00e1c FiO2.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">H\u1ec7 th\u1ed1ng th\u1edf l\u1ea1i m\u1ed9t ph\u1ea7n, 1\/3 kh\u00ed th\u1edf ra \u0111\u01b0\u1ee3c gi\u1eef l\u1ea1i trong t\u00fai tr\u1eef v\u00e0 \u0111\u01b0\u1ee3c th\u1edf l\u1ea1i. Do kh\u00ed th\u1edf c\u00f3 nhi\u1ec1u O2 n\u00ean FiO2 t\u0103ng. H\u1ec7 th\u1ed1ng n\u00e0y ch\u1ec9 d\u00f9ng cho b\u1ec7nh nh\u00e2n c\u00f3 kh\u00ed l\u01b0u th\u00f4ng b\u00ecnh th\u01b0\u1eddng, nh\u1ecbp h\u00f4 h\u1ea5p # 12 l\u1ea7n\/p. Khi b\u1ec7nh nh\u00e2n th\u1edf nhanh s\u00e2u h\u01a1n l\u00e0m FiO2 gi\u1ea3m v\u00e0 ng\u01b0\u1ee3c l\u1ea1i.<\/span><\/p>\n<p><em><span style=\"font-weight: 400;\">4.3.2. \u0110i\u1ec1u tr\u1ecb O2 qu\u00e1 m\u1ee9c:\u00a0<\/span><\/em><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; FiO2 cao: g\u00e2y m\u1ed9t s\u1ed1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng, ng\u1ed9 \u0111\u1ed9c (\u0111au t\u1ee9c sau x\u01b0\u01a1ng \u1ee9c trong v\u00f2ng 6h sau khi th\u1edf O2 FiO2 100%). FiO2 100% l\u00e0m x\u1eb9p ph\u1ed5i do h\u1ea5p thu (kh\u00ed \u1ee9 trong ph\u1ebf nang \u0111\u01b0\u1ee3c h\u1ea5p thu nhanh h\u01a1n b\u00ecnh th\u01b0\u1eddng khi n\u1ed3ng \u0111\u1ed9 O2 cao). Sau th\u1edf FiO2 100% s\u1ebd ph\u00e1t tri\u1ec3n shunt 10%.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; PaO2 cao: PaO2 cao \u1edf m\u00e1u v\u00f5ng m\u1ea1c g\u00e2y co m\u1ea1ch d\u1eabn \u0111\u1ebfn m\u00f9 v\u0129nh vi\u1ec5n. . B\u1ec7nh nh\u00e2n COPD v\u1edbi t\u0103ng PaCO2, t\u0103ng PO2 d\u1eabn \u0111\u1ebfn gi\u1ea3m th\u00f4ng kh\u00ed v\u00e0 t\u0103ng PaCO2, \u0111\u00f4i khi ng\u01b0ng th\u1edf \u1edf ng\u01b0\u1eddi nh\u1ea1y c\u1ea3m. PaO2 &gt; 150mmHg d\u1eabn \u0111\u1ebfn co m\u1ea1ch v\u00e0nh, r\u1ed1i lo\u1ea1n nh\u1ecbp.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">4.3.3.\u00a0 \u00c1p d\u1ee5ng l\u00e2m s\u00e0ng:<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0B\u01b0\u1edbc \u0111\u1ea7u ti\u00ean tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb O2 c\u1ea7n ph\u00e2n chia b\u1ec7nh nh\u00e2n th\u00e0nh 2 nh\u00f3m: nh\u00f3m nh\u1ea1y c\u1ea3m O2 v\u00e0 nh\u00f3m kh\u00f4ng nh\u1ea1y c\u1ea3m O2, do \u0111i\u1ec1u tr\u1ecb m\u1ed7i nh\u00f3m c\u00f3 kh\u00e1c nhau.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ B\u1ec7nh nh\u00e2n kh\u00f4ng nh\u1ea1y c\u1ea3m O2:\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Khi kh\u00f4ng c\u00f3 \u1ee9 CO2 hay COPD, \u0111i\u1ec1u tr\u1ecb O2 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng m\u00e0 kh\u00f4ng l\u01b0u t\u00e2m nhi\u1ec1u \u0111\u1ebfn gi\u1ea3m th\u00f4ng kh\u00ed. Kh\u00f4ng n\u00ean do d\u1ef1 cho O2 li\u1ec1u cao khi nghi ng\u1edd gi\u1ea3m O2 m\u00f4. O2 li\u1ec1u th\u1ea5p s\u1ebd th\u1eadt s\u1ef1 kh\u00f4ng \u0111\u1ee7 \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng nh\u1ea1y c\u1ea3m O2. Sau khi b\u1ec7nh nh\u00e2n \u1ed5n, li\u1ec1u O2 gi\u1ea3m d\u1ea7n \u0111\u1ec3 tr\u00e1nh bi\u1ebfn ch\u1ee9ng.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ B\u1ec7nh nh\u00e2n nh\u1ea1y c\u1ea3m O2:\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">C\u1ea7n c\u1ea9n th\u1eadn \u1edf b\u1ec7nh nh\u00e2n COPD hay \u1ee9 CO2 m\u1ea1n t\u00ednh. D\u00f9ng O2 qu\u00e1 m\u1ee9c c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong. Tuy nhi\u00ean, \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u v\u1eabn l\u00e0 \u0111i\u1ec1u ch\u1ec9nh gi\u1ea3m O2 m\u00f4. \u0110i\u1ec1u tr\u1ecb b\u01b0\u1edbc \u0111\u1ea7u trong COPD \u0111\u1ee3t c\u1ea5p l\u00e0 \u0111i\u1ec1u tr\u1ecb O2 li\u1ec1u th\u1ea5p. D\u00f9 PaCO2 &gt; 60-65 mmg, nhi\u1ec1u b\u1ec7nh nh\u00e2n COPD v\u1eabn c\u00f3 th\u1ec3 ch\u1ecbu \u0111\u1ef1ng \u0111\u01b0\u1ee3c m\u00e0 kh\u00f4ng c\u1ea7n th\u1edf m\u00e1y (tr\u1eeb khi pH &lt; 7.2 v\u00e0 t\u1ea5t c\u1ea3 c\u00e1c bi\u1ec7n ph\u00e1p kh\u00e1c th\u1ea5t b\u1ea1i).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb O2\/COPD l\u00e0 \u0111\u1ea1t <strong>60mmHg<\/strong> \u0111\u1ec3 tr\u00e1nh gi\u1ea3m O2 m\u00f4 v\u00e0 t\u0103ng PaCO2.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; Ch\u1ecdn l\u1ef1a FiO2: Trong \u0111\u1ee3t c\u1ea5p COPD, n\u1ebfu t\u0103ng FiO2 0.01 th\u00ec PaO2 t\u0103ng 3mmHg. VD b\u1ec7nh nh\u00e2n COPD c\u00f3 PaO2 39mmHg v\u1edbi FiO2 21%, th\u00ec \u0111\u1ec3 \u0111\u1ea1t PaO2 60mmHg, FiO2 c\u1ea7n l\u00e0 28%.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Ng\u1ed9 \u0111\u1ed9c CO2: lu\u00f4n lu\u00f4n \u00fd th\u1ee9c l\u00e0 t\u0103ng PaO2 d\u1eabn \u0111\u1ebfn t\u0103ng PaCO2.\u00a0\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">T\u0103ng PaCO2 t\u1ec9 l\u1ec7 v\u1edbi t\u0103ng FiO2. Trong m\u1ed9t nghi\u00ean c\u1ee9u, PaCO2 t\u0103ng 5mmHg khi FiO2 24%, 8 mmHg khi FiO2 28%. Kh\u00f4ng n\u00ean ng\u1eebng \u0111\u1ed9t ng\u1ed9t O2 \u0111i\u1ec1u tr\u1ecb v\u00ec PaCO2 t\u0103ng c\u00f3 th\u1ec3 g\u00e2y r\u1ed1i lo\u1ea1n th\u00eam n\u1eefa.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">T\u0103ng PaCO2 \u0111\u1ed9t ng\u1ed9t d\u1eabn \u0111\u1ebfn ng\u1ed9 \u0111\u1ed9c CO2 (CO2 narcosis): t\u0103ng PaCO2, toan m\u00e1u, l\u01a1 m\u01a1 \u0111\u1ebfn h\u00f4n m\u00ea. C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a t\u0103ng CO2 nh\u1eb9 v\u00e0 v\u1eeba g\u1ed3m gi\u1ea3m ch\u1ee9c n\u0103ng n\u00e3o, nh\u1ee9c \u0111\u1ea7u, u s\u1ea7u, th\u1ea5t \u0111i\u1ec1u.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 PaCO2 b\u00ecnh th\u01b0\u1eddng nh\u01b0ng c\u00f3 bi\u1ec3u hi\u1ec7n t\u0103ng th\u00e1n kh\u00ed m\u00e3n t\u00ednh: m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 PaCO2 gi\u1ea3m trong l\u00fac b\u1ed9c ph\u00e1t b\u1ec7nh, nh\u01b0 v\u1eady khi \u0111o PaCO2 th\u1ea5y n\u1eb1m trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng. Do \u0111\u00f3 c\u1ea7n th\u1eadn tr\u1ecdng khi cho O2 \u1edf b\u1ec7nh nh\u00e2n COPD b\u1ea5t k\u1ec3 c\u00f3 t\u0103ng PaCO2 hay kh\u00f4ng.<\/span><\/li>\n<\/ul>\n<h3><strong>4.4. \u0110i\u1ec1u tr\u1ecb t\u0103ng CO2<\/strong><\/h3>\n<ul>\n<li><span style=\"font-weight: 400;\">\u00a0T\u0103ng cacbonic g\u00e2y nhi\u1ec5m toan h\u00f4 h\u1ea5p ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n g\u00e2y gi\u1ea3m cung c\u1ea5p v\u00e0 t\u0103ng nhu c\u1ea7u th\u00f4ng kh\u00ed ho\u1eb7c th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc b\u1eb1ng m\u00e1y t\u1ea1m th\u1eddi thay th\u1ebf.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u00a0Vi\u1ec7c d\u00f9ng bicacbonat (NaHCO3) \u0111\u1ec3 s\u1eeda ch\u1eefa t\u00ecnh tr\u1ea1ng nhi\u1ec5m toan trong SHHC c\u0169ng c\u1ea7n h\u1ebft s\u1ee9c th\u1eadn tr\u1ecdng v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o, v\u00ec NaHCO3 kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng \u0111i\u1ec1u ch\u1ec9nh <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/nhiem-toan-la-tinh-trang-gi\/\">nhi\u1ec5m toan<\/a> l\u00e2u d\u00e0i trong khi c\u00f3 th\u1ec3 g\u00e2y nhi\u1ec5m toan n\u1ed9i b\u00e0o v\u00e0 \u0111\u1eb7c bi\u1ec7t c\u00f3 th\u1ec3 g\u00e2y n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng thi\u1ebfu oxy cho m\u00f4 t\u1ebf b\u00e0o do l\u00e0m t\u0103ng \u00e1i l\u1ef1c g\u1eafn k\u1ebft c\u1ee7a hemoglobin v\u1edbi oxy.<\/span><\/li>\n<\/ul>\n<h3><strong>4.5. \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n g\u00e2y SHHC<\/strong><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">C\u1ea7n ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n g\u00e2y SHHC song song c\u00f9ng v\u1edbi vi\u1ec7c s\u1eeda ch\u1eefa t\u00ecnh tr\u1ea1ng gi\u1ea3m oxy m\u00e1u, t\u0103ng cacbonic g\u00e2y nhi\u1ec5m toan h\u00f4 h\u1ea5p n\u1ebfu c\u00f3 th\u1ec3.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u00a0\u0110\u1ed1i v\u1edbi SHHC do c\u00e1c b\u1ec7nh t\u1ea1i ph\u1ed5i:\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">+ <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/di-vat-duong-tho-bo-quen\/\">L\u1ea5y b\u1ecf d\u1ecb v\u1eadt trong t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf<\/a>\u2026\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ Kh\u00e1ng sinh trong vi\u00eam ph\u1ed5i, gi\u00e3n ph\u1ebf qu\u1ea3n v\u00e0 ch\u1ed1ng vi\u00eam trong hen ph\u1ebf qu\u1ea3n v\u00e0 COPD\u2026\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ Ch\u1ecdc th\u00e1o <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/nguyen-nhan-va-chan-doan-tran-khi-mang-phoi\/\">d\u1eabn l\u01b0u trong tr\u00e0n d\u1ecbch \u2013 kh\u00ed m\u00e0ng ph\u1ed5i<\/a>\u2026\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2212 \u0110\u1ed1i v\u1edbi SHHC do nguy\u00ean nh\u00e2n ngo\u00e0i ph\u1ed5i:\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ Gi\u1ea3i \u0111\u1ed9c \u0111\u1eb7c hi\u1ec7u b\u1eb1ng <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/hoi-dap-bac-si\/ngo-doc-cap-do-thuoc-phien-thuoc-heroin-co-nhung-bieu-hien-gi\/\">Naloxon trong ng\u1ed9 \u0111\u1ed9c Heroin<\/a> \u2013 Morphin, Anexate trong ng\u1ed9 \u0111\u1ed9c Benzodiazepine\u2026\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ Ph\u1eabu thu\u1eadt l\u1ea5y m\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng trong CTSN, thu\u1ed1c <a href=\"https:\/\/www.vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/dieu-tri-tai-tuoi-mau-o-benh-nhan-thieu-mau-co-tim\/\">ti\u00eau s\u1ee3i huy\u1ebft t\u00e1i t\u01b0\u1edbi m\u00e1u<\/a> trong \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u\u2026<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0+ L\u1ecdc m\u00e1u, thay huy\u1ebft t\u01b0\u01a1ng trong b\u1ec7nh nh\u01b0\u1ee3c c\u01a1, Guillain-Barr\u00e9\u2026.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ C\u1ed1 \u0111\u1ecbnh gi\u1ea3m \u0111au t\u1ed1t trong g\u00e3y nhi\u1ec1u x\u01b0\u01a1ng s\u01b0\u1eddn, m\u1ea3ng s\u01b0\u1eddn di \u0111\u1ed9ng\u2026<\/span><\/p>\n<h3><strong><em>4.6. <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/nhung-dieu-can-biet-ve-tho-may\/\">Th\u1edf m\u00e1y<\/a> ( th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc &#8211; nh\u00e2n t\u1ea1o )<\/em><\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u2212 Ch\u1ec9 l\u00e0 bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 nh\u00e2n t\u1ea1o t\u1ea1m th\u1eddi ch\u1edd \u0111\u1ee3i gi\u1ea3i quy\u1ebft nguy\u00ean nh\u00e2n g\u00e2y SHHC v\u00e0 ph\u1ee5c h\u1ed3i h\u00f4 h\u1ea5p (th\u00f4ng kh\u00ed) t\u1ef1 nhi\u00ean.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2212 \u0110\u01b0\u1ee3c s\u1eed d\u1ee5ng khi th\u00f4ng kh\u00ed t\u1ef1 nhi\u00ean kh\u00f4ng \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1ee3c ch\u1ee9c n\u0103ng c\u1ee7a m\u00ecnh, nh\u1eb1m cung c\u1ea5p m\u1ed9t s\u1ef1 tr\u1ee3 gi\u00fap nh\u00e2n t\u1ea1o v\u1ec1 th\u00f4ng kh\u00ed v\u00e0 oxy h\u00f3a.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ Ch\u1ec9 \u0111\u1ecbnh:\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">T\u1ea7n s\u1ed1 h\u00f4 h\u1ea5p &gt; 35 l \/p .\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Th\u1edf v\u00e0o g\u1eafng s\u1ee9c t\u1ed1i \u0111a &lt; &#8211; 25 cmH2O.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Dung t\u00edch s\u1ed1ng &lt;10-15ml\/kg c\u00e2n n\u1eb7ng.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">PaO2 &lt; 60 mmHg v\u1edbi FiO2 &gt;60%.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">PaCO2 &gt;50mmHg v\u1edbi pH &lt; 7,35.<\/span><\/p>\n<h3><strong><em>4.7. Theo d\u00f5i b\u1ec7nh nh\u00e2n suy h\u00f4 h\u1ea5p<\/em><\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">&#8211; Nh\u1ecbp th\u1edf, Vt, s\u1eed d\u1ee5ng c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5, c\u00f3 th\u1edf ngh\u1ecbch th\u01b0\u1eddng.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; Khi BN th\u1edf m\u00e1y, c\u1ea7n theo d\u00f5i c\u1ea9n th\u1eadn nh\u1eefng bi\u1ebfn ch\u1ee9ng k\u1ebft h\u1ee3p th\u1edf m\u00e1y.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">&#8211; \u0110\u1eb7t catheter \u0111\u1ed9ng m\u1ea1ch, t\u0129nh m\u1ea1ch, thu\u1ed1c c\u1ea7n thi\u1ebft, kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch\u2026<\/span><\/p>\n<p>&nbsp;<\/p>\n<p>Xem th\u00eam:<\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/chan-doan-va-dieu-tri-suy-ho-hap-cap-o-tre-em\/\">Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb suy h\u00f4 h\u1ea5p c\u1ea5p \u1edf tr\u1ebb em | Vinmec<\/a><\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/cac-loai-suy-ho-hap-thuong-gap\/\">C\u00e1c lo\u1ea1i suy h\u00f4 h\u1ea5p th\u01b0\u1eddng g\u1eb7p | Vinmec<\/a><\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/nhi\/suy-ho-hap-cap-o-tre-em\/\">Suy h\u00f4 h\u1ea5p c\u1ea5p \u1edf tr\u1ebb em | Vinmec<\/a><\/p>\n<p>Video \u0111\u1ec1 xu\u1ea5t:<\/p>\n<p><iframe loading=\"lazy\" title=\"Suy h\u00f4 h\u1ea5p \u1edf tr\u1ebb s\u01a1 sinh c\u00f3 nguy hi\u1ec3m kh\u00f4ng| BS Ma V\u0103n Th\u1ea5m, BV  Ph\u00fa Qu\u1ed1c\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/HQXg2zNo4H0?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe><\/p>\n<p>Suy h\u00f4 h\u1ea5p \u1edf tr\u1ebb s\u01a1 sinh c\u00f3 nguy hi\u1ec3m kh\u00f4ng?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Suy h\u00f4 h\u1ea5p l\u00e0 m\u1ed9t trong nh\u1eefng t\u00ecnh tr\u1ea1ng nguy hi\u1ec3m v\u00e0 kh\u00f3 l\u01b0\u1eddng nh\u1ea5t hi\u1ec7n nay. N\u00f3 c\u00f3 th\u1ec3 x\u1ea3y ra m\u1ed9t c\u00e1ch \u0111\u1ed9t ng\u1ed9t, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u b\u00e1o tr\u01b0\u1edbc nh\u01b0ng c\u0169ng c\u00f3 khi n\u00f3 x\u1ea3y ra m\u1ed9t c\u00e1ch t\u1eeb t\u1eeb n\u00ean nhi\u1ec1u ng\u01b0\u1eddi b\u1ec7nh ch\u1ee7 quan cho \u0111\u1ebfn khi c\u00e1c tri\u1ec7u ch\u1ee9ng [&hellip;]<\/p>\n","protected":false},"author":17,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ph\u00e1c \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb suy h\u00f4 h\u1ea5p c\u1ea5p - Vinmec<\/title>\n<meta name=\"description\" content=\"Suy h\u00f4 h\u1ea5p l\u00e0 t\u00ecnh tr\u1ea1ng nguy hi\u1ec3m v\u00e0 kh\u00f3 l\u01b0\u1eddng nh\u1ea5t hi\u1ec7n nay.Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n s\u1edbm v\u00e0 k\u1ecbp th\u1eddi.\" \/>\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=\"Ph\u00e1c \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb suy h\u00f4 h\u1ea5p c\u1ea5p - 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