{"id":29254,"date":"2023-04-29T11:05:38","date_gmt":"2023-04-29T04:05:38","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29254"},"modified":"2023-04-29T11:05:38","modified_gmt":"2023-04-29T04:05:38","slug":"tran-dich-mang-phoi-do-lao-chan-doan-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/tran-dich-mang-phoi-do-lao-chan-doan-va-dieu-tri\/","title":{"rendered":"Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do lao: ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do lao l\u00e0 b\u1ec7nh kh\u00e1 th\u01b0\u1eddng g\u1eb7p, x\u1ebfp h\u00e0ng th\u1ee9 3 sau lao ph\u1ed5i v\u00e0 lao h\u1ea1ch, chi\u1ebfm 25% \u0111\u1ebfn 37% c\u00e1c tr\u01b0\u1eddng h\u1ee3p tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i. B\u1ec7nh c\u00f3 th\u1ec3 g\u1eb7p \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i, nh\u01b0ng \u1edf tu\u1ed5i tr\u1ebb nhi\u1ec1u h\u01a1n, nam nhi\u1ec1u h\u01a1n n\u1eef, c\u00f3 th\u1ec3 TDMP \u0111\u01a1n thu\u1ea7n ho\u1eb7c ph\u1ed1i h\u1ee3p v\u1edbi t\u1ed5n th\u01b0\u01a1ng lao \u1edf nhu m\u00f4 ph\u1ed5i. <\/strong>Ng\u01b0\u1eddi nhi\u1ec5m HTV c\u00f3 t\u1ef7 l\u1ec7 b\u1ec7nh cao h\u01a1n.\u00a0Ti\u00ean l\u01b0\u1ee3ng TDMP do lao n\u00f3i chung l\u00e0 t\u1ed1t n\u1ebfu \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u00fang, tuy nhi\u00ean c\u1ea7n \u0111\u1ec1 ph\u00f2ng c\u00e1c bi\u1ebfn ch\u1ee9ng n\u1eb7ng do ph\u00e1t hi\u1ec7n mu\u1ed9n ho\u1eb7c \u0111i\u1ec1u tr\u1ecb kh\u00f4ng \u0111\u00fang nh\u01b0 vi\u00eam m\u1ee7 m\u00e0ng ph\u1ed5i, tr\u00e0n d\u1ecbch k\u1ebft h\u1ee3p v\u1edbi tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, d\u00e0y d\u00ednh m\u00e0ng ph\u1ed5i, \u1ed5 c\u1eb7n m\u00e0ng ph\u1ed5i.<\/strong><\/p>\n

1. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do lao.<\/h2>\n

\u2014 Tri\u1ec7u ch\u1ee9ng: \u0111a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 bi\u1ec3u hi\u1ec7n ho, ch\u1ee7 y\u1ebfu l\u00e0 ho khan xu\u1ea5t hi\u1ec7n khi thay \u0111\u1ed5i t\u01b0 th\u1ebf, \u0111au ng\u1ef1c v\u00e0 s\u1ed1t, \u0111au ng\u1ef1c th\u01b0\u1eddng c\u00f3 tr\u01b0\u1edbc. Kh\u00f3
\nth\u1edf t\u0103ng d\u1ea7n ch\u1ee7 y\u1ebfu do t\u0103ng l\u01b0\u1ee3ng d\u1ecbch trong khoang m\u00e0ng ph\u1ed5i. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p bi\u1ec3u hi\u1ec7n \u00edt c\u1ea5p t\u00ednh h\u01a1n nh\u01b0 \u0111au ng\u1ef1c nh\u1eb9, s\u1ed1t nh\u1eb9, ho
\nkhan, s\u00fat c\u00e2n, m\u1ec7t m\u1ecfi.<\/p>\n

\u2014 Kh\u00e1m l\u00e2m s\u00e0ng t\u1ea1i ph\u1ed5i c\u00f3 h\u1ed9i ch\u1ee9ng 3 gi\u1ea3m: rung thanh gi\u1ea3m, g\u00f5 \u0111\u1ee5c, r\u00ec r\u00e0o ph\u1ebf nang gi\u1ea3m ho\u1eb7c m\u1ea5t, c\u00f3 th\u1ec3 th\u1ea5y ti\u1ebfng c\u1ecd m\u00e0ng ph\u1ed5i \u1edf giai \u0111o\u1ea1n kh\u1edfi
\n\u0111\u1ea7u ho\u1eb7c giai \u0111o\u1ea1n h\u1ea5p thu g\u1ea7n h\u1ebft d\u1ecbch.<\/p>\n

2. \u0110\u1eb7c \u0111i\u1ec3m c\u1eadn l\u00e2m s\u00e0ng c\u1ee7a tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do lao<\/h2>\n

\u2014 X-quang ph\u1ed5i th\u1eb3ng v\u00e0 nghi\u00eang: th\u1ea5y h\u00ecnh m\u1edd \u0111\u1ec1u. D\u1ef1a tr\u00ean X-quang c\u00f3 th\u1ec3 chia ra c\u00e1c m\u1ee9c \u0111\u1ed9 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i:<\/p>\n

+ Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i \u00edt: t\u00f9 g\u00f3c s\u01b0\u1eddn ho\u00e0nh.<\/p>\n

+ Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i trung b\u00ecnh: h\u00ecnh m\u1edd \u1edf n\u1eeda d\u01b0\u1edbi khoang m\u00e0ng ph\u1ed5i, \u0111\u01b0\u1eddng cong Damoiseau. Th\u01b0\u1eddng k\u00e8m theo c\u01a1 ho\u00e0nh b\u1ecb \u0111\u1ea9y th\u1ea5p, trung th\u1ea5t
\nl\u1ec7ch sang b\u00ean \u0111\u1ed1i di\u1ec7n.<\/p>\n

+ Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i nhi\u1ec1u: h\u00ecnh m\u1edd v\u01b0\u1ee3t qu\u00e1 1\/2 khoang m\u00e0ng ph\u1ed5i, c\u00f3 th\u1ec3 m\u1edd \u0111\u1ec1u to\u00e0n b\u1ed9 m\u1ed9t b\u00ean l\u1ed3ng ng\u1ef1c. K\u00e8m theo c\u01a1 ho\u00e0nh b\u1ecb \u0111\u1ea9y th\u1ea5p, trung
\nth\u1ea5t l\u1ec7ch sang b\u00ean \u0111\u1ed1i di\u1ec7n.<\/p>\n

\u2014 Si\u00eau \u00e2m m\u00e0ng ph\u1ed1i: th\u1ea5y h\u00ecnh tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, b\u00ean c\u1ea1nh \u0111\u00f3 c\u00f2n gi\u00fap \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng v\u00e1ch h\u00f3a khoang m\u00e0ng ph\u1ed5i.<\/p>\n

\u2014 Ch\u1ecdc h\u00fat d\u1ecbch m\u00e0ng ph\u1ed5i d\u1ecbch th\u01b0\u1eddng m\u00e0u v\u00e0ng chanh, r\u1ea5t hi\u1ebfm khi d\u1ecbch m\u00e0u h\u1ed3ng m\u00e0 v\u1eabn c\u00f3 nguy\u00ean nh\u00e2n do lao.<\/p>\n

\u2014 Ph\u1ea3n \u1ee9ng Mantoux: \u0111\u01b0\u1eddng k\u00ednh s\u1ea9n c\u1ee5c > 10 mm sau 72 gi\u1edd ti\u00eam trong da 5 \u0111\u01a1n v\u1ecb tuberculin \u0111\u01b0\u1ee3c coi l\u00e0 ph\u1ea3n \u1ee9ng d\u01b0\u01a1ng t\u00ednh. Mantoux (+) th\u1ea5y \u1edf 70-80%\u00a0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p TDMP do lao. \u1ede ng\u01b0\u1eddi nhi\u1ec5m HIV k\u00edch th\u01b0\u1edbc n\u00e0y tr\u00ean 5 mm l\u00e0 d\u01b0\u01a1ng t\u00ednh. N\u1ebfu k\u1ebft qu\u1ea3 \u00e2m t\u00ednh c\u0169ng kh\u00f4ng lo\u1ea1i tr\u1eeb ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n
\ndo lao.<\/p>\n

\u2014 X\u00e9t nghi\u1ec7m t\u00ecm AFB trong \u0111\u1eddm v\u00e0 d\u1ecbch m\u00e0ng ph\u1ed5i, v\u1edbi d\u1ecbch m\u00e0ng ph\u1ed5i n\u00ean l\u00e0m theo ph\u01b0\u01a1ng ph\u00e1p ly t\u00e2m l\u1eafng c\u1eb7n. B\u1ec7nh ph\u1ea9m c\u1ea7n g\u1eedi l\u00e0m x\u00e9t nghi\u1ec7m
\nnu\u00f4i c\u1ea5y t\u00ecm vi khu\u1ea9n lao. T\u1ef7 l\u1ec7 t\u00ecm th\u1ea5y AFB trong d\u1ecbch m\u00e0ng ph\u1ed5i b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p soi tr\u1ef1c ti\u1ebfp r\u1ea5t th\u1ea5p ch\u1ec9 0-10%.<\/p>\n

\u2014 X\u00e9t nghi\u1ec7m sinh h\u00f3a d\u1ecbch m\u00e0ng ph\u1ed5i th\u1ea5y tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i d\u1ecbch ti\u1ebft.<\/p>\n

\u2014 X\u00e9t nghi\u1ec7m t\u1ebf b\u00e0o trong d\u1ecbch m\u00e0ng ph\u1ed5i r\u1ea5t c\u00f3 l\u1ee3i \u00edch cho ch\u1ea9n \u0111o\u00e1n, d\u1ecbch m\u00e0ng ph\u1ed5i do lao th\u01b0\u1eddng c\u00f3 r\u1ea5t nhi\u1ec1u t\u1ebf b\u00e0o, ch\u1ee7 y\u1ebfu l\u00e0 t\u1ebf b\u00e0o lymph\u00f4 (> 70%). N\u1ebfu th\u00e0nh ph\u1ea7n b\u1ea1ch c\u1ea7u \u00e1i toan trong d\u1ecbch m\u00e0ng ph\u1ed5i tr\u00ean 10% g\u1ee3i \u00fd lo\u1ea1i tr\u1eeb nguy\u00ean nh\u00e2n do lao (n\u1ebfu kh\u00f4ng c\u00f3 tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i k\u00e8m theo).<\/p>\n

\u2014 Adenosin deaminase (ADA) d\u1ecbch m\u00e0ng ph\u1ed5i t\u0103ng, \u0111i\u1ec3n h\u00ecnh l\u00e0 tr\u00ean 70U\/L v\u00e0 hi\u1ebfm khi th\u1ea5p d\u01b0\u1edbi 40 U\/TL.<\/p>\n

\u2014 \u0110\u1ecbnh l\u01b0\u1ee3ng Interferon-Gamma d\u1ecbch m\u00e0ng ph\u1ed5i cho k\u1ebft qu\u1ea3 t\u0103ng cao tr\u00ean 140 pg\/ml.<\/p>\n

\u2014 Ph\u1ea3n \u1ee9ng nh\u00e2n gien (PCR) t\u00ecm vi khu\u1ea9n lao trong d\u1ecbch m\u00e0ng ph\u1ed5i c\u0169ng c\u00f3 vai tr\u00f2 nh\u1ea5t \u0111\u1ecbnh trong ch\u1ea9n \u0111o\u00e1n, tuy nhi\u00ean, c\u1ea7n l\u01b0u \u00fd \u0111\u1ebfn kh\u1ea3 n\u0103ng d\u01b0\u01a1ng
\nt\u00ednh gi\u1ea3.<\/p>\n

\u2014 Sinh thi\u1ebft m\u00e0ng ph\u1ed5i: l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n r\u1ea5t c\u1ea7n thi\u1ebft, k\u1ebft qu\u1ea3 cho th\u1ea5y c\u00e1c u h\u1ea1t trong t\u1ed5 ch\u1ee9c m\u00e0ng ph\u1ed5i th\u00e0nh, b\u1ec7nh ph\u1ea9m sinh thi\u1ebft c\u1ea7n
\n\u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m AFB c\u0169ng nh\u01b0 nu\u00f4i c\u1ea5y t\u00ecm vi khu\u1ea9n lao. T\u1ef7 l\u1ec7 x\u00e9t nghi\u1ec7m c\u1ea3 m\u00f4 b\u1ec7nh h\u1ecdc, soi tr\u1ef1c ti\u1ebfp v\u00e0 nu\u00f4i c\u1ea5y t\u00ecm vi khu\u1ea9n lao s\u1ebd cho k\u1ebft qu\u1ea3 d\u01b0\u01a1ng
\nt\u00ednh \u00edt nh\u1ea5t 1 trong ba x\u00e9t nghi\u1ec7m l\u00e0 91%.<\/p>\n

3. Gi\u00e1 tr\u1ecb c\u1ee7a m\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng trong ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n.<\/h2>\n

\u2014 T\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p TDMP \u0111\u1ec1u c\u1ea7n xem x\u00e9t nguy\u00ean nh\u00e2n do lao, X-quang ng\u1ef1c chu\u1ea9n v\u00e0 CT, x\u00e9t nghi\u1ec7m \u0111\u1eddm t\u00ecm AFB, t\u00ecm c\u00e1c t\u1ed5n th\u01b0\u01a1ng ph\u1ed1i
\nh\u1ee3p nh\u01b0 h\u1ea1ch ngo\u1ea1i bi\u00ean, ch\u1ecdc h\u00fat d\u1ecbch m\u00e0ng ph\u1ed5i l\u00e0m x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng t\u00f9y theo \u0111i\u1ec1u ki\u1ec7n s\u1eb5n c\u00f3.<\/p>\n

\u2014 N\u1ebfu t\u00ecm th\u1ea5y AFB ho\u1eb7c nu\u00f4i c\u1ea5y vi khu\u1ea9n lao d\u01b0\u01a1ng t\u00ednh trong d\u1ecbch m\u00e0ng ph\u1ed5i th\u00ec \u0111\u00f3 l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n TDMP do lao.<\/p>\n

\u2014 ADA >70 U\/L v\u00e0 t\u1ef7 l\u1ec7 b\u1ea1ch c\u1ea7u lympho tr\u00ean 75% c\u00f3 th\u1ec3 g\u1ee3i \u00fd ch\u1ea9n \u0111o\u00e1n TDMP do lao.<\/p>\n

\u2014 N\u1ebfu ADA t\u1eeb 40 \u0111\u1ebfn 70 U\/L v\u00e0 t\u1ef7 l\u1ec7 b\u1ea1ch c\u1ea7u lymph\u00f4 v\u00e0 b\u1ea1ch c\u1ea7u trung t\u00ednh tr\u00ean 75% c\u0169ng c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n TDMP do lao n\u1ebfu c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng,
\nX-quang ph\u00f9 h\u1ee3p ho\u1eb7c c\u00f3 th\u1ec3 xem x\u00e9t soi ho\u1eb7c sinh thi\u1ebft m\u00e0ng ph\u1ed1i.<\/p>\n

\u2014 N\u1ebfu ADA d\u01b0\u1edbi 40 U\/L c\u00f3 th\u1ec3 lo\u1ea1i tr\u1eeb TDMP do lao v\u00e0 c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng c\u00e1c k\u1ef9 thu\u1eadt \u0111\u1eb7c hi\u1ec7u h\u01a1n nh\u01b0 soi ho\u1eb7c sinh thi\u1ebft m\u00e0ng ph\u1ed5i.<\/p>\n

\u2014 Imterferon-Gamma t\u0103ng cao tr\u00ean 140 pg\/ml c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c TDMP do lao v\u1edbi \u0111\u1ed9 nh\u1eady v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao. T\u1ea1i \u0111i\u1ec3m c\u1eaft 149 pg\/m], IFN c\u00f3 \u00fd ngh\u0129a
\nch\u1ea9n \u0111o\u00e1n TDMP do lao v\u1edbi \u0111\u1ed9 nh\u1ea1y l\u00e0 84,2% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u l\u00e0 96,2 %.<\/p>\n

4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h2>\n

– TDMP \u00e1c t\u00ednh (ung th\u01b0 m\u00e0ng ph\u1ed5i nguy\u00ean ph\u00e1t ho\u1eb7c di c\u0103n): Th\u01b0\u1eddng d\u1ecbch m\u00e0u \u0111\u1ecf, x\u00e9t nghi\u1ec7m th\u1ea5y t\u1ebf b\u00e0o ung th\u01b0 trong d\u1ecbch m\u00e0ng ph\u1ed5i. ADA,
\nInterferon-Gamma th\u1ea5p. Ch\u1ee5p X-quang ph\u1ed5i sau khi h\u00fat d\u1ecbch m\u00e0ng ph\u1ed5i, ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT), soi ph\u1ebf qu\u1ea3n, soi m\u00e0ng ph\u1ed5i s\u1ebd l\u00e0 c\u00e1c k\u1ef9 thu\u1eadt r\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb cho ch\u1ea9n \u0111o\u00e1n TDMP \u00e1c t\u00ednh.<\/p>\n

\u2014 TDMP d\u1ecbch ti\u1ebft do nguy\u00ean nh\u00e2n kh\u00e1c nh\u01b0: ph\u1ea3n \u1ee9ng m\u00e0ng ph\u1ed5i c\u1ee7a vi\u00eam ph\u1ed5i, nh\u1ed3i m\u00e1u ph\u1ed5i, \u00e1p xe gan (\u0111\u1ed1i v\u1edbi b\u00ean ph\u1ea3i).<\/p>\n

\u2014 ADA c\u0169ng c\u00f3 th\u1ec3 cao trong 2 tr\u01b0\u1eddng h\u1ee3p TDMP l\u00e0 m\u1ee7 m\u00e0ng ph\u1ed5i v\u00e0 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i trong th\u1ea5p kh\u1edbp, tuy nhi\u00ean, d\u1ec5 d\u00e0ng ph\u00e2n bi\u1ec7t d\u1ef1a v\u00e0o h\u00ecnh \u1ea3nh
\nl\u00e2m s\u00e0ng v\u00e0 t\u1ebf b\u00e0o trong d\u1ecbch m\u00e0ng ph\u1ed5i kh\u00f4ng ph\u1ea3i \u01b0u th\u1ebf b\u1ea1ch c\u1ea7u lymph\u00f4.<\/p>\n

\u2014 \u0110\u1ed1i v\u1edbi c\u00e1c n\u01b0\u1edbc b\u1ec7nh lao c\u00f2n ph\u1ed5 bi\u1ebfn nh\u01b0 n\u01b0\u1edbc ta, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i n\u01b0\u1edbc v\u00e0ng chanh, d\u1ecbch ti\u1ebft, kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c c\u00e1c nguy\u00ean nh\u00e2n n\u00e0o kh\u00e1c th\u00ec c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n nh\u01b0 l\u00e0 TDMP do lao v\u00e0 ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb th\u1eed theo ph\u00e1c \u0111\u1ed3 lao.<\/p>\n

5. C\u00e1c th\u1ec3 \u0111\u1eb7c bi\u1ec7t c\u1ee7a TDMP do lao<\/h2>\n

\u2014 Tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i do lao:<\/p>\n

L\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng \u00edt g\u1eb7p \u0111\u1eb7c tr\u01b0ng b\u1edfi m\u1ee7 m\u00e0ng ph\u1ed5i c\u00f3 ch\u1ee9a nhi\u1ec1u vi khu\u1ea9n lao, kh\u00e1c v\u1edbi bi\u1ec3u hi\u1ec7n c\u1ea5p t\u00ednh c\u1ee7a vi\u00eam m\u1ee7 m\u00e0ng ph\u1ed5i do vi khu\u1ea9n.
\nC\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y th\u01b0\u1eddng c\u00f3 t\u1ed5n th\u01b0\u01a1ng t\u1eeb nhu m\u00f4 ph\u1ed5i g\u1ea7n m\u00e0ng ph\u1ed5i ho\u1eb7c c\u00e1c hang lao th\u00f4ng v\u1edbi m\u00e0ng ph\u1ed5i. M\u1ee7 m\u00e0ng ph\u1ed5i c\u00f3 th\u1ec3 t\u1ef1 do ho\u1eb7c kh\u01b0 tr\u00fa. T\u1ed5n
\nth\u01b0\u01a1ng m\u00e0ng ph\u1ed5i d\u00e0y d\u00ednh, v\u00f4i h\u00f3a, v\u00e0 d\u00e0y m\u00e0ng x\u01b0\u01a1ng s\u01b0\u1eddn v\u00f9ng m\u1ee7 m\u00e0ng ph\u1ed5i kh\u01b0 tr\u00fa. M\u1ee7 m\u00e0ng ph\u1ed5i do lao c\u00f3 nhi\u1ec1u t\u1ebf b\u00e0o lymph\u00f4 v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 AFB (+)
\ncao. \u0110i\u1ec1u tr\u1ecb tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i do lao c\u1ea7n d\u1eabn l\u01b0u m\u00e0ng ph\u1ed5i v\u00e0 xem x\u00e9t can thi\u1ec7p b\u00f3c \u1ed5 c\u1eb7n m\u00e0ng ph\u1ed5i b\u1eb1ng ph\u1eabu thu\u1eadt th\u00f4ng th\u01b0\u1eddng ho\u1eb7c ph\u1eabu thu\u1eadt n\u1ed9i
\nsoi 2 th\u00e1ng sau khi b\u1eaft \u0111\u1ea7u h\u00f3a tr\u1ecb li\u1ec7u ch\u1ed1ng lao.<\/p>\n

\u2014 TDMP- c\u00f3 th\u00f4ng ph\u1ebf qu\u1ea3n do lao<\/p>\n

Hi\u1ec7n nay \u00edt g\u1eb7p v\u00ec h\u00f3a tr\u1ecb li\u1ec7u ch\u1ed1ng lao c\u00f3 hi\u1ec7u qu\u1ea3. Ch\u1ec9 c\u00f2n g\u1eb7p \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p tr\u00e0n kh\u00ed tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do lao m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi
\nv\u00e0 \u0111\u00fang c\u00e1ch, c\u00f2n g\u1ecdi l\u00e0 \u1ed5 c\u1eb7n m\u00e0ng ph\u1ed5i do lao. Ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o h\u00ecnh \u1ea3nh m\u1ee9c n\u01b0\u1edbc h\u01a1i tr\u00ean phim X-quang ng\u1ef1c ho\u1eb7c b\u01a1m xanh methylen v\u00e0o m\u00e0ng ph\u1ed5i,
\nb\u1ec7nh nh\u00e2n kh\u1ea1c \u0111\u1ed3m c\u00f3 m\u00e0u xanh. Th\u1ec3 b\u1ec7nh n\u00e0y r\u1ea5t nguy hi\u1ec3m v\u00ec: (1) s\u1ef1 li\u00ean\u00a0th\u00f4ng ph\u1ebf qu\u1ea3n m\u00e0ng ph\u1ed5i l\u00e0 c\u1ea7u n\u1ed1i \u0111\u1ec3 vi khu\u1ea9n x\u00e2m nh\u1eadp v\u00e0o m\u00e0ng ph\u1ed5i g\u00e2y ra vi\u00eam m\u00e0ng ph\u1ed5i m\u1ee7 c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng g\u00e2y nhi\u1ec5m \u0111\u1ed9c; (2) khi khoang m\u00e0ng ph\u1ed5i c\u00f3 b\u1ed9i nhi\u1ec5m, nguy c\u01a1 vi\u00eam ph\u1ed5i do s\u1ef1 x\u00e2m nh\u1eadp c\u00e1c ch\u1ea5t nhi\u1ec5m khu\u1ea9n t\u1eeb m\u00e0ng ph\u1ed5i v\u00e0o c\u00e1c ph\u1ebf kh\u00ed qu\u1ea3n c\u00f2n l\u1ea1i; v\u00e0 (8) vi khu\u1ea9n lao trong khoang m\u00e0ng ph\u1ed5i c\u00f3 nguy c\u01a1 tr\u1edf n\u00ean kh\u00e1ng \u0111a thu\u1ed1c. \u0110i\u1ec1u tr\u1ecb TDMP c\u00f3 th\u00f4ng ph\u1ebf qu\u1ea3n do lao c\u1ea7n b\u1eaft \u0111\u1ea7u b\u1eb1ng h\u00f3a tr\u1ecb li\u1ec7u ch\u1ed1ng lao \u0111\u1ee7 m\u1ea1nh, \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng ph\u1ed1i h\u1ee3p v\u00e0 d\u1eabn l\u01b0u m\u00e0ng ph\u1ed5i \u0111i\u1ec3m th\u1ea5p c\u1ee7a \u1ed5 c\u1eb7n. Ph\u1eabu thu\u1eadt n\u00ean \u0111\u1eb7t ra sau h\u00f3a tr\u1ecb li\u1ec7u ch\u1ed1ng lao \u0111\u1ebfn khi AFB (-).<\/p>\n

6. \u0110i\u1ec1u tr\u1ecb tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do lao.<\/h2>\n

\u2014 TDMP do lao c\u1ea7n \u0111i\u1ec1u tr\u1ecb \u0111\u00fang c\u00e1ch \u0111\u1ec3 tr\u00e1nh b\u1ec7nh lao ti\u1ebfn tri\u1ec3n sau n\u00e0y, tr\u00e1nh d\u00e0y d\u00ednh m\u00e0ng ph\u1ed5i hay \u1ed5 c\u1eb7n m\u00e0ng ph\u1ed5i.<\/p>\n

\u2014 Ch\u1ecdc h\u00fat d\u1ecbch m\u00e0ng ph\u1ed5i \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh s\u1edbm \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 gi\u1ea3m nh\u1eb9 tri\u1ec7u ch\u1ee9ng, nh\u1eafc l\u1ea1i khi c\u00f3 tri\u1ec7u ch\u1ee9ng kh\u00f3 th\u1edf. C\u1ea7n ch\u00fa \u00fd v\u00f4 tr\u00f9ng v\u00e0 tr\u00e1nh
\ng\u00e2y tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i. N\u1ebfu kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng kh\u00f3 th\u1edf, \u0111au ng\u1ef1c \u0111\u00e1ng k\u1ec3 vi\u1ec7c ch\u1ecdc h\u00fat th\u01b0\u1eddng xuy\u00ean \u0111\u1ebfn l\u00fac h\u1ebft l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft, c\u00f9ng v\u1edbi t\u00e1c d\u1ee5ng
\nc\u1ee7a h\u00f3a tr\u1ecb li\u1ec7u d\u1ecbch m\u00e0ng ph\u1ed5i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c h\u1ea5p thu.<\/p>\n

– H\u00f3a tr\u1ecb li\u1ec7u: ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi ph\u00e1c \u0111\u1ed3 2RHZE\/4RH c\u00f3 ki\u1ec3m so\u00e1t tr\u1ef1c ti\u1ebfp to\u00e0n b\u1ed9 6 th\u00e1ng c\u1ee7a Ch\u01b0\u01a1ng tr\u00ecnh ch\u1ed1ng lao Qu\u1ed1c gia:<\/p>\n

+ 92 th\u00e1ng t\u1ea5n c\u00f4ng h\u00e0ng ng\u00e0y, li\u1ec1u theo c\u00e2n n\u1eb7ng: rifampixin 10 mg\/kg, rimifon 5 mg\/kg, pyrazinamid 25 mg\/kg v\u00e0 ethambutol 15kg.<\/p>\n

+ 4 th\u00e1ng duy tr\u00ec h\u00e0ng ng\u00e0y, li\u1ec1u t\u01b0\u01a1ng t\u1ef1 nh\u01b0 tr\u00ean: rifAmpixin, rimifon.<\/p>\n

+ Thu\u1ed1c u\u1ed1ng 1 l\u1ea7n l\u00fac \u0111\u00f3i (tr\u01b0\u1edbc b\u1eefa \u0103n 1 gi\u1edd ho\u1eb7c sau b\u1eefa \u0103n 2 gi\u1edd).<\/p>\n

– \u1ede ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh l\u00fd gan (vi\u00eam gan virus, nghi\u1ec7n r\u01b0\u1ee3u) c\u1ea7n b\u1ed5 sung c\u00e1c thu\u1ed1c b\u1ea3o v\u1ec7 gan v\u00e0 theo d\u00f5i ch\u1eb7t ch\u1ebd \u0111\u1ec1 ph\u00f2ng t\u00e1c d\u1ee5ng kh\u00f4ng
\nmong mu\u1ed1n c\u1ee7a thu\u1ed1c.<\/p>\n

+ \u1ede ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nhi\u1ec5m HIV c\u1ea7n \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p v\u1edbi thu\u1ed1c kh\u00e1ng virus (ARV) v\u00e0 \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng nhi\u1ec5m tr\u00f9ng c\u01a1 h\u1ed9i kh\u00e1c (cotrimoxazol).<\/p>\n

\u2014 T\u1eadp ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh s\u00f3m, ngay sau khi th\u1ef1c hi\u1ec7n ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb li\u1ec7u bao g\u1ed3m t\u1eadp th\u1edf c\u0103ng gi\u00e3n m\u00e0ng ph\u1ed5i t\u1eeb b\u00ean ngo\u00e0i v\u00e0
\nth\u1ed5i b\u00f3ng t\u0103ng d\u1ea7n \u0111\u1ec3 t\u0103ng gi\u00e3n n\u1edf ph\u1ed5i t\u1eeb b\u00ean trong.<\/p>\n

\u2014 Corticosteroid c\u00f3 th\u1ec3 c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng nhanh v\u00e0 t\u0103ng t\u00e1i h\u1ea5p thu d\u1ecbch m\u00e0ng ph\u1ed5i n\u00ean c\u00f3 th\u1ec3 d\u00f9ng trong 2 tu\u1ea7n \u0111\u1ea7u. T\u00e1c d\u1ee5ng ph\u00f2ng
\nng\u1eeba d\u00e0y d\u00ednh m\u00e0ng ph\u1ed5i c\u00f2n kh\u00f4ng r\u00f5 r\u00e0ng.<\/p>\n

\u2014 \u0110i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng m\u1ee7 m\u00e0ng ph\u1ed5i ho\u1eb7c th\u00f4ng ph\u1ebf qu\u1ea3n – m\u00e0ng ph\u1ed5i b\u1eb1ng d\u1eabn l\u01b0u m\u00e0ng ph\u1ed5i t\u1ed1i thi\u1ec3u ho\u1eb7c t\u1ed1i \u0111a, ph\u1eabu thu\u1eadt song song c\u00f9ng v\u1edbi
\nh\u00f3a tr\u1ecb li\u1ec7u \u0111\u1ee7 m\u1ea1nh.<\/p>\n

 <\/p>\n

Ngu\u1ed3n: B\u1ed9 Y t\u1ebf 2012, H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n b\u1ec7nh h\u00f4 h\u1ea5p.<\/p>\n","protected":false},"excerpt":{"rendered":"

Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do lao l\u00e0 b\u1ec7nh kh\u00e1 th\u01b0\u1eddng g\u1eb7p, x\u1ebfp h\u00e0ng th\u1ee9 3 sau lao ph\u1ed5i v\u00e0 lao h\u1ea1ch, chi\u1ebfm 25% \u0111\u1ebfn 37% c\u00e1c tr\u01b0\u1eddng h\u1ee3p tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i. B\u1ec7nh c\u00f3 th\u1ec3 g\u1eb7p \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i, nh\u01b0ng \u1edf tu\u1ed5i tr\u1ebb nhi\u1ec1u h\u01a1n, nam nhi\u1ec1u h\u01a1n n\u1eef, c\u00f3 th\u1ec3 TDMP \u0111\u01a1n thu\u1ea7n […]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"\nTr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do lao: ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do lao l\u00e0 b\u1ec7nh th\u01b0\u1eddng g\u1eb7p, g\u1eb7p nhi\u1ec1u \u1edf ng\u01b0\u1eddi tr\u1ebb, nam, c\u00f3 th\u1ec3 k\u00e8m t\u1ed5n th\u01b0\u01a1ng lao ph\u1ed5i. Di\u1ec5n ti\u1ebfn t\u1ed1t n\u1ebfu \u0111i\u1ec1u tr\u1ecb \u0111\u00fang.\" \/>\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=\"Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do lao: ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do lao l\u00e0 b\u1ec7nh th\u01b0\u1eddng g\u1eb7p, g\u1eb7p nhi\u1ec1u \u1edf ng\u01b0\u1eddi tr\u1ebb, nam, c\u00f3 th\u1ec3 k\u00e8m t\u1ed5n th\u01b0\u01a1ng lao ph\u1ed5i. 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