{"id":30123,"date":"2023-05-04T17:20:08","date_gmt":"2023-05-04T10:20:08","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30123"},"modified":"2023-05-10T12:07:23","modified_gmt":"2023-05-10T05:07:23","slug":"viem-phuc-mac","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/viem-phuc-mac\/","title":{"rendered":"Vi\u00eam ph\u00fac m\u1ea1c \u1edf b\u1ec7nh nh\u00e2n l\u1ecdc m\u00e0ng b\u1ee5ng li\u00ean t\u1ee5c ngo\u1ea1i tr\u00fa"},"content":{"rendered":"

Vi\u00eam ph\u00fac m\u1ea1c l\u00e0 m\u1ed9t trong nh\u1eefng bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p trong qu\u00e1 tr\u00ecnh l\u1ecdc m\u00e0ng b\u1ee5ng ngo\u1ea1i tr\u00fa. \u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh n\u00e0y, c\u00e1c b\u00e1c s\u0129 th\u01b0\u1eddng s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p nh\u01b0 x\u00e9t nghi\u1ec7m vi sinh, c\u1ea5y m\u00e1u ho\u1eb7c x\u00e9t nghi\u1ec7m m\u00e1u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n. \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 t\u00ecm ki\u1ebfm v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh k\u1ecbp th\u1eddi \u0111\u1ec3 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng v\u00e0 gi\u00fap b\u1ec7nh nh\u00e2n ph\u1ee5c h\u1ed3i nhanh ch\u00f3ng.<\/strong><\/p>\n

1. T\u1ed5ng quan<\/strong><\/h1>\n

L\u1ecdc m\u00e0ng b\u1ee5ng li\u00ean t\u1ee5c ngo\u1ea1i tr\u00fa (CAPD)<\/strong>: l\u00e0 m\u1ed9t trong nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb thay th\u1ebf cho nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh suy th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i. Sau khi th\u1ef1c hi\u1ec7n c\u00e1c k\u1ef9 thu\u1eadt ban \u0111\u1ea7u t\u1ea1i b\u1ec7nh vi\u1ec7n, \u0111\u1eb7t \u1ed1ng Catheter trong khoang \u1ed5 b\u1ee5ng ng\u01b0\u1eddi b\u1ec7nh, ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 t\u1ef1 l\u1ecdc m\u00e1u t\u1ea1i nh\u00e0 ri\u00eang, thay v\u00ec m\u1ed9t tu\u1ea7n ph\u1ea3i \u0111\u1ebfn b\u1ec7nh vi\u1ec7n \u0111\u1ec3 ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, h\u00e0ng th\u00e1ng ng\u01b0\u1eddi b\u1ec7nh ch\u1ec9 c\u1ea7n \u0111\u1ebfn b\u1ec7nh vi\u1ec7n \u0111\u1ec3 ki\u1ec3m tra \u0111\u1ecbnh k\u1ef3 m\u1ed9t l\u1ea7n. M\u1ed7i ng\u00e0y ng\u01b0\u1eddi b\u1ec7nh th\u1ef1c hi\u1ec7n b\u1ed1n l\u1ea7n l\u1ecdc m\u00e0ng b\u1ee5ng, \u0111\u01b0a hai l\u00edt d\u1ecbch l\u1ecdc v\u00e0o \u1ed5 b\u1ee5ng m\u1ed7i l\u1ea7n. M\u1ed7i l\u1ea7n th\u1ef1c hi\u1ec7n ch\u1ec9 m\u1ea5t 30 ph\u00fat. Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00e0y c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o chu k\u1ef3.<\/p>\n

Vi\u00eam ph\u00fac m\u1ea1c<\/strong>: l\u00e0 ph\u1ea3n \u1ee9ng vi\u00eam c\u1ea5p t\u00ednh c\u1ee7a l\u00e1 ph\u00fac m\u1ea1c v\u1edbi t\u00e1c nh\u00e2n vi khu\u1ea9n hay ho\u00e1 h\u1ecdc. Vi\u00eam ph\u00fac m\u1ea1c l\u00e0 m\u1ed9t trong c\u00e1c bi\u1ebfn ch\u1ee9ng hay g\u1eb7p \u1edf ng\u01b0\u1eddi b\u1ec7nh l\u1ecdc m\u00e0ng b\u1ee5ng li\u00ean t\u1ee5c ngo\u1ea1i tr\u00fa. N\u1ebfu b\u1ec7nh \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi th\u00ec ng\u01b0\u1eddi b\u1ec7nh nhanh ch\u00f3ng qua kh\u1ecfi v\u00e0 ti\u1ebfp t\u1ee5c th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c ph\u01b0\u01a1ng ph\u00e1p l\u1ecdc m\u00e0ng b\u1ee5ng.<\/p>\n

\"\"
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Ngu\u1ed3n<\/strong>: Peritonitis \u2013 A complication of peritoneal dialysis<\/em><\/figcaption><\/figure>\n

2. Ch\u1ea9n \u0111o\u00e1n<\/strong><\/h2>\n

2.1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/strong><\/h3>\n

2.1.1. L\u00e2m s\u00e0ng:<\/strong><\/p>\n

– \u0110au b\u1ee5ng: c\u00f3 khi \u0111au ho\u1eb7c kh\u00f4ng, \u0111\u00f4i khi \u0111au nhi\u1ec1u.<\/p>\n

– D\u1ea5u hi\u1ec7u \u1edf th\u00e0nh b\u1ee5ng: Co c\u1ee9ng th\u00e0nh b\u1ee5ng, c\u1ea3m \u1ee9ng ph\u00fac m\u1ea1c g\u1eb7p trong tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ebfn qu\u00e1 mu\u1ed9n.<\/p>\n

– S\u1ed1t: c\u00f3 khi s\u1ed1t ho\u1eb7c kh\u00f4ng.<\/p>\n

– D\u1ecbch l\u1ecdc m\u00e0ng b\u1ee5ng: d\u1ecbch \u0111\u1ee5c<\/p>\n

2.1.2. C\u1eadn l\u00e2m s\u00e0ng:<\/strong><\/p>\n

– X\u00e9t nghi\u1ec7m t\u1ebf b\u00e0o d\u1ecbch: c\u00f3 nhi\u1ec1u b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh ( > 100 BC\/mm3 trong \u0111\u00f3 c\u00f3 > 50% l\u00e0 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh)<\/p>\n

– X\u00e9t nghi\u1ec7m vi sinh: nu\u00f4i c\u1ea5y d\u1ecbch l\u1ecdc m\u00e0ng b\u1ee5ng c\u00f3 th\u1ec3 th\u1ea5y vi khu\u1ea9n E.coli ho\u1eb7c tr\u1ef1c khu\u1ea9n m\u1ee7 xanh, t\u1ee5 c\u1ea7u, n\u1ea5m…<\/p>\n

– Nhu\u1ed9m t\u00ecm tr\u1ef1c tr\u00f9ng kh\u00e1ng alcol-acid, PCR lao \u0111\u1ec3 t\u00ecm vi tr\u00f9ng lao<\/p>\n

– C\u1ea5y m\u00e1u c\u0169ng c\u00f3 th\u1ec3 th\u1ea5y vi khu\u1ea9n g\u00e2y b\u1ec7nh<\/p>\n

2.2. Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n<\/strong><\/h3>\n

– Nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam ph\u00fac m\u1ea1c: nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0 do ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng tu\u00e2n th\u1ee7 ch\u1ebf \u0111\u1ed9 v\u00f4 tr\u00f9ng trong th\u1ef1c hi\u1ec7n thay t\u00fai d\u1ecbch. C\u0169ng c\u00f3 th\u1ec3 g\u1eb7p do nhi\u1ec5m tr\u00f9ng t\u1eeb ch\u00e2n catheter di chuy\u1ec3n v\u00e0o \u0111\u01b0\u1eddng h\u1ea7m catheter v\u00e0 v\u00e0o khoang ph\u00fac m\u1ea1c.<\/p>\n

– C\u1ea5y m\u00e1u, c\u1ea5y n\u01b0\u1edbc d\u1ecbch l\u1ecdc \u1ed5 b\u1ee5ng th\u01b0\u1eddng t\u00ecm \u0111\u01b0\u1ee3c lo\u1ea1i vi khu\u1ea9n g\u00e2y vi\u00eam ph\u00fac m\u1ea1c. M\u1ed9t s\u1ed1 vi khu\u1ea9n c\u00f3 th\u1ec3 g\u1eb7p: Staphylococcus aureus, Enterococcus, Streptococcus, Pseudomonas, E.coli,…<\/p>\n

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

– Vi\u00eam ph\u00fac m\u1ea1c kh\u00f4ng t\u00ecm th\u1ea5y vi khu\u1ea9n khi nu\u00f4i c\u1ea5y:<\/p>\n

+ Do k\u1ef9 thu\u1eadt l\u1ea5y b\u1ec7nh ph\u1ea9m ho\u1eb7c k\u1ef9 thu\u1eadt nu\u00f4i c\u1ea5y ch\u01b0a \u0111\u00fang ph\u01b0\u01a1ng ph\u00e1p.<\/p>\n

+ Do ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 s\u1eed d\u1ee5ng kh\u00e1ng sinh tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n

– Vi\u00eam ph\u00fac m\u1ea1c kh\u00f4ng do \u0111\u01b0\u1eddng v\u00e0o t\u1eeb d\u1ecbch l\u1ecdc ho\u1eb7c \u0111\u01b0\u1eddng h\u1ea7m catheter: vi\u00eam ph\u00fac m\u1ea1c ru\u1ed9t th\u1eeba, th\u1ee7ng t\u1ea1ng r\u1ed7ng,…<\/p>\n

– D\u1ecbch l\u1ecdc m\u00e0ng b\u1ee5ng m\u00e0u \u0111\u1ee5c do d\u01b0\u1ee1ng ch\u1ea5p: t\u00ecm th\u1ea5y d\u01b0\u1ee1ng ch\u1ea5p trong d\u1ecbch l\u1ecdc m\u00e0ng b\u1ee5ng.<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb vi\u00eam ph\u00fac m\u1ea1c<\/strong><\/h2>\n

Sau \u0111\u00e2y l\u00e0 m\u1ed9t ph\u00e1c \u0111\u1ed3 hay \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong x\u1eed tr\u00ed ban \u0111\u1ea7u vi\u00eam ph\u00fac m\u1ea1c \u1edf ng\u01b0\u1eddi b\u1ec7nh l\u1ecdc m\u00e0ng b\u1ee5ng li\u00ean t\u1ee5c ngo\u1ea1i tr\u00fa:<\/p>\n

\u00c1p d\u1ee5ng cho \u0111a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u00fac m\u1ea1c \u1edf ng\u01b0\u1eddi b\u1ec7nh l\u1ecdc m\u00e0ng b\u1ee5ng li\u00ean t\u1ee5c ngo\u1ea1i tr\u00fa khi m\u1edbi nh\u1eadp vi\u1ec7n ch\u01b0a c\u00f3 k\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y vi khu\u1ea9n v\u00e0 kh\u00e1ng sinh \u0111\u1ed3.<\/p>\n

+ Kh\u00e1ng sinh to\u00e0n th\u00e2n<\/strong>: c\u00f3 th\u1ec3 d\u00f9ng m\u1ed9t trong c\u00e1c nh\u00f3m thu\u1ed1c sau:<\/p>\n

– Nh\u00f3m Cephalosporin th\u1ebf h\u1ec7 3: Cefoperazone, Ceftazidime,<\/p>\n

– Nh\u00f3m Beta lactam<\/p>\n

Li\u1ec1u thu\u1ed1c tu\u1ef3 thu\u1ed9c v\u00e0o t\u1eebng lo\u1ea1i kh\u00e1ng sinh \u00e1p d\u1ee5ng \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi b\u1ec7nh suy th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i \u0111ang l\u1ecdc m\u00e0ng b\u1ee5ng (th\u1ea9m ph\u00e2n ph\u00fac m\u1ea1c)<\/p>\n

Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb: 14 \u2013 21 ng\u00e0y.<\/p>\n

+ Kh\u00e1ng sinh t\u1ea1i ch\u1ed7<\/strong>: th\u1eddi gian \u0111i\u1ec1u tr\u1ecb 14 \u2013 21 ng\u00e0y<\/p>\n

L\u1ea7n thay d\u1ecbch<\/p>\n

L\u1ea7n 1<\/strong>: R\u1eeda \u1ed5 b\u1ee5ng li\u00ean ti\u1ebfp 3 t\u00fai d\u1ecbch l\u1ecdc n\u1ed3ng \u0111\u1ed91.5, m\u1ed7i t\u00fai pha 1000 \u0111\u01a1n v\u1ecb Heparine<\/p>\n

L\u1ea7n 2 (ng\u00e2m 6 gi\u1edd):<\/strong> Ng\u00e2m trong \u1ed5 b\u1ee5ng 2 l\u00edt d\u1ecbch l\u1ecdc 1.5 c\u00f3 pha:<\/p>\n

– Cephazoline 1 g x 1 l\u1ecd<\/p>\n

– Gentamycine 40mg x 1 l\u1ecd<\/p>\n

– Heparine 1000 \u0111\u01a1n v\u1ecb<\/p>\n

L\u1ea7n 3 (ng\u00e2m 4 gi\u1edd):<\/strong> Ng\u00e2m trong \u1ed5 b\u1ee5ng 2 l\u00edt d\u1ecbch l\u1ecdc1.5 c\u00f3 pha:<\/p>\n

– Cephazolin 250mg (1g x 1\/4 l\u1ecd)<\/p>\n

– Heparine 1000 \u0111\u01a1n v\u1ecb<\/p>\n

L\u1ea7n 4 (ng\u00e2m 4 gi\u1edd):<\/strong> Ng\u00e2m trong \u1ed5 b\u1ee5ng 2 l\u00edt d\u1ecbch l\u1ecdc 1.5 c\u00f3 pha:<\/p>\n

– Cephazoline 250 mg (1g x 1\/4 l\u1ecd)<\/p>\n

– Heparine 1000 \u0111\u01a1n v\u1ecb<\/p>\n

L\u1ea7n 5 (ng\u00e2m qua \u0111\u00eam):<\/strong> Ng\u00e2m trong \u1ed5 b\u1ee5ng 2 l\u00edt d\u1ecbch l\u1ecdc 1.5 c\u00f3 pha:<\/p>\n

– Cephazoline 1g x 1 l\u1ecd<\/p>\n

– Gentamycine 40mg x 1 l\u1ecd<\/p>\n

– Heparine 1000 \u0111\u01a1n v\u1ecb<\/p>\n

Khi c\u00f3 k\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y v\u00e0 kh\u00e1ng sinh \u0111\u1ed3<\/strong>:<\/p>\n

– N\u1ebfu vi khu\u1ea9n nh\u1ea1y c\u1ea3m v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1ng sinh tr\u00ean th\u00ec ti\u1ebfp t\u1ee5c d\u00f9ng cho \u0111\u1ee7 th\u1eddi gian l\u00e0 14 ng\u00e0y.<\/p>\n

– N\u1ebfu vi khu\u1ea9n kh\u00e1ng v\u1edbi m\u1ed9t trong c\u00e1c thu\u1ed1c kh\u00e1ng sinh tr\u00ean th\u00ec n\u00ean chuy\u1ec3n ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ebfn tuy\u1ebfn chuy\u00ean khoa c\u00f3 kinh nghi\u1ec7m \u0111i\u1ec1u tr\u1ecb.<\/p>\n

4. Ph\u00f2ng b\u1ec7nh vi\u00eam ph\u00fac m\u1ea1c<\/strong><\/h2>\n

– V\u1ec7 sinh s\u1ea1ch s\u1ebd \u0111\u1ea3m b\u1ea3o v\u00f4 tr\u00f9ng trong thao t\u00e1c thay d\u1ecbch: r\u1eeda tay b\u1eb1ng x\u00e0 ph\u00f2ng, \u0111eo kh\u1ea9u trang, d\u00f9ng ngu\u1ed3n n\u01b0\u1edbc s\u1ea1ch \u0111\u1ec3 v\u1ec7 sinh,..<\/p>\n

– Thay d\u1ecbch trong ph\u00f2ng \u0111\u00e3 \u0111\u01b0\u1ee3c v\u1ec7 sinh s\u1ea1ch s\u1ebd, t\u1ea9y tr\u00f9ng th\u01b0\u1eddng xuy\u00ean.<\/p>\n

Trong qu\u00e1 tr\u00ecnh l\u1ecdc m\u00e0ng b\u1ee5ng ngo\u1ea1i tr\u00fa, vi\u00eam ph\u00fac m\u1ea1c l\u00e0 m\u1ed9t trong nh\u1eefng bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p. Tuy nhi\u00ean, v\u1edbi s\u1ef1 ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed k\u1ecbp th\u1eddi, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i ho\u00e0n to\u00e0n. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb hi\u1ec7n \u0111\u1ea1i gi\u00fap b\u00e1c s\u0129 nhanh ch\u00f3ng x\u00e1c \u0111\u1ecbnh v\u00e0 \u0111\u01b0a ra gi\u1ea3i ph\u00e1p ph\u00f9 h\u1ee3p nh\u1ea5t cho b\u1ec7nh nh\u00e2n. Quan tr\u1ecdng h\u01a1n, vi\u1ec7c t\u00ecm ki\u1ebfm v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi gi\u00fap tr\u00e1nh \u0111\u01b0\u1ee3c c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 h\u1ed7 tr\u1ee3 cho qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i nhanh ch\u00f3ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 b\u1ec7nh th\u1eadn \u2013 ti\u1ebft ni\u1ec7u c\u1ee7a B\u1ed9 Y t\u1ebf 2015<\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam ph\u00fac m\u1ea1c l\u00e0 m\u1ed9t trong nh\u1eefng bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p trong qu\u00e1 tr\u00ecnh l\u1ecdc m\u00e0ng b\u1ee5ng ngo\u1ea1i tr\u00fa. \u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh n\u00e0y, c\u00e1c b\u00e1c s\u0129 th\u01b0\u1eddng s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p nh\u01b0 x\u00e9t nghi\u1ec7m vi sinh, c\u1ea5y m\u00e1u ho\u1eb7c x\u00e9t nghi\u1ec7m m\u00e1u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n. \u0110i\u1ec1u […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[],"yoast_head":"\nVi\u00eam ph\u00fac m\u1ea1c \u1edf b\u1ec7nh nh\u00e2n l\u1ecdc m\u00e0ng b\u1ee5ng li\u00ean t\u1ee5c ngo\u1ea1i tr\u00fa<\/title>\n<meta name=\"description\" content=\"Vi\u00eam ph\u00fac m\u1ea1c l\u00e0 m\u1ed9t trong 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