{"id":30845,"date":"2023-05-12T22:51:06","date_gmt":"2023-05-12T15:51:06","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30845"},"modified":"2023-05-13T22:29:09","modified_gmt":"2023-05-13T15:29:09","slug":"roi-loan-kiem-toan-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/12\/roi-loan-kiem-toan-o-tre-em\/","title":{"rendered":"R\u1ed1i lo\u1ea1n ki\u1ec1m toan \u1edf tr\u1ebb em"},"content":{"rendered":"
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R\u1ed1i lo\u1ea1n ki\u1ec1m toan \u1edf tr\u1ebb em l\u00e0 t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa c\u00e1c ch\u1ea5t ki\u1ec1m v\u00e0 acid trong c\u01a1 th\u1ec3. C\u00e2n b\u1eb1ng toan ki\u1ec1m c\u00f3 vai tr\u00f2 r\u1ea5t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi s\u1ef1 s\u1ed1ng c\u00f2n c\u1ee7a c\u01a1 th\u1ec3. Nh\u1eefng bi\u1ebfn \u0111\u1ed5i c\u1ee7a n\u1ed3ng \u0111\u1ed9 ion H (H+) d\u00f9 r\u1ea5t nh\u1ecf c\u0169ng \u0111\u1ee7 g\u00e2y ra nh\u1eefng bi\u1ebfn \u0111\u1ed5i l\u1edbn c\u00e1c ph\u1ea3n \u1ee9ng trong t\u1ebf b\u00e0o, th\u1eadm ch\u00ed c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong.\u00a0<\/strong><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

1. R\u1ed1i lo\u1ea1n ki\u1ec1m toan: Nhi\u1ec5m toan<\/h2>\n

1.1 Toan chuy\u1ec3n h\u00f3a<\/h3>\n

1.1.1 L\u00e2m s\u00e0ng nhi\u1ec5m toan chuy\u1ec3n h\u00f3a<\/h4>\n

C\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng c\u1ee7a nhi\u1ec5m ki\u1ec1m toan th\u01b0\u1eddng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u. Ki\u1ec1m chuy\u1ec3n ho\u00e1 c\u0169ng v\u1eady.<\/p>\n

+ T\u0103ng th\u00f4ng kh\u00ed m\u00e1u nh\u1eb9 th\u01b0\u1eddng kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng, m\u00e0 ch\u1ec9 c\u00f3 \u00a0th\u1ec3 nh\u1eadn bi\u1ebft qua kh\u00ed m\u00e1u, th\u1ea5y PCO2\u00a0<\/sub>gi\u1ea3m.<\/p>\n

+ Khi nhi\u1ec5m toan chuy\u1ec3n h\u00f3a n\u1eb7ng c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n th\u1edf nhanh, s\u00e2u, v\u00f4 c\u0103n ho\u1eb7c nh\u1ecbp th\u1edf Kussmaul. Tr\u1ebb l\u01a1 m\u01a1 , h\u00f4n m\u00ea v\u00e0 tru\u1ef5 m\u1ea1ch do t\u00ecnh tr\u1ea1ng nhi\u1ec5m toan n\u1eb7ng l\u00e0m gi\u1ea3m co b\u00f3p c\u1ee7a c\u01a1 tim.<\/p>\n

– Tri\u1ec7u ch\u1ee9ng gi\u00fap ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n:<\/p>\n

+ D\u1ea5u hi\u1ec7u s\u1ed1c, suy h\u00f4 h\u1ea5p..<\/p>\n

+ D\u1ea5u hi\u1ec7u m\u1ea5t n\u01b0\u1edbc do ti\u00eau ch\u1ea3y, ti\u1ec3u \u0111\u01b0\u1eddng.<\/p>\n

– X\u00e9t nghi\u1ec7m:<\/p>\n

+ X\u00e9t nghi\u1ec7m c\u01a1 b\u1ea3n : kh\u00ed m\u00e1u, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, glucose, use creatinin, t\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

+ X\u00e9t nghi\u1ec7m t\u00ecm nguy\u00ean nh\u00e2n : \u0111\u1ecbnh t\u00ednh c\u01a1 ch\u1ea5t \u1ee9 \u0111\u1ecdng trong m\u00e1u v\u00e0 n\u01b0\u1edbc ti\u1ec3u do men chuy\u1ec3n h\u00f3a, ch\u1ee9c n\u0103ng gan , bilan nhi\u1ec5m tr\u00f9ng , \u0111\u1ed9c ch\u1ea5t, si\u00eau \u00e2m v\u00e0 ch\u1ee5p CT\/MRI.<\/p>\n

\"R\u1ed1i
R\u1ed1i lo\u1ea1n ki\u1ec1m toan \u1edf tr\u1ebb<\/figcaption><\/figure>\n

1.1.2. Ch\u1ea9n \u0111o\u00e1n<\/h4>\n

1.1.2.1.Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/h5>\n

– L\u00e2m s\u00e0ng:<\/p>\n

+ D\u1ea5u hi\u1ec7u th\u1edf nhanh s\u00e2u, t\u0103ng th\u00f4ng kh\u00ed kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n, toan n\u1eb7ng r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1edf, th\u1edf Kaussmaul, tru\u1ef5 m\u1ea1ch, huy\u1ebft \u00e1p h\u1ea1.<\/p>\n

+ Th\u1ea7n kinh: nh\u1ee9c \u0111\u1ea7u, bu\u1ed3n n\u00f4n, l\u01a1 m\u01a1, h\u00f4n m\u00ea<\/p>\n

– X\u00e9t nghi\u1ec7m: pH\u00af (<7,35), HCO3<\/sub> \u00af\u00a0(<18mmol\/l), paCO2<\/sub> \u00af (<35mmHg), BE \u00af\u00a0(BE <-2)<\/b><\/p>\n

1.1.2.2. Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n nhi\u1ec5m toan chuy\u1ec3n h\u00f3a<\/h5>\n

\u0110\u1ec3 t\u00ecm nguy\u00ean nh\u00e2n nhi\u1ec5m toan chuy\u1ec3n h\u00f3a c\u00f3 th\u1ec3 d\u1ef1a v\u00e0o kho\u1ea3ng tr\u1ed1ng anion (anion gap) c\u1ee7a huy\u1ebft t\u01b0\u01a1ng v\u00e0 ph\u00e2n bi\u1ec7t nhi\u1ec5m to\u1ea1n chuy\u1ec3n h\u00f3a ngo\u00e0i th\u1eadn v\u00e0 nhi\u1ec5m toan chuy\u1ec3n h\u00f3a t\u1ea1i th\u1eadn<\/p>\n

    \n
  • Toan chuy\u1ec3n h\u00f3a d\u1ef1a v\u00e0o kho\u1ea3ng tr\u1ed1ng Anion (AG)<\/strong><\/li>\n<\/ul>\n

    – Nhi\u1ec5m toan chuy\u1ec3n h\u00f3a v\u1edbi kho\u1ea3ng tr\u1ed1ng anion t\u0103ng (AG\u00ad)<\/p>\n

    + Do t\u0103ng axit h\u1eefu c\u01a1: \u0111\u00e1i \u0111\u01b0\u1eddng, suy h\u00f4 h\u1ea5p, s\u1ed1c.<\/p>\n

    + Do gi\u1ea3m ti\u1ebft H+: suy th\u1eadn, nhi\u1ec5m toan \u1ed1ng th\u1eadn<\/p>\n

    + Do nhi\u1ec5m \u0111\u1ed9c: aspirin, r\u01b0\u1ee3u<\/p>\n

    + R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a b\u1ea9m sinh<\/p>\n

    – Nhi\u1ec5m toan chuy\u1ec3n h\u00f3a v\u1edbi kho\u1ea3ng tr\u1ed1ng Anion b\u00ecnh th\u01b0\u1eddng (AG), t\u0103ng clo m\u00e1u<\/p>\n

    + Do t\u0103ng HCl: d\u00f9ng NH4Cl, axit amin<\/p>\n

    + Do m\u1ea5t ki\u1ec1m: \u1ec9a ch\u1ea3y, nhi\u1ec5m toan \u1ed1ng th\u1eadn<\/p>\n

    + Do t\u00edch axit: nhi\u1ec5m toan \u1ed1ng th\u1eadn<\/p>\n

      \n
    • Toan chuy\u1ec3n h\u00f3a ngo\u00e0i th\u1eadn v\u00e0 do th\u1eadn<\/strong><\/li>\n<\/ul>\n

      – Nhi\u1ec5m toan chuy\u1ec3n h\u00f3a ngo\u00e0i th\u1eadn<\/p>\n

      + T\u0103ng axit n\u1ed9i sinh: h\u00f4n m\u00ea \u0111\u00e1i \u0111\u01b0\u1eddng, h\u00f4n m\u00ea gan, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, s\u1ed1c, thi\u1ebfu oxy, \u0111\u00f3i, s\u1ed1c.<\/p>\n

      + T\u0103ng axit ngo\u1ea1i sinh: ng\u1ed9 \u0111\u1ed9c aspirin, bacbituric, d\u00f9ng nhi\u1ec1u NH4Cl, arginin<\/p>\n

      + Do m\u1ea5t HCO3<\/sub>–<\/sup>: \u1ec9a ch\u1ea3y, d\u00f2 m\u1eadt, d\u1eabn l\u01b0u ru\u1ed9t non.<\/p>\n

      – Nhi\u1ec5m toan chuy\u1ec3n h\u00f3a do th\u1eadn.<\/p>\n

      + Do b\u1ec7nh l\u00fd \u1ed1ng th\u1eadn<\/p>\n

      + Do suy th\u1eadn to\u00e0n b\u1ed9.<\/p>\n

      – Mu\u1ed1n ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n ngo\u00e0i hay do th\u1eadn d\u01b0a vao pH m\u00e1u \u2013 pH ni\u1ec7u Gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng pH ni\u1ec7u : 4,8 \u2013 8.<\/p>\n

      1.1.2.3. \u0110i\u1ec1u tr\u1ecb nhi\u1ec5m toan chuy\u1ec3n h\u00f3a<\/h5>\n
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      • \u00a0\u0110i\u1ec1u ch\u1ec9nh s\u1ef1 thi\u1ebfu h\u1ee5t [HCO3<\/sub>–<\/sup>]:<\/strong><\/li>\n<\/ul>\n

        – \u0110\u1ed1i v\u1edbi NTCH c\u00f3 kho\u1ea3ng tr\u1ed1ng anion b\u00ecnh th\u01b0\u1eddng v\u00e0 nhi\u1ec5m toan chuy\u1ec3n h\u00f3a do th\u1eadn: b\u00f9 HCO3<\/sub>–<\/sup>\u00a0l\u00e0 c\u1ea7n thi\u1ebft v\u00e0 c\u00f3 t\u00ednh ch\u1ea5t h\u1ec7 th\u1ed1ng.<\/p>\n

        – B\u00f9 HCO3<\/sub>–<\/sup>\u00a0\u0111\u01b0\u1ee3c t\u00ednh theo c\u00f4ng th\u1ee9c: NaHCO3<\/sub>–<\/sup> (mmol) = BE x P x 0,<\/p>\n

        P: Tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 (kg)<\/p>\n

        L\u01b0u \u00fd:<\/p>\n

        + N\u1ebfu toan n\u1eb7ng c\u00f3 th\u1ec3 ti\u00eam TM ch\u1eadm 1mmol\/kg<\/p>\n

        + B\u00f9 1\/2 l\u01b0\u1ee3ng HCO3<\/sub>–<\/sup>\u00a0t\u00ednh theo c\u00f4ng th\u1ee9c, truy\u1ec1n ch\u1eadm TM trong 4 \u2013 6 gi\u1edd. Truy\u1ec1n duy tr\u00ec c\u00f2n l\u1ea1i trong 4 \u2013 6 gi\u1edd ti\u1ebfp<\/p>\n

        + Th\u1eed l\u1ea1i kh\u00ed m\u00e1u sau b\u00f9, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3<\/p>\n

        + Kh\u00f4ng truy\u1ec1n chung \u0111\u01b0\u1eddng truy\u1ec1n v\u1edbi Calcium, Dopamin, Dobutamin<\/p>\n

        + Ch\u1ec9 b\u00f9 khi toan h\u00f4 h\u1ea5p \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft<\/p>\n

        \u0110\u1ed1i v\u1edbi nhi\u1ec5m toan chuy\u1ec3n h\u00f3a c\u00f3 kho\u1ea3ng tr\u1ed1ng anion t\u0103ng.<\/p>\n

        – \u0110i\u1ec1u ch\u1ee7 y\u1ebfu l\u00e0 ph\u1ea3i \u0111i\u1ec1u tr\u1ecb theo nguy\u00ean nh\u00e2n.<\/p>\n

        – Vi\u1ec7c b\u1ed5 sung HCO3<\/sub>–\u00a0<\/sup>\u00a0c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc th\u1eadn tr\u1ecdng b\u1edfi v\u00ec n\u1ebfu b\u00f9 nhanh m\u1ed9t s\u1ed1 l\u01b0\u1ee3ng l\u1edbn c\u00f3 th\u1ec3 l\u00e0m bi\u1ebfn \u0111\u1ed5i c\u00e1c th\u00e0nh ph\u1ea7n kh\u00e1c c\u1ee7a d\u1ecbch th\u1ec3: l\u00e0m n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng toan trong t\u1ebf b\u00e0o v\u00e0 d\u1ecbch n\u00e3o tu\u1ef7 do s\u1ef1 t\u1ea1o n\u00ean CO2<\/sub>, c\u00f3 th\u1ec3 v\u1eadn chuy\u1ec3n t\u1ef1 do qua m\u00e0ng t\u1ebf b\u00e0o, ho\u1eb7c l\u00e0m gi\u1ea3m K m\u00e1u \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nh\u1ecbp tim<\/p>\n

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        • \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n g\u00e2y nhi\u1ec5m toan chuy\u1ec3n h\u00f3a:<\/strong><\/li>\n<\/ul>\n

          – Nhi\u1ec5m toan do b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng: insulin, truy\u1ec1n d\u1ecbch.<\/p>\n

          – Nhi\u1ec5m toan do t\u0103ng acid lactic do thi\u1ebfu O2<\/sub>: th\u1edf oxy qua m\u1eb7t n\u1ea1 ho\u1eb7c h\u00f4 h\u1ea5p vi\u1ec7n tr\u1ee3, ch\u1ed1ng s\u1ed1c trong suy tu\u1ea7n ho\u00e0.<\/p>\n

          – Nhi\u1ec5m toan acid salicylic (aspirin): ki\u1ec1m h\u00f3a n\u01b0\u1edbc ti\u1ec3u ho\u1eb7c l\u1ecdc m\u00e1u ngo\u00e0i th\u1eadn.<\/p>\n

          – Suy th\u1eadn: l\u1ecdc m\u00e1u ngo\u00e0i th\u1eadn.<\/p>\n

          – R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a b\u1ea9m sinh: h\u1ed9i ch\u1ea9n chuy\u00ean khoa chuy\u1ec3n h\u00f3a: ch\u1ecdn s\u1eefa, ch\u1ebf \u0111\u1ed9 \u0103n ph\u00f9 h\u1ee3p, vitamin th\u00edch h\u1ee3p<\/p>\n

          1.2. Nhi\u1ec5m toan h\u00f4 h\u1ea5p<\/h3>\n

          – Nhi\u1ec5m toan h\u00f4 h\u1ea5p l\u00e0 do t\u0103ng \u00e1p su\u1ea5t CO2<\/sub>, l\u00e0m gi\u1ea3m pH m\u00e1u. Nh\u1edd c\u01a1 ch\u1ebf b\u00f9 tr\u1eeb c\u1ee7a th\u1eadn, n\u1ed3ng \u0111\u1ed9 HCO3<\/sub>–<\/sup>\u00a0s\u1ebd t\u0103ng theo. Tu\u1ef3 theo t\u00ecnh tr\u1ea1ng t\u0103ng CO2<\/sub>\u00a0c\u1ea5p ho\u1eb7c m\u00e3n m\u00e0 c\u00f3 s\u1ef1 thay \u0111\u1ed5i HCO3<\/sub>–<\/sup>\u00a0theo.<\/p>\n

          – Trong nhi\u1ec5m toan h\u00f4 h\u1ea5p c\u1ea5p, c\u1ee9 t\u0103ng th\u00eam 10mmHg CO2<\/sub>\u00a0th\u00ec HCO3<\/sub>–\u00a0<\/sup>t\u0103ng th\u00eam 1 mmol, trong nhi\u1ec5m toan h\u00f4 h\u1ea5p man th\u00ec t\u0103ng th\u00eam 4mmol HCO3<\/sub>–<\/sup>.<\/p>\n

          1.2.1. L\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng nhi\u1ec5m toan h\u00f4 h\u1ea5p<\/h4>\n

          – D\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng c\u1ee7a nhi\u1ec5m toan h\u00f4 h\u1ea5p l\u00e0 do t\u00ecnh tr\u1ea1ng t\u0103ng CO2<\/sub>\u00a0trong m\u00e1u v\u00e0 th\u01b0\u1eddng k\u00e8m theo gi\u1ea3m O2<\/sub>\u00a0trong m\u00e1u.<\/p>\n

          + D\u1ea5u hi\u1ec7u th\u1ea7n kinh: tr\u1ebb nh\u1ee9c \u0111\u1ea7u, k\u00edch th\u00edch, v\u1eadt v\u00e3 r\u1ed3i sau \u0111\u00f3 \u0111i \u0111\u1ebfn l\u01a1 m\u01a1 h\u00f4n m\u00ea.<\/p>\n

          + Tim m\u1ea1ch: giai \u0111o\u1ea1n \u0111\u1ea7u m\u1ea1ch nhanh, huy\u1ebft \u00e1p t\u0103ng sau \u0111\u00f3 m\u1ea1ch y\u1ebfu v\u00e0 huy\u1ebft \u00e1p gi\u1ea3m.<\/p>\n

          + Da: l\u00fac \u0111\u1ea7u da \u0111\u1ecf do d\u00e3n m\u1ea1ch, v\u00e3 m\u1ed3 h\u00f4i l\u00e0m che m\u1ea5t d\u1ea5u hi\u1ec7u t\u00edm t\u00e1i.<\/p>\n

          + Tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh l\u00fd g\u00e2y nhi\u1ec5m toan h\u00f4 h\u1ea5p: nh\u01b0 t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh trung \u01b0\u01a1ng, c\u01a1 h\u00f4 h\u1ea5p, t\u1ea1i ph\u1ed5i\u2026<\/p>\n

          – C\u1eadn l\u00e2m s\u00e0ng:<\/p>\n

          + Kh\u00ed m\u00e1u: pH<7,35, paCO2<\/sub>>45mmHg, HCO3<\/sub>–<\/sup>\u00a0>26mmHg<\/p>\n

          + \u0110i\u1ec7n gi\u1ea3i \u0111\u1ed3: Na+<\/sup>, K+<\/sup>\u00a0t\u0103ng, Cl m\u00e1u gi\u1ea3m<\/p>\n

          + N\u01b0\u1edbc ti\u1ec3u: toan, pH < 5,5<\/p>\n

          1.2.2. Nguy\u00ean nh\u00e2n g\u00e2y nhi\u1ec5m toan h\u00f4 h\u1ea5p<\/h4>\n

          – T\u1ea5t c\u1ea3 nguy\u00ean nh\u00e2n l\u00e0m gi\u1ea3m th\u00f4ng kh\u00ed ph\u1ed5i.<\/p>\n

          + Do t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh trung \u01b0\u01a1ng: ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o, xu\u1ea5t huy\u1ebft n\u00e3o, m\u00e0ng n\u00e3o, t\u00ecnh tr\u1ea1ng h\u00f4n m\u00ea s\u00e2u, vi\u00eam n\u00e3o \u2013 m\u00e0ng n\u00e3o.<\/p>\n

          + Do li\u1ec7t c\u00e1c c\u01a1 h\u00f4 h\u1ea5p: vi\u00eam tu\u1ef7 ho\u1eb7c vi\u00eam \u0111a r\u1ec5 th\u1ea7n kinh v\u00e0 b\u1ec7nh b\u1ea1i li\u1ec7t th\u1ec3 h\u01b0\u1edbng th\u01b0\u1ee3ng.<\/p>\n

          + C\u00e1c b\u1ec7nh c\u01a1 v\u00e0 l\u1ed3ng ng\u1ef1c: b\u1ec7nh nh\u01b0\u1ee3c c\u01a1, bi\u1ebfn d\u1ea1ng l\u1ed3ng ng\u1ef1c n\u1eb7ng trong b\u1ec7nh c\u00f2i x\u01b0\u01a1ng n\u1eb7ng, g\u00f9 v\u1eb9o c\u1ed9t s\u1ed1ng<\/p>\n

          + C\u00e1c b\u1ec7nh l\u00fd \u1edf b\u1ed9 ph\u1eadn h\u00f4 h\u1ea5p c\u1ea5p v\u00e0 m\u1ea1n t\u00ednh: vi\u00eam ph\u1ed5i, hen ph\u1ebf qu\u1ea3n, tr\u00e0n d\u1ecbch ho\u1eb7c tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i 2 b\u00ean, x\u1eb9p ph\u1ed5i, d\u1ecb v\u1eadt \u0111\u01b0\u1eddng th\u1edf.<\/p>\n

          1.2.3. \u0110i\u1ec1u tr\u1ecb: theo tr\u00ecnh t\u1ef1 ABCs<\/h4>\n

          – L\u00e0m th\u00f4ng tho\u00e1ng \u0111\u01b0\u1eddng th\u1edf v\u00e0 cho th\u1edf oxy.<\/p>\n

          – Tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m toan h\u00f4 h\u1ea5p n\u1eb7ng (PaCO2<\/sub>\u00a0> 70mmHg) c\u1ea5p t\u00ednh ph\u1ea3i s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc.<\/p>\n

          – Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c dung d\u1ecbch ki\u1ec1m nh\u01b0 NaHCO3<\/sub>\u00a0c\u1ea7n th\u1eadn tr\u1ecdng v\u00ec c\u00f3 th\u1ec3 l\u00e0m t\u0103ng \u00e1p su\u1ea5t CO2<\/sub>. Ngo\u00e0i ra th\u01b0\u1eddng s\u1eed d\u1ee5ng dung d\u1ecbch THAM (0,3N tromethamine)<\/p>\n

          – \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n<\/p>\n

          2. R\u1ed1i lo\u1ea1n ki\u1ec1m toan: Nhi\u1ec5m ki\u1ec1m<\/h2>\n

          2.1. Nhi\u1ec5m ki\u1ec1m chuy\u1ec3n h\u00f3a<\/h3>\n

          Nhi\u1ec5m ki\u1ec1m chuy\u1ec3n h\u00f3a l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd do t\u0103ng HCO3<\/sub>–<\/sup>\u00a0v\u00e0 t\u0103ng pH m\u00e1u. Do s\u1ef1 b\u00f9 tr\u1eeb h\u00f4 h\u1ea5p s\u1ebd l\u00e0m gi\u1ea3m th\u00f4ng kh\u00ed, l\u00e0m t\u0103ng PCO2<\/sub>\u00a0m\u00e1u.<\/p>\n

          2.1.1. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.<\/h4>\n

          – Kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, t\u00ecnh tr\u1ea1ng gi\u1ea3m th\u00f4ng kh\u00ed ph\u1ed5i th\u01b0\u1eddng \u0111\u01b0\u1ee3c nh\u1eadn bi\u1ebft khi ph\u00e2n t\u00edch kh\u00ed m\u00e1u.<\/p>\n

          – Khi b\u1ecb nhi\u1ec5m ki\u1ec1m n\u1eb7ng tr\u1ebb c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u th\u1ea7n kinh r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c, l\u01a1 m\u01a1, ho\u1eb7c h\u00f4n m\u00ea.<\/p>\n

          – Th\u01b0\u1eddng c\u00f3 co gi\u1eadt c\u01a1 do gi\u1ea3m Ca ion trong m\u00e1u<\/p>\n

          2.1.2. Nguy\u00ean nh\u00e2n<\/h4>\n

          – Do m\u1ea5t Cl nhi\u1ec1u:<\/p>\n

          + N\u00f4n nhi\u1ec1u, h\u00fat d\u1ecbch d\u1ea1 d\u00e0y li\u00ean t\u1ee5c, ti\u00eau ch\u1ea3y m\u1ea5t Cl<\/p>\n

          + Nhi\u1ec5m toan sau khi t\u0103ng CO2<\/sub>\u00a0m\u00e1u.<\/p>\n

          + \u0110i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c l\u1ee3i ni\u1ec7u.<\/p>\n

          – Kh\u00f4ng m\u1ea5t Cl:<\/p>\n

          + C\u01b0\u1eddng aldosteron, HC Cushing, \u0111i\u1ec1u tr\u1ecb glucocorticoid.<\/p>\n

          + HC Bartter<\/p>\n

          + Gi\u1ea3m K m\u00e1u<\/p>\n

          + D\u00f9ng nhi\u1ec1u dung d\u1ecbch ki\u1ec1m<\/p>\n

          2.1.3. \u0110i\u1ec1u tr\u1ecb:<\/h4>\n

          – Nguy\u00ean t\u1eafc:<\/p>\n

          + H\u1ed3i ph\u1ee5c kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n v\u00e0 kali m\u00e1u.<\/p>\n

          + T\u00ecm v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1ef1 thi\u1ebfu h\u1ee5t clorua<\/p>\n

          + \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n: ng\u1eebng thu\u1ed1c l\u1ee3i ni\u1ec7u, d\u00f9ng thu\u1ed1c kh\u00e1ng aldosteron, diamox.<\/p>\n

          + Tr\u01b0\u1eddng h\u1ee3p c\u1ea7n thi\u1ebft ph\u1ea3i \u0111i\u1ec1u ch\u1ec9nh t\u00ecnh tr\u1ea1ng nhi\u1ec5m ki\u1ec1m b\u1eb1ng nh\u1ecf gi\u1ecdt t\u0129nh m\u1ea1ch dung d\u1ecbch NH4<\/sub>Cl ho\u1eb7c dung d\u1ecbch chlorhydrat arginine<\/p>\n

          2.2. Nhi\u1ec5m ki\u1ec1m h\u00f4 h\u1ea5p<\/h3>\n

          Nhi\u1ec5m ki\u1ec1m h\u00f4 h\u1ea5p x\u1ea3y ra khi PaCO2<\/sub>\u00a0gi\u1ea3m < 25 mmHg v\u00e0 pH t\u0103ng tr\u00ean 7,45. Do b\u00f9 tr\u1eeb c\u1ee7a th\u1eadn, HCO3<\/sub>–<\/sup>\u00a0s\u1ebd gi\u1ea3m tu\u1ef3 theo t\u00ecnh tr\u1ea1ng gi\u1ea3m CO2<\/sub>\u00a0m\u00e1u c\u1ea5p hay m\u1ea1n t\u00ednh.<\/p>\n

          Trong tr\u01b0\u1eddng h\u1ee3p gi\u1ea3m CO2<\/sub>\u00a0m\u00e1u c\u1ea5p th\u00ec c\u1ee9 gi\u1ea3m 10 mmHg CO2<\/sub>\u00a0th\u00ec HCO3<\/sub>–<\/sup>\u00a0gi\u1ea3m xu\u1ed1ng 2mmol\/l, c\u00f2n khi gi\u1ea3m CO2<\/sub>\u00a0m\u00e1u m\u00e3n t\u00ednh th\u00ec c\u1ee9 gi\u1ea3m 10 mmHg CO2<\/sub>\u00a0s\u1ebd gi\u1ea3m \u0111\u01b0\u1ee3c 5 mmol HCO3<\/sub>–<\/sup>.<\/p>\n

          2.2.1. L\u00e2m s\u00e0ng<\/h4>\n

          Nhi\u1ec5m ki\u1ec1m h\u00f4 h\u1ea5p th\u01b0\u1eddng g\u1eb7p trong t\u00ecnh tr\u1ea1ng t\u0103ng th\u00f4ng kh\u00ed ph\u1ed5i, \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n qua ph\u00e2n t\u00edch kh\u00ed m\u00e1u th\u1ea5y PCO2<\/sub>\u00a0gi\u1ea3m.<\/p>\n

          – Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 th\u1ec3 c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u th\u1ea7n kinh c\u01a1 do co th\u1eaft m\u1ea1ch n\u00e3o: m\u1ea1ch nhanh, lo\u1ea1n nh\u1ecbp th\u1ea5t, \u0111au ng\u1ef1c.<\/p>\n

          – C\u00f3 th\u1ec3 c\u00f3 tetani nh\u01b0 nhi\u1ec5m ki\u1ec1m chuy\u1ec3n h\u00f3a do gi\u1ea3m Ca+<\/sup><\/p>\n

          2.2.2. Nguy\u00ean nh\u00e2n<\/h4>\n

          – Nguy\u00ean nh\u00e2n trung \u01b0\u01a1ng: cao, ng\u1ed9 \u0111\u1ed9c aspirin, c\u00e1c b\u1ec7nh n\u00e3o (vi\u00eam n\u00e3o, u n\u00e3o).<\/p>\n

          – Do thi\u1ebfu m\u00e1u c\u1ea5p v\u00e0 m\u00e3n t\u00ednh (\u1edf v\u00f9ng n\u00fai cao, c\u00f3 thai, x\u01a1 gan)<\/p>\n

          – Do th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc qu\u00e1 m\u1ee9c.<\/p>\n

          2.2.3. \u0110i\u1ec1u tr\u1ecb<\/h4>\n

          – \u00cdt ph\u1ea3i can thi\u1ec7p<\/p>\n

          – N\u1ebfu t\u0103ng th\u00f4ng kh\u00ed qu\u00e1 m\u1ee9c: c\u00f3 th\u1ec3 cho tr\u1ebb th\u1edf trong t\u00fai k\u00edn, ho\u1eb7c d\u00f9ng thu\u1ed1c an th\u1ea7n.<\/p>\n

          <\/p>\n

          3. D\u1ef1 ph\u00f2ng r\u1ed1i lo\u1ea1n ki\u1ec1m toan \u1edf tr\u1ebb:<\/h2>\n

          \u0110\u1ec3 d\u1ef1 ph\u00f2ng r\u1ed1i lo\u1ea1n ki\u1ec1m toan \u1edf tr\u1ebb em, c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng m\u1ed9t s\u1ed1 bi\u1ec7n ph\u00e1p nh\u01b0 sau:<\/p>\n

            \n
          • Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n ki\u1ec1m toan: Khi b\u1ec7nh l\u00fd \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi, t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n ki\u1ec1m toan s\u1ebd \u0111\u01b0\u1ee3c gi\u1ea3m thi\u1ec3u.<\/li>\n
          • T\u01b0 v\u1ea5n cho ph\u1ee5 huynh v\u1ec1 ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng v\u00e0 sinh ho\u1ea1t h\u1ee3p l\u00fd: B\u00e1c s\u0129 c\u00f3 th\u1ec3 t\u01b0 v\u1ea5n cho ph\u1ee5 huynh v\u1ec1 c\u00e1ch \u0103n u\u1ed1ng v\u00e0 sinh ho\u1ea1t h\u1ee3p l\u00fd cho tr\u1ebb \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 r\u1ed1i lo\u1ea1n ki\u1ec1m toan.<\/li>\n
          • T\u0103ng c\u01b0\u1eddng gi\u00e1m s\u00e1t v\u00e0 theo d\u00f5i s\u1ee9c kh\u1ecfe c\u1ee7a tr\u1ebb: B\u00e1c s\u0129 c\u1ea7n t\u0103ng c\u01b0\u1eddng gi\u00e1m s\u00e1t v\u00e0 theo d\u00f5i s\u1ee9c kh\u1ecfe c\u1ee7a tr\u1ebb \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c tri\u1ec7u ch\u1ee9ng b\u1ea5t th\u01b0\u1eddng v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/li>\n<\/ul>\n

            T\u00f3m l\u1ea1i, r\u1ed1i lo\u1ea1n ki\u1ec1m toan \u1edf tr\u1ebb em l\u00e0 t\u00ecnh tr\u1ea1ng nguy hi\u1ec3m \u0111\u00f2i h\u1ecfi s\u1ef1 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. \u0110\u1ec3 d\u1ef1 ph\u00f2ng r\u1ed1i lo\u1ea1n ki\u1ec1m toan \u1edf tr\u1ebb em, c\u1ea7n ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan, t\u01b0 v\u1ea5n cho ph\u1ee5 huynh v\u1ec1 ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng v\u00e0 sinh ho\u1ea1t h\u1ee3p l\u00fd, t\u0103ng c\u01b0\u1eddng gi\u00e1m s\u00e1t v\u00e0 theo d\u00f5i s\u1ee9c kh\u1ecfe c\u1ee7a tr\u1ebb, t\u0103ng c\u01b0\u1eddng gi\u00e1o d\u1ee5c cho ph\u1ee5 huynh v\u00e0 tr\u1ebb v\u1ec1 s\u1ee9c kh\u1ecfe.<\/p>\n

            Ngu\u1ed3n: T\u1ed5ng h\u1ee3p<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

            R\u1ed1i lo\u1ea1n ki\u1ec1m toan \u1edf tr\u1ebb em l\u00e0 t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa c\u00e1c ch\u1ea5t ki\u1ec1m v\u00e0 acid trong c\u01a1 th\u1ec3. C\u00e2n b\u1eb1ng toan ki\u1ec1m c\u00f3 vai tr\u00f2 r\u1ea5t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi s\u1ef1 s\u1ed1ng c\u00f2n c\u1ee7a c\u01a1 th\u1ec3. Nh\u1eefng bi\u1ebfn \u0111\u1ed5i c\u1ee7a n\u1ed3ng \u0111\u1ed9 ion H (H+) d\u00f9 r\u1ea5t nh\u1ecf c\u0169ng \u0111\u1ee7 g\u00e2y […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15,33],"tags":[],"yoast_head":"\nR\u1ed1i lo\u1ea1n ki\u1ec1m toan \u1edf tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"R\u1ed1i lo\u1ea1n ki\u1ec1m toan l\u00e0 t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa c\u00e1c ch\u1ea5t ki\u1ec1m v\u00e0 acid trong c\u01a1 th\u1ec3. 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