{"id":30857,"date":"2023-05-12T23:14:39","date_gmt":"2023-05-12T16:14:39","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30857"},"modified":"2023-05-12T23:14:39","modified_gmt":"2023-05-12T16:14:39","slug":"thuat-ngu-va-cac-thong-so-trong-roi-loan-kiem-toan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/12\/thuat-ngu-va-cac-thong-so-trong-roi-loan-kiem-toan\/","title":{"rendered":"Thu\u1eadt ng\u1eef v\u00e0 c\u00e1c th\u00f4ng s\u1ed1 trong r\u1ed1i lo\u1ea1n ki\u1ec1m toan"},"content":{"rendered":"

R\u1ed1i lo\u1ea1n ki\u1ec1m toan (acid-base imbalance) l\u00e0 t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa acid v\u00e0 baz\u01a1 trong c\u01a1 th\u1ec3, d\u1eabn \u0111\u1ebfn s\u1ef1 thay \u0111\u1ed5i pH c\u1ee7a m\u00e1u v\u00e0 c\u00e1c ch\u1ea5t l\u1ecfng kh\u00e1c trong c\u01a1 th\u1ec3. N\u1ebfu m\u1ed9t trong c\u00e1c th\u00e0nh ph\u1ea7n c\u1ee7a h\u1ec7 th\u1ed1ng c\u00e2n b\u1eb1ng acid-baz\u01a1 b\u1ecb \u1ea3nh h\u01b0\u1edfng ho\u1eb7c b\u1ecb gi\u00e1n \u0111o\u1ea1n, s\u1ebd d\u1eabn \u0111\u1ebfn c\u00e1c r\u1ed1i lo\u1ea1n kh\u00e1c nhau c\u1ee7a c\u00e2n b\u1eb1ng acid-baz\u01a1.<\/strong><\/p>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng r\u1ed1i lo\u1ea1n ki\u1ec1m toan<\/h2>\n

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.<\/p>\n

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

2. Thu\u1eadt ng\u1eef v\u00e0 c\u00e1c th\u00f4ng s\u1ed1 trong th\u0103ng b\u1eb1ng Acid Baz\u01a1<\/h2>\n

2.1.\u00a0<\/i>PH<\/h3>\n

L\u00e0 logarit \u00e2m c\u1ee7a n\u1ed3ng \u0111\u1ed9 [H+], \u0111o b\u1eb1ng nmol\/l. B\u00ecnh th\u01b0\u1eddng pH t\u1eeb 7,35 \u2013 7,45<\/p>\n

2.2.\u00a0<\/i>\u00c1p l\u1ef1c ri\u00eang ph\u1ea7n CO2<\/sub>\u00a0(PCO2<\/sub>)<\/h3>\n

T\u01b0\u01a1ng \u1ee9ng v\u1edbi n\u1ed3ng \u0111\u1ed9 CO2<\/sub>\u00a0ho\u00e0 tan trong huy\u1ebft t\u01b0\u01a1ng m\u00e1u \u0111\u1ed9ng m\u1ea1ch, \u0111o b\u1eb1ng mmHg. B\u00ecnh th\u01b0\u1eddng PCO2<\/sub>\u00a0trong m\u00e1u \u0111\u1ed9ng m\u1ea1ch l\u00e0 35 \u2013 45 mmHg, trung b\u00ecnh l\u00e0 40\u00a0\u00b1\u00a05mmHg.<\/p>\n

2.3.\u00a0<\/i>N\u1ed3ng \u0111\u1ed9 HCO3<\/sub><\/h3>\n

Th\u01b0\u1eddng c\u00f3 2 gi\u00e1 tr\u1ecb:<\/p>\n

– Ki\u1ec1m chu\u1ea9n (SB-Standard Bicarbonat): l\u00e0 n\u1ed3ng \u0111\u1ed9 HCO3<\/sub>\u00a0trong huy\u1ebft t\u01b0\u01a1ng m\u00e1u \u0111\u1ed9ng m\u1ea1ch \u0111o \u1edf \u0111i\u1ec1u ki\u1ec7n chu\u1ea9n: PCO2<\/sub>\u00a0= 40mmHg, \u0111\u1ed9 b\u00e3o ho\u00e0 oxy 100% \u1edf nhi\u1ec7t \u0111\u1ed9 37o<\/sup>C. B\u00ecnh th\u01b0\u1eddng S.B = 24\u00b12mmol\/l.<\/p>\n

– Ki\u1ec1m th\u1ef1c: (aB-actual Bicarbonat): l\u00e0 n\u1ed3ng \u0111\u1ed9 [HCO3<\/sub>] trong m\u00e1u \u0111\u1ed9ng m\u1ea1ch \u0111o \u1edf \u0111i\u1ec1u ki\u1ec7n th\u1ef1c t\u1ebf. B\u00ecnh th\u01b0\u1eddng aB l\u00e0 22-26 mmHg<\/p>\n

2.4.\u00a0<\/i>Ki\u1ec1m \u0111\u1ec7m (BB-buffer Base)<\/h3>\n

– L\u00e0 t\u1ed5ng c\u00e1c anion \u0111\u1ec7m c\u1ee7a m\u00e1u bao g\u1ed3m [HCO3<\/sub>], HbO2<\/sub>, protein, HPO4<\/sub>–<\/sup>, NH3<\/sub>. b\u00ecnh th\u01b0\u1eddng.<\/p>\n

2.5. Ki\u1ec1m d\u01b0 (BE-Base excess)<\/h3>\n

– L\u00e0 hi\u1ec7u s\u1ed1 c\u1ee7a ki\u1ec1m \u0111\u1ec7m th\u1ef1c v\u00e0 ki\u1ec1m \u0111\u1ec7m trong \u0111i\u1ec1u ki\u1ec7n chu\u1ea9n. B\u00ecnh th\u01b0\u1eddng BE = 0\u00b12mmol\/l.<\/p>\n

2.6. \u00c1p su\u1ea5t oxy trong m\u00e1u \u0111\u1ed9ng m\u1ea1ch (PaO2<\/sub>)<\/h3>\n

B\u00ecnh th\u01b0\u1eddng PaO2<\/sub>\u00a0= 80 \u2013 100mmHg.<\/p>\n

2.7.\u00a0<\/i>\u0110\u1ed9 b\u00e3o ho\u00e0 oxy trong m\u00e1u \u0111\u1ed9ng m\u1ea1ch (SaO2<\/sub>)<\/h3>\n

Trong \u0111i\u1ec1u ki\u1ec7n b\u00ecnh th\u01b0\u1eddng \u0111\u1ed9 b\u00e3o ho\u00e0 oxy l\u00e0 94 \u2013 100%.<\/p>\n

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

– pH, PaCO2, PaO2 \u0111o b\u1eb1ng m\u00e1y.<\/p>\n

– C\u00e1c th\u00f4ng s\u1ed1 c\u00f2n l\u1ea1i c\u00f3 \u0111\u01b0\u1ee3c qua t\u00ednh to\u00e1n d\u1ef1a pH, PCO2, PO2, FiO2, T0<\/sup>, Hb. Do \u0111\u00f3, ph\u1ea3i ghi c\u00e1c th\u00f4ng s\u1ed1 FiO2, T0<\/sup>, Hb c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0o phi\u1ebfu x\u00e9t nghi\u1ec7m th\u1eed kh\u00ed m\u00e1u \u0111\u1ec3 nh\u1eadp v\u00e0o m\u00e1y \u0111o kh\u00ed m\u00e1u th\u00ec k\u1ebft qu\u1ea3 m\u1edbi ch\u00ednh x\u00e1c. N\u1ebfu kh\u00f4ng ghi, m\u00e1y ng\u1ea7m hi\u1ec3u FiO2 = 21%, T0<\/sup>\u00a0= 370<\/sup>C, Hb = 15 g%<\/p>\n

– AaDO2 = PA<\/sub>O2 \u2013 PaO2 = FiO2 (Pb \u2013 47) – PA<\/sub>CO2 \u2013 PaO2 = FiO2 (Pb \u2013 47) – PaCO2 \/R \u2013 PaO2. (R: th\u01b0\u01a1ng s\u1ed1 h\u00f4 h\u1ea5p)<\/p>\n

3. C\u00e1c b\u01b0\u1edbc \u0111\u1ecdc nhanh k\u1ebft qu\u1ea3 kh\u00ed m\u00e1u:<\/h2>\n

3.1. B\u01b0\u1edbc 1: \u0111\u1ecdc pH<\/h3>\n

– pH < 7,35 toan<\/p>\n

– pH > 7,45 ki\u1ec1m<\/p>\n

– pH b\u00ecnh th\u01b0\u1eddng: t\u00ednh % thay \u0111\u1ed5i PCO2\u00a0<\/sub>v\u00e0 HCO3<\/sub>–<\/sup>\u00a0so v\u1edbi tr\u1ecb s\u1ed1 b\u00ecnh th\u01b0\u1eddng \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p hay chuy\u1ec3n h\u00f3a l\u00e0 ch\u00ednh.<\/p>\n

VD1: pH: 7,39, PCO2<\/sub>: 30, HCO3<\/sub>–<\/sup>: 16, BE: -4<\/p>\n

pH: 7,39: b\u00ecnh th\u01b0\u1eddng, PCO2\u00a0<\/sub>gi\u1ea3m 25%, HCO3<\/sub>–<\/sup>\u00a0gi\u1ea3m 33%\u00a0\u00ae\u00a0toan chuy\u1ec3n h\u00f3a l\u00e0 ch\u00ednh<\/p>\n

VD2: pH: 7,45, PCO2<\/sub>: 30, HCO3<\/sub>–<\/sup>: 33, BE: +6<\/p>\n

pH: 7,45: b\u00ecnh th\u01b0\u1eddng, PCO2\u00a0\u00a0<\/sub>gi\u1ea3m 25%, HCO3<\/sub>–<\/sup> t\u0103ng 37,5%\u00a0 ki\u1ec1m chuy\u1ec3n h\u00f3a l\u00e0 ch\u00ednh, k\u00e8m ki\u1ec1m h\u00f4 h\u1ea5p<\/p>\n

VD3: pH: 7,38, PCO2\u00a0<\/sub>: 50, HCO3<\/sub>–<\/sup>: 28, BE: +2<\/p>\n

pH: 7,38: b\u00ecnh th\u01b0\u1eddng, PCO2\u00a0<\/sub>t\u0103ng 25%, HCO3<\/sub>–<\/sup> t\u0103ng 16,6%\u00a0 toan h\u00f4 h\u1ea5p l\u00e0 ch\u00ednh<\/p>\n

3.2. B\u01b0\u1edbc 2: \u0111\u1ecdc PCO2<\/sub><\/h3>\n

– PaCO2 thay \u0111\u1ed5i ng\u01b0\u1ee3c chi\u1ec1u v\u1edbi pH r\u1ed1i lo\u1ea1n v\u1ec1 h\u00f4 h\u1ea5p,<\/p>\n

– PCO2 thay \u0111\u1ed5i c\u00f9ng chi\u1ec1u v\u1edbi pH r\u1ed1i lo\u1ea1n v\u1ec1 chuy\u1ec3n h\u00f3a<\/p>\n

VD1: pH: 7,31, PCO2<\/sub>: 10, HCO3<\/sub>–<\/sup>: 5, BE: -14, Na+<\/sup>: 123, Cl–<\/sup>: 99<\/p>\n

pH: 7,31 <7.36: toan, PCO2\u00a0<\/sub>thay \u0111\u1ed5i c\u00f9ng chi\u1ec1u v\u1edbi pH: r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a toan chuy\u1ec3n h\u00f3a,<\/p>\n

VD2: pH: 7,24, PCO2<\/sub>: 60, HCO3<\/sub>–<\/sup>: 32, BE: +2<\/p>\n

pH: 7,24 < 7,35: toan, PCO2\u00a0<\/sub>thay \u0111\u1ed5i ng\u01b0\u1ee3c chi\u1ec1u v\u1edbi pH: r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p toan h\u00f4 h\u1ea5p<\/p>\n

3.3. B\u01b0\u1edbc 3: \u0111\u1ecdc ki\u1ec1m d\u01b0 (Base Excess:BE)<\/h3>\n

– BE > 2: ki\u1ec1m chuy\u1ec3n h\u00f3a,<\/p>\n

– BE < -2: toan chuy\u1ec3n h\u00f3a (l\u01b0u \u00fd HCO3<\/sub>–<\/sup>\u00a0t\u00f9y thu\u00f4c v\u00e0o thay \u0111\u1ed5 PCO2<\/sub>, trong khi BE th\u00ec kh\u00f4ng) t\u00ednh Anion Gap => t\u1ed5ng h\u1ee3p c\u00e1c r\u1ed1i lo\u1ea1n<\/p>\n

– C\u00f4ng th\u1ee9c t\u00ednh Anion gap: AG = Na \u2013 (HCO3<\/sub>–<\/sup>\u00a0+ Cl–<\/sup>) . B\u00ecnh th\u01b0\u1eddng AG = 12\u00a0\u00b1\u00a04 mEq\/L<\/p>\n

4. Ph\u00e2n lo\u1ea1i r\u1ed1i lo\u1ea1n ki\u1ec1m toan<\/h2>\n

4.1. Ph\u00e2n lo\u1ea1i r\u1ed1i lo\u1ea1n ki\u1ec1m toan<\/h3>\n

B\u1ea3ng 1. Ph\u00e2n lo\u1ea1i r\u1ed1i lo\u1ea1n ki\u1ec1m toan<\/p>\n\n\n\n\n\n\n\n
\n

R\u1ed1i lo\u1ea1n<\/b><\/p>\n<\/td>\n

\n

pH \u0111\u1ed9ng m\u1ea1ch<\/b><\/p>\n<\/td>\n

\n

Thay \u0111\u1ed5i nguy\u00ean ph\u00e1t<\/b><\/p>\n<\/td>\n

\n

Thay \u0111\u1ed5i b\u00f9 tr\u1eeb<\/b><\/p>\n<\/td>\n<\/tr>\n

Toan chuy\u1ec3n h\u00f3a<\/td>\n\n

\u00af<\/p>\n<\/td>\n

\n

\u00af\u00a0HCO3<\/sub>–<\/sup><\/p>\n<\/td>\n

\n

\u00af\u00a0PCO2<\/sub><\/p>\n<\/td>\n<\/tr>\n

Toan h\u00f4 h\u1ea5p<\/td>\n\n

\u00af<\/p>\n<\/td>\n

\n

\u00ad\u00a0PCO2<\/sub><\/p>\n<\/td>\n

\n

\u00ad\u00a0HCO3<\/sub>–<\/sup><\/p>\n<\/td>\n<\/tr>\n

Ki\u1ec1m chuy\u1ec3n h\u00f3a<\/td>\n\n

\u00ad<\/p>\n<\/td>\n

\n

\u00ad\u00a0HCO3<\/sub>–<\/sup><\/p>\n<\/td>\n

\n

\u00ad\u00a0PCO2<\/sub><\/p>\n<\/td>\n<\/tr>\n

Ki\u1ec1m h\u00f4 h\u1ea5p<\/td>\n\n

\u00ad<\/p>\n<\/td>\n

\n

\u00af\u00a0PCO2<\/sub><\/p>\n<\/td>\n

\n

\u00af\u00a0HCO3<\/sub>–<\/sup><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

4.2. S\u1ef1 b\u00f9 tr\u1eeb b\u00ecnh th\u01b0\u1eddng trong r\u1ed1i lo\u1ea1n ki\u1ec1m toan.<\/h3>\n

B\u1ea3ng 2. S\u1ef1 b\u00f9 tr\u1eeb trong r\u1ed1i lo\u1ea1n toan ki\u1ec1m<\/p>\n\n\n\n\n\n\n\n
\n

R\u1ed1i lo\u1ea1n<\/b><\/p>\n<\/td>\n

\n

B\u00f9 tr\u1eeb<\/b><\/p>\n<\/td>\n<\/tr>\n

Toan chuy\u1ec3n h\u00f3a<\/td>\nPCO2<\/sub>\u00a0(mmHg) = 1 \u2013 1,4 x HCO-3 (mEq\/l)<\/td>\n<\/tr>\n
Ki\u1ec1m chuy\u1ec3n h\u00f3a<\/td>\nPCO2<\/sub>\u00a0(mmHg) = 0,5 \u2013 1 x HCO-3 (mEq\/l)<\/td>\n<\/tr>\n
Toan h\u00f4 h\u1ea5p<\/p>\n

C\u1ea5p (<24h)<\/p>\n

M\u00e3n (3-5 ng\u00e0y)<\/td>\n

HCO3<\/sub>–<\/sup>\u00a0(mEq\/l) = 0,1 x PCO2<\/sub>\u00a0(mmHg)<\/p>\n

HCO3<\/sub>–<\/sup>\u00a0(mEq\/l) = 0,4 x PCO2<\/sub>\u00a0(mmHg)<\/td>\n<\/tr>\n

Ki\u1ec1m h\u00f4 h\u1ea5p<\/p>\n

C\u1ea5p (<12h)<\/p>\n

M\u00e3n (1-2 ng\u00e0y)<\/td>\n

HCO3<\/sub>–\u00a0<\/sup>(mEq\/l) = 0,2 x PCO2<\/sub>\u00a0(mmHg)<\/p>\n

HCO3<\/sub>–<\/sup>\u00a0(mEq\/l) = 0,4 \u2013 0,5 x PCO2<\/sub>\u00a0(mmHg)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

D\u1ef1a tr\u00ean thay \u0111\u1ed5i t\u1eeb gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng<\/p>\n

HCO3<\/sub>–<\/sup>\u00a0= 24 mmol\/l<\/p>\n

PCO2\u00a0<\/sub>= 40mmHg<\/p>\n

5. \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n ki\u1ec1m toan:<\/h2>\n

C\u00e1c r\u1ed1i lo\u1ea1n ki\u1ec1m toan c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c nhau, bao g\u1ed3m kh\u00f3 th\u1edf, \u0111au \u0111\u1ea7u, bu\u1ed3n n\u00f4n, n\u00f4n m\u1eeda, m\u1ec7t m\u1ecfi, kh\u00f4 mi\u1ec7ng, c\u01a1n co gi\u1eadt v\u00e0 m\u1ea5t \u00fd th\u1ee9c. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n ki\u1ec1m toan ph\u1ee5 thu\u1ed9c v\u00e0o nguy\u00ean nh\u00e2n g\u00e2y ra t\u00ecnh tr\u1ea1ng n\u00e0y, v\u00e0 bao g\u1ed3m \u0111i\u1ec1u ch\u1ec9nh c\u00e2n b\u1eb1ng acid-baz\u01a1 c\u1ee7a c\u01a1 th\u1ec3 th\u00f4ng qua vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ho\u1eb7c c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c.<\/p>\n

6. D\u1ef1 ph\u00f2ng r\u1ed1i lo\u1ea1n ki\u1ec1m toan:<\/h2>\n

\u0110\u1ed1i v\u1edbi b\u00e1c s\u0129, vi\u1ec7c ph\u00f2ng ng\u1eeba r\u1ed1i lo\u1ea1n ki\u1ec1m toan l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u00fap b\u1ea3o v\u1ec7 s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 m\u1ed9t s\u1ed1 c\u00e1ch m\u00e0 b\u00e1c s\u0129 c\u00f3 th\u1ec3 ph\u00f2ng ng\u1eeba r\u1ed1i lo\u1ea1n ki\u1ec1m toan:<\/p>\n

    \n
  • \u0110i\u1ec1u ch\u1ec9nh li\u1ec1u thu\u1ed1c: N\u1ebfu b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c nh\u01b0 diuretic, aspirin, ho\u1eb7c c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c c\u00f3 th\u1ec3 g\u00e2y ra r\u1ed1i lo\u1ea1n ki\u1ec1m toan, b\u00e1c s\u0129 c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u thu\u1ed1c sao cho ph\u00f9 h\u1ee3p v\u1edbi b\u1ec7nh nh\u00e2n.<\/li>\n
  • Ki\u1ec3m tra ch\u1ee9c n\u0103ng th\u1eadn: Ch\u1ee9c n\u0103ng th\u1eadn l\u00e0 y\u1ebfu t\u1ed1 quan tr\u1ecdng trong vi\u1ec7c duy tr\u00ec c\u00e2n b\u1eb1ng acid-baz\u01a1. B\u00e1c s\u0129 c\u1ea7n ki\u1ec3m tra ch\u1ee9c n\u0103ng th\u1eadn c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 r\u1ed1i lo\u1ea1n ki\u1ec1m toan v\u00e0 c\u00f3 bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba k\u1ecbp th\u1eddi.<\/li>\n
  • Gi\u00e1m s\u00e1t c\u00e2n b\u1eb1ng n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i: B\u00e1c s\u0129 c\u1ea7n gi\u00e1m s\u00e1t c\u00e1c ch\u1ec9 s\u1ed1 c\u00e2n b\u1eb1ng n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 r\u1ed1i lo\u1ea1n ki\u1ec1m toan v\u00e0 c\u00f3 bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba k\u1ecbp th\u1eddi.<\/li>\n
  • Th\u1ef1c hi\u1ec7n \u0111i\u1ec1u tr\u1ecb \u0111\u00fang c\u00e1ch: \u0110i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd nh\u01b0 b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng, suy th\u1eadn hay b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh \u0111\u00fang c\u00e1ch l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 r\u1ed1i lo\u1ea1n ki\u1ec1m toan.<\/li>\n
  • \u0110\u00e0o t\u1ea1o cho b\u1ec7nh nh\u00e2n: B\u00e1c s\u0129 c\u1ea7n gi\u1ea3ng d\u1ea1y cho b\u1ec7nh nh\u00e2n v\u1ec1 c\u00e1c thay \u0111\u1ed5i trong ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng v\u00e0 l\u1ed1i s\u1ed1ng l\u00e0nh m\u1ea1nh \u0111\u1ec3 gi\u00fap b\u1ec7nh nh\u00e2n ph\u00f2ng ng\u1eeba r\u1ed1i lo\u1ea1n ki\u1ec1m toan.<\/li>\n
  • Theo d\u00f5i s\u00e1t sao b\u1ec7nh nh\u00e2n: B\u00e1c s\u0129 c\u1ea7n theo d\u00f5i s\u00e1t sao t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao v\u1ec1 r\u1ed1i lo\u1ea1n ki\u1ec1m toan, v\u00e0 c\u00f3 bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba k\u1ecbp th\u1eddi khi c\u1ea7n thi\u1ebft.<\/li>\n<\/ul>\n

    Nh\u1eefng c\u00e1ch ph\u00f2ng ng\u1eeba tr\u00ean \u0111\u00e2y l\u00e0m gi\u1ea3m nguy c\u01a1 m\u1eafc c\u00e1c r\u1ed1i lo\u1ea1n ki\u1ec1m toan v\u00e0 b\u1ea3o v\u1ec7 s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n. Tuy nhi\u00ean, n\u1ebfu c\u00f3 b\u1ea5t k\u1ef3 \u0111i\u1ec1u g\u00ec kh\u00f4ng ch\u1eafc ch\u1eafn ho\u1eb7c nghi ng\u1edd v\u1ec1 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n, b\u00e1c s\u0129 c\u1ea7n th\u1ea3o lu\u1eadn v\u00e0 t\u01b0 v\u1ea5n k\u1ecbp th\u1eddi \u0111\u1ec3 \u0111\u01b0a ra c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<\/p>\n

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

    R\u1ed1i lo\u1ea1n ki\u1ec1m toan (acid-base imbalance) l\u00e0 t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa acid v\u00e0 baz\u01a1 trong c\u01a1 th\u1ec3, d\u1eabn \u0111\u1ebfn s\u1ef1 thay \u0111\u1ed5i pH c\u1ee7a m\u00e1u v\u00e0 c\u00e1c ch\u1ea5t l\u1ecfng kh\u00e1c trong c\u01a1 th\u1ec3. N\u1ebfu m\u1ed9t trong c\u00e1c th\u00e0nh ph\u1ea7n c\u1ee7a h\u1ec7 th\u1ed1ng c\u00e2n b\u1eb1ng acid-baz\u01a1 b\u1ecb \u1ea3nh h\u01b0\u1edfng ho\u1eb7c b\u1ecb gi\u00e1n \u0111o\u1ea1n, s\u1ebd […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15,29,33],"tags":[],"yoast_head":"\nThu\u1eadt ng\u1eef v\u00e0 c\u00e1c th\u00f4ng s\u1ed1 trong r\u1ed1i lo\u1ea1n ki\u1ec1m toan - 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 acid v\u00e0 baz\u01a1 trong c\u01a1 th\u1ec3, d\u1eabn \u0111\u1ebfn thay \u0111\u1ed5i pH c\u1ee7a m\u00e1u v\u00e0 c\u00e1c ch\u1ea5t l\u1ecfng kh\u00e1c.\" \/>\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=\"Thu\u1eadt ng\u1eef v\u00e0 c\u00e1c th\u00f4ng s\u1ed1 trong r\u1ed1i lo\u1ea1n ki\u1ec1m toan - 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