{"id":31056,"date":"2023-05-04T17:12:05","date_gmt":"2023-05-04T10:12:05","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31056"},"modified":"2023-05-04T17:12:05","modified_gmt":"2023-05-04T10:12:05","slug":"gian-phe-quan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/gian-phe-quan\/","title":{"rendered":"Gi\u00e3n ph\u1ebf qu\u1ea3n: Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Gi\u00e3n ph\u1ebf qu\u1ea3n l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd ph\u1ed5 bi\u1ebfn \u1edf c\u00e1c b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh ph\u1ed5i m\u00e3n t\u00ednh. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb gi\u00e3n ph\u1ebf qu\u1ea3n k\u1ecbp th\u1eddi v\u00e0 ch\u00ednh x\u00e1c l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh gi\u00e3n ph\u1ebf qu\u1ea3n c\u1ee7a B\u1ed9 Y t\u1ebf 2012.<\/strong><\/p>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng<\/strong><\/h1>\n

Gi\u00e3n ph\u1ebf qu\u1ea3n (GPQ) l\u00e0 t\u00ecnh tr\u1ea1ng t\u0103ng kh\u1ea9u k\u00ednh ph\u1ebf qu\u1ea3n li\u00ean t\u1ee5c, v\u0129nh vi\u1ec5n kh\u00f4ng h\u1ed3i ph\u1ee5c c\u1ee7a m\u1ed9t ho\u1eb7c nhi\u1ec1u ph\u1ebf qu\u1ea3n c\u00f3 \u0111\u01b0\u1eddng k\u00ednh tr\u00ean 2 mm. GPQ \u0111\u01b0\u1ee3c chia th\u00e0nh: GPQ h\u00ecnh t\u00fai, GPQ h\u00ecnh tr\u1ee5 v\u00e0 GPQ h\u00ecnh tr\u00e0ng h\u1ea1t. B\u1ec7nh g\u00e2y ra do s\u1ef1 ph\u00e1 h\u1ee7y t\u1ed5 ch\u1ee9c c\u1ee7a th\u00e0nh ph\u1ebf qu\u1ea3n.<\/p>\n

\"\"
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Ngu\u1ed3n: Bronchiectasis – European Lung Foundation<\/strong><\/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<\/em><\/strong><\/p>\n

– Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng.<\/strong><\/p>\n

+ Ho, kh\u1ea1c \u0111\u1eddm k\u00e9o d\u00e0i<\/strong>: l\u00e0 tri\u1ec7u ch\u1ee9ng r\u1ea5t quan tr\u1ecdng. \u0110\u1eddm m\u1ee7 m\u00e0u xanh ho\u1eb7c m\u00e0u v\u00e0ng, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 ho \u0111\u1eddm l\u1eabn m\u00e1u. L\u01b0\u1ee3ng \u0111\u1eddm trong ng\u00e0y c\u00f3 th\u1ec3 \u00edt (< 10 ml\/ng\u00e0y), trung b\u00ecnh (10-150 ml\/ng\u00e0y) ho\u1eb7c nhi\u1ec1u (> 150 ml\/ng\u00e0y). \u0110\u1ec3 l\u1eafng \u0111\u1eddm c\u00f3 3 l\u1edbp: l\u1edbp tr\u00ean l\u00e0 b\u1ecdt; l\u1edbp gi\u1eefa l\u00e0 nh\u1ea7y m\u1ee7; l\u1edbp d\u01b0\u1edbi l\u00e0 m\u1ee7 \u0111\u1ee5c. Kh\u1ea1c \u0111\u1eddm th\u01b0\u1eddng t\u0103ng l\u00ean khi c\u00f3 b\u1ed9i nhi\u1ec5m. C\u00f3 m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p ho khan ho\u1eb7c kh\u00f4ng ho (GPQ th\u1ec3 kh\u00f4 \u1edf c\u00e1c thu\u1ef3 tr\u00ean). M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 d\u1ea5u hi\u1ec7u c\u1ee7a vi\u00eam \u0111a xoang l\u00e0m h\u01b0\u1edbng t\u1edbi h\u1ed9i ch\u1ee9ng xoang ph\u1ebf qu\u1ea3n.<\/p>\n

+ Ho ra m\u00e1u:<\/strong> c\u00f3 th\u1ec3 l\u00e0 tri\u1ec7u ch\u1ee9ng duy nh\u1ea5t c\u1ee7a b\u1ec7nh. Ho m\u00e1u t\u00e1i ph\u00e1t nhi\u1ec1u l\u1ea7n, c\u00f3 th\u1ec3 k\u00e9o d\u00e0i nhi\u1ec1u n\u0103m. M\u1ee9c \u0111\u1ed9 ho m\u00e1u c\u00f3 th\u1ec3 \u00edt ho\u1eb7c nhi\u1ec1u t\u1eeb ho m\u00e1u nh\u1eb9 (< 50 ml); trung b\u00ecnh (50-200 ml), ho m\u00e1u n\u1eb7ng (> 200 ml), ho m\u00e1u r\u1ea5t n\u1eb7ng (> 500 ml\/ng\u00e0y) v\u00e0\/ho\u1eb7c g\u00e2y suy h\u00f4 h\u1ea5p c\u1ea5p.<\/p>\n

+ Kh\u00f3 th\u1edf<\/strong>: th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n mu\u1ed9n, l\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a suy h\u00f4 h\u1ea5p do t\u1ed5n th\u01b0\u01a1ng lan to\u1ea3 hai ph\u1ed5i; c\u00f3 th\u1ec3 c\u00f3 t\u00edm.<\/p>\n

+ S\u1ed1t:<\/strong> khi c\u00f3 nhi\u1ec5m khu\u1ea9n h\u00f4 h\u1ea5p, s\u1ed1t th\u01b0\u1eddng k\u00e8m theo kh\u1ea1c \u0111\u1eddm t\u0103ng v\u00e0 \/ho\u1eb7c thay \u0111\u1ed5i m\u00e0u s\u1eafc c\u1ee7a \u0111\u1eddm.<\/p>\n

+ \u0110au ng\u1ef1c<\/strong>: l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a nhi\u1ec5m khu\u1ea9n ph\u1ed5i \u1edf v\u00f9ng g\u1ea7n m\u00e0ng ph\u1ed5i ho\u1eb7c t\u00fai ph\u1ebf qu\u1ea3n gi\u00e3n c\u0103ng.<\/p>\n

– Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3<\/strong><\/p>\n

+ Kh\u00e1m ph\u1ed5i: th\u01b0\u1eddng th\u1ea5y ran n\u1ed5, ran \u1ea9m. Ran ng\u00e1y, ran r\u00edt ch\u1ec9 nghe th\u1ea5y trong \u0111\u1ee3t c\u1ea5p, c\u00f3 khi nghe th\u1ea5y ti\u1ebfng th\u1ed5i gi\u1ea3 hang, c\u00f3 th\u1ec3 th\u1ea5y h\u1ed9i ch\u1ee9ng \u0111\u00f4ng \u0111\u1eb7c co r\u00fat khi c\u00f3 x\u1eb9p ph\u1ed5i.<\/p>\n

+ M\u00f3ng tay khum \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb b\u1ed9i nhi\u1ec5m ph\u1ebf qu\u1ea3n nhi\u1ec1u l\u1ea7n, k\u00e9o d\u00e0i.<\/p>\n

+ C\u00f3 th\u1ec3 c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u00e2m ph\u1ebf m\u1ea1n: ph\u00f9 ch\u00e2n, gan to, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i,\u2026<\/p>\n

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

Tr\u00ean phim X-quang ph\u1ed5i chu\u1ea9n c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd ho\u1eb7c kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n GPQ trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p GPQ nhi\u1ec1u v\u00e0 n\u1eb7ng. Tuy nhi\u00ean ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh GPQ th\u01b0\u1eddng ph\u1ea3i d\u1ef1a v\u00e0o phim ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh l\u1edbp m\u1ecfng 1 mm, \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao.<\/p>\n

– H\u00ecnh \u1ea3nh X-quang ph\u1ed5i:<\/p>\n

+ Th\u00e0nh ph\u1ebf qu\u1ea3n t\u1ea1o th\u00e0nh c\u00e1c \u0111\u01b0\u1eddng song song (\u0111\u01b0\u1eddng ray).<\/p>\n

+ Th\u1ec3 t\u00edch c\u1ee7a thu\u1ef3 ph\u1ed5i c\u00f3 gi\u00e3n ph\u1ebf qu\u1ea3n nh\u1ecf l\u1ea1i, c\u00e1c \u0111\u01b0\u1eddng m\u1edd m\u1ea1ch m\u00e1u ph\u1ed5i x\u00edt l\u1ea1i v\u1edbi nhau n\u1ebfu c\u00f3 x\u1eb9p ph\u1ed5i.<\/p>\n

+ C\u00f3 c\u00e1c \u1ed5 s\u00e1ng nh\u1ecf gi\u1ed1ng h\u00ecnh \u1ea3nh t\u1ed5 ong, c\u00f3 th\u1ec3 c\u00f3 \u1ed5 s\u00e1ng v\u1edbi m\u1ef1c n\u01b0\u1edbc ngang k\u00edch th\u01b0\u1edbc th\u01b0\u1eddng kh\u00f4ng qu\u00e1 2 cm.<\/p>\n

+ H\u00ecnh \u1ea3nh vi\u00eam ph\u1ed5i t\u00e1i di\u1ec5n h\u00e0ng n\u0103m v\u1ec1 m\u00f9a l\u1ea1nh xung quanh khu v\u1ef1c gi\u00e3n ph\u1ebf qu\u1ea3n.<\/p>\n

+ C\u00e1c \u0111\u00e1m m\u1edd h\u00ecnh \u1ed1ng bi\u1ec3u hi\u1ec7n c\u1ee7a c\u00e1c ph\u1ebf qu\u1ea3n b\u1ecb l\u1ea5p \u0111\u1ea7y ch\u1ea5t nh\u1ea7y, m\u1ee7.<\/p>\n

+ Kho\u1ea3ng 7 – 30% tr\u01b0\u1eddng h\u1ee3p ch\u1ee5p ph\u1ed5i chu\u1ea9n kh\u00f4ng th\u1ea5y g\u00ec b\u1ea5t th\u01b0\u1eddng.<\/p>\n

– Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh vi t\u00ednh l\u1edbp m\u1ecfng, \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao: l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng trong ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh gi\u00e3n ph\u1ebf qu\u1ea3n. C\u00e1c d\u1ea5u hi\u1ec7u c\u00f3 th\u1ec3 g\u1eb7p:<\/p>\n

+ \u0110\u01b0\u1eddng k\u00ednh trong c\u1ee7a ph\u1ebf qu\u1ea3n l\u1edbn h\u01a1n \u0111\u1ed9ng m\u1ea1ch \u0111i k\u00e8m.<\/p>\n

+ C\u00e1c ph\u1ebf qu\u1ea3n kh\u00f4ng nh\u1ecf d\u1ea7n \u0111\u01b0\u1ee3c quy \u0111\u1ecbnh l\u00e0 khi 1 ph\u1ebf qu\u1ea3n tr\u00ean m\u1ed9t \u0111o\u1ea1n d\u00e0i 2 cm c\u00f3 \u0111\u01b0\u1eddng k\u00ednh t\u01b0\u01a1ng t\u1ef1 ph\u1ebf qu\u1ea3n \u0111\u00e3 ph\u00e2n chia ra ph\u1ebf qu\u1ea3n \u0111\u00f3.<\/p>\n

+ Th\u1ea5y ph\u1ebf qu\u1ea3n \u1edf c\u00e1ch m\u00e0ng ph\u1ed5i th\u00e0nh ng\u1ef1c d\u01b0\u1edbi 1 cm.<\/p>\n

+ Th\u1ea5y ph\u1ebf qu\u1ea3n \u0111i s\u00e1t v\u00e0o m\u00e0ng ph\u1ed5i trung th\u1ea5t.<\/p>\n

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

Ch\u1ec9 \u0111\u1eb7t ra khi ch\u01b0a ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh; c\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi:<\/p>\n

– \u00c1p xe ph\u1ed5i: r\u1ea5t kh\u00f3 ph\u00e2n bi\u1ec7t khi gi\u00e3n ph\u1ebf qu\u1ea3n c\u00f3 \u0111\u1ee3t b\u1ed9i nhi\u1ec5m c\u1ea5p.<\/p>\n

– Lao ph\u1ed5i.<\/p>\n

– K\u00e9n kh\u00ed \u1edf ph\u1ed5i b\u1ed9i nhi\u1ec5m: x\u00e1c \u0111\u1ecbnh b\u1eb1ng ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb<\/strong><\/h2>\n

3.1. \u0110i\u1ec1u tr\u1ecb b\u1ed9i nhi\u1ec5m ph\u1ebf qu\u1ea3n<\/strong><\/h3>\n

L\u1ef1a ch\u1ecdn kh\u00e1ng sinh ban \u0111\u1ea7u, d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng hay \u0111\u01b0\u1eddng ti\u00eam t\u00f9y theo m\u1ee9c \u0111\u1ed9 nhi\u1ec5m tr\u00f9ng, m\u00e0u s\u1eafc \u0111\u1eddm:<\/p>\n

– C\u00e1c kh\u00e1ng sinh th\u01b0\u1eddng d\u00f9ng trong gi\u00e3n ph\u1ebf qu\u1ea3n l\u00e0 cephalosporin th\u1ebf h\u1ec7 2: cefuroxim 2 g\/ng\u00e0y; Cephalosporin th\u1ebf h\u1ec7 3: cefotaxim 3-6 g\/ng\u00e0y, ceftazidim 3-6 g\/ng\u00e0y (chia 3 l\u1ea7n).<\/p>\n

– K\u1ebft h\u1ee3p v\u1edbi c\u00e1c kh\u00e1ng sinh nh\u00f3m aminoglycosid: gentamycin 3-5 mg\/kg\/ng\u00e0y ti\u00eam b\u1eafp 1 l\u1ea7n ho\u1eb7c amikacin 15 mg\/kg\/ng\u00e0y ti\u00eam b\u1eafp 1 l\u1ea7n ho\u1eb7c pha truy\u1ec1n t\u0129nh m\u1ea1ch v\u1edbi natriclorua 0,9% ho\u1eb7c nh\u00f3m quinolon: ciprofloxacin 1 g\/ng\u00e0y chia 2 l\u1ea7n, levofloxacin 750 mg\/ng\u00e0y, moxifloxacin 400 mg\/ng\u00e0y.<\/p>\n

– C\u00e1c thu\u1ed1c kh\u00e1c c\u00f3 th\u1ec3 d\u00f9ng thay th\u1ebf:<\/p>\n

+ Penicillin G 10-50 tri\u1ec7u \u0111\u01a1n v\u1ecb\/ng\u00e0y, pha truy\u1ec1n t\u0129nh m\u1ea1ch, k\u1ebft h\u1ee3p 1 kh\u00e1ng sinh nh\u00f3m aminoglycosid.<\/p>\n

+ N\u1ebfu nghi vi khu\u1ea9n ti\u1ebft betalactamase th\u00ec thay penicilin G b\u1eb1ng amoxicilin + acid clavunalic ho\u1eb7c ampicilin + sulbactam, li\u1ec1u d\u00f9ng 3-6 g\/ng\u00e0y.<\/p>\n

+ N\u1ebfu b\u1ec7nh nh\u00e2n kh\u1ea1c \u0111\u1eddm m\u1ee7 th\u1ed1i th\u00ec k\u1ebft h\u1ee3p nh\u00f3m betalactam v\u1edbi metronidazol 1-1,5 g\/ng\u00e0y truy\u1ec1n t\u0129nh m\u1ea1ch chia 2-3 l\u1ea7n, ho\u1eb7c penicilin G 10-50 tri\u1ec7u \u0111\u01a1n v\u1ecb k\u1ebft h\u1ee3p metronidazol 1-1,5 g\/ng\u00e0y truy\u1ec1n t\u0129nh m\u1ea1ch.<\/p>\n

– Thay \u0111\u1ed5i kh\u00e1ng sinh d\u1ef1a theo \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng v\u00e0 k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 n\u1ebfu c\u00f3.<\/p>\n

– Th\u1eddi gian d\u00f9ng kh\u00e1ng sinh: t\u00f9y theo t\u1eebng tr\u01b0\u1eddng h\u1ee3p. Th\u1eddi gian d\u00f9ng kh\u00e1ng sinh th\u00f4ng th\u01b0\u1eddng: 1-2 tu\u1ea7n. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p gi\u00e3n ph\u1ebf qu\u1ea3n n\u1eb7ng, vi khu\u1ea9n kh\u00e1ng thu\u1ed1c: th\u01b0\u1eddng c\u1ea7n d\u00f9ng kh\u00e1ng sinh d\u00e0i ng\u00e0y h\u01a1n, ho\u1eb7c b\u1ed9i nhi\u1ec5m do\u00a0Pseudomonas aeruginosa<\/em>, ho\u1eb7c\u00a0Staphylococcus areus<\/em>: th\u1eddi gian d\u00f9ng kh\u00e1ng sinh c\u00f3 th\u1ec3 t\u1edbi 3 tu\u1ea7n.<\/p>\n

3.2. D\u1eabn l\u01b0u \u0111\u1eddm<\/strong><\/h3>\n

– H\u01b0\u1edbng d\u1eabn cho b\u1ec7nh nh\u00e2n c\u00e1ch ho kh\u1ea1c \u0111\u1eddm v\u00e0 v\u1ed7 rung l\u1ed3ng ng\u1ef1c k\u1ebft h\u1ee3p v\u1edbi d\u1eabn l\u01b0u theo t\u01b0 th\u1ebf: tu\u1ef3 theo v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng ch\u1ecdn t\u01b0 th\u1ebf th\u00edch h\u1ee3p, th\u01b0\u1eddng c\u1ea7n \u0111\u1ec3 b\u1ec7nh nh\u00e2n n\u1eb1m \u0111\u1ea7u d\u1ed1c, sao cho \u0111\u1eddm, m\u1ee7 t\u1eeb ph\u1ebf qu\u1ea3n tho\u00e1t ra ngo\u00e0i d\u1ec5 d\u00e0ng.<\/p>\n

– K\u1ebft h\u1ee3p v\u1ed7 rung, l\u1eafc l\u1ed3ng ng\u1ef1c. M\u1ed7i ng\u00e0y n\u00ean l\u00e0m 2-3 l\u1ea7n, th\u1eddi gian m\u1ed7i l\u1ea7n t\u0103ng d\u1ea7n, 5-10-20 ph\u00fat, l\u00e0m tr\u01b0\u1edbc b\u1eefa \u0103n.<\/p>\n

– \u0110\u00e2y l\u00e0 ph\u01b0\u01a1ng ph\u00e1p d\u1eabn l\u01b0u \u0111\u01a1n gi\u1ea3n c\u00f3 k\u1ebft qu\u1ea3 t\u1ed1t v\u00e0 BN c\u1ea7n l\u00e0m th\u01b0\u1eddng xuy\u00ean h\u00e0ng ng\u00e0y k\u1ec3 c\u1ea3 khi kh\u00f4ng c\u00f3 b\u1ed9i nhi\u1ec5m ph\u1ebf qu\u1ea3n.<\/p>\n

– Soi ph\u1ebf qu\u1ea3n \u1ed1ng m\u1ec1m n\u1ebfu c\u00f3. Trong qu\u00e1 tr\u00ecnh soi ti\u1ebfn h\u00e0nh h\u00fat d\u1ecbch ph\u1ebf qu\u1ea3n l\u00e0m x\u00e9t nghi\u1ec7m vi sinh v\u1eadt, b\u01a1m r\u1eeda l\u00f2ng ph\u1ebf qu\u1ea3n, gi\u1ea3i ph\u00f3ng \u0111\u1eddm m\u1ee7 b\u00edt t\u1eafc.<\/p>\n

3.3. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng xoang ph\u1ebf qu\u1ea3n (GPQ v\u00e0 vi\u00eam \u0111a xoang m\u1ea1n t\u00ednh)<\/strong><\/h3>\n

C\u00f3 th\u1ec3 cho b\u1ec7nh nh\u00e2n u\u1ed1ng erythromycin 10 mg\/kg\/ng\u00e0y, chia 2 l\u1ea7n, k\u00e9o d\u00e0i t\u1eeb 6- 24 th\u00e1ng n\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng b\u1ecb c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c. Kh\u00f4ng d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi theophyllin ho\u1eb7c c\u00e1c thu\u1ed1c c\u00f9ng nh\u00f3m xanthin do nguy c\u01a1 g\u00e2y xo\u1eafn \u0111\u1ec9nh.<\/p>\n

3.4. \u0110i\u1ec1u tr\u1ecb t\u00ecnh tr\u1ea1ng co th\u1eaft ph\u1ebf qu\u1ea3n<\/strong><\/h3>\n

Khi b\u1ec7nh nh\u00e2n c\u00f3 kh\u00f3 th\u1edf, nghe ph\u1ed5i c\u00f3 ran r\u00edt, ran ng\u00e1y: c\u00f3 th\u1ec3 cho c\u00e1c thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n.<\/p>\n

– Thu\u1ed1c c\u01b0\u1eddng beta-2: salbutamol 4 mg x 4 vi\u00ean\/ng\u00e0y, u\u1ed1ng chia 4 l\u1ea7n; terbutalin 5 mg x 2-4 vi\u00ean\/ng\u00e0y, u\u1ed1ng chia 2-4 l\u1ea7n.<\/p>\n

– Thu\u1ed1c kh\u00e1ng cholinergic: ipratropium bromid kh\u00ed dung 2 ml\/l\u1ea7n x 3 l\u1ea7n\/ng\u00e0y.<\/p>\n

– Thu\u1ed1c kh\u00e1ng cholinergic k\u1ebft h\u1ee3p thu\u1ed1c c\u01b0\u1eddng beta-2: fenoterol\/ipratropium, salbutamol\/ipratropium: kh\u00ed dung 2 ml\/l\u1ea7n x 3 l\u1ea7n\/ng\u00e0y.<\/p>\n

– Thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i: bambuterol 10 mg u\u1ed1ng 1 vi\u00ean\/ng\u00e0y.<\/p>\n

3.5. \u0110i\u1ec1u tr\u1ecb ho m\u00e1u<\/strong><\/h3>\n

– Ho ra m\u00e1u nh\u1eb9: l\u01b0\u1ee3ng m\u00e1u ho kh\u1ea1c < 50 ml\/ng\u00e0y. N\u1eb1m ngh\u1ec9, \u0103n l\u1ecfng, d\u00f9ng thu\u1ed1c gi\u1ea3m ho, an th\u1ea7n thu\u1ed1c ng\u1ee7 n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh (c\u00f3 d\u1ea5u hi\u1ec7u co th\u1eaft ph\u1ebf qu\u1ea3n, suy h\u00f4 h\u1ea5p).<\/p>\n

– Ho m\u00e1u m\u1ee9c \u0111\u1ed9 trung b\u00ecnh: l\u01b0\u1ee3ng m\u00e1u ho kh\u1ea1c 50-200 ml\/ng\u00e0y:<\/p>\n

+ Ch\u0103m s\u00f3c chung: nh\u01b0 tr\u00ean<\/p>\n

+ Transamin 250 mg x 4 \u1ed1ng\/ng\u00e0y ti\u00eam t\u0129nh m\u1ea1ch.<\/p>\n

+ Morphin 0,01 g ti\u00eam d\u01b0\u1edbi da ho\u1eb7c t\u0129nh m\u1ea1ch (th\u1eadn tr\u1ecdng khi c\u00f3 suy h\u00f4 h\u1ea5p m\u1ea1n).<\/p>\n

+ D\u00f9ng kh\u00e1ng sinh cho t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p ho m\u00e1u t\u1eeb m\u1ee9c \u0111\u1ed9 trung b\u00ecnh tr\u1edf l\u00ean \u0111\u1ec3 ph\u00f2ng nhi\u1ec5m khu\u1ea9n.<\/p>\n

– Ho ra m\u00e1u n\u1eb7ng v\u00e0 r\u1ea5t n\u1eb7ng: l\u01b0\u1ee3ng m\u00e1u ho kh\u1ea1c > 200 ml\/ng\u00e0y.<\/p>\n

+ Ch\u0103m s\u00f3c chung, morphin, c\u00e1c thu\u1ed1c co m\u1ea1ch: nh\u01b0 tr\u00ean.<\/p>\n

+ Truy\u1ec1n d\u1ecbch, truy\u1ec1n m\u00e1u b\u1ed3i ph\u1ee5 kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n.<\/p>\n

+ H\u00fat \u0111\u1eddm m\u00e1u, \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n, ho\u1eb7c m\u1edf kh\u00ed qu\u1ea3n \u0111\u1ec3 h\u00fat lo\u1ea1i b\u1ecf c\u00e1c c\u1ee5c m\u00e1u \u0111\u00f4ng g\u00e2y b\u00edt t\u1eafc ph\u1ebf qu\u1ea3n.<\/p>\n

+ Soi ph\u1ebf qu\u1ea3n \u1ed1ng m\u1ec1m: x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed ch\u1ea3y m\u00e1u, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i khi g\u00e2y t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ebf qu\u1ea3n ho\u1eb7c ph\u1eabu thu\u1eadt c\u1eaft ph\u00e2n thu\u1ef3 ph\u1ed5i. B\u01a1m thu\u1ed1c co m\u1ea1ch gi\u00fap c\u1ea7m m\u00e1u t\u1ea1m th\u1eddi: dung d\u1ecbch epinephrin (adrenalin) pha lo\u00e3ng 0,1%. Gi\u1ea3i ph\u00f3ng m\u00e1u \u0111\u1ecdng trong \u0111\u01b0\u1eddng th\u1edf.<\/p>\n

+ Ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch ph\u1ebf qu\u1ea3n \u1edf BN ho m\u00e1u n\u1eb7ng, ho m\u00e1u dai d\u1eb3ng, t\u00e1i ph\u00e1t nhi\u1ec1u \u0111\u1ee3t. G\u00e2y b\u1ecbt t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ebf qu\u1ea3n n\u1ebfu th\u1ea5y h\u00ecnh \u1ea3nh b\u00fai ph\u00ecnh, th\u00f4ng \u0111\u1ed9ng m\u1ea1ch.<\/p>\n

+ X\u00e9t nghi\u1ec7m m\u00e1u ngo\u1ea1i vi c\u1ea5p \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 thi\u1ebfu m\u00e1u v\u00e0 b\u00f9.<\/p>\n

+ B\u00f9 kh\u1ed1i l\u01b0\u1ee3ng m\u00e1u m\u1ea5t ho\u1eb7c c\u00e1c ch\u1ebf ph\u1ea9m cao ph\u00e2n t\u1eed.<\/p>\n

– Ph\u1eabu thu\u1eadt: Ch\u1ec9 \u0111\u1ecbnh c\u1eaft ph\u00e2n thu\u1ef3, thu\u1ef3 ho\u1eb7c c\u1ea3 b\u00ean ph\u1ed5i cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p gi\u00e3n ph\u1ebf qu\u1ea3n khu tr\u00fa; gi\u00e3n ph\u1ebf qu\u1ea3n c\u00f3 ho m\u00e1u n\u1eb7ng ho\u1eb7c ho m\u00e1u t\u00e1i ph\u00e1t.<\/p>\n

4. Ph\u00f2ng b\u1ec7nh<\/strong><\/h2>\n

– Kh\u00f4ng h\u00fat thu\u1ed1c l\u00e1, thu\u1ed1c l\u00e0o, tr\u00e1nh m\u00f4i tr\u01b0\u1eddng c\u00f3 nhi\u1ec1u b\u1ee5i kh\u00f3i.<\/p>\n

– V\u1ec7 sinh r\u0103ng mi\u1ec7ng, tai – m\u0169i – h\u1ecdng.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 c\u00e1c \u1ed5 nhi\u1ec5m khu\u1ea9n v\u00f9ng tai m\u0169i h\u1ecdng, r\u0103ng mi\u1ec7ng, c\u00e1c b\u1ec7nh v\u1ec1 \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p nh\u01b0 vi\u00eam ph\u1ebf qu\u1ea3n c\u1ea5p, \u00e1p xe ph\u1ed5i.<\/p>\n

– Ti\u00eam ph\u00f2ng c\u00fam h\u00e0ng n\u0103m \u0111\u1ec3 \u0111\u1ec1 ph\u00f2ng nh\u1eefng \u0111\u1ee3t b\u1ed9i nhi\u1ec5m c\u1ee7a gi\u00e3n ph\u1ebf qu\u1ea3n.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb s\u1edbm lao s\u01a1 nhi\u1ec5m \u1edf tr\u1ebb em.<\/p>\n

– \u0110\u1ec1 ph\u00f2ng v\u00e0 l\u1ea5y s\u1edbm d\u1ecb v\u1eadt ph\u1ebf qu\u1ea3n n\u1ebfu c\u00f3.<\/p>\n

– R\u00e8n luy\u1ec7n th\u00e2n th\u1ec3 th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 t\u0103ng s\u1ee9c \u0111\u1ec1 kh\u00e1ng c\u1ee7a c\u01a1 th\u1ec3. Gi\u1eef \u1ea5m c\u1ed5 ng\u1ef1c, \u0111\u1ec1 ph\u00f2ng c\u00e1c \u0111\u1ee3t b\u1ed9i nhi\u1ec5m khi \u0111\u00e3 b\u1ecb gi\u00e3n ph\u1ebf qu\u1ea3n..<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh h\u00f4 h\u1ea5p c\u1ee7a B\u1ed9 Y t\u1ebf 2012<\/p>\n","protected":false},"excerpt":{"rendered":"

Gi\u00e3n ph\u1ebf qu\u1ea3n l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd ph\u1ed5 bi\u1ebfn \u1edf c\u00e1c b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh ph\u1ed5i m\u00e3n t\u00ednh. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb gi\u00e3n ph\u1ebf qu\u1ea3n k\u1ecbp th\u1eddi v\u00e0 ch\u00ednh x\u00e1c l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 h\u01b0\u1edbng d\u1eabn […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"\nGi\u00e3n ph\u1ebf qu\u1ea3n: Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Gi\u00e3n ph\u1ebf qu\u1ea3n l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd ph\u1ed5 bi\u1ebfn \u1edf c\u00e1c b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh ph\u1ed5i m\u00e3n t\u00ednh. 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