{"id":31781,"date":"2023-05-13T14:38:56","date_gmt":"2023-05-13T07:38:56","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31781"},"modified":"2023-05-13T14:38:56","modified_gmt":"2023-05-13T07:38:56","slug":"tran-mu-mang-phoi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/13\/tran-mu-mang-phoi\/","title":{"rendered":"Tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i: Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nguy hi\u1ec3m, c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c v\u1ea5n \u0111\u1ec1 nghi\u00eam tr\u1ecdng cho s\u1ee9c kh\u1ecfe c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. \u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh hi\u1ec7u qu\u1ea3, c\u00e1c B\u00e1c s\u0129 th\u01b0\u1eddng s\u1eed d\u1ee5ng nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p nh\u01b0 si\u00eau \u00e2m, ch\u1ee5p X-quang v\u00e0 th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt h\u00fat m\u1ee7. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh ph\u1ed5i c\u1ee7a B\u1ed9 Y t\u1ebf 2012.<\/strong><\/p>\n

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

Tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i l\u00e0 s\u1ef1 t\u00edch t\u1ee5 m\u1ee7 trong khoang m\u00e0ng ph\u1ed5i. B\u1ec7nh c\u00f3 th\u1ec3 do nhi\u1ec1u nguy\u00ean nh\u00e2n: vi\u00eam m\u00e0ng ph\u1ed5i, vi\u00eam ph\u1ed5i, \u00e1p xe ph\u1ed5i, ph\u1eabu thu\u1eadt l\u1ed3ng ng\u1ef1c, ch\u1ea5n th\u01b0\u01a1ng, \u00e1p xe d\u01b0\u1edbi ho\u00e0nh (\u00e1p xe gan, vi\u00eam ph\u00fac m\u1ea1c khu tr\u00fa…) v\u1ee1 v\u00e0o khoang m\u00e0ng ph\u1ed5i ho\u1eb7c k\u1ebft h\u1ee3p nhi\u1ec1u y\u1ebfu t\u1ed1 g\u00e2y n\u00ean. Vi khu\u1ea9n th\u01b0\u1eddng g\u1eb7p:\u00a0Klebsiella pneumoniae, Staphylococcus aureus<\/em>…, c\u00f3 th\u1ec3 do n\u1ea5m ho\u1eb7c amip.<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i<\/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

– Ti\u1ec1n s\u1eed b\u1ec7nh l\u00fd tr\u01b0\u1edbc \u0111\u00f3: vi\u00eam ph\u1ed5i, \u00e1p xe ph\u1ed5i, \u00e1p xe gan ho\u1eb7c ph\u1eabu thu\u1eadt l\u1ed3ng ng\u1ef1c…<\/p>\n

– S\u1ed1t: \u0111\u1ed9t ng\u1ed9t s\u1ed1t cao, dao \u0111\u1ed9ng. S\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p s\u1ed1t nh\u1eb9 k\u00e9o d\u00e0i, tr\u01b0\u1eddng h\u1ee3p n\u00e0y th\u01b0\u1eddng x\u1ea3y ra \u1edf ng\u01b0\u1eddi suy gi\u1ea3m mi\u1ec5n d\u1ecbch ho\u1eb7c \u0111\u00e3 d\u00f9ng kh\u00e1ng sinh.<\/p>\n

– Ho: ho khan ho\u1eb7c kh\u1ea1c \u0111\u1eddm. C\u00f3 tr\u01b0\u1eddng h\u1ee3p ho ra m\u1ee7. Kh\u00f3 th\u1edf. \u0110au ng\u1ef1c b\u00ean t\u1ed5n th\u01b0\u01a1ng. D\u1ea5u hi\u1ec7u m\u1ea5t n\u01b0\u1edbc: da kh\u00f4, \u0111\u00e1i \u00edt…<\/p>\n

– To\u00e0n th\u00e2n suy s\u1ee5p, g\u1ea7y s\u00fat, thi\u1ebfu m\u00e1u, m\u1eb7t h\u1ed1c h\u00e1c, th\u1ec3 tr\u1ea1ng nhi\u1ec5m tr\u00f9ng.<\/p>\n

– B\u00ean tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i: c\u00f3 th\u1ec3 th\u1ea5y th\u00e0nh ng\u1ef1c b\u00ean b\u1ec7nh l\u00fd ph\u00f9, k\u00e9m ho\u1eb7c kh\u00f4ng di \u0111\u1ed9ng, g\u00f5 \u0111\u1ee5c, rung thanh gi\u1ea3m ho\u1eb7c m\u1ea5t, r\u00ec r\u00e0o ph\u1ebf nang gi\u1ea3m. N\u1ebfu c\u00f3 tr\u00e0n kh\u00ed k\u00e8m theo c\u00f3 th\u1ec3 c\u00f3 g\u00f5 \u0111\u1ee5c v\u00f9ng th\u1ea5p v\u00e0 g\u00f5 vang \u1edf v\u00f9ng cao, c\u00f3 th\u1ec3 c\u00f3 tr\u00e0n kh\u00ed d\u01b0\u1edbi da.<\/p>\n

– Ch\u1ecdc th\u0103m d\u00f2 th\u1ea5y d\u1ecbch m\u00e0ng ph\u1ed5i c\u00f3 m\u00e0u \u0111\u1ee5c, v\u00e0ng, xanh ho\u1eb7c m\u00e0u n\u00e2u; m\u00f9i th\u1ed1i (g\u1ee3i \u00fd vi khu\u1ea9n y\u1ebfm kh\u00ed) \u0111\u00f4i khi ch\u1ecdc th\u0103m d\u00f2 kh\u00f4ng l\u1ea5y \u0111\u01b0\u1ee3c m\u1ee7 do tr\u00e0n m\u1ee7 \u0111\u00e3 v\u00e1ch h\u00f3a.<\/p>\n

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

– C\u00f4ng th\u1ee9c m\u00e1u: S\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u t\u0103ng, t\u0103ng t\u1ef7 l\u1ec7 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh, c\u00f3 th\u1ec3 c\u00f3 thi\u1ebfu m\u00e1u.<\/p>\n

– Ch\u1ee5p X-quang l\u1ed3ng ng\u1ef1c: th\u1ea5y h\u00ecnh \u1ea3nh tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i.<\/p>\n

– Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh: gi\u00fap x\u00e1c \u0111\u1ecbnh r\u00f5 v\u1ecb tr\u00ed, m\u1ee9c \u0111\u1ed9, t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 ph\u1ed5i, gi\u00fap x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed v\u00e0 \u0111\u01b0\u1eddng v\u00e0o \u0111\u1ec3 d\u1eabn l\u01b0u \u1ed5 m\u1ee7 m\u00e0ng ph\u1ed5i \u0111\u1eb7c bi\u1ec7t trong tr\u01b0\u1eddng h\u1ee3p tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i khu tr\u00fa, \u0111a \u1ed5.<\/p>\n

– Si\u00eau \u00e2m khoang m\u00e0ng ph\u1ed5i: th\u1ea5y h\u00ecnh \u1ea3nh tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, d\u1ecbch t\u0103ng t\u1ef7 tr\u1ecdng, kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t, c\u00f3 th\u1ec3 th\u1ea5y h\u00ecnh \u1ea3nh tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i v\u1edbi nhi\u1ec1u v\u00e1ch ng\u0103n.<\/p>\n

– X\u00e9t nghi\u1ec7m d\u1ecbch m\u00e0ng ph\u1ed5i: t\u1ebf b\u00e0o h\u1ecdc (nhi\u1ec1u b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n, th\u01b0\u1eddng > 60%, c\u00f3 t\u1ebf b\u00e0o tho\u00e1i ho\u00e1), vi khu\u1ea9n h\u1ecdc (soi t-\u01a1i, nhu\u1ed9m gram, c\u1ea5y d\u1ecbch m\u00e0ng ph\u1ed5i t\u00ecm vi khu\u1ea9n g\u00e2y b\u1ec7nh v\u00e0 l\u00e0m kh\u00e1ng sinh \u0111\u1ed3).<\/p>\n

– C\u1ea5y m\u00e1u t\u00ecm vi khu\u1ea9n g\u00e2y b\u1ec7nh.<\/p>\n

 <\/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 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Ngu\u1ed3n: Cleveland Clinic 2022<\/strong><\/figcaption><\/figure>\n

2.2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i<\/strong><\/h3>\n

– Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do lao: s\u1ed1t nh\u1eb9 v\u1ec1 chi\u1ec1u, d\u1ecbch m\u00e0ng ph\u1ed5i m\u00e0u v\u00e0ng chanh, t\u1ebf b\u00e0o d\u1ecbch m\u00e0ng ph\u1ed5i ch\u1ee7 y\u1ebfu l\u00e0 b\u1ea1ch c\u1ea7u lympho. C\u00f3 th\u1ec3 th\u1ea5y t\u1ed5n th\u01b0\u01a1ng n\u1ed1t, th\u00e2m nhi\u1ec5m tr\u00ean phim X-quang ph\u1ed5i. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh khi c\u00f3 k\u1ebft qu\u1ea3 AFB \u0111\u1eddm d\u01b0\u01a1ng t\u00ednh, PCR-MTB d\u1ecbch MP d\u01b0\u01a1ng t\u00ednh, v\u00e0\/ ho\u1eb7c sinh thi\u1ebft MP th\u1ea5y t\u1ed5n th\u01b0\u01a1ng nang lao…<\/p>\n

–\u00a0Tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i do lao<\/em><\/strong>\u00a0l\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, 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 khu tr\u00fa. T\u1ed5n th\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 khu tr\u00fa. M\u1ee7 m\u00e0ng ph\u1ed5i do lao th\u01b0\u1eddng c\u00f3 nhi\u1ec1u t\u1ebf b\u00e0o lymph\u00f4 v\u00e0 hay t\u00ecm th\u1ea5y AFB tr\u1ef1c ti\u1ebfp trong d\u1ecbch m\u1ee7 m\u00e0ng ph\u1ed5i.<\/p>\n

– Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i d\u1ecbch d\u01b0\u1ee1ng ch\u1ea5p: d\u1ecbch tr\u1eafng \u0111\u1ee5c nh\u01b0 s\u1eefa. \u0110\u1ecbnh l\u01b0\u1ee3ng triglycerid d\u1ecbch m\u00e0ng ph\u1ed5i > 110 mg\/dL (1,24 mmol\/L), t\u1ef7 l\u1ec7 triglycerid d\u1ecbch m\u00e0ng ph\u1ed5i\/huy\u1ebft thanh > 1; t\u1ef7 l\u1ec7 cholesterol d\u1ecbch m\u00e0ng ph\u1ed5i\/cholesterol huy\u1ebft thanh < 1.<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i<\/strong><\/h2>\n

3.1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/strong><\/h3>\n

– M\u1ee7 m\u00e0ng ph\u1ed5i ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa t\u1ea1i b\u1ec7nh vi\u1ec7n, \u1edf c\u00e1c \u0111\u01a1n v\u1ecb c\u00f3 kh\u1ea3 n\u0103ng \u0111\u1eb7t \u1ed1ng d\u1eabn l\u01b0u m\u00e0ng ph\u1ed5i. C\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng, nhi\u1ec5m \u0111\u1ed9c n\u1eb7ng nh\u01b0 c\u00f3 s\u1ed1c nhi\u1ec5m khu\u1ea9n, suy h\u00f4 h\u1ea5p ph\u1ea3i \u0111i\u1ec1u tr\u1ecb t\u1ea1i khoa h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c.<\/p>\n

– D\u1eabn l\u01b0u m\u1ee7 s\u1edbm, r\u1eeda m\u00e0ng ph\u1ed5i h\u00e0ng ng\u00e0y v\u1edbi natriclorua 0,9%, c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p b\u01a1m streptokinase v\u00e0o khoang m\u00e0ng ph\u1ed5i n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

– Kh\u00e1ng sinh d\u00f9ng li\u1ec1u cao, ph\u1ed1i h\u1ee3p \u00edt nh\u1ea5t hai lo\u1ea1i, \u0111\u01b0\u1eddng to\u00e0n th\u00e2n k\u00e9o d\u00e0i 4-6 tu\u1ea7n.<\/p>\n

– \u0110\u1ea3m b\u1ea3o dinh d\u01b0\u1ee1ng, b\u1ed3i ph\u1ee5 n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i.<\/p>\n

– Ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c \u1ed5 nhi\u1ec5m khu\u1ea9n nguy\u00ean ph\u00e1t, c\u00e1c b\u1ec7nh ph\u1ed1i h\u1ee3p n\u1ebfu c\u00f3.<\/p>\n

– V\u1eadt l\u00fd tr\u1ecb li\u1ec7u ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p s\u1edbm.<\/p>\n

3.2. D\u1eabn l\u01b0u m\u1ee7<\/strong><\/h3>\n

– Ch\u1ec9 \u0111\u1ecbnh:<\/p>\n

+ Ch\u1ecdc d\u00f2 th\u1ea5y d\u1ecbch m\u1ee7.<\/p>\n

+ T\u1ebf b\u00e0o d\u1ecbch m\u00e0ng ph\u1ed5i: c\u00f3 t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n tho\u00e1i ho\u00e1.<\/p>\n

+ Vi khu\u1ea9n: nhu\u1ed9m gram th\u1ea5y h\u00ecnh \u1ea3nh vi khu\u1ea9n, c\u1ea5y d\u1ecbch MP c\u00f3 vi khu\u1ea9n.<\/p>\n

+ Sinh h\u00f3a: pH < 7,2; Glucose < 60 mg\/dL.<\/p>\n

– Th\u1eadn tr\u1ecdng trong tr\u01b0\u1eddng h\u1ee3p sau: r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u n\u1eb7ng, \u1ed5 m\u1ee7 nh\u1ecf, \u1ed5 m\u1ee7 g\u1ea7n trung th\u1ea5t (c\u1ea7n ti\u1ebfn h\u00e0nh d\u1eabn l\u01b0u m\u1ee7 d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a m\u00e1y ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh l\u1ed3ng ng\u1ef1c n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n).<\/p>\n

– S\u1eed d\u1ee5ng \u1ed1ng d\u1eabn l\u01b0u 18 – 32F tu\u1ef3 t\u1eebng tr\u01b0\u1eddng h\u1ee3p. Sau khi \u0111\u1eb7t \u1ed1ng d\u1eabn l\u01b0u, h\u00fat li\u00ean t\u1ee5c v\u1edbi h\u1ec7 th\u1ed1ng d\u1eabn l\u01b0u k\u00edn \u00e1p l\u1ef1c – 20 \u0111\u1ebfn – 40 cm H2<\/sub>O. B\u00ecnh d\u1eabn l\u01b0u ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u1eb7t th\u1ea5p h\u01a1n l\u1ed3ng ng\u1ef1c ngay c\u1ea3 khi \u0111ang h\u00fat d\u1eabn l\u01b0u c\u0169ng nh\u01b0 l\u00fac di chuy\u1ec3n \u0111\u1ec3 tr\u00e1nh tr\u00e0o ng\u01b0\u1ee3c d\u1ecbch t\u1eeb b\u00ecnh d\u1eabn l\u01b0u v\u00e0o khoang m\u00e0ng ph\u1ed5i c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

– B\u01a1m r\u1eeda khoang m\u00e0ng ph\u1ed5i qua \u1ed1ng d\u1eabn l\u01b0u h\u00e0ng ng\u00e0y b\u1eb1ng natriclorua 0,9% cho t\u1edbi khi d\u1ecbch h\u00fat ra trong (th\u01b0\u1eddng r\u1eeda kho\u1ea3ng 1500 – 2000 ml). Kh\u00f4ng b\u01a1m r\u1eeda n\u1ebfu c\u00f3 r\u00f2 ph\u1ebf qu\u1ea3n m\u00e0ng ph\u1ed5i (bi\u1ec3u hi\u1ec7n ho, s\u1eb7c khi b\u01a1m r\u1eeda).<\/p>\n

– B\u01a1m streptokinase v\u00e0o khoang m\u00e0ng ph\u1ed5i:<\/p>\n

+ Ch\u1ec9 \u0111\u1ecbnh: khi m\u1ee7 m\u00e0ng ph\u1ed5i \u0111\u1eb7c, d\u1eabn l\u01b0u k\u00e9m, ho\u1eb7c c\u00f3 h\u00ecnh \u1ea3nh v\u00e1ch h\u00f3a khoang m\u00e0ng ph\u1ed5i.<\/p>\n

+ Ti\u1ebfn h\u00e0nh: sau khi r\u1eeda m\u00e0ng ph\u1ed5i, l\u1ea5y 100.000 – 300.000 \u0111\u01a1n v\u1ecb streptokinase pha v\u1edbi 100 ml natri clorua 0,9% sau \u0111\u00f3 b\u01a1m v\u00e0o khoang m\u00e0ng ph\u1ed5i. B\u01a1m 1 l\u1ea7n\/ng\u00e0y x 5 ng\u00e0y li\u00ean ti\u1ebfp. Sau b\u01a1m: k\u1eb9p \u1ed1ng d\u1eabn l\u01b0u 2- 4 gi\u1edd, sau \u0111\u00f3 m\u1edf k\u1eb9p, h\u00fat li\u00ean t\u1ee5c v\u1edbi h\u1ec7 th\u1ed1ng d\u1eabn l\u01b0u k\u00edn.<\/p>\n

+ Vi\u1ec7c b\u01a1m c\u00e1c thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft v\u00e0o khoang m\u00e0ng ph\u1ed5i s\u1ebd gi\u00fap d\u1eabn l\u01b0u m\u1ee7 d\u1ec5 d\u00e0ng h\u01a1n.<\/p>\n

+ Ph\u1ea3i \u0111\u01b0a cho ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 d\u00f9ng streptokinase th\u1ebb c\u00f3 ghi r\u00f5 vi\u1ec7c \u0111\u00e3 d\u00f9ng streptokinase \u0111\u1ec3 l\u1ea7n kh\u00e1c n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng lo\u1ea1i thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft th\u00ec kh\u00f4ng d\u00f9ng streptokinase n\u1eefa m\u00e0 d\u00f9ng lo\u1ea1i thu\u1ed1c kh\u00e1c \u0111\u1ec1 ph\u00f2ng tai bi\u1ebfn d\u1ecb \u1ee9ng.<\/p>\n

– Ch\u1ec9 \u0111\u1ecbnh r\u00fat \u1ed1ng d\u1eabn l\u01b0u khi:<\/p>\n

+ X-quang ho\u1eb7c si\u00eau \u00e2m m\u00e0ng ph\u1ed5i kh\u00f4ng c\u00f2n d\u1ecbch.<\/p>\n

+ \u1ed0ng d\u1eabn l\u01b0u kh\u00f4ng c\u00f2n ra m\u1ee7.<\/p>\n

+ B\u01a1m r\u1eeda th\u1ea5y d\u1ecbch trong.<\/p>\n

+ \u1ed0ng d\u1eabn l\u01b0u \u0111\u1eb7t qu\u00e1 10-14 ng\u00e0y m\u00e0 c\u00f2n m\u1ee7: c\u1ea7n thay \u1ed1ng d\u1eabn l\u01b0u m\u1edbi (c\u1ea5y vi khu\u1ea9n \u0111\u1ea7u \u1ed1ng d\u1eabn l\u01b0u).<\/p>\n

3.3. \u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i<\/strong><\/h3>\n

– Nguy\u00ean t\u1eafc d\u00f9ng kh\u00e1ng sinh:<\/p>\n

+ D\u00f9ng kh\u00e1ng sinh s\u1edbm<\/p>\n

+ Ph\u1ed1i h\u1ee3p t\u1eeb 2 kh\u00e1ng sinh tr\u1edf l\u00ean, theo \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch ho\u1eb7c ti\u00eam b\u1eafp.<\/p>\n

+ Li\u1ec1u cao ngay t\u1eeb \u0111\u1ea7u.<\/p>\n

+ S\u1eed d\u1ee5ng thu\u1ed1c ngay sau khi l\u1ea5y \u0111\u01b0\u1ee3c b\u1ec7nh ph\u1ea9m ch\u1ea9n \u0111o\u00e1n vi sinh v\u1eadt.<\/p>\n

+ Thay \u0111\u1ed5i kh\u00e1ng sinh d\u1ef1a theo di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng v\u00e0 kh\u00e1ng sinh \u0111\u1ed3 n\u1ebfu c\u00f3.<\/p>\n

+ Th\u1eddi gian d\u00f9ng kh\u00e1ng sinh \u00edt nh\u1ea5t 4 tu\u1ea7n (c\u00f3 th\u1ec3 k\u00e9o d\u00e0i \u0111\u1ebfn 6 tu\u1ea7n tu\u1ef3 theo l\u00e2m s\u00e0ng v\u00e0 X-quang ph\u1ed5i).<\/p>\n

– C\u00e1c lo\u1ea1i kh\u00e1ng sinh c\u00f3 th\u1ec3 d\u00f9ng nh\u01b0 sau:<\/p>\n

+ Penicilin G 10 – 50 tri\u1ec7u \u0111\u01a1n v\u1ecb tu\u1ef3 theo t\u00ecnh tr\u1ea1ng v\u00e0 c\u00e2n n\u1eb7ng c\u1ee7a b\u1ec7nh nh\u00e2n, pha truy\u1ec1n t\u0129nh m\u1ea1ch chia 3 – 4 l\u1ea7n\/ng\u00e0y, k\u1ebft h\u1ee3p v\u1edbi 1 kh\u00e1ng sinh nh\u00f3m aminoglycosid:<\/p>\n

    \n
  • Gentamycin 3-5 mg\/kg\/ng\u00e0y ti\u00eam b\u1eafp 1 l\u1ea7n ho\u1eb7c<\/li>\n
  • Amikacin 15 mg\/kg\/ng\u00e0y ti\u00eam b\u1eafp 1 l\u1ea7n ho\u1eb7c pha truy\u1ec1n t\u0129nh m\u1ea1ch trong 250 ml natriclorua 0,9%.<\/li>\n<\/ul>\n

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

    + N\u1ebfu nghi ng\u1edd do vi khu\u1ea9n gram \u00e2m th\u00ec d\u00f9ng cephalosporin th\u1ebf h\u1ec7 3 nh\u01b0 cefotaxime 3-6 g\/ng\u00e0y, ceftazidim 3-6 g\/ng\u00e0y; ho\u1eb7c imipenem k\u1ebft h\u1ee3p v\u1edbi kh\u00e1ng sinh nh\u00f3m aminoglycosid v\u1edbi li\u1ec1u t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u0111\u00e3 n\u00eau \u1edf tr\u00ean.<\/p>\n

    + N\u1ebfu nghi ng\u1edd do vi khu\u1ea9n y\u1ebfm kh\u00ed th\u00ec k\u1ebft h\u1ee3p nh\u00f3m betalactam + acid clavunalic; ho\u1eb7c ampicillin + sulbactam; ho\u1eb7c cephalosporin th\u1ebf h\u1ec7 3; ho\u1eb7c imipenem… v\u1edbi metronidazol li\u1ec1u 1-1,5 g\/ng\u00e0y, truy\u1ec1n t\u0129nh m\u1ea1ch chia 2-3 l\u1ea7n\/ng\u00e0y, ho\u1eb7c penicillin 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, ho\u1eb7c ho\u1eb7c penicilin G 10-50 tri\u1ec7u \u0111\u01a1n v\u1ecb k\u1ebft h\u1ee3p clindamycin 1,8 g\/ng\u00e0y truy\u1ec1n t\u0129nh m\u1ea1ch.<\/p>\n

    + N\u1ebfu tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i do nhi\u1ec5m khu\u1ea9n m\u1eafc ph\u1ea3i b\u1ec7nh vi\u1ec7n, khi ch\u01b0a c\u00f3 k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 c\u00f3 th\u1ec3 d\u00f9ng kh\u00e1ng sinh: ceftazidim 3-6 g\/ng\u00e0y chia 3 l\u1ea7n ho\u1eb7c piperacilin + tazobactam 4,5 g x 3 l\u1ea7n\/ng\u00e0y ho\u1eb7c imipenem, meropenem k\u1ebft h\u1ee3p kh\u00e1ng sinh nh\u00f3m aminoglycosid ho\u1eb7c quinolon, metronidazol. \u0110i\u1ec1u ch\u1ec9nh kh\u00e1ng sinh theo di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng v\u00e0 k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3.<\/p>\n

    + N\u1ebfu nghi ng\u1edd do t\u1ee5 c\u1ea7u: oxacillin 6-12 g\/ng\u00e0y ho\u1eb7c vancomycin 1-2 g\/ng\u00e0y, k\u1ebft h\u1ee3p v\u1edbi amikacin khi nghi do t\u1ee5 c\u1ea7u kh\u00e1ng thu\u1ed1c.<\/p>\n

    + N\u1ebfu do am\u00edp th\u00ec d\u00f9ng metronidazol 1,5 g\/ng\u00e0y, truy\u1ec1n t\u0129nh m\u1ea1ch chia 3 l\u1ea7n\/ng\u00e0y k\u1ebft h\u1ee3p v\u1edbi kh\u00e1ng sinh kh\u00e1c.<\/p>\n

    + Ch\u00fa \u00fd x\u00e9t nghi\u1ec7m creatinin m\u00e1u 2 l\u1ea7n trong m\u1ed9t tu\u1ea7n \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 s\u1eed d\u1ee5ng thu\u1ed1c nh\u00f3m aminoglycosid.<\/p>\n

    – \u0110\u00e1nh gi\u00e1 sau 1 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb:<\/p>\n

    + Ti\u1ebfn tri\u1ec3n t\u1ed1t:<\/p>\n

      \n
    • H\u1ebft s\u1ed1t, h\u1ebft kh\u00f3 th\u1edf.<\/li>\n
    • L\u01b0\u1ee3ng m\u1ee7 ra \u1ed1ng d\u1eabn l\u01b0u gi\u1ea3m.<\/li>\n
    • T\u1ed5n th\u01b0\u01a1ng tr\u00ean X-quang ph\u1ed5i thuy\u00ean gi\u1ea3m, ti\u1ebfp t\u1ee5c kh\u00e1ng sinh cho \u0111\u1ee7 4 – 6 tu\u1ea7n.<\/li>\n<\/ul>\n

      – Ti\u1ebfn tri\u1ec3n kh\u00f4ng t\u1ed1t:<\/p>\n

      + C\u00f2n s\u1ed1t.<\/p>\n

      + \u1ed0ng d\u1eabn l\u01b0u m\u00e0ng ph\u1ed5i ra m\u1ee7 k\u00e9o d\u00e0i.<\/p>\n

      + X-quang ph\u1ed5i kh\u00f4ng c\u1ea3i thi\u1ec7n.<\/p>\n

      Thay kh\u00e1ng sinh (d\u1ef1a v\u00e0o k\u1ebft qu\u1ea3 c\u1ea5y vi khu\u1ea9n m\u1ee7 m\u00e0ng ph\u1ed5i v\u00e0 kh\u00e1ng sinh \u0111\u1ed3 n\u1ebfu c\u00f3), t\u00ecm c\u00e1c \u1ed5 m\u1ee7 kh\u00e1c trong khoang m\u00e0ng ph\u1ed5i ch\u01b0a \u0111\u01b0\u1ee3c d\u1eabn l\u01b0u.<\/p>\n

      3.4. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng<\/strong><\/h3>\n

      – Cho paracetamol n\u1ebfu c\u00f3 s\u1ed1t > 38o<\/sup>C (th\u1eadn tr\u1ecdng \u1edf nh\u1eefng BN c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh l\u00fd gan m\u1eadt).<\/p>\n

      – Dinh d\u01b0\u1ee1ng: ch\u1ebf \u0111\u1ed9 \u0103n gi\u00e0u ch\u1ea5t dinh d\u01b0\u1ee1ng.<\/p>\n

      – Th\u1edf oxy khi c\u00f3 suy h\u00f4 h\u1ea5p.<\/p>\n

      – \u0110i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m tr\u00f9ng n\u1ebfu c\u00f3.<\/p>\n

      – B\u1ed3i ph\u1ee5 n\u01b0\u1edbc, \u0111i\u1ec7n gi\u1ea3i. D\u00f9ng th\u00eam vitamin B1, B6 li\u1ec1u cao n\u1ebfu c\u00f3 ti\u1ec1n s\u1eed nghi\u1ec7n r\u01b0\u1ee3u.<\/p>\n

      3.5. N\u1ed9i soi can thi\u1ec7p khoang m\u00e0ng ph\u1ed5i<\/strong><\/h3>\n

      Nh\u1eefng c\u01a1 s\u1edf c\u00f3 \u0111i\u1ec1u ki\u1ec7n n\u00ean ti\u1ebfn h\u00e0nh n\u1ed9i soi can thi\u1ec7p khoang m\u00e0ng ph\u1ed5i s\u1edbm \u0111\u1ec3 gi\u1ea3i ph\u00f3ng \u1ed5 m\u1ee7, b\u01a1m r\u1eeda khoang m\u00e0ng ph\u1ed5i, ph\u00e1t hi\u1ec7n v\u00e0 x\u1eed l\u00fd l\u1ed7 d\u00f2 ph\u1ebf qu\u1ea3n – m\u00e0ng ph\u1ed5i v\u00e0 c\u00f3 th\u1ec3 b\u00f3c m\u00e0ng ph\u1ed5i qua n\u1ed9i soi.<\/p>\n

      3.6. \u0110i\u1ec1u tr\u1ecb ngo\u1ea1i khoa<\/strong><\/h3>\n

      – Khi d\u00f9ng kh\u00e1ng sinh, d\u1eabn l\u01b0u m\u1ee7 th\u1ea5t b\u1ea1i sau 4-6 tu\u1ea7n.<\/p>\n

      – M\u1ee7 m\u00e0ng ph\u1ed5i c\u00f3 d\u00f2 ph\u1ebf qu\u1ea3n – m\u00e0ng ph\u1ed5i.<\/p>\n

      – Ph\u1eabu thu\u1eadt b\u00f3c v\u1ecf m\u00e0ng ph\u1ed5i khi m\u00e0ng ph\u1ed5i b\u1ecb d\u00e0y d\u00ednh nhi\u1ec1u, g\u00e2y h\u1ea1n ch\u1ebf ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p (l\u00e2m s\u00e0ng b\u1ec7nh nh\u00e2n kh\u00f3 th\u1edf, r\u1ed1i lo\u1ea1n th\u00f4ng kh\u00ed h\u1ea1n ch\u1ebf).<\/p>\n

      3.7. Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p<\/strong><\/h3>\n

      T\u1eadp s\u1edbm \u0111\u1ec3 m\u1ee7 tho\u00e1t ra ngo\u00e0i d\u1ec5 d\u00e0ng h\u01a1n v\u00e0 \u0111\u1ec1 ph\u00f2ng d\u00e0y d\u00ednh m\u00e0ng ph\u1ed5i v\u1ec1 sau. C\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n 1 ng\u00e0y sau khi \u0111\u1eb7t \u1ed1ng d\u1eabn l\u01b0u m\u00e0ng ph\u1ed5i.<\/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

      usechatgpt init success<\/div>\n","protected":false},"excerpt":{"rendered":"

      Tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nguy hi\u1ec3m, c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c v\u1ea5n \u0111\u1ec1 nghi\u00eam tr\u1ecdng cho s\u1ee9c kh\u1ecfe c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. \u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh hi\u1ec7u qu\u1ea3, c\u00e1c B\u00e1c s\u0129 th\u01b0\u1eddng s\u1eed d\u1ee5ng nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p nh\u01b0 si\u00eau \u00e2m, ch\u1ee5p X-quang v\u00e0 th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt h\u00fat m\u1ee7. 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