{"id":31999,"date":"2023-05-05T22:24:01","date_gmt":"2023-05-05T15:24:01","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31999"},"modified":"2023-05-05T22:50:06","modified_gmt":"2023-05-05T15:50:06","slug":"viem-phoi-cong-dong-vpcd-o-tre-em-chan-doan-va-phan-loai","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/viem-phoi-cong-dong-vpcd-o-tre-em-chan-doan-va-phan-loai\/","title":{"rendered":"Vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng (VPC\u0110) \u1edf tr\u1ebb em: Ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i"},"content":{"rendered":"

Vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng (VPC\u0110) l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh r\u1ea5t ph\u1ed5 bi\u1ebfn \u1edf tr\u1ebb em v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i VPC\u0110 l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u01b0a ra ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 v\u00e0 gi\u1ea3m thi\u1ec3u nguy c\u01a1 bi\u1ebfn ch\u1ee9ng. Trong b\u00e0i vi\u1ebft n\u00e0y, ch\u00fang ta s\u1ebd t\u00ecm hi\u1ec3u v\u1ec1 Vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng \u1edf tr\u1ebb em, bao g\u1ed3m c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1, tri\u1ec7u ch\u1ee9ng v\u00e0 c\u00e1ch ch\u1ea9n \u0111o\u00e1n b\u1ec7nh. Ch\u00fang ta c\u0169ng s\u1ebd t\u00ecm hi\u1ec3u v\u1ec1 c\u00e1c ph\u00e2n lo\u1ea1i c\u1ee7a VPC\u0110 d\u1ef1a tr\u00ean \u0111\u1ed9 tu\u1ed5i, tri\u1ec7u ch\u1ee9ng v\u00e0 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a b\u1ec7nh \u0111\u1ec3 \u0111\u01b0a ra ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<\/strong><\/p>\n

\"Khi
Khi n\u00e0o tr\u1ebb b\u1ecb vi\u00eam ph\u1ed5i c\u1ea7n nh\u1eadp vi\u1ec7n? | Vinmec<\/figcaption><\/figure>\n

1. Ch\u1ea9n \u0111o\u00e1n VPC\u0110:<\/strong><\/h2>\n

1.1 Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n VPC\u0110<\/strong><\/h3>\n

\u2022 Nghi ng\u1edd vi\u00eam ph\u1ed5i: s\u1ed1t, ho, kh\u00f3 th\u1edf nhanh, suy h\u00f4 h\u1ea5p v\u00e0 nghe ph\u1ed5i c\u00f3 ran n\u1ed5\/\u1ea9m. (Kh\u00f3 th\u1edf nhanh l\u00e0 d\u1ea5u hi\u1ec7u c\u00f3 \u0111\u1ed9 nh\u1ea1y cao). Tuy nhi\u00ean, m\u1ed9t d\u1ea5u hi\u1ec7u ri\u00eang r\u1ebd kh\u00f4ng th\u1ec3 ch\u1ea9n \u0111o\u00e1n ho\u1eb7c lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c vi\u00eam ph\u1ed5i.<\/p>\n

\u2022 Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i tr\u00ean th\u1ef1c t\u1ebf:
\n+ L\u00e2m s\u00e0ng: ho, th\u1edf nhanh, kh\u00f3 th\u1edf.
\n+ Xquang ng\u1ef1c: 1 ho\u1eb7c nhi\u1ec1u c\u00e1c h\u00ecnh \u1ea3nh:<\/p>\n

\u2022 \u0110\u1eb7c th\u00f9y ph\u1ed5i, \u0111\u1eb7c ph\u00e2n th\u00f9y ph\u1ed5i
\n\u2022 Th\u00e2m nhi\u1ec5m ph\u1ebf nang
\n\u2022 Th\u00e2m nhi\u1ec5m k\u1ebd
\n\u2022 Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i.
\n\u2022 Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n c\u1ee7a b\u1ed9 Y t\u1ebf:
\n– Tr\u1ebb ho, s\u1ed1t k\u00e8m theo \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c d\u1ea5u hi\u1ec7u:
\n+ Th\u1edf nhanh:
\n+ R\u00fat l\u00f5m l\u1ed3ng ng\u1ef1c (ph\u1ea7n d\u01b0\u1edbi l\u1ed3ng ng\u1ef1c l\u00f5m v\u00e0o \u1edf th\u00ec h\u00edt v\u00e0o)
\n+ Kh\u00e1m ph\u1ed5i th\u1ea5y b\u1ea5t th\u01b0\u1eddng: gi\u1ea3m th\u00f4ng kh\u00ed, c\u00f3 ti\u1ebfng b\u1ea5t th\u01b0\u1eddng (ran \u1ea9m, ran ph\u1ebf qu\u1ea3n, ran n\u1ed5…).<\/p>\n

1.2 C\u1eadn l\u00e2m s\u00e0ng:<\/strong><\/h3>\n

1.2.1 X quang<\/strong><\/p>\n

X-quang l\u00e0 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n ch\u00ednh m\u1eb7c d\u00f9 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng tr\u00ean X-quang c\u00f3 th\u1ec3 kh\u00f4ng t\u01b0\u01a1ng x\u1ee9ng v\u1edbi bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng.
\n\ud83e\udc6a Khi n\u00e0o c\u1ea7n l\u00e0m X-quang cho tr\u1ebb:
\n+ C\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a vi\u00eam ph\u1ed5i n\u1eb7ng.
\n+ Khi c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng kh\u00f4ng r\u00f5 r\u00e0ng.
\n+ Khi c\u1ea7n nh\u1eadp vi\u1ec7n (c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 bi\u1ec3u hi\u1ec7n, k\u00edch th\u01b0\u1edbc v\u00e0 \u0111\u1eb7c tr\u01b0ng c\u1ee7a nhu m\u00f4 b\u1ecb x\u00e2m nh\u1eadp v\u00e0 \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng bi\u1ebfn ch\u1ee9ng tr\u00ean tr\u1ebb).
\n+ C\u00f3 ti\u1ec1n s\u1eed vi\u00eam ph\u1ed5i t\u00e1i di\u1ec5n.
\n+ Lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd tim ph\u1ed5i n\u1ec1n ho\u1eb7c c\u00f3 ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c tr\u01b0\u1edbc \u0111\u00f3.
\n+ \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 bi\u1ebfn ch\u1ee9ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u1edbi tr\u1ebb c\u00f3 vi\u00eam ph\u1ed5i k\u00e9o d\u00e0i v\u00e0 kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh.
\n+ Lo\u1ea1i tr\u1eeb vi\u00eam ph\u1ed5i v\u1edbi tr\u1ebb t\u1eeb 3-36 th\u00e1ng c\u00f3 tri\u1ec7u ch\u1ee9ng s\u1ed1t > 39oC v\u00e0 b\u1ea1ch c\u1ea7u \u226520.000 tr\u1ebb l\u1edbn h\u01a1n (<10 tu\u1ed5i) c\u00f3 s\u1ed1t > 38oC, ho v\u00e0 c\u00f3 b\u1ea1ch c\u1ea7u \u2265 15.000.<\/p>\n

1.2.2 C\u00f4ng th\u1ee9c m\u00e1u<\/strong><\/p>\n

C\u00f4ng th\u1ee9c m\u00e1u l\u00e0 x\u00e9t nghi\u1ec7m th\u01b0\u1eddng quy, tuy nhi\u00ean kh\u00f4ng c\u1ea7n thi\u1ebft v\u1edbi tr\u1ebb \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa tr\u1eeb khi c\u00f4ng th\u1ee9c m\u00e1u gi\u00fap x\u00e1c \u0111\u1ecbnh lo\u1ea1i kh\u00e1ng sinh c\u1ea7n \u0111i\u1ec1u tr\u1ecb. C\u00f4ng th\u1ee9c m\u00e1u c\u00f3 th\u1ec3 gi\u00fap x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh tr\u00ean tr\u1ebb, tuy nhi\u00ean c\u00e1c d\u1ea5u hi\u1ec7u th\u01b0\u1eddng b\u1ecb ch\u1ed3ng l\u1ea5p v\u00e0 kh\u00f3 ph\u00e2n bi\u1ec7t. C\u1ee5 th\u1ec3<\/p>\n

\u2022 WBC <15,000\/mm3 h\u01b0\u1edbng \u0111\u1ebfn t\u00e1c nh\u00e2n kh\u00f4ng do vi khu\u1ea9n. Tr\u1eeb nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 th\u1ec3 gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh v\u00e0 c\u00e1c t\u1ebf b\u00e0o non chi\u1ebfm \u01b0u th\u1ebf.
\n\u2022 V\u1edbi tr\u01b0\u1eddng h\u1ee3p b\u1ea1ch c\u1ea7u t\u0103ng nh\u1eb9 v\u1edbi \u01b0u th\u1ebf lympho g\u1ee3i \u00fd vi\u00eam ph\u1ed5i do virut
\n\u2022 WBC >15,000\/mm3 h\u01b0\u1edbng \u0111\u1ebfn nguy\u00ean nh\u00e2n do vi khu\u1ea9n<\/p>\n

M\u1ed9t v\u00e0i tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t:<\/strong><\/p>\n

\u2022 Tr\u1ebb nhi\u1ec5m M. pneumoniae, influenza, or adenovirus pneumonia c\u00f3 th\u1ec3 c\u0169ng c\u00f3 WBC >15,000\/mm3
\n\u2022 Trong v\u00e0i tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u0103ng b\u1ea1ch c\u1ea7u \u01b0a acid tr\u00ean tr\u1ebb vi\u00eam ph\u1ed5i kh\u00f4ng bi\u1ec3u hi\u1ec7n s\u1ed1t, \u0111\u1eb7c bi\u1ec7t l\u00e0 do nguy\u00ean nh\u00e2n C. trachomatis<\/p>\n

\u2022 C\u00e1c ch\u1ea5t ch\u1ec9 \u0111i\u1ec3m vi\u00eam:
\nHi\u1ec7n nay c\u00f3 2 ch\u1ea5t ch\u1ec9 \u0111i\u1ec3m vi\u00eam th\u01b0\u1eddng d\u00f9ng l\u00e0 CRP v\u00e0 procalcitonin (PCT). Tuy nhi\u00ean c\u00e1c ch\u1ea5t ch\u1ec9 \u0111i\u1ec3m vi\u00eam \u0111\u1ec1u kh\u00f4ng \u0111\u1eb7c hi\u1ec7u v\u00e0 \u00edt c\u00f3 gi\u00e1 tr\u1ecb trong \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa. Tuy nhi\u00ean v\u1edbi nh\u1eefng tr\u1ebb c\u00f3 bi\u1ec3u hi\u1ec7n n\u1eb7ng, c\u00e1c gi\u00e1 tr\u1ecb n\u00e0y c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng \u0111\u1ec3 ph\u00e2n bi\u1ec7t.<\/p>\n

Kho\u1ea3ng 41% case vi\u00eam ph\u1ed5i do vi khu\u1ea9n c\u00f3 n\u1ed3ng \u0111\u1ed9 CRP kho\u1ea3n 40-60 mg\/L.<\/p>\n

PCT c\u00f3 th\u1ec3 nh\u1ea1y h\u01a1n nh\u01b0ng \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u kh\u00f4ng kh\u00e1c bi\u1ec7t v\u1edbi CRP.<\/p>\n

Gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng c\u1ee7a c\u00e1c ch\u1ea5t n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u c\u1ee5 th\u1ec3. \u0110\u1ed3ng th\u1eddi c\u00e1c ch\u1ea5t ch\u1ec9 \u0111i\u1ec3m vi\u00eam c\u00f3 th\u1ec3 h\u1eefu \u00edch trong vi\u1ec7c theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb.<\/p>\n

1.2.3 X\u00e9t nghi\u1ec7m x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n<\/strong><\/p>\n

\u2022 C\u1ea5y m\u00e1u:<\/strong> C\u1ea5y m\u00e1u n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf nh\u1eefng tr\u1ebb nh\u1eadp vi\u1ec7n (v\u1edbi m\u1ee9c n\u1eb7ng), \u0111\u1eb7c bi\u1ec7t v\u1edbi tr\u1ebb c\u00f3 bi\u1ebfn ch\u1ee9ng, gi\u00fap x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh.
\n\u2022 C\u1ea5y \u0111\u00e0m:<\/strong> X\u00e9t nghi\u1ec7m tr\u00ean \u0111\u00e0m g\u1ed3m nhu\u1ed9n Gram v\u00e0 nu\u00f4i c\u1ea5y.<\/p>\n

C\u00e1c c\u00e1ch l\u1ea5y \u0111\u00e0m:<\/strong><\/p>\n

\u2022 Ho kh\u1ea1c: v\u1edbi tr\u1ebb \u2265 10 tu\u1ed5i, tuy nhi\u00ean d\u1ec5 ngo\u1ea1i nhi\u1ec5m vi tr\u00f9ng th\u01b0\u1eddng tr\u00fa \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean. V\u1edbi tr\u1ebb <5 tu\u1ed5i th\u01b0\u1eddng n\u00f4n ra \u0111\u00e0m tuy nhi\u00ean \u00edt c\u00f3 gi\u00e1 tr\u1ecb x\u00e9t nghi\u1ec7m. C\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n h\u00fat d\u1ea1 d\u00e0y trong 3 ng\u00e0y li\u00ean ti\u1ebfp \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh (th\u01b0\u1eddng v\u1edbi lao).
\n\u2022 H\u00fat d\u1ecbch kh\u00ed qu\u1ea3n (NTA: nasotracheal aspiration) d\u00f9ng v\u1edbi tr\u1ebb nh\u1ecf, ch\u1ea5t l\u01b0\u1ee3ng t\u1ed1t khi ch\u1ee9a >25 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n v\u00e0 <10 t\u1ebf b\u00e0o l\u00e1t trong m\u1ed9t quang tr\u01b0\u1eddng.
\n\u2022 C\u1ea5y d\u1ecbch m\u00e0ng ph\u1ed5i: \u1edf b\u1ec7nh nh\u00e2n tr\u00e0n d\u1ecbch l\u01b0\u1ee3ng nhi\u1ec1u, ch\u1ecdc h\u00fat d\u1eabn l\u01b0u l\u00e0 c\u00e1ch h\u1eefu \u00edch \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng.
\n\u2022 C\u00e1c test x\u00e1c \u0111\u1ecbnh kh\u00e1ng nguy\u00ean vi khu\u1ea9n: c\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p nh\u01b0: PRC, ng\u01b0ng k\u1ebft h\u1ea1t latex\u2026 tuy nhi\u00ean v\u1eabn c\u00f2n b\u00e0n c\u00e3i
\n\u2022 Sinh thi\u1ebft ph\u1ed5i m\u00f9<\/a> ho\u1eb7c ch\u1ecdc h\u00fat qua da: cho ph\u00e9p x\u00e1c \u0111\u1ecbnh t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh nh\u01b0ng \u00edt l\u00e0m v\u00e0 nhi\u1ec1u bi\u1ebfn ch\u1ee9ng.<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t VPC\u0110:<\/strong><\/h2>\n

2.1<\/strong>. Vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n c\u1ea5p do virus: Th\u01b0\u1eddng g\u1eb7p tr\u1ebb < 2 tu\u1ed5i, kh\u1edfi ph\u00e1t sau vi\u00eam long h\u00f4 h\u1ea5p tr\u00ean, kh\u00f2 kh\u00e8, th\u1edf nhanh, RLLN, rale ph\u1ed5i,\u2026<\/p>\n

2.2<\/strong>. Hen PQ (C\u01a1n HPQ c\u1ea5p):<\/p>\n

+ Ti\u1ec1n s\u1eed hen ph\u1ebf qu\u1ea3n trong gia \u0111\u00ecnh.
\n+ Tr\u01b0\u1edbc \u0111\u00e2y \u0111\u00e3 b\u1ecb nhi\u1ec1u \u0111\u1ee3t nh\u01b0 v\u1eady.
\n+ Kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t kh\u00f4ng c\u00f3 nhi\u1ec5m tr\u00f9ng tr\u01b0\u1edbc \u0111\u00f3.
\n+ T\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan.
\n+ \u0110\u00e1p \u1ee9ng t\u1ed1t v\u1edbi thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n c\u00f3 t\u00e1c d\u1ee5ng nhanh \u0111\u01b0\u1eddng h\u00edt.<\/p>\n

2.3<\/strong>. Kh\u00f3 th\u1edf nhanh do nguy\u00ean nh\u00e2n tim m\u1ea1ch (tim b\u1ea9m sinh, suy tim, b\u1ec7nh l\u00fd c\u01a1 tim\u2026).<\/p>\n

2.4<\/strong>. Vi\u00eam ph\u1ed5i do h\u00f3a ch\u1ea5t (vi\u00eam ph\u1ed5i th\u1ee9 ph\u00e1t sau h\u1ed9i ch\u1ee9ng h\u00edt).<\/p>\n

2.5<\/strong>. Kh\u00f3 th\u1edf nhanh do b\u1ec7nh l\u00fd r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a, do ng\u1ed9 \u0111\u1ed9c.<\/p>\n

2.6<\/strong>. B\u1ec7nh l\u00fd ph\u1ed5i k\u1ebd.<\/p>\n

3. Ph\u00e2n lo\u1ea1i VPC\u0110 \u1edf tr\u1ebb em:<\/strong><\/h2>\n

Ph\u00e2n lo\u1ea1i vi\u00eam ph\u1ed5i \u2013 tr\u1ebb d\u01b0\u1edbi 5 tu\u1ed5i (Trong ph\u00e2n lo\u1ea1i < 5 tu\u1ed5i th\u00ec c\u00e1i n\u00e0o n\u1eb7ng? c\u00e1i n\u00e0o nh\u1eb9?)<\/strong><\/p>\n\n\n\n\n\n\n
D\u1ea5u hi\u1ec7u<\/strong><\/td>\nPh\u00e2n lo\u1ea1i<\/strong><\/td>\n<\/tr>\n
Ho ho\u1eb7c kh\u00f3 th\u1edf k\u00e8m theo \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c d\u1ea5u hi\u1ec7u sau:<\/p>\n

\u2663 T\u00edm trung t\u00e2m ho\u1eb7c SpO2 < 90%<\/p>\n

\u2663 D\u1ea5u hi\u1ec7u kh\u00f3 th\u1edf n\u1eb7ng: th\u1edf r\u00ean, r\u00fat l\u00f5m l\u1ed3ng ng\u1ef1c r\u1ea5t n\u1eb7ng<\/p>\n

\u2663 M\u1ed9t trong s\u1ed1 c\u00e1c d\u1ea5u hi\u1ec7u nguy hi\u1ec3m to\u00e0n th\u00e2n.<\/td>\n

Vi\u00eam ph\u1ed5i n\u1eb7ng<\/strong><\/td>\n<\/tr>\n
Ho ho\u1eb7c kh\u00f3 th\u1edf k\u00e8m theo \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c d\u1ea5u hi\u1ec7u sau:<\/p>\n

\u2663 T\u1ea7n s\u1ed1 th\u1edf nhanh: \u2265 50 l\u1ea7n\/ph\u00fat \u1edf tr\u1ebb 2-11 th\u00e1ng tu\u1ed5i; \u2265 40 l\u1ea7n\/ph\u00fat \u1edf tr\u1ebb 1-5 tu\u1ed5i<\/p>\n

\u2663 R\u00fat l\u00f5m l\u1ed3ng ng\u1ef1c.<\/td>\n

Vi\u00eam ph\u1ed5i<\/strong><\/td>\n<\/tr>\n
Kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u vi\u00eam ph\u1ed5i ho\u1eb7c vi\u00eam ph\u1ed5i n\u1eb7ng<\/td>\nHo ho\u1eb7c c\u1ea3m l\u1ea1nh<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*Ph\u00e2n lo\u1ea1i vi\u00eam ph\u1ed5i \u2013 tr\u1ebb tr\u00ean 5 tu\u1ed5i<\/strong><\/p>\n\n\n\n\n\n
D\u1ea5u hi\u1ec7u<\/strong><\/td>\nPh\u00e2n lo\u1ea1i<\/strong><\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nhi\u1ec7t \u0111\u1ed9 > 38,5\u00b0C<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 TST > 50 l\u1ea7n\/ph\u00fat<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0Kh\u00f3 th\u1edf n\u1eb7ng<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ph\u1eadp ph\u1ed3ng c\u00e1nh m\u0169i<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 T\u00edm<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Th\u1edf r\u00ean<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 D\u1ea5u hi\u1ec7u m\u1ea5t n\u01b0\u1edbc<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 T\u1ea7n s\u1ed1 tim nhanh<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Th\u1eddi gian \u0111\u1ea7y mao m\u1ea1ch \u2265 2 gi\u00e2y<\/td>\n

Vi\u00eam ph\u1ed5i n\u1eb7ng<\/strong><\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nhi\u1ec7t \u0111\u1ed9 < 38,5\u00b0C<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 TST < 50 l\u1ea7n\/ph\u00fat<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0Kh\u00f3 th\u1edf nh\u1eb9<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kh\u00f4ng n\u00f4n<\/td>\n

Vi\u00eam ph\u1ed5i<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

4. Nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam ph\u1ed5i<\/strong><\/h2>\n

M\u1ed9t s\u1ed1 ch\u00fa \u00fd:<\/strong>
\n\u2022 Tr\u00ean l\u00e2m s\u00e0ng, kh\u00f4ng th\u1ec3 ph\u00e2n bi\u1ec7t r\u1ea1ch r\u00f2i VP VK, virus v\u00e0 t\u00e1c nh\u00e2n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, h\u01a1n n\u1eefa VP VR th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u0111i k\u00e8m VP VK, VPK\u0110H.
\n\u2022 VR t\u1ea5n c\u00f4ng c\u1ee5c b\u1ed9, th\u01b0\u1eddng kh\u1edfi ph\u00e1t v\u1edbi tri\u1ec7u ch\u1ee9ng, vi\u00eam long \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean, L\u00e2m s\u00e0ng: Kh\u00f2 kh\u00e8, th\u00ec th\u1edf ra k\u00e9o d\u00e0i, g\u00f5 vang, RRPN gi\u1ea3m, rale r\u00edt, ng\u00e1y (do t\u00ecnh tr\u1ea1ng \u1ee9 kh\u00ed do ho\u1ea1i t\u1eed m\u00f4 kh\u00f4ng h\u1ed3i ph\u1ee5c).
\n\u2022 VR t\u1ea5n c\u00f4ng lan tr\u00e0n n\u00ean khi m\u1edbi x\u00e2m nh\u1eadp \u0111\u00e3 g\u00e2y vi\u00eam c\u1ea3 \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean v\u00e0 d\u01b0\u1edbi, \u0111\u1ed3ng th\u1eddi g\u00e2y bi\u1ec3u hi\u1ec7n \u1edf nhi\u1ec1u c\u01a1 quan: m\u1eaft, ti\u00eau h\u00f3a,\u2026
\n\u2022 VP virus v\u00e0 t\u00e1c nh\u00e2n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh: Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng r\u1ea7m r\u1ed9, tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 ngh\u00e8o n\u00e0n (do \u0111a s\u1ed1 t\u1ea5n c\u00f4ng m\u00f4 k\u1ebd).<\/p>\n

\u2022 VP virus:
\n+ Th\u01b0\u1eddng g\u1eb7p tr\u1ebb nh\u1ecf 2-3 tu\u1ed5i.
\n+ M\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m:<\/p>\n

\u2022 VP virus kh\u1edfi ph\u00e1t b\u1eb1ng vi\u00eam long h\u00f4 h\u1ea5p tr\u00ean (ch\u1ea3y m\u0169i, ho. RSV: Ho d\u1eef d\u1ed9i, Adenovirus: Ho g\u00e0).
\n\u2022 S\u1ed1t kh\u00f4ng cao.
\n\u2022 M\u1ee9c \u0111\u1ed9 kh\u00f3 th\u1edf th\u01b0\u1eddng tr\u1ed9i h\u01a1n c\u00e1c bi\u1ec3u hi\u1ec7n nhi\u1ec5m tr\u00f9ng v\u00e0 th\u1ef1c th\u1ec3 \u1edf ph\u1ed5i.
\n\u2022 Kh\u00f2 kh\u00e8.
\n\u2022 Rale lan t\u1ecfa, th\u01b0\u1eddng rale r\u00edt, rale ng\u00e1y, kh\u00f3 x\u00e1c \u0111\u1ecbnh (do tr\u1ebb nh\u1ecf v\u00e0 c\u00f3 t\u00ecnh tr\u1ea1ng kh\u00ed ph\u1ebf th\u1ee7ng).<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Tri\u1ec7u ch\u1ee9ng<\/strong><\/td>\nVP VK<\/strong><\/td>\nVP VR<\/strong><\/td>\n<\/tr>\n
Kh\u1edfi ph\u00e1t<\/td>\nC\u1ea5p<\/td>\nTh\u01b0\u1eddng v\u00e0i ng\u00e0y<\/td>\n<\/tr>\n
S\u1ed1t<\/td>\nCao<\/td>\nV\u1eeba ph\u1ea3i<\/td>\n<\/tr>\n
Nh\u1ecbp tim nhanh (>120l\/ph)<\/td>\nTh\u01b0\u1eddng g\u1eb7p<\/td>\nHi\u1ebfm g\u1eb7p<\/td>\n<\/tr>\n
TST nhanh (> 40l\/ph)<\/td>\nTh\u01b0\u1eddng g\u1eb7p<\/td>\nHi\u1ebfm g\u1eb7p (RSV th\u01b0\u1eddng g\u1eb7p)<\/td>\n<\/tr>\n
\u0110au ng\u1ef1c<\/td>\nTh\u01b0\u1eddng g\u1eb7p<\/td>\nHi\u1ebfm g\u1eb7p<\/td>\n<\/tr>\n
\u0110\u00e0m<\/td>\nNhi\u1ec1u<\/td>\n\u00cdt<\/td>\n<\/tr>\n
T\u0103ng ti\u1ebft<\/td>\nTh\u01b0\u1eddng g\u1eb7p<\/td>\nHi\u1ebfm g\u1eb7p<\/td>\n<\/tr>\n
H\u00ecnh \u1ea3nh th\u00e2m nhi\u1ec5m tr\u00ean Xquang<\/td>\nTh\u00f9y\/ ph\u00e2n th\u00f9y<\/td>\nT\u1ed5 ch\u1ee9c k\u1ebd\/ ph\u1ebf nang<\/td>\n<\/tr>\n
T\u0103ng BC m\u00e1u ngo\u1ea1i vi<\/td>\nTh\u01b0\u1eddng g\u1eb7p<\/td>\nHi\u1ebfm g\u1eb7p (Adenovirus c\u00f3 th\u1ec3 t\u0103ng BC)<\/td>\n<\/tr>\n
CRP<\/td>\nT\u0103ng<\/td>\nT\u0103ng nh\u1eb9\/ b\u00ecnh th\u01b0\u1eddng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u2666\u00a0VP kh\u00f4ng \u0111i\u1ec3n h\u00ecnh:<\/strong>
\n+ Clamydia pneumoniae:<\/strong>
\n\u2022 K\u00e9o d\u00e0i, 2 giai \u0111\u1ecdan: NKHH tr\u00ean (vi\u00eam h\u1ecdng, vi\u00eam thanh qu\u1ea3n, vi\u00eam xoang) \ud83e\udc6a vi\u00eam ph\u1ed5i, vi\u00eam PQ.
\n\u2022 L\u00e2m s\u00e0ng: Kh\u00f2 kh\u00e8, rale n\u1ed5 ho\u1eb7c rale \u1ea9m.
\n\u2022 CLS: VS t\u0103ng, XQ: th\u00e2m nhi\u1ec5m ph\u1ebf b\u00e0o ho\u1eb7c Vi\u00eam h\u1ea1 ph\u00e2n th\u00f9y, kh\u00f4ng c\u00f3 \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i.<\/p>\n

+ Mycoplasma pneumoniae:<\/strong>
\n\u2022 L\u00e2m s\u00e0ng: vi\u00eam h\u1ecdng \ud83e\udc6a kh\u00e0n ti\u1ebfng \ud83e\udc6a Ho (Ho khan). VP do M.pneumoniae: Ho (60%), S\u1ed1t (86%), Rale \u1ea9m, rale n\u1ed5 (85%). Th\u1eddi gian b\u1ecb b\u1ec7nh 13 ng\u00e0y m\u1eb7c d\u00f9 ho c\u00f3 th\u1ec3 k\u00e9o d\u00e0i c\u1ea3 th\u00e1ng.
\n\u2022 CLS: XQ kh\u00f4ng \u0111\u1eb7c hi\u1ec7u (kh\u00f4ng d\u00f9ng \u0111\u1ec3 ch\u1ea9n \u0111\u00f3an VP do M.pneumoniae): C\u00e1c d\u1ea3i m\u1edd quanh r\u1ed1n ph\u1ed5i (60%), th\u00e2m nhi\u1ec5m d\u1ea1ng l\u01b0\u1edbi – h\u1ea1t (40%), \u0111\u00f4ng \u0111\u1eb7c ph\u00e2n th\u00f9y ho\u1eb7c th\u00f9y (28%),…<\/p>\n

+ Legionella:<\/strong>
\n\u2022 2 h\u1ed9i ch\u1ee9ng: HC Legionnaire (vi\u00eam ph\u1ed5i nhi\u1ec1u \u1ed5 ho\u1ea1i t\u1eed), HC s\u1ed1t Pontiac (s\u1ed1t c\u1ea5p t\u00ednh, t\u1ef1 kh\u1ecfi, kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n h\u00f4 h\u1ea5p).
\n\u2022 L\u00e2m s\u00e0ng: \u0111au ng\u1ef1c, Ho khan, h\u1ed9i ch\u1ee9ng \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i.
\n\u2022 CLS: XQ: th\u00e2m nhi\u1ec5m k\u1ebd.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng<\/strong><\/td>\nNguy\u00ean nh\u00e2n \u0111i\u1ec3n h\u00ecnh<\/strong><\/td>\nNguy\u00ean nh\u00e2n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh<\/strong><\/td>\n<\/tr>\n
B\u1ec7nh nguy\u00ean<\/td>\nCh\u1ee7 y\u1ebfu l\u00e0 vi khu\u1ea9n, c\u00f3 th\u1ec3 l\u00e0 vi r\u00fat<\/td>\nC\u00f3 th\u1ec3 l\u00e0 vi khu\u1ea9n, n\u1ea5m, \u0111\u1ed9ng v\u1eadt nguy\u00ean ho\u1eb7c vi r\u00fat<\/td>\n<\/tr>\n
C\u00e1c nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p<\/td>\nStreptococcus pneumoniae,<\/em><\/p>\n

Staphylococcus aureus,<\/em><\/p>\n

Escherichia coli,\u00a0<\/em>v\u00e0<\/p>\n

Haemophilia influenzae<\/em><\/td>\n

Chlamydophila pneumoniae<\/em><\/p>\n

Mycoplasma pneumonia<\/em><\/p>\n

Legionella pneumophila<\/em><\/p>\n

Moraxella catarrhalis,<\/em><\/p>\n

vi khu\u1ea9n syncytial v\u00e0 virut c\u00fam A<\/td>\n<\/tr>\n

Bi\u1ec3u hi\u1ec7n tr\u00ean<\/p>\n

X Quang<\/td>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 H\u00ecnh \u1ea3nh \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i \u1edf th\u00f9y b\u1ecb vi\u00eam.<\/p>\n

 <\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kh\u00f4ng th\u1ea5y s\u1ef1 th\u00e2m nhi\u1ec5m \u1edf r\u1ed1n ph\u1ed5i v\u00e0 th\u01b0\u1eddng t\u1eadp trung trung t\u00e2m th\u00f9y v\u00e0 kh\u00f4ng h\u01b0\u1edbng ra ngo\u1ea1i vi.<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 C\u00f3 th\u1ec3 b\u1ecb \u1edf b\u1ea5t k\u1ef3 th\u00f9y n\u00e0o.<\/td>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kh\u00f4ng c\u00f3 h\u00ecnh \u1ea3nh \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i khu tr\u00fa bao g\u1ed3m v\u00e0 c\u00e1c khu v\u1ef1c h\u1ea1n ch\u1ebf c\u1ee7a ph\u1ed5i. Th\u01b0\u1eddng ph\u1ea3n \u00e1nh m\u1ed9t nhi\u1ec5m tr\u00f9ng nguy\u00ean ph\u00e1t, tr\u01b0\u1edbc khi c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a b\u1ec7nh vi\u00eam ph\u1ed5i kh\u00f4ng \u0111i\u1ec3n h\u00ecnh ti\u1ebfn tri\u1ec3n tri\u1ec3n. Giai \u0111o\u1ea1n n\u00e0y c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 vi\u00eam ph\u1ed5i tr\u00e0n (occult pneumonia).<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 S\u1ef1 th\u00e2m nhi\u1ec5m \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u \u1edf v\u00f9ng r\u1ed1n ph\u1ed5i v\u00e0 lan t\u1edbi ngo\u1ea1i vi v\u00e0 kh\u00f4ng b\u1ecb gi\u1edbi h\u1ea1n \u1edf th\u00f9y ph\u1ed5i.<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ch\u1ee7 y\u1ebfu \u1ea3nh h\u01b0\u1edfng t\u1ea1i c\u00e1c th\u00f9y d\u01b0\u1edbi. Tuy nhi\u00ean c\u00e1c th\u00f9y kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng.<\/td>\n<\/tr>\n

Tri\u1ec7u ch\u1ee9ng<\/td>\nC\u00f3 th\u1ec3 s\u1ed1t<\/td>\nS\u1ed1t, nh\u1ee9c \u0111\u1ea7u, \u0111\u1ed5 m\u1ed3 h\u00f4i v\u00e0 \u0111au c\u01a1 l\u00e0 ph\u1ed5 bi\u1ebfn<\/td>\n<\/tr>\n
CTM<\/td>\nWBC t\u0103ng<\/td>\nWBC b\u00ecnh th\u01b0\u1eddng<\/td>\n<\/tr>\n
S\u1ed1 l\u01b0\u1ee3ng v\u00e0 t\u00ednh ch\u1ea5t c\u1ee7a \u0111\u00e0m<\/td>\n\u0110\u00e0m nhi\u1ec1u k\u00e8m g\u00e2y ho<\/td>\n\u0110\u00e0m \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 v\u00e0 ho khan<\/td>\n<\/tr>\n
Nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean<\/td>\nKh\u00f4ng th\u01b0\u1eddng xuy\u00ean<\/td>\nTh\u1ec9nh tho\u1ea3ng v\u00e0 li\u00ean quan \u0111\u1ebfn k\u00edch th\u00edch g\u00e2y ho<\/td>\n<\/tr>\n
Nguy\u00ean nh\u00e2n do h\u00edt<\/td>\nC\u00f3 th\u1ec3 l\u00e0 do h\u00edt v\u00e0o c\u00e1c vi khu\u1ea9n<\/td>\nKh\u00f4ng bao gi\u1edd g\u00e2y ra b\u1edfi h\u00edt<\/td>\n<\/tr>\n
M\u00f4i tr\u01b0\u1eddng k\u00edch th\u00edch vi\u00eam ph\u1ed5i<\/td>\nKh\u00f4ng c\u1ee5 th\u1ec3<\/td>\nH\u1ec7 th\u1ed1ng \u0111i\u1ec1u h\u00f2a kh\u00f4ng kh\u00ed kh\u00f4ng \u0111\u01b0\u1ee3c v\u1ec7 sinh<\/td>\n<\/tr>\n
S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c tri\u1ec7u ch\u1ee9ng ngo\u00e0i ph\u1ed5i<\/td>\nKh\u00f4ng<\/td>\nC\u00f3<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

5. Ti\u00eau chu\u1ea9n nh\u1eadp vi\u1ec7n:<\/strong><\/h2>\n

* Ti\u00eau chu\u1ea9n nh\u1eadp vi\u1ec7n:<\/strong> (ph\u00e1c \u0111\u1ed3 Ngo\u1ea1i tr\u00fa nhi khoa 2016)<\/strong>
\n\u2022 Khi vi\u00eam ph\u1ed5i ch\u01b0a n\u1eb7ng
\n\u2022 Tr\u1ebb b\u1ecb vi\u00eam ph\u1ed5i c\u00f3 nh\u00e0 xa ho\u1eb7c kh\u00f4ng c\u00f3 \u0111i\u1ec1u ki\u1ec7n theo d\u00f5i
\n\u2022 Vi\u00eam ph\u1ed5i kh\u00f4ng \u0111\u00e1p \u1ee9ng sau 48 gi\u1edd \u0111i\u1ec1u tr\u1ecb
\nKhi c\u00f3 d\u1ea5u hi\u1ec7u suy h\u00f4 h\u1ea5p n\u1eb7ng, vi\u00eam ph\u1ed5i r\u1ea5t n\u1eb7ng c\u1ea7n nh\u1eadp c\u1ea5p c\u1ee9u.<\/p>\n

* Ti\u00eau chu\u1ea9n nh\u1eadp vi\u1ec7n \u0111\u1ed1i v\u1edbi tr\u1ebb em \u1edf c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n:<\/strong><\/p>\n

\u2022 \u0110\u1ed1i v\u1edbi tr\u1ebb nh\u0169 nhi:<\/strong>
\n+ SaO2 < 92%, t\u00edm
\n+ TST > 70 l\u1ea7n\/ph\u00fat
\n+ Kh\u00f3 th\u1edf
\n+ Ng\u01b0ng th\u1edf t\u1eebng c\u01a1n, th\u1edf r\u00ean
\n+ B\u1ecf \u0103n, b\u1ecf b\u00fa
\n+ Gia \u0111\u00ecnh kh\u00f4ng th\u1ec3 theo d\u00f5i t\u1ea1i nh\u00e0<\/p>\n

\u2022 \u0110\u1ed1i v\u1edbi tr\u1ebb l\u1edbn:<\/strong>
\n+ SaO2 < 92%, t\u00edm
\n+ TST > 50 l\u1ea7n\/ph\u00fat
\n+ Kh\u00f3 th\u1edf
\n+ Th\u1edf r\u00ean
\n+ D\u1ea5u hi\u1ec7u m\u1ea5t n\u01b0\u1edbc
\n+ Gia \u0111\u00ecnh kh\u00f4ng th\u1ec3 theo d\u00f5i t\u1ea1i nh\u00e0<\/p>\n

* Ti\u00eau chu\u1ea9n v\u00e0o ph\u00f2ng \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c \u1edf c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n:<\/strong>
\nC\u1ea7n c\u00e2n nh\u1eafc n\u1ebfu:
\n\u2022 Tr\u1ebb kh\u00f4ng th\u1ec3 duy tr\u00ec SaO2 >92% v\u1edbi FiO2 > 60%.
\n\u2022 Tr\u1ebb b\u1ecb s\u1ed1c.
\n\u2022 T\u1ea7n s\u1ed1 tim\u00a0v\u00e0 m\u1ea1ch t\u0103ng d\u1ea7n k\u00e8m bi\u1ec3u hi\u1ec7n suy h\u00f4 h\u1ea5p n\u1eb7ng v\u00e0 ki\u1ec7t s\u1ee9c, c\u00f3 th\u1ec3 k\u00e8m t\u0103ng PaCO2.
\n\u2022 Ng\u01b0ng th\u1edf t\u00e1i di\u1ec5n ho\u1eb7c th\u1edf ch\u1eadm b\u1ea5t th\u01b0\u1eddng.<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/p>\n

    \n
  • B\u00e0i gi\u1ea3ng \u0110H Y D\u01b0\u1ee3c Hu\u1ebf 2018<\/li>\n
  • Ph\u00e1c \u0111\u1ed3 ngo\u1ea1i tr\u00fa nhi khoa 2016<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

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