{"id":32028,"date":"2023-05-05T22:06:08","date_gmt":"2023-05-05T15:06:08","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32028"},"modified":"2023-05-05T22:12:32","modified_gmt":"2023-05-05T15:12:32","slug":"viem-xuong-ban-chan-dai-thao-duong-chan-doan-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/viem-xuong-ban-chan-dai-thao-duong-chan-doan-dieu-tri\/","title":{"rendered":"Vi\u00eam x\u01b0\u01a1ng b\u00e0n ch\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Vi\u00eam x\u01b0\u01a1ng \u1edf b\u00e0n ch\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/a> (DFO) h\u1ea7u h\u1ebft l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a nhi\u1ec5m tr\u00f9ng m\u00f4 m\u1ec1m lan t\u1edbi x\u01b0\u01a1ng, nhi\u1ec5m tr\u00f9ng \u1ea3nh h\u01b0\u1edfng v\u1ecf x\u01b0\u01a1ng \u0111\u1ea7u ti\u00ean sau \u0111\u00f3 lan t\u1edbi t\u1ee7y x\u01b0\u01a1ng. T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec5m tr\u00f9ng b\u00e0n ch\u00e2n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (DFI) n\u00ean \u0111\u01b0\u1ee3c nghi ng\u1edd c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn x\u01b0\u01a1ng khi k\u00e8m c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng c\u1ee7a nhi\u1ec5m tr\u00f9ng, \u0111\u1eb7c bi\u1ec7t trong tr\u01b0\u1eddng h\u1ee3p lo\u00e9t m\u1ea1n t\u00ednh ho\u1eb7c lo\u00e9t t\u00e1i ph\u00e1t.\u00a0<\/strong><\/p>\n

1. D\u1ecbch t\u1ec5 h\u1ecdc vi\u00eam x\u01b0\u01a1ng \u1edf b\u00e0n ch\u00e2n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/h2>\n

Nhi\u1ec5m tr\u00f9ng b\u00e0n ch\u00e2n l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p c\u1ee7a nh\u1eadp vi\u1ec7n li\u00ean quan \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 l\u00e0 y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y th\u01b0\u1eddng g\u1eb7p d\u1eabn \u0111\u1ebfn \u0111o\u1ea1n chi d\u01b0\u1edbi.<\/p>\n

Nhi\u1ec5m tr\u00f9ng th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u t\u1eeb v\u1ebft lo\u00e9t m\u00f4 m\u1ec1m, sau \u0111\u00f3 c\u00f3 th\u1ec3 lan \u0111\u1ebfn x\u01b0\u01a1ng. Trong \u0111\u00f3 c\u00f3 kho\u1ea3ng 20% b\u1ec7nh nh\u00e2n DFI\u00a0 c\u00f3 vi\u00eam x\u01b0\u01a1ng t\u1ee7y, l\u00e0m t\u0103ng nguy c\u01a1 \u0111o\u1ea1n chi d\u01b0\u1edbi. Qu\u1ea3n l\u00fd DFO \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 th\u00e1ch th\u1ee9c trong l\u00e2m s\u00e0ng.<\/p>\n

DFO c\u00f3 th\u1ec3 g\u1eb7p trong kho\u1ea3ng 20% b\u1ec7nh nh\u00e2n nhi\u1ec5m tr\u00f9ng b\u00e0n ch\u00e2n (DFI) nh\u1eb9 – trung b\u00ecnh v\u00e0 kho\u1ea3ng 50 – 60% trong DFI n\u1eb7ng.<\/p>\n

DFO c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng b\u1ea5t k\u1ef3 x\u01b0\u01a1ng n\u00e0o nh\u01b0ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf b\u00e0n ch\u00e2n tr\u01b0\u1edbc 90% (g\u1ed3m x\u01b0\u01a1ng b\u00e0n v\u00e0 x\u01b0\u01a1ng ng\u00f3n ch\u00e2n), k\u1ebf ti\u1ebfp l\u00e0 b\u00e0n ch\u00e2n gi\u1eefa 5% (g\u1ed3m x\u01b0\u01a1ng ghe, x\u01b0\u01a1ng ch\u00eam v\u00e0 x\u01b0\u01a1ng h\u1ed9p) v\u00e0 b\u00e0n ch\u00e2n sau 5% (x\u01b0\u01a1ng s\u00ean v\u00e0 x\u01b0\u01a1ng g\u00f3t). DFO \u1edf b\u00e0n ch\u00e2n tr\u01b0\u1edbc c\u00f3 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t h\u01a1n \u1edf b\u00e0n ch\u00e2n gi\u1eefa v\u00e0 sau.<\/p>\n

Nguy c\u01a1 \u0111o\u1ea1n chi d\u01b0\u1edbi \u0111\u1ebfn ph\u00eda tr\u00ean c\u1ed5 ch\u00e2n t\u0103ng nhi\u1ec1u n\u1ebfu DFO \u1edf b\u00e0n ch\u00e2n sau (50%) so v\u1edbi b\u00e0n ch\u00e2n gi\u1eefa (18.5%) v\u00e0 b\u00e0n ch\u00e2n tr\u01b0\u1edbc ch\u1ec9 0.33%.<\/p>\n

2. \u0110\u1eb7c \u0111i\u1ec3m vi sinh c\u1ee7a vi\u00eam x\u01b0\u01a1ng b\u00e0n ch\u00e2n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/h2>\n

\u0110\u1eb7c \u0111i\u1ec3m vi sinh trong DFI ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n, c\u01a1 \u0111\u1ecba, y\u1ebfu t\u1ed1 nguy c\u01a1, s\u1ef1 lan r\u1ed9ng v\u00e0 \u0111\u1ed9 s\u00e2u c\u1ee7a v\u1ebft th\u01b0\u01a1ng v\u00e0 y\u1ebfu t\u1ed1 vi m\u00f4i tr\u01b0\u1eddng.<\/p>\n

C\u00e1c nghi\u00ean c\u1ee9u d\u1ecbch t\u1ec5 cho th\u1ea5y, trong nhi\u1ec5m tr\u00f9ng m\u00f4 m\u1ec1m hi\u1ebfm khi l\u00e0 do m\u1ed9t t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh m\u00e0 th\u01b0\u1eddng l\u00e0 \u0111a t\u00e1c nh\u00e2n. Trong \u0111\u00f3, S. aureus<\/em> (chi\u1ebfm t\u1edbi 50% ca b\u1ec7nh), S. epidermidis<\/em> (chi\u1ebfm 25%), Streptococci<\/em> (chi\u1ebfm 30%) and Enterobacteriaceae<\/em> (chi\u1ebfm t\u1edbi to 40%) l\u00e0 nh\u1eefng t\u00e1c nh\u00e2n th\u01b0\u1eddng g\u1eb7p trong DFO.<\/p>\n

Trong c\u00e1c vi khu\u1ea9n Gram \u00e2m th\u00ec Escherichia coli<\/em>,\u00a0Klebsiella pneumoniae<\/em> v\u00e0 Proteus <\/em>l\u00e0 t\u00e1c nh\u00e2n th\u01b0\u1eddng g\u1eb7p sau \u0111\u00f3 \u0111\u1ebfn\u00a0Pseudomonas aeruginosa. <\/em><\/p>\n

T\u1ec9 l\u1ec7 nhi\u1ec5m vi khu\u1ea9n k\u1ef5 kh\u00ed th\u01b0\u1eddng th\u1ea5p. C\u00e1c DFO c\u0169ng cho th\u1ea5y ng\u00e0y c\u00e0ng t\u0103ng t\u1ec9 l\u1ec7 nhi\u1ec5m vi khu\u1ea9n \u0111a kh\u00e1ng, ch\u1ee7 y\u1ebfu l\u00e0 MRSA v\u00e0 c\u00e1c ch\u1ee7ng sinh ESBL (beta lactamase ph\u1ed5 r\u1ed9ng).<\/p>\n

3. Ch\u1ea9n \u0111o\u00e1n vi\u00eam x\u01b0\u01a1ng t\u1ee7y.<\/h2>\n

3.1. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n.<\/h3>\n

Ti\u00eau chu\u1ea9n v\u00e0ng cho ch\u1ea9n \u0111o\u00e1n vi\u00eam x\u01b0\u01a1ng t\u1ee7y l\u00e0 ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c vi khu\u1ea9n t\u1eeb m\u1eabu b\u1ec7nh ph\u1ea9m thu th\u1eadp \u0111\u00fang k\u0129 thu\u1eadt k\u00e8m theo s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u1ebf b\u00e0o vi\u00eam v\u00e0 ho\u1ea1i t\u1eed x\u01b0\u01a1ng tr\u00ean m\u00f4 h\u1ecdc.<\/p>\n

    \n
  • K\u1ebft qu\u1ea3 c\u1ea5y b\u1ec7nh ph\u1ea9m c\u00f3 th\u1ec3 \u00e2m t\u00ednh gi\u1ea3 do l\u1ea5y m\u1eabu sai, \u0111\u00e3 s\u1eed d\u1ee5ng kh\u00e1ng sinh tr\u01b0\u1edbc \u0111\u00f3, ho\u1eb7c t\u00e1c nh\u00e2n kh\u00f3 nu\u00f4i c\u1ea5y.<\/li>\n
  • K\u1ebft qu\u1ea3 c\u00f3 th\u1ec3 d\u01b0\u01a1ng t\u00ednh gi\u1ea3 do t\u1ea1p nhi\u1ec5m t\u1eeb vi khu\u1ea9n th\u01b0\u1eddng tr\u00fa trong v\u1ebft th\u01b0\u01a1ng ho\u1eb7c t\u1eeb da.<\/li>\n
  • Khi kh\u00f4ng c\u00f3 k\u1ebft qu\u1ea3 c\u1ea5y v\u00e0 m\u00f4 h\u1ecdc, ch\u1ea9n \u0111o\u00e1n vi\u00eam x\u01b0\u01a1ng khi th\u1ea5y m\u1ee7 ch\u1ea3y ra t\u1eeb x\u01b0\u01a1ng trong l\u00fac ph\u1eabu thu\u1eadt.<\/li>\n<\/ul>\n

    Ti\u00eau chu\u1ea9n c\u1ee7a IWGDF:\u00a0<\/strong><\/p>\n

    Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh (x\u00e1c su\u1ea5t >90%) khi:<\/p>\n

      \n
    • K\u1ebft qu\u1ea3 c\u1ea5y V\u00c0 m\u00f4 h\u1ecdc d\u01b0\u01a1ng t\u00ednh HO\u1eb6C<\/li>\n
    • M\u1ee7 ch\u1ea3y ra t\u1eeb x\u01b0\u01a1ng trong l\u00fac ph\u1eabu thu\u1eadt HO\u1eb6C<\/li>\n
    • T\u00e1ch ra \u0111\u01b0\u1ee3c m\u1eabu x\u01b0\u01a1ng t\u1eeb v\u1ebft lo\u00e9t HO\u1eb6C<\/li>\n
    • C\u00f3 h\u00ecnh \u1ea3nh abscess trong x\u01b0\u01a1ng tr\u00ean MRI HO\u1eb6C<\/li>\n
    • C\u00f3 2 ti\u00eau chu\u1ea9n c\u00f3 th\u1ec3 HO\u1eb6C 1 ti\u00eau chu\u1ea9n c\u00f3 th\u1ec3 + 2 ti\u00eau chu\u1ea9n c\u00f3 kh\u1ea3 n\u0103ng HO\u1eb6C 4 ti\u00eau chu\u1ea9n c\u00f3 kh\u1ea3 n\u0103ng d\u01b0\u1edbi \u0111\u00e2y.<\/li>\n<\/ul>\n

      Ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3 DFO (x\u00e1c su\u1ea5t 51 – 90%): c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb khi c\u00f3:<\/p>\n

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      • Th\u1ea5y \u0111\u01b0\u1ee3c b\u00e8 x\u01b0\u01a1ng qua v\u1ebft lo\u00e9t HO\u1eb6C<\/li>\n
      • MRI th\u1ea5y ph\u00f9 x\u01b0\u01a1ng v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c c\u1ee7a vi\u00eam x\u01b0\u01a1ng HO\u1eb6C<\/li>\n
      • K\u1ebft qu\u1ea3 c\u1ea5y d\u01b0\u01a1ng t\u00ednh nh\u01b0ng m\u00f4 h\u1ecdc \u00e2m t\u00ednh ho\u1eb7c kh\u00f4ng th\u1ef1c hi\u1ec7n HO\u1eb6C<\/li>\n
      • K\u1ebft qu\u1ea3 m\u00f4 h\u1ecdc d\u01b0\u01a1ng t\u00ednh nh\u01b0ng c\u1ea5y \u00e2m t\u00ednh ho\u1eb7c kh\u00f4ng th\u1ef1c hi\u1ec7n HO\u1eb6C<\/li>\n
      • C\u00f3 t\u1eeb 2 ti\u00eau chu\u1ea9n c\u00f3 kh\u1ea3 n\u0103ng d\u01b0\u1edbi \u0111\u00e2y.<\/li>\n<\/ul>\n

        Ch\u1ea9n \u0111o\u00e1n c\u00f3 kh\u1ea3 n\u0103ng DFO (10 – 50%):<\/p>\n

          \n
        • X quang c\u00f3 h\u00ecnh \u1ea3nh h\u1ee7y x\u01b0\u01a1ng HO\u1eb6C<\/li>\n
        • MRI c\u00f3 ph\u00f9 x\u01b0\u01a1ng HO\u1eb6C<\/li>\n
        • Test th\u0103m d\u00f2 x\u01b0\u01a1ng d\u01b0\u01a1ng t\u00ednh ho\u1eb7c th\u1ea5y \u0111\u01b0\u1ee3c v\u1ecf x\u01b0\u01a1ng HO\u1eb6C<\/li>\n
        • ESR > 70 mm\/h m\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n kh\u00e1c HO\u1eb6C<\/li>\n
        • V\u1ebft lo\u00e9t kh\u00f4ng l\u00e0nh m\u1eb7c d\u00f9 gi\u1ea3m t\u1ea3i l\u00ean ch\u00e2n v\u00e0 t\u01b0\u1edbi m\u00e1u \u0111\u1ea7y \u0111\u1ee7 trong >6 tu\u1ea7n HO\u1eb6C lo\u00e9t >2 tu\u1ea7n k\u00e8m d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng.<\/li>\n<\/ul>\n

          3.2. H\u1ecfi b\u1ec7nh v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng.<\/h3>\n

          Gi\u00fap ph\u00e1t hi\u1ec7n m\u1ed9t s\u1ed1 d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd DFO:<\/p>\n

            \n
          • H\u00ecnh \u1ea3nh “kh\u00fac d\u1ed3i” (sausage toe) g\u1ee3i \u00fd vi\u00eam x\u01b0\u01a1ng.<\/li>\n
          • V\u1ebft lo\u00e9t s\u00e2u, l\u00e2u l\u00e0nh sau 6 tu\u1ea7n ch\u0103m s\u00f3c v\u1ebft th\u01b0\u01a1ng v\u00e0 gi\u1ea3m t\u1ea3i l\u00ean b\u00e0n ch\u00e2n.<\/li>\n
          • L\u1ed9 x\u01b0\u01a1ng v\u00e0 di\u1ec7n t\u00edch lo\u00e9t 2\u00a0cm2<\/sup><\/li>\n
          • V\u1ebft th\u01b0\u01a1ng s\u00e2u t\u1edbi x\u01b0\u01a1ng, kh\u1edbp. Ti\u1ec1n s\u1eed \u0111\u00e3 t\u1eebng c\u00f3 v\u1ebft th\u01b0\u01a1ng, \u0111a v\u1ebft th\u01b0\u01a1ng.<\/li>\n
          • V\u1ebft lo\u00e9t s\u00e2u >3mm.<\/li>\n
          • Test th\u0103m d\u00f2 x\u01b0\u01a1ng d\u01b0\u01a1ng t\u00ednh (ch\u1ea1m \u0111\u01b0\u1ee3c b\u1edd x\u01b0\u01a1ng c\u1ee9ng) HO\u1eb6C nh\u00ecn th\u1ea5y x\u01b0\u01a1ng.<\/li>\n<\/ul>\n

            4. Qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng c\u00f3 vi\u00eam x\u01b0\u01a1ng b\u00e0n ch\u00e2n.<\/h2>\n
              \n
            • N\u1ebfu X quang x\u01b0\u01a1ng b\u00e0n ch\u00e2n cho th\u1ea5y h\u00ecnh \u1ea3nh g\u1ee3i \u00fd vi\u00eam x\u01b0\u01a1ng (\u0103n m\u00f2n v\u1ecf x\u01b0\u01a1ng, t\u0103ng ph\u1ea3n \u1ee9ng m\u00e0ng x\u01b0\u01a1ng, th\u1ea5u quang h\u1ed7n h\u1ee3p, x\u01a1 x\u01b0\u01a1ng), \u0111i\u1ec1u tr\u1ecb theo h\u01b0\u1edbng DFO, n\u00ean \u0111i\u1ec1u tr\u1ecb sau khi l\u1ea5y b\u1ec7nh ph\u1ea9m c\u1ea5y.<\/li>\n
            • N\u1ebfu X quang kh\u00f4ng th\u1ea5y d\u1ea5u hi\u1ec7u vi\u00eam x\u01b0\u01a1ng, \u0111i\u1ec1u tr\u1ecb ng\u01b0\u1eddi b\u1ec7nh b\u1eb1ng kh\u00e1ng sinh trong 2 tu\u1ea7n n\u1ebfu c\u00f3 nhi\u1ec5m khu\u1ea9n m\u00f4 m\u1ec1m, k\u1ebft h\u1ee3p ch\u0103m s\u00f3c t\u1ed1i \u01b0u v\u1ebft th\u01b0\u01a1ng v\u00e0 gi\u1ea3m t\u1ea3i b\u00e0n ch\u00e2n. Ch\u1ee5p phim l\u1ea1i sau 2 – 4 tu\u1ea7n.<\/li>\n
            • Phim ch\u1ee5p l\u1ea1i cho th\u1ea5y x\u01b0\u01a1ng v\u1eabn b\u00ecnh th\u01b0\u1eddng nh\u01b0ng v\u1eabn nghi ng\u1edd vi\u00eam x\u01b0\u01a1ng (test th\u0103m d\u00f2 x\u01b0\u01a1ng d\u01b0\u01a1ng t\u00ednh, v\u1ebft th\u01b0\u01a1ng kh\u00f4ng c\u1ea3i thi\u1ec7n) c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn: (1) l\u00e0m th\u00eam h\u00ecnh \u1ea3nh h\u1ecdc, \u01b0u ti\u00ean MRI, n\u1ebfu \u00e2m t\u00ednh th\u00ec lo\u1ea1i tr\u1eeb; (2) sinh thi\u1ebft x\u01b0\u01a1ng \u0111\u1ec3 c\u1ea5y v\u00e0 l\u00e0m gi\u1ea3i ph\u1eabu b\u1ec7nh; (3) \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh kinh nghi\u1ec7m (d\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 c\u1ea5y tr\u01b0\u1edbc \u0111\u00f3 ho\u1eb7c \u00edt nh\u1ea5t ph\u1ea3i bao ph\u1ee7 \u0111\u01b0\u1ee3c S.aureus<\/em>) trong 2 – 4 tu\u1ea7n r\u1ed3i \u0111\u00e1nh gi\u00e1 l\u1ea1i.<\/li>\n<\/ul>\n

              4.1. \u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n.<\/h3>\n

              L\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa khi:<\/p>\n

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              • Kh\u00f4ng nhi\u1ec5m tr\u00f9ng huy\u1ebft k\u00e9o d\u00e0i (sau 48 – 72h \u0111i\u1ec1u tr\u1ecb).<\/li>\n
              • B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 d\u00f9ng v\u00e0 dung n\u1ea1p kh\u00e1ng sinh.<\/li>\n
              • M\u1ee9c \u0111\u1ed9 ph\u00e1 h\u1ee7y x\u01b0\u01a1ng kh\u00f4ng g\u00e2y ra b\u1ea5t th\u01b0\u1eddng v\u1ec1 h\u00ecnh th\u00e1i h\u1ecdc b\u00e0n ch\u00e2n v\u0129nh vi\u1ec5n.<\/li>\n<\/ul>\n
                  \n
                • B\u1ec7nh nh\u00e2n kh\u00f4ng th\u00edch h\u1ee3p ph\u1eabu thu\u1eadt<\/li>\n
                • Kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng kh\u00e1ng sinh l\u00e2u d\u00e0i (nguy c\u01a1 nhi\u1ec5m C. difficile)<\/em><\/li>\n
                • Kh\u00f4ng c\u1ea7n ph\u1eabu thu\u1eadt \u0111\u1ec3 lo\u1ea1i b\u1ecf m\u00f4 nhi\u1ec5m tr\u00f9ng ho\u1eb7c ho\u1ea1i t\u1eed.<\/li>\n<\/ul>\n

                  Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh t\u1eeb 4 – 6 tu\u1ea7n v\u1edbi DFO, ban \u0111\u1ea7u truy\u1ec1n t\u0129nh m\u1ea1ch sau c\u00f3 th\u1ec3 chuy\u1ec3n \u0111\u01b0\u1eddng u\u1ed1ng. V\u1edbi ho\u1ea1i t\u1eed x\u01b0\u01a1ng kh\u00f4ng ph\u1eabu thu\u1eadt ho\u1eb7c c\u00f2n x\u01b0\u01a1ng ch\u1ebft sau ph\u1eabu thu\u1eadt c\u1ea7n \u0111i\u1ec1u tr\u1ecb \u00edt nh\u1ea5t 3 th\u00e1ng.<\/p>\n

                  4.2. \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt.<\/h3>\n

                  N\u00ean c\u00e2n nh\u1eafc khi:<\/p>\n

                    \n
                  • H\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng huy\u1ebft k\u00e9o d\u00e0i kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c.<\/li>\n
                  • Kh\u00f4ng d\u00f9ng ho\u1eb7c kh\u00f4ng dung n\u1ea1p kh\u00e1ng sinh.<\/li>\n
                  • Ph\u00e1 h\u1ee7y x\u01b0\u01a1ng x\u1ea5u \u0111i d\u00f9 \u0111ang \u0111i\u1ec1u tr\u1ecb.<\/li>\n
                  • Ph\u00e1 h\u1ee7y x\u01b0\u01a1ng g\u00e2y b\u1ea5t th\u01b0\u1eddng c\u01a1 h\u1ecdc b\u00e0n ch\u00e2n v\u0129nh vi\u1ec5n.<\/li>\n
                  • B\u1ec7nh nh\u00e2n tr\u00e1nh d\u00f9ng kh\u00e1ng sinh ho\u1eb7c mu\u1ed1n r\u00fat ng\u1eafn th\u1eddi gian l\u00e0nh v\u1ebft th\u01b0\u01a1ng.<\/li>\n
                  • Mu\u1ed1n x\u1eed l\u00fd v\u1ebft th\u01b0\u01a1ng m\u00f4 m\u1ec1m theo \u00fd mu\u1ed1n.<\/li>\n
                  • Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng kh\u00e1ng sinh d\u00e0i ng\u00e0y (nh\u01b0 c\u00f3 suy th\u1eadn).<\/li>\n<\/ul>\n

                    Theo khuy\u1ebfn c\u00e1o H\u1ed9i truy\u1ec1n nhi\u1ec5m M\u1ef9 2012 v\u1ec1 ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt \u1edf DFI:<\/strong><\/p>\n

                      \n
                    • C\u1ea7n h\u1ed9i ch\u1ea9n v\u1edbi b\u00e1c s\u0129 ph\u1eabu thu\u1eadt v\u1edbi DFI v\u1eeba – n\u1eb7ng.<\/li>\n
                    • C\u1ea7n can thi\u1ec7p ph\u1eabu thu\u1eadt kh\u1ea9n c\u1ea5p nhi\u1ec5m tr\u00f9ng b\u00e0n ch\u00e2n c\u00f3 khi trong m\u00f4 s\u00e2u, c\u00f3 abscess ho\u1eb7c ho\u1ea1i t\u1eed c\u00e2n; ph\u1eabu thu\u1eadt tr\u00ec ho\u00e3n v\u1edbi v\u1ebft th\u01b0\u01a1ng m\u00e0 c\u00e1c m\u00f4 kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng s\u1ed1ng ho\u1eb7c \u1ea3nh h\u01b0\u1edfng x\u01b0\u01a1ng, kh\u1edbp lan r\u1ed9ng.<\/li>\n
                    • C\u1ea7n ph\u1ed1i h\u1ee3p ph\u1eabu thu\u1eadt vi\u00ean m\u1ea1ch m\u00e1u \u0111\u1ec3 c\u00e2n nh\u1eafc t\u00e1i th\u00f4ng khi thi\u1ebfu m\u00e1u chi g\u00e2y bi\u1ebfn ch\u1ee9ng DFI.<\/li>\n<\/ul>\n

                      Khuy\u1ebfn c\u00e1o c\u1ee7a IWGDF 2019:<\/strong><\/p>\n

                        \n
                      • N\u00ean nhanh ch\u00f3ng tham kh\u1ea3o \u00fd ki\u1ebfn b\u00e1c s\u0129 ph\u1eabu thu\u1eadt trong tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng m\u1ee9c \u0111\u1ed9 n\u1eb7ng, ho\u1eb7c nhi\u1ec5m tr\u00f9ng m\u1ee9c \u0111\u1ed9 v\u1eeba ph\u1ea3i nh\u01b0ng ph\u1ee9c t\u1ea1p do ho\u1ea1i th\u01b0 lan r\u1ed9ng, nhi\u1ec5m tr\u00f9ng ho\u1ea1i t\u1eed, d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd \u00e1p xe s\u00e2u ho\u1eb7c h\u1ed9i ch\u1ee9ng ch\u00e8n \u00e9p khoang, ho\u1eb7c thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 chi d\u01b0\u1edbi nghi\u00eam tr\u1ecdng.<\/li>\n
                      • \u1ede m\u1ed9t b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 vi\u00eam x\u01b0\u01a1ng b\u00e0n ch\u00e2n kh\u00f4ng ph\u1ee9c t\u1ea1p, \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh kh\u00e1c ph\u1ea3i \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt, h\u00e3y c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p kh\u00e1ng sinh m\u00e0 kh\u00f4ng c\u1ea7n ph\u1eabu thu\u1eadt c\u1eaft x\u01b0\u01a1ng.<\/li>\n
                      • \u1ede m\u1ed9t b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 vi\u00eam x\u01b0\u01a1ng b\u00e0n ch\u00e2n, \u0111\u1ed3ng th\u1eddi nhi\u1ec5m tr\u00f9ng m\u00f4 m\u1ec1m, c\u1ea7n nhanh ch\u00f3ng \u0111\u00e1nh gi\u00e1 c\u00f3 c\u1ea7n ph\u1eabu thu\u1eadt, c\u0169ng nh\u01b0 theo d\u00f5i n\u1ed9i khoa v\u00e0 ngo\u1ea1i khoa t\u00edch c\u1ef1c sau ph\u1eabu thu\u1eadt<\/li>\n
                      • Ch\u1ecdn thu\u1ed1c kh\u00e1ng sinh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam x\u01b0\u01a1ng do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng trong s\u1ed1 nh\u1eefng thu\u1ed1c \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi vi\u00eam x\u01b0\u01a1ng trong c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng.<\/li>\n
                      • Kh\u00f4ng n\u00ean \u0111i\u1ec1u tr\u1ecb vi\u00eam x\u01b0\u01a1ng do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng b\u1eb1ng li\u1ec7u ph\u00e1p kh\u00e1ng sinh qu\u00e1 6 tu\u1ea7n. N\u1ebfu nhi\u1ec5m tr\u00f9ng kh\u00f4ng c\u1ea3i thi\u1ec7n l\u00e2m s\u00e0ng trong v\u00f2ng 2-4 tu\u1ea7n \u0111\u1ea7u, h\u00e3y xem x\u00e9t l\u1ea1i \u0111\u1ec3 l\u1ea5y m\u1eabu x\u01b0\u01a1ng \u0111\u1ec3 c\u1ea5y, ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf ho\u1eb7c ch\u1ecdn ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh thay th\u1ebf.<\/li>\n
                      • \u0110i\u1ec1u tr\u1ecb vi\u00eam x\u01b0\u01a1ng do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng b\u1eb1ng li\u1ec7u ph\u00e1p kh\u00e1ng sinh ch\u1ec9 trong v\u00e0i ng\u00e0y n\u1ebfu kh\u00f4ng c\u00f3 nhi\u1ec5m tr\u00f9ng m\u00f4 m\u1ec1m v\u00e0 t\u1ea5t c\u1ea3 c\u00e1c x\u01b0\u01a1ng b\u1ecb nhi\u1ec5m tr\u00f9ng \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf.<\/li>\n
                      • \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam x\u01b0\u01a1ng do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ban \u0111\u1ea7u \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng \u0111\u01b0\u1eddng ti\u00eam, h\u00e3y c\u00e2n nh\u1eafc chuy\u1ec3n sang kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 sinh kh\u1ea3 d\u1ee5ng cao sau kho\u1ea3ng 5 – 7 ng\u00e0y, n\u1ebfu vi khu\u1ea9n nh\u1ea1y c\u1ea3m v\u1edbi kh\u00e1ng sinh v\u00e0 c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng.<\/li>\n<\/ul>\n

                        T\u00e0i li\u1ec7u tham kh\u1ea3o:\u00a0<\/strong><\/p>\n

                        Benjamin A. Lipsky, Anthony R. Berendt, Paul B. Cornia, James C. Pile, Edgar J. G. Peters, David G. Armstrong, H. Gunner Deery, John M. Embil, Warren S. Joseph, Adolf W. Karchmer, Michael S. Pinzur, Eric Senneville, 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections,\u00a0Clinical Infectious Diseases<\/em>, Volume 54, Issue 12, 15 June 2012, Pages e132\u2013e173.<\/p>\n

                        Morales Lozano R, Gonz\u00e1lez Fern\u00e1ndez ML, Martinez Hern\u00e1ndez D, Beneit Montesinos JV, Guisado Jim\u00e9nez S, Gonzalez Jurado MA. Validating the probe-to-bone test and other tests for diagnosing chronic osteomyelitis in the diabetic foot. Diabetes Care. 2010 Oct;33(10):2140-5.<\/p>\n

                        Giurato L, Meloni M, Izzo V, Uccioli L. Osteomyelitis in diabetic foot: A comprehensive overview. World J Diabetes. 2017 Apr 15;8(4):135-142.<\/p>\n

                        Berendt AR, Peters EJ, Bakker K, Embil JM, Eneroth M, Hinchliffe RJ, Jeffcoate WJ, Lipsky BA, Senneville E, Teh J, Valk GD. Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. Diabetes Metab Res Rev. 2008 May-Jun;24 Suppl 1:S145-61.<\/p>\n

                        IWGDF 2019 guidance.<\/p>\n","protected":false},"excerpt":{"rendered":"

                        Vi\u00eam x\u01b0\u01a1ng \u1edf b\u00e0n ch\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (DFO) h\u1ea7u h\u1ebft l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a nhi\u1ec5m tr\u00f9ng m\u00f4 m\u1ec1m lan t\u1edbi x\u01b0\u01a1ng, nhi\u1ec5m tr\u00f9ng \u1ea3nh h\u01b0\u1edfng v\u1ecf x\u01b0\u01a1ng \u0111\u1ea7u ti\u00ean sau \u0111\u00f3 lan t\u1edbi t\u1ee7y x\u01b0\u01a1ng. T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec5m tr\u00f9ng b\u00e0n ch\u00e2n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (DFI) n\u00ean \u0111\u01b0\u1ee3c nghi ng\u1edd c\u00f3 […]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[80,33],"tags":[],"yoast_head":"\nVi\u00eam x\u01b0\u01a1ng b\u00e0n ch\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam x\u01b0\u01a1ng c\u00f3 th\u1ec3 g\u1eb7p \u1edf 60% nhi\u1ec5m tr\u00f9ng b\u00e0n ch\u00e2n n\u1eb7ng. 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