{"id":32108,"date":"2023-05-05T22:54:34","date_gmt":"2023-05-05T15:54:34","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32108"},"modified":"2023-05-05T22:54:34","modified_gmt":"2023-05-05T15:54:34","slug":"vet-loet-ban-chan-dai-thao-duong-huong-dan-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/vet-loet-ban-chan-dai-thao-duong-huong-dan-dieu-tri\/","title":{"rendered":"V\u1ebft lo\u00e9t b\u00e0n ch\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

V\u1ebft\u00a0lo\u00e9t b\u00e0n ch\u00e2n th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (\u0110T\u0110) c\u00f3 \u0111\u1ed3ng th\u1eddi hai ho\u1eb7c nhi\u1ec1u h\u01a1n y\u1ebfu t\u1ed1 nguy c\u01a1<\/a>, trong \u0111\u00f3 b\u1ec7nh l\u00fd th\u1ea7n kinh ngo\u1ea1i bi\u00ean v\u00e0 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean th\u01b0\u1eddng \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng. \u0110i\u1ec1u tr\u1ecb v\u1ebft lo\u00e9t bao g\u1ed3m kh\u00e1ng sinh ch\u1ed1ng nhi\u1ec5m khu\u1ea9n, c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng t\u01b0\u1edbi m\u00e1u \u0111\u1ebfn v\u1ebft lo\u00e9t, c\u1eaft l\u1ecdc, gi\u1ea3m t\u1ea3i l\u00ean b\u00e0n ch\u00e2n v\u00e0 ki\u1ec3m so\u00e1t b\u1ec7nh n\u1ec1n.\u00a0<\/strong><\/p>\n

1. \u0110i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n c\u1ee7a v\u1ebft lo\u00e9t b\u00e0n ch\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/h2>\n
    \n
  • Li\u1ec7u ph\u00e1p kh\u00e1ng sinh ban \u0111\u1ea7u cho h\u1ea7u h\u1ebft ng\u01b0\u1eddi b\u1ec7nh b\u1ecb nhi\u1ec5m tr\u00f9ng b\u00e0n ch\u00e2n \u0110T\u0110 l\u00e0 ch\u1ecdn theo kinh nghi\u1ec7m; m\u1ee5c ti\u00eau l\u00e0 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c t\u00e1c nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y b\u1ec7nh m\u00e0 kh\u00f4ng c\u1ea7n d\u00f9ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng kh\u00f4ng c\u1ea7n thi\u1ebft. \u0110i\u1ec1u tr\u1ecb quy\u1ebft \u0111\u1ecbnh cu\u1ed1i c\u00f9ng sau \u0111\u00f3 n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh theo \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng v\u1edbi kh\u00e1ng sinh theo kinh nghi\u1ec7m tu\u1ef3 t\u1eebng m\u1ee9c \u0111\u1ed9 ho\u1eb7c k\u1ebft qu\u1ea3 c\u1ea5y kh\u00e1ng sinh \u0111\u1ed3.<\/li>\n
  • C\u1ea5y l\u1ea1i d\u1ecbch v\u1ebft th\u01b0\u01a1ng trong \u0111i\u1ec1u ki\u1ec7n t\u1ed1i \u01b0u khi l\u00e2m s\u00e0ng v\u1eabn kh\u00f4ng \u0111\u00e1p \u1ee9ng hay \u0111\u00e1p \u1ee9ng k\u00e9m.<\/li>\n
  • D\u00f9ng kh\u00e1ng sinh \u0111\u01b0\u1eddng ti\u00eam cho t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng n\u1eb7ng v\u00e0 m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng v\u1eeba. Xem x\u00e9t chuy\u1ec3n qua kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng khi t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng \u0111\u00e3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t v\u00e0 c\u00f3 k\u1ebft qu\u1ea3 c\u1ea5y vi sinh h\u1ecdc.<\/li>\n
  • Ti\u1ebfp t\u1ee5c kh\u00e1ng sinh cho \u0111\u1ebfn khi t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft, th\u01b0\u1eddng t\u1eeb 2 \u2013 4 tu\u1ea7n cho nhi\u1ec5m tr\u00f9ng m\u00f4 m\u1ec1m l\u00e0 \u0111\u1ee7. Kh\u00f4ng nh\u1ea5t thi\u1ebft ph\u1ea3i d\u00f9ng kh\u00e1ng sinh cho \u0111\u1ebfn khi v\u1ebft lo\u00e9t l\u00e0nh ho\u00e0n to\u00e0n. Tuy nhi\u00ean, th\u1eddi gian d\u00f9ng kh\u00e1ng sinh l\u00fd t\u01b0\u1edfng v\u1eabn ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a nhi\u1ec5m tr\u00f9ng v\u00e0 t\u00ecnh tr\u1ea1ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/li>\n
  • Xem x\u00e9t ch\u1ecdn l\u1ef1a kh\u00e1ng sinh kinh nghi\u1ec7m ban \u0111\u1ea7u c\u00f3 hi\u1ec7u qu\u1ea3 tr\u00ean MRSA (Macrolide, Linezolid, Axit Fusidic,\u2026) khi c\u00f3 m\u1ed9t trong nh\u1eefng y\u1ebfu t\u1ed1 sau:<\/li>\n<\/ul>\n

    + C\u00f3 ti\u1ec1n s\u1eed nhi\u1ec5m MRSA<\/p>\n

    + C\u00f3 t\u1ef7 l\u1ec7 c\u1ea5y MRSA cao<\/p>\n

    + Nhi\u1ec5m tr\u00f9ng n\u1eb7ng.<\/p>\n

    2. \u0110i\u1ec1u tr\u1ecb c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng t\u01b0\u1edbi m\u00e1u \u0111\u1ebfn v\u1ebft lo\u00e9t b\u00e0n ch\u00e2n.<\/h2>\n
      \n
    • \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa, thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng v\u00e0 gi\u1ea3m c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng cho t\u1ea5t c\u1ea3 ng\u01b0\u1eddi b\u1ec7nh.<\/li>\n
    • \u0110i\u1ec1u tr\u1ecb t\u00e1i t\u01b0\u1edbi m\u00e1u c\u1ea7n \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng cho ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u00eau ch\u00ed \u201cT\u01b0\u1edbi m\u00e1u\u201d (Perfusion) t\u1eeb giai \u0111o\u1ea1n 3 tr\u1edf l\u00ean ho\u1eb7c t\u1ed5ng \u0111i\u1ec3m PEDIS theo IWDGF 2019 t\u1eeb 7 \u0111i\u1ec3m tr\u1edf l\u00ean.<\/li>\n<\/ul>\n

      2.1. \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng m\u1ea1ch m\u00e1u<\/h3>\n

      Ng\u01b0\u1eddi b\u1ec7nh n\u00ean \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 ng\u1eebng h\u00fat thu\u1ed1c v\u00e0 n\u00ean duy tr\u00ec huy\u1ebft \u00e1p v\u00e0 glucose m\u00e1u theo khuy\u1ebfn c\u00e1o h\u01b0\u1edbng d\u1eabn v\u1ec1 t\u0103ng huy\u1ebft \u00e1p v\u00e0 \u0110T\u0110. Ngo\u00e0i ra, t\u1ea5t c\u1ea3 c\u00e1c ng\u01b0\u1eddi b\u1ec7nh n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng statin v\u00e0 thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u.<\/p>\n

      2.2. T\u00e1i t\u01b0\u1edbi m\u00e1u<\/h3>\n
        \n
      • T\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u nu\u00f4i chi n\u1eb7ng v\u00e0 c\u1ea5p t\u00ednh c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi, \u0111\u00e2y l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u l\u00e2m s\u00e0ng, n\u1ebfu x\u1eed l\u00fd mu\u1ed9n s\u1ebd d\u1eabn \u0111\u1ebfn h\u1eadu qu\u1ea3 ho\u1ea1i t\u1eed kh\u00f4ng h\u1ed3i ph\u1ee5c. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean kh\u00e1c l\u00e0m gi\u1ea3m t\u01b0\u1edbi m\u00e1u v\u1ebft th\u01b0\u01a1ng c\u0169ng c\u1ea7n xem x\u00e9t \u00e1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p t\u00e1i t\u01b0\u1edbi m\u00e1u nh\u1eb1m th\u00fac \u0111\u1ea9y l\u00e0nh th\u01b0\u01a1ng v\u00e0 ng\u1eeba ho\u1eb7c tr\u00ec ho\u00e3n c\u1eaft c\u1ee5t trong t\u01b0\u01a1ng lai.<\/li>\n
      • Hai k\u1ef9 thu\u1eadt ch\u00ednh \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng l\u00e0 ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u n\u1ed1i m\u1ea1ch m\u00e1u v\u00e0 \u0111i\u1ec1u tr\u1ecb can thi\u1ec7p n\u1ed9i m\u1ea1ch.<\/li>\n<\/ul>\n

        M\u1ed9t s\u1ed1 ch\u1ec9 \u0111\u1ecbnh t\u00e1i t\u01b0\u1edbi m\u00e1u c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng nh\u01b0:<\/p>\n

          \n
        • \u1ede nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 huy\u1ebft \u00e1p c\u1ed5 ch\u00e2n <50mm Hg ho\u1eb7c ABI <0,5, c\u00e2n nh\u1eafc ch\u1ee5p m\u1ea1ch m\u00e1u c\u1ea5p. C\u0169ng n\u00ean xem x\u00e9t vi\u1ec7c ki\u1ec3m tra l\u1ea1i n\u1ebfu \u00e1p l\u1ef1c ng\u00f3n ch\u00e2n <30mmHg ho\u1eb7c TcpO2 <25 mmHg. Tuy nhi\u00ean, b\u00e1c s\u0129 l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc t\u00e1i th\u00f4ng m\u1ea1ch m\u00e1u \u1edf m\u1ee9c \u00e1p su\u1ea5t cao h\u01a1n \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh b\u1ecb nhi\u1ec5m tr\u00f9ng ho\u1eb7c m\u1ea5t m\u00f4 r\u1ed9ng.<\/li>\n
        • Khi v\u1ebft lo\u00e9t kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u c\u1ea3i thi\u1ec7n trong v\u00f2ng 6 tu\u1ea7n, m\u1eb7c d\u00f9 \u0111\u00e3 \u0111\u01b0\u1ee3c x\u1eed tr\u00ed t\u1ed1i \u01b0u, h\u00e3y c\u00e2n nh\u1eafc t\u00e1i th\u00f4ng m\u1ea1ch m\u00e1u, b\u1ea5t k\u1ec3 k\u1ebft qu\u1ea3 c\u1ee7a c\u00e1c x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n m\u1ea1ch m\u00e1u \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u1edf tr\u00ean.<\/li>\n
        • N\u1ebfu d\u1ef1 \u0111\u1ecbnh c\u1eaft c\u1ee5t cao (t\u1ee9c l\u00e0 tr\u00ean m\u1eaft c\u00e1 ch\u00e2n), tr\u01b0\u1edbc ti\u00ean h\u00e3y xem x\u00e9t l\u1ef1a ch\u1ecdn t\u00e1i t\u01b0\u1edbi m\u00e1u.<\/li>\n
        • M\u1ee5c \u0111\u00edch c\u1ee7a t\u00e1i th\u00f4ng m\u1ea1ch l\u00e0 kh\u00f4i ph\u1ee5c d\u00f2ng ch\u1ea3y tr\u1ef1c ti\u1ebfp \u0111\u1ebfn \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c \u0111\u1ed9ng m\u1ea1ch ch\u00e2n, t\u1ed1t nh\u1ea5t l\u00e0 \u0111\u1ed9ng m\u1ea1ch cung c\u1ea5p cho v\u00f9ng gi\u1ea3i ph\u1eabu c\u1ee7a v\u1ebft th\u01b0\u01a1ng.<\/li>\n<\/ul>\n

          3. \u0110i\u1ec1u tr\u1ecb ph\u1ee5c h\u1ed3i m\u00f4 h\u1ea1t<\/h2>\n

          Theo h\u01b0\u1edbng d\u1eabn c\u1ee7a IWGDF 2019 v\u00e0 NICE 2019: Ngay sau giai \u0111o\u1ea1n nhi\u1ec5m khu\u1ea9n ho\u1eb7c \u1edf v\u1ebft lo\u00e9t m\u1edbi ph\u00e1t hi\u1ec7n kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng, s\u1eed d\u1ee5ng b\u0103ng g\u1ea1c lipido-colloid t\u1ea9m sucrose octasulfate cho \u0111\u1ebfn khi v\u1ebft th\u01b0\u01a1ng l\u00e0nh, thay b\u0103ng h\u00e0ng ng\u00e0y ho\u1eb7c c\u00e1ch ng\u00e0y t\u00f9y t\u00ecnh tr\u1ea1ng v\u1ebft th\u01b0\u01a1ng. \u0110\u00e2y l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay gi\u00fap r\u00fat ng\u1eafn \u0111\u00e1ng k\u1ec3 th\u1eddi gian l\u00e0nh v\u1ebft lo\u00e9t so v\u1edbi b\u0103ng g\u1ea1c kh\u00e1c, \u0111\u1ed3ng th\u1eddi mang l\u1ea1i hi\u1ec7u qu\u1ea3 kinh t\u1ebf h\u01a1n c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u1ee5c h\u1ed3i m\u00f4 h\u1ea1t kh\u00e1c. Khi ti\u1ebfp x\u00fac v\u1edbi d\u1ecbch ti\u1ebft v\u1ebft th\u01b0\u01a1ng, lipido-colloid t\u1ea9m sucrose octasulfate s\u1ebd t\u1ea1o th\u00e0nh gel lipid \u0111\u1ec3 t\u1ea1o v\u00e0 duy tr\u00ec m\u1ed9t m\u00f4i tr\u01b0\u1eddng \u1ea9m c\u00f3 l\u1ee3i cho vi\u1ec7c ch\u1eefa l\u00e0nh. G\u1ea1c lipido-colloid t\u1ea9m sucrose octasulfate \u1ee9c ch\u1ebf Matrix Metalloproteinases (MMPs) d\u01b0 th\u1eeba v\u00e0 k\u00edch th\u00edch s\u1ef1 ph\u00e1t tri\u1ec3n, t\u0103ng sinh m\u1ea1ch m\u00e1u.<\/p>\n

          4. C\u1eaft l\u1ecdc<\/h2>\n

          – Nh\u1eefng l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c c\u1eaft l\u1ecdc v\u1ebft th\u01b0\u01a1ng, bao g\u1ed3m :<\/p>\n

          + L\u1ea5y \u0111i m\u00f4 ho\u1ea1i t\u1eed\/ m\u1ea3ng m\u1ee5c (Slough) v\u00e0 m\u00f4 x\u01a1 chai (Callus )<\/p>\n

          + Gi\u1ea3m \u00e1p l\u1ef1c l\u00ean b\u00e0n ch\u00e2n<\/p>\n

          + Gi\u00fap \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n v\u1ebft th\u01b0\u01a1ng<\/p>\n

          + Gi\u00fap d\u1eabn l\u01b0u d\u1ecbch ti\u1ebft hay m\u1ee7<\/p>\n

          + Gi\u00fap t\u1ed1i \u01b0u h\u00f3a vi\u1ec7c ch\u0103m s\u00f3c t\u1ea1i ch\u1ed7<\/p>\n

          + K\u00edch th\u00edch s\u1ef1 l\u00e0nh th\u01b0\u01a1ng<\/p>\n

          – Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1eaft l\u1ecdc :<\/p>\n

          + R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u<\/p>\n

          + Thi\u1ec3u n\u0103ng t\u01b0\u1edbi m\u00e1u t\u1ea1i ch\u1ed7<\/p>\n

          + B\u1ec7nh t\u1ef1 mi\u1ec5n v\u1edbi nhi\u1ec5m tr\u00f9ng v\u1ebft th\u01b0\u01a1ng n\u1eb7ng<\/p>\n

          + Nh\u1ea1y c\u1ea3m \u0111au<\/p>\n

          \u0110\u1ed3ng thu\u1eadn 2020 c\u1ee7a c\u00e1c chuy\u00ean gia qu\u1ed1c t\u1ebf v\u1ec1 v\u1ebft th\u01b0\u01a1ng kh\u00f4ng nh\u1eafc \u0111\u1ebfn c\u00e1c ph\u01b0\u01a1ng th\u1ee9c t\u1ef1 ph\u00e2n (Autolytic) & Enzyme. T\u01b0\u1edbi r\u1eeda & li\u1ec7u ph\u00e1p H\u00fat \u00e1p l\u1ef1c \u00e2m (NPWT) \u0111\u01b0\u1ee3c xem l\u00e0 c\u1eaft l\u1ecdc c\u01a1 h\u1ecdc.<\/p>\n

            \n
          • M\u1ed9t s\u1ed1 l\u01b0u \u00fd :<\/li>\n<\/ul>\n

            + C\u1eaft l\u1ecdc nhi\u1ec1u l\u1ea7n c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n m\u1ed9t l\u1ea7n duy nh\u1ea5t, c\u1ea7n k\u1ebft h\u1ee3p v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p tr\u1ecb li\u1ec7u kh\u00e1c (Kh\u00e1ng sinh, Gi\u1ea3m \u00e1p (off loading), H\u00fat \u00e1p l\u1ef1c \u00e2m,\u2026).<\/p>\n

            + C\u1eaft l\u1ecdc v\u00e0 r\u1eeda v\u1ebft th\u01b0\u01a1ng th\u01b0\u1eddng \u0111i \u0111\u00f4i v\u1edbi nhau<\/p>\n

            + Ch\u1ee9c n\u0103ng b\u00e0n ch\u00e2n, b\u1ea3o t\u1ed3n m\u00f4, tr\u00e1nh vi\u1ec7c c\u1eaft l\u1ecdc qu\u00e1 m\u1ee9c (\u0110\u00f2i h\u1ecfi k\u1ef9 n\u0103ng)<\/p>\n

            5.<\/em><\/strong> C\u1eaft c\u1ee5t chi v\u00e0 ch\u1ec9 \u0111\u1ecbnh.<\/em><\/strong><\/h2>\n

            C\u1eaft c\u1ee5t chi ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n sau khi \u0111\u00e3 can thi\u1ec7p \u0111\u1ea7y \u0111\u1ee7 t\u00ecnh tr\u1ea1ng t\u01b0\u1edbi m\u00e1u chi d\u01b0\u1edbi \u1edf ng\u01b0\u1eddi b\u1ec7nh lo\u00e9t b\u00e0n ch\u00e2n \u0110T\u0110. Ch\u1ec9 \u0111\u1ecbnh \u0111o\u1ea1n chi c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t trong m\u1ed9t s\u1ed1 t\u00ecnh hu\u1ed1ng sau:<\/p>\n

              \n
            • Thi\u1ebfu m\u00e1u chi tr\u1ea7m tr\u1ecdng k\u00e8m nhi\u1ec5m khu\u1ea9n ho\u1eb7c kh\u00f4ng k\u00e8m nhi\u1ec5m khu\u1ea9n nh\u01b0ng qu\u00e1 \u0111au kh\u00f4ng th\u1ec3 ki\u1ec3m so\u00e1t b\u1eb1ng n\u1ed9i khoa. (Ti\u00eau ch\u00ed \u201cT\u01b0\u1edbi m\u00e1u\u201d (Perfusion) trong thang PEDIS \u1edf giai \u0111o\u1ea1n 3 ho\u1eb7c 4)<\/li>\n
            • Nhi\u1ec5m khu\u1ea9n n\u1eb7ng \u0111e d\u1ecda t\u00ednh m\u1ea1ng m\u00e0 kh\u00f4ng th\u1ec3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c. (Ti\u00eau ch\u00ed \u201cNhi\u1ec5m tr\u00f9ng\u201d (Infection) trong thang PEDIS \u1edf giai \u0111o\u1ea1n 4) – Vi\u00eam x\u01b0\u01a1ng t\u1ee7y x\u01b0\u01a1ng kh\u00f4ng ph\u00f9 h\u1ee3p \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/li>\n
            • Theo \u00fd mu\u1ed1n c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/li>\n<\/ul>\n

              6. Gi\u1ea3m t\u1ea3i cho v\u1ebft lo\u00e9t b\u00e0n ch\u00e2n \u0110T\u0110<\/h2>\n
                \n
              • Khuy\u1ebfn ngh\u1ecb: Gi\u1ea3m t\u1ea3i v\u1edbi thi\u1ebft b\u1ecb kh\u00f4ng th\u1ec3 th\u00e1o r\u1eddi, cao \u0111\u1ebfn \u0111\u1ea7u g\u1ed1i.<\/li>\n
              • Ti\u00eau chu\u1ea9n v\u00e0ng l\u00e0 Khu\u00f4n b\u1ed9t b\u00f3 ti\u1ebfp x\u00fac to\u00e0n ph\u1ea7n (Total contact cast -TCC): Gi\u00fap ph\u00e2n ph\u1ed1i \u00e1p l\u1ef1c \u0111\u1ed3ng \u0111\u1ec1u tr\u00ean to\u00e0n b\u1ed9 b\u1ec1 m\u1eb7t c\u1ee7a b\u00e0n ch\u00e2n.<\/li>\n
              • Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: Thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 (ischaemia), v\u1ebft lo\u00e9t nhi\u1ec5m tr\u00f9ng ho\u1eb7c vi\u00eam t\u1ee7y x\u01b0\u01a1ng. M\u1ed9t b\u1ea5t l\u1ee3i kh\u00e1c c\u1ee7a TCC l\u00e0m cho sinh ho\u1ea1t h\u00e0ng ng\u00e0y c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh b\u1ecb \u1ea3nh h\u01b0\u1edfng, g\u00e2y k\u00edch \u1ee9ng da v\u00e0 t\u01b0\u01a1ng \u0111\u1ed1i t\u1ed1n k\u00e9m<\/li>\n
              • C\u00e1c thi\u1ebft b\u1ecb c\u00f3 th\u1ec3 th\u00e1o r\u1eddi (Gi\u00e0y \u0111i b\u1ed9 c\u00f3 th\u1ec3 th\u00e1o r\u1eddi \u2013 Removable cast walker, ho\u1eb7c Gi\u00e0y Scotchcast, d\u00e9p \u2013 healing sandals) c\u00f3 th\u1ec3 l\u00e0 l\u1ef1a ch\u1ecdn cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng th\u1ec3 s\u1eed d\u1ee5ng TCC, m\u1ed9t l\u1ef1a ch\u1ecdn th\u1ef1c d\u1ee5ng h\u01a1n cho ng\u01b0\u1eddi b\u1ec7nh, cho ph\u00e9p h\u1ecd t\u1eafm r\u1eeda v\u00e0 ng\u1ee7 th\u1ecfa m\u00e1i h\u01a1n. Tuy nhi\u00ean ng\u01b0\u1eddi b\u1ec7nh kh\u00f3 c\u00f3 th\u1ec3 mang thi\u1ebft b\u1ecb \u0111\u00fang qui \u0111\u1ecbnh<\/li>\n<\/ul>\n
                  \n
                • Trong b\u1ed1i c\u1ea3nh c\u1ee7a Vi\u1ec7t Nam vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 nh\u01b0 n\u1ea1ng, xe l\u0103n c\u0169ng gi\u00fap t\u00e1i ph\u00e2n b\u1ed1 \u00e1p l\u1ef1c \u1edf b\u00e0n ch\u00e2n (C\u1ea7n h\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi b\u1ec7nh hi\u1ec3u r\u00f5 m\u1ee5c \u0111\u00edch c\u1ee7a s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb \u0111\u1ec5 d\u1ec5 d\u00e0ng ch\u1ea5p nh\u1eadn), ngay c\u1ea3 n\u1ec9 d\u00e1n (Adhesive rayon felt) l\u00e0m \u0111\u1ec7m l\u00f3t xung quanh r\u00eca v\u1ebft th\u01b0\u01a1ng v\u00e0 mang gi\u00e0y h\u1ed7 tr\u1ee3 c\u0169ng l\u00e0 c\u00e1ch l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c \u1edf v\u00f9ng b\u1ecb lo\u00e9t.<\/li>\n<\/ul>\n

                  7. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh n\u1ec1n<\/h2>\n

                  Trong qu\u00e1 tr\u00ecnh ch\u0103m s\u00f3c ng\u01b0\u1eddi b\u1ec7nh lo\u00e9t b\u00e0n ch\u00e2n \u0110T\u0110, c\u1ea7n x\u00e1c \u0111\u1ecbnh c\u00e1c b\u1ec7nh l\u00fd n\u1ec1n v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 l\u00e0m c\u1ea3n tr\u1edf li\u1ec1n v\u1ebft lo\u00e9t, \u0111\u1ed3ng th\u1eddi ti\u1ebfn h\u00e0nh lo\u1ea1i b\u1ecf ch\u00fang:<\/p>\n

                    \n
                  • Ki\u1ec3m so\u00e1t glucose m\u00e1u, lipid m\u00e1u, t\u0103ng huy\u1ebft \u00e1p.<\/li>\n
                  • B\u1ed5 sung dinh d\u01b0\u1ee1ng cho ph\u00f9 h\u1ee3p.<\/li>\n
                  • \u0110i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh n\u1ec1n m\u1ea1n t\u00ednh kh\u00e1c.<\/li>\n<\/ul>\n

                    Ngu\u1ed3n: B\u1ed9 Y t\u1ebf 2023, H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb lo\u00e9t b\u00e0n ch\u00e2n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n","protected":false},"excerpt":{"rendered":"

                    V\u1ebft\u00a0lo\u00e9t b\u00e0n ch\u00e2n th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (\u0110T\u0110) c\u00f3 \u0111\u1ed3ng th\u1eddi hai ho\u1eb7c nhi\u1ec1u h\u01a1n y\u1ebfu t\u1ed1 nguy c\u01a1, trong \u0111\u00f3 b\u1ec7nh l\u00fd th\u1ea7n kinh ngo\u1ea1i bi\u00ean v\u00e0 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean th\u01b0\u1eddng \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng. \u0110i\u1ec1u tr\u1ecb v\u1ebft lo\u00e9t bao g\u1ed3m kh\u00e1ng sinh ch\u1ed1ng nhi\u1ec5m khu\u1ea9n, […]<\/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":"\nV\u1ebft lo\u00e9t b\u00e0n ch\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb v\u1ebft lo\u00e9t b\u00e0n ch\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng g\u1ed3m kh\u00e1ng sinh, c\u1ea3i thi\u1ec7n t\u01b0\u1edbi m\u00e1u, ph\u1ee5c h\u1ed3i m\u00f4 h\u1ea1t, c\u1eaft l\u1ecdc v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh n\u1ec1n.\" \/>\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=\"V\u1ebft lo\u00e9t b\u00e0n ch\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb - 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