{"id":33618,"date":"2023-05-14T15:49:06","date_gmt":"2023-05-14T08:49:06","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=33618"},"modified":"2023-05-14T15:49:06","modified_gmt":"2023-05-14T08:49:06","slug":"benh-mang-trong-cach-dieu-tri-va-phong-tranh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/14\/benh-mang-trong-cach-dieu-tri-va-phong-tranh\/","title":{"rendered":"B\u1ec7nh m\u00e0ng trong: C\u00e1ch \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u00f2ng tr\u00e1nh"},"content":{"rendered":"<p><strong>Nh\u01b0 ch\u00fang ta \u0111\u00e3 bi\u1ebft b\u1ec7nh m\u00e0ng trong l\u00e0 m\u1ed9t b\u1ec7nh r\u1ea5t nguy hi\u1ec3m c\u00f3 th\u1ec3 \u0111e d\u1ecda \u0111\u1ebfn t\u00ednh m\u1ea1ng \u1edf tr\u1ebb s\u01a1 sinh v\u00e0 \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng sau n\u00e0y cho tr\u1ebb. V\u1eady ch\u00fang ta \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng b\u1ec7nh n\u00e0y nh\u01b0 th\u1ebf n\u00e0o? B\u00e2y gi\u1edd ch\u00fang ta s\u1ebd b\u1eaft \u0111\u1ea7u t\u00ecm hi\u1ec3u nh\u00e9.<\/strong><\/p>\n<h2><strong>1. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh m\u00e0ng trong<\/strong><\/h2>\n<p>Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb bao g\u1ed3m:<\/p>\n<p><strong>Can thi\u1ec7p \u0111\u1eb7c hi\u1ec7u:<\/strong><\/p>\n<ul>\n<li>Li\u1ec7u ph\u00e1p Oxy: Th\u1edf oxy qua d\u1ee5ng c\u1ee5, th\u1edf CPAP, \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n, th\u1edf m\u00e1y<\/li>\n<li>Li\u1ec7u ph\u00e1p surfactant<\/li>\n<li>Li\u1ec7u ph\u00e1p corticoid tr\u01b0\u1edbc sinh<\/li>\n<\/ul>\n<p><strong>\u0110i\u1ec1u tr\u1ecb n\u00e2ng \u0111\u1ee1 :<\/strong><\/p>\n<ul>\n<li>Duy tr\u00ec th\u00e2n nhi\u1ec7t<\/li>\n<li>Ch\u1ed1ng toan m\u00e1u<\/li>\n<li>Cung c\u1ea5p \u0111\u1ee7 n\u0103ng l\u01b0\u1ee3ng, n\u01b0\u1edbc, \u0111i\u1ec7n gi\u1ea3i&#8230;<\/li>\n<li>Ch\u1ed1ng nhi\u1ec5m tr\u00f9ng<\/li>\n<\/ul>\n<h3><strong>1.1\u00a0 Can thi\u1ec7p \u0111\u1eb7c hi\u1ec7u b\u1ec7nh m\u00e0ng trong:<\/strong><\/h3>\n<p><strong>1.1.1 Li\u1ec7u ph\u00e1p oxy<\/strong><\/p>\n<ul>\n<li>Th\u1edf oxy qua d\u1ee5ng c\u1ee5<\/li>\n<li><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/nhi\/chi-dinh-tho-cpap-cho-tre-bi-suy-ho-hap\/\">Th\u1edf CPAP<\/a><\/li>\n<li>\u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n, th\u1edf m\u00e1y<\/li>\n<\/ul>\n<figure style=\"width: 600px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"\" src=\"https:\/\/i.imgur.com\/BYHC4lE.png\" alt=\"Ch\u0103m s\u00f3c tr\u1ebb s\u01a1 sinh th\u1edf m\u00e1y | Vinmec\" width=\"600\" height=\"336\" \/><figcaption class=\"wp-caption-text\">Ch\u0103m s\u00f3c tr\u1ebb s\u01a1 sinh th\u1edf m\u00e1y | Vinmec<\/figcaption><\/figure>\n<p><strong>1.1.1.1 Th\u1edf oxy qua d\u1ee5ng c\u1ee5:<\/strong><\/p>\n<p><strong>&#8211; M\u1ee5c ti\u00eau: G<\/strong>i\u1eef SpO2 = 88 &#8211; 92% (\u1edf tr\u1ebb non th\u00e1ng &lt;33 tu\u1ea7n), 90 -95% ( \u1edf tr\u1ebb &gt;33 tu\u1ea7n)<\/p>\n<p><strong>&#8211; C\u00e1ch cung c\u1ea5p<\/strong>: Li\u1ec1u Oxy cung c\u1ea5p cho tr\u1ebb s\u01a1 sinh t\u00f9y thu\u1ed9c v\u00e0o \u00e1c m\u1ee9c \u0111\u1ed9 suy h\u00f4 h\u1ea5p v\u00e0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh theo t\u1eebng lo\u1ea1i d\u1ee5ng c\u1ee5:<\/p>\n<ul>\n<li>Th\u1edf Oxy li\u1ec1u cao khi t\u00edm trung t\u00e2m, suy h\u00f4 h\u1ea5p m\u1ee9c \u0111\u1ed9 n\u1eb7ng khi kh\u00f4ng \u0111ap \u1ee9ng v\u1edbi li\u1ec1u trung b\u00ecnh<\/li>\n<li>Th\u1edf oxy li\u1ec1u trung b\u00ecnh khi suy h\u00f4 h\u1ea5p m\u1ee9c \u0111\u1ed9 trung b\u00ecnh &#8211; n\u1eb7ng<\/li>\n<li>Th\u1edf oxy li\u1ec1u th\u1ea5p khi suy h\u00f4 h\u1ea5p m\u1ee9c \u0111\u1ed9 nh\u1eb9<\/li>\n<\/ul>\n<table>\n<tbody>\n<tr>\n<td>&nbsp;<\/p>\n<p><strong>D\u1ee5ng c\u1ee5<\/strong><\/td>\n<td><strong>L\u01b0u l\u01b0\u1ee3ng Oxy<\/strong><\/td>\n<td><strong>\u01afu \u0111i\u1ec3m<\/strong><\/td>\n<td><strong>Nh\u01b0\u1ee3c \u0111i\u1ec3m<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>G\u1ecdng m\u0169i\u00a0<\/strong><\/td>\n<td>Th\u1ea5p &lt;0.5L\/ph\u00fat<\/p>\n<p>Trung b\u00ecnh 0.5-1 L\/ph\u00fat<\/p>\n<p>Cao 1-2 L\/ph\u00fat<\/td>\n<td>L\u01b0u l\u01b0\u1ee3ng oxy th\u1ea5p nh\u01b0 y\u00eau c\u1ea7u<\/p>\n<p>\u0110\u1eb7t \u0111\u00fang c\u00e1ch th\u00ec l\u01b0\u1ee3ng oxy \u0111\u01b0\u1ee3c duy tr\u00ec li\u00ean t\u1ee5c<\/td>\n<td>Lo\u1ea1i ri\u00eang cho tr\u1ebb s\u01a1 sinh<\/p>\n<p>C\u1ea7n d\u1ee5ng c\u1ee5 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c l\u01b0u l\u01b0\u1ee3ng oxy th\u1ea5p<\/p>\n<p>Oxy l\u1ea1nh tr\u1ef1c ti\u1ebfp v\u00e0o ph\u1ed5i<\/td>\n<\/tr>\n<tr>\n<td><strong>\u1ed0ng th\u00f4ng m\u0169i<\/strong><\/td>\n<td>Th\u1ea5p &lt;0.5L\/ph\u00fat<\/p>\n<p>Trung b\u00ecnh 0.5-1 L\/ph\u00fat<\/p>\n<p>Cao 1-2 L\/ph\u00fat<\/td>\n<td>L\u01b0u l\u01b0\u1ee3ng oxy th\u1ea5p nh\u01b0 y\u00eau c\u1ea7u<\/p>\n<p>\u0110\u1eb7t \u0111\u00fang c\u00e1ch th\u00ec l\u01b0\u1ee3ng oxy \u0111\u01b0\u1ee3c duy tr\u00ec<\/td>\n<td>T\u1eafc, k\u00edch th\u00edch, tr\u1ea7y x\u01b0\u1edbc<\/p>\n<p>C\u1ea7n d\u1ee5ng c\u1ee5 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c l\u01b0u l\u01b0\u1ee3ng oxy th\u1ea5p Oxy l\u1ea1nh tr\u1ef1c ti\u1ebfp v\u00e0o ph\u1ed5i<\/td>\n<\/tr>\n<tr>\n<td><strong>L\u1ec1u Oxy<\/strong><\/td>\n<td>Th\u1ea5p &lt;3 L\/ph\u00fat<\/p>\n<p>Trung b\u00ecnh 3 &#8211; 5L\/ph\u00fat<\/p>\n<p>Cao &gt;5L\/ph\u00fat<\/td>\n<td>L\u00e0m \u1ea5m \u0111\u01b0\u1ee3c oxy<\/p>\n<p>C\u00f3 th\u1ec3 \u0111\u01b0a v\u00e0o l\u01b0\u1ee3ng oxy l\u1edbn<\/td>\n<td>C\u1ea7n l\u01b0u l\u01b0\u1ee3ng oxy cao \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c l\u01b0u l\u01b0\u1ee3ng oxy c\u1ea7n thi\u1ebft<\/td>\n<\/tr>\n<tr>\n<td><strong>M\u1eb7t n\u1ea1<\/strong><\/td>\n<td>Th\u1ea5p &lt;1L\/ph\u00fat<\/p>\n<p>Trung b\u00ecnh 1-2 L\/ph\u00fat<\/p>\n<p>Cao &gt;2l\/ph\u00fat<\/td>\n<td>Oxy c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c cho nhanh Th\u00edch h\u1ee3p cho vi\u1ec7c th\u1edf oxy trong th\u1eddi gian ng\u1eafn<\/td>\n<td>L\u01b0u l\u01b0\u1ee3ng th\u1ea5p v\u00e0 m\u1eb7t n\u1ea1 nh\u1ecf th\u00ec CO2\u00a0 th\u1ec3 cao<\/p>\n<p>Kh\u00f3 b\u00fa khi \u0111ang th\u1edf oxy<\/p>\n<p>Kh\u00f3 c\u1ed1 \u0111\u1ecbnh m\u1eb7t n\u1ea1<\/td>\n<\/tr>\n<tr>\n<td><strong>L\u1ed3ng \u1ea5p<\/strong><\/td>\n<td>N\u1ebfu d\u00f9ng l\u1ec1u Oxy trong l\u1ed3ng \u1ea5p th\u00ec xem \u1edf tr\u00ean<\/p>\n<p>N\u1ed1i tr\u1ef1c ti\u1ebfn oxy v\u00e0o l\u1ed3ng \u1ea5p th\u00ec t\u00f9y theo t\u00f9ng nh\u00e0 s\u1ea3n xu\u1ea5t<\/td>\n<td>L\u00e0m \u1ea5m \u0111\u01b0\u1ee3c Oxy<\/td>\n<td>Kh\u00f3 kh\u0103n \u0111\u01b0a oxy v\u00e0o<\/p>\n<p>L\u01b0u l\u01b0\u1ee3ng r\u1ea5t cao \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c n\u1ed3ng \u0111\u1ed9 oxy c\u1ea7n<\/p>\n<p>Kh\u00f3 duy tr\u00ec n\u1ed3ng \u0111\u1ed9 oxy khi m\u1edf l\u1ed3ng \u1ea5p<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>1.1.1.2 Th\u1edf \u00e1p l\u1ef1c d\u01b0\u01a1ng li\u00ean t\u1ee5c (CPAP)<\/strong><u><br \/>\nC\u00e1c kh\u00e1i ni\u1ec7m:\u00a0<\/u><\/p>\n<p><strong>CPAP<\/strong> (Continous Positive Airway Pressure): \u00e1p l\u1ef1c d\u01b0\u01a1ng li\u00ean t\u1ee5c<\/p>\n<p><strong>NCPAP<\/strong> (Nasal\u00a0 Continous Positive Airway Pressure): \u00e1p l\u1ef1c d\u01b0\u01a1ng li\u00ean t\u1ee5c qua m\u0169i<\/p>\n<p><strong>PEEP <\/strong>(Positive End Expiratory Airway Presure): \u00e1p l\u1ef1c d\u01b0\u01a1ng cu\u1ed1i k\u00ec th\u1edf ra<\/p>\n<p><strong><em>\u0110\u1ea1i c\u01b0\u01a1ng:\u00a0<\/em><\/strong><\/p>\n<ul>\n<li>Ph\u01b0\u01a1ng ph\u00e1p h\u1ed7 tr\u1ee3 <strong>kh\u00f4ng x\u00e2m l\u1ea5n<\/strong> \u1edf b\u1ec7nh nh\u00e2n suy <strong>h\u00f4 h\u1ea5p c\u00f2n t\u1ef1 th\u1edf + th\u1ea5t b\u1ea1i<\/strong> <strong>v\u1edbi Oxy<\/strong><\/li>\n<li>\u1ee8ng d\u1ee5ng ch\u1ebf \u0111\u1ed9 th\u1edf t\u1ef1 nhi\u00ean b\u1eb1ng c\u00e1ch duy tr\u00ec m\u1ed9t \u00e1p l\u1ef1c d\u01b0\u01a1ng li\u00ean t\u1ee5c su\u1ed1t chu k\u00ec th\u1edf<\/li>\n<li>Gi\u1ea3m t\u1ec9 l\u1ec7 \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n<\/li>\n<\/ul>\n<p>CPAP c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n qua sonde m\u0169i, m\u1eb7t n\u1ea1 ho\u1eb7c n\u1ed9i kh\u00ed qu\u1ea3n.<\/p>\n<p><strong><em>T\u00e1c d\u1ee5ng c\u1ee7a CPAP:<br \/>\n&#8211; <\/em><\/strong>Gi\u00fap ph\u1ebf nang kh\u00f4ng b\u1ecb x\u1eb9p cu\u1ed1i k\u00ec th\u1edf ra \u00e0 t\u0103ng dung t\u00edch c\u1eb7n ch\u1ee9c n\u0103ng<\/p>\n<p>&#8211; Gi\u1ea3m shunt trong ph\u1ed5i: c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng x\u1eb9p ph\u1ed5i \u00e0 c\u1ea3i thi\u1ec7n shunt<\/p>\n<p>&#8211; L\u00e0m d\u00e3n ph\u1ebf qu\u1ea3n nh\u1ecf \u00e0\u00a0 gi\u1ea3m s\u1ee9c \u0111\u1ec1 kh\u00e1ng kh\u00f4ng kh\u00ed v\u00e0o ph\u1ed5i \u0111\u1ebfn m\u1ee9c t\u1ed1i thi\u1ec3u \u00e0\u00a0 gi\u1ea3m c\u00f4ng ph\u1ea3i s\u1eed d\u1ee5ng khi t\u1ef1 th\u1edf\u00e0 gi\u1ea3m suy h\u00f4 h\u1ea5p<\/p>\n<p>&#8211; T\u00e1i ph\u00e2n b\u1ed1 n\u01b0\u1edbc \u1edf m\u00f4 k\u1ebb ph\u1ed5i \ud83e\udc6al\u00e0m c\u1ea3i thi\u1ec7n trao \u0111\u1ed5i kh\u00ed<\/p>\n<figure style=\"width: 601px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"\" src=\"https:\/\/i.imgur.com\/pA04jIX.png\" alt=\"Ngu\u1ed3n: Slide b\u00e0i gi\u1ea3ng \u0110H Y Hu\u1ebf 2018\" width=\"601\" height=\"301\" \/><figcaption class=\"wp-caption-text\">Ngu\u1ed3n: Slide b\u00e0i gi\u1ea3ng \u0110H Y Hu\u1ebf 2018<\/figcaption><\/figure>\n<table style=\"height: 329px;\" width=\"882\">\n<tbody>\n<tr>\n<td><strong>Ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n<p>Suy h\u00f4 h\u1ea5p do h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p \u1edf tr\u1ebb non th\u00e1ng<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb c\u01a1n ng\u01b0ng th\u1edf \u1edf tr\u1ebb non th\u00e0ng<\/p>\n<p>Co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p nhi\u1ec1u sau khi \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n<\/p>\n<p>Th\u1edf oxy qua l\u1ec1u ho\u1eb7c \u1ed1ng th\u00f4ng m\u0169i v\u1edbi FiO2&gt;30% nh\u01b0ng kh\u00f4ng c\u1ea3i thi\u1ec7n ho\u1eb7c n\u1eb7ng h\u01a1n<\/p>\n<p>Sau ng\u01b0ng th\u1edf m\u00e1y<\/p>\n<p>Ph\u00f9 ph\u1ed5i, xu\u1ea5t huy\u1ebft ph\u1ed5i, x\u1eb9p ph\u1ed5i, li\u1ec7t c\u01a1 ho\u00e0nh<\/td>\n<td><strong>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n<p>Tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i ch\u01b0a d\u1eabn l\u01b0u<\/p>\n<p>S\u1ed1c gi\u1ea3m th\u1ec3 t\u00edch<\/p>\n<p>Tho\u00e1t v\u1ecb c\u01a1 ho\u00e0nh<\/p>\n<p>T\u1eafc l\u1ed7 m\u0169i sau<\/p>\n<p>Ch\u1ea3y m\u00e1u m\u0169i n\u0103ng<\/p>\n<p>H\u1edf h\u00e0m \u1ebfch<\/p>\n<p>Vi\u00eam ru\u1ed9t ho\u1ea1i t\u1eed<\/p>\n<p>T\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd&#8230;<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>K\u1ef9 thu\u1eadt ti\u1ebfn h\u00e0nh<\/strong><\/p>\n<p><strong>Nguy\u00ean t\u1eafc:<\/strong><\/p>\n<ul>\n<li>Ch\u1ecdn Fi02 \u0111\u1ec3 b\u1ea3o \u0111\u1ea3m SaO2 l\u00e0 90-95% v\u00e0 PaO2 l\u00e0 75-90mmHg.<\/li>\n<li><strong>\u0110ang t\u00edm t\u00e1i n\u1eb7ng, SaO2 gi\u1ea3m n\u1eb7ng, c\u00f3 c\u01a1n ng\u01b0ng th\u1edf k\u00e9o d\u00e0i:<\/strong> FiO2 kh\u1edfi \u0111\u1ea7u 100% theo d\u00f5i m\u1ed7i 15ph, t\u00f9y theo \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng v\u00e0 Sa02 \u00a0\u2193 d\u1ea7n FiO2.<\/li>\n<li><strong>Tr\u01b0\u1eddng h\u1ee3p kh\u00e1c:<\/strong> b\u1eaft \u0111\u1ea7u v\u1edbi FiO2 30-40%, \u2191 d\u1ea7n m\u1ed7i 5-10% song song vi\u1ec7c theo d\u00f5i l\u00e2m s\u00e0ng v\u00e0 \u0111\u00e1p \u1ee9ng SaO2. N\u00ean gi\u1eef FiO2 &lt; 60% (tr\u00e1nh tai bi\u1ebfn do ng\u1ed9 \u0111\u1ed9c oxy).<\/li>\n<li><strong>Ch\u1ecdn l\u1ef1a \u00e1p l\u1ef1c v\u00e0 FiO2 t\u1ed1i \u01b0u <\/strong><\/li>\n<\/ul>\n<p><strong>M\u1ee5c \u0111\u00edch CPAP: <\/strong>\u0111\u01b0a oxy trong m\u00e1u \u0111\u1ed9ng m\u1ea1ch v\u1ec1 tr\u1ecb s\u1ed1 b\u00ecnh th\u1eddng v\u1edbi \u00e1p l\u1ef1c CPAP trong gi\u1edbi h\u1ea1n an to\u00e0n v\u00e0 FiO2 t\u1ed1i thi\u1ec3u (FiO2 40%)<\/p>\n<p>Khi \u00e1p l\u1ef1c c\u00f2n th\u1ea5p (4 \u2013 5 cmH2O) m\u00e0 c\u1ea7n FiO2 &gt; 60% m\u1edbi gi\u1eef \u0111\u01b0\u1ee3c SaO2 t\u1ed1t \u00e0 t\u0103ng d\u1ea7n \u00e1p l\u1ef1c t\u1eeb 1 \u2013 2 cmH2O m\u1ed7i 30 ph\u00fat &#8211; 1 gi\u1edd song song v\u1edbi gi\u1ea3m FiO2. N\u1ebfu ph\u1ea3i d\u00f9ng \u00e1p l\u1ef1c cao v\u00e0 FiO\u00ad2 &gt; 60% \u00e0 ch\u1ebf \u0111\u1ed9 th\u1edf m\u00e1y<\/p>\n<ul>\n<li><strong>Ch\u1ec9 \u0111\u1ecbnh ng\u01b0ng CPAP<\/strong><\/li>\n<\/ul>\n<p>&#8211; \u0110\u00e1p \u1ee9ng t\u1ed1t v\u1edbi CPAP sau nhi\u1ec1u gi\u1edd \u00e0 gi\u1ea3m FiO2 m\u1ed7i l\u1ea7n 5% m\u1ed7i 30 ph\u00fat cho \u0111\u1ebfn khi FiO2 \u0111\u1ea1t 40% \u00a0gi\u1ea3m d\u1ea7n \u00e1p l\u1ef1c 2 cmH2O m\u1ed7i 2 gi\u1edd \u00e0 \u00e1p l\u1ef1c \u0111\u1ea1t 4 cmH2O.<br \/>\n&#8211; Ng\u01b0ng CPAP n\u1ebfu b\u1ec7nh nhi h\u1ed9i \u0111\u1ee7 c\u00e1c \u0111i\u1ec1u ki\u1ec7n sau:<br \/>\n* \u1ed4n \u0111\u1ecbnh l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng (kh\u00ed trong m\u00e1u) trong nhi\u1ec1u gi\u1edd.<br \/>\n* FiO2 &lt; 40% &amp; \u00e1p l\u1ef1c CPAP &lt; 4cmH2O (trong tr\u01b0\u1eddng h\u1ee3p \u0111ang th\u1edf CPAP \u00e1p l\u1ef1c cao, ph\u1ea3i gi\u1ea3m \u00e1p t\u1eeb t\u1eeb)<\/p>\n<p><strong>1.1.2\u00a0 Li\u1ec7u ph\u00e1p surfactant<\/strong><\/p>\n<p><strong>Lo\u1ea1i surfactant:\u00a0 <\/strong>c\u00f3 2 lo\u1ea1i l\u00e0 surfactant t\u1ef1 nhi\u00ean v\u00e0 surfactant t\u1ed5ng h\u1ee3p.<\/p>\n<p>Surfactant t\u1ef1 nhi\u00ean: \u0111\u01b0\u1ee3c l\u1ea5y b\u1eb1ng c\u00e1ch r\u1eeda ph\u1ed5i ho\u1eb7c nghi\u1ec1n m\u00f4 ph\u1ed5i \u0111\u1ed9ng v\u1eadt, sau \u0111\u00f3 s\u1ebd \u0111\u01b0\u1ee3c tinh ch\u1ebf b\u1eb1ng c\u00e1ch chi\u1ebft l\u1ea5y lipid, lo\u1ea1i b\u1ecf c\u00e1c th\u00e0nh ph\u1ea7n \u01b0a n\u01b0\u1edbc bao g\u1ed3m c\u00e1c surfactant \u01b0a n\u01b0\u1edbc protein A v\u00e0 D.<\/p>\n<p>Surfactant t\u1ed5ng h\u1ee3p: lo\u1ea1i t\u1ed5ng h\u1ee3p c\u00f3 ch\u1ee9a c\u1ed3n \u0111\u1ec3 ph\u00e2n b\u1ed5 dipalmitoyl phosphatidylcoline l\u00ean to\u00e0n b\u1ed9 b\u1ec1 m\u1eb7t ph\u1ebf nang c\u00f3 ch\u1ee9a kh\u00ed v\u00e0 d\u1ecbch<\/p>\n<p><strong>Ch\u1ec9 \u0111\u1ecbnh v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb:<\/strong><\/p>\n<ul>\n<li>Trong v\u00f2ng 15 ph\u00fat sau sinh cho t\u1ea5t c\u1ea3 c\u00e1c tr\u1ebb \u0111\u1ebb non d\u01b0\u1edbi 27 tu\u1ea7n<\/li>\n<li>Ho\u1eb7c d\u01b0\u1edbi 30 tu\u1ea7n m\u00e0 m\u1eb9 kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb corticoid tr\u01b0\u1edbc \u0111\u00f3<\/li>\n<\/ul>\n<p><strong>K\u0129 thu\u1eadt cung c\u1ea5p surfactant:<\/strong><\/p>\n<p>B\u01a1m surfactant tr\u1ef1c ti\u1ebfp qua \u1ed1ng NKQ: \u0111\u1eb7t PEEP qua CPAP ho\u1eb7c m\u00e1y\u00a0 th\u1edf \u00a0duy tr\u00ec \u00e1p l\u1ef1c d\u01b0\u01a1ng li\u00ean t\u1ee5c cu\u1ed1i k\u1ef3 th\u1edf ra \u00a0tr\u00e1nh x\u1eb9p ph\u1ebf nang\u00a0t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho surfactant ph\u00e2n b\u1ed1 \u0111\u1ec1u \u0111\u1ebfn t\u1eadn nh\u1eefng v\u00f9ng th\u00f4ng kh\u00ed k\u00e9m<\/p>\n<p>T\u00e1c d\u1ee5ng ph\u1ee5<\/p>\n<p>Gi\u1ea3m Oxy m\u00e1u v\u00e0 ch\u1eadm nh\u1ecbp tim tho\u00e1ng qua do t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf c\u1ea5p sau khi b\u01a1m surfactant<\/p>\n<p>C\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c li\u00ean quan \u0111\u1ebfn vi\u1ec7c \u0111\u1eb7t NKQ v\u00e0 th\u1edf m\u00e1y: ch\u1ea5n th\u01b0\u01a1ng kh\u00ed \u00e1p, li\u00ean quan \u0111\u1ebfn th\u00f4ng kh\u00ed \u00e1p l\u1ef1c d\u01b0\u01a1ng kh\u00f4ng li\u00ean t\u1ee5c, d\u00f2 kh\u00ed \u1edf ph\u1ed5i, t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng th\u1edf do \u1ed1ng NKQ.<\/p>\n<p><strong>1.1.3 Li\u1ec7u ph\u00e1p corticoid tr\u01b0\u1edbc sinh (Antenatal corticosteroid &#8211; ACS)<\/strong><\/p>\n<p><em>Ch\u1ec9 \u0111\u1ecbnh<\/em>:<\/p>\n<ul>\n<li>Thai ph\u1ee5 c\u00f3 nguy c\u01a1 sinh non \u1edf tu\u1ed5i thai t\u1eeb 24-34 tu\u1ea7n trong th\u1eddi gian 48-72 gi\u1edd tr\u01b0\u1edbc khi sinh, c\u00f3 bi\u1ec3u hi\u1ec7n ph\u1ed5i non v\u1edbi n\u1ed3ng \u0111\u1ed9 lecithin th\u1ea5p trong d\u1ecbch \u1ed1i<\/li>\n<\/ul>\n<p>T\u1ef7 l\u1ec7 L\/S &lt; 2\/1 \u0111\u1ec3 ng\u0103n ng\u1eeba c\u0169ng nh\u01b0 gi\u1ea3m \u0111\u1ed9 n\u1eb7ng c\u1ee7a RDS.<\/p>\n<p><strong><em>Li\u1ec1u l\u01b0\u1ee3ng v\u00e0 c\u00e1ch s\u1eed d\u1ee5ng<\/em><\/strong>:<\/p>\n<ul>\n<li>Betamethasone: 12mg ti\u00eam b\u1eafp 2 li\u1ec1u c\u00e1ch nhau 24 gi\u1edd<\/li>\n<li>Ho\u1eb7c Dexamethasone: 6mg ti\u00eam b\u1eafp 4 li\u1ec1u c\u00e1ch nhau 12 gi\u1edd<\/li>\n<li>Hi\u1ec7u qu\u1ea3 t\u1ed1i \u01b0u s\u1ebd b\u1eaft \u0111\u1ea7u 24 gi\u1edd sau khi ch\u1ec9 \u0111\u1ecbnh corticoid v\u00e0 k\u00e9o d\u00e0i trong v\u00f2ng 7 ng\u00e0y<\/li>\n<\/ul>\n<p>N\u1ebfu qu\u00e1 7 ng\u00e0y, k\u1ec3 t\u1eeb l\u00fac \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh corticoid m\u00e0 v\u1eabn ch\u01b0a sinh, v\u00e0 nguy c\u01a1 sinh non v\u1eabn c\u00f2n cao <strong>=&gt;<\/strong> ki\u1ec3m tra l\u1ea1i d\u1ecbch \u1ed1i. N\u1ebfu L\/S th\u1ea5p th\u00ec l\u1eadp l\u1ea1i li\u1ec1u corticoid \u0111\u00e3 cho.<\/p>\n<h3><strong>1.2 \u0110i\u1ec1u tr\u1ecb n\u00e2ng \u0111\u1ee1<\/strong><\/h3>\n<p>Duy tr\u00ec th\u00e2n nhi\u1ec7t \u1edf 36.5-37.5 \u00b0 C<\/p>\n<p>Ch\u1ed1ng nhi\u1ec5m toan (Toan chuy\u1ec3n h\u00f3a n\u1eb7ng): s\u1eed d\u1ee5ng NaHCO3 (ph\u1ea3i \u0111\u1ea3m b\u1ea3o th\u00f4ng kh\u00ed t\u1ed1t tr\u01b0\u1edbc khi ch\u1ec9 \u0111\u1ecbnh NaHCO3)<\/p>\n<p>Duy tr\u00ec n\u01b0\u1edbc, \u0111i\u1ec7n gi\u1ea3i v\u00e0 n\u0103ng l\u01b0\u1ee3ng 130-140 kcal\/kg\/ng\u00e0y (non th\u00e1ng), 120kcal\/kg\/ng\u00e0y (\u0111\u1ee7 th\u00e1ng) v\u1edbi glucose 10%. Suy h\u00f4 h\u1ea5p m\u1ee9c \u0111\u1ed9 trung b\u00ecnh c\u1ea7n truy\u1ec1n d\u1ecbch trong v\u00f2ng 12h \u0111\u1ea7u<\/p>\n<p>S\u1eefa m\u1eb9: cho \u0103n qua sonde n\u1ebfu suy h\u00f4 h\u1ea5p c\u1ea3i thi\u1ec7n, tr\u1ebb h\u1ebft t\u00edm<\/p>\n<ul>\n<li>Kh\u00e1ng sinh n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng v\u00e0 d\u1eebng l\u1ea1i s\u1edbm khi nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb<\/li>\n<li>Theo d\u00f5i huy\u1ebft \u00e1p th\u01b0\u1eddng xuy\u00ean, duy tr\u00ec t\u1ed1t tu\u1ea7n ho\u00e0n v\u00e0 kh\u1ea3 n\u0103ng v\u1eadn chuy\u1ec3n oxy, theo d\u00f5i h\u1ea1 calci v\u00e0 t\u0103ng billirubin m\u00e1u<\/li>\n<li>Gi\u00e1m s\u00e1t k\u1ef9 c\u00e1c bi\u1ebfn ch\u1ee9ng: xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd, c\u00f2n \u1ed1ng \u0111\u1ed9ng m\u1ea1ch, tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, b\u1ec7nh l\u00fd v\u00f5ng m\u1ea1c \u1edf tr\u1ebb non th\u00e1ng, lo\u1ea1n s\u1ea3n ph\u1ebf qu\u1ea3n ph\u1ed5i<\/li>\n<\/ul>\n<h2><strong>2. D\u1ef1 ph\u00f2ng<\/strong><\/h2>\n<p><strong>2.1. \u0110\u1ed1i v\u1edbi m\u1eb9:<\/strong><\/p>\n<ul>\n<li>N\u00e2ng cao th\u1ec3 tr\u1ea1ng, ki\u1ebfn th\u1ee9c y t\u1ebf, c\u1ea3i thi\u1ec7n m\u00f4i tr\u01b0\u1eddng s\u1ed1ng<\/li>\n<li>Qu\u1ea3n l\u00fd thai ngh\u00e9n t\u1ed1t, \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi thai ph\u1ee5 c\u00f3 nguy c\u01a1 cao (\u0110T\u0110, nhi\u1ec5m tr\u00f9ng trong l\u00fac mang thai, thi\u1ebfu oxy)<\/li>\n<li>Ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y sinh non, ch\u1eadm ph\u00e1t tri\u1ec3n trong b\u00e0o thai<\/li>\n<\/ul>\n<p>&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0110\u00e1nh gi\u00e1 lecithin\/ sphingomyelin trong n\u01b0\u1edbc \u1ed1i\u00a0\u00a0\u0111\u00e1nh gi\u00e1 \u0111\u1ed9 tr\u01b0\u1edfng th\u00e0nh c\u1ee7a ph\u1ed5i<\/p>\n<p><strong>2.2. \u0110\u1ed1i v\u1edbi tr\u1ebb: <\/strong>ph\u00e1t hi\u1ec7n v\u00e0 x\u1eed tr\u00ed k\u1ecbp th\u1eddi suy h\u00f4 h\u1ea5p s\u01a1 sinh<br \/>\n&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Gi\u00fap tr\u1ebb th\u1edf t\u1ed1t v\u1edbi t\u01b0 th\u1ebf th\u00edch h\u1ee3p, th\u1ef1c hi\u1ec7n h\u1ed3i s\u1ee9c s\u01a1 sinh ngay sau sinh th\u1eadt t\u1ed1t<\/p>\n<p>&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 T\u0103ng c\u01b0\u1eddng c\u00e1c bi\u1ec7n ph\u00e1p ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p cho tr\u1ebb sau th\u1eddi gian th\u1edf m\u00e1y, \u0111i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng v\u00e0 kh\u1eafc ph\u1ee5c di ch\u1ee9ng c\u1ee7a b\u1ec7nh<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Ngu\u1ed3n tham kh\u1ea3o<\/strong><\/p>\n<ul>\n<li>CLB Nhi khoa \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c Hu\u1ebf<\/li>\n<\/ul>\n<div id=\"USE_CHAT_GPT_AI_ROOT\" style=\"display: none; z-index: -1; position: absolute; top: -10000px; left: -10000px; width: 1px; height: 1px; overflow: hidden; opacity: 0; pointer-events: none;\">usechatgpt init success<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Nh\u01b0 ch\u00fang ta \u0111\u00e3 bi\u1ebft b\u1ec7nh m\u00e0ng trong l\u00e0 m\u1ed9t b\u1ec7nh r\u1ea5t nguy hi\u1ec3m c\u00f3 th\u1ec3 \u0111e d\u1ecda \u0111\u1ebfn t\u00ednh m\u1ea1ng \u1edf tr\u1ebb s\u01a1 sinh v\u00e0 \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng sau n\u00e0y cho tr\u1ebb. V\u1eady ch\u00fang ta \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng b\u1ec7nh n\u00e0y nh\u01b0 th\u1ebf n\u00e0o? B\u00e2y gi\u1edd ch\u00fang ta s\u1ebd b\u1eaft \u0111\u1ea7u t\u00ecm [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>B\u1ec7nh m\u00e0ng trong: C\u00e1ch \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u00f2ng tr\u00e1nh - Vinmec<\/title>\n<meta name=\"description\" content=\"Nh\u01b0 ch\u00fang ta \u0111\u00e3 bi\u1ebft b\u1ec7nh m\u00e0ng trong l\u00e0 m\u1ed9t b\u1ec7nh r\u1ea5t nguy hi\u1ec3m c\u00f3 th\u1ec3 \u0111e d\u1ecda \u0111\u1ebfn t\u00ednh m\u1ea1ng \u1edf tr\u1ebb s\u01a1 sinh v\u00e0 \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng sau n\u00e0y cho tr\u1ebb.\" \/>\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=\"B\u1ec7nh m\u00e0ng trong: C\u00e1ch \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u00f2ng tr\u00e1nh - 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