{"id":2284,"date":"2018-11-19T14:09:14","date_gmt":"2018-11-19T14:09:14","guid":{"rendered":"https:\/\/robot.yeupet.vn\/nhiem-trung-mau-o-cho-meo\/"},"modified":"2018-11-19T14:09:14","modified_gmt":"2018-11-19T14:09:14","slug":"nhiem-trung-mau-o-cho-meo","status":"publish","type":"post","link":"https:\/\/robot.yeupet.vn\/index.php\/2018\/11\/19\/nhiem-trung-mau-o-cho-meo\/","title":{"rendered":"Nhi\u1ec5m Tr\u00f9ng M\u00e1u \u1ede Ch\u00f3 M\u00e8o"},"content":{"rendered":"

1. Nguy\u00ean nh\u00e2n g\u00e2y nhi\u1ec5m tr\u00f9ng m\u00e1u tr\u00ean ch\u00f3 m\u00e8o<\/strong><\/p>\n

Nhi\u1ec5m khu\u1ea9n huy\u1ebft (bacteremia) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 c\u00e1c vi sinh s\u1ed1ng trong h\u1ec7 tu\u1ea7n ho\u00e0n. Nhi\u1ec5m tr\u00f9ng huy\u1ebft (sepsis) bi\u1ec3u hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng k\u1ebft h\u1ee3p v\u1edbi m\u1ed9t \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n \u0111\u1ed1i v\u1edbi t\u00e1c nh\u00e2n truy\u1ec1n nhi\u1ec5m. Nhi\u1ec5m khu\u1ea9n huy\u1ebft \u1edf ch\u00f3 v\u00e0 m\u00e8o \u0111\u01b0\u1ee3c d\u1ef1 \u0111o\u00e1n s\u1ebd x\u1ea3y ra \u1edf nhi\u1ec1u b\u1ec7nh truy\u1ec1n nhi\u1ec5m (v\u00ed d\u1ee5: vi\u00eam ph\u00fac m\u1ea1c, vi\u00eam v\u00fa, vi\u00eam tuy\u1ebfn ti\u1ec1n li\u1ec7t, vi\u00eam ph\u1ed5i, abscess ph\u1ed5i, vi\u00eam m\u00e0ng ph\u1ed5i m\u1ee7, b\u1ecdc m\u1ee7 \u1edf t\u1eed cung, vi\u00eam b\u1ec3 th\u1eadn, abscess \u1ed5 b\u1ee5ng\u2026), c\u0169ng nh\u01b0 trong nha khoa. Nhi\u1ec5m khu\u1ea9n huy\u1ebft c\u00f3 th\u1ec3 c\u0169ng x\u1ea3y ra trong qu\u00e1 tr\u00ecnh kh\u00e1m tr\u1ef1c tr\u00e0ng, n\u1ed9i s\u00f4i \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00e0 ph\u1eabu thu\u1eadt, v\u00e0 khi \u0111\u1eb7t \u1ed1ng th\u00f4ng trong t\u0129nh m\u1ea1ch ho\u1eb7c \u0111\u1ed9ng m\u1ea1ch.<\/span>\"nhiem-trung-mau-o-cho-meo\"<\/p>\n

Vi khu\u1ea9n x\u00e2m nh\u1eadp v\u00e0o m\u1ea1ch m\u00e1u.<\/p>\n

D\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng \u0111i\u1ec3n h\u00ecnh g\u00e2y ra b\u1edfi s\u1ef1 nhi\u1ec5m khu\u1ea9n huy\u1ebft bao g\u1ed3m nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 thay \u0111\u1ed5i, nh\u1ecbp tim nhanh, th\u1edf nhanh v\u00e0 t\u0103ng s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh, ho\u1eb7c gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh, c\u00e1c d\u1ea5u hi\u1ec7u n\u00e0y g\u1ecdi l\u00e0 \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n (SIRS). Kh\u00f4ng ph\u1ea3i t\u1ea5t c\u1ea3 b\u1ec7nh s\u00fac nhi\u1ec5m khu\u1ea9n huy\u1ebft s\u1ebd xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a nhi\u1ec5m tr\u00f9ng huy\u1ebft. SIRS \u0111\u1eb7c tr\u01b0ng b\u1edfi m\u1ed9t \u0111\u00e1p \u1ee9ng qua trung gian cytokine ph\u1ee9c t\u1ea1p v\u00e0 c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ed9ng b\u1edfi c\u00e1c t\u00edn hi\u1ec7u DAMPs t\u1eeb c\u00e1c t\u1ebf b\u00e0o b\u1ecb h\u01b0 h\u1ea1i l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng, vi\u00eam t\u1ee5y, t\u00ecnh tr\u1ea1ng thi\u1ebfu oxy v\u00e0 nh\u1eefng t\u1ed5n thu\u01a1ng kh\u00e1c. C\u00f3 l\u1ee3i cho v\u1eadt ch\u1ee7 n\u1ebfu ph\u1ea3n \u1ee9ng vi\u00eam ch\u1ec9 c\u1ee5c b\u1ed9 v\u00e0 \u0111\u01b0\u1ee3c c\u00e2n b\u1eb1ng b\u1edfi con \u0111\u01b0\u1eddng ch\u1ed1ng vi\u00eam. Tuy nhi\u00ean, vi\u00eam to\u00e0n th\u00e2n ho\u1eb7c s\u1ef1 th\u1ea5t b\u1ea1i trong vi\u1ec7c gi\u1ea3m ph\u1ea3n \u1ee9ng vi\u00eam c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn kh\u1ea3 n\u0103ng t\u1eed vong cao.<\/p>\n

2. D\u1ecbch t\u1ec5 h\u1ecdc<\/strong><\/p>\n

Y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a nhi\u1ec5m n\u1ed9i \u0111\u1ed9c t\u1ed1 huy\u1ebft tr\u00ean ch\u00f3 bao g\u1ed3m c\u00e1c b\u1ec7nh Parvovirus tr\u00ean ru\u1ed9t, d\u00e3n d\u1ea1 d\u00e0y v\u00e0 xo\u1eafn ru\u1ed9t, b\u1ecdc m\u1ee7 \u1edf t\u1eed cung, vi\u00eam v\u00fa, c\u00e1c nhi\u1ec5m tr\u00f9ng do vi khu\u1ea9n Gram \u00e2m. Nhi\u1ec5m n\u1ed9i \u0111\u1ed9c t\u1ed1 huy\u1ebft c\u00f3 th\u1ec3 t\u0103ng l\u00ean khi h\u1ec7 s\u1ed1 thanh th\u1ea3i c\u1ee7a gan \u0111\u1ed1i v\u1edbi LPS gi\u1ea3m, nh\u01b0 suy gan. B\u1ec7nh t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng m\u1eadt c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 v\u00ec mu\u1ed1i m\u1eadt li\u00ean k\u1ebft v\u1edbi n\u1ed9i \u0111\u1ed9c t\u1ed1 trong ru\u1ed9t. Nhi\u1ec5m tr\u00f9ng huy\u1ebft \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn l\u00e0 \u00edt ph\u1ed5 bi\u1ebfn h\u01a1n tr\u00ean m\u00e8o.Y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y nhi\u1ec5m tr\u00f9ng huy\u1ebft n\u1eb7ng tr\u00ean m\u00e8o bao g\u1ed3m vi\u00eam m\u00e0ng ph\u1ed5i m\u1ee7, nhi\u1ec5m tr\u00f9ng ph\u00fac m\u1ea1c, nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t c\u1ee7a b\u1ec7nh \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, vi\u00eam ph\u1ed5i, vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c, b\u1ecdc m\u1ee7 \u1edf t\u1eed cung v\u00e0 v\u1ebft th\u01b0\u01a1ng do b\u1ecb c\u1eafn. Nhi\u1ec5m tr\u00f9ng huy\u1ebft c\u0169ng \u0111\u01b0\u1ee3c xem l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong tr\u00ean ch\u00f3 m\u00e8o s\u01a1 sinh.<\/p>\n

3. Sinh b\u1ec7nh h\u1ecdc<\/strong><\/p>\n

Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a n\u1ed9i \u0111\u1ed9c t\u1ed1 trong m\u00e1u ch\u1ec9 x\u1ea3y ra khi qu\u00e1 tr\u00ecnh g\u1eafn k\u1ebft v\u00e0 l\u1ecdai b\u1ecf vi khu\u1ea9n qu\u00e1 nhi\u1ec1u. Vi khu\u1ea9n s\u1ed1ng c\u0169ng c\u00f3 th\u1ec3 di chuy\u1ec3n t\u1eeb l\u00f2ng ru\u1ed9t b\u1eb1ng c\u00e1ch ph\u00e1 v\u1ee1 h\u00e0ng r\u00e0o bi\u1ec3u m\u00f4 d\u1eabn \u0111\u1ebfn nhi\u1ec5m khu\u1ea9n huy\u1ebft, ho\u1eb7c c\u0169ng c\u00f3 th\u1ec3 gia t\u0103ng s\u1ef1 x\u00e2m nh\u1eadp v\u00e0o h\u1ec7 th\u1ed1ng tu\u1ea7n ho\u00e0n t\u1eeb c\u00e1c b\u1ec1 m\u1eb7t ni\u00eam m\u1ea1c kh\u00e1c, trong ph\u1eabu thu\u1eadt v\u00e0 t\u1eeb v\u1ebft th\u01b0\u01a1ng.<\/p>\n

\"nhiem-trung-mau-o-cho-meo-1\"<\/p>\n

4. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/strong><\/p>\n

D\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng \u0111i\u1ec3n h\u00ecnh g\u00e2y ra b\u1edfi s\u1ef1 nhi\u1ec5m khu\u1ea9n huy\u1ebft bao g\u1ed3m nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 thay \u0111\u1ed5i, nh\u1ecbp tim nhanh, th\u1edf nhanh v\u00e0 t\u0103ng s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh, ho\u1eb7c gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh, c\u00e1c d\u1ea5u hi\u1ec7u n\u00e0y g\u1ecdi l\u00e0 \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n (SIRS).<\/p>\n

5. Ch\u1ea9n \u0111o\u00e1n<\/strong><\/p>\n

Huy\u1ebft h\u1ecdc: C\u00e1c b\u1ea5t thu\u1eddng v\u1ec1 huy\u1ebft h\u1ecdc ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf nh\u1eefng ngu\u1eddi nhi\u1ec5m tr\u00f9ng huy\u1ebft bao g\u1ed3m thi\u1ebfu m\u00e1u, t\u0103ng b\u1ea1ch c\u1ea7u, gi\u1ea3m ti\u1ec3u c\u1ea7u, v\u00e0 k\u00edch h\u1ecdat h\u1ec7 th\u1ed1ng \u0111\u00f4ng m\u00e1u. B\u1ec7nh s\u00fac v\u1edbi nhi\u1ec5m tr\u00f9ng huy\u1ebft n\u1eb7ng v\u00e0 shock nhi\u1ec5m tr\u00f9ng huy\u1ebft thu\u1eddng ph\u00e1t tri\u1ec3n th\u00e0nh s\u1ef1 r\u1ed1i l\u1ecdan ch\u1ee9c n\u0103ng ho\u1eb7c suy gi\u1ea3m c\u01a1 quan (vd suy gan, DIC). M\u1ed9t s\u1ed1 ph\u1ed5 bi\u1ebfn h\u01a1n, nh\u1eefng b\u1ea5t thu\u1eddng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u bao g\u1ed3m t\u0103ng h\u1ea1 \u0111u\u1eddng huy\u1ebft, gi\u1ea3m albumin m\u00e1u v\u00e0 t\u0103ng bilirubin m\u00e1u.<\/p>\n

Ch\u1ec9 d\u1ea5u sinh h\u1ecdc: Ph\u00e1t hi\u1ec7n s\u1edbm nhi\u1ec5m tr\u00f9ng huy\u1ebft c\u1ea7n \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u01a1m v\u00ec t\u1ec9 l\u1ec7 t\u1eed vong t\u0103ng c\u00f9ng v\u1edbi s\u1ef1 t\u0103ng r\u1ed1i l\u1ecdan ch\u1ee9c n\u0103ng c\u01a1 quan, h\u1ea1 huy\u1ebft \u00e1p, v\u00e0 t\u0103ng lactate huy\u1ebft. C\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng \u0111\u1ea7u ti\u00ean nh\u01b0 th\u1edf nhanh, nh\u1ecbp tim nhanh, s\u1ed1t v\u00e0 t\u0103ng b\u1ea1ch c\u1ea7u l\u00e0 kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, v\u00ec v\u1eady c\u1ea7n vi\u1ec7c nghi\u00ean c\u1ee9u \u0111i\u1ec1u tra vi\u1ec7c s\u1ef1 d\u1ee5ng c\u00e1c ch\u1ec9 d\u1ea5u sinh h\u1ecdc \u0111ang di\u1ec5n ra. Ch\u1ec9 d\u1ea5u sinh h\u1ecdc n\u00f3i chung l\u00e0 c\u00e1ch \u0111o lu\u1eddng sinh h\u00f3a ho\u1eb7c t\u1ebf b\u00e0o c\u1ee7a m\u1ed9t t\u00ecnh tr\u1ea1ng ho\u1eb7c qu\u00e1 tr\u00ecnh sinh h\u1ecdc. Ch\u1ec9 d\u1ea5u sinh h\u1ecdc c\u1ee7a nhi\u1ec5m tr\u00f9ng huy\u1ebft kh\u00f4ng ch\u1ec9 c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a nhi\u1ec5m tr\u00f9ng m\u00e0 c\u00f2n gi\u00fap theo d\u00f5i m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a nhi\u1ec5m tr\u00f9ng.<\/p>\n

\n

Ph\u00e2n l\u1eadp vi khu\u1ea9n: Vi\u1ec7c x\u00e1c \u0111\u1ecbnh tr\u1ecdng t\u00e2m c\u1ee7a nhi\u1ec5m tr\u00f9ng huy\u1ebft v\u00e0 vi\u1ec7c l\u1ef1a ch\u1ecdn m\u00f4 ho\u1eb7c ch\u1ea5t d\u1ecbch nhi\u1ec5m tr\u00f9ng cho nu\u00f4i c\u1ea5y vi khu\u1ea9n v\u00e0 th\u1eed kh\u00e1ng sinh \u0111\u1ed3 l\u00e0 r\u1ea5t quan tr\u1ecdng.<\/p>\n<\/blockquote>\n

6. K\u1ebft qu\u1ea3 b\u1ec7nh l\u00fd<\/strong><\/p>\n

H\u1ec7 th\u1ed1ng \u0111\u00f4ng m\u00e1u:<\/strong> b\u1ea5t thu\u1eddng \u1edf con \u0111u\u1eddng \u0111\u00f4ng m\u00e1u v\u00e0 ti\u00eau s\u1ee3i huy\u1ebft \u0111\u00f3ng m\u1ed9t vai tr\u00f2 quan tr\u1ecdng trong s\u1ef1 ti\u1ebfn tri\u1ec3n th\u00e0nh r\u1ed1i l\u1ecdan ch\u1ee9c n\u0103ng c\u01a1 quan \u1edf b\u1ec7nh s\u00fac nhi\u1ec5m tr\u00f9ng huy\u1ebft.T\u0103ng \u0111\u00f4ng m\u00e1u giai \u0111\u1ecdan \u0111\u1ea7u, gi\u1ea3m \u0111\u00f4ng m\u00e1u khi b\u1ec7nh ti\u1ebfn tri\u1ec3n n\u1eb7ng h\u01a1n. Ba h\u1ec7 th\u1ed1ng protein ch\u1ed1ng \u0111\u00f4ng ch\u00ednh: antithrombin (AT), con \u0111u\u1eddng \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 m\u00f4 (TFPI) v\u00e0 protein C (PC). T\u1ea5t c\u1ea3 \u0111\u1ec1u b\u1ecb r\u1ed1i l\u1ecdan trong qu\u00e1 tr\u00ecnh nhi\u1ec5m tr\u00f9ng huy\u1ebft d\u1eabn \u0111\u1ebfn: gi\u1ea3m s\u1ef1 ti\u00eau h\u1ee7y fibrin, fibrin l\u1eafng \u0111\u1ecdng v\u00e0 s\u1ef1 suy gi\u1ea3m c\u1ee7a c\u00e1c th\u00e0nh ph\u1ea7n c\u1ee7a qu\u00e1 tr\u00ecnh \u0111\u00f4ng m\u00e1u c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n v\u00e0o t\u00ecnh tr\u1ea1ng thi\u1ebfu oxy \u1edf m\u00f4 v\u00e0 t\u0103ng s\u1ef1 suy gi\u1ea3m ch\u1ee9c n\u0103ng nhi\u1ec1u c\u01a1 quan.<\/p>\n

H\u1ec7 th\u1ed1ng tim m\u1ea1ch:<\/strong> s\u1ef1 thay \u0111\u1ed5i ch\u1ee9c n\u0103ng tim m\u1ea1ch l\u00e0 ph\u1ed5 bi\u1ebfn \u1edf nh\u1eefng b\u00eanh s\u00fac nhi\u1ec5m tr\u00f9ng huy\u1ebft. C\u00e1c cytokine l\u01b0u h\u00e0nh c\u00f3 li\u00ean quan d\u1eabn \u0111\u1ebfn s\u1ef1 x\u00e1o tr\u1ed9n th\u00f4ng qua ba c\u01a1 ch\u1ebf: gia t\u0103ng t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch m\u00e1u n\u00ean cho ph\u00e9p s\u1ef1 tho\u00e1t d\u1ecbch kh\u1ecfi m\u1ea1ch m\u00e1u, d\u1eabn \u0111\u1ebfn gi\u1ea3m th\u1ec3 t\u00edch huy\u1ebft tu\u01a1ng (Hypovolemia) v\u00e0 g\u00e2y ph\u00f9 m\u00f4; co b\u00f3p tim b\u1ecb suy y\u1ebfu v\u00e0 ti\u1ebfp theo l\u00e0 gi\u1ea3m cung lu\u1ee3ng tim, v\u00e0 m\u1ea1ch \u0111\u1eadp kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u, g\u00e2y ra s\u1ef1 r\u1ed1i l\u1ecdan ph\u00e2n ph\u1ed1i l\u01b0u lu\u1ee3ng m\u00e1u.<\/p>\n

H\u1ec7 th\u1ed1ng h\u00f4 h\u1ea5p:<\/strong> S\u1ef1 trao \u0111\u1ed5i kh\u00ed k\u00e9m \u1edf nh\u1eefng b\u1ec7nh s\u00fac nhi\u1ec5m tr\u00f9ng huy\u1ebft do nhi\u1ec1u y\u1ebfu t\u1ed1 v\u00e0 li\u00ean quan \u0111\u1ebfn n\u1ed9i m\u00f4, t\u1ed5n thu\u01a1ng bi\u1ec3u m\u00f4, t\u1ed5n thu\u01a1ng ph\u1ed5i ph\u1ee5 thu\u1ed9c b\u1ea1ch c\u1ea7u trung t\u00ednh, cytokine ti\u1ec1n vi\u00eam v\u00e0 b\u1ea5t th\u01b0\u1eddng trong s\u1ea3n xu\u1ea5t th\u00e0nh ph\u1ea7n v\u00e0 ch\u1ee9c n\u0103ng c\u1ee7a ch\u1ea5t kh\u00e1ng khu\u1ea9n b\u1ec1 m\u1eb7t surfactant. Cu\u1ed1i c\u00f9ng c\u00f3 m\u1ed9t s\u1ef1 t\u00edch t\u1ee5 c\u1ee7a d\u1ecbch l\u1ecfng gi\u00e0u protein trong c\u00e1c ph\u1ebf nang v\u00e0 s\u1ef1 x\u00e2m nh\u00e2p c\u1ee7a t\u1ebf b\u00e0o vi\u00eam, d\u1ecbch l\u1ecfng v\u00e0 m\u1ea3nh v\u1ee5n v\u00e0o kho\u1ea3ng tr\u1ed1ng k\u1ebd ph\u1ebf nang. \u0110i\u1ec1u n\u00e0y thu\u1eddng \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e0 ph\u1ebf nang x\u00e2m nh\u1eadp tr\u00ean x-quang v\u00f9ng ng\u1ef1c.<\/p>\n

R\u1ed1i lo\u1ea1n th\u1ea7n kinh:<\/strong> D\u1ea5u hi\u1ec7u h\u1ec7 th\u1ed1ng th\u1ea7n kinh trung \u01b0\u01a1ng nh\u01b0 gi\u1ea3m s\u1ef1 t\u1ec9nh t\u00e1o, ng\u1ea9n ng\u01a1, h\u00f4n m\u00ea, ho\u1eb7c co gi\u1eadt th\u01b0\u1eddng ph\u1ed5 bi\u1ebfn \u1edf ng\u01b0\u1eddi shock nhi\u1ec5m tr\u00f9ng huy\u1ebft. nh\u1eefng thay \u0111\u1ed5i th\u1ea7n kinh do nh\u1eefng x\u00e1o tr\u1ed9n, bao g\u1ed3m \u1ea3nh hu\u1edfng tr\u1ef1c ti\u1ebfp t\u1eeb \u0111\u1ed9c t\u1ed1 c\u1ee7a vi sinh v\u1eadt g\u00e2y b\u1ec7nh, gi\u1ea3m l\u01b0u lu\u1ee3ng m\u00e1u n\u00e3o, mao m\u1ea1ch r\u00f2 r\u1ec9 v\u00e0 r\u1ed1i l\u1ecdan ch\u1ee9c n\u0103ng h\u00e0ng r\u00e0o m\u00e1u n\u00e3o.<\/p>\n

H\u1ec7 th\u1ed1ng ti\u00eau h\u00f3a v\u00e0 gan:<\/strong> R\u1ed1i l\u1ecdan ch\u1ee9c n\u0103ng GI \u1edf b\u00eanh s\u00fac nhi\u1ec5m tr\u00f9ng huy\u1ebft th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n nh\u01b0 t\u1eafc ru\u1ed9t, dung n\u1ea1p th\u1ee9c \u0103n \u1edf \u0111u\u1eddng ru\u1ed9t k\u00e9m, n\u00f4n m\u1eeda, ti\u00eau ch\u1ea3y, lo\u00e9t \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, ti\u00eau ph\u00e2n \u0111en v\u00e0 ph\u00e2n c\u00f3 m\u00e1u.<\/p>\n

7. \u0110i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng m\u00e1u tr\u00ean ch\u00f3 m\u00e8o<\/strong><\/p>\n

\u0110i\u1ec3m ch\u00ednh c\u1ee7a phu\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh s\u00fac nhi\u1ec5m tr\u00f9ng huy\u1ebft v\u1eabn l\u00e0 ki\u1ec3m so\u00e1t ngu\u1ed3n g\u1ed1c g\u00e2y b\u1ec7nh \u0111\u1ec3 l\u1ecdai b\u1ecf nguy\u00ean nh\u00e2n v\u00e0 k\u1ebft h\u1ee3p v\u1edbi s\u1ef1 ch\u0103m s\u00f3c c\u1ea9n th\u1eadn.<\/p>\n

H\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n:<\/strong> Tr\u1ee3 s\u1ee9c tim m\u1ea1ch = truy\u1ec1n d\u1ecbch t\u00edch c\u1ef1c. \u0110\u1eb7t \u1ed1ng th\u00f4ng t\u0129nh m\u1ea1ch trung t\u00e2m s\u1ebd theo d\u00f5i c\u00e1c thay \u0111\u1ed5i trong t\u0129nh m\u1ea1ch trung t\u00e2m su\u1ed1t li\u1ec7u ph\u00e1p truy\u1ec1n d\u1ecbch \u0111\u1ec3 h\u1ed7 tr\u1ee3 quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb (s\u1eed d\u1ee5ng d\u1ecbch truy\u1ec1n, ch\u1ea5t g\u00e2y co m\u1ea1ch). Theo d\u00f5i tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 v\u00e0 \u0111\u1eb7t \u1ed1ng th\u00f4ng \u0111\u01b0\u1eddng ti\u1ec3u c\u0169ng c\u00f3 \u00edch trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 s\u1ef1 c\u00e2n b\u1eb1ng c\u1ee7a t\u1ed5ng s\u1ed1 ch\u1ea5t d\u1ecbch. Li\u1ec7u ph\u00e1p g\u1ed3m c\u00e1c th\u00e0nh ph\u1ea7n d\u1ecbch truy\u1ec1n \u0111\u1eb3ng tr\u01b0\u01a1ng (Lactated Ringer\u2019s, dextrose), d\u1ecbch keo t\u1ed5ng h\u1ee3p v\u00e0 m\u00e1u thu\u1eddng \u0111u\u1ee3c d\u00f9ng trong c\u00e1c ch\u1ea5t d\u1ecbch h\u1ed3i s\u1ee9c.<\/p>\n

H\u1ed7 tr\u1ee3 tim m\u1ea1ch:<\/strong> \u0110\u1ed9ng v\u1eadt b\u1ecb h\u1ea1 huy\u1ebft \u00e1p c\u00f3 kh\u1ea3 n\u0103ng hi\u1ec7u qu\u1ea3 t\u1ed1t t\u1eeb vi\u1ec7c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p bao g\u1ed3m nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 tri\u1ec7u ch\u1ee9ng d\u00e3n m\u1ea1ch ng\u1ecdai vi nh\u01b0 m\u00e0ng nh\u00e0y \u0111\u1ecf t\u01b0\u01a1i, xung huy\u1ebft r\u00eca. \u0110i\u1ec1u tr\u1ecb v\u1edbi vasopressin ngo\u1ea1i sinh v\u00e0 c\u00e1c ch\u1ea5t t\u0103ng huy\u1ebft \u00e1p h\u01b0\u1edbng giao c\u1ea3m (norepinephrine). K\u1ebft h\u1ee3p c\u1ee7a vasopressin v\u00e0 glucocorticoid c\u00f3 th\u1ec3 l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng s\u1ed1ng s\u00f3t. D\u00f9ng vasopressin \u1edf ch\u00f3 v\u00e0 m\u00e8o hi\u1ec7n nay c\u00f2n h\u1ea1n ch\u1ebf, nh\u01b0ng k\u1ebft qu\u1ea3 s\u01a1 b\u1ed9 tr\u00ean ch\u00f3 r\u1ea5t tri\u1ec3n v\u1ecdng. Thu\u1ed1c co m\u1ea1ch nh\u01b0 norepinephrine, dopamine, phenylephrine, v\u00e0 vasopressin th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng \u1edf b\u1ec7nh s\u00fac d\u00e3n m\u1ea1ch ng\u1ecdai vi. C\u1ea7n l\u01b0u \u00fd thu\u1ed1c g\u00e2y co m\u1ea1ch th\u01b0\u1eddng l\u00e0m t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn co m\u1ea1ch qu\u00e1 m\u1ee9c \u0111\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 v\u00f9ng (n\u1ed9i t\u1ea1ng, th\u1eadn) g\u00e2y thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a ho\u1eb7c \u1edf th\u1eadn v\u00e0 r\u1ed1i l\u1ecdan ch\u1ee9c n\u0103ng. \u0110\u1eb7c bi\u1ec7t \u1edf ch\u00f3 nhi\u1ec5m tr\u00f9ng huy\u1ebft, co m\u1ea1ch n\u1ed9i t\u1ea1ng c\u00f3 th\u1ec3 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam t\u00ecnh tr\u1ea1ng nhi\u1ec5m n\u1ed9i \u0111\u1ed9c t\u1ed1 huy\u1ebft b\u1edfi \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u00ednh to\u00e0n v\u1eb9n c\u1ee7a ru\u1ed9t b\u00ecnh th\u01b0\u1eddng v\u00e0 cho ph\u00e9p vi khu\u1ea9n di chuy\u1ec3n v\u00e0o m\u00e1u.<\/p>\n

S\u1eed d\u1ee5ng kh\u00e1ng sinh trong nhi\u1ec5m tr\u00f9ng huy\u1ebft:<\/strong> S\u1ef1 c\u00f4 l\u1eadp h\u00f3a k\u1ecbp th\u1eddi c\u00e1c \u1ed5 nhi\u1ec5m tr\u00f9ng huy\u1ebft ho\u1eb7c thu l\u1ea5y m\u00f4 ho\u1eb7c ch\u1ea5t d\u1ecbch nhi\u1ec5m khu\u1ea9n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh vi khu\u1ea9n v\u00e0 x\u00e1c \u0111\u1ecbnh kh\u00e1ng sinh nh\u1ea1y l\u00e0 h\u1ebft s\u1ee9c quan tr\u1ecdng trong. Tuy nhi\u00ean, m\u1eabu thu \u0111u\u1ee3c c\u00f3 th\u1ec3 kh\u00f4ng d\u00f9ng \u0111\u01b0\u1ee3c b\u1edfi s\u1ef1 b\u1ea5t \u1ed5n \u1edf tim ph\u1ed5i ho\u1eb7c s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a r\u1ed1i l\u1ecdan \u0111\u00f4ng m\u00e1u \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh s\u00fac. Trong khi ch\u1edd k\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y v\u00e0 kh\u00e1ng sinh nh\u1ea1y, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh theo kinh nghi\u1ec7m n\u00ean \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn d\u1ef1a tr\u00ean c\u00e1c y\u1ebfu t\u1ed1 sau: kh\u1ea3 n\u0103ng kh\u00e1ng khu\u1ea9n, h\u1ec7 VSV th\u01b0\u1eddng tr\u00fa c\u00f3 l\u1ee3i \u1edf c\u00e1c m\u00f4 b\u1ecb \u1ea3nh hu\u1edfng, l\u1ecbch s\u1eed d\u00f9ng kh\u00e1ng sinh g\u1ea7n \u0111\u00e2y v\u00e0 s\u1ef1 c\u00e2n nh\u1eafc kh\u00e1ng thu\u1ed1c v\u00e0 ngu\u1ed3n l\u00e2y nhi\u1ec5m. C\u00e1c kh\u00e1ng sinh di\u1ec7t khu\u1ea9n ph\u1ed5 r\u1ed9ng thu\u1eddng \u0111u\u1ee3c d\u00f9ng truy\u1ec1n t\u0129nh m\u1ea1ch cho b\u1ec7nh s\u00fac nhi\u1ec5m tr\u00f9ng huy\u1ebft. Nh\u1eefng \u0111i\u1ec1u ch\u1ec9nh s\u1ebd \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n sau khi c\u00f3 k\u1ebft qu\u1ea3 th\u1eed nghi\u1ec7m kh\u00e1ng sinh nh\u1ea1y.<\/p>\n

Ch\u1ea5t b\u1ea3o v\u1ec7 \u0111u\u1eddng ti\u00eau h\u00f3a:<\/strong> Chi\u1ebfn l\u01b0\u1ee3c ban \u0111\u1ea7u \u0111\u1ec3 ng\u0103n ch\u1eb7n c\u00e1c bi\u1ebfn ch\u1ee9ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a \u1edf ch\u00f3 v\u00e0 m\u00e8o b\u1ecb b\u1ec7nh n\u1eb7ng l\u00e0 \u0111\u1ea3m b\u1ea3o cung c\u1ea5p m\u00e1u cho GI \u0111\u1ea7y \u0111\u1ee7 v\u00e0 s\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t dinh du\u1ee1ng qua \u0111\u01b0\u1eddng ru\u1ed9t s\u1edbm (employ early enteral nutrition.). B\u1ec7nh s\u00fac c\u00f3 nguy c\u01a1 cao n\u00ean \u0111u\u1ee3c d\u1ef1 ph\u00f2ng b\u1eb1ng thu\u1ed1c gi\u1ea3m stress li\u00ean quan \u0111\u1ebfn xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a. Thu\u1ed1c bao g\u1ed3m omeprazole (PPI) 0,7-1mg\/kg u\u1ed1ng, m\u1ed7i 24 gi\u1edd; pantoprazole (PPI) 0,7-1mg\/kg u\u1ed1ng, m\u1ed7i 24 gi\u1edd; famotidine (H2RA) 0,5-1mg\/kg, m\u1ed7i 12-24 gi\u1edd; ranitidine (H2RA) 0.5- 4 mg\/kg IV, m\u1ed7i 8 \u0111\u1ebfn 12 gi\u1edd; v\u00e0 sucralfate (ch\u1ea5t b\u1ea3o v\u1ec7) 0.25-1g\/25 kg u\u1ed1ng, m\u1ed7i 6 \u0111\u1ebfn 8 gi\u1edd.<\/p>\n

Chi\u1ebfn lu\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung cho nhi\u1ec5m tr\u00f9ng huy\u1ebft: D\u00f9ng hydrocortisol \u0111\u01b0\u1ee3c khuy\u00ean d\u00f9ng \u1edf tr\u01b0\u1eddng h\u1ee3p shock nhi\u1ec5m tr\u00f9ng huy\u1ebft khi \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi li\u1ec7u ph\u00e1p truy\u1ec1n d\u1ecbch v\u00e0 thu\u1ed1c t\u0103ng huy\u1ebft \u00e1p, khi nghi ng\u1edd ho\u1eb7c \u0111\u00e3 ch\u1ee9ng minh c\u00f3 suy th\u01b0\u1ee3ng th\u1eadn (RAI: l\u01b0\u1ee3ng delta cortisol 8. Ti\u00ean l\u01b0\u1ee3ng<\/p>\n

T\u1ec9 l\u1ec7 s\u1ed1ng s\u00f3t \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 \u1edf ch\u00f3 v\u00e0 m\u00e8o v\u1edbi nhi\u1ec5m tr\u00f9ng huy\u1ebft l\u00e0 33% \u0111\u1ebfn 68%, v\u00e0 kh\u1ea3 n\u0103ng s\u1ed1ng c\u00f2n c\u1ee7a \u0111\u1ed9ng v\u1eadt b\u00f4 shock nhi\u1ec5m tr\u00f9ng huy\u1ebft th\u00ec th\u1ea5p h\u01a1n. T\u1ec9 l\u1ec7 t\u1eed vong t\u0103ng l\u00ean khi s\u1ed1 l\u01b0\u1ee3ng c\u00e1c c\u01a1 quan b\u1ecb r\u1ed1i l\u1ecdan ch\u1ee9c n\u0103ng t\u0103ng l\u00ean. Trong nhi\u1ec5m tr\u00f9ng huy\u1ebft do vi\u00eam ph\u00fac m\u1ea1c, t\u1ec9 l\u1ec7 s\u1ed1ng s\u00f3t du\u1eddng nh\u01b0 kh\u00f4ng \u0111u\u1ee3c c\u1ea3i thi\u1ec7n trong v\u00f2ng 20 n\u0103m qua, b\u1ea5t ch\u1ea5p nh\u1eefng c\u1ea3i ti\u1ebfn trong qu\u1ea3n l\u00fd ch\u0103m s\u00f3c. \u0110\u1ec3 t\u1ed1i \u0111a h\u00f3a hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb, ch\u1ea9n \u0111o\u00e1n th\u00edch h\u1ee3p c\u0169ng nh\u01b0 s\u1ef1 h\u1ed7 tr\u1ee3 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi v\u00e0 t\u00edch c\u1ef1c l\u00e0 c\u1ea7n thi\u1ebft.<\/p><\/p>\n","protected":false},"excerpt":{"rendered":"

1. Nguy\u00ean nh\u00e2n g\u00e2y nhi\u1ec5m tr\u00f9ng m\u00e1u tr\u00ean ch\u00f3 m\u00e8o Nhi\u1ec5m khu\u1ea9n huy\u1ebft (bacteremia) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 c\u00e1c vi sinh s\u1ed1ng trong h\u1ec7 tu\u1ea7n ho\u00e0n. Nhi\u1ec5m tr\u00f9ng huy\u1ebft (sepsis) bi\u1ec3u hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng k\u1ebft h\u1ee3p v\u1edbi m\u1ed9t \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n \u0111\u1ed1i v\u1edbi t\u00e1c nh\u00e2n truy\u1ec1n nhi\u1ec5m. Nhi\u1ec5m khu\u1ea9n huy\u1ebft […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2284","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/posts\/2284","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/comments?post=2284"}],"version-history":[{"count":0,"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/posts\/2284\/revisions"}],"wp:attachment":[{"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/media?parent=2284"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/categories?post=2284"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/robot.yeupet.vn\/index.php\/wp-json\/wp\/v2\/tags?post=2284"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}