B\u00e0i t\u1ed5ng quan n\u00e0y t\u1eadp trung v\u00e0o vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t c\u1ea5p \u1edf tr\u1ebb em t\u1ea1i c\u00e1c qu\u1ed1c gia c\u00f4ng nghi\u1ec7p, n\u01a1i virus chi\u1ebfm 75-90% nguy\u00ean nh\u00e2n c\u1ee7a vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t c\u1ea5p do nhi\u1ec5m tr\u00f9ng \u1edf tr\u1ebb em. Kho\u1ea3ng 20% tr\u01b0\u1eddng h\u1ee3p l\u00e0 do vi khu\u1ea9n, c\u00f2n ti\u00eau ch\u1ea3y k\u00e9o d\u00e0i 214 ng\u00e0y th\u01b0\u1eddng do k\u00fd sinh tr\u00f9ng, nh\u01b0ng chi\u1ebfm <5% tr\u01b0\u1eddng h\u1ee3p vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t c\u1ea5p. C\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh c\u1ee5 th\u1ec3 thay \u0111\u1ed5i theo m\u00f9a v\u00e0 kh\u00ed h\u1eadu.<\/p>\n
\u0110\u00e1nh gi\u00e1<\/h2>\nTi\u1ec1n s\u1eed b\u1ec7nh<\/h3>\n
Khai th\u00e1c b\u1ec7nh s\u1eed c\u1ea7n bao g\u1ed3m: th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t v\u00e0 th\u1eddi gian k\u00e9o d\u00e0i c\u1ee7a tri\u1ec7u ch\u1ee9ng, h\u1ecfi v\u1ec1 l\u01b0\u1ee3ng d\u1ecbch tr\u1ebb u\u1ed1ng v\u00e0o v\u00e0 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u00eau, c\u0169ng nh\u01b0 c\u00e1c \u0111\u1ea7u hi\u1ec7u c\u1ea3nh b\u00e1o (B\u1ea3ng 1).<\/p>\n
Do n\u00f4n v\u00e0 ti\u00eau ch\u1ea3y kh\u00f4ng \u0111\u1eb7c hi\u1ec7u cho vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t c\u1ea5p, n\u00ean c\u1ea7n c\u00e2n nh\u1eafc \u0111\u1ebfn c\u00e1c ch\u1ea9n \u0111o\u00e1n kh\u00e1c (B\u1ea3ng 2).<\/p>\n
M\u1eb7c d\u00f9 co gi\u1eadt th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn s\u1ed1t cao, nhi\u1ec5m tr\u00f9ng h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng ho\u1eb7c r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 do nhi\u1ec5m rotavirus \u1edf tr\u1ebb em.<\/p>\n
C\u00e1c khuy\u1ebfn c\u00e1o ch\u00ednh trong th\u1ef1c h\u00e0nh<\/h3>\n\n- Li\u1ec7u ph\u00e1p b\u00f9 d\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho tr\u1ebb b\u1ecb m\u1ea5t n\u01b0\u1edbc nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh trong vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t c\u1ea5p. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch trong vi\u1ec7c ng\u0103n ng\u1eeba nh\u1eadp vi\u1ec7n v\u00e0 t\u00e1i kh\u00e1m t\u1ea1i khoa c\u1ea5p c\u1ee9u. (Khuy\u1ebfn c\u00e1o m\u1ee9c B)<\/li>\n
- Tr\u1ebb b\u1ecb m\u1ea5t n\u01b0\u1edbc nh\u1eb9 n\u00ean \u0111\u01b0\u1ee3c cho u\u1ed1ng n\u01b0\u1edbc t\u00e1o pha lo\u00e3ng m\u1ed9t n\u1eeda, sau \u0111\u00f3 l\u00e0 c\u00e1c lo\u1ea1i n\u01b0\u1edbc u\u1ed1ng tr\u1ebb \u01b0a th\u00edch (n\u01b0\u1edbc tr\u00e1i c\u00e2y th\u01b0\u1eddng, s\u1eefa). C\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y gi\u00fap gi\u1ea3m nhu c\u1ea7u truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch so v\u1edbi vi\u1ec7c ch\u1ec9 d\u00f9ng dung d\u1ecbch ORS. (Khuy\u1ebfn c\u00e1o m\u1ee9c B)<\/li>\n
- R\u1eeda tay b\u1eb1ng x\u00e0 ph\u00f2ng l\u00e0 ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 trong vi\u1ec7c ph\u00f2ng ng\u1eeba c\u00e1c \u0111\u1ee3t vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t. Tuy nhi\u00ean, r\u1eeda tay v\u00e0 v\u1ec7 sinh \u0111\u01a1n thu\u1ea7n kh\u00f4ng ng\u0103n ng\u1eeba \u0111\u01b0\u1ee3c nhi\u1ec5m rotavirus. (Khuy\u1ebfn c\u00e1o m\u1ee9c A)<\/li>\n
- T\u1ea5t c\u1ea3 tr\u1ebb em n\u00ean \u0111\u01b0\u1ee3c u\u1ed1ng v\u1eafc-xin rota s\u1ed1ng, gi\u00e1m \u0111\u1ed9c l\u1ef1c \u0111\u1ec3 gi\u1ea3m t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n, vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t n\u1eb7ng v\u00e0 t\u1eed vong do nhi\u1ec5m rotavirus. (Khuy\u1ebfn c\u00e1o m\u1ee9c A)<\/li>\n
- Nu\u00f4i con b\u1eb1ng s\u1eefa m\u1eb9 gi\u00fap gi\u1ea3m t\u1ef7 l\u1ec7 m\u1eafc vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t c\u1ea5p v\u00e0 nh\u1eadp vi\u1ec7n v\u00ec ti\u00eau ch\u1ea3y \u1edf tr\u1ebb nh\u1ecf. (Khuy\u1ebfn c\u00e1o m\u1ee9c B)<\/li>\n<\/ul>\n
C\u00e1c \u0111i\u1ec3m m\u1edbi trong ch\u1ee7 \u0111\u1ec1 n\u00e0y<\/h3>\n
Vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t \u1edf tr\u1ebb em<\/strong><\/p>\n\n- Thang \u0111i\u1ec3m m\u1ea5t n\u01b0\u1edbc l\u00e2m s\u00e0ng (Clinical Dehydration Scale) \u0111\u00e1nh gi\u00e1 b\u1ed1n \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng \u0111\u1ec3 \u01b0\u1edbc l\u01b0\u1ee3ng m\u1ee9c \u0111\u1ed9 m\u1ea5t n\u01b0\u1edbc v\u00e0 \u0111\u1eb7c bi\u1ec7t h\u1eefu \u00edch trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh m\u1ea5t n\u01b0\u1edbc t\u1eeb trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng. Thang \u0111i\u1ec3m n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ki\u1ec3m ch\u1ee9ng trong nhi\u1ec1u b\u1ed1i c\u1ea3nh, c\u1ea3 \u1edf c\u00e1c khu v\u1ef1c c\u00f3 ngu\u1ed3n l\u1ef1c cao v\u00e0 th\u1ea5p, v\u00e0 cho k\u1ebft qu\u1ea3 so s\u00e1nh t\u1ed1t v\u1edbi ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 c\u00e2n n\u1eb7ng tr\u01b0\u1edbc v\u00e0 sau khi b\u00f9 d\u1ecbch \u2013 v\u1ed1n \u0111\u01b0\u1ee3c xem l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ec9nh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc.<\/li>\n
- T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) hi\u1ec7n nay khuy\u1ebfn ngh\u1ecb b\u00f9 n\u01b0\u1edbc b\u1eb1ng dung d\u1ecbch oresol c\u00f3 \u0111\u1ed9 th\u1ea9m th\u1ea5u gi\u1ea3m. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng ORS c\u1ee7a WHO ho\u1eb7c m\u1ed9t dung d\u1ecbch t\u1ef1 pha g\u1ed3m \u00bd th\u00eca c\u00e0 ph\u00ea mu\u1ed1i v\u00e0 6 th\u00eca c\u00e0 ph\u00ea \u0111\u01b0\u1eddng trong 1 l\u00edt n\u01b0\u1edbc.<\/li>\n<\/ul>\n
B\u1ea2NG 1<\/strong><\/p>\nC\u00e1c d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o \u1edf tr\u1ebb em b\u1ecb vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t c\u1ea5p<\/p>\n
\n\n\n\n\n- R\u1ed1i lo\u1ea1n tri gi\u00e1c<\/li>\n
- N\u00f4n ra d\u1ecbch m\u1eadt ho\u1eb7c n\u00f4n ra m\u00e1u<\/li>\n
- T\u00edm t\u00e1i<\/li>\n
- Kh\u00f3c kh\u00f4ng d\u1ed7 \u0111\u01b0\u1ee3c ho\u1eb7c qu\u1ea9y qu\u00e1 m\u1ee9c<\/li>\n
- Ch\u1ea9m xu\u1ea5t huy\u1ebft<\/li>\n
- T\u01b0\u1edbi m\u00e1u ngo\u1ea1i vi k\u00e9m<\/li>\n
- Th\u1edf nhanh<\/li>\n
- S\u1ed1t \u2265 40\u00b0C<\/li>\n
- V\u1ebb nhi\u1ec5m tr\u00f9ng<\/li>\n
- Tu\u1ed5i nh\u1ecf (d\u01b0\u1edbi 6 th\u00e1ng) ho\u1eb7c c\u00e2n n\u1eb7ng th\u1ea5p<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
B\u1ea2NG 2<\/strong><\/p>\nCh\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t ti\u00eau ch\u00e1y ho\u1eb7c n\u00f4n \u1edf tr\u1ebb em<\/p>\n
\n\n\nTri\u1ec7u ch\u1ee9ng<\/strong><\/td>\nCh\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3 g\u1eb7p<\/strong><\/td>\n<\/tr>\n\nR\u1ed3i lo\u1ea1n tri gi\u00e1c<\/td>\n Nhi\u1ec5m tr\u00f9ng h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, nhi\u1ec5m tr\u00f9ng huy\u1ebft<\/td>\n<\/tr>\n \nN\u00f4n ra d\u1ecbch m\u1eadt<\/td>\n T\u1eafc ru\u1ed9t<\/td>\n<\/tr>\n \nPh\u00e2n c\u00f3 m\u00e1u ho\u1eb7c nh\u1ea7y (\u0111\u1eb7c bi\u1ec7t k\u00e9o d\u00e0i > 2 tu\u1ea7n)<\/td>\n B\u1ec7nh ru\u1ed9t vi\u00eam (IBD)<\/td>\n<\/tr>\n \nKh\u00f3 th\u1edf<\/td>\n Vi\u00eam ph\u1ed5i<\/td>\n<\/tr>\n \nS\u1ed1t<\/td>\n C\u00e1c nhi\u1ec5m tr\u00fang kh\u00e1c nh\u01b0 vi\u00eam tai gi\u1eefa, nhi\u1ec5m | tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u c\u00f3 th\u1ec3 g\u00e2y bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n \u1edf tr\u1ebb em<\/td>\n<\/tr>\n \n\u0110au b\u1ee5ng khu tr\u00fa, ch\u01b0\u1edbng b\u1ee5ng ho\u1eb7c \u0111\u1ec1 kh\u00e1ng th\u00e0nh b\u1ee5ng<\/td>\n B\u1ee5ng ngo\u1ea1i khoa (vd: vi\u00eam ru\u1ed9t th\u1eeba)<\/td>\n<\/tr>\n \nC\u1ee9ng g\u00e1y ho\u1eb7c th\u00f3p ph\u1ed3ng<\/td>\n Vi\u00eam m\u00e0ng n\u00e3o<\/td>\n<\/tr>\n \nBan xu\u1ea5t huy\u1ebft<\/td>\n H\u1ed9i ch\u1ee9ng s\u1ed1c nhi\u1ec5m \u0111\u1ed9c (TSS)<\/td>\n<\/tr>\n \nG\u1ea7n \u0111\u00e2y c\u00f3 d\u00f9ng kh\u00e1ng sinh (vd: ampicillin)<\/td>\n T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a kh\u00e1ng sinh<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nT\u00ecnh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc<\/h3>\n
C\u00e1c d\u1ea5u hi\u1ec7u \u0111\u1ee1 lo ng\u1ea1i bao g\u1ed3m: \u0103n u\u1ed1ng b\u00ecnh th\u01b0\u1eddng, l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u b\u00ecnh th\u01b0\u1eddng, v\u00e0 kh\u00f4ng n\u00f4n \u00f3i. N\u1ebfu c\u00f3 c\u1ea3 ba \u0111i\u1ec1u n\u00e0y, th\u00ec kh\u1ea3 n\u0103ng m\u1ea5t n\u01b0\u1edbc c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng l\u00e0 r\u1ea5t th\u1ea5p.<\/p>\n
Tuy nhi\u00ean, kh\u00e1m l\u00e2m s\u00e0ng v\u1eabn l\u00e0 c\u00e1ch t\u1ed1t nh\u1ea5t \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc. Thang \u0111i\u1ec3m m\u1eaft n\u01b0\u1edbc l\u00e2m s\u00e0ng (Clinical Dehydration Scale – B\u00e1ng 3) \u0111\u00e1nh gi\u00e1 4 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng \u0111\u1ec3 \u01b0\u1edbc l\u01b0\u1ee3ng m\u1ee9c \u0111\u1ed9 m\u1ea5t n\u01b0\u1edbc, \u0111\u1eb7c bi\u1ec7t h\u1eefu \u00edch trong vi\u1ec7c ph\u00e1t hi\u1ec7n m\u1ea5t n\u01b0\u1edbc m\u1ee9c \u0111\u1ed9 v\u1eeba \u0111\u1ebfn n\u1eb7ng. Thang \u0111i\u1ec3m n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ki\u1ec3m ch\u1ee9ng trong nhi\u1ec1u b\u1ed1i c\u1ea3nh kh\u00e1c nhau, c\u1ea3 \u1edf nh\u1eefng n\u01a1i c\u00f3 \u0111i\u1ec1u ki\u1ec7n y t\u1ebf \u0111\u1ea7y \u0111\u1ee7 l\u1eabn h\u1ea1n ch\u1ebf, v\u00e0 cho k\u1ebft qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi ph\u01b0\u01a1ng ph\u00e1p so s\u00e1nh c\u00e2n n\u1eb7ng tr\u01b0\u1edbc v\u00e0 sau khi b\u00f9 n\u01b0\u1edbc.<\/p>\n
B\u1ea2NG 3<\/strong><\/p>\nThang \u0111i\u1ec3m m\u1ea5t n\u01b0\u1edbc l\u00e2m s\u00e0ng (Clinical Dehydration Scale)<\/p>\n
\n\n\n\u0110\u1eb7c \u0111i\u1ec3m<\/strong><\/td>\n0 \u0111i\u1ec3m<\/strong><\/td>\n1 \u0111i\u1ec3m<\/strong><\/td>\n2 \u0111i\u1ec3m<\/strong><\/td>\n<\/tr>\n\nTo\u00e0n tr\u1ea1ng<\/td>\n B\u00ecnh th\u01b0\u1eddng<\/td>\n Kh\u00e1t n\u01b0\u1edbc, b\u1ed3n ch\u1ed3n ho\u1eb7c l\u1edd \u0111\u1edd, nh\u01b0ng c\u00e1u g\u1eaft khi ch\u1ea1m v\u00e0o<\/td>\n Ng\u1ee7 g\u00e0, l\u1ea1nh, v\u00e0 m\u00f4 h\u00f4i, h\u00f4n m\u00ea<\/td>\n<\/tr>\n \nM\u1eaft<\/td>\n B\u00ecnh th\u01b0\u1eddng<\/td>\n H\u01a1i tr\u0169ng<\/td>\n R\u1ea5t tr\u0169ng<\/td>\n<\/tr>\n \nNi\u00eam m\u1ea1c<\/td>\n \u1ea8m<\/td>\n D\u00ednh (sticky)<\/td>\n Kh\u00f4<\/td>\n<\/tr>\n \nN\u01b0\u1edbc m\u1eaft<\/td>\n C\u00f3 n\u01b0\u1edbc m\u1eaft<\/td>\n \u00cdt n\u01b0\u1edbc m\u1eaft<\/td>\n Kh\u00f4ng c\u00f3 n\u01b0\u1edbc m\u1eaft<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n- 0 \u0111i\u1ec3m – M\u1ea5t n\u01b0\u1edbc <3%<\/li>\n
- 1 – 4 \u0111i\u1ec3m – M\u1ea5t n\u01b0\u1edbc nh\u1eb9 (3% – 6%)<\/li>\n
- 5 \u2013 8 \u0111i\u1ec3m – M\u1ea5t n\u01b0\u1edbc v\u1eeba \u0111\u1ebfn n\u1eb7ng (>6%)<\/li>\n<\/ul>\n
X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng<\/h3>\n
Ch\u1ec9 s\u1ed1 x\u00e9t nghi\u1ec7m duy nh\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh kh\u1ea3 n\u0103ng m\u1ea5t n\u01b0\u1edbc \u2264 5% l\u00e0 n\u1ed3ng \u0111\u1ed9 bicarbonat huy\u1ebft thanh > 15 mEq\/L (15 mmol\/L). Tuy nhi\u00ean, \u0111i\u1ec7n gi\u1ea3i, creatinin v\u00e0 \u0111\u01b0\u1eddng huy\u1ebft c\u0169ng n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh n\u1ebfu nhi\u1ec1u kh\u1ea3 n\u0103ng c\u1ea7n b\u00f9 d\u1ecbch t\u0129nh m\u1ea1ch. Natri huy\u1ebft thanh gi\u00fap x\u00e1c nh\u1eadn t\u1ec9nh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc t\u0103ng natri m\u00e1u, c\u1ea7n nghi ng\u1edd khi b\u1ec7nh nhi c\u00f3 bi\u1ec3u hi\u1ec7n: t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1, t\u0103ng ph\u1ea3n x\u1ea1, co gi\u1eadt, l\u01a1 m\u01a1 ho\u1eb7c h\u00f4n m\u00ea.<\/p>\n
\u1ede tr\u1ebb em b\u1ecb b\u1ec7nh nh\u1eb9, x\u00e9t nghi\u1ec7m ph\u00e2n th\u01b0\u1eddng kh\u00f4ng c\u1ea7n thi\u1ebft khi ch\u1ea9n \u0111o\u00e1n nhi\u1ec1u kh\u1ea3 n\u0103ng l\u00e0 vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t do virus. Tuy nhi\u00ean, x\u00e9t nghi\u1ec7m ph\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n nghi nhi\u1ec5m tr\u00f9ng huy\u1ebft, c\u00f3 m\u00e1u ho\u1eb7c nh\u1ea7y trong ph\u00e2n, ho\u1eb7c suy gi\u1ea3m mi\u1ec5n d\u1ecbch. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, c\u00e2y ph\u00e2n l\u00e0 x\u00e9t nghi\u1ec7m chu\u1ea9n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh trong vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t do vi khu\u1ea9n (c\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1ng nguy\u00ean v\u00e0\/ho\u1eb7c khu\u1ebfch \u0111\u1ea1i acid nucleic \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n Clostridium difficile v\u00e0 Campylobacter). Hi\u1ec7n nay, x\u00e9t nghi\u1ec7m PCR ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n virus g\u00e2y vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t \u1edf tr\u1ebb em nh\u1eadp vi\u1ec7n, v\u00ec vi\u1ec7c x\u00e1c \u0111\u1ecbnh c\u0103n nguy\u00ean virus gi\u00fap tr\u00e1nh l\u1ea1m d\u1ee5ng kh\u00e1ng sinh kh\u00f4ng c\u1ea7n thi\u1ebft.<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh b\u1ed5 sung cho x\u00e9t nghi\u1ec7m ph\u00e2n g\u1ed3m c\u00f3: Vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t sau khi \u0111i du l\u1ecbch n\u01b0\u1edbc ngo\u00e0i (x\u00e9t nghi\u1ec7m t\u1ec9m tr\u1ee9ng v\u00e0 k\u00fd sinh tr\u00f9ng); Ti\u00eau ch\u00e1y kh\u00f4ng c\u1ea3i thi\u1ec7n sau 7 ng\u00e0y (b\u1ea1ch c\u1ea7u trong ph\u00e2n c\u00f3 th\u1ec3 g\u1ee3i \u00fd nguy\u00ean nh\u00e2n vi\u00eam); Tri\u1ec7u ch\u1ee9ng x\u1ea3y ra trong b\u1ed1i c\u1ea3nh d\u1ecbch vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t trong c\u1ed9ng \u0111\u1ed3ng.<\/p>\n
\u0110i\u1ec1u tr\u1ecb<\/h2>\nNguy\u00ean t\u1eafc chung<\/h3>\n
M\u1ee5c ti\u00eau c\u1ee7a \u0111i\u1ec1u tr\u1ecb vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t c\u1ea5p bao g\u1ed3m ph\u00f2ng ng\u1eeba m\u1ea5t n\u01b0\u1edbc, x\u1eed tr\u00ed m\u1ea5t n\u01b0\u1edbc, v\u00e0 gi\u1ea3m th\u1eddi gian c\u0169ng nh\u01b0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a tri\u1ec7u ch\u1ee9ng. C\u00f3 nhi\u1ec1u h\u01b0\u1edfng d\u1eabn \u0111i\u1ec1u tr\u1ecb vi\u00eam d\u1ea1 d\u00e0y \u2013 ru\u1ed9t c\u1ea5p, ph\u1ea7n l\u1edbn d\u1ef1a tr\u00ean \u0111\u1ed3ng thu\u1eadn chuy\u00ean gia. C\u00e1c khuy\u1ebfn c\u00e1o c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c h\u01b0\u1edbng d\u1eabn, \u0111\u1eb7c bi\u1ec7t li\u00ean quan \u0111\u1ebfn li\u1ec1u l\u01b0\u1ee3ng dung d\u1ecbch ORS.<\/p>\n
Tuy nhi\u00ean, c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111\u1ec1u th\u1ed1ng nh\u1ea5t r\u1eb1ng tr\u1ebb b\u1ecb m\u1ea5t n\u01b0\u1edbc c\u1ea7n \u0111\u01b0\u1ee3c b\u00f9 d\u1ecbch, l\u01b0\u1ee3ng d\u1ecbch m\u1ea5t ti\u1ebfp t\u1ee5c ph\u1ea3i \u0111\u01b0\u1ee3c thay th\u1ebf, vi\u1ec7c b\u00fa m\u1eb9 c\u1ea7n \u0111\u01b0\u1ee3c duy tr\u00ec trong su\u1ed1t qu\u00e1 tr\u00ecnh b\u00f9 d\u1ecbch, v\u00e0 sau khi b\u00f9 d\u1ecbch ban \u0111\u1ea7u n\u00ean cho tr\u1ebb \u0103n ch\u1ebf \u0111\u1ed9 dinh d\u01b0\u1ee1ng ph\u00f9 h\u1ee3p l\u1ee9a tu\u1ed5i (kh\u00f4ng c\u1ea7n tr\u00e1nh c\u00e1c s\u1ea3n ph\u1ea9m t\u1eeb s\u1eefa). Nh\u1eadp vi\u1ec7n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p m\u1ea5t n\u01b0\u1edbc n\u1eb7ng, c\u00f3 v\u1ea5n \u0111\u1ec1 x\u00e3 h\u1ed9i (v\u00ed d\u1ee5: lo ng\u1ea1i v\u1ec1 kh\u1ea3 n\u0103ng ng\u01b0\u1eddi ch\u0103m s\u00f3c th\u1ef1c hi\u1ec7n \u0111\u00fang li\u1ec7u ph\u00e1p b\u00f9 d\u1ecbch ho\u1eb7c nh\u1eadn bi\u1ebft c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ea7n t\u1ea3i kh\u00e1m), b\u00f9 d\u1ecbch th\u1ea5t b\u1ea1i, ho\u1eb7c nghi ng\u1edd ch\u1ea9n \u0111o\u00e1n kh\u00e1c nghi\u00eam tr\u1ecdng. C\u00e1c h\u01b0\u1edbng d\u1eabn d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng \u0111\u1ec1u th\u1ed1ng nh\u1ea5t r\u1eb1ng thu\u1ed1c ch\u1ed1ng ti\u00eau ch\u1ea3y kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, nh\u01b0ng m\u1ed9t s\u1ed1 h\u01b0\u1edbng d\u1eabn khuy\u1ebfn ngh\u1ecb c\u00f3 th\u1ec3 d\u00f9ng thu\u1ed1c ch\u1ed1ng n\u00f4n ondansetron \u0111\u1ec3 c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng c\u1ee7a b\u00f9 d\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng. B\u1eb1ng ch\u1ee9ng g\u1ea7n \u0111\u00e2y cho th\u1ea5y c\u00e1c c\u00f4ng c\u1ee5 ph\u00e1c \u0111\u1ed3 l\u00e2m s\u00e0ng c\u0169ng gi\u00fap t\u0103ng c\u01b0\u1eddng vi\u1ec7c s\u1eed d\u1ee5ng b\u00f9 d\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng, gi\u1ea3m nhu c\u1ea7u truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch, v\u00e0 r\u00fat ng\u1eafn th\u1eddi gian n\u1eb1m t\u1ea1i khoa c\u1ea5p c\u1ee9u.<\/p>\n
B\u1ea2NG 4<\/strong><\/p>\nH\u01b0\u1edbng d\u1eabn c\u1ee7a WHO v\u1ec1 s\u1eed d\u1ee5ng ORS \u1edf tr\u1ebb em<\/p>\n
\n\n\nC\u00e2n n\u1eb7ng*<\/strong><\/td>\nTu\u1ed5i*<\/strong><\/td>\nL\u01b0\u1ee3ng ORS (mL) c\u1ea7n u\u1ed1ng trong 4 gi\u1edd \u0111\u1ea7u<\/strong><\/td>\n<\/tr>\n\n< 5 kg<\/td>\n < 4 th\u00e1ng<\/td>\n 200 – 400<\/td>\n<\/tr>\n \n5 – 7.9 kg<\/td>\n 4 – 11 th\u00e1ng<\/td>\n 200 – 400<\/td>\n<\/tr>\n \n8 – 10.9 kg<\/td>\n 12 – 23 th\u00e1ng<\/td>\n 600 – 800<\/td>\n<\/tr>\n \n11 – 15.9 kg<\/td>\n 2 – 4 tu\u1ed5i<\/td>\n 800 – 1200<\/td>\n<\/tr>\n \n16 – 29.9 kg<\/td>\n 5 – 14 tu\u1ed5i<\/td>\n 1200 – 2200<\/td>\n<\/tr>\n \n\u2265 30 kg<\/td>\n \u2265 15 tu\u1ed5i<\/td>\n 2200 – 4000<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n- N\u1ebfu b\u1ec7nh nhi mu\u1ed1n u\u1ed1ng nhi\u1ec1u ORS h\u01a1n so v\u1edbi b\u1ea3ng tr\u00ean, c\u00f3 th\u1ec3 cho u\u1ed1ng th\u00eam.<\/li>\n
- Khuy\u1ebfn kh\u00edch m\u1eb9 \u0111ang cho con b\u00fa ti\u1ebfp t\u1ee5c cho b\u00fa m\u1eb9.<\/li>\n
- V\u1edbi tr\u1ebb < 6 th\u00e1ng kh\u00f4ng b\u00fa m\u1eb9: n\u1ebfu d\u00f9ng ORS c\u00f4ng th\u1ee9c c\u0169 c\u1ee7a WHO (90 mEq natri\/L), c\u1ea7n pha th\u00eam 100 – 200 ml. n\u01b0\u1edbc s\u1ea1ch. N\u1ebfu d\u00f9ng ORS c\u00f4ng th\u1ee9c m\u1edbi v\u1edbi \u0111\u1ed9 th\u1ea9m th\u1ea5u gi\u00e1m (75 mEq natri\/L), th\u00ec kh\u00f4ng c\u1ea7n pha th\u00eam.<\/li>\n<\/ul>\n
*Ch\u1ec9 s\u1eed d\u1ee5ng tu\u1ed5i n\u1ebfu kh\u00f4ng bi\u1ebft c\u00e2n n\u1eb7ng.<\/p>\n
L\u01b0\u1ee3ng ORS (m.) c\u0169ng c\u00f3 th\u1ec3 t\u1ec9nh b\u1eb1ng c\u00f4ng th\u1ee9c: C\u00e2n n\u1eb7ng (kg) x 75.<\/p>\n
M\u1ea5t n\u01b0\u1edbc nh\u1eb9 (56%)<\/h3>\n
M\u1ea5t n\u01b0\u1edbc nh\u1eb9 do vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t c\u1ea5p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ea1i nh\u00e0, v\u1edbi li\u1ec7u ph\u00e1p b\u00f9 d\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng l\u00e0 \u0111i\u1ec1u tr\u1ecb ch\u1ee7 y\u1ebfu. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 v\u1ec1 t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n ho\u1eb7c t\u00e1i kh\u00e1m t\u1ea1i khoa c\u1ea5p c\u1ee9u gi\u1eefa nh\u00f3m b\u00f9 \u0111\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng v\u00e0 nh\u00f3m truy\u1ec1n d\u1ecbch t\u1ec9nh m\u1ea1ch, v\u00e0 ch\u1ec9 c\u00f3 1 trong 25 tr\u1ebb \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ORS cu\u1ed1i c\u00f9ng c\u1ea7n ph\u1ea3i truy\u1ec1n d\u1ecbch t\u1ec9nh m\u1ea1ch.<\/p>\n
Th\u00e0nh ph\u1ea7n \u0111i\u1ec7n gi\u1ea3i c\u1ee5 th\u1ec3 c\u1ee7a dung d\u1ecbch ORS kh\u00f4ng qu\u00e1 quan tr\u1ecdng trong tr\u01b0\u1eddng h\u1ee3p m\u1ea5t n\u01b0\u1edbc nh\u1eb9. V\u00ed d\u1ee5, m\u1ed9t nghi\u00ean c\u1ee9u \u1edf tr\u1ebb tr\u00ean s\u00e1u th\u00e1ng tu\u1ed5i cho th\u1ea5y vi\u1ec7c d\u00f9ng n\u01b0\u1edbc t\u00e1o pha lo\u00e3ng (n\u1eeda n\u1ed3ng \u0111\u1ed9) sau \u0111\u00f3 cho u\u1ed1ng c\u00e1c lo\u1ea1i th\u1ee9c u\u1ed1ng \u01b0a th\u00edch (nh\u01b0 n\u01b0\u1edbc tr\u00e1i c\u00e2y th\u00f4ng th\u01b0\u1eddng, s\u1eefa) gi\u00fap gi\u1ea3m nhu c\u1ea7u truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch v\u1ec1 sau so v\u1edbi ORS chu\u1ea9n, ch\u1ee7 y\u1ebfu v\u00ec tr\u1ebb d\u1ec5 d\u00e0ng u\u1ed1ng c\u00e1c lo\u1ea1i th\u1ee9c u\u1ed1ng n\u00e0y h\u01a1n so v\u1edbi ORS. Sau m\u1ed7i l\u1ea7n \u0111i ti\u00eau l\u00f2ng, T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) khuy\u1ec3n ngh\u1ecb cho tr\u1ebb d\u01b0\u1edbi hai tu\u1ed5i u\u1ed1ng 50 \u0111\u1ebfn 100 ml. d\u1ecbch, tr\u1ebb t\u1eeb hai \u0111\u1ebfn 10 tu\u1ed5i u\u1ed1ng 100 \u0111\u1ebfn 200 mL, v\u00e0 tr\u1ebb l\u1edbn h\u01a1n c\u00f3 th\u1ec3 u\u1ed1ng theo nhu c\u1ea7u. Tr\u1ebb em c\u00f3 th\u1ec3 ti\u00eau th\u1ee5 \u0111\u1ebfn 20 ml. d\u1ecbch tr\u00ean m\u1ed7i kg c\u00e2n n\u1eb7ng m\u1ed7i gi\u1edd.<\/p>\n
M\u1ea5t n\u01b0\u1edbc v\u1eeba \u0111\u1ebfn n\u1eb7ng (>6%)<\/h3>\n
\u0110i\u1ec1u tr\u1ecb m\u1ea5t n\u01b0\u1edbc m\u1ee9c \u0111\u1ed9 v\u1ee9a bao g\u1ed3m ORS k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c n\u1ebfu c\u1ea7n thi\u1ebft \u0111\u1ec3 gi\u1ea3m n\u00f3n v\u00e0 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng dung n\u1ea1p ORS. \u1ede tr\u1ebb em b\u1ecb m\u1ea5t n\u01b0\u1edbc v\u1eeba, b\u00f9 d\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi b\u00f9 d\u1ecbch t\u0129nh m\u1ea1ch trong vi\u1ec7c ng\u0103n ng\u1eeba nh\u1eadp vi\u1ec7n v\u00e0 t\u00e1i kh\u00e1m.<\/p>\n
ORS. Trong m\u1ed9t thay \u0111\u1ed5i g\u1ea7n \u0111\u00e2y, T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) hi\u1ec7n khuy\u1ebfn ngh\u1ecb s\u1eed d\u1ee5ng ORS c\u00f3 \u0111\u1ed9 th\u1ea9m th\u1ea5u gi\u1ea3m, v\u1edbi th\u00e0nh ph\u1ea7n g\u1ed3m 75 mEq natri\/L v\u00e0 75 mmol glucose\/L. h\u00f2a tan trong 1 l\u00edt n\u01b0\u1edbc. Tr\u01b0\u1edbc \u0111\u00e2y, c\u00f4ng th\u1ee9c ORS chu\u1ea9n c\u1ee7a WHO ch\u1ee9a 90 mEq natri\/L. N\u1ebfu s\u1eed d\u1ee5ng c\u00f4ng th\u1ee9c c\u0169 n\u00e0y cho tr\u1ebb d\u01b0\u1edbi s\u00e1u th\u00e1ng tu\u1ed5i, c\u1ea7n pha th\u00eam 100 – 200 mL n\u01b0\u1edbc s\u1ea1ch. Ngo\u00e0i ra, c\u00f3 th\u1ec3 s\u1eedd\u1ee5ng dung d\u1ecbch t\u1ef1 pha g\u1ed3m \u00bd th\u00eca c\u00e0 ph\u00ea mu\u1ed1i v\u00e0 6 th\u00eca c\u00e0 ph\u00ea \u0111\u01b0\u1eddng trong 1 l\u00edt n\u01b0\u1edbc. B\u1ea3ng 4 tr\u00ecnh b\u00e0y h\u01b0\u1edbng d\u1eabn c\u1ee7a WHO v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng ORS \u1edf tr\u1ebb em.<\/p>\n
Ng\u01b0\u1eddi ch\u0103m s\u00f3c n\u00ean \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn c\u00e1ch cho tr\u1ebb u\u1ed1ng ORS b\u1eb1ng xi lanh \u0111\u1ed1i v\u1edbi tr\u1ebb s\u01a1 sinh, v\u00e0 b\u1eb1ng th\u00eca ho\u1eb7c c\u1ed1c \u0111\u1ed1i v\u1edbi tr\u1ebb nh\u0169 nh\u1ec9 l\u1edbn h\u01a1n v\u00e0 tr\u1ebb nh\u1ecf. Tr\u1ebb d\u01b0\u1edbi hai tu\u1ed5i n\u00ean \u0111\u01b0\u1ee3c cho u\u1ed1ng 1 th\u00eca c\u00e0 ph\u00ea m\u1ed7i 1-2 ph\u00fat, tr\u1ebb l\u1edbn h\u01a1n n\u00ean \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch u\u1ed1ng t\u1eebng ng\u1ee5m nh\u1ecf th\u01b0\u1eddng xuy\u00ean tr\u1ef1c ti\u1ebfp t\u1eeb c\u1ed1c. N\u1ebfu x\u1ea3y ra n\u00f4n \u00f3i, khuy\u1ebfn c\u00e1o l\u00e0 ng\u1eebng 5-10 ph\u00fat, sau \u0111\u00f3 ti\u1ebfp t\u1ee5c cho u\u1ed1ng ORS ch\u1eadm h\u01a1n, m\u1ed7i 2-3 ph\u00fat m\u1ed9t l\u1ea7n.<\/p>\n
Thu\u1ed1c ch\u1ed1ng n\u00f4n.<\/em> Ondansetron th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng khi c\u1ea7n thi\u1ebft \u0111\u1ec3 ng\u0103n ng\u1eeba n\u00f4n trong l\u00fac tr\u1ebb u\u1ed1ng ORS. Trong m\u1ed9t b\u00e0i t\u1ed5ng quan Cochrane, tr\u1ebb \u0111\u01b0\u1ee3c d\u00f9ng thu\u1ed1c ch\u1ed1ng n\u00f4n \u00edt c\u00f3 kh\u1ea3 n\u0103ng ph\u1ea3i truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch h\u01a1n (RR – 0,40; KTC 95%, 0,26-0,60). M\u1ed9t b\u00e0i t\u1ed5ng quan h\u1ec7 th\u1ed1ng kh\u00e1c cho th\u1ea5y ondansetron gi\u00fap gi\u1ea3m s\u1ed1 ca nh\u1eadp vi\u1ec7n (NNT – 14; KTC 95%, 9-44), gi\u1ea3m nhu c\u1ea7u truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch (NNT – 5; KTC 95%, 4 \u2013 8), v\u00e0 gi\u1ea3m n\u00f3n t\u00e1i di\u1ec5n (NNT-5; KTC 95%, 4 – 7), nh\u01b0ng l\u1ea1i l\u00e0m t\u0103ng nguy c\u01a1 ti\u00eau ch\u00e1y.<\/p>\nLi\u1ec1u th\u00f4ng th\u01b0\u1eddng c\u1ee7a ondansetron l\u00e0 2 mg cho tr\u1ebb n\u1eb7ng 8 – 15 kg. 4 mg cho tr\u1ebb n\u1eb7ng 15 – 30 kg v\u00e0 8 mg cho tr\u1ebb n\u1eb7ng > 30 kg. Li\u1ec1u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1eadp l\u1ea1i n\u1ebfu tr\u1ebb n\u00f4n trong v\u00f2ng 15 ph\u00fat sau khi u\u1ed1ng thu\u1ed1c. Ondansetron kh\u00f4ng n\u00ean d\u00f9ng cho b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng QT d\u00e0i b\u1ea9m sinh. Ngo\u00e0i ra, lu\u00f4n ki\u1ec3m tra \u0111i\u1ec7n gi\u1ea3i tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c v\u00ec h\u1ea1 magnesi m\u00e1u v\u00e0 h\u1ea1 kali m\u00e1u l\u00e0m t\u0103ng nguy c\u01a1 k\u00e9o d\u00e0i kho\u1ea3ng QT. C\u00e1c thu\u1ed1c ch\u1ed1ng n\u00f4n th\u1ec3 h\u1ec7 c\u0169 nh\u01b0 promethazine v\u00e0 metoclopramide c\u00f3 t\u1ef7 l\u1ec7 t\u00e1c d\u1ee5ng ph\u1ee5 cao h\u01a1n v\u00e0 nh\u00ecn chung kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng.<\/p>\n
B\u00f9 d\u1ecbch t\u0129nh m\u1ea1ch.<\/em> Nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi li\u1ec7u ph\u00e1p b\u00f9 \u0111\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng k\u1ebft h\u1ee3p thu\u1ed1c ch\u1ed1ng n\u00f4n, c\u0169ng nh\u01b0 nh\u1eefng b\u1ec7nh nh\u00e2n m\u1ea5t n\u01b0\u1edbc n\u1eb7ng (v\u00ed d\u1ee5: c\u00f3 d\u1ea5u hi\u1ec7u s\u1ed1c ho\u1eb7c m\u1ea5t n\u01b0\u1edbc > 10%) c\u1ea7n \u0111\u01b0\u1ee3c nh\u1eadp vi\u1ec7n v\u00e0 b\u00f9 \u0111\u1ecbch t\u1ec9nh m\u1ea1ch. B\u1ea3ng 5 tr\u00ecnh b\u00e0y h\u01b0\u1edbng d\u1eabn c\u1ee7a WHO v\u1ec1 b\u00f9 d\u1ecbch t\u0129nh m\u1ea1ch trong m\u1ea5t n\u01b0\u1edbc n\u1eb7ng. \u0110\u1ed1i v\u1edbi tr\u1ebb v\u1eabn c\u00f3 kh\u1ea3 n\u0103ng u\u1ed1ng, n\u00ean cho u\u1ed1ng ORS b\u1eb1ng xi lanh, th\u00eca ho\u1eb7c c\u1ed1c cho \u0111\u1ebfn khi thi\u1ebft l\u1eadp \u0111\u01b0\u1ee3c \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch. Trong c\u00e1c c\u01a1 s\u1edf h\u1ea1n ch\u1ebf ngu\u1ed3n l\u1ef1c, c\u00f3 th\u1ec3 xem x\u00e9t b\u00f9 \u0111\u1ecbch qua sonde d\u1ea1 d\u00e0y n\u1ebfu kh\u00f4ng th\u1ec3 \u0111\u1eb7t \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch.<\/p>\nLactobacillus<\/em> \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n \u0111\u01b0\u1ee3c b\u00f9 \u0111\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng, nh\u01b0ng l\u1ee3i \u00edch c\u1ee7a n\u00f3 v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p cho th\u1ea5y Lactobacillus ch\u1ec9 l\u00e0m gi\u1ea3m r\u1ea5t \u00edt th\u1eddi gian b\u1ec7nh v\u00e0 s\u1ed1 l\u1ea7n \u0111i ti\u00eau. T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) khuy\u1ebfn ngh\u1ecb b\u1ed5 sung k\u1ebdm trong \u0111\u1ee3t ti\u00eau ch\u1ea3y c\u1ea5p, d\u1ef1a tr\u00ean c\u00e1c nghi\u00ean c\u1ee9u ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf nh\u1eefng qu\u1ed1c gia m\u00e0 tr\u1ebb em c\u00f3 nguy c\u01a1 thi\u1ebfu k\u00eam. Tuy nhi\u00ean, m\u1ed9t b\u00e0i t\u1ed5ng quan Cochrane nh\u1eadn th\u1ea5y ch\u01b0a c\u00f3 \u0111\u1ee7 d\u1eef li\u1ec7u \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh li\u1ec7u vi\u1ec7c b\u1ed5 sung k\u1ebdm c\u00f3 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 l\u00e2m s\u1ea3ng hay kh\u00f4ng.<\/p>\nB\u1ea2NG 5<\/strong><\/p>\nH\u01b0\u1edbng d\u1eabn c\u1ee7a WHO v\u1ec1 b\u00f9 d\u1ecbch t\u0129nh m\u1ea1ch (IV) cho tr\u1ebb em<\/p>\n
\n\n\nB\u1eaft \u0111\u1ea7u truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch ngay, n\u1ebfu b\u1ec7nh nhi c\u00f2n u\u1ed1ng \u0111\u01b0\u1ee3c, cho u\u1ed1ng ORS cho \u0111\u1ebfn khi thi\u1ebft l\u1eadp \u0111\u01b0\u1ee3c \u0111\u01b0\u1eddng truy\u1ec1n. Truy\u1ec1n 100 mL\/kg dung d\u1ecbch Ringer*, chia nh\u01b0 sau:<\/p>\n\n- Tr\u1ebb nh\u0169 nhi (< 12 th\u00e1ng tu\u1ed5i): Truy\u1ec1n 30 mL\/kg trong 1 gi\u1edd\u2020 Sau \u0111\u00f3 truy\u1ec1n 70 mL\/kg trong 5 gi\u1edd<\/li>\n
- Tr\u1ebb l\u1edbn h\u01a1n: Truy\u1ec1n 30 mL\/kg trong 30 ph\u00fat. Sau \u0111\u00f3 truy\u1ec1n 70 mL\/kg trong 2,5 gi\u1edd \u0110\u00e1nh gi\u00e1 l\u1ea1i b\u1ec7nh nhi m\u1ed7i 1 \u2013 2 gi\u1edd, n\u1ebfu t\u00ecnh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc kh\u00f4ng c\u1ea3i thi\u1ec7n, t\u0103ng t\u1ed1c \u0111\u1ed9 truy\u1ec1n d\u1ecbch. Sau 6 gi\u1edd (tr\u1ebb nh\u0169 nhi) ho\u1eb7c 3 gi\u1edd (tr\u1ebb l\u1edbn h\u01a1n), \u0111\u00e1nh gi\u00e1 l\u1ea1i b\u1ec7nh nhi \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh b\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb ti\u1ebfp theo.<\/li>\n<\/ul>\n
*- N\u1ebfu kh\u00f4ng c\u00f3 dung d\u1ecbch Ringer, c\u00f3 th\u1ec3 d\u00f9ng NaCl 0,9%.<\/p>\n
\u2020- C\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i m\u1ed9t l\u1ea7n n\u1ebfu m\u1ea1ch quay c\u00f2n r\u1ea5t y\u1ebfu ho\u1eb7c kh\u00f4ng b\u1eaft \u0111\u01b0\u1ee3c.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ph\u00f2ng ng\u1eeba<\/h2>\nR\u1eeda tay<\/h3>\n
R\u1eeda tay \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 bi\u1ec7n ph\u00e1p ch\u00ednh \u0111\u1ec3 ph\u00f2ng ng\u1eeba vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p t\u1eeb 30 nghi\u00ean c\u1ee9u cho th\u1ea5y c\u00e1c chi\u1ebfn d\u1ecbch r\u1eeda tay gi\u00fap gi\u1ea3m 30% t\u1ef7 l\u1ec7 m\u1eafc c\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. M\u1ed9t b\u00e0i t\u1ed5ng quan Cochrane c\u0169ng ghi nh\u1eadn k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1. Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y x\u00e0 ph\u00f2ng di\u1ec7t khu\u1ea9n hi\u1ec7u qu\u1ea3 h\u01a1n x\u00e0 ph\u00f2ng th\u01b0\u1eddng. Vi\u1ec7c s\u1eed d\u1ee5ng dung d\u1ecbch s\u00e1t khu\u1ea9n tay c\u00f3 c\u1ed3n k\u1ebft h\u1ee3p v\u1edbi v\u1ec7 sinh tay chu\u1ea9n c\u00f3 th\u1ec3 gi\u1ea3m t\u1ef7 l\u1ec7 vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t t\u1ea1i v\u0103n ph\u00f2ng, nh\u00e0 tr\u1ebb v\u00e0 gi\u1ea3m 30% t\u00ecnh tr\u1ea1ng ngh\u1ec9 h\u1ecdc. Tuy nhi\u00ean, ch\u1ec9 ri\u00eang vi\u1ec7c r\u1eeda tay v\u00e0 v\u1ec7 sinh kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 ng\u0103n ng\u1eeba nhi\u1ec5m rotavirus.<\/p>\n![\"R\u1eeda](\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/08\/viem-da-day-ruot-2.jpg\" "\\"\\"")
R\u1eeda tay \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 bi\u1ec7n ph\u00e1p ch\u00ednh \u0111\u1ec3 ph\u00f2ng ng\u1eeba vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t.<\/figcaption><\/figure>\nVaccine<\/h3>\n
Tr\u01b0\u1edbc khi c\u00f3 vaccine ph\u00f2ng rotavirus, g\u1ea7n nh\u01b0 t\u1ea5t c\u1ea3 tr\u1ebb em tr\u00ean to\u00e0n th\u1ebf gi\u1edbi \u0111\u1ec1u nhi\u1ec5m rotavirus tr\u01b0\u1edbc 3 \u0111\u1ebfn 5 tu\u1ed5i. Tuy nhi\u00ean, t\u1ef7 l\u1ec7 nhi\u1ec5m rotavirus \u0111\u00e3 gi\u1ea3m \u0111\u00e1ng k\u1ec3 nh\u1edd vi\u1ec7c s\u1eed d\u1ee5ng vaccine. C\u00e1c nghi\u00ean c\u1ee9u t\u1ea1i Mexico v\u00e0 Brazil cho th\u1ea5y vaccine gi\u00fap ng\u0103n ng\u1eeba 80.000 ca nh\u1eadp vi\u1ec7n v\u00e0 1.300 ca t\u1eed vong do ti\u00eau ch\u00e1y m\u1ed7i n\u0103m.<\/p>\n
C\u00e1c lo\u1ea1i vaccine rotavirus tr\u01b0\u1edbc \u0111\u00e2y c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 l\u1ed3ng ru\u1ed9t (kho\u1ea3ng 1\/10.000 tr\u1ebb s\u01a1 sinh). Tuy nhi\u00ean, c\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y v\u1edbi c\u00e1c lo\u1ea1i vaccine m\u1edbi h\u01a1n, nguy c\u01a1 n\u00e0y ch\u1ec9 t\u0103ng nh\u1eb9, v\u00e0o kho\u1ea3ng 1\/51.000 \u0111\u1ebfn 1\/68.000 tr\u1ebb s\u01a1 sinh.<\/p>\n
T\u1ea5t c\u1ea3 tr\u1ebb n\u00ean \u0111\u01b0\u1ee3c u\u1ed1ng vaccine rotavirus, c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u t\u1eeb 6 \u0111\u1ebfn 15 tu\u1ea7n tu\u1ed5i, nh\u1eb1m gi\u1ea3m nguy c\u01a1 vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t n\u1eb7ng, nh\u1eadp vi\u1ec7n v\u00e0 t\u1eed vong do nhi\u1ec5m rotavirus. Hai lo\u1ea1i vaccine rotavirus \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn s\u1eed d\u1ee5ng t\u1ea1i Hoa K\u1ef3 l\u00e0 Rotateq (khuy\u1ebfn c\u00e1o u\u1ed1ng l\u00fac 2, 4 v\u00e0 6 th\u00e1ng tu\u1ed5i) v\u00e0 Rotarix (khuy\u1ebfn c\u00e1o u\u1ed1ng l\u00fac 2 v\u00e0 4 th\u00e1ng tu\u1ed5i). Kho\u1ea3ng c\u00e1ch t\u1ed1i thi\u1ec3u gi\u1eefa c\u00e1c li\u1ec1u l\u00e0 4 tu\u1ea7n, v\u00e0 t\u1ea5t c\u1ea3 c\u00e1c li\u1ec1u n\u00ean \u0111\u01b0\u1ee3c u\u1ed1ng tr\u01b0\u1edbc 8 th\u00e1ng tu\u1ed5i. Tr\u1ebb sinh non c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c u\u1ed1ng vaccine theo l\u1ecbch th\u00f4ng th\u01b0\u1eddng.<\/p>\n
Hi\u1ec7n nay, vaccine ph\u00f2ng norovirus \u0111ang trong qu\u00e1 tr\u00ecnh th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng. C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 cho th\u1ea5y vaccine n\u00e0y t\u1ea1o ra \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch m\u1ea1nh m\u1ebd v\u00e0 c\u00f3 t\u00ednh dung n\u1ea1p t\u1ed1t \u1edf c\u1ea3 ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em.<\/p>\n
C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ph\u00f2ng ng\u1eeba kh\u00e1c<\/h3>\n
Vi\u1ec7c nu\u00f4i con ho\u00e0n to\u00e0n b\u1eb1ng s\u1eefa m\u1eb9 trong 4 th\u00e1ng \u0111\u1ea7u, v\u00e0 nu\u00f4i con b\u1eb1ng s\u1eefa m\u1eb9 m\u1ed9t ph\u1ea7n sau \u0111\u00f3, c\u00f3 li\u00ean quan \u0111\u1ebfn gi\u1ea3m t\u1ef7 l\u1ec7 m\u1eafc vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t c\u1ea5p trong n\u0103m \u0111\u1ea7u \u0111\u1eddi, c\u0169ng nh\u01b0 t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n do b\u1ec7nh ti\u00eau ch\u1ea3y. M\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 \u01b0\u1edbc t\u00ednh r\u1eb1ng 53% c\u00e1c ca nh\u1eadp vi\u1ec7n do ti\u00eau ch\u1ea3y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ng\u0103n ng\u1eeba m\u1ed7i th\u00e1ng nh\u1edd nu\u00f4i con ho\u00e0n to\u00e0n b\u1eb1ng s\u1eefa m\u1eb9, v\u00e0 hi\u1ec7u qu\u1ea3 b\u1ea3o v\u1ec7 n\u00e0y v\u1eabn \u0111\u01b0\u1ee3c duy tr\u00ec ngay c\u1ea3 sau khi ng\u1eebng cho b\u00fa.<\/p>\n
R\u1ea5t nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 t\u1eadp trung v\u00e0o c\u00e1c \u0111\u1eb7c t\u00ednh mi\u1ec5n d\u1ecbch c\u1ee7a s\u1eefa m\u1eb9. C\u00e1c kh\u00e1ng th\u1ec3 trong s\u1eeda m\u1eb9 ch\u1ec9 \u0111\u00f3ng g\u00f3p m\u1ed9t ph\u1ea7n nh\u1ecf v\u00e0o kh\u1ea3 n\u0103ng b\u1ea3o v\u1ec7 mi\u1ec5n d\u1ecbch c\u1ee7a tr\u1ebb, trong khi h\u1ec7 vi sinh \u0111\u01b0\u1eddng ru\u1ed9t, prebiotics, probiotics, mi\u1ec5n d\u1ecbch ni\u00eam m\u1ea1c, nucleotide v\u00e0 oligosaccharide l\u1ea1i c\u00f3 vai tr\u00f2 l\u1edbn h\u01a1n. Y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng bi\u1ec3u b\u00ec trong s\u1eefa m\u1eb9 gi\u00fap k\u00edch th\u00edch s\u1ef1 tr\u01b0\u1edfng th\u00e0nh c\u1ee7a bi\u1ec3u m\u00f4 ru\u1ed9t; IgA v\u00e0 oligosaccharide c\u00f3 t\u00e1c d\u1ee5ng ng\u0103n ch\u1eb7n s\u1ef1 b\u00e1m d\u00ednh c\u1ee7a m\u1ea7m b\u1ec7nh; v\u00e0 lactoferrin trong s\u1eefa m\u1eb9 c\u00f3 \u0111\u1eb7c t\u00ednh kh\u00e1ng khu\u1ea9n.<\/p>\n
M\u1ed9t s\u1ed1 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y r\u1eb1ng vi\u1ec7c b\u1ed5 sung probiotic h\u00e0ng ng\u00e0y cho tr\u1ebb em \u0111i nh\u00e0 tr\u1ebb gi\u00fap gi\u1ea3m t\u1ef7 l\u1ec7 m\u1eafc ti\u00eau ch\u00e1y nhi\u1ec5m tr\u00f9ng c\u1ea5p m\u00e0 kh\u00f4ng g\u00e2y ra t\u00e1c d\u1ee5ng ph\u1ee5. V\u00ed d\u1ee5, m\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y tr\u1ebb em t\u1ea1i c\u00e1c nh\u00e0 tr\u1ebb \u0111\u01b0\u1ee3c b\u1ed5 sung Lactobacillus reuteri gi\u00fap gi\u1ea3m chi ph\u00ed y t\u1ebf v\u00e0 gi\u1ea3m s\u1ed1 \u0111\u1ee3t ti\u00eau ch\u1ea3y. Tuy nhi\u00ean, b\u1eb1ng ch\u1ee9ng v\u1eabn c\u00f2n kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t trong h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 vi\u1ec7c b\u1ed5 sung probiotic v\u00e0o c\u00e1c b\u1eefa \u0103n c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb s\u1eeda t\u1ea1i nh\u00e0 tr\u1ebb.
\nC\u1ea7n c\u00f3 th\u00eam nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u00fang lo\u1ea1i v\u00e0 li\u1ec1u l\u01b0\u1ee3ng probiotic n\u00e0o l\u00e0 h\u1eefu \u00edch nh\u1ea5t. C\u00e1c b\u00e1c s\u0129 gia \u0111\u00ecnh c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc trao \u0111\u1ed5i v\u1edbi cha m\u1eb9 v\u1ec1 l\u1ee3i \u00edch ti\u1ec1m n\u0103ng c\u1ee7a probiotic trong ph\u00f2ng ng\u1eeba vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t nhi\u1ec5m tr\u00f9ng \u1edf tr\u1ebb em.<\/p>\n","protected":false},"excerpt":{"rendered":"
L\u01b0\u1ee3t d\u1ecbch: NT HN Vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t c\u1ea5p \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 m\u1ed9t b\u1ec7nh ti\u00eau ch\u1ea3y kh\u1edfi ph\u00e1t nhanh, c\u00f3 th\u1ec3 c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo bu\u1ed3n n\u00f4n, n\u00f4n, s\u1ed1t ho\u1eb7c \u0111au b\u1ee5ng. T\u1ea1i Hoa K\u1ef3, vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t c\u1ea5p g\u00e2y ra kho\u1ea3ng 1,5 tri\u1ec7u ca kh\u00e1m ngo\u1ea1i tr\u00fa, 200.000 ca nh\u1eadp vi\u1ec7n […]\n","protected":false},"author":1,"featured_media":134973,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-134972","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134972","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=134972"}],"version-history":[{"count":1,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134972\/revisions"}],"predecessor-version":[{"id":134976,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134972\/revisions\/134976"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/134973"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=134972"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=134972"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=134972"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
C\u00e1c \u0111i\u1ec3m m\u1edbi trong ch\u1ee7 \u0111\u1ec1 n\u00e0y<\/h3>\n
Vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t \u1edf tr\u1ebb em<\/strong><\/p>\n B\u1ea2NG 1<\/strong><\/p>\n C\u00e1c d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o \u1edf tr\u1ebb em b\u1ecb vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t c\u1ea5p<\/p>\n B\u1ea2NG 2<\/strong><\/p>\n Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t ti\u00eau ch\u00e1y ho\u1eb7c n\u00f4n \u1edf tr\u1ebb em<\/p>\n C\u00e1c d\u1ea5u hi\u1ec7u \u0111\u1ee1 lo ng\u1ea1i bao g\u1ed3m: \u0103n u\u1ed1ng b\u00ecnh th\u01b0\u1eddng, l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u b\u00ecnh th\u01b0\u1eddng, v\u00e0 kh\u00f4ng n\u00f4n \u00f3i. N\u1ebfu c\u00f3 c\u1ea3 ba \u0111i\u1ec1u n\u00e0y, th\u00ec kh\u1ea3 n\u0103ng m\u1ea5t n\u01b0\u1edbc c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng l\u00e0 r\u1ea5t th\u1ea5p.<\/p>\n Tuy nhi\u00ean, kh\u00e1m l\u00e2m s\u00e0ng v\u1eabn l\u00e0 c\u00e1ch t\u1ed1t nh\u1ea5t \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc. Thang \u0111i\u1ec3m m\u1eaft n\u01b0\u1edbc l\u00e2m s\u00e0ng (Clinical Dehydration Scale – B\u00e1ng 3) \u0111\u00e1nh gi\u00e1 4 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng \u0111\u1ec3 \u01b0\u1edbc l\u01b0\u1ee3ng m\u1ee9c \u0111\u1ed9 m\u1ea5t n\u01b0\u1edbc, \u0111\u1eb7c bi\u1ec7t h\u1eefu \u00edch trong vi\u1ec7c ph\u00e1t hi\u1ec7n m\u1ea5t n\u01b0\u1edbc m\u1ee9c \u0111\u1ed9 v\u1eeba \u0111\u1ebfn n\u1eb7ng. Thang \u0111i\u1ec3m n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ki\u1ec3m ch\u1ee9ng trong nhi\u1ec1u b\u1ed1i c\u1ea3nh kh\u00e1c nhau, c\u1ea3 \u1edf nh\u1eefng n\u01a1i c\u00f3 \u0111i\u1ec1u ki\u1ec7n y t\u1ebf \u0111\u1ea7y \u0111\u1ee7 l\u1eabn h\u1ea1n ch\u1ebf, v\u00e0 cho k\u1ebft qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi ph\u01b0\u01a1ng ph\u00e1p so s\u00e1nh c\u00e2n n\u1eb7ng tr\u01b0\u1edbc v\u00e0 sau khi b\u00f9 n\u01b0\u1edbc.<\/p>\n B\u1ea2NG 3<\/strong><\/p>\n Thang \u0111i\u1ec3m m\u1ea5t n\u01b0\u1edbc l\u00e2m s\u00e0ng (Clinical Dehydration Scale)<\/p>\n Ch\u1ec9 s\u1ed1 x\u00e9t nghi\u1ec7m duy nh\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh kh\u1ea3 n\u0103ng m\u1ea5t n\u01b0\u1edbc \u2264 5% l\u00e0 n\u1ed3ng \u0111\u1ed9 bicarbonat huy\u1ebft thanh > 15 mEq\/L (15 mmol\/L). Tuy nhi\u00ean, \u0111i\u1ec7n gi\u1ea3i, creatinin v\u00e0 \u0111\u01b0\u1eddng huy\u1ebft c\u0169ng n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh n\u1ebfu nhi\u1ec1u kh\u1ea3 n\u0103ng c\u1ea7n b\u00f9 d\u1ecbch t\u0129nh m\u1ea1ch. Natri huy\u1ebft thanh gi\u00fap x\u00e1c nh\u1eadn t\u1ec9nh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc t\u0103ng natri m\u00e1u, c\u1ea7n nghi ng\u1edd khi b\u1ec7nh nhi c\u00f3 bi\u1ec3u hi\u1ec7n: t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1, t\u0103ng ph\u1ea3n x\u1ea1, co gi\u1eadt, l\u01a1 m\u01a1 ho\u1eb7c h\u00f4n m\u00ea.<\/p>\n \u1ede tr\u1ebb em b\u1ecb b\u1ec7nh nh\u1eb9, x\u00e9t nghi\u1ec7m ph\u00e2n th\u01b0\u1eddng kh\u00f4ng c\u1ea7n thi\u1ebft khi ch\u1ea9n \u0111o\u00e1n nhi\u1ec1u kh\u1ea3 n\u0103ng l\u00e0 vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t do virus. Tuy nhi\u00ean, x\u00e9t nghi\u1ec7m ph\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n nghi nhi\u1ec5m tr\u00f9ng huy\u1ebft, c\u00f3 m\u00e1u ho\u1eb7c nh\u1ea7y trong ph\u00e2n, ho\u1eb7c suy gi\u1ea3m mi\u1ec5n d\u1ecbch. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, c\u00e2y ph\u00e2n l\u00e0 x\u00e9t nghi\u1ec7m chu\u1ea9n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh trong vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t do vi khu\u1ea9n (c\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1ng nguy\u00ean v\u00e0\/ho\u1eb7c khu\u1ebfch \u0111\u1ea1i acid nucleic \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n Clostridium difficile v\u00e0 Campylobacter). Hi\u1ec7n nay, x\u00e9t nghi\u1ec7m PCR ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n virus g\u00e2y vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t \u1edf tr\u1ebb em nh\u1eadp vi\u1ec7n, v\u00ec vi\u1ec7c x\u00e1c \u0111\u1ecbnh c\u0103n nguy\u00ean virus gi\u00fap tr\u00e1nh l\u1ea1m d\u1ee5ng kh\u00e1ng sinh kh\u00f4ng c\u1ea7n thi\u1ebft.<\/p>\n Ch\u1ec9 \u0111\u1ecbnh b\u1ed5 sung cho x\u00e9t nghi\u1ec7m ph\u00e2n g\u1ed3m c\u00f3: Vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t sau khi \u0111i du l\u1ecbch n\u01b0\u1edbc ngo\u00e0i (x\u00e9t nghi\u1ec7m t\u1ec9m tr\u1ee9ng v\u00e0 k\u00fd sinh tr\u00f9ng); Ti\u00eau ch\u00e1y kh\u00f4ng c\u1ea3i thi\u1ec7n sau 7 ng\u00e0y (b\u1ea1ch c\u1ea7u trong ph\u00e2n c\u00f3 th\u1ec3 g\u1ee3i \u00fd nguy\u00ean nh\u00e2n vi\u00eam); Tri\u1ec7u ch\u1ee9ng x\u1ea3y ra trong b\u1ed1i c\u1ea3nh d\u1ecbch vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t trong c\u1ed9ng \u0111\u1ed3ng.<\/p>\n M\u1ee5c ti\u00eau c\u1ee7a \u0111i\u1ec1u tr\u1ecb vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t c\u1ea5p bao g\u1ed3m ph\u00f2ng ng\u1eeba m\u1ea5t n\u01b0\u1edbc, x\u1eed tr\u00ed m\u1ea5t n\u01b0\u1edbc, v\u00e0 gi\u1ea3m th\u1eddi gian c\u0169ng nh\u01b0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a tri\u1ec7u ch\u1ee9ng. C\u00f3 nhi\u1ec1u h\u01b0\u1edfng d\u1eabn \u0111i\u1ec1u tr\u1ecb vi\u00eam d\u1ea1 d\u00e0y \u2013 ru\u1ed9t c\u1ea5p, ph\u1ea7n l\u1edbn d\u1ef1a tr\u00ean \u0111\u1ed3ng thu\u1eadn chuy\u00ean gia. C\u00e1c khuy\u1ebfn c\u00e1o c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c h\u01b0\u1edbng d\u1eabn, \u0111\u1eb7c bi\u1ec7t li\u00ean quan \u0111\u1ebfn li\u1ec1u l\u01b0\u1ee3ng dung d\u1ecbch ORS.<\/p>\n Tuy nhi\u00ean, c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111\u1ec1u th\u1ed1ng nh\u1ea5t r\u1eb1ng tr\u1ebb b\u1ecb m\u1ea5t n\u01b0\u1edbc c\u1ea7n \u0111\u01b0\u1ee3c b\u00f9 d\u1ecbch, l\u01b0\u1ee3ng d\u1ecbch m\u1ea5t ti\u1ebfp t\u1ee5c ph\u1ea3i \u0111\u01b0\u1ee3c thay th\u1ebf, vi\u1ec7c b\u00fa m\u1eb9 c\u1ea7n \u0111\u01b0\u1ee3c duy tr\u00ec trong su\u1ed1t qu\u00e1 tr\u00ecnh b\u00f9 d\u1ecbch, v\u00e0 sau khi b\u00f9 d\u1ecbch ban \u0111\u1ea7u n\u00ean cho tr\u1ebb \u0103n ch\u1ebf \u0111\u1ed9 dinh d\u01b0\u1ee1ng ph\u00f9 h\u1ee3p l\u1ee9a tu\u1ed5i (kh\u00f4ng c\u1ea7n tr\u00e1nh c\u00e1c s\u1ea3n ph\u1ea9m t\u1eeb s\u1eefa). Nh\u1eadp vi\u1ec7n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p m\u1ea5t n\u01b0\u1edbc n\u1eb7ng, c\u00f3 v\u1ea5n \u0111\u1ec1 x\u00e3 h\u1ed9i (v\u00ed d\u1ee5: lo ng\u1ea1i v\u1ec1 kh\u1ea3 n\u0103ng ng\u01b0\u1eddi ch\u0103m s\u00f3c th\u1ef1c hi\u1ec7n \u0111\u00fang li\u1ec7u ph\u00e1p b\u00f9 d\u1ecbch ho\u1eb7c nh\u1eadn bi\u1ebft c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ea7n t\u1ea3i kh\u00e1m), b\u00f9 d\u1ecbch th\u1ea5t b\u1ea1i, ho\u1eb7c nghi ng\u1edd ch\u1ea9n \u0111o\u00e1n kh\u00e1c nghi\u00eam tr\u1ecdng. C\u00e1c h\u01b0\u1edbng d\u1eabn d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng \u0111\u1ec1u th\u1ed1ng nh\u1ea5t r\u1eb1ng thu\u1ed1c ch\u1ed1ng ti\u00eau ch\u1ea3y kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, nh\u01b0ng m\u1ed9t s\u1ed1 h\u01b0\u1edbng d\u1eabn khuy\u1ebfn ngh\u1ecb c\u00f3 th\u1ec3 d\u00f9ng thu\u1ed1c ch\u1ed1ng n\u00f4n ondansetron \u0111\u1ec3 c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng c\u1ee7a b\u00f9 d\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng. B\u1eb1ng ch\u1ee9ng g\u1ea7n \u0111\u00e2y cho th\u1ea5y c\u00e1c c\u00f4ng c\u1ee5 ph\u00e1c \u0111\u1ed3 l\u00e2m s\u00e0ng c\u0169ng gi\u00fap t\u0103ng c\u01b0\u1eddng vi\u1ec7c s\u1eed d\u1ee5ng b\u00f9 d\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng, gi\u1ea3m nhu c\u1ea7u truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch, v\u00e0 r\u00fat ng\u1eafn th\u1eddi gian n\u1eb1m t\u1ea1i khoa c\u1ea5p c\u1ee9u.<\/p>\n B\u1ea2NG 4<\/strong><\/p>\n H\u01b0\u1edbng d\u1eabn c\u1ee7a WHO v\u1ec1 s\u1eed d\u1ee5ng ORS \u1edf tr\u1ebb em<\/p>\n *Ch\u1ec9 s\u1eed d\u1ee5ng tu\u1ed5i n\u1ebfu kh\u00f4ng bi\u1ebft c\u00e2n n\u1eb7ng.<\/p>\n L\u01b0\u1ee3ng ORS (m.) c\u0169ng c\u00f3 th\u1ec3 t\u1ec9nh b\u1eb1ng c\u00f4ng th\u1ee9c: C\u00e2n n\u1eb7ng (kg) x 75.<\/p>\n M\u1ea5t n\u01b0\u1edbc nh\u1eb9 do vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t c\u1ea5p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ea1i nh\u00e0, v\u1edbi li\u1ec7u ph\u00e1p b\u00f9 d\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng l\u00e0 \u0111i\u1ec1u tr\u1ecb ch\u1ee7 y\u1ebfu. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 v\u1ec1 t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n ho\u1eb7c t\u00e1i kh\u00e1m t\u1ea1i khoa c\u1ea5p c\u1ee9u gi\u1eefa nh\u00f3m b\u00f9 \u0111\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng v\u00e0 nh\u00f3m truy\u1ec1n d\u1ecbch t\u1ec9nh m\u1ea1ch, v\u00e0 ch\u1ec9 c\u00f3 1 trong 25 tr\u1ebb \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ORS cu\u1ed1i c\u00f9ng c\u1ea7n ph\u1ea3i truy\u1ec1n d\u1ecbch t\u1ec9nh m\u1ea1ch.<\/p>\n Th\u00e0nh ph\u1ea7n \u0111i\u1ec7n gi\u1ea3i c\u1ee5 th\u1ec3 c\u1ee7a dung d\u1ecbch ORS kh\u00f4ng qu\u00e1 quan tr\u1ecdng trong tr\u01b0\u1eddng h\u1ee3p m\u1ea5t n\u01b0\u1edbc nh\u1eb9. V\u00ed d\u1ee5, m\u1ed9t nghi\u00ean c\u1ee9u \u1edf tr\u1ebb tr\u00ean s\u00e1u th\u00e1ng tu\u1ed5i cho th\u1ea5y vi\u1ec7c d\u00f9ng n\u01b0\u1edbc t\u00e1o pha lo\u00e3ng (n\u1eeda n\u1ed3ng \u0111\u1ed9) sau \u0111\u00f3 cho u\u1ed1ng c\u00e1c lo\u1ea1i th\u1ee9c u\u1ed1ng \u01b0a th\u00edch (nh\u01b0 n\u01b0\u1edbc tr\u00e1i c\u00e2y th\u00f4ng th\u01b0\u1eddng, s\u1eefa) gi\u00fap gi\u1ea3m nhu c\u1ea7u truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch v\u1ec1 sau so v\u1edbi ORS chu\u1ea9n, ch\u1ee7 y\u1ebfu v\u00ec tr\u1ebb d\u1ec5 d\u00e0ng u\u1ed1ng c\u00e1c lo\u1ea1i th\u1ee9c u\u1ed1ng n\u00e0y h\u01a1n so v\u1edbi ORS. Sau m\u1ed7i l\u1ea7n \u0111i ti\u00eau l\u00f2ng, T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) khuy\u1ec3n ngh\u1ecb cho tr\u1ebb d\u01b0\u1edbi hai tu\u1ed5i u\u1ed1ng 50 \u0111\u1ebfn 100 ml. d\u1ecbch, tr\u1ebb t\u1eeb hai \u0111\u1ebfn 10 tu\u1ed5i u\u1ed1ng 100 \u0111\u1ebfn 200 mL, v\u00e0 tr\u1ebb l\u1edbn h\u01a1n c\u00f3 th\u1ec3 u\u1ed1ng theo nhu c\u1ea7u. Tr\u1ebb em c\u00f3 th\u1ec3 ti\u00eau th\u1ee5 \u0111\u1ebfn 20 ml. d\u1ecbch tr\u00ean m\u1ed7i kg c\u00e2n n\u1eb7ng m\u1ed7i gi\u1edd.<\/p>\n \u0110i\u1ec1u tr\u1ecb m\u1ea5t n\u01b0\u1edbc m\u1ee9c \u0111\u1ed9 v\u1ee9a bao g\u1ed3m ORS k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c n\u1ebfu c\u1ea7n thi\u1ebft \u0111\u1ec3 gi\u1ea3m n\u00f3n v\u00e0 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng dung n\u1ea1p ORS. \u1ede tr\u1ebb em b\u1ecb m\u1ea5t n\u01b0\u1edbc v\u1eeba, b\u00f9 d\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi b\u00f9 d\u1ecbch t\u0129nh m\u1ea1ch trong vi\u1ec7c ng\u0103n ng\u1eeba nh\u1eadp vi\u1ec7n v\u00e0 t\u00e1i kh\u00e1m.<\/p>\n ORS. Trong m\u1ed9t thay \u0111\u1ed5i g\u1ea7n \u0111\u00e2y, T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) hi\u1ec7n khuy\u1ebfn ngh\u1ecb s\u1eed d\u1ee5ng ORS c\u00f3 \u0111\u1ed9 th\u1ea9m th\u1ea5u gi\u1ea3m, v\u1edbi th\u00e0nh ph\u1ea7n g\u1ed3m 75 mEq natri\/L v\u00e0 75 mmol glucose\/L. h\u00f2a tan trong 1 l\u00edt n\u01b0\u1edbc. Tr\u01b0\u1edbc \u0111\u00e2y, c\u00f4ng th\u1ee9c ORS chu\u1ea9n c\u1ee7a WHO ch\u1ee9a 90 mEq natri\/L. N\u1ebfu s\u1eed d\u1ee5ng c\u00f4ng th\u1ee9c c\u0169 n\u00e0y cho tr\u1ebb d\u01b0\u1edbi s\u00e1u th\u00e1ng tu\u1ed5i, c\u1ea7n pha th\u00eam 100 – 200 mL n\u01b0\u1edbc s\u1ea1ch. Ngo\u00e0i ra, c\u00f3 th\u1ec3 s\u1eedd\u1ee5ng dung d\u1ecbch t\u1ef1 pha g\u1ed3m \u00bd th\u00eca c\u00e0 ph\u00ea mu\u1ed1i v\u00e0 6 th\u00eca c\u00e0 ph\u00ea \u0111\u01b0\u1eddng trong 1 l\u00edt n\u01b0\u1edbc. B\u1ea3ng 4 tr\u00ecnh b\u00e0y h\u01b0\u1edbng d\u1eabn c\u1ee7a WHO v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng ORS \u1edf tr\u1ebb em.<\/p>\n Ng\u01b0\u1eddi ch\u0103m s\u00f3c n\u00ean \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn c\u00e1ch cho tr\u1ebb u\u1ed1ng ORS b\u1eb1ng xi lanh \u0111\u1ed1i v\u1edbi tr\u1ebb s\u01a1 sinh, v\u00e0 b\u1eb1ng th\u00eca ho\u1eb7c c\u1ed1c \u0111\u1ed1i v\u1edbi tr\u1ebb nh\u0169 nh\u1ec9 l\u1edbn h\u01a1n v\u00e0 tr\u1ebb nh\u1ecf. Tr\u1ebb d\u01b0\u1edbi hai tu\u1ed5i n\u00ean \u0111\u01b0\u1ee3c cho u\u1ed1ng 1 th\u00eca c\u00e0 ph\u00ea m\u1ed7i 1-2 ph\u00fat, tr\u1ebb l\u1edbn h\u01a1n n\u00ean \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch u\u1ed1ng t\u1eebng ng\u1ee5m nh\u1ecf th\u01b0\u1eddng xuy\u00ean tr\u1ef1c ti\u1ebfp t\u1eeb c\u1ed1c. N\u1ebfu x\u1ea3y ra n\u00f4n \u00f3i, khuy\u1ebfn c\u00e1o l\u00e0 ng\u1eebng 5-10 ph\u00fat, sau \u0111\u00f3 ti\u1ebfp t\u1ee5c cho u\u1ed1ng ORS ch\u1eadm h\u01a1n, m\u1ed7i 2-3 ph\u00fat m\u1ed9t l\u1ea7n.<\/p>\n Thu\u1ed1c ch\u1ed1ng n\u00f4n.<\/em> Ondansetron th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng khi c\u1ea7n thi\u1ebft \u0111\u1ec3 ng\u0103n ng\u1eeba n\u00f4n trong l\u00fac tr\u1ebb u\u1ed1ng ORS. Trong m\u1ed9t b\u00e0i t\u1ed5ng quan Cochrane, tr\u1ebb \u0111\u01b0\u1ee3c d\u00f9ng thu\u1ed1c ch\u1ed1ng n\u00f4n \u00edt c\u00f3 kh\u1ea3 n\u0103ng ph\u1ea3i truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch h\u01a1n (RR – 0,40; KTC 95%, 0,26-0,60). M\u1ed9t b\u00e0i t\u1ed5ng quan h\u1ec7 th\u1ed1ng kh\u00e1c cho th\u1ea5y ondansetron gi\u00fap gi\u1ea3m s\u1ed1 ca nh\u1eadp vi\u1ec7n (NNT – 14; KTC 95%, 9-44), gi\u1ea3m nhu c\u1ea7u truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch (NNT – 5; KTC 95%, 4 \u2013 8), v\u00e0 gi\u1ea3m n\u00f3n t\u00e1i di\u1ec5n (NNT-5; KTC 95%, 4 – 7), nh\u01b0ng l\u1ea1i l\u00e0m t\u0103ng nguy c\u01a1 ti\u00eau ch\u00e1y.<\/p>\n Li\u1ec1u th\u00f4ng th\u01b0\u1eddng c\u1ee7a ondansetron l\u00e0 2 mg cho tr\u1ebb n\u1eb7ng 8 – 15 kg. 4 mg cho tr\u1ebb n\u1eb7ng 15 – 30 kg v\u00e0 8 mg cho tr\u1ebb n\u1eb7ng > 30 kg. Li\u1ec1u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1eadp l\u1ea1i n\u1ebfu tr\u1ebb n\u00f4n trong v\u00f2ng 15 ph\u00fat sau khi u\u1ed1ng thu\u1ed1c. Ondansetron kh\u00f4ng n\u00ean d\u00f9ng cho b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng QT d\u00e0i b\u1ea9m sinh. Ngo\u00e0i ra, lu\u00f4n ki\u1ec3m tra \u0111i\u1ec7n gi\u1ea3i tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c v\u00ec h\u1ea1 magnesi m\u00e1u v\u00e0 h\u1ea1 kali m\u00e1u l\u00e0m t\u0103ng nguy c\u01a1 k\u00e9o d\u00e0i kho\u1ea3ng QT. C\u00e1c thu\u1ed1c ch\u1ed1ng n\u00f4n th\u1ec3 h\u1ec7 c\u0169 nh\u01b0 promethazine v\u00e0 metoclopramide c\u00f3 t\u1ef7 l\u1ec7 t\u00e1c d\u1ee5ng ph\u1ee5 cao h\u01a1n v\u00e0 nh\u00ecn chung kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng.<\/p>\n B\u00f9 d\u1ecbch t\u0129nh m\u1ea1ch.<\/em> Nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi li\u1ec7u ph\u00e1p b\u00f9 \u0111\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng k\u1ebft h\u1ee3p thu\u1ed1c ch\u1ed1ng n\u00f4n, c\u0169ng nh\u01b0 nh\u1eefng b\u1ec7nh nh\u00e2n m\u1ea5t n\u01b0\u1edbc n\u1eb7ng (v\u00ed d\u1ee5: c\u00f3 d\u1ea5u hi\u1ec7u s\u1ed1c ho\u1eb7c m\u1ea5t n\u01b0\u1edbc > 10%) c\u1ea7n \u0111\u01b0\u1ee3c nh\u1eadp vi\u1ec7n v\u00e0 b\u00f9 \u0111\u1ecbch t\u1ec9nh m\u1ea1ch. B\u1ea3ng 5 tr\u00ecnh b\u00e0y h\u01b0\u1edbng d\u1eabn c\u1ee7a WHO v\u1ec1 b\u00f9 d\u1ecbch t\u0129nh m\u1ea1ch trong m\u1ea5t n\u01b0\u1edbc n\u1eb7ng. \u0110\u1ed1i v\u1edbi tr\u1ebb v\u1eabn c\u00f3 kh\u1ea3 n\u0103ng u\u1ed1ng, n\u00ean cho u\u1ed1ng ORS b\u1eb1ng xi lanh, th\u00eca ho\u1eb7c c\u1ed1c cho \u0111\u1ebfn khi thi\u1ebft l\u1eadp \u0111\u01b0\u1ee3c \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch. Trong c\u00e1c c\u01a1 s\u1edf h\u1ea1n ch\u1ebf ngu\u1ed3n l\u1ef1c, c\u00f3 th\u1ec3 xem x\u00e9t b\u00f9 \u0111\u1ecbch qua sonde d\u1ea1 d\u00e0y n\u1ebfu kh\u00f4ng th\u1ec3 \u0111\u1eb7t \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch.<\/p>\n Lactobacillus<\/em> \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n \u0111\u01b0\u1ee3c b\u00f9 \u0111\u1ecbch \u0111\u01b0\u1eddng u\u1ed1ng, nh\u01b0ng l\u1ee3i \u00edch c\u1ee7a n\u00f3 v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p cho th\u1ea5y Lactobacillus ch\u1ec9 l\u00e0m gi\u1ea3m r\u1ea5t \u00edt th\u1eddi gian b\u1ec7nh v\u00e0 s\u1ed1 l\u1ea7n \u0111i ti\u00eau. T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) khuy\u1ebfn ngh\u1ecb b\u1ed5 sung k\u1ebdm trong \u0111\u1ee3t ti\u00eau ch\u1ea3y c\u1ea5p, d\u1ef1a tr\u00ean c\u00e1c nghi\u00ean c\u1ee9u ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf nh\u1eefng qu\u1ed1c gia m\u00e0 tr\u1ebb em c\u00f3 nguy c\u01a1 thi\u1ebfu k\u00eam. Tuy nhi\u00ean, m\u1ed9t b\u00e0i t\u1ed5ng quan Cochrane nh\u1eadn th\u1ea5y ch\u01b0a c\u00f3 \u0111\u1ee7 d\u1eef li\u1ec7u \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh li\u1ec7u vi\u1ec7c b\u1ed5 sung k\u1ebdm c\u00f3 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 l\u00e2m s\u1ea3ng hay kh\u00f4ng.<\/p>\n B\u1ea2NG 5<\/strong><\/p>\n H\u01b0\u1edbng d\u1eabn c\u1ee7a WHO v\u1ec1 b\u00f9 d\u1ecbch t\u0129nh m\u1ea1ch (IV) cho tr\u1ebb em<\/p>\n *- N\u1ebfu kh\u00f4ng c\u00f3 dung d\u1ecbch Ringer, c\u00f3 th\u1ec3 d\u00f9ng NaCl 0,9%.<\/p>\n \u2020- C\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i m\u1ed9t l\u1ea7n n\u1ebfu m\u1ea1ch quay c\u00f2n r\u1ea5t y\u1ebfu ho\u1eb7c kh\u00f4ng b\u1eaft \u0111\u01b0\u1ee3c.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n R\u1eeda tay \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 bi\u1ec7n ph\u00e1p ch\u00ednh \u0111\u1ec3 ph\u00f2ng ng\u1eeba vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p t\u1eeb 30 nghi\u00ean c\u1ee9u cho th\u1ea5y c\u00e1c chi\u1ebfn d\u1ecbch r\u1eeda tay gi\u00fap gi\u1ea3m 30% t\u1ef7 l\u1ec7 m\u1eafc c\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. M\u1ed9t b\u00e0i t\u1ed5ng quan Cochrane c\u0169ng ghi nh\u1eadn k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1. Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y x\u00e0 ph\u00f2ng di\u1ec7t khu\u1ea9n hi\u1ec7u qu\u1ea3 h\u01a1n x\u00e0 ph\u00f2ng th\u01b0\u1eddng. Vi\u1ec7c s\u1eed d\u1ee5ng dung d\u1ecbch s\u00e1t khu\u1ea9n tay c\u00f3 c\u1ed3n k\u1ebft h\u1ee3p v\u1edbi v\u1ec7 sinh tay chu\u1ea9n c\u00f3 th\u1ec3 gi\u1ea3m t\u1ef7 l\u1ec7 vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t t\u1ea1i v\u0103n ph\u00f2ng, nh\u00e0 tr\u1ebb v\u00e0 gi\u1ea3m 30% t\u00ecnh tr\u1ea1ng ngh\u1ec9 h\u1ecdc. Tuy nhi\u00ean, ch\u1ec9 ri\u00eang vi\u1ec7c r\u1eeda tay v\u00e0 v\u1ec7 sinh kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 ng\u0103n ng\u1eeba nhi\u1ec5m rotavirus.<\/p>\n Tr\u01b0\u1edbc khi c\u00f3 vaccine ph\u00f2ng rotavirus, g\u1ea7n nh\u01b0 t\u1ea5t c\u1ea3 tr\u1ebb em tr\u00ean to\u00e0n th\u1ebf gi\u1edbi \u0111\u1ec1u nhi\u1ec5m rotavirus tr\u01b0\u1edbc 3 \u0111\u1ebfn 5 tu\u1ed5i. Tuy nhi\u00ean, t\u1ef7 l\u1ec7 nhi\u1ec5m rotavirus \u0111\u00e3 gi\u1ea3m \u0111\u00e1ng k\u1ec3 nh\u1edd vi\u1ec7c s\u1eed d\u1ee5ng vaccine. C\u00e1c nghi\u00ean c\u1ee9u t\u1ea1i Mexico v\u00e0 Brazil cho th\u1ea5y vaccine gi\u00fap ng\u0103n ng\u1eeba 80.000 ca nh\u1eadp vi\u1ec7n v\u00e0 1.300 ca t\u1eed vong do ti\u00eau ch\u00e1y m\u1ed7i n\u0103m.<\/p>\n C\u00e1c lo\u1ea1i vaccine rotavirus tr\u01b0\u1edbc \u0111\u00e2y c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 l\u1ed3ng ru\u1ed9t (kho\u1ea3ng 1\/10.000 tr\u1ebb s\u01a1 sinh). Tuy nhi\u00ean, c\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y v\u1edbi c\u00e1c lo\u1ea1i vaccine m\u1edbi h\u01a1n, nguy c\u01a1 n\u00e0y ch\u1ec9 t\u0103ng nh\u1eb9, v\u00e0o kho\u1ea3ng 1\/51.000 \u0111\u1ebfn 1\/68.000 tr\u1ebb s\u01a1 sinh.<\/p>\n T\u1ea5t c\u1ea3 tr\u1ebb n\u00ean \u0111\u01b0\u1ee3c u\u1ed1ng vaccine rotavirus, c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u t\u1eeb 6 \u0111\u1ebfn 15 tu\u1ea7n tu\u1ed5i, nh\u1eb1m gi\u1ea3m nguy c\u01a1 vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t n\u1eb7ng, nh\u1eadp vi\u1ec7n v\u00e0 t\u1eed vong do nhi\u1ec5m rotavirus. Hai lo\u1ea1i vaccine rotavirus \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn s\u1eed d\u1ee5ng t\u1ea1i Hoa K\u1ef3 l\u00e0 Rotateq (khuy\u1ebfn c\u00e1o u\u1ed1ng l\u00fac 2, 4 v\u00e0 6 th\u00e1ng tu\u1ed5i) v\u00e0 Rotarix (khuy\u1ebfn c\u00e1o u\u1ed1ng l\u00fac 2 v\u00e0 4 th\u00e1ng tu\u1ed5i). Kho\u1ea3ng c\u00e1ch t\u1ed1i thi\u1ec3u gi\u1eefa c\u00e1c li\u1ec1u l\u00e0 4 tu\u1ea7n, v\u00e0 t\u1ea5t c\u1ea3 c\u00e1c li\u1ec1u n\u00ean \u0111\u01b0\u1ee3c u\u1ed1ng tr\u01b0\u1edbc 8 th\u00e1ng tu\u1ed5i. Tr\u1ebb sinh non c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c u\u1ed1ng vaccine theo l\u1ecbch th\u00f4ng th\u01b0\u1eddng.<\/p>\n Hi\u1ec7n nay, vaccine ph\u00f2ng norovirus \u0111ang trong qu\u00e1 tr\u00ecnh th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng. C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 cho th\u1ea5y vaccine n\u00e0y t\u1ea1o ra \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch m\u1ea1nh m\u1ebd v\u00e0 c\u00f3 t\u00ednh dung n\u1ea1p t\u1ed1t \u1edf c\u1ea3 ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em.<\/p>\n Vi\u1ec7c nu\u00f4i con ho\u00e0n to\u00e0n b\u1eb1ng s\u1eefa m\u1eb9 trong 4 th\u00e1ng \u0111\u1ea7u, v\u00e0 nu\u00f4i con b\u1eb1ng s\u1eefa m\u1eb9 m\u1ed9t ph\u1ea7n sau \u0111\u00f3, c\u00f3 li\u00ean quan \u0111\u1ebfn gi\u1ea3m t\u1ef7 l\u1ec7 m\u1eafc vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t c\u1ea5p trong n\u0103m \u0111\u1ea7u \u0111\u1eddi, c\u0169ng nh\u01b0 t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n do b\u1ec7nh ti\u00eau ch\u1ea3y. M\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 \u01b0\u1edbc t\u00ednh r\u1eb1ng 53% c\u00e1c ca nh\u1eadp vi\u1ec7n do ti\u00eau ch\u1ea3y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ng\u0103n ng\u1eeba m\u1ed7i th\u00e1ng nh\u1edd nu\u00f4i con ho\u00e0n to\u00e0n b\u1eb1ng s\u1eefa m\u1eb9, v\u00e0 hi\u1ec7u qu\u1ea3 b\u1ea3o v\u1ec7 n\u00e0y v\u1eabn \u0111\u01b0\u1ee3c duy tr\u00ec ngay c\u1ea3 sau khi ng\u1eebng cho b\u00fa.<\/p>\n R\u1ea5t nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 t\u1eadp trung v\u00e0o c\u00e1c \u0111\u1eb7c t\u00ednh mi\u1ec5n d\u1ecbch c\u1ee7a s\u1eefa m\u1eb9. C\u00e1c kh\u00e1ng th\u1ec3 trong s\u1eeda m\u1eb9 ch\u1ec9 \u0111\u00f3ng g\u00f3p m\u1ed9t ph\u1ea7n nh\u1ecf v\u00e0o kh\u1ea3 n\u0103ng b\u1ea3o v\u1ec7 mi\u1ec5n d\u1ecbch c\u1ee7a tr\u1ebb, trong khi h\u1ec7 vi sinh \u0111\u01b0\u1eddng ru\u1ed9t, prebiotics, probiotics, mi\u1ec5n d\u1ecbch ni\u00eam m\u1ea1c, nucleotide v\u00e0 oligosaccharide l\u1ea1i c\u00f3 vai tr\u00f2 l\u1edbn h\u01a1n. Y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng bi\u1ec3u b\u00ec trong s\u1eefa m\u1eb9 gi\u00fap k\u00edch th\u00edch s\u1ef1 tr\u01b0\u1edfng th\u00e0nh c\u1ee7a bi\u1ec3u m\u00f4 ru\u1ed9t; IgA v\u00e0 oligosaccharide c\u00f3 t\u00e1c d\u1ee5ng ng\u0103n ch\u1eb7n s\u1ef1 b\u00e1m d\u00ednh c\u1ee7a m\u1ea7m b\u1ec7nh; v\u00e0 lactoferrin trong s\u1eefa m\u1eb9 c\u00f3 \u0111\u1eb7c t\u00ednh kh\u00e1ng khu\u1ea9n.<\/p>\n M\u1ed9t s\u1ed1 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y r\u1eb1ng vi\u1ec7c b\u1ed5 sung probiotic h\u00e0ng ng\u00e0y cho tr\u1ebb em \u0111i nh\u00e0 tr\u1ebb gi\u00fap gi\u1ea3m t\u1ef7 l\u1ec7 m\u1eafc ti\u00eau ch\u00e1y nhi\u1ec5m tr\u00f9ng c\u1ea5p m\u00e0 kh\u00f4ng g\u00e2y ra t\u00e1c d\u1ee5ng ph\u1ee5. V\u00ed d\u1ee5, m\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y tr\u1ebb em t\u1ea1i c\u00e1c nh\u00e0 tr\u1ebb \u0111\u01b0\u1ee3c b\u1ed5 sung Lactobacillus reuteri gi\u00fap gi\u1ea3m chi ph\u00ed y t\u1ebf v\u00e0 gi\u1ea3m s\u1ed1 \u0111\u1ee3t ti\u00eau ch\u1ea3y. Tuy nhi\u00ean, b\u1eb1ng ch\u1ee9ng v\u1eabn c\u00f2n kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t trong h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 vi\u1ec7c b\u1ed5 sung probiotic v\u00e0o c\u00e1c b\u1eefa \u0103n c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb s\u1eeda t\u1ea1i nh\u00e0 tr\u1ebb. L\u01b0\u1ee3t d\u1ecbch: NT HN Vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t c\u1ea5p \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 m\u1ed9t b\u1ec7nh ti\u00eau ch\u1ea3y kh\u1edfi ph\u00e1t nhanh, c\u00f3 th\u1ec3 c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo bu\u1ed3n n\u00f4n, n\u00f4n, s\u1ed1t ho\u1eb7c \u0111au b\u1ee5ng. T\u1ea1i Hoa K\u1ef3, vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t c\u1ea5p g\u00e2y ra kho\u1ea3ng 1,5 tri\u1ec7u ca kh\u00e1m ngo\u1ea1i tr\u00fa, 200.000 ca nh\u1eadp vi\u1ec7n […]\n","protected":false},"author":1,"featured_media":134973,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-134972","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134972","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=134972"}],"version-history":[{"count":1,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134972\/revisions"}],"predecessor-version":[{"id":134976,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134972\/revisions\/134976"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/134973"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=134972"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=134972"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=134972"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
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\n Tri\u1ec7u ch\u1ee9ng<\/strong><\/td>\n Ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3 g\u1eb7p<\/strong><\/td>\n<\/tr>\n \n R\u1ed3i lo\u1ea1n tri gi\u00e1c<\/td>\n Nhi\u1ec5m tr\u00f9ng h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, nhi\u1ec5m tr\u00f9ng huy\u1ebft<\/td>\n<\/tr>\n \n N\u00f4n ra d\u1ecbch m\u1eadt<\/td>\n T\u1eafc ru\u1ed9t<\/td>\n<\/tr>\n \n Ph\u00e2n c\u00f3 m\u00e1u ho\u1eb7c nh\u1ea7y (\u0111\u1eb7c bi\u1ec7t k\u00e9o d\u00e0i > 2 tu\u1ea7n)<\/td>\n B\u1ec7nh ru\u1ed9t vi\u00eam (IBD)<\/td>\n<\/tr>\n \n Kh\u00f3 th\u1edf<\/td>\n Vi\u00eam ph\u1ed5i<\/td>\n<\/tr>\n \n S\u1ed1t<\/td>\n C\u00e1c nhi\u1ec5m tr\u00fang kh\u00e1c nh\u01b0 vi\u00eam tai gi\u1eefa, nhi\u1ec5m | tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u c\u00f3 th\u1ec3 g\u00e2y bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n \u1edf tr\u1ebb em<\/td>\n<\/tr>\n \n \u0110au b\u1ee5ng khu tr\u00fa, ch\u01b0\u1edbng b\u1ee5ng ho\u1eb7c \u0111\u1ec1 kh\u00e1ng th\u00e0nh b\u1ee5ng<\/td>\n B\u1ee5ng ngo\u1ea1i khoa (vd: vi\u00eam ru\u1ed9t th\u1eeba)<\/td>\n<\/tr>\n \n C\u1ee9ng g\u00e1y ho\u1eb7c th\u00f3p ph\u1ed3ng<\/td>\n Vi\u00eam m\u00e0ng n\u00e3o<\/td>\n<\/tr>\n \n Ban xu\u1ea5t huy\u1ebft<\/td>\n H\u1ed9i ch\u1ee9ng s\u1ed1c nhi\u1ec5m \u0111\u1ed9c (TSS)<\/td>\n<\/tr>\n \n G\u1ea7n \u0111\u00e2y c\u00f3 d\u00f9ng kh\u00e1ng sinh (vd: ampicillin)<\/td>\n T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a kh\u00e1ng sinh<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n T\u00ecnh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc<\/h3>\n
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\n \u0110\u1eb7c \u0111i\u1ec3m<\/strong><\/td>\n 0 \u0111i\u1ec3m<\/strong><\/td>\n 1 \u0111i\u1ec3m<\/strong><\/td>\n 2 \u0111i\u1ec3m<\/strong><\/td>\n<\/tr>\n \n To\u00e0n tr\u1ea1ng<\/td>\n B\u00ecnh th\u01b0\u1eddng<\/td>\n Kh\u00e1t n\u01b0\u1edbc, b\u1ed3n ch\u1ed3n ho\u1eb7c l\u1edd \u0111\u1edd, nh\u01b0ng c\u00e1u g\u1eaft khi ch\u1ea1m v\u00e0o<\/td>\n Ng\u1ee7 g\u00e0, l\u1ea1nh, v\u00e0 m\u00f4 h\u00f4i, h\u00f4n m\u00ea<\/td>\n<\/tr>\n \n M\u1eaft<\/td>\n B\u00ecnh th\u01b0\u1eddng<\/td>\n H\u01a1i tr\u0169ng<\/td>\n R\u1ea5t tr\u0169ng<\/td>\n<\/tr>\n \n Ni\u00eam m\u1ea1c<\/td>\n \u1ea8m<\/td>\n D\u00ednh (sticky)<\/td>\n Kh\u00f4<\/td>\n<\/tr>\n \n N\u01b0\u1edbc m\u1eaft<\/td>\n C\u00f3 n\u01b0\u1edbc m\u1eaft<\/td>\n \u00cdt n\u01b0\u1edbc m\u1eaft<\/td>\n Kh\u00f4ng c\u00f3 n\u01b0\u1edbc m\u1eaft<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \n
X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng<\/h3>\n
\u0110i\u1ec1u tr\u1ecb<\/h2>\n
Nguy\u00ean t\u1eafc chung<\/h3>\n
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\n C\u00e2n n\u1eb7ng*<\/strong><\/td>\n Tu\u1ed5i*<\/strong><\/td>\n L\u01b0\u1ee3ng ORS (mL) c\u1ea7n u\u1ed1ng trong 4 gi\u1edd \u0111\u1ea7u<\/strong><\/td>\n<\/tr>\n \n < 5 kg<\/td>\n < 4 th\u00e1ng<\/td>\n 200 – 400<\/td>\n<\/tr>\n \n 5 – 7.9 kg<\/td>\n 4 – 11 th\u00e1ng<\/td>\n 200 – 400<\/td>\n<\/tr>\n \n 8 – 10.9 kg<\/td>\n 12 – 23 th\u00e1ng<\/td>\n 600 – 800<\/td>\n<\/tr>\n \n 11 – 15.9 kg<\/td>\n 2 – 4 tu\u1ed5i<\/td>\n 800 – 1200<\/td>\n<\/tr>\n \n 16 – 29.9 kg<\/td>\n 5 – 14 tu\u1ed5i<\/td>\n 1200 – 2200<\/td>\n<\/tr>\n \n \u2265 30 kg<\/td>\n \u2265 15 tu\u1ed5i<\/td>\n 2200 – 4000<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \n
M\u1ea5t n\u01b0\u1edbc nh\u1eb9 (56%)<\/h3>\n
M\u1ea5t n\u01b0\u1edbc v\u1eeba \u0111\u1ebfn n\u1eb7ng (>6%)<\/h3>\n
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\n B\u1eaft \u0111\u1ea7u truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch ngay, n\u1ebfu b\u1ec7nh nhi c\u00f2n u\u1ed1ng \u0111\u01b0\u1ee3c, cho u\u1ed1ng ORS cho \u0111\u1ebfn khi thi\u1ebft l\u1eadp \u0111\u01b0\u1ee3c \u0111\u01b0\u1eddng truy\u1ec1n. Truy\u1ec1n 100 mL\/kg dung d\u1ecbch Ringer*, chia nh\u01b0 sau:<\/p>\n \n
Ph\u00f2ng ng\u1eeba<\/h2>\n
R\u1eeda tay<\/h3>\n
Vaccine<\/h3>\n
C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ph\u00f2ng ng\u1eeba kh\u00e1c<\/h3>\n
\nC\u1ea7n c\u00f3 th\u00eam nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u00fang lo\u1ea1i v\u00e0 li\u1ec1u l\u01b0\u1ee3ng probiotic n\u00e0o l\u00e0 h\u1eefu \u00edch nh\u1ea5t. C\u00e1c b\u00e1c s\u0129 gia \u0111\u00ecnh c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc trao \u0111\u1ed5i v\u1edbi cha m\u1eb9 v\u1ec1 l\u1ee3i \u00edch ti\u1ec1m n\u0103ng c\u1ee7a probiotic trong ph\u00f2ng ng\u1eeba vi\u00eam d\u1ea1 d\u00e0y – ru\u1ed9t nhi\u1ec5m tr\u00f9ng \u1edf tr\u1ebb em.<\/p>\n","protected":false},"excerpt":{"rendered":"