{"id":32005,"date":"2022-03-01T16:14:35","date_gmt":"2022-03-01T09:14:35","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=32005"},"modified":"2022-03-01T16:15:46","modified_gmt":"2022-03-01T09:15:46","slug":"suy-than-cap","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/suy-than-cap\/","title":{"rendered":"Suy th\u1eadn c\u1ea5p: \u0110\u1ecbnh ngh\u0129a, tri\u1ec7u ch\u1ee9ng, \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<p style=\"text-align: right;\">T\u00e1c gi\u1ea3: PGS.TS. L\u00ea Th\u1ecb Luy\u1ebfn, TS.BS. L\u00ea Th\u1ecb H\u1eb1ng,<\/p>\n<p style=\"text-align: right;\">TS.BS. Nguy\u1ec5n Th\u1ecb H\u01b0\u01a1ng Giang, ThS.BS. Phan Th\u1ecb T\u1ed1 Nh\u01b0, ThS.BS. Tr\u1ea7n Th\u1ecb Thanh Huy\u1ec1n<\/p>\n<p><strong>B\u00e0i vi\u1ebft<a href=\"https:\/\/www.vnras.com\/drug\/2022\/03\/suy-than-cap.html\">\u00a0Suy th\u1eadn c\u1ea5p: \u0110\u1ecbnh ngh\u0129a, tri\u1ec7u ch\u1ee9ng, \u0111i\u1ec1u tr\u1ecb<\/a>\u00a0\u0111\u01b0\u1ee3c tr\u00edch trong ch\u01b0\u01a1ng 5 s\u00e1ch B\u1ec7nh h\u1ecdc (t\u00e1i b\u1ea3n l\u1ea7n th\u1ee9 hai n\u0103m 2021, c\u00f3 s\u1eeda ch\u1eefa b\u1ed5 sung), Nh\u00e0 xu\u1ea5t b\u1ea3n y h\u1ecdc.<\/strong><\/p>\n<p><strong><em>M\u1ee5c ti\u00eau h\u1ecdc t\u1eadp<\/em><\/strong><\/p>\n<ol>\n<li>N\u00eau \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n v\u00e0 c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a suy th\u1eadn c\u1ea5p.<\/li>\n<li>Tr\u00ecnh b\u00e0y \u0111\u01b0\u1ee3c tri\u1ec7u ch\u1ee9ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb suy th\u1eadn c\u1ea5p.<\/li>\n<\/ol>\n<h2 id=\"1-dinh-nghia-nguyen-nhan-va-phan-loai-co-che-benh-sinh\">1. \u0110\u1ecaNH NGH\u0128A, NGUY\u00caN NH\u00c2N V\u00c0 PH\u00c2N LO\u1ea0I, C\u01a0 CH\u1ebe B\u1ec6NH SINH<\/h2>\n<h3 id=\"1-1-dinh-nghia\">1.1. \u0110\u1ecbnh ngh\u0129a<\/h3>\n<p>Suy th\u1eadn c\u1ea5p (Acute Renal Failure) hay c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi v\u1edbi t\u00ean g\u1ecdi kh\u00e1c l\u00e0 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p (Acute Kidney Injury). \u0110\u00e2y l\u00e0 t\u00ecnh tr\u1ea1ng suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn nhanh ch\u00f3ng do nhi\u1ec1u nguy\u00ean nh\u00e2n c\u1ea5p t\u00ednh g\u00e2y n\u00ean, d\u1eabn t\u1edbi t\u0103ng n\u1ed3ng \u0111\u1ed9 ure, creatinin v\u00e0 m\u1ed9t s\u1ed1 ch\u1ea5t kh\u00e1c trong huy\u1ebft t\u01b0\u01a1ng.<\/p>\n<h3 id=\"1-2-nguyen-nhan-va-phan-loai\">1.2. Nguy\u00ean nh\u00e2n v\u00e0 ph\u00e2n lo\u1ea1i<\/h3>\n<h4 id=\"1-2-1-suy-than-cap-truoc-than-75\">1.2.1. SUY TH\u1eacN C\u1ea4P tr\u01b0\u1edbc th\u1eadn (75%)<\/h4>\n<p>Gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n<\/p>\n<ul>\n<li>M\u1ea5t m\u00e1u do ch\u1ea5n th\u01b0\u01a1ng, ch\u1ea3y m\u00e1u<\/li>\n<li>M\u1ea5t d\u1ecbch trong l\u00f2ng m\u1ea1ch<\/li>\n<li>T\u0103ng th\u1ea3i d\u1ecbch v\u00e0 mu\u1ed1i qua \u0111\u01b0\u1eddng n\u01b0\u1edbc ti\u1ec3u<\/li>\n<\/ul>\n<p>Gi\u1ea3m cung l\u01b0\u1ee3ng tim (suy tim c\u1ea5p,\u00a0<a href=\"https:\/\/nhathuocngocanh.com\/nhoi-mau-co-tim\/\" target=\"_self\" rel=\"noopener\" data-ail=\"61449\" data-wpel-link=\"internal\">nh\u1ed3i m\u00e1u c\u01a1 tim<\/a>, ch\u00e8n \u00e9p tim, t\u1eafc m\u1ea1ch ph\u1ed5i, t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i)<\/p>\n<p>S\u1ee9c c\u1ea3n h\u1ec7 th\u1ed1ng m\u1ea1ch th\u1ea5p:<\/p>\n<ul>\n<li>Nhi\u1ec5m tr\u00f9ng huy\u1ebft\/s\u1ed1c nhi\u1ec5m tr\u00f9ng<\/li>\n<li>S\u1ed1c ph\u1ea3n v\u1ec7<\/li>\n<li>Suy gan<\/li>\n<li>Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p<\/li>\n<\/ul>\n<p>Co c\u00e1c ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch \u0111\u1ebfn v\u00e0 ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch c\u1ea7u th\u1eadn<\/p>\n<ul>\n<li>C\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf calcineurin (cyclosporin, tacrolimus)<\/li>\n<li>T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft<\/li>\n<li>NSAIDs<\/li>\n<\/ul>\n<h4 id=\"1-2-2-suy-than-cap-tai-than-20\">1.2.2. Suy th\u1eadn c\u1ea5p t\u1ea1i th\u1eadn (20%)<\/h4>\n<p>T\u1ed5n th\u01b0\u01a1ng \u1ed1ng th\u1eadn c\u1ea5p:<\/p>\n<ul>\n<li>Ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn do thu\u1ed1c, h\u00f3a ch\u1ea5t (aminoglycosid, amphotericin B, ethylene glycol, ifosfamide, methotrexate, thu\u1ed1c c\u1ea3n quang, kim lo\u1ea1i n\u1eb7ng), ng\u1ed9 \u0111\u1ed9c m\u1eadt c\u00e1 tr\u1eafm\u2026<\/li>\n<li>Thi\u1ebfu m\u00e1u (th\u01b0\u01a1ng tr\u01b0\u1edbc th\u1eadn k\u00e9o d\u00e0i ho\u1eb7c n\u1eb7ng): do ph\u1eabu thu\u1eadt, NSAIDs, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, cyclosporin, T\u1eafc \u0111\u1ed9ng m\u1ea1ch ho\u1eb7c t\u0129nh m\u1ea1ch th\u1eadn<\/li>\n<\/ul>\n<p>T\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn<\/p>\n<ul>\n<li>Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p<\/li>\n<li>Vi\u00eam c\u1ea7u th\u1eadn do Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng<\/li>\n<li>B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/li>\n<li>H\u1ed9i ch\u1ee9ng Goodpasture (Vi\u00eam c\u1ea7u th\u1eadn do kh\u00e1ng th\u1ec3 kh\u00e1ng m\u00e0ng \u0111\u00e1y c\u1ea7u th\u1eadn) T\u1ed1n th\u01b0\u01a1ng k\u1ebd th\u1eadn:<\/li>\n<li>Vi\u00eam k\u1ebd th\u1eadn c\u1ea5p do thu\u1ed1c penicillin, NSAIDs vancomycin, quinolone, cephalosporin, sulfonamide, ciprofloxacin, thu\u1ed1c l\u1ee3i ti\u1ec3u thiazid, furosemid, cimetidin, phenytoin, allopurinol<\/li>\n<li>Nhi\u1ec5m tr\u00f9ng: Vi\u00eam th\u1eadn-b\u1ec3 th\u1eadn B\u1ec7nh m\u1ea1ch th\u1eadn c\u1ea5p t\u00ednh<\/li>\n<li>Huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch<\/li>\n<li>Huy\u1ebft kh\u1ed1i vi m\u1ea1ch<\/li>\n<li>Vi\u00eam \u0111a vi m\u1ea1ch<\/li>\n<li>Nh\u1ed3i m\u00e1u th\u1eadn, vi\u00eam t\u1eafc m\u1ea1ch th\u1eadn<\/li>\n<li>T\u0103ng huy\u1ebft \u00e1p \u00e1c t\u00ednh<\/li>\n<\/ul>\n<p>C\u00e1c b\u1ec7nh l\u00fd th\u00e2m nhi\u1ec5m: Leukemia, u lympho, sarcoidosis<\/p>\n<h4 id=\"1-2-3-suy-than-cap-sau-than-20\">1.2.3. Suy th\u1eadn c\u1ea5p sau th\u1eadn (20%)<\/h4>\n<p>Ch\u00edt h\u1eb9p \u0111\u01b0\u1eddng d\u1eabn ni\u1ec7u:<\/p>\n<ul>\n<li>Nguy\u00ean nh\u00e2n b\u00ean trong: s\u1ecfi ti\u1ebft ni\u1ec7u, kh\u1ed1i u, c\u1ee5c m\u00e1u \u0111\u1ed9ng, c\u00e1c d\u1ecb t\u1eadt b\u1ea9m sinh<\/li>\n<li>C\u00e1c nguy\u00ean nh\u00e2n b\u00ean ngo\u00e0i: u bu\u1ed3ng tr\u1ee9ng, u ph\u00fac m\u1ea1c<\/li>\n<li>Ch\u1ea5n th\u01b0\u01a1ng ni\u1ec7u qu\u1ea3n trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt ho\u1eb7c ch\u1ea5n th\u01b0\u01a1ng n\u1eb7ng, bu\u1ed9c nh\u1ea7m ni\u1ec7u qu\u1ea3n trong m\u1ed5 \u0111\u1ebb<\/li>\n<li>T\u1eafc ngh\u1ebdn b\u00e0ng quang: c\u00e1c kh\u1ed1i u, h\u1eb9p ni\u1ec7u \u0111\u1ea1o, t\u1eafc sonde b\u00e0ng quang, kh\u1ed1i u tuy\u1ebfn ti\u1ec1n li\u1ec7t; r\u1ed1i lo\u1ea1n th\u1ea7n kinh (do thu\u1ed1c, r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng c\u01a1 tr\u00f2n b\u00e0ng quang)<\/li>\n<li>T\u1eafc \u1ed1ng th\u1eadn do acyclovir, calci oxalat, indinavir, methotrexat, protein trong b\u1ec7nh l\u00fd t\u1ee7y x\u01b0\u01a1ng \u00e1c t\u00ednh, myoglobin, sulfonamid, triamteren, acid uric<\/li>\n<\/ul>\n<h3 id=\"1-3-co-che-benh-sinh\">1.3. C\u01a1 ch\u1ebf b\u1ec7nh sinh<\/h3>\n<p>Suy th\u1eadn c\u1ea5p do nhi\u1ec1u nguy\u00ean nh\u00e2n, nh\u00ecn chung c\u00f3 5 y\u1ebfu t\u1ed1 \u0111\u00f3ng g\u00f3p v\u00e0o c\u01a1 ch\u1ebf b\u1ec7nh sinh:<\/p>\n<ol>\n<li>Gi\u1ea3m l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn c\u1ea7u th\u1eadn d\u1eabn \u0111\u1ebfn gi\u1ea3m m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn c\u1ea5p t\u00ednh.<\/li>\n<li>Gi\u1ea3m t\u00ednh th\u1ea5m m\u00e0ng \u0111\u00e1y mao m\u1ea1ch c\u1ea7u th\u1eadn.<\/li>\n<li>M\u00e0ng t\u1ebf b\u00e0o \u1ed1ng th\u1eadn b\u1ecb h\u1ee7y ho\u1ea1i l\u00e0m d\u1ecbch l\u1ecdc c\u1ea7u th\u1eadn b\u1ecb khu\u1ebfch t\u00e1b tr\u1edf l\u1ea1i sau khi \u0111i qua \u1ed1ng th\u1eadn.<\/li>\n<li>T\u1eafc \u1ed1ng th\u1eadn do c\u00e1c t\u1ebf b\u00e0o, do s\u1eafc t\u1ed1, ho\u1eb7c s\u1ea3n ph\u1ea9m c\u1ee7a protein.<\/li>\n<li>T\u0103ng \u00e1p l\u1ef1c t\u1ed5 ch\u1ee9c k\u1ebd th\u1eadn do ph\u00f9 n\u1ec1.<\/li>\n<\/ol>\n<p>T\u1ea5t c\u1ea3 nh\u1eefng y\u1ebfu t\u1ed1 tr\u00ean d\u1eabn t\u1edbi gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn, y\u1ebfu t\u1ed1 n\u00e0o l\u00e0 ch\u00ednh, y\u1ebfu t\u1ed1 n\u00e0o l\u00e0 ph\u1ee5 c\u00f2n t\u00f9y thu\u1ed9c v\u00e0o nguy\u00ean nh\u00e2n v\u00e0 di\u1ec5n bi\u1ebfn c\u1ee7a qu\u00e1 tr\u00ecnh b\u1ec7nh l\u00fd.<\/p>\n<h2 id=\"2-trieu-chung\">2. TRI\u1ec6U CH\u1ee8NG<\/h2>\n<p>Suy th\u1eadn c\u1ea5p do b\u1ea5t c\u1ee9 nguy\u00ean nh\u00e2n n\u00e0o g\u00e2y ra nh\u01b0ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u1ec1u di\u1ec5n ra theo m\u1ed9t tr\u00ecnh t\u1ef1 bi\u1ebft tr\u01b0\u1edbc g\u1ed3m c\u00e1c giai \u0111o\u1ea1n sau:<\/p>\n<ul>\n<li>Giai \u0111o\u1ea1n t\u1ea5n c\u00f4ng c\u1ee7a c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh.<\/li>\n<li>Giai \u0111o\u1ea1n \u0111\u00e1i \u00edt, v\u00f4 ni\u1ec7u.<\/li>\n<li>Giai \u0111o\u1ea1n \u0111\u00e1i tr\u1edf l\u1ea1i (\u0111\u00e1i nhi\u1ec1u).<\/li>\n<li>Giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c.<\/li>\n<\/ul>\n<p>C\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng thay \u0111\u1ed5i t\u00f9y theo t\u1eebng giai \u0111o\u1ea1n c\u1ee7a b\u1ec7nh.<\/p>\n<h3 id=\"2-1-giai-doan-dai-it-vo-nieu\">2.1. Giai \u0111o\u1ea1n \u0111\u00e1i \u00edt, v\u00f4 ni\u1ec7u<\/h3>\n<ol>\n<li>\u0110\u00e1i \u00edt, v\u00f4 ni\u1ec7u: v\u00f4 ni\u1ec7u c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n t\u1eeb t\u1eeb, l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u gi\u1ea3m d\u1ea7n r\u1ed3i d\u1eabn t\u1edbi v\u00f4 ni\u1ec7u, nh\u01b0ng v\u00f4 ni\u1ec7u c\u0169ng c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u0111\u1ed9t ng\u1ed9t.<\/li>\n<li>Nit\u01a1 phi protein m\u00e1u t\u0103ng: ure m\u00e1u, creatinin m\u00e1u v\u00e0 acid uric m\u00e1u t\u0103ng cao. Khi n\u1ed3ng \u0111\u1ed9 ure, creatinin m\u00e1u t\u0103ng qu\u00e1 cao s\u1ebd xu\u1ea5t hi\u1ec7n H\u1ed9i ch\u1ee9ng ure m\u00e1u cao tr\u00ean l\u00e2m s\u00e0ng v\u1edbi c\u00e1c bi\u1ec3u hi\u1ec7n; kh\u00f3 th\u1edf, bu\u1ed3n n\u00f4n, n\u00f4n, ti\u00eau ch\u1ea3y, c\u00f3 th\u1ec3 h\u00f4n m\u00ea.<\/li>\n<li>R\u1ed1i lo\u1ea1n c\u00e2n b\u1eb1ng n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i:<\/li>\n<\/ol>\n<ul>\n<li>Ph\u00f9: do gi\u1ea3m m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn, c\u00f3 th\u1ec3 \u0111o l\u01b0\u1ee3ng n\u01b0\u1edbc \u0111\u01b0a v\u00e0o nhi\u1ec1u.<\/li>\n<li>\u1ee8 m\u00e1u t\u0103ng g\u00e2y r\u1ed1i lo\u1ea1n v\u1ec1 d\u1eabn truy\u1ec1n v\u00e0 t\u0103ng tr\u01b0\u01a1ng l\u1ef1c v\u00e0 th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn t\u1eed vong. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng l\u00e0 tim nh\u1ecbp t\u0103ng, lo\u1ea1n nh\u1ecbp, c\u00f3 th\u1ec3 ng\u1eebng tim. Tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 s\u00f3ng T cao nh\u1ecdn, \u0111\u1ed1i x\u1ee9ng, PQ d\u00e0i, QRS gi\u00e3n r\u1ed9ng, ST ch\u00eanh l\u00ean ho\u1eb7c ch\u00eanh xu\u1ed1ng. X\u00e9t nghi\u1ec7m: N\u1ed3ng \u0111\u1ed9 K+ m\u00e1u cao. Tr\u00ean th\u1ea7n kinh c\u01a1: c\u00f3 th\u1ec3 y\u1ebfu c\u01a1, li\u1ec7t c\u01a1.<\/li>\n<li>Na+, Ca++ m\u00e1u b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u1ea3m khi \u0103n nh\u1ea1t v\u00e0 b\u1ecb pha lo\u00e3ng.<\/li>\n<\/ul>\n<p>4. Toan m\u00e1u chuy\u1ec3n h\u00f3a (pH m\u00e1u gi\u1ea3m) do t\u00edch t\u1ee5 c\u00e1c acid c\u1ed1 \u0111\u1ecbnh.<\/p>\n<p>C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c:<\/p>\n<ul>\n<li>T\u0103ng huy\u1ebft \u00e1p m\u1ee9c \u0111\u1ed9 v\u1eeba.<\/li>\n<li>N\u01b0\u1edbc ti\u1ec3u c\u00f3 h\u1ed3ng c\u1ea7u, b\u1ea1ch c\u1ea7u, tr\u1ee5 h\u1ea1t t\u00f9y t\u1eebng tr\u01b0\u1eddng h\u1ee3p.<\/li>\n<\/ul>\n<h3 id=\"2-2-giai-doan-dai-nhieu\">2.2. Giai \u0111o\u1ea1n \u0111\u00e1i nhi\u1ec1u<\/h3>\n<p>L\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u t\u0103ng d\u1ea7n &gt;21\u00edt\/ng\u00e0y, c\u00f3 khi &gt;4-5l\u00edt\/ng\u00e0y k\u00e9o d\u00e0i kho\u1ea3ng 5-10 ng\u00e0y. Nguy c\u01a1 ch\u00ednh trong giai \u0111o\u1ea1n n\u00e0y l\u00e0:<\/p>\n<ul>\n<li>M\u1ea5t n\u01b0\u1edbc<\/li>\n<li>M\u1ea5t \u0111i\u1ec7n gi\u1ea3i: K+ m\u00e1u, Na+ m\u00e1u h\u1ea1.<\/li>\n<\/ul>\n<h3 id=\"2-3-giai-doan-hoi-phuc\">2.3. Giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c<\/h3>\n<p>Kh\u1ed1i l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u d\u1ea7n d\u1ea7n tr\u1edf v\u1ec1 m\u1ee9c b\u00ecnh th\u01b0\u1eddng, c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n. C\u00e1c r\u1ed1i lo\u1ea1n sinh h\u00f3a d\u1ea7n b\u00ecnh th\u01b0\u1eddng: ure, creatinin m\u00e1u gi\u1ea3m d\u1ea7n, ure, creatinin n\u01b0\u1edbc ti\u1ec3u t\u0103ng d\u1ea7n. Giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c nhanh hay ch\u1eadm t\u00f9y thu\u1ed9c v\u00e0o nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh nh\u01b0ng trung b\u00ecnh k\u00e9o d\u00e0i kho\u1ea3ng 6 th\u00e1ng \u0111\u1ebfn 1 n\u0103m.<\/p>\n<h2 id=\"3-bien-chung\">3. BI\u1ebeN CH\u1ee8NG<\/h2>\n<p>Suy th\u1eadn c\u1ea5p c\u00f3 nguy c\u01a1 cao d\u1eabn t\u1edbi c\u00e1c bi\u1ebfn ch\u1ee9ng sau \u0111\u00e2y, c\u00e1c bi\u1ebfn ch\u1ee9ng n\u00e0y d\u1ec5 d\u1eabn t\u1edbi t\u1eed vong.<\/p>\n<p>Nhi\u1ec5m khu\u1ea9n: Nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u th\u1ee9 ph\u00e1t sau v\u00f4 ni\u1ec7u r\u1ea5t cao, vi khu\u1ea9n ch\u1ee7 y\u1ebfu l\u00e0 E. Coli, Enterococci, \u00edt g\u1eb7p h\u01a1n l\u00e0 Staphylococcus, Bacillus pyocyaneus. B\u1ec7nh nh\u00e2n nhi\u1ec5m khu\u1ea9n c\u1ea7n ch\u00fa \u00fd tr\u00e1nh d\u00f9ng c\u00e1c kh\u00e1ng sinh g\u00e2y \u0111\u1ed9c v\u1edbi th\u1eadn.<\/p>\n<p>T\u0103ng K+ m\u00e1u g\u00e2y rung th\u1ea5t v\u00e0 ng\u1eebng l\u00e0m: t\u0103ng K+ m\u00e1u lu\u00f4n l\u00e0 nguy c\u01a1 \u0111e d\u1ecda t\u00ednh m\u1ea1ng b\u1ec7nh nh\u00e2n suy th\u1eadn c\u1ea5p, ngay c\u1ea3 hi\u1ec7n nay \u0111\u00e3 c\u00f3 th\u1eadn nh\u00e2n t\u1ea1o.<\/p>\n<p>Ph\u00f9 ph\u1ed5i c\u1ea5p: ph\u00f9 ph\u1ed5i c\u1ea5p l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n quan tr\u1ecdng g\u00e2y t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn c\u1ea5p c\u1ea7n \u0111\u01b0\u1ee3c d\u1ef1 ph\u00f2ng v\u00e0 x\u1eed tr\u00ed s\u1edbm. \u0110\u1eb7c bi\u1ec7t \u1edf nh\u1eefng ng\u01b0\u1eddi \u0111\u00e3 c\u00f3 b\u1ec7nh l\u00fd tim m\u1ea1ch ho\u1eb7c b\u1ec7nh l\u00fd ph\u00f4i t\u1eeb tr\u01b0\u1edbc khi b\u1ecb suy th\u1eadn c\u1ea5p, nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb nhi\u1ec5m \u0111\u1ed9c qua \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, b\u1ecfng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, l\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u1ec9 l\u1ec7 ph\u00f9 ph\u1ed5i c\u1ea5p cao.<\/p>\n<p>H\u00f4n m\u00ea v\u00e0 t\u1eed vong do ure m\u00e1u cao: s\u1eed d\u1ee5ng th\u1eadn nh\u00e2n t\u1ea1o bi\u1ebfn ch\u1ee9ng n\u00e0y \u00edt g\u1eb7p, tuy nhi\u00ean v\u1eabn c\u00f3 nguy c\u01a1 cao x\u1ea3y ra khi ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng v\u00e0 \u0111i\u1ec1u tr\u1ecb kh\u00f4ng \u0111\u00fang, \u0111\u1eb7c bi\u1ec7t trong giai \u0111o\u1ea1n v\u00f4 ni\u1ec7u.<\/p>\n<h2 id=\"4-chan-doan\">4. CH\u1ea8N \u0110O\u00c1N<\/h2>\n<h3 id=\"4-1-chan-doan-xac-dinh\">4.1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/h3>\n<p>Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh suy th\u1eadn c\u1ea5p c\u0103n c\u1ee9 v\u00e0o c\u00e1c y\u1ebfu t\u1ed1 sau:<\/p>\n<ul>\n<li>C\u00f3 nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 g\u00e2y suy th\u1eadn c\u1ea5p (\u0111\u00f4i khi kh\u00f4ng t\u00ecm \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n).<\/li>\n<li>V\u00f4 ni\u1ec7u ho\u1eb7c thi\u1ec3u ni\u1ec7u x\u1ea3y ra c\u1ea5p t\u00ednh.<\/li>\n<li>T\u1ed1c \u0111\u1ed9 gia t\u0103ng creatinin huy\u1ebft thanh &gt; 42,5 pmol trong v\u00f2ng 24 gi\u1edd \u2013 48 gi\u1edd so v\u1edbi creatinin n\u1ec1n (n\u1ebfu creatinin n\u1ec1n &lt;221 pmol\/1), ho\u1eb7c: T\u1ed1c \u0111\u1ed9 gia t\u0103ng creatinin huy\u1ebft thanh &gt; 20% trong v\u00f2ng 24 gi\u1edd \u0111\u1ebfn 48 gi\u1edd so v\u1edbi creatinin n\u1ec1n (n\u1ebfu creatinin n\u1ec1n &gt;221 pmol\/1).<\/li>\n<li>M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn gi\u1ea3m &lt; 60mL\/ph, x\u1ea3y ra sau v\u00f4 ni\u1ec7u.<\/li>\n<li>K+ m\u00e1u th\u01b0\u1eddng t\u0103ng.<\/li>\n<li>C\u00f3 th\u1ec3 c\u00f3 toan m\u00e1u chuy\u1ec3n ho\u00e1.<\/li>\n<li>Di\u1ec5n bi\u1ebfn qua 4 giai \u0111o\u1ea1n.<\/li>\n<\/ul>\n<h3 id=\"4-2-chan-doan-phan-biet-suy-than-cap-chuc-nang-voi-suy-than-cap-thuc-ton-hoai-tu-ong-than-cap\">4.2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t suy th\u1eadn c\u1ea5p ch\u1ee9c n\u0103ng v\u1edbi suy th\u1eadn c\u1ea5p th\u1ef1c t\u1ed5n (ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p).<\/h3>\n<p>B\u1ea3ng 5.3. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t suy th\u1eadn c\u1ea5p ch\u1ee9c n\u0103ng v\u00e0 suy th\u1eadn c\u1ea5p th\u1ef1c t\u1ed5n<\/p>\n<p>(Dieter Kleinknecht, 1992)<\/p>\n<table>\n<tbody>\n<tr>\n<td>Ch\u1ec9 s\u1ed1<\/td>\n<td>Suy th\u1eadn c\u1ea5p ch\u1ee9c n\u0103ng<\/td>\n<td>Suy th\u1eadn c\u1ea5p th\u1ef1c th\u1ec3<\/td>\n<\/tr>\n<tr>\n<td>\u0110\u1ed9 th\u1ea9m th\u1ea5u n\u01b0\u1edbc ti\u1ec3u s\u00e1ng s\u1edbm (mOsm\/kg H2O)<\/td>\n<td>&gt;500<\/td>\n<td>&lt;350<\/td>\n<\/tr>\n<tr>\n<td>2. Uosm\/Posm<\/td>\n<td>&gt;1,5<\/td>\n<td>&lt;1,1<\/td>\n<\/tr>\n<tr>\n<td>3. H\u1ec7 s\u1ed1 thanh th\u1ea3i n\u01b0\u1edbc t\u1ef1 do (Ch20 \u2013 mL\/ph)<\/td>\n<td>\u00c2m t\u00ednh<\/td>\n<td>Ti\u1ebfn t\u1edbi 0<\/td>\n<\/tr>\n<tr>\n<td>4. Natri ni\u1ec7u<\/td>\n<td>&lt;20<\/td>\n<td>&gt;40<\/td>\n<\/tr>\n<tr>\n<td>5. Ch\u1ec9 s\u1ed1 \u0111\u00e0o th\u1ea3i Natri FENa (%)<\/td>\n<td>&lt;1<\/td>\n<td>&gt; 1<\/td>\n<\/tr>\n<tr>\n<td>6. Creatinin ni\u1ec7u\/ Creatinin m\u00e1u<\/td>\n<td>&gt;40<\/td>\n<td>&lt;20<\/td>\n<\/tr>\n<tr>\n<td>7. Ure ni\u1ec7u\/ Ure m\u00e1u<\/td>\n<td>&gt;8<\/td>\n<td>&lt;3<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Uosm \u2013 \u0110\u1ed9 th\u1ea9m th\u1ea5u n\u01b0\u1edbc ti\u1ec3u<\/p>\n<p>Posm \u2013 \u0110\u1ed9 th\u1ea9m th\u1ea5u m\u00e1u<\/p>\n<h2 id=\"5-dieu-tri\">5. \u0110I\u1ec0U TR\u1eca<\/h2>\n<p>Hi\u1ec7n nay, ch\u01b0a c\u00f3 thu\u1ed1c \u0111\u1eb7c tr\u1ecb \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb suy th\u1eadn c\u1ea5p. CH\u00ednh v\u00ec v\u1eady, m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb \u1edf \u0111\u00e2y l\u00e0 lo\u1ea1i b\u1ecf nguy\u00ean nh\u00e2n, duy tr\u00ec s\u1ef1 s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n cho \u0111\u1ebfn khi c\u00e1c ch\u1ee9c n\u0103ng c\u1ee7a th\u1eadn t\u1ef1 ph\u1ee5c h\u1ed3i. Tu\u1ef3 thu\u1ed9c t\u1eebng giai \u0111o\u1ea1n nh\u01b0ng ch\u00fa tr\u1ecdng v\u00e0o giai \u0111o\u1ea1n \u0111\u00e1i \u00edt, v\u00f4 ni\u1ec7u.<\/p>\n<h3 id=\"5-1-muc-tieu-dieu-tri\">5.1. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/h3>\n<ol>\n<li>Ph\u00e1t hi\u1ec7n, \u0111i\u1ec1u tr\u1ecb ho\u1eb7c lo\u1ea1i b\u1ecf nguy\u00ean nh\u00e2n.<\/li>\n<li>C\u00e2n b\u1eb1ng d\u1ecbch v\u00e0 \u0111i\u1ec7n gi\u1ea3i.<\/li>\n<li>Gi\u1ea3m c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a suy th\u1eadn.<\/li>\n<li>Tr\u00e1nh s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c \u0111\u1ed9c v\u1edbi th\u1eadn.<\/li>\n<li>D\u1ef1 ph\u00f2ng c\u00e1c bi\u1ebfn ch\u1ee9ng.<\/li>\n<\/ol>\n<h3 id=\"5-2-nguyen-tac-chung\">5.2. Nguy\u00ean t\u1eafc chung<\/h3>\n<ul>\n<li>C\u1ea7n nhanh ch\u00f3ng lo\u1ea1i b\u1ecf nguy\u00ean nh\u00e2n g\u00e2y suy th\u1eadn c\u1ea5p n\u1ebfu c\u00f3 th\u1ec3<\/li>\n<li>\u0110i\u1ec1u ch\u1ec9nh c\u00e1c r\u1ed1i lo\u1ea1n tu\u1ea7n ho\u00e0n, trong \u0111\u00f3 \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ee5c h\u1ed3i l\u1ea1i l\u01b0\u1ee3ng m\u00e1u v\u00e0 d\u1ecbch, duy tr\u00ec huy\u1ebft \u00e1p t\u00e2m thu 100 \u2013 120mmHg.<\/li>\n<li>Ph\u1ee5c h\u1ed3i l\u1ea1i d\u00f2ng n\u01b0\u1edbc ti\u1ec3u.<\/li>\n<li>\u0110i\u1ec1u ch\u1ec9nh c\u00e1c r\u1ed1i lo\u1ea1n n\u1ed9i m\u00f4i do suy th\u1eadn c\u1ea5p g\u00e2y ra.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng ph\u00f9 h\u1ee3p v\u1edbi t\u1eebng giai \u0111o\u1ea1n c\u1ee7a b\u1ec7nh.<\/li>\n<li>Ch\u1ec9 \u0111\u1ecbnh l\u1ecdc m\u00e1u ngo\u00e0i th\u1eadn khi c\u1ea7n thi\u1ebft.<\/li>\n<\/ul>\n<h3 id=\"5-3-dieu-tri-theo-giai-doan-benh\">5.3. \u0110i\u1ec1u tr\u1ecb theo giai \u0111o\u1ea1n b\u1ec7nh<\/h3>\n<h4 id=\"5-3-1-giai-doan-tan-cong-cua-cac-nguyen-nhan\">5.3.1. Giai \u0111o\u1ea1n t\u1ea5n c\u00f4ng c\u1ee7a c\u00e1c nguy\u00ean nh\u00e2n<\/h4>\n<ul>\n<li>C\u1ea7n t\u00ecm nguy\u00ean nh\u00e2n \u0111\u1ec3 lo\u1ea1i b\u1ecf, \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c can thi\u1ec7p kh\u00e1c.<\/li>\n<li>Theo d\u00f5i s\u00e1t t\u00ecnh tr\u1ea1ng thi\u1ec3u ni\u1ec7u, v\u00f4 ni\u1ec7u c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec3 c\u00f3 ch\u1ea9n \u0111o\u00e1n suy th\u1eadn c\u1ea5p s\u1edbm.<\/li>\n<\/ul>\n<h4 id=\"5-3-2-giai-doan-thieu-nieu-vo-nieu\">5.3.2. Giai \u0111o\u1ea1n thi\u1ec3u ni\u1ec7u, v\u00f4 ni\u1ec7u<\/h4>\n<p>Gi\u1eef c\u00e2n b\u1eb1ng n\u01b0\u1edbc, \u0111i\u1ec7n gi\u1ea3i:<\/p>\n<ul>\n<li>\u1ede b\u1ec7nh nh\u00e2n v\u00f4 ni\u1ec7u c\u1ea7n \u0111\u1ea3m b\u1ea3o c\u00e2n b\u1eb1ng \u00e2m. \u0110i\u1ec1u n\u00e0y c\u00f3 ngh\u0129a l\u00e0 l\u01b0\u1ee3ng n\u01b0\u1edbc \u0111\u01b0a v\u00e0o (\u0103n u\u1ed1ng, truy\u1ec1n d\u1ecbch\u2026) ph\u1ea3i \u00edt h\u01a1n l\u01b0\u1ee3ng n\u01b0\u1edbc th\u1ea3i ra (n\u01b0\u1edbc ti\u1ec3u, ph\u00e2n, ch\u1ea5t n\u00f4n, m\u1ed3 h\u00f4i, h\u01a1i th\u1edf, da, chuy\u1ec3n h\u00f3a\u2026).<\/li>\n<li>L\u1ee3i ti\u1ec3u quai m\u1ea1nh th\u1ea3i K+.<\/li>\n<li>Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p SUY TH\u1eacN C\u1ea4P tr\u01b0\u1edbc th\u1eadn (m\u1ea5t n\u01b0\u1edbc, m\u1ea5t m\u00e1u) c\u1ea7n ph\u1ea3i ti\u1ebfn h\u00e0nh truy\u1ec1n \u0111\u1ee7 d\u1ecbch ho\u1eb7c m\u00e1u \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o t\u0103ng nhanh huy\u1ebft \u00e1p \u0111\u1ec3 tr\u00e1nh nguy c\u01a1 d\u1eabn \u0111\u1ebfn SUY TH\u1eacN C\u1ea4P t\u1ea1i th\u1eadn.<\/li>\n<\/ul>\n<p>\u0110i\u1ec1u tr\u1ecb t\u0103ng K+ m\u00e1u:<\/p>\n<p>H\u1ea1n ch\u1ebf t\u0103ng K+ m\u00e1u th\u1ee9c \u0103n rau qu\u1ea3 nhi\u1ec1u K+, thu\u1ed1c, d\u1ecbch truy\u1ec1n c\u00f3 K+.<\/p>\n<ul>\n<li>Lo\u1ea1i b\u1ecf c\u00e1c \u1ed5 ho\u1ea1i t\u1eed, ch\u1ed1ng nhi\u1ec5m khu\u1ea9n.<\/li>\n<li>Thu\u1ed1c t\u0103ng th\u1ea3i K+: l\u1ee3i ti\u1ec3u quai, glucose ph\u1ed1i h\u1ee3p insulin, calci gluconat.<\/li>\n<\/ul>\n<p>H\u1ea1n ch\u1ebf t\u0103ng ure m\u00e1u: ch\u1ebf \u0111\u1ed9 \u0103n gi\u1ea3m protein v\u00e0 lo\u1ea1i b\u1ecf \u1ed5 nhi\u1ec5m khu\u1ea9n Ch\u1ed1ng toan m\u00e1u<\/p>\n<p>Ch\u1ec9 \u0111\u1ecbnh l\u1ecdc m\u00e1u c\u1ea5p c\u1ee9u:<\/p>\n<ul>\n<li>Kh\u00f4ng \u0111\u00e1p \u1ee9ng c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u0103ng K+ m\u00e1u (K+ m\u00e1u &gt; 6,5 mmol\/1).<\/li>\n<li>Khi c\u00f3 bi\u1ec3u hi\u1ec7n toan m\u00e1u chuy\u1ec3n ho\u00e1 r\u00f5 pH&lt; 7,2 (khi ure &gt; 30 mmol\/l, creatinin &gt; 600 pmol\/1).<\/li>\n<li>Th\u1eeba d\u1ecbch n\u1eb7ng g\u00e2y ph\u00f9 ph\u1ed5i c\u1ea5p ho\u1eb7c d\u1ecda ph\u00f9 ph\u1ed5i c\u1ea5p.<\/li>\n<\/ul>\n<h4 id=\"5-3-3-giai-doan-dai-tro-lai\">5.3.3. Giai \u0111o\u1ea1n \u0111\u00e1i tr\u1edf l\u1ea1i<\/h4>\n<p>Ch\u1ee7 y\u1ebfu l\u00e0 c\u00e2n b\u1eb1ng n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i.<\/p>\n<h4 id=\"5-3-4-giai-doan-phuc-hoi-chuc-nang\">5.3.4. Giai \u0111o\u1ea1n ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng<\/h4>\n<ul>\n<li>Ch\u1ebf \u0111\u1ed9 \u0103n c\u1ea7n t\u0103ng protein khi ure m\u00e1u \u0111\u00e3 v\u1ec1 m\u1ee9c b\u00ecnh th\u01b0\u1eddng.<\/li>\n<li>Theo d\u00f5i \u0111\u1ecbnh k\u1ef3 theo ch\u1ec9 d\u1eabn th\u1ea7y thu\u1ed1c.<\/li>\n<li>Ti\u1ebfp t\u1ee5c ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n n\u1ebfu x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n. Ch\u00fa \u00fd c\u00e1c nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh (ch\u1eb3ng h\u1ea1n b\u1ec7nh l\u00fd c\u1ea7u th\u1eadn, b\u1ec7nh l\u00fd k\u1ebd th\u1eadn)<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>T\u00e1c gi\u1ea3: PGS.TS. L\u00ea Th\u1ecb Luy\u1ebfn, TS.BS. L\u00ea Th\u1ecb H\u1eb1ng, TS.BS. Nguy\u1ec5n Th\u1ecb H\u01b0\u01a1ng Giang, ThS.BS. Phan Th\u1ecb T\u1ed1 Nh\u01b0, ThS.BS. Tr\u1ea7n Th\u1ecb Thanh Huy\u1ec1n B\u00e0i vi\u1ebft\u00a0Suy th\u1eadn c\u1ea5p: \u0110\u1ecbnh ngh\u0129a, tri\u1ec7u ch\u1ee9ng, \u0111i\u1ec1u tr\u1ecb\u00a0\u0111\u01b0\u1ee3c tr\u00edch trong ch\u01b0\u01a1ng 5 s\u00e1ch B\u1ec7nh h\u1ecdc (t\u00e1i b\u1ea3n l\u1ea7n th\u1ee9 hai n\u0103m 2021, c\u00f3 s\u1eeda ch\u1eefa b\u1ed5 sung), Nh\u00e0 [&#8230;]\n","protected":false},"author":1,"featured_media":32007,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-32005","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\/32005","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=32005"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/32005\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/32007"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=32005"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=32005"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=32005"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}