{"id":34785,"date":"2022-11-27T15:35:18","date_gmt":"2022-11-27T08:35:18","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=34785"},"modified":"2022-11-27T15:47:05","modified_gmt":"2022-11-27T08:47:05","slug":"danh-gia-dieu-tri-nhiem-trung-huyet-va-soc-nhiem-trung","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/danh-gia-dieu-tri-nhiem-trung-huyet-va-soc-nhiem-trung\/","title":{"rendered":"\u0110\u00e1nh gi\u00e1 – \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng huy\u1ebft v\u00e0 s\u1ed1c nhi\u1ec5m tr\u00f9ng"},"content":{"rendered":"

Bi\u00ean d\u1ecbch: B\u00e1c s\u0129 Nguy\u1ec5n Ho\u00e0ng L\u1ed9c<\/em><\/p>\n

vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft \u0110\u00e1nh gi\u00e1 – \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng huy\u1ebft v\u00e0 s\u1ed1c nhi\u1ec5m tr\u00f9ng<\/a>,\u00a0<\/strong>xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y<\/a>.<\/p>\n

\u0110i\u1ec3m m\u1edbi<\/h2>\n
Vi\u1ec7c xu\u1ed1ng thang d\u1ecbch truy\u1ec1n trong nhi\u1ec5m khu\u1ea9n huy\u1ebft (c\u1eadp nh\u1eadt th\u00e1ng 6 n\u0103m 2022). Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n v\u1edbi sepsis, c\u00f3 m\u1ed9t s\u1ed1 h\u01b0\u1edbng d\u1eabn \u0111\u1ec1 c\u1ea5p \u0111\u1ebfn vi\u1ec7c khi n\u00e0o v\u00e0 xu\u1ed1ng thang truy\u1ec1n d\u1ecbch nh\u01b0 th\u1ebf n\u00e0o sau khi \u0111\u00e3 qua pha h\u1ed3i s\u1ee9c ban \u0111\u1ea7u. Trong m\u1ed9t nghi\u00ean c\u1ee9u (ki\u1ec3u trial) g\u1ea7n \u0111\u00e2y, tr\u00ean 1.500 b\u1ec7nh nh\u00e2n, m\u1ed5i b\u1ec7nh nh\u00e2n \u0111\u1ec1u \u0111\u01b0\u1ee3c truy\u1ec1n \u00edt nh\u1ea5t 1 l\u00edt d\u1ecbch v\u00e0 th\u1eddi \u0111i\u1ec3m l\u00e0 trong v\u00f2ng 12 ti\u1ebfng k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t s\u1ed1c, ng\u01b0\u1eddi ta quan s\u00e1t th\u1ea5y c\u00e1c b\u1ec7nh nh\u00e2n thu\u1ed9c nh\u00f3m truy\u1ec1n d\u1ecbch h\u1ea1n ch\u1ebf (v\u00ed d\u1ee5 nh\u01b0 ng\u01b0ng truy\u1ec1n, ho\u1eb7c bolus m\u1ed9t l\u01b0\u1ee3ng d\u1ecbch nh\u1ecf khi c\u1ea7n t\u01b0\u1edbi m\u00e1u c\u01a1 quan, l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u \u00edt), khi so v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n truy\u1ec1n d\u1ecbch chu\u1ea9n th\u00ec kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t g\u00ec v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong 90 ng\u00e0y c\u0169ng nh\u01b0 s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5. Ch\u00ednh v\u00ec th\u1ebf, c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y \u1ee7ng h\u1ed9 th\u00eam cho c\u00e1c chi\u1ebfn l\u01b0\u1ee3c ti\u1ebfp c\u1eadn ki\u1ec3u h\u1ea1n ch\u1ebf d\u1ecbch \u0111\u1ec3 xu\u1ed1ng thang d\u1ecbch truy\u1ec1n. Tuy nhi\u00ean, th\u1ec3 t\u00edch d\u1ecbch \u0111\u00e3 s\u1eed d\u1ee5ng \u0111\u1ec3 truy\u1ec1n trong c\u00e1c b\u1ec7nh nh\u00e2n c\u1ea3 2 nh\u00f3m trong c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y th\u00ec th\u1ea5p h\u01a1n c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 h\u1ed3i s\u1ee9c d\u1ecbch s\u1edbm trong sepsis \u0111\u00e3 b\u00e1o c\u00e1o tr\u01b0\u1edbc \u0111\u00e2y, \u0111\u00e3 \u0111\u01b0a ra nhi\u1ec1u nghi ng\u1ea1i r\u1eb1ng, trong th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng, vi\u1ec7c ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb sepsis theo ki\u1ec3u xu\u1ed1ng thang d\u1ecbch truy\u1ec1n cho \u0111\u1ebfn nay v\u1eabn c\u00f2n nhi\u1ec1u m\u1eb7t h\u1ea1n ch\u1ebf. V\u00e0 ch\u00ednh v\u00ec th\u1ebf, trong t\u01b0\u01a1ng lai s\u1ebd c\u1ea7n nhi\u1ec1u nghi\u00ean c\u1ee9u h\u01a1n n\u1eefa \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn truy\u1ec1n d\u1ecbch sau pha h\u1ed3i s\u1ee9c tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n sepsis.<\/p>\n
Gi\u1edbi thi\u1ec7u<\/h2>\n
Sepsis l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u1eb7c tr\u01b0ng b\u1eb1ng s\u1ef1 vi\u00eam h\u1ec7 th\u1ed1ng g\u00e2y ra do nhi\u1ec5m tr\u00f9ng. C\u00f3 m\u1ed9t s\u1ef1 ti\u1ebfp n\u1ed1i li\u00ean t\u1ee5c gi\u1eefa sepsis v\u00e0 septic s\u1ed1c. M\u1eb7c d\u00f9, c\u00e1c nghi\u00ean c\u1ee9u c\u00f3 nhi\u1ec1u \u0111i\u1ec3m kh\u00e1c nhau nh\u01b0ng nh\u00ecn chung th\u00ec t\u1ef7 l\u1ec7 t\u1eed vong \u01b0\u1edbc t\u00ednh l\u00e0 >10% v\u1edbi sepsis, v\u00e0 con s\u1ed1 n\u00e0y s\u1ebd >40% khi c\u00f3 t\u00ecnh tr\u1ea1ng s\u1ed1c xu\u1ea5t hi\u1ec7n.<\/p>\n
Trong b\u00e0i n\u00e0y, \u0111i\u1ec1u tr\u1ecb sepsis v\u00e0 septic s\u1ed1c s\u1ebd \u0111\u01b0\u1ee3c \u0111em ra b\u00e0n lu\u1eadn. Ti\u1ebfp c\u1eadn c\u1ee7a ch\u00fang t\u00f4i nh\u1ea5t qu\u00e1n v\u1edbi c\u00e1c h\u01b0\u1edbng d\u1eabn c\u1ee7a Surviving Sepsis Campaign \u0111\u01b0\u1ee3c ban h\u00e0nh v\u00e0o n\u0103m 2021.<\/p>\n
Trong khi hi\u1ec7n t\u1ea1i ch\u00fang ta s\u1eed d\u1ee5ng c\u00e1c \u0111\u1ecbnh ngh\u0129a c\u1ee7a Society of Critical Care Medicine (SCCM)\/European Society of Intensive Care Medicine (ESICM), c\u00e1c \u0111\u1ecbnh ngh\u0129a n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c c\u00e1c h\u1ed9i, \u0111\u1ed3ng thu\u1eadn ch\u1ea5p nh\u1eadn. V\u00ed d\u1ee5 nh\u01b0 trong khi Center for Medicare and Medicaid Services (CMS) v\u1eabn gi\u1eef s\u1ef1 \u1ee7ng h\u1ed9 cho c\u00e1c \u0111\u1ecbnh ngh\u0129a tr\u01b0\u1edbc \u0111\u00e2y khi ch\u1ea5p nh\u1eadn c\u00e1c kh\u00e1i ni\u1ec7m nh\u01b0 h\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n (SIRS), nhi\u1ec5m tr\u00f9ng huy\u1ebft, nhi\u1ec5m tr\u00f9ng huy\u1ebft n\u1eb7ng. Th\u00ec Infectious Diseases Society of America (IDSA) \u0111\u00e3 ch\u1ec9 ra vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c \u0111\u1ecbnh ngh\u0129a kh\u00e1i ni\u1ec7m v\u1eeba n\u00eau, b\u00ean c\u1ea1nh vi\u1ec7c c\u1ee9u m\u1ea1ng nh\u1eefng tr\u01b0\u1eddng h\u1ee3p s\u1ed1c th\u1eadt s\u1ef1, th\u00ec c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn m\u1ed9t bi\u1ebfn c\u1ed1 t\u1ea1m g\u1ecdi l\u00e0 \u0111i\u1ec1u tr\u1ecb qu\u00e1 tay kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n sepsis b\u1ec7nh nh\u1eb9 h\u01a1n.<\/p>\n
\u0110\u00e1nh gi\u00e1 c\u1ea5p c\u1ee9u v\u00e0 \u0111i\u1ec1u tr\u1ecb ngay<\/h2>\n
Vi\u1ec7c \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1eddng th\u1edf (n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh) v\u00e0 \u0111i\u1ec1u ch\u1ec9nh l\u1ea1i t\u00ecnh tr\u1ea1ng gi\u1ea3m oxy m\u00e1u \u0111i k\u00e8m v\u1edbi vi\u1ec7c truy\u1ec1n d\u1ecbch s\u1edbm v\u00e0 kh\u00e1ng sinh l\u00e0 c\u00e1c \u01b0u ti\u00ean trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb sepsis c\u0169ng nh\u01b0 septic s\u1ed1c.<\/p>\n
\u1ed4n \u0111\u1ecbnh h\u00f4 h\u1ea5p<\/h3>\n
H\u1ed7 tr\u1ee3 oxy n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n sepsis c\u00f3 ch\u1ec9 \u0111\u1ecbnh. SpO2 l\u00fd t\u01b0\u1edfng tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y th\u00ec cho t\u1edbi nay v\u1eabn ch\u01b0a bi\u1ebft ch\u00ednh x\u00e1c, nh\u01b0ng ch\u00fang t\u00f4i th\u01b0\u1eddng mu\u1ed1n \u0111\u1ea1t m\u1ed9t m\u1ee5c ti\u00eau SpO2 r\u01a1i v\u00e0o 90-96%.<\/p>\n
Thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch<\/h3>\n
\u0110\u01b0\u1eddng truy\u1ec1n n\u00ean \u0111\u01b0\u1ee3c \u0111\u1eb7t ngay khi c\u00f3 th\u1ec3 tr\u00ean b\u1ec7nh nh\u00e2n nghi ng\u1edd sepsis. Trong khi \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch ngo\u1ea1i bi\u00ean c\u00f3 th\u1ec3 l\u00e0 \u0111\u00e3 \u0111\u1ee7 cho v\u00e0i b\u1ec7nh nh\u00e2n, \u0111\u1eb7c bi\u1ec7t trong pha h\u1ed3i s\u1ee9c ban \u0111\u1ea7u, th\u00ec ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n s\u1ebd c\u1ea7n \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch trung t\u00e2m trong v\u00e0i th\u1eddi \u0111i\u1ec3m xuy\u00ean su\u1ed1t qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb sepsis c\u1ee7a h\u1ecd. Catheter t\u0129nh m\u1ea1ch trung t\u00e2m c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 truy\u1ec1n d\u1ecbch, kh\u00e1ng sinh v\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch, c\u0169ng nh\u01b0 r\u00fat m\u00e1u \u0111\u1ec3 th\u01b0\u1eddng qui l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m, \u0111\u1ed3ng th\u1eddi c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb th\u00f4ng qua CVP v\u00e0 ScvO2, nh\u01b0ng b\u1eb1ng ch\u1ee9ng trong c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean ch\u1ec9 ra c\u00e1c ch\u1ec9 s\u1ed1 n\u00e0y c\u00f2n nhi\u1ec1u h\u1ea1n ch\u1ebf.<\/p>\n
C\u00e1c x\u00e9t nghi\u1ec7m ban \u0111\u1ea7u<\/h3>\n
M\u1ed9t b\u1ec7nh s\u1eed k\u1ef9 c\u00e0ng c\u00f9ng v\u1edbi c\u00e1c x\u00e9t nghi\u1ec7m vi sinh v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ed3ng th\u1eddi trong khi \u1ed5n d\u1ecbnh \u0111\u01b0\u1eddng th\u1edf. C\u00e1c \u0111\u00e1nh gi\u00e1 n\u00e0y s\u1ebd gi\u00fap khoanh v\u00f9ng ngu\u1ed3n sepsis v\u00e0 s\u1ebd gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng kh\u00e1ng sinh ph\u00f9 h\u1ee3p.<\/p>\n
Th\u1ef1c hi\u1ec7n nhanh c\u00e1c \u0111i\u1ec3m sau \u0111\u00e2y (l\u00fd t\u01b0\u1edfng l\u00e0 trong v\u00f2ng 45 ph\u00fat t\u1eeb l\u00fac nh\u1eadp vi\u1ec7n), nh\u01b0ng d\u00f9 g\u00ec \u0111i n\u1eefa c\u0169ng kh\u00f4ng \u0111\u01b0\u1ee3c tr\u00ec ho\u00e3n s\u1eed d\u1ee5ng kh\u00e1ng sinh v\u00e0 d\u1ecbch truy\u1ec1n s\u1edbm:<\/p>\n
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C\u00f4ng th\u1ee9c m\u00e1u, sinh h\u00f3a gan th\u1eadn, \u0111\u00f4ng c\u1ea7m m\u00e1u bao g\u1ed3m c\u1ea3 D-dimer.<\/li>\n
Lactate m\u00e1u \u2013 t\u0103ng ( v\u00ed d\u1ee5 > 2 mmol\/L, ho\u1eb7c t\u0103ng tr\u00ean gi\u1edbi h\u1ea1n tr\u00ean t\u00f9y v\u00e0o ph\u00f2ng x\u00e9t nghi\u1ec7m) c\u00f3 th\u1ec3 ch\u1ec9 ra \u0111\u1ed9 n\u1eb7ng c\u1ee7a sepsis v\u00e0 \u0111\u1ed3ng th\u1eddi gi\u00fap theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb.<\/li>\n
C\u1ea5y m\u00e1u ngo\u1ea1i bi\u00ean (c\u1ea5y \u00e1i kh\u00ed v\u00e0 k\u1ef5 kh\u00ed t\u1eeb \u00edt nh\u1ea5t 2 v\u1ecb tr\u00ed), n\u01b0\u1edbc ti\u1ec3u, c\u1ea5y vi sinh t\u1eeb ngu\u1ed3n nghi ng\u1edd (\u0111\u00e0m,da, catheter, d\u1ecbch c\u01a1 th\u1ec3\u2026). Vi\u1ec7c r\u00fat m\u00e1u t\u1eeb catheter t\u0129nh m\u1ea1ch trung t\u00e2m \u0111\u1ec3 c\u1ea5y n\u00ean tr\u00e1nh v\u00ec c\u00e1c ch\u1ee7ng \u1edf \u0111\u1ea7u catheter th\u01b0\u1eddng c\u00f9ng ch\u1ee7ng v\u1edbi da, n\u00ean s\u1ebd t\u0103ng kh\u1ea3 n\u0103ng d\u01b0\u01a1ng t\u00ednh gi\u1ea3. N\u1ebfu \u0111\u00e3 r\u00fat m\u00e1u c\u1ea5y th\u00f4ng qua m\u1ed9t \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch, th\u00ec v\u1ecb tr\u00ed th\u1ee9 2 n\u00ean t\u1eeb vi\u1ec7c \u0111\u00e2m kim tr\u1ef1c ti\u1ebfp v\u00e0o t\u0129nh m\u1ea1ch.\n
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T\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c c\u1ea5y m\u00e1u s\u1edbm \u0111\u01b0\u1ee3c ch\u1ee9ng minh r\u00f5 nh\u1ea5t trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111a trung t\u00e2m v\u1edbi 325 b\u1ec7nh nh\u00e2n nghi ng\u1edd ho\u1eb7c \u0111\u00e3 x\u00e1c \u0111\u1ecbnh \u1ed5 nhi\u1ec5m v\u00e0 c\u00f3 t\u1ee5t huy\u1ebft \u00e1p ho\u1eb7c lactate m\u00e1u t\u0103ng tr\u00ean 4 mmol\/L. \u0110\u01b0\u1ee3c chia th\u00e0nh 2 nh\u00f3m, m\u1ed9t nh\u00f3m l\u1ea5y m\u00e1u tr\u01b0\u1edbc d\u00f9ng kh\u00e1ng sinh, nh\u00f3m c\u00f2n l\u1ea1i l\u1ea5y t\u1ea1i th\u1eddi \u0111i\u1ec3m trong 4 gi\u1edd sau khi d\u00f9ng kh\u00e1ng sinh. C\u1ea5y m\u1ecdc xu\u1ea5t hi\u1ec7n \u1edf nh\u00f3m tr\u01b0\u1edbc khi d\u00f9ng kh\u00e1ng sinh nhi\u1ec1u h\u01a1n nh\u00f3m c\u1ea5y sau d\u00f9ng kh\u00e1ng sinh (31.4% so v\u1edbi 19.4%).<\/li>\n<\/ul>\n<\/li>\n
Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch<\/li>\n
H\u00ecnh \u1ea3nh h\u1ecdc nh\u1eafm v\u00e0o \u1ed5 nhi\u1ec5m \u0111ang nghi ng\u1edd<\/li>\n
Procalcitonin \u2013 Trong khi gi\u00e1 tr\u1ecb c\u1ee7a procalcitonin trong ch\u1ea9n \u0111o\u00e1n sepsis c\u00f2n t\u01b0\u01a1ng \u0111\u1ed1i y\u1ebfu qua c\u00e1c nghi\u00ean c\u1ee9u, th\u00ec n\u00f3 v\u1eabn c\u00f3 gi\u00e1 tr\u1ecb cao \u0111\u1ec3 theo d\u00f5i nh\u1eb1m xu\u1ed1ng thang kh\u00e1ng sinh, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong nh\u00f3m b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng ho\u1eb7c nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p, c\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u ch\u1ec9 ra vai tr\u00f2 c\u1ee7a procalcitonin trong vi\u1ec7c h\u01b0\u1edbng d\u1eabn th\u1eddi gian d\u00f9ng kh\u00e1ng sinh trong nh\u00f3m b\u1ec7nh nh\u00e2n v\u1eeba n\u00eau, c\u00f2n \u0111\u1ed1i v\u1edbi c\u00e1c nh\u00f3m b\u1ec7nh nh\u00e2n nhi\u1ec5m khu\u1ea9n t\u1eeb c\u00e1c v\u1ecb tr\u00ed kh\u00e1c th\u00ec nghi\u00ean c\u1ee9u v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng.<\/li>\n<\/ul>\n
Li\u1ec7u ph\u00e1p h\u1ed3i s\u1ee9c ban \u0111\u1ea7u<\/h2>\n
N\u1ec1n t\u1ea3ng \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c li\u1ec7u ph\u00e1p h\u1ed3i s\u1ee9c ban \u0111\u1ea7u \u0111\u00f3 l\u00e0 ph\u1ea3i nhanh ch\u00f3ng \u0111\u1ea3m b\u1ea3o t\u00e1i t\u01b0\u1edbi m\u00e1u v\u00e0 s\u1eed d\u1ee5ng kh\u00e1ng sinh c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t.<\/p>\n
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T\u00e1i t\u01b0\u1edbi m\u00e1u \u0111\u1ea1t \u0111\u01b0\u1ee3c c\u1ea5p k\u1ef3 b\u1eb1ng c\u00e1ch truy\u1ec1n d\u1ecbch t\u00edch c\u1ef1c, s\u1eed d\u1ee5ng d\u1ecbch tinh th\u1ec3 v\u1edbi li\u1ec1u l\u01b0\u1ee3ng 30 mL\/kg (c\u00e2n n\u1eb7ng th\u1eadt), kh\u1edfi \u0111\u1ed9ng trong v\u00f2ng 1 gi\u1edd v\u00e0 ho\u00e0n th\u00e0nh trong 3 gi\u1edd k\u1ec3 t\u1eeb l\u00fac nh\u1eadp vi\u1ec7n.<\/li>\n
Kh\u00e1ng sinh kinh nghi\u1ec7m nh\u1eafm v\u00e0o t\u00e1c nh\u00e2n nghi ng\u1edd \u0111\u01b0\u1ee3c \u01b0u ti\u00ean trong 1 gi\u1edd \u0111\u1ea7u k\u1ec3 t\u1eeb l\u00fac nh\u1eadp vi\u1ec7n.<\/li>\n<\/ul>\n
Ti\u1ebfp c\u1eadn c\u1ee7a ch\u00fang t\u00f4i d\u1ef1a v\u00e0o nhi\u1ec1u nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean l\u1edbn m\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 l\u00e0 protocol \u0111i\u1ec1u tr\u1ecb (v\u00ed d\u1ee5 nh\u01b0 li\u1ec7u ph\u00e1p nh\u1eafm tr\u00fang \u0111\u00edch s\u1edbm trong \u0111i\u1ec1u tr\u1ecb sepsis early goal-directed therapy [EGDT]). C\u00e1c th\u00e0nh t\u1ed1 c\u1ee7a protocol n\u00e0y th\u01b0\u1eddng g\u1ed3m: kh\u00e1ng sinh v\u00e0 d\u1ecbch truy\u1ec1n s\u1edbm (1-6 gi\u1edd \u0111\u1ea7u) v\u00e0 s\u1eed d\u1ee5ng c\u00e1c ch\u1ec9 s\u1ed1 \u0111\u1ec3 theo d\u00f5i \u0111\u00e1p \u1ee9ng nh\u01b0: \u0111\u1ed9 b\u00e3o h\u00f2a oxy t\u0129nh m\u1ea1ch trung t\u00e2m (ScvO2) \u226570%, CVP 8 to 12 mmHg, (MAP) \u226565 mmHg, v\u00e0 th\u1ec3 t\u00edch n\u01b0\u1edbc ti\u1ec3u \u22650.5 mL\/kg\/hour.<\/p>\n
T\u1ea7m quan tr\u1ecdng c\u1ee7a s\u1eed d\u1ee5ng kh\u00e1ng sinh ch\u1ea1y \u0111ua theo th\u1eddi gian \u0111\u00e3 \u0111\u01b0\u1ee3c nh\u1ea5n m\u1ea1nh trong m\u1ed9t d\u1eef li\u1ec7u r\u1ea5t l\u1edbn v\u1edbi 50.000 b\u1ec7nh nh\u00e2n sepsis v\u00e0 septic s\u1ed1c v\u1edbi c\u00e1c g\u00f3i \u0111i\u1ec1u tr\u1ecb kh\u00e1c nhau. Ng\u01b0\u1eddi ta th\u1ea5y r\u1eb1ng c\u00e1c b\u1ec7nh nh\u00e2n ho\u00e0n th\u00e0nh \u201cg\u00f3i 3 gi\u1edd\u201d trong v\u00f2ng 3 gi\u1edd \u0111\u1ed5 l\u1ea1i c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong sau \u0111\u00f3 th\u1ea5p h\u01a1n nh\u1eefng b\u1ec7nh nh\u00e2n c\u0169ng ho\u00e0n th\u00e0nh \u201cg\u00f3i 3 gi\u1edd\u201d nh\u01b0ng v\u1edbi th\u1eddi gian l\u00e2u h\u01a1n.<\/p>\n
D\u1ecbch truy\u1ec1n (3 gi\u1edd \u0111\u1ea7u)<\/h3>\n
Th\u1ec3 t\u00edch \u2013 gi\u1ea3m th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch kh\u00e1 \u0111i\u1ec3n h\u00ecnh v\u00e0 c\u00f3 th\u1ec3 n\u1eb7ng trong b\u1ec7nh nh\u00e2n sepsis. Truy\u1ec1n m\u1ed9t l\u01b0\u1ee3ng d\u1ecbch nhanh v\u00e0 nhi\u1ec1u (30 mL\/kg) \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh nh\u01b0 l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n sepsis v\u00e0 septic s\u1ed1c, n\u1ebfu nh\u01b0 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng c\u1ee7a ph\u00f9 ph\u1ed5i. Tuy nhi\u00ean, m\u1ed9t v\u00e0i b\u1ec7nh nh\u00e2n s\u1ebd c\u1ea7n m\u1ed9t l\u01b0\u1ee3ng d\u1ecbch l\u1edbn h\u01a1n khuy\u1ebfn c\u00e1o, \u0111\u1eb7c bi\u1ec7t l\u00e0 tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c ch\u1ec9 d\u1ea5u \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng ho\u1eb7c huy\u1ebft \u0111\u1ed9ng c\u1ee7a vi\u1ec7c truy\u1ec1n d\u1ecbch.<\/p>\n
Truy\u1ec1n d\u1ecbch n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhanh (vd 500 mL), bolus nhanh. C\u00e1c \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng v\u00e0 huy\u1ebft \u0111\u1ed9ng c\u0169ng nh\u01b0 s\u1ef1 xu\u1ea5t hi\u1ec7n ho\u1eb7c kh\u00f4ng xu\u1ea5t hi\u1ec7n c\u1ee7a ph\u00f9 ph\u1ed5i n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc v\u00e0 sau m\u1ed5i l\u1ea7n bolus d\u1ecbch. Th\u1eed th\u00e1ch d\u1ecbch c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1eb7p l\u1ea1i cho \u0111\u1ebfn khi huy\u1ebft \u00e1p v\u00e0 t\u01b0\u1edbi m\u00e1u m\u00f4 \u0111\u1ea1t \u0111\u01b0\u1ee3c, ho\u1eb7c khi ph\u00f9 ph\u1ed5i xu\u1ea5t hi\u1ec7n.<\/p>\n
Ch\u1ecdn l\u1ef1a d\u1ecbch ph\u00f9 h\u1ee3p \u2013 C\u00e1c b\u1eb1ng ch\u1ee9ng t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u kh\u00f4ng t\u00ecm th\u1ea5y c\u00f3 m\u1ed9t s\u1ef1 xung \u0111\u1ed9t n\u00e0o (k\u1ec3 c\u1ea3 t\u1ef7 l\u1ec7 t\u1eed vong) gi\u1eefa d\u1ecbch albumin v\u00e0 d\u1ecbch tinh th\u1ec3 trong \u0111i\u1ec1u tr\u1ecb sepsis hay septic s\u1ed1c. Nh\u01b0ng s\u1ebd l\u00e0 c\u00f3 h\u1ea1i n\u1ebfu s\u1eed d\u1ee5ng d\u1ecbch pentastarch ho\u1eb7c hydroxyethyl starch. Kh\u00f4ng c\u00f3 vai tr\u00f2 c\u1ee7a d\u1ecbch cao ph\u00e2n t\u1eed.<\/p>\n
\u0110i\u1ec1u tr\u1ecb nhi\u1ec5m toan chuy\u1ec3n h\u00f3a \u2013 \u0111i\u1ec1u tr\u1ecb v\u1edbi bicarbonate<\/p>\n
Li\u1ec7u ph\u00e1p kh\u00e1ng sinh kinh nghi\u1ec7m (1 gi\u1edd \u0111\u1ea7u) \u2013<\/p>\n
X\u00e1c \u0111\u1ecbnh \u1ed5 nhi\u1ec5m nghi ng\u1edd – ngo\u00e0i vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh theo v\u1ecb tr\u00ed nhi\u1ec5m tr\u00f9ng nghi ng\u1edd th\u00ec nhi\u1ec5m tr\u00f9ng c\u00e1c khoang l\u1eadn c\u1eadn c\u0169ng n\u00ean \u0111\u01b0\u1ee3c c\u1eaft l\u1ecdc ho\u1eb7c d\u1eabn l\u01b0u (v\u00ed d\u1ee5 nh\u01b0 abcess) \u0111\u1ec3 c\u00f3 th\u1ec3 ki\u1ec3m so\u00e1t hi\u1ec7u qu\u1ea3 \u1ed5 nhi\u1ec5m.<\/p>\n
Th\u1eddi gian \u2013 M\u1ed9t khi \u0111\u00e3 cho r\u1eb1ng b\u1ec7nh nh\u00e2n b\u1ecb sepsis, li\u1ec1u t\u1ed1i \u01b0u kh\u00e1ng sinh t\u0129nh m\u1ea1ch n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ngay, l\u00fd t\u01b0\u1edfng nh\u1ea5t l\u00e0 1h \u0111\u1ea7u t\u1eeb khi nh\u1eadp vi\u1ec7n v\u00e0 sau khi \u0111\u00e3 c\u1ea5y. \u0110i\u1ec1u n\u00e0y l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c th\u1eadt s\u1ef1 v\u00ec n\u00f3 ph\u1ee5 thu\u1ed9c nhi\u1ec1u y\u1ebfu t\u1ed1 v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ch\u1eadm tr\u1ec5 kh\u00e1ng sinh ph\u00f9 h\u1ee3p. Tuy nhi\u00ean, khung th\u1eddi gian c\u1ee9ng nh\u1eafc 1 gi\u1edd \u0111\u1ea7u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng
\nsinh qu\u00e1 tay v\u00e0 kh\u00f4ng ph\u00f9 h\u1ee3p. IDSA mu\u1ed1n lo\u1ea1i b\u1ecf khuy\u1ebfn c\u00e1o vi\u1ec7c g\u01b0\u1ee3ng \u00e9p \u00e1p d\u1ee5ng khung th\u1eddi gian t\u1ed1i thi\u1ec3u chuy\u00ean bi\u1ec7t v\u00e0 thay v\u00e0o \u0111\u00f3 l\u00e0 c\u00e1c khuy\u1ebfn c\u00e1o linh \u0111\u1ed9ng h\u01a1n h\u01b0\u1edbng \u0111\u1ebfn d\u00f9ng kh\u00e1ng sinh ngay khi cho r\u1eb1ng c\u00f3 sepsis d\u1ef1a v\u00e0o ch\u1ea9n \u0111o\u00e1n c\u1ee7a c\u00e1c b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb.<\/p>\n
Ch\u1ecdn kh\u00e1ng sinh \u2013 vi\u1ec7c ch\u1ecdn s\u1eed d\u1ee5ng kh\u00e1ng sinh n\u00e0o c\u00f3 th\u1ec3 kh\u00e1 kh\u00f3 v\u00e0 n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t d\u1ef1a v\u00e0o b\u1ec7nh s\u1eed (v\u00ed d\u1ee5 nh\u01b0 ti\u1ec1n s\u1eed d\u00f9ng kh\u00e1ng sinh g\u1ea7n \u0111\u00e2y, nhi\u1ec5m vi sinh tr\u01b0\u1edbc \u0111\u00f3), b\u1ec7nh \u0111\u1ed3ng m\u1eafc, suy gi\u1ea3m mi\u1ec5n d\u1ecbch, m\u00f4i tr\u01b0\u1eddng m\u1eafc (c\u1ed9ng \u0111\u1ed3ng hay b\u1ec7nh vi\u1ec7n), \u1ed5 nhi\u1ec5m nghi ng\u1edd, s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a c\u00e1c thi\u1ebft b\u1ecb x\u00e2m l\u1ea5n, k\u1ebft qu\u1ea3 nhu\u1ed9m Gram, v\u00e0 t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh c\u1ee7a vi khu\u1ea9n. Nguy\u00ean l\u00fd c\u1ee7a vi\u1ec7c ch\u1ecdn l\u1ef1a kh\u00e1ng sinh s\u1ebd \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y d\u01b0\u1edbi \u0111\u00e2y nh\u01b0ng vi\u1ec7c ch\u1ecdn l\u1ef1a v\u1eabn c\u1ea7n ph\u1ea3i theo c\u00e1 nh\u00e2n h\u00f3a m\u1ed5i b\u1ec7nh nh\u00e2n.<\/p>\n
V\u1edbi h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n sepsis m\u00e0 ch\u01b0a \u0111\u1ebfn s\u1ed1c, ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb v\u1edbi m\u1ed9t ho\u1eb7c nhi\u1ec1u h\u01a1n m\u1ed9t kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng \u0111\u1ec3 ph\u1ee7 t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nguy\u00ean c\u00f3 th\u1ec3 c\u00f3. Vi\u1ec7c ph\u1ee7 n\u00e0y n\u00ean ch\u1ed1ng \u0111\u01b0\u1ee3c c\u1ea3 Gram d\u01b0\u01a1ng v\u00e0 Gram \u00e2m, v\u00e0 n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh th\u00ec n\u00ean ph\u1ee7 lu\u00f4n kh\u00e1ng n\u1ea5m (Candida) v\u00e0 hi\u1ebfm h\u01a1n l\u00e0 virus (influenza). Khi n\u00f3i \u0111\u1ebfn ph\u1ed5 r\u1ed9ng l\u00e0 mu\u1ed1n n\u00f3i \u0111\u1ebfn c\u00e1c thu\u1ed1c c\u00f3 th\u1ec3 ph\u1ee7 c\u1ea3 Gram \u00e2m v\u00e0 Gram d\u01b0\u01a1ng (eg, carbapenem, piperacillin-tazobactam). \u0110\u1ec3 \u0111\u1ea3m b\u1ea3o \u0111i\u1ec1u tr\u1ecb, nhi\u1ec1u b\u1ec7nh nh\u00e2n v\u1edbi s\u1ed1c nhi\u1ec5m tr\u00f9ng, nghi ng\u1edd t\u00e1c nh\u00e2n Gram \u00e2m c\u00f3 th\u1ec3 \u0111\u00f2i h\u1ecfi ph\u1ea3i s\u1eed d\u1ee5ng 2 kh\u00e1ng sinh t\u1eeb 2 nh\u00f3m kh\u00e1c nhau (li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p).<\/p>\n
C\u00e1c m\u1ea7m b\u1ec7nh nh\u01b0 Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, and Streptococcus pneumoniae, l\u00e0 c\u00e1c m\u1ea7m b\u1ec7nh n\u00ean lu\u00f4n \u0111\u01b0\u1ee3c nh\u1edb \u0111\u1ebfn khi s\u1eed d\u1ee5ng kh\u00e1ng sinh.<\/p>\n
Tuy nhi\u00ean, khi t\u00e1c nh\u00e2n kh\u00f4ng r\u00f5 r\u00e0ng, b\u00e1c s\u1ef9 n\u00ean c\u1ea7n l\u01b0u \u00fd \u0111\u1ebfn c\u00e1c m\u1ea7m b\u1ec7nh kh\u00e1c \u0111\u1eb7c bi\u1ec7t khi c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1:<\/p>\n
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Methicillin-resistant S. aureus \u2013 Methicillin-resistant S. aureus (MRSA) \u2013 kh\u00f4ng c\u00f2n l\u00e0 t\u00e1c nh\u00e2n b\u1ec7nh vi\u1ec7n n\u1eefa m\u00e0 c\u00f3 th\u1ec3 l\u00e0 t\u00e1c nh\u00e2n c\u1ed9ng \u0111\u1ed3ng. Ch\u00fang t\u00f4i s\u1ebd s\u1eed d\u1ee5ng Vancomycin truy\u1ec1n (ch\u1ec9nh theo ch\u1ee9c n\u0103ng th\u1eadn) th\u00eam v\u1edbi c\u00e1c kh\u00e1ng sinh kinh nghi\u1ec7m, \u0111\u1eb7c bi\u1ec7t tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n s\u1ed1c, ho\u1eb7c nguy c\u01a1 MRSA. Kh\u00e1ng sinh thay th\u1ebf g\u1ed3m daptomycin (v\u1edbi \u1ed5 nhi\u1ec5m kh\u00f4ng ph\u1ea3i \u1edf ph\u1ed5i), Linezolide n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ebfn khi nhi\u1ec5m MRSA k\u00e9o d\u00e0i dai d\u1eb3ng ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi Vancomycin.<\/li>\n<\/ul>\n
Trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, n\u1ebfu kh\u1ea3 n\u0103ng b\u1ec7nh nguy\u00ean kh\u00f4ng ph\u1ea3i l\u00e0 Pseudomonas, ch\u00fang t\u00f4i \u01b0u ti\u00ean k\u1ebft h\u1ee3p vancomycin v\u1edbi m\u1ed9t trong c\u00e1c kh\u00e1ng sinh sau \u0111\u00e2y:<\/p>\n
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M\u1ed9t Cephalosporin th\u1ebf h\u1ec7 3 (ceftriaxone ho\u1eb7c cefotaxime) ho\u1eb7c 4 (cefepime) ho\u1eb7c<\/li>\n
M\u1ed9t betalactam\/\u1ee9c ch\u1ebf men betalamase nh\u01b0 piperacillin-tazobactam, ho\u1eb7c<\/li>\n
M\u1ed9t kh\u00e1ng sinh nh\u00f3m carbapenem (imipenem ho\u1eb7c meropenem)<\/li>\n<\/ul>\n
Pseudomonas \u2013 m\u1eb7t kh\u00e1c, n\u1ebfu Pseudomonas l\u00e0 t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh nghi ng\u1edd, ch\u00fang t\u00f4i \u01b0u ti\u00ean k\u1ebft h\u1ee3p Vancomycin v\u1edbi m\u1ed9t ho\u1eb7c hai kh\u00e1ng sinh sau \u0111\u00e2y, t\u00f9y v\u00e0o \u0111\u1ed9 nh\u1ea1y kh\u00e1ng sinh c\u1ee7a t\u1eebng v\u00f9ng mi\u1ec1n:<\/p>\n
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Cephalosporin kh\u00e1ng \u0111\u01b0\u1ee3c Pseudomonas (ceftazidime, cefepime)<\/li>\n
Carbapenem kh\u00e1ng \u0111\u01b0\u1ee3c Pseudomonas (imipenem, meropenem), ho\u1eb7c<\/li>\n
M\u1ed9t betalactam\/\u1ee9c ch\u1ebf men betalamase kh\u00e1ng \u0111\u01b0\u1ee3c Pseudomonas (piperacillin-tazobactam) ho\u1eb7c<\/li>\n
M\u1ed9t kh\u00e1ng sinh nh\u00f3m Fluoroquinolone kh\u00e1ng \u0111\u01b0\u1ee3c Pseudomonas t\u1ed1t nh\u01b0 (ciprofloxacin), ho\u1eb7c<\/li>\n
Aminoglycoside (eg, gentamicin, amikacin), ho\u1eb7c<\/li>\n
Monobactam (eg, aztreonam)<\/li>\n<\/ul>\n<\/li>\n
C\u00e1c t\u00e1c nh\u00e2n Gram \u00e2m kh\u00f4ng- Pseudomonas (eg, E. coli, K. pneumoniae) \u2013 Trong qu\u00e1 kh\u1ee9, c\u00e1c b\u1ec7nh nguy\u00ean Gram \u00e2m th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u1ee7 th\u01b0\u1eddng qui b\u1edfi 2 kh\u00e1ng sinh t\u1eeb 2 nh\u00f3m thu\u1ed1c kh\u00e1c nhau. Tuy nhi\u00ean, nhi\u1ec1u nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng v\u00e0 2 ph\u00e2n t\u00edch l\u1edbn \u0111\u00e3 th\u1ea5t b\u1ea1i \u0111\u1ec3 ch\u1ee9ng minh s\u1ef1 v\u01b0\u1ee3t tr\u1ed9i c\u1ee7a vi\u1ec7c k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb so v\u1edbi ch\u1ec9 \u0111\u01a1n tr\u1ecb b\u1eb1ng duy nh\u1ea5t m\u1ed9t kh\u00e1ng sinh nh\u00f3m Cephalosporin ho\u1eb7c m\u1ed9t kh\u00e1ng sinh nh\u00f3m Carbapenem. Th\u00eam n\u1eefa, m\u1ed9t nghi\u00ean c\u1ee9u \u0111\u00e3 ghi nh\u1eadn khi ph\u1ee7 2 kh\u00e1ng sinh m\u00e0 trong \u0111\u00f3 c\u00f3 kh\u00e1ng sinh nh\u00f3m aminoglycosise s\u1ebd l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 xu\u1ea5t hi\u1ec7n c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 (ch\u1eb3ng h\u1ea1n nh\u01b0 \u0111\u1ed9c th\u1eadn). Ch\u00ednh v\u00ec l\u00fd do n\u00e0y, tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n nghi ng\u1edd nhi\u1ec5m t\u00e1c nh\u00e2n Gram \u00e2m, ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng \u0111\u01a1n tr\u1ecb m\u1ed9t kh\u00e1ng sinh hi\u1ec7u qu\u1ea3 duy nh\u1ea5t, v\u00e0 \u00edt g\u00e2y \u0111\u1ed9c nh\u1ea5t, ngo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh nh\u00e2n m\u00e0 c\u00f3 t\u00ecnh tr\u1ea1ng gi\u1ea3m b\u1ea1ch c\u1ea7u ho\u1eb7c c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 sepsis nghi ng\u1edd nhi\u1ec5m Pseudomonas, th\u00ec l\u00fac \u0111\u00f3 li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p kh\u00e1ng sinh c\u00f3 th\u1ec3 xem x\u00e9t.<\/li>\n
Nhi\u1ec5m n\u1ea5m x\u00e2m l\u1ea5n \u2013 \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng qui kh\u00e1ng n\u1ea5m kinh nghi\u1ec7m th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn trong \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh nh\u00e2n n\u1eb7ng m\u00e0 kh\u00f4ng c\u00f3 t\u00ecnh tr\u1ea1ng gi\u1ea3m b\u1ea1ch c\u1ea7u. Nhi\u1ec5m n\u1ea5m x\u00e2m l\u1ea5n r\u1ea5t ph\u1ee9c t\u1ea1p, \u0111\u1eb7c bi\u1ec7t khi b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 nguy c\u01a1 hi\u1ec7n di\u1ec7n: ph\u1eabu thu\u1eadt, dinh d\u01b0\u1ee1ng t\u0129nh m\u1ea1ch, \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh k\u00e9o d\u00e0i ho\u1eb7c n\u1eb1m vi\u1ec7n (\u0111\u1eb7c bi\u1ec7t l\u00e0 ICU), h\u00f3a tr\u1ecb, gh\u00e9p t\u1ea1ng, suy gan\/th\u1eadn m\u1ea1n, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, ph\u1eabu thu\u1eadt \u1ed5 b\u1ee5ng, thi\u1ebft b\u1ecb m\u1ea1ch m\u00e1u, s\u1ed1c nhi\u1ec5m tr\u00f9ng, ho\u1eb7c c\u1ea5y ra Candida spp.<\/li>\n
Tuy nhi\u00ean, n\u1ebfu nghi ng\u1edd cao nhi\u1ec5m n\u1ea5m Candida ho\u1eb7c Aspergillus ho\u1eb7c n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 gi\u1ea3m b\u1ea1ch c\u1ea7u, m\u1ed9t echinocandin (nh\u1eafm v\u00e0o Candida) ho\u1eb7c voriconazole (nh\u1eafm Aspergillus) th\u01b0\u1eddng l\u00e0 \u0111\u00e3 \u0111\u1ee7.<\/li>\n
Tr\u01b0\u1eddng h\u1ee3p kh\u00e1c \u2013 C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t Legionella (kh\u00e1ng sinh nh\u00f3m macrolide ho\u1eb7c fluoroquinolone)<\/li>\n<\/ul>\n
Li\u1ec1u l\u01b0\u1ee3ng thu\u1ed1c \u2013 c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng n\u00ean ch\u00fa \u00fd \u0111\u1ec3 c\u1ed1 g\u1eafng t\u1ed1i \u0111a h\u00f3a li\u1ec1u kh\u00e1ng sinh tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 sepsis ho\u1eb7c septic s\u1ed1c, d\u00f9ng li\u1ec1u t\u1ea3i cao nh\u1ea5t c\u00f3 th\u1ec3 d\u00f9ng \u0111\u01b0\u1ee3c. Chi\u1ebfn l\u01b0\u1ee3c n\u00e0y d\u1ef1a tr\u00ean vi\u1ec7c t\u0103ng th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 m\u00e0 c\u00f3 th\u1ec3 x\u1ea3y ra tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n sepsis sau khi s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p truy\u1ec1n d\u1ecbch v\u00e0 t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng cao h\u01a1n \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh c\u1ee7a thu\u1ed1c cao h\u01a1n. Truy\u1ec1n li\u00ean t\u1ee5c kh\u00e1ng sinh so v\u1edbi vi\u1ec7c truy\u1ec1n ng\u1eaft qu\u00e3ng, chi\u1ebfn l\u01b0\u1ee3c n\u00e0o hi\u1ec7u qu\u1ea3 h\u01a1n th\u00ec cho \u0111\u1ebfn l\u00fac n\u00e0y v\u1eabn c\u00f2n nhi\u1ec1u tranh c\u00e3i.<\/p>\n
Theo d\u00f5i \u0111\u00e1p \u1ee9ng<\/h2>\n
Sau khi d\u1ecbch truy\u1ec1n v\u00e0 kh\u00e1ng sinh kinh nghi\u1ec7m \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 th\u01b0\u1eddng xuy\u00ean. Ch\u00fang t\u00f4i \u0111\u1ec1 ngh\u1ecb s\u1eed d\u1ee5ng l\u00e2m s\u00e0ng, huy\u1ebft \u0111\u1ed9ng v\u00e0 c\u00e1c th\u00f4ng s\u1ed1 x\u00e9t nghi\u1ec7m \u0111\u01b0\u1ee3c \u0111\u01b0a ra b\u00ean d\u01b0\u1edbi b\u00e0i. Theo kinh nghi\u1ec7m theo d\u00f5i c\u1ee7a ch\u00fang t\u1ed1i h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n s\u1ebd \u0111\u00e1p \u1ee9ng sau 6-24h \u0111\u1ea7u truy\u1ec1n d\u1ecbch, tuy nhi\u00ean \u0111\u1ec3 kh\u1ecfi h\u1eb3n th\u00ec c\u00f3 th\u1ec3 c\u1ea7n v\u00e0i ng\u00e0y th\u1eadm ch\u00ed v\u00e0i tu\u1ea7n.<\/p>\n
Theo d\u00f5i catheter \u2013 trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, CVC ho\u1eb7c catheter \u0111\u1ed9ng m\u1ea1ch x\u00e2m l\u1ea5n s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1eb7t. V\u00ed d\u1ee5 m\u1ed9t catheter \u0111\u1ed9ng m\u1ea1ch s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1eb7t khi huy\u1ebft \u00e1p b\u1ec7nh nh\u00e2n c\u1ee9 bi\u1ebfn \u0111\u1ed9ng, v\u00ec k\u1ebft qu\u1ea3 \u0111\u1ecdc c\u1ee7a m\u00e1y \u0111o huy\u1ebft \u00e1p th\u00f4ng th\u01b0\u1eddng l\u00fac n\u00e0y kh\u00f4ng c\u00f2n \u0111\u00e1ng tin c\u1eady n\u1eefa, s\u1ef1 h\u1ed3i ph\u1ee5c t\u01b0\u1edbi m\u00e1u b\u1ecb k\u00e9o d\u00e0i (\u0111\u1eb7c bi\u1ec7t khi v\u1eadn m\u1ea1ch \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng), ho\u1eb7c c\u00e1c ch\u1ec9 s\u1ed1 \u0111o l\u01b0\u1eddng huy\u1ebft \u0111\u1ed9ng c\u1ee7a vi\u1ec7c \u0111\u00e1p \u1ee9ng truy\u1ec1n d\u1ecbch \u0111\u1ec3 theo d\u00f5i \u0111\u01b0\u1ee3c \u0111\u1eb7t ra. M\u1ed9t CVC c\u00f3 th\u1ec3 n\u00ean \u0111\u01b0\u1ee3c \u0111\u1eb7t \u0111\u1ec3 truy\u1ec1n m\u1ed9t l\u01b0\u1ee3ng d\u1ecbch l\u1edbn ho\u1eb7c ti\u00ean l\u01b0\u1ee3ng tr\u01b0\u1edbc ph\u1ea3i d\u00f9ng v\u1eadn m\u1ea1ch m\u00e0 \u0111\u01b0\u1eddng truy\u1ec1n ngo\u1ea1i bi\u00ean th\u00ec k\u00e9m ph\u00f9 h\u1ee3p, CVP ho\u1eb7c ScvO2 l\u00e0 c\u00e1c th\u00f4ng s\u1ed1 \u0111\u1ec3 theo d\u00f5i \u0111\u00e1p \u1ee9ng huy\u1ebft \u0111\u1ed9ng.<\/p>\n
Ch\u00fang t\u00f4i tin r\u1eb1ng catheter \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft s\u1eed d\u1ee5ng th\u01b0\u1eddng qui tr\u00ean b\u1ec7nh nh\u00e2n sepsis hay septic s\u1ed1c.<\/p>\n
L\u00e2m s\u00e0ng \u2013 n\u00ean theo d\u00f5i s\u1ef1 c\u00e1i thi\u1ec7n c\u1ee7a c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng nh\u01b0 MAP, l\u01b0u l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u, nh\u1ecbp tim, nh\u1ecbp th\u1edf, m\u00e0u s\u1eafc da, nhi\u1ec7t \u0111\u1ed9, SpO2, v\u00e0 t\u00ecnh tr\u1ea1ng tri gi\u00e1c. Trong c\u00e1c th\u00f4ng s\u1ed1 n\u00e0y, MAP\u226565 mmHg (MAP = [(2 x diastolic) + systolic]\/3) v\u00e0 l\u01b0u l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u \u22650.5 mL\/kg\/h l\u00e0 c\u00e1c th\u00f4ng s\u1ed1 ph\u1ed5 bi\u1ebfn \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. Ch\u00fang kh\u00f4ng \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u so s\u00e1nh v\u1edbi nhau v\u00e0 c\u0169ng kh\u00f4ng cho th\u1ea5y c\u00e1i n\u00e0o v\u01b0\u1ee3t tr\u1ed9i h\u01a1n c\u00e1i n\u00e0o trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng.<\/p>\n
M\u1ee5c ti\u00eau huy\u1ebft \u00e1p l\u00e0 MAP\u226565 mmHg d\u1ef1a tr\u00ean c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng l\u1edbn khi s\u1eed d\u1ee5ng gi\u00e1 tr\u1ecb n\u00e0y \u0111\u1ec3 l\u00e0m m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb. Nh\u01b0ng m\u1ee9c huy\u1ebft \u00e1p l\u00fd t\u01b0\u1edfng th\u00ec v\u1eabn kh\u00f4ng bi\u1ebft. Nh\u01b0ng ng\u01b0\u1eddi ta th\u1ea5y m\u1ee9c huy\u1ebft \u00e1p m\u1ee5c ti\u00eau cao h\u01a1n (MAPs (eg, \u226570 mmHg)) c\u00f3 th\u1ec3 g\u00e2y h\u1ea1i khi so v\u1edbi m\u1ee9c t\u1eeb 60-65mmHg. Ng\u01b0\u1eddi ta \u0111\u00e3 l\u00e0m h\u00e0ng lo\u1ea1t c\u00e1c nghi\u00ean c\u1ee9u v\u00e0 cho th\u1ea5y r\u1eb1ng m\u1ee9c huy\u1ebft \u00e1p m\u1ee5c ti\u00eau cao h\u01a1n s\u1ebd d\u1eabn \u0111\u1ebfn t\u1ef7 l\u1ec7 t\u1eed vong sau \u0111\u00f3 c\u0169ng cao h\u01a1n \u0111\u1eb7c bi\u1ec7t \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i.<\/p>\n
Huy\u1ebft \u0111\u1ed9ng \u2013 c\u00e1c th\u00f4ng s\u1ed1 huy\u1ebft \u0111\u1ed9ng c\u1ea3 t\u0129nh v\u00e0 \u0111\u1ed9ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh truy\u1ec1n d\u1ecbch nh\u01b0 th\u1ebf n\u00e0o ti\u1ebfp theo. C\u00e1c guidelines th\u00edch c\u00e1c th\u00f4ng s\u1ed1 \u0111\u1ed9ng v\u00ec n\u00f3 ch\u00ednh x\u00e1c h\u01a1n c\u00e1c th\u00f4ng s\u1ed1 t\u0129nh (CVP) trong ti\u00ean l\u01b0\u1ee3ng \u0111\u00e1p \u1ee9ng b\u00f9 d\u1ecbch.<\/p>\n
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C\u00e1c th\u00f4ng s\u1ed1 t\u0129nh \u2013 theo truy\u1ec1n th\u1ed1ng , \u0111i c\u00f9ng v\u1edbi MAP th\u00ec CVP l\u00e0 th\u01b0\u1edbc \u0111o \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng d\u1ecbch\n
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CVP m\u1ee5c ti\u00eau 8 to 12 mmHg<\/li>\n
ScvO2 \u226570% (\u226565% n\u1ebfu m\u1eabu m\u00e1u r\u00fat ra t\u1eeb catheter \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i)<\/li>\n<\/ul>\n<\/li>\n
C\u00e1c th\u00f4ng s\u1ed1 \u0111\u1ed9ng \u2013 nh\u1ecbp th\u1edf s\u1ebd l\u00e0m thay \u0111\u1ed5i \u0111\u01b0\u1eddng k\u00ednh t\u0129nh m\u1ea1ch ch\u1ee7, \u00e1p l\u1ef1c nh\u1ecbp c\u1ee7a \u0111\u1ed9ng m\u1ea1ch quay, velocity \u0111\u1ec9nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, left ventricular outflow tract velocity-time integral, v\u00e0 velocity c\u1ee7a d\u00f2ng \u0111\u1ed9ng m\u1ea1ch quay l\u00e0 c\u00e1c th\u00f4ng s\u1ed1 xem x\u00e9t \u0111\u1ec3 theo d\u00f5i \u0111\u00e1p \u1ee9ng b\u00f9 d\u1ecbch. Nhi\u1ec1u nghi\u00ean c\u1ee9u ch\u1ec9 ra c\u00e1c th\u00f4ng s\u1ed1 \u0111\u1ed9ng s\u1ebd ch\u00ednh x\u00e1c h\u01a1n, nh\u01b0ng ch\u1ecdn l\u1ef1a th\u00f4ng s\u1ed1 n\u00e0o th\u00ec c\u00f2n t\u00f9y v\u00e0o \u0111i\u1ec1u ki\u1ec7n t\u1eebng b\u1ec7nh vi\u1ec7n. Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n t\u1ef1 th\u1edf, ho\u1eb7c c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nh\u1ecbp tim kh\u00f4ng \u0111\u1ec1u, s\u1ef1 t\u0103ng cung l\u01b0\u1ee3ng tim (\u0111o \u0111\u01b0\u1ee3c th\u00f4ng qua si\u00eau \u00e2m tim, ph\u00e2n t\u00edch s\u00f3ng \u0111\u1ed9ng m\u1ea1ch, ho\u1eb7c catheter \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i) \u0111\u00e1p \u1ee9ng v\u1edbi nghi\u1ec7m ph\u00e1p n\u00e2ng ch\u00e2n c\u0169ng l\u00e0 m\u1ed9t bi\u1ec7n ph\u00e1p \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng \u0111\u00e1p \u1ee9ng b\u00f9 d\u1ecbch. V\u00e0 trong nhi\u1ec1u t\u00ecnh hu\u1ed1ng nghi\u1ec7m ph\u00e1p n\u00e2ng ch\u00e2n t\u1ecf ra ch\u00ednh x\u00e1c nh\u1ea5t v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i khi m\u00e0 kh\u00f4ng th\u1ec3 d\u00f9ng c\u00e1c th\u00f4ng s\u1ed1 \u0111\u1ed9ng.<\/li>\n<\/ul>\n
X\u00e9t nghi\u1ec7m<\/h3>\n
\u0110\u1ed9 thanh th\u1ea3i Lactate \u2013 m\u1eb7t d\u00f9, t\u1ea7n su\u1ea5t \u0111o l\u01b0\u1eddng \u0111\u1ec3 theo d\u00f5i d\u1ef1a v\u00e0o lactate l\u00e0 bao nhi\u00eau th\u00ec cho \u0111\u1ebfn nay v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft r\u00f5, quan \u0111i\u1ec3m c\u1ee7a ch\u00fang t\u00f4i, ch\u00fang t\u00f4i theo d\u00f5i m\u1ed5i 6h cho \u0111\u1ebfn khi gi\u00e1 tr\u1ecb lactate b\u1eaft \u0111\u1ea7u gi\u1ea3m. Trong khi nhi\u1ec1u guidelines \u0111\u00e3 h\u01b0\u1edbng d\u1eabn h\u1ed3i s\u1ee9c h\u01b0\u1edbng \u0111\u1ebfn s\u1ef1 b\u00ecnh th\u01b0\u1eddng h\u00f3a lactate nh\u01b0ng v\u1eabn ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y c\u1ea3i thi\u1ec7n lactate th\u00ec c\u1ea3i thi\u1ec7n outcome.<\/p>\n
\u0110\u1ed9 thanh th\u1ea3i lactate \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a b\u1eb1ng c\u00f4ng th\u1ee9c [(lactate l\u1ea5y ban \u0111\u1ea7u \u2013 lactate l\u1ea5y >2 gi\u1edd sau \u0111\u00f3)\/ lactate l\u1ea5y ban \u0111\u1ea7u] x 100. \u0110\u1ed9 thanh th\u1ea3i lactate v\u00e0 s\u1ef1 thay \u0111\u1ed5i c\u1ee7a n\u00f3 trong 12 gi\u1edd \u0111\u1ea7u h\u1ed3i s\u1ee9c l\u00e0 m\u1ed9t marker hi\u1ec7u qu\u1ea3. Nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra h\u1ed3i s\u1ee9c d\u1ef1a v\u00e0o lactate s\u1ebd l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong h\u01a1n l\u00e0 h\u1ed3i s\u1ee9c \u0111\u01a1n thu\u1ea7n.<\/p>\n
H\u01a1n n\u1eefa, lactate l\u00e0 m\u1ed9t marker t\u01b0\u01a1ng \u0111\u1ed1i y\u1ebfu v\u1ec1 t\u01b0\u1edbi m\u00e1u m\u00f4 sau khi h\u1ed3i qui t\u01b0\u1edbi m\u00e1u quay l\u1ea1i. T\u00f3m l\u1ea1i, gi\u00e1 tr\u1ecb c\u1ee7a lactate nh\u00ecn chung kh\u00f4ng gi\u00fap \u00edch g\u00ec nhi\u1ec1u sau khi h\u1ed3i ph\u1ee5c t\u01b0\u1edbi m\u00e1u, nh\u01b0ng c\u00f3 m\u1ed9t ngo\u1ea1i l\u1ec7: t\u0103ng lactate m\u00e1u l\u00e0 d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o cho b\u00e1c s\u0129 n\u00ean t\u00e1i \u0111\u00e1nh gi\u00e1 l\u1ea1i xem coi vi\u1ec7c t\u00e1i t\u01b0\u1edbi m\u00e1u c\u00f3 \u0111\u1ea7y \u0111\u1ee7 hay ch\u01b0a. Hi\u1ec7n nay, \u0111\u00e3 c\u00f3 nhi\u1ec1u thi\u1ebft b\u1ecb \u0111o lactate t\u1ea1i gi\u01b0\u1eddng, gi\u00fap t\u0103ng kh\u1ea3 n\u0103ng theo d\u00f5i cho b\u1ec7nh nh\u00e2n.<\/p>\n
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C\u00e1c x\u00e9t nghi\u1ec7m th\u01b0\u1eddng qui \u2013 c\u00e1c x\u00e9t nghi\u1ec7m, \u0111\u1eb7c bi\u1ec7t l\u00e0 ti\u1ec3u c\u1ea7u, sinh h\u00f3a v\u00e0 ch\u1ee9c n\u0103ng gan th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng (m\u1ed5i 6h) \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 cho \u0111\u1ebfn khi ch\u00fang quay l\u1ea1i gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng. T\u0103ng clo m\u00e1u n\u00ean tr\u00e1nh nh\u01b0ng n\u1ebfu c\u00f3 x\u1ea3y ra th\u00ec chuy\u1ec3n sang c\u00e1c ch\u1ebf ph\u1ea9m d\u1ecbch truy\u1ec1n h\u1ea1n ch\u1ebf Clo.<\/li>\n
Vi sinh \u2013 c\u00f4ng th\u1ee9c m\u00e1u v\u00e0 c\u1ea5y n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh. Khi c\u00f3 k\u1ebft qu\u1ea3 th\u00ec n\u00ean h\u01b0\u1edbng \u0111\u1ebfn m\u1ed9t chi\u1ebfn l\u01b0\u1ee3c kh\u00e1ng sinh an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 h\u01a1n.<\/li>\n
Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch \u2013 \u0111\u00e2y l\u00e0 x\u00e9t nghi\u1ec7m t\u1ed1i c\u1ea7n thi\u1ebft v\u00e0 nh\u1ea5t \u0111\u1ecbnh ph\u1ea3i c\u00f3 \u0111\u1ec3 theo d\u00f5i c\u00e1c chuy\u1ec3n bi\u1ebfn n\u1eb7ng v\u00e0 gi\u1ea3i quy\u1ebft c\u00e1c v\u1ea5n \u0111\u1ec1 b\u1ea5t th\u01b0\u1eddng v\u1ec1 trao \u0111\u1ed5i kh\u00ed. S\u1ef1 x\u1ea5u \u0111i ho\u1eb7c n\u1eb7ng l\u00ean c\u1ee7a t\u00ecnh tr\u1ea1ng trao \u0111\u1ed5i kh\u00ed c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t g\u1ee3i \u00fd cho ph\u00f9 ph\u1ed5i m\u00e0 c\u00f3 th\u1ec3 l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a t\u00ecnh tr\u1ea1ng h\u1ed3i s\u1ee9c d\u1ecbch qu\u00e1 tay v\u00e0 c\u0169ng c\u00f3 th\u1ec3 gi\u00fap ph\u00e1t hi\u1ec7n ra c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i t\u1eeb vi\u1ec7c \u0111\u1eb7t CVC, h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p, ho\u1eb7c thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch.<\/li>\n<\/ul>\n
Khu tr\u00fa \u00f4 nhi\u1ec5m khu\u1ea9n v\u00e0 ki\u1ec3m so\u00e1t ngu\u1ed3n nhi\u1ec5m<\/h2>\n
Theo kinh nghi\u1ec7m c\u1ee7a ch\u00fang t\u00f4i, b\u1ec7nh s\u1eed v\u00e0 th\u0103m kh\u00e1m k\u1ef9 c\u00e0ng l\u00e0 th\u00e0nh t\u1ed1 quan tr\u1ecdng nh\u1ea5t \u0111\u1ec3 ph\u00e1t hi\u1ec7n \u1ed5 nhi\u1ec5m. Theo c\u00f9ng v\u1edbi c\u00e1c x\u00e9t nghi\u1ec7m v\u00e0 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh kinh nghi\u1ec7m, x\u00e1c \u0111\u1ecbnh \u1ed5 nhi\u1ec5m nh\u1eb1m ki\u1ec3m so\u00e1t n\u00f3 l\u00e0 m\u1ee5c ti\u00eau quan tr\u1ecdng c\u1ea7n h\u01b0\u1edbng \u0111\u1ebfn tr\u00ean t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n c\u00f3 sepsis. B\u00ean c\u1ea1nh \u0111\u00f3, v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb ho\u1eb7c k\u00e9m \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u, c\u00e1c x\u00e9t nghi\u1ec7m n\u00ean nh\u1eafm v\u00e0o c\u00e1c t\u00e1c nh\u00e2n si\u00eau nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n.<\/p>\n
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X\u00e1c \u0111\u1ecbnh \u1ed5 nhi\u1ec5m \u2013 C\u00e1c x\u00e9t nghi\u1ec7m nh\u1eb1m t\u00ecm ra \u1ed5 nhi\u1ec5m n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t (trong v\u00f2ng 12h). C\u00e1c
\nx\u00e9t nghi\u1ec7m n\u00e0y c\u00f3 th\u1ec3 l\u00e0 c\u00e1c ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh ho\u1eb7c c\u00e1c x\u00e9t nghi\u1ec7m chuy\u00ean bi\u1ec7t h\u01a1n (v\u00ed d\u1ee5 nh\u01b0: d\u1ecbch kh\u1edbp, d\u1ecbch ch\u1ea3y r\u1eeda ph\u1ebf qu\u1ea3n\u2026). N\u1ebfu nhi\u1ec5m Candida or Aspergillus x\u00e2m l\u1ea5n b\u1ecb nghi ng\u1edd, c\u00e1c x\u00e9t nghi\u1ec7m n\u1ebfu c\u00f3 sau \u0111\u00e2y nh\u01b0 : 1,3 beta-D-glucan, galactomannan, and anti-mannan antibodies l\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m c\u00f3 th\u1ec3 gi\u00fap ch\u1ea9n \u0111o\u00e1n s\u1edbm t\u00ecnh tr\u1ea1ng nhi\u1ec5m n\u1ea5m.<\/li>\n
Ki\u1ec3m so\u00e1t \u1ed5 nhi\u1ec5m \u2013 ki\u1ec3m so\u00e1t \u1ed5 nhi\u1ec5m n\u00ean ki\u1ec3m so\u00e1t c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t, v\u00ec m\u1ed9t \u1ed5 nhi\u1ec5m kh\u00f4ng \u0111\u01b0\u1ee3c d\u1eabn l\u01b0u c\u00f3 th\u1ec3 kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi ch\u1ec9 d\u00f9ng kh\u00e1ng sinh \u0111\u01a1n \u0111\u1ed9c. C\u0169ng t\u01b0\u01a1ng t\u1ef1, m\u1ed9t catheter n\u00ean \u0111\u01b0\u1ee3c r\u00fat n\u1ebfu c\u00f3 d\u1ea5u hi\u1ec7u nhi\u1ec5m
\n(\u0111\u01b0\u01a1ng nhi\u00ean l\u00e0 sau khi \u0111\u00e3 \u0111\u1eb7t m\u1ed9t catheter kh\u00e1c thay th\u1ebf), ho\u1eb7c c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t c\u1eaft l\u1ecdc v\u00f9ng da b\u1ecb nhi\u1ec5m khu\u1ea9n\u2026 Th\u1eddi gian cho ph\u00e9p \u0111\u1ec3 ki\u1ec3m so\u00e1t \u1ed5 nhi\u1ec5m cho \u0111\u1ebfn nay v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft r\u00f5, nh\u01b0ng nhi\u1ec1u guidelines \u0111\u1ec1 ngh\u1ecb n\u00ean ki\u1ec3m so\u00e1t trong v\u00f2ng 6-12h. M\u1eb7c d\u00f9, theo lu\u1eadt ng\u00f3n tay c\u00e1i th\u00ec vi\u1ec7c ki\u1ec3m so\u00e1t \u1ed5 nhi\u1ec5m ph\u1ea3i c\u00e0ng nhanh c\u00e0ng t\u1ed1t nh\u01b0ng th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng c\u00f3 th\u1ec3 l\u00e0m \u0111\u01b0\u1ee3c.<\/li>\n<\/ul>\n
Nh\u00f3m b\u1ec7nh nh\u00e2n th\u1ea5t b\u1ea1i v\u1edbi \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u<\/h2>\n
B\u1ec7nh nh\u00e2n c\u00f3 gi\u1ea3m t\u01b0\u1edbi m\u00e1u k\u00e9o d\u00e0i m\u1eb7c d\u00f9 \u0111\u00e3 \u0111\u01b0\u1ee3c h\u1ed3i s\u1ee9c d\u1ecbch v\u00e0 kh\u00e1ng sinh \u0111\u1ea7y \u0111\u1ee7 n\u00ean \u0111\u01b0\u1ee3c t\u00e1i \u0111\u00e1nh gi\u00e1 l\u1ea1i d\u1ecbch v\u00e0 kh\u00e1ng sinh, v\u00e0 vi\u1ec7c ki\u1ec3m so\u00e1t \u1ed5 nhi\u1ec5m c\u0169ng nh\u01b0 s\u1ef1 ch\u00ednh x\u00e1c c\u1ee7a vi\u1ec7c ch\u1ea9n \u0111o\u00e1n sepsis ban \u0111\u1ea7u, v\u00e0\/ ho\u1eb7c b\u1ea1n \u0111\u00e3 x\u00e1c \u0111\u1ecbnh sai \u1ed5 nhi\u1ec5m, ho\u1eb7c b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 v\u1ea5n \u0111\u1ec1 \u0111\u1ed3ng m\u1eafc xu\u1ea5t hi\u1ec7n (ch\u1eb3ng h\u1ea1n nh\u01b0 tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i trong l\u00fac \u0111\u1eb7t catheter). C\u00e1c l\u1ef1a ch\u1ecdn kh\u00e1c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u1ec7c t\u1ee5t huy\u1ebft \u00e1p k\u00e9o d\u00e0i dai d\u1eb3ng nh\u01b0 : v\u1eadn m\u1ea1ch, t\u0103ng co b\u00f3p c\u01a1 tim, corticoids, v\u00e0 truy\u1ec1n m\u00e1u c\u0169ng s\u1ebd \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn trong chuy\u00ean \u0111\u1ec1 n\u00e0y.<\/p>\n
V\u1eadn m\u1ea1ch \u2013 v\u1eadn m\u1ea1ch t\u1ecf ra h\u1eefu \u00edch tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 t\u1ee5y huy\u1ebft \u00e1p d\u00f9 \u0111\u00e3 b\u00f9 \u0111\u1ee7 d\u1ecbch ho\u1eb7c tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n ph\u00f9 ph\u1ed5i do tim. D\u1ef1a tr\u00ean nhi\u1ec1u nghi\u00ean c\u1ee9u, c\u00e1c chuy\u00ean gia \u0111\u1ec1u tr\u00e1nh s\u1eed d\u1ee5ng Dopamine v\u00e0 th\u00edch d\u00f9ng noreadrenalin h\u01a1n. Th\u00eam n\u1eefa, nhi\u1ec1u guidelines \u0111\u1ec1 ngh\u1ecb b\u1ed5 sung c\u00e1c thu\u1ed1c h\u1ed7 tr\u1ee3 nh\u01b0 vasopressin (\u0111\u1ec3 gi\u1ea3m li\u1ec1u norepinephrin) ho\u1eb7c adrenalin (tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n t\u1ee5t huy\u1ebft \u00e1p dai d\u1eb3ng k\u00e9o d\u00e0i), nh\u01b0ng c\u0169ng c\u1ea7n d\u1ef1a v\u00e0o th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh. C\u00e1c guidelines \u0111\u1ec1u khuy\u1ebfn c\u00e1o n\u00ean s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch trung t\u00e2m khi s\u1eed d\u1ee5ng v\u1eadn m\u1ea1ch li\u1ec1u cao ho\u1eb7c ph\u1ea3i truy\u1ec1n k\u00e9o d\u00e0i, ho\u1eb7c d\u00f9ng nhi\u1ec1u v\u1eadn m\u1ea1ch tr\u00ean c\u00f9ng m\u1ed9t \u0111\u01b0\u1eddng truy\u1ec1n.<\/p>\n
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Thu\u1ed1c \u0111\u1ea7u tay \u2013 c\u00e1c d\u1eef li\u1ec7u \u1ee7ng h\u1ed9 cho vi\u1ec7c s\u1eed d\u1ee5ng noreadrenalin nh\u01b0 thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u1ea7u tay \u0111\u1ebfn t\u1eeb nhi\u1ec1u nghi\u00ean c\u1ee9u so s\u00e1nh \u0111\u1ed1i \u0111\u1ea7u n\u00f3 v\u1edbi c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch kh\u00e1c, cho th\u1ea5y hi\u1ec7u qu\u1ea3 v\u01b0\u1ee3t tr\u1ed9i c\u1ee7a noreadrenaline. Tuy nhi\u00ean, theo ch\u00fang t\u00f4i, v\u1eadn m\u1ea1ch \u0111\u1ea7u tay n\u00ean \u0111\u01b0\u1ee3c c\u00e1c nh\u00e2n h\u00f3a v\u00e0 n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc d\u1ef1a v\u00e0o c\u00e1c y\u1ebfu t\u1ed1 hi\u1ec7n h\u1eefu c\u1ee7a b\u1ec7nh nh\u00e2n bao g\u1ed3m: suy tim, lo\u1ea1n nh\u1ecbp, thi\u1ebfu m\u00e1u c\u01a1 quan\u2026V\u00ed d\u1ee5 nh\u01b0 tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n sepsis m\u00e0 c\u00f3 nh\u1ecbp nhanh qu\u00e1 r\u00f5 (v\u00ed d\u1ee5 nh\u01b0 rung nh\u0129 160 l\/p), c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf ho\u00e0n to\u00e0n t\u00e1c \u0111\u1ed9ng l\u00ean th\u1ee5 th\u1ec3 beta adrenergic (nh\u01b0 vasopressin) c\u00f3 th\u1ec3 l\u00e0 ph\u00f9 h\u1ee3p, n\u1ebfu b\u1ea1n tin r\u1eb1ng t\u00ecnh tr\u1ea1ng nh\u1ecbp nhanh \u0111\u1ea5y \u0111ang g\u00f3p ph\u1ea7n \u0111\u1ea9y b\u1ec7nh nh\u00e2n \u0111\u1ebfn t\u00ecnh tr\u1ea1ng m\u1ea5t b\u00f9. C\u0169ng t\u01b0\u01a1ng t\u1ef1, Dopamine c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn s\u1eed d\u1ee5ng n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nh\u1ecbp ch\u1eadm r\u00f5 r\u1ec7t; nh\u01b0ng c\u1ea7n lu\u00f4n nh\u1edb r\u1eb1ng kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng li\u1ec1u th\u1ea5p Dopamine v\u1edbi m\u1ee5c \u0111\u00edch b\u1ea3o v\u1ec7 th\u1eadn.<\/li>\n
C\u00e1c thu\u1ed1c h\u1ed7 tr\u1ee3 kh\u00e1c \u2013 vi\u1ec7c b\u1ed5 sung th\u00eam m\u1ed9t thu\u1ed1c th\u1ee9 hai, th\u1eadm ch\u00ed th\u1ee9 ba sau norepinephrin c\u00f3 th\u1ec3 c\u1ea7n.\n
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Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n v\u1edbi s\u1ed1c ph\u00e2n b\u1ed1 do sepsis, vasopressin c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u1ed5 sung th\u00eam. T\u1ed5ng k\u1ebft t\u1eeb 23 nghi\u00ean c\u1ee9u \u0111\u00e3 cho th\u1ea5y r\u1eb1ng k\u1ebft h\u1ee3p th\u00eam vasopressin l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n rung nh\u0129.<\/li>\n
Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n v\u1edbi s\u1ed1c nhi\u1ec5m tr\u00f9ng dai d\u1eb3ng k\u00e9o d\u00e0i k\u00e8m theo cung l\u01b0\u1ee3ng tim th\u1ea5p, th\u00eam m\u1ed9t thu\u1ed1c t\u0103ng s\u1ee9c b\u00f3p c\u00f3 th\u1ec3 l\u00e0 ph\u00f9 h\u1ee3p. Trong m\u1ed9t nghi\u00ean c\u1ee9u 234 b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m tr\u00f9ng, nghi\u00ean c\u1ee9u cho th\u1ea5y dobutamine t\u1ecf ra c\u00f3 nhi\u1ec1u \u00edch l\u1ee3i trong gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong (adrenalin th\u00ec ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
C\u00e1c \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 th\u00eam \u2013 h\u1ea7u h\u1ebft c\u00e1c chuy\u00ean gia \u0111\u1ec1u t\u00e1n \u0111\u1ed3ng c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 nh\u01b0: corticoid, truy\u1ec1n m\u00e1u, v\u00e0 t\u0103ng s\u1ee9c co b\u00f3p kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng th\u01b0\u1eddng qui tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m tr\u00f9ng, nh\u01b0ng c\u00f3 th\u1ec3 d\u00f9ng tr\u00ean c\u00e1c ca t\u1ee5t huy\u1ebft \u00e1p k\u00e9o d\u00e0i ho\u1eb7c trong c\u00e1c t\u00ecnh hu\u1ed1ng \u0111\u1eb7c bi\u1ec7t.<\/p>\n
Glucocorrticoids \u2013 c\u00e1c guidelines khuy\u1ebfn c\u00e1o kh\u00f4ng n\u00ean d\u00f9ng cho c\u00e1c b\u1ec7nh nh\u00e2n sepsis. Tuy nhi\u00ean, glucocorticoid c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p cho c\u00e1c b\u1ec7nh nh\u00e2n s\u1ed1c k\u00e9o d\u00e0i m\u1eb7c d\u00f9 \u0111\u00e3 b\u00f9 d\u1ecbch v\u00e0 v\u1eadn m\u1ea1ch \u0111\u1ea7y \u0111\u1ee7. (Chi ti\u1ebft vi\u1ec7c s\u1eed d\u1ee5ng glucocorticoid tr\u00ean b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m tr\u00f9ng s\u1ebd \u0111\u01b0\u1ee3c b\u00e0n trong m\u1ed9t chuy\u00ean \u0111\u1ec1 kh\u00e1c)<\/p>\n
T\u0103ng co b\u00f3p c\u01a1 tim \u2013 d\u00f9ng cho c\u00e1c b\u1ec7nh nh\u00e2n th\u1ea5t b\u1ea1i trong \u0111\u00e1p \u1ee9ng v\u1edbi d\u1ecbch truy\u1ec1n v\u00e0 v\u1eadn m\u1ea1ch. Dobutamine l\u00e0 thu\u1ed1c l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay, thay th\u1ebf b\u1eb1ng adrenaline.<\/p>\n
Truy\u1ec1n t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u \u2013 d\u1ef1a tr\u00ean c\u00e1c nghi\u00ean c\u1ee9u c\u00e1c c\u00e1c guidelines h\u01b0\u1edbng d\u1eabn truy\u1ec1n m\u00e1u cho c\u00e1c b\u1ec7nh nh\u00e2n n\u1eb7ng, ch\u00fang t\u00f4i th\u01b0\u1eddng s\u1ebd truy\u1ec1n h\u1ed3ng c\u1ea7u khi hemoglobin level \u22647 g\/dL (Hb\u22647 g\/dL). Ngo\u1ea1i tr\u1eeb nghi ng\u1edd c\u00f3 xu\u1ea5t huy\u1ebft \u0111ang di\u1ec5n ti\u1ebfn ho\u1eb7c thi\u1ebfu m\u00e1u c\u01a1 tim ti\u1ebfn tri\u1ec3n:<\/p>\n
\u1ee6ng h\u1ed9 cho vi\u1ec7c n\u00ean h\u1ea1n ch\u1ebf truy\u1ec1n m\u00e1u (khi Hb>7 g\/dL), \u0111\u1ebfn t\u1eeb c\u00e1c k\u1ebft qu\u1ea3 tr\u1ef1c ti\u1ebfp l\u1eabn gi\u00e1n ti\u1ebfp trong c\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m tr\u00f9ng. Xa h\u01a1n, c\u00e1c chuy\u00ean gia c\u0169ng \u0111\u1ed3ng thu\u1eadn tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n n\u1eb7ng nguy k\u1ecbch th\u00ec m\u1ee5c ti\u00eau truy\u1ec1n h\u1ed3ng c\u1ea7u l\u00e0 n\u00ean \u0111\u1ea1t \u0111\u01b0\u1ee3c Hb>7 g\/dL.<\/p>\n
Nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb<\/h2>\n
M\u1ed9t khi b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, m\u1ee5c ti\u00eau v\u1eabn n\u00ean t\u1eadp trung ki\u1ec3m so\u00e1t nhi\u1ec5m tr\u00f9ng, xu\u1ed1ng thang d\u1ecbch truy\u1ec1n v\u00e0 kh\u00e1ng sinh ngay khi th\u00edch h\u1ee3p. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 x\u1ea3y ra t\u1eeb v\u00e0i gi\u1edd cho \u0111\u1ebfn v\u00e0i ng\u00e0y t\u00f9y v\u00e0o t\u1eebng c\u01a1 \u0111\u1ecba b\u1ec7nh nh\u00e2n.<\/p>\n
X\u00e1c \u0111\u1ecbnh v\u00e0 ki\u1ec3m so\u00e1t \u1ed5 nhi\u1ec5m<\/h3>\n
Xu\u1ed1ng thang d\u1ecbch truy\u1ec1n \u2013 Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi li\u1ec7u ph\u00e1p truy\u1ec1n d\u1ecbch ban \u0111\u1ea7u (c\u1ea3i thi\u1ec7n v\u1ec1 l\u00e2m s\u00e0ng, huy\u1ebft \u0111\u1ed9ng v\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m, th\u01b0\u1eddng l\u00e0 v\u00e0i gi\u1edd cho \u0111\u1ebfn 1-2 ng\u00e0y). Ch\u00fang t\u00f4i th\u01b0\u1eddng gi\u1ea3m t\u1ed1c \u0111\u1ed9 ho\u1eb7c ng\u01b0ng d\u1ecbch truy\u1ec1n, cai v\u1eadn m\u1ea1ch h\u1ed7 tr\u1ee3 v\u00e0 n\u1ebfu c\u1ea7n c\u00f3 th\u1ec3 cho th\u00eam l\u1ee3i ti\u1ec3u. Trong khi v\u1edbi sepsis ban \u0111\u1ea7u l\u00e0 ph\u1ea3i b\u00f9 d\u1ecbch, nh\u01b0ng li\u1ec7u ph\u00e1p truy\u1ec1n d\u1ecbch s\u1ebd c\u00f3 h\u1ea1i n\u1ebfu tu\u1ea7n ho\u00e0n c\u1ee7a b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng n\u1eefa.<\/p>\n
Nhi\u1ec1u nghi\u00ean c\u1ee9u nh\u1ecf \u0111\u00e3 cho th\u1ea5y qu\u00e1 t\u1ea3i dich kh\u00e1 ph\u1ed5 bi\u1ebfn tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n sepsis, v\u00e0 d\u1eabn \u0111\u1ebfn nhi\u1ec1u can thi\u1ec7p (nh\u01b0 l\u1ee3i ti\u1ec3u ho\u1eb7c d\u1eabn l\u01b0u tr\u00e0n d\u1ecbch). V\u00e0 nhi\u1ec1u nghi\u00ean c\u1ee9u d\u1eabn ra chi\u1ebfn l\u01b0\u1ee3c b\u00f9 d\u1ecbch h\u1ea1n ch\u1ebf v\u1eeba \u0111\u1ee7 t\u1ea1o l\u00e0m gi\u1ea3m th\u1eddi gian n\u1eb1m ICU.<\/p>\n
Xu\u1ed1ng thang kh\u00e1ng sinh<\/h3>\n
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Xu\u1ed1ng thang \u2013 sau khi c\u00f3 k\u1ebft qu\u1ea3 c\u1ea5y v\u00e0\/ho\u1eb7c sau khi b\u1ec7nh nh\u00e2n c\u1ea3i thi\u1ec7n ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o n\u00ean thu h\u1eb9p c\u1eeda s\u1ed5 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh l\u1ea1i (th\u01b0\u1eddng sau v\u00e0i ng\u00e0y). Khi c\u00f3 th\u1ec3 kh\u00e1ng sinh thay \u0111\u1ed5i n\u00ean nh\u1eafm v\u00e0o b\u1ec7nh nguy\u00ean v\u00e0 \u0111\u1ed9 nh\u1ea1y c\u1ee7a n\u00f3. Tuy nhi\u00ean, th\u1ef1c t\u1ebf c\u00f3 \u0111\u1ebfn tr\u00ean 50% c\u00e1c ca sepsis kh\u00f4ng r\u00f5 b\u1ec7nh nguy\u00ean n\u00ean vi\u1ec7c xu\u1ed1ng thang kh\u00e1ng sinh s\u1ebd t\u00f9y v\u00e0o kinh nghi\u1ec7m c\u1ee7a b\u00e1c s\u1ef9 l\u00e2m s\u00e0ng.<\/li>\n
Th\u1eddi gian s\u1eed d\u1ee5ng kh\u00e1ng sinh \u2013 n\u00ean \u0111\u01b0\u1ee3c c\u00e1 nh\u00e2n h\u00f3a. V\u1edbi h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n th\u00ec th\u1eddi gian n\u00e0y dao \u0111\u1ed9ng t\u1eeb 3-8 ng\u00e0y. Tuy nhi\u00ean, th\u1eddi gian l\u00e2u h\u01a1n c\u00f3 th\u1ec3 c\u1ea7n tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng ch\u1eadm, m\u1ed9t \u1ed5 nhi\u1ec5m kh\u00f4ng th\u1ec3 d\u1eabn l\u01b0u, nhi\u1ec5m con S.aureus, m\u1ed9t v\u00e0i lo\u1ea1i n\u1ea5m (ch\u1eb3ng h\u1ea1n nhi\u1ec5m Candida x\u1ea5m l\u1ea5n s\u00e2u), nhi\u1ec5m virus (v\u00ed d\u1ee5 nh\u01b0 herpes ho\u1eb7c cytomegalovirus), vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c, \u1ed5 aspxe l\u1edbn, nhi\u1ec5m c\u00e1c b\u1ec7nh nguy\u00ean Gram \u00e2m c\u00f3 t\u1ef7 l\u1ec7 kh\u00e1ng thu\u1ed1c cao, gi\u1ea3m b\u1ea1ch c\u1ea7u ho\u1eb7c c\u00f3 n\u1ec1n suy gi\u1ea3m mi\u1ec5n d\u1ecbch. T\u01b0\u01a1ng \u0111\u01b0\u01a1ng, th\u1eddi gian \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 r\u00fat ng\u1eafn tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n k\u1ebft qu\u1ea3 c\u1ea5y \u00e2m t\u00ednh v\u00e0 c\u1ea3i thi\u1ec7n tr\u00ean l\u00e2m s\u00e0ng v\u00e0 c\u00e1c th\u00f4ng s\u1ed1 x\u00e9t nghi\u1ec7m quay v\u1ec1 b\u00ecnh th\u01b0\u1eddng nhanh ch\u00f3ng. Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n gi\u1ea3m b\u1ea1ch c\u1ea7u th\u00ec kh\u00e1ng sinh n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho \u0111\u1ebfn khi b\u1ea1ch c\u1ea7u quay tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng.<\/li>\n
Vai tr\u00f2 c\u1ee7a Procalcitonin \u2013 m\u1eb7c d\u00f9 \u0111\u00e3 c\u00f3 nhi\u1ec1u y v\u0103n v\u00e0 guidelines h\u01b0\u1edbng d\u1eabn vi\u1ec7c s\u1eed d\u1ee5ng procalcitonin \u0111\u1ec3 nh\u1eb1m h\u1ea1n ch\u1ebf vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh qu\u00e1 tay, nh\u01b0ng b\u1eb1ng ch\u1ee9ng h\u1ed7 tr\u1ee3 tr\u00ean th\u1ef1c h\u00e0nh v\u1eabn c\u00f2n kh\u00e1 nhi\u1ec1u h\u1ea1n ch\u1ebf. Tuy nhi\u00ean, c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 l\u1ee3i \u00edch c\u1ee7a procalcitonin tr\u00ean vi\u1ec7c gi\u1ea3m th\u1eddi gian ho\u1eb7c ng\u01b0ng kh\u00e1ng sinh \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n v\u1edbi vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng v\u00e0 vi\u00eam ph\u1ebf qu\u1ea3n c\u1ea5p, ch\u00ednh v\u00ec v\u1eady vi\u1ec7c x\u00e9t nghi\u1ec7m v\u00e0 \u1ee9ng d\u1ee5ng cho nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 v\u1ebb h\u1eefu d\u1ee5ng h\u01a1n nh\u00f3m b\u1ec7nh nh\u00e2n v\u1edbi c\u00e1c \u1ed5 nhi\u1ec5m kh\u00e1c.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"
Bi\u00ean d\u1ecbch: B\u00e1c s\u0129 Nguy\u1ec5n Ho\u00e0ng L\u1ed9c vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft \u0110\u00e1nh gi\u00e1 – \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng huy\u1ebft v\u00e0 s\u1ed1c nhi\u1ec5m tr\u00f9ng,\u00a0xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y. \u0110i\u1ec3m m\u1edbi Vi\u1ec7c xu\u1ed1ng thang d\u1ecbch truy\u1ec1n trong nhi\u1ec5m khu\u1ea9n huy\u1ebft (c\u1eadp nh\u1eadt th\u00e1ng 6 n\u0103m 2022). Tr\u00ean c\u00e1c b\u1ec7nh […]\n","protected":false},"author":1,"featured_media":34788,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-34785","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\/34785","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=34785"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/34785\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/34788"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=34785"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=34785"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=34785"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}