{"id":5401,"date":"2019-03-24T22:20:03","date_gmt":"2019-03-24T15:20:03","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=5401"},"modified":"2019-03-24T22:20:03","modified_gmt":"2019-03-24T15:20:03","slug":"su-dung-dich-tinh-the-dang-truong-thay-the-cho-dung-dich-muoi","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/su-dung-dich-tinh-the-dang-truong-thay-the-cho-dung-dich-muoi\/","title":{"rendered":"S\u1eed dung d\u1ecbch tinh th\u1ec3 \u0111\u1eb3ng tr\u01b0\u01a1ng thay th\u1ebf cho dung d\u1ecbch mu\u1ed1i."},"content":{"rendered":"<p>\u0110i\u1ec3m nghi\u00ean c\u1ee9u m\u1edbi c\u00f4ng b\u1ed1 (NEJM):<strong> L\u1ef1a ch\u1ecdn d\u1ecbch truy\u1ec1n &#8211; S\u1eed d\u1ee5ng d\u1ecbch tinh th\u1ec3 \u0111\u1eb3ng tr\u01b0\u01a1ng thay th\u1ebf cho dung d\u1ecbch mu\u1ed1i.<\/strong><\/p>\n<p>K\u1ebft qu\u1ea3 c\u1ee7a 2 nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c NEJM \u0111\u0103ng t\u1ea3i g\u1ea7n \u0111\u00e2y \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng b\u1ec7nh nh\u00e2n \u00edt b\u1ecb t\u1ed5n th\u01b0\u01a1ng th\u1eadn h\u01a1n khi \u0111\u01b0\u1ee3c truy\u1ec1n Ringer lactat thay cho dung d\u1ecbch mu\u1ed1i.<\/p>\n<p>Vi\u1ec7c l\u1ef1a ch\u1ecdn dung d\u1ecbch tinh th\u1ec3 \u0111\u1ec3 h\u1ed3i ph\u1ee5c th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n v\u1eabn th\u01b0\u1eddng xuy\u00ean g\u00e2y ra tranh c\u00e3i. Do lo ng\u1ea1i t\u00ecnh tr\u1ea1ng nhi\u1ec5m toan chuy\u1ec3n h\u00f3a k\u00e8m t\u0103ng chloride m\u00e1u khi d\u00f9ng dung d\u1ecbch mu\u1ed1i th\u01b0\u1eddng, c\u00e1c b\u00e1c s\u0129 th\u01b0\u1eddng l\u1ef1a ch\u1ecdn d\u1ecbch tinh th\u1ec3 \u0111\u1eb3ng tr\u01b0\u01a1ng h\u01a1n, nh\u01b0 Ringer lactat ho\u1eb7c Plasma-Lyte.<\/p>\n<p>Trong 2 th\u1eed nghi\u1ec7m song song \u1edf Vanderbilt, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn ng\u1eabu nhi\u00ean \u0111\u1ec3 s\u1eed d\u1ee5ng dung d\u1ecbch NaCl 0,9% ho\u1eb7c d\u1ecbch tinh th\u1ec3 \u0111\u1eb3ng tr\u01b0\u01a1ng (th\u01b0\u1eddng l\u00e0 Ringer lactat). M\u1ed9t th\u1eed nghi\u1ec7m \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh t\u1ea1i khoa c\u1ea5p c\u1ee9u (ED), th\u1eed nghi\u1ec7m c\u00f2n l\u1ea1i ti\u1ebfn h\u00e0nh t\u1ea1i khoa h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c (ICU). H\u1ec7 th\u1ed1ng k\u00ea \u0111\u01a1n b\u1eb1ng m\u00e1y t\u00ednh h\u01b0\u1edbng d\u1eabn nh\u00e2n vi\u00ean y t\u1ebf s\u1eed d\u1ee5ng d\u1ecbch truy\u1ec1n t\u01b0\u01a1ng \u1ee9ng v\u1edbi nh\u00f3m \u0111\u01b0\u1ee3c ch\u1ecdn ng\u1eabu nhi\u00ean.<\/p>\n<p>Trong th\u1eed nghi\u1ec7m t\u1ea1i khoa ICU, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c truy\u1ec1n d\u1ecbch tinh th\u1ec3 \u0111\u1eb3ng tr\u01b0\u01a1ng g\u1eb7p \u00edt bi\u1ebfn c\u1ed1 tr\u00ean th\u1eadn h\u01a1n, m\u1ed9t ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 g\u1ed9p bao g\u1ed3m tr\u01b0\u1eddng h\u1ee3p t\u1eed vong, ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o ho\u1eb7c t\u0103ng g\u1ea5p \u0111\u00f4i n\u1ed3ng \u0111\u1ed9 creatinin v\u00e0o th\u1eddi \u0111i\u1ec3m xu\u1ea5t vi\u1ec7n (NEJM JW Gen Med ng\u00e0y 15\/4 v\u00e0 N Engl J Med ng\u00e0y 1\/3; 378:819).<\/p>\n<p>Th\u1eed nghi\u1ec7m t\u1ea1i khoa ED (bao g\u1ed3m c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c chuy\u1ec3n t\u1eeb khoa ED sang \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c) c\u0169ng cho k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1. Hi\u1ec7u qu\u1ea3 c\u1ee7a d\u1ecbch truy\u1ec1n \u0111\u1eb3ng tr\u01b0\u01a1ng r\u00f5 r\u00e0ng h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m tr\u00f9ng huy\u1ebft v\u00e0 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c b\u1ed3i ph\u1ee5 l\u01b0\u1ee3ng th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n l\u1edbn (NEJM JW Gen Med ng\u00e0y 15\/4 v\u00e0 N Engl J Med ng\u00e0y 1\/3; 378:829).<\/p>\n<p>C\u1ea3 hai th\u1eed nghi\u1ec7m tuy \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ch\u1ec9 t\u1ea1i m\u1ed9t trung t\u00e2m duy nh\u1ea5t nh\u01b0ng v\u1edbi tr\u00ean 28000 b\u1ec7nh nh\u00e2n. C\u00e1c k\u1ebft qu\u1ea3 thu \u0111\u01b0\u1ee3c n\u00e0y c\u0169ng ph\u00f9 h\u1ee3p v\u1edbi xu h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 c\u00f3 tr\u01b0\u1edbc khi\u1ebfn r\u1ea5t nhi\u1ec1u b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c m\u1eb7c \u0111\u1ecbnh s\u1eed d\u1ee5ng Ringer lactat tr\u1eeb m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t (v\u00ed d\u1ee5: d\u1ecbch mu\u1ed1i truy\u1ec1n th\u00edch h\u1ee3p h\u01a1n trong tr\u01b0\u1eddng h\u1ee3p ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o v\u00ec t\u00ednh th\u1ea9m th\u1ea5u cao c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n ph\u00f9 n\u00e3o).<\/p>\n<p>Hai th\u1eed nghi\u1ec7m \u0111a trung t\u00e2m quy m\u00f4 l\u1edbn v\u1ec1 l\u1ef1a ch\u1ecdn d\u1ecbch truy\u1ec1n \u0111ang \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh hi v\u1ecdng s\u1ebd \u0111\u01b0a ra \u0111\u01b0\u1ee3c \u0111\u1ecbnh h\u01b0\u1edbng r\u00f5 r\u00e0ng h\u01a1n cho \u0111i\u1ec1u tr\u1ecb. Trong khi ch\u1edd \u0111\u1ee3i, Ringer lactat v\u1eabn l\u00e0 l\u1ef1a ch\u1ecdn t\u1ed1t h\u01a1n, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf b\u1ec7nh nh\u00e2n nhi\u1ec5m khu\u1ea9n c\u1ea7n ph\u1ea3i b\u00f9 m\u1ed9t l\u01b0\u1ee3ng l\u1edbn th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n.<\/p>\n<p>Ngu\u1ed3n: <a href=\"https:\/\/www.jwatch.org\/na48078\/2018\/12\/27\/nejm-journal-watch-general-medicine-year-review-2018\" rel=\"noopener\">https:\/\/www.jwatch.org\/na48078\/2018\/12\/27\/nejm-journal-watch-general-medicine-year-review-2018<\/a><\/p>\n<p>Ng\u01b0\u1eddi t\u1ed5ng h\u1ee3p: Nguy\u1ec5n Th\u1ecb Thu H\u00e0 &#8211; \u0110o\u00e0n Ph\u01b0\u01a1ng Th\u1ea3o<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0110i\u1ec3m nghi\u00ean c\u1ee9u m\u1edbi c\u00f4ng b\u1ed1 (NEJM): L\u1ef1a ch\u1ecdn d\u1ecbch truy\u1ec1n &#8211; S\u1eed d\u1ee5ng d\u1ecbch tinh th\u1ec3 \u0111\u1eb3ng tr\u01b0\u01a1ng thay th\u1ebf cho dung d\u1ecbch mu\u1ed1i. K\u1ebft qu\u1ea3 c\u1ee7a 2 nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c NEJM \u0111\u0103ng t\u1ea3i g\u1ea7n \u0111\u00e2y \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng b\u1ec7nh nh\u00e2n \u00edt b\u1ecb t\u1ed5n th\u01b0\u01a1ng th\u1eadn h\u01a1n khi \u0111\u01b0\u1ee3c truy\u1ec1n Ringer lactat thay [&#8230;]\n","protected":false},"author":1,"featured_media":5402,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5401","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\/5401","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=5401"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5401\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/5402"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=5401"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=5401"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=5401"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}