{"id":5808,"date":"2019-03-30T10:55:27","date_gmt":"2019-03-30T03:55:27","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=5808"},"modified":"2019-03-30T10:55:27","modified_gmt":"2019-03-30T03:55:27","slug":"be-gai-so-sinh-khoc-thet-tang-phan-xa-moro-di-ngoai-phan-long-va-mo-hoi-nhieu","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/be-gai-so-sinh-khoc-thet-tang-phan-xa-moro-di-ngoai-phan-long-va-mo-hoi-nhieu\/","title":{"rendered":"B\u00e9 g\u00e1i s\u01a1 sinh kh\u00f3c th\u00e9t, t\u0103ng ph\u1ea3n x\u1ea1 Moro, \u0111i ngo\u00e0i ph\u00e2n l\u1ecfng, v\u00e3 m\u1ed3 h\u00f4i nhi\u1ec1u"},"content":{"rendered":"<h2>Ca l\u00e2m s\u00e0ng<\/h2>\n[Nhi] Tr\u1ebb g\u00e1i s\u01a1 sinh \u0111\u1ee7 th\u00e1ng, ti\u1ec1n s\u1eed ng\u01b0\u1eddi m\u1eb9 nghi\u1ec7n heroin v\u00e0 khi mang thai \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng methadone. Tr\u1ebb c\u00f3 v\u1ebb kh\u00f4ng \u00e1p v\u00fa m\u1eb9 khi b\u1eaft \u0111\u1ea7u cho b\u00fa v\u00e0 r\u1ea5t qu\u1ea5y kh\u00f3c. Tr\u1ebb kh\u00f3c th\u00e9t, t\u0103ng ph\u1ea3n x\u1ea1 Moro, \u0111i ngo\u00e0i ph\u00e2n l\u1ecfng, v\u00e3 m\u1ed3 h\u00f4i nhi\u1ec1u.<\/p>\n<p>S\u1eed d\u1ee5ng c\u00f4ng c\u1ee5 l\u01b0\u1ee3ng ho\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a h\u1ed9i ch\u1ee9ng cai th\u1ea5y r\u1eb1ng tr\u1ebb c\u00f3 d\u1ea5u hi\u1ec7u m\u1ee9c \u0111\u1ed9 v\u1eeba c\u1ee7a h\u1ed9i ch\u1ee9ng cai s\u01a1 sinh.<\/p>\n<p>\u0110\u00e2u l\u00e0 x\u1eed tr\u00ed ban \u0111\u1ea7u ph\u00f9 h\u1ee3p nh\u1ea5t cho tr\u1ebb n\u00e0y?<\/p>\n<p>A. B\u1eaft \u0111\u1ea7u d\u00f9ng diazepam<br \/>\nB. B\u1eaft \u0111\u1ea7u d\u00f9ng morphine li\u1ec1u th\u1ea5p<br \/>\nC. B\u1eaft \u0111\u1ea7u truy\u1ec1n dextrose \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch<br \/>\nD. Khuy\u1ebfn kh\u00edch b\u00e0 m\u1eb9 \u1edf c\u00f9ng tr\u1ebb trong m\u00f4i tr\u01b0\u1eddng y\u00ean t\u0129nh<br \/>\nE. Dinh d\u01b0\u1ee1ng li\u00ean t\u1ee5c qua \u1ed1ng th\u00f4ng m\u0169i &#8211; d\u1ea1 d\u00e0y<\/p>\n<h2>\u0110\u00e1p \u00e1n: D.<\/h2>\n<p>\u0110i\u1ec3m then ch\u1ed1t: X\u1eed tr\u00ed ph\u00f9 h\u1ee3p nh\u1ea5t cho tr\u1ebb c\u00f3 d\u1ea5u hi\u1ec7u m\u1ee9c \u0111\u1ed9 v\u1eeba c\u1ee7a h\u1ed9i ch\u1ee9ng cai s\u01a1 sinh l\u00e0 ban \u0111\u1ea7u khuy\u1ebfn kh\u00edch b\u00e0 m\u1eb9 \u1edf c\u00f9ng tr\u1ebb trong m\u00f4i tr\u01b0\u1eddng y\u00ean t\u0129nh.<\/p>\n<h3>Gi\u1ea3i th\u00edch chi ti\u1ebft:<\/h3>\n<p>Tr\u1ebb nguy c\u01a1 cao m\u1eafc h\u1ed9i ch\u1ee9ng cai s\u01a1 sinh c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i c\u00e1c d\u1ea5u hi\u1ec7u cai thu\u1ed1c m\u00e0 ch\u00fang t\u1eebng ph\u01a1i nhi\u1ec5m trong b\u1ee5ng m\u1eb9. C\u00e1c d\u1ea5u hi\u1ec7u n\u00e0y bao g\u1ed3m t\u00ednh h\u01b0ng ph\u1ea5n th\u1ea7n kinh, nh\u01b0 k\u00edch th\u00edch, kh\u00f3c th\u00e9t v\u00e0 c\u00f3 th\u1ec3 c\u1ea3 co gi\u1eadt. C\u0169ng c\u00f3 th\u1ec3 g\u1eb7p c\u00e1c d\u1ea5u hi\u1ec7u r\u1ed1i lo\u1ea1n v\u1ec1 ti\u00eau ho\u00e1 &#8211; nh\u01b0 b\u00fa k\u00e9m, m\u00fat kh\u00f4ng ki\u1ec3m so\u00e1t v\u00e0 li\u00ean t\u1ee5c, \u0111i ph\u00e2n l\u1ecfng, m\u1ea5t n\u01b0\u1edbc.<\/p>\n<p>S\u1eed d\u1ee5ng thang \u0111i\u1ec3m l\u01b0\u1ee3ng ho\u00e1 c\u00e1c d\u1ea5u hi\u1ec7u cai (nh\u01b0 b\u1ea3ng \u0111i\u1ec3m Lipsitz ho\u1eb7c h\u1ec7 th\u1ed1ng thang \u0111i\u1ec3m h\u1ed9i ch\u1ee9ng cai s\u01a1 sinh Finnegan) c\u00f3 th\u1ec3 c\u00f3 \u00edch trong vi\u1ec7c xem x\u00e9t c\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng cai s\u01a1 sinh. C\u00e1c c\u00f4ng c\u1ee5 n\u00e0y c\u00f3 \u0111i\u1ec3m c\u00e0ng cao g\u1ee3i \u00fd d\u1ea5u hi\u1ec7u cai c\u00e0ng n\u1eb7ng.<\/p>\n<p>\u0110\u1ed1i v\u1edbi tr\u1ebb nguy c\u01a1 cao b\u1ecb h\u1ed9i ch\u1ee9ng cai methadone ho\u1eb7c c\u00e1c opioid kh\u00e1c, ch\u0103m s\u00f3c ban \u0111\u1ea7u c\u1ea7n ch\u00fa tr\u1ecdng vi\u1ec7c t\u1ed1i \u01b0u ho\u00e1 c\u00e1c x\u1eed tr\u00ed kh\u00f4ng d\u00f9ng thu\u1ed1c v\u00e0 khuy\u1ebfn kh\u00edch b\u00e0 m\u1eb9 \u1edf c\u00f9ng tr\u1ebb t\u1ea1i n\u01a1i y\u00ean t\u0129nh nh\u1eb1m t\u0103ng c\u01b0\u1eddng m\u1ed1i li\u00ean h\u1ec7 m\u1eb9 &#8211; con, ti\u1ebfp x\u00fac da \u00e1p da v\u00e0 cho tr\u1ebb b\u00fa.<\/p>\n<p>C\u01a1n \u0111\u00f3i qu\u00e1 m\u1ee9c l\u00e0m n\u1eb7ng th\u00eam h\u1ed9i ch\u1ee9ng cai s\u01a1 sinh. Do \u0111\u00f3, th\u00f4ng th\u01b0\u1eddng c\u1ea7n cho tr\u1ebb \u00edt s\u1eefa th\u00f4ng qua vi\u1ec7c b\u00fa m\u1eb9, b\u00fa s\u1eefa m\u1eb9 trong b\u00ecnh ho\u1eb7c u\u1ed1ng s\u1eefa c\u00f4ng th\u1ee9c. Vi\u1ec7c cho \u0103n qua \u1ed1ng th\u00f4ng m\u0169i &#8211; d\u1ea1 d\u00e0y l\u00e0 kh\u00f4ng sinh l\u00ed v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh tr\u00ean l\u00e2m s\u00e0ng. Cho b\u00fa s\u1eefa m\u1eb9 tr\u1ef1c ti\u1ebfp ho\u1eb7c qua b\u00ecnh \u00edt c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y nguy c\u01a1 h\u1ed9i ch\u1ee9ng cai s\u01a1 sinh n\u1eb7ng v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch. N\u1ebfu ti\u1ebfp t\u1ee5c g\u1eb7p kh\u00f3 kh\u0103n khi cho tr\u1ebb b\u00fa v\u00e0 tr\u1ebb v\u1eabn s\u00fat c\u00e2n d\u00f9 \u0111\u00e3 \u0111\u01b0\u1ee3c x\u1eed tr\u00ed ban \u0111\u1ea7u, l\u00fac n\u00e0y c\u00f3 th\u1ec3 \u0111\u1eb7t \u1ed1ng th\u00f4ng m\u0169i &#8211; d\u1ea1 d\u00e0y \u0111\u1ec3 cho \u0103n qua sonde ng\u1eaft qu\u00e3ng. C\u0169ng c\u00f3 th\u1ec3 c\u1ea7n t\u0103ng c\u01b0\u1eddng dinh d\u01b0\u1ee1ng cho tr\u1ebb do nhu c\u1ea7u dinh d\u01b0\u1ee1ng t\u0103ng l\u00ean li\u00ean quan \u0111\u1ebfn h\u1ed9i ch\u1ee9ng cai s\u01a1 sinh.<\/p>\n<p>Thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 d\u1ea5u hi\u1ec7u cai dai d\u1eb3ng m\u1ee9c \u0111\u1ed9 v\u1eeba \u0111\u1ebfn n\u1eb7ng ch\u1ec9 khi x\u1eed tr\u00ed ban \u0111\u1ea7u kh\u00f4ng d\u00f9ng thu\u1ed1c kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb l\u00e0 l\u00e0m gi\u1ea3m c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a h\u1ed9i ch\u1ee9ng cai s\u01a1 sinh v\u00e0 d\u1ef1 ph\u00f2ng c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 s\u1ed1t, s\u00fat c\u00e2n v\u00e0 co gi\u1eadt. Khi c\u1ea7n d\u00f9ng thu\u1ed1c trong h\u1ed9i ch\u1ee9ng cai s\u01a1 sinh, thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay \u0111i\u1ec3n h\u00ecnh l\u00e0 morphine ho\u1eb7c methadone \u0111\u01b0\u1eddng u\u1ed1ng. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng, c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 b\u1eb1ng phenobarbital ho\u1eb7c clonidine.<\/p>\n<p>Kh\u00f4ng n\u00ean d\u00f9ng diazepam \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng cai s\u01a1 sinh v\u00ec c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m ph\u1ea3n x\u1ea1 m\u00fat v\u00e0 nu\u1ed1t c\u0169ng nh\u01b0 g\u00e2y th\u00eam kh\u00f3 kh\u0103n cho vi\u1ec7c b\u00fa m\u1eb9.<\/p>\n<p>\u0110\u1ecbnh l\u01b0\u1ee3ng \u0111\u01b0\u1eddng huy\u1ebft l\u00e0 h\u1ee3p l\u00ed khi tr\u1ebb k\u00edch th\u00edch hay kh\u00f3 ch\u1ecbu; tuy nhi\u00ean d\u00f9ng dextrose theo kinh nghi\u1ec7m l\u00e0 kh\u00f4ng ph\u00f9 h\u1ee3p \u1edf tr\u1ebb n\u00e0y v\u1edbi ti\u1ec1n s\u1eed ph\u01a1i nhi\u1ec5m thu\u1ed1c trong b\u1ee5ng m\u1eb9 v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u c\u0169ng nh\u01b0 tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ed9i ch\u1ee9ng cai s\u01a1 sinh v\u00e0 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/h2>\n<p>MacMillan KDL et al. Association of rooming-in with outcomes for neonatal abstinence syndrome: a systematic review and meta-analysis. JAMA Pediatr 2018 Apr 1; 172:345.<\/p>\n<p>Lacaze-Masmonteil T and O&#8217;Flaherty P. Managing infants born to mothers who have used opioids during pregnancy. Paediatr Child Health 2018 May; 23:220.<\/p>\n<p>Kocherlakota P. Neonatal abstinence syndrome. Pediatrics 2014 Aug; 134:e547.<\/p>\n<p>Wachman EM et al. Neonatal abstinence syndrome: advances in diagnosis and treatment. JAMA 2018 Apr 3; 319:1362.<\/p>\n<p>Ngu\u1ed3n: NEJM<\/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<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ca l\u00e2m s\u00e0ng [Nhi] Tr\u1ebb g\u00e1i s\u01a1 sinh \u0111\u1ee7 th\u00e1ng, ti\u1ec1n s\u1eed ng\u01b0\u1eddi m\u1eb9 nghi\u1ec7n heroin v\u00e0 khi mang thai \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng methadone. Tr\u1ebb c\u00f3 v\u1ebb kh\u00f4ng \u00e1p v\u00fa m\u1eb9 khi b\u1eaft \u0111\u1ea7u cho b\u00fa v\u00e0 r\u1ea5t qu\u1ea5y kh\u00f3c. Tr\u1ebb kh\u00f3c th\u00e9t, t\u0103ng ph\u1ea3n x\u1ea1 Moro, \u0111i ngo\u00e0i ph\u00e2n l\u1ecfng, v\u00e3 m\u1ed3 h\u00f4i [&#8230;]\n","protected":false},"author":1,"featured_media":5809,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5808","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\/5808","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=5808"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5808\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/5809"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=5808"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=5808"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=5808"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}