{"id":10815,"date":"2023-08-02T23:35:00","date_gmt":"2023-08-02T15:35:00","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&p=10815"},"modified":"2025-02-11T13:36:18","modified_gmt":"2025-02-11T05:36:18","slug":"phan-2-xu-tri-benh-nhan-soc-nhiem-khuan-nhung-vi-du-thuc-te","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/phan-2-xu-tri-benh-nhan-soc-nhiem-khuan-nhung-vi-du-thuc-te\/","title":{"rendered":"Ph\u1ea7n 2: X\u1eed tr\u00ed b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n? Nh\u1eefng v\u00ed d\u1ee5 th\u1ef1c t\u1ebf"},"content":{"rendered":"\n

M\u1ede \u0110\u1ea6U<\/strong><\/p>\n\n\n\n

B\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n (septic shock) c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c t\u00e1c nh\u00e2n v\u1eadn m\u1ea1ch \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh huy\u1ebft \u00e1p v\u00e0 gi\u1ea3i quy\u1ebft t\u00ecnh tr\u1ea1ng nhi\u1ec5m toan lactic do nhi\u1ec5m tr\u00f9ng. C\u00f3 t\u1edbi 30 \u2013 40% tr\u01b0\u1eddng h\u1ee3p s\u1ed1c nhi\u1ec5m khu\u1ea9n b\u1ecb t\u1eed vong. B\u00e1c s\u0129 c\u1ea7n \u0111\u01b0a ra nhi\u1ec1u quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb khi ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n, bao g\u1ed3m l\u1ef1a ch\u1ecdn thu\u1ed1c v\u1eadn m\u1ea1ch v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3, B\u00e0i vi\u1ebft n\u00e0y h\u1ed7 tr\u1ee3 \u0111\u1ed9c gi\u1ea3 tr\u1ea3 l\u1eddi cho c\u00e2u h\u1ecfi \u201cl\u00e0m th\u1ebf n\u00e0o\u201d b\u1eb1ng nh\u1eefng v\u00ed d\u1ee5 th\u1ef1c t\u1ebf trong vi\u1ec7c \u0111\u01b0a ra l\u1ef1a ch\u1ecdn thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u1ea7u tay, \u0111\u01b0a ra huy\u1ebft \u00e1p \u0111\u00edch, \u0111\u01b0\u1eddng d\u00f9ng c\u1ee7a thu\u1ed1c v\u1eadn m\u1ea1ch, l\u1ef1a ch\u1ecdn thu\u1ed1c v\u1eadn m\u1ea1ch h\u00e0ng 2 v\u00e0 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3.<\/p>\n\n\n\n

Ch\u00fang t\u00f4i h\u00e2n h\u1ea1nh gi\u1edbi thi\u1ec7u \u0111\u1ebfn c\u00e1c b\u1ea1n \u0111\u1ecdc ph\u1ea7n ti\u1ebfp theo c\u1ee7a b\u00e0i vi\u1ebft L\u00e0m th\u1ebf n\u00e0o \u0111\u1ec3 l\u00ean thang thu\u1ed1c v\u1eadn m\u1ea1ch v\u00e0 corticoid trong \u0111i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m khu\u1ea9n? Nh\u1eefng v\u00ed d\u1ee5 th\u1ef1c t\u1ebf.<\/em> N\u1ebfu qu\u00fd v\u1ecb \u0111\u1ed3ng nghi\u1ec7p c\u00f3 nhu c\u1ea7u xem l\u1ea1i b\u00e0i vi\u1ebft ph\u1ea7n 1, click v\u00e0o \u0111\u01b0\u1eddng d\u1eabn: https:\/\/docquity.app.link\/GdMwxSFHSyb<\/a><\/p>\n\n\n\n

V\u00cd D\u1ee4 2<\/strong><\/p>\n\n\n\n

Sau 24 gi\u1edd, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c t\u0103ng li\u1ec1u norepinephrine l\u00ean \u0111\u1ebfn 0.5 \u00b5g\/kg\/ph\u00fat. B\u1ec7nh nh\u00e2n c\u0169ng \u0111\u01b0\u1ee3c \u0111\u1eb7t catheter t\u0129nh m\u1ea1ch trung t\u00e2m. Nhu c\u1ea7u oxy v\u00e0 thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n. Kh\u00e1ng sinh \u0111\u01b0\u1ee3c thu h\u1eb9p, c\u00f3 ph\u1ed5 tr\u00ean Escherichia coli<\/em> d\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y.<\/p>\n\n\n\n

Sau khi t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n d\u1ea7n \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n, v\u00e0o ng\u00e0y th\u1ee9 5, t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n l\u1ea1i tr\u1edf n\u1eb7ng. Huy\u1ebft \u00e1p c\u1ee7a b\u1ec7nh nh\u00e2n h\u1ea1 xu\u1ed1ng nhanh ch\u00f3ng m\u1eb7c d\u00f9 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng norepinephrine li\u1ec1u 0.5 \u00b5g\/kg\/ph\u00fat, vasoprssine li\u1ec1u 2.4 \u0111\u01a1n v\u1ecb\/gi\u1edd \u0111\u01b0\u1ee3c b\u1ed5 sung v\u00e0 sau \u0111\u00f3 ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c b\u1ed5 sung epinephrine li\u1ec1u 0.3 \u00b5g\/kg\/ph\u00fat. Huy\u1ebft \u00e1p c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0 95\/40 mmHg (huy\u1ebft \u00e1p trung b\u00ecnh 57 mmHg), t\u1ea7n s\u1ed1 tim 110 nh\u1ecbp\/ph\u00fat. B\u1ec7nh nh\u00e2n c\u0169ng \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1ed1i h\u1ee3p hydrocortisone v\u00e0 fludrocortisone. \u0110\u1ea7u chi c\u1ee7a b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed1m. N\u1ed3ng \u0111\u1ed9 lactate huy\u1ebft thanh l\u00e0 4.5 g\/l. Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng xu\u1ea5t huy\u1ebft, h\u1ed9i ch\u1ee9ng ch\u00e8n \u00e9p khoang b\u1ee5ng hay tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i. K\u1ebft qu\u1ea3 si\u00eau \u00e2m tim v\u1eabn kh\u00f4ng thay \u0111\u1ed5i, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u ch\u00e8n \u00e9p tim, r\u1ed1i lo\u1ea1n m\u1edbi \u1edf t\u00e2m th\u1ea5t tr\u00e1i v\u00e0 ph\u1ea3i.<\/p>\n\n\n\n

Ch\u1ea9n \u0111o\u00e1n n\u00e0o n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c dai d\u1eb3ng ho\u1eb7c s\u1ed1c tr\u1edf n\u1eb7ng?<\/em><\/strong><\/p>\n\n\n\n

S\u1ed1c tr\u1edf n\u1eb7ng ho\u1eb7c s\u1ed1c dai d\u1eb3ng m\u1eb7c d\u00f9 \u0111\u00e3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t ngu\u1ed3n c\u0103n ban \u0111\u1ea7u v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed3i s\u1ee9c n\u00ean \u0111\u01b0\u1ee3c nhanh ch\u00f3ng c\u00e2n nh\u1eafc \u0111\u00e1nh gi\u00e1 ch\u1ea9n \u0111o\u00e1n b\u1ed5 sung. Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p v\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p s\u1ed1c tr\u1edf n\u1eb7ng sau khi \u0111\u00e3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t ngu\u1ed3n c\u0103n ban \u0111\u1ea7u \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n trong b\u1ea3ng 1. M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 g\u00e2y tr\u1edf n\u1eb7ng t\u00ecnh tr\u1ea1ng s\u1ed1c th\u01b0\u1eddng bao g\u1ed3m nhi\u1ec5m tr\u00f9ng b\u1ec7nh vi\u1ec7n, s\u1ed1c t\u1eafc ngh\u1ebdn do thuy\u00ean t\u1eafc ph\u1ed5i ho\u1eb7c h\u1ed9i ch\u1ee9ng ch\u00e8n \u00e9p khoang b\u1ee5ng ho\u1eb7c s\u1ed1c tim do b\u1ec7nh l\u00fd c\u01a1 tim do nhi\u1ec5m khu\u1ea9n ho\u1eb7c lo\u1ea1n nh\u1ecbp.<\/p>\n\n\n\n

B\u1ea3ng 1. <\/strong>Nh\u1eefng c\u00e2n nh\u1eafc l\u00e2m s\u00e0ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng s\u1ed1c tr\u1edf n\u1eb7ng<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

N\u00ean ng\u1eebng l\u00ean thang thu\u1ed1c v\u1eadn m\u1ea1ch \u1edf li\u1ec1u n\u00e0o?<\/em><\/strong><\/p>\n\n\n\n

Kh\u00f4ng c\u00f3 ng\u01b0\u1ee1ng li\u1ec1u c\u1ee5 th\u1ec3 ng\u1eebng l\u00ean thang norepinephrin hay epinephrine. N\u1ebfu kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u cho th\u1ea5y huy\u1ebft \u00e1p g\u1ea7n \u0111\u1ea1t m\u1ee9c huy\u1ebft \u00e1p trung b\u00ecnh \u0111\u00e1p \u1ee9ng khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng norepinephrine ho\u1eb7c epinephrine \u1edf li\u1ec1u cao h\u01a1n, th\u00ec kh\u00f4ng c\u00f3 gi\u1edbi h\u1ea1n cho vi\u1ec7c l\u00ean thang c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch. Tuy nhi\u00ean, vasopressin th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9nh li\u1ec1u qu\u00e1 2.4 \u0111\u01a1n v\u1ecb\/gi\u1edd. Nhi\u1ec1u nghi\u00ean c\u1ee9u ti\u1ebfn h\u00e0nh \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb s\u1ed1c nhi\u00eam khu\u1ea9n b\u1eb1ng thu\u1ed1c v\u1eadn m\u1ea1ch li\u1ec1u cao, k\u1ebft qu\u1ea3 th\u1ea5y t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t giao \u0111\u1ed9ng kho\u1ea3ng 10 \u2013 54% 2 \u2013 6<\/sup>. Trong th\u1eed nghi\u1ec7m APROCCHSS, li\u1ec1u norepinephrine trung b\u00ecnh l\u00e0 1.08 \u00b5g\/kg\/ph\u00fat v\u00e0 li\u1ec1u epinephrine trung b\u00ecnh l\u00e0 2.01 \u00b5g\/kg\/ph\u00fat.<\/p>\n\n\n\n

C\u00f3 n\u00ean \u0111\u1eb7t catheter \u0111\u1ed9ng m\u1ea1ch trung t\u00e2m khi \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n s\u1ed1c kh\u00f3 tr\u1ecb?<\/em><\/strong><\/p>\n\n\n\n

Catheter \u0111\u1ed9ng m\u1ea1ch trung t\u00e2m th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1eb7t \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c kh\u00f3 tr\u1ecb v\u00e0 c\u00f3 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng tr\u1edf n\u1eb7ng ngay c\u1ea3 khi \u0111\u00e3 \u0111\u01b0\u1ee3c t\u0103ng li\u1ec1u thu\u1ed1c v\u1eadn m\u1ea1ch. H\u01b0\u1edbng d\u1eabn Surviving Sepsis Campaign \u0111\u01b0a ra khuy\u1ebfn c\u00e1o y\u1ebfu cho vi\u1ec7c theo d\u00f5i huy\u1ebft \u00e1p x\u00e2m l\u1ea5n nh\u01b0ng kh\u00f4ng ch\u1ec9 r\u00f5 n\u00ean theo d\u00f5i huy\u1ebft \u00e1p b\u1eb1ng \u0111\u01b0\u1eddng trung t\u00e2m hay ngo\u1ea1i bi\u00ean7<\/sup>.<\/p>\n\n\n\n

C\u00f3 n\u00ean \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m toan?<\/em><\/strong><\/p>\n\n\n\n

\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n nhi\u1ec5m toan m\u00e1u nghi\u00eam tr\u1ecdng, t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p v\u00e0 s\u1ed1c kh\u00f3 tr\u1ecb c\u00f3 th\u00f4ng kh\u00ed d\u1ef1 tr\u1eef, natri bicarbonate th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh v\u1edbi pH m\u1ee5c ti\u00eau > 7.3, \u0111\u1ed3ng th\u1eddi tr\u1ecb li\u1ec7u thay th\u1ebf th\u1eadn li\u00ean t\u1ee5c c\u0169ng \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ea7u n\u1ebfu t\u00ecnh tr\u1ea1ng nhi\u1ec5m toan m\u00e1u v\u1eabn kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t. Natri bicarbonate v\u00e0 li\u1ec7u th\u00e1p thay th\u1ebf th\u1eadn c\u00f3 th\u1ec3 \u0111i\u1ec1u ch\u1ec9nh t\u00ecnh tr\u1ea1ng nhi\u1ec5m toan ng\u1eafn h\u1ea1n.<\/p>\n\n\n\n

V\u00cd D\u1ee4 3<\/strong><\/p>\n\n\n\n

K\u1ebft qu\u1ea3 c\u1ea5y m\u00e1u c\u1ee7a b\u1ec7nh nh\u00e2n d\u01b0\u01a1ng t\u00ednh v\u1edbi Staphylococcus aureus <\/em>kh\u00e1ng methicillin. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n kh\u00e1ng sinh ph\u00f9 h\u1ee3p v\u00e0 \u0111\u1eb7t catheter t\u0129nh m\u1ea1ch trung t\u00e2m. Lactate huy\u1ebft thanh v\u00e0 t\u00ecnh tr\u1ea1ng gi\u00e3n m\u1ea1ch \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n, tuy nhi\u00ean, b\u1ec7nh nh\u00e2n v\u1eabn ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng norepinephrine \u1edf li\u1ec1u 0.3 \u00b5g\/kg\/ph\u00fat v\u00e0 vasopressin. Huy\u1ebft \u00e1p c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0 90\/50 mmHg (huy\u1ebft \u00e1p trung b\u00ecnh 63 mmHg) v\u00e0 t\u1ea7n s\u1ed1 tim 95 nh\u1ecbp\/ph\u00fat. K\u1ebft qu\u1ea3 si\u00eau \u00e2m tim kh\u00f4ng thay \u0111\u1ed5i v\u00e0 k\u1ebft qu\u1ea3 c\u1ea5y l\u1eb7p l\u1ea1i \u00e2m t\u00ednh.<\/p>\n\n\n\n

N\u00ean ng\u01b0ng thu\u1ed1c v\u1eadn m\u1ea1ch nh\u01b0 th\u1ebf n\u00e0o?<\/em><\/strong><\/p>\n\n\n\n

N\u00ean ng\u01b0ng norepinaphrine tr\u01b0\u1edbc, r\u1ed3i \u0111\u1ebfn vasopressin \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u1ea3 2 t\u00e1c nh\u00e2n n\u00e0y v\u00e0 c\u00f3 c\u1ea3i thi\u1ec7n v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng. Kh\u00f4ng c\u00f3 nhi\u1ec1u d\u1eef li\u1ec7u nghi\u00ean c\u1ee9u v\u1ec1 vi\u1ec7c ng\u01b0ng thu\u1ed1c v\u1eadn m\u1ea1ch. M\u1ed9t v\u00e0i nghi\u00ean c\u1ee9u quan s\u00e1t, \u0111\u01a1n trung t\u00e2m cho th\u1ea5y \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u1ea3 norepinephrine v\u00e0 vasopressin, vi\u1ec7c ng\u01b0ng vasopressin tr\u01b0\u1edbc c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 h\u1ea1 huy\u1ebft \u00e1p 8 \u2013 11<\/sup>. \u0110i\u1ec1u n\u00e0y cho th\u1ea5y norepinephrine n\u00ean \u0111\u01b0\u1ee3c ng\u01b0ng \u0111\u1ea7u ti\u00ean.<\/p>\n\n\n\n

V\u00cd D\u1ee4 4<\/strong><\/p>\n\n\n\n

Chi c\u1ee7a b\u1ec7nh nh\u00e2n \u1ea5m v\u00e0 \u0111\u01b0\u1ee3c t\u01b0\u1edbi m\u00e1u t\u1ed1t, t\u00ecnh tr\u1ea1ng t\u00e2m th\u1ea7n v\u00e0 ch\u1ee9c n\u0103ng th\u1eadn c\u0169ng \u0111\u01b0\u1ee3c c\u1ea3i thi\u00ean, tuy nhi\u00ean, khi h\u1ea1 li\u1ec1u vasopressin (2.4 \u0111\u01a1n v\u1ecb\/gi\u1edd) l\u00e0m h\u1ea1 huy\u1ebft \u00e1p trung b\u00ecnh xu\u1ed1ng m\u1ee9c 60 mmHg.<\/p>\n\n\n\n

N\u00ean l\u00e0m th\u1ebf n\u00e0o \u1edf b\u1ec7nh nh\u00e2n gi\u00e3n m\u1ea1ch dai d\u1eb3ng v\u00e0 kh\u00f4ng th\u1ec3 ng\u01b0ng thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u01b0\u1eddng ti\u00eam t\u0129nh m\u1ea1ch?<\/em><\/strong><\/p>\n\n\n\n

\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea3i thi\u1ec7n v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng, tuy nhi\u00ean v\u1eabn b\u1ecb gi\u00e3n m\u1ea1ch nh\u1eb9, dai d\u1eb3ng, huy\u1ebft \u00e1p trung b\u00ecnh m\u1ee5c ti\u00eau \u0111\u01b0\u1ee3c h\u1ea1 xu\u1ed1ng c\u00f2n 60 mmHg \u0111\u1ec3 h\u1ed7 tr\u1ee3 qu\u00e1 tr\u00ecnh ng\u01b0ng thu\u1ed1c v\u1eadn m\u1ea1ch. Nhi\u1ec1u khi, thu\u1ed1c an th\u1ea7n c\u0169ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng h\u1ea1 \u00e1p, do v\u1eady n\u00ean \u0111i\u1ec1u ch\u1ec9nh thu\u1ed1c an th\u1ea7n \u0111\u1ec3 gi\u1ea3m nhu c\u1ea7u thu\u1ed1c v\u1eadn m\u1ea1ch. N\u1ebfu c\u1ea7n thi\u1ebft th\u00ec n\u00ean ti\u1ebfn h\u00e0nh t\u00e1i \u0111\u00e1nh gi\u00e1 (theo b\u1ea3ng 1) \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nh\u1eefng y\u1ebfu t\u1ed1 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng c\u1ea7n thu\u1ed1c v\u1eadn m\u1ea1ch dai d\u1eb3ng.<\/p>\n\n\n\n

\u1ede b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c h\u1ea1 huy\u1ebft \u00e1p trung b\u00ecnh m\u1ee5c ti\u00eau v\u00e0 t\u1ed1i thi\u1ec3u h\u00f3a thu\u1ed1c an th\u1ea7n nh\u01b0ng v\u1eabn kh\u00f4ng hi\u1ec7u qu\u1ea3, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n suy gan, suy th\u1eadn th\u00ec c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc midodrine. Midodrine th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n v\u1edbi luefeu 10 \u2013 20 mg m\u1ed7i 8 gi\u1edd v\u1edbi li\u1ec1u gi\u1ea3m d\u1ea7n ho\u1eb7c ng\u01b0ng ngay sau \u0111\u00f3 \u0111\u1ec3 tr\u00e1nh t\u00ecnh tr\u1ea1ng s\u1eed d\u1ee5ng k\u00e9o d\u00e0i sau khi xu\u1ea5t vi\u1ec7n. N\u1ebfu kh\u00f4ng c\u00f3 ti\u1ebfn tri\u1ec3n trong vi\u1ec7c \u0111\u1ea1t huy\u1ebft \u00e1p trung b\u00ecnh m\u1ee5c ti\u00eau, th\u00ec midodrine \u0111\u01b0\u1ee3c ng\u01b0ng sau 24 \u2013 48 gi\u1edd.<\/p>\n\n\n\n

K\u1ebeT LU\u1eacN<\/strong><\/p>\n\n\n\n

\u1ede \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n, norepinephrine th\u01b0\u1eddng \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ea7u tr\u01b0\u1edbc, c\u00f3 th\u1ec3 b\u1eb1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch ngo\u1ea1i bi\u00ean ho\u1eb7c catheter midline. Huy\u1ebft \u00e1p trung b\u00ecnh m\u1ee5c ti\u00eau th\u01b0\u1eddng l\u00e0 60 \u2013 65 mmHg. N\u1ebfu li\u1ec1u norepinephrine s\u1eed d\u1ee5ng g\u1ea7n \u0111\u1ea1t m\u1ee9c 15 \u00b5g\/ph\u00fat, vasopressin b\u1eb1ng catheter t\u0129nh m\u1ea1ch trung t\u00e2m \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn l\u00e0 thu\u1ed1c v\u1eadn m\u1ea1ch b\u1ed5 sung cho \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n. Ph\u1ed1i h\u1ee3p hydrocortisone v\u00e0 fludrocartisone trong v\u00f2ng 7 ng\u00e0y c\u0169ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n. \u0110\u1ed3ng th\u1eddi, nh\u1eefng nguy\u00ean nh\u00e2n kh\u00e1c \u0111\u1ed3ng th\u1eddi g\u00e2y s\u1ed1c c\u0169ng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n s\u1ed1c kh\u00f3 tr\u1ecb, vi\u1ec7c theo d\u00f5i huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch trung t\u00e2m v\u00e0 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m toan \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc. N\u1ebfu t\u00ecnh tr\u1ea1ng gi\u00e3n m\u1ea1ch nh\u1eb9 v\u1eabn ti\u1ebfp t\u1ee5c dai d\u1eb3ng m\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 ng\u1ecdn chi, huy\u1ebft \u00e1p trung b\u00ecnh m\u1ee5c ti\u00eau \u0111\u01b0\u1ee3c gi\u1ea3m xu\u1ed1ng 60 mmHg, \u0111\u1ed3ng th\u1eddi \u0111i\u1ec1u ch\u1ec9nh ho\u1eb7c ng\u01b0ng thu\u1ed1c an th\u1ea7n n\u1ebfu c\u00f3 th\u1ec3, n\u1ebfu c\u1ea7n thi\u1ebft th\u00ec midodrine c\u0169ng \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n.<\/p>\n\n\n\n

\n\n\n\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/p>\n\n\n\n

    \n
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  4. Brown SM, Lanspa MJ, Jones JP, et al. Survival after shock requiring high-dose vasopressor therapy. Chest. 2013;143(3):664-671.<\/li>\n\n\n\n
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  6. Morelli A, Ertmer C, Lange M, et al. Effects of short-term simultaneous infusion of dobutamine and terlipressin in patients with septic shock: the DOBUPRESS study. Br J Anaesth. 2008;100(4): 494-503.<\/li>\n\n\n\n
  7. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247.<\/li>\n\n\n\n
  8. Hammond DA, McCain K, Painter JT, et al. Discontinuation of vasopressin before norepinephrine in the recovery phase of septic shock. J Intensive Care Med. 2019;34(10):805-810.<\/li>\n\n\n\n
  9. Bissell BD, Magee C, Moran P, Bastin MLT, Flannery AH. Hemodynamic instability secondary to vasopressin withdrawal in septic shock. J Intensive Care Med. 2019;34(9):761-765.<\/li>\n\n\n\n
  10. Bauer SR, Aloi JJ, Ahrens CL, Yeh JY, Culver DA, Reddy AJ. Discontinuation of vasopressin before norepinephrine increases the incidence of hypotension in patients recovering from septic shock: a retrospective cohort study. J Crit Care. 2010;25(2):362.e367. 362. e311.<\/li>\n\n\n\n
  11. Musallam N, Altshuler D, Merchan C, Zakhary B, Aberle C, Papadopoulos J. Evaluating vasopressor discontinuation strategies in patients with septic shock on concomitant norepinephrine and vasopressin infusions. Ann Pharmacother. 2018;52(8):733-739.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    M\u1ede \u0110\u1ea6U B\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n (septic shock) c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c t\u00e1c nh\u00e2n v\u1eadn m\u1ea1ch \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh huy\u1ebft \u00e1p v\u00e0 gi\u1ea3i quy\u1ebft t\u00ecnh tr\u1ea1ng nhi\u1ec5m toan lactic do nhi\u1ec5m tr\u00f9ng. C\u00f3 t\u1edbi 30 \u2013 40% tr\u01b0\u1eddng h\u1ee3p s\u1ed1c nhi\u1ec5m khu\u1ea9n b\u1ecb t\u1eed vong. B\u00e1c s\u0129 c\u1ea7n \u0111\u01b0a ra nhi\u1ec1u quy\u1ebft …<\/p>\n

    Ph\u1ea7n 2: X\u1eed tr\u00ed b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n? Nh\u1eefng v\u00ed d\u1ee5 th\u1ef1c t\u1ebf<\/span> Read More »<\/a><\/p>\n","protected":false},"author":123,"featured_media":10816,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"default","ast-global-header-display":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"articles_categories":[1370],"articles_tags":[],"articles_topics":[1440],"articles_languages":[1375],"articles_filters":[],"class_list":["post-10815","articles","type-articles","status-publish","has-post-thumbnail","hentry","articles_categories-medical-content-vi","articles_languages-vietnamese-vi"],"_links":{"self":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/10815","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles"}],"about":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/types\/articles"}],"author":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/users\/123"}],"replies":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/comments?post=10815"}],"version-history":[{"count":0,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/10815\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media\/10816"}],"wp:attachment":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media?parent=10815"}],"wp:term":[{"taxonomy":"articles_categories","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_categories?post=10815"},{"taxonomy":"articles_tags","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_tags?post=10815"},{"taxonomy":"articles_topics","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_topics?post=10815"},{"taxonomy":"articles_languages","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_languages?post=10815"},{"taxonomy":"articles_filters","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_filters?post=10815"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}