{"id":13042,"date":"2023-12-18T15:45:12","date_gmt":"2023-12-18T07:45:12","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&p=13042"},"modified":"2025-02-11T13:38:25","modified_gmt":"2025-02-11T05:38:25","slug":"kiem-soat-sot-10-diem-can-luu-y","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/kiem-soat-sot-10-diem-can-luu-y\/","title":{"rendered":"Ki\u1ec3m so\u00e1t s\u1ed1t: 10 \u0111i\u1ec3m c\u1ea7n l\u01b0u \u00fd"},"content":{"rendered":"\n

\u1ede b\u1ec7nh nh\u00e2n \u1ed1m n\u1eb7ng, s\u1ed1t l\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p. X\u00e1c minh nguy\u00ean nh\u00e2n g\u00e2y s\u1ed1t cho t\u1eebng tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ea3i l\u00e0 \u0111i\u1ec1u d\u1ec5 th\u1ef1c hi\u1ec7n. Nhi\u1ec1u nh\u00e2n vi\u00ean y t\u1ebf c\u00f3 xu h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb qu\u00e1 m\u1ee9c \u0111\u1ec3 h\u1ea1 s\u1ed1t cho b\u1ec7nh nh\u00e2n, d\u1eabn \u0111\u1ebfn nh\u1eefng t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i kh\u00f4ng mong mu\u1ed1n v\u00e0 k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng tr\u1edf n\u1eb7ng. Th\u01b0\u1eddng c\u00f3 kho\u1ea3ng nhi\u1ec7t \u0111\u1ed9 t\u1ed1i \u01b0u cho m\u1ed7i b\u1ec7nh nh\u00e2n m\u1eafc m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd c\u1ee5 th\u1ec3. Tr\u01b0\u1edbc khi kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb h\u1ea1 s\u1ed1t, c\u1ea7n hi\u1ec3u r\u00f5 kho\u1ea3ng nhi\u1ec7t \u0111\u1ed9 t\u1ed1i \u01b0u n\u00e0y khi b\u1ec7nh nh\u00e2n \u0111ang \u1ed1m n\u1eb7ng [1]. B\u00e0i vi\u1ebft tr\u00ecnh b\u00e0y v\u1ec1 10 \u0111i\u1ec3m c\u1ea7n l\u01b0u \u00fd khi h\u1ea1 s\u1ed1t \u1edf b\u1ec7nh nh\u00e2n tr\u01b0\u1edfng th\u00e0nh s\u1ed1t kh\u00f4ng gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh (non-neutropenic). \"\"<\/p>\n\n\n\n

H\u00ecnh 1. <\/strong>T\u00f3m t\u1eaft 10 \u0111i\u1ec3m c\u1ea7n l\u01b0u \u00fd khi ki\u1ec3m so\u00e1t s\u1ed1t<\/p>\n\n\n\n

\u0110i\u1ec3m 1: \u0110\u1ea3m b\u1ea3o \u0111o \u0111\u00fang nhi\u1ec7t \u0111\u1ed9<\/strong><\/p>\n\n\n\n

\u1ede b\u1ec7nh nh\u00e2n \u1ed1m n\u1eb7ng, bi\u1ec7n ph\u00e1p x\u00e2m l\u1ea5n th\u01b0\u1eddng mang \u0111\u1ebfn k\u1ebft qu\u1ea3 \u0111o l\u01b0\u1eddng nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 t\u1ed1t nh\u1ea5t [1]. M\u1ed9t nghi\u00ean c\u1ee9u ti\u1ebfn h\u00e0nh so s\u00e1nh nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 \u0111o \u0111\u01b0\u1ee3c t\u1eeb b\u00f3ng \u0111\u00e1i, th\u1ef1c qu\u1ea3n, tr\u1ef1c tr\u00e0ng, n\u00e1ch, b\u1eb9n v\u1edbi nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 \u0111o \u0111\u01b0\u1ee3c t\u1eeb catheter \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u1edf b\u1ec7nh nh\u00e2n \u1ed1m n\u1eb7ng. K\u1ebft qu\u1ea3 cho th\u1ea5y nhi\u1ec7t \u0111\u1ed9 \u0111o \u0111\u01b0\u1ee3c t\u1eeb th\u1ef1c qu\u1ea3n v\u00e0 b\u00f3ng \u0111\u00e1i c\u00f3 \u00edt ch\u00eanh l\u1ec7ch nh\u1ea5t so v\u1edbi nhi\u1ec7t \u0111\u1ed9 \u0111o \u0111\u01b0\u1ee3c t\u1eeb catheter \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, sau \u0111\u00f3 \u0111\u1ebfn nhi\u1ec7t \u0111\u1ed9 \u0111o \u0111\u01b0\u1ee3c t\u1eeb tr\u1ef1c tr\u00e0ng, n\u1ea1ch v\u00e0 b\u1eb9n. \u0110i\u1ec1u n\u00e0y c\u00f3 ngh\u0129a l\u00e0 nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 \u0111o \u0111\u01b0\u1ee3c t\u1eeb th\u1ef1c qu\u1ea3n\/b\u1ecdng \u0111\u00e1i \u0111\u00e1ng tin c\u1eady h\u01a1n k\u1ebft qu\u1ea3 \u0111o \u0111\u01b0\u1ee3c t\u1eeb tr\u1ef1c tr\u00e0ng, v\u00e0 k\u1ebft qu\u1ea3 \u0111o \u0111\u01b0\u1ee3c t\u1eeb n\u00e1ch v\u00e0 b\u1eb9n l\u00e0 k\u00e9m tin c\u1eady h\u01a1n c\u1ea3 [2].<\/p>\n\n\n\n

\u0110i\u1ec3m 2: L\u01b0u \u00fd s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c \u0111\u1ecbnh ngh\u0129a s\u1ed1t<\/strong><\/p>\n\n\n\n

Nhi\u1ec7t \u0111\u1ed9 b\u00ecnh th\u01b0\u1eddng c\u1ee7a c\u01a1 th\u1ec3 l\u00e0 37o<\/sup>C v\u00e0 th\u01b0\u1eddng c\u00f3 ch\u00eanh l\u1ec7ch 0.5 \u2013 1o<\/sup>C v\u1ec1 m\u1eb7t sinh l\u00fd [1]. D\u1eef li\u1ec7u hi\u1ec7n c\u00f3 g\u1ee3i \u00fd nhi\u1ec7t \u0111\u1ed9 b\u00ecnh th\u01b0\u1eddng m\u1edbi c\u1ee7a c\u01a1 th\u1ec3 l\u00e0 36.6o<\/sup>C. Ch\u00fang t\u00f4i \u0111\u00e3 tr\u00ecnh b\u00e0y v\u1ec1 k\u1ebft qu\u1ea3 n\u00e0y trong b\u00e0i vi\u1ebft \u201cNhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 b\u00ecnh th\u01b0\u1eddng m\u1edbi<\/a>\u201d.<\/p>\n\n\n\n

C\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb \u0111\u1ec1 xu\u1ea5t nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 \u2265 38.3o<\/sup>C c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 s\u1ed1t, tuy nhi\u00ean ng\u01b0\u1ee1ng x\u00e1c \u0111\u1ecbnh c\u00f3 th\u1ec3 th\u1ea5p h\u01a1n \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch [3]. Khi ch\u1ea9n \u0111o\u00e1n s\u1ed1t, c\u00e1c nguy\u00ean nh\u00e2n m\u00f4i tr\u01b0\u1eddng n\u00ean \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb. M\u1ed9t s\u1ed1 c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb nh\u01b0 li\u1ec7u ph\u00e1p thay th\u1ebf th\u1eadn ho\u1eb7c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb nh\u01b0 ketamine c\u0169ng c\u00f3 th\u1ec3 g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3.<\/p>\n\n\n\n

\u0110i\u1ec3m 3: Kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng ti\u1ebfn h\u00e0nh ch\u1ea9n \u0111o\u00e1n t\u1ed5ng qu\u00e1t \u1edf b\u1ec7nh nh\u00e2n s\u1ed1t<\/strong><\/p>\n\n\n\n

Ch\u00fang ta th\u01b0\u1eddng c\u00f3 th\u00f3i quen thu th\u1eadp m\u1eabu b\u1ec7nh ph\u1ea9m, ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ngu\u1ed3n g\u00e2y nhi\u1ec5m tr\u00f9ng kh\u1ea3 d\u0129 \u1edf b\u1ec7nh nh\u00e2n s\u1ed1t [1]. H\u00e0nh \u0111\u1ed9ng n\u00e0y ch\u1ec9 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o th\u1ef1c hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh kinh nghi\u1ec7m sau khi c\u00e2n nh\u1eafc v\u00e0 c\u00f3 l\u00fd do h\u1ee3p l\u00fd. Kh\u00f4ng n\u00ean ti\u1ebfn h\u00e0nh ch\u1ea9n \u0111o\u00e1n t\u1ed5ng qu\u00e1t \u1edf m\u1ecdi b\u1ec7nh nh\u00e2n s\u1ed1t, ch\u1eb3ng h\u1ea1n nh\u01b0 b\u1ec7nh nh\u00e2n s\u1ed1t ngay sau khi h\u1eadu ph\u1eabu th\u01b0\u1eddng l\u00e0 do \u0111\u1ec9nh \u0111\u00e1p \u1ee9ng vi\u00eam. S\u1ed1t s\u1edbm h\u1eabu ph\u1eabu th\u01b0\u1eddng hi\u1ebfm khi do nguy\u00ean nh\u00e2n nhi\u1ec5m tr\u00f9ng [4]. Ch\u1ea9n \u0111o\u00e1n bao qu\u00e1t \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y kh\u00f4ng h\u1eefu \u00edch m\u00e0 ch\u1ec9 g\u00e2y hao t\u1ed5n chi ph\u00ed v\u00e0 th\u1eddi gian [4].<\/p>\n\n\n\n

\u0110i\u1ec3m 4: C\u00e2n nh\u1eafc nguy\u00ean nh\u00e2n ngo\u00e0i nhi\u1ec5m tr\u00f9ng \u1edf b\u1ec7nh nh\u00e2n s\u1ed1t r\u1ea5t cao<\/strong><\/p>\n\n\n\n

\u0110a s\u1ed1 nhi\u1ec5m tr\u00f9ng th\u01b0\u1eddng kh\u00f4ng g\u00e2y ra s\u1ed1t > 38.9o<\/sup>C [1]. Hi\u1ebfm khi nhi\u1ec7t \u0111\u1ed9 trung t\u00e2m c\u00f3 th\u1ec3 v\u01b0\u1ee3t qu\u00e1 ng\u01b0\u1ee1ng 41.1o<\/sup>C khi nhi\u1ec5m tr\u00f9ng. Nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00f4ng li\u00ean quan \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng g\u00e2y s\u1ed1t r\u1ea5t cao (hyperpyrexia) c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 v\u00e0 \u0111i\u1ec1u tr\u1ecb chuy\u00ean bi\u1ec7t. Nh\u1eefng nguy\u00ean nh\u00e2n n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c h\u1eadu qu\u1ea3 l\u00e2m s\u00e0ng nghi\u00eam tr\u1ecdng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t k\u1ecbp th\u1eddi. Do v\u1eady, \u1edf b\u1ec7nh nh\u00e2n s\u1ed1t r\u1ea5t cao, c\u1ea7n ngh\u0129 ngay \u0111\u1ebfn nh\u1eefng nguy\u00ean nh\u00e2n ngo\u00e0i nhi\u1ec5m tr\u00f9ng. M\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc ch\u1eb3ng h\u1ea1n nh\u01b0 h\u1ed9i ch\u1ee9ng serotonin, t\u0103ng th\u00e2n nhi\u1ec7t \u00e1c t\u00ednh (malignant hyperthermia), h\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh (neuroleptic malignant syndrome), b\u00e3o gi\u00e1p, s\u1ed1c nhi\u1ec7t (heat stroke), ph\u1ea3n \u1ee9ng truy\u1ec1n m\u00e1u t\u00e1n huy\u1ebft c\u1ea5p t\u00ednh (acute hemolytic transfusion reaction), t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i c\u00f3 h\u1ea1i nghi\u00eam tr\u1ecdng c\u1ee7a thu\u1ed1c [5].<\/p>\n\n\n\n

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

H\u00ecnh 2.<\/strong> Nguy\u00ean nh\u00e2n g\u00e2y s\u1ed1t<\/p>\n\n\n\n

\u0110i\u1ec3m 5: \u0110i\u1ec1u tr\u1ecb t\u0103ng th\u00e2n nhi\u1ec7t \u00e1c t\u00ednh ch\u1ee7 \u0111\u1ed9ng<\/strong><\/p>\n\n\n\n

B\u1ec7nh nh\u00e2n t\u0103ng th\u00e2n nhi\u1ec7t \u00e1c t\u00ednh th\u01b0\u1eddng c\u00f3 bi\u1ec3u hi\u1ec7n t\u0103ng CO2<\/sub> \u0111\u1ed9ng m\u1ea1ch, c\u1ee9ng c\u01a1, lo\u1ea1n nh\u1ecbp, t\u0103ng th\u00e2n nhi\u1ec7t [1]. T\u0103ng th\u00e2n nhi\u1ec7t \u00e1c t\u00ednh c\u00f3 th\u1ec3 x\u1ea3y ra do ti\u1ebfp x\u00fac v\u1edbi c\u00e1c ch\u1ea5t g\u00e2y t\u00ea. C\u01a1 ch\u1ebf li\u00ean quan \u0111\u1ebfn gi\u1ea3m \u1ee9c ch\u1ebf mange c\u1ee7a s\u1ef1 ph\u00f3ng th\u00edch calci trong m\u1ea1ng n\u1ed9i sinh c\u01a1 ch\u1ea5t v\u00e0 s\u1ef1 x\u00e2m nh\u1eadp calci ngo\u1ea1i b\u00e0o [1]. Qu\u1ea3n l\u00fd t\u0103ng th\u00e2n nhi\u1ec7t \u00e1c t\u00ednh bao g\u1ed3m b\u1ed5 sung oxy, l\u00e0m m\u00e1t ngo\u00e0i c\u01a1 th\u1ec3, truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch v\u00e0 m\u1ed9t s\u1ed1 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb ch\u1eb3ng h\u1ea1n nh\u01b0 dantrolene [6].<\/p>\n\n\n\n

\u0110i\u1ec3m 6: Th\u1eadn tr\u1ecdng khi h\u1ea1 s\u1ed1t \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n<\/strong><\/p>\n\n\n\n

Nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 r\u1ea5t cao th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n. Nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt cho th\u1ea5y h\u1ea1 s\u1ed1t c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n [1]. H\u1ea1 s\u1ed1t \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n v\u1eabn c\u00f2n l\u00e0 v\u1ea5n \u0111\u1ec1 g\u00e2y nhi\u1ec1u tranh c\u00e3i. M\u1ed9t th\u1eed nghi\u1ec7m cho th\u1ea5y h\u1ea1 s\u1ed1t (m\u1ee5c ti\u00eau 36.5 \u2013 37o<\/sup>C) l\u00e0 bi\u1ec7n ph\u00e1p an to\u00e0n, h\u1ed7 tr\u1ee3 c\u1ea3i thi\u1ec7n huy\u1ebft \u0111\u1ed9ng h\u1ecdc, gi\u1ea3m nhu c\u1ea7u s\u1eed d\u1ee5ng thu\u1ed1c v\u1eadn m\u1ea1ch v\u00e0 t\u1eed vong s\u1edbm \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n [7]. Tr\u00e1i l\u1ea1i, nghi\u00ean c\u1ee9u kh\u00e1c l\u1ea1i cho th\u1ea5y n\u1ed7 l\u1ef1c h\u1ea1 s\u1ed1t \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n c\u00f3 li\u00ean quan \u0111\u1ebfn t\u1eed vong trong 28 ng\u00e0y [8]. Nghi\u00ean c\u1ee9u kh\u00e1c c\u0169ng cho th\u1ea5y n\u1ed7 l\u1ef1c h\u1ea1 s\u1ed1t l\u00e0m t\u0103ng nguy c\u01a1 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n \u0111i\u1ec1u tr\u1ecb \u1edf \u0111\u01a1n v\u1ecb ch\u0103m s\u00f3c t\u00edch c\u1ef1c c\u1ea7n th\u1edf m\u00e1y [9].<\/p>\n\n\n\n

C\u00f3 th\u1ec3 s\u1ef1 \u0111\u00e1p \u1ee9ng c\u1ee7a c\u01a1 th\u1ec3 \u0111\u1ed1i v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p h\u1ea1 s\u1ed1t l\u00e0 kh\u00e1c bi\u1ec7t gi\u1eefa b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n so v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng s\u1ed1c nhi\u1ec5m khu\u1ea9n.<\/p>\n\n\n\n

\u0110i\u1ec3m 7: Acetaminophen kh\u00f4ng c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n b\u1ecb s\u1ed1t<\/strong><\/p>\n\n\n\n

Acetaminophen th\u01b0\u1eddng \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 h\u1ea1 s\u1ed1t. Tuy nhi\u00ean, b\u1eb1ng ch\u1ee9ng hi\u1ec7n c\u00f3 kh\u00f4ng \u1ee7ng h\u1ed9 vi\u1ec7c h\u1ea1 s\u1ed1t b\u1eb1ng acetaminophen \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n. C\u1ee5 th\u1ec3 m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean, c\u00f3 \u0111\u1ed1i ch\u1ee9ng cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong gi\u1eefa nh\u00f3m b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n kh\u00f4ng \u0111\u01b0\u1ee3c h\u1ea1 s\u1ed1t v\u1edbi acetaminophen v\u00e0 nh\u00f3m b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1ee3c h\u1ea1 s\u1ed1t b\u1eb1ng acetaminophen [10]. M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c c\u00f2n cho th\u1ea5y acetaminophen l\u00e0m t\u0103ng huy\u1ebft \u00e1p v\u00e0 nh\u1ecbp tim \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1ee3c h\u1ea1 s\u1ed1t b\u1eb1ng acetaminophen [11]. Kh\u00f4ng nh\u1eefng v\u1eady, h\u1ea1 s\u1ed1t v\u1edbi acetaminophen c\u00f2n c\u00f3 th\u1ec3 g\u00e2y tr\u1ea7m tr\u1ecdng h\u01a1n t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n.<\/p>\n\n\n\n

\u0110i\u1ec3m 8: B\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n kh\u00f4ng k\u00e8m s\u1ed1t \u2013 kh\u00f4ng ph\u1ea3i l\u00e0 d\u1ea5u hi\u1ec7u t\u1ed1t<\/strong><\/p>\n\n\n\n

Khi b\u1ecb nhi\u1ec5m tr\u00f9ng, s\u1ed1t c\u00f3 th\u1ec3 x\u1ea3y ra do c\u00f3 s\u1ef1 t\u01b0\u01a1ng t\u00e1c gi\u1eefa t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh v\u00e0 t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch. V\u1eafng m\u1eb7t s\u1ed1t \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n c\u00f3 th\u1ec3 l\u00e0 d\u1ea5u ch\u1ec9 c\u1ee7a thi\u1ebfu h\u1ee5t \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch, c\u00f3 th\u1ec3 l\u00e0 gi\u1ea3m b\u1ea1ch c\u1ea7u lympho v\u00e0 gi\u1ea3m kh\u00e1ng nguy\u00ean leukocyte ng\u01b0\u1eddi (HLA). Tuy nhi\u00ean, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 n\u1ed3ng \u0111\u1ed9 cytokine ti\u1ec1n vi\u00eam gi\u1eefa b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n k\u00e8m s\u1ed1t v\u00e0 kh\u00f4ng k\u00e8m s\u1ed1t. Thay v\u00e0o \u0111\u00f3, c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch\/huy\u1ebft \u0111\u1ed9ng c\u00f3 th\u1ec3 hi\u1ec7n di\u1ec7n \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n kh\u00f4ng k\u00e8m s\u1ed1t [12]. B\u1ea5t k\u1ec3 nguy\u00ean nh\u00e2n l\u00e0 g\u00ec, b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n kh\u00f4ng k\u00e8m s\u1ed1t c\u00f3 nguy c\u01a1 t\u1ef7 vong cao g\u1ea5p 2 l\u1ea7n so v\u1edbi b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n k\u00e8m s\u1ed1t [1].<\/p>\n\n\n\n

\u0110i\u1ec3m 9: H\u1ea1 s\u1ed1t \u1edf b\u1ec7nh nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng n\u00e3o<\/strong><\/p>\n\n\n\n

T\u0103ng th\u00e2n nhi\u1ec7t c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf b\u1ec7nh nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng n\u00e3o ngay c\u1ea3 khi kh\u00f4ng c\u00f3 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng. Nguy\u00ean nh\u00e2n th\u01b0\u1eddng do th\u1ea7n kinh. Nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i li\u00ean t\u1ee5c \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y, s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p h\u1ea1 s\u1ed1t tr\u00ean b\u1ec1 m\u1eb7t v\u00e0\/ho\u1eb7c thi\u1ebft b\u1ecb l\u00e0m m\u00e1t n\u1ed9i m\u1ea1ch n\u1ebfu ph\u00e1t hi\u1ec7n c\u00f3 s\u1ed1t. Th\u01b0\u1eddng acetaminophen kh\u00f4ng hi\u1ec7u qu\u1ea3 \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y [13].<\/p>\n\n\n\n

\u0110i\u1ec3m 10: H\u1ea1 s\u1ed1t sau khi ng\u01b0ng tim<\/strong><\/p>\n\n\n\n

\u1ede b\u1ec7nh nh\u00e2n ng\u01b0ng tim, ph\u00f2ng ng\u1eeba s\u1ed1t \u0111\u01b0\u1ee3c \u1ee7ng h\u1ed9 b\u1edfi c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n g\u01b0ng tim, n\u00ean theo d\u00f5i nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3  th\u01b0\u1eddng chuy\u00ean v\u00e0 ch\u1ee7 \u0111\u1ed9ng ph\u00f2ng ng\u1eeba s\u1ed1t trong t\u1ed1i thi\u1ec3u 72 gi\u1edd \u1edf b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea sau khi \u0111\u01b0\u1ee3c h\u1ed3i s\u1ee9c do ng\u01b0ng tim [14].<\/p>\n\n\n\n

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

    \n
  1. Leone M, Juffermans NP, Nielsen ND. Ten tips on fever. Intensive Care Med. 2023 May;49(5):587-590. doi: 10.1007\/s00134-023-07049-0. <\/li>\n\n\n\n
  2. Lefrant JY, Muller L, de La Coussaye JE et al. Temperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulmonary artery core method. Intensive Care Med. 2013;29(3):414\u2013418. https:\/\/doi.org\/10.1007\/ s00134-002-1619-5<\/li>\n\n\n\n
  3. O\u2019Grady NP, Barie PS, Bartlett JG et al. Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Dis- eases Society of America. Crit Care Med. 2008;36(4):1330\u20131349. https:\/\/doi.org\/ 10.1097\/CCM.0b013e318169eda9<\/li>\n\n\n\n
  4. Lesperance R, Lehman R, Lesperance K et al. Early postoperative fever and the \u201croutine\u201d fever work-up: results of a prospec- tive study. J Surg Res. 2011;171(1):245\u2013250.<\/li>\n\n\n\n
  5. Niven DJ, Laupland KB, Tabah A et al. Diagnosis and management of temperature abnormality in ICUs: a EUROBACT investi- gators\u2019 survey. Crit Care. 2013;17(6):R289. https:\/\/doi.org\/10.1186\/cc13153<\/a><\/li>\n\n\n\n
  6. Hopkins PM, Girard T, Dalay S, Jenkins B et al. Malignant hyperthermia 2020: Guideline from the Association of Anaesthetists. Anaesthesia. 2021;76(5):655\u2013664. https:\/\/doi.org\/10.1111\/anae. 15317<\/a><\/li>\n\n\n\n
  7. Schortgen F, Clabault K, Katsahian S et al. Fever control using external cooling in septic shock: a rand- omized controlled trial. Am J Respir Crit Care Med. 2012;185(10):1088\u20131095. https:\/\/doi.org\/10.1164\/rccm.201110-1820OC<\/a><\/li>\n\n\n\n
  8. Lee BH, Inui D, Suh GY, Kim JY et al Fever and Antipyretic in Critically ill patients Evaluation (FACE) Study Group. Association of body tem- perature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study. Crit Care. 2012;16(1):R33. https:\/\/doi.org\/10.1186\/cc11211<\/a><\/li>\n\n\n\n
  9. Ye S, Xu D, Zhang C, Li M, Zhang Y. Efect of antipyretic therapy on mortality in critically ill patients with sepsis receiving mechanical ventila- tion treatment. Can Respir J. 2017;2017:3087505. https:\/\/doi.org\/10.1155\/2017\/ 3087505<\/li>\n\n\n\n
  10. Schell-Chaple HM, Liu KD, Matthay MA et al. Efects of IV Acetaminophen on core body temperature and hemody- namic responses in febrile critically ill adults: a randomized controlled trial. Crit Care Med. 2017;45(7):1199\u20131207. https:\/\/doi.org\/1097\/CCM.00000 00000002340<\/a><\/li>\n\n\n\n
  11. Hammond NE, Boyle M. Pharmacological versus non-pharma- cological antipyretic treatments in febrile critically ill adult patients: a systematic review and meta-analysis. Aust Crit Care. 2011;24(1):4\u201317. https:\/\/ doi.org\/10.1016\/j.aucc.2010.002<\/li>\n\n\n\n
  12. Wiewel MA, Harmon MB, van Vught Laet al. Risk factors, host response and outcome of hypothermic sepsis. Crit Care. 2016;20(1):328. https:\/\/doi.org\/10.1186\/ s13054-016-1510-3<\/li>\n\n\n\n
  13. Wiles MD, Braganza M, Edwards H et al. Management of traumatic brain injury in the non-neurosurgical intensive care unit: a narrative review of current evidence. Anaesthesia. 20 https:\/\/doi. org\/10.1111\/anae.15898<\/li>\n\n\n\n
  14. Sandroni C, Natalini D, Nolan JP. Temperature control after cardiac arrest. Crit Care. 2022;26(1):361. https:\/\/doi.org\/10.1186\/s13054-022-04238-z<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    \u1ede b\u1ec7nh nh\u00e2n \u1ed1m n\u1eb7ng, s\u1ed1t l\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p. X\u00e1c minh nguy\u00ean nh\u00e2n g\u00e2y s\u1ed1t cho t\u1eebng tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ea3i l\u00e0 \u0111i\u1ec1u d\u1ec5 th\u1ef1c hi\u1ec7n. Nhi\u1ec1u nh\u00e2n vi\u00ean y t\u1ebf c\u00f3 xu h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb qu\u00e1 m\u1ee9c \u0111\u1ec3 h\u1ea1 s\u1ed1t cho b\u1ec7nh nh\u00e2n, d\u1eabn \u0111\u1ebfn nh\u1eefng t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i …<\/p>\n

    Ki\u1ec3m so\u00e1t s\u1ed1t: 10 \u0111i\u1ec3m c\u1ea7n l\u01b0u \u00fd<\/span> Read More »<\/a><\/p>\n","protected":false},"author":123,"featured_media":13043,"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":[1437],"articles_languages":[1375],"articles_filters":[],"class_list":["post-13042","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\/13042","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=13042"}],"version-history":[{"count":0,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/13042\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media\/13043"}],"wp:attachment":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media?parent=13042"}],"wp:term":[{"taxonomy":"articles_categories","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_categories?post=13042"},{"taxonomy":"articles_tags","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_tags?post=13042"},{"taxonomy":"articles_topics","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_topics?post=13042"},{"taxonomy":"articles_languages","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_languages?post=13042"},{"taxonomy":"articles_filters","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_filters?post=13042"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}