{"id":273979,"date":"2011-06-29T12:16:00","date_gmt":"2011-06-29T05:16:00","guid":{"rendered":"https:\/\/clients-previewhub.com\/hoanmy_wp\/xu-tri-va-dieu-tri-dot-cap-benh-phoi-tac-nghen-man-tinh-copd\/"},"modified":"2025-11-08T19:19:24","modified_gmt":"2025-11-08T12:19:24","slug":"xu-tri-va-dieu-tri-dot-cap-benh-phoi-tac-nghen-man-tinh-copd","status":"publish","type":"post","link":"https:\/\/clients-previewhub.com\/hoanmy_wp\/xu-tri-va-dieu-tri-dot-cap-benh-phoi-tac-nghen-man-tinh-copd\/","title":{"rendered":"X\u1eed tr\u00ed v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0110\u1ee3t c\u1ea5p b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD)"},"content":{"rendered":"

\u0110\u1ee3t c\u1ea5p b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p, t\u1ea7n su\u1ea5t nh\u1eadp vi\u1ec7n v\u00e0 t\u1eed su\u1ea5t v\u00ec \u0111\u1ee3t c\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n COPD \u1edf n\u01b0\u1edbc ta r\u1ea5t cao v\u00e0 g\u00e2y m\u1ed9t g\u00e1nh n\u1eb7ng t\u00e0i ch\u00ednh cho gia \u0111\u00ecnh v\u00e0 x\u00e3 h\u1ed9i. Ch\u1ee9ng t\u1ecf vi\u1ec7c ki\u1ec3m so\u00e1t b\u1ec7nh n\u00e0y ch\u01b0a hi\u1ec7u qu\u1ea3, trong \u0111\u00f3 y\u1ebfu t\u1ed1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh v\u00e0 c\u00f3 c\u1ea3 vai tr\u00f2 c\u1ee7a b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb. B\u00e0i vi\u1ebft sau xin gi\u1edbi thi\u1ec7u t\u1ed5ng quan v\u1ec1 \u0111\u1ee3t c\u1ea5p b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u00e3n t\u00ednh v\u00e0 m\u1ed9t s\u1ed1 h\u01b0\u1edbng d\u1eabn trong x\u1eed tr\u00ed v\u00e0 \u0111i\u1ec1u tr\u1ecb COPD \u0111\u1ee3t c\u1ea5p<\/p>\n

 I. \u0110\u1ecaNH NGH\u0128A<\/strong><\/p>\n

COPD \u0111\u1ee3t c\u1ea5p l\u00e0 \u0111\u1ee3t n\u1eb7ng l\u00ean \u0111\u1ed9t ng\u1ed9t c\u1ee7a giai \u0111o\u1ea1n COPD \u1ed5n \u0111\u1ecbnh tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 c\u1ea7n thay \u0111\u1ed5i \u0111i\u1ec1u tr\u1ecb ngay<\/p>\n

II. L\u00c2M S\u00c0NG<\/strong><\/p>\n

1. B\u1ec7nh s\u1eed<\/strong>: c\u1ea7n khai th\u00e1c<\/p>\n

– Ti\u1ec1n c\u0103n COPD<\/p>\n

– Di\u1ec5n ti\u1ebfn \u0111\u1ee3t c\u1ea5p<\/p>\n

– Th\u00f3i quen c\u00f3 h\u1ea1i li\u00ean quan<\/p>\n

2. Tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n<\/strong><\/p>\n

– S\u1ed1t<\/p>\n

– Gi\u1ea3m t\u1ec9nh t\u00e1o<\/p>\n

– T\u00edm trung \u01b0\u01a1ng<\/p>\n

3. Tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p<\/strong><\/p>\n

– Th\u1edf nhanh > 24l\/ph<\/p>\n

– Co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p<\/p>\n

– C\u1eed \u0111\u1ed9ng l\u1ed3ng ng\u1ef1c ngh\u1ecbch l\u00fd<\/p>\n

– L\u1ed3ng ng\u1ef1c c\u0103ng th\u00f9ng<\/p>\n

– Th\u1edf ch\u00fam m\u00f4i<\/p>\n

4. Tri\u1ec7u ch\u1ee9ng tim m\u1ea1ch<\/strong><\/p>\n

– Tim nhanh<\/p>\n

– Huy\u1ebft \u0111\u1ed9ng h\u1ecdc kh\u00f4ng \u1ed5n \u0111\u1ecbnh<\/p>\n

– Suy tim ph\u1ea3i<\/p>\n

+ TMC (+)<\/p>\n

+ Gan to, \u0111\u1eadp theo nh\u1ecbp m\u1ea1ch<\/p>\n

+ Ph\u00f9 ch\u00e2n<\/p>\n

III. C\u1eacN L\u00c2M S\u00c0NG<\/strong><\/p>\n

1. \u0110\u00e1nh gi\u00e1 to\u00e0n th\u00e2n<\/strong><\/p>\n

– CTM<\/p>\n

– Ch\u1ee9c n\u0103ng gan, th\u1eadn<\/p>\n

– Ion \u0111\u1ed3, \u0110H<\/p>\n

– CRP<\/p>\n

2. H\u00f4 h\u1ea5p<\/strong><\/p>\n

– GP<\/p>\n

– Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch<\/p>\n

– Ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p: khi \u1ed5n<\/p>\n

3. Vi tr\u00f9ng<\/strong><\/p>\n

– C\u1ea5y \u0111\u00e0m<\/p>\n

– C\u1ea5y m\u00e1u n\u1ebfu c\u1ea7n<\/p>\n

4. Li\u00ean quan<\/strong><\/p>\n

– ECG : t\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u : P ph\u1ebf, l\u1edbn th\u1ea5t P, lo\u1ea1n nh\u1ecbp tim, BTTMCB<\/p>\n

– Si\u00eau \u00e2m tim<\/p>\n

IV. CH\u1ea8N \u0110O\u00c1N<\/strong><\/p>\n

1. Ch\u1ea9n \u0111o\u00e1n \u0111\u1ee3t c\u1ea5p<\/strong><\/p>\n

Khi c\u00f3 03 y\u1ebfu t\u1ed1 sau: Gia t\u0103ng kh\u00f3 th\u1edf; \u0110\u00e0m \u0111\u1ed5i m\u00e0u; T\u0103ng l\u01b0\u1ee3ng \u0111\u00e0m<\/p>\n

2. M\u1ee9c \u0111\u1ed9 \u0111\u1ee3t c\u1ea5p: <\/strong>Ch\u01b0a th\u1ed1ng nh\u1ea5t<\/p>\n

– Theo ATS\/ETS<\/p>\n\n\n\n\n\n
\n

Y\u1ebfu t\u1ed1 \u0111\u00e1nh gi\u00e1<\/strong><\/p>\n<\/td>\n

\n

M\u1ee9c \u0111\u1ed9 I<\/strong><\/p>\n<\/td>\n

\n

M\u1ee9c \u0111\u1ed9 II<\/strong><\/p>\n<\/td>\n

\n

M\u1ee9c \u0111\u1ed9 III<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Ti\u1ec1n s\u1eed<\/p>\n

+  B\u1ec7nh \u0111\u1ed3ng ph\u00e1t k\u1ebft h\u1ee3p(*)<\/p>\n

+  Ti\u1ec1n s\u1eed c\u00f3 nhi\u1ec1u \u0111\u1ee3t c\u1ea5p<\/p>\n

+  Giai \u0111o\u1ea1n COPD<\/p>\n<\/td>\n

\n

+<\/p>\n

+<\/p>\n

Nh\u1eb9\/TB<\/p>\n<\/td>\n

\n

+++<\/p>\n

+++<\/p>\n

TB\/N\u1eb7ng<\/p>\n<\/td>\n

\n

+++<\/p>\n

+++<\/p>\n

N\u1eb7ng<\/p>\n<\/td>\n<\/tr>\n

\n

Kh\u00e1m th\u1ef1c th\u1ec3<\/p>\n

+  Huy\u1ebft \u0111\u1ed9ng<\/p>\n

+  Th\u1edf nhanh, co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5<\/p>\n

+  Tc c\u00f2n sau x\u1eef tr\u00ed ban \u0111\u1ea7u<\/p>\n<\/td>\n

\n

\u1ed4n \u0111\u1ecbnh<\/p>\n

–<\/p>\n

–<\/p>\n<\/td>\n

\n

\u1ed4n \u0111\u1ecbnh<\/p>\n

+<\/p>\n

+<\/p>\n<\/td>\n

\n

\u1ed4n \u0111\u1ecbnh (\u00b1)<\/p>\n

++<\/p>\n

++<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

(*) : Suy tim, BTTNCB, suy th\u1eadn, suy gan, \u0110T\u0110,\u2026<\/p>\n

3. Giai \u0111o\u1ea1n COPD<\/strong><\/p>\n

*Theo GOLD<\/p>\n\n\n\n\n\n\n\n
\n

Giai \u0111o\u1ea1n<\/strong><\/p>\n<\/td>\n

\n

\u0110\u1eb7c \u0111i\u1ec3m<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

I      :Nh\u1eb9<\/p>\n<\/td>\n

\n

+   FEV1<\/sub> \/FVC <70%<\/p>\n

+  FEV1<\/sub> >= 80% tr\u1ecb s\u1ed1 d\u1ef1 \u0111o\u00e1n<\/p>\n

+   +\/- Tc m\u1ea1n t\u00ednh : ho, kh\u1ea1c \u0111\u00e0m<\/p>\n<\/td>\n<\/tr>\n

\n

II     : Trung b\u00ecnh<\/p>\n<\/td>\n

\n

+   FEV1<\/sub> \/FVC <70%<\/p>\n

+   50% \u2264 FEV1<\/sub> < 80%<\/p>\n

+   +\/- Tc m\u1ea1n t\u00ednh : ho, kh\u1ea1c \u0111\u00e0m<\/p>\n<\/td>\n<\/tr>\n

\n

III    : N\u1eb7ng<\/p>\n<\/td>\n

\n

+  FEV1<\/sub> \/FVC <70%<\/p>\n

+  30% \u2264 FEV1<\/sub> < 50%<\/p>\n

+   Tc m\u1ea1n t\u00ednh<\/p>\n<\/td>\n<\/tr>\n

\n

IV    : R\u1ea5t n\u1eb7ng<\/p>\n<\/td>\n

\n

+  FEV1<\/sub> \/FVC <70%<\/p>\n

+  FEV1<\/sub> <30% hay FEV1<\/sub> <50% ph\u1ed1i h\u1ee3p suy h\u00f4 h\u1ea5p m\u1ea1n t\u00ednh hay c\u00f3 suy tim ph\u1ea3i.<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*Theo H\u1ed9i l\u1ed3ng ng\u1ef1c Hoa K\u1ef3 (ATS)<\/p>\n\n\n\n\n\n\n\n\n
\n

\u0110\u1ed9 tr\u1ea7m tr\u1ecdng<\/strong><\/p>\n<\/td>\n

\n

FEV1<\/sub> \/FVC(Sau sd thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n)<\/strong><\/p>\n<\/td>\n

\n

FEV1<\/sub> (% th\u1ef1c t\u1ebf)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Nguy c\u01a1 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 :
\n–  H\u00fat thu\u1ed1c, tx m\u00f4i tr\u01b0\u1eddng \u00f4 nhi\u1ec5m<\/p>\n

– Ho, kh\u1ea1c \u0111\u00e0m, kh\u00f3 th\u1edf<\/p>\n

– Ti\u1ec1n s\u1eed gia \u0111\u00ecnh b\u1ec7nh h\u00f4 h\u1ea5p<\/p>\n<\/td>\n

\n

>70%<\/p>\n<\/td>\n

\n

\n<\/td>\n<\/tr>\n

\n

Nh\u1eb9<\/p>\n<\/td>\n

\n

\u2264 70%<\/p>\n<\/td>\n

\n

\u2265 80%<\/p>\n<\/td>\n<\/tr>\n

\n

Trung b\u00ecnh<\/p>\n<\/td>\n

\n

\u2264 70%<\/p>\n<\/td>\n

\n

[50-80)<\/p>\n<\/td>\n<\/tr>\n

\n

N\u1eb7ng<\/p>\n<\/td>\n

\n

\u2264 70%<\/p>\n<\/td>\n

\n

[30-50)<\/p>\n<\/td>\n<\/tr>\n

\n

R\u1ea5t n\u1eb7ng<\/p>\n<\/td>\n

\n

\u2264 70%<\/p>\n<\/td>\n

\n

<30<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

IV. NGUY\u00caN NH\u00c2N KH\u1edeI PH\u00c1T \u0110\u1ee2T C\u1ea4P<\/strong><\/p>\n

C\u00e1c nguy\u00ean nh\u00e2n kh\u1edf ph\u00e1t \u0111\u1ee3t c\u1ea5p c\u00f3 th\u1ec3 :<\/p>\n

– Hay g\u1eb7p nh\u1ea5t l\u00e0 nhi\u1ec5m khu\u1ea9n (th\u01b0\u1eddng g\u1eb7p do H. influenzae, S. pneumoniae, M. catarrhalis)<\/em><\/p>\n

– Nhi\u1ec5m vi r\u00fat<\/p>\n

– M\u1ec7t c\u01a1 h\u00f4 h\u1ea5p<\/p>\n

– Sai l\u1ea7m trong \u0111i\u1ec1u tr\u1ecb nh\u01b0 d\u00f9ng thu\u1ed1c an th\u1ea7n, thu\u1ed1c ch\u1eb9n Beta giao c\u1ea3m kh\u00f4ng ch\u1ecdn l\u1ecdc.<\/p>\n

– C\u00e1c thay \u0111\u1ed5i nhi\u1ec7t \u0111\u1ed9, kh\u00ed h\u1eadu, gia t\u0103ng \u00f4 nhi\u1ec5m m\u00f4i tr\u01b0\u1eddng, ch\u1ebf \u0111\u1ed9 \u0103n kh\u00f4ng \u0111\u1ee7.<\/p>\n

V. X\u1eec TR\u00cd<\/strong><\/p>\n

1. Ch\u1ec9 \u0111\u1ecbnh nh\u1eadp vi\u1ec7n<\/strong><\/p>\n

– C\u00e1c tri\u1ec7u ch\u1ee9ng gia t\u0103ng r\u00f5 r\u1ec7t<\/p>\n

– COPD m\u1ee9c \u0111\u1ed9 n\u1eb7ng khi \u1edf giai \u0111o\u1ea1n \u1ed5n \u0111\u1ecbnh<\/p>\n

– Xu\u1ea5t hi\u1ec7n nh\u1eefng d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng m\u1edbi (nh\u01b0 t\u00edm t\u00e1i, ph\u00f9 ngo\u1ea1i vi)<\/p>\n

– Kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u t\u1ea1i nh\u00e0<\/p>\n

– C\u00f3 c\u00e1c b\u1ec7nh l\u00fd n\u1eb7ng kh\u00e1c \u0111i k\u00e8m<\/p>\n

– M\u1edbi xu\u1ea5t hi\u1ec7n lo\u1ea1n nh\u1ecbp tim<\/p>\n

– Ch\u1ea9n \u0111o\u00e1n kh\u00f4ng ch\u1eafc ch\u1eafn<\/p>\n

– Tu\u1ed5i cao<\/p>\n

– Kh\u00f4ng \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 \u0111\u1ea7y \u0111\u1ee7 t\u1ea1i nh\u00e0<\/p>\n

2. Ch\u1ec9 \u0111\u1ecbnh nh\u1eadp ICU<\/strong><\/p>\n

– Kh\u00f3 th\u1edf n\u1eb7ng kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u ban \u0111\u1ea7u<\/p>\n

– R\u1ed1i lo\u1ea1n tri gi\u00e1c: l\u1eabn l\u1ed9n, l\u01a1 m\u01a1, h\u00f4n m\u00ea<\/p>\n

– Gi\u1ea3m Oxy m\u00e1u n\u1eb7ng ho\u1eb7c k\u00e9o d\u00e0i (PaO2 < 40 mmHg) v\u00e0\/ho\u1eb7c t\u0103ng th\u00e1n n\u1eb7ng (PaCO2 > 60 mm Hg), toan h\u00f4 h\u1ea5p n\u1eb7ng (pH < 7.25) d\u00f9 \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7y \u0111\u1ee7 b\u1eb1ng oxy v\u00e0 th\u00f4ng kh\u00ed \u00e1p l\u1ef1c d\u01b0\u01a1ng kh\u00f4ng x\u00e2m l\u1ea5n (NIPPV).<\/p>\n

– C\u1ea7n th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc x\u00e2m l\u1ea5n<\/p>\n

– Huy\u1ebft \u0111\u1ed9ng h\u1ecdc kh\u00f4ng \u1ed5n \u0111\u1ecbnh, c\u1ea7n d\u00f9ng thu\u1ed1c v\u1eadn m\u1ea1ch<\/p>\n

VI. \u0110I\u1ec0U TR\u1eca \u0110\u1ee2T C\u1ea4P<\/strong><\/p>\n

1. Thu\u1ed1c gi\u1ea3n ph\u1ebf qu\u1ea3n:<\/u><\/strong> l\u00e0 m\u1ed9t \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p<\/u><\/p>\n

+  Ph\u1ed1i h\u1ee3p thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n (Evidence A) : Anticholinergic + \u03b22 agonist t\u00e1c d\u1ee5ng ng\u1eafn.<\/em><\/p>\n

 Anticholinergic (ipratropium bromide)<\/em>: 2 \u2013 4 nh\u00e1t x\u1ecbt qua bu\u1ed3ng h\u00edt ho\u1eb7c 1 \u2013 2 \u1ed1ng phun kh\u00ed dung x 4 \u2013 6 l\u1ea7n\/ng\u00e0y<\/p>\n

\u03b22 agonist t\u00e1c d\u1ee5ng ng\u1eafn (salbutamol)<\/em>: 2 \u2013 4 nh\u00e1t x\u1ecbt qua bu\u1ed3ng h\u00edt ho\u1eb7c 1 \u2013 2 \u1ed1ng phun kh\u00ed dung x 4 \u2013 6 l\u1ea7n\/ng\u00e0y<\/p>\n

D\u1ea1ng ph\u1ed1i h\u1ee3p anticholinergic v\u00e0 \u03b22 agonist t\u00e1c d\u1ee5ng ng\u1eafn<\/em>: c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng n\u1ebfu \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi t\u1eebng lo\u1ea1i thu\u1ed1c tr\u00ean<\/p>\n

+  Methylxanthine (theophyllin ho\u1eb7c aminophyllin)<\/em><\/p>\n

D\u00f9 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i nh\u01b0ng vai tr\u00f2 trong \u0111\u1ee3t c\u1ea5p COPD c\u00f2n \u0111ang b\u00e0n c\u00e3i. Th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng th\u00eam n\u1ebfu BN \u0111\u00e1p \u1ee9ng kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 v\u1edbi c\u00e1c thu\u1ed1c gi\u00e3n PQ t\u00e1c d\u1ee5ng ng\u1eafn (Evidence B)<\/strong>.<\/p>\n

N\u1ebfu BN tr\u01b0\u1edbc \u0111\u00e2y ch\u01b0a d\u00f9ng nh\u00f3m xanthine: Diaphyline (\u1ed1ng 240 mg) 1 \u1ed1ng ti\u00eam m\u1ea1ch trong 30 ph\u00fat (qua b\u01a1m ti\u00eam t\u1ef1 \u0111\u1ed9ng) sau \u0111\u00f3 d\u00f9ng 1 \u2013 2 \u1ed1ng trong 24h. C\u1ea7n theo d\u00f5i s\u00e1t n\u1ed3ng \u0111\u1ed9 thu\u1ed1c v\u00e0 c\u00e1c ch\u1ea5t \u0111i\u1ec7n gi\u1ea3i.<\/p>\n

2. Corticosteroid \u0111\u01b0\u1eddng to\u00e0n th\u00e2n:<\/u><\/strong> hi\u1ec7n nay \u0111\u00e3 c\u00f3 b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng v\u1ec1 l\u1ee3i \u00edch c\u1ee7a corticosteroid \u0111\u01b0\u1eddng to\u00e0n th\u00e2n trong \u0111\u1ee3t c\u1ea5p c\u1ee7a COPD(Evidence A)<\/strong>. Li\u1ec1u t\u1ed1i \u01b0u ch\u01b0a \u0111\u01b0\u1ee3c th\u1ed1ng nh\u1ea5t.<\/p>\n

Theo GOLD (2007): prednisone\/prednisolone 30 \u2013 40 mg\/ng\u00e0y x 10 ng\u00e0y th\u01b0\u1eddng hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n (Evidence C)<\/strong><\/p>\n

Theo m\u1ed9t nghi\u00ean c\u1ee9u l\u1edbn (Systemic Corticosteroids in COPD Exacerbations) \u0111\u1ec1 ngh\u1ecb:<\/p>\n

+  Ng\u00e0y 1 \u2013 3: methylprednisolone 125 mg IV m\u1ed7i 6h<\/p>\n

+  Ng\u00e0y 4 \u2013 7: prednisone u\u1ed1ng 60 mg\/ng\u00e0y<\/p>\n

+  Ng\u00e0y 8 \u2013 11: prednisone u\u1ed1ng 40 mg\/ng\u00e0y<\/p>\n

+  Ng\u00e0y 12 \u2013 15: prednisone u\u1ed1ng 20 mg\/ng\u00e0y<\/p>\n

(!) : D\u00f9ng k\u00e9o d\u00e0i kh\u00f4ng l\u00e0m t\u0103ng hi\u1ec7u qu\u1ea3 m\u00e0 ch\u1ec9 t\u0103ng t\u00e1c d\u1ee5ng ph\u1ee5 (t\u0103ng \u0110H v\u00e0 teo c\u01a1)<\/p>\n

3. Kh\u00e1ng sinh<\/u><\/strong><\/p>\n

+  Ch\u1ec9 s\u1eed d\u1ee5ng kh\u00e1ng sinh khi<\/p>\n

– C\u00f3 c\u1ea3 ba tri\u1ec7u ch\u1ee9ng ch\u00ednh c\u1ee7a \u0111\u1ee3t c\u1ea5p (Evidence B)<\/strong><\/p>\n

– C\u00f3 hai trong ba tri\u1ec7u ch\u1ee9ng ch\u00ednh c\u1ee7a \u0111\u1ee3t c\u1ea5p trong \u0111\u00f3 ph\u1ea3i c\u00f3 m\u1ed9t tri\u1ec7u ch\u1ee9ng l\u00e0 \u0111\u00e0m \u0111\u1ed5i m\u00e0u \u0111\u1ee5c\/v\u00e0ng\/xanh (Evidence C)<\/strong><\/p>\n

– BN b\u1ecb \u0111\u1ee3t c\u1ea5p n\u1eb7ng c\u1ea7n th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc (Evidence B)<\/strong><\/p>\n

+  Ch\u1ecdn l\u1ef1a KS : V\u1ea5n \u0111\u1ec1 l\u1edbn \u1edf VN, theo khuy\u1ebfn c\u00e1o th\u1ebf gi\u1edbi<\/p>\n

Amoxicillin\/clavulanic acid<\/p>\n

Erythromycin ho\u1eb7c c\u00e1c macrolides kh\u00e1c (nh\u01b0 clarithromycin, azithromycin)<\/p>\n

Cephalosporin th\u1ebf h\u1ec7 II ho\u1eb7c III<\/p>\n

Doxycycline<\/p>\n

+  Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb 10 \u2013 14 ng\u00e0y (ngo\u1ea1i tr\u1eeb clarithromycin, azithromycin c\u00f3 th\u1ec3 ch\u1ec9 c\u1ea7n d\u00f9ng 3 \u2013 5 ng\u00e0y n\u1ebfu BN c\u00f3 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb)<\/p>\n

4. Oxy li\u1ec7u ph\u00e1p, c\u00f3 ki\u1ec3m so\u00e1t<\/u><\/strong><\/p>\n

Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng oxy c\u00f3 ki\u1ec3m so\u00e1t l\u00e0 n\u1ec1n t\u1ea3ng c\u1ee7a c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111\u1ee3t c\u1ea5p COPD trong b\u1ec7nh vi\u1ec7n v\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 r\u00f5 r\u1ec7t \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 gi\u1ea3m oxy m\u00e1u. Nguy\u00ean t\u1eafc s\u1eed d\u1ee5ng oxy nh\u01b0 sau:<\/p>\n

– Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch b\u1eaft bu\u1ed9c ph\u1ea3i th\u1ef1c hi\u1ec7n tru\u1edbc v\u00e0 sau s\u1eed d\u1ee5ng oxy v\u00e0 ph\u1ea3i ch\u1ee5p X Quang ng\u1ef1c.<\/p>\n

– Kh\u1edfi \u0111\u1ea7u oxy v\u1edbi FiO2 24% \u2013 28% qua \u1ed1ng sonde m\u0169i (t\u1ed1t nh\u1ea5t l\u00e0 qua m\u1eb7t n\u1ea1 Venturi \u0111\u1ec3 \u1ed5n \u0111\u1ecbnh FiO2).<\/p>\n

– Th\u1ef1c hi\u1ec7n l\u1ea1i kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch sau 30 ph\u00fat. M\u1ee5c ti\u00eau ban \u0111\u1ea7u <\/em>l\u00e0 \u0111\u1ea1t \u0111\u01b0\u1ee3c PaO2 \u2265 50 mmHg m\u00e0 kh\u00f4ng c\u00f3 gi\u1ea3m pH < 7,35 nh\u1edd \u0111\u00f3 tr\u00e1nh \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng toan h\u00f4 h\u1ea5p. M\u1ee5c ti\u00eau k\u1ebf ti\u1ebfp <\/em>l\u00e0 li\u1ec1u l\u01b0\u1ee3ng oxy \u0111i\u1ec1u ch\u1ec9nh sao cho PaO2 > 60 mmHg ho\u1eb7c \u0111\u1ed9 b\u00e3o ho\u00e0 oxy > 90% m\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u t\u0103ng CO2 m\u00e1u ho\u1eb7c gi\u1ea3m pH.<\/p>\n

– N\u1ebfu th\u1ea5t b\u1ea1i v\u1edbi FiO2 24% \u2013 28%  coi ch\u1eebng c\u00f3 vi\u00eam ph\u1ed5i, thuy\u00ean t\u1eafc ph\u1ed5i ho\u1eb7c tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i.<\/p>\n

– C\u1ea7n c\u1ea9n th\u1eadn v\u00ec khi t\u00ecnh tr\u1ea1ng \u1ee9 CO2 v\u00e0 toan h\u00f4 h\u1ea5p c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n ti\u1ec1m \u1ea9n m\u00e0 kh\u00f4ng l\u00e0m thay \u0111\u1ed5i tri\u1ec7u ch\u1ee9ng \u0111\u00e1ng k\u1ec3. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a \u1ee9 CO2 l\u00e0 c\u00e1c chi \u1ea5m, h\u01a1i \u0111\u1ecf do gi\u00e3n m\u1ea1ch, m\u1ea1ch n\u1ea3y m\u1ea1nh, d\u1ea5u run v\u1ea9y do \u1ee9 CO2, ng\u1ee7 g\u00e0, l\u01a1 m\u01a1.<\/p>\n

– C\u00f3 th\u1ec3 d\u00f9ng pulse oxymetry \u0111\u1ec3 theo d\u00f5i s\u1ef1 \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

5. Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc<\/u><\/strong><\/p>\n

5.1-Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc \u00e1p l\u1ef1c d\u01b0\u01a1ng kh\u00f4ng s\u00e2m l\u1ea5n (NIPPV)<\/p>\n

L\u1ee3i \u00edch \u0111\u00e3 ch\u1ee9ng minh (Evidence A), gi\u00fap :<\/p>\n

+  C\u1ea3i thi\u1ec7n th\u00f4ng kh\u00ed<\/p>\n

+  L\u00e0m gi\u1ea3m CO2 m\u00e1u gi\u00fap gi\u1ea3m toan h\u00f4 h\u1ea5p<\/p>\n

+  Gi\u1ea3m m\u1ee9c \u0111\u1ed9 kh\u00f3 th\u1edf trong 4 gi\u1edd \u0111\u1ea7u<\/p>\n

+  Gi\u1ea3m th\u1eddi gian n\u1eb1m vi\u1ec7n<\/p>\n

+  Tr\u00e1nh \u0111\u01b0\u1ee3c nhu c\u1ea7u th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc x\u00e2m l\u1ea5n<\/p>\n

+ Gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong<\/p>\n

Ti\u00eau chu\u1ea9n ch\u1ecdn l\u1ef1a b\u1ec7nh nh\u00e2n<\/p>\n

+  Kh\u00f3 th\u1edf v\u1eeba \u2013 n\u1eb7ng k\u00e8m s\u1eed d\u1ee5ng c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5 v\u00e0 c\u1eed \u0111\u1ed9ng b\u1ee5ng ngh\u1ecbch l\u00fd<\/p>\n

+  Toan m\u00e1u v\u1eeba \u2013 n\u1eb7ng (pH 7,25 \u2013 7,35) v\u00e0 t\u0103ng PaCO2 m\u00e1u 45 \u2013 60 mmHg<\/p>\n

+  Nh\u1ecbp th\u1edf > 25 l\u1ea7n\/ph\u00fat<\/p>\n

Ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb<\/p>\n

+  Ng\u01b0ng th\u1edf<\/p>\n

+  T\u00ecnh tr\u1ea1ng tim m\u1ea1ch kh\u00f4ng \u1ed5n \u0111\u1ecbnh (t\u1ee5t HA, lo\u1ea1n nh\u1ecbp tim, NMCT)<\/p>\n

+  R\u1ed1i lo\u1ea1n tri gi\u00e1c, BN kh\u00f4ng h\u1ee3p t\u00e1c<\/p>\n

+  Nguy c\u01a1 cao h\u00edt c\u00e1c ch\u1ea5t ti\u1ebft<\/p>\n

+  \u0110\u00e0m qu\u00e1 d\u00ednh ho\u1eb7c qu\u00e1 nhi\u1ec1u<\/p>\n

+  M\u1edbi ph\u1eabu thu\u1eadt v\u00f9ng m\u1eb7t ho\u1eb7c d\u1ea1 d\u00e0y \u2013 th\u1ef1c qu\u1ea3n<\/p>\n

+  Ch\u1ea5n th\u01b0\u01a1ng s\u1ecd m\u1eb7t<\/p>\n

+  D\u1ecb d\u1ea1ng v\u00f9ng m\u0169i h\u1ea7u<\/p>\n

+  Ph\u1ecfng<\/p>\n

+  Qu\u00e1 b\u00e9o ph\u00ec<\/p>\n

5.2-Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc x\u00e2m l\u1ea5n<\/p>\n

Ch\u1ec9 \u0111\u1ecbnh th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc x\u00e2m l\u1ea5n<\/em><\/p>\n

+  NIPPV th\u1ea5t b\u1ea1i ho\u1eb7c thu\u1ed9c ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb<\/p>\n

+  Kh\u00f3 th\u1edf n\u1eb7ng k\u00e8m s\u1eed d\u1ee5ng c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5 v\u00e0 c\u1eed \u0111\u1ed9ng b\u1ee5ng ngh\u1ecbch l\u00fd<\/p>\n

+  Nh\u1ecbp th\u1edf > 35 l\u1ea7n\/ph\u00fat<\/p>\n

+  Gi\u1ea3m O2 m\u00e1u \u0111e do\u1ea1 t\u00ednh m\u1ea1ng (PaO2 < 40 mmHg ho\u1eb7c PaO2\/FiO2 < 200 mmHg)<\/p>\n

+  Toan m\u00e1u n\u1eb7ng (pH < 7,25) v\u00e0 t\u0103ng th\u00e1n n\u1eb7ng (PaCO2 > 60 mmHg)<\/p>\n

+  Ng\u01b0ng th\u1edf<\/p>\n

+  R\u1ed1i lo\u1ea1n tri gi\u00e1c<\/p>\n

+  C\u00f3 c\u00e1c bi\u1ebfn ch\u1ee9ng tim m\u1ea1ch (t\u1ee5t HA, s\u1ed1c)<\/p>\n

+  C\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c (r\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1, nhi\u1ec5m tr\u00f9ng, vi\u00eam ph\u1ed5i, thuy\u00ean t\u1eafc ph\u1ed5i, ch\u1ea5n th\u01b0\u01a1ng do \u00e1p l\u1ef1c, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i l\u01b0\u1ee3ng nhi\u1ec1u)<\/p>\n

6. \u0110i\u1ec1u tr\u1ecb kh\u00e1c<\/u><\/strong><\/p>\n

– B\u00f9 n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i<\/p>\n

– Dinh d\u01b0\u1ee1ng \u0111\u1ea7y \u0111\u1ee7 ch\u00fa \u00fd nh\u1ea5t l\u00e0 khi b\u1ec7nh nh\u00e2n qu\u00e1 kh\u00f3 th\u1edf kh\u00f4ng \u0103n \u0111\u01b0\u1ee3c<\/p>\n

– Heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p: b\u1eaft bu\u1ed9c d\u00f9ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n c\u0103n b\u1ecb b\u1ec7nh l\u00fd thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i. Xem x\u00e9t d\u00f9ng \u1edf nh\u0169ng b\u1ec7nh nh\u00e2n b\u1ea5t \u0111\u1ed9ng, \u0111a h\u1ed3ng c\u1ea7u v\u00e0 thi\u1ebfu n\u01b0\u1edbc d\u00f9 cho c\u00f3 ti\u1ec1n c\u0103n b\u1ecb b\u1ec7nh l\u00fd thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i hay kh\u00f4ng<\/p>\n

– T\u1eadp VLTL gi\u00fap kh\u00e1c \u0111\u00e0m trong \u0111\u1ee3t c\u1ea5p COPD th\u01b0\u1eddng kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 m\u00e0 c\u00f2n l\u00e0m b\u1ec7nh nh\u00e2n m\u1ec7t h\u01a1n<\/p>\n

– Thu\u1ed1c tan \u0111\u00e0m kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb \u0111\u1ee3t c\u1ea5p COPD<\/p>\n

VII. THEO D\u00d5I<\/strong><\/p>\n

1. Ti\u00eau chu\u1ea9n xu\u1ea5t vi\u1ec7n<\/strong><\/p>\n

– Kh\u00f4ng c\u1ea7n d\u00f9ng thu\u1ed1c \u0111\u1ed3ng v\u1eadn \u03b22 d\u1ea1ng h\u00edt qu\u00e1 6 l\u1ea7n m\u1ed7i ng\u00e0y<\/p>\n

– B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111i l\u1ea1i trong ph\u00f2ng (n\u1ebfu tr\u01b0\u1edbc \u0111\u00e2y \u0111i l\u1ea1i \u0111\u01b0\u1ee3c)<\/p>\n

– B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0103n \u0111\u01b0\u1ee3c v\u00e0 ng\u1ee7 kh\u00f4ng b\u1ecb th\u1ee9c gi\u1ea5c th\u01b0\u1eddng xuy\u00ean do kh\u00f3 th\u1edf<\/p>\n

– T\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng \u1ed5n \u0111\u1ecbnh trong 12 \u2013 24 gi\u1edd<\/p>\n

– Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch \u1ed5n \u0111\u1ecbnh trong 12 \u2013 24 gi\u1edd<\/p>\n

– B\u1ec7nh nh\u00e2n ho\u1eb7c ng\u01b0\u1eddi ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n hi\u1ec3u \u0111\u1ea7y \u0111\u1ee7 v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u00fang c\u00e1c thu\u1ed1c<\/p>\n

– Tri\u1ec3n khai s\u1eed d\u1ee5ng O2 t\u1ea1i nh\u00e0 n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh (ki\u1ec3m tra KM\u0110M tr\u01b0\u1edbc xu\u1ea5t vi\u1ec7n)<\/p>\n

2. \u0110\u00e1nh gi\u00e1 l\u1ea1i 4 \u2013 6 tu\u1ea7n sau khi xu\u1ea5t vi\u1ec7n<\/strong><\/p>\n

– Kh\u1ea3 n\u0103ng \u0111\u01b0\u01a1ng \u0111\u1ea7u v\u1edbi m\u00f4i tr\u01b0\u1eddng s\u1ed1ng b\u00ecnh th\u01b0\u1eddng<\/p>\n

– \u0110o FEV1<\/p>\n

– \u0110\u00e1nh gi\u00e1 l\u1ea1i k\u1ef9 thu\u1eadt d\u00f9ng thu\u1ed1c d\u1ea1ng h\u00edt<\/p>\n

– S\u1ef1 hi\u1ec3u bi\u1ebft v\u1ec1 nh\u1eefng ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o<\/p>\n

– Nhu c\u1ea7u s\u1eed d\u1ee5ng oxy l\u00e2u d\u00e0i v\u00e0\/ho\u1eb7c m\u00e1y phun kh\u00ed dung t\u1ea1i nh\u00e0 (\u0111\u1ed1i v\u1edbi BN COPD r\u1ea5t n\u1eb7ng)<\/p>\n

3. Ch\u1ec9 \u0111\u1ecbnh oxy t\u1ea1i nh\u00e0<\/strong><\/p>\n

+  L\u00fac ngh\u1ec9 ng\u01a1i<\/p>\n

    \n
  • \n
      \n
    • \n

      PaO2<\/sub> < 55mmHg<\/p>\n<\/li>\n

    • \n

      SaO2<\/sub> < 88%<\/p>\n<\/li>\n

    • \n

      C\u00f3 t\u00e2m ph\u1ebf m\u1ea1n:<\/p>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

      +  Ph\u00f9 ch\u00e2n do suy tim \u1ee9 huy\u1ebft<\/p>\n

      +  T\u00e2m ph\u1ebf tr\u00ean ECG (D II, III, aVF), (>3mm)<\/p>\n

      +  \u0110a h\u1ed3ng c\u1ea7u: Hct >56%<\/p>\n

        \n
      • \n
          \n
        • \n

          Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t:<\/p>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

          +  PaO2<\/sub> : 90%<\/p>\n

          +  C\u00f3 b\u1ec7nh ph\u1ed5i.<\/p>\n

          BS. L\u00ca NGUY\u1ec4N ANH TU\u1ea4N<\/strong><\/p>\n

          Chuy\u00ean Khoa H\u00f4 H\u1ea5p \u2013 BV Ho\u00e0n M\u1ef9 S\u00e0i G\u00f2n<\/strong><\/p>\n

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

          1. National Heart, Lung and Blood Institute, Global Strategy for the Diagnosis,<\/em><\/p>\n

          2. Management, and Prevention of COPD, <\/em>Bethesda, NHLBI\/WHO Workshop<\/p>\n

          3. Report, Revised Sep 2005, NIH Publication. (http:\/\/www.goldcopd.com)<\/p>\n

          4. PJ Barnes, TT Hansel. An Atlas of Chronic Obstructive Pulmonary Disease<\/em>.<\/p>\n

          5. Parthenon Publishing 2004.<\/p>\n

          6. Gi\u00e1o tr\u00ecnh h\u00f4 h\u1ea5p \u0110HYDTPHCM- BVNDG\u0110\/Ts Nguy\u1ec5n Th\u1ecb T\u1ed1 Nh\u01b0<\/p>\n

          7. Gi\u00e1o tr\u00ecnh h\u00f4 h\u1ea5p-\u0110HYD Hu\u1ebf<\/p>\n

          8. COPD \u0111\u1ee3t c\u1ea5p-Ts Nguy\u1ec5n V\u0103n Th\u00e0nh, BV\u0110KTW C\u1ea7n Th\u01a1<\/p>\n","protected":false},"excerpt":{"rendered":"

          \u0110\u1ee3t c\u1ea5p b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p, t\u1ea7n su\u1ea5t nh\u1eadp vi\u1ec7n v\u00e0 t\u1eed su\u1ea5t v\u00ec \u0111\u1ee3t c\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1249],"tags":[],"class_list":["post-273979","post","type-post","status-publish","format-standard","hentry","category-tin-tuc-y-te"],"acf":[],"_links":{"self":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts\/273979","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/comments?post=273979"}],"version-history":[{"count":1,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts\/273979\/revisions"}],"predecessor-version":[{"id":311012,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts\/273979\/revisions\/311012"}],"wp:attachment":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/media?parent=273979"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/categories?post=273979"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/tags?post=273979"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}