{"id":3973,"date":"2018-08-24T23:41:26","date_gmt":"2018-08-24T16:41:26","guid":{"rendered":"https:\/\/yhoccongdong.org\/du-an-khoa-nhi\/2018\/08\/24\/cong-thuc-mau-va-cac-chat-phan-ung-viem-trong-phase-cap-o-benh-nhi-bi-viem-phoi-cong-dong\/"},"modified":"2024-03-04T13:50:30","modified_gmt":"2024-03-04T06:50:30","slug":"cong-thuc-mau-va-cac-chat-phan-ung-viem-trong-phase-cap-o-benh-nhi-bi-viem-phoi-cong-dong","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/nhi-khoa\/cong-thuc-mau-va-cac-chat-phan-ung-viem-trong-phase-cap-o-benh-nhi-bi-viem-phoi-cong-dong\/","title":{"rendered":"C\u00f4ng th\u1ee9c m\u00e1u v\u00e0 c\u00e1c ch\u1ea5t ph\u1ea3n \u1ee9ng vi\u00eam trong phase c\u1ea5p \u1edf b\u1ec7nh nhi b\u1ecb vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng"},"content":{"rendered":"<p style=\"text-align: justify\">S\u1ef1 bi\u1ebfn \u0111\u1ed5i c\u1ee7a c\u00f4ng th\u1ee9c m\u00e1u (CMT) v\u00e0 c\u00e1c ch\u1ea5t ph\u1ea3n \u1ee9ng vi\u00eam trong pha c\u1ea5p c\u00f3 th\u1ec3 cung c\u1ea5p c\u00e1c b\u1eb1ng ch\u1ee9ng \u0111\u1ec3 gi\u00fap ch\u00fang ta ph\u00e2n bi\u1ec7t vi\u00eam ph\u1ed5i l\u00e0 do virus hay vi khu\u1ea9n. Nh\u01b0ng ch\u00fang ta kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng n\u00f3 nh\u01b0 1 ti\u00eau chu\u1ea9n duy nh\u1ea5t hay c\u1ee9ng nh\u1eafc trong vi\u1ec7c ch\u1ec9 \u0111\u1ecbnh kh\u00e1ng sinh theo kinh nghi\u1ec7m. K\u1ec3 c\u1ea3 khi b\u1ea1ch c\u1ea7u b\u00ecnh th\u01b0\u1eddng v\u00e0 c\u00e1c ch\u1ea5t ph\u1ea3n \u1ee9ng vi\u00eam c\u00f3 n\u1ed3ng \u0111\u1ed9 th\u1ea5p c\u0169ng kh\u00f4ng lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c vi\u00eam ph\u1ed5i do vi khu\u1ea9n.<\/p>\n<h2 style=\"text-align: justify\">C\u00f4ng th\u1ee9c m\u00e1u (CTM, CBC).<\/h2>\n<p style=\"text-align: justify\">Tr\u00ean c\u00f4ng th\u1ee9c m\u00e1u ch\u00fang ta s\u1ebd quan s\u00e1t \u0111\u01b0\u1ee3c s\u1ef1 bi\u1ebfn \u0111\u1ed5i c\u1ee7a 3 d\u00f2ng t\u1ebf b\u00e0o m\u00e1u: b\u1ea1ch c\u1ea7u, h\u1ed3ng c\u1ea7u v\u00e0 ti\u1ec3u c\u1ea7u. Sai l\u1ea7m c\u1ee7a ch\u00fang ta th\u01b0\u1eddng g\u1eb7p l\u00e0 qu\u00e1 ch\u00fa tr\u1ecdng 1 d\u00f2ng b\u1ea1ch c\u1ea7u m\u00e0 kh\u00f4ng \u0111\u1eb7t s\u1ef1 bi\u1ebfn \u0111\u1ed5i c\u1ee7a 3 d\u00f2ng n\u00e0y trong m\u1ed9t m\u1ed1i t\u01b0\u01a1ng quan chung. Th\u01b0\u1eddng th\u00ec trong \u0111\u1ee3t b\u1ec7nh nhi\u1ec5m tr\u00f9ng c\u00f3 s\u1ed1t, d\u00f2ng h\u1ed3ng c\u1ea7u s\u1ebd gi\u1ea3m, th\u1ec3 hi\u1ec7n t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u gi\u1ea3 t\u1ea1o. Nhi\u1ec1u ng\u01b0\u1eddi \u0111\u00e3 v\u1ed9i v\u00e0ng ch\u1ea9n \u0111o\u00e1n tr\u1ebb b\u1ecb thi\u1ebfu m\u00e1u m\u00e0 kh\u00f4ng ki\u1ec3m tra l\u1ea1i CTM v\u00e0o m\u1ed9t d\u1ecbp kh\u00e1c, c\u00f3 khi c\u00f2n cho s\u1eaft ngay trong \u0111\u1ee3t \u0111\u1ee3t nhi\u1ec5m tr\u00f9ng. Ti\u1ec3u c\u1ea7u c\u0169ng s\u1ebd th\u01b0\u1eddng c\u00f3 bi\u1ebfn \u0111\u1ed5i trong \u0111\u1ee3t nhi\u1ec5m tr\u00f9ng, t\u0103ng hay gi\u1ea3m. S\u1ef1 s\u1ee5t gi\u1ea3m tr\u1ea7m tr\u1ecdng c\u1ee7a 2 ho\u1eb7c 3 d\u00f2ng t\u1ebf b\u00e0o n\u00e0y khi\u1ebfn ch\u00fang ta ph\u1ea3i suy ngh\u0129 th\u00eam v\u1ec1 h\u1ed9i ch\u1ee9ng th\u1ef1c b\u00e0o hay c\u00e1c b\u1ec7nh m\u00e1u \u00e1c t\u00ednh kh\u00e1c. \u1ede \u0111\u00e2y s\u1ebd b\u00e0n t\u1edbi d\u00f2ng b\u1ea1ch c\u1ea7u trong Vi\u00eam ph\u1ed5i tr\u1ebb em.<\/p>\n<p style=\"text-align: justify\">CMT th\u01b0\u1eddng kh\u00f4ng c\u1ea7n thi\u1ebft cho nh\u1eefng tr\u1ebb b\u1ecb nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p d\u01b0\u1edbi nh\u1eb9 ch\u1ec9 c\u1ea7n \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa, tr\u1eeb phi CTM c\u1ea7n \u0111\u1ec3 c\u1ee7ng c\u1ed1 kh\u1ea3 n\u0103ng nhi\u1ec5m vi khu\u1ea9n tr\u01b0\u1edbc khi cho kh\u00e1ng sinh. \u0110\u1ed1i v\u1edbi tr\u1ebb b\u00fa b\u1eb9 v\u00e0 tr\u1ebb em y\u00eau c\u1ea7u ph\u1ea3i nh\u1eadp vi\u1ec7n th\u00ec CMT l\u00e0 b\u1eaft bu\u1ed9c.<\/p>\n<ul style=\"text-align: justify\">\n<li>N\u1ebfu b\u1ea1ch c\u1ea7u (WBC) &lt; 15.000\/ microL th\u00ec vi\u00eam ph\u1ed5i n\u00e0y g\u1ee3i \u00fd t\u00e1c nh\u00e2n kh\u00f4ng ph\u1ea3i vi khu\u1ea9n, tr\u1eeb phi nh\u00ecn t\u1ed5ng tr\u1ea1ng \u0111\u1ee9a b\u00e9 x\u1ea5u, nh\u1eefng \u0111\u1ee9a tr\u1ebb n\u1eb7ng n\u1ec1 th\u1eadm ch\u00ed c\u00f2n c\u00f3 b\u1ea1ch c\u1ea7u trung t\u00ednh gi\u1ea3m v\u00e0 c\u00f3 t\u1ebf b\u00e0o non.<\/li>\n<li>N\u1ebfu b\u1ea1ch c\u1ea7u &gt; 15.000\/ microL th\u00ec g\u1ee3i \u00fd vi\u00eam ph\u1ed5i n\u00e0y l\u00e0 do vi khu\u1ea9n. Tuy nhi\u1ec5m, tr\u1ebb b\u1ecb vi\u00eam ph\u1ed5i kh\u00f4ng \u0111i\u1ec3n h\u00ecnh (Mycplasma Pneumoniae), vi\u00eam ph\u1ed5i do virus c\u00fam, ho\u1eb7c adenovirus c\u0169ng c\u00f3 th\u1ec3 l\u00e0m cho b\u1ea1ch c\u1ea7u t\u0103ng tr\u00ean 15.000.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>B\u1ea1ch c\u1ea7u \u00e1i toan<\/strong> trong m\u00e1u ngo\u1ea1i vi c\u00f3 th\u1ec3 gia t\u0103ng \u1edf nh\u1eefng tr\u1ebb vi\u00eam ph\u1ed5i kh\u00f4ng s\u1ed1t do nhi\u1ec5m C.trachomatis (Tr\u1ebb d\u01b0\u1edbi 4 th\u00e1ng).<\/p>\n<p style=\"text-align: justify\">Nh\u1eefng tr\u1ebb s\u1ed1t cao, m\u00e0 c\u00f3 b\u1ea1ch c\u1ea7u t\u0103ng cao tr\u00ean 20.000\/ microL th\u1eadm ch\u00ed l\u00e0 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p (ho) c\u0169ng c\u1ea7n ngh\u0129 t\u1edbi vi\u00eam ph\u1ed5i v\u00e0 ph\u1ea3i ch\u1ee5p <strong>Xquang ph\u1ed5i<\/strong> \u0111\u1ec3 lo\u1ea1i tr\u1eeb.<\/p>\n<p style=\"text-align: justify\">Quan s\u00e1t s\u1ed1 l\u01b0\u1ee3ng tuy\u1ec7t \u0111\u1ed1i b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh theo t\u1eebng l\u1ee9a tu\u1ed5i (b\u1ea1n n\u00ean s\u1eed d\u1ee5ng b\u1ea3ng c\u1ee7a MayoClinic) c\u0169ng gi\u00fap \u00edch cho b\u1ea1n ch\u1ec9 \u0111\u1ecbnh kh\u00e1ng sinh hay kh\u00f4ng.<\/p>\n<h2 style=\"text-align: justify\">C\u00e1c ch\u1ea5t ph\u1ea3n \u1ee9ng vi\u00eam trong pha c\u1ea5p<\/h2>\n<p style=\"text-align: justify\">C\u00e1c ch\u1ea5t ph\u1ea3n \u1ee9ng vi\u00eam trong pha c\u1ea5p nh\u01b0 t\u1ed1c \u0111\u1ed9 m\u00e1u l\u1eafng (ESR),CRP, PCT kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i th\u1ef1c hi\u1ec7n th\u01b0\u1eddng quy \u1edf nh\u1eefng tr\u1ebb \u0111\u01b0\u1ee3c ti\u00eam ch\u1ee7ng \u0111\u1ea7y \u0111\u1ee7 b\u1ecb vi\u00eam ph\u1ed5i \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa. Tuy nhi\u00ean v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng h\u01a1n y\u00eau c\u1ea7u ph\u1ea3i nh\u1eadp vi\u1ec7n, vi\u1ec7c \u0111\u1ecbnh l\u01b0\u1ee3ng c\u00e1c ch\u1ea5t n\u00e0y gi\u00fap cung c\u1ea5p c\u00e1c th\u00f4ng tin \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p style=\"text-align: justify\">Vi\u1ec7c \u0111o n\u1ed3ng \u0111\u1ed9 CRP huy\u1ebft thanh c\u0169ng c\u00f3 th\u1ec3 gi\u00fap \u00edch cho vi\u1ec7c ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c vi\u00eam ph\u1ed5i do virus hay vi\u00eam ph\u1ed5i 1 c\u00e1ch t\u01b0\u01a1ng \u0111\u1ed1i.<\/p>\n<p style=\"text-align: justify\">M\u1ed9t ph\u00e2n t\u00edch meta t\u1eeb 8 nghi\u00ean c\u1ee9u bao g\u1ed3m 1230 b\u1ec7nh nh\u00e2n, g\u1ee3i \u00fd r\u1eb1ng vi\u00eam ph\u1ed5i do vi khu\u1ea9n th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng tr\u1ebb c\u00f3 CRP t\u1eeb 35- 60 mg\/ L chi\u1ebfm 41%. gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n d\u01b0\u01a1ng c\u1ee7a CRP \u1edf nh\u00f3m c\u00f3 n\u1ed3ng \u0111\u1ed9 40 \u2013 60 mg\/ L l\u00e0 64%.<\/p>\n<p style=\"text-align: justify\">S\u1ef1 gia t\u0103ng c\u1ee7a n\u1ed3ng \u0111\u1ed9 PCT th\u00ec c\u00f3 \u0111\u1ed9 nh\u1ea1y t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nh\u01b0ng \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao h\u01a1n so v\u1edbi CRP trong vi\u1ec7c ph\u00e2n bi\u1ec7t gi\u1eefa vi\u00eam ph\u1ed5i vi khu\u1ea9n v\u00e0 vi\u00eam ph\u1ed5i virus<\/p>\n<p style=\"text-align: justify\">C\u00e1c ch\u1ea5t ph\u1ea3n \u1ee9ng vi\u00eam trong pha c\u1ea5p kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u1edbi m\u1ee5c \u0111\u00edch ch\u00ednh l\u00e0 \u0111\u1ec3 ph\u00e2n bi\u1ec7t vi\u00eam ph\u1ed5i virus hay vi khu\u1ea9n m\u00e0 n\u00ean s\u1eed d\u1ee5ng \u0111\u1ec3 theo d\u00f5i \u0111\u00e1p \u1ee9ng v\u1edbi li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u00ec h\u01a1n.<\/p>\n<h2 style=\"text-align: justify\">T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<ol>\n<li style=\"text-align: justify\"><a href=\"https:\/\/www.facebook.com\/diendannhikhoa\/posts\/753734001490789\" target=\"_blank\" rel=\"noopener\">https:\/\/www.facebook.com\/diendannhikhoa\/posts\/753734001490789<\/a><\/li>\n<li style=\"text-align: justify\"><a href=\"https:\/\/l.facebook.com\/l.php?u=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F4399688&amp;h=AT1KeBjsVDILc3eSD4rb6YzKOjhfhGi1BZ-xv-on5_bUh4vYXNEpLVSZuU-bfcuF2_LxtT5zIYUA08nbxUPMXU6td3eEj9zcT2k716ue4v4tw0Hcbm3K6r_sBgzmlTpaHoj_PDAE6E6BB1PCyBtUpdfTD27dPD6_qxKWdAH0LHaKwltFZDkQVWjPhY8QgcKOvhoVbFjbvX3Todn8jM1eJFWPm8FY300okIEHLfwu9govXGl4y3als0uDxX3Dv_V_2iYWXP6osIzmKnXThEEKnx0Vay_IO3K0dU7O7pweTpr6dNtnP8Sg19Z5Iykbd-KwNwmJS5eUcCCC2etVZVlreQ\" target=\"_blank\" rel=\"noopener nofollow\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/4399688<\/a><\/li>\n<li style=\"text-align: justify\"><a href=\"https:\/\/l.facebook.com\/l.php?u=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F%3Fterm%3DComparison%2Bof%2Btotal%2Bwhite%2Bblood%2Bcell%2Bcount%2Band%2Bserum%2BC-reactive%2Bprotein%2Blevels%2Bin%2Bconfirmed%2Bbacterial%2Band%2Bviral%2Binfections&amp;h=AT2mpbANCrYb_Ghdj2FzzoI3T0iao3_2XWutPuNZeOH6kZ2weJfoe0msB5NrmFK8hyRUiegpY-trPxkJItz3KWPh6SG4W8GMwJ6TqgLPgD8zgfOWR4YZfnjvXZ8AwOKNHpUu1QL5iP2IqWXHbz2h1nWtczjWMfk9GYqE5n520bIPBvDcYYqSAB9oIyY6T8SBm9ZtIblxkrwQ7nS0BU5Cyk0qpkS14d6oIdLWpHRa51gL5UutEVJ5PjBuD7HGP8-DAxfKbXuKhkiQ0R_1XJJ-pCoancKTke7o2yaXSpfdWN_nyD6ZvxcLYHFSx-NnJz8VVmSIXIpOCm6HP6LJmvpozw\" target=\"_blank\" rel=\"noopener nofollow\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/\u2026<\/a>.<\/li>\n<li style=\"text-align: justify\"><a href=\"https:\/\/l.facebook.com\/l.php?u=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F%3Fterm%3DAdenovirus%2Brespiratory%2Binfections%2Bin%2Bhospitalized%2Bchildren%253A%2Bclinical%2Bfindings%2Bin%2Brelation%2Bto%2Bspecies%2Band%2Bserotypes&amp;h=AT0nhmP_XNqflPOMdchL4ruzP7Rv5rh008D1_WeTTvK45M-GY74em_sULZUeYwS653xgLKAGyUvWFCGHMrQTwJPOFExmpX1E3JZS_q66Z166idz8vqkQLhx7gPaCnXuswDgJYvD5d7tPtNatvWoGtC30BsFwi-93LJh_0ARR06Kgm6SRiQlbBpjlfAEJzu5fLyHG_4PoWQz5uxWLsWdGD2NXlq8Qa4f6dC-_N3293S102GmSH_kQVBBfOMxTOXVf0dplj7K0HrUBgWysatHxZMCRBXy0hhCYdUoX4rZWXlQ32GWYVwG-5_9CW0saeMXB910EvphVLOLSByuCVaUnfg\" target=\"_blank\" rel=\"noopener nofollow\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/\u2026<\/a>.<\/li>\n<li style=\"text-align: justify\"><a href=\"https:\/\/l.facebook.com\/l.php?u=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F%3Fterm%3DClinical%2Bfeatures%2Bof%2Bradiologically%2Bconfirmed%2Bpneumonia%2Bdue%2Bto%2Badenovirus%2Bin%2Bchildren&amp;h=AT3115MdnxxQlgl8vovsiH2jEiwVTwynojYXJH4odE1wg0kl4nTcVbQCplq-XEN2LzY17Bkmdc_ugWJsaIeO_1r3QJw9lqf0ilZYvGeJpvTiKGtX4qkcXYT_g5yhD40PoZEsqE1sllYEDY3bSSLFexVVnqrPZmm9jixT5zOFGpJY5GCWTa7JwjFxOQgsxA48Haa-S46JiGMWQmrn9oVmMjLx9CS7n2o9_sgc7y_sIqLV-mSZsDneQqR435x7eh5PXlFXIjl021rJVXRyMjT0UHy1Rwx4aH-NLDJgiZYK9sqieIKTNSr3Bt0hRgc0BkBv2BAtPMr1CeZI7y2I5cUDCw\" target=\"_blank\" rel=\"noopener nofollow\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/\u2026<\/a>.<\/li>\n<li style=\"text-align: justify\"><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21890766\" target=\"_blank\" rel=\"noopener nofollow\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21890766<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>S\u1ef1 bi\u1ebfn \u0111\u1ed5i c\u1ee7a c\u00f4ng th\u1ee9c m\u00e1u v\u00e0 c\u00e1c ch\u1ea5t ph\u1ea3n \u1ee9ng vi\u00eam trong pha c\u1ea5p c\u00f3 th\u1ec3 gi\u00fap ch\u00fang ta ph\u00e2n bi\u1ec7t vi\u00eam ph\u1ed5i l\u00e0 do virus hay vi khu\u1ea9n.<\/p>\n","protected":false},"author":14,"featured_media":3974,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[6104],"tags":[5616,5617,5618,4575],"series":[3454],"coauthors":[],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>C\u00f4ng th\u1ee9c m\u00e1u v\u00e0 c\u00e1c ch\u1ea5t ph\u1ea3n \u1ee9ng vi\u00eam trong phase c\u1ea5p \u1edf b\u1ec7nh nhi b\u1ecb vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng - D\u1ef1 \u00e1n Nhi Khoa<\/title>\n<meta name=\"description\" content=\"S\u1ef1 bi\u1ebfn \u0111\u1ed5i c\u1ee7a c\u00f4ng th\u1ee9c m\u00e1u v\u00e0 c\u00e1c ch\u1ea5t ph\u1ea3n \u1ee9ng vi\u00eam trong pha 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