{"id":4251,"date":"2018-09-28T13:40:18","date_gmt":"2018-09-28T06:40:18","guid":{"rendered":"https:\/\/yhoccongdong.org\/du-an-khoa-nhi\/2018\/09\/28\/cap-nhat-dieu-tri-tieu-chay-cap-o-tre-em\/"},"modified":"2024-03-04T13:50:57","modified_gmt":"2024-03-04T06:50:57","slug":"cap-nhat-dieu-tri-tieu-chay-cap-o-tre-em","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/nhi-khoa\/cap-nhat-dieu-tri-tieu-chay-cap-o-tre-em\/","title":{"rendered":"C\u1eadp nh\u1eadt \u0111i\u1ec1u tr\u1ecb ti\u00eau ch\u1ea3y c\u1ea5p \u1edf tr\u1ebb em"},"content":{"rendered":"

Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng n\u00e0o g\u1ee3i \u00fd ti\u00eau ch\u1ea3y do vi khu\u1ea9n hay si\u00eau vi?<\/h2>\n

N\u1ebfu tr\u1ebb c\u00f3 s\u1ed1t cao (> 40 \u0111\u1ed9), \u0111au b\u1ee5ng, ph\u00e2n c\u00f3 m\u00e1u, c\u00f3 bi\u1ec3u hi\u1ec7n th\u1ea7n kinh th\u00ec g\u1ee3i \u00fd t\u00e1c nh\u00e2n vi khu\u1ea9n<\/strong><\/p>\n

N\u1ebfu tr\u1ebb c\u00f3 n\u00f4n nhi\u1ec1u, c\u00f3 bi\u1ec3u hi\u1ec7n vi\u00eam h\u00f4 h\u1ea5p k\u00e8m theo th\u00ec g\u1ee3i \u00fd si\u00eau vi<\/strong><\/p>\n

C\u00f3 c\u1ea7n x\u00e9t nghi\u1ec7m cho t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p ti\u00eau ch\u1ea3y c\u1ea5p \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00e1c nh\u00e2n g\u00e2y ti\u00eau ch\u1ea3y do si\u00eau vi hay vi khu\u1ea9n kh\u00f4ng?<\/h2>\n

N\u1ebfu t\u1ed5ng tr\u1ea1ng b\u00e9 \u1ed5n, kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n g\u1ee3i \u00fd vi khu\u1ea9n, c\u00e1c x\u00e9t nghi\u1ec7m kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o th\u01b0\u1eddng qui<\/p>\n

C\u00e1c x\u00e9t nghi\u1ec7m vi sinh n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh tr\u00ean 1 s\u1ed1 tr\u1ebb c\u00f3 b\u1ec7nh l\u00ed n\u1ec1n m\u1ea1n t\u00ednh, t\u1ed5ng tr\u1ea1ng x\u1ea5u ho\u1eb7c tri\u1ec7u ch\u1ee9ng ti\u00eau ch\u1ea3y k\u00e9o d\u00e0i<\/p>\n

B\u1ed5 sung k\u1ebdm<\/h2>\n

V\u1edbi c\u00e1c n\u01b0\u1edbc ngh\u00e8o v\u00e0 \u0111ang ph\u00e1t tri\u1ec3n vi\u1ec7c b\u1ed5 sung k\u1ebdm trong ti\u00eau ch\u1ea3y c\u1ea5p th\u00ec c\u00f3 l\u1ee3i cho ph\u1ea7n \u0111\u00f4ng d\u00e2n s\u1ed1, \u1edf c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n \u2013 n\u01a1i m\u00e0 t\u1ec9 l\u1ec7 thi\u1ebfu k\u1ebdm hi\u1ebfm th\u00ec b\u1ed5 sung k\u1ebdm c\u0169ng kh\u00f4ng th\u00eam l\u1ee3i \u00edch g\u00ec. B\u1ed5 sung k\u1ebdm c\u00f3 th\u1ec3 gia t\u0103ng t\u1ea7n su\u1ea5t n\u00f4n m\u1eeda v\u00e0 nh\u1eefng kh\u00f3 ch\u1ecbu \u1edf d\u1ea1 d\u00e0y.<\/p>\n

S\u1eefa lactose free<\/h2>\n

Kh\u00f4ng khuy\u1ebfn c\u00e1o th\u01b0\u1eddng quy cho tr\u1ebb b\u1ecb ti\u00eau ch\u1ea3y c\u1ea5p \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa (I,A).<\/p>\n

Kh\u00f4ng \u0111\u1ee7 d\u1eef li\u1ec7u \u0111\u1ec3 \u0111\u01b0a ra khuy\u1ebfn c\u00e1o \u1ee7ng h\u1ed9 hay ch\u1ed1ng l\u1ea1i vi\u1ec7c pha lo\u00e3ng s\u1eefa trong \u0111i\u1ec1u tr\u1ecb ti\u00eau ch\u1ea3y c\u1ea5p (I,A)<\/p>\n

Ch\u1ed1ng n\u00f4n<\/h2>\n

M\u1ed9t li\u1ec1u \u0111\u01a1n Odansetron \u0111\u01b0\u1eddng ti\u00eam hay u\u1ed1ng c\u00f3 l\u1ee3i cho ch\u1ee9ng n\u00f4n, l\u00e0m gi\u1ea3m nguy c\u01a1 m\u1ea5t n\u01b0\u1edbc, t\u0103ng kh\u1ea3 n\u0103ng dung n\u1ea1p n\u01b0\u1edbc \u0111\u01b0\u1eddng u\u1ed1ng (II,B).<\/p>\n

Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng \u1ee7ng h\u1ed9 vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1ed1ng n\u00f4n kh\u00e1c nh\u01b0: domperidone (motilium), metochlopramide (primperan)\u2026 trong \u0111i\u1ec1u tr\u1ecb n\u00f4n \u1edf tr\u1ebb b\u1ecb ti\u00eau ch\u1ea3y.<\/p>\n

C\u00e1c thu\u1ed1c h\u1ea5p ph\u1ee5<\/h2>\n

Diosmectite c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc trong \u0111i\u1ec1u tr\u1ecb AGE (vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t c\u1ea5p) (II,B), c\u00e1c thu\u1ed1c h\u1ea5p ph\u1ee5 kh\u00e1c: kaolin-pectin, attapulgite kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o<\/p>\n

Bismuth subsalicylate<\/h2>\n

Kh\u00f4ng khuy\u1ebfn c\u00e1o trong \u0111i\u1ec1u tr\u1ecb ti\u00eau ch\u1ea3y tr\u1ebb em (III, C)<\/p>\n

Racedotril<\/h2>\n

C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc trong \u0111i\u1ec1u t\u1ecb ti\u00eau ch\u1ea3y c\u1ea5p tr\u1ebb em (II,B)<\/p>\n

Oresol c\u1ea3i ti\u1ebfn<\/h2>\n

C\u00f3 m\u00f9i v\u1ecb v\u00e0 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng oresol h\u01b0\u01a1ng v\u1ecb chu\u1ea9n (II,B)<\/p>\n

Saccharomyces bouladii v\u00e0 Lactobacillus rhamnosus GG<\/h2>\n

\u0110\u00e2y l\u00e0 2 lo\u1ea1i probiotic men vi sinh kh\u00f4ng ch\u1ee9ng minh \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb ti\u00eau ch\u1ea3y c\u1ea5p tr\u1ebb em<\/p>\n

Ch\u1ed1ng s\u1ed1c<\/h2>\n

N\u1ebfu tr\u1ebb b\u1ecb ti\u00eau ch\u1ea3y c\u00f3 shock: 20 ml\/kg dung d\u1ecbch NS ho\u1eb7c Lactate ringer bolus t\u0129nh m\u1ea1ch, l\u1eb7p l\u1ea1i li\u1ec1u 2-3 sau 10- 15 ph\u00fat n\u1ebfu huy\u1ebft \u00e1p kh\u00f4ng c\u1ea3i thi\u1ec7n.<\/p>\n

N\u00ean t\u00ecm th\u00eam t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00ed kh\u00e1c g\u00e2y shock n\u1ebfu sau li\u1ec1u \u0111\u1ea7u bolus d\u1ecbch kh\u00f4ng h\u1ebft shock<\/p>\n

M\u1ea5t n\u01b0\u1edbc n\u1eb7ng<\/h2>\n

Tr\u1ebb b\u1ecb m\u1ea5t n\u01b0\u1edbc n\u1eb7ng c\u1ea7n truy\u1ec1n d\u1ecbch c\u00f3 th\u1ec3 d\u00f9ng dung d\u1ecbch NS 20 ml\/ kg truy\u1ec1n trong 2-4 gi\u1edd (II,B)<\/p>\n

Truy\u1ec1n d\u1ecbch duy tr\u00ec c\u00f3 th\u1ec3 d\u00f9ng dung d\u1ecbch c\u1ee7a dextrose (III,C)<\/p>\n

\u0110i\u1ec7n gi\u1ea3i<\/h2>\n

Kh\u00f4ng s\u1eed d\u1ee5ng d\u1ecbch c\u00f3 n\u1ed3ng \u0111\u1ed9 Na+ < 0.45% \u0111\u1ec3 d\u1ef1 ph\u00f2ng h\u1ea1 natri m\u00e1u trong 24 gi\u1edd \u0111\u1ea7u (III,C)<\/p>\n

Sau khi tr\u1ebb \u0111\u00e3 \u0111i ti\u1ec3u \u0111\u01b0\u1ee3c, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 \u0111\u01b0\u1ee3c bi\u1ebft c\u00f3 th\u1ec3 th\u00eam 20 meq K+\/ l d\u1ecbch<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n

https:\/\/www.facebook.com\/diendannhikhoa\/photos\/a.348249775372549\/677281015802755\/?type=3<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Ti\u00eau ch\u1ea3y c\u1ea5p k\u00e8m s\u1ed1t >40 \u0111\u1ed9, \u0111au b\u1ee5ng, ph\u00e2n m\u00e1u, g\u1ee3i \u00fd t\u00e1c nh\u00e2n vi khu\u1ea9n c\u00f2n n\u1ebfu k\u00e8m theo n\u00f4n nhi\u1ec1u, bi\u1ec3u hi\u1ec7n vi\u00eam h\u00f4 h\u1ea5p th\u00ec g\u1ee3i \u00fd si\u00eau vi<\/p>\n","protected":false},"author":14,"featured_media":4253,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[6104],"tags":[5741,5691,5742],"series":[3454],"coauthors":[2652],"acf":[],"yoast_head":"\nC\u1eadp nh\u1eadt \u0111i\u1ec1u tr\u1ecb ti\u00eau ch\u1ea3y c\u1ea5p \u1edf tr\u1ebb em - D\u1ef1 \u00e1n Nhi Khoa<\/title>\n<meta name=\"description\" content=\"Ti\u00eau ch\u1ea3y c\u1ea5p k\u00e8m s\u1ed1t >40 \u0111\u1ed9, \u0111au b\u1ee5ng, ph\u00e2n m\u00e1u, g\u1ee3i \u00fd t\u00e1c nh\u00e2n vi khu\u1ea9n c\u00f2n n\u1ebfu k\u00e8m theo n\u00f4n nhi\u1ec1u, bi\u1ec3u hi\u1ec7n 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