{"id":7141,"date":"2023-10-17T16:25:50","date_gmt":"2023-10-17T09:25:50","guid":{"rendered":"https:\/\/www.baohotoandien.com\/blog\/?p=7141"},"modified":"2025-03-11T12:36:37","modified_gmt":"2025-03-11T05:36:37","slug":"ton-thuong-do-hit-khoi-tu-dam-chay","status":"publish","type":"post","link":"https:\/\/baohotoandien.com\/blog\/ton-thuong-do-hit-khoi-tu-dam-chay\/","title":{"rendered":"T\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i t\u1eeb \u0111\u00e1m ch\u00e1y"},"content":{"rendered":"

T\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i (smoke inhalation injury) l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 l\u00e2m s\u00e0ng quan tr\u1ecdng \u0111\u00e3 bi\u1ebft \u1edf nh\u1eefng n\u1ea1n nh\u00e2n b\u1ecb h\u1ecfa ho\u1ea1n (Aub JC, 1943). vinbet <\/span><\/a>T\u1ed5n th\u01b0\u01a1ng do h\u00edt \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u1ed5n th\u01b0\u01a1ng g\u00e2y ra do h\u00edt ph\u1ea3i nh\u1eefng ch\u1ea5t kh\u00ed \u0111\u1ed9c h\u1ea1i, h\u01a1i v\u00e0 c\u00e1c h\u1ea1t b\u1ee5i ch\u1ee9a trong kh\u00f3i.<\/p>\n

GI\u1edaI THI\u1ec6U<\/b><\/h2>\n

T\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n l\u00e0 t\u1ed5n th\u01b0\u01a1ng nhi\u1ec7t, h\u00f3a ch\u1ea5t v\u00e0 ng\u1ed9 \u0111\u1ed9c h\u1ec7 th\u1ed1ng ho\u1eb7c b\u1ea5t k\u1ef3 s\u1ef1 k\u1ebft h\u1ee3p n\u00e0o c\u1ee7a nh\u1eefng t\u1ed5n th\u01b0\u01a1ng n\u00e0y. M\u1eb7c d\u00f9, th\u1ef1c t\u1ebf ch\u00fang ta \u0111\u00e3 c\u00f3 nhi\u1ec1u n\u0103m kinh nghi\u1ec7m \u0111i\u1ec1u tr\u1ecb c\u00e1c t\u1ed5n th\u01b0\u01a1ng trong h\u1ecfa ho\u1ea1n, nh\u01b0ng qu\u00e1 tr\u00ecnh sinh l\u00fd ph\u1ee9c t\u1ea1p c\u1ee7a t\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec3u r\u00f5, c\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n v\u1eabn kh\u00f4ng r\u00f5 r\u00e0ng, \u0111i\u1ec1u tr\u1ecb chuy\u00ean bi\u1ec7t v\u1eabn kh\u00f4ng hi\u1ec7u qu\u1ea3, v\u1eabn c\u00f2n kh\u00f3 x\u00e1c \u0111\u1ecbnh nguy c\u01a1 t\u1eed vong c\u1ee7a t\u1eebng c\u00e1 nh\u00e2n v\u00e0 nh\u1eefng bi\u1ebfn ch\u1ee9ng l\u00e2u d\u00e0i \u1edf nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t. \u0110i\u1ec1u n\u00e0y l\u00e0 do b\u1ea3n ch\u1ea5t ph\u1ee9c t\u1ea1p c\u1ee7a c\u00e1c t\u1ed5n th\u01b0\u01a1ng, bao g\u1ed3m s\u1ef1 thay \u0111\u1ed5i k\u1ebft h\u1ee3p \u0111a d\u1ea1ng c\u1ee7a th\u01b0\u01a1ng t\u1ed5n nhi\u1ec7t \u0111\u1ed1i v\u1edbi \u0111\u01b0\u1eddng th\u1edf tr\u00ean, s\u1ef1 k\u00edch \u1ee9ng ni\u00eam m\u1ea1c ph\u1ebf qu\u1ea3n v\u00e0 ph\u1ebf nang, qu\u00e1 tr\u00ecnh vi\u00eam do ti\u1ebfp x\u00fac v\u1edbi h\u00f3a ch\u1ea5t t\u1ea1i ch\u1ed7, \u1ea3nh h\u01b0\u1edfng to\u00e0n th\u00e2n do h\u1ea5p thu \u0111\u1ed9c ch\u1ea5t, m\u1ea5t bi\u1ec3u m\u00f4 c\u00f3 l\u00f4ng chuy\u1ec3n (ciliated epithelium), t\u00edch l\u0169y c\u00e1c m\u1ea3nh v\u1ee5n trong ph\u1ebf qu\u1ea3n, \u0111\u00e1p \u1ee9ng vi\u00eam th\u1ee9 ph\u00e1t c\u1ee7a h\u1ec7 th\u1ed1ng tr\u00ean ph\u1ed5i v\u00e0 nhi\u1ec5m tr\u00f9ng to\u00e0n th\u00e2n.<\/p>\n

C\u01a0 CH\u1ebe B\u1ec6NH SINH<\/h2>\n

T\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i c\u00f3 th\u1ec3 l\u00e0 h\u1eadu qu\u1ea3 tr\u1ef1c ti\u1ebfp do ti\u1ebfp x\u00fac v\u1edbi nhi\u1ec7t \u0111\u1ed9 v\u00e0 h\u00f3a ch\u1ea5t, \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch \u0111\u1ed1i v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 n\u00e0y, \u1ea3nh h\u01b0\u1edfng to\u00e0n th\u00e2n c\u1ee7a ch\u1ea5t \u0111\u1ed9c h\u00edt ph\u1ea3i, t\u00edch l\u0169y c\u00e1c m\u1ea3nh v\u1ee5n n\u1ed9i ph\u1ebf qu\u1ea3n v\u00e0 nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t. B\u1ea3n ch\u1ea5t \u0111\u00e1m ch\u00e1y t\u1ea1o ra kh\u00f3i c\u00f3 ch\u1ee9a nhi\u1ec1u lo\u1ea1i h\u00f3a ch\u1ea5t, c\u00e1c s\u1ea3n ph\u1ea9m kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1ed1t ch\u00e1y ho\u00e0n to\u00e0n v\u00e0 c\u00e1c h\u1ea1t r\u1ea5t nh\u1ecf l\u01a1 l\u1eedng trong kh\u00f4ng kh\u00ed (aerosolized debris) c\u00f3 k\u00edch th\u01b0\u1edbc r\u1ea5t kh\u00e1c nhau. Nhi\u1ec7t \u0111\u1ed9 kh\u00f4ng kh\u00ed trong \u0111\u00e1m ch\u00e1y thay \u0111\u1ed5i r\u1ea5t nhi\u1ec1u v\u00e0 \u1ea3nh h\u01b0\u1edfng tr\u00ean b\u1ec7nh nh\u00e2n l\u00e0 ph\u1ee9c t\u1ea1p v\u00e0 kh\u00f4ng th\u1ec3 \u0111o\u00e1n tr\u01b0\u1edbc.<\/p>\n

T\u1ed5n th\u01b0\u01a1ng t\u1ea1i ch\u1ed7 tr\u1ef1c ti\u1ebfp<\/b><\/h3>\n

T\u1ed5n th\u01b0\u01a1ng nhi\u1ec7t tr\u1ef1c ti\u1ebfp th\u01b0\u1eddng gi\u1edbi h\u1ea1n trong \u0111\u01b0\u1eddng th\u1edf tr\u00ean thanh m\u00f4n, tr\u1eeb tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm l\u00e0 h\u00edt ph\u1ea3i h\u01a1i n\u00f3ng nh\u01b0 h\u00edt ph\u1ea3i h\u01a1i n\u01b0\u1edbc \u00e1p l\u1ef1c trong khoang m\u00e1y. Ph\u1ea7n l\u1edbn t\u1ed5n th\u01b0\u01a1ng d\u01b0\u1edbi thanh m\u00f4n l\u00e0 do h\u00f3a ch\u1ea5t d\u1ea1ng bay h\u01a1i (aerosolized) v\u00e0 c\u00e1c s\u1ea3n ph\u1ea9m ch\u00e1y kh\u00f4ng ho\u00e0n to\u00e0n. Ph\u00e2n lo\u1ea1i v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e0y r\u1ea5t kh\u00f3 d\u1ef1 \u0111o\u00e1n, t\u00f9y v\u00e0o t\u00e1c nh\u00e2n v\u00e0 k\u00edch c\u1ee1 h\u1ea1t h\u00edt ph\u1ea3i, c\u00e1c h\u1ea1t nh\u1ecf h\u01a1n s\u1ebd \u0111i \u0111\u1ebfn c\u00e1c v\u1ecb tr\u00ed xa h\u01a1n trong \u0111\u01b0\u1eddng d\u1eabn kh\u00ed tr\u01b0\u1edbc khi l\u1eafng \u0111\u1ecdng. T\u00e1c \u0111\u1ed9ng t\u1ea1i ch\u1ed7 bao g\u1ed3m k\u00edch \u1ee9ng, ti\u1ebft nh\u1ea7y ni\u00eam m\u1ea1c, co th\u1eaft ph\u1ebf qu\u1ea3n, t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u ph\u1ebf qu\u1ea3n, suy gi\u1ea3m ch\u1ea5t ho\u1ea1t di\u1ec7n (surfactant) v\u00e0 vi\u00eam.<\/p>\n

Vi\u00eam th\u1ee9 ph\u00e1t<\/b><\/h3>\n

T\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i c\u00f3 th\u1ec3 g\u00e2y \u0111\u00e1p \u1ee9ng vi\u00eam n\u1eb7ng v\u00e0 \u0111a d\u1ea1ng, n\u00f3 c\u00f3 th\u1ec3 t\u1ea1o ra c\u00e1c g\u1ed1c t\u1ef1 do oxy h\u00f3a t\u1ea1i ch\u1ed7, thu h\u00fat c\u00e1c t\u1ebf b\u00e0o vi\u00eam g\u00e2y gi\u1ea3i ph\u00f3ng c\u00e1c ph\u00e2n t\u1eed v\u00e0 cytokine vi\u00eam (Albright JM, 2012). \u1ea2nh h\u01b0\u1edfng t\u1ea1i ph\u1ed5i c\u1ee7a ph\u1ea3n \u1ee9ng vi\u00eam bao g\u1ed3m co th\u1eaft ph\u1ebf qu\u1ea3n v\u00e0 co m\u1ea1ch, t\u0103ng ti\u1ebft ph\u1ebf qu\u1ea3n (bronchorrhea) v\u00e0 tr\u00e0n d\u1ecbch ph\u1ebf nang (alveolar flooding), xu\u1ea5t ti\u1ebft ph\u1ebf qu\u1ea3n (bronchial exudate) v\u00e0 h\u00ecnh th\u00e0nh ch\u1ea5t nh\u1ea7y d\u1ea1ng c\u00e2y ph\u1ebf qu\u1ea3n (bronchial cast), v\u00e0 b\u1ea5t t\u01b0\u01a1ng x\u1ee9ng th\u00f4ng kh\u00ed-t\u01b0\u1edbi m\u00e1u. Do \u1ea3nh h\u01b0\u1edfng l\u00ean to\u00e0n th\u00e2n, n\u00ean n\u1ebfu b\u1ec7nh nh\u00e2n t\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i v\u00e0 b\u1ecb b\u1ecfng da \u0111\u1ed3ng th\u1eddi, c\u1ea7n ph\u1ea3i t\u0103ng \u0111\u00e1ng k\u1ec3 th\u1ec3 t\u00edch c\u1ea7n h\u1ed3i s\u1ee9c (Endorf FW, 2007).<\/p>\n

Thi\u1ebfu oxy<\/b>\u00a0(anoxia)<\/h3>\n

Qu\u00e1 tr\u00ecnh oxy h\u00f3a c\u00e1c ch\u1ea5t d\u1ec5 ch\u00e1y l\u00e0m ti\u00eau th\u1ee5 nhanh ch\u00f3ng l\u01b0\u1ee3ng oxy c\u00f3 s\u1eb5n. Do \u0111\u00f3, h\u00edt ph\u1ea3i kh\u00ed thi\u1ebfu oxy c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng n\u00e3o do thi\u1ebfu oxy (hypoxic brain injury), n\u00ean c\u1ea7n \u0111i\u1ec1u tr\u1ecb gi\u1ed1ng nh\u01b0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng n\u00e3o do thi\u1ebfu oxy kh\u00e1c v\u00e0 k\u1ebft qu\u1ea3 th\u1ea7n kinh sau \u0111i\u1ec1u tr\u1ecb r\u1ea5t kh\u00e1c nhau.<\/p>\n

Ph\u01a1i nhi\u1ec5m carbon monoxide<\/b>(CO)<\/h3>\n

Carbon monoxide \u0111\u01b0\u1ee3c th\u1ea3i ra trong qu\u00e1 tr\u00ecnh \u0111\u1ed1t ch\u00e1y, n\u00f3 l\u00e0 lo\u1ea1i kh\u00ed kh\u00f4ng m\u00e0u v\u00e0 kh\u00f4ng m\u00f9i. N\u1ed3ng \u0111\u1ed9 CO trong kh\u00ed quy\u1ec3n n\u00f3i chung <0,001%, nh\u01b0ng n\u1ed3ng \u0111\u1ed9 CO ch\u1ec9 1% l\u00e0 \u0111\u1ee7 g\u00e2y t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng v\u00ec CO h\u1ea5p thu nhanh ch\u00f3ng qua bi\u1ec3u m\u00f4 ph\u1ed5i v\u00e0 c\u00f3 \u00e1i l\u1ef1c cao v\u1edbi hemoglobin, cao g\u1ea5p 200-250 l\u1ea7n so v\u1edbi O2<\/sub>\u00a0(Ernst A, 1998; McCall JE, 2005). Ng\u1ed9 \u0111\u1ed9c CO chi\u1ebfm \u0111\u1ebfn 80% c\u00e1c ca t\u1eed vong do t\u1ed5n th\u01b0\u01a1ng h\u00edt kh\u00f3i v\u00e0 ph\u1ea7n l\u1edbn x\u1ea3y ra trong v\u00f2ng 24 gi\u1edd \u0111\u1ea7u sau ph\u01a1i nhi\u1ec5m (Raub JA, 2000).<\/p>\n

CO g\u1eafn v\u1edbi c\u00e1c ph\u00e2n t\u1eed ch\u1ee9a heme v\u1edbi \u00e1i l\u1ef1c r\u1ea5t m\u1ea1nh, \u0111\u1eb7c bi\u1ec7t l\u00e0 hemoglobin v\u00e0 t\u1ea1o ra ph\u1ee9c h\u1ee3p carboxyhemoglobin (COHb) c\u1ef1c k\u1ef3 \u1ed5n \u0111\u1ecbnh, l\u00e0m gi\u1ea3m b\u00e3o h\u00f2a oxyhemoglobin v\u00e0 \u0111\u1ea9y \u0111\u01b0\u1eddng cong ph\u00e2n ly hemoglobin sang tr\u00e1i, gi\u1ea3m gi\u1ea3i ph\u00f3ng O2<\/sub>\u00a0cho m\u00f4 (Kao LW, 2004). Ngo\u00e0i ra, c\u00f2n \u1ee9c ch\u1ebf c\u1ea1nh tranh v\u1edbi ph\u1ee9c h\u1ee3p cytochrome oxidase ch\u1ee7 y\u1ebfu l\u00e0 P-450, ng\u0103n c\u1ea3n s\u1eed d\u1ee5ng O2<\/sub>\u00a0\u0111\u1ec3 t\u1ea1o ra n\u0103ng l\u01b0\u1ee3ng (Souza R, 2004). C\u01a1 ch\u1ebf kh\u00e1c l\u00e0 CO g\u1eafn v\u1edbi myoglobin l\u00e0m gi\u1ea3m d\u1ef1 tr\u1eef O2<\/sub>\u00a0trong c\u01a1 v\u00e0 peroxy h\u00f3a lipid trong n\u00e3o (Kealey GP, 2009). Peroxy h\u00f3a lipid n\u00e3o sau ti\u1ebfp x\u00fac CO c\u0169ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 t\u00e1i t\u01b0\u1edbi m\u00e1u sau thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, n\u00f3 qua trung gian thay \u0111\u1ed5i l\u01b0u l\u01b0\u1ee3ng m\u00e1u n\u00e3o v\u00e0 t\u1ed5n th\u01b0\u01a1ng oxy h\u00f3a do c\u00e1c g\u1ed1c t\u1ef1 do.<\/p>\n

N\u1ed3ng \u0111\u1ed9 COHb t\u1eeb 10-20% g\u00e2y nh\u1ee9c \u0111\u1ea7u v\u00e0 bu\u1ed3n n\u00f4n; 20-30% g\u00e2y y\u1ebfu c\u01a1 v\u00e0 suy gi\u1ea3m nh\u1eadn th\u1ee9c; 30-50% g\u00e2y thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim v\u00e0 m\u1ea5t \u00fd th\u1ee9c. N\u1ed3ng \u0111\u1ed9 cao h\u01a1n th\u01b0\u1eddng g\u00e2y t\u1eed vong. \u0110i\u1ec1u tr\u1ecb oxy trong th\u1eddi gian tr\u01b0\u1edbc v\u00e0o vi\u1ec7n c\u00f3 th\u1ec3 che l\u1ea5p m\u1ee9c \u0111\u1ed9 ti\u1ebfp x\u00fac ban \u0111\u1ea7u do n\u1ed3ng \u0111\u1ed9 COHb s\u1ebd b\u00ecnh th\u01b0\u1eddng nhanh ch\u00f3ng n\u1ebfu b\u1ec7nh nh\u00e2n th\u1edf oxy 100%, thanh th\u1ea3i cytochrome c\u00f3 th\u1ec3 l\u00e2u h\u01a1n. M\u1ed9t s\u1ed1 \u00edt b\u1ec7nh nh\u00e2n s\u1ebd b\u1ecb di ch\u1ee9ng th\u1ea7n kinh mu\u1ed9n sau ph\u01a1i nhi\u1ec5m CO (Guzman JA, 2012).<\/p>\n

Ph\u01a1i nhi\u1ec5m cyanide<\/b><\/h3>\n

Hydrogen cyanide l\u00e0 m\u1ed9t h\u1ee3p ch\u1ea5t d\u1ec5 bay h\u01a1i, h\u00ecnh th\u00e0nh do qu\u00e1 tr\u00ecnh ch\u00e1y kh\u00f4ng ho\u00e0n to\u00e0n c\u00e1c nguy\u00ean t\u1ed1 cacbon v\u00e0 nit\u01a1 trong \u0111\u00e1m ch\u00e1y ch\u1ee9a b\u00f4ng, t\u01a1 t\u1eb1m, g\u1ed7, gi\u1ea5y, nh\u1ef1a, x\u1ed1p\/b\u1ecdt bi\u1ec3n, acrylic v\u00e0 polyme t\u1ed5ng h\u1ee3p (Hamel J, 2011). S\u1ef1 t\u00e1i sinh c\u00e1c s\u1ea3n ph\u1ea9m nhi\u1ec7t ph\u00e2n trong kh\u00f4ng gian k\u00edn s\u1ebd l\u00e0m t\u0103ng t\u1ec9 l\u1ec7 h\u00ecnh th\u00e0nh hydrogen cyanide, t\u1ec9 l\u1ec7 n\u00e0y c\u00f3 th\u1ec3 t\u0103ng l\u00ean 10 l\u1ea7n trong m\u00f4i tr\u01b0\u1eddng thi\u1ebfu th\u00f4ng gi\u00f3.<\/p>\n

Hydrogen cyanide c\u00f3 kh\u1ea3 n\u0103ng g\u1eafn v\u1edbi ion s\u1eaft v\u00e0 v\u1eadn chuy\u1ec3n trong m\u00e1u b\u1edfi h\u1ed3ng c\u1ea7u. Trong m\u00f4i tr\u01b0\u1eddng n\u1ed9i b\u00e0o, hydrogen cyanide g\u1eafn v\u1edbi enzyme cytochrome c oxidase, bl\u1ed1c ho\u00e0n to\u00e0n chu k\u1ef3 h\u00f4 h\u1ea5p v\u00e0 s\u1ef1 h\u00ecnh th\u00e0nh ATP, g\u00e2y nhi\u1ec5m toan lactic n\u1eb7ng v\u00e0 t\u1eed vong trong v\u00f2ng v\u00e0i ph\u00fat sau ti\u1ebfp x\u00fac v\u1edbi l\u01b0\u1ee3ng l\u1edbn (Lawson-Smith P, 2011).<\/p>\n

Hydrogen cyanide sau h\u1ea5p thu s\u1ebd nhanh ch\u00f3ng bi\u1ebfn m\u1ea5t kh\u1ecfi \u200b\u200bm\u00e1u, th\u1eddi gian b\u00e1n h\u1ee7y alpha t\u1eeb 1-3 gi\u1edd, th\u1eddi gian b\u00e1n h\u1ee7y beta l\u00e0 44 gi\u1edd v\u00e0 kh\u00f3 \u0111o l\u01b0\u1eddng \u0111\u01b0\u1ee3c n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh c\u1ee7a n\u00f3 (O\u2019Brien DJ, 2011). Do \u0111\u00f3, c\u1ea7n l\u1ea5y m\u1eabu m\u00e1u c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t, ngay t\u1ea1i hi\u1ec7n tr\u01b0\u1eddng v\u00e0 n\u00ean b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc khi c\u00f3 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m, k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m th\u01b0\u1eddng m\u1ea5t trung b\u00ecnh 2 gi\u1edd. Gi\u1ed1ng nh\u01b0 COHb, hydrogen cyanide c\u1ea3n tr\u1edf vi\u1ec7c s\u1eed d\u1ee5ng oxy c\u1ee7a cytochrome, c\u00f9ng v\u1edbi thi\u1ebfu oxy v\u00e0 nhi\u1ec5m \u0111\u1ed9c CO s\u1ebd d\u1eabn \u0111\u1ebfn t\u1eed vong s\u1edbm trong t\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i c\u1ea5p t\u00ednh (Barillo DJ, 1994). Ng\u1ed9 \u0111\u1ed9c cyanide th\u01b0\u1eddng g\u00e2y nhi\u1ec5m toan k\u00e9o d\u00e0i m\u1eb7c d\u00f9 \u0111\u00e3 h\u1ed3i s\u1ee9c th\u00e0nh c\u00f4ng.<\/p>\n

Nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t v\u00e0 suy h\u00f4 h\u1ea5p<\/b><\/h3>\n

B\u1eafn c\u00e1 Vinbet <\/span><\/a>T\u1ed5n th\u01b0\u01a1ng bi\u1ec3u m\u00f4 n\u1ed9i ph\u1ebf qu\u1ea3n v\u00e0 ph\u1ebf nang d\u1eabn \u0111\u1ebfn t\u0103ng ti\u1ebft ch\u1ea5t nh\u1ea7y, l\u00e0m t\u0103ng s\u1ed1 l\u01b0\u1ee3ng m\u1ea3nh v\u1ee5n trong \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p v\u00e0 l\u00e0m gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng v\u00e0 hi\u1ec7u qu\u1ea3 l\u00e0m s\u1ea1ch c\u1ee7a l\u00f4ng chuy\u1ec3n. Nh\u1eefng v\u1ea5n \u0111\u1ec1 n\u00e0y g\u00f3p ph\u1ea7n g\u00e2y t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf nh\u1ecf ti\u1ebfn tri\u1ec3n, x\u1eb9p ph\u1ed5i, b\u1ea5t t\u01b0\u01a1ng x\u1ee9ng th\u00f4ng kh\u00ed\/t\u01b0\u1edbi m\u00e1u v\u00e0 nhi\u1ec5m tr\u00f9ng, g\u00e2y kh\u00f3 kh\u0103n trong ki\u1ec3m so\u00e1t t\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i nh\u1eefng ng\u00e0y sau b\u1ecb b\u1ecfng. Ph\u1ea7n l\u1edbn ca t\u1eed vong trong b\u1ec7nh vi\u1ec7n do t\u1ed5n th\u01b0\u01a1ng h\u00edt kh\u00f3i l\u00e0 do ph\u00e1t tri\u1ec3n nh\u1eefng t\u1ed5n th\u01b0\u01a1ng th\u1ee9 ph\u00e1t h\u01a1n l\u00e0 t\u1ed5n th\u01b0\u01a1ng ban \u0111\u1ea7u.<\/p>\n

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H\u00ecnh 1. Sinh b\u1ec7nh h\u1ecdc t\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i c\u1ea5p. (ngu\u1ed3n Toon MH, 2010, Crit Care Resusc)<\/figcaption><\/figure>\n

CHU\u1ea8N \u0110O\u00c1N<\/h2>\n

M\u1eb7c d\u00f9 c\u00f3 nhi\u1ec1u b\u1ea3ng ph\u00e2n lo\u1ea1i kh\u00e1c nhau, nh\u01b0ng ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng t\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i kh\u00f4ng ti\u00ean l\u01b0\u1ee3ng \u0111\u01b0\u1ee3c k\u1ebft c\u1ee5c (Ryan CM, 2012; Hassan Z, 2010). C\u00e1c ph\u01b0\u01a1ng ti\u1ec7n ch\u00ednh \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 l\u00e0 kh\u00e1m l\u00e2m s\u00e0ng, soi ph\u1ebf qu\u1ea3n v\u00e0 ch\u1ee5p X-quang.<\/p>\n

\u00a0\u0110\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng<\/b><\/h3>\n

Kh\u00e1m l\u00e2m s\u00e0ng l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n \u0111\u00e1ng tin c\u1eady nh\u1ea5t v\u00e0 g\u1ea7n \u0111\u00fang v\u1ec1 ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng. B\u1ec7nh s\u1eed b\u1ecb b\u1ecfng do ch\u00e1y trong kh\u00f4ng gian k\u00edn, b\u1ecfng da quanh m\u0169i v\u00e0 mi\u1ec7ng, ch\u00e1y x\u00e9m l\u00f4ng m\u0169i, b\u1ed3 h\u00f3ng\/b\u1ee5i than trong \u0111\u01b0\u1eddng th\u1edf, \u0111\u1eddm c\u00f3 than (carbonaceous sputum), kh\u00e0n gi\u1ecdng, th\u1edf kh\u00f2 kh\u00e8 v\u00e0 th\u1edf r\u00edt, t\u1ea5t c\u1ea3 \u0111\u1ec1u g\u1ee3i \u00fd t\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i. Ch\u1ec9 s\u1ed1 oxy h\u00f3a m\u00e1u t\u1ea1i th\u1eddi \u0111i\u1ec3m h\u1ed3i s\u1ee9c d\u1ecbch c\u00f3 m\u1ed1i t\u01b0\u01a1ng quan l\u1ecfng l\u1ebbo v\u1edbi m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i, v\u00e0 c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng r\u1ea5t l\u1edbn b\u1edfi th\u1ec3 t\u00edch d\u1ecbch h\u1ed3i s\u1ee9c v\u00e0 mode th\u1edf.<\/p>\n

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H\u00ecnh 2: Tri\u1ec7u ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i<\/figcaption><\/figure>\n

X\u00e9t nghi\u1ec7m<\/b><\/h3>\n

T\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u, urea v\u00e0 \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch, lactate m\u00e1u, n\u1ed3ng \u0111\u1ed9 COHb, AVDO2<\/sub>\u00a0(gi\u1ea3m ngh\u0129a l\u00e0 m\u1ea5t kh\u1ea3 n\u0103ng s\u1eed d\u1ee5ng oxy).<\/p>\n

Soi ph\u1ebf qu\u1ea3n<\/b><\/h3>\n

N\u1ed9i soi ph\u1ebf qu\u1ea3n \u1ed1ng m\u1ec1m l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng th\u1edf do h\u00edt kh\u00f3i, \u0111\u1ed9 ch\u00ednh x\u00e1c l\u00ean \u0111\u1ebfn 86%. Soi ph\u1ebf qu\u1ea3n \u1ed1ng m\u1ec1m c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c m\u1ea3nh v\u1ee5n than, ni\u00eam m\u1ea1c lo\u00e9t, xanh nh\u1ee3t v\u00e0 t\u0103ng ti\u1ebft (H\u00ecnh 2). Ngo\u00e0i ra, th\u01b0\u1eddng soi ph\u1ebf qu\u1ea3n \u1ed1ng m\u1ec1m \u0111\u1ec3 v\u1ec7 sinh \u0111\u01b0\u1eddng th\u1edf, lo\u1ea1i b\u1ecf c\u00e1c h\u1ea1t d\u1ecb v\u1eadt, ch\u1ea5t nh\u1eddn g\u00e2y t\u1eafc ngh\u1ebdn ph\u1ebf qu\u1ea3n v\u00e0 s\u1ed1 l\u01b0\u1ee3ng l\u1edbn c\u00e1c ch\u1ea5t ti\u1ebft vi\u00eam h\u00ecnh th\u00e0nh do ho\u1ea1i t\u1eed t\u1ebf b\u00e0o. M\u1eb7c d\u00f9, soi ph\u1ebf qu\u1ea3n \u1ed1ng m\u1ec1m c\u00f3 th\u1ec3 d\u1ef1 \u0111o\u00e1n ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh nh\u00e2n t\u1eeb g\u00f3c \u0111\u1ed9 h\u00f4 h\u1ea5p, nh\u01b0ng b\u1ea3ng ph\u00e2n \u0111\u1ed9 n\u1ed9i soi ph\u1ebf qu\u1ea3n ch\u1ec9 c\u00f3 m\u1ed1i t\u01b0\u01a1ng quan l\u1ecfng l\u1ebbo v\u1edbi di\u1ec5n ti\u1ebfn l\u00e2m s\u00e0ng (Spano S, 2016). M\u1ed9t h\u1ed3i c\u1ee9u \u0111o\u00e0n h\u1ec7 tr\u00ean 32 b\u1ec7nh nh\u00e2n b\u1ecfng r\u1ed9ng cho th\u1ea5y ph\u00e2n lo\u1ea1i n\u1ed9i soi ph\u1ebf qu\u1ea3n theo thang \u0111i\u1ec3m AIS (abbreviated injury score) [trong \u0111\u00f3 t\u1ed5n th\u01b0\u01a1ng nhi\u1ec7t \u0111\u01b0\u1eddng th\u1edf \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i l\u00e0 0 (kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng), 1 (t\u1ed5n th\u01b0\u01a1ng nh\u1eb9), 2 (t\u1ed5n th\u01b0\u01a1ng v\u1eeba ph\u1ea3i), 3 (t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng) ho\u1eb7c 4 (t\u1ed5n th\u01b0\u01a1ng r\u1ea5t n\u1eb7ng)] ph\u1ed1i h\u1ee3p v\u1edbi gi\u1ea3m PaO2<\/sub>\/FiO2<\/sub>\u00a0trong 24 gi\u1edd \u0111\u1ea7u sau nh\u1eadp ICU (Mosier MJ, 2012). M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecfng r\u1ed9ng c\u00f3 AIS cao l\u00fac nh\u1eadp vi\u1ec7n cho th\u1ea5y c\u00f3 m\u1ed1i t\u01b0\u01a1ng quan v\u1edbi th\u1eddi gian th\u1edf m\u00e1y d\u00e0i h\u01a1n (trung b\u00ecnh 3 ng\u00e0y \u0111\u1ed1i v\u1edbi \u0111\u1ed9 0 v\u00e0 23 ng\u00e0y \u0111\u1ed1i v\u1edbi \u0111\u1ed9 4), c\u00f3 nguy c\u01a1 ph\u1ea3i m\u1edf kh\u00ed qu\u1ea3n l\u1edbn h\u01a1n v\u00e0 n\u1eb1m ICU l\u00e2u h\u01a1n (Albright JM, 2012). M\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 kh\u00e1c cho th\u1ea5y gi\u1ea3m tuy\u1ec7t \u0111\u1ed1i 27% t\u1ec9 l\u1ec7 s\u1ed1ng s\u00f3t \u1edf b\u1ec7nh nh\u00e2n c\u00f3 AIS t\u1eeb 2-4 so v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 AIS l\u00e0 0 ho\u1eb7c 1 (Endorf FW, 2007).<\/p>\n

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H\u00ecnh 3. H\u00ecnh \u1ea3nh soi ph\u1ebf qu\u1ea3n \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n n\u1eef 30 tu\u1ed5i b\u1ecb t\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i. N\u1ed9i soi ph\u1ebf qu\u1ea3n l\u00fac nh\u1eadp vi\u1ec7n ghi nh\u1eadn h\u00ecnh \u1ea3nh ni\u00eam m\u1ea1c thanh kh\u00ed ph\u1ebf qu\u1ea3n b\u00e1m \u0111\u1ea7y b\u1ee5i than, vi\u00eam \u0111\u1ecf v\u00e0 d\u1ec5 ch\u1ea3y m\u00e1u (h\u00ecnh tr\u00ean). K\u1ebft qu\u1ea3 soi ph\u1ebf qu\u1ea3n sau 2 ng\u00e0y nh\u1eadp vi\u1ec7n, ngo\u00e0i b\u1ee5i than c\u00f2n c\u00f3 nhi\u1ec1u gi\u1ea3 m\u1ea1c \u1edf n\u1eafp thanh m\u00f4n, s\u1ee5n ph\u1ec5u, thanh qu\u1ea3n v\u00e0 c\u00e2y kh\u00ed ph\u1ebf qu\u1ea3n (h\u00ecnh d\u01b0\u1edbi).<\/figcaption><\/figure>\n

M\u1eb7c d\u00f9, soi ph\u1ebf qu\u1ea3n l\u00e0m s\u1ea1ch ph\u1ed5i c\u00f3 th\u1ec3 c\u00f3 gi\u00e1 tr\u1ecb sau \u0111\u00f3 trong th\u1eddi gian n\u1eb1m vi\u1ec7n, nh\u01b0ng gi\u00e1 tr\u1ecb c\u1ee7a vi\u1ec7c lo\u1ea1i b\u1ecf ngay c\u00e1c m\u1ea3nh v\u1ee5n nh\u00ecn th\u1ea5y khi n\u1ed9i soi v\u1eabn kh\u00f4ng r\u00f5. Soi ph\u1ebf qu\u1ea3n \u1ed1ng m\u1ec1m l\u1eb7p l\u1ea1i khi \u0111\u00e3 ch\u1ea9n \u0111o\u00e1n v\u1eabn c\u00f2n tranh c\u00e3i. Kh\u00f4ng c\u00f3 nghi\u00ean c\u1ee9u ti\u1ec1n c\u1ee9u v\u1ec1 v\u1ea5n \u0111\u1ec1 n\u00e0y trong y v\u0103n. M\u1ed9t nghi\u00ean c\u1ee9u tr\u00ean 624 b\u1ec7nh nh\u00e2n t\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng nhi\u1ec1u ph\u00e1c \u0111\u1ed3 kh\u00e1c nhau cho th\u1ea5y soi ph\u1ebf qu\u1ea3n \u1ed1ng m\u1ec1m t\u00edch c\u1ef1c c\u00f3 k\u1ebft qu\u1ea3 kh\u00f4ng kh\u00e1c bi\u1ec7t, m\u1eb7c d\u00f9 c\u00f3 v\u1ebb nh\u01b0 nh\u1eefng b\u1ec7nh nh\u00e2n soi ph\u1ebf qu\u1ea3n >1 l\u1ea7n c\u00f3 th\u1eddi gian n\u1eb1m vi\u1ec7n ng\u1eafn h\u01a1n (Carr JA, 2009).<\/p>\n

H\u00ecnh \u1ea3nh h\u1ecdc<\/b><\/h3>\n

X-quang ng\u1ef1c ngay sau nh\u1eadp vi\u1ec7n th\u01b0\u1eddng l\u00e0 b\u00ecnh th\u01b0\u1eddng, m\u1eb7c d\u00f9 sau \u0111\u00f3 c\u00f3 th\u1ec3 th\u1ea5y x\u1eb9p ph\u1ed5i lan t\u1ecfa, ph\u00f9 ph\u1ed5i ho\u1eb7c vi\u00eam ph\u1ebf qu\u1ea3n ph\u1ed5i, do \u0111\u00f3 n\u00f3 kh\u00f4ng h\u1eefu \u00edch \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ho\u1eb7c ph\u00e2n t\u1ea7ng \u0111\u1ed9 n\u1eb7ng (Putman CE, 1977) (H\u00ecnh 3). Ch\u1ee5p x\u1ea1 h\u00ecnh (radionuclide ventilation scanning) \u0111\u01b0\u1ee3c \u1ee7ng h\u1ed9, d\u1ea5u hi\u1ec7u c\u1ee7a t\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i l\u00e0 th\u1ea3i tr\u1eeb ph\u00f3ng x\u1ea1 kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u k\u00e8m theo t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf nh\u1ecf (Shiau YC, 2003). Tuy nhi\u00ean, k\u1ef9 thu\u1eadt n\u00e0y ph\u1ee9c t\u1ea1p v\u00e0 kh\u00f4ng \u0111\u00e1ng tin c\u1eady, do \u0111\u00f3 hi\u1ec7n nay r\u1ea5t hi\u1ebfm s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt n\u00e0y tr\u00ean l\u00e2m s\u00e0ng. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh c\u00f3 tri\u1ec3n v\u1ecdng \u0111\u1ec3 ph\u00e2n t\u1ea7ng \u0111\u1ed9 n\u1eb7ng v\u00e0 d\u1ef1 \u0111o\u00e1n di\u1ec5n ti\u1ebfn l\u00e2m s\u00e0ng (Yamamura H, 2015). Tuy nhi\u00ean, th\u00f4ng tin t\u1eeb CT kh\u00f4ng thay \u0111\u1ed5i \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 k\u00e8m theo chi ph\u00ed t\u00e0i ch\u00ednh n\u00ean c\u00f3 th\u1ec3 c\u1ea3n tr\u1edf vi\u1ec7c s\u1eed d\u1ee5ng m\u1ed9t c\u00e1ch th\u01b0\u1eddng quy. M\u1ed9t h\u1ed3i c\u1ee9u tr\u00ean 44 b\u1ec7nh nh\u00e2n b\u1ecfng cho th\u1ea5y ch\u1ee5p CT trong v\u00f2ng 24 gi\u1edd \u0111\u1ea7u sau nh\u1eadp vi\u1ec7n c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n k\u1ebft c\u1ee5c c\u1ee7a vi\u00eam ph\u1ed5i, ARDS v\u00e0 t\u1eed vong (Oh JS, 2012).<\/p>\n

\"\"
H\u00ecnh 3. X-quang ph\u1ed5i c\u1ee7a m\u1ed9t b\u1ec7nh nh\u00e2n n\u1eef 30 tu\u1ed5i b\u1ecb t\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i. (A) X-quang ph\u1ed5i l\u00fac nh\u1eadp vi\u1ec7n b\u00ecnh th\u01b0\u1eddng. (B) X-quang ph\u1ed5i sau 2 ng\u00e0y nh\u1eadp vi\u1ec7n v\u1edbi x\u1eb9p ph\u1ed5i d\u1ea1ng \u0111\u0129a, vi\u00eam v\u00e0 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i l\u01b0\u1ee3ng \u00edt 2 \u0111\u00e1y ph\u1ed5i.<\/figcaption><\/figure>\n

Ngu\u1ed3n: B\u1ec7nh Vi\u1ec7n Nh\u00e2n D\u00e2n 115<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

T\u1ed5n th\u01b0\u01a1ng do h\u00edt kh\u00f3i (smoke inhalation injury) l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 l\u00e2m s\u00e0ng quan tr\u1ecdng \u0111\u00e3 bi\u1ebft \u1edf nh\u1eefng n\u1ea1n nh\u00e2n b\u1ecb h\u1ecfa ho\u1ea1n…<\/p>\n","protected":false},"author":2,"featured_media":7150,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-7141","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-tips"],"_links":{"self":[{"href":"https:\/\/baohotoandien.com\/blog\/wp-json\/wp\/v2\/posts\/7141","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/baohotoandien.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/baohotoandien.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/baohotoandien.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/baohotoandien.com\/blog\/wp-json\/wp\/v2\/comments?post=7141"}],"version-history":[{"count":5,"href":"https:\/\/baohotoandien.com\/blog\/wp-json\/wp\/v2\/posts\/7141\/revisions"}],"predecessor-version":[{"id":8059,"href":"https:\/\/baohotoandien.com\/blog\/wp-json\/wp\/v2\/posts\/7141\/revisions\/8059"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/baohotoandien.com\/blog\/wp-json\/wp\/v2\/media\/7150"}],"wp:attachment":[{"href":"https:\/\/baohotoandien.com\/blog\/wp-json\/wp\/v2\/media?parent=7141"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/baohotoandien.com\/blog\/wp-json\/wp\/v2\/categories?post=7141"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/baohotoandien.com\/blog\/wp-json\/wp\/v2\/tags?post=7141"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}