{"id":12761,"date":"2022-02-13T22:22:09","date_gmt":"2022-02-13T15:22:09","guid":{"rendered":"https:\/\/cdcangiang.vn\/?p=12761"},"modified":"2022-02-13T22:22:09","modified_gmt":"2022-02-13T15:22:09","slug":"bao-cytokine-trong-covid-19-khong-moi-nhung-chua-cu","status":"publish","type":"post","link":"https:\/\/cdcangiang.vn\/index.php\/2022\/02\/13\/bao-cytokine-trong-covid-19-khong-moi-nhung-chua-cu\/","title":{"rendered":"B\u00e3o Cytokine trong COVID-19 kh\u00f4ng m\u1edbi nh\u01b0ng ch\u01b0a c\u0169"},"content":{"rendered":"<h2 class=\"article-summary\">Ch\u00fang ta \u0111ang th\u1ef1c hi\u1ec7n \u201cTh\u00edch \u1ee9ng an to\u00e0n, linh ho\u1ea1t, ki\u1ec3m so\u00e1t hi\u1ec7u qu\u1ea3 d\u1ecbch COVID-19\u201d, cu\u1ed9c s\u1ed1ng \u0111\u00e3 v\u00e0 \u0111ang d\u1ea7n tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng. Tuy nhi\u00ean, c\u0169ng kh\u00f4ng v\u00ec th\u1ebf m\u00e0 ch\u1ee7 quan, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ed1i v\u1edbi nh\u1eefng ca b\u1ec7nh COVID-19 n\u1eb7ng.<\/h2>\n<div class=\"article-body-text\">\n<p>Trong \u0111\u00f3, b\u00e3o Cytokine \u0111\u01b0\u1ee3c nh\u1eafc \u0111\u1ebfn nhi\u1ec1u b\u1edfi \u0111\u00e2y \u0111\u01b0\u1ee3c coi l\u00e0 ngu\u1ed3n g\u1ed1c c\u1ee7a t\u1ea5t c\u1ea3 trong COVID-19. N\u00f3i l\u00e0 ngu\u1ed3n g\u1ed1c l\u00e0 t\u1ea5t c\u1ea3 nh\u01b0ng n\u00f3 l\u1ea1i kh\u00f4ng ph\u1ea3i l\u00e0 t\u1ea5t c\u1ea3. V\u00ec sao l\u1ea1i v\u1eady?<\/p>\n<p>B\u00e0i vi\u1ebft c\u1ee7a BS. Nguy\u1ec5n Trung C\u1ea5p &#8211; Ph\u00f3 Gi\u00e1m \u0111\u1ed1c BV B\u1ec7nh Nhi\u1ec7t \u0111\u1edbi Trung \u01b0\u01a1ng, ng\u01b0\u1eddi tr\u1ef1c ti\u1ebfp tham gia \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u1ee9u s\u1ed1ng nhi\u1ec1u ca b\u1ec7nh COVID-19 nguy k\u1ecbch s\u1ebd gi\u00fap c\u00e1c y b\u00e1c s\u0129 c\u00f3 th\u00eam m\u1ed9t g\u00f3c nh\u00ecn trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n COVID-19.<\/p>\n<p>Khi t\u01b0 v\u1ea5n \u0111i\u1ec1u tr\u1ecb cho c\u00e1c \u0111\u1ed3ng nghi\u1ec7p, t\u00f4i th\u1ea5y m\u1ecdi ng\u01b0\u1eddi th\u01b0\u1eddng b\u0103n kho\u0103n: Kh\u00f4ng c\u00f3 l\u1ecdc m\u00e1u h\u1ea5p ph\u1ee5 cytokine, kh\u00f4ng c\u00f3 kh\u00e1ng th\u1ec3 kh\u00e1ng IL6 n\u00ean kh\u00f4ng \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c BN n\u1eb7ng.<\/p>\n<p>T\u00f4i \u0111\u00e3 c\u00f3 b\u00e0i vi\u1ebft v\u1ec1 b\u00e3o cytokine. N\u00f3 h\u1ebft s\u1ee9c r\u1ed1i v\u00e0 m\u00f9 m\u1edd, ch\u1ec9 &#8220;\u0111o\u00e1n&#8221; \u0111\u01b0\u1ee3c qua thang \u0111i\u1ec3m Cytokine score v\u00e0 c\u0169ng ch\u1ec9 \u0111o\u00e1n \u0111\u00fang \u0111\u01b0\u1ee3c 70-80%. Trong khi c\u00e1i m\u00e0 khi\u1ebfn b\u1ec7nh nh\u00e2n ch\u1ebft l\u1ea1i r\u1ea5t c\u1ee5 th\u1ec3 SUY H\u00d4 H\u1ea4P.<\/p>\n<p>V\u1eady \u0111i\u1ec1u g\u00ec li\u00ean quan \u0111\u1ebfn suy h\u00f4 h\u1ea5p \u1edf b\u1ec7nh nh\u00e2n COVID-19.<\/p>\n<p>SARS-CoV-2 t\u1ea5n c\u00f4ng v\u00e0o ph\u1ebf b\u00e0o type2 ph\u1ebf nang v\u00e0 n\u1ed9i m\u1ea1c mao m\u1ea1ch ph\u1ed5i qua receptor ACE2. H\u1eadu qu\u1ea3 \u0111\u1ea7u ti\u00ean l\u00e0m gi\u1ea3m ho\u1ea1t t\u00ednh ACE2 \u1edf nh\u1eefng v\u00f9ng t\u1ed5n th\u01b0\u01a1ng, d\u1eabn \u0111\u1ebfn t\u00ea li\u1ec7t kh\u1ea3 n\u0103ng chuy\u1ec3n \u0111\u1ed5i Angiotensin 2 th\u00e0nh Angiotensin 1-7 g\u00e2y co m\u1ea1ch t\u1ea1i ch\u1ed7. N\u1ebfu v\u00f9ng t\u1ed5n th\u01b0\u01a1ng r\u1ed9ng s\u1ebd c\u00f3 t\u00ecnh tr\u1ea1ng co c\u00e1c mao m\u1ea1ch ph\u1ed5i d\u1eabn \u0111\u1ebfn t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 m\u1edf c\u00e1c \u0111\u01b0\u1eddng n\u1ed1i t\u1eaft (bypass) d\u1eabn \u0111\u1ebfn gi\u1ea3m t\u1ef7 l\u1ec7 m\u00e1u \u0111\u01b0\u1ee3c b\u00e3o h\u00f2a oxy v\u00e0 x\u00e9t nghi\u1ec7m BNP, pro BNP t\u0103ng.<\/p>\n<p>H\u1eadu qu\u1ea3 th\u1ee9 2 l\u00e0 gi\u1ea3m s\u1ea3n xu\u1ea5t Surfactant t\u1ea1i ph\u1ebf nang do ph\u1ebf b\u00e0o type II s\u1ea3n xu\u1ea5t ra ch\u1ea5t n\u00e0y. N\u00f3 d\u1eabn \u0111\u1ebfn s\u1ef1 x\u1eb9p ph\u1ebf nang v\u00e0 h\u00ecnh th\u00e0nh m\u00e0ng hyaline trong ph\u1ebf nang g\u00e2y t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng ph\u1ebf nang lan t\u1ecfa (DAD) l\u00e0m gi\u1ea3m trao \u0111\u1ed5i oxy qua m\u00e0ng ph\u1ebf nang mao m\u1ea1ch g\u00e2y gi\u1ea3m oxy h\u00f3a m\u00e1u.<\/p>\n<p>H\u1eadu qu\u1ea3 th\u1ee9 3 l\u00e0 t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng mao m\u1ea1ch ph\u1ed5i v\u00e0 b\u00e3o cytokine d\u1eabn \u0111\u1ebfn ho\u1ea1t h\u00f3a qu\u00e1 tr\u00ecnh \u0111\u00f4ng m\u00e1u t\u1ea1i ph\u1ed5i (PIC) (PIC c\u00f3 v\u1ebb ch\u1ee7 y\u1ebfu theo con \u0111\u01b0\u1eddng ngo\u1ea1i sinh n\u00ean c\u00f3 v\u1ebb nh\u1eefng thu\u1ed1c h\u1ecd warfarin hay \u1ee9c ch\u1ebf ti\u1ec3u c\u1ea7u \u00edt hi\u1ec7u qu\u1ea3, m\u00e0 ch\u1ec9 c\u00f3 h\u1ecd heparin c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong).<\/p>\n<p>\u0110\u00f4ng m\u00e1u mao m\u1ea1ch ph\u1ed5i d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n trao \u0111\u1ed5i oxy v\u00e0 g\u00f3p ph\u1ea7n l\u00e0m t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 t\u0103ng gi\u00e1 tr\u1ecb XN BNP hay pro BNP. Qu\u00e1 tr\u00ecnh n\u00e0y n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t s\u1ebd d\u1eabn \u0111\u1ebfn t\u0103ng \u0111\u00f4ng lan t\u1ecfa v\u00e0 huy\u1ebft kh\u1ed1i nhi\u1ec1u v\u1ecb tr\u00ed kh\u00e1c trong c\u01a1 th\u1ec3. Nh\u1eadn bi\u1ebft s\u1edbm n\u00f3 b\u1eb1ng c\u00e1c x\u00e9t nghi\u1ec7m monomer, FDP ho\u1eb7c mu\u1ed9n h\u01a1n b\u1eb1ng gi\u00e1 tr\u1ecb D-dimer t\u0103ng.<\/p>\n<p>V\u1edbi 3 h\u1eadu qu\u1ea3 tr\u00ean th\u00ec b\u1ec7nh nh\u00e2n s\u1ebd c\u00f3 t\u00ecnh tr\u1ea1ng gi\u1ea3m oxy h\u00f3a m\u00e1u, nh\u01b0ng c\u01a1 h\u1ecdc ph\u1ed5i c\u00f2n \u00edt b\u1ecb \u1ea3nh h\u01b0\u1edfng, \u0111\u1ed9 gi\u00e3n n\u1edf ph\u1ed5i c\u00f2n t\u1ed1t v\u00e0 n\u00f3 t\u01b0\u01a1ng \u1ee9ng v\u1edbi type L trong ph\u00e2n lo\u1ea1i c\u1ee7a Gattinoni. V\u00e0 th\u1edf m\u00e1y \u1edf giai \u0111o\u1ea1n n\u00e0y c\u00f3 th\u1ec3 v\u1eabn ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c v\u1edbi th\u1edf \u00f4 xy n\u1ed3ng \u0111\u1ed9 cao (HFNC), ho\u1eb7c th\u1edf m\u00e1y ch\u01b0a c\u1ea7n PEEP cao v\u00e0 Vt th\u1ea5p nghi\u00eam ng\u1eb7t.<\/p>\n<p>N\u1ebfu mu\u1ed9n h\u01a1n h\u1eadu qu\u1ea3 th\u1ee9 4 s\u1ebd x\u1ea3y ra: T\u00ecnh tr\u1ea1ng DAT v\u00e0 PIC v\u00e0 b\u00e3o cytokine t\u1ea1i ch\u1ed7 s\u1ebd d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng tho\u00e1t d\u1ecbch v\u00e0 x\u00e2m nh\u1eadp t\u1ebf b\u00e0o vi\u00eam v\u00e0o kho\u1ea3ng k\u1ebd, v\u00e0 ph\u1ebf nang, t\u1ee9c l\u00e0 t\u1ed5n th\u01b0\u01a1ng ARDS \u0111i\u1ec3n h\u00ecnh. Khi \u0111\u00f3 \u0111\u1ed3ng th\u1eddi v\u1edbi t\u00ecnh tr\u1ea1ng oxy m\u00e1u gi\u1ea3m c\u00f2n th\u00eam t\u00ecnh tr\u1ea1ng ph\u1ed5i &#8220;c\u1ee9ng&#8221; h\u01a1n n\u00ean \u0111\u1ed9 c\u0103ng gi\u00e3n ph\u1ed5i gi\u1ea3m, c\u00e1c ph\u1ebf nang b\u1ecb l\u1ea5p \u0111\u1ea7y ho\u1eb7c \u0111\u00f3ng l\u1ea1i d\u1eabn \u0111\u1ebfn s\u1ee9c ch\u1ee9a c\u1ee7a ph\u1ed5i gi\u1ea3m. Do v\u1eady c\u1ea7n th\u1edf m\u00e1y v\u1edbi VT th\u1ea5p v\u00e0 PEEP cao h\u01a1n. Giai \u0111o\u1ea1n n\u00e0y t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi type H trong ph\u00e2n lo\u1ea1i c\u1ee7a Gattinoni.<\/p>\n<p>V\u1ec1 \u0111i\u1ec1u tr\u1ecb: Giai \u0111o\u1ea1n s\u1edbm \u0111\u1ec3 ng\u0103n ch\u1eb7n SARS-CoV-2 nh\u00e2n l\u00ean l\u00e0 vai tr\u00f2 c\u1ee7a c\u00e1c thu\u1ed1c kh\u00e1ng virus v\u00e0 kh\u00e1ng th\u1ec3 trung h\u00f2a virus, corticoid trong giai \u0111o\u1ea1n n\u00e0y c\u00f3 th\u1ec3 g\u00e2y h\u1ea1i. Tuy nhi\u00ean khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng DAD x\u1ea3y ra th\u00ec corticoid l\u1ea1i c\u00f3 vai tr\u00f2 c\u1ea3i thi\u1ec7n di\u1ec5n bi\u1ebfn v\u00e0 ti\u00ean l\u01b0\u1ee3ng. Qu\u00e1 tr\u00ecnh PIC c\u1ea7n \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t s\u1edbm b\u1eb1ng heparin \u0111\u1ec3 ng\u0103n ch\u1eb7n t\u00ecnh tr\u1ea1ng \u0111\u00f4ng m\u00e1u lan t\u1ecfa t\u1ea1i ph\u1ed5i v\u00e0 to\u00e0n th\u00e2n. Do \u0111\u00f3 LMWH li\u1ec1u \u0111i\u1ec1u tr\u1ecb c\u00f3 v\u1ebb \u01b0u th\u1ebf h\u01a1n li\u1ec1u d\u1ef1 ph\u00f2ng \u1edf nh\u1eefng BN c\u00f3 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i ti\u1ebfn tri\u1ec3n nhanh v\u00e0 m\u1edbi suy h\u00f4 h\u1ea5p \u1edf m\u1ee9c \u0111\u1ed9 th\u1edf oxy mask v\u00e0 HFNC\/NIV, c\u00f2n khi BN sang giai \u0111o\u1ea1n ph\u1ea3i th\u1edf m\u00e1y r\u1ed3i th\u00ec li\u1ec1u \u0111i\u1ec1u tr\u1ecb kh\u00f4ng \u01b0u th\u1ebf h\u01a1n li\u1ec1u d\u1ef1 ph\u00f2ng v\u00e0 c\u00f3 th\u1ec3 \u0111i k\u00e8m nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5 ph\u1ee9c t\u1ea1p.<\/p>\n<p>M\u1ee9c \u0111\u1ed9 \u0111\u00f3ng g\u00f3p c\u1ee7a t\u1eebng c\u01a1 ch\u1ebf t\u1ed5n th\u01b0\u01a1ng v\u00e0o t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p c\u1ee7a m\u1ed7i b\u1ec7nh nh\u00e2n r\u1ea5t kh\u00e1c nhau t\u00f9y thu\u1ed9c di\u1ec7n t\u1ed5n th\u01b0\u01a1ng, c\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p c\u1ee7a th\u1ea7y thu\u1ed1c. V\u00e0 s\u1ef1 chuy\u1ec3n \u0111\u1ed5i c\u00e1c giai \u0111o\u1ea1n c\u1ee7a m\u1ed7i t\u1ed5n th\u01b0\u01a1ng c\u0169ng kh\u00e1 nhanh ch\u00f3ng. Do v\u1eady, th\u1ea7y thu\u1ed1c c\u1ea7n \u0111\u00e1nh gi\u00e1 c\u1ee5 th\u1ec3 v\u00e0 li\u00ean t\u1ee5c di\u1ec5n bi\u1ebfn c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec3 ch\u1ec9 \u0111\u1ecbnh corticoid v\u00e0 ch\u1ed1ng \u0111\u00f4ng ph\u00f9 h\u1ee3p v\u00e0 \u0111\u00fang th\u1eddi \u0111i\u1ec3m, \u0111i\u1ec1u ch\u1ec9nh h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p ph\u00f9 h\u1ee3p v\u1edbi di\u1ec5n bi\u1ebfn suy h\u00f4 h\u00f4 h\u1ea5p v\u00e0 c\u01a1 h\u1ecdc ph\u1ed5i c\u1ee7a b\u1ec7nh nh\u00e2n. L\u1ecdc m\u00e1u hay \u1ee9c ch\u1ebf IL 6 kh\u00f4ng ph\u1ea3i bi\u1ec7n ph\u00e1p &#8220;cao c\u1ea5p&#8221; h\u01a1n nh\u1eefng bi\u1ec7n ph\u00e1p kh\u00e1c, ch\u01b0a k\u1ec3 hai bi\u1ec7n ph\u00e1p n\u00e0y \u1edf nh\u1eefng n\u01a1i kh\u00f4ng \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1ee3c ph\u00f2ng ch\u1ed1ng nhi\u1ec5m khu\u1ea9n t\u1ed1t c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n g\u00e2y nguy hi\u1ec3m cho b\u1ec7nh nh\u00e2n nhi\u1ec1u h\u01a1n nh\u1eefng \u00edch l\u1ee3i m\u00e0 n\u00f3 mang l\u1ea1i.<\/p>\n<p><strong>BS Nguy\u1ec5n Trung C\u1ea5p<\/strong><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Ch\u00fang ta \u0111ang th\u1ef1c hi\u1ec7n \u201cTh\u00edch \u1ee9ng an to\u00e0n, linh ho\u1ea1t, ki\u1ec3m so\u00e1t hi\u1ec7u qu\u1ea3 d\u1ecbch COVID-19\u201d, cu\u1ed9c s\u1ed1ng \u0111\u00e3 v\u00e0 \u0111ang d\u1ea7n tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng. Tuy nhi\u00ean, c\u0169ng kh\u00f4ng v\u00ec th\u1ebf m\u00e0 ch\u1ee7 quan, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ed1i v\u1edbi nh\u1eefng ca b\u1ec7nh COVID-19 n\u1eb7ng. Trong \u0111\u00f3, b\u00e3o Cytokine \u0111\u01b0\u1ee3c nh\u1eafc \u0111\u1ebfn nhi\u1ec1u b\u1edfi [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":12442,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"limit_modified_date":"","last_modified_date":"","footnotes":""},"categories":[241,235],"tags":[],"class_list":["post-12761","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cap-nhat-tin-covid","category-phong-chong-covid-19"],"_links":{"self":[{"href":"https:\/\/cdcangiang.vn\/index.php\/wp-json\/wp\/v2\/posts\/12761","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cdcangiang.vn\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cdcangiang.vn\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cdcangiang.vn\/index.php\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/cdcangiang.vn\/index.php\/wp-json\/wp\/v2\/comments?post=12761"}],"version-history":[{"count":0,"href":"https:\/\/cdcangiang.vn\/index.php\/wp-json\/wp\/v2\/posts\/12761\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cdcangiang.vn\/index.php\/wp-json\/wp\/v2\/media\/12442"}],"wp:attachment":[{"href":"https:\/\/cdcangiang.vn\/index.php\/wp-json\/wp\/v2\/media?parent=12761"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cdcangiang.vn\/index.php\/wp-json\/wp\/v2\/categories?post=12761"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cdcangiang.vn\/index.php\/wp-json\/wp\/v2\/tags?post=12761"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}