{"id":147404,"date":"2020-02-20T08:29:56","date_gmt":"2020-02-20T08:29:56","guid":{"rendered":"https:\/\/labinsights.com\/acf_article\/chan-doan-nhiem-trung-huyet-som-bang-cach-khai-thac-cac-gia-tri-tai-diem-cham-soc-poc-lactate\/"},"modified":"2026-01-27T09:55:05","modified_gmt":"2026-01-27T09:55:05","slug":"delivering-early-sepsis-diagnosis-by-harnessing-lactate-point-of-care-poc-values","status":"publish","type":"acf_article","link":"https:\/\/labinsights.com\/vi\/disease-area\/sepsis\/delivering-early-sepsis-diagnosis-by-harnessing-lactate-point-of-care-poc-values\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m tr\u00f9ng huy\u1ebft s\u1edbm b\u1eb1ng c\u00e1ch khai th\u00e1c c\u00e1c gi\u00e1 tr\u1ecb t\u1ea1i \u0111i\u1ec3m ch\u0103m s\u00f3c (POC) lactate"},"content":{"rendered":"

Nhi\u1ec5m tr\u00f9ng huy\u1ebft l\u00e0 m\u1ed9t k\u1ebb gi\u1ebft ng\u01b0\u1eddi to\u00e0n c\u1ea7u. Kho\u1ea3ng 27 tri\u1ec7u ng\u01b0\u1eddi tr\u00ean th\u1ebf gi\u1edbi b\u1ecb nhi\u1ec5m tr\u00f9ng huy\u1ebft m\u1ed7i n\u0103m v\u00e0 kho\u1ea3ng 8 tri\u1ec7u ng\u01b0\u1eddi ch\u1ebft v\u00ec c\u0103n b\u1ec7nh n\u00e0y, theo m\u1ed9t b\u00e0i vi\u1ebft v\u00e0o\u00a0th\u00e1ng 11 n\u0103m 2018 tr\u00ean The Lancet [1].\u00a0C\u00f2n l\u1ea1i 19 tri\u1ec7u ng\u01b0\u1eddi s\u1ed1ng v\u1edbi h\u1eadu qu\u1ea3 l\u00e2u d\u00e0i c\u1ee7a c\u0103n b\u1ec7nh n\u00e0y. Ch\u1ec9 t\u00ednh ri\u00eang \u1edf Th\u00e1i Lan, c\u00f3 kho\u1ea3ng 175.000 tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng huy\u1ebft m\u1ed7i n\u0103m v\u00e0 kho\u1ea3ng 45.000 tr\u01b0\u1eddng h\u1ee3p t\u1eed vong. T\u1ef7 l\u1ec7 t\u1eed vong n\u00e0y cao h\u01a1n t\u1ef7 l\u1ec7 t\u1eed vong do k\u1ebft h\u1ee3p c\u1ee7a nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p v\u00e0 \u0111\u1ed9t qu\u1ef5. Nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p t\u1eed vong c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ng\u0103n ng\u1eeba b\u1eb1ng ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 ch\u1ea9n \u0111o\u00e1n. Thai Ministry of Public Health \u0111\u00e3 cam k\u1ebft trong K\u1ebf ho\u1ea1ch chi\u1ebfn l\u01b0\u1ee3c n\u0103m 2019 v\u1ec1 vi\u1ec7c gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong li\u00ean quan \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng huy\u1ebft xu\u1ed1ng d\u01b0\u1edbi 22% v\u00e0o n\u0103m 2022, v\u1edbi m\u1ee5c ti\u00eau t\u1ea1m th\u1eddi d\u01b0\u1edbi 30% v\u00e0o n\u0103m 2018. Tuy nhi\u00ean, t\u1ef7 l\u1ec7 hi\u1ec7n t\u1ea1i v\u1eabn cao h\u01a1n m\u1ee5c ti\u00eau t\u1ea1m th\u1eddi, trong \u0111\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong do nhi\u1ec5m tr\u00f9ng huy\u1ebft m\u1eafc ph\u1ea3i trong c\u1ed9ng \u0111\u1ed3ng nghi\u00eam tr\u1ecdng dao \u0111\u1ed9ng kho\u1ea3ng 32%. \u0110\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau c\u1ee7a B\u1ed9 v\u00e0 c\u1ea3i thi\u1ec7n ho\u1ea1t \u0111\u1ed9ng ch\u0103m s\u00f3c cho b\u1ec7nh nh\u00e2n, b\u1ec7nh vi\u1ec7n ph\u1ea3i th\u00fac \u0111\u1ea9y c\u00e1c th\u00f4ng s\u1ed1 ch\u1ea9n \u0111o\u00e1n cho ph\u00e9p c\u00e1c h\u1ecdc vi\u00ean \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u00e0 s\u1edbm v\u1ec1 nhi\u1ec5m tr\u00f9ng huy\u1ebft v\u00e0 s\u1ed1c nhi\u1ec5m tr\u00f9ng. Xem x\u00e9t c\u00e1c h\u01b0\u1edbng d\u1eabn hi\u1ec7n c\u00f3, Thai Society for Critical Care Medicine khuy\u1ebfn ngh\u1ecb r\u1eb1ng hai th\u00f4ng s\u1ed1 sau \u0111\u00e2y \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o nh\u01b0 s\u00e0ng l\u1ecdc s\u1edbm nhi\u1ec5m tr\u00f9ng huy\u1ebft: (a) t\u00ecm hi\u1ec3u m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng (SOS) l\u00e0 b\u1ed1n ho\u1eb7c nhi\u1ec1u h\u01a1n b\u1ed1n; v\u00e0 (b) n\u1ed3ng \u0111\u1ed9 lactate l\u00e0 \u22652 mmol\/L. D\u1ef1a tr\u00ean nh\u1eefng khuy\u1ebfn c\u00e1o n\u00e0y, \u0111\u1ed9i ng\u0169 ch\u0103m s\u00f3c nhi\u1ec5m tr\u00f9ng huy\u1ebft t\u1ea1i B\u1ec7nh vi\u1ec7n Phitsanulok \u0111\u00e3 l\u1eadp m\u1ed9t \u0111\u1ec1 c\u01b0\u01a1ng m\u1edbi ph\u00e2n t\u1ea7ng b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc d\u1ef1a tr\u00ean m\u1ee9c lactate trong m\u00e1u v\u00e0 sau \u0111\u00f3 l\u00e0 \u0111i\u1ec3m SOS c\u1ee7a h\u1ecd. B\u1ea5t k\u1ef3 b\u1ec7nh nh\u00e2n n\u00e0o c\u00f3 s\u1ed1 \u0111i\u1ec3m SOS tr\u00ean b\u1ed1n \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 nguy c\u01a1 nhi\u1ec5m tr\u00f9ng huy\u1ebft cao. <\/p>\n

\"C\u00e1c<\/p>\n

Nh\u01b0 c\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng n\u1ed3ng \u0111\u1ed9 lactate c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n ch\u00ednh x\u00e1c trong m\u00e1u t\u0129nh m\u1ea1ch, \u0111\u1ed9ng m\u1ea1ch v\u00e0 mao m\u1ea1ch [2],\u00a0ch\u00fang t\u00f4i quy\u1ebft \u0111\u1ecbnh k\u1ebft h\u1ee3p d\u1ecbch v\u1ee5 x\u00e9t nghi\u1ec7m t\u1ea1i \u0111i\u1ec3m ch\u0103m s\u00f3c (POC) \u0111\u1eb7t t\u1ea1i c\u00e1c b\u1ec7nh vi\u1ec7n c\u1ed9ng \u0111\u1ed3ng trong m\u1ea1ng l\u01b0\u1edbi c\u1ee7a ch\u00fang t\u00f4i. C\u00e1c thi\u1ebft b\u1ecb POC c\u1ea7m tay n\u00e0y tr\u1ea3 v\u1ec1 k\u1ebft qu\u1ea3 ch\u1ec9 trong m\u1ed9t ph\u00fat. \u0110i\u1ec1u n\u00e0y nhanh h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi c\u00e1c d\u1ecbch v\u1ee5 ph\u00f2ng x\u00e9t nghi\u1ec7m truy\u1ec1n th\u1ed1ng. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 ph\u00e1t hi\u1ec7n ra r\u1eb1ng c\u00e1c thi\u1ebft b\u1ecb POC n\u00e0y c\u00f3 th\u1ec3 \u00edt ch\u00ednh x\u00e1c h\u01a1n so v\u1edbi ph\u00e2n t\u00edch d\u1ef1a tr\u00ean ph\u00f2ng x\u00e9t nghi\u1ec7m truy\u1ec1n th\u1ed1ng [3]. Vi\u1ec7c theo d\u00f5i 13 b\u1ec7nh vi\u1ec7n s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb POC c\u1ee7a ch\u00fang t\u00f4i \u0111\u00e3 x\u00e1c \u0111\u1ecbnh r\u1eb1ng \u0111i\u1ec3m lactate trong m\u00e1u n\u1eb1m trong kho\u1ea3ng ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c v\u00e0 nh\u01b0 v\u1eady v\u1edbi c\u00e1c thi\u1ebft b\u1ecb n\u00e0y, c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c l\u1ee3i \u00edch c\u1ee7a ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m tr\u00f9ng huy\u1ebft nhanh h\u01a1n. Sau khi th\u1ef1c hi\u1ec7n quy tr\u00ecnh m\u1edbi \u1edf \u0111\u1ecba ph\u01b0\u01a1ng c\u1ee7a ch\u00fang t\u00f4i, t\u1ef7 l\u1ec7 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n nhi\u1ec5m tr\u00f9ng huy\u1ebft ch\u1ec9 tr\u00ean 27%, th\u1ea5p h\u01a1n \u0111\u00e1ng k\u1ec3 m\u1ee5c ti\u00eau t\u1ea1m th\u1eddi d\u01b0\u1edbi 30%. V\u1edbi m\u1ed9t lo\u1ea1t c\u00e1c quy tr\u00ecnh nh\u01b0 th\u1ebf n\u00e0y, ch\u00fang ta c\u00f3 th\u1ec3 tr\u00e1nh \u0111\u01b0\u1ee3c c\u00e1c ca t\u1eed vong kh\u00f4ng c\u1ea7n thi\u1ebft v\u00ec c\u0103n b\u1ec7nh n\u00e0y v\u00e0 h\u01b0\u1edbng t\u1edbi \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau qu\u1ed1c gia \u0111\u1ea7y tham v\u1ecdng l\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong d\u01b0\u1edbi 22% v\u00e0o n\u0103m 2022. Nhi\u1ec5m tr\u00f9ng huy\u1ebft c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb khi ch\u1ea9n \u0111o\u00e1n s\u1edbm. K\u1ebft h\u1ee3p kh\u1ea3 n\u0103ng x\u00e9t nghi\u1ec7m POC m\u1edbi nh\u1ea5t v\u00e0o quy tr\u00ecnh thu\u1ed1c trong ph\u00f2ng x\u00e9t nghi\u1ec7m c\u1ee7a ch\u00fang t\u00f4i gi\u00fap b\u1ec7nh nh\u00e2n c\u00f3 k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n v\u00e0 gi\u1ea3m g\u00e1nh n\u1eb7ng cho h\u1ec7 th\u1ed1ng ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe. T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/em> <\/p>\n

[1]<\/a> Gilbert, A,J. 2018. Sepsis care bundles: a work in progress. The Lancet<\/em>, 6(11), pp.821-823.<\/p>\n

[2]<\/a> Pattharanitima, P., et al., 2011. Correlation of arterial, central venous and capillary lactate levels in septic shock patients. Journal of the Medical Association of Thailand,\u00a0<\/i>94 supplementary 1, S175-180.<\/p>\n

[3] <\/a>Stoll, D., et al., 2018.\u00a0Capillary and venous lactate measurements with a handheld device compared to venous blood-gas analysis for emergency patients.\u00a0Scandinavian journal of trauma, resuscitation and emergency medicine,\u00a0<\/i>26(1), pp.47.<\/p>\n","protected":false},"excerpt":{"rendered":"

Nhi\u1ec5m tr\u00f9ng huy\u1ebft l\u00e0 m\u1ed9t k\u1ebb gi\u1ebft ng\u01b0\u1eddi to\u00e0n c\u1ea7u. Kho\u1ea3ng 27 tri\u1ec7u ng\u01b0\u1eddi tr\u00ean th\u1ebf gi\u1edbi b\u1ecb nhi\u1ec5m tr\u00f9ng huy\u1ebft m\u1ed7i n\u0103m v\u00e0 kho\u1ea3ng 8 tri\u1ec7u ng\u01b0\u1eddi ch\u1ebft v\u00ec c\u0103n b\u1ec7nh n\u00e0y, theo m\u1ed9t b\u00e0i vi\u1ebft v\u00e0o\u00a0th\u00e1ng 11 n\u0103m 2018 tr\u00ean The Lancet [1].\u00a0C\u00f2n l\u1ea1i 19 tri\u1ec7u ng\u01b0\u1eddi s\u1ed1ng v\u1edbi h\u1eadu qu\u1ea3 l\u00e2u d\u00e0i […]<\/p>\n","protected":false},"author":1,"featured_media":84066,"parent":0,"menu_order":0,"template":"","meta":{"_acf_changed":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center 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