{"id":2086,"date":"2023-07-11T14:11:08","date_gmt":"2023-07-11T07:11:08","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=2086"},"modified":"2023-07-31T18:33:03","modified_gmt":"2023-07-31T11:33:03","slug":"loet-ap-luc","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/loet-ap-luc\/","title":{"rendered":"Lo\u00e9t \u00e1p l\u1ef1c"},"content":{"rendered":"

PREAMBLE<\/strong><\/h2>\n

Lo\u00e9t \u00e1p l\u1ef1c l\u00e0 d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng ph\u00e1 h\u1ee7y da, m\u00f4 d\u01b0\u1edbi da t\u1ea1i v\u00f9ng t\u00ec \u0111\u00e8. T\u1ed5n th\u01b0\u01a1ng xu\u1ea5t hi\u1ec7n do vi\u1ec7c t\u00ec \u0111\u00e8 g\u00e2y thi\u1ebfu m\u00e1u nu\u00f4i, oxy, dinh d\u01b0\u1ee1ng l\u00e0m m\u00f4 caseation<\/a>.<\/p>\n

Lo\u00e9t \u00e1p l\u1ef1c th\u01b0\u1eddng g\u1eb7p \u1edf c\u00e1c b\u1ec7nh nh\u00e2n n\u1eb1m l\u00e2u t\u1ea1i gi\u01b0\u1eddng, c\u00e1c v\u1ecb tr\u00ed th\u01b0\u1eddng g\u1eb7p l\u00e0 c\u00f9ng c\u1ee5t, v\u00f9ng li\u00ean m\u1ea5u chuy\u1ec3n x\u01b0\u01a1ng \u0111\u00f9i, m\u1eaft c\u00e1 ch\u00e2n, g\u00f3t ch\u00e2n, v\u00f9ng x\u01b0\u01a1ng ch\u1ea9m.<\/p>\n

Tr\u00ean th\u1ebf gi\u1edbi, lo\u00e9t \u00e1p l\u1ef1c g\u00e2y gia t\u0103ng \u00e1p l\u1ef1c v\u1ec1 ch\u0103m s\u00f3c v\u00e0 chi ph\u00ed y t\u1ebf. S\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n ch\u1ebft do lo\u00e9t \u00e1p l\u1ef1c t\u0103ng m\u1ea1nh. Theo b\u00e1o c\u00e1o c\u1ee7a WHO<\/a>, \u01b0\u1edbc t\u00ednh c\u00f3 29.000 ca t\u1eed vong v\u00e0o n\u0103m 2013, so v\u1edbi 14.000 ca \u1edf n\u0103m 1990.<\/p>\n

SINH L\u00dd B\u1ec6NH<\/strong><\/h2>\n

C\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn vi\u1ec7c xu\u1ea5t hi\u1ec7n m\u1ed9t v\u1ebft lo\u00e9t, nh\u01b0ng nguy\u00ean nh\u00e2n ch\u00ednh v\u1eabn l\u00e0 qu\u00e1 tr\u00ecnh thi\u1ebfu m\u00e1u t\u1ea1i ch\u1ed7. M\u00f4 m\u1ec1m c\u00f3 th\u1ec3 ch\u1ecbu m\u1ed9t \u00e1p l\u1ef1c kho\u1ea3ng 30 \u2013 32 mmHg trong m\u1ed9t kho\u1ea3ng th\u1eddi gian ng\u1eafn. N\u1ebfu \u00e1p l\u1ef1c k\u00e9o d\u00e0i ho\u1eb7c l\u1edbn h\u01a1n s\u1ebd g\u00e2y t\u1eafc ngh\u1ebdn c\u00e1c vi m\u1ea1ch g\u00e2y thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, l\u00e0m m\u00f4 ch\u1ebft, ho\u1ea1i t\u1eed g\u00e2y n\u00ean lo\u00e9t.<\/p>\n

H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n b\u1ecb lo\u00e9t \u00e1p l\u1ef1c \u0111\u1ec1u c\u00f3 b\u1ec7nh l\u00fd v\u1ec1 th\u1ea7n kinh v\u00e0 ho\u1eb7c th\u1ec3 ch\u1ea5t khi\u1ebfn b\u1ec7nh nh\u00e2n ph\u1ea3i n\u1eb1m motionless<\/a> t\u1ea1i gi\u01b0\u1eddng k\u00e9o d\u00e0i. M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 kh\u00e1c l\u00e0m gia t\u0103ng nguy c\u01a1 g\u00e2y ra lo\u00e9t \u00e1p \u1ef1c nh\u01b0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/a>, b\u1ec7nh th\u1eadn m\u1ea1n, COPD, tu\u1ed5i tr\u00ean 60, dinh d\u01b0\u1ee1ng k\u00e9m,\u2026<\/p>\n

PH\u00c2N \u0110\u1ed8 LO\u00c9T \u00c1P L\u1ef0C<\/strong><\/h2>\n

Hi\u1ec7n nay c\u00f3 nhi\u1ec1u c\u00e1ch ph\u00e2n \u0111\u1ed9 cho lo\u00e9t \u00e1p l\u1ef1c. Tuy nhi\u00ean, h\u1ec7 th\u1ed1ng ph\u00e2n \u0111\u1ed9 EPUAP \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng r\u1ed9ng r\u00e3i nh\u1ea5t do t\u00ednh \u0111\u01a1n gi\u1ea3n, d\u1ec5 \u00e1p d\u1ee5ng. Lo\u00e9t \u00e1p l\u1ef1c \u0111\u01b0\u1ee3c ph\u00e2n l\u00e0m 4 \u0111\u1ed9 d\u1ef1a tr\u00ean \u0111\u1ed9 s\u00e2u c\u1ee7a t\u1ed5n th\u01b0\u01a1ng.<\/p>\n

+ \u0110\u1ed9 I: Lo\u00e9t x\u1ea3y ra \u1edf l\u1edbp th\u01b0\u1ee3ng b\u00ec, xu\u1ea5t hi\u1ec7n c\u00e1c n\u1ed1t thay \u0111\u1ed5i s\u1eafc t\u1ed1 da. V\u00f9ng da t\u1ed5n th\u01b0\u01a1ng g\u00e2y \u0111au ho\u1eb7c ng\u1ee9a<\/p>\n

+ \u0110\u1ed9 II: T\u1ed5n th\u01b0\u01a1ng m\u1ea5t da, t\u1edbi l\u1edbp b\u00ec<\/p>\n

+ \u0110\u1ed9 III: T\u1ed5n th\u01b0\u01a1ng \u0111\u1ebfn m\u00f4 d\u01b0\u1edbi da, l\u1edbp c\u01a1 v\u00e0 x\u01b0\u01a1ng v\u1eabn c\u00f2n nguy\u00ean v\u1eb9n<\/p>\n

+ \u0110\u1ed9 IV: T\u1ed5n th\u01b0\u01a1ng \u0111\u1ebfn l\u1edbp g\u00e2n, c\u01a1, x\u01b0\u01a1ng, m\u00f4 \u0111\u1ec7m. V\u00f9ng t\u1ed5n th\u01b0\u01a1ng r\u1ed9ng. B\u1ec7nh nh\u00e2n lo\u00e9t \u00e1p l\u1ef1c \u0111\u1ed9 IV c\u00f3 nguy c\u01a1 nhi\u1ec5m tr\u00f9ng huy\u1ebft, \u0111e d\u1ecda t\u00ednh m\u1ea1ng cao.<\/p>\n

\"Picture1\"<\/p>\n

TREATMENT<\/strong><\/h2>\n

\u0110i\u1ec1u tr\u1ecb lo\u00e9t \u00e1p l\u1ef1c<\/a> \u0111\u00f2i h\u1ecfi nhi\u1ec1u ngu\u1ed3n l\u1ef1c. B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n khi \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u00f3 chi\u1ebfn l\u01b0\u1ee3c c\u1ee5 th\u1ec3. M\u1ee5c ti\u00eau l\u00e0 thay \u0111\u1ed5i c\u00e1c y\u1ebfu t\u1ed1 c\u0103n nguy\u00ean, lo\u1ea1i b\u1ecf nguy c\u01a1 lo\u00e9t t\u00ec \u0111\u00e8, ki\u1ec3m so\u00e1t t\u1ed1t c\u00e1c b\u1ec7nh \u0111i k\u00e8m.<\/p>\n

C\u1ea7n gi\u1ea3m th\u1eddi gian, \u00e1p l\u1ef1c t\u00ec \u0111\u00e8 l\u00ean v\u00f9ng lo\u00e9t nh\u1eb1m c\u1ea3i thi\u1ec7n m\u00e1u nu\u00f4i \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng. Dinh d\u01b0\u1ee1ng r\u1ea5t quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb. Qu\u00e1 tr\u00ecnh h\u1ed3i ph\u1ee5c v\u1ebft th\u01b0\u01a1ng \u0111\u00f2i h\u1ecfi nhu c\u1ea7u l\u1edbn v\u1ec1 protein, ion, vitamin,\u2026<\/p>\n

so do\u00a0<\/p>\n

Thay b\u0103ng v\u1ebft lo\u00e9t<\/strong><\/h3>\n

Qu\u1ea3n l\u00fd v\u1ebft th\u01b0\u01a1ng bao g\u1ed3m thay b\u0103ng, c\u1eaft l\u1ecdc gi\u00fap lo\u1ea1i b\u1ecf hi\u1ec7u qu\u1ea3 m\u00f4 ho\u1ea1i t\u1eed. Hi\u1ec7n nay c\u00f3 nhi\u1ec1u lo\u1ea1i g\u1ea1c, thu\u1ed1c h\u1ed7 tr\u1ee3 hi\u1ec7u qu\u1ea3 trong qu\u00e1 tr\u00ecnh thay b\u0103ng v\u1ebft th\u01b0\u01a1ng lo\u00e9t \u00e1p l\u1ef1c<\/p>\n

nh\u01b0: + G\u1ea1c c\u00f3 hydrocolloid: g\u1ea1c ch\u1ee9a m\u1ed9t gel \u0111\u1eb7c bi\u1ec7t gi\u00fap k\u00edch th\u00edch t\u1ea1o t\u1ebf b\u00e0o m\u1edbi, h\u1ea1n ch\u1ebf lan r\u1ed9ng m\u00f4 ho\u1ea1i t\u1eed ra xung quanh<\/p>\n

+ G\u1ea1c ch\u01b0a alginate: g\u1ea1c l\u00e0m t\u1eeb rong bi\u1ec3n, ch\u1ee9a nhi\u1ec1u natri, calci, gi\u00fap \u0111\u1ea9y nhanh qu\u00e1 tr\u00ecnh l\u00e0nh v\u1ebft th\u01b0\u01a1ng<\/p>\n

+ G\u1ea1c ch\u1ee9a nano b\u1ea1c: \u1ee9ng d\u1ee5ng t\u00ednh ch\u1ea5t kh\u00e1ng khu\u1ea9n c\u1ee7a b\u1ea1c, gi\u00fap ch\u1ed1ng l\u1ea1i s\u1ef1 t\u0103ng tr\u01b0\u1edfng c\u1ee7a vi khu\u1ea9n t\u1ea1i v\u1ebft lo\u00e9t<\/p>\n

+ C\u00e1c lo\u1ea1i kem v\u00e0 thu\u1ed1c m\u1ee1: ch\u1ee9a c\u00e1c ho\u1ea1t ch\u1ea5t k\u00edch th\u00edch l\u00e0nh v\u1ebft th\u01b0\u01a1ng, kh\u00e1ng khu\u1ea9n.<\/p>\n

Antibiotic<\/strong><\/h3>\n

Kh\u00e1ng sinh kh\u00f4ng n\u00ean ch\u1ec9 \u0111\u1ecbnh cho t\u1ea5t c\u1ea3 c\u00e1c lo\u00e9t \u00e1p l\u1ef1c. Kh\u00e1ng sinh \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p lo\u00e9t nhi\u1ec5m tr\u00f9ng, lan r\u1ed9ng, ho\u1ea1i t\u1eed m\u00f4 nhi\u1ec1u. C\u1ea7n l\u01b0u \u00fd, c\u1ea7n c\u1ea5y kh\u00e1ng sinh \u0111\u1ed3 \u0111\u1ec3 l\u1ef1a ch\u1ecdn kh\u00e1ng sinh ph\u00f9 h\u1ee3p. Ngo\u00e0i ra, kh\u00e1ng sinh n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi bi\u1ec7n ph\u00e1p thay b\u0103ng, c\u1eaft l\u1ecdc lo\u1ea1i b\u1ecf m\u00f4 ho\u1ea1i t\u1eed \u0111\u1ec3 t\u0103ng t\u00ednh hi\u1ec7u qu\u1ea3 ch\u0103m s\u00f3c v\u1ebft lo\u00e9t.<\/p>\n

Ph\u01b0\u01a1ng ph\u00e1p h\u00fat \u00e1p l\u1ef1c \u00e2m (VAC \u2013 vacuum assisted closure)<\/strong><\/h3>\n

Ph\u01b0\u01a1ng ph\u00e1p h\u1ed7 tr\u1ee3 c\u00f3 hi\u1ec7u qu\u1ea3 cao gi\u00fap t\u1ea1o \u00e1p su\u1ea5t \u00e2m quanh v\u1ebft lo\u00e9t, lo\u1ea1i b\u1ecf d\u1ecbch, m\u00f4 nhi\u1ec5m tr\u00f9ng. \u0110\u1ed3ng th\u1eddi gia t\u0103ng l\u01b0\u1ee3ng m\u00e1u nu\u00f4i \u0111\u1ebfn v\u00f9ng lo\u00e9t. Ngo\u00e0i ra, c\u00f2n gi\u1ea3m nhu c\u1ea7u thay b\u0103ng v\u1ebft th\u01b0\u01a1ng, ch\u0103m s\u00f3c \u0111i\u1ec1u d\u01b0\u1ee1ng.<\/p>\n

Surgery<\/strong><\/h3>\n

C\u00e1c v\u1ebft lo\u00e9t s\u1ea1ch nh\u1ecf \u0111\u01b0\u1ee3c l\u00e0m s\u1ea1ch v\u00e0 kh\u00e2u l\u1ea1i c\u00e1c m\u00e9p v\u1ebft lo\u00e9t v\u1edbi nhau.<\/p>\n

C\u00e1c tr\u01b0\u1eddng h\u1ee3p lo\u00e9t \u00e1p l\u1ef1c n\u1eb7ng, \u0111\u1ed9 III, IV ho\u1eb7c th\u1ea5t b\u1ea1i v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt b\u1eb1ng nhi\u1ec1u k\u1ef9 thu\u1eadt kh\u00e1c nhau.<\/p>\n

Gh\u00e9p da m\u1ecfng t\u1ef1 th\u00e2n: c\u00e1c v\u1ebft lo\u00e9t kh\u00f4ng l\u1ed9 m\u00f4 qu\u00ed, m\u00f4 h\u1ea1t m\u1ecdc t\u1ed1t \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh gh\u00e9p da m\u1ecfng t\u1ef1 th\u00e2n.<\/p>\n

V\u1ea1t t\u1ea1i ch\u1ed7: nhi\u1ec1u k\u1ef9 thu\u1eadt kh\u00e1c nhau \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 v\u00e0 mang l\u1ea1i nhi\u1ec1u k\u1ebft qu\u1ea3 t\u00edch c\u1ef1c nh\u01b0 tr\u01b0\u1ee3t skin flap<\/a>, xoay v\u1ea1t, v\u1ea1t Limberg.<\/p>\n

\"Hinh
H\u00ecnh 27.2<\/strong>. a:<\/strong> lo\u00e9t \u00e1p l\u1ef1c v\u00f9ng x\u01b0\u01a1ng ch\u1ea9m; b: <\/strong>v\u1ebft lo\u00e9t \u0111\u01b0\u1ee3c c\u1eaft l\u1ecdc \u0111\u1ec3 chu\u1ea9n b\u1ecb chuy\u1ec3n v\u1ea1t; c: <\/strong>che ph\u1ee7 b\u1eb1ng v\u1ea1t Limberg\u2019s; d:<\/strong> 2 tu\u1ea7n sau m\u1ed5 (Ngu\u1ed3n: Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: current understanding and newer modalities of treatment. Indian Journal of plastic surgery, 48(01), 004-016.)<\/em><\/figcaption><\/figure>
\"Hinh
H\u00ecnh 27.3<\/strong>. a:<\/strong> lo\u00e9t \u00e1p l\u1ef1c v\u00f9ng c\u00f9ng c\u1ee5t; b:<\/strong> v\u1ebft lo\u00e9t che ph\u1ee7 b\u1eb1ng v\u1ea1t Limberg\u2019s; c:<\/strong> 3 th\u00e1ng sau m\u1ed5; d:<\/strong> 2 n\u0103m sau m\u1ed5 (Ngu\u1ed3n: Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: current understanding and newer modalities of treatment. Indian Journal of plastic surgery, 48(01), 004-016.)<\/em><\/figcaption><\/figure><\/p>\n

V\u1ea1t l\u00e2n c\u1eadn: \u00e1p d\u1ee5ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p v\u1ebft lo\u00e9t l\u1edbn ho\u1eb7c v\u00f9ng \u0111\u1eb7c bi\u1ec7t, m\u00e0 kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n v\u1ea1t t\u1ea1i ch\u1ed7. V\u00ed d\u1ee5, lo\u00e9t l\u1edbn v\u00f9ng c\u00f9ng c\u1ee5t s\u1eed d\u1ee5ng v\u1ea1t c\u01a1 m\u00f4ng l\u1edbn che ph\u1ee7, v\u1ea1t V-Y c\u1ea3i ti\u1ebfn. \u1ede chi d\u01b0\u1edbi, v\u1ea1t \u201c\u0111\u1ea3o gi\u1eefa\u201d, v\u1ea1t x\u01b0\u01a1ng g\u00f3t trong, ngo\u00e0i, v\u1ea1t sural ng\u01b0\u1ee3c,\u2026<\/p>\n

\"Loet
H\u00ecnh 27.4.<\/strong> a:<\/strong> lo\u00e9t \u00e1p l\u1ef1c v\u00f9ng c\u00f9ng c\u1ee5t; b, c:<\/strong> s\u1eed d\u1ee5ng V-Y c\u1ea3i ti\u1ebfn che ph\u1ee7 v\u1ebft lo\u00e9t; d:<\/strong> 1 th\u00e1ng sau m\u1ed5; e:<\/strong> ho\u1ea1i t\u1eed m\u1ed9t ph\u1ea7n v\u1ea1t do b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c ch\u0103m s\u00f3c \u0111\u1ea7y \u0111\u1ee7; f:<\/strong> b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u0103m s\u00f3c c\u1ea3i thi\u1ec7n, v\u1ea1t sau 16 n\u0103m theo d\u00f5i (Ngu\u1ed3n: Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: current understanding and newer modalities of treatment. Indian Journal of plastic surgery, 48(01), 004-016.)<\/em><\/figcaption><\/figure>
\"27
H\u00ecnh 27.5<\/strong>. a:<\/strong> lo\u00e9t \u00e1p l\u1ef1c \u0111\u1ed9 IV v\u00f9ng c\u00f9ng c\u1ee5t; b:<\/strong> v\u1ebft lo\u00e9t \u0111\u01b0\u1ee3c che ph\u1ee7 b\u1eb1ng v\u1ea1t \u0111\u1ed9ng m\u1ea1ch m\u00f4ng tr\u00ean; c:<\/strong> 2 n\u0103m sau m\u1ed5 (Ngu\u1ed3n: Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: current understanding and newer modalities of treatment. Indian Journal of plastic surgery, 48(01), 004-016.)<\/em><\/figcaption><\/figure>
\"27.6\"
H\u00ecnh 27.6<\/strong>. a:<\/strong> lo\u00e9t \u00e1p l\u1ef1c v\u00f9ng g\u00f3t ch\u00e2n; b:<\/strong> v\u1ebft lo\u00e9t \u0111\u01b0\u1ee3c che ph\u1ee7 b\u1eb1ng v\u1ea1t \u201c\u0111\u1ea3o gi\u1eefa\u201d, gh\u00e9p da d\u00e0y t\u1ef1 th\u00e2n t\u1ea1i n\u01a1i cho; c:<\/strong> 1 tu\u1ea7n sau m\u1ed5; d:<\/strong> 3 th\u00e1ng sau m\u1ed5 (Ngu\u1ed3n: Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: current understanding and newer modalities of treatment. Indian Journal of plastic surgery, 48(01), 004-016.)<\/em><\/figcaption><\/figure>
\"27
H\u00ecnh 27.7. a: <\/strong>lo\u00e9t \u00e1p l\u1ef1c v\u00f9ng g\u00f3t ch\u00e2n; b:<\/strong> v\u1ebft lo\u00e9t \u0111\u01b0\u1ee3c che ph\u1ee7 b\u1eb1ng v\u1ea1t sural ng\u01b0\u1ee3c, gh\u00e9p da d\u00e0y t\u1ef1 th\u00e2n t\u1ea1i n\u01a1i cho; c:<\/strong> 36 th\u00e1ng sau m\u1ed5 (Ngu\u1ed3n: Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: current understanding and newer modalities of treatment. Indian Journal of plastic surgery, 48(01), 004-016.)<\/em><\/figcaption><\/figure><\/p>\n

V\u1ea1t t\u1ef1 do: \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t khi t\u1ea5t c\u1ea3 ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c th\u1ea5t b\u1ea1i.<\/p>\n

PH\u00d2NG TR\u00c1NH LO\u00c9T T\u00cc \u0110\u00c8<\/strong><\/h2>\n

B\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 lo\u00e9t t\u00ec \u0111\u00e8 c\u1ea7n ch\u0103m s\u00f3c c\u1ea9n th\u1eadn, theo d\u00f5i c\u00e1c v\u00f9ng ch\u1ecbu l\u1ef1c ho\u1eb7c \u0111\u00e3 c\u00f3 t\u1ed5n th\u01b0\u01a1ng da giai \u0111o\u1ea1n s\u1edbm. Gi\u1eef da b\u1ec7nh nh\u00e2n s\u1ea1ch, kh\u00f4. Lo\u1ea1i b\u1ecf c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y t\u1ed5n th\u01b0\u01a1ng da. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ec7m ch\u1ed1ng lo\u00e9t, c\u00e1c thi\u1ebft b\u1ecb kh\u00e1c \u0111\u1ec3 gi\u1ea3m \u00e1p l\u1ef1c l\u00ean c\u00e1c v\u00f9ng d\u1ec5 t\u1ed5n th\u01b0\u01a1ng c\u1ee7a c\u01a1 th\u1ec3. C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 di chuy\u1ec3n b\u1eb1ng c\u00e1ch ng\u1ed3i xe l\u0103n k\u00e9o d\u00e0i c\u0169ng c\u00f3 nguy c\u01a1 lo\u00e9t \u00e1p l\u1ef1c cao, \u0111\u1eb7c bi\u1ec7t \u1edf v\u00f9ng c\u00f9ng c\u1ee5t, li\u00ean m\u1ea5u chuy\u1ec3n.<\/p>\n

B\u00ean c\u1ea1nh \u0111\u00f3, b\u1ec7nh nh\u00e2n ho\u1eb7c ng\u01b0\u1eddi ch\u0103m s\u00f3c c\u1ea7n \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn v\u1ec1 nguy c\u01a1, c\u00e1ch ch\u0103m s\u00f3c ng\u01b0\u1eddi b\u1ec7nh, v\u00f9ng lo\u00e9t t\u00ec \u0111\u00e8. \u0110\u1ea3m b\u1ea3o dinh d\u01b0\u1ee1ng cho b\u1ec7nh nh\u00e2n nguy c\u01a1 cao ho\u1eb7c c\u00f3 lo\u00e9t t\u00ec \u0111\u00e8. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh truy\u1ec1n \u0111\u1ea1m, c\u00e1c ch\u1ea5t dinh d\u01b0\u1ee1ng khi kh\u00f4ng th\u1ec3 \u0103n u\u1ed1ng.<\/p>\n

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