{"id":18375,"date":"2023-04-11T22:53:57","date_gmt":"2023-04-11T15:53:57","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=18375"},"modified":"2023-04-14T13:52:03","modified_gmt":"2023-04-14T06:52:03","slug":"dieu-tri-xo-gan-mat-bu-tiep-can-toan-dien","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/11\/dieu-tri-xo-gan-mat-bu-tiep-can-toan-dien\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb x\u01a1 gan m\u1ea5t b\u00f9: ti\u1ebfp c\u1eadn to\u00e0n di\u1ec7n"},"content":{"rendered":"<p><strong>X\u01a1 gan l\u00e0 giai \u0111o\u1ea1n cu\u1ed1i c\u1ee7a nhi\u1ec1u b\u1ec7nh gan m\u1ea1n t\u00ednh kh\u00e1c nhau, c\u00f3 s\u1ef1 x\u01a1 h\u00f3a v\u00e0 bi\u1ebfn \u0111\u1ed5i c\u1ea5u tr\u00fac m\u00f4 b\u00ecnh th\u01b0\u1eddng th\u00e0nh c\u1ea5u tr\u00fac n\u1ed1t b\u1ea5t th\u01b0\u1eddng lan t\u1ecfa. X\u01a1 gan tr\u00ean l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia ra 2 th\u1ec3: c\u00f2n b\u00f9 v\u00e0 m\u1ea5t b\u00f9. X\u01a1 gan m\u1ea5t b\u00f9 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi c\u00f3 hi\u1ec7n di\u1ec7n c\u1ed5 tr\u01b0\u1edbng, ch\u1ea3y m\u00e1u b\u00fai gi\u00e3n t\u0129nh m\u1ea1ch (varix), b\u1ec7nh n\u00e3o gan ho\u1eb7c v\u00e0ng<\/strong>\u00a0<strong>da l\u00e0 bi\u1ec3u hi\u1ec7n c\u00e1c h\u1eadu qu\u1ea3 ch\u00ednh c\u1ee7a x\u01a1 gan l\u00e0 suy ch\u1ee9c n\u0103ng gan v\u00e0 t\u0103ng \u00e1p t\u0129nh m\u1ea1ch c\u1eeda.<\/strong><\/p>\n<h2><strong>1. \u0110\u00e1nh gi\u00e1 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb.<\/strong><\/h2>\n<p>&#8211; \u0110\u00e1nh gi\u00e1 tri\u1ec7u ch\u1ee9ng c\u1ee7a x\u01a1 gan: h\u1ed9i ch\u1ee9ng suy t\u1ebf b\u00e0o gan v\u00e0 h\u1ed9i ch\u1ee9ng t\u0103ng \u00e1p t\u0129nh m\u1ea1ch c\u1eeda.<\/p>\n<p>&#8211; \u0110\u00e1nh gi\u00e1 <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/roi-loan-tam-do-ruou-nhung-dieu-can-nho\/\">tri\u1ec7u ch\u1ee9ng c\u01a1 th\u1ec3 do r\u01b0\u1ee3u<\/a>.<\/p>\n<p>&#8211; \u0110\u00e1nh gi\u00e1 ch\u1ebf \u0111\u1ed9 \u0103n. H\u1ecfi v\u00e0 \u0111\u00e1nh gi\u00e1 v\u1ec1 h\u00e0m l\u01b0\u1ee3ng mu\u1ed1i, protein, ch\u1ea5t x\u01a1, t\u1ed5ng n\u0103ng l\u01b0\u1ee3ng.<\/p>\n<p>&#8211; \u0110\u00e1nh gi\u00e1 c\u00e1c tri\u1ec7u ch\u1ee9ng b\u1ec7nh n\u00e3o gan: r\u1ed1i lo\u1ea1n tri gi\u00e1c (ho\u1ea1t \u0111\u1ed9ng t\u00e2m th\u1ea7n ch\u1eadm ch\u1ea1p, l\u00fa l\u1eabn, ng\u1ee7 g\u00e0, hi\u1ec7n t\u01b0\u1ee3ng gi\u1eadt th\u1ecfng &#8211; asterixis). T\u00ecm v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t nh\u01b0:<\/p>\n<p>&#8211; Nhi\u1ec5m tr\u00f9ng huy\u1ebft: c\u1ea5y m\u00e1u, c\u1ea5y n\u01b0\u1edbc ti\u1ec3u, t\u00ecm tri\u1ec7u ch\u1ee9ng nhi\u1ec5m tr\u00f9ng huy\u1ebft theo ti\u00eau chu\u1ea9n SEPSIS-3:<\/p>\n<ul>\n<li>L\u00e0 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng (c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee7a c\u01a1 quan nhi\u1ec5m v\u00e0\/ho\u1eb7c c\u1ee7a h\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n) k\u00e8m theo b\u1eb1ng ch\u1ee9ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u t\u1ea1ng.<\/li>\n<li><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/hoi-chung-dap-ung-viem-toan-sirs-la-gi\/\">H\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n<\/a> (SIRS).<\/li>\n<li>Gi\u1ea3m t\u01b0\u1edbi m\u00e1u t\u1ea1ng: ti\u00eau chu\u1ea9n quick SOFA: r\u1ed1i lo\u1ea1n tri gi\u00e1c (GCS&lt;15), t\u1ea7n s\u1ed1 th\u1edf &gt;22 l\u1ea7n\/ph\u00fat, huy\u1ebft \u00e1p &lt;100 mmHg.<\/li>\n<li>Nhi\u1ec5m tr\u00f9ng x\u00e1c \u0111\u1ecbnh d\u1ef1a v\u00e0o c\u00e1c tri\u1ec7u ch\u1ee9ng khu tr\u00fa nh\u01b0 ho \u0111\u00e0m xanh, da n\u00f3ng \u0111\u1ecf, ti\u1ec3u l\u1eaft nh\u1eaft, ti\u1ec3u kh\u00f3,&#8230;v\u00e0 tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n nh\u01b0: s\u1ed1t, v\u00e3 m\u1ed3 h\u00f4i, \u1edbn l\u1ea1nh, m\u1ec7t m\u1ecfi,&#8230;<\/li>\n<\/ul>\n<p>&#8211; N\u1ebfu c\u00f3 b\u00e1ng: ch\u1ecdc d\u1ecbch, l\u00e0m x\u00e9t nghi\u1ec7m t\u1ebf b\u00e0o, protein v\u00e0 c\u1ea5y.<\/p>\n<p>&#8211; X quang ng\u1ef1c. T\u1ea7m so\u00e1t vi\u00eam ph\u1ed5i.<\/p>\n<p>&#8211; C\u00f4ng th\u1ee9c m\u00e1u, n\u1ed9i soi ti\u00eau h\u00f3a n\u1ebfu c\u00f3 tri\u1ec7u ch\u1ee9ng nghi ch\u1ea3y m\u00e1u \u0111\u01b0\u1eddng ti\u00eau h\u00f3a.<\/p>\n<p>&#8211;\u00a0 \u00a0Suy th\u1eadn: ure, creatinine m\u00e1u, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3.<\/p>\n<p>&#8211; T\u00e1o b\u00f3n. H\u1ecfi v\u1ec1 t\u00ednh ch\u1ea5t ph\u00e2n, m\u1ee9c \u0111\u1ed9, th\u1eddi gian kh\u1edfi ph\u00e1t, tri\u1ec7u ch\u1ee9ng k\u00e8m theo.<\/p>\n<p>&#8211; Thu\u1ed1c \u0111ang s\u1eed d\u1ee5ng (an th\u1ea7n, l\u1ee3i ti\u1ec3u li\u1ec1u cao).<\/p>\n<p><em><strong>1. 1. N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 suy th\u1eadn c\u1ea5p<\/strong><\/em>: \u0111\u00e1nh gi\u00e1 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 thay \u0111\u1ed5i \u0111\u01b0\u1ee3c nh\u01b0 thi\u1ebfu d\u1ecbch, do l\u1ee3i ti\u1ec3u, nhi\u1ec5m tr\u00f9ng huy\u1ebft, b\u1ec7nh th\u1eadn.<\/p>\n<p>&#8211; Si\u00eau \u00e2m \u0111\u00e1nh gi\u00e1 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ni\u1ec7u, t\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u. Protein ni\u1ec7u, protein m\u00e1u.<\/p>\n<p>&#8211; T\u00ecm d\u1ea5u m\u1ea5t n\u01b0\u1edbc: r\u1ed1i lo\u1ea1n tri gi\u00e1c, m\u1eaft tr\u0169ng, m\u00f4i kh\u00f4, u\u1ed1ng h\u00e1o h\u1ee9c, n\u1ebfp v\u00e9o da m\u1ea5t ch\u1eadm, m\u1ea1ch nhanh, huy\u1ebft \u00e1p h\u1ea1, CRT &gt;2s.<\/p>\n<p><em><strong>1.2. N\u1ebfu ng\u01b0\u1eddi b\u1ec7nh c\u00f3 c\u1ed5 tr\u01b0\u1edbng (b\u00e1ng).<\/strong><\/em><\/p>\n<p>&#8211; Xem x\u00e9t c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y c\u1ed5 tr\u01b0\u1edbng nh\u01b0 K, h\u1ed9i ch\u1ee9ng Budd-Chiari ho\u1eb7c suy tim.<\/p>\n<p>&#8211; Ch\u1ecdc d\u00f2 d\u1ecbch b\u00e1ng \u0111\u1ec3 x\u00e9t nghi\u1ec7m. L\u1ea5y 50mL l\u00e0m x\u00e9t nghi\u1ec7m vi sinh: t\u00ecm b\u1ea1ch c\u1ea7u, nu\u00f4i c\u1ea5y. Sinh h\u00f3a: protein v\u00e0 albumin. T\u1ebf b\u00e0o h\u1ecdc n\u1ebfu nghi b\u00e1ng li\u00ean quan K \u00e1c t\u00ednh, SAAG (serum-ascites albumin gradient) &lt;11.<\/p>\n<ul>\n<li>SAAG gi\u00fap ph\u00e2n bi\u1ec7t c\u1ed5 tr\u01b0\u1edbng do t\u0103ng \u00e1p c\u1eeda hay do nguy\u00ean nh\u00e2n kh\u00e1c.<\/li>\n<li>SAAG &gt; 11g\/L. G\u1ee3i \u00fd x\u01a1 gan, vi\u00eam gan r\u01b0\u1ee3u, b\u00e1ng do b\u1ec7nh tim, u di c\u0103n.<\/li>\n<li>SAAG &lt; 11g\/L. G\u1ee3i \u00fd K di c\u0103n ph\u00fac m\u1ea1c lan t\u1ecfa, lao m\u00e0ng b\u1ee5ng, do vi\u00eam t\u1ee5y, do h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0.<\/li>\n<\/ul>\n<h2><strong>2. Qu\u1ea3n l\u00fd to\u00e0n di\u1ec7n v\u00e0 c\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb cho x\u01a1 gan m\u1ea5t b\u00f9.<\/strong><\/h2>\n<h3><strong>2.1. Ch\u1ebf \u0111\u1ed9 \u0103n cho ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan m\u1ea5t b\u00f9.<\/strong><\/h3>\n<p>&#8211; M\u1ee5c ti\u00eau \u0111\u1ea1t ch\u1ebf \u0111\u1ed9 \u0103n gi\u00e0u protein, gi\u00e0u n\u0103ng l\u01b0\u1ee3ng.<\/p>\n<p>&#8211; Gi\u1ea3m l\u01b0\u1ee3ng protein t\u1eeb t\u1eeb n\u1ebfu c\u00f3 bi\u1ec3u hi\u1ec7n b\u1ec7nh l\u00fd n\u00e3o gan.<\/p>\n<p>&#8211; H\u1ea1n ch\u1ebf mu\u1ed1i n\u1ebfu c\u00f3 b\u00e1ng.<\/p>\n<p>&#8211; Cho vitamin K (Phytomenadione) 10mg ti\u00eam m\u1ea1ch ch\u1eadm 3 &#8211; 5 ph\u00fat. C\u00f3 th\u1ec3 l\u1eadp l\u1ea1i v\u00e0o ng\u00e0y 2 v\u00e0 ng\u00e0y 3.<\/p>\n<p>&#8211; N\u1ebfu nghi\u1ec7n r\u01b0\u1ee3u cho th\u00eam Pabrinex (ch\u1ee9a thiamin).<\/p>\n<p>\u2010 Ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3 b\u1ec7nh n\u00e3o Wernicke n\u1ebfu c\u00f3 tri\u1ec7u ch\u1ee9ng: l\u00fa l\u1eabn, gi\u1ea3m \u00fd th\u1ee9c, rung gi\u1eadt nh\u00e3n c\u1ea7u, li\u1ec7t v\u1eadn nh\u00e3n, th\u1ea5t \u0111i\u1ec1u, h\u1ea1 th\u00e2n nhi\u1ec7t, t\u1ee5t huy\u1ebft \u00e1p. X\u1eed tr\u00ed: ng\u00e0y 1 -2 (N1-2): Pabrinex 4 \u1ed1ng\u00a0 TTM 3 l\u1ea7n\/ng\u00e0y; th\u1eed Magnesium m\u00e1u v\u00e0 b\u00f9 Mg n\u1ebfu thi\u1ebfu. N3-N5: Pabrinex 2 \u1ed1ng TTM 3 l\u1ea7n\/ng\u00e0y. N6: chuy\u1ec3n \u0111\u01b0\u1eddng u\u1ed1ng thiamin 50mg 4 l\u1ea7n\/ng\u00e0y.<\/p>\n<h3><strong>2.2. X\u1eed tr\u00ed b\u1ec7nh n\u00e3o gan.<\/strong><\/h3>\n<p>&#8211; \u0110\u00e1nh gi\u00e1 c\u00e1c y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t (m\u1ee5c 1). N\u1ebfu c\u00f3 nghi ng\u1edd nhi\u1ec5m tr\u00f9ng huy\u1ebft, ch\u1ec9 \u0111\u1ecbnh kh\u00e1ng sinh. D\u00f9ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng.<\/p>\n<p>&#8211; Ng\u1eebng an th\u1ea7n.<\/p>\n<p>&#8211; Cho lactulose 20mL u\u1ed1ng 3 l\u1ea7n\/ng\u00e0y, t\u0103ng li\u1ec1u \u0111\u1ec3 b\u1ec7nh nh\u00e2n \u0111i ph\u00e2n s\u1ec7t 3 l\u1ea7n\/ng\u00e0y.<\/p>\n<h3><strong>2.3. X\u1eed tr\u00ed c\u1ed5 tr\u01b0\u1edbng \u1edf b\u1ec7nh nh\u00e2n x\u01a1 gan m\u1ea5t b\u00f9<\/strong>.<\/h3>\n<p>&#8211; Ch\u1ebf \u0111\u1ed9 \u0103n h\u1ea1n ch\u1ebf mu\u1ed1i.<\/p>\n<p>&#8211; L\u1ee3i ti\u1ec3u: kh\u1edfi \u0111\u1ea7u spironolacton 100 &#8211; 400mg\/ng\u00e0y. H\u1ed9i ch\u1ea9n chuy\u00ean gia n\u1ebfu k\u00e8m suy th\u1eadn, t\u0103ng kali, h\u1ea1 Na. T\u0103ng li\u1ec1u v\u00e0\/ho\u1eb7c th\u00eam furosemid theo ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 c\u00e2n n\u1eb7ng, m\u1ee5c ti\u00eau gi\u1ea3m kh\u00f4ng qu\u00e1 1kg\/ng\u00e0y.<\/p>\n<p>&#8211; N\u1ebfu c\u1ed5 tr\u01b0\u1edbng g\u00e2y suy h\u00f4 h\u1ea5p ho\u1eb7c kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb nh\u01b0 tr\u00ean, xem x\u00e9t ch\u1ecdc th\u00e1o d\u1ecbch b\u00e1ng. Khuy\u1ebfn c\u00e1o th\u00eam 100mL Albumin 20% cho m\u1ed7i 2.5L d\u1ecbch th\u00e1o. Sau ch\u1ecdc th\u00e1o n\u00ean cho l\u1ee3i ti\u1ec3u li\u1ec1u t\u1ed1i thi\u1ec3u \u0111\u1ec3 ng\u1eeba t\u00e1i l\u1eadp d\u1ecbch.<\/p>\n<p>&#8211; N\u1ebfu b\u1ea1ch c\u1ea7u d\u1ecbch b\u00e1ng &gt; 500\/mL ho\u1eb7c neutrophil &gt; 250\/mL, x\u1eed tr\u00ed nh\u01b0 vi\u00eam ph\u00fac m\u1ea1c nguy\u00ean ph\u00e1t:<\/p>\n<p>+ Kh\u00e1ng sinh ph\u00f9 h\u1ee3p.<\/p>\n<p>+ Human Albumin 20%, li\u1ec1u 1.5g\/kg TTM trong 6h, N1. N3 li\u1ec1u 1g\/kg truy\u1ec1n 3h.<\/p>\n<p>&#8211; \u0110i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng vi\u00eam ph\u00fac m\u1ea1c nguy\u00ean ph\u00e1t n\u1ebfu:<\/p>\n<p>+ B\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 1 \u0111\u1ee3t vi\u00eam ph\u00fac m\u1ea1c nguy\u00ean ph\u00e1t.<\/p>\n<p>+ Protein d\u1ecbch b\u00e1ng &lt; 10g\/L.<\/p>\n<p>+ D\u00f9ng cotrimoxazole 960mg u\u1ed1ng 1 l\u1ea7n\/ng\u00e0y (\u0111\u1ea7u tay) ho\u1eb7c ciprofloxacin 500mg u\u1ed1ng 1 vi\u00ean\/ng\u00e0y. Cotrimoxazole c\u00f3 th\u1ec3 g\u00e2y t\u0103ng Kali v\u00e0 gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n<h3><strong>2.4. X\u1eed tr\u00ed suy th\u1eadn c\u1ea5p.<\/strong><\/h3>\n<p>&#8211; \u0110\u1eb7t sonde ti\u1ec3u.<\/p>\n<p>&#8211; Ng\u1eebng l\u1ee3i ti\u1ec3u.<\/p>\n<p>&#8211; \u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng d\u1ecbch.<\/p>\n<p>&#8211; N\u1ebfu thi\u1ebfu d\u1ecbch truy\u1ec1n NaCl 0.9% 1 &#8211; 1.5L n\u1ebfu \u0111\u01b0\u1ee3c.<\/p>\n<p>&#8211; N\u1ebfu c\u00f3 b\u00e1ng ho\u1eb7c ph\u00f9 ngo\u1ea1i bi\u00ean cho:<\/p>\n<p>+ Human albumin 20% 100mL. N1 Li\u1ec1u 1g\/kg (2-5 chai). N2 &#8211; 16: 1 &#8211; 2 chai\/ng\u00e0y.<\/p>\n<p>+ Xem x\u00e9t terlipressin TMC kh\u1edfi \u0111\u1ea7u li\u1ec1u 0.5 &#8211; 2mg m\u1ed7i 4h. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh thi\u1ebfu m\u00e1u c\u01a1 tim, b\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i vi, lo\u1ea1n nh\u1ecbp tim.<\/p>\n<p>N\u1ebfu sau 24h, th\u1ec3 t\u00edch n\u01b0\u1edbc ti\u1ec3u kh\u00f4ng c\u1ea3i thi\u1ec7n, h\u1ed9i ch\u1ea9n v\u00e0 theo d\u00f5i \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch trung t\u00e2m.<\/p>\n<h3><strong>2.5. Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m tr\u00f9ng huy\u1ebft \u1edf b\u1ec7nh nh\u00e2n x\u01a1 gan m\u1ea5t b\u00f9.<\/strong><\/h3>\n<p>Chu\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o ti\u00eau chu\u1ea9n SEPSIS-3 v\u00e0 qSOFA.<\/p>\n<p>SEPSIS-3 d\u01b0\u01a1ng v\u00e0 qSOFA d\u01b0\u01a1ng: ti\u00ean l\u01b0\u1ee3ng n\u1eb7ng, chuy\u1ec3n khoa ICU.<\/p>\n<p>SEPSIS-3 d\u01b0\u01a1ng v\u00e0 qSOFA \u00e2m: theo d\u00f5i s\u00e1t SOFA.<\/p>\n<p>SEPSIS-3 \u00e2m v\u00e0 qSOFA \u00e2m: ti\u00ean l\u01b0\u1ee3ng t\u1ed1t.<\/p>\n<p>N\u1ebfu \u0111\u00e3 c\u00f3 SOFA l\u00fac v\u00e0o vi\u1ec7n: SEPSIS-3 d\u01b0\u01a1ng: chuy\u1ec3n khoa ICU. N\u1ebfu SEPSIS-3 \u00e2m, ti\u00ean l\u01b0\u1ee3ng t\u1ed1t.<\/p>\n<blockquote><p>Theo d\u00f5i: C\u00f4ng th\u1ee9c m\u00e1u, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, ure m\u00e1u, \u0111\u00f4ng c\u1ea7m m\u00e1u, ch\u1ee9c n\u0103ng gan, c\u00e2n n\u1eb7ng v\u00e0 tri\u1ec7u ch\u1ee9ng b\u1ec7nh n\u00e3o gan.<\/p>\n<p>&nbsp;<\/p>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/p>\n<p>Goldman-Cecil Medicine.<\/p>\n<p>Management of Decompensated Liver Disease<\/p>\n<p>EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis<\/p>\n<p>&nbsp;<\/p>\n<h1 class=\"noicon\"><\/h1>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p><\/blockquote>\n","protected":false},"excerpt":{"rendered":"<p>X\u01a1 gan l\u00e0 giai \u0111o\u1ea1n cu\u1ed1i c\u1ee7a nhi\u1ec1u b\u1ec7nh gan m\u1ea1n t\u00ednh kh\u00e1c nhau, c\u00f3 s\u1ef1 x\u01a1 h\u00f3a v\u00e0 bi\u1ebfn \u0111\u1ed5i c\u1ea5u tr\u00fac m\u00f4 b\u00ecnh th\u01b0\u1eddng th\u00e0nh c\u1ea5u tr\u00fac n\u1ed1t b\u1ea5t th\u01b0\u1eddng lan t\u1ecfa. X\u01a1 gan tr\u00ean l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia ra 2 th\u1ec3: c\u00f2n b\u00f9 v\u00e0 m\u1ea5t b\u00f9. X\u01a1 gan m\u1ea5t b\u00f9 [&hellip;]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>\u0110i\u1ec1u tr\u1ecb x\u01a1 gan m\u1ea5t b\u00f9: ti\u1ebfp c\u1eadn to\u00e0n di\u1ec7n - Vinmec<\/title>\n<meta name=\"description\" content=\"X\u01a1 gan m\u1ea5t b\u00f9 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi c\u00f3 hi\u1ec7n di\u1ec7n c\u1ed5 tr\u01b0\u1edbng, ch\u1ea3y m\u00e1u b\u00fai gi\u00e3n t\u0129nh m\u1ea1ch (varix), b\u1ec7nh n\u00e3o gan ho\u1eb7c v\u00e0ng\u00a0da\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u0110i\u1ec1u tr\u1ecb x\u01a1 gan m\u1ea5t b\u00f9: ti\u1ebfp c\u1eadn to\u00e0n di\u1ec7n - 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