{"id":18866,"date":"2023-04-12T19:30:15","date_gmt":"2023-04-12T12:30:15","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=18866"},"modified":"2023-04-19T12:22:31","modified_gmt":"2023-04-19T05:22:31","slug":"xuat-huyet-tieu-hoa-duoi-tieu-chay-tren-benh-nhan-sau-phau-thuat-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/xuat-huyet-tieu-hoa-duoi-tieu-chay-tren-benh-nhan-sau-phau-thuat-tim\/","title":{"rendered":"B\u1ec7nh ti\u00eau h\u00f3a tr\u00ean b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim"},"content":{"rendered":"<p><strong>B\u1ec7nh ti\u00eau h\u00f3a g\u1ed3m\u00a0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a d\u01b0\u1edbi, ti\u00eau ch\u1ea3y l\u00e0 hai v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim. T\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0 m\u1ea5t n\u01b0\u1edbc v\u00e0 ch\u1ea5t \u0111i\u1ec7n gi\u1ea3i, suy th\u1eadn v\u00e0 suy tim. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 c\u00e1c bi\u1ebfn ch\u1ee9ng.<\/strong><\/p>\n<h2><strong>1.Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a d\u01b0\u1edbi<\/strong><\/h2>\n<h3>1.1.Nguy\u00ean nh\u00e2n<\/h3>\n<ul>\n<li>Ch\u1ea3y m\u00e1u t\u1eeb c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u1ea1i tr\u00e0ng (polyp, u x\u01a1, b\u1ec7nh t\u00e1 tr\u00e0ng) c\u00f3 th\u1ec3 do ch\u1ea5t \u1ee9c ch\u1ebf \u0111\u00f4ng m\u00e1u<\/li>\n<li>Lo\u1ea1n s\u1ea3n m\u1ea1ch m\u00e1u \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. \u0110\u00e2y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 &#8220;H\u1ed9i ch\u1ee9ng Heyde&#8221; khi k\u1ebft h\u1ee3p v\u1edbi h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 k\u00e8m xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a d\u01b0\u1edbi v\u00e0 c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn b\u1ec7nh Von Willebrand. Ch\u1ea3y m\u00e1u th\u01b0\u1eddng c\u1ea3i thi\u1ec7n sau khi thay van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/li>\n<li>Vi\u00eam \u0111\u1ea1i tr\u00e0ng gi\u1ea3 m\u1ea1c do <em>Clostridioides difficile<\/em><\/li>\n<\/ul>\n<h3>1.2.Ch\u1ea9n\u00a0\u0111o\u00e1n:<\/h3>\n<p>Sau khi lo\u1ea1i tr\u1eeb ngu\u1ed3n ch\u1ea3y m\u00e1u \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a tr\u00ean, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng.<\/p>\n<h3>1.3.\u0110i\u1ec1u tr\u1ecb:<\/h3>\n<p>Bao g\u1ed3m vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh b\u1ea5t k\u1ef3 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u n\u00e0o v\u00e0 lo\u1ea1i b\u1ecf c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y ra:<\/p>\n<ul>\n<li>\u00a0Kh\u00e1ng sinh (vancomycin ho\u1eb7c fidaxomicin) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho vi\u00eam \u0111\u1ea1i tr\u00e0ng gi\u1ea3 m\u1ea1c, l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd \u0111\u01b0\u1eddng ru\u1ed9t g\u00e2y ra b\u1edfi vi khu\u1ea9n Clostridium difficile (C. difficile). \u0110\u00e2y l\u00e0 m\u1ed9t lo\u1ea1i vi khu\u1ea9n kh\u00e1 nguy hi\u1ec3m, c\u00f3 th\u1ec3 l\u00e0m suy y\u1ebfu h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch c\u1ee7a c\u01a1 th\u1ec3 v\u00e0 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0 ti\u00eau ch\u1ea3y, \u0111au b\u1ee5ng v\u00e0 s\u1ed1t. V\u00ec v\u1eady, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb vi\u00eam \u0111\u1ea1i tr\u00e0ng gi\u1ea3 m\u1ea1c l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 t\u0103ng c\u01b0\u1eddng s\u1ee9c kh\u1ecfe cho b\u1ec7nh nh\u00e2n.Vancomycin v\u00e0 fidaxomicin l\u00e0 hai lo\u1ea1i kh\u00e1ng sinh \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam \u0111\u1ea1i tr\u00e0ng gi\u1ea3 m\u1ea1c. C\u1ea3 hai lo\u1ea1i kh\u00e1ng sinh n\u00e0y \u0111\u1ec1u c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng khu\u1ea9n m\u1ea1nh m\u1ebd v\u00e0 th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng khi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c kh\u00f4ng hi\u1ec7u qu\u1ea3 ho\u1eb7c kh\u00f4ng th\u00edch h\u1ee3p.Vancomycin l\u00e0 m\u1ed9t kh\u00e1ng sinh \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n Gram d\u01b0\u01a1ng, bao g\u1ed3m C. difficile. Vancomycin ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf s\u1ef1 t\u1ed5ng h\u1ee3p v\u00e1ch t\u1ebf b\u00e0o c\u1ee7a vi khu\u1ea9n, g\u00e2y ra s\u1ef1 suy y\u1ebfu v\u00e0 ch\u1ebft c\u1ee7a ch\u00fang. \u0110i\u1ec1u n\u00e0y gi\u00fap l\u00e0m gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng vi khu\u1ea9n trong \u0111\u01b0\u1eddng ru\u1ed9t v\u00e0 gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh.Fidaxomicin c\u0169ng l\u00e0 m\u1ed9t kh\u00e1ng sinh \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam \u0111\u1ea1i tr\u00e0ng gi\u1ea3 m\u1ea1c. Fidaxomicin c\u00f3 c\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng kh\u00e1c v\u1edbi vancomycin, n\u00f3 ng\u0103n ch\u1eb7n s\u1ef1 sao ch\u00e9p c\u1ee7a DNA c\u1ee7a vi khu\u1ea9n, g\u00e2y ra s\u1ef1 suy y\u1ebfu v\u00e0 ch\u1ebft c\u1ee7a ch\u00fang. Fidaxomicin c\u0169ng c\u00f3 kh\u1ea3 n\u0103ng t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c enzyme vi khu\u1ea9n, gi\u00fap lo\u1ea1i b\u1ecf c\u00e1c vi khu\u1ea9n \u0111ang ph\u00e1t tri\u1ec3n v\u00e0 l\u00e0m gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng vi khu\u1ea9n trong \u0111\u01b0\u1eddng ru\u1ed9t.\n<p>Vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam \u0111\u1ea1i tr\u00e0ng gi\u1ea3 m\u1ea1c c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u00fang c\u00e1ch v\u00e0 theo ch\u1ec9 \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129. Vi\u1ec7c s\u1eed d\u1ee5ng qu\u00e1 nhi\u1ec1u kh\u00e1ng sinh ho\u1eb7c s\u1eed d\u1ee5ng ch\u00fang m\u1ed9t c\u00e1ch kh\u00f4ng th\u00edch h\u1ee3p c\u00f3 th\u1ec3 g\u00e2y ra t\u00e1c d\u1ee5ng ph\u1ee5 v\u00e0 l\u00e0m suy y\u1ebfu h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch c\u1ee7a c\u01a1 th\u1ec3. Do \u0111\u00f3, b\u1ec7nh nh\u00e2n c\u1ea7n tu\u00e2n th\u1ee7 \u0111\u1ea7y \u0111\u1ee7 h\u01b0\u1edbng d\u1eabn c\u1ee7a b\u00e1c s\u0129 v\u00e0 kh\u00f4ng ng\u1eebng theo d\u00f5i t\u00ecnh tr\u1ea1ng c\u1ee7a m\u00ecnh trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/li>\n<li>\u00a0Can thi\u1ec7p ph\u1eabu thu\u1eadt hi\u1ebfm khi c\u1ea7n thi\u1ebft cho ch\u1ea3y m\u00e1u dai d\u1eb3ng.<\/li>\n<\/ul>\n<h2><strong>2.Ti\u00eau ch\u1ea3y:<\/strong><\/h2>\n<p>Ti\u00eau ch\u1ea3y l\u00e0 m\u1ed9t trong nh\u1eefng v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p sau ph\u1eabu thu\u1eadt tim. T\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0 m\u1ea5t n\u01b0\u1edbc, m\u1ea5t ch\u1ea5t gi\u1ea3i, suy th\u1eadn v\u00e0 suy tim. Nguy\u00ean nh\u00e2n c\u1ee7a ti\u00eau ch\u1ea3y sau ph\u1eabu thu\u1eadt tim c\u00f3 th\u1ec3 l\u00e0m nhi\u1ec1u y\u1ebfu t\u1ed1 kh\u00e1c nhau, bao g\u1ed3m\u00a0 thu\u1ed1c, kh\u00e1ng sinh v\u00e0 vi khu\u1ea9n trong \u0111\u01b0\u1eddng ru\u1ed9t.\u00a0C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a ti\u00eau ch\u1ea3y bao g\u1ed3m ti\u00eau ch\u1ea3y, \u0111au b\u1ee5ng, kh\u00f3 ch\u1ecbu v\u00e0 m\u1ea5t n\u01b0\u1edbc. \u0110\u1ec3 \u0111i\u1ec1u tr\u1ecb ti\u00eau ch\u1ea3y sau ph\u1eabu thu\u1eadt tim, b\u00e1c s\u0129 th\u01b0\u1eddng s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng sinh v\u00e0 c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c \u0111\u1ec3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng v\u00e0 b\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng ru\u1ed9t.<\/p>\n<p>Ti\u00eau ch\u1ea3y ph\u00e1t tri\u1ec3n \u1edf b\u1ec7nh nh\u00e2n trong m\u00f4i tr\u01b0\u1eddng ICU th\u01b0\u1eddng l\u00e0 d\u1ea5u hi\u1ec7u \u0111\u00e1ng ng\u1ea1i v\u00ec n\u00f3 c\u00f3 th\u1ec3 do suy gi\u1ea3m l\u01b0u th\u00f4ng m\u00e1u t\u1edbi ru\u1ed9t g\u00e2y ra. Tuy nhi\u00ean, c\u00e1c v\u1ea5n \u0111\u1ec1 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c bao g\u1ed3m:<\/p>\n<ul>\n<li>S\u1eed d\u1ee5ng kh\u00e1ng sinh, c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m vi sinh v\u1eadt c\u00f3 l\u1ee3i \u0111\u01b0\u1eddng ru\u1ed9t v\u00e0 d\u1eabn \u0111\u1ebfn ti\u00eau ch\u1ea3y ngay c\u1ea3 khi kh\u00f4ng c\u00f3 Clostridium difficile.<\/li>\n<li>Vi\u00eam \u0111\u1ea1i tr\u00e0ng do C. difficile, c\u00f3 t\u1ed5ng t\u1ef7 l\u1ec7 ph\u00e1t sinh l\u00e0 0,8% v\u00e0 th\u01b0\u1eddng nh\u01b0ng kh\u00f4ng lu\u00f4n li\u00ean quan \u0111\u1ebfn th\u1eddi gian s\u1eed d\u1ee5ng kh\u00e1ng sinh k\u00e9o d\u00e0i. T\u1ef7 l\u1ec7 ph\u00e1t sinh t\u01b0\u01a1ng t\u1ef1 v\u1edbi s\u1eed d\u1ee5ng cephalosporins v\u00e0 fluoroquinolones. C. difficile ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i, n\u1eef gi\u1edbi, c\u00f3 b\u1ec7nh th\u1eadn m\u1ea1n(CKD) v\u00e0 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft sau ph\u1eabu thu\u1eadt. N\u00f3 c\u0169ng ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng \u1ee9c ch\u1ebf b\u01a1m proton(PPI) v\u00e0 nh\u1eadn nhi\u1ec1u ch\u1ebf ph\u1ea9m m\u00e1u. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 ti\u00eau ch\u1ea3y dai d\u1eb3ng ho\u1eb7c \u0111au b\u1ee5ng kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n v\u00e0 s\u1ef1 t\u0103ng b\u1ea1ch c\u1ea7u, c\u1ea7n xem x\u00e9t ch\u1ea9n \u0111o\u00e1n n\u00e0y v\u00e0 g\u1eedi m\u1eabu ph\u00e2n \u0111\u1ec3 ki\u1ec3m tra xem c\u00f3 C. Difficile kh\u00f4ng. Thu\u1ed1c u\u1ed1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u ngay khi nghi ng\u1edd v\u1ec1 ch\u1ea9n \u0111o\u00e1n b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng vancomycin (125 mg PO b\u1ed1n l\u1ea7n m\u1ed9t ng\u00e0y) ho\u1eb7c fidaxomicin (200 mg hai l\u1ea7n m\u1ed9t ng\u00e0y) trong 10 ng\u00e0y khi C. Difficile (+).<\/li>\n<\/ul>\n<h2><strong>3.K\u1ebft lu\u1eadn:<\/strong><\/h2>\n<p>Xu\u1ea5t huy\u1ebft ti\u00eau ho\u00e1 d\u01b0\u1edbi v\u00e0 ti\u00eau ch\u1ea3y l\u00e0 hai bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim. Nguy\u00ean nh\u00e2n c\u1ee7a hai t\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 do vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng, do s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u, lo\u1ea1n khu\u1ea9n ru\u1ed9t. T\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0 m\u1ea5t n\u01b0\u1edbc v\u00e0 ch\u1ea5t \u0111i\u1ec7n gi\u1ea3i, suy th\u1eadn v\u00e0 suy tim. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 c\u00e1c bi\u1ebfn ch\u1ee9ng. B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c quan s\u00e1t ch\u1eb7t ch\u1ebd v\u00e0 \u0111i\u1ec1u tr\u1ecb theo \u0111\u00fang ch\u1ec9 \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129 \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ee9c kh\u1ecfe v\u00e0 t\u0103ng c\u01b0\u1eddng \u0111\u1ed9ng l\u1ef1c cho qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i sau ph\u1eabu thu\u1eadt tim.<\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/\"><strong>B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec<\/strong><\/a> \u0111\u00e3 \u0111\u01b0a h\u1ec7 th\u1ed1ng m\u00e1y m\u00f3c, thi\u1ebft b\u1ecb hi\u1ec7n \u0111\u1ea1i \u0111\u1ea1t chu\u1ea9n v\u00e0o c\u00f4ng t\u00e1c th\u0103m kh\u00e1m, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 c\u00e1c b\u1ec7nh l\u00fd ti\u00eau h\u00f3a, gan m\u1eadt.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>B\u1ec7nh ti\u00eau h\u00f3a g\u1ed3m\u00a0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a d\u01b0\u1edbi, ti\u00eau ch\u1ea3y l\u00e0 hai v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim. T\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0 m\u1ea5t n\u01b0\u1edbc v\u00e0 ch\u1ea5t \u0111i\u1ec7n gi\u1ea3i, suy th\u1eadn v\u00e0 suy tim. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":20146,"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>B\u1ec7nh ti\u00eau h\u00f3a sau ph\u1eabu thu\u1eadt tim<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh ti\u00eau h\u00f3a g\u1ed3m xu\u1ea5t huy\u1ebft ti\u00eau ho\u00e1 d\u01b0\u1edbi, ti\u00eau ch\u1ea3y tr\u00ean b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p. 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