{"id":19003,"date":"2023-04-15T22:46:33","date_gmt":"2023-04-15T15:46:33","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19003"},"modified":"2023-04-17T14:29:03","modified_gmt":"2023-04-17T07:29:03","slug":"loet-tieu-hoa-do-stress-nguy-co-du-phong-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/loet-tieu-hoa-do-stress-nguy-co-du-phong-va-dieu-tri\/","title":{"rendered":"Lo\u00e9t ti\u00eau h\u00f3a do stress: nguy c\u01a1, d\u1ef1 ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Lo\u00e9t do stress l\u00e0 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng c\u1ea5p t\u00ednh \u1edf b\u1ec1 m\u1eb7t ni\u00eam m\u1ea1c \u1ed1ng ti\u00eau h\u00f3a tr\u00ean (th\u1ef1c qu\u1ea3n, d\u1ea1 d\u00e0y, t\u00e1 tr\u00e0ng) x\u1ea3y ra \u0111\u1ed1i \u1edf b\u1ec7nh nh\u00e2n n\u1eb7ng, c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 nguy c\u01a1 d\u1ec5 l\u00e0m xu\u1ea5t hi\u1ec7n lo\u00e9t. <\/strong><\/p>\n

Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a (XHTH) t\u1eeb t\u1ed5n th\u01b0\u01a1ng lo\u00e9t do stress l\u00e0 XHTH th\u1ee9 ph\u00e1t (nosocominal bleeding) c\u00f3 th\u1ec3 t\u1edbi 25% theo m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u. D\u1ef1 ph\u00f2ng XHTH t\u1eeb t\u1ed5n th\u01b0\u01a1ng lo\u00e9t\/stress l\u00e0 d\u1ef1 ph\u00f2ng lo\u00e9t\/stress.<\/strong><\/p>\n

1. C\u00e1c th\u1ec3 lo\u00e9t ti\u00eau h\u00f3a do stress<\/strong><\/h2>\n

\u2212Lo\u00e9t \u00a0do stress kh\u00f4ng tri\u1ec7u ch\u1ee9ng: lo\u00e9t kh\u00f4ng c\u00f3 xu\u1ea5t huy\u1ebft (n\u00f4n, \u0111i ngo\u00e0i ra m\u00e1u).<\/p>\n

\u2212 Th\u1ec3 lo\u00e9t c\u00f3 k\u00e8m theo xu\u1ea5t huy\u1ebft th\u1ec3 \u1ea9n v\u1edbi test nhanh (FOBT) ho\u1eb7c x\u00e9t nghi\u1ec7m mi\u1ec5n d\u1ecbch (FIT) t\u00ecm m\u00e1u \u1ea9n trong ph\u00e2n d\u01b0\u01a1ng t\u00ednh, cho th\u1ea5y c\u00f3 m\u00e1u trong ph\u00e2n.<\/p>\n

\u2212Lo\u00e9t k\u00e8m theo ch\u1ea3y m\u00e1u r\u00f5 r\u00e0ng: d\u1ecbch h\u00fat d\u1ea1 d\u00e0y v\u00e0\/ho\u1eb7c ph\u00e2n c\u00f3 m\u00e1u, m\u00e0u \u0111en nh\u01b0 b\u00e3 c\u00e0 ph\u00ea.<\/p>\n

\u2212Lo\u00e9t stress c\u00f3 XHTH n\u1eb7ng, c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng: XHTH g\u00e2y \u1ea3nh h\u01b0\u1edfng huy\u1ebft \u0111\u1ed9ng, huy\u1ebft \u00e1p (HA) t\u00e2m thu\/t\u00e2m tr\u01b0\u01a1ng gi\u1ea3m tr\u00ean 20mmHg trong 24h tr\u01b0\u1edbc ho\u1eb7c sau ch\u1ea3y m\u00e1u, ho\u1eb7c h\u1ea1 HA t\u01b0 th\u1ebf (m\u1ea1ch t\u0103ng 20 l\u1ea7n\/ph\u00fat, HA t\u00e2m thu gi\u1ea3m 10 mmHg) ho\u1eb7c hemoglobin gi\u1ea3m t\u1eeb 2g\/dL ho\u1eb7c c\u1ea7n ph\u1ea3i truy\u1ec1n t\u1eeb 2 \u0111\u01a1n v\u1ecb m\u00e1u trong 24h ho\u1eb7c ph\u1ea3i can thi\u1ec7p th\u1ee7 thu\u1eadt (n\u1ed9i soi c\u1ea7m m\u00e1u, c\u1ea7n d\u00f9ng\/t\u0103ng li\u1ec1u thu\u1ed1c v\u1eadn m\u1ea1ch).<\/p>\n

2. T\u1ec9 l\u1ec7 m\u1edbi m\u1eafc v\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1.<\/strong><\/h2>\n

Trong kho\u1ea3ng 50 n\u0103m tr\u01b0\u1edbc, n\u1ed9i soi cho th\u1ea5y t\u1ec9 l\u1ec7 lo\u00e9t do stress \u1edf b\u1ec7nh nh\u00e2n nguy k\u1ecbch, ch\u1ea5n th\u01b0\u01a1ng, b\u1ecfng chi\u1ebfm 75 \u2013 100%. Xu\u1ea5t huy\u1ebft \u1ea9n \u1edf b\u1ec7nh nh\u00e2n n\u1eb7ng c\u00f3 th\u1ec3 chi\u1ebfm \u0111\u1ebfn 15 \u2013 50%, xu\u1ea5t huy\u1ebft r\u00f5 tr\u00ean l\u00e2m s\u00e0ng chi\u1ebfm \u0111\u1ebfn 5 \u2013 25% b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c d\u1ef1 ph\u00f2ng.<\/p>\n

Nhi\u1ec1u nghi\u00ean c\u1ee9u th\u1ef1c hi\u1ec7n nh\u1eb1m t\u00ecm y\u1ebfu t\u1ed1 ti\u00ean \u0111o\u00e1n XHTH c\u1ea7n x\u1eed tr\u00ed cho th\u1ea5y m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 nguy c\u01a1 nh\u01b0:<\/p>\n

    \n
  • Th\u1edf m\u00e1y x\u00e2m nh\u1eadp tr\u00ean 48h (odds ratio 15.6)<\/li>\n
  • R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u (odds ratio 4.5)<\/li>\n
  • C\u00f3 t\u1eeb 3 b\u1ec7nh \u0111\u1ed3ng m\u1eafc (odds ratio 8.9)<\/li>\n
  • B\u1ec7nh l\u00fd gan (odds ratio 7.6)<\/li>\n
  • \u0110i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn (odds ratio 6.9)<\/li>\n
  • \u0110i\u1ec3m suy c\u01a1 quan cao (odds radio 1.4)<\/li>\n
  • B\u1ec7nh nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng th\u1ea7n kinh c\u00f3 nguy c\u01a1 nh\u1eadp ICU cao v\u00e0 x\u00e1c su\u1ea5t XHTH do stress cao.<\/li>\n
  • C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y XHTH n\u1eb7ng, c\u1ea7n x\u1eed tr\u00ed:<\/li>\n<\/ul>\n

    + B\u1ec7nh c\u1ea5p t\u00ednh: cho\u00e1ng, suy h\u00f4 h\u1ea5p, ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u, t\u1ed5n th\u01b0\u01a1ng da.<\/p>\n

    + B\u1ec7nh m\u1ea1n t\u00ednh: suy th\u1eadn, b\u1ec7nh gan m\u1ea1n, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, nhi\u1ec5m H.pylori.<\/p>\n

    + Thu\u1ed1c: ch\u1ed1ng \u0111\u00f4ng, ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u, NSAIDs.<\/p>\n

    + Do thi\u1ebft b\u1ecb: th\u1edf m\u00e1y, \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn, oxy h\u00f3a m\u00e1u ngo\u00e0i m\u00e0ng.<\/p>\n

      \n
    • Nu\u00f4i \u0103n \u0111\u01b0\u1eddng mi\u1ec7ng l\u00e0 chi\u1ebfn l\u01b0\u1ee3c d\u1ef1 ph\u00f2ng ch\u1ea3y m\u00e1u kh\u00f4ng d\u00f9ng thu\u1ed1c do ch\u1ea5t dinh d\u01b0\u1ee1ng trung h\u00f2a d\u1ecbch v\u1ecb, gi\u1ea3m ti\u1ebft prostaglandin.<\/li>\n<\/ul>\n

      V\u1ec1 ti\u00ean l\u01b0\u1ee3ng, b\u1ec7nh nh\u00e2n n\u1eb7ng c\u00f3 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tri\u1ec7u ch\u1ee9ng l\u00e0m t\u0103ng th\u1eddi gian n\u1eb1m ICU 4 \u2013 8 ng\u00e0y v\u00e0 nguy c\u01a1 t\u1ec9 vong.<\/p>\n

      3. T\u1ed5n th\u01b0\u01a1ng lo\u00e9t do stress tr\u00ean n\u1ed9i soi ti\u00eau h\u00f3a.<\/strong><\/h2>\n

      Kh\u1edfi \u0111\u1ea7u: lo\u00e9t do stress qua n\u1ed9i soi ti\u00eau h\u00f3a tr\u00ean l\u00e0 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed1m tr\u1ee3t \u0103n m\u00f2n, xu\u1ea5t huy\u1ebft d\u01b0\u1edbi n\u1ed9i m\u00f4 ni\u00eam m\u1ea1c. C\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n th\u00e0nh v\u1ebft tr\u1ee3t lo\u00e9t tr\u00ean b\u1ec1 m\u1eb7t, n\u1eb7ng s\u1ebd ti\u1ebfn tri\u1ec3n th\u00e0nh \u1ed5 lo\u00e9t th\u1ef1c s\u1ef1.<\/p>\n

      Lo\u00e9t d\u1ea1 d\u00e0y do stress g\u1ed3m 2 lo\u1ea1i:<\/em><\/p>\n

      \u2013 Nh\u1eefng t\u1ed5n th\u01b0\u01a1ng do stress lan tr\u00ean b\u1ec1 m\u1eb7t ni\u00eam m\u1ea1c: c\u1ea5p<\/p>\n

      t\u00ednh, \u0103n m\u00f2n, vi\u00eam tr\u1ee3t \u2018Stress-related mucosal damage<\/p>\n

      SRMD\u201d.<\/p>\n

      \u2013 Nh\u1eefng v\u1ebft lo\u00e9t s\u00e2u d\u01b0\u1edbi ni\u00eam m\u1ea1c th\u01b0\u1eddng \u1edf th\u00e2n v\u1ecb v\u00e0 \u0111\u00e1y v\u1ecb<\/p>\n

      g\u00e2y ch\u1ea3y m\u00e1u.<\/p>\n

      \"\"
      H\u00ecnh \u1ea3nh lo\u00e9t do stress qua n\u1ed9i soi ti\u00eau h\u00f3a tr\u00ean. Ngu\u1ed3n: Crit Care. 2014; 18(2): 213.<\/figcaption><\/figure>\n

       <\/p>\n

      4. Sinh b\u1ec7nh h\u1ecdc.<\/strong><\/h2>\n

      – Do nhi\u1ec1u y\u1ebfu t\u1ed1 ph\u1ee9c t\u1ea1p, ch\u01b0a \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch m\u1ed9t c\u00e1ch \u0111\u1ea7y \u0111\u1ee7.
      \n– Lo\u00e9t do stress: m\u1ea5t c\u00e2n b\u1eb1ng y\u1ebfu t\u1ed1 b\u1ea3o v\u1ec7 ni\u00eam m\u1ea1c v\u00e0 s\u1ea3n xu\u1ea5t nhi\u1ec1u axit d\u1ea1 d\u00e0y.
      \n-Y\u1ebfu t\u1ed1 b\u1ea3o v\u1ec7 bao g\u1ed3m:
      \n+Gi\u1ea3m c\u00e1c s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 b\u1ea3o v\u1ec7 ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y.
      \n+ Gi\u1ea3m ti\u1ebft ra ch\u1ea5t nh\u00e0y v\u00e0 bicarbonat.
      \n+ T\u0103ng gi\u1ea3i ph\u00f3ng c\u00e1c ch\u1ea5t trung gian g\u00e2y vi\u00eam: g\u1ed3m c\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a acid arachidonic, c\u00e1c cytokine g\u00e2y x\u00f3i m\u00f2n ni\u00eam m\u1ea1c, \u00b1 ti\u1ebfn tri\u1ec3n th\u00e0nh c\u00e1c \u1ed5 lo\u00e9t v\u00e0 XHTH.
      \n– C\u00e1c y\u1ebfu t\u1ed1 t\u1ea5n c\u00f4ng nh\u01b0:
      \n+ T\u0103ng ti\u1ebft acid d\u1ecbch v\u1ecb do k\u00edch th\u00edch s\u1ea3n xu\u1ea5t gastrin t\u1eeb t\u1ebf b\u00e0o th\u00e0nh v\u00e0 pepsin.
      \n+Stress g\u00e2y t\u0103ng gi\u1ea3i ph\u00f3ng c\u00e1c ch\u1ea5t trung gian g\u00e2y vi\u00eam.
      \n+ Gi\u1ea3m t\u01b0\u1edbi m\u00e1u t\u1ea1ng, gi\u1ea3m nhu \u0111\u1ed9ng d\u1ea1 d\u00e0y, ch\u1eadm qu\u00e1 tr\u00ecnh lo\u1ea1i b\u1ecf c\u00e1c ch\u1ea5t c\u00f3 t\u00ednh acid kh\u1ecfi d\u1ea1 d\u00e0y.
      \n+K\u00e9o d\u00e0i th\u1eddi gian ti\u1ebfp x\u00fac c\u1ee7a ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y v\u1edbi c\u00e1c ch\u1ea5t g\u00e2y vi\u00eam.
      \n\u1ede b\u1ec7nh nh\u00e2n ICU, c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0:
      \n– Y\u1ebfu t\u1ed1 vi\u00eam, h\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n qu\u00e1 m\u1ee9c.
      \n– Gi\u1ea3m t\u01b0\u1edbi m\u00e1u l\u00e1ch v\u00e0 r\u1ed1i lo\u1ea1n vi tu\u1ea7n ho\u00e0n, cung l\u01b0\u1ee3ng tim th\u1ea5p.
      \n– Ch\u1ea5n th\u01b0\u01a1ng n\u1eb7ng.
      \nC\u00e1c y\u1ebfu t\u1ed1 tr\u00ean g\u00e2y c\u00e1c nguy c\u01a1 g\u00e2y lo\u00e9t: (1) gi\u1ea3m t\u01b0\u1edbi m\u00e1u d\u1ea1 d\u00e0y v\u00e0 gi\u1ea3m pH (t\u0103ng ti\u1ebft acid), (2) m\u1ea5t t\u00ednh to\u00e0n v\u1eb9n ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y, (3) ph\u00e1 v\u1ee1 h\u00e0ng r\u00e0o b\u1ea3o v\u1ec7 l\u00e0 y\u1ebfu t\u1ed1 quan tr\u1ecdng nh\u1ea5t.<\/p>\n

      5. C\u00e1c khuy\u1ebfn c\u00e1o v\u1ec1 d\u1ef1 ph\u00f2ng lo\u00e9t do stress.<\/strong><\/h2>\n

      5.1. H\u1ed9i h\u1ed3i s\u1ee9c B\u1ed3 \u0110\u00e0o Nha 2019:<\/em><\/strong><\/h3>\n

      – Khuy\u1ebfn c\u00e1o duy tr\u00ec ho\u1eb7c b\u1eaft \u0111\u1ea7u thu\u1ed1c \u1ee9c ch\u1ebf ti\u1ebft acid (PPI) \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ec9 \u0111\u1ecbnh b\u1eaft bu\u1ed9c \u1ee9c ch\u1ebf ti\u1ebft acid. (Khuy\u1ebfn c\u00e1o m\u1ea1nh, ch\u1ee9ng c\u1ee9 m\u1ee9c trung b\u00ecnh).
      \n– N\u00ean \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng lo\u00e9t do stress khi c\u00f3 1 y\u1ebfu t\u1ed1 nguy c\u01a1 ch\u00ednh ho\u1eb7c 2 y\u1ebfu t\u1ed1 nguy c\u01a1 ph\u1ee5.
      \n+ Ch\u00ednh: r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u (ti\u1ec3u c\u1ea7u <50,000\/mL, INR >1.5, aPTT t\u0103ng g\u1ea5p \u0111\u00f4i); suy h\u00f4 h\u1ea5p c\u1ea7n th\u1edf m\u00e1y \u00edt nh\u1ea5t 48h; ch\u1ea5n th\u01b0\u01a1ng n\u00e3o, GCS<8, ch\u1ea5n th\u01b0\u01a1ng t\u1ee7y, b\u1ecfng >35%; nhi\u1ec5m tr\u00f9ng huy\u1ebft, SOFA>2.
      \n+ Ph\u1ee5: suy th\u1eadn c\u1ea5p\/m\u1ea1n, cho\u00e1ng, suy gan m\u1ea1n, d\u00f9ng li\u1ec1u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng hydrocortison >250mg\/ng\u00e0y, \u0111a ch\u1ea5n th\u01b0\u01a1ng.
      \n– Khuy\u1ebfn c\u00e1o d\u00f9ng PPI \u0111\u1ec3 d\u1ef1 ph\u00f2ng lo\u00e9t do stress.
      \n– Kh\u00f4ng khuy\u1ebfn c\u00e1o \u01b0u ti\u00ean thu\u1ed1c PPI n\u00e0o d\u00f9ng trong d\u1ef1 ph\u00f2ng.
      \n– D\u1ef1 ph\u00f2ng b\u1eb1ng kh\u00e1ng th\u1ee5 th\u1ec3 H2 (H2RBs) n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec5m C.difficile.
      \n– D\u1eebng thu\u1ed1c d\u1ef1 ph\u00f2ng n\u1ebfu b\u1ec7nh nh\u00e2n h\u1ebft y\u1ebfu t\u1ed1 nguy c\u01a1 v\u00e0 \u0103n \u0111\u01b0\u1ee3c \u0111\u01b0\u1eddng ti\u00eau h\u00f3a.<\/p>\n

      5.2. H\u1ed9i h\u1ed3i s\u1ee9c c\u1ea5p c\u1ee9u v\u00e0 H\u1ed9i ti\u00eau h\u00f3a Vi\u1ec7t Nam<\/strong><\/em><\/h3>\n

      \u0110i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng n\u1ebfu b\u1ec7nh nh\u00e2n thu\u1ed9c 1 trong 2 nh\u00f3m sau.
      \nNh\u00f3m c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 cao g\u00e2y lo\u00e9t do stress:<\/em>
      \n– B\u1ec7nh nh\u00e2n c\u00f3 th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o tr\u00ean 48 gi\u1edd.
      \n-B\u1ec7nh nh\u00e2n n\u1eb7ng v\u1edbi APACHE II \u2265 8 \u0111i\u1ec3m, k\u00e9m dung n\u1ea1p v\u1edbi dinh d\u01b0\u1ee1ng ti\u00eau h\u00f3a.
      \n-Trong b\u1ec7nh c\u1ea3nh b\u1ec7nh n\u1eb7ng c\u00f3 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u v\u1edbi ti\u1ec3u c\u1ea7u d\u01b0\u1edbi 50000\/ml
      \nho\u1eb7c INR > 1,5 ho\u1eb7c aPTT > 2 l\u1ea7n, ho\u1eb7c th\u1eddi gian prothrombin > 20 gi\u00e2y
      \ntrong v\u00f2ng 6 th\u00e1ng.
      \n-Ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o (Glasgow \u2264 8\u0111i\u1ec3m), ch\u1ea5n th\u01b0\u01a1ng t\u1ee7y s\u1ed1ng.
      \n-B\u1ecfng v\u1edbi di\u1ec7n t\u00edch tr\u00ean 35%.
      \nC\u00f3 t\u1eeb 2 y\u1ebfu t\u1ed1 nguy c\u01a1 nh\u00f3m sau:<\/em>
      \n\u2022 Nhi\u1ec5m khu\u1ea9n v\u1edbi \u0111i\u1ec3m SOFA \u22652
      \n\u2022 HC s\u1ed1c: thu\u1ed1c v\u1eadn m\u1ea1ch, lactat \u22654mmol\/l, HAtb<70
      \n\u2022 STC c\u1ea5p\/m\u1ea1n \u0111\u01b0\u1ee3c \u0110T l\u1ecdc m\u00e1u c\u1ea5p c\u1ee9u, LMLT
      \n\u2022 Suy gan m\u1ea1n, TS x\u01a1 gan, \uf0b1 gi\u00e3n TM TQ, ho\u1eb7c HC n\u00e3o gan
      \n\u2022 \u0110ang \u0110T glucocorticoide (\u2265 250mg hydrocortisone\/ng\u00e0y ho\u1eb7c t\u01b0\u01a1ng \u0111\u01b0\u01a1ng)
      \n\u2022 \u0110a ch\u1ea5n th\u01b0\u01a1ng<\/p>\n

      Li\u1ec1u d\u00f9ng v\u00e0 \u0111\u01b0\u1eddng d\u00f9ng.<\/em><\/strong>
      \n\u0110i\u1ec1u tr\u1ecb th\u1ec3 lo\u00e9t do stress g\u00e2y xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a cao.<\/em>
      \n\u2022 Thu\u1ed1c PPI (\u1ed1ng pantoprazole 40 mg, lansoprazole 30mg, omeprazol 40 mg,
      \nesomeprazole 40 mg, rabeprazole 20 mg)
      \n\u2022 Ti\u00eam TM li\u1ec1u \u0111\u1ea7u ti\u00ean 1 \u1ed1ng, duy tr\u00ec truy\u1ec1n TM 8 mg\/gi\u1edd h\u1ebft XHTH l\u00e2m s\u00e0ng v\u00e0 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh chuy\u1ec3n ti\u00eam TM 1-2 l\u1ea7n: 6h – 21h.
      \n\u2022 Chuy\u1ec3n \u0111\u01b0\u1eddng u\u1ed1ng 1-2 vi\u00ean\/ng\u00e0y khi h\u1ebft tri\u1ec7u ch\u1ee9ng XHTH v\u00e0 dung n\u1ea1p dinh d\u01b0\u1ee1ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a.
      \n\u2022 Ho\u1eb7c H2RBs: ti\u00eam famotidin 20 mg m\u1ed7i 12h ho\u1eb7c ranitidine 50 mg m\u1ed7i 6-8h. Ti\u1ebfp theo duy tr\u00ec truy\u1ec1n TM li\u00ean t\u1ee5c<\/p>\n

      D\u1ef1 ph\u00f2ng lo\u00e9t \u0111\u01b0\u1eddng ti\u00eau h\u00f3a do stress: nh\u00f3m nguy c\u01a1 cao.<\/em>
      \n\u2022 Thu\u1ed1c PPI (omeprazol \u1ed1ng 40mg ho\u1eb7c lansoprazol \u1ed1ng 30mg). V\u1edbi omeprazol ti\u00eam TM 40mg ng\u00e0y 1-2 l\u1ea7n.
      \n\u2022 Ho\u1eb7c H2RBs (ranitidin): ti\u00eam TM 50 mg x 2-3 l\u1ea7n\/ng\u00e0y.
      \n\u0110i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng nh\u00f3m c\u00f3 nguy c\u01a1 cao lo\u00e9t ti\u00eau h\u00f3a do stress n\u1eb1m vi\u1ec7n:<\/em>
      \n\u2022 Thu\u1ed1c PPI ti\u00eam TM 3-5 ng\u00e0y \u0111\u1ea7u x 2 \u1ed1ng\/ng\u00e0y sau \u0111\u00f3 1 \u1ed1ng\/ng\u00e0y
      \n\u2022 \u0110T d\u1ef1 ph\u00f2ng lo\u00e9t ch\u01b0a g\u00e2y XHTH v\u00e0 dung n\u1ea1p \u0111\u01b0\u1eddng ti\u00eau h\u00f3a t\u1ed1t: U\u1ed1ng c\u00e1c
      \nthu\u1ed1c nh\u00f3m PPI ho\u1eb7c c\u00e1c thu\u1ed1c H2RB.
      \n\u2022 BN kh\u00f4ng c\u00f3 XHTH nh\u01b0ng kh\u00f4ng dung n\u1ea1p v\u1edbi dinh d\u01b0\u1ee1ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u1ea7n theo d\u00f5i v\u00e0 xem x\u00e9t s\u1eed d\u1ee5ng thu\u1ed1c PPI ho\u1eb7c c\u00e1c thu\u1ed1c H2RBs \u0111\u01b0\u1eddng TM.<\/p>\n

      Theo d\u00f5i trong khi \u0111i\u1ec1u tr\u1ecb.<\/em>
      \n\u2022BN n\u1eb7ng n\u1eb1m t\u1ea1i c\u00e1c chuy\u00ean khoa kh\u00f4ng thu\u1ed9c nh\u00f3m nguy c\u01a1 cao v\u1eabn c\u1ea7n
      \ntheo d\u00f5i h\u00e0ng ng\u00e0y.
      \n\u2022Khi b\u1ec7nh di\u1ebfn bi\u1ebfn n\u1eb7ng, t\u0103ng c\u00e1c nguy c\u01a1 g\u00e2y lo\u00e9t ti\u00eau h\u00f3a do stress c\u1ea7n \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng s\u1edbm.
      \n\u2022K\u1ebft h\u1ee3p c\u00e1c bi\u1ec7n ph\u00e1p kh\u00e1c nh\u1eb1m gi\u1ea3m nguy c\u01a1 lo\u00e9t stress:
      \n-Nu\u00f4i \u0103n \u0111\u01b0\u1eddng ti\u00eau h\u00f3a s\u1edbm
      \n-Thay \u0111\u1ed5i thu\u1ed1c kh\u00e1c trong nh\u00f3m NSAIDs
      \n-Cai th\u1edf m\u00e1y s\u1edbm.<\/p>\n

      T\u00e0i li\u1ec7u tham kh\u1ea3o:
      \nSociedade Portuguesa de Cuidados Intensivos guidelines for stress ulcer prophylaxis in the intensive care unit; Rev. bras. ter. intensiva 31 (1) 2019.
      \nProphylaxis against Upper Gastrointestinal Bleeding in Hospitalized Patients, N Engl J Med 2018; 378:2506-2516.<\/p>\n

      Stress ulceration: prevalence, pathology and association with adverse outcomes, Crit Care. 2014; 18(2): 213.<\/p>\n

       <\/p>\n

       <\/p>\n","protected":false},"excerpt":{"rendered":"

      Lo\u00e9t do stress l\u00e0 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng c\u1ea5p t\u00ednh \u1edf b\u1ec1 m\u1eb7t ni\u00eam m\u1ea1c \u1ed1ng ti\u00eau h\u00f3a tr\u00ean (th\u1ef1c qu\u1ea3n, d\u1ea1 d\u00e0y, t\u00e1 tr\u00e0ng) x\u1ea3y ra \u0111\u1ed1i \u1edf b\u1ec7nh nh\u00e2n n\u1eb7ng, c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 nguy c\u01a1 d\u1ec5 l\u00e0m xu\u1ea5t hi\u1ec7n lo\u00e9t. Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a (XHTH) t\u1eeb t\u1ed5n th\u01b0\u01a1ng lo\u00e9t do stress l\u00e0 XHTH […]<\/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":"\nLo\u00e9t ti\u00eau h\u00f3a do stress: nguy c\u01a1, d\u1ef1 ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Lo\u00e9t do stress l\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u1ea5p t\u00ednh \u1edf ni\u00eam m\u1ea1c \u1ed1ng ti\u00eau h\u00f3a tr\u00ean x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u1eb7ng, c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 nguy c\u01a1 xu\u1ea5t hi\u1ec7n lo\u00e9t.\" \/>\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=\"Lo\u00e9t ti\u00eau h\u00f3a do stress: nguy c\u01a1, d\u1ef1 ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb - 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