{"id":21905,"date":"2023-04-17T17:28:34","date_gmt":"2023-04-17T10:28:34","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21905"},"modified":"2023-04-18T12:17:48","modified_gmt":"2023-04-18T05:17:48","slug":"chan-doan-va-dieu-tri-benh-san-la-ruot-nho","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/chan-doan-va-dieu-tri-benh-san-la-ruot-nho\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf"},"content":{"rendered":"

B\u1ec7nh s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf \u00a0l\u00e0 m\u1ed9t b\u1ec7nh l\u00e2y nhi\u1ec5m do s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf (Metagonimus yokogawai) g\u00e2y ra. B\u1ec7nh n\u00e0y ph\u1ed5 bi\u1ebfn \u1edf c\u00e1c n\u01b0\u1edbc \u0111ang ph\u00e1t tri\u1ec3n, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf tr\u1ebb em v\u00e0 ng\u01b0\u1eddi l\u1edbn tu\u1ed5i. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n<\/a> v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 n\u00e2ng cao cho s\u1ee9c kh\u1ecfe c\u1ed9ng \u0111\u1ed3ng.<\/strong><\/p>\n

1. Tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nghi ng\u1edd<\/span><\/b><\/h2>\n

L\u00e0 tr\u01b0\u1eddng h\u1ee3p c\u00f3 ti\u1ec1n s\u1eed d\u1ecbch t\u1ec5 \u0103n c\u00e1 n\u01b0\u1edbc l\u1ee3 ho\u1eb7c c\u00e1 n\u01b0\u1edbc ng\u1ecdt ch\u01b0a n\u1ea5u ch\u00edn ho\u1eb7c \u01b0\u1edbp mu\u1ed1i ho\u1eb7c ng\u01b0\u1eddi s\u1ed1ng \u1edf v\u00f9ng l\u01b0u h\u00e0nh s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf v\u00e0 c\u00f3 m\u1ed9t trong c\u00e1c tri\u1ec7u ch\u1ee9ng sau:<\/span><\/p>\n

+ M\u1ec7t m\u1ecfi, ch\u00e1n \u0103n;<\/span><\/p>\n

+ \u0110au b\u1ee5ng v\u00f9ng th\u01b0\u1ee3ng v\u1ecb, bu\u1ed3n n\u00f4n, b\u1ee5ng ch\u01b0\u1edbng, ti\u00eau ch\u1ea3y kh\u00f4ng th\u01b0\u1eddng xuy\u00ean;<\/span><\/p>\n

+ Thi\u1ebfu m\u00e1u;<\/span><\/p>\n

+ X\u00e9t nghi\u1ec7m: b\u1ea1ch c\u1ea7u \u00e1i toan t\u0103ng.<\/span><\/p>\n

\"\u0110au
\u0110au b\u1ee5ng v\u00f9ng th\u01b0\u1ee3ng v\u1ecb c\u00f3 th\u1ec3 l\u00e0 tri\u1ec7u ch\u1ee9ng nghi ng\u1edd b\u1ec7nh s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf<\/figcaption><\/figure>\n

2. Tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh x\u00e1c \u0111\u1ecbnh<\/span><\/b><\/h2>\n

L\u00e0 tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nghi ng\u1edd v\u00e0 x\u00e1c \u0111\u1ecbnh th\u00eam m\u1ed9t trong c\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng sau:<\/span><\/p>\n

– X\u00e9t nghi\u1ec7m ph\u00e2n hay d\u1ecbch t\u00e1 tr\u00e0ng x\u00e1c \u0111\u1ecbnh c\u00f3 tr\u1ee9ng s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf;<\/span><\/p>\n

– N\u1ed9i soi \u1ed1ng ti\u00eau h\u00f3a t\u00ecm \u0111\u01b0\u1ee3c s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf tr\u01b0\u1edfng th\u00e0nh;<\/span><\/p>\n

– X\u00e9t nghi\u1ec7m PCR x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf.<\/span><\/p>\n

3. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/span><\/b><\/h2>\n

– S\u00e1n l\u00e1 gan nh\u1ecf: Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 c\u00f3 v\u00e0ng da t\u1eafc m\u1eadt; S\u00e1n l\u00e1 gan nh\u1ecf g\u00e2y t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng m\u1eadt trong v\u00e0 ngo\u00e0i gan, vi\u00eam x\u01a1 \u0111\u01b0\u1eddng m\u1eadt g\u00e2y d\u00e0y th\u00e0nh \u0111\u01b0\u1eddng m\u1eadt v\u00e0 gi\u00e3n nh\u1eb9 \u0111\u01b0\u1eddng m\u1eadt. \u0110\u1eb7c bi\u1ec7t tr\u1ee9ng s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf h\u1ecd Heterophyidae r\u1ea5t gi\u1ed1ng tr\u1ee9ng s\u00e1n l\u00e1 gan nh\u1ecf c\u1ea3 v\u1ec1 h\u00ecnh th\u00e1i v\u00e0 k\u00edch th\u01b0\u1edbc. Tr\u1ee9ng s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf h\u1ecd Echinostomatidae d\u1ec5 nh\u1ea7m v\u1edbi tr\u1ee9ng giun \u0111\u0169a kh\u00f4ng th\u1ee5 tinh.<\/span><\/p>\n

– Giun l\u01b0\u01a1n \u0111\u01b0\u1eddng ru\u1ed9t: x\u00e9t nghi\u1ec7m soi t\u01b0\u01a1i ph\u00e2n t\u00ecm th\u1ea5y \u1ea5u tr\u00f9ng giun l\u01b0\u01a1n trong ph\u00e2n ho\u1eb7c ELISA ph\u00e1t hi\u1ec7n kh\u00e1ng th\u1ec3 giun l\u01b0\u01a1n d\u01b0\u01a1ng t\u00ednh.<\/span><\/p>\n

4. \u0110i\u1ec1u tr\u1ecb<\/h2>\n

4.1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/span><\/b><\/h3>\n

– \u0110i\u1ec1u tr\u1ecb s\u1edbm, \u0111\u00fang thu\u1ed1c \u0111\u1eb7c hi\u1ec7u, \u0111\u00fang ph\u00e1c \u0111\u1ed3;<\/span><\/p>\n

– \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 khi c\u1ea7n thi\u1ebft \u0111\u1ec3 n\u00e2ng cao th\u1ec3 tr\u1ea1ng cho ng\u01b0\u1eddi b\u1ec7nh;<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh t\u00e1i kh\u00e1m sau \u0111i\u1ec1u tr\u1ecb 1 th\u00e1ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb; n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh c\u00f2n nhi\u1ec5m b\u1ec7nh s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf th\u00ec ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb nh\u1eafc l\u1ea1i li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb;<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 b\u1ec7nh n\u1ec1n k\u00e8m theo, th\u00ec ph\u1ea3i k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb b\u1ec7nh n\u1ec1n.<\/span><\/p>\n

4.2. \u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u<\/span><\/b><\/h3>\n

a) Thu\u1ed1c: praziquantel<\/span>\u00a0<\/span>vi\u00ean n\u00e9n 600 mg.<\/span><\/p>\n

b) Li\u1ec1u d\u00f9ng<\/span><\/p>\n

– \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em \u2265 4 tu\u1ed5i: Li\u1ec1u 25 mg\/kg\/ng\u00e0y, li\u1ec1u duy nh\u1ea5t, u\u1ed1ng ngay sau khi \u0103n, kh\u00f4ng \u0111\u01b0\u1ee3c nhai thu\u1ed1c.<\/span><\/p>\n

– \u0110\u1ed1i v\u1edbi tr\u1ebb em < 4 tu\u1ed5i: Tham kh\u1ea3o b\u00e1c s\u1ef9 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i ch\u1eb7t.<\/span><\/p>\n

c) Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/span><\/p>\n

– Kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng cho ph\u1ee5 n\u1eef c\u00f3 thai;<\/span><\/p>\n

– Nh\u1eefng ng\u01b0\u1eddi c\u00f3 c\u01a1 \u0111\u1ecba d\u1ecb \u1ee9ng v\u1edbi thu\u1ed1c;<\/span><\/p>\n

– Ng\u01b0\u1eddi \u0111ang b\u1ecb b\u1ec7nh c\u1ea5p t\u00ednh ho\u1eb7c suy tim, suy gan, suy th\u1eadn, b\u1ec7nh t\u00e2m th\u1ea7n…<\/span><\/p>\n

d) H\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n ch\u00fa \u00fd khi s\u1eed d\u1ee5ng thu\u1ed1c:<\/span><\/p>\n

– Th\u1eddi k\u1ef3 cho con b\u00fa: Ng\u01b0\u1eddi m\u1eb9 ng\u1eebng cho con b\u00fa trong th\u1eddi gian d\u00f9ng thu\u1ed1c v\u00e0 72 gi\u1edd sau li\u1ec1u cu\u1ed1i c\u00f9ng; trong th\u1eddi gian n\u00e0y s\u1eefa ph\u1ea3i \u0111\u01b0\u1ee3c v\u1eaft b\u1ecf;<\/span><\/p>\n

– Kh\u00f4ng s\u1eed d\u1ee5ng r\u01b0\u1ee3u, bia trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb;<\/span><\/p>\n

– Kh\u00f4ng l\u00e1i xe, \u0111i\u1ec1u khi\u1ec3n m\u00e1y m\u00f3c trong khi u\u1ed1ng thu\u1ed1c v\u00e0 c\u1ea3 trong 24 gi\u1edd sau khi u\u1ed1ng praziquantel v\u00ec thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y ch\u00f3ng m\u1eb7t bu\u1ed3n ng\u1ee7;<\/span><\/p>\n

– Th\u1eadn tr\u1ecdng v\u1edbi ng\u01b0\u1eddi gi\u00e0, ng\u01b0\u1eddi suy dinh d\u01b0\u1ee1ng, ng\u01b0\u1eddi c\u00f3 r\u1ed1i lo\u1ea1n ti\u1ec1n \u0111\u00ecnh.<\/span><\/p>\n

4.3. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng<\/span><\/b><\/h3>\n

T\u00f9y theo bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u1ec3 ch\u1ec9 \u0111\u1ecbnh c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<\/span><\/p>\n

– Gi\u1ea3m \u0111au b\u1ee5ng: b\u1eb1ng c\u00e1c thu\u1ed1c ch\u1ed1ng co th\u1eaft \u0111\u01b0\u1eddng u\u1ed1ng.<\/span><\/p>\n

+ Thu\u1ed1c ch\u1ed1ng co th\u1eaft kh\u00f4ng kh\u00e1ng ti\u1ebft cholin.<\/span><\/p>\n

+ Thu\u1ed1c ch\u1ed1ng co th\u1eaft kh\u00e1ng ti\u1ebft cholin.<\/span><\/p>\n

– Ti\u00eau ch\u1ea3y v\u00e0 r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a: c\u00e1c men ti\u00eau h\u00f3a ngu\u1ed3n g\u1ed1c vi khu\u1ea9n nh\u01b0 antibio 1g, ng\u00e0y 6 vi\u00ean chia 3 l\u1ea7n;<\/span><\/p>\n

– B\u00f9 n\u01b0\u1edbc, \u0111i\u1ec7n gi\u1ea3i b\u1eb1ng u\u1ed1ng oresol: tr\u1ebb em 4 – 5 tu\u1ed5i ng\u00e0y u\u1ed1ng 750 \u0111\u1ebfn < 1.000ml; tr\u00ean 5 tu\u1ed5i ng\u00e0y u\u1ed1ng 1.000ml.<\/span><\/p>\n

– Ph\u00f9: x\u00e9t nghi\u1ec7m c\u00f3 gi\u1ea3m albumin m\u00e1u < 35 g\/l, ho\u1eb7c albumin > 35 g\/l k\u00e8m theo ph\u00f9 ngo\u1ea1i bi\u00ean n\u1eb7ng th\u00ec c\u00f3 ch\u1ec9 \u0111\u1ecbnh truy\u1ec1n d\u1ecbch albumin theo c\u00f4ng th\u1ee9c:<\/span><\/p>\n

L\u01b0\u1ee3ng albumin c\u1ea7n b\u00f9 = [0,25 (g\/dl)- Albumin\/m\u00e1u hi\u1ec7n t\u1ea1i (g\/dl)] x c\u00e2n n\u1eb7ng (kg) x 0,8.<\/span><\/p>\n

– Thi\u1ebfu m\u00e1u: B\u1ed5 sung acid folic, vi\u00ean s\u1eaft, vitamin B12 trong tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu m\u00e1u nh\u1eb9, u\u1ed1ng trong v\u00f2ng 3 – 6 th\u00e1ng.<\/span><\/p>\n

4.4. \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3<\/span><\/b><\/h3>\n

– N\u00e2ng cao th\u1ec3 tr\u1ea1ng c\u00f3 ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng, ngh\u1ec9 ng\u01a1i h\u1ee3p l\u00fd.<\/span><\/p>\n

– S\u1eed d\u1ee5ng vitamin t\u1ed5ng h\u1ee3p.<\/span><\/p>\n

4.5. Theo d\u00f5i sau \u0111i\u1ec1u tr\u1ecb<\/span><\/b><\/h3>\n

4.5.1. Theo d\u00f5i \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa<\/span><\/b><\/h4>\n

Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c theo d\u00f5i \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa kho\u1ea3ng 5 – 7 ng\u00e0y, \u0111\u01b0\u1ee3c l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n theo d\u00f5i \u0111i\u1ec1u tr\u1ecb, \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng c\u01a1 quan c\u1ee7a c\u01a1 th\u1ec3; \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh n\u1ec1n, l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u1ec3 theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh n\u1ec1n li\u00ean quan.<\/span><\/p>\n

4.5.2. Theo d\u00f5i \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa v\u00e0 sau \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa<\/span><\/b><\/h4>\n

– Kh\u00e1m l\u1ea1i sau 1 tu\u1ea7n: ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u1ea1i c\u00f4ng th\u1ee9c m\u00e1u, ch\u1ee9c n\u0103ng gan; x\u00e9t nghi\u1ec7m ph\u00e2n t\u00ecm tr\u1ee9ng s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf;<\/span><\/p>\n

– Kh\u00e1m l\u1ea1i sau 1 th\u00e1ng sau \u0111i\u1ec1u tr\u1ecb: ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u1ea1i c\u00f4ng th\u1ee9c m\u00e1u, ch\u1ee9c n\u0103ng gan; x\u00e9t nghi\u1ec7m ph\u00e2n t\u00ecm tr\u1ee9ng s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf;<\/span><\/p>\n

– Sau 1 tu\u1ea7n ho\u1eb7c sau 1 th\u00e1ng, n\u1ebfu x\u00e9t nghi\u1ec7m ph\u00e2n ng\u01b0\u1eddi b\u1ec7nh c\u00f2n c\u00f3 tr\u1ee9ng s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf ho\u1eb7c con s\u00e1n tr\u01b0\u1edfng th\u00e0nh, th\u00ec cho b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n v\u00e0 nh\u1eafc l\u1ea1i li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa.<\/span><\/p>\n

5. Ti\u00eau chu\u1ea9n kh\u1ecfi b\u1ec7nh<\/h2>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng gi\u1ea3m ho\u1eb7c h\u1ebft v\u00e0 x\u00e9t nghi\u1ec7m ph\u00e2n kh\u00f4ng t\u00ecm th\u1ea5y tr\u1ee9ng s\u00e1n l\u00e1 ru\u1ed9t sau \u0111i\u1ec1u tr\u1ecb 1 th\u00e1ng.<\/span><\/p>\n

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V\u00ec v\u1eady, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 ng\u0103n ng\u1eeba s\u1ef1 l\u00e2y lan c\u1ee7a b\u1ec7nh, gi\u1ea3m thi\u1ec3u t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 \u0111\u1ea3m b\u1ea3o cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111\u1ea1t hi\u1ec7u qu\u1ea3 t\u1ed1t nh\u1ea5t.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

B\u1ec7nh s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf \u00a0l\u00e0 m\u1ed9t b\u1ec7nh l\u00e2y nhi\u1ec5m do s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf (Metagonimus yokogawai) g\u00e2y ra. B\u1ec7nh n\u00e0y ph\u1ed5 bi\u1ebfn \u1edf c\u00e1c n\u01b0\u1edbc \u0111ang ph\u00e1t tri\u1ec3n, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf tr\u1ebb em v\u00e0 ng\u01b0\u1eddi l\u1edbn tu\u1ed5i. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 ng\u0103n […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[3],"yoast_head":"\nCh\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf \u00a0l\u00e0 m\u1ed9t b\u1ec7nh l\u00e2y nhi\u1ec5m do s\u00e1n l\u00e1 ru\u1ed9t nh\u1ecf (Metagonimus yokogawai) g\u00e2y ra. 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