{"id":23643,"date":"2023-04-20T23:13:00","date_gmt":"2023-04-20T16:13:00","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=23643"},"modified":"2023-04-21T10:29:06","modified_gmt":"2023-04-21T03:29:06","slug":"suy-gan-cap-huong-dan-chan-doan-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/20\/suy-gan-cap-huong-dan-chan-doan-va-dieu-tri\/","title":{"rendered":"Suy gan c\u1ea5p: h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Suy gan c\u1ea5p l\u00e0 t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan m\u1ed9t c\u00e1ch \u1ed3 \u1ea1t do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau d\u1eabn \u0111\u1ebfn b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng c\u1ea5p t\u00ednh v\u1edbi c\u00e1c bi\u1ec3u hi\u1ec7n:v\u00e0ng da, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u,b\u1ec7nh l\u00fd n\u00e3o gan, suy \u0111a t\u1ea1ng\u2026 \u1edf m\u1ed9t ng\u01b0\u1eddi tr\u01b0\u1edbc \u0111\u00f3 c\u00f3 ch\u1ee9c n\u0103ng gan b\u00ecnh th\u01b0\u1eddng. T\u1ef7 l\u1ec7 t\u1eed vong cao 50 – 90% n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb h\u1ee3p l\u00fd ho\u1eb7c kh\u00f4ng \u0111\u01b0\u1ee3c gh\u00e9p gan.\u00a0 <\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

1. Ch\u1ea9n \u0111o\u00e1n suy gan c\u1ea5p.<\/strong><\/h2>\n

1.1. D\u1ef1a v\u00e0o tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/h3>\n

B\u1ec7nh nh\u00e2n suy gan c\u1ea5p th\u01b0\u1eddng c\u00f3 ti\u1ec1n s\u1eed kh\u1ecfe m\u1ea1nh ho\u1eb7c kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n ti\u1ec1n s\u1eed b\u1ec7nh l\u00fd n\u1eb7ng n\u1ec1 tr\u01b0\u1edbc \u0111\u00f3. B\u1ec7nh nh\u00e2n kh\u1edfi ph\u00e1t v\u1edbi tri\u1ec7u ch\u1ee9ng: m\u1ec7t x\u1ec9u, bu\u1ed3n n\u00f4n, ch\u00e1n \u0103n sau \u0111\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n \u0111i\u1ec3n h\u00ecnh tr\u00ean l\u00e2m s\u00e0ng l\u00e0:<\/p>\n

–\u00a0\u00a0\u00a0 V\u00e0ng da v\u00e0 ni\u00eam m\u1ea1c t\u0103ng nhanh, n\u01b0\u1edbc ti\u1ec3u s\u1eabm m\u00e0u.<\/p>\n

–\u00a0\u00a0\u00a0 C\u00e1c tri\u1ec7u ch\u1ee9ng do r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u: ch\u1ea3y m\u00e1u d\u01b0\u1edbi da, ni\u00eam m\u1ea1c, xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a cao v\u00e0 th\u1ea5p, c\u00f3 th\u1ec3 xu\u1ea5t huy\u1ebft n\u00e3o.<\/p>\n

–\u00a0\u00a0\u00a0 H\u1ed9i ch\u1ee9ng n\u00e3o gan bi\u1ec3u hi\u1ec7n \u1edf nhi\u1ec1u m\u1ee9c \u0111\u1ed9 v\u00e0 t\u00f9y giai \u0111o\u1ea1n:<\/p>\n

+ \u0110\u1ed9 I: Thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i t\u00ecnh c\u1ea3m, gi\u1ea3m t\u1eadp trung ,r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7.<\/p>\n

+ \u0110\u1ed9 II: L\u01a1 m\u01a1, u \u00e1m, h\u00e0nh vi b\u1ea5t th\u01b0\u1eddng, \u1ee9ng x\u1eed kh\u00f4ng ph\u00f9 h\u1ee3p m\u1ea5t \u0111\u1ecbnh h\u01b0\u1edbng, c\u00f2n \u0111\u00e1p \u1ee9ng v\u1edbi l\u1eddi n\u00f3i.<\/p>\n

+ \u0110\u1ed9 III: Ng\u1ee7 g\u00e0, kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi l\u1eddi n\u00f3i, u \u00e1m r\u00f5 ,t\u0103ng ph\u1ea3n x\u1ea1.<\/p>\n

+ \u0110\u1ed9 IV: H\u00f4n m\u00ea, bi\u1ec3u hi\u1ec7n m\u1ea5t n\u00e3o, c\u00f3 th\u1ec3 c\u00f2n \u0111\u00e1p \u1ee9ng v\u1edbi k\u00edch th\u00edch \u0111au.<\/p>\n

–\u00a0\u00a0\u00a0 Suy th\u1eadn c\u1ea5p l\u00e0 bi\u1ebfn ch\u1ee9ng x\u1ea3y ra sau suy gan c\u1ea5p.<\/p>\n

–\u00a0\u00a0\u00a0 Nhi\u1ec5m tr\u00f9ng: hay g\u1eb7p vi\u00eam ph\u1ed5i, nhi\u1ec5m tr\u00f9ng ti\u1ebft ni\u1ec7u, nhi\u1ec5m khu\u1ea9n huy\u1ebft.<\/p>\n

–\u00a0\u00a0\u00a0 Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 t\u1eed vong trong b\u1ec7nh c\u1ea3nh suy \u0111a t\u1ea1ng.<\/p>\n

1.2. C\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n suy gan c\u1ea5p.<\/h3>\n

–\u00a0\u00a0\u00a0 C\u00e1c x\u00e9t nghi\u1ec7m sinh h\u00f3a, huy\u1ebft h\u1ecdc \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh nh\u00e2n:<\/p>\n

+ T\u0103ng bilirubin: n\u1ebfu t\u0103ng > 250 mmol\/l b\u1ec7nh nh\u00e2n r\u1ea5t n\u1eb7ng.<\/p>\n

+ AST v\u00e0 ALT t\u0103ng cao khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan n\u1eb7ng.<\/p>\n

+ INR, NH3, PT, aPTT, y\u1ebfu t\u1ed1 V, VII, VIII v\u00e0 fibrinogen.Th\u1eddi gian prothrombin PT k\u00e9o d\u00e0i\u00a0 t 1,5 l\u00e0 y\u1ebfu t\u1ed1 x\u00e1c \u0111\u1ecbnh b\u1ec7nh n\u1eb7ng.<\/p>\n

+ H\u1ea1 \u0111\u01b0\u1eddng m\u00e1u, h\u1ea1 natri m\u00e1u, h\u1ea1 mage m\u00e1u ,ki\u1ec1m h\u00f4 h\u1ea5p, toan chuy\u1ec3n h\u00f3a.<\/p>\n

+ T\u0103ng ure, creatinin m\u00e1u.<\/p>\n

–\u00a0\u00a0\u00a0 Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh:<\/p>\n

+ Si\u00eau \u00e2m \u1ed5 b\u1ee5ng, x\u00e1c \u0111\u1ecbnh k\u00edch th\u01b0\u1edbc gan, lo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh m\u1ea1n t\u00ednh kh\u00e1c \u1edf gan…<\/p>\n

+ Ch\u1ee5p c\u1eaft l\u1edbp s\u1ecd xem t\u00ecnh tr\u1ea1ng ph\u00f9 n\u00e3o, xu\u1ea5t huy\u1ebft n\u00e3o n\u1ebfu c\u00f3.<\/p>\n

–\u00a0\u00a0\u00a0 C\u00e1c x\u00e9t nghi\u1ec7m t\u00ecm nguy\u00ean nh\u00e2n<\/p>\n

+ Ng\u1ed9 \u0111\u1ed9c: l\u1ea5y n\u01b0\u1edbc ti\u1ec3u, m\u00e1u x\u00e1c \u0111\u1ecbnh v\u00e0 \u0111\u1ecbnh l\u01b0\u1ee3ng \u0111\u1ed9c ch\u1ea5t (nh\u01b0 n\u1ed3ng \u0111\u1ed9 paracetamol trong huy\u1ebft thanh).<\/p>\n

+ Huy\u1ebft thanh ch\u1ea9n \u0111o\u00e1n c\u00e1c lo\u1ea1i virut g\u00e2y vi\u00eam gan c\u1ea5p: vi\u00eam gan A (IgM); vi\u00eam gan B (HBsAg, Anti HBC, HBV DNA…). Vi\u00eam gan C(HCVAb,HCV-RNA), Epstein \u2013 Barr vir\u00fat (IgM, IgG) Cytomegalovirus (IgG, IgM). PCR v\u1edbi c\u00e1c vi r\u00fat: Herpes; Enterovirus, Adenovirus, Parovirus…<\/p>\n

+ Kh\u00e1ng th\u1ec3 t\u1ef1 mi\u1ec5n khi l\u00e2m s\u00e0ng nghi ng\u1edd vi\u00eam gan t\u1ef1 mi\u1ec5n.<\/p>\n

1.3. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/h3>\n

–\u00a0\u00a0\u00a0 Ch\u1ea9n \u0111o\u00e1n suy gan c\u1ea5p tr\u00ean l\u00e2m s\u00e0ng c\u1ea7n k\u1ebft h\u1ee3p \u0111\u1ea7y \u0111\u1ee7 c\u00e1c bi\u1ec3u hi\u1ec7n c\u1ee7a h\u1ed9i ch\u1ee9ng suy ch\u1ee9c n\u0103ng gan c\u1ea5p t\u00ednh, h\u1ed9i ch\u1ee9ng n\u00e3o gan: m\u1ec7t m\u1ecfi, v\u00e0ng da, xu\u1ea5t huy\u1ebft, d\u1ea5u hi\u1ec7u th\u1ea7n kinh…<\/p>\n

–\u00a0\u00a0\u00a0 C\u00e1c x\u00e9t nghi\u1ec7m sinh h\u00f3a: t\u0103ng bilirubin, NH3, AST, ALT th\u1eddi gian prothrombin k\u00e9o d\u00e0i \u2265 1,5.<\/p>\n

1.4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/h3>\n

Suy gan c\u1ea5p c\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi:<\/p>\n

–\u00a0\u00a0\u00a0 Ng\u1ed9 \u0111\u1ed9c thu\u1ed1c an th\u1ea7n g\u00e2y ng\u1ee7.<\/p>\n

–\u00a0\u00a0\u00a0 H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n

–\u00a0\u00a0\u00a0 H\u00f4n m\u00ea t\u0103ng \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u.<\/p>\n

–\u00a0\u00a0\u00a0 Tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o.<\/p>\n

–\u00a0\u00a0\u00a0 C\u00e1c b\u1ec7nh l\u00fd th\u1ea7n kinh kh\u00e1c.<\/p>\n

–\u00a0\u00a0\u00a0 \u0110\u1ee3t c\u1ea5p tr\u00ean m\u1ed9t b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh gan m\u1ea1n t\u00ednh (do vi\u00eam gan vi r\u00fat, x\u01a1 gan r\u01b0\u1ee3u, vi\u00eam gan t\u1ef1 mi\u1ec5n, b\u1ec7nh gan do r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a…).<\/p>\n

1.5. Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n.<\/h3>\n

–\u00a0\u00a0\u00a0 Suy gan c\u1ea5p do ng\u1ed9 \u0111\u1ed9c: x\u00e9t nghi\u1ec7m \u0111\u1ed9c ch\u1ea5t trong m\u00e1u n\u01b0\u1edbc ti\u1ec3u, d\u1ecbch d\u1ea1 d\u00e0y, \u0111\u1ecbnh l\u01b0\u1ee3ng paracetamol trong huy\u1ebft thanh.<\/p>\n

–\u00a0\u00a0\u00a0 Suy gan c\u1ea5p nghi do vi\u00eam gan virus: ch\u1ea9n \u0111o\u00e1n huy\u1ebft thanh: vi\u00eam gan A<\/p>\n

(IgM); vi\u00eam gan B (HbsAg; Anti HBC,\u0111\u1ebfm \u0111\u1ecbnh l\u01b0\u1ee3ng HBV DNA)….<\/p>\n

–\u00a0\u00a0\u00a0 Suy gan c\u1ea5p do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c: b\u1ec7nh t\u1ef1 mi\u1ec5n t\u00ecm kh\u00e1ng th\u1ec3 t\u1ef1 mi\u1ec5n, b\u1ec7nh r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a…<\/p>\n

–\u00a0\u00a0\u00a0 Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh: si\u00eau \u00e2m gan x\u00e1c \u0111\u1ecbnh t\u1eafc m\u1ea1ch gan, gan teo trong c\u00e1c vi\u00eam gan virus t\u1ed1i c\u1ea5p.<\/p>\n

1.6. Ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 suy gan c\u1ea5p.<\/h3>\n

Ph\u00e2n chia theo Lucke v\u00e0 Mallory: <\/strong>chia l\u00e0m 3 giai \u0111o\u1ea1n<\/p>\n

– Ti\u1ec1n tri\u1ec7u: l\u00e0 giai \u0111o\u1ea1n ch\u01b0a c\u00f3 v\u00e0ng da.<\/p>\n

–\u00a0\u00a0\u00a0 Giai \u0111o\u1ea1n trung gian: \u0111\u00e1nh d\u1ea5u b\u1eb1ng s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a v\u00e0ng da.<\/p>\n

–\u00a0\u00a0\u00a0 Giai \u0111o\u1ea1n cu\u1ed1i bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh l\u00fd n\u00e3o gan.<\/p>\n

Ph\u00e2n lo\u1ea1i l\u00e2m s\u00e0ng kinh \u0111i\u1ec3n: <\/strong>d\u1ef1a v\u00e0o kho\u1ea3ng th\u1eddi gian t\u1eeb khi bi\u1ec3u hi\u1ec7n v\u00e0ng da \u0111\u1ebfn khi xu\u1ea5t hi\u1ec7n b\u1ec7nh l\u00fd n\u00e3o gan.<\/p>\n

–\u00a0\u00a0\u00a0 Suy gan t\u1ed1i c\u1ea5p 7 ng\u00e0y.<\/p>\n

–\u00a0\u00a0\u00a0 Suy gan c\u1ea5p 8 – 28 ng\u00e0y.<\/p>\n

–\u00a0\u00a0\u00a0 Suy gan b\u00e1n c\u1ea5p 5 – 12 tu\u1ea7n.<\/p>\n

B\u1ec7nh l\u00fd n\u00e3o gan chia l\u00e0m 4 m\u1ee9c \u0111\u1ed9<\/strong>: r\u1ea5t h\u1eefu \u00edch trong ti\u00ean l\u01b0\u1ee3ng, theo d\u00f5i v\u00e0 th\u00e1i \u0111\u1ed9 x\u1eed tr\u00ed cho b\u1ec7nh nh\u00e2n.<\/p>\n

2. \u0110i\u1ec1u tr\u1ecb h\u1ed3i s\u1ee9c b\u1ec7nh nh\u00e2n suy gan c\u1ea5p.<\/h2>\n

2.1. C\u00e1c bi\u1ec7n ph\u00e1p h\u1ed3i s\u1ee9c c\u01a1 b\u1ea3n<\/h3>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 N\u1eb1m \u0111\u1ea7u cao 30 \u2013 45 \u0111\u1ed9 n\u1ebfu kh\u00f4ng c\u00f3 t\u1ee5t huy\u1ebft \u00e1p, h\u1ea1n ch\u1ebf t\u1ed1i \u0111a vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c an th\u1ea7n.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 H\u1ed3i s\u1ee9c h\u00f4 h\u1ea5p: t\u01b0 th\u1ebf an to\u00e0n, c\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p t\u00f9y thu\u1ed9c t\u00ecnh tr\u1ea1ng h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n. N\u1ebfu ph\u1ea3i \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n th\u1edf m\u00e1y, tr\u00e1nh d\u00f9ng PEEP qu\u00e1 cao v\u00ec l\u00e0m t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 H\u1ed3i s\u1ee9c tu\u1ea7n ho\u00e0n: duy tr\u00ec huy\u1ebft \u00e1p c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh cao h\u01a1n m\u1ee9c b\u00ecnh th\u01b0\u1eddng ho\u1eb7c huy\u1ebft \u00e1p n\u1ec1n \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o \u00e1p l\u1ef1c t\u01b0\u1edbi m\u00e1u n\u00e3o: s\u1eed d\u1ee5ng d\u1ecbch keo (albumin, gelatin) \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n, duy tr\u00ec Hb \u226510g\/dl. S\u1eed d\u1ee5ng thu\u1ed1c v\u1eadn m\u1ea1ch noradrenalin \u0111\u1ec3 duy tr\u00ec huy\u1ebft \u00e1p n\u1ebfu huy\u1ebft \u00e1p c n th\u1ea5p khi \u0111\u00e3 b\u00f9 \u0111\u1ee7 d\u1ecbch.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0110i\u1ec1u tr\u1ecb ch\u1ed1ng ph\u00f9 n\u00e3o: b\u1ec7nh nh\u00e2n suy gan c\u1ea5p \u1edf giai \u0111o\u1ea1n III v\u00e0 IV h\u1ea7u h\u1ebft c\u00f3 ph\u00f9 n\u00e3o. Ch\u1ebft n\u00e3o li\u00ean quan \u0111\u1ebfn ph\u00f9 n\u00e3o l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh c\u1ee7a t\u1eed vong do suy gan c\u1ea5p ngo\u00e0i c\u00e1c bi\u1ec7n ph\u00e1p \u0111\u1ea3m b\u1ea3o h\u00f4 h\u1ea5p, tu\u1ea7n ho\u00e0n nh\u01b0 tr\u00ean c\u1ea7n s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p:<\/p>\n

+ Manitol 20% :0,5g\/kg truy\u1ec1n t\u0129nh m\u1ea1ch trong 15 ph\u00fat l\u1eb7p l\u1ea1i n\u1ebfu \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u d\u01b0\u1edbi 320 mosm\/l.<\/p>\n

+ Duy tr\u00ec natri m\u00e1u 145 – 155 mmol\/l b\u1eb1ng truy\u1ec1n dung d\u1ecbch mu\u1ed1i natriclorua 3%.\u00a0 + Theo d\u00f5i v\u00e0 ki\u1ec3m so\u00e1t \u00e1p l\u1ef1c n\u1ed9i s\u1ecd n\u1ebfu th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c k\u1ef9 thu\u1eadt n\u00e0y. Ch\u1ec9 \u0111\u1ecbnh khi b\u1ec7nh nh\u00e2n \u1edf giai \u0111o\u1ea1n III, IV. \u0110\u1ea3m b\u1ea3o \u00e1p l\u1ef1c n\u1ed9i s\u1ecd < 25mmHg v\u00e0 \u00e1p l\u1ef1c t\u01b0\u1edbi m\u00e1u n\u00e3o 50 – 80mmHg.<\/p>\n

+ Thu\u1ed1c an th\u1ea7n n\u00ean s\u1eed d\u1ee5ng Pentobarbital (3 – 5mg\/kg li\u1ec1u ban \u0111\u1ea7u, sau \u0111\u00f3 duy tr\u00ec 1 – 3 mg\/kg\/gi\u1edd). Ch\u1ec9 \u0111\u1ecbnh khi b\u1ec7nh nh\u00e2n k\u00edch th\u00edch, co gi\u1eadt v\u00e0 \u0111au.<\/p>\n

2.2. C\u00e1c bi\u1ec7n ph\u00e1p h\u1ed3i s\u1ee9c c\u01a1 b\u1ea3n kh\u00e1c<\/h3>\n

+ D\u1ef1 ph\u00f2ng ch\u1ea3y m\u00e1u \u0111\u01b0\u1eddng ti\u00eau h\u00f3a: s\u1eed d\u1ee5ng kh\u00e1ng H2 li\u1ec1u cao: Ranitidin 1 – 3mg m\u1ed7i 8 gi\u1edd (t\u0129nh m\u1ea1ch) ho\u1eb7c \u1ee9c ch\u1ebf b\u01a1m proton.<\/p>\n

+ Theo d\u00f5i v\u00e0 \u0111i\u1ec1u ch\u1ec9nh n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i, th\u0103ng b\u1eb1ng toan ki\u1ec1m (L\u01b0u \u00fd h\u1ea1 natri m\u00e1u kh\u00f4ng b\u00f9 nhanh v\u00ec l\u00e0m t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd), c\u00e2n b\u1eb1ng d\u1ecbch v\u00e0o ra.<\/p>\n

+ Cung c\u1ea5p glucose b\u1eb1ng truy\u1ec1n dung d\u1ecbch glucose 10% ho\u1eb7c 20%, truy\u1ec1n li\u00ean t\u1ee5c v\u00e0 theo d\u00f5i \u0111\u01b0\u1eddng m\u00e1u theo gi\u1edd, tr\u00e1nh h\u1ea1 \u0111\u01b0\u1eddng m\u00e1u (l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong) c\u0169ng nh\u01b0 t\u0103ng \u0111\u01b0\u1eddng m\u00e1u l\u00e0m t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd.<\/p>\n

+ \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u: truy\u1ec1n plasma t\u01b0\u01a1i, ti\u1ec3u c\u1ea7u, y\u1ebfu t\u1ed1 t\u1ee7a khi c\u00f3 xu\u1ea5t huy\u1ebft t\u1ef1 ph\u00e1t ho\u1eb7c khi l\u00e0m th\u1ee7 thu\u1eadt x\u00e2m l\u1ea5n m\u00e0 INR > 1,5 ti\u1ec3u c\u1ea7u < 50.000; fibrinogen < 100mg\/dl. Vitamin K 10mg ti\u00eam t\u0129nh m\u1ea1ch \u0111\u1ec3 d\u1ef1 ph\u00f2ng.<\/p>\n

+ Dinh d\u01b0\u1ee1ng cho b\u1ec7nh nh\u00e2n suy gan c\u1ea5p \u01b0u ti\u00ean dinh d\u01b0\u1ee1ng \u0111\u01b0\u1eddng mi\u1ec7ng, \u0111\u1ea3m b\u1ea3o 35 – 40 Kcal\/kg\/ng\u00e0y; 0,5 – 1g protein\/kg\/ng\u00e0y.<\/p>\n

+ S\u1eed d\u1ee5ng kh\u00e1ng sinh:<\/p>\n

x Kh\u00e1ng sinh di\u1ec7t khu\u1ea9n \u0111\u01b0\u1eddng ru\u1ed9t ch\u1ecdn l\u1ecdc Neomycine, Rifampicin\u00a0 x S\u1eed d\u1ee5ng kh\u00e1ng sinh to\u00e0n th\u00e2n khi c\u00f3 b\u1eb1ng ch\u1ee9ng nhi\u1ec5m khu\u1ea9n.<\/p>\n

+ Thu\u1ed1c nhu\u1eadn tr\u00e0ng: Sorbitol, Duphalac.<\/p>\n

2.3. C\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb l\u1ecdc m\u00e1u h\u1ed7 tr\u1ee3 gan ngo\u00e0i c\u01a1 th\u1ec3<\/h3>\n

C\u00e1c bi\u1ec7n ph\u00e1p l\u1ecdc m\u00e1u c\u00f3 t\u00e1c d\u1ee5ng lo\u1ea1i b\u1ecf c\u00e1c ch\u1ea5t \u0111\u1ed9c s\u1ea3n sinh trong qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a, n\u00e2ng \u0111\u1ee1 gan v\u00e0 c\u00e1c c\u01a1 quan trong l\u00fac ch\u1edd \u0111\u1ee3i t\u1ebf b\u00e0o gan h\u1ed3i ph\u1ee5c ho\u1eb7c ch\u1edd \u0111\u1ee3i gh\u00e9p gan.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 L\u1ecdc m\u00e1u li\u00ean t\u1ee5c t\u0129nh m\u1ea1ch – t\u0129nh m\u1ea1ch (CVVH) ho\u1eb7c th\u1ea9m t\u00e1ch CVVHD. Ch\u1ec9 \u0111\u1ecbnh: b\u1ec7nh nh\u00e2n suy gan c\u1ea5p c\u00f3 suy th\u1eadn c\u1ea5p.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Thay huy\u1ebft t\u01b0\u01a1ng.: Thay huy\u1ebft t\u01b0\u01a1ng ch\u1ec9 \u0111\u1ecbnh khi: Bilirubin > 250 mmol\/l v\u00e0\/ ho\u1eb7c NH3> 150 \/l v\u00e0\/ ho\u1eb7c PT > 100 gi\u00e2y, \u0111\u1eb7c bi\u1ec7t n\u00ean th\u1ef1c hi\u1ec7n s\u1edbm khi tr\u00ean l\u00e2m s\u00e0ng c\u00f3 bi\u1ec3u hi\u1ec7n h\u1ed9i ch\u1ee9ng n\u00e3o gan \u1edf giai \u0111o\u1ea1n I , II<\/p>\n

– Gan nh\u00e2n t\u1ea1o (li\u1ec7u ph\u00e1p h\u1ea5p ph\u1ee5 ph\u00e2n t\u1eed t\u00e1i tu\u1ea7n ho\u00e0n \u2013 MARS) d\u00f9ng \u0111\u1ec3 h\u1ed7 tr\u1ee3 ch\u1ee9c n\u0103ng kh\u1eed \u0111\u1ed9c c\u1ee7a gan nh\u1edd lo\u1ea1i b\u1ecf c\u00e1c s\u1ea3n ph\u1ea9m chuy\u1ec3n h\u00f3a \u0111\u1ed9c h\u1ea1i h a tan trong n\u01b0\u1edbc c\u0169ng nh\u01b0 c\u00e1c ch\u1ea5t g\u1eafn k\u1ebft v\u1edbi protein b\u1eb1ng h\u1ec7 th\u1ed1ng MARS ngo\u00e0i c\u01a1 th\u1ec3, qua \u0111\u00f3 huy\u1ebft t\u01b0\u01a1ng \u0111\u01b0\u1ee3c l\u00e0m s\u1ea1ch trong kho\u1ea3ng th\u1eddi gian ch\u1edd \u0111\u1ee3i ch\u1ee9c n\u0103ng t\u1ebf b\u00e0o gan h\u1ed3i ph\u1ee5c ho\u1eb7c ph\u1eabu thu\u1eadt gh\u00e9p gan.<\/p>\n

2.4. \u0110i\u1ec1u tr\u1ecb theo nguy\u00ean nh\u00e2n<\/h3>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ng\u1ed9 \u0111\u1ed9c Paracetamol (v\u00e0 suy gan nhi\u1ec5m \u0111\u1ed9c c\u1ea5p t\u00ednh kh\u00e1c): N-acetylcysteine 140mg\/kg tr\u1ecdng l\u01b0\u1ee3ng ng\u01b0\u1eddi b\u1ec7nh li\u1ec1u ban \u0111\u1ea7u gi\u1edd, sau \u0111\u00f3 m\u1ed7i 4 gi\u1edd m\u1ed9t li\u1ec1u 70 mg \/kg \/l\u1ea7n (17 li\u1ec1u).<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 B\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n d\u1ecbch: corticoids.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Thu\u1ed1c kh\u00e1ng virus v\u1edbi vi\u00eam gan do vi r\u00fat.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0110\u00ecnh ch\u1ec9 thai ngh\u00e9n (gan nhi\u1ec5m m\u1ee1 c\u1ea5p n\u1eb7ng, h\u1ed9i ch\u1ee9ng HELLP \u2026).<\/p>\n

2.5. Gh\u00e9p gan:<\/h3>\n

C\u1ea7n li\u00ean h\u1ec7 v\u1edbi c\u00e1c \u0111\u01a1n v\u1ecb c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c gh\u00e9p gan trong qu\u00e1 tr\u00ecnh h\u1ed3i s\u1ee9c khi th\u1ea5y b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ec9 \u0111\u1ecbnh gh\u00e9p gan. Hi\u1ec7n t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb gh\u00e9p gan trong n\u01b0\u1edbc ch\u1ecdn ti\u00eau chu\u1ea9n theo King’s Colllege Hospital \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n suy gan c\u1ea5p.<\/p>\n

Ngu\u1ed3n: B\u1ed9 Y t\u1ebf 2015, H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c.<\/p>\n","protected":false},"excerpt":{"rendered":"

Suy gan c\u1ea5p l\u00e0 t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan m\u1ed9t c\u00e1ch \u1ed3 \u1ea1t do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau d\u1eabn \u0111\u1ebfn b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng c\u1ea5p t\u00ednh v\u1edbi c\u00e1c bi\u1ec3u hi\u1ec7n:v\u00e0ng da, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u,b\u1ec7nh l\u00fd n\u00e3o gan, suy \u0111a t\u1ea1ng\u2026 \u1edf m\u1ed9t ng\u01b0\u1eddi tr\u01b0\u1edbc \u0111\u00f3 c\u00f3 ch\u1ee9c n\u0103ng gan b\u00ecnh th\u01b0\u1eddng. […]<\/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":"\nSuy gan c\u1ea5p: h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Suy gan c\u1ea5p l\u00e0 t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan m\u1ed9t c\u00e1ch \u1ed3 \u1ea1t do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau d\u1eabn \u0111\u1ebfn b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng c\u1ea5p t\u00ednh.\" \/>\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=\"Suy gan c\u1ea5p: h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Suy gan c\u1ea5p l\u00e0 t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan m\u1ed9t c\u00e1ch \u1ed3 \u1ea1t do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau d\u1eabn \u0111\u1ebfn b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng c\u1ea5p t\u00ednh.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/20\/suy-gan-cap-huong-dan-chan-doan-va-dieu-tri\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-20T16:13:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-21T03:29:06+00:00\" \/>\n<meta name=\"author\" content=\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"8 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/20\/suy-gan-cap-huong-dan-chan-doan-va-dieu-tri\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/20\/suy-gan-cap-huong-dan-chan-doan-va-dieu-tri\/\",\"name\":\"Suy gan c\u1ea5p: h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - 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