{"id":24137,"date":"2023-04-19T18:32:17","date_gmt":"2023-04-19T11:32:17","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24137"},"modified":"2023-04-20T16:24:30","modified_gmt":"2023-04-20T09:24:30","slug":"tokyo-guideline-2018-nhung-cap-nhat-trong-viem-tui-mat","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/tokyo-guideline-2018-nhung-cap-nhat-trong-viem-tui-mat\/","title":{"rendered":"Tokyo Guideline 2018: nh\u1eefng c\u1eadp nh\u1eadt trong vi\u00eam t\u00fai m\u1eadt"},"content":{"rendered":"

Vi\u00eam t\u00fai m\u1eadt l\u00e0 m\u1ed9t s\u1ef1 vi\u00eam nhi\u1ec5m c\u1ee7a t\u00fai m\u1eadt th\u01b0\u1eddng x\u1ea3y ra do s\u1ecfi m\u1eadt. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, n\u00f3 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nhi\u1ec1u bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m. Tokyo Guideline\u00a0 2018 cung c\u1ea5p c\u00e1c khuy\u1ebfn ngh\u1ecb d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng cho vi\u1ec7c qu\u1ea3n l\u00fd vi\u00eam t\u00fai m\u1eadt. B\u00e0i vi\u1ebft n\u00e0y cung c\u1ea5p m\u1ed9t t\u1ed5ng quan v\u1ec1 c\u00e1c khuy\u1ebfn ngh\u1ecb ch\u00ednh \u0111\u1ec3 qu\u1ea3n l\u00fd vi\u00eam t\u00fai m\u1eadt c\u1ea5p.<\/strong><\/p>\n

1. Tokyo Guideline l\u00e0 g\u00ec<\/h2>\n

V\u00e0o n\u0103m 2007, h<\/span>\u01b0\u1edbng d\u1eabn Tokyo v\u1ec1 qu\u1ea3n l\u00fd vi\u00eam \u0111\u01b0\u1eddng m\u1eadt c\u1ea5p t\u00ednh\/vi\u00eam t\u00fai m\u1eadt\u00a0 c\u1ea5p<\/a> t\u00ednh (Tokyo Guideline 07) \u0111\u00e3 \u0111\u01b0\u1ee3c xu\u1ea5t b\u1ea3n tr\u00ean T\u1ea1p ch\u00ed Khoa h\u1ecdc Gan m\u1eadt T\u1ee5y<\/em> (JHBPS) l\u00e0 h\u01b0\u1edbng d\u1eabn nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng m\u1eadt c\u1ea5p t\u00ednh qu\u1ed1c\u00a0 gia \u0111\u1ea7u ti\u00ean tr\u00ean th\u1ebf gi\u1edbi. Tuy nhi\u00ean, sau khi xu\u1ea5t b\u1ea3n Tokyo Guideline 07, m\u1ed9t\u00a0 kho\u1ea3ng c\u00e1ch \u0111\u00e3 \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y gi\u1eefa c\u00e1c khuy\u1ebfn ngh\u1ecb v\u00e0\u00a0 c\u00e1c quy\u1ebft \u0111\u1ecbnh l\u00e2m s\u00e0ng v\u00e0 li\u1ec7u ph\u00e1p trong th\u1ebf gi\u1edbi th\u1ef1c. \u0110\u1ec3\u00a0 <\/span>gi\u1ea3i quy\u1ebft kho\u1ea3ng c\u00e1ch n\u00e0y, m\u1ed9t phi\u00ean b\u1ea3n c\u1eadp nh\u1eadt c\u1ee7a h\u01b0\u1edbng d\u1eabn TG13 \u0111\u00e3 \u0111\u01b0\u1ee3c xu\u1ea5t b\u1ea3n tr\u00ean JHBPS d\u1ef1a tr\u00ean s\u1ef1 \u0111\u1ed3ng\u00a0 thu\u1eadn qu\u1ed1c t\u1ebf \u0111\u01b0\u1ee3c c\u1eadp nh\u1eadt v\u00e0o n\u0103m 2012 v\u00e0 l\u1ea7n \u0111\u1ea7u ti\u00ean, <\/span>ph\u01b0\u01a1ng ph\u00e1p GRADE \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a b\u1eb1ng ch\u1ee9ng s\u1eb5n c\u00f3.<\/span><\/p>\n

\u0110\u1ec3 x\u00e1c minh c\u00e1c khuy\u1ebfn ngh\u1ecb trong h\u01b0\u1edbng d\u1eabn b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng\u00a0 c\u01a1 s\u1edf d\u1eef li\u1ec7u l\u1edbn, Gi\u00e1o s\u01b0 Takada \u0111\u00e3 thu th\u1eadp v\u00e0 ph\u00e2n t\u00edch k\u1ebft\u00a0 qu\u1ea3 c\u1ee7a c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c qu\u1ea3n l\u00fd theo TG13 trong m\u1ed9t d\u1ef1 \u00e1n\u00a0 nghi\u00ean c\u1ee9u chung \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n gi\u1eefa Nh\u1eadt B\u1ea3n v\u00e0 \u0110\u00e0i Loan. N\u0103m\u00a0 2018, Tokyo Guideline 18 \u0111\u01b0\u1ee3c t\u1ea1o ra d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng m\u1edbi thu \u0111\u01b0\u1ee3c th\u00f4ng\u00a0 qua d\u1ef1 \u00e1n nghi\u00ean c\u1ee9u chung n\u00e0y v\u00e0 v\u1edbi s\u1ef1 tham gia c\u1ee7a Gi\u00e1o s\u01b0\u00a0 Steven Strasberg v\u00e0 nhi\u1ec1u chuy\u00ean gia kh\u00e1c t\u1eeb kh\u1eafp n\u01a1i tr\u00ean th\u1ebf gi\u1edbi. M\u1ed9t c\u1eadp nh\u1eadt l\u1edbn trong Tokyo Guideline 18 l\u00e0 s\u1eeda \u0111\u1ed5i l\u01b0u \u0111\u1ed3 \u0111\u1ec3 qu\u1ea3n l\u00fd\u00a0 <\/span>vi\u00eam t\u00fai m\u1eadt c\u1ea5p (VTMC).\u00a0<\/span><\/p>\n

C\u00e1c l\u01b0u \u0111\u1ed3 cung c\u1ea5p m\u1ed9t l\u1ef1a ch\u1ecdn c\u00e1c chi\u1ebfn l\u01b0\u1ee3c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb VTMC\u00a0 \u1edf t\u1eebng m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng d\u1ef1a tr\u00ean ba y\u1ebfu t\u1ed1 r\u1ee7i ro: c\u00e1c y\u1ebfu t\u1ed1\u00a0 ti\u00ean \u0111o\u00e1n, \u0111i\u1ec3m Ch\u1ec9 s\u1ed1 b\u1ec7nh \u0111i k\u00e8m Charlson (CCI) v\u00e0 \u0111i\u1ec3m ph\u00e2n\u00a0 lo\u1ea1i t\u00ecnh tr\u1ea1ng th\u1ec3 ch\u1ea5t c\u1ee7a Hi\u1ec7p h\u1ed9i b\u00e1c s\u0129 g\u00e2y m\u00ea Hoa K\u1ef3 (ASA-PS) . Quy\u1ebft \u0111\u1ecbnh l\u1ef1a ch\u1ecdn c\u1eaft b\u1ecf t\u00fai m\u1eadt ho\u1eb7c d\u1eabn l\u01b0u t\u00fai m\u1eadt\u00a0 gi\u1edd \u0111\u00e2y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u01b0a ra b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng l\u01b0u \u0111\u1ed3 Tokyo Guideline 18.\u00a0<\/span><\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u00fai m\u1eadt c\u1ea5p<\/h2>\n

Theo H\u01b0\u1edbng d\u1eabn Tokyo 18, ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u00fai m\u1eadt c\u1ea5p \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh:<\/p>\n\n\n\n\n\n\n\n\n\n\n
A. D\u1ea5u hi\u1ec7u vi\u00eam c\u1ee5c b\u1ed9.<\/td>\n<\/tr>\n
(1) D\u1ea5u hi\u1ec7u Murphy, (2) Kh\u1ed1i l\u01b0\u1ee3ng RUQ \/ \u0111au \/ \u0111au<\/td>\n<\/tr>\n
B. D\u1ea5u hi\u1ec7u vi\u00eam to\u00e0n th\u00e2n, v.v.<\/td>\n<\/tr>\n
(1) S\u1ed1t, (2) CRP t\u0103ng, (3) s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u t\u0103ng<\/td>\n<\/tr>\n
C. K\u1ebft qu\u1ea3 h\u00ecnh \u1ea3nh<\/td>\n<\/tr>\n
Ph\u00e1t hi\u1ec7n h\u00ecnh \u1ea3nh \u0111\u1eb7c tr\u01b0ng c\u1ee7a vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh<\/td>\n<\/tr>\n
Ch\u1ea9n \u0111o\u00e1n nghi ng\u1edd:<\/b>\u00a0m\u1ed9t m\u1ee5c trong A + m\u1ed9t m\u1ee5c trong B<\/td>\n<\/tr>\n
Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/b>\u00a0m\u1ed9t m\u1ee5c trong A + m\u1ed9t m\u1ee5c trong B + C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

2. \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Vi\u00eam t\u00fai m\u1eadt c\u1ea5p \u0111\u1ed9 III (n\u1eb7ng)<\/strong><\/td>\n<\/tr>\n
Vi\u00eam t\u00fai m\u1eadt c\u1ea5p\u00a0 “\u0111\u1ed9 III” c\u00f3 li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u1ee7a b\u1ea5t k\u1ef3 c\u01a1 quan \/ h\u1ec7 th\u1ed1ng n\u00e0o sau \u0111\u00e2y:<\/td>\n<\/tr>\n
1. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim m\u1ea1ch: h\u1ea1 huy\u1ebft \u00e1p c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng dopamine \u22655 \u03bcg\/kg m\u1ed7i ph\u00fat, ho\u1eb7c b\u1ea5t k\u1ef3 li\u1ec1u norepinephrine n\u00e0o<\/td>\n<\/tr>\n
2. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea7n kinh: gi\u1ea3m m\u1ee9c \u0111\u1ed9 \u00fd th\u1ee9c<\/td>\n<\/tr>\n
3. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p: PaO2<\/sub>\/Fio2<\/sub>\u00a0T\u1ef7 l\u1ec7 <300<\/td>\n<\/tr>\n
4. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn: thi\u1ec3u ni\u1ec7u, creatinine >2,0 mg\/dl<\/td>\n<\/tr>\n
5. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan: PT-INR >1,5<\/td>\n<\/tr>\n
6. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng huy\u1ebft h\u1ecdc: s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u <100.000\/mm3<\/sup><\/td>\n<\/tr>\n
Vi\u00eam t\u00fai m\u1eadt c\u1ea5p \u0111\u1ed9 II (trung b\u00ecnh)<\/strong><\/td>\n<\/tr>\n
Vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh “\u0111\u1ed9 II” c\u00f3 li\u00ean quan \u0111\u1ebfn b\u1ea5t k\u1ef3 m\u1ed9t trong c\u00e1c \u0111i\u1ec1u ki\u1ec7n sau \u0111\u00e2y:<\/td>\n<\/tr>\n
1. S\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u t\u0103ng (>18.000 \/ mm3<\/sup>)<\/td>\n<\/tr>\n
2. Kh\u1ed1i s\u1edd th\u1ea5y \u1edf g\u00f3c ph\u1ea7n t\u01b0 b\u1ee5ng tr\u00ean b\u00ean ph\u1ea3i<\/td>\n<\/tr>\n
3. Th\u1eddi gian tri\u1ec7u ch\u1ee9ng >72 gi\u1edd<\/td>\n<\/tr>\n
4. D\u1ea5u vi\u00eam c\u1ee5c b\u1ed9 (vi\u00eam t\u00fai m\u1eadt ho\u1ea1i t\u1eed, \u00e1p xe quanh t\u00fai m\u1eadt, \u00e1p xe gan, vi\u00eam ph\u00fac m\u1ea1c m\u1eadt, vi\u00eam t\u00fai m\u1eadt kh\u00ed ph\u1ebf th\u0169ng)<\/td>\n<\/tr>\n
Vi\u00eam t\u00fai m\u1eadt c\u1ea5p \u0111\u1ed9 I (nh\u1eb9)<\/strong><\/td>\n<\/tr>\n
Vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh “\u0110\u1ed9 I” kh\u00f4ng \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau ch\u00ed c\u1ee7a vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh “\u0110\u1ed9 III” ho\u1eb7c “\u0110\u1ed9 II”. N\u00f3 c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n kh\u1ecfe m\u1ea1nh kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 quan v\u00e0 thay \u0111\u1ed5i vi\u00eam nh\u1eb9 trong t\u00fai m\u1eadt, l\u00e0m cho ph\u1eabu thu\u1eadt c\u1eaft t\u00fai m\u1eadt an to\u00e0n v\u00e0 r\u1ee7i ro th\u1ea5p<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

3. Qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n vi\u00eam t\u00fai m\u1eadt c\u1ea5p<\/h2>\n

3.1. Charlson comorbidity index<\/h3>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Ti\u00eau ch\u00ed<\/th>\n\u0110i\u1ec3m<\/th>\n<\/tr>\n
B\u1ec7nh k\u00e8m theo<\/strong><\/td>\n<\/td>\n<\/tr>\n
1<\/td>\n<\/tr>\n
1<\/td>\n<\/tr>\n
1<\/td>\n<\/tr>\n
1<\/td>\n<\/tr>\n
1<\/td>\n<\/tr>\n
1<\/td>\n<\/tr>\n
1<\/td>\n<\/tr>\n
1<\/td>\n<\/tr>\n
1<\/td>\n<\/tr>\n
1<\/td>\n<\/tr>\n
2<\/td>\n<\/tr>\n
2<\/td>\n<\/tr>\n
2<\/td>\n<\/tr>\n
2<\/td>\n<\/tr>\n
2<\/td>\n<\/tr>\n
2<\/td>\n<\/tr>\n
3<\/td>\n<\/tr>\n
6<\/td>\n<\/tr>\n
6<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n
\u0110i\u1ec3m<\/th>\n\u00dd ngh\u0129a<\/th>\n<\/tr>\n
\u2265 6<\/td>\nPh\u1eabu thu\u1eadt nguy c\u01a1 cao<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

3.2. Thang \u0111i\u1ec3m ASA-PS<\/h3>\n

\u0110i\u1ec3m ASA-PS l\u00e0 m\u1ed9t ch\u1ec9 s\u1ed1 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n b\u1edfi Hi\u1ec7p h\u1ed9i B\u00e1c s\u0129 G\u00e2y m\u00ea Hoa K\u1ef3 \u0111\u1ec3 cung c\u1ea5p s\u1ef1 hi\u1ec3u bi\u1ebft v\u1ec1 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt<\/p>\n\n\n\n\n\n\n\n\n\n
Ph\u00e2n lo\u1ea1i ASA-PS<\/th>\n\u0110\u1ecbnh ngh\u0129a<\/th>\nV\u00ed d\u1ee5, bao g\u1ed3m, nh\u01b0ng kh\u00f4ng gi\u1edbi h\u1ea1n \u1edf:<\/th>\n<\/tr>\n
ASA I<\/td>\nM\u1ed9t b\u1ec7nh nh\u00e2n kh\u1ecfe m\u1ea1nh b\u00ecnh th\u01b0\u1eddng<\/td>\nL\u00e0nh m\u1ea1nh, kh\u00f4ng h\u00fat thu\u1ed1c, kh\u00f4ng s\u1eed d\u1ee5ng ho\u1eb7c s\u1eed d\u1ee5ng r\u01b0\u1ee3u t\u1ed1i thi\u1ec3u<\/td>\n<\/tr>\n
Ch\u00e2u \u00c1 II<\/td>\nM\u1ed9t b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh h\u1ec7 th\u1ed1ng nh\u1eb9<\/td>\nB\u1ec7nh nh\u1eb9 ch\u1ec9 m\u00e0 kh\u00f4ng c\u00f3 gi\u1edbi h\u1ea1n ch\u1ee9c n\u0103ng \u0111\u00e1ng k\u1ec3. V\u00ed d\u1ee5 bao g\u1ed3m (nh\u01b0ng kh\u00f4ng gi\u1edbi h\u1ea1n): ng\u01b0\u1eddi h\u00fat thu\u1ed1c hi\u1ec7n t\u1ea1i, ng\u01b0\u1eddi u\u1ed1ng r\u01b0\u1ee3u x\u00e3 h\u1ed9i, mang thai, b\u00e9o ph\u00ec (30 < BMI < 40), DM \/ HTN \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t, b\u1ec7nh ph\u1ed5i nh\u1eb9<\/td>\n<\/tr>\n
ASA III<\/td>\nM\u1ed9t b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh h\u1ec7 th\u1ed1ng n\u1eb7ng<\/td>\nH\u1ea1n ch\u1ebf ch\u1ee9c n\u0103ng th\u1ef1c ch\u1ea5t; m\u1ed9t ho\u1eb7c nhi\u1ec1u b\u1ec7nh t\u1eeb trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng. V\u00ed d\u1ee5 bao g\u1ed3m (nh\u01b0ng kh\u00f4ng gi\u1edbi h\u1ea1n \u1edf): DM ho\u1eb7c HTN \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t k\u00e9m, COPD, b\u00e9o ph\u00ec (BMI \u226540), vi\u00eam gan ho\u1ea1t \u0111\u1ed9ng, nghi\u1ec7n r\u01b0\u1ee3u ho\u1eb7c l\u1ea1m d\u1ee5ng, m\u00e1y t\u1ea1o nh\u1ecbp tim c\u1ea5y gh\u00e9p, gi\u1ea3m ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u v\u1eeba ph\u1ea3i, ESRD l\u1ecdc m\u00e1u th\u01b0\u1eddng xuy\u00ean, PCA tr\u1ebb sinh non <60 tu\u1ea7n, ti\u1ec1n s\u1eed (>3 th\u00e1ng) NH\u1ed2I M\u00c1U C\u01a0 TIM, CVA, TIA ho\u1eb7c CAD\/stent<\/td>\n<\/tr>\n
ASA IV<\/td>\nM\u1ed9t b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh h\u1ec7 th\u1ed1ng nghi\u00eam tr\u1ecdng l\u00e0 m\u1ed1i \u0111e d\u1ecda th\u01b0\u1eddng tr\u1ef1c \u0111\u1ebfn t\u00ednh m\u1ea1ng<\/td>\nV\u00ed d\u1ee5 bao g\u1ed3m (nh\u01b0ng kh\u00f4ng gi\u1edbi h\u1ea1n \u1edf): NH\u1ed2I M\u00c1U C\u01a0 TIM, CVA, TIA ho\u1eb7c CAD\/stent g\u1ea7n \u0111\u00e2y (<3 th\u00e1ng), thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 tim li\u00ean t\u1ee5c ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng van n\u1eb7ng, gi\u1ea3m ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u nghi\u00eam tr\u1ecdng, nhi\u1ec5m tr\u00f9ng huy\u1ebft, DIC, ARD ho\u1eb7c ESRD kh\u00f4ng \u0111\u01b0\u1ee3c l\u1ecdc m\u00e1u theo l\u1ecbch tr\u00ecnh th\u01b0\u1eddng xuy\u00ean<\/td>\n<\/tr>\n
ASA V<\/td>\nM\u1ed9t b\u1ec7nh nh\u00e2n h\u1ea5p h\u1ed1i kh\u00f4ng \u0111\u01b0\u1ee3c mong \u0111\u1ee3i s\u1ebd s\u1ed1ng s\u00f3t n\u1ebfu kh\u00f4ng ph\u1eabu thu\u1eadt<\/td>\nV\u00ed d\u1ee5 bao g\u1ed3m (nh\u01b0ng kh\u00f4ng gi\u1edbi h\u1ea1n \u1edf): ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch b\u1ee5ng\/ng\u1ef1c b\u1ecb v\u1ee1, ch\u1ea5n th\u01b0\u01a1ng n\u1eb7ng, ch\u1ea3y m\u00e1u n\u1ed9i s\u1ecd c\u00f3 hi\u1ec7u \u1ee9ng kh\u1ed1i, ru\u1ed9t thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 khi \u0111\u1ed1i m\u1eb7t v\u1edbi b\u1ec7nh l\u00fd tim \u0111\u00e1ng k\u1ec3 ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng \u0111a c\u01a1 quan\/h\u1ec7 th\u1ed1ng<\/td>\n<\/tr>\n
ASA VI<\/td>\nM\u1ed9t b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c tuy\u00ean b\u1ed1 ch\u1ebft n\u00e3o c\u00f3 n\u1ed9i t\u1ea1ng \u0111ang \u0111\u01b0\u1ee3c l\u1ea5y ra cho m\u1ee5c \u0111\u00edch hi\u1ebfn t\u1eb7ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

3.3. \u0110i\u1ec1u tr\u1ecb<\/h3>\n

\u0110\u1ed9 I:<\/h4>\n
\"Tokyo
L\u01b0u \u0111\u1ed3 TG18 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh \u0111\u1ed9 I.<\/figcaption><\/figure>\n

VTMC \u0111\u1ed9 I kh\u00e1ng sinh, ch\u0103m s\u00f3c h\u1ed7 tr\u1ee3 ban \u0111\u1ea7u, theo d\u00f5i v\u00e0 ph\u1eabu thu\u1eadt n\u1ed9i soi c\u1eaft t\u00fai m\u1eadt s\u1edbm.<\/p>\n

    \n
  • \u00a0\u03bb, CCI 5 tr\u1edf xu\u1ed1ng v\u00e0\/ho\u1eb7c ASA lo\u1ea1i II tr\u1edf xu\u1ed1ng (nguy c\u01a1 th\u1ea5p);<\/li>\n
  • \u03bc, CCI 6 tr\u1edf l\u00ean v\u00e0\/ho\u1eb7c ASA lo\u1ea1i III tr\u1edf l\u00ean (nguy c\u01a1 kh\u00f4ng th\u1ea5p);<\/li>\n
  • \u25b5, trong tr\u01b0\u1eddng h\u1ee3p g\u1eb7p kh\u00f3 kh\u0103n nghi\u00eam tr\u1ecdng v\u1ec1 ph\u1eabu thu\u1eadt, n\u00ean s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf ho\u1eb7c chuy\u1ec3n trung t\u00e2m l\u1edbn h\u01a1n.<\/li>\n<\/ul>\n

    \u0110\u1ed9 II:<\/h4>\n
    \"Tokyo
    L\u01b0u \u0111\u1ed3 TG18 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam t\u00fai m\u1eadt c\u1ea5p \u0111\u1ed9 II<\/figcaption><\/figure>\n
      \n
    • \u03b1, kh\u00e1ng sinh v\u00e0 ch\u0103m s\u00f3c h\u1ed7 tr\u1ee3 chung th\u00e0nh c\u00f4ng;<\/li>\n
    • \u03c6, thu\u1ed1c kh\u00e1ng sinh v\u00e0 ch\u0103m s\u00f3c h\u1ed7 tr\u1ee3 n\u00f3i chung kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng vi\u00eam;<\/li>\n
    • \u03bb, CCI 5 tr\u1edf xu\u1ed1ng v\u00e0\/ho\u1eb7c ASA-PS lo\u1ea1i II tr\u1edf xu\u1ed1ng (nguy c\u01a1 th\u1ea5p);<\/li>\n
    • \u03bc, CCI 6 tr\u1edf l\u00ean v\u00e0\/ho\u1eb7c ASA-PS lo\u1ea1i III tr\u1edf l\u00ean (nguy c\u01a1 kh\u00f4ng th\u1ea5p);<\/li>\n
    • \u203b, c\u1ea7n xem x\u00e9t hi\u1ec7u su\u1ea5t nu\u00f4i c\u1ea5y m\u00e1u tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u d\u00f9ng kh\u00e1ng sinh;<\/li>\n
    • \u2020, nu\u00f4i c\u1ea5y m\u1eadt c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong qu\u00e1 tr\u00ecnh d\u1eabn l\u01b0u GB;<\/li>\n
    • \u25b5, trong tr\u01b0\u1eddng h\u1ee3p g\u1eb7p kh\u00f3 kh\u0103n nghi\u00eam tr\u1ecdng v\u1ec1 ph\u1eabu thu\u1eadt, n\u00ean s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf ho\u1eb7c chuy\u1ec3n trung t\u00e2m l\u1edbn h\u01a1n.<\/li>\n<\/ul>\n

      \u0110\u1ed9 III:<\/h4>\n
      \"Tokyo
      L\u01b0u \u0111\u1ed3 TG18 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam t\u00fai m\u1eadt c\u1ea5p \u0111\u1ed9 III<\/figcaption><\/figure>\n

      \u203b, c\u1ea7n xem x\u00e9t hi\u1ec7u su\u1ea5t nu\u00f4i c\u1ea5y m\u00e1u tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u d\u00f9ng kh\u00e1ng sinh;<\/p>\n

      #, c\u00e1c y\u1ebfu t\u1ed1 d\u1ef1 \u0111o\u00e1n ti\u00eau c\u1ef1c: v\u00e0ng da (TotalBil \u22652), r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea7n kinh, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p;<\/p>\n

      \u03a6, FOSF: suy h\u1ec7 c\u01a1 quan thu\u1eadn l\u1ee3i = suy tim m\u1ea1ch ho\u1eb7c suy h\u1ec7 th\u1ed1ng c\u01a1 quan th\u1eadn c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c nhanh sau khi nh\u1eadp vi\u1ec7n v\u00e0 tr\u01b0\u1edbc khi c\u1eaft t\u00fai m\u1eadt n\u1ed9i soi s\u1edbm trong VTMC;<\/p>\n

      *, trong tr\u01b0\u1eddng h\u1ee3p C\u1ea5p III, CCI (ch\u1ec9 s\u1ed1 b\u1ec7nh \u0111i k\u00e8m Charlson) 4 tr\u1edf l\u00ean, ASA-PS 3 tr\u1edf l\u00ean c\u00f3 nguy c\u01a1 cao; \u2020, nu\u00f4i c\u1ea5y m\u1eadt c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong qu\u00e1 tr\u00ecnh d\u1eabn l\u01b0u t\u00fai m\u1eadt;<\/p>\n

      \u03a8, trung t\u00e2m n\u00e2ng cao = ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t v\u00e0 k\u1ef9 thu\u1eadt n\u1ed9i soi ti\u00ean ti\u1ebfn c\u00f3 s\u1eb5n;<\/p>\n

      \u25b5, trong tr\u01b0\u1eddng h\u1ee3p g\u1eb7p kh\u00f3 kh\u0103n nghi\u00eam tr\u1ecdng v\u1ec1 ph\u1eabu thu\u1eadt, n\u00ean s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf ho\u1eb7c chuy\u1ec3n trung t\u00e2m l\u1edbn h\u01a1n.<\/p>\n

      K\u1ebft lu\u1eadn,<\/strong> Tokyo Guideline 2018 khuy\u1ebfn ngh\u1ecb c\u1eaft t\u00fai m\u1eadt b\u1eb1ng ph\u1eabu thu\u1eadt n\u1ed9i soi s\u1edbm cho h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n vi\u00eam t\u00fai m\u1eadt c\u1ea5p, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng. \u0110i\u1ec1u tr\u1ecb kh\u00f4ng ph\u1eabu thu\u1eadt b\u1eb1ng c\u00e1ch nh\u1ecbn \u0103n, truy\u1ec1n d\u1ecbch v\u00e0 kh\u00e1ng sinh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m ban \u0111\u1ea7u cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p nh\u1eb9, nh\u01b0ng b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd v\u00e0 c\u00e2n nh\u1eafc ph\u1eabu thu\u1eadt n\u1ebfu kh\u00f4ng c\u00f3 c\u1ea3i thi\u1ec7n ho\u1eb7c tri\u1ec7u ch\u1ee9ng r\u1ea7m r\u1ed9 h\u01a1n. C\u1eaft t\u00fai m\u1eadt b\u1eb1ng ph\u1eabu thu\u1eadt n\u1ed9i soi tr\u00ec ho\u00e3n kho\u1ea3ng 6-8 tu\u1ea7n sau \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u c\u00f3 th\u1ec3 an to\u00e0n h\u01a1n cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao.<\/p>\n

      T\u00e0i li\u1ec7u tham kh\u1ea3o: Tokyo Guidelines 2018<\/p>\n","protected":false},"excerpt":{"rendered":"

      Vi\u00eam t\u00fai m\u1eadt l\u00e0 m\u1ed9t s\u1ef1 vi\u00eam nhi\u1ec5m c\u1ee7a t\u00fai m\u1eadt th\u01b0\u1eddng x\u1ea3y ra do s\u1ecfi m\u1eadt. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, n\u00f3 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nhi\u1ec1u bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m. Tokyo Guideline\u00a0 2018 cung c\u1ea5p c\u00e1c khuy\u1ebfn ngh\u1ecb d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng cho vi\u1ec7c qu\u1ea3n l\u00fd vi\u00eam t\u00fai m\u1eadt. B\u00e0i vi\u1ebft n\u00e0y cung […]<\/p>\n","protected":false},"author":15,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[3],"yoast_head":"\nTokyo Guideline 2018: nh\u1eefng c\u1eadp nh\u1eadt trong vi\u00eam t\u00fai m\u1eadt - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam t\u00fai m\u1eadt l\u00e0 m\u1ed9t s\u1ef1 vi\u00eam nhi\u1ec5m c\u1ee7a t\u00fai m\u1eadt th\u01b0\u1eddng x\u1ea3y ra do s\u1ecfi m\u1eadt. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, n\u00f3 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nhi\u1ec1u bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m. Tokyo Guideline\u00a0 2018 cung c\u1ea5p c\u00e1c khuy\u1ebfn ngh\u1ecb d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng cho vi\u1ec7c qu\u1ea3n l\u00fd vi\u00eam t\u00fai m\u1eadt. B\u00e0i vi\u1ebft n\u00e0y cung c\u1ea5p m\u1ed9t t\u1ed5ng quan v\u1ec1 c\u00e1c khuy\u1ebfn ngh\u1ecb ch\u00ednh \u0111\u1ec3 qu\u1ea3n l\u00fd vi\u00eam t\u00fai m\u1eadt c\u1ea5p.\" \/>\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=\"Tokyo Guideline 2018: nh\u1eefng c\u1eadp nh\u1eadt trong vi\u00eam t\u00fai m\u1eadt - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Vi\u00eam t\u00fai m\u1eadt l\u00e0 m\u1ed9t s\u1ef1 vi\u00eam nhi\u1ec5m c\u1ee7a t\u00fai m\u1eadt th\u01b0\u1eddng x\u1ea3y ra do s\u1ecfi m\u1eadt. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, n\u00f3 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nhi\u1ec1u bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m. Tokyo Guideline\u00a0 2018 cung c\u1ea5p c\u00e1c khuy\u1ebfn ngh\u1ecb d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng cho vi\u1ec7c qu\u1ea3n l\u00fd vi\u00eam t\u00fai m\u1eadt. B\u00e0i vi\u1ebft n\u00e0y cung c\u1ea5p m\u1ed9t t\u1ed5ng quan v\u1ec1 c\u00e1c khuy\u1ebfn ngh\u1ecb ch\u00ednh \u0111\u1ec3 qu\u1ea3n l\u00fd vi\u00eam t\u00fai m\u1eadt c\u1ea5p.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/tokyo-guideline-2018-nhung-cap-nhat-trong-viem-tui-mat\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-19T11:32:17+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-20T09:24:30+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/grade-i-300x92.webp\" \/>\n<meta name=\"author\" content=\"Minh Tang Phuong\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Minh Tang Phuong\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"9 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\/19\/tokyo-guideline-2018-nhung-cap-nhat-trong-viem-tui-mat\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/tokyo-guideline-2018-nhung-cap-nhat-trong-viem-tui-mat\/\",\"name\":\"Tokyo Guideline 2018: nh\u1eefng c\u1eadp nh\u1eadt trong vi\u00eam t\u00fai m\u1eadt - Vinmec\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-19T11:32:17+00:00\",\"dateModified\":\"2023-04-20T09:24:30+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/1f3505046718c2227ed72bac35a0fbcc\"},\"description\":\"Vi\u00eam t\u00fai m\u1eadt l\u00e0 m\u1ed9t s\u1ef1 vi\u00eam nhi\u1ec5m c\u1ee7a t\u00fai m\u1eadt th\u01b0\u1eddng x\u1ea3y ra do s\u1ecfi m\u1eadt. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, n\u00f3 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nhi\u1ec1u bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m. Tokyo Guideline\u00a0 2018 cung c\u1ea5p c\u00e1c khuy\u1ebfn ngh\u1ecb d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng cho vi\u1ec7c qu\u1ea3n l\u00fd vi\u00eam t\u00fai m\u1eadt. 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