{"id":24520,"date":"2023-04-19T13:40:31","date_gmt":"2023-04-19T06:40:31","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24520"},"modified":"2023-04-19T14:27:54","modified_gmt":"2023-04-19T07:27:54","slug":"chan-doan-va-xu-tri-viem-tui-mat-cap-do-soi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/chan-doan-va-xu-tri-viem-tui-mat-cap-do-soi\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed vi\u00eam t\u00fai m\u1eadt c\u1ea5p do s\u1ecfi"},"content":{"rendered":"

Vi\u00eam t\u00fai m\u1eadt c\u1ea5p l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam c\u1ea5p t\u00ednh \u1edf t\u00fai m\u1eadt, th\u01b0\u1eddng l\u00e0 do s\u1ecfi t\u00fai m\u1eadt, ngo\u00e0i ra c\u00f2n c\u00f3 nguy\u00ean nh\u00e2n<\/a> kh\u00e1c (thi\u1ebfu m\u00e1u, r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng, t\u1ed5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp h\u00f3a ch\u1ea5t, vi tr\u00f9ng, \u0111\u1ed9ng v\u1eadt \u0111\u01a1n b\u00e0o, k\u00fd sinh tr\u00f9ng, b\u1ec7nh collagen, v\u00e0 ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng). T\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 g\u00e2y \u0111au nhi\u1ec1u,\u00a0 kh\u00f3 ch\u1ecbu v\u00e0 c\u00f3 nguy c\u01a1 cao g\u00e2y ra bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/strong><\/p>\n

\"H\u00ecnh
H\u00ecnh \u1ea3nh s\u1ecfi t\u00fai m\u1eadt<\/figcaption><\/figure>\n

1. Nguy\u00ean nh\u00e2n<\/b><\/h2>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0 90 – 95%: Do s\u1ecfi t\u00fai m\u1eadt <\/strong><\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0 5 \u2013 10%: Kh\u00f4ng do s\u1ecfi <\/strong><\/p>\n

+ C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c: Ch\u1ea5n th\u01b0\u01a1ng, th\u01b0\u01a1ng h\u00e0n, ung th\u01b0, h\u1eb9p c\u01a1 v\u00f2ng oddi.<\/p>\n

+ Vi khu\u1ea9n: C\u1ea5y d\u1ecbch t\u00fai m\u1eadt hay d\u1ecbch \u0111\u01b0\u1eddng m\u1eadt (+) kho\u1ea3ng 15 \u2013 50%, vi khu\u1ea9n th\u01b0\u1eddng g\u1eb7p Escherichia coli, Enterococcus, Klebsiella v\u00e0 Enterobacter.<\/p>\n

2. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/b><\/h2>\n

2.1.\u00a0\u00a0\u00a0 <\/strong>Giai \u0111o\u1ea1n 1 (T\u00fai m\u1eadt c\u0103ng to) <\/strong><\/h3>\n

–\u00a0\u00a0\u00a0\u00a0 \u0110au b\u1ee5ng v\u00f9ng th\u01b0\u1ee3ng v\u1ecb qu\u1eb7n t\u1eebng c\u01a1n<\/p>\n

–\u00a0\u00a0\u00a0\u00a0 \u00d3i (kh\u00f4ng b\u1edbt \u0111au)<\/p>\n

2.2.\u00a0\u00a0\u00a0 <\/strong>Giai \u0111o\u1ea1n 2 (Vi\u00eam t\u00fai m\u1eadt m\u1ee7) <\/strong><\/h3>\n

–\u00a0\u00a0\u00a0\u00a0 \u0110au b\u1ee5ng khu tr\u00fa HSP (\u0111au lien t\u1ee5c), c\u00f3 th\u1ec3 \u0111au sau l\u01b0ng ho\u1eb7c \u0111au \u1edf vai P. \uf02d To\u00e0n th\u00e2n: s\u1ed1t, t\u0103ng b\u1ea1ch c\u1ea7u<\/p>\n

–\u00a0\u00a0\u00a0\u00a0 Kh\u00e1m: Murphy (+)<\/p>\n

2.3.\u00a0\u00a0\u00a0 <\/strong>Giai \u0111o\u1ea1n 3 ( T\u00fai m\u1eadt ho\u1ea1i t\u1eed) <\/strong><\/h3>\n

–\u00a0\u00a0\u00a0\u00a0 To\u00e0n th\u00e2n: d\u1ea5u hi\u1ec7u nhi\u1ec5m \u0111\u1ed9, s\u1ed1t cao, t\u0103ng b\u1ea1ch c\u1ea7u<\/p>\n

–\u00a0\u00a0\u00a0\u00a0 C\u00f3 ph\u1ea3n \u1ee9ng th\u00e0nh b\u1ee5ng, co c\u1ee9ng th\u00e0nh b\u1ee5ng, ph\u1ea3n \u1ee9ng d\u1ed9i<\/p>\n

2.4.\u00a0\u00a0\u00a0 <\/strong>Giai \u0111o\u1ea1n 4 (Th\u1ee7ng t\u00fai m\u1eadt) <\/strong><\/h3>\n

–\u00a0\u00a0\u00a0\u00a0 Trung b\u00ecnh th\u1eddi gian th\u1ee7ng t\u00fai m\u1eadt 48-72h, s\u1edbm h\u01a1n v\u1edbi b\u1ec7nh nh\u00e2n \u0110T\u0110, b\u1ec7nh t\u1ea1o keo, vi\u00eam t\u1eafc \u0111\u1ed9ng m\u1ea1ch v.v\u2026<\/p>\n

3. C\u1eadn l\u00e2m s\u00e0ng<\/h2>\n

3.1.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 B\u1ea1ch c\u1ea7u t\u0103ng, CRP t\u0103ng<\/h3>\n

3.2.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Amygdales m\u00e1u t\u0103ng \u00edt<\/h3>\n

3.3.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bilirubin huy\u1ebft thanh<\/h3>\n

C\u00f3 th\u1ec3 t\u0103ng < 60mmol\/l do h\u1ed9i ch\u1ee9ng Mirrizzin, >60mmol\/l th\u01b0\u1eddng do s\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7.<\/p>\n

3.4.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 X Quang b\u1ee5ng kh\u00f4ng chu\u1ea9n b\u1ecb:<\/h3>\n

10 \u2013 15% th\u1ea5y s\u1ecfi (ph\u00e2n bi\u1ec7t s\u1ecfi th\u1eadn). C\u00f3 th\u1ec3 th\u1ea5y m\u1ef1c n\u01b0\u1edbc h\u01a1i trong t\u00fai m\u1eadt.<\/h3>\n

3.5.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 CT Scan:<\/h3>\n

\u0110\u00e2y l\u00e0 m\u1ed9t ch\u1ea9n \u0111o\u00e1n c\u00f3 gi\u00e1 tr\u1ecb cao, nh\u01b0ng kh\u00f4ng ph\u1ea3i XN \u0111\u1ea7u tay<\/p>\n

3.6.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 MRI:<\/h3>\n

Gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n cao, x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed gi\u1ea3i ph\u1eabu, m\u1eadt \u0111\u1ed9, c\u1ea5u tr\u00fac s\u1ecfi, \u0111\u1ed9 nh\u1ea1y 96.5%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 97.7%<\/p>\n

3.7.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Si\u00eau \u00e2m:<\/h3>\n

\u0110\u1ed9 nh\u1ea1y s\u1ecfi m\u1eadt ngo\u00e0i gan 95.9%, th\u00e0nh t\u00fai m\u1eadt d\u00e0y > 3mm, \u0111\u01b0\u1eddng k\u00ednh ngang t\u00fai m\u1eadt > 4cm, \u0111\u01b0\u1eddng k\u00ednh d\u1ecdc > 8cm.<\/p>\n

4. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n<\/strong><\/h2>\n

(Tokyo Guidelines 2006):<\/p>\n

    \n
  • 1.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 D\u1ea5u hi\u1ec7u vi\u00eam t\u00fai m\u1eadt khu tr\u00fa: \u0110au \u00bc b\u1ee5ng tr\u00ean P, Murphy (+)<\/li>\n
  • 2.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 D\u1ea5u hi\u1ec7u to\u00e0n th\u00e2n: S\u1ed1t, t\u0103ng CRP, t\u0103ng b\u1ea1ch c\u1ea7u.<\/li>\n
  • 3.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 H\u00ecnh \u1ea3nh h\u1ecdc c\u1ee7a vi\u00eam t\u00fai m\u1eadt<\/li>\n
  • 4.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ch\u1ea9n \u0111o\u00e1n: 01 d\u1ea5u hi\u1ec7u A, v\u00e0 d\u1ea5u hi\u1ec7u B (d\u1ea5u hi\u1ec7u t\u00edch c\u1ef1c)<\/li>\n
  • 5.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 H\u00ecnh \u1ea3nh h\u1ecdc c\u1ee7a vi\u00eam t\u00fai m\u1eadt kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n khi l\u00e2m s\u00e0ng nghi ng\u1edd.<\/li>\n<\/ul>\n

    5. Ph\u00e2n lo\u1ea1i theo c\u1ea5p \u0111\u1ed9(Theo TOKYO guideline 2013) <\/strong><\/h2>\n

    5.1.<\/strong> C\u1ea5p I (Vi\u00eam t\u00fai m\u1eadt nh\u1eb9) <\/strong><\/h3>\n

    –\u00a0\u00a0\u00a0\u00a0 T\u00ecnh tr\u1ea1ng vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh nh\u01b0ng kh\u00f4ng c\u00f3 thay \u0111\u1ed5i ch\u1ee9c n\u0103ng c\u00e1c c\u01a1 quan.<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 Kh\u1ed9ng c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a vi\u00eam t\u00fai m\u1eadt c\u1ea5p II, c\u1ea5p III<\/p>\n

    5.2.<\/strong> \u00a0\u00a0 <\/strong>C\u1ea5p II (<\/strong>Vi\u00eam t\u00fai m\u1eadt trung b\u00ecnh<\/strong>) <\/strong><\/h3>\n

    (Vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh k\u00e8m v\u1edbi b\u1ea5t k\u1ef3 d\u1ea5u hi\u1ec7u n\u00e0o d\u01b0\u1edbi \u0111\u00e2y).\u00a0 \uf02d Th\u1eddi gian xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng > 72h<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 S\u1edd \u0111\u01b0\u1ee3c kh\u1ed1i mass \u1edf \u00bc b\u1ee5ng tr\u00ean b\u00ean P<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 Vi\u00eam ph\u00fac m\u1ea1c khu tr\u00fa do t\u00fai m\u1eadt ho\u1ea1i t\u1eed, apxe t\u00fai m\u1eadt<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 B\u1ea1ch c\u1ea7u t\u0103ng > 18.000\/ml<\/p>\n

    5.3.<\/strong> \u00a0\u00a0 <\/strong>C\u1ea5p III( Vi\u00eam t\u00fai m\u1eadt n\u1eb7ng) <\/strong><\/h3>\n

    (Vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh k\u00e8m v\u1edbi b\u1ea5t k\u1ef3 d\u1ea5u hi\u1ec7u n\u00e0o d\u01b0\u1edbi \u0111\u00e2y).<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim m\u1ea1ch (h\u1ea1 HA c\u1ea7n \u0111i\u1ec1u tr\u1ecb v\u1edbi dopamine \u22655mcg\/kg\/ph\u00fat ho\u1eb7c li\u1ec1u b\u1ea5t k\u1ef3 Doputamine<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea7n kinh (gi\u1ea3m m\u1ee9c \u0111\u1ed9 \u00fd th\u1ee9c)<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p (t\u1ef7 l\u1ec7 PaO2\/FiO2 < 300)<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn (thi\u1ec3u ni\u1ec7u, creatinin > 2mg\/dl)<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan (PT INR > 1.5)<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 R\u1ed1i lo\u1ea1n huy\u1ebft h\u1ecdc (ti\u1ec3u c\u1ea7u gi\u1ea3m < 100.000\/mm3)<\/p>\n

    6. \u0110i\u1ec1u tr\u1ecb<\/strong><\/h2>\n

    \u0110i\u1ec1u tr\u1ecb vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh c\u01a1 b\u1ea3n bao g\u1ed3m: ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf t\u00fai m\u1eadt s\u1edbm v\u00e0 ph\u1eabu thu\u1eadt \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u cho t\u1eebng lo\u1ea1i m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u<\/p>\n

    6.1.<\/strong> \u00a0\u00a0\u00a0\u00a0 <\/strong>N\u1ed9i khoa <\/strong><\/h3>\n

    6.1.1. M\u1ee9c \u0111\u1ed9 nh\u1eb9 v\u00e0 m\u1ee9c \u0111\u1ed9 v\u1eeba: <\/strong><\/h4>\n

    –\u00a0\u00a0\u00a0\u00a0 Nh\u1ecbn \u0103n, \u0111\u1eb7t sonde m\u0169i \u2013 d\u1ea1 d\u00e0y<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 Truy\u1ec1n d\u1ecbch \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 D\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf ph\u00f3 giao c\u1ea3m (nh\u01b0 Atropin, Propanthelin) \u0111\u1ec3 \u1ee9c ch\u1ebf th\u1ea7n kinh X (gi\u1ea3m ti\u1ebft acid, gi\u1ea3m co th\u1eaft c\u01a1 v\u00f2ng Oddi v\u00e0 co b\u00f3p t\u00fai m\u1eadt).<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 Theo d\u00f5i c\u00f4ng th\u1ee9c m\u00e1u m\u1ed7i 6 gi\u1edd, theo d\u00f5i nhi\u1ec7t \u0111\u1ed9 m\u1ed7i 2 gi\u1edd, theo d\u00f5i kh\u00e1m b\u1ee5ng m\u1ed7i 2 -3 gi\u1edd.<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 N\u1ebfu b\u1ec7nh nh\u00e2n qua c\u01a1n \u0111au c\u0169ng n\u00ean s\u1eafp x\u1ebfp m\u1ed5 ch\u01b0\u01a1ng tr\u00ecnh s\u1edbm.<\/p>\n

    6.1.2. M\u1ee9c \u0111\u1ed9 v\u1eeba kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng: <\/strong><\/h4>\n

    –\u00a0\u00a0\u00a0\u00a0 M\u1ee9c \u0111\u1ed9 nh\u1eb9 v\u00e0 m\u1ee9c \u0111\u1ed9 v\u1eeba \u0111\u00e1p \u1ee9ng.<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 B\u1ed5 sung c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ec7nh l\u00fd \u0111i k\u00e8m.<\/p>\n

    – D\u00f9ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng b\u1eb1ng \u0111\u01b0\u1eddng to\u00e0n th\u00e2n \u0111\u1ec3 h\u1ea1n ch\u1ebf nhi\u1ec5m tr\u00f9ng nh\u1ea5t l\u00e0 c\u00e1c b\u1ec7nh nh\u00e2n gi\u00e0 tr\u00ean 70 tu\u1ed5i, b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec3u \u0111\u01b0\u1eddng\u2026(Cephalosporin th\u1ebf h\u1ec7 3,\u00a0 Beta-lactam + Metronidazol).<\/p>\n

    6.2.<\/strong> \u00a0\u00a0\u00a0\u00a0 <\/strong>Ngo\u1ea1i khoa <\/strong><\/h3>\n

    –\u00a0\u00a0\u00a0\u00a0 N\u1ebfu b\u1ec7nh nh\u00e2n gi\u00e0 y\u1ebfu, suy ki\u1ec7t n\u1eb7ng, \u0111\u1ebfn mu\u1ed9n, nhi\u1ec5m \u0111\u1ed9c n\u1eb7ng, c\u00f3 b\u1ec7nh m\u1ea1n t\u00ednh nh\u01b0 ti\u1ec3u \u0111\u01b0\u1eddng, lao ph\u1ed5i, b\u1ec7nh tim m\u1ea1ch\u2026v\u00e0 n\u1ebfu t\u00fai m\u1eadt kh\u00f4ng vi\u00eam n\u1eb7ng l\u1eafm th\u00ec d\u1eabn l\u01b0u t\u00fai m\u1eadt.<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 N\u1ebfu b\u1ec7nh nh\u00e2n tr\u1ebb, th\u1ec3 tr\u1ea1ng t\u1ed1t, m\u1ed5 s\u1edbm tr\u01b0\u1edbc 48 gi\u1edd v\u00e0 t\u00fai m\u1eadt vi\u00eam n\u1eb7ng (nung m\u1ee7 hay ho\u1ea1i t\u1eed) th\u00ec n\u00ean c\u1eaft t\u00fai m\u1eadt.<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 Th\u1eddi gian \u0111\u1ec3 chuy\u1ec3n m\u1ed5 n\u1ed9i soi sang m\u1ed5 h\u1edf c\u1eaft t\u00fai m\u1eadt:<\/p>\n

    + Khi ph\u1eabu thu\u1eadt n\u1ed9i soi g\u1eb7p kh\u00f3 kh\u0103n (t\u00f9y theo kh\u1ea3 n\u0103ng c\u1ee7a ph\u1eabu thu\u1eadt vi\u00ean n\u1ed9i soi), b\u00e1c s\u0129 ph\u1eabu thu\u1eadt kh\u00f4ng ng\u1ea7n ng\u1ea1i chuy\u1ec3n sang m\u1ed5 m\u1edf. (Kh\u00f4ng ph\u1ea3i l\u00e0 b\u1ea5t l\u1ee3i cho b\u1ec7nh nh\u00e2n m\u00e0 l\u00e0 ng\u0103n ch\u1eb7n tai bi\u1ebfn v\u00e0 bi\u1ebfn ch\u1ee9ng khi ph\u1eabu thu\u1eadt n\u1ed9i soi c\u1eaft t\u00fai m\u1eadt kh\u00f3 kh\u0103n).<\/p>\n

    –\u00a0\u00a0\u00a0\u00a0 Th\u1eddi gian \u0111\u1ec3 m\u1ed5 c\u1eaft t\u00fai m\u1eadt sau m\u1edf d\u1eabn l\u01b0u t\u00fai m\u1eadt ra da:<\/p>\n

    + \u00a0\u00a0 Th\u1ef1c hi\u1ec7n v\u00e0i ng\u00e0y sau khi d\u1eabn l\u01b0u t\u00fai m\u1eadt ra da<\/p>\n

    + \u00a0\u00a0 T\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n c\u1ea3i thi\u1ec7n sau d\u1eabn l\u01b0u<\/p>\n

    + \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kh\u00f4ng c\u00f3 bi\u1ebfn ch\u1ee9ng c\u1ee7a d\u1eabn l\u01b0u: t\u1ee5 m\u00e1u, \u00e1p xe, vi\u00eam ph\u00fac m\u1ea1c m\u1eadt, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i …<\/p>\n

    * Bi\u1ebfn ch\u1ee9ng ph\u1eabu thu\u1eadt:<\/strong><\/p>\n

    + \u00a0\u00a0 T\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng m\u1eadt v\u00e0 c\u00e1c c\u01a1 quan kh\u00e1c.<\/p>\n

    + \u00a0\u00a0 \u00a0Nhi\u1ec5m tr\u00f9ng v\u1ebft m\u1ed5, t\u1eafc ru\u1ed9t, ch\u1ea3y m\u00e1u, x\u1eb9p ph\u1ed5i, thuy\u00ean t\u1eafc m\u1ea1ch do huy\u1ebft kh\u1ed1i, nhi\u1ec5m tr\u00f9ng ti\u1ec3u.<\/p>\n

    T\u00f3m l\u1ea1i quy\u1ebft \u0111\u1ecbnh ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p nh\u1ea5t cho m\u1ed7i b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u01b0a ra sau khi tham kh\u1ea3o \u00fd ki\u1ebfn c\u1ee7a c\u00e1c chuy\u00ean gia y t\u1ebf v\u00e0 x\u00e1c \u0111\u1ecbnh c\u00e1c y\u1ebfu t\u1ed1 li\u00ean quan nh\u01b0 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe chung, l\u1ecbch s\u1eed b\u1ec7nh v\u00e0 kh\u1ea3 n\u0103ng ch\u1ecbu \u0111\u1ef1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

    T\u00e0i li\u1ec7u tham kh\u1ea3o: <\/strong><\/p>\n

    1.\u00a0\u00a0\u00a0\u00a0\u00a0 S\u1ecfi \u0111\u01b0\u1eddng m\u1eadt, Nguy\u1ec5n \u0110\u00ecnh H\u1ed1i \u2013 Nguy\u1ec5n M\u1eadu Anh, 2012.<\/p>\n

    2.\u00a0\u00a0\u00a0\u00a0\u00a0 Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Vi\u00eam t\u00fai m\u1eadt c\u1ea5p l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam c\u1ea5p t\u00ednh \u1edf t\u00fai m\u1eadt, th\u01b0\u1eddng l\u00e0 do s\u1ecfi t\u00fai m\u1eadt, ngo\u00e0i ra c\u00f2n c\u00f3 nguy\u00ean nh\u00e2n kh\u00e1c (thi\u1ebfu m\u00e1u, r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng, t\u1ed5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp h\u00f3a ch\u1ea5t, vi tr\u00f9ng, \u0111\u1ed9ng v\u1eadt \u0111\u01a1n b\u00e0o, k\u00fd sinh tr\u00f9ng, b\u1ec7nh collagen, v\u00e0 ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng). T\u00ecnh […]<\/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 x\u1eed tr\u00ed vi\u00eam t\u00fai m\u1eadt c\u1ea5p do s\u1ecfi - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam t\u00fai m\u1eadt c\u1ea5p l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam c\u1ea5p t\u00ednh \u1edf t\u00fai m\u1eadt, th\u01b0\u1eddng l\u00e0 do s\u1ecfi t\u00fai m\u1eadt, ngo\u00e0i ra c\u00f2n c\u00f3 nguy\u00ean nh\u00e2n kh\u00e1c (thi\u1ebfu m\u00e1u, r\u1ed1i lo\u1ea1n ...\" \/>\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=\"Ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed vi\u00eam t\u00fai m\u1eadt c\u1ea5p do s\u1ecfi - 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