{"id":24540,"date":"2023-04-19T11:22:07","date_gmt":"2023-04-19T04:22:07","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24540"},"modified":"2023-04-21T11:57:26","modified_gmt":"2023-04-21T04:57:26","slug":"tiep-can-dieu-tri-ton-thuong-than-cap-o-benh-nhan-xo-gan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/tiep-can-dieu-tri-ton-thuong-than-cap-o-benh-nhan-xo-gan\/","title":{"rendered":"Ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p \u1edf b\u1ec7nh nh\u00e2n x\u01a1 gan"},"content":{"rendered":"<p><strong>\u1ede b\u1ec7nh nh\u00e2n x\u01a1 gan, ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p d\u1ef1a v\u00e0o ti\u00eau chu\u1ea9n KDIGO hi\u1ec7u ch\u1ec9nh, l\u00e0 t\u0103ng creatinine huy\u1ebft thanh (sCr) &gt;0.3mg\/dL trong v\u00f2ng 48h ho\u1eb7c t\u0103ng &gt;50% so v\u1edbi creatinine n\u1ec1n trong v\u00f2ng 3 th\u00e1ng. T\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p (AKI) \u1edf ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t trong c\u00e1c th\u1ec3 sau: AKI tr\u01b0\u1edbc th\u1eadn, AKI trong h\u1ed9i ch\u1ee9ng gan th\u1eadn (HRS), AKI t\u1ea1i th\u1eadn (ch\u1ee7 y\u1ebfu ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p) v\u00e0 sau th\u1eadn.<\/strong><\/p>\n<h2><strong>1. Ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p \u1edf ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan.<\/strong><\/h2>\n<p>S\u1eed d\u1ee5ng sCr \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn \u1edf ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan c\u00f3 nhi\u1ec1u h\u1ea1n ch\u1ebf. Ch\u1ec9 m\u1ed9t s\u1ef1 t\u0103ng nh\u1eb9 c\u1ee7a sCr c\u0169ng \u0111\u00e3 c\u00f3 s\u1ef1 gi\u1ea3m n\u1eb7ng c\u1ee7a \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn (GFR).<\/p>\n<p>\u0110\u1ee9ng tr\u01b0\u1edbc b\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng sCr c\u1ea7n ph\u00e2n bi\u1ec7t \u0111\u00f3 l\u00e0 gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn trong t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p, b\u1ec7nh th\u1eadn c\u1ea5p (AKD) hay b\u1ec7nh th\u1eadn m\u1ea1n (CKD). C\u00e1c ti\u00eau chu\u1ea9n c\u1ee7a KDIGO \u0111\u01b0\u1ee3c \u0111\u01b0a ra:<\/p>\n<ul>\n<li>AKI: t\u0103ng sCr &gt;50% so v\u1edbi m\u1ee9c n\u1ec1n trong v\u00f2ng 7 ng\u00e0y ho\u1eb7c t\u0103ng &gt;0.3mg\/dL trong v\u00f2ng 2 ng\u00e0y.<\/li>\n<li>AKD: GFR &lt; 60ml\/ph\u00fat\/1.73m2 da trong &lt; 3 th\u00e1ng, ho\u1eb7c gi\u1ea3m GFR &gt;35% trong &lt;3 th\u00e1ng, ho\u1eb7c t\u0103ng sCr &gt;50% trong &lt;3 th\u00e1ng. V\u1ec1 h\u00ecnh \u1ea3nh h\u1ecdc:\u00a0 c\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u1eadn &lt;3 th\u00e1ng.<\/li>\n<li>CKD: GFR &lt; 60ml\/ph\u00fat\/1.73m2 da t\u1eeb 3 th\u00e1ng tr\u1edf l\u00ean. V\u1ec1 h\u00ecnh \u1ea3nh h\u1ecdc: t\u1ed5n th\u01b0\u01a1ng th\u1eadn t\u1eeb 3 th\u00e1ng.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>Khi ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p, c\u1ea7n \u0111\u00e1nh gi\u00e1 s\u1edbm nguy\u00ean nh\u00e2n\/y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y c\u1ee7a b\u1ec7nh. \u1ede ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan, \u0111\u00f3 l\u00e0:<\/p>\n<p>&#8211; Nhi\u1ec5m tr\u00f9ng.<\/p>\n<p>&#8211; L\u1ee3i ti\u1ec3u qu\u00e1 m\u1ee9c do thu\u1ed1c.<\/p>\n<p>&#8211; Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a.<\/p>\n<p>&#8211; Ch\u1ecdc th\u00e1o d\u1ecbch b\u00e1ng kh\u00f4ng b\u00f9 \u0111\u1ee7 th\u1ec3 t\u00edch.<\/p>\n<p>&#8211; D\u00f9ng thu\u1ed1c \u0111\u1ed9c th\u1eadn, NSAIDs.<\/p>\n<p>AKI tr\u01b0\u1edbc th\u1eadn do gi\u1ea3m th\u1ec3 t\u00edch, c\u00f3 th\u1ec3 do c\u00e1c nguy\u00ean nh\u00e2n: d\u00f9ng l\u1ee3i ti\u1ec3u, lactulose, m\u1ea5t m\u00e1u.<\/p>\n<p>AKI t\u1ea1i th\u1eadn c\u00f3 th\u1ec3 do: vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p, vi\u00eam th\u1eadn m\u00f4 k\u1ebd c\u1ea5p, b\u1ec7nh c\u1ea7u th\u1eadn do tr\u1ee5 m\u1eadt, ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p.<\/p>\n<p>Khi kh\u00f4ng t\u00ecm th\u1ea5y nguy\u00ean nh\u00e2n r\u00f5 r\u00e0ng, c\u1ea7n x\u1eed tr\u00ed ngay, \u0111\u1eb7c bi\u1ec7t t\u1eadp trung v\u00e0o t\u1ea7m so\u00e1t v\u00e0 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng. C\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u, ch\u1eb9n beta, thu\u1ed1c d\u00e3n m\u1ea1ch, thu\u1ed1c \u0111\u1ed9c th\u1eadn, NSAIDs n\u00ean ng\u1eebng ngay l\u1eadp t\u1ee9c.<\/p>\n<h2><strong>2. H\u1ed9i ch\u1ee9ng gan th\u1eadn: \u0111\u1ecbnh ngh\u0129a, ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed.<\/strong><\/h2>\n<h3><strong>2.1. \u0110\u1ecbnh ngh\u0129a<\/strong><\/h3>\n<p>H\u1ed9i ch\u1ee9ng gan th\u1eadn (HRS) l\u00e0 m\u1ed9t d\u1ea1ng suy ch\u1ee9c n\u0103ng th\u1eadn kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng m\u00f4 h\u1ecdc. HRS \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 co m\u1ea1ch th\u1eadn d\u1eabn t\u1edbi gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn, gi\u1ea3m GFR trong s\u1ef1 gi\u00e3n m\u1ea1ch t\u1ea1ng v\u00e0 m\u1ea1ch h\u1ec7 th\u1ed1ng.<\/p>\n<h3><strong>2.2. Ch\u1ea9n \u0111o\u00e1n HRS theo ti\u00eau chu\u1ea9n ICA-AKI<\/strong><\/h3>\n<ul>\n<li><a href=\"https:\/\/www.vinmec.com\/vi\/tieu-hoa-gan-mat\/thong-tin-suc-khoe\/chan-doan-va-cac-giai-doan-cua-xo-gan\/\">X\u01a1 gan c\u00f3 c\u1ed5 tr\u01b0\u1edbng<\/a> (b\u00e1ng).<\/li>\n<li>Ch\u1ea9n \u0111o\u00e1n AKI theo ti\u00eau chu\u1ea9n AKI-ICA.<\/li>\n<li>Kh\u00f4ng c\u1ea3i thi\u1ec7n sCr sau 2 ng\u00e0y ng\u1eebng l\u1ee3i ti\u1ec3u v\u00e0 b\u00f9 th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n b\u1eb1ng albumin 1g\/kg\/ng\u00e0y &#8211; 100\/ng\u00e0y.<\/li>\n<li>Kh\u00f4ng c\u00f3 cho\u00e1ng.<\/li>\n<li>Kh\u00f4ng s\u1eed d\u1ee5ng <a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/cac-loai-thuoc-co-gay-hai-cho-cua-ban\/\">thu\u1ed1c \u0111\u1ed9c th\u1eadn<\/a> g\u1ea7n \u0111\u00e2y.<\/li>\n<li>Kh\u00f4ng b\u1ec7nh l\u00fd nhu m\u00f4 th\u1eadn th\u1ec3 hi\u1ec7n qua \u0111\u1ea1m ni\u1ec7u v\u00e0 ti\u1ec3u m\u00e1u vi th\u1ec3 v\u00e0\/ho\u1eb7c <a href=\"https:\/\/vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/sieu-am-co-biet-bi-suy-khong\/\">b\u1ea5t th\u01b0\u1eddng tr\u00ean si\u00eau \u00e2m<\/a>.<\/li>\n<\/ul>\n<p><strong>Ch\u1ea9n \u0111o\u00e1n giai \u0111o\u1ea1n AKI:<\/strong><\/p>\n<p>Giai \u0111o\u1ea1n 1. T\u0103ng sCr &gt;0.3mg\/dL ho\u1eb7c t\u0103ng 1.5 &#8211; 2 l\u1ea7n m\u1ee9c n\u1ec1n.<\/p>\n<p>Giai \u0111o\u1ea1n 1A. SCr &lt; 1.5mg\/dL.<\/p>\n<p>Giai \u0111o\u1ea1n 1B. sCR &gt;1.5mg\/dL.<\/p>\n<p>Giai \u0111o\u1ea1n 2. T\u0103ng sCr t\u1eeb 2 &#8211; 3 l\u1ea7n m\u1ee9c n\u1ec1n.<\/p>\n<p>Giai \u0111o\u1ea1n 3. T\u0103ng sCr tr\u00ean 3 l\u1ea7n m\u1ee9c n\u1ec1n ho\u1eb7c &gt;4mg\/dL (353.6mcmol\/L).<\/p>\n<p><strong>Ph\u00e2n lo\u1ea1i c\u1ee7a HRS:<\/strong><\/p>\n<p>HRS type 1: gi\u1ea3m nhanh ch\u1ee9c n\u0103ng th\u1eadn, t\u0103ng g\u1ea5p \u0111\u00f4i sCr \u0111\u1ebfn 2.5mg\/dL d\u01b0\u1edbi 2 tu\u1ea7n.<\/p>\n<p>HRS type 2: sCr gi\u1ea3m v\u1eeba v\u00e0 \u1ed5n \u0111\u1ecbnh &gt;1.5mg\/dL nh\u01b0ng kh\u00f4ng th\u1ecfa ti\u00eau chu\u1ea9n HRS type 1.<\/p>\n<p>ICA c\u00f2n ph\u00e2n lo\u1ea1i HRS th\u00e0nh 2 th\u1ec3: HRS &#8211; AKI (HRS type 1) v\u00e0 HRS non-AKI (type 2). Ch\u1ea9n \u0111o\u00e1n HRS non-AKI trong b\u1ec7nh c\u1ea3nh b\u1ec7nh th\u1eadn m\u1ea1n ho\u1eb7c b\u1ec7nh th\u1eadn c\u1ea5p kh\u00f4ng th\u1ecfa ti\u00eau chu\u1ea9n AKI v\u00e0 k\u00e9o d\u00e0i &lt; 90 ng\u00e0y. HRS non-AKI \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi GFR&lt;60ml\/ph\u00fat\/1.73m2 v\u00e0 sCr t\u0103ng &lt; 50% so v\u1edbi m\u1ee9c n\u1ec1n.<\/p>\n<h3><strong>2.3. X\u1eed tr\u00ed HRS<\/strong><\/h3>\n<ul>\n<li>C\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng gan: \u0111i\u1ec1u tr\u1ecb vi\u00eam gan r\u01b0\u1ee3u, vi\u00eam gan virus B.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa: d\u00f9ng thu\u1ed1c v\u00e0 \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn (RRT).<\/li>\n<\/ul>\n<p><strong>Thu\u1ed1c co m\u1ea1ch v\u00e0 b\u00f9 th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n:<\/strong><\/p>\n<p>B\u00f9 th\u1ec3 t\u00edch th\u01b0\u1eddng d\u00f9ng albumin. Li\u1ec1u 1g\/kg\/ng\u00e0y &#8211; 100g\/ng\u00e0y trong 2 ng\u00e0y, sau \u0111\u00f3 20 &#8211; 40g\/ng\u00e0y. Theo EASL, li\u1ec1u albumin 20 &#8211; 40g\/ng\u00e0y.<\/p>\n<p>Thu\u1ed1c co m\u1ea1ch th\u01b0\u1eddng ch\u1ecdn vasopressin analog, trong \u0111\u00f3 terlipressin t\u00e1c d\u1ee5ng tr\u00ean V1 receptor v\u00e0 \u00edt t\u00e1c d\u1ee5ng ph\u1ee5. Bi\u1ebfn ch\u1ee9ng khi s\u1eed d\u1ee5ng c\u00f3 th\u1ec3 g\u1eb7p \u1edf 12% b\u1ec7nh nh\u00e2n v\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n thi\u1ebfu m\u00e1u c\u01a1 tim, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean, m\u1ea1ch m\u00e1u n\u00e3o. Li\u1ec1u 1 &#8211; 2 mg m\u1ed7i 4 &#8211; 6h, t\u1ed1i \u0111a 12mg\/ng\u00e0y, d\u00f9ng t\u1ed1i thi\u1ec3u 3 &#8211; 5 ng\u00e0y. Theo EASL, li\u1ec1u kh\u1edfi \u0111\u1ea7u 0.5 &#8211; 1mg bolus m\u1ed7i 4 &#8211; 6h, c\u00f3 th\u1ec3 truy\u1ec1n li\u00ean t\u1ee5c li\u1ec1u 2mg\/ng\u00e0y.<\/p>\n<p>M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p cho th\u1ea5y Norepinephrine c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng terlipressin khi k\u1ebft h\u1ee3p v\u1edbi albumin v\u00e0 c\u00f3 \u00edt t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n h\u01a1n.<\/p>\n<p>T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a terlipressin v\u00e0 norepinephrine l\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng thi\u1ebfu m\u00e1u c\u01a1 tim, \u0111\u1ed9t qu\u1ef5. Do \u0111\u00f3, c\u1ea7n t\u1ea7m so\u00e1t \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>Khi HRS t\u00e1i ph\u00e1t sau ng\u01b0ng \u0111i\u1ec1u tr\u1ecb, c\u1ea7n kh\u1edfi \u0111\u1ed9ng \u0111i\u1ec1u tr\u1ecb l\u1ea1i.<\/p>\n<p>Theo \u0111\u1ecbnh ngh\u0129a m\u1edbi c\u1ee7a HRS-AKI, \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb ho\u00e0n to\u00e0n \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a khi hi\u1ec7u s\u1ed1sCr &lt;0.3mg\/dL so v\u1edbi m\u1ee9c n\u1ec1n, \u0111\u00e1p \u1ee9ng m\u1ed9t ph\u1ea7n \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 c\u00f3 gi\u1ea3m \u0111\u1ed9 AKI v\u1ec1 m\u1ee9c t\u0103ng &gt;0.3mg\/dL so v\u1edbi m\u1ee9c n\u1ec1n.<\/p>\n<p><strong>Ph\u1eabu thu\u1eadt t\u1ea1o shut c\u1eeda ch\u1ee7 TIPS.<\/strong> S\u1eed d\u1ee5ng TIPS c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng th\u1eadn \u1edf b\u1ec7nh nh\u00e2n HRS type 1.<\/p>\n<p><strong>\u0110i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn:<\/strong> c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong b\u1ea5t k\u00ec th\u1ec3 AKI, ch\u1ec9 \u0111\u1ecbnh t\u00f9y m\u1ee9c \u0111\u1ed9 n\u1eb7ng. \u0110\u1ed1i v\u1edbi th\u1ec3 HRS-AKI, \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc khi kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c co m\u1ea1ch v\u00e0 albumin. Ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n x\u01a1 gan t\u01b0\u01a1ng t\u1ef1 nh\u01b0 d\u00e2n s\u1ed1 chung:<\/p>\n<ul>\n<li>R\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i ho\u1eb7c r\u1ed1i lo\u1ea1n th\u0103ng b\u1eb1ng ki\u1ec1m toan n\u1eb7ng, kh\u00e1ng tr\u1ecb.<\/li>\n<li>Qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch n\u1eb7ng ho\u1eb7c kh\u00e1ng tr\u1ecb.<\/li>\n<li>H\u1ed9i ch\u1ee9ng ure m\u00e1u cao.<\/li>\n<\/ul>\n<h2><strong>4. D\u1ef1 ph\u00f2ng t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p do h\u1ed9i ch\u1ee9ng gan th\u1eadn.<\/strong><\/h2>\n<p>D\u1ef1 ph\u00f2ng HRS-AKI c\u0169ng nh\u01b0 c\u00e1c nguy\u00ean nh\u00e2n AKI kh\u00e1c d\u1ef1a v\u00e0o s\u1eed d\u1ee5ng albumin \u1edf b\u1ec7nh nh\u00e2n vi\u00eam ph\u00fac m\u1ea1c nguy\u00ean ph\u00e1t v\u00e0 d\u1ef1 ph\u00f2ng vi\u00eam ph\u00fac m\u1ea1c nguy\u00ean ph\u00e1c b\u1eb1ng norfloxacin. Ngo\u00e0i ra, s\u1eed d\u1ee5ng pentoxyfilline c\u0169ng gi\u1ea3m t\u1ec9 l\u1ec7 m\u1eafc suy th\u1eadn \u1edf ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan v\u00e0 HRS type 1 c\u0169ng nh\u01b0 t\u1ec9 l\u1ec7 t\u1eed vong \u1edf ng\u01b0\u1eddi b\u1ec7nh vi\u00eam gan do r\u01b0\u1ee3u n\u1eb7ng.<\/p>\n<p>Khuy\u1ebfn c\u00e1o li\u1ec1u albumin 1.5g\/kg l\u00fac ch\u1ea9n \u0111o\u00e1n v\u00e0 1g\/kg v\u00e0o ng\u00e0y 3 \u1edf b\u1ec7nh nh\u00e2n vi\u00eam ph\u00fac m\u1ea1c nguy\u00ean ph\u00e1t \u0111\u1ec3 d\u1ef1 ph\u00f2ng AKI.<\/p>\n<p>Khuy\u1ebfn c\u00e1o li\u1ec1u norfloxacin 400mg\/ng\u00e0y \u0111\u1ec3 d\u1ef1 ph\u00f2ng vi\u00eam ph\u00fac m\u1ea1c nguy\u00ean ph\u00e1t (nhi\u1ec5m tr\u00f9ng d\u1ecbch b\u00e1ng) c\u0169ng nh\u01b0 d\u1ef1 ph\u00f2ng HRS-AKI.<\/p>\n<p><strong>T\u00e0i li\u1ec7u tham kh\u1ea3o:\u00a0<\/strong><\/p>\n<p class=\"article-header__title\">EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis.<\/p>\n<p>Textbook of critical care, 8e. NXB Elsevier.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u1ede b\u1ec7nh nh\u00e2n x\u01a1 gan, ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p d\u1ef1a v\u00e0o ti\u00eau chu\u1ea9n KDIGO hi\u1ec7u ch\u1ec9nh, l\u00e0 t\u0103ng creatinine huy\u1ebft thanh (sCr) &gt;0.3mg\/dL trong v\u00f2ng 48h ho\u1eb7c t\u0103ng &gt;50% so v\u1edbi creatinine n\u1ec1n trong v\u00f2ng 3 th\u00e1ng. T\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p (AKI) \u1edf ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t trong c\u00e1c [&hellip;]<\/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":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p \u1edf b\u1ec7nh nh\u00e2n x\u01a1 gan - Vinmec<\/title>\n<meta name=\"description\" content=\"T\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p \u1edf ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan c\u00f3 th\u1ec3 tr\u01b0\u1edbc th\u1eadn, HRS, t\u1ea1i th\u1eadn ho\u1eb7c sau th\u1eadn. 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