{"id":25787,"date":"2023-04-20T23:55:21","date_gmt":"2023-04-20T16:55:21","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25787"},"modified":"2023-04-21T11:49:08","modified_gmt":"2023-04-21T04:49:08","slug":"hoi-chung-gan-than-cap-huong-dan-xu-tri-hoi-suc","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/20\/hoi-chung-gan-than-cap-huong-dan-xu-tri-hoi-suc\/","title":{"rendered":"H\u1ed9i ch\u1ee9ng gan th\u1eadn c\u1ea5p: h\u01b0\u1edbng d\u1eabn x\u1eed tr\u00ed h\u1ed3i s\u1ee9c"},"content":{"rendered":"

H\u1ed9i ch\u1ee9ng gan th\u1eadn (HCGT) l\u00e0 t\u00ecnh tr\u1ea1ng suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn c\u1ea5p t\u00ednh x\u1ea3y ra tr\u00ean ng\u01b0\u1eddi b\u1ec7nh b\u1ecb b\u1ec7nh gan c\u1ea5p ho\u1eb7c \u0111\u1ee3t c\u1ea5p \u1edf b\u1ec7nh gan giai \u0111o\u1ea1n cu\u1ed1i<\/a>, ch\u1ee7 y\u1ebfu g\u1eb7p \u1edf ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan c\u1ed5 tr\u01b0\u1edbng t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda, vi\u00eam gan do r\u01b0\u1ee3u, ho\u1eb7c hi\u1ebfm g\u1eb7p h\u01a1n nh\u01b0 kh\u1ed1i u gan, vi\u00eam gan t\u1ed1i c\u1ea5p do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c nhau (vi\u00eam gan vi r\u00fat, x\u01a1 gan m\u1eadt ti\u00ean ph\u00e1t, vi\u00eam gan nhi\u1ec5m \u0111\u1ed9c, t\u1ed5n th\u01b0\u01a1ng gan trong s\u1ed1c).<\/strong><\/p>\n

1. X\u1eed tr\u00ed ban \u0111\u1ea7u v\u00e0 v\u1eadn chuy\u1ec3n c\u1ea5p c\u1ee9u b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng gan th\u1eadn.<\/h2>\n
    \n
  • X\u1eed tr\u00ed c\u00e1c d\u1ea5u hi\u1ec7u n\u1eb7ng:<\/strong><\/li>\n<\/ul>\n

    + Suy th\u1eadn c\u1ea5p: \u0111\u1eb7t \u1ed1ng th\u00f4ng t\u0129nh m\u1ea1ch trung t\u00e2m \u0111\u1ec3 ki\u1ec3m so\u00e1t th\u1ec3 t\u00edch n\u01b0\u1edbc v\u00e0o-ra, d\u00f9ng l\u1ee3i ti\u1ec3u khi c\u00f3 thi\u1ec3u ni\u1ec7u, v\u00f4 ni\u1ec7u.<\/p>\n

    +T\u0103ng kali m\u00e1u: n\u1ebfu kali m\u00e1u > 6 mmol\/l v\u00e0 ho\u1eb7c c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp tim c\u1ea7n \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u.<\/p>\n

    + Ph\u00f9 ph\u1ed5i c\u1ea5p, ph\u00f9 to\u00e0n th\u00e2n: ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c l\u1ee3i ti\u1ec3u furosemid ti\u00eam t\u0129nh m\u1ea1ch 20-40 mg\/l\u1ea7n, kh\u00f4ng \u0111\u00e1p \u1ee9ng cho t\u1edbi 100-200 mg\/l\u1ea7n, t\u1ed1i \u0111a 600-1000mg\/ng\u00e0y.<\/p>\n

    + H\u1ed9i ch\u1ee9ng n\u00e3o-gan: c\u1ea7n lo\u1ea1i tr\u1eeb h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, duy tr\u00ec truy\u1ec1n t\u0129nh m\u1ea1ch glucosa 10-20%, gi\u1ea3i ph\u00f3ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, \u0111\u1eb7t canun mayo mi\u1ec7ng, tr\u00e1nh \u1ee9 \u0111\u1ecdng \u0111\u1eddm, n\u1ebfu c\u00f3\u00a0 suy h\u00f4 h\u1ea5p, r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c c\u1ea7n \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n b\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf, \u0111\u1ec1 ph\u00f2ng thi\u1ebfu oxy.<\/p>\n

    + Ph\u00f9 n\u00e3o, co gi\u1eadt: b\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf, an th\u1ea7n c\u1eaft c\u01a1n gi\u1eadt b\u1eb1ng diazepam 10 mg ti\u00eam b\u1eafp ho\u1eb7c t\u0129nh m\u1ea1ch (ho\u1eb7c midazolam 5 mg, phenobacbital 100 mg).<\/p>\n

    Khi v\u1eadn chuy\u1ec3n ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n ch\u00fa \u00fd \u0111\u1ea3m b\u1ea3o v\u1ec1 h\u00f4 h\u1ea5p, tu\u1ea7n ho\u00e0n, r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c g\u00e2y m\u1ea5t kh\u1ea3 n\u0103ng t\u1ef1 b\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf, r\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/p>\n

    2. X\u1eed tr\u00ed t\u1ea1i b\u1ec7nh vi\u1ec7n<\/h2>\n

    2.1. M\u1ee5c ti\u00eau<\/h3>\n
      \n
    • \u0110i\u1ec1u tr\u1ecb t\u00ecnh tr\u1ea1ng gi\u00e3n m\u1ea1ch n\u1ed9i t\u1ea1ng v\u00e0 co \u0111\u1ed9ng m\u1ea1ch th\u1eadn.<\/li>\n
    • Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng v\u00e0 h\u1ed7 tr\u1ee3 c\u00e1c ch\u1ee9c n\u0103ng gan v\u1eabn ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 duy tr\u00ec c\u00e1c ch\u1ee9c n\u0103ng c\u1ee7a gan \u0111\u1eb7c bi\u1ec7t trong th\u1eddi gian ch\u1edd \u0111\u01b0\u1ee3c gh\u00e9p gan.<\/li>\n
    • \u0110i\u1ec1u tr\u1ecb y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y l\u00e0m xu\u1ea5t hi\u1ec7n HCGT.<\/li>\n<\/ul>\n

      2.2. \u0110i\u1ec1u tr\u1ecb y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y xu\u1ea5t hi\u1ec7n h\u1ed9i ch\u1ee9ng gan th\u1eadn<\/h3>\n
        \n
      • Nhi\u1ec5m tr\u00f9ng: vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, nhi\u1ec5m khu\u1ea9n ti\u1ebft ni\u1ec7u, vi\u00eam c\u01a1\u2026<\/li>\n<\/ul>\n

        + C\u1ea5y t\u00ecm vi khu\u1ea9n g\u00e2y b\u1ec7nh, l\u00e0m kh\u00e1ng sinh \u0111\u1ed3.<\/p>\n

        + Kh\u00e1ng sinh theo \u1ed5 nhi\u1ec5m khu\u1ea9n.<\/p>\n

          \n
        • Ph\u00f9 v\u00e0 t\u0103ng d\u1ecbch c\u1ed5 ch\u01b0\u1edbng: th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi c\u00f3 gi\u1ea3m albumin m\u00e1u.<\/li>\n<\/ul>\n

          + Ki\u1ec3m so\u00e1t c\u00e2n b\u1eb1ng d\u1ecbch v\u00e0o ra.<\/p>\n

          + D\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u: furosemide, ti\u00eam ho\u1eb7c u\u1ed1ng, v\u00e0 ho\u1eb7c v\u1edbi spironolacton.<\/p>\n

          + Truy\u1ec1n albumin: albumin truy\u1ec1n 5%, 20%, \u0111\u01b0a albumin m\u00e1u v\u1ec1 gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng.<\/p>\n

          + Ch\u1ecdc th\u00e1o d\u1ecbch c\u1ed5 ch\u01b0\u1edbng khi b\u1ee5ng qu\u00e1 c\u0103ng g\u00e2y kh\u00f3 th\u1edf, \u1ea3nh h\u01b0\u1edbng t\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u c\u01a1 n\u0103ng, x\u00e9t ngh\u1ec7m c\u00e1c th\u00e0nh ph\u1ea7n trong d\u1ecbch c\u1ed5 ch\u01b0\u1edbng.<\/p>\n

            \n
          • Nhi\u1ec5m tr\u00f9ng d\u1ecbch c\u1ed5 ch\u01b0\u1edbng: d\u1ec5 x\u1ea3y ra khi c\u00f3 ch\u1ecdc d\u1ecbch c\u1ed5 ch\u01b0\u1edbng nhi\u1ec1u l\u1ea7n.<\/li>\n<\/ul>\n

            + C\u00e1c tri\u1ec7u ch\u1ee9ng nhi\u1ec5m tr\u00f9ng.<\/p>\n

            + \u0110au b\u1ee5ng.<\/p>\n

            + X\u00e9t nghi\u1ec7m d\u1ecbch c\u1ed5 ch\u01b0\u1edbng: b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n, protein, soi, c\u1ea5y t\u00ecm vi khu\u1ea9n.<\/p>\n

            + Kh\u00e1ng sinh t\u0129nh m\u1ea1ch: c\u00f3 t\u00e1c d\u1ee5ng v\u1edbi vi khu\u1ea9n Enterobacteriaceae, S.pneumonia, Enterococci <\/em>nh\u01b0 Cephalosporin th\u1ebf h\u1ec7 3, Piperacillin-tazobactam, Ertapenem. N\u1ebfu E.Coli<\/em> c\u00f3 men ESBL (+) d\u00f9ng nh\u00f3m Carbapenem c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi 1 thu\u1ed1c nh\u00f3m quinolon.<\/p>\n

              \n
            • Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a cao v\u00e0 th\u1ea5p: do t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda, t\u0129nh m\u1ea1ch ch\u1ee7. Do gi\u1ea3m c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u, do ti\u1ec3u c\u1ea7u gi\u1ea3m.<\/li>\n<\/ul>\n

              + N\u1ed9i soi ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a, can thi\u1ec7p c\u1ea7m m\u00e1u ho\u1eb7c gi\u1ea3m \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda t\u00f9y theo ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

              + \u0110i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda: th\u00f4ng t\u0129nh m\u1ea1ch c\u1eeda- ch\u1ee7 trong gan (TIPS) t\u00f9y theo ch\u1ec9 \u0111\u1ecbnh v\u00e0 kh\u1ea3 n\u0103ng ti\u1ebfn h\u00e0nh k\u1ef9 thu\u1eadt.<\/p>\n

              + \u0110\u00e1nh gi\u00e1 c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u, b\u1ed5 sung c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u (ti\u1ec3u c\u1ea7u, plasma t\u01b0\u01a1i, s\u1ee3i huy\u1ebft).<\/p>\n

              + Truy\u1ec1n m\u00e1u theo m\u1ee9c \u0111\u1ed9 m\u1ea5t m\u00e1u, \u0111\u1ea3m b\u1ea3o Hb 9-11 g\/l\u00edt.<\/p>\n

              2.3. C\u00e1c thu\u1ed1c d\u00e3n m\u1ea1ch th\u1eadn:<\/h3>\n

              Prostaglandin, \u0111\u1ed1i kh\u00e1ng Endothelin-1 c\u00f3 vai tr\u00f2 ho\u1ea1t h\u00f3a c\u00e1c ET-1 trong x\u01a1 gan. K\u1ebft qu\u1ea3 ch\u01b0a r\u00f5 r\u00e0ng.<\/p>\n

              2.4. C\u00e1c thu\u1ed1c co m\u1ea1ch h\u1ec7 th\u1ed1ng trong \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng gan th\u1eadn:<\/h3>\n

              S\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c co m\u1ea1ch vasopressin ph\u1ea3i lu\u00f4n k\u1ebft h\u1ee3p v\u1edbi b\u1ed3i ph\u1ee5 th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n.<\/p>\n

                \n
              • Terlipressin: d\u1eabn ch\u1ea5t c\u1ee7a vasopressin.<\/li>\n<\/ul>\n

                + Terlipressin: c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng th\u1eadn t\u1edbi 65%, ch\u1ec9 \u0111\u1ecbnh HCGT typ 1.<\/p>\n

                + C\u1ea3i thi\u1ec7n \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng h\u1ea1 natri m\u00e1u do h\u00f2a lo\u00e3ng.<\/p>\n

                + Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb 7-14 ng\u00e0y.<\/p>\n

                + Li\u1ec1u d\u00f9ng: Terlipressin 0.5-2mg m\u1ed7i 4 gi\u1edd ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c truy\u1ec1n li\u00ean t\u1ee5c\u00a0n\u1ebfu n\u1ed3ng \u0111\u1ed9 creatinin huy\u1ebft thanh kh\u00f4ng gi\u1ea3m, t\u0103ng li\u1ec1u l\u00ean 1mg, ho\u1eb7c 1,5mg,\u00a0ho\u1eb7c 2mg m\u1ed7i 4 gi\u1edd cho t\u1edbi khi n\u1ed3ng \u0111\u1ed9 creatinin huy\u1ebft thanh gi\u1ea3m.<\/p>\n

                + K\u1ebft h\u1ee3p v\u1edbi truy\u1ec1n albumin li\u1ec1u 1g\/kg c\u00e2n n\u1eb7ng trong ng\u00e0y \u0111\u1ea7u v\u00e0 sau \u0111\u00f3 li\u1ec1u 40g albumin m\u1ed7i ng\u00e0y. \u0110i\u1ec1u tr\u1ecb \u0111\u01a1n thu\u1ea7n terlipressin kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o.<\/p>\n

                + D\u1eebng thu\u1ed1c khi n\u1ed3ng \u0111\u1ed9 creatinin huy\u1ebft thanh kh\u00f4ng gi\u1ea3m 50% sau 7 ng\u00e0y s\u1eed d\u1ee5ng li\u1ec1u cao Terlipressin, ho\u1eb7c sau 3 ng\u00e0y \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb.<\/p>\n

                + C\u00f3 \u0111\u00e1p \u1ee9ng: \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i \u0111\u1ebfn khi HCGT t\u1ed1t l\u00ean ho\u1eb7c t\u1ed1i \u0111a 14 ng\u00e0y.<\/p>\n

                + T\u00e1c d\u1ee5ng ph\u1ee5: c\u00f3 th\u1ec3 g\u00e2y co m\u1ea1ch, g\u00e2y thi\u1ebfu m\u00e1u v\u00e0 r\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/p>\n

                  \n
                • C\u00e1c \u0111i\u1ec1u tr\u1ecb thay th\u1ebf kh\u00e1c khi Terlipressin kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng:<\/li>\n<\/ul>\n

                  + Midodrine: thu\u1ed1c kh\u00e1ng ch\u1ecdn l\u1ecdc th\u1ee5 th\u1ec3 \u03b11. Kh\u1edfi li\u1ec1u 2.5 \u2013 7.5mg \u0111\u01b0\u1eddng u\u1ed1ng chia 3 l\u1ea7n\/ng\u00e0y, t\u0103ng d\u1ea7n t\u1eeb t\u1eeb t\u1edbi li\u1ec1u 12.5mg\/ ng\u00e0y, k\u1ebft h\u1ee3p v\u1edbi Octreotide kh\u1edfi li\u1ec1u 100mg ti\u00eam d\u01b0\u1edbi da, t\u0103ng d\u1ea7n \u0111\u1ebfn 200mg\/ng\u00e0y, chia 2 l\u1ea7n v\u00e0 truy\u1ec1n Albumin 40g\/ng\u00e0y. T\u0103ng li\u1ec1u sao cho t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch trung b\u00ecnh kho\u1ea3ng 15mmHg ho\u1eb7c \u0111\u01b0a huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch trung b\u00ecnh l\u00ean kho\u1ea3ng 90mmHg. \u0110i\u1ec1u tr\u1ecb \u00edt nh\u1ea5t 20 ng\u00e0y.<\/p>\n

                  + Octreotide (d\u1eabn ch\u1ea5t c\u1ee7a somatostatin)<\/p>\n

                  + Noradrenaline: li\u1ec1u 0.5 \u2013 3mg\/gi\u1edd, t\u0103ng d\u1ea7n cho t\u1edbi khi n\u00e2ng huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch trung b\u00ecnh th\u00eam 10-15 mmHg, k\u1ebft h\u1ee3p v\u1edbi albumin v\u00e0 furosemide c\u0169ng c\u00f3 hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n nh\u01b0 terlipressin \u1edf ng\u01b0\u1eddi b\u1ec7nh HCGT.<\/p>\n

                    \n
                  • V\u1edbi HCGT typ 2: hi\u1ec7n nay ch\u01b0a c\u00f3 \u0111\u1ee7 b\u1eb1ng ch\u00ednh v\u1ec1 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c co m\u1ea1ch.<\/li>\n
                  • C\u00e1c \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb khi s\u1eed d\u1ee5ng thu\u1ed1c co m\u1ea1ch<\/li>\n<\/ul>\n

                    + \u0110\u00e1p \u1ee9ng ho\u00e0n to\u00e0n: gi\u1ea3m n\u1ed3ng \u0111\u1ed9 creatinin m\u00e1u < 130\u03bcmol\/l.<\/p>\n

                    + T\u00e1i ph\u00e1t: l\u1ea1i suy th\u1eadn sau khi d\u1eebng \u0111i\u1ec1u tr\u1ecb, creatinin m\u00e1u >130\u03bcmol\/l.<\/p>\n

                    + \u0110\u00e1p \u1ee9ng m\u1ed9t ph\u1ea7n: gi\u1ea3m n\u1ed3ng \u0111\u1ed9 creatinin huy\u1ebft thanh \u2265 50% gi\u00e1 tr\u1ecb creatinin ban \u0111\u1ea7u, nh\u01b0ng kh\u00f4ng t\u1edbi m\u1ee9c d\u01b0\u1edbi 130\u03bcmol\/l.<\/p>\n

                    + Kh\u00f4ng \u0111\u00e1p \u1ee9ng: kh\u00f4ng gi\u1ea3m creatinin ho\u1eb7c gi\u1ea3m < 50% gi\u00e1 tr\u1ecb creatinin ban \u0111\u1ea7u nh\u01b0ng creatinine huy\u1ebft thanh cu\u1ed1i c\u00f9ng v\u1eabn tr\u00ean 130\u03bcmol\/l.<\/p>\n

                    2.5. TIPS (c\u1ea7u n\u1ed1i b\u00ean \u2013 b\u00ean h\u1ec7 th\u1ed1ng t\u0129nh m\u1ea1ch c\u1eeda v\u00e0 t\u0129nh m\u1ea1ch ch\u1ee7):<\/h3>\n

                    M\u1edbi c\u00f3 \u00edt nghi\u00ean c\u1ee9u \u0111\u00e1nh gi\u00e1 vai tr\u00f2 c\u1ee7a TIPS<\/p>\n

                      \n
                    1. \n
                        \n
                      • Ch\u1ec9 \u0111\u1ecbnh: HCGT c\u1ea5p, d\u1ecbch c\u1ed5 ch\u01b0\u1edbng kh\u00e1ng tr\u1ecb, ch\u1edd gh\u00e9p gan, c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 c\u1ed5 tr\u01b0\u1edbng dai d\u1eb3ng \u1edf ng\u01b0\u1eddi b\u1ec7nh typ 2.<\/li>\n
                      • T\u00e1c d\u1ee5ng sau l\u00e0m TIPS: l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda, t\u0103ng cung l\u01b0\u1ee3ng tim v\u00e0 l\u00e0m t\u0103ng th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n trung t\u00e2m, c\u1ea3i thi\u1ec7n t\u01b0\u1edbi m\u00e1u th\u1eadn, t\u0103ng m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn.<\/li>\n
                      • Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tr\u00ean ng\u01b0\u1eddi b\u1ec7nh HCGT c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh n\u00e3o gan n\u1eb7ng, c\u00f3 n\u1ed3ng \u0111\u1ed9 bilirbin huy\u1ebft thanh > 85\u03bcmol\/L, ho\u1eb7c Child-Pugh tr\u00ean 12 \u0111i\u1ec3m.<\/li>\n
                      • Bi\u1ebfn ch\u1ee9ng c\u1ee7a TIPS: h\u1ed9i ch\u1ee9ng n\u00e3o gan, nhi\u1ec5m tr\u00f9ng, h\u1eb9p t\u1ea1i v\u1ecb tr\u00ed c\u1ea7u n\u1ed1i.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n

                         <\/p>\n

                        2.6. C\u00e1c bi\u1ec7n ph\u00e1p l\u1ecdc m\u00e1u, l\u1ecdc gan nh\u00e2n t\u1ea1o<\/h3>\n
                          \n
                        • L\u1ecdc m\u00e1u ng\u1eaft qu\u00e3ng ho\u1eb7c l\u1ecdc m\u00e1u li\u00ean t\u1ee5c (IHD hay CVVH)<\/li>\n<\/ul>\n

                          + Ch\u1ec9 \u0111\u1ecbnh khi: th\u1eeba d\u1ecbch, t\u0103ng g\u00e1nh th\u1ec3 t\u00edch d\u1eabn \u0111\u1ebfn ph\u00f9 n\u00e3o, co gi\u1eadt, ph\u00f9 ph\u1ed5i c\u1ea5p, ho\u1eb7c t\u0103ng kali m\u00e1u c\u1ea5p >6 mmol\/l\u00edt ho\u1eb7c c\u00f3 r\u1ed1i lo\u1ea1n tr\u00ean \u0111i\u1ec7n tim, toan chuy\u1ec3n h\u00f3a pH < 7,10.<\/p>\n

                          + Tai bi\u1ebfn khi l\u1ecdc m\u00e1u: ch\u1ea3y m\u00e1u n\u1eb7ng, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, t\u0103ng huy\u1ebft \u00e1p.<\/p>\n

                            \n
                          • Thay huy\u1ebft t\u01b0\u01a1ng (PEX), l\u1ecdc gan v\u1edbi h\u1ea5p ph\u1ee5 ph\u00e2n t\u1eed li\u00ean t\u1ee5c (MARS):<\/li>\n<\/ul>\n

                            + Ch\u1ec9 \u0111\u1ecbnh: h\u1ed9i ch\u1ee9ng n\u00e3o gan giai \u0111o\u1ea1n II v\u1edbi NH3 m\u00e1u t\u0103ng cao, x\u00e9t nghi\u1ec7m bilirubin to\u00e0n ph\u1ea7n > 250 \u00b5mol\/l, suy gi\u1ea3m c\u00e1c ch\u1ee9c n\u0103ng c\u1ee7a gan.<\/p>\n

                            + K\u1ef9 thu\u1eadt \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh h\u00e0ng ng\u00e0y, ch\u00fa \u00fd c\u00e1c r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u v\u00e0 thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng dung cho k\u1ef9 thu\u1eadt n\u00e0y.<\/p>\n

                            + Hi\u1ec7u qu\u1ea3 t\u1ea1m th\u1eddi trong giai \u0111o\u1ea1n ch\u1edd gh\u00e9p gan.<\/p>\n

                            2.7. Gh\u00e9p gan<\/h3>\n
                              \n
                            • Gh\u00e9p gan l\u00e0 \u0111i\u1ec1u tr\u1ecb t\u1ed1t nh\u1ea5t cho HCGT, c\u00f3 t\u1ef7 l\u1ec7 s\u1ed1ng sau 3 n\u0103m kho\u1ea3ng 70%, cho \u0111\u1ebfn nay v\u1eabn l\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00f3 hi\u1ec7u qu\u1ea3 nh\u1ea5t.<\/li>\n
                            • C\u00e2n nh\u1eafc \u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1, nghi ng\u1edd xu\u1ea5t hi\u1ec7n HCGT typ<\/li>\n
                            • Ti\u00ean l\u01b0\u1ee3ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi ng\u01b0\u1eddi b\u1ec7nh tr\u01b0\u1edbc \u0111\u00f3 kh\u00f4ng b\u1ecb HCGT.<\/li>\n<\/ul>\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":"

                              H\u1ed9i ch\u1ee9ng gan th\u1eadn (HCGT) l\u00e0 t\u00ecnh tr\u1ea1ng suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn c\u1ea5p t\u00ednh x\u1ea3y ra tr\u00ean ng\u01b0\u1eddi b\u1ec7nh b\u1ecb b\u1ec7nh gan c\u1ea5p ho\u1eb7c \u0111\u1ee3t c\u1ea5p \u1edf b\u1ec7nh gan giai \u0111o\u1ea1n cu\u1ed1i, ch\u1ee7 y\u1ebfu g\u1eb7p \u1edf ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan c\u1ed5 tr\u01b0\u1edbng t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda, vi\u00eam gan do r\u01b0\u1ee3u, ho\u1eb7c hi\u1ebfm […]<\/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":"\nH\u1ed9i ch\u1ee9ng gan th\u1eadn c\u1ea5p: h\u01b0\u1edbng d\u1eabn x\u1eed tr\u00ed h\u1ed3i s\u1ee9c - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1ed9i ch\u1ee9ng gan th\u1eadn l\u00e0 suy th\u1eadn c\u1ea5p \u1edf ng\u01b0\u1eddi b\u1ec7nh gan c\u1ea5p \/\u0111\u1ee3t c\u1ea5p b\u1ec7nh gan m\u1ea1n. 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