{"id":27205,"date":"2023-04-23T22:55:03","date_gmt":"2023-04-23T15:55:03","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27205"},"modified":"2023-04-23T22:55:03","modified_gmt":"2023-04-23T15:55:03","slug":"cap-nhap-chan-doan-viem-tuy-cap-theo-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/cap-nhap-chan-doan-viem-tuy-cap-theo-bo-y-te\/","title":{"rendered":"C\u1eadp nh\u1eadp ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u1ee5y c\u1ea5p theo B\u1ed9 Y t\u1ebf"},"content":{"rendered":"

Vi\u00eam t\u1ee5y c\u1ea5p (acute pancreatitis<\/a>) l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh vi\u00eam c\u1ea5p t\u00ednh c\u1ee7a t\u1ee5y, bi\u1ec3u hi\u1ec7n \u1edf nhi\u1ec1u m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau: m\u1ee9c \u0111\u1ed9 nh\u1eb9 ch\u1ec9 c\u1ea7n n\u1eb1m vi\u1ec7n ng\u1eafn ng\u00e0y, \u00edt bi\u1ebfn ch\u1ee9ng. M\u1ee9c \u0111\u1ed9 n\u1eb7ng, b\u1ec7nh di\u1ec5n bi\u1ebfn ph\u1ee9c t\u1ea1p, t\u1ef7 l\u1ec7 t\u1eed vong cao 20-50%, trong b\u1ec7nh c\u1ea3nh suy \u0111a t\u1ea1ng, nhi\u1ec5m tr\u00f9ng. <\/span><\/strong>C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y cho th\u1ea5y trong vi\u00eam t\u1ee5y c\u1ea5p c\u00f3 t\u0103ng cao n\u1ed3ng \u0111\u1ed9 c\u00e1c cytokin trong m\u00e1u IL6, IL8, TNF<\/span>a<\/span>\u2026,th\u00fac \u0111\u1ea9y ph\u1ea3n \u1ee9ng vi\u00eam ch\u00ednh l\u00e0 nguy\u00ean nh\u00e2n d\u1eabn \u0111\u1ebfn suy \u0111a t\u1ea1ng trong vi\u00eam t\u1ee5y c\u1ea5p. V\u00ec v\u1eady c\u1ea7n ph\u1ea3i ch\u1ea9n \u0111o\u00e1n s\u1edbm b\u1ec7nh \u0111\u1ec3 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111\u1ea1t hi\u1ec7u qu\u1ea3 t\u1ed1t nh\u1ea5t.<\/span><\/strong><\/p>\n

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Vi\u00eam t\u1ee5y c\u1ea5p (acute pancreatitis<\/a>) l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh vi\u00eam c\u1ea5p t\u00ednh c\u1ee7a t\u1ee5y<\/span><\/figcaption><\/figure>\n

1. Nguy\u00ean nh\u00e2n c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p<\/h2>\n

– L\u1ea1m d\u1ee5ng r\u01b0\u1ee3u l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn \u1edf Vi\u1ec7t nam.<\/span><\/p>\n

– Nguy\u00ean nh\u00e2n c\u01a1 h\u1ecdc:s\u1ecfi m\u1eadt,s\u1ecfi t\u1ee5y, l\u00e0 nguy\u00ean nh\u00e2n \u0111\u1ee9ng h\u00e0ng th\u1ee9 2.<\/span><\/p>\n

– Do r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a:<\/span><\/p>\n

+ T\u0103ng tryglycerit m\u00e1u l\u00e0 nguy\u00ean nh\u00e2n ng\u00e0y c\u00e0ng hay g\u1eb7p \u1edf Vi\u1ec7t nam.<\/span><\/p>\n

+ T\u0103ng canxi m\u00e1u: nh\u01b0 u tuy\u1ebfn gi\u00e1p, c\u01b0\u1eddng c\u1eadn gi\u00e1p…<\/span><\/p>\n

– Sau ph\u1eabu thu\u1eadt: nh\u1ea5t l\u00e0 ph\u1eabu thu\u1eadt b\u1ee5ng g\u1ea7n t\u1ee5y, quanh t\u1ee5y.<\/span><\/p>\n

– Sau n\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng (ERCP).<\/span><\/p>\n

– Do ch\u1ea5n th\u01b0\u01a1ng, b\u1ea7m d\u1eadp v\u00f9ng b\u1ee5ng.<\/span><\/p>\n

– Sau gh\u00e9p t\u1ea1ng: nh\u01b0 c\u00e1c bi\u1ebfn ch\u1ee9ng sau gh\u00e9p gan, th\u1eadn.<\/span><\/p>\n

– Gan nhi\u1ec5m m\u1ee1 c\u1ea5p \u1edf th\u1eddi k\u1ef3 c\u00f3 thai.<\/span><\/p>\n

– Do nhi\u1ec5m tr\u00f9ng: quai b\u1ecb, vi\u00eam gan virus, giun \u0111\u0169a.<\/span><\/p>\n

– Do thu\u1ed1c: sulfonamide, 6MP, furosemide, ethanol, oestrogen…<\/span><\/p>\n

– B\u1ec7nh l\u00fd t\u1ed5 ch\u1ee9c li\u00ean k\u1ebft: lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, vi\u00eam mao m\u1ea1ch ho\u1ea1i t\u1eed, Schonlein Henock…<\/span><\/p>\n

* Kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n:<\/span><\/i><\/b>\u00a010% c\u00e1c tr\u01b0\u1eddng h\u1ee3p.<\/span><\/p>\n

2. Tri\u1ec7u ch\u1ee9ng <\/span><\/b>c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p<\/h2>\n

2.1. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/span><\/b><\/h3>\n

Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a VTC x\u1ea3y ra h\u1ebft s\u1ee9c c\u1ea5p t\u00ednh, \u0111\u1ed9t ng\u1ed9t, di\u1ec5n bi\u1ebfn ph\u1ee9c t\u1ea1p, c\u00f3 th\u1ec3 c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u ngo\u1ea1i khoa xen l\u1eabn, \u0111\u1eb7c bi\u1ec7t trong VTC ho\u1ea1i t\u1eed.<\/span><\/p>\n

a) Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng: Bao g\u1ed3m c\u00e1c d\u1ea5u hi\u1ec7u sau<\/span><\/p>\n

– \u0110au b\u1ee5ng: l\u00e0 d\u1ea5u hi\u1ec7u n\u1ed5i b\u1eadt nh\u1ea5t, th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n m\u1ed9t c\u00e1ch \u0111\u1ed9t ng\u1ed9t \u1edf v\u00f9ng th\u01b0\u1ee3ng v\u1ecb, c\u00f3 th\u1ec3 lan l\u00ean ng\u1ef1c, ra hai m\u1ea1ng s\u01b0\u1eddn hai b\u00ean, xi\u00ean ra sau l\u01b0ng. \u0110au li\u00ean t\u1ee5c, d\u1eef d\u1ed9i k\u00e9o d\u00e0i nhi\u1ec1u gi\u1edd, c\u00f3 th\u1ec3 \u0111au kh\u1edfi ph\u00e1t sau khi \u0103n. C\u0169ng c\u00f3 khi kh\u1edfi ph\u00e1t t\u1ef1 nhi\u00ean.<\/span><\/p>\n

– N\u00f4n: \u0111a s\u1ed1 ng\u01b0\u1eddi b\u1ec7nh c\u00f3 n\u00f4n ho\u1eb7c bu\u1ed3n n\u00f4n, l\u00fac \u0111\u1ea7u n\u00f4n ra th\u1ee9c \u0103n, sau \u0111\u00f3 n\u00f4n ra d\u1ecbch, n\u00f4n xong c\u00f3 th\u1ec3 \u0111\u1ee1 \u0111au ho\u1eb7c kh\u00f4ng.<\/span><\/p>\n

– B\u00ed trung \u0111\u1ea1i ti\u1ec7n: do t\u00ecnh tr\u1ea1ng li\u1ec7t ru\u1ed9t c\u01a1 n\u0103ng, ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng trung ti\u1ec7n, kh\u00f4ng \u0111i ngo\u00e0i, b\u1ee5ng tr\u01b0\u1edbng v\u00e0 \u0111\u1ea7y t\u1ee9c kh\u00f3 ch\u1ecbu.<\/span><\/p>\n

– Kh\u00f3 th\u1edf: do \u0111au, do tr\u00e0n d\u1ecbch m\u00e0ng b\u1ee5ng, m\u00e0ng ph\u1ed5i.<\/span><\/p>\n

b) Tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n<\/span><\/p>\n

– S\u1ed1t: th\u01b0\u1eddng c\u00f3 s\u1ed1t nh\u1eb9, c\u00f3 th\u1ec3 s\u1ed1t cao v\u00ec vi\u00eam nhi\u1ec5m \u0111\u01b0\u1eddng m\u1eadt do s\u1ecfi, giun ho\u1eb7c do ho\u1ea1i t\u1eed t\u1ee5y r\u1ed9ng.<\/span><\/p>\n

– M\u1ea1ch, huy\u1ebft \u00e1p:<\/span><\/p>\n

+ Vi\u00eam t\u1ee5y c\u1ea5p th\u1ec3 nh\u1eb9: t\u00ecnh tr\u1ea1ng to\u00e0n th\u00e2n th\u01b0\u1eddng kh\u00f4ng tr\u1ea7m tr\u1ecdng, ng\u01b0\u1eddi b\u1ec7nh m\u1ec7t m\u1ecfi nh\u01b0ng t\u1ec9nh, m\u1ea1ch, HA \u1ed5n \u0111\u1ecbnh, kh\u00f4ng kh\u00f3 th\u1edf.<\/span><\/p>\n

+ Vi\u00eam t\u1ee5y c\u1ea5p th\u1ec3 n\u1eb7ng: c\u00f3 th\u1ec3 c\u00f3 t\u00ecnh tr\u1ea1ng s\u1ed1c, v\u00e3 m\u1ed3 h\u00f4i, ch\u00e2n tay l\u1ea1nh, nh\u1ee3t nh\u1ea1t, tinh th\u1ea7n ch\u1eadm ch\u1ea1p, m\u1ea1ch nhanh, HA t\u1ee5t, ng\u01b0\u1eddi b\u1ec7nh h\u1ed1t ho\u1ea3ng, k\u00edch \u0111\u1ed9ng ho\u1eb7c ng\u01b0\u1ee3c l\u1ea1i n\u1eb1m l\u1edd \u0111\u1edd, m\u1ec7t m\u1ecfi, c\u00f3 nh\u1eefng m\u1ea3ng b\u1ea7m t\u00edm \u1edf ch\u00e2n tay, th\u00e2n th\u1ec3, th\u1edf nhanh n\u00f4ng.<\/span><\/p>\n

c) Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3<\/span><\/p>\n

– B\u1ee5ng ch\u01b0\u1edbng: b\u1ee5ng ch\u01b0\u1edbng \u0111\u1ec1u, c\u00f3 khi ch\u01b0\u1edbng \u1edf v\u00f9ng tr\u00ean r\u1ed1n nhi\u1ec1u h\u01a1n, g\u00f5 vang do li\u1ec7t ru\u1ed9t c\u01a1 n\u0103ng, kh\u00f4ng c\u00f3 quai ru\u1ed9t n\u1ed5i, r\u1eafn b\u00f2 nh\u01b0 trong t\u1eafc ru\u1ed9t c\u01a1 h\u1ecdc. Khi \u1ed5 b\u1ee5ng c\u00f3 nhi\u1ec1u d\u1ecbch c\u00f3 th\u1ec3 g\u00f5 \u0111\u1ee5c \u1edf v\u00f9ng th\u1ea5p.<\/span><\/p>\n

– Ph\u1ea3n \u1ee9ng th\u00e0nh b\u1ee5ng: c\u00f3 th\u1ec3 ph\u1ea3n \u1ee9ng c\u1ee5c b\u1ed9 hay to\u00e0n b\u1ed9 v\u00f9ng tr\u00ean r\u1ed1n, xu\u1ea5t hi\u1ec7n \u1edf h\u1ea1 s\u01b0\u1eddn b\u00ean ph\u1ea3i khi nguy\u00ean nh\u00e2n g\u00e2y VTC l\u00e0 s\u1ecfi m\u1eadt.<\/span><\/p>\n

– M\u1ea3ng c\u1ee9ng tr\u00ean r\u1ed1n: c\u00f3 th\u1ec3 s\u1edd th\u1ea5y m\u1ea3ng c\u1ee9ng v\u00f9ng th\u01b0\u1ee3ng v\u1ecb, c\u00f3 khi lan sang hai v\u00f9ng d\u01b0\u1edbi s\u01b0\u1eddn, ranh gi\u1edbi kh\u00f4ng r\u00f5, kh\u00f4ng di \u0111\u1ed9ng, \u1ea5n \u0111au, c\u1ea3m gi\u00e1c ngay d\u01b0\u1edbi tu\u1ef5 do hi\u1ec7n t\u01b0\u1ee3ng ho\u1ea1i t\u1eed m\u1ee1.<\/span><\/p>\n

– \u0110i\u1ec3m s\u01b0\u1eddn l\u01b0ng m\u1ed9t hay hai b\u00ean \u0111au: c\u00f3 \u1edf h\u1ea7u h\u1ebft c\u00e1c ng\u01b0\u1eddi b\u1ec7nh VTC, \u0111i\u1ec3m \u0111au n\u00e0y \u0111\u01b0\u1ee3c Mayo-Robson v\u00e0 Korte m\u00f4 t\u1ea3 t\u1eeb n\u0103m 1906, \u0111\u01b0\u1ee3c T\u00f4n Th\u1ea5t T\u00f9ng cho l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng quan tr\u1ecdng c\u1ee7a VTC.<\/span><\/p>\n

– C\u00f3 tri\u1ec7u ch\u1ee9ng v\u00e0ng da k\u00e8m gan to khi nguy\u00ean nh\u00e2n li\u00ean quan v\u1edbi t\u00fai m\u1eadt to do s\u1ecfi, giun ho\u1eb7c s\u1ecfi \u0111\u01b0\u1eddng m\u1eadt g\u00e2y t\u00ecnh tr\u1ea1ng \u1ee9 m\u1eadt ho\u1eb7c do vi\u00eam gan.<\/span><\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng (nh\u1ea5t l\u00e0 trong VTC th\u1ec3 ho\u1ea1i t\u1eed) c\u00f3 th\u1ec3 g\u1eb7p c\u00e1c m\u1ea3ng b\u1ea7m t\u00edm d\u01b0\u1edbi da \u1edf hai b\u00ean m\u1ea1ng s\u01b0\u1eddn (d\u1ea5u hi\u1ec7u Grey Turner) hay quanh r\u1ed1n (d\u1ea5u hi\u1ec7u Cullen), \u0111\u00e2y l\u00e0 d\u1ea5u hi\u1ec7u r\u1ea5t \u0111\u1eb7c hi\u1ec7u, bi\u1ec3u hi\u1ec7n s\u1ef1 ch\u1ea3y m\u00e1u \u1edf v\u00f9ng t\u1ee5y v\u00e0 quanh t\u1ee5y.<\/span><\/p>\n

2.2. Tri\u1ec7u ch\u1ee9ng c\u1eadn l\u00e2m s\u00e0ng<\/span><\/b><\/h3>\n

a) Sinh h\u00f3a<\/span><\/p>\n

– Amylase m\u00e1u t\u0103ng > 3 l\u1ea7n b\u00ecnh th\u01b0\u1eddng c\u00f3 \u1edf 70% c\u00e1c tr\u01b0\u1eddng h\u1ee3p (t\u0103ng sau 1 – 2 gi\u1edd \u0111au, t\u0103ng cao sau 24 gi\u1edd v\u00e0 b\u00ecnh th\u01b0\u1eddng sau 2 – 3 ng\u00e0y).<\/span><\/p>\n

– Lipase t\u0103ng c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n h\u01a1n l\u00e0 t\u0103ng amylase.<\/span><\/p>\n

– CRP t\u0103ng c\u00f3 \u00fd ngh\u0129a ti\u00ean l\u01b0\u1ee3ng.<\/span><\/p>\n

– Cytokine huy\u1ebft thanh t\u0103ng (IL6, IL8, TNF<\/span>a<\/span>..) x\u00e9t nghi\u1ec7m r\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb. Tuy nhi\u00ean x\u00e9t nghi\u1ec7m n\u00e0y m\u1edbi ch\u1ec9 th\u1ef1c hi\u1ec7n \u1edf c\u00e1c \u0111\u01a1n v\u1ecb th\u1ef1c hi\u1ec7n nghi\u00ean c\u1ee9u.<\/span><\/p>\n

b) Huy\u1ebft h\u1ecdc<\/span><\/p>\n

– B\u1ea1ch c\u1ea7u t\u0103ng, trung t\u00ednh t\u0103ng, Hematocrit t\u0103ng do m\u00e1u c\u00f4 \u0111\u1eb7c.<\/span><\/p>\n

– R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh n\u1eb7ng. Th\u01b0\u1eddng hay c\u00f3 d\u1ea5u hi\u1ec7u c\u1ee7a<\/span><\/p>\n

\u0111\u00f4ng m\u00e1u n\u1ed9i qu\u1ea3n r\u1ea3i r\u00e1c (DIC).<\/span><\/p>\n

c) Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/span><\/p>\n

– Xquang \u1ed5 b\u1ee5ng.<\/span><\/p>\n

+ B\u1ee5ng nhi\u1ec1u h\u01a1i.<\/span><\/p>\n

+ C\u00e1c quai ru\u1ed9t g\u1ea7n t\u1ee5y gi\u00e3n.<\/span><\/p>\n

– Si\u00eau \u00e2m (kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c khi b\u1ee5ng ch\u01b0\u1edbng h\u01a1i).<\/span><\/p>\n

+ T\u1ee5y to to\u00e0n b\u1ed9 ho\u1eb7c t\u1eebng ph\u1ea7n (\u0111\u1ea7u, th\u00e2n ho\u1eb7c \u0111u\u00f4i).<\/span><\/p>\n

+ \u0110\u01b0\u1eddng vi\u1ec1n xung quanh t\u1ee5y kh\u00f4ng r\u00f5 r\u00e0ng, m\u1eadt \u0111\u1ed9 kh\u00f4ng \u0111\u1ec1u, gi\u1ea3m \u00e2m ho\u1eb7c \u00e2m vang h\u1ed7n h\u1ee3p.<\/span><\/p>\n

+ C\u00f3 th\u1ec3 c\u00f3 d\u1ecbch quanh t\u1ee5y v\u00e0 c\u00e1c khoang trong \u1ed5 b\u1ee5ng.<\/span><\/p>\n

– C\u1eaft l\u1edbp vi t\u00ednh (CT scan) c\u00f3 gi\u00e1 tr\u1ecb nh\u1ea5t trong ch\u1ea9n \u0111o\u00e1n<\/span><\/p>\n

+ T\u1ee5y to ra ho\u1eb7c b\u00ecnh th\u01b0\u1eddng.<\/span><\/p>\n

+ B\u1edd kh\u00f4ng \u0111\u1ec1u, c\u00f3 th\u1ec3 c\u00f3 h\u00ecnh \u1ea3nh \u1ed5 ho\u1ea1i t\u1eed, cho bi\u1ebft m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng quanh t\u1ee5y v\u00e0 xa t\u1ee5y.<\/span><\/p>\n

3. Ch\u1ea9n \u0111o\u00e1n <\/span><\/b>vi\u00eam t\u1ee5y c\u1ea5p<\/h2>\n

3.1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/span><\/b><\/h3>\n

Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh VTC theo ti\u00eau chu\u1ea9n Atlanta s\u1eeda \u0111\u1ed5i 2007.<\/span><\/p>\n

a) L\u00e2m s\u00e0ng<\/span><\/p>\n

\u0110au th\u01b0\u1ee3ng v\u1ecb \u0111\u1ed9t ng\u1ed9t, \u0111au d\u1eef d\u1ed9i, \u0111au xuy\u00ean ra sau l\u01b0ng k\u00e8m theo bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n.<\/span><\/p>\n

b) C\u1eadn l\u00e2m s\u00e0ng<\/span><\/p>\n

– Amylase v\u00e0 \/ho\u1eb7c lipase m\u00e1u t\u0103ng cao tr\u00ean 3 l\u1ea7n so v\u1edbi gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng.<\/span><\/p>\n

– Cytokine huy\u1ebft thanh t\u0103ng.<\/span><\/p>\n

– Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh: c\u00f3 h\u00ecnh \u1ea3nh \u0111i\u1ec3n h\u00ecnh c\u1ee7a VTC tr\u00ean si\u00eau \u00e2m ho\u1eb7c ch\u1ee5p CT:<\/span><\/p>\n

+Si\u00eau \u00e2m: T\u1ee5y to to\u00e0n b\u1ed9 ho\u1eb7c t\u1eebng ph\u1ea7n (\u0111\u1ea7u, th\u00e2n ho\u1eb7c \u0111u\u00f4i), \u0111\u01b0\u1eddng vi\u1ec1n xung quanh t\u1ee5y kh\u00f4ng r\u00f5 r\u00e0ng, m\u1eadt \u0111\u1ed9 echo kh\u00f4ng \u0111\u1ec1u, gi\u1ea3m \u00e2m ho\u1eb7c \u00e2m vang h\u1ed7n h\u1ee3p, c\u00f3 th\u1ec3 c\u00f3 d\u1ecbch quanh t\u1ee5y v\u00e0 c\u00e1c khoang trong \u1ed5 b\u1ee5ng.<\/span><\/p>\n

+ CT: T\u1ee5y to ra ho\u1eb7c b\u00ecnh th\u01b0\u1eddng, b\u1edd kh\u00f4ng \u0111\u1ec1u, c\u00f3 th\u1ec3 c\u00f3 h\u00ecnh \u1ea3nh \u1ed5 ho\u1ea1i t\u1eed, cho bi\u1ebft m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng quanh t\u1ee5y v\u00e0 xa t\u1ee5y.<\/span><\/p>\n

3.2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/span><\/b><\/h3>\n

– Th\u1ee7ng d\u1ea1 d\u00e0y: Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u1ec1n s\u1eed d\u1ea1 d\u00e0y hay kh\u00f4ng, \u0111au d\u1eef d\u1ed9i, b\u1ee5ng co c\u1ee9ng, XQ c\u00f3 li\u1ec1m h\u01a1i.<\/span><\/p>\n

– T\u1eafc ru\u1ed9t: \u0110au b\u1ee5ng, n\u00f4n, b\u00ed trung \u0111\u1ea1i ti\u1ec7n, XQ c\u00f3 m\u1ee9c n\u01b0\u1edbc, m\u1ee9c h\u01a1i.<\/span><\/p>\n

– C\u01a1n \u0111au b\u1ee5ng gan:<\/span><\/p>\n

+ C\u00f3 tam ch\u1ee9ng Charcot.<\/span><\/p>\n

+ Si\u00eau \u00e2m th\u1ea5y c\u00f3 s\u1ecfi, u.<\/span><\/p>\n

– Vi\u00eam ph\u00fac m\u1ea1c: c\u00f3 h\u1ed9i ch\u1ee9ng nhi\u1ec5m khu\u1ea9n, co c\u1ee9ng to\u00e0n b\u1ee5ng, th\u0103m t\u00fai c\u00f9ng Douglas \u0111au.<\/span><\/p>\n

– Nh\u1ed3i m\u00e1u m\u1ea1c treo (hi\u1ebfm): \u0111au d\u1eef d\u1ed9i \u0111\u1ed9t ng\u1ed9t, t\u1eebng c\u01a1n, c\u00f3 \u1ec9a ra m\u00e1u, m\u1ed5 th\u0103m d\u00f2 m\u1edbi bi\u1ebft \u0111\u01b0\u1ee3c.<\/span><\/p>\n

– Nh\u1ed3i m\u00e1u c\u01a1 tim: \u0110au th\u1eaft ng\u1ef1c, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 c\u00f3 nh\u1ed3i m\u00e1u c\u01a1 tim.<\/span><\/p>\n

– Ph\u00ecnh t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng: \u0111au b\u1ee5ng, huy\u1ebft \u00e1p gi\u1eefa tay v\u00e0 ch\u00e2n ch\u00eanh l\u1ec7ch nhi\u1ec1u, si\u00eau \u00e2m ho\u1eb7c CT-scan b\u1ee5ng c\u00f3 b\u01a1m thu\u1ed1c c\u1ea3n quang s\u1ebd ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c.<\/span><\/p>\n

3.3. Ch\u1ea9n \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 c\u1ee7a VTC<\/span><\/b><\/h3>\n

C\u00f3 nhi\u1ec1u thang \u0111i\u1ec3m \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e2y d\u1ef1ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng,nh\u1eb9 c\u1ee7a VTC, c\u00e1c thang \u0111i\u1ec3m hay s\u1eed d\u1ee5ng l\u00e0:<\/span><\/p>\n

– Thang \u0111i\u1ec3m APACHEII: ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u0111i\u1ec3m APACHEII <8 l\u00e0 VTC nh\u1eb9;ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u0111i\u1ec3m APACHEII \u2265 8 l\u00e0 VTC n\u1eb7ng.<\/span><\/p>\n

– Thang \u0111i\u1ec3m Ranson: n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh c\u00f3 <3 y\u1ebfu t\u1ed1 trong 11 y\u1ebfu t\u1ed1 l\u00e0 VTC nh\u1eb9;n\u1ebfu c\u00f3 \u2265 3 trong 11 y\u1ebfu t\u1ed1 l\u00e0 vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng, c\u00e0ng nhi\u1ec1u y\u1ebfu t\u1ed1 th\u00ec t\u00ecnh tr\u1ea1ng c\u00e0ng n\u1eb7ng v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u00e0ng x\u1ea5u.<\/span><\/p>\n

– Thang \u0111i\u1ec3m Glasgow (imrie): ng\u01b0\u1eddi b\u1ec7nh c\u00f3 < 3 y\u1ebfu t\u1ed1 trong 8 y\u1ebfu t\u1ed1 l\u00e0 VTC nh\u1eb9; ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u2265 3 trong 8 y\u1ebfu t\u1ed1 l\u00e0 vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng, c\u00e0ng nhi\u1ec1u y\u1ebfu t\u1ed1 t\u00ecnh tr\u1ea1ng c\u00e0ng n\u1eb7ng v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u00e0ng x\u1ea5u.<\/span><\/p>\n

– D\u1ef1a v\u00e0o ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (thang \u0111i\u1ec3m Balthazar s\u1eeda \u0111\u1ed5i) (d\u1ef1a theo m\u1ee9c \u0111\u1ed9 ph\u00f9 t\u1ee5y v\u00e0 m\u1ee9c \u0111\u1ed9 ho\u1ea1i t\u1eed), n\u1ebfu \u0111i\u1ec3m Balthazar < 7 \u0111i\u1ec3m l\u00e0 VTC nh\u1eb9 v\u00e0 n\u1ebfu \u2265 7 \u0111i\u1ec3m l\u00e0 vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng.<\/span><\/p>\n

– D\u1ef1a v\u00e0o \u00e1p l\u1ef1c \u1ed5 b\u1ee5ng t\u1eeb b\u1ec7nh nh\u00e2n VTC kh\u00f4ng c\u00f3 t\u0103ng \u00e1p l\u1ef1c \u1ed5 b\u1ee5ng ho\u1eb7c t\u0103ng nh\u01b0ng \u1edf \u0111\u1ed9 I (< 21cm H2<\/sub>O) l\u00e0 VTC nh\u1eb9 v\u00e0 b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p l\u1ef1c \u1ed5 b\u1ee5ng t\u1eeb \u0111\u1ed9 II tr\u1edf l\u00ean (\u2265 21 cm H2<\/sub>O) l\u00e0 VTC n\u1eb7ng.<\/span><\/p>\n

Ch\u1ea9n \u0111o\u00e1n VTC n\u1eb7ng theo ti\u00eau chu\u1ea9n hi\u1ec7p h\u1ed9i t\u1ee5y h\u1ecdc th\u1ebf gi\u1edbi 2007<\/span><\/i><\/b><\/p>\n

* Giai \u0111o\u1ea1n s\u1edbm (tu\u1ea7n \u0111\u1ea7u)<\/span><\/b><\/p>\n

– VTC n\u1eb7ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a khi ng\u01b0\u1eddi b\u1ec7nh c\u00f3 h\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam h\u1ec7 th\u1ed1ng (SIRS) v\u00e0\/ho\u1eb7c ph\u00e1t tri\u1ec3n th\u00e0nh suy t\u1ea1ng.<\/span><\/p>\n

– Ngo\u00e0i ra, n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh VTC tr\u00ean c\u01a1 \u0111\u1ecba: suy th\u1eadn, b\u1ec7nh l\u00fd tim m\u1ea1ch, suy gi\u1ea3m mi\u1ec5n d\u1ecbch \u0111\u1ec1u \u0111\u01b0\u1ee3c coi l\u00e0 VTC n\u1eb7ng.<\/span><\/p>\n

* Giai \u0111o\u1ea1n sau 1 tu\u1ea7n<\/span><\/b><\/p>\n

Sau 1 tu\u1ea7n, VTC n\u1eb7ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a khi c\u00f3 suy \u00edt nh\u1ea5t 1 t\u1ea1ng v\u00e0 k\u00e9o d\u00e0i tr\u00ean 48 gi\u1edd. Ch\u1ea9n \u0111o\u00e1n suy t\u1ea1ng d\u1ef1a v\u00e0o thang \u0111i\u1ec3m Marshall chung cho ng\u01b0\u1eddi b\u1ec7nh vi\u00eam t\u1ee5y \u1edf t\u1ea5t c\u1ea3 c\u00e1c khoa l\u00e2m s\u00e0ng, \u0111i\u1ec1u tr\u1ecb. V\u1edbi ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m \u1edf HSTC c\u1ea7n s\u1eed d\u1ee5ng thang \u0111i\u1ec3m SOFA \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u00e0o theo d\u00f5i suy t\u1ea1ng.<\/span><\/p>\n

(Suy t\u1ea1ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a khi \u0111i\u1ec3m Marshall ho\u1eb7c \u0111i\u1ec3m SOFA cho t\u1ea1ng \u0111\u00f3 \u2265 2 \u0111i\u1ec3m. Suy \u0111a t\u1ea1ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a khi c\u00f3 \u2265 2 t\u1ea1ng suy k\u00e9o d\u00e0i \u2265 48 gi\u1edd).<\/span><\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam t\u1ee5y c\u1ea5p (acute pancreatitis) l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh vi\u00eam c\u1ea5p t\u00ednh c\u1ee7a t\u1ee5y, bi\u1ec3u hi\u1ec7n \u1edf nhi\u1ec1u m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau: m\u1ee9c \u0111\u1ed9 nh\u1eb9 ch\u1ec9 c\u1ea7n n\u1eb1m vi\u1ec7n ng\u1eafn ng\u00e0y, \u00edt bi\u1ebfn ch\u1ee9ng. M\u1ee9c \u0111\u1ed9 n\u1eb7ng, b\u1ec7nh di\u1ec5n bi\u1ebfn ph\u1ee9c t\u1ea1p, t\u1ef7 l\u1ec7 t\u1eed vong cao 20-50%, trong b\u1ec7nh c\u1ea3nh suy \u0111a t\u1ea1ng, nhi\u1ec5m […]<\/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":[],"yoast_head":"\nC\u1eadp nh\u1eadp ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u1ee5y c\u1ea5p theo B\u1ed9 Y t\u1ebf - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh vi\u00eam c\u1ea5p t\u00ednh c\u1ee7a t\u1ee5y, bi\u1ec3u hi\u1ec7n \u1edf nhi\u1ec1u m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau. 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