{"id":29670,"date":"2023-05-02T16:06:13","date_gmt":"2023-05-02T09:06:13","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29670"},"modified":"2023-05-02T16:06:13","modified_gmt":"2023-05-02T09:06:13","slug":"cap-nhap-ky-thuat-cat-doan-tinh-mach-cua-ghep-tu-than","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/02\/cap-nhap-ky-thuat-cat-doan-tinh-mach-cua-ghep-tu-than\/","title":{"rendered":"C\u1eadp nh\u1eadp k\u1ef9 thu\u1eadt c\u1eaft \u0111o\u1ea1n t\u0129nh m\u1ea1ch c\u1eeda, gh\u00e9p t\u1ef1 th\u00e2n"},"content":{"rendered":"

C\u1eaft \u0111o\u1ea1n t\u0129nh m\u1ea1ch c\u1eeda th\u01b0\u1eddng ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p u tu\u1ef5<\/a>, u \u0111\u01b0\u1eddng m\u1eadt x\u00e2m l\u1ea5n t\u0129nh m\u1ea1ch c\u1eeda. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111o\u1ea1n t\u0129nh m\u1ea1ch b\u1ecb c\u1eaft d\u00e0i, s\u1ebd c\u1ea7n gh\u00e9p \u0111o\u1ea1n. M\u1ea3nh gh\u00e9p t\u1ef1 th\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ea5y t\u1eeb \u0111o\u1ea1n t\u0129nh m\u1ea1ch hi\u1ec3n (Saphen) ho\u1eb7c t\u0129nh m\u1ea1ch th\u1eadn tr\u00e1i. C\u1eadp nh\u1eadp k\u1ef9 thu\u1eadt c\u1eaft \u0111o\u1ea1n t\u0129nh m\u1ea1ch c\u1eeda (SMV) v\u00e0 gh\u00e9p t\u1ef1 th\u00e2n trong ph\u1eabu thu\u1eadt l\u00e0 m\u1ed9t b\u01b0\u1edbc ti\u1ebfn quan tr\u1ecdng trong vi\u1ec7c c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m nguy c\u01a1 ph\u1eabu thu\u1eadt cho b\u1ec7nh nh\u00e2n.\u00a0<\/strong><\/p>\n

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H\u00ecnh \u1ea3nh minh h\u1ecda t\u0129nh m\u1ea1ch c\u1eeda<\/figcaption><\/figure>\n

1. Ch\u1ec9 \u0111\u1ecbnh<\/b><\/h2>\n

– U tu\u1ef5 x\u00e2m l\u1ea5n t\u0129nh m\u1ea1ch c\u1eeda<\/p>\n

– U \u0111\u01b0\u1eddng m\u1eadt<\/a> x\u00e2m l\u1ea5n t\u0129nh m\u1ea1ch c\u1eeda<\/p>\n

2. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/b><\/h2>\n

– U di c\u0103n xa, di c\u0103n ph\u00fac m\u1ea1c:\u00a0V\u00ec c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u00e3 m\u1eafc b\u1ec7nh ung th\u01b0, vi\u1ec7c ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 kh\u00f4ng hi\u1ec7u qu\u1ea3 ho\u1eb7c g\u00e2y nguy hi\u1ec3m cho s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

– B\u1ec7nh l\u00fd n\u1ed9i khoa n\u1eb7ng: b\u1ec7nh tim m\u1ea1ch, h\u00f4 h\u1ea5p, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u\u2026 : C\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb c\u00e1c b\u1ec7nh l\u00fd n\u1ed9i khoa n\u1eb7ng nh\u01b0 b\u1ec7nh tim m\u1ea1ch, h\u00f4 h\u1ea5p, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u c\u00f3 nguy c\u01a1 cao g\u1eb7p ph\u1ea3i c\u00e1c bi\u1ebfn ch\u1ee9ng sau ph\u1eabu thu\u1eadt c\u1eaft \u0111o\u1ea1n t\u0129nh m\u1ea1ch c\u1eeda v\u00e0 gh\u00e9p t\u1ef1 th\u00e2n.<\/p>\n

3. Chu\u1ea9n b\u1ecb<\/b><\/h2>\n

3.1. Ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n: <\/b><\/h3>\n

L\u00e0 ph\u1eabu thu\u1eadt vi\u00ean chuy\u00ean khoa ti\u00eau ho\u00e1, m\u1ea1ch m\u00e1u.<\/p>\n

3.2. Ng\u01b0\u1eddi b\u1ec7nh:<\/b><\/h3>\n

– Ng\u01b0\u1eddi b\u1ec7nh ph\u1ea3i \u0111\u01b0\u1ee3c l\u00e0m \u0111\u1ea7y \u0111\u1ee7 x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng b\u1ec7nh, giai \u0111o\u1ea1n b\u1ec7nh, \u0111\u00e1nh gi\u00e1 to\u00e0n th\u00e2n (tim m\u1ea1ch, h\u00f4 h\u1ea5p, \u0111\u00f4ng m\u00e1u).<\/p>\n

– Ng\u00e0y tr\u01b0\u1edbc m\u1ed5 ph\u1ea3i \u0111\u01b0\u1ee3c v\u1ec7 sinh th\u00e2n th\u1ec3, c\u1ea1o l\u00f4ng b\u1ed9 ph\u1eadn sinh d\u1ee5c, th\u1ee5t th\u00e1o s\u1ea1ch.<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch \u0111\u1ea7y \u0111\u1ee7 v\u1ec1 b\u1ec7nh l\u00fd, v\u1ec1 quy tr\u00ecnh ph\u1eabu thu\u1eadt, c\u00e1c tai bi\u1ebfn r\u1ee7i ro c\u00f3 th\u1ec3 x\u1ea3y ra trong v\u00e0 sau ph\u1eabu thu\u1eadt.<\/p>\n

3.3. Ph\u01b0\u01a1ng ti\u1ec7n:<\/b><\/h3>\n

– Khung van x\u00edch n\u00e2ng th\u00e0nh b\u1ee5ng.<\/p>\n

– B\u1ed9 d\u1ee5ng c\u1ee5 \u0111\u1ea1i ph\u1eabu ti\u00eau ho\u00e1.<\/p>\n

– B\u1ed9 d\u1ee5ng c\u1ee5 m\u1ea1ch m\u00e1u: clamp m\u1ea1ch m\u00e1u c\u00e1c lo\u1ea1i, d\u1ee5ng c\u1ee5 kh\u00e2u n\u1ed1i m\u1ea1ch m\u00e1u: ch\u1ec9 prolene 5\/0 6\/0\u2026<\/p>\n

– Ch\u1ec9 ti\u00eau 3.0, 4.0, ch\u1ec9 kh\u00f4ng ti\u00eau 4.0, 5.0\u2026<\/p>\n

– M\u00e1y si\u00eau \u00e2m trong m\u1ed5 (n\u1ebfu c\u00f3).<\/p>\n

4. C\u00e1c b\u01b0\u1edbc ti\u1ebfn h\u00e0nh<\/b><\/h2>\n

4.1. T\u01b0 th\u1ebf:<\/b><\/h3>\n

– Ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m ng\u1eeda, 2 tay d\u1ea1ng vu\u00f4ng g\u00f3c v\u1edbi ng\u01b0\u1eddi.<\/p>\n

– Ph\u1eabu thu\u1eadt vi\u00ean \u0111\u1ee9ng b\u00ean ph\u1ea3i ng\u01b0\u1eddi b\u1ec7nh, ng\u01b0\u1eddi ph\u1ee5 1 v\u00e0 2 \u0111\u1ee9ng b\u00ean tr\u00e1i, d\u1ee5ng c\u1ee5 vi\u00ean \u0111\u1ee9ng c\u00f9ng b\u00ean ph\u1eabu thu\u1eadt vi\u00ean.<\/p>\n

4.2. V\u00f4 c\u1ea3m: <\/b><\/h3>\n

G\u00e2y m\u00ea n\u1ed9i kh\u00ed qu\u1ea3n, \u0111\u1eb7t sonde d\u1ea1 d\u00e0y, \u0111\u1eb7t sonde ti\u1ec3u, vein ngo\u1ea1i vi v\u00e0 trung \u01b0\u01a1ng. Th\u01b0\u1eddng k\u00ea m\u1ed9t g\u1ed1i nh\u1ecf \u1edf m\u0169i \u1ee9c \u0111\u1ec3 b\u1ed9c l\u1ed9 r\u00f5 \u0111\u01b0\u1eddng m\u1ed5, s\u00e1t tr\u00f9ng to\u00e0n b\u1ed9 \u1ed5 b\u1ee5ng t\u1eeb d\u01b0\u1edbi n\u00fam v\u00fa \u0111\u1ebfn x\u01b0\u01a1ng mu.<\/p>\n

4.3. K\u1ef9 thu\u1eadt:<\/b><\/h3>\n

– B\u01b0\u1edbc 1 – m\u1edf b\u1ee5ng: t\u00f9y theo th\u01b0\u01a1ng t\u1ed5n: \u0111\u01b0\u1eddng tr\u1eafng gi\u1eefa, \u0111\u01b0\u1eddng d\u01b0\u1edbi s\u01b0\u1eddn m\u1edf r\u1ed9ng l\u00ean m\u0169i \u1ee9c ho\u1eb7c \u0111\u01b0\u1eddng ch\u1eef J.<\/p>\n

– B\u01b0\u1edbc 2: \u0110\u00e1nh gi\u00e1 th\u01b0\u01a1ng t\u1ed5n \u0111\u1ea1i th\u1ec3 d\u1ecbch \u1ed5 b\u1ee5ng, t\u1ed5n th\u01b0\u01a1ng ph\u00fac m\u1ea1c, h\u1ea1ch cu\u1ed1ng gan, t\u1ed5 ch\u1ee9c u.<\/p>\n

– B\u01b0\u1edbc 3: B\u1ed9c l\u1ed9 t\u0129nh m\u1ea1ch c\u1eeda v\u00f9ng cu\u1ed1ng gan: t\u0129nh m\u1ea1ch c\u1eeda n\u1eb1m sau \u1ed1ng m\u1eadt ch\u1ee7 v\u00e0 \u0111\u1ed9ng m\u1ea1ch gan.<\/p>\n

– B\u01b0\u1edbc 4: Chu\u1ea9n b\u1ecb \u0111o\u1ea1n t\u0129nh m\u1ea1ch t\u1ef1 th\u00e2n: c\u00f3 th\u1ec3 l\u1ea5y t\u0129nh m\u1ea1ch hi\u1ec3n ho\u1eb7c \u0111o\u1ea1n t\u0129nh m\u1ea1ch th\u00e2n tr\u00e1i c\u00f3 chi\u1ec1u d\u00e0i mong mu\u1ed1n.<\/p>\n

– B\u01b0\u1edbc 5: C\u1eaft \u0111o\u1ea1n t\u0129nh m\u1ea1ch c\u1eeda; Clamp 2 \u0111\u1ea7u tr\u00ean v\u00e0 d\u01b0\u1edbi c\u1ee7a t\u0129nh m\u1ea1ch c\u1eeda, c\u1eaft \u0111o\u1ea1n TM c\u1eeda c\u00f3 u x\u00e2m l\u1ea5n.<\/p>\n

– B\u01b0\u1edbc 6: N\u1ed1i 2 \u0111\u1ea7u t\u0129nh m\u1ea1ch c\u1eeda t\u1eadn t\u1eadn v\u1edbi \u0111o\u1ea1n t\u0129nh m\u1ea1ch gh\u00e9p t\u1ef1 th\u00e2n: kh\u00e2u v\u1eaft b\u1eb1ng ch\u1ec9 prolene 5\/0 ho\u1eb7c 6\/0.<\/p>\n

– B\u01b0\u1edbc 7: Lau \u1ed5 b\u1ee5ng, \u0111\u1eb7t d\u1eabn l\u01b0u: \u0111\u1eb7t d\u1eabn l\u01b0u d\u01b0\u1edbi gan, \u0111\u00f3ng b\u1ee5ng.<\/p>\n

5. Theo d\u00f5i v\u00e0 x\u1eed tr\u00ed tai bi\u1ebfn<\/b><\/h2>\n

5.1. Theo d\u00f5i:<\/b><\/h3>\n

Khi ng\u01b0\u1eddi b\u1ec7nh r\u00fat \u0111\u01b0\u1ee3c \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n th\u00ec \u0111\u01b0\u1ee3c chuy\u1ec3n v\u1ec1 b\u1ec7nh ph\u00f2ng, th\u1edf Oxy > 48h, nu\u00f4i d\u01b0\u1ee1ng b\u1eb1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch >72h, c\u00e1c x\u00e9t nghi\u1ec7m sinh h\u00f3a m\u00e1u, \u0111\u00f4ng m\u00e1u, c\u00f4ng th\u1ee9c m\u00e1u \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u00e0o ng\u00e0y 1, 3, 5, 7 sau m\u1ed5.<\/p>\n

5.2. Bi\u1ebfn ch\u1ee9ng v\u00e0 c\u00e1ch x\u1eed tr\u00ed:<\/b><\/h3>\n

– Ch\u1ea3y m\u00e1u: m\u00e1u ch\u1ea3y qua d\u1eabn l\u01b0u, b\u1ee5ng ch\u01b0\u1edbng t\u0103ng d\u1ea7n, m\u1ea1ch nhanh, huy\u1ebft \u00e1p t\u1ee5t, h\u1ed3ng c\u1ea7u, hematocrit gi\u1ea3m. X\u1eed tr\u00ed: truy\u1ec1n m\u00e1u, h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c, m\u1ed5 l\u1ea1i c\u1ea7m m\u00e1u<\/p>\n

– H\u1eb9p, t\u1eafc t\u0129nh m\u1ea1ch c\u1eeda: bi\u1ec3u hi\u1ec7n d\u1ecbch \u1ed5 b\u1ee5ng ch\u1ea3y nhi\u1ec1u, men gan t\u0103ng. Si\u00eau \u00e2m doppler th\u1ea5y huy\u1ebft kh\u1ed1i g\u00e2y t\u1eafc ho\u1eb7c h\u1eb9p TM c\u1eeda. X\u1eed tr\u00ed: d\u00f9ng ch\u1ed1ng \u0111\u00f4ng, m\u1ed5 l\u1ea1i l\u1ea5y huy\u1ebft.<\/p>\n

6. \u01afu \u0111i\u1ec3m c\u1ee7a k\u1ef9 thu\u1eadt c\u1eaft \u0111o\u1ea1n t\u0129nh m\u1ea1ch c\u1eeda, gh\u00e9p t\u1ef1 th\u00e2n<\/h2>\n

\u01afu \u0111i\u1ec3m c\u1ee7a k\u1ef9 thu\u1eadt c\u1eaft \u0111o\u1ea1n t\u0129nh m\u1ea1ch c\u1eeda(SMV) v\u00e0 gh\u00e9p t\u1ef1 th\u00e2n trong ph\u1eabu thu\u1eadt l\u00e0:<\/p>\n

– Gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t ung th\u01b0: C\u1eaft \u0111o\u1ea1n t\u0129nh m\u1ea1ch c\u1eeda v\u00e0 gh\u00e9p t\u1ef1 th\u00e2n gi\u00fap lo\u1ea1i b\u1ecf c\u00e1c t\u1ebf b\u00e0o ung th\u01b0 c\u00f2n s\u00f3t l\u1ea1i trong SMV, gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t ung th\u01b0.<\/p>\n

– T\u0103ng t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t: K\u1ef9 thu\u1eadt n\u00e0y gi\u00fap t\u0103ng t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt.<\/p>\n

– Gi\u1ea3m nguy c\u01a1 ch\u1ea3y m\u00e1u: C\u1eaft \u0111o\u1ea1n t\u0129nh m\u1ea1ch c\u1eeda v\u00e0 gh\u00e9p t\u1ef1 th\u00e2n gi\u00fap gi\u1ea3m nguy c\u01a1 ch\u1ea3y m\u00e1u trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt.<\/p>\n

– Gi\u1ea3m th\u1eddi gian ph\u1eabu thu\u1eadt: K\u1ef9 thu\u1eadt n\u00e0y gi\u00fap gi\u1ea3m th\u1eddi gian ph\u1eabu thu\u1eadt v\u00e0 t\u0103ng t\u1ed1c \u0111\u1ed9 h\u1ed3i ph\u1ee5c sau ph\u1eabu thu\u1eadt.<\/p>\n

– Gi\u1ea3m s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a b\u1ec7nh: Khi c\u1eaft \u0111o\u1ea1n SMV, c\u00e1c t\u1ebf b\u00e0o ung th\u01b0 kh\u00f4ng th\u1ec3 ph\u00e1t tri\u1ec3n v\u00e0 lan r\u1ed9ng \u0111\u1ebfn c\u00e1c b\u1ed9 ph\u1eadn kh\u00e1c trong c\u01a1 th\u1ec3.<\/p>\n

7. H\u1ea1n ch\u1ebf<\/h2>\n

H\u1ea1n ch\u1ebf c\u1ee7a k\u1ef9 thu\u1eadt c\u1eaft \u0111o\u1ea1n t\u0129nh m\u1ea1ch c\u1eeda v\u00e0 gh\u00e9p t\u1ef1 th\u00e2n trong ph\u1eabu thu\u1eadt l\u00e0:<\/p>\n

– Ph\u1eabu thu\u1eadt ph\u1ee9c t\u1ea1p: \u0110\u00e2y l\u00e0 m\u1ed9t ph\u1eabu thu\u1eadt ph\u1ee9c t\u1ea1p \u0111\u00f2i h\u1ecfi k\u1ef9 n\u0103ng v\u00e0 kinh nghi\u1ec7m c\u1ee7a c\u00e1c b\u00e1c s\u0129 ph\u1eabu thu\u1eadt.<\/p>\n

– Nguy c\u01a1 nhi\u1ec5m tr\u00f9ng: Khi c\u1eaft \u0111o\u1ea1n SMV, c\u00f3 nguy c\u01a1 nhi\u1ec5m tr\u00f9ng v\u00e0 s\u01b0ng t\u1ea5y.<\/p>\n

– Nguy c\u01a1 ch\u1ea3y m\u00e1u: Khi gh\u00e9p t\u1ef1 th\u00e2n, c\u00f3 th\u1ec3 x\u1ea3y ra nguy c\u01a1 ch\u1ea3y m\u00e1u trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt.<\/p>\n

– Ph\u1ee5c h\u1ed3i sau ph\u1eabu thu\u1eadt l\u00e2u d\u00e0i: Sau ph\u1eabu thu\u1eadt, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u1ea7n th\u1eddi gian d\u00e0i \u0111\u1ec3 ph\u1ee5c h\u1ed3i v\u00e0 h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n.<\/p>\n

– Chi ph\u00ed cao: Ph\u1eabu thu\u1eadt c\u1eaft \u0111o\u1ea1n SMV v\u00e0 gh\u00e9p t\u1ef1 th\u00e2n l\u00e0 m\u1ed9t ph\u1eabu thu\u1eadt ph\u1ee9c t\u1ea1p v\u00e0 \u0111\u00f2i h\u1ecfi nhi\u1ec1u t\u00e0i nguy\u00ean, do \u0111\u00f3, chi ph\u00ed ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 kh\u00e1 cao.<\/p>\n

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

C\u1eaft \u0111o\u1ea1n t\u0129nh m\u1ea1ch c\u1eeda th\u01b0\u1eddng ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p u tu\u1ef5, u \u0111\u01b0\u1eddng m\u1eadt x\u00e2m l\u1ea5n t\u0129nh m\u1ea1ch c\u1eeda. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111o\u1ea1n t\u0129nh m\u1ea1ch b\u1ecb c\u1eaft d\u00e0i, s\u1ebd c\u1ea7n gh\u00e9p \u0111o\u1ea1n. M\u1ea3nh gh\u00e9p t\u1ef1 th\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ea5y t\u1eeb \u0111o\u1ea1n t\u0129nh m\u1ea1ch hi\u1ec3n (Saphen) ho\u1eb7c t\u0129nh m\u1ea1ch th\u1eadn tr\u00e1i. 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