{"id":30077,"date":"2023-05-04T17:21:45","date_gmt":"2023-05-04T10:21:45","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30077"},"modified":"2023-05-10T12:12:54","modified_gmt":"2023-05-10T05:12:54","slug":"loc-mang-bung","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/loc-mang-bung\/","title":{"rendered":"L\u1ecdc m\u00e0ng b\u1ee5ng li\u00ean t\u1ee5c: Nh\u1eefng bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p"},"content":{"rendered":"

L\u1ecdc m\u00e0ng b\u1ee5ng li\u00ean t\u1ee5c l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb thay th\u1ebf ch\u1ee9c n\u0103ng th\u1eadn th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. Tuy nhi\u00ean, nh\u01b0 b\u1ea5t k\u1ef3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00e0o kh\u00e1c, l\u1ecdc m\u00e0ng b\u1ee5ng li\u00ean t\u1ee5c c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p ph\u1ea3i m\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng.<\/strong><\/p>\n

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Ngu\u1ed3n<\/strong>: Peritoneal Dialysis – Nephure for Rane Kidney Disease<\/em><\/figcaption><\/figure>\n

1. Bi\u1ebfn ch\u1ee9ng nhi\u1ec5m tr\u00f9ng<\/strong><\/h1>\n

1.1. Vi\u00eam ph\u00fac m\u1ea1c<\/strong>:<\/h3>\n

Vi\u00eam ph\u00fac m\u1ea1c l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y nh\u1eadp vi\u1ec7n.<\/p>\n

1.1.1. Ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u00fac m\u1ea1c<\/strong>: Khi c\u00f3 2 trong 3 ti\u00eau chu\u1ea9n sau \u0111\u00e2y<\/p>\n

– S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a vi khu\u1ea9n trong nu\u00f4i c\u1ea5y ho\u1eb7c nhu\u1ed9m Gram<\/p>\n

– D\u1ecbch \u0111\u1ee5c ( s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch \u2265 100\/mm; \u2265 50% l\u00e0 bc \u0111a nh\u00e2n trung t\u00ednh)<\/p>\n

– C\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a VPM: \u0111au b\u1ee5ng, c\u1ea3m \u1ee9ng ph\u00fac m\u1ea1c..<\/p>\n

1.1.2. \u0110i\u1ec1u tr\u1ecb vi\u00eam ph\u00fac m\u1ea1c<\/strong>: \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u c\u1ee7a VPM d\u1ef1a v\u00e0o kinh nghi\u1ec7m v\u00e0 th\u01b0\u1eddng d\u00f9ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng cho c\u1ea3 vi khu\u1ea9n gram \u00e2m v\u00e0 d\u01b0\u01a1ng. K\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y t\u00ecm vi khu\u1ea9n trong d\u1ecbch l\u1ecdc m\u00e0ng b\u1ee5ng s\u1ebd quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u00fac m\u1ea1c theo ph\u00e1c \u0111\u1ed3 n\u00e0o. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb ph\u1ee5 thu\u1ed9c v\u00e0o vi khu\u1ea9n v\u00e0 \u0111\u1ed9 n\u1eb7ng c\u1ee7a vi\u00eam ph\u00fac m\u1ea1c, v\u00ed d\u1ee5 v\u1edbi nhi\u1ec5m tr\u00f9ng t\u1ee5 c\u1ea7u d\u1ecbch t\u1ec5 l\u00e0 14 ng\u00e0y v\u00e0 h\u1ea7u h\u1ebft c\u00e1c nhi\u1ec5m tr\u00f9ng kh\u00e1c l\u00e0 3 tu\u1ea7n.<\/p>\n

1.2.Nhi\u1ec5m tr\u00f9ng li\u00ean quan \u0111\u1ebfn Catheter<\/strong><\/h3>\n
    \n
  • Nhi\u1ec5m tr\u00f9ng exit site \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a khi c\u00f3 m\u1ee7, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 t\u1ea5y \u0111\u1ecf \u1edf v\u1ecb tr\u00ed exit site.<\/li>\n
  • Nhi\u1ec5m tr\u00f9ng c\u1ee7a catheter d\u01b0\u1edbi da (\u0111\u01b0\u1eddng h\u1ea7m) c\u00f3 bi\u1ec3u hi\u1ec7n \u0111au, s\u01b0ng t\u1ea5y, \u0111\u1ecf, c\u1ee9ng l\u00ean \u1edf v\u00f9ng \u0111\u01b0\u1eddng h\u1ea7m.<\/li>\n<\/ul>\n

    X\u1eed tr\u00ed<\/strong>: c\u1ea5y d\u1ecbch m\u1ee7, d\u1ecbch vi\u00eam t\u00ecm vi khu\u1ea9n. D\u1ef1a v\u00e0o kinh nghi\u1ec7m \u0111i\u1ec1u tr\u1ecb vi\u00eam t\u1ea1i ch\u1ed7 v\u00e0 kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng, ch\u1edd k\u1ebft qu\u1ea3 c\u1ea5y vi khu\u1ea9n \u0111\u1ec3 l\u1ef1a ch\u1ecdn kh\u00e1ng sinh ph\u00f9 h\u1ee3p. Theo d\u00f5i v\u00e0 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng vi\u00eam, c\u00f3 th\u1ec3 si\u00eau \u00e2m \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 \u1ee9 d\u1ecbch v\u00e0 \u00fa m\u1ee7 \u1edf \u0111\u01b0\u1eddng h\u1ea7m. N\u00ean thay b\u0103ng 3h\/l\u1ea7n ho\u1eb7c nhi\u1ec1u h\u01a1n.<\/p>\n

    2. C\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00f4ng nhi\u1ec5m tr\u00f9ng<\/strong><\/h2>\n

    2.1. Bi\u1ebfn ch\u1ee9ng li\u00ean quan \u0111\u1ebfn Catheter<\/strong><\/h3>\n

    – Bi\u1ebfn ch\u1ee9ng sau m\u1ed5<\/strong>: bao g\u1ed3m ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ebfn c\u00e1c c\u01a1 quan trong \u1ed5 b\u1ee5ng( ru\u1ed9t, b\u00e0ng quang) ho\u1eb7c m\u1ea1ch m\u00e1u, ch\u1ea3y m\u00e1u ho\u1eb7c nhi\u1ec5m tr\u00f9ng.<\/p>\n

    – D\u00f2 d\u1ecbch<\/strong>: D\u00f2 d\u1ecbch x\u1ea3y ra \u1edf 7% bn trong n\u0103m \u0111\u1ea7u ti\u00ean. Nguy c\u01a1 d\u00f2 t\u0103ng l\u00ean\u00a0 n\u1ebfu th\u1eddi gian ngh\u1ec9 ng\u01a1i sau m\u1ed5 ng\u1eafn. D\u00f2 d\u1ecbch li\u00ean quan \u0111\u1ebfn k\u1ef9 thu\u1eadt \u0111\u1eb7t Catheter, ch\u1ea5n th\u01b0\u01a1ng, ho\u1eb7c b\u1ea5t th\u01b0\u1eddng gi\u1ea3i ph\u1eabu c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec1u t\u1ef1 li\u1ec1n. Ng\u1eebng l\u1ecdc c\u00e0ng l\u00e2u, c\u01a1 h\u1ed9i li\u1ec1n c\u00e0ng l\u1edbn. N\u1ebfu d\u00f2 d\u1ecbch t\u1ed3n t\u1ea1i dai d\u1eb3ng c\u1ea7n r\u00fat Catheter v\u00e0 \u0111\u1eb7t l\u1ea1i v\u00e0o v\u1ecb tr\u00ed kh\u00e1c.<\/p>\n

    – D\u1ecbch ra k\u00e9m<\/strong>: D\u1ecbch ra k\u00e9m th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n khi th\u1ec3 t\u00edch d\u1ecbch ra \u00edt h\u01a1n \u0111\u00e1ng k\u1ec3 th\u1ec3 t\u00edch d\u1ecbch v\u00e0o v\u00e0 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a d\u00f2 quanh Catheter. Th\u01b0\u1eddng x\u1ea3y ra s\u1edbm sau ph\u1eabu thu\u1eadt, trong ho\u1eb7c s\u1edbm sau \u0111\u1ee3t vi\u00eam ph\u00fac m\u1ea1c ho\u1eb7c b\u1ea5t c\u1ee9 giai \u0111o\u1ea1n n\u00e0o. C\u00e1c y\u1ebfu t\u1ed1 trong l\u00f2ng \u1ed1ng (c\u1ee5c m\u00e1u \u0111\u00f4ng, fibrin) ho\u1eb7c ngo\u00e0i l\u00f2ng \u1ed1ng ( t\u00e1o b\u00f3n, b\u00edt c\u00e1c l\u1ed7 c\u1ee7a Catheter b\u1edfi c\u00e1c t\u1ea1ng l\u00e2n c\u1eadn ho\u1eb7c m\u1ea1c n\u1ed1i bao quanh, \u0111\u1ea7u Catheter l\u1ea1c ch\u1ed7 ra kh\u1ecfi h\u1ed1 ch\u1eadu, \u0111\u1eb7t Catheter kh\u00f4ng ch\u00ednh x\u00e1c) l\u00e0 nh\u1eefng nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t.<\/p>\n

    \u0110i\u1ec1u tr\u1ecb<\/strong>: T\u00f9y v\u00e0o t\u1eebng nguy\u00ean nh\u00e2n<\/p>\n

    + Ki\u1ec3m tra xem Catheter c\u00f3 b\u1ecb xo\u1eafn v\u1eb7n kh\u00f4ng<\/strong>: n\u1ebfu c\u00f3, th\u01b0\u1eddng c\u1ea7n ph\u1eabu thu\u1eadt \u0111\u1eb7t l\u1ea1i Catheter ho\u1eb7c lo\u1ea1i b\u1ecf cuff \u1edf b\u1ec1 m\u1eb7t<\/p>\n

    + \u0110i\u1ec1u tr\u1ecb t\u00e1o b\u00f3n<\/strong>: m\u1ed9t trong c\u00e1c b\u01b0\u1edbc n\u00ean l\u00e0m tr\u01b0\u1edbc ti\u00ean \u1edf ng\u01b0\u1eddi b\u1ec7nh t\u1eafc ngh\u1ebdn d\u00f2ng d\u1ecbch ra l\u00e0 d\u00f9ng thu\u1ed1c nhu\u1eadn tr\u00e0ng. \u0110i\u1ec1u tr\u1ecb t\u00e1o b\u00f3n gi\u1ea3i quy\u1ebft \u0111\u01b0\u1ee3c g\u1ea7n 50% c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1eafc ngh\u1ebdn d\u00f2ng d\u1ecbch ra do Catheter.<\/p>\n

    + Heparin<\/strong>: th\u00eam Heparin v\u00e0o d\u1ecbch l\u1ecdc m\u00e0ng b\u1ee5ng( 250-500 UI\/l\u00edt) b\u1ea5t c\u1ee9 khi n\u00e0o quan s\u00e1t th\u1ea5y fibrin \u1edf d\u00f2ng d\u1ecbch ra. Tuy nhi\u00ean, heparin c\u00f3 t\u00e1c d\u1ee5ng d\u1ef1 ph\u00f2ng h\u01a1n l\u00e0 \u0111i\u1ec1u tr\u1ecb v\u00e0 th\u01b0\u1eddng \u00edt th\u00e0nh c\u00f4ng trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u1eafc ngh\u1ebdn.<\/p>\n

    + C\u00e1c thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft<\/strong>: n\u1ebfu Heparin kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3, c\u1ea7n d\u00f9ng thu\u1ed1c ti\u00eau s\u1ee3i huy\u1ebft( streptokinase, Urokinase, c\u00e1c ch\u1ea5t ho\u1ea1t h\u00f3a plasminogen m\u00f4)<\/p>\n

    + S\u1eeda l\u1ea1i v\u1ecb tr\u00ed Catheter<\/strong>: N\u1ebfu t\u1eafc ngh\u1ebdn kh\u00f4ng gi\u1ea3m khi \u00e1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p tr\u00ean, nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 do m\u1ea1c n\u1ed1i ho\u1eb7c c\u00e1c m\u00f4 kh\u00e1c l\u00e0m b\u00edt \u0111\u1ea7u Catheter.<\/p>\n

    Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, c\u1ea7n gi\u1ea3i ph\u00f3ng Catheter ra kh\u1ecfi ch\u1ed7 bao b\u1ecdc m\u1ea1c n\u1ed1i v\u00e0 \u0111\u1eb7t l\u1ea1i \u1edf v\u1ecb tr\u00ed kh\u00e1c trong \u1ed5 b\u1ee5ng.<\/p>\n

    + \u0110\u1eb7t l\u1ea1i Catheter<\/strong>: N\u1ebfu c\u00e1c bi\u1ec7n ph\u00e1p tr\u00ean th\u1ea5t b\u1ea1i, c\u1ea7n \u0111\u1eb7t l\u1ea1i Catheter kh\u00e1c.<\/p>\n

    D\u1ecbch v\u00e0o k\u00e9m<\/strong>: truy\u1ec1n 2 l\u00edt v\u00e0o \u1ed5 b\u1ee5ng th\u01b0\u1eddng m\u1ea5t 15 ph\u00fat. Th\u1eddi gian n\u00e0y c\u00f3 th\u1ec3 d\u00e0i h\u01a1n ho\u1eb7c d\u1ecbch ho\u00e0n to\u00e0n kh\u00f4ng v\u00e0o \u0111\u01b0\u1ee3c. C\u1ea7n l\u00e0m nh\u1eefng bi\u1ec7n ph\u00e1p sau<\/p>\n

    + Ki\u1ec3m tra xem c\u00f3 xo\u1eafn v\u1eb7n: n\u1ebfu c\u00f3, c\u1ea7n \u0111\u1eb7t l\u1ea1i Catheter ho\u1eb7c b\u1ecf cuff b\u1ec1 m\u1eb7t<\/p>\n

    + B\u01a1m m\u1ea1nh 20 ml mu\u1ed1i pha heparin<\/p>\n

    + N\u1ebfu catheter v\u1eabn b\u1ecb t\u1eafc, ki\u1ec3m tra XQ th\u1ea5y Catheter n\u1eb1m sai v\u1ecb tr\u00ed c\u1ea7n s\u1eeda l\u1ea1i v\u1ecb tr\u00ed Catheter<\/p>\n

    + N\u1ebfu Catheter \u1edf \u0111\u00fang v\u1ecb tr\u00ed, truy\u1ec1n urokinase ( 25000 \u0111\u01a1n v\u1ecb trong 2 ml mu\u1ed1i) v\u00e0o l\u00f2ng \u1ed1ng v\u00e0 gi\u1eef t\u1ea1i ch\u1ed7 trong 2-4 h<\/p>\n

    M\u00f2n cuff<\/strong>: Cuff b\u1ec1 m\u1eb7t c\u00f3 th\u1ec3 g\u1eb7m v\u00e0o da v\u00ec nhi\u1ec5m tr\u00f9ng exit site ho\u1eb7c do l\u00fac \u0111\u1ea7u \u0111\u1eb7t qu\u00e1 g\u1ea7n da v\u00f9ng exit site ho\u1eb7c cuff s\u00e2u t\u00e1ch kh\u1ecfi l\u1edbp c\u01a1 th\u00e0nh b\u1ee5ng.<\/p>\n

    C\u1ea7n c\u1eaft b\u1ecf cuff b\u1ec1 m\u1eb7t.<\/p>\n

    \u0110au khi truy\u1ec1n d\u1ecbch v\u00e0o<\/strong>: li\u00ean quan \u0111\u1ebfn d\u1ecbch l\u1ecdc c\u00f3 pH th\u1ea5p, nhi\u1ec7t \u0111\u1ed9 d\u1ecbch l\u1ecdc cao b\u1ea5t th\u01b0\u1eddng, m\u1ea1c n\u1ed1i bao b\u1ecdc catheter, ho\u1eb7c \u00e1p l\u1ef1c \u0111\u01b0\u1ee3c t\u1ea1o ra b\u1edfi c\u00e1c c\u1ea5u tr\u00fac l\u00e2n c\u1eadn( ru\u1ed9t, \u00e2m \u0111\u1ea1o, th\u1eebng tinh) trong th\u1eddi gian cho d\u1ecbch v\u00e0o. M\u1ea1c n\u1ed1i bao b\u1ecdc v\u00e0 \u00e1p l\u1ef1c t\u0103ng trong c\u00e1c t\u1ea1ng l\u00e2n c\u1eadn th\u01b0\u1eddng g\u1eb7p nh\u1ea5t v\u00e0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1ch s\u1eeda l\u1ea1i v\u1ecb tr\u00ed Catheter. Th\u00eam Natri hydroxide ho\u1eb7c Natri bicarbonate v\u00e0o d\u1ecbch l\u1ecdc ho\u1eb7c s\u1eed d\u1ee5ng d\u1ecbch bicarbonate c\u00f3 th\u1ec3 gi\u1ea3m c\u1ea3m gi\u00e1c \u0111au<\/p>\n

    \u0110au khi x\u1ea3 d\u1ecbch ra<\/strong>: \u0111i\u1ec1u n\u00e0y th\u01b0\u1eddng x\u1ea3y ra khi vi\u00eam ph\u00fac m\u1ea1c ho\u1eb7c v\u00e0i tu\u1ea7n \u0111\u1ea7u ti\u00ean sau khi b\u1eaft \u0111\u1ea7u l\u1ecdc m\u00e0ng b\u1ee5ng. Chuy\u1ec3n sang ch\u1ebf \u0111\u1ed9 l\u1ecdc m\u00e0ng b\u1ee5ng b\u1eb1ng m\u00e1y ki\u1ec3u th\u1ee7y tri\u1ec1u th\u01b0\u1eddng gi\u00fap gi\u1ea3m c\u1ea3m gi\u00e1c n\u00e0y.<\/p>\n

    2.2. C\u00e1c bi\u1ebfn ch\u1ee9ng c\u01a1 h\u1ecdc c\u1ee7a l\u1ecdc m\u00e0ng b\u1ee5ng<\/strong><\/h3>\n

    Hai y\u1ebfu t\u1ed1 g\u00f3p ph\u1ea7n g\u00e2y t\u0103ng \u00e1p l\u1ef1c trong \u1ed5 b\u1ee5ng l\u00e0 l\u01b0\u1ee3ng d\u1ecbch v\u00e0o truy\u1ec1n v\u00e0o trong \u1ed5 b\u1ee5ng v\u00e0 t\u01b0 th\u1ebf c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh trong th\u1eddi gian ng\u00e2m d\u1ecbch<\/p>\n

    –Tho\u00e1t v\u1ecb<\/strong>: Kho\u1ea3ng 10-20% bn c\u00f3 bi\u1ec3u hi\u1ec7n tho\u00e1t v\u1ecb t\u1ea1i th\u1eddi \u0111i\u1ec3m n\u00e0o \u0111\u00f3. Nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 bao g\u1ed3m th\u1ec3 t\u00edch d\u1ecbch l\u1ecdc l\u1edbn, c\u00e1c thi\u1ebfu s\u00f3t c\u1ee7a th\u00e0nh b\u1ee5ng b\u1ea9m sinh. V\u1ecb tr\u00ed th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 tho\u00e1t v\u1ecb ch\u1ed7 \u0111\u1eb7t Catheter, r\u1ed1n, b\u1eb9n. Tho\u00e1t v\u1ecb \u0111\u00e1ng k\u1ec3 n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i khoa, sau \u0111\u00f3 gi\u1eef \u00e1p l\u1ef1c th\u1ea5p trong \u1ed5 b\u1ee5ng \u0111\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho li\u1ec1n v\u1ecb tr\u00ed tho\u00e1t v\u1ecb.<\/p>\n

    –Ph\u00f9 sinh d\u1ee5c<\/strong>: D\u1ecbch l\u1ecdc c\u00f3 th\u1ec3 ch\u1ea3y \u0111\u1ebfn v\u00f9ng sinh d\u1ee5c b\u1eb1ng 2 \u0111\u01b0\u1eddng: m\u1ed9t l\u00e0 \u0111i qua \u0111\u01b0\u1eddng th\u00f4ng v\u1edbi \u00e2m \u0111\u1ea1o g\u00e2y ra \u1ed5 t\u1ee5 d\u1ecbch( hydrocele) v\u00e0 th\u1ee9 hai l\u00e0 d\u1ecbch t\u1eeb v\u1ecb tr\u00ed y\u1ebfu c\u1ee7a th\u00e0nh b\u1ee5ng ch\u1ea3y xu\u1ed1ng g\u00e2y ph\u00f9 \u1edf bao quy \u0111\u1ea7u v\u00e0 b\u00ecu. N\u1ebfu do con \u0111\u01b0\u1eddng th\u1ee9 nh\u1ea5t c\u00f3 th\u1ec3 s\u1eeda ch\u1eefa b\u1eb1ng ph\u1eabu thu\u1eadt, n\u1ebfu do con \u0111\u01b0\u1eddng th\u1ee9 hai c\u00f3 th\u1ec3 \u0111\u1eb7t l\u1ea1i Catheter. \u0110\u1ec3 c\u00f3 th\u1eddi gian li\u1ec1n, chuy\u1ec3n t\u1ea1m th\u1eddi sang TNT ho\u1eb7c LMB li\u00ean t\u1ee5c b\u1eb1ng m\u00e1y(CCPD) v\u1edbi th\u1ec3 t\u00edch d\u1ecbch \u00edt.<\/p>\n

    –Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i<\/strong>: Do \u00e1p l\u1ef1c \u1ed5 b\u1ee5ng t\u0103ng, d\u1ecbch l\u1ecdc c\u00f3 th\u1ec3 t\u1eeb khoang m\u00e0ng b\u1ee5ng di chuy\u1ec3n l\u00ean khoang m\u00e0ng ph\u1ed5i th\u00f4ng qua v\u1ecb tr\u00ed y\u1ebfu c\u1ee7a c\u01a1 ho\u00e0nh. H\u1ea7u h\u1ebft x\u1ea3y ra \u1edf m\u00e0ng ph\u1ed5i ph\u1ea3i. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng b\u1eb1ng c\u00e1ch ng\u1eebng l\u1ecdc v\u00e0 ch\u1ecdc th\u00e1o n\u1ebfu c\u1ea7n. \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n b\u1eb1ng ph\u1eabu thu\u1eadt s\u1eeda c\u01a1 ho\u00e0nh ho\u1eb7c g\u00e2y d\u00ednh khoang m\u00e0ng ph\u1ed5i.<\/p>\n

    –\u0110au l\u01b0ng<\/strong>: \u00c1p l\u1ef1c \u1ed5 b\u1ee5ng t\u0103ng v\u00e0 trung t\u00e2m tr\u1ecdng l\u1ef1c chuy\u1ec3n ra ph\u00eda tr\u01b0\u1edbc, khi\u1ebfn c\u1ed9t s\u1ed1ng c\u00f3 xu h\u01b0\u1edbng \u01b0\u1ee1n ra. Ng\u01b0\u1eddi b\u1ec7nh th\u01b0\u1eddng b\u1ecb \u0111au l\u01b0ng v\u00e0 \u0111au th\u1ea7n kinh t\u1ecda. \u0110\u1ec3 kh\u1eafc ph\u1ee5c, c\u00f3 th\u1ec3 thay d\u1ecbch nhi\u1ec1u l\u1ea7n v\u00e0 m\u1ed7i l\u1ea7n \u00edt d\u1ecbch ho\u1eb7c ti\u1ebfn h\u00e0nh l\u1ecdc m\u00e0ng b\u1ee5ng b\u1eb1ng m\u00e1y v\u1edbi l\u01b0\u1ee3ng d\u1ecbch ng\u00e2m ban ng\u00e0y \u00edt.<\/p>\n

    2.3. C\u00e1c bi\u1ebfn ch\u1ee9ng chuy\u1ec3n h\u00f3a c\u1ee7a l\u1ecdc m\u00e0ng b\u1ee5ng<\/strong><\/h3>\n

    – H\u1ea5p thu Glucose v\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/strong>: M\u1ed9t s\u1ed1 l\u1edbn ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng c\u1ea7n insulin khi l\u1ecdc m\u00e0ng b\u1ee5ng, th\u1eadm ch\u00ed n\u1ebfu tr\u01b0\u1edbc \u0111\u00f3 h\u1ecd kh\u00f4ng c\u1ea7n insulin. \u0110i\u1ec1u n\u00e0y m\u1ed9t ph\u1ea7n do glucose \u0111\u01b0\u1ee3c h\u1ea5p thu t\u1eeb d\u1ecbch l\u1ecdc v\u00e0o m\u00e1u k\u1ebft h\u1ee3p v\u1edbi hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng c\u00e2n. Kho\u1ea3ng 60-80% glucose trong d\u1ecbch l\u1ecdc \u0111\u01b0\u1ee3c h\u1ea5p thu trong m\u1ed7i l\u1ea7n thay d\u1ecbch, c\u00f3 th\u1ec3 \u0111\u1ea1t t\u1edbi 100-150 g\/ng\u00e0y. N\u00f3 c\u00f3 th\u1ec3 g\u00e2y t\u0103ng insulin v\u00e0 triglyceride trong m\u00e1u. \u0110\u1ec3 gi\u1ea3m thi\u1ec3u t\u00ecnh tr\u1ea1ng h\u1ea5p thu glucose, ng\u01b0\u1eddi b\u1ec7nh n\u00ean h\u1ea1n ch\u1ebf mu\u1ed1i n\u01b0\u1edbc \u0111\u1ec3 lo\u1ea1i b\u1ecf nhu c\u1ea7u d\u00f9ng lo\u1ea1i d\u1ecbch \u01b0u tr\u01b0\u01a1ng, \u0111\u1ed3ng th\u1eddi c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn c\u00e1c lo\u1ea1i d\u1ecbch kh\u00e1c nh\u01b0 polyglucose ho\u1eb7c amino acids<\/p>\n

    – R\u1ed1i lo\u1ea1n lipid m\u00e1u<\/strong>: Ng\u01b0\u1eddi b\u1ec7nh l\u1ecdc m\u00e0ng b\u1ee5ng th\u01b0\u1eddng c\u00f3 cholesterol to\u00e0n ph\u1ea7n v\u00e0 LDL cholesterol cao, HDL cholesterol th\u1ea5p, apoB cao, apoA-1 th\u1ea5p, triglyceride cao, lipoprotein alpha cao. R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a lipid l\u00e0 nguy c\u01a1 \u0111\u00e1ng k\u1ec3 g\u00e2y x\u01a1 v\u1eefa \u0111m. Ng\u01b0\u1eddi b\u1ec7nh n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng statin, fibrate, tr\u00e1nh r\u01b0\u1ee3u v\u00e0 thu\u1ed1c g\u00e2y t\u0103ng lipid m\u00e1u, gi\u1ea3m thi\u1ec3u nhu c\u1ea7u s\u1eed d\u1ee5ng d\u1ecbch \u01b0u tr\u01b0\u01a1ng.<\/p>\n

    – M\u1ea5t protein<\/strong>: M\u1ed7i l\u1ea7n d\u1eabn l\u01b0u d\u1ecbch, ng\u01b0\u1eddi b\u1ec7nh m\u1ea5t l\u01b0\u1ee3ng protein kho\u1ea3ng \u22650,5g\/l\u00edt, t\u01b0\u01a1ng \u0111\u01b0\u01a1ng kho\u1ea3ng 10-20 g\/ng\u00e0y, \u0111\u1eb7c bi\u1ec7t \u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 m\u00e0ng v\u1eadn chuy\u1ec3n cao ho\u1eb7c trung b\u00ecnh cao, ho\u1eb7c trong \u0111\u1ee3t VPM. Kh\u1eafc ph\u1ee5c b\u1eb1ng ch\u1ebf \u0111\u1ed9 \u0103n \u0111\u1ec3 b\u00f9 v\u00e0o l\u01b0\u1ee3ng protein b\u1ecb m\u1ea5t \u0111i.<\/p>\n

    – R\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i v\u00e0 ki\u1ec1m toan<\/strong><\/p>\n

    2.4. C\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c c\u1ee7a l\u1ecdc m\u00e0ng b\u1ee5ng<\/strong><\/h3>\n

    – Suy dinh d\u01b0\u1ee1ng<\/strong>: Suy dinh d\u01b0\u1ee1ng nh\u1eb9-trung b\u00ecnh g\u1eb7p \u1edf kho\u1ea3ng 40% v\u00e0 suy dinh d\u01b0\u1ee1ng tr\u1ea7m tr\u1ecdng g\u1eb7p \u1edf 8-10% ng\u01b0\u1eddi b\u1ec7nh. \u0110i\u1ec1u tr\u1ecb b\u1eb1ng d\u00f9ng d\u1ecbch l\u1ecdc amino acid ho\u1eb7c s\u1eed d\u1ee5ng m\u1ed9t s\u1ed1 thu\u1ed1c nh\u01b0 thu\u1ed1c th\u00fac \u0111\u1ea9y t\u0103ng tr\u01b0\u1edfng( Domperidone) ho\u1eb7c steroid t\u0103ng \u0111\u1ed3ng h\u00f3a( Nandrolone).<\/p>\n

    – Bi\u1ebfn ch\u1ee9ng tim m\u1ea1ch<\/strong>: T\u1eed vong do tim m\u1ea1ch \u1edf nh\u00f3m ng\u01b0\u1eddi b\u1ec7nh n\u00e0y v\u1eabn r\u1ea5t cao. Nguy\u00ean nh\u00e2n bao g\u1ed3m r\u1ea5t nhi\u1ec1u y\u1ebfu t\u1ed1. M\u1ed9t v\u00e0i y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn b\u1ea3n th\u00e2n ph\u01b0\u01a1ng ph\u00e1p, v\u1edbi s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a m\u00e0ng t\u0103ng v\u1eadn chuy\u1ec3n, s\u1ef1 xu\u1ea5t hi\u1ec7n vi\u00eam trong m\u00f4i tr\u01b0\u1eddng suy dinh d\u01b0\u1ee1ng v\u00e0 x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch, r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a calci phospho v\u00e0 calci h\u00f3a m\u1ea1ch m\u00e1u.<\/p>\n

    – L\u1ecdc m\u00e1u kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7:<\/strong> M\u1ea5t ch\u1ee9c n\u0103ng th\u1eadn t\u1ed3n d\u01b0 l\u00e0 y\u1ebfu t\u1ed1 quan tr\u1ecdng nh\u1ea5t g\u00e2y ra l\u1ecdc m\u00e1u kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7. C\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng l\u1ecdc m\u00e1u b\u1eb1ng vi\u1ec7c t\u0103ng s\u1ed1 l\u1ea7n thay d\u1ecbch h\u00e0ng ng\u00e0y, t\u0103ng th\u1ec3 t\u00edch ng\u00e2m d\u1ecbch v\u00e0 t\u0103ng \u0111\u1ed9 \u01b0u tr\u01b0\u01a1ng c\u1ee7a d\u1ecbch l\u1ecdc.<\/p>\n

    – Suy si\u00eau l\u1ecdc<\/strong>: m\u00e0ng b\u1ee5ng ph\u1ea3n \u1ee9ng v\u1edbi nh\u1eefng thay \u0111\u1ed5i \u0111\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi m\u00f4i tr\u01b0\u1eddng m\u1edbi b\u1eb1ng c\u00e1ch d\u00e0y l\u00ean v\u00e0 t\u0103ng sinh m\u00e0ng \u0111\u00e1y c\u1ea3 trung bi\u1ec3u m\u00f4 c\u0169ng nh\u01b0 mao m\u1ea1ch. Nh\u1eefng thay \u0111\u1ed5i n\u00e0y x\u1ea3y ra th\u1ee9 ph\u00e1t do m\u00e0ng b\u1ee5ng ti\u1ebfp x\u00fac v\u1edbi nh\u1eefng ch\u1ea5t kh\u00f4ng sinh l\u00fd c\u1ee7a d\u1ecbch l\u1ecdc, \u0111\u1ed3ng th\u1eddi c\u0169ng l\u00e0 ho\u1ea1t \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp c\u1ee7a glucose v\u00e0 c\u00e1c ch\u1ea5t gi\u00e1ng h\u00f3a c\u1ee7a glucose bao g\u1ed3m c\u00e1c s\u1ea3n ph\u1ea9m glycosyl h\u00f3a cu\u1ed1i c\u00f9ng l\u00ean m\u00e0ng b\u1ee5ng. \u0110i\u1ec1u tr\u1ecb t\u1ed1t nh\u1ea5t l\u00e0 gi\u1ea3m th\u1eddi gian ng\u00e2m d\u1ecbch, thay d\u1ecbch ban \u0111\u00eam b\u1eb1ng m\u00e1y k\u1ebft h\u1ee3p v\u1edbi s\u1eed d\u1ee5ng d\u1ecbch icodextrin ban ng\u00e0y.<\/p>\n

    Ngu\u1ed3n tham kh\u1ea3o<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 b\u1ec7nh th\u1eadn \u2013 ti\u1ebft ni\u1ec7u c\u1ee7a B\u1ed9 Y t\u1ebf 2015<\/p>\n","protected":false},"excerpt":{"rendered":"

    L\u1ecdc m\u00e0ng b\u1ee5ng li\u00ean t\u1ee5c l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb thay th\u1ebf ch\u1ee9c n\u0103ng th\u1eadn th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. Tuy nhi\u00ean, nh\u01b0 b\u1ea5t k\u1ef3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00e0o kh\u00e1c, l\u1ecdc m\u00e0ng b\u1ee5ng li\u00ean t\u1ee5c c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p ph\u1ea3i m\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng. 1. Bi\u1ebfn ch\u1ee9ng nhi\u1ec5m tr\u00f9ng 1.1. Vi\u00eam ph\u00fac m\u1ea1c: Vi\u00eam […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[],"yoast_head":"\nL\u1ecdc m\u00e0ng b\u1ee5ng li\u00ean t\u1ee5c: Nh\u1eefng bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p - Vinmec<\/title>\n<meta name=\"description\" content=\"L\u1ecdc m\u00e0ng b\u1ee5ng li\u00ean t\u1ee5c l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb thay th\u1ebf ch\u1ee9c n\u0103ng th\u1eadn th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. 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