{"id":30492,"date":"2023-05-04T17:18:09","date_gmt":"2023-05-04T10:18:09","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30492"},"modified":"2023-05-08T13:17:55","modified_gmt":"2023-05-08T06:17:55","slug":"benh-than-man-2","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/benh-than-man-2\/","title":{"rendered":"B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i: Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i (ESRD) l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd nghi\u00eam tr\u1ecdng v\u00e0 ph\u1ee9c t\u1ea1p, \u0111\u00f2i h\u1ecfi s\u1ef1 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb chuy\u00ean s\u00e2u v\u00e0 ch\u00ednh x\u00e1c. B\u00e0i vi\u1ebft n\u00e0y s\u1ebd gi\u00fap b\u1ea1n hi\u1ec3u r\u00f5 h\u01a1n v\u1ec1 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 theo d\u00f5i b\u1ec7nh nh\u00e2n ESRD.<\/strong><\/p>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng v\u00e0 \u0111\u1ecbnh ngh\u0129a b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i<\/strong><\/h1>\n
    \n
  • B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i (end stage renal disease, ESRD)<\/strong> l\u00e0 b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n 5. \u0110\u00e2y l\u00e0 giai \u0111o\u1ea1n n\u1eb7ng nh\u1ea5t c\u1ee7a b\u1ec7nh th\u1eadn m\u1ea1n (BTM) v\u1edbi m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn (GFR) < 15mL\/ph\/1,73 m2 , bi\u1ec3u hi\u1ec7n b\u1eb1ng h\u1ed9i ch\u1ee9ng ur\u00ea m\u00e1u, v\u00e0 t\u00ecnh tr\u1ea1ng n\u00e0y s\u1ebd g\u00e2y t\u1eed vong n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn.<\/li>\n
  • H\u1ed9i ch\u1ee9ng ur\u00ea m\u00e1u (uremic syndrome)<\/strong> l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng, g\u00e2y ra kh\u00f4ng ch\u1ec9 do s\u1ef1 gia t\u0103ng c\u1ee7a ur\u00ea huy\u1ebft thanh, m\u00e0 c\u00f2n t\u0103ng h\u01a1n 100 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c nit\u01a1 kh\u00e1c trong m\u00e1u nh\u01b0 peptide, aminoacid, creatinin,\u2026khi ng\u01b0\u1eddi b\u1ec7nh b\u1ecb suy th\u1eadn (c\u1ea5p ho\u1eb7c m\u1ea1n). Thu\u1eadt ng\u1eef ch\u00ednh x\u00e1c h\u01a1n l\u00e0 \u201ch\u1ed9i ch\u1ee9ng t\u0103ng azote m\u00e1u\u201d. Do kh\u00f4ng ph\u1ea3i ch\u1ea5t n\u00e0o c\u0169ng \u0111o \u0111\u1ea1t \u0111\u01b0\u1ee3c, n\u00ean cho \u0111\u1ebfn nay, ur\u00ea v\u00e0 cr\u00e9atinine t\u0103ng \u0111\u1ed3ng ngh\u0129a v\u1edbi s\u1ef1 t\u0103ng c\u00e1c s\u1ea3n ph\u1ea9m azote kh\u00e1c.<\/li>\n
  • T\u0103ng azote m\u00e1u (azotemia)<\/strong> l\u00e0 s\u1ef1 gia t\u0103ng n\u1ed3ng \u0111\u1ed9 c\u00e1c s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c nit\u01a1 trong m\u00e1u nh\u01b0 protein, peptide, amino acid, creatinin, ur\u00ea, uric acid, ammoniac, hippurates, s\u1ea3n ph\u1ea9m tho\u00e1i h\u00f3a c\u1ee7a acid nh\u00e2n, polyamine, myoinositol, phenols, benzoates, v\u00e0 indoles.<\/li>\n<\/ul>\n

    2. Nguy\u00ean nh\u00e2n c\u1ee7a b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i<\/h2>\n

    Ba nh\u00f3m nguy\u00ean nh\u00e2n h\u1eb1ng \u0111\u1ea7u g\u00e2y BTM giai \u0111o\u1ea1n cu\u1ed1i tr\u00ean th\u1ebf gi\u1edbi l\u00e0 (1) \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, (2) t\u0103ng huy\u1ebft \u00e1p, (3) b\u1ec7nh c\u1ea7u th\u1eadn. N\u1ebfu t\u1ea1i c\u00e1c n\u01b0\u1edbc \u0111\u00e3 ph\u00e1t tri\u1ec3n, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u1eabn chi\u1ebfm \u01b0u th\u1ebf trong khi t\u1ea1i c\u00e1c n\u01b0\u1edbc \u0111ang ph\u00e1t tri\u1ec3n, nguy\u00ean nh\u00e2n h\u1eb1ng \u0111\u1ea7u v\u1eabn l\u00e0 b\u1ec7nh c\u1ea7u th\u1eadn (30-48%).<\/p>\n

    3. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i<\/h2>\n

    B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111\u1ecdan cu\u1ed1i c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a h\u1ed9i ch\u1ee9ng ur\u00ea huy\u1ebft bao g\u1ed3m ba r\u1ed1i lo\u1ea1n ch\u00ednh l\u00e0:<\/p>\n

      \n
    • R\u1ed1i lo\u1ea1n g\u00e2y ra do s\u1ef1 t\u00edch t\u1ee5 c\u00e1c ch\u1ea5t th\u1ea3i, v\u00e0 \u0111\u1ed9c ch\u1ea5t trong c\u01a1 th\u1ec3, quan tr\u1ecdng nh\u1ea5t l\u00e0 s\u1ea3n ph\u1ea9m bi\u1ebfn d\u01b0\u1ee1ng c\u1ee7a protein.<\/li>\n
    • R\u1ed1i lo\u1ea1n l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a s\u1ef1 m\u1ea5t d\u1ea7n c\u00e1c ch\u1ee9c n\u0103ng kh\u00e1c c\u1ee7a th\u1eadn nh\u01b0 \u0111i\u1ec1u h\u00f2a th\u0103ng b\u1eb1ng n\u1ed9i m\u00f4i, n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i, n\u1ed9i t\u00ed\u1ebft t\u1ed1<\/li>\n
    • R\u1ed1i l\u1ecdan l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a ph\u1ea3n \u1ee9ng vi\u00eam ti\u1ebfn tri\u1ec3n g\u00e2y ra \u1ea3nh h\u01b0\u1edfng l\u00ean m\u1ea1ch m\u00e1u v\u00e0 dinh d\u01b0\u1ee1ng.<\/li>\n<\/ul>\n
      \"\"
      Ngu\u1ed3n: Perioperative Management of Patients With End-Stage Renal Disease<\/strong><\/figcaption><\/figure>\n

      3.1. R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a natri<\/strong><\/p>\n

      C\u00f3 th\u1ec3 t\u0103ng ho\u1eb7c gi\u1ea3m natri m\u00e1u<\/p>\n

      3.2. R\u1ed1i lo\u1ea1n b\u00e0i ti\u1ebft n\u01b0\u1edbc<\/strong><\/h3>\n

      Ti\u1ec3u \u0111\u00eam l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u00ecnh tr\u1ea1ng th\u1ea3i n\u01b0\u1edbc ti\u1ec3u v\u00e0 sodium v\u1edbi m\u1ee9c \u0111\u1ed9 th\u1ea9m th\u1ea5u c\u1ed1 \u0111\u1ecbnh. Ng\u01b0\u1eddi b\u1ec7nh d\u1ec5 b\u1ecb thi\u1ebfu n\u01b0\u1edbc v\u00e0 mu\u1ed1i, n\u1ebfu ti\u1ebft ch\u1ebf qu\u00e1 m\u1ee9c, v\u00e0 d\u1ec5 gi\u1ea3m natri huy\u1ebft thanh, n\u1ebfu u\u1ed1ng qu\u00e1 nhi\u1ec1u n\u01b0\u1edbc.<\/p>\n

      3.3. R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a kali<\/strong><\/h3>\n
        \n
      • Ng\u01b0\u1eddi b\u1ec7nh suy th\u1eadn m\u1ea1n, th\u1eadn t\u0103ng ti\u1ebft aldosteron l\u00e0m t\u0103ng th\u1ea3i kali t\u1ea1i \u1ed1ng th\u1eadn xa, v\u00e0 t\u0103ng th\u1ea3i kali qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Do v\u1eady, kali m\u00e1u ch\u1ec9 t\u0103ng \u1edf BTM giai \u0111o\u1ea1n cu\u1ed1i C\u1ea7n t\u00ecm nguy\u00ean nh\u00e2n kh\u00e1c n\u1ebfu t\u0103ng kali xu\u1ea5t hi\u1ec7n tr\u01b0\u1edbc giai \u0111\u1ecdan cu\u1ed1i<\/li>\n
      • Gi\u1ea3m kali \u00edt g\u1eb7p h\u01a1n \u1edf ng\u01b0\u1eddi b\u1ec7nh BTM, ch\u1ee7 y\u1ebfu do ti\u1ebft ch\u1ebf ngu\u1ed3n nh\u1eadp kali, k\u00e8m v\u1edbi vi\u1ec7c d\u00f9ng l\u1ee3i ti\u1ec3u qu\u00e1 li\u1ec1u, ho\u1eb7c do t\u0103ng m\u1ea5t kali qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a.<\/li>\n<\/ul>\n

        3.4. Toan chuy\u1ec3n h\u00f3a trong <\/strong>b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i<\/h3>\n

        Suy th\u1eadn m\u1ea1n: l\u01b0\u1ee3ng acid b\u00e0i ti\u1ebft b\u1ecb kh\u1ed1ng ch\u1ebf trong kho\u1ea3ng h\u1eb9p t\u1eeb 30-40mmol\/ng\u00e0y, n\u00ean d\u1ec5 b\u1ecb toan chuy\u1ec3n h\u00f3a.<\/p>\n

        3.5. R\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1 calcium v\u00e0 phosphorus<\/strong><\/h3>\n

        Suy th\u1eadn m\u1ea1n: th\u1eadn gi\u1ea3m b\u00e0i ti\u1ebft phospho v\u00e0 calci, g\u00e2y t\u0103ng phospho trong m\u00e1u. \u0110\u1ec3 duy tr\u00ec t\u00edch s\u1ed1 phospho v\u00e0 calci \u1ed5n \u0111\u1ecbnh trong m\u00e1u, calci m\u00e1u gi\u1ea3m khi phospho t\u0103ng, k\u00edch th\u00edch tuy\u1ebfn c\u1eadn gi\u00e1p ti\u1ebft PTH, l\u00e0m t\u0103ng huy \u0111\u1ed9ng calci t\u1eeb x\u01b0\u01a1ng v\u00e0o m\u00e1u, ph\u1ee9c h\u1ee3p calci – phospho t\u0103ng l\u1eafng \u0111\u1ecdng t\u1ea1i m\u00f4, g\u00e2y r\u1ed1i lo\u1ea1n chu chuy\u1ec3n x\u01b0\u01a1ng, t\u0103ng b\u00e0i ti\u1ebft phospho t\u1ea1i \u1ed1ng th\u1eadn.<\/p>\n

        3.6. R\u1ed1i lo\u1ea1n v\u1ec1 tim m\u1ea1ch<\/strong><\/h3>\n

        B\u1ec7nh l\u00fd tim m\u1ea1ch l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y b\u1ec7nh v\u00e0 t\u1eed vong \u1edf m\u1ecdi giai \u0111o\u1ea1n c\u1ee7a b\u1ec7nh th\u1eadn m\u1ea1n, nh\u1ea5t l\u00e0 khi ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ebfn giai \u0111o\u1ea1n cu\u1ed1i.<\/p>\n

        – T\u0103ng huy\u1ebft \u00e1p v\u00e0 d\u00e0y th\u1ea5t tr\u00e1i<\/p>\n

        – Suy tim sung huy\u1ebft<\/p>\n

        – Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/p>\n

        – d-B\u1ec7nh m\u1ea1ch m\u00e1u<\/p>\n

        3.7. R\u1ed1i lo\u1ea1n v\u1ec1 huy\u1ebft h\u1ecdc<\/strong><\/p>\n

        3.7.1. Thi\u1ebfu m\u00e1u \u1edf ng\u01b0\u1eddi b\u1ec7nh BTM<\/strong><\/p>\n

        3.7.2. R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u \u1edf ng\u01b0\u1eddi b\u1ec7nh BTM<\/strong><\/p>\n

        R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u bao g\u1ed3m k\u00e9o d\u00e0i th\u1eddi gian m\u00e1u \u0111\u00f4ng, gi\u1ea3m ho\u1ea1t t\u00ednh c\u1ee7a y\u1ebfu t\u1ed1 III ti\u1ec3u c\u1ea7u, gi\u1ea3m \u0111\u1ed9 t\u1eadp trung ti\u1ec3u c\u1ea7u v\u00e0 gi\u1ea3m prothrombin.<\/p>\n

        3.7.3. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng b\u1ea1ch c\u1ea7u<\/strong><\/p>\n

        R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng b\u1ea1ch c\u1ea7u nh\u01b0 gi\u1ea3m s\u1ea3n xu\u1ea5t b\u1ea1ch c\u1ea7u, gi\u1ea3m ch\u1ee9c n\u0103ng b\u1ea1ch c\u1ea7u do suy dinh d\u01b0\u1ee1ng, toan chuy\u1ec3n h\u00f3a, m\u00f4i tr\u01b0\u1eddng t\u0103ng ur\u00ea m\u00e1u, v\u00e0 do teo h\u1ea1ch lympho.<\/p>\n

        3.8. R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a v\u00e0 dinh d\u01b0\u1ee1ng<\/strong><\/h3>\n

        Bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n<\/p>\n

        \u0102n gi\u1ea3m \u0111\u1ea1m s\u1ebd gi\u00fap gi\u1ea3m bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n, tuy nhi\u00ean s\u1ebd t\u0103ng nguy c\u01a1 suy dinh d\u01b0\u1ee1ng.<\/p>\n

        3.9. R\u1ed1i lo\u1ea1n th\u1ea7n kinh c\u01a1<\/strong><\/h3>\n

        – Tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh c\u01a1 b\u1eaft \u0111\u1ea7u xu\u1ea9t hi\u1ec7n t\u1eeb BTM giai \u0111\u1ecdan 3 nh\u01b0 gi\u1ea3m tr\u00ed nh\u1edb, k\u00e9m t\u1eadp trung, r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7. Sau \u0111\u00f3, ti\u1ebfn tri\u1ec3n th\u00e0nh th\u1ea7n kinh k\u00edch th\u00edch nh\u01b0 n\u1ea5c c\u1ee5c, chu\u1ed9t r\u00fat, \u0111au xo\u1eafn v\u1eb7n c\u01a1, n\u1eb7ng h\u01a1n trong giai \u0111o\u1ea1n suy th\u1eadn n\u1eb7ng l\u00e0 rung v\u1eaby, clonus c\u01a1, co gi\u1eadt v\u00e0 h\u00f4n m\u00ea.<\/p>\n

        – Tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh ng\u1ecdai bi\u00ean xu\u1ea5t hi\u1ec7n t\u1eeb BTM giai \u0111o\u1ea1n 4<\/p>\n

        – Tri\u1ec7u ch\u1ee9ng r\u1ed1i lo\u1ea1n th\u1ea7n kinh c\u1ea3m gi\u00e1c ng\u01b0\u1eddi b\u1ec7nh BTM giai \u0111o\u1ea1n cu\u1ed1i l\u00e0 ch\u1ec9 \u0111i\u1ec3m ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n l\u1ecdc m\u00e1u.<\/p>\n

        – B\u1ec7nh th\u1ea7n kinh ngo\u1ea1i bi\u00ean \u1edf ng\u01b0\u1eddi b\u1ec7nh BTM l\u00e0 ch\u1ec9 \u0111\u1ecbnh c\u1ee7a \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn, ngo\u1ea1i tr\u1eeb t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh tr\u00ean ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n

        3.10. R\u1ed1i lo\u1ea1n n\u1ed9i ti\u1ebft v\u00e0 chuy\u1ec3n h\u00f3a<\/strong><\/h3>\n
          \n
        • Hormone sinh d\u1ee5c: \u1ede ng\u01b0\u1eddi b\u1ec7nh n\u1eef, gi\u1ea3m estrogen g\u00e2y r\u1ed1i lo\u1ea1n kinh nguy\u1ec7t, gi\u1ea3m kh\u1ea3 n\u0103ng th\u1ee5 thai v\u00e0 d\u1ec5 s\u1ea3y thai, nh\u1ea5t l\u00e0 khi m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn gi\u1ea3m c\u00f2n 40 ml\/ph, ch\u1ec9 c\u00f3 20% s\u1ea3n ph\u1ee5 c\u1ee7a th\u1ec3 sanh \u0111\u01b0\u1ee3c con c\u00f2n s\u1ed1ng v\u00e0 ng\u01b0\u1ee3c l\u1ea1i, thai k\u1ef3 s\u1ebd \u0111\u1ea9y nhanh ti\u1ebfn tri\u1ec3n c\u1ee7a suy th\u1eadn. \u1ede ng\u01b0\u1eddi b\u1ec7nh nam, gi\u1ea3m n\u1ed3ng \u0111\u1ed9 testosterone, r\u1ed1i lo\u1ea1n t\u00ecnh d\u1ee5c, v\u00e0 thi\u1ec3u s\u1ea3n tinh tr\u00f9ng.<\/li>\n
        • C\u00e1c r\u1ed1i lo\u1ea1n n\u1ed9i ti\u1ebft n\u00e0y s\u1ebd c\u1ea3i thi\u1ec7n sau \u0111i\u1ec1u tr\u1ecb l\u1ecdc m\u00e1u t\u00edch c\u1ef1c ho\u1eb7c sau gh\u00e9p th\u1eadn th\u00e0nh c\u00f4ng.<\/li>\n<\/ul>\n

          3.11. T\u1ed5n th\u01b0\u01a1ng da<\/strong><\/h3>\n

          T\u1ed5n th\u01b0\u01a1ng da tr\u00ean BTM \u0111ang ti\u1ebfn tri\u1ec3n \u0111a d\u1ea1ng nh\u01b0<\/p>\n

            \n
          • Da v\u00e0ng xanh do thi\u1ebfu m\u00e1u, c\u00f3 th\u1ec3 gi\u1ea3m sau \u0111i\u1ec1u tr\u1ecb erythropoietin<\/li>\n
          • Xu\u1ea5t huy\u1ebft da ni\u00eam, m\u1ea3ng b\u1ea7m tr\u00ean da do r\u1ed1i lo\u1ea1n \u0111\u00f4ng c\u1ea7m m\u00e1u<\/li>\n
          • Da t\u0103ng s\u1eafc t\u1ed1 do t\u0103ng l\u1eafng \u0111\u1ecdng c\u00e1c s\u1ea3n ph\u1ea9m bi\u1ebfn d\u01b0\u1ee1ng t\u0103ng s\u1eafc t\u1ed1, ho\u1eb7c urochrome, tri\u1ec7u ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 v\u1eabn t\u1ed3n t\u1ea1i v\u00e0 gia t\u0103ng sau l\u1ecdc m\u00e1u<\/li>\n
          • Ng\u1ee9a l\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi b\u1ec7nh suy th\u1eadn m\u1ea1n v\u00e0 c\u00f3 th\u1ec3 k\u00e9o d\u00e0i ngay sau khi \u0111\u00e3 \u0111\u01b0\u1ee3c l\u1ecdc m\u00e1u.<\/li>\n
          • B\u1ec7nh da x\u01a1 do th\u1eadn (nephrogenic fibrosing dermopathy) bi\u1ec3u hi\u1ec7n b\u1eb1ng t\u1ed5n th\u01b0\u01a1ng x\u01a1 ti\u1ebfn tri\u1ec3n v\u00f9ng m\u00f4 d\u01b0\u1edbi da v\u00f9ng c\u00e1nh tay v\u00e0 ch\u00e2n t\u01b0\u01a1ng t\u1ef1 t\u1ed5n th\u01b0\u01a1ng da do ph\u00f9 ni\u00eam x\u01a1 h\u00f3a, xu\u1ea5t hi\u1ec7n \u1edf ng\u01b0\u1eddi b\u1ec7nh suy th\u1eadn m\u1ea1n, th\u01b0\u1eddng \u1edf ng\u01b0\u1eddi b\u1ec7nh \u0111ang l\u1ecdc m\u00e1u, c\u00f3 k\u00e8m d\u00f9ng gadolinium trong ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) l\u00e0 m\u1ed9t trong c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh.<\/li>\n<\/ul>\n

            4. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i<\/strong><\/h2>\n

            4.1. M\u1ee5c ti\u00eau c\u1ee7a \u0111i\u1ec1u tr\u1ecb <\/strong>b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i<\/h3>\n

            – Chu\u1ea9n b\u1ecb \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn khi th\u1eadn suy n\u1eb7ng<\/p>\n

            \u0110i\u1ec1u ch\u1ec9nh li\u1ec1u thu\u1ed1c \u1edf ng\u01b0\u1eddi b\u1ec7nh suy th\u1eadn<\/p>\n

            – \u0110i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a h\u1ed9i ch\u1ee9ng ur\u00ea huy\u1ebft cao nh\u01b0 thi\u1ebfu m\u00e1u, suy dinh d\u01b0\u1ee1ng, t\u0103ng huy\u1ebft \u00e1p, r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a canxi – phospho, r\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i.<\/p>\n

            – \u0110i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng tim m\u1ea1ch, v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1.<\/p>\n

            4.2. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng<\/strong><\/h3>\n

            Tu\u1ef3 theo b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng b\u1ea5t th\u01b0\u1eddng n\u00e0o th\u00ec ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p<\/p>\n

            4.3. Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn<\/strong><\/h3>\n

            Tr\u1eeb phi ng\u01b0\u1eddi b\u1ec7nh t\u1eeb ch\u1ed1i, m\u1ecdi ng\u01b0\u1eddi b\u1ec7nh BTM giai \u0111o\u1ea1n cu\u1ed1i, v\u1edbi l\u00e2m s\u00e0ng c\u1ee7a h\u1ed9i ch\u1ee9ng ur\u00ea huy\u1ebft cao (th\u01b0\u1eddng x\u1ea3y ra khi \u0111\u1ed9 thanh th\u1ea3i creatinin d\u01b0\u1edbi 15 ml\/ph\u00fat, ho\u1eb7c s\u1edbm h\u01a1n \u1edf ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng) \u0111\u1ec1u c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn.<\/p>\n

            C\u00e1c ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn<\/strong>:<\/p>\n

            – T\u0103ng kali m\u00e1u kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/p>\n

            – Toan chuy\u1ec3n h\u00f3a n\u1eb7ng (khi vi\u1ec7c d\u00f9ng HCO3 c\u00f3 th\u1ec3 s\u1ebd g\u00e2y qu\u00e1 t\u1ea3i tu\u1ea7n ho\u00e0n).<\/p>\n

            – Qu\u00e1 t\u1ea3i tu\u1ea7n h\u00f2an, ph\u00f9 ph\u1ed5i c\u1ea5p kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb l\u1ee3i ti\u1ec3u.<\/p>\n

            – Suy dinh d\u01b0\u1ee1ng ti\u1ebfn tri\u1ec3n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi can thi\u1ec7p kh\u1ea9u ph\u1ea7n<\/p>\n

            – M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn t\u1eeb 5-10ml\/ph\/1,73 m2 ( ho\u1eb7c BUN > 100mg\/dL, creatinine <\/span> huy\u1ebft thanh > 10mg\/dL)<\/p>\n

            L\u1ef1a ch\u1ecdn h\u00ecnh th\u1ee9c \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn<\/p>\n

            C\u00f3 ba h\u00ecnh th\u1ee9c \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn bao g\u1ed3m:<\/strong><\/p>\n

              \n
            • Th\u1eadn nh\u00e2n t\u1ea1o (ho\u1eb7c th\u1ea9m t\u00e1ch m\u00e1u, hemodialysis, HD)<\/li>\n
            • Th\u1ea9m ph\u00e2n ph\u00fac m\u1ea1c (peritoneal dialysis, PD)<\/li>\n
            • Gh\u00e9p th\u1eadn.<\/li>\n<\/ul>\n

              C\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn m\u1ed9t trong ba ph\u01b0\u01a1ng ph\u00e1p, tu\u1ef3 v\u00e0o t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3 c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh<\/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":"

              B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i (ESRD) l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd nghi\u00eam tr\u1ecdng v\u00e0 ph\u1ee9c t\u1ea1p, \u0111\u00f2i h\u1ecfi s\u1ef1 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb chuy\u00ean s\u00e2u v\u00e0 ch\u00ednh x\u00e1c. B\u00e0i vi\u1ebft n\u00e0y s\u1ebd gi\u00fap b\u1ea1n hi\u1ec3u r\u00f5 h\u01a1n v\u1ec1 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 theo d\u00f5i b\u1ec7nh nh\u00e2n ESRD. 1. \u0110\u1ea1i c\u01b0\u01a1ng v\u00e0 […]<\/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":"\nB\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i: Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i (end stage renal disease, ESRD) l\u00e0 b\u00eanh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n 5. \u0110\u00e2y l\u00e0 giai \u0111\u1ecdan n\u1eb7ng nh\u1ea5t c\u1ee7a b\u1ec7nh th\u1eadn m\u1ea1n (BTM)\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i: Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - 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