{"id":31205,"date":"2023-05-04T16:23:08","date_gmt":"2023-05-04T09:23:08","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31205"},"modified":"2023-05-04T16:23:08","modified_gmt":"2023-05-04T09:23:08","slug":"huong-dan-quy-trinh-gay-me-trong-noi-soi-dai-trang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/huong-dan-quy-trinh-gay-me-trong-noi-soi-dai-trang\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn quy tr\u00ecnh g\u00e2y m\u00ea trong n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng"},"content":{"rendered":"

N\u1ed9i soi \u0111\u1ea1i tr\u00e0ng c\u00f3 g\u00e2y m\u00ea l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n, \u0111\u01b0a \u0111\u00e8n soi m\u1ec1m t\u1eeb h\u1eadu m\u00f4n \u0111i ng\u01b0\u1ee3c l\u00ean \u0111\u1ebfn manh tr\u00e0ng \u0111\u1ec3 quan s\u00e1t t\u1ed5n th\u01b0\u01a1ng c\u1ee7a to\u00e0n b\u1ed9 \u0111\u1ea1i tr\u00e0ng. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y gi\u00fap qu\u00e1 tr\u00ecnh ch\u1ea9n \u0111o\u00e1n c\u00e1c b\u1ec7nh l\u00fd \u0111\u1ea1i tr\u00e0ng s\u1edbm v\u00e0 ch\u00ednh x\u00e1c, h\u1ed7 tr\u1ee3 cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n k\u1ecbp th\u1eddi.<\/span><\/strong><\/p>\n

\"\"<\/p>\n

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

Cho t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd b\u1ec7nh l\u00fd \u0111\u1ea1i tr\u00e0ng.<\/span><\/p>\n

1.1. Ch\u1ec9 \u0111\u1ecbnh soi \u0111\u1ea1i tr\u00e0ng ch\u1ea9n \u0111o\u00e1n<\/span><\/b><\/h3>\n

– Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi m\u1eafc ung th\u01b0 \u0111\u1ea1i tr\u00e0ng<\/span><\/p>\n

– \u0110i ngo\u00e0i ph\u00e2n \u0111en<\/a> (soi d\u1ea1 d\u00e0y b\u00ecnh th\u01b0\u1eddng)<\/span><\/p>\n

– Thi\u1ebfu m\u00e1u ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n<\/span><\/p>\n

– Hemocult d\u01b0\u01a1ng t\u00ednh<\/span><\/p>\n

– \u1ec8a ch\u1ea3y k\u00e9o d\u00e0i ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n (soi \u0111\u1ec3 sinh thi\u1ebft t\u1eebng \u0111o\u1ea1n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n colite collagene).<\/span><\/p>\n

– \u1ec8a ch\u1ea3y c\u1ea5p t\u00ednh<\/span><\/p>\n

– R\u1ed1i lo\u1ea1n \u0111\u1ea1i ti\u1ec7n<\/span><\/p>\n

– Ki\u1ec3m tra nh\u1eefng b\u1ea5t th\u01b0\u1eddng kh\u00f4ng r\u00f5 tr\u00ean phim X Quang<\/span><\/p>\n

– \u0110au d\u1ecdc khung \u0111\u1ea1i tr\u00e0ng ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n<\/span><\/p>\n

– Ch\u1ea3y m\u00e1u th\u1ea5p ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n<\/span><\/p>\n

– Soi ki\u1ec3m tra \u0111\u1ecbnh k ng\u01b0\u1eddi b\u1ec7nh c\u00f3 polyp, ung th\u01b0 \u0111\u1ea1i tr\u00e0ng<\/span><\/p>\n

– B\u1ec7nh t\u00fai th\u1eeba<\/span><\/p>\n

– C\u00e1c b\u1ec7nh vi\u00eam \u0111\u1ea1i tr\u00e0ng do m\u1ecdi nguy\u00ean nh\u00e2n<\/span><\/p>\n

1.2. Ch\u1ec9 \u0111\u1ecbnh soi \u0111\u1ea1i tr\u00e0ng \u0111i\u1ec1u tr\u1ecb<\/span><\/b><\/h3>\n

– C\u1eaft polyp<\/span><\/p>\n

– L\u1ea5y d\u1ecb v\u1eadt<\/span><\/p>\n

– C\u1ea7m m\u00e1u<\/span><\/p>\n

– Nong ch\u1ed7 h\u1eb9p<\/span><\/p>\n

– \u0110i\u1ec1u tr\u1ecb xo\u1eafn \u0111\u1ea1i tr\u00e0ng (v\u00e0 manh tr\u00e0ng)<\/span><\/p>\n

1.3. Ch\u1ec9 \u0111\u1ecbnh soi \u0111\u1ea1i tr\u00e0ng theo d\u00f5i<\/span><\/b><\/h3>\n

– Sau c\u1eaft polyp, n\u1ebfu polyp l\u00e0nh t\u00ednh, soi ki\u1ec3m tra sau 3 n\u0103m, sau \u0111\u00f3 c\u1ee9 5 n\u0103m m\u1ed9t l\u1ea7n.<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh vi\u00eam \u0111\u1ea1i tr\u00e0ng c\u00f3 lo\u1ea1n s\u1ea3n n\u1eb7ng<\/span><\/p>\n

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

– Nghi ng\u1edd h\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p.<\/p>\n

– T\u0103ng huy\u1ebft \u00e1p ch\u01b0a ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c.<\/span><\/p>\n

– Nghi ng\u1edd th\u1ee7ng t\u1ea1ng r\u1ed7ng.<\/span><\/p>\n

– Nghi ng\u1edd ph\u00ecnh, t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh trong t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p.<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh suy tim n\u1eb7ng.<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n kh\u00f4ng h\u1ee3p t\u00e1c.<\/span><\/p>\n

– Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i: t\u1ee5t huy\u1ebft \u00e1p HA t\u00e2m tr\u01b0\u01a1ng < 90mmHg.<\/span><\/p>\n

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

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

B\u00e1c s\u1ef9 \u0111\u00e3 c\u00f3 ch\u1ee9ng ch\u1ec9 t\u1ed1t nghi\u1ec7p n\u1ed9i soi Ti\u00eau h\u00f3a v\u00e0 2 \u0111i\u1ec1u d\u01b0\u1ee1ng ph\u1ee5 n\u1ed9i soi.<\/span><\/p>\n

3.2. Ph\u01b0\u01a1ng ti\u1ec7n<\/span><\/b><\/h3>\n

3.2.1. B\u1ed9 m\u00e1y n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng \u1ed1ng m\u1ec1m<\/span><\/i><\/b><\/p>\n

– M\u00e1y soi \u0111\u1ea1i tr\u00e0ng c\u00f3 video ho\u1eb7c kh\u00f4ng c\u00f3 video d\u00e0i 130 – 140 cm l\u00e0 hay dung nh\u1ea5t.<\/span><\/p>\n

– M\u00e1y soi \u0111\u1ea1i tr\u00e0ng d\u00e0i 165- 180 cm cho ph\u00e9p quan s\u00e1t t\u1ed1t manh tr\u00e0ng trong tr\u01b0\u1eddng h\u1ee3p \u0111\u1ea1i tr\u00e0ng qu\u00e1 d\u00e0i.<\/span><\/p>\n

– M\u00e1y soi \u0111\u1ea1i tr\u00e0ng ng\u1eafn 70-110 cm \u0111\u1ec3 soi \u0111\u1ea1i tr\u00e0ng<\/span><\/p>\n

3.2.2. C\u00e1c ph\u1ee5 t\u00f9ng \u0111i k\u00e8m<\/span><\/i><\/b><\/p>\n

– K\u00ecm sinh thi\u1ebft, d\u00e2y c\u1eaft polyp<\/span><\/p>\n

– K\u00ecm l\u1ea5y d\u1ecb v\u1eadt<\/span><\/p>\n

– K\u00ecm ti\u00eam c\u1ea7m m\u00e1u<\/span><\/p>\n

– Overtube<\/span><\/p>\n

– Thu\u1ed1c nhu\u1ed9m m\u00e0u \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng nh\u1ecf: xanh metylen, indigo carmin, m\u1ef1c t\u00e0u v.v \u0111\u1ec3 \u0111\u00e1nh d\u1ea5u ch\u1ed7 polyp \u0111\u00e3 c\u1eaft<\/span><\/p>\n

3.2.3. C\u00e1c thu\u1ed1c d\u00f9ng trong soi \u0111\u1ea1i tr\u00e0ng<\/span><\/i><\/b><\/p>\n

– Thu\u1ed1c ti\u1ec1n m\u00ea: Midazolam 5 mg\/ml, Propofol 10 mg\/ml<\/span><\/p>\n

– Thu\u1ed1c gi\u1ea3m \u0111au: Fentanyl 0,1 mg\/2 ml<\/span><\/p>\n

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

\u0110\u01b0\u1ee3c chu\u1ea9n b\u1ecb l\u00e0m s\u1ea1ch \u0111\u1ea1i tr\u00e0ng tr\u01b0\u1edbc. BN t\u1ed1i h\u00f4m tr\u01b0\u1edbc khi soi \u0103n ch\u00e1o. BN u\u1ed1ng Fortran 3 g\u00f3i pha v\u1edbi 3 l\u00edt n\u01b0\u1edbc trong v\u00f2ng 2 ti\u1ebfng tr\u01b0\u1edbc khi n\u1ed9i soi 6h. Sau khi \u0111i v\u1ec7 sinh s\u1ea1ch s\u1ebd n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng. N\u1ebfu BN t\u00e1o b\u00f3n, cho BN u\u1ed1ng thu\u1ed1c nhu\u1eadn tr\u00e0ng Folax x 3 g\u00f3i\/ ng\u00e0y trong 3 ng\u00e0y.<\/span><\/p>\n

3.3.1. Ch\u1ebf \u0111\u1ed9 \u0103n<\/span><\/i><\/b><\/p>\n

– Ng\u1eebng c\u00e1c thu\u1ed1c c\u00f3 ch\u1ea5t s\u1eaft tr\u01b0\u1edbc 3-4 ng\u00e0y<\/span><\/p>\n

– \u0102n ch\u1ebf \u0111\u1ed9 \u0103n kh\u00f4ng c\u00f3 ch\u1ea5t x\u01a1 1 ng\u00e0y<\/span><\/p>\n

3.3.2. Chu\u1ea9n b\u1ecb \u0111\u1ea1i tr\u00e0ng<\/span><\/i><\/b><\/p>\n

– C\u00f3 nhi\u1ec1u c\u00e1ch \u0111\u1ec3 r\u1eeda s\u1ea1ch \u0111\u1ea1i tr\u00e0ng nh\u01b0ng hi\u1ec7n nay ng\u01b0\u1eddi ta th\u1ea5y d\u00f9ng dung d\u1ecbch u\u1ed1ng Fortrans l\u00e0 hi\u1ec7u qu\u1ea3 nh\u1ea5t, lo\u1ea1i tr\u1eeb tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi b\u1ec7nh c\u00f3 bi\u1ec3u hi\u1ec7n b\u00e1n t\u1eafc th\u00ec ph\u1ea3i \u00e1p d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p th\u1ee5t r\u1eeda nhi\u1ec1u l\u1ea7n (3 l\u00edt n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd ho\u1eb7c n\u01b0\u1edbc \u1ea5m).<\/span><\/p>\n

– D\u00f9ng Fortrans c\u00f3 th\u1ec3 bu\u1ed3n n\u00f4n, n\u00ean d\u00f9ng thu\u1ed1c c\u1ee7a nh\u00f3m Metoclopramid, Domperidon, Cisapride.<\/span><\/p>\n

– \u0110\u1ed1i v\u1edbi c\u00e1c ng\u01b0\u1eddi b\u1ec7nh b\u1ecb t\u00e1o b\u00f3n, c\u00f3 th\u1ec3 cho chu\u1ea9n b\u1ecb b\u1eb1ng c\u00e1ch cho d\u00f9ng thu\u1ed1c nhu\u1eadn tr\u00e0ng (Forlax) trong v\u00e0i ng\u00e0y tr\u01b0\u1edbc soi.<\/span><\/p>\n

– N\u1ebfu ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng u\u1ed1ng \u0111\u01b0\u1ee3c kh\u1ed1i l\u01b0\u1ee3ng n\u01b0\u1edbc l\u1edbn, ng\u01b0\u1eddi ta c\u00f3 th\u1ec3 \u0111\u1eb7t \u1ed1ng th\u00f4ng d\u1ea1 d\u00e0y r\u1ed3i b\u01a1m d\u1ecbch qua \u0111\u00f3.<\/span><\/p>\n

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

4.1. Quy tr\u00ecnh g\u00e2y m\u00ea<\/span><\/b><\/h3>\n

– Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c th\u0103m kh\u00e1m t\u1ed5ng th\u1ec3, l\u00e0m \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 th\u01b0\u1eddng quy tr\u01b0\u1edbc soi.<\/span><\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c \u0111\u1eb7t \u0111\u01b0\u1eddng truy\u1ec1n Glucose 5 % ho\u1eb7c Ringer Lactate.<\/span><\/p>\n

– M\u1eafc Lifescope \u0111\u1ec3 theo d\u00f5i: Sp0<\/span>2,<\/span>\u00a0nh\u1ecbp tim, nh\u1ecbp th\u1edf, huy\u1ebft \u00e1p.<\/span><\/p>\n

– Th\u1edf oxy qua \u1ed1ng th\u00f4ng m\u0169i<\/span><\/p>\n

– Li\u1ec1u ban \u0111\u1ea7u: Midazolam 2 mg v\u00e0 Fentanyl 25 \u00b5g ti\u00eam t\u0129nh m\u1ea1ch, c\u00f3 th\u1ec3 t\u0103ng th\u00eam m\u1ed9t li\u1ec1u t\u01b0\u01a1ng t\u1ef1 c\u1ee9 sau 2-3 ph\u00fat n\u1ebfu c\u1ea7n. C\u00f3 th\u1ec3 d\u00f9ng t\u1edbi 5 mg Midazolam v\u00e0 100 \u00b5g Fentanyl.<\/span><\/p>\n

– Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p Naloxone 0,4 mg ti\u00eam t\u0129nh m\u1ea1ch.<\/span><\/p>\n

– Li\u1ec1u ban \u0111\u1ea7u v\u1edbi propofol: 20-40 mg m\u1ed7i 10 gi\u00e2y t\u00f9y \u0111\u00e1p \u1ee9ng \u0111\u1ebfn khi b\u1eaft \u0111\u1ea7u m\u00ea, ng\u01b0\u1eddi cao tu\u1ed5i: gi\u1ea3m li\u1ec1u. T\u1ed1c \u0111\u1ed9 truy\u1ec1n: 2 ml\/10 gi\u00e2y.<\/span><\/p>\n

– Sau khi ti\u1ebfn h\u00e0nh xong th\u1ee7 thu\u1eadt ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c theo d\u00f5i tr\u00ean lifescope 15-30 ph\u00fat t\u1ea1i ph\u00f2ng h\u1ed3i t\u1ec9nh tr\u01b0\u1edbc khi ra vi\u1ec7n.<\/span><\/p>\n

4.2. K\u1ef9 thu\u1eadt soi<\/span><\/b><\/h3>\n

– T\u01b0 th\u1ebf ng\u01b0\u1eddi b\u1ec7nh: n\u1eb1m ng\u1eeda ho\u1eb7c nghi\u00eang tr\u00e1i<\/span><\/p>\n

– \u1ede t\u01b0 th\u1ebf n\u1eb1m ng\u1eeda th\u00ec d\u1ec5 \u00e1p d\u1ee5ng, d\u1ec5 nh\u00ecn th\u1ea5y \u00e1nh s\u00e1ng qua th\u00e0nh b\u1ee5ng v\u00e0 ng\u01b0\u1eddi b\u1ec7nh d\u1ec5 th\u1edf h\u01a1n.<\/span><\/p>\n

– C\u00f2n \u1edf t\u01b0 th\u1ebf nghi\u1ec7ng tr\u00e1i: d\u1ec5 \u0111\u01b0a \u0111\u00e8n qua ch\u1ed7 n\u1ed1i tr\u1ef1c tr\u00e0ng- \u0111\u1ea1i tr\u00e0ng sigma.<\/span><\/p>\n

– B\u01b0\u1edbc \u0111\u1ea7u ti\u00ean: th\u0103m h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng r\u1ed3i \u0111\u01b0a \u0111\u1ec1n v\u00e0o sau khi \u0111\u00e3 b\u00f4i tr\u01a1n m\u00e1y b\u1eb1ng m\u1ee1 lidocain ho\u1eb7c silicon.<\/span><\/p>\n

– Soi \u0111o\u1ea1n tr\u1ef1c tr\u00e0ng \u00edt g\u1eb7p kh\u00f3 kh\u0103n, c\u00f3 th\u1ec3 quan s\u00e1t to\u00e0n b\u1ed9 tr\u1ef1c tr\u00e0ng khi ph\u1ed1i h\u1ee3p quay ng\u01b0\u1ee3c m\u00e1y.<\/span><\/p>\n

– Kh\u00f3 kh\u0103n \u0111\u1ea7u ti\u00ean l\u00e0 khi \u0111\u01b0a \u0111\u00e8n qua \u0111\u1ea1i tr\u00e0ng sigma, \u0111o\u1ea1n n\u00e0y \u0111\u1ea1i tr\u00e0ng r\u1ea5t l\u1ecfng l\u1ebbo, d\u1ec5 t\u1ea1o th\u00e0nh cu\u1ed9n ki\u1ec3u \u03b1. Khi \u0111\u1ea9y m\u00e1y, m\u00e1y ti\u1ebfn l\u00ean cao ra ph\u00eda tr\u01b0\u1edbc tr\u1ef1c tr\u00e0ng sau \u0111\u00f3 l\u1ea1i v\u00f2ng xu\u1ed1ng v\u00e0 ra sau. Ph\u1ea3i r\u00fat h\u01a1i v\u00e0 quay \u0111\u00e8n theo chi\u1ec1u kim \u0111\u1ed3ng h\u1ed3 ho\u1eb7c ng\u01b0\u1ee3c l\u1ea1i v\u00e0 h\u00fat h\u01a1i<\/span><\/p>\n

– Cu\u1ed9n ki\u1ec3u omega: \u0111\u00f4i khi \u0111\u01b0a \u0111\u00e8n qua \u0111\u1ea1i tr\u00e0ng sigma d\u1ec5 t\u1ea1o m\u1ed9t g\u00f3c nh\u1ecdn \u1edf ch\u1ed7 n\u1ed1i \u0111\u1ea1i tr\u00e0ng sigma v\u00e0 \u0111\u1ea1i tr\u00e0ng xu\u1ed1ng, ph\u1ea3i thay \u0111\u1ed5i t\u01b0 th\u1ebf, h\u00fat h\u01a1i v\u00e0 \u00e9p h\u1ed1 ch\u1eadu tr\u00e1i. B\u00ecnh th\u01b0\u1eddng g\u00f3c tr\u00e1i c\u00e1ch h\u1eadu m\u00f4n 40-70 cm.<\/span><\/p>\n

– G\u00f3c l\u00e1ch \u0111\u00f4i khi cu\u1ed9n ng\u01b0\u1ee3c, kh\u00f3 \u0111\u1ea9y \u0111\u00e8n, ph\u1ea3i r\u00fat \u0111\u00e8n quay ng\u01b0\u1ee3c chi\u1ec1u kim \u0111\u1ed3ng h\u1ed3 ho\u1eb7c thay \u0111\u1ed5i t\u01b0 th\u1ebf.<\/span><\/p>\n

– Qua \u0111\u1ea1i tr\u00e0ng ngang th\u01b0\u1eddng \u00edt kh\u00f3 kh\u0103n, nh\u01b0ng khi \u0111o\u1ea1n n\u00e0y qu\u00e1 d\u00e0i ph\u1ea3i h\u00fat h\u01a1i v\u00e0 \u00e9p b\u1ee5ng \u1edf \u0111\u1ea1i tr\u00e0ng sigma, \u0111\u1ea1i tr\u00e0ng g\u00f3c l\u00e1ch v\u00e0 gi\u1eefa b\u1ee5ng.<\/span><\/p>\n

– Ph\u1ea3i cho \u0111\u00e8n t\u1edbi manh tr\u00e0ng b\u1eb1ng c\u00e1ch h\u00fat b\u1edbt h\u01a1i, \u00e9p v\u00f9ng \u0111\u1ea1i tr\u00e0ng ngang ho\u1eb7c \u0111\u1ea1i tr\u00e0ng sigma ho\u1eb7c \u0111\u1ea1i tr\u00e0ng g\u00f3c l\u00e1ch v\u00e0 thay \u0111\u1ed5i t\u01b0 th\u1ebf.<\/span><\/p>\n

– \u0110\u1ec3 qua van Bauhin: h\u01b0\u1edbng \u0111\u1ea7u \u0111\u00e8n xu\u1ed1ng s\u00e2u h\u01a1n v\u1ecb tr\u00ed c\u1ee7a van, sau \u0111\u00f3 b\u01a1m c\u0103ng manh tr\u00e0ng r\u1ed3i r\u00fat \u0111\u00e8n l\u00ean t\u1edbi m\u00e9p d\u01b0\u1edbi van. B\u01a1m h\u01a1i c\u0103ng \u0111\u1ec3 m\u1edf l\u1ed7 van v\u00e0 \u0111\u1ea9y \u0111\u00e8n v\u00e0o, h\u1ed5i tr\u00e0ng d\u1ec5 nh\u1eadn bi\u1ebft v\u00ec h\u00ecnh \u1ea3nh ni\u00eam m\u1ea1c h\u01a1i l\u1ea7n s\u1ea7n.<\/span><\/p>\n

Nh\u1eefng kh\u00f3 kh\u0103n trong soi \u0111\u1ea1i tr\u00e0ng c\u00f3 th\u1ec3 do 1 trong 5 nguy\u00ean nh\u00e2n:<\/span><\/p>\n

+ Sau khi ph\u1eabu thu\u1eadt \u1edf ti\u1ec3u khung ho\u1eb7c m\u1ed5 \u0111\u1ea1i tr\u00e0ng<\/span><\/p>\n

+ Vi\u00eam t\u00fai th\u1eeba<\/span><\/p>\n

+ B\u1ea5t th\u01b0\u1eddng v\u1ec1 gi\u1ea3 ph\u1eabu: \u0111\u1ea1i tr\u00e0ng qu\u00e1 d\u00e0i<\/span><\/p>\n

+ \u1ede c\u00e1c ng\u01b0\u1eddi b\u1ec7nh qu\u00e1 b\u00e9o, kh\u00f3 \u00e9p b\u1ee5ng ho\u1eb7c \u00e9p kh\u00f4ng c\u00f3 k\u1ebft qu\u1ea3<\/span><\/p>\n

+ Nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh g\u1ea7y, b\u00e9<\/span><\/p>\n

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

– Theo d\u00f5i: to\u00e0n tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh trong qu\u00e1 tr\u00ecnh l\u00e0m th\u1ee7 thu\u1eadt.<\/span><\/p>\n

– Ph\u00e1t hi\u1ec7n v\u00e0 x\u1eed tr\u00ed c\u00e1c bi\u1ebfn ch\u1ee9ng (ch\u1ea3y m\u00e1u khi l\u1ea5y b\u1ec7nh ph\u1ea9m, th\u1ee7ng \u0111\u1ea1i tr\u00e0ng, m\u1ea1ch ch\u1eadm ho\u1eb7c ng\u1eebng tim do c\u01b0\u1eddng ph\u1ebf v\u1ecb), ghi v\u00e0o phi\u1ebfu tr\u1ea3 k\u1ebft qu\u1ea3 ho\u1eb7c cho ng\u01b0\u1eddi b\u1ec7nh nh\u1eadp vi\u1ec7n x\u1eed tr\u00ed ti\u1ebfp t\u00f9y thu\u1ed9c t\u1eebng bi\u1ebfn ch\u1ee9ng.<\/span><\/p>\n

5.1. C\u00e1c bi\u1ebfn ch\u1ee9ng soi \u0111\u1ea1i tr\u00e0ng<\/span><\/b><\/h3>\n

5.1.1. Th\u1ee7ng \u0111\u1ea1i tr\u00e0ng<\/span><\/i><\/b>: Hay g\u1eb7p nh\u1ea5t 0,14-0,2 %<\/span><\/p>\n

– Nguy\u00ean nh\u00e2n: Hay li\u00ean quan t\u1edbi d\u00ednh sau m\u1ed5, t\u00fai th\u1eeba vi\u00eam n\u1eb7ng, vi\u00eam lo\u00e9t n\u1eb7ng, h\u1eb9p \u0111\u1ea1i tr\u00e0ng, b\u00e1c s\u1ef9 \u00edt kinh nghi\u1ec7m<\/span><\/p>\n

– V\u1ecb tr\u00ed hay th\u1ee7ng: \u0111\u1ea1i tr\u00e0ng sigma<\/span><\/p>\n

– Th\u1ee7ng c\u00f3 th\u1ec3 do: \u0111\u01b0a \u0111\u00e8n kh\u00f4ng \u0111\u00fang h\u01b0\u1edbng, \u0111\u1ee9t d\u00e2y d\u00ednh, b\u01a1m h\u01a1i ph\u1ed1i h\u1ee3p v\u1edbi \u00e9p t\u1eeb ngo\u00e0i v\u00e0o ch\u1ed7 \u0111\u1ea1i tr\u00e0ng b\u1ec7nh l\u00fd, th\u1ee7ng t\u00fai th\u1eeba do b\u01a1m h\u01a1i qu\u00e1 c\u0103ng.<\/span><\/p>\n

– \u0110i\u1ec1u tr\u1ecb: ngo\u1ea1i khoa l\u00e0 ch\u00ednh.<\/span><\/p>\n

– Tr\u1eeb tr\u01b0\u1eddng h\u1ee3p th\u1ee7ng diastatic, ch\u00fang ta c\u00f3 th\u1ec3 gi\u1eef \u0111i\u1ec1u r\u1ecb n\u1ed9i khoa, nh\u01b0ng ch\u1ec9 trong tr\u01b0\u1eddng h\u1ee3p \u0111\u1ea1i tr\u00e0ng chu\u1ea9n b\u1ecb r\u1ea5t s\u1ea1ch: \u0111i\u1ec1u tr\u1ecb b\u1eb1ng h\u00fat s\u1ea1ch d\u1ecbch, kh\u00e1ng sinh v\u00e0 nu\u00f4i d\u01b0\u1ee1ng b\u1eb1ng truy\u1ec1n. N\u1ebfu theo d\u00f5i c\u00f3 c\u00e1c bi\u1ebfn ch\u1ee9ng: s\u1ed1t, co c\u1ee9ng b\u1ee5ng, b\u1ea1ch c\u1ea7u cao th\u00ec ph\u1ea3i chuy\u1ec3n x\u1eed tr\u00ed ngo\u1ea1i khoa.<\/span><\/p>\n

5.1.2. Nhi\u1ec5m khu\u1ea9n huy\u1ebft<\/span><\/i><\/b><\/p>\n

C\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u1edf c\u00e1c ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nguy c\u01a1 cao: ng\u01b0\u1eddi b\u1ec7nh thay van nh\u00e2n t\u1ea1o, ng\u01b0\u1eddi b\u1ec7nh c\u00f3 suy gi\u1ea3m mi\u1ec5n d\u1ecbch, x\u01a1 gan c\u1ed5 ch\u01b0\u1edbng<\/span><\/p>\n

5.1.3. Ch\u01b0\u1edbng h\u01a1i n\u1eb7ng<\/span><\/i><\/b><\/p>\n

– Do b\u01a1m h\u01a1i nhi\u1ec1u, \u0111\u1ec3 \u0111\u1ec1 ph\u00f2ng th\u1ee7ng ph\u1ea3i ch\u1ee5p b\u1ee5ng kh\u00f4ng chu\u1ea9n b\u1ecb<\/span><\/p>\n

– H\u00fat h\u1ebft h\u01a1i<\/span><\/p>\n

5.1.4. Vasovagal reflex<\/span><\/i><\/b>: m\u1ea1ch ch\u1eadm, h\u1ea1 huy\u1ebft \u00e1p, l\u1ea1nh ch\u00e2n tay<\/span><\/p>\n

\u0110i\u1ec1u tr\u1ecb: Atropin<\/span><\/p>\n

5.1.5. Bi\u1ebfn ch\u1ee9ng li\u00ean quan v\u1edbi ti\u1ec1n m\u00ea<\/span><\/i><\/b><\/p>\n

5.2. Bi\u1ebfn ch\u1ee9ng c\u1ee7a soi \u0111\u1ea1i tr\u00e0ng \u0111i\u1ec1u tr\u1ecb<\/span><\/b><\/h3>\n

5.2.1. Ch\u1ea3y m\u00e1u sau c\u1eaft polyp:<\/span><\/i><\/b>\u00a00,7 – 2,24 %<\/span><\/p>\n

5.2.2. Th\u1ee7ng \u0111\u1ea1i tr\u00e0ng<\/span><\/i><\/b>: Khi c\u1eaft c\u00e1c polyp kh\u00f4ng cu\u1ed1ng, c\u1eaft v\u00e0o th\u00e0nh ho\u1eb7c c\u01b0\u1eddng \u0111\u1ed9 \u0111i\u1ec7n m\u1ea1nh l\u00e0m ho\u1ea1i t\u1eed th\u00e0nh.<\/span><\/p>\n

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

N\u1ed9i soi \u0111\u1ea1i tr\u00e0ng c\u00f3 g\u00e2y m\u00ea l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n, \u0111\u01b0a \u0111\u00e8n soi m\u1ec1m t\u1eeb h\u1eadu m\u00f4n \u0111i ng\u01b0\u1ee3c l\u00ean \u0111\u1ebfn manh tr\u00e0ng \u0111\u1ec3 quan s\u00e1t t\u1ed5n th\u01b0\u01a1ng c\u1ee7a to\u00e0n b\u1ed9 \u0111\u1ea1i tr\u00e0ng. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y gi\u00fap qu\u00e1 tr\u00ecnh ch\u1ea9n \u0111o\u00e1n c\u00e1c b\u1ec7nh l\u00fd \u0111\u1ea1i tr\u00e0ng s\u1edbm v\u00e0 ch\u00ednh x\u00e1c, h\u1ed7 tr\u1ee3 […]<\/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":"\nH\u01b0\u1edbng d\u1eabn quy tr\u00ecnh g\u00e2y m\u00ea trong n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng<\/title>\n<meta name=\"description\" content=\"N\u1ed9i soi \u0111\u1ea1i tr\u00e0ng c\u00f3 g\u00e2y m\u00ea l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n, \u0111\u01b0a \u0111\u00e8n soi m\u1ec1m t\u1eeb h\u1eadu m\u00f4n \u0111i ng\u01b0\u1ee3c l\u00ean \u0111\u1ebfn manh tr\u00e0ng \u0111\u1ec3 quan s\u00e1t t\u1ed5n ...\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta 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