{"id":31468,"date":"2023-05-04T16:25:07","date_gmt":"2023-05-04T09:25:07","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31468"},"modified":"2023-05-04T16:25:07","modified_gmt":"2023-05-04T09:25:07","slug":"noi-soi-dai-truc-trang-do-phan-giai-cao","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/noi-soi-dai-truc-trang-do-phan-giai-cao\/","title":{"rendered":"N\u1ed9i soi \u0111\u1ea1i tr\u1ef1c tr\u00e0ng \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao"},"content":{"rendered":"

Do nhu c\u1ea7u c\u1ea7n thi\u1ebft ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng ung th\u01b0 s\u1edbm \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00ec v\u1eady n\u1ed9i soi \u0111\u00e3 ph\u00e1t tri\u1ec3n c\u00e1c c\u00f4ng ngh\u1ec7 m\u1edbi \u0111\u1ec3 \u0111\u00e1p \u1ee9ng nhu c\u1ea7u \u0111\u00f3. C\u00e1c th\u1ebf h\u1ec7 m\u00e1y n\u1ed9i soi m\u1edbi \u0111\u00e3 ra \u0111\u1eddi v\u1edbi c\u00e1c th\u1ebf h\u1ec7 m\u00e1y n\u1ed9i soi v\u1edbi \u0111\u1ed9 ph\u00e2n d\u1ea3i cao cho ph\u00e9p quan s\u00e1t chi ti\u1ebft t\u1ed5n th\u01b0\u01a1ng \u1edf ni\u00eam m\u1ea1c \u1ed1ng ti\u00eau h\u00f3a. K\u1ef9 thu\u1eadt n\u1ed9i soi \u0111\u1ea1i tr\u1ef1c tr\u00e0ng \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao \u0111ang \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t tri\u1ec3n r\u1ed9ng r\u00e3i tr\u00ean th\u1ebf gi\u1edbi, gi\u00fap ph\u00e1t hi\u1ec7n c\u00e1c b\u1ec7nh l\u00fd s\u1edbm v\u00e0 \u0111\u01b0a ra ph\u01b0\u01a1ng th\u1ee9c \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p v\u00e0 hi\u1ec7u qu\u1ea3.<\/span><\/strong><\/p>\n

\"\"<\/p>\n

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

N\u1ed9i soi \u0111\u1ea1i tr\u1ef1c tr\u00e0ng to\u00e0n b\u1ed9 \u0111\u1ed9 ph\u00e2n d\u1ea3i cao \u0111\u00e3 t\u1ea1o n\u00ean m\u1ed9t b\u01b0\u1edbc \u0111\u1ed9t ph\u00e1 \u0111\u1ed1i v\u1edbi s\u00e0ng l\u1ecdc v\u00e0 ch\u1ea9n \u0111o\u00e1n ung th\u01b0 \u0111\u1ea1i tr\u00e0ng<\/a> \u1edf giai \u0111o\u1ea1n s\u1edbm v\u00e0 giai \u0111o\u1ea1n r\u1ea5t s\u1edbm v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00e1c \u1edf ni\u00eam m\u1ea1c \u0111\u1ea1i tr\u00e0ng<\/span><\/p>\n

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

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

– Nng\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 thu < 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

– 01B\u00e1c s\u1ef9 \u0111\u00e3 c\u00f3 ch\u1ee9ng ch\u1ec9 t\u1ed1t nghi\u1ec7p n\u1ed9i soi Ti\u00eau h\u00f3a.<\/span><\/p>\n

– 02 \u0110i\u1ec1u d\u01b0\u1ee1ng.<\/span><\/p>\n

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

– M\u00e1y n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng \u0111\u1ed3ng b\u1ed9 c\u00f3 h\u1ec7 th\u1ed1ng HDTVs<\/span><\/p>\n

– M\u00e1y theo d\u00f5i lifescope v\u00e0 d\u1ee5ng c\u1ee5 c\u1ea5p c\u1ee9u: m\u1eb7t n\u1ea1, b\u00f3ng b\u00f3p, n\u1ed9i kh\u00ed qu\u1ea3n.<\/span><\/p>\n

– Thu\u1ed1c m\u00ea v\u00e0 ti\u1ec1n m\u00ea: 2 \u1ed1ng midazolam 5mg; 2 \u1ed1ng fantanyl 0,1 mg; 2 \u1ed1ng propofol.<\/span><\/p>\n

– 01 K\u00ecm sinh thi\u1ebft<\/span><\/p>\n

– 05 L\u1ecd \u0111\u1ef1ng b\u1ec7nh ph\u1ea9m<\/span><\/p>\n

– 05 Lam k\u00ednh<\/span><\/p>\n

– 02 B\u01a1m ti\u00eam 20 ml<\/span><\/p>\n

– 02 G\u0103ng tay 6 \u0111\u00f4i<\/span><\/p>\n

– 02 \u00c1o m\u1ed5<\/span><\/p>\n

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

– Ng\u01b0\u1eddi b\u1ec7nh t\u1ed1i h\u00f4m tr\u01b0\u1edbc khi soi \u0103n ch\u00e1o. Ng\u01b0\u1eddi b\u1ec7nh u\u1ed1ng 3 g\u00f3i Fortran, pha v\u1edbi 3 l\u00edt n\u01b0\u1edbc trong v\u00f2ng 2 ti\u1ebfng tr\u01b0\u1edbc khi n\u1ed9i soi 6gi\u1edd. Sau khi \u0111i v\u1ec7 sinh s\u1ea1ch s\u1ebd n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng. N\u1ebfu ng\u01b0\u1eddi b\u1ec7nh t\u00e1o b\u00f3n, cho ng\u01b0\u1eddi b\u1ec7nh u\u1ed1ng thu\u1ed1c nhu\u1eadn tr\u00e0ng Folax x 3 g\u00f3i\/ ng\u00e0y trong 3 ng\u00e0y.<\/span><\/p>\n

H\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi b\u1ec7nh u\u1ed1ng thu\u1ed1c l\u00e0m s\u1ea1ch \u0111\u1ea1i tr\u00e0ng ho\u1eb7c li\u00ean h\u1ec7 n\u01a1i th\u1ee5t th\u00e1o l\u00e0m s\u1ea1ch \u0111\u1ea1i tr\u00e0ng n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng u\u1ed1ng \u0111\u01b0\u1ee3c.<\/span><\/p>\n

– Gi\u1ea3i th\u00edch ng\u01b0\u1eddi b\u1ec7nh: m\u1ee5c \u0111\u00edch, tai bi\u1ebfn th\u1ee7 thu\u1eadt.<\/span><\/p>\n

– C\u00e1c b\u1ec7nh nh\u00e2n nguy c\u01a1 cao: tu\u1ed5i > 60, nghi ng\u1edd c\u00f3 b\u1ec7nh l\u00fd tim- ph\u1ed5i m\u1ea1n t\u00ednh c\u1ea7n l\u00e0m th\u00eam x\u00e9t nghi\u1ec7m \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 v\u00e0 X quang tim ph\u1ed5i.<\/span><\/p>\n

3.4. H\u1ed3 s\u01a1 b\u1ec7nh \u00e1n<\/span><\/b><\/h3>\n

– Ki\u1ec3m tra kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/span><\/p>\n

– Nh\u1eadn gi\u1ea5y ch\u1ec9 \u0111\u1ecbnh.<\/span><\/p>\n

– Gi\u1ea3i th\u00edch ng\u01b0\u1eddi b\u1ec7nh k\u00fd gi\u1ea5y \u0111\u1ed3ng \u00fd l\u00e0m th\u1ee7 thu\u1eadt.<\/span><\/p>\n

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

– M\u1eddi ng\u01b0\u1eddi b\u1ec7nh v\u00e0o ph\u00f2ng, h\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi b\u1ec7nh thay qu\u1ea7n.<\/span><\/p>\n

– H\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m l\u00ean c\u00e1ng th\u1ee7 thu\u1eadt.<\/span><\/p>\n

– M\u1eafc monitor theo d\u00f5i, theo ch\u1ec9 \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u1ef9 soi.<\/span><\/p>\n

– H\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m l\u00ean c\u00e1ng th\u1ee7 thu\u1eadt \u0111\u00fang t\u01b0 th\u1ebf. Ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng t\u1ef1 \u0111i l\u1ea1i \u0111\u01b0\u1ee3c ph\u1ea3i gi\u00fap ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m l\u00ean c\u00e1ng.<\/span><\/p>\n

– \u0110i\u1ec1u d\u01b0\u1ee1ng ph\u1ea3i theo d\u00f5i t\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh, th\u00f4ng b\u00e1o b\u00e1c s\u1ef9 khi c\u00f3 b\u1ea5t th\u01b0\u1eddng, lu\u00f4n \u0111\u1ed9ng vi\u00ean v\u00e0 h\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi b\u1ec7nh h\u1ee3p t\u00e1c \u0111\u1ec3 ti\u1ebfn h\u00e0nh th\u1ee7 thu\u1eadt thu\u1eadn l\u1ee3i.<\/span><\/p>\n

– Th\u00f4ng b\u00e1o cho ng\u01b0\u1eddi b\u1ec7nh b\u1eaft \u0111\u1ea7u l\u00e0m th\u1ee7 thu\u1eadt, h\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi b\u1ec7nh ph\u1ed1i h\u1ee3p trong qu\u00e1 tr\u00ecnh l\u00e0m th\u1ee7 thu\u1eadt.<\/span><\/p>\n

– N\u1ed9i soi theo quy tr\u00ecnh chu\u1ea9n quan s\u00e1t ni\u00eam m\u1ea1c tr\u1ef1c tr\u00e0ng v\u00e0 to\u00e0n b\u1ed9 \u0111\u1ea1i tr\u00e0ng, \u0111\u1ec3 ch\u1ebf \u0111\u1ed9 ph\u00e2n d\u1ea3i cao quan s\u00e1t c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u1ea1i tr\u1ef1c tr\u00e0ng. Ra y l\u1ec7nh ch\u1ee5p \u1ea3nh minh h\u1ecda t\u1ed5n th\u01b0\u01a1ng. Ra y l\u1ec7nh l\u00e0m x\u00e9t nghi\u1ec7m ho\u1eb7c sinh thi\u1ebft n\u1ebfu c\u1ea7n.<\/span><\/p>\n

– Theo d\u00f5i to\u00e0n tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh trong to\u00e0n b\u1ed9 qu\u00e1 tr\u00ecnh l\u00e0m th\u1ee7 thu\u1eadt<\/span><\/p>\n

– Sau khi k\u1ebft th\u00fac th\u1ee7 thu\u1eadt, \u0111\u00e1nh v\u00e0 in k\u1ebft qu\u1ea3.<\/span><\/p>\n

– Sau khi B\u00e1c s\u1ef9 k\u1ebft th\u00fac qu\u00e1 tr\u00ecnh n\u1ed9i soi, \u0111i\u1ec1u d\u01b0\u1ee1ng ph\u1ea3i gi\u00fap ng\u01b0\u1eddi b\u1ec7nh d\u1eady v\u00e0 \u0111\u01b0a ng\u01b0\u1eddi b\u1ec7nh ra kh\u1ecfi ph\u00f2ng n\u1ed9i soi t\u1edbi n\u01a1i ng\u1ed3i ch\u1edd.<\/span><\/p>\n

– H\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi b\u1ec7nh<\/span><\/p>\n

– B\u1ed5 sung th\u00eam phi\u1ebfu x\u00e9t nghi\u1ec7m, sinh thi\u1ebft n\u1ebfu c\u1ea7n.<\/span><\/p>\n

– \u0110i\u1ec1u d\u01b0\u1ee1ng r\u1eeda m\u00e1y theo quy tr\u00ecnh k\u1ef9 thu\u1eadt.<\/span><\/p>\n

– Tr\u1ea3 k\u1ebft qu\u1ea3 n\u1ed9i soi cho ng\u01b0\u1eddi b\u1ec7nh.<\/span><\/p>\n

H\u00ecnh 1.\u00a0<\/span><\/b>H\u00ecnh A l\u00e0 h\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng \u1edf \u0111\u1ea1i tr\u00e0ng tr\u00ean m\u00e1y n\u1ed9i soi th\u00f4ng th\u01b0\u1eddng, h\u00ecnh B, C l\u00e0 h\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng nhu\u1ed9m m\u00e0u ph\u00f3ng \u0111\u1ea1i.<\/span><\/p>\n

5. Theo d\u00f5i<\/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

Theo d\u00f5i to\u00e0n tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh trong qu\u00e1 tr\u00ecnh l\u00e0m th\u1ee7 thu\u1eadt n\u1ed9i soi \u0111\u1ea1i tr\u1ef1c tr\u00e0ng \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 cho b\u1ec7nh nh\u00e2n. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i trong qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt n\u00e0y:<\/p>\n

– V\u1eadn \u0111\u1ed9ng h\u00f4 h\u1ea5p v\u00e0 t\u00ecnh tr\u1ea1ng h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n: V\u1eadn \u0111\u1ed9ng h\u00f4 h\u1ea5p v\u00e0 t\u00ecnh tr\u1ea1ng h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i trong qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o b\u1ec7nh nh\u00e2n \u0111ang \u0111\u01b0\u1ee3c cung c\u1ea5p \u0111\u1ee7 oxy v\u00e0 kh\u00f4ng b\u1ecb suy h\u00f4 h\u1ea5p.<\/p>\n

– T\u00ecnh tr\u1ea1ng huy\u1ebft \u00e1p v\u00e0 nh\u1ecbp tim c\u1ee7a b\u1ec7nh nh\u00e2n: T\u00ecnh tr\u1ea1ng huy\u1ebft \u00e1p v\u00e0 nh\u1ecbp tim c\u1ee7a b\u1ec7nh nh\u00e2n c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o b\u1ec7nh nh\u00e2n kh\u00f4ng b\u1ecb t\u0103ng huy\u1ebft \u00e1p ho\u1eb7c nh\u1ecbp tim ch\u1eadm ho\u1eb7c nhanh qu\u00e1 m\u1ee9c.<\/p>\n

– T\u00ecnh tr\u1ea1ng \u0111\u01b0\u1eddng huy\u1ebft c\u1ee7a b\u1ec7nh nh\u00e2n: N\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecb ti\u1ec3u \u0111\u01b0\u1eddng, t\u00ecnh tr\u1ea1ng \u0111\u01b0\u1eddng huy\u1ebft c\u1ee7a b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o kh\u00f4ng c\u00f3 bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m x\u1ea3y ra.<\/p>\n

\u0110\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 cho b\u1ec7nh nh\u00e2n, c\u00e1c y\u1ebfu t\u1ed1 tr\u00ean c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i k\u1ef9 l\u01b0\u1ee1ng trong qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt N\u1ed9i soi \u0111\u1ea1i tr\u1ef1c tr\u00e0ng \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao. N\u1ebfu c\u1ea7n thi\u1ebft, b\u00e1c s\u0129 c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh c\u00e1c x\u00e9t nghi\u1ec7m v\u00e0 ki\u1ec3m tra kh\u00e1c \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

6. Tai bi\u1ebfn v\u00e0 x\u1eed tr\u00ed<\/span><\/b><\/h2>\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, m\u1ea1ch ch\u1eadm ho\u1eb7c ng\u1eebng tim trong khi l\u00e0m th\u1ee7 thu\u1eadt, 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

T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/span><\/b><\/p>\n

1. H. Niwa. H. Tajiri, M. Nakajima, K Yasuda (2008).\u00a0<\/span><\/b>New Challenges in Gastrointestinal Endoscopy. Springer. pp163-200<\/span><\/p>\n

2. Shinji Tanaka, Tonya Kaltenbach, Kazuaki Chayama, Roy Soetikno (2006).\u00a0<\/span><\/b>High-magnification colonoscopy(with videos). Gastrointestinal endoscopy volume 64, No 4; 607<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Do nhu c\u1ea7u c\u1ea7n thi\u1ebft ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng ung th\u01b0 s\u1edbm \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00ec v\u1eady n\u1ed9i soi \u0111\u00e3 ph\u00e1t tri\u1ec3n c\u00e1c c\u00f4ng ngh\u1ec7 m\u1edbi \u0111\u1ec3 \u0111\u00e1p \u1ee9ng nhu c\u1ea7u \u0111\u00f3. 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