{"id":32535,"date":"2023-05-14T20:37:46","date_gmt":"2023-05-14T13:37:46","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32535"},"modified":"2023-05-18T13:12:12","modified_gmt":"2023-05-18T06:12:12","slug":"chan-doan-lam-dung-ruou-va-nghien-ruou-theo-icd-10","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/14\/chan-doan-lam-dung-ruou-va-nghien-ruou-theo-icd-10\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n l\u1ea1m d\u1ee5ng r\u01b0\u1ee3u v\u00e0 nghi\u1ec7n r\u01b0\u1ee3u theo ICD-10"},"content":{"rendered":"

L\u1ea1m d\u1ee5ng r\u01b0\u1ee3u v\u00e0 nghi\u1ec7n r\u01b0\u1ee3u l\u00e0 nh\u1eefng v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe m\u00e0 h\u00e0ng tri\u1ec7u ng\u01b0\u1eddi tr\u00ean to\u00e0n th\u1ebf gi\u1edbi \u0111ang ph\u1ea3i \u0111\u1ed1i m\u1eb7t. Tuy nhi\u00ean, nh\u1eadn di\u1ec7n v\u00e0 ch\u1ea9n \u0111o\u00e1n c\u00e1c v\u1ea5n \u0111\u1ec1 n\u00e0y kh\u00f4ng ph\u1ea3i l\u00e0 \u0111i\u1ec1u d\u1ec5 d\u00e0ng, v\u00e0 n\u00f3 c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng \u0111\u1ebfn s\u1ee9c kh\u1ecfe v\u00e0 \u0111\u1eddi s\u1ed1ng x\u00e3 h\u1ed9i c\u1ee7a m\u1ed9t ng\u01b0\u1eddi. Trong b\u00e0i vi\u1ebft n\u00e0y, ch\u00fang ta s\u1ebd t\u00ecm hi\u1ec3u v\u1ec1 ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n l\u1ea1m d\u1ee5ng r\u01b0\u1ee3u v\u00e0 nghi\u1ec7n r\u01b0\u1ee3u theo ICD-10.<\/strong><\/p>\n

\"nghien-ruou\"
\u1ea2nh m\u00f4 t\u1ea3 b\u1ec7nh nh\u00e2n l\u1ea1m d\u1ee5ng r\u01b0\u1ee3u<\/figcaption><\/figure>\n

1.T\u1ed5ng quan<\/strong><\/h2>\n

1.1. L\u1ea1m d\u1ee5ng r\u01b0\u1ee3u<\/strong><\/h3>\n

\u00a0Theo ICD-10 thi g\u1ecdi l\u00e0 s\u1eed d\u1ee5ng r\u01b0\u1ee3u c\u00f3 h\u1ea1i, theo DSM IV th\u00ec g\u1ecdi l\u00e0 l\u1ea1m d\u1ee5ng r\u01b0\u1ee3u. L\u1ea1m d\u1ee5ng r\u01b0\u1ee3u \u0111\u01b0\u1ee3c quy \u0111\u1ecbnh theo ti\u00eau chu\u1ea9n chung v\u1ec1 l\u1ea1m d\u1ee5ng c\u00e1c \u0111\u1ed9c ch\u1ea5t. L\u1ea1m d\u1ee5ng \u0111\u1ed9c ch\u1ea5t l\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng th\u00e1i qu\u00e1 m\u1ed9t ch\u1ea5t t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn t\u00e2m th\u1ea7n n\u00e0o \u0111\u00f3 c\u00f3 h\u1ea1i cho s\u1ee9c kh\u1ecfe v\u1ec1 m\u1eb7t c\u01a1 th\u1ec3 c\u0169ng nh\u01b0 t\u00e2m th\u1ea7n. L\u1ea1m d\u1ee5ng \u0111\u1ed9c ch\u1ea5t g\u00e2y ra nhi\u1ec1u h\u1eadu qu\u1ea3 x\u1ea5u v\u1ec1 m\u1eb7t x\u00e3 h\u1ed9i, kh\u00f4ng \u0111\u01b0\u1ee3c ng\u01b0\u1eddi chung quanh ch\u1ea5p nh\u1eadn v\u00e0 kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi m\u00f4i tr\u01b0\u1eddng v\u0103n ho\u00e1, c\u00e1c h\u1eadu qu\u1ea3 x\u1ea5u v\u1ec1 m\u1eb7t x\u00e3 h\u1ed9i nh\u01b0 b\u1ecb b\u1eaft gi\u1eef, m\u1ea5t vi\u1ec7c l\u00e0m, m\u00e2u thu\u1eabn v\u1ee3 ch\u1ed3ng … kh\u00f4ng n\u1eb7ng \u0111\u1ebfn n\u1ed7i \u0111\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n.<\/span><\/p>\n

1.2. Nghi\u1ec7n r\u01b0\u1ee3u<\/strong><\/h3>\n

\u00a0Hay c\u00f2n g\u1ecdi l\u00e0 l\u1ec7 thu\u1ed9c r\u01b0\u1ee3u l\u00e0 to\u00e0n b\u1ed9 nh\u1eefng h\u00e0nh vi, nh\u1eadn th\u1ee9c, v\u00e0 \u0111\u00e1p \u1ee9ng sinh l\u00fd c\u1ee7a ng\u01b0\u1eddi s\u1eed d\u1ee5ng m\u1ed9t ho\u1eb7c nhi\u1ec1u ch\u1ea5t t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn t\u00e2m th\u1ea7n n\u00e0o \u0111\u00f3 l\u00e0m cho b\u1ea3n th\u00e2n ng\u01b0\u1eddi nghi\u1ec7n d\u1ea7n d\u1ea7n kh\u00f4ng l\u00e0m \u0111\u01b0\u1ee3c nh\u1eefng c\u00f4ng vi\u1ec7c kh\u00e1c n\u1eefa. \u0110\u1eb7c \u0111i\u1ec3m c\u01a1 b\u1ea3n c\u1ee7a nghi\u1ec7n l\u00e0 s\u1ef1 th\u00e8m mu\u1ed1n m\u00e3nh li\u1ec7t c\u00f3 khi mang t\u00ednh ch\u1ea5t c\u01b0\u1ee1ng b\u1ee9c ph\u1ea3i u\u1ed1ng r\u01b0\u1ee3u cho \u0111\u01b0\u1ee3c. Sau khi cai nghi\u1ec7n n\u1ebfu t\u00e1i nghi\u1ec7n th\u00ec h\u1ed9i ch\u1ee9ng nghi\u1ec7n l\u1ea1i xu\u1ea5t hi\u1ec7n r\u1ea5t nhanh h\u01a1n c\u1ea3 l\u1ea7n nghi\u1ec7n \u0111\u1ea7u ti\u00ean.<\/span><\/p>\n

2. Nguy\u00ean nh\u00e2n<\/strong><\/h2>\n

R\u01b0\u1ee3u l\u00e0 m\u1ed9t th\u1ee9c u\u1ed1ng c\u00f3 t\u1eeb l\u00e2u \u0111\u1eddi v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong nhi\u1ec1u n\u1ec1n v\u0103n ho\u00e1, trong c\u00e1c l\u1ec5 h\u1ed9i, d\u00f9ng trong y khoa, u\u1ed1ng r\u01b0\u1ee3u \u0111\u1ec3 \u201cl\u1ea5y s\u1ee9c\u201d…nh\u01b0ng u\u1ed1ng l\u1ea1m d\u1ee5ng r\u01b0\u1ee3u v\u00e0 nghi\u1ec7n r\u01b0\u1ee3u l\u00e0 nh\u1eefng tr\u1ea1ng th\u00e1i b\u1ec7nh l\u00fd c\u00f3 nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau.\u00a0<\/span><\/p>\n

Do nguy\u00ean nh\u00e2n nghi\u1ec7n r\u01b0\u1ee3u v\u1eabn ch\u01b0a x\u00e1c \u0111\u1ecbnh r\u00f5, nh\u01b0ng ng\u01b0\u1eddi ta nh\u1eadn th\u1ea5y c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 g\u00e2y nghi\u1ec7n r\u01b0\u1ee3u nh\u01b0 do di truy\u1ec1n (nam gi\u1edbi nhi\u1ec1u h\u01a1n n\u1eef gi\u1edbi, tr\u00ean \u0111i\u1ec7n n\u00e3o c\u1ee7a con nh\u1eefng ng\u01b0\u1eddi nghi\u1ec7n c\u00f3 s\u00f3ng alpha bi\u00ean \u0111\u1ed9 th\u1ea5p), do t\u1eadp t\u00ednh (do b\u1eaft ch\u01b0\u1edbc ho\u1eb7c b\u1ea1n b\u00e8 l\u00f4i k\u00e9o), do y\u1ebfu t\u1ed1 sinh h\u1ecdc, t\u00e2m l\u00fd…ng\u01b0\u1eddi ta nh\u1eadn th\u1ea5y b\u1ed1 m\u1eb9 nghi\u1ec7n r\u01b0\u1ee3u th\u00ec con c\u00e1i c\u00f3 t\u1ef7 l\u1ec7 u\u1ed1ng r\u01b0\u1ee3u cao ( kho\u1ea3ng 25%).<\/span><\/p>\n

\u00a0Nghi\u1ec7n r\u01b0\u1ee3u th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi tr\u1ea7m c\u1ea3m<\/a> (ngay c\u1ea3 \u0111\u1ed1i v\u1edbi v\u1ee3 c\u1ee7a ng\u01b0\u1eddi nghi\u1ec7n), h\u00e0nh vi ph\u1ea1m ph\u00e1p, nh\u00e2n c\u00e1ch ch\u1ed1ng x\u00e3 h\u1ed9i c\u1ee7a b\u1ea3n th\u00e2n ng\u01b0\u1eddi nghi\u1ec7n c\u0169ng nh\u01b0 \u1edf ng\u01b0\u1eddi th\u00e2n l\u00e0 nam gi\u1edbi.<\/span><\/p>\n

Nghi\u00ean c\u1ee9u \u1edf nh\u1eefng c\u1eb7p sinh \u0111\u00f4i c\u00f9ng tr\u1ee9ng cho th\u1ea5y ch\u00fang c\u00f3 t\u1ef7 l\u1ec7 c\u00f9ng u\u1ed1ng r\u01b0\u1ee3u cao h\u01a1n nh\u1eefng c\u1eb7p sinh \u0111\u00f4i kh\u00e1c tr\u1ee9ng. Con nu\u00f4i \u00edt u\u1ed1ng r\u01b0\u1ee3u h\u01a1n l\u00e0 con \u0111\u1ebb c\u1ee7a nh\u1eefng ng\u01b0\u1eddi nghi\u1ec7n.<\/span><\/p>\n

\u00a0Y\u1ebfu t\u1ed1 v\u0103n ho\u00e1 x\u00e3 h\u1ed9i c\u0169ng r\u1ea5t quan tr\u1ecdng, trong nh\u1eefng x\u00e3 h\u1ed9i H\u1ed3i gi\u00e1o thi vi\u1ec7c u\u1ed1ng r\u01b0\u1ee3u ho\u00e0n to\u00e0n b\u1ecb c\u1ea5m do l\u00fd do t\u00edn ng\u01b0\u1ee1ng ch\u1ee9 kh\u00f4ng ph\u1ea3i do l\u00fd do s\u1ee9c kho\u1ebb. C\u00e1c t\u00e1c \u0111\u1ed9ng t\u00e2m l\u00fd m\u1ea1nh l\u00ean nh\u1eefng ng\u01b0\u1eddi c\u00f3 y\u1ebfu t\u1ed1 di truy\u1ec1n l\u00e0m ph\u00e1t sinh nghi\u1ec7n r\u01b0\u1ee3u, y\u1ebfu t\u1ed1 n\u00e0y th\u01b0\u1eddng t\u00e1c \u0111\u1ed9ng l\u00ean nam gi\u1edbi nhi\u1ec1u h\u01a1n \u201cnam v\u00f4 t\u1eedu nh\u01b0 k\u1ef3 v\u00f4 phong\u201d, \u201c v\u00f4 t\u1eedu b\u1ea5t th\u00e0nh 96 l\u1ec5\u201d. Theo s\u1ed1 li\u1ec7u \u0111i\u1ec1u tra t\u1ea1i Ph\u01b0\u1eddng \u0110\u00fac TP Hu\u1ebf t\u1ef7 l\u1ec7 nghi\u1ec7n r\u01b0\u1ee3u v\u00e0 l\u1ea1m d\u1ee5ng r\u01b0\u1ee3u trong c\u1ed9ng \u0111\u1ed3ng l\u00e0 3,21%, \u1edf H\u00e0 T\u00e2y l\u00e0 3,60%, \u1edf \u0110\u00e0 N\u1eb5ng l\u00e0 5,59%.<\/span><\/p>\n

3. T\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd c\u1ee7a r\u01b0\u1ee3u trong c\u01a1 th\u1ec3<\/strong><\/h2>\n

Sau khi u\u1ed1ng, ta th\u1ea5y r\u01b0\u1ee3u xu\u1ea5t hi\u1ec7n trong m\u00e1u v\u00e0 tu\u1ef3 theo n\u1ed3ng \u0111\u1ed9 c\u1ee7a r\u01b0\u1ee3u m\u00e0 ng\u01b0\u1eddi u\u1ed1ng c\u00f3 nhi\u1ec1u c\u1ea3m gi\u00e1c kh\u00e1c nhau.<\/span><\/p>\n

\u00a0– 1-100mg\/dl\u00a0 \u00a0 \u00a0 \u00a0 C\u1ea3m th\u1ea5y tho\u1ea3i m\u00e1i, \u00eam d\u1ecbu.<\/span><\/p>\n

\u00a0– 100-150mg\/dl\u00a0 \u00a0 M\u1ea5t ph\u1ed1i h\u1ee3p \u0111\u1ed9ng t\u00e1c v\u00e0 d\u1ec5 b\u1ecb k\u00edch th\u00edch.\u00a0<\/span><\/p>\n

– 150-200mg\/dl\u00a0 \u00a0 \u00a0N\u00f3i kh\u00f4ng r\u00f5 v\u00e0 th\u1ea5t \u0111i\u1ec1u.\u00a0<\/span><\/p>\n

– >250mg\/dl\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Ng\u1ea5t ho\u1eb7c h\u00f4n m\u00ea.<\/span><\/p>\n

\u00a0Ngo\u00e0i ra ta c\u00f2n nh\u1eadn th\u1ea5y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nghi\u1ec7n r\u01b0\u1ee3u c\u00f3 – MCV (Mean corpuscular volume) cao \u0111\u1ebfn 95%\u00a0<\/span><\/p>\n

– Cholesterol m\u00e1u t\u0103ng cao\u00a0<\/a><\/span><\/p>\n

– Lactate dehydrogenase t\u0103ng.<\/a><\/span><\/p>\n

\u00a0– Th\u1ec3 t\u00edch h\u1ed3ng c\u1ea7u gi\u1ea3m<\/a><\/span><\/p>\n

\u00a0– T\u0103ng Acid uric.<\/a>\u00a0<\/span><\/p>\n

– 75% b\u1ec7nh nh\u00e2n nghi\u1ec7n r\u01b0\u1ee3u c\u00f3 men Gamma-glutamyltransferase t\u0103ng, \u0111\u00e2y l\u00e0 ch\u1ec9 \u0111i\u1ec3m c\u1eadn l\u00e2m s\u00e0ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n b\u1ec7nh nh\u00e2n nghi\u1ec7n r\u01b0\u1ee3u s\u1edbm nh\u1ea5t .<\/span><\/p>\n

– SGOT v\u00e0 SGPT \u0111\u1ec1u t\u0103ng<\/a>.<\/span><\/p>\n

\"benh-gan-do-ruou\"
\u1ea2nh m\u00f4 t\u1ea3 t\u1ed5n th\u01b0\u01a1ng gan do r\u01b0\u1ee3u<\/figcaption><\/figure>\n

4. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng<\/strong><\/h2>\n

Th\u1eadt ra kh\u00f4ng c\u00f3 m\u1ed9t h\u00ecnh \u1ea3nh \u0111i\u1ec3n h\u00ecnh c\u1ee7a m\u1ed9t b\u1ec7nh nh\u00e2n nghi\u1ec7n r\u01b0\u1ee3u v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng, c\u00e1c h\u00ecnh th\u1ee9c u\u1ed1ng r\u01b0\u1ee3u c\u0169ng nh\u01b0 c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u1ec1u kh\u00e1c nhau t\u00f9y t\u1eebng tr\u01b0\u1eddng h\u1ee3p m\u1ed9t. Trong giai \u0111o\u1ea1n \u0111\u1ea7u ch\u00fang ta kh\u00f3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c b\u1ec7nh nh\u00e2n u\u1ed1ng r\u01b0\u1ee3u v\u00ec ng\u01b0\u1eddi n\u00e0o c\u0169ng ph\u1ee7 nh\u1eadn vi\u1ec7c u\u1ed1ng nhi\u1ec1u r\u01b0\u1ee3u c\u1ee7a m\u00ecnh h\u01a1n n\u1eefa c\u00e1c tri\u1ec7u ch\u1ee9ng c\u00f2n ngh\u00e8o n\u00e0n, ta ch\u1ec9 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c nh\u1edd v\u00e0o nh\u1eefng th\u00f4ng tin c\u1ee7a gia \u0111\u00ecnh ho\u1eb7c b\u1ea1n b\u00e8, c\u01a1 quan. <\/span><\/p>\n

\u0110\u1ea7u ti\u00ean l\u00e0 s\u1ef1 thay \u0111\u1ed5i v\u1ec1 th\u00f3i quen sinh ho\u1ea1t h\u1eb1ng ng\u00e0y, n\u0103ng su\u1ea5t lao \u0111\u1ed9ng gi\u1ea3m s\u00fat, l\u01b0\u1eddi bi\u1ebfng, ch\u1eadm ch\u1ea1p hay v\u1eafng m\u1eb7t t\u1ea1i c\u01a1 quan kh\u00f4ng c\u00f3 l\u00fd do, nh\u00e2n c\u00e1ch thay \u0111\u1ed5i nh\u1eb9, nhi\u1ec1u c\u1ea3m x\u00fac…. Khi nghi\u1ec7n r\u01b0\u1ee3u ti\u1ebfn tri\u1ec3n, m\u1ed9t v\u00e0i thay \u0111\u1ed5i v\u1ec1 m\u1eb7t c\u01a1 th\u1ec3 b\u1eaft \u0111\u1ea7u xu\u1ea5t hi\u1ec7n nh\u01b0 n\u1ed5i tr\u1ee9ng c\u00e1 \u0111\u1ecf \u1edf m\u1eb7t, m\u0169i to v\u00e0 \u0111\u1ecf \u1edf m\u1ed9t v\u00e0i b\u1ec7nh nh\u00e2n, h\u1ed3ng ban \u1edf l\u00f2ng b\u00e0n tay<\/a>, gan l\u1edbn v\u00e0 th\u00e2m nhi\u1ec5m m\u1ee1<\/a> \u0111\u00e2y l\u00e0 bi\u1ec3u hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng \u1edf gan \u0111\u1ea7u ti\u00ean c\u1ee7a ng\u01b0\u1eddi nghi\u1ec7n r\u01b0\u1ee3u, hay b\u1ecb nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p<\/a>, ng\u1ea5t x\u1ec9u, hay b\u1ecb tai n\u1ea1n do \u0111i\u1ec1u khi\u1ec3n xe c\u1ed9 kh\u00f4ng ch\u00ednh x\u00e1c. Trong giai \u0111o\u1ea1n sau thi xu\u1ea5t hi\u1ec7n x\u01a1 gan<\/a>, v\u00e0ng da<\/a>, b\u1ee5ng b\u00e1ng<\/a>, teo tinh ho\u00e0n, v\u00fa to, m\u1ea5t vi\u1ec7c, gia \u0111\u00ecnh tan v\u1ee1.<\/span><\/p>\n

\"xo-gan\"
Gi\u1ea3i ph\u1eabu \u0111\u1ea1i th\u1ec3 c\u1ee7a b\u1ec7nh nh\u00e2n x\u01a1 gan n\u1eb7ng, m\u1ea5t nhu m\u00f4 gan v\u00e0 xu\u1ea5t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng n\u1ed1t<\/figcaption><\/figure>\n

5. T\u00e1c h\u1ea1i c\u1ee7a r\u01b0\u1ee3u<\/strong><\/h2>\n