{"id":34776,"date":"2023-06-08T17:48:44","date_gmt":"2023-06-08T10:48:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=34776"},"modified":"2023-06-08T17:48:59","modified_gmt":"2023-06-08T10:48:59","slug":"trieu-chung-va-dieu-tri-benh-viem-tui-mat-cap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/06\/08\/trieu-chung-va-dieu-tri-benh-viem-tui-mat-cap\/","title":{"rendered":"Tri\u1ec7u ch\u1ee9ng v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam t\u00fai m\u1eadt c\u1ea5p"},"content":{"rendered":"<p><strong>Vi\u00eam t\u00fai m\u1eadt c\u1ea5p (VTMC) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam c\u1ee7a t\u00fai m\u1eadt, v\u1edbi nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0 do t\u1eafc ngh\u1ebdn do s\u1ecfi k\u1eb9t c\u1ed5 \u1ed1ng t\u00fai m\u1eadt. Kho\u1ea3ng 90% c\u00e1c ca l\u00e2m s\u00e0ng li\u00ean quan \u0111\u1ebfn s\u1ecfi t\u00fai m\u1eadt , 10% c\u00e1c ca c\u00f2n l\u1ea1i vi\u00eam t\u00fai m\u1eadt x\u1ea3y ra khi kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a s\u1ecfi. Vi\u00eam t\u00fai m\u1eadt kh\u00f4ng do s\u1ecfi th\u01b0\u1eddng c\u00f3 li\u00ean quan \u0111\u1ebfn v\u1ea5n \u0111\u1ec1 \u1ee9 m\u1eadt nh\u01b0: \u00a0T\u1eafc \u1ed1ng t\u00fai m\u1eadt do u, x\u01a1, h\u1eb9p c\u01a1 v\u00f2ng Oddi, nh\u00fa t\u00e1 l\u1edbn, ch\u1ea5n th\u01b0\u01a1ng&#8230;<\/strong><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-34777 size-full\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/images.jpg\" alt=\"viem-tui-mat-cap\" width=\"275\" height=\"183\" \/><\/p>\n<h2>1. \u0110\u1ea1i c\u01b0\u01a1ng vi\u00eam t\u00fai m\u1eadt c\u1ea5p<\/h2>\n<p><strong>1.1 Gi\u1ea3i ph\u1eabu t\u00fai m\u1eadt<\/strong><\/p>\n<p>T\u00fai m\u1eadt \u00a0l\u00e0 m\u1ed9t t\u00fai ch\u1ee9a h\u00ecnh qu\u1ea3 l\u00ea li\u00ean t\u1ee5c v\u1edbi \u1ed1ng gan chung v\u00e0 \u1ed1ng m\u1eadt ch\u1ee7 qua \u1ed1ng- t\u00fai m\u1eadt. K\u00edch th\u01b0\u1edbc t\u00fai m\u1eadt trung b\u00ecnh t\u1eeb 7 \u0111\u1ebfn 10 cm chi\u1ec1u d\u00e0i, 3 \u0111\u1ebfn 5 cm \u0111\u01b0\u1eddng t\u00ednh v\u00e0 th\u1ec3 t\u00edch kho\u1ea3ng 30 \u0111\u1ebfn 60 ml.<\/p>\n<p>T\u00fai m\u1eadt n\u1eb1m \u1edf m\u1eb7t d\u01b0\u1edbi gan v\u00e0 \u0111\u01b0\u1ee3c ph\u1ee7 m\u1ed9t ph\u1ea7n b\u1edfi m\u1ed9t l\u1edbp ph\u00fac m\u1ea1c.<\/p>\n<p>. T\u00fai m\u1eadt \u0111\u01b0\u1ee3c chia th\u00e0nh \u0111\u00e1y t\u00fai m\u1eadt, th\u00e2n t\u00fai m\u1eadt, ph\u1ea7n ph\u1ec5u, c\u1ed5 t\u00fai m\u1eadt v\u00e0 \u1ed1ng t\u00fai m\u1eadt. Chi\u1ec1u d\u00e0i \u1ed1ng t\u00fai m\u1eadt thay \u0111\u1ed5i t\u1eeb 1 \u0111\u1ebfn 5 cm v\u00e0 \u0111\u01b0\u1eddng k\u00ednh \u1ed1ng t\u00fai m\u1eadt kho\u1ea3ng 3 \u0111\u1ebfn 7 mm, \u1ed1ng t\u00fai m\u1eadt th\u01b0\u1eddng h\u1ee3p v\u1edbi \u1ed1ng gan chung t\u1ea1o th\u00e0nh m\u1ed9t g\u00f3c nh\u1ecdn.<\/p>\n<p>T\u00fai m\u1eadt \u0111\u01b0\u1ee3c quy c\u1ea5p m\u00e1u b\u1edfi m\u1ed9t \u0111\u1ed9ng m\u1ea1ch duy nh\u1ea5t.<\/p>\n<p>\u0110\u1ed9ng m\u1ea1ch t\u00fai m\u1eadt (\u0110MTM) c\u00f3 th\u1ec3 xu\u1ea5t ph\u00e1t t\u1eeb \u0111\u1ed9ng m\u1ea1ch gan tr\u00e1i, \u0111\u00f4ng m\u1ea1ch gan chung, \u0111\u1ed9ng m\u1ea1ch v\u1ecb t\u00e1 tr\u00e0ng, hay \u0111\u1ed9ng m\u1ea1ch m\u1ea1c treo tr\u00e0ng tr\u00ean, \u0110MTM chia th\u00e0nh c\u00e1c nh\u00e1nh n\u00f4ng v\u00e0 c\u00e1c nh\u00e1nh s\u00e2u tr\u01b0\u1edbc khi \u0111i v\u00e0o t\u00fai m\u1eadt. \u1ed0ng gan chung, gan, v\u00e0 \u1ed1ng t\u00fai m\u1eadt h\u1ee3p th\u00e0nh c\u00e1c c\u1ea1nh c\u1ee7a tam gi\u00e1c Chacot.\u00a0 Tam gi\u00e1c n\u00e0y ch\u1ee9a nh\u1eefng c\u1ea5u tr\u00fac quan tr\u1ecdng b\u00ean trong l\u00e0 \u0111\u1ed9ng m\u1ea1ch t\u00fai m\u1eadt , \u0111\u1ed9ng m\u1ea1ch gan ph\u1ea3i v\u00e0 h\u1ea1ch b\u1ea1ch huy\u1ebft c\u1ee7a \u1ed1ng t\u00fai m\u1eadt, h\u1ea1ch Calot l\u00e0 n\u01a1i h\u1ee3p l\u01b0u ch\u00ednh c\u1ee7a c\u00e1c \u1ed1ng b\u1ea1ch huy\u1ebft c\u1ee7a t\u00fai m\u1eadt .<\/p>\n<p><strong>Sinh l\u00fd b\u1ec7nh c\u1ee7a vi\u00eam t\u00fai m\u1eadt c\u1ea5p<\/strong><\/p>\n<p>Sinh b\u1ec7nh h\u1ecdc ch\u00ednh c\u1ee7a VTMC l\u00e0 t\u00ecnh tr\u1ea1ng t\u1eafc ngh\u1ebdn c\u1ee7a \u1ed1ng t\u00fai m\u1eadt. Khi t\u00ecnh tr\u1ea1ng t\u1eafc ngh\u1ebdn x\u1ea3y ra do s\u1ecfi ch\u1ea9n \u0111o\u00e1n \u00a0l\u00e0 Vi\u00eam t\u00fai m\u1eadt c\u1ea5p do s\u1ecfi . S\u1ef1 t\u1eafc ngh\u1ebdn k\u00e9o d\u00e0i, t\u00fai m\u1eadt s\u1ebd b\u1ecb thi\u1ebfu m\u00e1u v\u00e0 d\u1eabn \u0111\u1ebfn ho\u1ea1i t\u1eed. Cu\u1ed1i c\u00f9ng, vi\u00eam t\u00fai m\u1eadt c\u1ea5p th\u00e0nh vi\u00eam t\u00fai m\u1eadt ho\u1ea1i t\u1eed v\u00e0 \u00a0d\u1eabn \u0111\u1ebfn th\u1ee7ng t\u00fai m\u1eadt, vi\u00eam ph\u00fac m\u1ea1c khu tr\u00fa hay to\u00e0n th\u1ec3.<\/p>\n<p><strong>1.2 Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng:\u00a0<\/strong><\/p>\n<ul>\n<li>S\u1ed1t<\/li>\n<li>\u0110au \u00bc tr\u00ean ph\u1ea3i<\/li>\n<li>\u0110i\u1ec3m \u0111au murphy (+)<\/li>\n<li>V\u00e0ng da n\u1ebfu c\u00f3: vi\u00eam s\u1ecfi \u0111\u01b0\u1eddng m\u1eadt \u0111i k\u00e8m hay h\u1ed9i ch\u1ee9ng Mirizzi<\/li>\n<\/ul>\n<p><strong>1.3 Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n \u0111\u1ed9 vi\u00eam t\u00fai m\u1eadt Tokyo Guideline 2018<\/strong><\/p>\n<p>VTMC hi\u1ec7n nay \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n \u0111\u1ed9 \u00a0theo Tokyo Guideline 2018<\/p>\n<p>B\u1ea3ng 1. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u00fai m\u1eadt c\u1ea5p theo Tokyo Guideline:<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"902\">A. D\u1ea5u hi\u1ec7u vi\u00eam t\u1ea1i ch\u1ed7<\/p>\n<p>1. Dau Murphy<\/p>\n<p>2. \u0110au \/\u1ea9n \u0111au kh\u1ed1i u \u00bc tr\u00ean ph\u1ea3i \u1ed5 b\u1ee5ng<\/td>\n<\/tr>\n<tr>\n<td width=\"902\">B:<\/p>\n<p>1. S\u1ed1t<\/p>\n<p>2. T\u0103ng CRP<\/p>\n<p>3. T\u0103ng s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u<\/td>\n<\/tr>\n<tr>\n<td width=\"902\">C. Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/td>\n<\/tr>\n<tr>\n<td width=\"902\">Tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc ghi nh\u1eadn c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a vi\u00eam t\u00fai m\u1eadt c\u1ea5p.<\/p>\n<p>=&gt; Nghi ng\u1edd Vi\u00eam t\u00fai m\u1eadt c\u1ea5p khi c\u00f3 1 d\u1ea5u hi\u1ec7u A + 1. d\u1ea5u hi\u1ec7u B<\/p>\n<p>=&gt; X\u00e1c \u0111\u1ecbnh Vi\u00eam t\u00fai m\u1eadt c\u1ea5p khi c\u00f3 1 d\u1ea5u hi\u1ec7u A + 1 d\u1ea5u hi\u1ec7u B +C.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>B\u1ea3ng 2. Ph\u00e2n \u0111\u1ed9 VTMCtheo Tokyo Guideline 2018 (Khi b\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t trong c\u00e1c ti\u00eau chu\u1ea9n)<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"902\">\u0110\u1ed9 III: Vi\u00eam t\u00fai m\u1eadt c\u1ea5p n\u1eb7ng<\/p>\n<p>1. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim m\u1ea1ch huy\u1ebft \u00e1p t\u1ee5t c\u1ea7n \u0111i\u1ec1u tra dopamine 5 mcg\/ kg\/ph\u00fat, ho\u1eb7c dobutamin v\u1edbi li\u1ec1u b\u1ea5t k\u1ef3.<\/p>\n<p>2. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea7n kinh<\/p>\n<p>3. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p (Pa0\/FiO2 &lt; 300)<\/p>\n<p>4. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn (thi\u1ebfu ni\u1ec7u, creatinine 20 mg<\/p>\n<p>5. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan (INR &gt; 1,5)<\/p>\n<p>6. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng huy\u1ebft h\u1ecdc (ti\u1ec3u c\u1ea7u &lt; 100 000 mm<\/td>\n<\/tr>\n<tr>\n<td width=\"902\">\u00a0\u0110\u1ed9 II: Vi\u00eam t\u00fai m\u1eadt c\u1ea5p\u00a0 trung b\u00ecnh<\/p>\n<p>1. WBC &gt; 18.000 G\/L<\/p>\n<p>2. \u1ea2n \u0111\u1ec1 kh\u00e1ng h\u1ea1 s\u01b0\u1eddn ph\u1ea3i<\/p>\n<p>3. Tri\u1ec7u ch\u1ee9ng k\u00e9o d\u00e0i &gt; 72h<\/p>\n<p>4. K\u1ebft h\u1ee3p v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng t\u1ea1i ch\u1ed7 (Vi\u00eam ph\u00fac m\u1ea1c m\u1eadt, \u00e1p xe quanh t\u00fai m\u1eadt, \u00e1p xe gan, vi\u00eam t\u00fai m\u1eadt ho\u1ea1i t\u1eed)<\/td>\n<\/tr>\n<tr>\n<td width=\"902\">\u0110\u1ed9 I: Vi\u00eam t\u00fai m\u1eadt c\u1ea5p nh\u1eb9:\u00a0 Kh\u00f4ng c\u00f3 c\u00e1c ti\u00eau chu\u1ea9n c\u1ee7a \u0111\u1ed9 2 v\u00e0 \u0111\u1ed9 3<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>2. \u0110i\u1ec1u tr\u1ecb<\/h2>\n<p><strong>2.1 Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr<\/strong>\u1ecb: khi b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng vi\u00eam t\u00fai m\u1eadt c\u1ea5p ph\u1ed1i h\u1ee3p c\u00f9ng l\u00fac vi\u1ec7c \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa k\u00e8m theo vi\u1ec7c ph\u1eabu thu\u1eadt ho\u1eb7c c\u00f3 nh\u1eb1m \u1ed5n \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng c\u1ea5p t\u00ednh cho b\u1ec7nh nh\u00e2n.<\/p>\n<p>Kh\u00e1ng sinh l\u1ef1a ch\u1ecdn: Kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng theo kinh nghi\u1ec7m.<\/p>\n<p><strong>2.2\u00a0 Ph\u1eabu thu\u1eadt:\u00a0<\/strong><\/p>\n<p>C\u1eaft t\u00fai m\u1eadt m\u1ed5 m\u1edf hay n\u1ed9i soi \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb cho vi\u00eam t\u00fai m\u1eadt c\u1ea5p, c\u1eaft t\u00fai m\u1eadt m\u1ed5 m\u1edf ch\u1ec9 c\u00f2n \u00e1p d\u1ee5ng khi th\u1ea5t b\u1ea1i v\u1edbi m\u1ed5 n\u1ed9i soi ho\u1eb7c kh\u00f4ng \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n ph\u1eabu thu\u1eadt n\u1ed9i soi nh\u01b0ng kh\u00f4ng chuy\u1ec3n vi\u1ec7n \u0111\u01b0\u1ee3c.\u00a0Th\u1eddi \u0111i\u1ec3m can thi\u1ec7p ph\u1eabu thu\u1eadt ng\u00e0y nay v\u1eabn c\u00f2n g\u00e2y tranh c\u00e3i.<\/p>\n<p>V\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 vi\u00eam t\u00fai m\u1eadt c\u1ea5p nh\u01b0ng c\u00f3 nguy c\u01a1 ph\u1eabu thu\u1eadt cao th\u00ec d\u1eabn l\u01b0u t\u00fai m\u1eadt xuy\u00ean gan qua da (PTGBD) d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t.<\/p>\n<p><strong>2.3 Chi\u1ebfn l\u01b0\u1ee3c can thi\u1ec7p ph\u1eabu thu\u1eadt:\u00a0<\/strong><\/p>\n<p>Vi\u00eam t\u00fai m\u1eadt c\u1ea5p \u0111\u1ed9 I: ph\u1eabu thu\u1eadt n\u1ed9i soi c\u1eaft t\u00fai m\u1eadt s\u1edbm (trong v\u00f2ng 72 gi\u1edd l\u00e0 th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t) l\u00e0 l\u1ef1a ch\u1ecdn h\u00e0ng \u0111\u1ea7u cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y. Tuy nhi\u00ean \u1edf nh\u00e2n c\u00f3 nguy c\u01a1 ph\u1eabu thu\u1eadt cao, kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb v\u00e0 h\u1ed3i s\u1ee9c n\u1ed9i khoa l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean. Khi t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n c\u1ea3i thi\u1ec7n v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa ban \u0111\u1ea7u, ph\u1ea9u thu\u1eadt \u00a0c\u1eaft t\u00fai m\u1eadt \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh th\u1ef1c hi\u1ec7n,<\/p>\n<p>Vi\u00eam t\u00fai m\u1eadt c\u1ea5p \u0111\u1ed9 II: vi\u00eam t\u1ee5y m\u1eadt c\u1ea5p \u1edf giai \u0111o\u1ea1i n\u00e0y c\u00f3 \u00a0tinh trang vi\u00eam t\u1ea1i ch\u1ed7 n\u1eb7ng n\u1ec1, n\u00ean ph\u1eabu thu\u1eadt vi\u00ean H\u1ed9i C\u1ea5n nh\u1eafc d\u1ef1a tr\u00ean \u0111\u1ed9 kh\u00f3 c\u1ee7a vi\u1ec7c C\u1eaft t\u00fai m\u1eadt \u0111\u1ec3 l\u1ef1a ch\u1ecdn phong ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p. C\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf c\u01a1 s\u1edf c\u00f3 kinh nghi\u1ec7m.\u00a0 n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ph\u1eabu thu\u1eadt cao c\u1ea7n d\u1eabn l\u01b0u t\u00fai m\u1eadt kh\u1ea9n n\u1ebfu kh\u00f4ng n\u00ean chuy\u1ec1n b\u1ec7nh nh\u00e2n \u0111\u1ebfn trung t\u00e2m c\u00f3 kinh nghi\u1ec7m,<\/p>\n<p>Vi\u00eam t\u00fai m\u1eadt c\u1ea5p \u0111\u1ed9 III: vi\u00eam t\u00fai m\u1eadt c\u00f3 c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 quan. H\u1ed3i s\u1ee9c n\u1ed9i khoa, h\u1ed7 tr\u1ee3 th\u00f4ng kh\u00ed, tu\u1ea7n ho\u00e0n + kh\u00e1ng sinh k\u1ebft h\u1ee3p Ph\u1eabu thu\u1eadt<\/p>\n<p>C\u1eaft t\u00fai m\u1eadt s\u1edbm ho\u1eb7c kh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong \u0111i\u1ec1u ki\u1ec7n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c . \u0111\u00e1nh gi\u00e1 b\u1eb1ng c\u00e1c thang \u0111i\u1ec3m FOSF, CCI v\u00e0 ASA &#8211; PS. Ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng suy ch\u1ee9c n\u0103ng tim m\u1ea1ch, th\u1eadn phuc h\u1ed3i nhanh ch\u00f3ng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1eb1ng FOSF c\u00f3 ngh\u0129a l\u00e0 t\u00ecnh tr\u1ea1ng suy h\u1ec7 th\u1ed1ng tin h\u1ed3i ph\u1ee5c sau nh\u1eadp vi\u1ec7n v\u00e0 tr\u01b0\u1edbc ph\u1eabu thu\u1eadt. V\u00ec b\u1ec7nh. c\u1ea5p grade III c\u00f3 m\u1ed9t ho\u1eb7c nhi\u1ec1u c\u01a1 quan b\u1ecb r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng, CCI 4 \u0111i\u1ec3m v\u00e0 ASA \u00a0PS 3 tr\u1edf l\u00ean l\u00e0 y\u1ebfu t\u1ed1 \u0111\u1ee7 \u0111\u1ec3 th\u1ef1c hi\u1ec7n c\u1eaft t\u00fai m\u1eadt. N\u1ebfu kh\u00f4ng, d\u1eabn l\u01b0u t\u00fai m\u1eadt s\u1edbm n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n. C\u1eaft t\u00fai m\u1eadt tr\u00ec ho\u00e3n (sau 6 tu\u1ea7n k\u1ec3 t\u1eeb th\u1eddi \u0111i\u1ec3m x\u00e1c \u0111\u1ecbnh) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n sau khi t\u00ecnh tr\u1ea1ng b\u1ec7nh c\u1ea5p t\u00ednh \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n.<\/p>\n<p><strong>2.4 Qu\u1ea3n l\u00fd vi\u00eam t\u00fai m\u1eadt c\u1ea5p theo Tokyo Guideline 18:\u00a0<\/strong><\/p>\n<p>VTMC \u0111\u1ed9 I, khuy\u1ebfn ngh\u1ecb ph\u1eabu thu\u1eadt n\u1ed9i soi c\u1eaft t\u00fai m\u1eadt s\u1edbm (trong v\u00f2ng 72 gi\u1edd k\u1ec3 t\u1eeb th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t) n\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i , tuy nhi\u00ean \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh v\u00e0 h\u1ed3i s\u1ee9c n\u1ed9i khoa v\u1eabn l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean.<\/p>\n<p>VTMC \u0111\u1ed9 II, n\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau ch\u00ed (Charlson Comorbidity Index) \u00a0CCI &lt;=5 v\u00e0 (American Society of Anesthesiologist ) ASA &#8211; PS &lt; 2,ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt n\u1ed9i soi c\u1eaft t\u00fai m\u1eadt s\u1edbm \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n s\u1edbm ho\u1eb7c sau khi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa v\u00e0\/ho\u1eb7c d\u1eabn l\u01b0u t\u00fai m\u1eadt sau \u0111\u00f3\u00a0 ph\u1eabu thu\u1eadt n\u1ed9i soi c\u1eaft t\u00fai m\u1eadt<\/p>\n<p>VTMC \u00a0\u0111\u1ed9 III: \u00a0c\u1eaft t\u00fai m\u1eadt n\u1ed9i soi \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n n\u1ebfu th\u1ecfa c\u00e1c \u00a0c\u00e1c ti\u00eau ch\u00ed CCI&lt;3, ASA &#8211; PS &lt; 2 v\u00e0 \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ea1i m\u1ed9t trung t\u00e2m ti\u00ean ti\u1ebfn n\u01a1i c\u00f3 b\u00e1c s\u0129 ph\u1eabu thu\u1eadt c\u00f3 kinh nghi\u1ec7m.<\/p>\n<p>N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 ph\u1eabu thu\u1eadt, n\u00ean d\u1eabn l\u01b0u \u0111\u01b0\u1eddng m\u1eadt s\u1edbm\/kh\u1ea9n c\u1ea5p, sau \u0111\u00f3 ph\u1eabu thu\u1eadt n\u1ed9i soi c\u1eaft t\u00fai m\u1eadt tr\u00ec ho\u00e3n khi t\u00ecnh tr\u1ea1ng chung c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n.<\/p>\n<p>Xem th\u00eam: <a href=\"https:\/\/www.vinmec.com\/vi\/tieu-hoa-gan-mat\/thong-tin-suc-khoe\/soi-tui-mat-nguyen-nhan-trieu-chung-va-cach-dieu-tri\/\">S\u1ecfi t\u00fai m\u1eadt &#8211; Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 c\u00e1ch \u0111i\u1ec1u tr\u1ecb<\/a><\/p>\n<p><strong>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong> B\u00e0i gi\u1ea3ng \u0110i\u1ec1u tr\u1ecb h\u1ecdc ngo\u1ea1i khoa &#8211; \u0110\u1ea1i h\u1ecdc Y &#8211; d\u01b0\u1ee3c TPHCM<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Vi\u00eam t\u00fai m\u1eadt c\u1ea5p (VTMC) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam c\u1ee7a t\u00fai m\u1eadt, v\u1edbi nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0 do t\u1eafc ngh\u1ebdn do s\u1ecfi k\u1eb9t c\u1ed5 \u1ed1ng t\u00fai m\u1eadt. Kho\u1ea3ng 90% c\u00e1c ca l\u00e2m s\u00e0ng li\u00ean quan \u0111\u1ebfn s\u1ecfi t\u00fai m\u1eadt , 10% c\u00e1c ca c\u00f2n l\u1ea1i vi\u00eam t\u00fai m\u1eadt x\u1ea3y ra khi [&hellip;]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Tri\u1ec7u ch\u1ee9ng v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam t\u00fai m\u1eadt c\u1ea5p - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam t\u00fai m\u1eadt c\u1ea5p \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam c\u1ee7a t\u00fai m\u1eadt, v\u1edbi nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0 do t\u1eafc ngh\u1ebdn do s\u1ecfi k\u1eb9t c\u1ed5 \u1ed1ng t\u00fai m\u1eadt.\" \/>\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=\"Tri\u1ec7u ch\u1ee9ng v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam t\u00fai m\u1eadt c\u1ea5p - 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