{"id":34880,"date":"2023-06-10T13:10:44","date_gmt":"2023-06-10T06:10:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=34880"},"modified":"2023-06-10T13:14:20","modified_gmt":"2023-06-10T06:14:20","slug":"xuat-huyet-tieu-hoa-trieu-chung-va-cach-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/06\/10\/xuat-huyet-tieu-hoa-trieu-chung-va-cach-dieu-tri\/","title":{"rendered":"Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a: tri\u1ec7u ch\u1ee9ng v\u00e0 c\u00e1ch \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<p><strong>Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a l\u00e0 t\u00ecnh tr\u1ea1ng m\u00e1u tho\u00e1t ra kh\u1ecfi l\u00f2ng m\u1ea1ch ch\u1ea3y v\u00e0o \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Bao g\u1ed3m xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean (ngu\u1ed3n g\u1ed1c xu\u1ea5t huy\u1ebft \u1edf ph\u00eda tr\u00ean g\u00f3c Treiz) v\u00e0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a d\u01b0\u1edbi (ngu\u1ed3n g\u1ed1c xu\u1ea5t huy\u1ebft \u1edf ph\u00eda d\u01b0\u1edbi g\u00f3c Treiz). Tri\u1ec7u ch\u1ee9ng XHTH \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n b\u1eb1ng 2 h\u00ecnh th\u1ee9c ch\u00ednh: \u00f3i m\u00e1u \/ ti\u00eau m\u00e1u \u2013 ti\u00eau ph\u00e2n \u0111en. \u0110\u00e2y l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u ti\u00eau h\u00f3a th\u01b0\u1eddng g\u1eb7p tr\u00ean l\u00e2m s\u00e0ng.<\/strong><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-34881 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/d05656c8-9b60-4253-b8c0-a68dd4cd7dbc-300x300.jpg\" alt=\"xuat-huyet-tieu-hoa\" width=\"300\" height=\"300\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/d05656c8-9b60-4253-b8c0-a68dd4cd7dbc-300x300.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/d05656c8-9b60-4253-b8c0-a68dd4cd7dbc-150x150.jpg 150w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/d05656c8-9b60-4253-b8c0-a68dd4cd7dbc-768x768.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/d05656c8-9b60-4253-b8c0-a68dd4cd7dbc.jpg 1024w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<h2>1. C\u00e1c nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p c\u1ee7a xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a<\/h2>\n<table width=\"900\">\n<tbody>\n<tr>\n<td colspan=\"2\" width=\"900\"><strong><em>Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean<\/em><\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"135\">Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td width=\"765\">Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng<\/p>\n<p>Vi\u00eam d\u1ea1 d\u00e0y (stress, r\u01b0\u1ee3u, thu\u1ed1c) H\u1ed9i ch\u1ee9ng Mallory &#8211; Weiss<\/td>\n<\/tr>\n<tr>\n<td width=\"135\">\u00cdt g\u1eb7p<\/td>\n<td width=\"765\">Vi\u00eam th\u1ef1c qu\u1ea3n<\/p>\n<p>Tho\u00e1t v\u1ecb ho\u00e0nh<\/p>\n<p>Ch\u1ea3y m\u00e1u \u0111\u01b0\u1eddng m\u1eadt<\/p>\n<p>Ung th\u01b0 b\u00f3ng Vater<\/p>\n<p>Lo\u1ea1n s\u1ea3n m\u1ea1ch m\u00e1u ho\u1eb7c d\u1ecb d\u1ea1ng m\u1ea1ch m\u00e1u kh\u00e1c (d\u00e3n m\u1ea1ch m\u00e1u xu\u1ea5t huy\u1ebft di truy\u1ec1n)<\/p>\n<p>Ung th\u01b0 d\u1ea1 d\u00e0y &#8211; th\u1ef1c qu\u1ea3n<\/p>\n<p>Vi\u00eam t\u00e1 tr\u00e0ng<\/p>\n<p>D\u00f2 \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 &#8211; t\u00e1 tr\u00e0ng.<\/p>\n<p>T\u00fai th\u1eeba t\u00e1 tr\u00e0ng<\/p>\n<p>Bi\u1ebfn ch\u1ee9ng n\u1eb7ng c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p.<\/p>\n<p>Hemophillia (k\u1ec3 c\u1ea3 nguy\u00ean nh\u00e2n do thu\u1ed1c)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" width=\"900\"><strong><em>Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a d\u01b0\u1edbi<\/em><\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"135\">Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td width=\"765\">T\u00fai th\u1eeba \u0111\u1ea1i tr\u00e0ng Lo\u1ea1n s\u1ea3n m\u1ea1ch m\u00e1u B\u1ec7nh ru\u1ed9t vi\u00eam<\/p>\n<p>Lao ru\u1ed9t<\/p>\n<p>L\u1ecb amib<\/td>\n<\/tr>\n<tr>\n<td width=\"135\">\u00cdt g\u1eb7p<\/td>\n<td width=\"765\">Ung th\u01b0 \u0111\u1ea1i tr\u00e0ng v\u00e0 polyp \u0111\u1ea1i tr\u00e0ng B\u1ec7nh ru\u1ed9t thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9<\/p>\n<p>T\u00fai th\u1eeba Meckel<\/p>\n<p>Vi\u00eam ru\u1ed9t sau x\u1ea1 tr\u1ecb<\/p>\n<p>Tr\u0129<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<h2>2. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/h2>\n<p><strong>2.1 Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng<\/strong><\/p>\n<p><strong><em><u>N\u00f4n ra m\u00e1u<\/u><\/em><\/strong><\/p>\n<ul>\n<li>N\u1ebfu l\u00e0 n\u00f4n ra m\u00e1u th\u00ec ch\u1eafc ch\u1eafn l\u00e0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean.<\/li>\n<li>Khi khai th\u00e1c nh\u1edb h\u1ecfi v\u1ec1 t\u00ednh ch\u1ea5t c\u1ee7a ch\u1ea5t n\u00f4n \u0111\u1ec3 g\u1ee3i \u00fd \u0111\u00f3 l\u00e0 m\u00e1u: m\u00e1u th\u01b0\u1eddng c\u00f3 m\u00e0u \u0111\u1ecf t\u01b0\u01a1i, \u0111\u1ecf b\u1ea7m, ho\u1eb7c n\u00e2u \u0111en, c\u00f3 m\u00e1u c\u1ee5c, l\u1ecfng c\u00f3 l\u1eabn th\u1ee9c \u0103n. Do t\u00e1c \u0111\u1ed9ng c\u1ee7a HCl v\u00e0 pepsin n\u00ean m\u00e1u t\u1ea1o th\u00e0nh hematin (m\u00e0u \u0111en). N\u1ebfu m\u00e0u \u0111\u1ecf t\u01b0\u01a1i ch\u1ee9ng to m\u00e1u c\u00f3 th\u1ec3 xu\u1ea5t huy\u1ebft t\u1eeb th\u1ef1c qu\u1ea3n ho\u1eb7c m\u00e1y ch\u1ea3y t\u1eeb d\u1ea1 d\u00e0y nh\u01b0ng ch\u1ea3y nhanh v\u00e0 nhi\u1ec1u kh\u00f4ng \u0111\u1ee7 th\u1eddi gian \u0111\u1ec3 bi\u1ebfn hene th\u00e0nh hematin.<\/li>\n<li>S\u1ed1 l\u01b0\u1ee3ng: \u00edt hay nhi\u1ec1u, n\u00f4n 1 hay nhi\u1ec1u l\u1ea7n trong ng\u00e0y.<\/li>\n<li>C\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c t\u00ecnh tr\u1ea1ng: ch\u1ea3y m\u00e1u cam, ho ra m\u00e1u, \u0103n ti\u1ebft canh. \u0110\u1ec3 ph\u00e2n bi\u1ec7t ch\u1ea3y m\u00e1u cam ta kh\u00e1m tai m\u0169i h\u1ecdng, \u0111\u1ec3 ph\u00e2n bi\u1ec7t ho ra m\u00e1u (m\u00e1u th\u01b0\u1eddng l\u00e0 \u0111\u1ecf t\u01b0\u01a1i, s\u1ed1 l\u01b0\u1ee3ng \u00edt h\u01a1n, c\u00f3 b\u1ecdt, kh\u00f4ng c\u00f3 th\u1ee9c \u0103n m\u00e0 c\u00f3 \u0111\u00e0m v\u00e0 c\u00f3 tri\u1ec7u ch\u1ee9ng ho tr\u01b0\u1edbc \u0111\u00f3, pH ki\u1ec1m).<\/li>\n<\/ul>\n<p><strong><u>Ti\u00eau ph\u00e2n \u0111en<\/u><\/strong><\/p>\n<ul>\n<li>V\u1ecb tr\u00ed c\u00f3 th\u1ec3 l\u00e0 XHTH tr\u00ean ho\u1eb7c XHTH d\u01b0\u1edbi.<\/li>\n<li>T\u00ednh ch\u1ea5t m\u00e1u \u0111i ti\u00eau ra ngo\u00e0i thay \u0111\u1ed5i t\u00f9y thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed ch\u1ea3y m\u00e1u, th\u1eddi gian di chuy\u1ec3n trong ru\u1ed9t v\u00e0 l\u01b0\u1ee3ng m\u00e1u.<\/li>\n<li>L\u01b0\u1ee3ng m\u00e1u 60 ml + th\u1eddi gian 8 gi\u1edd -&gt; ph\u00e2n \u0111en.<\/li>\n<li>L\u01b0\u1ee3ng m\u00e1u 200 &#8211; 400 ml -&gt; ph\u00e2n nh\u01b0 h\u1eafc \u00edn.<\/li>\n<\/ul>\n<p>XHTH d\u01b0\u1edbi c\u00f3 th\u1ec3 g\u00e2y ti\u00eau ph\u00e2n \u0111en nh\u01b0ng hi\u1ebfm khi c\u00f3 tri\u1ec7u ch\u1ee9ng gi\u1ed1ng nh\u01b0 h\u1eafc \u00edn, d\u00ednh v\u00e0 b\u00f3ng.<\/p>\n<ul>\n<li>Ti\u00eau ph\u00e2n \u0111en c\u00f3 th\u1ec3 x\u1ea3y ra \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c \u0111\u1ed3ng th\u1eddi v\u1edbi n\u00f4n ra m\u00e1u.<em><u> Khi g\u1eb7p ti\u00eau ph\u00e2n \u0111en:<\/u><\/em><\/li>\n<\/ul>\n<p>Lo\u1ea1i tr\u1eeb ph\u00e2n \u0111en l\u00e0 do thu\u1ed1c s\u1eaft, bismuth, than ho\u1ea1t.<\/p>\n<p>T\u00ednh ch\u1ea5t ph\u00e2n nh\u01b0 th\u1ebf n\u00e0o: ph\u00e2n n\u00e1t nh\u01b0 b\u00e3 c\u00e0 ph\u00ea, \u0111en b\u00f3ng d\u00ednh hay ph\u00e2n ch\u1eb7t th\u00e0nh khu\u00f4n.<\/p>\n<p>C\u00f3 \u0111i k\u00e8m n\u00f4n ra m\u00e1u kh\u00f4ng<\/p>\n<p><u>Ti\u00eau m\u00e1u \u0111\u1ecf<\/u><\/p>\n<p>Th\u01b0\u1eddng l\u00e0 do xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a d\u01b0\u1edbi. N\u1ebfu l\u00e0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean th\u00ec l\u01b0\u1ee3ng m\u00e1u ch\u1ea3y ph\u1ea3i nhi\u1ec1u v\u00e0 nhanh (xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean n\u1eb7ng).<\/p>\n<ul>\n<li>T\u00ednh ch\u1ea5t c\u1ea7n m\u00f4 t\u1ea3: m\u00e1u \u0111\u1ecf t\u01b0\u01a1i hay \u0111\u1ecf b\u1ea7m, \u0111i ra tr\u01b0\u1edbc ph\u00e2n hay m\u00e1u l\u1eabn v\u00e0o ph\u00e2n, l\u01b0\u1ee3ng m\u00e1u nhi\u1ec1u hay \u00edt, s\u1ed1 l\u1ea7n \u0111i c\u1ea7u ra m\u00e1u nh\u01b0 v\u1eady. C\u00f3 kh\u1ed1i sa ra ngo\u00e0i khi \u0111i c\u1ea7u hay kh\u00f4ng?<\/li>\n<\/ul>\n<p><em><u>Khi\u00a0 g\u1eb7p \u0111i c\u1ea7u ra m\u00e1u \u0111\u1ecf t\u01b0\u01a1i:<\/u><\/em><\/p>\n<p>Lo\u1ea1i tr\u1eeb ph\u00e2n \u0111\u1ecf do d\u00f9ng rifampicin .M\u00e1u ra tr\u01b0\u1edbc ph\u00e2n hay ra sau ph\u00e2n. \u0110i c\u1ea7u b\u00f3n hay ti\u00eau ch\u1ea3y. L\u01b0\u1ee3ng m\u00e1u nhi\u1ec1u hay \u00edt. \u0110i c\u1ea7u ra m\u00e1u \u0111\u1ecf t\u01b0\u01a1i bao nhi\u00eau l\u1ea7n trong ng\u00e0y.<\/p>\n<p>C\u00e1c tri\u1ec7u ch\u1ee9ng k\u00e8m theo: \u00a0\u0110au th\u01b0\u1ee3ng v\u1ecb, \u0111au b\u1ee5ng, s\u00f4i ru\u1ed9t. Hoa m\u1eaft, \u00f9 tai, ch\u00f3ng m\u1eb7t, kh\u00e1t n\u01b0\u1edbc.<\/p>\n<table width=\"864\">\n<tbody>\n<tr>\n<td width=\"526\"><strong><em>Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean<\/em><\/strong><\/td>\n<td width=\"338\"><strong><em>Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a d\u01b0\u1edbi<\/em><\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"526\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 N\u00f4n ra m\u00e1u: m\u00e1u t\u01b0\u01a1i hay m\u00e1u b\u1ea7m l\u1eabn th\u1ee9c \u0103n.<\/p>\n<p>&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ti\u00eau ph\u00e2n \u0111en nh\u01b0 b\u00e3 c\u00e0 ph\u00ea.<\/p>\n<p>&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ti\u00eau ra m\u00e1u b\u1ea7m<\/td>\n<td width=\"338\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ti\u00eau ra m\u00e1u \u0111\u1ecf t\u01b0\u01a1i.<\/p>\n<p>&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ti\u00eau ra m\u00e1u b\u1ea7m.<\/p>\n<p>&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00cdt khi \u0111i c\u1ea7u ph\u00e2n \u0111en.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<h2>2.2 Kh\u00e1m l\u00e2m s\u00e0ng<\/h2>\n<p><strong><u>Khi kh\u00e1m c\u1ea7n ch\u00fa \u00fd t\u00ecm nh\u1eefng d\u1ea5u hi\u1ec7u sau:<\/u><\/strong><\/p>\n<ul>\n<li>Da ni\u00eam nh\u1ee3t, tr\u1eafng b\u1ec7t.<\/li>\n<li>M\u1ea1ch nhanh nh\u1eb9, kh\u00f3 b\u1eaft.<\/li>\n<li>Huy\u1ebft \u00e1p gi\u1ea3m.<\/li>\n<li>Tri gi\u00e1c: t\u1ec9nh t\u00e1o, m\u1ec7t, li b\u00ec, v\u1eadt v\u1ea3.<\/li>\n<\/ul>\n<p><strong><em>Tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd b\u1ec7nh l\u00fd nguy\u00ean nh\u00e2n:<\/em><\/strong><\/p>\n<ul>\n<li>C\u00e1c d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd b\u1ec7nh l\u00ed gan m\u1ea1n: v\u00e0ng da, sao m\u1ea1ch, gan to l\u00e1ch to, xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u.<\/li>\n<li>D\u1ea5u \u0111\u1ec1 kh\u00e1ng th\u00e0nh b\u1ee5ng<\/li>\n<li>Th\u0103m tr\u1ef1c tr\u00e0ng: l\u00e0 th\u1ee7 thu\u1eadt quan tr\u1ecdng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ednh ch\u1ea5t ph\u00e2n v\u00e0 ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng \u1edf h\u1eadu m\u00f4n.<\/li>\n<\/ul>\n<p><strong><em>C\u00e1c d\u1ea5u hi\u1ec7u b\u00e1o hi\u1ec7u s\u1ed1c:<\/em><\/strong><\/p>\n<ul>\n<li>Nghi\u1ec7m ph\u00e1p thay \u0111\u1ed5i huy\u1ebft \u00e1p theo t\u01b0 th\u1ebf: N\u1ebfu \u0111\u00e3 c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng r\u1ecf th\u00ec kh\u00f4ng c\u1ea7n th\u1ef1c hi\u1ec7n nghi\u1ec7m ph\u00e1p n\u00e0y. Khi cho b\u1ec7nh nh\u00e2n chuy\u1ec3n t\u01b0 th\u1ebf t\u1eeb n\u1eb1m sang ng\u1ed3i th\u1ecfng ch\u00e2n xu\u1ed1ng gi\u01b0\u1eddng, n\u1ebfu nh\u01b0 m\u1ea1ch t\u0103ng nhi\u1ec1u h\u01a1n 20 bpm ho\u1eb7c SBP gi\u1ea3m nhi\u1ec1u h\u01a1n 10 mmHg -&gt; nghi\u1ec7m ph\u00e1p d\u01b0\u01a1ng t\u00ednh -&gt; b\u1ec7nh nh\u00e2n \u0111\u00e3 m\u1ea5t &gt; 1L m\u00e1u. Tuy nhi\u00ean n\u1ebfu nh\u01b0 b\u1ec7nh nh\u00e2n gi\u00e0, ho\u1eb7c d\u00f9ng thu\u1ed1c h\u1ea1 \u00e1p c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra t\u00ecnh tr\u1ea1ng h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf.<\/li>\n<li>Th\u1edf n\u00f4ng v\u00e0 th\u1edf y\u1ebfu -&gt; c\u00f3 thi\u1ebfu oxy m\u00f4.<\/li>\n<li>Chi l\u1ea1nh, l\u00fa l\u1eabn ho\u1eb7c k\u00edch \u0111\u1ed9ng g\u1ee3i \u00fd c\u00f3 gi\u1ea3m oxy m\u00f4 (d\u00f9 sinh hi\u1ec7u b\u00ecnh th\u01b0\u1eddng)<\/li>\n<\/ul>\n<p><strong>\u00a02.3 <em>C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c:<\/em><\/strong><\/p>\n<ul>\n<li>S\u1ed1t c\u00f3 th\u1ec3 g\u1eb7p trong 80% tr\u01b0\u1eddng h\u1ee3p XHTH tr\u00ean.<\/li>\n<li>ARDS c\u00f3 th\u1ec3 x\u1ea3y ra trong v\u00f2ng 24h \u0111\u1ea7u c\u1ee7a s\u1ed1c gi\u1ea3m th\u1ec3 t\u00edch.<\/li>\n<li>Thuy\u00ean t\u1eafc ph\u1ed5i<\/li>\n<li>Thi\u1ec3u ni\u1ec7u<\/li>\n<li>H\u00f4n m\u00ea gan (b\u1ec7nh n\u00e3o gan)<\/li>\n<\/ul>\n<p>\u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng<\/p>\n<table width=\"990\">\n<tbody>\n<tr>\n<td width=\"234\">C\u00e1c y\u1ebfu t\u1ed1 \u0111\u00e1nh gi\u00e1<\/td>\n<td width=\"223\">N\u1eb6NG<\/td>\n<td width=\"263\">TRUNG B\u00ccNH<\/td>\n<td width=\"271\">NH\u1eb8<\/td>\n<\/tr>\n<tr>\n<td width=\"234\">T\u1ed5ng tr\u1ea1ng<\/td>\n<td width=\"223\">B\u1ee9c r\u1ee9t, v\u1eadt v\u00e3<\/p>\n<p>Kh\u00e1t n\u01b0\u1edbc<\/p>\n<p>Ti\u1ec3u \u00edt<\/td>\n<td width=\"263\">M\u1ec7t m\u1ecfi Ch\u00f3ng m\u1eb7t<\/p>\n<p>V\u00e3 m\u1ed3 h\u00f4i<\/td>\n<td width=\"271\">T\u1ed1t<\/p>\n<p>H\u01a1i m\u1ec7t m\u1ecfi<\/td>\n<\/tr>\n<tr>\n<td width=\"234\">Da ni\u00eam, t\u00ecnh tr\u1ea1ng t\u01b0\u1edbi m\u00e1u ngo\u1ea1i vi<\/td>\n<td width=\"223\">L\u1ea1nh chi<\/td>\n<td width=\"263\">Xanh xao, t\u00e1i nh\u1ee3t<\/td>\n<td width=\"271\">B\u00ecnh th\u01b0\u1eddng<\/td>\n<\/tr>\n<tr>\n<td width=\"234\">Sinh hi\u1ec7u<\/td>\n<td width=\"223\">M\u1ea1ch r\u1ea5t nhanh &gt; 120 bpm<\/p>\n<p>Huy\u1ebft \u00e1p k\u1eb9t ho\u1eb7c SBP &lt; 90 mmHg<\/td>\n<td width=\"263\">M\u1ea1ch nhanh trung b\u00ecnh t\u1eeb 100 &#8211; 120 bpm &#8216;<\/p>\n<p>H\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf<\/td>\n<td width=\"271\">M\u1ea1ch b\u00ecnh th\u01b0\u1eddng &lt; 100 bpm<\/p>\n<p>Huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng<\/td>\n<\/tr>\n<tr>\n<td width=\"234\">Hct<\/td>\n<td width=\"223\">&lt; 20%<\/td>\n<td width=\"263\">20 &#8211; 30%<\/td>\n<td width=\"271\">&gt; 30%<\/td>\n<\/tr>\n<tr>\n<td width=\"234\">L\u01b0\u1ee3ng m\u00e1u m\u1ea5t<\/td>\n<td width=\"223\">&gt; 30%<\/td>\n<td width=\"263\">20 &#8211; 30%<\/td>\n<td width=\"271\">&lt; 20%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>3. \u0110i\u1ec1u tr\u1ecb xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a<\/h2>\n<p><strong>3.1 C\u1ea5p c\u1ee9u ban \u0111\u1ea7u cho b\u1ec7nh nh\u00e2n XHTH<\/strong><\/p>\n<p>H\u1ed3i s\u1ee9c cho XHTH m\u1ee9c \u0111\u1ed9 nh\u1eb9:<\/p>\n<ul>\n<li>Sau khi th\u00e0n l\u1eadp \u0111\u01b0\u1eddng tuy\u1ec1n d\u1ecbch, ti\u1ebfn h\u00e0nh sang b\u01b0\u1edbc ti\u1ebfp theo l\u00e0 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n v\u00e0 \u0111i\u1ec1u tr\u1ecb theo nguy\u00ean nh\u00e2n.<\/li>\n<\/ul>\n<p><strong><em>H\u1ed3i s\u1ee9c cho b\u1ec7nh nh\u00e2n \u1edf m\u1ee9c \u0111\u1ed9 trung b\u00ecnh:<\/em><\/strong><\/p>\n<ul>\n<li>\u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 m\u00e1u m\u1ea5t theo tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3: 70 &#8211; 75 mL\/kg \u0111\u1ec3 ph\u1ee5c h\u1ed3i l\u1ea1i th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n t\u01b0\u01a1ng \u1ee9ng b\u1eb1ng lo\u1ea1i d\u1ecbch \u0111\u1eb3ng tr\u01b0\u01a1ng.<\/li>\n<li>\u01afu ti\u00ean d\u00f9ng huy\u1ebft thanh m\u1eb7n v\u00ec kh\u1ea3 n\u0103ng gi\u1eef huy\u1ebft \u00e1p, m\u1ea1ch v\u00e0 b\u00e1n h\u1ee7y ch\u1eadm.<\/li>\n<\/ul>\n<p>N\u1ebfu m\u1ea1ch v\u00e0 huy\u1ebft \u00e1p \u1ed5n \u0111\u1ecbnh th\u00ec chuy\u1ec3n sang giai \u0111o\u1ea1n ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n.<\/p>\n<p><strong><em>H\u1ed3i s\u1ee9c cho b\u1ec7nh nh\u00e2n \u1edf m\u1ee9c \u0111\u1ed9 n\u1eb7ng:<\/em><\/strong><\/p>\n<ul>\n<li>B\u1ed3i ho\u00e0n th\u1ec3 tich kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n b\u1eb1ng d\u1ecbch v\u00e0 m\u00e1u v\u1edbi t\u1ef7 l\u1ec7 1 m\u00e1u : 2 d\u1ecbch \u0111\u1eb3ng tr\u01b0\u01a1ng. Truy\u1ec1n cho \u0111\u1ebfn khi:<\/li>\n<li>M\u1ea1ch v\u00e0 huy\u1ebft \u00e1p \u1ed5n \u0111\u1ecbnh, kh\u00f4ng c\u00f2n s\u1ed1c.<\/li>\n<li>Kh\u00f4ng c\u00f2n d\u1ea5u hi\u1ec7u thi\u1ebfu oxy n\u00e3o: h\u1ed1t ho\u1ea3ng, lo \u00e2u, b\u1ee9t r\u1ee9t, v\u1eadt v\u1ea3, li b\u00ec, h\u00f4n m\u00ea (r\u1ed1i lo\u1ea1n tri gi\u00e1c).<\/li>\n<li>Hct &gt; 20%, RBC &gt; 2 tri\u1ec7u\/mm<sup>3<\/sup> (\u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi c\u00f3 b\u1ec7nh l\u00ed tim m\u1ea1ch v\u00e0 l\u1edbn tu\u1ed5i n\u00ean l\u1ea5y m\u1ee5c ti\u00eau l\u00e0 Hct &gt; 25% v\u00e0 RBC &gt; 2.5 tri\u1ec7u\/mm<sup>3<\/sup>).<\/li>\n<\/ul>\n<p><strong><u>\u0110\u0103t sonde d\u1ea1 d\u00e0y:<\/u><\/strong><\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"526\"><strong>\u01afu \u0111i\u1ec3m<\/strong><\/td>\n<td width=\"365\"><strong>Nh\u01b0\u1ee3c \u0111i\u1ec3m<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"526\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Gi\u00fap ch\u1ea9n \u0111o\u00e1n v\u00e0 theo d\u00f5i XHTH tr\u00ean. Tuy nhi\u00ean sonde d\u1ea1 d\u00e0y kh\u00f4ng th\u1ea5y m\u00e1u trong 10 &#8211; 15% tr\u01b0\u1eddng h\u1ee3p XHTH.<\/p>\n<p>&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Gi\u00fap theo d\u1ecfi t\u00e1i xu\u1ea5t huy\u1ebft sau khi \u0111i\u1ec1u tr\u1ecb<\/p>\n<p>&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 H\u1ed7 tr\u1ee3 \u0111i\u1ec1u tr\u1ecb: l\u00e0m s\u1ea1ch d\u1ea1 d\u00e0y. L\u00e0m gi\u1ea3m \u0111\u1ed9 acid d\u1ea1 d\u00e0y (r\u1eeda d\u1ea1 d\u00e0y)<\/td>\n<td width=\"365\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 G\u00e2y kh\u00f3 ch\u1ecbu cho b\u1ec7nh nh\u00e2n.<\/p>\n<p>&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 G\u00e2y tr\u00e0o ng\u01b0\u1ee3c v\u00e0 d\u1ec5 h\u00edt s\u1eb7c.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong><u>C\u1ea7m m\u00e1u:<\/u><\/strong><\/p>\n<ul>\n<li>Ng\u01b0ng ngay ch\u1ed1ng \u0111\u00f4ng \u0111ang s\u1eed d\u1ee5ng (heparin, warfarin)<\/li>\n<li>Ng\u01b0ng ngay c\u00e1c thu\u1ed1c NSAIDs.<\/li>\n<li>Ch\u00edch vitamin K (IM ho\u1eb7c SC) 10 mg n\u1ebfu PT k\u00e9o d\u00e0i do \u0111i\u1ec1u tr\u1ecb warfarin ho\u1eb7c b\u1ec7nh l\u00ed gan m\u1eadt nh\u01b0ng n\u00f3 c\u1ea7n nhi\u1ec1u gi\u1edd \u0111\u1ebfn nhi\u1ec1u ng\u00e0y m\u1edbi c\u00f3 t\u00e1c d\u1ee5ng \u0111\u1ea7y \u0111\u1ee7 (d\u00f9ng trong 3 ng\u00e0y).<\/li>\n<\/ul>\n<p><strong>Ch\u1ec9 \u0111\u1ecbnh truy\u1ec1n m\u00e1u<\/strong><\/p>\n<ul>\n<li>M\u1ea5t m\u00e1u n\u1eb7ng \u0111ang di\u1ec5n ti\u1ebfn tr\u00ean l\u00e2m s\u00e0ng<\/li>\n<li>M\u1ea5t m\u00e1u c\u1ea5p v\u1edbi huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh<\/li>\n<li>Thi\u1ebfu m\u00e1u c\u1ea5p v\u1edbi t\u00ecnh tr\u1ea1ng cung c\u1ea5p oxy kh\u00f4ng \u0111\u1ee7 (da l\u1ea1nh, ng\u1ee7 g\u00e0, k\u00edch th\u00edch, thi\u1ec3u ni\u1ec7u \u2013 v\u00f4 ni\u1ec7u, toan lactate m\u00e1u,\u2026)<\/li>\n<li>Hg &lt; 7 &#8211; 8 g\/dL t\u00f9y thu\u1ed9c v\u00e0o t\u1eebng b\u1ec7nh nh\u00e2n<\/li>\n<\/ul>\n<p><strong>3.2 T\u00ecm v\u00e0 \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n g\u00e2y xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a.<\/strong><\/p>\n<ul>\n<li>D\u00e3n TM hay b\u1ec7nh d\u1ea1 d\u00e0y t\u0103ng \u00e1p c\u1eeda tr\u00ean b\u1ec7nh nh\u00e2n b\u1ec7nh gan hay l\u1ea1m d\u1ee5ng r\u01b0\u1ee3u<\/li>\n<li>D\u00f2 \u0111\u1ed9ng m\u1ea1ch-ru\u1ed9t tr\u00ean b\u1ec7nh nh\u00e2n ti\u1ec1n c\u0103n ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng hay th\u1ef1c hi\u1ec7n c\u00e1c ph\u1eabu thu\u1eadt m\u1ea3nh gh\u00e9p \u0111\u1ed9ng m\u1ea1ch<\/li>\n<li>D\u1ecb d\u1ea1ng m\u1ea1ch m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n b\u1ec7nh th\u1eadn, h\u1eb9p \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, b\u1ec7nh d\u00e3n m\u1ea1ch m\u00e1u xu\u1ea5t huy\u1ebft di truy\u1ec1n<\/li>\n<li>Lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng \u1edf b\u1ec7nh nh\u00e2n ti\u1ec1n c\u0103n nhi\u1ec5m H.pylori hay h\u00fat thu\u1ed1c l\u00e1<\/li>\n<li>B\u1ec7nh \u00e1c t\u00ednh : h\u00fat thu\u1ed1c l\u00e1, l\u1ea1m d\u1ee5ng r\u01b0\u1ee3u, nhi\u1ec5m H.pylori<\/li>\n<li>Lo\u00e9t b\u1edd mi\u1ec7ng n\u1ed1i: ph\u1eabu thu\u1eadt n\u1ed1i ru\u1ed9t<\/li>\n<\/ul>\n<ul>\n<li>Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa ho\u1eb7c n\u1ed9i soi \u0111i\u1ec1u tr\u1ecb.<\/li>\n<li>\u0110\u00e3 truy\u1ec1n tr\u00ean 5 \u0111\u01a1n v\u1ecb m\u00e1u \/ 24 gi\u1edd m\u00e0 kh\u00f4ng duy tr\u00ec \u0111\u01b0\u1ee3c huy\u1ebft \u0111\u1ed9ng.<\/li>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 nh\u00f3m m\u00e1u hi\u1ebfm.<\/li>\n<\/ul>\n<p>Xem th\u00eam: <a href=\"https:\/\/www.vinmec.com\/vi\/tieu-hoa-gan-mat\/thong-tin-suc-khoe\/tim-hieu-ve-benh-viem-loet-da-day-ta-trang\/\">T\u00ecm hi\u1ec3u v\u1ec1 lo\u00e9t d\u1ea1 d\u00e0y<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a l\u00e0 t\u00ecnh tr\u1ea1ng m\u00e1u tho\u00e1t ra kh\u1ecfi l\u00f2ng m\u1ea1ch ch\u1ea3y v\u00e0o \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Bao g\u1ed3m xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean (ngu\u1ed3n g\u1ed1c xu\u1ea5t huy\u1ebft \u1edf ph\u00eda tr\u00ean g\u00f3c Treiz) v\u00e0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a d\u01b0\u1edbi (ngu\u1ed3n g\u1ed1c xu\u1ea5t huy\u1ebft \u1edf ph\u00eda d\u01b0\u1edbi g\u00f3c Treiz). Tri\u1ec7u ch\u1ee9ng XHTH \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n [&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>Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a: tri\u1ec7u ch\u1ee9ng v\u00e0 c\u00e1ch \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a (XHTH) l\u00e0 t\u00ecnh tr\u1ea1ng m\u00e1u tho\u00e1t ra kh\u1ecfi l\u00f2ng m\u1ea1ch ch\u1ea3y v\u00e0o \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. 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