{"id":35635,"date":"2023-06-26T15:59:44","date_gmt":"2023-06-26T08:59:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=35635"},"modified":"2023-06-26T16:18:15","modified_gmt":"2023-06-26T09:18:15","slug":"chan-thuong-gan-nguyen-nhan-chan-doan-lam-sang-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/06\/26\/chan-thuong-gan-nguyen-nhan-chan-doan-lam-sang-va-dieu-tri\/","title":{"rendered":"Ch\u1ea5n th\u01b0\u01a1ng gan: Nguy\u00ean nh\u00e2n, ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<p><strong>Ch\u1ea5n th\u01b0\u01a1ng gan l\u00e0 m\u1ed9t trong nh\u1eefng ch\u1ea5n th\u01b0\u01a1ng \u1ed5 b\u1ee5ng th\u01b0\u1eddng g\u1eb7p. Gan l\u00e0 t\u1ea1ng \u0111\u1eb7c l\u1edbn nh\u1ea5t trong c\u01a1 th\u1ec3 con ng\u01b0\u1eddi. Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ch\u1ea5n th\u01b0\u01a1ng gan ng\u00e0y c\u00e0ng ti\u1ebfn b\u1ed9 trong 3 th\u1eadp ni\u00ean g\u1ea7n \u0111\u00e2y. V\u1edbi nh\u1eefng ch\u1ea5n th\u01b0\u01a1ng nh\u1eb9, \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n c\u00f3 t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng cao. \u0110i\u1ec1u tr\u1ecb ch\u1ea5n th\u01b0\u01a1ng gan n\u1eb7ng hi\u1ec7n v\u1eabn l\u00e0 m\u1ed9t trong nh\u1eefng th\u00e1ch th\u1ee9c v\u00ec t\u1ef7 l\u1ec7 t\u1eed vong nh\u00ecn chung c\u00f2n cao.<\/strong><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-35636 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/2c8e898c-540f-4399-88f6-667a4074a3c7-300x300.jpg\" alt=\"chan-thuong-gan\" width=\"300\" height=\"300\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/2c8e898c-540f-4399-88f6-667a4074a3c7-300x300.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/2c8e898c-540f-4399-88f6-667a4074a3c7-150x150.jpg 150w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/2c8e898c-540f-4399-88f6-667a4074a3c7-768x768.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/2c8e898c-540f-4399-88f6-667a4074a3c7.jpg 1024w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<h2>1. \u0110\u1ea1i c\u01b0\u01a1ng<\/h2>\n<p><strong>1.1 Gi\u1ea3i ph\u1eabu gan<\/strong><\/p>\n<p><strong>&#8211; V\u1ecb tr\u00ed:<\/strong> \u1edf t\u1ea7ng tr\u00ean m\u1ea1c treo k\u1ebft tr\u00e0ng ngang, trong \u00f4 d\u01b0\u1edbi ho\u00e0nh ph\u1ea3i (P), nh\u01b0ng l\u1ea5n sang \u00f4 th\u01b0\u1ee3ng v\u1ecb v\u00e0 \u00f4 d\u01b0\u1edbi ho\u00e0nh tr\u00e1i. Tr\u00f4ng nh\u01b0 \u0111\u00fac theo khu\u00f4n v\u00f2m ho\u00e0nh. N\u1ebfu \u0111\u1ed1i chi\u1ebfu l\u00ean th\u00e0nh ng\u1ef1c th\u00ec gan l\u00ean t\u1eadn kho\u1ea3ng gian s\u01b0\u1eddn IV tr\u00ean \u0111\u01b0\u1eddng v\u00fa P, b\u1edd d\u01b0\u1edbi gan ch\u1ea1y d\u1ecdc b\u1edd s\u01b0\u1eddn P.<\/p>\n<p><strong>&#8211; H\u00ecnh th\u1ec3 ngo\u00e0i:<\/strong> c\u00f3 h\u00ecnh d\u1ea1ng nh\u01b0 qu\u1ea3 d\u01b0a h\u1ea5u c\u1eaft ch\u1ebfch t\u1eeb T sang P theo 1 b\u00ecnh di\u1ec7n nh\u00ecn l\u00ean tr\u00ean ra trc v\u00e0 sang P. Do \u0111\u00f3 gan c\u00f3 2 m\u1eb7t \u00a0l\u00e0 m\u1eb7t ho\u00e0nh l\u1ed3i \u1edf tr\u00ean \u00e1p s\u00e1t v\u00e0o c\u01a1 ho\u00e0nh v\u00e0 m\u1eb7t t\u1ea1ng \u1edf d\u1ee9oi ti\u1ebfp x\u00fac v\u1edbi c\u00e1c t\u1ea1ng r\u1ed7ng trong \u1ed5 b\u1ee5ng. Gan ch\u1ec9 c\u00f3 1 b\u1edd duy nh\u1ea5t l\u00e0 b\u1edd d\u01b0\u1edbi.<\/p>\n<p>&#8211; Gan c\u00f3 h\u1ec7 th\u1ed1ng m\u1ea1ch m\u00e1u phong ph\u00fa \u0111\u01b0\u1ee3c c\u1ea5p m\u00e1u b\u1edfi \u0111\u1ed9ng m\u1ea1ch gan v\u00e0 t\u0129nh m\u1ea1ch c\u1eeda, v\u00e0 \u0111\u01b0\u1ee3c d\u1eabn l\u01b0u m\u00e1u v\u1ec1 t\u0129nh m\u1ea1ch ch\u1ee7 qua c\u00e1c t\u0129nh m\u1ea1ch gan.<\/p>\n<p><strong>1.2 Nguy\u00ean nh\u00e2n v\u00e0 c\u01a1 ch\u1ebf<\/strong><\/p>\n<p>Nguy\u00ean nh\u00e2n g\u00e2y ra ch\u1ea5n th\u01b0\u01a1ng gan t\u00f9y theo \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u1eebng qu\u1ed1c gia. T\u1ea1i Vi\u1ec7t Nam, ch\u1ea5n th\u01b0\u01a1ng gan \u0111a s\u1ed1 l\u00e0 do tai n\u1ea1n giao th\u00f4ng ho\u1eb7c tai n\u1ea1n lao \u0111\u1ed9ng, \u1ea9u \u0111\u1ea3, t\u00e9 cao\u2026<\/p>\n<ul>\n<li>Ch\u1ea5n th\u01b0\u01a1ng: t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9t ng\u1ed9t do va \u0111\u1eadp tr\u1ef1c ti\u1ebfp; thay \u0111\u1ed5i l\u1ef1c qu\u00e1n t\u00ednh do d\u1eebng \u0111\u1ed9t ng\u1ed9t khi di chuy\u1ec3n t\u1ed1c \u0111\u1ed9 cao.<\/li>\n<li>V\u1ebft th\u01b0\u01a1ng: t\u00f9y theo l\u00e1 ph\u00fac m\u1ea1c th\u00e0nh c\u00f3 th\u1ee7ng hay kh\u00f4ng =&gt; V\u1ebft th\u01b0\u01a1ng th\u1ea5u b\u1ee5ng hay kh\u00f4ng th\u1ea5u b\u1ee5ng. V\u1ebft th\u01b0\u01a1ng xuy\u00ean khi \u0111\u1ea1n \u0111\u1ea1o qua v\u1edbi m\u1ed9t l\u1ed7 v\u00e0o v\u00e0 m\u1ed9t l\u1ed7 ra. V\u1ebft th\u01b0\u01a1ng ch\u1ed9t ch\u1ec9 m\u1ed9t l\u1ed7 v\u00e0o, m\u1ea3nh hay \u0111\u1ea1n n\u1eb1m trong b\u1ec1 d\u00e0y th\u00e0nh b\u1ee5ng ho\u1eb7c \u1ed5 b\u1ee5ng; v\u1ebft th\u01b0\u01a1ng ti\u1ebfp tuy\u1ebfn khi \u0111\u1ea1n \u0111\u1ea1o tr\u1ee3t qua b\u1ec1 d\u00e0y th\u00e0nh b\u1ee5ng =&gt; c\u00e1c t\u1ea1ng t\u1ed5n th\u01b0\u01a1ng theo c\u01a1 ch\u1ebf s\u00f3ng \u0111\u1ed9ng.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>1.3 L\u00e2m s\u00e0ng v\u00e0 ph\u00e2n \u0111\u1ed9 ch\u1ea5n th\u01b0\u01a1ng gan<\/strong><\/p>\n<p>B\u1ec7nh nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng gan th\u01b0\u1eddng nh\u1eadp vi\u1ec7n trong b\u1ec7nh c\u1ea3nh \u0111a ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n<p>C\u1ea7n xem x\u00e9t ch\u1ea5n th\u01b0\u01a1ng gan khi b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u:<\/p>\n<p>&#8211; C\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng: c\u00f3 t\u00e1c \u0111\u1ed9ng l\u1ef1c v\u00f9ng b\u1ee5ng tr\u00ean, ph\u1ea7n th\u1ea5p c\u1ee7a th\u00e0nh ng\u1ef1c ph\u1ea3i ho\u1eb7c h\u00f4ng l\u01b0ng ph\u1ea3i.<\/p>\n<p>&#8211; \u0110au v\u00f9ng b\u1ee5ng tr\u00ean ph\u1ea3i sau ch\u1ea5n th\u01b0\u01a1ng, c\u00f3 th\u1ec3 k\u00e8m theo \u0111au ng\u1ef1c ph\u1ea3i hay vai ph\u1ea3i do c\u00f3 ch\u1ea5n th\u01b0\u01a1ng l\u1ed3ng ng\u1ef1c ho\u1eb7c c\u01a1 ho\u00e0nh. M\u1ee9 \u0111\u1ed9 \u0111au t\u00f9y theo m\u1ee9c \u0111\u1ed9 ch\u1ea5n th\u01b0\u01a1ng gan, ng\u1ef1c, m\u00e1u trong \u1ed5 ph\u00fac m\u1ea1c, ng\u01b0\u1ee1ng \u0111au c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n<p>&#8211; To\u00e0n th\u00e2n: d\u1ea5u hi\u1ec7u m\u1ea5t m\u00e1u c\u1ea5p, shock ch\u1ea5n th\u01b0\u01a1ng nh\u01b0 da xanh, ni\u00eam nh\u1ee3t, chi l\u1ea1nh,k\u00e9o d\u00e0i th\u1eddi gian \u0111\u1ed5 \u0111\u1ea7y mao m\u1ea1ch, \u0111\u1eb7c bi\u1ec7t l\u00e0 d\u1ea5u hi\u1ec7u m\u1ea1ch nhanh tr\u00ean 100 l\u1ea7n\/ph\u00fat, huy\u1ebft \u00e1p t\u00e2m thu &lt;= 90mmHg, nh\u1ecbp tim &gt;=120 l\u1ea7n\/ph\u00fat (theo Advance Trauma Life Support-ATLS), d\u1ea5u hi\u1ec7u th\u1ea7n kinh v\u1eadt v\u00e3 k\u00edch th\u00edch hay l\u01a1 m\u01a1.<\/p>\n<p>&#8211; Kh\u00e1m l\u00e2m s\u00e0ng:<\/p>\n<ul>\n<li>D\u1ea5u b\u1ea7m, x\u00e2y x\u00e1c da ho\u1eb7c v\u1ebft th\u01b0\u01a1ng ph\u1ea7n th\u1ea5p th\u00e0nh ng\u1ef1c, h\u00f4ng l\u01b0ng, b\u1ee5ng tr\u00ean ph\u1ea3i<\/li>\n<li>C\u00e1c d\u1ea5u hi\u1ec7u g\u00e3y x\u01b0\u01a1ng s\u01b0\u1eddn, tr\u00e0n kh\u00ed d\u01b0\u1edbi da, tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i<\/li>\n<li>B\u1ee5ng b\u00e8, g\u00f5 \u0111\u1ee5c v\u00f9ng th\u1ea5p t\u00f9y theo m\u1ee9c \u0111\u1ed9 ch\u1ea3y m\u00e1u<\/li>\n<li>C\u1ea3m \u1ee9ng ph\u00fac m\u1ea1c hay ph\u1ea3n \u1ee9ng th\u00e0nh b\u1ee5ng<\/li>\n<li>Gan c\u00f3 th\u1ec3 b\u1ecb v\u1ee1 n\u00e1t, n\u1ee9t r\u1ed9ng g\u00e2y ch\u1ea3y m\u00e1u v\u00e0o \u1ed5 b\u1ee5ng hay c\u00f3 th\u1ec3 v\u1ee1 d\u01b0\u1edbi bao<\/li>\n<\/ul>\n<p>( trong nhu m\u00f4 ), ho\u1eb7c b\u1ecb b\u1ee9t r\u00e1ch kh\u1ecfi c\u00e1c d\u00e2y ch\u1eb1ng treo gan. V\u00f9ng gan b\u1ecb v\u1ee1 n\u00e1t v\u1edbi nhi\u1ec1u m\u00f4 ho\u1ea1i t\u1eed v\u00e0 m\u1ea1ch m\u00e1u, \u0111\u01b0\u1eddng m\u1eadt trong gan b\u1ecb \u0111\u1ee9t r\u00e1ch l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a ch\u1ea3y m\u00e1u \u1ed3 \u1ea1t trong \u1ed5 b\u1ee5ng hay r\u00f2 r\u1ec9 d\u1ecbch m\u1eadt, nhi\u1ec5m tr\u00f9ng \u1ed5 b\u1ee5ng sau ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n<ul>\n<li>V\u1ebft th\u01b0\u01a1ng gan c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t \u0111\u01b0\u1eddng r\u00e1ch, v\u1ee1 s\u00e2u \u0111\u01b0\u1ee3c b\u00edt b\u1edfi c\u1ee5c m\u00e1u \u0111\u00f4ng hay b\u1ecb v\u1ee1 n\u00e1t v\u1edbi b\u1edd v\u1ebft th\u01b0\u01a1ng nham nh\u1edf n\u1ebfu do ho\u1ea3 kh\u00ed.<\/li>\n<\/ul>\n<p>C\u00e1c h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng<\/p>\n<ul>\n<li>T\u1ee5 m\u00e1u d\u01b0\u1edbi bao<\/li>\n<li>R\u00e1ch nhu m\u00f4 gan<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng m\u1eadt<\/li>\n<li>Th\u01b0\u01a1ng t\u1ed5n gan c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia l\u00e0m 6 m\u1ee9c \u0111\u1ed9 :<\/li>\n<\/ul>\n<p><strong>B\u1ea3ng1. Ph\u00e2n \u0111\u1ed9 th\u01b0\u01a1ng t\u1ed5n gan theo Moore:<\/strong><\/p>\n<p>&nbsp;<\/p>\n<table width=\"723\">\n<tbody>\n<tr>\n<td width=\"182\"><strong>Ph\u00e2n \u0111\u1ed9<\/strong><\/td>\n<td width=\"541\"><strong>Th\u01b0\u01a1ng t\u1ed5n<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"182\">\u0110\u1ed9 1<\/td>\n<td width=\"541\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 T\u1ee5 m\u00e1u d\u01b0\u1edbi bao &lt; 10% di\u1ec7n t\u00edch<\/p>\n<p>&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 R\u00e1ch bao gan v\u00e0 nhu m\u00f4 &lt; 1cm chi\u1ec1u s\u00e2u<\/td>\n<\/tr>\n<tr>\n<td width=\"182\">\u0110\u1ed9 2<\/td>\n<td width=\"541\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 T\u1ee5 m\u00e1u d\u01b0\u1edbi bao gan 10% &#8211; 50% di\u1ec7n t\u00edch hay trong nhu m\u00f4 &lt; 10cm \u0111\u01b0\u1eddng k\u00ednh<\/p>\n<p>&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 V\u1ee1 gan 1 &#8211; 3cm b\u1ec1 s\u00e2u v\u00e0 &lt; 10cm chi\u1ec1u d\u00e0i<\/td>\n<\/tr>\n<tr>\n<td width=\"182\">\u0110\u1ed9 3<\/td>\n<td width=\"541\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 T\u1ee5 m\u00e1u d\u01b0\u1edbi bao gan lan r\u1ed9ng &gt; 50% di\u1ec7n t\u00edch hay trong nhu m\u00f4 &gt; 10cm \u0111\u01b0\u1eddng k\u00ednh<\/p>\n<p>&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 V\u1ee1 gan &gt; 3cm b\u1ec1 s\u00e2u<\/td>\n<\/tr>\n<tr>\n<td width=\"182\">\u0110\u1ed9 4<\/td>\n<td width=\"541\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 V\u1ee1 gan 25 -75% thu\u1ef3 gan hay t\u1eeb 1 &#8211; 3 h\u1ea1 ph\u00e2n thu\u1ef3 trong m\u1ed9t thu\u1ef3 gan<\/td>\n<\/tr>\n<tr>\n<td width=\"182\">\u0110\u1ed9 5<\/td>\n<td width=\"541\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 V\u1ee1 &gt; 75% thu\u1ef3 gan hay tr\u00ean 3 h\u1ea1 ph\u00e2n thu\u1ef3 trong m\u1ed9t thu\u1ef3 gan<\/p>\n<p>&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 C\u00f3 th\u01b0\u01a1ng t\u1ed5n m\u1ea1ch m\u00e1u ( t\u0129nh m\u1ea1ch ch\u1ee7 sau gan, c\u00e1c t\u0129nh m\u1ea1ch gan l\u1edbn )<\/td>\n<\/tr>\n<tr>\n<td width=\"182\">\u0110\u1ed9 6<\/td>\n<td width=\"541\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Gan b\u1ecb \u0111\u1ee9t ra kh\u1ecfi c\u00e1c d\u00e2y ch\u1eb1ng treo gan, cu\u1ed1ng gan<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>B\u1ea3ng ph\u00e2n lo\u1ea1i WSES chia t\u1ed5n th\u01b0\u01a1ng gan th\u00e0nh 4 lo\u1ea1i d\u1ef1a theo ph\u00e2n lo\u1ea1i AAST<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"264\"><\/td>\n<td width=\"204\"><strong>WSES grade<\/strong><\/td>\n<td width=\"211\"><strong>AAST<\/strong><\/td>\n<td width=\"280\"><strong>Huy\u1ebft \u0111\u1ed9ng<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"264\"><strong>Nh\u1eb9<\/strong><\/td>\n<td width=\"204\">Grade I<\/td>\n<td width=\"211\">I-II<\/td>\n<td width=\"280\">\u1ed4n \u0111\u1ecbnh<\/td>\n<\/tr>\n<tr>\n<td width=\"264\"><strong>Trung b\u00ecnh<\/strong><\/td>\n<td width=\"204\">Grade II<\/td>\n<td width=\"211\">III<\/td>\n<td width=\"280\">\u1ed4n \u0111\u1ecbnh<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"264\"><strong>N\u1eb7ng<\/strong><\/td>\n<td width=\"204\">Grade III<\/td>\n<td width=\"211\">IV-V<\/td>\n<td width=\"280\">\u1ed4n \u0111\u1ecbnh<\/td>\n<\/tr>\n<tr>\n<td width=\"204\">Grade IV<\/td>\n<td width=\"211\">I-VI<\/td>\n<td width=\"280\">Kh\u00f4ng \u1ed5n \u0111\u1ecbnh<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<h2><strong>3. \u0110i\u1ec1u tr\u1ecb ch\u1ea5n th\u01b0\u01a1ng gan<\/strong><\/h2>\n<p><strong>3.1 Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/strong><\/p>\n<ul>\n<li>\u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n kh\u00f4ng m\u1ed5 cho b\u1ec7nh nh\u00e2n (BN) c\u00f3 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh b\u1ea5t k\u1ec3 c\u00e1c ph\u00e2n \u0111\u1ed9.<\/li>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh, ho\u1eb7c c\u00f3 vi\u00eam ph\u00fac m\u1ea1c: -&gt; ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt.<\/li>\n<\/ul>\n<p>Huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh \u0111\u01b0\u1ee3c coi l\u00e0 t\u00ecnh tr\u1ea1ng huy\u1ebft \u00e1p t\u00e2m thu l\u00fac nh\u1eadp vi\u1ec7n &lt;90 mmHg v\u00e0 nh\u1ecbp tim &gt;= 120 l\u1ea7n\/ph\u00fat (ATLS) v\u1edbi b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng l\u00e0 s\u1ed1c m\u1ea5t m\u00e1u, thay \u0111\u1ed5i m\u1ee9c \u0111\u1ed9 \u00fd th\u1ee9c v\u00e0 \/ ho\u1eb7c kh\u00f3 th\u1edf, ho\u1eb7c &gt; 90 mmHg nh\u01b0ng c\u1ea7n truy\u1ec1n \/ truy\u1ec1n li\u1ec1u bolus v\u00e0 \/ ho\u1eb7c thu\u1ed1c v\u1eadn m\u1ea1ch ho\u1eb7c y\u00eau c\u1ea7u truy\u1ec1n \u00edt nh\u1ea5t 4 \u0111\u01a1n v\u1ecb h\u1ed3ng c\u1ea7u trong v\u00f2ng 8 gi\u1edd \u0111\u1ea7u ti\u00ean.<\/p>\n<p><strong>3.2 \u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n<\/strong><\/p>\n<p><u>Khuy\u1ebfn c\u00e1o c\u1ee7a WSES 2020<\/u><\/p>\n<ul>\n<li>L\u1ef1a ch\u1ecdn cho t\u1ea5t c\u1ea3 BN c\u00f3 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh V\u00c0 lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c c\u1ea7n ph\u1ea3i m\u1ed5 (khuy\u1ebfn c\u00e1o 2A)<\/li>\n<li>Nh\u1eefng BN c\u00f3 \u0111\u00e1p \u1ee9ng tho\u00e1ng qua v\u1edbi h\u1ed3i s\u1ee9c ban \u0111\u1ea7u WSESII, WSESIII, ch\u1ec9 n\u00ean \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n \u1edf nh\u1eefng trung t\u00e2m c\u00f3 PTVkinh nghi\u1ec7m, c\u00f3 s\u1eb5n ph\u00f2ng m\u1ed5, ICU, DSA, c\u00e1c ch\u1ebf ph\u1ea9m m\u00e1u (khuy\u1ebfn c\u00e1o 2B)<\/li>\n<li>CT Scan c\u00f3 c\u1ea3n quang lu\u00f4n c\u00f3 cho BN \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n (khuy\u1ebfn c\u00e1o 2A)<\/li>\n<li>C\u00e1c nghi\u1ec7m ph\u00e1p ch\u1ea9n \u0111o\u00e1n, kh\u00e1m l\u00e2m s\u00e0ng l\u1eb7p l\u1ea1i nhi\u1ec1u l\u1ea7n \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1ef1 thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i l\u00e2m s\u00e0ng trong su\u1ed1t th\u1eddi gian \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n (khuy\u1ebfn c\u00e1o 2A)<\/li>\n<li>TAE c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c coi l\u00e0 can thi\u1ec7p \u0111\u1ea7u tay \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh v\u1ec1 huy\u1ebft \u0111\u1ed9ng c\u00f3 d\u1ea5u tho\u00e1t m\u1ea1ch tr\u00ean CT scan (khuy\u1ebfn c\u00e1o 2B)<\/li>\n<li>Theo d\u00f5i t\u1ea1i ICU cho BN c\u00f3 ch\u1ea5n th\u01b0\u01a1ng gan WSESII, WSES III \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 t\u1eed vong (khuy\u1ebfn c\u00e1o 2B)<\/li>\n<li>Tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd c\u00f3 ch\u1ea5n th\u01b0\u01a1ng b\u1ee5ng v\u00e0o vi\u1ec7n mu\u1ed9n, n\u1ed9i soi th\u0103m d\u00f2 \u0111\u01b0\u1ee3c xem l\u00e0 ch\u1ec9 \u0111\u1ecbnh m\u1edf r\u1ed9ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n, v\u00e0 thi\u1ebft l\u1eadp k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb ti\u1ebfp theo (khuy\u1ebfn c\u00e1o 2C). Trong su\u1ed1t qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n, n\u1ed9i soi ng\u1eaft qu\u1ea3ng cung c\u1ea5p c\u00e1c th\u00f4ng tin quan trong t\u00ecnh tr\u1ea1ng \u1ed5 b\u1ee5ng, gi\u00fap l\u1eadp k\u1ebf ho\u1ea1ch m\u1edf b\u1ee5ng\/n\u1ed9i soi t\u1ee9c th\u00ec hay sau \u0111\u00f3.<\/li>\n<\/ul>\n<p><strong>3.3 \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt<\/strong><\/p>\n<p><u>Khuy\u1ebfn c\u00e1o WSES 2020<\/u><\/p>\n<ul>\n<li>BN huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh v\u00e0 kh\u00f4ng \u0111\u00e1p \u1ee9ng h\u1ed3i s\u1ee9c (WSESIV) (khuy\u1ebfn c\u00e1o 2A)<\/li>\n<li>M\u1ee5c \u0111\u00edch ch\u00ednh c\u1ee7a ph\u1eabu thu\u1eadt l\u00e0 ki\u1ec3m so\u00e1t xu\u1ea5t huy\u1ebft v\u00e0 r\u00f2 r\u1ec9 m\u1eadt v\u00e0 b\u1eaft \u0111\u1ea7u h\u1ed3i s\u1ee9c ki\u1ec3m so\u00e1t t\u1ed5n th\u01b0\u01a1ng c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t (khuy\u1ebfn c\u00e1o 2A)<\/li>\n<li>Tr\u00e1nh c\u1eaft gan l\u1edbn, xem x\u00e9t trong c\u00e1c ph\u1eabu thu\u1eadt ti\u1ebfp theo (khuy\u1ebfn c\u00e1o 2B)<\/li>\n<li>TAE:h\u1eefu \u00edch trong tr\u01b0\u1eddng h\u1ee3p ch\u1ea3y m\u00e1u \u0111\u1ed9ng m\u1ea1ch dai d\u1eb3ng sau c\u00e1c th\u1ee7 thu\u1eadt ki\u1ec3m so\u00e1t t\u1ed5n th\u01b0\u01a1ng (khuy\u1ebfn c\u00e1o 2A)<\/li>\n<\/ul>\n<p>Xem th\u00eam: <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/cac-trieu-chung-chan-thuong-bung-kin\/\">C\u00e1c tri\u1ec7u ch\u1ee9ng ch\u1ea5n th\u01b0\u01a1ng b\u1ee5ng k\u00edn<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ch\u1ea5n th\u01b0\u01a1ng gan l\u00e0 m\u1ed9t trong nh\u1eefng ch\u1ea5n th\u01b0\u01a1ng \u1ed5 b\u1ee5ng th\u01b0\u1eddng g\u1eb7p. Gan l\u00e0 t\u1ea1ng \u0111\u1eb7c l\u1edbn nh\u1ea5t trong c\u01a1 th\u1ec3 con ng\u01b0\u1eddi. Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ch\u1ea5n th\u01b0\u01a1ng gan ng\u00e0y c\u00e0ng ti\u1ebfn b\u1ed9 trong 3 th\u1eadp ni\u00ean g\u1ea7n \u0111\u00e2y. V\u1edbi nh\u1eefng ch\u1ea5n th\u01b0\u01a1ng nh\u1eb9, \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n c\u00f3 t\u1ef7 l\u1ec7 th\u00e0nh [&hellip;]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[4,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ch\u1ea5n th\u01b0\u01a1ng gan: Nguy\u00ean nh\u00e2n, ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Ch\u1ea5n th\u01b0\u01a1ng gan l\u00e0 m\u1ed9t trong nh\u1eefng ch\u1ea5n th\u01b0\u01a1ng \u1ed5 b\u1ee5ng th\u01b0\u1eddng g\u1eb7p. 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