{"id":13198,"date":"2018-09-03T13:45:57","date_gmt":"2018-09-03T06:45:57","guid":{"rendered":"https:\/\/yhoccongdong.org\/du-an-khac\/nguyen-nhan-gian-tinh-mach-thuc-quan-va-cach-kiem-soat\/"},"modified":"2024-03-17T04:20:49","modified_gmt":"2024-03-16T21:20:49","slug":"nguyen-nhan-gian-tinh-mach-thuc-quan-va-cach-kiem-soat","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/du-an-khac\/nguyen-nhan-gian-tinh-mach-thuc-quan-va-cach-kiem-soat\/","title":{"rendered":"Nguy\u00ean nh\u00e2n gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n v\u00e0 c\u00e1ch ki\u1ec3m so\u00e1t"},"content":{"rendered":"<p>&nbsp;<\/p>\n<p>V\u1ee1 gi\u00e3n t\u0129nh m\u1ea1ch xu\u1ea5t huy\u1ebft th\u01b0\u1eddng x\u1ea3y ra t\u1eeb c\u00e1c t\u0129nh m\u1ea1ch gi\u00e3n t\u1ea1i v\u1ecb tr\u00ed ch\u1ed7 n\u1ed1i gi\u1eefa t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n v\u00e0 h\u1ec7 th\u1ed1ng t\u0129nh m\u1ea1ch ch\u1ee7. Gi\u00e3n t\u0129nh m\u1ea1ch c\u00f3 xu h\u01b0\u1edbng \u1edf th\u1ef1c qu\u1ea3n \u0111o\u1ea1n xa v\u00e0 \/ ho\u1eb7c ph\u1ea7n tr\u00ean d\u1ea1 d\u00e0y nh\u01b0ng gi\u00e3n t\u0129nh m\u1ea1ch khu tr\u00fa c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u1edf ph\u1ea7n d\u01b0\u1edbi d\u1ea1 d\u00e0y, ru\u1ed9t gi\u00e0 v\u00e0 ru\u1ed9t non. Ph\u1ea7n l\u1edbn c\u00e1c b\u1ec7nh nh\u00e2n gi\u00e3n t\u0129nh m\u1ea1ch ch\u1ea3y m\u00e1u c\u00f3 b\u1ec7nh gan m\u1ea1n t\u00ednh. Ch\u1ea3y m\u00e1u l\u00e0 tri\u1ec7u ch\u1ee9ng nghi\u00eam tr\u1ecdng v\u00e0 c\u00f3 th\u1ec3 \u0111e d\u1ecda t\u00ednh m\u1ea1ng. K\u00edch th\u01b0\u1edbc c\u1ee7a gi\u00e3n t\u0129nh m\u1ea1ch v\u00e0 m\u1ee9c \u0111\u1ed9 ch\u1ea3y m\u00e1u c\u00f3 li\u00ean quan tr\u1ef1c ti\u1ebfp \u0111\u1ebfn \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n, m\u00e0 th\u01b0\u1eddng l\u00e0 li\u00ean quan tr\u1ef1c ti\u1ebfp \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng tr\u00ean n\u1ec1n m\u1ed9t b\u1ec7nh gan. Gi\u00e3n t\u0129nh m\u1ea1ch l\u1edbn v\u1edbi nh\u1eefng \u0111\u1ed1m \u0111\u1ecf c\u00f3 nguy c\u01a1 b\u1ecb v\u1ee1 cao nh\u1ea5t.<\/p>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"size-full wp-image-10254 aligncenter\" src=\"https:\/\/yhoccongdong.com\/du-an-khac\/wp-content\/uploads\/sites\/6\/2016\/04\/gian-tinh-mach-thuc-quan.jpg\" alt=\"Gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n\" width=\"660\" height=\"330\" \/><\/p>\n<h2><strong>D\u1ecbch t\u1ec5 h\u1ecdc<\/strong><\/h2>\n<ul>\n<li>Ch\u1ea3y m\u00e1u t\u1eeb gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n chi\u1ebfm 5-11% c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ea3y m\u00e1u \u0111\u01b0\u1eddng ti\u00eau h\u00f3a tr\u00ean (UGIB).<\/li>\n<li>\u1ede c\u00e1c n\u01b0\u1edbc ph\u01b0\u01a1ng T\u00e2y, x\u01a1 gan do r\u01b0\u1ee3u v\u00e0 virus l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u c\u1ee7a b\u1ec7nh t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda v\u00e0 gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n.<\/li>\n<li>30% b\u1ec7nh nh\u00e2n b\u1ecb <a href=\"https:\/\/yhoccongdong.com\/thongtin\/xo-gan-va-cac-bien-chung-cua-xo-gan\/\" target=\"_blank\" rel=\"noopener\">x\u01a1 gan<\/a> c\u00f2n b\u00f9 v\u00e0 60-70% b\u1ec7nh nh\u00e2n b\u1ecb x\u01a1 gan m\u1ea5t b\u00f9 c\u00f3 gi\u00e3n t\u0129nh m\u1ea1ch d\u1ea1 d\u00e0y-th\u1ef1c qu\u1ea3n t\u1ea1i th\u1eddi \u0111i\u1ec3m n\u00e0y.<\/li>\n<li>Gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n ti\u1ebfn tri\u1ec3n trong kho\u1ea3ng 8% b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh gan m\u1ea1n t\u00ednh m\u1ed7i n\u0103m trong hai n\u0103m \u0111\u1ea7u ti\u00ean v\u00e0 30% b\u1ec7nh nh\u00e2n v\u00e0o n\u0103m th\u1ee9 s\u00e1u.<\/li>\n<li>Nguy c\u01a1 ch\u1ea3y m\u00e1u gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n trong n\u0103m \u0111\u1ea7u ti\u00ean sau khi x\u00e1c \u0111\u1ecbnh l\u00e0 30%.<\/li>\n<\/ul>\n<h2><strong>Nguy\u00ean nh\u00e2n<\/strong><\/h2>\n<p>C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n l\u00e0 nh\u1eefng g\u00ec c\u00f3 th\u1ec3 g\u00e2y t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda. M\u1ed9t s\u1ed1 v\u00ed d\u1ee5 trong b\u1ea3ng sau.<\/p>\n<p><img decoding=\"async\" class=\"alignnone size-full wp-image-10252 aligncenter\" src=\"\/\/yhoccongdong.com\/wp-content\/uploads\/2016\/04\/nguyen-nhan-cua-gian-tinh-mach-thuc-quan.png\" alt=\"Nguy\u00ean nh\u00e2n c\u1ee7a gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n\" width=\"702\" height=\"330\" \/><\/p>\n<h2><strong>C\u00e1c y\u1ebfu t\u1ed1 l\u00e0m t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft do gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n<\/strong><\/h2>\n<p>\u0110\u00e2y c\u0169ng l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 \u0111\u00e3 l\u00e0m t\u0103ng nguy c\u01a1 t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda:<\/p>\n<ul>\n<li>B\u1ec7nh gan m\u1ea5t b\u00f9.<\/li>\n<li>Suy dinh d\u01b0\u1ee1ng.<\/li>\n<li>U\u1ed1ng r\u01b0\u1ee3u.<\/li>\n<li>Ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c.<\/li>\n<li>Nh\u1ecbp sinh h\u1ecdc.<\/li>\n<li>T\u0103ng \u00e1p l\u1ef1c \u1ed5 b\u1ee5ng.<\/li>\n<li>Aspirin.<\/li>\n<li>Thu\u1ed1c ch\u1ed1ng vi\u00eam (NSAID).<\/li>\n<li>Nhi\u1ec5m tr\u00f9ng do vi khu\u1ea9n (nguy\u00ean nh\u00e2n ban \u0111\u1ea7u v\u00e0 y\u1ebfu t\u1ed1 t\u00e1i ph\u00e1t c\u1ee7a ch\u1ea3y m\u00e1u)<\/li>\n<\/ul>\n<h2><strong>Bi\u1ec3u hi\u1ec7n<\/strong><\/h2>\n<p><strong>C\u00e1c tri\u1ec7u ch\u1ee9ng<\/strong><\/p>\n<ul>\n<li>N\u00f4n ra m\u00e1u (th\u01b0\u1eddng g\u1eb7p nh\u1ea5t), \u0111i c\u1ea7u ph\u00e2n \u0111en.<\/li>\n<li>\u0110au b\u1ee5ng.<\/li>\n<li>Tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh gan v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd.<\/li>\n<li>Nu\u1ed1t kh\u00f3 \/ nu\u1ed1t \u0111au (\u0111au khi nu\u1ed1t; kh\u00f4ng th\u01b0\u1eddng g\u1eb7p).<\/li>\n<li>Nh\u1ea7m l\u1eabn v\u1edbi b\u1ec7nh n\u00e3o th\u1ee9 ph\u00e1t (th\u1eadm ch\u00ed h\u00f4n m\u00ea).<\/li>\n<\/ul>\n<p><strong>D\u1ea5u hi\u1ec7u\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><\/p>\n<ul>\n<li>M\u1ea5t m\u1ea1ch ngo\u1ea1i vi.<\/li>\n<li>Xanh xao.<\/li>\n<li>H\u1ea1 huy\u1ebft \u00e1p v\u00e0 nh\u1ecbp tim nhanh (s\u1ed1c).<\/li>\n<li>L\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u gi\u1ea3m.<\/li>\n<li>\u0110i c\u1ea7u ph\u00e2n \u0111en.<\/li>\n<li>D\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh gan m\u1ea1n t\u00ednh.<\/li>\n<li>Gi\u1ea3m ch\u1ec9 s\u1ed1 Glasgow.<\/li>\n<\/ul>\n<p>C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a nhi\u1ec5m tr\u00f9ng c\u0169ng c\u00f3 th\u1ec3 th\u01b0\u1eddng c\u00f3 m\u1eb7t.<\/p>\n<h2><strong>C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/h2>\n<ul>\n<li>N\u1ed9i soi r\u1ea5t c\u1ea7n thi\u1ebft trong giai \u0111o\u1ea1n \u0111\u1ea7u.<\/li>\n<li>FBC &#8211; hemoglobin c\u00f3 th\u1ec3 th\u1ea5p; MCV c\u00f3 th\u1ec3 cao, b\u00ecnh th\u01b0\u1eddng hay th\u1ea5p; ti\u1ec3u c\u1ea7u c\u0169ng c\u00f3 th\u1ec3 th\u1ea5p; WCC c\u00f3 th\u1ec3 t\u0103ng l\u00ean.<\/li>\n<li>Ch\u1ee9c n\u0103ng \u0111\u00f4ng m\u00e1u bao g\u1ed3m INR.<\/li>\n<li>Ch\u1ee9c n\u0103ng th\u1eadn.<\/li>\n<li>LFTs.<\/li>\n<li>Nh\u00f3m m\u00e1u v\u00e0 ph\u1ea3n \u1ee9ng ch\u00e9o.<\/li>\n<li>X-quang ng\u1ef1c &#8211; b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 h\u00edt ph\u1ea3i hay c\u00f3 nhi\u1ec5m tr\u00f9ng ng\u1ef1c.<\/li>\n<li>Ch\u1ecdc d\u1ecbch m\u00e0ng b\u1ee5ng c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft n\u1ebfu vi\u00eam ph\u00fac m\u1ea1c nghi ng\u1edd do vi khu\u1ea9n.<\/li>\n<li>Kh\u1ea3o s\u00e1t c\u00e1c d\u1ea5u hi\u1ec7u ch\u1ec9 \u0111i\u1ec3m nguy\u00ean nh\u00e2n c\u01a1 b\u1ea3n c\u1ee7a t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda (xem b\u00e0i vi\u1ebft T\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n ri\u00eang bi\u1ec7t).<\/li>\n<\/ul>\n<h2><strong>Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/strong><\/h2>\n<p>C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c c\u1ee7a UGIB \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea trong chuy\u00ean \u0111\u1ec1 <a href=\"http:\/\/patient.info\/doctor\/upper-gastrointestinal-bleeding-includes-rockall-score\" target=\"_blank\" rel=\"noopener\">Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a cao<\/a> (bao g\u1ed3m Thang \u0111i\u1ec3m Rockall).<\/p>\n<h2><strong>Ki\u1ec3m so\u00e1t <\/strong><\/h2>\n<p>Ki\u1ec3m so\u00e1t ch\u1ea3y m\u00e1u do gi\u00e3n t\u0129nh m\u1ea1ch c\u1ea5p t\u00ednh bao g\u1ed3m c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch, n\u1ed9i soi th\u1eaft t\u0129nh m\u1ea1ch b\u1eb1ng d\u1ea3i b\u0103ng v\u00e0 kh\u00e1ng sinh d\u1ef1 ph\u00f2ng. T\u1ea1o th\u00f4ng n\u1ed1i c\u1eeda ch\u1ee7 trong gan qua t\u0129nh m\u1ea1ch c\u1ea3nh (TIPS) \u0111\u01b0\u1ee3c d\u00e0nh \u00a0nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng \u0111\u00e1p \u1ee9ng ho\u1eb7c kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng ban \u0111\u1ea7u v\u1edbi m\u1ee9c ki\u1ec3m so\u00e1t c\u01a1 b\u1ea3n.<\/p>\n<p><strong>Vi\u1ec7n Qu\u1ed1c gia v\u1ec1 y t\u1ebf v\u00e0 ch\u0103m s\u00f3c (NICE) h\u01b0\u1edbng d\u1eabn:<\/strong><\/p>\n<ul>\n<li>Terlipressin n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng cho b\u1ec7nh nh\u00e2n nghi ng\u1edd ch\u1ea3y m\u00e1u do gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n. \u0110i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c d\u1eebng l\u1ea1i sau khi c\u1ea7m m\u00e1u th\u00e0nh c\u00f4ng, ho\u1eb7c sau n\u0103m ng\u00e0y, tr\u1eeb khi c\u00f3 m\u1ed9t d\u1ea5u hi\u1ec7u kh\u00e1c g\u1ee3i \u00fd ph\u1ea3i d\u00f9ng thu\u1ed1c tr\u1edf l\u1ea1i.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh d\u1ef1 ph\u00f2ng n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng cho b\u1ec7nh nh\u00e2n nghi ng\u1edd ho\u1eb7c \u0111\u00e3 x\u00e1c \u0111\u1ecbnh xu\u1ea5t huy\u1ebft do v\u1ee1 gi\u00e3n t\u0129nh m\u1ea1ch. S\u1eed d\u1ee5ng kh\u00e1ng sinh l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 t\u1ef7 l\u1ec7 t\u1eed vong c\u1ee7a b\u1ec7nh nh\u00e2n ti\u1ebfn tri\u1ec3n UGIB c\u1ea5p g\u1eafn v\u1edbi b\u1ec7nh gan m\u00e3n t\u00ednh.<\/li>\n<li>Gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n:\n<ul>\n<li>V\u00f2ng th\u1eaft cao sau n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a do gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n<\/li>\n<li>TIPS n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t n\u1ebfu ch\u1ea3y m\u00e1u gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c b\u1eb1ng v\u00f2ng cao su.<\/li>\n<li>NICE khuy\u1ebfn c\u00e1o r\u1eb1ng c\u00f3 \u0111\u1ee7 b\u1eb1ng ch\u1ee9ng \u0111\u1ec3 ch\u1ee9ng minh r\u1eb1ng \u0111\u1eb7t stent c\u00f3 hi\u1ec7u qu\u1ea3 cho b\u1ec7nh nh\u00e2n gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n m\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c \u0111\u00e3 th\u1ea5t b\u1ea1i trong vi\u1ec7c ki\u1ec3m so\u00e1t ch\u1ea3y m\u00e1u.<\/li>\n<\/ul>\n<\/li>\n<li>Gi\u00e3n t\u0129nh m\u1ea1ch d\u1ea1 d\u00e0y:\n<ul>\n<li>Ti\u00eam n\u1ed9i soi c\u1ee7a N-butyl-2-cyanoacrylate cho b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a do gi\u00e3n t\u0129nh m\u1ea1ch d\u1ea1 d\u00e0y.<\/li>\n<li>TIPS n\u00ean \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng n\u1ebfu ch\u1ea3y m\u00e1u d\u1ea1 d\u00e0y gi\u00e3n t\u0129nh m\u1ea1ch kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1eb1ng c\u00e1ch ti\u00eam n\u1ed9i soi c\u1ee7a N-butyl-2-cyanoacrylate.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>H\u1ed3i s\u1ee9c<\/strong><\/p>\n<ul>\n<li>\u0110\u00e1nh gi\u00e1 \u0111\u01b0\u1eddng th\u1edf &#8211; c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 n\u1ebfu gi\u1ea3m ch\u1ec9 s\u1ed1 Glasgow.<\/li>\n<li>Trong c\u1ed9ng \u0111\u1ed3ng, g\u1ecdi xe c\u1ee9u th\u01b0\u01a1ng kh\u1ea9n tr\u01b0\u01a1ng &#8211; \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 s\u1ed1c, \u0111\u1eb7t b\u1ec7nh nh\u00e2n xu\u1ed1ng v\u00e0 n\u00e2ng ch\u00e2n b\u1ec7nh nh\u00e2n l\u00ean (nh\u01b0ng, n\u1ebfu b\u1ec7nh nh\u00e2n n\u00f4n nhi\u1ec1u sau \u0111\u00f3 d\u1ec5 c\u00f3 nguy c\u01a1 h\u00edt ph\u1ea3i, v\u00ec v\u1eady t\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n l\u00e0 v\u00f4 c\u00f9ng quan tr\u1ecdng); cung c\u1ea5p oxy v\u00e0 t\u00ecm \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch, t\u1ed1t nh\u1ea5t l\u00e0 \u0111\u01b0\u1eddng truy\u1ec1n l\u1edbn, v\u1edbi t\u1ed1i thi\u1ec3u l\u00e0 hai \u0111\u01b0\u1eddng truy\u1ec1n (t\u0129nh m\u1ea1ch trung t\u00e2m c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u khi c\u1ea7n thi\u1ebft).<\/li>\n<li>Cung c\u1ea5p 40% oxy n\u1ebfu th\u1edf nhanh ho\u1eb7c r\u1ed1i lo\u1ea1n nh\u1ecbp.<\/li>\n<li>B\u1eaft \u0111\u1ea7u h\u1ed3i s\u1ee9c v\u1edbi truy\u1ec1n t\u0129nh m\u1ea1ch nhanh dung d\u1ecbch tinh th\u1ec3 v\u00e0 dung d\u1ecbch keo.<\/li>\n<li>Truy\u1ec1n m\u00e1u (th\u1eed ph\u1ea3n \u1ee9ng ch\u00e9o k\u1ebft h\u1ee3p) c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t &#8211; n\u1ebfu ch\u1eadm tr\u1ec5 c\u00f3 th\u1ec3 d\u00f9ng nh\u00f3m m\u00e1u O Rh \u00e2m. M\u1ee5c \u0111\u00edch ban \u0111\u1ea7u l\u00e0 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb gi\u1ea3m th\u1ec3 t\u00edch m\u00e1u -. Tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u00f3 th\u1ec3 c\u1ea7n m\u1ed9t v\u00e0i l\u00edt m\u00e1u.<\/li>\n<li>B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c m\u1eafc monitor \u0111\u1ec3 theo d\u00f5i c\u00e1c ch\u1ec9 s\u1ed1 tim m\u1ea1ch, huy\u1ebft \u00e1p, nh\u1ecbp tim v\u00e0 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u (\u0111\u1eb7t catheter \u0111\u1ebfn khi b\u1ec7nh nh\u00e2n \u0111\u00e3 \u1ed5n \u0111\u1ecbnh).<\/li>\n<li>\u0110\u1eb7t \u1ed1ng th\u00f4ng m\u0169i d\u1ea1 d\u00e0y \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a s\u1ef1 ch\u1ea3y m\u00e1u v\u00e0 r\u1eeda d\u1ea1 d\u00e0y tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n n\u1ed9i soi.<\/li>\n<li>Thi\u1ebfu m\u00e1u n\u1eb7ng v\u00e0 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u th\u00ec ph\u1ea3i truy\u1ec1n m\u00e1u. Nhi\u1ec1u ng\u01b0\u1eddi trong s\u1ed1 c\u00e1c b\u1ec7nh nh\u00e2n s\u1ebd c\u00f3 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u v\u00e0 do \u0111\u00f3, ti\u00eam t\u0129nh m\u1ea1ch vitamin K ngay l\u1eadp t\u1ee9c.. N\u1ebfu INR \u0111\u01b0\u1ee3c k\u00e9o d\u00e0i, cung c\u1ea5p cho huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i \u0111\u00f4ng l\u1ea1nh. Truy\u1ec1n ti\u1ec3u c\u1ea7u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u.<\/li>\n<li>C\u00f3 m\u1ed9t s\u1ed1 lo ng\u1ea1i r\u1eb1ng truy\u1ec1n n\u01b0\u1edbc mu\u1ed1i c\u00f3 th\u1ec3 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam c\u1ed5 tr\u01b0\u1edbng nh\u01b0ng b\u1ea3n ch\u1ea5t c\u1ee7a c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u1ea9n c\u1ea5p c\u1ea7n thi\u1ebft ph\u1ea3i s\u1eed d\u1ee5ng ch\u00fang.<\/li>\n<\/ul>\n<p>Xem x\u00e9t vi\u1ec7c \u0111\u1eb7t catheter t\u0129nh m\u1ea1ch\u00a0 trung t\u00e2m\/ catheter \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh ho\u1eb7c ng\u01b0\u1eddi gi\u00e0, ho\u1eb7c nh\u1eefng ng\u01b0\u1eddi c\u00f3 b\u1ec7nh tim ho\u1eb7c ph\u1ed5i, theo d\u00f5i c\u00e2n b\u1eb1ng l\u01b0\u1ee3ng d\u1ecbch truy\u1ec1n (s\u1eed d\u1ee5ng qu\u00e1 m\u1ee9c c\u00f3 th\u1ec3 g\u00e2y ph\u00f9 n\u1ec1, c\u1ed5 tr\u01b0\u1edbng v\u00e0 h\u1ea1 natri m\u00e1u).<\/p>\n<p><strong>N\u1ed9i soi\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><\/p>\n<ul>\n<li>N\u1ed9i soi kh\u1ea9n c\u1ea5p l\u00e0 c\u1ea7n thi\u1ebft cho xu\u1ea5t huy\u1ebft do v\u1ee1 gi\u00e3n t\u0129nh m\u1ea1ch. N\u1ed9i soi c\u1ea5p c\u1ee9u v\u1edbi \u1ed1ng soi m\u1ec1m gi\u00fap x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n v\u00e0 ngu\u1ed3n ch\u1ea3y m\u00e1u m\u1ed9t c\u00e1ch ch\u00ednh x\u00e1c.<\/li>\n<li>N\u1ed9i soi kh\u1ea9n c\u1ea5p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u1ea3m b\u1ea3o s\u1ee9c kh\u1ecfe c\u00f3 nguy c\u01a1 r\u1ee7i ro ; y\u00eau c\u1ea7u nh\u00e2n s\u1ef1 \u0111\u1ea7y \u0111\u1ee7 v\u00e0 c\u00f3 s\u1ef1 c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n h\u1ed3i s\u1ee9c c\u1ea7n thi\u1ebft.<\/li>\n<li>N\u1ed9i soi gi\u00fap d\u1ec5 x\u00e1c \u0111\u1ecbnh c\u00e1c \u0111i\u1ec3m ch\u1ea3y m\u00e1u v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/li>\n<li>Th\u1eaft v\u00f2ng cao su l\u00e0 s\u1ef1 l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean c\u1ee7a \u0111i\u1ec1u tr\u1ecb.<\/li>\n<li>Ch\u00edch x\u01a1 v\u1eabn \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i nh\u01b0 l\u00e0 m\u1ed9t li\u1ec7u ph\u00e1p \u0111\u1ea7u tay cho ch\u1ea3y m\u00e1u do v\u1ee1 gi\u00e3n t\u0129nh m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n x\u01a1 gan, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi th\u1eaft v\u00f2ng cao su kh\u00f4ng c\u00f3 s\u1eb5n. Tuy nhi\u00ean, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c c\u00f3 th\u1ec3 ng\u0103n xu\u1ea5t huy\u1ebft trong \u0111a s\u1ed1 c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y. Hi\u1ec7n nay ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng thuy\u1ebft ph\u1ee5c trongvi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c li\u1ec7u ph\u00e1p x\u01a1 ho\u00e1 kh\u1ea9n c\u1ea5p do gi\u00e3n t\u0129nh m\u1ea1ch ch\u1ea3y m\u00e1u trong x\u01a1 gan l\u00e0 \u0111i\u1ec1u tr\u1ecb duy nh\u1ea5t ban \u0111\u1ea7u so v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch.<\/li>\n<\/ul>\n<p><strong>Thu\u1ed1c v\u1eadn m\u1ea1ch<\/strong><\/p>\n<ul>\n<li>Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch (terlipressin, octreotide ho\u1eb7c somatostatin) l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong m\u1ed9t c\u00e1ch \u0111\u00e1ng k\u1ec3 v\u00e0 b\u00f9 d\u1ecbch c\u1ea5p do m\u1ecdi nguy\u00ean nh\u00e2, gi\u00fap ki\u1ec3m so\u00e1t t\u1ed1t t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u00eat l\u00e0m th\u1eddi gian n\u1eb1m vi\u1ec7n ng\u1eafn h\u01a1n.<\/li>\n<li>Terlipressin l\u00e0 m\u1ed9t ch\u1ea5t t\u01b0\u01a1ng t\u1ef1 vasopressin v\u00e0 c\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 cho th\u1ea5y n\u00f3 l\u00e0 t\u1ed1t h\u01a1n gi\u1ea3 d\u01b0\u1ee3c trong xu\u1ea5t huy\u1ebft do gi\u00e3n t\u0129nh m\u1ea1ch. Terlipress l\u00e0 thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn trong xu\u1ea5t huy\u1ebft do gi\u00e3n t\u0129nh m\u1ea1ch c\u1ea5p t\u00ednh. N\u00f3 n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng cho t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n nghi ng\u1edd do gi\u00e3n t\u0129nh m\u1ea1ch ch\u1ea3y m\u00e1u tr\u01b0\u1edbc khi n\u1ed9i soi v\u00e0 sau ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh.<\/li>\n<li>Vasopressin v\u00e0 terlipressin kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong s\u1ed1c gi\u1ea3m th\u1ec3 t\u00edch n\u1eb7ng v\u00e0 b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh tim n\u1eb7ng.<\/li>\n<\/ul>\n<p><strong>B\u00edt t\u0129nh m\u1ea1ch gi\u00e3n b\u1eb1ng keo<\/strong><\/p>\n<ul>\n<li>T\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi l\u00e0m t\u1eafc gi\u00e3n t\u0129nh m\u1ea1ch b\u1eb1ng m\u1ed9t ch\u1ea5t gi\u1ed1ng nh\u01b0 keo (N-butyl-2-cyanoacrylate).<\/li>\n<li>\u0110\u1eb7c bi\u1ec7t t\u1ed1t cho d\u1ea1 d\u00e0y ho\u1eb7c vi\u00eam d\u1ea1 d\u00e0y-th\u1ef1c qu\u1ea3n ch\u1ea3y m\u00e1u do gi\u00e3n t\u0129nh m\u1ea1ch.<\/li>\n<li>Tuy nhi\u00ean, c\u00f3 m\u1ed9t nguy c\u01a1 thuy\u00ean t\u1eafc \u0111\u1ebfn ph\u1ed5i, l\u00e1ch ho\u1eb7c n\u00e3o.<\/li>\n<\/ul>\n<p><strong>S\u1eed d\u1ee5ng b\u00f3ng ch\u00e8n (Sonde Sengstaken-Blakemore)<\/strong><\/p>\n<ul>\n<li>B\u00f3ng ch\u00e8n \u0111\u01b0\u1ee3c coi nh\u01b0 l\u00e0 m\u1ed9t \u0111i\u1ec1u tr\u1ecb t\u1ea1m th\u1eddi cho xu\u1ea5t huy\u1ebft do gi\u00e3n t\u0129nh m\u1ea1ch kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c.<\/li>\n<li>Sonde Sengstaken-Blakemore (t\u1ed1t h\u01a1n l\u00e0 gi\u1eef trong t\u1ee7 l\u1ea1nh \u0111\u1ec3 l\u00e0m c\u1ee9ng cao su v\u00e0 l\u00e0m cho di chuy\u1ec3n d\u1ec5 d\u00e0ng h\u01a1n) \u0111\u01b0\u1ee3c \u0111\u01b0a qua mi\u1ec7ng v\u00e0 xu\u1ed1ng d\u1ea1 d\u00e0y.<\/li>\n<li>Kh\u00f4ng kh\u00ed l\u00e0m bong d\u1ea1 d\u00e0y ph\u1ed3ng l\u00ean v\u00e0 sau \u0111\u00f3 l\u00e0 b\u00f3ng d\u1ea1 d\u00e0y \u0111\u01b0\u1ee3c k\u00e9o l\u00ean ch\u1ed1ng ng\u00e3 ba th\u1ef1c qu\u1ea3n-kh\u00ed qu\u1ea3n, n\u00e9n gi\u00e3n t\u0129nh m\u1ea1ch d\u01b0\u1edbi ni\u00eam m\u1ea1c.<\/li>\n<li>Sonde Sengstaken-Blakemore c\u0169ng ch\u1ee9a m\u1ed9t qu\u1ea3 b\u00f3ng th\u1ef1c qu\u1ea3n m\u00e0 ch\u1ec9 d\u00f9ng khi c\u1ea7n thi\u1ebft &#8211; khi b\u00f3ng d\u1ea1 d\u00e0y kh\u00f4ng l\u00e0m vi\u1ec7c.<\/li>\n<li>N\u1ebfu ch\u1ea3y m\u00e1u v\u1eabn ti\u1ebfp t\u1ee5c, n\u00f3 c\u00f3 th\u1ec3 l\u00e0 \u1ed1ng \u0111\u1eb7t sai v\u1ecb tr\u00ed ho\u1eb7c ch\u1ea3y m\u00e1u t\u1eeb ngu\u1ed3n kh\u00e1c.<\/li>\n<\/ul>\n<p><strong>T\u1ea1o th\u00f4ng n\u1ed1i c\u1eeda ch\u1ee7 trong gan qua t\u0129nh m\u1ea1ch c\u1ea3nh (TIPS)<\/strong><\/p>\n<ul>\n<li>T\u1ea1o th\u00f4ng n\u1ed1i c\u1eeda ch\u1ee7 trong gan qua t\u0129nh m\u1ea1ch c\u1ea3nh \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb xu\u1ea5t huy\u1ebft k\u00e9o d\u00e0i do gi\u00e3n t\u0129nh m\u1ea1ch kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c.<\/li>\n<li>Qua t\u0129nh m\u1ea1ch c\u1ea3nh trong, \u1ed1ng th\u00f4ng s\u1ebd \u0111i xuy\u00ean da \u0111\u1ebfn t\u0129nh m\u1ea1ch gan, d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m ho\u1eb7c hu\u1ef3nh quang.<\/li>\n<li>M\u1ed9t \u0111\u01b0\u1eddng d\u1eabn \u0111\u01b0\u1ee3c t\u1ea1o n\u00ean t\u1eeb t\u0129nh m\u1ea1ch gan v\u00e0o t\u0129nh m\u1ea1ch c\u1eeda &#8211; do \u0111\u00f3 l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda. Sau \u0111\u00f3 m\u1ed9t stent kim lo\u1ea1i m\u1edf r\u1ed9ng \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o \u0111\u1ec3 t\u1ea1o m\u1ed9t c\u1ea7u n\u1ed1i.<\/li>\n<li>T\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng cao nh\u01b0ng bi\u1ebfn ch\u1ee9ng n\u00e3o \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong 25% c\u00e1c tr\u01b0\u1eddng h\u1ee3p (nh\u01b0 huy\u1ebft kh\u1ed1i t\u1eeb gan) v\u00e0 t\u00ecnh tr\u1ea1ng b\u00edt c\u1ea7u n\u1ed1i trong v\u00f2ng m\u1ed9t n\u0103m l\u00ean \u0111\u1ebfn 50% tr\u01b0\u1eddng h\u1ee3p.<\/li>\n<\/ul>\n<p><strong>Ph\u1eabu thu\u1eadt <\/strong><\/p>\n<ul>\n<li>ph\u1eabu thu\u1eadt t\u00e1ch r\u1eddi c\u00e1c t\u0129nh m\u1ea1ch n\u1ed1i gi\u1eefa 2 h\u1ec7 t\u0129nh m\u1ea1ch c\u1eeda v\u00e0 t\u0129nh m\u1ea1ch \u0111\u01a1n (ph\u1ee5 thu\u1ed9c v\u00e0o h\u1ec7 ch\u1ee7) quanh ph\u1ea7n tr\u00ean bao t\u1eed v\u00e0 quanh ph\u1ea7n d\u01b0\u1edbi th\u1ef1c qu\u1ea3n \u0111\u1ec3 cho c\u00e1c TM \u0111i v\u00e0o bao t\u1eed v\u00e0 th\u1ef1c qu\u1ea3n x\u1eb9p v\u00e0 do \u0111\u00f3 ng\u01b0ng ch\u1ea3y m\u00e1u l\u00e0 nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p hi\u1ebfm nh\u01b0ng c\u00f3 th\u1ec3 c\u00f3 m\u1ed9t vai tr\u00f2 cho c\u00e1c b\u1ec7nh nh\u00e2n v\u1edbi gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n v\u00e0 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch l\u00e1ch kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c th\u1ee7 thu\u1eadt b\u1eafc c\u1ea7u v\u00e0 nh\u1eefng ng\u01b0\u1eddi ti\u1ebfp t\u1ee5c c\u00f3 gi\u00e3n t\u0129nh m\u1ea1ch ch\u1ea3y m\u00e1u d\u00f9 \u0111\u00e3 n\u1ed9i soi v\u00e0 \u0111i\u1ec1u tr\u1ecb d\u01b0\u1ee3c l\u00fd.<\/li>\n<li>Gh\u00e9p gan l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh gan ti\u1ebfn tri\u1ec3n.<\/li>\n<\/ul>\n<p><em>C\u00e1c v\u1ea5n \u0111\u1ec1 kh\u00e1c c\u1ee7a ki\u1ec3m so\u00e1t xu\u1ea5t huy\u1ebft do gi\u00e3n t\u0129nh m\u1ea1ch<\/em><\/p>\n<ul>\n<li>Tr\u00e1nh s\u1eed d\u1ee5ng thu\u1ed1c an th\u1ea7n n\u1ebfu c\u00f3 th\u1ec3.<\/li>\n<li>B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c qu\u1ea3n l\u00fd t\u1ed1t nh\u1ea5t tr\u00ean ITU \/ HDU.<\/li>\n<li>Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng nhi\u1ec5m tr\u00f9ng x\u1ea3y ra trong l\u00ean \u0111\u1ebfn 50% b\u1ec7nh nh\u00e2n v\u00e0 k\u00e8m v\u1edbi c\u00e1c bi\u1ebfn ch\u1ee9ng n\u1eb7ng h\u01a1n. Ng\u01b0\u1eddi ta cho r\u1eb1ng vi khu\u1ea9n th\u1ea3i ra n\u1ed9i \u0111\u1ed9c t\u1ed1 l\u00e0m t\u0103ng \u00e1p c\u1eeda v\u00e0 l\u00e0m gi\u1ea3m \u0111\u00f4ng m\u00e1u. Thu\u1ed1c kh\u00e1ng sinh do \u0111\u00f3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ea7u ti\u00ean &#8211; V\u00ed d\u1ee5, ciprofloxacin.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb b\u1ec7nh n\u00e3o gan n\u1ebfu c\u00f3.<\/li>\n<\/ul>\n<h2><strong>Ph\u00f2ng ng\u1eeba <\/strong><\/h2>\n<ul>\n<li>C\u00f3 m\u1ed9t ch\u1ee9ng minh r\u1eb1ng kh\u00f4ng c\u00f3 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u ng\u0103n ch\u1eb7n s\u1ef1 h\u00ecnh th\u00e0nh c\u1ee7a gi\u00e3n t\u0129nh m\u1ea1ch.<\/li>\n<li>Ng\u0103n ng\u1eeba xu\u1ea5t huy\u1ebft do v\u1ee1 gi\u00e3n t\u0129nh m\u1ea1ch \u0111\u1ea7u ti\u00ean ph\u1ee5 thu\u1ed9c v\u00e0o k\u00edch c\u1ee1 \/ \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a gi\u00e3n t\u0129nh m\u1ea1ch. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n gi\u00e3n t\u0129nh m\u1ea1ch nh\u1ecf v\u00e0 c\u00f3 nguy c\u01a1 cao g\u00e2y ch\u1ea3y m\u00e1u, thu\u1ed1c ch\u1eb9n b\u00eata kh\u00f4ng ch\u1ecdn l\u1ecdc \u0111\u01b0\u1ee3c \u01b0u ti\u00ean, trong khi b\u1ec7nh nh\u00e2n m\u1ee9c \u0111\u1ed9 trung b\u00ecnh \/ gi\u00e3n t\u0129nh m\u1ea1ch l\u1edbn c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ch\u1eb9n b\u00eata ho\u1eb7c d\u1ea3i th\u1eaft th\u1ef1c qu\u1ea3n.<\/li>\n<li>Ng\u0103n ng\u1eeba xu\u1ea5t huy\u1ebft do gi\u00e3n t\u0129nh m\u1ea1ch t\u00e1i ph\u00e1t bao g\u1ed3m s\u1ef1 k\u1ebft h\u1ee3p thu\u1ed1c ch\u1eb9n v\u00e0 n\u1ed9i soi th\u1eaft v\u00f2ng cao su.<\/li>\n<\/ul>\n<p><strong>S\u00e0ng l\u1ecdc qua n\u1ed9i soi<\/strong><\/p>\n<ul>\n<li>T\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n x\u01a1 gan m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n n\u00ean c\u00f3 n\u1ed9i soi, t\u00ecm gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n.<\/li>\n<li>Gi\u00e3n t\u0129nh m\u1ea1ch trung b\u00ecnh ho\u1eb7c l\u1edbn c\u1ea7n d\u00f9ng ch\u1eb9n b\u00eata trong l\u1ea7n \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u ti\u00ean (\u0111i\u1ec1u tr\u1ecb v\u00f4 th\u1eddi h\u1ea1n).<\/li>\n<li>N\u1ebfu c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi ch\u1eb9n beta, c\u00e1c gi\u00e3n t\u0129nh m\u1ea1ch n\u00ean \u0111\u01b0\u1ee3c ho\u1eb7c ti\u00eam x\u01a1.<\/li>\n<li>V\u1ec1 l\u00e2u d\u00e0i, s\u00e0ng l\u1ecdc n\u1ed9i soi c\u1ea7n \u0111\u01b0\u1ee3c l\u1eb7p \u0111i l\u1eb7p l\u1ea1i &#8211; v\u00ed d\u1ee5, 2 \u0111\u1ebfn 3 n\u0103m trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p gi\u00e3n t\u0129nh m\u1ea1ch nh\u1ecf.<\/li>\n<li>Nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 s\u1ed1ng s\u00f3t sau m\u1ed9t xu\u1ea5t huy\u1ebft do gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng ch\u1eb9n b\u00eata, c\u00f3 ho\u1eb7c kh\u00f4ng d\u00f9ng ph\u1ed1i h\u1ee3p nitrat v\u00e0 s\u00e0ng l\u1ecdc n\u1ed9i soi v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/li>\n<\/ul>\n<p>Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p c\u1ee7a gan gradient \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch v\u1edbi m\u1ee5c ti\u00eau gi\u1ea3m d\u01b0\u1edbi 12 mm Hg \u0111\u01b0\u1ee3c cho l\u00e0 gi\u1ea3m \u0111\u00e1ng k\u1ec3 t\u1ef7 l\u1ec7 t\u1eed vong.<\/p>\n<h2><strong>Ti\u00ean l\u01b0\u1ee3ng<\/strong><\/h2>\n<ul>\n<li>Nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 b\u1ecb ch\u1ea3y m\u00e1u m\u1ed9t l\u1ea7n t\u1eeb gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n c\u00f3 70% c\u01a1 h\u1ed9i t\u00e1i xu\u1ea5t huy\u1ebft. Kho\u1ea3ng m\u1ed9t ph\u1ea7n ba ti\u1ebfp t\u1ee5c c\u00e1c \u0111\u1ee3t ch\u1ea3y m\u00e1u g\u00e2y t\u1eed vong.<\/li>\n<li>Nguy c\u01a1 t\u1eed vong cao nh\u1ea5t trong v\u00e0i ng\u00e0y \u0111\u1ea7u ti\u00ean sau khi b\u1ecb ch\u1ea3y m\u00e1u v\u00e0 gi\u1ea3m d\u1ea7n trong s\u00e1u tu\u1ea7n \u0111\u1ea7u ti\u00ean.<\/li>\n<li>Li\u00ean quan th\u1eadn, h\u00f4 h\u1ea5p, tim m\u1ea1ch v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n mi\u1ec5n d\u1ecbch chi\u1ebfm 20-65% t\u1ef7 l\u1ec7 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n.<\/li>\n<\/ul>\n<h2><strong>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/h2>\n<p><a href=\"http:\/\/patient.info\/doctor\/oesophageal-varices\" target=\"_blank\" rel=\"noopener\">http:\/\/patient.info\/doctor\/oesophageal-varices<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n l\u00e0 nh\u1eefng g\u00ec c\u00f3 th\u1ec3 g\u00e2y t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda. G\u1ed3m nguy\u00ean nh\u00e2n tr\u01b0\u1edbc gan, t\u1ea1i gan v\u00e0 sau gan<\/p>\n","protected":false},"author":177,"featured_media":2175,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5301,5148,5149,5243],"tags":[3449,7121,7122],"series":[6409],"coauthors":[],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Nguy\u00ean nh\u00e2n gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n v\u00e0 c\u00e1ch ki\u1ec3m so\u00e1t - Y H\u1ecdc C\u1ed9ng \u0110\u1ed3ng<\/title>\n<meta name=\"description\" content=\"C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n l\u00e0 nh\u1eefng g\u00ec c\u00f3 th\u1ec3 g\u00e2y t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda. 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