{"id":3215,"date":"2025-02-04T11:28:27","date_gmt":"2025-02-04T04:28:27","guid":{"rendered":"https:\/\/hienbacsi.com\/?p=3215"},"modified":"2025-02-04T11:28:27","modified_gmt":"2025-02-04T04:28:27","slug":"2-bien-chung-phoi-cung-thuong-gap-cua-xo-gan","status":"publish","type":"post","link":"https:\/\/hienbacsi.com\/index.php\/2025\/02\/04\/2-bien-chung-phoi-cung-thuong-gap-cua-xo-gan\/","title":{"rendered":"2 bi\u1ebfn ch\u1ee9ng ph\u1ed5i c\u0169ng th\u01b0\u1eddng g\u1eb7p c\u1ee7a x\u01a1 gan"},"content":{"rendered":"\n

ThS BS Tr\u1ea7n H\u1eefu Hi\u1ec1n<\/mark><\/strong><\/p>\n\n\n\n

T\u1ed1t nghi\u1ec7p b\u1eb1ng DIU \u0110H CORSE C\u1ed9ng Ho\u00e0 Ph\u00e1p<\/mark><\/strong><\/p>\n\n\n\n

Th\u00e0nh vi\u00ean H\u1ed9i Nghi\u00ean C\u1ee9u Gan Ch\u00e2u \u00c2u<\/mark><\/strong><\/p>\n\n\n\n

<\/figure>\n\n\n\n

Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda (HH)<\/p>\n\n\n\n

T\u1ed5ng quan<\/p>\n\n\n\n

Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda (HH) l\u00e0 m\u1ed9t d\u1ea1ng tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i c\u00f3 t\u00ednh ch\u1ea5t th\u1ea5m, x\u1ea3y ra do t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda. B\u1ec7nh c\u00f3 ti\u00ean l\u01b0\u1ee3ng x\u1ea5u, v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong cao h\u01a1n so v\u1edbi m\u1ee9c d\u1ef1 \u0111o\u00e1n d\u1ef1a tr\u00ean thang \u0111i\u1ec3m MELD (Model for End-Stage Liver Disease).<\/p>\n\n\n\n

Nguy\u00ean nh\u00e2n v\u00e0 D\u1ecbch t\u1ec5 h\u1ecdc<\/p>\n\n\n\n

<\/figure>\n\n\n\n

\u2022 HH ch\u1ee7 y\u1ebfu x\u1ea3y ra do c\u00e1c khi\u1ebfm khuy\u1ebft nh\u1ecf tr\u00ean c\u01a1 ho\u00e0nh, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho d\u1ecbch c\u1ed5 tr\u01b0\u1edbng di chuy\u1ec3n v\u00e0o khoang m\u00e0ng ph\u1ed5i.<\/p>\n\n\n\n

\u2022 Th\u01b0\u1eddng g\u1eb7p d\u01b0\u1edbi d\u1ea1ng tr\u00e0n d\u1ecbch m\u1ed9t b\u00ean, v\u1edbi t\u1ef7 l\u1ec7 ph\u00e2n b\u1ed1:<\/p>\n\n\n\n

\u2022 75% b\u00ean ph\u1ea3i<\/p>\n\n\n\n

\u2022 17% b\u00ean tr\u00e1i<\/p>\n\n\n\n

\u2022 10% hai b\u00ean<\/p>\n\n\n\n

Ch\u1ea9n \u0111o\u00e1n<\/p>\n\n\n\n

\u2022 Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n quan tr\u1ecdng l\u00e0 ch\u00eanh l\u1ec7ch albumin huy\u1ebft thanh – d\u1ecbch m\u00e0ng ph\u1ed5i (SPAG) >1,1 g\/dL.<\/p>\n\n\n\n

\u2022 N\u1ed3ng \u0111\u1ed9 protein v\u00e0 albumin trong d\u1ecbch m\u00e0ng ph\u1ed5i c\u00f3 th\u1ec3 t\u0103ng nh\u1eb9 so v\u1edbi d\u1ecbch c\u1ed5 tr\u01b0\u1edbng.<\/p>\n\n\n\n

H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb<\/p>\n\n\n\n

\u2022 H\u1ea1n ch\u1ebf mu\u1ed1i k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 ch\u1ecdc h\u00fat m\u00e0ng ph\u1ed5i khi c\u1ea7n thi\u1ebft l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u.<\/p>\n\n\n\n

\u2022 Trong tr\u01b0\u1eddng h\u1ee3p HH kh\u00e1ng tr\u1ecb ho\u1eb7c t\u00e1i ph\u00e1t, n\u00ean c\u00e2n nh\u1eafc \u0111\u1eb7t shunt c\u1eeda ch\u1ee7 trong gan qua t\u0129nh m\u1ea1ch c\u1ea3nh (TIPS) ho\u1eb7c gh\u00e9p gan.<\/p>\n\n\n\n

\u2022 Tr\u00e1nh \u0111\u1eb7t \u1ed1ng d\u1eabn l\u01b0u m\u00e0ng ph\u1ed5i do nguy c\u01a1 t\u1ea1o r\u00f2 r\u1ec9 d\u1ecbch v\u00e0 t\u0103ng t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng.<\/p>\n\n\n\n

\u2022 Kh\u00f4ng khuy\u1ebfn kh\u00edch g\u00e2y d\u00ednh m\u00e0ng ph\u1ed5i b\u1eb1ng h\u00f3a ch\u1ea5t, do nguy c\u01a1 h\u00ecnh th\u00e0nh \u1ed5 d\u1ecbch khu tr\u00fa.<\/p>\n\n\n\n

\u2022 \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi TIPS, c\u00f3 th\u1ec3 xem x\u00e9t \u0111\u1eb7t catheter m\u00e0ng ph\u1ed5i c\u00f3 \u0111\u01b0\u1eddng h\u1ea7m d\u01b0\u1edbi da, tuy nhi\u00ean c\u1ea7n c\u00e2n nh\u1eafc nguy c\u01a1 m\u1ea5t protein v\u00e0 suy dinh d\u01b0\u1ee1ng.<\/p>\n\n\n\n

Vi\u00eam m\u1ee7 m\u00e0ng ph\u1ed5i t\u1ef1 ph\u00e1t (SBE)<\/p>\n\n\n\n

T\u1ed5ng quan<\/p>\n\n\n\n

SBE l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng nhi\u1ec5m tr\u00f9ng nghi\u00eam tr\u1ecdng li\u00ean quan \u0111\u1ebfn HH, v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong l\u00ean \u0111\u1ebfn 20% d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh th\u00edch h\u1ee3p.<\/p>\n\n\n\n

\u2022 C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 g\u1ed3m: nh\u1eadp khoa h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c (ICU), \u0111i\u1ec3m MELD cao, v\u00e0 th\u1ea5t b\u1ea1i v\u1edbi ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh ban \u0111\u1ea7u.<\/p>\n\n\n\n

Nguy\u00ean nh\u00e2n v\u00e0 D\u1ecbch t\u1ec5 h\u1ecdc<\/p>\n\n\n\n

\u2022 SBE x\u1ea3y ra \u1edf 13\u201316% b\u1ec7nh nh\u00e2n c\u00f3 HH.<\/p>\n\n\n\n

\u2022 C\u00e1c vi khu\u1ea9n th\u01b0\u1eddng g\u1eb7p trong SBE bao g\u1ed3m:<\/p>\n\n\n\n

\u2022 Escherichia coli<\/p>\n\n\n\n

\u2022 C\u00e1c lo\u00e0i Streptococcus<\/p>\n\n\n\n

\u2022 C\u00e1c lo\u00e0i Enterococcus<\/p>\n\n\n\n

\u2022 C\u00e1c lo\u00e0i Klebsiella<\/p>\n\n\n\n

\u2022 Pseudomonas<\/p>\n\n\n\n

Ch\u1ea9n \u0111o\u00e1n<\/p>\n\n\n\n

\u2022 C\u1ea5y m\u00e1u (hi\u1ebfu kh\u00ed v\u00e0 k\u1ef5 kh\u00ed) n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng kh\u00e1ng sinh \u0111\u1ec3 t\u0103ng t\u1ef7 l\u1ec7 ph\u00e1t hi\u1ec7n vi khu\u1ea9n.<\/p>\n\n\n\n

\u2022 Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n SBE bao g\u1ed3m:<\/p>\n\n\n\n

\u2022 D\u1ecbch m\u00e0ng ph\u1ed5i c\u00f3 c\u1ea5y vi khu\u1ea9n d\u01b0\u01a1ng t\u00ednh k\u00e8m theo >250 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh (PMN) tr\u00ean mm\u00b3<\/p>\n\n\n\n

\u2022 D\u1ecbch m\u00e0ng ph\u1ed5i c\u1ea5y \u00e2m t\u00ednh, nh\u01b0ng s\u1ed1 l\u01b0\u1ee3ng PMN >500 t\u1ebf b\u00e0o\/mm\u00b3, v\u1edbi \u0111i\u1ec1u ki\u1ec7n kh\u00f4ng c\u00f3 vi\u00eam ph\u1ed5i tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc<\/p>\n\n\n\n

H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb<\/p>\n\n\n\n

\u2022 Kh\u00e1ng sinh kinh nghi\u1ec7m (t\u01b0\u01a1ng t\u1ef1 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u00fac m\u1ea1c nhi\u1ec5m tr\u00f9ng t\u1ef1 ph\u00e1t – SBP):<\/p>\n\n\n\n

\u2022 Ceftriaxone 2g t\u0129nh m\u1ea1ch m\u1ed7i 24 gi\u1edd, k\u00e9o d\u00e0i 7\u201310 ng\u00e0y<\/p>\n\n\n\n

\u2022 B\u1ed5 sung albumin:<\/p>\n\n\n\n

\u2022 1,5 g\/kg v\u00e0o ng\u00e0y \u0111\u1ea7u ti\u00ean<\/p>\n\n\n\n

\u2022 1 g\/kg v\u00e0o ng\u00e0y th\u1ee9 ba, n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh<\/p>\n\n\n\n

\u2022 Tuy nhi\u00ean, vai tr\u00f2 c\u1ee7a truy\u1ec1n albumin trong HH v\u00e0 SBE v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5 r\u00e0ng.<\/p>\n\n\n\n

\u2022 Ch\u1ec9 \u0111\u1eb7t d\u1eabn l\u01b0u m\u00e0ng ph\u1ed5i khi c\u00f3 d\u1ecbch m\u1ee7 \u0111\u1eb7c.<\/p>\n\n\n\n

L\u01b0u \u00fd b\u1ed5 sung<\/p>\n\n\n\n

\u2022 B\u1ec7nh nh\u00e2n HH v\u00e0 SBE c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i s\u00e1t \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 nhi\u1ec5m tr\u00f9ng huy\u1ebft ho\u1eb7c suy gan ti\u1ebfn tri\u1ec3n.<\/p>\n\n\n\n

\u2022 Do ti\u00ean l\u01b0\u1ee3ng x\u1ea5u, n\u00ean xem x\u00e9t gh\u00e9p gan s\u1edbm \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n.<\/p>\n\n\n\n

\u2022 Hi\u1ec7n kh\u00f4ng c\u00f3 \u0111i\u1ec3m \u01b0u ti\u00ean MELD cho HH ho\u1eb7c SBP, ngo\u1ea1i tr\u1eeb c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u00e1i ph\u00e1t ho\u1eb7c m\u1ea1n t\u00ednh \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn tr\u00ean c\u01a1 s\u1edf t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3.<\/p>\n\n\n\n

\u2022 HH c\u00f3 th\u1ec3 g\u00e2y kh\u00f3 kh\u0103n trong ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng gan-ph\u1ed5i (HPS) ho\u1eb7c t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i do t\u0103ng \u00e1p c\u1eeda (POPH).<\/p>\n","protected":false},"excerpt":{"rendered":"

ThS BS Tr\u1ea7n H\u1eefu Hi\u1ec1n T\u1ed1t nghi\u1ec7p b\u1eb1ng DIU \u0110H CORSE C\u1ed9ng Ho\u00e0 Ph\u00e1p Th\u00e0nh vi\u00ean H\u1ed9i Nghi\u00ean C\u1ee9u Gan Ch\u00e2u \u00c2u Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do t\u0103ng \u00e1p l\u1ef1c…<\/p>\n","protected":false},"author":1,"featured_media":3213,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[131],"tags":[51],"jetpack_featured_media_url":"https:\/\/hienbacsi.com\/wp-content\/uploads\/2025\/02\/img_2821-1.jpg","_links":{"self":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts\/3215"}],"collection":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/comments?post=3215"}],"version-history":[{"count":1,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts\/3215\/revisions"}],"predecessor-version":[{"id":3216,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts\/3215\/revisions\/3216"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/media\/3213"}],"wp:attachment":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/media?parent=3215"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/categories?post=3215"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/tags?post=3215"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}