\n1. H\u1ecd v\u00e0 t\u00ean: HU\u1ef2NH TH\u1eca Q.
\n2. Tu\u1ed5i: 73 (sinh n\u0103m 1951)
\n3. Gi\u1edbi t\u00ednh: N\u1eef
\n4. \u0110\u1ecba ch\u1ec9: 2\/4c D\u01b0\u01a1ng C\u00f4ng Khi \u1ea5p 1, x\u00e3 Xu\u00e2n Th\u1edbi Th\u01b0\u1ee3ng, huy\u1ec7n H\u00f3c M\u00f4n, th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh, Vi\u1ec7t Nam.
\n5. Ngh\u1ec1 nghi\u1ec7p: L\u00e0m n\u00f4ng
\n6. Chi thu\u1eadn: Tay (P) – Ch\u00e2n (P)
\n7. Ng\u00e0y gi\u1edd v\u00e0o vi\u1ec7n: 6h 45′ – ng\u00e0y 10\/09\/2024
\n8. Ng\u00e0y gi\u1edd l\u00e0m b\u1ec7nh \u00e1n: 8h 50′ – ng\u00e0y 10\/09\/2024<\/p>\n
\nII. L\u00dd DO V\u00c0O VI\u1ec6N: \u0111au 1\/4 d\u01b0\u1edbi \u0111\u00f9i (T)<\/strong><\/p>\n \nIII. B\u1ec6NH S\u1eec:<\/strong><\/p>\n \nB\u1ec7nh nh\u00e2n v\u00e0 ng\u01b0\u1eddi nh\u00e0 khai: \nIV. TI\u1ec0N S\u1eec<\/strong><\/p>\n \n1. B\u1ea3n th\u00e2n \nV. L\u01af\u1ee2C QUA C\u00c1C C\u01a0 QUAN<\/strong><\/p>\n \n\u2022 Tim m\u1ea1ch: kh\u00f4ng h\u1ed3i h\u1ed9p, kh\u00f4ng \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, kh\u00f4ng \u0111au ng\u1ef1c \nVI. KH\u00c1M L\u00c2M S\u00c0NG (8h 50′, ng\u00e0y 10\/09\/2024)<\/strong><\/p>\n \nA\/ Kh\u00e1m t\u1ed5ng tr\u1ea1ng VII. T\u00d3M T\u1eaeT B\u1ec6NH \u00c1N<\/strong><\/p>\n \nB\u1ec7nh nh\u00e2n n\u1eef, 73 tu\u1ed5i v\u00e0o vi\u1ec7n v\u00ec \u0111au 1\/4 d\u01b0\u1edbi \u0111\u00f9i (T) + quanh g\u1ed1i (T) do tai n\u1ea1n sinh ho\u1ea1t ng\u00e0y th\u1ee9 1. Qua h\u1ecfi b\u1ec7nh v\u00e0 th\u0103m kh\u00e1m l\u00e2m s\u00e0ng ghi nh\u1eadn: \nVIII. \u0110\u1eb6T V\u1ea4N \u0110\u1ec0<\/strong><\/p>\n \nD\u1ea5u hi\u1ec7u g\u00e3y \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f9i (P) IX. CH\u1ea8N \u0110O\u00c1N S\u01a0 B\u1ed8:<\/strong><\/p>\n \nG\u00e3y k\u00edn \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f9i (T) ng\u00e0y th\u1ee9 1 do tai n\u1ea1n sinh ho\u1ea1t hi\u1ec7n t\u1ea1i ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng \/ T\u0103ng huy\u1ebft \u00e1p – Thi\u1ebfu m\u00e1u c\u01a1 tim – \u0110\u00e1i Th\u00e1o \u0110\u01b0\u1eddng type 2<\/p>\n \nX. BI\u1ec6N LU\u1eacN L\u00c2M S\u00c0NG<\/strong><\/p>\n \nB\u1ec7nh nh\u00e2n n\u1eef, 73 tu\u1ed5i, v\u00e0o vi\u1ec7n v\u00ec l\u00fd do \u0111au 1\/4 \u0111\u00f9i d\u01b0\u1edbi (T) v\u00e0 g\u1ed1i (T) do tai n\u1ea1n sinh ho\u1ea1t ng\u00e0y th\u1ee9 1. Qua h\u1ecfi b\u1ec7nh v\u00e0 th\u0103m kh\u00e1m, \u1edf b\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t s\u1ed1 v\u1ea5n \u0111\u00e8 sau: \nXI. \u0110\u1ec0 NGH\u1eca C\u1eacN L\u00c2M S\u00c0NG V\u00c0 K\u1ebeT QU\u1ea2 \u0110\u00c3 C\u00d3<\/strong><\/p>\n \n1. \u0110\u1ec1 ngh\u1ecb c\u1eadn l\u00e2m s\u00e0ng: \u0110\u1ecdc phim \u0110\u1ecdc phim \u0110\u1ecdc phim – X quang ng\u1ef1c th\u1eb3ng<\/p>\n \u0110\u1ecdc phim \nM\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng v\u00f9ng c\u1ed9t s\u1ed1ng th\u1eaft l\u01b0ng: (T-score: -3.6) \nXII. CH\u1ea8N \u0110O\u00c1N X\u00c1C \u0110\u1ecaNH<\/strong><\/p>\n \nG\u00e3y k\u00edn \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f9i (T) lo\u1ea1i A1 theo Muller AO ng\u00e0y th\u1ee9 1 do tai n\u1ea1n sinh ho\u1ea1t hi\u1ec7n t\u1ea1i ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng – Lo\u00e3ng x\u01b0\u01a1ng – Theo d\u00f5i Suy th\u1eadn c\u1ea5p\/ T\u0103ng huy\u1ebft \u00e1p – Thi\u1ebfu m\u00e1u c\u01a1 tim – \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2<\/p>\n \nXIII. \u0110I\u1ec0U TR\u1eca<\/strong><\/p>\n \n1. H\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb: XIV. TI\u00caN L\u01af\u1ee2NG<\/strong><\/p>\n – Ti\u00ean l\u01b0\u1ee3ng g\u1ea7n: Trung b\u00ecnh. V\u00ec: b\u1ec7nh nh\u00e2n \u0111\u00e3 cao tu\u1ed5i, c\u00f3 nhi\u1ec1u b\u1ec7nh l\u00fd n\u1ec1n nh\u01b0: T\u0103ng huy\u1ebft \u00e1p, Thi\u1ebfu m\u00e1u c\u01a1 tim, \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2,…;\u0111\u01b0\u1eddng huy\u1ebft b\u1ec7nh nh\u00e2n ch\u01b0a \u1ed5n \u0111\u1ecbnh .D\u00f9 hi\u1ec7n t\u1ea1i tr\u00ean b\u1ec7nh nh\u00e2n ch\u01b0a ghi nh\u1eadn c\u00e1c bi\u1ebfn ch\u1ee9ng: cho\u00e1ng, t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u hay th\u1ea7n kinh,… <\/p>","protected":false},"featured_media":4256,"comment_status":"open","ping_status":"closed","template":"","tags":[],"chuyen-muc":[188],"class_list":["post-4278","bai-giang","type-bai-giang","status-publish","has-post-thumbnail","hentry","chuyen-muc-benh-an-mau"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4278","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang"}],"about":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/types\/bai-giang"}],"replies":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/comments?post=4278"}],"version-history":[{"count":2,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4278\/revisions"}],"predecessor-version":[{"id":4290,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4278\/revisions\/4290"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/4256"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=4278"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=4278"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=4278"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nC\u00e1ch nh\u1eadp vi\u1ec7n # 2 gi\u1edd, b\u1ec7nh nh\u00e2n \u0111ang \u0111i t\u1eeb nh\u00e0 v\u1ec7 sinh ra th\u00ec ch\u00e2n (P) b\u1ecb tr\u01b0\u1ee3t ch\u00e2n, BN co g\u1ed1i, nghi\u00eang ng\u01b0\u1eddi sang (T) va \u0111\u1eadp tr\u1ef1c ti\u1ebfp 1\/4 \u0111\u00f9i d\u01b0\u1edbi (T), g\u1ed1i (T) xu\u1ed1ng n\u1ec1n c\u1ee9ng. . B\u1ec7nh nh\u00e2n kh\u00f4ng va \u0111\u1eadp v\u00f9ng \u0111\u1ea7u khi ng\u00e3. Sau khi ng\u00e3, b\u1ec7nh nh\u00e2n t\u1ec9nh, \u0111au nhi\u1ec1u v\u00f9ng 1\/4 d\u01b0\u1edbi \u0111\u00f9i (T); b\u1ec7nh nh\u00e2n ng\u1ed3i g\u1ea5p g\u1ed1i (T), du\u1ed7i ch\u00e2n (P) tr\u00ean m\u1eb7t \u0111\u1ea5t kh\u00f4ng ch\u1ecbu \u0111\u01b0\u1ee3c l\u1ef1c. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ng\u01b0\u1eddi nh\u00e0 h\u1ed7 tr\u1ee3 du\u1ed7i th\u1eb3ng ch\u00e2n (T), d\u00f9ng thanh g\u1ed7 c\u1ed1 \u0111\u1ecbnh ch\u00e2n (T) v\u00e0 \u0111\u01b0a \u0111\u1ebfn B\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t b\u1eb1ng xe taxi.
\nTrong qu\u00e1 tr\u00ecnh di\u1ec5n ti\u1ebfn b\u1ec7nh, b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111au \u0111\u1ea7u hay ch\u00f3ng m\u1eb7t, kh\u00f4ng bu\u1ed3n n\u00f4n, kh\u00f4ng kh\u00f3 th\u1edf, kh\u00f4ng \u0111au ng\u1ef1c, ti\u00eau ti\u1ec3u t\u1ef1 ch\u1ee7.
\nT\u00ecnh tr\u1ea1ng l\u00fac nh\u1eadp vi\u1ec7n:
\n– B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t
\n– Kh\u00f4ng \u0111au \u0111\u1ea7u, kh\u00f4ng bu\u1ed3n n\u00f4n
\n– \u0110au nhi\u1ec1u v\u00f9ng g\u1ed1i (T)
\n– H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng g\u1ed1i (T)
\n– D\u1ea5u hi\u1ec7u sinh t\u1ed3n:
\nM\u1ea1ch: 135 l\u1ea7n\/ph\u00fat
\nHuy\u1ebft \u00e1p: 180\/ 100 mmHg
\nNhi\u1ec7t \u0111\u1ed9: 37 0C
\nNh\u1ecbp th\u1edf: 20 l\u1ea7n\/ph\u00fat
\nSpO2: 95%
\nC\u1eadn l\u00e2m s\u00e0ng c\u1ea5p c\u1ee9u: Ch\u1ee5p Xquang ng\u1ef1c th\u1eb3ng; Ghi \u0111i\u1ec7n tim c\u1ea5p c\u1ee9u t\u1ea1i gi\u01b0\u1eddng; Ch\u1ee5p Xquang khung ch\u1eadu th\u1eb3ng; Ch\u1ee5p Xquang kh\u1edbp g\u1ed1i th\u1eb3ng, nghi\u00eang ho\u1eb7c ch\u1ebfch; Ch\u1ee5p Xquang x\u01b0\u01a1ng \u0111\u00f9i th\u1eb3ng nghi\u00eang.
\nX\u1eed tr\u00ed \u1edf c\u1ea5p c\u1ee9u: Paracetamol 01 chai (TTM) C g\/ph\u00fat
\nN\u1eb9p c\u1ed1 \u0111\u1ecbnh \u0111\u00f9i – c\u1eb3ng – b\u00e0n ch\u1ed1ng xoay ch\u00e2n (T)
\nDi\u1ec5n ti\u1ebfn t\u1eeb l\u00fac nh\u1eadp vi\u1ec7n \u0111\u1ebfn l\u00fac kh\u00e1m: B\u1ec7nh nh\u00e2n t\u1ec9nh, gi\u1ea3m \u0111au, c\u00f2n s\u01b0ng n\u1ec1 1\/4 d\u01b0\u1edbi \u0111\u00f9i (T) v\u00e0 quanh g\u1ed1i (T), kh\u00f4ng \u0111i l\u1ea1i \u0111\u01b0\u1ee3c.<\/p>\n
\na\/ N\u1ed9i khoa
\n– T\u0103ng huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n c\u00e1ch \u0111\u00e2y h\u01a1n 10 n\u0103m t\u1ea1i B\u1ec7nh vi\u1ec7n Tr\u01b0ng V\u01b0\u01a1ng. Huy\u1ebft \u00e1p t\u00e2m thu cao nh\u1ea5t \u0111o \u0111\u01b0\u1ee3c: 180 mmHg, huy\u1ebft \u00e1p t\u00e2m thu d\u1ec5 ch\u1ecbu: 130-140mmHg. B\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb li\u00ean t\u1ee5c b\u1eb1ng thu\u1ed1c u\u1ed1ng Tovecor plus (Perindopril 5mg + Indapamid 12.5 mg) (u\u1ed1ng) ng\u00e0y 01 l\u1ea7n, m\u1ed7i l\u1ea7n 01 vi\u00ean (s\u00e1ng).
\n– \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n c\u00e1ch \u0111\u00e2y kho\u1ea3ng 10 n\u0103m t\u1ea1i B\u1ec7nh vi\u1ec7n Tr\u01b0ng V\u01b0\u01a1ng, \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c:
\nHumalog Mix 75\/25 (TDD) ng\u00e0y 01 l\u1ea7n, m\u1ed7i l\u1ea7n 14 UI (chi\u1ec1u tr\u01b0\u1edbc \u0103n 5 ph\u00fat)
\nMetformin 1000mg (u\u1ed1ng) ng\u00e0y 02 l\u1ea7n, m\u1ed7i l\u1ea7n 01 vi\u00ean (s\u00e1ng, chi\u1ec1u sau \u0103n)
\nTRIDJANTAB 5mg (Linagliptin) (u\u1ed1ng) ng\u00e0y 01 l\u1ea7n, m\u1ed7i l\u1ea7n 01 vi\u00ean (s\u00e1ng)
\nGliclada 30mg (Gliclazid) (u\u1ed1ng) ng\u00e0y 01 l\u1ea7n, m\u1ed7i l\u1ea7n 01 vi\u00ean (s\u00e1ng tr\u01b0\u1edbc \u0103n 30 ph\u00fat)
\n– B\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n c\u00e1ch \u0111\u00e2y kho\u1ea3ng g\u1ea7n 5 n\u0103m t\u1ea1i B\u1ec7nh vi\u1ec7n Tr\u01b0ng V\u01b0\u01a1ng, \u0111i\u1ec1u tr\u1ecb li\u00ean t\u1ee5c b\u1eb1ng thu\u1ed1c. Tunadimet 75mg (Clopidogrel) ng\u00e0y u\u1ed1ng 01 l\u1ea7n, m\u1ed7i l\u1ea7n 01 vi\u00ean (s\u00e1ng)
\n– T\u0103ng lipid m\u00e1u h\u1ed7n h\u1ee3p \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n c\u00f9ng l\u00fac v\u1edbi B\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, t\u1ea1i B\u1ec7nh vi\u1ec7n Tr\u01b0ng V\u01b0\u01a1ng, hi\u1ec7n \u0111ang u\u1ed1ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb li\u00ean t\u1ee5c. Atorvastatin ng\u00e0y u\u1ed1ng 01 l\u1ea7n, m\u1ed7i l\u1ea7n 01 vi\u00ean (chi\u1ec1u).
\nb\/ Ngo\u1ea1i khoa: Ch\u01b0a ghi nh\u1eadn ti\u1ec1n c\u0103n ph\u1eabu thu\u1eadt hay ch\u1ea5n th\u01b0\u01a1ng tr\u01b0\u1edbc \u0111\u00e2y.
\nc\/ D\u1ecb \u1ee9ng: Ch\u01b0a ghi nh\u1eadn ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng.
\nd\/ Th\u00f3i quen: kh\u00f4ng h\u00fat thu\u1ed1c l\u00e1, u\u1ed1ng r\u01b0\u1ee3u bia
\ne\/ S\u1ea3n – Ph\u1ee5 khoa
\n– PARA: 4004 (sinh th\u01b0\u1eddng)
\n– M\u00e3n kinh n\u0103m 49 tu\u1ed5i
\n2. Gia \u0111\u00ecnh: Ch\u01b0a ghi nh\u1eadn ti\u1ec1n c\u0103n b\u1ec7nh l\u00fd li\u00ean quan.<\/p>\n
\n\u2022 H\u00f4 h\u1ea5p: kh\u00f4ng kh\u00f3 th\u1edf, kh\u00f4ng ho
\n\u2022 Ti\u00eau ho\u00e1: kh\u00f4ng \u0111au b\u1ee5ng, kh\u00f4ng bu\u1ed3n n\u00f4n, kh\u00f4ng n\u00f4n
\n\u2022 Ti\u1ebft ni\u1ec7u: kh\u00f4ng ti\u1ec3u g\u1eaft bu\u1ed1t, n\u01b0\u1edbc ti\u1ec3u v\u00e0ng trong
\n\u2022 C\u01a1 x\u01b0\u01a1ng kh\u1edbp: \u0111au 1\/4 d\u01b0\u1edbi \u0111\u00f9i (T), v\u00f9ng g\u1ed1i (T), kh\u00f4ng \u0111i l\u1ea1i \u0111\u01b0\u1ee3c
\n\u2022 Th\u1ea7n kinh: kh\u00f4ng \u0111au \u0111\u1ea7u, kh\u00f4ng d\u1ea5u th\u1ea7n kinh khu tr\u00fa<\/p>\n
\n– B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t
\n– D\u1ea5u hi\u1ec7u sinh t\u1ed3n:
\nM\u1ea1ch: 110 l\u1ea7n\/ph\u00fat,
\nHuy\u1ebft \u00e1p: 140\/ 80 mmHg
\nNhi\u1ec7t \u0111\u1ed9: 37 0C
\nNh\u1ecbp th\u1edf: 20 l\u1ea7n\/ph\u00fat
\n– Da, ni\u00eam m\u1ea1c h\u1ed3ng nh\u1ea1t
\n– Chi \u1ea5m, m\u1ea1ch quay r\u00f5, CRT < 2s
\n– Kh\u00f4ng ph\u00f9
\n– Th\u1ec3 tr\u1ea1ng: Ti\u1ec1n b\u00e9o ph\u00ec, BMI= 23,3 kg\/m2 theo IDI & WPRO
\n(C\u00e2n n\u1eb7ng: 56 kg, Chi\u1ec1u cao: 1,55 m)
\n– D\u1ea5u v\u00e9o da m\u1ea5t nhanh
\n– Tuy\u1ebfn gi\u00e1p kh\u00f4ng to
\n– H\u1ea1ch ngo\u1ea1i vi s\u1edd kh\u00f4ng ch\u1ea1m.
\nB\/ Kh\u00e1m c\u00e1c c\u01a1 quan
\n1. Kh\u00e1m c\u01a1 x\u01b0\u01a1ng kh\u1edbp:
\nNH\u00ccN: BN n\u1eb1m du\u1ed7i th\u1eb3ng 2 ch\u00e2n tr\u00ean gi\u01b0\u1eddng, m\u1edf n\u1eb9p ch\u1ed1ng xoay ch\u00e2n (T)
\n– Ch\u00e2n (P): Kh\u00f4ng th\u1ea5y v\u1ebft th\u01b0\u01a1ng, kh\u00f4ng sang th\u01b0\u01a1ng, kh\u00f4ng b\u1ea7m t\u00edm, kh\u00f4ng u c\u1ee5c, kh\u00f4ng s\u1eb9o m\u1ed5 c\u0169, kh\u00f4ng bi\u1ebfn d\u1ea1ng.
\n– Ch\u00e2n (T):
\n+ Kh\u00f4ng th\u1ea5y v\u1ebft th\u01b0\u01a1ng v\u00f9ng \u0111\u00f9i (T)
\n+ Kh\u00f4ng u c\u1ee5c, kh\u00f4ng s\u1eb9o m\u1ed5 c\u0169
\n+ \u0110\u1ea7u c\u00e1c ng\u00f3n ch\u00e2n h\u1ed3ng
\n+ S\u01b0ng n\u1ec1 v\u00f9ng 1\/4 d\u01b0\u1edbi \u0111\u00f9i (T) v\u00e0 quanh g\u1ed1i (T)
\n+ Bi\u1ebfn d\u1ea1ng kh\u1edbp g\u1ed1i: M\u1ea5t h\u00f5m t\u1ef1 nhi\u00ean kh\u1edbp g\u1ed1i (T)
\n+ Ch\u00e2n (T) ng\u1eafn h\u01a1n ch\u00e2n (P) #2 cm
\n+ C\u1eb3ng ch\u00e2n (T) xoay ngo\u00e0i
\nS\u1edc:
\n– Ch\u00e2n (P): ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng
\n– Ch\u00e2n (T):
\n+ Chi \u1ea5m, CRT < 2s
\n+ S\u1ee9c c\u01a1: kh\u00f4ng kh\u00e1m \u0111\u01b0\u1ee3c do b\u1ec7nh nh\u00e2n \u0111au nhi\u1ec1u
\n+ Tr\u01b0\u01a1ng l\u1ef1c c\u01a1: \u0111\u1ed9 ch\u1eafc (+ +); \u0111\u1ed9 ve v\u1ea9y, co do\u00e3i (kh\u00f4ng kh\u00e1m \u0111\u01b0\u1ee3c do b\u1ec7nh nh\u00e2n \u0111au nhi\u1ec1u)
\n+ \u1ea4n \u0111au ch\u00f3i \u0111\u1ea7u d\u01b0\u1edbi \u0111\u00f9i (T)
\n+ \u1ea4n \u0111au quanh g\u1ed1i (T)
\n+ M\u1ea1ch mu ch\u00e2n, m\u1ea1ch ch\u00e0y sau b\u1eaft \u0111\u01b0\u1ee3c \u0111\u1ec1u, r\u00f5
\n\u0110O:
\n– Ch\u00e2n (P): ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng
\n+ Chi\u1ec1u d\u00e0i tuy\u1ec7t \u0111\u1ed1i – t\u01b0\u01a1ng \u0111\u1ed1i: 40 – 42 cm
\n+ Chu vi v\u00f2ng chi (P) (qua x\u01b0\u01a1ng b\u00e1nh ch\u00e8): 34 cm
\n– Ch\u00e2n (T): Kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c chi\u1ec1u d\u00e0i, chu vi ch\u00e2n (T) do b\u1ec7nh nh\u00e2n \u0111ang \u0111eo n\u1eb9p c\u1ed1 \u0111\u1ecbnh
\nV\u1eacN \u0110\u1ed8NG: H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng g\u1ea5p kh\u1edbp g\u1ed1i (T). C\u00e1c ng\u00f3n ch\u00e2n c\u1eed \u0111\u1ed9ng \u0111\u01b0\u1ee3c.
\nC\u1ea2M GI\u00c1C: Kh\u00f4ng t\u00ea b\u00ec m\u1eb7t sau c\u1eb3ng ch\u00e2n (T), gan b\u00e0n ch\u00e2n (T)
\n2. Kh\u00e1m tu\u1ea7n ho\u00e0n
\n– L\u1ed3ng ng\u1ef1c c\u00e2n \u0111\u1ed1i, kh\u00f4ng c\u00f3 \u1ed5 \u0111\u1eadp b\u1ea5t th\u01b0\u1eddng, di\u1ec7n \u0111\u1eadp m\u1ecfm tim #2cm.
\n– V\u1ecb tr\u00ed m\u1ecfm tim khoang li\u00ean s\u01b0\u1eddn IV \u0111\u01b0\u1eddng trung \u0111\u00f2n (T), rung miu (-), Harzer(-)
\n– Ti\u1ebfng tim T1,T2 \u0111\u1ec1u, r\u00f5
\n– Nh\u1ecbp tim 88 l\u1ea7n\/ph\u00fat, \u0111\u1ec1u, kh\u00f4ng ph\u00e1t hi\u1ec7n \u00e2m th\u1ed5i b\u1ea5t th\u01b0\u1eddng.
\n3. Kh\u00e1m h\u00f4 h\u1ea5p
\n– L\u1ed3ng ng\u1ef1c c\u00e2n \u0111\u1ed1i, kh\u00f4ng co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5, kh\u00f4ng s\u1eb9o m\u1ed5 c\u0169, di \u0111\u1ed9ng \u0111\u1ec1u theo nh\u1ecbp th\u1edf.
\n– Rung thanh \u0111\u1ec1u 2 b\u00ean ph\u1ebf tr\u01b0\u1eddng.
\n– G\u00f5 ph\u1ed5i trong.
\n– R\u00ec r\u00e0o ph\u1ebf nang \u00eam d\u1ecbu 2 ph\u1ebf tr\u01b0\u1eddng, ph\u1ed5i kh\u00f4ng ran
\n4. Kh\u00e1m ti\u00eau ho\u00e1
\n– B\u1ee5ng m\u1ec1m c\u00e2n \u0111\u1ed1i , kh\u00f4ng tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7, kh\u00f4ng v\u1ebft m\u1ed5 c\u0169, di \u0111\u1ed9ng \u0111\u1ec1u theo nh\u1ecbp th\u1edf, r\u1ed1n l\u00f5m.
\n– Nhu \u0111\u1ed9ng ru\u1ed9t 12 l\u1ea7n\/ 2 ph\u00fat, kh\u00f4ng \u00e2m th\u1ed5i b\u1ea5t th\u01b0\u1eddng.
\n– B\u1ee5ng m\u1ec1m, kh\u00f4ng \u0111i\u1ec3m \u0111au khu tr\u00fa.
\n– Gan kh\u00f4ng to, l\u00e1ch s\u1edd kh\u00f4ng ch\u1ea1m.
\n5. Kh\u00e1m th\u1eadn – ti\u1ebft ni\u1ec7u
\n– H\u1ed1 th\u1eaft l\u01b0ng kh\u00f4ng s\u01b0ng n\u1ec1, u c\u1ee5c, xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da, kh\u00f4ng s\u1eb9o m\u1ed5 c\u0169.
\n– Ch\u1ea1m th\u1eadn (-)
\n– \u0110i\u1ec3m \u0111au ni\u1ec7u qu\u1ea3n tr\u00ean, ni\u1ec7u qu\u1ea3n gi\u1eefa 2 b\u00ean (-)
\n6. Kh\u00e1m th\u1ea7n kinh:
\n– B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t
\n– C\u1ed5 m\u1ec1m, Kernig(-), Brudzinski(-)
\n– Kh\u00f4ng d\u1ea5u th\u1ea7n kinh khu tr\u00fa
\n7. Kh\u00e1m c\u00e1c c\u01a1 quan kh\u00e1c: Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng.<\/p>\n
\n* Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:
\n– \u0110au nhi\u1ec1u 1\/4 d\u01b0\u1edbi \u0111\u00f9i (T)
\n– H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp g\u1ed1i (T)
\n*Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:
\n– Huy\u1ebft \u00e1p: 180\/100 mmHg, M\u1ea1ch: 135 l\u1ea7n\/ ph\u00fat (l\u00fac nh\u1eadp vi\u1ec7n) –> 140\/80 mmHg, M\u1ea1ch 110 l\u1ea7n\/ ph\u00fat (khi th\u0103m kh\u00e1m)
\n– Bi\u1ebfn d\u1ea1ng chi: Ch\u00e2n (T) ng\u1eafn h\u01a1n ch\u00e2n (P)#2cm, m\u1ea5t h\u00f5m t\u1ef1 nhi\u00ean kh\u1edbp g\u1ed1i (T)
\n– \u1ea4n \u0111au ch\u00f3i v\u00f9ng \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f9i (T)
\n– \u1ea4n \u0111au v\u00f9ng quanh g\u1ed1i (T)
\n– Gi\u1edbi h\u1ea1n v\u1eadn \u0111\u1ed9ng g\u1ea5p g\u1ed1i (T)
\n– S\u01b0ng n\u1ec1 v\u00f9ng 1\/4 d\u01b0\u1edbi \u0111\u00f9i v\u00e0 g\u1ed1i (T)
\n– M\u1ea1ch mu ch\u00e2n, m\u1ea1ch ch\u00e0y sau b\u1eaft \u0111\u01b0\u1ee3c, \u0111\u1ec1u r\u00f5 2 b\u00ean
\n– C\u00e1c \u0111\u1ea7u ng\u00f3n ch\u00e2n (T) h\u1ed3ng.
\n– C\u00e1c ng\u00f3n ch\u00e2n (T) c\u1eed \u0111\u1ed9ng \u0111\u01b0\u1ee3c
\n– Chi \u1ea5m, CRT<2s
\n– Kh\u00f4ng t\u00ea b\u00ec m\u1eb7t sau c\u1eb3ng ch\u00e2n (T), gan b\u00e0n ch\u00e2n (T)
\n* Ti\u1ec1n c\u0103n:
\n– T\u0103ng huy\u1ebft \u00e1p
\n– Thi\u1ebfu m\u00e1u c\u01a1 tim
\n– \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2
\n– T\u0103ng lipid m\u00e1u h\u1ed7n h\u1ee3p<\/p>\n
\n– Bi\u1ebfn d\u1ea1ng chi: Ch\u00e2n (T) ng\u1eafn h\u01a1n ch\u00e2n (P) #2cm, m\u1ea5t h\u00f5m t\u1ef1 nhi\u00ean kh\u1edbp g\u1ed1i (T)
\n– \u1ea4n \u0111au ch\u00f3i v\u00f9ng \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f9i (T)
\n– \u0110au quanh v\u00f9ng g\u1ed1i (T)
\n– H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp g\u1ed1i (T)
\n– S\u01b0ng n\u1ec1 1\/4 d\u01b0\u1edbi \u0111\u00f9i (T) v\u00e0 g\u1ed1i (T)
\nHuy\u1ebft \u00e1p: 180\/100 mmHg, M\u1ea1ch: 135 l\u1ea7n\/ ph\u00fat (l\u00fac nh\u1eadp vi\u1ec7n) –> 140\/80 mmHg, M\u1ea1ch 110 l\u1ea7n\/ ph\u00fat (khi th\u0103m kh\u00e1m) <\/p>\n
\n– B\u1ec7nh nh\u00e2n c\u00f3 c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng r\u00f5 r\u00e0ng (do tai n\u1ea1n sinh ho\u1ea1t), b\u1ec7nh nh\u00e2n kh\u00f4ng va \u0111\u1eadp v\u00f9ng \u0111\u1ea7u c\u00e1c b\u1ed9 ph\u1eadn kh\u00e1c n\u00ean ngh\u0129 nhi\u1ec1u \u0111\u1ebfn b\u1ec7nh nh\u00e2n b\u1ecb G\u00e3y x\u01b0\u01a1ng do c\u01a1 n\u0103ng. Sau tai n\u1ea1n, b\u1ec7nh nh\u00e2n t\u1ec9nh, \u0111au nhi\u1ec1u v\u00f9ng 1\/4 d\u01b0\u1edbi \u0111\u00f9i (T) v\u00e0 g\u1ed1i (T), b\u1ec7nh nh\u00e2n kh\u00f4ng t\u1ef1 \u0111\u1ee9ng d\u1eady \u0111\u01b0\u1ee3c; b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng: ch\u00e2n (T) ng\u1eafn h\u01a1n ch\u00e2n (P) # 2 cm, bi\u1ebfn d\u1ea1ng kh\u1edbp g\u1ed1i (T) (m\u1ea5t h\u00f5m t\u1ef1 nhi\u00ean kh\u1edbp g\u1ed1i (T)) k\u00e8m c\u00e1c d\u1ea5u hi\u1ec7u kh\u00f4ng ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng: \u1ea5n \u0111au ch\u00f3i v\u00f9ng \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f9i (T) v\u00e0 g\u1ed1i (T), h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp g\u1ed1i (T), s\u01b0ng n\u1ec1 v\u00f9ng 1\/4 d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f9i (T) v\u00e0 g\u1ed1i (T) n\u00ean ngh\u0129 nhi\u1ec1u \u0111\u1ebfn b\u1ec7nh nh\u00e2n b\u1ecb G\u00e3y \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f9i (T) do tai n\u1ea1n sinh ho\u1ea1t –> \u0110\u1ec1 ngh\u1ecb ch\u1ee5p Xquang \u0111\u00f9i (T) th\u1eb3ng – nghi\u00eang, Xquang g\u1ed1i (T) th\u1eb3ng – nghi\u00eang \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n (\u0111\u00e3 c\u00f3). Tuy nhi\u00ean, do tu\u1ed5i t\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e3 cao (73 tu\u1ed5i), c\u00f3 c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng r\u00f5 r\u00e0ng n\u00ean \u0111\u1ec3 tr\u00e1nh b\u1ecf s\u00f3t t\u1ed5n th\u01b0\u01a1ng –> \u0111\u1ec1 ngh\u1ecb ch\u1ee5p Xquang khung ch\u1eadu th\u1eb3ng (\u0111\u00e3 c\u00f3)
\n– G\u00e3y k\u00edn v\u00ec th\u0103m kh\u00e1m kh\u00f4ng ph\u00e1t hi\u1ec7n v\u1ebft th\u01b0\u01a1ng t\u1ea1i v\u1ecb tr\u00ed ch\u1ea5n th\u01b0\u01a1ng.
\n– Hi\u1ec7n t\u1ea1i ch\u01b0a ghi nh\u1eadn c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0:
\nCho\u00e1ng ch\u1ea5n th\u01b0\u01a1ng, s\u1ed1c m\u1ea5t m\u00e1u, s\u1ed1c \u0111au: v\u00ec b\u1ec7nh nh\u00e2n t\u1ec9nh, kh\u00f4ng ch\u00f3ng m\u1eb7t, kh\u00f4ng c\u00f3 v\u1ebft th\u01b0\u01a1ng, ni\u00eam h\u1ed3ng nh\u1ea1t, chi \u1ea5m, ch\u1ec9 s\u1ed1 cho\u00e1ng < 1 (khi th\u0103m kh\u00e1m).
\nH\u1ed9i ch\u1ee9ng t\u1eafc m\u1ea1ch do m\u1ee1: v\u00ec b\u1eaft \u0111\u01b0\u1ee3c \u0111\u1ed9ng m\u1ea1ch mu ch\u00e2n, ch\u00e0y sau \u0111\u1ec1u r\u00f5.
\nH\u1ed9i ch\u1ee9ng ch\u00e8n \u00e9p khoang: b\u1ec7nh nh\u00e2n \u0111au nhi\u1ec1u, gi\u1ea3m \u0111au khi b\u1ea5t \u0111\u1ed9ng, kh\u00f4ng d\u1ecb c\u1ea3m, kh\u00f4ng m\u1ea5t m\u1ea1ch (m\u1ea1ch mu ch\u00e2n, m\u1ea1ch ch\u00e0y sau b\u1eaft \u0111\u01b0\u1ee3c \u0111\u1ec1u, r\u00f5), kh\u00f4ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u \u0111\u1ea7u chi, chi \u1ea5m, CRT<2s.
\nT\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh ch\u00e0y: v\u00ec khi th\u0103m kh\u00e1m b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 c\u1ea3m gi\u00e1c t\u00ea b\u00ec m\u1eb7t sau c\u1eb3ng ch\u00e2n v\u00e0 gan b\u00e0n ch\u00e2n (T), v\u1eabn c\u1eed \u0111\u1ed9ng c\u00e1c ng\u00f3n ch\u00e2n \u0111\u01b0\u1ee3c.
\nT\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u: chi \u1ea5m, kh\u00f4ng ph\u00e1t hi\u1ec7n v\u1ebft b\u1ea7m, CRT<2s, c\u00e1c \u0111\u1ea7u ng\u00f3n ch\u00e2n h\u1ed3ng, b\u1eaft \u0111\u01b0\u1ee3c m\u1ea1ch mu ch\u00e2n, ch\u00e0y sau ch\u00e2n (T).
\n– B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd T\u0103ng huy\u1ebft \u00e1p, \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2, B\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, T\u0103ng lipid m\u00e1u h\u1ed7n h\u1ee3p n\u00ean \u0111\u1ec1 ngh\u1ecb x\u00e9t nghi\u1ec7m Triglycerid m\u00e1u, Cholersterol; T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u; Ghi \u0111i\u1ec7n tim t\u1ea1i gi\u01b0\u1eddng (ECG \u0111\u00e3 c\u00f3); Si\u00eau \u00e2m Doppler tim \u0111\u1ec3 \u0111\u00e1nh gi\u00e1.
\n– B\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i (> 60 tu\u1ed5i), c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 lo\u00e3ng x\u01b0\u01a1ng: n\u1eef, l\u1edbn tu\u1ed5i, \u0111\u00e3 m\u00e3n kinh, th\u1ec3 tr\u1ea1ng Ti\u1ec1n b\u00e9o ph\u00ec (BMI=23,3 kg\/m2), \u0111ang b\u1ecb ch\u1ea5n th\u01b0\u01a1ng v\u00e0 \u0111ang b\u1ecb g\u00e3y x\u01b0\u01a1ng. \u0110\u1ec1 ngh\u1ecb \u0111o lo\u00e3ng x\u01b0\u01a1ng, x\u00e9t nghi\u1ec7m \u0111\u1ecbnh l\u01b0\u1ee3ng 25-OH vitamin D \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n.<\/p>\n
\n– C\u1eadn l\u00e2m s\u00e0ng h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n (\u0111\u00e3 c\u00f3)
\n– C\u1eadn l\u00e2m s\u00e0ng th\u01b0\u1eddng quy\/ti\u1ec1n ph\u1eabu
\n+ C\u00f4ng th\u1ee9c m\u00e1u
\n+ \u0110\u1ecbnh danh nh\u00f3m m\u00e1u h\u1ec7 ABO, Rhsues
\n+ Sinh h\u00f3a m\u00e1u (glucose, ure, creatinin, eGFR, AST, AGT) ; \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3: Na+, K+, Cl-, Calci
\n+ Si\u00eau \u00e2m Doppler tim
\n+ Si\u00eau \u00e2m \u1ed5 b\u1ee5ng
\n+ X quang ng\u1ef1c th\u1eb3ng
\n+ \u0110o lo\u00e3ng x\u01b0\u01a1ng
\n+ Bilan \u0111\u00f4ng c\u1ea7m m\u00e1u (aPTT, TQ, TL, INR)
\n+ T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u
\n2. K\u1ebft qu\u1ea3 c\u1eadn l\u00e2m s\u00e0ng \u0111\u00e3 c\u00f3:
\n– X quang khung ch\u1eadu th\u1eb3ng:<\/p>\n![\"1\"](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/1.png\" "\\"\\"")
<\/p>\n
\n\u2022 H\u1ecd v\u00e0 t\u00ean b\u1ec7nh nh\u00e2n: HU\u1ef2NH TH\u1eca Q. , n\u1eef, 73 tu\u1ed5i
\n\u2022 M\u00e3 s\u1ed1 b\u1ec7nh nh\u00e2n: 23930679
\n\u2022 Ng\u00e0y th\u00e1ng n\u0103m ch\u1ee5p: 10\/9\/2024
\n\u2022 Lo\u1ea1i phim: X quang khung ch\u1eadu th\u1eb3ng
\n\u2022 Ch\u1ea5t l\u01b0\u1ee3ng phim: \u0111\u1ea1t
\n\u2022 Ch\u1ea5t l\u01b0\u1ee3ng tia: chu\u1ea9n
\n\u2022 M\u00f4 t\u1ea3: M\u00f4 m\u1ec1m: ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng
\nKhung ch\u1eadu: ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng
\nKh\u1edbp h\u00e1ng: ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng
\n\u0110\u1ea7u tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i: ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng
\nTh\u00e2n x\u01b0\u01a1ng \u0111\u00f9i: ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng
\nK\u1ebft lu\u1eadn: ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng
\n– X quang kh\u1edbp g\u1ed1i (T) th\u1eb3ng – nghi\u00eang<\/p>\n![\"2\"](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/2.png\" "\\"\\"")
![\"3\"](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/3.png\" "\\"\\"")
\n\u2022 H\u1ecd v\u00e0 t\u00ean b\u1ec7nh nh\u00e2n: HU\u1ef2NH TH\u1eca Q. , n\u1eef, 73 tu\u1ed5i
\n\u2022 M\u00e3 s\u1ed1 b\u1ec7nh nh\u00e2n: 23930679
\n\u2022 Ng\u00e0y th\u00e1ng n\u0103m ch\u1ee5p: 10\/9\/2024
\n\u2022 Lo\u1ea1i phim: X quang kh\u1edbp g\u1ed1i (T) th\u1eb3ng – nghi\u00eang
\n\u2022 Ch\u1ea5t l\u01b0\u1ee3ng phim: \u0111\u1ea1t
\n\u2022 Ch\u1ea5t l\u01b0\u1ee3ng tia: chu\u1ea9n
\n\u2022 M\u00f4 t\u1ea3: M\u00f4 m\u1ec1m: S\u01b0ng n\u1ec1 1\/3 d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f9i.
\nV\u1ecb tr\u00ed g\u00e3y: \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f9i (T).
\n\u0110\u01b0\u1eddng g\u00e3y: ch\u00e9o.
\nDi l\u1ec7ch: ch\u1ed3ng ng\u1eafn + sang b\u00ean + g\u1eadp g\u00f3c + xoay
\nCh\u01b0a ghi nh\u1eadn t\u1ed5n th\u01b0\u01a1ng \u0111i k\u00e8m.
\nK\u1ebft lu\u1eadn : G\u00e3y \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f9i (T) ph\u00e2n lo\u1ea1i A1 theo Muller AO
\n– X quang x\u01b0\u01a1ng \u0111\u00f9i (T) th\u1eb3ng – nghi\u00eang<\/p>\n![\"4\"](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/4.png\" "\\"\\"")
\n\u2022 H\u1ecd v\u00e0 t\u00ean b\u1ec7nh nh\u00e2n: HU\u1ef2NH TH\u1eca Q. , n\u1eef, 73 tu\u1ed5i
\n\u2022 M\u00e3 s\u1ed1 b\u1ec7nh nh\u00e2n: 23930679
\n\u2022 Ng\u00e0y th\u00e1ng n\u0103m ch\u1ee5p: 10\/9\/2024
\n\u2022 Lo\u1ea1i phim: X quang x\u01b0\u01a1ng \u0111\u00f9i (T) th\u1eb3ng – nghi\u00eang
\n\u2022 Ch\u1ea5t l\u01b0\u1ee3ng phim: \u0111\u1ea1t
\n\u2022 Ch\u1ea5t l\u01b0\u1ee3ng tia: chu\u1ea9n
\n\u2022 M\u00f4 t\u1ea3: Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng
\nK\u1ebft lu\u1eadn: Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng<\/p>\n![\"H\u00ecnh](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/5.png\" "\\"\\"")
\n\u2022 H\u1ecd v\u00e0 t\u00ean b\u1ec7nh nh\u00e2n: HU\u1ef2NH TH\u1eca Q. , n\u1eef, 73 tu\u1ed5i
\n\u2022 M\u00e3 s\u1ed1 b\u1ec7nh nh\u00e2n: 23930679
\n\u2022 Ng\u00e0y th\u00e1ng n\u0103m ch\u1ee5p: 10\/9\/2024
\n\u2022 Lo\u1ea1i phim: X quang ng\u1ef1c th\u1eb3ng
\n\u2022 Ch\u1ea5t l\u01b0\u1ee3ng phim: \u0111\u1ea1t
\n\u2022 Ch\u1ea5t l\u01b0\u1ee3ng tia: chu\u1ea9n
\n\u2022 Chi\u1ec1u th\u1ebf sau tr\u01b0\u1edbc
\n\u2022 M\u00f4 t\u1ea3: Kh\u00ed qu\u1ea3n kh\u00f4ng di l\u1ec7ch
\nKh\u00f4ng g\u00e3y x\u01b0\u01a1ng
\nB\u00f3ng tim kh\u00f4ng to
\nV\u00f2m ho\u00e0nh r\u00f5
\nCh\u01b0a ghi nh\u1eadn t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 ph\u1ed5i
\nK\u1ebft lu\u1eadn: Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng
\n– \u0110o lo\u00e3ng x\u01b0\u01a1ng <\/p>\n![\"H\u00ecnh](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/6.png\" "\\"\\"")
![\"H\u00ecnh](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/7.png\" "\\"\\"")
![\"H\u00ecnh](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/8.png\" "\\"\\"")
![\"H\u00ecnh](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/9.png\" "\\"\\"")
\nM\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng v\u00f9ng c\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i: (T-score: -1.9)
\nK\u1ebft lu\u1eadn: Lo\u00e3ng x\u01b0\u01a1ng c\u1ed9t s\u1ed1ng th\u1eaft l\u01b0ng
\n– ECG: Nh\u1ecbp xoang \u0111\u1ec1u, t\u1ea7n s\u1ed1 135 l\u1ea7n\/ ph\u00fat. Tr\u1ee5c trung gian
\n– Sinh ho\u00e1 m\u00e1u
\nGlucose: 9.3 mmol\/L
\nUre: 6.4 mmol\/L
\nCreatinin: 100.0 umol\/L
\neGFR: 50.1 ml\/ph\u00fat
\nAST (GOT): 21 U\/L
\nALT (GPT) 12 U\/L
\nCholesterol: 3.0 mmol\/L
\nTriglycerid: 2.0 mmol\/L
\n\u0110i\u1ec7n gi\u1ea3i \u0111\u1ed3: Na+: 139 mmol\/L
\nK+: 3.8 mmol\/L
\nCl-: 100 mmol\/L
\nCalci : 2.46 mmol\/L
\n–> Glucose t\u0103ng, b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed \u0110\u00e1i Th\u00e1o \u0110\u01b0\u1eddng type 2, t\u00ecnh tr\u1ea1ng \u0111\u01b0\u1eddng huy\u1ebft c\u1ee7a b\u1ec7nh nh\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t. \u0110\u1ec1 ngh\u1ecb x\u00e9t nghi\u1ec7m \u0111\u01b0\u1eddng huy\u1ebft l\u00fac \u0111\u00f3i.
\neGFR gi\u1ea3m => ch\u1ee9c n\u0103ng th\u1eadn b\u1ecb gi\u1ea3m. Theo d\u00f5i th\u00eam.
\nC\u00e1c ch\u1ec9 s\u1ed1 c\u00f2n l\u1ea1i trong gi\u1edbi h\u1ea1n
\n– T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u:
\nURO: norm micromo
\nGLU: norm mmol\/L
\nBIL: neg micromo
\nKET: 0.5 mmol\/L
\nS.G: 1.019
\nBLD: 25\/uL Mpt\/L
\npH: 5
\nPRO: 1.5 g\/L
\nNIT: neg
\nLEU: 100\/uL Mpt\/L
\n–> PRO t\u0103ng ngh\u0129 do b\u1ec7nh nh\u00e2n \u0111ang c\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p, ngh\u0129 do b\u1ec7nh nh\u00e2n \u0111ang m\u1eafc c\u00e1c b\u1ec7nh l\u00fd nh\u01b0 T\u0103ng huy\u1ebft \u00e1p, \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 nh\u01b0ng kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t –> g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u1eadn
\n– Si\u00eau \u00e2m \u1ed5 b\u1ee5ng:
\nTh\u1eadn: – Th\u1eadn ph\u1ea3i: K\u00edch th\u01b0\u1edbc b\u00ecnh th\u01b0\u1eddng, gi\u1edbi h\u1ea1n v\u1ecf- t\u1ee7y r\u00f5, kh\u00f4ng s\u1ecfi, kh\u00f4ng \u1ee9 n\u01b0\u1edbc.
\n– Th\u1eadn tr\u00e1i: K\u00edch th\u01b0\u1edbc b\u00ecnh th\u01b0\u1eddng, gi\u1edbi h\u1ea1n v\u1ecf -tu\u1ef7 r\u00f5, c\u00f3 b\u00f3ng c\u1ea3n \u00e2m d#15 mm, kh\u00f4ng \u1ee9 n\u01b0\u1edbc.
\nK\u1ebft lu\u1eadn: S\u1ecfi th\u1eadn (T)
\n– Si\u00eau \u00e2m Doppler tim:
\nK\u1ebft lu\u1eadn: Ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i b\u1ea3o t\u1ed3n, EF 74%
\nC\u00e1c bu\u1ed3ng tim kh\u00f4ng d\u1eabn
\nTh\u00e0nh tim kh\u00f4ng d\u00e0y
\nV\u00e1ch li\u00ean nh\u0129, li\u00ean th\u1ea5t nguy\u00ean v\u1eb9n
\nKh\u00f4ng r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng.
\nPAPs = 25 mmHg, kh\u00f4ng t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.
\nD\u1ecbch m\u00e0ng tim (-). Kh\u00f4ng huy\u1ebft kh\u1ed1i trong bu\u1ed3ng tim.<\/p>\n
\n– B\u1ea5t \u0111\u1ed9ng v\u1edbi n\u1eb9p ch\u1ed1ng xoay.
\n– Gi\u1ea3m \u0111au.
\n– Ch\u1ed1ng ph\u00f9 n\u1ec1.
\n– \u0110i\u1ec1u tr\u1ecb b\u1ec7nh n\u1ec1n.
\n– B\u00f9 d\u1ecbch
\n– D\u1ef1 ph\u00f2ng huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u
\n– Theo d\u00f5i sinh hi\u1ec7u h\u1eb1ng ng\u00e0y
\n2. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3:
\n– \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt: Ph\u1eabu thu\u1eadt k\u1ebft h\u1ee3p x\u01b0\u01a1ng n\u1eb9p v\u00edt
\n– Thu\u1ed1c: Ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p, \u0111\u01b0\u1eddng huy\u1ebft
\nParacetamol 1g\/100ml 01 chai x 2 (TTM) C gi\u1ecdt\/ ph\u00fat (8h – 20h)
\nEnoxaparin 30mg 01 \u1ed1ng (TDD)
\nInsulin (Humalog 75\/25) 16 UI (TDD) (chi\u1ec1u tr\u01b0\u1edbc \u0103n 5 ph\u00fat)
\nMetformin 1000mg 01 vi\u00ean x 2 (u) (s\u00e1ng – chi\u1ec1u sau khi \u0103n)
\nTRIDJANTAB 5mg (Linagliptin) 01 vi\u00ean (u) (s\u00e1ng)
\nGliclada 30mg (Gliclazid) 01 vi\u00ean (u) (s\u00e1ng tr\u01b0\u1edbc \u0103n 30 ph\u00fat)
\nAmlodipin 5mg 01 vi\u00ean (u)
\nX\u00e9t nghi\u1ec7m \u0111\u01b0\u1eddng huy\u1ebft \u0111\u00f3i –> \u0111i\u1ec1u ch\u1ec9nh thu\u1ed1c \u0111\u1ec3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n
\n– Ti\u00ean l\u01b0\u1ee3ng xa: Trung b\u00ecnh. Nguy c\u01a1 nhi\u1ec5m khu\u1ea9n sau m\u1ed5, c\u1ee9ng kh\u1edbp, …C\u1ea7n t\u1eadp v\u1eadt l\u00fd tr\u1ecb li\u1ec7u sau m\u1ed5 \u0111\u1ec3 d\u1ef1 ph\u00f2ng bi\u1ebfn ch\u1ee9ng.<\/p>\n