{"id":4291,"date":"2024-12-01T17:30:38","date_gmt":"2024-12-01T10:30:38","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=4291"},"modified":"2024-12-01T17:30:38","modified_gmt":"2024-12-01T10:30:38","slug":"benh-an-ngoai-khoa-tien-phau-3","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/benh-an-ngoai-khoa-tien-phau-3\/","title":{"rendered":"B\u1ec6NH \u00c1N NGO\u1ea0I KHOA ( TI\u1ec0N PH\u1eaaU)"},"content":{"rendered":"
I. H\u00c0NH CH\u00cdNH:\u00a0<\/strong><\/div>\n
\u00a0<\/div>\n
– H\u1ecd v\u00e0 t\u00ean: V\u0168 TH\u1eca T.<\/div>\n
– Gi\u1edbi t\u00ednh: N\u1eef<\/div>\n
– N\u0103m sinh: 1945\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Tu\u1ed5i: 79<\/div>\n
– D\u00e2n t\u1ed9c: Kinh<\/div>\n
– \u0110\u1ecba ch\u1ec9: 135\/47\/142, \u0110\u01b0\u1eddng G\u00f2 Xo\u00e0i, Ph\u01b0\u1eddng B\u00ecnh H\u01b0ng H\u00f2a, Qu\u1eadn B\u00ecnh T\u00e2n, TP H\u1ed3 Ch\u00ed Minh<\/div>\n
– Ngh\u1ec1 nghi\u1ec7p: N\u1ed9i tr\u1ee3<\/div>\n
– Ng\u00e0y gi\u1edd v\u00e0o vi\u1ec7n: 09 gi\u1edd 06 ph\u00fat, ng\u00e0y 04\/09\/2024<\/div>\n
– Ng\u00e0y gi\u1edd l\u00e0m b\u1ec7nh \u00e1n: 20 gi\u1edd 00 ph\u00fat, ng\u00e0y 06\/09\/2024<\/div>\n
\u00a0<\/div>\n
II. L\u00dd DO V\u00c0O VI\u1ec6N:<\/strong> \u0110au h\u00f4ng (P) k\u00e8m h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng h\u00e1ng (P)<\/div>\n
\u00a0<\/div>\n
III. B\u1ec6NH S\u1eec:<\/strong><\/div>\n
\u00a0<\/div>\n
\u00a0 \u00a0B\u1ec7nh nh\u00e2n khai, c\u00e1ch nh\u1eadp vi\u1ec7n kho\u1ea3ng 04 gi\u1edd khi b\u1ec7nh nh\u00e2n \u0111ang sinh ho\u1ea1t t\u1ea1i nh\u00e0 th\u00ec tr\u01b0\u1ee3t ch\u00e2n (P), v\u00f9ng h\u00f4ng (P) va \u0111\u1eadp tr\u1ef1c ti\u1ebfp v\u00e0o ch\u00e2n b\u00e0n, t\u01b0 th\u1ebf \u0111\u00f9i d\u1ea1ng. Sau \u0111\u00f3 b\u1ec7nh t\u1ef1 \u0111\u1ee9ng l\u00ean v\u00e0 ti\u1ebfp t\u1ee5c b\u1ecb ng\u00e3 va \u0111\u1eadp tr\u1ef1c ti\u1ebfp m\u00f4ng (P) xu\u1ed1ng n\u1ec1n c\u1ee9ng, kh\u00f4ng xay x\u00e1t da, kh\u00f4ng va ch\u1ea1m ph\u1ea7n \u0111\u1ea7u. Sau ng\u00e3 b\u1ec7nh nh\u00e2n t\u1ec9nh v\u00e0 than \u0111au nhi\u1ec1u v\u00f9ng h\u00f4ng v\u00e0 m\u00f4ng (P), h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp h\u00e1ng (P), b\u1ec7nh nh\u00e2n c\u1ea3m gi\u00e1c \u0111au ch\u00f3i v\u00f9ng h\u00f4ng (P) khi \u0111\u1ee9ng tr\u1ee5 ch\u00e2n (P), s\u01b0ng n\u1ec1 1\/3 tr\u00ean \u0111\u00f9i (P).<\/div>\n
\u00a0 \u00a0T\u1ea1i nh\u00e0 b\u1ec7nh nh\u00e2n kh\u00f4ng x\u1eed tr\u00ed g\u00ec v\u00e0 \u0111\u01b0\u1ee3c ng\u01b0\u1eddi th\u00e2n \u0111\u01b0a \u0111\u1ebfn kh\u00e1m t\u1ea1i BV Qu\u1eadn T\u00e2n Ph\u00fa, ch\u1ee5p X – quang, \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n: G\u00e3y li\u00ean m\u1ea5u chuy\u1ec3n x\u01b0\u01a1ng \u0111\u00f9i (P) v\u00e0 x\u1eed tr\u00ed n\u1eb9p c\u1ed1 \u0111\u1ecbnh \u0111\u00f9i c\u1eb3ng b\u00e0n ch\u00e2n ch\u1ed1ng xoay (P) sau \u0111\u00f3 chuy\u1ec3n \u0111\u1ebfn BV Th\u1ed1ng Nh\u1ea5t ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb.<\/div>\n
Trong qu\u00e1 tr\u00ecnh b\u1ec7nh, b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111au \u0111\u1ea7u, bu\u1ed3n n\u00f4n, kh\u00f4ng n\u00f4n, kh\u00f4ng \u0111au ng\u1ef1c kh\u00f3 th\u1edf, kh\u00f4ng \u0111au b\u1ee5ng, kh\u00f4ng y\u1ebfu li\u1ec7t chi, kh\u00f4ng n\u00f3i kh\u00f3, ti\u00eau ti\u1ec3u t\u1ef1 ch\u1ee7.<\/div>\n
\u00a0 \u00a0 \u00a0 T\u00ecnh tr\u1ea1ng l\u00fac nh\u1eadp vi\u1ec7n:\u00a0<\/div>\n
– B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t.<\/div>\n
– Than \u0111au v\u00f9ng h\u00f4ng v\u00e0 m\u00f4ng (P) nhi\u1ec1u (VAS 8\/10) , h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp h\u00e1ng (P), b\u00e0n ch\u00e2n (P) \u0111\u1ed7 ngo\u00e0i, b\u00e0n tay v\u00e0 b\u00e0n ch\u00e2n hai b\u00ean \u0111\u1ec1u \u1ea5m, h\u1ed3ng.<\/div>\n
– S\u01b0ng n\u1ec1 1\/3 tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i<\/div>\n
– Ch\u1ee5p X-quang t\u1ea1i tuy\u1ebfn d\u01b0\u1edbi cho k\u1ebft qu\u1ea3: G\u00e3y li\u00ean m\u1ea5u chuy\u1ec3n x\u01b0\u01a1ng \u0111\u00f9i \u2192 chuy\u1ec3n l\u00ean khoa CTCH l\u00fac 09h45.<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0Di\u1ec5n ti\u1ebfn b\u1ec7nh ph\u00f2ng:<\/div>\n
Ng\u00e0y 01 (04\/09\/2024): B\u1ec7nh nh\u00e2n t\u1ec9nh, n\u1eb9p \u0111\u00f9i ch\u00e2n (P), than \u0111au nhi\u1ec1u v\u00f9ng h\u00f4ng v\u00e0 m\u00f4ng (P), s\u01b0ng n\u1ec1 v\u00f9ng 1\/3 tr\u00ean \u0111\u00f9i (P), v\u1eadn \u0111\u1ed9ng ch\u00e2n (P) \u0111au ch\u00f3i, \u0103n u\u1ed1ng \u0111\u01b0\u1ee3c, ti\u1ec3u v\u00e0ng trong kh\u00f4ng g\u1eaft, bu\u1ed1t, n\u01b0\u1edbc ti\u1ec3u kh\u00f4ng c\u1eb7n l\u1eafng. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh c\u00e1c x\u00e9t nghi\u1ec7m ti\u1ec1n ph\u1eabu, x-quang kh\u1edbp h\u00e1ng th\u1eb3ng \u2013 nghi\u00eang, \u0111o m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng, k\u1ebft qu\u1ea3 \u0111\u01b0\u1eddng m\u00e1u 11.6 mmol\/L v\u00e0 \u0111\u01b0\u1ee3c x\u1eed tr\u00ed Paracetamol 1g\/100ml 02 chai TTM C g\/p, Lovenox 4000UI anti-xa\/0,4 ml 01 b\u01a1m ti\u00eam TDD 1A.\u00a0<\/div>\n
\u00a0<\/div>\n
Ng\u00e0y 02 ( 05\/09\/2024): B\u1ec7nh nh\u00e2n t\u1ec9nh, kh\u00f4ng s\u1ed1t, gi\u1ea3m \u0111au v\u00f9ng h\u00f4ng v\u00e0 m\u00f4ng (P), s\u01b0ng b\u1ea7m 1\/3 tr\u00ean \u0111\u00f9i (P), h\u1ea1n ch\u1ebf di \u0111\u1ed9ng ch\u00e2n (P), \u0103n u\u1ed1ng \u0111\u01b0\u1ee3c. B\u1ec7nh nh\u00e2n c\u00f3 truy\u1ec1n 02 \u0111\u01a1n v\u1ecb 350ml m\u00e1u to\u00e0n ph\u1ea7n, tr\u01b0\u1edbc v\u00e0 sau truy\u1ec1n m\u00e1u b\u1ec7nh nh\u00e2n t\u1ec9nh, sinh hi\u1ec7u \u1ed5n, kho\u1ea3ng 11 gi\u1edd b\u1ec7nh nh\u00e2n t\u1ec9nh, than \u0111au \u0111\u1ea7u, \u0111o HA: 190\/100 mmHg \u0111\u01b0\u1ee3c x\u1eed tr\u00ed captoril 01 vi\u00ean (ng\u1eadm d\u01b0\u1edbi l\u01b0\u1ee1i), 16 gi\u1edd c\u00f9ng ng\u00e0y, b\u1ec7nh nh\u00e2n \u0111au \u0111\u1ea7u nhi\u1ec1u, kh\u00f4ng ch\u00f3ng m\u1eb7t, kh\u00f4ng kh\u00f3 th\u1edf, chi \u1ea5m, huy\u1ebft \u00e1p \u0111o \u0111\u01b0\u1ee3c HA: 215\/90 mmHg x\u1eed tr\u00ed Nicardipin 10mg\/ml 02 \u1ed1ng (b\u01a1m ti\u00eam \u0111i\u1ec7n) 03ml\/h.<\/div>\n
\u00a0<\/div>\n
Ng\u00e0y 03 ( 06\/09\/2024): B\u1ec7nh nh\u00e2n t\u1ec9nh, kh\u00f4ng s\u1ed1t, gi\u1ea3m \u0111au v\u00f9ng h\u00f4ng v\u00e0 m\u00f4ng (P), s\u01b0ng b\u1ea7m t\u00edm 1\/3 tr\u00ean \u0111\u00f9i (P), h\u1ea1n ch\u1ebf di \u0111\u1ed9ng ch\u00e2n (P), \u0103n u\u1ed1ng \u0111\u01b0\u1ee3c, kh\u00f4ng ti\u1ec3u \u0111\u01b0\u1ee3c, \u0111\u1eb7t sonde ti\u1ec3u l\u00fac 17 gi\u1edd, n\u01b0\u1edbc ti\u1ec3u v\u00e0ng trong, kh\u00f4ng c\u1eb7n l\u1eafng. \u0110\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh x\u00e9t nghi\u1ec7m t\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u, soi c\u1eb7n l\u1eafng, forritin n\u01b0\u1edbc ti\u1ec3u, s\u1eaft TP.<\/div>\n
\u00a0<\/div>\n
IV. TI\u1ec0N S\u1eec:<\/strong><\/div>\n
\u00a0<\/div>\n
1. Ti\u1ec1n s\u1eed b\u1ea3n th\u00e2n:<\/div>\n
a. Ti\u1ec1n s\u1eed n\u1ed9i khoa:<\/div>\n
– T\u0103ng huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1ch \u0111\u00e2y h\u01a1n 10 n\u0103m, tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb thu\u1ed1c theo toa c\u1ee7a B\u00e1c s\u0129 BV Qu\u1eadn T\u00e2n Ph\u00fa. Huy\u1ebft \u00e1p t\u00e2m thu cao nh\u1ea5t ghi nh\u1eadn l\u00e0 200 mmHg v\u00e0 huy\u1ebft \u00e1p t\u00e2m thu b\u1ec7nh nh\u00e2n th\u1ea5y d\u1ec5 ch\u1ecbu l\u00e0 130 mmHg.<\/div>\n
– B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n IV \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n c\u00e1ch \u0111\u00e2y kho\u1ea3ng 6 th\u00e1ng t\u1ea1i BV Tr\u01b0ng V\u01b0\u01a1ng kh\u00f4ng ghi nh\u1eadn c\u00f3 \u0111i\u1ec1u tr\u1ecb\u00a0<\/div>\n
b. Ti\u1ec1n s\u1eed ngo\u1ea1i khoa: Ph\u1eabu thu\u1eadt u x\u01a1 t\u1eed cung c\u00e1ch \u0111\u00e2y kho\u1ea3ng 20 n\u0103m t\u1ea1i BV Th\u1ed1ng Nh\u1ea5t, ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt m\u1ed5 m\u1edf<\/div>\n
c. Ti\u1ec1n s\u1eed s\u1ea3n khoa:<\/div>\n
– M\u00e3n kinh n\u0103m 40 tu\u1ed5i.<\/div>\n
– PARA: 1001<\/div>\n
d. D\u1ecb \u1ee9ng: Ch\u01b0a ghi nh\u1eadn ti\u1ec1n c\u0103n d\u1ecb \u1ee9ng v\u1edbi th\u1ee9c \u0103n, n\u01b0\u1edbc u\u1ed1ng, thu\u1ed1c \u0111i\u1ec1u tr\u1ecb.<\/div>\n
e. Th\u00f3i quen sinh ho\u1ea1t: v\u1eadn \u0111\u1ed9ng nh\u1eb9, kh\u00f4ng u\u1ed1ng r\u01b0\u1ee3u bia, kh\u00f4ng h\u00fat thu\u1ed1c l\u00e1.<\/div>\n
2.\u00a0 Ti\u1ec1n s\u1eed gia \u0111\u00ecnh: ch\u01b0a ghi nh\u1eadn b\u1ec7nh l\u00ed li\u00ean quan.<\/div>\n
\u00a0<\/div>\n
V. L\u01af\u1ee2C QUA C\u00c1C C\u01a0 QUAN<\/strong><\/div>\n
\u00a0<\/div>\n
– H\u00f4 h\u1ea5p : kh\u00f4ng kh\u00f3 th\u1edf, kh\u00f4ng ho.<\/div>\n
– Tim m\u1ea1ch: kh\u00f4ng \u0111au ng\u1ef1c, kh\u00f4ng h\u1ed3i h\u1ed9p \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c.<\/div>\n
– Ti\u00eau ho\u00e1 : kh\u00f4ng \u0111au b\u1ee5ng , kh\u00f4ng bu\u1ed3n n\u00f4n hay n\u00f4n.\u00a0<\/div>\n
– Ti\u1ebft ni\u1ec7u : b\u00ed ti\u1ec3u, \u0111\u1eb7t sonde ti\u1ec3u, n\u01b0\u1edbc ti\u1ec3u v\u00e0ng trong.<\/div>\n
– Th\u1ea7n kinh : \u0111au v\u00f9ng tr\u00e1n, kh\u00f4ng ch\u00f3ng m\u1eb7t , kh\u00f4ng nh\u00ecn m\u1edd , kh\u00f4ng y\u1ebfu li\u1ec7t.<\/div>\n
– C\u01a1 x\u01b0\u01a1ng kh\u1edbp : \u0111au v\u00f9ng h\u00f4ng v\u00e0 m\u00f4ng (P) , h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp h\u00e1ng (P).\u00a0<\/div>\n
\u00a0<\/div>\n
VI. KH\u00c1M L\u00c2M S\u00c0NG: 18 gi\u1edd 10 ph\u00fat, 06\/09\/2024<\/strong><\/div>\n
\u00a0<\/div>\n
1. T\u1ed5ng qu\u00e1t:<\/div>\n
– B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t<\/div>\n
– Da ni\u00eam m\u1ea1c h\u1ed3ng nh\u1ea1t<\/div>\n
– C\u1ee7ng m\u1ea1c m\u1eaft kh\u00f4ng v\u00e0ng<\/div>\n
– L\u00f4ng t\u00f3c m\u00f3ng kh\u00f4ng d\u1ec5 g\u00e3y r\u1ee5ng, m\u00f3ng c\u00f2n \u0111\u1ed9 cong sinh l\u00fd<\/div>\n
– Kh\u00f4ng ph\u00f9<\/div>\n
– Kh\u00f4ng d\u1ea5u m\u1ea5t n\u01b0\u1edbc<\/div>\n
– Tuy\u1ebfn gi\u00e1p kh\u00f4ng to, h\u1ea1ch ngo\u1ea1i vi kh\u00f4ng s\u1edd ch\u1ea1m<\/div>\n
– M\u1ea1ch quay v\u00e0 m\u1ea1ch mu ch\u00e2n \u0111\u1ec1u r\u00f5 hai b\u00ean, CRT<2s<\/div>\n
– C\u00e2n n\u1eb7ng= 60 kg, chi\u1ec1u cao= 156 cm\u00a0 \u00a0\u2192\u00a0 \u00a0 BMI = 22,26 kg\/m2, th\u1ec3 tr\u1ea1ng b\u00ecnh th\u01b0\u1eddng theo (IDI & WPRO)<\/div>\n
– Sinh hi\u1ec7u:<\/div>\n
M\u1ea1ch: 75 l\u1ea7n\/ph\u00fat<\/div>\n
Nhi\u1ec7t \u0111\u1ed9: 37 0C<\/div>\n
Huy\u1ebft \u00e1p: 150\/80 mm\/Hg<\/div>\n
Nh\u1ecbp th\u1edf: 18 l\u1ea7n\/ph\u00fat<\/div>\n
2. Kh\u00e1m h\u1ec7 c\u01a1 quan:<\/div>\n
a. H\u1ec7 tim m\u1ea1ch:<\/div>\n
– L\u1ed3ng ng\u1ef1c c\u00e2n \u0111\u1ed1i, di \u0111\u1ed9ng \u0111\u1ec1u theo nh\u1ecbp th\u1edf, kh\u00f4ng u, kh\u00f4ng s\u1eb9o, kh\u00f4ng sao m\u1ea1ch, kh\u00f4ng tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7.<\/div>\n
– Kh\u00f4ng \u1ed5 \u0111\u1eadp b\u1ea5t th\u01b0\u1eddng.<\/div>\n
– M\u1ecfm tim \u1edf khoang li\u00ean s\u01b0\u1eddn IV \u0111\u01b0\u1eddng trung \u0111\u00f2n tr\u00e1i, di\u1ec7n \u0111\u1eadp 1x2cm.<\/div>\n
– Harzer (-), rung mi\u00eau (-), d\u1ea5u n\u1ea3y tr\u01b0\u1edbc ng\u1ef1c (-).<\/div>\n
– T1, T2 \u0111\u1ec1u r\u00f5, kh\u00f4ng \u00e2m th\u1ed5i.<\/div>\n
b. H\u1ec7 h\u00f4 h\u1ea5p:<\/div>\n
– L\u1ed3ng ng\u1ef1c c\u00e2n \u0111\u1ed1i, kh\u00f4ng co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5, kh\u00f4ng u, kh\u00f4ng s\u1eb9o m\u1ed5 c\u0169.<\/div>\n
– Rung thanh \u0111\u1ec1u hai b\u00ean.<\/div>\n
– G\u00f5 trong.<\/div>\n
– R\u00ec r\u00e0o ph\u1ebf nang \u00eam d\u1ecbu hai ph\u1ebf tr\u01b0\u1eddng, kh\u00f4ng nghe ran b\u1ec7nh l\u00ed.<\/div>\n
\u00a0<\/div>\n
c. H\u1ec7 ti\u00eau h\u00f3a:<\/div>\n
– B\u1ee5ng c\u00e2n \u0111\u1ed1i, di \u0111\u1ed9ng \u0111\u1ec1u theo nh\u1ecbp th\u1edf, kh\u00f4ng u c\u1ee5c, s\u1eb9o m\u1ed5 v\u00f9ng h\u1ea1 v\u1ecb k\u00edch th\u01b0\u1edbc # 8×0,5cm.<\/div>\n
– Nhu \u0111\u1ed9ng ru\u1ed9t 12 l\u1ea7n\/2p, kh\u00f4ng \u00e2m th\u1ed5i \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng.<\/div>\n
– B\u1ee5ng g\u00f5 trong.<\/div>\n
– B\u1ee5ng m\u1ec1m, gan l\u00e1ch kh\u00f4ng s\u1edd ch\u1ea1m.<\/div>\n
– Kh\u00f4ng \u0111i\u1ec3m \u0111au khu tr\u00fa.<\/div>\n
d. H\u1ec7 ti\u1ebft ni\u1ec7u<\/div>\n
– V\u00f9ng h\u1ed1 th\u1eaft l\u01b0ng kh\u00f4ng u, kh\u00f4ng s\u1eb9o , v\u00f9ng h\u00f4ng l\u01b0ng (P) c\u00f3 m\u1ea3ng b\u1ea7m t\u00edm.<\/div>\n
– Ch\u1ea1m th\u1eadn (-)<\/div>\n
– C\u1ea7u b\u00e0ng quang (-)<\/div>\n
– Kh\u00f4ng \u0111i\u1ec3m \u0111au ni\u1ec7u qu\u1ea3n tr\u00ean v\u00e0 gi\u1eefa 02 b\u00ean.<\/div>\n
e. H\u1ec7 th\u1ea7n kinh:<\/div>\n
– C\u1ed5 m\u1ec1m<\/div>\n
– Kh\u00f4ng d\u1ea5u th\u1ea7n kinh \u0111\u1ecbnh v\u1ecb, kh\u00f4ng d\u1ea5u run v\u1eaby.<\/div>\n
f. H\u1ec7 c\u01a1 x\u01b0\u01a1ng kh\u1edbp<\/div>\n
– Nh\u00ecn:\u00a0<\/div>\n
B\u1ec7nh nh\u00e2n n\u1eb1m tr\u00ean gi\u01b0\u1eddng, \u0111ang n\u1eb9p \u0111\u00f9i c\u1eb3ng b\u00e0n ch\u00e2n (P) ch\u1ed1ng xoay, th\u00e1o n\u1eb9p \u0111\u00e1nh gi\u00e1:<\/div>\n
+ Kh\u00f4ng c\u00f3 v\u1ebft th\u01b0\u01a1ng da, kh\u00f4ng x\u00e2y x\u00e1t da, kh\u00f4ng b\u00f3ng n\u01b0\u1edbc, c\u00e1c ng\u00f3n ch\u00e2n h\u1ed3ng 2 b\u00ean ch\u00e2n<\/div>\n
+ Ch\u00e2n (P) xoay ngo\u00e0i.<\/div>\n
+ Ch\u00e2n (P) ng\u1eafn h\u01a1n ch\u00e2n (T) #4cm.<\/div>\n
+ V\u00f9ng 1\/3 tr\u00ean \u0111\u00f9i (P) s\u01b0ng, b\u1ea7m t\u00edm<\/div>\n
+ H\u1ea1n ch\u1ebf kh\u00e9p d\u1ea1ng \u0111\u00f9i (P)<\/div>\n
– S\u1edd\u00a0<\/div>\n
+ S\u1edd chi \u1ea5m, b\u1eaft m\u1ea1ch mu ch\u00e2n v\u00e0 m\u1ea1ch kho\u00e8o \u0111\u1ec1u, r\u00f5 hai b\u00ean ch\u00e2n.<\/div>\n
+ C\u1ea3m gi\u00e1c 02 b\u00ean ch\u00e2n c\u00f2n, kh\u00f4ng t\u00ea.<\/div>\n
+ Kh\u00f4ng ghi nh\u1eadn h\u00f5m kh\u1edbp r\u1ed7ng, d\u1ea5u l\u00f2 xo (b\u1ec7nh nh\u00e2n \u0111au nhi\u1ec1u kh\u00f4ng kh\u00e1m \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c)<\/div>\n
+ S\u1ee9c c\u01a1 ch\u00e2n (P) 4\/5, ch\u00e2n (T) 5\/5<\/div>\n
+ Tr\u01b0\u01a1ng l\u1ef1c c\u01a1:<\/div>\n
\u00a0 \u00a0 \u00a0 \u0110\u1ed9 ch\u1eafc: hai b\u00ean ch\u00e2n \u0111\u1ec1u nhau<\/div>\n
\u00a0 \u00a0 \u00a0 \u0110\u1ed9 do\u00e3i: kh\u00f4ng \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c do b\u1ec7nh nh\u00e2n \u0111au<\/div>\n
\u00a0 \u00a0 \u00a0 \u0110\u1ed9 ve v\u1eaby: kh\u00f4ng \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c do b\u1ec7nh nh\u00e2n \u0111au.<\/div>\n
+ \u0110i\u1ec3m \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i (P) \u1ea5n \u0111au ch\u00f3i, \u1ea5n v\u00f9ng tam gi\u00e1c Scarpa (P)\u00a0 \u0111au<\/div>\n
– \u0110o:<\/div>\n
+ Chi\u1ec1u d\u00e0i x\u01b0\u01a1ng \u0111\u00f9i t\u01b0\u01a1ng \u0111\u1ed1i (gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean \u2013 m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i): Ch\u00e2n (T) 42cm –\u00a0 ch\u00e2n (P) 39cm<\/div>\n
+ Chi\u1ec1u d\u00e0i x\u01b0\u01a1ng \u0111\u00f9i tuy\u1ec7t \u0111\u1ed1i (m\u1ea5u chuy\u1ec3n l\u1edbn \u2013 m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i): Ch\u00e2n (T) 38cm – ch\u00e2n (P) 35cm<\/div>\n
+ Chu vi (c\u00e1ch gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean 15 cm):\u00a0<\/div>\n
Ch\u00e2n (P) 62cm, ch\u00e2n (T) 41cm<\/div>\n
– Kh\u00e1m v\u1eadn \u0111\u1ed9ng kh\u1edbp h\u00e1ng (T): kh\u00f4ng gi\u1edbi h\u1ea1n v\u1eadn \u0111\u1ed9ng<\/div>\n
– Kh\u00e1m v\u1eadn \u0111\u1ed9ng kh\u1edbp h\u00e1ng (P):g\u1ea5p – du\u1ed7i kh\u00f4ng kh\u00e1m \u0111\u01b0\u1ee3c, d\u1ea1ng – kh\u00e9p, xoay trong – xoay ngo\u00e0i b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c do \u0111au.<\/div>\n
g. Kh\u00e1m c\u00e1c c\u01a1 quan kh\u00e1c: ch\u01b0a ghi nh\u1eadn c\u00f3 b\u1ea5t th\u01b0\u1eddng.<\/div>\n
\u00a0<\/div>\n
VI. T\u00d3M T\u1eaeT B\u1ec6NH \u00c1N<\/strong><\/p>\n<\/div>\n
BN n\u1eef, 79 tu\u1ed5i v\u00e0o vi\u1ec7n v\u00ec \u0111au v\u00f9ng h\u00f4ng (P) ng\u00e0y 3 do TNSH. Qua h\u1ecfi b\u1ec7nh v\u00e0 th\u0103m kh\u00e1m l\u00e2m s\u00e0ng ghi nh\u1eadn:<\/div>\n
– Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:<\/div>\n
+ \u0110au v\u00f9ng h\u00f4ng v\u00e0 m\u00f4ng (P) ( VAS 8\/10).<\/div>\n
+ S\u01b0ng b\u1ea7m t\u00edm v\u00f9ng b\u1eb9n \u2013 \u0111\u00f9i (P)<\/div>\n
+ B\u00ed ti\u1ec3u, \u0111\u00e3 \u0111\u1eb7t sonde ti\u1ec3u.<\/div>\n
– Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:\u00a0<\/div>\n
+ Ni\u00eam h\u1ed3ng nh\u1ea1t<\/div>\n
+ Kh\u00f4ng v\u1ebft th\u01b0\u01a1ng, x\u00e2y x\u00e1t hai b\u00ean ch\u00e2n.<\/div>\n
+ Ch\u00e2n (P) bi\u1ebfn d\u1ea1ng xoay ngo\u00e0i, s\u01b0ng b\u1ea7m t\u00edm 1\/3 tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i (P).<\/div>\n
+ Chi\u1ec1u d\u00e0i ch\u00e2n (P) ng\u1eafn h\u01a1n chi\u1ec1u d\u00e0i ch\u00e2n (T) #4cm<\/div>\n
+ Ch\u00e2n \u1ea5m, m\u1ea1ch khoeo, mu ch\u00e2n (P) b\u1eaft r\u00f5, kh\u00f4ng t\u00ea.\u00a0\u00a0<\/div>\n
+ \u1ea4n \u0111au ch\u00f3i \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i (P), \u1ea5n \u0111au v\u00f9ng tam gi\u00e1c Scarpa (P)\u00a0\u00a0<\/div>\n
+ Chu vi \u0111\u00f9i (P) l\u1edbn h\u01a1n \u0111\u00f9i (T).<\/div>\n
+ V\u1eadn \u0111\u1ed9ng h\u1ea1n ch\u1ebf g\u1ea5p – du\u1ed7i, d\u1ea1ng – kh\u00e9p, xoay trong – xoay ngo\u00e0i h\u00f4ng (P<\/div>\n
– Ti\u1ec1n s\u1eed: T\u0103ng huy\u1ebft \u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n IV kh\u00f4ng \u0111i\u1ec1u tr\u1ecb.<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 U x\u01a1 t\u1eed cung \u0111\u00e3 ph\u1eabu thu\u1eadt.<\/div>\n
\nVII. \u0110\u1eb6T V\u1ea4N \u0110\u1ec0<\/strong><\/p>\n<\/div>\n
D\u1ea5u hi\u1ec7u g\u00e3y \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i (P).<\/div>\n
H\u1ed9i ch\u1ee9ng thi\u1ebfu m\u00e1u m\u1ea1n<\/div>\n
Osteoporosis<\/div>\n
Ti\u1ec1n c\u0103n: t\u0103ng huy\u1ebft \u00e1p, b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n IV, u x\u01a1 t\u1eed cung \u0111\u00e3 ph\u1eabu thu\u1eadt.<\/div>\n
\nVIII. CH\u1ea8N \u0110O\u00c1N S\u01a0 B\u1ed8 V\u00c0 CH\u1ea8N \u0110O\u00c1N PH\u00c2N BI\u1ec6T<\/strong><\/div>\n
\n– Ch\u1ea9n \u0111o\u00e1n s\u01a1 b\u1ed9: G\u00e3y k\u00edn li\u00ean m\u1ea5u chuy\u1ec3n x\u01b0\u01a1ng \u0111\u00f9i (P) ng\u00e0y 3 do TNSH, ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng \u2013 Thi\u1ebfu m\u00e1u m\u1ea1n\/ T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 III theo ESC\/ESH 2018- B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n IV – U x\u01a1 t\u1eed cung \u0111\u00e3 ph\u1eabu thu\u1eadt<\/div>\n
– Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:\u00a0<\/div>\n
G\u00e3y k\u00edn c\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i (P) ng\u00e0y 03 do TNSH, ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng \u2013 Thi\u1ebfu m\u00e1u m\u1ea1n\/ T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 III theo ESC\/ESH 2018 – B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n IV – U x\u01a1 t\u1eed cung \u0111\u00e3 ph\u1eabu thu\u1eadt.<\/div>\n
Tr\u1eadt kh\u1edbp h\u00e1ng (P) ng\u00e0y 03 do TNSH, ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng \u2013 Thi\u1ebfu m\u00e1u m\u1ea1n\/ T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 III theo ESC\/ESH 2018 \u2013 B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n IV \u2013 U x\u01a1 t\u1eed cung \u0111\u00e3 ph\u1eabu thu\u1eadt<\/div>\n
\nIX. BI\u1ec6N LU\u1eacN L\u00c2M S\u00c0NG<\/strong><\/div>\n
\n\u00a0 \u00a0 B\u1ec7nh nh\u00e2n n\u1eef, 79 tu\u1ed5i nh\u1eadp vi\u1ec7n v\u00ec \u0111au v\u00e0 h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng v\u00f9ng h\u00f4ng (P) sau tai n\u1ea1n sinh ho\u1ea1t. B\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 g\u00e3y x\u01b0\u01a1ng \u0111\u00f9i v\u1edbi c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp ng\u00e3 \u0111\u1eadp v\u00f9ng m\u00f4ng (P) xu\u1ed1ng n\u1ec1n c\u1ee9ng, t\u01b0 th\u1ebf \u0111\u00f9i d\u1ea1ng, sau ng\u00e3 c\u00f3 \u0111au v\u00f9ng h\u00f4ng v\u00e0 m\u00f4ng (P), kh\u1edbp h\u00e1ng (P) b\u1ecb h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng.Ngo\u00e0i ra tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a d\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafc g\u00e3y x\u01b0\u01a1ng \u0111\u00f9i (P) g\u1ed3m: ch\u00e2n (P) bi\u1ebfn d\u1ea1ng xoay ngo\u00e0i, chi (P) ng\u1eafn h\u01a1n chi (T). \u0110\u1ed3ng th\u1eddi c\u00f3 k\u00e8m c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a d\u1ea5u hi\u1ec7u kh\u00f4ng ch\u1eafc ch\u1eafc g\u00e3y x\u01b0\u01a1ng nh\u01b0: s\u01b0ng b\u1ea7m t\u00edm 1\/3 v\u00f9ng tr\u00ean \u0111\u00f9i (P), \u1ea5n \u0111au ch\u00f3i \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i (P)v\u00e0 v\u00f9ng tam gi\u00e1c Scarpa .Ngh\u0129 \u0111\u1ebfn g\u00e3y k\u00edn v\u00ec sau tai n\u1ea1n kh\u00f4ng th\u1ea5y \u0111\u1ea7u x\u01b0\u01a1ng g\u00e3y xuy\u00ean da th\u00f4ng v\u1edbi b\u00ean ngo\u00e0i hay v\u00e1ng m\u1ee1 th\u00f4ng ra ngo\u00e0i.<\/div>\n
\u00a0<\/div>\n
\u00a0 Kh\u00e1m ghi nh\u1eadn b\u1ec7nh nh\u00e2n c\u00f3 \u0111au v\u00f9ng h\u00f4ng v\u00e0 m\u00f4ng (P), h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp h\u00e1ng (P), ch\u00e2n (P) xoay ngo\u00e0i, \u1ea5n \u0111au ch\u00f3i \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i, s\u01b0ng n\u1ec1 b\u1ea7m t\u00edm 1\/3 tr\u00ean \u0111\u00f9i (P) v\u00e0 d\u1ea5u hi\u1ec7u b\u1ea7m t\u00edm lan r\u1ed9ng do v\u00f9ng li\u00ean m\u1ea5u chuy\u1ec3n c\u00f3 nhi\u1ec1u m\u1ea1ch m\u00e1u nu\u00f4i n\u00ean khi t\u1ed5n th\u01b0\u01a1ng v\u1ecb tr\u00ed n\u00e0y s\u1ebd \u0111\u1ed3ng th\u1eddi th\u01b0\u01a1ng t\u1ed5n \u0111\u1ebfn nhi\u1ec1u m\u1ea1ch m\u00e1u d\u1eabn \u0111\u1ebfn xu\u1ea5t huy\u1ebft v\u00e0 t\u1ee5 m\u00e1u l\u01b0\u1ee3ng nhi\u1ec1u v\u00e0 h\u00ecnh th\u00e0nh v\u1ebft b\u1ea7m t\u00edm ng\u00e0y c\u00e0ng lan r\u1ed9ng, chi\u1ec1u d\u00e0i tuy\u1ec7t \u0111\u1ed1i x\u01b0\u01a1ng \u0111\u00f9i (P) ng\u1eafn h\u01a1n x\u01b0\u01a1ng \u0111\u00f9i (T)\u00a0 n\u00ean ngh\u0129 nhi\u1ec1u \u0111\u1ebfn g\u00e3y li\u00ean m\u1ea5u chuy\u1ec3n, tuy nhi\u00ean \u1ea5n v\u00f9ng tam gi\u00e1c Scarpa b\u1ec7nh nh\u00e2n \u0111au n\u00ean kh\u00f4ng lo\u1ea1i tr\u1eeb g\u00e3y c\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i.Ngh\u0129 \u00edt h\u01a1n \u0111\u1ebfn tr\u1eadt kh\u1edbp h\u00e1ng v\u00ec kh\u00e1m l\u00e2m s\u00e0ng kh\u00f4ng ghi nh\u1eadn c\u00f3 h\u00f5m kh\u1edbp r\u1ed7ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t c\u1ea7n \u0111\u1ec1 ngh\u1ecb c\u1eadn l\u00e2m s\u00e0ng X – quang x\u01b0\u01a1ng \u0111\u00f9i (P) th\u1eb3ng \u2013 nghi\u00eang v\u00e0 X- quang khung ch\u1eadu th\u1eb3ng.<\/div>\n
\u00a0<\/div>\n
\u00a0 Hi\u1ec7n t\u1ea1i b\u1ec7nh ng\u00e0y 03 ch\u01b0a ghi nh\u1eadn c\u00f3 c\u00e1c bi\u1ebfn ch\u1ee9ng:\u00a0<\/div>\n
– S\u1ed1c ch\u1ea5n th\u01b0\u01a1ng \u00edt ngh\u0129 v\u00ec b\u1ec7nh nh\u00e2n c\u00f3 HA: 150\/80 mmHg, m\u1ea1ch 75 l\/p v\u00e0 ch\u1ec9 s\u1ed1 s\u1ed1c CSC:0,9375<1, ni\u00eam h\u1ed3ng nh\u1ea1t, tay ch\u00e2n \u1ea5m, CRT<2s.<\/div>\n
– Bi\u1ebfn ch\u1ee9ng ch\u00e8n \u00e9p khoang do b\u1ec7nh nh\u00e2n gi\u1ea3m \u0111au, kh\u00f4ng t\u00ea, b\u1ec7nh kh\u00f4ng c\u00f3 c\u1ea3m gi\u00e1c c\u0103ng c\u1ee9ng (li\u1ec7t), b\u1eaft m\u1ea1ch mu ch\u00e2n, m\u1ea1ch khoe 02 b\u00ean \u0111\u1ec1u r\u00f5 kh\u00f4ng y\u1ebfu hay gi\u1ea3m, chi h\u1ed3ng kh\u00f4ng t\u00e1i nh\u1ea1t, tuy nhi\u00ean v\u1eabn c\u1ea7n theo d\u00f5i v\u00ec bi\u1ebfn ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 x\u1ea3y ra k\u00e9o d\u00e0i \u0111\u1ebfn 6 ng\u00e0y sau ch\u1ea5n th\u01b0\u01a1ng.<\/div>\n
– C\u00e1c bi\u1ebfn ch\u1ee9ng thuy\u00ean t\u1eafc m\u1ea1ch m\u00e1u do m\u1ee1 v\u00e0 bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh \u00edt ngh\u0129 \u0111\u1ebfn do \u0111\u1ea7u ng\u00f3n chi b\u1ec7nh nh\u00e2n \u1ea5m, kh\u00f4ng t\u00ea, c\u1ea3m gi\u00e1c n\u00f4ng s\u00e2u c\u00f2n, b\u1eaft m\u1ea1ch khoeo – m\u1ea1ch mu ch\u00e2n (P) b\u1ec7nh nh\u00e2n c\u00f2n r\u00f5.<\/div>\n
– Kh\u00e1m 02 ch\u00e2n ghi nh\u1eadn kh\u00f4ng c\u00f3 n\u1ed1t ph\u1ecfng n\u01b0\u1edbc, \u0111\u1ea7u chi kh\u00f4ng s\u01b0ng n\u1ec1 => kh\u00f4ng r\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng\u00a0<\/div>\n
\u00a0 \u00a0B\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u m\u1ea1n t\u00ednh v\u00ec l\u00e2m s\u00e0ng kh\u00e1m th\u1ea5y ni\u00eam b\u1ec7nh nh\u00e2n h\u1ed3ng nh\u1ea1t, ti\u1ec1n s\u1eed b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n IV=> C\u1ea7n \u0111\u1ec1 ngh\u1ecb c\u1eadn l\u00e2m s\u00e0ng t\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i vi \u0111\u1ec3 \u0111\u00e1nh gi\u00e1.<\/div>\n
\u00a0 \u00a0 B\u1ec7nh nh\u00e2n l\u00e0 n\u1eef gi\u1edbi, cao tu\u1ed5i, m\u00e3n kinh v\u00e0 c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n IV l\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y lo\u00e3ng x\u01b0\u01a1ng \u1edf b\u1ec7nh nh\u00e2n n\u00e0y => \u0110o m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng<\/div>\n
B\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng b\u00ed ti\u1ec3u v\u00e0 tri\u1ec7u ch\u1ee9ng n\u00e0y v\u1eeba m\u1edbi x\u1ea3y ra c\u00f3 th\u1ec3 ngh\u0129 \u0111\u1ebfn do nhi\u1ec5m tr\u00f9ng, vi\u00eam \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u c\u1ea7n \u0111\u1ec1 ngh\u1ecb t\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u.\u00a0<\/div>\n
B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed t\u0103ng huy\u1ebft \u00e1p \u0111ang \u0111i\u1ec1u tr\u1ecb, huy\u1ebft \u00e1p t\u00e2m thu cao nh\u1ea5t t\u1eebng ghi nh\u1eadn 200mmHg v\u00e0 huy\u1ebft \u00e1p t\u00e2m thu b\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y d\u1ec5 ch\u1ecbu l\u00e0 130 => T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 III theo ESC 2018.<\/div>\n
Ti\u1ec1n s\u1eed b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n IV kh\u00f4ng \u0111i\u1ec1u tr\u1ecb\u00a0 => \u0111\u1ec1 ngh\u1ecb c\u1eadn l\u00e2m s\u00e0ng sinh h\u00f3a m\u00e1u: Creatinin, Ure, eGFR.<\/div>\n
X. \u0110\u1ec0 NGH\u1eca C\u1eacN L\u00c2M S\u00c0NG V\u00c0 K\u1ebeT QU\u1ea2<\/div>\n
1. C\u1eadn l\u00e2m s\u00e0ng x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n:\u00a0<\/div>\n
– X – quang \u0111\u00f9i (P) th\u1eb3ng nghi\u00eang.<\/div>\n
– X – quang khung ch\u1eadu th\u1eb3ng.\u00a0<\/div>\n
– \u0110o m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng<\/div>\n
– T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u.<\/div>\n
2. C\u1eadn l\u00e2m s\u00e0ng th\u01b0\u1eddng quy:<\/div>\n
– T\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i vi.<\/div>\n
– Sinh h\u00f3a m\u00e1u: AST, ALT, Ure, Creatinin, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3.<\/div>\n
– ECG<\/div>\n
– X – quang ng\u1ef1c th\u1eb3ng<\/div>\n
3. C\u1eadn l\u00e2m s\u00e0ng h\u1ed7 tr\u1ee3 \u0111i\u1ec1u tr\u1ecb: si\u00eau \u00e2m tim,…<\/div>\n
4. K\u1ebft qu\u1ea3 c\u1eadn l\u00e2m s\u00e0ng:<\/div>\n
– TPTTBM, nh\u00f3m m\u00e1u:<\/div>\n
04\/0906\/09<\/div>\n
WBC 13.09 11.80 K\/uL<\/div>\n
NEU% 86.4 70.03 %<\/div>\n
LYM% 5.7 14.8 %<\/div>\n
MONO % 7.8 11.7 %<\/div>\n
RBC 2.53 3.83 M\/uL<\/div>\n
HGB 8.0 12.2 g\/dL<\/div>\n
HCT 25.2 35.9 %<\/div>\n
MCV 99.9 93.6 fL<\/div>\n
MCH 31.6 31.7 Pg<\/div>\n
MCHC 31.7 33.9 g\/dL<\/div>\n
PLT 262 268 K\/uL<\/div>\n
Nh\u00f3m m\u00e1u ABO, RhO, (+)<\/div>\n
\u00a0K\u1ebft lu\u1eadn:\u00a0<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 Ch\u1ec9 s\u1ed1 b\u1ea1ch c\u1ea7u t\u0103ng \u01b0u th\u1ebf NEU% nh\u01b0ng tr\u00ean l\u00e2m s\u00e0ng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 h\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng ngh\u0129 nhi\u1ec1u t\u0103ng b\u1ea1ch c\u1ea7u do ph\u1ea3n \u1ee9ng \u0111\u1ec1 ngh\u1ecb l\u00e0m th\u00eam CRP\u00a0<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 Ch\u1ec9 s\u1ed1 Hb ( ng\u00e0y 04\/09): 8.0 g\/dl gi\u1ea3m, MCV, MCH trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng => thi\u1ebfu m\u00e1u h\u1ed3ng c\u1ea7u \u0111\u1eb3ng s\u1eafc \u0111\u1eb3ng b\u00e0o m\u1ee9c \u0111\u1ed9 trung b\u00ecnh.<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 Ch\u1ec9 s\u1ed1 Hb ( ng\u00e0y 06\/09): 12.2 g\/dL t\u0103ng sau khi \u0111\u01b0\u1ee3c truy\u1ec1n m\u00e1u\u00a0<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 Ch\u1ec9 s\u1ed1 ti\u1ec3u c\u1ea7u trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng.<\/div>\n
– Sinh h\u00f3a m\u00e1u:(04\/09)<\/div>\n
Glucose m\u00e1u 11.6 mmol\/L<\/div>\n
Ure 20.8 mmol\/l<\/div>\n
Creatinin 252 Mmol\/L<\/div>\n
eGFR 16.97 mL\/phut<\/div>\n
Cl- 110 mmol\/L<\/div>\n
Ph\u1ea3n \u1ee9ng CRP 26.9 mg\/L<\/div>\n
K\u1ebft lu\u1eadn:<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0Glucose m\u00e1u b\u1ea5t k\u00ec t\u0103ng cao => \u0111\u1ec1 ngh\u1ecb l\u00e0m l\u1ea1i \u0111\u01b0\u1eddng huy\u1ebft l\u00fac \u0111\u00f3i<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0\u0110\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn 16.97 mL\/phut gi\u1ea3m k\u00e8m theo ch\u1ec9 s\u1ed1 creatinin 252 Mmol\/L t\u0103ng => G\u1ee3i \u00fd t\u00ecnh tr\u1ea1ng gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn m\u1ee9c \u0111\u1ed9 IV.<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0Ch\u1ec9 s\u1ed1 CRP t\u0103ng cao g\u1ee3i \u00fd t\u00ecnh vi\u00eam, tuy nhi\u00ean trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ea5n th\u01b0\u01a1ng n\u00ean ngh\u0129 nhi\u1ec1u t\u0103ng CRP do ph\u1ea3n \u1ee9ng (stress ch\u1ea5n th\u01b0\u01a1ng v\u00e0 t\u1ed5n th\u01b0\u01a1ng m\u00f4).<\/div>\n
\u00a0<\/div>\n
– X\u00e9t nghi\u1ec7m \u0111\u01b0\u1eddng m\u00e1u mao m\u1ea1ch t\u1ea1i gi\u01b0\u1eddng (05\/09) : 5.7 mmol\/L =>\u0110\u01b0\u1eddng huy\u1ebft \u0111\u00f3i b\u1ec7nh nh\u00e2n trong m\u1ee9c 5,6-6,9 mmol\/L l\u00e0 ti\u1ec1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/div>\n
– \u0110\u1ecbnh l\u01b0\u1ee3ng Glucose, CRP (06\/09)<\/div>\n
Glucose m\u00e1u 7.48 mmol\/L<\/div>\n
Ph\u1ea3n \u1ee9ng CRP 40.7 mg\/L<\/div>\n
– K\u1ebft lu\u1eadn:\u00a0<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0Glucose m\u00e1u b\u1ea5t k\u00ec t\u0103ng => \u0111\u1ec1 ngh\u1ecb l\u00e0m HbA1c \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0Ch\u1ec9 s\u1ed1 CRP t\u0103ng cao g\u1ee3i \u00fd t\u00ecnh tr\u1ea1ng vi\u00eam trong c\u01a1 th\u1ec3 ho\u1eb7c ph\u1ea3n \u1ee9ng c\u1ee7a c\u01a1 th\u1ec3 v\u1edbi ch\u1ea5n th\u01b0\u01a1ng.<\/div>\n
– ECG:\u00a0<\/div>\n
B\u1ec7nh nh\u00e2n n\u1eef 79 tu\u1ed5i.<\/div>\n
\u0110o \u0111i\u1ec7n tim ng\u00e0y 04\/09\/2024<\/div>\n
Nh\u1ecbp xoang \u0111\u1ec1u, t\u1ea7n s\u1ed1 75 l\/p<\/div>\n
Tr\u1ee5c QRS trung gian<\/div>\n
– X – quang ng\u1ef1c th\u1eb3ng: B\u1ec7nh nh\u00e2n n\u1eef, 79 tu\u1ed5i, phim ch\u1ee5p ng\u00e0y 04\/09\/2024<\/div>\n
\u00a0<\/div>\n
\n
\"H\u00ecnh
1<\/figcaption><\/figure>\n<\/div>\n
\u00a0<\/div>\n
K\u1ebft qu\u1ea3: B\u00f3ng tim kh\u00f4ng l\u1edbn, cung \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u00f3ng v\u00f4i.<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Kh\u00f4ng th\u1ea5y t\u1ed5n th\u01b0\u01a1ng m\u00e0ng ph\u1ed5i, nhu m\u00f4 ph\u1ed5i.<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0X\u01b0\u01a1ng l\u1ed3ng ng\u1ef1c b\u00ecnh th\u01b0\u1eddng<\/div>\n
– X – quang\u00a0 kh\u1edbp h\u00e1ng nghi\u00eang v\u00e0 kh\u1edbp h\u00e1ng th\u1eb3ng 02 b\u00ean.<\/div>\n
\n
\"H\u00ecnh
2<\/figcaption><\/figure>
\"H\u00ecnh
3<\/figcaption><\/figure>\n<\/div>\n
\u00a0<\/div>\n
+ B\u1ec7nh nh\u00e2n n\u1eef, 79 tu\u1ed5i, phim ch\u1ee5p ng\u00e0y 04\/09\/2024<\/div>\n
+ T\u01b0 th\u1ebf ch\u1ee5p: th\u1eb3ng<\/div>\n
+\u00a0 Ch\u1ea5t l\u01b0\u1ee3ng phim:<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0Ti\u00eau chu\u1ea9n phim: c\u01b0\u1eddng \u0111\u1ed9 tia \u0111\u1ee7, phim ch\u1ee5p \u0111\u1ee7 qua hai kh\u1edbp tr\u00ean v\u00e0 d\u01b0\u1edbi \u1ed5 g\u00e3y.<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0T\u1ed5n th\u01b0\u01a1ng: Kh\u00f4ng ghi nh\u1eadn t\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m, kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng kh\u1edbp k\u00e8m theo.<\/div>\n
G\u00e3y li\u00ean m\u1ea5u chuy\u1ec3n x\u01b0\u01a1ng \u0111\u00f9i (P), \u0111\u01b0\u1eddng g\u00e3y ph\u1ee9c t\u1ea1p c\u00f3 m\u1ea3nh r\u1eddi, di l\u1ec7ch ch\u1ed3ng ng\u1eafn.<\/div>\n
K\u1ebft lu\u1eadn: G\u00e3y li\u00ean m\u1ea5u chuy\u1ec3n x\u01b0\u01a1ng \u0111\u00f9i (P) 31A2-1 theo AO<\/div>\n
– \u0110o m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p DEXA 2 v\u1ecb tr\u00ed:<\/div>\n
\u00a0 \u00a0B\u1ec7nh nh\u00e2n n\u1eef, 79 tu\u1ed5i<\/div>\n
\u00a0 \u00a0M\u00f4 t\u1ea3: M\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng v\u00f9ng c\u1ed9t s\u1ed1ng th\u1eaft l\u01b0ng: T \u2013 score \u2013 3.3\u00a0<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 M\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng v\u00f9ng c\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i: T \u2013 score \u2013 3.5<\/div>\n
\u00a0 \u00a0K\u1ebft lu\u1eadn: lo\u00e3ng x\u01b0\u01a1ng c\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 c\u1ed9t s\u1ed1ng th\u1eaft l\u01b0ng.\u00a0<\/div>\n
– Si\u00eau \u00e2m tim:\u00a0<\/div>\n
\u00a0B\u1ec7nh nh\u00e2n n\u1eef 79 tu\u1ed5i<\/div>\n
\u00a0Si\u00eau \u00e2m ng\u00e0y 04\/09\/2024<\/div>\n
\u00a0Ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i b\u1ea3o t\u1ed3n, EF 68%<\/div>\n
\u00a0V\u00f4i h\u00f3a v\u00f2ng van 2 l\u00e1<\/div>\n
\u00a0H\u1edf van 3 l\u00e1 1\/4<\/div>\n
\u00a0C\u00e1c bu\u1ed3ng tim kh\u00f4ng d\u00e3n<\/div>\n
\u00a0Th\u00e0nh tim kh\u00f4ng d\u00e0y<\/div>\n
\u00a0V\u00e1ch li\u00ean nh\u0129, li\u00ean th\u1ea5t nguy\u00ean v\u1eb9n<\/div>\n
\u00a0 Kh\u00f4ng r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng, PAPs= 25mmHg, kh\u00f4ng t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. Kh\u00f4ng d\u1ecbch m\u00e0ng tim, kh\u00f4ng huy\u1ebft kh\u1ed1i trong bu\u1ed3ng tim<\/div>\n
\u00a0<\/div>\n
XI. CH\u1ea8N \u0110O\u00c1N X\u00c1C \u0110\u1ecaNH<\/strong><\/p>\n<\/div>\n
\u00a0 \u00a0 G\u00e3y k\u00edn li\u00ean m\u1ea5u chuy\u1ec3n x\u01b0\u01a1ng \u0111\u00f9i (P) ph\u00e2n \u0111\u1ed9 31A2-1 theo AO ng\u00e0y th\u1ee9 03 do TNSH, ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng – Thi\u1ebfu m\u00e1u m\u1ea1n \u0111\u1eb3ng s\u1eaft \u0111\u1eb3ng b\u00e0o – Lo\u00e3ng x\u01b0\u01a1ng \u2013 Theo d\u00f5i \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2\/ T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 III theo ESC 2018 – B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n IV – U x\u01a1 t\u1eed cung \u0111\u00e3 ph\u1eabu thu\u1eadt.<\/div>\n
XII. \u0110I\u1ec0U TR\u1eca\u00a0<\/div>\n
1. H\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb<\/div>\n
– B\u1ea5t \u0111\u1ed9ng<\/div>\n
– Gi\u1ea3m \u0111au<\/div>\n
– Gi\u1ea3m s\u01b0ng n\u1ec1<\/div>\n
– Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 huy\u1ebft \u00e1p\u00a0<\/div>\n
– N\u00e2ng t\u1ed5ng tr\u1ea1ng b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc m\u1ed5<\/div>\n
– Ph\u1eabu thu\u1eadt<\/div>\n
2. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3<\/div>\n
– N\u1eb9p \u0111\u00f9i – c\u1eb3ng – b\u00e0n ch\u00e2n ph\u1ea3i ch\u1ed1ng xoay<\/div>\n
– \u1ed4n \u0111\u1ecbnh b\u1ec7nh nh\u00e2n, sau \u0111\u00f3 ph\u1eabu thu\u1eadt \u0111\u00f3ng \u0111inh n\u1ed9i t\u1ee7y c\u00f3 ch\u1ed1t.<\/div>\n
– Theo d\u00f5i sinh hi\u1ec7u bi\u1ebfn ch\u1ee9ng g\u00e3y x\u01b0\u01a1ng<\/div>\n
– Thu\u1ed1c:\u00a0<\/div>\n
Paracetamol 0.5 g\u00a0<\/div>\n
01 vi\u00ean x 3 (u)\u00a0<\/div>\n
Bisoprolol 2,5 mg<\/div>\n
01 vi\u00ean (u)<\/div>\n
Mixtard 30 ( 0,7IU + 0,3 IU)\/1IU<\/div>\n
S\u00e1ng: 10 IU \u2013 Chi\u1ec1u: 5IU<\/div>\n
\u00a0<\/div>\n
XIII. TI\u00caN L\u01af\u1ee2NG<\/strong><\/div>\n
\u00a0<\/div>\n
G\u1ea7n: Trung b\u00ecnh, v\u00ec b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i, c\u00f3 nhi\u1ec1u b\u1ec7nh n\u1ec1n k\u00e8m theo, nguy c\u01a1 t\u00e9 ng\u00e3 cao, s\u1ef1 l\u00e0nh v\u1ebft th\u01b0\u01a1ng di\u1ec5n ra ch\u1eadm, nhi\u1ec5m tr\u00f9ng v\u1ebft m\u1ed5, r\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng.\u00a0<\/div>\n
Xa: Trung b\u00ecnh, th\u1eddi gian h\u1ed3i ph\u1ee5c l\u00e2u s\u1ebd k\u00e9o d\u00e0i th\u1eddi gian n\u1eb1m vi\u1ec7n t\u0103ng nguy c\u01a1 m\u1eafc c\u00e1c b\u1ec7nh nh\u01b0 vi\u00eam ph\u1ed5i b\u1ec7nh vi\u1ec7n, vi\u00eam \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u, teo c\u01a1, bi\u1ebfn ch\u1ee9ng lo\u00e9t do t\u00ec \u0111\u00e8 do b\u1ea5t \u0111\u1ed9ng l\u00e2u, t\u1eed vong.<\/div>\n
\u00a0<\/div>\n
XIV. D\u1ef0 PH\u00d2NG<\/strong><\/div>\n
\u00a0<\/div>\n
Theo d\u00f5i di\u1ec5n bi\u1ebfn b\u1ec7nh h\u00e0ng ng\u00e0y, ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 huy\u1ebft \u00e1p m\u1ee9c m\u1ee5c ti\u00eau.<\/div>\n
Sau ph\u1eabu thu\u1eadt thay b\u0103ng v\u1ebft th\u01b0\u01a1ng, ph\u00f2ng tr\u00e1nh nhi\u1ec5m khu\u1ea9n.<\/div>\n
H\u01b0\u1edbng d\u1eabn c\u00e1c b\u00e0i t\u1eadp v\u1eadt l\u00fd tr\u1ecb li\u1ec7u sau ph\u1eabu thu\u1eadt, t\u1eadp v\u1eadn \u0111\u1ed9ng s\u1edbm.<\/div>\n
Dinh d\u01b0\u1ee1ng \u0111\u1ea7y \u0111\u1ee7, h\u1ee3p l\u00fd.<\/div>\n
Tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 t\u00e1i kh\u00e1m theo h\u1eb9n.<\/div>","protected":false},"featured_media":4256,"comment_status":"open","ping_status":"closed","template":"","tags":[],"chuyen-muc":[188],"class_list":["post-4291","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\/4291","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=4291"}],"version-history":[{"count":3,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4291\/revisions"}],"predecessor-version":[{"id":4298,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4291\/revisions\/4298"}],"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=4291"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=4291"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=4291"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}