{"id":4375,"date":"2024-12-23T16:00:29","date_gmt":"2024-12-23T09:00:29","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=4375"},"modified":"2024-12-23T16:00:29","modified_gmt":"2024-12-23T09:00:29","slug":"ngoai-chan-thuong-chinh-hinh","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/ngoai-chan-thuong-chinh-hinh\/","title":{"rendered":"NGO\u1ea0I CH\u1ea4N TH\u01af\u01a0NG CH\u1ec8NH H\u00ccNH"},"content":{"rendered":"

Danh s\u00e1ch sinh vi\u00ean:
\nL\u00ca GIA KH\u00c1NH HUY\u1ec0N – 207720101031
\nPH\u1ea0M \u0110\u1ed6 \u0110\u0102NG KHOA – 207720101034
\n\u0110O\u00c0N QUANG KI\u00caN – 207720101035
\nL\u1edbp: Y2020
\nNh\u00f3m: 3B\u1ec6NH \u00c1N NGO\u1ea0I CH\u1ea4N TH\u01af\u01a0NG CH\u1ec8NH H\u00ccNH
\nI. H\u00c0NH CH\u00cdNH:<\/strong>
\nH\u1ecd v\u00e0 t\u00ean: L\u00c2M THANH N.
\nGi\u1edbi t\u00ednh: N\u1eef
\nSinh n\u0103m: 03\/10\/1939 (85 tu\u1ed5i)
\nD\u00e2n t\u1ed9c: Hoa
\nNgh\u1ec1 nghi\u1ec7p: Bu\u00f4n b\u00e1n (\u0110\u00e3 ngh\u1ec9 h\u01b0u)
\n\u0110\u1ecba ch\u1ec9: 27 X\u00f3m \u0110\u1ea5t, Ph\u01b0\u1eddng 8, Qu\u1eadn 11, Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh
\nM\u00e3 s\u1ed1 b\u1ec7nh nh\u00e2n: 24915229
\nNh\u1eadp vi\u1ec7n v\u00e0o khoa C\u1ea5p c\u1ee9u b\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t v\u00e0o 20h05 ng\u00e0y 26\/04\/2024 \ud83e\udc6a Khoa CTCH l\u00fac 23h20 ng\u00e0y 26\/04\/2024
\nNg\u01b0\u1eddi th\u00e2n: Nguy\u1ec5n Th\u1ecb Kim Ng\u1ecdc
\nCh\u00e2n thu\u1eadn: Ch\u00e2n ph\u1ea3i
\nII. L\u00dd DO NH\u1eacP VI\u1ec6N:<\/strong>
\n\u0110au \u0111\u00f9i ph\u1ea3i
\nIII. B\u1ec6NH S\u1eec:<\/strong>
\nB\u1ec7nh nh\u00e2n & ng\u01b0\u1eddi nh\u00e0 khai b\u1ec7nh:
\nC\u00e1ch nh\u1eadp vi\u1ec7n 12h, b\u1ec7nh nh\u00e2n \u0111ang \u0111i b\u1ed9 tr\u00ean \u0111\u01b0\u1eddng th\u00ec ph\u1ea3i l\u00f9i l\u1ea1i \u0111\u1ec3 n\u00e9 xe ch\u1edf h\u00e0ng n\u00ean b\u1ecb ng\u00e3 \u0111\u1eadp m\u00f4ng ph\u1ea3i xu\u1ed1ng n\u1ec1n s\u00e2n, kh\u00f4ng c\u00f3 va qu\u1eb9t, kh\u00f4ng \u0111\u1eadp \u0111\u1ea7u v\u00e0 c\u00e1c b\u1ed9 ph\u1eadn kh\u00e1c xu\u1ed1ng n\u1ec1n s\u00e2n. B\u1ec7nh nh\u00e2n sau khi ng\u00e3 th\u1ea5y \u0111au ch\u00f3i li\u00ean t\u1ee5c v\u00f9ng \u0111\u00f9i v\u00e0 v\u00f9ng ch\u1eadu b\u00ean ph\u1ea3i, kh\u00f4ng c\u00f3 v\u1ebft b\u1ea7m t\u00edm, kh\u00f4ng x\u00e2y x\u00e1t da, kh\u00f4ng s\u01b0ng n\u00f3ng \u0111\u1ecf. B\u1ec7nh nh\u00e2n t\u1ef1 l\u1ebft \u0111\u01b0\u1ee3c v\u00e0o nh\u00e0 v\u00e0 n\u1eb1m ngh\u1ec9, kh\u00f4ng t\u1ef1 x\u1eed tr\u00ed g\u00ec th\u00eam, c\u01a1n \u0111au kh\u00f4ng gi\u1ea3m. 19h chi\u1ec1u c\u00f9ng ng\u00e0y b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ng\u01b0\u1eddi nh\u00e0 \u0111\u01b0a \u0111i nh\u1eadp c\u1ea5p c\u1ee9u BVTN.
\nTrong su\u1ed1t qu\u00e1 tr\u00ecnh ch\u1ea5n th\u01b0\u01a1ng, b\u1ec7nh nh\u00e2n t\u1ec9nh t\u00e1o, kh\u00f4ng hoa m\u1eaft ch\u00f3ng m\u1eb7t, kh\u00f4ng nh\u1ee9c \u0111\u1ea7u bu\u1ed3n n\u00f4n, kh\u00f4ng kh\u00f3 th\u1edf, kh\u00f4ng \u0111au ng\u1ef1c.
\nT\u00ecnh tr\u1ea1ng l\u00fac nh\u1eadp vi\u1ec7n t\u1ea1i c\u1ea5p c\u1ee9u:
\n– B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t, ni\u00eam m\u1ea1c h\u1ed3ng, m\u1ea1ch \u0111\u1ec1u, r\u00f5, chi \u1ea5m.
\n– \u0110au v\u00f9ng \u0111\u00f9i ph\u1ea3i, VAS: 6 \u0111i\u1ec3m.
\n– Sinh hi\u1ec7u:
\no M\u1ea1ch: 74 l\u1ea7n\/ph\u00fat
\no Nhi\u1ec7t \u0111\u1ed9: 37,2 \u0111\u1ed9 C
\no Huy\u1ebft \u00e1p: 110\/90 mmHgo Nh\u1ecbp th\u1edf: 18 l\u1ea7n\/ph\u00fat
\no SpO2: 98%
\n– X\u1eed tr\u00ed l\u00fac nh\u1eadp vi\u1ec7n: Ch\u0103m s\u00f3c c\u1ea5p 2, N\u1eb9p \u0111\u00f9i – c\u1eb3ng – b\u00e0n ch\u00e2n ch\u1ed1ng xoay
\nT\u00ecnh tr\u1ea1ng hi\u1ec7n t\u1ea1i:
\n– B\u1ec7nh nh\u00e2n t\u1ec9nh, huy\u1ebft \u0111\u1ed9ng \u1ed5n
\n– Tim \u0111\u1ec1u, ph\u1ed5i ran \u1ea9m, ho khan \u00edt, kh\u00f4ng \u0111au t\u1ee9c ng\u1ef1c. B\u1ee5ng m\u1ec1m, kh\u00f4ng \u0111i\u1ec3m \u0111au khu tr\u00fa.
\n– H\u00e1ng ph\u1ea3i n\u1eb9p v\u1ea3i. B\u1eaft m\u1ea1ch mu ch\u00e2n ph\u1ea3i (+)
\n– Huy\u1ebft \u00e1p: 140\/90 mmHg
\n– M\u1ea1ch: 84 l\/p
\n– Nh\u1ecbp th\u1edf: 19 l\/p
\nIV. TI\u1ec0N S\u1eec:<\/strong>
\n1. B\u1ea3n th\u00e2n:
\n– N\u1ed9i khoa: 18 n\u0103m tr\u01b0\u1edbc b\u1ec7nh nh\u00e2n \u0111i kh\u00e1m t\u1ea1i ph\u00f2ng kh\u00e1m Vi\u1ec7t M\u1ef9 SG.
\n+ \u0110T\u0110 type 2, \u0111ang d\u00f9ng thu\u1ed1c ph\u00f2ng kh\u00e1m k\u00ea t\u1ea1i nh\u00e0, tu\u00e2n th\u1ee7 t\u1ed1t, t\u00e1i kh\u00e1m \u0111\u1ecbnh k\u1ef3 6 th\u00e1ng\/l\u1ea7n.
\nThu\u1ed1c: Metformin, Gliclazide
\n+ T\u0103ng huy\u1ebft \u00e1p: tu\u00e2n th\u1ee7 s\u1eed d\u1ee5ng thu\u1ed1c, t\u00e1i kh\u00e1m \u0111\u1ecbnh k\u1ef3 6 th\u00e1ng\/l\u1ea7n. HA t\u00e2m thu cao nh\u1ea5t: 180 mmHg, HA t\u00e2m thu trung b\u00ecnh 160 mmHg sau khi u\u1ed1ng thu\u1ed1c.
\nThu\u1ed1c: Amlodipin, Losartan
\n+ C\u01a1n \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh, B\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9:
\nThu\u1ed1c: Bisoprolol, Trimetazidine Dihydroclorid, Clopidogrel, Atorvastatin
\n– Ngo\u1ea1i khoa: Ch\u01b0a ghi nh\u1eadn ti\u1ec1n c\u0103n ph\u1eabu thu\u1eadt.
\n– S\u1ea3n khoa: 8008, sinh th\u01b0\u1eddng, m\u00e3n kinh n\u0103m 53 tu\u1ed5i.
\n– D\u1ecb \u1ee9ng: Ch\u01b0a ghi nh\u1eadn ti\u1ec1n c\u0103n d\u1ecb \u1ee9ng.
\n– Kh\u00f4ng s\u1eed d\u1ee5ng r\u01b0\u1ee3u bia, thu\u1ed1c l\u00e1
\n2. Gia \u0111\u00ecnh:
\nCh\u01b0a ghi nh\u1eadn ti\u1ec1n c\u0103n b\u1ec7nh l\u00fd li\u00ean quan.
\nV. L\u01af\u1ee2C QUA C\u00c1C C\u01a0 QUAN:<\/strong>
\n– Tim m\u1ea1ch: Kh\u00f4ng \u0111au t\u1ee9c ng\u1ef1c, kh\u00f4ng h\u1ed3i h\u1ed9p, kh\u00f4ng \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c
\n– H\u00f4 h\u1ea5p: Ho khan \u00edt, kh\u00f4ng kh\u00f3 th\u1edf, kh\u00f4ng kh\u00f2 kh\u00e8
\n– Ti\u00eau ho\u00e1: B\u1ee5ng kh\u00f4ng \u0111au, \u0111i c\u1ea7u ph\u00e2n s\u1ec7t
\n– Th\u1eadn: Ti\u1ec3u v\u00e0ng trong, kh\u00f4ng ti\u1ec3u g\u1eaft bu\u1ed1t- Th\u1ea7n kinh: Kh\u00f4ng \u0111au \u0111\u1ea7u, kh\u00f4ng ch\u00f3ng m\u1eb7t, kh\u00f4ng bu\u1ed3n n\u00f4n
\nVI. KH\u00c1M L\u00c2M S\u00c0NG (8h30 ng\u00e0y 02\/05\/2024):<\/strong>
\n1. T\u1ed5ng tr\u1ea1ng:
\n– B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t, GCS 15\u0111 (E4V5M6)
\n– Th\u1ec3 tr\u1ea1ng gi\u00e0, r\u0103ng r\u1ee5ng
\n– Da, ni\u00eam m\u1ea1c m\u1eaft h\u1ed3ng.
\n– Kh\u00f4ng c\u00f3 v\u1ebft th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m
\n– CRT < 2 s
\n– T\u1ed5 ch\u1ee9c d\u01b0\u1edbi da: Kh\u00f4ng ph\u00f9, kh\u00f4ng xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da
\n– H\u1ec7 th\u1ed1ng l\u00f4ng t\u00f3c m\u00f3ng: T\u00f3c b\u1ea1c, kh\u00f4, m\u00f3ng tay b\u1eb9t
\n– H\u1ea1ch ngo\u1ea1i vi: Kh\u00f4ng s\u1edd ch\u1ea1m
\n– Tuy\u1ebfn gi\u00e1p: Kh\u00f4ng to
\n– D\u1ea5u hi\u1ec7u sinh t\u1ed3n:
\n\u25cf Nhi\u1ec7t \u0111\u1ed9: 37.5 \u0111\u1ed9 C
\n\u25cf Nh\u1ecbp th\u1edf: 19 l\u1ea7n\/ph\u00fat
\n\u25cf M\u1ea1ch: 84 nh\u1ecbp\/ph\u00fat
\n\u25cf HA: 140\/90 mmHg
\n\u21d2 Ch\u1ec9 s\u1ed1 cho\u00e1ng = 84\/140 = 0.6 \u2192 Trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng
\n– C\u00e2n n\u1eb7ng: 52 kg
\n– Chi\u1ec1u cao: 154 cm
\n\u21d2 BMI = 21.9 \ud83e\udc6a Th\u1ec3 tr\u1ea1ng b\u00ecnh th\u01b0\u1eddng theo IDI & WPRO
\n2. Tim m\u1ea1ch:
\n– M\u1ecfm tim \u1edf khoang li\u00ean s\u01b0\u1eddn V, \u0111\u01b0\u1eddng trung \u0111\u00f2n tr\u00e1i.
\n– Tim \u0111\u1ec1u, T1, T2 r\u00f5, t\u1ea7n s\u1ed1 84 l\u1ea7n\/ph\u00fat.
\n– Kh\u00f4ng \u00e2m th\u1ed5i b\u1ec7nh l\u00fd.
\n– Kh\u00f4ng \u1ed5 \u0111\u1eadp b\u1ea5t th\u01b0\u1eddng, kh\u00f4ng rung mi\u00eau.
\n3. H\u00f4 h\u1ea5p:
\n– L\u1ed3ng ng\u1ef1c c\u00e2n \u0111\u1ed1i, di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf.
\n– Th\u1edf \u00eam, kh\u00f4ng co k\u00e9o.
\n– Kh\u00f4ng d\u1ea5u sao m\u1ea1ch.
\n– Ran \u1ea9m n\u1ed5 2 \u0111\u00e1y ph\u1ed5i.
\n4. Ti\u00eau h\u00f3a:- B\u1ee5ng m\u1ec1m, di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf.
\n– Kh\u00f4ng tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7.
\n– G\u00f5 trong kh\u1eafp b\u1ee5ng.
\n– Kh\u00f4ng \u0111i\u1ec3m \u0111au khu tr\u00fa, kh\u00f4ng s\u1edd th\u1ea5y kh\u1ed1i, u c\u1ee5c.
\n– Gan, l\u00e1ch kh\u00f4ng s\u1edd ch\u1ea1m.
\n5. Ti\u1ebft ni\u1ec7u – sinh d\u1ee5c:
\n– C\u1ea7u b\u00e0ng quang (-)
\n– Ch\u1ea1m th\u1eadn (-)
\n6. Th\u1ea7n kinh:
\n– C\u1ed5 m\u1ec1m
\n– Kh\u00f4ng d\u1ea5u th\u1ea7n kinh khu tr\u00fa
\n7. C\u01a1 x\u01b0\u01a1ng kh\u1edbp:
\nNH\u00ccN:
\nB\u1ec7nh nh\u00e2n n\u1eb1m tr\u00ean gi\u01b0\u1eddng, \u0111ang mang n\u1eb9p \u0111\u00f9i – c\u1eb3ng – b\u00e0n ch\u00e2n b\u00ean ph\u1ea3i ch\u1ed1ng xoay, th\u00e1o n\u1eb9p \u0111\u00e1nh gi\u00e1
\n– Ch\u00e2n b\u00ean ph\u1ea3i xoay ngo\u00e0i
\n– Ch\u00e2n b\u00ean ph\u1ea3i ng\u1eafn h\u01a1n ch\u00e2n b\u00ean tr\u00e1i
\n– Da kh\u00f4ng s\u01b0ng n\u1ec1 quanh kh\u1edbp h\u00e1ng b\u00ean ph\u1ea3i, s\u1edd kh\u00f4ng th\u1ea5y c\u0103ng c\u1ee9ng da, kh\u00f4ng b\u1ea7m t\u00edm, kh\u00f4ng \u0111\u1ed1m xu\u1ea5t huy\u1ebft, kh\u00f4ng v\u1ebft th\u01b0\u01a1ng, kh\u00f4ng b\u00f3ng n\u01b0\u1edbc da
\n– C\u00e1c \u0111\u1ea7u ng\u00f3n ch\u00e2n h\u1ed3ng
\nS\u1edc:
\n– \u1ea4n \u0111au \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i
\n– \u1ea4n \u0111au ch\u00f3i v\u00f9ng tam gi\u00e1c Scarpa b\u00ean b\u00ean ph\u1ea3i (c\u1ea1nh trong: b\u1edd trong c\u01a1 kh\u00e9p d\u00e0i, c\u1ea1nh ngo\u00e0i: B\u1edd trong c\u01a1 may, c\u1ea1nh \u0111\u1ec9nh: d\u00e2y ch\u1eb1ng b\u1eb9n)
\n– Tam gi\u00e1c Bryant b\u00ean b\u00ean ph\u1ea3i kh\u00f4ng vu\u00f4ng c\u00e2n
\n– Kh\u00f4ng \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c \u0111\u01b0\u1eddng Nelaton b\u00ean b\u00ean ph\u1ea3i do b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c \u0111\u1ed9ng t\u00e1c h\u00e1ng g\u1eadp 45 \u0111\u1ed9.
\n– Ch\u00e2n \u1ea5m, m\u1ea1ch b\u1eb9n, khoeo, mu ch\u00e2n, ch\u00e0y sau 2 b\u00ean \u0111\u1ec1u r\u00f5.
\n– C\u1ea3m gi\u00e1c n\u00f4ng s\u00e2u 2 b\u00ean c\u00f2n, kh\u00f4ng t\u00ea
\n– V\u00f9ng g\u1ed1i tr\u00e1i kh\u00f4ng \u0111au
\nG\u00d5:
\n– Kh\u00f4ng th\u1ef1c hi\u1ec7n g\u00f5 d\u1ed3n do b\u1ec7nh nh\u00e2n \u0111au.\u0110O:
\nCh\u00e2n
\nb\u00ean ph\u1ea3i
\nCh\u00e2n
\nb\u00ean tr\u00e1i
\nChi\u1ec1u d\u00e0i t\u01b0\u01a1ng \u0111\u1ed1i (\u0111o t\u1eeb gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean – l\u1ed3i c\u1ea7u ngo\u00e0i
\nx\u01b0\u01a1ng \u0111\u00f9i) 40 cm 43 cm
\nChi\u1ec1u d\u00e0i tuy\u1ec7t \u0111\u1ed1i (\u0111o t\u1eeb m\u1ea5u chuy\u1ec3n l\u1edbn x\u01b0\u01a1ng \u0111\u00f9i – l\u1ed3i c\u1ea7u
\nngo\u00e0i x\u01b0\u01a1ng \u0111\u00f9i) 35 cm 35 cm
\nChu vi \u0111\u00f9i (\u0111o d\u01b0\u1edbi gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean 15 cm) 36 cm 36 cm
\nV\u1eacN \u0110\u1ed8NG:
\n– Kh\u00f4ng kh\u00e1m \u0111\u01b0\u1ee3c v\u1eadn \u0111\u1ed9ng kh\u1edbp h\u00e1ng b\u00ean ph\u1ea3i do b\u1ec7nh nh\u00e2n \u0111au.
\n8. C\u00e1c c\u01a1 quan kh\u00e1c: Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng
\nVII. T\u00d3M T\u1eaeT B\u1ec6NH \u00c1N:<\/strong>
\nB\u1ec7nh nh\u00e2n n\u1eef, 85 tu\u1ed5i, nh\u1eadp vi\u1ec7n v\u00ec \u0111au h\u00e1ng b\u00ean ph\u1ea3i ng\u00e0y th\u1ee9 1 c\u1ee7a b\u1ec7nh. Qua h\u1ecfi b\u1ec7nh v\u00e0 th\u0103m kh\u00e1m ghi nh\u1eadn:
\n\u25cf Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:
\n\u25cb \u0110au h\u00e1ng b\u00ean ph\u1ea3i
\n\u25cb H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng ch\u00e2n ph\u1ea3i
\n\u25cf Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:
\n\u25cb Huy\u1ebft \u00e1p: 140\/90 mmHg
\n\u25cb Ch\u00e2n b\u00ean ph\u1ea3i bi\u1ebfn d\u1ea1ng xoay ngo\u00e0i
\n\u25cb Ch\u00e2n b\u00ean ph\u1ea3i ng\u1eafn h\u01a1n ch\u00e2n b\u00ean tr\u00e1i 3 cm
\n\u25cb Tam gi\u00e1c Bryant kh\u00f4ng vu\u00f4ng c\u00e2n
\n\u25cb \u1ea4n \u0111au ch\u00f3i \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i v\u00e0 tam gi\u00e1c Scarpa b\u00ean b\u00ean ph\u1ea3i
\n\u25cb Ch\u00e2n \u1ea5m, m\u1ea1ch khoeo, mu ch\u00e2n, ch\u00e0y sau b\u00ean b\u00ean ph\u1ea3i b\u1eaft r\u00f5, kh\u00f4ng t\u00ea
\n\u25cf Ti\u1ec1n c\u0103n:
\n\u25cb T\u0103ng huy\u1ebft \u00e1p
\n\u25cb \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2
\nVIII. \u0110\u1eb6T V\u1ea4N \u0110\u1ec0:<\/strong>
\n– D\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafn g\u00e3y \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i: Ch\u00e2n ph\u1ea3i di l\u1ec7ch xoay ngo\u00e0i v\u00e0 ch\u1ed3ng ng\u1eafn.
\n– Ti\u1ec1n c\u0103n: T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 III theo ESC 2020 \u2013 \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2.
\nIX. CH\u1ea8N \u0110O\u00c1N S\u01a0 B\u1ed8 – CH\u1ea8N \u0110O\u00c1N PH\u00c2N BI\u1ec6T:<\/strong>
\nCh\u1ea9n \u0111o\u00e1n s\u01a1 b\u1ed9:
\n– G\u00e3y k\u00edn li\u00ean m\u1ea5u chuy\u1ec3n x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i gi\u1edd th\u1ee9 12 do tai n\u1ea1n sinh ho\u1ea1t ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng\/T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 III theo ESC 2020 \u2013 \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2
\nCh\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:
\n– G\u00e3y k\u00edn c\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i gi\u1edd th\u1ee9 12 do tai n\u1ea1n sinh ho\u1ea1t ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng\/T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 III theo ESC 2020 \u2013 \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2
\n– G\u00e3y 1\/3 tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i gi\u1edd th\u1ee9 12 do tai n\u1ea1n sinh ho\u1ea1t ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng\/T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 III theo ESC 2020 \u2013 \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2
\nX. BI\u1ec6N LU\u1eacN L\u00c2M S\u00c0NG:<\/strong>
\nB\u1ec7nh nh\u00e2n n\u1eef, 85 tu\u1ed5i, v\u00e0o vi\u1ec7n v\u00ec \u0111au v\u00e0 h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng v\u00f9ng h\u00e1ng b\u00ean ph\u1ea3i sau tai n\u1ea1n sinh ho\u1ea1t:
\n– C\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp l\u00e0 t\u00e9 \u0111\u1eadp v\u00f9ng m\u00f4ng b\u00ean ph\u1ea3i xu\u1ed1ng n\u1ec1n c\u1ee9ng, t\u01b0 th\u1ebf \u0111\u00f9i d\u1ea1ng, sau t\u00e9 c\u00f3 \u0111au v\u00f9ng h\u00e1ng v\u00e0 m\u00f4ng b\u00ean ph\u1ea3i, h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng v\u00f9ng h\u00e1ng b\u00ean ph\u1ea3i.
\n– D\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i: Ch\u00e2n b\u00ean ph\u1ea3i bi\u1ebfn d\u1ea1ng xoay ngo\u00e0i, ng\u1eafn h\u01a1n b\u00ean ch\u00e2n b\u00ean tr\u00e1i.
\n– D\u1ea5u hi\u1ec7u kh\u00f4ng ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng: \u1ea4n \u0111au ch\u00f3i \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i v\u00e0 tam gi\u00e1c Scarpa b\u00ean ph\u1ea3i, m\u1ea5t v\u1eadn \u0111\u1ed9ng kh\u1edbp h\u00e1ng b\u00ean ph\u1ea3i
\n– Ngh\u0129 g\u00e3y k\u00edn v\u00ec kh\u00f4ng c\u00f3 v\u1ebft th\u01b0\u01a1ng
\n– Ngh\u0129 g\u00e3y li\u00ean m\u1ea5u chuy\u1ec3n x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i nhi\u1ec1u h\u01a1n g\u00e3y c\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i v\u00ec:
\no B\u1ec7nh nh\u00e2n kh\u00f4ng \u0111i l\u1ea1i \u0111\u01b0\u1ee3c, m\u1ee9c \u0111\u1ed9 \u0111au nhi\u1ec1u v\u00e0 kh\u00f4ng c\u00f3 t\u01b0 th\u1ebf gi\u1ea3m \u0111au (v\u00ed d\u1ee5 t\u01b0 th\u1ebf d\u1ea1ng \u0111\u00f9i \u1ebfch k\u00e8m g\u1ea5p h\u00e1ng)
\no Tam gi\u00e1c Bryant m\u1ea5t h\u00ecnh d\u1ea1ng vu\u00f4ng c\u00e2n
\no Ch\u00e2n b\u00ean ph\u1ea3i bi\u1ebfn d\u1ea1ng xoay ngo\u00e0i, \u1ea5n \u0111au ch\u00f3i tam gi\u00e1c Scarpa b\u00ean b\u00ean ph\u1ea3i
\no Chi\u1ec1u d\u00e0i ch\u00e2n b\u00ean ph\u1ea3i ng\u1eafn h\u01a1n ch\u00e2n b\u00ean tr\u00e1i
\nTuy nhi\u00ean b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u b\u1ea7m t\u00edm lan r\u1ed9ng \u2192 \u0110\u1ec1 ngh\u1ecb X-quang x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i th\u1eb3ng nghi\u00eang, X-quang khung ch\u1eadu th\u1eb3ng.
\n– B\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t s\u1ed1 d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd tr\u1eadt kh\u1edbp h\u00e1ng nh\u01b0: \u0111au, m\u1ea5t c\u01a1 n\u0103ng, s\u01b0ngn\u1ec1 v\u00f9ng kh\u1edbp h\u00e1ng \u2192 G\u1ee3i \u00fd tr\u1eadt kh\u1edbp h\u00e1ng ki\u1ec3u mu. Tuy nhi\u00ean b\u1ec7nh nh\u00e2n c\u00f3 chi\u1ec1u d\u00e0i t\u01b0\u01a1ng \u0111\u1ed1i v\u00e0 tuy\u1ec7t \u0111\u1ed1i c\u1ee7a \u0111\u00f9i b\u00ean ph\u1ea3i \u0111\u1ec1u gi\u1ea3m #3cm, kh\u00f4ng c\u00f3 d\u1ea5u \u1ed5 c\u1ed1i r\u1ed7ng khi s\u1edd tam gi\u00e1c Scarpa \u21d2 \u00cdt ngh\u0129 tr\u1eadt kh\u1edbp h\u00e1ng nh\u01b0ng c\u1ea7n theo d\u00f5i
\nX-quang \u0111\u1ec3 lo\u1ea1i tr\u1eeb ho\u00e0n to\u00e0n
\n– T\u1ed5n th\u01b0\u01a1ng c\u01a1 quan k\u00e8m theo: qua th\u0103m h\u1ecfi b\u1ec7nh s\u1eed, b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111au b\u1ee5ng, kh\u00f4ng \u0111au h\u00f4ng l\u01b0ng, kh\u00f4ng \u0111au \u0111\u1ea7u, th\u0103m kh\u00e1m l\u00e2m s\u00e0ng cho th\u1ea5y, b\u1ee5ng m\u1ec1m kh\u00f4ng \u0111i\u1ec3m \u0111au khu tr\u00fa, ch\u1ea1m th\u1eadn (-), gan l\u00e1ch kh\u00f4ng s\u1edd ch\u1ea1m, c\u1ea7u b\u00e0ng quang (-), ti\u1ec3u \u0111\u01b0\u1ee3c, kh\u00f4ng \u1ea5n \u0111au g\u00f3c s\u01b0\u1eddn \u2013 s\u1ed1ng \ud83e\udc6a \u00cdt ngh\u0129 t\u1ed5n th\u01b0\u01a1ng t\u1ea1ng \u1ed5 b\u1ee5ng (t\u1ea1ng \u0111\u1eb7c, b\u00e0ng quang)
\nHi\u1ec7n t\u1ea1i ng\u00e0y th\u1ee9 6 c\u1ee7a b\u1ec7nh (ho\u00e3n ph\u1eabu thu\u1eadt do b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng Clopidogrel v\u00e0 ngh\u1ec9 l\u1ec5 30\/4 – 1\/5) c\u00f3 th\u1ec3 c\u00f3 c\u00e1c bi\u1ebfn ch\u1ee9ng sau:
\n– Cho\u00e1ng ch\u1ea5n th\u01b0\u01a1ng: \u00edt ngh\u0129 v\u00ec l\u00e2m s\u00e0ng b\u1ec7nh nh\u00e2n t\u1ec9nh, kh\u00f4ng ch\u00f3ng m\u1eb7t, m\u1ea1ch v\u00e0 nh\u1ecbp th\u1edf trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng, ch\u1ec9 s\u1ed1 cho\u00e1ng 0.6, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u b\u1ea7m t\u00edm lan r\u1ed9ng.
\n– T\u1eafc m\u1ea1ch m\u00e1u do m\u1ee1: kh\u00f4ng ngh\u0129 v\u00ec m\u1ea1ch khoeo, ch\u00e0y sau, mu ch\u00e2n b\u00ean ph\u1ea3i b\u1eaft r\u00f5.
\n– Ch\u00e8n \u00e9p khoang: \u00edt ngh\u0129 v\u00ec b\u1ec7nh nh\u00e2n gi\u1ea3m \u0111au, kh\u00f4ng t\u00ea b\u00ec, m\u1ea1ch b\u1eaft \u0111\u1ec1u r\u00f5.
\n– T\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u: \u00edt ngh\u0129 do da v\u00f9ng b\u00e0n ch\u00e2n v\u00e0 c\u1eb3ng ch\u00e2n v\u1eabn h\u1ed3ng h\u00e0o v\u00e0 s\u1edd \u1ea5m \u2013 \u0111\u01b0\u1ee3c t\u01b0\u1edbi m\u00e1u t\u1ed1t, b\u1eaft \u0111\u01b0\u1ee3c m\u1ea1ch mu ch\u00e2n v\u00e0 m\u1ea1ch ch\u00e0y sau.
\n– T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh: \u00edt ngh\u0129 do b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 c\u1ea3m gi\u00e1c t\u00ea b\u00ec \u1edf gan ch\u00e2n (bi\u1ebfn ch\u1ee9ng li\u1ec7t TK h\u00f4ng to), \u1edf m\u1eb7t tr\u01b0\u1edbc trong \u0111\u00f9i (bi\u1ebfn ch\u1ee9ng li\u1ec7t TK \u0111\u00f9i), c\u1ea3m
\ngi\u00e1c n\u00f4ng s\u00e2u v\u1eabn c\u00f2n \u1edf c\u1eb3ng ch\u00e2n v\u00e0 b\u00e0n ch\u00e2n (TK m\u00e1c).
\n– R\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng c\u1ea5p t\u00ednh: \u00edt ngh\u0129 do kh\u00e1m kh\u00f4ng c\u00f3 b\u00f3ng n\u01b0\u1edbc da c\u1ea1nh \u1ed5 g\u00e3y.
\n– Bi\u1ebfn ch\u1ee9ng g\u00e3y x\u01b0\u01a1ng k\u00edn chuy\u1ec3n s\u00e1ng g\u00e3y h\u1edf: \u00edt ngh\u0129 do kh\u00f4ng s\u1edd th\u1ea5y \u0111\u1ea7u x\u01b0\u01a1ng d\u01b0\u1edbi m\u1eb7t da, kh\u00f4ng quan s\u00e1t th\u1ea5y v\u1ebft th\u01b0\u01a1ng.
\nXI. \u0110\u1ec0 NGH\u1eca C\u1eacN L\u00c2M S\u00c0NG:<\/strong>
\n1. B\u1ed9 CLS ti\u1ec1n ph\u1eabu
\n2. CLS ch\u1ea9n \u0111o\u00e1n:
\n– X-quang x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i th\u1eb3ng-nghi\u00eang
\n– X-quang khung ch\u1eadu th\u1eb3ng
\n3. CLS th\u01b0\u1eddng quy:
\n– C\u00f4ng th\u1ee9c m\u00e1u
\n– \u0110\u00f4ng c\u1ea7m m\u00e1u to\u00e0n b\u1ed9
\n– Sinh h\u00f3a m\u00e1u: Glucose, AST, ALT, Urea, Creatinine, eGFR, Ion \u0111\u1ed3, CRP
\n– Bilan lipid m\u00e1u: Cholesterol TP, HDL-C, LDL-C, Triglyceride- \u0110i\u1ec7n t\u00e2m \u0111\u1ed3
\n– X-quang ng\u1ef1c th\u1eb3ng
\n– T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u
\n4. CLS h\u1ed7 tr\u1ee3 \u0111i\u1ec1u tr\u1ecb:
\n– Si\u00eau \u00e2m tim
\n– \u0110o DEXA
\nXII. K\u1ebeT QU\u1ea2 C\u1eacN L\u00c2M S\u00c0NG V\u00c0 BI\u1ec6N LU\u1eacN:<\/strong>
\n1. C\u00f4ng th\u1ee9c m\u00e1u:
\nT\u00ean x\u00e9t nghi\u1ec7m
\n0h22
\n27\/04
\n19h26
\n01\/05
\nKho\u1ea3ng tham chi\u1ebfu \u0110\u01a1n v\u1ecb
\nWBC 9.31 6.59 4.01 – 11.42 K\/uL
\nNEU% 80.0 65.1 40 – 74 %
\nLYM% 14.9 26.1 19 – 48 %
\nMONO% 5.0 6.8 3.4 – 9.2 %
\nEOS% 0.1 1.9 0.0 – 7.0 %
\nBASO% 0.0 0.1 0.0 – 1.5 %
\nNEU# 7.46 4.29 1.7 – 7.5 K\/uL
\nLYM# 1.39 1.72 1.2 – 4.0 K\/uL
\nMONO# 0.46 0.45 0.2 – 0.8 K\/uL
\nEOS# 0.00 0.13 0.0 – 0.6 K\/uL
\nBASO# 0.00 0.00 0.0 – 0.1 K\/uL
\nRBC 4.19 4.26 4.01 – 5.79 M\/uL
\nHGB 12.3 12.0 11.5 – 15.0 g\/dL
\nHCT 36.6 37.0 34.4 – 48.6 %
\nMCV 87.2 87.0 80 – 99 fLMCH 29.3 28.1 27 – 33 pg
\nMCHC 33.6 32.3 32 – 36 g\/dL
\nRDW 12.6 12.7 11.5 – 15.5 %
\nPLT 156.0 188.0 150 – 450 K\/uL
\nMPV 10.8 10.8 7.4 – 10.9 fL
\n– K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m l\u00fac 0h22 27\/04 cho th\u1ea5y NEU% t\u0103ng c\u00f9ng v\u1edbi LYM% gi\u1ea3m tuy nhi\u00ean gi\u00e1 tr\u1ecb NEU# v\u00e0 LYM# n\u1eb1m trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng \u2192 Ch\u1ec9 s\u1ed1 b\u1ea1ch
\nc\u1ea7u trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng.
\n– Ch\u1ec9 s\u1ed1 h\u1ed3ng c\u1ea7u v\u00e0 ti\u1ec3u c\u1ea7u trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng.
\n2. \u0110\u00f4ng m\u00e1u – Nh\u00f3m m\u00e1u:
\nT\u00ean x\u00e9t nghi\u1ec7m 0h22
\n27\/04
\n19h26
\n01\/05
\nKho\u1ea3ng tham
\nchi\u1ebfu
\n\u0110\u00f4ng m\u00e1u
\naPTT (TCK) 30.1 25 – 37 Gi\u00e2y
\nTh\u1eddi gian prothrombin
\nTQ 11.5 9.3 – 12.0 Gi\u00e2y
\nTL. Prothrombine 94 > 70 %
\nINR 1.04 0.84 – 1.29
\nHuy\u1ebft h\u1ecdc
\n\u0110\u1ecbnh nh\u00f3m m\u00e1u h\u1ec7
\nRH (D) +
\nNh\u00f3m m\u00e1u h\u1ec7 ABO A
\n– Ch\u1ec9 s\u1ed1 \u0111\u00f4ng m\u00e1u trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng3. Sinh h\u00f3a m\u00e1u:
\nT\u00ean x\u00e9t nghi\u1ec7m 0h42
\n27\/04
\nKho\u1ea3ng tham
\nchi\u1ebfu \u0110\u01a1n v\u1ecb
\nGlucose 11.2 4.11 – 6.05 mmol\/L
\nUr\u00ea 5.46 2.76 – 8.07 mmol\/L
\nCreatinin 102 44 – 80 \u03bcmol\/L
\neGFR 47.48 >= 60 mL\/ph\u00fat
\nAST 51.6 10 – 35 U\/L
\nALT 30.3 10 – 35 U\/L
\n\u0110i\u1ec7n gi\u1ea3i \u0111\u1ed3
\nNa+ 137.2 135 – 145 mmol\/L
\nK+ 3.59 3.5 – 5.0 mmol\/L
\nCl- 99.5 98 – 106 mmol\/L
\nCalci 2.48 2.15 – 2.5 mmol\/L
\n– \u0110\u01b0\u1eddng huy\u1ebft \u1edf th\u1eddi \u0111i\u1ec3m b\u1ea5t k\u1ef3 cao h\u01a1n gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng, ngh\u0129 nhi\u1ec1u do b\u1ec7nh c\u1ea3nh \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 18 n\u0103m \u1edf b\u1ec7nh nh\u00e2n.
\n– Creatinin t\u0103ng nh\u01b0ng kh\u00f4ng c\u00f3 m\u1ee9c Creatinin n\u1ec1n c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng Suy th\u1eadn c\u1ea5p theo KDIGO 2012 \u2192 \u0110\u1ec1 ngh\u1ecb th\u1ef1c hi\u1ec7n l\u1ea1i Creatinin m\u00e1u sau
\n48h.
\n– eGFR gi\u1ea3m cho th\u1ea5y b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn nh\u01b0ng ch\u01b0a \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n \u0111\u1ec3 ph\u00e2n \u0111\u1ed9 Suy th\u1eadn m\u1ea1n theo KDIGO 2012 \u2192 \u0110\u1ec1 ngh\u1ecb th\u1ef1c hi\u1ec7n
\nSi\u00eau \u00e2m b\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 th\u1ef1c hi\u1ec7n l\u1ea1i eGFR sau 3 th\u00e1ng.
\n– AST t\u0103ng nh\u1eb9, ALT kh\u00f4ng t\u0103ng \u2192 Ngh\u0129 nhi\u1ec1u do nguy\u00ean nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng \u1edf b\u1ec7nh nh\u00e2n.
\nT\u00ean x\u00e9t nghi\u1ec7m 19h Kho\u1ea3ng tham \u0110\u01a1n v\u1ecb01\/05 chi\u1ebfu
\nCRP 20.61 < 5 mg\/L
\n– CRP t\u0103ng nh\u01b0ng tr\u00ean l\u00e2m s\u00e0ng b\u1ec7nh nh\u00e2n kh\u00f4ng ghi nh\u1eadn c\u00e1c d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng, c\u00e1c ch\u1ec9 s\u1ed1 b\u1ea1ch c\u1ea7u n\u1eb1m trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng \u2192 Ngh\u0129 nhi\u1ec1u CRP t\u0103ng do ch\u1ea5n th\u01b0\u01a1ng.
\n4. T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u:
\nT\u00ean x\u00e9t nghi\u1ec7m 8h37
\n27\/04\/2024
\nKho\u1ea3ng tham
\nchi\u1ebfu \u0110\u01a1n v\u1ecb
\nURO norm 0 – 25 \u03bcmol\/L
\nGLU 56 mmol\/L 0 – 3.3 mmol\/L
\nBIL neg 0 – 5.9 \u03bcmol\/L
\nKET neg 0 – 0.75 mmol\/L
\nS.G 1.010 0 – 1.015
\nBLD 5 – 10 Ery\/uL 0 – 15 Ery\/uL
\npH 7 4.8 – 7.4
\nPRO 5 g\/L 0 – 0.25 g\/L
\nNIT neg Negative
\nLEU 75 Leu\/uL 0 – 50 Leu\/uL
\n– B\u1ec7nh nh\u00e2n c\u00f3 glucose trong n\u01b0\u1edbc ti\u1ec3u cao v\u01b0\u1ee3t ng\u01b0\u1ee1ng, ngh\u0129 nhi\u1ec1u do b\u1ec7nh c\u1ea3nh \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 18 n\u0103m \u1edf b\u1ec7nh nh\u00e2n
\n– LEU t\u0103ng nh\u01b0ng NIT \u00e2m t\u00ednh, tr\u00ean l\u00e2m s\u00e0ng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ti\u1ec3u g\u1eaft, ti\u1ec3u bu\u1ed1t, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng \u2192 Kh\u00f4ng ngh\u0129 nguy\u00ean nh\u00e2n nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u
\n– LEU v\u00e0 PRO \u0111\u1ec1u t\u0103ng ngh\u0129 nhi\u1ec1u do nguy\u00ean nh\u00e2n suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn \u2192 Th\u1ef1c hi\u1ec7n c\u00e1c \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn kh\u00e1c nh\u01b0 tr\u00ean5. Si\u00eau \u00e2m tim (28\/04\/2024):
\nK\u1ebft lu\u1eadn:
\n– Ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i b\u1ea3o t\u1ed3n, EF 60%
\n– Van \u0110MC d\u00e0y, v\u00f4i h\u00f3a
\n– H\u1edf van 3 l\u00e1 1,5\/4
\n– C\u00e1c bu\u1ed3ng tim kh\u00f4ng d\u00e3n
\n– Th\u00e0nh tim kh\u00f4ng d\u00e0y
\n– V\u00e1ch li\u00ean nh\u0129, li\u00ean th\u1ea5t nguy\u00ean v\u1eb9n
\n– Kh\u00f4ng r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng
\n– PAPs = 25 mmHg, kh\u00f4ng t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i
\n– D\u1ecbch m\u00e0ng tim (-)
\n– Kh\u00f4ng huy\u1ebft kh\u1ed1i trong bu\u1ed3ng tim
\nNh\u1eadn x\u00e9t:
\n– K\u1ebft qu\u1ea3 Si\u00eau \u00e2m tim cho th\u1ea5y b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng v\u00f4i h\u00f3a van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 H\u1edf nh\u1eb9 van 3 l\u00e1, ngo\u1ea3i ra kh\u00f4ng ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng kh\u00e1c. B\u00ean c\u1ea1nh \u0111\u00f3 tr\u00ean
\nl\u00e2m s\u00e0ng kh\u00f4ng ghi nh\u1eadn c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh tim m\u1ea1ch.
\n6. Si\u00eau \u00e2m \u1ed5 b\u1ee5ng:
\nM\u00f4 t\u1ea3 h\u00ecnh \u1ea3nh:
\nGan:
\n– K\u00edch th\u01b0\u1edbc: Kh\u00f4ng to
\n– Nhu m\u00f4: S\u00e1ng, gi\u1ea3m \u00e2m v\u00f9ng s\u00e2u
\n– M\u1ea1ch m\u00e1u: T\u0129nh m\u1ea1ch c\u1eeda v\u00e0 T\u0129nh m\u1ea1ch gan kh\u00f4ng d\u00e3n
\nM\u1eadt:
\n– T\u00fai m\u1eadt: K\u00edch th\u01b0\u1edbc: kh\u00f4ng to; Th\u00e0nh: kh\u00f4ng d\u00e0y, kh\u00f4ng th\u1ea5y s\u1ecfi
\n– \u0110\u01b0\u1eddng m\u1eadt: \u1ed0ng m\u1eadt ch\u1ee7 v\u00e0 \u0111\u01b0\u1eddng m\u1eadt trong gan kh\u00f4ng d\u00e3n, kh\u00f4ng s\u1ecfi
\nT\u1ee5y:
\n– K\u00edch th\u01b0\u1edbc: Kh\u00f4ng to
\n– Nhu m\u00f4: \u0110\u1ed3ng nh\u1ea5t, kh\u00f4ng sang th\u01b0\u01a1ng khu tr\u00fa
\nL\u00e1ch:
\n– K\u00edch th\u01b0\u1edbc: Kh\u00f4ng to
\n– Nhu m\u00f4: \u0110\u1ed3ng nh\u1ea5t, kh\u00f4ng sang th\u01b0\u01a1ng khu tr\u00fa
\n– M\u1ea1ch m\u00e1u: T\u0129nh m\u1ea1ch l\u00e1ch kh\u00f4ng d\u00e3n
\nTh\u1eadn:
\n– Th\u1eadn ph\u1ea3i: K\u00edch th\u01b0\u1edbc b\u00ecnh th\u01b0\u1eddng, gi\u1edbi h\u1ea1n v\u00f5 – t\u1ee7y r\u00f5, kh\u00f4ng s\u1ecfi, kh\u00f4ng \u1ee9 n\u01b0\u1edbc, c\u00f3 kh\u1ed1i echo tr\u1ed1ng d# 14mm- Th\u1eadn tr\u00e1i: K\u00edch th\u01b0\u1edbc b\u00ecnh th\u01b0\u1eddng, gi\u1edbi h\u1ea1n v\u00f5 – t\u1ee7y r\u00f5, kh\u00f4ng s\u1ecfi, kh\u00f4ng \u1ee9 n\u01b0\u1edbc,
\nc\u00f3 kh\u1ed1i echo tr\u1ed1ng d# 19mm
\nB\u00e0ng quang: Th\u00e0nh kh\u00f4ng d\u00e0y, kh\u00f4ng s\u1ecfi
\nT\u1eed cung: Teo nh\u1ecf
\nPh\u1ea7n ph\u1ee5: Teo nh\u1ecf
\n\u0110\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng: Kh\u00f4ng ph\u00ecnh
\nD\u1ecbch \u1ed5 b\u1ee5ng: Kh\u00f4ng th\u1ea5y tr\u00ean si\u00eau \u00e2m
\nD\u1ecbch m\u00e0ng ph\u1ed5i:
\n– B\u00ean ph\u1ea3i: Kh\u00f4ng th\u1ea5y tr\u00ean si\u00eau \u00e2m
\n– B\u00ean tr\u00e1i: Kh\u00f4ng th\u1ea5y tr\u00ean si\u00eau \u00e2m
\nGhi nh\u1eadn kh\u00e1c: V\u00f9ng h\u1ed1 ch\u1eadu ph\u1ea3i c\u00f3 kh\u1ed1i echo tr\u1ed1ng d# 18*29 mm, gi\u1edbi h\u1ea1n r\u00f5, doppler \u00e2m t\u00ednh
\nK\u1ebft lu\u1eadn:
\n– Gan nhi\u1ec5m m\u1ee1
\n– Nang hai th\u1eadn
\n– Nang m\u1ea1c treo h\u1ed1 ch\u1eadu ph\u1ea3i
\nNh\u1eadn x\u00e9t:
\n– Nang hai th\u1eadn \u1edf b\u1ec7nh nh\u00e2n ngh\u0129 nhi\u1ec1u do nguy\u00ean nh\u00e2n tu\u1ed5i gi\u00e0, d\u1eabn \u0111\u1ebfn suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ec9 ra tr\u00ean k\u1ebft qu\u1ea3 sinh h\u00f3a.
\n(T\u00e0i li\u1ec7u tham kh\u1ea3o:
\nS. P. Laucks, M. S. F. McLachlan, Aging and simple cysts of the kidney, British Journal of Radiology, Volume 54, Issue 637, 1 January 1981, Pages 12\u201314,
\nhttps:\/\/doi.org\/10.1259\/0007-1285-54-637-12 Garfield K, Leslie SW. Simple Renal Cyst. [Updated 2023 Aug 28]. In: StatPearls
\n[Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK499900\/)
\n– C\u1ea7n theo d\u00f5i Nang m\u1ea1c treo h\u1ed1 ch\u1eadu ph\u1ea3i, \u0111\u00e1nh gi\u00e1 Nang l\u00e0 do t\u00ecnh tr\u1ea1ng vi\u00eam hay do t\u00ecnh tr\u1ea1ng ung th\u01b0 (Tr\u00ean l\u00e2m s\u00e0ng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng,
\nkh\u00f4ng c\u00f3 h\u1ed9i ch\u1ee9ng c\u1eadn ung n\u00ean \u00edt ngh\u0129 do 2 nguy\u00ean nh\u00e2n \u0111\u00e3 n\u00eau tr\u00ean).
\n7. X-quang x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i th\u1eb3ng v\u00e0 X-quang khung ch\u1eadu th\u1eb3ng (26\/04\/2024):<\/p>\n

 <\/p>\n

 <\/p>\n

\"H\u00ecnh
1<\/figcaption><\/figure>
\"H\u00ecnh
2<\/figcaption><\/figure><\/p>\n

X-quang x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i th\u1eb3ng:
\nH\u00e0nh ch\u00ednh:
\n– H\u1ecd t\u00ean b\u1ec7nh nh\u00e2n: L\u00c2M THANH N. 85 tu\u1ed5i
\n– Ng\u00e0y ch\u1ee5p: 26\/04\/2024
\n– T\u01b0 th\u1ebf ch\u1ee5p: phim th\u1eb3ng AP
\n– V\u1ecb tr\u00ed: \u0111\u00f9i b\u00ean ph\u1ea3iTi\u00eau chu\u1ea9n phim:
\n– Tia v\u1eeba, th\u1ea5y m\u00f4 m\u1ec1m, th\u1ea5y v\u1ecf x\u01b0\u01a1ng
\n– T\u1ef7 l\u1ec7 phim 100%
\n– Qua 2 kh\u1edbp 2 \u0111\u1ea7u x\u01b0\u01a1ng g\u00e3y
\n– Thi\u1ebfu b\u00ecnh di\u1ec7n nghi\u00eang
\n\u0110\u1ecdc phim:
\n– V\u1ecb tr\u00ed g\u00e3y: c\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i
\n– \u0110\u01b0\u1eddng g\u00e3y: ch\u00e9o
\n– Di l\u1ec7ch: ch\u1ed3ng ng\u1eafn, xoay trong, kh\u00f4ng di l\u1ec7ch g\u1eadp g\u00f3c, kh\u00f4ng di l\u1ec7ch sang b\u00ean, kh\u00f4ng di l\u1ec7ch xa
\n– Kh\u00f4ng th\u1ea5y m\u1ea5t x\u01b0\u01a1ng
\n– C\u00e1c t\u1ed5n th\u01b0\u01a1ng li\u00ean quan:
\n+ Kh\u00f4ng th\u1ea5y u x\u01b0\u01a1ng
\n+ Kh\u00f4ng th\u1ea5y h\u01a1i trong m\u00f4
\nK\u1ebft lu\u1eadn: G\u00c3Y C\u1ed4 X\u01af\u01a0NG \u0110\u00d9I b\u00ean ph\u1ea3i, GARDEN III
\nX-quang khung ch\u1eadu th\u1eb3ng:
\nH\u00e0nh ch\u00ednh:
\n– H\u1ecd t\u00ean b\u1ec7nh nh\u00e2n: L\u00c2M THANH N. 85 tu\u1ed5i
\n– Ng\u00e0y ch\u1ee5p: 26\/04\/2024
\n– T\u01b0 th\u1ebf ch\u1ee5p: phim th\u1eb3ng AP- V\u1ecb tr\u00ed: khung ch\u1eadu
\nTi\u00eau chu\u1ea9n phim:
\n– Tia v\u1eeba, th\u1ea5y m\u00f4 m\u1ec1m, th\u1ea5y v\u1ecf x\u01b0\u01a1ng
\n– T\u1ef7 l\u1ec7 phim 100%
\n\u0110\u1ecdc phim:
\n– Kh\u00f4ng ph\u00f9 n\u1ec1 m\u00f4 m\u1ec1m xung quanh kh\u1edbp h\u00e1ng b\u00ean ph\u1ea3i
\n– \u0110\u01b0\u1eddng shenton m\u1ea5t li\u00ean t\u1ee5c
\n– Kh\u00f4ng ghi nh\u1eadn h\u00ecnh \u1ea3nh tr\u1eadt kh\u1edbp h\u00e1ng
\n– Kh\u00f4ng m\u1ea5t li\u00ean t\u1ee5c c\u00e1c \u0111\u01b0\u1eddng: b\u1edd tr\u01b0\u1edbc \u1ed5 c\u1ed1i, tr\u1ea7n \u1ed5 c\u1ed1i, \u0111\u01b0\u1eddng ch\u1eadu ng\u1ed3i, \u0111\u01b0\u1eddng ch\u1eadu l\u01b0\u1ee3c => kh\u00f4ng g\u1ee3i \u00fd g\u00e3y x\u01b0\u01a1ng ch\u1eadu k\u00e8m theo
\n– Kh\u00f4ng th\u1ea5y d\u1ecb v\u1eadt b\u1ea5t th\u01b0\u1eddng
\n– V\u1ecb tr\u00ed g\u00e3y: c\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i
\n– \u0110\u01b0\u1eddng g\u00e3y: ch\u00e9o
\n– Di l\u1ec7ch: ch\u1ed3ng ng\u1eafn, xoay trong, kh\u00f4ng di l\u1ec7ch g\u1eadp g\u00f3c, kh\u00f4ng di l\u1ec7ch sang b\u00ean, kh\u00f4ng di l\u1ec7ch xa
\n– Kh\u00f4ng th\u1ea5y m\u1ea5t x\u01b0\u01a1ng
\n– C\u00e1c t\u1ed5n th\u01b0\u01a1ng li\u00ean quan:
\n+ Kh\u00f4ng th\u1ea5y u x\u01b0\u01a1ng
\n+ Kh\u00f4ng th\u1ea5y h\u01a1i trong m\u00f4
\nK\u1ebft lu\u1eadn: G\u00c3Y C\u1ed4 X\u01af\u01a0NG \u0110\u00d9I B\u00caN PH\u1ea2I, GARDEN III<\/p>\n

\"H\u00ecnh
3<\/figcaption><\/figure>\n

\nXIII. CH\u1ea8N \u0110O\u00c1N X\u00c1C \u0110\u1ecaNH:<\/strong>
\nG\u00e3y k\u00edn c\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i b\u00ean ph\u1ea3i Type 3 theo GARDEN ng\u00e0y th\u1ee9 1 ch\u01b0a bi\u1ebfn ch\u1ee9ng\/ T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 III ESC 2020 \u2013 \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2<\/p>\n

\"H\u00ecnh
4<\/figcaption><\/figure>\n

XIV. H\u01af\u1edaNG \u0110I\u1ec0U TR\u1eca:<\/strong>
\n\u0110i\u1ec1u tr\u1ecb th\u1ef1c th\u1ee5:
\nC\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i c\u00f3 \u00edt m\u1ea1ch m\u00e1u nu\u00f4i d\u01b0\u1ee1ng n\u00ean kh\u00f3 li\u1ec1n x\u01b0\u01a1ng n\u1ebfu k\u1ebft h\u1ee3p x\u01b0\u01a1ng v\u00e0 nhi\u1ec1u nguy c\u01a1 bi\u1ebfn ch\u1ee9ng nh\u01b0 kh\u1edbp gi\u1ea3, ho\u1ea1i t\u1eed ch\u1ecfm, tho\u00e1i h\u00f3a kh\u1edbp nh\u1ea5t l\u00e0 \u1edf c\u00e1c b\u1ec7nh
\nnh\u00e2n cao tu\u1ed5i ===> PH\u1eaaU THU\u1eacT THAY KH\u1edaP H\u00c1NG (P) B\u00c1N PH\u1ea6N<\/p>\n","protected":false},"featured_media":4376,"comment_status":"open","ping_status":"closed","template":"","tags":[],"chuyen-muc":[188],"class_list":["post-4375","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\/4375","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=4375"}],"version-history":[{"count":2,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4375\/revisions"}],"predecessor-version":[{"id":4382,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4375\/revisions\/4382"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/4376"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=4375"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=4375"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=4375"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}